RESILIENCE Questionnaire
This questionnaire was developed by the early childhood service providers, pediatricians, psychologists, and health advocates of Southern Kennebec Healthy Start, Augusta, Maine, in 2006, and updated in February 2013. For more information, visit:
https://acestoohigh.com
Please select the most accurate answer for each statement:
* Required
Email address
*
Your email
I believe that my mother loved me when I was little.
*
1 point
Definitely true
Probably true
Not sure
Probably Not True
Definitely Not True
I believe that my father loved me when I was little.
*
1 point
Definitely true
Probably true
Not sure
Probably Not True
Definitely Not True
When I was little, other people helped my mother and father take care of me and they seemed to love me.
*
1 point
Definitely true
Probably true
Not sure
Probably Not True
Definitely Not True
I’ve heard that when I was an infant someone in my family enjoyed playing with me, and I enjoyed it, too.
*
1 point
Definitely true
Probably true
Not sure
Probably Not True
Definitely Not True
When I was a child, there were relatives in my family who made me feel better if I was sad or worried.
*
1 point
Definitely true
Probably true
Not sure
Probably Not True
Definitely Not True
When I was a child, neighbors or my friends’ parents seemed to like me.
*
1 point
Definitely true
Probably true
Not sure
Probably Not True
Definitely Not True
When I was a child, teachers, coaches, youth leaders or ministers were there to help me.
*
1 point
Definitely true
Probably true
Not sure
Probably Not True
Definitely Not True
Someone in my family cared about how I was doing in school.
*
1 point
Definitely true
Probably true
Not sure
Probably Not True
Definitely Not True
My family, neighbors and friends talked often about making our lives better.
*
1 point
Definitely true
Probably true
Not sure
Probably Not True
Definitely Not True
We had rules in our house and were expected to keep them.
*
1 point
Definitely true
Probably true
Not sure
Probably Not True
Definitely Not True
When I felt really bad, I could almost always find someone I trusted to talk to.
*
1 point
Definitely true
Probably true
Not sure
Probably Not True
Definitely Not True
As a youth, people noticed that I was capable and could get things done.
*
1 point
Definitely true
Probably true
Not sure
Probably Not True
Definitely Not True
I was independent and a go-getter.
*
1 point
Definitely true
Probably true
Not sure
Probably Not True
Definitely Not True
I believed that life is what you make it.
*
1 point
Definitely true
Probably true
Not sure
Probably Not True
Definitely Not True
A copy of your responses will be emailed to the address you provided.
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