About You and Your Head Start Program

1. What is your current position?

• Disabilities Coordinator
• Education Coordinator
• Social Services Coordinator

2. What is the age range of children within the Head Start programs you serve?

3. Are there any special characteristics of the Head Start personnel or children that you serve (e.g., "Most of the teachers I serve are first or second year teachers.")?

4. How long have you held your current position?

_____________________ years

5. How many hours per day do you work directly with:

_____ hr./day with children enrolled in Head Start or their families
_____ hr./day with Head Start personnel

6. Please list professional organizations to which you belong.

7. Please indicate specific areas of information you think would help you to be more effective and efficient in improving outcomes for children with emotional and behavioral problems. If you check or write in several information needs, please number them in terms of importance, with "1" indicating "most important."

Improving Children's Learning and Adjustment

Assessment

____ prereferral process
____ screening for potential emotional and behavioral problems
____ curriculum relevant assessment
____ on-going assessment
____ measures of home environment
____ measures of community resources
____ other (specify):

Interventions

____ strategies to prevent emotional and behavioral problems
____ teaching social skills
____ teaching cognitive skills
____ promoting social and emotional development
____ strategies such as modeling and role-playing
____ techniques for managing behavior problems in the classroom
____ medication
____ technology
____ child counseling techniques
____ parent counseling
____ play therapy
____ other (specify):

8. Please indicate specific areas of information that would help you to be more effective and efficient in working with families. If you check or write in several information needs, please number them in terms of importance, with "1" indicating "most important."

Working with Families

Practices

____ coordinating Head Start and home efforts
____ establishing effective communication channels
____ connecting families to other service providers in the community
____ other (specify):

Special Families

____ working with culturally/linguistically diverse families
____ strategies for contacting hard-to-reach families
____ other (specify):

Working with Other Professionals

9. Do you have access to any of the following resources for information? Use a scale of 1 to 3 to rate your ease of access, "1" being "very accessible" and "3" being "not very accessible."

____ mental health counselor
____ psychologist
____ behavior consultant/specialist/analyst
____ Head Start administrator
____ Technical Assistance provider
____ professional libraries
____ professional conferences/workshops
____ resource centers
____ other (specify):

10. We are interested in knowing how, or from whom, you get information about working with children with emotional and behavioral problems. Please rate on an ascending scale, with "1" being the "best source."

____ mental health counselor
____ psychologist
____ behavior consultant/specialist/analyst
____ Head Start administrator
____ Technical assistance provider
____ professional libraries
____ professional conferences/workshops
____ resource centers
____ other (specify):

11. Is there someone in the Head Start program (national, regional, or local level) whose job it is to give you such assistance?

• yes
• no

If yes, what is that person's title? ______________________________

12. Check which professionals you would care to receive information about, concerning both what they do and how to collaborate with them.

____ mental health counselors
____ technical assistance providers
____ social workers
____ other Head Start personnel
____ teachers
____ administrators
____ psychologists

13. In general, who has been most helpful to you in obtaining new information about working with the children you serve? If you check or write in several individuals, please number them in terms of importance, with "1" indicating "most helpful."

____ mental health counselors
____ social workers
____ general education teachers
____ special education teachers
____ administrators
____ psychologists
____ university professors
____ other (specify):

Information Format

14. We understand that many of the traditional ways of distributing information often are not effective. Think of an example of information that you received recently that was helpful to you. What was it about the information that made it useful?

15. In what format was the information given to you?

____ workshop or conference
____ written material
____ audio or video tapes
____ Internet
____ other teachers
____ other (specify):

16. Which of the following would be your preferred way(s) to receive information? If you check or write in several choices, please number them in terms of importance, with "1" indicating "most preferred."

____ Internet (i.e., listserv or email), accessed from:

• facility
• home
• other (specify):

____ World Wide Web
____ postal service
____ 800 telephone number
____ demonstration site
____ videotapes
____ peer
____ conference
____ workshop
____ teleconference
____ computer disk
____ other (specify):

17. Do you have access to the Internet?

• yes
• no

If yes, where?________________

18. Do you have an E-mail address?

• yes
• no

Your address:___________________

19. Is there anything else about your information needs that you can tell us?

Barriers

20. Please name one major barrier to improving services for children with emotional and behavioral problems and their families.

21. Thank you very much for taking your time to complete this Questionnaire. With your permission, may we keep you on our mailing list to receive updated information?

• yes
• no

22. Would it be acceptable for us to contact you in the future, if we have other questions?

• yes
• no

If yes, please record your name, address, and telephone number:

Name: ______________________________

Address:

___________________________________________________________

___________________________________________________________

___________________________________________________________

Telephone: ______________________________

23. Please check below if you would like a copy of our Center Information Booklet sent to you at the address above. Our booklet also is available here on our web site, where you can print out a copy for your personal use.

• Yes, please send me a Center Information Booklet.

If you need to reach us, our telephone number is 1-888/457-1551.

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