OMB #: 0970-0485
EXPIRATION: 9/30/2019
14 – Staff Survey for Sites Testing Parenting Intervention
CONTENTS
Module A: Staff Roles and Responsibilities
Module B: Organizational structure
Module C: Reflection on staff role
Module D: For facilitators/trainers working with program group in parenting sites
Module E: Staff background
SECTION i. INTRODUCTION
As you know, your organization is part of a large study called Building Bridges and Bonds. Thank you for your support thus far! Today we are asking for your support by completing the B3 staff survey.
The survey should take you less than 40 minutes to complete. We want to ensure the voices of all staff working with any B3 study members are heard. Your responses will be kept private to the extent permitted by law and used only for research purposes. They will be combined with the responses of other staff and no individual names will be reported.
Participation in the survey is completely voluntary. There are no known risks of participating in this survey, except that you may feel uncomfortable answering some questions in the survey. You can refuse to answer those questions if you wish.
If you have any questions about the survey, please do not hesitate to contact MDRC. You can reach MDRC by calling 1-855-907-6703 or emailing b3@mdrc.org.
Thank you for completing this survey.
Before starting the survey, please read and answer the statement below.
THE
PAPERWORK REDUCTION ACT OF 1995 This
collection of information is voluntary and will be used to learn
about the effects of parenting and employment services for fathers.
Public reporting burden for this collection of information is
estimated to average 40 minutes per survey, 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 information collection is 0970-0XXX and the
expiration date is 9/30-2019. Send
comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this
burden to Erika Lundquist; 16 E 34th
St, MDRC, 19th
Floor, New York, NY 10016; (212) 340-8605; Attn: OMB-PRA
(0970-0485).
i1. I have read the introduction and understand that the information I provide will be kept private to the extent permitted by law and used only for research purposes. My responses will be combined with the responses of other staff and no individual names will be reported.
I agree with the above statement and will complete the survey 1
I do not agree with the above statement and will not complete the survey 0 END SURVEY
[PROGRAMMING NOTE: i1 is mandatory. If i1=0, the next screen should say “Thank you for your answer. We understand and thank you for your time.” and end the survey]
Module A: Staff Roles and Responsibilities
Thanks for starting the survey! We know staff play an important role in the success of the B3 study. The first set of questions asks about your role within [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE].
A1. What is your job title at [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE]? [Programming note: Limit characters to 50]
_________________ (fill in)
Don’t know
Decline to answer
A2. When did you start working at [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE]?
___ ___ month __ __ __ __year [programming note: Drop down menu for month and year. Month options: the digits 1 – 12, don’t know, refuse; year options: “1950 – 2017”]
Don’t Know
Decline to answer
A3a. What types of fathers do you currently work with?
Mostly B3 study Just Beginning fathers
Mostly B3 study “no Just Beginning” fathers
Mostly fathers not eligible for the B3 study
I do not work with fathers [END SURVEY]
Don’t know
A3b. Do you currently facilitate any Just Beginning sessions?
Yes
No
Don’t Know
Decline
to answer
There is no question A4
A5. How many hours do you work in a typical week at [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE]? Please report actual, not scheduled, hours. Round to the nearest whole hour.
(programming note: set maximum number of hours to 80)
___ ____ [programming note: 2 digits maximum]
Number of Hours
Don’t Know
Decline to answer
A6. Do you focus on the following areas in your work with fathers at [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE]?
|
YES |
NO |
Don’t know |
Decline to Answer |
Healthy marriage and relationships |
1 |
0 |
|
|
Parenting |
1 |
0 |
|
|
Job Development |
1 |
0 |
|
|
In program case management |
1 |
0 |
|
|
Post program case management/support |
1 |
0 |
|
|
Social Services / Emergency Needs |
1 |
0 |
|
|
Other [Programming note: allow fill in; limit to 100 characters]___________________________
Don’t know
Decline to answer
We are now going to ask you some questions about how long you spend doing various tasks related to your role at [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE].
A7. Which activities are you involved in at [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE]? [programming note: check all that apply]
Outreach to recruit potential program participants
Eligibility screening an intake
Working with clients individually
Planning and facilitatingworkshops with clients
Administrative work (i.e. paperwork, data entry, staff meetings, training)
Other , ___________ (allow fill in for other response)
A8. We would like to ask you more specifically about how you spend your time at [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE]. WIf you do not spend time on an activity then mark it as zero (0)
[Programming note: allow 2 digit response maximum. Please add a rolling sum of hours to questions in A8. After answering all of A8 – add a reminder message that states “In an earlier question you stated you worked [INSTERT FILL IN RESPONSE FROM A5] hours in a typical week. You have accounted for [INSERT ROLLING SUM FOR A8]. Please take a moment to check over your answers]
|
|
|
Hours in a typical work week |
|
|
|
ONLY if select ‘Outreach to recruit potential program participants’ in A7 |
Conduct outreach to recruit potential program participants |
|
Don’t Know |
Decline to answer |
|
ONLY if select ‘eligibility screening and intake’ in A7 |
Eligibility screening and intake of potential participants |
|
Don’t Know |
Decline to answer |
|
ONLY if select ‘Working with client individually in person’ in A7 |
Helping individual fathers address barriers and life challenges |
|
Don’t Know |
Decline to answer |
|
ONLY if select ‘Working with client individually’ in A7 |
Help participants prepare for or obtain employment in one-on-one setting. Do not include group work. |
|
Don’t Know |
Decline to answer |
|
ONLY if select ‘Planning and facilitating workshops with clients’ in A7 |
Planning for JB workshops |
|
Don’t Know |
Decline to answer |
|
ONLY if select ‘Planning and facilitating workshops with clients’ in A7 |
Facilitating JB workshops |
|
Don’t Know |
Decline to answer |
|
ONLY if select ‘Planning and facilitating workshops with clients’ in A7 |
Planning for other parenting workshops that are not Just Beginning |
|
Don’t Know |
Decline to answer |
|
ONLY if select ‘Planning and facilitating workshops with clients’ in A7 |
Facilitating other parenting workshops that are not Just Beginning |
|
Don’t Know |
Decline to answer |
|
ONLY if select ‘Planning and facilitating workshops with clients’ in A7 |
Planning employment readiness workshops |
|
Don’t Know |
Decline to answer |
|
ONLY if select ‘Planning and facilitating workshops with clients’ in A7 |
Facilitating employment readinessnes workshops |
|
Don’t Know |
Decline to answer |
|
ONLY if select ‘Administrative/office work’ in A7 |
Managing or supervising other individuals at your organization |
|
Don’t Know |
Decline to answer |
|
ONLY if select ‘Administrative/office work’ in A7 |
Data entry (nFORM or other systems) |
|
Don’t Know |
Decline to answer |
|
ONLY if select ‘Administrative/office work’ in A7 |
Staff meetings, supervision or participating in peer to peer support |
|
Don’t Know |
Decline to answer |
|
ONLY if select ‘Other’‘ in A7 |
Prefill written response from ‘other’ category in A7 |
|
Don’t Know |
Decline to answer |
A8o. How many hours in a typical week do you spend on other activities that were not listed?
_____________ hours in a typical work week.
Don’t know
Decline to answer
The next set of questions will ask you about your training and the caseload you carry.
A9. Have you received any formal training in the past year related to the work you are doing with fathers?
Yes
No
Don’t Know
Decline to answer
A10. Do you carry a caseload of a specific group of fathers with whom you responsible for staying in contact? [programming note: mandatory question]
Yes
No SKIP to A12
Don’t Know SKIP to A12
Decline to answer SKIP to A12
A10a. In the past month, how many fathers were on your caseload?
______ fathers (fill in number)
Don’t Know
Decline to answer
A10b. In the past month, how many fathers on your caseload did you consider active, meaning you have regular contact with them?
_____fathers (fill in)
Don’t know
Decline to Answer
A11. How many fathers do you have contact with in a typical week? This could be in person, over the phone, by email, or text.
_________ fathers per week (fill in number) [programming note: fill in #, require at least 1 digit, maximum 3 digits]
Don’t know
Decline to answer
A12. Do you remind fathers of upcoming meetings or workshops?
Yes
No [SKIP TO B1]
Don’t Know [SKIP TO B1]
Decline to answer [SKIP TO B1]
A13. How often do you use these methods to give reminders? Check one (box) per line.
[Programming note: want respondent to check one option per line]
|
Never |
Rarely |
Sometimes |
Often |
Decline to Answer |
Emails |
|
|
|
|
|
Text Messages |
|
|
|
|
|
Phone Calls |
|
|
|
|
|
In Person |
|
|
|
|
|
Other ____________ (Programming note: Fill in response) |
|
|
|
|
|
Module B: Organizational Structure
One module complete! The characteristics and structure of the organization you work for also plays an integral part of the B3 study. The next module asks what you think about how well your organization supports your work.
Please read the following statements and indicate the degree to which you disagree or agree with them.
B1. These questions relate to your experience working at [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE].
|
|
Strongly Disagree |
Disagree |
Uncertain |
Agree |
Strongly agree |
Decline to Answer
|
A |
My job role is clearly defined. |
1 |
2 |
3 |
4 |
5 |
9 |
B |
Keeping fathers engaged in program services is a challenge for the [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE] |
1 |
2 |
3 |
4 |
5 |
9 |
C |
Facilities here are well suited for programmatic activities. |
1 |
2 |
3 |
4 |
5 |
9 |
D |
The [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE] operates with clear goals and objectives |
1 |
2 |
3 |
4 |
5 |
9 |
e |
[PREFILL NAME OF B3 ORGANIZATION FROM DATABASE] is an effective program. |
1 |
2 |
3 |
4 |
5 |
9 |
B2. These questions relate to staffing at [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE].
|
|
Strongly Disagree |
Disagree |
Uncertain |
Agree |
Strongly agree |
Decline to answer |
A |
Staff have all necessary resources to support fathers’ needs |
1 |
2 |
3 |
4 |
5 |
9 |
B |
[PREFILL NAME OF B3 ORGANIZATION FROM DATABASE] has the right set of staff working with fathers. |
1 |
2 |
3 |
4 |
5 |
9 |
C |
Program staff are overburdened. |
1 |
2 |
3 |
4 |
5 |
9 |
D |
There are enough staff here to meet the current client needs. |
1 |
2 |
3 |
4 |
5 |
9 |
E |
Mutual trust and cooperation among staff in this program are strong. |
1 |
2 |
3 |
4 |
5 |
9 |
F |
Staff here are given a lot of freedom in working with their clients. |
1 |
2 |
3 |
4 |
5 |
9 |
G |
It is important that staff in our program share some common characteristics or life experiences with the fathers we work with. |
1 |
2 |
3 |
4 |
5 |
9 |
B3. These questions relate to management at [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE].
|
|
Strongly Disagree |
Disagree |
Uncertain |
Agree |
Strongly agree |
Decline to answer |
A |
I have a good relationship with [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE] management |
1 |
2 |
3 |
4 |
5 |
9 |
B |
Management at [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE] fully trust my professional opinion |
1 |
2 |
3 |
4 |
5 |
9 |
C |
The organization’s leadership is committed to the success of [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE] |
1 |
2 |
3 |
4 |
5 |
9 |
D |
Within [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE] it is clear who I report to |
1 |
2 |
3 |
4 |
5 |
9 |
E |
Ideas and suggestions from staff get fair consideration by [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE] management |
1 |
2 |
3 |
4 |
5 |
9 |
F |
Staff initiative is discouraged by program management |
1 |
2 |
3 |
4 |
5 |
9 |
g |
The communication between program leadership and staff involved in [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE] implementation is effective |
1 |
2 |
3 |
4 |
5 |
9 |
Module C: Reflection on Staff role
[Programming note: for direct staff only; will be indicated in the Prefill file.]
Two modules complete! Thanks for answering our questions! This module of questions ask for you to reflect on what you think about your job and working with fathers at [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE].
C1. Please read the following statements and indicate the degree to which you disagree or agree with them. When answering, please think about your work with fathers at [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE].
|
|
Strongly Disagree |
Disagree |
Uncertain |
Agree |
Strongly agree |
Decline to Answer |
a. |
I am motivated to apply skills from training to my work. |
1 |
2 |
3 |
4 |
5 |
9 |
b. |
I consistently plan ahead and carry out my plans |
1 |
2 |
3 |
4 |
5 |
9 |
c. |
I am satisfied at my job. |
1 |
2 |
3 |
4 |
5 |
9 |
d. |
I have the ongoing support I need to do my job well. |
1 |
2 |
3 |
4 |
5 |
9 |
e. |
I usually accomplish whatever I set my mind on. |
1 |
2 |
3 |
4 |
5 |
9 |
f. |
I am under too many work-related pressures to do my job effectively. |
1 |
2 |
3 |
4 |
5 |
9 |
g. |
Learning and using new procedures is easy for me. |
1 |
2 |
3 |
4 |
5 |
9 |
h. |
I consider the work I do to be important. |
1 |
2 |
3 |
4 |
5 |
9 |
i. |
I am confident in my ability to successfully do my job. |
1 |
2 |
3 |
4 |
5 |
9 |
j. |
I receive the necessary training to do my job effectively. |
1 |
2 |
3 |
4 |
5 |
9 |
k. |
I have the skills needed to conduct effective group workshops. |
1 |
2 |
3 |
4 |
5 |
9 |
C2a. Think about a father you have worked with or spoken with most recently at [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE]. How much do you disagree or agree with the following statements about working with this father?
[Programming note: ONLY if answer to A3a is “Mostly B3 study JB fathers” OR “Mostly B3 study “no JB fathers “; randomize order of items]
|
|
Strongly Disagree |
Disagree |
Uncertain |
Agree |
Strongly agree |
Decline to Answer |
A |
I am confident in my ability to help this father |
1 |
2 |
3 |
4 |
5 |
9 |
B |
I check in at least weekly with this father. |
1 |
2 |
3 |
4 |
5 |
9 |
C |
The father and I have formed a mutual trust. |
1 |
2 |
3 |
4 |
5 |
9 |
D |
My educational background or professional training has helped me work effectively with this father. |
1 |
2 |
3 |
4 |
5 |
9 |
e |
It is a priority to make sure this father knows that I am personally committed to his success. |
1 |
2 |
3 |
4 |
5 |
9 |
F |
The father and I have a lot of shared life experiences.. |
1 |
2 |
3 |
4 |
5 |
9 |
G |
My work or life experience has helped me work effectively with this father. |
1 |
2 |
3 |
4 |
5 |
9 |
H |
My mastery of program materials impacts a father’s outcome in the program |
1 |
2 |
3 |
4 |
5 |
9 |
C2b. Still thinking about that same father you have worked with or spoken with most recently at [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE], how much do you disagree or agree with the following statements about working with this father?
[Programming note: ONLY if answer to A3a is “Mostly B3 study JB fathers” OR “Mostly B3 study “no JB” fathers “; randomize order of items]
|
|
Strongly Disagree |
Disagree |
Uncertain |
Agree |
Strongly agree |
Decline to Answer |
a |
This father and I agree about the steps to be taken to improve his situation. |
1 |
2 |
3 |
4 |
5 |
9 |
b |
My relationship with this father is an essential component of his program services. |
1 |
2 |
3 |
4 |
5 |
9 |
C |
Creating a sense of community for this father is an important element of keeping him engaged. |
1 |
2 |
3 |
4 |
5 |
9 |
D |
The content of [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE] is relevant for this father. |
1 |
2 |
3 |
4 |
5 |
9 |
e |
Participating in the [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE] is helping my client become a better father. |
1 |
2 |
3 |
4 |
5 |
9 |
F |
A father’s commitment to the program is more important than my mastery of program content. |
1 |
2 |
3 |
4 |
5 |
9 |
G |
A father’s success in the program is his responsibility. |
1 |
2 |
3 |
4 |
5 |
9 |
MODULE D: FOR FACILITATORS/TRAINERS WORKING WITH PROGRAM GROUP IN PARENTING SITES
[Programming note: ONLY staff who answered ‘Yes’ to A3b are eligible for this module]
The next set of questions ask specifically about delivering Just Beginning. If you are not responsible for providing Just Beginning to fathers, please answer “NO” to the first question.
D1. How long does a JB session normally take (including the father skills training, father-child play time, and the father debrief)?
___ ____ _____ [programming note, allow 3 digit response]
Don’t Know
Decline to answer
D2. How much time does it usually take you to prepare for each Just Beginning session?
Less than 1 hour
Between 1 and 2 hours
Between 2 and 3 hours
More than 3 hours
Don’t Know
Decline to answer
D3. Has the amount you need to prepare for a Just Beginning session changed since the start of the study?
Yes
No
Don’t Know
Decline to answer
D4. Some program staff get professional advice/technical assistance/coaching directly from Just Beginning staff, while others get support from the research team or from an on-site supervisor or coach. For each of the statements below, indicate how much you disagree or agree based on any professional advice you’ve received about implementing Just Beginning.
|
|
Strongly Disagree |
Disagree |
Uncertain |
Agree |
Strongly Agree |
Decline to answer |
|
If I need professional advice about Just Beginning I know who to ask. |
1 |
2 |
3 |
4 |
5 |
8
|
|
I am comfortable seeking professional advice about implementing Just Beginning. |
1 |
2 |
3 |
4 |
5 |
8 |
|
In general, responses to my questions about Just Beginning are prompt. |
1 |
2 |
3 |
4 |
5 |
8 |
|
Responses to my questions about Just Beginning are helpful. |
1 |
2 |
3 |
4 |
5 |
8 |
Please read the following statements about Just Beginning implementation and indicate the degree to which you disagree or agree with them.
D5a. These questions relate to your thoughts about Just Beginning and providing parenting services. [Programming note: randomize order]
|
|
Strongly Disagree |
Disagree |
Uncertain |
Agree |
Strongly Agree |
Decline to answer |
a |
Just Beginning operates with clear goals and objectives |
1 |
2 |
3 |
4 |
5 |
8 |
B
|
Just Beginning is helpful to me in my work with fathers |
1 |
2 |
3 |
4 |
5 |
8 |
C |
The Just Beginning training helped me better support my clients’ needs. |
1 |
2 |
3 |
4 |
5 |
8 |
D |
The parenting techniques taught in Just Beginning are helping clients become better fathers. |
1 |
2 |
3 |
4 |
5 |
8 |
E |
I feel confident in my ability to improve men’s fathering skills. |
1 |
2 |
3 |
4 |
5 |
8 |
F |
I am capable of teaching fathers parenting skills. |
1 |
2 |
3 |
4 |
5 |
8 |
G |
I am able to help each father become a stronger parent |
1 |
2 |
3 |
4 |
5 |
8 |
h |
I feel able to guide fathers through parenting challenges. |
1 |
2 |
3 |
4 |
5 |
8 |
I |
A father’s commitment to Just Beginning is more important than my mastery of program curriculum. |
1 |
2 |
3 |
4 |
5 |
8 |
J |
I think Just Beginning will make a difference in the future for the dads I work with |
1 |
2 |
3 |
4 |
5 |
8 |
K |
I have seen Just Beginning make a difference for the dads I work with |
1 |
2 |
3 |
4 |
5 |
8 |
L |
A father’s success in Just Beginning is mainly his responsibility. |
1 |
2 |
3 |
4 |
5 |
8 |
M |
Using nFORM has been a challenge for me. |
1 |
2 |
3 |
4 |
5 |
8 |
D5b. The next set of questions is about your implementation of Just Beginning. [Programming note: randomize order]
|
|
Strongly Disagree |
Disagree |
Uncertain |
Agree |
Strongly Agree |
Decline to answer |
A |
I am motivated to utilize Just Beginning skills in my work |
1 |
2 |
3 |
4 |
5 |
8 |
B |
I am confident in my ability to successfully implement Just Beginning. |
1 |
2 |
3 |
4 |
5 |
8 |
C |
Learning the Just Beginning procedures were easy for me. |
1 |
2 |
3 |
4 |
5 |
8 |
D |
Implementing Just Beginning makes my job harder. |
1 |
2 |
3 |
4 |
5 |
8 |
E |
Keeping fathers engaged in Just Beginning is easier than in other program services. |
1 |
2 |
3 |
4 |
5 |
8 |
F |
Using new Just Beginning procedures is easy for me. |
1 |
2 |
3 |
4 |
5 |
8 |
G |
Implementing Just Beginning takes too much time away from my other responsibilities. |
1 |
2 |
3 |
4 |
5 |
8 |
H |
My mastery of the Just Beginning curriculum impacts a father’s outcome in the program |
1 |
2 |
3 |
4 |
5 |
8 |
I |
Delivering JB is my main responsibility |
1 |
2 |
3 |
4 |
5 |
8 |
D5c. The next set of questions is about [PREFILL B3 ORGANIZATION]’s implementation of Just Beginning . [Programming note: randomize order]
|
|
Strongly Disagree |
Disagree |
Uncertain |
Agree |
Strongly Agree |
|
Decline to answer |
|
Facilities at [PREFILL ORGANIZATION] are well suited for Just Beginning activities. |
1 |
2 |
3 |
4 |
5 |
|
8 |
|
The design of the play space is well suited for father/child interaction. |
1 |
2 |
3 |
4 |
5 |
|
8 |
|
The toys available for fathers and children are well suited for father/child interaction |
1 |
2 |
3 |
4 |
5 |
|
8 |
|
The playroom here allows the privacy needed for one on one father-child sessions. |
1 |
2 |
3 |
4 |
5 |
|
8 |
|
My duties with Just Beginning are clearly related to the goals of the fatherhood program. |
1 |
2 |
3 |
4 |
5 |
|
8 |
|
Program staff is overburdened because of Just beginning implementation |
1 |
2 |
3 |
4 |
5 |
|
8 |
|
Program leadership is committed to the success of Just Beginning |
1 |
2 |
3 |
4 |
5 |
|
8 |
|
[PREFILL B3 ORG NAME] has the right set of people implementing Just Beginning. |
1 |
2 |
3 |
4 |
5 |
|
8 |
|
I have the ongoing support I need to do my Just Beginning job well. |
1 |
2 |
3 |
4 |
5 |
|
8 |
Module E: Staff Background
Thanks for your responses so far. This is the last set of questions for you! We would like to know more about your previous work and life experiences before your current position at [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE].. As a reminder, this information will not be shared with anyone outside of the B3 study team. It will not be used in any way that could identify you in discussions with your organization’s managers or in a report.
E1. What population do you have prior experience working with before your current position? [Programming note: can check multiple]
Custodial parents
Non-custodial parents
Children
Justice-involved individuals (paroles, former prisoners, probationers)
Other ____________________________[programming note: allow fill in]
None of the above
Don’t know
Decline to answer
E2. Please mark ‘yes’ for each activity you have prior experience in before working at your current position. ]
[programming note: randomize order ]
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Yes, I have prior experience |
No, I do not have prior experience |
Decline to Answer |
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Providing parenting and/or fatherhood education? |
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Providing healthy relationship education? |
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Helping clientsprepare for or obtain employment? |
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Providing referrals for clients to other services |
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Helping individuals apply for benefits or to participate in services? |
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Working with other social service organizations on behalf of a client? |
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Work with employers on behalf of a client |
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Providing services that use cognitive behavioral techniques? |
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Providing mental or behavioral health services |
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Using motivational interviewing |
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Working in ministry, as a pastor or /other clergy |
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Recruiting or enrolling participants into a voluntary program? |
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Managing or supervising staff? |
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Providing financial education? |
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Working in pre-release programs? |
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Working in the child welfare system? |
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Working in the child support system? |
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Working as a classroom teacher |
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Received services from [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE] before my current job. |
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E3. Have you ever been arrested or incarcerated?
Yes
No
Don’t know
Decline to answer
E4. Have you ever received public assistance (such as TANF/welfare, food stamps, SSI, etc.)?1
Yes
No
Don’t know
Decline to answer
E5. Are you …
Male
Female
Other (specify) _____________
Don’t Know
Decline to answer
E6. How old are you (in years)?
_ _ years old (programming note: 2 digit entry)
Don’t know
Decline to answer
E7. Are you a parent?
Yes
No [SKIP to F8]
Don’t know
Decline to answer
E7a. Have you had experience as a non-custodial parent, a single parent, or living apart from your child?
Yes
No
Don’t know
Decline to answer
E8. Are you Hispanic, Latino, or of Spanish origin? (Select one or more)
No, not of Hispanic, Latino or Spanish origin
Yes, Mexican, Mexican American, Chicano/a
Yes, Puerto Rican
Yes, another Hispanic, Latino, or Spanish origin
Don’t Know
Decline to answer
E9. What is your race? (Select one or more)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Other (specify) __________________________
Don’t Know
Decline to answer
E10. What is the highest level of education you have completed?
High School: Diploma [Go to E12]
High School: General Education Development or GED [Go to E12]
Some college/some postsecondary vocational courses
2-year or 3-year college degree (Associates degree)
Vocational school diploma
4-year college degree (Bachelor’s degree)
Some graduate work/no graduate degree
Graduate or professional degree (e.g. MA, MBA, PH.D, JD, MD, MSW)
Don’t Know
Decline to answer
E11. What was your program of study after graduating high school?
Addictions counseling
Other counseling
Education
Vocational Rehabilitation
Criminal Justice
Psychology
Social Work/Human Services
Administration
Ministry
Military
Law Enforcement
Health/Medicine
Other (Specify ________________)
Don’t Know
Decline to answer
E12. Is English your primary language?
Yes [SKIP TO END SURVEY]
No
Don’t know[SKIP TO END SURVEY]
Decline to answer[SKIP TO END SURVEY]
E14. What is your primary language?
Spanish
Other,_________(specify)
Don’t know
Decline to answer
E15. Do you use this language with the fathers you work with?
Yes
No
Don’t know
Decline to answer
END SURVEY MESSAGE:
You have now completed the B3 survey!
Thank you for taking the time out of your busy day to help us learn more about you and your experiences at [PREFILL NAME OF B3 ORGANIZATION FROM DATABASE]. This information is an essential piece to understanding B3 and your fatherhood programming. We greatly appreciate your time!
1 ETJD/STED staff survey
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | edits accepted - OMB resubmit post 2nd frn |
Author | Emily Brennan |
File Modified | 0000-00-00 |
File Created | 2021-01-21 |