CBSQ Child form: Initial
Date……………..…….Family ID……………… Child ID………………
How are things?
After someone has died, people feel lots of different things. Not everyone feels the same.
I feel cross
I feel ok
I feel sad
This page has some things that different children have said. You might agree with some but not others.
Thinking about your ............................................who died and how things are for you at the moment, can you tell us
how much the sentences below sound like you?
How much do these sentences sound like you? Please tick the box to show us
Not
like me
A bit like
me
Quite a lot
like me
Totally like
me
Not
like me
A bit like
me
Quite a lot
like me
Totally like
me
Not
like me
A bit like
me
Quite a lot
like me
Totally like
me
I get on ok with my family
Not
like me
A bit like
me
Quite a lot
like me
Totally like
me
I worry a lot
Not
like me
A bit like
me
Quite a lot
like me
Totally like
me
Sometimes I feel happy
Not
like me
A bit like
me
Quite a lot
like me
Totally like
me
I’ve got someone to talk to if
I’m worried or sad
I get on ok at school
I know what happened when
they died
Thank you for your time - your answers matter to us
If you need someone to know how you are feeling now, please talk to an adult or ask to speak to someone from
the place that gave you the form.
© A Penny 2014