Mom's Hierarchy of Needs© study on the pandemic's impact on self-care, household responsibilities, work/life happiness & wellbeing for parents.

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

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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)
· Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning)
· Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing)

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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)
· Children’s activities (i.e. Entertainment, Sports, Play, Classes/Learning)
· Household/Housework (i.e., Meals, Finances, Repairs, Cleaning & Organizing)

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

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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 and why?

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* 6. What do you wish you had to improve your wellbeing right now and why?

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* 7. If you work for an employer, what policies or benefits should they implement or change to better support your work/life happiness and wellness? (If you are self-employed or don’t work for pay, just enter N/A.)”

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* 8. 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-interests (i.e, Fun, Hobbies, Learning new skills)
Healthy Relationships  (i.e. connection with other adults such as partner/friends)

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

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

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

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* 12. What new things are you doing in the current situation that you hope to keep doing after things reopen and return to normal?

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* 13. 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 worker
As a spouse or partner
As a caregiver to yourself

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

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* 15. How many children in each age range below, currently live in your household?

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* 16. What is your gender?

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* 17. Which of the following best describes your current relationship status?

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* 18. Check all that apply

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* 20. What is your racial or ethnic identity? (Select all that apply.)

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* 21. 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 weekly Mom's Hierarchy of Needs email update, please leave your email address. It will always be kept confidential & your answers anonymous.

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