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Decision-Making Questionnaire for Parents of Youth with Disabilities
This form is designed to gather information from parents on the decision-making skills of their children ages 1-5. This information along with information from youth with disabilities, will be used to make a decision-making resource for parents and to help them implement supported decision making with their youth.
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* Indicates required question
Please provide your email address to be contacted with further developments and to receive the final.
Your answer
Child's Age
Your answer
Child's State or Territory
*
Choose
Alabama
Alaska
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
Child's Disability type (check all that apply)
*
Physical (ex. affects mobility. They may use aids like wheelchairs, walkers, and braces)
Intellectual (effects cognition and learning. usually born with it. significant crossover with Developmental Disability.)
Sensory (i.e. blind or d/Deaf or Tactile disability)
Developmental (a disability you were born with or develop in chilhood. usually effects cognition, learning, behavior, communication and sometimes physically. significant crossover with Intellectual Disability)
Psychiatric (affects thinking and the mind. They may have Schizophrenia, Anxiety, Bipolar, or other
Other:
Required
Child's specific Disability (list all that apply)
*
Your answer
What sort of decisions does your child make? (ex, what toy to play with, picking what clothes they will want, answering, via voice or gesture, yes/no questions)
*
Your answer
What sort of decisions are currently challenging for your child? (when to eat instead of playing more, what clothes are appropriate for school and for weather)
*
Your answer
Are there behaviors your child exhibits that you could use help in supporting them? (ex. distress when making decisions, making impulsive decisions, not yet making decisions, difficulty communicating to you, their decisions)
*
Your answer
If you have non-disabled children too, do you engage your disabled child in the similar decision-making activities as their non-disabled siblings at that age?
Yes
No
N/A
Clear selection
Is your child already connected to any services related to their disability? (Family Support Group, Local Independent Living Center, Parent Training and Information Centers, Early Intervention, the Arc etc.)
*
Your answer
About the Researcher
About the researcher
My name is Wednesday Jones and I am Youth Ambassador with the Center on Youth Voice Youth Choice (CYVYC). Youth Ambassadors with the CYVYC are youth with intellectual and developmental disabilities advocating for Supported Decision Making and Alternatives to Guardianship in their state.
My project is creating a resource for parents to use to support their youngest youth in making good decisions. Your answers will help me learn what concerns parents have about building their youth's decision making skills.
If you have additional questions or would like to follow up, my email address wjones@able-sc.org.
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