Supporting Statement for OMB Clearance Request
Appendix I: HPOG-Impact and HPOG-NIE 15-month Participant Follow-Up Survey
National Implementation Evaluation of the Health Profession Opportunity Grants (HPOG) to Serve TANF Recipients and Other Low-Income Individuals and HPOG Impact Study
0970-0394
April 24, 2013
Revised July 25, 2013
Submitted by:
Office of Planning,
Research & Evaluation
Administration for Children & Families
U.S. Department of
Health
and Human Services
Federal Project Officers:
Molly Irwin and Mary Mueggenborg
Appendix I: HPOG-Impact and HPOG-NIE 15-month Participant Follow-Up Survey
Introduction
Hello, my name is [ ]. May I please speak with _____?
Thank you for taking the time to talk with me today. This interview will take about 40 minutes to complete, and when we are done, we will send you a $30 check, in appreciation for your time. I work for a company called Abt SRBI. Abt SRBI is an independent research company and we are helping the Administration for Children and Families (ACF) in the U.S. Department of Health and Human Services (HHS) with its evaluation of the Health Profession Opportunity Grants (HPOG) program. You agreed to be part of the study around [RAD] (when you signed a consent form to let researchers collect information from you).
We need to talk with people who got into the program and those who did not. Your participation in this study will help policymakers and program operators better understand how to help people attain educational credentials and find and keep jobs in the healthcare field. This interview will include questions on your education activities, your use of services, and your overall well-being.
Before we begin the survey, I would like to assure you that all of your responses on this survey will be kept private; your name will not appear in any written reports we produce. Your responses to these questions are completely voluntary. That means you may choose not to answer any question, or you may stop the interview if you wish, but we hope you don’t. Your responses to these questions will in no way affect your participation in any programs or your receipt of any kinds of public benefits or services. The information you provide will be kept private and only used for this study.
According to the Paperwork Reduction Act (PRA), an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is 0970-0394 and it expires xx/xx/xxxx. If you have comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, please send them to [Contact Name]; [Contact Address]; Attn: OMB-PRA (0970-0397).Do you have any questions before we begin?
Let’s begin now.
Screener/Verification:
First I just need to verify that I am speaking with the correct person.
What is your date of birth? ___________ (MM/DD/YYYY)
What are the last 4 digits of your Social Security Number? __ __ __ __
School or Training Experiences
My first set of questions is about any school or training experiences you have had since [RAD]. To help you remember this date, our records show that it was about then that you applied for the [HPOG] program [AT (NAME OF HOST INSITUTION, IF DIFFERENT FROM PROGRAM NAME)].
Since [RAD], have you taken any classes or been in an instructional program of any kind anywhere, even for a short time? This may have included classes on basic skills, ESL, college courses, occupational training, or other skills such as how to succeed in school or career readiness. These classes may have been offered by a community organization, college, high school, employer, or somewhere else.
Yes (ASK Q1a below)
No (GO TO Q24 p.10)
REFUSED (GO TO Q24 p.10)
DON’T KNOW (GO TO Q24 p.10)
IF YES: Are you currently enrolled in any classes, or enrolled but between terms, at some place that is providing education or training?
Yes
No
Don’t know
Refused
At what type of place(s) have you taken these classes? Choose all that apply.
Adult education /adult high school/community school/night school
Community based/nonprofit organization
Private school/company that provides training
Community or technical college (2 year college)
4 year college/university
State unemployment/employment office
One-stop career center
Your place of employment
Someplace else, specify:____
REFUSED
DON’T KNOW
I’m going to mention some different types of classes. For each one, please tell me if it is a type that you are taking or have taken since [RAD]. I’m interested in any classes you have taken, even if you only went for a short time.
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Yes |
No |
Don’t know |
Refused |
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IF ANSWERED “YES” TO Q3a (classes to learn English as a second language), CONTINUE.
IF DID NOT ANSWER “YES” TO Q3a, GO TO INSTRUCTION BELOW Q5 THIS PAGE.
I have a few questions about the English as a Second Language, or ESL classes you have taken.
Regardless of whether you finished them, how many ESL classes have you taken since [RAD]?
__ __ __ number of ESL classes
REFUSED
DON’T KNOW
How many ESL classes have you completed since [RAD]?
__ __ __ number of basic skills classes
REFUSED
DON’T KNOW
IF ANSWERED “YES” TO Q3b (classes to improve basic skills), CONTINUE.
IF DID NOT ANSWER “YES” TO Q3b, GO TO INSTRUCTION BELOW Q7 NEXT PAGE.
Now I have some questions about the basic skills classes you have taken.
Regardless of whether you completed them, how many basic skills classes have you taken since [RAD]?
__ __ __ number of basic skills classes
REFUSED
DON’T KNOW
How many basic skills classes have you completed since [RAD]?
__ __ __ number of basic skills classes
REFUSED
DON’T KNOW
IF ANSWERED “YES” TO Q3e (other skills classes), CONTINUE.
IF DID NOT ANSWER “YES” TO Q3e, GO TO INSTRUCTION BELOW Q13 p. 6.
Now I’d like to ask about the classes you have taken in other skills, such as how to succeed at school, work, or other areas of life. I’m interested in any classes you have taken of this type, whether or not they were for college credit.
Regardless of whether you completed them, how many other skills classes have you taken since [RAD]?
______ number of other skills classes
REFUSED
DON’T KNOW
Were these other skills classes offered for college credit?
YES
SOME BUT NOT ALL
NO
REFUSED
DON’T KNOW
In total, for about how many days or weeks have you attended these other skills classes?
__ __ __ number of days
OR
__ __ __ number of weeks
REFUSED
DON’T KNOW
And for about how many hours have you attended these other skills classes each week?
__ __ __ number of hours
REFUSED
DON’T KNOW
Are you currently taking any other skills classes right now?
YES
NO
REFUSED
DON’T KNOW
How many other skills classes have you completed since [RAD]?
______ number of other skills classes
REFUSED
DON’T KNOW
I’m going to read a list of subjects that other skills classes sometimes cover. For each one, please tell me whether it received a great deal of attention, some attention, or no attention in any of the other skills classes you have taken since [RAD]:
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A great deal of attention |
Some attention |
No attention |
Don’t know |
Refused |
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IF ANSWERED “YES” TO Q3c (classes providing regular college credit), CONTINUE.
IF DID NOT ANSWER “YES” TO Q3c, GO TO INSTRUCTION BELOW Q19a p.8.
Now I have some questions about classes you have taken for regular college credit.
Regardless of whether you finished them, about how many classes for college credit have you enrolled in since [RAD]?
______ number of classes
REFUSED
DON’T KNOW
Have you earned any regular college credits so far since [RAD]?
YES (CONTINUE)
NO (GO TO Q19)
REFUSED (GO TO Q19)
DON’T KNOW (GO TO Q19)
IF YES: How many credits have you earned?
__ __ __ number of credits
Don’t know
Refused
About when did you start taking classes for college credit? Please give me the month and year you started.
___ ___ month ___ ___ ___ ___ year
Are you currently taking any classes for college credit? Answer “yes” if you are on a spring, summer, or holiday break.
YES (GO TO Q19)
NO (ASK Q18a BELOW)
REFUSED (GO TO Q19)
DON’T KNOW (GO TO Q19)
IF NO: About when did you stop taking college credit classes? Please give me the month and the year you last attended.
___ ___ month ___ ___ ___ ___ year
Don’t know
Refused
Did you start any classes for college credit that you did not complete?
YES (ASK Q19a NEXT PAGE)
NO (GO TO INSTRUCTION BELOW Q19a NEXT PAGE)
REFUSED (GO TO INSTRUCTION BELOW Q19a NEXT PAGE)
DON’T KNOW (GO TO INSTRUCTION BELOW Q19a NEXT PAGE)
IF YES: What was the main reason that you stopped attending these classes?
DO NOT READ LIST, RECORD FULL ANSWER AND THEN BACKFILL ONE RESPONSE AFTER RESPONDENT ANSWERS
POOR GRADES
TOO HARD/WASN’T GETTING IT
CLASSES OR PROGRAM POORLY TAUGHT
STARTED OTHER SCHOOL/TRAINING
NOT ENOUGH MONEY TO CONTINUE
NOT ENOUGH TIME TO CONTINUE
DIDN’T LIKE PROGRAM
LOST MOTIVATION
NOT INTERESTED IN PROGRAM
DIDN’T THINK IT WOULD HELP ME FIND A JOB
ILLNESS
PREGNANCY
CHILD CARE ISSUES
OTHER FAMILY REASONS
TRANSPORTATION/COORDINATION PROBLEMS
FOUND JOB/RE-EMPLOYED
OTHER (SPECIFY)____
REFUSED
DON’T KNOW
IF ANSWERED “YES” TO Q3d (classes providing occupational training), CONTINUE.
IF DID NOT ANSWER “YES” TO Q3d, GO TO CREDENTIALS SECTION p. 10.
Now I’d like to ask about the occupational training classes you said you have taken. These were the job training classes you have taken that were not for college credit but covered more than basic English and math skills.
Regardless of whether you finished them, how many occupational training classes have you taken since [RAD]?
__ __ __ number of classes
Don’t know
Refused
About when did you start taking occupational training classes? Please give me the month and year you started.
___ ___ month ___ ___ ___ ___ year
Don’t know
Refused
Are you currently receiving this occupational training?
YES (GO TO Q23 NEXT PAGE)
NO (ASK 22a NEXT PAGE)
REFUSED (GO TO Q23 NEXT PAGE)
DON’T KNOW (GO TO Q23 NEXT PAGE)
IF NO: About when did you stop taking occupational training classes? Please give me the month and year you last attended.
___ ___ month ___ ___ ___ ___ year
Don’t know
Refused
Did you start any occupational training that you did not complete?
YES (ASK Q23a BELOW)
NO (GO TO CREDENTIALS SECTION NEXT PAGE)
REFUSED (GO TO CREDENTIALS SECTION NEXT PAGE)
DON’T KNOW (GO TO CREDENTIALS SECTION NEXT PAGE)
IF YES: What was the main reason that you stopped attending the training?
DO NOT READ LIST, RECORD FULL ANSWER AND THEN BACKFILL ONE RESPONSE AFTER RESPONDENT ANSWERS
POOR GRADES
TOO HARD/WASN’T GETTING IT
CLASSES OR PROGRAM POORLY TAUGHT
STARTED OTHER SCHOOL/TRAINING
NOT ENOUGH MONEY TO CONTINUE
NOT ENOUGH TIME TO CONTINUE
DIDN’T LIKE PROGRAM
LOST MOTIVIATION
NOT INTERESTED IN PROGRAM
DIDN’T THINK IT WOULD HELP ME FIND A JOB
ILLNESS
PREGNANCY
CHILD CARE ISSUES
OTHER FAMILY REASONS
TRANSPORTATION/COORDINATION PROBLEMS
FOUND JOB/RE-EMPLOYED
OTHER (Please SPECIFY)____
REFUSED
DON’T KNOW
Credentials
Now I’m going to ask you questions about your overall training experience since [RAD].
Have you taken classes to prepare for work in a particular occupation?
YES (ASK 24a BELOW)
NO (GO TO Q25 THIS PAGE)
REFUSED (GO TO Q25 THIS PAGE)
DON’T KNOW (GO TO Q25 THIS PAGE)
IF YES: Have you taken classes to prepare for work in a particular healthcare occupation?
Yes (ASK Q24ai BELOW)
No (GO TO Q25 THIS PAGE)
Refused (GO TO Q25 THIS PAGE)
Don’t know (GO TO Q25 THIS PAGE)
IF YES: I am going to read you a list of types of healthcare occupations. Please tell me which types you have prepared for when taking those classes. Choose all that apply.
Administrative (such as Medical Records and Health Information Technicians)
Technical (such as Medical and Clinical Laboratory Technicians)
Direct personal care (such as Home Health Aids or Certified Nursing Assistants)
Other, Please specify: _____________________________________________
REFUSED
DON’T KNOW
In the next set of questions we are interested the highest level of education you have completed as of right now. I will first ask about the highest academic degree and then I will ask about the highest occupational training.
As of right now, what is the highest degree or level of regular academic education that you have completed?
Grade 1 through 12 (no high school degree/GED)
High school diploma
GED or alternative credential
Some college credit but less than one year of college credit
One or more years of college credit, but no degree
Associate’s degree
Bachelor’s degree or above
REFUSED
DON’T KNOW
As of right now, what is the highest level of occupational training that you have completed?
No formal training (GO TO INSTRUCTION BELOW Q25bi NEXT PAGE)
Some non-degree coursework or training, but no professional, state, or industry certificate, license, or credential (GO TO INSTRUCTION BELOW Q25bi NEXT PAGE)
A professional, state, or industry certificate, license, or credential (PROBE: A professional certification or license shows you are qualified to perform a specific job like Licensed Realtor, Certified Medical Assistant, Certified Construction Manager, or an IT certification) (ASK Q25bi BELOW)
Refused
Don’t know
What type of professional, state, or industry certificate, license, or credential did you receive? (RECORD VERBATIM) ________________________________________________
IF ANSWERED “YES” TO Q1, CONTINUE.
IF DID NOT ANSWER “YES” TO Q1 (no training since RAD), GO TO INSTRUCTION ABOVE Q28 p.16.
Services and Assistance Received
In the next set of questions we are interested in the types of services and assistance you may have received since [RAD].
We will start with financial assistance. We are interested in helping you may have received paying for school-related expenses—such as tuition, books, and lab, certification or exam fees—or living expenses—such as rent, food, child care, and transportation while you studied.
I’m going to read a list of funding sources of that you might have used to pay for these school or living expenses. For each item, please tell me if the funding source helped pay for these expenses since [RAD].
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Yes |
No |
Don’t know |
Refused |
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IF ANSWERED “YES” IN ANY ITEM IN Q26a–l, CONTINUE.
IF DID NOT ANSWER “YES” IN ANY ITEM IN Q26a–l, GO TO Q27 p.15.
For each source you named, I am now going to ask which types of expenses were paid by the source.
IF Q26a “YES”: Did your own earnings help pay for:
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Yes |
No |
Don’t know |
Refused |
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IF Q26b “YES”: Did your spouse/partner’s earnings help pay for:
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Yes |
No |
Don’t know |
Refused |
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IF Q26c “YES”: Did your own or your spouse/partner’s savings help pay for:
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Yes |
No |
Don’t know |
Refused |
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IF Q26d “YES”: Did the financial help from your parent or other family member help pay for:
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Yes |
No |
Don’t know |
Refused |
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IF Q26e “YES”: Did the loans in your name help pay for:
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Yes |
No |
Don’t know |
Refused |
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IF Q26f “YES”: Did the loans in your parents’ name help pay for:
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Yes |
No |
Don’t know |
Refused |
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IF Q26g “YES”: Did the Pell grant or other government grant or scholarship—not counting loans that you have to pay back help pay for:
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Yes |
No |
Don’t know |
Refused |
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IF Q26h “YES”: Did the grant or scholarship from any non-government source help pay for:
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Yes |
No |
Don’t know |
Refused |
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IF Q26i “YES”: Did the financial support from your employer help pay for:
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Yes |
No |
Don’t know |
Refused |
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IF Q26j “YES”: Did the funds from a one-stop career center or state unemployment/employment office help pay for:
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Yes |
No |
Don’t know |
Refused |
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IF Q26k “YES”: Did the financial support from a school help pay for:
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Yes |
No |
Don’t know |
Refused |
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IF Q26l “YES”: Did the [OTHER SOURCE SPECIFIED IN Q26l] help pay for:
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Yes |
No |
Don’t know |
Refused |
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IF ANSWERED “YES” IN ANY ITEM IN Q26g–l, CONTINUE.
IF DID NOT ANSWER “YES” IN ANY ITEM IN Q26g–l, GO TO Q27 THIS PAGE.
In your opinion, how helpful have HPOG staff been in helping you access these sources of funding that can help pay for school expenses, such as tuition, books, and lab or exam fees? Would you say the HPOG staff have been…
Very helpful
Somewhat helpful
Not at all helpful
Don’t know
Refused
In your opinion, how helpful have HPOG staff been in helping you access these sources of funding that can help pay for living expenses, such as rent, food, child care, and transportation while you studied? Would you say the HPOG staff have been…
Very helpful
Somewhat helpful
Not at all helpful
Don’t know
Refused
How difficult would you say it has been to obtain enough financial support for school? Would you say that it has been very difficult, somewhat difficult, or not very difficult to obtain enough financial support for school?
VERY DIFFICULT
SOMEWHAT DIFFICULT
NOT VERY DIFFICULT
REFUSED
DON’T KNOW
In the next set of questions we are interested in the types of services other than financial assistance that you may have received since [RAD].
I’m going to read a list of types of services and assistance. Please let me know if you have received any of the following since [RAD]. Since [RAD], have you received [SERVICE FROM BELOW] from any source?
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Yes |
No |
Don’t know |
Refused |
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IF ANSWERED “YES” IN ANY ITEM FROM Q28a–k, CONTINUE.
IF DID NOT ANSWER “YES” IN ANY ITEM FROM Q28a-k, GO TO INSTRUCTIONS BELOW Q27xii, p. 19.
For each support service you named, I am now going to ask how many times you received the service since [RAD].
IF Q31a YES: About how many times did you receive academic advising?
1-2
3-4
5-6
7-8
9+
REFUSED
DON’T KNOW
IF Q31b YES: About how many times did you receive financial aid advising?
1-2
3-4
5-6
7-8
9+
REFUSED
DON’T KNOW
IF Q31c YES: About how many times did you receive tutoring?
1-2
3-4
5-6
7-8
9+
REFUSED
DON’T KNOW
IF Q31d YES: About how many times did you receive career counseling?
1-2
3-4
5-6
7-8
9+
REFUSED
DON’T KNOW
IF Q31e YES: About how many times did you receive job search or placement assistance?
1-2
3-4
5-6
7-8
9+
REFUSED
DON’T KNOW
IF Q31f YES: About how many times did you receive help arranging for supports or case management?
1-2
3-4
5-6
7-8
9+
REFUSED
DON’T KNOW
IF Q31g YES: About how many times have you taken comprehensive assessments?
1-2
3-4
5-6
7-8
9+
REFUSED
DON’T KNOW
IF Q31h YES: About how many times did you receive personal counseling?
1-2
3-4
5-6
7-8
9+
REFUSED
DON’T KNOW
IF Q31i YES: About how many times did you met with peer support groups?
1-2
3-4
5-6
7-8
9+
REFUSED
DON’T KNOW
IF Q31j YES: About how many times did you receive emergency assistance?
1-2
3-4
5-6
7-8
9+
REFUSED
DON’T KNOW
IF Q31k YES: About how many times did you receive incentives?
1-2
3-4
5-6
7-8
9+
REFUSED
DON’T KNOW
In your opinion, how helpful have HPOG staff been in providing or helping you access these support services? Would you say the HPOG staff have helped ….
A great deal
Some
Not at all
REFUSED
DON’T KNOW
IF DID NOT ANSWER “YES” TO Q1 (no training since RAD), GO TO EDUCATION GOALS SECTION p.21.
IF ANSWERED “YES” TO Q1, CONTINUE.
Now I’m going to ask you questions about your overall training experience since [RAD].
During your overall training experience since [RAD], have you been offered any of the following opportunities for direct experiences with occupations related to your studies or career goals?
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Yes |
No |
Don’t know |
Refused |
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IF DID NOT ANSWER “YES” IN ANY ITEM FROM Q29a–f, GO TO Q30 NEXT PAGE.
IF ANSWERED “YES” IN ANY ITEM FROM Q29a–f, CONTINUE.
In your opinion, how helpful have HPOG staff been in providing or helping you access these kinds of opportunities for direct experiences with occupations related to your studies or career goals? Would you say the HPOG staff have been …
Very helpful
Somewhat helpful
Not at all helpful
Refused
Don’t know
Think about all of the classes you have taken and all of the supports you received since [RAD]. In general, how satisfied were you with your overall training experience? Would you say you were …
Very satisfied
Somewhat satisfied
Not satisfied
Refused
Don’t know
Since [RAD], how much emphasis has there been on being part of a community with other students, instructors, and staff? Would you say a great deal, some, or none?
A GREAT DEAL
SOME
NONE
REFUSED
DON’T KNOW
Education Goals
Now I’d like to talk to you a bit about your education goals.
IF ANSWERED “NO” TO Q1, (no training since RA) CONTINUE.
IF ANSWERED “YES” TO Q1 (training since RA), GO TO INSTRUCTIONS ABOVE Q33 NEXT PAGE.
Can you tell me the main reason why you have not enrolled in school since [RAD]?
DO NOT READ LIST, RECORD FULL ANSWER AND THEN BACKFILL ONE RESPONSE
You don’t feel you need more education right now?
You are waiting to apply for a particular program?
You aren’t sure what would be the best program for you?
You don’t think you have strong enough academic skills/credentials?
You don’t have enough time due to work?
You don’t have enough time due to family responsibilities?
You don’t think you could get enough financial aid to afford to go?
You haven’t been able to get into the kind of program you wanted?
Some other reason? Please specify: ________________________
Refused (GO TO Q34 NEXT PAGE)
Don’t know (GO TO Q34 NEXT PAGE)
Are there other important reasons why you have not enrolled in school since [RAD]?
Yes (CONTINUE)
No (GO TO Q34 NEXT PAGE)
Refused (GO TO Q34 NEXT PAGE)
Don’t know (GO TO Q34 NEXT PAGE)
What are the other important reasons why you have not enrolled in school since [RAD]?
DO NOT READ LIST, RECORD FULL ANSWER AND THEN BACKFILL ONE RESPONSE
You don’t feel you need more education right now
You are waiting to apply for a particular program
You aren’t sure what would be the best program for you
You don’t think you have strong enough academic skills/credentials
You don’t have enough time due to work
You don’t have enough time due to family responsibilities
You don’t think you could get enough financial aid to afford to go
You haven’t been able to get into the kind of program you wanted
Other (please specify: ____________________ )
Refused
Don’t know
IF ANSERED “NO” TO Q1a (not currently enrolled), CONTINUE.
IF ANSWERED “YES” TO Q1a (currently enrolled), GO TO Q34 THIS PAGE
IF NOT CURRENTLY ENROLLED: Are you planning to go back to school at some point?
YES
NO
REFUSED
DON’T KNOW
In the next set of questions we are interested the highest level of education you eventually expect to complete. I will first ask about the highest academic degree and then I will ask about the highest level of occupational training.
What is the highest level of regular academic education that you eventually expect to complete?
Grades 1-12 (no high school degree/GED)
High school diploma
GED or alternative credential
Some college credit but less than one year of college credit
One or more years of college credit, but no degree
Associate’s degree
Bachelor’s degree
Graduate degree
REFUSED
DON’T KNOW
What is the highest level of occupational training that you eventually expect to complete?
No formal training
Some non-degree coursework or training, but no professional, state, or industry certificate, license, or credential.
A professional, state, or industry certificate, license, or credential. PROBE: A professional certification or license shows you are qualified to perform a specific job like Licensed Realtor, Certified Medical Assistant, Certified Construction Manager, or an IT certification.
REFUSED
DON’T KNOW
How much do you agree or disagree with the following statement: I am making progress towards my long-range educational goals? Would you say you strongly agree, somewhat agree, somewhat disagree, strongly disagree?
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
REFUSED
DON’T KNOW
Healthcare and Employment Experience
This next set of questions, I’d like to ask you about your current employment and healthcare experiences. I’ll start with questions about your current employment.
Are you currently working at a job for pay?
YES (ASK CONTINUE)
NO (GO TO Q37 p.25)
REFUSED (GO TO Q37 p.25)
DON’T KNOW (GO TO Q37 p.25)
How many hours per week on average are you currently working? Include all jobs if you have more than one job.
___ ___ ___ number of hours
Refused
Don’t know
About how much do you typically earn per hour before taxes in your current job? Answer for your main job if more than one.
$___ ___ ___ . ___ ___ per hour (GO TO Q36c THIS PAGE)
Refused (CONTINUE)
Don’t know (GO TO Q36c THIS PAGE)
[IF R DOESN’T KNOW HOURLY RATE]: Can you tell me how much you earned for some other time period besides hourly, such as per day, per week, every two weeks, or month?
$ ___ ___ ___ . ___ ___ PER DAY
$ ___ ___ ___ . ___ ___ PER WEEK
$ ___ ___ ___ . ___ ___ EVERY 2 WEEKS/TWICE A MONTH
$ ___ ___ ___ . ___ ___ EVERY MONTH
$ ___ ___ ___ . ___ ___ PER JOB/PER PIECE
$ ___ ___ ___. ___ ___ PER COMMISSION
$ ___ ___ ___ . ___ ___ ANNUALLY
Do you work for a healthcare employer?
YES (GO TO Q36d NEXT PAGE)
NO (ASK Q36di BELOW)
REFUSED (ASK Q36di BELOW)
DON’T KNOW (ASK Q36di BELOW)
Have you worked for a healthcare employer since [RAD]?
Yes
No
Refused
Don’t know
Are you employed in a healthcare job?
YES (GO TO Q36dii THIS PAGE)
NO (ASK Q36di BELOW)
REFUSED (ASK Q36di BELOW)
DON’T KNOW (ASK Q36di BELOW)
Have you worked in a healthcare job since [RAD]?
Yes (ASK Q36dii BELOW)
No (GO TO Q36diii THIS PAGE)
Refused (GO TO Q36diii THIS PAGE)
Don’t know (GO TO Q36diii THIS PAGE)
I am going to read you a list of types of healthcare occupations. Please tell me which type best describes the healthcare jobs you have had since [RAD]. (Choose all that apply if you have had more than one healthcare job since [RAD].):
Administrative (such as Medical Records and Health Information Technicians)
Technical (such as Medical and Clinical Laboratory Technicians)
Direct personal care (such as Home Health Aids or Certified Nursing Assistants)
Other, Please specify
REFUSED
DON’T KNOW
GO TO Q36e, THIS PAGE
IF DID NOT WORK IN HEALTHCARE SINCE RAD: What kind of work do you do in your current job, that is, what is your occupation? If you have more than one job, please answer for your main job.
__________________________________________________________________
Refused
Don’t know
What is your current job title? If you have more than one job, please answer for your main job.
________________________________________________________________________
Refused
Don’t know
At your current job, does your employer offer health insurance, regardless of whether you take it from them?
YES (GO TO Q36fi BELOW)
NO (GO TO Q36fii THIS PAGE)
REFUSED (GO TO Q36fii THIS PAGE)
DON’T KNOW (GO TO Q36fii THIS PAGE)
IF YES INSURANCE: Do you receive insurance through your employer?
YES (GO TO CAREER GOALS SECTION p.28)
NO (GO TO Q36fii BELOW)
REFUSED (GO TO Q36fii BELOW)
DON’T KNOW (GO TO Q36fii BELOW)
IF NO EMPLOYER INSURANCE: Do you receive insurance from another source?
YES (GO TO CAREER GOALS SECTION p.28)
NO (GO TO CAREER GOALS SECTION p.28)
REFUSED (GO TO CAREER GOALS SECTION p.28)
DON’T KNOW (GO TO CAREER GOALS SECTION p.28)
IF 36 “NO” (NOT EMPLOYED): Have you worked at a job for pay since [RAD]?
Yes (CONTINUE)
No (GO TO CAREER GOALS SECTION p.28)
Refused (GO TO CAREER GOALS SECTION p.28)
Don’t know (GO TO CAREER GOALS SECTION p.28)
How many hours per week on average were you working at your most recent job? Include all jobs at that time if you had more than one job.
___ ___ ___ number of hours
Refused
Don’t know
About how much did you typically earn per hour before taxes in your most recent job? If you had more than one job, please answer for your main job.
$___ ______ ___ . ___ ___ per hour (GO TO Q37c NEXT PAGE)
Refused (GO TO Q37c NEXT PAGE)
Don’t know (ASK Q37bi BELOW)
IF DOESN’T KNOW HOURLY RATE: Can you tell me how much you earned for some other time period besides hourly, such as per day, per week, every two weeks, or month?
$ ___ ___ ______ ___ PER DAY
$ ___ ___ ___ ___ ___ PER WEEK
$ ___ ___ ___ ___ ___ EVERY 2 WEEKS/TWICE A MONTH
$ ___ ___ ______ ___ EVERY MONTH
$ ___ ___ ___ ___ ___ PER JOB/PER PIECE
$ ___ ___ ___ ___ ___ PER COMMISSION
$ ___ ___ ______ ___ ANNUALLY
Have you worked for a healthcare employer since [RAD]?
Yes
No
Refused
Don’t know
Have you worked in a healthcare job since [RAD]?
Yes (ASK Q37di BELOW)
No (GO TO Q37dii THIS PAGE)
Don’t know (GO TO Q37dii THIS PAGE)
Refused (GO TO Q37dii THIS PAGE)
IF YES: I am going to read you a list of types of healthcare occupations. Please tell me which type best describes the healthcare jobs you have had since [RAD]. Choose all that apply if you have had more than one healthcare job since [RAD].
Administrative (such as Medical Records and Health Information Technicians)
Technical (such as Medical and Clinical Laboratory Technicians)
Direct personal care (such as Home Health Aids or Certified Nursing Assistants)
Other (Please specify: ________________________________________)
Refused
Don’t know
GO TO Q37e, THIS PAGE
IF HAVE NOT WORKED IN HEALTHCARE SINCE RAD: What kind of work did you do in your most recent job, that is, what was your occupation? If you had more than one job, please answer for your main job.
_______________________________________________
Refused
Don’t know
What was your job title at your most recent job? If you had more than one job, please answer for your main job.
_______________________________________________
Refused
Don’t know
At your most recent job, did your employer offer health insurance, regardless of whether you took it from them?
Yes (GO TO Q37fi NEXT PAGE)
No (GO TO Q37fii NEXT PAGE)
Refused (GO TO Q37fii NEXT PAGE)
Don’t know (GO TO Q37fii NEXT PAGE)
IF YES: Did you receive insurance through your employer?
Yes (GO TO CAREER GOALS SECTION NEXT PAGE)
No (GO TO Q37gii BELOW)
Refused (GO TO Q37gii BELOW)
Don’t know (GO TO Q37gii BELOW)
IF NO: Did you receive insurance from another source?
Yes
No
Refused
Don’t know
Career Goals
Now I’d like to talk to you a bit about your career goals.
I am going to read you two statements. Please tell me whether you would you say you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with the following statements:
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Strongly agree |
Somewhat agree |
Somewhat disagree |
Strongly disagree |
Don’t know |
Refused |
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Do you expect to be working for pay in the next six months?
Yes (CONTINUE)
No (GO TO Q40 THIS PAGE)
REFUSED (GO TO Q40 THIS PAGE)
DON’T KNOW (GO TO Q40 THIS PAGE)
How many hours do you expect to be working in a typical week?
__ __ __ number of hours
Refused
Don’t know
Do you expect to be working in a healthcare job or for a healthcare employer?
Yes
No
REFUSED
DON’T KNOW
I am going to read you two statements about your work preferences. Please tell me whether you would say you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with the following statements:
[IF ANSWERED “YES” IN Q36 (currently working): If I was not currently working, I would/[If ANSWERED “NO” IN Q36 (not currently working): I will] take any job even if the pay is low.
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
Refused
Don’t know
[IF ANSWERED “YES” IN Q36 (currently working): If I was not currently working, I would]/[If ANSWERED “NO” IN Q36 (not currently working): I] want only the kind of job that is related to my training/education?
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
Refused
Don’t know
How much must a job pay per hour for it to make sense for you to take it?
$___ ___ ___ . ___ ___ per hour
Refused
Don’t know
I am going to read you a list of statements. Please tell me how important is each of the following to you in your life (not, somewhat, or very)?
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Somewhat important |
Not important |
Don’t know |
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Knowledge of Career Opportunities in Healthcare
Now I’d like to get a sense of your understanding of healthcare related career opportunities in your local area.
Would you say you know the kind of careers that are available in healthcare in your local area?
Yes (ASK Q43a BELOW)
No (GO TO INSTRUCTIONS BELOW Q43a NEXT PAGE)
Refused (GO TO INSTRUCTIONS BELOW Q43a NEXT PAGE)
Don’t know (GO TO INSTRUCTIONS BELOW Q43a NEXT PAGE)
What type of credential or degree do you need to qualify for a job like the kinds that you just reported to be available in your local area? Choose one.
Certificate, license, or credential
Associate’s Degree
Bachelor’s degree or higher
Work experience/on-the-job training
Other reason (please specify: ____________________________)
IF ANSWERED “NO” IN Q36 (not currently working), GO TO BARRIERS IN EMPLOYMENT SECTION p.32.
IF ANSWERED “YES” IN Q36 (currently working), CONTINUE.
In your current job, are there promotion opportunities?
Yes (ASK Q44a BELOW)
No (GO TO BARRIERS IN EMPLOYMENT SECTION p.32)
REFUSED (GO TO BARRIERS IN EMPLOYMENT SECTION p.32)
DON’T KNOW (GO TO BARRIERS IN EMPLOYMENT SECTION p.32)
IF YES: Would you need additional education or training to be promoted?
Yes (ASK Q44ai BELOW)
No (GO TO BARRIERS IN EMPLOYMENT SECTION p.32)
REFUSED (GO TO BARRIERS IN EMPLOYMENT SECTION p.32)
DON’T KNOW (GO TO BARRIERS IN EMPLOYMENT SECTION p.32)
What type of credential or degree do you need to be promoted? Choose one.
Certificate, license, or credential
Associate’s Degree
Bachelor’s degree or higher
Work experience/on-the-job training
Other reason (specify)
Refused (GO TO BARRIERS IN EMPLOYMENT SECTION p.32)
Don’t know (GO TO BARRIERS IN EMPLOYMENT SECTION p.32)
About how long would it take you to earn the credential or degree?
0-3 months
4-6 months
6 months to a year
More than a year
Refused
Don’t know
Barriers to Employment
There are many things that could affect a person’s ability to go to school or work, search for jobs, and manage family responsibilities. The next few questions are about these situations
In the past 12 months, how often did each of the following situations interfere with your school, work, job search, or family responsibilities:
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Sometimes |
Very often |
Don’t know |
Refused |
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How difficult do you think it is to get a job in your chosen field or occupation?
Not difficult (GO TO Perceived Self-Efficacy and Motivation SECTION NEXT PAGE)
Somewhat difficult (CONTINUE)
Very difficult (CONTINUE)
Refused (CONTINUE)
Don’t know (CONTINUE)
Do you think any of the following situations make it difficult? Choose all that apply.
Child care arrangements?
Transportation?
Alcohol or drug use?
An illness or health condition?
Lack of required education?
Lack of experience?
Lack of job openings?
Other (Please specify)
Refused
Don’t know
Perceived Self-Efficacy and Motivation
In general, some people have an easier or harder time with these kinds of problems or difficulties. How true do you believe are the following statements: (1 = Not at all true, 2 = Somewhat true, 3 = Mostly true, 4 = Entirely true)
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Not at all true |
Somewhat true |
Mostly true |
Entirely true |
Don’t know |
Refused |
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Income and Household
Now I’d like to talk to you about your family and current household.
Besides you, who among the following live in your household at least half the time?
Your spouse
Yes (GO TO Q48c THIS PAGE)
No (ASK Q48b BELOW)
Refused (ASK Q48b BELOW)
Don’t know (ASK Q48b BELOW)
IF NO SPOUSE: Your unmarried partner
Yes
No
Refused
Don’t know
Your [IF Q48b “YES” (UNMARRIED PARTNER): or your partner’s] biological, adopted, or step children aged 17 or younger
Yes
No
Refused
Don’t know
Other relatives aged 17 or younger such as younger siblings, nephews and nieces [IF Q48b “YES” (LIVES WITH PARTNER): of yours or your partner’s]
Yes
No
Refused
Don’t know
Your mother or father [IF Q48a “YES” (LIVES WITH SPOUSE): or your in-laws)/IF Q48b “YES” (LIVES WITH PARTNER): or your partner’s mother or father]
Yes
No
Refused
Don’t know
Your adult children or other relatives aged 18 or older [IF Q48b “YES” (LIVES WITH PARTNER): or those of your partner]
Yes
No
Refused
Don’t know
Anyone else aged 17 or younger such as children of friends or housemates
Yes
No
Refused
Don’t know
Anyone else aged 18 or older such as friends or housemates
Yes
No
Refused
Don’t know
IF ANSWERED “NO” IN Q48c, Q48d, AND Q48g (NO CHILDREN 17 OR YOUNGER), GO TO INSTRUCTIONS BELOW Q50 THIS PAGE.
IF ANSWERED “YES” IN Q48c, Q48d, AND Q48g (CHILDREN 17 OR YOUNGER), CONTINUE.
How many persons aged 17 or younger live with you at least half the time? Include biological, adopted, foster, step, and any other children, as well as younger siblings.
___ ___ number of persons 17 or younger
Refused
Don’t know
For how many of these children are you or your [IF 48a “YES” MARRIED: spouse/[IF 48b “YES” UNMARRIED PARTNER: partner] the legal guardian?
___ ___ number of children
Refused
Don’t know
Now, I am going to ask you some questions about your personal and household income in (PRIOR MONTH). I will ask you first about your personal income then I will ask about the income of other members of your household. Again, I want to assure you that none of your answers will be discussed with anyone.
Did you personally have income or benefits from any of the following sources in [PRIOR MONTH]?
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Yes |
No |
Don’t know |
Refused |
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IF ANSWERED “YES” IN Q51j: About how much did you receive in job earnings in [PRIOR MONTH]?
$___ ___ ___ ___ . ___ ___
Thinking of all of the income you received last month, what was your total personal income in (PRIOR MONTH)? Please include your job earnings, benefits, and any other types of income except for tax refunds in your answer. [EXPLAIN IF NECESSARY: PLEASE DO NOT INCLUDE ANY REFUNDS OF FEDERAL, STATE OR LOCAL INCOME TAXES PAID IN PAST YEARS].
$ ____________________ (GO TO INSTRUCTIONS BELOW Q53a NEXT PAGE)
Refused (CONTINUE)
Don’t know (CONTINUE)
Would you say your total personal income in [PRIOR MONTH] was…
None ($0)
$500 or less
$501-$1000
$1001-$1500
$1501-$2000
$2001-$2500
$2501 or more
Refused
Don’t know
IF ANSWERED “NO” TO ALL ITEMS IN Q48a—Q48h (NO OTHER HOUSEHOLD MEMEBRS), GO TO CONTACT INFORMATION SECTION p.38.
IF ANSWERED “YES” TO ANY ITEM IN Q51a—Q51j (OTHER HOUSEHOLDMEMBERS), CONTINUE.
Now, let’s go through the same list of income sources for other household members who lived with you at least half the time last month. In [PRIOR MONTH] did anyone else in your household have income or benefits from any of the following sources?
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No |
Don’t know |
Refused |
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Thinking of all of the income received by you and the people in your household last month, what was your total income for everyone living together in your household in [PRIOR MONTH]? Please consider anyone who lived in your household for at least half of [PRIOR MONTH] when you answer this question. Please don’t include tax refunds in your answer. [EXPLAIN IF NECESSARY: PLEASE DO NOT INCLUDE ANY REFUNDS OF FEDERAL, STATE OR LOCAL INCOME TAXES PAID IN PAST YEARS].
$ __________________ (GO TO CONTACT INFORMATION SECTION NEXT PAGE)
Refused (CONTINUE)
Don’t know (CONTINUE)
Which of the following categories best describes your total household income? Please consider income received by anyone who lived in your household for at least half of [PRIOR MONTH] when you answer this question. Would you say your total household income in [PRIOR MONTH] was…
None ($0)
$500 or less
$501-$1000
$1001-$1500
$1501-$2000
$2001-$2500
$2501 or more
Refused
Don’t know
Contact Information
Before we complete this portion of the interview, I would also like to make sure I have your contact information recorded correctly.
I have your name recorded as [FIRST MI LAST]. Is this still correct or have you changed your name?
YES, STILL CORRECT (GO TO Q56 THIS PAGE)
NO, NAME CHANGED
Your first name now?:
Your last name now?:
I have your address recorded as [STREET, APT, CITY, STATE, ZIP]. Is this still correct or have you moved?
YES, STILL CORRECT (GO TO Q57 THIS PAGE)
NO, MOVED
Refused
Don’t know
What is your new street address or PO box number?
Is there a complex or building name?
Is there an apartment number?
In what city?
In what state?
What is the zip code?
I have your primary phone number recorded as [xxx-xxx-xxxx]. Is this still correct or do you have a new primary phone number?
YES, STILL CORRECT (GO TO Q58 THIS PAGE)
NO, NEW NUMBER
Refused
Don’t know
IF YES: What is the new number, starting with the area code?
IF YES: Is that a home, cell, shelter, work, or other number?
Home
Cell
Shelter
Work
Other
I have your secondary phone number recorded as [xxx-xxx-xxxx]. Is this still correct or do you have a new secondary number?
YES, STILL CORRECT (GO TO Q59 NEXT PAGE)
NO, NEW NUMBER
What is the new number, starting with the area code?
Is that a home, cell, shelter, work, or other number?
Home
Cell
Shelter
Work
Other
Do you have another phone number where we can reach you? This can be your cell phone or work number.
YES (CONTINUE)
NO (GO TO Q60 THIS PAGE)
Refused (GO TO Q60 THIS PAGE)
Don’t know (GO TO Q60 THIS PAGE)
What is the number, starting with the area code?
Is that a home, cell, shelter, work, or other number?
Home
Cell
Shelter
Work
Other
IF CELL PHONE: Do we have your permission to contact you on that number via text message?
YES,
NO (SKIP TO Q60)
Refused
Don’t know
Do we have your permission to contact you on that number via automated text message? An automated text message is a prewritten message that is sent at a later date. Examples of an automated text message may be one that reminds you to complete a form or call to set up an appointment.
REPEAT Q59 UNTIL ALL PHONE NUMBERS ARE RECORDED
I have your email address recorded as [xxx@xxx.xxx]. Is this still correct or do you have a new email address?
YES, CORRECT (GO TO Q61 THIS PAGE)
NO, NEW EMAIL
Refused
Don’t know
What is your new email address?
Do you have any other email addresses?
YES
NO (GO TO PARAGRAPH ABOVE Q62 THIS PAGE)
Refused (GO TO PARAGRAPH ABOVE Q62 THIS PAGE)
Don’t know (GO TO PARAGRAPH ABOVE Q62 THIS PAGE)
What is the additional email address?
REPEAT Q61 UNTIL ALL EMAIL ADDRESSES ARE RECORDED
Thank you very much for your time today. To help us be able to get back in touch with you in the future, we would like to review the names, telephone numbers and addresses of the two people you previously mentioned who will always know how to reach you. This information will be kept strictly private and will only be used if we are unable to contact you.
When you applied for [PROGRAM NAME] you said that [CONTACT #1] was a person who would always know where you are and how to reach you. Is [CONTACT#1] still a person who does not live with you and will always know how to contact you?
YES (VERIFY CONTACT INFORMATION)
NO (ASK Q62a NEXT PAGE)
Refused (ASK Q62a NEXT PAGE)
Don’t know (ASK Q62a NEXT PAGE)
Could you please tell me the name of a person who does not live with you and will always know how to contact you?
YES (ASK Q62ai BELOW)
NO (GO TO Q63 THIS PAGE)
Refused (GO TO Q63 THIS PAGE)
Don’t know (GO TO Q63 THIS PAGE)
IF YES:
What is his/her first name?
What is his/her middle name?
What is his/her last name?
Does his/her name have a suffix?
What is the street address or PO box number?
Is there a complex or building name?
Is there an apartment number?
In what city?
In what state?
What is the zip code?
What is [his/her] home phone number, starting with the area code?
What is [his/her] cell phone number, starting with the area code?
What is [his/her] email address?
What is [his/her] relationship to you?
Friend
Relative
Other (Specify:)
Refused
Do not know
When you applied for [PROGRAM NAME] you said that [CONTACT #2] was a person who would always know where you are and how to reach you. Is [CONTACT#2] still a person who does not live with you and will always know how to contact you?
YES (VERIFY CONTACT INFORMATION)
NO (ASK Q63a THIS PAGE)
Refused (ASK 63a THIS PAGE)
Don’t know (ASK 63a THIS PAGE)
Could you please tell me the name of another person who does not live with you and will always know how to contact you?
YES (ASK Q63ai BELOW)
NO (GO TO INSTRUCTIONS BELOW Q63xiv NEXT PAGE)
Refused (GO TO INSTRUCTIONS BELOW Q63xiv NEXT PAGE)
Don’t know (GO TO INSTRUCTIONS BELOW Q63xiv NEXT PAGE)
IF YES:
What is his/her first name?
What is his/her middle name?
What is his/her last name?
Does his/her name have a suffix?
What is the street address or PO box number?
Is there a complex or building name?
Is there an apartment number?
In what city?
In what state?
What is the zip code?
What is [his/her] home phone number, starting with the area code?
What is [his/her] cell phone number, starting with the area code?
What is [his/her] email address?
What is [his/her] relationship to you?
Friend
Relative
Other (Specify:)
Refused
Do not know
Thank you very much for your time today.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Jennifer Lewis |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |