Adolescent Drug Misuse and Family Conflict Questionnaire - Essay Example

Adolescent Drug Misuse and Family Conflict Questionnaire Information Sheet Hello…… Before I begin I would like to thank you for your time. I am astudent at College in London. I am working towards my degree in Social Work and am conducting a study to gain knowledge about adolescent drug misuse and family conflict. In order to do this I need your help. The brief questionnaire attached will help me collect the information I need to study the problems faced by adolescents in dealing with home life difficulties and see if drug misuse is involved. Several factors are important to relay to you: The survey has nothing to do with Centre Point Hostel (They were just kind enough to allow me to distribute it here.) You do not have to participate in the survey. It is strictly voluntary. The survey is anonymous. No one will know who filled out the questionnaire. Participation does require you to sign a consent form, but the consent form will be separated from the questionnaire itself so your answers will not be matched with your name. There is no benefit to you for taking part in the survey. However, your assistance would be greatly appreciated. You are free at any time to stop filling out the survey – no questions asked. Thank You for your Time. I really appreciate your help. *****If you have specific questions leave a note at the office and I’ll get back with you. I check in daily Adolescent Drug Misuse and Family Conflict Questionnaire Thanks Again for Helping! Kindly sign and date the form below after reading and initialling the questions below. Please Initial each question in the appropriate block YES NO Have you read the Research Participant Information Sheet? Have you had an opportunity to ask questions and discuss this study? Have you received satisfactory answers to all your questions? Who have you spoken to? Do you understand that you will not be referred to by name in any report concerning the study? Do you understand that you are free to withdraw from the study: at any time without having to give a reason for withdrawing? without affecting your status at Centre Point? Do you agree to take part in this study? Signature of Research Participant: Date: Name in capitals: Witness statement I am satisfied that the above-named has given informed consent. Witnessed by: Date: Name in capitals: Adolescent Drug Misuse and Family Conflict Questionnaire 1. Are you : MALE  FEMALE  2. What age group are you in? 14 – 16  17 – 18  3. I’m : Chinese  Indian  Irish  Caribbean  Mixed Race  Black  White  Asian  Bangladeshi  Pakistani  Black  Other____________ 4. Family Make-Up – When you last lived at home, who all lived in the house? FATHER  MOTHER  STEP: FATHER  MOTHER  PARENT’S PARTNER  OLDER: BROTHER  SISTER  YOUNGER: BROTHER  SISTER OTHER (Please identify) _________________________________________ 5. Have you ever used illegal drugs? YES  NO  6. If yes, what? (Check all that apply) Ecstasy  weed (aka cannabis)  alcohol  Amphetamine  anabolic steroids  cocaine  LSD  heroin  Lightening flash magic  mushrooms opium  Other Please state ______________ 7. Are you currently using drugs? YES  NO  IF NO, When was the last time you used illegal drugs? ____________ 8. How old were you when you started using drugs? (Fill in Age) ___________ 9. Does anyone else in your family use illegal drugs? YES  NO  IF YES, WHO? _______________________________________________ 10. Did you use drugs whilst living at home? YES  NO  10. Are you currently homeless? YES  NO  If Yes, Why? ____________________________________________ 11. Have you been homeless before? YES  NO  If yes, how many times? ______ 12. How would you describe your relationship with your natural father? VERY GOOD  GOOD  FAIR  POOR  TERRIBLE  13. How would you describe your relationship with your natural mother? VERY GOOD  GOOD  FAIR  POOR  TERRIBLE  13. How would you describe your relationship with any other adult in the home? VERY GOOD  GOOD  FAIR  POOR  TERRIBLE  What is the other adult’s relationship to you? _______________________ 14, Have you ever gotten into a physical fight with someone at home? YES  NO  If Yes, who? ____________________________________________________ And Why? ____________________________________________________ And How often? _________________________________________________ 15 Did you leave home on your own or were you asked to leave? _________________ If asked to leave by whom and why? __________________________________ 16. In the remaining space kindly tell me about the reasons you left home Thank You so Much for Your Help!!!!!!!! Read More