Abuse Survey

[Guest guest]

This is just a reminder.

Please forward this survey on to anyone & everyone!

We are requesting that the surveys be in by Feb. 15 so we may begin compiling the results.

Unfortunately many parents have responded to the survey but are too afraid of retaliation to complete it- this is so very sad & must not continue! We assure you that all responses are confidential!

The completed surveys we have received so far are simply unspeakable. That these things are happening in the public schools and then being covered up is mind boggling.

The survey is pasted below, it can be completed and returned as it is, or it can also be accessed at: http://www.mothersfromhell2.org/about/survey.htm where the text will need to be copied and pasted into an email to respond.

Please send all responses to: beth@...

Thank you for your assistance.

Beth Randall, President, Mothers From Hell 2

www.mothersfromhell2.org

Data Collection Regarding Abuse of Children With Special Needs in United States Public Schools by School Staff & Administration from 1995 to the Present

Mothers From Hell 2 is documenting abuse (physical & emotional/psychological) of children with special needs in United States Public Schools by school staff and administration from 1995 to the present.

Once the data has been compiled we will discern the most effective use of the information to facilitate systemic changes.

This survey will be distributed nationally in order to ensure the most accurate results.

This survey may be completed online and e-mailed to beth@... or printed and mailed to MFH2, P.O. Box 19, German Valley, IL 61039. Please return as soon as possible. The survey is accessible on the website, www.mothersfromhell2.org , as well. To email the survey you need to copy and paste the body of the survey onto an email, complete the survey in your email and send it to beth@... .

Please respond only with cases of physical and emotional/psychological abuse by school staff or administration- while we agree that the denial of services leading to regression is mistreatment and sexual abuse is abhorrent, as is peer bullying; this research is intended to capture data regarding only physical and emotional/psychological abuse by school staff and administration.

This survey may be completed by parents, relatives, caregivers, students, teachers, therapists, staff, administrators, etc.

Completion & submission of this survey to MFH2 constitutes consent for the information to be compiled with other survey responses and distributed as MFH2 determines.

Personally identifiable information, however, will be kept confidential and shared only with the MFH2 Board of Directors.

Please check all answers that apply by placing an X in front of the appropriate answers.

Note: there is space at the end for a brief written statement/explanation of the incident(s) you are reporting.

Person filling out this survey is: ____Parent ___Relative ____Caregiver ____Student (current or former)

___Staff ____Teacher ____Therapist ____ Administrator ____other (specify________)

Year(s) in which abuse occurred: ____1995 _____1996 _____1997 ____1998 ____1999 ____2000

____2001 ____2002 ____2003 _____2004

Grade(s) student was in when abused:

___K ___1 ___2 ___3 ___4 ___5 ___6 ___7 ___8 ___9 ___10___11 ___12

Student’s Initials, State in Which the Abuse Occurred, Date of Birth, Disability Diagnosis (this information is only to prevent duplication and to categorize by state, age and disability): _________________________________

Type of abuse: ______Physical _____Emotional/Psychological

Aspect(s) of the abuse: ____Harassment _____Public Humiliation ____Berating/Insults ______Kicking

_____Hitting/Punching ______Dragging _____Slapping _____Scratching _____Burning

_____Harming with Implement (for ex: ruler, stick, paddle, pencil, chair, wire, water)

______Use of Restraint ____ Force Feeding Food

______Force Feeding Inedible Items (for ex: vomit, crayons, paper)

______Electric Shock _____Deprivation of Food/Drink ____Extended Isolation/Confinement

_____ Use of Adversives (lemon juice spray for example) ____Other (please specify below)

School staff/personnel/administration involved - directly and indirectly: ____Teacher ____Aide

____Therapist ____Principal ____ Superintendent _____Custodian _____Kitchen staff

____ Bus Driver _____ Other (specify _____)

Effects of abuse on student: ____Bruising ____Scarring ____Bleeding ____Fear of School

____Post Traumatic Stress Disorder ____Fear of Strangers/Adults _____Vision Loss _____Hearing Loss

____Seizure _____Paralysis _____Loss of finger, toe, arm, leg ______Loss of Life

____ Injury requiring Medical attention ____Other (describe below)

Substantiation/documentation/evidence of abuse: _____Photo ____Witness ____Sworn Testimony

_____Legal Decision ____Criminal Conviction _____Written Account _____ Medical Record

_____Written Investigation Report _____ Psychological Records

_____Other (describe below)

Training level of abuser : ____Certified in non-violent crisis prevention _____Certified in physical restraint

_____Certified teacher (___regular education or ____special education) _____Certified administrator

____Certified therapist ______Certified therapy assistant

______Paraprofessional or aide (___with training or ___without)

_____Do not know (___information requested but withheld or ____not requested)

Action taken by school in response to abuse: ____Written investigation ____Report to child protection agency

____Report to law enforcement _____Dismissal of Abuser ____Transfer of Abuser within the district

_____Reprimand of Abuser without dismissal (____written or _____verbal) ____No action taken against abuser

______Reprimand of victim (____written or ____verbal) ______Suspension or expulsion of victim

______Reprisal in school setting (____victim _____abuser)

______ Intimidation of Parent to prevent reporting the abuse (explain below)

______ Retaliation by school for Parent reporting the abuse (explain below)

______Sought Medical Attention for student (if so, did the medical professional report the abuse to

authorities________) ______Other (describe below)

Action taken by parents/others: _____Report to child protection agency _____ Report to law enforcement

____Report to advocacy agency ______Sought Medical Attention for student (if so, did the medical

professional report the abuse to authorities________)

_____File written complaint (___with School District and/or ___State Board/Dept. of Education)

______File a due process lawsuit ____File a damages lawsuit _____ Request IEP meeting

_____Request change in Placement or Setting

Outcome of any actions taken: _____Dismissal of abuser ______Criminal conviction

______Change in school policy _____Training _____ Monetary damages award _____Compensatory services

______Official finding of abuse by child protection agency _____Change in student placement or setting

______ Retaliation by school for Parent reporting the abuse (explain below)

______ No outcome ____Other (please describe below)

Size of school district (total student enrollment): ___Under 1,000 ____1,000-5,000 ____5,000 -10,000

____10,000 - 20,000 _____20,000 + ____Do not know

Type of District : ____Rural ____Town ____Suburban ____Urban

Direct Effects the abuse has had on the Family: _____Moved away ( to another ____district ____state)

____Withdrew /Homeschooling child(ren) _____Legal expenses ______Therapy/Medical expenses

______ Loss of income (due to ____home schooling and/or ____legal battles)

_____Loss of status in community/friends/family (ostracized because of standing up to the school)

_____Emotional/psychological effects of sibling(s) from the incident(s)

_____Divorce/marital conflict

Media coverage: ______Reported by you ______Reported by school ______Reported by other source

_____Positive coverage (sympathetic to victim) _____Negative coverage (sympathetic to school, blame victim)

_____Newspaper _______Television ______Radio ______Local ______Regional ______National

_____Mixed results ( describe below)

For MFH2 to follow up with you on this information and verify its accuracy please provide:

(Note: Contact information will be kept strictly confidential.

However, providing this information is optional due to the sensitive nature of the survey.)

Name:

Address:

City & State & Zip Code:

Phone Number with Area Code:

Email Address:

Please describe the incident(s) of abuse as briefly as possible using no names - titles only - and initials only to identify your child: