Family Caregiver Questionnaire

Program ID#__________ Classroom ID#__________ Caregiver ID#___________

Do not write in box. For study use only.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is xxxx-xxxx. The time required to complete this information collection is estimated to average 30 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have any comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Education, Washington, D.C. 20202-4651. If you have comments or concerns regarding the status of your individual submission of this form, write directly to: Rafael Valdivieso, U.S. Department of Education, 555 New Jersey Avenue, NW, Room 506E, Washington, D.C. 20208.

Responses to this data collection will be used only for statistical purposes. The reports prepared for this study will summarize findings across the sample and will not associate responses with a specific program or individual. We will not provide information that identifies you or your program to anyone outside the study team, except as required by law.

Your cooperation in completing this survey is needed to make the results of this study comprehensive, reliable, and timely.

5. Family Caregiver Questionnaire

Program Level Information

1. What is the age of the oldest child in your care? ________ years

2. What is the age of the youngest child in your care? __________ months

3. How many of the children you currently care for have special needs?

This includes those children with a diagnosed disability, a chronic illness or medical problem, or a severe social/emotional problem.

____________children

4. Approximately what number of the children enrolled in your care belong to the following racial-ethnic groups?

Enter “0” if your program has no children of that racial-ethnic group. The number column should sum to total enrollment of the program.

	NUMBER
a. American Indian or Alaska Native ………………………………….	_____
b. Asian ………………………………………………………………………….	_____
c. Black or African American ……………………………………………..	_____
d. Hispanic or Latino ………………………………………………………..	_____
e. Native Hawaiian or Other Pacific Islander ………………………	_____
f. White ………………………………………………………………………….	_____
g. TOTAL ………………………………………………………………………..	_____

5. Do you charge for the child care that you provide?

• No

• Yes  Go to question 7

6. If you do not charge for the child care that you provide, do you have any kind of “in trade” arrangement with the parents?

• No

• Yes

If you do not charge for the child care that you provide please skip to question 9.

7. What do you charge for full-time care of infants and toddlers?

Full-time is 30 or more hours per week.

Record rates for infants and toddlers separately if rates vary.

Infants (ages ____ to _____ months)

1. $_______________ per hour

2. $_______________ per day

3. $_______________ per week

4. $_______________ per month

5.  Not Applicable, I do not provide full-time care to infants

Toddlers (ages ____ to _____ months)

6. $_______________ per hour

7. $_______________ per day

8. $_______________ per week

9. $_______________ per month

10.  Not Applicable, I do not provide full-time care to toddlers

8. What do you charge for part-time care?

Part-time is less than 30 hours per week.

Record rates for infants and toddlers separately if rates vary.

Infants (ages ____ to _____ months)

1. $_______________ per hour

2. $_______________ per day

3. $_______________ per week

4. $_______________ per month

5.  Not Applicable, I do not provide part-time care to infants

Toddlers (ages ____ to _____ months)

6. $_______________ per hour

7. $_______________ per day

8. $_______________ per week

9. $_______________ per month

10.  Not Applicable, I do not provide part-time care to toddlers

Caregiver Information

9. In a typical day, how many hours do you provide child care? ____________ hours per day

10. In a typical week, how many days do you provide child care? ___________ days per week

11. Are any of the children in your care related to you?

• No

• Yes

1a. If yes, how many? _________ children

12. What is your job title?

 Owner or Licensee

 Lead Caregiver

• Assistant Caregiver

• Primary Caregiver

• Aide

• Other (please specify) __________________

13. What is your birth date? MONTH __ __

DAY __ __

YEAR __ __ __ __

14. Are you of Hispanic or Latino origin?

• Yes

• No

15. Please select one or more of the following categories to best describe your race.

Please select one or more.

• American Indian or Alaska Native

• Black or African American

• Asian

• Native Hawaiian or other Pacific Islander

• White

16. What is your primary language?

 English

• Spanish

• Other (please specify) __________________

17. What language do you speak most with the children that you care for?

 English

• Spanish

• Other (please specify) __________________

18. If you are paid for the child care you provide, how much are you paid? $ __________

 Not Applicable, not paid

18a. Is that per . . .  Hour

 Week

 Month

 Year

 Other (please specify) ______________________

 Not Applicable, not paid

19. Before you began taking care of children in your home, what kind of experience in child care had you had? Mark all that apply.

• None or very limited experience

• Raised own child(ren)

• Lots of babysitting

• Informal care for other children (including grandchildren or other children related to you)

• Provided paid home care (family day care in someone else’s home, nanny, etc.)

• Worked in a child care center/nursery school/preschool

20. What is the highest level of school you have completed? Mark one response.

• Less than high school diploma/ no GED

• A high school diploma or GED

• Some college, but no degree

• An associate’s of arts (A.A.) degree

• A bachelor’s degree (B.A. or B.S.)

