Parent FG Screener

Thank you for your interest in participating in one of our online focus groups!

We are the Strategic Planning Initiative for Families and Youth (SPIFFY) Coalition, which strives to promote the health and well-being of young people, and prevent youth alcohol, cannabis, and nicotine and tobacco use throughout Hampshire County. The goal of these online focus groups (which will take place over Zoom) is to learn from parents and caregivers about what's going on with youth substance use and mental health. We will use the information shared during these discussions to shape our substance use prevention efforts in the months and years to come, so we are very interested in hearing what you have to say! To enroll in one of our online focus groups, please fill out the following form.
First, we need some personal information about you. We are asking for your email and/or cell phone number so that we can be in touch about details of the study. Your email and cell will not be shared or used for any other purposes.
Your name

First NameLast Name
Would you rather be contacted by email or your cell phone via text?
Email*
example@example.com
Cell
What town do you live in?
We are asking the following questions to ensure that parents and caregivers from a variety of backgrounds are included in our focus groups.
How do you identify? Please select all that apply.

American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or other Pacific IslanderWhite
Which of the following best represents how you think of yourself?

LesbianGayBisexualStraight or heterosexualI identify in some other way
How would you describe yourself?

FemaleMaleTransgenderNon-binaryI identify in some other way
What was your total household income before taxes in the last 12 months?

Less than $25,000$25,000 to $49,999$50,000 to $74,999$75,000 to $99,000$100,000 to $124,999$125,000 to $149,000$150,000 or more
We will be conducting focus groups during the weeks of May 9 and May 16. During these weeks, when are you generally available to participate in one of our online focus groups? Focus groups last approximately 1-1.5 hours. Please select all that apply.

Weekdays at noonWeekdays at 4:00pmWeekdays at 5:00pmWeekdays at 7:30pmWeekends at 9:00amWeekends at 2:00pmNone of these times work for me
Are there any days of the week that do NOT work for you to attend a focus group?

MondaysTuesdaysWednesdaysThursdaysFridaysSaturdaysSundays
Now we have a few questions about your child, or children. We are asking the following questions because we want to make sure that parents with children from a variety of backgrounds are part of this project, so thank you for providing this information.
How many children do you have?
Are any of your children in middle or high school?*

YesNo
Thinking about your child who is in middle or high school, or children who are in middle or high school, what school(s) do they attend?
Still thinking about your child or children in middle or high school, do any identify as lesbian, gay, bisexual, or in some other way?

YesNoNot sure
Does your middle or high schooler identify as transgender, non-binary, or in some other way? If you have more than one child in middle or high school, do any of them identify as trans, non-binary, or in some other way?

YesNoNot sure
To the best of your knowledge, how does your child, or children, identify? Please select all that apply.

American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or other Pacific IslanderWhiteOther
Is your middle or high school student living with a disability? If you have more than one child in middle or high school, are any of them living with a disability?

YesNo
If you answered yes, what disability or disabilities are they living with?
Please click "submit" below for your responses to be recorded. You will receive an email in the next day or two from our team to schedule your participation in an online focus group. Thank you!
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Thank you for your interest in participating in one of our online focus groups!

First, we need some personal information about you. We are asking for your email and/or cell phone number so that we can be in touch about details of the study. Your email and cell will not be shared or used for any other purposes.

We are asking the following questions to ensure that parents and caregivers from a variety of backgrounds are included in our focus groups.

Now we have a few questions about your child, or children. We are asking the following questions because we want to make sure that parents with children from a variety of backgrounds are part of this project, so thank you for providing this information.

Please click "submit" below for your responses to be recorded. You will receive an email in the next day or two from our team to schedule your participation in an online focus group. Thank you!