INTRODUCTION:

We are collecting information about childhood trauma. We are doing this to learn what needs there might be in our area, and what we can do to help. We do not need you to put your name on this form. Your answers are anonymous and will be used to improve the services we offer. The survey should take about 15 minutes to complete.

We truly appreciate your insight and your time. If you have any questions, please contact us at equipttherapy@gmail.com
EVENTS:

Sometimes, scary or very upsetting things happen to people. These things can sometimes affect what we think, how we feel, and what we do.

If any of the things have happened to any of the children you work with, please select 'Yes'.
1. Have any of the children you work with ever seen people pushing, hitting, throwing things at each other, or stabbing, shooting, or trying to hurt each other?
2. Has someone ever really hurt any of the children you work with? Hit, punched, or kicked them really hard with hands, belts, or other objects, or tried to hurt them physically in any way?
3. Has someone ever touched any of the children you work with on the parts of their body that a bathing suit covers, in a way that made you or them uncomfortable? Or has someone had the child touch them in that way?
4. Has anything else very upsetting or scary happened to any of the children you work with (loved one died, separated from loved one, been left alone for a long time, not had enough food to eat, serious accident or illness, fire, dog bite, bullying)? What was it?
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REACTIONS:

Sometimes scary or upsetting events affect how people think, feel, and act. The next questions ask how the children you work with have been feeling and thinking recently. How often did each of these happen in the last 30 days?

If any of these apply to more than one child, please estimate the most frequent occurrences.
5. A child you work with has strong feelings in their body when they remember something that happened (sweating, heart beats fast, feel sick).
6. A child you work with tries to stay away from people, places, or things that remind them about something that happened.
7. A child you work with has trouble feeling happy or has other emotional difficulties.
8. A child you work with has trouble sleeping.
9. It’s hard for a child you work with to concentrate or pay attention, or they have problems at school.
10. A child you work with feels alone and not close to people around them.
11. A child you work with has issues with eating, weight or their body.
12. A child you work with engages in self-destructive or risky behaviour, such as hurting themselves or taking drugs.
13. If a child you work with has any issues related to the questions above, what kind of support would they find helpful? You can select more than one.
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14. Where would you recommend this support to take place? You can select more than one.
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15. Have any of the children you work with had or tried to get help with this issue before. You can select more than one.
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16. Please tell us the age groups of the children you work with. You can select more than one group.
18. Please tell us the ethnicity of the children you work with. You can select more than one.
  • Asian or Asian British
  • Black, Black British, Caribbean or African
  • Mixed or multiple ethnic groups
  • White
  • Other ethnic group