IYJ Youth Outcomes Survey

Intensive Youth Justice Youth Outcomes (Caregiver)
You will be asked to provide feedback on your youth's behavior and progress.
Name of Person Completing Survey
First NameLast Name
Youth Name
Please print first and last name.
Start Date Of Program Participation
Month/Year
End Date Of Program Participation
Month/Year
IMPORTANT: Your personal information (i.e. name, phone number, address, etc.) will be kept confidential. General feedback may be shared with program supervisors and/or workers to help improve program services.
Please provide honest answers on the current status of the youth named above.

1. As compared to previous experiences with the youth before and during the beginning phases of program participation, do you see improvements in:

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
Taking initiative and responsibility for goals
Identifying own strengths
Identifying own challenges or barriers
Youth's ability to work through challenges or setbacks
Problem-solving
Identifying risks and benefits of own actions
Asking for appropriate assistance
Respecting boundaries, rules, and agreements
Youth's friendships and social activities
Maintain healthy boundaries for self and others

2. Please rate youth's current ability to:

	Not Satisfied	Somewhat Satisfied	Satisfied	Very Satisfied	Not Applicable
Take medications responsibly
Communicate with caregivers appropriately
Complete responsibilities independently (i.e. chores, schoolwork, etc... with few or no reminders)
Respect curfews and limits
Set own limits appropriately

3. Are there other areas in which you have noticed an improvement for the youth?
4. Are there areas in which you would still like to see notable improvements?

5. Please rate your confidence level for the youth's ability to:

	Nervous	Somewhat Nervous	Fairly Confident	Very Confident
Continue positive progress
Keep their healthy relationships
Follow through on agreements and expectations
Maintain safety for themselves and others

For the following questions, please reflect on how things have changed for you personally.
6. During the duration of this program, did you find yourself making changes as well? If 'Yes', what changes?
7. The following is a list of 6 parenting skills. Please rate how often you use each skill.
Never Rarely Sometimes Often
Active Listening
Reframing
I-Messages
Clear Expectations
Logical Consequences
8. The following is the same list of 6 parenting skills. Please rate how often you used each skill before involvement with the IYJ Program.
Never Rarely Sometimes Often
Active Listening
Reframing
I-Messages
Clear Expectations
Logical Consequences

9. Please rate how helpful you have found each skill in helping you create the change you wanted to see.

10. In thinking about this service ending, are there elements of support you think would still be beneficial to you? If so, please describe in the space below.
Thank you for your feedback!
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Intensive Youth Justice Youth Outcomes (Caregiver)