Parent interview (including Parent child report)
Migrant and Seasonal Head Start Study
Parent Interview updated 3-17-17_clean
Parent interview (including Parent child report)
OMB: 0970-0493
OMB #0970-0493 Expiration: 07/31/2018
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MSHS Parent Interview
Spring 2017
Paperwork Reduction Act Statement: The referenced collection of information is voluntary. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The valid OMB control number for this information collection is 0970-0493 which expires 07/31/2018. The time required to complete this collection of information is estimated to average 60 minutes, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the collection of information. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: Abt Associates, 55 Wheeler Street, Cambridge MA 02138 Attention: Linda Caswell. |
CONTENTS
A. CHILD CHARACTERISTICS 6
B. HOUSEHOLD MEMBER CHARACTERISTICS 7
C. HOUSEHOLD LINGUISTIC ABILITIES/PRACTICES 11
D. CHILD HEALTH 1
E. WORK AND RESOURCES 4
F. HOUSEHOLD MEMBERS’ HEALTH 7
G. RAISING A CHILD 11
H. HOUSING 13
I. CHILD CARE ARRANGEMENTS AND MSHS INVOLVEMENT 15
INTRODUCTION
(INTERVIEWER READS THIS TO PARENT.)
Hello, my name is _______. We would like to interview you about [MSHS CHILD]’s experiences in Migrant and Seasonal Head Start and other things related to (his/her) Migrant and Seasonal Head Start experience. Thank you for agreeing to talk with me.
As you may remember, the purpose of this study is to learn more about families in the Migrant and Seasonal Head Start Program and the different kinds of services that are provided to children and families.
The interview will take about 45 minutes of your time to complete. We will also ask you some questions about your child’s behaviors. These questions will take an additional 15 minutes to complete. As a thank you, we will give you $30 for your time completing the survey. We will also do some activities with your child at the MSHS center so that we can find out how MSHS programs can help children learn and grow. We will give your child a small toy that is worth about $2 to thank him/her. We will also ask your child’s teachers some questions about your child, to better understand your child’s social skills, behaviors, and approaches to learning, and will observe your child’s classroom.
Everything we talk about today will be kept private to the extent permitted by law. To protect your privacy, we have a Certificate of Confidentiality from the National Institutes of Health. We can use this to refuse by law to give information that may identify you. But, if we learn that a child or adult is in danger, by law we must report this. This could mean legal action. No one from your MSHS program will see or hear your answers or learn about how your child does on the activities. We will only report the results for parents and children as a group. We will not personally identify either you or your child in any report or materials from this study. I will ask you questions and type in your answers. If you have any questions at any time during this interview, please feel free to ask them. You may stop me at any time and you may ask me to go back to earlier questions to change your answers. There are no right or wrong answers to these questions.
Your participation is completely voluntary. If you choose not to complete this interview, it will not affect you or your child’s participation in the Migrant and Seasonal Head Start Program.
The things you tell me are very important, so please answer as best as you can. Occasionally, I may have to ask a question that does not apply to you or may seem sensitive in nature. You may choose not to answer these questions or any others. If that happens, just tell me and I will move on to the next question.
Do you have any questions before we begin?
SCREENER QUESTIONS
MARK LANGUAGE USED FOR INTERVIEW:
English
Spanish
Other language (specify)______________________________
Now, I would like to confirm some information about you and your child.
Before we get started, I would like to make sure we have your name written correctly. [READ NAME FROM CONSENT FORM TO RESPONDENT AND VERIFY SPELLING.]
Correct GO TO SCREENER QUESTION 5
Incorrect
May I have the correct spelling of your name?
Yes
No GO TO SCREENER QUESTION 5
Don’t know/Refused GO TO SCREENER QUESTION 5
RECORD CORRECT SPELLING OF RESPONDENT’S NAME.
FIRST NAME:
MIDDLE NAME:
LAST NAME:
ADDITIONAL LAST NAME(S):
Do you go by any other name besides [NAME OF RESPONDENT]? For example, do you use other names when completing paperwork?
Yes
No GO TO SCREENER QUESTION 8
Don’t know/Refused GO TO SCREENER QUESTION 8
Can you give me that name?
Yes
No GO TO SCREENER QUESTION 8
Don’t know/Refused GO TO SCREENER QUESTION 8
RECORD ADDITIONAL RESPONDENT NAMES.
FIRST NAME:
MIDDLE NAME:
LAST NAME:
ADDITIONAL LAST NAME(S):
What is your birth date?
| | | / | | | / | 1 | 9 | | |
MONTH DAY YEAR
Don’t know/Refused
Now, I would like to make sure we have your child’s name written correctly. Is it [CHILD’s NAME]? [READ NAME FROM CONSENT FORM TO RESPONDENT AND VERIFY SPELLING.]
Yes, correct GO TO SCREENER QUESTION 12
No, incorrect
May I have the correct spelling of [HIS/HER]’s name?
Yes
No GO TO SCREENER QUESTION 12
Don’t know/Refused GO TO SCREENER QUESTION 12
RECORD CORRECT SPELLING OF MSHS CHILD’S NAME.
FIRST NAME:
MIDDLE NAME:
LAST NAME:
ADDITIONAL LAST NAME(S):
Is the [CHILD’S] birth date [MONTH/DAY/YEAR]? [Read date from consent form]
Yes GO TO SCREENER QUESTION 14
No
Don’t know/Refused GO TO SCREENER QUESTION 14
What is the correct birth date?
| | | / | | | / | 2 | 0 | | |
MONTH DAY YEAR
Don’t know/Refused
I would like to talk with the person most responsible for [MSHS CHILD]’s care. Are you that person?
