Resilience/Stress Questionnaire Resilience/Stress Questionnaire Person completing Questionnaire: Mother Father Professional OtherOther Birth Year(s) of child(ren) Your answers are confidential. You do not need to share them with anyone but you may find it helpful to do so. If answering any of the questions is disturbing, you may answer them at another time if you prefer. Please circle the most accurate answer under each statement: 1. I believe that my mother loved me when I was little. Definitely True Probably True Not Sure Probably Not True Definitely Not True 2. I believe that my father loved me when I was little. Definitely True Probably True Not Sure Probably Not True Definitely Not True 3. When I was little, other people helped my mother and father take care of me and they seemed to love me. Definitely True Probably True Not Sure Probably Not True Definitely Not True 4. I’ve heard that when I was an infant someone in my family enjoyed playing with me, and I enjoyed it, too. Definitely True Probably True Not Sure Probably Not True Definitely Not True 5. When I was a child, there were relatives in my family who made me feel better if I was sad or worried. Definitely True Probably True Not Sure Probably Not True Definitely Not True 6. When I was a child, neighbors or my friends’ parents seemed to like me. Definitely True Probably True Not Sure Probably Not True Definitely Not True 7. When I was a child, teachers, coaches, youth leaders, or ministers were there to help me. Definitely True Probably True Not Sure Probably Not True Definitely Not True 8. Someone in my family cared about how I was doing in school. Definitely True Probably True Not Sure Probably Not True Definitely Not True 9. My family, neighbors and friends talked often about making our lives better. Definitely True Probably True Not Sure Probably Not True Definitely Not True 10. We had rules in our house and were expected to keep them. Definitely True Probably True Not Sure Probably Not True Definitely Not True 11. When 1 felt really bad, I could almost always find someone 1 trusted to talk to Definitely True Probably True Not Sure Probably Not True Definitely Not True 12. As a youth, people noticed that I was capable and could get things done. Definitely True Probably True Not Sure Probably Not True Definitely Not True 13. I was independent and a go-getter. Definitely True Probably True Not Sure Probably Not True Definitely Not True 14. I believed that life is what you make it. Definitely True Probably True Not Sure Probably Not True Definitely Not True If you are human, leave this field blank. Submit Start Over