The Home-Based Child Care Toolkit for Nurturing School-Age Children Pilot Study

Instrument 3

HBCC-NSAC Toolkit Provider Questionnaire

The Home-Based Child Care Toolkit for Nurturing School-Age Children (HBCC-NSAC Toolkit)

[If web or hard-copy administered: Mathematica is conducting the Home-Based Child Care Toolkit for Nurturing School-Age Children (HBCC-NSAC Toolkit) Pilot Study with the Erikson Institute for the Office of Planning, Research, and Evaluation within the Administration for Children and Families in the U.S. Department of Health and Human Services.

Thank you in advance for completing the HBCC-NSAC Toolkit provider questionnaire!

The Paperwork Reduction Act Burden Statement: This collection of information is voluntary and will be used to learn about the experiences of home-based child care providers. Public reporting burden for this collection of information is estimated to average [IF PHASE ONE: 45 minutes] [IF PHASE TWO: 30 minutes] including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. 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 collection is 0970-0355 and the expiration date is 08/31/2024. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Patricia Del Grosso, 600 Alexander Park, Suite 100, Princeton, NJ 08540; Attn: OMB-PRA 0970-0355.

RESPONDENT WILL READ CONSENT LETTER AND SIGN OR CHECK YES TO CONSENT FORM (APPENDIX F)]

[If telephone administered:

Hello [NAME], 

CONFIRM YOU ARE SPEAKING TO THE NAMED PROVIDER. IF NOT, CONFIRM PHONE NUMBER, EMAIL, AND A GOOD CALLBACK TIME. 

CONFIRM PROVIDER CAN TAKE THE CALL IN [ENGLISH/SPANISH]. IF WRONG LANGUAGE, CONFIRM PHONE NUMBER, EMAIL, AND A GOOD CALLBACK TIME (IF POSSIBLE FOR INTERVIEWER WITH PREFERRED LANGUAGE TO CALL BACK). 

This is [STUDY TEAM MEMBER NAME]. I’m calling to complete the Home-Based Child Care Toolkit for Nurturing School-Age Children (HBCC-NSAC Toolkit) provider questionnaire over the phone with [RESPONDENT NAME]. This discussion will take about 30 minutes. Talking with us on this call is completely up to you and voluntary and will be used to learn about the experiences of home-based child care providers. We will keep your responses private. Because this is a federally funded study, I want to tell you that 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 collection is 0970-0355 and the expiration date is 08/31/2024. There are no right or wrong answers to any of the questions and you can tell us you don’t want to answer any of the questions.

I would like to go over the consent letter that was sent to you to answer your questions and obtain your verbal consent to participate in this study.

READ HOME-BASED CHILD CARE TOOLKIT FOR NURTURING SCHOOL-AGE CHILDREN PILOT STUDY PROVIDER CONSENT LETTER (APPENDIX F).

Do you have questions about the content of the consent letter or the study activities? ANSWER QUESTIONS.

Now I will read the consent statement to you and record your response.

READ HOME-BASED CHILD CARE TOOLKIT FOR NURTURING SCHOOL-AGE CHILDREN PILOT STUDY PROVIDER CONSENT FORM (APPENDIX F).

Do you agree with the statement that I just read?

IF YES: I am recording that you provided verbal consent to participate in this study. Would you like the study team to mail you a paper copy of the completed consent form? ]

Introduction

[If web or hard-copy administered: Please read this information before using the HBCC-NSAC Toolkit.]

[If telephone administered: Now, I will introduce the HBCC-NSAC Toolkit.]

Individuals like you who care for children in a home, or home-based child care (HBCC) providers, play an important role in caring for children and supporting their development. However, many measures to support HBCC providers in this role were not created for HBCC providers. Most were originally made for child care providers and teachers who work in child care and early education centers. Also, many of the resources focus on infants, toddlers, and preschoolers, and not school-age children or children across these age groups. The HBCC-NSAC Toolkit was created for and with input from HBCC providers.

You should complete the HBCC-NSAC Toolkit if each of the following statements is true for you:

• You are a home-based child care provider, which is someone who regularly cares for children other than their own in a home. This includes being a licensed family child care (FCC) provider, or someone who cares for their family, friend, or neighbor’s (FFN) child(ren); for example, a relative like a grandma/grandpa or auntie/uncle, or a babysitter, or nanny.

• You care for at least one school-age child for at least 10 hours per week in a home and may care for younger children too. School-age children are children who are age 5 and in kindergarten, or ages 6 through 12.

• You are interested in ways to help school-age children learn and grow and build connections to their families and community.

The HBCC-NSAC Toolkit has two tools:

1. The Provider Questionnaire begins with a few questions that guide you through a series of questions about how you support children in your care.

2. The Family Questionnaire is an optional tool that you can give to children’s family members (for example, parent or primary caregiver) that can help you and families talk about the time you spend with children.

[If web administered:

• There are no right or wrong answers to the questions.

• For most questions in the survey, you will answer by clicking the box or circle to select your response, or by entering a number in the appropriate box.

• To go back to the previous questions, click the "Back" button at the bottom of the screen. Please note that this command is only available in certain sections.

• If you need to stop before you have finished, close the webpage. The answers you provide before closing this page will be securely stored and available when you return.

• If you do not enter a response within 30 minutes, the survey will be locked. You will need to log in again when you decide to continue.]

HBCC-NSAC Toolkit Provider Questionnaire

[If web or hard-copy administered: It should take you about [phase 1: 45/phase 2: 30] minutes to complete the questionnaire.]

Getting Started

[If web or hard-copy administered: Instructions: Answer questions 1-5 below.]

[If web or hard-copy administered: Questions 1-5/if telephone administered: Next, I will] ask you to identify the age groups of the children you care for and the times of day you care for children. If you do not currently care for school-age children, answer based on the school-age children you have cared for in the last 12 months. These questions ask about the number of “school-age” children and “under school-age” children in your care. Please use the following definitions:

• School-age children: Children who are age 5 and in kindergarten, or ages 6 through 12.

• Under school-age children: Children who are ages birth through 5 and not yet in kindergarten.

1. How many total children do you care for at least once a week?

1. _______

2. How many under school-age children do you care for at least once a week?

1. _______

3. How many school-age children ages 5 through 8 do you care for at least once a week?

1. _______

4. How many school-age children ages 9 through 12 do you care for at least once a week?

1. _______

5. Do you regularly (at least once a week) care for children (any age) during any of the following hours? (Select all that apply)

□ 7 a.m.–6 p.m.

□ Before 7 a.m.

□ After 6 p.m.

[If web or hard-copy administered: Based on your answers to questions 1-4, find the pictures for the age group(s) of the children in your care. Some sections in the provider questionnaire will have questions for all three age groups, but other sections might only have questions for one or two age groups. You can skip questions if you do not care for children with the ages in the picture. Please use the following definitions:

• School-age children: Children who are age 5 and in kindergarten, or ages 6 through 12.

• Under school-age children: Children who are ages birth through 5 and not yet in kindergarten.]

If you care for any under school-age children and any school-age children, answer questions with this picture. If not, skip these questions.	Mix of children under school-age and school-age
If you care for any school-age children ages 5 through 8, answer questions with this picture. If not, skip these questions.	School-age children ages 5 through 8
If you care for any school-age children ages 9 through 12, answer questions with this picture. If not, skip these questions.	School-age children ages 9 through 12

Instructions

[If telephone administered: Next, I will give instructions to help you answer questions in the provider questionnaire.] Each section has an introduction and definitions of key terms in the questions. The questions ask about the practices you do with children in your care. “Practice” includes all the ways you interact with and do things with children in your care.

For each question, [if web or hard-copy administered: check the box/if telephone administered: tell me the answer] that best shows how you currently support children in your care. If you care for children in more than one age group, answer based on the age group the question focuses on. If your answer differs based on the child, think about the average experience of children in your care. In other words, on average, what do the children in your care experience on a given day? For example, if you teach one child how to enter play with others “a lot” but only “rarely” for another, you should mark “sometimes” as the average experience.

The questions may ask for different kinds of responses:

[If web or hard-copy administered: Use the guidance below/ if telephone administered: I will read some guidance] to help choose the best response when you need to answer how frequently you do something.

A lot I do this practice multiple times per day or most times when there is an opportunity to do so with children in my care (for example, if you care for school-age children only on weekends, you can still check “a lot” if you use that strategy multiple times a day or throughout the time when you are with them).

Sometimes I do this occasionally, but I don’t necessarily do it every day or most of the times when I could do it.

Rarely I have done it before and may do it again, but I don’t do this every day or most of the times when I could do it.

Never I have never done this before.

Don’t know I’m not sure or I don’t remember.

Not Applicable This does not apply to me (for example, if the question is about multiple children, but you care for only one child). Please note that only some questions have a “Not Applicable” option.

[If web or hard-copy administered: Use the guidance/ if telephone administered: Now, I will read some guidance] below to help choose the best response for yes/no questions.

Yes I do this.

No I do not do this.

Don’t know I’m not sure or I don’t remember.

Not Applicable This does not apply to me (for example, if the question is about multiple children, but you care for only one child). Please note that only some questions have a “Not Applicable” option.

In addition, [if web or hard-copy administered: check the “I want to do this more” box/if telephone administered: you can say “I want to do this more”] for any question with a practice that you would like to do more often or with more children, learn how to do, or just want to try out.

Once you are done, there are optional reflection questions that can help you think about what you learned. For example, whether and how often you use a practice, if you do so with all the children who could benefit from it, and whether you think you should do it more often or with additional children. Keep in mind that not all practices will be used each day, and some children may need supports more often than others. You can reflect on what you learned alone, or with a coach, mentor, or another HBCC provider!

I. Support for Social Development

[If telephone administered: First I’m going to ask you questions about support for social development.]

The questions in this section ask about how you support children’s social development, which begins with building a warm and positive relationship with them. They also ask about how you support children’s perspective taking and nonverbal communication, their social skills (including building friendships), how you support antibullying and antiracism, and how you support interacting with the community outside of the home. This section focuses on practices that help children learn to understand each other, collaborate, cooperate, communicate, and respect others.

Key terms used in this section:

• Bias. Bias is a tendency to think about or behave differently based on a characteristic of a person or group compared with another. Biases may be held by an individual, group, or institution and can have negative or positive consequences.

• Bullying. Bullying involves repeated verbal, physical, or social behavior that can cause harm. Bullying can include hurtful teasing; name calling; targeted exclusion; lying about another child; manipulating and controlling another child; restraining a child; or hitting, kicking, or pinching. Bullying can happen when children are in your care or not in your care (for example, at school or a local park).

• Nonverbal communication. Nonverbal communication are ways of communicating without words. For example, what a person communicates through body language, gestures, facial expressions, vocal tone, and sounds.

• Perspective taking. Children learn how to understand (or take the perspective of) what other people are feeling or experiencing that is different from what they feel or experience.

• Social cues. Social cues are forms of communication that help kids “read” and react to other people. Social cues include expressions, body language, tone of voice, and personal space or boundaries.

• Social conflicts. These are issues or disagreements that come up between children and peers, such as disagreements when children have different opinions, temperaments, or styles of play, or if they want the same toys, materials, or attention that other children have.

Age groups in this section:

This section includes the following age groups.

	For these items, respond based on when you are caring for any school-age children… Younger children refers to the younger school-aged children in your care (for example, a 6 year old child). Older children refers to older school-aged children in your care (for example, a 10 year old child).
	For these items, respond based on when you are caring for any school-age children ages 9 through 12…
	For these items, respond based on when you are caring for school-age children and under school-age children at the same time… Younger children refers to under school-age children (for example, infants or toddlers). Older children refers to school-age children (for example, a 10 year old child).

Start Time: _______

			Please check one: I do this…						Check if…
What I do to support children			A lot	Sometimes	Rarely	Never	Don’t know	Not applicable	I want to do this more
I.A. [If telephone administered: The first topic in this section is] Builds and strengthens a positive relationship with children
		When I am caring for any school-age children (age 5 and in kindergarten or ages 6 through 12)…
1. I use children’s names or their preferred name(s) in a positive context (for example, “I will put your drawing over here for us to admire, Momo”; “Jose, your building looks very stable”; or “Lola, you are thinking like a scientist”).			☐	☐	☐	☐	☐		☐
2. I use positive comments about the children (for example, “Jorge, you cleaned up your work area beautifully” or “Maria, thanks for keeping the popcorn away from the baby. You are helping me keep him safe from choking”).			☐	☐	☐	☐	☐		☐
3. I tell children that I care about, love, and admire them (for example, “You are important to me”).			☐	☐	☐	☐	☐		☐
4. I share joy with children (for example, I smile and share excitement, play or dance alongside them, encourage laughter, plan fun activities with them).			☐	☐	☐	☐	☐		☐
5. I use touch in positive ways that show children warmth and affection (for example, hugs, pats on the back, braiding hair, or high fives).			☐	☐	☐	☐	☐		☐
6. I encourage children to talk about their interests, such as favorite activities, movies and books they enjoy, and what they are looking forward to doing.			☐	☐	☐	☐	☐		☐
7. I listen carefully and acknowledge children’s thoughts and feelings (for example, by restating, asking questions, or adding more to what they tell me).			☐	☐	☐	☐	☐		☐
8. I encourage children to choose how they want to receive or show affection (for example, allowing children to choose their morning greeting, like a high five, hug, or dance move).			☐	☐	☐	☐	☐		☐
9. I take time to regulate my own emotions (for example, taking a breath and gathering my thoughts and feelings) before responding to children.			☐	☐	☐	☐	☐		☐
10. I join children in their activities (for example, I do crafts, play games, or dance and sing with children).			☐	☐	☐	☐	☐		☐
I.B. [If telephone administered: The next topic in this section is] Supports children’s perspective-taking and nonverbal communication
		When I am caring for any school-age children (age 5 and in kindergarten or ages 6 through 12)…
1. I make an effort to recognize and label my own feelings in front of children (for example, “When you help me get lunch ready, I am so grateful”).			☐	☐	☐	☐	☐		☐
2. I help children think about how other people might be feeling by pointing out social cues, facial expressions, tone of voice, body language, or words (for example, pointing out how a character in a movie is expressing emotions through body language; or having the children take turns showing how they express different emotions, including positive emotions).			☐	☐	☐	☐	☐		☐
3. When sharing books, stories, shows, or videos, I encourage children to talk about how different characters feel.			☐	☐	☐	☐	☐		☐
4. I encourage children to express their feelings through art and writing (for example, drawing comics, writing a short story, or journaling).			☐	☐	☐	☐	☐		☐
5. I help children think about the different ways other children express feelings (for example, by talking about vocal tones and volume, facial expressions, or body position: “Julian is talking quickly and sounds really excited! Are you excited, Julian?”).			☐	☐	☐	☐	☐		☐
6. I give opportunities for children to perform, draw, write, or tell stories and ask how the characters in their story feel.			☐	☐	☐	☐	☐		☐
7. I ask questions to help children think about different perspectives (for example, while reading a book, “Reema, would you have done the same thing that Ralph did? How do you think his family feels when he runs away?”).			☐	☐	☐	☐	☐		☐
8. I help children practice different experiences or situations (for example, pretending to go to a restaurant and order food or acting out with puppets how to resolve a conflict with younger children).			☐	☐	☐	☐	☐		☐
9. I use games and activities that require children to work together to be successful (for example, jumping rope or double dutch outside or tossing a beach ball to each other).			☐	☐	☐	☐	☐	☐	☐
10. I help children understand and respect the personal space needs of others (for example, creating cues in tape or a carpet square that define where children can or cannot go, or giving reminders like “Remember Hector said he does not like to be touched? What if you sit on the other side of the table to give him some space?”).			☐	☐	☐	☐	☐		☐
11. I invite children to talk with me about social experiences that trouble them (for example, if they are hurt or confused by another person’s reaction).			☐	☐	☐	☐	☐		☐
12. If children talk about social issues in their lives, I listen without judgement (for example, keeping my facial expression neutral if they tell me something I don’t agree with and asking open-ended questions about the things they tell me).			☐	☐	☐	☐	☐	☐	☐
	When I am caring for school-age children (age 5 and in kindergarten or ages 6 through 12) and under school-age children (ages birth through 5 and not yet in kindergarten)…
13. I help older children recognize how younger children might be feeling by pointing out facial expressions, body language, or noises they make (for example, how babies turn their head away and close their eyes when they need a break, or how a toddler might bite when their gums hurt from teething).			☐	☐	☐	☐	☐		☐
14. I point out and talk about older children’s feelings to younger children to help them understand other people’s emotions.			☐	☐	☐	☐	☐		☐
I.C. [If telephone administered: The next topic in this section is] Supports children’s social skills
		When I am caring for any school-age children (age 5 and in kindergarten or ages 6 through 12) …
1. I talk about children who do things together, like trying hard, being helpful, or cooperating and enjoying playing (for example, “Kai really worked hard at catching the ball that Paz threw to him”; “Arya and Nia enjoyed pretending to be a patient and a doctor”).			☐	☐	☐	☐	☐		☐
2. I provide opportunities for children to interact with one another (for example, being partners for games and activities, taking turns doing tasks, or being clean-up buddies).			☐	☐	☐	☐	☐	☐	☐
3. I provide activities that encourage children to help others, take turns, or work toward the same goal (for example, an art project, building a cardboard house, a gardening project, or a cooking activity).			☐	☐	☐	☐	☐		☐
4. I help children interact with each other successfully by giving prompts or suggestions (for example, “What does it mean when someone goes to the calm area to read or listen to music? Do you think you should give Chriselle some time before you ask her to play again?”).			☐	☐	☐	☐	☐	☐	☐
5. I teach children how to enter play with others (for example, by suggesting they watch other children first, providing words children can use, or pointing out positive examples in shows or stories).			☐	☐	☐	☐	☐		☐
6. If children are having a hard time making friends and connections, I give them extra support.			☐	☐	☐	☐	☐	☐	☐
7. If children are having social conflicts, I provide strategies to help them solve their problems step by step (for example, I ask children to identify the problem, how they each feel, and talk with them about different ways they could solve the problem).			☐	☐	☐	☐	☐	☐	☐
8. I help children think about how to solve social conflicts before they occur (for example, we practice what to do if someone is in our personal space).			☐	☐	☐	☐	☐		☐
9. If children are upset with each other, I remind them about ways to calm down (for example, giving themselves a strong hug, using a comfort object like their favorite stuffed animal, or clenching and then relaxing their hands and arms).			☐	☐	☐	☐	☐	☐	☐
10. When children are calm, I help them practice ways to manage emotions and solve social conflicts (for example, practicing breathing techniques or labeling feelings as an activity).			☐	☐	☐	☐	☐		☐
11. I respond to all forms of aggression between children (for example, hitting another child, name calling, leaving a child out of the group, or spreading rumors about a child).			☐	☐	☐	☐	☐	☐	☐
12. I respond calmly to aggression between children by using teaching or problem solving (for example, I help children calm down and talk to each other about their feelings, and how they could help each other feel better again).			☐	☐	☐	☐	☐	☐	☐
		When I am caring for school-age children (age 5 and in kindergarten or ages 6 through 12) and under school-age children (ages birth through 5 and not yet in kindergarten) …
13. I provide opportunities for older and younger children to do things together (for example, letting younger children put the ingredients into the bowl after older children measure it out, or using open-ended materials such as Play-Doh or markers that they all can use to create an art project together).			☐	☐	☐	☐	☐		☐
14. During meal or snack times, I give both younger children and older children a task so that they can all help together (for example, peeling fruit, putting food on plates, or wiping the table).			☐	☐	☐	☐	☐	☐	☐
15. During pretend play, I help younger children join activities (for example, suggesting a role for them, such as “Can baby Janelle be your patient today?”).			☐	☐	☐	☐	☐		☐
I.D. [If telephone administered: The next topic in this section is] Supports antibullying and antibias practices
		When I am caring for any school-age children (age 5 and in kindergarten or ages 6 through 12)…
1. I make an effort to learn about biases I may have and how they might influence the way I interact with children or their families (for example, what kind of assumptions do I make about how children will act based on their gender, race, ethnicity, religion, language, ability, or family structure?).			☐	☐	☐	☐	☐		☐
2. I talk to families about how to work together with their children to address children’s experiences with bullying or discrimination.			☐	☐	☐	☐	☐		☐
3. I use books, stories, or shows to discuss discrimination, racism, and unfair treatment that people have experienced (due to race, gender, immigration status, religious beliefs, body type, or disabilities).			☐	☐	☐	☐	☐		☐
4. I share books, stories, or shows that explore social justice and equity themes (for example, about important historical moments, or people who have spoken up for their community).			☐	☐	☐	☐	☐		☐
5. I share books, stories, or shows that positively portray people with different characteristics (for example, people with different abilities or body sizes).			☐	☐	☐	☐	☐		☐
6. I share stories that celebrate the achievements of people from different backgrounds, such as racial, ethnic, religious, or gender identities or abilities, or different family structures, like living with their grandparents.			☐	☐	☐	☐	☐		☐
7. I talk with children about people from different racial and ethnic backgrounds who have been successful or demonstrated positive values.			☐	☐	☐	☐	☐		☐
8. I give children opportunities to hear stories from people from different cultures (for example, stories from grandparents or community members or listening to folktales from around the world).			☐	☐	☐	☐	☐		☐
9. I respond to children’s curiosity about social issues appearing in the news or in their community and point out the people who show positive values and help others (for example, how our neighbors help each other make it safe to play in the park).			☐	☐	☐	☐	☐		☐
10. I help children learn acceptable ways to stand up for each other and themselves in the face of teasing, bullying, or other forms of discrimination (for example, offer support to peers, correcting a stereotype).			☐	☐	☐	☐	☐		☐
11. I observe children to look for potential signs of bullying (for example, changes in eating habits, unexplainable injuries, sudden loss of friends or exclusion from activities, or sudden aggressive behavior).			☐	☐	☐	☐	☐		☐
12. When children share their feelings and experiences with me, I thank them and let them know I am glad they talked with me.			☐	☐	☐	☐	☐		☐
13. If children talk about experiences of unfair treatment, I affirm that their experiences and feelings about it are understandable (for example, I would be angry and confused if that happened to me).			☐	☐	☐	☐	☐	☐	☐
14. If children talk about experiences of unfair treatment or aggression, I help them think about what they might do next and the importance of not allowing others to hurt them (for example, staying in safe areas and with friends they trust, telling a trusted adult, or role playing how to react appropriately and ask for help).			☐	☐	☐	☐	☐	☐	☐
15. I encourage children to think about how they can help others in their wider community (for example, talking positively about a community clean-up event, encouraging children to hold doors open or carry a grocery bag for an older adult).			☐	☐	☐	☐	☐		☐
16. I provide opportunities for children to volunteer and support others in their wider community (for example, helping in community gardens, community clean-ups, or food donation and toy drives; or writing letters to mayors and state representatives about important neighborhood issues like clean water).			☐	☐	☐	☐	☐		☐
		When I am caring for any school-age children ages 9 through 12…
17. I use history and recent events to talk about discrimination, racism, and unfair treatment that might happen (for example, discussing police encounters and the history of racism).			☐	☐	☐	☐	☐		☐
18. I help children explore social issues they are curious about (for example, looking up a public figure on the internet, finding library books about social issues).			☐	☐	☐	☐	☐		☐
19. I help children think of ways to participate in social issues that are important to them (for example, writing letters to a community leader, thinking about ways they can help make things better).			☐	☐	☐	☐	☐		☐

End Time: _______

II. Support for Emotional Development

[If telephone administered: Next, I’m going to ask you questions about support for emotional development.]

The questions in this section ask about how you provide support for children’s emotional development. Support for emotional development includes how to help children understand, express, and regulate or manage their own emotions. The questions also ask how you support children’s sense of belonging in your HBCC and help children develop a positive self-identity, including a positive racial and ethnic identity. The questions acknowledge building relationships with children who may have different types of positive and negative experiences in and outside of your care.

Key terms used in this section:

• Emotional cues. Emotional cues include facial expressions, postures, and actions that communicate children’s feelings without using words. They might include wincing or scrunching up their face if they are in pain; turning away or stepping back if they feel scared or uncomfortable; being more quiet than usual if they are nervous; or laughing, giggling, and moving close to you if they are happy and comfortable. Some children do not follow the typical expression of emotions. For example, some may smile when they have done something wrong (likely in an effort to try to make things better).

• Racial and ethnic identity. Refers to a person’s thoughts and feelings about their race and ethnicity and the process of developing those thoughts and feelings.

• Self-identity. Refers to a person’s thoughts and feelings about who they are and the process of developing those thoughts and feelings. Many possible characteristics may influence one’s self-identity including abilities, race, ethnicity, culture, gender, religion or spiritual beliefs, temperament, hobbies, athleticism, and more.

• Sense of belonging. A sense of belonging is feeling accepted and valued by others and sharing common experiences and trust.

Age groups in this section:

This section includes the following age groups.

	For these items, respond based on when you are caring for any school-age children Younger children refers to the younger school-aged children in your care (for example, a 6 year old child). Older children refers to older school-aged children in your care (for example, a 10 year old child).
	For these items, respond based on when you are caring for any school-age children ages 9 through 12…
	For these items, respond based on when you are caring for school-age children and under school-age children … Younger children refers to under school-age children (for example, infants or toddlers). Older children refers to school-age children (for example, a 10 year old child).

Start Time: _______

		Please check one: I do this…						Check if…
What I do to support children		A lot	Sometimes	Rarely	Never	Don’t know	Not applicable	I want to do this more
II.A. [If telephone administered: The first topic in this section is] Helps children understand and regulate emotions
	When I am caring for any school-age children (age 5 and in kindergarten or ages 6 through 12)…
1. I help children label their positive feelings.		☐	☐	☐	☐	☐		☐
2. I help children label their negative feelings.		☐	☐	☐	☐	☐		☐
3. When children seem sad, I encourage them to explain what they are feeling without giving or forcing a solution.		☐	☐	☐	☐	☐		☐
4. I ask children which emotions they are communicating (for example, “Do you need a little time to yourself?” when a child turns away from me; or “Are you frustrated?” when a child throws a pencil).		☐	☐	☐	☐	☐		☐
5. I give children time and a place to regroup or do something else if they are not ready to talk about what is bothering them.		☐	☐	☐	☐	☐		☐
6. Children know safe places in the home to go for quiet time to themselves (for example, a reading nook or quiet area of the room with soft furniture or pillows and books).		☐	☐	☐	☐	☐		☐
7. I help children find ways to calm down and relieve stress when they are upset (for example, listening to music, writing in a journal, petting an animal, hugging a soft toy, humming, stretching their body, and relaxing muscles from head to toe).		☐	☐	☐	☐	☐		☐
8. I encourage older children to show younger children how to calm themselves down (for example, practicing a breathing or stretching exercise with a younger child).		☐	☐	☐	☐	☐	☐	☐
9. I model the ways I regulate my own emotions in front of children (for example, taking a breath and pausing to gather my thoughts and feelings).		☐	☐	☐	☐	☐		☐
10. I encourage children’s efforts to manage their emotions (for example, “I know you were feeling angry, but you did great explaining your feelings”).		☐	☐	☐	☐	☐		☐
11. I encourage children to use positive comments and affirmations with each other (for example, “Wow, Mark, I really like your new shoes!” and “I really like that picture you drew, Diana.”).		☐	☐	☐	☐	☐	☐	☐
	When I am caring for school-age children (age 5 and in kindergarten or ages 6 through 12) and under school-age children (ages birth through 5 and not yet in kindergarten)…
12. I help older children understand the emotions behind younger children’s actions (for example, “Amber is touching your book because she’s curious about what you’re reading. Would you like to read a sentence to her?”).		☐	☐	☐	☐	☐		☐
II.B. [If telephone administered: The next topic in this section is] Supports a positive sense of belonging
	When I am caring for any school-age children (age 5 and in kindergarten or ages 6 through 12)…
1. I invite children to talk about things from home or school (for example, “What was your most and least favorite thing about school today?” or “Sami has a dog, too. Can you tell Sami about your new dog?”)		☐	☐	☐	☐	☐		☐
2. I gather children as a group and help each of them share something with the others (for example, during circle time or snack time, I ask children to share what they learned in school that day or did over the weekend, or describe their favorite outdoor activities).		☐	☐	☐	☐	☐	☐	☐
3. I make an effort to get to know children’s families (for example, asking families about activities their children like to do at home or staggering pick-up/drop-off times to make time for conversations with families).		☐	☐	☐	☐	☐		☐
4. I comment about the positive values children demonstrate (for example, “Min, you showed a lot of kindness and patience with Yoon when you taught him how to play that new game”).		☐	☐	☐	☐	☐		☐
5. I greet children when they join me or a group (for example, “Looks like Carla is joining us to read this book! Let’s make some more room for her to sit.”).		☐	☐	☐	☐	☐		☐
6. I encourage families who speak different languages than I do to share familiar words or phrases from their home language(s).		☐	☐	☐	☐	☐	☐	☐
7. I use items in my space that reflect children’s home lives, cultures, or communities to start conversations with children (for example, showing a photo album with pictures of children’s families, or talking about a painting of our neighborhood).		☐	☐	☐	☐	☐		☐
8. Children can see their home language(s) in my space (for example, in posters on the wall, on labels, or on books within their reach).		☐	☐	☐	☐	☐		☐
9. I provide children who are more vocal and energetic opportunities to share their talents with others (for example, showing a dance move or asking them to sing a song for the group).		☐	☐	☐	☐	☐	☐	☐
10. I provide children who are quiet and reserved opportunities to feel good about their strengths (for example, asking them to tell or read a story to other children, displaying their artwork for other children to see, praising their strengths).		☐	☐	☐	☐	☐	☐	☐
11. I provide opportunities for children to take ownership of daily routines or activities (for example, being responsible for setting the table, organizing toys).		☐	☐	☐	☐	☐		☐
12. I encourage children to talk about their favorite activities they do at home.		☐	☐	☐	☐	☐		☐
	When I am caring for school-age children (age 5 and in kindergarten or ages 6 through 12) and under school-age children (ages birth through 5 and not yet in kindergarten)…
13. I help older and younger children do things to build a relationship with each other (for example, telling riddles or knock-knock jokes to each other, using their own special handshakes, I point out similarities between children).		☐	☐	☐	☐	☐		☐
14. I give older and younger children tasks they can do together during routines (for example, asking an older child to carry plates to the table and a younger child to put a spoon next to each plate).		☐	☐	☐	☐	☐		☐
15. I encourage older children to ask younger children about things they do at home or school (for example, asking what they like to do at school, asking what foods they like to eat at home).		☐	☐	☐	☐	☐		☐
II.C. [If telephone administered: The next topic in this section is] Supports a positive self-identity
	When I am caring for any school-age children (age 5 and in kindergarten or ages 6 through 12)…
1. I make positive comments about children’s families and family backgrounds (for example, “What is the best thing/part about living with your grandparents?” or “It’s so great that Mateo’s mom can teach us songs in Spanish.”).		☐	☐	☐	☐	☐		☐
2. I make positive comments individualized to each child (for example, “Amir, I really enjoyed reading the story you are writing”, or “Carla is a good artist and might be willing to draw pictures for your book.”).		☐	☐	☐	☐	☐		☐
3. When I’m with children who speak different languages, I incorporate their language(s) in our daily activities (for example, listening to music or singing familiar songs; if I’m fluent in their language, telling stories, reading books, watching shows).		☐	☐	☐	☐	☐	☐	☐
4. I plan activities that acknowledge each family’s cultural traditions (for example, eating a food from each family’s home together, learning a game, celebrating holiday traditions).		☐	☐	☐	☐	☐		☐
5. I talk to children about community events where their cultural backgrounds are celebrated (for example, festivals, block parties, food markets).		☐	☐	☐	☐	☐		☐
6. I use stories to talk about social issues relevant to children’s own lives (for example, reading a book about children who migrate to new countries or talking about civil rights movements).		☐	☐	☐	☐	☐		☐

[If telephone administered: The next topic in this section is] II.D. Supports a positive racial and ethnic identity

[If telephone administered: These questions will address how] All children develop their own racial and ethnic identity. Young children often explore their racial and ethnic identities as they grow older and interact with others and the world. The questions in this section will ask you about sharing positive messages, imagery, and stories about children’s racial and ethnic identities as well as other practices to help children learn and explore their curiosities about their own and other races, ethnicities, and cultures.

			Please check one: I do this…						Check if…
What I do to support children			A lot	Sometimes	Rarely	Never	Don’t know	Not applicable	I want to do this more
	When I am caring for any school-age children (age 5 and in kindergarten or ages 6 through 12)…
1. I make positive comments that affirm children’s racial and ethnic background(s) (for example, “I love how you style your braids” or “Your hijab is a beautiful color today”).			☐	☐	☐	☐	☐		☐
2. I share books, stories, or videos that show people from children’s racial and ethnic background(s) in positive roles (for example, videos or books about community leaders, inventors, and changemakers).			☐	☐	☐	☐	☐		☐
3. I tell stories about people relevant to children’s own lives (for example, telling children of immigrants about community leaders who also are immigrants).			☐	☐	☐	☐	☐		☐
4. I talk to children about their family history or ancestors (for example, life in their homeland, their family tree, places their families have lived, stories told by grandparents).			☐	☐	☐	☐	☐		☐
5. I help children explore their own interests about their racial and ethnic background(s) (for example, help a child to ask the librarian or look up more information on the internet).			☐	☐	☐	☐	☐		☐
6 I involve children in activities that families agree reflect their racial and ethnic background(s) (for example, games, foods, art, music, dance, or songs).			☐	☐	☐	☐	☐		☐
7. I involve children in celebrations or holidays from their own racial or ethnic background(s).			☐	☐	☐	☐	☐		☐
		When I am caring for any school-age children ages 9 through 12…
8. I help older children find age-appropriate books or media created by people from their own racial or ethnic background(s).			☐	☐	☐	☐	☐		☐
9. I encourage older children to share information about their culture with younger children.			☐	☐	☐	☐	☐		☐

End Time: _______

III. Positive and proactive behavior management

[If telephone administered: Next, I’m going to ask you questions about positive and proactive behavior management]

The questions in this section ask about how you help children learn different ways to resolve conflicts and positive ways to express their emotions before conflicts or tantrums happen. They will ask about how you use the environment, predictable routines, questions, role playing, stories, listening, and other strategies to help children learn and understand the impact of their behavior and grow in their ability to make good decisions and resolve social conflicts.

Key terms used in this section:

Predictable routines. Routines or schedules that are consistent and familiar to children.

Responsive routines. Routines or schedules that are flexible in response to children’s needs. They may be adjusted for a child’s needs on particular days (for example, based on changes to activities or if a child is feeling unwell or tired that day).

0. Proactive and positive disciplinary practices. Disciplinary practices that focus on encouraging children’s positive behaviors and reducing their negative behaviors by helping them understand the consequences of their behaviors, both good and bad. These include strategies for anticipating and helping children learn how to negotiate or resolve conflict before it happens.

Age groups in this section:

This section includes the following age groups.

	For these items, respond based on when you are caring for any school-age children … Younger children refers to the younger school-aged children in your care (for example, a 6 year old child). Older children refers to older school-aged children in your care (for example, a 10 year old child).
	For these items, respond based on when you are caring for school-age children and under school-age children … Younger children refers to under school-age children (for example, infants or toddlers). Older children refers to school-age children (for example, a 10 year old child).

Start Time: _______

		Please check one: I do this…						Check if…
What I do to support children		A lot	Sometimes	Rarely	Never	Don’t know	Not applicable	I want to do this more
IIIA. [If telephone administered: The first topic in this section is] Uses predictable and responsive routines
	When I am caring for any school-age children (age 5 and in kindergarten or ages 6 through 12)…
1. I have predictable routines or schedules for children so they know what will happen each day.		☐	☐	☐	☐	☐		☐
2. I take time to welcome or say goodbye to all children when they arrive or leave the home (for example, if a child arrives while we are in the middle of an activity, I say hello and welcome them into the group).		☐	☐	☐	☐	☐		☐
3. I explain changes in the schedule or routine to children (for example, “We are going to eat lunch earlier today to make sure we can go on our walk before it rains!”).		☐	☐	☐	☐	☐		☐
4. I let children know when we will be changing activities (transitions) before they happen (for example, “We will start getting ready to go outside in five minutes”).		☐	☐	☐	☐	☐		☐
5. I give children opportunities to help plan our routines and schedules (for example, children help select the book we read or the game we play outside).		☐	☐	☐	☐	☐		☐
6. I monitor children’s behavior and change plans as needed (for example, when children lose interest in activities, are disruptive, are hungry or tired).		☐	☐	☐	☐	☐		☐
7. I try to understand what children’s behaviors are telling me and come up with a plan to help them (for example, noticing that a child begins to get grumpy most days before snack time and asking if they are hungry earlier in the day).		☐	☐	☐	☐	☐		☐
8. I help children manage their behavior during stressful situations (for example, making a positive comment when children calmly share that they are upset or angry, reminding children to take deep breaths, or asking them questions about what they want to happen and how they can achieve it).		☐	☐	☐	☐	☐		☐
9. I provide children with opportunities to think for themselves: create, problem solve, and plan and work together to make decisions (for example, joint projects, choose-your-own-adventure stories).		☐	☐	☐	☐	☐		☐
10. I ask families about family routines and use them with children when possible (for example, serving food family style or in individual servings, singing favorite songs, or putting time limits on screen time).		☐	☐	☐	☐	☐		☐
11. I monitor what children are doing without interfering unless there is a persistent problem (for example, I allow them to manage their own problem before stepping in and listen or watch for any change in volume, tone, or emotional cues).		☐	☐	☐	☐	☐		☐
12. When children are having trouble following directions, I adjust the words I use or demonstrate what to do.		☐	☐	☐	☐	☐		☐
	When I am caring for school-age children (age 5 and in kindergarten or ages 6 through 12) and under school-age children (ages birth through 5 and not yet in kindergarten)…
13. I invite older children to help when I am caring for younger children (for example, preparing bottles, preparing for naptime).		☐	☐	☐	☐	☐		☐
14. I explain to older children the routines of the younger children (for example, naptime, mealtime).		☐	☐	☐	☐	☐		☐
15. I adjust activities so older and younger children all can be included without getting upset (for example, adjusting directions or allowing more time for different tasks—such as setting different rules for younger children when playing games or giving more time for them to get dressed to go outside).		☐	☐	☐	☐	☐		☐
III.B. [If telephone administered: The next topic in this section is] Uses proactive and positive disciplinary practices
	When I am caring for any school-age children (age 5 and in kindergarten or ages 6 through 12)…
1. I ask children about their feelings before a conflict or disagreement occurs.		☐	☐	☐	☐	☐		☐
2. I give children attention regardless of how they behave (for example, “Krista, great job sharing with your brother” or “Owen, I know you want to play with the toy, but it’s still Alexa’s turn, so you can’t take it from her. What can you play with in the meantime?”).		☐	☐	☐	☐	☐		☐
3. I discuss consequences for children’s behavior, both good and bad, when children are calm (that is, not in the heat of the moment).		☐	☐	☐	☐	☐		☐
4. I discuss and develop rules with children and explain the consequences of not following those rules (for example, I ask questions like, “What could happen if someone throws toys inside?” or “So, what kind of rule will help us respect the toys we share?”).		☐	☐	☐	☐	☐		☐
5. I take time to support children through the problem-solving process during conflicts or disagreements (for example, identifying the problem, discussing the harm caused, agreeing on how to address the harm).		☐	☐	☐	☐	☐		☐
6. I arrange activities to make it easier for children to make good choices and follow rules (for example, talk about acceptable behaviors before starting the activity, have a sign-up list for favorite activities, post a sign with reminders of good behavior).		☐	☐	☐	☐	☐		☐
7. I invite children to help me plan ways to make it easier for them to follow the rules (for example, picking out the calming activities they want to do when they are upset, like doing a dance movement or deep breathing).		☐	☐	☐	☐	☐		☐
8. When one child’s behavior harms another child, I ask the child who was harmed what impact the behavior had on them.		☐	☐	☐	☐	☐	☐	☐
9. When one child’s behavior harms another child, I use standard language to help the child who was harmed say, “I felt [state feeling] when you [state behavior that harmed]. Next time please [do or don’t do…].”		☐	☐	☐	☐	☐	☐	☐
10. When a child misbehaves, I ask how they think their behavior impacted others.		☐	☐	☐	☐	☐		☐
11. I ask children to share positive comments with others about their behavior (for example, “I felt really happy for you when you…” or “Thank you for…that made me feel [positive emotion]”).		☐	☐	☐	☐	☐		☐
	When I am caring for school-age children (age 5 and in kindergarten or ages 6 through 12) and under school-age children (ages birth through 5 and not yet in kindergarten)…
12. I arrange the areas where children play, eat, or sleep in ways that will help prevent problems (for example, making sure there is enough room for children to work or play together peacefully, placing breakable items in safe places, or allowing older children to use breakable materials only while the younger children nap).		☐	☐	☐	☐	☐		☐
13. I explain to older children the rules for younger children (for example, “We keep these toys away from the little ones because they could put them in their mouths and choke. Can you play with this toy over by the table?”).		☐	☐	☐	☐	☐		☐
14. I invite older children to plan ways that make it easier to balance younger children’s routines (for example, invite an older child who is energetic to jump and dance around before drawing quietly while the baby naps).		☐	☐	☐	☐	☐		☐
15. I adapt my rules for children of different ages and ability levels (for example, some children may need more or different types of reminders).		☐	☐	☐	☐	☐		☐

End Time: _______

IV. Support for Learning

[If telephone administered: Next, I’m going to ask you questions about support for learning.]

The questions in this section ask about the ways you provide learning opportunities to children; how you help children develop a “can-do” attitude; how you support children’s problem-solving skills; and how you work with their families to strengthen connections with their home lives, including relating activities and the home to their habits, traditions, and beliefs.

The section includes practices that can be done during everyday learning moments (for example, practicing math using snacks during snack time) or more structured learning (for example, curricula-based activities or a science project activity). For older school-age children, some questions ask about schoolwork or additional academic activities, which you may or may not do depending on your agreement with families.

Key terms used in this section:

• “Can-Do” attitude or growth mindset. A belief that skills, abilities, or intelligence can develop and grow over time.

• Positive approaches to learning. A way of thinking about learning opportunities which includes characteristics such as curiosity, persistence, creativity, and problem-solving skills.

• Scaffolding. Helping or supporting children’s learning and development of new skills that are just beyond their current skill level.

Age groups in this section:

This section includes the following age groups.

For these items, respond based on when you are caring for any school-age children … Younger children refers to the younger school-aged children in your care (for example, a 6 year old child). Older children refers to older school-aged children in your care (for example, a 10 year old child).

Start Time: _______

			Please check one: I do this…						Check if…
What I do to support children			A lot	Sometimes	Rarely	Never	Don’t know	Not applicable	I want to do this more
IV.A. [If telephone administered: The first topic in this section is] Provides learning opportunities
	When I am caring for any school-age children (age 5 and in kindergarten or ages 6 through 12) …
1. I use everyday materials to support children’s learning (for example, magazines and newspapers, recipes or instructions for an activity, growing spices or houseplants, measuring cups).			☐	☐	☐	☐	☐		☐
2. I provide materials that can be used in different ways so children can create different shapes and designs (for example, dominoes can be used to play the traditional game, but also to learn about motion and space, create different shapes and designs, and practice math skills; or magnifying glasses can be used for exploration and investigation).			☐	☐	☐	☐	☐		☐
3. I talk with children about how I use math (measuring, counting, estimating) in everyday activities (for example, I tell children that we measure the ingredients when we cook so we know how much of each ingredient is needed in our food).			☐	☐	☐	☐	☐		☐
4. I provide different open-ended materials that can be used to create musical instruments and other crafts (for example, popsicle sticks, paper towel rolls, milk cartons, blocks, sand).			☐	☐	☐	☐	☐		☐
5. I provide opportunities for children to read books or watch online videos on how to do things they’re interested in (for example, how a bike works, how to fix something that is broken, or how to bake a cake).			☐	☐	☐	☐	☐		☐
6. When children show an interest in something, I help them find books or activities (for example, if a child is interested in art, I help them find an online museum or show them how to use shading in their drawings).			☐	☐	☐	☐	☐		☐
7. When children show an interest in a topic, I ask for their ideas about that topic and what we might do to learn more.			☐	☐	☐	☐	☐		☐
8. I invite children to plan activities that follow their interests.			☐	☐	☐	☐	☐		☐
9. I provide opportunities for children to write stories, work on art activities, take photos, or make up stories and plays.			☐	☐	☐	☐	☐		☐
10. I provide children with time and space for themselves for individual activities (for example, reading or listening to music on their own).			☐	☐	☐	☐	☐		☐
11. I encourage children to read and share books or sing songs with each other or with me.			☐	☐	☐	☐	☐		☐
12. I teach children games that have patterns (for example, hand claps and dance moves).			☐	☐	☐	☐	☐		☐
13. I look for opportunities in the community to support children’s understanding about their world and how it works (for example, community events, a mobile science bus at the park, open house at the fire station, or reading events at a library).			☐	☐	☐	☐	☐		☐
14. I encourage older children to help younger children learn new things.			☐	☐	☐	☐	☐	☐	☐
15. I encourage younger children to respect that older children need time and space to do schoolwork or more difficult activities.			☐	☐	☐	☐	☐	☐	☐
IV.B. [If telephone administered: The next topic in this section is] Supports positive approaches to learning and a growth mindset
		When I am caring for any school-age children (age 5 and in kindergarten or ages 6 through 12)…
1. I comment on children’s effort instead of when they complete a task (for example, I tell children “I admire how hard you’re working on that difficult puzzle”).			☐	☐	☐	☐	☐		☐
2. I talk about how everybody has an opportunity to grow and change (for example, improving their reading skills or sharing how I’ve grown and changed).			☐	☐	☐	☐	☐		☐
3. I talk to children about how they have changed over time (for example, I describe to children how they’ve gained new skills over time).			☐	☐	☐	☐	☐		☐
4. I talk to children about their strengths (for example, things they can do well or that they like about themselves).			☐	☐	☐	☐	☐		☐
5. I let children know they can reach their goals even when there are challenges.			☐	☐	☐	☐	☐		☐
6. I remind children that there are different ways to learn.			☐	☐	☐	☐	☐		☐
7. I help children stay focused on the things they are doing.			☐	☐	☐	☐	☐		☐
8. I support children in carrying out their plans (for example, providing materials for birthday cards they want to make or asking them what characters they need in their play).			☐	☐	☐	☐	☐		☐
9. I share books, stories, or videos about people overcoming challenges.			☐	☐	☐	☐	☐		☐
10. I support children in completing tasks until they reach their goal, even if it is hard for them.			☐	☐	☐	☐	☐		☐
IV.C. [If telephone administered: The next topic in this section is] Scaffolds problem solving
		When I am caring for any school-age children (age 5 and in kindergarten or ages 6 through 12)…
1. I provide support for children learning complex skills (for example, I encourage children to start with the easiest step they can do and then show them the next step and have them try it).			☐	☐	☐	☐	☐		☐
2. I read books with children that are more challenging than what they can read on their own.			☐	☐	☐	☐	☐		☐
3. I ask children questions that require them to explain their responses (for example, questions that do not have a simple yes or no answer).			☐	☐	☐	☐	☐		☐
4. If children have schoolwork, I ask children questions about different ways they can approach a problem they might be having with their schoolwork.			☐	☐	☐	☐	☐	☐	☐
5. I help children locate resources for things they find difficult (for example, when they have trouble with math, I look for an online resource).			☐	☐	☐	☐	☐		☐
6. I talk with children about how to break a difficult task into smaller, easier steps (for example, I show children how to put a puzzle together by first finding the outer pieces).			☐	☐	☐	☐	☐		☐
7. I show children a different way to think about a problem and ask them how they might solve it (for example, I ask questions or use “I wonder…” statements, or ask children to think about how to solve their problem instead of fixing it for them).			☐	☐	☐	☐	☐		☐
8. When children face a difficult problem, I talk about what the problem is.			☐	☐	☐	☐	☐		☐
9. I encourage children to ask a friend to show them how to solve the problem.			☐	☐	☐	☐	☐		☐
IV.D. [If telephone administered: The next topic in this section is] Collaborates with families to strengthen learning connections with home
	When I am caring for any school-age children (age 5 and in kindergarten or ages 6 through 12)…
1. I ask families how they would like me to reinforce and support children’s learning, including during the summer and other school holidays or breaks.			☐	☐	☐	☐	☐		☐
2. I meet with families (for example, during pick-up or drop-off, or a scheduled time either in person or virtually) to update them on what and how their children are doing while in my care.			☐	☐	☐	☐	☐		☐
3. I try to honor families’ preferences for how older and younger children interact.			☐	☐	☐	☐	☐	☐	☐
4. I ask families about their values and cultures so I can incorporate them when their children are in my care.			☐	☐	☐	☐	☐		☐
5. I ask families what I can do to support their child if they have special needs.			☐	☐	☐	☐	☐	☐	☐
6. I share information with families about their child’s day (for example, during pick-up or via texts or phone calls).			☐	☐	☐	☐	☐		☐
7. I share positive comments about children and their progress with their families (for example, I text or call parents to let them know “Kip worked really hard at playing basketball today” or “Amani concentrated on today’s math puzzle and finished it all”).			☐	☐	☐	☐	☐		☐
8. If I allow screentime, I talk with families about what kind of screen time is appropriate for their children when they are in my care.			☐	☐	☐	☐	☐	☐	☐

End Time: _______

V. Support for Health and Physical Development

[If telephone administered: Next, I’m going to ask you questions about support for health and physical development.]

Along with what children do at home and school, HBCC providers can support children’s physical and health development. The questions in this section ask about how you provide different kinds of activities to support children’s physical well-being; help children learn different physical activities that are fun and interesting to them; and promote overall health, safety, and nutrition.

This section includes examples of activities you might do indoors or outdoors. Not all providers have access to safe outdoor spaces. Even if you do not go outdoors with children, most of the questions can be answered using indoor activities.

Key terms used in this section:

• Active play. Moderate to vigorous physical activity that encourages children to move freely and have fun.

• Scaffolding. Helping or supporting children’s learning and development of new skills that are just beyond their current skill level.

Age groups in this section:

This section includes the following age groups.

For these items, respond based on when you are caring for any school-age children … Younger children refers to the younger school-aged children in your care (for example, a 6 year old child). Older children refers to older school-aged children in your care (for example, a 10 year old child).

Start Time: _______

		Please check one: I do this…						Check if…
What I do to support children		A lot	Sometimes	Rarely	Never	Don’t know	Not applicable	I want to do this more
V.A. [If telephone administered: The first topic in this section is] Provides a variety of activities to support physical well-being
	When I am caring for any school-age children (age 5 and in kindergarten or ages 6 through 12)…
1. I talk with children about the benefits of movement and exercise (for example, how moving our bodies gives us more energy, can make us feel happier, can help us learn more easily, gives us strong bones and healthy bodies).		☐	☐	☐	☐	☐		☐
2. I invite children to plan and choose what physical activities they would like to do.		☐	☐	☐	☐	☐		☐
3. I encourage children to include physical movements in everyday routines that are appropriate for their abilities (for example, climbing stairs instead of using elevators, skipping to the bus stop, balancing on one foot while brushing their teeth).		☐	☐	☐	☐	☐		☐
4. I use participating in physical activity in positive ways for all children (for example, being physically active is one way to have fun or learn new skills).		☐	☐	☐	☐	☐		☐
5. I help children learn to relax their bodies (for example, stretching or taking deep breaths).		☐	☐	☐	☐	☐		☐
6. I stretch my body to show children the importance of stretching after a lot of sitting or after using muscles in a repetitive movement.		☐	☐	☐	☐	☐		☐
7. I help children learn how to do different physical activities (for example, find videos on YouTube to learn a new dance move or body stretch).		☐	☐	☐	☐	☐		☐
8. I encourage children to participate in some active play that builds their muscles, bones, and heart health (for example, dancing, skipping, jumping rope, walking, and games/activities that involve a lot of movement).		☐	☐	☐	☐	☐		☐
9. I join children in activities or games that they play outside (for example, gardening together; pitching a ball; playing basketball; refereeing; or calling out the signals for red light, green light).		☐	☐	☐	☐	☐		☐
10. I offer activities that increase children’s balance and body control (for example, hopscotch, yoga, tai-chi, judo, wrestling).		☐	☐	☐	☐	☐		☐
11. I provide children with regular access to space with play equipment or opportunities outside of my indoor space (for example, backyard, park, playground, climbing gym, basketball court, sledding hill).		☐	☐	☐	☐	☐		☐
12. We go for walks or play outside when it is safe to do so.		☐	☐	☐	☐	☐		☐
13. I provide children with opportunities to explore the natural and physical environment (for example, mixing oil and water, growing sprouts or herbs in the kitchen, watching science or nature documentaries, hatching caterpillars, or exploring with water and sand).		☐	☐	☐	☐	☐		☐
V.B. [If telephone administered: The next topic in this section is] Communicates with families about health and physical development
	When I am caring for any school-age children (age 5 and in kindergarten or ages 6 through 12)…
1. I ask children what physical activities they like to do at home and school.		☐	☐	☐	☐	☐		☐
2. I plan for physical activities that represent children’s backgrounds (for example, dances and games from their culture or around the world).		☐	☐	☐	☐	☐		☐
3. I invite children to show how to do physical activities they know from home (for example, demonstrating dance moves they do at home or a game they play outdoors).		☐	☐	☐	☐	☐		☐
4. I talk with families about the importance of the physical activities and exercises we do.		☐	☐	☐	☐	☐		☐
5. When children spend the night, I use bedtime routines that connect them to home (for example, reading a familiar book, having them leave a voicemail for their parents, offering a healthy pre-bed snack they have at home).		☐	☐	☐	☐	☐	☐	☐
6. If I feed children, I ask families about foods their child likes at home (for example, spicy or bland, types of spices used at home).		☐	☐	☐	☐	☐	☐	☐
7. If families send food for their children, I talk to families about healthy food options familiar to them.		☐	☐	☐	☐	☐	☐	☐
V.C. [If telephone administered: The next topic in this section is] Scaffolds physical activity
	When I am caring for any school-age children (age 5 and in kindergarten or ages 6 through 12)…
1. I break activities into smaller or simpler steps to help children learn physical skills (for example, practice dribbling or playing horse in basketball).		☐	☐	☐	☐	☐		☐
2. I support children in doing physical skills they could not do before, including things they were scared to try (for example, going down a slide, joining double dutch (jumping rope), climbing a ladder).		☐	☐	☐	☐	☐		☐
3. I give children time and opportunities to practice their physical skills (for example, time to practice jump rope, hula hoop, or kicking a ball).		☐	☐	☐	☐	☐		☐
4. I include all children in physical activities regardless of their characteristics (for example, invite girls and boys to play a ball game or encourage less coordinated children to join).		☐	☐	☐	☐	☐		☐
5. I adapt physical activities so all children are included, including those who might have more difficulty (for example, children of different ages or those with limited physical strength or coordination).		☐	☐	☐	☐	☐		☐
6. I use games and activities that children can participate in without waiting with nothing to do for long periods of time (for example, avoiding games such as wall ball, where children who are “out” have to wait on the side).		☐	☐	☐	☐	☐		☐
7. I teach children how they can play physically active games together, even when they’re different ages (for example, having different rules for younger and older children: younger children are allowed to use a beachball that they drop themselves when it is their turn at kickball).		☐	☐	☐	☐	☐	☐	☐
8. I talk with children about which physical activities they feel comfortable, confident, and safe in doing, and which ones are more challenging for them.		☐	☐	☐	☐	☐		☐

