Please indicate how often you’ve had the below experiences with your child in the last 30 days. If you have more than one child, you may answer the following questions based on experiences you may have had with any of your children. Question Title * 1. My child said something awful might happen to them. Never Almost Never Sometimes Often Almost Always Question Title * 2. My child seemed nervous/scared. Never Almost Never Sometimes Often Almost Always Question Title * 3. My child seemed to be worried about what could happen to them. Never Almost Never Sometimes Often Almost Always Question Title * 4. My child was afraid of going to school. Never Almost Never Sometimes Often Almost Always Question Title * 5. It was hard for my child to relax. Never Almost Never Sometimes Often Almost Always Question Title * 6. My child seemed mad/fed up. Never Almost Never Sometimes Often Almost Always Question Title * 7. My child’s overall irritability caused my child to have problems. Never Almost Never Sometimes Often Almost Always Question Title * 8. My child could not stop feeling sad. Never Almost Never Sometimes Often Almost Always Question Title * 9. My child expressed feeling alone/lonely. Never Almost Never Sometimes Often Almost Always Question Title * 10. My child was easily angered. Never Almost Never Sometimes Often Almost Always Question Title * 11. The violence in the community had a major impact on my child’s wellbeing. Never Almost Never Sometimes Often Almost Always Question Title * 12. My child has experienced the death of someone close to them. Never Almost Never Sometimes Often Almost Always If you or someone you know wants to speak to a culturally responsive counsellor, contact our Racial Equity Support Line at 503-575-3764. Done
