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ENCUESTA PARA FAMILIAS DE ADULTOS 2020-21
Gracias por tomarse el tiempo de completar esta encuesta. Sus opiniones ayudarán a que el estado de California mejore los servicios y las ayudas para personas con discapacidades intelectuales o del desarrollo y sus familias. Además, sus respuestas nos permitirán comparar los resultados y la satisfacción de las familias de todos los estados.
Completar esta encuesta le llevará aproximadamente 15 minutos.
Sus respuestas son confidenciales
Si no se siente cómodo respondiendo a alguna de las preguntas, no la conteste. Sin embargo, es muy importante que intente responder a todas las preguntas con la mayor exactitud posible para que podamos obtener información completa.
Si desea recibir ayuda para leer o comprender esta encuesta, o si necesita un intérprete, por favor comunicase con: Olga Solomon, PhD osolomon@chla.usc.edu o Hazel Owens, MPH hazelowensmph@gmail.com .
¡GRACIAS!
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What is today's date and the time you are starting this survey?
Now D-M-Y H:M Enter as DD/MM/YYYY
From which agency do you obtain support?
* must provide value
Hub City Autism Network
Lada Lotta Love
Angel-Lena
Chinese Parents Association for the Disabled (CPAD)
Access Nonprofit Center (Parenting Black Children)
Fantastic Friends
Loving Hands Children's Home
Leap of Faith Family to Family Support
Therapeutic Play Foundation
Tichenor Clinic for Children
Other
None
Specify other support agency
Part 1: Information about your family
A. Does your family member with a disability live at home with you?
Yes
No
PLEASE STOP HERE. YOU HAVE COMPLETED THE SURVEY.
B. Is there more than one person with an intellectual/developmental disability in your household?
Yes
No
C. How old is your child?
Please enter in years
D. What is the gender of your child?
Female
Male
E. Has your child been diagnosed with any of the conditions listed below? (Check all that apply)
Specify other disabilities
F. Has your child been diagnosed with any of the health conditions listed below? (Check all that apply.)
Specify other health condition
G. What is your child's race and ethnicity? (Check all that apply.)
American Indian or Alaska Native
Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other Asian)
Black or African American
Pacific Islander (Native Hawaiian, Guamanian or Chamorro, Samoan, Other Pacific Islander)
White
Hispanic/Latino (Mexican, Mexican-American, Chicano, Puerto Rican, Cuban, Other Spanish/Hispanic/Latino)
Other
H. What is your child's preferred means of communication? (Check ONE -- the most frequently used.)
Spoken
Gestures/body language
Sign language or finger spelling
Communication aid/device
Other
Specify other type of communication
I. If your child needs support to manage self-injurious, disruptive, or destructive behavior, how much support is needed? (Check ONE.)
No support needed (no issues with managing behavior)
Some support needed; requires only occasional assistance or monitoring
Extensive support needed; frequent or severe enough to require regular assistance
J. About how much help (support) does your child need with daily personal care activities (for example, bathing, dressing, eating)? (Check ONE.)
No support needed (no help needed with personal care activities)
Some support needed; requires only occasional assistance or monitoring
Extensive support needed
K. What language do you usually speak at home?
English
Spanish
Other
Under 35
35-54
55-74
75 or older
M. How would you describe your health?
Excellent
Very good
Fairly good
Poor
N. How are you related to this child? (Check ONE.)
Parent (biologicial, adoptive, or foster)
Sibling
Grandparent
Other
Please describe other relationship
O. Is anyone in your family paid to provide support to your child with a disability? (Check all that apply.)
P. How many adults (age 18 and older) live in the household?
One
Two
Three
Four or more
Q. How many children under age 18 live in the household (including the child about whom you are responding to this survey)?
One
Two
Three
Four or more
R. What is your highest education level?
No high school diploma/GED
High school diploma/GED
Vocational school or certificate program
Some college
College degree or higher
S. What was the total income last year of all wage earners in your household? Do not include state/federal benefits such as SSI, SSDI, etc. (Check ONE.)
Up to $15,000
$15,001-$25,000
$25,001-$50,000
$50,001-$75,000
Over $75,000
No earned income
Prefer not to say
T. Do you live in an urban or rural area?
Urban or suburban (in or near a city or large town)
Rural (outside of a city or town)
Don't know
Part 2: Questions about services and supports
5. Do you need help planning for your child's future with respect to any of the following? (Check all that apply.)
Specify other help needed.
6. If you asked for crisis or emergency services during the past year, were services provided when needed?
No
Yes
Don't know
Does not apply -- Did not ask for these services
7. Does your child have a service plan, such as an Individual Program Plan (IPP) or Individual Family Service Plan (IFSP)? (Does your family have a list of services his/her service coordinator will help get? Note: This plan would be in addition to a special education plan, IEP, or Section 504 plan.)
No --> Go to Question 13
Yes
Don't know --> Go to Question 13
8. Does the plan include all the services and supports your child needs?
No
Yes
Don't know
Does not apply -- child does not have a service plan (no IPP or IFSP)
9. Does your family member get all the services listed in the plan?
No
Yes
Don't know
Does not apply -- child does not have a service plan (IPP or IFSP)
10. Did you or another family member help make the plan?
No
Yes
Don't know
Does not apply -- child does not have a service plan (IPP or IFSP)
11. Did your child help make the plan?
No
Yes
Don't know
Does not apply -- child does not have a service plan (IPP or IFSP)
12. Did you discuss how to handle emergencies (such as a medical emergency or natural disaster) at your child's last service planning meeting?
