PARC Wayne Satisfaction Survey

Full Name

First Name Last Name

E-mail

I. Type of Contact with the PARC Program (please check all that apply):

Face to face in own home Written (letters/mail) Telephone E-mail/Electronic

When considering the type and amount of contact you had with PARC staff, how satisfied were you?

	1	2	3	4	5	6

1 is Completely Satisfied, 6 is Not at All Satisfied

II. Services Utilized in the PARC Program (please check all that apply):

Case Management

24-hr contact by worker Received description of PARC services Received description of and how to access other community resources Received In-Home services for 6-8 weeks

Coordination of Community Services

One-to-One contact with specific PARC staff PARC staff advocated for you to receive community services Special Education Services are in Place Mental health services are in place Medicaid is active You have received a resource guide Medical Subsidy is in place

Information Dissemination

You were able to reach PARC staff 24/7 You were connected to community resources You received information within 72 hours of your request

Adoptive Family Support

You and/or child/youth participated in monthly support groups You participated in trainings

Communication, Technology and Information Sharing

You have used the PARC website You have sent/received e-mails from PARC staff You have received either by mail or electronically the Quarterly Newsletter

When considering the services you received from PARC staff, how satisfied were you?

	1	2	3	4	5	6

1 is Completely Satisfied, 6 is Not at All Satisfied

III. Timeliness of Response

When considering the time it took PARC staff to return phone calls/e-mails/letters, how satisfied were you?

	1	2	3	4	5	6

1 is Completely Satisfied, 6 is Not at All Satisfied

When considering the time it took PARC staff to response to your specific requests, how satisfied were you?

	1	2	3	4	5	6

1 is Completely Satisfied, 6 is Not at All Satisfied

IV. Thoroughness of Information Provided

When considering the information provided by PARC staff, how satisfied were you?

	1	2	3	4	5	6

1 is Completely Satisfied, 6 is Not at All Satisfied

When considering the usefulness of the information (i.e. did it help), how satisfied were you?

	1	2	3	4	5	6

1 is Completely Satisfied, 6 is Not at All Satisfied

What did you like best about the services?

What are some problems or concerns?

Would you recommend the PARC program to other adoptive families?

Yes No

Enter the message as it's shown *

Post Adoption Resource Centers Client Satisfaction Survey

Your Information