1. The consultant responded to my referral in a timely manner. 3
2. The consultants role was clearly explained to me. 3
3. I felt I had a good relationship with the consultant. 3
4. I believe the consultation service was helpful. 3
5. I felt listened to by the consultant. 3
6. The consultant respected my opinions. 3
7. The consultant answered my questions. 3
8. I learned new ways to help children with challenging behaviors. 3
9. The consultation service positively affected the way I relate to children. 3
10. Overall, I am satisfied with the consultation service I recieved. 3
11. I feel the referring situation has improved. 3
12. What is ONE thing youre doing differently because of the consultation service you received?
n/a
13. Would you recommend this consultation service to other childcare providers? Why or why not?
n/a
14. How can this consultation service be improved?
n/a
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?
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):
Other comments:
OPTIONAL - Consultants Name:
OPTIONAL - Your Name:
Admin Information
Case ID: 6578
Case Title: 025-000-111
Case Type: child_family_focused
Survey Target: provider