Greetings,

We are a group of Parent/Caregiver run organizations from across California who are working together to improve services and supports to our families.  We have been provided a grant to strengthen the voice of parents and caregivers of children and youth.  As part of this project, we will be providing a variety of activities to parents and caregivers, as well as to those who provide supports and services to you and your children.

You are the best resource we have to identify strengths and needs of California’s families. To help us get to know you and your family better, we are asking that you fill out the following survey.  The information you provide will help us develop training and advocacy activities.  Although we want to know your thoughts on each question, you can skip any question you do not want to answer or do not know the answer to.  

We hope that you will provide us with your name and contact information at the end of the survey so that we can send you the results of this survey, keep you updated on our activities, and provide you with information that will help you and your family.

If you have any questions about this survey or want to know more about us, please call (805) 384-1555 or email Info@unitedparents.org.

Thank you for your time.

United Parents

Young Minds Advocacy

Capital Adoptive Families Alliance

California Alliance of Caregivers

California Mental Health Advocates for Children and Youth

East Bay Children’s Law Office

Children’s Law Center – Sacramento

* 1. Which city do you live in or near?

* 2. Which county do you live in?

* 3. What is your relationship to the children in your care? (check all that apply)

* 4. What are the ages of the child/children you care for? (Check all that apply)

* 5. What is the race of the child/children you care for? (check all that apply)

* 6. What is/are the gender of the child/children you care for? (check all that apply)

* 7. What is your child’s sexual orientation:

* 8. Has the child/children you care for experienced trauma? (check all that apply)

* 9. If your answer to the question above is “yes”, was the trauma: (check all that apply)

* 10. What kinds of concerns do you have about the child/children you care for? (check all that apply)

* 11. Are you receiving the services and supports you need for you and the child or youth you care for?

* 12. If you answered “no” or “don’t know” to the question above, why? (check all that apply)

* 13. How do you find out about community resources and supports? (check all that apply)

* 14. Which of the above is most helpful to you?

* 15. What information and training/classes have you received? (check all that apply)

* 16. What are your preferred method(s) of getting information and training/education?

* 17. Where do you receive the information and training/classes: (check all that apply)

* 18. What additional information and training/classes do you need? (check all that apply)

* 19. Do you receive support from a parent partner, family partner or family advocate?

* 20. If you answered “yes” to the question above, who connected you to the parent partner or family advocate? (check all that apply)

* 21. What types of supports and services do you receive from your parent partner/family advocate? (check all that apply)

* 22. Which local agencies or individuals need to be trained about the needs of you and the child or youth you care for? (check all that apply)

* 23. What topics do you think would be helpful to the local agencies or individuals listed above to understand your family’s needs? (check all that apply)

* 24. Which statewide entities or individuals need to be trained about the needs of you and the youth you care for? (check all that apply)

* 25. What type of training would be helpful to the statewide entities or individuals listed above? (check all that apply)

* 26. Do you know who the local decision maker is who decides what services and supports you and your family receives?

* 27. If you do know the local decision makers, list them here (i.e.: agencies, job titles, names)

* 28. What is the best way to contact that individual or entity?

* 29. What additional supports do you and the child or youth you care for need? List by most important first.

* 30. Is there other information about yourself or family that you would like us to know?

* 31. Please provide names and locations of any parent/caregiver education, support, and/or advocacy group you are aware of:

* 32. How can we best contact you to invite you to events that may interest you or provide you with resources you/your child need?

* 33. Please provide your first name and last name or initial:

* 34. What is your phone number?

* 35. What is your email address?

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