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pdfOMB No.: 0970–0354
Expiration Date: 10/31/2021
Parent Survey
Draft for OMB (Redacted)
February 21, 2020
ADMINISTRATIVE NOTES
INTERVIEWER INSTRUCTIONS APPEAR IN CAPS
Interview text to read to the respondent appears in bold
Baby FACES 2020 Parent Survey
1
OMB (Redacted)
A. ABOUT RESPONDENT
ALL
PROGRAMMER: TREAT INTRODUCTION TEXT AS INFO QUESTION [INTERVIEWER DOES NOT HAVE TO
CLICK 1 TO CONTINUE]
We’d like to start by learning a bit more about you and your background.
IF A0 = 0 (RESPONDENT ENROLLED AS PREGNANT IS STILL PREGNANT)
PROGRAMMER: FILL DUEDATE FROM PRELOAD
Source: Baby FACES 2018
Item title: ConfirmDueDate
A0a.
What is your due date?
PROGRAMMER: DISPLAY DUE DATE FROM PRELOAD AS INTERVIEWER NOTE
INSTRUCTION: COMPARE RESPONSE WITH DATE DISPLAYED AND CODE
RESPONSE.
DUE DATE IS CORRECT ....................................... 1
DUE DATE IS INCORRECT/NOT RECORDED ..... 2
A0B
DON’T KNOW .......................................................... D
REFUSED ................................................................ R
IF A0A=2
Source: Baby FACES 2018
Item title: CorrectDueDate
A0b.
PROGRAMMER: ALLOW DATE TO BE ENTERED/REVISED ON THIS SCREEN.
INSTRUCTION: RECORD/UPDATE RESPONDENT’S DUE DATE.
INSTRUCTION: ENTER DATE AS MM/DD/YYYY
|
| |/| | |/|
Month
Day
|
| |
Year
|
PROGRAMMER: ONLY DISPLAY THE BELOW INTERVIEWER NOTE IF DUEDATE IS
MISSING FROM PRELOAD.
INSTRUCTION: IF RESPONDENT PROVIDES MONTH/YEAR BUT IS NOT SURE OF EXACT
DAY, SAY: Is your due date closer to the beginning of the month, the end, or sometime in
the middle? [CODE AS ‘01’ FOR BEGINNING, ‘15’ FOR MIDDLE, AND 25 FOR END]
Baby FACES 2020 Parent Survey
2
OMB (Redacted)
PREGNANT = 1
Source: Baby FACES 2018
Item title: Firstchild
A0c.
Will this be your first child?
YES .......................................................................... 1
NO ............................................................................ 0
REFUSED ................................................................ r
A0c=0
Source: New item
Item title:
A0d.
How many other children have you given birth to?
INTERVIEWER PLEASE INCLUDE LIVE BIRTHS ONLY.
|
|
| CHILDREN
DON’T KNOW/REFUSED ..................................................................................... d
PREGNANT = 0
PROGRAMMER: IF PREGNANT = 1 OR A0 = 1, SET A1 TO 1.
Source: Baby FACES 2009
Item title: RReltoCh
A1.
What is your relationship to [CHILD]?
MOTHER/FEMALE GUARDIAN .............................. 1
FATHER/MALE GUARDIAN .................................... 2
SISTER .................................................................... 3
BROTHER ............................................................... 4
GIRLFRIEND OR PARTNER OF CHILD’S
PARENT/GUARDIAN .............................................. 5
BOYFRIEND OR PARTNER OF CHILD’S
PARENT/GUARDIAN .............................................. 6
GRANDMOTHER .................................................... 7
GRANDFATHER...................................................... 8
AUNT ....................................................................... 9
UNCLE ..................................................................... 10
COUSIN ................................................................... 11
OTHER RELATIVE .................................................. 12
OTHER NON-RELATIVE ......................................... 13
REFUSED ................................................................ r
Baby FACES 2020 Parent Survey
3
OMB (Redacted)
IF PREGNANT = 0 AND A1 = 1 [RESPONDENT IS MOTHER/FEMALE GUARDIAN]
PROGRAMMER: IF PREGNANT = 1 OR A0 = 1, SET A1A TO 1.
Source: Baby FACES 2009
Item title: RReltoCh2
A1a.
Are you [CHILD]’s…
Birth mother, .......................................................... 1
Adoptive mother, ................................................... 2
Stepmother, or ....................................................... 3
Foster mother or female guardian? ..................... 4
REFUSED ................................................................ r
IF A1 = 2 [RESPONDENT IS FATHER/MALE GUARDIAN]
Source: Baby FACES 2009
Item title: RReltoCh3
A1b.
Are you [CHILD]’s...
Birth father, ............................................................. 1
Adoptive father, ...................................................... 2
Stepfather, or.......................................................... 3
Foster father or male guardian? ........................... 4
REFUSED ................................................................ r
IF A1 GE 3, R [RESPONDENT IS NOT MOTHER/FEMALE GUARDIAN OR FATHER/MALE GUARDIAN]
Source: Baby FACES 2009
Item title: LegalGuardian
A1c.
Are you [CHILD]’s legal guardian?
YES .......................................................................... 1
NO ............................................................................ 0
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
Baby FACES 2020 Parent Survey
4
OMB (Redacted)
IF A1 GE 3 [RESPONDENT IS NOT MOTHER/FEMALE GUARDIAN OR FATHER/MALE GUARDIAN]
PROGRAMMER: USES CALCULATION DERIVED FROM PRELOAD VARIABLE CHDOB
Source: Baby FACES 2018
Item title: ResideChMos
A1d.
For how many months have you lived with [CHILD]?
PROGRAMMER:
RESPONSE CANNOT BE GREATER THAN CHILD’S CHRONOLOGICAL
AGE AT TIME OF INTERVIEW
PROGRAMMER:
DISPLAY CHILD’S AGE IN MONTHS AS INTERVIEWER NOTE
INSTRUCTION:
IF RESPONDENT SAYS ALL OF THE TIME, ENTER CHILD’S AGE IN
MONTHS.
|
|
| MONTHS (RANGE 1 – 40)
LESS THAN ONE MONTH ................................................................................... 0
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
SOFT CHECK: IF RESPONSE IS GT AGE OF CHILD OR GT 40 MONTHS: I just want to confirm that
you have lived with [CHILD] since he/she was born. Is that correct? [IF YES, ENTER CHILD AGE AS
DISPLAYED]
ALL: PROGRAMMER: DISPLAY TEXT IN BRACKETS AS WELL IF A0 = 1 (PREGNANT TO PARENT)
Source: Baby FACES 2009 [COMPONENT OF RISK INDEX]
Item title: RDOB
A2.
[Later, I will ask you some questions about your new baby. But first, I am going to ask
you some questions about your background.] What is your birth date?
INSTRUCTION: ENTER DATE AS MM/DD/YYYY
|
| |/| | |/|
Month
Day
|
| |
Year
|
REFUSED ................................................................ r
PROGRAMMER: DOB CANNOT BE IN THE FUTURE
INTERVIEWER: I entered your date of birth as [FILL A2]. I must have entered this incorrectly.
Please repeat the date.
SOFT CHECK; IF YEAR AT A2 IS LESS THAN 1968 (R IS GT 50 YEARS OLD):
INTERVIEWER: I entered your date of birth as [FILL A2]. Is this correct?
SOFT CHECK; IF YEAR AT A2 IS GREATER THAN 2000 (R IS LT 18 YEARS OLD):
INTERVIEWER: I entered your date of birth as [FILL A2]. Is this correct?
IF A2 IS MISSING OR REFUSED [ANY PART OF BIRTH DATE FIELD NOT ANSWERED]
Source: Baby FACES 2009
Item title: RAge
A2a.
How old are you?
|
|
| YEARS (RANGE 14 – 99)
REFUSED ................................................................ r
Baby FACES 2020 Parent Survey
5
OMB (Redacted)
SOFT CHECK; IF A2A IS EQUAL TO OR GT 50 YEARS OLD:
INTERVIEWER: I entered your age as [FILL A2a]. Is this correct?
SOFT CHECK; IF A2A IS LESS THAN 18 YEARS OLD:
INTERVIEWER: I recorded your age as [FILL A2a]. Is that correct?
IF PREGNANT = 1 OR A1A = 1 [RESPONDENT IS BIO MOTHER];
EXCLUDE IF A0C = 1 [PREGNANCY IS FIRST CHILD FOR PREGNANT RESPONDENT]
Source: Baby FACES 2009 [COMPONENT OF RISK INDEX]
Item title: RAgeFirstChild
A3.
How old were you when you gave birth for the first time?
PROBE: Your best estimate is fine.
|
|
| YEARS (RANGE 10 – 60)
DON’T KNOW………………………………………..
d
REFUSED…………………………………………….
r
SOFT CHECK; IF A3 IS LT 14 OR GT 50:
INTERVIEWER: I entered the age when you first gave birth as [FILL A3]. Is this correct?
ALL
Source: Adapted from Baby FACES 2009
Item title: RSex
A4.
Are you male or female?
MALE ....................................................................... 1
FEMALE ................................................................... 2
OTHER .................................................................... 3
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
Baby FACES 2020 Parent Survey
6
OMB (Redacted)
ALL
Source: OMB Guidance
Item title: REthnicity
A5.
Are you of Hispanic, Latino/a, or Spanish origin? You may choose one or more.
IF ONLY SAYS ‘YES,’ ASK: Is your origin Mexican, Puerto Rican, Cuban, or something
else?
PROGRAMMER: CODE ALL THAT APPLY. HOWEVER, IF ‘1’ IS SELECTED, NO OTHER
OPTION CAN BE ENDORSED.
NO, NOT OF HISPANIC, LATINO/A, OR SPANISH ORIGIN .........1
YES, MEXICAN, MEXICAN AMERICAN, CHICANO/A...................2
YES, PUERTO RICAN ....................................................................3
YES, CUBAN ...................................................................................4
YES, ANOTHER HISPANIC, LATINO/A, OR SPANISH ORIGIN ...5
DON’T KNOW .................................................................. d
REFUSED ....................................................................... r
ALL
Source: OMB Guidance
Item title: RRace
A6.
What is your race? You may choose one or more. Is it…
PROGRAMMER: CODE ALL THAT APPLY
White ....................................................................... 1
Black or African American .................................... 2
American Indian or Alaska Native ........................ 3
Asian ....................................................................... 4
Native Hawaiian or Other Pacific Islander ........... 5
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
ALL
Source: Adapted from Baby FACES 2009
Item title: RBornUS
A7.
Were you born in the United States, or in some other country?
INSTRUCTION: CODE AS “1” IF RESPONDENT SAYS HE/SHE WAS BORN IN ANY OF THE
FOLLOWING U.S. TERRITORIES: PUERTO RICO, U.S. VIRGIN ISLANDS, GUAM,
NORTHERN MARIANA ISLANDS, OR AMERICAN SAMOA.
USA .......................................................................... 1
OUTSIDE OF THE USA .......................................... 2
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
Baby FACES 2020 Parent Survey
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OMB (Redacted)
A7 = 2 (RESPONDENT NOT BORN IN USA)
PROGRAMMER: USES CALCULATION DERIVED FROM RESPONDENT’S AGE (A2/A2A)
Source: Baby FACES 2009
Item title: RYrsUS
A7a.
How many years have you lived in the United States?
INSTRUCTION: ENTER ‘01’ IF LESS THAN 1 YEAR. IF HAS LIVED IN US ‘ON AND OFF,’
ASK: Thinking about all the years overall that you have been in the United States, about
how many years would that be?
|
|
| NUMBER (RANGE 1 – 99)
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
SOFT CHECK: RESPONSE CANNOT BE GREATER THAN RESPONDENT’S CHRONOLOGICAL AGE
AT TIME OF INTERVIEW.
INTERVIEWER: I recorded that you have lived in the United States for [FILL A7A] years, but this is
greater than your current age based on the information you gave me. Is this correct?
Baby FACES 2020 Parent Survey
8
OMB (Redacted)
ASK ONLY IF RESPONDENT IS BIO MOTHER OR BIO FATHER
FILL STEM AS FOLLOWS:
IF PREGNANT = 1, DISPLAY “your unborn child’s” AND “father” ; IF PREGNANT = 0, DISPLAY [CHILD]’s
FROM PRELOAD OR FROM NEWBORNFN. IF PREGNANT = 0 AND CHILD’S NAME FROM PRELOAD IS
MISSING, DISPLAY “your child’s” ;
IF A1A=1, DISPLAY “father” ; IF A1B=1, DISPLAY “mother”
Source: Adapted from Baby FACES 2009
Item title: RReltoOthBioParent
A8.
What is your relationship with [your unborn child’s/[CHILD]’s] [father/mother]? Is…
PROGRAMMER: IF SPEAKING TO BIRTH MOTHER, HIDE RESPONSE OPTION 7; IF
SPEAKING TO BIRTH FATHER, HIDE RESPONSE OPTIONS 6 AND 8.
[He/She] your [boyfriend/girlfriend] or partner,..................
1
PROGRAMMER: IF A1a = 1, DISPLAY “He” and “boyfriend”
PROGRAMMER: IF A1b = 1, DISPLAY “She” and “girlfriend”
Are you are married to [him/her], ........................................
2
PROGRAMMER: IF A1a = 1, DISPLAY “him”
PROGRAMMER: IF A1b = 1, DISPLAY “her”
Divorced, ................................................................................
3
Separated, or .........................................................................
4
Are you not in a relationship at this time? .........................
5
BIRTH FATHER IS DECEASED .............................................
6
BIRTH MOTHER IS DECEASED ...........................................
7
BIRTH FATHER IS UNKNOWN…………………
8
DON’T KNOW .........................................................................
d
REFUSED ...............................................................................
r
SKIP IF A8 = 2 (RESPONDENT BIO PARENT MARRIED TO FOCAL CHILD’S OTHER BIO PARENT).
PROGRAMMER: IF A8=2, SET A9 TO 1.
Baby FACES 2020 Parent Survey
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OMB (Redacted)
PROGRAMMER: IF A8 = 6 OR A8 = 7 (BIRTH FATHER OR MOTHER IS DECEASED), DISPLAY TEXT IN BRACKETS
Source: Baby FACES 2018
Item title: RReltoOthBioParent2
A9.
[I’m very sorry for your loss. Please accept my condolences. PAUSE]
What is your current marital status?
INSTRUCTION: IF RESPONDENT SAYS “SINGLE,” CONFIRM HE/SHE HAS NEVER BEEN
MARRIED.
MARRIED ................................................................ 1
SEPARATED, BUT STILL LEGALLY MARRIED .... 2
DIVORCED .............................................................. 3
SINGLE/NEVER MARRIED ..................................... 4
WIDOWED ............................................................... 5
REFUSED ................................................................ r
ALL
Source: Baby FACES 2009 [COMPONENT OF RISK INDEX]
Item title: RWrkStatus
A10.
Are you currently employed for pay or income, including self-employment?
INSTRUCTION: IF RESPONDENT SAYS HE OR SHE IS ON PARENTAL LEAVE, CODE “YES” FOR
THIS QUESTION AND CODE “ON PARENTAL LEAVE” IN a10A.
YES ........................................................................
1
NO ..........................................................................
0
RETIRED ...............................................................
2
DISABLED/UNABLE TO WORK ............................
3
DON’T KNOW ........................................................
d
REFUSED ..............................................................
r
IF A10=1 (CURRENTLY WORKING FOR PAY)
Source: Baby FACES 2018
Item title: RWrkStatus2
A10a. Are you currently working a full-time job, or do you have one or more part-time jobs? A fulltime job is one in which you work for 35 hours or more per week.
INSTRUCTION: IF RESPONDENT SAYS PART-TIME AND OFFERS NOTHING MORE ABOUT
AMOUNT OF HOURS, ASK: Do you work multiple part-time jobs that total 35 or more hours
per week?
WORKING FULL TIME (35 HOURS A WEEK OR MORE) .....................................
1
WORKING MULTIPLE PART TIME JOBS THAT TOTAL 35 OR MORE HOURS ..
2
WORKING PART TIME JOB(S) – LESS THAN 35 HOURS A WEEK ....................
3
ON PARENTAL LEAVE ........................................
4
DON’T KNOW ..........................................................................................................
d
REFUSED ................................................................................................................
r
Baby FACES 2020 Parent Survey
10
OMB (Redacted)
IF A10=0, 2, 3, D, R (NOT CURRENTLY WORKING AT A JOB FOR PAY)
Source: Baby FACES 2009 [COMPONENT OF RISK INDEX]
Item title: RWrkStatus3
A10b.
Have you worked at a job for pay or income, including self-employment in the past 12
months?
YES ........................................................................
1
NO ..........................................................................
0
DON’T KNOW ........................................................
d
REFUSED ..............................................................
r
IF A10=1 (CURRENTLY WORKING FOR PAY)
Source: New Item
A10c.
Does your work schedule, that is the days of the week or the hours per day, often change
from week to week, or is your work schedule generally the same every week?
WORK SCHEDULE CHANGES WEEK TO WEEK .................................................
1
WORK SCHEDULE GENERALLY THE SAME EVERY WEEK ..............................
2
DON’T KNOW ..........................................................................................................
d
REFUSED ................................................................................................................
r
IF A10c=1 (WORK SCHEDULE CHANGES WEEKLY)
Source: New Item
A10d.
When your schedule changes, how far in advance do you usually know what days and
hours you will be working? Do you find out.. (READ)
One week or less ahead of time, .......................
1
Between one and two weeks ahead of time, ....
2
Between three to four weeks ahead of time, or
3
Four weeks or more ahead of time?
4
DON’T KNOW ..........................................................................................................
d
REFUSED ................................................................................................................
r
Baby FACES 2020 Parent Survey
11
OMB (Redacted)
IF A10=1 (CURRENTLY WORKING FOR PAY)
Source: New Item
A10e.
Does your work ever require you to work evenings, overnight, or on weekends?
INSTRUCTION: IF RESPONDENT SAYS “YES,” CONFIRM WHICH TIMES. IF NEEDED
EXPLAIN EVENINGS ARE FROM MONDAY-FRIDAY BETWEEN 6 PM AND 10 PM;
OVERNIGHTS ARE MONDAY THROUGH FRIDAY BETWEEN 10 PM AND 6 AM; AND
WEEKENDS ARE ANYTIME ON SATURDAY OR SUNDAY.
PROGRAMMER: CODE ALL THAT APPLY.
NO EVENING, OVERNIGHT OR WEEKEND HOURS ...................1
YES, EVENINGS (M-F 6-10 PM).....................................................2
YES, OVERNIGHTS (M-F 10PM-6AM) ...........................................3
YES, WEEKENDS (ANYTIME SATURDAY OR SUNDAY) ............4
DON’T KNOW .................................................................. d
REFUSED ....................................................................... r
ALL
Source: Baby FACES 2009 [COMPONENT OF RISK INDEX]
Item title: REducation
A11.
What is the highest grade or year of school that you completed?
INSTRUCTION: If ‘high school’, PROBE: What is the last grade you completed?
INSTRUCTION: If ‘college’, PROBE: Did you receive a degree? What type of degree?
UP TO 8TH GRADE .........................................................................
1
9TH TO 11TH GRADE .....................................................................
2
12TH GRADE BUT NO DIPLOMA ...................................................
3
HIGH SCHOOL DIPLOMA/EQUIVALENT .......................................
4
SOME VOCATIONAL/TECHNICAL SCHOOL BUT NO DIPLOMA .
5
VOCATIONAL/TECHNICAL DIPLOMA ...........................................
6
SOME COLLEGE COURSES BUT NO DEGREE ...........................
7
ASSOCIATE’S DEGREE .................................................................
8
BACHELOR’S DEGREE ..................................................................
9
GRADUATE OR PROFESSIONAL SCHOOL BUT NO DEGREE ..
10
MASTER’S DEGREE (M.A., M.S.)...................................................
11
DOCTORATE DEGREE (PH.D., ED.D.) ..........................................
12
PROFESSIONAL DEGREE AFTER BACHELOR’S DEGREE
(MEDICINE/MD; DENTISTRY/DDS; LAW/JD/LLB; ETC.) ...............
13
DON’T KNOW ..................................................................................
d
REFUSED ........................................................................................
R
Baby FACES 2020 Parent Survey
12
OMB (Redacted)
ALL
Source: New Item
Item title:
A11X.
Was any of your schooling completed in another country?
YES ........................................................................
1
NO ..........................................................................
0
DON’T KNOW ........................................................
d
REFUSED ..............................................................
r
IF A11 = 4, 5, 6, 7, D, R
Source: Baby FACES 2009
Item title: RDiplomaGED
A11a.
Which do you have, a high school diploma or a GED?
HIGH SCHOOL DIPLOMA ....................................
1
GED.......................................................................
2
DON’T KNOW .......................................................
d
REFUSED .............................................................
r
ALL
Source: Baby FACES 2009 [COMPONENT OF RISK INDEX]
Item title: REnCourses
A12.
Are you now attending or enrolled in any courses, classes, or workshops for workrelated reasons or personal interest?
PROBE:
Some examples include college or university degree or certificate
programs, computer courses, job training courses, basic reading or math
classes, family literacy classes or GED preparation classes.
YES…………………………………………………
1
NO…………………………………………………..
0
DON’T KNOW……………………………………..
d
REFUSED………………………………………….
r
Baby FACES 2020 Parent Survey
13
OMB (Redacted)
IF A10 = 0, 1, D, R (SKIP IF RETIRED OR UNABLE TO WORK)
Source: Baby FACES 2009 [COMPONENT OF RISK INDEX]
Item title: RJobTraining
A13.
Are you currently participating in a job-training or on-the-job-training program?
YES………………………………………………….
1
NO……………………………………………………
0
DON’T KNOW………………………………………
d
REFUSED…………………………………………...
r
ALL
Source: Adapted from Baby FACES 2009
Item title: RPrgmAssistance
A14a.
Has [PROGRAM] Early Head Start helped you attend school or enroll in classes or
workshops?
YES…………………………………………………..
1
NO……………………………………………………
0
DON’T KNOW………………………………………
d
REFUSED…………………………………………..
r
A14a=1
Source: New item
Item title: XXX
A14b.
How did [PROGRAM] Early Head Start help you attend school or enroll in classes or
workshops? Did they…
Yes
No
a. Help you find classes or workshops?
1
0
b. Assist with applications ?
1
0
c. Help find financial aid?
1
0
d. Assist with child care while you attended school/class?
1
0
e. Assist with transportation to school/class?
1
0
Baby FACES 2020 Parent Survey
14
OMB (Redacted)
ALL
Source: Baby FACES 2009
Item title: RPrgmAssistance
A14c.
Has [PROGRAM] Early Head Start helped you find a job?
YES…………………………………………………..
1
NO……………………………………………………
0
DON’T KNOW………………………………………
d
REFUSED…………………………………………..
r
A14c=1
Source: New item
Item title: XXX
A14d.
How did [PROGRAM] Early Head Start help you find a job? Did they…
Yes
No
a. Offer career counseling?
1
0
b.
1
0
c. Help find or apply for a job training program?
1
0
d. Help prepare for an interview?
1
0
e. Connect you with another community organization that
offered support for finding a job?
1
0
Assist with child care during an interview or while
working?
1
0
g. Assist with transportation to an interview or the job?
1
0
f.
Assist with a job application?
Baby FACES 2020 Parent Survey
15
OMB (Redacted)
B. ABOUT FOCAL CHILD
PROGRAMMER: SKIP SECTION B IF PREGNANT = 1 (SECTION NOT ADMINISTERED TO PREGNANT WOMEN)
PREGNANT = 0
PROGRAMMER: FILL CHILD FIRST NAME FROM PRELOAD; DO NOT ASK B1 IF NAME WAS COLLECTED AT
NewbornFN
IF NO NAME PROVIDED IN PRELOAD AND RESPONDENT REFUSES TO PROVIDE NAME (B1 = R), FILL
[CHILD] WITH “your child” FOR REMAINDER OF INTERVIEW.
IF B1 = 0 OR 2, NAME AS RECORDED IN B1A SHOULD BE USED AS FILL FOR [CHILD] FOR REMAINDER OF
INTERVIEW.
Source: Baby FACES 2018
Item title: ChName
B1.
The next few questions are about [CHILD]. First, I would like to make sure we have
[CHILD]’s first name recorded correctly.
PROGRAMMER:
DISPLAY CHILD’S NAME FROM PRELOAD AS INTERVIEWER NOTE.
PROGRAMMER: IF CHILD’S NAME IS MISSING IN PRELOAD, DISPLAY THIS TEXT IN
PLACE OF THE STEM TEXT SHOWN ABOVE: The next few questions are about your child
that was selected to participate in the Baby FACES study. Please tell me your child’s first
name.
PROGRAMMER: IF CHILD’S NAME IS MISSING IN PRELOAD, HIDE RESPONSE OPTIONS 1
AND 2. IF CHILD’S NAME IS IN PRELOAD, HIDE RESPONSE OPTION 0.
INSTRUCTION:
VERIFY SPELLING IF NAME IS SHOWN. IF NOT SHOWN, RECORD.
RECORD CHILD’S FIRST NAME ......................................................................... 0
GO TO B1A
FIRST NAME DISPLAYED IS CORRECT ............................................................ 1
GO TO B2
FIRST NAME DISPLAYED IS INCORRECT ........................................................ 2
GO TO B1A
REFUSED……………………………………………………………………………….r
GO TO B2
B1 = 0 OR 2
Source: Baby FACES 2018
Item title: ChNameProvided
B1a.
INSTRUCTION: RECORD CHILD’S FIRST NAME AS PROVIDED BY RESPONDENT. VERIFY
SPELLING BEFORE PROCEEDING TO THE NEXT SCREEN.
________________________________________________________
FIRST NAME
REFUSED……………………………………………………………………………….R
Baby FACES 2020 Parent Survey
16
OMB (Redacted)
PREGNANT = 0
Source: Baby FACES 2009
Item title: ChSex
B2.
Just to confirm, is [CHILD] a boy or a girl?
BOY ......................................................................... 1
GIRL ......................................................................... 2
PREGNANT = 0
PROGRAMMER: FILL CHDOB FROM PRELOAD
Source: Baby FACES 2009
Item title: ConfirmChDOB
What is [CHILD]’s birth date?
B3a.
PROGRAMMER: DISPLAY CHILD’S BIRTH DATE FROM PRELOAD AS INTERVIEWER NOTE
INSTRUCTION: COMPARE RESPONSE WITH DATE DISPLAYED AND CODE RESPONSE
BIRTH DATE IS CORRECT .................................... 1
UPDATE CHILD’S BIRTH DATE ............................. 2
B3B
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
IF B3A=2
Source: Baby FACES 2009
Item title: CorrectChDOB
B3b.
PROGRAMMER: ALLOW DATE TO BE ENTERED/REVISED ON THIS SCREEN.
INSTRUCTION: RECORD/UPDATE CHILD’S BIRTH DATE.
INSTRUCTION: ENTER DATE AS MM/DD/YYYY
|
| |/| | |/|
Month
Day
|
| |
Year
|
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
PROGRAMMER: SOFT CHECK: CHILD DOB CANNOT BE IN THE FUTURE; AND CHILD’S
AGE AT TIME OF INTERVIEW CANNOT BE GREATER THAN 40 MONTHS.
INTERVIEWER: I entered [CHILD]’s date of birth as [FILL B3B]. I must have entered this
incorrectly. Please repeat the date.
Baby FACES 2020 Parent Survey
17
OMB (Redacted)
IF B3B = D, R OR INCOMPLETE (ANY PART OF BIRTH DATE FIELD NOT ANSWERED)
Source: Adapted from Baby FACES 2009
Item title: ChAgeMos
B3c.
What is [CHILD]’s age in months?
INSTRUCTION: ENTER ‘01’ IF LESS THAN 1 MONTH OLD.
|
|
| MONTHS (RANGE 1 – 40)
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
PREGNANT = 0
Source: Baby FACES 2009
Item title: ChPremie
B4.
Was [CHILD] born early or prematurely?
YES ........................................................................1
NO ..........................................................................0
DON’T KNOW ........................................................d
IF B4 = 1 (BORN PREMATURELY)
Source: Baby FACES 2009
Item title: ChWksEarly
B4a.
How many weeks early was [CHILD] born?
PROBE: Your best estimate is fine.
|
|
| WEEK(S) (RANGE 01 – 20)
DON’T KNOW .......................................................... d
IF B4A = D (RESPONDENT DOESN’T KNOW NUMBER OF WEEKS PREMATURE)
Source: Baby FACES 2009
Item title: ChWksEarly2
B4a.1.
At how many weeks was [CHILD] delivered?
PROBE: Your best estimate is fine.
|
|
| NUMBER OF WEEKS WHEN CHILD WAS DELIVERED (RANGE 20 – 39)
DON’T KNOW .......................................................... d
Baby FACES 2020 Parent Survey
18
OMB (Redacted)
PREGNANT = 0
Source: Baby FACES 2009
Item title: ChWghtAtBirth
B5.
How much did [CHILD] weigh when (he/she) was born?
INSTRUCTION: THERE ARE 16 OZ IN ONE POUND.
|
|
OR |
| POUNDS AND |
|.|
|
| OUNCES
| KILOGRAMS
POUNDS (RANGE 01 – 25)
OUNCES (RANGE 00 – 15)
KG (RANGE 0.5 – 12.9)
DON’T KNOW ..........................................
d
REFUSED ................................................
r
IF B5 = D, R (WEIGHT AT BIRTH IS DON’T KNOW OR REFUSED)
Source: Baby FACES 2009
Item title: ChWghtAtBirth2
B5a.
Was [CHILD]’s birth weight . . .
normal (5 lbs. 8 oz. [2.5 kilograms] or more),
1
low (at least 3 lbs. 4 oz. [1.5 kilograms] but less than
5 lbs. 8 oz. [2.5 kilograms]), or
2
very low (under 3 lbs. 4 oz. [1.5 kilograms])?
3
DON’T KNOW ..............................................................................
d
REFUSED ....................................................................................
r
PREGNANT = 0
Source: Adapted from Baby FACES 2009
Item title: ChBornUS
B6.
Was [CHILD] born in the United States, or in some other country?
INSTRUCTION: CODE AS “1” IF RESPONDENT SAYS CHILD WAS BORN IN ANY OF THE
FOLLOWING U.S. TERRITORIES: PUERTO RICO, U.S. VIRGIN ISLANDS, GUAM,
NORTHERN MARIANA ISLANDS, OR AMERICAN SAMOA.
USA .......................................................................... 1
OUTSIDE OF THE USA .......................................... 2
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
Baby FACES 2020 Parent Survey
19
OMB (Redacted)
IF B6 = 2 (CHILD NOT BORN IN USA)
PROGRAMMER: USES CALCULATION DERIVED FROM CHILD’S AGE
Source: Baby FACES 2009
Item title: ChYrsUS
B6a.
How many months has [CHILD] lived in the United States?
INSTRUCTION: ENTER ‘01’ IF LESS THAN 1 MONTH.
|
|
| NUMBER (RANGE 1 – 40)
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
SOFT CHECK: RESPONSE CANNOT BE GREATER THAN CHILD’S CHRONOLOGICAL AGE AT TIME
OF INTERVIEW.
INTERVIEWER: I recorded that [CHILD] has lived in the United States for [FILL B6A] month(s), but
this is greater than the child’s current age based on the information you gave me. Is this correct?
PREGNANT = 0
Source: OMB Guidance
Item title: ChEthnicity
B7.
Is [CHILD] of Hispanic, Latino/a, or Spanish origin? You may choose one or more.
INSTRUCTION: IF ONLY SAYS ‘YES,’ ASK, Is this child’s origin Mexican, Puerto Rican,
Cuban, or something else?
PROGRAMMER: CODE ALL THAT APPLY. HOWEVER, IF ‘1’ IS SELECTED, NO OTHER
OPTION CAN BE ENDORSED.
NO, NOT OF HISPANIC, LATINO/A, OR SPANISH ORIGIN ........... 1
YES, MEXICAN, MEXICAN AMERICAN, CHICANO/A...................... 2
YES, PUERTO RICAN ....................................................................... 3
YES, CUBAN ...................................................................................... 4
YES, ANOTHER HISPANIC, LATINO/A, OR SPANISH ORIGIN ..... 5
DON’T KNOW ..................................................................................... d
REFUSED ........................................................................................... r
PREGNANT = 0
Source: OMB Guidance
Item title: ChRace
B8.
What is [CHILD]’s race? You may choose one or more. Is it…
PROGRAMMER: CODE ALL THAT APPLY
White ....................................................................... 1
Black or African American .................................... 2
American Indian or Alaska Native ........................ 3
Asian ....................................................................... 4
Native Hawaiian or Other Pacific Islander ........... 5
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
Baby FACES 2020 Parent Survey
20
OMB (Redacted)
C. ABOUT HOUSEHOLD
ALL
Source: Adapted from Baby FACES 2009
Item title: LiveInHHCount
C1.
My next questions are about all the people who live in the same household as you (and
[CHILD]).
Including you (and [CHILD]), how many of the following people live in your household?
PROGRAMMER: IF PREGNANT = 0, DISPLAY “and [CHILD]” ABOVE.
Number of people
a. Adults age 18 and older
(RANGE 00 – 20)
|
|
|
b. Children between age 5 and age 17
(RANGE 00 – 20)
|
|
|
c.
(RANGE 00 – 20)
|
|
|
Children under age 5
PROGRAMMER: ADD SOFT CHECK IF PREGNANT=0 and C1c=0:
I entered that there are 0 children under age 5 in your household. I must have entered this
incorrectly. Please repeat the number of children under age 5 living in your household.
PROGRAMMER: CALCULATE SUM (C1A TO C1C). SET AS HOUSE TOTAL. HOUSE TOTAL CANNOT
EQUAL 0 SINCE RESPONDENT IS ALWAYS TO BE INCLUDED. IF PREGNANT = 0, HOUSE TOTAL
SHOULD HAVE A MINIMUM VALUE OF 2 (RESPONDENT AND FOCAL CHILD).
ALL
Source: Baby FACES 2009
Item title: LiveInHHConfirm
C1HH.
Just to confirm, is it correct that a total of [HOUSE TOTAL] [people/person], including
you (and [CHILD]), live in your household?
PROGRAMMER: IF PREGNANT = 0, DISPLAY “and [CHILD]” ABOVE.
PROGRAMMER: IF HOUSE TOTAL=1, DISPLAY “person” ABOVE. ELSE, DISPLAY
“people”
YES ........................................................................
1
NO ..........................................................................
0
DON’T KNOW ........................................................
d
REFUSED ..............................................................
r
Baby FACES 2020 Parent Survey
21
OMB (Redacted)
IF C1HH = 0
C1HHa. What have I recorded incorrectly? I recorded that, including you (and [CHILD]), [FILL C1A]
adult(s) 18 and older, [FILL C1B] child(ren) between the ages of 5 and 17, and [FILL C1C]
child(ren) under the age of 5 live in your home.
PROGRAMMER: IF PREGNANT = 0, DISPLAY “and [CHILD]” ABOVE.
FIX ADULTS 18 AND OLDER ...............................
1
C1A
FIX CHILDREN AGES 5 TO 17 .............................
2
C1B
FIX CHILDREN UNDER AGE 5 .............................
3
C1C
IF PREGNANT = 0 OR A0 = 1 (RESPONDENT IS NOT/NO LONGER PREGNANT)
Source: New
Item title:
C1HHb.
Thinking now about [CHILD] specifically, does [he/she] live in another household at least
some of the time?
YES .......................................................................... 1
NO ............................................................................ 0
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
ALL
Source: Baby FACES 2009 [COMPONENT OF RISK INDEX]
Item title: RSpouseorPartner
C2.
Do you have a spouse or partner who lives in this household?
YES .......................................................................... 1
NO ............................................................................ 0
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
PROGRAMMER: IF C2 = 1, GO TO C4. ASK C4-C13 ABOUT SPOUSE/PARTNER. ONCE COMPLETED, LOOP
BACK TO C3. IF ((PREGNANT=1 AND HOUSE TOTAL GE 3) OR (PREGNANT=0 AND HOUSE TOTAL GE 4)) (AT
LEAST ONE PERSON IN HOUSE OTHER THAN RESPONDENT, SPOUSE, AND SAMPLE CHILD), ASK C3. IF C3
= 1, ASK C4-C13 ABOUT OTHER PERSON IN HOUSEHOLD.
IF C2 = 0, D, R AND ((PREGNANT=1 AND HOUSE TOTAL GE 2) OR (PREGNANT=0 AND HOUSE TOTAL GE 3))
(AT LEAST ONE PERSON IN HOUSEHOLD OTHER THAN RESPONDENT AND SAMPLE CHILD), GO DIRECTLY
TO C3. IF C3 = 1, ASK C4-C13 ABOUT OTHER PERSON IN HOUSEHOLD.
IF (C2 = 0, D, R AND ((PREGNANT=1 AND HOUSE TOTAL GE 2) OR (PREGNANT=0 AND HOUSE TOTAL GE 3)))
OR (C2=1 AND ((PREGNANT=1 AND HOUSE TOTAL GE 3) OR (PREGNANT=0 AND HOUSE TOTAL GE 4)))
Baby FACES 2020 Parent Survey
22
OMB (Redacted)
Source: New item
Item title: ParentFigureInHH
C3.
Is there another person in this household that [will be/is] like a parent to [the new
baby/[CHILD]]?
PROGRAMMER: IF PREGNANT = 1, DISPLAY “will be” AND “the new baby” ; IF PREGNANT
= 0, DISPLAY “is” AND [CHILD].
YES .......................................................................... 1
NO ............................................................................ 0
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
IF C2 = 1 OR C3 = 1 (SPOUSE/PARTNER OR OTHER PARENTAL FIGURE IN HOUSEHOLD)
Source: Adapted from Baby FACES 2009
Item title: ParentFigureSex
C4.
Is (your spouse or partner / this person) male or female?
PROGRAMMER: IF C2=1, DISPLAY “your spouse or partner”;
IF C3=1, DISPLAY “this person”
MALE ....................................................................... 1
FEMALE ................................................................... 2
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
IF C2 = 1 OR C3 = 1 (SPOUSE/PARTNER OR OTHER PARENTAL FIGURE IN HOUSEHOLD)
Source: Adapted from Baby FACES 2009
Item title: ParentFigureReltoCh
C5.
What is (his/her/this person’s) relationship to [the new baby/[CHILD]]?
PROGRAMMER: IF C4=1, DISPLAY “his”; IF C4=2, DISPLAY “her”; IF C4=D, R, DISPLAY
“this person’s”
PROGRAMMER: IF PREGNANT=1, DISPLAY “the new baby” ; IF PREGNANT=0, DISPLAY
[CHILD].
MOTHER/FEMALE GUARDIAN .............................. 1
FATHER/MALE GUARDIAN .................................... 2
SISTER .................................................................... 3
BROTHER ............................................................... 4
GIRLFRIEND OR PARTNER OF CHILD’S
PARENT/GUARDIAN .............................................. 5
BOYFRIEND OR PARTNER OF CHILD’S
PARENT/GUARDIAN .............................................. 6
GRANDMOTHER .................................................... 7
GRANDFATHER...................................................... 8
AUNT ....................................................................... 9
UNCLE ..................................................................... 10
COUSIN ................................................................... 11
Baby FACES 2020 Parent Survey
23
OMB (Redacted)
OTHER RELATIVE .................................................. 12
OTHER NON-RELATIVE ......................................... 13
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
IF C5=1 (MOTHER/FEMALE GUARDIAN)
Source: Adapted from Baby FACES 2009
Item title: ParentFigureReltoCh2
C5a.
Is she [the new baby’s/[CHILD]’s]…?
PROGRAMMER: IF PREGNANT = 1, DISPLAY “the new baby’s”; IF PREGNANT = 0, DISPLAY
[CHILD].
Birth mother, ....................................................
1
Adoptive mother, .............................................
2
Stepmother, or ..................................................
3
Foster mother or female guardian? ..............
4
PROGRAMMER: IF PREGNANT = 1, DISPLAY ; IF
d
= 0,
DON’T KNOW ....................................................
REFUSED ..........................................................
r
IF C5=2 (FATHER/MALE GUARDIAN)
Source: Adapted from Baby FACES 2009
Item title: ParentFigureReltoCh3
C5b.
Is he [the new baby’s/[CHILD]’s]…?
PROGRAMMER: IF PREGNANT = 1, DISPLAY “the new baby’s”; IF PREGNANT = 0, DISPLAY
[CHILD].
Birth father, ......................................................
Adoptive father, ...............................................
Stepfather, or ....................................................
Foster father or male guardian? ....................
1
2
3
4
PROGRAMMER: IF PREGNANT = 1, DISPLAY ; IF
d
= 0,
DON’T KNOW ....................................................
REFUSED ..........................................................
r
Baby FACES 2020 Parent Survey
24
OMB (Redacted)
IF C2 = 1 OR C3 = 1 (SPOUSE/PARTNER OR OTHER PARENTAL FIGURE IN HH)
Source: OMB Guidance
Item title: ParentFigureEthnicity
C6.
Is (he/she/this person) of Hispanic, Latino/a, or Spanish origin? You may choose one or
more.
IF ONLY SAYS ‘YES,’ ASK: Is (his/her/this person’s) origin Mexican, Puerto Rican, Cuban,
or something else?
PROGRAMMER: IF C4=1, DISPLAY “he” AND “his”; IF C4=2, DISPLAY “she” AND “her”;
IF C4=D, R, DISPLAY “this person” AND “this person’s”
PROGRAMMER: CODE ALL THAT APPLY. HOWEVER, IF ‘1’ IS SELECTED, NO OTHER
OPTION CAN BE ENDORSED.
NO, NOT OF HISPANIC, LATINO/A, OR SPANISH ORIGIN ................ 1
YES, MEXICAN, MEXICAN AMERICAN, CHICANO/A ........................... 2
YES, PUERTO RICAN ............................................................................ 3
YES, CUBAN ........................................................................................... 4
YES, ANOTHER HISPANIC, LATINO/A, OR SPANISH ORIGIN ........... 5
DON’T KNOW .......................................................................................... d
REFUSED ................................................................................................ r
IF C2 = 1 OR C3 = 1 (SPOUSE/PARTNER OR OTHER PARENTAL FIGURE IN HH)
Source: OMB Guidance
Item title: ParentFigureRace
C7.
What is (his/her/this person’s) race? You may choose one or more. Is it…
PROGRAMMER: IF C4=1, DISPLAY “his”; IF C4=2, DISPLAY “her”; IF C4=D, R, DISPLAY
“this person’s”
PROGRAMMER: CODE ALL THAT APPLY
White ....................................................................... 1
Black or African American .................................... 2
American Indian or Alaska Native ........................ 3
Asian ....................................................................... 4
Native Hawaiian or Other Pacific Islander ........... 5
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
Baby FACES 2020 Parent Survey
25
OMB (Redacted)
IF C2 = 1 OR C3 = 1 (SPOUSE/PARTNER OR OTHER PARENTAL FIGURE IN HH)
Source: Adapted from Baby FACES 2009
Item title: ParentFigureBornUS
C8.
Was (he/she/this person) born in the United States, or in some other country?
INSTRUCTION: CODE AS “1” IF RESPONDENT SAYS HE/SHE WAS BORN IN ANY OF THE
FOLLOWING U.S. TERRITORIES: PUERTO RICO, U.S. VIRGIN ISLANDS, GUAM,
NORTHERN MARIANA ISLANDS, OR AMERICAN SAMOA.
PROGRAMMER: IF C4=1, DISPLAY “he”; IF C4=2, DISPLAY “she”; IF C4=D, R, DISPLAY
“this person”
USA .......................................................................... 1
OUTSIDE OF THE USA .......................................... 2
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
IF C8 = 2 (IF SPOUSE/PARTNER OR OTHER PARENTAL FIGURE NOT BORN IN USA)
Source: Baby FACES 2009
Item title: ParentFigureYrsUS
C8a.
How many years has (he/she/this person) lived in the United States?
INSTRUCTION: ENTER ‘01’ IF LESS THAN 1 YEAR. IF RESPONDENT REPORTS THIS
PERSON HAS LIVED IN US ‘ON AND OFF,’ ASK: Thinking about all the years overall that
(he/she/this person) has been in the United States, about how many years would that be?
PROGRAMMER: IF C4=1, DISPLAY “he”; IF C4=2, DISPLAY “she”; IF C4=D, R, DISPLAY
“this person”
|
|
| NUMBER (RANGE 1 – 99)
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
IF C2 = 1 OR C3 = 1 (SPOUSE/PARTNER OR OTHER PARENTAL FIGURE IN HH)
Source: Baby FACES 2009
Item title: ParentFigureWrkStatus
C9.
Is (he/she/this person) currently working at a job for pay or income, including selfemployment?
PROGRAMMER: IF C4=1, DISPLAY “he”; IF C4=2, DISPLAY “she”; IF C4=D, R, DISPLAY
“this person”
INSTRUCTION: IF RESPONDENT SAYS THIS PERSON ON MATERNITY LEAVE, CODE
“NO.”
YES ........................................................................
1
NO ..........................................................................
0
RETIRED ...............................................................
2
DISABLED/UNABLE TO WORK ............................
3
DON’T KNOW ........................................................
d
REFUSED ..............................................................
r
Baby FACES 2020 Parent Survey
26
OMB (Redacted)
IF C9=1 (SPOUSE/PARTNER OR OTHER PARENTAL FIGURE CURRENTLY WORKING FOR PAY)
Source: Baby FACES 2018
Item title: ParentFigureWrkStatus2
C9a.
Is (he/she/this person) currently working a full-time job, or does (he/she/this person) have
one or more part-time jobs?
INSTRUCTION: IF RESPONDENT SAYS PART-TIME AND OFFERS NOTHING MORE ABOUT
AMOUNT OF HOURS, ASK: Does (he/she/this person) work multiple part-time jobs that total
35 or more hours per week?
PROGRAMMER: IF C4=1, DISPLAY “he”; IF C4=2, DISPLAY “she”; IF C4=D, R, DISPLAY “this
person”
WORKING FULL TIME (35 HOURS A WEEK OR MORE) .....................................
1
WORKING MULTIPLE PART TIME JOBS THAT TOTAL 35 OR MORE HOURS ..
2
WORKING PART TIME JOB(S) – LESS THAN 35 HOURS A WEEK ....................
3
DON’T KNOW ..........................................................................................................
d
REFUSED ................................................................................................................
r
IF C9 = 0, 2, 3, D, R (SPOUSE/PARTNER OR OTHER PARENTAL FIGURE NOT CURRENTLY WORKING AT A JOB
FOR PAY)
Source: Baby FACES 2009
Item title: ParentFigureWrkStatus3
C10.
Has (he/she/this person) worked at a job for pay or income, including self-employment in
the past 12 months?
PROGRAMMER: IF C4=1, DISPLAY “he”; IF C4=2, DISPLAY “she”; IF C4=D, R, DISPLAY
“this person”
YES ........................................................................
1
NO ..........................................................................
0
DON’T KNOW ........................................................
d
REFUSED ..............................................................
r
Baby FACES 2020 Parent Survey
27
OMB (Redacted)
IF C2 = 1 OR C3 = 1 (SPOUSE/PARTNER OR OTHER PARENTAL FIGURE IN HH)
Source: Baby FACES 2009
Item title: ParentFigureEducation
C11.
What is the highest grade or year of school that (he/she/this person) completed?
INSTRUCTION:
completed?
If ‘high school’, PROBE:
What is the last grade (he/she/this person)
INSTRUCTION: If ‘college’, PROBE: Did (he/she/this person) receive a degree? What type
of degree?
PROGRAMMER: IF C4=1, DISPLAY “he”; IF C4=2, DISPLAY “she”; IF C4=D, R, DISPLAY
“this person”
UP TO 8TH GRADE .........................................................................
1
9TH TO 11TH GRADE .....................................................................
2
12TH GRADE BUT NO DIPLOMA ...................................................
3
HIGH SCHOOL DIPLOMA/EQUIVALENT .......................................
4
VOCATIONAL/TECHNICAL SCHOOL BUT NO DIPLOMA ............
5
VOCATIONAL/TECHNICAL DIPLOMA ...........................................
6
SOME COLLEGE COURSES BUT NO DEGREE ...........................
7
ASSOCIATE’S DEGREE .................................................................
8
BACHELOR’S DEGREE ..................................................................
9
GRADUATE OR PROFESSIONAL SCHOOL BUT NO DEGREE ..
10
MASTER’S DEGREE (M.A., M.S.)...................................................
11
DOCTORATE DEGREE (PH.D., ED.D.) ..........................................
12
PROFESSIONAL DEGREE AFTER BACHELOR’S DEGREE
(MEDICINE/MD; DENTISTRY/DDS; LAW/JD/LLB; ETC.) ...............
13
DON’T KNOW ..................................................................................
d
REFUSED ........................................................................................
r
IF C11 = 4, 5, 6, 7, D, R
Source: Baby FACES 2009
Item title: ParentFigureDiplomaGED
C11a.
Which does (he/she/this person) have, a high school diploma or a GED?
PROGRAMMER: IF C4=1, DISPLAY “he”; IF C4=2, DISPLAY “she”; IF C4=D, R, DISPLAY
“this person”
HIGH SCHOOL DIPLOMA ....................................
1
GED.......................................................................
2
DON’T KNOW .......................................................
d
REFUSED .............................................................
r
SURVEY NOTE: C12 AND C13 HAVE BEEN ADDED HERE TO OBTAIN INFORMATION ABOUT BIRTH
MOTHERS IN THE SCENARIO WHERE WE ARE INTERVIEWING THE BIRTH FATHER AND THE BIRTH
MOTHER RESIDES IN THE HOME AS WELL.
Baby FACES 2020 Parent Survey
28
OMB (Redacted)
IF C5A = 1
Source: Baby FACES 2009 [COMPONENT OF RISK INDEX]
Item title: BioMomEnCourses
C12.
Is she now attending or enrolled in any courses, classes, or workshops for work-related
reasons or personal interest?
PROBE:
Some examples include college or university degree or certificate
programs, computer courses, job training courses, basic reading or math
classes, family literacy classes or GED preparation classes.
YES…………………………………………………
1
NO…………………………………………………..
0
DON’T KNOW……………………………………..
d
REFUSED………………………………………….
r
IF C5A = 1 AND C9 = 0, 1, D, R; (SKIP IF RETIRED OR UNABLE TO WORK)
Source: Baby FACES 2009 [COMPONENT OF RISK INDEX]
Item title: BioMomJobTraining
C13.
Is she currently participating in a job-training or on-the-job-training program?
YES………………………………………………….
1
NO……………………………………………………
0
DON’T KNOW………………………………………
d
REFUSED…………………………………………...
r
Baby FACES 2020 Parent Survey
29
OMB (Redacted)
D. ABOUT BIRTH MOTHER/FATHER
IF A1A NE 1 (RESPONDENT IS NOT BIRTH MOTHER) AND A8 NE 7 (BIRTH MOTHER IS NOT DECEASED) AND
C5A (LOOP 1 AND LOOP 2) NE 1 (BIO MOM DOES NOT LIVE WITH RESPONDENT)
Now I’m going to ask you some questions about [CHILD]’s birth mother.
IF A1A NE 1 (RESPONDENT IS NOT BIRTH MOTHER) AND C5A (LOOP 1 AND LOOP 2) NE 1 (BIRTH MOTHER
DOES NOT RESIDE IN HH WITH RESPONDENT) AND A8 NE 7 (BIRTH MOTHER IS NOT DECEASED)
Source: MIHOPE 15-MONTH FOLLOW-UP
Item title: BioMomReasonAbsent
D4.
There are many reasons for children not living with their mothers. Why is [CHILD]’s
mother not living with (him/her)?
PROGRAMMER: CODE ALL THAT APPLY. IF B2=1, DISPLAY “him” ; IF B2=2, DISPLAY
“her”
PROBE: Are there any other reasons?
LACK OF MONEY TO RAISE CHILD……………………………..
1
ILLNESS/HOSPITALIZATION………………………………………
2
DRINKING PROBLEM………………………………………………
3
DRUG PROBLEM……………………………………………………
4
MENTAL HEALTH PROBLEM……………………………………..
5
JAIL/INCARCERATED…………………………………………
6
CHILD ABUSED / DOMESTIC VIOLENCE…………………………
7
COURT ORDER/CHILD SERVICES WOULD NOT ALLOW IT…
8
DID NOT WANT CHILD…………………………………..
9
MILITARY/ARMED FORCES…………………………………..
10
LEFT/MOVED AWAY…………………………………..
11
DIVORCED/SEPARATED/NOT ROMANTICALLY INVOLVED…
12
NOT MARRIED YET/LIVING WITH PARENTS……
13
DECEASED…………………………………………..
14
SOMETHING ELSE (SPECIFY) ...................................................
99
DON’T KNOW ...............................................................................
D
REFUSED………………………………………………………………
r
IF D4 = 14 (MOTHER IS DECEASED)
PROGRAMMER: ONLY DISPLAY IF MOTHER IS REPORTED DECEASED AT PREVIOUS ITEM.
D4info. I’m very sorry for your loss. Please accept my condolences.
Baby FACES 2020 Parent Survey
30
OMB (Redacted)
IF A1A NE 1 (RESPONDENT IS NOT BIRTH MOTHER) AND A8 NE 7 (BIRTH MOTHER IS NOT DECEASED) AND
D4 NE 14 (BIRTH MOTHER IS NOT DECEASED)
Source: Baby FACES 2009 [COMPONENT OF RISK INDEX]
Item title: BioMomDOB
D1.
What is [CHILD]’s mother’s birth date?
INSTRUCTION: IF RESPONDENT PROVIDES MONTH/YEAR BUT IS NOT SURE OF EXACT
DATE, SAY: Is her birth date closer to the beginning of the month, the end, or sometime
in the middle? [ENTER ‘01’ FOR BEGINNING, ‘15’ FOR MIDDLE, AND 25 FOR END]
INSTRUCTION: ENTER DATE AS MM/DD/YYYY
|
| |/| | |/|
Month
Day
|
| |
Year
|
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
PROGRAMMER: DOB CANNOT BE IN THE FUTURE
INTERVIEWER: I entered her date of birth as [FILL D1]. I must have entered this incorrectly. Please
repeat the date.
SOFT CHECK; IF YEAR AT D1 IS LESS THAN 1970 (R IS GT 50 YEARS OLD):
INTERVIEWER: I entered her date of birth as [FILL D1]. Is this correct?
SOFT CHECK; IF YEAR AT D1 IS GREATER THAN 2002 (R IS LT 18 YEARS OLD):
INTERVIEWER: I entered her date of birth as [FILL D1]. Is this correct?
IF D1 IS D, R, M (ANY PART OF BIRTH DATE FIELD NOT ANSWERED)
Source: Baby FACES 2009
Item title: BioMomAge
D1a.
How old is she?
|
|
| YEARS (RANGE 14-99)
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
Baby FACES 2020 Parent Survey
31
OMB (Redacted)
IF A1A NE 1 (RESPONDENT IS NOT BIRTH MOTHER) AND A8 NE 7 (BIRTH MOTHER IS NOT DECEASED) AND
D4 NE 14 (BIRTH MOTHER IS NOT DECEASED)
Source: Baby FACES 2009 [COMPONENT OF RISK INDEX]
Item title: BioMomAgeFirstChild
D2.
How old was she when she gave birth for the first time?
PROBE: Your best estimate is fine.
|
|
| YEARS (RANGE 10 – 60)
DON’T KNOW………………………………………..
d
REFUSED…………………………………………….
r
IF A1A NE 1 (RESPONDENT IS NOT BIRTH MOTHER) AND C5A (LOOP 1 AND LOOP 2) NE 1 (BIRTH MOTHER
DOES NOT RESIDE IN HH WITH RESPONDENT) AND A8 NE 7 (BIRTH MOTHER IS NOT DECEASED) AND D4
NE 14 (BIRTH MOTHER IS NOT DECEASED)
Source: Baby FACES 2009 [COMPONENT OF RISK INDEX]
Item title: BioMomEducation
D3.
What is the highest grade or year of school that she completed?
INSTRUCTION: If ‘high school’, PROBE: What is the last grade she completed?
INSTRUCTION: If ‘college’, PROBE: Did she receive a degree? What type of degree?
UP TO 8TH GRADE .........................................................................
1
9TH TO 11TH GRADE .....................................................................
2
12TH GRADE BUT NO DIPLOMA ...................................................
3
HIGH SCHOOL DIPLOMA/EQUIVALENT .......................................
4
VOCATIONAL/TECHNICAL SCHOOL BUT NO DIPLOMA ............
5
VOCATIONAL/TECHNICAL DIPLOMA ...........................................
6
SOME COLLEGE COURSES BUT NO DEGREE ...........................
7
ASSOCIATE’S DEGREE .................................................................
8
BACHELOR’S DEGREE ..................................................................
9
GRADUATE OR PROFESSIONAL SCHOOL BUT NO DEGREE ..
10
MASTER’S DEGREE (M.A., M.S.)...................................................
11
DOCTORATE DEGREE (PH.D., ED.D.) ..........................................
12
PROFESSIONAL DEGREE AFTER BACHELOR’S DEGREE
(MEDICINE/MD; DENTISTRY/DDS; LAW/JD/LLB; ETC.) ...............
13
DON’T KNOW ..................................................................................
d
REFUSED ........................................................................................
r
Baby FACES 2020 Parent Survey
32
OMB (Redacted)
IF D3 = 4, 5, 6, 7, D, R
Source: Baby FACES 2009
Item title: BioMomDiplomaGED
D3a.
Which does she have, a high school diploma or a GED?
HIGH SCHOOL DIPLOMA ....................................
1
GED.......................................................................
2
DON’T KNOW .......................................................
d
REFUSED .............................................................
r
IF A1A NE 1 (RESPONDENT IS NOT BIRTH MOTHER) AND C5A (LOOP 1 AND LOOP 2) NE 1 (BIRTH MOTHER
DOES NOT RESIDE IN HH WITH RESPONDENT) AND D4 NE 14 (BIRTH MOTHER IS NOT DECEASED) AND A8
NE 7 (BIRTH MOTHER IS NOT DECEASED)
Source: Baby FACES 2009
Item title: BioMomSeenChild3Mos
D5.
In the last three months, about how often has [CHILD] seen (his/her) mother? Was it . . .
PROGRAMMER: IF B2=1, DISPLAY “his;” IF B2=2, DISPLAY “her.”
PROBE: That would be in the last 90 days.
Every day or almost every day, .........................
6
A few times a week, ............................................
5
A few times a month, ..........................................
4
About once a month, ..........................................
3
Less often than that, or ......................................
2
Never? ..................................................................
1
DON’T KNOW .......................................................
d
REFUSED .............................................................
r
IF A1B NE 1 (RESPONDENT IS NOT BIRTH FATHER) AND C5B (LOOP 1 AND LOOP 2) NE 1 (BIRTH FATHER
DOES NOT RESIDE IN HH WITH RESPONDENT) AND A8 NE 6 (BIRTH FATHER IS NOT DECEASED) AND A8
NE 8 (BIRTH FATHER IS NOT UNKNOWN)
Now I’m going to ask you some questions about [the new baby’s/[CHILD]’s] birth father.
PROGRAMMER: IF PREGNANT=1, DISPLAY “the new baby’s” ; IF PREGNANT=0, DISPLAY [CHILD]
IF A1B NE 1 (RESPONDENT IS NOT BIRTH FATHER) AND C5B (LOOP 1 AND LOOP 2) NE 1 (BIRTH FATHER
DOES NOT RESIDE IN HH WITH RESPONDENT); EXCLUDE A8=6 (BIRTH FATHER IS DECEASED); EXCLUDE
A8=8 (BIRTH FATHER IS UNKNOWN)
FILL STEM AS FOLLOWS:
IF PREGNANT = 1, DISPLAY “the baby” … “will not be” … “his or her”
IF PREGNANT = 0, DISPLAY [CHILD]… “is not”
IF PREGNANT = 0 AND B2 = 1, DISPLAY “his”; IF PREGNANT = 0 AND B2 = 2, DISPLAY “her”
Baby FACES 2020 Parent Survey
33
OMB (Redacted)
Source: Adapted from Baby FACES 2009
Item title: BioDadReasonAbsent
D7.
There are many reasons for children not living with their fathers. Please tell me why [the
baby/[CHILD]] [will not be/is not] living with [his or her / his / her] father.
PROBE: Are there any other reasons?
PROGRAMMER: CODE ALL THAT APPLY
LACK OF MONEY TO RAISE CHILD……………………………..
1
ILLNESS/HOSPITALIZATION………………………………………
2
DRINKING PROBLEM………………………………………………
3
DRUG PROBLEM……………………………………………………
4
MENTAL HEALTH PROBLEM……………………………………..
5
JAIL/INCARCERATED…………………………………………
6
CHILD ABUSED / DOMESTIC VIOLENCE…………………………
7
COURT ORDER/CHILD SERVICES WOULD NOT ALLOW IT…
8
DID NOT WANT CHILD…………………………………..
9
MILITARY/ARMED FORCES…………………………………..
10
LEFT/MOVED AWAY…………………………………..
11
DIVORCED/SEPARATED/NOT ROMANTICALLY INVOLVED…
12
NOT MARRIED YET/LIVING WITH PARENTS……
13
DECEASED…………………………………………..
14
FATHER IS UNKNOWN…………………………………………..
15
SOMETHING ELSE (SPECIFY) ...................................................
99
DON’T KNOW ...............................................................................
D
REFUSED………………………………………………………………
r
Baby FACES 2020 Parent Survey
34
OMB (Redacted)
IF D7 = 14 (FATHER IS DECEASED)
PROGRAMMER: ONLY DISPLAY IF FATHER IS REPORTED DECEASED AT PREVIOUS ITEM.
D7info. I’m very sorry for your loss. Please accept my condolences.
Baby FACES 2020 Parent Survey
35
OMB (Redacted)
IF A1B NE 1 (RESPONDENT IS NOT BIRTH FATHER) AND C5B (LOOP 1 AND LOOP 2) NE 1 (BIRTH FATHER
DOES NOT RESIDE IN HH WITH RESPONDENT) AND A8 NE 6 (BIRTH FATHER IS NOT DECEASED) AND A8
NE 8 (BIRTH FATHER IS NOT UNKNOWN) AND D7 NE 14 (BIRTH FATHER IS NOT DECEASED) and D7 NE 15
(BIRTH FATHER IS NOT UNKNOWN)
Source: Baby FACES 2009
Item title: BioDadEducation
D6.
What is the highest grade or year of school that he completed?
INSTRUCTION: If ‘high school’, PROBE: What is the last grade he completed?
INSTRUCTION: If ‘college’, PROBE: Did he receive a degree? What type of degree?
UP TO 8TH GRADE .........................................................................
1
9TH TO 11TH GRADE .....................................................................
2
12TH GRADE BUT NO DIPLOMA ...................................................
3
HIGH SCHOOL DIPLOMA/EQUIVALENT .......................................
4
VOCATIONAL/TECHNICAL SCHOOL BUT NO DIPLOMA ............
5
VOCATIONAL/TECHNICAL DIPLOMA ...........................................
6
SOME COLLEGE COURSES BUT NO DEGREE ...........................
7
ASSOCIATE’S DEGREE .................................................................
8
BACHELOR’S DEGREE ..................................................................
9
GRADUATE OR PROFESSIONAL SCHOOL BUT NO DEGREE ..
10
MASTER’S DEGREE (M.A., M.S.)...................................................
11
DOCTORATE DEGREE (PH.D., ED.D.) ..........................................
12
PROFESSIONAL DEGREE AFTER BACHELOR’S DEGREE
(MEDICINE/MD; DENTISTRY/DDS; LAW/JD/LLB; ETC.) ...............
13
DON’T KNOW ..................................................................................
d
REFUSED ........................................................................................
r
IF D6 = 4, 5, 6, 7, D, R
Source: Baby FACES 2009
Item title: BioDadDiplomaGED
D6a.
Which does he have, a high school diploma or a GED?
HIGH SCHOOL DIPLOMA ....................................
1
GED.......................................................................
2
DON’T KNOW .......................................................
d
REFUSED .............................................................
r
Baby FACES 2020 Parent Survey
36
OMB (Redacted)
IF A1B NE 1 (RESPONDENT IS NOT BIRTH FATHER) AND C5B (LOOP 1 AND LOOP 2) NE 1 (BIRTH FATHER
DOES NOT RESIDE IN HH WITH RESPONDENT); EXCLUDE IF A8=6 (BIRTH FATHER IS DECEASED);
EXCLUDE D7=14 (BIRTH FATHER IS DECEASED); EXCLUDE A8=8 (BIRTH FATHER IS UNKNOWN; EXCLUDE
D7=15 (BIRTH FATHER IS UNKNOWN); EXCLUDE IF PREGNANT = 1
Source: Baby FACES 2009
Item title: BioDadSeenChild3Mos
D8.
In the last three months, about how often has [CHILD] seen (his/her) father? Was it . . .
PROGRAMMER: IF B2=1, DISPLAY “his;” IF B2=2, DISPLAY “her.”
PROBE: That would be in the last 90 days.
Every day or almost every day, .........................
6
A few times a week, ............................................
5
A few times a month, ..........................................
4
About once a month, ..........................................
3
Less often than that, or ......................................
2
Never? ..................................................................
1
DON’T KNOW .......................................................
d
REFUSED .............................................................
r
IF A1B NE 1 (RESPONDENT IS NOT BIRTH FATHER) AND C5B (LOOP 1 AND LOOP 2) NE 1 (BIRTH FATHER
DOES NOT RESIDE IN HH WITH RESPONDENT); EXCLUDE IF A8=6 (BIRTH FATHER IS DECEASED);
EXCLUDE D7=14 (BIRTH FATHER IS DECEASED); EXCLUDE A8=8 (BIRTH FATHER IS UNKNOWN); EXCLUDE
D7=15 (BIRTH FATHER IS UNKNOWN); EXCLUDE IF PREGNANT = 1
Source: Baby FACES 2009
Item title: BioDadFinancialSupport
D9.
(Are you/Is your family) currently receiving child support payments or any other financial
support for [CHILD] from (his/her) father?
PROGRAMMER: IF A1A = 1 (RESPONDENT IS BIRTH MOTHER), DISPLAY “Are you” ; IF
A1A NE 1 (RESPONDENT IS SOMEONE ELSE), DISPLAY “Is your family”
PROGRAMMER: IF B2=1, DISPLAY “his;” IF B2=2, DISPLAY “her.”
YES .......................................................................
1
NO .........................................................................
0
DON’T KNOW .......................................................
d
REFUSED .............................................................
r
Baby FACES 2020 Parent Survey
37
OMB (Redacted)
IF A1A NE 1 (RESPONDENT IS NOT BIRTH MOTHER) AND C5A (LOOP 1 AND LOOP 2) NE 1 (BIRTH MOTHER
DOES NOT RESIDE IN HH WITH RESPONDENT); EXCLUDE IF A8=7 (BIRTH MOTHER IS DECEASED)
Source: Newitem
Item title: BioMomFinancialSupport
D9a.
(Are you/Is your family) currently receiving child support payments or any other financial
support for [CHILD] from (his/her) mother?
PROGRAMMER: IF A1B = 1 (RESPONDENT IS BIRTH MOTHER), DISPLAY “Are you” ; IF
A1B NE 1 (RESPONDENT IS SOMEONE ELSE), DISPLAY “Is your family”
PROGRAMMER: IF B2=1, DISPLAY “his;” IF B2=2, DISPLAY “her.”
YES .......................................................................
1
NO .........................................................................
0
DON’T KNOW .......................................................
d
REFUSED .............................................................
r
Baby FACES 2020 Parent Survey
38
OMB (Redacted)
E. HOUSEHOLD LANGUAGES
These next questions are about the languages spoken in your household.
PROGRAMMER: IF INTERVIEW IS BEING CONDUCTED IN ENGLISH, ASK E1A. IF SPANISH, GO TO E1B
Source: Baby FACES 2009
Item title: OtherHHLang1
E1a.
Is any language other than English spoken in your home? These can be languages
spoken by you or other adults or children who live in your home.
YES ……………………………………………….
1
NO ………………………………………………...
0
DON’T KNOW ……………………………………
d
REFUSED ………………………………………..
r
PROGRAMMER: IF INTERVIEW IS BEING CONDUCTED IN SPANISH, ASK E1B
Source: Adapted from Baby FACES 2009
Item title: OtherHHLang2
E1b.
YES ……………………………………………….
1
NO ………………………………………………...
0
DON’T KNOW ……………………………………
d
REFUSED ………………………………………..
r
PROGRAMMER: ASK IF E1A OR E1B = 1.
Source: Adapted from Baby FACES 2009
Item title: HHLangsSpoken
E2.
What languages are spoken in your home?
PROBE: These can be languages spoken by you or other adults or children who live in
your home.
PROBE: Any other languages?
PROGRAMMER: CODE ALL THAT APPLY
ENGLISH……………………………………………………
1
SPANISH……………………………………………………
2
OTHER LANGUAGE (SPECIFY): _________________
3
OTHER LANGUAGE (SPECIFY): _________________
4
REFUSED……………………………………………………
r
Baby FACES 2020 Parent Survey
39
OMB (Redacted)
ALL
Source: Adapted from Baby FACES 2009
Item title: RPrimaryLang
E3.
What is your primary language?
PROBE: By primary, we mean the language that you feel most comfortable
communicating in.
PROGRAMMER: IF DK OR R AND THE INTERVIEW IS BEING CONDUCTED IN ENGLISH,
CODE AS ENGLISH (1). IF DK OR R AND THE INTERVIEW IS BEING CONDUCTED IN
SPANISH, CODE AS SPANISH (2).
ENGLISH……………………………………………………
1
SPANISH……………………………………………………
2
OTHER LANGUAGE (SPECIFY): _________________
3
DON’T KNOW………………………………………………
d
REFUSED……………………………………………………
r
IF E3 NE 1 (RESPONDENT’S PRIMARY LANGUAGE IS NOT ENGLISH)
Source: Adapted from Baby FACES 2009
Item title: RLangLiteracy
E4.
How well do you [INSERT ITEM (a) to (f)]? Would you say not at all, not well, well, or very
well?
PROGRAMMER: CODE ONLY ONE RESPONSE FOR EACH STATEMENT. ALLOW FOR
ENTRY OF DK (D) AND REF (R) RESPONSES
PROGRAMMER: IF E3=2 AND INTERVIEW IS BEING CONDUCTED IN SPANISH, FILL FOR
E4E AND E4F NEEDS TO SHOW AS español (AND NOT Spanish).
NOT AT
ALL
NOT
WELL
WELL
VERY
WELL
a. understand English ....
1
2
3
4
b. speak English ..............
1
2
3
4
c.
read English ................
1
2
3
4
d. write in English ...........
1
2
3
4
e. read [FILL E3] ..............
1
2
3
4
f.
1
2
3
4
write in [FILL E3 ..........
Baby FACES 2020 Parent Survey
40
OMB (Redacted)
IF PREGNANT = 0 AND (E1A OR E1B = 1)
PROGRAMMER: IF E2 NE 3, 4, R FILL “Spanish” (SPANISH IS ONLY NON-ENGLISH LANGUAGE SPOKEN IN
HOME); IF E2 NE 2, R FILL “other language” (A LANGUAGE OTHER THAN ENG/SP IS ONLY NON-ENGLISH
LANGUAGE SPOKEN IN HOME); IF E2= (2 AND 3) OR (2 AND 4) (SPANISH AND ANOTHER NON-ENG
LANGUAGE), DISPLAY “other language” ; IF E1B=1 and E2 NE 2, 3, 4, R DISPLAY “Spanish” (INTERVIEW IS
BEING CONDUCTED IN SPANISH AND RESPONDENT REPORTS ENG SPOKEN IN HOME)
Source: Adapted from Baby FACES 2009
Item title: LangSpokentoChild
E5.
What language do you or others in your household speak most often to [CHILD]?
All English, ............................................................................................................ 5
More English than [Spanish/other language], ................................................... 4
Equal [Spanish/other language] and English, ................................................... 3
More [Spanish/other language] than English, or .............................................. 2
All [Spanish/other language]? ............................................................................ 1
DON’T KNOW ........................................................................................................ d
REFUSED .............................................................................................................. r
IF PREGNANT = 0 AND (E1A OR E1B = 1)
PROGRAMMER: IF E2 NE 3, 4, R FILL “Spanish” (SPANISH IS ONLY NON-ENGLISH LANGUAGE SPOKEN IN
HOME); IF E2 NE 2, R FILL “other language” (A LANGUAGE OTHER THAN ENG/SP IS ONLY NON-ENGLISH
LANGUAGE SPOKEN IN HOME); IF E2= (2 AND 3) OR (2 AND 4) (SPANISH AND ANOTHER NON-ENG
LANGUAGE), DISPLAY “other language”; IF E1B=1 and E2 NE 2, 3, 4, R DISPLAY “Spanish” (INTERVIEW IS
BEING CONDUCTED IN SPANISH AND RESPONDENT REPORTS ENG SPOKEN IN HOME)
PROGRAMMER: IF CHILD AGE AT TIME OF INTERVIEW IS LT 6 MONTHS, DISPLAY TEXT IN BRACKETS.
Source: Adapted from Baby FACES 2009
Item title: LangSpokenbyChild
E6.
What language does [CHILD] use when (he/she) speaks to you or others at home? [If child
is not yet speaking, just let me know.] Would you say . . .
PROGRAMMER: IF B2=1, DISPLAY “he” ; IF B2=2, DISPLAY “she”
All English, ............................................................................................................ 5
More English than [Spanish/other language], ................................................... 4
Equal [Spanish/other language] and English, ................................................... 3
More [Spanish/other language] than English, or .............................................. 2
All [Spanish/other language]? ............................................................................ 1
CHILD IS NOT YET SPEAKING ............................................................................ 98
DON’T KNOW ........................................................................................................ d
REFUSED .............................................................................................................. r
Baby FACES 2020 Parent Survey
41
OMB (Redacted)
F. CHILD-PARENT ACTIVITIES AND ROUTINES
PROGRAMMER: SKIP SECTION F IF PREGNANT = 1 (SECTION NOT ADMINISTERED TO PREGNANT WOMEN)
Next, I would like you to think about things you and others in your family may do together with
[CHILD], including some of the typical routines in your household.
PREGNANT = 0
Source: Baby FACES 2009
Item title: BooksinHome
F1.
How many books for children are there in your home? Would you say . . .
PROBE: This can include children’s books for [CHILD] or other children who may also live
in your home.
zero, ......................................................................... 0
1 to 4, ....................................................................... 1
5 to 10, ..................................................................... 2
11 to 25, or .............................................................. 3
more than 25? ........................................................ 4
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
PREGNANT = 0
Source: Adapted from Baby FACES 2009
Item title: ReadtoCh
F2.
How often do you or others in your household read or look at books with [CHILD]? Would
you say…
PROBE: This can include books that you or others in your household look at or read with
[CHILD] in places outside your home, such as at a library.
more than once a day,……………………………..
4
about once a day,…………………………………..
3
a few times a week,…………………………………
2
once a week, or……………………………………..
1
less than once a week…………………………….
0
DON’T KNOW……………………………………….
d
REFUSED……………………………………………
r
Baby FACES 2020 Parent Survey
42
OMB (Redacted)
PREGNANT = 0
Source: Adapted from Baby FACES 2009
Item title: TellStorytoCh
F3.
How often do you or others in your household tell a story to [CHILD]? By storytelling, we
mean telling [CHILD] a story without an actual book. This can include telling a made-up
story, or telling stories about events that have actually happened. Would you say you or
others in your household do this . . .
more than once a day,…………………………….
4
about once a day,………………………………….
3
a few times a week,………………………………..
2
once a week, or…………………………………….
1
less than once a week ……………………………
0
DON’T KNOW……………………………………….
d
REFUSED……………………………………………
r
PREGNANT = 0
Source: Baby FACES 2018
Item title: SingtoCh
F4.
How often do you or others in your household sing to or with [CHILD]? Would you say…
more than once a day,…………………………….
4
about once a day,………………………………….
3
a few times a week,………………………………..
2
once a week, or…………………………………….
1
less than once a week ……………………………
0
DON’T KNOW……………………………………….
d
REFUSED……………………………………………
r
PREGNANT = 0
Source: Baby FACES 2009
Item title: EveningMeal
F5.
In a typical week, please tell me the number of days at least some of the family eats the
evening meal together.
PROBE IF VARIES: On average, how many days?
|
|
(RANGE 0 – 7)
DON’T KNOW ...................................................................................
d
REFUSED .........................................................................................
r
Baby FACES 2020 Parent Survey
43
OMB (Redacted)
PREGNANT = 0
Source: Baby FACES 2009
Item title: FedRegTimes
F6.
In a typical day, is [CHILD] fed at regular times?
YES .......................................................................
1
NO .........................................................................
0
DON’T KNOW .......................................................
d
REFUSED .............................................................
r
PREGNANT = 0
Source: Adapted from Baby FACES 2009
Item title: LengthNaps
F7a.
On average, for how long does [CHILD] nap during the day?
PROGRAMMER: HOURS AND MINUTES MUST BE GT OR EQ 0 (UNLESS CODED AS 98).
INSTRUCTION: ENTER A VALUE FOR BOTH HOURS AND MINUTES, EVEN IF IT IS ZERO.
|
|
| HOURS AND (RANGE 00 – 15)
|
|
| MINUTES
(RANGE 00 – 59)
CHILD DOES NOT NAP ...................................................................
98
DON’T KNOW ...................................................................................
d
REFUSED .........................................................................................
r
GO TO F8
SOFT CHECK: IF RESPONSE IS GT 8 hours: I just want to confirm that you are including only day
time sleep in your response. Is this correct?
PREGNANT = 0 AND F7a NE 98
Source: Adapted from Baby FACES 2009
Item title: RegNaptime
F7.
Does [CHILD] have a regular naptime during the day?
YES .......................................................................
1
NO .........................................................................
0
DON’T KNOW .......................................................
d
REFUSED .............................................................
r
Baby FACES 2020 Parent Survey
44
OMB (Redacted)
PREGNANT = 0
Source: Adapted from Baby FACES 2009
Item title: RegBedtime
F8.
Does [CHILD] have a regular bedtime at night?
PROBE: We are interested in what time (he/she) goes to bed, not what time (he/she)
actually falls asleep.
YES .......................................................................
1
NO .........................................................................
0
DON’T KNOW .......................................................
d
REFUSED .............................................................
r
PREGNANT = 0
Source: Baby FACES 2009
Item title: SleepHours
F8a.
How many hours does [CHILD] usually sleep each night?
PROBE: This should not include time the child spends lying awake trying to fall asleep.
PROGRAMMER: HOURS AND MINUTES MUST BE GT OR EQ 0.
INSTRUCTION: ENTER A VALUE FOR BOTH HOURS AND MINUTES, EVEN IF IT IS ZERO.
|
|
| HOURS AND (RANGE 00 – 15)
|
|
| MINUTES
(RANGE 00 – 59)
DON’T KNOW ...................................................................................
d
REFUSED .........................................................................................
r
PREGNANT = 0
Source: Baby FACES 2018
Item title: LengthScreenTime
F9.
About how much screen time does [CHILD] get on a typical day? By screen time, we mean
any time [he/she] spends watching TV or using a mobile device such as a smartphone,
iPad, or other tablet to play games or watch videos.
PROGRAMMER: HOURS AND MINUTES MUST BE GT OR EQ 0 (UNLESS CODED AS 98).
IF RESPONDENT MENTIONS CHILD SPENDS DIFFERENT AMOUNTS OF TIME ON
WEEKDAYS VERSUS WEEKENDS, SAY: Thinking both about weekdays and weekends,
about how much time would you say is typical? Your best estimate is fine.
INSTRUCTION: ENTER A VALUE FOR BOTH HOURS AND MINUTES, EVEN IF IT IS ZERO.
|
|
| HOURS AND (RANGE 00 – 15)
|
|
| MINUTES
(RANGE 00 – 59)
CHILD GETS NO SCREEN TIME ....................................................
98
DON’T KNOW ...................................................................................
d
REFUSED .........................................................................................
r
Baby FACES 2020 Parent Survey
45
OMB (Redacted)
F9 = D, R, OR GT 0 MINUTES (SKIP IF F9 = 98)
Source: Baby FACES 2018
Item title: HowScreenTime
F9.1
Now I am going to ask you about some ways [CHILD] may use the TV, computer, or mobile
devices. How often…
[FILL ITEM a–c] Would you say, never, rarely, some of the time, or most of the time?
PROGRAMMER: BOLD RESPONSE OPTIONS TEXT FOR ITEMS F9.1A TO F9.1C
(INTERVIEWER SHOULD READ AFTER EACH ITEM)
PROBE: Mobile devices include smartphones, iPads, e-readers, or other tablet devices.
PROGRAMMER: CODE ONLY ONE RESPONSE FOR EACH STATEMENT. ALLOW FOR
ENTRY OF DK (D) AND REF (R) RESPONSES
NEVER
RARELY
SOME OF
THE TIME
MOST OF
THE TIME
1
2
3
4
1
2
3
4
1
2
3
4
a. Does [CHILD] watch TV or use a computer
or mobile device alone so that [he/she]
can keep busy while you do other things?
This can be at home or while you are out
together. ..................................
b. Do you and [CHILD] watch TV or use a
computer or mobile device to do things
together? Things you might do together
include watch shows, play games, use
educational applications, or read stories.
c.
Does [CHILD] watch TV or use a computer
or mobile device before taking a nap or
going to bed?
Baby FACES 2020 Parent Survey
46
OMB (Redacted)
PREGNANT = 0
Source: Confusion, Hubbub, and Order Scale (CHAOS)
Permissions: Items in this section were published in the Journal of Applied Developmental Psychology, Vol. 16, Methany AP, Wachs
TD, Ludwig, JL, Phillips, K. Bringing Order out of Chaos: Psychometric Characteristics of the Confusion, Hubbub, and Order Scale,
pp. 429-444, Copyright Elsevier, 1995. Subitems K and M updated in consultation with developer (Wachs).
PROGRAMMER: DISPLAY ON FIRST SCREEN FOR THIS SECTION THE FOLLOWING, SHADED GRAY AND IN CAPS:
“PLEASE CLICK HERE FOR COPYRIGHT INFORMATION.” “HERE” SHOULD BE A HYPERLINK THAT WHEN CLICKED
DISPLAYS THE ABOVE COPYRIGHT/PERMISSIONS INFORMATION.
Item title: CHAOS
F10.
Next, I am going to read some statements that describe how things are like in many
households.
Please tell me how much each statement describes your home.
[FILL ITEM b–o, a]. Would you say very much, somewhat, a little, or not at all?
PROGRAMMER: THE RESPONSE OPTION TEXT SHOWN HERE SHOULD APPEAR IN BOLD
FOR THE FIRST TWO ITEMS AND EVERY 4TH ITEM THEREAFTER.
PROGRAMMER: CODE ONLY ONE RESPONSE FOR EACH STATEMENT. ALLOW FOR
ENTRY OF DK (D) AND REF (R) RESPONSES.
PROGRAMMER: PRESERVE ITEM NUMBERING AS SHOWN; ITEM A INTENTIONALLY
MOVED TO LAST ITEM IN SERIES.
VERY MUCH
SOMEWHAT
A LITTLE
NOT AT ALL
1
2
3
4
1
2
3
4
d. We are usually able to “stay on top of
things”
1
2
3
4
e. No matter how hard we try, we
always seem to be running late
1
2
3
4
1
2
3
4
g. At home we can talk to each other
without being interrupted
1
2
3
4
h. There is often a fuss going on at our
home
1
2
3
4
No matter what our family plans, it
usually doesn’t seem to work out
1
2
3
4
You can’t hear yourself think in our
home
1
2
3
4
1
2
3
4
b. We can usually find things when we
need them
c. We almost always seem to be rushed
f.
i.
j.
It’s a real “zoo” in our home
k. I often get drawn into other people’s
arguments at home
(this can include arguments between
adults or between adults and
children)
Baby FACES 2020 Parent Survey
47
OMB (Redacted)
l.
Our home is a good place to relax
1
2
3
4
1
2
3
4
1
2
3
4
o. First thing in the day, we have a
regular routine in our home
1
2
3
4
a. There is very little commotion in our
home
1
2
3
4
m. The phone (calls or texts) takes up a
lot of time in our home
n.
The atmosphere in our home is calm
Baby FACES 2020 Parent Survey
48
OMB (Redacted)
G. PROGRAM SERVICES
The next questions are about services you and your family may have received from Early Head
Start at [PROGRAM].
ALL
PROGRAMMER: IF PREGNANT =1, SET G2.1 = 2. DO NOT DISPLAY QUESTION.
Source: Adapted from Baby FACES 2009
Item title: ServiceType
G2.1
I am going to read you three descriptions of the types of services Early Head Start
programs often provide. Please do not include any other child care program [CHILD] may
be enrolled in other than [PROGRAM].
Which of the following best describes the kind of care [CHILD] currently receives from
[PROGRAM]?
Center-based, meaning Early Head Start services are
provided at a child care center ..................................................................1
Home-based, meaning a home visitor from the program
visits your family in your home on a regular basis and the
program may also organize group socializations or activities
with other families elsewhere, or, .............................................................2
Both center-based and home-based services. For example, child
attends classes at a center multiple times a week and home visitor
comes to your home every couple of weeks ............................................3
SOME OTHER PROGRAM OPTION (SPECIFY) .........................................99
DON’T KNOW ...............................................................................................d
REFUSED .....................................................................................................r
IF PREGNANT = 0 OR A0 = 1 (RESPONDENT IS NOT/NO LONGER PREGNANT)
Source: Baby FACES 2009
G.2.1a.
I’d like to ask you about other types of child care arrangements that [CHILD] may receive
on a regular basis at least once a week from someone other than you. This includes
regular care and any early childhood programs, whether or not there is a charge or fee,
but not occasional babysitting.
