YSS-F (rev 20201020) YSS-F rev 2020-10-20 Youth Services Survey for Families (YSS-F)Client name* First Last Client Date of Birth* MM slash DD slash YYYY Today's Date* MM slash DD slash YYYY Program* CGC FFT MDFT IICAPS Child First Please select the response that best reflects your level of satisfaction.1. Overall, I am satisfied with the services my child received.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 2. I helped to choose my child's services.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 3. I helped to choose my child's treatment goals.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 4. The people helping my child stuck with us no matter what.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 5. I felt my child had someone to talk to when he/she was troubled.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 6. I participated in my child's treatment.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 7. The services my child and/or family received were right for us.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 8. The location of services was convenient for us.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 9. Services were available at times that were convenient for us.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 10. My family got the help we wanted for my child.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 11. My family got as much help as we needed for my child.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 12. Staff treated me with respect.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 13. Staff respected my family's religious/spiritual beliefs.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 14. Staff spoke with me in a way that I understood.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 15. Staff were sensitive to my cultural/ethnic background.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 16. As a result of the services my child and/or family received, my child is better at handling daily life.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 17. As a result of the services my child and/or family received, my child gets along better with family members.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 18. As a result of the services my child and/or family received, my child gets along better with friends and other people.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 19. As a result of the services my child and/or family received, my child is doing better in school.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 20. As a result of the services my child and/or family received, my child is better able to cope when things go wrong.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 21. As a result of the services my child and/or family received, I am satisfied with our family life right now.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 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.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 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.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 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.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 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.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 26. As a result of the services my child and/or family received, I have people with whom I can do enjoyable things.* Strongly agree Agree Undecided Disagree Strongly disagree Refused 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?*
