| IN1. |
Hello, I’m (NAME) and I’m
(calling) from (LOCAL RESEARCH INSTITUTION). May I please speak with
SAMPLE MEMBER/NAME ON CONTACT SHEET? SAMPLE
MEMBER AVAILABLE . . . . . 1
SAMPLE MEMBER NOT
AVAILABLE . . . . . . . . . . . . . . . . . . . . . 0 3 GO
TO IN3 (PAGE 2) |
| |
|
| IN2. |
Recently we sent you a letter about the study
(LOCAL RESEARCH
INSTITUTION) is doing with the U.S. Department of Health and
Human Services to learn more about the needs and experiences
of (parents/guardians) of young children. When you applied to
Early Head Start, you were told that you would be called about
this study a few times over the next few years and you agreed
to help us. ([TIME] ago you were interviewed about some of the
services you use and assistance you need.)
14 MONTH INTERVIEW: This part of the study
focuses on you and FOCUS CHILD. We would like to visit your
home, interview you, and spend some time with FOCUS CHILD, allowing
(him/her) to show us all the things (he/she) has been learning.
We would also like to videotape you and FOCUS CHILD doing some
activities together.
24, 36 MONTH INTERVIEW ONLY: You
may remember that we visited you and FOCUS CHILD at home when (he/she)
was about 14 months old. We interviewed you and did some activities
with FOCUS CHILD, allowing (him/her) to show us all the things (he/she)
learned. We also videotaped you and FOCUS CHILD doing some activities
together. We would like to visit you at home again and do a similar
set of activities.
Your participation is voluntary. The visit will take
between 2.5 and 3.5 hours to complete and we will give you (LOCAL
INCENTIVE) for completing the interview. Do you have any questions? |
| |
|
| IN3. |
INTERVIEWER, CODE IF KNOWN,
OTHERWISE, READ: Does SAMPLE MEMBER/NAME ON CONTACT SHEET
live here?
| YES |
1 |
| NO . |
0 |
| DON'T KNOW |
8 |
|
| |
|
| |
A. |
INTERVIEWER, CODE IF KNOWN, OTHERWISE,
READ: Does FOCUS CHILD still live with (you/SAMPLE MEMBER/NAME
ON CONTACT SHEET)? |
| |
|
|
| |
B. |
INTERVIEWER, CODE WITHOUT ASKING: |
| |
|
| BOTH SAMPLE MEMBER AND FOCUS CHILD LIVING THERE |
1 |
 |
GO TO C |
| SAMPLE MEMBER NOT LIVING THERE, CHILD IS |
2 |
|
READ IN4 (PAGE 4) |
| SAMPLE MEMBER IS LIVING THERE, CHILD IS NOT |
3 |
|
READ IN5 (PAGE 4) |
| CHILD IN FOSTER CARE |
4 |
|
GO TO IN10 (PAGE 6) |
| GIVEN UP FOR ADOPTION |
5 |
|
GO TO ENDING 2 (PAGE 11) |
| NEITHER SAMPLE MEMBER NOR CHILD LIVES THERE |
6 |
|
GO TO IN17 (PAGE 8) |
| CHILD DECEASED |
7 |
|
READ E AND F (PAGE 3) |
| DON’T KNOW IF SAMPLE MEMBER OR FOCUS CHILD
LIVES THERE |
8 |
|
ASK TO SPEAK TO
SOMEONE ELSE |
|
| |
|
|
| |
C. |
INTERVIEWER: CODE WITHOUT ASKING, OR
ASK: IS NOW A GOOD
TIME TO TALK TO SAMPLE MEMBER?
| YES |
1 |
|
GO TO IN4 (PAGE 4) |
| NO |
0 |
|
|
|
| |
|
|
| |
D. |
When would be a good time to (call back/return) to
talk with SAMPLE MEMBER/NAME ON CONTACT SHEET?
PROBE: We are conducting a survey of (parents/guardians)
of young children.
INTERVIEWER: RECORD DATE AND TIME FOR CALL
BACK/RETURN
VISIT ON CONTACT SHEET.
Thank you for your time. I will (call back/return)
when SAMPLE MEMBER/NAME ON CONTACT SHEET is available. |
| |
|
|
| |
|
|
| |
|
|
| |
|
READ IF CHILD IS DECEASED: |
| |
E |
I am sorry to hear that. Please tell me what
was the date of FOCUS CHILD’s death?
| |
|___|___| / |
|___|___| / 19 |
|___|___| |
| |
MONTH |
DAY |
YEAR |
|
| |
|
|
| |
F. |
What was the cause of FOCUS CHILD’s death?
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________ |
|
| |
|
|
| |
|
|
| |
|
|
| IN4. |
|
Are you the person who lives with FOCUS CHILD and
has primary responsibility for (her/his) care; (are you/who is)
the person who makes decisions about FOCUS CHILD’s care, including
(her/his) daily routine, health care, and child care?
| PROBE: |
Who is the person who has primary
responsibility for caring for FOCUS CHILD? |
| |
YES |
1 |
|
GO TO IN16 (PAGE 8) |
| NO |
0 |
|
|
|
| |
|
|
| IN5. |
|
Is FOCUS CHILD living separately from (you/[his/her]
mother) permanently or just for a few days or weeks?
| PROBE: |
Who is the person who has primary
responsibility for caring for FOCUS CHILD? |
| |
PERMANENTLY |
1 |
|
GO TO IN16 |
| SHORT TIME |
2 |
|
GO TO SCHEDULING A, (PAGE 11) |
|
| |
|
|
| IN6. |
|
Who currently has primary responsibility for caring
for FOCUS CHILD?
PROBE: This would be the person who makes
decisions about FOCUS CHILD’s care, including (his/her)
daily routine, health care, and child care.
CAREGIVER’S FULL NAME: _________________________________________________
| CHILD GIVEN UP FOR ADOPTION |
7 |
|
GO TO ENDING 2 (PAGE 11) |
| DON’T KNOW |
8 |
|
GO TO IN17 (PAGE 8) |
|
| |
|
|
| IN7. |
|
What is CAREGIVER’s address?
| STREET: |
|
| APT. NUMBER: |
|
| CITY: |
|
| STATE:_______ ZIP CODE: _______ |
|
| DON'T KNOW |
8 |
| REFUSED |
9 |
|
| |
|
|
| IN8. |
|
What is CAREGIVER’s telephone number?
| TELEPHONE NUMBER: |
|
| NO TELEPHONE |
7 |
| DON'T KNOW |
8 |
| REFUSED |
9 |
|
| |
|
|
| IN9. |
|
What is CAREGIVER’s relationship to FOCUS
CHILD?
| PARENT |
1 |
 |
|
GO TO IN14
(PAGE 7) |
| GRANDPARENT |
2 |
| AUNT OR UNCLE |
3 |
| COUSIN |
4 |
| BROTHER OR SISTER |
5 |
| OTHER RELATIVE (SPECIFY) |
6 |
|
|
|
| FOSTER PARENT |
7 |
|
|
GO
TO IN10 (PAGE 6) |
| ADOPTIVE PARENT |
8 |
|
GO TO ENDING 2 (PAGE 11) |
| OTHER NONRELATIVE |
98 |
|
GO TO IN14 (PAGE 7) |
| CHILD DECEASED |
99 |
|
READ
A AND B (PAGE 6) |
|
| |
|
|
| |
A. |
I am sorry to hear that. Please tell me what
was the date of the child’s death?
| |
|___|___| / |
|___|___| / 19 |
|___|___| |
| |
MONTH |
DAY |
YEAR |
|
| |
|
|
| |
B. |
What was the cause of FOCUS CHILD’s death?
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________ |
|
| |
|
|
| |
|
|
| |
|
|
| IN10. |
|
What is the name of the agency that placed FOCUS
CHILD with his/her foster parents?
| |
|
| INTERVIEWER: |
BE SURE TO GET THE COMPLETE NAME. IF
THE
PERSON GIVES YOU AN ACRONYM (SUCH AS DYFS FOR DEPARTMENT OF
YOUTH AND FAMILY SERVICES), OBTAIN THE ENTIRE NAME. |
| NAME OF AGENCY: _______________________________________________________ |
|
| |
|
|
| IN11. |
|
What is the name of the FOCUS CHILD’s case
worker? FULL NAME OF CASE WORKER: ____________________________________________ |
| |
|
|
| IN12. |
|
Do you have a telephone number where I can reach CASE
WORKER? |
| |
|
| TELEPHONE NUMBER: |
|
| DON'T KNOW |
8 |
| REFUSED |
9 |
|
| |
|
|
| IN13. |
|
Do you have the address for NAME OF AGENCY? |
| |
|
| STREET: |
|
| APT. NUMBER: |
|
| CITY: |
|
| STATE:_______ ZIP CODE: _______ |
|
| DON'T KNOW |
8 |
| REFUSED |
9 |
|
| |
|
|
| IN14. |
|
When did (you/SAMPLE MEMBER) stop having responsibility
for FOCUS CHILD? |
| |
|
| |
|___|___| / |
|___|___| / 19 |
|___|___| |
| |
MONTH |
DAY |
YEAR |
|
| |
|
|
| IN15. |
|
Why did (you/SAMPLE MEMBER) give up primary responsibility
for FOCUS CHILD? RECORD VERBATIM THEN CIRCLE ALL THAT APPLY. |
| |
|
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________ |
|
| |
|
|
| |
|
|
| |
|
| PARENT'S HEALTH |
1 |
| DRUG USE |
2 |
| ALCOHOL USE |
3 |
| COULDN'T AFFORD CHILD |
4 |
| STATE MANDATED |
5 |
| DIDN'T WANT TO RAISE CHILD |
6 |
|
| |
|
|
| |
A. |
INTERVIEWER: NEW CAREGIVER IS . . . |
| |
|
AGENCY (CHECK IN10)GO
TO ENDING 1 (PAGE 11)
KNOWN INDIVIDUAL - YOU ARE TALKING TOGO
TO IN16 (PAGE 8)
KNOWN INDIVIDUAL - YOU NEED TO CONTACTGO
TO ENDING 1 (PAGE 11) |
| |
|
|
| IN16. |
|
INTERVIEWER: IF CAREGIVER IS NOT THE
PERSON ON CONTACT SHEET, READ: Recently we sent SAMPLE MEMBER/NAME
ON CONTACT SHEET a letter about a study LOCAL RESEARCH INSTITUTION
is doing with the U.S. Department of Health and Human Services. The
purpose of the study is to learn more about the needs and experiences
of (parents/guardians) of young children. When SAMPLE MEMBER/NAME
ON CONTACT SHEET applied to Early Head Start (she/he) agreed to help
us with this study. Since you are the person responsible for FOCUS
CHILD, we would like to talk to you about the study and interview
you about FOCUS CHILD. We would also like to videotape you and FOCUS
CHILD playing together. Your participation
is voluntary. The visit will take between 2.5 and 3.5 hours to complete
and we will give you (LOCAL INCENTIVE) for completing the interview.
Do you have any questions? |
| |
|
|
| |
|
| GO
TO SCHEDULING B (PAGE 11) |
|
| |
|
|
| IN17. |
|
Do you know anyone who would know where to find SAMPLE
MEMBER and/or FOCUS CHILD or someone who knows where to find them?
SAMPLE MEMBER agreed to be part of a research study and it is important
for us to talk to (him/her) or the person who has FOCUS CHILD. |
| |
|
|
| |
|
|
| |
|
| YES, SAMPLE MEMBER |
1 |
|
GO
TO IN18 (PAGE 9) |
| YES, FOCUS CHILD |
2 |
|
GO
TO IN19 (PAGE 10) |
| NO |
0 |
|
GO
TO ENDING 1 (PAGE 11) |
|
| |
|
|
| IF PERSON KNOWS HOW TO FIND SAMPLE
MEMBER: |
| |
| IN18. |
|
Do you have an address where I can contact SAMPLE MEMBER
or someone who would know where (he/she) is? |
| |
|
| YES |
1 |
|
RECORD BELOW IN A |
| NO |
0 |
|
READ B |
|
| |
|
|
| |
A. |
| INTERVIEWER: |
RECORD COMPLETE ADDRESS; INCLUDE
APARTMENT NUMBER; RECORD STREET ADDRESS IN ADDITION TO MAILING
ADDRESS IF DIFFERENT. IF PERSON WHO KNOWS SAMPLE MEMBER, BE
SURE TO RECORD FULL NAME. |
|
| |
|
|
| |
|
| MAILING ADDRESS |
STREET ADDRESS |
| NAME: ___________________________________________ |
| _________________________ |
_________________________ |
| _________________________ |
_________________________ |
| _________________________ |
_________________________ |
| _________________________ |
_________________________ |
|
| |
|
|
| |
B. |
Do you have a telephone number where I can reach SAMPLE
MEMBER or someone who knows where (he/she) is? |
| |
|
| |
YES |
1 |
|
RECORD BELOW |
| |
NO |
0 |
|
GO TO IN19 (PAGE 10) |
|
| |
|
|
| |
C. |
| INTERVIEWER: |
RECORD ANY POSSIBLE TELEPHONE NUMBERS
WHERE SAMPLE MEMBER CAN BE LOCATED. RECORD AREA CODE. |
|
| |
|
| |
(_______)- |
________- |
________________ |
| |
(_______)- |
________- |
________________ |
| |
(_______)- |
________- |
________________ |
|
| |
|
|
| IF PERSON KNOWS HOW TO FIND FOCUS
CHILD: |
| |
|
|
| IN19. |
|
Do you have the address where I can find FOCUS CHILD
or someone who knows where (he/she) is? |
| |
|
| |
YES |
1 |
|
RECORD BELOW IN A |
| |
NO |
0 |
|
READ B |
|
| |
|
|
| |
A. |
| INTERVIEWER: |
RECORD COMPLETE ADDRESS; INCLUDE
APARTMENT NUMBER; RECORD STREET ADDRESS IN ADDITION TO MAILING
ADDRESS IF DIFFERENT. IF PERSON WHO KNOWS FOCUS CHILD, BE SURE
TO RECORD FULL NAME. |
