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May 9, 2008  
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    		•
    Parental Influence Questionnaire

    Note: Think of one child when completing the following questionnaire.

    1.  My child shares his/her goals and interests with me.
    Never









    		Frequently
     
    2.  My child participates in family activities.
    Never









    		Frequently
     
    3.  My child and I enjoy a hobby or activity together.
    Never









    		Frequently
     
    4.  My child comes to me when he/she has done something wrong.
    Never









    		Frequently
     
    5.  My child is interested in my opinion.
    Never









    		Frequently
     
    6.  My child tells me about his/her friends?
    Never









    		Frequently
     
    7.  When receiving correction, my child is receptive and teachable.
    Never









    		Frequently
     
    8.  My child welcomes my affection.
    Never









    		Frequently
     
    9.  My child shares his/her struggles with me.
    Never









    		Frequently
     
    10.  My child asks me for help.
    Never









    		Frequently
     
    11.  My child informs me when his/her plans change.
    Never









    		Frequently
     
    12.  My child talks with me when hurting (physically or emotionally).
    Never









    		Frequently
     
    Your score: 12
    Scoring the Parental Influence Questionnaire

    This survey is based on the following:

    Your ability to help things go right for your child is determined by how often you connect with your child and openly share concerns, struggles, and successes with one another.

    > 84

    If your score is greater than 84, chances are you are connecting with your child frequently and are having a great deal of positive influence in your child’s life. Continue to find ways to spend quality and frequent time with your child.

    60-84

    If your score is between 60 and 84, spend less time correcting and focus on finding ways to increase the frequency and the quality of the time you spend with you child.

    48-59

    If your score is between 48 and 59, spend less time correcting and focus on finding ways to increase the frequency and the quality of the time you spend with your child—and ask for help. Invite your child’s favorite coach, teacher, relative, or neighbor to spend frequent, quality time with your child.

    < 48

    If your score is less than 48, seek an outside intervention for you and your child (i.e., counseling, groups, and/or treatment program—depending upon the degree of at-risk choices your child is making) to help heal and strengthen the parent-child relationship.

    Note: Take this survey again in 60 days to see if you have made any improvement.

     
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    "Our daughter has been home from Anasazi for a year now. She is a much kinder person, caring and loving towards us as her parents. For the most part, she is respectable towards us. She will normally do her chores now without argument… She is doing very well in school. Thank you for giving our daughter back to us."
    --Mother, South Dakota
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