Autism Caregiver Survey Please fill out the following information only if you have a child formally diagnosed with Autism Spectrum Disorder (ASD). Question Title * 1. What is your relationship to the child? Parent Grandparent Legal guardian Other (please specify) Question Title * 2. What is your child’s ethnicity? White/Caucasian African-American Hispanic/Latine Asian Other (please specify) Question Title * 3. What is the primary language spoken in your home? English Spanish Portuguese Other (please specify) Question Title * 4. What insurance coverage does your child with ASD have? Private/Commercial Insurance (e.g. BCBS, Harvard Pilgrim, etc.) MassHealth/Medicaid TRICARE Private/Commercial Insurance with MassHealth as secondary Uninsured/Other Question Title * 5. What is your child’s current age: Question Title * 6. Excluding school services, what interventions/services, if any, has your child received? (Select all that apply) Floor time Early Intervention Speech & Language Therapy Occupational Therapy Physical Therapy Children’s Behavioral Health Initiative (CBHI): In-Home Therapy, In Home Behavioral Services, Therapeutic mentor, Intensive Care Coordination, Family Support & Training/Family Partner ABA (Applied Behavior Analysis) services Other (please specify) Question Title * 7. What intervention/services were most helpful for your child and why/how? Question Title * 8. What intervention/services were least helpful for your child and why/how? Question Title * 9. As it relates to ABA services outside of school, please choose the most relevant statement below: My child received or is receiving ABA services outside of school (If yes, skip next question) My child is NOT receiving ABA services outside of school Question Title * 10. If your child is NOT receiving ABA services, please check the reasons: ABA was not recommended We were not interested in ABA Child is receiving ABA through school Insurance did not cover ABA services Insurance covered ABA, but could not afford deductible and/or co-pays I have pursued ABA services for my child but encountered extensive waitlists I have applied for ABA services and my child was assessed by a provider but services have not/did not start Could not access ABA due to scheduling issues Lack of language access Other: Next