Parents, How Are Uncertain Times Affecting Your Life & Work Now?

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?

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

Yes

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

Less than 12 months old

1 - 2 years old

3 - 5 years old

6 - 10 years old

11 - 13 years old

14 - 17 years old

18 years old or older

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* 16. What is your gender?

Female

Male

Non-Binary

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

Married

Widowed

Divorced

Separated

In a domestic partnership or civil union

Single, but cohabiting with a significant other

Single, never married

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* 18. Check all that apply

I work full-time for an employer

I work part-time for an employer

I am a business owner

No, I don't work for pay

Other (please specify)

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* 19. In what country do you live?

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

African-American/Black

East Asian

Hispanic/Latinx

Middle Eastern

American Indian/Alaskan Native

Pacific Islander

South Asian

Southeast Asian

White

None of the above, please specify...

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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.