Supervisor Survey Baseline

OMB Control No: _____

Expiration Date: ______

Length of time for instrument: 1.25 hours

ATTACHMENT 13: MIHOPE SUPERVISOR SURVEY_

BASELINE

5/29/2012

SUPERVISOR SURVEY - BASELINE

The U.S. Department of Health and Human Services has contracted with MDRC to evaluate the federal Maternal, Infant and Early Childhood Home Visiting program (MIECHV).

The Mother and Infant Home Visiting Program Evaluation (MIHOPE) is designed to build knowledge for policymakers and practitioners about the effectiveness of MIECHV.

Your answers will be kept confidential. Only the research team will have access to this information. Your answers will not be shared with anyone at your program or any other agencies. In our research reports, the information you provide will not be attributed by name to you or your individual program.

One objective of MIHOPE is to learn about the role of supervisors in home visiting programs.

We are requesting that you complete this survey because you are a supervisor in one of the home visiting programs participating in MIHOPE. Your answers will help us to understand your role in the home visiting program and your perspective on the home visiting program.

• It will take about 1 hour and 15 minutes to complete this survey.

• If you are unsure how to answer a question, please give the best answer you can rather than leaving it blank.

• We would appreciate your response by MM/DD/YYYY.

• If you have questions at any time during the study, please call Alexander Vazquez at MDRC toll-free at 1-877-311-6372 or email [email protected].

• To thank you for your time, we will be sending you a gift card for $30.

Supervisor Survey – Baseline

A. DEMOGRAPHICS

1. What was the highest level/degree you completed in school?

 Some High School, no degree [SKIP TO 3]

 High School/GED [SKIP TO 3]

 Vocational/technical training program

 Some college, no degree

 Associate’s degree

 Bachelor’s degree

 Master’s degree (e.g., MA, MS, MSW)

 Professional degree (e.g., LLB, LD, MD, DDS)

 Doctorate degree (e.g., PhD, EdD)

2. Field of study: CHECK ALL THAT APPLY. (Responses not limited to highest degree completed.)

 Child development

 Early childhood education

 Education

 Psychology

 Social work/Social welfare

 Nursing

 Other (specify)

3. Are you of Hispanic, Latino/a or Spanish origin? One or more categories may be selected.

 No, not of Hispanic, Latino/a, or Spanish origin

 Yes, Mexican, Mexican American, Chicano/a

 Yes, Puerto Rican

 Yes, Cuban

 Yes, Another Hispanic, Latino/a or Spanish origin

4. What is your race? One or more categories may be selected.

 White

 Black or African American

 American Indian or Alaska Native

 Asian Indian

 Chinese

 Filipino

 Japanese

 Korean

 Vietnamese

 Other Asian

 Native Hawaiian

 Guamanian or Chamorro

 Samoan

 Other Pacific Islander

 Other

5. What is your age?

 Under 20 years

 20-29

 30-39

 40-49

 50-59

 60 or older

6. What is your sex?

 Male

 Female

B. EMPLOYMENT HISTORY

In this section, we would like to know about your employment history prior to working at [HV PROGRAM SITE].

1. Prior to your current position, did you have experience providing home visiting services to families?

 No [SKIP TO 4]

 Yes

2. In which models do you have prior experience providing home visiting services to families? CHECK ALL THAT APPLY.

 Nurse Family Partnership

 Parents as Teachers

 Healthy Families America

 Early Head Start

 Other (specify): _________

3. How many total years of prior experience do you have providing home visiting services?

 None

 Less than 1 year

 1-2 years

 3-5 years

 5-10 years

 More than 10 years

4. Do you have prior experience working with high risk families in any of the following settings? CHECK ALL THAT APPLY.

 In-home child care

 Daycare

 Preschool

 School, Grades K-12 (non-nurse)

 After school program

 Special education program

 Nurse

 School nurse

 Home health care

 Other health care

 Social Services

 Mentoring programs

 Mental health agencies

 Other

5. How many total years of experience supervising home visitors do you have at this agency and at any other agency?

 None

 Less than 1 year

 1-2 years

 3-5 years

 5-10 years

 More than 10 years

C. CURRENT POSITION

1. When did you begin your present job as a supervisor?

__________Month __________Year

2. How many hours do you work in a typical week?

HOURS:

3. In a typical week, how do these [Q2 ANSWER] hours break down across these activities?

Activities	Number of Hours
Providing one-on-one supervision
Providing group supervision
Observation of home visits
Home visiting (including first visits)
Recruiting families
Preparing for home visits
Travel to home visits
Transporting families
Initial assessments
Time spent on the phone
Group meetings
Manual paperwork
Data entry into computer
Receiving supervision
Training
Other (specify):

