Media Assessment – Brave Parenting

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First, a few general questions

This will help us ask the right questions about your family and technology use in your home.

All information is kept confidential and not shared beyond providing it to you. There is no obligation to provide your name or other identifying information to receive your results.

This assessment takes approximately 5-10 minutes to complete.

Do you have any children?*
- Yes
- Not yet, but I am planning for the future.
We are excited that you are planning for your future and want to consider the role that media and technology will play in your home! We won't ask as many questions, but we will provide some additional resources to help you plan for your future.

How many children do you have?*

What age range does your child/children fall into? (Check all that apply)*
- 0-1
- 1-3
- 3-6
- 6-12
- 13-17
- 18+

What is your relationship status?*
- Married
- Single
- Divorced
- Widowed

Now, lets examine the media and technology in your home.
What type of phone do you have?*
- iPhone
- Android
- Other
- No Phone

What type of phone does your spouse have?*
- iPhone
- Android
- Other
- No Phone

Are there computers in your home?*
- Yes, both PCs and MACs
- Yes, one or more PCs.
- Yes, one or more MACs
- No

What type(s) of computer(s) do you have?*
- Desktop(s)
- Laptop(s)
- Both
- I don't know

Is the computer (or computers) kept in a PUBLIC area of your home? (ie. living room)*
- Permanently
- Often
- Sometimes
- Rarely
- No

What other devices are in your home?*
- Amazon Echo
- Amazon Fire Stick
- Android tablet
- Apple iPad
- Apple TV
- Chromecast
- Google Home
- Kindle Fire
- Nintendo Gaming System (DS, Switch, Wii)
- Oculus
- Playstation
- Roku
- Smart TV
- Xbox
- Other
- None
This field is hidden when viewing the form
Total Home Devices

Do you subscribe to any streaming services?*
- Amazon Prime
- Apple TV+
- Direct TV Stream
- Disney+
- Fubo
- Hulu
- Netflix
- Max
- Paramount+
- Peacock
- Philo
- Sling
- None
This field is hidden when viewing the form
Total Streaming Services

Do you have a home phone?*
- Yes - Old fashion landline
- Yes - Home smartphone
- No

Now, Let's review your media usage...
Your children are watching your media usage whether you realize it or not. The more honest you are with your answers, the faster you can make positive changes that will impact your entire family.
Now, Let's review your media usage...
Your future children will be watching your media usage whether you realize it or not. The more honest you are with your answers, the faster you can make positive changes that will impact your entire family.

Do you monitor your phone usage?*
- Yes, ScreenTime on iOS.
- Yes, Digital Wellbeing on Android.
- Yes, I monitor in a different way.
- No, I don't track my phone usage.

Do you find yourself carrying your phone in your hand instead of a pocket or other location?*
- Always
- Often
- Sometimes
- Not Often
- Rarely
- Never

Do you keep your phone out when you are talking with other people?*
- Always
- Often
- Sometimes
- Not Often
- Rarely
- Never

Do you keep earbuds / AirPods in your ears when talking to others?*
- Always
- Often
- Sometimes
- Not Often
- Rarely
- Never

What social media accounts do you have?*
- Facebook
- Instagram
- TikTok
- Snapchat
- YouTube
- X / Twitter
- Pinterest
- LinkedIn
- Quora
- Discord
- Twitch
- Threads
- Tumblr
- Mastodon
- BeReal
- None
This field is hidden when viewing the form
Total Social Media Accounts

Do you have social media on your phone?*
- Yes
- No

Do you keep you phone out while eating?*
- Always
- Often
- Sometimes
- Not Often
- Rarely
- Never

Do you watch movies or stream media on your phone while you eat?*
- Always
- Often
- Sometimes
- Not Often
- Rarely
- Never

Do you scroll social media on your phone while you eat?*
- Always
- Often
- Sometimes
- Not Often
- Rarely
- Never

Do you use your phone, computer, or devices within one hour before you go to bed?*
- Always
- Often
- Sometimes
- Not Often
- Rarely
- Never

Do you use your computer to scroll social media?*
- Always
- Often
- Sometimes
- Not Often
- Rarely
- Never

Estimate how many times a day you look at your phone (notifications).*
- 500+ times a day
- 200-500 times a day
- 100-200 times a day
- 50-100 times a day
- 25-50 times a day
- 10-25 times a day
- Less than 10 times a day

Do you try to limit your phone usage in front of your kids?*
- Yes
- No
- Sometimes

