School-Based Tele-Counseling Feasibility Study Parents Survey

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* 1. What is your gender?

Female

Male

Other (specify)

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* 2. Are you of Hispanic or Latino/a origin?

Yes

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* 3. Which race or ethnicity best describes you? (Please choose only one.)

American Indian or Alaskan Native

Asian / Pacific Islander

Black or African American

Hispanic

White / Caucasian

I prefer not to answer

Multiple ethnicity/ Other (please specify)

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* 4. Are you the legal guardian of a child in a Phillips County School?

Yes

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* 5. How many children do you have?

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* 6. Please list the age(s) of your child(ren)

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* 7. How old are you?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

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* 8. Are you a single parent?

Yes

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* 9. Do you have support from family sources in caring for your child/children?

Yes

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* 10. Do you have support from friends in caring for your child/children?

Yes

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* 11. Do you have support from a religious community in caring for your child/children?

Yes

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* 12. Do you have support from another source in caring for your child/children?

Yes

If yes, please describe

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* 13. Have you ever worried your child (or children) suffered from depression, anxiety, behavior problems?

Yes

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* 14. Are you concerned for your child’s (or children's) emotional wellbeing?

Yes

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* 15. Do you think mental health is important?

Yes

Why or why not? (please specify)

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* 16. Do you feel your child would benefit from mental health services?

Yes

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* 17. Have you ever tried to take your child to mental health appointments and had difficulty getting them there?

Yes

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* 18. If yes, what was the main source of problems (select all that apply)

Transportation (lack of)

Transportation (distance to appointment)

Gas

Time

Work

Cost

Insurance

Other (please specify)

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* 19. If mental health services were offered at your child’s school, would you be okay with them attending the appointment while at school?

Yes

Why or why not? (please specify)

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* 20. Telehealth medical services are when a person has a private and secure appointment with a doctor, nurse, or therapist using the computer and video like FaceTime.

Do you think it is a good idea to offer these types of mental health services at the school?

Yes

Why or why not? (please specify)

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* 21. What do you think might be some problems with doing this?

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* 22. How satisfied are you with the student support services offered at your child’s school?

Strongly Satisfied

Satisfied

Neutral

Dissatisfied

Strongly Dissatisfied

School-Based Tele-Counseling Feasibility Study Parents Survey

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* 1. What is your gender?

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* 2. Are you of Hispanic or Latino/a origin?

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* 3. Which race or ethnicity best describes you? (Please choose only one.)

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* 4. Are you the legal guardian of a child in a Phillips County School?

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* 5. How many children do you have?

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* 6. Please list the age(s) of your child(ren)

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* 7. How old are you?

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* 8. Are you a single parent?

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* 9. Do you have support from family sources in caring for your child/children?

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* 10. Do you have support from friends in caring for your child/children?

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* 11. Do you have support from a religious community in caring for your child/children?

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* 12. Do you have support from another source in caring for your child/children?

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* 13. Have you ever worried your child (or children) suffered from depression, anxiety, behavior problems?

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* 14. Are you concerned for your child’s (or children's) emotional wellbeing?

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* 15. Do you think mental health is important?

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* 16. Do you feel your child would benefit from mental health services?

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* 17. Have you ever tried to take your child to mental health appointments and had difficulty getting them there?

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* 18. If yes, what was the main source of problems (select all that apply)

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* 19. If mental health services were offered at your child’s school, would you be okay with them attending the appointment while at school?

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* 20. Telehealth medical services are when a person has a private and secure appointment with a doctor, nurse, or therapist using the computer and video like FaceTime.Do you think it is a good idea to offer these types of mental health services at the school?

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* 21. What do you think might be some problems with doing this?

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* 22. How satisfied are you with the student support services offered at your child’s school?

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* 23. What other comments do you have about these questions?

* 20. Telehealth medical services are when a person has a private and secure appointment with a doctor, nurse, or therapist using the computer and video like FaceTime.

Do you think it is a good idea to offer these types of mental health services at the school?