First 5 Humboldt 2017 Playgroup Participant Survey

Playgroup Name: _______________________ Date: __________________

1. On average, about how many times each month do you take part in this playgroup?
_____times/month

2. How long have you been coming to this playgroup?

1-3 months 4-6 months 7-9 months 10-12 months 1-2 years more than 2 years

3. If this playgroup was open in summer months, how likely would you be to attend?
Definitely would attend Probably would attend Might attend Probably wouldn’t attend
Definitely wouldn’t attend

4. Please rate how much you agree or disagree with the following statements about this playgroup by
checking the answer that best fits your feelings about each statement
Strongly Agree Disagree Strongly Not
agree disagree applicable
a. Staff members are welcoming and respectful

b. Staff members help me to understand healthy

child and family development
c. Staff members are respectful of my cultural
traditions and values
d. Staff members have helped me to learn about
services, resources, and opportunities that are
available in the community
e. Staff help provide opportunities for me to
meet and get to know other families
f. Overall, this program has provided valuable
support for me and my family
g. I would recommend this playgroup to a friend

5. In general, how much positive effect has this playgroup had on you, your child, or your family (for
example, did your, or your child’s, ideas or behaviors change for the better)? (Please check one answer)
A lot  Some  A little  None  Does not apply

Please add any comments you have about the effect this playgroup has had on you/your child/your
family or anything you are doing differently as a result of taking part in this playgroup:

6. How satisfied are you with this playgroup? (Please check one answer)
Very satisfied Mostly satisfied Somewhat satisfied Somewhat dissatisfied Very dissatisfied

In your opinion, how could this playgroup be improved?

7. What, if any, concerns have you had/do you have about bringing your child to this playgroup?
What has helped or would help with these concerns?

8. Does the child attending this playgroup with you have an IEP (Individual Education Plan) or IFSP
(Individualized Family Service Plan) for any special needs?
 Yes  No  Not applicable (no 0-5 age child attends the program with me)

9. Are you aware that the playgroup leader here can refer you to a First 5 Humboldt-funded Child and
Family Specialist (these Specialists are: Meg/Omi, Beth, Laura, and Katie) you can talk to about any
questions you might have about your child’s development?
 Yes  No  Not sure

Have you ever talked with one of the Specialists (Meg/Omi, Beth, Laura, or Katie) at this
playgroup?
 Yes  No  Not sure

Comments about the Specialists:

10. As a result of the services/activities I have taken part in at this playgroup, (Please check one box on
each line that best fits your feelings)
Strongly Agree Disagree Strongly Not
As a result of this playgroup… Agree Disagree Applicable

a. My child and I are more connected to

other children and adults
b. I know where to get information about
services and activities for me/my child/my
family
c. I have discovered new things about my
child’s strengths and/or needs
d. I have learned more about what
skills/behaviors are typical for my child’s
age
e I feel less stress

f. I deal better with parenting issues

g. I feel more supported as a parent

h. I have someone I can talk with about

my concerns and frustrations
i. My child has learned to feel more
comfortable around other children
j. My child and I engage in play together
more often
11. On average, about how many times each month do you and your child take part in any of the First
5 Humboldt funded playgroups shown below? (Please include this playgroup)

_____times/month

First 5 Humboldt Funded

Playgroups
Arcata Playcenter McKinleyville Playgroup Trinidad Playgroup
Blue Lake Playgroup Miranda Playgroup Tiny Tots Arcata at Methodist
Discovery Museum Playgroup Manila Playgroup Weitchpec Playgroup
FUN Playcenter Orleans Playgroup Weott Playgroup
Fortuna Playgroup Redway Playgroup Willow Creek Playgroup
Loleta Playgroup Rio Dell Playgroup
Mattole Playgroup Shelter Cove Playgroup

12. How long have you been coming to any of the First 5 funded playgroups listed above?
1-3 months 4-6 months 7-9 months 10-12 months 1-2 years more than 2 years

13. In a usual week, about how many days do you or any other family members read stories or look at
picture books with your child?
 Every day  3-6 days  1-2 days  Never

14. In a usual week, about how many days do you or any other family member play music or sing
songs with your child?
 Every day  3-6 days  1-2 days  Never

15. How often do you and your child go to the library or book mobile?
 Once/week or more  2-3 times/month  Once/month  A few times/year or less

16. How often do you and your child attend “Share a Story/Story Hour” at the library?
 Once/week or more  2-3 times/month  Once/month  A few times/year or less

17. The library is a “family friendly” place for families with young children.
 Strongly agree  Agree  Disagree  Strongly disagree

18. The library is a good place to get information about parenting.

 Strongly agree  Agree  Disagree  Strongly disagree

Please add any comments you have about children’s services/activities/materials at the library:
Questions 19 through 25 are demographic questions about you/your family and help us with program
planning, evaluation, and outreach. Please know that nothing you share with us will be used to
personally identify you. If you prefer not to answer any of these questions, check “decline to state”
where applicable.

19A. How many people live in the child’s/children’s household?

Number of adults over 18 (including you):____ Number of children ages 0-2:____
Number of children ages 3-5:___ Number of children ages 6-18:____

19B. How old are the 0-5 age children? (Please check all that apply-if you have twins/triplets etc.,
please write in the number of children rather than just checking the box)
 0-6 months old 7-12 months old 13-18 months old 19 -24 months old
 between 2 & 3 years old  between 3 & 4 years old   between 4 & 5 years old  5 years old

19C. Are you or your partner pregnant?  Yes  No Not applicable  Decline to state

20. Race/Ethnicity that you identify with most closely:

African American/Black Asian/Asian American Hispanic/Latino Native American Multi-ethnic
Pacific Islander White Other: _________________  Decline to state

21. What language do you speak most of the time at your home?
 English  Spanish   Other (please specify): _________________  Decline to state

22. What is your highest level of education?

Less than high school Some high school  High school degree/GED Some college
AA/AS degree BA/BS degree MA/MS degree or higher Decline to state

23. Yearly household income at child’s residence before taxes (your best estimate!): $0-$16,395
$16,396-$22,108 $22,109-$27,821 $27,822-$33,534 $33,535-$39,248 $39,249-$44,961
$44,962-$50,688 $50,689-$56,429 $56,430-$62,169  $62,170-$73,651 $73,652 and over
Decline to state  Don’t know

24. How old are you? _____

17 or under 18-21 22-26 27-35 36-45 46-55 56-65 66 or over

25. What town do you live in or closest to? ______________

26. Please add any comments you would like to make about the services/activities provided by this
program: