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A Survey for Caregivers of Children With Autism
You have been selected to participate in this survey based upon your lived experience as either a caregiver or professional who works with children with autism. Your responses will provide valuable information that only comes from those who have lived experience working with children with autism. Your input will inform the process of developing a comprehensive and interactive emergency preparedness guide for children with autism and their caretakers that focuses on emergency sheltering. This survey should take approximately 7 minutes to complete and all answers can be anonymous if you choose.
*
1.
Have you provided care to a child with Autism Spectrum Disorder (ASD)?
(Required.)
No
Yes
2.
In what capacity was your experience gained?
Professional
Personal
Other (please specify)
3.
Have you cared for a child with ASD during a disaster?
Yes
No
4.
Have you cared for a child with ASD in a temporary mass shelter?
No (If no, base future answers on what you would expect)
Yes (If yes, base future answers off of lived experiences)
Other (please specify)
5.
Do you have an up to date disaster preparedness plan that your child with ASD understands and has access to?
Yes
No
Other (please specify)
6.
Scenario
for the rest of the questions: You are caring for a child with ASD during a disaster in a temporary mass shelter during a natural disaster.
Question:
Below is a list of common stressors within a mass shelter that could have an impact on your child if exposed. Rank each stressor on the level of impact it would have on your kid.
Use the scale: 0 (no impact) to 10 (severe impact)
0
(no impact)
1
2
3
4
5
6
7
8
9
10 (Severe Impact)
Bright Lights
0
(no impact)
1
2
3
4
5
6
7
8
9
10 (Severe Impact)
Crowds
0
(no impact)
1
2
3
4
5
6
7
8
9
10 (Severe Impact)
Loud or consistent Noise
0
(no impact)
1
2
3
4
5
6
7
8
9
10 (Severe Impact)
Lack of Nutritional Options
0
(no impact)
1
2
3
4
5
6
7
8
9
10 (Severe Impact)
Change of Routine
0
(no impact)
1
2
3
4
5
6
7
8
9
10 (Severe Impact)
An Unfamiliar Environment
0
(no impact)
1
2
3
4
5
6
7
8
9
10 (Severe Impact)
Forced socialization
0
(no impact)
1
2
3
4
5
6
7
8
9
10 (Severe Impact)
7.
Below is a list of common
stressors
that can occur within a mass shelter. Select the
reaction(s)
that your child may have to the corrilating stressor.
Increased irritability
Hiding
Stimming
Physical symptoms
Run away
Yelling
Violent behavior
Tantrum/Meltdown
Emotional withdraw
Bright Lights
Increased irritability
Hiding
Stimming
Physical symptoms
Run away
Yelling
Violent behavior
Tantrum/Meltdown
Emotional withdraw
Crowds
Increased irritability
Hiding
Stimming
Physical symptoms
Run away
Yelling
Violent behavior
Tantrum/Meltdown
Emotional withdraw
Loud or consistent Noise
Increased irritability
Hiding
Stimming
Physical symptoms
Run away
Yelling
Violent behavior
Tantrum/Meltdown
Emotional withdraw
Lack of Nutritional Options
Increased irritability
Hiding
Stimming
Physical symptoms
Run away
Yelling
Violent behavior
Tantrum/Meltdown
Emotional withdraw
Change of Routine
Increased irritability
Hiding
Stimming
Physical symptoms
Run away
Yelling
Violent behavior
Tantrum/Meltdown
Emotional withdraw
An Unfamiliar Environment
Increased irritability
Hiding
Stimming
Physical symptoms
Run away
Yelling
Violent behavior
Tantrum/Meltdown
Emotional withdraw
Forced socialization
Increased irritability
Hiding
Stimming
Physical symptoms
Run away
Yelling
Violent behavior
Tantrum/Meltdown
Emotional withdraw
Other (please specify)
8.
Below is a list of common
reactions
to stressors. Select the
intervention
(s) that would be helpful in mitigating the correlating reaction.
(Scroll to the right for more reaction options)
Physical pressure
Quiet environment
Dark environment
Personal space
Explanations of circumstance
Counseling
Stim device
Food of choice
Electronics (TV/games)
Personal items (i.e. toys, blankets..)
Increased irritability
Physical pressure
Quiet environment
Dark environment
Personal space
Explanations of circumstance
Counseling
Stim device
Food of choice
Electronics (TV/games)
Personal items (i.e. toys, blankets..)
Hiding
Physical pressure
Quiet environment
Dark environment
Personal space
Explanations of circumstance
Counseling
Stim device
Food of choice
Electronics (TV/games)
Personal items (i.e. toys, blankets..)
Stimming
Physical pressure
Quiet environment
Dark environment
Personal space
Explanations of circumstance
Counseling
Stim device
Food of choice
Electronics (TV/games)
Personal items (i.e. toys, blankets..)
Physical symptoms
Physical pressure
Quiet environment
Dark environment
Personal space
Explanations of circumstance
Counseling
Stim device
Food of choice
Electronics (TV/games)
Personal items (i.e. toys, blankets..)
Run away
Physical pressure
Quiet environment
Dark environment
Personal space
Explanations of circumstance
Counseling
Stim device
Food of choice
Electronics (TV/games)
Personal items (i.e. toys, blankets..)
Yelling
Physical pressure
Quiet environment
Dark environment
Personal space
Explanations of circumstance
Counseling
Stim device
Food of choice
Electronics (TV/games)
Personal items (i.e. toys, blankets..)
Violent behavior
Physical pressure
Quiet environment
Dark environment
Personal space
Explanations of circumstance
Counseling
Stim device
Food of choice
Electronics (TV/games)
Personal items (i.e. toys, blankets..)
Tantrum/Meltdown
Physical pressure
Quiet environment
Dark environment
Personal space
Explanations of circumstance
Counseling
Stim device
Food of choice
Electronics (TV/games)
Personal items (i.e. toys, blankets..)
Emotional withdraw
Physical pressure
Quiet environment
Dark environment
Personal space
Explanations of circumstance
Counseling
Stim device
Food of choice
Electronics (TV/games)
Personal items (i.e. toys, blankets..)
Physical withdraw
Physical pressure
Quiet environment
Dark environment
Personal space
Explanations of circumstance
Counseling
Stim device
Food of choice
Electronics (TV/games)
Personal items (i.e. toys, blankets..)
Other (please specify)
9.
Considering the answers in the table, fill in the blanks below with up to 5 items that were or would be beneficial to mitigating stress for a child with ASD in a mass shelter. (i.e. weighted blanket, and headphones)
1
2
3
4
5
10.
Provide up to 3 preparedness tips would you suggest for a caregiver of a child with ASD if having to seek emergency mass shelter
1
2
3
11.
For those who have cared for a child with ASD in a mass shelter:
What knowledge or resources do you wish you had before entering the shelter?