ACF OPRE CORE - Publications and Reports - Reaching Out to Families: Head Start Recruitment and Enrollment Practices

Appendix G: Parent Interview

A Feasibility Study of Head Start Recruitment and Enrollment

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Spring ‘00 Parent Interview

COVER SHEET

Respondent ID number:	______	______	______
Field Interviewer ID number:	______	______	______
Date of Interview	___ ___/	___ ___/	___ ___
	month	day	year
Time of interview start:	______ :	______
	hour	minute
Time of interview end:	______ :	______
	hour	minute

Interview location:
	CHILD’s home	02
	Other (Please specify)	03

PHONE ELIGIBILITY SCREEN (Level 1) Hello, this is (INTERVIEWER NAME) and we are preparing to do a study to learn more about preschool education and child care services. The study is sponsored by the Federal Department of Health and Human Services in Washington, D.C. I’m not asking for any money or trying to sell you anything -- I’d only like to ask you a few brief questions.
First, are you a member of this household and at least 18 years old?
	No	01	Ask for someone 18 years old and member of household
	Yes	02

Including everyone who usually lives in your household, such as family, relatives, friends, or boarders, are there any children in the household between the ages of 3 and 5 years old?
	No	01	Terminate interview
	Yes	02

a. Are you the parent or guardian who lives at this house and who is most responsible for CHILD’s care?
	No	01	Ask to speak to Primary Caregiver
	Yes	02

[DEFINITION OF WHO IS SPONSORING STUDY, IF RESPONDENT ASKS: The Administration on Children, Youth and Families is part of the Department of Health and Human Services. ACYF is the part of the federal government that administers programs for children and their families].

PHONE ELIGIBILITY SCREEN (Level 2)
Including yourself, how many adults age 18 and older live in your household? ___ ___ number of adults
Including your child that is 3-5 years old, how many children age 17 and younger live in your household? ___ ___ number of children
In the past two years, did any member of your household receive, on a regular basis, public assistance or benefits from the welfare office such as TANF, SSI., emergency assistance money payments, vouchers, transportation assistance, subsidized child care, or job training?
	No	01
	Yes	02	Go to 8
Is your 3-5 year old child a foster child or does he/she have a disability that has been diagnosed by a professional?
	No	01
	Yes	02	Go to 8

**Head Start 1999 Income Guidelines**
Size of Family Unit	Income
1	$8,240
2	11,060
3	13,880
4	16,700
5	19,520
6	22,340
7	25,160
8	27,980

For family units with more than 8 members, add $2,820 for each additional member.

It is important for this study that we include households in a wide variety of economic situations. For 1999, was the total income for everyone in this household, before taxes, below (Amount from Table 1) or above (Amount from Table 1).
	Below or at	01	Go to 8
	Above	02	Terminate Interview

PHONE ELIGIBILITY SCREEN (Level 3)
Have you ever heard of the Head Start Program?
	No	01	Go to Page 5
	Yes	02

8a. How did you hear about the Head Start Program?

	DO NOT READ LIST. CIRCLE ONE RESPONSE.

	Family/friend	01
	Referral from another agency	02
	Word of mouth	03
	Head Start came to visit at our home	04
	Previous children in Head Start	05
	Flyer/mailing	06
	Saw Head Start in community	07
	Through older child’s school	08
	Other (please specify) __________________________	09
Have your children ever been enrolled in the Head Start Program?
	No	01
	Yes	02	Terminate interview

Have you ever completed an application or filled-out any papers so your child could attend Head Start?
	No	01
	Yes	02	Terminate interview

SCHEDULE INTERVIEW APPOINTMENT We will be in your area from ( ) and would like to interview you in person. We can come to your home or meet you at a public place such as a library or a McDonalds. The interview will take less than 45 minutes and you will be paid $25 to cover any costs you might incur such as for babysitting or transportation. Once we schedule an appointment, I will mail you a letter with information about the study, a consent form to sign, and an invoice to complete so we may pay you after the interview is finished.

May I have please have your address? _____________________________________________________________________
	(Street)
	________________________________________________________________________
	(Town/City)	(State)	(Zip Code)

	And your name? __________________________________________________________


I will be available from (state availability). What day and time will be most convenient for us to interview you?
	Appointment day and time:_____________________________________________
	Interview Location ____________________________________________________

Thank you very much. We really appreciate your help with this important study. I look forward to meeting you next week.

INTRODUCTION Thank you for agreeing to talk with me. As I explained on the phone, the purpose of this study is to learn more about preschool education and child care options for families with preschool age children. We know that sometimes families with young children face many challenges. We want to learn about these from a parent’s point of view. Information from this study will be used to help develop better services for children and their families. 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 will ever know your answers because your name will never be attached. Your participation is completely voluntary. If you choose not to complete this interview, it will not affect you or your child in anyway. The things you do tell me are very important, so please be as accurate as possible. Occasionally, I may have to ask a question that does not apply to you. If that happens, just tell me and I will move on the next question. Our interview should take approximately 45 minutes. At the end of the interview, I will give you your money and 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?

A1. What is the first name of your 3 to 5 year old child?		______________________________________________

A2. Are you the person most responsible for CHILD’s care?
	No	01
	Yes	02
A3. Who is most responsible for CHILD’s care?

