study on home-based intervention

[Guest guest]

Hello! My name is . I am a junior at Liberty University. I

am doing research on the effects of intensive home-based early

intervention on developmentally delayed children. Please take 5

minutes to complete the following survey and email it to me at

amreitz@... as soon as possible. Thank you for your help in

this exiting movement!

Child's diagnosed disability(ies) or at-risk condition:

Name of program/organization of early intervention your child is

involved in:

Hours per day your child is involved in intervention:

Hours of treatment carried out by family members:

By professionals:

By outside help (excluding professionals):

Your relationship to child (mother, father, etc.):

SES (high, middle, low):

Your age:

The age of your child:

Number of years your child has participated in a home based

intervention program:

Child's neurological (mental) age before beggining program (or IQ if

known):

Child's current neurological (mental) age (or IQ if known):

Was your child ever involved in another early intervention program

(not home based)?

Please rate the success of that program:

Has there been any other major family changes (besides the program)

that might have affected the child's developmental pattern?

Did you receive any parent training regarding early intervention?

Number of hours:

Number of books read on the subject:

Please rate your child (1-10) in the following areas BEFORE beggining

your home-based program:

age appropriateness

self-esteem

competency

sociability

curiosity

verbalization

alertness

health

activity level

Please rate your child (1-10) in the following areas since beggining

your home-based program:

age appropriateness

self-esteem

competency

sociability

curiosity

verbalization

alertness

health

activity level

Please rate your self (1-10) in the following areas BEFORE beggining

your home-based program:

confidence

sensitivity

self-esteem

relationship to child

Please rate your self (1-10) in the following areas since beggining

your home-based program:

confidence

sensitivity

self-esteem

relationship to child

Please do not provide names and EMAIL DIRECTLY TO

amreitz@.... Thank you!