| Domain | Question | Answers | Source | Source Link | |
|---|---|---|---|---|---|
| 1 | Demographics | Before the pandemic began in the US (March 2020), did you already have a child that was between the ages of 0-5? | • Yes • No | Developed by RAPID Team | NA |
| 2 | Demographics | What is your race or origin? | • White (e.g., German, Irish, English, Italian) • Hispanic, Latinx, or Spanish origin (e.g., Mexican/Mexican American, Puerto Rican, Cuban, Dominican, Salvadoran, Colombian) • Black or African American (e.g., African American, Jamaican, Haitian, Nigerian, Ethiopian, Somalian) • Asian (e.g., Chinese, Filipino, Asian Indian, Vietnamese, Korean, Japanese) • American Indian or Alaska Native (e.g., Navajo Nation, Blackfeet Tribe, Muscogee (Creek) Nation, Mayan, Doyon, Native Village of Barrow Inupiat Traditional Government) • Native Hawaiian or Other Pacific Islander (e.g., Native Hawaiian, Samoan, Guamanian or Chamorro, Tongan, Fijian, Marshallese) • Middle Eastern or North African (e.g., Lebanese, Egyptian) • Some Other Race or Origin | NA | |
| 3 | Demographics | Are you currently enrolled in any of the following? | • GED program • Undergraduate or post-secondary degree program • Graduate degree program (Master's, doctorate) • Non-degree credentialing program • Not Listed (please specify) • Not Applicable | NA | |
| 4 | Childcare | Currently, do you use any of the following types of childcare for at least 5 hours per week? Select all that apply. | • Any type of paid or unpaid center-based care, such as a pre-school, day care center, public pre-kindergarten, Head Start, or faith-based nursey school • Any other type of paid or unpaid paid care by a relative, friend, neighbor, or non-center based professional childcare provider inside or outside the home • None of the above • Other, please describe: | RAPID Team modified from the National Survey of Early Care and Education (NSECE) | NA |
| 5 | Childcare | Are you currently looking for childcare, either additional/other childcare than your current situation or because you do not currently have childcare? | • Yes • No | NA | |
| 6 | Childcare | Have you had any difficulty finding space in a home- or center-based child care program in the past 6 months? | • Yes • No • Not applicable, I did not need a spot in a child care program | NA | |
| 7 | Childcare | Have you had any difficulty finding other types of child care (e.g., sitter, nanny) in the past 6 months? | • Yes • No | NA | |
| 8 | Childcare | Has this difficulty finding care impacted your ability to work? | • Yes • No • Not applicable, I do not work | NA | |
| 9 | Childcare | [Display if: Yes to Have you had any difficulty finding space in a home- or center-based child care program?] To your knowledge, did staffing shortages at the home- or center-based program in which your child is enrolled cause disruptions to your child care (examples: temporarily closed classrooms, reduced hours)? | • Yes, staffing challenges caused disruptions to my child care • My childcare was disrupted, but I don’t know why • My child care was disrupted for another reason • No disruptions | Developed by RAPID Team | NA |
| 10 | Health | The following questions ask about your and your child's (age 0-5) health and healthcare behaviors. Have you missed a well-baby/well-child check-up since the coronavirus (COVID-19) pandemic began? | • Yes • No • Not Applicable | Developed by RAPID Team | NA |