A Workshop for the Region 4 Intermediate Units (IU 9, IU ...



EARLY INTERVENTION PROGRAM



1-800-326-8528

Dear Parents:

We are committed to a quality Early Intervention Program and would like your input regarding our services. Please take a few minutes to answer the following questions and include any comments or suggestions that you feel will be helpful to us. Your honesty and cooperation are appreciated and will help us to improve. Please return this survey to us by July 11, 2003. A pre-addressed, stamped envelope is enclosed for your convenience. Thank you.

Parent Survey 2002-2003

1. How long have you been receiving Early Intervention services from BLaST Intermediate Unit #17?

___________________

2. Where did you learn about BLaST Intermediate Unit #17’s Early Intervention services?

_____ Transition from MH/MR _____ Head Start

_____ Doctor/Clinic _____ Newspaper Ad

_____ Community Screening _____ Other – Please list

_____ Preschool/Day Care ______________________________________

3. Do you have any suggestions how we might better reach children who may be in need of service?

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

4. Which Parent Trainings offered by BLaST Intermediate Unit #17 did you attend?

Oct 2002 Early Childhood Conference ___________

Nov 2002 Autism Conference ___________

Feb 2003 Transition Training for Parents ___________

Mar 2003 Why Do Children Misbehave? ___________

May 2003 Families Learning Together ___________

I did not attend any Parent Trainings ___________

5. Please list any specific needs or suggestions for parent training.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

(over)

6. Are you aware that all Early Intervention services are confidential? Yes ______ No ______

7. Are you aware of the BLaST website, ? Yes ______ No ______

8. Have you accessed and found the BLaST website useful? A S N D

9. Has your Early Intervention (EI) staff person provided information regarding

the Local Interagency Coordinating Council (LICC)? A S N D

10. Do you participate in activities of your Local Interagency Coordinating

Council (LICC)? A S N D

11. Has your EI staff person provided information based on your child’s needs? A S N D

12. Has your EI staff person provided information based on your family’s needs? A S N D

13. Has your EI staff person provided information on typical childhood social

and behavioral growth and development? A S N D

14. Has the EI staff been sensitive to the cultural concerns of your family? A S N D

15. Does the EI staff respond to your concerns in a timely manner? A S N D

16. Has your EI staff person provided information or activities to develop early

literacy skills with your child? A S N D

17. Does the EI staff give you support, suggestions, activities and ideas to use

between visits? A S N D

18. Do you feel comfortable following through with these learning activities? A S N D

19. Do you feel you have been an equal partner in developing a program for

your child? A S N D

20. Were you satisfied with the transition process from Infant-Toddler

(MH-MR) programming to BLaST IU #17 programming? A S N D

21. Does the EI staff help you with planning for your child’s entry to the

public school system? A S N D

22. Were you satisfied with the transition process from BLaST IU #17

programming to school age programming? A S N D

23. Were you satisfied that your child is learning skills to be successful in

kindergarten? A S N D

24. Overall, have EI services provided by BLaST IU #17 been a benefit

to your child and family? A S N D

In what way?

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Other comments:

If you have any questions, please contact your local service coordinator:

Dan Knapp Karen Rush

(570) 673-6001 (570) 323-8561

dknapp@ krush@

Optional:

Name: __________________________________________________________________________

Address: ________________________________________________________________________

________________________________________________________________________

Phone: ________________________________________________________________________

A Regional Education Service Agency Serving Bradford, Lycoming, Sullivan, and Tioga Counties

An Equal Opportunity Employer In Compliance With Title IX and Sections 503 and 504

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Use this key to help you answer the following questions:

A = Always S = Sometimes N = Never D = Don’t Know

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