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2026 Environmental Map Update

2026 Survey of California's Hospice and Palliative Care Resources for Children

The goal of this survey is to gather information about California's current pediatric hospice and palliative care landscape, including all hospital- and community-based resources and services that are offered to patients and their families. The data gathered will be used to update our Environmental Map. The Map is an online resource that lists the providers of services, their locations, and the kinds of resources and services they offer. The map can be found at https://chpcc.org/resources. Only the organization's name, physical address, web address, and services will be included in any future online resources created from this survey. No other personal information, such as your name, email address, phone number, or other details, will be shared or made public. Additionally, the data acquired from this survey will help to inform the coalition's future activities.
1.Personal Information
2.What is your job title?
3.Organization name
4.Organization Phone Number
5.Organization address
6.Organization Website
7.Organization tax status?
8.Under what license or licenses does your organization operate? (select all that apply)
9.Does the organization have a dedicated pediatric care team? If NO please skip to question #12
10.The following clinicians make up the pediatric care team at the organization (select all that apply):
11.How many of your team are certified in pediatric palliative or hospice care in the organization? (select all that apply)
12.Which population(s) does your organization work with? (Select all that apply) - Children are defined as newborn through age 21 for the purpose of this survey.
13.What services does the organization provide? (Select all that apply)
14.What type of care is offered to pediatric patients and their families by the organization (please select all that apply):
15.What specific services does the organization provide for pediatric patients? (select all that apply):
16.What are the organization's source(s) of reimbursement for pediatric services: (select all that apply)
17.How many prenatal pediatric patients does the organization treat on an annual basis?
18.How many newborns and toddlers (ages 0 to 4) does the organization treat on an annual basis?
19.How many school-aged children (ages 5 to 12) does the organization treat on an annual basis?
20.How many young adults (ages 13 to 21) does the organization treat on an annual basis?
21.Which counties—the entire county or just a portion of it—does the organization serve? (Select all that apply)
22.Would you like to add anything more about the organization?
23.Who should we get in touch with if we need more information about the organization, its services, or programs?
24.Other information