We are interested in understanding the experiences of youth and families in Pennsylvania during the COVID-19 pandemic. You are being asked to answer some questions about mental health/illness, schooling, social experiences, and what we can do to help each other. Please be assured that your responses will be kept completely confidential and will be reported as combined group information except for individual testimonials. By completing this form you provide consent for your data to be combined in aggregate as well as the use of any written testimonial to be used in a completely anonymous manner. You acknowledge that the data and information gathered will be distributed to entities including but not limited to: state and local government, private provider agencies, non-profit agencies, and participant respondents, all upon request and in the interests of developing appropriate service responses to the COVID-19 pandemic.

This survey should take less than 10 minutes to complete. If you have other questions about why we are collecting this information, please contact pmhca@pmhca.org. 

The first part of this survey includes non-identifying demographic information for parents to fill out.

The second part of this survey asks youth or parents and their youth together to describe your experiences since the COVID-19 pandemic began in March of 2020.

By filling out this survey, you acknowledge that your participation in the survey is voluntary; you are 18 years of age and older and you are representing yourself or an individual who is underage or incapacitated; and that you are aware that you may choose to terminate your participation in the survey at any time and for any reason.

Question Title

* 1. What is your child's age range? If you have more than one school-aged child, please fill out a separate survey for each child.

Question Title

* 2. What is your race?

Question Title

* 3. What county do you live in?

Question Title

* 4. What type of area do you live in?

Question Title

* 5. How has the COVID-19 pandemic affected your family's daily life?

Question Title

* 6. How has your relationship with your child changed since the beginning of the pandemic?

Question Title

* 7. Have you noticed a difference in your child's behavior or personality since the beginning of the COVID-19 pandemic?

Question Title

* 8. I am completing the following questions in this survey with my child or allowing my child to complete the following questions in this survey on their own with my permission.

Question Title

* 9. Have you felt isolated or more alone since COVID started?

Question Title

* 10. How have your friendships changed since the pandemic began?

Question Title

* 11. Has COVID affected the way you think about the future?

Question Title

* 12. How do you feel about your area opening back up to 100% capacity?

Question Title

* 13. How has your relationship with your family changed since the pandemic began?

Question Title

* 14. How has COVID affected your daily life?

Question Title

* 15. Is your school currently:

Question Title

* 16. How do you feel your school performance has been affected in the 20-21 school year?

Question Title

* 17. How has your access to therapy, counseling, or other mental health services been since COVID-19 began?

Question Title

* 18. Are you satisfied with meeting with your therapist online (telehealth)?

Question Title

* 19. Has your social media use frequency changed since the pandemic began?

Less Use No Change More Use
Clear
i We adjusted the number you entered based on the slider’s scale.

Question Title

* 20. How much time are you spending on social media & gaming every day during the COVID-19 pandemic? (fb, insta, tiktok, snapchat, youtube, fortnite, roblox, etc.)

Question Title

* 21. Describe challenges you’ve experienced during COVID:

Question Title

* 22. Describe successes you’ve experienced during COVID:

T