School of Medicine
Discipline of Psychiatry
Evaluation Unit
Draft Principles and Actions for Services and People
Working with Children of Parents With A Mental
Illness
Evaluation Questionnaire for
Agencies/Organisations/Service Providers
1. The name/title of the agency/service/organisation responding to this
questionnaire is: (mandatory)
__________________________________________________________
_____________________________________________________________
2. Please tick which sector the agency/service/organisation responding to
this questionnaire is in:
Private Sector
Public Sector
Non-Government
Sector
Other (please
specify)
_______________
_______________
3. This agency/service/organisation falls within the following category(s)
(please tick as many as are applicable): (mandatory to tick at least one
category)
Organisation
Adult Mental Health Service
Child and Adolescent Mental
Health Service
Community Service Provider
Church/religious
affiliated/funded/institution
Peak body/organisation
Funding body
State/Territory Government
Department
Professional advisors
Other Mental Health Service
Providers
General Non-Government
Organisations (State based)
Tick
Organisation
Professional group/colleges
Mental Health Network
Provider of
undergraduate/postgraduate/inservice training.
Accommodation Service
Youth Service
Child/youth information Service
General health service provider
Child Protection/Welfare
Service
Family support service
Rural and Remote
Tick
General Non-Government
Organisations (National)
Culturally and Linguistically
Diverse/Non English Speaking
Background
Disability Service
Addiction Service
Other groups/networks (please
specify) __________________
_________________________
Perinatal/Early Childhood
General Practice
Education
Indigenous
Justice/legal
Community Organisation
4. This agency/service/organisation provides services to the following (please
tick as many as are applicable): (minimum of one required)
Client Group
Consumers of Mental Health
Services
Carers
Families
Parents with Mental Illness
Aboriginal and/or Torres
Strait Islander people
People of Non-English
Speaking Backgrounds
Children under the age of 8
years
Children 8-12years old
Young People 13-18 years
Young Adults 18-25 years
Children/Young People with a
Parent(s) with Mental Illness
Tick
Client Group
Tick
The general population
Rural and Remote
Communities/located people
People engaged in the Justice
system
People with disability(ies)
Students
People with addictions
Other service providers
Professionals
Other client group (please
specify) __________________
_________________________
_________________________
5. What Australian state or territory is the agency/service/organisation based
in?
New South Wales (NSW)
Tasmania
Victoria
Western Australia
Queensland
South Australia
Northern Territory
Australian Capital Territory
(ACT)
Not located in Australia
OR
If located overseas please indicate country:
_________________________________________(Country)
6. Is the agency/service/organisation located in a capital city (including its
suburbs), major town, rural area, or remote area? (mandatory)
Capital
City
Major
Town
Rural
Area
Remote
Area
Other:
________________
________________
____
7. Would your agency/service/organisation like to join
the AICAFMHA Mews e-list to receive updates about
the COPMI project?
Yes
No
Already a
member
Email address to subscribe: ______________________________
8. Optional - The contact details of the agency/service/organisation
responding to this questionnaire are:
Contact Person:_________________________________________________
Phone:________________________________________________________
Email: ________________________________________________________
Other details: ___________________________________________________
9. How much of the Principles and Actions for Services and People Working
with Children Off Parents With A Mental Illness draft document have you
read?
Skim read parts relevant to Read more than ½
Read Completely
agency/service/organisation including specific parts
relevant to
agency/service/organisation
10. In general how readable was this document?
1____ 2____ 3____ 4____ 5____ 6____ 7____ 8____ 9____ 10
Very readable
Not at all readable
11. In general how easy or difficult was this document to understand?
1____ 2____ 3____ 4____ 5____ 6____ 7____ 8____ 9____ 10
Very easy
Very difficult
12. In general has this document influenced
the agency/service/organisation’s
understanding/knowledge of the topic of
Children of Parents with a Mental Illness?
Yes
No
Don’t know
Please comment:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
13. How comprehensive are the document’s Guiding Principles (pages 1213)?
Very
Comprehensive Neither
Not particularly Not at all
comprehensive
comprehensive comprehensive comprehensive
or not
comprehensive
Please comment:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
14. Please indicate the relevance of each Action Area section to your
agency/service/organisation:
Type of
Specific Action area
Specifically Parts of Not
Action
section:
relevant
this
really
Area:
and/or very section relevant
relevant
are
relevant
Action
Section 4.1 – Identification of
Areas –
Risk factors
Individual
Section 4.2 – Support for
Workers
families and children
and/or
Section 4.3 – Addressing
teams
grief and loss issues
Section 4.4 - Access to
information, education and
decision-making
Section 4.5 - Care and
protection of children
Action
Section 5.1 – Identification of
Areas –
Risk factors
System
Section 5.2 – Support for
responses families and children
Section 5.3 – Addressing
grief and loss issues
Section 5.4 - Access to
information, education and
decision-making
Section 5.5 - Care and
protection of children
Section 5.6 – Partnerships
and cross-agency processes
Section 5.7 - Workforce
development and service
reorientation
Section 5.8 – Research and
evaluation
15. In general how useful are the Action Areas – Individual workers and/or
teams?
Very useful
Useful
Neither useful Not
or not useful
particularly
useful
Not at all
useful
Please comment:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
16. In general how useful are the Action Areas – System responses?
Very useful
Useful
Neither useful Not
or not useful
particularly
useful
Not at all
useful
Please comment:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
17. How readily can aspects of the Action Areas be adopted by your
agency/service/organisation?
A. Agency/Service/Organisation currently meets recommendations/guidelines:
Completely
Partially
Not at all
Don’t know
B. Agency/Service/Organisation should be able to adopt most aspects of the
Action Areas:
Within 1 year
Within 5 years
Don’t know
Not at all
C. Please comment:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
18. Will any specific Action Areas cause
problems for your
agency/service/organisation?
Yes
Don’t know
No
Please comment:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
19. In general what would assist your agency/service/organisation in
implementing outstanding Action Areas or parts of Action Areas?
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
20. Are there any major gaps in the document
which must be addressed?
Yes
No
Don’t know
Please comment:
___________________________________________________
___________________________________________________
___________________________________________________
21. It there a specific action area that you would like
to see changed?
Yes
No
Don’t know
Please note any additions or changes you think are necessary:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
22. Please add any other comments in the following space:
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
23. Approximately how long did it take you to complete this survey?
(mandatory)
(minutes)
24. Date Survey Completed on:
______________________________________