Initial Visit Caregiver Survey

Thank you for taking a few minutes to tell us about your experience with the South Enotah Child Advocacy Center. The information you provide will help us improve our services and better assist our clients. Your answers are confidential and will not be traced back to you, nor can this information be used in any legal proceedings. Your participation in the survey is voluntary – if you do not wish to answer a question, please leave it blank. If you have questions while completing the survey, please speak with the nearest staff member. For questions following this visit, please contact the Center.

What is your child's gender?

What is your child's gender? Female Male Other
What is your child’s race/ethnicity? CHECK ALL THAT APPLY.

What is your child’s race/ethnicity? CHECK ALL THAT APPLY. Black or African American American Indian or Alaska Native Multi-Racial Hispanic or Latino Asian White/Caucasian Native Hawaiian or Other Pacific Islander Other Other

Please select the option that most closely reflects your experience with the Center for each of the following statements.
	Strongly Agree	Somewhat Agree	Somewhat Disagree	Strongly Disagree	I don't know
1. I believe my child felt safe at the Center	1. I believe my child felt safe at the CenterStrongly Agree	1. I believe my child felt safe at the CenterSomewhat Agree	1. I believe my child felt safe at the CenterSomewhat Disagree	1. I believe my child felt safe at the CenterStrongly Disagree	1. I believe my child felt safe at the CenterI don't know
2. The Center staff made sure I understood the reason for our visit to the Center.	2. The Center staff made sure I understood the reason for our visit to the Center.Strongly Agree	2. The Center staff made sure I understood the reason for our visit to the Center.Somewhat Agree	2. The Center staff made sure I understood the reason for our visit to the Center.Somewhat Disagree	2. The Center staff made sure I understood the reason for our visit to the Center.Strongly Disagree	2. The Center staff made sure I understood the reason for our visit to the Center.I don't know
3. When I came to the Center, my child and I were greeted and received attention in a timely manner.	3. When I came to the Center, my child and I were greeted and received attention in a timely manner.Strongly Agree	3. When I came to the Center, my child and I were greeted and received attention in a timely manner.Somewhat Agree	3. When I came to the Center, my child and I were greeted and received attention in a timely manner.Somewhat Disagree	3. When I came to the Center, my child and I were greeted and received attention in a timely manner.Strongly Disagree	3. When I came to the Center, my child and I were greeted and received attention in a timely manner.I don't know
4. I was given information about the services and programs provided by the Center.	4. I was given information about the services and programs provided by the Center.Strongly Agree	4. I was given information about the services and programs provided by the Center.Somewhat Agree	4. I was given information about the services and programs provided by the Center.Somewhat Disagree	4. I was given information about the services and programs provided by the Center.Strongly Disagree	4. I was given information about the services and programs provided by the Center.I don't know
5. My questions were answered to my satisfaction.	5. My questions were answered to my satisfaction.Strongly Agree	5. My questions were answered to my satisfaction.Somewhat Agree	5. My questions were answered to my satisfaction.Somewhat Disagree	5. My questions were answered to my satisfaction.Strongly Disagree	5. My questions were answered to my satisfaction.I don't know
6. The process for the interview of my child at the Center was clearly explained to me.	6. The process for the interview of my child at the Center was clearly explained to me.Strongly Agree	6. The process for the interview of my child at the Center was clearly explained to me.Somewhat Agree	6. The process for the interview of my child at the Center was clearly explained to me.Somewhat Disagree	6. The process for the interview of my child at the Center was clearly explained to me.Strongly Disagree	6. The process for the interview of my child at the Center was clearly explained to me.I don't know
7. I was given information about possible behaviors I might expect from my child in the days and weeks ahead.	7. I was given information about possible behaviors I might expect from my child in the days and weeks ahead.Strongly Agree	7. I was given information about possible behaviors I might expect from my child in the days and weeks ahead.Somewhat Agree	7. I was given information about possible behaviors I might expect from my child in the days and weeks ahead.Somewhat Disagree	7. I was given information about possible behaviors I might expect from my child in the days and weeks ahead.Strongly Disagree	7. I was given information about possible behaviors I might expect from my child in the days and weeks ahead.I don't know
8. The staff members at the Center were friendly and pleasant.	8. The staff members at the Center were friendly and pleasant.Strongly Agree	8. The staff members at the Center were friendly and pleasant.Somewhat Agree	8. The staff members at the Center were friendly and pleasant.Somewhat Disagree	8. The staff members at the Center were friendly and pleasant.Strongly Disagree	8. The staff members at the Center were friendly and pleasant.I don't know
9. After our visit at the Center, I feel I know what to expect with the situation facing my child and me.	9. After our visit at the Center, I feel I know what to expect with the situation facing my child and me.Strongly Agree	9. After our visit at the Center, I feel I know what to expect with the situation facing my child and me.Somewhat Agree	9. After our visit at the Center, I feel I know what to expect with the situation facing my child and me.Somewhat Disagree	9. After our visit at the Center, I feel I know what to expect with the situation facing my child and me.Strongly Disagree	9. After our visit at the Center, I feel I know what to expect with the situation facing my child and me.I don't know
10. The Center staff provided me with resources to support my child and respond to his or her needs in the days and weeks ahead.	10. The Center staff provided me with resources to support my child and respond to his or her needs in the days and weeks ahead.Strongly Agree	10. The Center staff provided me with resources to support my child and respond to his or her needs in the days and weeks ahead.Somewhat Agree	10. The Center staff provided me with resources to support my child and respond to his or her needs in the days and weeks ahead.Somewhat Disagree	10. The Center staff provided me with resources to support my child and respond to his or her needs in the days and weeks ahead.Strongly Disagree	10. The Center staff provided me with resources to support my child and respond to his or her needs in the days and weeks ahead.I don't know

11. Did someone at the Center give you information about how to get services like counseling or family support for your child? This could include:

• Giving you the name and phone number of a person or agency.

• Introducing you to a service professional.

• Making an appointment for your child

11. Did someone at the Center give you information about how to get services like counseling or family support for your child? This could include:

• Giving you the name and phone number of a person or agency.

• Introducing you to a service professional.

• Making an appointment for your child Yes No I don't know My child did not need those services.
12. Did someone at the Center give you information about how to get services like counseling or family support for yourself?

12. Did someone at the Center give you information about how to get services like counseling or family support for yourself? Yes No I don't know I did not need those services.
13a. Would you have liked additional services for your child that were not offered by the Center?

13a. Would you have liked additional services for your child that were not offered by the Center? Yes No I don't Know
13b. If yes, what types of services would you have liked for your child?