Substitute Caregiver Survey

The Clermont County Opiate Task Force (OTF) was designed to bring community members and resources together from all sectors affected by opiate related issues to help develop solutions to the problem. 

As a result of addiction, children are often exposed to trauma and displaced from their homes. At times they may end up living with family members or friends when their parents can't care for them.

This survey is intended to help The Clermont County OTF understand the needs of these individuals, often referred to as substitute caregivers,  who care for those children.  

This survey is confidential. Some of the questions ask if you would like additional information, or would be willing to participate in focus groups.  We will only be able to contact you if you provide your preferred method of contact information in the comments section following those questions.   You are NOT REQUIRED to provide any identiying information to participate in this survey.  

If you or a loved one is in crisis and needs help accessing treatment, please contact the crisis hotline at 528-SAVE(7283). You may also look at our website, www.getcleannowclermont.org, for more information.  

As a substitute caregiver, or someone closely connected to a substitute caregiver , we thank you for your commitment. Your input on this survey is vital to help us better understand what you need most to take the best care of these children and yourselves.

Thank you again for your input.

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* 1. Are you, a family member, or friend providing substitute care for a child(ren) of a family member or friend?

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* 2. What brought the child(ren) into your care? (please check all that apply)

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* 3. Are you receiving any assistance in caring for the child(ren) from any of the agencies listed below?  Please check all that apply.

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* 4. Are there other areas in which you need support in order to provide better care for the child(ren)?  Please check all that apply.

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* 5. Did you, the caregiver, experience any of the following prior to turning age 18?  Please check all that apply.

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* 6. If you checked any answers in question 5, are you receiving any services to address your experience(s)?

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* 7. Has the child(ren) for whom you are providing care experienced, or do you suspect they have experienced, any of the following before coming to your care?  Please check all that apply.

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* 8. If you checked any answers in question #7, is the child(ren) receiving any services to address that experience(s)?

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* 9. If you checked any answers in question #7, would you be willing to participate in a focus group to share your experiences to help guide providers in better ways to help and support you?

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* 10. In the future, would you be willing to participate in any of the following to find out more information about resources and services that could  be beneficial to you or the child(ren) in your care?  Please check options that apply.

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* 11. What have we missed?  Please feel free to add any suggestions you would like that could help us better understand your needs and the needs of the child(ren) in your care.  

Thank you again for your time. If your or a loved one is in crisis and needs help accessing treatment, please contact the crisis hotline at 528-SAVE(7283). You may also look at our website, www.getcleannowclermont.org, for more information.

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