FACES Survey

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FACES members advocate on the local, state and national level, bringing awareness to the need for accessible and effective services for Vermont families. Your voices need to be heard! Get involved now!

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Visit our links section and find other online resources that may be of use to you. Go there now!

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Household Survey on Youth Substance Use

This survey was designed BY family members FOR family members. In order to reach our goal of making Vermont adolescent substance abuse and mental health services more effective, we need to hear from you!

Instructions:

  1. This survey is completely confidential. All information collected by this survey will be used for assessment and planning purposes only. No names will be used or released to any other organization or publication. We value your privacy!
  2. Complete one (1) survey for each child under the age of 21 living in your household.
  3. Complete no more than one (1) survey per child, per year.
  4. By providing your zip code, information will be summarized into a region-specific format.
  5. To find out the information for your specific region, please contact us
  6. For paper copies of this survey to be used at your parent groups, schools, coalitions or other community groups or events, please contact us

* indicates a required field.

For this survey:

  1. "your child" means the youth or young adult that you provide care for
  2. "drugs" includes tobacco or other drugs, inlcuding prescription drug abuse
* Your Zip Code:
* Age of Child:
Do you think that your child is using drugs? Yes No
Do you think that your child is drinking alcohol? Yes No
Does your child take alcohol or drugs, including prescription drugs, from parents, siblings, other relatives? Yes No
Do you know where to find help for your child if he or she is using alcohol or drugs? Yes No
Is your child in alcohol or drug treatment or counseling now (or in the past)? Yes No
If yes, is/was it helpful? Please explain:
If yes, was there anything that was difficult about getting help for your child? (example: waiting list; transportation) Please explain:
Do you know where you can find help for yourself and your family if your child is using alcohol or drugs? Yes   No
Have you ever had alcohol or drug treatment for yourself? Yes   No
If yes, was it helpful? Yes   No
Is your child receiving mental health services? Yes   No
Does your child have health insurance? Yes   No
Does his or her health insurance cover the cost of treatment services? Yes   No
Have you experienced stigma or discrimination as a result of someone's substance use? Yes   No
Are you or another household member in long-term recovery from alcohol or drug addiction? Yes   No
What types of support do you (or would you) use? Please check all that apply
Parent Support Group
Educational Workshops
Parent "Warm Line"
Help Navigating Services
Parent Advocacy Group
12 Step Support
Additional Comments: