Parent survey

NAMI Minnesota is collaborating with MACMH to gain input on the children's mental health system from families and youth. This information will be used to improve the children's mental health system through things like legislative change and service development.
NOTE: The information will be presented as group data to protect any identifying information you might include in this survey.

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* 1. What is your child's age?

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* 2. What county do you live in?

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* 3. Please specify your child's race (you may select more than one)

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* 4. Please indicate your child's specific ethnicity and/or tribal affiliation (ex. Somali, Hmong, Chinese, etc.)

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* 5. How long has your child been receiving mental health services or treatment?

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* 6. What is your child's diagnosis? (select all that apply)

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* 7. What type of classroom/school is your child in?

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* 8. Indicate which special services your child receives at school:

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* 9. If your child receives special education services, which is the main category
under which they receive services?

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* 10. What has made it difficult for you/your child to get help? (Select all that apply)

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* 11. Please provide feedback about your experiences with the below services:

  My child HAS received this service My child has NOT needed this service My child needed this service and COULDN'T get it I am not aware of this service
Individual therapy (weekly, bi-weekly, or monthly appointment with a therapist)
School-linked mental health services (therapy at school with a licensed therapist, NOT the school counselor)
Psychiatry/medication management
Behavioral health home (specific service provided by an agency that communicates/coordinates with your providers)
In-home therapy/skills building (CTSS)
Personal Care Assistance (PCA)
Respite care
Mental health case management
Mobile crisis/stabilization
Intensive outpatient services (therapy multiple times/week, individually or in a group 1-2 hours/session)
Day treatment
CADI waiver (Community Access for Disability Inclusion, financial support through the county)
DD waiver (Developmental Disabilities Waiver, financial support through the county)
Youth ACT
Hospital in-reach service coordination (specific service provided by hospitals after discharge)
Partial hospitalization
Residential treatment
Therapeutic foster care
PRTF (Psychiatric Residential Treatment Facility)
Inpatient hospitalization

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* 12. If you could create a new service what would it look like?

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* 13. Describe 1-3 changes you would like to see in the children's mental health system

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* 14. Please select the service your child most recently received

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* 15. Please complete the table below based on the service you selected in question 14:

  Strongly agree Somewhat agree Disagree Strongly disagree
My child’s treatment was individualized for their needs
My child’s treatment was provided in a setting in which they were comfortable
The provider involved me in creating a treatment plan for my child
The provider asked my child about their treatment goals
The provider included me as an active participant in my child's treatment
The provider asked about our family’s culture
My child’s treatment was in line with our culture and beliefs
My child’s provider used language that I understood
My child’s provider communicated/worked with the other provider’s on my child’s team
My child’s provider talked about wellness in their treatment/services (i.e. physical activity, meditation, healthy food, etc.)

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* 16. Are you willing to talk with us further? If so, please enter your information below

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* 17. Is there anything you would like to add?

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