Yes GO TO SCREENER QUESTION 16
No GO TO SCREENER QUESTION 15; THEN END INTERVIEW
Who is the person most responsible for [MSHS CHILD]’s care?
NAME
ADDRESS
CITY
STATE: |___|___|
|___|___|___| - |___|___|___| - |___|___|___|___| TELEPHONE
Don’t know/Refused
What is your sex? (SELECT ONE ONLY.)
Male
Female
Other
Don’t Know/Refused
What is your relationship to [MSHS CHILD]? (CODE ONLY ONE.)
Biological mother
Biological father
Adoptive mother
Adoptive father
Stepmother
Stepfather
Grandmother
Grandfather
Great grandmother
Great grandfather
Sister/stepsister
Brother/stepbrother
Other relative or in-law (female)
Other relative or in-law (male)
Foster parent (female)
Foster parent (male)
Other non-relative (female)
Other non-relative (male)
Parent’s partner (female)
Parent’s partner (male)
Don’t Know/Refused
Is there a [male/female] who is also responsible for [MSHS CHILD]’s care? This is typically a [husband/wife] or the [MSHS CHILD’s] biological [father/mother]. (OTHER CAREGIVER MUST BE THE RESPONDENT’S SPOUSE OR PARTNER, OR THE CHILD’S BIOLOGICAL PARENT. DO NOT CONSIDER OTHER EXTENDED FAMILY THAT TAKES CARE OF CHILD.)
Yes
No GO TO SECTION A (CHILD CHARACTERISTICS) QUESTION 1
Don’t Know/Refused GO TO SECTION A (CHILD CHARACTERISTICS) QUESTION 1
What is [OTHER CAREGIVER’s] relationship to [MSHS CHILD]? (CODE ONLY ONE.)
MSHS Child’s biological mother
MSHS Child’s biological father
Stepmother
Stepfather
Parent’s partner (female)
Parent’s partner (male)
Adoptive mother
Adoptive father
Foster parent (female)
Foster parent (male)
Don’t Know/Refused
What is the first name of this person?
First Name of “OTHER CAREGIVER”: ________________________________________
Don’t Know/Refused
What is your relationship to [OTHER CAREGIVER]? (SELECT ONE ONLY.)
Married
Not married but cohabiting/Living with a partner
Separated
Divorced
Other family member (Specify: ______________________________)
Other (Specify: ______________________________)
Don’t Know/Refused
Now I am going to ask you some questions about your child.
Is [MSHS Child] a boy or a girl? (SELECT ONE.)
Boy
Girl
Don’t Know/Refused
What is [MSHS CHILD]’s race/ ethnicity? (Select one or more.)
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Don’t Know/Refused
IF RESPONDENT DID NOT SELECT “HISPANIC OR LATINO” GO TO QUESTION 4.
Which Hispanic or Latino origin best describes your child? (Select one or more.)
Mexican, Mexican-American, Chicano/a
Puerto Rican
Cuban
Another Hispanic, and/or Latino origin (specify): _____________________
Don’t Know/Refused
In what country was [MSHS CHILD] born? (SELECT ONE ONLY.)
U.S.A. GO TO SECTION B
Mexico
Puerto Rico
Central America (specify: ____________________)
South America (specify: ____________________)
Caribbean (specify: ____________________)
Southeast Asia (Indonesia, Cambodia, Vietnam, Laos, Thailand)
(specify: ____________________)Pacific Islands (The Philippines, Guam, Fiji, Etc.)
(specify: ____________________)Asia (China, Japan, Korea, Etc.) (specify: ____________________)
Africa (specify: ____________________)
Other: ________ (specify: ____________________)
Don’t Know/Refused
In what year did [MSHS Child] first move to the United States?
Year: | 2 | 0 | | |
Don’t Know/Refused
Now I am going to ask you some questions about yourself and your family.
What is your race/ ethnicity? (Select one or more.)
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander _
White
Don’t Know/Refused
IF RESPONDENT DID NOT SELECT HISPANIC OR LATINO, GO TO QUESTION 3.
Which Hispanic or Latino origin best describes you? (Select one or more.)
Mexican, Mexican-American, Chicano/a
Puerto Rican
Cuban
Another Hispanic, and/or Latino origin (specify): _____________________
Don’t Know/Refused
In what country were you born? (SELECT ONE ONLY.)
U.S.A. GO TO QUESTION 6.
Mexico
Puerto Rico
Central America (specify: ____________________)
South America (specify: ____________________)
Caribbean (specify: ____________________)
Southeast Asia (Indonesia, Cambodia, Vietnam, Laos, Thailand)
(specify: ____________________)Pacific Islands (The Philippines, Guam, Fiji, Etc.)
(specify: ____________________)Asia (China, Japan, Korea, Etc.) (specify: ____________________)
Africa (specify: ____________________)
Other: ________ (specify: ____________________)
Don’t Know/Refused
In what year did you first enter the U.S. to either work or live?
Year: ____________
Don’t Know/Refused
How many months or years have you spent in your home country since moving to the U.S., not counting time you may have spent in your home country?
Years: _______________
Months: _______________
Don’t Know/Refused
What is the highest grade or year of school you completed? (SELECT ONE ONLY.)
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In what country did you complete the highest grade? (SELECT ONE ONLY.)
U.S.A.
Mexico
Puerto Rico
Central America (specify: ____________________)
South America (specify: ____________________)
Caribbean (specify: ____________________)
Southeast Asia (Indonesia, Cambodia, Vietnam, Laos, Thailand)
(specify: ____________________)Pacific Islands (The Philippines, Guam, Fiji, Etc.)
(specify: ____________________)Asia (China, Japan, Korea, Etc.) (specify: ____________________)
Africa (specify: ____________________)
Other: ________ (specify: ____________________)
Don’t Know/Refused
Now I am going to ask you some questions about [OTHER CAREGIVER], the child’s other primary caregiver. (GO TO QUESTION 15 IF THERE IS NO OTHER CAREGIVER; I.E., IF SCREENER QUESTION 18 IS ‘NO’ OR ‘DON’T KNOW/REFUSED’.)
What is the race/ ethnicity of [OTHER CAREGIVER]? (Select one or more.)
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander _
White
Don’t Know/Refused
Which Hispanic or Latino origin best describes [OTHER CAREGIVER]? (Select one or more.)
Mexican, Mexican-American, Chicano/a
Puerto Rican
Cuban
Another Hispanic, and/or Latino origin (specify): _____________________
Don’t Know/Refused
In what country was [OTHER CAREGIVER] born?
U.S.A. GO TO QUESTION 13.
Mexico
Puerto Rico
Central America (specify: ____________________)
South America (specify: ____________________)
Caribbean (specify: ____________________)
Southeast Asia (Indonesia, Cambodia, Vietnam, Laos, Thailand)
(specify: ____________________)Pacific Islands (The Philippines, Guam, Fiji, Etc.)
(specify: ____________________)Asia (China, Japan, Korea, Etc.) (specify: ____________________)
Africa (specify: ____________________)
Other: ________ (specify: ____________________)
Don’t Know/Refused
In what year did [OTHER CAREGIVER] first enter the U.S. to either work or live?
Year: ____________
Don’t Know/Refused
How many years or months has [OTHER CAREGIVER] spent in your home country since moving to the U.S, not counting time [he/she] may have spent in [his/her] home country?
Years: _______________
Months: _______________
Don’t Know/Refused
What is the highest grade or year of school [OTHER CAREGIVER] completed? (SELECT ONE ONLY.)
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In what country did [OTHER CAREGIVER] complete the highest grade?
U.S.A.
Mexico
Puerto Rico
Central America (specify: ____________________)
South America (specify: ____________________)
Caribbean (specify: ____________________)
Southeast Asia (Indonesia, Cambodia, Vietnam, Laos, Thailand)
(specify: ____________________)Pacific Islands (The Philippines, Guam, Fiji, Etc.)
(specify: ____________________)Asia (China, Japan, Korea, Etc.) (specify: ____________________)
Africa (specify: ____________________)
Other: ________ (specify: ____________________)
Don’t Know/Refused
Now I am going to ask you some questions about your family.
What is your current marital status? (SELECT ONE ONLY.)
Married
Cohabiting/Living with a partner
Separated
Divorced
Widowed
Single
Other______________
Don’t Know/Refused
Who lives with [MSHS CHILD] and what is their relationship to [MSHS CHILD]? Please mention all family members and non-family members, including yourself.
[INTERVIEWER:
DOCUMENT NUMBER OF INDIVIDUALS PER CATEGORY, ALSO, PROBE FOR AGE OF
CHILDREN AND WHETHER THEY HAD EVER ATTENDED MSHS IN ANY LOCATION.]
Biological Mother
Stepmother/Mother figure
Biological Father
Stepfather/Father figure
Aunt (#_____________)
Uncle (#_____________)
Grandmother/Great grandmother (#_____________)
Grandfather/Great grandfather (#_____________)
Godmother (#_____________)
Godfather (#_____________)
Male adult friend (#_____________)
Female adult friend (#_____________)
Sibling 1 (Age: ______________, Went to MSHS? Y/N)
Sibling 2 (Age: ______________, Went to MSHS? Y/N)
Sibling 3 (Age: ______________, Went to MSHS? Y/N)
Sibling 4 (Age: ______________, Went to MSHS? Y/N)
Sibling 5 (Age: ______________, Went to MSHS? Y/N)
Cousin 1 (Age: ______________, Went to MSHS? Y/N)
Cousin 2 (Age: ______________, Went to MSHS? Y/N)
Cousin 3 (Age: ______________, Went to MSHS? Y/N)
Cousin 4 (Age: ______________, Went to MSHS? Y/N)
Cousin 5 (Age: ______________, Went to MSHS? Y/N)
Other Child 1 (Age:_____________ Went to MSHS? Y/N)
Other Child 2 (Age:_____________ Went to MSHS? Y/N)
Other Child 3 (Age:_____________ Went to MSHS? Y/N)
Now I am going to ask you some questions about your language use.
What are all the languages that you understand or speak, including indigenous languages? (SELECT ALL THAT APPLY.)
[INTERVIEWER:
IF ONLY ENGLISH OR SPANISH ARE REPORTED, ASK SPECIFICALLY THE
INDIGENOUS LANGUAGES LISTED BELOW.]
English
Spanish
Haitian Creole
Mixtec
Kanjobal
Zapotec
Other language (specify): ______________________________
Don’t Know/Refused
Now I am going to ask you some questions about how well you understand, speak, read, and write in different languages. (ALWAYS ASK ABOUT ENGLISH, THEN ONLY ASK ABOUT LANGUAGES THAT RESPONDENT INDICATED IN QUESTION C1.)
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How well do you __________ the language?
