Mana Ake Feedback Form

Mana Ake Feedback Form

We appreciate your feedback on our Mana Ake programme. Your input helps us to continuously improve our services and better support tamariki and whānau across Te Tai o Poutini.
Date:*

DayMonthYear
Date
Name:*

First NameLast Name
Relationship to tamariki (child):*

Parent/CaregiverSchool Staff (e.g. Teacher, Counsellor, etc.)Whānau MemberOther (Please Specify)
Location/Region:*

MāwheraHokitika/WestlandKawatiriSouth Westland
Overall Experience with Mana Ake
1. Did you feel that the support provided by Mana Ake Kaiawhina was helpful?*

YesSomewhatNo
Comments:
2. Were the services provided by Mana Ake Kaiawhina culturally responsive and respectful to your family’s values?*

YesSomewhatNo
Comments:
3. How would you rate the accessibility of Mana Ake services?*

Very AccessibleAccessibleSomewhat DifficultDifficult
Comments:
Programme Impact
1. What changes, if any, have you noticed in your tamariki as a result of Mana Ake's support? (Check all that apply)*

Improved WellbeingIncreased ConfidenceBetter Social SkillsImproved Behaviour at HomeImproved Behaviour at SchoolLearned New Skills or StrategiesAccessed Additional Support ServicesNo Notable ChangeOther (Please Specify)
2. What specific skills or strategies did your child gain through the programme? (Check all that apply)*

Emotional RegulationResiliencePositive Self-TalkConflict ResolutionCoping with Change or LossManaging AnxietyEnhanced Social SkillsOther (Please Specify)
Programme Delivery
1. How did you find the delivery of the programme?*

EffectiveSomewhat EffectiveNot Effective
Comments:
2. Were the Mana Ake Kaiawhina professional, respectful, and supportive in their interactions?*

YesSomewhatNo
Comments:
3. Did you receive clear and regular communication from Mana Ake Kaiawhina about your child’s progress?*

Yes, it was very clear and regularSomewhat clearNo, it was unclear
Comments:
4. Did the Mana Ake Kaimahi provide timely responses to your questions or concerns?*

YesSomewhatNo
Comments:
Programme-Specific Feedback

Please rate their effectiveness
1. I Am Valued
Was the programme helpful?*

YesNo
How did it impact your child’s self-esteem and social skills?*
2. Seasons for Growth
Did this programme help your child understand and cope with change/loss?*

YesNo
Comments:
3. Brave Brains
Was this programme effective in helping your child manage anxiety?*

YesNo
Comments:
4. LEGO-Based Therapy
Did this programme support your child’s social and communication skills?*

YesNo
Comments:
5. Friendship/Social Skills Groups (Kapa hoa)
Was this group beneficial for your child’s social development?*

YesNo
Comments:
6. One-on-One Support
How did the individual support sessions impact your child’s wellbeing?*
Whānau Experience and Engagement
1. Did Mana Ake provide opportunities for you to be involved in your child’s journey?*

YesSomewhatNo
Comments:
2. Did Mana Ake provide helpful tools or resources to support your child at home?*

YesSomewhatNo
Comments:
3. How satisfied are you with the level of whānau involvement provided by Mana Ake?*

Very SatisfiedSatisfiedSomewhat SatisfiedDissatisfied
Comments:
Suggestions for Improvment
1. What did Mana Ake do well? *
2. What areas of the Mana Ake programme could be improved?*
2. What areas of the Mana Ake programme could be improved?*
3. Is there anything you wish the Mana Ake programme included or did differently?*
4. Would you like additional support or follow-up from Mana Ake on specific topics? (check all that apply)

Anxiety and Stress ManagementSocial Skills BuildingResilience and Coping StrategiesGrief and LossParenting and Family SupportOther (Please Specify)
Permission for Future Contact
1. Would you be open to participating in follow-up interviews or focus groups to further discuss your experience?*

YesNo
2. Can Mana Ake contact you for more information or clarification about your feedback?*

YesNo
Preferred Contact Information
Imēra (Email)
example@example.com
Waea pūkoro (Phone Number):

Area CodePhone Number
Thank you for taking the time to share your thoughts with us.

Your feedback is invaluable and plays a vital role in shaping the way we provide care and support. We deeply appreciate your insights.
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Mana Ake Feedback Form

Overall Experience with Mana Ake

Programme Impact

Programme Delivery

Programme-Specific Feedback

1. I Am Valued

2. Seasons for Growth

3. Brave Brains

4. LEGO-Based Therapy

5. Friendship/Social Skills Groups (Kapa hoa)

6. One-on-One Support

Whānau Experience and Engagement

Suggestions for Improvment

Permission for Future Contact

Preferred Contact Information