Case Number
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Site Name:
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Primary Teacher
First Name
Last Name
Today's Date
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What was most helpful about working with the TCP?
Please share a brief story or example that illustrates how the TCP helped you, a child in your program, or a family.
In what ways could the TCP be improved?
I understood the steps involved in the intake process (Observation, Parent & Teacher interviews, ASQ screenings, PKBS-2 questionnaires)
I understood the steps involved in the intervention (Goal & Action Plan, Interventions, and Referrals)
The consultant worked collaboratively with our program to develop a Goal and Action plan
I was satisfied with how the consultant worked with me. (e.g., the consultant was respectful and efficient, etc.)
To what extent did your program implement the actions in the Goal and Action Plan?
If you indicated 1-3 above, please describe the reasons why you did not fully implement all the goals in the Goal and Action Plan. (e.g., not enough time, did not know how, child improved, etc.)
Participating in the TCP program helped strengthen my ability to work with children with behavioral, social-emotional, or developmental challenges
Our program will continue to use strategies from consultation in our ongoing work with children and families
The consultant worked effectively with the family
Since participating in TCP, our program now communicates more frequently with the child’s family about his/her progress
After participating in TCP, our program is able to communicate more effectively with the child’s family
The resources and referrals offered to our program were helpful
The resources and referrals offered to the family were helpful
I learned about resources and services in the community for families
Is there anything else that you would like to share about your experience with The Consultation Project?
Would you like any follow up to this survey?
For follow up, please let us know how best to contact you: Phone
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