Georgia Child Abuse and Neglect Prevention Plan
Parent, Caregiver and Neighbor Survey

Instructions

We are interested in learning more about how supports and resources available in the community can help assist caregivers in caring for children. This information will assist community leaders in identifying needs and planning to better fill these needs in the future. All individual responses are anonymous and will be kept confidential. The survey should take approximately 10 minutes to complete.

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* 1. Communities often have organizations that support families. Please indicate if you are familiar with the following institutions in your community.

Other (please specify)

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* 2. Please indicate if you have used or been actively involved with the following institutions in your community.

Other (please specify)

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* 3. People have different ways of describing their community. How well do the following statements describe people in your community?

	Not at all	Somewhat	Mostly	All of the time	Don't know
If I had an emergency, even people I do not know would be willing to help.	If I had an emergency, even people I do not know would be willing to help. Not at all	If I had an emergency, even people I do not know would be willing to help. Somewhat	If I had an emergency, even people I do not know would be willing to help. Mostly	If I had an emergency, even people I do not know would be willing to help. All of the time	If I had an emergency, even people I do not know would be willing to help. Don't know
People here know that they can get help if they are in trouble.	People here know that they can get help if they are in trouble. Not at all	People here know that they can get help if they are in trouble. Somewhat	People here know that they can get help if they are in trouble. Mostly	People here know that they can get help if they are in trouble. All of the time	People here know that they can get help if they are in trouble. Don't know
People can depend on each other in this community.	People can depend on each other in this community. Not at all	People can depend on each other in this community. Somewhat	People can depend on each other in this community. Mostly	People can depend on each other in this community. All of the time	People can depend on each other in this community. Don't know
My friends in this community are a part of my everyday activities.	My friends in this community are a part of my everyday activities. Not at all	My friends in this community are a part of my everyday activities. Somewhat	My friends in this community are a part of my everyday activities. Mostly	My friends in this community are a part of my everyday activities. All of the time	My friends in this community are a part of my everyday activities. Don't know
Living in this community gives me a secure feeling.	Living in this community gives me a secure feeling. Not at all	Living in this community gives me a secure feeling. Somewhat	Living in this community gives me a secure feeling. Mostly	Living in this community gives me a secure feeling. All of the time	Living in this community gives me a secure feeling. Don't know
This is a very good community to bring up children.	This is a very good community to bring up children. Not at all	This is a very good community to bring up children. Somewhat	This is a very good community to bring up children. Mostly	This is a very good community to bring up children. All of the time	This is a very good community to bring up children. Don't know

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* 4. Please indicate the extent to which you agree with the following statements.

	Strongly disagree	Disagree	Agree	Strongly Agree	Don't Know
I can generally get to where I need to go in my community.	I can generally get to where I need to go in my community. Strongly disagree	I can generally get to where I need to go in my community. Disagree	I can generally get to where I need to go in my community. Agree	I can generally get to where I need to go in my community. Strongly Agree	I can generally get to where I need to go in my community. Don't Know
My community has educational opportunities for children.	My community has educational opportunities for children. Strongly disagree	My community has educational opportunities for children. Disagree	My community has educational opportunities for children. Agree	My community has educational opportunities for children. Strongly Agree	My community has educational opportunities for children. Don't Know
My community is overall a clean, well-kept community.	My community is overall a clean, well-kept community. Strongly disagree	My community is overall a clean, well-kept community. Disagree	My community is overall a clean, well-kept community. Agree	My community is overall a clean, well-kept community. Strongly Agree	My community is overall a clean, well-kept community. Don't Know
I can find help with childcare in my community when I need it.	I can find help with childcare in my community when I need it. Strongly disagree	I can find help with childcare in my community when I need it. Disagree	I can find help with childcare in my community when I need it. Agree	I can find help with childcare in my community when I need it. Strongly Agree	I can find help with childcare in my community when I need it. Don't Know
I am very satisfied with my neighborhood as a place to live.	I am very satisfied with my neighborhood as a place to live. Strongly disagree	I am very satisfied with my neighborhood as a place to live. Disagree	I am very satisfied with my neighborhood as a place to live. Agree	I am very satisfied with my neighborhood as a place to live. Strongly Agree	I am very satisfied with my neighborhood as a place to live. Don't Know
I feel safe in my neighborhood.	I feel safe in my neighborhood. Strongly disagree	I feel safe in my neighborhood. Disagree	I feel safe in my neighborhood. Agree	I feel safe in my neighborhood. Strongly Agree	I feel safe in my neighborhood. Don't Know

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* 5. From time to time, people in communities offer help to each other to deal with simple issues around parenting. In the past 30 days, have you helped a neighbor or friend by:

	Not Needed	No	Once	More than once
Taking care of their child(ren) on a regular basis (e.g. daily or weekly)?	Taking care of their child(ren) on a regular basis (e.g. daily or weekly)? Not Needed	Taking care of their child(ren) on a regular basis (e.g. daily or weekly)? No	Taking care of their child(ren) on a regular basis (e.g. daily or weekly)? Once	Taking care of their child(ren) on a regular basis (e.g. daily or weekly)? More than once
Taking care of their child(ren) when something unexpected happened?	Taking care of their child(ren) when something unexpected happened? Not Needed	Taking care of their child(ren) when something unexpected happened? No	Taking care of their child(ren) when something unexpected happened? Once	Taking care of their child(ren) when something unexpected happened? More than once
Running an errand for them or helping them shop?	Running an errand for them or helping them shop? Not Needed	Running an errand for them or helping them shop? No	Running an errand for them or helping them shop? Once	Running an errand for them or helping them shop? More than once
Giving them a ride somewhere?	Giving them a ride somewhere? Not Needed	Giving them a ride somewhere? No	Giving them a ride somewhere? Once	Giving them a ride somewhere? More than once
Helping them around the house with a chore/repair?	Helping them around the house with a chore/repair? Not Needed	Helping them around the house with a chore/repair? No	Helping them around the house with a chore/repair? Once	Helping them around the house with a chore/repair? More than once
Lending them money or tools?	Lending them money or tools? Not Needed	Lending them money or tools? No	Lending them money or tools? Once	Lending them money or tools? More than once
Giving them food, clothing or other supplies?	Giving them food, clothing or other supplies? Not Needed	Giving them food, clothing or other supplies? No	Giving them food, clothing or other supplies? Once	Giving them food, clothing or other supplies? More than once
Caring for someone who is ill?	Caring for someone who is ill? Not Needed	Caring for someone who is ill? No	Caring for someone who is ill? Once	Caring for someone who is ill? More than once
Giving them information or advice about raising children?	Giving them information or advice about raising children? Not Needed	Giving them information or advice about raising children? No	Giving them information or advice about raising children? Once	Giving them information or advice about raising children? More than once
Providing information about a community organization that can help them?	Providing information about a community organization that can help them? Not Needed	Providing information about a community organization that can help them? No	Providing information about a community organization that can help them? Once	Providing information about a community organization that can help them? More than once

Other (please specify)

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* 6. Now thinking about this in terms of help you might have needed, in the past 30 days, have you asked someone for help in any of the following ways?

