Parents, How is Social Distance Affecting Your Life & Work Right Now?

Mom's Hierarchy of Needs^© study on COVID-19's impact to self-care, household responsibilities & work/life happiness for parents.

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* 1. Has your childcare been disrupted by COVID-19?

Yes

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* 2. Since social distancing, school closures and quarantines, are you doing more, less or about the same amount of housework and childcare?

	More	Less	About the Same Amount	N/A
· Childcare (i.e., Bedtime, Bathing, Feeding, Milestones, Wellbeing/Health)	· Childcare (i.e., Bedtime, Bathing, Feeding, Milestones, Wellbeing/Health) More	· Childcare (i.e., Bedtime, Bathing, Feeding, Milestones, Wellbeing/Health) Less	· Childcare (i.e., Bedtime, Bathing, Feeding, Milestones, Wellbeing/Health) About the Same Amount	· Childcare (i.e., Bedtime, Bathing, Feeding, Milestones, Wellbeing/Health) N/A
· Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning)	· Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning) More	· Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning) Less	· Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning) About the Same Amount	· Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning) N/A
· Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing)	· Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing) More	· Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing) Less	· Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing) About the Same Amount	· Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing) N/A

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* 3. Has your spouse/partner taken on more, less or about the same amount of housework and childcare since social distance/quarantines have taken place?

	More	Less	About the Same Amount	N/A - I don't live with a spouse or partner
· Childcare (i.e., Bedtime, Bathing, Feeding/Meals, Milestones, Wellbeing/health)	· Childcare (i.e., Bedtime, Bathing, Feeding/Meals, Milestones, Wellbeing/health) More	· Childcare (i.e., Bedtime, Bathing, Feeding/Meals, Milestones, Wellbeing/health) Less	· Childcare (i.e., Bedtime, Bathing, Feeding/Meals, Milestones, Wellbeing/health) About the Same Amount	· Childcare (i.e., Bedtime, Bathing, Feeding/Meals, Milestones, Wellbeing/health) N/A - I don't live with a spouse or partner
· Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning)	· Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning) More	· Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning) Less	· Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning) About the Same Amount	· Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning) N/A - I don't live with a spouse or partner
· Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing)	· Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing) More	· Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing) Less	· Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing) About the Same Amount	· Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing) N/A - I don't live with a spouse or partner

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* 4. Are you working from your home during this time of social distance?

Yes

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* 5. If you could have access to anything you need to help improve your productivity right now, what would it be?

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* 6. What do you wish you had to improve your level of work happiness/satisfaction right now?

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* 7. Self-care is everything you do to maintain mental, emotional and physical well-being. Have your established self-care rituals changed since COVID-19? Are you doing more, less or about the same amount of the following?

	More	Less	About the Same Amount
·Self-care (i.e., Sleep, Movement, Health, Stress Level Management)	·Self-care (i.e., Sleep, Movement, Health, Stress Level Management) More	·Self-care (i.e., Sleep, Movement, Health, Stress Level Management) Less	·Self-care (i.e., Sleep, Movement, Health, Stress Level Management) About the Same Amount
Self-interests (i.e, Fun, Hobbies, Learning new skills)	Self-interests (i.e, Fun, Hobbies, Learning new skills) More	Self-interests (i.e, Fun, Hobbies, Learning new skills) Less	Self-interests (i.e, Fun, Hobbies, Learning new skills) About the Same Amount
Healthy Relationships (i.e. connection with other adults such as partner/friends)	Healthy Relationships (i.e. connection with other adults such as partner/friends) More	Healthy Relationships (i.e. connection with other adults such as partner/friends) Less	Healthy Relationships (i.e. connection with other adults such as partner/friends) About the Same Amount

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* 8. Beyond the financial hardship, what has been the hardest part of dealing with this new situation?

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* 9. What unexpected benefits or rewards have you experienced in this new situation?

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* 10. What do you normally do that you’ve stopped doing in the current situation?

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* 11. What new things are you doing in the current situation that you hope to keep doing after things go back to normal?

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* 12. On a five-point scale, (where 1 is doing a Terrible Job and 5 is doing a Great Job) how do you feel you’re doing right now in each of your roles/areas of responsibility?

	1. Terribly	2. Not as well as usual	3. The same as usual	4. Better than usual	5. Really well	N/A - This doesn’t apply to me
As a parent	As a parent 1. Terribly	As a parent 2. Not as well as usual	As a parent 3. The same as usual	As a parent 4. Better than usual	As a parent 5. Really well	As a parent N/A - This doesn’t apply to me
As a worker	As a worker 1. Terribly	As a worker 2. Not as well as usual	As a worker 3. The same as usual	As a worker 4. Better than usual	As a worker 5. Really well	As a worker N/A - This doesn’t apply to me
As a spouse or partner	As a spouse or partner 1. Terribly	As a spouse or partner 2. Not as well as usual	As a spouse or partner 3. The same as usual	As a spouse or partner 4. Better than usual	As a spouse or partner 5. Really well	As a spouse or partner N/A - This doesn’t apply to me
As a caregiver to yourself	As a caregiver to yourself 1. Terribly	As a caregiver to yourself 2. Not as well as usual	As a caregiver to yourself 3. The same as usual	As a caregiver to yourself 4. Better than usual	As a caregiver to yourself 5. Really well	As a caregiver to yourself N/A - This doesn’t apply to me

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* 13. Does your child (or children) live with you either full or part-time?

Yes

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* 14. How many children, by age, currently live in your household?

Less than 1 year old

1 year old

2 years old

3 years old

4 years old

5 years old

6 years old

7 years old

8 years old

9 years old

10 years old

11 years old

12 years old

13 years old

14 years old

15 years old

16 years old

17 years old

18 years old or older

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* 15. Are you female or male?

Female

Male

Non-Binary

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* 16. Do you work for pay?

	I work for an employer	I am a business owner
Full-time	Full-time I work for an employer	Full-time I am a business owner
Part-time	Part-time I work for an employer	Part-time I am a business owner
No, I don't work for pay	No, I don't work for pay I work for an employer	No, I don't work for pay I am a business owner

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* 17. In what country do you live?

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* 18. OPTIONAL question: If you are interested in the topics of self-care, growth & stress management for Moms and would like to join the mailing list for invitations to future research studies & the Mom's Hierarchy of Needs weekly email update, please leave your email address. It will always be kept confidential & your answers anonymous.