CTSS InHome Family

CTSS InHome Family Survey

Please help our agency to improve our services by answering some questions about the services your child has received OVER THE LAST THREE MONTHS. Your answers are confidential and will not influence the services you or your child receive. Please indicate if you Strongly Agree, Agree, Undecided, Disagree, Strongly Disagree or if the question is not applicable to your situation for each of the statements below:

Question Title

* 1. Today's Date

Date / Time

Date

Question Title

* 2. Please choose which county you live in:

Aitkin

Cass

Crow Wing

Morrison

Todd

Wadena

Question Title

* 3. Collaboration

	Strongly Agree	Agree	Undecided	Disagree	Strongly Disagree	N/A
I believe the goals on my child's treatment plan accurately reflect their strengths and challenges.	I believe the goals on my child's treatment plan accurately reflect their strengths and challenges. Strongly Agree	I believe the goals on my child's treatment plan accurately reflect their strengths and challenges. Agree	I believe the goals on my child's treatment plan accurately reflect their strengths and challenges. Undecided	I believe the goals on my child's treatment plan accurately reflect their strengths and challenges. Disagree	I believe the goals on my child's treatment plan accurately reflect their strengths and challenges. Strongly Disagree	I believe the goals on my child's treatment plan accurately reflect their strengths and challenges. N/A

Comments:

Question Title

* 4. Accessibility

	Strongly Agree	Agree	Undecided	Disagree	Strongly Disagree	N/A
My family has struggled in the past to access mental health services for my child.	My family has struggled in the past to access mental health services for my child. Strongly Agree	My family has struggled in the past to access mental health services for my child. Agree	My family has struggled in the past to access mental health services for my child. Undecided	My family has struggled in the past to access mental health services for my child. Disagree	My family has struggled in the past to access mental health services for my child. Strongly Disagree	My family has struggled in the past to access mental health services for my child. N/A
Having these services makes it easier for my child to access the mental health services they need.	Having these services makes it easier for my child to access the mental health services they need. Strongly Agree	Having these services makes it easier for my child to access the mental health services they need. Agree	Having these services makes it easier for my child to access the mental health services they need. Undecided	Having these services makes it easier for my child to access the mental health services they need. Disagree	Having these services makes it easier for my child to access the mental health services they need. Strongly Disagree	Having these services makes it easier for my child to access the mental health services they need. N/A

Comments:

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* 5. Communication

	Strongly Agree	Agree	Undecided	Disagree	Strongly Disagree	N/A
Staff communicate with me in such a way that I understand my child's diagnosis, goals, treatment and progress.	Staff communicate with me in such a way that I understand my child's diagnosis, goals, treatment and progress. Strongly Agree	Staff communicate with me in such a way that I understand my child's diagnosis, goals, treatment and progress. Agree	Staff communicate with me in such a way that I understand my child's diagnosis, goals, treatment and progress. Undecided	Staff communicate with me in such a way that I understand my child's diagnosis, goals, treatment and progress. Disagree	Staff communicate with me in such a way that I understand my child's diagnosis, goals, treatment and progress. Strongly Disagree	Staff communicate with me in such a way that I understand my child's diagnosis, goals, treatment and progress. N/A
Staff have adequately explained to me the services available to my family and child through the program, as well as other services Northern Pines offers.	Staff have adequately explained to me the services available to my family and child through the program, as well as other services Northern Pines offers. Strongly Agree	Staff have adequately explained to me the services available to my family and child through the program, as well as other services Northern Pines offers. Agree	Staff have adequately explained to me the services available to my family and child through the program, as well as other services Northern Pines offers. Undecided	Staff have adequately explained to me the services available to my family and child through the program, as well as other services Northern Pines offers. Disagree	Staff have adequately explained to me the services available to my family and child through the program, as well as other services Northern Pines offers. Strongly Disagree	Staff have adequately explained to me the services available to my family and child through the program, as well as other services Northern Pines offers. N/A

Comments:

Question Title

* 6. Outcomes

	Strongly Agree	Agree	Undecided	Disagree	Strongly Disagree	N/A
I have seen my child and family make progress as a result of the interventions staff use and the relationships my child has with staff.	I have seen my child and family make progress as a result of the interventions staff use and the relationships my child has with staff. Strongly Agree	I have seen my child and family make progress as a result of the interventions staff use and the relationships my child has with staff. Agree	I have seen my child and family make progress as a result of the interventions staff use and the relationships my child has with staff. Undecided	I have seen my child and family make progress as a result of the interventions staff use and the relationships my child has with staff. Disagree	I have seen my child and family make progress as a result of the interventions staff use and the relationships my child has with staff. Strongly Disagree	I have seen my child and family make progress as a result of the interventions staff use and the relationships my child has with staff. N/A

Comments:

Question Title

* 7. Professionalism

	Strongly Agree	Agree	Undecided	Disagree	Strongly Disagree	N/A
Staff treat my family and my child with respect.	Staff treat my family and my child with respect. Strongly Agree	Staff treat my family and my child with respect. Agree	Staff treat my family and my child with respect. Undecided	Staff treat my family and my child with respect. Disagree	Staff treat my family and my child with respect. Strongly Disagree	Staff treat my family and my child with respect. N/A

Comments:

CTSS InHome Family