	Name: ________________________________________________________________________
	Address: ______________________________________________________________________
	Phone: ________________________________________________________________________

	TERMINATE INTERVIEW. Reschedule time with correct respondent

A4. What is your relationship to CHILD?
	DO NOT READ LIST. CIRCLE ONE RESPONSE.

	Mother .........................................Is that birth or adopted?
	birth	01	SKIP TO A6
	adopted	02	SKIP TO A6
	Father...........................................Is that birth or adopted?
	birth	03	SKIP TO A6
	adopted	04	SKIP TO A6
	Stepmother	05	SKIP TO A6
	Stepfather	06	SKIP TO A6
	Grandmother	07
	Grandfather	08
	Great Grandmother	09
	Great Grandfather	10
	Sister/stepsister	11
	Brother/stepbrother	12
	Other Relative or In-law (Female)	13
	Other Relative or In-law (Male)	14
	Foster Parent (Female)	15
	Foster Parent (Male)	16
	Other Non-relative (Female)	17
	Other Non-relative (Male)	18
	Parent’s Partner (Female)	19
	Parent’s Partner (Male)	20
	Don’t Know/ Didn’t Respond	99

A5. Are you CHILD’s legal guardian?
	No	01
	Yes	02

A6. Is CHILD a boy or a girl?
	Boy	01
	Girl	02

A7. What is CHILD’S birth date?		____	____/	_____ _____/	_____ _____
		Month		Day	Year

B. ACTIVITIES WITH YOUR CHILD Now I have some questions about you and CHILD at home. B1. 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 B2
	Once or twice	02
	Three or more times	03
	Every day	04

B1a. Who read to CHILD in the past week?

	DO NOT READ LIST. CIRCLE ALL THAT APPLY.

	Mother/Mother-figure	01
	Father/Father-figure	02
	Other household member	03
	Non-household member	04

B3. In the past week, have you or someone in your family done the following things with CHILD? (READ LIST BELOW) B4. IF YES: How many times have you done this in the past week? Would you say one or two times, or three or more?

B5. **AFTER COMPLETING ALL OF B3 AND B4(a-k), ASK THE FOLLOWING FOR EACH ACTIVITY CODED "YES" IN B3:** Who (Read Item)?
B3. In the past week, have you or someone in your family ...			B4		B5
			How many times?		Who (READ ITEM)? DO NOT READ CHOICES. CIRCLE ALL THAT APPLY.
			1-2	3+	Mother/ Mother Figure	Father/ Father figure	Other Household Member	Non- Household Member
	NO	YES
a. Told (him/her) a story?	01	02	1-2	3+	01	02	03	04
b. Taught (him/her) letters, words, or numbers?	01	02	1-2	3+	01	02	03	04
c. Taught (him/her)songs or music?	01	02	1-2	3+	01	02	03	04
d. Worked on arts and crafts with (him/her)?	01	02	1-2	3+	01	02	03	04
e. Played with toys or games indoors?	01	02	1-2	3+	01	02	03	04
f. Played a game, sport, or exercised together?	01	02	1-2	3+	01	02	03	04
g. 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
h. 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
i. Talked about what happened during (his/her) day?	01	02	1-2	3+	01	02	03	04
j. Talked about TV programs or videos?	01	02	1-2	3+	01	02	03	04
k. Played counting games like singing? songs with numbers or reading books with numbers	01	02	1-2	3+	01	02	03	04

B6.

In the past month, that is since (MONTH)(DAY), has anyone in your family done the following things with CHILD?

B7. AFTER COMPLETING ALL OF B6(a-j), ASK THE FOLLOWING FOR EACH ACTIVITY CODED "YES": Who has (READ ITEM) with CHILD?
B6. In the past month, that is since (MONTH)(DAY), has anyone in your family done the following things with CHILD?			B7. [ASK ONLY AFTER COMPLETING ALL OF B6] Who has (READ ITEM) with CHILD? [DO NOT READ CHOICES. CIRCLE ALL THAT APPLY. IF NOT MOTHER/ OR FATHER/, CLARIFY IF HOUSEHOLD OR NON-HOUSEHOLD MEMBER]
			Mother/ Mother Figure	Father/ Father figure	Other Household Member	Non- Household Member
	NO	YES
a. Visited a library?	01	02	01	02	03	04
b. Gone to a movie?	01	02	01	02	03	04
c. Gone to a play, concert, or other live show?	01	02	01	02	03	04
d. Gone to a mall?	01	02	01	02	03	04
e. Visited an art gallery, museum, or historical site?	01	02	01	02	03	04
f. Visited a playground, park, or gone on a picnic?	01	02	01	02	03	04
g. Visited a zoo or aquarium?	01	02	01	02	03	04
h. Talked with CHILD about (his/her) family history or ethnic heritage?	01	02	01	02	03	04
i. Attended an event sponsored by a community, ethnic, or religious group?	01	02	01	02	03	04
j. Attended an athletic or sporting event in which CHILD was not a player?	01	02	01	02	03	04

C. DISABILITIES

C1.	Does CHILD have any special needs or disabilities--for example, physical, emotional, language, hearing, learning difficulty, or other special needs?

