Please answer the following questions so we can evaluate how well we have responded to your/your family’s needs. Your participation in this survey is voluntary and all of your answers will be anonymous.
For statements 3-15, please choose the most appropriate answer to tell us if you agree or disagree with the statements. For the remaining questions, please write your answers in the space provided.

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* 1. For how many months were you involved with the FWS Intensive Services Program:

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* 2. I received services in:

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* 3. I participated in my placement goals.

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* 4. The workers helped me to develop goals that met my needs.

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* 5. I felt heard and respected by the workers.

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* 6. The workers identified both strengths and needs in my family.

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* 7. Other family members and I were invited to participate in my placement as needed.

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* 8. My culture was respected and taken into consideration by the workers.

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* 9. The workers were able to effectively communicate with me in the official language of my choosing.

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* 10. NEOFACS staff communicated well with each other and you.

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* 11. I am more able to manage difficulties than before my placement.

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* 12. The services I received allowed me to meet my goals.

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* 13. I have strengthened skills and abilities because of the services provided.

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* 14. I have less needs and symptoms because of the services provided.

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* 15. I would recommend NEOFACS to other families.

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* 16. Please describe your reasons for ending service (check all that apply)

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* 17. What did NEOFACS do well?

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* 18. What change(s) can NEOFACS make that would have the biggest positive impact on the service you received?

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* 19. Additional Comments:

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