Device & Social Media Usage Self-Assessment

Instructions: For each statement below, circle or write the number that best reflects your experience. Then answer the short-response questions honestly. There are no right or wrong answers—this is for your personal reflection.

Part 1: Likert-Scale Reflection

Please rate the following statements on a scale of 1 to 5, where:
1 = Strongly Disagree 2 = Disagree 3 = Neutral 4 = Agree 5 = Strongly Agree

1. I often check my phone within 5 minutes of waking in the morning.
   Response: ________
   
   

2. I feel anxious or unsettled when I can’t access social media for a period of time.
   Response: ________
   
   

3. I frequently lose track of time when using certain apps (e.g., social media, games, streaming).
   Response: ________
   
   

4. I find it difficult to put my device down during meals or family time.
   Response: ________
   
   

5. I intentionally schedule “screen-free” periods each day (for example, during meals or before bedtime).
   Response: ________
   
   

Part 2: Usage Estimates

6. On a typical weekday, estimate the total number of hours you spend actively using your smartphone or tablet (not including calls):
   Response: ________ hours per day
   
   

7. On a typical weekday, estimate the total number of hours you spend on social media (all platforms combined):
   Response: ________ hours per day
   
   

Part 3: Short-Answer Reflection

8. List three apps, websites, or online activities where you tend to lose track of time.
   
   
   
   
   
   
   

9. Describe one device-related habit you’d most like to change in the next two weeks.
   
   
   
   
   
   
   

10. What is one benefit you hope to gain by setting healthier digital boundaries for yourself and your family?
    
    
    
    
    
    
    

Boundary-Setting Strategies Handout

Use these core strategies to establish healthy digital boundaries for yourself and your family. Review each strategy, consider the examples, and jot down how you might implement it in your home.

1. Establish Screen-Free Zones & Times

What it is: Designated areas or periods when no one uses devices (e.g., mealtimes, bedrooms, family room).

Example: No phones or tablets at the dinner table; devices stay in a charging basket in the kitchen.

Tips:

• Choose zones that matter most—meal times, family gatherings, or one evening per week.
• Post a simple sign or poster as a reminder.

Notes on implementation:

2. Manage Notifications Mindfully

What it is: Control alerts so devices don’t interrupt important moments or create constant distractions.

Example: Turn off non-essential app notifications after 8 PM or use “Do Not Disturb” during homework time.

Tips:

• Review notification settings weekly.
• Group lesser-priority apps into a “silent” category.

Notes on implementation:

3. Schedule Tech Check-In Times

What it is: Set aside specific times to review messages, social media, and emails rather than checking continuously.

Example: Check social media only twice a day—in mid-morning and after dinner—for no more than 15 minutes each.

Tips:

• Use timers or alarms to signal start and stop.
• Communicate your check-in schedule to family members.

Notes on implementation:

4. Create a Central Charging Station

What it is: A shared location where all family devices are charged and stored overnight.

Example: A basket or docking station in the hallway where phones go at 9 PM and stay until morning.

Tips:

• Make it part of the nightly routine—“Once devices are in the station, lights out.”
• Personalize with colored cords or labels for each family member.

Notes on implementation:

5. Define Device Curfews & Limits

What it is: Clear rules about when devices must be off or put away (e.g., no screens after 9 PM).

Example: No screen time one hour before bedtime to improve sleep quality and reduce blue-light exposure.

Tips:

• Use device settings to enforce curfews (e.g., Downtime on iOS, Digital Wellbeing on Android).
• Discuss the benefits—better sleep, more family connection—so everyone understands the why.

Notes on implementation:

Reflection & Action Planning

1. Which two strategies do you feel most ready to try this week?

   1. ---

   2. ---

2. What potential challenges might you encounter, and how will you address them?

3. How will you involve your children or partner in creating and upholding these boundaries?
   
   
   
   
   
   
   

Digital Boundaries Action Planning Worksheet (SMART Goals)

Instructions: Use this worksheet to craft SMART (Specific, Measurable, Achievable, Relevant, Time-bound) digital boundary goals. Complete two short-term goals (1–2 weeks) and two long-term goals (1–3 months). Then pair up to get feedback and refine your plans.

1. Short-Term SMART Goal #1 (1–2 Weeks)

a. Specific: What exactly will you do?







b. Measurable: How will you track progress?







c. Achievable: What resources or supports make this realistic?







d. Relevant: Why is this important for your family?







e. Time-bound: By what date will this be complete?

Action Steps:

2. Short-Term SMART Goal #2 (1–2 Weeks)

a. Specific:







b. Measurable:







c. Achievable:







d. Relevant:







e. Time-bound:

Action Steps:

3. Long-Term SMART Goal #1 (1–3 Months)

a. Specific:







b. Measurable:







c. Achievable:







d. Relevant:







e. Time-bound:

Action Steps:

4. Long-Term SMART Goal #2 (1–3 Months)

a. Specific:







b. Measurable:







c. Achievable:







d. Relevant:







e. Time-bound:

Action Steps:

5. Peer Feedback (Partner Name: ___________________)

Key Feedback & Suggestions:

6. Plan Refinement

Based on feedback, how will you adjust your SMART elements or action steps?

7. Resources & Support Needed

What tools, strategies, or people will help you stay on track?

Next Steps:

• Display this worksheet prominently (fridge, desk, etc.) to remind you of your commitments.
• Schedule brief weekly check-ins with your partner or a family member to review progress.
• Celebrate achievements and set new SMART goals as you succeed!

Family Tech Use Agreement

Date Created: ___________________

Family Name: ___________________

Family Members & Devices

List each person and the devices they use:

1. Name: __________________________ Role: ____________ Devices: _______________________
   
   
2. Name: __________________________ Role: ____________ Devices: _______________________
   
   
3. Name: __________________________ Role: ____________ Devices: _______________________
   
   
4. Name: __________________________ Role: ____________ Devices: _______________________
   
   

1. Device-Free Family Meals

• Start Time: ____________ End Time: ____________
• Location (e.g., kitchen, dining room): __________________________
• Notes/Exceptions:
  
  
  
  
  

2. Daily Screen Time Limits

• Adults (Specify names & limits):
  • _______________________ : _____ hours/day
  • _______________________ : _____ hours/day
• Children (Specify age & limits):
  • Age ___ : _____ hours/day
  • Age ___ : _____ hours/day
• Notes (weekend vs. weekday, bonus time, etc.):
  
  
  
  
  
  
  

3. Central Charging Station & Curfews

• Location of charging station: __________________________
• Curfew Time (devices off/docked): ____________
• Exceptions or special cases:
  
  
  
  
  

4. Tech Check-In Times

• Morning Check-In: ____________ for ______ minutes
• Evening Check-In: ____________ for ______ minutes
• Rules for check-ins (e.g., no multitasking, no devices in bedrooms):
  
  
  
  
  
  

5. Notification Management

• “Do Not Disturb” windows:
  • From ____________ to ____________ daily
• Priority apps/contacts allowed during DND:
  • __________________________
• Additional notes:
  
  
  
  
  

6. Consequences & Support

• If a boundary is broken, our agreed consequence is:
  • __________________________
• Ways we will support each other to stick to this agreement:
  • __________________________
  
  
  
  
  

7. Review & Updates

• Next Review Date: ____________
• Frequency of review (e.g., monthly, quarterly): ____________
• How changes will be made (family vote, discussion, etc.): ____________
  
  
  
  

Signatures

By signing below, we agree to uphold this Family Tech Use Agreement.

Parent/Guardian 1: __________________________ Date: ____________


Parent/Guardian 2: __________________________ Date: ____________


Child (optional): __________________________ Date: ____________

This agreement is designed to foster healthy digital habits and strengthen family connection.

Tech Habits Poll

Time: 5–10 minutes

Instructions: Use a quick show of hands or a digital polling tool (e.g., Zoom poll, Mentimeter) to answer the following. Record the tallies on the flip chart or whiteboard, then spend a few minutes discussing any surprises.

1. How often do you check your phone within the first 15 minutes of waking up?

   • Option A: Never / Almost Never
   • Option B: 1–5 times
   • Option C: 6–10 times
   • Option D: 11+ times

2. On an average weekday, how many total hours do you spend on social media?

   • Option A: Less than 1 hour
   • Option B: 1–3 hours
   • Option C: 4–6 hours
   • Option D: 7+ hours

3. At meal times, how frequently do you allow devices at the table?

   • Option A: Always
   • Option B: Sometimes
   • Option C: Rarely
   • Option D: Never

4. Do you currently use any built-in tools (e.g., “Do Not Disturb,” app timers) to limit interruptions?

   • Option A: Yes
   • Option B: No

5. Do you feel anxious or restless when you can’t access your phone or social media for an hour?

   • Option A: Yes
   • Option B: No

Brief Discussion (5 minutes):
• Which poll result surprised you the most?


• What does this reveal about your own or your family’s tech habits?


• How might these insights inform the boundaries you set today?

Commitment Sticky Notes

Time: 10 minutes
Materials: Sticky notes, pens, flip chart or poster space

Instructions:

1. Hand out one sticky note and a pen to each participant.
2. Ask everyone to write one specific digital boundary or goal they commit to putting into practice over the next 1–2 weeks.
   • Prompt examples:
   • “I commit to _________”
   • “To support family time, I will _________”
   • “Each evening, I will _________”
3. Encourage concise, positive statements (one or two lines).
4. Invite participants to post their sticky notes on the flip chart or designated poster.
5. Once all notes are up, ask 2–3 volunteers to read theirs aloud and share why they chose it.
6. Celebrate each commitment with group applause or a brief word of encouragement.
7. Wrap up by reminding participants to keep a photo of the board or place their note somewhere visible (e.g., fridge, desk) to reinforce accountability.

Unplug to Connect: Facilitator Script

Warm-Up Poll (10 minutes)

“Good morning and welcome, everyone!
Thank you for joining our ‘Unplug to Connect’ workshop.
To kick us off, we’re going to use a quick poll to surface our current tech habits.

Please take a moment to look at the flip chart or projector where I’ve displayed our Tech Habits Poll.
Use a show of hands (or your polling tool) to answer each question.
I’ll record the tallies here on the board.

1. How often do you check your phone within the first 15 minutes of waking up?
2. On an average weekday, how many total hours do you spend on social media?
3. At mealtimes, how frequently do you allow devices at the table?
4. Do you use built-in tools like “Do Not Disturb” or app timers?
5. Do you feel anxious when you can’t access your phone for an hour?

[Pause to collect responses and tally on the board.]

“Thanks for that.
Which result surprised you the most?
[Wait for 2–3 responses.]
What does that tell you about your family’s device habits?
[Invite 1–2 quick comments.]
These insights will help guide the boundaries we set today.”

Introduction & Self-Assessment (15 minutes)

“Let’s shift gears and review our objectives for this morning:

• Identify personal and family device habits
• Explore practical boundary-setting strategies
• Develop a customized family tech use agreement

By the end of our time together, you’ll leave with clear goals and a written agreement you can start using right away.

I’m now handing out the Device and Social Media Usage Self-Assessment.
Please complete Part 1 and Part 2 of the quiz—about 10 minutes.
Be honest; your reflections are for your eyes first, then you’ll share one key insight.

[Set a timer for 10 minutes as participants complete the self-assessment.]

“Time’s up!
Turn to a neighbor and share one surprising takeaway from your assessment—take 5 minutes.”

[After 5 minutes of pairs sharing, reconvene the group.]

“Who would like to share one insight from your conversation?
[Invite 2–3 volunteers briefly.]

Great—thank you!
These reflections prime us for exploring strategies that address the challenges you noticed.”

Exploring Boundary-Setting Strategies (20 minutes)

“Next, let’s dive into five core strategies outlined in our Boundary-Setting Strategies Handout.
I’ll introduce each one with a quick example, then we’ll brainstorm healthy versus unhealthy tech habits on the flip chart.

1. Screen-Free Zones & Times (e.g., no devices at the dinner table)
2. Manage Notifications Mindfully (e.g., DND during homework)
3. Schedule Tech Check-Ins (e.g., two 15-minute app checks per day)
4. Central Charging Station (e.g., family basket in hallway)
5. Device Curfews & Limits (e.g., no screens after 9 PM)

[Briefly highlight each strategy and jot a sticky note example under “Healthy Habits” and “Unhealthy Habits.”]

“Now, please form small groups of three or four.
Pick one common family tech challenge—maybe bedtime scrolling or distracted dinners—and propose one of these strategies as a solution.
You have 10 minutes; be ready to share your group’s idea.”

[Circulate, then after 10 minutes, bring everyone back together.]

“Let’s hear from each group—what challenge did you pick, and which boundary strategy do you recommend?
[Allow 2 minutes per group, up to 4 groups.]

Thank you for those creative solutions!”

Action Planning & Agreement Creation (35 minutes)

“Now we move into action planning.
Please open your Digital Boundaries Action Planning Worksheet.
We’ll model one short-term goal together:

• Specific: ‘During dinner, we will place all phones in a basket at 6 PM’
• Measurable: We’ll check the basket nightly for one week
• Achievable: Everyone has access to the basket by the dining table
• Relevant: This protects our family meal time
• Time-bound: Starting tonight through next Sunday

[Write that example on the board under “Short-Term Goal #1.”]

“Now it’s your turn—spend 10 minutes drafting two short-term goals (1–2 weeks) and two long-term goals (1–3 months) on your worksheet.”

[After 10 minutes:]
“Great work!
Turn to a partner, swap worksheets, and provide feedback for 10 minutes.
Focus on clarity and achievability.”

[After peer feedback:]
“Finally, let’s create our family tech use agreement.
I’ve printed the Family Tech Use Agreement Template for each of you.
I’ll model filling Clause #1—Device-Free Family Meals: Start 6 PM, End 7 PM in the dining room, no exceptions.
Who would like to suggest the next key clause?
[Invite input: screen time limits, charging station location, check-in times, etc.]
Fill in at least four clauses for your own family agreement in the next 10 minutes.”

Reflection & Commitment (10 minutes)

“We’re almost there!
Would anyone like to share one personal goal and one clause from your family agreement?
[Allow 2–3 volunteers, brief applause after each sharing.]

To close, please grab a sticky note and pen for Commitment Sticky Notes.
Write one clear commitment you’ll put into practice over the next two weeks—one or two lines.
Then post it on the flip chart.

[Give participants 3 minutes to write and post their notes.]

“Who would like to read their commitment aloud?
[Invite 2 volunteers, celebrate each one.]

Thank you all for your courageous sharing today.
By setting these boundaries, you’re investing in stronger, healthier family connections.

Next Steps & Support:
• I’ll email you our online toolkit and templates.
• Join our optional follow-up support group starting next month.
• Feel free to reach out to me at [email protected] for coaching or questions.

Thank you for your energy and engagement.
Enjoy the rest of your day, and happy unplugging to connect!”

Next Steps & Resources Handout

Thank you for participating in Unplug to Connect! Below are options for ongoing support, downloadable materials, and trusted external resources to help you sustain healthy digital boundaries.

1. Join Our Follow-Up Support Group

• Monthly Virtual Check-Ins: Share successes, troubleshoot challenges, and learn from other parents.
• Details & Registration: Follow-Up Support Group Info

2. Downloadable Workshop Toolkit

Access all session materials in one place. Feel free to revisit, print, or share with family and friends:

• Unplug to Connect Slides
• Unplug to Connect Script
• Device & Social Media Usage Self-Assessment
• Boundary-Setting Strategies Handout
• Digital Boundaries Action Planning Worksheet
• Family Tech Use Agreement Template
• Commitment Sticky Notes

3. Recommended External Resources

• Common Sense Media: Reviews, tips, and family tech guides
https://www.commonsensemedia.org
• Center for Humane Technology: Articles on mindful device design
https://www.humanetech.com
• American Academy of Pediatrics – Family Media Plan: Interactive tool to set age-appropriate screen guidelines
https://www.healthychildren.org/English/media

4. Individual Coaching & Support

If you’d like one-on-one guidance or have questions:

• Email: [email protected]
• Schedule a Coaching Session: https://example.com/schedule

5. Next Steps for Your Family

1. Set Calendar Reminders for your short-term goals and family agreement reviews.
2. Display Key Commitments prominently (fridge, workspace) to reinforce accountability.
3. Plan a Family Check-In in 1–2 weeks to celebrate successes and adjust as needed.
4. Revisit Your Toolkit monthly to refresh strategies and set new boundaries.

You’re now equipped with the knowledge, tools, and community support to foster lasting, healthy digital habits and stronger family connections. Keep going—you’ve got this!