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.

How many children did you bring to the center that were served?

How many children did you bring to the center that were served? One Two Three Four Five
What is the child/children's gender? (if more than one child check all that apply)

What is the child/children's gender? (if more than one child check all that apply) Female Male Other
What is the child/children's race/ethnicity? CHECK ALL THAT APPLY.

What is the child/children'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
How are you associated to the child/children?

How are you associated to the child/children? Bio-parent Family Relative Family Friend DFCS Care 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	Does Not Apply
1. I believe the child felt safe at the Center.	1. I believe the child felt safe at the Center.Strongly Agree	1. I believe the child felt safe at the Center.Somewhat Agree	1. I believe the child felt safe at the Center.Somewhat Disagree	1. I believe the child felt safe at the Center.Strongly Disagree	1. I believe the child felt safe at the Center.I Don't Know	1. I believe the child felt safe at the Center.Does Not Apply
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	2. The Center staff made sure I understood the reason for our visit to the Center.Does Not Apply
3. When I came to the Center, the child and I were greeted and received attention in a timely manner.	3. When I came to the Center, the child and I were greeted and received attention in a timely manner.Strongly Agree	3. When I came to the Center, the child and I were greeted and received attention in a timely manner.Somewhat Agree	3. When I came to the Center, the child and I were greeted and received attention in a timely manner.Somewhat Disagree	3. When I came to the Center, the child and I were greeted and received attention in a timely manner.Strongly Disagree	3. When I came to the Center, the child and I were greeted and received attention in a timely manner.I Don't Know	3. When I came to the Center, the child and I were greeted and received attention in a timely manner.Does Not Apply
4. The Center was respectful of my culture and values.	4. The Center was respectful of my culture and values.Strongly Agree	4. The Center was respectful of my culture and values.Somewhat Agree	4. The Center was respectful of my culture and values.Somewhat Disagree	4. The Center was respectful of my culture and values.Strongly Disagree	4. The Center was respectful of my culture and values.I Don't Know	4. The Center was respectful of my culture and values.Does Not Apply
5. I was given information about the services and programs provided by the Center and resources in the community.	5. I was given information about the services and programs provided by the Center and resources in the community.Strongly Agree	5. I was given information about the services and programs provided by the Center and resources in the community.Somewhat Agree	5. I was given information about the services and programs provided by the Center and resources in the community.Somewhat Disagree	5. I was given information about the services and programs provided by the Center and resources in the community.Strongly Disagree	5. I was given information about the services and programs provided by the Center and resources in the community.I Don't Know	5. I was given information about the services and programs provided by the Center and resources in the community.Does Not Apply
6. My questions were answered to my satisfaction.	6. My questions were answered to my satisfaction.Strongly Agree	6. My questions were answered to my satisfaction.Somewhat Agree	6. My questions were answered to my satisfaction.Somewhat Disagree	6. My questions were answered to my satisfaction.Strongly Disagree	6. My questions were answered to my satisfaction.I Don't Know	6. My questions were answered to my satisfaction.Does Not Apply
7. I now have a better understanding about the Criminal Justice Process.	7. I now have a better understanding about the Criminal Justice Process.Strongly Agree	7. I now have a better understanding about the Criminal Justice Process.Somewhat Agree	7. I now have a better understanding about the Criminal Justice Process.Somewhat Disagree	7. I now have a better understanding about the Criminal Justice Process.Strongly Disagree	7. I now have a better understanding about the Criminal Justice Process.I Don't Know	7. I now have a better understanding about the Criminal Justice Process.Does Not Apply
8. I was given information about possible behaviors I might expect from my child in the days and weeks ahead.	8. I was given information about possible behaviors I might expect from my child in the days and weeks ahead.Strongly Agree	8. I was given information about possible behaviors I might expect from my child in the days and weeks ahead.Somewhat Agree	8. I was given information about possible behaviors I might expect from my child in the days and weeks ahead.Somewhat Disagree	8. I was given information about possible behaviors I might expect from my child in the days and weeks ahead.Strongly Disagree	8. I was given information about possible behaviors I might expect from my child in the days and weeks ahead.I Don't Know	8. I was given information about possible behaviors I might expect from my child in the days and weeks ahead.Does Not Apply
9. The staff members at the Center were friendly and pleasant.	9. The staff members at the Center were friendly and pleasant.Strongly Agree	9. The staff members at the Center were friendly and pleasant.Somewhat Agree	9. The staff members at the Center were friendly and pleasant.Somewhat Disagree	9. The staff members at the Center were friendly and pleasant.Strongly Disagree	9. The staff members at the Center were friendly and pleasant.I Don't Know	9. The staff members at the Center were friendly and pleasant.Does Not Apply
10. After our visit at the Center, I feel I can contact the staff with any questions/crisis situtations for the child.	10. After our visit at the Center, I feel I can contact the staff with any questions/crisis situtations for the child.Strongly Agree	10. After our visit at the Center, I feel I can contact the staff with any questions/crisis situtations for the child.Somewhat Agree	10. After our visit at the Center, I feel I can contact the staff with any questions/crisis situtations for the child.Somewhat Disagree	10. After our visit at the Center, I feel I can contact the staff with any questions/crisis situtations for the child.Strongly Disagree	10. After our visit at the Center, I feel I can contact the staff with any questions/crisis situtations for the child.I Don't Know	10. After our visit at the Center, I feel I can contact the staff with any questions/crisis situtations for the child.Does Not Apply
11. The Center staff provided me with resources to support the child and respond to his or her needs in the on going future.	11. The Center staff provided me with resources to support the child and respond to his or her needs in the on going future.Strongly Agree	11. The Center staff provided me with resources to support the child and respond to his or her needs in the on going future.Somewhat Agree	11. The Center staff provided me with resources to support the child and respond to his or her needs in the on going future.Somewhat Disagree	11. The Center staff provided me with resources to support the child and respond to his or her needs in the on going future.Strongly Disagree	11. The Center staff provided me with resources to support the child and respond to his or her needs in the on going future.I Don't Know	11. The Center staff provided me with resources to support the child and respond to his or her needs in the on going future.Does Not Apply

12. Did someone at the Center give you information about how to get services like counseling or family support for the 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 the child.

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

13. 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.
14a. Would you have liked additional services for your child or yourself that were not offered by the Center?

14a. Would you have liked additional services for your child or yourself that were not offered by the Center? Yes No I don't Know
14b. If yes, what types of services would you have liked for the child or yourself?