Combined Home Visitor - Supervisor Baseline Survey

OMB Control No: _____

Expiration Date: ______

Length of time for instrument: 1.75 hours

ATTACHMENT 13: MIHOPE SUPERVISOR/HV COMBO SURVEY

8/14/2012

SUPERVISOR/HV COMBO SURVEY

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 45 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 $40.

Supervisor/HV Combo Survey

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

 Training program degree (e.g, nursing diploma)

 Associate’s degree (e.g, AA, AS, ADN)

 Bachelor’s degree (e.g., BA, BS, BSN)

 Master’s degree (e.g., MA, MS, MSW, MSN)

 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?

 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

 No prior experience

 Other (specify): _________

5. How many total years of experience supervising home visitors do you have at this or another 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? Please enter the month and year in numeric format. If you cannot recall which month you began, please leave it blank.

__________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?

Please enter the number of hours you spend doing each of the following activities in a typical week. You can enter part of an hour for an activity that is less than an hour. Please enter 0 for activities you do not typically complete.

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 and eligibility screens
Time spent on the phone
Staff group meetings
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 E]

 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?

 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%)

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, but I do prepare home visit plans

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

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

 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 use a curriculum to prepare your home visit plans?

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

 No

The following questions are about your informal observation of parents interacting with their child during home visits. Informal observation includes when you are visiting a family and you see the parent and child interact under normal circumstances.

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

The following questions are about your formal observation of parents interacting with their child during home visits. Formal observation includes when you set aside time during a visit to observe the parent and child interact and you might ask them to do a task together or for the parent to teach the child something.

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?

 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%)

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 cases in paper records

 Review specific cases in management information system

 Review reports I generate

 Review reports that are routinely generated by our program

 Do not monitor home visitor performance

 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]

 View video recordings only

 Observe in person only

 View video recordings and observes in person

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

 Observe all home visitors

 Observe home visitors who are newly hired

 Observe home visitors who request to be observed

 Observe home visitors who need extra help

 Observe 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, what types of feedback do you give to the home visitor? CHECK ALL THAT APPLY.

 Written feedback on a standard form

 Written feedback not on a standard form

 Verbal feedback with explicit areas for improvement

 Verbal feedback with little specific instruction

 I do not give feedback

6. Who is your supervisor? Please specify your supervisor’s title/position at the agency.

_______________________________________________________________________

7. Do you receive direct supervision on the caseload you provide home visits to?

 No (Skip to Section G, Technology Resources)

 Yes

E. SUPERVISION

1. Do you have one-on-one supervision meetings with your supervisor? Supervision meetings are meetings in which your supervisor provides you feedback or guidance on your home visiting caseload.

 Yes

 No [SKIP TO 3]

2. About how often, on average, do you have one-on-one 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

3. Do you have group supervision meetings with your supervisor?

 Yes

 No [SKIP TO 5]

4. 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

5. Do your supervisors or mentors ever go with you on visits to observe you working with families or view video recordings of your home visits as part of supervision?

 No [SKIP TO SECTION F]

 Views video recordings only

 Observes in person only

 Views video recordings and observes in person

6. How many of your home visits have they viewed in the past 12 months, either in person or by watching video recordings?

 One

 Two

 Three

 Four

 Five

 Six to ten

 Eleven or more

7. When your supervisor observes you, how often does she give you feedback at any time (either right after the visit or sometime later)?

 Always

 Usually

 Sometimes

 Rarely

 Never

8. How helpful is the feedback to you?

 Extremely helpful

 Very helpful

 Somewhat helpful

 Not very helpful

 Not at all helpful

M. Expectations. Think about the expectations that your supervisor has of you as a home visitor. Please express your agreement or disagreement with the statements below.

My supervisor expects me 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.							

R. Feedback. Think about the feedback that you receive from your supervisor. Please express your agreement or disagreement with the statements below.

My supervisor gives me positive and constructive feedback on how I 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.							

Instructions: Next, we are interested in the guidance you receive from supervisors or other sources about your work as a home visitor. In this section, Questions 1-5 are asked for each service area listed below, A-H.

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. How often does your supervisor give you 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. How helpful is your supervisor’s guidance concerning [SERVICE AREA]?

 Never helpful

 Rarely helpful

 Sometimes helpful

 Frequently helpful

 Always helpful

G. TECHNOLOGY RESOURCES

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

 Yes

 No

1b. 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 my office

 Yes, I have access to a shared computer at my 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

4. Do you document what happens during a home visit on paper forms?

 Yes

 No [SKIP TO 7]

5. How easy is it for you to document what happens during a home visit on paper forms?

 Very easy in all respects

 Easy in most respects

 Easy in some respects

 Not at all easy

6. How easy is it for you to go back and retrieve information you might need from your paper forms?

 Very easy in all respects

 Easy in most respects

 Easy in some respects

 Not at all easy

7. Do you document what happens during a home visit electronically?

 Yes, electronically on laptops/tablets/iPads during a home visit

 Yes, electronically when I am at an office computer

 Yes, both during a home visit and at the office

 No [SKIP TO SECTION G]

8. How easy is it for you to document what happens during a home visit electronically?

 Very easy in all respects

 Easy in most respects

 Easy in some respects

 Not at all easy

9. How easy is it for you to go back and retrieve information you might need from the electronic record?

 Very easy in all respects

 Easy in most respects

 Easy in some respects

 Not at all easy

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 system?

 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 totally disagree to 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.

Please answer all items. If an item does not completely apply to your situation, try to select the closest or best answer from the alternatives given. Please feel free to interpret the item in the best way you see fit. When considering your responses, please think about how each statement applies to your home visiting agency.

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 maternal 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 maternal 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 children’s preventive health 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

J. PROGRAM REFERRALS

1. Overall, how would you rate your supervisor’s guidance on how to make referrals for the community services your families need?

 Poor

 Fair

 Good

 Excellent

 Unsure

2. How do you usually arrange referrals with families?

 I arrange the referral myself nearly all of the time

 I arrange the referral myself most of the time

 I arrange the referral myself about half of the time

 The family arranges the referral about half of the time

 The family arranges the referral most of the time

 The family arranges the referral nearly all of the time

In this section, Questions 3-7 are asked for each service type listed below, A-L.

Service Type:

1. Prenatal Care

2. Maternal Preventive Care

3. Family Planning and Reproductive Health Care

4. Substance Use (Alcohol and other drugs) Treatment

5. Mental Health Treatment

6. Domestic Violence Shelter

7. Domestic Violence Counseling/Anger Management

8. Adult Education Services (including GED and ESL)

9. Job Training and Employment

10. Pediatric Primary Care

11. Childcare

12. Early Intervention Services

3. Is there at least one organization which provides [SERVICE TYPE] in your area?

 No [SKIP TO Q3 FOR NEXT SERVICE TYPE]

 Yes

4. What is the name of the organization to which you most often make referrals for [SERVICE TYPE]?

 Not sure of the name [SKIP TO Q3 FOR NEXT SERVICE TYPE]

 The name is: _______________________

5. How easy or hard is it for the families you work with to get services from this agency?

 Unsure

 Very Easy

 Relatively Easy

 Relatively Difficult

 Very Difficult

6. Overall, how effective do you think this agency has been in meeting families’ needs for [SERVICE TYPE]?

 Unsure

 Very effective

 Quite effective

 Somewhat effective

 Not effective at all

7. Overall, how would you rate how well you and this agency are able to share information about the families you refer?

 Poor

 Fair

 Good

 Excellent

 Unsure

[GO TO QUESTION 3 FOR NEXT SERVICE AREA]

K. 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.							

K. Concerns. Please express your agreement or disagreement with the statements below. We are interested in knowing your thoughts about the families you currently serve.

I am sometimes concerned it could hurt my relationship with a mother if I talk with her about….	Strongly Agree	Agree	Slightly Agree	Neutral	Slightly Disagree	Disagree	Strongly Disagree
Prenatal nutrition, exercise, and access to care.							
Her prenatal care provider’s recommendations.							
Her physical health habits and access to primary care outside of pregnancy.							
Her family planning and birth spacing.							
Her tobacco use.							
Her alcohol and other drug use.							
Her mental health.							
Her relationships with family and friends.							
Partner violence.							
Her plans for school and work							
The public benefits she receives and needs.							
Breastfeeding.							
How she manages her child’s behavior.							
Her child’s development.							
Home safety.							
Her child’s health care.							
Her child care arrangements.							

N. Effectiveness. Please express your agreement or disagreement with the statements below. We are interested in knowing your thoughts about the families you currently serve.

I feel I am effective in helping 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.							

O. Comfort. Please express your agreement or disagreement with the statements below. We are interested in knowing your thoughts about the families you currently serve.

I feel comfortable talking with mothers about how 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 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. Training. Think about your training and the families that receive home visiting at your program site. Please express your agreement or disagreement with the statements below.

I feel I am adequately trained 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.							

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 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 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.							

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. Each question has 7 response choices, please choose the response which is closest to how you feel. You may pick a response that is between the labeled response choices.

For example, if you feel that your job is a little easier than before, you should answer as below:

At the present time, as a result of MIECHV,

My job is….

Much easier than before			About the same as before			Much harder than before
		X				

At the present time, as a result of MIECHV,

1. My work is….

Much easier than before			About the same as before			Much harder than before
						

2. My role is…

Much clearer than before			About the same as before			Much less clear than before
						

3. My responsibilities are…

Much greater than before			About the same as before			Much less than before
						

4. My program site operates…

Much more efficiently than before			About the same as before			Much less efficiently than before
						

5. The time I spend on documentation is…

Much greater than before			About the same as before			Much less than before
						

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

Much higher than before			About the same as before			Much lower than before
						

7. My program’s benefits for families are…

Much broader than before			About the same as before			Much narrower than before
						

S. Factors for Service Delivery

The following questions are about your role as a home visitor. Each question has 7 response choices between two opposite ends of the spectrum. Please choose the response anywhere along the spectrum which is closest to how you feel.

For example, if you feel that there is usually enough time in visits to do everything you are expected to do, you should answer as below:

1.

There is too little time in a home visit to do all the things that my program expects me to do.

   X   

I often have to search for things to do in order to fill up an hour.

There is too little time in a home visit 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.
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.

U. Challenging Situations

INSTRUCTIONS:

There are many situations that create difficulties for home visitors in carrying out activities with families. For each question, please indicate how confident you are in carrying out each activity. The scale ranges from 0 to 10.
0	1	2	3	4	5	6	7	8	9	10
Notat all confident				Moderately confident						Completely confident

When another family member gives the expectant mother conflicting information about prenatal health, how confident do you feel helping the expectant mother follow the prenatal care provider’s recommendations?
	0	1	2	3	4	5	6	7	8	9	10

When the parent seems unmotivated, how confident do you feel helping the expectant mother follow the prenatal care provider’s recommendations?
	0	1	2	3	4	5	6	7	8	9	10

When the family’s culture does not believe in contraception, how confident do you feel promoting family planning and birth spacing?
	0	1	2	3	4	5	6	7	8	9	10

When the parent has incorrect information or is confused about contraception options, how confident do you feel promoting family planning and birth spacing?
	0	1	2	3	4	5	6	7	8	9	10

When another family member does not believe that the parent’s substance abuse problem is a concern, how confident do you feel getting the parent to seek help for a substance abuse problem?
	0	1	2	3	4	5	6	7	8	9	10

When the parent does not acknowledge a substance abuse problem, how confident do you feel getting the parent to seek help for a substance abuse problem?
	0	1	2	3	4	5	6	7	8	9	10

When another family member does not believe that the parent’s mental health problem is a concern, how confident do you feel getting the parent to seek help for a mental health problem?
	0	1	2	3	4	5	6	7	8	9	10

When the parent does not acknowledge a mental health problem, how confident do you feel getting the parent to seek help for a mental health problem?
	0	1	2	3	4	5	6	7	8	9	10

When the parent lacks support from other family members, how confident do you feel helping the parent make a plan to deal with a violent relationship?
	0	1	2	3	4	5	6	7	8	9	10

When the parent is afraid to address the issue, how confident do you feel helping the parent make a plan to deal with a violent relationship?
	0	1	2	3	4	5	6	7	8	9	10

When another family member does not support the parent’s school or work goals, how confident do you feel problem solving with the parent to overcome barriers to school or work?
	0	1	2	3	4	5	6	7	8	9	10

When the parent seems unmotivated, how confident do you feel problem solving with the parent to overcome barriers to school or work?
	0	1	2	3	4	5	6	7	8	9	10

When another family member gives the parent conflicting information about how to parent, how confident do you feel motivating the parent to adopt positive parenting techniques?
	0	1	2	3	4	5	6	7	8	9	10

When the parent feels uncomfortable or silly interacting or talking with an infant, how confident do you feel motivating the parent to adopt positive parenting techniques?
	0	1	2	3	4	5	6	7	8	9	10

When another family member gives the parent conflicting information about the child’s health, how confident do you feel helping the parent follow the pediatric primary care provider’s recommendations?
	0	1	2	3	4	5	6	7	8	9	10

When the parent seems unmotivated, how confident do you feel helping the parent follow the pediatric primary care provider’s recommendations?
	0	1	2	3	4	5	6	7	8	9	10

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

9. Prenatal Health

10. Maternal Physical Health

11. Substance Use

12. Stress and Mental Health

13. Healthy Adult Relationships

14. Family Economic Self-Sufficiency

15. Parenting to Support Child Development

16. Parenting to Support Child Health

2. On average, about how often do you provide home visitors 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]?

 Never

 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

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

 None [SKIP TO Q1 FOR NEXT SERVICE AREA]

 A few

 About half

 Most

 All

 Don’t know [SKIP TO Q1 FOR NEXT SERVICE AREA]

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

 Never helpful

 Rarely helpful

 Sometimes helpful

 Frequently helpful

 Always helpful

3. Have you accessed these professionals in the past six months?

 No [SKIP TO Q1 FOR NEXT SERVICE AREA]

 Yes

3. How helpful are these professionals to you?

 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:

		Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
		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:

		Not At All True	Somewhat Not True	Neutral	Somewhat True	Very True
		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.

	Please rank how strong you believe your supervisor is in each of these areas:	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.						