• Graduate or professional school but no degree

• Master’s degree (M.A. or M.S. etc)

• Doctorate degree (PhD or EDD)

• Professional degree after bachelor’s degree (MD, DDS, JD, etc.)

21. Do you have any degree in early childhood education or a related field other than a Child Development Associate (CDA) credential?

Related fields include nursing, psychology, elementary education, social work, speech pathology, or special education.

• No

• Yes  Go to question 23

22. Do you have any coursework leading to a degree in early childhood education or a related field?

• No

• Yes

• Not Applicable, have degree in early childhood education or a related field

23. Have you received any early childhood education or care training in the last 12 months? By training, we mean courses, workshops, seminars, or in-service training.

• No  Go to question 28

• Yes

24. Where was this/these training(s)? Mark all that apply.

• Conference

• Workshop

• Child Development Associate training

• Other in-service training

• College course

• Adult education course

• Correspondence course

• Other (please specify) _____________________________

• Not Applicable, did not receive training in the last 12 months

25. What was the topic of this/these training(s)? Mark all that apply.

• Child development: cognitive/intellectual/language development

• Child development: social/emotional development

• Child development: physical growth and motor skills

• Curriculum planning

• Working with parents

• Child abuse prevention

• Health and safety

• Physical care of children

• Discipline practices

• Other (please specify) ____________________________

• Not applicable, did not receive training in the last 12 months

26. Was any of this training specific to the care of infants (under 24 months)?

• No

• Yes

• Not Applicable, did not receive training in the last 12 months

27. In the last 12 months, did you receive . . .

• Less than 15 hours of training

• 15 hours or more of training

• Not Applicable, did not receive training in the last 12 months

28. Do you have a Child Development Associate (CDA) credential?

• No

• Yes

• Currently working on a CDA

29. Do you have any other state awarded certificates or credentials pertaining to early childhood education or care, or a related field such as nursing, social work, psychology or special education?

• No  Go to question 31

• Yes

30. Which certificates or credentials pertaining to early childhood education or care, or a related field, do you have? Mark all that apply.

• A state certificate in early childhood education

• A state certificate in elementary education

• A state certificate in secondary education

• A state certificate in special education

• Another state education certificate

• A license as a registered nurse (RN)

• A license as a licensed practical nurse (LPN)

• A certification or license as a social worker

• A certificate or license as a psychologist

• A certificate of clinical competence/speech pathologist (CCC/SP)

• Children’s Center Permit (California)

• Other license, certificate or credential (please specify)______________________

• Not Applicable, do not have any other certificates, licenses, or credentials

31. Are you currently a member of a national, state, or local professional association for early childhood education?

Some examples are: National Association for the Education of Young Children (NAEYC), National Head Start Association (NHSA), National Association for Family Child Care (NAFCC), National Education Association (NEA).

• No

• Yes

32. Do you have any children?

• No  Go to question 33

• Yes

32a. If yes, how many children do you have who are less than 16 years old? ___children

32b. How many of these children (from 31a) live with you? ____ children

32c. How many of these children (from 31a) are in your home when the other children you care for are in your home as well? _____ children

32d. How old is your youngest child? _______ years

32e. How old is your oldest child? _________ years

Caregiver beliefs and attitudes

33. How important would you say each of the following goals is for you in the care that you provide, not at all important, a little important, or very important?

Circle the number that corresponds to how important you would say each of the goals is for you in the care that you provide. Not at all=1, a little=2, and very important=3.

	Not at all	A little	Very important
a. To provide religious instruction ………………………………………………..	1	2	3
b. To provide care for children so parents can work ………………………	1	2	3
c. To prepare children for school with a strong academic curriculum	1	2	3
d. To provide compensatory education for disadvantaged children ….	1	2	3
e. To promote children’s overall development (social, language, etc.)	1	2	3
f. To teach children appreciation for their own or other cultures …….	1	2	3
g. To provide a warm and loving environment for all children …………	1	2	3

34. Below are some statements other people have made about rearing and educating children. For each one, please circle the number that best indicates how you feel in general about raising children.

1—Strongly disagree

2—Mildly disagree

3—Not sure

4—Mildly agree

5—Strongly agree

	Strongly disagree	Mildly disagree	Not sure	Mildly agree	Strongly agree
Since parents lack special training in education, they should not question the teacher's teaching methods. ……………………….	1	2	3	4	5
Children should be treated the same regardless of the differences among them. ….	1	2	3	4	5
Children should always obey the teacher. …….	1	2	3	4	5
Preparing for the future is more important for a child than enjoying today. ……………………….	1	2	3	4	5
Children will not do the right thing unless they must. ……………………………………………………….	1	2	3	4	5
Children should be allowed to disagree with their parents if they feel their own ideas are better. ………………………………………………………	1	2	3	4	5
Children should be kept busy with work and study at home and at school. ……………………..	1	2	3	4	5
	Strongly disagree	Mildly disagree	Not sure	Mildly agree	Strongly agree
The major goal of education is to put basic information into the minds of the children. …..	1	2	3	4	5
In order to be fair, a teacher must treat all children alike. ……………………………………………	1	2	3	4	5
The most important thing to teach children is absolute obedience to whoever is in authority.	1	2	3	4	5
Children learn best by doing things themselves rather than listening to others. ….	1	2	3	4	5
Children must be carefully trained early in life or their natural impulses will make them unmanageable. …………………………………………	1	2	3	4	5
Children have a right to their own point of view and should be allowed to express it. ……	1	2	3	4	5
Children's learning results mainly from being presented basic information again and again.	1	2	3	4	5
Children like to teach other children. ……………	1	2	3	4	5
The most important thing to teach children is absolute obedience to parents. …………………..	1	2	3	4	5
The school has the main responsibility for a child's education. ………………………………………	1	2	3	4	5
Children generally do not do what they should unless someone sees to it. …………………………	1	2	3	4	5
Parents should teach their children that they should be doing something useful at all times.	1	2	3	4	5
It's all right for a child to disagree with his/her parents. …………………………………………	1	2	3	4	5
Children should always obey their parents. ….	1	2	3	4	5
Teachers need not be concerned with what goes on in a child's home. ………………………….	1	2	3	4	5
Parents should go along with the game when their child is pretending something. …………….	1	2	3	4	5
Parents should teach their children to have unquestioning loyalty to them. ……………………	1	2	3	4	5
Teachers should discipline all the children the same. ……………………………………………………….	1	2	3	4	5
Children should not question the authority of their parents. …………………………………………….	1	2	3	4	5
What parents teach their child at home is very important to his/her school success. …….	1	2	3	4	5
Children will be bad unless they are taught what is right. …………………………………………….	1	2	3	4	5
A child's ideas should be seriously considered in making family decisions. …………………………	1	2	3	4	5
A teacher has no right to seek information about a child's home background. ……………….	1	2	3	4	5

35. When you think about your experiences caring for children, how much, if at all, are the following items a concern for you?

Please think about how it is right now providing care for children. For each item, please circle the number that corresponds with the response that is closest to how you feel about the item. If an item does not apply to you please circle NA.

1—Not at all

2—Rarely

3—Sometimes

4—All of the time

NA—Not applicable

	Not at all	Rarely	Sometimes	All of the time	Not Applicable
a. Continually cleaning up children’s messes ………………………………………….	1	2	3	4	NA
b. Being with young children all of the time ………………………………………………	1	2	3	4	NA
c. A child crying or whining a lot …………	1	2	3	4	NA
d. Caring for children takes too much out of you ……………………………………………	1	2	3	4	NA
e. Having to do tasks you don’t feel should be your responsibility ……………	1	2	3	4	NA
f. Having to juggle conflicting tasks or duties ……………………………………………	1	2	3	4	NA
g. Lack of appreciation from the child’s/children’s parents …………………	1	2	3	4	NA
h. The money you make …………………….	1	2	3	4	NA
i. Being exposed to illness or injury …….	1	2	3	4	NA
j. Having little chance for career advancement …………………………………	1	2	3	4	NA
k. Lack of support from agencies or other professionals …………………………	1	2	3	4	NA
l. Society’s lack of recognition for your work ……………………………………………..	1	2	3	4	NA
m. Limited opportunity for professional development ………………………………….	1	2	3	4	NA

36. When you think about taking care of children, how much, if at all, are the following items a rewarding part of being a caregiver, for you?

Please think about how it is right now providing care for children. For each item, please circle the number that corresponds with the response that is closest to how you feel about the item. If an item does not apply to you please circle NA.

1—Not at all

2—Rarely

3—Sometimes

4—All of the time

NA—Not applicable

	Not at all	Rarely	Sometimes	All of the time	Not Applicable
a. Seeing children’s excitement over new things ………………………………………………	1	2	3	4	NA
b. The happiness and smiles on young children’s faces …………………………………	1	2	3	4	NA
c. The affection the children show you ……	1	2	3	4	NA
d. Seeing the world through children’s eyes	1	2	3	4	NA
e. Being needed by the child/children ……..	1	2	3	4	NA
f. The challenge of caring for young children ……………………………………………	1	2	3	4	NA
g. Being able to set your own work schedule …………………………………………..	1	2	3	4	NA
h. Being able to work as part of a team or group ……………………………………………….	1	2	3	4	NA
i. Your supervisor paying attention to what you have to say …………………………	1	2	3	4	NA
j. Being able to make decisions on your own …………………………………………………	1	2	3	4	NA
k. Having friendly co-workers …………………	1	2	3	4	NA
l. Having hours that fit your needs …………	1	2	3	4	NA
m. Being able to watch your own children while earning money …………………………	1	2	3	4	NA
n. The work fitting your skills …………………	1	2	3	4	NA

Thank you for taking the time to complete this questionnaire.

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