In-Person Materials

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National Mental Health Study (NMHS) Field Test

In-Person Materials

OMB: 0930-0380

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National Mental Health Study Field Test,
Supporting Statement
Attachment F – Appointment Card

Interview Appointment

Just a reminder: I appreciate you taking time for this important study

and look forward to our appointment to complete the interview.
You will receive $40 in cash upon completion of the interview!

I have you scheduled for the following:

Day: _____________ Date: _____________ Time: ___________

Interviewer: ___________________________________________

RTI International
Research Triangle Park, NC 27709-2194

Interview Appointment

Just a reminder: I appreciate you taking time for this important study

and look forward to our appointment to complete the interview.
You will receive $40 in cash upon completion of the interview!

I have you scheduled for the following:

Day: _____________ Date: _____________ Time: ___________

Interviewer: ___________________________________________

RTI International
Research Triangle Park, NC 27709-2194

National Mental Health Study Field Test,
Supporting Statement
Attachment H – Introduction and Informed
Consent Scripts

Introduction and Informed Consent
Adult
INTRODUCE YOURSELF AND STUDY AS NECESSARY: Hello, I’m ________, and
I’m working on a nationwide study sponsored by the U.S. Department of Health and
Human Services. You should have received a letter about this study. (SHOW LEAD
LETTER, IF NECESSARY.)
READ THE INFORMATION IN THE BOX BELOW
BEFORE STARTING EVERY INTERVIEW
This year, we are interviewing about 1,200 people across the nation. You have been
randomly chosen to take part. You will represent over 270,000 other people who are similar
to you. You may choose not to take part in this study, but no one else can take your place.
We will give you $40 when you finish the interview.
GIVE STUDY DESCRIPTION TO R IF YOU HAVE NOT ALREADY DONE SO.
This study asks about a variety of mental health conditions such as depression and anxiety
and other health related topics such as treatment and healthcare experiences. There are
additional questions about your health, relationships, sexual behaviors, substance use, selfharm and experiences with and exposure to crime and violence. It takes about an hour.
You will answer most of the questions on the computer, so I will not see your answers. We
are only interested in the combined responses from all 1,200 people, not just one person’s
answers. This is why we keep your answers separate from your name and address. RTI
may contact you by phone or mail to ask a few questions about the quality of my work. This
is why we ask for your phone number and current address at the end of the interview. We
may also ask you to consider participating in future studies. When we contact you in the
future, you can decide whether or not you want to be in the study.
While the interview has some personal questions, federal law keeps your answers private.
We hope that protecting your privacy will help you to give accurate answers. The only
exceptions to this promise of confidentiality are if you tell me that you intend to seriously harm
yourself or someone else. In these situations, I need to tell my supervisor.
Your participation is voluntary. You may consider some of the questions to be sensitive in
nature and some of the questions may also make you feel certain emotions, such as
sadness. Remember that you can refuse to answer any questions that you do not want to
answer, and you can stop the interview at any time. If you become upset at any time during
the interview and wish to speak to a mental health professional about how you are feeling, I
will provide you with toll-free hotline numbers.
If it is all right with you, let’s get started. Can we find a private place to complete the
interview?
1

Parental Consent to Interview Respondents Age 13-17
INTRODUCE YOURSELF AND STUDY AS NECESSARY: Hello, I’m ________, and I’m working
on a nationwide study sponsored by the U.S. Department of Health and Human Services. You
should have received a letter about this study. (SHOW LEAD LETTER, IF NECESSARY.) Are
you [ADOLESCENT’S] parent or legal guardian? [IF RESPONDENT SAYS ‘NO’ ASK] Do you
have the legal authority to say whether or not [ADOLESCENT] could participate in this study?
[If not, interviewer should ask to speak to the parent or guardian who has legal custody].

Your (AGE) year-old adolescent has been selected to be in this study. Your adolescent’s
participation is voluntary.
This interview asks about a variety of mental health issues that young people may face, such as
depression or sadness, anxiety and fears, attention and concentration difficulties, and other health
related issues, like substance use, sexual behavior, self-harm, and healthcare services. The
interview includes questions about your adolescent’s experiences at home and in school, including
his or her experience with various forms of discipline as well as experience with and exposure to
crime and violence. The interview also asks your adolescent about the mental health, substance
use, suicide and criminal justice involvement of parents and other family members. This study
includes adolescents who do and do not have mental health issues.
All of your adolescent’s answers will be confidential and used only for statistical purposes. Since
your adolescent will answer most of the questions on the computer, I will never see the answers,
and you are not allowed to see them either. In addition, your adolescent needs to do the interview
in a private setting. The interview takes about an hour.
The answers that your adolescent enters into the computer will be kept completely private. There
are two things that I cannot keep private. If your adolescent chooses to say something to me while
taking the computer-based interview that suggests he or she wants to seriously harm him or herself
or is at risk of serious harm by an adult, I may need to call someone who can help. In this case, I
will also ask your adolescent’s permission to speak with you about the situation.
Your adolescent may consider some of the questions to be sensitive in nature and some of the
questions may also make your adolescent feel certain emotions, such as sadness. Your adolescent
can refuse to answer any questions that s/he does not want to answer, and your adolescent can
stop the interview at any time. If your adolescent becomes upset at any time during the interview
and wishes to speak to a mental health professional about how s/he is feeling, I will provide your
adolescent with toll-free hotline numbers.
We may also ask your adolescent to consider participating in future studies. When we contact you
in the future, you can decide whether or not you want your adolescent to be in the study.
If it is all right with you, I will ask your adolescent if he or she would like to participate in the
interview.
2

FIRST, READ SCRIPT BELOW AND OBTAIN PERMISSION FROM THE
PARENT/LEGAL GUARDIAN

ONCE PARENTAL PERMISSION HAS BEEN GIVEN, CONFIRM THE
PARENT/LEGAL GUARDIAN OR ANOTHER ADULT WILL BE PRESENT FOR THE
DURATION OF THE INTERVIEW. THEN, READ THE INFORMATION IN THE BOX
BELOW BEFORE STARTING EVERY INTERVIEW WITH A 13-17 YEAR OLD

Informed Assent for Adolescents 13-17 Years Old
This year, we are interviewing about 1,200 people across the nation. You have been randomly
chosen to take part. You will represent over 73,000 young people in this country who are similar
to you. You may choose not to take part in this study, but no one else can take your place. We
will give you $40 when you finish the interview.
GIVE STUDY DESCRIPTION TO R IF YOU HAVE NOT ALREADY DONE SO.
This study asks about a variety of mental health issues that young people may face, such as
depression or sadness, anxiety and fears, attention and concentration difficulties and other health
related issues, such as treatment and healthcare experiences. The interview will also ask you
about your health, substance use, sexual behaviors, self-harm and experiences with and
exposure to crime and violence. This study includes young people who do and do not have
mental health issues.
Your parent said that you can take part in this interview if you want to. It is your choice whether
you take part in this study. It takes about an hour. You will answer most of the questions on the
computer, so I will not see your answers. Your answers will never be seen by either your parents
or your school. We are only interested in the combined responses from all 1,200 people, not just
one person’s answers. This is why we keep your answers separate from your name and address.
RTI may contact you by phone or mail to ask a few questions about the quality of my work. This
is why we ask for your phone number and current address at the end of the interview. We may
also ask you to consider participating in future studies. When we contact you in the future, you
can decide whether or not you want to be in the study.
While the interview has some personal questions, federal law keeps your answers private. We
hope that protecting your privacy will help you to give accurate answers. You can quit the
interview at any time and you can refuse to answer any questions. There are two things that I
cannot keep private. If you tell me that you plan to seriously harm yourself or that you are at
serious risk of being harmed by an adult, I may need to call someone who can help.
Your participation is voluntary. You may consider some of the questions to be sensitive in nature
and some of the questions may also make you feel certain emotions, such as sadness.
Remember that you can refuse to answer any questions that you do not want to answer, and you
can stop the interview at any time. If you become upset at any time during the interview and wish
to speak to a mental health counselor about how you are feeling, I will provide you with toll-free
hotline numbers.
Do you want to participate in this study?

National Mental Health Study Field Test,
Supporting Statement
Attachment T – Showcard Booklet

National Mental Health
Study
SHOWCARD BOOKLET

RTI INTERNATIONAL

RTI Telephone Numbers
Tech Support .......... (877) 677-2741
Headway ................ (800) 208-7043
To reach other RTI staff, call 1-800-848-4079 then ask the
operator for the employee with whom you wish to speak.
Website Addresses
RTI ......................... http://www.rti.org
SAMHSA ................. http://www.samhsa.gov
NIMH………………… http://www.nimh.nih.gov

Interview Troubleshooting Guide

To suppress a Hard Error involving two questions:
• Read the message box carefully.
–
–

–

If the first question listed is the one to be changed, press [ENTER].
If the second question listed is the one to be changed, press the down arrow to
highlight the second question, then press [ENTER].
In the rare event that neither question needs to be changed and the data entered
are correct, press [Tab] until the Suppress box is highlighted and press [ENTER],
then provide an explanation for why the error was suppressed.

To edit a lengthy response:

•

With the cursor in the answer field, press the Insert key [Ins]. Use the arrow keys to
move to the precise place within the answer field to edit or add to existing text. If
necessary, record additional text in a comment box, by pressing [F8].

To correct range errors:
•
•
•

For numerical questions, read the box carefully, making note of the expected range, if
provided in the message. Press [ENTER] to clear the error, then type a new answer
within range.
For pre-coded questions, read the message box carefully, then press [ENTER] to clear
the error. Type a new answer that corresponds with a pre-coded answer choice on the
screen.
For multiple choice questions (Code All That Apply), read the message box carefully, then
press [ENTER] to clear the error. Type a new answer that corresponds with a pre-coded
answer choice on the screen, pressing the [Space bar] between each response as needed.

To correct date errors:
•

Review the instructions on the screen to determine the date format for the question.
For “MM-DD-YYYY” format, the date must be entered with a 2-digit month and day and
4-digit year. For “MM-YYYY” format, the date must be entered with a 2-digit month and
4-digit year. Do not enter dashes or spaces—just the number including any leading
zeros for month or day.

If an R needs assistance with an ACASI question, provide the corresponding steps above
for the problem they are having. Take care not to view the screen while assisting the R, to
ensure the confidentiality of their answers. For additional details on entering CAI responses
and troubleshooting error messages, refer to Chapter 5 in your FI Computer Manual.

UNITED STATES DEPARTMENT OF HEALTH & HUMAN SERVICES
ROCKVILLE, MD 20857

[NAME County/Parish/District] Resident at:
1234 Main Street
Anywhere, XX 12345
Dear [NAME County/Parish/District] Resident:
The U.S. Department of Health and Human Services (DHHS) is conducting a study called the National Mental Health
Study. This study asks questions about mental health and other health-related topics. Knowledge gained from this study
will improve our ability to describe and understand mental health issues in the United States.
Your address was randomly chosen along with almost 3,600 others across the country. RTI International, a nonprofit
organization, was selected to conduct this study. Soon, an RTI interviewer will be in your neighborhood to give you more
information. When the interviewer arrives, please ask to see his or her personal identification card. An example of the ID
card is shown below.
First, the interviewer will ask a few general questions. In appreciation for the time taken to answer these screening
questions, the household member will receive [FILL: $5/$10] in cash. Then the interviewer may ask one or two
members of your household to complete an interview. It is possible that no one from your household will be chosen to be
interviewed. Every person who is chosen and completes the full interview will receive $40 in cash.
By Federal law*, the answers you give will be kept confidential and will be used only for statistical purposes.
This letter is addressed to “Resident” because your address was selected, and we do not know your name. Feel free to ask
the interviewer any questions you have about the study. More information is also available on the study website at:
https://www.nmhsweb.org, or you may contact us at [PHONE NUMBER FILL].
We may also ask you to consider participating in future studies. When we contact you in the future, you can decide
whether or not you want to participate.
Your help is very important to this study’s success. Thank you for your cooperation.
Sincerely,

Lisa J. Colpe, PhD, MPH
National Study Director, DHHS

Grace Medley
National Field Director, DHHS

Amy Kowalski
National Field Director, RTI

You will be contacted by:
___________________________________________
Interviewer Name

*Confidentiality protected by the Confidential Information Protection and Statistical Efficiency Act of 2002 (PL 107-347)
Authorized by the U.S. Congress as part of Section 505 of the Public Health Service Act (42 USC 290aa4)
Approved by Office of Management and Budget (OMB Approval No. UPDATE)

U.S. Department of Health and Human Services

NMHS Study
Description

The National Mental Health Study (NMHS) is a nationally representative study that will:
•
•

Examine the frequency of a variety of mental health conditions;
Investigate connections between mental health problems and treatment.

Knowledge gained from this study will improve our ability to describe and understand mental
health issues in the United States.
This study is sponsored by the Substance Abuse and Mental Health Services Administration
(SAMHSA) and the National Institute of Mental Health (NIMH), both part of the U.S.
Department of Health and Human Services.
Your address is one of several in this area randomly chosen for the NMHS. Your name and
address will never be connected to your answers. Also, federal law requires us to keep all of
your answers confidential. Any data that you provide will only be used by authorized
personnel for statistical purposes according to the Confidential Information Protection and
Statistical Efficiency Act of 2002.
The screening questions take just a few minutes. We will give you [FILL: $5/$10] when you
finish the screening. If anyone is chosen, the interview will take about an hour. You can
refuse to answer any questions, and you can quit at any time. Each person who is chosen
and completes the interview will receive $40 in cash.
If you have questions about the study, call the Project Representative at 1-800-XXX-XXXX. If
you have questions about your rights as a study participant, call RTI’s Office of Research
Protection at 1-866-214-2043 (a toll-free number). You can also visit our project website:
https://www.nmhsweb.org for more information. Thank you for your cooperation and time.

Lisa J. Colpe, Ph.D., MPH
National Study Director, DHHS

Grace Medley
National Field Director, DHHS

Your confidentiality is protected by the Confidential Information Protection and Statistical Efficiency Act of 2002
(CIPSEA, PL 107-347). Any project staff or authorized data user who violates CIPSEA may be subject to a jail term of up to 5
years, a fine of up to $250,000, or both.
NOTICE: Public reporting burden for this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, Paperwork Reduction Project (XXXX-XXXX); Room 15E57B;
5600 Fishers Lane, Rockville, MD 20857. 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 project is XXXX-XXXX, expiration date XX/XX/XX.

SHOWCARD 1

AMERICAN INDIAN OR ALASKA NATIVE

ASIAN

BLACK OR AFRICAN AMERICAN

NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER

WHITE

SHOWCARD 2
0

NO SCHOOLING COMPLETED

1ST GRADE COMPLETED

2ND GRADE COMPLETED

3RD GRADE COMPLETED

4TH GRADE COMPLETED

5TH GRADE COMPLETED

6TH GRADE COMPLETED

7TH GRADE COMPLETED

8TH GRADE COMPLETED

9TH GRADE COMPLETED

10TH GRADE COMPLETED

11TH GRADE COMPLETED

REGULAR HIGH SCHOOL DIPLOMA

12TH GRADE, NO DIPLOMA

GED CERTIFICATE OF HIGH SCHOOL
COMPLETION

SOME COLLEGE CREDIT, BUT NO DEGREE

ASSOCIATE’S DEGREE (FOR EXAMPLE, AA, AS)

BACHELOR’S DEGREE (FOR EXAMPLE, BA, BS)

MASTER’S DEGREE (FOR EXAMPLE, MA, MS,
MENG, M. ED, MSW, MBA)

DOCTORATE DEGREE (FOR EXAMPLE, PHD, EDD)

PROFESSIONAL DEGREE BEYOND A BACHELOR’S
DEGREE (FOR EXAMPLE, MD, DDS, DVM, LLB, JD)

SHOWCARD 3
1

SEPTEMBER 2001 OR LATER

AUGUST 1990 TO AUGUST 2001 (INCLUDING
PERSIAN GULF WAR)

MAY 1975 TO JULY 1990

MARCH 1961 TO APRIL 1975 (VIETNAM ERA)

FEBRUARY 1955 TO FEBRUARY 1961

JULY 1950 TO JANUARY 1955 (KOREAN
WAR)

JANUARY 1947 TO JUNE 1950

DECEMBER 1941 TO DECEMBER 1946
(WORLD WAR II)

NOVEMBER 1941 OR EARLIER

SHOWCARD 4
1
2
3
4
5
6
7

--------

ABILIFY
ABILIFY MAINTENA
ADDERAL
ADDERAL XR
ALPRAZOLAM
AMBIEN
AMITRIPTYLINE

8 -- AMPHETAMINE
9 -- ANAFRANIL
10 -- ARIPIPRAZOLE
11 -- ARMODAFINIL
12 -- ARTANE
13 -- ASENAPINE
14 -- ATIVAN
15
16
17
18

-----

ATOMOXETINE
BELSOMRA
BENZTROPINE
BRINTELLIX

19 -- BUDEPRION SR
20 -- BUDEPRION XL
21 -- BUPROPION

22
23
24
25
26
27
28
29

---------

BUSPAR
BUSPIRONE
CARBAMAZEPINE
CARBATROL
CATAPRES
CELEXA
CHLORDIAZEPOZIDE
CHLORPROMAZINE

30
31
32
33
34
35
36

--------

CITALOPRAM
CLOMIPRAMINE
CLONAZEPAM
CLONIDINE
CLOZAPINE
CLOZARIL
COGENTIN

37 -- CONCERTA
38-- CYMBALTA
39 -- CYTOMEL
40 -- DAYTRANA
41 -- DEPAKENE
42 -- DEPAKOTE
43 -- DEPAKOTE
SPRINKLES
44 -- DESOXYN
45 -- DESVENLAFAXINE
46 -- DESYREL
47 -- DEXEDRINE
48 -DEXMETHYLPHENIDATE
49 -DEXTROAMPHETAMINE
50 -DEXTROAMPHETAMINE/
AMPHETAMINE
51 -- DIAZEPAM
52 -- DIVALPROEX
53 -- DOXEPIN
54 -- DULOXETINE
55 -- EFFEXOR
56 -- ELAVIL
57 -- ESCITALOPRAM
58 -- ESKALITH

59
60
61
62
63
64
65

--------

66
67
68
69
70
71
72

ESZOPICLONE
EVEKEO
FANAPT
FETZIMA
FLUOXETINE
FLUPHENAZINE
FLUPHENAZINE
DECANOATE
-- FLUVOXAMINE
-- FOCALIN
-- FORFIVO XL
-- GABAPENTIN
-- GABITRIL
-- GEODON
-- GUANFACINE

73
74
75
76

-----

HALDOL
HALDOL DECANOATE
HALOPERIDOL
HALOPERIDOL
DECANOATE
77 -- HETLIOZ
78 -- ILOPERIDONE
79 -- INDERAL

80
81
82
83
84
85
86
87

---------

INTUNIV
INVEGA
INVEGA SUSTENNA
ISOCARBOXAZID
KLONOPIN
LAMICTAL
LAMOTRIGINE
LATUDA

88
89
90
91
92
93
94
95
96
97

-----------

LEVOMILNACIPRAN
LEXAPRO
LIBRIUM
LISDEXAMFETAMINE
LITHIUM
LITHOBID
LORAZEPAM
LUNESTA
LURASIDONE
LUVOX

98 -- LYRICA
99 -- MARPLAN

PARNATE
PAROXETINE
PAXIL
PHENELZINE
PRAZOSIN
PREGABALIN
PRISTIQ
PROCENTRA
PROLIXIN
PROLIXIN
DECANOATE
127 -- PROPRANOLOL
128 -- PROVIGIL

100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115

129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144

-----------------

MELATONIN
METADATE
METHAMPHETAMINE
METHYLIN
METHYLPHENIDATE
MINIPRESS
MIRTRAZAPINE
MODAFINIL
NARDIL
NEURONTIN
NORTRIPTYLINE
NUVIGIL
OLANZAPINE
OXCARBAZEPINE
PALIPERIDONE
PALIPERIDONE
PALMITATE

117
118
119
120
121
122
123
124
125
126

-----------

146
147
148
149
150
151
152
153
154
155

-----------------

156 -- TRIHEXYPHENIDYL
157 -- TRIIODOTHYRONINE
(T3)
158 -- TRILEPTAL
159 -- VALIUM
160 -- VALPROIC ACID
161 -- VENLAFAXINE
162 -- VIIBRYD
163 -- VILAZODONE
164 -- VORTIOXETINE
165 -- VYVANSE
166 -- WELLBUTRIN
167 -- XANAX
168 -- ZALEPLON
169 -- ZENZEDI
170 -- ZIPRASIDONE
171 -- ZOLOFT
172 -- ZOLPIDEM
173 -- ZOLPIMIST

PROZAC
QUETIAPINE
QUILLIVANT XR
RAMELTEON
REMERON
RESTORIL
RISPERDAL
RISPERDAL CONSTA
RISPERIDONE
RITALIN
ROZEREM
SAPHRIS
SEROQUEL
SERTRALINE
SILENOR
SONATA

-----------

SUVOREXANT
TASIMELTEON
TEGRETOL
TEMAZEPAM.
TENEX
THORAZINE
TOPAMAX
TOPIRAMATE
TRANYLCYPROMINE
TRAZODONE

(EXTENDED RELEASE
INJECTABLE)

116 -- PAMELOR

145 -- STRATTERA

174 -- ZYPREXA
175 -- ZYPREXA
RELPREVV

SHOWCARD 5
1

SELF

HUSBAND

SON (INCLUDES STEP, FOSTER, ADOPTIVE)

SON-IN-LAW

BROTHER (INCLUDES HALF, STEP, FOSTER,
ADOPTIVE)

BROTHER-IN-LAW

FATHER (INCLUDES STEP, FOSTER,
ADOPTIVE)

FATHER-IN-LAW

UNCLE

NEPHEW

GRANDFATHER

GRANDSON

COUSIN

EX-HUSBAND

UNMARRIED PARTNER

HOUSEMATE OR ROOMMATE

TENANT, BOARDER, OR EXCHANGE STUDENT

OTHER RELATIVE

OTHER NON-RELATIVE

SHOWCARD 6
1

SELF

WIFE

DAUGHTER (INCLUDES STEP, FOSTER,
ADOPTIVE)

DAUGHTER-IN-LAW

SISTER (INCLUDES HALF, STEP, FOSTER,
ADOPTIVE)

SISTER-IN-LAW

MOTHER (INCLUDES STEP, FOSTER,
ADOPTIVE)

MOTHER-IN-LAW

AUNT

NIECE

GRANDMOTHER

GRANDDAUGHTER

COUSIN

EX-WIFE

UNMARRIED PARTNER

HOUSEMATE OR ROOMMATE

TENANT, BOARDER, OR EXCHANGE STUDENT

OTHER RELATIVE

OTHER NON-RELATIVE

SHOWCARD 7

INCOME EARNED AT A JOB OR BUSINESS
RETIREMENT, DISABILITY, OR SURVIVOR PENSION
UNEMPLOYMENT OR WORKER’S COMPENSATION
VETERAN’S ADMINISTRATION PAYMENTS
CHILD SUPPORT
ALIMONY
INTEREST INCOME
DIVIDENDS FROM STOCKS OR MUTUAL FUNDS
INCOME FROM RENTAL PROPERTIES, ROYALTIES,
ESTATES OR TRUSTS

SHOWCARD 8

LESS THAN $1,000

$1,000 - $1,999

$2,000 - $2,999

$3,000 - $3,999

$4,000 - $4,999

$5,000 - $5,999

$6,000 - $6,999

$7,000 - $7,999

$8,000 - $8,999

$9,000 - $9,999

$10,000 - $10,999

$11,000 - $11,999

$12,000 - $12,999

$13,000 - $13,999

$14,000 - $14,999

$15,000 - $15,999

$16,000 - $16,999

$17,000 - $17,999

$18,000 - $18,999

$19,000 - $19,999

SHOWCARD 9

$20,000 - $24,999

$25,000 - $29,999

$30,000 - $34,999

$35,000 - $39,999

$40,000 - $44,999

$45,000 - $49,999

$50,000 - $74,999

$75,000 - $99,999

$100,000 - $149,999

$150,000 OR MORE

SHOWCARD Y2

The medicine was not helping

The child or one of his/her parents thought
the problem would get better without more
medicine

The child’s family couldn’t afford to pay for
the medicine

The child was too embarrassed to continue
taking the medicine

The child or one of his/her parents wanted to
solve the problem without medications

The medicine caused side effects that made
the child stop

The child was afraid that he/she would get
dependent on the medication

Someone in the child’s personal life
pressured him/her to stop

Any other reason for stopping

SHOWCARD Y3

The medicine was not helping

You or one of your parents thought the problem
would get better without more medicine

Your family couldn’t afford to pay for the medicine

You were too embarrassed to continue taking the
medicine

You or one of your parents wanted to solve the
problem without medications

The medicine caused side effects that made you
stop

You were afraid that you would get dependent on
the medication

Someone in your personal life pressured you to
stop

Any other reason for stopping

Enumeration Rules
PERSONS WHO ARE NOT TO BE INCLUDED ON ROSTER:



Persons under the age of 13 at the time of screening (do count them in the total SDU
Members number)



Persons who are institutionalized at the time of screening



Persons who will not live at the SDU for most of the time during the quarter

PERSONS WHO ARE TO BE INCLUDED ON ROSTER:



Persons who will live at the SDU for most of the time during the quarter (provided
they are 13 or older and not institutionalized at the time of screening)

PERSONS ON ACTIVE DUTY IN THE UNITED STATES’ MILITARY/ARMED FORCES:



Active duty personnel who live at the SDU for half or more of the quarter will be
rostered, but then will be made ineligible by the tablet prior to selection

KNOWN CITIZENS OF FOREIGN COUNTRIES:



DO NOT INCLUDE:

—

citizens of foreign countries living on the premises of an
embassy, ministry, legation, chancellery, or consulate

—

citizens of foreign countries who consider themselves to
be just visiting or traveling in the United States
(regardless of the length of time they will be staying at the
SDU)

DO INCLUDE citizens of foreign countries who are not living on the premises of an
embassy, ministry, etc., but who are living/studying/working in the United States and
who will be living at the SDU for most of the time during the quarter.

NMHS Screening/Interviewing Tasks
Carefully review the below list to be sure you understand how to properly complete each task, referring to the
FI Manual section(s) as needed for details.
Global Tasks

Manual

Read Verbatim Using the Exact Words Provided
Do not skip or change words. Do not add additional words or explanations. Take
your time to ensure you read each word.
Know the Study
Accurately and concisely answer respondent questions about the study and
participation.
Use Materials Correctly
Be organized and have materials accessible. Hand required materials as prompted
on the screen. Remember to pack the Showcard Booklet, and Interview Incentive
Receipt copies at the end of the interview. Do not ask for any other materials to be
returned.
Protect Respondent Rights
Follow ALL informed consent protocols exactly. Treat all information observed/
provided confidentially. Treat each person you encounter respectfully, professionally
and ethically. Never reveal a respondent’s answers to anyone, including the
respondent’s family members. Resist the temptation to reveal even positive
information gleaned from an interview to parents or other household members.
Perform all Tasks in an Unbiased Manner
Work calmly and professionally. Any comments must be neutral and unbiased.

TBD

Screening Tasks

TBD

Manual

Use Segment Materials to locate the correct SDU
Introduce Yourself and the Study to the Screening Respondent (SR)
SR must be an adult (18+) resident of the SDU. Have your ID badge visible. Include
the 4 points: your name, you represent RTI International, the sponsor is the US
Department of Health and Human Services, and mention/offer the Lead Letter.
Obtain Informed Consent for screening
Give the SR a copy of the Study Description to keep, and read the Informed
Consent screen verbatim.
Complete the Household Roster
Ask the questions verbatim and carefully enter responses. The SR must hear each
question read in its entirety one time to hear all options. Subsequently you may
accept responses early, only if the SR interrupts. Never assume or code by
observation other than gender (with one RARE exception if ethnicity/race refused for
Householder – see FI Manual).
Screening Incentive
If the SR is not selected for an interview provide the $5 or $10 screening incentive
and a receipt to the SR.
Transition to the Interview Smoothly
For selected respondent(s), share selection information with SR and interview
respondent(s) if available. Ask and be prepared to complete the interview(s) at that
time.
Collect Verification Information (for SDUs with no one selected)
Read the text verbatim and enter details accurately.

TBD
TBD

TBD

NMHS Screening/Interviewing Tasks (continued)
Interview Tasks
Obtain Parental Permission to Speak with Selected Youth
PRIOR to talking with youth about the study, read the script available on the tablet
Respondent Selection screen to the parent/guardian.
Introduce Yourself and the Study to the interview respondent (R)
Accurately answer any questions the R may have.
Obtain Parental Permission to Interview Selected Youth
Read the top box of the youth script from the Showcard Booklet to the
parent/guardian. If two youth are selected, read the script twice to obtain separate
permission for each youth. Confirm an adult will be at home during the interview.
Complete Informed Consent Protocols
Read the age appropriate script from the Showcard Booklet verbatim and when
prompted give the R a copy of the Study Description to keep (unless the R was the
SR and still has a copy available; in all other situations, provide a copy to the R).
Choose an interview location that gives the respondent privacy
Set up the Laptop Properly and Efficiently
Plug in laptop and headphones, and place fresh covers on the ear pieces in front of
R. Turn on laptop and enter password. Enter the QuestID to begin the interview.
Ask Questions as Worded; Ask All Questions
Allow R time to respond. Do not rush the R or allow R to rush you. Ask all questions
even if you think you know the answer. Never assume/code by observation. Probe
to ensure accurate/complete responses, particularly for initial answer of don’t know.
Use Showcards Properly
Turn the Showcard Booklet to the proper card, and give it to the R when instructed
on the screen (or lay it on the table for the R). Do not prop up or hold the booklet
yourself. Take the booklet back when finished with the question.
Introduce the Laptop to the R
Read the introduction screens verbatim. As instructed, first point (with your finger)
then read the description. Be sure the R can see the keyboard. Offer the
headphones and demonstrate the volume adjustment.
Be Available During the ACASI
Assist if the R has questions, but be sure you cannot see the screen. To protect
confidentiality and privacy, NEVER read the ACASI questions out loud or allow them
to play through the laptop speakers (even if the R thinks it is OK). Prepare the end
of interview forms (Interview Incentive Receipt: Case ID ONLY). Leave the
headphones plugged in until the very end of the interview.
Describe Parent Interview and Obtain Parent’s Cooperation
After the adolescent begins the self-administered portion of the NMHS interview
provide the knowledgeable parent present in the home a copy of the Parent Study
Description, invite the parent to complete the parent interview, and administer
informed consent. If the parent agrees to participate in the parent interview, you will
record the adolescent’s initials, parent e-mail address and parent cell phone
number in the tablet. You will then record the parent questionnaire ID as well as
the adolescent’s initials on the Parent Interview Information Card. You will
encourage the parent to complete the interview while you are in the household.

Manual
TBD

TBD
TBD

TBD

TBD
TBD

TBD

Interview Tasks
Describe Clinical Reappraisal Study (CRS) Interview and Obtain Cooperation
At the end of each in-person NMHS interview, an algorithm will determine whether
the respondent should be invited to participate in the Clinical Reappraisal Study
(CRS). If a respondent has been selected to complete the follow-up clinical
interview, a series of recruitment screens will automatically display on your
computer. If an adult is selected, you will hand the CRS Study Description to the
adult and attempt to obtain consent to complete the CRS interview.

Manual
TBD

If an adolescent is selected for the CRS, you will briefly explain the selection to the
adolescent and then ask to speak to one of his or her parents or legal guardians.
You will hand the CRS Study Description to the parent/legal guardian and read the
parental introductory script from the tablet. You will explain the importance of the
CRS interviews and provide information about the process. If the parent gives
permission, you will hand the CRS Study Description to the adolescent and attempt
to obtain assent from the adolescent.
If an adolescent’s selection algorithm indicates the need for a parent CRS interview
you will ask to speak to the adult who was selected to complete the web/telephone
parent interview for the adolescent. If that parent is present, you will explain to the
parent that he/she was also selected for a follow-up interview. You will hand the
CRS Study Description to the parent and attempt to obtain consent for the parent to
complete the CRS interview.
Complete the QC Form Process
Read the screen text exactly.
Complete the Incentive Process
Follow the steps on the screen in order (hand cash, mark box, sign and date receipt,
give R top copy). Read the text on the screen verbatim. Provide a Q&A Brochure to
the R, or the parent/guardian of a youth, reading the screen text. (This is not
required if you provided a brochure earlier, such as when explaining the study.)
Understand your professionalism and dedication make a difference!

TBD
TBD

TBD

2017 National Mental Health Study
Summary of the Questionnaire
To help you learn more about the National Mental Health Study and the types of questions the
interviewer will ask, please read the following summary of the questionnaire.
Keep in mind that not all participants will see every question—the questions depend on each person’s
experiences. Furthermore, participants can always refuse to answer any questions during the interview.
Demographics
In this section an interviewer will ask questions about date of birth, race, marital status, educational
background, health status, and military service history.
Sample Questions:




Are you now married, widowed, divorced, separated, or have you never married?
What is the highest grade or year of school you have completed?
Did you speak a language other than English at home when you were growing up?

Computer Practice Session
In this section, the interviewer will show the participant how to use the laptop computer and lets him/her
practice using a short practice session.

Physical and Mental Health
Participants will complete this section privately, on their own, using one of the study’s laptop computers.
The computer will ask all participants about physical health, mental health, mental health treatment, and
prescription medication use.
Sample Questions:






In general, would you say your health is excellent, very good, good, fair, or poor?
In the past 12 months, how many times have you been hospitalized overnight for a
physical health problem?
Have you ever had a time in your life when you had a great deal of concern about or
strongly feared being too fat or overweight?
Have you ever in your life had attacks of anger when all of a sudden you lost control and
broke or smashed something worth more than a few dollars?
How often in the past 30 days did you feel sad or depressed?

Other Background Information
Part I. Participants will answer the first set of background questions on their own, using one of the study’s
laptop computers.
The computer may only ask about a few topics, depending on whether they are relevant to a participant.
Topics may include: encounters with the police or the court system; homelessness; head injuries; stressful
experiences; family medical history; tobacco, alcohol, and drugs– use and treatment; relationships and
social networks; childhood experiences; and employment.
6

Sample Questions:






Have you ever had a time in your life when you considered yourself homeless?
Think of the time in your life when you used the most alcohol. During that time, how often did
you drink?
How many biological children have you had?
Were you raised mostly in a large city, suburbs of a large city, a small city, a town or village, or
in a rural area?
Did you work for pay at any time in the last year?

Part II. An interviewer will read the second set of background questions aloud and enter the participant’s
answers into the computer.
The interviewer will ask about the number of people who live in the participant’s household and a few
basic details about each. Then, where appropriate, the interviewer will ask whether a second, more
knowledgeable household member should answer the rest of the questions. The interviewer will then ask
questions on the remaining topics: income and health insurance. For youth, an interviewer will also ask
questions about prescription medication use during this section, since these may be difficult for youths to
answer directly to the computer, as adults do while in the Physical and Mental Health section.
Sample Questions:



Before taxes and other deductions, was the total combined family income last year more or less
than 20,000 dollars?
Are you covered by any kind of health insurance or some other kind of health care plan?

The interviewer is available to answer any additional questions you may have about the National Mental
Health Study questionnaire.

Thank you for your cooperation and help!

Sampling Process Explanation
Sam ple: A representative part of a population that is studied to gain information about the whole population.
N M HS target population: Civilian, non-institutional population aged 13 years or older residing within all states of
the United States, except for Alaska and Hawaii, and the District of Columbia.
THE PROCESS:
RTI statisticians draw a smaller sample of the target population designed to represent the population as a
whole using probability sampling. Steps 1-3 were conducted by the 2016 NSDUH survey, while Steps 4-6 are
conducted by NMHS using retired segments from the 2016 NSDUH survey.
Step 1:
Break each state into geographic areas, called State Sampling Regions (SSRs) using population estimates
and housing unit counts from the Census Bureau.
o Number of SSRs is dependent on the population of the state.
o Each SSR within a state is expected to yield the same number of interviews. This means the more
densely populated the area, the smaller the region.
Step 2:
Break each SSR up into segments.
o Scientifically selected to ensure the sample accurately represents the United States’ population.
o Each area is assigned a “probability,” or “chance,” of being selected based on the Census
population count.
Step 3:
Dwelling units (DUs) within the segments are counted and listed, and recorded on the List of DUs or Group
Quarters Listing Form.
Step 4:
All Retired Segments from the 2016 NSDUH survey from a randomly selected sample of 60 SSRs will be
used for household selection in the next step.
o Each selected SSR will have 2 retired segments, for a total of 120 retired segments to be used for
NMHS sampling.
Step 5:
From the listed DUs in the retired NSDUH segments, specific housing units (HUs) and group quarters units
(GQUs) are randomly selected.
o Selected units are called sample dwelling units (SDUs) which you contact for screening and
possible interviewing. Approximately 3,600 SDUs are randomly selected, where 30 households are
selected within each of the 120 segments.
Step 6:
Either 0, 1, or 2 persons (respondents) are selected for the interview using the roster information entered
into the tablet during screening. Approximately 1,200 respondents are expected to complete the interview for
the Field Test.
o Eligibility for interview is based only on the AGE of the SDU members
o All screening data are used by RTI statisticians
Analysis:
“Sample Weighting” is used to determine how many people in the population each respondent represents.
o 1 adult - represents over 270,000 other adults
o 1 adolescent - represents over 73,000 other adolescents
FIELD INTERVIEWER’S ROLE
Maintain the integrity of the sample by:
o Using segment materials properly
o Following project procedures, including editing address and missed DU protocols
o Investigating discrepancies between the materials and what you actually see in the field
o Paying close attention to details
8

Sampling Process Explanation (continued)
United States

(48 States + DC,
Not Alaska or Hawaii)

State Sampling Regions
(SSRs) from NSDUH

Number of SSRs varies by State
60 SSRs selected

Segments (NSDUH)
2 per SSR

Listed Dwelling Units
(NSDUH)
Selection of Retired NSDUH Segments
For NMHS Sample
(30 Households per Segment)

Selected Dwelling Units
Within Retired NSDUH Segments
~3,600 randomly selected

Respondents

1 adult = over 270,000 other adults
1 adolescent = over 73,000 other adolescents

Overview of the Screening and Interview Process
Review segment materials to locate area and plot the best
and most direct travel route to and from the area.
Prepare and mail lead letters.

Locate (using the segment materials) and contact selected DU.

Determine that the SDU is a true HU or GQU.

Complete Record of Calls (ROC) in
Tablet. Try DU later. If unit is
vacant, not a DU, or only a temporary
residence, verify with neighbor or
other knowledgeable person.
Complete verification information
and ROC.

Try to determine a good time to
return. Complete ROC.

Is anyone home?
Yes

Is an eligible SR
(resident of DU, 18+)
available?

Yes
Complete the household roster and selection process with the SR.

Any
respondents
selected?

Obtain verification information and
thank SR. Complete ROC.

Establish an appointment. Complete
ROC, including an entry about the
interview appointment.

Yes
Can the
selected R complete
interview now?
Yes
Introduce self, study, and obtain informed consent from respondent.
(Obtain parent/guardian permission before speaking to a selected youth.)
Introduce Parent Study , Administer Informed
If Adolescent
Interviewed Consent, Provide Parent Interview Information sheet,
give respondent cash and completed receipt

Conduct interview.
Complete end of the interview tasks, including Quality Control (QC) Form.

Give respondent cash and completed receipt. Give adult respondents & parent/
guardian of youth respondents a Q&A Brochure if not done already.

Selected for Clinical
Reappraisal Study (CRS)?

Yes

Administer CRS Recruiting Script(s)
& Parent Permission (if applicable)

Agree to participate
in CRS?

No
No
No
Thank respondent, complete ROC.
Transmit data to RTI.
Mail Quality Control Form to RTI within 24 hours.

Yes

Give respondent cash and
completed receipt.

Overview of the Screening and Interview Process (continued)
When you work in the field, you will encounter a variety of situations:

Can’t screen (i.e. no one home, vacant units, SR not available, etc.)
•
•
•
•

touch Case ID on the Select Case Screen, touch Screen DU
approach unit and discover you can’t screen
obtain verification information for codes 10, 13 and 18
complete ROC to document situation

Screen only (codes 22, 25, 26, 30)
•
•
•
•
•
•

touch Case ID on the Select Case Screen, touch Screen DU
approach unit and obtain participation of eligible SR
complete screening
if screening incentive case, provide screening incentive and receipt
obtain verification information
complete ROC

Screen, then interview (31, 32 and then 70)
•
•
•
•
•
•
•
•

•

touch Case ID on the Select Case Screen, touch Screen DU
approach unit and obtain participation of eligible SR
complete screening
if screening incentive case and the SR is not selected for an interview provide screening
incentive and receipt
obtain participation/informed consent of selected respondent(s) (and permission of
parent/guardian if minor)
prepare laptop and enter QuestID from tablet
conduct interview(s) with available selected respondent(s)
IF ADOLESCENT SELECTED AS A RESPONDENT: When adolescent begins ACASI section of
interview inform parent of Parent Interview, gain parent’s cooperation to participate,
administer informed consent, provide parent with Parent Interview Information Card, preincentive and receipt. Encourage parent to participate while you are in the household.
perform end of interview steps by carefully following the instructions on the screen for
completing the electronic Quality Control and incentive procedures (including screening
incentive if interview respondent was also SR), providing a Q&A Brochure to each adult
respondent and the parent/guardian of each youth respondent, if not done earlier
if a respondent is selected to participate in the CRS interview the CRS recruiting script will
appear on laptop. Gain the respondent’s cooperation to participate, administer informed
consent/assent, obtain contact information, and provide pre-incentive and receipt. If parent
also selected for CRS follow the same steps above.
complete ROC(s) in tablet for screening and completed interview(s)

Screen, make appointment for interview (codes 31, 32 and then 50)
•
•
•
•
•
•
•

touch Case ID on the Select Case Screen, touch Screen DU
approach unit and obtain participation of eligible SR
complete screening
if screening incentive case provide screening incentive and receipt
complete ROC for screening
complete ROC to document appointment for each selected respondent
prepare appointment card and give to each respondent
11

Interview only at appointment time or other follow-up contact
•
•
•
•
•

•

touch Case ID on the Select Case Screen, review selections and roster
obtain participation/informed consent of selected respondent(s) (and permission of
parent/guardian if minor)
prepare laptop and enter QuestID from tablet
conduct interview(s) with selected respondent(s)
IF ADOLESCENT SELECTED AS A RESPONDENT: When adolescent begins ACASI section of
interview inform parent of Parent Interview, gain parent’s cooperation to participate, administer
informed consent, provide parent with Parent Interview Information Card, pre-incentive and
receipt. Encourage parent to participate while you are in the household.
perform end of interview steps by carefully following the instructions on the screen for
completing the electronic Quality Control Form and incentive procedures (including screening
incentive if interview respondent was also SR), providing a Q&A Brochure to each adult
respondent and the parent/guardian of each youth respondent, if not done earlier
if a respondent is selected to participate in the CRS interview CRS recruiting scripts will appear
on laptop. Gain the respondent’s cooperation to participate, administer informed
consent/assent, obtain contact information, and provide pre-incentive and receipt. If parent
also selected for CRS follow the same steps above.
complete ROC(s) in tablet

Guidelines for Speaking with Neighbors
When speaking with neighbors, it’s important only to ask for and obtain certain information. Always
be very general and concise, and do not offer more information than is necessary.
If the neighbor is suspicious and won’t provide any information unless you tell them why you are
interested in a particular address, simply state the household has been selected to participate in a
national study. Do not name or describe the survey.
You CAN speak to a neighbor to:
1. Verify whether someone actually lives at the selected DU(s)
2. Find out a good time to find the residents at home
3. Obtain verification data if the SDU is vacant
When speaking with neighbors, you CANNOT:
1. Explain that the household has been selected to participate in the NMHS
2. Obtain screening information for the selected DU(s)
Suggested wording to use when speaking with neighbors:
“Hello, my name is [INSERT NAME] with RTI International. I am working on a nationwide study
sponsored by the U.S. Department of Health and Human Services and need to speak with your
neighbor. Do you know when would be a good time to find them at home?”
OR
“Hello, my name is [INSERT NAME] with RTI International. Your neighbor has been selected to
participate in a national study and I’m having trouble catching them at home. Do you know when a
good time would be for me to find them at home?”
Suggested wording for vacancy verification:
“Hello, my name is [INSERT NAME] with RTI International. Your neighbor has been selected to
participate in a national study, but it looks like the house may be vacant. Can you tell me if someone
lives there?”

Informed Consent Reference Guide
This reference guide is not a replacement for information contained in your FI Manual, but is a
listing of crucial protocols that must be followed when obtaining informed consent. Refer to
pages TBD through TBD in your FI Manual for more information on informed consent procedures.

ADOLESCENT INFORMED CONSENT PROCEDURES:
Parental Permission:
•

Before talking with the selected adolescent, ask the parent/guardian for permission to speak
with the adolescent using the Parental Introductory script on the tablet.

•

After the parent agrees, speak with the selected adolescent. Introduce yourself and the study,
providing materials as necessary, and inform the adolescent they have been selected for the
interview.

•

Once the adolescent agrees to do the interview, read the top box of the Intro to CAI 13-17 to
parent/ guardian and obtain their permission to interview the adolescent. Permission MUST be
given IN PERSON

•

After parental permission has been given, confirm the parent/guardian or another adult will be
present for the duration of the interview (not in interview room)

•

If you obtain permission from one parent/guardian who is not home when you return to do
the interview, you may only proceed if the other parent/guardian is available, grants
permission for the interview, and confirms he/she or another adult will be present for the
duration of the interview

•

If the parent/guardian cannot communicate well enough in English to understand the Intro to
CAI:
o If parent speaks Spanish, have the parent read the Spanish translation of the Intro to CAI
themselves (if you are not a RTI-Certified bilingual FI who could read it to them)


If parent cannot read, the adolescent or another translator may read script to the
parent, along with reading the Spanish Study Description

o If language is other than Spanish, the adolescent or another translator may use the script
and Study Description and translate the information for the parent
o Use the adolescent or translator to confirm the parent/guardian or another adult will be
present for the duration of the interview and answer any questions the parent may have
•

Exception: If the adolescent is 17 years old and living independently without a parent or
guardian residing in the home (such as a college student), proceed with adult Informed
Consent procedures.

After Obtaining Parental Permission:
•

Read the main box of the Intro to CAI 13-17 to the adolescent. When instructed, give the
adolescent a Study Description to read and keep.

ADULT INFORMED CONSENT PROCEDURES:
•

Read the Intro to CAI 18+ to R. When instructed, give the R a Study Description to read and
keep (unless the R was the SR and still has a copy available; in all other situations, provide a
copy to the R).
o If R cannot read the Study Description themselves, you must read it to them
14

The Interview Process
Informed Consent Procedures
•

READ THE INFORMED CONSENT FOUND AT THE FRONT OF THIS BOOKLET TO RESPONDENT

•

If the respondent is 13 - 17 years old, obtain parental permission first

Choose the Best Interview Location
•

Consider the following issues:
– Privacy and ethics
– Comfort and safety
– Battery power and/or the availability of an electrical outlet

•

Be flexible in choosing a location, but never compromise NMHS protocols

Setting up the Computer
•

Unpack the computer and plug it in using the extension cord if needed

•

Place clean headphone covers on the ear pieces of the headphones and plug the headphones
into the computer

•

Press the Power button and WAIT for the computer to boot up

•

While waiting, make sure you have the QuestID displayed on the tablet, your Showcard
Booklet, a Quality Control Form and envelope, a Q&A Brochure (if not given earlier), $30
interview incentive, $40 CRS pre-incentive in case R is selected for the CRS, and an Interview
Incentive Receipt

•

Enter the password, then enter the QuestID from the tablet to begin the interview

Conducting the Interview
•

Obtain informed consent (if not done earlier)

•

If respondent is under the age of 13 or is active in the military, the computer will automatically
complete this case (If this occurs, remember to enter a Code 79 in the tablet and explain the
situation)

•

Use the Showcards as instructed

•

During the ACASI, be available to assist the respondent without being intrusive
 IF ADOLESCENT SELECTED AS A RESPONDENT: Inform parent of Parent Interview, gain
parent’s cooperation to participate, administer informed consent, provide parent with
Parent Interview Information Card, pre-incentive and receipt. Encourage parent to
participate while you are in the household.
 Prepare the Quality Control Form:



•

–

Record the date and approximate interview completion time

–

Print your name and FI ID # legibly

–

Record the Case ID, including the A or B

–

Indicate which parent (or guardian) gave permission if respondent is a minor

Prepare the Interview Incentive Receipt:
–

Record the Case ID, including the A or B

–

Do not sign, date or check the box for cash acceptance until prompted by the computer

Other possible tasks include: review your ROCs and plan work for the day, re-read portions
of the FI Computer Manual or FI Manual (access from the FI Assistant feature or remove a
15

The Interview Process (continued)
chapter or two at a time from the binder), re-read the Job Aids section in the Showcard
Booklet, and review materials for information to use when obtaining cooperation
•

Enter the QC ID and the Case ID when prompted and follow Quality Control Form procedures
– For a youth, the Quality Control Form should be completed by a parent or guardian (If no
parent is available, it is acceptable for the youth to complete the form)
– The R/parent should place the Quality Control Form into the envelope and seal it (If
R/parent refuses to complete the Quality Control Form, ask him/her to write “REFUSED”
across the top)

•

Give R the $30 cash, sign, date and mark the appropriate cash acceptance box on the
Interview Incentive Receipt and give the respondent the top copy

•

Give adult interview respondents and parent/guardian of youth respondents a Q&A Brochure
(if not done earlier)

•

If one of the respondents is selected to participate in the CRS interview CRS recruiting scripts
will appear on laptop. Gain the respondent’s cooperation to participate, administer informed
consent/assent, obtain contact information, and provide pre-incentive and receipt. If parent
also selected for CRS follow the same steps above.

When Finished with the Interview
•

Turn off your laptop

•

Pack up your equipment:
– Unplug the power cord from the computer first, unplug from the wall, then wrap them up and
place in carrying case
– Close the screen, place the laptop in the case and zip closed
– Remember your tablet, Showcard Booklet, and other papers

•

THANK YOUR RESPONDENT!

•
•

Enter a Code 70 in your tablet.
Answer the FI debriefing questions

•

Mail Quality Control Form to RTI within 24 hours of completion of the interview

•

Mail Interview Incentive Receipt (FS copy) to your FS each week

Possible Respondent Difficulties
•

Is the respondent physically, mentally, and emotionally capable of participating?
– Slow the pace of the questions to see if comprehension improves
– Allow adequate time to answer
– If the eligible participant does not seem to understand what he/she is being asked to

consent/assent to, politely discontinue the consent/assent process and speak with your FS

– If respondent does not seem to understand, politely discontinue the interview and speak with

your FS

•

Is the respondent intoxicated or under the influence of other drugs?
– Attempt to schedule another time to return

•

Is the respondent blind or paralyzed?
16

– Take the time to figure out if respondent can complete interview–each interview is precious!
– Only in these situations are you allowed to enter the responses during the ACASI portion for

the respondent (Make note of this in the FI debriefing questions)

•

Does the respondent exhibit behaviors that suggest he or she may have difficulty reading?

– Remember that the respondent can listen to all the questions through the headphones and
answer most questions with a number

Instructions for Using the Certificate of Participation
At the end of the interview, you can give a Certificate of Participation that authenticates the
respondent’s participation in NMHS. Youth and other interested respondents may use the
completed certificate to verify with teachers or group leaders that they participated in NMH, and
may then receive credit for participating in the study. Possibilities include:
•
•
•

extra credit for school
incorporating the NMHS experience into a school project
credit towards community service hours.

It is the respondents’ responsibility to arrange to receive any possible credit. Respondents and
parents must understand that:
•
•
•

they are responsible for making arrangements for any credit
their school or group may or may not give credit; credit is not guaranteed
no advance arrangements have been made with any schools or community groups.

The certificate is worded to allow for use with respondents other than middle or high school students,
such as a young adult required to perform community service or for classes beyond high school.
However, the certificate should be used primarily with youth respondents. Adult respondents should
not receive a certificate unless they ask for acknowledgement that he/she completed the study or
seem very interested in receiving one.
Upon completion of the interview, prepare the certificate by:
•
•

filling in the date the interview was completed
and your FI name and ID number.

To preserve confidentiality, the respondent adds his or her name at a later time.
Also provide a Question and Answer Brochure along with the certificate, as it contains additional
details and includes contact information where interested persons can obtain additional information.

ROC Comments
ROC comments should be appropriate, non-judgmental, and:
•
•
•

Informative – Record appointment times, best times to return, who you talked to, or if no
adult was home, record which cars were in the driveway.
Helpful – Note relevant information for you to use in preparing to return or when discussing
the case with your supervisor. If a case gets transferred to another FI, the notes are very
important to the new FI to understand what has happened.
Concise – Explain your comments directly, leaving out unnecessary words or information.
Your comments must be easily understood by you, your FS, other FIs, and project managers.

Examples of good ROCs:
•
•
•

•

CB after 7:00 pm
2:30 Sat appt
W M 15ish said parents home after 8:00
HISP F 60s send SPAN letter

PROJECT ABBREVIATIONS
R
SR
FI
Q&A
DU

respondent (for the interview)
screening respondent
field interviewer
Q&A Brochure
dwelling unit

STANDARD ABBREVIATIONS
days of the week
F
M
B
W
HISP
SPAN
INFO
REF

(with 3 letters)
female
male
black
white
Hispanic
Spanish
information
refused

SUGGESTED HELPFUL ABBREVIATIONS
CB
APPT
AM
AFTRN
PM
NGHBR
GTKPR
WKND

call back (or come back)
appointment
morning
afternoon
evening
neighbor
gatekeeper
weekend

Refusal Reasons
Use these descriptions to help you classify refusals.
1.

Too busy/no time/did too many already
The number one reason for refusals is lack of time.

Surveys/ Government invasive / teen exposure
These people feel that the government invades their privacy too much with surveys. There
may be philosophical, political, or religious reasons for not participating in surveys. Parents
may be concerned about exposing their teen to the sensitive subject matter in the survey.

Clarify confidentiality, legitimacy, selection
Be sure to listen carefully to what respondents are telling you—questions about the legitimacy
of the survey or how the survey guarantees confidentiality can often be explained by you on
the doorstep, if you understand their concern.

“Nothing in it for me”/ Uncooperative
Sometimes people will either not give a reason for their refusal or they’ll tell you that there’s
no reason for them to participate.

Gatekeeper / Parent / HH member disallow
Sometimes you encounter a refusal situation controlled by another person besides the person
selected for the interview. A spouse, parent, guardian, or another influential person in the
household may refuse for the selected individual, or deny you the ability to talk directly to the
selected person. Even if you are able to talk with the selected person, he or she may refuse
because of the other person’s opinions.

Welfare / INS / ICE / USCIS concern
Persons involved with various government programs may fear that you are a welfare worker or
an immigration officer checking on their status.

Too ill / house messy / not dressed
These refusals are situational and will not generate a refusal letter. They refused because you
caught them at an awkward time.

