Family Outcomes Survey

Directions:

¨       On the following pages, please circle the number that best describes your family right now.  If a statement almost describes your family, but not quite, circle the number just below the statement.  For example, if the statement under 3 almost describes your family, but not quite, circle the 2.

¨       You will notice that the responses include the word “we.”  This refers to your family.  It’s okay if you are answering just for yourself (your own opinion or experience) or as a family with a shared opinion or experiences.

© 2005 SRI International.  Version:  12-7-05.  This survey was developed by Don Bailey, Kathy Hebbeler, and Mary Beth Bruder as part of the Early Childhood Outcomes (ECO) Center.  Permission is granted to reproduce this survey for state and local program use.  When reproducing, please identify as “Developed by the Early Childhood Outcomes Center with support from the Office of Special Education Programs, U.S. Department of Education.”    Please contact [email-masked] if you wish to use or adapt the survey.

Family Outcomes Survey

Understanding your child’s strengths, abilities, and special needs

1. Your child is growing and learning.  How well do you understand your child’s development?

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2

3

4

5

6

7

We are just beginning to understand our child’s development

We have a basic understanding of our child’s development, but still have a lot to learn

We have a pretty good understanding of our child’s development

We understand our child’s development very well

2. Some children have special health needs, a disability, or are delayed in their development.  How much do you know about your child’s special needs?

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2

3

4

5

6

7

Right now we do not know very much

We have learned some things, but still have a lot of unanswered questions

We know a lot, but still need or want to know more

We are confident that we know most of what we need to know right now

3. Professionals who work with you and your child want to know if the things they do are working.  Are you able to tell if your child is making progress?

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2

3

4

5

6

7

Right now we can’t tell if our child is making progress

We sometimes can tell if our child is making progress, but still have a lot to learn

We usually can tell if our child is making progress

We almost always can tell if our child is making progress

Knowing your rights and advocating for your child

4.  A variety of programs and services may be available for your child and family.  Do you know what is available for your child and family?

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2

3

4

5

6

7

We are just beginning to learn about the programs and services that are available

We know about some programs and services, but still have a lot to learn

We think we are aware of most available programs and services

We are very aware of the programs and services that are available

5. Parents often meet with professionals to plan services or activities.  How comfortable are you participating in these meetings?

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3

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5

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7

Right now we are very uncomfortable participating in meetings

We are not very comfortable participating in meetings, but we do it anyway

We are pretty comfortable participating in meetings

We are very comfortable participating in meetings

6. Families of children with special needs have rights, and there are things you can do if you are not satisfied.  How well do you know your rights and what to do if you are not satisfied?

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2

3

4

5

6

7

We are not sure about our rights or what to do if we are not satisfied

We understand our basic rights but are not sure about all of our options if we are not satisfied

We think we know most of our rights and what to do if we are not satisfied

We are very aware of our rights and know exactly what to do if we are not satisfied

Helping your child develop and learn

7. All parents help their children develop and learn, but sometimes it is hard to know what to do.  How would you describe your ability to help your child develop and learn?

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2

3

4

5

6

7

We need to know a lot more about how to help our child develop and learn

We know the basics of helping our child develop and learn, but still have many questions

We feel pretty sure that we know how to help our child develop and learn

We are very sure that we know how to help our child develop and learn

8. All parents try to help their children learn to behave the way they would like, but sometimes it is hard to know what to do.  How would you describe your ability to help your child learn to behave the way you would like?

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2

3

4

5

6

7

We need to know a lot more about how to help our child behave like we want

We know the basics of helping our child behave, but still have many questions

We feel pretty sure that we know how to help our child behave

We are very sure that we know how to help our child behave

9. Your family has worked with professionals to develop a plan to help your child learn new skills and behaviors.  How much are you able to help your child learn or practice these new skills at home or in your community?

1

2

3

4

5

6

7

We have not yet started to help our child learn or practice these skills and behaviors

We have started to help our child learn and practice these skills and behaviors, but it is not a regular thing yet

We often help our child learn and practice these skills and behaviors, but it is not as regular as we would like

We regularly help our child learn and practice these skills and behaviors throughout the day

Having support systems

10. Many people feel that talking with another person helps them deal with problems or celebrate when good things happen.  Does your family have someone you trust to listen and talk with you?

