Parental Burnout Reflection Check (PBRC)

Think about the last 14 days.
Choose a number for each statement:
0 Not at all, 1 Rarely, 2 Sometimes, 3 Often, 4 Almost always.

Reflection tool (not diagnostic)

Important

This is a reflection + coaching check-in and is not a validated diagnostic instrument. If you’re in distress or feel unsafe, consider reaching out to a licensed professional or local supports.

Part A — Your 2-Week Snapshot

Optional tracking: items #2 and #4 can be reverse-scored for your own notes (shown in results).

Part B — Four Burnout Signals

These 16 items power the main score (0–64) and the “highest signal” result.

Items completed

0/16

Part C — What’s driving it? (Load vs. Resources)

Choose up to 3 loaders and up to 3 missing resources.

Top 3 Loaders

0/3

Other (optional)

Top 3 Resources Missing

0/3

Other (optional)

Part D — Your 7-Day Micro-Plan (choose ONE)

After you calculate results, we’ll auto-suggest a plan based on your highest signal (you can override it).

My highest burnout signal is

Pick one action for the week

What might block me?

My workaround

Who will support me?

Your Results

Informational only — not diagnosis. Use this to decide what support to add next.

Part B Total Score

—/64

—

Highest Burnout Signal

—

Subscale Scores (0–16)

Depletion—

Distancing—

Saturation—

Self-gap—

Suggested next step (based on your highest signal)

—

Part A (optional) reverse-score note

For your personal tracking, Part A items #2 and #4 can be reverse-scored (4→0, 3→1, 2→2, 1→3, 0→4).

Your selections: #2 = — (reverse: —), #4 = — (reverse: —)

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