Thank you for visiting our survey form pilot page.
This page will show you the questions that will appear in sections in a questionaire that will be sent to about 450 people in the London area who are members of the DSA.
The main point of the survey is to find out about services offered in specific areas of London. The results will eventually be published on our web site in the form of a services database that will be searchable. Personal information about individuals will not be published.
If you have any comments about the sort of questions we should be asking please send an email to info@downs-syndrome-london.org.uk

Section 1: About the person who has Down’s Syndrome

Do you yourself have Down’s Syndrome? Yes o No o
Are you the parent or carer of a person with Down’s Syndrome? Yes o No o
Your name . . .
Your address . .
Post code . . . . . . . . . . . . .
Tel: Fax: . . . . . . . . . . . . . . . . . . . . . email . . .
In which London Borough do you live?
Which health authority covers your area?
Date of birth of the person who has Down’s Syndrome . . ./ . . ./ . . . .
In which hospital was the person with Down’s Syndrome born? . .
If the hospital was outside London, when did the person with Down’s Syndrome come to London?
Does the person with Down’s Syndrome have any brothers or sisters?
Number of brothers . . .
Number of sisters . . . . . . . . .
Dates of birth of brothers . . .
Dates of birth of sisters . . .
Do any of the brothers and sisters have special needs?
If so, describe what that is . .

Section 2: Education

Has the person with Down’s Syndrome attended an educational establishment in London? Yes o No o
If No then please go to section 3.
At what age did he or she start school?. .
Describe the last school or college he/she attended.
Was it? State funded o Private o Charity or Church funded o Special needs school o
Other, please specify
Is the establishment; Day only o Boarding o Other,
please specify Name of head teacher and name and address of school . .
If the person with Down’s Syndrome has received an educational Statement from a London authority did this cover the educational requirements?
Not applicable o Don’t know o Yes o No o
In your view did the school fulfil the requirements of the Statement?
Not applicable o Don’t know o Yes o No o
How many hours per week were specified in the Statement?
What special needs did the school have to supply in order to fulfil the statement and how successful was this?

Section 3: Services provided by the state in your area

Which of the following state run services were offered in your area?
Physiotherapy o Occupational therapy o Portage or home help o Speech therapy o Music therapy o Toy library o Other, please specify o Other, please specify o
How long did you have to wait for each service:
Physiotherapy ....Occupational therapy ....Portage or home help ....Speech therapy ....Music therapy ....Toy library ....Other, please specify ....Other, please specify ....
If the person with Down’s Syndrome is pre school age has your local authority been involved in a government funded “Sure Start” scheme for pre school children? Yes o No o
If Yes, please inform us what they did and if it helped you.
What services offered by the state in your area could be improved and how you would benefit?

Section 4: Private and charity services

Please photocopy this section if you are telling us about several organisations.
Tell us about any non state run services which help babies, children or adults with Down’s Syndrome:
Name of organisation
Address . .
Post code
Tel
Fax . . . . . . . . . . . . . . . . . . . . . .
email
web site address
Is the organisation;
a charity o a support group o church or religious group o parent run group o other, please specify
What do they offer to help people with Down’s Syndrome?

Section 5: Accommodation

Which of the following applies to the person with Down’s Syndrome?
Living with parents or carers o Living in own accommodation o Living in sheltered accommodation o Living in an institution o Living in a group home o Living in a hostel o
Approximately how many hours per week does a support worker spend with the person who has Down’s Syndrome dealing with any problems?
Who else helps with any accommodation problems?

Section 6: Work

Does the person with Down’s Syndrome work? Yes o No o
If yes, is the job: Employed full time o Employed part time o Work experience o Self employed o Non paid work o
How many hours of work per week?
What sort of job/s is it?
What work does the job/s involve?