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2. 
3. Family Treatment Court Participant Survey
5. Gender:
   -- Select One --FemaleMaleTransgender
6. Age:
   -- Select One --18-2425-3435-4445-5455-6465+
7. Race/Ethnicity:
   -- Select One --White or CaucasianBlack or African AmericanHispanic or LatinoAsian or Asian AmericanAmerican Indian or Alaska NativeNative Hawaiian or other Pacific IslanderAnother Race
8. Education:
   -- Select One --Some High SchoolHigh School GraduateGED Some CollegeCollege Graduate
10. Marital Status:
    -- Select One --SingleMarriedDivorced
11. Employed?

    1. Yes
    2. No
15. How has FTC helped to improve your ability to parent?*

    1. A Great Deal
    2. A Lot
    3. A Moderate Amount
    4. A Little
    5. None at All
16. How has FTC assisted with your recovery?*

    1. A Great Deal
    2. A Lot
    3. A Moderate Amount
    4. A Little
    5. None at All
18. In which ways have you benefited from joining FTC?*

    Please check all that apply:

    1. Immediate, Free Assessment for Treatment
    2. Assistance Finding Treatment
    3. Faster Access to Treatment
    4. Access to More Resources
    5. Regular Contact with FTC Case Manager

    1. Regular Contact with Peer Support
    2. Assistance Making/Keeping Appointments
    3. Assistance with Transportation
    4. Regular Praise from FTC Team
    5. Frequent Contact with Your Judge

    1. Free Drug Screens
    2. Assistance with Medication
    3. Assistance with Food/Grocery
    4. Christmas Assistance
    5. Assistance with Clothing/Furniture/Household Items
20. In which areas do you need more assistance?*

    Please check all that apply:

    1. Immediate, Free Assessment for Treatment
    2. Assistance Finding Treatment
    3. Faster Access to Treatment
    4. Access to More Resources
    5. Regular Contact with FTC Case Manager

    1. Regular Contact with Peer Support
    2. Assistance Making/Keeping Appointments
    3. Assistance with Transportation
    4. Regular Praise from FTC Team
    5. Frequent Contact with Your Judge

    1. Free Drug Screens
    2. Assistance with Medication
    3. Assistance with Food/Grocery
    4. Christmas Assistance
    5. Assistance with Clothing/Furniture/Household
22. Prior to joining FTC, did you feel like you were in need of treatment?*

    1. Yes
    2. No
    3. Don't Know
23. How beneficial has treatment been?*

    1. A Great Deal
    2. A Lot
    3. A Moderate Amount
    4. A Little
    5. None at All
25. Do you have any ideas/suggestions to improve incentives?*
26. Do you have an ideas/suggestions to improve sanctions?*
28. Which sanctions did you find most effective?*

    Please check all that apply:

    1. Daily Reporting/Contact with Case Manager
    2. Daily Sponsor Contact
    3. Relapse Inventory
    4. Therapeutic Written Assignment
    5. Fines
    6. Increased Treatment
    7. Daily Drug Screens

    1. Apology Letters
    2. Time Management Plan
    3. Making up Missed Groups/Sessions
    4. Remaining at FTC to Complete Assignments
    5. Increased Surveillance Visits
    6. Jail
    7. Other
29. Other:*
31. Overall, how would you rate your experience in FTC?*

    1. Very Positive
    2. Somewhat Positive
    3. Neutral
    4. Somewhat Negative
    5. Very Negative
32. Other Comments/Suggestions:
Leave This Blank:


34. 1. Receive an email copy of this form.
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