Episcenter Parent Practice Form

  • MM slash DD slash YYYY
  • Pre = Prior to attending this program; Post = After attending this program
  • Parent Practices Interview

    This section asks questions about different ways of disciplining children and teaching them right from wrong. Please fill in the box that best corresponds to how you would answer the following questions. Please only fill in one box for each item.
  • NeverSeldomSometimesAbout half the timeOftenVery OftenAlways
    A) Raise your voice (scold or yell)
    B) Get your child to correct the problem or make up for his/her mistake
    C) Threaten to punish him/her (but not really punish him/her)
    D) Give him/her a time out
    E) Take away privileges (like TV, playing with friends)
    F) Give your child a spanking
    G)Slap or hit your child (but not spanking)
    H) Discuss the problem with child or ask questions
  • Not at all likelySlightly likelySomewhat likelyModerately likelyQuite likelyVery likelyExtremely likely
    A) Raise your voice (scold or yell)
    B) Get your child to correct the problem or make up for his/her mistake
    C) Threaten to punish him/her (but not really punish him/her)
    D) Give him/her a time out
    E) Take away privileges (like TV, playing with friends)
    F) Give your child a spanking
    G) Slap or hit your child (but not spanking)
    H) Discuss the problem with child or ask questions
  • Not at all likelySlightly likelySomewhat likelyModerately likelyQuite likelyVery likelyExtremely likely
    A) Raise your voice (scold or yell)
    B) Get your child to correct the problem or make up for his/her mistake
    C) Threaten to punish him/her (but not really punish him/her)
    D) Give him/her a time out
    E) Take away privileges (like TV, playing with friends)
    F) Give your child a spanking
    G) Slap or hit your child (but not spanking)
    H) Discuss the problem with child or ask questions
  • NeverSeldomSometimesAbout half the timeOftenVery OftenAlways
    A) If you ask your child to do something and he/she doesn't do it, how often do you give up trying to get him/her to do it?
    B) If you warn your child that you will discipline him/her if she/he doesn't stop, how often do you actually discipline him/her if he/she keeps on misbehaving?
    C) How often does your child get away with things that you feel he/she should have been disciplined for?
    D) If you have decided to punish your child, how often do you change your mind based on your child's explanations, excuses or arguments?
    E) How often do you show anger when you discipline your child?
    F) How often do arguments with your child build up and you do or say things you don't mean to?
    G) How often is your child successful in getting around the rules that you have set?
    H) How often does the kind of punishment you give your child depend on your mood?
  • NeverSeldomSometimesAbout half the timeOftenVery OftenAlways
    A) Praise or compliment your child
    B) Give your child a hug, kiss, pat, handshake, or high five
    C) Buy something for him/her (such as special food, a small toy) or give him/her money for good behavior
    D) Give him/her an extra privilege (such as cake, go to the movies, special activity) for good behavior
    E) Give points or starts on a chart
  • Less than once per weekAbout once per weekA few times per week, but not dailyAbout once per day2-5 times per day6-10 times per dayMore than 10 times per day
  • I was not with my child in the last 2 daysNeverOnceTwice3 Times4 or 5 Times6 or 7 TimesMore than 7 Times
    A) Praise or compliment your child for anything he/she did well?
    B) give your child something extra, like a small gift, privileges, or a special activity with you, for something he/she did well?
  • Strongly DisagreeDisagreeSlightly DisagreeNeither Agree Nor DisagreeSlightly AgreeAgreeStrongly Agree
    A) Giving children a reward for good behavior is bribery.
    B) I shouldn't have to reward my children to get them to do things they are supposed to do.
    C) I believe in using rewards to teach my child how to behave.
    D) It is important to praise children when they do well.
    E) I would like to praise my child more often than criticize him/her, but it is hard to find behaviors to praise.
    F) If I give my child praise or rewards to encourage good behavior, he/she will demand rewards for everything.
    G) If a child is having trouble doing something he/she is supposed to do (such as going to bed, picking up toys), it is a good idea to set up a reward or an extra privilege for doing it.
  • Strongly disagreeDisagreeSlightly DisagreeNeither Agree Nor DisagreeSlightly AgreeAgreeStrongly Agree
    A) I have made clear rules or expectations for my child about chores
    B) I have made clear rules or expectations for my child about not fighting, stealing, lying, etc.
    C) I have made clear rules or expectations for my child about gong to bed and getting up on time
  • Not at all likelySlightly likelySomewhat likelyModerately likelyQuite likelyVery likelyExtremely likely
    A) When your child completes his/her chores, how likely are you to praise or reward your child?
    B) When your child does NOT complete his/her chores, how likely are you to punish your child (such as taking away a privilege or grounding him/her)?
    C) When your child fights, steals, or lies, how likely are you to punish your child?
    D) When your child goes to bed or gets up on time, how likely are you to praise or reward your child?
  • Revised 1/20/12. This document is adapted from the Oregon Social Learning Center's (OSLC) Discipline Questionnaire. The PPI can be administered as an interview or used as a self-report questionnaire completed by the child's primary caregiver.

I enjoy the little everyday successes, whether it be watching our kids advance in speech class, or having them open up about how they are feeling. – COBYS Resource Parents Austin and Cathy