ACF OPRE: Head Start Family and Child Experiences Survey (FACES)

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PDF Version, B&W

OMB Approval Number: 0970-0151 Esp 06/2000

RESPONDENT ID ___ ___ ___ ___ ___

BATCH # 8-10/
CARD# 11-12/01

Head Start Family and Child Experiences Survey

Fall '97 Parent Interview

INTERVIEWER:

RECORD CHILD'S NAME BELOW. REMOVE SHEET AND DESTROY AFTER VERIFYING CHILD'S NAME.

CHILD'S NAME _____________________________

Head Start Family and Child Experiences Survey
Fall '97 Parent Interview
Cover Sheet

Respondent ID number: ___ ___ -___ - ___ - ___ ___ ___

Head Start Center: _______________________________

City and State: _______________________________

Field Interviewer ID number: ___ ___ ___

Date of Interview:	__ __/ __ __/ __ __
	month day year

Time of interview start:	__ __ : __ __
	hour minute

Time of interview end:	__ __ : __ __
	hour minute

Interview location:

Head Start center	01
CHILD's home	02
Other (Please specify)	03

Will the interview be completed in whole or in part with an interpreter?

No	01
Yes	02

If so, what language will be used? _______________________________

IF YES: Have Interpreter sign confidentiality form before interview

Thank you for agreeing to talk with me. The purpose of this study is to learn more about families in the Head Start Program as well as learn more about the Head Start Program your child attends. We want to learn how Head Start provides different kinds of services to children and families. I want to talk with you (again) so we can understand about Head Start from a parent's point of view. Information from this study will be used to help Head Start better serve children and their families.

I will ask you questions and write down your answers. You may stop me at any time, and you may go back to earlier questions to change your answers. No one from the Head Start Program will see or hear your answers. Your participation is completely voluntary. If you choose not to complete this interview, it will not affect you or your child’s participation in Head Start programs. The things you tell me are very important, so please be as accurate as possible. Occasionally, I may have to ask a question that does not apply to you. If that happens, just tell me and I will move on to the next question. Our interview should take approximately one hour. Do you have any questions?

Before we begin, let me read the following to you:

Notice: According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB Control Number. The valid OMB Control Number for this information collection is 0970-0151 (expires 06/2000). The time required to complete this information collection is estimated to average 1 hour per response, including time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

At the end of the interview, I will give you some addresses as well as some phone numbers in case you would like more information about the study or this interview. Do you have any questions?

INTERVIEWER:

USE CHILD’S NAME WHENEVER “CHILD” (ALL CAPITAL LETTERS) APPEARS IN A QUESTION.

PROBE AND ENTER 99 FOR “DON’T KNOW” RESPONSES.

DO NOT READ “DON’T KNOW” RESPONSE CATEGORIES.

ELIGIBILITY SCREEN

First, I need to ask about your relationship with CHILD.

Is CHILD the correct name of your child?

INTERVIEWER:

After verifying name of child, remove cover sheet and destroy. DO NOT WRITE NAME OF CHILD ON QUESTIONNAIRE.

We want to interview the person most responsible for CHILD’s care. Are you that person?

No	01
Yes	02	SKIP TO 4

Who is most responsible for CHILD’s care?

Name: _______________________________

Address: _______________________________

Phone: _______________________________

TERMINATE INTERVIEW.

What is your relationship to CHILD?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

Mother	01	SKIP TO A1
Father	02	SKIP TO A1
Stepmother	03	SKIP TO A1
Stepfather	04	SKIP TO A1
Grandmother	05
Grandfather	06
Great Grandmother	07
Great Grandfather	08
Sister/stepsister	09
Brother/stepbrother	10
Other Relative or In-law (Female)	11
Other Relative or In-law (Male)	12
Foster Parent (Female)	13
Foster Parent (Male)	14
Other Non-relative (Female)	15
Other Non-relative (Male)	16
Parent's Partner (Female)	17
Parent's Partner (Male)	18
Don't Know/ Didn't Respond	99

Are you CHILD’s legal guardian?

No	01
Yes	02

A. ABOUT YOUR CHILD AND FAMILY

A1.

Is CHILD a boy or a girl?

Boy	01
Girl	02

A2.

What is CHILD’S birth date?

__ __/ __ __/ __ __

month day year

A3.

When did CHILD begin Head Start?

__ __/ __ __

month year

A4.

How did you and CHILD find out about this Head Start program?

DO NOT READ LIST. CIRCLE ALL THAT APPLY.

Family/friend	01
Referral from another agency	02
Word of mouth	03
Head Start came to visit at our home	04
Previous children in Head Start	05
Flyer/mailing	06
Other (Please specify) __________	07

A5.

How does CHILD usually get to the Head Start Program to attend classes or group activities?

DO NOT READ LIST. CIRCLE ALL THAT APPLY.

Head Start school bus		01
Personal transportation (including car or car pool)		02
Public transportation (bus/subway)		03
Walks		04
Other (Please specify) ____________________		05
Don't Know (Give prompt)		99

A6.

How long does it take for CHILD to travel from home to the Center? __ __ minutes

A7.

How many days per week does CHILD attend Head Start class? __ __ days/week

A8.

How many hours per day does CHILD spend in Head Start class? __ __ hours/day

A9.

Did CHILD attend any center-based child care or child development programs before (he/she) entered Head Start?

No	01	SKIP TO A12
Yes	02

A10.

How old was CHILD when (he/she) first started such a program? __ __ months

A11.

How old was CHILD when (he/she) stopped attending that program? __ __ months

	Still attending	80

A12.

Including any other children (or grandchildren) who may have been in Head Start, how long have you been involved with Head Start as a (parent/grandparent/primary caregiver)?

(Suggested Probe): Is this your first child in Head Start? __ __ years OR __ __ months

A13.

Were you ever enrolled in Head Start as a child?

No	01
Yes	02
Don't Know	99

B. ACTIVITIES WITH YOUR CHILD
Now I have some questions about you and CHILD at home.

B1.

How many times have you or someone in your family read to CHILD in the past week? Would you say...

READ LIST. CIRCLE ONE RESPONSE.

Not at all	01	SKIP TO B2
Once or twice	02
Three or more times	03
Every day	04

B1a.

Who read to CHILD in the past week?

DO NOT READ LIST. CIRCLE ALL THAT APPLY.

Mother/Mother-figure	01
Father/Father-figure	02
Other household member	03
Non-household member	04

B2.

For about how long does CHILD enjoy being read to at a sitting? PROBE: About how many minutes?

CODE 000 IF CHILD DOESN'T LIKE TO BE READ TO AT ALL.

__ __ __ minutes

B3.

In the past week, have you or someone in your family done the following things with CHILD?
(READ LIST BELOW)

B4.

IF YES: How many times have you done this in the past week? Would you say one or two times, or three or more?

B5.

AFTER COMPLETING ALL OF B3 AND B4(a-k), ASK THE FOLLOWING FOR EACH ACTIVITY CODED “YES” IN B3: Who (Read Item)?

B3. In the past week, have you or someone in your family...			B4.		B5.
B3. In the past week, have you or someone in your family...			How many times?		Who (READ ITEM)? DO NOT READ CHOICES. CIRCLE ALL THAT APPLY.
	No	Yes	1-2	3+	Mother /Mother Figure	Father /Father Figure	Other Household Member	Non- Household Member
Told (him/her) a story?	01	02	1-2	3+	01	02	03	04
Taught (him/her) letters, words, or numbers?	01	02	1-2	3+	01	02	03	04
Taught (him/her)songs or music?	01	02	1-2	3+	01	02	03	04
Worked on arts and crafts with (him/her)?	01	02	1-2	3+	01	02	03	04
Played with toys or games indoors?	01	02	1-2	3+	01	02	03	04
Played a game, sport, or exercised together?	01	02	1-2	3+	01	02	03	04
Took (him/her) along while doing errands like going to the post the bank, or the store?	01	02	1-2	3+	01	02	03	04
Involved (him/her) in household chores like cooking, cleaning, the table, or caring for pets?	01	02	1-2	3+	01	02	03	04
Talked about what happened in Head Start?	01	02	1-2	3+	01	02	03	04
Talked about TV programs or videos?	01	02	1-2	3+	01	02	03	04
Played counting games like singing songs with numbers or reading books with numbers?	01	02	1-2	3+	01	02	03	04

B6.

In the past month, that is since (MONTH)(DAY), has anyone in your family done the following things with CHILD?

B7.

AFTER COMPLETING ALL OF B6(a-k), ASK THE FOLLOWING FOR EACH ACTIVITY CODED “YES”:
Who has (READ ITEM) with CHILD?

B6. In the past month, that is since (MONTH)(DAY), has anyone in your family done the following things with CHILD?			B7. [ASK ONLY AFTER COMPLETING ALL OF B6]
			Who has (READ ITEM) with CHILD? [DO NOT READ CHOICES. CIRCLE ALL THAT APPLY. IF NOT MOTHER/ OR FATHER/, CLARIFY IF HOUSEHOLD OR NON-HOUSEHOLD MEMBER.]
	No	Yes	Mother /Mother Figure	Father /Father Figure	Other Household Member	Non- Household Member
Visited a library?	01	02	01	02	03	04
Gone to a movie?	01	02	01	02	03	04
Gone to a play, concert, or other live show?	01	02	01	02	03	04
Gone to a mall?	01	02	01	02	03	04
Visited an art gallery, museum, or historical site?	01	02	01	02	03	04
Visited a playground, park, or gone on a picnic?	01	02	01	02	03	04
Visited a zoo or aquarium?	01	02	01	02	03	04
Talked with CHILD about (his/her) family history or ethnic heritage?	01	02	01	02	03	04
Attended an event sponsored by a community, ethnic, or religous group.	01	02	01	02	03	04
Attended an athletic or sporting event in which CHILD was not a player?	01	02	01	02	03	04

B8.

Which of the following do you have in your home for you or CHILD to look at or read?

READ LIST.

	NO	YES
Children's books	01	02
Comic books	01	02
Magazines for children	01	02
Magazines for adults like Newsweek or People or Sports Illustrated	01	02
Newspapers	01	02
Catalogs	01	02
Religious books like a bible or prayer book	01	02
Dictionaries or encyclopedias	01	02
Other books like novels or biographies or non-fiction	01	02

C. DISABILITIES

C1.

Does CHILD have any special needs or disabilities--for example, physical, emotional, language, hearing, learning difficulty, or other special needs?

No	01	SKIP TO D1
Yes	02
Don't Know	99	SKIP TO D1

C2.

How would you describe CHILD’S special need or needs? PROBE: Any others?

DO NOT READ LIST. CIRCLE ALL THAT APPLY.

A specific learning disability		01
Mental retardation		02
A speech impairment		03
A language impairment		04
An emotional/behavioral disorder		05
Deafness		06
Another hearing impairment		07
Blindness		08
Another visual impairment		09
An orthopedic impairment		10
Another health impairment lasting six months or more		11
Autism		12
Traumatic brain injury		13
Non-categorical/Developmental delay		14
Other (Please specify)		15
Don't know		99

C3.

(Does/Do) CHILD’s (disability/disabilities) affect (his/her) ability to learn?

No	01
Yes	02
Don't Know	99

C4.

Did you or another family member participate in developing an Individualized Education Program or Plan (IEP) for CHILD?

SHOW PARENT A COPY OF AN IEP USED BY PROGRAM.

No	01
Yes	02	SKIP TO C6
Don't Know	99	SKIP TO D1

C5.

Why not? __________________________________________
___________________________________________________
___________________________________________________ SKIP TO D1
(Suggested Probe: Were you given the opportunity to participate?)

C6.

How satisfied are you with the plan? Are you ...

READ LIST. CIRCLE ONE RESPONSE.

Very dissatisfied	01
Somewhat dissatisfied	02
Somewhat satisfied	03
Very satisfied	04
Don't Know	99

D. YOUR CHILD'S ACTIVITIES
These next questions are about things that different children do at different ages. These things may or may not be true for CHILD.

D1.

Can CHILD recognize...

READ LIST. CIRCLE ONE RESPONSE.

All of the letters of the alphabet,	01
Most of them,	02
Some of them, or	03
None of them?	04

D2.

How high can CHILD count? Would you say...

READ LIST. CIRCLE ONE RESPONSE.

Not at all	01
Up to five	02
Up to ten	03
Up to twenty	04
Up to fifty, or	05
Up to 100 or more	06

D3.

How many written numbers can CHILD recognize? ____ numbers

D4.

If CHILD had a pile of blocks, what is the largest number (she/he) can tell you (she/he) has?

___ ___ ___ largest number

D5.

Can CHILD button (his/her) clothes?

No	01
Yes	02

D6.

Does CHILD hold a pencil properly?

No	01
Yes	02

D7.

How often does CHILD like to write or pretend to write? Would you say ...

READ LIST. CIRCLE ONE RESPONSE.

Never	01
Has done it once or twice	02
Sometimes	03
Often	04
Don't Know	99

D8.

Does CHILD mostly write and draw rather than scribble?

No	01
Yes	02

D9.

Can CHILD write (his/her) first name even if some of the letters are backward?

No	01
Yes	02
Don't Know	99

D10.

Does CHILD trip, stumble, or fall easily?

No	01
Yes	02

D11.

When CHILD speaks, is (he/she) understandable to a stranger?

No	01
Yes	02

D12.

Did CHILD start speaking later than other children you know?

No	01
Yes	02

D13.

Does CHILD stutter or stammer?

No	01
Yes	02

D14.

Does CHILD ever look at a book with pictures and pretend to read?

No	01	SKIP TO D16
Yes	02

D15.

When CHILD pretends to read a book, does it sound like a connected story, or does (he/she) tell what’s in each picture without much connection between them?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

Sounds like connected story	01
Tells what's in each picture	02
Does both	03

D16.

Does CHILD recognize (his/her) own first name in writing or in print?

No	01
Yes	02
Don't Know	99

D17.

Can CHILD identify the colors red, yellow, blue, and green by name? Would you say...

READ LIST. CIRCLE ONE RESPONSE.

All of them,	01
Some of them, or	02
None of them?	03

E. YOUR CHILD'S BEHAVIOR

E1.

In general, thinking about CHILD now or over the past month, tell me how well the following statements describe CHILD’S usual behavior: For each one, tell me if it is very true or often true, sometimes or somewhat true, or not true.

READ LIST. CIRCLE ONE RESPONSE FOR EACH.

	Very True or Often True	Sometimes or Somewhat True	Not/ True
Makes friends easily?	01	02	03
Enjoys learning?	01	02	03
Has temper tantrums or hot temper?	01	02	03
Can't concentrate, can't pay attention for long?	01	02	03
Is very restless, and fidgets a lot?	01	02	03
Likes to try new things?	01	02	03
Shows imagination in work and play?	01	02	03
Is unhappy, sad, or depressed?	01	02	03
Comforts or helps others?	01	02	03
Hits and fights with others?	01	02	03
Worries about things for a long time?	01	02	03
Accepts friends' ideas in sharing and playing?	01	02	03
Doesn't get along with other kids?	01	02	03
Wants to hear that he or she is doing okay?	01	02	03
Feels worthless or inferior?	01	02	03
Makes changes from one activity to another with difficulty?	01	02	03
Is nervous, highstrung, or tense?	01	02	03
Acts too young for (his/her) age?	01	02	03
Is disobedient at home?	01	02	03

F. HOUSEHOLD RULES
Now I'd like to ask you a few questions about rules and setting limits in the home.

F1.

In your house, are there rules or routines about. . .

READ LIST. CIRCLE ONE RESPONSE FOR EACH.

	NO	YES	NA
What TV programs CHILD can watch?	01	02	03
How many hours CHILD can watch TV?	01	02	03
What kinds of food CHILD eats?	01	02	03
What time CHILD goes to bed?	01	02	03
What chores CHILD does?	01	02	03

F2.

Sometimes children mind pretty well and sometimes they don’t. Have you spanked CHILD in the past week for not minding?

No	01	SKIP TO F4
Yes	02

F3.

About how many times in the past week? ____ number of times

F4.

Have you used time out or sent CHILD to (his/her) room in the past week for not minding?

No	01	SKIP TO F6
Yes	02

F5.

About how many times in the past week? ____ number of times

F6.

If CHILD has a tantrum in a public place, such as a supermarket, what do you do? PROBE "NEVER HAPPENS": If it did happen, what would you do? PROBE: Anything else?

DO NOT READ LIST. CIRCLE ALL THAT APPLY.

Ignore (Him/her)	01
Pick up child and leave place	02
Leave and expect child to follow	03
Talk to child	04
Threaten to take away treats/privileges	05
Shout at child	06
Spank child	07
Slap or shake (him/her)	08
Threaten "time out" when you get home	09
Threaten another punishment at home	10
Threaten child with response of other household adult	11
Try to calm child down	12
Give in to child's tantrum	13
Other (Please specify)	14

G. YOU AND YOUR FAMILY
Now I’m going to ask you some questions about you and your family. Remember that all of your responses will remain confidential.

G1.

What is your birth date?	__ __/ __ __/ __ __
	month day year

G2.

What is your current marital status?

Single, never married	01
Married	02
Separated	03
Divorced	04
Widowed	05

G2a.

How old were you at the birth of your first child? ____ years old

G3.

Including yourself, how many adults age 18 and older live in your household? ___ number of adults

G4.

Including CHILD, how many children age 17 and younger live in your household? ___ number of children

G5.

Please tell me the first name of everyone in your household. PROBE: Is there anyone else in your household?

G5. First Name	G7. How old is NAME?	G8. Is or was this person ever enrolled in Head Start or Early Head Start 01=No 02=Yes 90=NA 99=Don't Know	G9. Is NAME employed? 01=No 02=Yes 90=NA 99=Don't Know	G10. Does NAME have a high school diploma or GED? 01=No, still in school 02=No, not in school 03=Yes, Diploma 04= Yes, GED 90=NA 99=Don't Know
		IF YOUNGER THAN 25:	IF OLDER THAN 15:	IF OLDER THAN 15:
(CHILD)
(Respondent)








RELATIONSHIP CODES:
01=Mother 02=Father 03=Stepmother 04=Grandmother 05=Grandmother 06=Grandfather	07=Great grandmother 08=Great grandfather 09=Sister/Stepsister 10=Brother/Stepbrother 11=Other relative or in-law (female) 12=Other relative or in-law (male)		13=Foster parent (female) 14=Foster parent (male) 15=Other non-relative (female) 16=Other non-relative (male) 17=Parent's partner (male) 18=Parent's partner (female) 99=Don't know/Didn't Respond

INTERVIEWER:

IF MOTHER IS RESPONDENT ...SKIP TO G18

IF MOTHER IS NOT RESPONDENT AND

NOT IN HOUSEHOLD...GO TO G11

IN HOUSEHOLD...SKIP TO G16

G11.

Does CHILD’s mother live within an hour’s ride of CHILD?

No	01
Yes	02
Mother is deceased	03	SKIP TO G18
Don't Know	99

G12.

Does she contribute to the financial support of the child?

No	01
Yes	02
Don't Know	99

G13.

How often does CHILD see (his/her) mother? Does (he/she) see her ...

READ LIST. CIRCLE ONE RESPONSE.

Rarely or never	01
Several times a year	02
Several times a month	03
Several times a week	04
Every day	05
Don't know	99

G14.

Is there anyone else who is like a mother to CHILD?

No	01	SKIP TO G16
Yes	02

G15.

