What is the year during which you are completing this survey?
In which Indiana county do you live?
Adams Allen Bartholomew Benton Blackford Boone Brown Carroll Cass Clark Clay Clinton Crawford Daviess Dearborn Decatur De Kalb Delaware Dubois Elkhart Fayette Floyd Fountain Franklin Fulton Gibson Grant Greene Hamilton Hancock Harrison Hendricks Henry Howard Huntington Jackson Jasper Jay Jefferson Jennings Johnson Knox Kosciusko LaGrange LaPorte Lake Lawrence Madison Marion Marshall Martin Miami Monroe Montgomery Morgan Newton Noble Ohio Orange Owen Parke Perry Pike Porter Posey Pulaski Putnam Randolph Ripley Rush Scott Shelby Spencer St. Joseph Starke Steuben Sullivan Switzerland Tippecanoe Tipton Union Vanderburgh Vermillion Vigo Wabash Warren Warrick Washington Wayne Wells White Whitley
Primary Role:
* must provide value
School personnel
Medical professional
Family Member
Individual with Autism Spectrum Disorder (ASD) over 18
Justice System Personnel
Community Provider
Other (please specify)
If you chose "other", please specify your role
Do you have an additional role in regards to working with individuals with ASD?
School personnel
Medical professional
Family Member
Individual with Autism Spectrum Disorder (ASD) over 18
Justice System Personnel
Community Provider
Other (please specify)
N/A
If you chose "other", please specify
In which Indiana county do you provide or access services?
Adams Allen Bartholomew Benton Blackford Boone Brown Carroll Cass Clark Clay Clinton Crawford Daviess Dearborn Decatur De Kalb Delaware Dubois Elkhart Fayette Floyd Fountain Franklin Fulton Gibson Grant Greene Hamilton Hancock Harrison Hendricks Henry Howard Huntington Jackson Jasper Jay Jefferson Jennings Johnson Knox Kosciusko LaGrange LaPorte Lake Lawrence Madison Marion Marshall Martin Miami Monroe Montgomery Morgan Newton Noble Ohio Orange Owen Parke Perry Pike Porter Posey Pulaski Putnam Randolph Ripley Rush Scott Shelby Spencer St. Joseph Starke Steuben Sullivan Switzerland Tippecanoe Tipton Union Vanderburgh Vermillion Vigo Wabash Warren Warrick Washington Wayne Wells White Whitley
How many years of experience do you have in your role?
What is your race/ethnicity? (Check all that apply)
If chose "other", please specify your race/ethnicity
What is your highest level of completed education?
No high school
Some high school
High school graduate / GED
Vocational/ Technical school
Some college
College degree
Some graduate studies
Graduate degree
Other (please specify)
N/A
If you chose "other", please specify your highest level of completed education
How would you describe your role?
Biological parent
Adoptive parent
Foster parent
Grandparent
Legal Guardian
Other family member (please specify)
N/A
Please specify your role.
Which of the following best describes your marital status?
Married to / Living with child's other parent
Married to / Living with person other than child's parent
Separated/ Divorced
Never been married
Widowed
Other
N/A
If you chose "other", please specify your marital status
Male
Female
Which of the following is close to your annual household income?
Under $20,0000 $20,000 - $39,000 $40,000 - $59,999 $60,000- $79,999 $80,000 - $99,999 $100,000 or above
What is the sex of the child with ASD in your household?
Male
Female
How old is/are the child(ren) with ASD in your household?
What is his/her ethnicity?
If you chose "other", please specify the race/ ethnicity of your child
How many siblings does he/she have?
0 1 2 3 4 +
How many total children do you have with a diagnosis of Autism Spectrum Disorder (ASD)?
0 1 2 3 4+
What is/are the child(ren) with ASD's primary medical diagnosis?
If you chose "other", please specify what is the child with ASD's primary diagnosis
How old was/were the child(ren) with ASD when he/she first received this medical diagnosis?
Do/Does the child(ren) with ASD CURRENTLY have any of the following medical diagnoses? (Check all that apply)
If you chose "other", please specify any current diagnosis the child with ASD has
Did the child(ren) with ASD receive any of the following medical diagnoses PRIOR to receiving his/ her autism diagnosis? (Check all that apply)
If you chose "other", please specify the child with ASD's diagnosis prior to autism diagnosis
Do/Does the child(ren) with ASD also have an educational classification of ASD?
Yes
No
Was the educational classification received prior to the medical diagnosis?
Yes
No
At any time have the educational classification and medical diagnosis of the child differed?
Yes
No
How old was/were the child(ren) with ASD when there was first concern about his/ her development?
What type of professional first provided a medical diagnosis of ASD to the child(ren) with ASD?
Developmental Pediatrician
Neurologist
Primary Care Physician (Family Physician/ Pediatrician)
Psychiatrist
Psychologist
Other, please specify
N/A
If you chose "other", please specify which professional fist diagnosed the child with autism
How many miles did you travel for evaluation to receive the initial medical diagnosis (round trip)?
0-20 miles
21-40 miles
41-60 miles
61-80 miles
81-100 miles
More than 100 miles
How many professionals (e.g., psychologist, developmental pediatrician) did you visit and from what specialties were these professionals practicing before your child(ren) with ASD received an autism medical diagnosis?
After receiving a medical diagnosis, what form of follow-up and resources/ services did you receive? (Check all that apply)
If you chose "other", what follow-up or resources did you receive?
How do you pay for the child(ren) with ASD's behavioral or psychiatric health care services? (Check all that apply)
If you chose "other", please specify how you pay for the child with ASD's health care services
Have you taken the child(ren) with ASD to the emergency room for behavioral or psychiatric reasons in the past year?
Yes
No
If yes, on how many occasions?
In the past year, has the child with ASD been admitted to a hospital or hospital-like setting for behavioral or psychiatric reasons?
Yes
No
If yes, on how many occasions?
What was/were the reason(s) the child with ASD in your was admitted to a hospital or hospital-like setting? (Check all that apply)
If you chose "other", please specify what were the reasons your child was admitted?
How was the child with ASD admitted?
My child (under 14) was admitted by his/her caregivers
My adolescent child (14-18) was admitted by his/her parents and agreed to this admission
My adolescent child (14-18) was admitted by his/her parents and did not agree to the admission
My adult child (18 or older) admitted him/herself (201, voluntary treatment)
My adult child (18, or older) was admitted against his/her will (302, involuntary treatment)
What is the child with ASD's current living situation?
With parent(s) in a family home
with other relative(s) in a family home
Residential facility
Group home
Lives on own with support
Lives on own without support
How satisfied or dissatisfied are you with the child with ASD's current living arrangement?
Very Satisfied
Satisfied
Dissatisfied,
Very Dissatisfied
What is the child with ASD's current employment status?
Employed, full time
Employed, part time
Not employed, but looking for employment
Not employed
Other
N/A
If you chose "other", please specify
How has the child with ASD looked for employment services? (Check all that apply)
If you chose "other", please specify
Does the child with ASD have an IEP (Individualized Learning Education Plan) or equivalent?
Yes
No
How strongly do you agree or disagree with the following statement: "My child's IEP (or equivalent) addresses all of my concerns for my child's development and education"
Strongly Agree Agree Disagree Strongly Disagree
Does the child with ASD have a Behavior Intervention Support Plan?
Yes
No
In the last year, has the child with ASD been disciplined at school in any of the following ways?
Has the child with ASD's behavior resulted in any of the following interactions with the police? (Check all that apply)
What long-term plans do you have for the child with ASD when you are no longer able to care for them?
If you chose "other", what are your long-term plans
Functional Skills (e.g., communication skills, social skills, play/leisure activities)
Daily Living (e.g., hygiene, sleeping, feeding, dressing, toilet)
Problem Behaviors (e.g., aggression, disruptive behavior, running away, self-injury)
Obsessive- Compulsive Behaviors
What limitations do you face accessing primary health care? (Check all that apply)
If you chose "other", please specify what limitations you face accessing primary health care
What limitations do you face accessing dental services? (Check all that apply)
If you chose "other", please specify where you face limitations accessing dental services
What limitations do you face accessing mental health services? (Check all that apply)
If you chose "other", please specify where you face limitations accessing mental health services
What limitations do you face accessing specialty care (e.g., therapies, interventions)? (Check all that apply)
If you chose "other", please specify where you face limitations accessing specialty care (e.g., therapies, interventions).
What limitations do you face accessing the specialty health and education services mentioned? (Check all that apply)
If you chose "other", please specify what limitations you face accessing the specialty health and education services mentioned
What limitations do you face accessing the family support services mentioned? (Check all that apply)
If you chose "other", please specify what limitations you face accessing the family support services mentioned
Where do you typically obtain most informative resources/materials (e.g., publications, handouts, brochures) about ASD/DD?
