Attachment 37. AIAN FACES 2019 special Head Start teacher child report_June 2022_clean

OMB #: 0970-0151

Expiration Date: 12/31/2023

American Indian and Alaska Native Head Start Family and Child Experiences Survey (AIAN FACES)

Fall 2021 and Spring 2022 Special Head Start Teacher Child Report

The Paperwork Reduction Act Statement: This collection of information is voluntary and will be used to provide descriptive information about Head Start programs and the families they serve. Public reporting burden for this collection of information is estimated to average 7 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB number and expiration date for this collection are OMB #: 0970-0151, Exp: 12/31/2023. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Lizabeth Malone, Mathematica, 1100 1st Street, NE, 12th Floor, Washington, DC 20002.

Survey Information

Mathematica is conducting the American Indian and Alaska Native Head Start Family and Child Experiences Survey (AIAN FACES) under contract with the Administration for Children and Families (ACF) of the U.S. Department of Health and Human Services (HHS).

To enhance the information we obtain by surveying their parents, we need for you to complete this brief form, the Teacher Child Report, about each of the children in the study who are from your class. The Teacher Child Report (TCR) asks you to report on the current language, learning, and social skills; classroom conduct; and approaches to learning that you have observed in these children from your class. Your class may be held virtually or some children may attend your class virtually. Please do your best to answer the questions based on your experiences with the child so far this year.

The form will take about 7 minutes for each child.

Taking part is completely voluntary. There are no risks or direct benefits from taking part in the study. If you choose to take part in the study but then decide you want to leave the study at any point, that is okay.

No one outside of the Mathematica study team will be able to connect you to the responses you provide in the teacher-child report. That means other program staff, including your supervisor, will not know how you answered the questions. Some questions might ask you to answer questions in your own words. We may use statements or parts of statements you make in connection with the study; however, we will not identify you as the source of the statement; we also will not identify your program or community. We will never identify you or any individual parent, child, or other staff member, in any report; reports will contain only general study results. All information collected as part of AIAN FACES will be kept private to the extent permitted by law unless we learn that a child has been hurt or is in danger or you tell us that you plan to seriously hurt yourself or someone else – then by law, we must make a report to the appropriate legal authorities. In the future, survey responses from the study (with nothing identifying individuals, programs, or communities) will be securely shared only with qualified individuals who are studying Head Start children, their families, and programs.

We have a Certificate of Confidentiality from the National Institutes of Health. The Certificate helps us protect your privacy. This strictly limits when the study team can give out information that identifies you, even in court. However, we may need to share your information if it shows a serious threat to you or to others, including reporting to authorities when required by law. The U.S. Department of Health and Human Services (DHHS) may ask for data for an audit or evaluation. If they do, we will need to provide it. However, only DHHS staff involved in the review will see it.

A1. Are you currently the Head Start teacher for the child listed on the front of this survey? (Use an “X” to mark your response.)

1  Yes GO TO A1a

0  No GO TO A2

A1a. How does the child currently attend your class?

Note: In-person refers to instruction taking place face-to-face with you and the child and should be selected if that is the usual mode of instruction for the child, even if the child is receiving virtual instruction temporarily due to COVID exposure. Virtual or remote instruction should be selected when a child does not meet with you in person and instead receives instruction in real time via a web-based video platform such as Zoom, or completes assignments on the child/family’s own time on platforms such as Class Dojo or Ready Rosie, or on paper with instructional materials sent home. Hybrid should be selected if the child receives a combination of in-person and virtual or remote instruction.

1  In-person

2  Virtual or remote

3  Hybrid

A1b. How many days per week and hours per day do you see the child in-person?

| | | Days per week

| | | Hours per day (on average)

A1c. How many days per week and hours per day do you see the child virtually?

| | | Days per week

| | | Hours per day (on average)

A1d. Which type of class does this child attend?

1  A full day class

2  A morning class only

3  An afternoon class only

4  A home visit only

A1e.     What days of the week does the class this child attends meet?

MARK ALL THAT APPLY

  1  □   Monday

  2  □   Tuesday

  3  □   Wednesday

  4  □   Thursday

  5  □   Friday

GO TO B1.

A2. What is the main reason you are no longer this child’s teacher?

1  Child moved to another class

in the same center GO TO A3

2  Child moved to another center GO TO A3a

3  Child left the Head Start program GO TO A4

4  Child was never in my class/

I don’t know this child GO TO A5

A3. What is the name of the Head Start teacher whose class this child currently attends?

Name:

A3a. What is the name of the Head Start center where this child went?

Name:

A4. Please record the last date this child was in your class.

| | | / | | | / | | | | |

Month Day Year

A5. Thank you for completing this form.

These questions are about things that different children do at different ages. These things may or may not be true for this child.

B1. Can this child recognize…

1  All of the letters of the alphabet,

2  Most of them,

3  Some of them, or

4  None of them?

B2. How high can this child count? Would you say…

1  Not at all,

2  Up to five,

3  Up to ten,

4  Up to twenty,

5  Up to fifty, or

6  Up to 100 or more?

B3. How often does this child like to write or pretend to write? Would you say…

1  Never,

2  Has done it once or twice,

3  Sometimes, or

4  Often?

B4a. Can this child demonstrate a beginning understanding of the relationship between sounds and letters (e.g., the letter B makes a “buh” sound)? Would you say…

1  Not at all,

2  For one or two letters,

3  For a few (up to 5) letters, or

4  For several (6 or more) letters?

B5. Please answer “Yes” or “No” to each question about this child’s abilities.

	MARK “YES” OR “NO” ON EACH LINE
	YES	NO
a. Does this child mostly write and draw rather than scribble?	1 	0 
b. Can this child write their first name even if some of the letters are backward?	1 	0 
g. Does this child recognize their own first name in writing or in print?	1 	0 
h. Does this child read any other words in writing or in print?	1 	0 
i. Can this child identify rhyming words?	1 	0 

B6. Can this child identify basic shapes such as triangle, rectangle, circle, or square?

1  All of them, GO TO B6a

2  Most of them, GO TO B6a

3  Some of them, or GO TO B6a

4  None of them? GO TO B7

B6a. Can this child describe the differences between a rectangle and a triangle?

1  Yes

0  No

B7. Can this child sort objects by any of the following attributes?

MARK ALL THAT APPLY

1  Color

2  Shape

3  Size

4  Function (for example, things we use to write, things we sit on)

88  No opportunity to observe

B8. Can this child put more than three things in order by length or height?

1  Yes

0  No

88  No opportunity to observe

B9. If you show this child some objects (for example, several toy cars), can this child consistently tell you how many objects there are without counting?

1  Not consistently for even 1 or 2

2  Up to 2 objects

3  Up to 3 objects

4  Up to 4 objects

5  Up to 5 objects

88  No opportunity to observe

B10. Can this child tell you how many more you would need when you have 2 cups but want to have 5 cups?

1  Yes

0  No

88  No opportunity to observe

Mathematica’s agreement with the publisher/developer of this set of 12 items (C1a – C1l) does not allow us to share the items publicly without prior written approval.

Please describe this child according to how true each of these statements has been during the past month, from “not true” to “somewhat or sometimes true” to “very true or often true.” Please do your best to answer the questions based on your experiences with the child. If remote or virtual classroom services have prevented you from observing a particular behavior, please select “no opportunity to observe.” For each item, mark only one code.

	MARK ONE PER ROW
	NOT TRUE	SOMEWHAT OR SOMETIMES TRUE	VERY TRUE OR OFTEN TRUE	NO OPPORTUNITY TO OBSERVE
a. Acts too young for their age	1 	2 	3 	88 
b. Can't concentrate, can't pay attention for long	1 	2 	3 	88 
c. Mathematica’s agreement with the publisher/developer of this item does not allow us to share the items publicly without prior written approval	1 	2 	3 	88 
d. Mathematica’s agreement with the publisher/developer of this item does not allow us to share the items publicly without prior written approval	1 	2 	3 	88 
e. Mathematica’s agreement with the publisher/developer of this item does not allow us to share the items publicly without prior written approval	1 	2 	3 	88 
f. Hits or fights with others	1 	2 	3 	88 
g. Keeps to themself; tends to withdraw	1 	2 	3 	88 
h. Lacks confidence in learning new things or trying new activities	1 	2 	3 	88 
i. Is nervous, high-strung, or tense	1 	2 	3 	88 
j. Is very restless, fidgets all the time, can't sit still	1 	2 	3 	88 
k. Mathematica’s agreement with the publisher/developer of this item does not allow us to share the items publicly without prior written approval	1 	2 	3 	88 
l. Has temper tantrums or hot temper	1 	2 	3 	88 
m. Often seems unhappy, sad, or depressed	1 	2 	3 	88 
n. Worries about things for a long time	1 	2 	3 	88 

H1. Please describe this child according to how they approach tasks. How often in the past month did they act this way? Was it “never,” “sometimes,” “often,” or “very often.”? Please do your best to answer the questions based on your experiences with the child. If remote or virtual classroom services have prevented you from observing a particular behavior, please select “no opportunity to observe.” For each item, mark only one code.

	MARK ONE PER ROW
	NEVER	SOMETIMES	OFTEN	VERY OFTEN	NO OPPORTUNITY TO OBSERVE
a. Keeps belongings organized	1 	2 	3 	4 	88 
b. Pays attention well	1 	2 	3 	4 	88 
c. Shows eagerness to learn new things	1 	2 	3 	4 	88 
d. Easily adapts to changes in routine	1 	2 	3 	4 	88 
e. Persists in completing tasks	1 	2 	3 	4 	88 
f. Works independently	1 	2 	3 	4 	88 

F1. Has any professional such as a doctor or other health or education professional mentioned this child having a developmental problem or delay, for example, any developmental concerns or disability, such as physical, emotional, language, hearing difficulty or other developmental concerns?

MARK ONLY ONE

1  Yes

0  No

d  Don’t know

F2. How did the doctor or other health or education professional describe this child’s developmental concerns or disability?

MARK ALL THAT APPLY

1  VISION IMPAIRMENT

2  BLINDNESS

3  HEARING IMPAIRMENT/HARD OF HEARING

4  DEAFNESS

5  MOTOR IMPAIRMENT

6  SPEECH IMPAIRMENT/DIFFICULTY

COMMUNICATING

7  MENTAL RETARDATION

8  DEVELOPMENT DELAY

9  AUTISM OR Pervasive Developmental

DISORDER (PDD)

10  BEHAVIOR PROBLEMS/HYPERACTIVITY/

ATTENTION DEFICIT (ADD or ADHD)

11  OPPOSITIONAL DEFIANT DISORDER

12  OTHER (Specify)

d  Don’t know

GO TO F5

F3. Since this child has enrolled in Head Start, has anyone reported concerns about their health or development?

Note: This item does not refer to normal health concerns (e.g., “she has a lot of colds”); it refers to the conditions listed in F4 below. The concerns may be identified by yourself, another staff member, a parent, or anyone else.

1  Yes

0  No

d  Don’t know

F4. To your knowledge, what areas of this child’s health and development appear to be of concern?

MARK ALL THAT APPLY

1  VISION IMPAIRMENT

2  BLINDNESS

3  HEARING IMPAIRMENT/HARD OF HEARING

4  DEAFNESS

5  MOTOR IMPAIRMENT

6  SPEECH IMPAIRMENT/DIFFICULTY

COMMUNICATING

7  MENTAL RETARDATION

8  DEVELOPMENT DELAY

9  AUTISM OR Pervasive Developmental

DISORDER (PDD)

10  BEHAVIOR PROBLEMS/HYPERACTIVITY/

ATTENTION DEFICIT (ADD or ADHD)

11  OPPOSITIONAL DEFIANT DISORDER

12  OTHER (Specify)

d  Don’t know

F5. What has been done so far to address the child’s condition or the concerns about the child’s health and development?

The definition of IFSP/IEP is as follows: “a written plan that describes goals for this child and the services they should receive.”

MARK ALL THAT APPLY

1  Discussions/plans are in progress

2a  A mental health specialist has been contacted

2b  Other consultants or specialist have been contacted

3  The child has been observed or evaluated

4  A meeting with the parents and the disability services team has been made

5  An individualized education plan (IEP) or an Individual Family Service Plan (IFSP) has been developed

6  Modifications or accommodations to the classroom or class activities have been made

d  Don’t know

If F5 = 5 (An IEP or IFSP has been developed), go to F5a. Otherwise, go to G1.

F5a. Did you participate in the child’s IEP or IFSP meeting?

1  Yes

0  No

d  Don’t know

F5b. Which of the following services has the child received?

MARK ALL THAT APPLY

1  Speech or language therapy

2  Social work services

3  Psychological services

4  Special education teacher services

5  Other services

d  Don’t know

If F5b = 1, 2, 3, 4, OR 5, go to F5c.

Otherwise, go to G1

F5c. How were these services delivered?

MARK ALL THAT APPLY

1  Consultation

Note: Consultation includes recommending modifications, accommodations, or other methods to support the child’s learning and development.

2  Direct teaching or services by a specialist in the classroom

3  Direct teaching or services by a specialist in another classroom or setting

4  Direct teaching or services by a specialist virtually

d  Don’t know

SPRING ONLY

F6. About how often has the child missed a Head Start class (virtual or in-person) during the past year?

Please answer this question thinking about the child’s attendance for scheduled classroom sessions. Do not consider a child missing class due to the center being closed.

1  Never,

2  One to five days,

3  Six to ten days,

4  Eleven to twenty days, or

5  More than twenty days?

G1. Why did you choose to complete the paper questionnaire rather than complete the questionnaire on the Web?

MARK ALL THAT APPLY

1  Did not have access to a computer

2  Computers were in use by others at the times

I wanted to do the questionnaire

3 Started survey, but experienced technical

problems such as…

3a  Screen frozen

3b  Took too long to load the first page

3c  Took too long to load subsequent pages

4 Tried to log into Web address, but an error

message appeared…

4a  “Invalid password”

4b  “This page has expired”

4c  “This website is busy, please try

again later”

5  Computer screen too small to read questions,

such as required too much scrolling—up or

down, side to side

6  Unable to read the questions on the screen

because of the color scheme on the computer

7  Chose to complete the paper questionnaire

because it was readily available

G2. What kind of help could we have given you to make it easier to complete this form on the web?

Thank you for your participation in AIAN FACES!