	Not Needed	No	Once	More than once
Taking care of your child(ren) on a regular basis (e.g. daily or weekly)?	Taking care of your child(ren) on a regular basis (e.g. daily or weekly)? Not Needed	Taking care of your child(ren) on a regular basis (e.g. daily or weekly)? No	Taking care of your child(ren) on a regular basis (e.g. daily or weekly)? Once	Taking care of your child(ren) on a regular basis (e.g. daily or weekly)? More than once
Taking care of your child(ren) when something unexpected happened?	Taking care of your child(ren) when something unexpected happened? Not Needed	Taking care of your child(ren) when something unexpected happened? No	Taking care of your child(ren) when something unexpected happened? Once	Taking care of your child(ren) when something unexpected happened? More than once
Running an errand for you or helping you shop?	Running an errand for you or helping you shop? Not Needed	Running an errand for you or helping you shop? No	Running an errand for you or helping you shop? Once	Running an errand for you or helping you shop? More than once
Giving you a ride somewhere?	Giving you a ride somewhere? Not Needed	Giving you a ride somewhere? No	Giving you a ride somewhere? Once	Giving you a ride somewhere? More than once
Helping you around the house with a chore/repair?	Helping you around the house with a chore/repair? Not Needed	Helping you around the house with a chore/repair? No	Helping you around the house with a chore/repair? Once	Helping you around the house with a chore/repair? More than once
Lending you money or tools?	Lending you money or tools? Not Needed	Lending you money or tools? No	Lending you money or tools? Once	Lending you money or tools? More than once
Giving you food, clothing or other supplies?	Giving you food, clothing or other supplies? Not Needed	Giving you food, clothing or other supplies? No	Giving you food, clothing or other supplies? Once	Giving you food, clothing or other supplies? More than once
Caring for you when you were ill?	Caring for you when you were ill? Not Needed	Caring for you when you were ill? No	Caring for you when you were ill? Once	Caring for you when you were ill? More than once
Giving you information or advice about raising children?	Giving you information or advice about raising children? Not Needed	Giving you information or advice about raising children? No	Giving you information or advice about raising children? Once	Giving you information or advice about raising children? More than once
Providing information about a community organization that can help you?	Providing information about a community organization that can help you? Not Needed	Providing information about a community organization that can help you? No	Providing information about a community organization that can help you? Once	Providing information about a community organization that can help you? More than once

Other (please specify)

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* 7. Many families have a number of strengths as well as challenges. From the statements below, please indicate how well each characteristic describes your "family."

	Rarely	Occasionally	Most of the time	All of the time
In my family, we openly talk about problems.	In my family, we openly talk about problems. Rarely	In my family, we openly talk about problems. Occasionally	In my family, we openly talk about problems. Most of the time	In my family, we openly talk about problems. All of the time
In my family, we take time to listen to each other.	In my family, we take time to listen to each other. Rarely	In my family, we take time to listen to each other. Occasionally	In my family, we take time to listen to each other. Most of the time	In my family, we take time to listen to each other. All of the time
My family is able to solve problems.	My family is able to solve problems. Rarely	My family is able to solve problems. Occasionally	My family is able to solve problems. Most of the time	My family is able to solve problems. All of the time
My family can consistently meet our basic needs (e.g. food, clothing, shelter).	My family can consistently meet our basic needs (e.g. food, clothing, shelter). Rarely	My family can consistently meet our basic needs (e.g. food, clothing, shelter). Occasionally	My family can consistently meet our basic needs (e.g. food, clothing, shelter). Most of the time	My family can consistently meet our basic needs (e.g. food, clothing, shelter). All of the time
My family enjoys spending time together.	My family enjoys spending time together. Rarely	My family enjoys spending time together. Occasionally	My family enjoys spending time together. Most of the time	My family enjoys spending time together. All of the time
Members of my family are physically healthy.	Members of my family are physically healthy. Rarely	Members of my family are physically healthy. Occasionally	Members of my family are physically healthy. Most of the time	Members of my family are physically healthy. All of the time
Members of my family are emotionally healthy.	Members of my family are emotionally healthy. Rarely	Members of my family are emotionally healthy. Occasionally	Members of my family are emotionally healthy. Most of the time	Members of my family are emotionally healthy. All of the time
My family is able to find resources in the community when we need them.	My family is able to find resources in the community when we need them. Rarely	My family is able to find resources in the community when we need them. Occasionally	My family is able to find resources in the community when we need them. Most of the time	My family is able to find resources in the community when we need them. All of the time

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* 8. Raising children is challenging. Please indicate how often each statement applies to you in thinking about the relationship with your youngest child living at home.

