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CPS-AIM-P v2
Thank you very much for taking the time to complete this form! This information helps us determine how well we are teaching the concepts of Collaborative Problem Solving and helps our program pursue funding to keep the class free of charge.
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Please submit one survey for each class participant in your home.
Name (First name and last initial) or ID Number
Your answer
Date:
MM
/
DD
/
YYYY
Please select the answer which is closest to the last week of class you attended or how long it has been since you last took the class.
Choose
Week 1 or before class starts
Last class of a 4 week class
Week 5
Week 7 or 8 (or the last class of a 6 or 7 week class)
3 months after taking the class
6 months after taking the class
7 months or more after taking the class
Intro class only (One session introducing the model)
Drop in Group
1. My child and I frequently struggle with each other.
Strongly Agree
1
2
3
4
5
6
7
Strongly Disagree
Clear selection
2. My child chooses to act out in order to get out of doing things he/she doesn't like.
Strongly Agree
1
2
3
4
5
6
7
Strongly Disagree
Clear selection
3. My child's behavior towards me is unpredictable.
Strongly Agree
1
2
3
4
5
6
7
Strongly Disagree
Clear selection
4. Dealing with my child drains my energy.
Strongly Agree
1
2
3
4
5
6
7
Strongly Disagree
Clear selection
5. The struggles I have with my child are very intense.
Strongly Agree
1
2
3
4
5
6
7
Strongly Disagree
Clear selection
6. I cannot predict my child's meltdowns or tantrums.
Strongly Agree
1
2
3
4
5
6
7
Strongly Disagree
Clear selection
7. My child intentionally pushes my buttons or manipulates me.
Strongly Agree
1
2
3
4
5
6
7
Strongly Disagree
Clear selection
8. I am at my maximum stress level when I am with my child.
Strongly Agree
1
2
3
4
5
6
7
Strongly Disagree
Clear selection
9. I don't understand why my child explodes or implodes.
Strongly Agree
1
2
3
4
5
6
7
Strongly Disagree
Clear selection
10. My child could behave better if he/she just worked harder at it.
Strongly Agree
1
2
3
4
5
6
7
Strongly Disagree
Clear selection
11. My child behaves in negative ways in order to get attention.
Strongly Agree
1
2
3
4
5
6
7
Strongly Disagree
Clear selection
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