Parent Survey

Before starting the survey, please note that we are asking for responses from parents or caregivers of children ages 0-17 who live in their home in Adams, Arapahoe, Denver, or Douglas counties only. Thank you!

Please answer questions 1-14 about yourself and the children living in your home.

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* 1. What county do you live in?

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* 2. What zip code do you live in?

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* 3. How many children age 0 to 17 currently live in your home?

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* 4. How old is/are the child/children in your home? Mark all that apply

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* 5. Is/are your child/children Hispanic, Latino/a or Spanish origin?

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* 6. What are the race(s) of the child/children living in your home. Mark all that apply.

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* 7. What kind of health insurance does/do your child/children have? Mark all that apply.

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* 8. What is your household income? Mark ONE response.

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* 9. During the past 12 months, where did you usually take your child/children for routine medical care such as check-ups? Mark one response.

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* 10. During the past 12 months, where did you usually take your child/children for immediate medical care for issues such as high fever, vomiting, or injury? Mark one response.

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* 11. What are some reasons that my prevent or delay you from getting medical care for your child/children? Mark up to 3 responses.

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* 12. During the past 12 months, have you or any of family members you live with been unable to get any of the following when it was really needed? Check all that apply.
If you were able to get all of the following resources when you needed them, please mark, "NONE - we were able to get all these things when they were needed."

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* 13. During the past 12 months, has a doctor, nurse, or other health care worker talked with you about your ability to get or pay for any of the following? Check all that apply.

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* 14. During the past 12 months, what community resources have you used? Mark all that apply.

The goal of the next question (Question 15) is to understand what you think are the most critical health needs for children in your community. Please answer the next question about children who live in your community, not just your children.

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* 15. When you think about the most critical health needs for children in your community, please rank each health need below on a scale of 1 to 3, with 1 being less critical and 3 being very critical. If you think of a health concern that is not listed here, please write it in under “other” and provide your ranking.

  1 - Less critical 2 - Somewhat critical 3 - Very critical Not sure
Accidents and injuries
Asthma
Care for children with special needs (physical, emotional, developmental or behavioral)
Dental care
Diabetes
Early child care and education
Healthy pregnancies and childbirth (not teen pregnancy)
Immunizations (vaccines) and infectious diseases
Mental or behavioral health
Nutrition
Obesity
Physical activity
Respiratory health other than asthma (COPD, cystic fibrosis)
Sexual health
Suicide prevention
Teen pregnancy
The goal of the next question (Question 16) is to understand what you think are other critical needs or concerns that affect child health in your community. Please answer the next question about children who live in your community, not just your children.

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* 16. When you think about other critical needs or concerns that affect child health in your community, please rank each community concerns below on a scale of 1 to 3, with 1 being less critical and 3 being very critical. If you think of a concern that is not listed here, please write it under “other” and provide your ranking.

  1 - Less critical 2 - Somewhat critical 3 - Very critical Not Sure
Access to benefits (Medicaid, WIC, food stamps)
Access to or cost of child care
Bullying and other stressors in school
Child abuse and neglect
Crime and community violence
Domestic violence
Educational needs
Family member alcohol or drug use
Housing
Hunger or access to healthy food
Lack of employment opportunities
Legal problems
Parenting education (parenting skills for child development)
Safe neighborhoods and places for children to play
Social Media
Traffic safety
Transportation challenges
Thank you for your input!

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