National Conferences
State Conferences
General Disability Support Networks (e.g., The Arc of Indiana, About Special Kids, IN*SOURCE, )
Autism Support Services (e.g., HANDS in Autism, Autism Society of Indiana, Indiana Resource Center for Autism)
Schools
Medical professionals
Other providers (e.g., therapists, consultants)
Other parents
Support groups
Professional Literature
Lay literature (i.e., books, magazines)
Internet
TV
Other
N/A
Please specify where you receive those resources/materials.
Where do you typically obtain training (e.g., workshops, inservices, web modules) about ASD/DD?
National Conferences
State Conferences
General Disability Support Networks (e.g., The Arc of Indiana, About Special Kids, IN*SOURCE, )
Autism Support Services (e.g., HANDS in Autism, Autism Society of Indiana, Indiana Resource Center for Autism)
Schools
Medical professionals
Other providers (e.g., therapists, consultants)
Other parents
Support groups
Professional Literature
Lay literature (i.e., books, magazines)
Internet
TV
Other
N/A
Please specify where you typically obtain other training.
If you selected "Other", what other types of training/professional development do you prefer?
Northwest Northeast North Central East Central Southwest Southeast
Indiana School District(s)
Primary role for school personnel (check all that apply)
Special education teacher
General education teacher
School psychologist
Consultant (e.g., autism consultant, behavioral consultant)
Related service personnel (e.g., occupational therapist, physical therapist, speech language pathologist)
Paraprofessional
School Nurse
Support Staff (e.g., bus drivers, cafeteria staff)
Building -level administrator (e.g., principal, assistant principal, guidance counselor)
District -level administrator (e.g., special education director, superintendent)
University Personnel
Other, please specify
N/A
Please specify your role.
School level (check all that apply)
Public School
Private School
Charter School
Residential School
Day Program
University
Commuter- Campus
Other, please specify
N/A
If you chose "other", please specify
What percentage of the students you interact with have ASD?
0-20%
21-40%
41-60%
61-80%
81-100%
Type of educational setting you work most with these students
If other, please specify educational setting
How often do you interact with students with ASD?
In which setting do you experience the most challenge with students
What challenges do you face when interacting with individuals with ASD? (check all that apply)
If you chose "other", please specify
Where do you typically obtain information resources/materials (e.g., publications, handouts, brochures) about ASD? (check all that apply)
National Conferences
State Conferences
General Disability Support Networks (e.g., The Arc of Indiana, About Special Kids, IN*SOURCE,)
Autism Support Services (e.g., HANDS in Autism, Autism Society of Indiana, Indiana Resource Center for Autism)
Outside Consultants (e.g., STAR, Ziggurat, Positive Behavior Supports consultants)
Local District(s)' Autism Teams / Autism Consultants
Professional Literature
Lay literature (i.e., books, magazines)
Parents
Internet
TV
Schools
Indiana Resource Network Centers
Medical Professionals
Other providers (e.g., therapists, consultants)
Other, please specify
N/A
Please specify where you typically obtain your other resources/materials.
Where do you typically obtain training (e.g., workshops, in-services, web-based modules) about ASD? (Check all that apply).
National Conferences
State Conferences
General Disability Support Networks (e.g., The Arc of Indiana, About Special Kids, IN*SOURCE)
Autism Support Services (e.g., HANDS in Autism, Autism Society of Indiana, Indiana Resource Center for Autism)
Outside Consultants (e.g., STAR, Ziggurat, PBS consultants)
Local District(s)' Autism Teams / Autism Consultants
Parents
Internet
TV
Schools
Support Groups
Indiana Resource Network Centers
Medical Professionals
Professional Literature
Lay Literature e.g., books, magazines)
Other providers (therapists, consultants)
Other, please specify
N/A
If you chose "other", please specify.
Where does your district and school personnel typically obtain interactive professional development (e.g., workshops, in-services, web modules) regarding ASD? (check all that apply)
National Conferences
State Conferences
General Disability Support Networks (e.g., The Arc of Indiana, About Special Kids, IN*SOURCE)
Autism Support Services (e.g., HANDS in Autism, Autism Society of Indiana, Indiana Resource Center for Autism)
Outside Consultants (e.g., STAR, Ziggurat, PBS consultants)
Local District(s)' Autism Teams / Autism Consultants
Parents
Internet
TV
Schools
Professional Literature
Lay Literature (e.g., books, magazines)
Medical Professionals
Other providers (e.g., therapists, consultants)
Teacher
Other, please specify
N/A
Please specify where your district and school personnel typically obtain interactive professional development.