No	01	SKIP TO D1
Yes	02
Don't Know	99	SKIP TO D1

C2.	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

C3.	Does CHILD receive services for (his/her) disability?

	No	01
	Yes	02

D. YOUR CHILD’S BEHAVIOR

D1.	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
a. Makes friends easily?	01	02	03
b. Enjoys learning?	01	02	03
c. Has temper tantrums or hot temper?	01	02	03
d. Can't concentrate, can't pay attention for long?	01	02	03
e. Is very restless, and fidgets a lot?	01	02	03
f. Likes to try new things?	01	02	03
g. Shows imagination in work and play?	01	02	03
h. Is unhappy, sad, or depressed?	01	02	03
i. Comforts or helps others?	01	02	03
j. Hits and fights with others?	01	02	03
k. Worries about things for a long time?	01	02	03
l. Accepts friends' ideas in sharing and playing?	01	02	03
m. Doesn't get along with other kids?	01	02	03
n. Wants to hear that he or she is doing okay?	01	02	03
o. Feels worthless or inferior?	01	02	03
p. Makes changes from one activity to another with difficulty?	01	02	03
q. Is nervous, high-strung, or tense?	01	02	03
r. Acts too young for (his/her) age?	01	02	03
s. Is disobedient at home?	01	02	03

E. HOUSEHOLD RULES

Now I’d like to ask you a few questions about rules and setting limits in the home

E1. In your house, are there rules or routines about. . .

**READ LIST. CIRCLE ONE RESPONSE FOR EACH.**
	NO	YES	NA
a. What TV programs CHILD can watch?	01	02	03
b. How many hours CHILD can watch TV?	01	02	03
c. What kinds of food CHILD eats?	01	02	03
d. What time CHILD goes to bed?	01	02	03
e. What chores CHILD does?	01	02	03

E2.	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 E4
	Yes	02

E3.

About how many times in the past week?

___ ___ number of times

E4.	Have you used time out or sent CHILD to (his/her) room in the past week for not minding?

	No	01	SKIP TO F1
	Yes	02

E5.

About how many times in the past week?

___ ___ number of times

F. YOU AND YOUR FAMILY

Now I’m going to ask you some questions about you and your family.

F1. What is your birth date?		____ ____/	_____ _____/	_____ _____
		Month	Day	Year

F2.	What is your current marital status?

	Single, never married	01
	Married	02
	Separated	03
	Divorced	04
	Widowed	05

F3.

How old were you at the birth of your first child?

____ ____ years old

F5. Please tell me the first name of everyone in your household. PROBE: Is there anyone else in your household?
			IF OLDER THAN 15:
F5. First Name	F6. What is NAME’s relationship to CHILD? (See codes below)	F7. How old is NAME?	F8. Is NAME employed? 01=No 02=Yes 90=NA 99=DK
a.(Respondent)
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
RELATIONSHIP CODES: 01=Mother (biological) 02=Mother (adoptive) 03=Father (biological) 04=Father (adoptive) 05=Stepmother 06=Stepfather 07=Grandmother 08=Grandfather		09=Great grandmother 10=Great grandfather 11=Sister/Stepsister 12=Brother/Stepbrother 13=Other relative or in-law (female) 14=Other relative or in-law (male)	15=Foster parent (female) 16=Foster parent (male) 17=Other non-relative (female) 18=Other non-relative (male) 19=Parent’s partner (female) 20=Parent’s partner (male) 99=Don’t know/Didn’t Respond


INTERVIEWER:	IF MOTHER IS RESPONDENT		SKIP TO F16
	IF MOTHER IS NOT RESPONDENT AND
		NOT IN HOUSEHOLD	GO TO F9
		IN HOUSEHOLD	SKIP TO F14

F9.	Does CHILD’s mother live within an hour’s ride of CHILD?

No	01
Yes	02
Mother is deceased	03	Ask F12 and F13, then Skip to F16
Don't Know	99

F10.	Does she contribute to the financial support of the child?

	No	01
	Yes	02
	Don't Know	99

F11.	How often does CHILD see (his/her) mother? Does (he/she) see her ...

READ LIST. CIRCLE ONE RESPONSE.

	Rarely or never	01
	Several times a year	02
	Several times a month	03
	Several times a week	04
	Every day	05
	Don’t know	99

REMINDER -- IF MOTHER IS DECEASED, ASK F12-F15 THEN SKIP TO F16

F12.	Is there anyone else who is like a mother to CHILD?

	No	01	SKIP TO F14
	Yes	02

F13.	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
	A relative of the child who lives in the household,	04
	A relative of the child who doesn’t live in the household	05
	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

F14.	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

F15.	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? ________________________________________
Is that: Full-time	02
Part-time	03
Seasonal	04

		Unemployed, not looking for work	05
		Looking for Work	05
		Laid off	07
		In School/training	08
		In Jail/prison	09
		In Military	10
		Something Else (Please specify)________________....	11
		Don’t Know	99


INTERVIEWER:	IF FATHER IS RESPONDENT		SKIP TO F23
	IF FATHER IS NOT RESPONDENT AND
		NOT IN HOUSEHOLD	GO TO F16
		IN HOUSEHOLD	SKIP TO F21

F16.	Does CHILD’s father live within an hour’s ride of CHILD?

