MANSFIELD AUTISM PRACTITIONER

FAMILY FEEDBACK ON MAP VISIT

Your feedback is important for us to maintain and improve the quality of the services we offer to families. Please take a few minutes to fill in this survey and tell us about your recent experience with our MAP visit for Term 2 2020.

Question Title

* 1. Which area do you live?

Mallee

Wimmera South West

Barwon

Central Highlands

Loddon

Goulburn

Ovens Murray

Gippsland

Metro Melbourne

Unsure

Town Name

Question Title

* 2. Overall, how many MAP visits have you had since starting service with MASS?

1 to 6 days

6 to 12 days

More than 12 days

More than 24 days

Other

Comment

Question Title

* 3. What is the name of your Autism Practitioner?

Question Title

* 4. Please indicate the type of goals that you are working on with your MAP

Independent Living Skills - Toileting

Independent Living Skills - Sleeping

Independent Living Skills - Self Care (Hygiene, Washing, Dressing, Brushing Teeth etc)

Diet

Emotion Regulation / Behaviour

Social Skills

Communication

Community Access

School

Other (please specify)

Question Title

* 5. Please rate the following

	Strongly Agree	Agree	Disagree	Strongly Disagree	Not Applicable
I am finding the MAP visits useful	I am finding the MAP visits useful Strongly Agree	I am finding the MAP visits useful Agree	I am finding the MAP visits useful Disagree	I am finding the MAP visits useful Strongly Disagree	I am finding the MAP visits useful Not Applicable
I feel that I have more strategies to use when supporting my child at home	I feel that I have more strategies to use when supporting my child at home Strongly Agree	I feel that I have more strategies to use when supporting my child at home Agree	I feel that I have more strategies to use when supporting my child at home Disagree	I feel that I have more strategies to use when supporting my child at home Strongly Disagree	I feel that I have more strategies to use when supporting my child at home Not Applicable
I feel more confident with my parenting skills	I feel more confident with my parenting skills Strongly Agree	I feel more confident with my parenting skills Agree	I feel more confident with my parenting skills Disagree	I feel more confident with my parenting skills Strongly Disagree	I feel more confident with my parenting skills Not Applicable
The family responds positively to the visits	The family responds positively to the visits Strongly Agree	The family responds positively to the visits Agree	The family responds positively to the visits Disagree	The family responds positively to the visits Strongly Disagree	The family responds positively to the visits Not Applicable
We are now able to access the community with more confidence	We are now able to access the community with more confidence Strongly Agree	We are now able to access the community with more confidence Agree	We are now able to access the community with more confidence Disagree	We are now able to access the community with more confidence Strongly Disagree	We are now able to access the community with more confidence Not Applicable
The MAP also supports my other children	The MAP also supports my other children Strongly Agree	The MAP also supports my other children Agree	The MAP also supports my other children Disagree	The MAP also supports my other children Strongly Disagree	The MAP also supports my other children Not Applicable
I would recommend a MAP package to a friend	I would recommend a MAP package to a friend Strongly Agree	I would recommend a MAP package to a friend Agree	I would recommend a MAP package to a friend Disagree	I would recommend a MAP package to a friend Strongly Disagree	I would recommend a MAP package to a friend Not Applicable
I have increased my understanding of Autism	I have increased my understanding of Autism Strongly Agree	I have increased my understanding of Autism Agree	I have increased my understanding of Autism Disagree	I have increased my understanding of Autism Strongly Disagree	I have increased my understanding of Autism Not Applicable

Question Title

* 6. Which goals are you making progress with?

Independent Living Skills - Toileting

Independent Living Skills - Sleeping

Independent Living Skills - Self Care (Hygiene, Washing, Dressing, Brushing Teeth etc)

Diet

Emotion Regulation / Behaviour

Social Skills

Communication

Community Access

School

Just started working on goals

None

Comments

Question Title

* 7. Overall has the Autism Practitioner visits been beneficial for the family?

Strongly Agree

Agree

Not Sure

Disagree

Strongly Disagree

Please comment on the benefits of the MAP Package

Question Title

* 8. Additional Comments / Suggestions regarding the Autism Practitioner visits

Question Title

* 9. Would you like a follow up phone call to discuss the service?

Yes

If yes, please write your child's name and a contact phone number in the field below: