Client Questionnaire Question Title * Date survey completed Date Date Question Title * Please indicate the service this survey pertains to: Brief Services: Walk-In Services CAMHP Counselling and Therapy: General counselling/therapy, School Based Mental Health Crisis Services: Mobile Crisis Family/Caregiver Skill Building: Triple P Intensive Treatment Services: Day Treatment, Intensive Supervision and Support Program , Family Intervention Support Program, Therapeutic Foster Care Specialized Consultation/Assessment Services: Eating Disorder Intervention, Trauma, Psychology, TAPP-C FRIENDS Anxiety Group Service Not Specified SNAP Group PLEASE TELL US HOW YOU FEEL ABOUT OUR SERVICE.1 - Strongly Disagree .........................................5 - Strongly Agree Question Title * Participation… You participated in your child’s treatment. 1 2 3 4 5 Does not apply Question Title * Goals… The worker helped you to develop a specific plan that met your needs. 1 2 3 4 5 Does not apply Question Title * Relationship… You felt heard and respected by the worker. 1 2 3 4 5 Does not apply Question Title * Treatment… Your worker identified both strengths and problem areas in your family. 1 2 3 4 5 Does not apply Question Title * Culture… Your culture was respected and taken into consideration by the worker. 1 2 3 4 5 Does not apply Question Title * Family Centered Care… You and other family members were invited to participate in treatment as needed. 1 2 3 4 5 Does not apply Question Title * Communication… Compass staff seem to communicate well with each other and with you. 1 2 3 4 5 Does not apply Question Title * Outcome… You are more able to manage your problems than before treatment. 1 2 3 4 5 Does not apply Question Title * Information… You received information about other resources that was helpful. 1 2 3 4 5 Does not apply Question Title * Overall Care… You would recommend Compass to other families. 1 2 3 4 5 Does not apply Question Title * . Yes No N/A Length of time waiting for service was reasonable Length of time waiting for service was reasonable Yes Length of time waiting for service was reasonable No Length of time waiting for service was reasonable N/A Services were integrated and coordinated Services were integrated and coordinated Yes Services were integrated and coordinated No Services were integrated and coordinated N/A You were involved in key service decisions You were involved in key service decisions Yes You were involved in key service decisions No You were involved in key service decisions N/A Transitions/referrals were supported and timely Transitions/referrals were supported and timely Yes Transitions/referrals were supported and timely No Transitions/referrals were supported and timely N/A Question Title * As a result of services have you seen a... Yes No N/A Reduction in severity of needs or symptoms Reduction in severity of needs or symptoms Yes Reduction in severity of needs or symptoms No Reduction in severity of needs or symptoms N/A Improvement in functioning/enhanced strengths Improvement in functioning/enhanced strengths Yes Improvement in functioning/enhanced strengths No Improvement in functioning/enhanced strengths N/A Majority of treatment goals accomplished Majority of treatment goals accomplished Yes Majority of treatment goals accomplished No Majority of treatment goals accomplished N/A Question Title * What do we do well? Question Title * What would improve our service for you? Question Title * Other Comments: Next
