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Pediatric survey

This survey is geared toward the primary caretaker of a child or children in chronic pain.  Pediatric pain isn't recognized or well-understood; we hope you can help us change that by participating in this survey.
 
The goal of this survey is to collect information so our organization can more accurately address and share the realities faced by children and families who experience chronic pain. This survey should take approximately 10 minutes.  Thank you for your time in filling out the survey and helping us make a difference. 
1. How many children in your family live with chronic pain? *This question is required.
2. Age of your child(ren) with chronic pain. *This question is required.
3. What percent of their life would you estimate your child has experienced chronic pain? *This question is required.
4. What is your child's race or ethnicity? (Optional)
5. Is your child Hispanic or Latino(a)? (Optional)
6. To which gender identity does your child(ren) most identify? (Optional)
7.  Please rate your child's average daily pain on a scale of 0-10, with 10 being the worst possible pain and 0 being no pain. *This question is required.
0
5
10
8. On average, how many medical appointments does your child have per month? *This question is required.
9. How many confirmed medical diagnoses does your child have?   *This question is required.
10. Does your child live with any of these specific conditions? Please check all that apply. *This question is required.
  • Neurological
  • Endocrinological
  • Musculoskeletal
  • Gastrointestinal
  • Gynecological
  • Autoimmune/Rheumatological
  • Hematological
  • Oncological
  • Infectious Disease
11.  What types of providers does your child currently see for managing their pain conditions? (Check all that apply) *This question is required.
  • Generalist
  • Integrative
  • Specialist
12.  Which type of provider is primarily responsible for managing your child's pain conditions? (Select only one.) *This question is required.
  • Generalist
  • Integrative
  • Specialist
13.  Which of these providers would you like your child to see or see more of, but haven't because of limited resources, whether cost, insurance barriers, travel time, etc.? (Check all that apply.) *This question is required.
  • Generalist
  • Integrative
  • Specialist
14. Have you faced any of the following barriers to your child's care? Please check all that apply. *This question is required.
  • * This question is required.
15. In the past year, how many times would you estimate that you have had to decline desired treatment or therapies due to not being able to afford it? (Optional)
16. Do you wish you had more education/information about different therapies or medications? *This question is required.
17.  Overall, which category of pain management do you feel is emphasized most by your child's providers? (Select only one.) *This question is required.
18. Which categories of pain management do you wish were emphasized more by your child's providers? (Select all that apply.) *This question is required.
19. In the past year how many times has your child been hospitalized inpatient due to their pain conditions?   *This question is required.
20. In an average year, how many days was your child admitted to the hospital?
20. What kind of health insurance is your child enrolled in?   *This question is required.
21. How much would you estimate you spend out of pocket on medical care for your child's pain conditions per year, including deductibles, copays, over the counter medicine, self pay medical treatment, devices, etc.? *This question is required.
22. How many different prescribed medications does your child currently take?  *This question is required.
23. On average, how many over-the-counter medications does your child use?  *This question is required.
24. Has your child tried medical cannabis for pain management? *This question is required.
25. Why hasn't your child tried medical cannabis?
25. Prior to Covid 19, did your child attend school in person?  *This question is required.
26. Prior to the Covid 19 shutdown, on average how many days per month did your child have to miss school either entirely or partially due to their pain conditions? For example: too sick to go or stay in school, doctors appointments, etc.
26. Why did your child not attend school in person prior to the Covid 19 school shutdowns?
26. Has your child experienced any of the following due their chronic pain conditions? *This question is required.
27. Does your child's pain condition(s) require use of any type of assistive device? (ex. wheelchair, cane, crutches, braces, etc.) Please reply "yes" even if it may only be occasionally.  *This question is required.
28. On average, how many times per month does your child avoid using a wheelchair, cane, crutches, braces or other devices to avoid embarrassment even if the result of not using it will cause more pain?  
 
28. What kind of assistive devices does your child use?
28. How many other immediate family members (parents and siblings) are diagnosed with chronic pain?
  *This question is required.
29. Has your child's pain restricted your ability (as parent or caretaker) to engage in any of the following activities? *This question is required.
30. You've indicated your child's pain conditions has impacted your ability to work.  How so?
30. Have you and your child participated in an in-person or a virtual Pediatric Pain Warrior Retreat?  *This question is required.
31. How did attending a Pediatric Pain Warrior retreat, either in person or online, help your child and family? Check all that apply.
31. Which three of the following options do you think would benefit your child the most (Pick only 3)? *This question is required.
32. Which three of the following topics are of most interest to you and your family in webinar format? (Pick only 3) *This question is required.