What school personnel within your school/district(s) do you provide with opportunities for professional development in the area of ASD? (check all that apply)
Special education teacher
General education teacher
School psychologist
Consultant (e.g., autism consultant, behavioral consultant)
Related service personnel (e.g., occupational therapist, physical therapist, speech language pathologist)
Paraprofessional
Support Staff (e.g., bus drivers, cafeteria staff)
Building-level administrator (e.g., principal, assistant principal, guidance counselor)
District-level administrator (e.g., special education director, superintendent)
Other, please specify
N/A
What other school personnel do you intend on providing with opportunities for professional development in the area of ASD?
If you selected "Other" in the question above, what other types of training/professional development do you prefer?
What are the perceived barriers to training in your school or program? (Check all that apply)
If you chose "other", please specify perceived barriers
Are you familiar with the discipline policy for your school and/ or district?
Yes
No
How effective do you feel your discipline policies are?
Very Effective
Somewhat Effective
Makes No Difference
Somewhat Ineffective
Very Ineffective
How frequently are discipline policies reviewed within your school?
Often
Somewhat Often
Rarely
Never
I Don't Know
Do you have a positive or proactive strategies in place within your school?
Yes
No
I Don't Know
If yes, how effective are the positive or proactive strategies in place within your school?
Very Effective
Somewhat Effective
Makes No Difference
Somewhat Ineffective
Very Ineffective
Does your school have a school-wide positive behavior supports (SWPBS) in place?
Yes
No
I don't know
If yes, how effective are the school-wide positive behavior supports?
Very Effective
Somewhat Effective
Makes No Difference
Somewhat Ineffective
Very Ineffective
Does you have an active Response to Instruction (Rtl) process in place within your school?
Yes
No
I Don't Know
If yes, how effective is the Response to Instruction? (RtI)
Very Effective
Somewhat Effective
Makes No Difference
Somewhat Ineffective
Very Ineffective
Do you have a positive or proactive strategies in lace within your organization?
Yes
No
I Don't Know
Pediatrician
Developmental Pediatricians
General Practitioner/Family Physician
Psychiatrist
Therapist (e.g., psychologist, social worker)
Specialist (e.g., dentist, optometrist)
Neurologists
Geneticist
Nurse/nurse practitioner
Lab technician
Resident
Medical student
EMS Personnel
Other, please specify
N/A
Please specify the type of role that you fill.
Percentage of patients with ASD:
None
0-20%
21-40%
41-60%
61-80%
81-100%
N/A
Where do you typically interact with patients with ASD? (Check all that apply)
If you chose "other", please specify where you typically interact with ASD patients
Where do you typically obtain information resource/materials (e.g., publications, handouts, brochures) about ASD? (check all that apply)
National Conferences
State Conferences
Professional associations
Previous academic training
General Disability Support Networks (e.g., The Arc of Indiana, About Special Kids, IN*SOURCE, )
Autism Support Services (e.g., HANDS in Autism, Autism Society of Indiana, Indiana Resource Center for Autism)
Schools
Other medical professionals
Other Providers (e.g.,therapists,consultants)
Service providers
Parents
Support groups
Internet
TV
Professional Literature
Lay literature (e.g., books, magazines)
Previous academic associations
Professional associations
Service providers
Other, please specify
N/A
Please specify where you obtain your other informative resources/materials about ASD.
Where do you typically obtain training (e.g., workshops, web-basede modules) about ASD? (check all that apply)
National Conferences
State Conferences
Professional associations
Previous academic training
General Disability Support Networks (e.g., The Arc of Indiana, About Special Kids, IN*SOURCE)
Autism Support Services (e.g., HANDS in Autism, Autism Society of Indiana, Indiana Resource Center for Autism)
Schools
Other medical professionals
Other providers (e.g., therapists, consultants)
Service providers
Parents
Support groups
Internet
TV
Professional Literature
Lay literature (e.g., books, magazines)
Previous academic associations
Professional associations
Service providers
Other, please specify
N/A
Please specify where you obtain other informative resources/materials about ASD.
If you selected "Other" above, what other types of training/professional development do you prefer?
Which of the following best describes your current marital status?
Married
Separated/ Divorced
Never been married
Widowed
N/A
Do you have any children?
Yes
No, but planning on having them
No, undecided
No, and I don't want children
Which of the following is closest to your annual household income?
Under $20,000 $20,000- $39,999 $40,000- $59.999 $60,000- $79,999 $80,000- $99,999 $100,000 or above
Are you currently in school?
Yes, high school
Yes, two year school
Yes, four year school
Yes, graduate school
Vocational/technical school
No, but I would like to be
No
What is the status of your enrollment?
Full time
Part time
Are you aware of assistance and/or resources for individuals with disabilities at your school?
Yes, but I don't use them
Yes, and I do use them
No
Have you been identified in your school as needing accommodations (e.g., tutoring, monitoring, special housing, counseling)?
Yes
No
I don't know
What are your plans after graduation?
Continue education
Look for full-time employment
Look for part-time employment
I don't know
Are you currently employed?
Yes, full-time
Yes, part-time
No, but currently looking for a job
No, I am retired
No
Which of the following have you used/do use to look for employment? (Check all that apply)
If you chose "other", how have you looked for employment?
Compared to peers in the work force, do you feel discriminated against in any of the following ways? (Check all that apply)
If you chose "other", please specify
Are the employees that you work with aware of your autism?
What is your current living situation?
Independently, alone
Independently, with roommates
On own with support
With parents or other relatives
In a residential facility
In a group home
How satisfied are you with your living arrangement?
Very Satisfied
Satisfied
Dissatisfied
Very Dissatisfied
How do you travel for work, school, or other activities?
Drive myself or use public transportation on my own
Depend on family member or friend for support
Use transportation provided by school or work
Other, please specify
N/A
If you chose "other", how do you travel for work, school, or other activities?
What is/was your primary medical diagnosis?
Autism Spectrum Disorder (ASD)
Asperger's Disorder
Autistic Disorder/ Autism
Childhood Disintegrative Disorder
Pervasive Development Disorder, not otherwise specified (PDD/NOS)
Rhett's Syndrome
Other, please specify
N/A
If you chose "other", please specify
Have you also been diagnosed with or treated with any of the following? (Check all that apply)
If you chose "other", please specify
What limitations do you face accessing the specialty health and education services mentioned? (Check all that apply)
If you chose "other", please specify
How are these services paid for? (Check all that apply)
If you chose "other", please specify
In the past year, have you gone to the hospital or hospital-like setting for behavioral or psychiatric reasons?
Yes
No
What was/were the reasons you were admitted to the hospital/ hospital-like setting?
If you chose "other", please specify
I admitted myself (201, Voluntary Treatment)
I was admitted against my will (302, Involuntary Treatment
Have you had any of the following interactions with the police? (Check all that apply)
If you chose "other", please specify
What limitations do you face accessing primary health services? (Check all that apply)
If you chose "other", please specify
What limitations do you face accessing dental services? (Check all that apply)
If you chose "other", please specify
What limitations do you face accessing mental health services? (Check all that apply)
If you chose "other", please specify
What limitations do you face accessing specialty care (e.g., therapies, interventions)? (Check all that apply)
If you chose "other", please specify
What is your primary role?
Police Office
Fire Fighter
Prosecutor
Public Defender
Parole/ Probation Officer
Lawyer
Other, please specify
If you chose "other", please specify
Where do you typically obtain informative resource/materials (e.g., publications, handouts, brochures) about ASD? (check all that apply)
National Conferences
State Conferences
Professional associations
Previous academic training
General Disability Support Networks (e.g., The Arc of Indiana, About Special Kids, IN*SOURCE)
Autism Support Services (e.g., HANDS in Autism, Autism Society of Indiana, Indiana Resource Center for Autism)
Schools
Other medical professionals
Other providers (e.g., therapists,consultants)
Service providers
Parents
Support groups
Internet
TV
Professional Literature
Lay literature (e.g., books, magazines)
Previous academic associations
Professional associations
Service providers
Other, please specify
N/A
If you chose "other", please specify
Where do you typically obtain training (e.g., workshops, web modules) about ASD? (check all that apply)
National Conferences
State Conferences
Professional associations
Previous academic training
General Disability Support Networks (e.g., The Arc of Indiana, About Special Kids, IN*SOURCE)
Autism Support Services (e.g., HANDS in Autism, Autism Society of Indiana, Indiana Resource Center for Autism)
Schools
Other medical professionals
Other providers (e.g., therapists,consultants)
Service providers
Parents
Support groups
Internet
TV
Professional Literature
Lay literature (e.g., books, magazines)
Previous academic associations
Professional associations
Service providers
Other, please specify
N/A
If you chose "other", please specify
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