Columbus Behavioral Health
124 County Line Road West, Suite B, Westerville, OH 43082, 614.360.2600
Kid's Mental Health Survey-All responses are anonymous

We want to know what your biggest pandemic parenting challenges have been and your impressions of how your child's mental health have been impacted.
Sign in to Google to save your progress. Learn more
How long have you been receiving services from Columbus Behavioral Health? *
How many children are in your family?
Clear selection
What age ranges of children are in your family? Check all that apply *
Required
What are the biggest problems your CHILD has faced during the pandemic? *
Not a problem
Mild
Moderate
Severe
Academic problems
Anger/irritability
Anxiety
Boredom
Concentration problems
Depression
Disconnected from faith
Dislikes online school
Eating Issues
Hates being home
Isolation from friends
Lack of socialization
Loneliness
OCD
Self Harm
Sibling problems
Sleep disturbance
Suicidal thoughts
Too much screen time
Worries about family
How much has each of these stressors been a problem for you during the pandemic? *
Not really a problem
Mild
Moderate
Severe
Anxiety
Child's behavior problems
Co-parenting
Depression
Family Issues
Finances
Health problems
Loneliness
Loss of loved one
No childcare
No time for me
Political distress
Relationship issues
Teaching my child
Unemployment
Work/Home balance
Other
If you are feeling burned out as a parent, how do you feel like this burn out has most impacted your parenting? *
Required
What are your biggest concerns or worries about how the pandemic has impacted your child (or children)? *
Not a problem
Mild
Moderate
Severe
Behind academically
Hates school
Misbehaves in public
Won't have friends
Social Development
Worse Anxiety
Worse Depression
Do you feel well connected to your school district resources? *
Do you have family members or friends on whom you can depend on for support in dealing with your parenting challenges? *
If your child has an academic or mental health problem, do you know whom in your child's school to reach out to? *
What kind of medical or behavioral health services would be helpful to you and your children in recovering from the pandemic?
Are you vaccinated against COVID-19? *
How has access to telehealth been helpful for you?
Oops! Did we miss something? Please share anything else about your experience that you would like us to know.
Please check all that apply *
Required
What impact has COVID-19 had on YOUR mental and physical health? (check all that apply) *
Required
Compared to before coming to Columbus Behavioral Health, *
NA/not area of concern for me
No improvement at all ☚ī¸
A bit of improvement 🙂
Significant improvement 😀
I am better able to control/manage my anxiety, worry or fear?
I am less sad, depressed, down, or hopeless
I get along better with those close to me
I have more interest in or receive more pleasure from things I value
My symptoms interfere less with my daily activities/work
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of columbusbh.com. Report Abuse
Google Forms