This is a survey about your experience changing to an adult approach to care. You may choose to answer this survey or not. Your responses to this survey are confidential. How often did your child’s health care provider explain Did your child’s health care provider actively work with things in a way that is easy to understand? your child to think about and plan for the future (e.g., Always take time to discuss future plans about education, Usually work, relationships, and development of independent Sometimes living skills)?* Never A lot Some How often did your child’s health care provider listen A little Not at all carefully to you? How often did your child schedule his or her own Always appointments with his or her health care provider? Usually Never Sometimes Sometimes Never Usually Always Does your child’s health care provider respect how your customs or beliefs affect your care? Did your child’s health care provider explain legal A lot changes in privacy, decision-making, and consent that Some take place at age 18? A little Yes Not at all No Did your child’s health care provider discuss with you Does your child’s health care provider actively work or have an office policy that explains changing to an with him or her to create a written plan to meet his or adult approach to care? her health goals and needs?* Yes Yes No No Did your child’s health care provider talk to your child Did your child’s health care provider create and share without you in the room? a medical summary with your child? Yes Yes No No Did your child’s health care provider actively work with Do you know how your child will be insured as he or your child to gain skills to manage his or her own she becomes an adult?* health and health care (e.g., know his or her Yes medications and their side effects, know what to do in No an emergency)?* A lot How could your child’s health care provider have Some made changing to an adult approach to care better for A little your child? Not at all
This is a survey about your experience changing to an adult approach to care. You may choose to answer this survey or not. Your responses to this survey are confidential. How often did your child’s health care provider explain things in a way that is easy to understand? Always Usually Sometimes Never How often did your child’s health care provider listen carefully to you? Always Usually Sometimes Never Does your child’s health care provider respect how your customs or beliefs affect your care? A lot Some A little Not at all Did your child’s health care provider discuss with you or have an office policy that explains changing to an adult approach to care? Yes No Did your child’s health care provider talk to your child without you in the room? Yes No Did your child’s health care provider actively work with your child to gain skills to manage his or her own health and health care (e.g., know his or her medications and their side effects, know what to do in an emergency)?* A lot Some A little Not at all Did your child’s health care provider actively work with your child to think about and plan for the future (e.g., take time to discuss future plans about education, work, relationships, and development of independent living skills)?* A lot Some A little Not at all How often did your child schedule his or her own appointments with his or her health care provider? Never Sometimes Usually Always Did your child’s health care provider explain legal changes in privacy, decision-making, and consent that take place at age 18? Yes No Does your child’s health care provider actively work with him or her to create a written plan to meet his or her health goals and needs?* Yes No Did your child’s health care provider create and share a medical summary with your child? Yes No Do you know how your child will be insured as he or she becomes an adult?* Yes No How could your child’s health care provider have made changing to an adult approach to care better for your child?
2YouthtoAdultApproachtoCareWithoutChangingProvidersPackage.docx