Family/Client Service Interest Survey #2

Tell us what you need...

Lanterman Regional Center will be asking the Department of Developmental Services for funds to develop services that our clients need. Help us identify what services are needed by completing this brief survey.

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* 1. Tell us about you...

Name (Optional)

Email Address (Optional)

Phone Number (Optional)

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* 2. I am a:

Client

Parent/Family Member

Service Provider

Community Member

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* 3. What age is the Regional Center Client

Under 3

3-12

13-18

19-34

35-64

65+

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* 4. What Language do you prefer?

English

Spanish

Chinese Mandarin or Cantonese

Japanese

Farsi

Arabic

Korean

Armenian

Tagalog

Other (please specify)

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* 5. Where do you (client) live?

Glendale

Burbank-Foothill

Pasadena

LA Wilshire

LA Hollywood

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* 6. Here are some services Service Coordinators say are needed. Select all that YOU think are needed.

Behavioral respite

Physical Therapy

Speech Therapy

Occupational Therapy

Behavior Management Services for Children

Behavior Management Services for Adults

After school program (Ages 6 - 10)

After school program (Ages 11 - 13)

After school program (Ages 14 - 17)

Social skills training (Ages 6 - 10)

Social skills training (Ages 11 - 13)

Social skills training (Ages 14 - 17)

Social Skills Training (Ages 18-25)

Social Skills Training (Ages 26+)

Specialized Homes

Client Money Management

Employment support

Community Integration

Other (please specify)

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* 7. Please provide any additional comments you may have on the services selected.

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* 8. Are there other areas or options that you feel are lacking in the community?

Affordable Housing

Social Opportunites (Clubs, Scouting, etc.)

Law/Forensic Advocacy

Parent Education/Training

Anger Management Training

Higher Education/College Support

Other (please specify)

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* 9. Are you using all of your FDLRC approved services?

Yes

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* 10. If you answered no to question 9, why have you not used your approved services? (Check all that apply)

Service provider does not have staff available to provide the service.

I am on a waitlist for the service.

Service provider does not have a bilingual staff available to provide the services.

Service provider cannot provide services during the time/s that I need it.

My work/family schedule makes it hard for me to participate in the service.

I stopped in-person services due to COVID and remote services do not work for our family.

I have services from other sources such as In Home Supportive Services, Department of Rehabilitation, my child’s school, and/or my private health insurance, which currently meet the needs of myself/my family at this time.

Not applicable to me

Other (please specify any other services not being used and why)

Family/Client Service Interest Survey #2

Tell us what you need...

Question Title

* 1. Tell us about you...

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* 2. I am a:

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* 3. What age is the Regional Center Client

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* 4. What Language do you prefer?

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* 5. Where do you (client) live?

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* 6. Here are some services Service Coordinators say are needed. Select all that YOU think are needed.

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* 7. Please provide any additional comments you may have on the services selected.

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* 8. Are there other areas or options that you feel are lacking in the community?

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* 9. Are you using all of your FDLRC approved services?

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* 10. If you answered no to question 9, why have you not used your approved services? (Check all that apply)

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* 11. Are there any other things that would help you to be more successful?