Youth Services Survey for Families (YSS-F)

Client name*

First Last

Client Date of Birth*

Today's Date*

Program*

Please select the response that best reflects your level of satisfaction.

1. Overall, I am satisfied with the services my child received.*

2. I helped to choose my child's services.*

3. I helped to choose my child's treatment goals.*

4. The people helping my child stuck with us no matter what.*

5. I felt my child had someone to talk to when he/she was troubled.*

6. I participated in my child's treatment.*

7. The services my child and/or family received were right for us.*

8. The location of services was convenient for us.*

9. Services were available at times that were convenient for us.*

10. My family got the help we wanted for my child.*

11. My family got as much help as we needed for my child.*

12. Staff treated me with respect.*

13. Staff respected my family's religious/spiritual beliefs.*

14. Staff spoke with me in a way that I understood.*

15. Staff were sensitive to my cultural/ethnic background.*

16. As a result of the services my child and/or family received, my child is better at handling daily life.*

17. As a result of the services my child and/or family received, my child gets along better with family members.*

18. As a result of the services my child and/or family received, my child gets along better with friends and other people.*

19. As a result of the services my child and/or family received, my child is doing better in school.*

20. As a result of the services my child and/or family received, my child is better able to cope when things go wrong.*

21. As a result of the services my child and/or family received, I am satisfied with our family life right now.*

22. As a result of the services my child and/or family received, my child is better able to do things he or she wants to do.*

23. As a result of the services my child and/or family received, I know people who will listen and understand me when I need to talk.*

24. As a result of the services my child and/or family received, I have people that I am comfortable talking with about my child's problems.*

25. As a result of the services my child and/or family received, in a crisis I would have the support I need from family or friends.*

26. As a result of the services my child and/or family received, I have people with whom I can do enjoyable things.*

27. What has been the most helpful thing about the services you and your child received over the last six months?*

28. What would improve the services here?*