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.

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. 4

9. The consultation service positively affected the way I relate to children. 4

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

11. I feel the referring situation has improved. 4

12. What is ONE thing youre doing differently because of the consultation service you received?
Our Program is now using ASQ-SE.

13. Would you recommend this consultation service to other childcare providers? Why or why not?
Absolutely! This service has provided a lot of positive feed back to our teachers and families. This service has offered my staff another set of listening ears, many new ideas, and showed us other resources to use. We Appreciate all the help and guidance this service offers our program and families.

14. How can this consultation service be improved?
We wish she could do classroom assessments regularly center wide vs just one room or child.

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:
Rachel Slivik is always professional, and always makes my staff feel heard. We appreciate all she offers to our program and our families.

OPTIONAL - Consultants Name: Rachel Slivik

OPTIONAL - Your Name: Hailey Pratt