Instrument 7: Staff Child Report

Staff Child Report – Home Visitors
Programming Specifications
Draft for OMB (Redacted)
February 21, 2020

ABOUT THIS SURVEY
PROGRAMMER: DISPLAY BELOW TEXT ON INTRO1. ‘WELCOME’ LINE BELOW SHOULD
APPEAR BOLD IN CONFIRMIT.
Welcome to the Baby FACES Staff Child Report for Home Visitors
• PROGRAMMER: IF VERSION = 0, DISPLAY: The questions in this survey are about
[MOTHER FIRST NAME] [MOTHER LAST NAME]. PROGRAMMER: FULL NAME SHOULD
APPEAR IN BOLD.
• PROGRAMMER: IF VERSION = 1-4, DISPLAY: The questions in this survey are about
[CHILD FIRST NAME] [CHILD LAST NAME].
• [PROGRAMMER: IF VERSION 0, FILL “client.” IF VERSIONS 1-4, FILL “child’s parent” AND
INCLUDE TEXT IN BRACKETS] Throughout this survey, we will be asking you to respond
to questions about your interactions with this [client/child’s parent]. [This can include the
child’s mother or a guardian who serves as the child’s primary caregiver. When
responding to these questions, please think about the parent who you interact with most
often, unless otherwise noted.]
• The survey will take about 15 minutes to complete. The questions in this survey can be
answered selecting the box next to your response. For a few questions, you will be asked
to type in a brief response.
• If you are unsure how to answer a question, please give the best answer you can rather
than leaving it blank.
• If you begin the survey and need to complete it at a later time, all of your responses will
be saved. After logging back in, you will be directed to the item where you last left off.
PROGRAMMER: DISPLAY BELOW TEXT ON INTRO2
• [PROGRAMMER: IF VERSIONS 1-4, INCLUDE TEXT IN BRACKETS] Your participation in
the study is voluntary. All information you provide will be kept private to the extent
permitted by law. Neither your name nor the [child’s or] family’s name will be attached to
any information you give us; and it will not be shared with others at your Early Head Start
program.
• If you have any questions, please contact the Baby FACES team at Mathematica Policy

Research at 1-833-763-2178, or email us at [email protected].
• This collection of information will be used to describe the characteristics of children and
families served by Early Head Start, and the characteristics and features of programs and
staff that serve them. An agency may not conduct or sponsor, and a person is not required
to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB number for this information collection is 0970–0354 and the expiration
date is 10/31/2021.

Prepared by Mathematica Policy Research

2

OMB (Redacted)

PROGRAMMER: DISPLAY BELOW TEXT ON INTRO3.
• This survey works best on computers and tablets. We do not recommend you complete
the survey on a smartphone, as it may take longer and will require scrolling throughout.
• Do not use your browser’s back and forward buttons. Instead, use the “Back” and “Next”
buttons on the bottom of each screen to move through the survey.

Prepared by Mathematica Policy Research

3

OMB (Redacted)

Source: Items A1-A4 adapted from Baby FACES 2009
PROGRAMMER: IF VERSION = 0 [PREGNANT WOMEN], 1 [NEWBORN-7 MOS], 2 [8-16 MOS], 3 [17-30 MOS], AND 4 [31-37 MOS]

SECTION A. BACKGROUND
A1.

Are you currently the Early Head Start home visitor for this [client/child’s family]?
PROGRAMMER: FILL “client” IF VERSION = 0; FILL “child’s family” IF VERSION = 1-4.
1

□

2

 Not currently, but I was this [client’s/family’s] home visitor within the past 2 months

0

□

Yes
No

PROGRAMMER: IF A1=1, 2, OR MISSING
PROGRAMMER: IF A1=1 OR MISSING, FILL WITH “have you been”. IF A1=2, FILL WITH “were you”
A1a.
For how many months (have you been / were you) providing home visiting services to this
[client/family]?
If you [have been/were] this [client’s/family’s] home visitor for less than 1 month, please enter 1.
PROGRAMMER: IF A1=1, FILL WITH “have been”. IF A1=2, FILL WITH “were”
|___|___| MONTHS