4. How likely are you to leave your present job in the next 12 months?

 Very unlikely

 Somewhat unlikely

 Somewhat likely

 Very likely

5. Do you supervise home visitors in any other home visiting programs?

 No [SKIP TO SECTION D]

 Yes

6. What model do these other home visiting programs use? CHECK ALL THAT APPLY.

 Nurse Family Partnership

 Parents as Teachers

 Healthy Families America

 Early Head Start

 Other (specify): _________

D. SERVICES PROVIDED

1. Do you yourself have a family caseload?

 No [SKIP TO SECTION E]

 Yes

2. In what language(s) are you fluent enough to provide home visiting services? CHECK ALL THAT APPLY.

 English

 Spanish

 Other (specify): _________

3. How many families are in your current caseload? _________

4. Please rate the size of your current caseload:

 Lighter than you are able to handle

 About right

 Heavier than you are able to handle

5. In the past 6 months, how often have you had a caseload that was more than what you could handle effectively?

 Never

 Rarely

 Sometimes

 Often

 Nearly always

 Always

6. Are you required to prepare home visit plans in advance of each visit? A home visit plan generally includes written documentation of planned visit content, focus areas, and discussion points along with documentation of handouts, materials, or resources to be provided.

 Yes

 Not required, and I do not prepare home visit plans [SKIP TO 9]

 Not required, but I do prepare home visit plans

7. About how often do you prepare home visit plans in advance of visits?

 Always

 Nearly always

 Often

 Sometimes

 Rarely

 Never

8. Do you use a curriculum to prepare your home visit plans?

 Yes, what is the name of the curriculum? _________

 No

9. Do you informally observe parents interacting with their child throughout the home visit?

 No [SKIP TO 14]

 Yes

10. How often do you informally observe parents interacting with their child throughout the home visit?

 Almost every visit

 Most visits

 About half of visits

 Some visits

 Few visits

11. What types of feedback does your [HV PROGRAM SITE] expect you to give the parent about his/her interaction with the child to manage problem behaviors? CHECK ALL THAT APPLY.

 Explore reasons for negative parenting behaviors

 Suggest alternative approaches to parenting

 Reinforce positive parenting behaviors

 Not expected to give feedback

12. What types of feedback does your [HV PROGRAM SITE] expect you to give the parent about his/her interaction with the child to promote cognitive and language skills? CHECK ALL THAT APPLY.

 Explore reasons for negative parenting behaviors

 Suggest alternative approaches to parenting

 Reinforce positive parenting behaviors

 Not expected to give feedback

13. What types of feedback does your [HV PROGRAM SITE] expect you to give the parent about his/her interaction with the child to promote social emotional development? CHECK ALL THAT APPLY.

 Explore reasons for negative parenting behaviors

 Suggest alternative approaches to parenting

 Reinforce positive parenting behaviors

 Not expected to give feedback

14. Do you formally observe parents interacting with their child as a specific part of the home visit?

 No [SKIP TO SECTION E]

 Yes

15. How often do you formally observe parents interacting with their child as a specific part of the home visit?

 Almost every visit

 Most visits

 About half of visits

 Some visits

 Few visits

16. In formal observation, do you use any specific tool(s) to assess the quality of parent-child interaction?

 Yes, what is the name of the tool(s)? _________

 No

17. Do you use video recording when formally observing parents interacting with their children?

 Yes

 No [SKIP TO 19]

18. Do you review the video recording with the family?

 Yes

 No

19. What types of feedback does your [HV PROGRAM SITE] expect you to give the parent about his/her interaction with the child to manage problem behaviors? CHECK ALL THAT APPLY.

 Explore reasons for negative parenting behaviors

 Suggest alternative approaches to parenting

 Reinforce positive parenting behaviors

 Not expected to give feedback

20. What types of feedback does your [HV PROGRAM SITE] expect you to give the parent about his/her interaction with the child to promote cognitive and language skills? CHECK ALL THAT APPLY.

 Explore reasons for negative parenting behaviors

 Suggest alternative approaches to parenting

 Reinforce positive parenting behaviors

 Not expected to give feedback

21. What types of feedback does your [HV PROGRAM SITE] expect you to give the parent about his/her interaction with the child to promote social emotional development? CHECK ALL THAT APPLY.

 Explore reasons for negative parenting behaviors

 Suggest alternative approaches to parenting

 Reinforce positive parenting behaviors

 Not expected to give feedback

E. SUPERVISION

1. How many home visitors do you supervise? ____________

2. Please rate the size of your current supervisor to home visitor ratio:

 Lighter than you are able to handle

 About right

 Heavier than you are able to handle

3. In the past 6 months, how often have you had a supervisor to home visitor ratio that was more than what you could handle effectively?

