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.

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

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

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

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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.
People here know that they can get help if they are in trouble.
People can depend on each other in this community.
My friends in this community are a part of my everyday activities. 
Living in this community gives me a secure feeling.
This is a very good community to bring up children. 

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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.
My community has educational opportunities for children.
My community is overall a clean, well-kept community. 
I can find help with childcare in my community when I need it.
I am very satisfied with my neighborhood as a place to live.
I feel safe in my neighborhood.

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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) when something unexpected happened?
Running an errand for them or helping them shop?
Giving them a ride somewhere?
Helping them around the house with a chore/repair? 
Lending them money or tools?
Giving them food, clothing or other supplies?
Caring for someone who is ill?
Giving them information or advice about raising children?
Providing information about a community organization that can help them? 

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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) when something unexpected happened?
Running an errand for you or helping you shop?
Giving you a ride somewhere?
Helping you around the house with a chore/repair?
Lending you money or tools?
Giving you food, clothing or other supplies?
Caring for you when you were ill?
Giving you information or advice about raising children?
Providing information about a community organization that can help you?

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

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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 believe my child misbehaves in order to upset me.
I praise my child when he/she behaves well.
I am happy being with my child.
My child and I are very close to each other.
I am able to soothe or comfort my child when he/she is upset.
I spend time with my child doing what she/he likes to do.
I know what to expect from my child as she/he grows and develops.
My child and I laugh together.
My child and I play together.

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

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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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* 17. What is your estimated annual household income?

0 of 17 answered
 

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