Behaviour Support Survey Phase Change 1-2 Behaviour Support Survey Phase Change 1-2 Name of Child Name of those who filled out this survey/were present when survey was filled out Relationship to Child If possible, did the child assist with filling out this survey? Yes No 1. Do you feel that the plan is written in a way that respects the child and their needs? Yes No Comments 2. Do you feel that the plan is written in a way that reflects cultural and family values while considering the family’s current situation? Yes No Comments 3. Has this plan been clearly communicated to you? Yes No Comments 4. Do you feel that with a high level of training and support, you can implement this plan? Yes No Comments 5. Are you able to commit the time necessary into receiving coaching and implementing the plan? Yes No Comments Submit If you are human, leave this field blank. Δ