Is [CHILD]…
YES
NO
DK
REF
a. Attending or receiving services from another Early Head
Start Program?
1
0
d
r
b. Attending or receiving services from a Head Start Program?
1
0
d
r
Attending a formal child care program other than Early
Head Start or Head Start such as at a day care center or
preschool?
.......................................................................................................
1
0
d
r
d. Attending a formal family child care program? A program in
which one or two caregivers provide care for a small group
1
0
d
r
c.
Baby FACES 2020 Parent Survey
49
OMB (Redacted)
of children in the caregiver’s home.
.......................................................................................................
IF ANY G.2.1a.a-d = 1 (ATTENDING A FORMAL PROGRAM)
this program IF TOTAL SELECTED “YES” AT G.2.1a.a-d = 1;
any of these programs IF TOTAL SELECTED “YES” AT G.2.1a.a-d = 2 – 4
Source: Baby FACES 2009
G.2.1b. Did [PROGRAM] Early Head Start help you find or enroll in (this program/any of these
programs)?
YES .......................................................................... 1
NO ............................................................................ 0
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
ALL
Source: Adapted from Baby FACES 2009
G.2.1a. cont.
Is [CHILD]…
YES
e. Receiving child care from a relative other than a parent, for
example, from grandparents, brothers or sisters, or any
other relatives?
.......................................................................................................
f.
Receiving child care from a non-relative, either in your
home or someone else’s?
.......................................................................................................
NO
DK
REF
1
0
d
r
1
0
d
r
IF G2.1 = 1 (CENTER-BASED) OR [(G2.1 = 99, D, OR R) AND (PRGMOPT = 1)]
PROGRAMMER: IF B2 = 1, FILL “he” ; IF B2 = 2, FILL “she”
Baby FACES 2020 Parent Survey
50
OMB (Redacted)
Source: Baby FACES 2009
Item title: HomeVisitPastYr
G2.2
Home visitors may have come to do activities with you and [CHILD] or talk to you about
how [he/she] is doing or about how your family is getting along. Has anyone from
[PROGRAM] Early Head Start visited you at home in the past year?
YES .......................................................................... 1
NO ............................................................................ 0
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
G2.1 = 2, 3 (HOME-BASED OR COMBO) OR [(G2.1 = 99, D, OR R) AND (PRGMOPT = 2, 3)]
OR G2.2 = 1 (RECEIVED HOME VISITS)
Source: Adapted from Baby FACES 2009
Item title: FreqHVs
G2.3
How often do you typically receive home visits from [PROGRAM]?
INSTRUCTION:
HOME-BASED SHOULD BE AT LEAST TWO OR THREE TIMES A MONTH.
BOTH CENTER AND HOME-BASED SHOULD BE AT LEAST ONCE A
MONTH.
INSTRUCTION:
READ LIST IF NECESSARY
PROGRAMMER: SINCE LIST MAY BE READ IF NECESSARY, PLEASE SHOW SPANISH
TEXT IN SPANISH VERSION OF INSTRUMENT.
ONCE A WEEK OR MORE ..................................... 5
TWO OR THREE TIMES A MONTH ....................... 4
ONCE A MONTH ..................................................... 3
A COUPLE OF TIMES A YEAR .............................. 2
AT LEAST ONCE A YEAR ...................................... 1
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
Baby FACES 2020 Parent Survey
51
OMB (Redacted)
IF [G2.1 = 2 (HOME-BASED) OR [(G2.1 = 99, D, OR R) AND (PRGMOPT = 2)]]
AND G2.3 = 1 – 3 (LESS THAN TWO OR THREE TIMES A MONTH)
PROGRAMMER: DISPLAY “and [CHILD]” IF PREGNANT = 0
Source: Baby FACES 2009
Item title: ConfirmServiceType1
GV1.
I have recorded that you [and [CHILD]] receive home-based services, but that you typically
only receive home visits [FILL ANSWER FROM G2.3]. Have I recorded something
incorrectly?
INSTRUCTION:
CENTER: EHS SERVICES PROVIDED AT CENTER AND STAFF MAY VISIT
FAMILY AT HOME A FEW TIMES PER YEAR
HOME: HOME VISITOR VISITS FAMILY IN HOME ON REGULAR BASIS
AND MAY ORGANIZE GROUP SOCIALIZATIONS OR ACTIVITIES WITH
OTHER FAMILIES ELSEWHERE
BOTH: GOES TO CENTER SEVERAL DAYS PER WEEK AND GETS HOME
VISITS AT LEAST MONTHLY
CHANGE SERVICE TYPE ...................................... 1
G2.1
CHANGE FREQUENCY OF HOME VISITS ........... 2
G2.3
CORRECT; CONTINUE .......................................... 0
IF [G2.1 = 3 (COMBO) OR [(G2.1 = 99, D, OR R) AND (PRGMOPT = 3)]]
AND G2.3 = 1 – 2 (LESS THAN ONCE PER MONTH)
Source: Baby FACES 2009
Item title: ConfirmServiceType2
GV2.
I have recorded that [CHILD] receives both home-based and center-based care, but that you
typically receive home visits less than once a month. Have I recorded something
incorrectly?
INSTRUCTION:
CENTER: EHS SERVICES PROVIDED AT CENTER AND STAFF MAY VISIT
FAMILY AT HOME A FEW TIMES PER YEAR
HOME: HOME VISITOR VISITS FAMILY IN HOME ON REGULAR BASIS
AND MAY ORGANIZE GROUP SOCIALIZATIONS ELSEWHERE
BOTH: GOES TO CENTER SEVERAL DAYS PER WEEK AND GETS HOME
VISITS AT LEAST MONTHLY
CHANGE SERVICE TYPE ...................................... 1
G2.1
CHANGE FREQUENCY OF HOME VISITS ........... 2
G2.3
CORRECT; CONTINUE .......................................... 0
Baby FACES 2020 Parent Survey
52
OMB (Redacted)
PREGNANT= 0
Source: Baby FACES 2009
Item title: ChildServedinCenter
G3.
Is [CHILD] receiving Early Head Start child care at a [PROGRAM] center?
¿Está [CHILD] recibiendo cuidado de niños Early Head Start en un centro [PROGRAM]?
INSTRUCTION: THIS DOES NOT INCLUDE GROUP SOCIALIZATIONS AT A CENTER
YES .......................................................................... 1
NO ............................................................................ 0
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
Baby FACES 2020 Parent Survey
53
OMB (Redacted)
IF [(G2.1 = 1 OR 3 (CENTER–BASED OR COMBO)) OR [(G2.1 = 99, D, OR R) AND (PRGMOPT = 1, 3)]]
AND G3 = 0 (NOT IN CENTER)
FILL WITH “center-based” IF G2.1 = 1 OR [(G2.1 = 99, D, OR R) AND (PRGMOPT = 1)]
FILL WITH “both center and home-based” IF G2.1 = 3 OR [(G2.1 = 99, D, OR R) AND (PRGMOPT = 3)]
Source: Baby FACES 2009
Item title: ConfirmServiceType3
GV3.
I recorded that [CHILD] receives [center-based / both center and home-based] care, but that
[CHILD] is not receiving child care at a [PROGRAM] child development center. What have I
recorded incorrectly?
CHANGE SERVICE TYPE ...................................... 1
G2.1
CHANGE THAT CHILD IS RECEIVING CARE ....... 2
G3
G3 = 1 (CHILD RECEIVES EHS CENTER CARE)
Source: Baby FACES 2009
Item title: DaysPerWeekatCenter
G4.
How many days each week does [CHILD] go to [PROGRAM]?
|___| DAYS (RANGE 0 – 7)
LESS THAN ONCE A WEEK…………………..
0
DON’T KNOW……………………………………
d
REFUSED………………………………………..
r
G3 = 1 (CHILD RECEIVES EHS CENTER CARE)
Source: Baby FACES 2009
Item title:
G4a.
How many hours each day (does/did) [CHILD] go to [PROGRAM]?
PROBE: Your best estimate is fine.
INTERVIEWER: IF RESPONDENT SAYS “IT VARIES”, ASK FOR THE MOST TYPICAL
NUMBER OF HOURS PER DAY.
|___|___| HOURS (RANGE 01 – 18)
DON’T KNOW
d
REFUSED
r
SOFT CHECK: IF G4a = 9 – 18; I want to be sure I recorded your answer correctly. Did you say
(FILL G4a ANSWER) hours each day?
HARD CHECK: IF G4a GT 18; I want to be sure I recorded your answer correctly. Did you say
(FILL G4a ANSWER) hours each day?
INTERVIEWER: IF RESPONDENT CONFIRMS ANSWER, SEEK SUPERVISOR FOR ASSISTANCE
Baby FACES 2020 Parent Survey
54
OMB (Redacted)
ALL
Source: Adapted from Baby FACES 2009
Item title: ProgramParticipation
G5.
Now I’m going to ask you about activities you or your family may have taken part in
through [PROGRAM] Early Head Start. For each one, tell me if you did not participate
at all, participated once or twice, or participated three or more times.
Since September, did you or other family members [INSERT ITEMS a-l] [at [PROGRAM]]?
PROBE: Did you or other family members not participate at all, participate once or twice,
or participate three or more times?
PROGRAMMER: HIDE “[at [PROGRAM]]” FOR G5H
PROGRAMMER: CODE ONLY ONE RESPONSE FOR EACH STATEMENT. ALLOW FOR
ENTRY OF DK (D) AND REF (R) RESPONSES
NOT AT
ALL
ONCE OR
TWICE
THREE OR
MORE TIMES
a. Attend workshops on job skills
0
1
2
b. Attend parent workshops on raising children
0
1
2
c.
Attend events meant to engage men/fathers
0
1
2
d. Attend Early Head Start special events or
activities, such as a children's performance
or a holiday party
0
1
2
e. Attend group socialization activities for
parents and their children
0
1
2
f.
0
1
2
0
1
2
0
1
2
m. Attend workshops on prenatal education
0
1
2
n. Attend workshops on nutrition or exercise
0
1
2
Volunteer in an Early Head Start classroom
g. Volunteer at the program in some other way,
such as doing maintenance, chores, or
shopping for the program
l.
Participate on the Policy Council or some
other committee
Baby FACES 2020 Parent Survey
55
OMB (Redacted)
ALL
Source: New
Item title:
G6.
Since September, did [PROGRAM] Early Head Start offer activities that you wanted to
participate in, but could not because …(READ EACH ITEM AND RECORD YES OR NO
FOR EACH).
PROGRAMMER: CODE ONLY ONE RESPONSE FOR EACH STATEMENT. ALLOW FOR
ENTRY OF DK (D) AND REF (R) RESPONSES
YES
NO
DK
REF
a. You did not have child care?
1
0
d
r
b. You did not have transportation?
1
0
d
r
c.
1
0
d
r
d. You did not have the information abouthe time or location
for the activity?
1
0
d
r
e. You had a work schedule conflict?
1
0
d
r
You did not have enough notice?
Baby FACES 2020 Parent Survey
56
OMB (Redacted)
H. STAFF-PARENT RELATIONSHIPS
ALL
teacher IF CENTER-BASED (PRGMOPT = 1);
home visitor IF HOME-BASED (PRGMOPT = 2);
Source: Baby FACES 2009
H0a.
The next part of the interview is about your relationship with
(IF CENTER-BASED (PRGMOPT = 1))
[CHILD]’s teacher.
(IF HOME-BASED (PRGMOPT = 2))
your family’s home visitor.
When you signed the consent form, the program told us that ([CHILD]’s teacher/ your
family’s home visitor) was [StaffFirstName] [StaffLastName]. I’d like you to think about
that person when you answer the next questions.
CONTINUE ........................................................................................................... 1
NO, CANNOT ANSWER ABOUT TEACHER/HOME VISITOR............................ 0
GO TO H0a1
H0a = 0
H0a1.
Please tell me the name of [CHILD]’s teacher or your family’s home visitor. I’d like you to
think about this person when you answer the next questions.
________________________________________________
FIRST AND LAST NAME
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
(G2.1 = 99, D, OR R) AND (PRGMOPT = 3)]
Source: Baby FACES 2009
Item title: SelectProviderType
H0b.
The next questions are about your relationship with [CHILD]’s care provider. I’d like you
to think about the person from [PROGRAM] that [CHILD] has spent the most time with or
the person that has been most involved in (his/her) development. Would you like to
answer about [CHILD]’s teacher or about your home visitor?
TEACHER ................................................................ 1
HOME VISITOR ....................................................... 2
FILL FOR INDICATED ITEMS IN SECTION:
IF H0b = 1 (TEACHER), FILL teacher;
IF H0b = 2 (HOME VISITOR), FILL home visitor;
Baby FACES 2020 Parent Survey
57
OMB (Redacted)
IF PREGNANT = 0 AND
((H0a = 1 AND PRGMOPT = 1) OR (H0a=0 AND (G2.1 = 1 OR [(G2.1 =3, 99, D, OR R) AND (PRGMOPT = 1)]))
OR H0b = 1 [CENTER-BASED])
Source: Cocaring Relationship Questionnaire (CRQ) – Parent Version
Permissions: Items in this section were adapted in consultation with the authors. Lang, S. N., Schoppe-Sullivan, S. J., & Jeon, L.
(2017). Examining a self-report measure of parent-teacher cocaring relationships and associations with parental involvement. Early
Education and Development, 28(1), 96-114.
PROGRAMMER: DISPLAY ON FIRST SCREEN FOR THIS SECTION THE FOLLOWING, SHADED GRAY AND IN CAPS:
“PLEASE CLICK HERE FOR COPYRIGHT INFORMATION.” “HERE” SHOULD BE A HYPERLINK THAT WHEN CLICKED
DISPLAYS THE ABOVE COPYRIGHT/PERMISSIONS INFORMATION.
Item title: CRQCenterBased
H1a.
PROGRAMMER: IF B2=1, DISPLAY “hijo”; IF B2=2, DISPLAY “hija”
Now I am going to read you a list of statements about the way you and your child’s teacher work
together. For each item, I’d like you to tell me how true you feel the statement is, where 0 is “not
true” and 6 is “very true.” You may pick any number between 0 and 6. Let’s begin. [FILL ITEM a–q].
Using a scale where 0 is “not true” and 6 is “very true,” how true is this statement for you?
PROGRAMMER: BOLD RESPONSE OPTIONS TEXT FOR FIRST TWO ITEMS AND EVERY 4TH ITEM
THEREAFTER.
PROGRAMMER: CODE ONLY ONE RESPONSE FOR EACH STATEMENT. ALLOW FOR ENTRY OF DK
(D) AND REF (R) RESPONSES.
NOT
TRUE
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
VERY
TRUE
I believe my child’s teacher is a good
educator
0
1
2
3
4
5
6
My child’s teacher asks my opinion
on issues related to caring for my
child
0
1
2
3
4
5
6
My child’s teacher pays a great deal
of attention to my child
0
1
2
3
4
5
6
My child’s teacher and I have the
same goals for my child
0
1
2
3
4
5
6
My child’s teacher and I have different
ideas about how to raise my child
0
1
2
3
4
5
6
My child’s teacher tells me I am doing
a good job or otherwise lets me know
I am being a good parent
0
1
2
3
4
5
6
My child’s teacher and I have different
ideas regarding my child’s eating,
sleeping, and/or other routines
0
1
2
3
4
5
6
My child’s teacher sometimes makes
jokes or sarcastic comments about
the things I do as a parent
0
1
2
3
4
5
6
My child’s teacher does not trust my
abilities as a parent
0
1
2
3
4
5
6
My child’s teacher and I have different
standards for my child’s behavior
0
1
2
3
4
5
6
My child’s teacher tries to show that
she or he is better than me at caring
for my child
0
1
2
3
4
5
6
My child’s teacher has a lot of
patience with my child
0
1
2
3
4
5
6
0
1
2
3
4
5
6
m. My child’s teacher and I often discuss
the best way to meet my child’s
Baby FACES 2020 Parent Survey
58
OMB (Redacted)
NOT
TRUE
VERY
TRUE
needs
n.
o.
p.
q.
When we are together, my child’s
teacher sometimes competes with me
for my child’s attention
0
1
2
3
4
5
6
My child’s teacher undermines my
parenting
0
1
2
3
4
5
6
When I’m at my wits end as a parent,
my child’s teacher gives me the
support I need
0
1
2
3
4
5
6
My child’s teacher makes me feel like
I’m the best possible parent for my
child
0
1
2
3
4
5
6
Baby FACES 2020 Parent Survey
59
OMB (Redacted)
IF PREGNANT = 0 AND
((H0a = 1 AND PRGMOPT = 2) OR (H0a=0 AND (G2.1 = 2 OR [(G2.1 = 3, 99, D, OR R) AND (PRGMOPT = 2)))] OR
H0b = 2 [HOME-BASED])
Source: Cocaring Relationship Questionnaire (CRQ) – Parent Version
Permissions: Items in this section were adapted in consultation with the authors. Lang, S. N., Schoppe-Sullivan, S. J., & Jeon, L.
(2017). Examining a self-report measure of parent-teacher cocaring relationships and associations with parental involvement. Early
Education and Development, 28(1), 96-114.
PROGRAMMER: DISPLAY ON FIRST SCREEN FOR THIS SECTION THE FOLLOWING, SHADED GRAY AND IN CAPS:
“PLEASE CLICK HERE FOR COPYRIGHT INFORMATION.” “HERE” SHOULD BE A HYPERLINK THAT WHEN CLICKED
DISPLAYS THE ABOVE COPYRIGHT/PERMISSIONS INFORMATION.
