Survey for Delivery of Special Services and Mental Health Services to our Children and Families

Name    
Job Location     A.M. Brooks Bachman Burbank Clifton EHS Lakewest EHS Pleasant Grove East Dallas East Triad Office Emanuel Lutheran Ferguson Oates Gannon Grand Prairie Home Base Horace Landauer Irving I. Bock Jerry Junkins Kinkeade Lake June Lakewest Lancaster-Kiest Margaret H. Cone Martin Luther King,Jr. Mesquite Mi Escuelita, Anita Martinez Mi Escuelita, Cockrell Hill Mi Escuelita, Crossover Nolan Estes Oak Cliff Pearl C. Anderson Pierce Rosie M. Harris Science Place II Socorro Gonzales South Triad Office Sunnyview Walnut Plaza Wesley-Rankin West Garland West Triad Office

1    Number of clients served in your Center over the last two months by Special Services/Mental provider or SS/MH referral source?

2.A.    Estimate of the average amount of time, per week, the Mental Health Professional spent in your Center over the last two months.

  4 hours or less     5 - 8 hours     9 - 12 hours     13 - 16 hours     17 or more

2.B.    Rate the level of professional communication skills of the Mental Health Professional serving your Center with Children

  Very Poor      Poor       Fair       Good       Excellent 

2.C.    Rate the level of professional communication skills of the Mental Health Professional serving your Center with Parents

  Very Poor      Poor       Fair       Good       Excellent 

2.D.    Rate the level of professional communication skills of the Mental Health Professional serving your Center with Staff

  Very Poor      Poor       Fair       Good       Excellent 

2.E.    Rate the effectiveness of the Mental Health Professional at your Center

  Very Poor      Poor       Fair       Good       Excellent      No Idea  

3.A.    Estimate of the average amount of time, per week, the Special Education Coordinator spent in your Center over the last two months.

  4 hours or less     5 - 8 hours     9 - 12 hours     13 - 16 hours     17 or more

3.B.    Rate the level of professional communication skills of the Special Education Coordinator serving your Center with Children

  Very Poor      Poor       Fair       Good       Excellent 

3.C.    Rate the level of professional communication skills of the Special Education Coordinator serving your Center with Parents

  Very Poor      Poor       Fair       Good       Excellent 

3.D.    Rate the level of professional communication skills of the Special Education Coordinator serving your Center with Parents

  Very Poor      Poor       Fair       Good       Excellent 

3.E.    Rate the effectiveness of the Special Education Coordinator at your Center

  Very Poor      Poor       Fair       Good       Excellent      No Idea  

4.A.    Estimate of the average amount of time, per week, the Psychologist Associate spent in your Center over the last two months.

  4 hours or less     5 - 8 hours     9 - 12 hours     13 - 16 hours     17 or more

4.B.    Rate the level of professional communication skills of the Psychologist Associate serving your Center with Children

  Very Poor      Poor       Fair       Good       Excellent 

4.C.    Rate the level of professional communication skills of the Psychologist Associate serving your Center with Parents

  Very Poor      Poor       Fair       Good       Excellent 

4.D.    Rate the level of professional communication skills of the Psychologist Associate serving your Center with Staff

  Very Poor      Poor       Fair       Good       Excellent 

4.E.    Rate the effectiveness of the Psychologist Associate at your Center

  Very Poor      Poor       Fair       Good       Excellent      No Idea  

5.    How many children at your center are receiving direct services from the local I,S.D.?

   1   2   3   4   5  or more

6.    How many children at your center are receiving direct services from a HSGD contracted service provider?

   1   2   3   4   5  or more

7.    How many children at your center are receiving direct services from a HSGD SS/MH staff person?

   1   2   3   4   5 or more 

8.    How many children in your Center who should be receiving services from SS/MH staff or service provider are non-English speaking?

   1   2   3   4   5  or more

9.    How would you rate your training or knowledge base to supervise the SS/MH staff who work in your Center?

  Very Poor      Poor       Fair       Good       Excellent 

In terms of HEAD START of Greater Dallas, Inc. providing the best possible services to special needs children and their families, what specific suggestions do you have?

Thank you for your input.