∞Inspire Hope-Seek Change-Strengthen Families∞

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* 1. Caregiver Name

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* 2. Youth's Name

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* 3. Youth's Date of Birth

Date

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* 4. Today's Date

Date
This survey allows you to tell us what you think about your Dually Involved Youth Multi-Disciplinary Team (MDT) experience.  By completing this survey, you will help us improve the MDT process and the Dually Involved Youth initiative.  Under each question check the answer that best matches what you feel about this experience.  Most of the questions allow you to add additional comments if you wish.  Your answers will remain confidential and will not help or hurt your relationship with the MDT or the relationship of your child with the MDT.   

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* 5. Did you meet with your MDT (multi-disciplinary team)? (check one)

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* 6. How satisfied are you with the MDT meeting? (check one)

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* 7. How satisfied are you with your communication with the MDT? (check one)

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* 8. Staff value me as a person. (check one)

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* 9. Staff were willing to work with me. (check one)

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* 10. When decisions about my child's treatment were made, I felt like I was a partner with staff and that they listened to what I wanted to accomplish. (check one)

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* 11. I received a clear explanation of the program’s rules, requirements, and expectations. (check one)

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* 12. Staff explained to me what my responsibilities would be. (check one)

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* 13. When I interacted with staff, they were professional, polite, and respectful. (check one)

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* 14. I know who to contact if I have concerns or questions? (check one)

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* 15. Is there anything else you want to tell us about your experience with the MDT?

 

Thank you for completing the survey.  Your thoughts will help us improve this initiative.

 

 

 
In partnership between:
Clark County Domestic Relations Court-Juvenile Section ~ Clark County Department of Job and Family Services

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