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. 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. 4

11. I feel the referring situation has improved. 3

12. What is ONE thing youre doing differently because of the consultation service you received?
By offering Ellie more appropriate choice she was making some progress although it was small. For example sitting by her and offering big hugs or little hugs when she is feeing dysregulated or upset. BY sitting with her it helped to make a connection and build a safe space for her whenever she needed it.

13. Would you recommend this consultation service to other childcare providers? Why or why not?
Absolutely! By working with Christina this gives me knowledge to better understand the needs of both the child and the family.

14. How can this consultation service be improved?
BY having a larger referral information base and a defined outline of what constitutes a referral. For example if we feel that the child would benefit from a speech referral then being better informed of how to do this would be helpful.

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: