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

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PDF Version, B&W

OMB Approval Number: 0970-0151 Esp 06/2000

RESPONDENT ID ___ ___ ___ ___ ___

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

Head Start Family and Child Experiences Survey

Spring '98 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 '98 Parent Interview

Cover Sheet

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

Head Start Center: _______________________________

City and State: _______________________________

Field Interviewer ID number: ___ ___ ___

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

Site Manager Quality Control Review
__ __ __	__ __/ __ __/ __ __
ID	Date of Review

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

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

Interview location:

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

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

No	01
Yes	02

If so, what language will be used? _______________________________

IF YES: Have Interpreter sign confidentiality form before interview.

Thank you for agreeing to talk with me again. We are continuing to learn more about families in the Head Start Program as well as learn more about the Head Start Program your child attends. We are learning how Head Start provides different kinds of services to children and families. 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 will be 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

Again, thank you for agreeing to talk with me. We interviewed parents in the fall when their children entered the Head Start program and now we are interviewing these same parents in the spring at the end of the program year.

Are you the person interviewed last (MONTH OF FALL INTERVIEW) when we conducted the fall interview?

No	01
Yes	02	SKIP TO A3

1a.

Is that person available?

No	01
Yes	02	End Interview

Reschedule with original respondent

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

No	01
Yes	02	SKIP TO A3

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	19	SKIP TO A1
	adopted	20	SKIP TO A1

Stepmother

SKIP TO A1

Stepfather

SKIP TO A1

Grandmother

Grandfather

Great Grandmother

Great Grandfather

Sister/stepsister

Brother/stepbrother

Other Relative or In-law (Female)

Other Relative or In-law (Male)

Foster Parent (Female)

Foster Parent (Male)

Other Non-relative (Female)

Other Non-relative (Male)

Parent's Partner (Female)

Parent's Partner (Male)

Don't Know/ Didn't Respond

Are you CHILD's legal guardian?

No	01
Yes	02

A. ABOUT YOUR CHILD AND FAMILY

Remember, you may recognize some of the questions I'm going to ask from last fall, 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?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

Never	01	SKIP TO A5
1-5 days	02
6-10 days	03
More than 10 days	04
Don't Know	99

A4.

What is the most frequent reason for CHILD'S missing Head Start?

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

A5.

Including any other children (or grandchildren) who may have been in Head Start, how many years have you been involved with Head Start as a (parent/grandparent/primary caregiver)? Only count the years when child(ren) (was/were) actually enrolled in Head Start.

(Suggested Probe): Is this your first child in Head Start?

__ __ years OR __ __ months

B. SATISFACTION WITH HEAD START
Now I would 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 dissatisfied	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, help with speech and language development	01	02	03	04	99
Identifying and helping to provide services that help your family--or example, public assistance, transportation, or job training	01	02	03	04	99
Maintaining a safe program--for example, 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 A RESPONSE, ASK THE FOLLOW-UP QUESTION, B4.

B4.

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

B3.

B4.

READ LIST.

Never

Some- times

Often

Always

Don't
know

Why?

CHILD feels safe and secure in Head 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 affectionnate 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, or three more times.

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

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.

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
Every day	04

D1a.

Who read to CHILD in the past week?

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. In the past week, have you or someone in your..			D4. How many times?		D5. Who (READ ITEM)? DO NOT READ CHOICES. CIRCLE ALL THAT APPLY.
D3. In the past week, have you or someone in your..			1-2	3+	Mother/Mother Figure	Father/Father figure	Other Household Member	Non-Household Member
	NO	YES
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, the bank, or the store?	01	02	1-2	3+	01	02	03	04
Involved (him/her) in household chores like cooking, cleaning, setting the table, or caring for pets?	01	02	1-2	3+	01	02	03	04
Talked about what happened in Head Start?	01	02	1-2	3+	01	02	03	04
Talked about TV programs or videos?	01	02	1-2	3+	01	02	03	04
Played counting games like singing? songs with numbers or reading books with numbers	01	02	1-2	3+	01	02	03	04

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. In the past month, that is since (MONTH)(DAY), has anyone in your family done the following things with CHILD?			D7. [ASK ONLY AFTER COMPLETING ALL OF D6] Who has (READ ITEM)? [DO NOT READ CHOICES. CIRCLE ALL THAT APPLY. IF NOT MOTHER/ OR FATHER/, CLARIFY IF HOUSEHOLD OR NON-HOUSEHOLD MEMBER]
	NO	YES	Mother/Mother Figure	Father/Father figure	Other Household Member	Non-Household Member
Visited a library?	01	02	01	02	03	04
Gone to a movie?	01	02	01	02	03	04
Gone to a play, concert, or other live show?	01	02	01	02	03	04
Gone to a mall?	01	02	01	02	03	04
Visited an art gallery, museum, or historical site?	01	02	01	02	03	04
Visited a playground, park, or gone on a picnic?	01	02	01	02	03	04
Visited a zoo or aquarium?	01	02	01	02	03	04
Talked with CHILD about (his/her) family history or ethnic heritage?	01	02	01	02	03	04
Attended an event sponsored by a community, ethnic, or religous group?	01	02	01	02	03	04
Attended an athletic or sporting event in which CHILD was not a player?	01	02	01	02	03	04

D8.

Which of the following do you have in your home?

READ LIST.

YES

Children’s books

Comic books

Magazines for children

Magazines for adults like Newsweek or People or Sports Illustrated

Newspapers

Catalogs

Religious books like a bible or prayer book

Dictionaries or encyclopedias

Other books like novels or biographies or non fiction

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 after CHILD enrolled in Head Start?

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?	___________________________________________________
	___________________________________________________
	___________________________________________________	SKIP TO F1

[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 ...

READ LIST. CIRCLE ONE RESPONSE.

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	SKIP TO E7
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 all 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 E7
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...

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	Somewhat or Sometimes 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? ____________________________________________________

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?

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 everenrolled in Head Start orEarly Head Start?

01=No
02=Yes
90=NA
99=Don't Know

J9.

Is NAME employed?

01=No
02=Yes
90=NA
99=DK

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

INTERVIEWER:	IF MOTHER IS RESPONDENT	SKIP TO J18
INTERVIEWER:	IF MOTHER IS NOT RESPONDENT AND NOT IN HOUSEHOLD IN HOUSEHOLD	SKIP TO J11 SKIP TO J16

J11.

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

No	01	SKIP TO J1
Yes	02
Mother is deceased	03	Ask J-14-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
Everyday	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	SKP TO J16
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 28 (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.

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

INTERVIEWER:	IF FATHER IS RESPONDENT	SKIP TO J25
INTERVIEWER:	IF FATHER IS NOT RESPONDENT AND NOT IN HOUSEHOLD IN HOUSEHOLD	SKIP TO J18 SKIP TO J23

J18.

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

No	01	SKIP TO J1
Yes	02
Father is deceased	03	Ask J-21-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
Everyday	05
Don't know	99

REMINDER - IF FATHER IS DECEASED, ASK J21-J22A THEN SKIP TO J25

J21.

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

No	01	SKP 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	01
IF YES: What is his occupation? __________________
Unemployed	02
Looking for Work	03
Laid off	04
In School/training	05
In Jail/prison	06
In Military	07
Something Else (Please specify) __________________	08
Don't Know	99

J25.

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

No	01	SKP 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
Associates 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 (MONTH OF FALL INTERVIEW)?

No	01	SKP TO J29
Yes	02

J28.

What kind of certificate, diploma or degree?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

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

J29.

What language is most frequently spoken in your home?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

English	01
French	02
Spanish	03
Cambodian (Khmer)	04
Chinese	05
Haitian Creole	06
Hmong	07
Japanese	08
Korean	09
Vietnamese	10
Arabic	11
Other (Please specify) ___________________	12

K. EMPLOYMENT AND INCOME
Now, I would like to ask you some questions about the sources of income for your household. 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 K5
Yes	02

K2.

How many jobs do you have currently?

__ jobs

K3.

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

INTERVIEWER:

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

REPEAT K3 AND K4 FOR UP TO THREE JOBS MENTIONED. RECORD IN SPACE BELOW QUESTIONS.

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 DESCRIPT IONS	JOB STATUS
	Seasonal	Full-time	Part-time
__________________________________	01	02	03
__________________________________	01	02	03
__________________________________	01	02	03

K5.

In how many of the last six 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 FoodProgram 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

COMPLETE TABLE (a - l). IF K9a AND K9c and K9d ARE all NO, THEN SKIP TO K11

K10.

To continue to receive welfare or public assistance, are you required to ...

	NO	YES	NA
Attend job training?	01	02	03
Attend school or a GED class?	01	02	03
Get a job?	01	02	03
Do something else? (Please specify) _____________________	01	02	03

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

K.10a.

How have these changes or requirements affected your life now?

DO NOT READ LIST. CIRCLE ALL THAT APPLY.

Changes have no effect	01
More difficult to find child care	02
More difficult to obtain subsidies to help pay for child care	03
Friends or relatives depended on for support are not available
because of their work or training requirements	04
Need to provide more support to family and/or friends	05
Transportation needs have increased	06
Reduced time for involvement in Head Start	07
A reduction in other benefits	08
Other (Please specify)	09
Don't know	99

K10b.

How has Head Start been a help or a problem for you as you deal with these changes?

DO NOT READ LIST. CIRCLE ALL THAT APPLY.

Helped me understand about the welfare reform requirements	01
Helped with child care	02
Helped get needed education or training	03
Helped find a job	04
Helped get transportation	05
Required too much participation	06
Required participation at inconvenient times	07
Head Start had done nothing	08
Head Start does not understand welfare reform requirements	09
Head Start sessions are not long enough	10
Other (Please specify )	12
Don't know	99

K11.

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

PROBE:

Your best guess would be fine.


FAMILY		$\|__\|, \|__\| \|__\| \|__\| SKIP TO K13
Refused	98	SKIP TO K13
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 of your own	01	SKIP TO K14
A house, apartment, or trailer that you share	02	SKIP TO K14
Transitional housing	03	SKIP TO K14
A homeless shelter	04	SKIP TO K14
Or someplace else? (Please specify)	05	SKIP TO K14

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 six months? ___ ___ times moved

K15.

Do you currently live in public or subsidized housing?

No	01
Yes	02

K16.

Since (MONTH OF LAST INTERVIEW) 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, 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

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 September.

FOR EACH ITEM, READ QUESTION ALONG THE TOP. IF (L2) IS YES ASK L3, IF (L3) IS YES ASK L4. MOVE ON TO NEXT ITEM.

INCOME ASSISTANCE
		L2. Since September, have you or anyone in your household needed ...		L3. 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, got service on my own 04=Yes, referred to service 05=Yes, provided service directly
		No	Yes	No	Yes
a.	Income assistance--like welfare, SSI, unemployment insurance	01	02	01	02
b.	Food and nutrition assistance-- like Food Stamps or WIC	01	02	01	02
c.	Help with housing	01	02	01	02
d.	Help with utilities (running water, hot water, heat, telephone service)	01	02	01	02
EMPLOYMENT ASSISTANCE
e.	Job training and employment assistance	01	02	01	02
f.	Education assistance -- for example, GED, college, learning to read, English as a second language	01	02	01	02
g.	Help getting transportation to a job or training	01	02	01	02
h.	Child care for CHILD before or after the Head Start day	01	02	01	02
i.	Child care for other children in the household	01	02	01	02
HEALTH CARE
j.	MEDICAID/local name for MEDICAID	01	02	01	02
k.	Medical or dental care for CHILD	01	02	01	02
l.	Medical or dental care for adults	01	02	01	02
m.	Alcohol or drug abuse treatment or counseling	01	02	01	02
n.	Mental health services	01	02	01	02
SOCIAL SERVICES
o.	Legal aid	01	02	01	02
p.	Help dealing with family violence	01	02	01	02
q.	Help in solving other family problems	01		01

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.

MI.

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
a.	Do you pay for it yourself?	01	02
b.	Does a government agency pay?	01	02
c.	Does an employer pay?	01	02
d.	Does someone else pay?	01	02
e.	Do you trade child care with someone else?	01	02
f.	Is it free or no charge? (PROBE for other categories)	01	02
g.	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
a.	CHILD feels safe and secure in care.	01	02	03	04	99
b.	CHILD gets lots of individual attention.	01	02	03	04	99
c.	CHILD'S caregiver is open to new information and learning.	01	02	03	04	99

N. FAMILY HEALTH CARE

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	04
Poor	05

N2.

Since (MONTH OF LAST INTERVIEW), has CHILD had an illness or condition that requires regular, ongoing care?

No	01
Yes	02
Don't Know	99

N3.

Where does CHILD 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
Yes	01	SKIP TO N6

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
a.	Tooth brushing	01	02
b.	Washing hands before meals	01	02
c.	Washing hands after using toilet	01	02
d.	Eating nutritious and healthful foods	01	02
e.	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	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?

READ LIST. CIRCLE ONE RESPONSE.

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
a.	Exercising more regularly	01	02
b.	Eating more nutritious or healthful food	01	02
c.	Brushing your teeth more regularly	01	02
d.	Using seat belts more regularly	01	02
e.	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...

