SECTION A: FAMILY
COMPOSITION |
The first few questions are about you and other family members
living in your household at the present time. |
A3. |
Not including yourself and (FOCUS
CHILD), how many people are there in your family now? Include
anyone in your household who is related to you by blood,
marriage, adoption, or commitment; and people who are temporarily
away, for example, at school or in a hospital. Include (FOCUS
CHILD)’s
parents who may not live in your household if you consider
them part of your family.
INTERVIEWER: IF “NONE,” PROBE: Do you have children living with you?
PROBE:By someone related by
commitment we mean someone like your boyfriend or girlfriend.
|___ |___| NUMBER OF OTHER PEOPLE IN FAMILY |
NO A4-A17 THIS VERSION.
|
A18. |
Are you currently married, separated,
divorced, widowed, living together unmarried, or have you never
been married? |
MARRIED |
01 |
SEPARATED |
02 |
DIVORCED |
03 |
WIDOWED |
04 |
LIVING TOGETHER UNMARRIED |
05 |
NEVER MARRIED, NOT LIVING TOGETHER UNMARRIED |
00 |
|
NO A19-A24 THIS VERSION.
NO SECTION B THIS VERSION.
NO SECTION C THIS VERSION.
|
SECTION D: EMPLOYMENT |
D1. |
Are you currently working, in school,
in a training program, or are you doing something else?
PROBE: IF RESPONDENT IS NOT WORKING,
ASK: Are you looking for work?
|
|
CIRCLE ALL
THAT APPLY |
WORKING |
01 |
![arrow](https://webarchive.library.unt.edu/eot2008/20090110034930im_/http://www.acf.hhs.gov/programs/opre/ehs/ehs_resrch/instruments/images/arrow.gif) |
GO TO D23 |
|
UNEMPLOYED |
02 |
|
LOOKING FOR WORK |
03 |
LAID OFF |
04 |
IN SCHOOL/TRAINING |
05 |
KEEPING HOUSE/PARENTING |
06 |
IN MILITARY |
07 |
|
NO D2-D19 THIS VERSION.
NO D21-D22 THIS VERSION.
|
D23. |
The next questions are about your
current job. When did you start working
for your current employer?
PROBE FOR BEGINNING, MIDDLE, OR END OF MONTH
IF EXACT DATES ARE NOT KNOWN. IF “BEGINNING,”
ENTER 05; IF “MIDDLE,” ENTER 15; IF “END,”
ENTER 25.
IF THERE IS MORE THAN ONE CURRENT EMPLOYER,
ASK THIS AND FOLLOWING QUESTIONS ABOUT EMPLOYER FOR WHOM RESPONDENT
WORKS THE MOST HOURS.
|
START: |
|___|___| / |
|___|___| / 19 |
|___|___| |
|
|
MONTH |
DAY |
YEAR |
|
NO D24 THIS VERSION.
|
D25. |
How many days per week do you usually
work in that job?
PROBE: How many days in an average
week?
|
|
|
|___ | DAYS PER WEEK
|
D26 |
And how many hours per day do you
usually work in that job? Please include regular overtime hours.
PROBE: How many hours in an
average day?
|
|
|
|___ |___| HOURS PER DAY
|
D27. |
What is your work schedule at your
current job?
READ RESPONSE CATEGORIES IF NECESSARY.
RECORD ONE RESPONSE.
|
REGULAR DAYTIME SCHEDULE |
01 |
REGULAR EVENING SCHEDULE |
02 |
REGULAR NIGHT SCHEDULE |
03 |
ROTATING SHIFT |
04 |
SPLIT SHIFT |
05 |
IRREGULAR SCHEDULE |
06 |
WEEKENDS ONLY |
07 |
OTHER (SPECIFY)
________________________ |
00 |
|
D28. |
What is your hourly rate of pay before
taxes and deductions?
WATCH THE DECIMAL POINT.
|
|
|
$ |___|___|.|___|___| PER HOUR |
|
NOT PAID BY HOUR |
-4 |
DON'T KNOW |
-1 |
REFUSED |
- |
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3GO TO D30 |
|
D29. |
How much are your weekly
earnings before taxes and other deductions? Please
include tips, commissions, and regular overtime pay you may
receive.
CIRCLE PAY PERIOD CODE. |
|
|
$ |___|___|,|___|___|___| |
PER WEEK |
01 |
PER DAY |
02 |
ONCE EVERY TWO WEEKS |
03 |
TWICE A MONTH |
04 |
PER MONTH |
05 |
PER YEAR |
06 |
DON'T KNOW |
-1 |
REFUSED |
-3 |
|
D30. |
Now I would like to ask about benefits
that are available to you on this job. Are the following benefits
available to you?
READ CATEGORIES.
CIRCLE YES OR NO FOR EACH.
|
|
|
YES |
NO |
a. |
Paid sick leave? |
01 |
00 |
b. |
Paid Vacation? |
01 |
00 |
c. |
Employer-provided transportation? |
01 |
00 |
|
NO D31-D39 THIS VERSION.
|
D20. |
How many jobs [,if any,] have you
had since (LAST PSI INTERVIEW DATE)? Please include both full-time
or part-time jobs, including active military service.
PROBE: Include jobs like babysitting
or housekeeping if you were paid. Count babysitting, housekeeping,
or odd jobs for different families together as one job.
|___ |___| JOBS |
NONE |
00 |
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GO TO SECTION E |
DON'T KNOW |
-1 |
REFUSED |
-3 |
|
D40. |
How much of the time since (LAST
PSI INTERVIEW DATE) have you held a job or jobs in which you
worked at least 20 hours per week? Would you say that you’ve
worked at least 20 hours per week for all of the time since
(LAST PSI INTERVIEW DATE), most of the time, about half of the
time, less than half of the time, or never? |
ALL OF THE TIME |
01 |
MOST OF THE TIME |
02 |
ABOUT HALF OF THE TIME |
03 |
LESS THAN HALF OF THE TIME |
04 |
NEVER |
05 |
DON'T KNOW |
-1 |
REFUSED |
-3 |
|
NO SUPPLEMENT THIS VERSION.
|
SECTION E: EDUCATIONAL ATTAINMENT |
E1. |
The next questions are about your
educational background.
|
E.2. |
Have you received any degrees, diplomas,
or certificates since (LAST PSI INTERVIEW DATE)? |
YES |
01 |
|
NO |
00 |
DON'T KNOW |
-1 |
![](https://webarchive.library.unt.edu/eot2008/20090110034930im_/http://www.acf.hhs.gov/programs/opre/ehs/ehs_resrch/instruments/images/brackets.gif) |
GO TO E24 |
REFUSED |
-3 |
|
E.3 |
What types of degrees, diplomas,
or certificates have you received (since LAST PSI INTERVIEW
DATE)?
PROBE: IF RESPONDENT SAYS “NONE,”
ASK: Did you complete an elementary, middle, or junior
high school program?
PROBE: IF RESPONDENT SAYS “HIGH
SCHOOL DIPLOMA,” ASK: Did you receive your high
school diploma through a GED program?
CIRCLE THE CODE FOR EACH DIPLOMA OR CERTIFICATE
REPORTED.
|
|
CIRCLE ALL THAT APPLY |
A. |
NONE |
00 |
B. |
ELEMENTARY, MIDDLE, OR JUNIOR HIGH SCHOOL
DIPLOMA |
01 |
C. |
ABE OR ADULT BASIC EDUCATION CERTIFICATE
(PRE-GED) |
02 |
D. |
GED CERTIFICATE |
03 |
E. |
HIGH SCHOOL DIPLOMA |
04 |
F. |
AA OR ASSOCIATES DIPLOMA OR DEGREE (TWO-YEAR) |
05 |
G. |
BA OR BS OR COLLEGE DIPLOMA OR DEGREE (FOUR-YEAR) |
06 |
H. |
ESL OR ENGLISH AS A SECOND LANGUAGE CERTIFICATE |
07 |
I. |
VOCATIONAL, TECHNICAL
OR TRADE DIPLOMA, CERTIFICATE, OR DEGREE (SPECIFY)
____________________________________________________
|___ |___|
|
08 |
J. |
NURSING DEGREE (LPN OR RN) |
09 |
K. |
BUSINESS CERTIFICATE OR DEGREE |
10 |
L. |
SECRETARIAL CERTIFICATE OR DEGREE |
11 |
M. |
OTHER TYPES (SPECIFY)
____________________________________________________ |___
|___| |
12
|
N. |
MEDICAL ASSISTANT, CNA, DENTAL HYGIENIST |
13 |
O. |
CHILD CARE CERTIFICATE/TEACHERS AIDE |
14 |
P. |
GRADUATE DEGREE (MA, PH.D., MD, JD, TH.D.) |
15 |
Q. |
CHILD DEVELOPMENT ASSOCIATE (CDA) CREDENTIAL |
16 |
|
NO E4-E23 THIS VERSION.
The next questions are about school or training programs
you may have attended since (LAST PSI INTERVIEW DATE).
|
E24. |
How many school programs, training
programs, and other courses have you attended since (LAST PSI
INTERVIEW DATE)? Please include regular high school, adult basic
education or GED courses, vocational or trade school, Job Corps,
college, or other types of school as well as training programs
to help you learn job skills or get a job. Also include classes
you may have attended to learn English or improve your reading
skills.
PROBE: Include beauty school
and secretarial or nursing courses. |
|
|___ |___| SCHOOL OR TRAINING PROGRAMS/COURSES
NONE . . . . . . . . . . . . . . . . . . . . . . . . . .
. 00
GO TO SECTION F |
NO E25-E26 THIS VERSION.
NO E25-E30 THIS VERSION.
|
E31. |
VERIFY OR ASK:
What types of school or training have you attended since (LAST
PSI INTERVIEW DATE)? |
|
CIRCLE ALL
THAT APPLY |
ELEMENTARY OR MIDDLE SCHOOL (GRADE 1-8)
|
01 |
HIGH SCHOOL (GRADE 9-12) |
02 |
ABE-ADULT BASIC EDUCATION PROGRAM (PRE-GED)
|
03 |
GED PROGRAM |
04 |
ESL-ENGLISH AS A SECOND LANGUAGE PROGRAM |
05 |
NURSING SCHOOL (LPN OR RN) |
06 |
BUSINESS OR SECRETARIAL SCHOOL |
07 |
VOCATIONAL, TECHNICAL, ORTRADE SCHOOL |
08 |
COMMUNITY OR JUNIOR COLLEGE (2-YEAR) |
09 |
COLLEGE (4-YEAR) |
10 |
ALTERNATIVE SCHOOL |
11 |
JOB PLACEMENT PROGRAM |
12 |
ON-THE-JOB TRAINING |
13 |
HOME STUDY |
14 |
JOB SEARCH/READINESS PROGRAM |
15 |
MEDICAL ASSISTANT, CNA, DENTAL HYGIENIST
|
16 |
POSTGRADUATE PROGRAM |
17 |
CDA CLASS |
18 |
OTHER TYPE (SPECIFY)
___________________________________________ |
00 |
DON'T KNOW |
-1 |
REFUSED |
-3 |
|
NO E32-E35 THIS VERSION.
NO E36-E40 THIS VERSION.
|
SECTION F: CHILD CARE AND DEVELOPMENT |
NO F1-F26 THIS
VERSION.
|
F27. |
Has anyone from Early Head Start
or another program, health agency, or social service agency
visited you and (FOCUS CHILD) at home
since (LAST PSI INTERVIEW DATE)? Please do not include
(NAMES OF DATA COLLECTORS/research staff) who may have visited
you to talk to you about (FOCUS CHILD) and collect information
for the Early Head Start Evaluation. |
YES |
01 |
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GO TO F28 |
NO |
00 |
|
|
A. |
Home visitors may have come to do activities
with you and (FOCUS CHILD) or talk to you about how (he/she)
is doing or about how your family is getting along. Has anyone
from Early Head Start or another program or agency visited you
at home since (LAST PSI INTERVIEW DATE)?
PROBE: Please do not include
(NAMES OF DATA COLLECTORS/ research staff) who may have visited
you to talk to you about (FOCUS CHILD) and collect information
for the Early Head Start Evaluation. |
YES |
01 |
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GO TO F28 |
NO |
00 |
![](https://webarchive.library.unt.edu/eot2008/20090110034930im_/http://www.acf.hhs.gov/programs/opre/ehs/ehs_resrch/instruments/images/brackets.gif) |
GO TO B |
DON'T KNOW |
-1 |
REFUSED |
-3 |
GO TO F39, PAGE 13 |
|
|
|
|
|
B. |
IF “NO,” ASK:
Has anyone from Early Head Start or another program,
health agency, or social service agency visited you and (FOCUS
CHILD) at another place, such as (FOCUS CHILD)’s child
care or another person’s home, since (LAST PSI INTERVIEW
DATE)? |
YES |
01 |
|
NO |
00 |
DON'T KNOW |
-1 |
![](https://webarchive.library.unt.edu/eot2008/20090110034930im_/http://www.acf.hhs.gov/programs/opre/ehs/ehs_resrch/instruments/images/brackets.gif) |
GO TO F39, PAGE 13 |
REFUSED |
-3 |
|
F28. |
Since (LAST PSI INTERVIEW
DATE), did the (person/persons) who visited you and (FOCUS CHILD)
show you activities or talk about ways to help the growth and
development of your child? |
|
F29. |
Where did the person(s) who visited you come
from? PROBE: From what program or
organization? PROBE: Any place else? |
|
CIRCLE ALL
THAT APPLY |
EARLY HEAD START |
01 |
DEPARTMENT OF SOCIAL SERVICES |
02 |
HEALTH CENTER OR HEALTH PROGRAM |
03 |
OTHER SITE SPECIFIC |
04 |
OTHER SITE SPECIFIC |
05 |
WIC |
06 |
PARENTS AS TEACHERS |
07 |
SCHOOL |
08 |
FAMILY PRESERVATION PROGRAM/ AGENCY |
09 |
HEAD START |
10 |
OTHER (SPECIFY)
_________________________________________
_________________________________________ |
00 |
|
F30. |
Since (LAST PSI INTERVIEW DATE), how often were
you and (FOCUS CHILD)
visited by . . .
READ LIST IF NECESSARY. |
|
a. IF F29 = 01: Someone from
NAME OF EHS
PROGRAM? |
b. IF F29 > 01: People from
other programs or agencies? |
ONLY ONCE |
01 |
01 |
TWO OR THREE TIMES
A WEEK |
02 |
02 |
ONCE A WEEK |
03 |
03 |
TWO OR THREE TIMES
A MONTH |
04 |
04 |
ONCE A MONTH |
05 |
05 |
LESS THAN ONCE
A MONTH |
06 |
06 |
OTHER (SPECIFY)
________________________ |
00 |
00 |
NOT APPLICABLE |
-4 |
-4 |
DON'T KNOW |
-1 |
-1 |
REFUSED |
-3 |
-3 |
|
NO F31-F38 THIS VERSION.
|
F39. |
Since (LAST PSI INTERVIEW
DATE), have you attended classes, lectures, group activities
for parents, or other events that provided information on parenting
or training to help you be a better parent? |
|
NO F40-42 THIS VERSION.
|
F43. |
Since (LAST PSI INTERVIEW
DATE), did (FOCUS CHILD) and you participate together
in organized group programs for parents and children?
INTERVIEWER: USE EXAMPLES FROM YOUR AREA. |
|
NO F44-F48 THIS
VERSION.
|
F49. |
Since (LAST PSI INTERVIEW DATE), have you attended
parent support group sessions (other than the classes or programs
you already told me about)? These are meetings with other mothers
or fathers where parents can talk and share information about
being a parent. |
|
NO F50-F52 THIS VERSION.
NO SECTION G THIS VERSION.
NO SECTION I THIS VERSION.
|
SECTION H: HOUSING |
NO H1-H7 THIS VERSION.
|
H8. |
Have you ever been homeless
since (LAST PSI INTERVIEW DATE)? |
|
NO H9-H10 THIS VERSION.
|
SECTION J: HEALTH STATUS |
NO J1 THIS VERSION.
|
J2. |
IF RESPONDENT IS
MALE OR IF RESPONDENT IS FEMALE OVER 50, SKIP TO SECTION K,
PAGE 18. |
NO J3-J8 THIS VERSION.
|
|
INTERVIEWER: CODE
IF KNOWN. OTHERWISE ASK: |
J9. |
How many children have
you given birth to since (LAST
PSI INTERVIEW DATE)? Please do not include miscarriages or stillbirths. |
|
|
|___| CHILDREN |
NONE |
00 |
![](https://webarchive.library.unt.edu/eot2008/20090110034930im_/http://www.acf.hhs.gov/programs/opre/ehs/ehs_resrch/instruments/images/brackets.gif) |
GO TO SECTION K, PAGE 18 |
DON'T KNOW |
-1 |
REFUSED |
-3 |
|
J10. |
|
Please tell me when your youngest child was born. |
|___|___| / |
|___|___| / 19 |
|___|___| |
MONTH |
DAY |
YEAR |
|
J10b. |
|
Did you see a doctor or health professional,
or go to a clinic for prenatal care before your youngest child
was born? |
|
J11. |
How much did your youngest
child weigh at birth? |
|
|
|___|___| |
AND |
|___|___| |
POUNDS |
|
OUNCES |
|
OR |
|
|___|.|___|___|___| KILOGRAMS |
|
NO J12 THIS VERSION.
|
J13. |
Was your youngest child
born more than two weeks before or two weeks after the doctor
expected? |
YES, BEFORE |
01 |
YES, AFTER |
02 |
NO |
00 |
|
J14. |
How many weeks (early/late)
was your youngest child? |
|___ |___|
WEEKS |
DON'T KNOW |
-1 |
|
J15. |
Did you have any complications
during your pregnancy with your youngest child? |
|
J16. |
As a newborn baby, did
your most recent child stay in the hospital after (he/she) was
born because of medical problems? Please include only the days
(he/she) stayed in the hospital because of medical problems.
Do not include the time spent in the hospital at birth. |
YES |
01 |
NO |
00
|
![arrow](https://webarchive.library.unt.edu/eot2008/20090110034930im_/http://www.acf.hhs.gov/programs/opre/ehs/ehs_resrch/instruments/images/arrow.gif) |
GO TO J21, PAGE 17 |
|
J17. |
How many days did
your youngest child stay in the hospital after birth because
of medical problems?
|___|___|___| DAYS |
|
J18. |
How many of those days
did your youngest child spend in the neonatal intensive care
unit in the hospital after birth?
|___|___|___| DAYS |
|
NO J19-J20 THIS
VERSION.
|
J21. |
Did you breastfeed your
youngest child? |
|
NO J22-J28 THIS
VERSION.
J29 MOVED TO SECTION K.
NO J30-J38 THIS VERSION.
|
SECTION K: HEALTH CARE SERVICES |
K1. |
The next questions are
about (FOCUS CHILD)’s and your health care. First, do
you have a regular health care
provider? |
|
NO K2 THIS VERSION.
|
K3. |
Does (FOCUS CHILD) have
a regular health care provider? |
|
K4. |
Where do you usually
take (FOCUS CHILD) for health care? Include visits for preventative
care, such as immunizations or physical exams, and visits
for health problems, such as illness or injury.
INTERVIEWER: IF THEY SEE A HMO DOCTOR IN
A PRIVATE DOCTOR’S
OFFICE, CODE 6.
PROBE: Does (she/he) see a doctor
in a private office; a doctor in a clinic or HMO facility;
another type of health care provider in a clinic, hospital,
or emergency room; or does (she/he) go somewhere else for
health care? |
|
CIRCLE ALL
THAT APPLY |
EMERGENCY ROOM, OUTPATIENT |
01 |
HOSPITAL OR WALK-UP CLINIC |
02 |
COMMUNITY HEALTH CENTER |
03 |
CLINIC |
04 |
HEALTH MAINTENANCE ORGANIZATION (HMO) |
05 |
PRIVATE DOCTOR’S OFFICE |
06 |
CHILD WAS NOT TAKEN ANYWHERE FOR MEDICAL
CARE |
07 |
OTHER (SPECIFY)
_________________________________________ |
00 |
|
NO K5-K7 THIS VERSION.
|
K8. |
|
Did (FOCUS CHILD) visit a doctor, nurse, or other
medical professional since (LAST PSI INTERVIEW DATE)? |
YES |
01 |
NO |
00
|
![arrow](https://webarchive.library.unt.edu/eot2008/20090110034930im_/http://www.acf.hhs.gov/programs/opre/ehs/ehs_resrch/instruments/images/arrow.gif) |
GO TO K15 |
|
K9. |
How many times did you
take (FOCUS CHILD) to visit a doctor, nurse, or other health
professional since (LAST PSI INTERVIEW DATE)?
PROBE: IF RESPONDENT DOESN’T KNOW OR REFUSES: Did (FOCUS
CHILD) visit a health professional such as a doctor or nurse
at least once since (LAST PSI INTERVIEW DATE)?
|___ |___| NUMBER OF VISITS |
|
NO K10-K14 THIS
VERSION.
|
K15. |
|
Did you, (FOCUS CHILD), or other members of your
family ever visit an emergency room for a health problem since
(LAST PSI INTERVIEW DATE)? |
|
NO K16-K19 THIS
VERSION.
|
K20. |
Did (FOCUS CHILD) receive
immunizations since (LAST PSI INTERVIEW DATE)? |
|
NO K21-K22 THIS
VERSION.
|
J29. |
Is (FOCUS CHILD) limited
in any way in any activities because of an impairment or a health
problem? |
|
K25a. |
Does (FOCUS CHILD) have
a problem or condition that makes (him/her) eligible for early
intervention services from (NAME OF LOCAL PART H PROGRAM) or
some other program? |
YES |
01 |
|
NO |
00 |
![](https://webarchive.library.unt.edu/eot2008/20090110034930im_/http://www.acf.hhs.gov/programs/opre/ehs/ehs_resrch/instruments/images/brackets.gif) |
GO TO K29 |
DON'T KNOW |
-1 |
REFUSED |
-3 |
|
K26. |
Did you or (FOCUS CHILD)
receive any early intervention or therapy services from (NAME
OF LOCAL PART H PROGRAM) or another program or agency since
(LAST PSI INTERVIEW DATE)?
PROBE: Early intervention services
are services designed to meet the needs of very young children
with special needs. They are provided by the state or the
school system, usually at no cost to parents. |
|
NO K27-K28 THIS
VERSION.
|
(New)K29. |
Are you, yourself, currently
covered by any kind of health insurance, such as Medicaid or
private health insurance plan, or by a Health Maintenance Organization
(HMO) that covers hospital or doctor bills? |
|
NO K30 THIS VERSION.
|
(New)K31. |
|
(Is your child/Are your children) currently covered
by any kind of health insurance, such as Medicaid or a private
health insurance plan, or by a Health Maintenance Organization
(HMO) that covers hospital or doctor bills? |
|
NO K32-K34 THIS
VERSION.
|
SECTION L: OTHER SERVICES |
L1. |
(LOCAL NAME), social
workers, family workers, case managers, and family advocates
can provide a variety of services. For example, they may
help a person find a job, get help for a medical or drug
problem, get help for a child with special needs, offer advice
about how to improve someone’s life, or help a person
apply for government programs or benefits.
Since (LAST PSI INTERVIEW DATE), did you or your family
meet or talk with a (LOCAL NAME) social worker, case manager,
service coordinator, or family advocate from any of the
following programs or places?
|
|
|
YES |
NO |
DON'T
KNOW |
REFUSED |
a |
Early Head Start? |
01 |
00 |
-1 |
-3 |
b |
Department of Social or Human Services? |
01 |
00 |
-1 |
-3 |
c |
A health center or health program? |
01 |
00 |
-1 |
-3 |
d |
LOCAL PART H PROGRAM? |
01 |
00 |
-1 |
-3 |
e |
Any other program or agency? (SPECIFY)
___________________________________
___________________________________
___________________________________ |
01 |
00 |
-1 |
-3 |
|
L2. |
INTERVIEWER: CHECK
L1. DOES a, b, c, d, or e EQUAL “YES”? DID
THE RESPONDENT MEET WITH A SOCIAL WORKER, CASE MANAGER, SERVICE
COORDINATOR, OR FAMILY ADVOCATE?
|
YES |
01 |
|
NO |
00 |
![](https://webarchive.library.unt.edu/eot2008/20090110034930im_/http://www.acf.hhs.gov/programs/opre/ehs/ehs_resrch/instruments/images/brackets.gif) |
GO TO (New)M1, PAGE 25 |
DON'T KNOW |
-1 |
REFUSED |
-3 |
|
L3. |
Since (LAST PSI INTERVIEW
DATE), how often did you or your family meet or talk with (a)
case manager(s) from (this program/these programs) at home,
in person, or by telephone? Was it two to three times per
week, once a week, two to three times a month, once a month,
less than once a month, or only once?
ASK FOR EACH PROGRAM MENTIONED IN L1:
How often did you meet or talk with the case manager(s)
from (PROGRAM IN L1)?
|
|
EARLY
HEAD
START |
DEP'T
OF SOCIAL
SERVICES |
HEALTH
CENTER
OR
PROGRAM |
LOCAL
PROGRAM |
OTHER
PROGRAM |
ONLY ONCE |
01 |
01 |
01 |
01 |
01 |
TWO TO THREE TIMES
PER WEEK |
02 |
02 |
02 |
02 |
02 |
ONCE
A WEEK |
03 |
03 |
03 |
03 |
03 |
TWO TO THREE TIMES
PER MONTH |
04 |
04 |
04 |
04 |
04 |
ONCE A MONTH |
05 |
05 |
05 |
05 |
05 |
LESS THAN ONCE
A MONTH |
06 |
06 |
06 |
06 |
06 |
OTHER (SPECIFY)
_______________________
_______________________ |
00 |
00 |
00 |
00 |
00 |
DON'T KNOW |
-1 |
-1 |
-1 |
-1 |
-1 |
REFUSED |
-3 |
-3 |
-3 |
-3 |
-3 |
|
NO L4-L25 THIS VERSION.
|
L26. |
INTERVIEWER: CHECK
L1a. DID THE SAMPLE MEMBER MEET OR TALK
WITH A CASE MANAGER FROM EARLY HEAD START? |
YES |
01 |
NO |
00
|
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GO TO L29 |
|
L28. |
Now I would like to
ask you about your satisfaction with your Early Head Start
(case manager(s)/social worker(s))? How satisfied were you
with your overall relationship with your Early Head Start
(case manager (s)/social worker(s))?
Please tell me whether you (are/were) very satisfied, somewhat
satisfied, satisfied but would change something, or very dissatisfied.
|
VERY SATISFIED |
01 |
SOMEWHAT SATISFIED |
02 |
SATISFIED BUT WOULD CHANGE SOMETHING |
03 |
VERY DISSATISFIED |
04 |
|
L29. |
|
INTERVIEWER: CHECK L1b, L1c, L1d, AND L1e.
DID THE SAMPLE
MEMBER MEET WITH ANY OTHER CASE MANAGERS? |
|
NO L30-L32 THIS
VERSION.
|
L33. |
Now I would like to
ask you about your satisfaction with your (case manager(s)/
social worker(s)) from (OTHER AGENCIES IN L1)? How satisfied
were you with your overall relationship with your (case manager(s)/social
worker(s))?
Please tell me whether you (are/were) very satisfied, somewhat
satisfied, satisfied but would change something, or very
dissatisfied with each aspect of what (he/she/they) did.
|
VERY SATISFIED |
01 |
SOMEWHAT SATISFIED |
02 |
SATISFIED BUT WOULD CHANGE SOMETHING |
03 |
VERY DISSATISFIED |
04 |
|
SECTION M: OTHER FAMILY SUPPORT
SERVICES |
(New) M1. |
Now I would like to
ask you about kinds of income and support you and members of
your family who live with you are currently receiving. Do you
or any other family members who live with you currently receive
. . . |
TYPE
OF INCOME/SUPPORT |
CURRENTLY
RECEIVING? |
YES |
NO |
a. |
A check or income from AFDC, TANF, or
welfare for families with children? |
01 |
00 |
b. |
A check or income from General Assistance
or General Relief? |
01 |
00 |
c. |
A check or income from Supplemental Security
Income (SSI)? |
01 |
00 |
d. |
A check or income from Social Security
Retirement, Disability, or Survivor’s Benefits
(SSA)? |
01 |
00 |
e. |
Unemployment Insurance benefits? |
01 |
00 |
f |
Food Stamps? |
01 |
00 |
g |
WIC vouchers? |
01 |
00 |
h |
Child support payments? |
01 |
00 |
i |
Medicaid or medical assistance? |
01 |
00 |
|
|
M2. |
INTERVIEWER: IS M1a
EQUAL TO 01? ARE RESPONDENT OR FAMILY
MEMBERS CURRENTLY RECEIVING WELFARE? |
YES |
01 |
NO |
00 |
![arrow](https://webarchive.library.unt.edu/eot2008/20090110034930im_/http://www.acf.hhs.gov/programs/opre/ehs/ehs_resrch/instruments/images/arrow.gif) |
GO TO M47 |
|
NO M3 THIS VERSION.
|
M4. |
Are you
currently receiving AFDC, TANF, or welfare for families with
children? |
|
M4a. |
Please tell me which
of the following statements are true for the family you grew
up in. |
|
|
TRUE |
FALSE |
DON'T
KNOW |
a |
At least one of my parents had a paid job
most of the time |
01 |
00 |
-1 |
b |
At least one of my parents had a paid job
some of the time |
01 |
00 |
-1 |
c |
My parent(s) were on welfare, social security,
or other public assistance sometimes |
01 |
00 |
-1 |
d |
My parent(s) were on welfare, social security,
or other public assistance most of the time |
01 |
00 |
-1 |
|
NO M5-M46 THIS VERSION.
|
M47. |
Have you or any family
members who lived with you received emergency assistance since
(LAST PSI INTERVIEW DATE)? That would be assistance with things
like food, clothing, housing, housing repair, shelter from abuse,
counseling, or emergency medical care? |
|
NO M48-M50 THIS
VERSION.
|
M51. |
In the last year, what
was the amount of money all members of your family received
before taxes and other deductions? Please include your own income
and that of all members of your family who lived with you. Include
money you received from jobs, welfare, or any other source.
PROBE: Your best estimate would
be fine. |
$ |__|__|,|__|__|__| FAMILY INCOME |
![](https://webarchive.library.unt.edu/eot2008/20090110034930im_/http://www.acf.hhs.gov/programs/opre/ehs/ehs_resrch/instruments/images/brackets.gif) |
GO TO SECTION O |
LESS THAN $10 . . . . . . . . . 99999 |
|
M52. |
less than $3,000, |
01 |
between $3,000 and $4,500, |
02 |
between $4,500 and $6,000, |
03 |
between $6,000 and $7,500, |
04 |
between $7,500 and $9,000, |
05 |
between $9,000 and $10,500, |
06 |
between $10,500 and $12,000, |
07 |
between $12,000 and $13,500, |
08 |
between $13,500 and $15,000, |
09 |
between $15,000 and $16,500, |
10 |
between $16,500 and $18,000, |
11 |
between $18,000 and $21,000, |
12 |
between $21,000 and $24,000, |
13 |
between $24,000 and $27,000, |
14 |
between $27,000 and $30,000, or |
15 |
over $30,000? |
16 |
DON'T KNOW |
-1 |
REFUSED |
-3 |
|
SECTION O: SUMMARY OF PROGRAM
EXPERIENCES |
O0. |
INTERVIEWER: IS THIS
AN EHS PROGRAM FAMILY? |
YES |
01 |
NO |
00
|
![arrow](https://webarchive.library.unt.edu/eot2008/20090110034930im_/http://www.acf.hhs.gov/programs/opre/ehs/ehs_resrch/instruments/images/arrow.gif) |
GO TO ENDING, PAGE 34 |
|
Finally, I would like to ask
you to think back on your experiences over the last three
years.
|
O1. |
How long did you participate
in (NAME OF LOCAL EHS PROGRAM)? Your best estimate is fine. |
|
|
|___ |___| MONTHS
|
O2. |
Did you leave (LOCAL
EHS PROGRAM) before (FOCUS CHILD) turned 3 years old? |
YES |
01 |
NO |
00 |
![arrow](https://webarchive.library.unt.edu/eot2008/20090110034930im_/http://www.acf.hhs.gov/programs/opre/ehs/ehs_resrch/instruments/images/arrow.gif) |
GO TO O4 |
|
O3. |
Why did you leave the
(LOCAL EHS PROGRAM)? |
MOVED |
01 |
DID NOT HAVE TIME FOR IT |
02 |
DID NOT LIKE PROGRAM |
03 |
PROGRAM COULDN'T HELP ME |
04 |
JUST STOPPED GOING |
05 |
OTHER (SPECIFY)
_____________________________ |
00 |
|
|
O4. |
What program will (FOCUS
CHILD) be in after leaving (LOCAL EHS PROGRAM)? |
HEAD START |
01 |
PRESCHOOL |
02 |
CHILD CARE CENTER |
03 |
FAMILY CHILD CARE |
04 |
NONE |
00 |
|
O5. |
Please tell me how often
you participated in the following activities at (LOCAL EHS PROGRAM)
since you enrolled in the program. For each one, tell me if
you did not participate at all or if you participated once or
twice, or three or more times.
INTERVIEWER: FOR FIRST 2 ITEMS, PROBE
IF RESPONSE IS 3 OR
MORE TIMES: Would you say you participated at least
monthly or more often than monthly?
|
|
NOT AT ALL |
ONCE OR TWICE |
3 OR MORE TIMES |
AT LEAST MONTHLY |
MORE THAN ONCE
A MONTH |
DON'T KNOW |
a. |
Visited with an Early Head
Start staff member in my home |
01 |
02 |
03 |
04 |
05 |
-1 |
b. |
Attend group activities for parents and
their children |
01 |
02 |
03 |
04 |
05 |
-1 |
c. |
Attend parent education meetings or workshops
on topics such as job skills or child-rearing |
01 |
02 |
03 |
|
-1 |
d. |
Attended an Early Head Start social event
|
01 |
02 |
03 |
-1 |
e. |
Volunteered in an Early Head Start classroom
|
01 |
02 |
03 |
-1 |
f. |
Volunteered to help out at the (LOCAL EHS
PROGRAM) or served on a committee, but not in a classroom
or on Policy Council |
01 |
02 |
03 |
-1 |
g. |
Participated on the (LOCAL EHS PROGRAM)
Policy Council |
01 |
02 |
03 |
-1 |
|
O6. |
During the time that
you were participating in (NAME OF LOCAL EHS
PROGRAM), how much time would you say you usually spent in these
program activities in a typical month?
PROBE: Would you say you typically
spent less than 2 hours a month, between 2 and 5 hours a
month, between 6 and 10 hours per month, or more than 10
hours per month?
|
|
|___|___| HOURS PER MONTH OR
LESS THAN 2 HOURS PER MONTH |
01 |
2 TO 5 HOURS PER MONTH |
02 |
6 TO 10 HOURS PER MONTH |
03 |
MORE THAN 10 HOURS PER MONTH |
04 |
|
O7. |
|
How much time would you say (FOCUS CHILD) usually
spent in these program activities in a typical month? Please
include the time (FOCUS CHILD) was in (NAME OF LOCAL EHS PROGRAM)
child care, participating in home visits, or participating
in group socialization activities in a typical month.
PROBE: Would you say (FOCUS
CHILD) typically spent less than 2 hours a month, between
2 and 5 hours a month, between 6 and 20 hours per month,
between 20 and 40 hours per month, or more than 40 hours
per month?
|
|
|
|___|___| HOURS PER MONTH OR
LESS THAN 2 HOURS PER MONTH |
01 |
2 TO 5 HOURS PER MONTH |
02 |
6 TO 20 HOURS PER MONTH |
03 |
20t to 40 HOURS PER MONTH |
04 |
MORE THAN 40 HOURS PER MONTH |
05 |
|
O8. |
How satisfied were you
with the help or support you received from (LOCAL EHS PROGRAM)
in the following areas? |
How satisfied were you with
how well the program . . . |
VERY
SATISFIED |
SOMEWHAT
SATISFIED |
SOMEWHAT
DISSATISFIED |
VERY
DISSATISFIED |
DID NOT NEED
HELP IN THIS AREA |
a |
Helped you become a good parent? |
01 |
02 |
03 |
04 |
05 |
b |
Helped (FOCUS CHILD) grow and develop?
|
01 |
02 |
03 |
04 |
05 |
c |
Supported and respected you family's culture?
|
01 |
02 |
03 |
04 |
05 |
d |
Helped you get education or job training,
for example, helped you enroll in GED or college courses,
helped you learn to read, or helped you get into other
education or training activities? |
01 |
02 |
03 |
04 |
05 |
e |
Helped you get a job, keep a job, or make
job-related decisions? |
01 |
02 |
03 |
04 |
05 |
f |
Helped you obtain assistance such as welfare,
SSI, unemployment insurance, WIC or food stamps? |
01 |
02 |
03 |
04 |
05 |
g |
Helped you understand, comply with, or
deal with welfare reform? |
01 |
02 |
03 |
04 |
05 |
h |
Helped you get essential things you needed,
like housing, clothing, food, or utilities such as water,
heat, or telephone? |
01 |
02 |
03 |
04 |
05 |
i |
Helped you arrange child care for (FOCUS
CHILD)? |
01 |
02 |
03 |
04 |
05 |
j |
Helped you arrange child care for other
children in your family? |
01 |
02 |
03 |
04 |
05 |
k |
Helped you get health care for your child
or yourself? |
01 |
02 |
03 |
04 |
05 |
l |
Helped you arrange transportation? |
01 |
02 |
03 |
04 |
05 |
m |
Helped you deal with a problem such as
depression, domestic violence, or drug use? |
01 |
02 |
03 |
04 |
05 |
n |
Helped you learn to speak or read English?
|
01 |
02 |
03 |
04 |
05 |
o |
Helped you become friends with other parents
in (LOCAL EHS PROGRAM)? |
01 |
02 |
03 |
04 |
05 |
p. |
Supported you in becoming more involved
in community groups? |
01 |
02 |
03 |
04 |
05 |
q. |
Helped you have better relationships within
your family? |
01 |
02 |
03 |
04 |
05 |
r. |
Helped (FOCUS CHILD) become ready to enter
preschool? |
01 |
02 |
03 |
04 |
05 |
s. |
Helped you overall? |
01 |
02 |
03 |
04 |
05 |
|
O9. |
What were the two most
important things that (LOCAL EHS PROGRAM) helped you and your
family with?
RECORD VERBATIM THEN CIRCLE ALL THAT APPLY.
|
|
CIRCLE TWO
RESPONSES |
CHILD CARE |
01 |
CHILD DEVELOPMENT |
02 |
PARENTING |
03 |
JOB |
04 |
EDUCATION |
05 |
WELFARE REFORM |
06 |
HEALTH CARE |
07 |
SELF ESTEEM |
08 |
TRANSPORTATION |
09 |
HOUSING |
10 |
BASIC NEEDS (FOOD, CLOTHING) |
11 |
MAKING FRIENDS |
12 |
OTHER (SPECIFY) |
13 |
_________________________________________ |
|
NOTHING |
00 |
|
O10. |
|
Was there anything about (LOCAL
EHS PROGRAM) that made it hard for you to participate? |
YES |
01 |
|
NO |
00 |
![](https://webarchive.library.unt.edu/eot2008/20090110034930im_/http://www.acf.hhs.gov/programs/opre/ehs/ehs_resrch/instruments/images/brackets.gif) |
GO TO END |
DON'T KNOW |
-1 |
REFUSED |
-3 |
|
O10a. |
|
What was that?
|
RECORD VERBATIM
THEN CIRCLE ALL THAT APPLY.
|
|
CIRCLE ALL
THAT APPLY |
REQUIRED TOO MUCH TIME |
01 |
WORK SCHEDULE INTERFERED |
02 |
COULD NOT HELP ME |
03 |
STAFF CHANGED |
04 |
DID NOT GET ALONG WITH SOME STAFF |
05 |
CHILD CARE HOURS INADEQUATE |
06 |
DID NOT PROVIDE CHILD CARE |
07 |
SOMEONE IN FAMILY DID NOT WANT ME TO PARTICIPATE
|
08 |
STAFF DID NOT SPEAK MY LANGUAGE |
09 |
OTHER (SPECIFY)
_________________________________________ |
10 |
|
CONCLUSION (CUSTOMIZE, DEPENDING
ON LOCAL PLANS FOR LONGITUDINAL FOLLOWUP):
|
|
INTERVIEWER, CODE
WITHOUT ASKING. HOW WELL DOES THE RESPONDENT SPEAK ENGLISH?
|
VERY WELL |
01 |
WELL |
02 |
NOT WELL |
03 |
NOT AT ALL |
04 |
|
Thank you so much for completing
this final interview in the National Early Head Start Study.
Over the last 3 years, you have made an important contribution
to helping us learn about the needs of families with infants
and toddlers in this country, and we appreciate your help
very much.
|