	Please check one:				Check if…
	Yes	No	Don’t know	Not applicable	I want to do this more
9. I stop any criticism from others when children have difficulty with physical activity.	☐	☐	☐	☐	☐
10. I show children how to encourage other children who are learning a new skill.	☐	☐	☐	☐	☐
11. I remind children that athletes keep trying and practice over and over again.	☐	☐	☐		☐

		Please check one: I do this…						Check if…
What I do to support children		A lot	Sometimes	Rarely	Never	Don’t know	Not applicable	I want to do this more
V.D. [If telephone administered: The next topic in this section is] Promotes health, safety, and nutrition
	When I am caring for any school-age children (age 5 and in kindergarten or ages 6 through 12)…
1. I plan for potential safety issues (for example, putting unsafe materials out of reach of young children or having a system to watch over both older and younger children when they go outside).		☐	☐	☐	☐	☐		☐
2. I make sure all children participate safely in physical activities (for example, slides and climbing structures that are not too tall for the child, soft and rubber balls appropriately sized for the child’s ability, helmets for bikes and skateboards).		☐	☐	☐	☐	☐		☐
3. I plan ways to keep children safe when I take them outside (for example, going outside when there are neighbors to help watch them, using a buddy system, telling children ahead of time where they can play outside).		☐	☐	☐	☐	☐		☐
4. I use physical reminders (for example, painter’s tape on the floor, mats, carpet squares) to remind children about different areas for play.		☐	☐	☐	☐	☐		☐
5. I talk with children about safety and ask them to tell me about potential safety problems (for example, a potholder too close to a stove burner, a slide that is too hot, or tripping hazards).		☐	☐	☐	☐	☐		☐
6. I talk with older children about how they can help younger children stay safe (for example, keeping cabinet doors shut, keeping small objects like marbles out of reach, having a younger buddy when they play outside).		☐	☐	☐	☐	☐	☐	☐
7. I show children how to lift and carry heavy objects safely.		☐	☐	☐	☐	☐		☐
8. I help children practice good hygiene and avoid spreading germs (for example, children wash their hands before eating, after using the bathroom, or after playing outside or doing messy art.)		☐	☐	☐	☐	☐		☐
9. I talk to children and families about the importance of getting enough sleep for physical and mental health and success in school.		☐	☐	☐	☐	☐		☐
10. I help children practice healthy sleep habits (for example, no screen time before bed or using predictable and calming bedtime routines like deep, slow breathing).		☐	☐	☐	☐	☐	☐	☐
11. I work with families to manage children’s use of media to protect mental health and well-being (for example, turning off the television when a traumatic event has occurred, protecting children from social media).		☐	☐	☐	☐	☐		☐
12. If I feed children, I ask families about their food preferences and nutritional alternatives for their children (for example, nut or dairy allergies, vegetarian, vegan, sensitivity to gluten).		☐	☐	☐	☐	☐	☐	☐
13. If I feed children, I provide opportunities for children to help me plan and prepare for meals (for example, giving children options for what they want to eat next week, setting the table, counting out enough snacks for everyone).		☐	☐	☐	☐	☐	☐	☐
14. I talk about what healthy foods can do for the body (for example, milk, beans, whole grains, fresh fruit, and vegetables) instead of labeling any foods as good or bad.		☐	☐	☐	☐	☐		☐
15. I help children learn how to eat healthily by sparking curiosity about foods (for example, watching videos or playing games and apps like those on MyPlate.gov).		☐	☐	☐	☐	☐		☐
16. If I feed children, I include different food groups.		☐	☐	☐	☐	☐	☐	☐
17. I make sure that children drink water, especially when it is hot and after they have been very active.		☐	☐	☐	☐	☐		☐
18. If I feed children, I limit the sweets children eat and drink.		☐	☐	☐	☐	☐	☐	☐
19. If I feed children, I limit the salty snacks children eat.		☐	☐	☐	☐	☐	☐	☐

End Time: _______

HBCC-NSAC Toolkit Provider Questionnaire: Next Steps

[If telephone administered: You have completed all the questions in the provider questionnaire.]

You may [if web or hard-copy administered: look back at] [if telephone administered think about] your responses to identify your strengths (practices you already do), practices you want to do or do more of, and topics or practices you want to learn more about. [If web or hard-copy administered: If you want to, you can use the questions below to help you look back and plan for the future.] [If telephone administered: If you want to, I can read you questions that can help you think back and plan for the future. Would you like me to read you these questions? IF YES: Continue. IF NO: SKIP TO END.]

It could be especially helpful to talk about your answers to the provider questionnaire with someone else like a coach, mentor, or fellow HBCC provider. For example, you and another provider could complete the provider questionnaire at the same time and use the questions to spark discussion, celebrate each other’s strengths, and help each other develop a plan for what you will do next. We encourage you to discuss these strategies with others.

[If telephone administered: I will now read our recommended reflection questions. You do not need to provide answers to these questions.]

Recommended Reflection Questions:

1. Now, thinking about the practices where you [if web or hard-copy administered: checked] [if telephone administered: chose] “a lot” above, reflect on these questions:

2. What helps you do these things a lot?

1. How do you think children in your care benefit from the practices you’re already doing a lot?

2. Do you think these are your strengths? How can you build on those strengths? Are there additional times or additional children you think would benefit from these practices?

2. Now, thinking about the practices where you [if web or hard-copy administered: checked] [if telephone administered: chose] “sometimes” above, reflect on these questions:

3. What helps you do these practices?

4. Do you want to do these practices more or less often, or more with certain groups of the children in your care?

5. What would help you do that practice more effectively – at the most beneficial times or with children who will benefit the most from it?

3. Now, thinking about the practices where you [if web or hard-copy administered: checked] [if telephone administered: chose] “rarely” above, reflect on these questions:

6. Are these practices important to you?

7. Do you want to do these practices more often?

8. Do you want to learn more about a practice before you do more of it? If so, what can you do to learn more (for example, can you search online, or talk to a friend, peer, or coach)?

9. What would help you do that practice more?

4. Now, thinking about the practices where you [if web or hard-copy administered: checked] [if telephone administered: chose] “never” above, reflect on these questions:

10. Are these practices important to you?

11. Do you want to learn more about a practice before you try it? If so, what can you do to learn more (for example, can you search online, or talk to a friend, peer, or coach)?

12. Have you discussed these practices with other HBCC owners or professional development providers to learn why and when they might be helpful for the children in your care?

5. If you care for more than one child, are there any practices for which your answer changed depending on the child? For example, do you think you do the practice “rarely” for one child but “a lot” for another child? Think about why this may be so. Is it related to something about the child, such as the child’s maturity level, language spoken, abilities, or special needs?

[If telephone administered: Those are all the questions I have for you. Thank you again for your time! We would like to mail you a $50 gift card to thank you.  

CONFIRM MAILING ADDRESS.]

[If web or hard-copy administered: TOKEN OF APPRECIATION MAILING ADDRESS CONFIRMATION]

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