NBS PROXY EXPERIMENT PROTOCOL: Proxy Screener
NOTE: This screener is a pre-requisite for the actual survey, which is conducted immediately after. The Privacy Act and Paperwork Reduction Act statements are provided on the actual surveys.
THREE ITEM COGNITIVE ASSESSMENT TO SELECT PROXY
The three item cognitive assessment is the current method used by NBS to determine need for a proxy. The three questions are asked at the beginning of the interview before any substantive questions are asked. If respondents are unable to restate accurately any description after two attempts, we ask if someone else could answer questions on their behalf. All three questions must be answered accurately for the sample person to be eligible for the interview. These items have been included in all previous NBS administrations. The complete round 4 NBS questionnaire is provided in as a separate file.
A subset of respondents will not receive the three item assessment, but will be randomly assigned to the treatment condition (string of missing responses)--if they answer “don’t know” or “refused” to 6 or more pre-specified items at the beginning of the survey, they will be considered ineligible to complete the survey and a proxy respondent will be sought.
A74. Next, I will explain some facts about the survey. After I explain, I will ask you three questions so I can be sure my explanation was clear.
Here’s the first explanation. The survey asks about your health, daily activities, and any you might have. Please tell me in your own words what the survey is about.
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW” RECORD AS “LISTS NONE”
LISTS NONE 00
LISTS ONLY 1 TOPIC 01
LISTS ANY 2 TOPICS 02 (A77)
LISTS 3 TOPICS 03 (A77)
REFUSED r
A75 IS DELETED
A76. INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.
Let’s try that again. The survey asks about your health, daily activities , and any jobs you might have. Please tell me in your own words, what the survey is about.
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW” RECORD AS “LISTS NONE”
LISTS NONE 00 (TICS1)
LISTS ONLY 1 TOPIC 01 (TICS1)
LISTS ANY 2 TOPICS 02
LISTS 3 TOPICS 03
REFUSED r (TICS1)
A77. Here is the next explanation. Taking part in the survey is completely voluntary. Completely voluntary means you can choose whether or not to take part. If you decide to take part, you can refuse to answer any questions you do not like and you can stop the interview at any time you choose. Whether you choose to take part or not, your disability benefits will not be affected in any way.
When I say your participation is completely voluntary, what does that mean to you?
PROBE: IF RESPONDENT SAYS: It is voluntary, PROBE: What does that mean?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: I can decide to take part or not to take part. I can refuse to take part if I want. I don’t have to do this. I can do this if I want. No one will take away my benefits if I refuse, etc.
INTERVIEWER: IF NAME/PROXY SAYS “DON’T KNOW” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER 01 (A78)
INACCURATE ANSWER 02
REFUSED r
A77a. INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.
Let’s try that again. Taking part in the survey is completely voluntary. Completely voluntary means you can choose whether or not to take part. If you decide to take part, you can refuse to answer any questions you do not like and you can stop the interview at any time you choose. Whether you choose to take part or not, your disability benefits will not be affected in any way. When I say your participation is completely voluntary, what does that mean to you?
PROBE: IF RESPONDENT SAYS: It is voluntary, PROBE: What does that mean?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: I can decide to take part or not to take part. I can refuse to take part if I want. I don’t have to do this. I can do this if I want. No one will take away my benefits if I refuse, etc.
INTERVIEWER: IF NAME/PROXY SAYS “DON’T KNOW” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER 01
INACCURATE ANSWER 02 (TICS1)
REFUSED r (TICS1)
A78. Here’s the last explanation. All your answers will be kept confidential and used only for the research purposes of the study. When I say that your answers will be kept confidential, what does that mean to you?
PROBE: IF RESPONDENT OR PROXY SAYS: It is confidential, PROBE: What does that mean?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: My answers will be secret. Only researchers will see what I said. What I say will be (kept) private. It will only be used for research; etc.
INTERVIEWER: IF RESPONDENT SAYS: “DON’T KNOW,” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER 01 (TICS1)
INACCURATE ANSWER 02
REFUSED r
A78a. INTERVIEWER: YOU ARE ASKING THIS QUESTION FOR THE SECOND AND LAST TIME.
Let’s try that again. All your answers will be kept confidential and used only for the research purposes of the study.
When I say that your answers will be kept confidential, what does that mean to you?
PROBE: IF RESPONDENT OR PROXY SAYS: It is confidential, PROBE: What does that mean?
INTERVIEWER: EXAMPLES OF ACCURATE ANSWERS ARE: My answers will be secret. Only researchers will see what I said. What I say will be (kept) private. It will only be used for research; etc.
INTERVIEWER: IF RESPONDENT SAYS “DON’T KNOW” RECORD AS “INACCURATE ANSWER”
ACCURATE ANSWER 01 (TICS1)
INACCURATE ANSWER - FAILED 02 (TICS1)
REFUSED r (TICS1)
TICS
In past administrations, sample members who did not respond accurately to the cognitive assessment items where asked immediately if someone else could answer the study questions. For the experiment, we will administer the Telephone Interview of Cognitive Status (TICS) (a standardized test of cognitive functioning) to a random subset of respondents in the treatment and control group and ask respondents 4 questions from the NBS, prior to requesting a proxy or continuing with the interview.
TICS1 Please tell me your full name.
TICS2 What is today’s date?
TICS3 Where are you right now?
TICS4 Please count backward from 20 to 1.
TICS5 I am going to read you a list of 10 words. Please listen carefully and try to remember them. When I am done, tell me as many of the words as you can, in any order. The words are cabin, pipe, elephant, chest, silk, theater, watch, whip, pillow, giant. Now tell me all of the words you can remember.
TICS6 I would like you to take the number 100 and subtract 7. Now keep subtracting 7 from the answer until I tell you to stop.
TICS7 What do people usually use to cut paper?
TICS8 How many things are in a dozen?
What do you call the prickly green plant that lives in the desert?
What animal does wool come from?
TICS8 Please repeat this after me: “No its, ands, or buts.” Now please repeat this after me: “Methodist Episcopal”
TICS9 Who is the President of the United States right now?
Who is the Vice-President?
TICS10 With your finger, tap five times on the part of the speak into.
TICS11 I am going to say a word and I want you to give me it’s opposite. For example, if I said “hot”, you would say “cold”. What is the opposite of “west”?
What is the opposite of “generous?”
NBS ITEMS ASKED BEFORE SCREEN-OUT
Respondents who are screened out by either method will be asked seven items from the NBS before a proxy is requested. Respondents who are not screened out will receive these items later in the survey.
J1. Now, I’m going to ask you about different types of health insurance coverage {you/NAME} might have.
Are you currently covered by Medicare?
PROBE: Medicare is health insurance coverage provided nationally to certain disabled people under age 65, including Social Security Disability Insurance beneficiaries that have been receiving benefits for more than 24 months.
YES 01
NO 00
DON’T KNOW d
REFUSED r
J2. There is a program called Medicaid that pays for health care for persons in need. Are you currently covered by Medicaid?
OTHERWISE USE:
There is a program called Medicaid that pays for health care for persons in need. In your state, you may also hear it called {STATEMED FROM {NAME’S} CURRENT STATE}. Are you currently covered by Medicaid?
PROBE: Medicaid is a state medical assistance program that serves low-income people and Social Security Income recipients with disabilities
YES 01
NO 00
DON’T KNOW d
REFUSED r
Now, I’m going to ask about incentives and supports that Social Security offers to people getting disability benefits, to encourage them to work. Please tell me if you have ever heard of these incentives or supports or used any of them.
E21. Have you ever heard of the Ticket to Work program?
PROBE: The Ticket to Work program provides services to help disability beneficiaries achieve
steady, long-term employment by providing them greater choices and opportunities to go to work if they want to.
YES 01 (E36)
NO 00
DON’T KNOW d
REFUSED r
E22. Have you heard of any new Social Security programs in the last few years that allow disability beneficiaries to get services to help them go to work or earn more?
YES 01 (E25)
NO 00
DON’T KNOW d
REFUSED r
E25. Does the program you’ve heard of include a certificate or Ticket that you would give to a service provider in exchange for services?
YES 01
NO 00
DON’T KNOW d
REFUSED r
E36. Have you ever used your Ticket to sign up with an Employment Network? Employment Networks are organizations or businesses that offer services to help people with disabilities work or earn more money as part of the Ticket to Work Program.
PROBE: Employment Networks can be public or private and can include the State Vocational Rehabilitation Agency.
YES 01
NO 00
DON’T KNOW d
REFUSED r
E37. Were you signed up with any Employment Networks or a State Vocational Rehabilitation Agency at any time in 2005?
PROBE: Employment Networks are organizations or businesses that offer services to help people with disabilities work or earn more money as part of the Ticket to Work Program. Employment Networks can be public or private and can include the State Vocational Rehabilitation Agency.
PROBE: Employment Networks are organizations or businesses that offer services to help people with disabilities work or earn more money as part of the Ticket to Work Program. Employment Networks can be public or private and can include the State Vocational Rehabilitation Agency.
YES 01 (A80)
NO 00 (A80)
DON’T KNOW d (A80)
REFUSED r (A80)
IDENTIFYING A PROXY
Once these items are completed, respondents who screen out will be directed to item A80 and receive the following script:
A80. Thank you. Our study rules say that we need to find someone who can help answer the survey questions. Is there someone there who could answer questions about your health, daily activities, and any jobs you might have?
PROBE: This might be someone who lives with you, a friend, or someone like a social worker or case worker.
YES, PROXY COMES TO PHONE 01 (CONTINUE WITH PROXY)
YES, CALL BACK PROXY LATER 02
YES, PROXY LIVES ELSEWHERE 03
NO PROXY AVAILABLE 04 (END INTERVIEW)
DON’T KNOW d (END INTERVIEW)
REFUSED r (END INTERVIEW)
| File Type | application/msword |
| File Title | MEMORANDUM |
| Author | Debra Wright |
| File Modified | 2009-12-08 |
| File Created | 2009-12-08 |