Who is this person?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

The respondent,	01
The respondent's (spouse/partner) who lives in the household,	02
The respondent's (spouse/partner) who doesn't live in the household,..	03
A relative of the child who lives in the household,	04
A relative of the child who doesn't live in the household	05
A friend of the family who lives in the household, or	06
A friend of the family who doesn't live in the household	07

ENTER THE PERSON "LETTER" FROM GRID ON PAGE 22 (QUESTION G5) BELOW.

G15a.

___ person letter from G5 grid page 22

G16.

What is the highest grade or year of regular school that CHILD’s mother completed?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

No formal schooling	00
Less than 8th grade	07
8th grade	08
9th grade	09
10th grade	10
11th grade	11
12th grade	12
High school diploma	13
GED	14
Some college	15
Associate's degree	16
Bachelor's degree	17
Graduate degree	18
Don't know	99

G17.

Is she currently working, in school, in a training program, or is she doing something else?

DO NOT READ LIST. CIRCLE ALL THAT APPLY.

Working	01
IF YES: What is her occupation? _______________________________
Unemployed	02
Looking for Work	03
Laid off	04
In School/training	05
In Jail/prison	06
In Military	07
Something Else (Please specify)	08
Don't Know	99

INTERVIEWER:

IF FATHER IS RESPONDENT ...SKIP TO G25

IF FATHER IS NOT RESPONDENT AND

NOT IN HOUSEHOLD...GO TO G18

IN HOUSEHOLD...SKIP TO G23

G18.

Does CHILD’s father live within an hour’s ride of CHILD?

No	01
Yes	02
Father is deceased	03	SKIP TO G25
Don't Know	99

G19.

Does he contribute to the financial support of the child?

No	01
Yes	02
Don't Know	99

G20.

How often does CHILD see (his/her) father? Does (he/she) see him ...

READ LIST. CIRCLE ONE RESPONSE.

Rarely or never	01
Several times a year	02
Several times a month	03
Several times a week	04
Every day	05
Don't know	99

G21.

Is there anyone else who is like a father to CHILD?

No	01	SKIP TO G23
Yes	02

G22.

Who is this person?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

The respondent,	01
The respondent's (spouse/partner) who lives in the household,	02
The respondent's (spouse/partner) who doesn't live in the household,..	03
A relative of the child who lives in the household,	04
A relative of the child who doesn't live in the household	05
A friend of the family who lives in the household, or	06
A friend of the family who doesn't live in the household	07

ENTER THE PERSON "LETTER" FROM GRID ON PAGE 22 (QUESTION G5) BELOW.

G22a.

___ person letter from G5 grid page 22

G23.

What is the highest grade or year of regular school that CHILD’s father completed?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

No formal schooling	00
Less than 8th grade	07
8th grade	08
9th grade	09
10th grade	10
11th grade	11
12th grade	12
High school diploma	13
GED	14
Some college	15
Associate's degree	16
Bachelor's degree	17
Graduate degree	18
Don't know	99

G24.

Is he currently working, in school, in a training program, or is he doing something else?

DO NOT READ LIST. CIRCLE ALL THAT APPLY.

Working	01
IF YES: What is his occupation? _______________________________
Unemployed	02
Looking for Work	03
Laid off	04
In School/training	05
In Jail/prison	06
In Military	07
Something Else (Please specify)	08
Don't Know	99

G25.

Is any language other than English spoken in your home?

No	01	SKIP TO G31
Yes	02

G26.

What are those languages?

DO NOT READ LIST. CIRCLE ALL THAT APPLY.

French	01
Spanish	02
Cambodian (Khmer)	03
Chinese	04
Haitian Creole	05
Hmong	06
Japanese	07
Korean	08
Vietnamese	09
Arabic	10
Other (Please specify) ___________________	11

G27.

Do you or your family need someone from Head Start to speak to you in (LANGUAGE from G26)?

No	01
Yes	02	SKIP TO G29

G28.

Is someone from Head Start available to speak to you or your family in (LANGUAGE from G26)?

No	01
Yes	02

G29.

Does CHILD ever need or want a member of the Head Start teaching staff to speak in (LANGUAGE from G26)?

No	01
Yes	02	SKIP TO 31

G30.

Is there someone in the classroom at Head Start available for CHILD to speak in (LANGUAGE from G26)?

No	01
Yes	02

G31.

What is CHILD's racial or ethinic background?

DO NOT READ LIST. CIRCLE ONE RESPONSE. IF MULTIRACIAL, CODE UNDER "OTHER."

Asian or Pacific Islander	01
Black (African American; non Hispanic)	02
White (Caucasian; non-Hispanic)	03
Hispanic (Latino)	04
Native American or American Indian or Alaskan Native	05
Other (Please specify) _______________________	06

G32.

In what country was CHILD born?

USA	01	SKIP TO G34
Other (Please specify country) ___________________	02

G33.

How many years has CHILD lived in the United States? ______ years

G34.

In what country were you born?

USA	01	SKIP TO G38
Other (Please specify country) ___________________	02

G35.

How many years have you lived in the United States? ______ years

G36.

Did you attend school outside the U.S.?

No	01
Yes	02	SKIP TO G38

G37.

How many years did you attend school before coming to the U.S.? ______ years

G38.

How many grades of school did you complete?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

No formal schooling	00
Less than 8th grade	07
8th grade	08
9th grade	09
10th grade	10
11th grade	11
12th grade	12

G39.

Do you have a high school diploma or GED?

No	01	SKIP TO G42
Yes, Diploma	02
Yes, GED	03

G40.

Have you attended college?

No	01	SKIP TO G42
Yes	02

G41.

Have you received any degrees? (IF YES) What is your highest degree?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

No	01
Yes, Associate's Degree	02
Yes, Bachelor's Degree	03
Yes, Graduate Degree	04

G42.

Did you attend vocational or trade school?

No	01
Yes	02

G43.

Have you obtained any job-related certificates or licenses?

DO NOT READ LIST. CIRCLE ALL THAT APPLY.

No	01
Yes, trade license or certificate	02
Yes, CDA. (Child Development Associate)	03
Yes, other (Please specify) _________________	04

G44.

Are you currently working towards any certificate, diploma, or degree?

No	01	SKIP TO H1
Yes	02

G45.

What kind of certificate, diploma, or degree?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

Trade license or certificate	01
GED certificate (or equivalent)	02
High school diploma	03
Associates degree	04
CDA (Child Development Associate)	05
Bachelor's degree	06
Graduate degree	07
Other (Please specify)	08

H. EMPLOYMENT AND INCOME
Now, I would like to ask you some questions about the sources of income for your household. As I said earilier, this information will remain confidential and will not be reported to any agency or Head Start.

H1.

Do you have any earnings from a job or jobs, including self-employment?

No	01	SKIP TO H1
Yes	02

H2.

How many jobs do you have currently? ___ jobs

INTERVIEWER:

IF MORE THAN 3 JOBS, ASK FOR JOBS WORKED MOST HOURS.

REPEAT H3 AND H4 FOR UP TO THREE JOBS MENTIONED. RECORD IN SPACE BELOW QUESTIONS.

H3.

What do you do in (this job / the first job / the second job / the third job)? [Record answer below]

H4.

Is this job full-time or 30 or more hours per week; part-time or less than 30 hours per week; or seasonal or occasional during certain times of the year?

H3.	H4.
JOB DESCRIPTIONS	JOB STATUS
	Seasonal	Full-time	Part-time
1. ______________	01	02	03
2. ______________	01	02	03
3. ______________	01	02	03

H5.

In how many of the last twelve months have you worked? ______ months worked

H6.

Are you currently looking for a job?

No	01
Yes	02

H7.

Not including yourself, how many other adults contribute to your household income? ______ adults

H8.

Is CHILD covered by health insurance other than Medicaid through your job(s) or the job of another employed adult?

No	01
Yes	02

H9.

Do you or any member of your household receive any of the following other sources of household income or support?

READ LIST		NO	YES
Welfare (TANF)		01	02
Unemployment Insurance		01	02
Food Stamps		01	02
WIC--Special Supplemental Food Program for Women, Infants, and Children		01	02
	NOTE: If Yes in d.:
	d1. Is CHILD receiving WIC benefits?	01	02
Child support		01	02
SSI or SSDI		01	02
Social Security Retirement or Survivor's benefits		01	02
Loan repayments--for example, from friends, relatives, and so forth		01	02
Medicaid or medical assistance		01	02
Payments for providing foster care		01	02
Energy assistance		01	02
Money given to the family		01	02
Other (Please specify) __________________________________		01	02

COMPLETE TABLE (a - l). IF H9a AND H9c and H9d ARE all NO, THEN SKIP TO H11

H10.

In some states people who receive different types of public assistance are being required to do certain things such as take courses, get job training, or find a job. Are you now required to...

	NO	YES	DK
Attend job training?	01	02	99
Attend school or a GED class?	01	02	99
Get a job?	01	02	99
Do something else? (Please specify) ______________________________	01	02	99

H11.

Thinking about all of the sources of income you just told me about, what was the total income for your household last month?

PROBE: Your best guess would be fine.

FAMILY	$\|__\|, \|__\|__\|__\|	SKIP TO H13
Refused	98	SKIP TO H13
Don't Know	99

H12.

Would you say it was . . .

less than $250	01
between $250 and $500	02
between $500 and $1,000	03
between $1,000 and $1,500	04
between $1,500 and $2,000	05
between $2,000 and $2,500, or	06
over $2,500?	07
Refused	08
Don't Know	99

Our next questions are about the place where you and CHILD live.

H13.

In what type of housing do you live? Do you live in ...

READ LIST. CIRCLE ONE RESPONSE.

A house, apartment, or trailer on your own (only your family)	01	SKIP TO H14
A house, apartment, or trailer that you share	02
Transitional housing	03	SKIP TO H14
A homeless shelter	04	SKIP TO H14
Or someplace else? (Please specify) _______________________________	05	SKIP TO H14

H13a.

How long have you shared housing? ___ months OR ___ years

H13b.

Why do you share housing?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

Can't afford to live alone/low income	01
To help with the bills/expenses	02
Transitional situation (building a house, etc.)	03
Other (please specify) ___________________________	04

H14.

How many times have you moved in the last 12 months? ______ times moved

H15.

Do you currently live in public or subsidized housing?

No	01
Yes	02

H16.

Since CHILD was born, has your family ever been homeless or not had a regular place to live?

No	01	SKIP TO I1
Yes	02

H17.

How many times has this happened? ______ times

H18.

Where did you stay?

DO NOT READ LIST. CIRCLE ALL THAT APPLY.

Homeless shelter	01
On the street	02
In a car	03
In a motel	04
Doubling up with others as a last resort	05
Other (Please specify) ____________________	06

H19.

What was the longest time you were without a place to live?

____ days or
____ weeks or
____ months

H20.

Since CHILD began Head Start have you been without a place to live at any time?

No	01	SKIP TO I1
Yes	02

H21.

Did Head Start help you with this housing problem in any way? (IF YES) How?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

No, Head Start did not help	01	SKIP TO I1
Yes, gave info or made a referral (e.g., phone call)	02
Yes, gave help to get the service (e.g., filling out forms, transportation, providing child care)	03
Yes, helped in some other way (Please specify) _____________________	04

H22.

How helpful was this assistance? Was it...

READ LIST. CIRCLE ONE RESPONSE.

Not at all helpful,	01
A little helpful,	02
Helpful, or	03
Very Helpful?	04

I. COMMUNITY SERVICES
Families with young children sometimes need help of various kinds. Now I'd like to ask about how Head Start may have helped your family.

I1.

Did you or another family member complete a Head Start Family Needs Assessment in which you were asked about your family's particular needs, interests, goals, strengths, and so on?

SHOW PARENT COPY OF A HEAD START FAMILY
NEEDS ASSESSMENT USED BY PROGRAM

No	01
Yes	02
Don't know	99

I2.

Now I have some questions about your household’s experiences with various community agencies. I would like to know about services your household has needed since CHILD was born.

FOR EACH ITEM, READ QUESTION ALONG THE TOP. IF (I2) IS YES ASK I3, IF (I3) IS YES ASK I4. MOVE ON TO NEXT ITEM.

	I2.		I3.		I4.
	Since CHILD was born, have you or anyone in your household needed ...		IF YES IN I2: Have you received it?		IF YES IN I3: Did Head Start help with this in any way? Why 01t? or How? 01=01, we were already receiving 02=01, Head Start did 01t help 03=No, we didn’t need their help 04=Yes, referred to service 05=Yes, provided service directly
	No	Yes	No	Yes
	INCOME ASSISTANCE
Income assistance--like welfare, SSI, unemployment insurance	01	02	01	02
Food and nutrition assistance-- like food Stamps or WIC	01	02	01	02
Help with housing	01	02	01	02
Help with utilities (running water, hot water, heat, telephone service)	01	02	01	02
	EMPLOYMENT ASSISTANCE
Job training and employment assistance	01	02	01	02
Education assistance -- for example, GED, college, learning to read, English as a second language	01	02	01	02
Help getting transportation to a job or training	01	02	01	02
Child care for CHILD before or after the Head Start day	01	02	01	02
Child care for other children in the household	01	02	01	02
	HEALTHCARE
MEDICAID/local name for MEDICAID	01	02	01	02
Medical or dental care for CHILD	01	02	01	02
Medical or dental care for adults	01	02	01	02
Alcohol or drug abuse treatment or counseling	01	02	01	02
Mental health services	01	02	01	02
	SOCIAL SERVICES
Legal aid	01	02	01	02
Help dealing with family violence	01	02	01	02
Help in solving other family problems	01	02	01	02

J. CHILD CARE
Now I'd like to ask you some questions about any child care arrangements, other than Head Start, that you may have used for CHILD.

J1.

Let’s think about the years before CHILD was enrolled in Head Start. During that time, was (he/she) cared for on a regular basis (10 hrs/wk or more) by someone other than yourself?

No	01	SKIP TO J5
Yes	02

J2.

How old in months was CHILD when (he/she) first started in a child care arrangement for 10 or more hours per week?

______ months old

J3.

Thinking about all of the child care arrangements that CHILD was in before enrollment in Head Start, (a) where and by whom was that care provided? (b) Which arrangement did you use most frequently?

DO NOT READ LIST.

CIRCLE ALL THAT APPLY
(a)

CIRCLE THE ONE USED MOST
(b)

At CHILD's home by a relative

At CHILD's home by a non-relative

In a relative's home

In a friend's or neighbor's home

Family day care home

Other child care center/child development program

At Head Start (not including time in class)

Other (Please specify) ____________________________

J4.

Before enrolling in Head Start, in how many different arrangements did CHILD spend 10 or more hours per week?

______ arrangements

Now let’s talk about any child care arrangements that you use for CHILD right now. Child care does not include time in Head Start class, but may include separate child care at the Head Start center before or after class. This does not include babysitting used for social activities such as going out in the evening.

J5.

Is CHILD in child care before or after Head Start?

No	01	SKIP TO K1
Yes	02

J6.

In how many different child care arrangements does CHILD spend time each week? ______ arrangements

J7.

Where is that care provided?

IF MORE THAN ONE CHILD CARE ARRANGEMENT, ASK ABOUT PRIMARY ARRANGEMENT. DO NOT READ LIST. CIRCLE ONE RESPONSE.

At CHILD's home by a relative	01
At CHILD's home by a non-relative	02
In a relative's home	03
In a friend's or neighbor's home	04
Family day care home	05
Other child care center/child development program	06
At Head Start (not including time in class)	07
Other (Please specify) ______________________________	08

J8.

Is that person or place licensed, certified, or regulated?

No	01
Yes	02
Don't know	99

J9.

How many hours a week is this care used? ______ hours per week

J10.

Who pays for this child care?

DO NOT READ LIST. CIRCLE ALL THAT APPLY.

	NO	YES
Do you pay for it yourself?	01	02
Does a government agency pay?	01	02
Does an employer pay?	01	02
Does someone else pay?	01	02
Do you trade child care with someone else?	01	02
Is it free or no charge? (PROBE for other categories)	01	02
Other (Please specify) _____________________	01	02

J11.

Now I’m going to ask you about CHILD’S experience in this care. Please let me know which answer best describes CHILD’s experience.

READ LIST. CIRCLE ONE RESPONSE FOR EACH.

	Never	Sometimes	Often	Always	Don't Know
CHILD feels safe and secure in care.	01	02	03	04	99
CHILD gets lots of individual attention.	01	02	03	04	99
CHILD'S caregiver is open to new information and learning.	01	02	03	04	99

K. FAMILY HEALTHCARE

K1.

Now I'm going to ask you about your family's health care needs. Overall, would you say CHILD'S health is:...

READ LIST. CIRCLE ONE RESPONSE.

Excellent,	01
Very Good,	02
Good,	03
Fair, or	04
Poor?	05

K2.

Does CHILD have an illness or condition that requires regular, ongoing care?

Don't know

K3.

How much did CHILD weigh when (he/she) was born? ______ Pounds ______ Ounces

Don't know

K4.

Does CHILD have a regular health care provider for routine medical care, for example, well-child care and checkups?

No	01
Yes	02

K5.

Where does CHILD usually go for routine medical care? Does (he/she) go to a ...

READ LIST. CIRCLE ONE RESPONSE.

Doctor's office or private clinic (including HMO)	01
Hospital outpatient clinic	02
Hospital emergency room	03
Public health department	04
Community health center	05
Migrant clinic	06
Indian Health Service	07
Or some place else (Please specify) ________________________	08

K6.

Has Head Start helped you find a regular health care provider for CHILD? IF YES: How?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

Had a health care provider prior to enrollment	01
Head Start has not helped but I wish it would	02
Found a health care provider on my own	03
Provided information, including brochures, meetings, or conversations	04
Made referrals, for example, phone calls	05
Provided health care directly	06
Helped in some other way (Please specify) ___________________	07

K7.

Where does CHILD usually go for medical care when (he/she) is sick or injured? Does (he/she) go to a ...

Doctor's office or private clinic (including HMO)	01
Hospital outpatient clinic	02
Hospital emergency room	03
Public health department	04
Community health center	05
Migrant clinic	06
Indian Health Service	07
Or some place else (Please specify) ________________________	08

K8.

Where does CHILD go for dental care? Does (he/she) go to a ...

Private dentist's office	01
Hospital dental clinic	02
Public health department dental clinic	03
Community health center dental clinic	04
Migrant dental clinic	05
Indian Health Service dental clinic	06
Some place else (Please specify) ________________________	07
Or CHILD hasn't been to the dentist yet	08

K9.

Would you say your health in general is excellent, very good, good, fair, or poor?

CIRCLE ONE RESPONSE.

Excellent,	01
Very Good,	02
Good,	03
Fair, or	04
Poor?	05

K10.

Does any impairment or health problem now keep you from working at a job or business?

No	01	SKIP TO K12
Yes	02

K11.

Are you limited in the kind or amount of work you can do because of any impairment or health problem?

No	01
Yes	02

K12.

Does anyone in your household, other than CHILD, have an illness or condition that requires regular, ongoing care?

No	01
Yes	02

K13.

Do you have a regular health care provider for your own routine medical care, for example, checkups?

No	01
Yes	02

K14.

Where do you usually go for routine medical care? Do you go to a ...

READ LIST. CIRCLE ONE RESPONSE.

Doctor's office or private clinic (including HMO)	01
Hospital outpatient clinic	02
Hospital emergency room	03
Public health department	04
Community health center	05
Migrant clinic	06
Indian Health Service	07
Or some place else (Please specify) ________________________	08

K15.

Has Head Start helped you find a regular health care provider for yourself? IF YES: How?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

Had a health care provider prior to enrollment	01
Head Start has not helped but I wish it would	02
Found a health care provider on my own	03
Provided information, including brochures, meetings, or conversations	04
Made referrals, for example, phone calls	05
Provided health care directly	06
Helped in some other way (Please specify) ___________________	07

K16.

Does anyone in your household smoke cigarettes regularly?

No	01
Yes	02

K17.

Does anyone in your household have a drinking problem?

No	01
Yes	02
Refused	98

K18.

Does anyone in your household have a drug problem?

No	01
Yes	02
Refused	98

L. HOME SAFETY

L1.

Please tell me if you follow certain safety practices. Do you...

	No	Yes	NA	Don't know
Always use a safety seat or seat belt for CHILD when in the car	01	02	03	99
Keep medicines in childproof bottles and out of children's reach	01	02	03	99
Have at least one operating smoke detector in your home with a working battery	01	02	03	99
Keep cleaning materials out of reach of children and/or in locked cabinets	01	02	03	99
Have a first-aid kit at home	01	02	03	99
Keep the poison control center number and other emergency numbers by the telephone	01	02	03	99
Always supervise CHILD when crossing the street or riding tricycles/bicycles near traffic	01	02	03	99
Always keep matches and cigarette lighters out of CHILD's reach	01	02	03	99
Always supervise CHILD when (he/she) is in the bathtub	01	02	03	99

M. HOME AND NEIGHBORHOOD CHARACTERISTICS
The next questions are about situations that can be difficult for families. I'm going to ask about things that may have happened to you or others in your household over the past year. Please remember, all of your answers are held in the strictest confidence. We will not tell anyone what you say, including Head Start.

M1.

For each of the following items, please tell me how often each one happened to you during the past year.

READ LIST. CIRCLE ONE RESPONSE FOR EACH.

	Never	Once	More than once	Refused
I saw non-violent crimes take place in my neighborhood -- for example, selling drugs or stealing.	01	02	03	98
I heard or saw violent crime take place in my neighborhood.	01	02	03	98
I know someone who was a victim of a violent crime in my neighborhood.	01	02	03	98
I was a victim of violent crime in my neighborhood.	01	02	03	98
I was a victim of violent crime in my home.	01	02	03	98

M2.

Has CHILD ever been a witness to a violent crime or domestic violence?

No	01
Yes	02
Refused	98
Don't know	99

M3.

Has CHILD ever been the victim of a violent crime or domestic violence?

No	01
Yes	02
Refused	98
Don't know	99

M4.

Since CHILD was born, have you, another household member, (or a non-household biological parent) been arrested or charged with any crime by the police?

No	01	SKIP TO M5
Yes	02
Refused	98	SKIP TO M5

M4a.

Who was arrested or charged? _______________________________________________

Refused

SKIP TO M5

M4b.

Did (he/she/they) spend anytime in jail?

No	01
Yes	02
Refused	98

M5.

Has CHILD ever lived apart from you (or mother) not including vacations or shared custody arrangements?

M5a.

For how long? _______________________________________________

Refused

M5b.

With whom? _______________________________________________

Refused

N. YOUR FEELINGS

N1.

I'm going to read a list of feelings or attitudes people have about themselves. After I read each one please tell me if you strongly disagree, disagree, agree, or strongly agree that you feel this way.

READ LIST. CIRCLE ONE RESPONSE FOR EACH.

	Strongly Disagree	Disagree	Agree	Strongly Agree
There is really no way I can solve some of the problems I have.	01	02	03	04
Sometimes I feel that I'm being pushed around in life.	01	02	03	04
I have little control over the things that happen to me.	01	02	03	04
I can do just about anything I really set my mind to do.	01	02	03	04
I often feel helpless in dealing with the problems of life.	01	02	03	04
What happens to me in the future depends mostly on me.	01	02	03	04
There is little I can do to change many of the important things in my life.	01	02	03	04

I am going to read a list of ways you may have felt or behaved. Please tell me how often you have felt this way during the past week.

N2.

How often during the past week have you felt (INTERVIEWER: READ STATEMENT)--would you say: rarely or never, some or a little of the time, occasionally or a moderate amount of time, or most or all of the time?

READ LIST. CIRCLE ONE RESPONSE FOR EACH.

	Rarely or Never (Less than 1 Day)	Some or a Little (1-2 Days)	Occasionally or Moderate (3-4 Days)	Most or All (5-7 Days)
Bothered by things that usually don't bother you	01	02	03	04
You did not feel like eating; your appetite was poor	01	02	03	04
That you could not shake off the blues, even with help from your family and friends	01	02	03	04
You had trouble keeping your mind on what you were doing	01	02	03	04
Depressed	01	02	03	04
That everything you did was an effort	01	02	03	04
Fearful	01	02	03	04
Your sleep was restless	01	02	03	04
You talked less than usual	01	02	03	04
Lonely	01	02	03	04
Sad	01	02	03	04
You could not get "going"	01	02	03	04

Many people and groups can be helpful to members of a family raising a young child. We want to know how helpful different people and groups are to your family.

N3.

Please tell me how helpful each of the following have been to you in terms of raising CHILD over the past 3 to 6 months. How helpful have (INSERT PERSON/GROUP) been? (HAVE/HAS) (PERSON) been not at all helpful, sometimes helpful, generally helpful, very helpful, or extremely helpful?

READ LIST. CIRCLE ONE RESPONSE FOR EACH.

How helpful (have/has) been?		Not Very Helpful	Somewhat Helpful	Very Helpful	Not Applicable or Don't Know
a.	CHILD's (father/mother/parents)	01	02	03	99
b.	Grandparents or other relatives	01	02	03	99
c.	Your friends	01	02	03	99
d.	Co-workers	01	02	03	99
e.	Professional helpgivers like counselors or social workers	01	02	03	99
f.	Head Start staff	01	02	03	99
g.	Other child care providers	01	02	03	99
h.	Religious or social group member	01	02	03	99
i.	Anyone else (Please specify)	01	02	03	99

N4.

What are the major ways you feel Head Start could help CHILD this year? PROBE: Anything else?

INTERVIEWER:

RECORD ANSWERS BELOW. CODE RESPONSES ON PAGE 59 AT END OF INTERVIEW.

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

N5.

What are the major ways you think Head Start could help your family this year? PROBE: Anything else?

INTERVIEWER:

RECORD ANSWERS BELOW. CODE RESPONSES ON PAGE 59 AT END OF INTERVIEW.

INTERVIEWER:

CODE VERBATIM RESPONSES FROM N4 AND N5 IN GRID BELOW AFTER COMPLETING INTERVIEW.

	N4	N5		N4	N5
Child Benefits	10	10	Adult Education	60	60
Academic readiness	11	11	Preparing for GED	61	61
Social interactions with children	12	12	GED	62	62
Social interactions with adults	13	13	Vocational/technical training	63	63
Help with speech/language	14	14	Adult education class	64	64
Child health/nutrition/immunizations	15	15	English literacy skills	65	65
Child dental services	16	16	Finance/budgeting	66	66
Mental health counseling	17	17	Child Development Associate (CDA)	67	67
Help for special needs	18	18	Received college degree	68	68
Safe haven from home/neighborhood	19	19
Family Health Care	20	20	Parenting Benefits	70	70
Health education (nutrition/fitness)	21	21	Communication skills	71	71
Medical services	22	22	Discipline	72	72
Dental services	23	23	Nutrition	73	73
Mental Health counseling	24	24	Reading/education	74	74
			Understanding child growth and development	75	75
Child Skills	25	25	Food/Clothing	76	76
Independence	26	26	Holiday gifts/toys/books	77	77
Manners	27	27
Good habits (pick up toys, set table)	28	28
Referrals and/or information	30	30	Parent Social Benefits	80	80
Social services	31	31	Make new friends	81	81
Legal aid	32	32	Increase self-confidence	82	82
Public assistance	33	33	Social support/emotional support	83	83
Medicaid, etc	34	34	Family contentment	84	84
Employment	40	40	Volunteer Opportunities	90	90
Job skills	41	41	Housing	91	91
Job searching skills	42	42	Transportation	92	92
Job interviewing skills.	43	43	Head Start can not help	93	93
Opportunity to work	44	44
Child Care	50	50	Other	98	98
Before Head Start	51	51	________________________________
After Head Start	52	52	________________________________
For Other Children	53	53	Don't Know	99	99

N6.

If you could change anything about Head Start that you think would help it better serve children and families, what would it be?

____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________ SKIP TO Section P

O. CONFIDENCE RATINGS

COMPLETE AFTER INTERVIEW IS CONCLUDED

O1.

Interview Completion Code:

Respondent terminated interview prematurely	01
Respondent refused interview	02
Respondent unable to respond (Please specify) ___________________________________	03
Interview completed ...

O2.

Please rate the following qualities of the respondent, the interviewing situation, and the data The Respondent (was/had):

a.	Able to understand questions easily	7	6	5	4	3	2	1	Hardly able to understand
b.	Truthful	7	6	5	4	3	2	1	Untruthful
c.	Accurate	7	6	5	4	3	2	1	Inaccurate
d.	Interested in the interview	7	6	5	4	3	2	1	Not interested in the interview
e.	Cooperative	7	6	5	4	3	2	1	Uncooperative
f.	No English language problem	7	6	5	4	3	2	1	Spoke English with great difficulty
g.	Interviewed without interruption	7	6	5	4	3	2	1	Interrupted often
h.	Your opinion about the overall quality of the data:
	High	7	6	5	4	3	2	1	Low

DON'T FORGET TO CODE N4 AND N5 ON PAGE 59.

P. TRACKING INFORMATION

Thank you for spending this time with me. I would also like to thank you for participating in this interview and will give you money in just a few minutes. As we explained to you before, we plan to interview you again in the spring and we need to know how to get in touch with you.

P1.

What is your telephone number? (area code) __ __ __ - __ __ __ - __ __ __ __ SKIP TO P3A

No telephone	01
Refused	98

P2.

Can you give me a number where you can be reached? (area code) __ __ __ - __ __ __ - __ __ __ __

No telephone	01	SKIP TO P3A
Refused	98	SKIP TO P3A

P3.

Whose telephone is that?

Name __________________________________________
Refused	98

P3a.

Do you have another phone number like a beeper number or cell phone number?

No beeper or cell phone number		01

Beeper	__ __ __ - __ __ __ - __ __ __ __
Cell Phone	__ __ __ - __ __ __ - __ __ __ __

P4.

Please give me your permanent address ...

Address	_________________________________________________________
	Street		Apt.
	_________________________________________________________
	Town/City	State	Zip Code

P5.

Where are you employed? __________________________________________________

Not employed

SKIP TO P7a

P6.

What is your work telephone phone number? (area code) __ __ __ - __ __ __ - __ __ __ __

Would you please tell me the names, addresses and telephone numbers of three people who will know how to contact you a year from now?

P7a

Contact 1 name: __________________________________________________

P7b.

Relationship to respondent: ____ Relative (specify) _______________ ____ Nonrelative

P7c.

Address	_________________________________________________________
	Street		Apt.
	_________________________________________________________
	Town/City	State	Zip Code

P8a

Contact 2 name: __________________________________________________

P8b.

Relationship to respondent: ____ Relative (specify) _______________ ____ Nonrelative

P8c.

Address	_________________________________________________________
	Street		Apt.
	_________________________________________________________
	Town/City	State	Zip Code

P9a

Contact 3 name: __________________________________________________

P9b.

Relationship to respondent: ____ Relative (specify) _______________ ____ Nonrelative

P9c.

Address	_________________________________________________________
	Street		Apt.
	_________________________________________________________
	Town/City	State	Zip Code

GET SIGNATURE BELOW. REMOVE SECTION P FROM QUESTIONNAIRE. TEAR OFF LAST PAGE WITH NAMES AND GIVE TO RESPONDENT..

I give permission to the contacts named above to release my current address and phone number to a representative of the Head Start FACES study.

_____________________________	______________________________	_____________
Respondent's Signature	Print Name	Date

Head Start Family and Child Experiences Survey

Thank you very much for your cooperation. If you have any questions about the study or the inteview, you may call the following numbers:

Louisa Tarullo, Ed.D.
Adminstration on Children, Youth and Families
(202) 205-9632

David Connell, Ph.D.
Abt Associates, Inc.
(617) 349-2804

Nicholas Zill, Ph.D.
Westat, Inc.
(301) 294-4448

You may send your comments regarding the interview burden or any other aspect of this collection of information, including suggestions for reducing this burden, to:

Reports Clearance Officer
Adminstration for Children and Families
U.S. Department of Health and Human Services
370 L`Enfant Promenade, S.W.
Washington, D.C. 20447

Office of Management and Budget
Paperwork Reduction Project
OMB Control No. 0970-0151 Exp. 06/2000
Washington, D.C. 20503

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Head Start Family and Child Experiences Survey Fall '97 Parent Interview

Head Start Family and Child Experiences Survey

Fall '97 Parent Interview