Understand
Speak
Read
Write
English
Not at all
Not well
Well
Very Well
Don’t Know/ Refused
Not at all
Not well
Well
Very Well
Don’t Know/ Refused
Not at all
Not well
Well
Very Well
Don’t Know/ Refused
Not at all
Not well
Well
Very Well
Don’t Know/ Refused
Other 1
Specify: ____________
Not at all
Not well
Well
Very Well
Don’t Know/ Refused
Not at all
Not well
Well
Very Well
Don’t Know/ Refused
Not at all
Not well
Well
Very Well
Don’t Know/ Refused
Not at all
Not well
Well
Very Well
Don’t Know/ Refused
Other 2
Specify: ____________
Not at all
Not well
Well
Very Well
Don’t Know/ Refused
Not at all
Not well
Well
Very Well
Don’t Know/ Refused
Not at all
Not well
Well
Very Well
Don’t Know/ Refused
Not at all
Not well
Well
Very Well
Don’t Know/ Refused
Now I am going to ask you some questions about the languages that your child uses, and the languages that you use with your child.
Is your child talking yet? (SELECT ONE ONLY.)
Yes
No
Don’t Know/Refused
What language(s) does [MSHS CHILD] speak at home now? (SELECT ALL THAT APPLY.)
[INTERVIEWER: IF ONLY ENGLISH OR SPANISH ARE REPORTED, ASK SPECIFICALLY THE INDIGENOUS LANGUAGES LISTED BELOW.]
English
Spanish
Haitian Creole
Mixtec
Kanjobal
Zapotec
Other language (specify): __________________
Don’t Know/Refused
What languages do you use to speak to [MSHS CHILD]? (INTERVIEWER: SELECT ALL THAT APPLY. IF ONLY ENGLISH OR SPANISH ARE REPORTED, ASK SPECIFICALLY THE INDIGENOUS LANGUAGES LISTED BELOW. IF MORE THAN ONE LANGUAGE REPORTED, ASK RESPONDENT TO RANK THE LANGUAGES IN TERMS OF HOW FREQUENTLY THEY SPEAK THE LANGUAGE WITH MSHS CHILD, WHERE 1 = MOST FREQUENTLY USED LANGUAGE.)
#____ English
#____ Spanish
#____ Haitian Creole
#____ Mixtec
#____ Kanjobal
#____ Zapotec
#____ Other language (specify): __________________
Don’t Know/Refused
How much [LANGUAGE #1 IDENTIFIED in QUESTION C5] and [LANGUAGE #2 IDENTIFIED IN QUESTION C5] do you use when speaking to [MSHS CHILD]? (SELECT ONE ONLY.
All [LANGUAGE #1]
More [LANGUAGE #1] than [LANGUAGE #2]
The same amount of [LANGUAGE #1] and [LANGUAGE #2]
More [LANGUAGE #1] than [LANGUAGE #2]
All [LANGUAGE #2]
Don’t Know/Refused
How much English do you speak to [MSHS CHILD]? (SELECT ONE ONLY.)
None or a few words
A little
Some
A lot
Don’t Know/Refused
What languages do other adults in your household 18 and older use when SPEAKING to [MSHS CHILD] at home? (SELECT ALL THAT APPLY. SKIP IF NO OTHER ADULTS IN HOUSEHOLD; SEE QUESTION B16.)
English
Spanish
Haitian Creole
Mixtec
Kanjobal
Zapotec
Other language (specify): __________________
Don’t Know/Refused
What languages do other children in your household use when SPEAKING to [MSHS CHILD] at home? Include all the languages spoken by children in your household who are 17 and younger. (SELECT ALL THAT APPLY. SKIP IF NO OTHER CHILDREN IN HOUSEHOLD; SEE QUESTION B16.)
English
Spanish
Haitian Creole
Mixtec
Kanjobal
Zapotec
Other language (specify): __________________
Don’t Know/Refused
Now I am going to ask you some questions about [MSHS CHILD]’s health.
Overall, would you say [MSHS CHILD]’s health is… (SELECT ONE ONLY.)
Excellent
Very Good
Good
Fair
Poor
Don’t Know
Don’t Know/Refused
When [YOU WERE/MSHS CHILD’S MOTHER WAS] pregnant with [MSHS CHILD], did you/[MSHS CHILD’S MOTHER] see a doctor or go to a clinic for prenatal care? (SELECT ONE ONLY.)
Yes
No
Don’t Know/Refused
Was [MSHS CHILD] born prematurely, like more than two weeks before [he/she] was due? (SELECT ONE ONLY.)
Yes
No
Don’t Know/Refused
How much did [MSHS CHILD] weigh when (he/she) was born?
Number of pounds, number of ounces: _____________________
Don’t Know/Refused
Did [YOU/CHILD’S MOTHER] ever breast-feed [MSHS CHILD]? (SELECT ONE ONLY.)
Yes
No
Don’t Know/Refused
Does [MSHS CHILD] have teeth yet?
Yes
No GO TO QUESTION 10
Don’t Know/Refused
How many times a day are [MSHS CHILD]’s teeth brushed at home?
________ times per day
Don’t Know/Refused
Has [MSHS CHILD] gone to the dentist in the past year? (SELECT ONE ONLY.)
Yes
No
Don’t Know/Refused
How many of your child’s teeth have cavities or fillings, or need them?
____________ teeth
When was the last time [MSHS CHILD] saw a medical doctor for a regular checkup? (SELECT ONE ONLY.)
Less than 3 months ago
3-6 months ago
6 months- 1 year ago
1-2 years ago
More than 2 years ago
Never
Don’t Know/Refused
Has [MSHS CHILD] received all, most, some, or none of their vaccinations for his/her age? (SELECT ONE ONLY.)
All
Most
Some
(He/she) never received immunizations
Don’t Know/Refused
When you take [MSHS CHILD] in a car or truck, how is (he/she) usually seated? (SELECT ONE ONLY.)
Car seat with its own straps
Booster seat used with seatbelt
Seatbelt by itself
Parent’s lap
No restraint
Don’t Know/Refused
Does [MSHS Child] have… (SELECT ONE PER ROW.)
-
Yes
No
Don’t Know/Refused
Difficulty seeing objects in the distance or letters on paper?
Any physical development issues such as problems with the way (he/she) uses (his/her) arms or legs?
Difficulty with speech or communicating?
A developmental disability or delay?
Behavioral trouble or difficulty paying attention to learn?
(SELECT ONE PER ROW). IF YES, Does [MSHS CHILD]’s [CONDITION] prevent him/her from doing any normal activities like going to school or playing with other children? (SELECT ONE ONLY.)
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In the past year, has a doctor, nurse, or other medical professional told you that…
If yes, does condition prevent normal activities…
Yes
No
Don’t Know/
Refused
Yes
No
[MSHS CHILD] has a serious medical condition such as a heart defect, epilepsy or seizures?
[MSHS CHILD] is allergic to things such as dust, animals, or medicines or to certain foods such as peanuts or milk?
[MSHS CHILD] has asthma?
[MSHS CHILD] has diabetes?
[MSHS Child] has an ear infection?
[MSHS CHILD]’s weight is too low?
[MSHS CHILD]’s weight is too high?
Have another medical condition?
(Specify): ____________________________
Now, let’s talk about the places you work.
Approximately how many total years have you done agricultural work in the U.S.?
Years: _____________
Don’t Know/Refused
Are you currently working? (SELECT ONE ONLY.)
Yes
No GO TO QUESTION 7
Don’t Know/Refused GO TO QUESTION 7
What type of work do you do? (SELECT ALL THAT APPLY.)
Agricultural Work
Non-Agricultural Work GO TO QUESTION 6
Don’t Know/Refused GO TO QUESTION 6
What type of agricultural work do you do? (SELECT ALL THAT APPLY AND SPECIFY.)
Fruits (Specify: __________________)
Nuts (Specify: __________________)
Vegetables (Specify: __________________)
Trees and Shrubs (Specify: __________________)
Flowers and Grasses (Specify: __________________)
Livestock (Specify: __________________)
Poultry (Specify: __________________)
Fishery (Specify: __________________)
Other Agricultural Work (Specify: _____________________________)
Don’t Know/Refused
What is your agricultural job? (SELECT ALL THAT APPLY.)
Planting
Picking or harvesting
Packing
Pesticide and/or herbicide application
Fertilization and Pollination
Collection of meat, fur, skins, feathers, eggs, milk, or honey (etc.)
Animal care (feed, herd, brand, weigh, clean, breed, shear, etc.)
Farm maintenance (working with machinery, fixing fences, irrigation)
Transportation
Supervising
Other (Specify: ________________________)
Don’t Know/Refused
How long have you been working at this location?
_________ (Specify unit: days, weeks, months, years)
Don’t Know/Refused
Now I have some questions about [OTHER CAREGIVER]. (GO TO QUESTION 14 IF THERE IS NO OTHER CAREGIVER; I.E., IF SCREENER QUESTION 18 IS ‘NO’ OR ‘DON’T KNOW/REFUSED’.)
Approximately how many total years has [OTHER CAREGIVER] done agricultural work in the U.S.?
Years: _____________
Don’t Know/Refused
Is [OTHER CAREGIVER] currently working? (SELECT ONE ONLY.)
Yes
No GO TO QUESTION 13
Don’t Know/Refused GO TO QUESTION 13
What type of work does [OTHER CAREGIVER] do? (SELECT ALL THAT APPLY).
Agricultural Work
Non-Agricultural Work GO TO QUESTION 12
Don’t Know/Refused GO TO QUESTION 12
What type of agricultural work does [OTHER CAREGIVER] do? (SELECT ALL THAT APPLY AND SPECIFY.)
Fruits (Specify: __________________)
Nuts (Specify: __________________)
Vegetables (Specify: __________________)
Trees and Shrubs (Specify: __________________)
Flowers and Grasses (Specify: __________________)
Livestock (Specify: __________________)
Poultry (Specify: __________________)
Fishery (Specify: __________________)
Other Agricultural Work (Specify: _____________________________)
Don’t Know/Refused
What is [OTHER CAREGIVER]’s agricultural job? (SELECT ALL THAT APPLY.)
Planting
Picking or harvesting
Packing
Pesticide and/or herbicide application
Fertilization and Pollination
Collection of meat, fur, skins, feathers, eggs, milk, or honey (etc.)
Animal care (feed, herd, brand, weigh, clean, breed, shear, etc.)
Farm maintenance (working with machinery, fixing fences, irrigation)
Transportation
Supervising
Other (Specify: ________________________)
Don’t Know/Refused
How long has [OTHER CAREGIVER] been working at this location?
______________ (Specify unit: days, weeks, months, years)
Don’t Know/Refused
Within the past 3 years, did you or [OTHER CAREGIVER] travel more than 75 miles or spend the night away from your home or permanent address for the purpose of agricultural work?
(ONLY ASK ABOUT OTHER CAREGIVER IF SCREENER QUESTION 18 IS ‘NO’ OR ‘DON’T KNOW/REFUSED’.)
Yes
No
Don’t Know /Refused
Last year (in 2016) what was your family’s total income from all types of work you did, in U.S. dollars?
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How much of that income was from agricultural employment?
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(SELECT ONE PER ROW.)
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Yes
No
Don’t Know/Refused
Do you have enough money each month to make ends meet?
Do you have difficulty paying your bills each month?
Do you worry about your food running out before you have money to buy more?
In the last 12 months, did you ever eat less than you felt you should because there wasn’t enough money to buy food?
In the last 12 months, did [MSHS CHILD] ever eat less than you felt s/he should because there wasn’t enough money to buy food?
Do you have enough diapers to change [MSHS CHILD] after each soiling? (SKIP IF CHILD AGE 3 OR OLDER; SEE SCREENER QUESTIONS 12 & 13)
Are you able to take showers/baths as frequently as you would like?
Are you able to wash your clothes when you need to?
Now I am going to ask you some questions about your health and your family’s health.
Would you say your health in general is … (SELECT ONE ONLY.)
Excellent
Very Good
Good
Fair
Poor
Don’t Know/Refused
How much pain have you had during the past 4 weeks? (SELECT ONE ONLY.)
None
Very Mild
Moderate
Severe
Very Severe
Don’t Know/Refused
How much exhaustion have you felt during the past 4 weeks? (SELECT ONE ONLY.)
Not at all
Very Mild
Moderate
Severe
Very Severe
Don’t Know/Refused
In the last 12 months, have you been exposed to, loaded, mixed or applied pesticides? (SELECT ALL THAT APPLY.)
Yes, exposed to
Yes, loaded, mixed or applied
No GO TO QUESTION 6
Don’t Know/Refused GO TO QUESTION 6
Which of the following classes of pesticides have you been exposed to, loaded, mixed or applied in the last 12 months? (SELECT ALL THAT APPLY.)
Insecticide
Herbicide
Fungicide
Rodenticide
Other (specify): ________________________
Don’t know type
Don’t Know/Refused
Now I have some questions about [OTHER CAREGIVER]. (GO TO QUESTION 9 IF THERE IS NO OTHER CAREGIVER; I.E., IF SCREENER QUESTION 18 IS ‘NO’ OR ‘DON’T KNOW/REFUSED’.)
Would you say the health of [OTHER CAREGIVER] is … (SELECT ONE ONLY.)
Excellent
Very Good
Good
Fair
Poor
Don’t Know/Refused
In the last 12 months, has [OTHER CAREGIVER] been exposed to, loaded, mixed or applied pesticides? (SELECT ONE ONLY.)
Yes, exposed to
Yes, loaded, mixed, or applied
No GO TO QUESTION 9
Don’t Know/Refused GO TO QUESTION 9
Which of the following classes of pesticides was [OTHER CAREGIVER] exposed to, load, mix or apply in the last 12 months? (SELECT ALL THAT APPLY.)
Insecticide
Herbicide
Fungicide
Rodenticide
Other (specify): ________________________
Don’t know type
Don’t Know/Refused
Now I have some questions about how you have felt in the past week.
How often during the past week have you … (SELECT ONE PER ROW.)
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Rarely or Never |
Some or a little of the time |
Occasionally or a moderate amount of time |
Most or all of the time |
Don’t Know/ Refused |
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Now, I will ask you questions about experiences that some families who do agricultural work have reported as stressful.
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Yes
No
Not at all stressful
Somewhat stressful
Moderately stressful
Extremely stressful
Don’t Know/ Refused
Is it difficult to be away from family members?
(If yes) How stressful is this for you?
Do you sometimes have difficulty finding a place to live?
(If yes) How stressful is this for you?
Have you experienced discrimination in this country?
(If yes) How stressful is this for you?
Was migrating to this country difficult?
(If yes) How stressful is this for you?
Do you sometimes have difficulty finding a job?
(If yes) How stressful is this for you?
Do you worry about your children's education?
(If yes) How stressful is this for you?
Now, I will ask you questions about experiences that some families who do agricultural work have reported as helpful to their families for staying strong. How helpful is/are ___________ to you and your family?
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Not at all helpful
Somewhat helpful
Moderately helpful
Extremely helpful
Refused
Your partner/Spouse
A belief in God or your faith
Dedicating yourself to your children’s future
A belief that working hard will lead to a better life for your family
The next questions are about the health insurance plans for you and your household.
Is [MSHS CHILD] currently covered by health insurance? (SELECT ONLY ONE.)
Yes
No
Don’t Know/Refused
Since ([MSHS CHILD] was born, was there any time when (he/she) did not have any health insurance coverage? (SELECT ONE ONLY.)
Yes
No
Don’t Know/Refused
Has MSHS helped you find medical care or a doctor for [MSHS CHILD]? (SELECT ONE ONLY.)
Yes
No, I did not need help from MSHS
No, I could use this help but did not receive it from MSHS
Don’t Know/Refused
Is [MSHS CHILD] currently covered by dental insurance? (SELECT ONE ONLY.)
Yes
No
Don’t Know/Refused
Did MSHS help you find dental care for [MSHS CHILD]? (SELECT ONE ONLY.)
Yes
No, I did not need help from MSHS
No, I could use this help but did not receive it from MSHS
Don’t Know/Refused
In the past year has there been a time when you or a family member needed medical attention but did not receive it because you did not have insurance or the money to pay for it? (SELECT ONE ONLY.)
Yes
No
Don’t Know/Refused
The next set of questions is about your child’s daily schedule.
Where does [MSHS CHILD] usually sleep at night? (SELECT ONE ONLY.)
In crib
Own bed
In a bed with parents
In a bed with individuals other than parents
On sofa
Sleeps alone on a mattress on the floor
Share a mattress on the floor with family members
On the floor without a mattress
Other(Specify): ____________________
Don’t Know/Refused
At about what time does [MSHS CHILD] fall asleep at night?
|__|__| |__|__|
HOUR MINUTES AM / PM
Don’t Know/Refused
At about what time does [MSHS CHILD] wake up in the morning?
|__|__| |__|__|
HOUR MINUTES AM / PM
Don’t Know/Refused
Does [MSHS Child] usually wake up at night?
Yes
No GO TO QUESTION 6.
Approximately how many minutes/hours is [MSHS Child] awake at night?
Minutes/hours per night: ____________________
Does not wake up at night
Don’t Know/Refused
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Never |
Rarely |
Sometimes |
Always |
Refused |
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The next set of questions is about things that you may do with your child.
In the past week, how many days did you or someone in your family do the following things with [MSHS CHILD]? (SELECT ONE PER ROW. SKIP QUESTIONS 8.A-8.G IF CHILD IS < 2 YEARS; SEE SCREENER QUESTIONS 12 & 13)
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5-7 days
a week
3-4 days
a week
1-2 days
a week
0 days
Don’t Know/ Refused
Taught (him/her) letters, words, or numbers?
Counted different things with (him/her)?
Worked on arts and crafts with (him/her)?
Played a game, sport, or exercised together?
Played with toys or games indoors?
Talked about what happened in MSHS?
Involved (him/her) in household chores like cooking, cleaning, setting the table?
Read or look at books with (him/her)?
Tell stories to (him/her)?
Sang songs with (him/her)?
Dance with (him/her)?
Took (him/her) along while doing errands like going to the store?
Took (him/her) to a religious service or event?
About how many children’s books does [MSHS CHILD] have in your home now, including library books? Please only include books that are for children.
Number of books: ____________ IF ZERO GO TO QUESTION 10.
Don’t Know/Refused
Are these books…
Mostly in Spanish and some in English
Equal amount in Spanish and in English
Mostly in English and some in Spanish
Other language (specify): __________________
Don’t Know/Refused
-
Never
Rarely
Sometimes
Always
Don’t Know/ Refused
Fight in your family?
Lose your tempers?
Get so angry you throw things?
Criticize each other?
Hit each other?
In the past two years, how many times did your family move?
Number of times: ________ IF ZERO GO TO QUESTION 4.
Don’t Know/Refused
Can you tell me all the places you lived the last 2 years, starting with the most recent location and working back?
Town 1: |___________________| State 1: |______| Country 1: |____________________|
Town 2: |___________________| State 2: |______| Country 2: |____________________|
Town 3: |___________________| State 3: |______| Country 3: |____________________|
Town 4: |___________________| State 4: |______| Country 4: |____________________|
Town 5: |___________________| State 5: |______| Country 5: |____________________|
Town 6: |___________________| State 6: |______| Country 6: |____________________|
Don’t Know/Refused
Why did you leave these locations? (SELECT ALL THAT APPLY.)
My job or my partner’s job ended, or would be ending soon.
We heard of another opportunity
We no longer had a place to live
The Migrant and Seasonal Head Start center closed
We were not able to get health care or social services
It was expensive to live there
Other (Specify): _________________________________________________
Don’t Know/Refused
What type of housing does [MSHS CHILD] live in now? (SELECT ONE ONLY).
Single-family home
Townhome/ duplex
Apartment
Mobile home/trailer
Motel or hotel
Dormitory or barracks
Campsite or tent
Without shelter
Other (Specify): ____________________
Don’t Know/Refused
Where is [MSHS CHILD’S] housing located? (SELECT ONE ONLY.)
Off farm and not owned/administered by employer
Off farm and owned/ administered by employer
On farm
Other (Specify): ___________________
Don’t Know/Refused
Why did you choose to live in this community? (SELECT ALL THAT APPLY.)
I/ We heard that there were jobs available
I/We have friends or relatives who live in this area
I/We knew there was a place for our family to live while in the area
I/We knew that Migrant and Seasonal Head Start services would be available
I/We knew that other child care would be available
I/We knew that health care and social services (such as welfare or food stamps) were easy to get
It is cheap to live here
This is my home base
Other (Specify): ________________________________)
Don’t Know/Refused
Does [MSHS CHILD’S] home have adequate…? (SELECT ONE ONLY.)
-
Yes
No
Don’t Know/ Refused
Plumbing/Bathrooms
Water
Cooling
Refrigeration
Cooking appliances (like stove, oven)
How many minutes does it take for [MSHS CHILD] to get from [HIS/HER] home to the MSHS center? (SELECT ONE.)
5 – 15 minutes
16 – 30 minutes
31 – 45 minutes
46 – 60 minutes
Over 60 minutes
Don’t Know/Refused
What type of transportation does [MSHS CHILD] use to get from [HIS/HER] home to the MSHS center? (SELECT ALL THAT APPLY.)
Migrant and Seasonal Head Start bus
Other Migrant and Seasonal Head Start transportation
Parent or Relative drives
Employer drives
Public transportation
Walk
Other (Specify: ____________________________)
Don’t Know/Refused
Location |
1. Was [MSHS CHILD] with you? |
2. While you were [at location] what kind of child care did [MSHS CHILD] receive? (Read options out loud. SELECT ALL THAT APPLY.) |
3. While (AT LOCATION), did [MSHS CHILD] ever have to go with you to your agricultural work, even one time? (SKIP IF RESPONDENT NEVER WORKED IN AGRIGULTURAL WORK; I.E. IF QUESTION E1 IS ZERO.) |
CURRENT LOCATION |
N/A |
When [MSHS Child] isn’t at this center, what kind of child care does he/she have? Cared for by adult in child’s home Cared for by adult at a home, but out of child’s home Cared for by other child Taken to work with parent Home alone Don’t Know/Refused |
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Earlier, you told us you moved to CITY 1]. When you lived here… |
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Cared for at center (Specify name[s] of center[s]:_____) Cared for by adult in child’s home Cared for by adult at a home, but out of child’s home Cared for by other child Taken to work with parent Home alone Don’t Know/Refused |
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Earlier, you told us you moved to [CITY 2]. When you lived here… |
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Cared for at center (Specify name[s] of center[s]:_____) Cared for by adult in child’s home Cared for by adult at a home, but out of child’s home Cared for by other child Taken to work with parent Home alone Don’t Know/Refused |
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Earlier, you told us you moved to [CITY 3]. When you lived here… |
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Cared for at center (Specify name[s] of center[s]:_____) Cared for by adult in child’s home Cared for by adult at a home, but out of child’s home Cared for by other child Taken to work with parent Home alone Don’t Know/Refused |
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When did [MSHS CHILD] start attending [Insert name of Migrant and Seasonal Head Start Center]?
Month:
January February March April May June
July August September October November December
Year: ___________
Don’t Know/Refused
Is this [MSHS CHILD’S] first time in Migrant and Seasonal Head Start? (SELECT ONE ONLY.)
Yes
No, attended at a different location
Don’t Know/Refused
For how many months or years has [MSHS CHILD] attended any Migrant and Seasonal Head Start program in all of the places you have ever lived?
Length of time (specify unit - months or years): _____________________________
Don’t Know/Refused
Does your family plan your moves to other locations based on Migrant and Seasonal Head Start locations?
Yes
No
Don’t Know/Refused
Would you recommend Migrant and Seasonal Head Start to other families?
Yes
No
Don’t Know/Refused
Why did you want [MSHS CHILD] to attend Migrant and Seasonal Head Start? (SELECT ALL THAT APPLY.)
To prepare my child for a school education
To access health and dental services
Because I knew my child would receive meals and snacks during the day
My child has a disability, and Migrant and Seasonal Head Start knows how to work with children with disabilities
Because it is free/there is no cost
It is the only full-day care available
I needed child care services for my child
MSHS provides quality care, safety, good staffing
MSHS helps my child’s development (socialization, communication)
To learn English
So my child does not need to go to the field/ keep my child safe
Other (Specify): __________________________________________________
Don’t Know/Refused
How often do you receive information from the MSHS about [MSHS CHILD] or the program activities? (SELECT ONE ONLY.)
More than once a week
Once a week
2-3 times a month
Once a month
A few times a year
Don’t Know/Refused
How do you receive this information? (SELECT ALL THAT APPLY).
In person at the center
In person at the bus stop
In person at home
By telephone
In Writing
Don’t Know/Refused
Please indicate how often you have participated in the following activities at [MSHS CHILD]’s center since the beginning of this season. For each one, tell me if that is not yet, once or twice, several times, about once a month, or at least once a week. How often have you ... (SELECT ONE PER ROW.) How often have you….
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Not yet
Once or twice
Several times
About once a month
At least once a week
Don’t Know/ Refused
Volunteered or helped out in [MSHS CHILD]’s classroom?
Attended Head Start social events for children and families?
Attended parent education meetings or workshops focusing on topics such as job skills or child-rearing?
Attended parent-teacher conferences?
Visited with a MSHS staff member in your home?
Participated in a parent Committee or other Head Start planning groups?
Any other Head Start Activities? (Specify: _________________)
At [Insert name of Migrant and Seasonal Head Start Center], How often is someone available and able to speak to you in your preferred language? (SELECT ONE.)
Always
Almost Always
Sometimes
Almost Never
Never
Don’t Know/Refused
During the past year, have you or anyone in your household received any of the following from [PROGRAM]?
-
Yes
No
Don’t Know/ Refused
Help finding good child care when child is not at [MSHS center]
Help getting to and from work or other places (transportation)
Short-term help getting or paying for things you need in an emergency
Help finding a job
Education or job training
Help finding or paying for housing
Help finding health services
Help finding mental health or substance abuse services
Help with utilities (running water, hot water, heat, telephone service)
Food and nutrition assistance—like Food Stamps or WIC
Income assistance--like welfare TANF, SSI
Classes in English as a Second Language
Advice from a lawyer
Please tell me if any of the following have kept you from participating as much as you would like in [MSHS CHILD]’s MSHS program this past season? (SELECT ALL THAT APPLY.)
Work schedule
Transportation
Migrant and Seasonal Head Start doesn’t provide enough opportunities to participate
Uncomfortable because of language or cultural differences
Concern for safety while getting to the center
Other (Specify): ______________________________________
Don’t Know/Refused
What are the major ways Migrant and Seasonal Head Start helped [MSHS CHILD] this season? (SELECT ALL THAT APPLY.)
Child had a place to go
Kept child safe
Improved health
Get ready for school
Taught responsibility
Made child happy
Improved language skills
Improved literacy skills
Helped child make friends
Improved child’s behavior
Other (Specify): ______________________________
Don’t Know/Refused
What are the major ways Migrant and Seasonal Head Start helped your family this season? (SELECT ALL THAT APPLY.)
Provided steady child care
Served as a resource for information
Provided material resources
Provided links to medical and dental care
Improved parenting skills
Provide links to other community resources
Provided a safe place for families to gather
Health care
Finances
Addressing family conflict
Other (specify): ____________________________________
Don’t Know/Refused
If Migrant and Seasonal Head Start programs were to receive more money, how should the programs use the money to better serve children and families? (SELECT ALL THAT APPLY.)
Extending hours per day
Extending days per week
Extending weeks or months to season
Educational materials
Professional staff
Facilities
Child safety
Food
Transportation
Other (specify): ____________________________________
Don’t Know/Refused
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Audra Nakas |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |
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