Caregiver Bonds Survey (for Parent Coaching)

Overview: Research shows strong bonds in the caregiver-child relationship offer trust and safety vital to healthy development. The following factors are found to contribute to strong, positive bonds.

Directions: Please rate your current levels of each of these factors on a scale from 0-10. 0 represents completely absent and 10 represents present and strong.

1. Warmth and attunement (Caregiver kindness toward the child and being in tune with the child’s needs) 🔲

2. Caregiver self-care (Caregiver attends to their own needs) 🔲

3. Intentional values and modeling (Caregiver is aware of the values they want to promote in the relationship and actively works to demonstrate those values) 🔲

4. Availability (Caregiver is available and dependable) 🔲

5. Involvement (Caregiver is involved in the child’s life) 🔲

6. Autonomy granting (Caregiver allows the child developmentally appropriate independence) 🔲

7. Healthy boundaries (Appropriate and safe behavior in the relationship) 🔲

8. Demonstrates interest and mattering (Caregiver shows interest in who the child is, the child’s perspective, and ensures the child feels a sense of value) 🔲

9. Constructive communication (Caregiver encourages bi-directional communication to understand one another) 🔲

10. Collaborative problem-solving (Caregiver involves the child in finding solutions) 🔲

Which of the above areas stand out as those you’d like to improve through coaching?

Create goal statements for each. (Example: I want to learn to prioritize my self-care.)

1. I want to.................
2. I want to.................