Parent Survey about FSWs

Appendix A-5:
Parent Survey about Family Service Workers (FSWs)

Family and
Early Care and
Education Provider
Relationship Study

Parent Survey About Family Service Workers

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OMB No.: XXXX-XXXX
Expiration Date: XX/XXXX

Parent Survey about Family Service Workers
Thank you for agreeing to participate in the Family and Early Care and Education Provider Relationship
Study. The results will help us develop surveys that teachers, child care providers, and policymakers can
use to improve children’s care and education.
This survey asks questions about your family service worker. Please only think about this person when
answering the following questions.
All information obtained from this study will be kept private. The report summarizing the findings will
not contain any names or identifying information.
Please follow these steps:
1. Complete the parent survey about family service workers. It takes approximately 10 minutes.
Please use a black or blue pen to complete this form.
Mark

to indicate your answer.

If you change your answer, mark
right answer.

on the wrong answer, and mark

to indicate the

2. Use the self-addressed, postage-paid envelope, to mail the survey back to:

XXXXX XXXXXX
Westat
1600 Research Boulevard
Rockville, Maryland
20850-3129
3. As a token of our appreciation for your time and effort, you will receive a check for $25 within 2-3
weeks of our receipt of your completed questionnaire.

Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for
reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not
conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB
number.
The office of Management and Budget has approved the data collection under OMB #XXXX-XXXX. OPRE is authorized to conduct
this study under Section 649 of the Head Start Act, as amended by the Improving Head Start for School Readiness Act of 2007,
codified at 42 United States Code (U.S.C.) 9844.

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OMB No.: XXXX-XXXX
Expiration Date: XX/XXXX

1. Since September, how often have you talked to your family service worker about the following?
[MARK ONE BOX IN EACH ROW.]
Never

Rarely

Sometimes

Very often

a. Your child’s experiences in the education
and care setting ...........................................
b. Your child’s abilities ..................................
c. Your child’s general behavior ....................
d. Goals you have for your child ....................
e. What to expect at each stage of your
child’s development ..................................
f. Your vision for your child’s future .............

2. How often do you have difficulty communicating with your family service worker because he or
she has a strong accent or speaks a different language than you?
[MARK ONLY ONE BOX.]
Never .........................................................................................................
Rarely ........................................................................................................
Sometimes .................................................................................................
Very often ..................................................................................................

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OMB No.: XXXX-XXXX
Expiration Date: XX/XXXX

3. How comfortable do you feel sharing the following information with your family service
worker?
[MARK ONE BOX IN EACH ROW.]
Very
uncomfortable

Uncomfortable

a. If your child has siblings ............................
b. If you have other adult relatives living in
your household ...........................................
c. Your household schedule ...........................
d. Your marital status .....................................
e. Your personal relationship with a spouse
or partner ....................................................
f.

Your employment status ...........................

g. Your financial situation ............................
h. Your health ...............................................
i.

Your family life ........................................

j.

The role that faith and religion play in
your household ........................................

k. Your family’s culture and values ............
l.

What you do outside of the education and
care setting to encourage your child’s
learning ....................................................

m. How you discipline your child ................
n. Problems your child is having at home ...
o. Changes happening at home ....................
p. Health issues your child has, such as food
allergies or asthma ...................................

4. How often does your family service worker ask about your family?
[MARK ONLY ONE BOX.]
Never .........................................................................................................
Rarely ........................................................................................................
Sometimes .................................................................................................
Very often ..................................................................................................

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Comfortable

Very
comfortable

OMB No.: XXXX-XXXX
Expiration Date: XX/XXXX

5. If you had a problem with your family service worker, how comfortable would you feel talking
to him or her about it?
[MARK ONLY ONE BOX.]
Very uncomfortable ...................................................................................
Uncomfortable ...........................................................................................
Comfortable ...............................................................................................
Very comfortable .......................................................................................
6. How often does your family service worker:
[MARK ONE BOX IN EACH ROW.]
Never

Rarely

Sometimes

Very often

a. Work with you to develop strategies you
can use at home to support your child’s
learning and development? .........................
b. Listen to your ideas about ways to change
or improve the education and care your
child receives? ...........................................
c. Offer you advice about parenting? ............
d. Remember personal details about your
family when speaking with you? ...............
e. Provide you with opportunities to give
feedback on your family service worker’s
performance? .............................................

7. How much do you agree or disagree with the following statement?
My family service worker has increased my confidence to accomplish goals for myself.
[MARK ONLY ONE BOX.]
Strongly disagree .......................................................................................
Disagree .....................................................................................................
Agree .........................................................................................................
Strongly agree............................................................................................

8. How much do you agree or disagree with the following statement?
My family service worker has increased my confidence as a parent.
[MARK ONLY ONE BOX.]
Strongly disagree .......................................................................................
Disagree .....................................................................................................
Agree .........................................................................................................
Strongly agree............................................................................................
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OMB No.: XXXX-XXXX
Expiration Date: XX/XXXX

9. How much do you agree or disagree with the following statement?
My family service worker has my best interests at heart.
[MARK ONLY ONE BOX.]
Strongly disagree .......................................................................................
Disagree .....................................................................................................
Agree .........................................................................................................
Strongly agree............................................................................................

10. How much do you agree or disagree with the following statement?
My family service worker has my child’s best interests at heart.
[MARK ONLY ONE BOX.]
Strongly disagree .......................................................................................
Disagree .....................................................................................................
Agree .........................................................................................................
Strongly agree............................................................................................
11.  Please indicate how much the following words are like your family service worker.
My family service worker is…
[MARK ONE BOX IN EACH ROW.]
Not at all like A little like my A lot like my Exactly like my
my family
family service family service family service
service worker
worker
worker
worker

a. Caring ..........................................................
b. Understanding .............................................
c. Rude ............................................................
d. Flexible ........................................................
e. Dependable ..................................................
f.

Trustworthy .................................................

g. Impatient......................................................
h. Unfriendly ..................................................
i.

Respectful ...................................................

j.

Judgmental..................................................

k. Available ....................................................

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OMB No.: XXXX-XXXX
Expiration Date: XX/XXXX

12.

How strongly do you agree or disagree with the following statement?
My family service worker sees this job as just a paycheck.
[MARK ONLY ONE BOX.]
Strongly disagree ....................................................................................
Disagree .................................................................................................
Agree ......................................................................................................
Strongly agree ........................................................................................

13.

How strongly do you agree or disagree with the following statements?
[MARK ONE BOX IN EACH ROW.]
Strongly
disagree

Disagree

Agree

Strongly agree

a.

My family service worker judges my
family because of our faith and religion...

b.

My family service worker judges my
family because of our culture and values .

c.

My family service worker judges my
family because of our race/ethnicity .......

d.

My family service worker judges my
family because of our financial situation

14.

How easy or difficult is it for you to reach your family service worker during the day if you
have a question or if a problem comes up? 
[MARK ONLY ONE BOX.]
Very difficult ..........................................................................................
Difficult ..................................................................................................
Easy ........................................................................................................
Very easy................................................................................................

15.

On a scale of 1-5, where 1 is the worst you can imagine and 5 is the best you can imagine,
how would you describe your relationship with your family service worker?
[MARK THE BOX NEXT TO THE NUMBER THAT BEST DESCRIBES YOUR RELATIONSHIP.]
Worst
1

Best
2

3

4

6

5

OMB No.: XXXX-XXXX
Expiration Date: XX/XXXX

16.

For how long has your current family service worker been working with your family?
[MARK ONLY ONE BOX.]
Less than 6 months ...............................................................................
6 months-less than 1 year .....................................................................
1 year-less than 2 years.........................................................................
2 years or more .....................................................................................

17. 

What language do you most speak at home?
[MARK ONLY ONE BOX.]
English ..................................................................................................
Spanish .................................................................................................
English and Spanish equally .................................................................
English and another language equally ..................................................
Other language......................................................................................

18.

What is your race?
[MARK ALL THAT APPLY.]
White ......................................................................................................
Black or African American ....................................................................
American Indian or Alaska Native .........................................................
Asian Indian ...........................................................................................
Chinese ...................................................................................................
Filipino ...................................................................................................
Japanese .................................................................................................
Korean ....................................................................................................
Vietnamese .............................................................................................
Other Asian ............................................................................................
Native Hawaiian .....................................................................................
Guamanian or Chamorro ........................................................................
Samoan ...................................................................................................
Other Pacific Islander .............................................................................

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OMB No.: XXXX-XXXX
Expiration Date: XX/XXXX

19.

What is the highest level of education you have completed?
[MARK ONLY ONE BOX.]
Less than a high school diploma ............................................................
High school diploma or GED .................................................................
Some college, no degree ........................................................................
Associate’s degree ..................................................................................
Bachelor’s degree ...................................................................................
Graduate school degree ..........................................................................
END: THANK YOU FOR COMPLETING THIS SURVEY

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