ACF OPRE: Early Head Start Research and Evaluation Project (EHSRE)

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OMB No.: 0970-0143

Expiration Date: 8/31/2000

EARLY HEAD START PARENT INTERVIEW

FOR PARENTS OF 3-YEAR-OLD CHILDREN

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Table of Contents

Public reporting burden for this collection of information is estimated to average 2 hours per response for the interview and assessments, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to ACF Reports Clearance Officer, Paperwork Reduction Project (OMB# 0970-0143), Administration for Children and Families, Office of Information Services, 370 L’Enfant Promenade, S.W., Washington, DC 20447. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The OMB number for this project is 0970-0143.

MPR ID #:

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DATA COLLECTOR ID #:

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DATE:

\|___\|___\| /	\|___\|___\| / 19	\|___\|___\|
MONTH	DAY	YEAR

TIME START:

|___|___| : |___|___| AM/PM

TIME END:

|___|___| : |___|___| AM/PM

Final Disposition Code: |___|___|

Conducted for
Mathematica Policy Research, Inc.
P.O. Box 2393 Princeton, NJ 08543-2393
and
Administration on Children, Youth, and Families
U.S. Department of Health and Human Services

Items 1.1 A-W and 1.2. PSI. Abidin, Richard R. Parenting Stress Index, Third Edition: Professional Manual. Odessa, FL: Psychological Assessment Resources, Inc., 1995. “Adapted and reproduced by special permission of the Publisher, Psychological Assessment Resources, Inc., Odessa, FL 33556, from the Parenting Stress Index by Richard R. Abiding, Ed.D., Copyright 1990 by PAR, Inc. Further reproduction is prohibited without permission from PAR, Inc.”

Items 3.5 A-E. FES. Reproduced by special permission of the Publisher, Mind Garden, Inc., www.mindgarden.com from the Family Environment Scale by Rudolf H. Moos and Bernice S. Moos. Copyright 1974, 1994, and 2002 by Rudolf Moos. All rights reserved. Further reproduction is prohibited without the Publisher’s written consent.

Items 4.16 A-J. PRS. Parent-Caregiver Relationship Scale. Copyright James Elicker, Illene C. Noppe, and Lloyd D. Noppe, 1996.

Items various, starting at 5.7. HOME. Caldwell, Bettye M., and Robert H. Bradley.
Administration Manual: Home Observation for Measurement of the Environment. Little Rock, AR: University of Arkansas at Little Rock, 2003.

Items 9.1 A-MM. CBC. Achenbach System of Empirically-Based Assessment, Child Behavior Checklist. Achenbach, Thomas M. and Leslie A. Rescorla. Manual for the ASEBA Preschool Forms and Profiles. Burlington, VT: University of Vermont Department of Psychiatry, 2000.

INTERVIEWER:

PLEASE NOTE: IN QUESTIONS THAT REFER TO THE PARENT/MOTHER OF THE FOCUS CHILD, WE MEAN “THE PERSON FUNCTIONING IN THAT ROLE WHO IS THE RESPONDENT.” THIS COULD BE THE MOTHER, FATHER, GRANDMOTHER OR SOME OTHER RELATIVE. PLEASE ADAPT THE SPECIFIC QUESTION LANGUAGE AS NECESSARY.

INTRODUCTION

Hello. Thank you for agreeing to talk with us (again). As I mentioned (on the phone/when we made the appointment), the entire visit will take about 2 hours. The visit has three parts. (Just as we did last time.) I will need to spend about a half hour with (CHILD), letting (him/her) show me some of the things (he/she) has been learning. Next, I will take out different toys for (CHILD) to play with while I videotape you and (him/her) together. While you, (CHILD) and I are working together, it would be best if we were not interrupted. Finally, I will be asking you some questions about (CHILD) and your family routines. (Many of these questions are the same or similar to questions we asked you when [CHILD] was 2 years old.) As we go along, I will be telling you what we need you to do. And please, if you have any questions, feel free to ask them!

If at any time you need to take a break to take care of (CHILD) (or your other children), please let me know.

All the information you give me is confidential. Neither your name nor (CHILD)’s will be attached to any of the information you give us. If there is ever anything you are not comfortable talking about or doing, please let me know and we will skip that part.

Is this a good time for (CHILD)? We can start with (his/her) activities or with the interview if you think (he/she) isn’t at (his/her) best right now.

IS THIS A GOOD TIME FOR CHILD?

YES	01		GO TO SECTION 0
NO	00		START INTERVIEW, RETURN TO SECTION 0 WHEN CHILD IS READY

SECTION 0

CHILD ASSESSMENT AND VIDEOTAPE

INTERVIEWER: WHEN ARE YOU DOING THE BAYLEY?

AT START OF VISIT	01
AFTER START OF QUESTIONNAIRE	00		Which section?

INTRODUCTION TO THE BAYLEY:

0.1

Now I would like to give (CHILD) a chance to show us some of the skills (he/she) has been learning. These activities are designed to be fun for children and we think (he/she) will enjoy most of them.

I will need a few minutes to get my materials set up. Would you please see if (CHILD) needs anything such as (changing/a bathroom break) or a snack so that (he/she) will be comfortable. (Also, we need to make sure that the other children let (CHILD) do these tasks by (him/her)self).

0.2

All the toys we will use are non-toxic, clean and safe, and have been thoroughly washed. We don’t expect (CHILD) to be able to do all the tasks. They are designed for a wide range of children. Please don’t try and help (him/her) out.

WHEN YOU DO THE BAYLEY, IF POSSIBLE, HAVE THE PARENT COMPLETE THE SELF ADMINISTERED QUESTIONNAIRE. QUESTIONS IN THE SAQ ARE 1.1, 1.2, 1.3, 7.1-7.3, 9.1 AND 10.1-10.5.

PROCEED WITH BAYLEY BOOKLET.

WHEN CHILD HAS HAD A BREAK, ADMINISTER THE PPVT-111.

SECTION 1

RAISING A CHILD

1.0

INTERVIEWER: DID PARENT COMPLETE THE SELF-ADMINISTERED
VERSION OF THESE QUESTIONS (SAQ 1)?

YES	01		GO TO SECTION 2
NO	00		CONTINUE

1.1

ITEMS DELETED FROM THIS VERSION TO PROTECT
AUTHOR/PUBLISHER COPYRIGHT. SEE PAGE ii FOR FULL CITATION.

1.2

ITEMS DELETED FROM THIS VERSION TO PROTECT
AUTHOR/PUBLISHER COPYRIGHT. SEE PAGE ii FOR FULL CITATION.

1.3

ITEMS DELETED FROM THIS VERSION.

SECTION 2

CHILD'S HEALTH

(The next/my first) questions are about (CHILD)’s health.

2.1

Overall, since (THIS MONTH) of last year, would you say (CHILD)'s health has been . . .
PROBE: In the last 12 months.

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

2.2

Since (his/her) second birthday, how many different times has (CHILD) stayed in a hospital for at least one night?

|___ |___| TIMES

NONE

GO TO Q2.3

Altogether, since (his/her) second birthday, how many nights did (CHILD) stay in a hospital?

|___ |___|___| NIGHTS

(Was this/Were any of these) hospitalization(s) because of an accident or injury?

YES	01
NO	00		GO TO D

1) How many of these hospitalizations were because of an accident or injury?

|___ |___| NUMBER OF HOSPITALIZATIONS

2) How many nights did (CHILD) stay in the hospital because of an accident or injury?

|___ |___| NUMBER OF NIGHTS

CODE WITHOUT ASKING IF ONLY ONE HOSPITALIZATION:
How many of the (NUMBER IN Q2.2A) hospitalizations were because of . . .

1) Dehydration/diarrhea?	\|___\|___\|___\| TIMES
2) Asthma/Pneumonia/acute respiratory infection/bronchitis/breathing problems?	\|___\|___\|___\| TIMES
3) Surgery or an operation (SPECIFY)	\|___\|___\|___\| TIMES
_____________________________________________	\|___\|___\|
4) High fever of unknown cause?	\|___\|___\|___\| TIMES
5) Something else? (SPECIFY)	\|___\|___\|___\| TIMES
_____________________________________________	\|___\|___\|

2.3

INTERVIEWER CODE: FAMILY LIVES:

IN AN APARTMENT

A. WHAT FLOOR?
|__|__| FLOOR

IN A HOUSE

PUBLIC SHELTER

2.4-2.8

NO QUESTIONS 2.4-2.8 IN THIS VERSION.

