|
OMB#: 0970-0151
EXPIRATION DATE: 6/2001 |
Spring 2000 |
|
KINDERGARTEN
AND
FIRST GRADE FOLLOWUP
of the
Head Start Family and Child Experiences Survey
|
Child Name: _____________________________ |
ID Number: ______________________________ |
DOB: _____________ |
|
|
Date: _________ |
Interviewer: ___________________________ |
|
Complete |
|
Westat |
|
Hello, may I speak with [SPRING ‘99
RESPONDENT]? |
S1. |
SPRING ‘99 RESPONDENT IS: |
|
THERE AND AVAILABLE |
1 |
(GO TO MAIN INTRODUCTION) |
NOT CURRENTLY AVAILABLE |
2 |
|
NO LONGER THERE |
3 |
(GO TO S3) |
|
S2. |
When would be the best time for me to call back to
reach (him/her)? |
|
BEST DAY: __________________ |
TIME: _________ |
|
THANK RESPONDENT AND END CONVERSATION.
RECORD CALLBACK INFORMATION ON CALL RECORD.
|
S3. |
I am trying to reach the person most responsible for
[CHILD]. Would that (still) be [SPRING ‘99 RESPONDENT]? |
|
|
S4. |
Could you please tell me how I can reach (him/her)? |
|
NAME: _________________________________________________________ |
STREET: ________________________________________________________ |
CITY: ______________________ |
STATE: __________ |
ZIP: __________ |
|
THANK RESPONDENT AND END CONVERSATION.
USE INFORMATION OBTAINED ABOVE TO CONTACT SPRING ‘99 RESPONDENT.
|
S5. |
Who is most responsible for [CHILD]’s care? |
|
NAME: ________________________________________________________ |
STREET: ______________________________________________________ |
CITY: ______________________ |
STATE: __________ |
ZIP: __________ |
|
THANK RESPONDENT AND END CONVERSATION.
USE INFORMATION OBTAINED ABOVE TO CONTACT SPRING ‘99 RESPONDENT.
|
S6. |
What is (your/his/her) relationship to [CHILD]? (DO
NOT READ LIST. CIRCLE ONE RESPONSE.) |
|
MOTHER (BIRTH/ADOPTIVE) |
01 |
FATHER (BIRTH/ADOPTIVE) |
02 |
STEPMOTHER |
03 |
STEPFATHER |
04 |
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 |
|
S7. |
Since last spring, how many months (have/has (you/he/she))
been the person most responsible for [CHILD]’s care? |
|
NUMBER OF MONTHS: ___________ |
|
S8. |
MOST RESPONSIBLE PERSON IS: |
|
PERSON YOU ARE CURRENTLY SPEAKING
WITH |
1 |
(GO TO MAIN INTRODUCTION) |
SOMEONE ELSE |
2 |
(THANK R AND END CONVERSATION.
USE INFORMATION FROM S5 TO CONTACT MOST RESPONSIBLE PERSON)
|
|
MAIN INTRODUCTION |
(Hello), my name is __________
and I am (calling) from Westat. We are part of the research team that
is conducting a study of the Head Start Program. (You may remember
that) someone from the research team talked to (you/SPRING ‘99
RESPONDENT) last Spring, while your child, [CHILD’S NAME], was
attending (Head Start/kindergarten)
As part of this same study, the Family and Child Experiences Survey,
we would like to again interview you, administer a child assessment
to [CHILD], and ask [CHILD]’s current teacher some questions.
The study will help us learn more about what happens to children
and families who have participated in Head Start and what happens
when the children enter (kindergarten/first grade). We want to get
your point of view on how [CHILD] is doing in school and what is
now happening in your family. This information will be used to help
Head Start better serve children and families. To compensate you
for your time in participating in
|
S9. |
We would like to ask you a few questions now, (similar
to the interview you did last spring). It should take about 30 minutes. |
IF THIS IS NOT A GOOD
TIME TO COMPLETE THE INTERVIEW, RECORD APPOINTMENT TIME ON THE CALL
RECORD. THEN COMPLETE THE CONSENT/TEACHER INFORMATION
FORM.
|
First, I want you to know
that your participation is voluntary and your responses will be kept
completely confidential. |
S10. |
I just want to confirm your relationship to [CHILD].
Are you (his/her)… |
|
MOTHER (BIRTH/ADOPTIVE) |
01 |
FATHER (BIRTH/ADOPTIVE) |
02 |
STEPMOTHER |
03 |
STEPFATHER |
04 |
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 |
|
S11. |
Now, about your language background. What was the first
language you learned to speak? |
|
ENGLISH |
1 |
(GO TO S13) |
SPANISH |
2 |
|
ENGLISH AND SPANISH EQUALLY |
3 |
|
ENGLISH AND ANOTHER LANGUAGE EQUALLY |
4 |
|
ANOTHER LANGUAGE (SPECIFY) _____________________________ |
5 |
|
|
S12. |
What language do you speak most at home now? |
|
ENGLISH |
1 |
SPANISH |
2 |
ENGLISH AND SPANISH EQUALLY |
3 |
ENGLISH AND ANOTHER LANGUAGE EQUALLY |
4 |
ANOTHER LANGUAGE (SPECIFY) _____________________________ |
5 |
|
S13. |
Now I’d like to talk with you about [CHILD]’s
school experiences. Is [CHILD] attending (or enrolled in) school? |
|
YES |
1 |
|
NO |
2 |
(GO TO S16) |
HOME SCHOOLED |
3 |
(GO TO S16) |
|
S14. |
What grade or year is [CHILD] attending? |
|
HEAD START |
01 |
|
(GO TO S16) |
NURSERY/PRESCHOOL/PREKINDERGARTEN |
02 |
|
(GO TO S16) |
TRANSITIONAL KINDERGARTEN |
03 |
|
(GO TO S18) |
KINDERGARTEN |
04 |
PREFIRST GRADE (AFTER K) |
05 |
FIRST GRADE |
06 |
SECOND GRADE |
07 |
UNGRADED |
08 |
|
(GO TO S15) |
|
S15. |
What grade would [CHILD] be in if (he/she) were attending
a school with regular grades? |
|
NURSERY/PRESCHOOL/PREKINDERGARTEN/HEAD START |
01 |
|
(GO TO S16) |
TRANSITIONAL KINDERGARTEN |
02 |
|
(GO TO S16) |
KINDERGARTEN |
03 |
PREFIRST GRADE (AFTER K) |
04 |
FIRST GRADE |
05 |
SECOND GRADE |
06 |
UNGRADED, NO EQUIVALENT |
07 |
|
(GO TO S18) |
|
S16. |
Do you expect [CHILD] to be enrolled in (kindergarten/first
grade/second grade) next year or the year after that? |
|
NEXT YEAR |
1 |
YEAR AFTER THAT |
2 |
NEITHER, DON'T EXPECT CHILD TO ATTEND (K/1(ST)/2(ND)) |
3 |
REFUSED |
7 |
DON'T KNOW |
8 |
|
S17. |
This spring we are only looking at children attending
kindergarten and first grade. [But we would like to call you next
spring, when [CHILD] is in (kindergarten/first grade).] I do not
have any more questions for you right now, but thank you for your
time.
(VERIFY MAILING ADDRESS AND NAME ON TRACKING INFORMATION FORM.)
|
END INTERVIEW
|
S18. |
CHILD IS ATTENDING. |
|
KINDERGARTEN |
1 |
(GO TO A1) |
PREFIRST GRADE/FIRST GRADE/2(ND)
GRADE
FIRST GRADE BUT PARENT DID NOT |
2 |
(GO TO C1) |
|
COMPLETE 1999 INTERVIEW |
3 |
(GO TO BOX A4) |
|
A. HEAD
START EXPERIENCE |
A1. |
Is this (CHILD)’s first year in kindergarten? |
|
YES |
1 |
(GO TO BOX A4.) |
NO |
2 |
(GO TO A2) |
|
A2. |
Did you agree with the school’s decision to have
your child take a second year of kindergarten? Would you say you… |
|
Strongly agreed with school's decision |
1 |
Somewhat agreed with it |
2 |
Somewhat disagreed with school's decision |
3 |
Strongly disagreed with school's decision.. |
4 |
|
A3. |
Has your child had a different teacher this year or
the same teacher he/she had last year? |
|
Different teacher |
1 |
Same teacher |
2 |
|
A4. |
Has your child received any special instruction or
tutoring or was he/she put in a special class or group to help him/her
this year or has he/she received pretty much the same kind of instruction
he/she received last year? |
|
SPECIAL INSTRUCTION OR TUTORING |
1 |
SPECIAL CLASS OR GROUP |
2 |
SAME KIND OF INSTRUCTION AS LAST YEAR |
3 |
|
BOX A-4 |
RESPONDENT... |
|
COMPLETED K PARENT INTERVIEW
LAST YEAR |
1 |
(GO TO C1) |
DID NOT COMPLETE K PARENT INTERVIEW LAST
YEAR |
2 |
(GO TO A5) |
|
A5. |
Did (CHILD) keep going to Head Start until the end
of the program year, or did (he/she) stop going before the program
ended? |
|
KEPT GOING TO END OF PROGRAM YEAR |
1 |
(GO
TO SECTION B) |
STOPPED GOING BEFORE END OF PROGRAM YEAR |
2 |
(GO TO A6) |
OTHER (specify) ________________________________ |
3 |
(GO TO A6) |
|
A6. |
When did (CHILD) stop going to Head Start? |
|
_____/ |
_____/ |
_____/ |
MONTH |
DAY |
YEAR |
|
A7. |
Why did (CHILD) stop going to Head Start? What was
the most important reason?
(CIRCLE ONLY ONE) |
|
ILLNESS OF CHILD |
01 |
ILLNESS OF 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 |
NEEDED FULL-DAY CHILD CARE |
08 |
OTHER (SPECIFY) ____________________________________________ |
09 |
|
A8. |
After he/she stopped going to Head Start and before
he/she started kindergarten (or first grade), did you enroll (CHILD)
in another preschool or child development program? |
|
|
IF MORE THAN ONE PROGRAM,
ASK ABOUT PRIMARY PROGRAM.
|
A9. |
What kind of program was that? Was it… |
|
A public school prekindergarten, |
01 |
A private school prekindergarten or nursery school, |
02 |
A child care center or child development program, |
03 |
Another Head Start program, or |
04 |
Somewhere else? (Specify) ___________________ |
05 |
|
A10. |
For how many days a week did (CHILD) go to that program? |
|
|
A11. |
How many hours a week was (CHILD) at that program? |
|
HOURS A WEEK: ___________ |
|
A12. |
As far as helping (CHILD) learn and get ready for school,
do you think that program was …. |
|
Not as good as Head Start, |
01 |
Just as good as Head Start, or |
02 |
Better than Head Start? |
03 |
|
A13. |
After he/she stopped going to Head Start and before
(he/she) started Kindergarten (or first grade) did (CHILD) receive
child care on a regular basis from someone other than a parent? (That
is, child care other than in the preschool program you just told me
about. Don’t count occasional use of babysitters.) |
|
|
A14. |
Where was that care provided? (IF MORE THAN ONE
CHILD CARE ARRANGEMENT, ASK ABOUT PRIMARY ARRANGEMENT. 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 OR NEIGHBOR’S HOME |
04 |
FAMILY DAY CARE HOME |
05 |
CHILD CARE CENTER |
06 |
OTHER (specify) ___________________________ |
07 |
|
A15. |
Was that person or place licensed, certified, or regulated? |
|
|
A16. |
For how many days a week was (CHILD) cared for (by
that person/in that place)? |
|
|
A17. |
For how many hours a week was (CHILD) cared for (by
that person/in that place)? |
|
HOURS A WEEK: ___________ |
|
BOX A-17 |
CHILD IS IN... |
|
|
|
KINDERGARTEN |
1 |
(GO TO B1) |
|
FIRST GRADE |
2 |
(GO TO C1) |
|
B. KINDERGARTEN
SCHOOL CHARACTERISTICS |
IF
CHILD IS IN FIRST GRADE, GO TO C1. |
Now I’d like to talk
with you about [CHILD]’s school experiences. |
B1. |
Does [CHILD] go to a full-day or part-day kindergarten? |
|
|
B2. |
How many hours each day does (he/she) spend in kindergarten? |
|
NUMBER OF HOURS PER DAY: ___________ |
|
B3. |
How many days each week does (he/she) spend in kindergarten? |
|
NUMBER OF DAYS PER WEEK: ___________ |
|
B4. |
Approximately how many days has [CHILD] been absent
from class since the beginning of the school year, that is, since
last September? |
|
NUMBER OF DAYS ABSENT: ___________ |
|
BOX B-4 |
IF NUMBER OF DAYS
ABSENT IS GREATER THAN 5 CHECK THIS BOX
|
… AND THEN ASK B5. OTHERWISE, GO TO C1. |
|
|
B5. |
What is the most frequent reason for [CHILD]’s
missing class? |
|
ILLNESS OF CHILD |
01 |
ILLNESS OF 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 (SPECIFY) ____________________________________________ |
08 |
|
C. SCHOOL
CHARACTERISTICS |
(Now let’s talk about
the school [CHILD] goes to (now).) |
C1. |
Does [CHILD] go to a public or private school? |
|
PUBLIC |
1 |
(GO TO C4) |
PRIVATE |
2 |
|
HOME-SCHOOLED |
3 |
(GO TO C4) |
|
C2. |
Is the school church-related or not church-related? |
|
CHURCH-RELATED |
1 |
|
NOT CHURCH-RELATED |
2 |
(GO TO C4) |
|
C3. |
Is it a Catholic school? |
|
|
C4. |
Approximately how many students are in [CHILD]’s
class? |
|
NUMBER OF STUDENTS IN CLASS: ___________ |
|
C5. |
How many teachers are in [CHILD]’s
class?
|
|
NUMBER OF TEACHERS IN CLASS: ___________ |
|
D. SCHOOL PRACTICES |
D1. |
For each statement that I read you, please tell me
how well [CHILD]’s school has been doing the following things
(during this school year):
[IF NECESSARY, READ AFTER EACH STATEMENT.]: Would you say [CHILD]’s
school does this very well, just O.K., or doesn’t do it
at all? |
|
|
Does it very well |
Just O.K. |
Does not do it at all |
Don't know |
- Lets you know (between report cards) how [CHILD] is doing
in school.
|
1 |
2 |
3 |
8 |
- Helps you understand what children at [CHILD]'s age are
like
|
1 |
2 |
3 |
8 |
- Makes you aware of chances to volunteer at the school
|
1 |
2 |
3 |
8 |
- Provides workshops, materials, or advice about how to
help [CHILD] learn at home
|
1 |
2 |
3 |
8 |
- Provides information on community services to help [CHILD]
or your family
|
1 |
2 |
3 |
8 |
LANGUAGE MOST SPOKEN AT HOME IS
NOT ENGLISH, ASK: |
|
- Understands the needs of families who don't speak English
|
1 |
2 |
3 |
8 |
|
E. FAMILY/SCHOOL INVOLVEMENT |
Now I’d like to ask
you about your involvement with [CHILD]’s current school. |
E1. |
Since the beginning of this school year, have you … |
IF E1a-d ARE ALL NO, SKIP TO
F1
|
E2. |
During this school year, about how many times have
you gone to meetings or participated in activities at [CHILD]’s
school? |
|
NUMBER OF TIMES: ___________ |
|
F. TEACHER FEEDBACK ON
CHILD'S SCHOOL PERFORMANCE AND BEHAVIOR |
|
YES |
NO |
- Attended a general school meeting, for example, an open
house, a back-to-school night or a meeting of a parent-teacher
organization?
|
1 |
2 |
- Gone to a regularly-scheduled parent-teacher conference
with [CHILD]'s teacher?
|
1 |
2 |
- Attended a school or cla ss event, such as a play, (or)
sports event because of [CHILD]?
|
1 |
2 |
- Acted as a volunteer at the school or served on a committee?
|
1 |
2 |
Here are some things teachers
tell parents about how their children are doing in school. For each
one, please tell me if a teacher said something like this about [CHILD],
or wrote it in a note or on a report card during this school year,
even if you didn’t agree. |
F1. |
Since the beginning of this school year, has a teacher
said or written that [CHILD]… |
|
|
YES |
NO |
- Has been doing really well in school?
|
1 |
2 |
- Has not been learning up to (his/her) capabilities?
|
1 |
2 |
- Doesn't concentrate or does not pay attention for long?
|
1 |
2 |
- Has been acting up in school or disrupting the class?
|
1 |
2 |
- Has often seemed sad or unhappy in class?
|
1 |
2 |
- Has been very restless, fidgets all the time, or doesn't
sit still?
|
1 |
2 |
- Has been having trouble taking turns, sharing or cooperating
with other children?
|
1 |
2 |
- Gets along with other children or works well in a group?
|
1 |
2 |
- Is very enthusiastic and interested in a lot of different
things?
|
1 |
2 |
- Lacks confidence in learning new things or taking part
in new activities?
|
1 |
2 |
- It's hard to understand what (he/she) is saying?
|
1 |
2 |
- Is often sleepy or tired in class?
|
1 |
2 |
- Likes to speak out in class and express (his/her) ideas?
|
1 |
2 |
- Is often bored in class?
|
1 |
2 |
|
|
F2. |
As far as you know, is [CHILD] going to be promoted
to (first grade/second grade/third grade) this coming fall, or will
he/she spend another year in (kindergarten/first grade/second grade)? |
|
YES, WILL BE PROMOTED TO (FIRST/SECOND/THIRD)
GRADE |
1 |
NO, WILL SPEND ANOTHER YEAR IN
(KINDERGARTEN/FIRST GRADE/SECOND GRADE) |
2 |
NO, WILL GO INTO A TRANSITIONAL CLASS |
3 |
|
F3. |
Now that [CHILD] has been in (kindergarten/first grade/second
grade) for most of a school year, satisfied are you with what Head
Start did to help [CHILD] and your family be prepared for school?
Are you… |
|
Very dissatisfied, |
1 |
Somewhat dissatisfied, |
2 |
Somewhat satisfied, or |
3 |
Very satisfied? |
4 |
|
G. YOUR
CHILD'S ABILITIES |
G1. |
CHILD IS IN …. |
|
KINDERGARTEN |
1 |
(GO TO G2) |
FIRST GRADE |
2 |
(GO TO G6) |
|
These next questions are about
things that different children do at different ages. These things
may or may not be true for [CHILD]. |
G2. |
Can [CHILD] identify the colors red, yellow, blue,
and green by name? Would you say… |
|
All of them |
1 |
Some of them, or |
2 |
None of them? |
3 |
|
G3. |
Can (he/she) recognize… |
|
All of the letters of the alphabet, |
1 |
Most of them, |
2 |
Some of them, or |
3 |
None of them? |
4 |
|
G4. |
How high can [CHILD] count? Would you say… |
|
Not at all, |
1 |
Up to five, |
2 |
Up to ten, |
3 |
Up to twenty, |
4 |
Up to fifty, or |
5 |
Up to 100 or more? |
6 |
|
G5. |
Does [CHILD]... |
|
|
Yes |
No |
- Mostly write and draw rather than scribble?
|
1 |
2 |
- Write (his/her) first name, even if some of the letters
are backwards?
|
1 |
2 |
- Trip, stumble, or fall easily?
|
1 |
2 |
- Stutter or stammer?
|
1 |
2 |
- When [CHILD] speaks, is (he/she) understandable to a stranger?
|
1 |
2 |
|
G6. |
Is [CHILD] able to read story books on (his/her) own
now? |
|
|
G7. |
Does [CHILD] actually read the words written in the
book, or does (he/she) look at the book and pretend to read? |
|
READS THE WRITTEN WORDS |
1 |
|
PRETENDS TO READ |
2 |
(GO TO G10) |
DOES BOTH |
3 |
|
|
G8. |
How old was [CHILD] in years and months when (he/she)
began reading simple, whole sentences? |
|
|
YEARS: ________ MONTHS:
_________ |
(GO TO G11) |
|
G9. |
Does (he/she) ever look at a book with pictures and
pretend to read? |
|
YES |
1 |
|
NO |
2 |
(GO TO BOX G-10) |
|
G10. |
When (he/she) 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? |
|
SOUNDS LIKE CONNECTED STORY |
1 |
TELLS WHAT'S IN EACH PICTURE |
2 |
DOES BOTH |
3 |
|
BOX G-10 |
CHILD IS IN... |
|
|
|
KINDERGARTEN |
1 |
(GO TO H1) |
|
FIRST GRADE |
2 |
(GO TO I1) |
|
G11. |
About how many story books did (CHILD) read on (his/her)
own last month? (Books school assigned do not count.) |
|
NUMBER OF BOOKS: ___________ |
|
G12. |
Did (he/she) pick out the books on (his/her) own, or
did you help (him/her) choose them? |
|
PICKED ON OWN |
1 |
PARENT HELPED |
2 |
BOTH |
3 |
CHILD READ NO BOOKS LAST MONTH |
4 |
|
BOX G-12 |
CHILD IS IN... |
|
|
|
KINDERGARTEN |
1 |
(GO TO H1) |
|
FIRST GRADE |
2 |
(GO TO I1) |
|
H. YOUR CHILD'S BEHAVIOR |
IF CHILD IS IN FIRST
GRADE, GO TO I1. |
H1. |
I am going to read you a list of statements describing
things that children sometimes do. For each statement, I want you
to tell me how often [CHILD] acts in this way. For each one, would
you say never, sometimes, often, or very often? |
|
(READ ALL ITEMS. CIRCLE ONE RESPONSE FOR EACH.
REPEAT CATEGORIES AS NECESSARY.)
How often does (CHILD). |
Never |
Sometimes |
Often |
Very often |
- Easily join others in play?
|
1 |
2 |
3 |
4 |
- Respond appropriately to teasing?
|
1 |
2 |
3 |
4 |
- Make and keep friends?
|
1 |
2 |
3 |
4 |
- Comfort or help others?
|
1 |
2 |
3 |
4 |
- Worry about things?
|
1 |
2 |
3 |
4 |
- Listen carefully to others?
|
1 |
2 |
3 |
4 |
- Act sad?
|
1 |
2 |
3 |
4 |
- Control his/her temper?
|
1 |
2 |
3 |
4 |
- Cooperate with family members?
|
1 |
2 |
3 |
4 |
- Keep working at something until he/she is finished?
|
1 |
2 |
3 |
4 |
- Argue with others?
|
1 |
2 |
3 |
4 |
- Fight with others?
|
1 |
2 |
3 |
4 |
- Show interest in a variety of things?
|
1 |
2 |
3 |
4 |
- Have a tantrum when he/she does not get his/her way?
|
1 |
2 |
3 |
4 |
- Concentrate on a task and ignore distractions?
|
1 |
2 |
3 |
4 |
- Easily become angry?
|
1 |
2 |
3 |
4 |
- Appear to be lonely?
|
1 |
2 |
3 |
4 |
- Help with chores?
|
1 |
2 |
3 |
4 |
- Have a problem being accepted and liked by others?
|
1 |
2 |
3 |
4 |
- Act impulsively?
|
1 |
2 |
3 |
4 |
- Show low self-esteem?
|
1 |
2 |
3 |
4 |
- Eager to learn new things?
|
1 |
2 |
3 |
4 |
- Hyperactive?
|
1 |
2 |
3 |
4 |
- Creative in work or play?
|
1 |
2 |
3 |
4 |
- Nervous, high-strung, or tense?
|
1 |
2 |
3 |
4 |
- Disobedient at home?
|
1 |
2 |
3 |
4 |
|
I. ACTIVITIES WITH
YOUR CHILD |
I1. |
As far as you know, is [CHILD] going to be promoted
to (first grade/second grade/third grade) this coming fall, or will
he/she spend another year in (kindergarten/first grade/second grade)? |
|
KINDERGARTEN |
1 |
(GO TO I2) |
FIRST GRADE |
2 |
(GO TO 13) |
|
Now I have some questions
about you and [CHILD] at home. |
I2. |
In the past week, have you or someone in your family
done the following things with [CHILD]?
IF YES, ASK: How many times have you or someone in your family done
this in the past week? Would you say one or two times, or three or
more times? |
|
|
YES |
NO |
|
1-2 TIMES |
3+ TIMES |
- Told (him/her) a story?
|
1 |
2 |
1 |
2 |
- Taught (him/her) letters, words, or numbers?
|
1 |
2 |
1 |
2 |
- Taught (him/her) songs or music?
|
1 |
2 |
1 |
2 |
- Worked in arts and crafts with (him/her)?
|
1 |
2 |
1 |
2 |
- Played a game, sport, or exercised together?
|
1 |
2 |
1 |
2 |
- Took (him/her) along while doing errands like going to
the post office, the bank, or the store?
|
1 |
2 |
1 |
2 |
- Involved (him/her) in household chores like cooking, cleaning,
setting the table, or caring for pets?
|
1 |
2 |
1 |
2 |
|
I3. |
How many times have you or someone in your family read
to [CHILD] in the past week? Would you say… |
|
Not at all, |
1 |
Once or twice, |
2 |
3 or more times, or |
3 |
Everyday? |
4 |
|
I4. |
In the past month, have you or someone
in your family done the following things with [CHILD]? |
|
|
YES |
NO |
- Visited a library?
|
1 |
2 |
- Gone to a movie?
|
1 |
2 |
- Gone to a play, concert, or other live show?
|
1 |
2 |
- Gone to a mall?
|
1 |
2 |
- Visited an art gallery, museum, or historical site?
|
1 |
2 |
- Visited a playground, park, or gone on a picnic?
|
1 |
2 |
- Visited a zoo or aquarium?
|
1 |
2 |
- Talked with [CHILD] about (his/her) family history or
ethnic heritage?
|
1 |
2 |
- Attended an event sponsored by a community, ethnic, or
religious group?
|
1 |
2 |
- Attended an athletic or sporting event in which [CHILD]
was not a player?
|
1 |
2 |
|
J. HOUSEHOLD RULES |
Now I’d like to ask
you a few questions about rules and setting limits at home. |
J1. |
In your house, are there general rules about… |
|
|
YES |
NO |
- What TV programs [CHILD] can watch?
|
1 |
2 |
- How many hours [CHILD] can watch TV?
|
1 |
2 |
- What kinds of food [CHILD] eats?
|
1 |
2 |
- What time [CHILD] goes to bed?
|
1 |
2 |
- What chores [CHILD] does?
|
1 |
2 |
|
J2. |
About how many hours a day does [CHILD] watch television? |
|
|
J3. |
Sometimes kids mind pretty well and sometimes they
don’t. Have you spanked [CHILD] in the past week for not minding? |
|
|
J4. |
About how many times in the past week? |
|
NUMBER OF TIMES: ___________ |
|
K. HEALTH AND DISABILITY |
Now I have a few questions
about [CHILD]’s health. |
K1. |
Does [CHILD] have any special needs or disabilities
– for example, physical, emotional, language, hearing, learning
difficulty, or other special needs? |
|
|
K2. |
How would you describe [CHILD]’s needs? Does
(she/he) have…. |
|
|
YES |
NO |
DON'T KNOW |
- A specific learning disability?
|
1 |
2 |
8 |
- Mental retardation?
|
1 |
2 |
8 |
- A speech impairment?
|
1 |
2 |
8 |
- A serious emotional disturbance?
|
1 |
2 |
8 |
- Deafness or another hearing impairment?
|
1 |
2 |
8 |
- Blindness or another visual impairment?
|
1 |
2 |
8 |
- An orthopedic impairment?
|
1 |
2 |
8 |
- Another health impairment lasting 6 months or more?
|
1 |
2 |
8 |
|
BOX K-2 |
IF NO TO K2a-h, CHECK THIS BOX... |
|
. |
THEN SKIP TO K6. |
|
K3. |
(Does/Do) [CHILD]’s (disability/disabilities)
affect (his/her) ability to learn? |
|
|
K4. |
Did you or another family member participate in developing
an Individualized Education Program or Plan (IEP) for [CHILD]? |
|
|
K5. |
How satisfied are you with the plan? Would you say
you are… |
|
Very dissatisfied, |
1 |
Somewhat dissatisfied, |
2 |
Somewhat satisfied, or |
3 |
Very satisfied? |
4 |
|
K6. |
Overall, would you say [CHILD]’s health is…. |
|
Excellent, |
1 |
Very good, |
2 |
Good, |
3 |
Fair, or |
4 |
Poor? |
5 |
|
K7. |
Does [CHILD] have a regular health care provider for
routine medical care, for example, well-child care and check-ups? |
|
|
K8. |
About how long has it been since [CHILD] last saw a
medical doctor or other health professional for a checkup or other
routine care? Would you say… |
|
Less than 1 year, |
1 |
1 year, but less than 2 years, or |
2 |
2 years, or more? |
3 |
|
K9. |
Has [CHILD] ever been to a dentist or dental hygienist
for dental care? |
|
|
K10. |
About how long has it been since [CHILD] last saw a
dentist or dental hygienist for dental care? Would you say… |
|
Less than 1 year, |
1 |
1 year, but less than 2 years, or |
2 |
2 years, or more? |
3 |
|
K11. |
Now some questions about your health.
Would you say your health in general is… |
|
Excellent, |
1 |
Very good, |
2 |
Good, |
3 |
Fair, or |
4 |
Poor? |
5 |
|
K12. |
Does any impairment or health problem now
keep you from working at a job or business? |
|
|
K13. |
Are you limited in the kind or amount of work you can
do because of any impairment or health problem? |
|
|
K14. |
Do you have a regular health care provider for your
own routine medical care, for example, checkups? |
|
|
K15. |
Does anyone in your household smoke cigarettes regularly? |
|
|
L. CHILD'S MOTHER AND FATHER |
BOX L-1 |
|
RESPONDENT IS: (CIRCLE ONE.) |
|
|
[CHILD]’s BIO/ADPOTIVE
MOTHER |
1
|
(ASK QUESTIONS ABOUT
R) |
|
|
NOT [CHILD]’s BIO/ADOPTIVE MOTHER. |
2 |
(ASK QUESTIONS ABOUT MOTHER)
|
|
Now I’m going to ask
you some questions about (you/(CHILD)’s mother). |
L1. |
(Are you/Is she) of Spanish, Hispanic, or Latino origin? |
|
YES |
1 |
(GO TO L2) |
NO |
2 |
(GO TO L3) |
REFUSED |
7 |
(GO TO L3) |
DON'T KNOW |
8 |
(GO TO L3) |
|
L2. |
Which one or more of these groups (are you/is she) |
|
- Mexican, Mexican American, Chicano,
|
1 |
- Puerto Rican,
|
2 |
- Cuban, or
|
3 |
- Another Spanish/Hispanic/Latino group?
|
4 |
|
REFUSED |
7 |
|
DON'T KNOW |
8 |
|
L3. |
What is (your/her) race? (Circle all that are mentioned.) |
|
WHITE |
01 |
BLACK, AFRICAN AMERICAN, OR NEGRO |
02 |
AMERICAN INDIAN OR ALASKA NATIVE
(SPECIFY) _____________________________________________ |
03 |
ASIAN INDIAN |
04 |
CHINESE |
05 |
FILIPINO |
06 |
JAPANESE |
07 |
KOREAN |
08 |
VIETNAMESE |
09 |
OTHER ASIAN (SPECIFY) |
10 |
NATIVE HAWAIIAN |
11 |
GUAMANIAN OR CHAMORRO |
12 |
SAMOAN |
13 |
OTHER PACIFIC ISLANDER (SPECIFY) ____________________ |
14 |
ANOTHER RACE (SPECIFY) _____________________________ |
15 |
REFUSED |
97 |
DON'T KNOW |
98 |
|
IF
R IS BIO/ADOPTIVE MOTHER, GO TO L9.
|
L4. |
Is [CHILD]’s mother in this household? |
|
MOTHER IN HOUSEHOLD |
1 |
(GO TO L8) |
MOTHER NOT IN HOUSEHOLD |
2 |
(GO TO L5) |
MOTHER DECEASED |
3 |
(GO TO L10) |
|
L5. |
Does [CHILD]’s mother live in the same city or
county as [CHILD]? |
|
|
L6. |
In the past year, on about how many
days has [CHILD] seen (his/her) mother? |
|
NUMBER OF DAYS: ___________ |
|
L7. |
How long has it been since [CHILD] last had contact
with (his/her) mother? |
|
[CHILD] NEVER HAD CONTACT |
00 |
|
DON'T KNOW |
98 |
|
OR
NUMBER: ________ |
DAYS |
1 |
|
WEEKS |
2 |
|
MONTHS |
3 |
|
YEARS |
4 |
|
BOX L-7 |
IF NO CONTACT IN LAST 12 MONTHS, CHECK THIS BOX... |
|
. |
THEN SKIP TO L9. |
|
L8. |
Since (the beginning of this school year), has [CHILD]’s
mother… |
|
|
YES |
NO |
DON'T KNOW |
- Attended a general school meeting, for example, an open
house, a back-to-school night, or a meeting of a parentteacher
organization?
|
1 |
2 |
8 |
- Gone to a regularly scheduled parent-teacher conference
with [CHILD]'s teacher?
|
1 |
2 |
8 |
- Attended a school or class event, such as a sports event
because of [CHILD]?
|
1 |
2 |
8 |
- Acted as a volunteer at the school or served on a committee?
..
|
1 |
2 |
8 |
|
L9. |
What is (your/her) current marital status? |
|
MARRIED |
1 |
SEPERATED |
2 |
DIVORCED |
3 |
WIDOWED |
4 |
NEVER MARRIED |
5 |
|
L10. |
What is the highest grade or year of school that (you/she)
completed? |
|
UP TO 8TH GRADE |
01 |
9TH TO 11TH GRADE |
02 |
12TH GRADE BUT NO DIPLOMA |
03 |
HIGH SCHOOL DIPLOMA/EQUIVALENT |
04 |
VOC/TECH PROGRAM AFTER HIGH SCHOOL
BUT
NO VOC/TECH DIPLOMA |
05 |
VOC/TECH DIPLOMA AFTER HIGH SCHOOL |
06 |
SOME COLLEGE BUT NO DEGREE |
07 |
ASSOCIATE'S DEGREE |
08 |
BACHELOR'S DEGREE |
09 |
GRADUATE OR PROFESSIONAL SCHOOL BUT NO DEGREE |
10 |
MASTER'S DEGREE (MA , MS) |
11 |
DOCTORATE DEGREE (PHD, EDD) |
12 |
PROFESSIONAL DEGREE AFTER BACHELOR'S DEGREE
(MEDICINE/MD; DENTISTRY/DDS; LAW/JD/LLB; ETC.) |
13 |
DON'T KNOW |
98 |
|
IF CHILD'S MOTHER DECEASED
OR HAD NO CONTACT IN LAST YEAR,
GO TO BOX L-16. |
|
L11. |
(Are you/Is she) currently working towards any certificate,
diploma, or degree? |
|
YES |
1 |
(GO TO L12) |
NO |
2 |
(GO TO L13) |
REFUSED |
7 |
(GO TO L13) |
DON'T KNOW |
8 |
(GO TO L13) |
|
L12. |
What kind of certificate, diploma, or degree? |
|
TRADE LICENSE OR CERTIFICATE |
01 |
GED CERTIFICATE (OR EQUIVALENT) |
02 |
HIGH SCHOOL DIPLOMA |
03 |
ASSOCIATE'S DEGREE |
04 |
CHILD DEVELOPMENT ASSOCIATE (CDA) |
05 |
BACHELOR'S DEGREE |
06 |
GRADUATE DEGREE |
07 |
OTHER (PLEASE SPECIFY) _________________ |
08 |
REFUSED |
97 |
DON'T KNOW |
98 |
|
L13. |
(Have you/Has she) completed a certificate, diploma,
or degree since last spring? |
|
YES |
1 |
|
NO |
2 |
(GO TO L15) |
REFUSED |
7 |
(GO TO L15) |
DON'T KNOW |
8 |
(GO TO L15) |
|
L14. |
What kind of certificate, diploma, or degree? (CIRCLE
ONE RESPONSE.) |
|
TRADE LICENSE OR CERTIFICATE |
01 |
GED CERTIFICATE (OR EQUIVALENT) |
02 |
HIGH SCHOOL DIPLOMA |
03 |
ASSOCIATE'S DEGREE |
04 |
CHILD DEVELOPMENT ASSOCIATE (CDA) |
05 |
BACHELOR'S DEGREE |
06 |
GRADUATE DEGREE |
07 |
OTHER (PLEASE SPECIFY) _________________ |
08 |
REFUSED |
97 |
DON'T KNOW |
98 |
|
L15. |
(Are you/Is she) currently working full-time, working
part-time, looking for work, in school, in a training program, keeping
house, or something else? (CIRCLE ONE RESPONSE.) |
|
WORKING FULL-TIME (30 HOURS OR MORE PER WEEK) |
01 |
WORKING PART-TIME |
02 |
LOOKING FOR WORK |
03 |
LAID OFF FROM WORK |
04 |
IN SCHOOL/TRAINING |
05 |
IN JAIL/PRISON |
06 |
IN MILITARY |
07 |
KEEPING HOUSE |
08 |
SOMETHING ELSE (PLEASE SPECIFY) ___________________ |
09 |
REFUSED |
97 |
DON'T KNOW |
98 |
|
BOX L-15 |
IF R IS CHILD'S (BIRTH/ADOPTIVE)
MOTHER |
OR |
IF R IS NOT CHILD'S (BIRTH/ADOPTIVE) MOTHER,
BUT CHILD'S (BIRTH/ADOPTIVE) MOTHER IS IN HOUSEHOLD,
CHECK THIS BOX... |
|
. |
THEN SKIP TO L9. |
|
L16. |
In the past 12 months, (have you/has
your family) received any child support payments for [CHILD] from
(his/her) mother? |
|
|
BOX L-16 |
|
RESPONDENT IS: (CIRCLE ONE.) |
|
|
[CHILD]’s BIO/ADPOTIVE
FATHER |
1
|
(ASK QUESTIONS ABOUT
R) |
|
|
NOT [CHILD]’s BIO/ADOPTIVE FATHER. |
2 |
(ASK QUESTIONS ABOUT FATHER)
|
|
Now I'm going to ask you some
questions about (you/(CHILD)’s father). |
L17. |
(Are you/Is he) of Spanish, Hispanic, or Latino origin? |
|
YES |
1 |
(GO TO L18) |
NO |
2 |
(GO TO L19) |
REFUSED |
7 |
(GO TO L19) |
DON'T KNOW |
8 |
(GO TO L19) |
|
L18. |
Which one or more of these groups (are you/is he)… |
|
- Mexican, Mexican American, Chicano,
|
1 |
- Puerto Rican,
|
2 |
- Cuban, or
|
3 |
- Another Spanish/Hispanic/Latino group?
|
4 |
|
REFUSED |
7 |
|
DON'T KNOW |
8 |
|
L19. |
What is (your/his) race? (Circle all that are mentioned.) |
|
WHITE |
01 |
BLACK, AFRICAN AMERICAN, OR NEGRO |
02 |
AMERICAN INDIAN OR ALASKA NATIVE
(SPECIFY) _____________________________________________ |
03 |
ASIAN INDIAN |
04 |
CHINESE |
05 |
FILIPINO |
06 |
JAPANESE |
07 |
KOREAN |
08 |
VIETNAMESE |
09 |
OTHER ASIAN (SPECIFY) |
10 |
NATIVE HAWAIIAN |
11 |
GUAMANIAN OR CHAMORRO |
12 |
SAMOAN |
13 |
OTHER PACIFIC ISLANDER (SPECIFY) ____________________ |
14 |
ANOTHER RACE (SPECIFY) _____________________________ |
15 |
REFUSED |
97 |
DON'T KNOW |
98 |
|
IF R IS FATHER, GO
TO L25. |
L20. |
Is [CHILD]’s father in this household? |
|
FATHER IN HOUSEHOLD |
1 |
(GO TO L24) |
FATHER NOT IN HOUSEHOLD |
2 |
|
FATHER DECEASED |
3 |
(GO TO L26) |
|
L21. |
Does [CHILD]’s father live in the same city or
county as [CHILD] ? |
|
YES |
1 |
|
NO |
2 |
|
Refused |
7 |
|
Don't know |
8 |
|
|
L22. |
In the past year, on about how many
days has [CHILD] seen (his/her) father? |
|
NUMBER OF DAYS: ___________ |
|
L23. |
How long has it been since [CHILD] last had contact
with (his/her) father? |
|
[CHILD] NEVER HAD CONTACT |
00 |
|
DON'T KNOW |
98 |
|
OR
NUMBER: ________ |
DAYS |
1 |
|
WEEKS |
2 |
|
MONTHS |
3 |
|
YEARS |
4 |
|
BOX L-23 |
IF NO CONTACT IN LAST 12 MONTHS, CHECK THIS BOX... |
|
. |
THEN SKIP TO L25. |
|
L24. |
(Since the beginning of this school year), has [CHILD]’s
father… |
|
|
YES |
NO |
DON'T KNOW |
- Attended a general school meeting, for example, an open
house, a back-to-school night, or a meeting of a parentteacher
organization?
|
1 |
2 |
8 |
- Gone to a regularly scheduled parent-teacher conference
with [CHILD]'s teacher?
|
1 |
2 |
8 |
- Attended a school or class event, such as a sports event
because of [CHILD]?
|
1 |
2 |
8 |
- Acted as a volunteer at the school or served on a committee?
..
|
1 |
2 |
8 |
|
L25. |
What is (your/his) current marital status? |
|
MARRIED |
1 |
SEPERATED |
2 |
DIVORCED |
3 |
WIDOWED |
4 |
NEVER MARRIED |
5 |
|
L26. |
What is the highest grade or year of school that you/[CHILD’s]
father completed? |
|
UP TO 8TH GRADE |
01 |
9TH TO 11TH GRADE |
02 |
12TH GRADE BUT NO DIPLOMA |
03 |
HIGH SCHOOL DIPLOMA/EQUIVALENT |
04 |
VOC/TECH PROGRAM AFTER HIGH SCHOOL
BUT
NO VOC/TECH DIPLOMA |
05 |
VOC/TECH DIPLOMA AFTER HIGH SCHOOL |
06 |
SOME COLLEGE BUT NO DEGREE |
07 |
ASSOCIATE'S DEGREE |
08 |
BACHELOR'S DEGREE |
09 |
GRADUATE OR PROFESSIONAL SCHOOL BUT NO DEGREE |
10 |
MASTER'S DEGREE (MA , MS) |
11 |
DOCTORATE DEGREE (PHD, EDD) |
12 |
PROFESSIONAL DEGREE AFTER BACHELOR'S DEGREE
(MEDICINE/MD; DENTISTRY/DDS; LAW/JD/LLB; ETC.) |
13 |
DON'T KNOW |
98 |
|
IF CHILD'S FATHER DECEASED
OR
HAD NO CONTACT IN LAST YEAR, SKIP TO BOX M1. |
|
L27. |
(Are you/Is he) currently working full-time, working
part-time, looking for work, in school, in a training program, keeping
house, or something else? (CIRCLE ONE RESPONSE.) |
|
WORKING FULL-TIME (30 HOURS OR MORE PER WEEK) |
01 |
WORKING PART-TIME |
02 |
LOOKING FOR WORK |
03 |
LAID OFF FROM WORK |
04 |
IN SCHOOL/TRAINING |
05 |
IN JAIL/PRISON |
06 |
IN MILITARY |
07 |
KEEPING HOUSE |
08 |
SOMETHING ELSE (PLEASE SPECIFY) ___________________ |
09 |
REFUSED |
97 |
DON'T KNOW |
98 |
|
BOX L-27 |
IF R IS NOT CHILD'S FATHER, BUT CHILD'S FATHER
IS IN HOUSEHOLD,
CHECK THIS BOX... |
|
. |
THEN SKIP TO M1. |
|
L28. |
In the past 12 months, (have you/has your family) received
any child support payments for [CHILD] from (his/her) father?
|
|
YES |
1 |
|
NO |
2 |
|
REFUSED |
7 |
|
DON'T KNOW |
8 |
|
|
M. INCOME
AND HOUSING |
Now I would like to ask you
some questions about the sources of income for your household. This
information will remain confidential. |
M1. |
Including yourself, how many adults contribute to your
household income? |
|
NUMBER OF ADULTS: ___________ |
|
M2. |
Does your family have health insurance other than Medicaid
through (your job) or the job of another employed adult in the household? |
|
YES |
1 |
|
NO |
2 |
|
REFUSED |
7 |
|
DON'T KNOW |
8 |
|
|
M3. |
Did you receive any of the following other sources
of household income or support in the past six months? |
|
|
YES |
NO |
- Welfare, TANF, or general assistance
|
1 |
2 |
- Unemployment insurance
|
1 |
2 |
- Food Stamps
|
1 |
2 |
- WIC -- Special supplemental food program
for Women, Infants, and Children
|
1 |
2 |
- Child support
|
1 |
2 |
- SSI or Social Security Retirement, Disability, or Survivor's
benefits
|
1 |
2 |
- Payments for providing foster care
|
1 |
2 |
|
BOX M-3 |
|
IF M3 a, c, OR d WERE ANSWERED YES,
CHECK THIS BOX... |
|
. |
THEN ASK TO M4.