No	01
Yes	02
Father is deceased	03	Ask F19 and F20, then Skip to F23
Don't Know	99

F17.	Does he contribute to the financial support of the child?

	No	01
	Yes	02
	Don't Know	99

F18.	How often does CHILD see (his/her) father? Does (he/she) see him ...

READ LIST. CIRCLE ONE RESPONSE.

	Rarely or never	01
	Several times a year	02
	Several times a month	03
	Several times a week	04
	Every day	05
	Don’t know	99

REMINDER -- IF FATHER IS DECEASED, ASK F19-F20, THEN SKIP TO F23

F19.	Is there anyone else who is like a father to CHILD?

	No	01	SKIP TO F21
	Yes	02

F20.	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
	A relative of the child who lives in the household,	04
	A relative of the child who doesn’t live in the household	05
	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

F21.	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

F22.	Is he 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 his occupation? ________________________________________
Is that: Full-time	02
Part-time	03
Seasonal	04

		Unemployed, not looking for work	05
		Looking for Work	05
		Laid off	07
		In School/training	08
		In Jail/prison	09
		In Military	10
		Something Else (Please specify)________________....	11
		Don’t Know	99

F23.	What is the highest grade or year of regular school that you have completed?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

	No formal schooling	00
	Less than 8th grade	07
	8th grade	08
	9th grade	09
	10th grade	10
	11th grade	11
	12th grade	12
	High school diploma	13
	GED	14
	Some college	15
	Associate’s degree	16
	Bachelor’s degree	17
	Graduate degree	18
	Don’t know	99

F24.	Are you currently working towards any certificate, diploma, or degree?

	No	01
	Yes	02

F25.	What language is most frequently spoken in your home?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

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

F26.	What is CHILD’s racial or ethnic background?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

	Asian or Pacific Islander	01
	Black (African American; non-Hispanic)	02
	White (Caucasian; non-Hispanic)	03
	Hispanic (Latino)	04
	Native American or American Indian or Alaskan Native	05
	Other (Please Specify)_________________________________	06

F27.	In what country was CHILD born?

	USA	01
	Other (Please specify country)	02

F28.	In what country were you born?

	USA	01
	Other (Please specify country)	02

F29.

How many years have you lived in the United States?

______ ______years

G. 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.

G1.	Do you have any earnings from a job or jobs, including self-employment?

	No	01	SKIP TO G4
	Yes	02

G2.

How many jobs do you have currently?

______ jobs

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

G3.	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?

Job	Seasonal	Full-time	Part-time
(1)	01	02	03
(2)	01	02	03
(3)	01	02	03

G4.

In how many of the last twelve months have you worked?

______ ______ months worked

G5.	Are you currently looking for (a/another) job?

	No	01
	Yes	02

G6.

Not including yourself, how many other adults contribute to your household income?

______ ______ adults

G7.	Is CHILD covered by health insurance from any of the following sources?

READ LIST.

		No	Yes
a.	Health insurance through your job(s) or the job of another employed adult?...	01	02
b.	Health insurance purchased by you as an individual or family?	01	02
c.	Health insurance covered by Medicaid or by another public assistance program such as a Medicaid HMO?	01	02
d.	Health insurance covered by CHIP (Child Health Insurance Program)?	01	02
e.	No insurance coverage at all	01	02

G8.	Do you or any member of your household receive any of the following other sources of household income or support?

READ LIST		NO	YES
a.	Welfare (TAN)	01	02
b.	Unemployment Insurance	01	02
c.	Food Stamps	01	02
d.	WIC--Special Supplemental Food Program for Women, Infants, and Children	01	02
	NOTE: If Yes in d.: d1. Is CHILD receiving WIC benefits?	01	02
e.	Child support	01	02
f.	SSI or SSDI	01	02
g.	Social Security Retirement or Survivor's benefits	01	02
h.	Loan repayments--for example, from friends, relatives, and so forth	01	02
i.	Medicaid or medical assistance	01	02
j.	Payments for providing foster care	01	02
k.	Energy assistance	01	02
l.	Money given to the family	01	02
m.	Education grants/assistance	01	02
n.	Other (Please specify)__________________________________	01	02

G9.	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 G11
Refused	98	SKIP TO G11
Don't Know	99

G10.	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.

G11.

How many times have you moved in the last year?

____ ____ times moved

G12.	Do you currently own your own home or apartment, pay rent, or live in public or subsidized housing?

	Owns or buying home or apartment	01
	Rents (without public assistance)	02
	Public or subsidized housing	03
	Some other arrangement	04

G13.	Since CHILD was born, has your family ever been homeless or not had a regular place to live?

	No	01
	Yes	02

G14.	What type of transportation do you and your family usually use when you have to go somewhere, for example, to work or school, or to shop for groceries? [PROBE]: What is your main method of transportation?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

Own or family vehicle	01
Friend's or other relative's vehicle	02
Public transportation	03
Taxicab	04
Walk	05
Other (please specify)	04

G15.	How far is your home from the nearest bus, train, or subway stop or station?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

One block or less	01
Two to six blocks	02
Seven blocks to one mile	03
One to five miles	04
More than five miles	05
No public transportation in the area	06

**G16.** I would like to ask you several questions about whether you and your family have enough resources to meet the needs of your family as a whole, as well as the needs of individual family members. For each item that I mention, please let me know which answer best describes how well the needs are met on a regular basis in your family
(that is, month-in and month-out).
QUESTION: To what extent are the following resources adequate for your family? Do you have enough ...	Rarely or never	Sometimes	Frequently or Always	Does not apply
a. food for three meals a day?	01	02	03	99
b. money to buy necessities (e.g. food, clothing)?	01	02	03	99
c. clothes for your family?	01	02	03	99
d. room or space in your home or apartment?	01	02	03	99
e. furniture for your home or apartment?	01	02	03	99
f. money to pay monthly bills?	01	02	03	99
g. sleep or rest?	01	02	03	99
h. time to be by yourself?	01	02	03	99
i. time to be with your child(ren)?	01	02	03	99
j. time to be with your spouse?	01	02	03	99
k. time to be with close friends?	01	02	03	99
i. time to be together as a family?	01	02	03	99
m. time to socialize?	01	02	03	99
n. toys for your child(ren)?	01	02	03	99
o. money to buy things for yourself?	01	02	03	99
p. money for travel or vacations?	01	02	03	99
q. money for family entertainment (e.g., movies)?	01	02	03	99
r. money to save?	01	02	03	99
s. to give your child(ren) all that you want to give them?	01	02	03	99
t. heat for your house or apartment?	01	02	03	99
u. medical care for your family?	01	02	03	99
v. public assistance (SSI, TANF, Medicaid, etc.)?	01	02	03	99
w. dependable transportation (own car or provided by others?	01	02	03	99
x. telephone or access to a phone?	01	02	03	99
y. babysitting for your child(ren)?	01	02	03	99
z. child care/day care for your child(ren)?	01	02	03	99
aa. dental care for your family?	01	02	03	99

H. CHILD CARE

Now let’s talk about any child care arrangements that you use for CHILD right now. This does not include babysitting used for social activities such as going out in the evening.

H1.	Is CHILD currently in child care?

	No	01	SKIP TO H11
	Yes	02

H2.	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

H3.	Is that person or place licensed, certified, or regulated?

	No	01
	Yes	02
	Don't Know	99

H4.

How many hours a week is this care used?

____ ____ hours per week

H5.	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

H6.	How did you first learn about this child care provider?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

Referred by friend, neighbor, relative	01
Referred by a welfare or social service case manager	02
Newspaper, advertisement, or yellow pages	03
Referred by community-based agency or program	04
Referred by resource and referral agency, R&R, or I&R	05
Provider is family member	06
Already knew provider	07
Word of mouth	08
Bulletin or message board	09
Other (Please specify) ____________________________	10

H7.

Why did you decide to use this type of child care? _____________________________________________________________________

_______________________________________________________________________________________________________________

H8.

What do you like about this child care? ______________________________________________________________________________

_______________________________________________________________________________________________________________

H9.

What do you not like about this child care? ___________________________________________________________________________

_______________________________________________________________________________________________________________

H10.	How satisfied (are/were) you with how easy it is to get CHILD to your child care provider?

READ LIST. CIRCLE ONE RESPONSE.

Very satisfied	01
Satisfied	02
Neither satisfied no dissatisfied	03
Dissatisfied	04
Very Dissatisfied	05

H11.	If you could use any type of child care and not have to worry about how much it would cost, what type of child care arrangement would you prefer to use for CHILD?

DO NOT READ LIST. CIRCLE ONE RESPONSE.

CHILD's other parent or stepparent	01
Respondent's partner	02
CHILD's sibling	03
CHILD's grandparent	04
Other relative of CHILD	05
Friend or neighbor of parent	06
Other non-relative	07
Day or group care center	08
Nursery, preschool, or Head Start	09
Child cares for self	10
Respondent's work or activity at home	11
Respondent would care for CHILD at work or activity place	12
Respondent would stay at home and care for child	13
Other arrangement (Please specify) ________________________________	14

H12.

[If yes response to Q8] You mentioned earlier when we first spoke, that you had heard of Head Start. What are your impressions of Head Start?
Probe: What kind of program is it? Did you consider using Head Start? Why not?

_______________________________________________________________________________________________________________

I. FAMILY HEALTH CARE

i1.	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

i2.	Does CHILD had an illness or condition that requires regular, ongoing care?

No	01
Yes	02
Don't Know	99

i3.	Does CHILD have a regular health care provider for routine medical care such as well-child care and check-ups?

No	01
Yes	02
Don't Know	99

i3.	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

i4.	Does any impairment or health problem now keep you from working at a job or business?

	No	01
	Yes	02	SKIP TO F16

i5.	Are you limited in the kind or amount of work you can do because of any impairment or health problem?

	No	01
	Yes	02

i6.	Do you smoke tobacco such as cigarettes or cigars now?

	No	01	SKIP TO F16b
	Yes	02

i6a. On average, how many cigarettes do you smoke a day?

READ LIST. CIRCLE ONE RESPONSE.

Less than one cigarette a day	01
One to five cigarettes a day	02
About ½ pack a day (6-15 cigarettes)	03
About a pack a day (16-25 cigarettes)	04
About a 1 ½ packs a day (26-35 cigarettes)	05
About 2 packs or more a day (over 35 cigarettes)	06

i6b. Is there (anyone/anyone else) in your household that smokes tobacco, like cigarettes or cigars?

	No	01	SKIP TO F17
	Yes	02

i6c. Would that be

READ LIST. CIRCLE ONE RESPONSE.

Less than one cigarette a day	01
One to five cigarettes a day	02
About ½ pack a day (6-15 cigarettes)	03
About a pack a day (16-25 cigarettes)	04
About a 1 ½ packs a day (26-35 cigarettes)	05
About 2 packs or more a day (over 35 cigarettes)	06

The next few questions are about drinks of alcoholic beverages. By a “drink” we mean a can or bottle of beer, a glass of wine or a wine cooler, a shot of liquor, or a mixed drink with liquor in it.

i7.	Think specifically about the past 30 days – on how many days did you drink one or more drinks of alcoholic beverages?

		______ ______	Days
I have drunk alcoholic beverages but not during the past 30 days	01
I have never drunk an alcoholic beverage in my life	02	SKIP TO I8
Refused to answer	98	SKIP TO I8

i7a. On the days that you drank during the past 30 days, how many drinks did you usually have?

		____ ____	Drink(s) per day
	Refused to answer	98	SKIP TO I8

i7b. During the past 30 days, on how many days did you have 5 or more drinks on the same occasion?
By “occasion” we mean at the same time or within a couple of hours of each other.

		______ ______	Days
On the days I drank, I never had 5 or more drinks	01
Refused to answer	98	SKIP TO I8

i8.	Is there (anyone/anyone else) in your household that drinks alcohol?

No	01	SKIP TO 19
Yes	02
Refused	98

i8a. Would that be

READ LIST. CIRCLE ONE RESPONSE.

Never	01
Once or twice a year	02
Once or twice a month	03
Once or twice a week	04
3 or more times a week	05
Daily	06

i9. Have you ever used any of the following drugs?						i10. Now I’d like to ask about your use of drugs during the past 12 months.
			No	Yes	Ref	Daily	Weekly	Monthly	Less Often	Not at All
	a.	Marijuana or hashish	01	02	98	01	02	03	04	05
	b.	Sedatives, tranquilizers, amphetamines without a prescription (also known as downers, uppers, speed, black beauties)	01	02	98	01	02	03	04	05
	c.	Cocaine, Crack Cocaine, or Heroin	01	02	98	01	02	03	04	05
	d.	Any other drug I didn't mention	01	02	98	01	02	03	04	05

i11.	Is there (anyone/anyone else) in your household that uses marijuana?

No	01	SKIP TO I12
Yes	02
Refused	98	SKIP TO I12

i11a. Would that be

READ LIST. CIRCLE ONE RESPONSE.

Daily	01
Weekly	02
Monthly	03
Less often	04

i12.	Is there (anyone/anyone else) in your household that uses any other of the drugs we just mentioned?

No	01	SKIP TO I13
Yes	02
Refused	98	SKIP TO I13

i12a. Would that be

READ LIST. CIRCLE ONE RESPONSE.

Daily	01
Weekly	02
Monthly	03
Less often	04

Now, I’d like you to think about any problems you might have had in the last twelve months when you used (alcohol/drugs/alcohol and drugs).

ONLY ASK ABOUT SUBSTANCES THAT WERE MENTIONED IN PREVIOUS QUESTIONS.

DURING THE PAST 12 MONTHS	Never	Once or Twice	Three or four times	Five or six times	More than six times	NA/Don't use drug	Ref
I13. How many times have you or anyone in your household gotten into trouble with family or friends including a husband/wife/partner) because of the use of
a. alcohol?	01	02	03	04	05	06	98
b. marijuana?	01	02	03	04	05	06	98
c. Other drugs?	01	02	03	04	05	06	98
I14. How often have you or anyone in your household had problems with your physical health because of the use of
a. alcohol?	01	02	03	04	05	06	98
b. marijuana?	01	02	03	04	05	06	98
c. Other drugs?	01	02	03	04	05	06	98
I15. How many times have you or anyone in your household gotten in trouble with the police because of the use of
a. alcohol?	01	02	03	04	05	06	98
b. marijuana?	01	02	03	04	05	06	98
c. Other drugs?	01	02	03	04	05	06	98
I16. How many times have you or anyone in your household missed work or had to call in sick because of the use of
a. alcohol?	01	02	03	04	05	06	98
b. marijuana?	01	02	03	04	05	06	98
c. Other drugs?	01	02	03	04	05	06	98

J. 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. Please remember, all of your answers are held in the strictest confidence. We will not tell anyone what you say.

J1.	For each of the following items, please tell me how often each one happened to you.

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

J2a.	I’m going to read a list of characteristics about neighborhoods. On a scale of 1-5, where 1 means “mostly false” and 5 means “mostly true”, please tell me how true these statements are for your neighborhood.

