CHICS Liverpool Service Evaluation Survey 2014
1. Please help us by describing your family by ticking appropriate boxes:
Membership Type
Parents of child diagnosed with cancer
Bereaved Parents
Relative
Friend
Neighbour
Professional
Yes / No
Children’s Age
Local Authority Area
Liverpool
Sefton
St Helens
Halton (Runcorn / Widnes)
Warrington
Knowsley
Lancashire
2. CHICS Support Meetings
Do you attend the Support meetings held the second Tue of the month? Yes / No
If your answer is No please can you outline in the space below why you are unable to
attend?
If you have stopped attending please can you indicate why?
3. CHICS Family Support Service
In the early days after diagnosis on a scale of 1 (low) to 10 (high) how much
emotional support did you receive from family and friends?
Score =
Were you aware of CHICS visiting the ward in Alder Hey? Yes / No
Did a CHICS member of staff or volunteer make contact with you? Yes / No
If the answer is Yes, on a scale from 1 (low) to 10 (high) how helpful and supportive
was the CHICS Visit?
Score =
What other help could the Family Group have provided in those early weeks of
diagnosis?
If you are still attending Outpatients clinic please answer the following questions:
Are you aware of CHICS presence in Outpatients? Yes / No
Have you been contacted by a CHICS representative in Outpatients? Yes / No
4. CHICS Advice and Information Packs
When did you hear about CHICS after diagnosis?
1 – 2 weeks
1 – 2 months
Longer
How were made aware of CHICS:
Contact Method
a) Received family pack
b) CHICS visiting ward /clinic
c) Hospital staff
d) CHICS members’
e) Poster/ leaflet etc. on ward
f)
Poster/leaflet etc. at clinic
g) Macmillan nurse/Social worker
h) Other – please specify
Please tick applicable method
5. Longer Term Support
Please identify what activities if any you would interested in attending as a family /
children only?
Activity
Social meetings for parents
Specialist Guest Speaker Meetings
Family Outings (parents / siblings etc)
Children only trips / outings
Family parties during the year
Themed Trips
Theatre / Museum / Musical visits
Social Events
Short Break Group Holidays - families
Short Break Group Holidays - children
Respite Breaks
Others – please specify
1- 3 months
Longer Term
Not Applicable
6. Future Support Role
How would you like to be involved in CHICS in the future?
Activity
Befriending recently diagnosed families
Events / outings organisation
Fundraising
Others – please specify
Yes / No
7. As a result of accessing CHICS do you feel you are more aware, informed and
prepared for the processes and procedures involved in the treatment of your child?
Yes / No
What part of the service has helped you the most?
8. As a result of accessing CHICS have you developed coping mechanisms for dealing
with the emotional stresses on the family?
Yes / No
What has been most useful aspect of the service for you?
9. By accessing CHICS do you feel the personal development and life chances of your
child have been increased?
Yes / No
How have CHICS helped you?
10. Please add further comments about CHICS service below and do you feel there are
any gaps that need to be considered for the future
Many thanks for completing the survey please add your name and address below so CHICS
can contact you to discuss any of the points completed. If you wish to remain anonymous
please leave blank.
Name
Address
Tel No
E mail
Please return to
Eddie Hincks
22 Ayrshire Road,
Liverpool
L4 7XW or e-mail to eddie.chics@blueyonder.co.uk