 Never

 Rarely

 Sometimes

 Often

 Always

4. Do you have one-on-one supervision meetings with home visitors? Supervision meetings are meetings in which you provide feedback or guidance on their home visiting caseload.

 Yes

 No [SKIP TO 8]

5. About how often, on average, do you have scheduled one-on-one supervision meetings with each home visitor?

 Weekly or more frequently

 Every two weeks

 Every three weeks

 Monthly

 Once every 1-3 months

 Once every 4-6 months

 Once a year

 Never

6. Do you use a form to guide one-on-one supervision? ‘

 Yes

 No [SKIP TO 8]

7. If so, how often do you use this form?

 All of the time (100%)

 Nearly all of the time (85%-99%)

 Most of the time (61%-84%)

 About half of the time (40%-60%)

 Some of the time (15%-39%)

 Nearly none of the time (1-14%)

 None of the time (0%)

8. Do you have group supervision meetings with home visitors?

 Yes

 No [SKIP TO 10]

9. About how often, on average, do you have group supervision meetings?

 Weekly or more frequently

 Every two weeks

 Every three weeks

 Monthly

 Once every 1-3 months

 Once every 4-6 months

 Once a year

 Never

10. How do you monitor home visitor performance? CHECK ALL THAT APPLY

 Review my supervision notes

 Review specific cases in paper records

 Review specific cases in management information system

 Review reports I generate

 Review reports that are routinely generated by our program

 Other (specify): _________

F. SUPERVISION OBSERVATION

1. Do you ever observe home visitors in actual visits or by reviewing video-recordings of their visits as part of supervision?

 No [SKIP TO SECTION G]

 Views video recordings only

 Observes in person only

 Views video recordings and observes in person

2. Do you observe all home visitors or only under certain conditions? CHECK ALL THAT APPLY.

 Observes all home visitors

 Observes home visitors who are newly hired

 Observes home visitors who request to be observed

 Observes home visitors who need extra help

 Observes home visitors under other conditions (specify): _________

3. For each home visitor, about how many times do you observe a home visit?

 Less than one time per year

 One time per year

 Two times per year

 Three times per year

 Four times per year

 Five times per year

 Six to ten times per year

 Eleven or more times per year

4. Do you use any specific tool(s) for observing home visits?

 Yes, what is the name of the tool(s)? _________

 No

5. When you observe a home visit, how often do you give the home visitor feedback, either right after the visit or sometime later?

 Always

 Usually

 Sometimes

 Rarely

 Never

6. How helpful do you believe your feedback is to improving home visitor performance?

 Extremely helpful

 Very helpful

 Somewhat helpful

 Not very helpful

 Not at all helpful

G. TECHNOLOGY RESOURCES

1. Do you have laptops/tablets/iPads for use during observation of home visits?

 Yes

 No

2. Do you have an appropriate, private space to conduct one-on-one supervision?

 Yes

 No

3. Do you have access to a computer at your office?

 Yes, I have access to my own computer at the office

 Yes, I have access to a shared computer at the office

 No

4. Does your center/office have Internet access available to you?

 Yes, I have reliable Internet access at the office

 Yes, I have Internet access at the office, but it is sometimes unreliable

 No, I do not have Internet access at the office

5. How do you document your notes from supervision sessions with home visitors? CHECK ALL THAT APPLY.

 In writing on paper forms

 Electronically on laptops/tablets/iPads

 Electronically when I am at an office computer

 I do not document notes from supervision sessions [SKIP TO SECTION H]

 Other (specify): _________

6. How easy is it for you to document your notes from supervision sessions with home visitors?

 Very easy in all respects

 Easy in most respects

 Easy in some respects

 Not at all easy

7. Are any of your notes from supervision sessions entered into your program’s management information session?

 Yes

 No

H. WELL-BEING

Instructions: Thinking about your relationships in general, please indicate the extent to which you agree or disagree with each of the twenty-nine statements. The scale ranges from 1 (totally disagree) to 6 (totally agree). Please select only one response for each statement. There are no wrong or right answers; please select the answer that most generally applies to you.

		Totally Disagree	Strongly Disagree	Disagree	Agree	Strongly Agree	Totally Agree
1.	I feel confident that other people will be there for me when I need them.						
2.	I prefer to depend on myself rather than other people.						
3.	I prefer to keep to myself.						
4.	Achieving things is more important than building relationships.						
5.	Doing your best is more important than getting on with others.						
6.	If you’ve got a job to do, you should do it no matter who gets hurt.						
7.	It’s important to me that others like me.						
8.	I find it hard to make a decision unless I know what other people think.						
9.	My relationships with others are generally superficial.						
10.	Sometimes I think I am no good at all.						
11.	I find it hard to trust other people.						
12.	I find it difficult to depend on others.						
13.	I find that others are reluctant to get as close as I would like.						

14.	I find it relatively easy to get close to other people.						
15.	I find easy to trust others.						
16.	I feel comfortable depending on other people.						
17.	I worry that others won’t care about me as much as I care about them.						
18.	I worry about people getting too close.						
19.	I worry that I won’t measure up to other people.						
20.	I have mixed feelings about being close to others.						
21.	I wonder why people would want to be involved with me.						
22.	I worry a lot about my relationships.						
23.	I wonder how I would cope without someone to love me.						
24.	I feel confident about relating to others.						
25.	I often feel left out or alone.						
26.	I often worry that I do not really fit with other people.						
27.	Other people have their own problems, so I don’t bother them with mine.						
28.	If something is bothering me, others are generally aware and concerned.						
29.	I am confident that other people will like and respect me.						

Instructions: For each statement, please choose which best describes how you have been feeling in the past week: Rarely or none of the time; some or a little of the time (1-2 days), occasionally (3-4 days), or most of the time (5-7 days).

		Rarely or None of the Time	Some or a Little of the Time (1-2 days)	Occasionally (3-4 days)	Most of the Time (5-7 days)
30.	I felt depressed.				
31.	I felt that everything I did was an effort.				
32.	My sleep was restless.				
33.	I was happy.				
34.	I felt lonely.				
35.	People were unfriendly.				
36.	I enjoyed life.				
37.	I felt sad.				
38.	I felt that people disliked me.				
39.	I could not get going.				

I. ORGANIZATIONAL SOCIAL CONTEXT MEASURE

This is a copyrighted measure. © The University of Tennessee Children’s Mental Health services Research Center, 2006. Organizational Social Context (OSC). The scale may not be used without the express written consent of the Children’s Mental Health Services Research Center.

J. PROGRAM OUTCOMES

Instructions: In this section, we would like to learn how staff members perceive their program’s intended outcomes. In general, a program outcome is a benefit to a child, parent, or family. For example, some programs might see the improvement of prenatal health as an important outcome. 

Below is a list of possible outcomes for home visiting programs. We know your program may care about all of these benefits for your families.  However, we would like to get a sense of which outcomes you think your program believes may be more important than others.  We would like you to check the box that best represents what you think your program believes about the outcome.

To help you decide on an outcome’s rank, think about whether it is discussed routinely in training and supervision. Think about what staff in your agency are told about its importance. Checkthe box that best describes your program’s ranking of this outcome.

1. Considering all of the outcomes your program aims to achieve, how much of a priority is promoting good prenatal health, such as diet, exercise, rest, and not smoking?

										
0	1	2	3	4	5	6	7	8	9	10
Not a Priority at All					Moderate Priority					Highest Priority

2. Considering all of the outcomes your program aims to achieve, how much of a priority is preventing poor birth outcomes, such as pre-term birth and low birth weight?

										
0	1	2	3	4	5	6	7	8	9	10
Not a Priority at All					Moderate Priority					Highest Priority

3. Considering all of the outcomes your program aims to achieve, how much of a priority is promoting breastfeeding?

										
0	1	2	3	4	5	6	7	8	9	10
Not a Priority at All					Moderate Priority					Highest Priority

4. Considering all of the outcomes your program aims to achieve, how much of a priority is promoting maternal physical health outside of pregnancy, such as good nutrition, exercise, and rest?

										
0	1	2	3	4	5	6	7	8	9	10
Not a Priority at All					Moderate Priority					Highest Priority

5. Considering all of the outcomes your program aims to achieve, how much of a priority is promoting family planning and birth spacing?

										
0	1	2	3	4	5	6	7	8	9	10
Not a Priority at All					Moderate Priority					Highest Priority

6. Considering all of the outcomes your program aims to achieve, how much of a priority is preventing and reducing tobacco use?

										
0	1	2	3	4	5	6	7	8	9	10
Not a Priority at All					Moderate Priority					Highest Priority

7. Considering all of the outcomes your program aims to achieve, how much of a priority is preventing and reducing mental health and substance use problems?

										
0	1	2	3	4	5	6	7	8	9	10
Not a Priority at All					Moderate Priority					Highest Priority

8. Considering all of the outcomes your program aims to achieve, how much of a priority is preventing and reducing domestic violence?

										
0	1	2	3	4	5	6	7	8	9	10
Not a Priority at All					Moderate Priority					Highest Priority

9. Considering all of the outcomes your program aims to achieve, how much of a priority is promoting family economic self-sufficiency, such as reaching goals for employment and education?

										
0	1	2	3	4	5	6	7	8	9	10
Not a Priority at All					Moderate Priority					Highest Priority

10. Considering all of the outcomes your program aims to achieve, how much of a priority is promoting child preventive care, such as having all recommended well-child visits, being up-to-date on immunizations, and having parents baby-proof their home to prevent injuries?

										
0	1	2	3	4	5	6	7	8	9	10
Not a Priority at All					Moderate Priority					Highest Priority

11. Considering all of the outcomes your program aims to achieve, how much of a priority is promoting positive parenting behaviors, such as nurturing, encouraging the child’s learning, and using positive behavior management techniques?

										
0	1	2	3	4	5	6	7	8	9	10
Not a Priority at All					Moderate Priority					Highest Priority

12. Considering all of the outcomes your program aims to achieve, how much of a priority is preventing and reducing child abuse and neglect?

										
0	1	2	3	4	5	6	7	8	9	10
Not a Priority at All					Moderate Priority					Highest Priority

13. Considering all of the outcomes your program aims to achieve, how much of a priority is promoting child cognitive and language development and social- emotional well-being?

										
0	1	2	3	4	5	6	7	8	9	10
Not a Priority at All					Moderate Priority					Highest Priority

M. IMPACTS

Please express your agreement or disagreement with the statements below. We are interested in knowing your thoughts about families who are currently receiving services or who have completed the program.

I feel that as a result of the services my program site has provided….		Strongly Agree	Agree	Slightly Agree	Neutral	Slightly Disagree	Disagree	Strongly Disagree
1.	Expectant women are more likely to get adequate prenatal care.							
	More expectant women have healthy nutrition and exercise habits while pregnant.							
	More babies are born full-term and normal weight.							
	More mothers have healthy eating and exercise habits outside of pregnancy.							
	Mothers are more likely to space their births.							
	Fewer mothers use tobacco.							
	Fewer mothers have problem alcohol and other drug use.							
	Mothers are better able to recognize and address mental health issues.							
	Fewer mothers are depressed.							
	Fewer mothers have high parenting stress.							
	Mothers are better able to recognize and address partner violence.							
	More mothers develop relationships with people they can count on.							
	More mothers get the public benefits for which they qualify.							
	More families become economically self sufficient.							
	Mothers are more likely to start and continue breastfeeding.							
	More mothers use positive child behavior management techniques.							
	More mothers support their children’s cognitive and language development.							
	More mothers support their children’s social-emotional development.							
	Children have better cognitive and language development.							
	More children are securely attached.							
	Fewer children are abused or neglected.							
	Fewer homes have safety hazards.							
	More children are up to date on their shots and well child care.							
	Fewer children have injuries requiring medical care.							

L. EXPECTATIONS

Think about the expectations that you have for the home visitors you supervise. Please express your agreement or disagreement with the statements below.

I expect home visitors to help mothers…		Strongly Agree	Agree	Slightly Agree	Neutral	Slightly Disagree	Disagree	Strongly Disagree
1.	Have a healthy lifestyle prenatally, such as good nutrition, exercise and prenatal care.							
	Develop a healthy lifestyle outside of pregnancy, such as good nutrition, exercise and preventive health care.							
	Space their births.							
	Reduce their tobacco use.							
	Recognize and deal with problem alcohol and other drug use.							
	Recognize and deal with mental health issues.							
	Recognize and deal with partner violence.							
	Get the public benefits for which they qualify.							
	Become economically self-sufficient.							
	Start and continue breastfeeding.							
	Use positive child behavior management techniques.							
	Support their children’s cognitive and language development.							
	Support their children’s social-emotional development.							
	Baby-proof their homes.							
	Secure high quality child care.							
	Make sure their children are up to date on shots and well child care.							

M. EFFECTIVENESS

Please express your agreement or disagreement with the statements below. We are interested in knowing your thoughts about the home visitors you currently supervise.

I feel I am effective in supervising home visitors in how they help mothers….		Strongly Agree	Agree	Slightly Agree	Neutral	Slightly Disagree	Disagree	Strongly Disagree
1.	Have a healthy lifestyle prenatally, such as good nutrition, exercise and prenatal care.							
	Develop a healthy lifestyle outside of pregnancy, such as good nutrition, exercise and preventive health care.							
	Space their births.							
	Reduce their tobacco use.							
	Recognize and deal with problem alcohol and other drug use.							
	Recognize and deal with mental health issues.							
	Recognize and deal with partner violence.							
	Get the public benefits for which they qualify.							
	Become economically self-sufficient.							
	Start and continue breastfeeding.							
	Use positive child behavior management techniques.							
	Support their children’s cognitive and language development.							
	Support their children’s social-emotional development.							
	Baby-proof their homes.							
	Secure high quality child care.							
	Make sure their children are up to date on shots and well child care.							

N. COMFORT

Please express your agreement or disagreement with the statements below. We are interested in knowing your thoughts about the home visitors you currently supervise.

I feel comfortable supervising home visitors on how they work with mothers about….		Strongly Agree	Agree	Slightly Agree	Neutral	Slightly Disagree	Disagree	Strongly Disagree
1.	Their prenatal health habits and use of prenatal care.							
	Their health habits and use of primary care outside of pregnancy.							
	Family planning and birth spacing.							
	Their tobacco use.							
	Their alcohol and other drug use.							
	Their mental health issues.							
	Partner violence.							
	Their need for and use of public benefits.							
	Becoming economically self-sufficient.							
	Breastfeeding.							
	Child behavior management techniques.							
	Supporting their child’s cognitive and language development.							
	Supporting their child’s social-emotional development.							
	Baby-proofing their homes.							
	Securing high quality child care.							
	Making sure their children are up to date on shots and well child care.							

O. TRAINING

Think about your training and the home visitors you currently supervise at your program site. Please express your agreement or disagreement with the statements below.

I feel I am adequately trained to supervise home visitors to help mothers….		Strongly Agree	Agree	Slightly Agree	Neutral	Slightly Disagree	Disagree	Strongly Disagree
1.	Have a healthy lifestyle prenatally, such as good nutrition, exercise and prenatal care.							
	Develop a healthy lifestyle outside of pregnancy, such as good nutrition, exercise and preventive health care.							
	Space their births.							
	Reduce their tobacco use							
	Recognize and deal with problem alcohol and other drug use.							
	Recognize and deal with mental health issues.							
	Recognize and deal with partner violence.							
	Get the public benefits for which they qualify.							
	Become economically self-sufficient.							
	Start and continue breastfeeding.							
	Use positive child behavior management techniques.							
	Support their children’s cognitive and language development.							
	Support their children’s social-emotional development.							
	Baby-proof their homes.							
	Secure high quality child care.							
	Make sure their children are up to date on shots and well child care.							

P. STRATEGIES AND TOOLS

Think about the strategies and tools provided by your program site. Please express your agreement or disagreement with the statements below.

My program gives home visitors useful strategies and tools to help mothers….		Strongly Agree	Agree	Slightly Agree	Neutral	Slightly Disagree	Disagree	Strongly Disagree
1.	Have a healthy lifestyle prenatally, such as good nutrition, exercise and prenatal care.							
	Develop a healthy lifestyle outside of pregnancy, such as good nutrition, exercise and preventive health care.							
	Space their births.							
	Reduce their tobacco use.							
	Recognize and deal with problem alcohol and other drug use.							
	Recognize and deal with mental health issues.							
	Recognize and deal with partner violence.							
	Get the public benefits for which they qualify.							
	Become economically self-sufficient.							
	Start and continue breastfeeding.							
	Use positive child behavior management techniques.							
	Support their children’s cognitive and language development.							
	Support their children’s social-emotional development.							
	Baby-proof their homes.							
	Secure high quality child care.							
	Make sure their children are up to date on shots and well child care.							

Q. FEEDBACK

Think about the feedback that you provide to home visitors. Please express your agreement or disagreement with the statements below.

I am effective in giving home visitors positive and constructive feedback on how they work with mothers to….		Strongly Agree	Agree	Slightly Agree	Neutral	Slightly Disagree	Disagree	Strongly Disagree
1.	Have a healthy lifestyle prenatally, such as good nutrition, exercise and prenatal care.							
	Develop a healthy lifestyle outside of pregnancy, such as good nutrition, exercise and preventive health care.							
	Space their births.							
	Reduce their tobacco use.							
	Recognize and deal with problem alcohol and other drug use.							
	Recognize and deal with their mental health issues.							
	Recognize and deal with partner violence.							
	Get the public benefits for which they qualify.							
	Become economically self-sufficient.							
	Start and continue breastfeeding.							
	Use positive child behavior management techniques.							
	Support their children’s cognitive and language development.							
	Support their children’s social-emotional development.							
	Baby-proof their homes.							
	Secure high quality child care.							
	Make sure their children are up to date on shots and well child care.							

R. MIECHV

The following questions are about how your program has changed recently as a result of MIECHV funding. Please check the box which is closest to how you feel.

At the present time, as a result of MIECHV,

1. My work is….

Easier than before			About the same as before			Harder than before
						

2. My role is…

Clearer than before			About the same as before			Less clear than before
						

3. My responsibilities are…

Greater than before			About the same as before			Less than before
						

4. My program site operates…

More efficiently than before			About the same as before			Less efficiently than before
						

5. The time I spend on documentation is…

Greater than before			About the same as before			Less than before
						

6. The quality of the services my site provides is…

Higher than before			About the same as before			Lower than before
						

7. My program’s benefits for families are…

Broader than before			About the same as before			Narrower than before
						

S. FACTORS FOR SERVICE DELIVERY

The following questions are about your role as a supervisor and your perceptions of the role of home visitors you supervise. Please check the box which is closest to how you feel.

