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Parent and Community Member Needs Assessment Survey
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Thank you for taking the time to complete this survey!
The purpose of this survey is to better understand your community's needs. The survey will take about 5 minutes. Please only take this survey one time. Your participation is greatly appreciated.
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1.
Are you a parent or caregiver to a child under the age of 18?
(Required.)
Yes
No
Prefer not to answer
*
2.
What county do you live in?
(Required.)
Brazoria
Harris
Matagorda
Other (please specify)
*
3.
What is your zip code?
(Required.)
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4.
What is your age?
(Required.)
Under 18
18-24
25-34
35-44
45-54
55-64
65+
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5.
Which factors do you believe most contribute to substance use and behavioral health challenges in our community?
Select up to 3
(Required.)
Adverse childhood experiences (e.g., abuse, neglect, household substance use)
Family conflict or lack of parental involvement
Economic hardship and poverty
Lack of access to mental health care and support services
Peer pressure and social norms around substance use
Community violence or unsafe environments
Limited access to positive youth activities and mentorship
Social media and media influences
Lack of education and awareness about substance use risks
Other (please specify)