Thank you for connecting with the HANDS in Autism® Interdisciplinary Training and Resource Center! With a primary mission of building bridges of information, resources, collaboration and training across family, educational, medical and community systems, we appreciate your partnership and look forward to future partnership.
As part of these efforts, we would appreciate feedback related to your experience with our Center. The following survey will take 6-7 minutes and your input is invaluable in improving systems, resources, and opportunities for individuals, families, providers, and communities. Upon completion of the survey, you will receive a confirmation email that can be used to document such survey completion along with a confirmation of any hours for which you were engaged in training, resource sharing, networking, or dissemination efforts. For questions, please contact Dr. Naomi Swiezy (nswiezy@iupui.edu), Dr. Tiffany Neal (nealtiff@iupui.edu) or call (317) 274-2675.
What date was the event?
* must provide value
Today M-D-Y
What is your first and last name?
* must provide value
What is your email address?
* must provide value
Was this the first time you have worked with the HANDS in Autism® Center?
* must provide value
Yes
No
How did you learn about the HANDS in Autism® Center?
Please specify which HANDS Social Media
In the past, what service(s), resource(s), or training(s) did you accessed from the HANDS in Autism® Center?
General request or question (e.g., phone, email or walk-in request or question)
HANDS in Autism® website materials (e.g., handouts, toolkits, etc.)
eLearning (e.g., modules, podcasts, webcasts, etc.)
HANDS in Autism® bookstore or informational materials distributed by mail, at a workshop or other community or Center event/activity
Observation of services, workshop or programming
Webinar or web-based presentation
Case or setting-specific consultation
Direct services or programming
Demonstration classroom or site
Conference
Next Steps™ workshop
Partial day workshop
Full day workshop
3-day workshop
5-day workshop
Workshop series (partial or full day workshops held across a period of time)
HANDS in Autism® social media
LCC event (meeting, call)
LCC regional summit
IIACC quarterly meeting
PLC event (steering committee meeting or call, review, module or group participation)
HANDS in Autism® Center Tour
Other (please specify)
What service(s), resource(s), or training(s) did you recently access from the HANDS in Autism® Center?
General request or question (e.g., phone, email or walk-in request or question)
HANDS in Autism® website materials (e.g., handouts, toolkits, etc.)
eLearning (e.g., modules, podcasts, webcasts, etc.)
HANDS in Autism® bookstore or informational materials distributed by mail, at a workshop or other community or Center event/activity
Observation of services, workshop or programming
Webinar or web-based presentation
Case or setting-specific consultation
Direct services or programming
Demonstration classroom or site
Conference
Next Steps™ workshop
Partial day workshop
Full day workshop
3-day workshop
5-day workshop
Workshop series (partial or full day workshops held across a period of time)
HANDS in Autism® social media
LCC event (meeting, call)
LCC regional summit
IIACC quarterly meeting
PLC event (steering committee meeting or call, review, module or group participation)
HANDS in Autism® Center Tour
Other (please specify)
Please further specify name of recently accessed services/resources/training
Which eLearning Module did you complete?
In what way did you access the service or resource through the HANDS in Autism® Center?
How did you hear about the service, resource, or training opportunity?
Please specify which Social Media platform informed you of the service, resource, or training
During your most recent experience with the HANDS in Autism® Center, what HANDS staff member(s) were involved?
Please specify the HANDS staff member or volunteer name
Name one or two ideas that you HAVE applied or WILL apply as a result of participating in or accessing this service.
What additional/related topics would interest you?
What suggestions or recommendations do you have for improving this and future services?
Have you shared HANDS in Autism® resources or information with others in the past?
Yes, frequently
Yes, sometimes
Yes, once
No, but I intend to do so
No
Which of the following best describes your primary role?
* must provide value
How would you describe your family role?
Biological parent
Adoptive parent
Foster parent
Grandparent
Legal Guardian
Sibling
Other family member (please specify)
Primary role for school personnel
Special education teacher
General education teacher
School psychologist
Consultant (e.g., autism consultant, behavioral consultant)
Related service personnel (e.g., occupational therapist, physical therapist, speech language pathologist)
Paraprofessional
School Nurse
Support Staff (e.g., bus driver, cafeteria staff)
Building -level administrator (e.g., principal, assistant principal, guidance counselor)
District -level administrator (e.g., special education director, superintendent)
University Personnel
Other (please specify)
Primary medical provider role
Pediatrician
Developmental Pediatrician
General Practitioner/Family Physician
Psychiatrist
Therapist (e.g., psychologist, social worker)
Specialist (e.g., dentist, optometrist)
Neurologist
Geneticist
Nurse/nurse practitioner
Lab technician
Resident
Medical student
EMS Personnel
Other (please specify)
What is your primary justice system role?
Emergency Medical Professional
Police Officer
Deputy/Sheriff
Fire Fighter
Prosecutor
Public Defender
Parole/Probation Officer
Lawyer
Judge
Other (please specify)
What is your primary community role?
ABA/ Behavior Consultants
Therapist (ST, OT, PT, DT)
Respite Provider
Day Care Provider
Residential / Day Program Personnel
Social Worker/ Counselor
Caseworker
University Professor
Psychologist
Other (please specify)
How long have you been in your primary role?
0 - 4 years
5 - 9 years
10 - 14 years
15 - 20 years
More than 20 years
What is the age group of individuals you work with in your primary role?
Which best describes your primary setting?
Public School
Private School
Charter School
Medical/Therapist Office
Family/Home
Outpatient Clinic
Residential Facility
Day Treatment Facility
Group Home
Hospital
University
Other (please specify)
General Education Classroom
Resource Classroom
Self-Contained Classroom
Other (please specify)
Please indicate any other roles you currently serve or have served in the past
How would you describe your family role?
Biological parent
Adoptive parent
Foster parent
Grandparent
Legal Guardian
Sibling
Other family member (please specify)
Primary role for school personnel
Special education teacher
General education teacher
School psychologist
Consultant (e.g., autism consultant, behavioral consultant)
Related service personnel (e.g., occupational therapist, physical therapist, speech language pathologist)
Paraprofessional
School Nurse
Support Staff (e.g., bus driver, cafeteria staff)
Building -level administrator (e.g., principal, assistant principal, guidance counselor)
District -level administrator (e.g., special education director, superintendent)
University Personnel
Other (please specify)
Primary medical provider role
Pediatrician
Developmental Pediatrician
General Practitioner/Family Physician
Psychiatrist
Therapist (e.g., psychologist, social worker)
Specialist (e.g., dentist, optometrist)
Neurologist
Geneticist
Nurse/nurse practitioner
Lab technician
Resident
Medical student
EMS Personnel
Other (please specify)
What is your primary justice system role?
Emergency Medical Professional
Police Officer
Deputy/Sheriff
Fire Fighter
Prosecutor
Public Defender
Parole/Probation Officer
Lawyer
Judge
Other (please specify)
What is your secondary community role?
ABA/ Behavior Consultants
Therapist (ST, OT, PT, DT)
Respite Provider
Day Care Provider
Residential / Day Program Personnel
Social Worker/ Counselor
Caseworker
University Professor
Psychologist
Other (please specify)
Which best describes your ethnicity? (Select all that apply)
Please specify ethnicity:
In what geographical region of the state do you reside?
Northwest
Northeast
North Central
Central
East
Southeast
Southwest
South Central
Outside Indiana
Which best describes your residence locale?
Rural (in the country, < 1,000 persons per sq. mile)
Suburban (1,000 - 3,000 persons per sq. mile)
Urban (in the city, 3,000 persons per sq. mile)
In what geographical region of the state do you work? (select all that apply)
Which best describes your employment locale?
Rural (in the country, < 1,000 persons per sq. mile)
Suburban (1,000 - 3,000 persons per sq. mile)
Urban (in the city, 3,000 persons per sq. mile)
Thank you for taking the time to respond to our survey! While each question and response are of great value to our efforts ongoing, we would truly appreciate it if you could take a moment to share about your memories and/or experience as you reflect upon ways you have engaged with HANDS in Autism® resources, trainings and team members.
Please reflect and share about your experience with HANDS in Autism® services, resources, or interactions.
Please indicate your email address If you would be willing to be contacted by a HANDS in Autism® team member to share more about your experience in the future.