Family survey

Instrument 6. Family Survey

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

Family Survey

What is a home-based provider?

For this survey, “home-based provider” is a person who takes care of your child(ren) in a home. For you, this might be a professional caregiver (like a family child care setting) or a family member, friend, or neighbor. We will refer to the person who shared this survey with you as “your child’s provider” or “your caregiver” throughout this survey.

Your child(ren)’s home-based provider plays an important role in caring for your child(ren) and helping them reach their full potential.

This survey asks you questions about your experiences having your child(ren) in home-based care and your child's provider. It should take you about 15 minutes to complete the survey.

[IF PAPER: First, please enter the time you start this survey.

Start Time: | | | : | | | AM/PM]

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 15minutes 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 Office of Management and Budget (OMB) control number. The OMB number for this collection is 0970-XXXX and the expiration date is XX/XX/2024. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Ashley Kopack Klein, [email protected], 600 Alexander Park, Suite 100, Princeton, NJ 08540; Attn: OMB-PRA 0970-XXXX.

Part I

Instructions: Write in your responses to these short answer questions about your child(ren) cared for by the home-based provider who shared this survey with you (we refer to this person as “your child’s provider”). For example, if you have 3 children cared for by your child’s provider, fill out the information for each child (Child 1, Child 2, and Child 3). There is space for up to 4 children.

Child 1

1a. What is your relationship to Child 1?

□ Primary parent or guardian

□ Grandparent

□ Other relative

□ Other non-relative

1b. Is Child 1 of Hispanic, Latino/a, or Spanish origin?

□ Yes

□ No

1c. What is Child 1’s race? Check all that apply.

□ American Indian or Alaska Native

□ Asian

□ Black or African American

□ Native Hawaiian or Other Pacific Islander

□ White

□ Another race (please fill in):

1d. Child 1’s age: | | | years or | | | months

Child 2

2a. What is your relationship to Child 2?

□ Primary parent or guardian

□ Grandparent

□ Other relative

□ Other non-relative

2b. Is Child 2 of Hispanic, Latino/a, or Spanish origin?

□ Yes

□ No

2c. What is Child 2’s race? Check all that apply.

□ American Indian or Alaska Native

□ Asian

□ Black or African American

□ Native Hawaiian or Other Pacific Islander

□ White

□ Another race (please fill in):

2d. Child 2’s age: | | | years or | | | months

Child 3

3a. What is your relationship to Child 3?

□ Primary parent or guardian

□ Grandparent

□ Other relative

□ Other non-relative

3b. Is Child 3 of Hispanic, Latino/a, or Spanish origin?

□ Yes

□ No

3c. What is Child 3’s race? Check all that apply.

□ American Indian or Alaska Native

□ Asian

□ Black or African American

□ Native Hawaiian or Other Pacific Islander

□ White

□ Another race (please fill in):

3d. Child 3’s age: | | | years or | | | months

Child 4

4a. What is your relationship to Child 4?

□ Primary parent or guardian

□ Grandparent

□ Other relative

□ Other non-relative

4b. Is Child 4 of Hispanic, Latino/a, or Spanish origin?

□ Yes

□ No

4c. What is Child 4’s race? Check all that apply.

□ American Indian or Alaska Native

□ Asian

□ Black or African American

□ Native Hawaiian or Other Pacific Islander

□ White

□ Another race (please fill in):

4d. Child 4’s age: | | | years or | | | months

5. What are the main language(s) you use at home with your child(ren)?

Home language 1:

Home language 2:

5. Do you or others in your household usually speak to your child(ren) in languages other than the ones listed above? (This could include the languages grandparents, siblings, or other household members speak to your child.)

□ Yes

□ No

Part II

[FOR REVIEWERS: Citation: Emlen, A. C., P.E. Koren, and K.H. Schultze. A Packet of Scales for Measuring Quality of Child Care from a Parent’s Point of View. Portland, OR: Regional Research Institute for Human Services, Portland State University, 2000. http://www.ssw.pdx.edu/focus/emlen/pgOregon.php & http://www.hhs.oregonstate.edu/familypolicy/occrp/publications.html.]

Instructions: Please think about how the following statements describe either your: child’s provider (or “caregiver”), your child’s experience with their provider, or your child’s experience in care.

As you answer each question:

• Think only about your child’s provider who shared this survey with you

• Think about all of your children cared for by this provider

Then, choose…

• Never

• Rarely

• Sometimes

• Often

• Always

• Don’t know

• Does not apply to me

	Never	Rarely	Sometimes	Often	Always	Don't know	Does not apply to me
1. My child feels safe and secure in care.	☐	☐	☐	☐	☐	☐	☐
2. The caregiver is warm and affectionate toward my child.	☐	☐	☐	☐	☐	☐	☐
3. It’s a healthy place for my child.	☐	☐	☐	☐	☐	☐	☐
4. My child is treated with respect.	☐	☐	☐	☐	☐	☐	☐
5. My child is safe with this caregiver.	☐	☐	☐	☐	☐	☐	☐
6. My child gets a lot of individual attention.	☐	☐	☐	☐	☐	☐	☐
7. My caregiver and I share information.	☐	☐	☐	☐	☐	☐	☐
8. My caregiver is open to new information and learning.	☐	☐	☐	☐	☐	☐	☐
9. My caregiver shows she (he) knows a lot about children and their needs.	☐	☐	☐	☐	☐	☐	☐
10. The caregiver handles discipline matters easily without being harsh.	☐	☐	☐	☐	☐	☐	☐
11. My child likes the caregiver.	☐	☐	☐	☐	☐	☐	☐
12. My caregiver is supportive of me as a parent.	☐	☐	☐	☐	☐	☐	☐
13. There are a lot of creative activities going on.	☐	☐	☐	☐	☐	☐	☐
14. It’s an interesting place for my child.	☐	☐	☐	☐	☐	☐	☐
15. My caregiver is happy to see my child.	☐	☐	☐	☐	☐	☐	☐

	Never	Rarely	Sometimes	Often	Always	Don't know	Does not apply to me
16. The caregiver makes an effort to get to know my child.	☐	☐	☐	☐	☐	☐	☐
17. The caregiver accepts my child for who she (he) is.	☐	☐	☐	☐	☐	☐	☐
18. The caregiver takes an interest in my child.	☐	☐	☐	☐	☐	☐	☐
19. My child feels accepted by the caregiver.	☐	☐	☐	☐	☐	☐	☐
20. I feel welcomed by the caregiver.	☐	☐	☐	☐	☐	☐	☐
21. My caregiver accepts the way I raise my child.	☐	☐	☐	☐	☐	☐	☐
22. My child has been happy in this arrangement.	☐	☐	☐	☐	☐	☐	☐
23. My child has been irritable since being in this arrangement.	☐	☐	☐	☐	☐	☐	☐
24. My child feels isolated and alone in care.	☐	☐	☐	☐	☐	☐	☐

	Never	Rarely	Sometimes	Often	Always	Don't know	Does not apply to me
25. My child is safe with this caregiver.	☐	☐	☐	☐	☐	☐	☐
26. There are too many children being cared for at the same time.	☐	☐	☐	☐	☐	☐	☐
27. The caregiver needs more help with the children.	☐	☐	☐	☐	☐	☐	☐
28. The caregiver gets impatient with my child.	☐	☐	☐	☐	☐	☐	☐
29. The children seem out of control.	☐	☐	☐	☐	☐	☐	☐
30. The children watch too much TV.	☐	☐	☐	☐	☐	☐	☐
31. I worry about bad things happening to my child in care.	☐	☐	☐	☐	☐	☐	☐
32. Dangerous things are kept out of reach.	☐	☐	☐	☐	☐	☐	☐
33. There are plenty of toys, books, pictures, and music for my child.	☐	☐	☐	☐	☐	☐	☐
34. In care, my child has many natural learning experiences.	☐	☐	☐	☐	☐	☐	☐
35. The caregiver provides activities that are just right for my child.	☐	☐	☐	☐	☐	☐	☐

Go to Part III.

[IF PAPER: Please enter the time you finished this survey.

End Time: | | | : | | | AM/PM]

Thank you for completing the family survey!