Family Survey 2 - OhioGuidestone Research Portal

Protective Factors Survey, 2nd Edition (PFS-2)

Electronic Agreement *

By checking this box, I agree to use electronic records and electronic signatures.

I am a: *

Study Participant
Client or Community Member
Staff member
Unsure

Staff Name *

First

Last

FOR STAFF USE ONLY

Date Survey Completed *

First & Last Name -or- Access Code *

Please enter your full first and last name. If you are in an OhioGuidestone research study, please use your access code. Need help? Email: research@ohioguidestone.org.

Pre or Post *

Pre
Post

Your responses to this survey are confidential. If you need assistance completing the form, please ask a member of the staff.

For each of the following, mark the response that most closely matches how you feel.

The future looks good for our family. *

In my family, we take time to listen to each other. *

There are things we do as a family that are special just to us. *

My child misbehaves just to upset me. *

I feel like I'm always telling my kids "no" or "stop." *

I have frequent power struggles with my kids. *

How I respond to my child depends on how I'm feeling. *

I have people who believe in me. *

I have someone in my life who gives me advice, even when it's hard to hear. *

When I am trying to work on achieving a goal, I have friends who will support me. *

When I need someone to look after my kids on short notice, I can find someone I trust. *

I have people I trust to ask for advice about (check all that apply) *

The following questions are about your experiences so far in this program or organization. Your answers to these questions can help staff improve services for you and others like you, so it's important you answer honestly. For each of the following, mark the response that most closely matches how you feel.

I feel like staff here understand me. *

No one here seems to believe that I can change. *

When I talk to people here about my problems, they just don't seem to understand. *

Sometimes it's hard for families to afford everything they need. For each of the following, check all that apply.

In the past month, were you unable to pay for: *

Rent or mortgage
Utilities or bills (electricity, gas/heat, cell phone, etc.)
Groceries/food (including baby formula, diapers)
Child care/day care
Medicine, medical expenses, or co-pays
Basic household or personal hygiene items
Transportation (including gas, bus passes, shared rides)
I was able to pay for all of these

In the past year, have you: *

Delayed or not gotten medical or dental care
Been evicted from your home or apartment
Lived at a shelter, in a hotel/motel, in an abandoned building, or in a vehicle
Moved in with other people, even temporarily, because you could not afford to pay rent, mortgage, or bills
Lost access to your regular transportation (e.g. vehicle totaled or repossessed)
Been unemployed when you really needed and wanted a job
None of these apply to me

I have trouble affording what I need each month. *

I am able to afford the food I want to feed my family. *

Has demographic data below already been collected for this participant? *

Yes
No

Please tell us about the children living in your household.

CHILD #1 *

Male
Female
Non-binary/Third-Gender/Other
Prefer not to answer

Age (in years) *

This child lives in my house *

Yes
No

What is your relationship to this child? *

CHILD #2

Male
Female
Non-binary/Third-Gender/Other
Prefer not to answer

Age (in years)

This child lives in my house

Yes
No

What is your relationship to this child?

CHILD #3

Male
Female
Non-binary/Third-Gender/Other
Prefer not to answer

Age (in years)

This child lives in my house

Yes
No

What is your relationship to this child?

CHILD #4

Male
Female
Non-binary/Third-Gender/Other
Prefer not to answer

Age (in years)

This child lives in my house

Yes
No

What is your relationship to this child?

These last few questions are about you and your household. They will be used to help program staff understand the needs of people and families they are serving, and improve the service provision. Remember, your responses to this survey are confidential.

Your Sex *

Male
Female
Non-Binary/Third-Gender/Other
Prefer not to answer

Your Age (in years) *

Primary Language Spoken at Home *

Other Language *

Race/Ethnicity (Please choose as many as apply) *

Other Race/Ethnicity *

Relationship Status *

Family Housing *

Total Family Income *

Highest Level of Education *

Which, if any, of the following do you or your family currently receive? (Check all that apply) *