Item title: CRQHomeBased
H1b.
Now I am going to read you a list of statements about the way you and your home visitor work
together. For each item, I’d like you to tell me how true you feel the statement is, where 0 is “not
true” and 6 is “very true.” You may pick any number between 0 and 6. Let’s begin. [FILL ITEM b–q].
Using a scale where 0 is “not true” and 6 is “very true,” how true is this statement for you?
PROGRAMMER: BOLD RESPONSE OPTIONS TEXT FOR FIRST TWO ITEMS.
PROGRAMMER: CODE ONLY ONE RESPONSE FOR EACH STATEMENT. ALLOW FOR ENTRY OF DK
(D) AND REF (R) RESPONSES.
NOT
TRUE
b.
f.
My home visitor asks my opinion on
issues related to caring for my child
0
1
2
3
4
5
6
My home visitor tells me I am doing a
good job or otherwise lets me know I
am being a good parent
0
1
2
3
4
5
6
0
1
2
3
4
5
6
When I’m at my wits end as a parent,
my home visitor gives me the support
I need
0
1
2
3
4
5
6
My home visitor makes me feel like
I’m the best possible parent for my
child
0
1
2
3
4
5
6
m. My home visitor and I often discuss
the best way to meet my child’s
needs
p.
q.
VERY
TRUE
PROGRAMMER: IF B2=1, DISPLAY “hijo”; IF B2=2, DISPLAY “hija
Baby FACES 2020 Parent Survey
60
OMB (Redacted)
IF (H0A = 1 AND PRGMOPT = 2) OR (H0A=0 AND (G2.1 = 2 OR [(G2.1 = 3, 99, D, OR R) AND (PRGMOPT =
2)])) OR H0B = 2 [HOME-BASED]
Source: Working Alliance Inventory (WAI; adapted for use in EBHV) (PROPRIETARY)
Permissions: Items in this section are from an adapted version of the WAI from Santos, Robert G. “Development and Validation of a
Revised Short Version of the Working Alliance Inventory.” Unpublished doctoral dissertation. Winnipeg, Manitoba: University of
Manitoba, 2005. Reprinted by permission of the Society for Psychotherapy Research © 2016.
PROGRAMMER: DISPLAY ON FIRST SCREEN FOR THIS SECTION THE FOLLOWING, SHADED GRAY AND IN CAPS:
“PLEASE CLICK HERE FOR COPYRIGHT INFORMATION.” “HERE” SHOULD BE A HYPERLINK THAT WHEN CLICKED
DISPLAYS THE ABOVE COPYRIGHT/PERMISSIONS INFORMATION.
Item title: WAI
H2.
I am going to read you some statements that describe ways a parent might think or feel
about his or her home visitor. For each, please tell me how often you think or feel that way.
Please tell me if you feel this way never, rarely, occasionally, sometimes, often, very often,
or always. Your first thoughts are what we are interested in.
[FILL ITEM a–l]. Would you say you feel this way never, rarely, occasionally, sometimes,
often, very often, or always? PROGRAMMER: BOLD RESPONSE OPTIONS TEXT FOR FIRST TWO
ITEMS AND EVERY 4TH ITEM THEREAFTER.
PROGRAMMER: CODE ONLY ONE RESPONSE FOR EACH STATEMENT. ALLOW FOR ENTRY OF DK
(D) AND REF (R) RESPONSES.
Items H2a to H2l are protected under copyright and have been redacted from this instrument.
Source: Working Alliance Inventory (adapted for used in EBHV)
Baby FACES 2020 Parent Survey
61
OMB (Redacted)
IF (H0A = 1 AND PRGMOPT = 2) OR (H0A=0 AND (G2.1 = 2 OR [(G2.1 = 3, 99, D, OR R) AND (PRGMOPT = 2)]))
OR H0B = 2 [HOME-BASED]
PROGRAMMER: VARIATIONS IN TEXT AND APPLICABLE ITEMS BASED ON ‘PREGNANT’ (ITEMS E, L, M, N)
Source: Adaptation of Strength-Based Practices Inventory (SBPI)
Permissions:.
PROGRAMMER: DISPLAY ON FIRST SCREEN FOR THIS SECTION THE FOLLOWING, SHADED GRAY AND IN CAPS:
“PLEASE CLICK HERE FOR COPYRIGHT INFORMATION.” “HERE” SHOULD BE A HYPERLINK THAT WHEN CLICKED
DISPLAYS THE ABOVE COPYRIGHT/PERMISSIONS INFORMATION.
Item title: ParentSatisfactionWithHVs
H3.
These next statements are about your experiences during your home visits. Please tell me
how much you agree or disagree with each statement where 1 is strongly disagree and 7 is
strongly agree. You may pick any number between 1 and 7.
My home visitor… [FILL a – p]. Would you say you strongly disagree, somewhat disagree,
neither disagree nor agree, somewhat agree, or strongly agree?
PROGRAMMER: CODE ONLY ONE RESPONSE FOR EACH STATEMENT. ALLOW FOR
ENTRY OF DK (D) AND REF (R) RESPONSES.
Items H3a to H3p are protected under copyright and have been redacted from this instrument.
Source: Strength-Based Practices Inventory (Adapted)
Baby FACES 2020 Parent Survey
62
OMB (Redacted)
PROGRAMMER: FOR REMAINING ITEMS IN SECTION, FILL AS FOLLOWS:
IF PREGNANT=1, DISPLAY “your” ; IF PREGNANT=0, DISPLAY “[CHILD]”
IF (H0a = 1 AND PRGMOPT = 1) OR (H0a=0 AND (G2.1 = 1 OR [(G2.1 = 99, D, OR R) AND (PRGMOPT = 1)])) OR
H0b = 1 [CENTER-BASED],
DISPLAY “teacher”
IF (H0a = 1 AND PRGMOPT = 2) OR (H0a=0 AND (G2.1 = 2 OR [(G2.1 = 99, D, OR R) AND (PRGMOPT = 2)])) OR
H0b = 2 [HOME-BASED], DISPLAY
“home visitor”
E4B = 1, 2 (RESPONDENT SPEAKS ENGLISH ‘NOT AT ALL’ OR ‘NOT WELL’)
Source: Baby FACES 2018
Item title: StaffSpeakstoParentInPreferredLang
H4.
Does [your/[CHILD]’s] Early Head Start [teacher/home visitor] speak to you in your
preferred language?
YES .......................................................................... 1
NO ............................................................................ 0
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
E4B = 1, 2 (RESPONDENT SPEAKS ENGLISH ‘NOT AT ALL’ OR ‘NOT WELL’)
Source: Adapted from Baby FACES 2009
Item title: LangStaffSpeakstoParent
H5.
What language does [your/[CHILD]’s] Early Head Start [teacher/home visitor] usually use
when talking to you?
INSTRUCTION: ‘ANOTHER LANGUAGE’ CAN INCLUDE SPANISH OR ANY OTHER NONENGLISH LANGUAGE.
All English ............................................................................................................. 5
More English than another language ................................................................. 4
English and another language equally .............................................................. 3
More of another language than English ............................................................. 2
All in another language ........................................................................................ 1
DON’T KNOW ........................................................................................................ d
REFUSED .............................................................................................................. r
Baby FACES 2020 Parent Survey
63
OMB (Redacted)
H5 = 3, 4, 5 (RESPONDENT DOESN’T SPEAK ENGLISH WELL/AT ALL AND IS SPOKEN TO IN ENGLISH)
Source: Baby FACES 2009
Item title: TranslatorAtProgram
H5a.
Did someone translate for you so you could talk with [your/[CHILD]’s] Early Head Start
[teacher/home visitor]?
YES .......................................................................... 1
NO ............................................................................ 0
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
H5A = 0 (NO TRANSLATOR PROVIDED)
Source: Baby FACES 2009
Item title: RTroubleUnderstandingStaff
H5a.1. Did you have any trouble understanding [your/[CHILD]’s] Early Head Start [teacher/home
visitor]’s English?
YES .......................................................................... 1
NO ............................................................................ 0
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
H5A = 0 (NO TRANSLATOR PROVIDED)
Source: Baby FACES 2009
Item title: StaffTroubleUndertandingR
H5a.2. Did [your/[CHILD]’s] Early Head Start [teacher/home visitor] have any trouble
understanding you?
YES .......................................................................... 1
NO ............................................................................ 0
DON’T KNOW .......................................................... d
REFUSED ................................................................ r
Baby FACES 2020 Parent Survey
64
OMB (Redacted)
I. RESPONDENT HEALTH
The next questions are about your health and health-related behaviors.
ALL
Source: Adapted from Baby FACES 2009
Item title: RHealthIns
I1.
Do you have health insurance for yourself? This can include private insurance, Medicaid
[(which may also be known as [STATE MEDICAID AGENCY FROM BOX I1] in your state)],
or any other government program that pays for medical care.
PROGRAMMER: INCLUDE TEXT IN BRACKETS WITH FILL ONLY FOR STATES SHOWING
STATE-SPECIFIC PROGRAMS IN BOX I1 AND WHEN RESPONDENT STATE IS NOT
MISSING.
YES .......................................................................
1
NO .........................................................................
0
DON’T KNOW .......................................................
d
REFUSED .............................................................
r
PREGNANT = 0
Source: Adapted from Baby FACES 2009
Item title: ChHealthIns
I2.
Do you have health insurance for [CHILD]?
YES .......................................................................
1
NO .........................................................................
0
DON’T KNOW .......................................................
d
REFUSED .............................................................
r
PREGNANT = 0
Source: Baby FACES 2009
Item title: ProgramHealthInsHelp
I3.
Has [PROGRAM] Early Head Start helped you find health insurance for [CHILD]?
YES .......................................................................
1
NO .........................................................................
0
DON’T KNOW .......................................................
d
REFUSED .............................................................
r
Baby FACES 2020 Parent Survey
65
OMB (Redacted)
BOX I1
STATE MEDICAID PROGRAMS
Alabama
Alaska
Arizona
DenaliCare
Arizona Health Care Cost
Containment System
Arkansas
California
Colorado
Connecticut
Delaware
District of
Columbia
Florida
Georgia
Hawaii
Idaho
Medi-Cal
Health First Colorado
HUSKY Health
Diamond State Health Plan
New
Hampshire
New Jersey
New Mexico
New York
North Carolina
New Jersey FamilyCare
Centennial Care
Community Care of North
Carolina or Carolina ACCESS
North Dakota
QUEST Integration
Illinois
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
Indiana
Hoosier Healthwise
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Iowa Health Link
KanCare
Mississippi
Missouri
Montana
Nebraska
Nevada
Healthy Louisiana
MaineCare
HealthChoice Program
MassHealth
Medical Assistance or
MinnesotaCare
South
Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
SoonerCare
Oregon Health Plan
Medical Assistance or
HealthChoices
Rhode Island Medical Assistance
Program or RIte Care
Healthy Connections
TennCare
STAR
Green Mountain Care
Medallion 3.0
Apple Health
Mountain Health Trust
BadgerCare Plus
Wyoming
Missouri HealthNet
Baby FACES 2020 Parent Survey
66
OMB (Redacted)
THE IC3 SERIES OF QUESTION WERE ASKED ON THE PARENT CHILD REPORT IN 2018.
PREGNANT = 0
Next we would like to learn about your child’s health.
I3C1. Which of the following best describes your child’s overall health?
excellent, ...............................................................
1
very good, .............................................................
2
good,......................................................................
3
fair, or ....................................................................
4
poor? .....................................................................
5
DON’T KNOW ........................................................
d
REFUSED ..............................................................
r
PREGNANT = 0
I3C2. Does your child have a regular health care provider? This can include a doctor, nurse, or
other health care worker.
YES ...................................................................................................
1
NO .....................................................................................................
0
DON’T KNOW ...................................................................................
d
REFUSED .........................................................................................
r
I3C2 = 1 (CHILD HAS HEALTH CARE PROVIDER)
I3C2a.
Did your Early Head Start program help you find your child’s regular health care
provider?
YES ...................................................................................................
1
NO .....................................................................................................
0
DON’T KNOW ...................................................................................
d
REFUSED .........................................................................................
r
Baby FACES 2020 Parent Survey
67
OMB (Redacted)
PREGNANT = 0
I3C3. How old was your child when they last saw a doctor, nurse, or other health care worker for
a well-visit or regular checkup? Please record your child’s age in months at the time of the
visit.
IF CHILD WAS LESS THAN 1 MONTH OLD, WRITE ‘01’ BELOW
|___|___| MONTHS OLD
DON’T KNOW ....................................................................................................... d
REFUSED ............................................................................................................. r
PREGNANT = 0
ITEM I3C5 NOT INCLUDED IN VERSION 1 (PARENTS OF CHILDREN NEWBORN TO 7 MONTHS)
I3C5. Has your child ever seen a dentist?
YES ...................................................................................................
1
NO .....................................................................................................
0
DON’T KNOW ...................................................................................
d
REFUSED .........................................................................................
r
ALL
Source: Baby FACES 2009
Item title: RGeneralHealth
I4.
[Now thinking about yourself,] (Would/would) you say your health in general is . . .
PROGRAMMER: IF PREGNANT=0, DISPLAY TEXT IN BRACKETS
excellent, ...............................................................
1
very good, .............................................................
2
good,......................................................................
3
fair, or ....................................................................
4
poor? .....................................................................
5
DON’T KNOW ........................................................
d
REFUSED ..............................................................
r
Baby FACES 2020 Parent Survey
68
OMB (Redacted)
Source: CESD-R. Permissions: Items in this section are from Eaton WW, Muntaner C, Smith C, Tien A, Ybarra M. Center for Epidemiologic
Studies Depression Scale: Review and revision (CESD and CESD-R). In: Maruish ME, ed. The Use of Psychological Testing for Treatment
Planning and Outcomes Assessment. 3rd ed. Mahwah, NJ: Lawrence Erlbaum; 2004:363-377
PCRVERSION = 0 (PREGNANT WOMEN NOT RECEIVING A PCR)
I8.
Next, I am going to read a list of ways you may have felt or behaved. Please tell me how
often you have felt this way in the past week or so.
[FILL ITEM a–t]. Would you say: less than 1 day, 1 to 2 days, 3 to 4 days, 5 to 7 days in the
past week, or nearly every day for 2 weeks?
PROGRAMMER: BOLD RESPONSE OPTIONS TEXT FOR FIRST TWO ITEMS AND EVERY
4TH ITEM THEREAFTER. CODE ONLY ONE RESPONSE FOR EACH STATEMENT. ALLOW
FOR ENTRY OF DK (D) AND REF (R) RESPONSES
INSTRUCTION: IF ‘NO’ OR ‘NEVER,’ CODE AS LESS THAN 1 DAY
MARK ONE PER ROW
LESS
THAN 1
DAY
a.
My appetite was poor
b.
I could not shake off the blues
c.
I had trouble keeping my mind on what I was
doing
0
0
0
d.
I felt depressed
0
e.
My sleep was restless
0
f.
I felt sad
g.
I could not get going
h.
Nothing made me happy
i.
I felt like a bad person
j.
I lost interest in my usual activities
k.
I slept much more than usual
l.
I felt like I was moving too slowly
0
0
0
0
0
0
0
m. I felt fidgety
0
n.
I wished I were dead
0
o.
I wanted to hurt myself
0
p.
I was tired all the time
0
q.
I did not like myself
0
r.
I lost a lot of weight without trying to
0
Baby FACES 2020 Parent Survey
69
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
1-2 DAYS
IN PAST
WEEK
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
3-4 DAYS
IN PAST
WEEK
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
5-7 DAYS
IN PAST
WEEK
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
3
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
NEARLY
EVERY DAY
FOR 2
WEEKS
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
4
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
OMB (Redacted)
MARK ONE PER ROW
LESS
THAN 1
DAY
s.
I had a lot of trouble getting to sleep
t.
I could not focus on important things
0
0
1-2 DAYS
IN PAST
WEEK
□
□
1
1
□
□
3-4 DAYS
IN PAST
WEEK
2
2
□
□
5-7 DAYS
IN PAST
WEEK
3
3
□
□
NEARLY
EVERY DAY
FOR 2
WEEKS
4
4
□
□
I8_info1.
PROGRAMMER: IF ITEM I8N OR I8O IS GT 0, DISPLAY AFTER ADMINISTRATION OF I8T
Based on some of your responses, it sounds like you may be having a hard time. I’m sorry. At the
end of the interview, I can give you a number to call if you feel you need some support.
PCRVERSION = 0 (PREGNANT WOMEN NOT RECEIVING A PCR)
The next few questions are about tobacco, alcohol, and drug use. As a reminder, all of the
information you share with me is private and will not be shared with anyone from your program.
You do not have to answer any questions that make you feel uncomfortable. Just let me know and
I will move on to the next question.
Source: Adapted from Baby FACES 2009
Item title: TobaccoPast30Days
I5.
During the past 30 days, did you or anyone else in your household smoke tobacco, such
as cigarettes or cigars?
YES .......................................................................
1
NO .........................................................................
0
DON’T KNOW .......................................................
d
REFUSED .............................................................
r
PCRVERSION = 0 (PREGNANT WOMEN NOT RECEIVING A PCR)
Source: New Item
Item title: VapingPast30Days
I5a.
During the past 30 days, have you or anyone else in your household used nicotine
“vaping” products, such as e-cigarettes?
YES .......................................................................
1
NO .........................................................................
0
DON’T KNOW .......................................................
d
REFUSED .............................................................
r
IF I5 = 1 OR I5A = 1 (SMOKED/VAPED DURING LAST 30 DAYS)
Source: Baby FACES 2018
Item title: ProgramCessationHelp
Baby FACES 2020 Parent Survey
70
OMB (Redacted)
I5b.
Did [PROGRAM] Early Head Start offer resources or support to you or anyone else in
your household for reducing or quitting the use of tobacco or nicotine “vaping”?
YES .......................................................................
1
NO .........................................................................
0
DON’T KNOW .......................................................
d
REFUSED .............................................................
R
Baby FACES 2020 Parent Survey
71
OMB (Redacted)
PCRVERSION = 0 (PREGNANT WOMEN NOT RECEIVING A PCR)
Source: Adapted from MIHOPE 2 Parent Survey
I5c. The next questions are about drinking alcoholic beverages. By a “drink” we mean a can or
bottle of beer, a wine cooler or glass of wine, a shot of liquor, or a mixed drink.
During the past 30 days, how many alcoholic drinks did you have in an average week?
MARK ONE ONLY
1
2
3
4
5
6
7
d
□
□
□
□
□
□
□
□
None
Less than 1 drink
1 to 3 drinks
4 to 6 drinks
7 to 13 drinks
14 to 19 drinks
20 or more drinks
Don’t know
PCRVERSION = 0 (PREGNANT WOMEN NOT RECEIVING A PCR)
Source: Adapted from MIHOPE 2 Parent Survey
I5d.
In the last 30 days, how many times did you or anyone in your household drink 4 alcoholic
drinks or more in one day? Would you say…
MARK ONE ONLY
1
2
3
4
5
□
□
□
□
□
6 or more times
4 to 5 times
2 to 3 times
1 time
Never
PCRVERSION = 0 (PREGNANT WOMEN NOT RECEIVING A PCR)
Source: New item
I5d1. Did Early Head Start offer resources or support to you or anyone else in your household to
help reduce or quit drinking alcohol?
YES .......................................................................
1
NO .........................................................................
0
DON’T KNOW .......................................................
d
REFUSED .............................................................
R
Baby FACES 2020 Parent Survey
72
OMB (Redacted)
PCRVERSION = 0 (PREGNANT WOMEN NOT RECEIVING A PCR)
Source: Adapted from the National Survey for Drug Use and Health
I5E1. In the past 30 days, have you or has anyone in your household used heroin (smack, horse)
or a prescription pain reliever (oxy, percs, vikes) in a way that was not directed by a doctor? By
“not directed by a doctor” we mean used without a prescription; used in greater amounts, more
often, or longer than prescribed; or used in any other way not prescribed by a doctor.
YES .......................................................................
1
NO .........................................................................
0
DON’T KNOW .......................................................
d
REFUSED .............................................................
R
PCRVERSION = 0 (PREGNANT WOMEN NOT RECEIVING A PCR)
Source: Adapted from the National Survey for Drug Use and Health
I5f1. In the past 30 days have you or has anyone in your household used marijuana (weed, pot) or
hashish (hash)?
YES .......................................................................
1
NO .........................................................................
0
DON’T KNOW .......................................................
d
REFUSED .............................................................
R
PCRVERSION = 0 (PREGNANT WOMEN NOT RECEIVING A PCR)
Source: Adapted from the National Survey for Drug Use and Health
I5f2. What about other types of drugs, such as amphetamines (uppers, ice, speed, crystal meth,
crank), cocaine (rock, coke, crack), tranquilizers (downers, ludes), hallucinogens (LSD, acid, PCP,
angel dust, ecstasy), or sniffing gasoline, glue, or aerosols? Have you or anyone in your household
used any of these in the past 30 days?
YES .......................................................................
1
NO .........................................................................
0
DON’T KNOW .......................................................
d
REFUSED .............................................................
R
PCRVERSION = 0 (PREGNANT WOMEN NOT RECEIVING A PCR)
Source: Adapted from MIHOPE 2 Parent Survey
I5g. Did Early Head Start offer resources or support to you or anyone else in your household to
help reduce or quit using drugs?
YES .......................................................................
1
NO .........................................................................
0
DON’T KNOW .......................................................
d
REFUSED .............................................................
R
Baby FACES 2020 Parent Survey
73
OMB (Redacted)
J. SOCIAL SUPPORT AND COMMUNITY ENVIRONMENT
PCRVERSION = 0 (PREGNANT WOMEN NOT RECEIVING A PCR)
Source: Healthy Families Parenting Inventory (items from the Social Support subscale) (PROPRIETARY)
Permissions: Items in this section are from the Healthy Families Parenting Inventory, LeCroy & Milligan Associates, Inc., 2004.
PROGRAMMER: DISPLAY ON FIRST SCREEN FOR THIS SECTION THE FOLLOWING, SHADED GRAY AND IN CAPS:
“PLEASE CLICK HERE FOR COPYRIGHT INFORMATION.” “HERE” SHOULD BE A HYPERLINK THAT WHEN CLICKED
DISPLAYS THE ABOVE COPYRIGHT/PERMISSIONS INFORMATION.
Item title: HFPI-SocialSupport
J1.
Now I am going to read a list of statements that describes how some people may
behave or feel.
For each statement, please tell me the answer that best fits for you.
[FILL ITEM a–e]. Would you say you feel like this rarely or never, a little of the time, some
of the time, a good part of the time, or always or most of the time? PROGRAMMER: BOLD
RESPONSE OPTIONS TEXT FOR FIRST TWO ITEMS.
PROGRAMMER: CODE ONLY ONE RESPONSE FOR EACH STATEMENT. ALLOW FOR
ENTRY OF DK (D) AND REF (R) RESPONSES.
Items J1a to J1e are protected under copyright and have been redacted from this instrument.
Source: Healthy Families Parenting Inventory (Social Support subscale)
Baby FACES 2020 Parent Survey
74
OMB (Redacted)
K. NEEDS AND RESOURCES
ALL
Source: Economic Strain Questionnaire (version adapted from FACES) (PROPRIETARY)
Permissions: Items in this section are from Conger, R. D., Ge, X., Elder, G. H., Lorenz, F. O. and Simons, R. L. (1994), Economic
Stress, Coercive Family Process, and Developmental Problems of Adolescents. Child Development, 65: 541–561. Version of
Record online: 28 JUN 2008 doi:10.1111/j.1467-8624.1994.tb00768.x Blackwell Publishing Limited © 1994 by the Society for
Research in Child Development, Inc.
PROGRAMMER: DISPLAY ON FIRST SCREEN FOR THIS SECTION THE FOLLOWING, SHADED GRAY AND IN CAPS:
“PLEASE CLICK HERE FOR COPYRIGHT INFORMATION.” “HERE” SHOULD BE A HYPERLINK THAT WHEN CLICKED
DISPLAYS THE ABOVE COPYRIGHT/PERMISSIONS INFORMATION.
Item title:EconStrain1
K1.
Please think about how you feel about your family's economic situation. For each
statement, indicate how much you agree or disagree.
[FILL ITEM a-d]. Would you say you strongly agree, agree, neither agree nor disagree,
disagree, or strongly disagree?
[FILL ITEM a-d].
PROGRAMMER: BOLD RESPONSE OPTIONS TEXT FOR FIRST TWO ITEMS.
PROGRAMMER: CODE ONLY ONE RESPONSE. ALLOW ENTRY OF DK (D) AND REF (R).
Items K1a to K1d are protected under copyright and have been redacted from this instrument.
Source: Economic Strain Questionnaire
Baby FACES 2020 Parent Survey
75
OMB (Redacted)
ALL
Source: Economic Strain Questionnaire (version adapted from FACES) (PROPRIETARY)
Item title: EconStrain2
K2.
This item is protected under copyright and has been redacted from this instrument.
Source: Economic Strain Questionnaire
Baby FACES 2020 Parent Survey
76
OMB (Redacted)
ALL
Source: Economic Strain Questionnaire (version adapted from FACES) (PROPRIETARY)
Item title: EconStrain3
K3.
This item is protected under copyright and has been redacted from this instrument.
Source: Economic Strain Questionnaire
Baby FACES 2020 Parent Survey
77
OMB (Redacted)
L. INCOME AND HOUSING
ALL
Source: Baby FACES 2009 [SUBITEMS WELFARE, FOOD STAMPS, SSI ARE COMPONENTS OF RISK INDEX]
Item title: IncomeSupports
L1.
The next questions are about income support you or someone in your household may
have received.
In the past 12 months, did you or anyone in your household receive [INSERT a-g] . . .
PROGRAMMER: ASK L2 IMMEDIATELY AFTER EACH “YES” RESPONSE TO L1A-G. THEN
INTERVIEWER RETURNS TO L1 TO ASK ABOUT REMAINING INCOME SUPPORTS.
PROGRAMMER: INCLUDE FILL IN BRACKETS ONLY FOR STATES SHOWING STATESPECIFIC TANF PROGRAMS IN BOX L1B AND WHEN RESPONDENT STATE IS NOT
MISSING..
YES
NO
DON’T
KNOW
REFUSED
1
0
d
r
1
0
d
r
1
0
d
r
1
0
d
r
1
0
d
r
1
0
d
r
1
0
d
r
a. WIC, that is Special Supplemental Food Program
for Women, Infants, and Children?
b. support from TANF [, [STATE WELFARE
AGENCY FROM BOX L1B],] or welfare?
PROBE: TANF is also known as the Temporary
Assistance for Needy Families program.
c.
support from unemployment insurance? ..
d. SNAP, that is Supplemental Nutrition Assistance
Program, or food stamps?
e. SSI or Social Security Retirement, Disability, or
Survivor’s benefits?
f.
payments for providing foster care?
g. energy assistance?
Baby FACES 2020 Parent Survey
78
OMB (Redacted)
WHERE L1a-g = 1
Source: Baby FACES 2009
Item title: IncomeSupports2
L2a-g.
Did [PROGRAM] refer you to another agency for [INSERT a-g]?
YES ...................................................................................................
1
NO .....................................................................................................
0
DON’T KNOW ...................................................................................
d
REFUSED .........................................................................................
r
END LOOP.
Baby FACES 2020 Parent Survey
79
OMB (Redacted)
BOX L1B
STATE TANF PROGRAMS
Alabama
Family Assistance Program or
JOBS Program
Montana
Alaska
Alaska Temporary Assistance
Program
Nebraska
Aid to Dependent Children or
Employment First
Arizona
Cash Assistance
Transitional Employment
Assistance
Nevada
Arkansas
New Hampshire
NEON
Financial Assistance to Needy
Families
California
CalWORKs
New Jersey
Work First New Jersey
Colorado
Colorado Works
Temporary Family Assistance or
Jobs First Employment Services
New Mexico
New York
New Mexico Works
Temporary Assistance
North Carolina
Work First
North Dakota
JOBS
Ohio
Ohio Works First
Connecticut
Delaware
District of
Columbia
Florida
Temporary Cash Assistance
Georgia
Oklahoma
Hawaii
Oregon
Idaho
JOBS
Temporary Assistance For Families Pennsylvania
in Idaho
Illinois
Rhode Island
Rhode Island Works
Indiana
IMPACT
South Carolina
Iowa
Family Investment Program
South Dakota
Kansas
Successful Families Program
K-TAP or Kentucky Transitional
Assistance Program
Tennessee
Families First
Texas
Choices
Family Independence Temporary
Assistance Program or STEP
Program
ASPIRE
Utah
Family Employment Program
Vermont
Reach Up
Temporary Cash Assistance
Transitional Aid to Families with
Dependent Children or
Employment Services Program
Virginia
VIEW
Washington
Work First
Michigan
Family Independence Program or
PATH
West Virginia
West Virginia Works
Minnesota
Minnesota Family Investment
Program
Wisconsin
Wisconsin Works
Wyoming
POWER
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Mississippi
Missouri
Temporary Assistance or Missouri
Work Assistance
Baby FACES 2020 Parent Survey
80
OMB (Redacted)
ALL
Source: Baby FACES 2009
Item title: AdultsHHIncome
L3.
Including yourself, how many adults contribute to your household income?
|___|___| NUMBER (RANGE 01 – 20)
DON’T KNOW .................................................................
d
REFUSED .......................................................................
r
PCRVERSION = 0 (PREGNANT WOMEN NOT RECEIVING A PCR)
Source: Baby FACES 2009
Item title: AmountHHIncome
L4.
In the last 12 months, what was the total income of all members of your household from
all sources before taxes and other deductions? Please include your own income and the
income of everyone living with you. Please include the money you have told me about
from jobs and public assistance programs, as well as any sources we haven’t discussed,
such as rent, interest, and dividends.
$|___|___|___|,|___|___|___| PER |___|___| CODE
per week,
1
L5
every two weeks,
2
L5
per month, or
3
L5
per year?
4
L5
DON’T KNOW
d
REFUSED
r
IF L4 = D, R
Source: Baby FACES 2009
Item title: HHIncomeRange
L4a.
I just need a range. Was it . . .
$25,000 or less, or………………………………………………
1
L4a.1
more than $25,000?..............................................................
2
L4a.2
DON’T KNOW…………………………………………………….
d
L5
REFUSED…………………………………………………………
r
L5
Baby FACES 2020 Parent Survey
81
OMB (Redacted)
IF L4A = 1 (RANGE IS 25,000 OR LESS)
Source: Baby FACES 2009
Item title: HHIncomeRange1
L4a.1.
Was it . . .
$5,000 or less,……………………………………………………..
1
$5,001 to $10,000,…………………………………………………
2
$10,001 to $15,000,………………………………………………..
3
$15,001 to $20,000, or…………………………………………….
4
$20,001 to $25,000?.................................................................
5
DON’T KNOW………………………………………………………
d
REFUSED…………………………………………………………..
r
IF L4A = 2 (RANGE IS MORE THAN 25,000)
Source: Baby FACES 2009
Item title: HHIncomeRange2
L4a.2.
Was it . . .
$25,001 to $30,000,………………………………………………..
6
$30,001 to $35,000,………………………………………………..
7
$35,001 to $40,000,………………………………………………..
8
$40,001 to $50,000,………………………………………………..
9
$50,001 to $75,000, or…………………………………………….
10
more than $75,000?……………………………………………….
11
DON’T KNOW……………………………………………………..
d
REFUSED………………………………………………………….
r
ALL
Source: Baby FACES 2009
Item title: HousingType1
L5.
The next questions are about housing. Do you now live in . . .
a house, apartment, or trailer with your family only,………….
a house, apartment, or trailer you share with another family,
transitional housing (apartment) or a homeless shelter, or….
somewhere else? (SPECIFY) ………………………………………
1
2
3
99
______________________________________________
DON’T KNOW…………………………………………………………..
REFUSED……………………………………………………………….
d
r
Baby FACES 2020 Parent Survey
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OMB (Redacted)
ALL
Source: Baby FACES 2009
Item title: MovedPastYear
L6.
Have you moved in the past year?
YES………………………………………………………………….
1
NO……………………………………………………………………
0
DON’T KNOW……………………………………………………….
d
REFUSED…………………………………………………………..
r
IF L6 = 1 (MOVED IN PAST YEAR)
Source: Baby FACES 2009
Item title: NumberMovesPastYear
L6a.
How many times have you moved in the past year?
|___|___| NUMBER
(RANGE 1 – 12)
DON’T KNOW………………………………………………………….
d
REFUSED………………………………………………………………
r
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L5 = 1, 2, D, R, 99 (NOT IN TRANSITIONAL HOUSING OR HOMELESS SHELTER)
Source: Baby FACES 2009
Item title: HousingType2
L7.
Do you currently own your home or apartment, pay rent, or live in public or subsidized
housing?
OWNS OR IS BUYING HOME OR APARTMENT…………………
1
RENTS (WITHOUT PUBLIC ASSISTANCE) ……………………..
2
PUBLIC OR SUBSIDIZED HOUSING …………………………….
3
LIVING RENT-FREE IN HOME OF RELATIVES OR FRIENDS
4
SOME OTHER ARRANGEMENT (SPECIFY) …………………….
99
DON’T KNOW………………………………………………………….
d
REFUSED………………………………………………………………
r
ALL
Source: Baby FACES 2009
Item title: ProgamHousingHelp
L8.
Did [PROGRAM] Early Head Start help you find a place to live?
YES ………………………………………………………………….
1
NO……………………………………………………………………
0
DON’T KNOW……………………………………………………….
d
REFUSED…………………………………………………………….
r
I8_info2.
PROGRAMMER: JUST PRIOR TO “THANKS,” DISPLAY IF ITEM I8N OR I8O IS GT 0
I mentioned earlier that there is a toll-free helpline that I can give you. This national Lifeline offers
free and confidential support for people in distress, and is available 24 hours a day. Please let me
know when you are ready to write it down. PAUSE. The number is 1-800-273-8255.
INSERT FINAL SPECS FOR BACK END/SCREENER HERE
Baby FACES 2020 Parent Survey
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OMB (Redacted)
| File Type | application/pdf |
| File Title | Baby FACES CATI Parent Interview Baseline Spring 2010 Data Collection |
| Subject | Questionnaire |
| Author | MPR STAFF |
| File Modified | 2020-02-21 |
| File Created | 2020-02-21 |