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

2. The consultants role was clearly explained to me. 3

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

4. I believe the consultation service was helpful. 3

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. 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?
I am using more visuals with my students. This is helping them not only hear, but see what they should be doing.

13. Would you recommend this consultation service to other childcare providers? Why or why not?
Yes. I think it was extremely helpful to have someone else in the classroom to help understand the behaviors. As a teacher I have to help many children, so I cannot dedicate all my attention to one child. When Jill was here she was able to watch and give suggestions she felt would benefit the child.

14. How can this consultation service be improved?
I loved all the resources provided. I would have liked to have more time to talk about how to successfully implement them. It was a challenge to look at them and talk about them with the students present.

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: