Instructions: This survey is completed by clients 7 years and older. Check one response that best describes SAFY for each statement.
Division -- Northern Kentucky South Bend Cincinnati DRC Columbia Las Vegas Columbus/Groveport Montgomery Shelter Services Oklahoma City Huntsville Cleveland Louisville Lawton SAFY Behavioral Health Charleston Lexington Somerset Arlington Findlay/Lima Muncie Dayton Birmingham Tiffin Sidney Greenville Canton/Akron Ft. Wayne Merrillville AMERICA RANCHO DRIVE PATRICK LANE DCR DESERT COTTAGE
Age
Race -- White / Caucasian Black / African American Hispanic / Latino Multiracial (2 or more races) Asian American Indian or Alaska Native Native Hawaiian or Other Pacific Islander
Gender -- Female Male
SAFY staff listens to my concerns or problems and help me in working on those problems -- Agree Somewhat Agree Somewhat Disagree Disagree
My foster parents provide a safe, caring home for me. -- Agree Somewhat Agree Somewhat Disagree Disagree
I feel a part of the family -- Agree Somewhat Agree Somewhat Disagree Disagree
I am asked to share my thoughts about my treatment plan -- Agree Somewhat Agree Somewhat Disagree Disagree
My treatment plan talks about my "after foster care" plan (to return home, live independently, etc.). -- Agree Somewhat Agree Somewhat Disagree Disagree
My foster parents and SAFY staff help me to learn basic living skills and/or independent living skills. -- Agree Somewhat Agree Somewhat Disagree Disagree
My foster parents and SAFY staff help me adjust to school. -- Agree Somewhat Agree Somewhat Disagree Disagree
My foster parents and SAFY staff help take care of my school concerns or issues. -- Agree Somewhat Agree Somewhat Disagree Disagree
I am happy with my behavior changes. -- Agree Somewhat Agree Somewhat Disagree Disagree
I can participate in activities with others of my race/culture (i.e. events, music, sports, books, religious activities.) -- Agree Somewhat Agree Somewhat Disagree Disagree
Additional Comments