READ LIST. CIRCLE ONE RESPONSE FOR EACH.

		Never	Sometimes	Most of the time	Always	NA	Don't Know
a.	Use a safety seat or seat belt for CHILD when in the car	01	02	03	04	05	99
b.	Keep medicines in childproof bottles and out of children's reach	01	02	03	04	05	99
c.	Have at least one operating smoke detector in your home with a working battery	01	02	03	04	05	99
d.	Keep cleaning materials out of reach of children and/or in locked cabinets	01	02	03	04	05	99
e.	Have a first-aid kit at home	01	02	03	04	05	99
f.	Keep the poison control center number and other emergency numbers by the telephone	01	02	03	04	05	99
g.	Supervise CHILD when crossing the street or riding tricycles/bicycles near traffic	01	02	03	04	05	99
h.	Keep matches and cigarette lighters out of CHILD's reach	01	02	03	04	05	99
i.	Supervise CHILD when (he/she) is in the bathtub	01	02	03	04	05	99
j.	Keep firearms under lock and key	01	02	03	04	05	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 (MONTH OF LAST INTERVIEW).

READ LIST. CIRCLE ONE RESPONSE FOR EACH.

		Never	Once	More than once	Refused
a.	I saw non-violent crimes take place in my neighborhood -- for example, selling drugs or stealing.	01	02	03	98
b.	I heard or saw violent crime take place in my neighborhood.	01	02	03	98
c.	I know someone who was victim of a violent crime in my neighborhood.	01	02	03	98
d.	I was a victim of violent crime in my neighborhood.	01	02	03	98
e.	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 (MONTH OF LAST INTERVIEW)?

No	01
Yes	02
Refused	98
Don't know	99

P2b.

Has CHILD been a witness to domestic violence since (MONTH OF LAST INTERVIEW)?

No	01
Yes	02
Refused	98
Don't know	99

P3a.

Has CHILD been the victim of a violent crime since (MONTH OF LAST INTERVIEW)?

No	01
Yes	02
Refused	98
Don't know	99

P3b.

Has CHILD been the victim of domestic violence since (MONTH OF LAST INTERVIEW)?

No	01
Yes	02
Refused	98
Don't know	99

P4.

Since (MONTH OF LAST INTERVIEW) have you, another household member (or a non-household biological parent) been arrested or charged with any crime by the police?

No	SKIP TO P5
Yes	02
Refused	98 SKIP TO P5

P4a.

Who was arrested or charged?

Refused ...................98 SKIP TO P5

P4b.

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

No	01
Yes	02
Refused	98

P5.

Since (MONTH OF LAST INTERVIEW) has CHILD lived apart from you (or mother) not including vacations or shared custody arrangements?

No	SKIP TO Q1
Yes	02
Refused	98 SKIP TO Q1

P5a.

For how long? __________________________________________________

Refused ........ 98

P5b.

With whom? _____________________________________________________

Refused ........ 98

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
a.	There is really no way I can solve some of the problems I have.	01	02	03	04
b.	Sometimes I feel that I'm being pushed around in life.	01	02	03	04
c.	I have little control over the things that happen to me.	01	02	03	04
d.	I can do just about anything I really set my mind to do.	01	02	03	04
e.	I often feel helpless in dealing with the problems of life.	01	02	03	04
f.	What happens to me in the future depends mostly on me.	01	02	03	04
g.	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)
a.	Bothered by things that usually don't bother you	01	02	03	04
b.	You did not feel like eating; your appetite was poor	01	02	03	04
c.	That you could not shake off the blues, even with help from your family and friends	01	02	03	04
d.	You had trouble keeping your mind on what you were doing	01	02	03	04
e.	Depressed	01	02	03	04
f.	That everything you did was an effort	01	02	03	04
g.	Fearful	01	02	03	04
h.	Your sleep was restless	01	02	03	04
i.	You talked less than usual	01	02	03	04
j.	Lonely	01	02	03	04
k.	Sad	01	02	03	04
l.	ou 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, sometimes helpful, generally helpful, very helpful, or extremely helpful?

READ LIST. CIRCLE ONE RESPONSE FOR EACH.

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

Q4.

Thinking back over CHILD’S last year in Head Start, what are the major ways Head Start has 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

ATTENTION:

NEW RESPONDENT........... GO TO SUPPLEMENT

OTHERWISE, CONTINUE WITH NEXT PAGE

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	Print Child's 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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