YOUTH SERVICES SURVEY FOR FAMILIES (YSS-F)

Revised Version: February 17, 2006

Please help our agency make services better by answering some questions about the services your child received OVER THE 

LAST 6 MONTHS. Your answers are confidential and will not influence the services you or your child receive. Please indicate 

if you Strongly Disagree, Disagree, Are Undecided, Agree, or Strongly Agree with each of the statements below. Put a cross 

(X) in the box that best describes your answer. Thank you!!!

 

 

1. Overall, I am satisfied with the services my child received -----------------

2. I helped to choose my child s services -----------------------------------------

3. I helped to choose my child s treatment goals--------------------------------- 

4. The people helping my child stuck with us no matter what -----------------

5. I felt my child had someone to talk to when he/she was troubled ----------

6. I participated in my child s treatment-------------------------------------------

7. The services my child and/or family received were right for us------------

8. The location of services was convenient for us -------------------------------

9. Services were available at times that were convenient for us ---------------

10. My family got the help we wanted for my child ------------------------------

11. My family got as much help as we needed for my child---------------------

12. Staff treated me with respect ----------------------------------------------------

13. Staff respected my family s religious/spiritual beliefs -----------------------

14. Staff spoke with me in a way that I understood-------------------------------

15. Staff were sensitive to my cultural/ethnic background-----------------------

As a result of the services my child and/or family received: 

16. My child is better at handling daily life ----------------------------------------

17. My child gets along better with family members-----------------------------

18. My child gets along better with friends and other people--------------------

19. My child is doing better in school and/or work -------------------------------

20. My child is better able to cope when things go wrong -----------------------

21. I am satisfied with our family life right now ---------------------------------- 

22. My child is better able to do things he or she wants to do ------------------- 

As a result of the services my child and/or family received: please answer 

for relationships with persons other than your mental health provider(s)

23. I know people who will listen and understand me when I need to talk ---- 

24. I have people that I am comfortable talking with about my child’s 

problems. --------------------------------------------------------------------------- 

25. In a crisis, I would have the support I need from family or friends.-------- 

26. I have people with whom I can do enjoyable things-------------------------- 

Strongly 

Disagree 

(1)

Disagree

(2)

Undecided

(3)

Agree

(4)

Strongly 

Agree

(5)

27. What has been the most helpful thing about the services you and your child received over the last 6 months?

 

28. What would improve the services here? 

 
Please answer the following questions to let us know how your child is doing.

29. Is your child currently living with you?  Yes  No

30. Has your child lived in any of the following places in the last 6 months? (CHECK ALL THAT APPLY)

 a. With one or both parents

 b. With another family member

 c. Foster home

 d. Therapeutic foster home

 e. Crisis Shelter 

 f. Homeless shelter

 g. Group home

 h. Residential treatment center

  i. Hospital

 j. Local jail or detention facility

  k. State correctional facility

  l. Runaway/homeless/on the streets

  m. Other (describe): 

31. In the last year, did your child see a medical doctor (or nurse) for a health check up or because he/she was sick? (Check one) 

 Yes, in a clinic or office  Yes, but only in a hospital emergency room  No  Do not remember

32. Is your child on medication for emotional/behavioral problems?  Yes  No

32a. If yes, did the doctor or nurse tell you and/or your child what side effects to watch for?  Yes  No

33. Is your child still getting services from this Center?  Yes  No

34. How long did your child receive services from this Center?

  a. Less than 1 month

  b. 1 -5 months 

  c. 6 months to 1 year

 d. More than 1 year (skip to questions 41)

 

35. Was your child arrested since beginning to receive mental health 

services? 

  Yes  No

36. Was your child arrested during the 12 months prior to that?

  Yes  No

37. Since your child began to receive mental health services, have their 

encounters with the police...

  a. been reduced (for example, they have not been 

 arrested, hassled by police, taken by police to a 

 shelter or crisis program)

  b. stayed the same

  c. increased

  d. not applicable (They had no police encounters this 

 year or last year

38. Was your child expelled or suspended during since beginning 

services?

  Yes  No

39. Was your child expelled or suspended during the 12 months prior to 

that?

  Yes  No 

40. Since starting to receive services, the number of days my child was 

in school is

a.  Greater

b.  About the same

c.  Less

d.  Does not apply (please select why this does not apply)

i. child did not have a problem with attendance before 

starting services

ii. child is too young to be in school

iii. child was expelled from school

iv. child is home schooled

v. Child dropped out of school

vi. Other: _______________________

41. Was your child arrested during the last 12 months? 

  Yes  No 

42. Was your child arrested during the 12 months prior to that?

  Yes  No

43. Over the last year, have your child’s encounters with the 

police... 

  a. been reduced (for example, they have not been 

 arrested, hassled by police, taken by police to a 

 shelter or crisis program)

  b. stayed the same

  c. increased

  d. not applicable (They had no police encounters this 

 year or last year

44. Was your child expelled or suspended during the last 12 

months? 

  Yes  No

45. Was your child expelled or suspended during the 12 months 

prior to that?

  Yes  No

46. Over the last year, the number of days my child was in school 

is

a.  Greater

b.  About the same

c.  Less

d.  Does not apply (please select why this does not 

apply) 

i. child did not have a problem with attendance 

before starting services

ii. child is too young to be in school

iii. child was expelled from school

iv. child is home schooled

v. Child dropped out of school 

vi. Other: _______________________
Please answer the following questions to let us know a little about your child.

A. Are either of the child’s parents of Spanish/Hispanic/Latino? 

 Hispanic or Latino Origin  Not of Hispanic or Latino Origin

B. What is your Child’s Race? (mark all that apply)

 American Indian or Alaska Native  Asian  Black (African American)

 Native Hawaiian or Other Pacific Islander  White (Caucasian)  Other: Describe 

C. Child’s Birth Date: 

D. Child’s Gender: Male Female

E. Does your child have Medicaid insurance? Yes No

Thank you for taking the time to answer these questions!