Parenting with a Disability
Resources and Services Survey

Through the Looking Glass and its National Resource Center for Parents with Disabilities is conducting this survey to locate possible resources and services for parents with disabilities or deafness and their children. We are surveying individuals as well as both disability-agencies and parenting/family-agencies. Potential resources will be contacted and interviewed for more detailed information. Through the Looking Glass will compile and then publish a searchable database of resources on our website, www.lookingglass.org.

Please fill out this brief survey about your agency/organization or about an agency/organization that you have personally used and wish to share with Through the Looking Glass.If you would prefer to print out the survey form and fill it in by hand, please download our Adobe Acrobat resource survey form.

Parenting Resource Survey.PDF

Resource Survey Online Form

Information About You
Your Name (required)

Please check the boxes below as they describe you.
Staff at Resource
Parent with a Disability or Deafness

Resource Contact Information
Name of Resource (required)
Mailing Address
City State/Province ZIP/Postal code
Country
Website (omit "http://")
E-mail
Phone Fax

1. Which ethnicities does this Resource serve?
Caucasian
African American
Latino/Hispanic
Asian - Specify Asian ethnicity:
Native American/Alaskan Native
Pacific Islander
Don't Know

2. Which age-ranges does this Resource serve?
Infants & Toddlers (0-3 years)
Preschool (3-5 years)
School Age (6-11 years)
Adolescents (12-18 years)
18 years and Over
All Ages
Don't Know

3. Who does this Resource serve?
Children Only
Parents/Adults Only
Grandparents/seniors Only
Whole Family (parents and children together)
Don't Know

4. How many total clients does this Resource serve annually, on average?

5a. Which Disabilities of Adults, if any, does this Resource serve?

Physical
Emotional/Psychiatric
Spinal Cord Injury
Medical
Multiple Sclerosis
Deaf/Hard of Hearing
Blind/Visually Impaired
Cerebral Palsy
Traumatic Brain Injury
Learning
Developmental/Intellectual
Autistic Spectrum Disorder
Don't Know

5b. Which Disabilities of Children, if any, does this Resource serve?

Physical
Emotional/Psychiatric
Spinal Cord Injury
Medical
Multiple Sclerosis
Deaf/Hard of Hearing
Blind/Visually Impaired
Cerebral Palsy
Traumatic Brain Injury
Learning
Developmental/Intellectual
Autistic Spectrum Disorder
Don't Know

6. Which geographic areas does this Resource serve?
(check or specify all that apply)

San Francisco Bay Area CountiesAll Bay Area Counties
Alameda
Contra Costa
Marin
Santa Clara
San Mateo
San Francisco
Solano
Sonoma

City-wide only (specify)
County-wide only (specify)
State-wide only (specify)
Regional (specify)
All of U.S.
International (specify countries)
Don't Know

7. Does this Resource provide materials/services in languages other than English?
Yes - Specify other Languages:
No
Don't Know

8. Which types of services does this Resource provide? (check all that apply)

Adoption
Advocacy
ASL Interpreting
Assistive Technology
Breastfeeding/lactation
Case Management
Center-Based
Childcare
Child Developmental Assessment/Intervention
Child Protective Services
Counseling
Crisis Intervention
Custody
Developmental Guidance
Domestic Violence
Early Intervention
Emergency Services
Education
Employment
Equipment Vendor
Fabricator
Family Support
Fathering
Foster Care
Head Start
Health Care
Home-Based
Homelessness
Home modifications/ramps
Housing
Independent Living Center
Information & Referral

Legal
Library
Media
Medical
Mental Health
Mothering
Multi-Cultural
Nutrition/WIC
OT/PT
Parent Network
Parenting Classes
Parenting Evaluation
Parenting with a Disability
Perinatal
Peer Counseling
Personal Attendant
Policy
Pregnancy & Birthing
Public Health Nursing
Recreation
Rehabilitation
Research
Respite Care
Social Services
Special Education
Substance Abuse
Support Groups
Transportation
Tutoring
Don't Know
Other

9. Does this Resource provide services to low-income individuals/families?
Yes
No
Don't Know

10. Does this Resource provide specialized services for Parents with Disabilities or Deafness?
(check all that apply)
Parent Support Groups
Parenting Adaptations - Specify types of parenting adaptations:
Parent-Child Early Intervention
Parenting Evaluations
Other - Describe other specialized services:
Don't Know

11. How many Parents with Disabilities or Deafness does this Resource serve annually?

12. How many Parents with Disabilities who are raising Children with Disabilities does this Resource serve annually?

13. In which ways is this Resource accessible to people with disabilities or deafness?
(check all that apply)
Wheelchair Accessible
Braille Signage
Materials in Alternate Formats
Braille
Large Print
Disk
ASL Interpreters
ASL Fluent Staff
Other Adaptations - Specify other Adaptations:
Don't Know

14. Is this Resource located near accessible Public Transportation?
Yes
No
Don't Know

15. Does this Resource provide Home-Based Services?
Yes
No
Don't Know

16. What is the average level of training of the supervisors at this Resource?
None
Paraprofessional
High School
College
Master's
Doctorate
Don't Know

17. What is the average level of training of the staff at this Resource?
None
Paraprofessional
High School
College
Master's
Doctorate
Don't Know

18. How many staff at this Resource have a disability or a family member with a disability?

19. Please describe the biggest obstacles this Resource faces in providing services to Parents with Disabilities or Deafness.

20. Portions of this information may be posted on TLG's website as a resource for parents with disabilities and their families.
Yes
No

21. I would be available for someone at Through the Looking Glass to discuss responses to the survey in more detail.
Yes
No

22. I/this organization would be interested in being part of a local or regional network of individuals and agencies to explore how to provide more services to parents with disabilities.
Yes
No

23. This organization is interested in training regarding parents with disabilities.
Yes
No

Thank you so much for your feedback.

Parenting with a Disability Resources and Services Survey

Resource Survey Online Form

Thank you so much for your feedback.

Parenting with a Disability
Resources and Services Survey