		Mostly	False		Mostly	True
a.	My neighborhood is a good place to live.	01	02	03	04	05
b.	My neighborhood is a good place to raise children.	01	02	03	04	05
c.	The people moving into the neighborhood in the past year or so are good for the neighborhood.	01	02	03	04	05
d.	I would like to move out of this neighborhood.	01	02	03	04	05
e.	There are some children in the neighborhood that I do not want my children to play with.	01	02	03	04	05
f.	The people moving into the neighborhood in the past year or so are bad for the neighborhood.	01	02	03	04	05
g.	For the most part, the police come within a reasonable amount of time when they are called.	01	02	03	04	05
h.	There is too much traffic in my neighborhood.	01	02	03	04	05
i.	There are enough bus stops in my neighborhood	01	02	03	04	05
j.	My neighborhood is conveniently located in the city.	01	02	03	04	05
k.	If I had to move out of this neighborhood, I would be sorry to leave.	01	02	03	04	05

J2b.	I’m going to read a list of things that some neighborhoods have. On a scale of 1-5, where 1 means “rarely” and 5 means “frequently”, please tell me how often the following occur in your neighborhood.

		Rarely			Frequently
a.	Litter or trash on the sidewalks and streets.	01	02	03	04	05
b.	Graffiti on buildings or walls.	01	02	03	04	05
c.	Abandoned cars.	01	02	03	04	05
d.	Vacant, abandoned, or boarded up buildings.	01	02	03	04	05
e.	Drug dealers or users hanging around.	01	02	03	04	05
f.	Drunks hanging around.	01	02	03	04	05
g.	Unemployed adults loitering.	01	02	03	04	05
h.	Young adults loitering	01	02	03	04	05
i.	Gang activity.	01	02	03	04	05
j.	Absentee landlords.	01	02	03	04	05
k.	Houses and yards not kept up.	01	02	03	04	05
l.	Disorderly or misbehaving groups of young children (younger than teenagers)	01	02	03	04	05
m.	Disorderly or misbehaving groups of teenagers.	01	02	03	04	05
n.	Disorderly or misbehaving groups of adults.	01	02	03	04	05

J3.	Has CHILD ever been a witness to a violent crime?

	No	01
	Yes	02
	Refused	98
	Don't know	99

J4.	Has CHILD ever been a witness to domestic violence?

	No	01
	Yes	02
	Refused	98
	Don't know	99

J5.	Has CHILD ever been the victim of a violent crime?

	No	01
	Yes	02
	Refused	98
	Don't know	99

J6.	Has CHILD ever been the victim of domestic violence?

	No	01
	Yes	02
	Refused	98
	Don't know	99

J7.	Since CHILD was born, have you, another household member (or a non-household biological parent) been arrested or charged with any crime by the police?

No	01	SKIP TO J8
Yes	02
Refused	98	SKIP TO J8

	J7a. Who was arrested or charged?
		Refused	98	SKIP TO J8

J7b. Did (he/she/they) spend anytime in jail?

	No	01
	Yes	02
	Refused	98

J8.	Since last spring, has CHILD lived apart from you (or mother) not including vacations or shared custody arrangements?

No	01	SKIP TO J9
Yes	02
Refused	98	SKIP TO J9

	J8a. For how long?
		Refused	98

	J8b. With whom?
		Refused	98

J9.	Have you ever been hit, kicked, punched, or otherwise hurt by someone within the past year?

No	01	SKIP TO J10
Yes	02
Refused	98

J9a. By whom?

ASK RELATIONSHIP, NOT NAME OF PERSON.

J10.	Do you feel safe in your current relationship?

	No	01
	Yes	02
	Refused	98

J11.	Is there a partner from a previous relationship who is making you feel unsafe now?

	No	01
	Yes	02
	Refused	98

K. Feelings

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.

K2.	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. You could not get "going"	01	02	03	04

Many people and groups can be helpful to members of a family raising a young child. We want to know how helpful different people and groups are to your family.

K3.	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
g. Non-family 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

K5. I am going to read you a list of things that may affect the lives of children and families. Please think about the past year and answer yes or no for the following things. You may explain any of your answers.
[Transitions] [Measuring Life Events]
	No	Yes
a. Did you get married?	01	02
b. Did you become engaged to be married?	01	02
c. Did you get divorced?	01	02
d. Did you separate from your partner (spouse, girl/boyfriend), even though you may be back together now?	01	02
e. Did you gain a new family member (through birth, adoption, someone moving in)?	01	02
f. Did you separate from a family member (older child moved out)?	01	02
g. Has someone you were close to died or been killed?	01	02
h. Was there a major change in your living conditions (moving, remodeling, deterioration of home or neighborhood)?	01	02
i. Has your child lived with someone else at some point during the past year?	01	02
j. Has a family member had a serious illness?	01	02
k. Has a family member been jailed or in prison?	01	02
l. Has there been a change in your work (new job, lost job, change in location)?	01	02
m. Has there been a change in your partner's work (new job, lost job, change in location)?	01	02
n. Have there been any other event(s) which you think have effected you or your child in the past year?	01	02

