OMB #: 0970-0531
EXPIRATION: 07/31/2022
Instrument 3 - SIRF Reflections from Fathers
MDRC will develop an electronic data collection approach using Qualtrics that the Learning Cycle Manager and staff at each site can use to solicit reflections from fathers to be used in each site’s learning cycle reflection process. All possible questions are noted below but the exact deployment of them will depend on the interventions being tested with each site.
Hello! [name the program] is partnering with MDRC, a nonprofit organization, to learn how to better support fathers in their program. The project is called Strengthening the Implementation of Responsible Fatherhood Programs, or SIRF. [Name the program] is one of 10 fatherhood programs involved in this project.
As part of this project, we’d like to hear about your experiences with [name the program] by asking you a few questions. Your responses will help the program to better engage fathers in their services. Your responses will also be combined with those from the other programs participating in the project to come up with ideas for how fatherhood programs nationwide can be better in the future.
It will take about 15 minutes to give your feedback. We will not ask you to provide any personal information. Your responses will be kept private. Providing your feedback is your choice. There is no penalty for not answering these questions.
If you have questions about this project you can reach out to MDRC by email (SIRF@mdrc.org) or call the SIRF hotline at (877) 375-9340.
This project is funded by the U.S. Department of Health and Human Services.
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to gather preliminary information about the fatherhood field and explore with fatherhood programs the research questions that are of interest and the design options that are feasible. Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. The answers you give will be kept private. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0531 and the expiration date is 07/31/2022. If you have any comments on this collection of information, please contact; Charles.Michalopoulos@mdrc.org, and Dina Israel; Dina.Israel@mdrc.org; Attn: OMB-PRA (0970-0531).
|
|
|
Consent |
Given what you just read about the purpose of this project, please select a response below.
|
|
|
|
|
|
How did you hear about [name the program]?
Select one. |
|
|
How did you hear about [name the program]? |
[short form response]
[move to 4. Wait_time] |
|
How long did you wait before reaching out to [name the program]?
Select one. |
[move to 5. Impression] |
|
What were your first impressions of [name the program]? |
[short form response]
[move to 6. Enroll_reason] |
|
What was your main reason for enrolling in [name the program]?
Select one. |
[move to 7. Participated or exit_responder, depending on site and timing in cycle] |
|
|
|
|
Have you attended any services from [name the program] in [timeframe]?
Select one. |
|
Question series for fathers who did not attend any services during timeframe in question.
|
||
|
What was the main reason you did not attend?
Select one.
|
|
|
What was the main reason it was difficult to attend?
Select one. |
|
|
Why was the time or location inconvenient?
Select one. |
[move to Exit_responder] |
|
What type of personal or family issue?
Select one. |
[move to Exit_responder] |
|
What made it difficult to attend? |
[short form response]
[move to Exit_responder] |
|
Why are you no longer interested in services?
Select one. |
|
|
What did you not like about the program?
Select one. |
|
|
What did you not like about the program? |
[short form response]
[move to Exit_responder] |
|
What was the reason you did not attend? |
[short form response]
[move to Exit_responder] |
Question series for fathers who did attend during the timeframe in question.
|
||
|
About how many times have you met with someone from [name the program] since [timeframe]?
Select one. |
[move to 18. challenge_part] |
|
Do you ever find it challenging to attend services offered by [name the program]? |
|
|
What is the main challenge you have to attend services offered by [name the program]?
Select one. |
|
|
What type of personal or family issue?
Select one. |
Move to [27. support goals] |
|
What specifically made it inconvenient?
Select one. |
Move to [27. support goals] |
|
What could help you be more motivated?
Select one. |
Move to [23. support goals] |
|
What is the another challenge you have to attend services offered by [name the program]?
|
|
|
What type of personal or family issue?
Select one. |
|
|
What specifically made it inconvenient?
Select one. |
|
|
What could help you be more motivated?
Select one. |
|
Question series for fathers who did attend during the timeframe in question.
|
||
|
Do you feel that [name the program]’s support is helping you to reach your goals? |
|
|
What additional support do you need to reach your goals?
|
[short free-form response]
[move to 29. most_useful] |
|
What aspect of [name the program] do you think is most useful for you to meet your goals?
Select one.
|
[move to Exit_responder] |
|
||
Exit_responder |
Thank you for responding! Your input will help [name the program] to improve! We wish you success in reaching your goals. |
|
Exit_no_consent |
Thanks for considering. We wish you all the best on your fatherhood journey. |
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Michelle Manno |
File Modified | 0000-00-00 |
File Created | 2021-05-31 |