CHILD ABUSE RECOGNITION AND INTERVENTION SURVEY

PART I: DEMOGRAPHIC QUESTIONS

1. Your Race/Ethnicity: _________________________________
Your Age: ___________ Your Gender: __________________
2. Are you a parent? (Circle "yes" even if your children are over eighteen and/or no
longer living with you.)
Yes

No

If yes, please fill out the table below for your youngest six children.
Age

Gender

Relation (check one)

age: ____| gender: __________| |__ biological |__ adopted |__ step-child
age: ____| gender: __________| |__ biological |__ adopted |__ step-child
age: ____| gender: __________| |__ biological |__ adopted |__ step-child
age: ____| gender: __________| |__ biological |__ adopted |__ step-child
age: ____| gender: __________| |__ biological |__ adopted |__ step-child
age: ____| gender: __________| |__ biological |__ adopted |__ step-child

PART II: CHILD ABUSE

3. How many children do you estimate grow up in abusive households in
Massachusetts? (Circle one)
less than 5%

5% - 10%

41% - 60%

11% - 20%

21% - 40%

greater than 60%

4. How confident are you of your answer to number (3)? (Circle one.)
1

(5 = very confident)

5. Agree or disagree with the following statements:

Abusive parents can be identified by the way they act in public with their children.
(1 = never)

(5 = always)

If a child is being abused at home, they will tell another adult.

(1 = never)

(5 = always)

Children tend to lie or exaggerate, so it is difficult to believe them when they say their
parents are mistreating them.
(1 = never)

(5 = always)

If I learn that a child is being abused, I know what steps to take.

(1 = disagree) 1

(5 = agree)

PART III: WHAT IS CHILD ABUSE?

Read the following scenarios and answer the questions that follow.
Gerry whips his children with a belt whenever they misbehave. When confronted about it, he
says he's "toughening them up for the real world."
6. Which of the following words would you apply to this scenario? (Circle as
many or as few as apply.)
discipline

conflict

violence

abuse

none of the

above
7. Would you or do you act similarly? (Check one)
___ Yes.

___ No, but I don't condemn this behavior.

___ No, and Gerry should NOT treat his children this way.
Matilda regularly uses physical punishment -- slapping or spanking her children when they
misbehave. She is careful never to leave bruises or any other visible damage.
8. Which of the following words would you apply to this scenario? (Circle any
number.)
discipline

conflict

violence

abuse

none of the

above
9. Would you or do you act similarly? (Check one.)
___ Yes.

___ No, but I don't condemn this behavior.

___ No, and Matilda should NOT be hitting her children this way.
When Rebecca learns that her daughter Jane has been smoking marijuana, she does everything
she can to break the girl's habit. She regularly searches Jane's room and schoolbag. She also
sets a strict curfew. One night, when Jane returns home more than an hour past curfew, Rebecca
yells at her and threatens to beat her.
10. Which of the following words would you apply to this scenario? (Circle any
number.)

discipline

conflict

violence

abuse

none of the

above
11. Would you have done the same thing in this situation? (Check one.)
___ Yes.

___ No, but I don't condemn this behavior.

___ No, and Rebecca should NOT have threatened Jane.

Thomas (four years old) ran into the street without checking for cars. As a result, he would have
been run over by a car, but his father Steven managed to pick him up and remove him to safety.
Steven does not regularly spank his children, but he made an exception today day to show
Thomas how serious he is when he says "Don't go into the street."
12. Which of the following words would you apply to this scenario? (Circle any
number.)
discipline

conflict

violence

abuse

none of the

above
13. Would you have done the same thing in this situation? (Check one.)
___ Yes.

___ No, but I would not condemn this behavior.

___ No, and Steven should NOT have spanked Thomas.

Jonah's parents are going to a Christmas party, and they want him to come with them. Jonah
does not want to go. His parents keep pressuring him until he agrees to go, even though he is
clearly unhappy.
14. Which of the following words would you apply to this scenario? (Circle any
number.)
discipline

conflict

violence

abuse

none of the

above
15. Would you have done the same thing in this situation? (Check one.)
___ Yes.

___ No, but I don't condemn this behavior.

___ No, and his parents should NOT have acted this way either.