	Rarely	Occasionally	Most of the time	All of the time	Not applicable
I know how to help my child.	I know how to help my child. Rarely	I know how to help my child. Occasionally	I know how to help my child. Most of the time	I know how to help my child. All of the time	I know how to help my child. Not applicable
I believe my child misbehaves in order to upset me.	I believe my child misbehaves in order to upset me. Rarely	I believe my child misbehaves in order to upset me. Occasionally	I believe my child misbehaves in order to upset me. Most of the time	I believe my child misbehaves in order to upset me. All of the time	I believe my child misbehaves in order to upset me. Not applicable
I praise my child when he/she behaves well.	I praise my child when he/she behaves well. Rarely	I praise my child when he/she behaves well. Occasionally	I praise my child when he/she behaves well. Most of the time	I praise my child when he/she behaves well. All of the time	I praise my child when he/she behaves well. Not applicable
I am happy being with my child.	I am happy being with my child. Rarely	I am happy being with my child. Occasionally	I am happy being with my child. Most of the time	I am happy being with my child. All of the time	I am happy being with my child. Not applicable
My child and I are very close to each other.	My child and I are very close to each other. Rarely	My child and I are very close to each other. Occasionally	My child and I are very close to each other. Most of the time	My child and I are very close to each other. All of the time	My child and I are very close to each other. Not applicable
I am able to soothe or comfort my child when he/she is upset.	I am able to soothe or comfort my child when he/she is upset. Rarely	I am able to soothe or comfort my child when he/she is upset. Occasionally	I am able to soothe or comfort my child when he/she is upset. Most of the time	I am able to soothe or comfort my child when he/she is upset. All of the time	I am able to soothe or comfort my child when he/she is upset. Not applicable
I spend time with my child doing what she/he likes to do.	I spend time with my child doing what she/he likes to do. Rarely	I spend time with my child doing what she/he likes to do. Occasionally	I spend time with my child doing what she/he likes to do. Most of the time	I spend time with my child doing what she/he likes to do. All of the time	I spend time with my child doing what she/he likes to do. Not applicable
I know what to expect from my child as she/he grows and develops.	I know what to expect from my child as she/he grows and develops. Rarely	I know what to expect from my child as she/he grows and develops. Occasionally	I know what to expect from my child as she/he grows and develops. Most of the time	I know what to expect from my child as she/he grows and develops. All of the time	I know what to expect from my child as she/he grows and develops. Not applicable
My child and I laugh together.	My child and I laugh together. Rarely	My child and I laugh together. Occasionally	My child and I laugh together. Most of the time	My child and I laugh together. All of the time	My child and I laugh together. Not applicable
My child and I play together.	My child and I play together. Rarely	My child and I play together. Occasionally	My child and I play together. Most of the time	My child and I play together. All of the time	My child and I play together. Not applicable

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* 9. How many children under age 18 are currently living with you?

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* 10. What is the age of the youngest child living at home?

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* 11. Do you share caregiving responsibilities for your child(ren) with another adult on a regular basis?

Yes

Other (please specify)

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* 12. In which Georgia County do you live?

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* 13. Your gender?

Male

Female

Decline to answer

Other (please specify)

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* 14. Your age?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

Decline to answer

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* 15. Your ethnicity/race? (select all that apply)

White or Caucasian

Black or African American

Hispanic or Latino American

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Decline to answer

Other (please specify)

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* 16. What is the highest level of education you have completed?

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* 17. What is your estimated annual household income?

Under $15,000

Between $15,000 and $29,999

Between $30,000 and $49,999

Between $50,000 and $74,999

Between $75,000 and $99,999

Between $100,000 and $150,000

Over $150,000

Decline to answer

	Not available in my community	No	Yes
Religious or faith organizations	Religious or faith organizations Not available in my community	Religious or faith organizations No	Religious or faith organizations Yes
Hospital/urgent care clinics	Hospital/urgent care clinics Not available in my community	Hospital/urgent care clinics No	Hospital/urgent care clinics Yes
Primary care doctors (for adults)	Primary care doctors (for adults) Not available in my community	Primary care doctors (for adults) No	Primary care doctors (for adults) Yes
Pediatricians	Pediatricians Not available in my community	Pediatricians No	Pediatricians Yes
Neighborhood watch organizations	Neighborhood watch organizations Not available in my community	Neighborhood watch organizations No	Neighborhood watch organizations Yes
Resident, tenant or homeowner associations	Resident, tenant or homeowner associations Not available in my community	Resident, tenant or homeowner associations No	Resident, tenant or homeowner associations Yes
Parent organizations that work with schools (e.g. PTA, school improvement councils)	Parent organizations that work with schools (e.g. PTA, school improvement councils) Not available in my community	Parent organizations that work with schools (e.g. PTA, school improvement councils) No	Parent organizations that work with schools (e.g. PTA, school improvement councils) Yes
Sports or recreational programs for children and youth (e.g. Little League, scouting, summer activities programs, etc.)	Sports or recreational programs for children and youth (e.g. Little League, scouting, summer activities programs, etc.) Not available in my community	Sports or recreational programs for children and youth (e.g. Little League, scouting, summer activities programs, etc.) No	Sports or recreational programs for children and youth (e.g. Little League, scouting, summer activities programs, etc.) Yes
Programs for pre-school children (2-4 years of age)	Programs for pre-school children (2-4 years of age) Not available in my community	Programs for pre-school children (2-4 years of age) No	Programs for pre-school children (2-4 years of age) Yes
Quality rated, center-based care	Quality rated, center-based care Not available in my community	Quality rated, center-based care No	Quality rated, center-based care Yes
Libraries	Libraries Not available in my community	Libraries No	Libraries Yes
Parenting education/parent support programs	Parenting education/parent support programs Not available in my community	Parenting education/parent support programs No	Parenting education/parent support programs Yes
Home visiting programs	Home visiting programs Not available in my community	Home visiting programs No	Home visiting programs Yes
Family Resource Centers	Family Resource Centers Not available in my community	Family Resource Centers No	Family Resource Centers Yes
Respite or emergency child care for yong children	Respite or emergency child care for yong children Not available in my community	Respite or emergency child care for yong children No	Respite or emergency child care for yong children Yes

Georgia Child Abuse and Neglect Prevention Plan Parent, Caregiver and Neighbor Survey

Instructions

Question Title

* 1. Communities often have organizations that support families. Please indicate if you are familiar with the following institutions in your community.

Question Title

* 2. Please indicate if you have used or been actively involved with the following institutions in your community.

Question Title

* 3. People have different ways of describing their community. How well do the following statements describe people in your community?

Question Title

* 4. Please indicate the extent to which you agree with the following statements.

Question Title

* 5. From time to time, people in communities offer help to each other to deal with simple issues around parenting. In the past 30 days, have you helped a neighbor or friend by:

Question Title

* 6. Now thinking about this in terms of help you might have needed, in the past 30 days, have you asked someone for help in any of the following ways?

Question Title

* 7. Many families have a number of strengths as well as challenges. From the statements below, please indicate how well each characteristic describes your "family."

Question Title

* 8. Raising children is challenging. Please indicate how often each statement applies to you in thinking about the relationship with your youngest child living at home.

Question Title

* 9. How many children under age 18 are currently living with you?

Question Title

* 10. What is the age of the youngest child living at home?

Question Title

* 11. Do you share caregiving responsibilities for your child(ren) with another adult on a regular basis?

Question Title

* 12. In which Georgia County do you live?

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* 13. Your gender?

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* 14. Your age?

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* 15. Your ethnicity/race? (select all that apply)

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* 16. What is the highest level of education you have completed?

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* 17. What is your estimated annual household income?

Georgia Child Abuse and Neglect Prevention Plan
Parent, Caregiver and Neighbor Survey