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Social Networks

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Online Survey : Clinical Uses of Social Networks (SN)

Name: 
Email Address: 

Please send my free packet of Inventory Booklets to:
Name: 
Address: 
City: 
State/Province: 
Zip/Postal Code: 
Country: 

Have you used Social Networks?
Clinical   Research   Teaching    Planning on using it   Have not used

Have any of your colleagues used Social Networks?
Yes   No

In which type(s) of facility do you work?
School   Rehabilitation Hospital   Group Home   Acute Care Hospital
Private Practice   University Clinic   Other

With which age groups have you used/will you use Social Networks?
Infants/preschoolers   School age   Youth   Adults   Elderly  

Individuals with whom you have used/plan to use Social Networks have been diagnosed as having the follow types of disorders: (Choose all that apply)
Types of disordersPreschoolChildrenYouthAdultsElderly
Acquired disabilities (non specified)
Aphasia
Autism spectrum disorders
Apraxia, developmental
Apraxia, acquired
Cerebral palsy
Dementia
Down Syndrome
Developmental disabilities (non specified)
Motor Neuron Disease/Amyotrophic lateral sclerosis
Multiple sclerosis
Severe language delays/disorders
Traumatic brain injury
Other
Other
Other

What language version did you use?
If not English, please identify the translator:

Please indicate which sections of Social Networks have you used:
Identifying information
Skills and Abilities of individual
Circles of communication partners
Modes of expression
Representational strategies - input
Selection techniques
Strategies that support interaction/expression
Strategies that support interaction/comprehension
Topics of conversation
Types of communicator
Summary sheet A
Summary sheet B
Summary sheet C
Summary sheet D

Are there areas where you feel you would like further training or explanation or exemplification? (For instance, would you like more guidance with respect to interviewing, interpreting the collected information, developing goals and plans and/or using the information from Social Networks to guide intervention selection and implementation.)
No        Yes   Please list:

Did you make any changes when administering the tool?
Order of presentation?
If yes, please describe briefly below:
Wording of interview questions?
If yes, please describe briefly below:
Range of individuals interviewed?
If yes, please describe briefly below:
Methods of data collection?
If yes, please describe briefly below:
Additions?
If yes, please describe briefly below:
Other?
If yes, please describe briefly below:

How have individuals with complex communication needs responded to the interviews?

Very negative
   
Negative
   
Neutral
   
Positive
   
Very positive
Comments:


How have family members responded to the interviews?

Very negative
   
Negative
   
Neutral
   
Positive
   
Very positive
Comments:


How have paid workers responded to the interviews?

Very negative
   
Negative
   
Neutral
   
Positive
   
Very positive
Comments:


How have you and/or your colleagues who conduct the Social Networks interviews responded to the tool?

Very negative
   
Negative
   
Neutral
   
Positive
   
Very positive
Comments:


What, if any, problems have you encountered when using Social Networks?


What suggestions would you give other professionals who might use Social Networks?


I feel Social Networks has helped to foster and/or strengthen a team approach to the intervention process.

Very negative
   
Negative
   
Neutral
   
Positive
   
Very positive
Comments:


Generally speaking what kinds of interventions has Social Networks led you to make?


If we were to create a second edition what should be added (or deleted?)


Can we include your name in a list of people who have some clinical experience using Social Networks?
No        Yes   If yes, How should we list you and what is the best way to contact you?:
Contact information:

Would you consider working with Sarah Blackstone on a case example for publication in Augmentative Communication News or the ACI website?
No        Yes   If yes, I am thinking about someone who has (diagnosis) and is approximately years old.
Additional information:

Other comments or questions?


Thank you very much for participating with us. Your extra inventory books and Social Network FAQs are on the way! Let us know if we can be of further help.

We will keep you informed of our progress.




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Augmentative Communication, Inc.     

One Surf Way, #237
Monterey, CA 93940
Phone : (831) 649-3050
FAX : (831) 646-5428
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