Walla Walla County Autism Needs Assessment Parent/Community Survey

Walla Walla County Autism Needs Assessment Parent/Community Survey
Thank you for agreeing to complete this survey. Since most respondents will be parents/guardians, the survey refers to the autistic person as "your child". This "child" may be of any age. The term autism is used to refer to all Autism Spectrum Disorders (ASD). If you are a parent/caregiver to more than one autistic person, you may complete a survey for each person you provide care for. If you choose to complete only one survey, please complete the survey for the oldest autistic person. All participants will remain anonymous. All data resulting from this survey will be reported to keep all parties anonymous, and will be used to inform direct services and policies, and will not be used for research.

Where does your child live?

Walla Walla CountyColumbia CountyUmatilla County, OregonOther
Please identify yourself:

MotherFatherOther
Has your child received an autism diagnosis?
Who provided your child's diagnosis?

School staffMedical providerOther
How old was your child at diagnosis?
How long did you wait to get a diagnosis following the diagnosis referral?
What type of professional first diagnosed your child with autism?

Doctor/Nurse/Primary Medical ProviderDevelopmental PediatricianPsychologistPsychiatristNuerologistOther
Where did your child receive the diagnosis?

In Walla WallaIn Washington State but outside of Walla Walla CountyOutside of Washington State
How far did you travel to receive your child's autism diagnosis?

0-20 miles21-50 miles50-100 milesmore than 100 miles
After your child's diagnosis, did you receive any of the following services? (Select all that apply.)

Early Intervention/Birth to Three/ESITFamily SupportSpeech TherapyPhysical TherapyBehavioral/mental health services/ABAOccupational TherapyOther
Before your child's diagnosis did, they receive any of the following services? (Select all that apply.)

Early Intervention/Birth to Three/ESITFamily SupportSpeech TherapyPhysical TherapyBehavioral/mental health services/ABAOccupational TherapyOther
Are you waiting to get an autism assessment for your child?
Do you intend to get an autism assessment for your child?
Where are you in the process of receiving the autism assessment?

Need a referral to get an autism assessmentHave a referral to assessment and waiting for the appointmentHad an assessment and autism was not diagnosed but want a second opinionOther
Has your child ever received any of the following services? (Select all that apply.)

Occupational TherapyEarly Intervention/Birth to Three/ESITSpeech TherapyPhysical TherapyBehavioral/mental health services/ABADid not receiveOther
What services is your child currently receiving? (Select all that apply.)

Occupational TherapyEarly InterventionSpeech TherapyPhysical TherapyBehavioral/mental health servicesHave not receivedOther
How do you pay for your child's health care services?

Private health insuranceMedicaid/Apple HealthOut of Pocket (self-pay)I don't knowOther
What is your child's current living situation?

With parent in a family homeWith other relative(s) in a family homeResidential FacilityFoster HomeGroup HomeLives on own with supportLives on own without supportOther
How satisfied are you with your child's current living situation?

Very satisfiedSatisfiedDissatifiedVery Dissatisfied
Is your child receiving therapy or intervention for any of the following issues? (Select all that apply.)

Self-injurious behaviorSleep issuesAnxiety/Mood/RegulationMedicationAggressive behaviorsRunning awayToiletingSensory ProcessingHave not receivedOther
In what setting(s) does your child receive services?

Private medical clinicSchoolEarly Head StartHead Start/ECEAPOther
For the therapies or interventions your child is receiving, do you feel they are all needed?
Are there any therapies or interventions your child needs but is not receiving?
What long-term plans do you have for your child when you are no longer able to care for them? (Select all that apply.)

Arranged housing plansSet up a financial trustDesignated guardianshipDesignated power of attorneyCurrently developing plansNone at this timeOther
Has your child's needs related to autism or suspected autism affected your ability to work outside of the home?
Has your child ever had an IEP (Individualized Education Plan) or a Individualized Family Service Plan (IFSP)?
Has your child ever had a 504 Plan (accommodations)?
Have you experienced difficulties accessing healthcare for your child?
Please describe the difficulties you have experienced.
What services do you need to support you and your family that you are not currently receiving? (Select all that apply.)

Short term respite careChildcareFamily counselingSibling support/counselingParent support groups/counselingABA TherapyDay Habilitation/Center based respiteNoneOther
What is the primary mode of transportation for your family?

Own private vehicleRide share/Uber/LyftPublic Transportion/BusWalk/bikeOther
Are services provided to your child in your and your child's preferred language?

Yes, alwaysYes, usuallyYes, sometimesNo or rarely
What else do you want to tell us about your experiences caring for your child?
Thank you for your participation!
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