Appx C_NSCAW III_Caregiver Interview_Revised Jan 2021_Clean

OPRE Study: National Survey of Child and Adolescent Well-Being Second Cohort (NSCAW III): Data Collection [Longitudinal Study]

Appx C_NSCAW III_Caregiver Interview_Revised Jan 2021_Clean

OMB: 0970-0202

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0970-0202 can be found here:

Document [docx]

Download: docx | pdf

Appendix C: Caregiver Interview

QP – Questionnaire Introduction C-1

NP – Up Frong Verification Module C-4

HH – Household Roster C-15

GH – Group Home Household Roster C-67

LE – Child’s Living Environment C-81

CE – Community Environment C-97

HS - Child Health and Services C-99

LP - Independent Living Module for CG of EY C-175

SD - Social Emotional Development C-177

PS – Prosocial Skills: Ages 3-5 C-184

PT - Prosocial Skills: AGES 6-10 C-196

PU - Prosocial Skills: AGES 11+ C-208

TE – Emotional Regulation – Temperment: Ages 0-3 C-220

TC – Youth Behavior (Checklist for Ages 1.5-5) C-239

BC – Youth Behavior (Checklist for Ages 6-18) C-264

IN - Income C-295

SR - Services Received by Caregiver C-299

SS - Social Support C-323

PH – Physical Health C-326

FC - Services Received by Foster Caregivers C-329

AP – Adoption Modeule for Foster Parents C-334

PP - Permanency Planning for Foster and Adoptive Caregivers C-337

AZ - ACASI Introduction C-347

DP - Depression C-350

PD - Psychological Distress C-358

HF – Mental Health and Functioning C-361

AD – Alcohol Dependence C-364

DD – Drug Dependence C-367

IL – Involvement with the Law C-372

DS – Discipline & Child Maltreatment C-376

DV – Domestic Violence C-390

SF – Satisfaction with Caseworker C-397

HO – Home Scales C-401

EE – Expressed Emotion C-415

LF - Locator Form C-416

LK - Permission for Data Linkage C-433

VF - Verifications C-437

IO – HOME Observational C-440

================================================================================

Current Caregiver Interview

================================================================================

QP – QUESTIONNAIRE INTRODUCTION

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

P_QP_BGN [ PQP_BGN ] NoDeliv

@bCASE ID : ^main_case.zrid

Subject: ^main_case.subject

Adult: ^main_case.ad_last ^main_case.ad_first

Child: ^main_case.childfull

Child's DOB: ^strChildDOB

Child's age: ^AgeYY

Child's sex: ^Global.sex

@sIF INFORMATION ABOVE IS CORRECT, PRESS "1" AND ENTER TO CONTINUE.

IF INFORMATION ABOVE IS INCORRECT, CLOSE THE INTERVIEW TO RETURN TO

CMS.@s@B

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

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

P_QP0a [ PQP0a ] NO LABEL

INTERVIEWER: THE STUDY PROTOCOL REQUIRES THAT THIS RESPONDENT MUST (1)

CURRENTLY LIVE WITH THE CHILD, AND/OR (2) MUST HAVE LIVED WITH THE CHILD FOR

AT LEAST @bONE MONTH@b.

INTERVIEWER: PRESS 1 FOR CONSENT FORMS IN DOCMAN. PLEASE CHOOSE AND

READ THE CORRECT CONSENT FORM FROM DOCMAN AND OBTAIN SIGNATURE. AFTER

COLLECTING SIGNATURE AND FINALIZING FORM, YOU WILL THEN BE BROUGHT BACK TO

THE INTERVIEW.

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont

Continue 1 Continue

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

P_QPCO1 Start CO DocMan

@bSTART DOCMAN CONSENT FORM @b

INTERVIEWER: PRESS UP ARROW IF YOU WANT TO GO TO PREVIOUS SCREEN.

Question Type: BDocMan

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

Logic before:

If status from DocMan=491 ask P_QPCO2 else ask P_QPCO3

P_QPCO2 [ P_QPCO2 ] End CO DocMan

@bDOCMAN CONSENT FORM IS COMPLETED@b

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont

Continue 1 Continue

Logic after:

Skip to P_QP0a

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

P_QPCO3 [ P_QPCO3 ] NO LABEL

@bDOCMAN CONSENT FORM IS NOT COMPLETED@b

Question Type: TDMR1F, noDK, noRF

_1 1 REDO THE FORM IN DOCMAN

_2 2 RESPONDENT REFUSED TO COMPLETE ELECTRONIC FORM BUT

SIGNED PAPER FORM

_3 3 A TECHNICAL PROBLEM PREVENTED THE ELECTRONIC FORM

FROM BEING COMPLETED BUT RESPONDENT SIGNED PAPER

FORM

_4 4 EXIT - RESPONDENT REFUSES SO THERE'S NO INTERVIEW

Logic after:

If 1 GOTO P_QPCO1

If 4 EXIT interview

IF 3 Ask P_QPCO4

ELSE GOTO P_QP0aa

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

P_QPCO4 [ P_QPCO4 ] NO LABEL

@bDOCMAN CONSENT FORM IS NOT COMPLETED@b

GIVE DETAILS ABOUT THE TECHNICAL PROBLEM:

Question Type: STRING[60]

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

Logic before:

P_do_CARI

P_QP0aa [ PQP0aa ] NO LABEL

INTERVIEWER: DID R AGREE TO THE USE OF CARI FOR RECORDING THE INTERVIEW?

Question Type: BConsent

Logic after:

IF RESPONSE = 1 (YES), GOTO P_QP1.

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

Logic before:

IF P_not_cari

P_QP0ba [ PQP0ba ] NO LABEL

I just need to confirm that you do not want this interview to be recorded. Is that correct?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF RESPONSE = 2 (NO), GOTO P_QP0aa.

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

Logic before:

Fill: If PERMANENT CAREGIVER Many of the questions will be about ^CHILD, including any

services ^fillhe/she may need or receive, while others focus on your experiences with the child

welfare system. The study is being conducted for the Administration for Children and Families, an

agency within the U.S. Department of Health and Human Services. Your participation is voluntary,

but it is very important because you represent many other families in the system.

Fill: If IF NON-PERMANENT CAREGIVER The questions will focus on one of the children in your

care, ^CHILD, and the services ^fillhe/she may need or receive. There are also some questions

about your experiences with the child welfare system. The study is being conducted for the

Administration for Children and Families, an agency within the U.S. Department of Health and

Human Services. Your participation is voluntary, but it is very important because you represent

many other caregivers in the system.

P_QP1 [ PQP1 ] NO LABEL

This survey is called the National Survey of Child and Adolescent Well-Being. It is designed to

help us learn about the needs of children and families in the child welfare system and their use of

child welfare services.

^FILLS.P_QP1 As explained in the consent form you signed, we will hold your responses in the

strictest confidence, as Federal law requires. You may decline to answer any question you wish.

If you have any questions, please let me know.

Did you receive a copy of the letter and brochure describing the survey?

YES --> CONTINUE

NO ---> GIVE R A COPY OF THE LETTER AND BROCHURE

Let's begin.

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^FillP_QP1

PermCG Many of the questions will be about ^GLOBAL.CHILD, including any

services ^Fills.HeShe may need or receive, while others focus on your

experiences with the child welfare system. The study is being

conducted for the Administration for Children and Families, an agency

within the U.S. Department of Health and Human Services. Your

participation is voluntary, but it is very important because you represent

many other families in the system.

NonPermCG The questions will focus on one of the children in your care,

^GLOBAL.CHILD, and the services ^Fills.HeShe may need or receive.

There are also some questions about your experiences with the child

welfare system. The study is being conducted for the Administration for

Children and Families, an agency within the U.S. Department of Health

and Human Services. Your participation is voluntary, but it is very

important because you represent many other caregivers in the system.

NP - UP-FRONT VERIFICATION MODULE

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

Logic before:

Preloads from CMS>ch_eman< [allow 1] [# emancipated kid] >CH_indliv< [allow 1] [# emancipated

kid, living independantly for over 90 days] >ch_wthcg< [allow 1] [# lives with CG] >ch_wthcg90<

[allow 1] [# lived with the CG in the past 90 days - 3 months]

UP-FRONT VERIFICATION MODULE Verification of CID - Case Initiation DataIF CHILD IS

LEGALLY EMANCIPATED, FILL -CHILD IS LEGALLY EMANCIPATED ACCORDING TO THE

GOVERNING STATE LAWS. IF CHILD IS LEGALLY EMANCIPATED AND DOES NOT LIVE WITH

A CAREGIVER, FILL -CHILD DOES@b NOT @bLIVE WITH A CAREGIVER. IF CHILD IS

LEGALLY EMANCIPATED, DOES NOT LIVE WITH A CAREGIVER AND HAS NOT LIVED WITH A

CAREGIVER FOR THE PAST 90 DAYS,FILL -CHILD HAS@b NOT @bLIVED WITH A

CAREGIVER DURING THE PAST 90 DAYS. -CAREGIVER INTERVIEW IS@b NOT

@bREQUIRED.IF CHILD IS LEGALLY EMANCIPATED, DOES NOT LIVE WITH A CAREGIVER

BUT HAS LIVED WITH A CAREGIVER FOR THE PAST 90 DAYS, FILLCHILD HAS LIVED WITH

A CAREGIVER DURING THE PAST 90 DAYS. CAREGIVER INTERVIEW IS REQUIRED. IF

CHILD IS LEGALLY EMANCIPATED BUT LIVES WITH A CAREGIVER, FILL -CHILD LIVES WITH

A CAREGIVER. -CAREGIVER INTERVIEW IS REQUIRED. IF CHILD IS NOT LEGALLY

EMANCIPATED, FILL -CHILD IS@b NOT @bLEGALLY EMANCIPATED ACCORDING TO THE

GOVERNING STATE LAWS. -CAREGIVER INTERVIEW IS REQUIRED.

P_NP0 [ PNP0 ] NO LABEL

INTERVIEWER: PLEASE VERIFY THE CHILD'S EMANCIPATION STATUS FROM THE

CID:@/@/^fills.P_NP01@/ ^fills.P_NP02 @/^fills.P_NP03

IS THE INFORMATION LISTED ABOVE CORRECT?

IF YES, ENTER 1 (YES)

IF NO, YOU MUST BREAKOFF THIS INTERVIEW AND RETURN TO THE CID TO CORRECT

THE EMANCIPATION STATUS OF THE CHILD.

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^fillP_NP01

LE -CHILD IS LEGALLY EMANCIPATED ACCORDING TO THE

GOVERNING STATE LAWS.

NLE -CHILD IS@b NOT @bLEGALLY EMANCIPATED ACCORDING TO THE

GOVERNING STATE LAWS.

-CAREGIVER INTERVIEW IS REQUIRED.

BLANK1

Question Fill: ^fillP_NP02

LE_DNL -CHILD DOES@b NOT @bLIVE WITH A CAREGIVER.

BLANK2

Question Fill: ^fillP_NP03

LE_DNL90M -CHILD HAS@b NOT @bLIVED WITH A CAREGIVER DURING THE

PAST 90 DAYS.

-CAREGIVER INTERVIEW IS@b NOT @bREQUIRED.

LE_LW90L -CHILD HAS LIVED WITH A CAREGIVER DURING THE PAST 90 DAYS.

CAREGIVER INTERVIEW IS REQUIRED.

LE_LW -CHILD LIVES WITH A CAREGIVER.

-CAREGIVER INTERVIEW IS REQUIRED.

blank3

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

P_NP1a [ PNP1a ] Does CH live with R

INTERVIEWER: THIS IS THE @bCURRENT CAREGIVER@b INSTRUMENT. DOES ^CHILD

LIVE WITH RESPONDENT?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

1 = YES GO TO P_NP2am

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

P_NP1am [ PNP1am ] CH stop living with R - M

When did ^CHILD stop living with you? Please tell me the month and year.

MONTH

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

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

P_NP1ay [ PNP1ay ] CH stop living with R - Y

When did ^CHILD stop living with you? Please tell me the month and year.

YEAR

Question Type: 1990..2013

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

P_NP2am [ PNP2am ] CH begin living with R - M

When did ^child begin living with you?

INTERVIEWER: IF R CANNOT PROVIDE DAY, ASK FOR MONTH AND YEAR

MONTH

Question Type: TMonth, noDK, noRF

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

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

P_NP2ad [ PNP2ad ] CH begin living with R - D

When did ^child begin living with you?

INTERVIEWER: IF R CANNOT PROVIDE DAY, ASK FOR MONTH AND YEAR

DAY

Question Type: 1..31

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

P_NP2ay [ PNP2ay ] CH begin living with R - Y

When did ^child begin living with you?

INTERVIEWER: IF R CANNOT PROVIDE DAY, ASK FOR MONTH AND YEAR

YEAR

Question Type: 1990..2013, noDK, noRF

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

Logic before:

IF MONTH/YEAR IN P_NP1am, P_NP1ay IS MORE THAN 3 MONTHS BEFORE INTERVIEW

MONTH/YEAR, GO TO P_NP3a; ELSE, COMPUTE NUMBER OF DAYSBETWEEN INTERVIEW

DATE AND DATE CHILD BEGAN LIVING WITH R IN (P_NP2am - P_NP2ay) IF DIFFERENCE

CAN BE COMPUTED AS DAYS AND LT 30 DAYS, GO TO P_NP3a; ELSE, IF DIFFERENCE GE

30 DAYS, GO TO P_NPRCHKIF DIFFERENCE CANNOT BE COMPUTED AS DAYS AND

MONTH/YEAR IN P_NP2am, P_NP2ay IS SAME AS MONTH/YEAR OF INTERVIEW OR 1

MONTH BEFORE MONTH/YEAR OF INTERVIEW, GO TO P_NP2chk; ELSE IF P_NP2am,

P_NP2ay IS TWO OR MORE MONTHS BEFORE MONTH/YEAR OF INTERVIEW, GO TO

P_NP2chk [ PNP2chk ] CH begin living with R before/after int date - 30 days

Did ^CHILD begin living with you before or after ^intdateminus30

Question Type: TonAfter

ON_BEFORE 1 ON OR BEFORE

_AFTER 2 AFTER

Logic after:

1 = ON OR BEFORE [fill INTERVIEW DATE MINUS 30 DAYS] GO TO P_NPRCHK

2 = AFTER [fill INTERVIEW DATE MINUS 30 DAYS] GO TO P_NP3a

REF, DK GO TO P_NP3a

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

Logic before:

IF CHILD IS EMANCIPATED PER CID AND MONTH/YEAR IN P_NP1am, P_NP1ay IS MORE

THAN 3 MONTHS BEFORE INTERVIEW MONTH/YEAR, fill:INTERVIEWER: THE STUDY

PROTOCOL SPECIFIES THAT A CAREGIVER INTERVIEW IS REQUIRED ONLY IF THE

EMANCIPATED YOUTH CURRENTLY LIVES WITH THE CAREGIVER OR LIVED WITH A

CAREGIVER DURING THE LAST 3 MONTHS.ELSE fill: INTERVIEWER: THE STUDY

PROTOCOL REQUIRES THAT THIS RESPONDENT MUST (1) CURRENTLY LIVE WITH THE

CHILD, AND/OR (2) MUST HAVE LIVED WITH THE CHILD FOR AT LEAST @bONE MONTH@b.

P_NP3a [ PNP3a ] Supervisor authorize interview

^fills.P_NP3A

HAS YOUR SUPERVISOR AUTHORIZED YOU TO CONDUCT THE CURRENT CAREGIVER

INTERVIEW WITH THIS RESPONDENT EVEN THOUGH THE STUDY CRITERIA HAVE NOT

BEEN MET?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^FillP_NP3a

more3 INTERVIEWER: THE STUDY PROTOCOL SPECIFIES THAT A

CAREGIVER INTERVIEW IS REQUIRED ONLY IF THE EMANCIPATED

YOUTH CURRENTLY LIVES WITH THE CAREGIVER OR LIVED WITH A

CAREGIVER DURING THE LAST 3 MONTHS.

else3orless INTERVIEWER: THE STUDY PROTOCOL REQUIRES THAT THIS

RESPONDENT MUST (1) CURRENTLY LIVE WITH THE CHILD, AND/OR

(2) MUST HAVE LIVED WITH THE CHILD FOR AT LEAST @bONE

MONTH@b.

Logic after:

1 = YES GOTO P_NP5a

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

P_NP4 [ PNP4 ] NO LABEL

Because ^CHILD doesn't live with you currently, or has lived with you for a short period of time, I

need to talk to my supervisor to see if I should go ahead and interview you. Let me check with my

supervisor and get back to you in case I need to schedule an interview with you at a later date.

Thank you for your time today.

INTERVIEWER: PRESS ENTER TO GO BACK TO CASE MANAGEMENT SYSTEM AND CALL

Question Type: TCont

Continue 1 Continue

Logic after:

GOTO CASE MANAGEMENT SCREEN.

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

Logic before:

DISPLAY GRID SHOWING NAME, RELATIONSHIP AND CAREGIVER TYPE FROM CID

(EXAMPLE SHOWN BELOW)Name Relationship to CHILD Caregiver Type from CID

Respondent?FILL NAME FROM CID SCREEN 4 FILL RELATIONSHIP FROM CID SCREEN 4

PrimaryFILL NAME FROM CID SCREEN 5 fILL RELATIONSHIP FROM CID SCREEN 5

P_NPRCHK [ PNPRCHK ] NO LABEL

INTERVIEWER: SELECT WHICH PERSON IS THE RESPONDENT ^cg_info

Question Type: TPNPRCHK, noDK, noRF

_Primary 1 Primary Caregiver: ^cg_cid.cga_first ^cg_cid.cga_initl ^cg_cid.cga_last

^cg_cid.cga_suffx

_Secondary 2 Secondary Caregiver: ^cg_cid.cgb_first ^cg_cid.cgb_initl

^cg_cid.cgb_last ^cg_cid.cgb_suffx

NotListed 3 Respondent is not listed above

Logic after:

IF R IS PRIMARY OR SECONDARY CG, GO TO P_NP5a; ELSE GO TO P_NP5e

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

Logic before:

FILL NAME BELOW FROM CID SCREEN (4 OR 5) FOR PERSON IN P_NP5a MARKED AS R

P_NP5a [ PNP5x ] PCG name verification

INTERVIEWER: VERIFY THE PRIMARY CAREGIVER'S NAME:

FIRST: ^pRFIRST

MIDDLE INITIAL: ^pRINITL

LAST: ^pRLAST

IS THIS CORRECT?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

1 = YES GOTO P_NP6a

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

P_NP5b [ PNP5b ] Correct PCG first name

INTERVIEWER: CORRECT FIRST NAME AS NEEDED.

