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pdfOMB 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 20 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 your continued participation 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 21
Please answer the following demographic questions to the best of your ability.
Has your relationship status changed since you took the last survey (within the last 3 months)?
o Yes
o No
Display This Question:
If Has your relationship status changed since you took the last survey (within the last 3 months)? =
Yes
What is your relationship 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): ________________________________________________
Page 2 of 21
[NEXT]
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, away for training
o Yes, on TDY
o No
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
Page 3 of 21
[NEXT]
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
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
Page 4 of 21
[NEXT]
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
Display This Question:
If What is your relationship status? = Single, in a relationship
Or What is your relationship status? = Married
What is you partner's age in years?
________________________________________________________________
Display This Question:
If What is your relationship status? = In a relationship
Or What is your relationship status? = Married
What is your partner's sex?
o Male
o Female
Page 5 of 21
[NEXT]
Display This Question:
If What is your relationship status? = 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? = 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
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
Page 6 of 21
[NEXT]
Display This Question:
If What is your relationship status? = 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
Display This Question:
If Wave 1 What is your military status? = Active Duty Member
Has your deployment, training, or TDY status changed since the last time you took the survey
(within the last 3 months)?
o Yes, my deployment status changed.
o Yes, my training status changed.
o Yes, my TDY status changed.
o No.
[NEXT]
Page 7 of 21
Display This Question:
If Has your deployment, training, or TDY status changed since the last time you took the survey
(within the last 3 months)? = Yes, my deployment status changed.
Yes
Are you currently
deployed?
Are you expected to be
deployed in the next
three months?
No
Length of
Deployment
o
o
___________
o
o
___________
Display This Question:
If Has your deployment, training, or TDY status changed since the last time you took the survey
(within the last 3 months)? = Yes, my training status changed.
Yes
Are you currently away
for training?
Are you expected to be
away for training in the
next three months?
No
Length of Training
o
o
___________
o
o
___________
Display This Question:
If Has your deployment, training, or TDY status changed since the last time you took the survey
(within the last 3 months)? = Yes, my TDY status changed.
Yes
Are you currently on
TDY?
Are you expected to go
on TDY in the next
three months?
No
Length of TDY
o
o
___________
o
o
___________
Page 8 of 21
[NEXT]
Did your living situation change since the last time you took the survey (within the last 3
months)?
o Yes, where I live changed.
o Yes, who I lived with changed.
o Yes, where I live and who I live with changed.
o No.
Skip To: Pregnancy If Did your living situation change since the last time you took the survey (within the
last 3 months)? = No.
Skip To: Live With If Did your living situation change since the last time you took the survey (within the
last 3 months)? = Yes, who I lived with changed.
Skip To: Live on Installation If Did your living situation change since the last time you took the survey
(within the last 3 months)? = Yes, where I live changed.
Skip To: Live With If Did your living situation change since the last time you took the survey (within the
last 3 months)? = Yes, where I live and who I live with changed.
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, grandparents, or other family members
o Living with other adults
o
Other (SPECIFY, please do not include any personally identifiable information such as
names in your response): ________________________________________________
Page 9 of 21
[NEXT]
Display This Question:
If Did your living situation change since the last time you took the survey (within the last 3 months)? =
Yes, who I lived with changed.
Do you live on the installation?
o Yes
o No
Display This Question:
If Did your living situation change since the last time you took the survey (within the last 3 months)? =
Yes, who I lived with changed.
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
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
Page 10 of 21
[NEXT]
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
Has there been a change in the number of children living with you since the last time you took
the survey (within the last 3 months)?
o Yes, there are more children living with me.
o Yes, there are less children living with me.
o No.
Display This Question:
If Has there been a change in the number of children living with you since the last time you took the
survey (within the last 3 months)? = Yes, there are more children living with me.
Did you or your partner give birth or adopt a child over the last 3 months?
o Yes
o No
Display This Question:
If Has there been a change in the number of children living with you since the last time you took the
survey (within the last 3 months)? = Yes, there are more children living with me
If Has there been a change in the number of children living with you since the last time you took the
survey (within the last 3 months)? = Yes, there are less children living with me
How many children are living with you?
Page 11 of 21
________________________________________________________________.
[NEXT]
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
Display This Question:
If Has there been a change in the number of children living with you since the last time you took the
survey (within the last 3 months)? = Yes, there are more children living with me.
Please provide the following information for any child who started living with you since the last
time you took the survey (within the last 3 months).
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 12 of 21
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 13 of 21
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 14 of 21
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 15 of 21
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 16 of 21
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 17 of 21
We’re interested in your feelings about your involvement with NPSP. There are no right or
wrong answers to any of our questions. Please answer as honestly and openly as you can.
Here are some of the ways families may feel about having NPSP in their lives. Some are
positive and some are negative. You may have both positive and negative feelings at the same
time. Please read the following statements carefully. Then, thinking about how you feel right
now about your involvement with NPSP, please indicate how much you agree or disagree with
each.
Strongly
disagree
I believe my
family will get
the help we
really need
from NPSP.
I realize I
need some
help to make
sure my kids
have what
they need.
I was fine
before NPSP
got involved.
The problem
is theirs, not
mine.
I really want
to make use
of the
services
(help) NPSP
is providing
me.
It’s hard for
me to work
with the
home visitor
I’ve been
assigned.
Anything I
say they’re
going to turn
it around to
make me
look bad.
Disagree
Not sure
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
Page 18 of 21
Strongly
disagree
There’s a
good reason
why NPSP is
involved in
my family.
Working with
NPSP has
given me
more hope
about how
my life is
going to go in
the future.
I think my
home visitor
and I respect
each other.
I’m not just
going through
the motions.
I’m really
involved in
working with
NPSP.
My home
visitor and I
agree about
what’s best
for my child.
I feel like I
can trust
NPSP to be
fair and to
see my side
of things.
I think things
will get better
for my
child(ren)
because
NPSP is
involved.
Disagree
Not sure
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 19 of 21
What NPSP
wants me to
do is the
same as
what I want.
There were
definitely
some
problems in
my family
that NPSP
saw.
My home
visitor doesn’t
understand
where I’m
coming from
at all.
NPSP is
helping me
take care of
some
problems in
our lives
I believe
NPSP is
helping my
family get
stronger.
NPSP is not
out to get me.
Strongly
disagree
Disagree
Not sure
o 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
[NEXT]
Page 20 of 21
Thank you for taking the time to complete this survey. Your responses have been recorded.
You will receive $20 compensation via an Amazon gift code within the next 7 business days.
This will come in an email directly from Amazon. If you have questions related to the study or
your compensation, please contact the Penn State evaluation team at [email protected]. You will
receive the link to your next survey in 3-months and/or upon NPSP service completion. Thank
you again for your continued participation in the Navy NPSP Evaluation.
Please close the current tab on your web browser.
Page 21 of 21
| File Type | application/pdf |
| File Title | Microsoft Word - Client Wave 2 Survey.docx |
| File Modified | 2022-07-13 |
| File Created | 2022-05-10 |