here - Equinox Consulting
1. Welcome to the survey Gloucestershire County Council is reviewing the services that it commissions for carers from the black and minority ethnic community. Equinox Consulting have been asked to undertake a survey of carers with a view to making recommendations on how best the service should be designed to assist carers with their caring roles. We are asking that you participate in this survey that will take about 30 minutes of your time. We believe that the valuable information you provide will help us to better understand how to support you in your caring role. *A Carer is anyone who cares, unpaid for family member or friend who due to illness, disability, a mental health problem or an addiction cannot cope without their support. 2. Carer Profile 1. Do you spend time providing unpaid support to a family member, partner, or friend who is ill, frail, disabled or has mental health or substance abuse problems, who would not be able to cope without your support? Yes No 2. What is your ethnic origin? White Mixed Asian Black Other Ethnicity Other (please specify) 3. Which Council do you pay your council tax to? Cheltenham Stroud Cotswold Gloucester Tewkesbury Forest of Dean Other (please specify) 3. Caring duties 4. What is the gender of the person you are caring for? Male Female Transgender 5. How old are they? <5 6-17 18-25 26-44 45-64 65-79 80+ 1 6. Why do they need your care? Learning disabilities Substance abuse Mental health issues Physical Old and frail disabilities Ill and end of life Ill with long term condition Other (please specify) 7. What is your relationship to them? Parent Child Sibling Friend other relative Spouse/Partner 8. How long have you been caring for them? under 3 months 4 - 12 months 1 - 2 years 3- 5 years over 5 years 9. Why are you the person providing care for them? 10. How many hours a week do you care for them? 1-19 20-34 35-49 50+ 11. Please describe the type of support that you provide for the person you support and care for 12. Does anyone else assist you with the care that you provide? Yes No 13. Does a paid care worker also provide services to the person you look after? Yes No 4. Your Support Needs We would like to hear how providing the care and support affects you and if there is any way you can be assisted in your role. 14. How does your caring role affect your normal life and day to day activities? 15. What are the THREE most important ways that the caring role affects your life? 1 2 3 2 16. What things would you like to do but you are unable to do because of your caring responsibilities? 17. What would make a positive difference to your caring role? 18. Have you ever sought assistance from anyone relating to your care role? Yes No 19. Please explain why you have not sought any support? 20. Who have you asked for assistance relating to your caring role? 1 2 3 21. How did you find out about the fact that help was available? GP Family Newspaper Local Authority Leaflet Carer Organisation Community group Advert Friend Radio Other (please specify) 5. Services Received 22. which organisations provide you with services? Short breaks Respite Information Advice Training and education toolkits for caring skills emotional support financial allowances 3 23. How have these services helped you in your role as a carer? 6. Carers Assessment 24. Have you received carers assessment? Yes No 25. Did you receive assistance in planning the support that you needed? Yes No 26. Which organisations provide you with assessment and support planning 1 2 3 27. How would you rate the assessment and support planning you received? excellent good satisfactory poor 28. What would have improved your experience of assessment and support planning? 7. Access to information 29. Have you used information and advice services? Yes No 30. Which organisations provided you with information and advice 1 2 3 31. How would you rate the information and advice you receive? excellent good satisfactory poor 32. What additional information and advice would you find useful? 1 2 3 4 8. Having a break from Caring 33. Do you receive a carers break? Yes No 34. Which is the main organisation that provides you with a break? 35. How would you rate the carer breaks you receive? excellent good satisfactory poor 36. Please explain why you have given this rating 37. How could the breaks service you currently receive be improved? 9. Emotional Support 38. Have you used an emotional support service. e.g.counselling, carer support group or support from another person? Yes No 39. Which is the main organisation that provided you with emotional support? 40. How would you rate the emotional support you receive? excellent good satisfactory poor 41. How can the emotional support you receive be improved? 10. Hearing your Views Every carer has a right to have their views heard to influence decisions and to influence the services that are developed for carers 42. Do you get any support to have your views heard? Yes No 5 43. If Yes, state which organisations assist you? 1 2 3 44. If No, what stops you from having your views heard? 45. How would you rate the support you receive to have your views heard? excellent good satisfactory poor 46. How can the support you receive to have your views heard be improved? 11. Additional support issues 47. Do you belong to any networking or support organisation? Yes No 48. If Yes, please tell us the main ones you belong to 1 2 3 49. What happens when you are not able to provide the care you usually do? I am registered on the Carers Emergency Scheme I make my own arrangements 50. Please explain the reasons for your choice 51. What are the three most important services that you receive? 1 2 3 6 52. How would you rate the services you receive? excellent good satisfactory poor 1 2 3 53. What further support would help you in your caring role? 54. Is the ethnicity or religion of the person who supports you important to you? Very important Important fairly important Not important 55. Why is this? 12. Demographics 56. How old are you? <8 8-11 12-17 18-25 26-44 45-64 65-79 80+ 57. What is your gender? Female Male Transgender 58. Which of the following best describes your current marital status? Married In a domestic partnership or civil union Widowed Single, but cohabiting with a significant other Divorced Single, never married Separated 59. How many children do you have? Dependant Non-dependant 60. Which of the following categories best describes your employment status? Employed, working full-time Not employed, NOT looking for work Employed, working part-time Retired Not employed, looking for work Not able to work due to disability 7 61. What is your religion? Christian Buddhist Sikh Muslim Jewish None Rastafari Hindu would prefer not to say Other (please specify) 62. How would you describe your sexual orientation? Heterosexual Gay/Bisexual Prefer not to say 63. Would you like to be contacted to participate in a focus group or in-depth interview? Yes No 64. Please provide us with your contact details Name Address PostCode Telephone Number Email address 8
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