K6. We are interested in learning how you respond when you are dealing with upsetting or bothersome events that involve your family. Please think about all the upsetting, troubling, or bothersome events that have affected your family *in the past month*. Now think about how you *usually* responded to those events. [Transitions - Carver, Shaver, & Weintraub, 1989]
In response to upsetting family events, how much did you try to . . .	Not at all	Some- what	Quite a Bit	A Great Deal
a. Let your feelings out by crying or yelling?	01	02	03	04
b. Find something funny about the situation?	01	02	03	04
c. Give up trying to reach your goals in the situation?	01	02	03	04
d. Hold back or restrain yourself until the time was right to do something?	01	02	03	04
e. Make a plan about the best way to deal with the situation?	01	02	03	04
f. Put aside other activities so you could deal with situation?	01	02	03	04
g. Take action to get rid of the problems in the situation?	01	02	03	04
h. Seek spiritual comfort by praying or meditating?	01	02	03	04
i. Take your mind off the situation by doing other things?	01	02	03	04
j. Tell someone your feelings about the situation to get some support?	01	02	03	04
k. Get some advice from someone about what to do?	01	02	03	04
l. Be alone for a period of time?	01	02	03	04
m. Think about the situation as a chance to learn or grow as a person?	01	02	03	04
n. Decide to learn to live with the situation?	01	02	03	04
o. Make jokes about the situation?	01	02	03	04
p. Think hard to come up with a strategy for the situation?	01	02	03	04
q. Seek God's help or put your trust in a higher power?	01	02	03	04
r. Think about other things so you could forget about the situation?	01	02	03	04
s. Get some understanding or sympathy from someone?	01	02	03	04
t. Talk to someone who could do something to help you?	01	02	03	04
u. Get away from everything and everyone so you could deal with this alone?	01	02	03	04
v. Help yourself feel better by using drugs or alcohol?	01	02	03	04
w. Express yourself emotions by trying to destroy something or hurt someone?	01	02	03	04
x. Think about the situation less by drinking alcohol or taking drugs?	01	02	03	04

Those are all the questions I have for you. Thank you very much for your time.

INTERVIEWER:

Please give respondent money, get completed receipt, tear-off last page of names and numbers and give to respondent.

Complete the evaluation pages after interview.

Attach original screener to back of questionnaire.

L. QUESTIONNAIRE EVALUATION

Please provide provide feedback about the interview. Include information about the question content, question flow, respondent’s reaction, length of interview or anything you deem important.

A. Introduction

B. Activities With Your Child

C. Disabilities

D. Your Child’s Behavior

E. Household Rules

F. You and Your Family

G. Employment

H. Child Care

I. Family Health Care

J. Home and Neighborhood Characteristics

K. Feelings

M: CONFIDENCE RATINGS

COMPLETE AFTER INTERVIEW IS CONCLUDED.

M1.	Interview Completion Code:

Respondent terminated interview prematurely	01
Respondent refused interview	02
Respondent unable to respond (Please specify) ________________________________________	03
Interview completed	04

M2.	Please rate the following qualities of the respondent, the interviewing situation, and the data. The Respondent (was/had):

a.	Able to understand questions easily	7	6	5	4	3	2	1	Hardly able to understand
b.	Truthful	7	6	5	4	3	2	1	Untruthful
c.	Accurate	7	6	5	4	3	2	1	Inaccurate
d.	Interested in the interview	7	6	5	4	3	2	1	Not interested in the interview20/
e.	Cooperative	7	6	5	4	3	2	1	Uncooperative
f.	No English language problem	7	6	5	4	3	2	1	Spoke English with great difficulty
g.	Interviewed without interruption	7	6	5	4	3	2	1	Interrupted often
h.	Your opinion about the overall quality of the data:
	High	7	6	5	4	3	2	1	Low

A Feasibility Study of Head Start Recruitment and Enrollment

Thank you very much for your cooperation. If you have any questions about the study or the interview, you may call the following numbers:

Louisa Tarullo, Ed.D.
Administration on Children, Youth and Families
(202) 205-8324

David Connell, Ph.D.
Abt Associates, Inc.
(617) 349-2804

Robert W. O’Brien, Ph.D.
The CDM Group, Inc.
(301) 654-6740

Table of Contents | Previous | Next

Appendix G: Parent Interview

A Feasibility Study of Head Start Recruitment and Enrollment

Spring ‘00 Parent Interview

COVER SHEET

PHONE ELIGIBILITY SCREEN (Level 1)

PHONE ELIGIBILITY SCREEN (Level 2)

PHONE ELIGIBILITY SCREEN (Level 3)

SCHEDULE INTERVIEW APPOINTMENT

INTRODUCTION

B. ACTIVITIES WITH YOUR CHILD

C. DISABILITIES

D. YOUR CHILD’S BEHAVIOR

E. HOUSEHOLD RULES

F. YOU AND YOUR FAMILY

G. EMPLOYMENT AND INCOME

H. CHILD CARE

I. FAMILY HEALTH CARE

J. HOME AND NEIGHBORHOOD CHARACTERISTICS

K. Feelings

L. QUESTIONNAIRE EVALUATION

M: CONFIDENCE RATINGS

A Feasibility Study of Head Start Recruitment and Enrollment