Dually Involved Youth

Caregiver Services Survey

∞Inspire Hope-Seek Change-Strengthen Families∞

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1. Caregiver Name (Required.)

Name

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2. Youth Name (Required.)

Name

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3. Youth's Date of Birth (Required.)

MM/DD/YYYY

Date

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4. Today's Date

MM/DD/YYYY

Date

This survey allows you to tell us what you think about your Dually Involved Youth experience. By completing this survey, you will help us improve 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 Court or with Job & Family Services.

Question Title

5. Are you satisfied with the types of services in your child's DIY treatment plan? (check one)

Very Satisfied

Mostly Satisfied

Not Sure

Mostly Dissatisfied

Very Dissatisfied

Why do you feel this way?

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6. Are there services you think your child should have gotten but did not? (check one)

Yes

Please explain.

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7. Are there services your child received you do not think they needed? (check one)

Yes

Please explain.

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8. Are you satisfied with the providers who gave your child services? (check one)

Very Satisfied

Mostly Satisfied

Not Sure

Mostly Dissatisfied

Very Dissatisfied

Why do you feel this way?

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9. If you are not satisfied, did you inform your child's case worker? (check one)

Yes

Please explain why or why not.

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10. Was there a service provider you liked better than the others? (check one)

Yes

Please explain.

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11. Was there a service provider you liked less than the others? (check one)

Yes

Please explain.

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12. How satisfied were you with the court proceedings? (check one)

Very Satisfied

Mostly Satisfied

Not Sure

Mostly Dissatisfied

Very Dissatisfied

Why do you feel this way?

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13. Staff valued me as a person? (check one)

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

Why do you feel this way?

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14. Staff were willing to work with me? (check one)

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

Why do you feel this way?

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15. 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)

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

Why do you feel this way?

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

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

Why do you feel this way?

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17. Is there anything else you want to tell us about your experience with the DIY program?

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

Dually Involved Youth Caregiver Services Survey

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* 1. Caregiver Name (Required.)

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* 2. Youth Name (Required.)

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* 3. Youth's Date of Birth (Required.)

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* 4. Today's Date

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* 5. Are you satisfied with the types of services in your child's DIY treatment plan? (check one)

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* 6. Are there services you think your child should have gotten but did not? (check one)

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* 7. Are there services your child received you do not think they needed? (check one)

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* 8. Are you satisfied with the providers who gave your child services? (check one)

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* 9. If you are not satisfied, did you inform your child's case worker? (check one)

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* 10. Was there a service provider you liked better than the others? (check one)

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* 11. Was there a service provider you liked less than the others? (check one)

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* 12. How satisfied were you with the court proceedings? (check one)

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* 13. Staff valued me as a person? (check one)

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

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

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* 17. Is there anything else you want to tell us about your experience with the DIY program?

Dually Involved Youth

Caregiver Services Survey

1. Caregiver Name (Required.)

2. Youth Name (Required.)

3. Youth's Date of Birth (Required.)

4. Today's Date

5. Are you satisfied with the types of services in your child's DIY treatment plan? (check one)

6. Are there services you think your child should have gotten but did not? (check one)

7. Are there services your child received you do not think they needed? (check one)

8. Are you satisfied with the providers who gave your child services? (check one)

9. If you are not satisfied, did you inform your child's case worker? (check one)

10. Was there a service provider you liked better than the others? (check one)

11. Was there a service provider you liked less than the others? (check one)

12. How satisfied were you with the court proceedings? (check one)

13. Staff valued me as a person? (check one)

14. Staff were willing to work with me? (check one)

15. 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)

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

17. Is there anything else you want to tell us about your experience with the DIY program?