Community Assessment: Parent Survey

Steps in Administering the Parent Survey

1. Decide who will be responsible for processing returned surveys, "tracking" nonreturns, doing follow-up phoning and mailing, and data entry of survey responses.
2. Obtain school lists of enrolled students and addresses and phone numbers (for follow-up only).
3. Decide the number of surveys needed (recommended approach: subtract from current enrollment the number of households with 2 or more children enrolled, then add 10 % for replacing "lost" surveys).
4. Arrange for duplicating and collating the survey booklets.
5. Decide what incentive you will use and gain a firm commitment from the "sponsor" to supply you with it by your "due date."
6. Decide who will be the contact person for questions.
7. Determine the procedure and personnel for collecting returns, "tracking" nonreturns, and doing follow-up phoning and mailing.
8. Prepare and duplicate the cover letter.
9. Arrange for assembly of "packets" (survey, cover letter, and return envelope in an envelope).
10. Send home "packets" (survey, cover letter, and return envelope in an envelope).
11. Begin data entry as soon as possible after the returns come in.
12. ONE WEEK after send-home date, do first follow-up. Telephone nonrespondents (evenings are best).

Ask parent whether survey was received. Emphasize that the results won't be accurate without everyone's response. Briefly explain the purpose of the survey and the incentive, and offer to administer the survey now, over the phone.

If the parent declines and has already received the survey, ask the parent to return it tomorrow.

If the parent has not received the survey, get a current mailing address, and mail a packet (including a postage-paid return envelope) the next day.

Plan on making up to 7 CALLBACKS, and vary the time of calling (daytime, evening, weekend).

If the parent is not reached by phone after 7 ATTEMPTS, mail a packet (including a postage-paid return envelope) the next day.

AT 2 WEEKS after the original send-home date, do a second follow-up on any surveys still not returned. Follow same procedures as above.

Parent Survey

In some families, children have a doctor, nurse practitioner, or physician's assistant; in other families, they do not.

1. In your family, does your child have a doctor, nurse practitioner, or physician's assistant for routine checkups?

__ No

1a. What is the most important reason your child does not have a doctor, nurse practitioner, or physician's assistant for routine checkups? (Check one.)

__ 1-I don't know where to go.
__ 2-I can't afford it.
__ 3-I can't find a provider who accepts Medicaid/Dr Dynasaur insurance.
__ 4-It's too far away, or I don't have transportation.
__ 5-I only take my child to the doctor when he or she is sick.
__ 6-Other (Please describe.)

__ Yes

1b. When your child arrives at the provider's office, how long does he or she usually need to wait to be seen if he or she already has an appointment? (Check one.)

__ 1-Less than 30 minutes
__ 2-Between 30 minutes and 1 hour
__ 3-More than 1 hour

Now we want to ask about checkups for your child.

2. When was your child's most recent checkup? (Check one.)

__ 1-My child has never had a medical checkup
__ 2-Within the past year
__ 3-Between 1 and 2 years ago
__ 4-Between 3 and 4 years ago
__ 5-More than 4 years ago

2a. If your child has not had a checkup in the last 2 years, what is the reason? (Check one.)

__ 1-I don't know where to go.
__ 2-My child is not due for a checkup yet.
__ 3-My health insurance does not cover checkups.
__ 4-I can't find a doctor who accepts Medicaid/Dr Dynasaur insurance.
__ 5-Doctors are too far away, or I don't have transportation.
__ 6-I don't have child care for my other children.
__ 7-The doctor's office hours are inconvenient.
__ 8-I couldn't get time off from work to take my child.
__ 9-My child only needs a doctor when he or she is sick.
__ 10-I had to wait too long to get an appointment.

Now we want to ask you about some health care services you may have used or may need to use.

3. If your child were sick on a weekday and needed medical care, where would you take him or her? (Check one.)

__ 1-A doctor's office or health center
__ 2-A hospital clinic
__ 3-An urgent care clinic
__ 4-A hospital mergency room
__ 5-Other (Please describe.)

 

4. Is there one person or place you can contact to learn more about health-related services available in your community for your children? (Check one.)

__ 1-Yes
__ 2-No
__ 3-Not sure

5. If your child required any of the following services during the past year, were you able to get it? If your child did not need the service, please check NA ('not applicable'). (Check one.)

5m. What is difficult about getting the services listed above? Please comment below.

6. Which of the following best describes your current health insurance for your child? (Check one.)

__ 1-No insurance coverage
__ 2-Blue Cross/Blue Shield
__ 3-Managed care plan
__ 4-Medicaid or "Dr Dynasaur"
__ 5-Other private insurance
__ 6-Combination of Medicaid and private insurance

7. Was there any time during the past year that your child was not covered by any type of health insurance (including Medicaid/"Dr Dynasaur")? (Check one.)

__ 1-Yes
__ 2-No
__ 3-Don't know

8. In the past year, has cost prohibited your child from receiving any of the following? (Check all that apply.)

Parent Survey

This next section asks about dental care services for your child.

A dentist is someone who provides checkups and preventive care for your teeth, like cleaning and polishing, and takes care of problems like cavities, toothaches, and dental injuries.

In some families, children have a dentist; in other families, they don't.

9. In your family, does your child have a dentist for routine checkups? (Check one.)

__ No

1a. What is the most important reason your child does not have a dentist for routine checkups? (Check one.)

__ 1-I don't know where to go.
__ 2-I can't afford it.
__ 3-I can't find a dentist who accepts Medicaid/"Dr Dynasaur" insurance.
__ 4-It's too far away, or I don't have transportation.
__ 5-I only take my child to the dentist when he or she has a dental problem.
__ 6-My child is not old enough to need dental care.
__ 7-Other (Please describe.)

__ Yes

1b. When your child arrives at the dentist's office, how long does he or she usually need to wait to be seen if he or she already has an appointment? (Check one.)

__ 1-Less than 30 minutes
__ 2-Between 30 minutes and 1 hour
__ 3-More than 1 hour

10. When was your child's most recent dental checkup (for routine dental care)? (Check one.)

__ 1-My child has never had a dental checkup
__ 2-Within the past 6 months
__ 3-Within the past year
__ 4-Within the past 2 years
__ 5-Within the past 4 years
__ 6-More than 4 years ago

10a. If your child has not had a checkup in the last 2 years, why not? (Check one.)

__ 1-I don't know where to go.
__ 2-My child is not due for a checkup yet.
__ 3-My health insurance does not cover dental checkups.
__ 4-I can't find a dentist who accepts Medicaid/"Dr Dynasaur" insurance.
__ 5-Dentists are too far away, or I don't have transportation.
__ 6-I don't have child care for my other children.
__ 7-The dentist's office hours are inconvenient.
__ 8-I couldn't get time off from work to take my child.
__ 9-My child only needs a dentist when he or she has a dental problem.
__ 10-I had to wait too long to get an appointment.
__ 11-The dentist's office could only put my child on a waiting list.
__ 12-My child is afraid to go or would not go.

The next few questions ask about paying for dental services.

11. Which of the following best describes your current dental insurance for your child? (Check one.)

__ 1-No insurance coverage
__ 2-Delta Dental
__ 3-Managed care plan
__ 4-Medicaid or "Dr Dynasaur"
__ 5-Other private insurance
__ 6-Combination of Medicaid and private insurance

12. Was there any time during the past year that your child was not covered by any type of dental insurance/benefits (including Medicaid/"Dr Dynasaur")? (Check one.)

__ 1-Yes
__ 2-No
__ 3-Don't know

13. In the past year, has cost prohibited your child from receiving any of the following? (Check all that apply.)

13e. Other (Please describe.) ______________

The next section asks about any help or services you may need related to your child's behavior.

14. In the past year, has your child's behavior caused a serious problem for learning in school, or living at home with your family, or getting along with other children? (Check one.)

__ 1-Yes
__ 2-No

(Check as many as you like.)

14p. Other (Please describe.) ______________

14q. If you got help, were you satisfied with it?

__ 1-Yes
__ 2- No

If no, please explain.

 

14r. If you did not get help, what is the reason?

__ 1-Not available in the community.
__ 2-I couldn't afford it.
__ 3-My child would not go.
__ 4-The waiting list for an appointment was too long.
__ 5-I did not know where to turn for help.
__ 6-I was worried about what people might think.
__ 7-Other (Please describe.)

 

15. Please answer this question only if you have a child with multiple health needs. Answer for your child with special needs, even if this is not the child you are responding about in the rest of the survey.

Do you feel that services for your child are coordinated among his or her different providers? (Check one.)

__ 1-Yes
__ 2-No
__ 3-Not sure

Comments: _______________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

16. We may not have addressed all of your concerns with regard to health-related services. Are there any medical or health-related services not available that you would like to see in your community? (Please list.)

Finally, we would like to ask a few questions about yourself that will help us interpret the results.

17. What is your relationship to the child or children you have described in this survey? (Check one.)

__ 1-Parent
__ 2-Step parent
__ 3-Grandparent
__ 4-Guardian
__ 5-Foster parent
__ 6-Other (Please describe.)

18. This child is a

__ 1-Girl
__ 2-Boy

19. How old is this child?

20. What was the last grade this child completed?

21. What is the total number of children (younger than 18) living with you?

22. What is your ZIP code?

23. Have you moved in the past year? (Check one.)

__ 1-No
__ 2-Yes

24. Please write today's date.

SUGGESTED COVER LETTER FOR SURVEY

(Print on School Letterhead)

(Date)

Dear Parent/Guardian:

I'm sure few issues are as important to you as your health, but finding and paying for health care is often a big problem for today's parents. This is an issue not just for parents, but for schools, too, because schools are where most children spend their day.

This is why I'm asking every school parent to help (community name) with the kind of information we need to see where we are, and how far we need to go to have quality health care available for our children and adolescents. (Community name) has been given an opportunity to do a community assessment of child and adolescent health. This local effort is headed by (name of school or sponsor). It's very important that the results truly represent all the parents in (community name), so please take a little time to give us your input on the enclosed (title of survey).

If you have more than 1 child in school, please answer only for the child whose next birthday comes first. The completed survey should be returned to that child's classroom teacher, in the enclosed envelope, as soon as possible.

You can be surethat your responses will be confidential. The survey has an identification number for mailing purposes only. This is so we may check your name off the list when the survey is returned. Your name will never be placed on the survey, and at no other point during this process will you be matched with your answers.

The results of the survey will be used by (name of community child health action team) to help (community name) plan how to provide better health services to our children and families. As a "thank you" for your help, each family that returns the completed survey will receive (describe incentive, sponsorship).

Any questions you might have can be answered by (name of contact person) at (phone number).

Thank you for your assistance.

Sincerely,

(Title)