No
Yes
Don't know
Does not apply -- Did not take part in meeting
13. Does your child have a transition plan (as part of an IEP or Section 504 plan through his/her high school, usually starting at age 14)?
No --> Go to Question 15
Yes
Don't know --> Go to Question 15
Does not apply -- Child is under 14 --> Go to Question 15
14. If yes, did you help make the transition plan?
No
Yes
Don't know
Does not apply -- Child is under 14 or does not have a transition plan
15. Do you feel prepared to handle the needs of your child in an emergency such as a medical emergency or natural disaster?
No
Yes
Don't know
32. If you need respite services, how often are you able to use them? (Respite is support for family or other care-providers to allow them to take a break from providing care for a time-limited period.)
Always
Usually
Sometimes
Seldom/Never
Don't know --> Go to Question 34
Does not apply - Do not need respite services --> Go to Question 34
33. If you have used respite services in the past year , were you satisfied with the quality of the respite services?
Always
Usually
Sometimes
Seldom/Never
Don't know
Does not apply - Have not received or did not have access to respite services in past year
34. Does your family get the supports and services it needs?
No
Yes --> Go to Question 36
Don't know --> Go to Question 36
35. If no to Question 34, what additional services does your family need? (Check all that apply.)
Specify other services needed
39. Do service providers for your child work together to provide support? (For example, does the agency providing transportation work together with the agency providing in-home support if necessary?)
No
Yes
Don't know
Does not apply -- Only one service provider
40. Did you, your child, or someone else in your family choose your child's service coordinator?
No, didn't choose but can change service coordinator if wanted
No, didn't choose and cannot change service coordinator if wanted
Yes
Don't know
Does not apply -- No service coordinator
41. Does your child take part in activities in the community? (For example, going out to a restaurant, movie, or sporting event)
No
Yes
Don't know
42. For your child, what makes it hard to take part in activities in the community? (Check all that apply.)
Specify other difficulties
43. Does your child spend time with children who do not have developmental disabilities? (This can include siblings)
No
Yes
Don't know
44. In your community, are there resources that your family can use that are not provided by the I/DD agency? (For example, recreational programs, community housing, library programs, religious groups, etc.)
No
Yes
Don't know
45. Does your family take part in any family-to-family networks in your community? (For example, Parent to Parent, sibling networks, etc.)
No
Yes
Don't know
Does not apply - None in my community
46. Overall, are you satisfied with the services and supports your family currently receives?
Always
Usually
Sometimes
Seldom/Never
Don't know
47. Do you know how to file a complaint or grievance about provider agencies or staff?
No
Yes
Don't know
48. If a complaint or grievance was filed or resolved in the past year, are you satisfied with the way it was handled?
No
Yes
Don't know
Does not apply -- No complaint or grievance filed or resolved in the past year
49. Do you know how to report abuse or neglect related to your child?
No
Yes
50. Within the past year, was a report of abuse or neglect filed on behalf of your child?
No --> Go to Question 53
Yes
Don't know --> Go to Question 53
51. If yes to Question 50, did the appropriate people respond to the report?
No
Yes
Don't know
Does not apply -- No abuse or neglect reported in the past year
52. If yes to Q50, if someone outside of your family reported abuse or neglect, were you notified of the report in a timely manner?
No
Yes
Don't know
Does not apply -- No abuse or neglect reported in the past year by someone else
53. Do you feel that services and supports have made a positive difference in the life of your family member?
No
Yes
Don't know
54. Have services and supports reduced your family's out-of-pocket expenses for your child's care?
No
Yes
Don't know
55. Do you feel that family supports have improved your ability to care for your child?
No
Yes
Don't know
56. Have the services or supports that your family member received during the past year been reduced, suspended, or terminated?
No --> Go to Question 58
Yes
Don't know --> Go to Question 58
57. If yes to Q56, did the reduction, suspension, or termination of these services or supports affect your family negatively?
No
Yes
Don't know
Does not apply -- Services/supports not reduced, suspended, or terminated in the past year
58. Have the services or supports that your child received been increased in the past year?
No
Yes
Don't know
59. Are services and supports helping your child to live a good life?
No
Yes
Don't know
INFORMATION AND PLANNING
Please do not enter any person information (names, addresses, etc.), names of providers, service coordinators, agencies, or contact information of any sort.
ACCESS AND DELIVERY OF SUPPORTS
CHOICE AND CONTROL
INVOLVEMENT IN THE COMMUNITY
Please do not enter any personal information (names, addresses, etc.), names of providers, service coordinators, agencies, or contact information of any sort .
SATISFACTION WITH SERVICES
SERVICES DURING COVID-19
Is there anything else you'd like to discuss? (Please write your answer in the box)
1. How long did it take you to complete this survey (in minutes)?
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2. Where there any questions that were difficult to understand? Please provide question number and the reason.
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