1.

There is too little time in one-on-one supervision to do all the things that my program expects me to do.

      

I often have to search for things to do in order to fill up an hour of one-on-one supervision.

2.

The home visitor’s role in promoting positive parenting is too rigidly defined; they don’t have the flexibility they need to tailor services.

      

The home visitor’s role in promoting positive parenting is not defined well enough; they don’t know what they are expected to do with families.

3.

The home visitor’s role in addressing parenting risks is too rigidly defined; they don’t have the flexibility they need to tailor services.

      

The home visitor’s role in addressing parenting risks is not defined well enough; they don’t know what they are expected to do with families.

4.

The home visitor’s role in promoting family economic self-sufficiency is too rigidly defined; they don’t have the flexibility they need to tailor services.

      

The home visitor’s role in promoting family economic self-sufficiency is not defined well enough; they don’t know what they are expected to do with families.

5.

My program defines service tailoring completely and provides training to build home visitors’ skills in tailoring.

      

My program does not define service tailoring very clearly and does not provide training in building home visitors’ skills in tailoring.

6.

It is clear to home visitors which parts of their job are the most important to carry out with each family.

      

It is hard for home visitors to decide which parts of their job are the most important to carry out with each family.

7.

The home visitor’s role is only to help the mother address issues that she herself already recognizes.

      

The home visitor’s role is to help the mother address issues she already recognizes AND to help her recognize and address those she does not yet recognize.

8.

The home visitor’s role is only to help mothers who are already motivated to take action.

      

The home visitor’s role is both to help mothers who are already motivated to take action AND to motivate those who are not yet ready to take action.

9.

The home visitor’s role is to promote positive parenting only by reinforcing the positive parenting behaviors that she sees.

      

The home visitor’s role is to promote positive parenting BOTH by reinforcing the positive behaviors that she sees AND to promote the mother’s use of alternative approaches to negative parenting that she sees.

10.

The home visitor’s role is to promote positive parenting only by reinforcing appropriate parenting attitudes and beliefs.

      

The home visitor’s role is to promote positive parenting by BOTH reinforcing appropriate parenting attitudes and beliefs AND to influence mothers to change inappropriate parenting attitudes and beliefs.

11.

All the activities of a home visitor’s role fit together in a way that makes sense.

      

It is hard to see how all the activities of a home visitor’s role fit together.

12.

All of the activities home visitors are expected to carry out with families are important.

      

I question the value of many of the activities home visitors are expected to carry out with families.

13.

It is clear how working toward one program goal with a family helps achieve the other program goals as well.

      

The goals of my program don’t fit together well; working toward one program goal is a distraction from working toward other program goals.

14.

I guide home visitors in how to tailor services to each family.

      

I let home visitors decide on their own how to tailor services to each family.

15.

I guide home visitors in how to work with families when the family’s goals are different from our program site’s goals.

      

I let home visitors decide on their own how to balance program goals and family goals.

T. HEALTH CARE SERVICES

1. Does your program expect home visitors to assure that the mother has health care coverage or access to a clinic that provides free or low-cost care?

 No

 Yes

2. Has your program provided you with excellent training to supervise home visitors in how to assure that the mother has health care coverage or access to a clinic that provides free or low-cost care?

 No

 Yes

3. Does your program have resources available to help home visitors assure that the mother has health care coverage or access to a clinic that provides free or low-cost care?

 No

 Yes

4. Does your program expect home visitors to assure that the child has health care coverage or access to a clinic that provides free or low-cost care?

 No

 Yes

5. Has your program provided you with excellent training to supervise home visitors in how to assure that the child has health care coverage or access to a clinic that provides free or low-cost care?

 No

 Yes

6. Does your program have resources available to help home visitors assure that the child has health care coverage or access to a clinic that provides free or low-cost care?

 No

 Yes

U. RESOURCES AVAILABLE TO YOU

Instructions: Next, we are interested in the guidance you provide to home visitors in your caseload.

IN THIS SECTION, QUESTIONS 1-6 ARE ASKED FOR SERVICE AREAS A-H, BELOW.

Service Area

1. Prenatal Health

2. Maternal Physical Health

3. Substance Use

4. Stress and Mental Health

5. Healthy Adult Relationships

6. Family Economic Self-Sufficiency

7. Parenting to Support Child Development

8. Parenting to Support Child Health

1. On average, about how often do you provide a home visitor with guidance about [SERVICE AREA] ?

 Never [SKIP TO 3]

 Once a week

 Once every two weeks

 Once a month

 Once every couple of months

 Once every 6 months

 Once a year

 Less frequently than once a year

2. Overall, how responsive have home visitors been to your guidance concerning [SERVICE AREA]?

 None are responsive

 A few are responsive

 About half are responsive

 Most are responsive

 All are responsive

3. Besides you, do your home visitors have easy access to one or more other professionals to consult with about [SERVICE AREA]?

 No [SKIP TO Q1 FOR NEXT SERVICE AREA]

 Yes

 Not sure [SKIP TO Q1 FOR NEXT SERVICE AREA]

3. As part of supervision, how often do you suggest home visitors consult with these professionals about [SERVICE AREA]?

 Always

 Nearly always

 Often

 Sometimes

 Rarely

 Never

3. How many of your home visitors have accessed these professionals in the past six months?

 None

 A few

 About half

 Most

 All

3. How helpful do you believe these professionals have been to your home visitors?

 Never helpful

 Rarely helpful

 Sometimes helpful

 Frequently helpful

 Always helpful

[GO TO Q1 FOR NEXT SERVICE AREA]

V. RATING OF SUPERVISION

1. For this question, we would like you to think about what occurs day-to-day at your work place. Read the following statements and consider how true they are for you and your place of employment. Please rank the following statements on a scale with 1 being the lowest and 5 being the highest:

		Lowest				Highest
		1	2	3	4	5
a.	I have adequate support from my supervisor to make appropriate decisions in my day-to-day work.					
b.	My supervisor encourages my input and respects my ideas.					
c.	My supervisor is responsive to me.					
d.	My supervisor is knowledgeable about the specific work I do (e.g., issues related to families and children).					

2. This question also asks you to think about your own direct supervisor. The chart below lists traits that may or may not describe your supervisor. Please rank the following traits for your supervisor on a scale with 1 being the lowest and 5 being the highest:

		Lowest				Highest
		1	2	3	4	5
a.	Positive attitude					
b.	Team player/inclusivity of decision making					
c.	Approachability					
d.	Patience					
e.	Understanding and empathy					
f.	Ability to set boundaries					
g.	Respectfulness					
h.	Supportive advocate for staff					
i.	Appreciative of individual skills, needs, and interests					
j.	Accessible					
k.	Helps me solve problems and get information					

3. Instructions: The following table describes areas towards which supervisors work at becoming successful. Think about your own direct supervisor and rank how strong you believe s/he is in each of these areas. Use the description below for the definition of each numbered ranking. If you have never observed your supervisor in this area, select N/A.

Rankings are defined as:

1. Serious Issue – A pressing need to address.

2. Weakness – Results have fallen short in this area.

3. Skilled/OK – The manager does what is expected and is about the same as most others.

4. Talented – Notable strength in this area; manager is better than most and could be a coach in this area.

5. Towering Strength – Manager is outstanding in this area and is a role model.

		1 Serious Issue	2 Weak-ness	3 Skilled /OK	4 Talented	5 Towering Strength	N/A
a.	Listening:
	Practices attentive and active listening. Has patience to hear people out. Can accurately restate the opinions of others even when not in agreement.						

b.	Composure:
	Is cool under pressure. Does not become defensive or irritated when times are tough. Is considered mature. Can be counted to hold things together during tough times. Can handle stress. Is not knocked off balance by the unexpected. Is a settling influence in a crisis.						
c.	Decision-Making Ability:
	Makes good decisions based on a mixture of analysis, wisdom, experience, and judgment. Most solutions or suggestions turn out to be correct and accurate. Sought out by others for advice.						
d.	Sociocultural Diversity:
	Deals effectively with all races, nationalities, cultures, disabilities, and ages, and both sexes. Supports fair and equal treatment for all. Is aware of sociocultural issues and their effect on clients and colleagues. Makes room for sociocultural discussion in team discussions.						
e.	Knowledge Base
	Has mastery of the content of early childhood development and early childhood mental health. Knows how to engage families and is effective at intervention strategies. Is a resource for other team members. Shares knowledge readily and effectively.						
f.	Directing/Supervising Others:
	Is good at establishing clear guidelines. Sets stretch goals. Distributes workload appropriately. Lays out work in a well-planned manner. Maintains two-way dialogue. Brings out the best in people. Is a clear communicator. Provides support as needed. Helps others meet their goals.						
g.	Informing:
	Provides the information people need to know to do their jobs and feel good about being a member of the team. Provides individuals with information so that they can make accurate decisions. Is timely with information.						

h.	Motivating Others:
	Knows what motivates others or how to do it. People who work with the supervisor want to do their best. Empowers others. Many people want to work for this leader. Is a good reader of others. Motivates others.						
i.	Training Ability:
	Conceptualizes and organizes ideas for effective learning. Balances content and process in training. Is able to create training materials that are helpful to others. Is able to present ideas to a diverse group. Is well prepared. Facilitates training well.						