1. What is your role with CYWA? Pick the one that is the best match.

par

ent/f

amily

mem

ber

teac

her/e

ducato

r

adm

inis

trato

r/polic

ymak

er

stu

dent

hea

lth p

rofe

ssio

nal

rese

archer

/NDCPD s

taff

per

son w

ith A

SD

oth

er

15%

42%

12% 12%

0%

3%

13%

3%

a. parent/family memberb. teacher/educatorc. administrator/policymakerd. studente. health professionalf. researcher/NDCPD staffg. person with ASDh. other

CYWA = Children & Youth with Autism

2. Do you live in a rural, urban or remote rural community? (Select one)

urb

an (p

opulatio

n gr..

.

rura

l (pop

ulatio

n bet

...

rem

ote ru

ral (

popula

ti..

35%

23%

43%a. urban (population greater than 50,000)

b. rural (population between 3,000 and 49,999)

c. remote rural (population less than 3,000)

3. Look at the map on the screen. Select the region in which you live in ND.

2%

40%

3%

12%

2%3%

26%

8%

5%

12 3 4

8 7 6 5

a. Region 1b. Region 2c. Region 3d. Region 4e. Region 5f. Region 6g. Region 7h. Region 8i. Other

4. Which professional typically diagnoses autism in your community? (Select one)

ped

iatri

cian

s

clin

ical

psyc

hologist

s

psy

chia

trist

fam

ily p

ract

itioner

s

sch

ool psy

cholo

gists

educa

tional

spec

ialis

ts

none

of t

he a

bove

don’

t know

9%

46%

11%

20%

3%5%3%3%

a. pediatricians

b. clinical psychologists

c. psychiatrist

d. family practitioners

e. school psychologists

f. educational specialists

g. none of the above

h. don’t know

5. In your experience, when are most ND children first diagnosed with ASD?

(Select one)

bef

ore s

econd b

irthda

y

bet

wee

n se

cond-th

ird...

bet

wee

n th

ird-fo

urth

...

bet

wee

n fo

urth-fi

fth b

...

afte

r age

five

don’t

know

5%

30%

18%21%

9%

18%

a. before second birthdayb. between second-third birthdayc. between third-fourth birthdayd. between fourth-fifth birthdaye. after age fivef. don’t know

6. Where do families in your community typically travel to get a diagnosis?

(Select one)

no tr

avel

nee

ded

out o

f sta

te

to w

est s

ide

of sta

te

to e

ast s

ide

of s

tate

don’t

know

40%

6%

18%

24%

12%

a. no travel neededb. out of statec. to west side of stated. to east side of statee. don’t know

7. How are treatments for CYWA typically financed by most families? (Select one)

priv

ate

pay

hea

lth in

sura

nce

sch

ool d

istri

ct

ear

ly in

terv

entio

n

don’t

know

oth

er

17%

21%

2%

22%

8%

29%a. private pay

b. health insurance

c. school district

d. early intervention

e. don’t know

f. other

8. Who is the primary provider for treatments of CYWA in your community?

(Select one)

fam

ily a

t hom

e

pre

-sch

ool pro

gram

s

priv

ate

spec

ialis

ts

public

sch

ools

med

ical

clin

ics

none

avai

lable

oth

er

18%

5% 6%2%4%3%

62%

a. family at home

b. pre-school programs

c. private specialists

d. public schools

e. medical clinics

f. none available

g. other

9. Select one treatment that you believe is most important for CYWA.

ear

ly in

terv

entio

n

beh

avio

r inte

rven

tion

in-h

ome

support

soci

al sk

ill tr

ainin

g

tran

sitio

n support

diet

/nutri

tion

spee

ch & la

nguage

ther

apy

phys

ical

/occu

patio

nal th

erap

y

don’

t know

oth

er

65%

10%7% 6%

1%1%1%

7%

1%1%

a. early interventionb. behavior interventionc. in-home supportd. social skill traininge. transition supportf. diet/nutritiong. speech & language therapyh. physical/occupational therapyi. don’t knowj. other

10. What is your preferred method of training on ASD issues? (Select one)

work

shops

web

inar

s

onlin

e cl

asse

s

books

colle

ge co

urse

s

tech

nical

ass

ista

nce...

59%

2%

27%

5%3%4%

a. workshops

b. webinars

c. online classes

d. books

e. college courses

f. technical assistance on site

11. Does your community offer supports to families of CYWA?

yes n

o

don’t

know

58%

19%23%

a. yes

b. no

c. don’t know

12. Select 3 of the training topics you believe would be most helpful for

professionals to receive or access?

89

2831

63

02

40

2021

111

a. screening & diagnosisb. discrete trial trainingc. pivotal response trainingd. structured teachinge. positive behavior interventionf. social storiesg. picture exchange systemh. diet and medical interventionsi. don’t knowj. other

13. Select 3 training topics that you believe are most helpful for families to receive

or access?

63

1814

31

32

54

25

33

123

a. screening & diagnosisb. discrete trial training c. pivotal response trainingd. structured teachinge. positive behavior interventionf. social storiesg. picture exchange systemh. diet and medical interventionsi. don’t knowj. other

14. Select the support that you believe is most important for families of CYWA?

hom

e vi

sita

tion

inte

nsive

in-h

ome

support

finan

cial

support

sib

ling su

pport

trai

ned re

spite

car

egiv

ers

hom

e m

odifi

catio

ns

oth

er

3%

44%

23%

0%3%

4%

22%

1%

a. home visitationb. intensive in-home supportc. financial supportd. sibling supporte. trained respitef. caregiversg. home modificationsh. other

15. Select 3 changes for North Dakota that you believe should be addressed in the

next year?

Updat

e th

e DPI A

utis...

Est

ablis

h cl

inic

s to

d...

Dev

elop w

ebin

ars

a..

Exa

min

e po

ssib

le u

n...

Dev

elop m

odels

for e

...

Oth

er

60

108

6

134

4250

a. Update the DPI Autism guidelines

b. Establish clinics to diagnose and treat CYWA

c. Develop webinars and modules

d. Examine possible underlying causes for ASD

e. Develop models for early intervention and treatment

f. Other