IPV FAIR Client Satisfaction Survey

Name*

First Last

Date*

Please help us improve our program by answering some questions about the services you have received. We are interested in your honest opinion, whether they are positive or negative. Please answer all of the questions. We also welcome your comments and suggestions. Thank you very much, we really appreciate your help

What is your sex?*

Female
Male

1. How would you rate the quality of service you received from your clinician?*

Excellent
Good
Fair
Poor

2. How would you rate the quality of service you received from your Family Navigator?*

3. To what extent has this program met your needs?*

Almost all
Most
A few
None

4. To what extent has this program met your child(ren)'s needs?*

Almost all
Most
A few
None
Child(ren) did not meet with Navigator or Clinician

5. Have you noticed any positive changes in your child(ren)'s behavior as a result of this program?*

Definitely yes
Mostly yes
Unsure
Mostly not
Definitely not
My child(ren) did not partcipate

6. To what extent has this program met your partner's needs?*

7. Have you noticed any positive changes in your partner's behavior as a result of this program?*

Definitely yes
Mostly yes
Unsure
Mostly not
Definitely not
My partner did not participate

8. How satisfied are you with the amount of help you received?*

Very satisfied
Mostly satisfied
Mildly dissatisfied
Quite dissastisfied

9. Have the services you received helped you to deal more effectively with your concerns/problems?*

Helped a great deal
Helped somewhat
Really didn’t help
Seemed to make things worse

10. If a friend or family member needed help, would you recommend the program?*

11. If you were to seek or need help again, would you come back to the program?*

12. How did you feel about the length of the program?*

Way too short
A little too short
Just right
A little too long
Way too long

How helpful were the following aspects of the progam:

1. Individual sessions with my therapist*

Very helpful
Helpful
Neither helpful or unhelpful
Unhelpful
Very unhelpful
Not applicable or part of my treatment

2. Help from the Family Navigator*

Very helpful
Helpful
Neither helpful or unhelpful
Unhelpful
Very unhelpful
Not applicable or not part of my treatment

3.Getting connected to another service/program for myself or my child(ren)*

Very helpful
Helpful
Neither helpful or unhelpful
Unhelpful
Very unhelpful
Not applicable or not part of my treatment

4. Developing a safety plan for me and my family*

Very helpful
Helpful
neither helpful or unhelpful
Unhelpful
Very unhelpful
Not applicable or not part of my treatment

5. Talking about my parents/family background with my therapist*

Very helpful
Helpful
Neither helpful or unhelpful
Unhelpful
Very unhelpful
Not applicable or not part of my treatment

6. Discussing my role as a parent*

Very helpful
Helpful
Neither helpful or unhelpful
Unhelpful
Very unhelpful
Not applicable or not part of my treatment

7. Practicing communication skills*

Very helpful
Helpful
Neither helpful or unhelpful
Unhelpful
Very unhelpful
Not applicable or not part of my treatment

8. learning relaxation/coping strategies*

Very helpful
Helpful
Neither helpful or unhelpful
Unhelpful
Very unhelpful
Not applicable or not part of my treatment

9. Identifying my triggers and how to handle them*

Very helpful
Helpful
Neither helpful or unhelpful
Unhelpful
Very unhelpful
Not applicable or not part of my treatment

10. Reducing my aggression/conflict with partner*

Very helpful
Helpful
Neither helpful or unhelpful
Unhelpful
Very unhelpful
Not applicable or not part of my treatment

11. Providing me with parenting skills*

Very helpful
Helpful
Neither helpful or unhelpful
Unhelpful
Very unhelpful
Not applicable or not part of my treatment

12. Helping me to understand my child(ren)*

Very helpful
Helpful
Neither helpful or unhelpful
Unhelpful
Very unhelpful
Not applicable or not part of my treatment

13. Helping me to communicate with my coparent*

Very helpful
Helpful
Neither helpful or unhelpful
Unhelpful
Very unhelpful
Not applicable or not part of my treatment

14. Improving my relationship with my children*

Very helpful
Helpful
Neither helpful or unhelpful
Unhelpful
Very unhelpful
Not applicable or not part of my treatment

In your words, please tell us what you liked most about the program.

In your words, please tell us what you liked least about the program?

Do you have any suggestions for how to improve the program?

Forms – IPV-FAIR Satisfaction Survey

IPV FAIR Client Satisfaction Survey (rev 20200616)

IPV FAIR Client Satisfaction Survey

How helpful were the following aspects of the progam: