Measurement Development: Quality of Family-Provider Relationships in Early Care and Education

Parent Questionnaire about Family Service Workers – DRAFT

In the following pages, we will ask questions about your Family Service Worker and about your relationship with him or her. Some of these questions will be about how your Family Service Worker works with your family.

1. Since September, how often have you met with or talked to your Family Service Worker about the following?

[MARK ONE BOX IN EACH ROW.]

	Never	Rarely	Sometimes	Very often
How your child is doing in the Head Start program
Your work and school goals
Your child’s abilities
Your child’s learning or development
Goals you have for your child
Goals you have for yourself
How your child is progressing towards your goals you have set for him/her
How you are progressing towards goals you have set for yourself
What to expect at each stage of your child’s development
Problems your child is having in the Head Start program
Problems you may be having with work or school
Your vision for your child’s future
Your vision for your family’s future

2. Since September, how often has your Family Service Worker:

[MARK ONE BOX IN EACH ROW.]

	Never	Rarely	Sometimes	Very often
Suggested activities for you and your child to do together?
Answered your questions when they came up?
Taken your values and culture into account when serving you?
Offered you books or materials on parenting?

3. How comfortable would or do you feel sharing the following information with your Family Service Worker?

[MARK ONE BOX IN EACH ROW.]

	Very uncomfortable	Uncomfortable	Comfortable	Very comfortable
How many children you have
How many adult relatives live in your household
Your work and school schedule
Your marital status
Your personal relationship with a spouse or partner
Your employment status
Your financial situation
Your parenting style
Your family life
The role that faith and religion play in your household
Your family’s culture and values
What you do outside of the Head Start setting to encourage your child’s learning
How you discipline your child
Problems your child is having at home
Changes happening at home
p. Health issues your child has, such as food allergies or asthma
q. Health issues you or other family members may have

4. How much are the following statements like your Family Service Worker?

My Family Service Worker…

[MARK ONE BOX IN EACH ROW.]

	Not at all like my Family Service Worker	A little like my Family Service Worker	A lot like my Family Service Worker	Exactly like my Family Service Worker
a. Encourages me to be involved in all aspects of my child’s care and education in our Head Start program
b. Respects me as a parent
c. Is flexible in response to my work or school schedule
d. Treats me like an expert on my child
e. Asks me questions to show he/she cares about my family
f. Shows respect for different ethnic heritages
g. Is respectful of religious beliefs
h. Encourages parents to provide feedback on the services and support he/she provides them

5. How strongly do you agree or disagree with the following statements?

[MARK ONE BOX IN EACH ROW.]

	Strongly disagree	Disagree	Agree	Strongly agree
a. My Family Service Worker judges my family because of our faith and religion
b. My Family Service Worker judges my family because of our culture and values
c. My Family Service Worker judges my family because of our race/ethnicity
d. My Family Service Worker judges my family because of our financial situation

6. Since September, how often have you met with or talked to your Family Service Worker about how you feel about the services that your Family Service Worker provides you and your family?

[MARK ONLY ONE BOX.]

Never

Rarely

Sometimes

Very often

7. If you had a problem with your Family Service Worker, how comfortable would you feel talking to him or her about it?

[MARK ONLY ONE BOX.]

Very uncomfortable

Uncomfortable

Comfortable

Very comfortable

8. How often does your Family Service Worker:

[MARK ONE BOX IN EACH ROW.]

	Never	Rarely	Sometimes	Very often
a. Ask about your family?
b. Work with you to develop strategies you can use at home to support your child’s learning and development?
c. Listen to your ideas about ways to change or improve the care and education your child receives?
d. Offer you ideas or suggestions about parenting?
e. Remember personal details about your family when speaking with you?

9. Please indicate how much the following words are like your Family Service Worker.

My Family Service Worker is…

[CHECK ONE BOX IN EACH ROW.]

	Not at all like my Family Service Worker	A little like my Family Service Worker	A lot like my Family Service Worker	Exactly like my Family Service Worker
a. Caring
b. Understanding
c. Rude
d. Flexible
e. Dependable
f. Trustworthy
g. Impatient
h. Unfriendly
i. Respectful
j. Judgmental
k. Available

10. Please indicate how much you agree or disagree with the following statements.

[MARK ONE BOX IN EACH ROW.]

	Strongly disagree	Disagree	Agree	Strongly agree
a. My Family Service Worker is open to learning different ways to help parents and children
b. My Family Service Worker and I work together to make sure my child has the best care and support
My Family Service Worker has increased my confidence to accomplish goals for myself.
My Family Service Worker has my best interests at heart.
My Family Service Worker sees this job as just a paycheck

11. How easy or difficult is it for you to reach your Family Service Worker during the day if you have a question or if a problem comes up?

[MARK ONLY ONE BOX.]

Very difficult

Difficult

Easy

Very easy

12. On a scale of 1-5, where 1 is the worst you can imagine and 5 is the best you can imagine, how would you describe your relationship with your Family Service Worker?

[MARK THE BOX NEXT TO THE NUMBER THAT BEST DESCRIBES YOUR RELATIONSHIP.]

Worst Best

1

2

3

4

5

The next set of questions asks about the age of your child, your experience with Family Service Workers, and your background.

13. How old is your child?

[MARK ONLY ONE BOX.]

Less than 1 year old

1- 2 years old

3- 4 years old

5 years or older

14. For how long has your current Family Service Worker been working with your family?

[MARK ONLY ONE BOX.]

Less than six months

6 months-less than 1 year

1 year-less than 2 years

2 years or more

15. Thinking about all of your children, how many Family Service Workers have you ever worked with?

[MARK ONLY ONE BOX.]

1

2-3

4-5

More than 5

16. What language do you most speak at home?

[MARK ONLY ONE BOX.]

English

Spanish

English and Spanish equally

English and another language equally

Other language

17. Are you Hispanic, Latino/a or of Spanish origin?

Yes

No

18. What is your race?

[MARK ALL THAT APPLY.]

White

Black or African American

American Indian or Alaska Native

Asian Indian

Chinese

Filipino

Japanese

Korean

Vietnamese

Other Asian

Native Hawaiian

Guamanian or Chamorro

Samoan

Other Pacific Islander

19. What is the highest level of education you have completed?

[MARK ONLY ONE BOX.]

Less than a high school diploma

High school diploma or GED

Some college, no degree

Associate’s degree

Bachelor’s degree

Graduate school degree

20. What would you say was your household’s income last year, before taxes?

[MARK ONLY ONE BOX.]

Less than $25,000

$25,000- $34,999

$35,000- $44,999

$45,000- $54,999

$55,000- $74,999

$75,000 or more

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