2.9

How often does (CHILD) ride in a private car? Would you say . . .

	CIRCLE ONE
Every day,	01
A few times a week,	02
A few times a month, or	03
Never?	04	GO TO Q3.1

When you take (CHILD) in a car, do you usually put (him/her) in a car seat, booster seat, in the regular seat with a seatbelt on, or does (he/she) just sit in the car?

	CIRCLE ONE
CAR SEAT	01
BOOSTER SEAT	02
REGULAR SEATBELT	03
PARENT'S LAP	04
NO RESTRAINT	05

When you take (CHILD) in a car, does (he/she) usually sit in the front seat or back seat?

	CIRCLE ONE
FRONT	01
BACK	02
VARIES	03

SECTION 3

HOUSEHOLD COMPOSITION

3.1

Not including you and (CHILD), how many other people lived in this (house/apartment) with you last month?

PROBE: In the last 30 days.

|___ |___|

NO ONE ELSE--ONLY SELF AND (CHILD)

GO TO Q4.1

3.2

Are any of these people (your/MOTHER’S) spouse or partner?

YES	01
NO	00

3.3

How (are these people/is this person) related to (CHILD)?

CIRCLE CODE THEN RECORD NUMBER OF PEOPLE IN BOXES.

	CIRCLE ALL THAT APPLY
FATHER	01	\|___\|___\|
STEPPARENT	02	\|___\|___\|
AUNT, UNCLE, GREAT-AUNT OR GREAT-UNCLE	03	\|___\|___\|
GRANDPARENT OR GREAT GRANDPARENT	04	\|___\|___\|
SIBLING (BROTHER OR SISTER)	05	\|___\|___\|
STEPBROTHER OR STEPSISTER	06	\|___\|___\|
NEPHEW OR NIECE	07	\|___\|___\|
COUSIN	08	\|___\|___\|
OTHER RELATIVE OR IN-LAW	09	\|___\|___\|
NON-RELATIVE ADULT (INCLUDE MOTHER’S PARTNER, BOYFRIEND)	10	\|___\|___\|
NON-RELATIVE CHILD	11	\|___\|___\|
OTHER (SPECIFY)	12	\|___\|___\|
__________________________________________________________________		\|___\|___\|
MOTHER	13	\|___\|___\|
FOSTER MOTHER	14	\|___\|___\|
FOSTER PARENT	15	\|___\|___\|
TOTAL SHOULD EQUAL NUMBER IN Q3.1

3.4

INT ERVIEWER: CHECK Q3.1, PAGE 9. DO MOTHER AND CHILD LIVE WITH ANYONE ELSE?

YES	01
NO	00		GO TO Q4.1

3.5

I’m going to read you some statements about how the people who live with you get along and settle arguments. For each statement, please tell me if you strongly agree, mildly agree, mildly disagree, or strongly disagree with it for your household.

(READ ITEM) Do you strongly agree, mildly agree, mildly disagree, or strongly disagree with this?

CODE ONLY ONE RESPONSE FOR EACH STATEMENT.

		STRONGLY AGREE	MILDLY AGREE	MILDLY DISAGREE	STRONGLY DISAGREE
A.	We fight a lot	04	03	02	01
B.	We hardly ever lose our tempers	04	03	02	01
C.	We sometimes get so angry we throw things	04	03	02	01
D.	We often criticize each other	04	03	02	01
E.	We sometimes hit each other	04	03	02	01

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EARLY HEAD START PARENT INTERVIEW

FOR PARENTS OF 3-YEAR-OLD CHILDREN

SECTION 0 CHILD ASSESSMENT AND VIDEOTAPE

SECTION 1 RAISING A CHILD

SECTION 2 CHILD'S HEALTH

SECTION 3 HOUSEHOLD COMPOSITION

SECTION 0

CHILD ASSESSMENT AND VIDEOTAPE

SECTION 1

RAISING A CHILD

SECTION 2

CHILD'S HEALTH

SECTION 3

HOUSEHOLD COMPOSITION