Birth to Three, Then What?: Early Interventions role in the inclusion of children with Down syndrome

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1 Birth to Three, Then What?: Early Interventions role in the inclusion of children with Down syndrome Thank you for taking the time to complete this survey. Your answers are very important to us. If you have any questions feel free to *If you are the parent of more than one child with Down syndrome, you will only be providing answers for ONE of your children. It is important to select the child that attends elementary school and was provided Early Intervention services (i.e. children who are adopted internationally may not have received Early Intervention services prior to their adoption). If more than one child attends elementary and received Early Intervention please use the oldest child, still attending elementary school. How old are you? How old is your child with Down syndrome? *Only answer about the child selected for this survey please. What is the race of your child? (multiple answers may be selected) White/Caucasian/European American Native American or Alaskan Native Other Black or African American Native Hawaiian or other Pacific islander No answer Asian What is the gender of your child with Down syndrome? Male Female Do you have other children in addition to your child with Down syndrome? Yes No What is the maximum level of education completed by at least one parent in the household?

2 No high school diploma or GED High school diploma or GED Some college/ Associates degree Bachelor's degree Master's degree Doctoral degree What is the level of income for the household? $0-$9,999 $10,000-$29,999 $30,000-$49,999 $50,000-$74,999 $75,000-$99,000 $100,000 and above Did your child receive Early Intervention (also referred to as Birth to Three) services prior to entering school? Yes No How long did your child receive Early Intervention services from birth until entering schooling? Less than 1 year 1-2 years 2-3 years 4 or more What forms of therapy did your child receive in Early Intervention? (check all that apply) Physical Therapy Behavioral Therapy Therapeutic Listeni Occupational Therapy Play Therapy Vision Therapy Speech Therapy Sensory Therapy Other Specialized Instruction Respiratory Therapy Other Aquatic Therapy Feeding Therapy Other How many hours per week did your child receive Physical Therapy in Early Intervention? How many hours per week did your child receive Occupational Therapy in Early Intervention? How many hours per week did your child receive Speech Therapy in Early Intervention?

3 How many hours per week did your child receive Specialized Instruction in Early Intervention? How many hours per week did your child receive Aquatic Therapy in Early Intervention? How many hours per week did you child receive Behavioral Therapy in Early Intervention? How many hours per week did your child receive Play Therapy in Early Intervention? How many hours per week did your child receive Sensory Therapy in Early Intervention? How many hours per week did your child receive Respiratory Therapy in Early Intervention? How many hours per week did your child receive Feeding Therapy in Early Intervention? How many hours per week did your child receive Therapeutic Listening Therapy in Early Intervention? How many hours per week did your child receive Vision Therapy in Early Intervention? How many hours per week did your child receive ${q://qid9/choicetextentryvalue/13} Therapy in Early Intervention? How many hours per week did your child receive ${q://qid9/choicetextentryvalue/14} Therapy in Early Intervention? How many hours per week did your child receive ${q://qid9/choicetextentryvalue/15} Therapy in Early Intervention? At what age did your child enter schooling? (any form of schooling other than daycare) 3 years 4 years 5 years 6 years What is the current grade level of your child?

4 Preschool/ Head start Kindergarten 1st grade 2nd grade 3rd grade 4th grade 5th grade 6th grade What form of schooling does your child with Down syndrome attend? Public School Private/ Religious School Specialized School (school specifically designed for students with disabilities) Cyber School Home School No Answer Please describe if there was a particular reason (or reasons) this form of schooling was selected for your child? How many hours per week does your child attend school? How strongly do you agree with the following statement: "My child with Down syndrome has a medical condition that limits his/her involvement in a general education classroom." Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree The following question is to determine how many hours per week your child is pulled out of a general education classroom for therapies and special education classes (specialized instruction). Estimations are permitted, however, the accuracy of the data you provide in this section will help determine the accuracy of our study. This information may be provided in your child's IEP (Individualized Education Plan). Please type the number of hours per week your child spends in each of the following categories (during school hours) in the corresponding column. (for example: if your child spends 1 1/2 hours per week in Physical therapy but only 30 minutes is spent in

5 therapy inside the general education classroom put "1" to indicate 1 hour in the first column and ".5" to indicate one half hour in the second column). Please round to the nearest half hour. Physical Therapy Occupational Therapy Speech Therapy Aquatic Therapy Behavioral Support Play Therapy Sensory Therapy Respiratory Therapy Feeding Therapy Therapeutic Listening Vision Therapy Specialized Instruction* (includes all subjects/classes your child receives special education for) Other Provided outside the general education classroom (type # of hours) Provided within the general education classroom (type # of hours) Unsure whether your child's therapy is provided inside or outside of general education classroom (type # of hours) Do (ma What school did/ do your other child(ren) attend? Public Private/Religious Specialized School Cyber School Home School Other No Answer How important is it that your child with Down syndrome attend the same school as your other children? Strongly Disagree Disagree Neither Agree nor Disagree Agree Strongly Agree What additional services/programs/ sources of support are your family involved in or connected with outside of Early Intervention Service and his/her school?

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