Professional Parent Advocacy Training Evaluation - Part 3
The NJPC Professional Advocacy Training Evaluation Part 3 has been developed to determine if the training is effective in transferring knowledge, empowering parents, and improving outcomes for children involved in the Mental Health, Juvenile Justice, Child Welfare and Special Education Systems. Approximately one year after the training, a NJPC staff person will contact you to participate in the evaluation.

Please complete a form for each child with special needs.

Parent Information
Your Initials *
Example: If your name is Oliver Perez, please type "OP"
Your answer
Training Location *
Where you attended your training session
Training Year *
What year did you begin attending your training sessions
Number of Children *
Your answer
Number of Children with Special Needs *
Your answer
Your Relationship to Child *
Your Current Parenting Status *
Your Sex *
Your Marital Status *
Your Ethnicity *
Please check all that apply
Required
Your Employment Status *
Your Health Insurance *
Your Family’s Total Yearly Income *
Your Educational Status/Highest Grade Completed *
Example: 8 = 8th grade, 12 = 12th grade, 13 = college freshman, 16 = college senior
Your answer
What is the language you use most often at home? *
Have you had a DCP&P (Division of Child Protection & Permanency/DYFS) case or do you have an open case at this time? *
I receive services as a result of: *
Please check all that apply
Required
I receive services through the following organizations:
Please separate each organization with a comma
Your answer
As a child, my family was involved in the following systems: *
Please check all that apply
Required
Child Information
Child's Age *
Your answer
Child's Sex *
Child’s Living Arrangement *
Child's Grade in School *
Example: 8 = 8th grade, 100 = Pre-K, 101 = Kindergarten, 0 = Does Not Attend School
Your answer
Child No Longer Attends School Because *
Child's Ethnicity *
Please check all that apply
Required
Child has the following health insurance *
Child receives services as a result of *
Please check all that apply
Required
Child currently receives services from the following systems: *
Please check all that apply
Required
Child has received services for the following number of years *
If the child has been receiving services for less than one year, please type in "1"
Your answer
Child is currently taking medication for their mental health challenges *
If yes, please list medication(s)
Please separate each medication with a comma
Your answer
Has the child ever received treatment on a psychiatric inpatient unit of a hospital? (CCIS) *
Has the child ever been in a residential treatment center? *
Has the child ever been arrested? *
Has the child ever been incarcerated? *
Has the child ever been on probation? *
Is your child currently in a hospital? *
Is your child currently in a residential treatment center? *
Is your child currently in a detention facility? *
Is your child currently on probation? *
How often does the child attend school? *
How well is the child doing in school, in generally? *
How satisfied are you with the child’s academic progress? *
How many friends does the child have? *
How satisfied are you with the child’s friendships? *
Describe the child’s attitude, in general *
How hopeful is the child about their future? *
How does the child feel about themselves? *
I feel that I have the right to approve all services the child receives. *
I feel confident about participating in treatment planning or IEP meetings for the child. *
I know how to get services for the child, and I know the steps to take when I am concerned about the services the child is or is not receiving. *
I make sure that professionals understand my opinions about the services the child needs. *
I am actively involved in making decisions about what services the child needs. *
I stay in regular contact with those who are providing services for the child. *
Professionals treat me as an equal partner when deciding services for the child. *
Do you feel that all of the child’s mental health, school and personal needs are being met? *
Do you feel that the services being offered to the child are tailored to his/her needs? *
Do you feel that the services being offered to the child are tailored to his/her strengths? *
Do you agree with the child’s current treatment plan? *
Did you sign with the child's treatment plan? *
Does your child currently have a Case Manager? *
Example: Child study team, care manager, probation officer, social worker, case worker, etc.
If yes, from which agency/agencies?
Please separate each agency with a comma
Your answer
Do you feel that the child’s case manager listens to you when you talk about the child’s needs?
Only answer the question if your child currently has some sort of case management
Does the child’s case manager make you feel comfortable?
Only answer the question if your child currently has some sort of case management
Does the child’s case manager support your participation and decisions?
Only answer the question if your child currently has some sort of case management
Does the child’s case manager collaborate with other agencies to coordinate all services the child needs for mental health, education, legal, social services, and others?
Only answer the question if your child currently has some sort of case management
Community Involvement
Are you interested in or involved in any of the following, on either a volunteer or paid basis?
Please check all that apply
Comments on Community Involvement
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms