www.thefamilymap.org
version 5.4
Date of Interview
Fecha de la entrevista:
Location of Interview - 00000001
En el hogar
Location of Interview - 2
En otra casa
Location of Interview - 3
En la escuela
Location of Interview - 4
En un lugar público
Lugar donde se realizó la entrevista:
Target Child - 1
1
Target Child - 2
2
Target Child - 3
3
Target Child - 4
4
Niño destinatario
Prenatal Inventario
Code of the interviewer
Entrevista realizada por:
AgenCode
Código de agencia:
state
Ubicación:
region
Región:
CenCode
Colegio:
ClassCode
Clase:
Sent - 1
Sent - 0
isSaved - 1
isSaved - 0
Parent ID
Parent ID
(Use '00000' for test records)
What do you consider your child's race - q1a_1
Blanco(a)
What do you consider your child's race - q1a_2
India Americano o India de Alaska
What do you consider your child's race - q1a_3
Asiático(a)
What do you consider your child's race - q1a_4
Negro(a)
What do you consider your child's race - q1a_5
India de Hawaii o de otra isla del Pacífico
What do you consider your child's race - q1a_6
De otra raza
b) ¿Se considera usted latina o hispana?
Do you consider your child to be Hispanic or Latino - 1
Sí
Do you consider your child to be Hispanic or Latino - 0
No
1. a) ¿De qué raza su hijo considera usted?
Indique todas las opciones que le correspondan.
Other - Race Identified
c) ¿Nació usted en los Estados Unidos?
were you born in the United States - 1
Sí
were you born in the United States - 0
No
Country of Origin - Name
Indique su país de orígen
Si contestó que no:
your age - 1
16 años o menos
your age - 2
De 17 a 18 años
your age - 3
De 19 a 24 años
your age - 4
De 25 a 34 años
your age - 5
De 35 a 40 años
your age - 6
41 años o más
2. ¿Qué edad tiene usted actualmente?
How old are you in years
Años
Para las madres embarazadas
EL MAPA FAMILIAR PRENATAL
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Prenatal Span V2
Nombre de la madre embarazada:
Name of the child
Date of Interview
Fecha en la que nacerá el/la bebé:
Prenatal Inventario
Parent ID
Parent ID
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Prenatal Span V2
Child One Name
Child one relationship to mother
Child Two Name
Child two relationship to mother
Child Three Name
Child three relationship to mother
Child Four Name
Child four relationship to mother
Child Five Name
Child five relationship to mother
Child Six Name
Child six relationship to mother
Child Seven Name
Child seven relationship to mother
APOYO INTERNO
SECCIÓN No. 1
S1. Aparte del inglés, ¿hablan otro idioma en su hogar a regularmente?
Language spoken in home - 0
No
Language spoken in home - 1
Español
Language spoken in home - 2
Otro idioma:
Other - None English Language Spoken in Home
Comfortable Speaking English - 1
Comfortable Speaking English - 2
Comfortable Speaking English - 3
Comfortable Speaking English - 4
Do Family Members Translate English for You with Program Staff - 1
Do Family Members Translate English for You with Program Staff - 2
Do Family Members Translate English for You with Program Staff - 3
Do Family Members Translate English for You with Program Staff - 4
Do you understand the written mateials presented - 1
Do you understand the written mateials presented - 2
Do you understand the written mateials presented - 3
Do you understand the written mateials presented - 4
Do you feel comfortable asking program staff to translate written mateials for you - 1
Do you feel comfortable asking program staff to translate written mateials for you - 2
Do you feel comfortable asking program staff to translate written mateials for you - 3
Do you feel comfortable asking program staff to translate written mateials for you - 4
S2. ¿Ha participado o está participando actualmente en un programa parecido a éste?
Head Start, HIPPY, programa de visitas al hogar
Involved in Similar Program Previously - 0
No
Involved in Similar Program Previously - 1
Sí
Si contestó que sí:
Other - name of previous program involved with
a) ¿Se ha establecido alguna meta relacionadas en dicho programa?
Goals with this Program? - 0
No
Goals with this Program? - 1
Sí
S3. ¿Cuántos niños(as) viven en el hogar con usted?
Incluya solamente a personas menores de 18 años.
No incluya a la mamá.
children in home - 0
0
children in home - 1
1
children in home - 2
2
children in home - 3
3
children in home - 4
4
children in home - 5
5
children in home - 6
6
children in home - 7
7
Nombre:
Parentesco de esta persona con la mamá:
Ningún otro niño(a)
S4. ¿Está Ud. inscrita en una escuela actualmente?
S5. ¿Hasta qué nivel educativo ha llegado? (que haya finalizado)
completed school classification - 1
completed school classification - 2
completed school classification - 3
completed school classification - 4
completed school classification - 5
completed school classification - 6
No termine la Preparatoria
Diploma de Preparatoria
GED
Escuela Técnica, Certificado
Técnico/Licencia
Título Universitario
(de 4 años)
Current school enrollment - 1
Current school enrollment - 2
Current school enrollment - 3
Current school enrollment - 4
Current school enrollment - 5
No estoy inscrita
Examen Dessarollo Educ General GED
Escuela Preparatoria o Secundaria
Vocacional, Certificado Técnico/Licencia
Universidad
Titulo Asociado de 2 años o algún crédito de Universidad
Marque el total:
¿Qué programa?
Siempre
Frecuente-
mente
A
veces
Casi nunca
NoZone_4
Si respondió que No, pase a la pregunta S2.
Si alguna de las respuestas anteriores se encuentra en las áreas sombreadas:
Considere El inglés como segundo idioma como una meta.
Si actualmente no está inscrita, ni tampoco ha terminado la escuela preparatoria:
Considere La educación como una meta.
Utilice la Tarjeta de Respuestas
Con qué frecuencia:
¿Le ayuda algún miembro de su familia a hablar en inglés con el personal del programa debido a que esa persona lo habla mejor?
b)
a)
¿Se siente tranquilo(a) al hablar en inglés?
¿Puede entender la información por escrito que le han dado de parte del programa?
c)
¿Se siente tranquilo(a) al pedirle al personal del programa que le traduzcan los materiales informativos?
d)
Prenatal Inventario
Parent ID
Parent ID
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Prenatal Span V2
S6. Durante la semana pasada, ¿cuántas horas pagadas trabajó usted?
(O si la pasada semana no fue usual, indique la cantidad de horas que normalmente trabaja. Sume las horas de todos los trabajos.)
No está
trabajando
hours worked last week - 1
hours worked last week - 2
hours worked last week - 3
hours worked last week - 4
hours worked last week - 5
hours worked last week - 6
hours worked last week - 7
hours worked last week - 8
De 0 a 10 horas
De 11 a 20 horas
De 21 a 30 horas
De 31 a 40 horas
De 41 a 50 horas
De 51 a 60 horas
De 60 horas en adelante
a) ¿Cuánto tiempo ha estado en este trabajo?
(Indique el trabajo más reciente si tiene más de un trabajo)
time at job - 1
time at job - 2
time at job - 3
time at job - 4
time at job - 5
3 meses o menos
De 3 a 6
meses
De 7 meses
a un año
De 1 a 3 años
De 3 años a más
b) ¿Cuántos trabajos tiene actualmente?
number of jobs - 1
1
number of jobs - 2
2
number of jobs - 3
3
c) ¿Cuál turno trabaja regularmente
what kind of shift do you work - 1
what kind of shift do you work - 2
what kind of shift do you work - 3
what kind of shift do you work - 4
what kind of shift do you work - 5
Un turno normal durante el día
Un turno normal durante la tarde
Un turno normal durante la noche
Un turno con horario combinado
Otro tipo de turno
What shift do you usually work - detail?
S7. ¿Cuántos adultos viven en el hogar con usted?
Incluya solamente a personas mayores de 18 años. No incluya a la mamá.
number of adults in home - 0
0
number of adults in home - 1
1
number of adults in home - 2
2
number of adults in home - 3
3
number of adults in home - 4
4
number of adults in home - 5
5
number of adults in home - 6
6
number of adults in home - 7
7
number of adults in home - 8
8
number of adults in home - 9
9
S8. S8. ¿Usted o algún miembro de la familia recibe pagos por desempleo?
receiving unemployment payments - 00000001
Sí
receiving unemployment payments - 0
No
S9. Ahora queremos platicar sobre el otro padre de su bebé, ya sea que viva con usted o no.
Nombre
¿Qué parentesco tiene con su hijo(a)?
¿Cuánto tiempo han vivido en la misma casa?
¿Hasta qué nivel educativo ha llegado? (que haya finalizado)
¿Está inscrito en alguna escuela actualmente?
¿Cuántas horas trabajadas le pagan actualmente?
name of parental figure outside the home
Padre que vive fuera del hogar
name of parental figure in the home
Padre que viva en el hogar
time lived together - 1
time lived together - 2
time lived together - 3
Un año o menos
De 2 a 3 años
De 4 años en adelante
relationship to child - 1
relationship to child - 2
relationship to child - 3
Padre biológico
Padrastro, Padre de Crianza, Padre Adoptivo
Su compañero
e) ¿No está trabajando actualmente debido a que está embarazada.
not working because of child birth - 0
No
not working because of child birth - 1
Sí
Relationship to child - 1
Relationship to child - 2
Relationship to child - 3
Padre biológico
Padrastro, Padre de Crianza, Padre Adoptivo
Su compañero
NoZone_S6
Si no está trabajando, pase a la pregunta “e”.
Si alguna respuesta se encuentra en el área sombreada: Considere el Empleo como una meta.
Si actualmente no está inscrito, ni tampoco ha terminado la escuela preparatoria:
Considere La educación como una meta.
Universidad
Instituto Técnico
Diploma de Preparatoria /GED
No terminó la Preparatoria
education level - 1
education level - 2
education level - 3
education level - 4
Universidad
Instituto Técnico
Preparatoria/ GED
No
current enrollment status - 1
current enrollment status - 2
current enrollment status - 3
current enrollment status - 4
hours working per week - 1
hours working per week - 2
hours working per week - 3
hours working per week - 4
50 horas o más
Entre 20 a 50 horas
20 horas o menos
Entre 0 y 10 horas
education level - 1
education level - 2
education level - 3
education level - 4
No terminó la Preparatoria
Diploma de Preparatoria /GED
Instituto Técnico
Universidad
current enrollment status - 1
current enrollment status - 2
current enrollment status - 3
current enrollment status - 4
Universidad
Instituto Técnico
Preparatoria/ GED
No
hours worked per week - 1
hours worked per week - 2
hours worked per week - 3
hours worked per week - 4
50 horas o más
Entre 20 y 50 horas
20 horas o menos
Entre 0 y 10 horas
d)¿Ha hablado con su doctor acerca de los esfuerzos físicos que tendrá al trabajar estando embarazada? Si contesta “si”, no conteste la siguiente pregunta “e”?
S6d - 0
No
S6d - 1
Sí
Skip e.
Prenatal Inventario
Parent ID
Parent ID
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Prenatal Span V2
S10. Hablemos acerca de las otras personas que viven en el hogar que le ayudan actualmente o que le podrían ayudar cuando nazca su bebé. ¿Cómo se llaman?
Nombre
¿Qué parentesco tiene esta persona con su hijo(a)?
¿Por cuánto tiempo han vivido en la misma casa?
¿Qué nivel educativo completó?
¿Está inscrito(a) en alguna escuela actualmente?
¿Cuántas horas pagadas trabaja esa persona actualmente?
Name of Other Adult living in the home - one
other adult one - number of years lived in home - 1
other adult one - number of years lived in home - 2
other adult one - number of years lived in home - 3
Un año o menos
2 a 3 años
4 años en adelante
other adult one - completed education level - 1
other adult one - completed education level - 2
other adult one - completed education level - 3
other adult one - completed education level - 4
No terminó la Preparatoria
Preparatoria/ GED
Instituto Técnico
Universidad
other adult one - Classification of Education Currently enrolled in - 1
other adult one - Classification of Education Currently enrolled in - 2
other adult one - Classification of Education Currently enrolled in - 3
other adult one - Classification of Education Currently enrolled in - 4
No
Preparatoria/ GED
Instituto Técnico
Universidad
other adult one - hours per week currently working - 1
other adult one - hours per week currently working - 2
other adult one - hours per week currently working - 3
other adult one - hours per week currently working - 4
Entre 0 y 10 horas
20 horas o menos
Entre 20 y 50 horas
50 horas o más
relationship to child - one - 1
relationship to child - one - 2
relationship to child - one - 3
Abuelo (a) del niño(a)
Tío (a) del niño (a)
Otro
relationship to child - other - one
Name of Other Adult living in the home - two
other adult two - number of years lived in home - 1
other adult two - number of years lived in home - 2
other adult two - number of years lived in home - 3
Un año o menos
2 a 3 años
4 años
en adelante
other adult two - completed education level - 1
other adult two - completed education level - 2
other adult two - completed education level - 3
other adult two - completed education level - 4
No terminó la Preparatoria
Preparatoria/ GED
Instituto Técnico
Universidad
other adult two - Classification of Education Currently enrolled in - 1
other adult two - Classification of Education Currently enrolled in - 2
other adult two - Classification of Education Currently enrolled in - 3
other adult two - Classification of Education Currently enrolled in - 4
No
Preparatoria/ GED
Instituto Técnico
Universidad
other adult two - hours per week currently working - 1
other adult two - hours per week currently working - 2
other adult two - hours per week currently working - 3
other adult two - hours per week currently working - 4
Entre 0 y 10 horas
20 horas o menos
Entre 20 y 50 horas
50 horas o más
relationship to child - two - 1
relationship to child - two - 2
relationship to child - two - 3
Abuelo (a) del niño(a)
Tío (a) del niño (a)
Otro
relationship to child - other - two
Name of Other Adult living in the home - three
other adult three - number of years lived in home - 1
other adult three - number of years lived in home - 2
other adult three - number of years lived in home - 3
Un año o menos
2 a 3 años
4 años en adelante
other adult three - completed education level - 1
other adult three - completed education level - 2
other adult three - completed education level - 3
other adult three - completed education level - 4
No terminó la Preparatoria
Preparatoria/ GED
Instituto Técnico
Universidad
other adult three - Classification of Education Currently enrolled in - 1
other adult three - Classification of Education Currently enrolled in - 2
other adult three - Classification of Education Currently enrolled in - 3
other adult three - Classification of Education Currently enrolled in - 4
No
Preparatoria/ GED
Instituto Técnico
Universidad
other adult three - hours per week currently working - 1
other adult three - hours per week currently working - 2
other adult three - hours per week currently working - 3
other adult three - hours per week currently working - 4
Entre 0 y 10 horas
20 horas o menos
Entre 20 y 50 horas
50 horas o más
relationship to child - three - 1
relationship to child - three - 2
relationship to child - three - 3
Abuelo (a) del niño(a)
Tío (a) del niño (a)
Otro
relationship to child - other - three
(Pregunte acerca de un máximo de 3 personas Pase a la siguiente pregunta si nadie más vive en el hogar.)
Si actualmente no está inscrito/a, ni tampoco ha terminado la secundaria: Considere La educación como una meta.
1.
2.
3.
A muchas nuevas madres les cuesta trabajo encontrar a alguien que le ayude a cuidar a su hijo/a cuando necesita salir o regresar a trabajar. Piense en todas las personas que usted podría preguntar que cuide a su bebé (marque todas las respuestas que apliquen)
S11.
S12.
En los primeros tres meses de vida de su bebé, ¿quién cuidará al bebé cuando usted tenga que salir sin su bebé por un corto tiempo?
a)
¿Cualquiera de estas personas tiene menos de 12 años?
Al año después de que nazca su bebé, ¿quién cuidará al bebé/a la bebé cuando usted tenga que regresar al trabajo o a la escuela?
a)
¿Cualquiera de estas personas tiene menos de 12 años?
Si hay alguna respuesta en el área sombreada: Considere El cuidado de los niños como meta.
S11a - 0
No
S11a - 1
Yes
s11 - 1
No estoy segura
s11 - 2
Mi companero
s11 - 3
Otro familiar
s11 - 4
Vecino o amigo
s11 - 5
Un empleado/a de un centro
s12 - 1
No estoy segura
s12 - 2
mi companero
s12 - 3
Otro familiar
s12 - 4
Vecino o amgio
s12 - 5
Un empleado/a de un centro
S12a - 0
No
S12a - 1
Yes
Prenatal Inventario
Parent ID
Parent ID
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Prenatal Span V2
Esta entrevista incluirá preguntas sobre su familia durante el año, mes y semana pasada.
R1.
R1. Antes de seguir adelante, ¿El mes pasado, fue un mes normal para usted?
Has the past month been typical for you? - 1
Sí
Has the past month been typical for you? - 0
No
R2.
In the last 6 months, have you been separated from the family more than a week? - 1
Sí
In the last 6 months, have you been separated from the family more than a week? - 0
No
In the last 6 months, has another adult in the household been separated from the family more than a week? - 1
Sí
In the last 6 months, has another adult in the household been separated from the family more than a week? - 0
No
Otra persona
Usted
R3.
Durante
el año pasado
, ¿cuántas veces se ha cambiado de casa?
R4.
¿Tiene planes de cambiarse de casa durante
el próximo año
?
R5.
Durante el año pasado, ¿ha vivido usted o su niño con otros familiares o amigos, en un albergue, hotel, en un vehículo o en otro tipo de vivienda temporal?
In the past year how many times has your child moved residences? - 0
0
In the past year how many times has your child moved residences? - 1
1
In the past year how many times has your child moved residences? - 2
2
In the past year how many times has your child moved residences? - 3
3
In the past year how many times has your child moved residences? - 4
Más
Do you plan to move residences in the next year? - 1
Sí
Do you plan to move residences in the next year? - 0
No
Have you and your child lived with family or friends or in a shelter, hotel, car or other temporary housing in the past year? - 1
Sí
Have you and your child lived with family or friends or in a shelter, hotel, car or other temporary housing in the past year? - 0
No
El tener una rutina diaria y una casa organizada puede ayudar a las personas de muchas maneras. Las siguientes preguntas tienen que ver con lo que ha sucedido
la semana pasada
.
Si la semana pasada no fue muy normal (por ejemplo si salió de viaje), pregunte sobre la semana antepasada. Si la persona no tiene una rutina relacionada con uno de los siguientes puntos, entonces marque la columna que dice “Ningún día”.
Ningún día
1
día
2 días
3 días
4 días
5 días
6 días
7 días
R6.
En cuanto a
los últimos 7 días
, ¿cuántos días:
Si alguna respuestas se encuentra en el área sombreada: Considere las estrategias de apoyo como una meta.
Si alguna respuestas se encuentra en el área sombreada: Considere la vivienda como una meta.
Si alguna respuesta se encuentra en el área sombreada: Considere La rutina diaria como una meta.
En los
próximos 6 meses
, ¿cree que usted o alguien más en su casa va a estar separado/a de la familia por más de una semana (debido a las fuerzas armadas, un trabajo o porque estará en la cárcel)?
RUTINAS
SECCIÓN No. 2
b)
Se acostó aproximadamente a la misma hora?
In the past 7 days, how many of those days did your child get a bath at about the same time, if less than 6 months did you do for them? - 0
In the past 7 days, how many of those days did your child get a bath at about the same time, if less than 6 months did you do for them? - 1
In the past 7 days, how many of those days did your child get a bath at about the same time, if less than 6 months did you do for them? - 2
In the past 7 days, how many of those days did your child get a bath at about the same time, if less than 6 months did you do for them? - 3
In the past 7 days, how many of those days did your child get a bath at about the same time, if less than 6 months did you do for them? - 4
In the past 7 days, how many of those days did your child get a bath at about the same time, if less than 6 months did you do for them? - 5
In the past 7 days, how many of those days did your child get a bath at about the same time, if less than 6 months did you do for them? - 6
In the past 7 days, how many of those days did your child get a bath at about the same time, if less than 6 months did you do for them? - 7
In the past 7 days, how many of those days did your child go to bed at about the same time, if less than 6 months did you do for them? - 0
In the past 7 days, how many of those days did your child go to bed at about the same time, if less than 6 months did you do for them? - 1
In the past 7 days, how many of those days did your child go to bed at about the same time, if less than 6 months did you do for them? - 2
In the past 7 days, how many of those days did your child go to bed at about the same time, if less than 6 months did you do for them? - 3
In the past 7 days, how many of those days did your child go to bed at about the same time, if less than 6 months did you do for them? - 4
In the past 7 days, how many of those days did your child go to bed at about the same time, if less than 6 months did you do for them? - 5
In the past 7 days, how many of those days did your child go to bed at about the same time, if less than 6 months did you do for them? - 6
In the past 7 days, how many of those days did your child go to bed at about the same time, if less than 6 months did you do for them? - 7
c)
Se mantuvo a su rutina regular por la mañana?
R7.
¿Cuántas horas está encendida la televisión en la casa durante un día normal de la semana aunque nadie la esté viendo?
R7 - 0
R7 - 1
R7 - 2
R7 - 3
R7 - 4
R7 - 5
R7 - 7
R7 - 6
R7 - 8
R7 - 9
R7 - 10
R7 - 11
R7 - 12
8 a 9 horas
10 horas o más
9 a 10 horas
7 a 8 horas
6 a 7 horas
5 a 6 horas
4 a 5 horas
3 a 4 horas
2 a 3 horas
1 a 2 horas
½ a 1 hora
½ hora o menos
Ninguna hora
In the past year how many times has your child moved residences? - 1
Muy probable
In the past year how many times has your child moved residences? - 2
Probable
In the past year how many times has your child moved residences? - 3
No estoy segura
In the past year how many times has your child moved residences? - 4
No muy probable
In the past year how many times has your child moved residences? - 5
No es probable para nada
Durante
el año pasado
, ¿cuántas veces se ha cambiado de casa?
R8.
Se necesita espacio para el/la bebé
Safety Concerns in the Home - 1
1
Safety Concerns in the Home - 2
2
Safety Concerns in the Home - 3
3
Safety Concerns in the Home - 4
4
El espacio para el bebé ya está listo o planificado
Un hogar muy activo
Safety Concerns Outside of Home - 1
1
Safety Concerns Outside of Home - 2
2
Safety Concerns Outside of Home - 3
3
Safety Concerns Outside of Home - 4
4
Un hogar muy calmado
Si 2 o más de las respuestas se encuentran en el área sombreada:Considere La organización del hogar como una meta.
Safety Concerns in the Home - 1
1
Safety Concerns in the Home - 2
2
Safety Concerns in the Home - 3
3
Safety Concerns in the Home - 4
4
Un hogar no muy organizado
Un hogar muy organizado
Un hogar demasiado lleno de gente
Un hogar que no está demasiado lleno de gente
Safety Concerns in the Home - 1
1
Safety Concerns in the Home - 2
2
Safety Concerns in the Home - 3
3
Safety Concerns in the Home - 4
4
Prenatal Inventario
Parent ID
Parent ID
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Page 6 of 19
Prenatal Span V2
Aún los bebés de corta edad se pueden beneficiar de las cosas y objetos que pueden escuchar, ver y tocar. Recuerde, estas cosas pueden ser de las que se venden en las tiendas, de las hechas a mano o de las que se utilizan para algo distinto, como las ollas y cacerolas.
L1.
¿Cuántos tipos de cosas tiene usted que su bebé va a poder:
0
1
2
3 o mas
Do you have things that your child (less than 12 months) can use their muscles with - ball, crib gym, jumpr rope or swing? - 0
Do you have things that your child (less than 12 months) can use their muscles with - ball, crib gym, jumpr rope or swing? - 1
Do you have things that your child (less than 12 months) can use their muscles with - ball, crib gym, jumpr rope or swing? - 2
Do you have things that your child (less than 12 months) can use their muscles with - ball, crib gym, jumpr rope or swing? - 3
c)
Tocar y abrazar
como los animales de peluche o tapete de juego con texturas?
Do you have things that your child (less than 12 months) can feel or cuddle - stuffed animal, soft cloth, play mat with textures? - 0
Do you have things that your child (less than 12 months) can feel or cuddle - stuffed animal, soft cloth, play mat with textures? - 1
Do you have things that your child (less than 12 months) can feel or cuddle - stuffed animal, soft cloth, play mat with textures? - 2
Do you have things that your child (less than 12 months) can feel or cuddle - stuffed animal, soft cloth, play mat with textures? - 3
b)
Utilizar para hacer ruido como una sonaja, algo que dé vueltas, vibre o haga ruidos como zumbidos?
Do you have things that your child (less than 12 months) can make noise with - rattle, spin, jitter, whir? - 0
Do you have things that your child (less than 12 months) can make noise with - rattle, spin, jitter, whir? - 1
Do you have things that your child (less than 12 months) can make noise with - rattle, spin, jitter, whir? - 2
Do you have things that your child (less than 12 months) can make noise with - rattle, spin, jitter, whir? - 3
a)
Ver como un espejo en la cuna, un adorno móvil o lamparita de noche que proyecte la luz hacia el techo del cuarto?
Do you have things that your child (less than 12 months) can see - mirror in the crib, mobile, night light that projects light onto ceiling? - 0
Do you have things that your child (less than 12 months) can see - mirror in the crib, mobile, night light that projects light onto ceiling? - 1
Do you have things that your child (less than 12 months) can see - mirror in the crib, mobile, night light that projects light onto ceiling? - 2
Do you have things that your child (less than 12 months) can see - mirror in the crib, mobile, night light that projects light onto ceiling? - 3
0
1 a 2
3 a 9
10 o más
Muchas personas disfrutan leer y es importante que los niños sean expuestos a los libros y a la lectura a temprana edad.
Do you have a library card? - 1
Sí
Do you have a library card? - 0
No
L2.
¿Qué tan seguido lee usted en la casa?
How many children's books does your child have of his or her own or share with brothers or sisters? - 0
How many children's books does your child have of his or her own or share with brothers or sisters? - 1
How many children's books does your child have of his or her own or share with brothers or sisters? - 2
How many children's books does your child have of his or her own or share with brothers or sisters? - 3
L4.
¿Tiene una tarjeta para la biblioteca?
L3.
¿Cuántos libros infantiles que se puedan limpiar o lavar tiene
para su bebé? Frecuentemente, estos libros están hechos de
vinilo, tela o cartón.
d)
Utilizar para mover sus músculos como una pelota, gimnasio para bebé, juguete en el que pueda brincar, triciclo o resbaladilla?
EL APRENDIZAJE A TEMPRANA EDAD SECCIÓN No. 3
Si 2 o más respuestas se encuentran en el area sombreada:
Considere Los materiales educativos como una meta.
Si todas las respuestas se encuentran en las áreas sombreadas:
Considere los materiales de lectura como uno meta.
Need books in home
More than 10 books or magazines
bookobs - 1
1
bookobs - 2
2
bookobs - 3
3
bookobs - 4
4
4
L2 - 1
Everyday or almost everyday
L2 - 2
A few times a week
L2 - 3
Once a week
L2 - 4
A few times a month
L2 - 5
A few times a year
L2 - 6
Never
Todos los días o casi todos los días
Algunas veces a la semana
Una vez a la semana
Algunas veces al mes
Algunas veces al año
Nunca
Prenatal Inventario
Parent ID
Parent ID
Thefamilymap.org
© 2016, BioVentures, LLC, All rights reserved
Page 7 of 19
Prenatal Span V2
X1.
Cada mujer embarazada siente diferente acerca de su embarazo. Durante la última semana, ¿con qué frecuencia usted:
Utilice la Tarjeta de Respuestas
Poco tiempo o nunca
A veces
Mucho o todo el tiempo
a)
b)
c)
d)
e)
Se ha preguntado cómo se verá el bebé?
Disfrutó o desea con ansias poder disfrutar el sentir que se mueva el/la bebé?
Les ha dicho a otras personas lo que el/la bebé hace dentro de su vientre?
Ha tratado de imaginarse lo que el/la bebé está haciendo?
Ha acariciado a su bebé al acariciarse el vientre?
Si 3 de las respuestas o más se encuentran en el área sombreada: Considere La educación prenatal como una meta familiar.
Utilice la Tarjeta de Respuestas
X2.
Al pensar en la forma en el que su bebé se comportará durante los primeros 6 meses, ¿qué tan de acuerdo está usted con los siguientes puntos?:
a)
b)
c)
d)
Un(a) bebé puede llorar por 20 ó 30 minutos a la vez, sin importar cuánto usted trate de consolarlo/a.
El cuidar al bebé/a la bebé deja a los padres sintiéndose cansado(a), frustrado(a) o abrumado(a).
Un(a) bebé puede entender palabras que no puede decir.
Los bebés lloran y ensucian sus pañales para molestar a sus padres.
Estoy completamente en desacuerdo
No estoy de acuerdo
Estoy completamen te de acuerdo
Estoy de acuerdo
Si 2 de las respuestas o más se encuentran en el área sombreada: Considere La educación prenatal como una meta familiar.
X1a - 1
X1a - 2
X1a - 3
X1b - 1
X1b - 2
X1b - 3
X1c - 1
X1c - 2
X1c - 3
X1d - 1
X1d - 2
X1d - 3
X1e - 1
X1e - 2
X1e - 3
X2a - 1
X2a - 2
X2a - 3
X2a - 4
X2b - 1
X2b - 2
X2b - 3
X2b - 4
X2c - 1
X2c - 2
X2c - 3
X2c - 4
X2d - 1
X2d - 2
X2d - 3
X2d - 4
Prenatal Inventario
Parent ID
Parent ID
Thefamilymap.org
© 2016, BioVentures, LLC, All rights reserved
Page 8 of 19
Prenatal Span V2
Las próximas preguntas tienen que ver con el crimen y cuestiones de la seguridad en su vecindario. Al hablar del vecindario nos referimos a las cuadras que rodean su casa o a un área que al caminar se encuentre a poca distancia de la misma.
E3.
En su vecindario, ¿qué tan serio es el problema de la venta y el uso de drogas? Diría usted que:
No es serio
No es tan serio
Mas o menos serio
Muy serio
Is your neighborhood have issues with people selling or using drugs? - 1
Is your neighborhood have issues with people selling or using drugs? - 2
Is your neighborhood have issues with people selling or using drugs? - 3
Is your neighborhood have issues with people selling or using drugs? - 4
Nunca
A veces
Mucho
Todo el tiempo
Thinking about crime and safety in your neighborhood, how often do you think about moving because of the safety of the neighborhood? - 1
Thinking about crime and safety in your neighborhood, how often do you think about moving because of the safety of the neighborhood? - 2
Thinking about crime and safety in your neighborhood, how often do you think about moving because of the safety of the neighborhood? - 3
Thinking about crime and safety in your neighborhood, how often do you think about moving because of the safety of the neighborhood? - 4
Nunca suceden
Casi nunca suceden
Suceden mas o menos a menudo
Suceden muy a menudo
How often are there problems with muggings, burglaries, assaults, or other criminal activities in your neighborhood? - 1
How often are there problems with muggings, burglaries, assaults, or other criminal activities in your neighborhood? - 2
How often are there problems with muggings, burglaries, assaults, or other criminal activities in your neighborhood? - 3
How often are there problems with muggings, burglaries, assaults, or other criminal activities in your neighborhood? - 4
E4.
En su vecindario, ¿con qué frecuencia hay problemas de atracos, robos, asaltos, agresiones u otras actividades criminales? Diría usted que estas cosas:
E5.
Durante
el último año
, ¿cuántas veces le han lastimado físicamente
a usted o a otra persona que viva en su casa
?
Muy malo
Mas o menos malo
Mas o menos bueno
Muy bueno
How do you feel about your neighborhood - doe you feel it is good or bad? - 1
How do you feel about your neighborhood - doe you feel it is good or bad? - 2
How do you feel about your neighborhood - doe you feel it is good or bad? - 3
How do you feel about your neighborhood - doe you feel it is good or bad? - 4
El vecindario no es seguro
How Safe or Unsafe is your neighborhood? - 1
1
How Safe or Unsafe is your neighborhood? - 2
2
How Safe or Unsafe is your neighborhood? - 3
3
How Safe or Unsafe is your neighborhood? - 4
4
El vecindario es seguro
LA SEGURIDAD DE SU MEDIO AMBIENTE SECCIÓN No. 5
Utilice la tarjeta de respuestas
E1.
¿Qué piensa de su vecindario? Considera que es:
E2.
Al pensar en el crimen y la seguridad de su vecindario, ¿qué tan a menudo piensa en mudarse debido a la falta de seguridad allí? Diría usted que:
Si alguna de las respuestas se encuentra en el área sombreada:
Considere La vivienda o Estrategias de seguridad como una meta.
Nunca
1 vez
2 veces
3 veces
Más de 3 veces
E5 - 0
E5 - 1
E5 - 2
E5 - 3
E5 - 4
Prenatal Inventario
Parent ID
Parent ID
Thefamilymap.org
© 2016, BioVentures, LLC, All rights reserved
Page 9 of 19
Prenatal Span V2
Las siguientes preguntas tienen que ver con las personas que podrían ayudarle a criar a su hijo(a). Si más de una persona comparte con usted la tarea de criar a su hijo(a), conteste las preguntas sobre la persona con quien usted está menos de acuerdo.
Pase a la siguiente pregunta únicamente si no hay otra persona adentro o fuera del hogar que le ayude
.
Nunca o raras veces
Algunas veces
A menudo o siempre
Regarding people that help you raise your child - how often do you and this person have disagreements about how to raise your child? - 1
Regarding people that help you raise your child - how often do you and this person have disagreements about how to raise your child? - 2
Regarding people that help you raise your child - how often do you and this person have disagreements about how to raise your child? - 3
Regarding people that help you raise your child - how often does conversations turn hostile or angey with them? - 1
Regarding people that help you raise your child - how often does conversations turn hostile or angey with them? - 2
Regarding people that help you raise your child - how often does conversations turn hostile or angey with them? - 3
Regarding people that help you raise your child - how often do disagreements related to money to buy things for or support the child occurre? - 1
Regarding people that help you raise your child - how often do disagreements related to money to buy things for or support the child occurre? - 2
Regarding people that help you raise your child - how often do disagreements related to money to buy things for or support the child occurre? - 3
F2.
Cuando usted y esta persona hablan sobre cómo criar a su hijo(a), ¿con qué frecuencia la conversación lleva un tono hostil o de enojo?
F3.
Los próximos puntos tienen que ver con los miembros de la familia u otras personas que usted considera parte de la familia a quienes vé por lo menos semanalmente. Por favor indique con qué frecuencia es cierto lo que dice cada punto con respecto a su familia:
Nunca o raras veces
A veces
A menudo o siempre
Regarding family members or others you consider family that you see at least weekly - how often is it true for people to lose their tempers? - 1
Regarding family members or others you consider family that you see at least weekly - how often is it true for people to lose their tempers? - 2
Regarding family members or others you consider family that you see at least weekly - how often is it true for people to lose their tempers? - 3
F4.
Las personas que forman parte de mi familia pierden los estribos.
Regarding family members or others you consider family that you see at least weekly - how often is it true for people to feel very close? - 1
Regarding family members or others you consider family that you see at least weekly - how often is it true for people to feel very close? - 2
Regarding family members or others you consider family that you see at least weekly - how often is it true for people to feel very close? - 3
F5.
Los miembros de la familia son muy unidos.
Regarding family members or others you consider family that you see at least weekly - how often is it true for people to raise their voices to yell or in anger? - 1
Regarding family members or others you consider family that you see at least weekly - how often is it true for people to raise their voices to yell or in anger? - 2
Regarding family members or others you consider family that you see at least weekly - how often is it true for people to raise their voices to yell or in anger? - 3
F6.
Levantamos la voz y gritamos de enojo.
Regarding family members or others you consider family that you see at least weekly - how often is it true for people to be supportive of each other? - 1
Regarding family members or others you consider family that you see at least weekly - how often is it true for people to be supportive of each other? - 2
Regarding family members or others you consider family that you see at least weekly - how often is it true for people to be supportive of each other? - 3
F7.
Las personas que forman parte de mi familia nos ayudamos y nos apoyamos el uno al otro.
F1.
¿Con qué frecuencia usted y esta persona no están de acuerdo en cuanto a cómo criar a su hijo(a)?
¿Con qué frecuencia usted y esta persona no están de acuerdo con respecto al dinero para comprar cosas para el/la niño(a) o el dinero para mantenerlo/a? (como la manutención si no están casados).
LA UNIDAD FAMILIAR SECCIÓN No. 6
Si 2 respuestas o más se encuentran en el área sombreada:
Considere La consejería para las relaciones personales como una meta.
Si 2 de las respuestas o más se encuentran en el área sombreada: Considere La consejería familiar como una meta.
Utilice la tarjeta de respuestas
Utilice la tarjeta de respuestas
Prenatal Inventario
Parent ID
Parent ID
Thefamilymap.org
© 2016, BioVentures, LLC, All rights reserved
Page 10 of 19
Prenatal Span V2
Al pensar en cómo espera que su niño(a) se comporte en los primeros 6 meses,
¿qué tan de acuerdo está con los siguientes puntos?
When you child has done something wrong, how often do you - use time out - make your child stand or sit in a corner or chair? - 1
When you child has done something wrong, how often do you - use time out - make your child stand or sit in a corner or chair? - 2
When you child has done something wrong, how often do you - use time out - make your child stand or sit in a corner or chair? - 3
When you child has done something wrong, how often do you - use time out - make your child stand or sit in a corner or chair? - 4
El consolar al/a la bebé cuando está llorando lo(a) consentirá.
D1.
When you child has done something wrong, how often do you - take away privileges or object/toy for a period of time, restrict access? - 1
When you child has done something wrong, how often do you - take away privileges or object/toy for a period of time, restrict access? - 2
When you child has done something wrong, how often do you - take away privileges or object/toy for a period of time, restrict access? - 3
When you child has done something wrong, how often do you - take away privileges or object/toy for a period of time, restrict access? - 4
No hay problema con darles unas nalgadas a los bebés.
D2.
When you child has done something wrong, how often do you - redirect, distract, or turn the child's attention to something else? - 1
When you child has done something wrong, how often do you - redirect, distract, or turn the child's attention to something else? - 2
When you child has done something wrong, how often do you - redirect, distract, or turn the child's attention to something else? - 3
When you child has done something wrong, how often do you - redirect, distract, or turn the child's attention to something else? - 4
A veces, el papá o la mamá necesita pedirle a otra persona que cuide al/a la bebé que está llorando para poder descansar un rato.
D3.
When you child has done something wrong, how often do you - discuss the problem - ask questions - teach them? - 1
When you child has done something wrong, how often do you - discuss the problem - ask questions - teach them? - 2
When you child has done something wrong, how often do you - discuss the problem - ask questions - teach them? - 3
When you child has done something wrong, how often do you - discuss the problem - ask questions - teach them? - 4
When you child has done something wrong, how often do you - ignore it? - 1
When you child has done something wrong, how often do you - ignore it? - 2
When you child has done something wrong, how often do you - ignore it? - 3
When you child has done something wrong, how often do you - ignore it? - 4
When you child has done something wrong, how often do you - yell at your child? - 1
When you child has done something wrong, how often do you - yell at your child? - 2
When you child has done something wrong, how often do you - yell at your child? - 3
When you child has done something wrong, how often do you - yell at your child? - 4
D4.
El darles unas nalgadas a los bebés es la manera más efectiva de cambiar el comportamiento de mi hijo(a) a largo plazo.
PREPARÁNDOSE PARA LA DISCIPLINA DE SU HIJO/A SECCIÓN No. 7
Utilice la tarjeta de respuestas
Estoy
completamente en desacuerdo
No estoy de acuerdo
Estoy de acuerdo
Estoy
completamente de acuerdo
Si alguna respuesta se encuentra en el área sombreada:
Considere La educación para el padre y madre de familia como una meta.
D5.
El mover los objetos que se pueden quebrar es mejor que darle palmadas a las manos de mi niño(a).
D6.
Mi hijo(a) resultará consentido/a si lo(a) cargo demasiado.
Prenatal Inventario
Parent ID
Parent ID
Thefamilymap.org
© 2016, BioVentures, LLC, All rights reserved
Page 11 of 19
Prenatal Span V2
Has a Plan of Action or Needs help with Planning - 1
1
Has a Plan of Action or Needs help with Planning - 2
2
Has a Plan of Action or Needs help with Planning - 3
3
Has a Plan of Action or Needs help with Planning - 4
4
A veces es difícil que las familias obtengan toda la atención médica que necesitan. La siguiente parte de la entrevista es acerca de la salud de su familia.
H1.
¿Tiene
usted
algún problema de salud o enfermedad que requiera atención médica regular y continua? Por ejemplo, una discapacidad, una enfermedad mental o problemas de salud crónicos como el asma, alergias severas, anemia de células falciformes o parálisis cerebral.
Do you have a health issue or illness that requires regular, ongoing care or medication? - 0
No
Do you have a health issue or illness that requires regular, ongoing care or medication? - 1
Si
Si su respuesta es No, pase a la pregunta H2.
Anote la condición médica:
Notate Condition - Details
Determine la necesidad: ¿Comprende qué es lo que el doctor o terapeuta quiere que usted haga a diario para tratar el problema de salud? ¿Tiene algún plan que el doctor le haya dado? ¿Se siente tranquila al seguir el plan? ¿Tiene algún problema que le impida seguir y cumplir con el plan?
H2.
¿Hay
alguien más
en la casa que tenga algún problema de salud o enfermedad que requiera atención médica regular y continua?
Does your child have a health issue or illness that requires ongoing care or medication? - 0
No
Does your child have a health issue or illness that requires ongoing care or medication? - 1
Si
Si su respuesta es No, pase a la pregunta H3.
Anote la condición médica:
Notate Condition - Details
Determine la necesidad: ¿Tiene algún plan que el doctor le haya dado? ¿Se siente tranquilo/a con el plan?
H3.
¿Ha visitado al dentista en los últimos 6 meses para su chequeo regular?
H4.
¿Puede obtener atención médica cuando usted está enferma o cuando se ha lastimado (que no sea la que se recibe en una sala de urgencias de un hospital)?
No
Sí
Do you have a doctor you consider your child's doctor? - 0
No
Do you have a doctor you consider your child's doctor? - 1
Sí
H6.
a)
Piense en cuando usted habló con su doctor, enfermera o partera,
Do you have a dentist you consider to be your child's dentist? - 0
Do you have a dentist you consider to be your child's dentist? - 1
Does your child have health insurance? - 0
Does your child have health insurance? - 1
Can you get health care when your child is sick or injured that is not from a hospital emergency room? - 0
Can you get health care when your child is sick or injured that is not from a hospital emergency room? - 1
¿Piensa usted tener seguro medico para sí misma después de que nazca su bebé?
No
Sí
H5.
¿Tiene usted seguro médico en este momento?
SALUD
SECCIÓN No. 8
Necesita ayuda con el plan
Has a Plan of Action or Needs help with Planning - 1
1
Has a Plan of Action or Needs help with Planning - 2
2
Has a Plan of Action or Needs help with Planning - 3
3
Has a Plan of Action or Needs help with Planning - 4
4
Tiene un plan y lo está cumpliendo
Si alguna de las respuestas se encuentra en el área sombreada:
Considere La asistencia médica como una meta.
Si alguna de las respuestas se encuentra en el área sombreada:
Considere El cuidado médico como una meta.
Si alguna de las respuestas se encuentra en el área sombreada:
Considere El cuidado prenatal como una meta.
¿Ha hablado usted con su doctor, enfermera o partera acerca de lo siguiente?:
b)
c)
d)
e)
f)
g)
h)
i)
La nutrición y el aumento de peso
Fumar o tomar alcohol
Medicinas u otras drogas
Planificación para el parto
Las señales y los síntomas de parto 3 semanas antes de la fecha programada (bebé prematuro)
Qué hacer si el parto se adelanta a la fecha
Qué hacer si usted se siente deprimida durante el embarazo o después del nacimiento
Planificación familiar después del nacimiento
No hay nadie en casa
Sí, la atención médica le cuesta.
¿Entiende lo que su doctor quiere que haga diaramente para mantener un embarazo saludable?
H7a - 0
No
H7a - 1
Yes
H7e - 0
No
H7e - 1
Yes
H7f - 0
No
H7f - 1
Yes
H7g - 0
No
H7g - 1
Yes
H7h - 0
No
H7h - 1
Yes
H7b - 0
No
H7b - 1
Yes
H7c - 0
No
H7c - 1
Yes
H7d - 0
No
H7d - 1
Yes
H7i - 0
No
H7i - 1
Yes
¿Ha recibido atención médica prenatal de parte de un doctor, enfermera o partera?
H7
H7 - 0
No
H7 - 1
Si
NoZone_4_2
If no, skip to H8
Prenatal Inventario
Parent ID
Parent ID
Thefamilymap.org
© 2016, BioVentures, LLC, All rights reserved
Page 12 of 19
Prenatal Span V2
No
Sí
H10.
¿Sabe cómo inscribir a su hijo/a en un programa de seguro médico?
Can you get health care when you are sick or injured that is not from a hospital emergency room? - 0
Can you get health care when you are sick or injured that is not from a hospital emergency room? - 1
H11.
¿Ha hablado con un doctor, enfermera u otro profesional acerca de la lactancia o amamantar?
H12.
¿Ha hablado con un profesional médico acerca de los medios anticonceptivos durante la lactancia?
Is anyone else in your home pregnant? - 0
Is anyone else in your home pregnant? - 1
H13.
¿Planifica usted amamantar a su hijo/a?
Menos de un mes
1 mes
De 2 a 5 meses
6 meses o mayor
H14.
En su opinión, ¿cuántos meses tendrá su bebé
H15.
¿Durante el
mes pasado
, cuántas veces a la semana hizo usted ejercicio como correr o caminar por al menos 30 minutos?
H16.
¿Durante el
mes pasado
, cuántas veces a la semana ha sentido que no durmió o no descansó lo suficiente?
H17.
Ninguno
Menos de 1
De 1 a 5
De 6 a 10
¿Fuma alguien cigarrillos adentro de su
hogar
?
H18.
H19.
¿Fuma alguien cigarrillos adentro de su
carro
?
H20.
En los 3 meses antes de embarazarse, ¿cuántos cigarrillos fumaba en un día normal? Un paquete tiene 20 cigarrillos.
En el último mes, ¿cuántos cigarrillos fumaba en un día normal?
No
Sí
Si hay alguna respuesta en el área sombreada:
Considere El acceso al cuidado médico como una meta.
H9.
¿Ha identificado a un doctor para cuidar a su bebé después del parto?
Do you have health insurance? - 0
Do you have health insurance? - 1
Si alguna de las respuestas se encuentra en las áreas sombreadas: Considere El apoyo para la lactancia materna como una meta.
Si alguna de las respuestas se encuentra en las áreas sombreadas:
Considere Las prácticas saludables como una meta.
Si alguna respuesta se encuentra en las áreas sombreadas:
Considere El cese de fumar como una meta.
Piense en el tiempo después del nacimiento de su hijo/a
Ninguna
De 1 a 2 veces a la semana
De 3 a 4 veces a la semana
Más
H8.
H8. ¿Actualmente alguien más en su hogar que esté embarazada?
No sé
De 11
a 20
De 21 a 40
41 o más
No
Sí
a)
b)
cuando usted le dé fórmula?
cuando usted le introduzca otra comida que no sea la leche materna o fórmula?
H11 - 0
H11 - 1
H13 - 0
H13 - 1
H13 - 2
H14a - 1
H14a - 2
H14a - 3
H14a - 4
H14b - 1
H14b - 2
H14b - 3
H14b - 4
H15 - 0
H15 - 1
H15 - 2
H15 - 3
H16 - 0
H16 - 1
H16 - 2
H16 - 3
H17 - 0
H17 - 1
H18 - 0
H18 - 1
H19 - 0
H19 - 1
H19 - 2
H19 - 3
H19 - 4
H19 - 5
H19 - 6
H20 - 0
H20 - 1
H20 - 2
H20 - 3
H20 - 4
H20 - 5
H20 - 6
Can you get health care when you are sick or injured that is not from a hospital emergency room? - 0
Can you get health care when you are sick or injured that is not from a hospital emergency room? - 1
Prenatal Inventario
Parent ID
Parent ID
Thefamilymap.org
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Page 13 of 19
Prenatal Span V2
H21.
alguno de sus mejores amigos tiene problema con las bebidas alcohólicas o las drogas?
Muchas personas necesitan ayuda para saber sobrellevar a familiares o amigos que tienen problemas con el alcohol o las drogas.
H22.
alguno de sus familiares más cercanos tiene problema con las bebidas alcohólicas o las drogas (padres, hermanos)?
a)
¿Alguno de estos amigos o familiares vive en su casa?
No o no toman
Sí
Do any of your closest friends have a problem with drinking or drugs? - 0
Do any of your closest friends have a problem with drinking or drugs? - 1
Do any of your close family members have a problem with drinking or drugs? - 0
Do any of your close family members have a problem with drinking or drugs? - 1
Do any of these friends or family members live in your home? - 0
Do any of these friends or family members live in your home? - 1
Antes de estar embarazada, ¿se sentía que debería de reducir la cantidad de bebidas alcohólicas que tomaba o la cantidad de drogas que usaba?
In the past year, have you felt you ought to cut down on your drinking or drug use? - 0
In the past year, have you felt you ought to cut down on your drinking or drug use? - 1
H24.
Durante los 3 meses antes de estar embarazada, ¿cúantas bebidas alcohólicas en promedio tomó en una semana?
Si alguna de las respuestas se encuentra en las áreas sombreadas:
Considere Información sobre el Trastorno del espectro alcohólico fetal o Alcohol/Drogas como una meta.
Compartir información acerca del alcohol y las drogas
Share Alcohol or Drug Cessation Information - Does Not Need Information. - 1
1
Share Alcohol or Drug Cessation Information - Does Not Need Information. - 2
2
Share Alcohol or Drug Cessation Information - Does Not Need Information. - 3
3
Share Alcohol or Drug Cessation Information - Does Not Need Information. - 4
4
No necesita información
¿Es que
H23.
Si alguna de las respuestas se encuentra en las áreas sombreadas:
Considere La consejería como una meta.
H25.
H26.
H27.
Durante el mes pasado, ¿cuántas bebidas alcohólicas en promedio tomó en una semana?
A cualquiera de los miembros de la familia, ¿le han diagnosticado que padece de depresión?
A usted, ¿le han diagnosticado que padece de depresión?
Ninguno
Menos de 1
De 1 a 3
De 4 a 6
De 7
a 13
14 o más
Sí,
actualmente
Anteriormente
No
H24 - 0
H24 - 1
H24 - 2
H24 - 3
H24 - 4
H24 - 5
H25 - 0
H25 - 1
H25 - 2
H25 - 3
H25 - 4
H25 - 5
H26 - H26_Y
H26 - H26_P
H26 - H26_N
H27 - H27_Y
H27 - H27_P
H27 - H27_N
Prenatal Inventario
Parent ID
Parent ID
Thefamilymap.org
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Page 14 of 19
Prenatal Span V2
Utilice la tarjeta de respuestas
Nunca
Varios días
Más de la mitad del tiempo
Casi todos los días
H28.
Durante
las últimas 2 semanas
, ¿con qué frecuencia:
a)
se ha sentido mal, deprimida o sin esperanza?
b)
se ha sentido mal por tener poco interés o gusto por hacer las cosas?
c)
se ha sentido mal porque se molesta o se irrita fácilmente?
d)
se ha sentido mal porque de repente le ha dado miedo sin razón alguna?
e)
se ha sentido mal por la tensión o los nervios?
f)
se ha sentido mal por tener momentos de terror o de pánico?
g)
se ha sentido mal por entrar en discusiones a menudo?
Si alguna de las respuestas a los puntos de las letras ‘a’ a la ‘g’ se encuentra en las áreas sombreadas: Considere La consejería como una meta.
Compartir información sobre la crianza de los hijos o sobre la salud
Share Alcohol or Drug Cessation Information - Does Not Need Information. - 1
1
Share Alcohol or Drug Cessation Information - Does Not Need Information. - 2
2
Share Alcohol or Drug Cessation Information - Does Not Need Information. - 3
3
Share Alcohol or Drug Cessation Information - Does Not Need Information. - 4
4
No necesita información
Preocupaciones acerca de la depresión: Sume las respuestas de los puntos ‘a’ y ‘b’. Un puntaje más alto indica más síntomas depresivos. 0 = ninguna acción, 1 = información acerca de la depresión, 2 o 3 = sugerir servicios.
H28a - 0
H28a - 1
H28a - 2
H28a - 3
H28b - 0
H28b - 1
H28b - 2
H28b - 3
H28c - 0
H28c - 1
H28c - 2
H28c - 3
H28d - 0
H28d - 1
H28d - 2
H28d - 3
H28e - 0
H28e - 1
H28e - 2
H28e - 3
H28f - 0
H28f - 1
H28f - 2
H28f - 3
H28g - 0
H28g - 1
H28g - 2
H28g - 3
Prenatal Inventario
Parent ID
Parent ID
Thefamilymap.org
© 2016, BioVentures, LLC, All rights reserved
Page 15 of 19
Prenatal Span V2
La siguiente parte de la entrevista es para determinar si usted necesita ayuda para satisfacer las necesidades de su familia. Durante el pasado año, ¿cuántas veces:
Ningu na vez
1 o más vec es
No sé
no pudo pagar
una cuenta mensual importante
como el alquiler de la vivienda, pago de un vehículo, reparación de la casa, pago de guardería u otro pago pendiente?
B2.
In the past year, how many times - were you unable to pay an important monthly bill such as rent, car payment, house repair, child care, or other outstanding payment? - 0
In the past year, how many times - were you unable to pay an important monthly bill such as rent, car payment, house repair, child care, or other outstanding payment? - 1
In the past year, how many times - were you unable to pay an important monthly bill such as rent, car payment, house repair, child care, or other outstanding payment? - 2
no pudo cubrir el costo de
una atención médica, del dentista o medicina
?
B3.
In the past year, how many times - were you unable to afford medical care, dental care or medicine? - 0
In the past year, how many times - were you unable to afford medical care, dental care or medicine? - 1
In the past year, how many times - were you unable to afford medical care, dental care or medicine? - 2
tuvo problemas con el transporte debido a que no tenía dinero para pagar la gasolina para el vehículo, para pagar las reparaciones del vehículo o para pagar el bus, taxi u otro medio de transporte?
B4.
In the past year, how many times - did you have problems with transportation because you could not afford to buy gas for the car or pay for repairs or for a bus, cab or other transportation? - 0
In the past year, how many times - did you have problems with transportation because you could not afford to buy gas for the car or pay for repairs or for a bus, cab or other transportation? - 1
In the past year, how many times - did you have problems with transportation because you could not afford to buy gas for the car or pay for repairs or for a bus, cab or other transportation? - 2
¿Ha tenido un caso activo para la protección infantil?
B5.
In the past year, how many times - were you owed child support and unable to receive it? - 0
In the past year, how many times - were you owed child support and unable to receive it? - 1
In the past year, how many times - were you owed child support and unable to receive it? - 2
¿Estuvo usted o el padre de su hijo(a) involucrado/a con el sistema legal?
B6.
In the past year, how many times - have you had an open child protective case? - 0
In the past year, how many times - have you had an open child protective case? - 1
In the past year, how many times - have you had an open child protective case? - 2
B7.
In the past year, how many times - were you or your child's other parent involved with the legal system? - 0
In the past year, how many times - were you or your child's other parent involved with the legal system? - 1
In the past year, how many times - were you or your child's other parent involved with the legal system? - 2
En el próximo año, ¿usted espera que vaya a necesitar ayuda para pagar:los servicios básicos como la luz, el agua, el alquiler, el transporte o la atención médica?
B8.
In the next year, how many times - do you expect you will need help paying for basic services such as utilities, rent, transportation or health care? - 0
In the next year, how many times - do you expect you will need help paying for basic services such as utilities, rent, transportation or health care? - 1
In the next year, how many times - do you expect you will need help paying for basic services such as utilities, rent, transportation or health care? - 2
B8. En el próximo año, ¿usted espera que vaya a necesitar ayuda para pagar: los suministros necesarios para su hijo(a) como los pañales, fórmula y ropa para la cama?
B9.
B10.
La comida que compró no le alcanzó y no tenía dinero para comprar más.
Usted u otras personas que viven en casa comieron menos o no comieron porque no había suficiente dinero para la comida.
In the past year - nutritious food - how many times did the food that you bought just didn't last and you didn't have money to get more? - 0
In the past year - nutritious food - how many times did the food that you bought just didn't last and you didn't have money to get more? - 1
In the past year - nutritious food - how many times did the food that you bought just didn't last and you didn't have money to get more? - 2
In the past year - nutritious food - how many times did you or others in your household cut the size of your meals or skipped meals because there wasn't enough money for food? - 0
In the past year - nutritious food - how many times did you or others in your household cut the size of your meals or skipped meals because there wasn't enough money for food? - 1
In the past year - nutritious food - how many times did you or others in your household cut the size of your meals or skipped meals because there wasn't enough money for food? - 2
Nunca sucedio
A veces sucedio
A menudo sucedio
B1. le desconectaron el servicio de gas, luz, agua o teléfono debido a que no tenía suficiente dinero para pagar la cuenta?
B1.
In the past year, how many times - did you have any of your utilities such as gas, electric, water or telephone service turned off because there wasn't enough money to pay the bill? - 0
In the past year, how many times - did you have any of your utilities such as gas, electric, water or telephone service turned off because there wasn't enough money to pay the bill? - 1
In the past year, how many times - did you have any of your utilities such as gas, electric, water or telephone service turned off because there wasn't enough money to pay the bill? - 2
Durante el
año pasado
, al pensar en la alimentación y nutrición, ¿con qué frecuencia era cierto cada uno de los siguientes puntos?
NECESIDADES BÁSICAS
SECCIÓN No. 9
Utilice la tarjeta de respuestas
Si alguna respuesta se encuentran en el área sombreada:
Considere la ayuda alimenticia como una meta.
Si alguna respuesta se encuentra en el área sombreada:
Considere La educación sobre la nutrición como una meta.
una meta
En
el año pasado
,
Si alguna respuesta se encuentra en el área sombreada:
Considere Las necesidades básicas como una meta.
B11.
Más de 1 cada día
1 cada día
De 2 a 6 cada semana
Una vez cada semana
Ninguna
Meta de porciones diarias
1 taza
De 3 a 4 tazas
Un total de 6 ½ oz
De 6 a 8 tazas
3 tazas
2 tazas
Ninguna
a)
Productos lácteos como la leche, el queso, el yogurt
b)
Carnes como de res, de pollo, el pescado y huevos
c)
La proteína como los frijoles, guisantes, nueces, mantequilla de maní, hamburguesa vegetariana
d)
Grupo de panes, arroz, pasta, cereales, tortillas
e)
Verduras y vegetales de color verde oscuro o anaranjado y amarillo como las verduras de hojas verdes, zanahorias, brócoli, calabazín, camote –
pero no incluya las papas fritas
f)
Frutas como las manzanas, naranjas, bananos, uvas, melocotones, puré de manzana –
pero no incluya el jugo
g)
Los dulces de azúcar como los pasteles, dulces, o bebidas azucaradas como las sodas, las bebidas deportivas o el jugo y otras bebidas de frutas
About how often does your child eat food from the food group - Formula? - 1
About how often does your child eat food from the food group - Formula? - 2
About how often does your child eat food from the food group - Formula? - 3
About how often does your child eat food from the food group - Formula? - 4
About how often does your child eat food from the food group - Formula? - 5
About how often does your child eat food from the food group - Dairy Products like milk, cheese, yogurt? - 1
About how often does your child eat food from the food group - Dairy Products like milk, cheese, yogurt? - 2
About how often does your child eat food from the food group - Dairy Products like milk, cheese, yogurt? - 3
About how often does your child eat food from the food group - Dairy Products like milk, cheese, yogurt? - 4
About how often does your child eat food from the food group - Dairy Products like milk, cheese, yogurt? - 5
About how often does your child eat food from the food group - Meat like beef, chicken, fish, eggs? - 1
About how often does your child eat food from the food group - Meat like beef, chicken, fish, eggs? - 2
About how often does your child eat food from the food group - Meat like beef, chicken, fish, eggs? - 3
About how often does your child eat food from the food group - Meat like beef, chicken, fish, eggs? - 4
About how often does your child eat food from the food group - Meat like beef, chicken, fish, eggs? - 5
About how often does your child eat food from the food group - protein like beans, peas, nuts, peanut butter, veggie burger? - 1
About how often does your child eat food from the food group - protein like beans, peas, nuts, peanut butter, veggie burger? - 2
About how often does your child eat food from the food group - protein like beans, peas, nuts, peanut butter, veggie burger? - 3
About how often does your child eat food from the food group - protein like beans, peas, nuts, peanut butter, veggie burger? - 4
About how often does your child eat food from the food group - protein like beans, peas, nuts, peanut butter, veggie burger? - 5
About how often does your child eat food from the food group - grains like bread, rice, pasta, cereals, tortillas? - 1
About how often does your child eat food from the food group - grains like bread, rice, pasta, cereals, tortillas? - 2
About how often does your child eat food from the food group - grains like bread, rice, pasta, cereals, tortillas? - 3
About how often does your child eat food from the food group - grains like bread, rice, pasta, cereals, tortillas? - 4
About how often does your child eat food from the food group - grains like bread, rice, pasta, cereals, tortillas? - 5
About how often does your child eat food from the food group - Dark Green Vegetables or Orange-Yellow Vegetables like greens, carrots, broccoli, squash, sweet potatoes - but not french fries? - 1
About how often does your child eat food from the food group - Dark Green Vegetables or Orange-Yellow Vegetables like greens, carrots, broccoli, squash, sweet potatoes - but not french fries? - 2
About how often does your child eat food from the food group - Dark Green Vegetables or Orange-Yellow Vegetables like greens, carrots, broccoli, squash, sweet potatoes - but not french fries? - 3
About how often does your child eat food from the food group - Dark Green Vegetables or Orange-Yellow Vegetables like greens, carrots, broccoli, squash, sweet potatoes - but not french fries? - 4
About how often does your child eat food from the food group - Dark Green Vegetables or Orange-Yellow Vegetables like greens, carrots, broccoli, squash, sweet potatoes - but not french fries? - 5
About how often does your child eat food from the food group - Fruits like apples, oranges, bananas, grapes, peaches, applesauce - but not juice? - 1
About how often does your child eat food from the food group - Fruits like apples, oranges, bananas, grapes, peaches, applesauce - but not juice? - 2
About how often does your child eat food from the food group - Fruits like apples, oranges, bananas, grapes, peaches, applesauce - but not juice? - 3
About how often does your child eat food from the food group - Fruits like apples, oranges, bananas, grapes, peaches, applesauce - but not juice? - 4
About how often does your child eat food from the food group - Fruits like apples, oranges, bananas, grapes, peaches, applesauce - but not juice? - 5
Un vaso o botella de agua
¿Qué tan seguido come o toma usted de cada uno de los siguientes grupos?
About how often does your child eat food from the food group - sugary sweets like cakes, candy or sugary drinks like soda, sportsdrinks, juice or fruit drinks? - 1
About how often does your child eat food from the food group - sugary sweets like cakes, candy or sugary drinks like soda, sportsdrinks, juice or fruit drinks? - 2
About how often does your child eat food from the food group - sugary sweets like cakes, candy or sugary drinks like soda, sportsdrinks, juice or fruit drinks? - 3
About how often does your child eat food from the food group - sugary sweets like cakes, candy or sugary drinks like soda, sportsdrinks, juice or fruit drinks? - 4
About how often does your child eat food from the food group - sugary sweets like cakes, candy or sugary drinks like soda, sportsdrinks, juice or fruit drinks? - 5
h)
Utilice la Tarjeta de Respuestas
Prenatal Inventario
Parent ID
Parent ID
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Page 16 of 19
Prenatal Span V2
Ahora hablemos acerca de las preocupaciones sobre la seguridad. Al pensar en el pasado mes, ¿cuántas veces ha realizado un viaje, aunque haya sido un viaje corto:
C1.
y se ha puesto el cinturón de seguridad correctamente en la parte de abajo sobre sus caderas y a lo largo de su clavícula?
C2.
¿Tiene un asiento de seguridad infantil para el vehículo?
C3.
C4.
In the past month, how many rides has your child taken even on short trips - in the front seat of a vehicle? - 0
In the past month, how many rides has your child taken even on short trips - in the front seat of a vehicle? - 1
In the past month, how many rides has your child taken even on short trips - in the front seat of a vehicle? - 2
In the past month, how many rides has your child taken even on short trips - in the front seat of a vehicle? - 3
Nunca
De 1 a 9 viajes
10 veces o más
Todos los viajes
Después de que nazca su bebé, ¿planifica usted o alguien más:
C5.
C6.
C7.
¿Hay un detector de humo que funcione bien para cada piso de su casa?
C4. En caso de un incendio, ¿hay dos salidas libres que se puedan utilizar? Pueden ser dos puertas o una ventana por donde se puede salir.
¿Puede mantener su mano por varios segundos debajo del agua caliente corriento sin que se queme?
¿Vive en un edificio que se haya construido
antes del 1978
cuando se prohibió el uso de pintura a base de plomo?
En los últimos 2 meses, ¿le ha hecho una prueba a su(s) detector(es) de humo?
Does anyone living in your home smoke cigarettes? - 0
Does anyone living in your home smoke cigarettes? - 2
Does anyone living in your home smoke cigarettes? - 1
No
Does anyone smoke cigarettes inside your home? - 0
Does anyone smoke cigarettes inside your home? - 2
Does anyone smoke cigarettes inside your home? - 1
Does anyone smoke cigarettes inside your car? - 0
Does anyone smoke cigarettes inside your car? - 2
Does anyone smoke cigarettes inside your car? - 1
No sé
Sí
Is there a working smoke detector in your home for each level? - 0
Is there a working smoke detector in your home for each level? - 2
Is there a working smoke detector in your home for each level? - 1
Have you tested your smoke detectors in the last 2 months? - 0
Have you tested your smoke detectors in the last 2 months? - 2
Have you tested your smoke detectors in the last 2 months? - 1
a)
b)
dejar que su bebé duerma con usted en la cama o sofá?
dejar que su bebé duerma en la habitación de usted (pero no en la misma cama)?
c)
d)
c) acostar a su bebé en su espalda( boca arriba) siempre para dormir en la noche o para las siestas?
dejar que su bebé duerma con cubrecamas suaves o juguetes de peluche?
In the past month, how many rides has your child taken even on short trips - on an All-Terrain Vehicle or 4-Wheeler, tractor, riding lawnmower or similar off-road vehicle? - 0
In the past month, how many rides has your child taken even on short trips - on an All-Terrain Vehicle or 4-Wheeler, tractor, riding lawnmower or similar off-road vehicle? - 1
Sí
No
When you child sleeps, do you or anyone else - co-sleep with your baby in the same bed or couch? - 0
No
When you child sleeps, do you or anyone else - co-sleep with your baby in the same bed or couch? - 2
Don't Know
When you child sleeps, do you or anyone else - co-sleep with your baby in the same bed or couch? - 1
Yes
No sé
When you child sleeps, do you or anyone else - let the baby sleep in the room with you but not in the same bed? - 0
No
When you child sleeps, do you or anyone else - let the baby sleep in the room with you but not in the same bed? - 2
Don't Know
When you child sleeps, do you or anyone else - let the baby sleep in the room with you but not in the same bed? - 1
Yes
When you or anyone else puts your baby down to sleep - is the baby always placed on the child's back to sleep? - 0
No
When you or anyone else puts your baby down to sleep - is the baby always placed on the child's back to sleep? - 2
Don't Know
When you or anyone else puts your baby down to sleep - is the baby always placed on the child's back to sleep? - 1
Yes
When you or anyone else puts your baby down to sleep - let teh baby sleep on soft bedding or with any stuffed toys? - 0
No
When you or anyone else puts your baby down to sleep - let teh baby sleep on soft bedding or with any stuffed toys? - 2
Don't Know
When you or anyone else puts your baby down to sleep - let teh baby sleep on soft bedding or with any stuffed toys? - 1
Yes
SEGURIDAD EN EL HOGAR Y EN EL VEHÍCULO
SECCIÓN No. 10
Si alguna de las respuestas se encuentra en el área sombreada:
Considere La seguridad vehicular como una meta.
Si alguna respuesta se encuentra en el área sombreada:
Considere Las estrategias para la seguridad como una meta.
Si alguna respuesta se encuentra en el área sombreada:
Considere Seguridad infantil al dormir como una meta.
a)
(El calentador de agua tiene que ponerse al máximo de 120 grados Fahrenheit.)
Prenatal Inventario
Parent ID
Parent ID
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Page 17 of 19
Prenatal Span V2
C8.
Cuna/cama que no tenga espacios entre las barras mayor del ancho de su mano que es no mayor de 2 3/8 pulgada de ancho (alrededor de los 6 centímetros)
a)
Tome un momento para pensar en dónde va a dormir y jugar su niño/a. ¿Cuál de las siguientes cosas tiene en su casa?
Cuna/cama cerca de ventanas que tienen cordones para las persianas o cerca de una unidad de calefacción
b)
Escalera sin agarraderas o barrandas
c)
Una mesa para cambiar pañales sin baranda o con baranda menos de 5 centímetros de altura
d)
Gabinetes de la cocina o baño que no tiene candado o seguro
e)
f)
C9.
Detergente para ropa o suministros de limpieza
a)
Tome un momento para pensar en la ubicación de los siguientes artículos de la casa. ¿Cuáles de las siguientes cosas podría encontrar un(a) niño/a y obtener si lo intentara?
Líquido para encender una parrillacerca de una unidad de calefacción
b)
Fósforos o encendedores
c)
Hierro
d)
Medicinas
e)
Cerveza, vino u otro alcohol
f)
Cuchillos, tijeras u otros objetos filosos
g)
Herramientas como serruchos, destornilladores, etc
h)
Armas de fuego como pistolas u otras armas
i)
Artículos de tocador como enjuage bucal, perfume, laca para el pelo o esmalte para uñas
j)
Juguetes u objetos pequeños que pueden ser riesgos de asfixia
k)
Regarding Household Item Location Within Your Home - Could your child find and access - laundry detergent or cleaning supplies, if they tried? - 2
Regarding Household Item Location Within Your Home - Could your child find and access - laundry detergent or cleaning supplies, if they tried? - 0
Regarding Household Item Location Within Your Home - Could your child find and access - laundry detergent or cleaning supplies, if they tried? - 1
Regarding Household Item Location Within Your Home - Could your child find and access - BBQ Lighter Fluid, if they tried? - 2
Regarding Household Item Location Within Your Home - Could your child find and access - BBQ Lighter Fluid, if they tried? - 0
Regarding Household Item Location Within Your Home - Could your child find and access - BBQ Lighter Fluid, if they tried? - 1
Regarding Household Item Location Within Your Home - Could your child find and access - matches or lighters, if they tried? - 2
Regarding Household Item Location Within Your Home - Could your child find and access - matches or lighters, if they tried? - 0
Regarding Household Item Location Within Your Home - Could your child find and access - matches or lighters, if they tried? - 1
Regarding Household Item Location Within Your Home - Could your child find and access - Iron, if they tried? - 2
Regarding Household Item Location Within Your Home - Could your child find and access - Iron, if they tried? - 0
Regarding Household Item Location Within Your Home - Could your child find and access - Iron, if they tried? - 1
Regarding Household Item Location Within Your Home - Could your child find and access - medications, if they tried? - 2
Regarding Household Item Location Within Your Home - Could your child find and access - medications, if they tried? - 0
Regarding Household Item Location Within Your Home - Could your child find and access - medications, if they tried? - 1
Regarding Household Item Location Within Your Home - Could your child find and access - alcoholic beverages, if they tried? - 2
Regarding Household Item Location Within Your Home - Could your child find and access - alcoholic beverages, if they tried? - 0
Regarding Household Item Location Within Your Home - Could your child find and access - alcoholic beverages, if they tried? - 1
No
Sí
No tiene
Preocupaciones sobre la seguridad del bebé/de la bebe a la hora de dormir
Safety Concerns in the Home - 1
1
Safety Concerns in the Home - 2
2
Safety Concerns in the Home - 3
3
Safety Concerns in the Home - 4
4
No hay preocupaciones sobre la seguridad del bebé/de la bebe a la hora de dormir
Preocupaciones sobre la seguridad dentro de la casa
Safety Concerns Outside of Home - 1
1
Safety Concerns Outside of Home - 2
2
Safety Concerns Outside of Home - 3
3
Safety Concerns Outside of Home - 4
4
No hay preocupaciones sobre la seguridad dentro de la casa
Si alguna de las respuestas se encuentra en el área sombreada: Considere La seguridad del niño/a como una meta.
Una mascota que se puede volver agresiva
Si alguna respuesta se encuentra en el área sombreada: Considere La seguridad del hogar como una meta.
No
Sí
No tiene
Regarding Household Item Location Within Your Home - Could your child find and access - laundry detergent or cleaning supplies, if they tried? - 2
Regarding Household Item Location Within Your Home - Could your child find and access - laundry detergent or cleaning supplies, if they tried? - 0
Regarding Household Item Location Within Your Home - Could your child find and access - laundry detergent or cleaning supplies, if they tried? - 1
Regarding Household Item Location Within Your Home - Could your child find and access - BBQ Lighter Fluid, if they tried? - 2
Regarding Household Item Location Within Your Home - Could your child find and access - BBQ Lighter Fluid, if they tried? - 0
Regarding Household Item Location Within Your Home - Could your child find and access - BBQ Lighter Fluid, if they tried? - 1
Regarding Household Item Location Within Your Home - Could your child find and access - matches or lighters, if they tried? - 2
Regarding Household Item Location Within Your Home - Could your child find and access - matches or lighters, if they tried? - 0
Regarding Household Item Location Within Your Home - Could your child find and access - matches or lighters, if they tried? - 1
Regarding Household Item Location Within Your Home - Could your child find and access - Iron, if they tried? - 2
Regarding Household Item Location Within Your Home - Could your child find and access - Iron, if they tried? - 0
Regarding Household Item Location Within Your Home - Could your child find and access - Iron, if they tried? - 1
Regarding Household Item Location Within Your Home - Could your child find and access - medications, if they tried? - 2
Regarding Household Item Location Within Your Home - Could your child find and access - medications, if they tried? - 0
Regarding Household Item Location Within Your Home - Could your child find and access - medications, if they tried? - 1
Regarding Household Item Location Within Your Home - Could your child find and access - alcoholic beverages, if they tried? - 2
Regarding Household Item Location Within Your Home - Could your child find and access - alcoholic beverages, if they tried? - 0
Regarding Household Item Location Within Your Home - Could your child find and access - alcoholic beverages, if they tried? - 1
Regarding Household Item Location Within Your Home - Could your child find and access - knives, scissors, or other sharp objects, if they tried? - 2
Regarding Household Item Location Within Your Home - Could your child find and access - knives, scissors, or other sharp objects, if they tried? - 0
Regarding Household Item Location Within Your Home - Could your child find and access - knives, scissors, or other sharp objects, if they tried? - 1
Regarding Household Item Location Within Your Home - Could your child find and access - tools like saws, screwdrivers and such, if they tried? - 2
Regarding Household Item Location Within Your Home - Could your child find and access - tools like saws, screwdrivers and such, if they tried? - 0
Regarding Household Item Location Within Your Home - Could your child find and access - tools like saws, screwdrivers and such, if they tried? - 1
Regarding Household Item Location Within Your Home - Could your child find and access - firearms like guns or other weaponry, if they tried? - 2
Regarding Household Item Location Within Your Home - Could your child find and access - firearms like guns or other weaponry, if they tried? - 0
Regarding Household Item Location Within Your Home - Could your child find and access - firearms like guns or other weaponry, if they tried? - 1
Regarding Household Item Location Within Your Home - Could your child find and access - toiletries such as mouthwash, perfume, hair spray, or nail polish, if they tried? - 2
Regarding Household Item Location Within Your Home - Could your child find and access - toiletries such as mouthwash, perfume, hair spray, or nail polish, if they tried? - 0
Regarding Household Item Location Within Your Home - Could your child find and access - toiletries such as mouthwash, perfume, hair spray, or nail polish, if they tried? - 1
Regarding Household Item Location Within Your Home - Could your child find and access - toys or objects small enough to be a choking hazard, if they tried? - 2
Regarding Household Item Location Within Your Home - Could your child find and access - toys or objects small enough to be a choking hazard, if they tried? - 0
Regarding Household Item Location Within Your Home - Could your child find and access - toys or objects small enough to be a choking hazard, if they tried? - 1
Safety Concerns in the Home - 1
1
Safety Concerns in the Home - 2
2
Safety Concerns in the Home - 3
3
Safety Concerns in the Home - 4
4
Preocupaciones sobre la seguridad fuera de la casa
No hay preocupaciones sobre la seguridad fuera de la casa
Prenatal Inventario
Parent ID
Parent ID
Thefamilymap.org
© 2016, BioVentures, LLC, All rights reserved
Page 18 of 19
Prenatal Span V2
La mayoría de las mujeres necesitan ayuda durante los meses después del nacimiento de su hijo(a).
Muy poco o nunca
A veces
Mucho o todo el tiempo
In the past month, how often was someone available to - Listen to you when you needed to talk? - 1
In the past month, how often was someone available to - Listen to you when you needed to talk? - 2
In the past month, how often was someone available to - Listen to you when you needed to talk? - 3
In the past month, how often was someone available to - help with daily chores if you were sick? - 1
In the past month, how often was someone available to - help with daily chores if you were sick? - 2
In the past month, how often was someone available to - help with daily chores if you were sick? - 3
In the past month, how often was someone available to - Loan you $100 if you needed it? - 1
In the past month, how often was someone available to - Loan you $100 if you needed it? - 2
In the past month, how often was someone available to - Loan you $100 if you needed it? - 3
a)
escucharla cuando usted necesitaba hablar con alguien?
b)
ayudarla con los quehaceres diarios si usted estaba enferma?
I1.
Durante
el último mes
, ¿con qué frecuencia estaba alguien disponible para:
c)
prestarle $100 si usted los necesitaba?
ayudarla a diario con su bebé durante las primeras semanas?
llamar cuando necesita una noche para dormir bien?
Después del nacimiento de su bebé, ¿con qué frecuencia cree que alguien estará disponible para:
pedir consejos normales sobre cómo cuidar a su bebé, por ejemplo, cómo bañar a su bebé?
a)
b)
c)
I2.
cuidar a su bebé cuando necesita un descanso, por ejemplo, si su bebé tiene cólicos o si está bastante intranquilo(a)?
d)
In the past month, how often have you participated in - neighborhood or comunity organization, committee, club or sports team? - 1
In the past month, how often have you participated in - neighborhood or comunity organization, committee, club or sports team? - 2
In the past month, how often have you participated in - neighborhood or comunity organization, committee, club or sports team? - 3
In the past month, how often have you participated in - church service or other religious club or activity? - 1
In the past month, how often have you participated in - church service or other religious club or activity? - 2
In the past month, how often have you participated in - church service or other religious club or activity? - 3
In the past month, how often have you participated in - visit a friend or neighbor's house? - 1
In the past month, how often have you participated in - visit a friend or neighbor's house? - 2
In the past month, how often have you participated in - visit a friend or neighbor's house? - 3
In the past month, how often have you participated in - hobby or sport with a friend? - 1
In the past month, how often have you participated in - hobby or sport with a friend? - 2
In the past month, how often have you participated in - hobby or sport with a friend? - 3
la ha acompañado durante las visitas al doctor?
ha hablado con usted sobre cómo le va con el embarazo?
ha escuchado los latidos del corazón del/de la bebé?
a)
b)
c)
ha hablado sobre el futuro con el/la bebé?
d)
In the past month, how often have you participated in - mother figure visited with people working with program you are involved in? - 1
In the past month, how often have you participated in - mother figure visited with people working with program you are involved in? - 2
In the past month, how often have you participated in - mother figure visited with people working with program you are involved in? - 3
In the past month, how often have you participated in - mother figure volunteered at this program or other places? - 1
In the past month, how often have you participated in - mother figure volunteered at this program or other places? - 2
In the past month, how often have you participated in - mother figure volunteered at this program or other places? - 3
In the past month, how often have you participated in - father figure visited with people working with program you are involved in? - 1
In the past month, how often have you participated in - father figure visited with people working with program you are involved in? - 2
In the past month, how often have you participated in - father figure visited with people working with program you are involved in? - 3
In the past month, how often have you participated in - father figure volunteered at this program or other places? - 1
In the past month, how often have you participated in - father figure volunteered at this program or other places? - 2
In the past month, how often have you participated in - father figure volunteered at this program or other places? - 3
INTEGRACIÓN SOCIAL
SECCIÓN No. 11
Utilice la Tarjeta de Respuestas
Si alguna de las respuestas se encuentra en el área sombreada: Considere El sistema de apoyo como una meta.
Utilice la Tarjeta de Respuestas
Si alguna de las respuestas se encuentra en el área sombreada:
Considere El cuidado para descansar como una meta.
Si alguna de las respuestas se encuentra en el área sombreada:
Considere La consejería sobre las relaciones personales como una de meta.
I3.
Muy poco o nunca
A veces
Mucho o todo el tiempo
Al pensar en este embarazo, ¿con qué frecuencia se comunica con el padre del bebé?
Muy poco o nunca
A veces
Mucho o todo el tiempo
No hay
contacto
Al pensar en la comunicación que tiene con él, ¿con qué frecuencia él:
I3d - 1
I3d - 2
I3d - 3
I3_noco - 1
I3_Contact
Si no, vaya al I4.
Prenatal Inventario
Parent ID
Parent ID
Thefamilymap.org
© 2016, BioVentures, LLC, All rights reserved
Page 19 of 19
Prenatal Span V2
I4.
Durante
el mes pasado
, ¿con qué frecuencia ha participado usted en las siguientes actividades?
Utilice la Tarjeta de Respuestas
Si todas las respuestas se encuentran en el área sombreada: Considere La participación en la comunidad como una meta.
Una o dos veces al mes
Una vez a la semana
Más de una vez a la semana
Ninguna vez
Compartir información sobre el programa de voluntariado
No necesita información
Need for Sharing Volunteer Information - No Need - 1
1
Need for Sharing Volunteer Information - No Need - 2
2
Need for Sharing Volunteer Information - No Need - 3
3
Need for Sharing Volunteer Information - No Need - 4
4
Si todas las respuestas se encuentran en el área sombreada:
Considere el participar en el programa como una meta.
g)
La mamá ayudó como voluntaria en este programa o en otros lugares
h)
El papá o la persona que hace de papá visitó a las personas que trabajan con el programa ___________________________
(indique el nombre de su programa)
i)
El papá o la persona que hace de papá ayudó como voluntario en este programa o en otros lugares
f)
La mamá visitó a las personas que trabajan con el programa _____________________ (indique el nombre de su programa)
Las clases prenatales u otras clases para aprender sobre la crianza de los hijos
Una organización, comité, club o equipo deportivo del vecindario o de la comunidad
Un servicio de una iglesia u otro club o actividad religiosa
a)
b)
c)
Ir de visita a la casa de un(a) amigo/a o vecino/a
d)
Un pasatiempo o en el deporte con un(a) amigo/a
e)
In the past month, how often have you participated in - neighborhood or comunity organization, committee, club or sports team? - 0
In the past month, how often have you participated in - neighborhood or comunity organization, committee, club or sports team? - 1
In the past month, how often have you participated in - neighborhood or comunity organization, committee, club or sports team? - 2
In the past month, how often have you participated in - neighborhood or comunity organization, committee, club or sports team? - 3
In the past month, how often have you participated in - church service or other religious club or activity? - 0
In the past month, how often have you participated in - church service or other religious club or activity? - 1
In the past month, how often have you participated in - church service or other religious club or activity? - 2
In the past month, how often have you participated in - church service or other religious club or activity? - 3
In the past month, how often have you participated in - visit a friend or neighbor's house? - 0
In the past month, how often have you participated in - visit a friend or neighbor's house? - 1
In the past month, how often have you participated in - visit a friend or neighbor's house? - 2
In the past month, how often have you participated in - visit a friend or neighbor's house? - 3
In the past month, how often have you participated in - hobby or sport with a friend? - 0
In the past month, how often have you participated in - hobby or sport with a friend? - 1
In the past month, how often have you participated in - hobby or sport with a friend? - 2
In the past month, how often have you participated in - hobby or sport with a friend? - 3
In the past month, how often have you participated in - mother figure visited with people working with program you are involved in? - 0
In the past month, how often have you participated in - mother figure visited with people working with program you are involved in? - 1
In the past month, how often have you participated in - mother figure visited with people working with program you are involved in? - 2
In the past month, how often have you participated in - mother figure visited with people working with program you are involved in? - 3
In the past month, how often have you participated in - mother figure volunteered at this program or other places? - 0
In the past month, how often have you participated in - mother figure volunteered at this program or other places? - 1
In the past month, how often have you participated in - mother figure volunteered at this program or other places? - 2
In the past month, how often have you participated in - mother figure volunteered at this program or other places? - 3
In the past month, how often have you participated in - father figure visited with people working with program you are involved in? - 0
In the past month, how often have you participated in - father figure visited with people working with program you are involved in? - 1
In the past month, how often have you participated in - father figure visited with people working with program you are involved in? - 2
In the past month, how often have you participated in - father figure visited with people working with program you are involved in? - 3
In the past month, how often have you participated in - father figure volunteered at this program or other places? - 0
In the past month, how often have you participated in - father figure volunteered at this program or other places? - 1
In the past month, how often have you participated in - father figure volunteered at this program or other places? - 2
In the past month, how often have you participated in - father figure volunteered at this program or other places? - 3
I4a - 0
I4a - 1
I4a - 2
I4a - 3
When finished with the interview, please press "save" below or at the top of the page to save the form.
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