Mansfield Parent Support Survey Question Title * 1. Person completing the survey? Mother Father Other carer Question Title * 2. Age of person completing the survey? U20 20-25 26-35 36-45 46 + Question Title * 3. Household structure? Single parent Couple with children Blended family Same sex couple with children Question Title * 4. How many children are in the household? Question Title * 5. Ages of the children in the household? Question Title * 6. Have you sought support for your child/ren or family previously in Mansfield? Yes No If yes, please describe your experience, was it negative/positive and why? Question Title * 7. Do you have concerns about any of the following topics? Sibling relationships Parent/child relationships Peer relationships Behaviour Child/adolescent development Physical health Psychological/emotional health Finance/budgeting Disability Education Drug/alcohol use Boundaries Discipline Communication Other (please describe) Question Title * 8. In relation to pre-schoolers, are you interested in finding out more information about any of the following topics? Bedwetting or toileting Physical fights with parents/siblings/friends Verbal fights with parents/siblings/friends Positive parenting Defiant behaviour Attention seeking Appears insecure Meal time/Snack time/Nutrition Bed time/Sleeping Technology and screen time Has trouble following instructions or doing as told Cries/yells/whines easily or often Tantrums How to promote a loving attachment Routine Other or feel free to tell us more about the concerns above Question Title * 9. In relation to primary school children, are you interested in more information about any of the following topics? Child development Emotional competence/skills Communication Anxiety Positive Parenting Sibling relationships/conflict How to strengthen your relationship with your child Behaviour Boundaries/limit setting/consequences/discipline Pre-puberty Bed time/sleeping Meal time/snack time/nutrition Cyber safety, technology and screen time Bullying Other or feel free to tell us more about the concerns above Question Title * 10. In relation to adolescents, are you interested in finding out more information about any of the following topics? Adolescent development Drug/alcohol use Communication How to strengthen your relationship with your adolescent Peer relationships Puberty Romantic relationships Sex Building a stronger connection to your adolescent Discipline Understanding and promoting good mental health Anxiety and stress Depression Self-harm Suicide Bullying Sleeping Nutrition Cyber safety, technology and screen time Other or feel free to tell us more about the concerns above Question Title * 11. Are there any additional concerns or areas of interest relating to your child/ren (or family) that you would like more support with? Yes No If yes, please describe Question Title * 12. If the relevant information was being offered please tick the ways in which you would be prepared to receive this information Flyers/information booklet One-off session with large group of parents (10+) One-off session with small group of parents (less than 10) A series of information sessions with large group of parents (10+) A series of information sessions with small group of parents (less than 10) Individual/one on one sessions Online Other (please describe) Question Title * 13. Have you heard about Family Services at Mansfield Shire Council where Family Counselling is offered? Yes No Question Title * 14. I know where to find Parent Support in my community such as Mothergoose, play groups, family counselling, mental health information Yes No Question Title * 15. I would like to know more about Parent Support services in my community Yes No Question Title * 16. Have you or anyone in your family experienced family violence either now or in the past? Yes No Question Title * 17. Using any number from 0 to 10, where 0 is very unlikely and 10 is very likely, what number would you use to rate how likely you would be to attend an information session on any of the relevant issues? 10 - Very likely 9 8 7 6 5 4 3 2 1 - Very unlikely 10 - Very likely 9 8 7 6 5 4 3 2 1 - Very unlikely Question Title * 18. If you would like to enter the draw for the $250 supermarket voucher please provide your name and phone number (please be assured your answers will remain private and confidential) Name Email Address Phone Number Done