1. What is your role with CYWA? Pick the one that is the best match.

1. :00 1. What is your role with CYWA? Pick the one that is the best match. • parent/family member • teacher/educator • administrator/policymaker • student • health professional • researcher/NDCPD staff • person with ASD • other CYWA = Children & Youth with Autism

2. :00 2. Do you live in a rural, urban or remote rural community? (Select one) • urban (population greater than 50,000) • rural (population between 3,000 and 49,999) • remote rural (population less than 3,000)

3. 3 4 8 5 6 7 2 1 :00 3. Look at the map on the screen. Select the region in which you live in ND. • Region 1 • Region 2 • Region 3 • Region 4 • Region 5 • Region 6 • Region 7 • Region 8 • Other

4. :00 4. Which professional typically diagnoses autism in your community? (Select one) • pediatricians • clinical psychologists • psychiatrist • family practitioners • school psychologists • educational specialists • none of the above • don’t know

5. :00 5. In your experience, when are most ND children first diagnosed with ASD? (Select one) • before second birthday • between second-third birthday • between third-fourth birthday • between fourth-fifth birthday • after age five • don’t know

6. :00 6. Where do families in your community typically travel to get a diagnosis? (Select one) • no travel needed • out of state • to west side of state • to east side of state • don’t know

7. :00 7. How are treatments for CYWA typically financed by most families? (Select one) • private pay • health insurance • school district • early intervention • don’t know • other

8. :00 8. Who is the primary provider for treatments of CYWA in your community? (Select one) • family at home • pre-school programs • private specialists • public schools • medical clinics • none available • other

9. :00 9. Select one treatment that you believe is most important for CYWA. • early intervention • behavior intervention • in-home support • social skill training • transition support • diet/nutrition • speech & language therapy • physical/occupational therapy • don’t know • other

10. :00 10. What is your preferred method of training on ASD issues? (Select one) • workshops • webinars • online classes • books • college courses • technical assistance on site

11. :20 11. Does your community offer supports to families of CYWA? • yes • no • don’t know

12. :00 12. Select 3 of the training topics you believe would be most helpful for professionals to receive or access? • screening & diagnosis • discrete trial training • pivotal response training • structured teaching • positive behavior intervention • social stories • picture exchange system • diet and medical interventions • don’t know • other

13. :00 13. Select 3 training topics that you believe are most helpful for families to receive or access? • screening & diagnosis • discrete trial training • pivotal response training • structured teaching • positive behavior intervention • social stories • picture exchange system • diet and medical interventions • don’t know • other

14. :00 14. Select the support that you believe is most important for families of CYWA? • home visitation • intensive in-home support • financial support • sibling support • trained respite • caregivers • home modifications • other

15. :00 15. Select 3 changes for North Dakota that you believe should be addressed in the next year? • Update the DPI Autism guidelines • Establish clinics to diagnose and treat CYWA • Develop webinars and modules • Examine possible underlying causes for ASD • Develop models for early intervention and treatment • Other