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Sample
of
ReCAPP Parent-Child
Connectedness Survey
- What
is your e-mail address? (required)
- What best describes your current occupation?
o Elementary School Teacher
o Middle School Teacher
o High School Teacher
o Health Educator
o School Nurse
o Social Worker
o Counselor
o Health Care Provider (other than in school)
o Program Manager/Administrator
o Academic/Professor
o Researcher
o Student
o Parent
o Other (please specify):_____________________
- How many years have you been working in adolescent pregnancy
prevention or related field?
o Less than one year
o 1-2 years
o 3-5 years
o 6-10 years
o more than 10 years
- What age group BEST describes the people you serve?
o 0-5
o 6-11
o 12-18
o 19-24
o 25 and older
- Had you heard of the term "parent-child connectedness" before
taking this survey? (If no, skip to Question 7.)
o Yes
o No
- If
you have heard of the term "parent-child connectedness" before,
please tell us about HOW you learned heard about it.
- What
does the term "parent-child connectedness" mean to you?
- Based on your professional experiences, list the three most
important factors that you believe STRENGTHEN parent-child connectedness.
Strengthening Factor #1________________
Strengthening Factor #2________________
Strengthening Factor #3________________
- Based
on your professional experiences, list the three most important factors
that you believe BREAK DOWN parent-child connectedness.
Break Down Factor #1________________
Break Down Factor #2________________
Break Down Factor #3________________
- Rate
the statement below:
"Parent-child connectedness" is relevant to the work I do.
o 1 = Strongly disagree
o 2 = Disagree
o 3 = Agree
o 4 = Strongly agree
o NS = Not sure
- Have
you IMPLEMENTED interventions designed to strengthen parent-child connectedness?
o Yes
o No
- Have you been involved in DEVELOPING an intervention explicitedly
designed to strengthen parent-child connectedness?
o Yes
o No
- Describe
program activities that you and/or your organization are conducting
that you believe strengthen parent-child connectedness, if any.
- Of
the 24 possible PROTECTIVE factors (factors that strengthen) associated
with parent-child connectedness listed below, which do you think you
and/or your organization could realistically impact? (Select
all that apply.)
o Parents supervise and monitor their child
o Parents set expectations for their child
o Parents provide rules and structure
o Parents provide family leadership
o Parents support child's autonomy
o Parents respect child's needs, differences and boundaries
o Parents provide encouragement and support to child
o Parents provide guidance to child
o Parents protect child
o Parents provide care giving in an emotionally responsive way
o Family works together towards common goals
o Family is flexible and open to change
o Family has positive outlook (hope, optimistic view, confidence in
overcoming odds)
o Family maintains a strong sense of family values, traditions and/or
rituals
o Family makes time for positive activities
o Family is connected to community and relatives
o Parents have knowledge of child's lifestyle and peer pressures
o Family members talk open and clearly about themselves
o Parents have good listening skills
o Parents give clear and consistent messages
o Family is financially secure
o Parents have happy marriage
o Parents maintain a close relationship with their parents
o Family stress is low
- Of
the 13 possible RISK factors (factors that weaken) associated with the
lack of parent-child connectedness listed below, which do you think
you and/or your organization could realistically impact? (Select
all that apply.)
o Loss of caregiver due to separation, divorce or death
o Rejection of child by parent
o Physical abuse of child by parent
o Sexual abuse of child by parent
o Neglect of child by parent
o Family violence/domestic violence
o Psychological control of child by parent
o Over protection of child by parent
o Use of punitive discipline
o Family conflict
o Poor parent-child communication
o Maternal depression
o Parental abuse of alcohol and/or other substances
- Rate
each of the following statements:
My interest in learning more about parent-child connectedness
and its influence on preventin adolescent pregnancy is best described
as:
o 1= High
o 2= Medium
o 3= Low
o NS= Not Sure
My interest in incorporating parent-child connectedness program activities
into my work is best described as:
o 1= High
o 2= Medium
o 3= Low
o NS= Not sure
- Is
there anything else you would like to tell us?
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