Need to discuss with FS
In some cases, a respondent’s refusal won’t fit any of the above categories, but you are able
to gather a sense of what is preventing them from participating. With this option write a very
specific note in the refusal comment section to alert your FS. Then you can talk with him/her
about how best to handle the refusal.
20

Result Codes

01
02
03
04
05
06
07
08
09

Pending Screening Codes
No One at DU
Screening Respondent (SR)
Unavailable
Neighbor Indicates Occupancy
Pending Incapable
Pending Language Barrier (Spanish)
Pending Language Barrier (Other)
Pending Refusal
Unable to Locate SDU
Pending Other - Specify

Final Screening Codes

Requires
FS Approval

Verification
Info Required

Tablet
Auto Codes

Requires
FS Approval

Verification
Info Required

Tablet
Auto Codes

Ineligible SDUs
10
13
18
19
20
22
25
26
29





Vacant
Not Primary Residence
Not a Dwelling Unit
GQU Listed as HU
HU Listed as GQU
All Military
No Eligible SDU Members
Respondent (R) in DU Less than ½
Quarter
Listing Error













Screening Not Obtained
11
12
14
15
16
17
21
23




No One at DU - Repeated
Screening Respondent (SR)
Unavailable - Repeated
Final Incapable
Final Language Barrier (Spanish)
Final Language Barrier (Other)
Final Refusal
Denied Access
Final Other - Specify








Screening Completed
30
31
32

No One Selected for Interview
One Selected for Interview
Two Selected for Interview
21

Result Codes (continued)

50
51
52
53
54
55
56
57
58
59

70
71
72
73
74
75
76
77
78
79

Pending Interview Codes
Appointment for Interview
No One at DU
Respondent (R) Unavailable
Pending Break-off (Partial Interview)
Pending Incapable
Pending Language Barrier (Spanish)
Pending Language Barrier (Other)
Pending Refusal
Pending Parental Refusal for age 1217
Pending Other - Specify

Final Interview Codes
Interview Complete
No One at DU - Repeated
Respondent (R) Unavailable Repeated
Final Break-off (Partial Interview)
Final Incapable
Final Language Barrier (Spanish)
Final Language Barrier (Other)
Final Refusal
Final Parental Refusal for age 12-17
Final Other - Specify

Requires
FS Approval

Verification
Info Required

Tablet
Auto Codes

Requires
FS Approval

Verification
Info Required

Tablet
Auto Codes












Counting and Listing Abbreviations
COLORS
BG
BK
BL
BR
DK
GR
GN
LT
MED
OR
PK
RD
TN
WH
YL

ADDRESSES
Beige
Black
Blue
Brown
Dark
Grey
Green
Light
Medium
Orange
Pink
Red
Tan
White
Yellow

ADD
ALY
APT
AVE
BLK
BLVD
BLDG
CIR
CT
DRWR
DR
HWY
JCT
LN
PKWY
PL
PT
PO

OTHER/GENERAL
Address
Alley
Apartment
Avenue
Block
Boulevard
Building
Circle
Court
Drawer
Drive
Highway
Junction
Lane
Parkway
Place
Point
Post Office
(Box)
Road
Route
Street
Terrace

RD
RTE
ST
TER

DIRECTION/ORIENTATION

STRUCTURE/MATERIALS

ABV
ACR
ADJ
AFT
BCK
BEF
BEH
BTWN
BTM
E
FRT
L
N
NE
NW
RE
R
S
SE
SW
W

ALUM
BRK
BRNSTN
CDR
CBLK
CEM
LOG
RCK
SDG
STN
STU
VNY

Above
Across
Adjacent
After
Back
Before
Behind
Between
Bottom
East
Front
Left
North
Northeast
Northwest
Rear
Right
South
Southeast
Southwest
West

ARCHITECTURE/BUILDING
STYLE
APT
CPCD
CLNL
CONDO
CNTP
DBLWID
DPX
RCH
RF
SPL
TRAD
TRLR
TRANS

Apartment
Cape Cod
Colonial
Condominium
Contemporary
Doublewide
Duplex
Ranch
Roof
Split Level
Traditional
Trailer
Transitional

Aluminum
Brick
Brownstone
Cedar
Cement Block
Cement
Log
Rock
Siding
Stone
Stucco
Vinyl

TYPES OF ROOFS
FLT

Flat

GBL

Gable

GMBR Gambrel
HIP

Hip

MNSD Mansard
SHGL Shingle
SPNTL Spanish Tile
TIN
Tin

ATT
BSMT
BUS
CPT
CG
CHNLNK
CHMY
CHUR
COL
COR
CO
DB
DRMR
DBL
DRWY
ELCMTR
ENT
EXT
EXTR
FEN
FLR
FDN
FRM
FR
GAR
GRD
GRV
GRND
HSE
LG
MBX
MID
MI
PKT
PCH
PVT
RR
RSTR
RM
SCRN
SHK
SHUT
SD
STR
STY
TR
UC
VAC
VER
VEST
WIN
WD

Attached
Basement
Business
Carport
Cattleguard
Chainlink
Chimney
Church
Column
Corner
County
Doorbell
Dormer
Double
Driveway
Electric Motor
Entrance
Exit
Exterior
Fence
Floor
Foundation
Frame
From
Garage
Guard
Gravel
Ground
House
Large
Mailbox
Middle
Mile
Picket
Porch
Private
Railroad
Restaurant
Room
Screen/Screened
Shake
Shutters
Side Door
Store
Story
Trim
Under
Construction
Vacant
Veranda
Vestibule
Window
Wood

Editing Address Protocol
When to Edit an Address
Editing SDU addresses should not be a common task. An address should only be edited if the
physical address is missing or incorrect, such as when only a description of the SDU is provided.
Before editing an address, first confirm you are at the correct selected dwelling unit. To do this, use a
combination of project resources, including the handwritten List of DUs, block listing maps, and the
address or description in your tablet. If you are confident you are at the correct DU but the address is
incorrect, you should consult the Editing Address Protocol chart. It will guide you on the steps to
follow.
When you edit an address, there are two additional steps you must take to complete the process.
First, you must enter a note in the Record of Calls explaining the reason for the edit. Second, you
should notify your FS of the edit. Your FS must update their copy of the segment materials with the
edit, and in many cases notify RTI’s Sampling Department to update the project sampling frame.
Never make edits to an address which creates a duplicate of an address already listed on the
original List of DUs. Enter a note in the Record of Calls describing the situation and address
discrepancy, and then obtain permission from your FS and Sampling before making the edit.
Carefully checking the original List of DUs before making an edit will ensure no duplication occurs.
After reviewing the Editing Address Protocol chart, if you are unsure whether an address should be
edited or the appropriate procedures to follow, enter detailed notes about the situation in the ROCs
and contact your FS promptly for assistance.
When NOT to Edit an Address
In order to maintain the integrity of the sample, there are specific situations when you should not edit
an address. These situations are listed as “Improper” in the third column of the Editing Address
Protocol chart.
For example, addresses must never be edited due to screening on the incorrect line or at the wrong
dwelling unit. Always double-check the address at the top of the tablet screen and consult your
segment materials to prevent this type of error.
Also, do not change an address or description to a Post Office Box, but instead enter any PO Box
information in the Record of Calls.
Lastly, do not edit addresses to change abbreviations to full spellings, such as “Dr.” to “Drive,” or from
full spellings to abbreviations, such as “Boulevard” to “Blvd.”
Reminder:
Always refer to the chart:


when deciding whether or not to edit an address, and



to be certain all appropriate procedures have been completed when editing an address.

EDITING ADDRESS PROTOCOL
REMINDER: Always review your segment maps, original list of dwelling units, and tablet information before editing
SDU addresses.
Scenario

Description of Situation

Proper or
Improper to Edit

Appropriate FI Action

Description edited to a street
address

Proper

Check handwritten list of DUs, if address is not on list,
delete description; enter street address in tablet;
proceed with screening; enter notes in ROCs; notify FS

Street name spelling corrected or
drive/avenue/street/etc. corrected

Proper

Edit address in tablet; proceed with screening; enter
notes in ROCs; notify FS

Proper

Edit address in tablet; proceed with screening; enter
notes in ROCs; notify FS

Proper

Check handwritten list of DUs, if address is not on list,
edit address in tablet; proceed with screening; enter
notes in ROCs; notify FS

Correction of one SDU address
due to 911/U.S. Postal Service/
local government address
revisions
Correction of listing error for one
SDU (includes edits to street/apt.
number)

Adding apt. numbers to
differentiate between added units
in a SDU or on SDU property

Proper

Check handwritten list of DUs, if address is not on list,
edit address in tablet; proceed with screening; enter
notes in ROCs; notify FS

City, state, or zip code corrected

Proper

Edit address in tablet; proceed with screening; enter
notes in ROCs; notify FS

Within controlled access
buildings/complexes, edits to
addresses for multiple units
originally gained through "blind"
listing or listing by buzzer/mailbox

Proper (with prior
approval from FS)

Notify FS; if approved by FS, edit address in tablet;
proceed with screening; enter notes in ROCs

Complete street name change

Proper (with prior
approval from FS and
Sampling)