OTHERWISE, GO TO M5. |
|
M4. |
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 or is someone
else in the household required to… |
|
|
YES |
NO |
- Attend job training?
|
1 |
2 |
- Attend school or a GED class?
|
1 |
2 |
- Get a job?
|
1 |
2 |
- Do something else? (please specify)
|
1 |
2 |
|
M5. |
Thinking about all of the sources of income you just
told me about, what was the total income for your household last month
before taxes and other deductions? Your best guess would be fine. |
|
HOUSEHOLD INCOME |
$___, ___ ___ ___ |
(GO TO M7) |
|
|
|
OR |
|
|
|
REFUSED |
97 |
(GO TO M7) |
DON'T KNOW |
98 |
(GO TO M6) |
|
M6. |
Would you say it was… |
|
Less than $250 |
01 |
Between $251 and $500 |
02 |
Between $501 and $1000 |
03 |
Between $1001 and $1500 |
04 |
Between $1501 and $2000 |
05 |
Between $2001 and $2500 or |
06 |
Over $2500 |
07 |
REFUSED |
97 |
DON'T KNOW |
98 |
|
The next questions are about
housing. |
M7. |
Do you now live in … |
|
A house, apartment, or trailer with your famil
only, |
1 |
A house, apartment, or trailer you share with
another family |
2 |
Transitional housing (apartment) or a homeless
shelter, or |
3 |
Somewhere else? |
4 |
(please specify) __________________________ |
|
|
M8. |
How many times have you moved in the last six months? |
|
|
M9. |
Do you currently own your home or apartment, pay rent,
or live in public or subsidized housing? |
|
OWNS OR IS BUYING HOME OR APARTMENT |
1 |
RENTS (WITHOUT PUBLIC ASSISTANCE) |
2 |
PUBLIC OR SUBSIZED HOUSING |
3 |
SOME OTHER ARRANGEMENT |
4 |
|
M10. |
In the last year, has [CHILD] ever been a witness to
a crime or domestic violence? |
|
YES |
1 |
|
NO |
2 |
|
REFUSED |
7 |
|
DON'T KNOW |
8 |
|
|
M11. |
In the last year, has [CHILD] ever been the victim
of a crime or domestic violence? |
|
YES |
1 |
|
NO |
2 |
|
REFUSED |
7 |
|
DON'T KNOW |
8 |
|
|
M12. |
In the last year, has anyone in your household or
([CHILD]’s (biological) (father/mother)) been arrested or charged
with any crime by the police? |
|
YES |
1 |
|
NO |
2 |
(GO TO BOX M-13) |
REFUSED |
7 |
(GO TO BOX M-13) |
DON'T KNOW |
8 |
(GO TO BOX M-13) |
|
M13. |
Did this person spend any time in jail? |
|
YES |
1 |
|
NO |
2 |
|
REFUSED |
7 |
|
DON'T KNOW |
8 |
|
|
BOX M-13 |
CHILD IS IN... |
|
|
|
KINDERGARTEN |
1 |
(GO TO
N1) |
|
FIRST GRADE |
2 |
(GO TO
END OF INTERVIEW) |
|
N. CHILD
CARE |
IF CHILD IS IN FIRST
GRADE, GO TO END OF INTERVIEW. |
Now let’s talk about
any child care arrangements that you are currently using for [CHILD].
Child care does not include time in (his/her) kindergarten class,
but may include searate child care arrangements at school before or
after class.
|
N1. |
Is [CHILD] in child care? |
|
|
N2. |
In how many different child care arrangements does
[CHILD] spend time each week? |
|
NUMBER OF ARRANGEMENTS: ___________ |
|
N3. |
Where is the primary care provided? |
|
IN [CHILD'S] HOME WITH SOMEONE OTHER THAN PARENT |
1 |
RELATIVE'S HOME |
2 |
NONRELATIVE'S HOME |
3 |
AT THE SCHOOL IN A BEFORE- OR AFTER-SCHOOL PROGRAM
(OR WRAP-AROUND CARE) |
4 |
OTHER CHILD CARE CENTER |
5 |
OTHER (PLEASE SPECIFY) ______________________________________ |
6 |
|
N4. |
How many hours per week is this care used? |
|
HOURS PER WEEK: ___________ |
|
N5. |
Who pays for this child care? |
|
|
YES |
NO |
- Do you pay for it yourself?
|
1 |
2 |
- Does a government agency pay?
|
1 |
2 |
- Does an employer pay?
|
1 |
2 |
- Do you trade child care with someone else?
|
1 |
2 |
- OTHER (PLEASE SPECIFY)
|
1 |
2 |
|
N6. |
Now I’m going to ask you about [CHILD]’s
experiences in child care. Please let me know which of these statements
best describes [CHILD]’s experience: never, sometimes, often,
or always: |
|
|
Never |
Some-times |
Often |
Always |
- [CHILD] feels safe and secure in care.
|
1 |
2 |
3 |
4 |
- [CHILD] gets lots of individual attention
|
1 |
2 |
3 |
4 |
- [CHILD]'s caregiver is open to new information and learning
|
1 |
2 |
3 |
4 |
|
O. YOUR
FEELINGS |
O1. |
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. |
|
|
Strongly disagree |
Disagree |
Agree |
Strongly agree |
- There is really no way I can solve some of the problems
I have
|
1 |
2 |
3 |
4 |
- Sometimes I feel that I'm being pushed around in life
|
1 |
2 |
3 |
4 |
- I have little control over the things that happen to me
|
1 |
2 |
3 |
4 |
- I can do just about anything I really set my mind to do
|
1 |
2 |
3 |
4 |
- I often feel helpless in dealing with the problems of
life
|
1 |
2 |
3 |
4 |
- What happens to me in the future depends mostly on me
|
1 |
2 |
3 |
4 |
- There is little I can do to change many of the important
things in my life
|
1 |
2 |
3 |
4 |
|
O2. |
I am going to read a list of ways you may have felt
or behaved. Please tell me how often you have felt this way during
the past week: rarely or never, some or a little,
occasionally or moderately, or most or all
of the time. |
|
|
Rarely or never |
Some or a little |
Occasionally or moderately |
Most or all of the time |
- Bothered by things that usually don't bother you
|
1 |
2 |
3 |
4 |
- You did not feel like eating; your appetite was poor
|
1 |
2 |
3 |
4 |
- That you could not shake off the blues, even with help
from your family and friends
|
1 |
2 |
3 |
4 |
- You had trouble keeping your mind on what you were doing
|
1 |
2 |
3 |
4 |
- Depressed
|
1 |
2 |
3 |
4 |
- That everything that you did was an effort
|
1 |
2 |
3 |
4 |
- Fearful
|
1 |
2 |
3 |
4 |
- Your sleep was restless
|
1 |
2 |
3 |
4 |
- You talked less than usual
|
1 |
2 |
3 |
4 |
- You felt lonely
|
1 |
2 |
3 |
4 |
- You felt sad
|
1 |
2 |
3 |
4 |
- You could not get "going"
|
1 |
2 |
3 |
4 |
|
END OF INTERVIEW |
Those are all the questions
that I have right now. I would like to thank you very much for participating
in this interview. |
INTERVIEWER: GO TO
CONSENT/TEACHER INFO FORM. |
IF CONSENT/TEACHER INFO
ALREADY OBTAINED, CONTINUE BELOW. |
|
I’d like to schedule
a time to assess [CHILD]/Someone will contact you soon to schedule
a time to assess [CHILD]). As I mentioned before, once the assessment
has been completed, you will receive $25 for your time and [CHILD]
will receive a small surprise. |
COMMENTS: ____________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________ |
If found, return to:
Westat
1650 Research Boulevard
Rockville, MD 20850
|