On-Call Accompaniment Survey

Please complete this survey for yourself and/or your children. If you do not have children, or your children are not receiving services from Embrace, please complete the survey with only yourself in mind.

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* 1. Where did you receive on-call accompaniment services?

Hospital

Law Enforcement Center

Community-Based Medical Site

Child Advocacy Center

Health and Human Services

Court

Transportation

Other (please specify)

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* 2. Please respond to the following statements about emotional and physical safety.

	Yes	No	Kind of
I now have a safety plan in place for myself and/or my children. For example, I now know safe people, safe places, and safe options.	I now have a safety plan in place for myself and/or my children. For example, I now know safe people, safe places, and safe options. Yes	I now have a safety plan in place for myself and/or my children. For example, I now know safe people, safe places, and safe options. No	I now have a safety plan in place for myself and/or my children. For example, I now know safe people, safe places, and safe options. Kind of
I now have more ideas for healthy coping skills for myself and/or my children.	I now have more ideas for healthy coping skills for myself and/or my children. Yes	I now have more ideas for healthy coping skills for myself and/or my children. No	I now have more ideas for healthy coping skills for myself and/or my children. Kind of

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* 3. I feel comfortable connecting with Embrace staff or another safe person in my life.

Yes

Kind of

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* 4. I feel the staff at Embrace respect me and/or my children.

Yes

Kind of

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* 5. The Embrace advocate was helpful and knowledgeable, they let me know what options were available.

Yes

Kind of

Comments:

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* 6. What rating would you give Embrace? (5 stars=perfect rating)

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* 7. The materials given to me by the Embrace advocate were helpful.

Yes

Kind of

Comments:

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* 8. The other people present (e.g. law enforcement, nurses, social worker etc.) were helpful and kind.

Yes

Kind of

Comments:

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* 9. We celebrate the diversity of all people. Please mark all races and ethnicities you identify as:

American Indian or Alaska Native

Southeast Asian

Other Asian

Black or African American

Hispanic or Latnix

Native Hawaiian or other Pacific Islander

White

Mulitple Races

Other race not listed

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* 10. Do you identify as LGBTQ+?

Yes

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* 11. Do you identify as having a disability? (Physical, mental, developmental, deaf/hard of hearing)

Yes

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* 1. Where did you receive on-call accompaniment services?

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* 2. Please respond to the following statements about emotional and physical safety.

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* 3. I feel comfortable connecting with Embrace staff or another safe person in my life.

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* 4. I feel the staff at Embrace respect me and/or my children.

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* 5. The Embrace advocate was helpful and knowledgeable, they let me know what options were available.

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* 6. What rating would you give Embrace? (5 stars=perfect rating)

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* 7. The materials given to me by the Embrace advocate were helpful.

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* 8. The other people present (e.g. law enforcement, nurses, social worker etc.) were helpful and kind.

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* 9. We celebrate the diversity of all people. Please mark all races and ethnicities you identify as:

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* 10. Do you identify as LGBTQ+?

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* 11. Do you identify as having a disability? (Physical, mental, developmental, deaf/hard of hearing)

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* 12. Other comments about your experience.