CFT Questionnaire - Is this right for your child?
Thank you for your interest in The Children’s Friendship Training (CFT) Program through the Simcoe County District School Board (SCDSB). This questionnaire will provide key information that will help us determine if CFT may be a good fit for your child and family. Upon submitting the questionnaire, you will be contacted by Crystal Gronc. If you have any questions please contact Crystal, ASD After School Social Skills Program Coordinator through email at cgronc@scdsb.on.ca
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How did you find out about the CFT Program through the SCDSB? *
Name of child (first and last): *
Age of child: *
Gender: *
Parent/Guardian name (first and last): *
Email address: *
Phone Number (home): *
Phone Number (cell): *
Address (street# and/or unit#, street name, city, postal code): (may be used to drop off materials to the child) *
The CFT Program is a parent-assisted intervention for children in elementary school that are having difficulties making or keeping friends. Is the child in elementary school, and would this program be of interest to their family? *
There is a caregiver component of the CFT Program which requires one caregiver to attend on a consistent basis. Another caregiver is welcome to attend, but for continuity, it is suggested caregivers do not trade-off attending. Would at least one caregiver be available to consistently attend the program with the child/during a parent training session? *
There are separate caregiver and child sessions that meet each week over a 9-week period. Caregivers are taught how to help their children make friends by acting as social coaches outside of the group for 15 minutes before or after the child session. Would caregivers agree to attend and complete all homework assignments? *
Does the child want to have friends and learn new strategies? Would he/she/they be motivated to learn how to make new friends and attend the class? 1= extremely resistant, 7=Is open to being helped and wants desperately to improve *
Extremely resistant
Open to being helped and wants desperately to improve
Is the child's family be able to attend CFT using a virtual platform (Zoom)? e.g. has at least one device at home and can access the internet *
What are the child's favourite activities or special interests? *
What road block(s) does the child have making friends? Please check off all options that apply *
Required
Does the child have any type of psychological or medical diagnosis? Please check off all options that apply *
Required
How severely affected is the child's communication? This will help us understand his/her language and conversational abilities. 1= Uses echolalia, brief sentences or single words, needs frequent adult support, very limited verbal expressive abilities, 7=Mainstreamed in advanced academic classes, socially awkward, trouble making/keeping friends *
uses echolalia, brief sentences or single words, very limited verbal expressive abilities
mainstreamed in advanced academic classes, socially awkward, trouble making/keeping friends
Does your child read at grade level? *
What educational classroom setting is the child currently placed in? *
Academically, is the child on an adapted or modified program below grade level? *
Does the child have any aggressive behavioral difficulties at home or school? *
Does the child have a group of friends at school? *
Does the child have play dates with peers or have friends come over? *
Does the child know how to play simple board games (e.g. UNO, Sorry, etc.) *
Does the child know how to play school recess games? (e.g. Grounders, 4-square, soccer, etc.) *
Here are a few topics covered in the CFT Program class. Which of the following skills does the child require assistance with? Please check off all options that apply *
Required
Any other questions or comments?
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