Early Intervention Services Family Survey Maryland Infants and Toddlers Program

This survey is for families receiving early intervention services through the Maryland Infants and Toddlers Program (MITP). Your responses will help guide efforts to improve services through an Individualized Family Service Plan (IFSP) and results for Maryland’s children and families. You may skip any item that you feel does not apply to your family.

Section 1

  1. MY RELATIONSHIP TO THIS CHILD

  2. CHILD’S AGE WHEN FIRST REFERRED TO EARLY INTERVENTION

Impact of early intervention services on your family

  1. Over the past year, early intervention services have helped me and/or my family participate in typical activities for children and families in my community.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  2. Over the past year, early intervention services have helped me and/or my family know about services in the community.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  3. Over the past year, early intervention services have helped me and/or my family know where to go for support to meet my child's needs.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  4. Over the past year, early intervention services have helped me and/or my family know where to go for support to meet my family's needs.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  5. Over the past year, early intervention services have helped me and/or my family get the services that my child and family need.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  6. Over the past year, early intervention services have helped me and/or my family feel more confident in my skills as a parent.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  7. Over the past year, early intervention services have helped me and/or my family make changes in family routines that will benefit my child with special needs.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  8. Over the past year, early intervention services have helped me and/or my family be more effective in managing my child's behavior.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  9. Over the past year, early intervention services have helped me and/or my family do activities that are good for my child even in times of stress.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  10. Over the past year, early intervention services have helped me and/or my family feel that I can get the services and supports that my child and family need.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  11. Over the past year, early intervention services have helped me and/or my family understand how the early intervention system works.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  12. Over the past year, early intervention services have helped me and/or my family be able to evaluate how much progress my child is making.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  13. Over the past year, early intervention services have helped me and/or my family feel that my child will be accepted and welcomed in the community.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  14. Over the past year, early intervention services have helped me and/or my family feel that my family will be accepted and welcomed in the community.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  15. Over the past year, early intervention services have helped me and/or my family communicate more effectively with the people who work with my child and family.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  16. Over the past year, early intervention services have helped me and/or my family understand the roles of the people who work with my child and family.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  17. Over the past year, early intervention services have helped me and/or my family know about my child’s and family's rights concerning early intervention services.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  18. Over the past year, early intervention services have helped me and/or my family do things with and for my child that are good for my child's development.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  19. Over the past year, early intervention services have helped me and/or my family understand my child's special needs.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  20. Over the past year, early intervention services have helped me and/or my family feel that my efforts are helping my child.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  21. Over the past year, early intervention services have helped me and/or my family figure out solutions to problems as they come up.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  22. Over the past year, early intervention services have helped me and/or my family feel that I can handle the challenges of parenting a child with special needs.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree

Only complete the following questions if your child turned 3 years old before July 1, 2017 and your family continues to receive early intervention services through an Extended Individualized Family Service Plan (IFSP).

  1. Over the past year, early intervention services have helped me and/or my family understand my options in order to make the best choice for my child and family to continue services through an extended IFSP or move to services through an IEP.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree
  2. Over the past year, early intervention services have helped me and/or my family support my child to be ready for school by assisting me to teach my child pre‐reading activities (such as naming pictures) and pre‐math activities (such as sorting household items) during daily routines.

    Very Strongly Agree
    Strongly Agree
    Agree
    Disagree
    Strongly Disagree
    Very Strongly Disagree

Final Section

  1. County of service during 2016-2017 (Select the Maryland County that provided services for the most days if you lived in more than one County during 2016-2017):

  2. Child’s age as of June 30, 2017?

  3. What is your child’s gender?

  4. Is your child Hispanic/Latino?

  5. Select one or more races from the 5 racial groups listed below:

    American Indian or Alaskan Native
    Asian
    Black or African-American
    Native Hawaiian or Pacific Islander
    White
  6. Child’s eligibility determination:

Thank you for your participation!