Do you post pictures of your children on social media?*
- Always
- Often
- Sometimes
- Not Often
- Rarely
- Never

Are you on your phone when your children are also eating at the table?*
- Always
- Often
- Sometimes
- Not Often
- Rarely
- Never

Are you and your spouse on the same page when it comes to parenting?*
- 100% on the same page
- Mostly on the same page
- Sometimes on the same page
- Generally not on the same page
- Not at all on the same page

Are you and your spouse on the same page when it comes to technology?*
- 100% on the same page
- Mostly on the same page
- Sometimes on the same page
- Generally not on the same page
- Not at all on the same page

Now, Let's talk about your child's media usage...
Since you have more than one child, answer these questions based on your oldest child. The oldest child generally sets the standard in your home for media and devices. If your oldest child isn't the best child to choose, feel free to pick your second oldest.

Does your child have access to a phone?*
- Yes
- No

What type of phone? (Check any that apply)*
- iPhone
- Android (Samsung, Google, etc)
- Flip phone
- Bark Phone
- Gabb Phone
- Pinwheel Phone
- Troomi Phone
- Other Phone

At what age did you provide the phone?*

Does the phone have parental controls enabled?*
- Yes
- No

Who knows the passwords for the account tied to the phone?*
- I do and my child does not
- Both myself and my child
- My child does and I do not

Does your child have the ability to install and delete apps?*
- Yes
- No
- I don't know

Do you know what apps are on your child's phone?*
- Yes
- No
- I don't know

Do you limit where your child can take the phone INSIDE the home?*
- Yes
- No

Do you limit where your child can take the phone OUTSIDE the home?*
- Yes
- No

Do you take the phone up at night or have a location outside of your child's bedroom for overnight storage?*
- Yes
- No

Does your child have access to the browser on the phone?*
- Yes
- No
- I don't know

What devices does your child have access to?*
- Amazon Echo
- Amazon Fire Stick
- Android tablet
- Apple iPad
- Apple TV
- Chromecast
- Google Home
- Kindle Fire
- Nintendo Gaming System (DS, Switch, Wii)
- Oculus
- Playstation
- Roku
- Smart TV
- Xbox
- Other
- None
This field is hidden when viewing the form
Total Device Access

Do you have parental controls activated on all devices your child has access to?*
- Yes
- No
- I don't know

Do you have parental controls activated on all streaming services?*
- Yes
- No
- I don't know

Does your child have access to your computer(s)?*
- Yes, with supervision
- Yes, without supervision
- No

Does your child play video games (on any device, computer, or console)*
- Yes
- No
- I don't know

Are there any restrictions on what games your child plays?*
- Yes
- No
- I don't know

Does your child play video games online?*
- Yes
- No
- I don't know

Does your child communicate with online friends when playing video games?*
- Yes
- No
- I don't know

Does your child have access to social media?*
- Yes, with supervision
- Yes, without supervision
- No

What social media accounts does your child have?*
- Facebook
- Instagram
- TikTok
- Snapchat
- YouTube
- X / Twitter
- Pinterest
- LinkedIn
- Quora
- Discord
- Twitch
- Threads
- Tumblr
- Mastodon
- BeReal
This field is hidden when viewing the form
Total Child Social Media Accounts

Who controls the passwords to the social media accounts?*
- I do
- We both do
- My child does
- I don't know

Are you blocking inappropriate content (ie. Pornography) on all devices in your home?*
- Yes
- No
- I don't know

Have you talked to your child about digital predators?*
- Yes
- No
- I don't know enough about predators myself.

Have you talked to your child about online safety?*
- Yes
- No
- I don't know

Have you talked to your child about cyberbullying?*
- Yes
- No
- I don't know

Does your child understand the consequences of their online actions?*
- Yes
- No
- I don't know

How many MINUTES a day does your child spend on the following?
On their phone, not on social media (in minutes)*
On social media (in minutes)*
Playing video games (in minutes)*
Watching movies or streaming shows (in minutes)*
This field is hidden when viewing the form
Total Minutes

Do you have a plan for media usage and devices access in your home?*
- Yes, I plan ahead and implementing a strategy with any new devices or media.
- No, I go with the flow with new devices and media.

Are there any topics on media or devices that you would like to know more about? (Optional)

Optional

If you complete the information below, we will also email you a copy of your assessment results. This is highly recommended. The results are detailed and can easily be referred to if you have a copy.
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