BTSNL Parent Survey

BTSNL Parent Survey

All information provided in this survey will remain confidential and will only be used for the purpose of studying and improving support for children's mental health.
Name*

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Child's Information:
Child's Age   Type a label
Child's Gender   Type a label
Grade and School Year     Type a label
Do you have any specific concerns about your child's mental health or emotional well-being? If yes, please explain.
Emotional Well-Being:
1. Over the past month, how often has your child seemed sad, anxious, or worried?

NeverRarelySometimesOftenAlways
2. How does your child handle stress or difficult emotions? (Check all that apply)

Talks about feelingsEngages in self-soothing activities (e.g., drawing, listening to music)Withdraws or isolatesBecomes easily frustrated or angryOther
Behavioral Concerns
1. Has your child shown any of the following behaviors? (Check all that apply)

Difficulty concentrating or focusingExcessive irritability or angerTrouble sleeping or nightmaresChanges in appetite (eating too much or too little)Physical complaints (e.g., stomachaches, headaches) without a clear causeAvoidance of social situations or schoolSelf-harming behavior (e.g., cutting, hitting)Other
2. Has your child experienced any significant life changes or stressful events in the past year (e.g., moving, family changes, loss)?
Yes
No
If Yes, please explain.      Type a label
Social Development
1. How does your child interact with others? (Check all that apply)

Enjoys spending time with friendsPrefers to be aloneHas difficulty making or keeping friendsEngages in group activities or team sportsShows empathy and concern for othersOther
2. Does your child have trouble expressing or discussing their emotions with others?
Yes
No
If Yes, please explain.       Type a label
Support and Resources
1. Have you noticed any changes in your child's school performance or attitude toward school?

Yes, significant declineYes, slight declineNo changeYes, improvementUnsure
2. Has your child been involved in any professional mental health support? (e.g., therapy, counseling)?
Yes
No
If Yes, how often?      Type a label
3. Do you feel that you have the resources or support to help manage your child's mental health?

YesNoSomewhat
4. Would you be interested in resources, workshops, or counseling to support your child's mental health?

YesNo
5. How confident are you in your ability to support your child's emotional and mental health?

Very confidentConfidentSomewhat confidentNot Confident
Thank you for completing this survey. Your feedback is valuable and will help guide us in providing support for your child.
Should be Empty:

BTSNL Parent Survey

Emotional Well-Being:

Behavioral Concerns

Social Development

Support and Resources

Thank you for completing this survey. Your feedback is valuable and will help guide us in providing support for your child.