Parent/Teacher Survey for Adapted Puberty Health Education Program

Question Title

* 1. Dear Parents and Teachers,

Thank you for allowing us to present the Adapted Puberty Health Education Program for Children with Autism and Special Needs to your child/student.
We would appreciate it if you would take a few moments to fill out the attached survey to provide feedback regarding how you feel your child/student has reponded to the program and materials provided by the Robert Crown Center for Health Education. Please feel free to add or write any additional information you feel necessary.
Thank you for your assistance in addressing this very important topic.

Program Objectives
These are the goals for the program:

Children will understand the changes that happen during puberty;
1. Growth spurts
2. Hair growth
3. Oil and sweat production
4. Body odor
5. Pimples
6. Voice deepens
7. Emotional changes
8. Breast development and menstruation (girls only)
9. Change in size of penis and testicles, wet dreams, erections (boys only)
Children will learn to care for their bodies and these changes as they go through puberty.
Children will recognize the difference between good touch and bad touch and how to address these
situations.
Children will distinguish appropriate private and public behaviors.

Questionnaire for Parents and Teachers

1. Since the presentation, has your child/student demonstrated and/or verbalized increased knowledge and comfort of the topics addressed in the goals?

Yes

Please provide specific examples.

Question Title

* 2. Based on feedback from your child/student:

	Yes	No
Was the information presented in a manner that was appropriate for your child/student's level of understanding?	Was the information presented in a manner that was appropriate for your child/student's level of understanding? Yes	Was the information presented in a manner that was appropriate for your child/student's level of understanding? No
Did the program allow enough interaction?	Did the program allow enough interaction? Yes	Did the program allow enough interaction? No
Were the teaching methods effective for your child/student?	Were the teaching methods effective for your child/student? Yes	Were the teaching methods effective for your child/student? No
Are there other teaching methods we could use that may better address these students?	Are there other teaching methods we could use that may better address these students? Yes	Are there other teaching methods we could use that may better address these students? No

Additional feedback

Question Title

* 3. Based on feedback from your child/student:

	Yes	No
Was the length of the program appropriate for your child/student?	Was the length of the program appropriate for your child/student? Yes	Was the length of the program appropriate for your child/student? No
Was the amount of content appropriate for your child/student?	Was the amount of content appropriate for your child/student? Yes	Was the amount of content appropriate for your child/student? No

Please explain

Question Title

* 4. What other suggestions do you have regarding the parent program, teacher support materials, student materials and online resources so that we may further improve this program to better serve these students needs?

Thank you very much for your time. Your input is very valuable. If you have any other questions or concerns, please feel free to contact us at the number or emaill address listed below.
The Robert Crown Center for Health Education
21 Salt Creek Lane
Hinsdale, Illinoins 60521
Office: 630-325-1900