FASD Experiences

FASD Experiences, Michigan FASD Task Force Survey

The Michigan Fetal Alcohol Spectrum Disorder Task Force is conducting a survey to gain understanding of the experiences of persons who have been identified as having a Fetal Alcohol Spectrum Disorder (FASD) and those who may suspect that they are on the spectrum.

Your participation in this survey is totally voluntary. You do not have to take this survey. You many choose to not answer any or all of the survey questions. Your responses are appreciated.

This survey can be taken on a computer, over the phone, or by using a paper version of this survey. If you would like a paper version or to take this survey over the phone, please contact June Malachowski at june.malachowski@wayne,edu or 313-577-6389.

If you have questions about the survey, another person may help you. The survey is anonymous. Please do not write your name on the survey.

If you are not an individual who has an FASD please respond to the questions reflecting what you know about the person.

Question Title

* 1. Are you a resident of Michigan?

Yes

Question Title

* 2. If no, what state or country do you come from?

Question Title

* 3. As the person taking this survey, I am:

A person who has an FASD or believes they have an FASD

A person assisting another person with this survey

A parent, relative, guardian or caretaker of a person with an FASD

A friend of a person with an FASD

Other:

Other (please specify)

Question Title

* 4. How old are you in years (the individual with the FASD)?

Question Title

* 5. I identify as:

Female

Male

Prefer not to say

Other (please specify)

Question Title

* 6. Which best describes your race and ethnicty? (Please select all that apply)

White

Hispanic or Latino/Latina

Black or African American

Native Hawaiian or Pacific Islander

Asian American

American Indian or Alaskan Native

Prefer not to answer

Other (please specify)

Question Title

* 7. I am reasonably sure that my mother drank some alcohol while she was pregnant with me.

Yes

Prefer not to answer

Question Title

* 8. I consider myself to have a Fetal Alcohol Spectrum Disorder.

Yes

Not sure

Prefer not to answer

Question Title

* 9. I know what FASD is or what being on the spectrum means.

Yes

Not sure

Prefer not to answer

Question Title

* 10. I have been diagnosed as having Fetal Alcohol Syndrome or identified as having an Fetal Alcohol Spectrum Disorder.

Yes

Not sure

Prefer not to answer

Question Title

* 11. I learned or knew I was on the spectrum:

Before age 12

Between the ages of 13 and 17

After age 18

Not sure

Prefer not to answer

Question Title

* 12. I know where to go to be screened for FASD.

Yes

Not sure

Prefer not to answer

Question Title

* 13. I know someone with FASD.

Yes

Not sure

Prefer not to answer

Question Title

* 14. Someone in my family has FASD.

Yes

Not sure

Prefer not to answer

Question Title

* 15. I know about resources (such as a clinic, medical office or hospital) in or near where I live for treatment, intervention, and support with FASD.

Yes

Not sure

Prefer not to answer

Question Title

* 16. I know of internet resources for treatment, intervention, and support for those with FASD.

Yes

Not sure

Prefer not to answer

Question Title

* 17. I believe having FASD has a substantial impact on my family and/or friends.

Yes

Not sure

Prefer not to answer

Please explain the impact.

Question Title

* 18. I have experienced challenges with the following (please check all that apply):

Education including elementary school, high school, job/skills training, and college

Employment-finding a job

Housing-finding a place to live

Dealing with police, court, the probation system, and jail or prison

Mental health

Substance addiction/recovery

Social activities including interpersonal communication, friendships and relationships

Recreation, hobbies, and leisure activities

Accessing Social Security Disability benefits, Medicaid, health care, or other services

Transition from child to adult services

Prefer not to answer

Other (please specify)

Question Title

* 19. I believe that the challenges I have experienced in the areas below are because of FASD (please check all that apply):

Education including elementary school, high school, job/skills training, and college

Employment-finding a job

Housing-finding a place to live

Dealing with police, court, the probation system, and jail or prison

Mental health

Substance addiction/recovery

Social activities including interpersonal communication, friendships and relationships

Recreation, hobbies, and leisure activities

Accessing Social Security Disability benefits, Medicaid, health care, or other services

Transition from child to adult services

Prefer not to answer

Other (please specify)

Question Title

* 20. I have needs and would like additional help in the following areas (please check all that apply):

Education including elementary school, high school, job/skills training, and college

Employment-finding a job

Housing-finding a place to live

Dealing with police, court, the probation system, and jail or prison

Mental health

Substance addiction/recovery

Social activities including interpersonal communication, friendships and relationships

Recreation, hobbies, and leisure activities

Accessing Social Security Disability benefits, Medicaid, health care, or other services

Transition from child to adult services

Prefer not to answer

Other (please specify)

Thank you for taking time to complete this survey!