(RANGE 1-40)

PROGRAMMER: IF VERSION = 1-4
SOFT CHECK: RESPONSE CANNOT BE GREATER THAN CHILD’S CHRONOLOGICAL AGE (BASED ON
PROJECTED CHILD AGE IN MOS AT TIME OF SITE VISIT); You have entered [FILL A1a] month(s), but this
is greater than the child’s current age based on our records. Please confirm your response.
SURVEY NOTE: AFTER A1A, INSTRUMENT VERSION 0 PROCEEDS TO D6; VERSION 1 PROCEEDS TO D1; VERSION 2
PROCEEDS TO SECTION B1 IF CHILD PROJECTED AGE IN MOS AT TIME OF SITE VISIT IS AT LEAST 12 MOS;
VERSION 2 PROCEEDS TO SECTION C1 IF CHILD PROJECTED AGE IN MOS AT TIME OF SITE VISIT IS 8-11 MOS.
VERSIONS 3 AND 4 PROCEED TO B1. PROGRAMMER, THESE SPECS ARE PROVIDED BELOW.

PROGRAMMER: IF A1=0
A2.
What is the main reason you are no longer this [client’s/family’s] home visitor?
PROGRAMMER: MARK ONE ONLY. DO NOT DISPLAY OPTIONS 2 AND 3 IF VERSION = 0. IF VERSION 0, FILL
WITH “Client” AND “program”; OTHERWISE, FILL WITH “Family” AND “center”
1
2
4
5

□
□
□
□

[Client/Family] transferred to another home visitor in the same [program/center]
Child moved from home- to center-based care in this program
[Client/Family] left this Early Head Start program
Child aged out of Early Head Start

PROGRAMMER: IF A2 = 1 OR 2
A3.
What is the name of this [client’s/child’s] current Early Head Start home visitor [or teacher]?
PROGRAMMER: ONLY DISPLAY TEXT IN BRACKETS IF VERSION = 1-4

Name: _________________________________________________
PROGRAMMER: IF A1 = 0
A4.
Please record the last date you had this [client/family] on your caseload.
PROGRAMMER: IF VERSION 0, FILL WITH “client”; OTHERWISE, FILL WITH “family”

|

|
MONTH

|/|

|

|/|

DAY

|

|

|

|

YEAR

SOFT CHECK: DATE CANNOT BE IN THE FUTURE. You have entered [FILL A4], which is in the future.
Please check and confirm your entry.

Prepared by Mathematica Policy Research

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OMB (Redacted)

PROGRAMMER: VALID YEAR RANGES ARE 2017 TO 2020.
PROGRAMMER: IF A1 = 0

A_end. You have reached the end of this survey.
If you would like to go back to any question, use the "Back" button to navigate back through the
survey.
Please click "Next" to submit your completed survey.
PROGRAMMER: CLICKING NEXT WILL BRING THE RESPONDENT TO A NEW SCREEN.

Your survey has been submitted. Thank you for your participation in Baby FACES!
PROGRAMMER: RE-DIRECT RESPONDENT TO THE BABY FACES PAGE ON MATHEMATICA’S EXTERNAL
SITE: https://www.mathematica-mpr.com/our-publications-and-findings/projects/baby-faces-2018
PROGRAMMER: IF A2 = 1 OR 2, WE WILL ATTEMPT TO FIND THE BEST RESPONDENT FOR COMPLETING
THE HVCR FOR THIS CHILD. IN THIS SCENARIO, THE SURVEY TEAM NEEDS TO BE ALERTED ABOUT
THIS CASE. IF A2 = 3 OR 4, WE WILL FINAL STATUS.

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OMB (Redacted)

Source: BITSEA, B1-B2 (PROPRIETARY)
PROGRAMMER: IF VERSION = 2 (8-16 MOS), 3 (17-30 MOS), OR 4 (31-37 MOS).
PROGRAMMER: FOR VERSION = 2, ONLY IF CHILD PROJECTED AGE IN MOS AT TIME OF SITE VISIT IS AT LEAST 12 MOS. [FOR HARD COPY, SECTION B WILL BE ASKED
FOR ALL CHILDREN BETWEEN 8-16 MOS (VERSION 2) TO AVOID ASKING HV’S IF CHILD IS AT LEAST 12 MOS, WHICH MAY INTRODUCE ERROR]

SECTION B. SOCIAL SKILLS
B1.

The first set of questions contains statements about 1- to 3-year-old children. Many statements
describe normal feelings and behaviors, but some describe things that can be problems. Some may
seem too young or too old for this child. Please do your best to answer every question.
For each statement, please select the answer that best describes this child in the past month.

Items B1a to B1hh are protected under copyright and have been redacted from this instrument.
Source: Briggs-Gowan, M.J., and A.S. Carter. The Brief Infant–Toddler Social and Emotional Assessment
(BITSEA). San Antonio, TX: Harcourt Assessment, 2006.

Prepared by Mathematica Policy Research

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OMB (Redacted)

B2.

The following questions are about feelings and behaviors that can be problems for young children.
Some of the questions may be a bit hard to understand, especially if you have not seen them in a
child. Please do your best to answer them anyway.
For each statement, please select the answer that best describes this child in the past month.

Items B2a to B2h are protected under copyright and have been redacted from this instrument.
Source: Briggs-Gowan, M.J., and A.S. Carter. The Brief Infant–Toddler Social and Emotional Assessment
(BITSEA). San Antonio, TX: Harcourt Assessment, 2006.

Prepared by Mathematica Policy Research

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OMB (Redacted)

Source: MacArthur-Bates Communicative Development Inventories, Infant and Toddler Short Forms and CDI-III (PROPRIETARY)
Included in versions: 2 [8-16 mos], 3 [17-30 mos], and 4 [31-37 mos]; Different item sets for age versions

SECTION C. LANGUAGE AND COMMUNICATION

PROGRAMMER: HOME VISITORS WILL BE ASKED TO COMPLETE THE ENGLISH CDI WORD LIST USING THE RELEVANT
AGE FORM. THESE AGE-BASED VOCABULARY LISTS INCLUDE APPROXIMATELY 100 WORDS EACH AND ARE
APPENDED AT THE END OF THIS DOCUMENT.

C1.

The following is a list of typical words in young children’s vocabularies. We are interested
specifically in the words this child understands or says in English. We will ask parents about the
child’s home language.
For words this child does not yet understand, select the first option (does not understand). For
words he/she understands but does not yet say on his/her own, select the second option
(understands). For words he/she understands and also says on his/her own, select the third option
(understands and says). If this child uses a different pronunciation of a word or another word with
the same meaning (for example, “raffe” for “giraffe” or “nana” for “grandma”), select the word
anyway. For each item, select only one response.
Remember, this is a “catalogue” of words that are used by many different children. Don’t worry if
this child knows only a few right now.

These items are protected under copyright and have been redacted from this instrument.
Source: MacArthur-Bates Communicative Development Inventories.

Prepared by Mathematica Policy Research

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OMB (Redacted)

Source: MacArthur-Bates Communicative Development Inventories, Infant Long Form, First Communicative Gestures (12 items) (PROPRIETARY)
Included in versions: 2 [8-16 mos]

C2.1.

When infants are first learning to communicate, they often use gestures to make their wishes
known. For each item below, select the response that describes this child’s actions right now.

Items C2.1a to C2.1l are protected under copyright and have been redacted from this instrument.
Source: MacArthur-Bates Communicative Development Inventories.

Source: MacArthur-Bates Communicative Development Inventories, Toddler Short Form and CDI-III, Combining words (PROPRIETARY)
IncludedHas
in versions:
3 [17-30begun
mos] andto
4 [31-37
mos] words yet, such as “nother cookie” or “doggie bite?”
C2.2.
this child
combine

C2.2. This item is protected under copyright and has been redacted from this instrument.
Source: MacArthur-Bates Communicative Development Inventories

Prepared by Mathematica Policy Research

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OMB (Redacted)

Source: MacArthur-Bates Communicative Development Inventories, Sentences, CDI-III (PROPRIETARY)
Included in versions: 4 [31-37 mos]

C2.3. For each pair of sentences below, select the one that sounds most like the way this child talks at the
moment. If this child is saying sentences even more complicated than the two provided, select the
second one.

Items C2.3a to C2.3l are protected under copyright and have been redacted from this instrument.
Source: MacArthur-Bates Communicative Development Inventories.

Prepared by Mathematica Policy Research

10

OMB (Redacted)

Source: MacArthur-Bates Communicative Development Inventories, Using Language, CDI-III (PROPRIETARY)
Included in versions: 4 [31-37 mos]

C2.4.

These next questions are about how this child uses language to communicate in English. For each
item, select only one response.

Items C2.4a to C2.4l are protected under copyright and have been redacted from this instrument.
Source: MacArthur-Bates Communicative Development Inventories.

Prepared by Mathematica Policy Research

11

OMB (Redacted)

Source: Items D1 to D6 adapted from Baby FACES 2009
PROGRAMMER: IF VERSION = 0 (PREGNANT WOMEN D6 ONLY), 1 (NEWBORN-7 MOS), 2 (8-16 MOS), 3 (17-30 MOS), OR 4 (31-37 MOS).

SECTION D.
PROGRAMMER: IF VERSION = 1-4

D1. Since September, has this child been given a developmental screening?
1

 Yes

0

 No

D3. Since September, have you had any concerns about the child’s development?
1

 Yes

0

 No

GO TO D6

PROGRAMMER: IF D3 = MISSING, GO TO D3a
PROGRAMMER: IF D3=1 OR MISSING

D3a.

Since September, has this child been referred by anyone in your program to any of the following?
PROGRAMMER: MARK ALL THAT APPLY. IF OPTION 7 IS ENDORSED, NO OTHER OPTION CAN BE SELECTED.
1

 Health care provider

3

 Mental health care provider

4

 Part C or Part B or other disabilities services provider

5

 Child care partner or other child care provider

7

 NO REFERRALS MADE SINCE SEPTEMBER

PROGRAMMER: IF D3a=1, 3, or 4

D5. What was the reason for the referral?
PROGRAMMER: MARK ALL THAT APPLY
1

 Behavior problem

2

 Emotional problem

3

 Attention problem

4

 Developmental or cognitive delay

5

 Problems with the use of arms or legs

6

 Speech problem

7

 Hearing problem

8

 Vision problem

9

 Something else (Please specify)
____________________________

SOFT CHECK: IF D5_9 IS ENDORSED BUT SPECIFY IS LEFT BLANK: Please specify the reason for the
child’s referral.

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OMB (Redacted)

PROGRAMMER: IF VERSION = 0-4

D6. Thinking about this entire family, have you referred anyone [other than the child] to any of the
following since September?
PROGRAMMER: MARK ALL THAT APPLY. IF OPTION 7 IS ENDORSED, NO OTHER OPTION CAN BE SELECTED.
PROGRAMMER: IF VERSION = 0, FILL WITH “the entire family”; IF VERSION 1-4, FILL WITH “this child and the
child’s entire family”
1

 Health care provider

2

 Prenatal care provider

3

 Mental health care provider

4

 Disabilities services provider

5

 Child care partner or other child care provider

6

 Other community service provider (such as job training, housing assistance provider)

7

 NO REFERRALS MADE SINCE SEPTEMBER

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13

OMB (Redacted)

Source: Items E3-E6, E8-E9 adapted from MIHOPE Family Services Home Visitor Log
PROGRAMMER: IF VERSION = 0 [PREGNANT WOMEN], 1 [NEWBORN-7 MOS], 2 [8-16 MOS], 3 [17-30 MOS], AND 4 [31-37 MOS]

SECTION E. HOME VISITS

In this section, we want you to think about the contact you have had with this family, specifically face-toface and non-face-to-face contacts. You will also be asked to think back to any visits you had scheduled
that did not occur. Please answer the following questions to the best of your ability and only with regard to
this particular family.
PROGRAMMER: ALL
Source: New Item

E1.

Thinking back to the last time this family missed an appointment, what was the main reason?
PROGRAMMER: MARK ONE ONLY

5

□
□
□
□
□

7

□

1
2
3
4

Family crisis
Sick client or child
Unable to locate the family
[Client lost custody] [PROGRAMMER: DO NOT DISPLAY OPTION IF VERSION = 0]
Client declined further participation (this would include going back to work, school,
getting services from other agencies, pressure from family members, etc.)
Other (specify) ____________________________________________________

PROGRAMMER: ALL

E9.

Excluding any group activities, how many face-to-face (in-person) visits were scheduled with this
family during the past 4 weeks?
PROGRAMMER: MARK ONE ONLY
0
1
2
3
4
5

□
□
□
□
□
□

0
1
2
3
4
More than 4

PROGRAMMER: ALL

E3.

And how many face-to-face (in-person) visits did you have with this family during the past 4
weeks?
PROGRAMMER: MARK ONE ONLY
0
1
2
3
4
5

□
□
□
□
□
□

0

GO TO E5

1
2
3
4
More than 4

PROGRAMMER: IF E3 = 0 OR MISSING, GO TO E5.

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OMB (Redacted)

PROGRAMMER: IF E3 = 1-5

E4.

During any of the face-to-face contacts you had with this family during the past 4 weeks, which of
the following topics/activities were addressed?
PROGRAMMER: MARK ALL THAT APPLY

CAREGIVER

27

□
□
□
□
□
□
□
□
□
□
□
□
□
□

14

□

1
2
3
4
5
6
7
8
9
10
11
12
13

Domestic violence or anger management
Education
Economic management/financial self-sufficiency
Family planning
Finding alternate caregivers/child care
Housing
Job training and employment
Maternal physical health (outside of pregnancy)
Mental health or stress
Prenatal health behaviors/prenatal care
Social support
Tobacco use
Alcohol misuse
Opioid misuse (including use of heroin or use of prescription pain relievers in a way that
was not directed by a doctor)
Other drug use

PARENTING BEHAVIOR/CHILD OUTCOMES
15
26
27
28
29
30
17
18
19
20
21
22
23

□ Breastfeeding/feeding/nutrition
□ Child’s approaches to learning
□ child’s social-emotional development
□ Child’s language and communication
□ Child’s cognition
□ Child’s perceptual, motor, and physical development
□ Child health
□ Child/home safety
□ Co-parenting
□ Developmentally appropriate care/routines
□ Discipline/behavior management
□ Lead exposure in home
□ Parent-child interaction

FAMILY
24
25

□
□

Health insurance/Medicaid/SCHIP
Public/governmental assistance

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OMB (Redacted)

PROGRAMMER: ALL

E5.

In the past 4 weeks, did you refer this family to services or provide agency contact information for
any of the following areas?
PROGRAMMER: MARK ALL THAT APPLY; IF OPTION 0 SELECTED, NO OTHER OPTION CAN BE ENDORSED.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
17

15
16
0

□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□
□

Adult education services (including GED and ESL)
Childcare
Domestic violence counseling/anger management
Domestic violence shelter
Early intervention services/Part C services
Family planning and reproductive health care
Housing
Job training and employment
Maternal preventive care
Mental health treatment
Pediatric primary care
Prenatal care
Public assistance (SNAP, WIC, Medicaid, SCHIP, TANF, etc.)
Treatment for alcohol misuse
Treatment for opioid misuse (including use of heroin or use of prescription pain relievers in
a way that was not directed by a doctor)
Other drug use treatment
Resources to help quit or reduce smoking or vaping
DID NOT PROVIDE REFERRALS OR PROVIDE AGENCY CONTACT INFORMATION DURING THE PAST 4 WEEKS

PROGRAMMER: IF E3 = 0 OR MISSING, GO TO E11
PROGRAMMER: IF E3 = 1-5

For these next questions, please think about the most recent home visit you had with this family during
the past 4 weeks.
E6.

Who participated in the home visit?
PROGRAMMER: MARK ALL THAT APPLY
1
2
3
4
5
6

□
□
□
□
□
□

Mother of child/pregnant client
[Focal child] [PROGRAMMER: DO NOT DISPLAY OPTION IF VERSION = 0]
Father of child/client’s current partner
Other adult family member
Other child(ren) in the home
Other professional (nurse, early interventionist, child welfare worker, supervisor, etc.)

PROGRAMMER: IF E3 = 1-5
Source: Adapted from Baby FACES 2018

E6a.

In what language did you conduct this home visit?
1
2
3
4
5

□
□
□
□
□

All in English
More English than Spanish (or some other language)
Equally English and Spanish (or some other language)
More Spanish (or some other language) than English
All in Spanish (or some other language)

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OMB (Redacted)

PROGRAMMER: IF E3 = 1-5
Source: Adapted from Baby FACES 2009 Content and Characteristics Form

E7.

On a scale from 1 to 5, how well aligned were the activities and topics you had planned to cover
during your most recent home visit compared with what actually happened? A value of “1”
indicates that the visit was “not well aligned” with what you had planned, and a value of “5” means
it was “very well aligned.” PROGRAMMER: SELECT ONE RESPONSE.
NOT WELL ALIGNED
1

□

VERY WELL ALIGNED
2

□

3

□

GO TO E7a

4

□

5

□

GO TO E8

PROGRAMMER: IF E7=MISSING, GO TO E8.

PROGRAMMER: IF E7 = 1-4
Source: Adapted from Baby FACES 2009 Content and Characteristics Form

E7a. Please mark the reason(s) why you feel your most recent visit with this family was not very well
aligned with what you planned to accomplish.
PROGRAMMER: MARK ALL THAT APPLY
1
2
3

□
□
□

Family crisis
Sick client or sick child/child asleep
Client [or child] not engaged in activity or child preferred a different activity
[PROGRAMMER: SHOW TEXT IN BRACKETS IF VERSION = 1-4]

4
5
6
8
7

□
□
□
□
□

Space constraints
Client interested in another topic
Presence of other people limited client’s responses or distracted child
Enrollment or other paperwork issues
Other (specify) __________________________________________________________

SOFT CHECK: IF E7A_7 IS ENDORSED BUT SPECIFY IS LEFT BLANK: Please specify the other reason(s) why

you feel your most recent visit with this family was not very well aligned with what you planned.
PROGRAMMER: IF E3 = 1-5

E8.

How would you describe the family’s follow through from the previous visit?
PROGRAMMER: MARK ONE ONLY
0
1
2
3
4

□
□
□
□
□

NOT APPLICABLE – NO FOLLOW THROUGH ANTICIPATED/ASSIGNED

Client could not remember previous activities/discussion/referrals
Client remembered but did not follow through
Client followed through incompletely
Client followed through completely

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OMB (Redacted)

PROGRAMMER: ALL
Source: New item

E11.

Not including face-to-face (in-person) visits with this family during the past 4 weeks, in which of
the following ways have you communicated with them?
PROGRAMMER: MARK ONE PER ROW
YES

NO

a. Talking or leaving messages via telephone ...

1



0



b. Texting ...............................................................

1



0



c.

Sending emails ..................................................

1



0



d. Writing notes or letters .....................................

1



0



e. Connecting via social networking sites .........

