1. When things don’t go well, I don’t blame myself.	This is not an issue for me.	This is going ok for me, but could be better.	I’d like help with this.
2. When trying new things, I do all of the following: I am patient with myself and don’t expect myself to get things right away I feel comfortable pushing myself beyond my comfort zone I can be flexible with my plans and expectations.	This is a strength for me.	This is going ok for me, but could be better.	I’d like help with this.
3. My baby and I are bonding.	This is going well for me.	This is going ok for me, but could be better.	I’d like help with this.
4. Most of the time my baby’s crying doesn’t overwhelm me.	This is a strength for me.	This is going ok for me, but could be better.	I’d like help with this.
5. Most of the time I am able to calm myself down when I have strong emotions (such as stress, worries, anger) or distressing thoughts.	This is a strength for me.	This is going ok for me, but could be better.	I’d like help with this.
6. I have people in my life that help to make sure I’m taking care of myself. For example, people in my life check-in with me about taking care of myself, or they help me to take care of myself by doing things like watching the baby.	This is going well for me.	This is going ok for me, but could be better.	I’d like help with this.
7. I am able to get the materials I need to take care of the baby and myself (such as diapers and food).	This is not an issue for me.	This is going ok for me, but could be better.	I’d like help with this.
8. I am getting more experienced with taking care of my baby.	This is going well for me.	This is going ok for me, but could be better.	I’d like help with this.
9. When I do things well, I am able to give myself credit for it.	This is a strength for me.	This is going ok for me, but could be better.	I’d like help with this.
10. If you have people in your life who help and support you: when I am talking to people in my life who help or support me, I do all of the following: I can be open and honest I can trust people to help me I can ask for help and take help when it is offered	This is a strength for me.	This is going ok for me, but could be better.	I’d like help with this.
11. I have been able to get my baby into a routine.	This is going well for me.	This is going ok for me, but could be better.	I’d like help with this.
12. When I have a question about parenting or early motherhood, I know how to get an answer that I trust.	This is going well for me.	This is going ok for me, but could be better.	I’d like help with this.
13. I am involved in activities outside of the house (such as friendships, hobbies, professional or volunteer work).	This is going well for me.	This is going ok for me, but could be better.	I’d like help with this.
14. I know myself (when I need to ask for help, what I need, what makes me feel better when I feel down, worried, or stressed).	This is a strength for me.	This is going ok for me, but could be better.	I’d like help with this.
15. My home environment is safe and stable.	This is not an issue for me.	This is going ok for me, but could be better.	I’d like help with this.
16. I know that taking care of myself is important, and guilt does not get in the way of taking care of my own needs.	This is a strength for me.	This is going ok for me, but could be better.	I’d like help with this.
17. I am able to sleep at night when my baby is sleeping.	This is going well for me.	This is going ok for me, but could be better.	I’d like help with this.
18. When thinking about social pressures, I don’t do any of the following: feel like I have to reach the expectations of others worry about other people’s judgments of me compare myself to others.	This is a strength for me.	This is going ok for me, but could be better.	I’d like help with this.
19. I plan and manage time well.	This is a strength for me.	This is going ok for me, but could be better.	I’d like help with this.
20. I have people in my life that I can talk to openly and honestly about my feelings and experiences.	This is not an issue for me.	This is going ok for me, but could be better.	I’d like help with this.
21. I have people to help me with childcare and household management (cooking, cleaning, shopping, etc.).	This is not an issue for me.	This is going ok for me, but could be better.	I’d like help with this.
22. I understand what my baby is trying to tell me (through their cries, body language, etc.).	This is a strength for me.	This is going ok for me, but could be better.	I’d like help with this.
23. If you or your co-parent are currently working: my workplace/my partner’s workplace has been understanding and flexible since I have had my baby.	This is not an issue for me.	This is going ok for me, but could be better.	I’d like help with this.
24. I am not experiencing physical pain or discomfort.	This is not an issue for me.	This is going ok for me, but could be better.	I’d like help with this.