Page 1 - Parenting Assessments
P. 1
Parent Assessment
Parenting Pamphlets
Parent’s Name: _______________________
Case Manager: _______________________ Today’s Date: _________________
Strongly Disagree Strongly Disagree
Circle the response that best matches your feeling. Agree Agree
1. I am confident in my parenting skills SA A D SD P-
2. I get along well with my child’s other parent. SA A D SD P7-
3. My kids have never been physically or emotionally abused. SA A D SD P1-
4. My kids are having problems with my separation or divorce. SA A D SD P7
5. My neighborhood feels safe to me. SA A D SD P1-
6. I know how to comfort my crying child. SA A D SD P2-
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7. My child follows a daily routine. SA A D SD P8-
8. I don’t know when to start potty training my child. SA A D SD P2
9. My child is having problems with my partner/spouse. SA A D SD P8
For Evaluation Only
10. I give in to my kids sometimes because I feel guilty. SA A D SD P3
11. My child is overweight. SA A D SD P9
12. I feel like I am a good role model for my child. SA A D SD P3-
13. My children get regular medical checkups once a year. SA A D SD P9-
14. I catch my kids lying a lot. SA A D SD P4
15. I regularly talk with my child’s teachers. SA A D SD P10-
16. My kids don’t listen to me. SA A D SD P4
17. I think having a good education is important. SA A D SD P10-
18. I feel comfortable disciplining my kids. SA A D SD P5-
19. I don’t feel safe around my child. SA A D SD P11
20. I usually don’t follow through on punishment when my kids break the rules. SA A D SD P5
21. I’m concerned about some of my child’s behavior. SA A D SD P11
22. I am constantly having a conflict with my child. SA A D SD P6
23. I worry about feeding my family. SA A D SD P12
24. I never get angry with my friends or family. SA A D SD P6-
25. I need to find better childcare for my kids. SA A D SD P12
26. I have friends and family I can count on. SA A D SD P-
27. I yell a lot at my kids. SA A D SD P
28. My kids are home alone a lot of times. SA A D SD P
Parent Pre-Assessment Parenting Pamphlet Series
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