1



0



f.

1



0



1



0



Having an in-person, informal conversation (that
is, not part of a planned visit) ..........................

g. Other (specify)
_____________________________________

SOFT CHECK: IF E11_G IS ENDORSED BUT SPECIFY IS LEFT BLANK: Please specify the other way(s) you have

communicated with this family during the past 4 weeks.

PROGRAMMER: IF ANY ‘YES’ TO ITEMS E11a to E11g
Source: New item

E12.

Thinking about a typical week, how often did you communicate with this family in any of these
ways?

|___|___| TIME(S)

Prepared by Mathematica Policy Research

(RANGE 0-50)

18

OMB (Redacted)

Source: Working Alliance Inventory (adapted for used in EBHV) (PROPRIETARY)
Included in versions: 0 [pregnant women], 1 [newborn-7 mos], 2 [8-16 mos], 3 [17-30 mos], and 4 [31-37 mos]; same items for all age versions

SECTION F. PARENT-HOME VISITOR RELATIONSHIP
F1.

Below are statements that describe ways a home visitor might think or feel about the [client/parent]
with whom she/he is working. For each statement, please check the box that describes how often
you think or feel that way. For example, if the statement describes the way you always think or feel,
select “always.” Work fast, your first thoughts are the ones we would like to see. Please don't
forget to respond to every item.

Items F1a to F1l are protected under copyright and have been redacted from this instrument.
Source: Working Alliance Inventory (adapted for used in EBHV)

Prepared by Mathematica Policy Research

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OMB (Redacted)

Source: Items G1-G2 adapted from Baby FACES 2009
PROGRAMMER: 0 [PREGNANT WOMEN G2 ONLY], 1 [NEWBORN-7 MOS], 2 [8-16 MOS], 3 [17-30 MOS], AND 4 [31-37 MOS]

SECTION G. PARENT ENGAGEMENT

PROGRAMMER: IF VERSION = 1-4
G1. In which of the following ways has this family participated in Early Head Start since September? If both
parents are involved, please answer the questions concerning both parents.
PROGRAMMER: MARK ONE PER ROW

PROGRAMMER: ITEMS B AND C NOT IN THIS VERSION

YES

a. As members of a parent council or other governing bodies?

1



0



D



d. By helping at special events or activities?

1



0



D



e. By attending special events or activities, such as a children's
performance, or a holiday party?

D



1



0



f.

1



0



D



By attending parent workshops?

NO

NOT SURE

PROGRAMMER: DISPLAY G1A TO G1F ON SAME SCREEN AND ALLOW FOR DON’T KNOW OPTION.
REQUIRE RESPONSE FOR EACH ITEM: Please provide a response for each of these activities.
PROGRAMMER: IF VERSION = 0-4
PROGRAMMER: FOR ITEMS G2A TO G2E, DISPLAY 2 ITEMS PER SCREEN. DISPLAY INTRO WITH G2A/C.
FILL “client” OR “client’s” IF VERSION = 0; FILL “parent” OR “parent’s” IF VERSION = 1-4
G2.

For each of the following, please mark the response that best describes how engaged this
[client/parent] has been in the program since September.
a. Thinking first about appointments, would you say…
1
2
3
4

□
□
□
□

[Client/Parent] kept most appointments scheduled since September
[Client/Parent] kept some appointments, but cancelled others
[Client/Parent] missed or cancelled most appointments
[Client/Parent] had no scheduled appointments since September

PROGRAMMER: ITEM B NOT IN THIS VERSION
c. Now thinking about this [client’s/parent’s] participation in activities offered by the program,
would you say this parent participated in…
1
2
3
4

□
□
□
□

Many activities offered by the program since September
Some activities, but passed on others
Only a few activities offered by the program
No activities since September

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d. Which best describes this parent’s attitude and receptivity to the program? Would you say this
parent was…
1
2
3

