Anonymous Questionnaire

Does your child...

  • Do things at school you keep getting called about?
  • Seem much sadder or more anxious than other children?
  • Ever want to hurt themselves or someone else?
  • Act more hyper than other children their age?
  • Have a lot of trouble making friends?
  • Have a diagnosis such as ADHD, Mood Disorder, Bipolar Disorder, Depression, Oppositional Defiant Disorder, Disruptive Mood Dysregulation Disorder or Anxiety?

If you answered yes or maybe to any of these questions, or if you feel that your child has emotional, social or behavioral challenges not described in the questions above, please take a few minutes to answer the following questions by circling the answers that best say how you feel. If a question doesn’t apply to you or you don’t want to answer it, skip it.

Your feedback will help Families as Allies focus on the most important ways to help Mississippi children and families. Your answers are anonymous and confidential.

Families as Allies is the only statewide organization run by and for families of children with mental health challenges. Our mission is to make sure families are partners in their children’s care. We support each other and work together to help the systems that serve our children be as responsive as possible. Membership is free and open to any Mississippi parent or caregiver of a child with a mental health challenge. Please visit our website at or call us at 601-355-0915 to learn more. We welcome you to join us.

Thank you for taking the time to share your thoughts with us. If you would like to contact us about this survey or anything else, we can be reached at 601-355-0915 or Survey results will be posted on our website and Facebook page.

What County do you live in? (This question will not be used to identify you)
Does your child and/or your family receive any type of mental health services or support related your child (for example seeing a doctor, going to therapy or being in a parent support group)?
Please Describe
If your child or family receives mental health services, how helpful are the services?
How much do you feel your input and partnership is valued by the mental health providers?
Does your child get any extra support or help at school
Please Describe
If your child gets extra support or help at school, how helpful is it?
Does your child’s teacher spend extra time and adapt things for your child when needed?
How much do you feel your input and partnership is valued by your child’s school
Has your family ever been involved with the Department of Human Services (DHS)?
If your family has ever been involved with DHS, how much do you feel DHS valued your input and partnership?
Has your child ever been in a psychiatric residential treatment facility (PRTF)?
If your child has ever been in a PRTF, how much do you feel the PRTF valued your input and partnership?
Before answering these questions, had you ever heard of Families as Allies?
If yes, how did you first hear about Families as Allies? (please describe)
If you have ever contacted Families as Allies, how helpful was Families as Allies?
If your family has ever been involved with Families as Allies, how much do you feel they valued your input and partnership?
Do you want to tell us anything else about any of the questions above or do you have any ideas or suggestions about making things better for our children?