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2

3

4

5

6

7

Right now, we really don’t have anyone we can talk with about the things that are happening in our lives

We can probably find at least one person we could talk with, but are not very satisfied with the situation

We usually have other people that we can talk with about things

There are definitely people in our lives we can talk with whenever we need to

11. Families sometimes must rely on other people for help when they need it, for example to provide a ride, run an errand, or watch their child for a short period of time.  Do you have someone you can call on when you need help with things?

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2

3

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5

6

7

Right now our family really doesn’t have anyone we can call on when we need help with things

In an emergency we have people we can call on for help, but not for the everyday things

Usually there is someone that we can call on for help when we need it

We almost always have other people we can call on for help when we need it

12. Most families have things they enjoy doing.  How much is your family able to do the things you enjoy?

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3

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5

6

7

Right now it is really difficult to do any of the things we enjoy

We are able to participate in some of the things we enjoy, but not nearly as much as we would like

We are able to participate in many of the activities we enjoy

We are able to participate in almost all of the activities we enjoy

Accessing your community

13. All children need medical care.  How would you describe the medical care you have for your child right now?

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2

3

4

5

6

7

We do not have the medical care we want for our child

We have some medical care, but still have a long way to go before it is what we want

We have good medical care for our child

We have excellent medical care for our child

14. Many families have a need for quality childcare.  By this, we do not mean occasional babysitting, but regular childcare, either part-day or full-day.  How would you describe the childcare you have for your child right now?

CHECK HERE IF YOU HAVE NOT WANTED CHILD CARE, AND GO TO QUESTION 15.

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7

We do not have the childcare we want OR because of our child’s special needs we have decided not to look for it.

We have some childcare, but still have a long way to go before it is what we want

We have good childcare for our child

We have excellent childcare for our child

15. Many families want their child to play with other children or participate in religious, community, or social activities.  How would you describe your child’s participation in these activities right now?

CHECK HERE IF YOU HAVE NOT WANTED YOUR CHILD TO PARTICIPATE IN SUCH ACTIVITIES AND GO TO QUESTION 16

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7

Right now our child does not participate in activities we want OR because of our child’s special needs we have decided not to look for it

Our child participates in some social or community activities, but we have a long way to go before it is what we want

Our child has good participation in social or community activities

Our child has excellent participation in social or community activities

Your feelings about early intervention

16.  To what extent has early intervention helped your family know and understand your rights?

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5

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7

Early intervention has not helped us know about our family’s rights

Early intervention has done a few things to help us know about our rights

Early intervention has provided good help so that we know our family’s rights

Early intervention has done an excellent job of helping us know about our family’s rights

17.  To what extent has early intervention helped your family effectively communicate your child’s needs?

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7

Early intervention has not helped us effectively communicate our child’s needs

Early intervention has done a few things to help us effectively communicate our child’s needs

Early intervention has done a good job of helping us effectively communicate our child’s needs

Early intervention has done an excellent job of helping us effectively communicate our child’s needs

18. To what extent has early intervention helped your family be able to help your child develop and learn?

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7

Early intervention has not helped us help our child develop and learn

Early intervention has done a few things so that we can help our child develop and learn

Early intervention has done a good job of helping us help our child develop and learn

Early intervention has done an excellent job of helping us help our child develop and learn

Looking towards the future

19. Considering everything about your family, in general how would you describe your family’s overall life situation RIGHT NOW?

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7

Right now, our family’s overall  life situation is poor

Right now, our family’s overall  life situation is fair

Right now, our family’s overall life situation is good

Right now, our family’s overall life situation is very good

20. Considering everything about your family, in general what do you think about your family’s FUTURE overall life situation (what it will be like five to ten years from now)?

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7

We feel that our family’s overall life situation in the next 5 to 10 years will not be as good as it is right now

We feel that our family’s overall life situation in the next 5 to 10 years will be about the same as it is right now

We feel that our family’s overall life situation in the next 5 to 10 years will be better than it is right now

We feel that our family’s overall life situation in the next 5 to 10 years will be much better than it is right now

21. Families face many transitions (changes) as their children get older, such as moving to new schools or into new service programs.  How prepared are you and your child for future transitions?

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7

We are not prepared for future transitions for our child and family

We are uncertain about  future transitions for our child and family

We are somewhat prepared for future transitions for our child and family

We are prepared for future transitions for our child and family