0704-XXXX_Client Wave 1 Survey

OMB CONTROL NUMBER: 0704-XXXX
OMB EXPIRATION DATE: XX/XX/XXXX
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0704-XXXX, is estimated to
average 40 minutes per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding the burden estimate or
burden reduction suggestions to the Department of Defense, Washington Headquarters
Services, at [email protected]. Respondents
should be aware that notwithstanding any other provision of law, no person shall be subject to
any penalty for failing to comply with a collection of information if it does not display a currently
valid OMB control number.

Thank you for participating in the Navy New Parent Support Program (NPSP) Evaluation. Your
responses and feedback are an important part of examining NPSP home visitation programing
effectiveness. Your participation will help to ensure that families with children 0-3-years-old can
rely on high quality home visitation programs.
Your responses will remain confidential, so please answer as openly and honestly as possible.
Your participation is voluntary, so you may skip any question that you do not want to answer. If
you are an active duty service member, please be sure to complete this survey while you are off
duty.
You can move through the survey using the green [NEXT] button. Once you click the [NEXT]
button, you will not be able to return to the previous page.
For some of the pages, you might have to scroll down to answer all the questions. For all
questions. Select your answer choice by clicking on it. Please be sure to read the instructions
on each page of the survey, as the answer choices are not the same on each page.
Please click the [NEXT] button to begin the survey.

Page 1 of 30

Please answer the following demographic questions to the best of your ability.
What is your military status?

o Active Duty Member
o Family Member, Spouse
o Retired Military
o Family Member, Daughter
o
Other (SPECIFY, please do not include any personally identifiable information such as
names in your response): ________________________________________________
What is the sponsor's military status?

o Active Duty
o Retired Military
o
Other (SPECIFY, please do not include any personally identifiable information such as
names in your response): ________________________________________________
How is the sponsor related to you?

o I am the sponsor
o My spouse is the sponsor
o My parent is the sponsor
o
Other (SPECIFY, please do not include any personally identifiable information such as
names in your response): ________________________________________________
Have you received New Parent Support Services before (such as with another child or at a prior
duty station)?

o Yes
o No

Page 2 of 30

[NEXT]
Display This Question:
If What is your military status? = Active Duty Member

Are you expected to be deployed, go away for training, or go on TDY in the next three months?

o Yes, deployment
o Yes, training
o Yes, TDY
o No
Display This Question:
If Is your partner expected to be deployed, go away for training, or go on TDY in the next three
months? = Yes, deployed
If Is your partner expected to be deployed, go away for training, or go on TDY in the next three
months? = Yes, away for training
If Is your partner expected to be deployed, go away for training, or go on TDY in the next three
months? = Yes, on TDY

How long are you expected to be away for your upcoming deployment, training, or TDY?
Please only enter numbers. For months only,
enter 0 years.

Years

Months

[NEXT]

Page 3 of 30

What is your marital status?

o Single, not in a relationship
o Single, in a relationship
o Married
o Divorced
o Separated
o Widowed
Display This Question:
If What is your relationship status? = Single, in a relationship
Or What is your relationship status? = Married

What is your partner’s military status?

o Active Duty Member
o Family Member, Spouse
o Unmarried Partner
o Retired Military
o
Other (SPECIFY, please do not include any personally identifiable information such as
names in your response): ________________________________________________
Display This Question:
If What is your partner’s military status? = Active Duty Member

Is your partner currently deployed, away for training, or on TDY?

o Yes, deployed
o Yes, training
Page 4 of 30

o Yes, TDY
o No

[NEXT]

Display This Question:
If Is your partner currently deployed, away for training, or on TDY? = Yes, deployed
If Is your partner currently deployed, away for training, or on TDY? = Yes, away for training
If Is your partner currently deployed, away for training, or on TDY? = Yes, on TDY

How long will your partner be away due to deployment, training, or TDY?
Please only enter numbers. For months only,
enter 0 years.

Years

Months

Display This Question:
If Is your partner currently deployed, away for training, or on TDY? = No

Is your partner expected to be deployed, go away for training, or go on TDY in the next three
months?

o Yes, deployment
o Yes, training
o Yes, TDY
o No

Page 5 of 30

[NEXT]
Display This Question:
If Is your partner expected to be deployed, go away for training, or go on TDY in the next three
months? = Yes, deployed
If Is your partner expected to be deployed, go away for training, or go on TDY in the next three
months? = Yes, away for training
If Is your partner expected to be deployed, go away for training, or go on TDY in the next three
months? = Yes, on TDY

How long is your partner expected to be away for their upcoming deployment, training, or TDY?
Please only enter numbers. For months only,
enter 0 years.

Years

Months

Display This Question:
If What is your relationship status? = Single, in a relationship
Or What is your relationship status? = Married

Has your partner received New Parent Support Services before (such as with another child or at
a prior duty station)?

o Yes
o No
o Unsure
What is your age in years?
________________________________________________________________
Page 6 of 30

[NEXT]
Display This Question:
If What is your relationship status? = Single, in a relationship
Or What is your relationship status? = Married

What is your partner's age in years?
________________________________________________________________
What is your sex?

o Male
o Female
Display This Question:
If What is your relationship status? = Single, in a relationship
Or What is your relationship status? = Married

What is your partner's sex?

o Male
o Female
Did you immigrate to the United States?

o Yes
o No
Are you Spanish/Hispanic/Latino?

o
Yes, Mexican, Mexican-American, Chicano, Puerto Rican, Cuban, or other
Spanish/Hispanic/Latino
o No, not Spanish/Hispanic/Latino
[NEXT]
Page 7 of 30

What is your race? (select all that apply)

▢
▢
▢
▢
▢

American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

Display This Question:
If What is your relationship status? = Single, in a relationship
Or What is your relationship status? = Married

Did your partner immigrate to the United States?

o Yes
o No
Display This Question:
If What is your relationship status? = Single, in a relationship
Or What is your relationship status? = Married

Is your partner Spanish/Hispanic/Latino?

o
Yes, Mexican, Mexican-American, Chicano, Puerto Rican, Cuban, or other
Spanish/Hispanic/Latino
o No, not Spanish/Hispanic/Latino
[NEXT]

Page 8 of 30

What is your partner’s race? (select all that apply)

▢
▢
▢
▢
▢

American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White

What is the last year of school you completed?

o 7th grade or less
o 8th grade
o Some high school/GED
o High school graduate
o Vocational school training
o Some college
o College graduate
o Post-B.A. Training
o Advanced Degree

[NEXT]

Page 9 of 30

Display This Question:
If What is your relationship status? =Single, in a relationship
Or What is your relationship status? = Married

What is the last year of school your partner completed?

o 7th grade or less
o 8th grade
o Some high school/GED
o High school graduate
o Vocational school training
o Some college
o College graduate
o Post-B.A. Training
o Advanced Degree
What is an estimate of your household's total yearly income?

o $0-$10,000
o $10,001-$20,000
o $20,001-$30,000
o $30,001-$40,000
o $40,001-$50,000
o $50,001-$60,000
o $60,001-$70,000
o $70,001-$80,000
o $80,001-$90,000
o $90,001-$100,000
o More than $100,000
[NEXT]
Page 10 of 30

Do you live on the installation?

o Yes
o No
Display This Question:
If Do you live on the installation? = No

What is your current living situation?

o Own
o Rent
o Shared housing with relatives or friends
o Temporary (Shelter, temporary with friends or relatives)
o Homeless
Who do you currently live with?

o Living together with your partner/spouse
o Living alone (or with children only)
o Living with your parents (or other adults)
o
Other living situation (SPECIFY, please do not include any personally identifiable
information such as names in your response): ___________________

[NEXT]

Page 11 of 30

Approximately how long have you been [Insert Response from Previous Question]?
Please only enter numbers. For months only,
enter 0 years.

Years

Months

Yes
Did you PCS in the last three
months?
Are you planning for a PCS in
the next three months?

o
o

No

o
o

Are you or your partner currently pregnant?

o Yes
o No
Display This Question:
If Are you or your partner currently pregnant? = Yes

Is this your first child?

o Yes
o No
[NEXT]

Page 12 of 30

Display This Question:
If Are you or your partner currently pregnant? = Yes

How many weeks pregnant?
________________________________________________________________
Are you or your partner currently in the process of adoption?

o Yes
o No
Display This Question:
If Are you or your partner currently in the process of adoption? = Yes

Is this your first child?

o Yes
o No
Did you or your partner give birth or adopt a child over the last 12 months?

o Yes
o No
Display This Question:
If Did you or your partner give birth or adopt a child over the last 12 months? = Yes

Is this your first child?

o Yes
o No
[NEXT]
Page 13 of 30

How many children are living with you?
________________________________________________________________
Display This Question:
If How many children are living with you? Text Response Is Greater Than or Equal to 1

Do you have any children living with you who are from a prior relationship? (either yours or your
partner's)

o Yes
o No
Please provide the following information for the child (0-3-years-old) for which you are currently
receiving NPSP services.
Date of birth or expected
date of birth if still pregnant
(mm/dd/yyyy):
Sex:

Your relationship to the child:
Does this child have any
special needs or a disability?

o Male
o Female
o Yes
o No

Display This Question:
If What is your relationship status? = Single, in a relationship
Or What is your relationship status? = Married

What is your partner’s relationship to this child?
________________________________________________________________

[NEXT]

Page 14 of 30

Display This Question:
If How many children are living with you? Text Response Is Greater Than or Equal to 1

Please provide the following information for the other children living with you.
Child

Age (Please only
enter numbers. For
months only, enter 0
years.)

1
Years: _____
Months: _____
2
Years: _____
Months: _____
3
Years: _____
Months: _____
4
Years: _____
Months: _____

Sex

Any special needs or
a disability?

o Male
o Female

o Yes
o No

o Male
o Female

o Yes
o No

o Male
o Female

o Yes
o No

o Male
o Female

o Yes
o No
[NEXT]

Page 15 of 30

Display This Question:
If Are you or your partner currently pregnant? = Yes

Please read the following statements and choose the best response.
Strongly
Disagree
Agree
disagree

Strongly agree

My partner is
very supportive
of this
pregnancy.

o

o

o

o

This is an
unplanned
pregnancy.

o

o

o

o

This is not a
good time for me
to have a baby.

o

o

o

o
[NEXT]

Display This Question:
If What is your relationship status? = Single, in a relationship
Or What is your relationship status? = Married

Please read the following statements and choose the best response.
Strongly
Disagree
Agree
disagree
My partner
treats me well.

Strongly agree

o

o

o

o

My partner and I
have a very
good
relationship.

o

o

o

o

I wish my
partner and I got
along better.

o

o

o

o

o

o

o

o

o

o

o

o

I have thought
seriously about
ending my
relationship with
my partner.
My partner
sometimes
drinks five or
more drinks at a

Page 16 of 30

time, but mostly
on weekends.

[NEXT]
Please read the following statements and choose the best response.
Strongly
Disagree
Agree
disagree

Strongly agree

This is a very
stressful time for
me.

o

o

o

o

At times I feel
out of control,
like I'm losing it.

o

o

o

o

Uncontrolled
anger can be a
problem in my
family.

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

I sometimes
drink five or
more drinks of
alcohol at a time,
but mostly on
weekends.

o

o

o

o

It is sometimes
necessary to
discipline a child
with a good,
hard spanking.

o

o

o

o

I can think of a
situation when I

o

o

o

o

I only have a few
friends/family to
help with the
baby (my
children).
I feel very
isolated.
I sometimes
drink enough to
feel really high
or drunk.

Page 17 of 30

would approve
of a wife
slapping a
husband's face.
Strongly
disagree
I can think of a
situation when I
would approve
of a husband
slapping a wife's
face.

Disagree

Agree

Strongly
agree

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

My parents
helped me when
I had problems.

o

o

o

o

I have unhappy
memories of my
childhood.

o

o

o

o

My parents did
not comfort me
when I was
upset.

o

o

o

o

It is sometimes
necessary for
parents to slap a
teen who talks
back or is getting
into trouble.
When I was a
child I was
spanked or hit a
lot by my mother
or father.
When I was a
teenager, I was
hit a lot by my
mother or father.
When I was
growing up, I
saw my mother
or father hit or
throw something
at their partner.

Page 18 of 30

Strongly
disagree

Disagree

Agree

Strongly
agree

My income is
often inadequate
for basic needs.

o

o

o

o

I feel that I have
a number of
good qualities.

o

o

o

o

o

o

o

o

I frequently feel
as if I am not as
good as others.

o

o

o

o

I feel I do not
have much to be
proud of.

o

o

o

o

All in all, I am
inclined to feel
that I am a
failure.

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

I feel that I am a
person of worth,
at least on an
equal basis with
others.

Someone I'm
close to makes
me feel
confident in
myself.
There is
someone I can
talk to openly
about anything.
There is
someone I can
talk to about
problems in my
relationship.
I have someone
to borrow money
from in an
emergency.

Page 19 of 30

Strongly
disagree

Disagree

Agree

Strongly
agree

o

o

o

o

I have someone
who helps me
around the
house.

o

o

o

o

I have someone
I can count on in
times of need.

o

o

o

o

I usually wake
up feeling pretty
good.

o

o

o

o

I think good
things will
happen to me in
the future.

o

o

o

o

There are times
when I feel life is
not worth living.

o

o

o

o

o

o

o

o

I have someone
to take care of
my child/children
for several hours
if needed.

I feel sad quite
often.

Have you or your partner been involved in a suspected or verified case of child abuse or
neglect?

o Yes
o No
Have you or your partner been involved in a suspected or verified case of spouse abuse?

o Yes
o No
[NEXT]

Page 20 of 30

Part I. Please select the response that describes how often the statements are true for you or
your family.
About
Half the
Time

Very
Rarely

Rarely

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

4. My family
pulls together
when things
are stressful.

o

o

o

o

o

o

o

5. My family is
able to solve
our problems.

o

o

o

o

o

o

o

Never
1. In my
family, we talk
about
problems.
2. When we
argue, my
family listens
to "both sides
of the story."
3. In my
family, we
take time to
listen to each
other.

Frequently

Very
Frequently

Always

Part II. Please select the response that best describes how much you agree or disagree with
the statement.
Strongly
Disagree
6. I have
others who will
listen when I
need to talk
about my
problems.
7. When I am
lonely, there
are several
people I can
talk to.

Mostly
Disagree

Slightly
Disagree

Neutral

Slightly
Agree

Mostly
Agree

Strongly
Agree

o

o

o

o

o

o

o

o

o

o

o

o

o

o

Page 21 of 30

8. I would have
no idea where
to turn if my
family needed
food or
housing.
9. I wouldn't
know where to
go for help if I
had trouble
making ends
meet.
10. If there is a
crisis, I have
others I can
talk to.
11. If I needed
help finding a
job, I wouldn’t
know where to
go for help.

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

Part III. This part of the survey asks about parenting and your relationship with your child. For
this section, please focus on the child (0-3-years-old) for which you are currently receiving
NPSP services. Please select the response that best describes how much you agree or
disagree with the statement.
Strongly
Disagree
12. There
are many
times when
I don't know
what to do
as a parent.

Mostly
Disagree

Slightly
Disagree

Neutral

Slightly
Agree

Mostly
Agree

Strongly
Agree

o

o

o

o

o

o

o

13. I know
how to help
my child
learn.

o

o

o

o

o

o

o

14. My child
misbehaves
just to
upset me.

o

o

o

o

o

o

o
Page 22 of 30

Part IV. Please tell us how often each of the following happens in your family.
About
Half the
Time

Never

Very
Rarely

Rarely

o

o

o

o

o

o

o

16. When I
discipline my
child, I lose
control.

o

o

o

o

o

o

o

17. I am
happy being
with my
child.

o

o

o

o

o

o

o

18. My child
and I are
very close to
each other.

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

15. I praise
my child
when he/she
behaves
well.

19. I am able
to soothe my
child when
he/she is
upset.
20. I spend
time with my
child doing
what he/she
likes to do.

Frequently

Very
Frequently

Always

[NEXT]

Page 23 of 30

The following questionnaire includes a series of statements which may be applied to yourself.
Read each of the statements and determine if you AGREE or DISAGREE with the statement. If
you agree with a statement, select A for agree. If you disagree with a statement, select DA for
disagree. Remember to reach each statement; it is important not to skip any statement.

1. I am a happy person.
2. I know what is the right and
wrong way to act.
3. I sometimes act without
thinking.
4. I am often lonely inside.
5. My family fights a lot.
6. Everything in a home
should always be in its place.
7. I often feel very upset.
8. Sometimes I have bad
thoughts.
9. I sometimes worry that I
will not have enough to eat.
10. I am easily upset by my
problems.
11. Sometimes I feel all alone
in the world.
12. My family has problems
getting along.
13. Children should never
disobey.
14. I sometimes lose my
temper.
15. I often feel worthless.
16. My family has many
problems.
17. It is okay to let a child
stay in dirty diapers for a
while.
18. I am often upset and do
not know why.

Agree
A

Disagree
DA

o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o

o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Page 24 of 30

19. Children should be quiet
and listen.
20. I sometimes fail to keep
all of my promises.
21. I often feel very alone.
22. My life is good.
23. I am often upset.
24. Other people have made
my life unhappy.
25. I sometimes say bad
words.
26. I am often depressed.
27. Children should not learn
how to swim.
28. My life is happy.
29. I sometimes worry that
my needs will not be met.
30. I often feel alone.
31. A child needs very strict
rules.
32. Other people have made
my life hard.
33. People sometimes take
advantage of me.

Agree

Disagree

A

DA

o
o
o
o
o
o
o
o
o
o
o
o
o
o
o

o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
[NEXT]

Page 25 of 30

The following statements describe feelings and perceptions about the experience of being a
parent. Think of each of the items in terms of how your relationship with your child or children
typically is. Please select the response that best describes how much you agree or disagree
with each statement.
Strongly
disagree
I am happy in
my role as a
parent.
There is little
or nothing I
wouldn’t do for
my child(ren) if
it was
necessary.
Caring for my
child(ren)
sometimes
takes more
time and
energy than I
have to give.
I sometimes
worry whether
I am doing
enough for my
child(ren).
I feel close to
my child(ren).
I enjoy
spending time
with my
child(ren).
My child(ren)
is (are) an
important
source of
affection for
me.
Having
children gives
me a more
certain and

Disagree

Undecided

Agree

Strongly
agree

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o
Page 26 of 30

optimistic view
for the future.
Strongly
disagree
The major
source of
stress in my
life is my
child(ren).
Having
children
leaves little
time and
flexibility in my
life.
Having
children has
been a
financial
burden.
It is difficult to
balance
different
responsibilities
because of my
child(ren).
The behavior
of my
child(ren) is
often
embarrassing
or stressful to
me.
If I had to do it
over again, I
might decide
not to have
children.
I feel
overwhelmed
by the
responsibility
of being a
parent.

Disagree

Undecided

Agree

Strongly
agree

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o
Page 27 of 30

Having
children has
meant having
too few
choices and
too little
control over
my life.
I am satisfied
as a parent.
I find my
child(ren)
enjoyable.

Strongly
disagree

Disagree

Undecided

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

Agree

Strongly
agree

[NEXT]

Page 28 of 30

Below is a list of some of the ways you may have felt or behaved.
Please indicate how often you have felt this way during the past week by using the scale
provided.
Rarely or none
of the time (less
than 1 day)
1. I was
bothered by
things that
usually don't
bother me.
2. I had trouble
keeping my
mind on what I
was doing.
3. I felt
depressed.
4. I felt that
everything I did
was an effort.
5. I felt hopeful
about the future.
6. I felt fearful.
7. My sleep was
restless.
8. I was happy.
9. I felt lonely.
10. I could not
"get going."

Some or a little
of the time (1-2
days)

Occasionally or
a moderate
amount of time
(3-4 days)

Most of the time
(5-7 days)

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o

o
o
o
o
o
o

o
o
o
o
o
o

o
o
o
o
o
o

o
o
o
o
o
o
[NEXT]

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