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Parenting Challenges Survey.
Please answer the following questions as honestly as possible.
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Please State your Gender
Male
Female
Other:
Please state your age
16-20
21-25
26-30
31-40
41-50
Other:
Please state relationship status
divorced/separated
Single
Widowed
Married
Partner - not cohabiting
What is your parenting status?
Cohabiting Parent
Single parent
Shared Care Parent
Other:
How many Children do you have in your care?
1
2
3
4
Other:
How old are your children?
0-3
4-7
7-10
11-14
15-18
18 +
Clear selection
What do you find the most challenging in your parenting role at the current time?
Your answer
On a Scale of 1-5 How stressed do you feel with your current situation?
Extremely
1
2
3
4
5
Not at all
Clear selection
What do you consider to be your best quality /strength in your parenting role?
Please State:
Your answer
Do you receive any support from extended family or friends to help you with your parenting role?
yes
no
On a scale of 1-5 How are you managing your role as a parent?
Struggling to cope
1
2
3
4
5
Extremely well
Clear selection
Are you experiencing any difficulties with managing your child's behaviour?
Yes - I am having a meltdown!
No - they are little angels
sometimes - when they are bored
Other:
What aspects of your parenting role would you consider as currently working well for you?
Please state:
Your answer
Is there any area of your parenting role that you feel you need help with now?
Please state:
Your answer
How would you describe your current mental health state?
My mental health is not affected - I feel great
I am struggling to cope and feel stressed all the time.
My mental health has significantly deteriorated
My mental health has deteriorated slightly
What are your biggest parenting worries and fears at the current time?
Your answer
Are you currently receiving any professional support to help you manage your parenting role or your mental health
Please state type of support
Your answer
Do you feel you need support to manage your parenting role?
Yes Please
No Thank you
Clear selection
What support do you consider would be helpful to you in your parenting role?
Please state:
Your answer
Would you consider using a coach/mentor to help you manage your parenting role?
yes
No
Other:
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