|
| |
|
|
| |
|
| MAILING ADDRESS |
STREET ADDRESS |
| NAME: ___________________________________________ |
| _________________________ |
_________________________ |
| _________________________ |
_________________________ |
| _________________________ |
_________________________ |
| _________________________ |
_________________________ |
|
| |
|
|
| |
B. |
| |
YES |
1 |
|
RECORD BELOW IN C |
| |
NO |
0
|
|
GO TO ENDING 2 (PAGE 11) |
|
| |
|
|
| |
C. |
| INTERVIEWER: |
RECORD ANY POSSIBLE TELEPHONE NUMBERS
WHERE FOCUS CHILD CAN BE REACHED. RECORD AREA CODE. |
|
| |
|
| |
(_______)- |
________- |
________________ |
| |
(_______)- |
________- |
________________ |
| |
(_______)- |
________- |
________________ |
|
| |
|
|
| IF PERSON KNOWS HOW TO FIND FOCUS
CHILD: |
| |
| IN19. |
|
Do you have an address where I can contact FOCUS CHILD
or someone who would know where (he/she) is? |
| |
|
| YES |
1 |
|
RECORD BELOW IN A |
| NO |
0 |
|
READ B |
|
| |
|
|
| |
A. |
| INTERVIEWER: |
RECORD COMPLETE ADDRESS; INCLUDE APARTMENT
NUMBER; RECORD STREET ADDRESS IN ADDITION TO MAILING ADDRESS
IF DIFFERENT. IF PERSON WHO KNOWS SAMPLE MEMBER, BE SURE TO
RECORD FULL NAME. |
|
| |
|
|
| |
|
| MAILING ADDRESS |
STREET ADDRESS |
| NAME: ___________________________________________ |
| _________________________ |
_________________________ |
| _________________________ |
_________________________ |
| _________________________ |
_________________________ |
| _________________________ |
_________________________ |
|
| |
|
|
| |
B. |
Do you have a telephone number where I can reach FOCUS
CHILD or someone who knows where (he/she) is? |
| |
|
| YES |
1 |
|
RECORD BELOW IN C |
| NO |
0 |
|
GO TO ENDING 2 (PAGE 11) |
|
| |
|
|
| |
C. |
| INTERVIEWER: |
RECORD ANY POSSIBLE TELEPHONE NUMBERS
WHERE FOCUS CHILD CAN BE REACHED. RECORD AREA CODE. |
|
| |
|
| |
(_______)- |
________- |
________________ |
| |
(_______)- |
________- |
________________ |
| |
(_______)- |
________- |
________________ |
|
| |
|
|
| SCHEDULING A |
| |
When will (he/she) be back with your (his/her)
mother? |
| |
|
| |
|___|___| / |
|___|___| |
| |
MONTH |
DAY |
|
| |
|
| |
RECORD THIS ON CONTACT SHEET AND
SCHEDULE CALLBACK OR APPOINTMENT. |
| |
|
|
| SCHEDULING B |
| |
When would be a good time for me
to come and spend some time with you and FOCUS CHILD? This should
be a time when FOCUS CHILD is likely to be awake and alert and when
interruptions will be at a minimum. INTERVIEWER:
RECORD DATE AND TIME ON CONTACT SHEET. |
| |
|
|
| ENDING 1 |
| |
Thank you very much for your time. For
this study, we can only interview the person who currently has primary
responsibility for FOCUS CHILD. |
| |
|
|
| |
|
| |
|
|
| |
UPDATE “PEOPLE WHO CAN HELP
FIND ME FORM” THEN THANK RESPONDENT AND END INTERVIEW. |
| |
|
|
| ENDING 2 |
| |
I’m sorry because (you [did/do] not
have your baby/your baby died) the questions in the survey will not
apply to you. |
| |
|
|
| ENDING 3 |
| |
Thank you very much for your time. If you
should hear from SAMPLE MEMBER or the person responsible for FOCUS
CHILD, please ask (him/her) to contact (SITE COORDINATOR) at (LOCAL
RESEARCH INSTITUTION) at (TELEPHONE NUMBER) and say that (he/she)
is calling about the Parent Services Interview. |
| |
|
|
| |
| INTERVIEWER: |
IF NECESSARY, LEAVE WRITTEN INFORMATION
ON “SORRY I MISSED YOU” NOTE PAD PROVIDED. |
|
| |
|
|
| |
| EXIT
SCREENER AND CONTACT PEOPLE
LISTED IN IN18 AND IN19 AND PERSONS
LISTED ON THE “PEOPLE WHO CAN HELP
FIND ME” FORM. |
|
