1. The consultant responded to my referral in a timely manner. 4

2. The consultants role was clearly explained to me. 4

3. I felt I had a good relationship with the consultant. 4

4. I believe the consultation service was helpful. 4

5. I felt listened to by the consultant. 4

6. The consultant respected my opinions. 4

7. The consultant answered my questions. 4

8. I learned new ways to help children with challenging behaviors.

9. The consultation service positively affected the way I relate to children.

10. Overall, I am satisfied with the consultation service I recieved. 4

11. I feel the referring situation has improved. 2

12. What is ONE thing youre doing differently because of the consultation service you received?
Consultation services were primarily focused on classroom observation, SMART goal development within the educational environment, and resources/support for educational providers. There was limited direct change identified for in home or patent/Child interaction. Therefore, cannot specifically identify something that our family is doing differently. Perhaps - consultation services reinforced existing efforts within the home, and aided in better advocacy within the educational environment.

13. Would you recommend this consultation service to other childcare providers? Why or why not?
Yes - would certainly recommend this consultation service to other families, especially those that feel caught in the middle of a broken educational system and advocating to meet their child's unique needs.

14. How can this consultation service be improved?
Especially in circumstances where the services are being delivered in a collaborative structure between the educational system and a family - shared documentation would be appreciated. This is essential when all parties are developing a plan of action to support a child- creates transparency and accountability across parties and ensures clarity in roles and responsibilities.

15. To be answered by the family: Over the past 30 days, how many days of work or school has the family/caregiver missed due to the challenges a child has experienced while in child care? 2

16. To be answered by the family: Please rate your stress level related to your child’s challenges at ChildCare(please edit if you like the idea of adding it): 8

Other comments:

OPTIONAL - Consultants Name:

OPTIONAL - Your Name: