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? |
|
|
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. |
|
1. |
Are you the person interviewed last spring
when we conducted the spring 1998 interview? |
|
|
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? |
|
|
2. |
We want to interview the person most responsible for
CHILD’s care. Are you that person? |
|
|
3. |
Who is most responsible for CHILD’s care? |
|
Name: _______________________________ |
Address: _______________________________ |
Phone: _______________________________ |
|
|
|
4. |
What is your relationship to CHILD? |
|
DO
NOT READ LIST. CIRCLE ONE RESPONSE. |
|
|
|
|
Is that birth or adopted? |
|
birth |
19 |
SKIP TO A1 |
|
adopted |
20 |
SKIP TO A1 |
|
|
|
|
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 |
|
|
5. |
Are you CHILD’s legal guardian? |
|
|
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? |
|
|
|
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. |
|
Never |
|
Sometimes |
|
Often |
|
Always |
|
Don't
Know |
Why? |
- CHILD feels safe and secure in Start.
|
01 |
02 |
03 |
04 |
99 |
|
- CHILD gets lots of individual attention.
|
01 |
02 |
03 |
04 |
99 |
|
- CHILD's teacher is open to new information
and learning.
|
01 |
02 |
03 |
04 |
99 |
|
- CHILD has been happy in the program.
|
01 |
02 |
03 |
04 |
99 |
|
- The teacher is warm and affectionate towards
CHILD.
|
01 |
02 |
03 |
04 |
99 |
|
- CHILD is treated with respect by teachers.
|
01 |
02 |
03 |
04 |
99 |
|
- The teacher takes an interest in CHILD.
|
01 |
02 |
03 |
04 |
99 |
|
- CHILD feels accepted by the teacher.
|
01 |
02 |
03 |
04 |
99 |
|
- The teacher is supportive of you as a parent.
|
01 |
02 |
03 |
04 |
99 |
|
- You feel welcomed by the teacher.
|
01 |
02 |
03 |
04 |
99 |
|
- The teacher handles discipline matters easily
without being harsh.
|
01 |
02 |
03 |
04 |
99 |
|
- The teacher seems happy and content.
|
01 |
02 |
03 |
04 |
99 |
|
- The assistant teacher/aide is warm and affectionate
towards CHILD.
|
01 |
02 |
03 |
04 |
99 |
|
|
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? |
|
|
NO |
|
YES |
- Your need for child care
|
01 |
|
02 |
- Your work schedule interferes
|
01 |
|
02 |
- Your school or training schedule interferes
|
01 |
|
02 |
- You need transportation
|
01 |
|
02 |
- You don't know others at Head Start
|
01 |
|
02 |
- You feel uncomfortable at Head Start
|
01 |
|
02 |
- You have health problems that interfere
|
01 |
|
02 |
- CHILD's teacher is uncomfortable with parents
in the classroom
|
01 |
|
02 |
- Head Start doesn't provide enough opportunities
for you to participate
|
01 |
|
02 |
- You have had bad experiences with Head Start
in the past
|
01 |
|
02 |
- You are uncomfortable because of language
or cultural differences
|
01 |
|
02 |
- You have concern for your safety while getting
to Head Start
|
01 |
|
02 |
- You need more support from your spouse or
partner
|
01 |
|
02 |
- Other (Please specify) _______________________________________________________________
|
01 |
|
02 |
|
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. |
|
|
|
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. |
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 |
|
|
|
- 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? |
|
|
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... |
|
|
NO |
|
YES |
|
DK |
- Your local school district?
|
01 |
|
02 |
|
99 |
- State or local health or social service agency?
|
01 |
|
02 |
|
99 |
- Doctor or clinic?
|
01 |
|
02 |
|
99 |
- Head Start?
|
01 |
|
02 |
|
99 |
- Some other source (Please specify)?
|
01 |
|
02 |
|
99 |
|
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? |
|
|
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? |
|
|
F5. |
Can CHILD button (his/her) clothes? |
|
|
F6. |
Does CHILD hold a pencil properly? |
|
|
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? |
|
|
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? |
|
|
F11. |
When CHILD speaks, is (he/she) understandable to a
stranger? |
|
|
F12. |
Did CHILD start speaking later than other children
you know? |
|
|
F13. |
Does CHILD stutter or stammer? |
|
|
F14. |
Does CHILD ever look at a book with pictures and pretend
to read? |
|
|
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? |
|
|
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? |
|
|
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? |
|
|
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? |
|
|
|
IF YOUNGER THAN
25: |
IF OLDER THAN 15: |
J5.
First Name |
J6.
What is NAME's relationship to CHILD?
(See codes below) |
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 |
J10.
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 |
- (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? |
|
|
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? |
|
|
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? |
|
|
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? |
|
|
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? |
|
|
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? |
|
|
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? |
|
|
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? |
|
|
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? |
|
|
No |
|
Yes |
- It is more difficult to find child care
|
01 |
|
02 |
- It is more difficult to pay for child care
|
01 |
|
02 |
- It is more difficult for me to depend on
friends and relatives for support because of their work
or training requirements
|
01 |
|
02 |
- I have to provide more support to my family
and/or friends
|
01 |
|
02 |
- My transportation needs have increased
|
01 |
|
02 |
- I have less time to be involved at Head Start
|
01 |
|
02 |
- My other benefits have been reduced
|
01 |
|
02 |
- Any other (please specify) ________________________________________
|
01 |
|
02 |
- (Do not read) Don't know
|
01 |
|
02 |
- (Do not read) Changes have had no effect
|
01 |
|
02 |
|
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? |
|
|
K16. |
Since last spring have you been homeless or not had
a regular place to live? |
|
|
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? |
|
|
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? |
|
|
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? |
|
|
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? |
|
|
|
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? |
|
|
N10. |
Are you limited in the kind or amount of work you can
do because of any impairment or health problem? |
|
|
N11. |
Does anyone in your household, other than CHILD, have
an illness or condition that requires regular, ongoing care? |
|
|
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? |
|
|
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? |
|
|
N15. |
In the past year, has anyone in your
household had a drinking problem? |
|
|
N16. |
In the past year, has anyone in your
household had a drug problem? |
|
|
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? ____________________________________________________ |
|
|
P4b. |
Did (he/she/they) spend anytime in jail? |
|
|
|
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? ____________________________ |
|
|
P5b. |
With whom? ______________________________ |
|
|
|
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? |
|
|
Q5d. |
Have you found having a Family Service
Worker to be a useful part of the Head Start Program? |
|
|
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 |
01 |
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 |
|