Returning to School Emotional Health Survey
The screening tool such as this can assist in delivering the necessary levels of intervention to our students.  Please note this is not a diagnostic tool, but rather proactive approach for planning and implementing prevention and early intervention strategies.  Thank you for your partnership in supporting our students.
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1.  What is your child's first and last name ? *
2.  What school does your child attend? *
3. What grade will your child be entering in the 2020-2021 school year?
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4. How concerned are you about your child's current social and emotional well-being?
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5. Have you or anyone in your family experienced a loss over the last few months related to COVID-19 or other related factors?
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6. How concerned are you about your child's current peer relationships?
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7. In the past month, how often has your child spoken with  their friends/peers?
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8. Has your child been able to participate in any activities outside of school since the Spring?
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9. Over the past month does your child appear to be  anxious, withdrawn, and/or depressed?
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10. Has your child experienced any of the following over the past few months?
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11. Has there been a change to your housing situation?
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12. How concerned are you about your family's housing situation?
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13.  Over the past several months has there been a change to your family composition such as a separation, divorce, birth/adoption of a child, additional family member living in the home?
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14.  Over the past several months have you or a household family member experienced a loss of employment?
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15.  Anything else we should know about your child or family to help support them in their social, emotional and mental health well being?   *
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