ACF Survey for Parents and Caregivers - 2

If you are a parent or caregiver of an individual with autism and/or intellectual disabilities, you are invited to participate in an online survey on behalf of Autism Cares Foundation. This survey is being conducted among parents and caregivers, service providers, and educators to better understand the needs and to better target Autism Cares Foundation's efforts in the community. The internet-based survey, conducted by an independent consulting team, will take 10-15 minutes and may be completed at your convenience. Our goal is to summarize our findings by November 15, 2020.
Please note that the results of this study will be used for market research purposes only, and all responses will be kept strictly confidential. Your personal information will not be linked to any of your answers and will not be shared on an individual basis.
Name (optional): 


A red asterisk (*) indicates required questions.

  1. Relationship to Individual with Special Needs*


  1. Location*


  1. Do you know the organization Autism Cares Foundation?*
    Yes
    No


  1. If answer to number 3 is yes, what do you know about this organization?*


  1. In your opinion, please indicate the level of disability for your child? *
    Minimal Support Needed
    Moderate Level of Support Needed
    High Level of Support Needed


  1. How old is the child you are focusing on for this survey?*


  1. What services, outside of school, is your family member currently receiving, or has received in the past 5 years? Select all that apply*
    Behavior Support
    Respite
    Family Community Activities
    TSS
    Supports Coordinator
    Mobile Therapist
    OT
    PT
    Speech
    Job Training and/or Supported Employment
    Mental Health Services (Psychologist or Psychiatrics Care)
    No Out of School Services
    Home and Community
    Buddy Companion
    None of Above
    Other


  1. Does your child have a Supports Coordinator?*
    Yes
    No


  1. If yes to answer 8, how often do you meet with the Supports Coordinator?
    Once a year
    2-3 times per year
    4-6 times per year
    More than 6 times per year
    Less than once per year


  1. If yes to answer 8, is your Supports Coordinator an active member of your child's IEP team?
    Yes
    No


  1. Does your child have Medical ACCESS?*
    Yes
    No


  1. If answer to number 11 is no, why?
    Had ACCESS but it expired
    Was denied
    Have not completed paperwork
    Not able to complete paperwork
    Do not know what this is
    Was removed from coverage
    Other


  1. Where does/did your child attend school?*
    Home School in own public school district
    Regional class in own public school district
    Regional class through the IU in other school district
    Private School
    Home School
    Residential
    Other


  1. How long do you anticipate your child living with you at home?*
    Until the age of 25
    Until the age of 30
    Until the age of 35
    Until I am no longer able to care for them


  1. What supports do you anticipate your child to need after they leave high school, please select as many as you feel your child will need*
    In Home Behavioral Supports
    Mental Health (Psychiatric Care)
    In Home Medical Care
    Supervised Day Program
    Supported Employment
    Job Coaching
    Social Training
    Community Navigation
    Supported Recreation
    Transportation
    Respite Care
    Group Home: Independent with Minimal Supports
    Group Home: Higher Level of Supports
    Residential
    Other


  1. Based on what you selected in number 15, now only choose the top 5 you feel your child will need when they leave high school.*
    In Home Behavior Supports
    Mental Health (psychiatric care)
    In Home Medical Supports
    Supervised Day Program
    Supported Employment
    Job Coaching
    Social Training
    Community Navigation
    Supported Recreation
    Transportation
    Respite Care
    Group Home Independent with Minimal Supports
    Group Home Higher Level of Supports
    Residential
    Other


  1. How prepared are you to navigate the system for your child after high school?*
     
      1 2 3 4 5  
    Very Prepared  Not Prepared


  1. Do you have any comments or concerns about programming for your child after high school, or if already 21, concerns now?*


  1. Do you have Waiver Funding?*
    Yes
    No


  1. If Yes to Waver, Which Waiver does you family member have?


  1. If No to Waiver, Why Not?*
    Have not filed paperwork as of yet
    Child is still in high school or younger
    On waiting list
    Does not qualify for waiver funding
    Do not know about waivers


  1. Would you be interested in follow up questions/conversations with a member of our team? If so, please enter your name and contact information.*