Baby FACES: HOME VISITOR INTERVIEW

What languages are used for instruction in
your class?

What is the highest level of school you have MARK ONE
completed?
1 Some high school
2 High school graduate or GED
If you are still in school or no longer in
3 Some college courses, but no degree
school: Please tell us about the last year of 4 Two year college degree
schooling you finished.
5 Four year college degree
6 Some graduate school
7 Graduate degree

Staff Demographics

Staff Demographics

1

1. Fluent
2 Not fluent but can speak the language
3 Can't speak the language but can understand when someone
else is speaking
4 Can neither speak nor understand the language
"MARK ALL THAT APPLY
1. ENGLISH
2. SPANISH
3. VIETNAMESE
4. CHINESE
5. JAPANESE
6. KOREAN
7. A FILIPINO LANGUAGE
8. OTHER LANGUAGE (SPECIFY) Please tell me what
other languages are used for instruction in this classroom?"

FOR EACH LANGUAGE SELECTED:
How fluent are you in this language?
COLUMN

Staff Demographics

Question Response
MARK ALL THAT APPLY
1 ENGLISH
2 SPANISH
3 CREOLE
4 MANDARIN
5 CANTONESE
6 JAPANESE
7 VIETNAMESE
8 OTHER (SPECIFY)
9 OTHER (SPECIFY)

Question Item
What language or languages do you speak?
ROWS

Survey Section
Staff Demographics

PRIMARY CAREGIVER/ HOME VISITOR INTERVIEW

Primary Caregiver and EHSREP
Home Visitor CAPI

Primary Caregiver and FACES 2006
Home Visitor CAPI

Primary Caregiver and New
Home Visitor CAPI

Primary Caregiver or
Home Visitor
Used in prior Study
Primary Caregiver and EHSREP
Home Visitor CAPI

Question Item
Have you had any of the following special
child care training?

Are you currently enrolled in any of the
following special child care trainings?

Survey Section
Staff Demographics

Staff Demographics

2

a Currently enrolled in an Early Childhood Education at an
accredited institution of higher education
b. Currently enrolled in CDA training at an accredited
institution of higher education
c. Currently enrolled in a course of early childhood training
from some other organization (not an accredited college or
university) that leads toward a state infant-toddler credential,
the CDA, a family child care certificate, or other credential
recognized in your state

Primary Caregiver and SEHSP
Home Visitor CAPI

Primary Caregiver or
Question Response
Home Visitor
Used in prior Study
a. A Graduate degree in Early Childhood Education or a
Primary Caregiver and SEHSP
related field
Home Visitor CAPI
b. A Baccalaureate degree in Early Childhood Education or a
related field
c. Associate degree in Early Childhood Education or a related
field
d. Child Development Associate (CDA) credential
e. State-awarded preschool, infant/toddler, family child care or
home-based certification, credential, or licensure that meets or
exceeds CDA requirements

PRIMARY CAREGIVER/ HOME VISITOR INTERVIEW

3

How many times a year do your managers or Never; _Times per year
staff supervisors conduct staff trainings?

Program
Implementation

Male; Female

MARK ALL THAT APPLY
1. WHITE
2. BLACK OR AFRICAN AMERICAN
3. AMERICAN INDIAN OR ALASKA NATIVE (SPECIFY)
4. ASIAN INDIAN
5. CHINESE
6. FILIPINO
7. JAPANESE
8. KOREAN
9. VIETNAMESE
10. ASIAN (NOT FURTHER SPECIFIED)
11. NATIVE HAWAIIAN
12. GUAMANIAN OR CHAMORRO
13. SAMOAN
14. OTHER PACIFIC ISLANDER (SPECIFY)
15. ANOTHER RACE
16. DON’T KNOW
17. REFUSED
18. OTHER (SPECIFY) “Please tell me what is your race?”

1 Mexican, Mexican American, Chicano, Puerto Rican,
2 Cuban, or
3 another Spanish/Hispanic/Latino group? (SPECIFY)

Question Response
Yes; No

INTERVIEWER CODE WITHOUT
ASKING

What is your race? You may name more
than one if you like.

Question Item
Are you of Spanish, Hispanic, or Latino
origin?
Which one of these best describes you

Staff Demographics

Survey Section
Staff Demographics

PRIMARY CAREGIVER/ HOME VISITOR INTERVIEW

Primary Caregiver and SEHSP
Home Visitor CAPI

Primary Caregiver and EHSREP
Home Visitor CAPI

Primary Caregiver or
Home Visitor
Used in prior Study
Primary Caregiver and FACES 2006
Home Visitor CAPI

Do you need to submit written lesson plans? Yes; No
1. Once a month
IF YES:
2. Two times a month
How often do you submit written lesson
3. Three times a month
plans?
4. More than three times a month

Program
Implementation

4

1. Once a month
2. Once every 1-3 months
3. Once every 4-6 months
4. Once a year
5. Never

How frequently do you have supervision
meetings?

Program
Implementation

Program
Implementation

Primary Caregiver and New
Home Visitor CAPI

Primary Caregiver and New
Home Visitor CAPI

Primary Caregiver and New
Home Visitor CAPI

New

Primary Caregiver
CAPI

1. One-on-one supervision
2. Group supervision
3. Both
Yes; No

Do you have one-on-one supervision
meetings, group supervision meetings or
both?
Are supervision meetings scheduled
regularly?

Program
Implementation

Primary Caregiver and New
Home Visitor CAPI

Primary Caregiver or
Home Visitor
Used in prior Study
Primary Caregiver and SEHSP
Home Visitor CAPI

Yes; No

Yes; No

Do you have an individual development
plan?

FOR EACH YES ASK:
Who is eligible to receive [FILL IN EACH
BENEFIT OFFERED]?

Question Item
Question Response
Does your Early Head Start program or
Yes; No
grantee agency provide any of the following:
a. Tuition reimbursement for relevant college
courses
b. Workshop fees or other costs for outside
training
c. Time during work hours for staff
development activities such as attending
courses or workshops

Program
Implementation

Survey Section
Program
Implementation

PRIMARY CAREGIVER/ HOME VISITOR INTERVIEW

Program
Implementation

As part of your employment in this Early
Head Start program do you have the
following?

Program
Implementation
Yes; No

Question Response
Yes; No

4. Our Early Head Start program helps
primary caregivers/ home visitors to work
effectively with families from different
cultural groups.

3. Our Early Head Start program helps
primary caregivers/ home visitors to work
effectively with children with disabilities.

2. Our Early Head Start program allows
primary caregivers/ home visitors input into
planning curriculum.

1. Overall, our Early Head Start program has
high morale

5

Please tell me the extent to which you agree 1. Strongly disagree, 2. Disagree, 3. Neutral, 4. Agree, 5.
or disagree with the following statements:
Strongly Agree, NA, DK

A. Educational stipends to cover workshops?
B. Retirement/pension plan?
C. Life insurance?
D. Paid maternity/paternity leave?
E. Paid health insurance?
F. Dental insurance?
G. Paid sick leave?
H. Paid holidays?
I. Paid vacations?

Question Item
Have you been assigned a mentor?

Survey Section
Program
Implementation

PRIMARY CAREGIVER/ HOME VISITOR INTERVIEW

Primary Caregiver and SEHSP Work Climate
Home Visitor CAPI
Survey (Modified)

Primary Caregiver and EHSREP
Home Visitor CAPI

Primary Caregiver or
Home Visitor
Used in prior Study
Primary Caregiver and FACES 2006
Home Visitor CAPI

6

hh:mm, child does not nap

Sleep Individualization How long does a typical nap usually last?
(center-based only)

Do you have any parents of current or former Yes; No
Head Start children employed in your center?

Number

Sleep Individualization How many naps do the children take in a
(center-based only)
typical day?

Primary Caregiver/
Home Visitor Ratings

Primary Caregiver
CAPI

Yes; No

Sleep Individualization IF YES: Do children take naps other than at
(center-based only)
the routine nap times?

Primary Caregiver
CAPI

Primary Caregiver
CAPI

Primary Caregiver
CAPI

New

Primary Caregiver
CAPI

FACES 2006

New

New

New

New

Home Visitor CAPI

Sleep Individualization During home visits, do encourage parents to Yes; No
provide adequate sleep for their
infants/toddlers?
Sleep Individualization Are there sleep routines in place at your
Yes; No
(center-based only)
center?

Radloff, L. S. (1977). The CES-D scale: A
self-report depression scale for research in
the general population. Applied
Psychological Measurement, 1, 385-401

CES-D Short Form (20 items)

Mental Health/ Well
Being

Primary Caregiver and ECLS-B
Home Visitor CAPI

Primary Caregiver or
Home Visitor
Used in prior Study
Primary Caregiver and FACES 2006/EHSREP
Home Visitor CAPI

Rarely or never, some or a little of the time, occasionally or a Primary Caregiver and EHSREP
moderate amount of time, or most or all of the time
Home Visitor CAPI

Has a doctor ever told you that you have . . . Yes; No
a. Asthma
b. Allergies
c. A serious mental illness, such as
schizophrenia, a paranoid disorder, a bipolar
disorder, or manic episodes
d. Diabetes
e. Major depression
f. A learning disability

Physical Health

Question Response
Excellent, very good, good, fair, or poor?

Question Item
Now, let’s talk about your health. Would
you say your health in general is . . .

Survey Section
Physical Health

PRIMARY CAREGIVER/ HOME VISITOR INTERVIEW

Primary Caregiver/
Home Visitor Ratings

Primary Caregiver/
Home Visitor Ratings

Survey Section
Primary Caregiver/
Home Visitor Ratings

7

Number- Percentage

Question Response
Yes; No

In general, how often do families typically
1. Often
attend home visits as scheduled? Would you 2. Sometimes
say…
3. Rarely
4. Never

a. As classroom
volunteers................................
b. As members of a parent council or other
governing bodies..............................
c. By doing maintenance, chores, or
shopping for the
center............................................................
d. By helping at special events or
activities...................................................
e. By attending special events or activities,
such as a children's performance, holiday
party, etc.....................

What percent of the children in your center
have parents who participate in
any of the following ways?

a. as classroom aides, or bus monitors or
drivers?
b. with screening or child assessment?
c. as consultants or workshop leaders?
d. home visitors?
e. as interpreters for non-English speaking or
limited English-speaking families?
f. in recruiting families?
g. mentor or encourage other families to
participate?

Question Item
During this year and the past Early Head
Start year, have parent volunteers in your
center helped . . .

PRIMARY CAREGIVER/ HOME VISITOR INTERVIEW

Home Visitor CAPI

Primary Caregiver
CAPI

New

ECLS-B

Primary Caregiver or
Home Visitor
Used in prior Study
Primary Caregiver
FACES 2006
CAPI

Do you have access to a computer?

Do you have laptops for use during home
visits?
Does your Early Head Start program have
internet access?

Use of data

Use of data

Use of data

Question Item
In general, how often do families typically
attend center based visits as scheduled?
Would you say...

Survey Section
Primary Caregiver/
Home Visitor Ratings

Yes; No

Yes; No

8

Question Response
1. Often
2. Sometimes
3. Rarely
4. Never
Yes; No

PRIMARY CAREGIVER/ HOME VISITOR INTERVIEW

New

New

Primary Caregiver and New
Home Visitor CAPI

Primary Caregiver
CAPI
Home Visitor CAPI

Primary Caregiver or
Home Visitor
Used in prior Study
Primary Caregiver
New
CAPI