□
□
□

Very engaged (asked questions, was willing to try new things)
Somewhat engaged (asked a few questions, was hesitant to try a few new things)
Not engaged (didn’t ask many questions, little interest in new things)

e. How would you describe the family’s participation in group socialization activities? Would you
say they attended…
1
2
3
4

□
□
□
□

All or nearly all the offered group socialization activities since September
Some of the group socialization activities
At least one group socialization activity
No group socialization activities since September

G_name.
PROGRAMMER: PLEASE SHOW APPROPRIATE TEXT BASED ON INSTRUMENT MODE. FOR WEB AND DE VERSIONS,
PREFILL STAFF FIRST AND LAST NAME FROM PRELOAD.
TEXT TO APPEAR IN DE VERSION: Please compare the first and last names recorded by the respondent in item

G3n of the survey and below, and indicate your response.
TEXT TO APPEAR IN WEB VERSION: Thank you for responding to this survey. Please confirm your first and last

names for your thank-you check, and record the appropriate response below. If you need to make a
correction to your name, you will be able to do so on the next screen. We will mail the check directly to the
Baby FACES coordinator at your program; he/she will then deliver it to you.
[FIRST NAME] [LAST NAME]
PROGRAMMER: FOR WEB VERSION, DISPLAY FIRST OPTION; FOR DE VERSION, DISPLAY SECTION OPTION

1

□
□

2

□

0

The name as displayed is correct / Both names match
This is me; but I need to make a spelling correction / The names are the almost the same, but
differ in spelling
The name shown is someone other than me / The names appear to be two different people

PROGRAMMER: FOR WEB AND DE VERSIONS, IF G_NAME = 1, 2, OR MISSING, GO TO G_NAMEFIX. FOR WEB VERSION,
IF G_NAME = 0, GO TO G_END. FOR DE VERSION, IF G_NAME = 0, GO TO G3.

G_namefix.
TEXT TO APPEAR IN DE VERSION: Enter the names as recorded by the respondent in item G3n of the survey.
TEXT TO APPEAR IN WEB VERSION: Please enter your complete first and last names for your thank-you check.
PROGRAMMER: PLEASE ALLOW ENTRY OF ‘FIRST NAME’ AND ‘LAST NAME’ IN TWO SEPARATE FIELDS THAT ARE
CLEARLY LABELED AS SUCH.
First name: ___________________
Last name: ___________________
PROGRAMMER: FOR WEB VERSION, GO TO G_END. FOR DE VERSION, GO TO G3.

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21

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PROGRAMMER: DISPLAY FOR DE VERSION ONLY. ITEM G3 BELOW APPEARS IN HARD COPY VERSION (“Please
indicate today’s date”). SO THAT WE HAVE THIS INFORMATION REGARDLESS OF MODE (WEB OR HARD COPY), WE
WILL NEED TO (1) CAPTURE DATE OF COMPLETION FOR WEB AND (2) ENTER DATE OF COMPLETION AS RECORDED
ON HARD COPY WHEN ENTERING COMPLETED FORMS INTO CONFIRMIT.
PROGRAMMER: VALID MONTH RANGES ARE 02 TO 07. YEAR CANNOT BE A VALUE OTHER THAN 2018.

G3.

|

Please enter the date recorded by the respondent in item G3 of the survey. This should indicate the
date they completed the survey.

|

MONTH

G_end.

|/|

|
DAY

|/|

|

|

|

|

YEAR

You have reached the end of this survey.

If you would like to go back to any question, use the "Back" button to navigate back through the survey.
Please click "Next" to submit your completed survey.
PROGRAMMER: CLICKING NEXT WILL BRING THE RESPONDENT TO A NEW SCREEN.
Your survey has been submitted. Thank you for your participation in Baby FACES!
PROGRAMMER: RE-DIRECT RESPONDENT TO THE BABY FACES PAGE ON MATHEMATICA’S EXTERNAL
SITE: https://www.mathematica-mpr.com/our-publications-and-findings/projects/baby-faces-2018

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22

OMB (Redacted)