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CST Family Needs Survey 2016
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CST Family Needs Survey 2016

Please answer just a few general questions to start.
Then, please rate whether you have been able to get effective professional help for different issues or concerns about your child.
Then, rate the types of help you may have had, or would like to have, for your child and family.
Finally, rate things that get in the way of being able to get or keep certain services.

________________________________________________________________________________
Your child's age:
Your child's gender:
Your child’s diagnosis or primary mental health / behavioral concern(s):
Aggression/violence:
Doesn't apply to my child
Applies but we haven't sought help
We have tried but can't get help
Have been able to get some help
Satisfied with the help we have gotten
Alcohol or drugs:
Doesn't apply to my child
Applies but we haven't sought help
We have tried but can't get help
Have been able to get some help
Satisfied with the help we have gotten
Anxiety:
Doesn't apply to my child
Applies but we haven't sought help
We have tried but can't get help
Have been able to get some help
Satisfied with the help we have gotten
Attachment Issues:
Doesn't apply to my child
Applies but we haven't sought help
We have tried but can't get help
Have been able to get some help
Satisfied with the help we have gotten
Attention problems (ADHD):
Doesn't apply to my child
Applies but we haven't sought help
We have tried but can't get help
Have been able to get some help
Satisfied with the help we have gotten
Autism:
Doesn't apply to my child
Applies but we haven't sought help
We have tried but can't get help
Have been able to get some help
Satisfied with the help we have gotten
Cognitive disability:
Doesn't apply to my child
Applies but we haven't sought help
We have tried but can't get help
Have been able to get some help
Satisfied with the help we have gotten
Defiant / breaks rules:
Doesn't apply to my child
Applies but we haven't sought help
We have tried but can't get help
Have been able to get some help
Satisfied with the help we have gotten
Delinquent (in trouble with the law):
Doesn't apply to my child
Applies but we haven't sought help
We have tried but can't get help
Have been able to get some help
Satisfied with the help we have gotten
Depression:
Doesn't apply to my child
Applies but we haven't sought help
We have tried but can't get help
Have been able to get some help
Satisfied with the help we have gotten
Eating disorder:
Doesn't apply to my child
Applies but we haven't sought help
We have tried but can't get help
Have been able to get some help
Satisfied with the help we have gotten
Hurting self:
Doesn't apply to my child
Applies but we haven't sought help
We have tried but can't get help
Have been able to get some help
Satisfied with the help we have gotten
Learning Problems:
Doesn't apply to my child
Applies but we haven't sought help
We have tried but can't get help
Have been able to get some help
Satisfied with the help we have gotten
Out of touch with reality (hearing things, paranoid, etc.):
Doesn't apply to my child
Applies but we haven't sought help
We have tried but can't get help
Have been able to get some help
Satisfied with the help we have gotten
School behavior or attendance problems:
Doesn't apply to my child
Applies but we haven't sought help
We have tried but can't get help
Have been able to get some help
Satisfied with the help we have gotten
Post-Traumatic Stress (PTSD):
Doesn't apply to my child
Applies but we haven't sought help
We have tried but can't get help
Have been able to get some help
Satisfied with the help we have gotten
Suicidal thoughts or behavior:
Doesn't apply to my child
Applies but we haven't sought help
We have tried but can't get help
Have been able to get some help
Satisfied with the help we have gotten
Out of control behavior:
Doesn't apply to my child
Applies but we haven't sought help
We have tried but can't get help
Have been able to get some help
Satisfied with the help we have gotten
Please specify any 'out of control behavior':
Other concerns:
Doesn't apply to my child
Applies but we haven't sought help
We have tried but can't get help
Have been able to get some help
Satisfied with the help we have gotten
Please specify any 'other concerns':
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