Client survey - Autism Assistance Programme

What is the age of your child?

345678910 and over

Who lives in the child’s home?

Parent/s and siblingsJust parent/s

Approximate length of time you have been a client of Support Dogs?

In addition to autism, does your child have any other medical conditions?

At what age was your child diagnosed with autism?

Since your child has been partnered with their support dog has the level of medication they require?

ReducedIncreasedStayed the sameN/A

Since having a support dog have you seen a change in number of medical appointments for child has needed? (For example, fewer injuries from accidents that required attention.)

ReducedIncreasedStayed the same

Since your child has been partnered with their support dog would you class their dog as your child’s main aid for managing their autism?

YesNo

Have you seen a difference in number of visits to your home by a health worker since your child’s support dog partnership?

YesNo

Have you seen a reduction in the number of emergency calls made to NHS services since your child’s partnership?

YesNo

Are you currently in paid employment?

YesNo

Do you believe your employment opportunities are wider because of the support from your child’s support dog?

YesNo

Do you do any volunteer work in any capacity?

YesNo

If yes, has the opportunity to volunteer increased because of your child’s support dog?

YesNo

In addition to your child’s support dog, does your child require regular assistance with care needs?

YesNo

If yes is this provided by

YourselfPartnerA siblingAnother friend/family memberA carer provided by a Local Authority or NHS organisationSomeone else

If care is not provided by a paid care worker do you feel the main carer’s role as care giver is reducing their opportunities with any of the following:

EducationSociallyEmploymentOther

Has your child’s support dog reduced their care needs?

YesNo

Has your support dog increased your child’s confidence in their ability to try to independently care for themselves?

YesNo

If yes, previous to your child’s support dog partnership did their heavy reliance on others for care without help effect your;

Mental health - YesMental health - NoPhysical health - YesPhysical health - No

My child has suffered with mental health conditions.

Since my child’s partnership with their support dog their mental health has improved.

Before my child’s support dog they would experience periods of stress and/or anxiety.

My support dog has had a positive impact on my mental health as a parent.

My child’s support dog has had a positive impact on my family unit.

Before my child’s support dog my and/or my partners ability to work was affected due to care needs.

Since my child’s support dog my partner and I have more opportunity for paid employment.

I feel my child’s support dog has helped my partner’s mental health.

I feel my child’s partnership with a support dog has helped my partner’s physical health.

I feel my relationship with my partner has been strengthened due to my child’s partnership with their support dog.

If you previously had care help from your child’s siblings do you feel this has been reduced by your support dog.

Since the help from my child’s support dog I feel my other children can concentrate more on their education or training needs.

I believe my child’s support dog partnership has improved the mental health of my child’s siblings.

I believe my support dog partnership has improved my child’s physical health.

My child’s support dog has increased my child’s confidence to attend family events.

My child’s support dog has increased my child’s confidence attending social events.

My child’s support dog has decrease my child’s anxiety at social events.

My child’s support dog is a catalyst conversation with strangers.

My child’s support dog gives my child the confidence to meet new people.

My child’s support dog makes my child feel safer in public areas.

My child’s support dog gives my child the confidence to use public transport.

Are there any other comments you would like to make regarding the impact of having a support dog on relationships with other family members?

Are there any other comments you would like to make regarding the impact of having a support dog on your mental health as a parent?

Client survey - Autism Assistance Programme

Employment and volunteering

How far do you agree with the following statements