PARC Wayne Satisfaction Survey

Full Name

First NameLast Name

E-mail

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

Face to face in own homeWritten (letters/mail)TelephoneE-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 workerReceived description of PARC servicesReceived description of and how to access other community resourcesReceived In-Home services for 6-8 weeks

Coordination of Community Services

One-to-One contact with specific PARC staffPARC staff advocated for you to receive community servicesSpecial Education Services are in PlaceMental health services are in placeMedicaid is activeYou have received a resource guideMedical Subsidy is in place

Information Dissemination

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

Adoptive Family Support

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

Communication, Technology and Information Sharing

You have used the PARC websiteYou have sent/received e-mails from PARC staffYou 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?

YesNo

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