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. 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?
Since I am not in the classroom on a regular basis I wouldn't say I am doing things differently with the child receiving services but have been able to help support the lead teacher as she navigates the behaviors and have had more conversations with the child's mom regarding her child's needs.

13. Would you recommend this consultation service to other childcare providers? Why or why not?
Yes. I think the lead teacher they worked with felt supported through this service and it gave the family a lot of support in navigating the child's behaviors as well.

14. How can this consultation service be improved?
It would have been helpful if things were shared with me more about what was being worked on by the lead teacher or what they saw during their observations so that I could better have supported the classroom.

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: