Protective Factors Survey

Protective Factors Survey

Friends National Resource Center for Community-Based Child Abuse Prevention. Form Preview
Survey Questionnaire Form
  • Protective Factors Survey

    Thank you for taking the time to answer these questions. The following questions will help provide better service at DCCC.
  •  -  - Pick a Date
  •   Male Female
    Child 1
    Child 2
    Child 3
    Child 4
  •   Month Day Year
    Child 1
    Child 2
    Child 3
    Child 4
  •   Birth Parent Adoptive Parent Grandparent Sibling Legal Guardian
    Child 1
    Child 2
    Child 3
    Child 4
  •   Never Very Rarely Rarely About half the time Frequently Very Frequently Always
    In my family, we talk about problems.
    When we argue, my family listens to both sides of the story.
    In my family, we take time to listen to each other.
    My family pulls together when things are stressful.
    My family is able to solve our problems.
  •   Strongly Disagree Mostly Disagree Slightly Disagree Neutral Slightly Agree Mostly Agree Strongly Agree
    I have others who will listen when I need to talk about my problems.
    When I am lonely, there are several people I can talk to.
    I would have no idea where to turn in my family needed food or housing.
    I wouldn't know where to go for help if I had trouble making ends meet.
    If there is a crisis, I have others I can talk to.
    If I needed help finding a job, I wouldn't know where to go for help.
  •  -  - Pick a Date
  •   Strongly Disagree Mostly Disagree Slightly Disagree Neutral Slightly Agree Mostly Agree Strongly Agree
    There are many times when I don't know what to do as a parent.
    I know how to help my child learn.
    My child misbehaves just to upset me.
  •   Never Very Rarely Rarely About half the time Frequently Very Frequently Always
    I praise my child when he/she behaves well.
    When I discipline my child, I lose control.
    I am happy being with my child.
    My child and I are very close to each other.
    I am able to soothe my child when he/she is upset.
    I spend time with my child doing what he/she likes to do.
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