The Role of Families and Guardians in Safeguarding Human Rights

* 1. Have you been informed of the following regarding the human rights of your family member, or person for whom you support decision-making?

  Yes No
a. Family member's human rights and your role in providing for and protecting them?
b. The role of a human rights officer?
c. The role of a human rights coordinator?
d. The role of a human rights committee?
e. The role of a human rights specialist?

* 2. Which of the following describes your role as a family member or guardian in the DDS Human Rights System?

* 3. Are DDS Area Office personnel you have relationships with accessible and responsive to your concerns/questions regarding human rights issues?

* 4. Which, if any, of the following groups or persons has been helpful in answering human rights questions or concerns? (please check all that apply)

* 5. Are there human rights questions or concerns you have tried to convey that have not been attended to?

* 6. Do you feel sufficiently informed about the various DDS and community resources you can use to address concerns regarding safety, suspicions of abuse/neglect or other human rights issues?

* 7. Do you find human rights personnel and activities are culturally sensitive and user friendly in:

  Yes No No experience with this
a. communication methods
b. presentations
c. trainings

* 8. If your family member has communication challenges, do you feel staff (including human rights personnel), are well trained in and use appropriate and effective means of communication with him/her?

* 9. Do you feel your family member's choices and/or preferences are respected when selecting services and/or service providers?

* 10. Are you satisfied with the provider staff's responses to your family member's needs in the following areas?

  Yes No
a. Medical
b. Dental
c. Behavioral
d. Nutritional

* 11. Do you feel direct care staff are sufficiently trained to appropriately convey health issues and report incidents, as well as on-going needs, to the health care providers your family member sees?

* 12. Overall, do you feel that DDS adequately addresses your questions and concerns regarding your family member's human rights and your role in protecting those rights?

* 13. Which region does the person you safeguard receive services from?

* 14. What is your status regarding the person you are safeguarding? (Please check the one that applies)