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CHILD CARE NEEDS SURVEY
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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1
Brief description of the issue. NOTE: All information you provide is anonymous and will be used only as part of this child care survey.
Please circle the response number that best describes the issue:
It is difficult for a child to handle his emotions. He or she has outbursts of emotion for the slightest reason;
The child becomes impulsive. He or she may break or throw things, scream, or show destructive behaviour in other ways;
A sociable child suddenly withdraws, argues, becomes defiant for no apparent reason;
The child often lies, steals or takes things that do not belong to him or her;
Bad behaviour at school: fights, lateness and absenteeism;
Quarrels and conflicts with family members become more frequent, which affects his or her social life;
Quarrels and conflicts with peers become more frequent, which affects his or her social life;
He or she cannot concentrate on anything, becomes restless, lazy or inattentive;
The child's sexual behaviour is not appropriate for his age;
He or she denies all your instructions, breaks the established rules just to make you angry;
The child self-harms or thinks about it. Expresses thoughts of suicide;
Children with special education needs;
none of the above (Please describe) ____________________________. Example: A. Disrespect and defiance, swearing, aggressive or violent behaviour, lying, bullying, manipulation, low motivation and laziness, poor school behaviour.
2
Please describe which options have already been tried or/and which challenges do you have during the issue solving process.
Example: A. Conversations with the family and the child, meetings with a mentor at school and a school psychologist, in case of bullying or conflicts, talks with other children and their parents, consulting with GP; getting psychological help online from Ukrainian doctors (otherwise on your own); involving other third-party organisations (Wij Groningen, Empatia, ZYzorgt, Helder GGZ) that provide assistance to children; what you have tried to do to help a child with special needs (special social support for the family (purchase of additional necessary things (special transport, furniture), assistance with special educational institutions, special medical care or something else. box will expand as you type.
3
Please describe the solution that is in your opinion might contribute to solve the issue.
box will expand as you type.
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