BREAK Exchange Member Profile Survey

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Welcome to the BREAK Exchange! The Building Respite Evidence and Knowledge (BREAK) Exchange is an international group of researchers, respite providers, agencies, and individuals who are committed to building a culture of evidence-based respite care.

Please complete the following Member Profile Survey to help us get to know you better.

For reference, we are using the American terms respite for short break and caregiver for carer.

Name

Country

State/Province

Name of organization (if applicable)

What is your current position in your organization? (if applicable)

Brief description of organization (if applicable)

Website and social media links (if applicable)

Which of the following groups of people do you work with/serve (if applicable)? (Select all that apply.)

Children with disabilities (i.e. physical or developmental)

Adults with disabilities (i.e. physical or developmental)

Older adults (i.e. Alzheimer's and dementia)

Other:

What is your primary ROLE as it relates to respite services?

Researcher

Respite Provider

Respite Agency/Program Administrator or Director

Individual interested in respite care

Caregiver

Care Recipient/Individual with a disability

Other:

Clear selection

Which of the following ACTIVITIES are you or your organization involved in? (Select all that apply.)

Provide respite services

Assist caregivers in accessing respite services

Train respite providers

Evaluate respite programs

Conduct respite-related research

Other:

What areas are you INTERESTED in? (Select all that apply)

Practice (i.e. providing respite care and/or ensure respite services are provided)

Research (i.e. conducting or partnering on studies involving respite services)

Evaluation (i.e. conducting or partnering on evaluation projects involving respite services)

Policy (i.e. informing or implementing policies related to respite)

Other:

In what aspects of the BREAK Exchange would you like to be involved? (Select all that apply.)

Reading monthly e-newsletter

Contributing to monthly e-newsletter newsletters

Hosting quarterly webinars

Viewing quarterly webinars

Participating in monthly virtual networking hour events

Using resources on the website

Building partnerships with other members

Following social media updates

Other:

Would you like the BREAK Exchange to consider featuring your work in our monthly NEWSLETTER?

Yes

Maybe

Clear selection

Would you like the BREAK Exchange to consider featuring your work in one of our WEBINARS?

Yes

Maybe

Clear selection

Would you like your information to be added/updated in the publicly available/searchable BREAK Exchange MEMBER DATABASE on our website? This database helps create connections and potential collaborations.

Yes

Clear selection

Please describe any additional questions or comments you would like to share.

Thank you for completing the BREAK Exchange Member Profile Survey!

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