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* 1. Do you live in Stephens or Jefferson County?

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* 2. How many children in your home were born since mid-2019?

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* 3. How many children in your home were born before mid-2019?

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* 4. How are you related to the child (or children) you are raising that were born since mid-2019?

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* 5. Since 2020, how often have you been able to get your child (or children) all the food and other basics they need?

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* 6. Since 2020, what has prevented you from seeing a doctor or getting medicine when someone in your household has been sick or injured?

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* 7. Thinking about the children you are raising, how old is the first child born since mid-2019?

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* 8. Think about the child whose age you gave in Question 6. Would you say their general health is:

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* 9. Think about the child whose age you gave in Question 6. Has this child ever been referred to speech therapy, physical or occupational therapy, or Sooner Start?

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* 10. How often does the child whose age you gave in Question 6 get along with other children?

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* 11. Think about the child whose age you gave in Question 6. How often did you worry this child is doing the following things at the “typical,” “right,” or same age as other children:

  Constantly Sometimes Never Too soon for this
Sleeping through the night
Sitting Up
Crawling
Walking
Learning to talk
Playing with other children
Calming/soothing themselves
Following simple instructions

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* 12. How often does your child whose age you gave in Question 6 have tantrums or “melt downs”?

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* 13. How often does the child(ren) you are raising see family members who don’t live with you, like cousins or grandparents?

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* 14. How happy are you raising one or more children born since mid-2019?

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* 15. How many people can you call when you really need help?

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* 16. Since the coronavirus began in 2020, how often have you felt so angry or frustrated that you yelled at, hit, or shook your child?

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* 17. Since the coronavirus began in 2020, how often have you felt so sad or anxious that you are unable to hold your baby, respond to baby’s cry, or play with your child when they asked you to?

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* 18. Since 2020, how often have you felt safe at home?

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* 19. Since 2020, how often have you felt safe being outside in your neighborhood or town?

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* 20. Since 2020, how often has alcohol or drug use by an adult in your home created stress in your family relationships?

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* 21. Was anyone in your household every diagnosed with COVID-19?

This is an anonymous survey for parents/caregivers who had young children (born 2019-5/2023) during COVID-19. As a thank you for completing the survey, you can enter to win a $25 gift card! To enter, at the end of the survey is a space to enter your contact information. This form is not linked to the survey and your responses will remain completely anonymous. Your participation in the gift card drawing is completely voluntary.

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