Revised Attachment 1

[Type text]

Date:	September 12, 2016
To:	Allen Beck and Jessica Stroop, BJS
From:	Darby Steiger, Leanne Heaton
Subject:	Findings from facility and non-facility cognitive testing

This memo presents the results of cognitive testing conducted for the third National Survey of Youth in Custody (NSYC-3) in August 2016. This included interviews with 20 male and female adjudicated youth in three youth correctional facilities. It also included interviews with 10 non-facility LGBT youth in Rockville, MD. The memo presents the methodology used for each population, followed by an overview of results. The appendices present detailed findings for each question that was tested.

Methodology

Facility Youth

Westat conducted 20 cognitive interviews with adjudicated youth in three ILP correctional facilities between August 22 and August 25 to test new items being considered for NSYC-3. The facilities included two in Ohio – the Circleville Juvenile Correctional Facility (CJCF) (5 males) and the Center of Adolescent Services (CAS) in New Lebanon (5 females) and one in Kentucky – the Lake Cumberland Youth Development Center (YDC) (10 males). Two senior Westat interviewers traveled to each site to conduct the interviews. A contact person was designated at each facility who was responsible for selecting the youth and keeping their personally identifiable information protected from the interviewers. Each facility provided a list of the demographic characteristics of the youth being interviewed, including age, race/ethnicity, and length of stay in the facility (Table 1). Notably, none of the youth we interviewed were under the age of 15.

Prior to testing the items, youth were handed an assent form, which was read aloud by the interviewer. The interviewer addressed any questions, then asked the youth to mark a box on the assent form indicating their permission to proceed. The interviewer signed the assent form, and provided an unsigned copy of it to the youth. At the end of the interview, youth were asked if they would like to speak with a counselor regarding any of the content discussed during the interview. None of the youth requested to speak with a counselor.

Table 1. Demographic characteristics of facility youth

Facility	Gender	Age	Race	Length of stay
CJCF Circleville, OH	Male (n=5)	17 (n=3) 18 (n=1) 19 (n=1)	White (n=2) Black/AA (n=2) Hispanic (n=1)	6 months or less (n=1) >6 mo, <1 year (n=2) 1 year or more (n=2)
CAS New Lebanon, OH	Female (n=5)	15 (n=1) 16 (n=2) 17 (n=1) 20 (n=1)	White (n=2) Black/AA (n=3) Hispanic (n=0)	6 months or less (n=1) >6 mo, <1 year (n=2) 1 year or more (n=2)
YDC Monticello, KY	Male (n=10)	17 (n=7) 18 (n=1) 20 (n=2)	White (n=3) Black/AA (n=7) Hispanic (n=0)	6 months or less (n=9) >6 mo, <1 year (n=0) 1 year or more (n=1)

Interviewers were trained to identify any comments by youth that would suggest they or other youth had been abused or harmed, which would trigger mandatory reporting procedures. None of the youth shared any information that led to a mandatory report.

The goals of testing were to ensure that youth understood the questions, terminology, and response categories. While the NSYC interview is conducted via ACASI administration, the cognitive interviews were conducted using a paper version of the questions, with the interviewer reading the questions aloud to the respondent. A total of 62 questions were tested with youth. Some had multiple sub-parts to them, resulting in a total of 126 individual items being tested. In order to gather feedback on all items within the one-hour interview, the questions were divided into two separate protocols such that each youth was presented with roughly half of the items. All facility youth were asked items pertaining to sexual orientation and gender identity (SOGI) so that we could obtain enough information about those items (Table 2).

Several of the items covered sensitive material including staff grooming behaviors, sexual activity between youth and between youth and staff, drug use, history of victimization, and disabilities. Youth were asked to only provide their interpretation of these items rather than answer them directly. For these items, questions were presented on laminated pages so that youth were prevented from marking their answers.

Table 2. Items tested in facility interviews

Version 1 (68 items)	# of items	Version 2 (62 items)	# of items
Facility living conditions	9	Legal counsel and institutional experiences	4
Staff treatment	6	Solitary confinement	9
Misconduct/victimization	1	Youth/gang involvement	4
Education on PREA	8	Drug use*	2
Grooming behaviors*	4	Staff incident details*	25
Mental health	15	History of victimization*	3
Youth incident details*	18
If time permitted. . .
Disability items*	3	Treatment program and services	11
Sexual orientation/gender identity	4	Sexual orientation/gender identity	4

*Respondents were instructed not to answer the questions, only to comment on their interpretation of the

question.

Non-facility Youth

In order to more thoroughly test the SOGI items, Westat conducted 10 interviews with non-facility youth who were gay, lesbian, bisexual or transgender (LGBT) or had a close family member or friend who was LGBT. Youth and young adults between the ages of 12 to 21 were recruited through a variety of sources including the local LGBT support groups SMYAL and PFLAG, Craigslist ads, and friends or relatives of Westat employees. Participants were screened to ensure there was a mix of ages, genders, sexual orientation, race/ethnicity, and education levels (Table 3). Youth under the age of 18 were instructed to have their parent or guardian contact the recruiter in order to be screened for the interview, to provide permission for Westat to schedule the interview with their child, and to provide contact information so that a parental consent form could be sent prior to the interview date. Westat received a total of 22 inquiries about the project. Ten of those inquiries resulted in completed interviews. Four individuals were screened out or cancelled their interview appointment. Eight participants spoke with the recruiter but did not return follow-up calls requesting to speak with their parent or guardian.

Table 3. Demographic characteristics of non-facility youth

Characteristic	N	Gender	Age	Race	Grade Level
Gay, Lesbian, Bisexual	5*	Male (n=3) Female (n=2)	16 (n=1) 17 (n=1) 18 (n=2) 20 (n=1)	White (n=1) Black/AA (n=3) Hispanic (n=1) Asian (n=1)	10th, 11th, 12th
Transgender	3*	Male (n=3)	15 (n=1) 16 (n=2)	White (n=3)	9th and 10th
LGBT Family Member or Friend	2	Male (n=2)	13 (n=1) 17 (n=1)	Black/AA (n=2)	7th and 11th
Straight	1	Male (n=1)	17 (n=1)	White (n=1)	11th

*Note: One respondent identified as both gay and transgender and is counted as both in this table. Total

Youth N = 10.

Two Westat interviewers conducted the 10 interviews over the course of 2 weeks (August 15 – 26, 2016) at Westat headquarters in Rockville, MD and the SMYAL (Supporting and Mentoring Youth Advocates and Leaders) office in Washington, DC. Written parental consent for youth under the age 18 was requested at the time of scheduling and was required prior to the start of the interview. Youth assent was then obtained by the interviewers at the beginning of the interview. Young adults over the age of 18 followed traditional consent procedures and signed a consent form at the start of the interview. Permission to record the interviews was obtained from all participants (and parents of youth).

A total of 7 questions (4 SOGI and 3 disability items) were tested with the youth and young adults¹. To test the SOGI items, participants were asked to circle their answers and provide their interpretation of the questions. If the participant was recruited because they had a close family member or friend who was LGBT, they were asked to review the items again and think about how that person might answer the questions. Participants were then presented with the disability questions and were asked not to answer the questions, but only to comment on their understanding of the items.

Each interview lasted less than 30 minutes and participants received $25. Due to the sensitive nature of the topics covered, the participants were also provided a list of LGBT support resources in case they wished to speak with someone after the interview.

Results

Out of the 126 items tested in the facility interviews, including the seven questions also asked in the non-facility interviews, 74 items worked well and no changes are being recommended (see the appendix for these items). For 23 items, we are recommending substantive edits that we would like to discuss with BJS, including 2 items we would like to delete. These are summarized in Table 4 below and more details are provided in the appendix. For the remaining 29 items that were tested, we are recommending minor wording changes, which are outlined in Table 5. Fuller justification for these edits are provided in the two appendices. Appendix 1 covers the questions tested in Version 1 of the facility interviews, and also includes the findings from the non-facility youth on the SOGI and disability items. Appendix 2 covers the items tested for Version 2 of the facility interviews.

Of the items that we are not recommending for change are those related to opinions about the facility staff (e.g., ST1 – ST6). During the development of the questionnaire, there was some discussion about changing the scale of these questions from what was used on NSYC-2 (yes/no) to a four point scale (None of the staff, few of the staff, Most of the staff, All of the staff). There was agreement among the respondents that the four point scale was preferable.

We are recommending changes to some questions that, under ideal circumstances, should go through another round of testing. We also did not interview any facility youth under 15 and only a three who were less than 17. We should discuss whether we should consider doing additional testing while the pilot interviews are being conducted to supplement information from the pilot test.

All recommended changes are shown in yellow highlighting. Questions are presented in the order in which they appear in the core survey, followed by questions in the alternative survey. The location of each item in Appendix 1 or 2 is denoted in parentheses in each table.

Table 4. Items requiring substantive edits

Item and Appendix Page #	Tested wording	Proposed revised wording	Discussion points
GI2 (A1-16)	Do you currently describe yourself as male, female or transgender? Male Female Transgender None of these Not sure	Do you currently think of yourself as …? Male Female Transgender male Transgender female Something else Not sure	One adjudicated female initially answered this according to how others think of her, rather than how she thinks of herself. ‘Think of’ may better elicit reports of self-identification than describe which implies how you explain yourself to others. Split “transgender” into “transgender male” and “transgender female” to provide transgender respondents with more accurate response options. Change “none of these” to “something else” to be more inclusive.
GI3 (A1-18)	Do you consider yourself… (Males) Gay Straight, that is, not gay Bisexual Something else Not sure (Females) Lesbian or gay Straight, that is, not lesbian or gay Bisexual Something else Not sure	Do you consider yourself… Gay or lesbian Bisexual Straight (not gay, lesbian or bisexual) Something else Not sure	Transgender youth answered GI3 based on the gender they currently identified as and not as their assigned sex. This shows that those who report something other than male or female in GI2 would not know which version of GI3 to answer. These should be combined into a single item. One non-facility youth noted that bisexual can also be considered straight, so we have switched the order of the response options and added a clarification to the straight option.
GI4 (A1-19)	People are different in their sexual attraction to other people. Which best describes your feelings? Only attracted to males Mostly attracted to males Equally attracted to females and males Mostly attracted to females Only attracted to females Not sure	People are different in their sexual attraction to other people. Which best describes your feelings? Only attracted to males Mostly attracted to males Equally attracted to females and males Mostly attracted to females Only attracted to females Something else Not sure	One transgender non-facility youth described himself as pansexual and noted he does not recognize gender or a binary system of male/female. Including a something else option would have helped this respondent.
GR3.1 (A1-5)	Since you got here, has any staff member ever offered you extra privileges at the canteen or commissary including food, personal items, clothing or other items? Yes No DK/REF	Since you got here, has any staff member ever offered you things like drugs, cigarettes, alcohol or other items you were not allowed to have in the facility? Yes No DK/REF	This item did not elicit any descriptions about grooming behaviors. Rather, youth had varying interpretations of it, including several who thought it referred to getting a reward or an extra item from commissary if youth helped out or pitched in; and one KY male who thought this technique might be used by staff to help a youth feel better if they were having difficulty adjusting. We recommend deleting this item and just using the NSYC-2 grooming item about being offered items that were not allowed at the facility as a sharper way to measure grooming.
EP5 (A1-5)	Do you think youth in this facility would feel safe reporting any sexual abuse to staff? Yes No	Is there a staff member here that you would feel safe reporting sexual abuse to? Yes No	Youth in each facility were confused by this question, wondering how to respond if some youth would feel safe, or if some youth might feel safe only talking to some staff. One KY male questioned whether the question should really be asking about how “comfortable” they would feel rather than how “safe”. Our recommendation makes it about the respondent, rather than asking the respondent to project how other youth feel, and determining if there is at least one, rather than generalizing to all youth and all staff.
D380 (A1-13) E410 (A2-11)	Have your feelings changed since the incident happened? Yes No	Delete item.	Some youth were unsure how others might answer this question, since some feelings might change and others might not. We think it would be better to remove the item as a filter question and ask everyone D390 and E420, to report on their feelings now, looking back.
DI1 DI2 DI3 (A1-14, A1-15))	Because of a physical, mental or emotional problem, do you have serious difficulty concentrating, remembering, or making decisions? Yes No Is the difficulty you experience because of a physical problem? Is the difficulty you experience because of a mental or emotional problem?	Do you have serious difficulty concentrating, remembering, or making decisions? (Removed intro phrase) Yes No Did a physical problem cause you to have this serious difficulty? Did a mental or emotional problem cause you to have this serious difficulty?	Nearly all facility and non-facility youth had difficulty cognitively processing question DI1, with many focusing only on one aspect of the question, such as ability to make decisions, rather than focusing on whether they have serious difficulty with this, or whether it was actually caused by a physical, mental, or emotional problem. While the question originates from YRBS and could allow us to compare facility youth to general population youth, we think it is a poorly worded question. We think a simplified question with follow-up on the cause of the problem would work better. But this does interfere with comparison to YRBS
FL9 (A1-1)	I feel like I have enough privacy here from staff and other youth Yes No	Delete item.	This item had a variety of interpretations, from several youth who thought it meant privacy from others asking about them and their past, to one youth who thought about privacy while on the phone or in reading his mail. Several youth living in a dormitory setting noted that the only privacy they have is on the toilet, and for some, that was “enough.” We think the item may be too elusive for youth to answer.
MH2a (A1-8)	During your first years at school—say between the ages of kindergarten and second grade—was there ever a period lasting six months or longer when you… Lost interest very quickly in games or work Yes No	The next question is about concentration problems that usually start before the age of seven. These problems include: not being able to keep your mind on what you are doing losing interest very quickly in games or work trouble finishing what you started without being distracted not listening when people spoke to you. During your first years at school – say between the ages of kindergarten and second grade – was there ever a period lasting six months or longer when you had a lot more trouble with problems of this sort than most children?	Some facility youth had difficulty recalling this timeframe, and some youth provided feedback on specific items, with one noting that she did not have “work” at that age, and another noting that she listened to teachers, but not to peers at that age. Note that we did not provide the contextual language in these items to focus on concentration issues. This will affect comparability to the National Co-morbidity Survey- Adolescent Supplement (NCS-A).) Consider returning the original wording of the NCS-A question so there is a direct comparison with youth in the general population. The original items was used as a screening probe to identify youth with possible symptoms of ADD/ADHD. When a youth endorsed this screening probe in the NCS-A , he/she received the section on ADD/ADHD to determine full diagnostic criteria. The way the item is presented now in NSYC-3 testing is without the context of “concentration problems” and the description the “concentration problems” so we lose comparability. We recommend returning to the original wording in NCS-A, which is one of the items recommended on the K-6 supplement.
MH2b (A1-8)	Had trouble finishing what you started without being distracted Yes No
MH2c (A1-8)	Were not listening when people spoke to you. Yes No
MH4a (A1-9)	Did you ever have a period lasting six months or longer when you often did things that got you in trouble with adults such as: a. losing your temper, arguing?	Did you ever have a period lasting six months or longer when you often did things that got you in trouble with adults such as losing your temper arguing or talking back to adults refusing to do what your teachers or parents asked you to do annoying people on purpose being grouchy and irritable?	While respondents did not express any difficulty answering these items, we would like to consider returning the original wording of the NCS-A question so there is a direct comparison with youth in the general population. The original item was used as a screening probe to identify youth with possible symptoms of ODD. When a youth endorsed this screening probe in the NCS-A , he/she received the section on ODD to determine full diagnostic criteria. This item was one of the items recommended on the K-6 supplement.
MH4b (A1-9)	b. talking back to adults
MH4c (A1-9)	c. refusing to do what your teachers or parents asked you to do
MH4d (A1-9)	d. annoying people on purpose
MH4e (A1-9)	e. being grouchy or irritable
MH22c (A1-10)	Before you came to this facility, did a professional ever tell you have…? Another anxiety disorder, such panic disorder, obsessive compulsive disorder (OCD), or social anxiety? Yes No	Before you came to this facility, did a professional ever tell you that you have any of the following mental or emotional conditions (not including conditions like ADD or ADHD)? Another anxiety disorder, such as panic disorder, obsessive compulsive disorder (OCD), or social anxiety?	In cognitive testing, respondents did not seem to know where to categorize ADD, ADHD and ODD, with some wanting to report those conditions at this item. In the full study, youth will be asked about these conditions earlier in the instrument, so the stem question for items in MH22 should remind respondents not to think about these conditions here.
LC1 LC2 LC3 (A2-2)	Do you have a lawyer or legal counsel? Since you came to this facility, have you asked to see, call, or write to (your/a) lawyer or legal counsel? Since you have been here, have you been allowed to see, call, or write to (your/a) lawyer or legal counsel?	Have you seen or talked to a lawyer or legal counsel since you have been in this facility? LC2. IF NO TO LC1: Would this facility allow you to see or talk to a lawyer if you wanted to? LC3. (IF NO TO LC1:) Since you have been at this facility, have you been told that you cannot see or talk to a lawyer?	Many youth thought LC2 and LC3 were asking the same question. Some youth wondered how to answer LC1 if they had a lawyer during their sentencing but do not currently have one. We think the series may be more effective by restructuring as shown here.

Table 5. Items requiring minor wording edits

Item	Tested wording	Proposed revised wording	Discussion points
ST2 (A1-2)	How many staff use force when they don’t really need to? None of the staff Few of the staff Most of the staff All of the staff	How many staff use physical force when they don’t really need to? None of the staff Few of the staff Most of the staff All of the staff	Two KY males were uncertain whether this was referring to verbal force or physical force, or both.
GR7 (A1-6)	Since you got here, has any staff member ever spent time alone with you and asked you not to tell anyone? Yes No	Since you got here, has any staff member ever spent time alone with you and asked you not to tell anyone? Yes No	Youth understood the question, and explained that staff members are not supposed to be with youth alone at any time. We recommend underlining “and” to emphasize both parts of the statement.
GA8 (A2-5)	Have you ever had to do or pay something to have gangs leave you alone? Yes No	Have you ever had to do something or pay someone to have a gang in this facility leave you alone? Yes No	While respondents understood the question clearly, the interviewers note that the question is missing the focus on “this facility.”
HV9 (A2-12)	Did any of this happen while you were being arrested or detained by a law enforcement officer? Yes No	Did any of this happen while you were being arrested or detained by police? Yes No	There was some variation in the understanding of “law enforcement officer”, with examples of police, sheriff, lieutenant police, probation officers, “anyone with a gun and a badge,” and a KY male who thought about the people transporting the youth. Because of the variety of responses provided, we recommend being more precise with the scope of this item to focus on “police” rather than “law enforcement officers”.
EP1 (A1-4)	After you got to this facility (this time), when did you first learn that all forms of sexual abuse and harassment are not allowed? Within the first 24 hours after you got here Between 1 and 10 days after you got here (this time) More than 10 days after you got here (this time) I was never told that all forms of sexual abuse and harassment are not allowed	After you got to this facility (this time), when did you first learn that all forms of sexual abuse and harassment are not allowed? On the day you got here (within the first 24 hours) Between 1 and 10 days after you got here (this time) More than 10 days after you got here (this time) You were never told that all forms of sexual abuse and harassment are not allowed	All respondents answered with the first response option, with most noting that it was immediately upon arrival, or within the first few hours. One OH female was confused by how to answer, because she misunderstood “within the first 24 hours” and was expecting an answer that corresponded with “immediately” or “on the day you arrived.”
EP4c (A1-4)	How were you given information about these rules? c. Brochure/flier/ pamphlet/handout	How were you given information on facility rules about sexual abuse and harassment? c. Brochure/flier/ pamphlet/ handout (remove handout)	An OH female expressed confusion about the difference between a handout and a handbook.
EP4d (A1-4)	d. Handbook	d. Handbook with facility rules	An OH female expressed confusion about the difference between a handout and a handbook. Others who understood this explained that it was a larger document with the rules of the facility, including this topic.
EP4f (A1-5)	f. Telephone system	f. Other	Nearly all described this as a “tip line” that they would use to report sexual abuse or harassment, rather than a tool that was used to teach them information about the rules. One OH female and one KY male thought a telephone system was actually used to convey the information. Remove this option and replace with “Other” as a catch-all.
13 (A1-11) 17 (A1-13) 12 (A2-9) 16 (A2-11)	In the days after this happened, how did you feel about what happened? Thinking about it now, how do you feel about what happened? Extremely upset Quite upset A little upset Not upset at all Glad it happened	In the days after this happened, how did you feel about what happened? Thinking about it now, how do you feel about what happened? Very upset A little upset Not upset at all Glad it happened	Respondents were generally able to differentiate between the different levels of being upset, but several thought it was just too many categories (both OH males and KY males). Some thought this might be difficult for respondents to answer because it would require them to think about something that they did not want to remember or admit it.
14 (A1-12) 13 (A2-9)	Did you feel any of the following ways after this happened? d. Vulnerable	Did you feel any of the following ways after this happened? d. Helpless	Many did not recognize this word. Some had no idea what it meant. Others were able to guess what it meant with reasonable accuracy, such as, “easy to talk into something,” “easy prey,” “easy target,” “couldn’t do anything about it” “could get you at any time.”
15 (A1-13) 14 (A2-10)	Did you feel any of the following ways after this happened? e. Like you were in control	Did you feel any of the following ways after this happened? e. Like you were in control of the situation	One KY youth did not understand this item at all. While two youth thought this meant being in control of themselves, most thought this was asking about being in control of the situation or in control of the other person, such as a “power trip”.
3 (A2-7)	Still thinking just about this time that (FILL DESCRIPTION), was the staff member who you had sexual contact with… A staff member who directly supervises youth/correctional officer A teacher or educator Medical or mental health staff Other staff working in the facility A volunteer in the facility	Still thinking just about this time that (FILL DESCRIPTION), was the staff member who you had sexual contact with… A staff member who directly supervises youth/correctional officer A teacher or educator A doctor, nurse, or other medical staff A therapist or other mental health staff Other staff working in the facility A volunteer in the facility	Several youth did not understand what was meant by mental health staff and many seemed to only be focusing on medical staff, bringing up “nurse” as an example.
8 (A2-8)	What were these other youth doing at the time? They were helping make it happen They were trying to stop it from happening They knew it was happening, but did nothing	What were these other youth doing at the time? (Mark all that apply) They were helping make it happen They were trying to stop it from happening They knew it was happening, but did nothing	All youth correctly understood these categories, but it is possible that more than one category could apply if multiple youth were aware and responding differently.
FL6 (A1-1)	These next questions ask about this place and what it’s like to live here. Room lights are turned off at night when youth are sleeping. Yes No	These next questions ask about this place and what it’s like to live here. Room lights are turned off or dimmed at night when youth are sleeping. Yes No	Several youth across facilities wondered how to answer if room lights are “dimmed,” or if nightlights or lanterns are used.
FL13 (A1-1)	These next questions ask about this place and what it’s like to live here. The staff here set up celebrations for holidays and youths' birthdays. Yes No	These next questions ask about this place and what it’s like to live here. The staff here set up celebrations for holidays and/or youths' birthdays. Yes No	One youth was unsure how to answer because there are celebrations for holidays but not birthdays.
MH1g (A1-7)	We just reviewed a number of negative feelings and experiences during the past 30 days. Taking them altogether, did these feelings occur more often in the past 30 days than is usual for you, less often than usual, or about the same as usual? More often Less often About the same Never had any	You said you felt the following ways in the past 30 days: (IF MH1A=1-4) Nervous (IF MH1B=1-4) Hopeless (And so on) Taking them all together, did these feelings occur more often in the past 30 days than is usual for you, less often than usual, or about the same as usual? More often Less often About the same Never had any	One KY male had difficulty answering because he was unclear what was meant by “than is usual”. He was unclear if that meant what was usual since he had been in the facility, or what was usual across his life. Another KY youth was completely confused and did not know how to answer the question. While some youth will be comparing their past 30 day experiences to what is usual since they have been in the facility, and others may be comparing to their experiences prior to arriving at the facility, we do not recommend clarifying what is meant by “usual”. Because of the skip pattern after items A-F, if item G will appear on a new screen, the respondent should be reminded of the items they indicated in A-F. Our recommendations also adapt the item for self-administration.
SC1 (A2-3)	Since coming to this facility have you ever been confined in a separate room, other than your own room, without contact with other youth? Yes No	Since coming to this facility have you ever been isolated or secluded in a separate room, other than your own room, without contact with other youth? Yes No	One OH male thought “without contact” meant without being able to physically touch other youth, and “confined” meant being actually with other youth. One KY youth did not understand the item, thinking it was asking about being in a separate room with someone else. KY youth explained that youth may be placed in a separate room, but the door might not be closed. Other terms used for “confined to a separate room” included “isolation room”, “room restriction” and “secluded in a different room.”
SC2 (A2-3)	What was the reason you were confined in a separate room, other than your own room, without contact with other youth?	What was the reason you were isolated or secluded in a separate room, other than your own room, without contact with other youth?	No changes are recommended to this series, other than applying the SC1 edit to the stem of the question to refer to being “isolated or secluded,” rather than “confined.”
SC4 (A2-4)	Since coming to this facility, what was the longest time you were confined in a separate room, other than your own room, without contact with other youth?	Since coming to this facility, what was the longest time you were isolated or secluded in a separate room, other than your own room, without contact with other youth?	No changes are recommended to this series, other than applying the SC1 edit to the stem of the question to refer to being “isolated or secluded,” rather than “confined.”
SC5 (A2-4)	Since coming to this facility, have you been confined to your room for breaking facility rules? Yes No	Since coming to this facility, have you been isolated or secluded in your room for breaking facility rules? Yes No Does not apply	In the KY facility, youth live in a dormitory all together, so this question may be confusing if they cannot be confined to their room.
SC7 (A2-4)	Since coming to this facility, what was the longest time you have been confined to your own room for breaking facility rules?	Since coming to this facility, what was the longest time you have been isolated or secluded in your own room for breaking facility rules?	No changes are recommended to this series, other than applying the SC5 edit to the stem of the question to refer to being “isolated or secluded,” rather than “confined.”
TP3 (A2-13) TP6 (A2-14)	When you received counseling for your drug or alcohol problems, what kind of counseling was it? a. Just you and the counselor b. Yourself and other youths with a counselor c. Yourself and your family with a counselor d. Other	When you have received counseling at this facility for your drug or alcohol problems, who has been in the counseling sessions? a. Just you and the counselor b. Yourself and other youths with a counselor c. Yourself and your family with a counselor d. Other	Some youth were confused about how to answer this question because they are still receiving this treatment, or are about to receive a particular type of the treatment. The question is actually asking about the “kind” of counseling, whereas the answer choices are about the people that are present in the counseling.
TP4 (A2-14)	How helpful was the counseling for your drug or alcohol problems?	How helpful has the counseling been for your drug or alcohol problems?	As per comments at TP3, change the tense of the question to acknowledge that some youth may still be in the process of counseling.

1 All 20 facility youth also answered the SOGI questions, and 9 facility youth were shown the disability items. The analysis of these items reflects findings from both facility and non-facility youth.