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

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OMB Approval Number: 0970-0151 Esp 06/2000

RESPONDENT ID ___ ___ ___ ___ ___

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

Head Start Family and Child Experiences Survey

Spring '99 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
Spring '99 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

Home-based child	01
Center-based child	02

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 again. It is important to talk with you again so we can continue to understand about Head Start from a parent's point of view. Information from this study is being used to help Head Start better serve children and their families.

Just like the last time, 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. You may recognize some questions from the last interview but it is important to ask them again. 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

Are you the person interviewed last spring when we conducted the spring 1998 interview?

No	01
Yes	02	SKIP TO A1

1a.

Is that person available?

No	01
Yes	02	End Interview
Reschedule with original respondent

1b.

Are you the person we interviewed in the fall of 1997?

No	01
Yes	02	SKIP TO A1

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

Is that birth or adopted?
	birth	19	SKIP TO A1
	adopted	20	SKIP TO A1

Father

Is that birth or adopted?
	birth	21	SKIP TO A1
	adopted	22	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
Remember, you may recognize some of the questions, but it is important for us to ask them again.

A1.

Is CHILD a boy or a girl?

Boy	01
Girl	02

A2.

What is CHILD’S birth date?

__ __/ __ __/ __ __

month day year

A3.

About how often has CHILD missed Head Start this past year?

Never	01	SKIP TO B1
1-5 days	02
6-10 days	03
More than 10 days	04
Don't Know	05

A4.

What is the most frequent reason for CHILD’s missing Head Start this past year?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

Illness (child)	01
Illness (family member)	02
Conflict with parent's work or school schedule	03
Lack of transportation	04
Bad weather	05
Child did not want to go	06
Parent decision not to send child or to send child elsewhere	07
Other (Please specify) _________________________________	08
Don't Know	99

B. SATISFACTION WITH HEAD START
Now I'd like to ask you some questions about CHILD's Head Start program.

B1.

Based on what has happened at Head Start over the past year, how satisfied are you with how well Head Start is doing in each of the following areas:

IF "VERY OR SOMEWHAT DISSATISFIED" IS GIVEN AS A RESPONSE, ASK THE FOLLOW-UP QUESTION, B2.

B2.

Why do you feel dissatisfied with your Head Start experience in (READ QUESTION MARKED “VERY OR SOMEWHAT DISSATISFIED”)?

	B1.					B2.
How satisfied are you with how well Head Start is ...	Very dissatisfied	Somewhat dissatisfied	Somewhat satisfied	Very satisfied	N/A or DK	IF VERY OR SOMEWHAT DISSATISFIED: Why?
Helping CHILD to grow and develop	01	02	03	04	99
Being open to your ideas and participation	01	02	03	04	99
Supporting and respecting your family's culture and background	01	02	03	04	99
Identifying and providing services for CHILD--for example, health screening, with speech and language development	01	02	03	04	99
Identifying and helping to provide that help your family--for example, assistance, transportation, or job training	01	02	03	04	99
Maintaining a safe program--for secure playgrounds, clean and tidy classrooms	01	02	03	04	99
Preparing CHILD to enter kindergarten	01	02	03	04	99
Helping you become more involved in groups that are active in your community	01	02	03	04	99

B3.

Now I’m going to ask you about CHILD’s and your experience in Head Start. Please let me know which answer best describes CHILD’s and your Head Start experience.

IF "NEVER" IS GIVEN AS THE RESPONSE, ASK THE FOLLOW-UP QUESTION, B4.

B4.

Why do you feel (READ ITEM) is never true?

B3.

B4.

READ LIST.

Never

Sometimes

Often

Always

Don't Know

Why?

CHILD feels safe and secure in Start.

CHILD gets lots of individual attention.

CHILD's teacher is open to new information and learning.

CHILD has been happy in the program.

The teacher is warm and affectionate towards CHILD.

CHILD is treated with respect by teachers.

The teacher takes an interest in CHILD.

CHILD feels accepted by the teacher.

The teacher is supportive of you as a parent.

You feel welcomed by the teacher.

The teacher handles discipline matters easily without being harsh.

The teacher seems happy and content.

The assistant teacher/aide is warm and affectionate towards CHILD.

C. YOUR ACTIVITIES IN HEAD START

C1.

Please indicate how often you have participated in the following activities at CHILD’s Head Start center since the beginning of this Head Start year.

For each one, tell me if that is not yet, once or twice, 3-10 times, more than once a month, or more than once a week.

How often have you ...	Not yet	Once or twice	3-10 times	More than once a month	More than once a week
Volunteered or helped out in CHILD's classroom?	01	02	03	04	05
Observed in CHILD's classroom for at least 30 minutes?	01	02	03	04	05
Prepared food or materials for special events such as a holiday celebration or special cultural event?	01	02	03	04	05
Helped with field trips or other special events?	01	02	03	04	05
Attended Head Start social events such as bazaars or fairs for children and families?	01	02	03	04	05
Attended parent education meetings or workshops focusing on topics such as job skills or child-rearing?	01	02	03	04	05
Attended parent-teacher conferences?	01	02	03	04	05
Visited with a Head Start staff member in your home?	01	02	03	04	05
Attended a Head Start event with spouse or partner?	01	02	03	04	05
Attended a Head Start event with another adult?	01	02	03	04	05
Participated in Policy Council, monitoring-related activities, or other Head Start planning groups?	01	02	03	04	05
Called or visited another Head Start parent on a matter related to Head Start ?	01	02	03	04	05
Prepared or distributed newsletters, fliers, or Head Start materials?	01	02	03	04	05
Participated in fundraising activities?	01	02	03	04	05
Other (Please describe): ___________________________________ __________________________________________________________	01	02	03	04	05

C2.

Some parents have a hard time participating in their child’s Head Start program. Please tell me if any of the following things have kept you from participating as much as you would like in CHILD’s Head Start Program this past year?

READ LIST.

YES

Your need for child care

Your work schedule interferes

Your school or training schedule interferes

You need transportation

You don't know others at Head Start

You feel uncomfortable at Head Start

You have health problems that interfere

CHILD's teacher is uncomfortable with parents in the classroom

Head Start doesn't provide enough opportunities for you to participate

You have had bad experiences with Head Start in the past

You are uncomfortable because of language or cultural differences

You have concern for your safety while getting to Head Start

You need more support from your spouse or partner

Other (Please specify) _______________________________________________________________

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

D1.

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 D2
Once or twice	02
Three or more times	03
Everyday	04

D1a.

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

D2.

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

D3.

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

D4.

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

D5.

AFTER COMPLETING ALL OF D3 AND D4(a-k), ASK THE FOLLOWING FOR EACH ACTIVITY CODED “YES” IN D3: Who (Read Item)?

D3.			D4.		D5.
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.
In the past week, have you or someone in your family...	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 office, bank, or the store?	01	02	1-2	3+	01	02	03	04
Involved (him/her) in household like cooking, cleaning, setting the or caring for pets?	01	02	1-2	3+	01	02	03	04
Talked about what happened in 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 with numbers?	01	02	1-2	3+	01	02	03	04

D6.

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

D7.

AFTER COMPLETING ALL OF D6(a-j), ASK THE FOLLOWING FOR EACH ACTIVITY CODED “YES”: Who has (READ ITEM) with CHILD?

D6.			D7.
In the past month, that is since (MONTH)(DAY), has anyone in your family done the following things with CHILD?			[ASK ONLY AFTER COMPLETING ALL OF D6] 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]
			Mother/ Mother-Figure	Father/ Father-Figure	Other Household Member	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 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 religious group?	01	02	01	02	03	04
Attended an athletic or sporting event which CHILD was not a player?	01	02	01	02	03	04

D8.

Which of the following do you have in your home?

Children's books	NO	YES
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 nonfiction	01	02

E. DISABILITIES

E1.

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

No	01	SKIP TO F1
Yes	02
Don't Know	99	SKIP TO F1

E2.

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

E3.

Was this special need or disability diagnosed by a professional during the past year?

No	01
Yes	02

E4.

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

No	01
Yes	02
Don't Know	99

E5.

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 E7
Don't Know	99	SKIP TO E10

E6.

Why not?	______________________________________________ ______________________________________________ ______________________________________________
	[Suggested Probe: "Were you given the opportunity to participate?]

E7.

Is CHILD receiving ...

READ LIST. CIRCLE ONE RESPONSE.

None or a few of the services identified in the IEP	01
Some of the services	02
Most of the services, or	03
All of the services identified in the IEP?	04
Don't Know	99

E8.

How satisfied were you with those services? Were you...

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

E9.

How helpful was Head Start with...

READ LIST. CIRCLE ONE RESPONSE FOR EACH.

	Not at all helpful	A little helpful	Helpful	Very helpful	Don't Know
Assisting you in talking with other schools and agencies, and knowing about other resources for meeting CHILD's special needs	01	02	03	04	99
Helping you to better meet the special needs of CHILD in the home--for example, providing proper diet and exercise, continuing recommended therapy, and so on	01	02	03	04	99

E10.

Is CHILD receiving services for (his/her) (disability/disabilities) from...

READ LIST.

YES

Your local school district?

State or local health or social service agency?

Doctor or clinic?

Head Start?

Some other source (Please specify)?

E11.

Do all of the children in CHILD’s room or group at Head Start program have disabling conditions, or is (he/she) in a mixed group with some children who have disabilities and some who don’t?

All	01	SKIP TO E13
Mixed	02
Don't Know	99	SKIP TO E13

E12.

Does CHILD usually spend all day of (his/her) time at Head Start in the mixed group, or does (he/she) sometimes leave the group for separate services or instruction?

Spends time in the mixed group	01
Sometimes leaves the mixed group	02
Don't know	99

E13.

Do you think there are any areas or ways that the Head Start program could improve in providing services to children with special needs and their families?

No	01	SKIP TO F1
Yes	02

E14.

How?	______________________________________________

F. 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.

F1.

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

F2.

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

F3.

How many written numbers can CHILD recognize? __ __ numbers

F4.

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

__ __ __ largest number

F5.

Can CHILD button (his/her) clothes?

No	01
Yes	02

F6.

Does CHILD hold a pencil properly?

No	01
Yes	02

F7.

How often does CHILD like to write or pretend to write?

READ LIST. CIRCLE ONE RESPONSE.

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

F8.

Does CHILD mostly write and draw rather than scribble?

No	01
Yes	02

F9.

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

No	01
Yes	02
Don't Know	99

F10.

Does CHILD trip, stumble, or fall easily?

No	01
Yes	02

F11.

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

No	01
Yes	02

F12.

Did CHILD start speaking later than other children you know?

No	01
Yes	02

F13.

Does CHILD stutter or stammer?

No	01
Yes	02

F14.

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

No	01	SKIP TO F16
Yes	02

F15.

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

F16.

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

No	01
Yes	02
Don't Know	99

F17.

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

G. YOUR CHILD'S BEHAVIOR

G1.

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

H. GETTING READY FOR KINDERGARTEN

H1.

Where will CHILD attend school this coming fall? Will (he/she) be ...

READ LIST. CIRCLE ONE RESPONSE.

Returning to Head Start	01	SKIP TO I1
Attending Pre-Kindergarten	02
Attending Kindergarten	03
Attending another preschool	04
Not attending any school	05	SKIP TO I1
Don't Know	99	SKIP TO I1

H2.

What is the name of the school CHILD will attend next year? ________________________________________

H3.

Where is the elementary school located?	________________________________________ city
	________________________________________ street (if known)

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

I1.

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

I2.

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 I4
Yes	02

I3.

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

I4.

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

No	01	SKIP TO I6
Yes	02

I5.

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

I6.

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

I7.

Has Head Start taught you any new ways to discipline or set limits with CHILD?

No	01	SKIP TO J1
Yes	02

I8.

What are some examples?

DO NOT READ LIST. CIRCLE ALL THAT APPLY.

Use time out	01
Ignore child	02
Talk to child	03
Positive reinforcement	04
Other (please specify) ______________	05

J. YOU AND YOUR FAMILY
Now I’m going to ask you some questions about you and your family.

J1.

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

J2.

What is your current marital status?

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

J3.

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

J4.

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

J5.

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

J5. First Name	J7. How old is NAME?	J8. Is or was this person ever enrolled in Head Start or Early Head Start 01=No 02=Yes 90=NA 99=Don't Know	J9. Is NAME employed? 01=No 02=Yes 90=NA 99=Don't Know
		IF YOUNGER THAN 25:	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 (female) 18=Parent's partner (male) 99=Don't know/ Didn't Respond

INTERVIEWER:

IF MOTHER IS RESPONDENT ...SKIP TO J18

IF MOTHER IS NOT RESPONDENT AND

NOT IN HOUSEHOLD...GO TO J11

IN HOUSEHOLD...SKIP TO J16

J11.

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

No	01
Yes	02
Mother is deceased	03	Ask J14-J15a, then Skip to J18
Don't Know	99

J12.

Does she contribute to the financial support of the child?

No	01
Yes	02
Don't Know	99

J13.

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

REMINDER - - IF MOTHER IS DECEASED, ASK J14-J15a THEN SKIP TO J18

J14.

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

No	01	SKIP TO G16
Yes	02

J15.

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	SKIP TO J16
A relative of the child who lives in the household,	04
A relative of the child who doesn't live in the household	05	SKIP TO J16
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	SKIP TO J16

ENTER THE PERSON "LETTER" FROM GRID ON PAGE 22 (QUESTION J5) BELOW.

J15a.

___ person letter from J5 grid page 28

J16.

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

J17.

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

DO NOT READ LIST. CIRCLE ALL THAT APPLY.

IF YES: What is her occupation?
Is that:	Full-time	02
	Part-time	03
	Seasonal	04

Unemployed	05
Looking for Work	06
Laid off	07
In School/training	08
In Jail/prison	09
In Military	10
Something Else (Please specify) _______________________________	11
Don't Know	99

INTERVIEWER:

IF FATHER IS RESPONDENT ...SKIP TO J25

IF FATHER IS NOT RESPONDENT AND

NOT IN HOUSEHOLD...GO TO J18

IN HOUSEHOLD...SKIP TO J23

J18.

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

No	01
Yes	02
Father is deceased	03	Ask J21-J22a, then Skip to J25
Don't Know	99

J19.

Does he contribute to the financial support of the child?

No	01
Yes	02
Don't Know	99

J20.

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

J21.

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

No	01	SKIP TO J23
Yes	02

J22.

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	SKIP TO J23
A relative of the child who lives in the household,	04
A relative of the child who doesn't live in the household	05	SKIP TO J23
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	SKIP TO J23

ENTER THE PERSON "LETTER" FROM GRID ON PAGE 28 (QUESTION J5) BELOW.

	J22a.	___ person letter from J5 grid page 28

J23.

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

J24.

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
IF YES: What is his occupation?
Is that:	Full-time	02
	Part-time	03
	Seasonal	04

Unemployed	05
Looking for Work	06
Laid off	07
In School/training	08
In Jail/prison	09
In Military	10
Something Else (Please specify) _______________________________	11
Don't Know	12

J24a.

What is the highest grade or year of regular school that you have 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

J25.

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

No	01	SKIP TO J27
Yes	02

J26.

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
Associate's degree	04
CDA (Child Development Associate)	05
Bachelor's degree	06
Graduate degree	07
Other (Please specify) ___________________	08

J27.

Have you completed a certificate, diploma or degree since last spring?

No	01
Yes	02	SKIP TO K1

J28.

What kind of certificate, degree, or diploma?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

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

K. 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.

K1.

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

No	01	SKIP TO H1
Yes	02

K2.

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.

K3.

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

K4.

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?

K3.	K4.
JOB DESCRIPTIONS	JOB STATUS
	Seasonal	Full-time	Part-time
1. ___________________________________________	01	02	03
2. ___________________________________________	01	02	03
3. ___________________________________________	01	02	03

K5.

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

K6.

Are you currently looking for a/another job?

No	01
Yes	02

K7.

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

K8.

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

No	01
Yes	02

K9.

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
Education grants/assistance		01	02
Other (Please specify) _____________________________________________		01	02

K9o.

In the past two years, did any member of your household receive public assistance or benefits from the welfare office?

No	01
Yes	02

If ResponIf Respondent answered "YES" to K9a, K9c, K9o, continue with K10. Else SKIP to K11.KI9d or K9o, continue with K10. Else SKIP to K11

K10.

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

IF YnIF YES TO ANY OF THE ABOVE, ASK K10A, K10B, and K10C OTHERWISE SKIP TO K11KND K10C OTHERWISE SKIP TO K11

K10a.

Have these changes or requirements affected your life in any of the following ways?

READ LIST.

Yes

It is more difficult to find child care

It is more difficult to pay for child care

It is more difficult for me to depend on friends and relatives for support because of their work or training requirements

I have to provide more support to my family and/or friends

My transportation needs have increased

I have less time to be involved at Head Start

My other benefits have been reduced

Any other (please specify) ________________________________________

(Do not read) Don't know

(Do not read) Changes have had no effect

K10b.

Thinking about the changes you have had to deal with, has Head Start

	No	Yes
Helped you understand the welfare reform requirements?	01	02
Helped with child care?	01	02
Helped you get needed education or training?	01	02
Helped you find a job?	01	02
Helped you get transportation?	01	02
Required too much participation from you?	01	02
Required you to participate at inconvenient times?	01	02
Helped you in any other way not mentioned? (Please specify) __________________________________________	01	02

K10c.

What else (could/could have) Head Start (do/done) to help you with these changes that has not been done?

___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

K11.

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

K12.

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	98
Don't Know	99

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

K13.

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

K13a.

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

K13b.

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

K14.

How many times have you moved in the last year? __ __ times moved

K15.

Do you currently own your own home or apartment, pay rent, or live in public or subsidized housing?

No	01
Yes	02

K16.

Since last spring have you been homeless or not had a regular place to live?

No	01	SKIP TO L1
Yes	02

K17.

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 L1
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

K18.

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

L. COMMUNITY SERVICES
Families with young children sometimes need help of various kinds. Now I'd like to know about whether Head Start has helped your family.

L1.

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

L2.

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 last spring.

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.

	L2.		L3.		L4.
	Since last spring, have you or anyone in your household needed ...		IF YES IN L2: Have you received it?		IF YES IN L3: Did Head Start help with this in any way? Why not? or How? 01=No, we were already receiving 02=No, Head Start did not 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

M. CHILD CARE
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.

M1.

Is CHILD in child care before or after Head Start?

No	01	SKIP TO N1
Yes	02

M2.

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

M3.

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

M4.

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

No	01
Yes	02
Don't know	99

M5.

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

M6.

Who pays for this child care?

READ LIST.

	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

M7.

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

N. FAMILY HEALTHCARE

N1.

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

N2.

Since last spring, has CHILD had an illness or condition that requires regular, ongoing care?

No	01
Yes	02
Don't know	99

N3.

Where does CHILD usually go for routine medical care like well-child care or regular check-ups?

READ LIST. CIRCLE ONE RESPONSE.

A private doctor, private clinic, or HMO	01
An outpatient clinic run by a hospital	02
The emergency room at a hospital	03
Public health department or community health center	04
A migrant health clinic	05
The Indian Health Service	06
Other (Please specify) __________________________	07
Don't Know	99

N4.

Do you take CHILD to the same place when (he/she) is sick or injured?

No	01	SKIP TO N6
Yes	02

N5.

Where does CHILD go for medical care when (he/she) is sick or injured?

READ LIST. CIRCLE ONE RESPONSE.

A private doctor, private clinic, or HMO	01
An outpatient clinic run by a hospital	02
The emergency room at a hospital	03
Public health department or community health center	04
A migrant health clinic	05
The Indian Health Service	06
Other (Please specify) ____________________________	07
Don't Know	99

N6.

Where does CHILD go for dental care?

READ LIST. CIRCLE ONE RESPONSE.

Child has not been to the dentist yet	01
A private dentist, private clinic, or HMO	02
An outpatient dental clinic run by a hospital	03
The Public Health Department or a community dental clinic	04
A migrant dental clinic	05
The Indian Health Service Dental Clinic	06
Other (Please specify) _________________________________	07
Don't Know	99

N7.

Have CHILD’s health habits improved in the following areas because of Head Start?

	NO	YES
Tooth brushing	01	02
Washing hands before meals	01	02
Washing hands after using toilet	01	02
Eating nutritious and healthful foods	01	02
Exercising and staying fit	01	02

N8.

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

N9.

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

No	01	SKIP TO N11
Yes	02

N10.

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

No	01
Yes	02

N11.

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

No	01
Yes	02

N12.

Where do you go for routine medical care?

The same place as CHILD	01
A private doctor, private clinic, or HMO	02
An outpatient clinic run by a hospital	03
The emergency room at a hospital	04
Public health department or community health center	05
A migrant health clinic	06
The Indian Health Service	07
Other (Please specify) ____________________________	08
Don't Know	99

N13.

Have your health habits improved in the following areas because of Head Start?

READ LIST.

	No	Yes
Exercising more regularly	01	02
Eating more nutritious or healthful food	01	02
Brushing your teeth more regularly	01	02
Using seat belts more regularly	01	02
Improving safety in your home	01	02

N14.

Does anyone in your household smoke cigarettes regularly?

No	01
Yes	02
Refused	98

N15.

In the past year, has anyone in your household had a drinking problem?

No	01
Yes	02
Refused	98

N16.

In the past year, has anyone in your household had a drug problem?

No	01
Yes	02
Refused	98

O. HOME SAFETY

O1.

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

	No	Yes	NA	Don't know
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
Supervise CHILD when crossing the street or riding tricycles/bicycles near traffic	01	02	03	99
Keep matches and cigarette lighters out of CHILD's reach	01	02	03	99
Supervise CHILD when (he/she) is in the bathtub	01	02	03	99
Keep firearms under lock and key	01	02	03	99

P. 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 since our last visit. Please remember, all of your answers are held in the strictest confidence. We will not tell anyone what you say, including Head Start.

P1.

For each of the following items, please tell me how often each one happened to you since last spring.

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

P2a.

Has CHILD been a witness to a violent crime since last spring?

No	01
Yes	02
Refused	98
Don't know	99

P2b.

Has CHILD ever been a witness to domestic violence since last spring?

No	01
Yes	02
Refused	98
Don't know	99

P3a.

Has CHILD been the victim of a violent crime since last spring?

No	01
Yes	02
Refused	98
Don't know	99

P3b.

Has CHILD been the victim of domestic violence since last spring?

No	01
Yes	02
Refused	98
Don't know	99

P4.

Since last spring 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 P5
Yes	02
Refused	98	SKIP TO P5

P4a.

Who was arrested or charged? ____________________________________________________

Refused

SKIP TO P5

P4b.

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

No	01
Yes	02
Refused	98

P5.

Since last spring, has CHILD lived apart from you (or mother) not including vacations or shard customdy arrangements?

No	01	SKIP TO Q1
Yes	02
Refused	98	SKIP TO Q1

P5a.

For how long? ____________________________

Refused

P5b.

With whom? ______________________________

Refused

Q. YOUR FEELINGS

Q1.

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. Looking at the categories on this card, please tell me how often you have felt this way during the past week.

Q2.

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.

How often during the past week have you felt ...	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.

Q3.

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, somewhat helpful, or very 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
CHILD's (father/mother/parents)	01	02	03	99
Grandparents or other relatives	01	02	03	99
Your friends	01	02	03	99
Co-workers	01	02	03	99
Professional helpgivers	01	02	03	99
Head Start staff	01	02	03	99
Other child care providers	01	02	03	99
Religious or social group member	01	02	03	99
Anyone else (Please specify) __________________	01	02	03	99

Q4.

Thinking back over CHILD's last year in Head Start, what are the major ways Head Start could helped CHILD? PROBE: What else?

INTERVIEWERS:

RECORD ANSWERS BELOW. CODE RESPONSES ON PAGE 62 AFTER END OF INTERVIEW.

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

Q5.

What are the major ways you think Head Start has hleped your family.PROBE: Did they help your familyin any other areas besides educating CHILD? What else?

INTERVIEWERS:

RECORD ANSWERS BELOW. CODE RESPONSES ON PAGE 62 AFTER END OF INTERVIEW.

__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

INTERVIEWERS:

CODE VERBATIM RESPONSES FROM Q4 AND Q5 IN GRID BELOW AFTER COMPLETING INTERVIEW.

	Q4	Q5		Q4	Q5
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

Q5a.

If you or your family had a problem or concern, who at Head Start would you turn to for help?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

Family Service Worker	01
Teacher	02
Assistant Teacher	03
Center Director	04
I would not go to anyone at Head Start for help	05
Other (please specify) __________________	06

Q5b.

Have you meet with your Head Start Family Service Worker in the past year?

No	01
Yes	02
I don't know who my Family Service Worker is ...	03	SKIP TO Q6

Q5c.

Has your Family Service Worker helpded your family in any way?

No	01
Yes	02

Q5d.

Have you found having a Family Service Worker to be a useful part of the Head Start Program?

No	01
Yes	02

Q6.

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 S

R: CONFIDENCE RATINGS

COMPLETE AFTER INTERVIEW IS CONCLUDED.

R1.

Interview Completion Code:

Respondent terminated interview prematurely	01
Respondent refused interview	02
Respondent unable to respond (Please specify) ____________________________	03
Interview completed ...	04

R2.

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

Able to understand questions easily	7	6	5	4	3	2	1	Hardly able to understand
Truthful	7	6	5	4	3	2	1	Untruthful
Accurate	7	6	5	4	3	2	1	Inaccurate
Interested in the interview	7	6	5	4	3	2	1	Not interested in the interview
Cooperative	7	6	5	4	3	2	1	Uncooperative
No English language problem	7	6	5	4	3	2	1	Spoke English with great difficulty
Interviewed without interruption	7	6	5	4	3	2	1	Interrupted often
Your opinion about the overall qualityof the data:
High	7	6	5	4	3	2	1	Low

DON'T FORGET TO CODE Q4 AND Q6 ON PAGE 62.

S: 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.

S1.

What is your telephone number? (area code) __ __ __ - __ __ __ - __ __ __ __ SKIP TO S3A

No telephone	01
Refused	98

S2.

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

No telephone	01	SKIP TO S3A
Refused	98	SKIP TO S3A

S3.

Whose telephone is that?

Name: _________________________________
Refused	98

S3a.

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

No beeper or cell phone number		01

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

S4.

Please give me your permanent address ...

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

S5.

Where are you employed? ________________________________________________

Not employed

SKIP TO P7a

S6.

What is your work telephone 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?

S7a

Contact 1 name: __________________________________________________

S7b.

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

S7c.

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

S8a.

Contact 2 name: __________________________________________________

S8b.

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

S8c.

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

S9a

Contact 3 name: __________________________________________________

S9b.

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

S9c.

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

GET RESPONDENT'S SIGNATURE BELOW. REMOVE SECTION S FROM THE INTERVIEW AND PLACE IN ENVELOPE. 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. (new request)
Washington, D.C. 20503

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