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Old- On-Call Accompaniment Survey
Please complete this survey for yourself and/or your children. If you do not have children, or your children are not receiving services from Embrace, please complete the survey with only yourself in mind.
1.
Where did you receive on-call accompaniment services?
Hospital
Law Enforcement Center
Community-Based Medical Site
Child Advocacy Center
Health and Human Services
Court
Transportation
Other (please specify)
2.
Please respond to the following statements about emotional and physical safety.
Yes
No
Kind of
I now have a safety plan in place for myself and/or my children. For example, I now know safe people, safe places, and safe options.
Yes
No
Kind of
I now have more ideas for healthy coping skills for myself and/or my children.
Yes
No
Kind of
3.
I feel comfortable connecting with Embrace staff or another safe person in my life.
Yes
No
Kind of
4.
I feel the staff at Embrace respect me and/or my children.
Yes
No
Kind of
5.
The Embrace advocate was helpful and knowledgeable, they let me know what options were available.
Yes
No
Kind of
Comments:
6.
What rating would you give Embrace? (5 stars=perfect rating)
1 star
2 stars
3 stars
4 stars
5 stars
7.
The materials given to me by the Embrace advocate were helpful.
Yes
No
Kind of
Comments:
8.
The other people present (e.g. law enforcement, nurses, social worker etc.) were helpful and kind.
Yes
No
Kind of
Comments:
9.
We celebrate the diversity of all people. Please mark all races and ethnicities you identify as:
American Indian or Alaska Native
Southeast Asian
Other Asian
Black or African American
Hispanic or Latnix
Native Hawaiian or other Pacific Islander
White
Mulitple Races
Other race not listed
10.
Do you identify as LGBTQ+?
Yes
No
11.
Do you identify as having a disability? (Physical, mental, developmental, deaf/hard of hearing)
Yes
No
12.
Other comments about your experience.