Caregiver Survey for the Child Abuse Prevention Coalition
Child Abuse continues to remain a serious and potentially detrimental public health problem that our nation's children and families are faced with every day. It has been found that about one in every ten children will become a victim of child sexual abuse before their 18th birthday. (D2L.org, 2013) The Child Abuse Prevention Coalition is a group of Duluth area organizations committed to collaborating and learning together and being a catalyst to building effective community outreach and support to eliminate child abuse. The data collected in survey responses will assist our coalition in determining how we can best support local families and children through caregivers’ identified needs regarding child abuse prevention. At the end of the survey, participants are invited to be entered into an optional raffle to win prizes from local businesses! Survey responses are confidential, but if participants do enter the raffle an email address is required to enter*.  

*Email addresses will be used solely to contact recipients of prize raffles and will not be utilized for any other purposes.  
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On a scale of 1 to 4, how confident do you feel in being able to respond to your child, or a child in your life, disclosing physical or sexual abuse? *
1: Not confident, 2: Somewhat confident, 3: Confident, 4: Very confident
Not Confident
Very Confident
If you are not at a 4: Very Confident, what information do you feel you need to bring yourself to a 4: Very Confident rating?
Please select all that apply.
On a scale of 1-4, how confident do you feel in recognizing signs of sexual abuse in your child? *
1: Not confident, 2: Somewhat Confident, 3: Confident, 4: Very Confident
Not Confident
Very Confident
If you are not at a 4: Very Confident, what information do you feel you need to bring yourself to a 4: Very Confident rating?
Please select all that apply.
On a scale of 1-4, how confident do you feel in having conversations with your child(ren) about sexual abuse prevention? *
1: Not confident, 2: Somewhat Confident, 3: Confident, 4: Very Confident
Not Confident
Very Confident
If you are not at a 4: Very Confident, what information do you feel you need to bring yourself to a 4: Very Confident rating?
Please select all that apply.
On a scale of 1-4, how confident do you feel in having conversations with your child(ren) about sexuality? *
1: Not confident, 2: Somewhat Confident, 3: Confident, 4: Very Confident
Not Confident
Very Confident
If you are not at a 4: Very Confident, what information do you feel you need to bring yourself to a 4: Very Confident rating?
Please select all that apply.
On a scale of 1-4, how confident do you feel talking to your child(ren) about healthy relationships? *
1: Not confident, 2: Somewhat Confident, 3: Confident, 4: Very Confident
Not Confident
Very Confident
If you are not at a 4: Very Confident, what information do you feel you need to bring yourself to a 4: Very Confident rating?
Please select all that apply.
Where has, or where do you expect, your child(ren) to receive education and information on sexuality and sexual abuse? *
Please select all that apply.
Required
How would you prefer that information about child sexual abuse and sexual development be delivered to you? *
Please select all that apply.
Required
What selection best describes where you live in the Twin Ports area? *
What is the age of your child(ren)? *
Please select all that apply
Required
Have you, or your family, ever utilized any programming or services from the following organizations? *
Please select all that apply.
Required
Thank you for taking the time to share your thoughts and assisting the Child Abuse Prevention Coalition in better understanding how we can best serve our community! If you are interested in being entered into a raffle for prizes from local businesses, please leave your preferred email address in the space provided below. If you do not provide an email you will not be entered into the drawing. Email addresses will be used solely to contact recipients of prize raffles and will not be utilized for any other purposes. Values of raffle prizes range from $20-$75.
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