Behaviour Support Survey Phase Change 4-5 Behaviour Support Survey Phase Change 4-5 Name of child Name of those who filled out this survey/were present when this survey was filled out Relationship to child If possible, did the child assist with filling out this survey? Yes No 1. Have you noticed a positive behaviour change in the child? Yes No Comments 2. Do you feel that the initial behaviour goals have been met and maintained? Yes No Comments 3. Did this process respect the child and their needs? Yes No Comments 4. Do you feel that this plan helped support the child? Yes No Comments 5. Did the plan reflect the cultural and family values while considering the family’s situation? Yes No Comments 6. Do you feel that there has been an appropriate level of communication throughout this process? Yes No Comments 7. Do you feel that an appropriate level of coaching has been provided to help you support the child through this process? Yes No Comments 8. Are you able to continue running strategies that were learned through this process to support the child? Yes No Comments Submit If you are human, leave this field blank. Δ
