Greetings,

Parents and Caregivers for Wellness is a group of Parent/Caregiver run organizations from across California who are working together to improve services and supports to our families.  We have been provided a grant to strengthen the voice of parents and caregivers of children and youth.  As part of this project, we will be providing a variety of activities to parents and caregivers, as well as to those who provide supports and services to you and your children.

You are the best resource we have to identify strengths and needs of California’s families. To help us get to know you and your family better, we are asking that you fill out the following survey.  The information you provide will help us develop training and advocacy activities.  Although we want to know your thoughts on each question, you can skip any question you do not want to answer or do not know the answer to.  

We hope that you will provide us with your name and contact information at the end of the survey so that we can send you the results of this survey, keep you updated on our activities, and provide you with information that will help you and your family.

If you have any questions about this survey or want to know more about us, please call (805) 384-1555, email mhannah@unitedparents.org or look us up on Facebook.

Thank you for your time.

United Parents

Capital Adoptive Families Alliance

California Alliance of Caregivers

California Mental Health Advocates for Children and Youth

East Bay Children’s Law Offices

Mental Health America, Northern California

Which city do you live in or near?

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* 1. Which city do you live in or near?

What is the age of the child in your home requiring/receiving mental health services?

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* 3. What is the age of the child in your home requiring/receiving mental health services?

What is your relationship to the child in your care? (check all that apply)

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* 4. What is your relationship to the child in your care? (check all that apply)

Which category best describes your child? (check all that apply)

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* 5. Which category best describes your child? (check all that apply)

What kinds of concerns do you have about the child/children you care for? (check all that apply)

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* 6. What kinds of concerns do you have about the child/children you care for? (check all that apply)

Are you receiving the services and supports you need for you and the child or youth you care for?

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* 7. Are you receiving the services and supports you need for you and the child or youth you care for?

If you answered “no” or “don’t know” to the question above, why? (check all that apply)

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* 8. If you answered “no” or “don’t know” to the question above, why? (check all that apply)

How do you find out about community resources and supports? (check all that apply)

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* 9. How do you find out about community resources and supports? (check all that apply)

What additional information and training/classes do you need? (check all that apply)

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* 10. What additional information and training/classes do you need? (check all that apply)

Which local agencies or individuals need to be trained about the needs of you and the child or youth you care for? (check all that apply)

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* 11. Which local agencies or individuals need to be trained about the needs of you and the child or youth you care for? (check all that apply)

What topics/trainings do you think would be helpful to the local agencies or individuals listed above to understand your family’s needs?

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* 12. What topics/trainings do you think would be helpful to the local agencies or individuals listed above to understand your family’s needs?

Do you know who the local decision maker is who decides what services and supports you and your family receives?

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* 13. Do you know who the local decision maker is who decides what services and supports you and your family receives?

If you could advocate for anything for you/your child, what would it be?

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* 14. If you could advocate for anything for you/your child, what would it be?

If you would like to be contacted regarding events that may interest you or provide you with resources you/your child need:

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* 15. If you would like to be contacted regarding events that may interest you or provide you with resources you/your child need:

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