FIRST NAME:

Question Type: string[30]

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

P_NP5c [ PNP5c ] Correct PCG middle name

INTERVIEWER: CORRECT MIDDLE NAME AS NEEDED.

MIDDLE NAME:

Question Type: string[30], empty

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

P_NP5d [ PNP5d ] Correct PCG last name

INTERVIEWER: CORRECT LAST NAME AS NEEDED.

LAST NAME:

Question Type: string[30]

Logic after:

GO TO P_NP6a

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

P_NP5E1 [ PNP5E1 ] Enter R first name

INTERVIEWER: ENTER THE RESPONDENT'S NAME:

FIRST NAME:

Question Type: string[30]

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

P_NP5E2 [ PNP5E2 ] Enter R middle name

INTERVIEWER: ENTER THE RESPONDENT'S NAME:

MIDDLE INITIAL:

Question Type: string[3], empty

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

P_NP5E3 [ PNP5E3 ] Enter R last name

INTERVIEWER: ENTER THE RESPONDENT'S NAME:

LAST NAME:

Question Type: string[30]

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

Logic before:

FILL RELATIONSHIP FROM CID SCREEN 4 OR 5 FOR PERSON IN P_NP5a MARKED AS R IF

R IS PRIMARY OR SECONDARY CG FROM CID; ELSE, IF R IS NOT LISTED ON CID; USE

RELATIONSHIP FROM CID SCREEN 4 OR 5 DEPENDING ON EXPECTED RESPONDENT

FROM CID SCREEN 7

P_NP6a [ PNP6x ] Verify PCG relation to CH

INTERVIEWER: VERIFY THE PRIMARY CAREGIVER'S RELATIONSHIP TO ^CHILD:

^RELATIONSHIP

IS THIS CORRECT?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

1 = YES GOTO P_NP8ac

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

P_NP7a [ PNP7x ] PCGs relation to CH

INTERVIEWER: CODE PRIMARY CAREGIVER'S RELATIONSHIP TO ^CHILD.

Question Type: TCH14a

biomom 1 BIOLOGICAL MOTHER

stepmom 2 STEP-MOTHER

adoptmom 3 ADOPTIVE MOTHER

fostmom 4 FOSTER MOTHER

sister 5 SISTER

aunt 6 AUNT

grandma 7 GRANDMOTHER

biodad 8 BIOLOGICAL FATHER

stepdad 9 STEP-FATHER

adoptdad 10 ADOPTIVE FATHER

fostdad 11 FOSTER FATHER

brother 12 BROTHER

uncle 13 UNCLE

grandpa 14 GRANDFATHER

otherrel 95 OTHER RELATIVE

othernonrel 96 OTHER NON-RELATIVE

Logic after:

95 = OTHER RELATIVE (SPECIFY) GOTO P_NP7b

96 = OTHER NON-RELATIVE (SPECIFY) GOTO P_NP7c

ELSE, GOTO P_NP8a

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

Logic before:

IF P_NP7a = 95,

P_NP7b [ PNP7b ] Other PCG relative reltionship to CH

PLEASE SPECIFY OTHER RELATIVE RELATIONSHIP.

RELATIONSHIP:

Question Type: string[30]

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

Logic before:

IF P_NP7a = 96,

P_NP7c [ PNP7c ] Other PCG non-relative reltionship to CH

PLEASE SPECIFY OTHER NON-RELATIVE RELATIONSHIP.

RELATIONSHIP:

Question Type: string[30]

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

Logic before:

IF R IS PRIMARY CAREGIVER FROM CID, GO TO P_NP8a; ELSE IF R IS SECONDARY CG

FROM CID OR NOT LISTED ON CID, GO TO P_NP10a. FILL NAME BELOW FROM CID SCREEN

P_NP8a [ PNP8x ] SCG name verification

INTERVIEWER: VERIFY THAT ^CHILD's CURRENT SECONDARY CAREGIVER IS:

FIRST: ^pSFirst

MIDDLE INITIAL: ^pSInitl

LAST: ^PSLast

IS THIS CORRECT?

Question Type: TPNP8F, noDk, noRF

YES 1 YES

NO 2 NO

NOCG2 3 CHILD DOES NOT HAVE A SECONDARY CAREGIVER

Logic after:

1 = YES GOTO P_NP9a

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

P_NP8b [ PNP8b ] Correct SCG first name

INTERVIEWER: CORRECT FIRST NAME IF NEEDED.

FIRST NAME:

Range: 30

Question Type: string[30]

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

P_NP8c [ PNP8c ] Correct SCG middle name

INTERVIEWER: CORRECT MIDDLE NAME IF NEEDED.

MIDDLE NAME:

Question Type: string[30], empty

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

P_NP8d [ PNP8d ] Correct SCG last name

INTERVIEWER: CORRECT LAST NAME IF NEEDED.

LAST NAME:

Question Type: string[30]

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

P_NP9a [ PNP9x ] Verify SCG relation to CH

INTERVIEWER: VERIFY THAT ^CHILD'S CURRENT SECONDARY CAREGIVER'S

RELATIONSHIP TO ^CHILD IS:

^cg_cid.cgb_reltxt

IS THIS CORRECT?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

1 = YES GOTO P_NP10a

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

Logic before:

[IF CHILD DOES NOT LIVE WITH A

CAREGIVER PER CID, FILL: MOST RECENT/ELSE, FILL: CURRENT]

P_NP9b [ PNP9b ] SCGs relation to CH

INTERVIEWER: CODE^fills.currrecent SECONDARY CAREGIVER'S RELATIONSHIP TO ^CHILD.

Question Type: TCH14a

biomom 1 BIOLOGICAL MOTHER

stepmom 2 STEP-MOTHER

adoptmom 3 ADOPTIVE MOTHER

fostmom 4 FOSTER MOTHER

sister 5 SISTER

aunt 6 AUNT

grandma 7 GRANDMOTHER

biodad 8 BIOLOGICAL FATHER

stepdad 9 STEP-FATHER

adoptdad 10 ADOPTIVE FATHER

fostdad 11 FOSTER FATHER

brother 12 BROTHER

uncle 13 UNCLE

grandpa 14 GRANDFATHER

otherrel 95 OTHER RELATIVE

othernonrel 96 OTHER NON-RELATIVE

Logic after:

95 = OTHER RELATIVE GOTO P_NP9c

96 = OTHER NON-RELATIVE GOTO P_NP9d

ELSE, GOTO Y_CH10a

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

Logic before:

IF P_NP9b = 95, ASK p_NP9C

P_NP9c [ PNP9c ] Other SCG relative reltionship to CH

SPECIFY OTHER RELATIVE RELATIONSHIP

RELATIONSHIP:

Question Type: string[30]

Logic after:

GO TO P_NP10a

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

Logic before:

IF P_NP9b = 96, ASK P_NP9D

P_NP9d [ PNP9d ] Other SCG non-relative reltionship to CH

SPECIFY OTHER NON-RELATIVE RELATIONSHIP

RELATIONSHIP:

Question Type: string[30]

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

Logic before:

IF WAVE 1, GOTO P_NP11a. ELSE, ASK P_NP10a.FILL NAME OF CURRENT CAREGIVER

RESPONDENT FROM LAST WAVE

P_NP10a [ PNP10x ] Verify respondent's name

INTERVIEWER: IS RESPONDENT'S NAME DISPLAYED BELOW?

^lastwavenamecur

Question Type: TYN

yes 1 YES

no 2 NO

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

P_NP11a

INTERVIEWER: IS THE CHILD LIVING IN A FAMILY SETTING?

A FAMILY SETTING INCLUDES LIVING WITH A BIRTH PARENT, ADOPTIVE PARENT, RELATIVES, FICTIVE KIN, OR FOSTER PARENTS.

Question Type: TYN

yes 1 YES [GO TO P_NP12a]

no 2 NO [GO TO P_NP12b]

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

P_NP12a

FROM THE CATEGORIES BELOW, WHAT BEST DESCRIBES ^CHILD'S FAMILY SETTING?

With one or both birth parents
With one or both adoptive parents
With relatives oR FICTIVE KIN (E.G. GODPARENTS or FAMILY FRIEND)
With non-relatives IN A FOSTER HOME

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

P_NP12b

FROM THE CATEGORIES BELOW, WHAT BEST DESCRIBES ^CHILD'S NON-FAMILY SETTING?

In an emergency shelter
In a specialized or therapeutic foster home or therapeutic home
In a group home
In a residential treatment facility
IN A psychiatric hospital
In a medical hospital or facility
In a place of detention (e.g., juvenile detention, juvenile or adult corrections)
In transitional independent living Apartment, HOME, OR FACILITY
CHILD LIVES ON OWN (INCLUDES SCHOOL/COLLEGE, MILITARY, ETC.)
Whereabouts unknown, runaway
OTHER

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

Logic before:

IF P_NP12b =3 or 4, ASK P_NP13a. ELSE, GO TO P_NP14a.

P_NP13a [ PNP13a ] Facility description

USE CARD 0. Please look at Card 0 and tell me which answer best describes this facility.

Question Type: TFacDesc

SMALLFAM 1 SMALL FAMILY GROUP HOME (RUN BY FAMILY WITH HELP OF

ADDITIONAL STAFF, 3-6 BEDS)

GROUP 2 GROUP HOME (3-6 BEDS)

SMALLRES 3 SMALL SIZED RESIDENTIAL FACILITY (7-12 BEDS)

MID 4 MID SIZED RESIDENTIAL FACILITY (13 TO 20 BEDS)

LARGE 5 LARGE SIZED RESIDENTIAL FACILITY (20 TO 49 BEDS)

LARGEST 6 LARGEST RESIDENTIAL FACILITY (50 OR MORE BEDS)

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

P_NP14a [ PNP14a ] Is R the CHs LG

INTERVIEWER: IS THE RESPONDENT ^CHILD'S LEGAL GUARDIAN, THAT IS, THE PERSON

REQUIRED TO GIVE CONSENT FOR ^CHILD'S INTERVIEW?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

GOTO P_NPEND

HH - HOUSEHOLD ROSTER

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

Logic before:

IF WAVE = 1, START AT P_HH1. ELSE, START AT P_HH0.

P_HH0a [ PHH0a ] Verify CHs full name

I'd like to begin by updating some of the information in our records about you, ^CHILD, and

^Fills.HisHer household and family.

Is ^CHILD's full name still ^ChildFullName?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Question Fill: ^fillhisher

his his

her her

Logic after:

FILL FIRST, MIDDLE, AND LAST NAME FROM P_HH1a IN PREVIOUS WAVE. If P_HH0a=yes

GOTO P_HH2ca.

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

P_HH0a1 [ PH0aFN ] NO LABEL

What is ^CHILD's full legal name now?

First:

Question Type: string[20]

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

P_HH0a2 [ PH0aMN ] NO LABEL

What is ^CHILD's full legal name now?

Middle:

Question Type: string[20], empty

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

P_HH0a3 [ PH0aLN ] NO LABEL

What is ^CHILD's full legal name now?

Last:

Question Type: string[20]

Logic after:

GOTO P_HH2ca.

September, 2016 Page 18 of 591

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

P_HH1a [ PHH1a ] Ch full name

I'd like to begin by asking some questions about you, ^CHILD, and ^Fills.HisHer household and

family. Let's start with ^CHILD.

What is ^CHILD's full legal name?

First:

Question Type: string[20]

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

P_HH1b [ PHH1b ] Ch full name

What is ^CHILD's full legal name?

Middle:

Question Type: string[20], empty

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

P_HH1c [ PHH1c ] Ch full name

What is ^CHILD's full legal name?

Last:

Question Type: string[20]

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

P_HH2n [ PHH2a ] CH age in years

How old is ^CHILD?

AGE

Question Type: 0..18, noDK, noRF

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

P_HH2am [ PHH2amm ] NO LABEL

When was ^CHILD born?

MONTH

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

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

P_HH2ad [ PHH2add ] NO LABEL

When was ^CHILD born?

DAY

Question Type: 1..31

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

P_HH2ay [ PHH2ayy ] NO LABEL

When was ^CHILD born?

YEAR

Question Type: 1990..2013

Logic after:

EVALUATE RESPONSES TO P_HH2n AND P_HH2am-y FOR CONSISTENCY. IF CONSISTENT,

GO TO P_HH2ba, OTHERWISE DISPLAY INCONSISTENCY TEXT LISTED BELOW: I have

entered ^CHILD's age as ^P_HH2n and birthday as ^ChildDOB. These are inconsistent. I must

have something wrong. Which one do I need to correct?

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

Logic before:

EVALUATE RESPONSES TO P_HH2n AND P_HH2am-y FOR CONSISTENCY. IF CONSISTENT,

GO TO P_HH2ba, OTHERWISE DISPLAY INCONSISTENCY TEXT LISTED BELOW.

P_HH2c [ PHH2c ] Inconsistent CH age and CH DOB

I have entered ^CHILD's age as ^P_HH2n and birthday as ^ChildDOB. These are inconsistent. I

must have something wrong. Which one do I need to correct?

Question Type: TCkAge, noDK, noRF

dob 1 CORRECT DATE OF BIRTH

age 2 CORRECT AGE

Logic after:

If 1 GOTO P_HH2am-y

If 2 GOTO P_HH2n

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

P_HH2ba [ PHH2ba ] CH sex

(IF UNCLEAR, ASK:) Is ^CHILD a boy or girl?

(THE CONTROL CARD INDICATES THAT THE CHILD IS A ^ChildSex. IF THIS IS NOT

CORRECT, VERIFY THAT YOU ARE ASKING ABOUT THE CORRECT CHILD BEFORE

CONTINUING.)

Question Type: TSexC

male 1 MALE

female 2 FEMALE

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

P_HH2ca [ PHH2cx ] CH current grade

What grade is ^CHILD currently in?

(IF CHILD ON SUMMER BREAK, RECORD GRADE HE/SHE WILL BE IN WHEN SCHOOL

RESUMES. IF CHILD HAS GRADUATED, ENTER CHILD NOT IN SCHOOL)

Question Type: TgradeC

preschool 44 NURSERY SCHOOL/PRESCHOOL/HEAD START

kindergrtn 55 KINDERGARTEN

first 1 FIRST GRADE

second 2 SECOND GRADE

third 3 THIRD GRADE

fourth 4 FOURTH GRADE

fifth 5 FIFTH GRADE

sixth 6 SIXTH GRADE

seventh 7 SEVENTH GRADE

eighth 8 EIGHTH GRADE

ninth 9 NINTH GRADE

tenth 10 TENTH GRADE

eleventh 11 ELEVENTH GRADE

twelfth 12 TWELFTH GRADE

vocatech 13 VOCATIONAL/TECHNICAL

college 14 ANY YEAR OF COLLEGE

ungraded 17 UNGRADED PLACEMENT

notinschool 18 CHILD NOT IN SCHOOL

tooyoung 19 TOO YOUNG FOR SCHOOL

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

Logic before:

IF P_HH2ca = 18, DK or REF, GO TO P_HH2cb; ELSE GO TO P_HH2da

P_HH2cb [ PHH2cb ] Highest grade in school CH has completed

What is the highest grade in school ^CHILD has completed?

Question Type: THH2Grd

preschool 44 NURSERY SCHOOL/PRESCHOOL/HEAD START

kindergrtn 55 KINDERGARTEN

first 1 FIRST GRADE

second 2 SECOND GRADE

third 3 THIRD GRADE

fourth 4 FOURTH GRADE

fifth 5 FIFTH GRADE

sixth 6 SIXTH GRADE

seventh 7 SEVENTH GRADE

eighth 8 EIGHTH GRADE

ninth 9 NINTH GRADE

tenth 10 TENTH GRADE

eleventh 11 ELEVENTH GRADE

twelfth 12 TWELFTH GRADE (GED)

vocatech 13 VOCATIONAL/TECHNICAL

college 14 ANY YEAR OF COLLEGE

ungraded 17 UNGRADED PLACEMENT

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

Logic before:

IF P_HH2ca = 01-12, ASK P_HH2da. ELSE, GOTO P_HH3a.

P_HH2da [ PHH2da ] CH repeated any grades since last interview

Since ^Global.LastInt, has ^CHILD repeated any grades?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If NO GOTO P_HH3a

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

P_HH2e [ PHH2e ] Labels are in Logic After

Which grades has ^Fills.HeShe repeated?

CODE ALL THAT APPLY.

Question Type: TGrdRepS

kindergrtn 55 KINDERGARTEN

first 1 FIRST GRADE

second 2 SECOND GRADE

third 3 THIRD GRADE

fourth 4 FOURTH GRADE

fifth 5 FIFTH GRADE

sixth 6 SIXTH GRADE

seventh 7 SEVENTH GRADE

eighth 8 EIGHTH GRADE

ninth 9 NINTH GRADE

tenth 10 TENTH GRADE

eleventh 11 ELEVENTH GRADE

twelfth 12 TWELFTH GRADE

Question Fill: ^fillheshe

he he

she she

Logic after:

COMPARE GRADES IN P_HH2e TO GRADE IN P_HH2ca. GRADES REPEATED CANNOT BE

HIGHER THAN CURRENT GRADE. IF INCONSISTENT, DISPLAY: I have recorded that ^CHILD is

currently in the ^P_HH2ca but that ^Fills.HeShe repeated ^P_HH2ea. These are inconsistent. I

must have something wrong. Which one do I need to correct?; PHHTG_55 --Which grades has CH

repeated - kindergarten; PHHTG_1 --Which grades has CH repeated - first grade; PHHTG_2 --

Which grades has CH repeated - second grade; PHHTG_3 --Which grades has CH repeated - third

grade; PHHTG_4 --Which grades has CH repeated - fourth grade; PHHTG_5 --Which grades has

CH repeated - fifth grade; PHHTG_6 --Which grades has CH repeated - sixth grade; PHHTG_7 --

Which grades has CH repeated - seventh grade; PHHTG_8 --Which grades has CH repeated -

eighth grade; PHHTG_9 --Which grades has CH repeated - ninth grade; PHHTG_10 --Which grades

has CH repeated - tenth grade; PHHTG_11 --Which grades has CH repeated - eleventh grade;

PHHTG_12 --Which grades has CH repeated - twelfth grade

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

Logic before:

COMPARE GRADES IN P_HH2e TO GRADE IN P_HH2ca. GRADES REPEATED CANNOT BE

HIGHER THAN CURRENT GRADE. IF INCONSISTENT, DISPLAY question and fill incorrect

response text from P_HH2ea.

P_HH2ec [ PHH2ecka ] Inconsistent CH grade and CH repeated grades

I have recorded that ^CHILD is currently in the ^P_HH2ca but that ^Fills.HeShe repeated

^P_HH2e[k]. These are inconsistent. I must have something wrong. Which one do I need to

correct?

Question Type: TPHH2ec

hh2ca 1 CURRENT GRADE

hh2ea 2 REPEATED GRADE(S)

Question Fill: ^fillheshe

he he

she she

Logic after:

If 1 GOTO P_HH2ca;

If 2 GOTO P_HH2e

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

Logic before:

IF AGE < 16, GOTO P_HH4a. Fill: IF WAVE > 1:" What is ^CHILD's marital status? Is

^Fills.HeShe ..." ELSE:"USE CARD 1. Please look at Card 1. What is ^CHILD's marital status?

P_HH3a [ PHH3a ] CH marital status

USE CARD 1. Please look at Card 1.

What is ^CHILD's marital status? Is ^Fills.HeShe...

Question Type: TMarSt2F

married 1 Married,

separated 2 Separated,

divorced 3 Divorced,

widowed 4 Widowed, or

nevermarried 5 Has ^Fills.HeShe never been married?

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

P_HH4a [ PHH4a ] Verify Rs first name

Next, I need to record the first name of each adult living in this household. By "living in this

household" I mean each adult who considers this their current primary residence, or who stays

here at least three nights per week, every week.

Let's start with you. Your first name is ^CAREGIVER1. Is that correct?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If YES GOTO P_HH5

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

P_HH4a1 [ PHH4aa ] Correct Rs first name

What is your first name?

FIRST NAME:

Question Type: string[20]

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

P_HH5BEG [ PHH5BEG ] NoDeliv

PLEASE PRESS "1" TO CONTINUE.

Question Type: BCallCARIRouter

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

Logic before:

FILL IF SECONDARY CAREGIVER HAS BEEN IDENTIFIED IN QP SECTION: In addition to

yourself, I have (FILL NAME OF SECONDARY CAREGIVER FROM QP SECTION).

P_HH5 [ PHH5 ] Labels are in Logic After

What are the first names of the other adults, age 18 or over who live

here?^Fills.P_HH5^CAREGIVER2^Fills.OnlyDot Let's start with the oldest and work down to the

youngest adult in this household. (RECORD ON GRID BELOW. DO NOT ENTER CG NAME

HERE.)

Now, I'd like to know the names of all children and teenagers aged 17 and under living in this

household. Not including ^CHILD, let's start with the oldest and work down to the youngest child

in this household. (DO NOT ENTER THE STUDY CHILD'S NAME HERE.)

Question Type: TStr20a, empty

_20 1 STRING[20]

Question Fill: ^FillP_HH5

cregvr2 ·In addition to yourself, I have·

Logic after:

Allow 10 names with 20 characters each; PHH5_1 --First name of other adult age 18 or over - 1;

PHH5_2 --First name of other adult age 18 or over - 2; PHH5_3 --First name of other adult age 18 or

over - 3; PHH5_4 --First name of other adult age 18 or over - 4; PHH5_5 --First name of other adult

age 18 or over - 5; PHH5_6 --First name of other adult age 18 or over - 6; PHH5_7 --First name of

other adult age 18 or over - 7; PHH5_8 --First name of other adult age 18 or over - 8; PHH5_9 --First

name of other adult age 18 or over - 9; PHH5_10 --First name of other adult age 18 or over - 10

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

P_HH6a [ PHH6ax ] Rs relationship to CH

USE CARD 2. Please look at the list on Card 2. What is your relationship to ^CHILD?

(PROBE TO DETERMINE IF BIOLOGIC, STEP, ADOPTIVE, FOSTER, ETC.)

Question Type: TRlCrd2F

_2 2 MOTHER (BIOLOGICAL)

_3 3 FATHER (BIOLOGICAL)

_4 4 STEP-MOTHER

_5 5 STEP-FATHER

_6 6 ADOPTIVE MOTHER

_7 7 ADOPTIVE FATHER

_8 8 FOSTER MOTHER

_9 9 FOSTER FATHER

_10 10 FULL SISTER

_11 11 FULL BROTHER

_12 12 HALF SISTER

_13 13 HALF BROTHER

_14 14 STEP-SISTER

_15 15 STEP-BROTHER

_16 16 FOSTER SISTER

_17 17 FOSTER BROTHER

_18 18 ADOPTIVE SISTER

_19 19 ADOPTIVE BROTHER

_30 30 AUNT

_31 31 UNCLE

_32 32 GREAT AUNT

_33 33 GREAT UNCLE

_34 34 COUSIN

_40 40 MATERNAL GRANDMOTHER

_41 41 PATERNAL GRANDMOTHER

_42 42 MATERNAL GRANDFATHER

_43 43 PATERNAL GRANDFATHER

_44 44 MATERNAL GREAT-GRANDMOTHER

_45 45 PATERNAL GREAT-GRANDMOTHER

_46 46 MATERNAL GREAT-GRANDFATHER

_47 47 PATERNAL GREAT-GRANDFATHER

_94 94 BABYSITTER

_95 95 OTHER BLOOD RELATIVE

_96 96 OTHER NON-RELATIVE

Logic after:

If 2,3,16,17,18,19 then GO TO P_HH6hm; If 95 then GO TO P_HH6as1; If 96 then GO TO

P_HH6as2; else GO TO P_HH6b

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

Logic before:

IF P_HH6a = 95

P_HH6as1 [ PHH6as1 ] Rs other relative relationship to CH

PLEASE SPECIFY OTHER RELATIVE RELATIONSHIP.

RELATIONSHIP:

Question Type: string[30]

Logic after:

GO TO P_HH6b

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

Logic before:

IF P_HH6a = 96

P_HH6as2 [ PHH6as2 ] Rs other non-relative relationship to CH

PLEASE SPECIFY OTHER NON-RELATIVE RELATIONSHIP.

RELATIONSHIP:

Question Type: string[30]

Logic after:

GO TO P_HH6b

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

Logic before:

If ch_eman = yes (Child is EY) ship P_HH6b

P_HH6b [ PHH6b ] Has R legally adopted CH

Have you legally adopted ^CHILD, that is, have you signed court papers to complete an adoption

process for ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If YES then GO TO P_HH6f; if NO then GO TO P_HH6c

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

P_HH6c [ PHH6c ] Did fstr care/social services agency help

Did anyone from a foster care or social services agency help arrange for you to care for ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

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

P_HH6d [ PHH6d ] Regularly talk CW about CH

Do you regularly talk to a caseworker about ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

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

P_HH6e [ PHH6e ] Currently receive payments for being CHs foster parent

Do you currently receive payments for being ^CHILD's foster parent?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

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

Logic before:

ASK P_HH6f if P_HH6a = 6,7,8 or 9; ELSE GO TO P_HH6hm

P_HH6f [ PHH6f ] Is R related to CH

Are you related to ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If NO then GO TO P_HH6hm

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

P_HH6g [ PHH6g ] Aside from the PHH6a rel, what is your other rel to CHILD

USE CARD 3. Aside from being ^CHILD's ^P_HH6a, what is your relationship to ^CHILD?

Question Type: TRelHH6g

_2 2 MOTHER (BIOLOGICAL)

_3 3 FATHER (BIOLOGICAL)

_10 10 FULL SISTER

_11 11 FULL BROTHER

_12 12 HALF SISTER

_13 13 HALF BROTHER

_14 14 STEP-SISTER

_15 15 STEP-BROTHER

_16 16 FOSTER SISTER

_17 17 FOSTER BROTHER

_18 18 ADOPTIVE SISTER

_19 19 ADOPTIVE BROTHER

_30 30 AUNT

_31 31 UNCLE

_32 32 GREAT AUNT

_33 33 GREAT UNCLE

_34 34 COUSIN

_40 40 MATERNAL GRANDMOTHER

_41 41 PATERNAL GRANDMOTHER

_42 42 MATERNAL GRANDFATHER

_43 43 PATERNAL GRANDFATHER

_44 44 MATERNAL GREAT-GRANDMOTHER

_45 45 PATERNAL GREAT-GRANDMOTHER

_46 46 MATERNAL GREAT-GRANDFATHER

_47 47 PATERNAL GREAT-GRANDFATHER

_95 95 OTHER BLOOD RELATIVE

_96 96 OTHER NON-RELATIVE

Logic after:

IF P_HH6g = 95; GO TO P_HH6gs1; ELSE IF P_HH6g = 96, GO TO P_HH6gs2; ELSE IF P_HH6g

NE 95 OR 96, GO TO P_HH6hm

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

Logic before:

IF P_HH6g = 95

P_HH6gs1 [ PHH6gs1 ] SPECIFY, OTHER RELATIVE RELATIONSHIP

PLEASE SPECIFY OTHER RELATIVE RELATIONSHIP.

RELATIONSHIP:

Question Type: string[30]

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

Logic before:

IF P_HH6g = 96

P_HH6gs2 [ PHH6gs2 ] SPECIFY, OTHER NON-RELATIVE RELATIONSHIP

PLEASE SPECIFY OTHER NON-RELATIVE RELATIONSHIP.

RELATIONSHIP:

Question Type: string[30]

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

P_HH6hm [ PHH7am ] NO LABEL

What is your date of birth?

MONTH

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

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

P_HH6hd [ PHH7ad ] NO LABEL

What is your date of birth?

DAY

Question Type: 1..31

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

P_HH6hy [ PHH7ay ] NO LABEL

What is your date of birth?

YEAR

Question Type: 1913..1996

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

P_HH6hn [ PHH7bb ] Caregivers age

How old are you now?

YEARS OLD

Question Type: 15..95

Logic after:

COMPARE AGE CALCULATED FROM DATE OF BIRTH IN P_HH6hm-y TO AGE REPORTED IN

P_HH6hn. IF AGES AGREE OR INCOMPLETE INFORMATION MAKES THE CHECK

IMPOSSIBLE TO PERFORM, GOTO P_HH6i. IF AGES DISAGREE, FILL: Based on the date of

birth I entered, the computer has calculated that you are FILL CALCULATED AGE FROM

P_HH6hm-y YEARS OLD. This is different from the age I entered for you. Which of these needs

to be corrected? Your date of birth or your age?

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

Logic before:

COMPARE AGE CALCULATED FROM DATE OF BIRTH IN P_HH6hm-y TO AGE REPORTED IN

P_HH6hn. IF AGES AGREE OR INCOMPLETE INFORMATION MAKES THE CHECK

IMPOSSIBLE TO PERFORM, GOTO P_HH6i. IF AGES DISAGREE

P_HH6hc [ PHH7bcka ] age-DOB check

Based on the date of birth I entered, the computer has calculated that you are ^Rage years old.

This is different from the age I entered for you. Which of these needs to be corrected? Your date

of birth or your age?

Question Type: TCkAge, noDK, NoRF

dob 1 CORRECT DATE OF BIRTH

age 2 CORRECT AGE

Logic after:

If 1 GO BACK TO P_HH6hm-y

If 2 GO BACK TO P_HH6hn

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

Logic before:

IF P_HH6a = 2-33, 40-47 sex can be determined so set P_HH6i accordingly and skip P_HH6i

else, ask P_HH7a.

P_HH6i [ PHH8c ] CGs sex

INTERVIEWER: RECORD SEX OF R.

Question Type: TSexC

male 1 MALE

female 2 FEMALE

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

Logic before:

ASK P_HH7a THROUGH P_HH7c FOR EACH PERSON LISTED IN P_HH5. SET NEXT PERSON

LISTED IN P_HH5 AS VARIABLE <PERSON>

P_HH7a [ PHH7a ] Labels are in Logic After

USE CARD 4. Let's talk about ^PERSON. Looking at Card 4, what is ^PERSON's relationship to

^CHILD? (PROBE TO DETERMINE BIOLOGIC, STEP, ADOPTIVE, FOSTER, ETC.)

Question Type: TReld2Ar

_2 2 MOTHER (BIOLOGICAL)

_3 3 FATHER (BIOLOGICAL)

_4 4 STEP-MOTHER

_5 5 STEP-FATHER

_6 6 ADOPTIVE MOTHER

_7 7 ADOPTIVE FATHER

_8 8 FOSTER MOTHER

_9 9 FOSTER FATHER

_10 10 FULL SISTER

_11 11 FULL BROTHER

_12 12 HALF SISTER

_13 13 HALF BROTHER

_14 14 STEP-SISTER

_15 15 STEP-BROTHER

_16 16 FOSTER SISTER

_17 17 FOSTER BROTHER

_18 18 ADOPTIVE SISTER

_19 19 ADOPTIVE BROTHER

_30 30 AUNT

_31 31 UNCLE

_32 32 GREAT AUNT

_33 33 GREAT UNCLE

_34 34 COUSIN

_40 40 MATERNAL GRANDMOTHER

_41 41 PATERNAL GRANDMOTHER

_42 42 MATERNAL GRANDFATHER

_43 43 PATERNAL GRANDFATHER

_44 44 MATERNAL GREAT-GRANDMOTHER

_45 45 PATERNAL GREAT-GRANDMOTHER

_46 46 MATERNAL GREAT-GRANDFATHER

_47 47 PATERNAL GREAT-GRANDFATHER

_94 94 BABYSITTER

_95 95 OTHER BLOOD RELATIVE

_96 96 OTHER NON-RELATIVE

Logic after:

PHH7a_1 --Other adult in HH relationship to CH - 1; PHH7a_2 --Other adult in HH relationship to

CH - 2; PHH7a_3 --Other adult in HH relationship to CH - 3; PHH7a_4 --Other adult in HH

relationship to CH - 4; PHH7a_5 --Other adult in HH relationship to CH - 5; PHH7a_6 --Other adult

in HH relationship to CH - 6; PHH7a_7 --Other adult in HH relationship to CH - 7; PHH7a_8 --Other

adult in HH relationship to CH - 8; PHH7a_9 --Other adult in HH relationship to CH - 9; PHH7a_10 --

Other adult in HH relationship to CH - 10

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

Logic before:

IF P_HH7a = 95

P_HH7as1 [ PHH7as1 ] Labels are in Logic After

PLEASE SPECIFY OTHER RELATIVE RELATIONSHIP.

RELATIONSHIP:

Question Type: Tstr30Ar

_30 1 STRING[30]

Logic after:

PHH7as1_1 --Other adult in HH othr rltve relationship to CH - 1; PHH7as1_2 --Other adult in HH

othr rltve relationship to CH - 2; PHH7as1_3 --Other adult in HH othr rltve relationship to CH - 3;

PHH7as1_4 --Other adult in HH othr rltve relationship to CH - 4; PHH7as1_5 --Other adult in HH

othr rltve relationship to CH - 5; PHH7as1_6 --Other adult in HH othr rltve relationship to CH - 6;

PHH7as1_7 --Other adult in HH othr rltve relationship to CH - 7; PHH7as1_8 --Other adult in HH

othr rltve relationship to CH - 8; PHH7as1_9 --Other adult in HH othr rltve relationship to CH - 9;

PHH7as1_10 --Other adult in HH othr rltve relationship to CH - 10

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

Logic before:

IF P_HH7a = 96

P_HH7as2 [ PHH7as2 ] Labels are in Logic After

PLEASE SPECIFY OTHER NON-RELATIVE RELATIONSHIP.

RELATIONSHIP:

Question Type: Tstr30Ar

_30 1 STRING[30]

Logic after:

PHH7as2_1 --Other adult in HH othr non-rltve relationship to CH - 1; PHH7as2_2 --Other adult in

HH othr non-rltve relationship to CH - 2; PHH7as2_3 --Other adult in HH othr non-rltve relationship

to CH - 3; PHH7as2_4 --Other adult in HH othr non-rltve relationship to CH - 4; PHH7as2_5 --Other

adult in HH othr non-rltve relationship to CH - 5; PHH7as2_6 --Other adult in HH othr non-rltve

relationship to CH - 6; PHH7as2_7 --Other adult in HH othr non-rltve relationship to CH - 7;

PHH7as2_8 --Other adult in HH othr non-rltve relationship to CH - 8; PHH7as2_9 --Other adult in

HH othr non-rltve relationship to CH - 9; PHH7as2_10 --Other adult in HH othr non-rltve relationship

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

P_HH7bn [ PHHGE ] Labels are in Logic After

How old is ^PERSON?

YEARS OLD

Question Type: TInt095Ar

_0_95 1 0..95

Logic after:

PHHGE_1 --Age HH member 1; PHHGE_2 --Age HH member 2; PHHGE_3 --Age HH member 3;

PHHGE_4 --Age HH member 4; PHHGE_5 --Age HH member 5; PHHGE_6 --Age HH member 6;

PHHGE_7 --Age HH member 7; PHHGE_8 --Age HH member 8; PHHGE_9 --Age HH member 9;

PHHGE_10 --Age HH member 10

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

Logic before:

IF P_HH7a = 2-33, 40-47 the sex can be determined so fill P_HH7c appropriately and GOTO

P_HH7 for the next HH member until all have been asked about.

P_HH7c [ PHHEX ] Labels are in Logic After

IF SEX UNCLEAR, ASK: Is ^PERSON male or female?

Question Type: TGenr10F

male 1 MALE

female 2 FEMALE

Logic after:

GO BACK TO P_HH7a UNTIL ALL ROSTER MEMBERS COVERED.; PHHEX_1 --Sex HH

member 1; PHHEX_2 --Sex HH member 2; PHHEX_3 --Sex HH member 3; PHHEX_4 --

Sex HH member 4; PHHEX_5 --Sex HH member 5; PHHEX_6 --Sex HH member 6;

PHHEX_7 --Sex HH member 7; PHHEX_8 --Sex HH member 8; PHHEX_9 --Sex HH

member 9; PHHEX_10 --Sex HH member 10

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

Logic before:

DISPLAY SUMMARY SCREEN LISTING ALL MEMBERS OF HOUSEHOLD.

P_HH7d [ PHH7D ] NoDeliv

INTERVIEWER: VERIFY HOUSEHOLD ROSTER.

RESPONDENT: ^main_case.sj_first, AGE: ^P_HH6hn, SEX: ^P_HH6i

CHILD: ^Global.Child, AGE: ^ChildAge, SEX: ^Global.Sex

^HHRoster

Question Type: TCH30F, noDK, NoRF

cont 1 CONTINUE

change 2 MAKE CHANGES

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

Logic before:

IF ALL OTHER HH MEMBERS ARE AGES 0-17 GO TO P_HH9a; ELSE, GO TO HH8aa. IF A 2nd

CG WAS IDENTIFIED IN CID AND CONFIRMED IN NP SECTION, ASK HH8aa.

P_HH8aa [ PHH8aa ] Other adult in HH responsible for CH

Aside from yourself, is there another adult in the household who is responsible for ^CHILD's

health, education and well-being?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If NO then GO TO P_HH9a

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

Logic before:

DISPLAY LIST OF ADULT (P_HH7bn GE 18 OR P_HH7bn UNKNOWN) HOUSEHOLD MEMBERS

FROM P_HH5, INCLUDING 2ND CG IDENTIFIED IN CID AND CONFIRMED IN NP SECTION.

P_HH8ab [ PHH8ab ] Name of other adult in HH responsible for CH

Who is that person?

(CODE ENTRY FROM LIST OF NAMES BELOW)

IF MORE THAN ONE OTHER ADULT IN HOUSEHOLD (BESIDES R) THAT IS RESPONSIBLE

FOR CHILD, ASK FOR ADULT WHO IS MOST RESPONSIBLE

Question Type: TRosList

_1 1 ^Global.Adult[1]

_2 2 ^Global.Adult[2]

_3 3 ^Global.Adult[3]

_4 4 ^Global.Adult[4]

_5 5 ^Global.Adult[5]

_6 6 ^Global.Adult[6]

_7 7 ^Global.Adult[7]

_8 8 ^Global.Adult[8]

_9 9 ^Global.Adult[9]

_10 10 ^Global.Adult[10]

Logic after:

Fill LIST: 1 = FILL FIRST NAME FROM P_HH5 LINE 1 AND AGE FROM P_HH7bn, etc. DEFINE

CAREGIVER2 AS PERSON IDENTIFIED IN P_HH8ab

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

Logic before:

IF P_HH7a FOR CAREGIVER2 = 2,3,16,17,18 or 19, GO TO P_HH8f; ELSE GO TO P_HH8b

P_HH8b [ PHH8b ] Has CG legally adopted CH

Has ^CAREGIVER2 legally adopted ^CHILD, that is, has ^Fills.HeShe signed court papers to

complete an adoption process for ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If YES then GO TO P_HH8f

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

Logic before:

IF P_HH6c = 1 OR P_HH6d = 1 OR P_HH6e = 1; GO TO P_HH8f; ELSE ASK P_HH8c

P_HH8c [ PHH8b2 ] Foster care/soc serv agency hlp arrng CAREGIVER2 for CHILD?

Did anyone from a foster care or social services agency help arrange for ^CAREGIVER2 to care

for ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

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

P_HH8d [ PHH8d ] Does CG regularly talk to caseworker about CH

Does ^CAREGIVER2 regularly talk to a caseworker about ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

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

P_HH8e [ PHH8e ] Does CG rcv payments for bing CHs foster parent

I understand that ^CAREGIVER2 is ^CHILD's ^CAREGIVER2_Rel.

Does ^CAREGIVER2 currently receive any payments for being ^CHILD's foster parent?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

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

Logic before:

ASK P_HH8f if P_HH7a = 6,7,8 or 9; ELSE GO TO P_HH8hm

P_HH8f [ PHH8f ] Is CG related to CH

Is ^CAREGIVER2 related to ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If NO then GO TO P_HH8hm

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

Logic before:

if P_HH7a = 6,7,8 or 9 set fills.p_hh8g to _6, _7, _8, _9 (adoptive or foster mom or dad)

P_HH8g [ PHH8g ] Aside from the P_HH8g rel, what is CARGIVER2s rel to CHILD

USE CARD 5. Aside from being ^CHILD's ^Fills.P_HH8g, what is ^CAREGIVER2's relationship to

^CHILD?

Question Type: TRelHH6g

_2 2 MOTHER (BIOLOGICAL)

_3 3 FATHER (BIOLOGICAL)

_10 10 FULL SISTER

_11 11 FULL BROTHER

_12 12 HALF SISTER

_13 13 HALF BROTHER

_14 14 STEP-SISTER

_15 15 STEP-BROTHER

_16 16 FOSTER SISTER

_17 17 FOSTER BROTHER

_18 18 ADOPTIVE SISTER

_19 19 ADOPTIVE BROTHER

_30 30 AUNT

_31 31 UNCLE

_32 32 GREAT AUNT

_33 33 GREAT UNCLE

_34 34 COUSIN

_40 40 MATERNAL GRANDMOTHER

_41 41 PATERNAL GRANDMOTHER

_42 42 MATERNAL GRANDFATHER

_43 43 PATERNAL GRANDFATHER

_44 44 MATERNAL GREAT-GRANDMOTHER

_45 45 PATERNAL GREAT-GRANDMOTHER

_46 46 MATERNAL GREAT-GRANDFATHER

_47 47 PATERNAL GREAT-GRANDFATHER

_95 95 OTHER BLOOD RELATIVE

_96 96 OTHER NON-RELATIVE

Question Fill: ^FillP_HH8g

_6 ADOPTIVE MOTHER

_7 ADOPTIVE FATHER

_8 FOSTER MOTHER

_9 FOSTER FATHER

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

Logic before:

IF P_HH8g = 95

P_HH8gs1 [ PHH8gs1 ] SPECIFY, OTHER RELATIVE RELATIONSHIP

PLEASE SPECIFY OTHER RELATIVE RELATIONSHIP.

RELATIONSHIP:

Question Type: string[30]

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

Logic before:

IF P_HH8g = 96

P_HH8gs2 [ PHH8gs2 ] SPECIFY, OTHER NON-RELATIVE RELATIONSHIP

PLEASE SPECIFY OTHER NON-RELATIVE RELATIONSHIP.

RELATIONSHIP:

Question Type: string[30]

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

P_HH8hm [ PHH8hm ] CAREGIVER2s date of birth - MONTH

What is ^CAREGIVER2's date of birth?

MONTH

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

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

P_HH8hd [ PHH8hd ] CAREGIVER2s date of birth - DAY

What is ^CAREGIVER2's date of birth?

DAY

Question Type: 1..31

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

P_HH8hy [ PHH8hy ] CAREGIVER2s date of birth - YEAR

What is ^CAREGIVER2's date of birth?

YEAR

Question Type: 1913..1996

Logic after:

COMPARE AGE CALCULATED FROM DATE OF BIRTH IN P_HH8hm-y TO AGE REPORTED IN

P_HH7bn. IF AGES AGREE OR INCOMPLETE INFORMATION MAKES THE CHECK

IMPOSSIBLE TO PERFORM, GOTO P_HH9a. IF AGES DISAGREE, FILL: Based on the date of

birth I entered, the computer has calculated that CAREGIVER2 is FILL CALCULATED AGE FROM

P_HH8hm-y YEARS OLD. This is different from the age I entered for (him/her). Which of these

needs to be corrected? (His/Her) date of birth or (his/her) age?

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

Logic before:

COMPARE AGE CALCULATED FROM DATE OF BIRTH IN P_HH8hm-y TO AGE REPORTED IN

P_HH7bn. IF AGES AGREE OR INCOMPLETE INFORMATION MAKES THE CHECK

IMPOSSIBLE TO PERFORM, GOTO P_HH9a. IF AGES DISAGREE

P_HH8i [ PHH8i ] CAREGIVER2 date of birth and age do not match

Based on the date of birth I entered, the computer has calculated that ^CAREGIVER2 is ^RAge

years old. This is different from the age I entered for ^Fills.HimHer. Which of these needs to be

corrected? ^Fills.HisHer date of birth or ^Fills.HisHer age?

Question Type: TCkAge, NoDK, NoRF

dob 1 CORRECT DATE OF BIRTH

age 2 CORRECT AGE

Logic after:

If 1 GO BACK TO P_HH8hm-y

If 2 GO BACK TO P_HH8hn

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

Logic before:

IF RESPONDENT OR CAREGIVER2 IS BIOLOGICAL PARENT (P_HH6a = 2,3 OR P_HH6g = 2,3

OR P_HH7a = 2,3 OR P_HH8g = 2,3) OR RESPONDENT OR CAREGIVER2 IS ADOPTIVE HAS

ADOPTED CHILD (P_HH6b = 1 OR P_HH8b = 1), GO TO HH11a; ELSE ASK P_HH9a - P_HH10A

P_HH9a [ PHH9a ] Are you CHs LG

Are you ^CHILD's legal guardian?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If YES then GO TO P_HH10a

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

Logic before:

IF NO CAREGIVER2, GO TO P_HH9d

P_HH9c [ PHH9c ] Is CG CHs LG

Is ^CAREGIVER2 ^CHILD's legal guardian?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

IF YES then GO TO P_HH10a

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

P_HH9d [ PHH9d ] Does CH have a LG living in the HH

Does ^CHILD have a legal guardian living in the household?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If NO then GO TO P_HH10a

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

Logic before:

DISPLAY LIST OF HOUSEHOLD MEMBERS FROM P_HH5: 1 = FILL FIRST NAME FROM

P_HH5 LINE 1, etc

P_HH9e [ PHH9e ] Who is CHs LG

Who is ^CHILD's legal guardian?

(CODE ENTRY FROM LIST OF NAMES BELOW)

Question Type: TRosList

_1 1 ^Global.Adult[1]

_2 2 ^Global.Adult[2]

_3 3 ^Global.Adult[3]

_4 4 ^Global.Adult[4]

_5 5 ^Global.Adult[5]

_6 6 ^Global.Adult[6]

_7 7 ^Global.Adult[7]

_8 8 ^Global.Adult[8]

_9 9 ^Global.Adult[9]

_10 10 ^Global.Adult[10]

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

P_HH10a [ PHH10a ] Consider your home to be CHs permanent home

Do you consider your home to be ^CHILD's permanent home?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

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

P_HH11a [ PHH12a ] Rs marital status

USE CARD 6. Now I have a few more questions about you. Please look at Card 6. Are you

currently...

NOTE: "MARRIED" CAN INCLUDE LEGAL AND COMMON LAW MARRIAGES, DEPENDING ON

Question Type: TMStat

married 1 Married,

separated 2 Separated,

divorced 3 Divorced,

widowed 4 Widowed, or

nevermarried 5 Have you never been married?

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

Logic before:

IF P_HH5 IS BLANK, THAT IS "R LIVES ALONE", GO TO HH15a; ASK P_HH12a FOR EACH

PERSON LISTED IN P_HH5. SET NEXT PERSON LISTED IN P_HH5 AS VARIABLE <PERSON>

P_HH12a [ PHH12x ] Labels are in Logic After

USE CARD 7. Please look at the list on Card 7. What is ^PERSON's relationship to you?

Question Type: TReHH12a

_1 1 SPOUSE

_2 2 UNMARRIED PARTNER, BOYFRIEND/GIRLFRIEND

_3 3 CHILD (BIOLOGICAL)

_4 4 CHILD (ADOPTIVE)

_5 5 CHILD (STEP)

_6 6 CHILD (FOSTER)

_7 7 GRANDCHILD

_8 8 MOTHER (BIRTH/ADOPTIVE/STEP/FOSTER/OTHER)

_9 9 FATHER (BIRTH/ADOPTIVE/STEP/FOSTER/OTHER)

_10 10 BROTHER/SISTER

_11 11 GRANDFATHER/GRANDMOTHER

_12 12 NIECE/NEPHEW

_13 13 AUNT/UNCLE

_14 14 COUSIN

_15 15 GREAT GRANDCHILD

_16 16 HOUSEMATE/ROOMMATE

_17 17 ROOMER/BOARDER

_18 18 OTHER RELATIVE

_19 19 OTHER NONRELATIVE

_20 20 UNRELATED LEGAL GUARDIAN

Logic after:

IF P_HH12a = 18 GO TO P_HH12as1; ELSE IF P_HH12a = 19, GO TO P_HH12as2; ELSE

CONTINUE TO NEXT PERSON UNTIL ALL RELATIONSHIPS TO R HAVE BEEN DETERMINED;

THEN GO TO P_HH13am; PHH12x_1 --R 2 marital status; PHH12x_2 --R 3 marital status;

PHH12x_3 --R 4 marital status; PHH12x_4 --R 5 marital status; PHH12x_5 --R 6 marital status;

PHH12x_6 --R 7 marital status; PHH12x_7 --R 8 marital status; PHH12x_8 --R 9 marital status;

PHH12x_9 --R 10 marital status; PHH12x_10 --R 11 marital status

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

Logic before:

IF P_HH12a = 18

P_HH12as1 [ PHH12as1 ] Labels are in Logic After

PLEASE SPECIFY OTHER RELATIVE RELATIONSHIP.

RELATIONSHIP:

Question Type: Tstr30Ar

_30 1 STRING[30]

Logic after:

PHH12as1_1 --Other relative 2 reltionship; PHH12as1_2 --Other relative 3 reltionship; PHH12as1_3

--Other relative 4 reltionship; PHH12as1_4 --Other relative 5 reltionship; PHH12as1_5 --Other

relative 6 reltionship; PHH12as1_6 --Other relative 7 reltionship; PHH12as1_7 --Other relative 8

reltionship; PHH12as1_8 --Other relative 9 reltionship; PHH12as1_9 --Other relative 10 reltionship;

PHH12as1_10 --Other relative 11 reltionship

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

Logic before:

IF P_HH12a = 19

P_HH12as2 [ PHH12as2 ] Labels are in Logic After

PLEASE SPECIFY OTHER NON-RELATIVE RELATIONSHIP.

RELATIONSHIP:

Question Type: Tstr30Ar

_30 1 STRING[30]

Logic after:

PHH12as2_1 --Other non-relative 2 reltionship; PHH12as2_2 --Other non-relative 3 reltionship;

PHH12as2_3 --Other non-relative 4 reltionship; PHH12as2_4 --Other non-relative 5 reltionship;

PHH12as2_5 --Other non-relative 6 reltionship; PHH12as2_6 --Other non-relative 7 reltionship;

PHH12as2_7 --Other non-relative 8 reltionship; PHH12as2_8 --Other non-relative 9 reltionship;

PHH12as2_9 --Other non-relative 10 reltionship; PHH12as2_10 --Other non-relative 11 reltionship

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

Logic before:

IF SPOUSE HAS BEEN IDENTIFIED (P_HH12a = 1), ASK P_HH13am - ay; ELSE GO TO

P_HH13am [ PHH13bm ] NO LABEL

What is your spouse's date of birth?

MONTH

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

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

P_HH13ad [ PHH13bd ] NO LABEL

What is your spouse's date of birth?

DAY

Question Type: 1..31

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

P_HH13ay [ PHH13by ] NO LABEL

What is your spouse's date of birth?

YEAR

Question Type: 1913..1993

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

Logic before:

ASK P_HH15A -- P_HH29E FOR RESPONDENT - ASK P_HH15AC -- P_HH29EC FOR

CAREGIVER2

P_HH15a [ PHH15x ] Rs highest degree

USE CARD 8. Please look at Card 8. What is the highest grade in school you have completed?

Please include vocational or technical training and any years in college you may have completed.

Question Type: TGraH15F

LESS 0 LESS THAN FIRST GRADE

FIRST 1 FIRST GRADE

SECON 2 SECOND GRADE

THIRD 3 THIRD GRADE

FOURT 4 FOURTH GRADE

FIFTH 5 FIFTH GRADE

SIXTH 6 SIXTH GRADE

SEVEN 7 SEVENTH GRADE

EIGHT 8 EIGHTH GRADE

NINTH 9 NINTH GRADE

TENTH 10 TENTH GRADE

ELEVE 11 ELEVENTH GRADE

TWELFTH 12 TWELFTH GRADE

VOCATIO 13 VOCATIONAL/TECHNICAL

SOMECOL 14 SOME COLLEGE CREDIT, LESS THAN 1 YEAR

col1_3 15 1 TO 3 YEARS OF COLLEGE

col4MO 16 4 OR MORE YEARS OF COLLEGE

UNGRAD 17 UNGRADED PLACEMENT

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

P_HH16a [ PHH16x ] Rs highest grade completed

USE CARD 9. Please look at Card 9. What is the highest degree, diploma, or certificate you hold?

Question Type: TGraH16F

NONE 1 NONE

HIGH 2 HIGH SCHOOL EQUIVALENCY (for example: GED)

H_S 3 H.S. DIPLOMA

VOCA 4 VOCATIONAL TECH CERTIFICATE/DIPLOMA (for example: DENTAL

TECHNICIAN, COSMETOLOGY LICENSE, ETC.)

NURS 5 NURSING DIPLOMA/CERTIFICATE

ASSO 6 ASSOCIATE DEGREE (for example: AA, AS, ASN)

BACH 7 BACHELOR'S DEGREE (for example: BA, AB, BS, BSN)

MAST 8 MASTERS DEGREE (for example MA, MS, MEng, Med, MSW, MBA)

GRAD 9 GRADUATE OR PROFESSIONAL DEGREE (for example MD, DDS,

DVM, LLB, JD, PhD, EdD)

OTHER 10 OTHER

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

P_HH17a [ PHH17a ] R currently enrolled in school

Are you currently enrolled in school?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

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

P_HH18n [ PHH18a ] Rs # bio children

How many children have you ^Fills.P_HH18?

NUMBER OF BIRTHS:

Question Type: 0..20

Question Fill: ^fillP_HH18

male fathered

female given birth to

Logic after:

FILL BASED ON SUBJECT'S SEX: given birth to/fathered

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

P_HH21a [ PHH21a ] Rs current employment situation

USE CARD 10. Please look at Card 10. Which of the categories on the card best describes your

current employment situation?

NOTE: DO NOT INCLUDE VOLUNTEER WORK (ONLY "PAID" WORK.)

Question Type: TWKCRD6F

_1 1 REGULARLY WORK FULL-TIME, 35 OR MORE HOURS/WEEK

_2 2 REGULARLY WORK PART-TIME, LESS THAN 35 HOURS/WEEK

_3 3 WORK SOMETIMES, WHEN WORK'S AVAILABLE

_4 4 UNEMPLOYED, LOOKING FOR WORK

_5 5 DON'T WORK BECAUSE OF FAMILY RESPONSIBILITIES

_6 6 DON'T WORK BECAUSE RETIRED

_7 7 DON'T WORK BECAUSE OF ILLNESS OR DISABILITY

_8 8 DON'T WORK BECAUSE DON'T WANT TO WORK

_9 9 DON'T WORK BECAUSE CURRENTLY A STUDENT

_10 10 OTHER

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

Logic before:

IF P_HH21a = 1-2 GO TO P_HH24a; ELSE, CONTINUE.

P_HH22a [ PHH22a ] R worked for pay in last 6 mos

Have you worked for pay any time in the @blast 6 months@b?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If NO then GOTO P_HH26ac

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

P_HH23a [ PHH23x ] Rs last job/occupation

USE CARD 11. Please look at Card 11 and tell me which of the categories best describes your

@blast@b job or occupation.

Question Type: TJobCard

_1 1 CLERICAL

_2 2 CRAFTSPERSON

_3 3 FARMER, FARM MANAGER

_4 4 LABORER

_5 5 MANAGER, ADMINISTRATOR

_6 6 MILITARY

_7 7 OPERATOR

_8 8 OWNER, PROPRIETOR

_9 9 PROFESSIONAL 1

_10 10 PROFESSIONAL 2

_11 11 PROTECTIVE SERVICE

_12 12 SALES

_13 13 SCHOOL TEACHER

_14 14 SERVICE WORKER

_15 15 TECHNICAL

_16 16 OTHER

Logic after:

GOTO P_HH26a

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

P_HH24a [ PHH24a ] R currently has >1 job?

Do you @bcurrently@b have more than one job?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

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

Logic before:

IF HH24a=1, FILL: @bmain@b

P_HH25a [ PHH25x ] Rs main job/occupation

USE CARD 11. Please look at Card 11 and tell me which of the categories best describes the

kind of work that you do on your^Fills.P_HHmain job?

Question Type: TJobCard

_1 1 CLERICAL

_2 2 CRAFTSPERSON

_3 3 FARMER, FARM MANAGER

_4 4 LABORER

_5 5 MANAGER, ADMINISTRATOR

_6 6 MILITARY

_7 7 OPERATOR

_8 8 OWNER, PROPRIETOR

_9 9 PROFESSIONAL 1

_10 10 PROFESSIONAL 2

_11 11 PROTECTIVE SERVICE

_12 12 SALES

_13 13 SCHOOL TEACHER

_14 14 SERVICE WORKER

_15 15 TECHNICAL

_16 16 OTHER

Question Fill: ^FillP_HHmain

main @b·main@b

Logic after:

IF P_HH25a = 16, GO TO P_HH25as; ELSE GO TO P_HH26a

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

P_HH25as [ PHH25as ] What do you do on your main job

What do you do on your^Fills.P_HHmain job?

Question Type: string[80]

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

P_HH26a [ PHH26x ] R Spanish/Hispanic/Latino

Are you Spanish, Hispanic, or Latino?

Question Type: TRaceGrp

no 1 No, not Spanish/Hispanic/Latino

mex 2 Yes, Mexican, Mexican-American, Chicano

pr 3 Yes, Puerto Rican

cuba 4 Yes, Cuban

other 5 Yes, Other

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

P_HH27a [ PHH27a ] Labels are in Logic After

USE CARD 12. Please look at Card 12. What is your race? You may pick one or more groups

from the card.

Question Type: TRaceC

amerind 1 AMERICAN INDIAN OR ALASKA NATIVE

asian 2 ASIAN

black 3 BLACK OR AFRICAN AMERICAN

pacislandr 4 NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER

white 5 WHITE

Logic after:

PHH7TG_1 --CCG Amer Indian/Alaskan Native; PHH7TG_2 --CCG Asian; PHH7TG_3 --CCG Black

or African American; PHH7TG_4 --CCG Native Hawaiian/othr Pac Islander; PHH7TG_5 --CCG

White; PHH7TG_7 --CCG Race DK; PHH7TG_8 --CCG Race RF

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

P_HH28a [ PHH28a ] R born in the US

Were you born in the United States? The United States includes the 50 states and the District of

Columbia, but not US territories.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If NO then GOTO P_HH28a3

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

P_HH28a1 [ PHH28ac ] NO LABEL

In what city and state were you born?

CITY:

Question Type: string[30]

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

P_HH28a2 [ PHH28as ] NO LABEL

STATE:

Question Type: string[2]

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

Logic before:

ASK IF P_HH28a = 2

P_HH28a3

In what country were you born?

MEXICO..................................................................................................1

GUATEMALA..........................................................................................2

CUBA.....................................................................................................3

DOMINICAN REPUBLIC........................................................................................ ... 4

INDIA......................................................................................................5

CHINA....................................................................................................6

PHILIPPINES.........................................................................................7

JAPAN....................................................................................................8

KOREA...................................................................................................9

VIETNAM...............................................................................................10

GUAM.....................................................................................................11

SAMOA..................................................................................................12

OTHER (SPECIFY)................................................................................13

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

P_HH29n [ PHH29a ] Total years R lived in US

How many years all together have you been living in the U.S.?

(COUNT THE SUM OF ALL TIME SPENT IN THE U.S., EVEN IF NOT CONTINUOUS.)

YEARS:

Question Type: 0..95

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

P_HH29d [ PHH29d ] R a citizen of the US

Are you a citizen of the United States?

Question Type: TWhBorn

_1 1 Yes, born in the United States

_2 2 Yes, born in Puerto Rico, Guam, the U.S. Virgin Islands, or Northern

Marianas

_3 3 Yes, born abroad of American parent or parents

_4 4 Yes, U.S. citizen by naturalization

_5 5 No, not a citizen of the United States

Logic after:

If 1 then goto P_HHd1;

If 2,3,4 then GOTO P_HH30a;

If 5 then GOTO P_HH29e

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

Logic before:

EVALUATE RESPONSES TO P_HH28a AND P_HH29d FOR CONSISTENCY. IF HH28a = 1 and

29d = 1, GO TO P_HH30a, IF HH28a = NO and HH29d = 1 DISPLAY INCONSISTENCY TEXT

LISTED BELOW

P_HH29d1 [ PHH29d1 ] Confirm R born in the US

I previously entered that you were not born in the United States and now have entered that you are

a citizen of the United States because you were born in the United States. These are

inconsistent. I must have something wrong. Which one do I need to correct?

Question Type: TckHH29d

_1 1 CHANGE BORN IN US

_2 2 CHANGE CITIZEN ANSWER

Logic after:

If = 1, GOTO P_HH28a;

If = 2, GOTO P_HH29d

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

P_HH29e [ PHH29e ] R legal resident of US-green crd/visa/lgl imgr doc

Are you a legal resident of the US, that is, do you have a green card, a working visa permit or

GH - GROUP HOME HOUSEHOLD ROSTER

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

Logic before:

IF P_NP10a = 4, COMPLETE SECTION GH. ELSE, ADMINISTER OTHER HOUSEHOLD

ROSTER MODULE (SECTION HH). Fill: IF WAVE = 1: I'd like to begin by asking some questions

about you,/Else: I'd like to begin by updating some of the information in our records about you,

P_GH1a [ PGH1F ] CH First Name

^Fills.P_GH1a ^CHILD, and other residents of this group home.

What is ^CHILD's full legal name now?

First:

Question Type: string[20]

Question Fill: ^FillP_GH1a

wave1 I'd like to begin by asking some questions about you,

wavemore1 I'd like to begin by updating some of the information in our records about

you,

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

P_GH1b [ PGH1M ] CH Middle Name

What is ^CHILD's full legal name now?

Middle:

Question Type: string[20], empty

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

P_GH1c [ PGH1L ] CH Last Name

What is ^CHILD's full legal name now?

Last:

Question Type: string[20]

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

P_GH2n [ PGH2a ] CH Age in Years

How old is ^CHILD?

AGE

Question Type: 0..18

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

P_GH3m [ PGH3m ] CH Birth Month

When was ^CHILD born?

MONTH

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

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

P_GH3d [ PGH3d ] CH Birth Day of Month

When was ^CHILD born?

DAY

Question Type: 1..31

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

P_GH3y [ PGH3y ] CH Birth Year

When was ^CHILD born?

YEAR

Question Type: 1990..2013

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

Logic before:

EVALUATE RESPONSES TO P_GH2n AND P_GH3m-y FOR CONSISTENCY. IF CONSISTENT,

GO TO P_GH4a; OTHERWISE DISPLAY INCONSISTENCY TEXT LISTED BELOW.

P_GH4c [ PGH4c ] Confirm CHs age

I have entered ^CHILD's age as ^P_GH2n and birthday as ^ChildDOB. These are inconsistent. I

must have something wrong. Which one do I need to correct?

Question Type: TCkAge

dob 1 CORRECT DATE OF BIRTH

age 2 CORRECT AGE

Logic after:

if age GOTO P_GH2n; If dob GOTO P_GH3m-y

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

P_GH4a [ PGH4a ] Is CH male or female

(IF UNCLEAR, ASK:) Is ^CHILD a boy or girl?

(THE CONTROL CARD INDICATES THAT THE CHILD IS A ^ChildSex. IF THIS IS NOT

CORRECT, VERIFY THAT YOU ARE ASKING ABOUT THE CORRECT CHILD BEFORE

CONTINUING.)

Question Type: TSexC, NoDK, NoRF

male 1 MALE

female 2 FEMALE

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

P_GH5m [ PGH5m ] Month CH began living in facility

In what month and year did ^CHILD begin living here?

(NOTE: IF CHILD HAS HAD MULTIPLE PLACEMENTS IN THE FACILITY, RECORD THE DATE

THE MOST RECENT PLACEMENT OCCURRED.)

MONTH

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

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

P_GH5y [ PGH5y ] Year CH began living in facility

In what month and year did ^CHILD begin living here?

(NOTE: IF CHILD HAS HAD MULTIPLE PLACEMENTS IN THE FACILITY, RECORD THE DATE

THE MOST RECENT PLACEMENT OCCURRED.)

YEAR

Question Type: 1990..2013

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

P_GH6a [ PGH6x ] CH current school grade

What grade is ^CHILD currently in?

FR NOTE: REMOTE LEARNING, SUCH AS ATTENDING SCHOOL ONLINE COUNTS AS BEING ENROLLED.

(IF CHILD ON SUMMER BREAK, RECORD GRADE HE/SHE WILL BE IN WHEN SCHOOL

RESUMES. IF CHILD HAS GRADUATED, ENTER CHILD NOT IN SCHOOL.)

Question Type: TgradeC

preschool 44 NURSERY SCHOOL/PRESCHOOL/HEAD START

kindergrtn 55 KINDERGARTEN

first 1 FIRST GRADE

second 2 SECOND GRADE

third 3 THIRD GRADE

fourth 4 FOURTH GRADE

fifth 5 FIFTH GRADE

sixth 6 SIXTH GRADE

seventh 7 SEVENTH GRADE

eighth 8 EIGHTH GRADE

ninth 9 NINTH GRADE

tenth 10 TENTH GRADE

eleventh 11 ELEVENTH GRADE

twelfth 12 TWELFTH GRADE

vocatech 13 VOCATIONAL/TECHNICAL

college 14 ANY YEAR OF COLLEGE

ungraded 17 UNGRADED PLACEMENT

notinschool 18 CHILD NOT IN SCHOOL

tooyoung 19 TOO YOUNG FOR SCHOOL

Logic after:

IF P_GH6a = 18, DK or REF, GO TO P_GH6aa; ELSE GO TO P_GH7a

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

P_GH6aa [ PGH6aa ] Highest grade CH completed?

What is the highest grade in school ^CHILD has completed?

Question Type: THH2Grd

preschool 44 NURSERY SCHOOL/PRESCHOOL/HEAD START

kindergrtn 55 KINDERGARTEN

first 1 FIRST GRADE

second 2 SECOND GRADE

third 3 THIRD GRADE

fourth 4 FOURTH GRADE

fifth 5 FIFTH GRADE

sixth 6 SIXTH GRADE

seventh 7 SEVENTH GRADE

eighth 8 EIGHTH GRADE

ninth 9 NINTH GRADE

tenth 10 TENTH GRADE

eleventh 11 ELEVENTH GRADE

twelfth 12 TWELFTH GRADE (GED)

vocatech 13 VOCATIONAL/TECHNICAL

college 14 ANY YEAR OF COLLEGE

ungraded 17 UNGRADED PLACEMENT

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

Logic before:

IF AGE < 16, GOTO P_GH8n.

P_GH7a [ PGH7a ] CH Marital Status

USE CARD 1. Please look at Card 1. What is ^CHILD's marital status? Is ^Fills.HeShe...

Question Type: TMarSt2F

married 1 Married,

separated 2 Separated,

divorced 3 Divorced,

widowed 4 Widowed, or

nevermarried 5 Has ^Fills.HeShe never been married?

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

P_GH8n [ PGH8a ] # Adults resp for CH care in 24hr period

How many adults, in total, are regularly responsible for ^CHILD's care during a 24 hour period?

ADULTS

Question Type: 0..40

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

P_GH9a [ PGH9a ] CH siblings living in facility

Do any of ^CHILD's siblings live in this facility?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if NO GOTO P_GH11n

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

P_GH10n [ PGH10a ] # CH siblings living in facility

How many?

NUMBER:

Question Type: 0..20

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

P_GH11n [ PGH11a ] Total # children living in facility

In total, how many children live in the facility?

(RECORD THE TOTAL NUMBER OF CHILDREN IN THE HOME/FACILITY, NOT JUST THOSE

LIVING IN THE COTTAGE OR ON THE SAME FLOOR WITH THE CHILD.)

NUMBER:

Question Type: 0..100

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

P_GH12n [ PGH12a ] # children living w/CH in residence/cottage

How many children live in the cottage/residence with ^CHILD?

NUMBER

Question Type: 0..100

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

Logic before:

IF P_GH12n > 8, GOTO P_GH16a. ELSE, ASK P_GH13.

P_GH13 [ PGH13 ] Labels are in Logic After

What are the first names of the children who share ^CHILD's housing unit. Let's start with the

oldest and work our way down to the youngest. (RECORD ON GRID BELOW.)

(DO NOT ENTER THE STUDY CHILD'S NAME HERE.)

FIRST NAME:

Question Type: TStr20Ar8, Empty

Logic after:

SCREEN REPEATS UNTIL RESPONDENT INDICATES THERE ARE NO OTHER HOUSEHOLD

MEMBERS.; PGHMEM_1 --Name of other resident child #1; PGHMEM_2 --Name of other resident

child #2; PGHMEM_3 --Name of other resident child #3; PGHMEM_4 --Name of other resident child

#4; PGHMEM_5 --Name of other resident child #5; PGHMEM_6 --Name of other resident child #6;

PGHMEM_7 --Name of other resident child #7; PGHMEM_8 --Name of other resident child #8

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

Logic before:

REPEAT P_GH14n TO P_GH15a UNTIL ALL ROSTER MEMBERS IN P_GH13 ARE COVERED.

P_GH14n [ PGH14n ] Labels are in Logic After

How old is ^Person?

YEARS OLD

Question Type: Tint0_18Ar

_0_18 1 0..18

Logic after:

PGHAGE_1 --Age of other res child #1; PGHAGE_2 --Age of other res child #2; PGHAGE_3 --Age

of other res child #3; PGHAGE_4 --Age of other res child #4; PGHAGE_5 --Age of other res child

#5; PGHAGE_6 --Age of other res child #6; PGHAGE_7 --Age of other res child #7; PGHAGE_8 --

Age of other res child #8

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

P_GH15a [ PGH15a ] Labels are in Logic After

IF SEX UNCLEAR, ASK: Is ^Person male or female?

Question Type: TGenr10F

male 1 MALE

female 2 FEMALE

Logic after:

PGHSEX_1 --Sex of other res child #1; PGHSEX_2 --Sex of other res child #2; PGHSEX_3 --

Sex of other res child #3; PGHSEX_4 --Sex of other res child #4; PGHSEX_5 --Sex of

other res child #5; PGHSEX_6 --Sex of other res child #6; PGHSEX_7 --Sex of other res

child #7; PGHSEX_8 --Sex of other res child #8

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

Logic before:

DISPLAY SUMMARY SCREEN LISTING ALL MEMBERS OF HOUSEHOLD.

P_GH15c [ PGH15c ] NoDeliv

INTERVIEWER: VERIFY HOUSEHOLD ROSTER.

RESPONDENT: ^main_case.sj_first

CHILD: ^Global.Child, AGE: ^ChildAge, SEX: ^Global.Sex

^HHRoster

Question Type: TCH30F, noDK, NoRF

cont 1 CONTINUE

change 2 MAKE CHANGES

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

P_GH16a [ PGH16a ] R name correct

Next, I need to record some information about you. Your first name is ^CAREGIVER1. Is that

correct?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If YES GOTO P_GH18m

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

P_GH17 [ PGH17a ] R first name

What is your first name?

FIRST NAME:

Question Type: string[20]

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

P_GH18m [ PGH18m ] R Birth Month

What is your date of birth?

MONTH

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

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

P_GH18d [ PGH18d ] R Birth Day of Month

What is your date of birth?

DAY

Question Type: 1..31

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

P_GH18y [ PGH18y ] R Birth Year

What is your date of birth?

YEAR

Question Type: 1913..1990

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

P_GH19n [ PGH19a ] R Current Age

How old are you now?

YEARS OLD

Question Type: 18..95

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

Logic before:

COMPARE AGE CALCULATED FROM DATE OF BIRTH IN P_GH18m-y TO AGE REPORTED IN

P_GH19n. IF AGES AGREE OR INCOMPLETE INFORMATION MAKES THE CHECK

IMPOSSIBLE TO PERFORM, GOTO P_GH20a. IF AGES DISAGREE, FILL

P_GH20c [ PGH20cka ] Is R Age or DOB wrong

Based on the date of birth I entered, the computer has calculated that you are ^iAge years old.

This is different from the age I entered for you. Which of these needs to be corrected? Your date

of birth or your age?

Question Type: TCkAge, noDK, noRF

dob 1 CORRECT DATE OF BIRTH

age 2 CORRECT AGE

Logic after:

if 1 GO BACK TO P_GH18m-y ; If 2 GO BACK TO P_GH19n

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

P_GH20a [ PGH20a ] R Age cmpr to other GH CG

Compared to other workers in a position like yours in this facility, are you...

Question Type: Twage

About 1 About the same age as most,

Older 2 Older than most, or

Younger 3 Younger than most?

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

P_GH21a [ PGH21a ] R Sex

INTERVIEWER: RECORD SEX OF R.

Question Type: TSexC

male 1 MALE

female 2 FEMALE

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

P_GH22a [ PGH22x ] R Highest Degree

USE CARD 8. Please look at Card 8. What is the highest grade in school you have completed?

Please include vocational or technical training and any years in college you may have completed.

Question Type: TGraH15F

LESS 0 LESS THAN FIRST GRADE

FIRST 1 FIRST GRADE

SECON 2 SECOND GRADE

THIRD 3 THIRD GRADE

FOURT 4 FOURTH GRADE

FIFTH 5 FIFTH GRADE

SIXTH 6 SIXTH GRADE

SEVEN 7 SEVENTH GRADE

EIGHT 8 EIGHTH GRADE

NINTH 9 NINTH GRADE

TENTH 10 TENTH GRADE

ELEVE 11 ELEVENTH GRADE

TWELFTH 12 TWELFTH GRADE

VOCATIO 13 VOCATIONAL/TECHNICAL

SOMECOL 14 SOME COLLEGE CREDIT, LESS THAN 1 YEAR

col1_3 15 1 TO 3 YEARS OF COLLEGE

col4MO 16 4 OR MORE YEARS OF COLLEGE

UNGRAD 17 UNGRADED PLACEMENT

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

P_GH23a [ PGH23x ] R Highest Grade in School

USE CARD 9. Please look at Card 9. What is the highest degree, diploma, or certificate you

Question Type: TGraH16F

NONE 1 NONE

HIGH 2 HIGH SCHOOL EQUIVALENCY (for example: GED)

H_S 3 H.S. DIPLOMA

VOCA 4 VOCATIONAL TECH CERTIFICATE/DIPLOMA (for example: DENTAL

TECHNICIAN, COSMETOLOGY LICENSE, ETC.)

NURS 5 NURSING DIPLOMA/CERTIFICATE

ASSO 6 ASSOCIATE DEGREE (for example: AA, AS, ASN)

BACH 7 BACHELOR'S DEGREE (for example: BA, AB, BS, BSN)

MAST 8 MASTERS DEGREE (for example MA, MS, MEng, Med, MSW, MBA)

GRAD 9 GRADUATE OR PROFESSIONAL DEGREE (for example MD, DDS,

DVM, LLB, JD, PhD, EdD)

OTHER 10 OTHER

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

P_GH24a [ PGH24a ] R Educ cmpr to other GH CG

In general, how would you compare your educational achievement to that of other staff that work

with ^CHILD? Would you say...

Question Type: TWEduc

same 1 Your educational achievement is about the same as the other staff that

work with the child,

higher 2 You have higher education than most of the other staff, or

lower 3 You have lower education than most of the other staff?

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

P_GH25a [ PGH25a ] R Currently In School

Are you currently enrolled in school?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

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

P_GH26a [ PGH26a ] R Employment Situation

USE CARD 10. Please look at Card 10. Which of the categories on the card best describes your

current employment situation?

NOTE: DO NOT INCLUDE VOLUNTEER WORK (ONLY "PAID" WORK.)

Question Type: TWKCRD6F

_1 1 REGULARLY WORK FULL-TIME, 35 OR MORE HOURS/WEEK

_2 2 REGULARLY WORK PART-TIME, LESS THAN 35 HOURS/WEEK

_3 3 WORK SOMETIMES, WHEN WORK'S AVAILABLE

_4 4 UNEMPLOYED, LOOKING FOR WORK

_5 5 DON'T WORK BECAUSE OF FAMILY RESPONSIBILITIES

_6 6 DON'T WORK BECAUSE RETIRED

_7 7 DON'T WORK BECAUSE OF ILLNESS OR DISABILITY

_8 8 DON'T WORK BECAUSE DON'T WANT TO WORK

_9 9 DON'T WORK BECAUSE CURRENTLY A STUDENT

_10 10 OTHER

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

P_GH27a [ PGH27a ] R Employment Position

What is your position at the group home?

Question Type: TGpPos

_1 1 GROUP HOME DIRECTOR (ACROSS ALL COTTAGES OR UNITS OF

PROGRAM)

_2 2 CLINICAL SUPERVISOR (ACROSS ALL COTTAGES OR UNITS OF

PROGRAM)

_3 3 COTTAGE SUPERVISOR(ACROSS ALL SHIFTS)

_4 4 SHIFT SUPERVISOR (MOST SENIOR PERSON ON THIS SHIFT)

_5 5 LINE/MILEU STAFF

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

P_GH28n [ PGH28a ] R Length of Employment at facility

How long have you been working at this facility?

NUMBER:

Question Type: 1..40

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

P_GH28a [ PGH28u ] R Length of Employment M/Y code

(Is that months or years?)

Question Type: TMMsYrs

Months 1 MONTHS

Years 2 YEARS

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

P_GH29a [ PGH29a ] R More >1 job

Do you @bcurrently@b have more than one job?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

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

P_GH30a [ PGH30x ] R Spanish/Hispanic/Latino

Are you Spanish, Hispanic, or Latino?

Question Type: TRaceGrp

no 1 No, not Spanish/Hispanic/Latino

mex 2 Yes, Mexican, Mexican-American, Chicano

pr 3 Yes, Puerto Rican

cuba 4 Yes, Cuban

other 5 Yes, Other

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

P_GH32 [ PGH32 ] Labels are in Logic After

USE CARD 12. Please look at Card 12. What is your race? You may pick one or more groups

from the card.

Question Type: TRaceC

amerind 1 AMERICAN INDIAN OR ALASKA NATIVE

asian 2 ASIAN

black 3 BLACK OR AFRICAN AMERICAN

pacislandr 4 NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER

white 5 WHITE

Logic after:

PGH2TG_1 --R race - American Indian or Alaskan; PGH2TG_2 --R race - Asian; PGH2TG_3 --R

race - Black or African American; PGH2TG_4 --R race - Hawaiian or Pac Islander; PGH2TG_5 --R

race - White; PGH2TG_6--R race - DK; PGH2TG_7--R race - RF

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

P_GH33a [ PGH33a ] CH cntct bio mthr from fac

Has ^CHILD had any contact with ^Fills.HisHer biological mother since ^Fills.HeShe began living

here in ^P_GH5m ^P_GH5y? By contact, we mean seeing her in person, talking with her over the

telephone, or having some other contact with her.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if NO GOTO P_GH35a

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

P_GH34n [ PGH34a ] Last CH cntct w/ bio mthr wks or mths

How long ago was the last contact?

(NOTE: IF WITHIN THE PAST WEEK, ENTER 1 WEEK AGO.)

NUMBER:

Question Type: 0..97

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

P_GH34a [ PGH34u ] CH cntct bio mthr wk/mth flag

(Is that weeks or months?)

Question Type: TWksMM

wks 1 WEEKS

mos 2 MONTHS

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

P_GH35a [ PGH35x ] CH birth mother location

Is ^CHILD's biological mother currently living in town, out of town, out of state, out of the country,

in the hospital, in an institution or residential treatment facility, or in jail or a detention center?

Question Type: TPHH30ba

IN_TOWN 1 IN TOWN

OUTOFTOWN 2 OUT OF TOWN

OUTOFSTAT 3 OUT OF STATE

OUTOFCONT 4 OUT OF THE COUNTRY

INHOSP 5 IN THE HOSPITAL

ININST 6 IN AN INSTITUTION OR RESIDENTIAL TREATMENT

INJAIL 7 OR IN JAIL OR A DETENTION CENTER

DECEASED 8 DECEASED

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

P_GH36a [ PGH36a ] CH cntct bio fthr from fac

Has ^CHILD had any contact with ^Fills.HisHer biological father since ^Fills.HeShe began living

here in ^P_GH5m ^P_GH5y? By contact, we mean seeing him in person, talking with him over

the telephone, or having some other contact with him.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If NO GOTO P_GH38a

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

P_GH37n [ PGH37a ] Last CH cntct w/ bio fthr wks or mths

How long ago was the last contact?

(NOTE: IF WITHIN THE PAST WEEK, ENTER 1 WEEK AGO.)

NUMBER:

Question Type: 0..97

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

P_GH37a [ PGH37u ] CH cntct bio fthr wk/mth flag

(Is that weeks or months?)

Question Type: TWksMM

wks 1 WEEKS

mos 2 MONTHS

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

P_GH38a [ PGH38x ] CH birth father location

Is ^CHILD's biological father currently living in town, out of town, out of state, out of the country, in

the hospital, in an institution or residential treatment facility, or in jail or a detention center?

Question Type: TPHH30ba

IN_TOWN 1 IN TOWN

OUTOFTOWN 2 OUT OF TOWN

OUTOFSTAT 3 OUT OF STATE

OUTOFCONT 4 OUT OF THE COUNTRY

INHOSP 5 IN THE HOSPITAL

ININST 6 IN AN INSTITUTION OR RESIDENTIAL TREATMENT

INJAIL 7 OR IN JAIL OR A DETENTION CENTER

DECEASED 8 DECEASED

Logic after:

GOTO P_GHEND

LE - CHILD’S LIVING ENVIRONMENT

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

Logic before:

IF WAVE > 1, FILL: Since (DATE OF LAST INTERVIEW)

P_LE1aa [ PLE1aa ] Some1 othr than R prmrly rspnsbl for CHs luv/support 1

The next few questions ask about the people who have provided care and support for ^CHILD at different times during ^CHILD's life.

^Fills.Since^tempDate^Fills.P_LE1a there a time when someone other than you was primarily

responsible for providing ^CHILD with care and support? This might include times that you were

unavailable to ^CHILD for several weeks or months, or when things in your life kept you from

having time for being a parent. Do not include very short periods like a weekend away.

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^FillP_LE1a

wave1 Was

wavemore1 , was

Logic after:

IF P_LE1A = YES THEN LOOP TO COLLECT UP TO 10 TIME PERIODS. AFTER LOOP

COMPLETES GOTO P_LEEND. IF = 2, GOTO P_LEEND.

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

Logic before:

SUBLOOP - COLLECT UP TO 10 DATES

P_LE_35m_38A NO LABEL

Question Type: Array[1..10] OF BP_LE_35m_38A

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

P_LE1SM [ PLE1SM ] Labels are in Logic After

In what month and year did that period of time begin?

MONTH:

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

Logic after:

PLE1SM_1 --Othr prmrly rspnsbl for CHs luv/support begin - month 1; PLE1SM_2 --Othr prmrly

rspnsbl for CHs luv/support begin - month 2; PLE1SM_3 --Othr prmrly rspnsbl for CHs luv/support

begin - month 3; PLE1SM_4 --Othr prmrly rspnsbl for CHs luv/support begin - month 4; PLE1SM_5 -

-Othr prmrly rspnsbl for CHs luv/support begin - month 5; PLE1SM_6 --Othr prmrly rspnsbl for CHs

luv/support begin - month 6; PLE1SM_7 --Othr prmrly rspnsbl for CHs luv/support begin - month 7;

PLE1SM_8 --Othr prmrly rspnsbl for CHs luv/support begin - month 8; PLE1SM_9 --Othr prmrly

rspnsbl for CHs luv/support begin - month 9; PLE1SM_10 --Othr prmrly rspnsbl for CHs luv/support

begin - month 10

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

P_LE1SY [ PLE1SY ] Labels are in Logic After

In what month and year did that period of time begin?

YEAR:

Question Type: 1990..2013

Logic after:

Range: YEAR OF CHILD'S BIRTH - YEAR OF INTERVIEW; PLE1SY_1 --Othr prmrly rspnsbl for

CHs luv/support begin - year 1; PLE1SY_2 --Othr prmrly rspnsbl for CHs luv/support begin - year 2;

PLE1SY_3 --Othr prmrly rspnsbl for CHs luv/support begin - year 3; PLE1SY_4 --Othr prmrly

rspnsbl for CHs luv/support begin - year 4; PLE1SY_5 --Othr prmrly rspnsbl for CHs luv/support

begin - year 5; PLE1SY_6 --Othr prmrly rspnsbl for CHs luv/support begin - year 6; PLE1SY_7 --

Othr prmrly rspnsbl for CHs luv/support begin - year 7; PLE1SY_8 --Othr prmrly rspnsbl for CHs

luv/support begin - year 8; PLE1SY_9 --Othr prmrly rspnsbl for CHs luv/support begin - year 9;

PLE1SY_10 --Othr prmrly rspnsbl for CHs luv/support begin - year 10

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

P_LE36FM [ PLE1FM ] Labels are in Logic After

In what month and year did that period of time end?

MONTH:

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

Logic after:

PLE1FM_1 --Othr prmrly rspnsbl for CHs luv/support end - month 1; PLE1FM_2 --Othr prmrly

rspnsbl for CHs luv/support end - month 2; PLE1FM_3 --Othr prmrly rspnsbl for CHs luv/support end

- month 3; PLE1FM_4 --Othr prmrly rspnsbl for CHs luv/support end - month 4; PLE1FM_5 --Othr

prmrly rspnsbl for CHs luv/support end - month 5; PLE1FM_6 --Othr prmrly rspnsbl for CHs

luv/support end - month 6; PLE1FM_7 --Othr prmrly rspnsbl for CHs luv/support end - month 7;

PLE1FM_8 --Othr prmrly rspnsbl for CHs luv/support end - month 8; PLE1FM_9 --Othr prmrly

rspnsbl for CHs luv/support end - month 9; PLE1FM_10 --Othr prmrly rspnsbl for CHs luv/support

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

P_LE36FY [ PLE1FY ] Labels are in Logic After

In what month and year did that period of time end?

YEAR:

Question Type: 1990..2013

Logic after:

Range: YEAR OF CHILD'S BIRTH - YEAR OF INTERVIEW; PLE1FY_1 --Othr prmrly rspnsbl for

CHs luv/support end - year 1; PLE1FY_2 --Othr prmrly rspnsbl for CHs luv/support end - year 2;

PLE1FY_3 --Othr prmrly rspnsbl for CHs luv/support end - year 3; PLE1FY_4 --Othr prmrly rspnsbl

for CHs luv/support end - year 4; PLE1FY_5 --Othr prmrly rspnsbl for CHs luv/support end - year 5;

PLE1FY_6 --Othr prmrly rspnsbl for CHs luv/support end - year 6; PLE1FY_7 --Othr prmrly rspnsbl

for CHs luv/support end - year 7; PLE1FY_8 --Othr prmrly rspnsbl for CHs luv/support end - year 8;

PLE1FY_9 --Othr prmrly rspnsbl for CHs luv/support end - year 9; PLE1FY_10 --Othr prmrly rspnsbl

for CHs luv/support end - year 10

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

P_LE1AB [ PLE1AB ] Labels are in Logic After

USE CARD 18. During this time, who was the person primarily responsible for providing ^CHILD

with love and support? What is this person’s relationship to ^CHILD?

Question Type: TRlCrd2F

_2 2 MOTHER (BIOLOGICAL)

_3 3 FATHER (BIOLOGICAL)

_4 4 STEP-MOTHER

_5 5 STEP-FATHER

_6 6 ADOPTIVE MOTHER

_7 7 ADOPTIVE FATHER

_8 8 FOSTER MOTHER

_9 9 FOSTER FATHER

_10 10 FULL SISTER

_11 11 FULL BROTHER

_12 12 HALF SISTER

_13 13 HALF BROTHER

_14 14 STEP-SISTER

_15 15 STEP-BROTHER

_16 16 FOSTER SISTER

_17 17 FOSTER BROTHER

_18 18 ADOPTIVE SISTER

_19 19 ADOPTIVE BROTHER

_30 30 AUNT

_31 31 UNCLE

_32 32 GREAT AUNT

_33 33 GREAT UNCLE

_34 34 COUSIN

_40 40 MATERNAL GRANDMOTHER

_41 41 PATERNAL GRANDMOTHER

_42 42 MATERNAL GRANDFATHER

_43 43 PATERNAL GRANDFATHER

_44 44 MATERNAL GREAT-GRANDMOTHER

_45 45 PATERNAL GREAT-GRANDMOTHER

_46 46 MATERNAL GREAT-GRANDFATHER

_47 47 PATERNAL GREAT-GRANDFATHER

_94 94 BABYSITTER

_95 95 OTHER BLOOD RELATIVE

_96 96 OTHER NON-RELATIVE

Logic after:

PLE1AB_1 --Rltnshp 2 CH of othr prmrly rspnsbl for CHs luv/spprt 1; PLE1AB_2 --Rltnshp 2 CH of

othr prmrly rspnsbl for CHs luv/spprt 2; PLE1AB_3 --Rltnshp 2 CH of othr prmrly rspnsbl for CHs

luv/spprt 3; PLE1AB_4 --Rltnshp 2 CH of othr prmrly rspnsbl for CHs luv/spprt 4; PLE1AB_5 --

Rltnshp 2 CH of othr prmrly rspnsbl for CHs luv/spprt 5; PLE1AB_6 --Rltnshp 2 CH of othr prmrly

rspnsbl for CHs luv/spprt 6; PLE1AB_7 --Rltnshp 2 CH of othr prmrly rspnsbl for CHs luv/spprt 7;

PLE1AB_8 --Rltnshp 2 CH of othr prmrly rspnsbl for CHs luv/spprt 8; PLE1AB_9 --Rltnshp 2 CH of

othr prmrly rspnsbl for CHs luv/spprt 9; PLE1AB_10 --Rltnshp 2 CH of othr prmrly rspnsbl for CHs

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

Logic before:

DISPLAY THE FOLLOWING ON SCREEN FOR EACH TIME PERIOD REPORTED

PERIOD 1:BEGIN DATE: P_LE1sm P_LE1sy END DATE: P_LE36fm P_LE36fy RELATIONSHIP

TO CHILD: P_LE1ab

PERIOD 2:BEGIN DATE: P_LE1sm P_LE1sy END DATE: P_LE36fm P_LE36fy RELATIONSHIP

TO CHILD: P_LE1ab

PERIOD #: BEGIN DATE: P_LE1sm P_LE1sy END DATE: P_LE36fm P_LE36fy RELATIONSHIP

TO CHILD: P_LE1ab

IF WAVE > 1, FILL: Since (DATE OF LAST INTERVIEW ELSE FILL EMPTY

P_LE1AC [ PLE1AC ] Labels are in Logic After

^strDisplayPeriods

Other than the time period(s) you just told me about, was there another time when someone else

was responsible for providing ^CHILD with love and support^Fills.P_LE1AC^tempDate?

IF NECESSARY, REMIND RESPONDENT OF THE TIME PERIODS ALREADY REPORTED SO

THE SAME TIME PERIOD IS NOT REPORTED TWICE.

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^FillP_LE1AC

wavemore1 ·since·

Logic after:

If YES GOTO P_LE1sm

If NO GOTO P_LE42a; PLE1AC_1 --Some1else othr than R rspnsbl for CHs love/support 1;

PLE1AC_2 --Some1else othr than R rspnsbl for CHs love/support 2; PLE1AC_3 --Some1else othr

than R rspnsbl for CHs love/support 3; PLE1AC_4 --Some1else othr than R rspnsbl for CHs

love/support 4; PLE1AC_5 --Some1else othr than R rspnsbl for CHs love/support 5; PLE1AC_6 --

Some1else othr than R rspnsbl for CHs love/support 6; PLE1AC_7 --Some1else othr than R rspnsbl

for CHs love/support 7; PLE1AC_8 --Some1else othr than R rspnsbl for CHs love/support 8;

PLE1AC_9 --Some1else othr than R rspnsbl for CHs love/support 9; PLE1AC_10 --Some1else othr

than R rspnsbl for CHs love/support 10

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

P_LE1

Now I’d like to ask you about the different places CHILD has lived over the past two years.

First, let me confirm your current address:

PRELOAD STREET ADDRESS, UNIT NUMBER, CITY, ZIPCODE FROM CID AND MAKE UPDATES AS NECESSARY

P_LE2

What type of place is this? [Don’t read this list to the respondent. PICK ONE.]

1. Youth's own apartment or house

2. Permanent caregiver's apartment or house

3. Relative's apartment or house with permanent caregiver

3. Friend's apartment or house

4. Someone else's apartment or house

5. University housing (dormitory)

6. Psychiatric hospital or psychiatric unit

7. Substance abuse treatment or detox program

8. Other type of hospital

9. Correctional institution (jail, prison, detention center, etc.)

10. Homeless shelter

11. Domestic violence shelter?

12. On the street (abandoned building, park, bus station, car, etc.)

13. Hotel, motel, or single residence occupancy

14. Other

15. Kin-care setting (relative's home)

16. Foster home

17. Treatment foster care, specialized foster care, or family foster agency

18. Group home or residential facility

19. Other out-of-home care arrangement

20. Ranaway

21. UNKNOWN TO RESPONDENT

P_LE3MO and P_LE3YR

In what month and year did CHILD start living here?

MONTH: ____

Range: 01-12

YEAR: _______

IF DON'T KNOW MONTH, PROBE, Do you know what season it was?

Was it Winter, Spring, Summer, Fall?

By Winter, we mean December, January, or February.

By Spring, we mean March, April, or May.

By Summer, we mean June, July, August.

By Fall, we mean September, October, November

IF WINTER, PROBE Was it late in the year (Dec) or early in the following year (Jan, Feb).

Enter January as month of move if unsure

IF SPRING, PROBE: Was school ending? Enter April if unsure

IF SUMMER, PROBE: Were kids in school? Enter July if unsure

IF FALL, PROBE Was it before Halloween? Enter October if unsure

What day did CHILD start living here? PROBE: Do you remember if it was the beginning, middle, or end of the month?

IF INCONSISTENT: I previously entered that you moved in after this date. These are inconsistent. I must have something wrong. Which date do I need to correct?

P_LE4

How many rooms are there for the household not counting bathrooms? [NOTE: Count all rooms that can be “lived in”, e.g., bedroom, living room, kitchen. Don’t include bathrooms, hallways, pantries, closets, or unfinished attic or basement]

1. ENTER NUMBER OF ROOMS UP TO 19:______

2. CHECK HERE IF 20 OR MORE: _____

P_LE5A – PHC5J

Did all household members live here the entire time with CHILD? NO IF HOUSEHOLD MEMBER MOVED-IN SINCE LIVING THERE, MOVED AWAY, BORN, WENT TO COLLEGE

NOTE: HOUSEHOLD ROSTER GENERATED IN HH SECTION IS DISPLAYED BELOW

HHMEMBER1 lived there the entire time? YES/NO

HHMEMBER2 lived there the entire time? YES/NO

HHMEMBER3 lived there the entire time? YES/NO

HHMEMBER4 lived there the entire time? YES/NO

HHMEMBER5 lived there the entire time? YES/NO

HHMEMBER6 lived there the entire time? YES/NO

HHMEMBER7 lived there the entire time? YES/NO

HHMEMBER8 lived there the entire time? YES/NO

HHMEMBER9 lived there the entire time? YES/NO

HHMEMBER10 lived there the entire time? YES/NO

P_LE6

Was this a voluntary move?

P_LE7

Why did the household move here? CODE ALL THAT APPLY

COST

SPACE

HOUSING QUALITY

SAFETY

NEIGHBORHOOD/SCHOOLS

FAMILY/FRIENDS

LIVED HERE BEFORE/ALREADY KNEW THE NEIGHBORHOOD

NO BETTER OPTIONS

NEEDED TO MOVE

P_LE8

Was CHILD or the family homeless? By homeless we mean 1) living on the streets or in a shelter, or (2) staying someplace on a temporary basis because you could not afford to live elsewhere.

P_LE9

Did CHILD change schools when he/she moved in?

P_LE10

Why did CHILD move here? [DO NOT READ TO PARTICIPANT. CODE ALL THAT APPLY.]

1. ABUSE/NEGLECT OR FEAR OF ABUSE/NEGLECT OF CHILD

2. AVOID HOMELESSNESS / HOUSING STABILITY

3. AVOID SCHOOL CHANGE

4. HELP WITH PARENTING

5. SAFER PLACE, NEIGHORHOOD, ENVIRONMENT

6. JOB OR SCHOOL-RELATED

7. CONFLICT WITH FAMILY

8. CAREGIVER HEALTH/MENTAL HEALTH PROBLEMS

9. CAREGIVER DRUG/ALCOHOL PROBLEMS/TREATMENT

10. CAREGIVER INCARCERATION/JAIL/PRISON

11. CHILD OUT-OF-CONTROL, UNMANAGEABLE, TRUANT

12. CHILD PHYSICAL HEALTH PROBLEMS

13. CHILD RAN AWAY

14. NO REASON GIVEN

15. OTHER

P_LE11

Who decided to have CHILD live here? CODE ALL THAT APPLY

1. PERMANENT CAREGIVER

2. CHILD’S OTHER PARENT

3. RELATIVES / FAMILY FRIENDS

4. CHILD WELFARE, COURTS

5. CHILD

P_LE12

Was there anywhere else CHILD lived since [DATE TWO YEARS BEFORE INTERVIEW DATE]?

YES
NO {GO TO P_LEEND}

INFORMATION ABOUT ALL OTHER PLACES CHILD LIVED WITHIN THE PAST 2 YEARS

P_LE13

Where did CHILD live before? What type of place was it? [Don’t read this list to the respondent. PICK ONE.]

1. Youth's own apartment or house

2. Permanent caregiver's apartment or house

3. Relative's apartment or house with permanent caregiver

3. Friend's apartment or house

4. Someone else's apartment or house

5. University housing (dormitory)

6. Psychiatric hospital or psychiatric unit

7. Substance abuse treatment or detox program

8. Other type of hospital

9. Correctional institution (jail, prison, detention center, etc.)

10. Homeless shelter

11. Domestic violence shelter?

12. On the street (abandoned building, park, bus station, car, etc.)

13. Hotel, motel, or single residence occupancy

14. Other

15. Kin-care setting (relative's home)

16. Foster home

17. Treatment foster care, specialized foster care, or family foster agency

18. Group home or residential facility

19. Other out-of-home care arrangement

20. Ranaway

21. UNKNOWN TO RESPONDENT

P_LE14

Were you living with CHILD?

What was the street address? IF UNSURE OF STREET ADDRESS, RECORD MAJOR CROSS STREETS WITH CITY, STATE, AND ZIP

P_LE15ST

STREET ADDRESS: ____________________________________

P_LE15UN

UNIT NUMBER: _________________

P_LE15CR

IF STREET ADDRESS NOT KNOWN, MAJOR CROSS STREETS:

_______________________________________________

P_LE15CT

CITY: ________________________________________

P_LE15SA

STATE: ______________________________________

P_LE15ZP

ZIP: _________________

P_LE16MO and P_LE16YR

In what month and year did CHILD start living there?

MONTH: _____

Range: 01-12

YEAR: _______

IF DON'T KNOW MONTH, PROBE, Do you know what season it was?

Was it Winter, Spring, Summer, Fall?

By Winter, we mean December, January, or February.

By Spring, we mean March, April, or May.

By Summer, we mean June, July, August.

By Fall, we mean September, October, November

IF WINTER, PROBE Was it late in the year (Dec) or early in the following year (Jan, Feb).

Enter January as month of move if unsure

IF SPRING, PROBE: Was school ending? Enter April if unsure

IF SUMMER, PROBE: Were kids in school? Enter July if unsure

IF FALL, PROBE Was it before Halloween? Enter October if unsure

What day did CHILD start living here? PROBE: Do you remember if it was the beginning, middle, or end of the month?

IF INCONSISTENT: I previously entered that you moved in after this date. These are inconsistent. I must have something wrong. Which date do I need to correct?

P_LE17

How many people lived or stayed there with CHILD?

NUMBER OF PEOPLE: ______________

INCLUDE ANYONE NOT ON HHROSTER WHO LIVED FOR MORE THAN 2 MONTHS, OR LESS IF HAD NO OTHER PLACE TO STAY. EXCLUDE PEOPLE MENTIONED ON ROSTER, COLLEGE STUDENTS LIVING AWAY OR DEPLOYED MEMBERS OF HOUSEHOLD

P_LE18

How many rooms were there for the household not counting bathrooms? [NOTE: Count all rooms that can be “lived in”, e.g., bedroom, living room, kitchen. Don’t include bathrooms, hallways, pantries, closets, or unfinished attic or basement]

1. ENTER NUMBER OF ROOMS UP TO 19: ______

2. CHECK HERE IF 20 OR MORE: ___

P_LE18A – P_LE18J

Did all household members live here the entire time with CHILD? NO IF HOUSEHOLD MEMBER MOVED-IN SINCE LIVING THERE, MOVED AWAY, BORN, WENT TO COLLEGE

NOTE: HOUSEHOLD ROSTER GENERATED IN HH SECTION IS DISPLAYED BELOW

HHMEMBER1 lived there the entire time? YES/NO

HHMEMBER2 lived there the entire time? YES/NO

HHMEMBER3 lived there the entire time? YES/NO

HHMEMBER4 lived there the entire time? YES/NO

HHMEMBER5 lived there the entire time? YES/NO

HHMEMBER6 lived there the entire time? YES/NO

HHMEMBER7 lived there the entire time? YES/NO

HHMEMBER8 lived there the entire time? YES/NO

HHMEMBER9 lived there the entire time? YES/NO

HHMEMBER10 lived there the entire time? YES/NO

P_LE19

Was this a voluntary move?

P_LE20

Why did the household move there? CODE ALL THAT APPLY

COST

SPACE

HOUSING QUALITY

SAFETY

NEIGHBORHOOD/SCHOOLS

FAMILY/FRIENDS

LIVED HERE BEFORE/ALREADY KNEW THE NEIGHBORHOOD

NO BETTER OPTIONS

NEEDED TO MOVE

P_LE21

Was CHILD or the family homeless? By homeless we mean 1) living on the streets or in a shelter, or (2) staying someplace on a temporary basis because you could not afford to live elsewhere.

P_LE22

Did CHILD change schools when he/she moved in?

P_LE23

Why did CHILD move there? [DO NOT READ TO PARTICIPANT. CODE ALL THAT APPLY.]

1. ABUSE/NEGLECT OR FEAR OF ABUSE/NEGLECT OF CHILD

2. AVOID HOMELESSNESS / HOUSING STABILITY

3. AVOID SCHOOL CHANGE

4. HELP WITH PARENTING

5. SAFER PLACE, NEIGHORHOOD, ENVIRONMENT

6. JOB OR SCHOOL-RELATED

7. CONFLICT WITH FAMILY

8. CAREGIVER HEALTH/MENTAL HEALTH PROBLEMS

9. CAREGIVER DRUG/ALCOHOL PROBLEMS/TREATMENT

10. CAREGIVER INCARCERATION/JAIL/PRISON

11. CHILD OUT-OF-CONTROL, UNMANAGEABLE, TRUANT

12. CHILD PHYSICAL HEALTH PROBLEMS

13. CHILD RAN AWAY

14. NO REASON GIVEN

15. OTHER

P_LE24

Who decided to have CHILD live there? CODE ALL THAT APPLY.

1. PERMANENT CAREGIVER

2. CHILD’S OTHER PARENT

3. RELATIVES / FAMILY FRIENDS

4. CHILD WELFARE, COURTS

5. CHILD

P_LE25

What was the main reason for moving out? DO NOT READ TO RESPONDENT. PICK ONE.

1. Evicted

2. Couldn't afford

3. Job loss/Lack of work

4. Asked to leave/household disagreement

5. Personal safety/victimized/domestic violence

6. Too crowded/needed more space

7. Building problems (repairs, fire, drug dealers, tec.)

8. Neighborhood problems

9. Too far from work/school

10. Too far from family/friends

11. Other housing opportunity became available

12. Financial situation got better

13. To be on one's own/be independent

14. To reside with significant other

15. Break up with significant other

16. Trouble with the law or being arrested

17. Released from jail/prison

18. Entered hospital/treatment center/program

19. Left hospital/treatment center/program

20. Other

21. DK

P_LE26

Is there anywhere else CHILD lived since [DATE TWO YEARS BEFORE INTERVIEW DATE]?

YES {REPEAT LOOP STARTING WITH P_LE13}
NO {GO TO P_LEEND}

{P_LEEND}

CE - COMMUNITY ENVIRONMENT

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

P_CE1a [ PCE1a ] Prblm in nghbrhd/community - assaults and muggings

USE CARD 19. Now I'd like to ask you some questions about your neighborhood and

community. For each item I read, please tell me if this issue is not a problem at all, somewhat of

a problem, or a big problem in your neighborhood. Please pick your answer from Card 19.

NOTE: ALL QUESTIONS IN THIS SECTION REFER TO "CURRENT" PROBLEMS.

Assaults and muggings? Would you say this is…

Question Type: TProblem

notaprob 1 not a problem at all,

someprob 2 somewhat of a problem, or

bigprob 3 a big problem in your neighborhood?

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

P_CE2a [ PCE2a ] Prblm in nghbrhd/community - delinquent/drug gangs

USE CARD 19. Delinquent gangs or drug gangs? Would you say this is ...

Question Type: TProblem

notaprob 1 not a problem at all,

someprob 2 somewhat of a problem, or

bigprob 3 a big problem in your neighborhood?

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

P_CE3a [ PCE3a ] Prblm in nghbrhd/community - open drug use/dealing

USE CARD 19. Open drug use or drug dealing?

(Would you say this is...READ CATEGORIES AS NEEDED.)

NOTE: THIS MEANS VISIBLE OR PUBLIC DRUG USE.

Question Type: TProblem

notaprob 1 not a problem at all,

someprob 2 somewhat of a problem, or

bigprob 3 a big problem in your neighborhood?

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

P_CE4a [ PCE4a ] Prblm in nghbrhd/community - unsupervised chren

USE CARD 19. Unsupervised children?

(Would you say this is...READ CATEGORIES AS NEEDED.)

Question Type: TProblem

notaprob 1 not a problem at all,

someprob 2 somewhat of a problem, or

bigprob 3 a big problem in your neighborhood?

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

P_CE5a [ PCE5a ] Prblm in nghbrhd/community - grps teens hanging out

USE CARD 19. Groups of teenagers hanging out in public places and making a nuisance of

themselves?

(Would you say this is...READ CATEGORIES AS NEEDED.)

Question Type: TProblem

notaprob 1 not a problem at all,

someprob 2 somewhat of a problem, or

bigprob 3 a big problem in your neighborhood?

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

P_CE6a [ PCE6a ] Nghbrhd cmprs to othrs - how safe

For these next items, please think about how your neighborhood compares to most other

neighborhoods.

Is your neighborhood ...

Question Type: TSafe

safer 1 safer,

assafe 2 about the same, or

notsafe 3 not as safe as most neighborhoods?

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

P_CE7a [ PCE7a ] Nghbrhd cmprs to othrs - nghbrs help each other

Does your neighborhood have ...

Question Type: TNbrHlp

morehelp 1 more neighbors help each other,

samehelp 2 about the same number of neighbors help each other, or

fewhelp 3 fewer neighbors help each other than most neighborhoods?

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

P_CE8a [ PCE8a ] Nghbrhd cmprs to othrs - nghbrhd involved parents

Does your neighborhood have ...

Question Type: TParents

moreinv 1 more involved parents,

sameinv 2 about the same number of involved parents, or

fewerinv 3 fewer involved parents than most neighborhoods?

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

P_CE9a [ PCE9a ] Nghbrhd cmprs to othrs - nghbrhd better place

Is your neighborhood ...

Question Type: TNHood

better 1 a better place to live,

aboutsame 2 about the same, or

worse 3 a worse place to live than most neighborhoods?

Logic after:

P_CEEND

HS - Child Health and Services

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

Logic before:

P_HS1aaa

Has [CHILD] lived with you for most or all of the past 12 months?

1=YES {GO TO P_HS49}

2=NO

P_HS1bbb

For how many consecutive months has [CHILD] lived with you?

Number of months____ RANGE 1 - 11

PROGRAMMER INFO:

“Time in Household” is length of time that CHILD has lived with CAREGIVER. It is the difference between the "number of months" and interview date.

If "Time in Household" >= 12 months (meaning 1 year) and number of months <= DOB (meaning since birth) then Group = 1

Else If "Time in Household" >= 12 months (meaning 1 year) and Number of months > DOB then Group = 2

Else if "Time in Household" < 12 months then group = 3

Other assumptions:

if group 3, meaning the child has been living there less than a year, and child has been living there since birth, then the fills "Since the child has lived with you" can be replaced by the word "birth". Example questions are P_HS45a, P_HS50aa, etc..

[IF WAVE = 1:] Now I’d like to ask you some questions about ^CHILD’s health and the services [fill

he/she] is receiving.

[IF WAVE > 1]: The next questions are about ^CHILD’s health and the services [fill he/she] has

received in the past 12 months.

[ALL:] Overall, would you say ^CHILD’s health is…

P_HS1a [ PHS1a ] CH overall health

^fills.p_hs1a1 ^child's health and the services ^fills.heshe ^fills.p_hs1a2.

Overall, would you say ^CHILD's health is. . .

Question Type: THealth

exclnt 1 excellent

vgood 2 very good

good 3 good

fair 4 fair, or

poor 5 poor

Question Fill: ^FillP_HS1A1

Wave1_1 Now I’d like to ask you some questions about

Wave2_1 The next questions are about

Question Fill: ^FillP_HS1A2

Wave1_2 is receiving.

Wave2_2 has received in the past 12 months.

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

P_HS1aa [ PHS1aa ] CH up-to-date w/immunizations

Is ^CHILD up-to-date with ^fills.hisher immunizations or shots?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^fillhisher

his his

her her

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

P_HS1h1a [ PHS1h1a ] NO LABEL

Does ^CHILD take medicine or drugs prescribed by a doctor other than regular vitamins?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

2 = NO GOTO P_HS1h4a

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

P_HS1h2a [ PHS1h2a ] NO LABEL

Is this because of a medical, behavioral, or other health condition that ^CHILD still has?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

2 = NOGOTO P_HS1h4a

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

P_HS1h3a [ PHS1h3a ] NO LABEL

Has this condition been going on or is it expected to go on for at least one year?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS1h4a [ PHS1h4a ] Does CH have life-threatening allergic reactions?

Does ^CHILD have @blife-threatening@b allergic reactions?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

2 = NOGOTO P_HS1h16a

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

P_HS1h5a [ PHS1h5a ] NO LABEL

Is this because of a medical, behavioral, or other health condition that ^CHILD still has?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

2 = NOGOTO P_HS1h7a

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

P_HS1h6a [ PHS1h6a ] Lfe thrtng alrgc cndtion on going or xpctd to for 1 year

Has this condition been going on or is it expected to go on for at least one year?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS1h7a [ PHS1h7a ] NO LABEL

Has a doctor told you that ^CHILD needs to follow a special diet or avoid certain foods?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

2 = NO GOTO P_HS1h10a

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

P_HS1h8a [ PHS1h8a ] NO LABEL

Is this because of a medical, behavioral, or other health condition that ^CHILD still has?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

2 = NO GOTO P_HS1h10a

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

P_HS1h9a [ PHS1h9a ] NO LABEL

Has this condition been going on or is it expected to go on for at least one year?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS1h10a [ PHS1h10a ] NO LABEL

Does ^CHILD go to a medical doctor or specialist on a regular basis?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

2 = NO GOTO P_HS1h13a

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

P_HS1h11a [ PHS1h11a ] NO LABEL

Is this because of a medical, behavioral, or other health condition that ^CHILD still has?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_HS1h11a = NO THEN GOTO P_HS1h13a

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

P_HS1h12a [ PHS1h12a ] NO LABEL

Has this condition been going on or is it expected to go on for at least one year?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS1h13a [ PHS1h13a ] NO LABEL

Does ^CHILD go to a counselor, psychiatrist, psychologist, or social worker on a regular basis?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

2 = NOGOTO P_HS1h16a

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

P_HS1h14a [ PHS1h14a ] NO LABEL

Is this because of a medical, behavioral, or other health condition that ^CHILD still has?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

2 = NOGOTO P_HS1h16a

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

P_HS1h15a [ PHS1h15a ] NO LABEL

Has this condition been going on or is it expected to go on for at least one year?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS1h16a [ PHS1h16a ] CH rcv srvcs such as phys/occ/speech thrpy

Does ^CHILD now receive services such as physical therapy, occupational therapy, speech or

language therapy, or orientation and mobility training on a regular basis?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS1h17a [ PHS1h17a ] NO LABEL

Is this because of a medical, behavioral, or other health condition that ^CHILD still has?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

2 = NOGOTO P_HS1h19a

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

P_HS1h18a [ PHS1h18a ] NO LABEL

Has this condition been going on or is it expected to go on for at least one year?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS1h19a [ PHS1h19a ] Has CH ever been hospitalized?

Has ^CHILD ever been hospitalized?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 2, GOTO P_HS1h22a

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

P_HS1h20a [ PHS1h20a ] Hsptlzd for mdcl/othr hlth cndtion that CH still has

Is this because of a medical or other health condition that ^CHILD still has?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 2, GOTO P_HS1h22a

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

P_HS1h21a [ PHS1h21a ] Hsptlzd cndtion on going or xpctd to for 1 year

Has this condition been going on or is it expected to go on for at least one year?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS1h22a [ PHS1h22a ] CH nded mdcl hlth-related/mntl hlth srvcs unable to get

Has ^CHILD needed medical, health-related, or mental health services that ^fills.heshe has been

unable to get?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS1h23a [ PHS1h23a ] NO LABEL

Is this because of a medical, behavioral, or other health condition that ^CHILD still has?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

2 = NOGOTO P_HS1h25a

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

P_HS1h24a [ PHS1h24a ] NO LABEL

Has this condition been going on or is it expected to go on for at least one year?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS1h25a [ PHS1h25a ] R tld by mdcl doc/spclst that CH has dlay in phys grwth

Have you been told by a medical doctor or specialist that ^CHILD has a serious delay in

^fills.hisher @bphysical@b growth or development?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS1h26a [ PHS1h26a ] R tld by mdcl doc/spclst that CH has dlay in emot grwth

Have you been told by a medical doctor or specialist that ^CHILD has a serious delay in

^fills.hisher @bmental or emotional@b growth or development?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS1h27a [ PHS1h27a ] Cmprd to othr chldrn CH reduces efrt can exrt in actvty

Compared to other children or youth ^fills.hisher age, does ^CHILD have to reduce the amount of

time or effort that ^fills.heshe can exert in any activity?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF =2, GOTO P_HS1h30a

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

P_HS1h28a [ PHS1h28a ] Reduces efrt because med/behav/othr hlth cond CH still has

Is this because of a medical, behavioral, or other health condition that ^CHILD still has?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 2, GOTO P_HS1h30a

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

P_HS1h29a [ PHS1h29a ] Reduces efrt cndition gong on/xpctd to go on 1 year

Has this condition been going on or is it expected to go on for at least one year?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS1h30a [ PHS1h30a ] Is CH blind/nearly blind/or dificulty seeing

Is ^CHILD blind, nearly blind, or does ^fills.heshe have difficulty seeing?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 2, GOTO P_HS1h33a

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

P_HS1h31a [ PHS1h31a ] Rglr eye glasses/cntct lnses completely crct CH vision prblm

Do regular eye glasses or contact lenses completely correct the problem?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF YES or DK to HS1h31a, then go to HS1h33a. IF NO, go to HS1h32a.

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

P_HS1h32a [ PHS1h32a ] CH vision condition going on/xpctd to go on 1 year

Has this condition been going on or is it expected to go on for at least one year?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS1h33a [ PHS1h33a ] Is CH deaf/nearly deaf/difficulty hearing

Is ^CHILD deaf, nearly deaf, or does ^fills.heshe have difficulty hearing?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 2, GOTO P_HS1h35

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

P_HS1h34a [ PHS1h34a ] CH hearing condition going on/xpctd to go on 1 year

Has this condition been going on or is it expected to go on for at least one year?

Question Type: TYN

yes 1 YES

no 2 NO

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

Logic before:

Iif P_HH2ca is not equal to 18 (Child not in school) or 19 (Too young for school) , then ask

P_HS1h35. Else, skip to the instruction before P_HS1h38a

P_HS1h35 [ PHS1h35 ] Labels are in Logic After

Now I will read a list of special arrangements in school or child care. Please answer yes or no to

each of the following types of special arrangements that ^CHILD receives:

CODE ALL THAT APPLY

Question Type: TArrgmtS

ModSched 1 modification of class schedule, curriculum, or gym classes?

access 2 making the classroom accessible for ^fills.hisher use?

spequip 3 getting and using special equipment?

splunch 4 providing special lunches or snack?

sptrans 5 providing special transportation?

tutor 6 tutoring by a teacher or other professional, or resource room?

NONE 7 NONE OF THE ABOVE

Logic after:

PHS1h35_1 --CH rcvs mdfction of cls schdl/curriculum/gym classes; PHS1h35_2 --CH rcvs making

the classroom accessible for their use; PHS1h35_3 --CH rcvs getting and using special

equipment; PHS1h35_4 --CH rcvs providing special lunches or snack; PHS1h35_5 --CH rcvs

providing special transportation; PHS1h35_6 --CH rcvs tutoring by teacher/othr prof/resource room;

PHS1h35_7 --CH rcvs NONE OF THE ABOVE; PHS1h35_8--CH rcvs - DK; PHS1h35_9--CH rcvs -

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

P_HS1h36a_h37a NO LABEL

Question Type: array[1..6] of BP_HS1h36a_h37a

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

Logic before:

FOR EACH ANSWER YES IN P_HS1h35, ASK NEXT TWO QUESTIONS.

ADD BANNER AT TOP OF EACH LETTING INTERVIEWER KNOW WHICH ANSWER

CATEGORY FROM P_HS1h35 IS BEING ASKED ABOUT.

P_HS1h36a [ PHS1h36a ] NO LABEL

SPECIAL ARRANGEMENT: "@B^fills.P_HS1H35@B"

Is this because of a medical, behavioral, or other health condition that ^CHILD still has?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^FillP_HS1h35

modsched MODIFICATION OF CLASS SCHEDULE, CURRICULUM, OR GYM

CLASSES

access MAKING THE CLASSROOM ACCESSIBLE FOR ^FILLS.hisher USE

spequip GETTING AND USING SPECIAL EQUIPMENT

splunch PROVIDING SPECIAL LUNCHES OR SNACK

sptrans PROVIDING SPECIAL TRANSPORTATION

tutor TUTORING BY A TEACHER OR OTHER PROFESSIONAL, OR

RESOURCE ROOM

Logic after:

2 = NO exit submodules and GOTO P_HS1h38a (after last answer in p_hs1h35)

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

P_HS1h37a [ PHS1h37a ] NO LABEL

SPECIAL ARRANGEMENT: "@B^fills.P_HS1H35@B"

Has this condition been going on or is it expected to go on for at least one year?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^FillP_HS1h35

modsched MODIFICATION OF CLASS SCHEDULE, CURRICULUM, OR GYM

CLASSES

access MAKING THE CLASSROOM ACCESSIBLE FOR ^FILLS.hisher USE

spequip GETTING AND USING SPECIAL EQUIPMENT

splunch PROVIDING SPECIAL LUNCHES OR SNACK

sptrans PROVIDING SPECIAL TRANSPORTATION

tutor TUTORING BY A TEACHER OR OTHER PROFESSIONAL, OR

RESOURCE ROOM

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

P_HS1h38a [ PHS1h38a ] Except occsnal wrds CH has trbl undrstndng smpl instrctions

Except for occasional words, does ^CHILD have trouble understanding simple instructions?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS1h39a [ PHS1h39a ] Except occsnal wrds othrs otsde fam have trbl undrstndng CH

Except for occasional words, when ^CHILD talks, do others outside the family have trouble

understanding ^fills.himher?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS1h40nf [ PHS1h40nf ] CHs approximate height - feet

Can you tell me approximately what ^CHILD's height is?

FEET:

Question Type: 0..6

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

P_HS1h40ni [ PHS1h40ni ] CHs approximate height - inches

Can you tell me approximately what ^CHILD's height is?

INCHES:

Question Type: 0..11

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

P_HS1h41n [ PHS1h41n ] CHs approximate weight - pounds

Can you tell me approximately what ^CHILD's weight is?

POUNDS:

Question Type: 0..350

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

P_HS1h42 [ PHS1h42 ] Consider CH over/under weight or about right

Do you consider ^CHILD now to be...

Question Type: TWeight

over 1 Overweight

under 2 Underweight, or

aboutright 3 About the right weight?

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

P_HS3a1a [ PHS3a1a ] CH currently have asthma

To the best of your knowledge, does ^CHILD currently have any of the following:

Asthma?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a2a [ PHS3a2a ] CH currently have ADD or ADHD

(To the best of your knowledge, does ^CHILD currently have any of the following:)

Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder, that is ADD or ADHD?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a3a [ PHS3a3a ] CH currently have autism or ASD

(To the best of your knowledge, does ^CHILD currently have any of the following:)

Autism, Asperger’s Disorder, pervasive developmental disorder, or other Autism Spectrum Disorder, that is ASD?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a4a [ PHS3a4a ] CH currently have down syndrome

(To the best of your knowledge, does ^CHILD currently have any of the following:)

Down Syndrome?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a5a [ PHS3a5a ] CH currently have intellectual disability or developmental delay

(To the best of your knowledge, does ^CHILD currently have any of the following:)

Intellectual disability, also known as mental retardation or developmental delay?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a6a [ PHS3a6a ] CH currently have dprsion/anxty/etng dsrdr/othr emot prblm

(To the best of your knowledge, does ^CHILD currently have any of the following:)

Depression, anxiety, an eating disorder, or other emotional problems?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a7a [ PHS3a7a ] CH currently have diabetes

(To the best of your knowledge, does ^CHILD currently have any of the following:)

Diabetes?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

1 = YES GOTO P_HS3a8a

2 = NO GOTO P_HSa9a

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

P_HS3a8a [ PHS3a8a ] Does CH use insulin?

Does ^CHILD use insulin?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a9a [ PHS3a9a ] CH currently have heart problem

(To the best of your knowledge, does ^CHILD currently have any of the following:)

A heart problem, including Congenital Heart Disease?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a10a [ PHS3a10a ] CH currently have blood problems

(To the best of your knowledge, does ^CHILD currently have any of the following:)

Blood problems such as Anemia or Sickle Cell Disease? Please do not include Sickle Cell Trait.

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a11a [ PHS3a11a ] CH currently have cystic fibrosis

(To the best of your knowledge, does ^CHILD currently have any of the following:)

Cystic Fibrosis?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a12a [ PHS3a12a ] CH currently have cereberal palsy

(To the best of your knowledge, does ^CHILD currently have any of the following:)

Cerebral Palsy?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a13a [ PHS3a13a ] CH currently have muscular dystrophy

(To the best of your knowledge, does ^CHILD currently have any of the following:)

Muscular Dystrophy?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a14a [ PHS3a14a ] CH currently have epilepsy/seizure disorder

(To the best of your knowledge, does ^CHILD currently have any of the following:)

Epilepsy or other seizure disorder?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a15a [ PHS3a15a ] CH currently have migraine/frq headaches

(To the best of your knowledge, does ^CHILD currently have any of the following:)

Migraine or frequent headaches?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a16a [ PHS3a16a ] CH currently have arthritis/joint problems

(To the best of your knowledge, does ^CHILD currently have any of the following:)

Arthritis or other joint problems?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a19a [ PHS3a19a ] CH currently have dental problems

(To the best of your knowledge, does ^CHILD currently have any of the following:)

Dental problems?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a21a [ PHS3a21a ] CH currently have repeated ear infections

(To the best of your knowledge, does ^CHILD currently have any of the following:)

Repeated ear infections?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a24a [ PHS3a24a ] CH currently have back/neck problems

(To the best of your knowledge, does ^CHILD currently have any of the following:)

Back or neck problems?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a25a [ PHS3a25a ] CH currently have hypertension/high blood pressure

(To the best of your knowledge, does ^CHILD currently have any of the following:)

Hypertension or high blood pressure?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a26a [ PHS3a26a ] CH currently have AIDS

(To the best of your knowledge, does ^CHILD currently have any of the following:)

AIDS?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a28a [ PHS3a28a ] CH currently have chronic bronchitis

(To the best of your knowledge, does ^CHILD currently have any of the following:)

Chronic bronchitis?

Question Type: TYN

yes 1 YES

no 2 NO

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

P_HS3a31a [ PHS3a31a ] CH currently have other health problems

(To the best of your knowledge, does ^CHILD currently have any of the following:)

LP - Independent Living Module for CG of EY

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

Logic before:

[ADMINISTER SECTION LP TO PERMANENT AND NON-PERMANENT CAREGIVERS OF

EMANCIPATED YOUTH WHO RESIDE OUTSIDE THE CAREGIVER’S HOME. IF CHILD IS

EMANCIPATED AND DOES NOT CURRENTLY LIVE WITH A CAREGIVER PER CID, CONTINUE.

ELSE, GOTO P_LPEND.]

P_LP1a [ PLP1a ] CH discussed emancipation plans w/ CG

Next, we would like to ask a few questions about ^CHILD's plans to emancipate, that is, to live

independently.

Before ^CHILD began living independently, did ^Fills.heshe discuss ^Fills.hisher plans to leave

with you, or did ^Fills.heshe make ^Fills.hisher own plans?

Question Type: TPlans

DISCUSS 1 DISCUSSED PLANS WITH CAREGIVER

MADE 2 MADE OWN PLANS

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

P_LP2a [ PLP2a ] CH had job when beg indep living

At the time ^CHILD began living independently, did ^Fills.heshe have a job?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_LP2a = NO GOTO P_LP3a

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

P_LP2aa [ PLP2aa ] CH had full/part-time job

Was this a full-time or part-time job?

Question Type: TFP35F

Fulltime 1 FULL-TIME JOB (35 OR MORE HOURS A WEEK)

Parttime 2 PART-TIME JOB (LESS THAN 35 HOURS A WEEK)

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

P_LP3a [ PLP3a ] CH had place live when indep living

At the time ^CHILD began living independently, did ^Fills.heshe have a place to live?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_LP3a = NO GOTO P_LP5a

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

P_LP4a [ PLP4a ] Where emancipated CH planned to live

Where was ^CHILD planning to live?

Question Type: TLivWith

Relative 1 WITH BIOLOGICAL RELATIVES

BoyGirlFrnd 2 WITH A BOYFRIEND OR GIRLFRIEND

Friends 3 WITH OTHER FRIENDS

Military 4 PLANNED TO JOIN MILITARY

JobCorp 5 PLANNED TO JOIN JOB CORP/JOB TRAINING PROGRAM

College 6 PLANNED TO GO TO COLLEGE

OthPlace 7 OTHER PLACE

Question Fill: ^FillBoyGirlFrnd

BOYFRIEND BOYFRIEND

GIRLFRIEND GIRLFRIEND

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

P_LP5a [ PLP5a ] CG offered help emancipated CH if needed

Did you offer to help ^CHILD in the future if ^Fills.heshe needed it?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_LP5a = NO GOTO P_LP7a

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

P_LP6 [ PLP6 ] Labels are in Logic After

What kind of help did you offer to ^CHILD?

CODE ALL THAT APPLY.

Question Type: THelpS

Financial 1 FINANCIAL HELP

Place 2 PLACE TO STAY

Food 3 FOOD OR CLOTHING

Transport 4 TRANSPORTATION

Support 5 SUPPORT/GUIDANCE/ADVICE

Other 6 OTHER HELP

Logic after:

PLP6TG_1--CG offered eman CH - finanical help; PLP6TG_2--CG offered eman CH - place to stay;

PLP6TG_3--CG offered eman CH - food/clothing; PLP6TG_4--CG offered eman CH - transportation;

PLP6TG_5--CG offered eman CH - support/advice; PLP6TG_6--CG offered eman CH - other help;

PLP6TG_7--CG offered eman CH - DK; PLP6TG_8--CG offered eman CH - RF

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

P_LP7a [ PLP7a ] CG belv emancipated CH successfl lvng indep

How successful do you think ^CHILD will be living independently? Would you say...

Question Type: TSuccess

Very 1 Very successful,

Some 2 Somewhat successful, or

_Not 3 Not at all successful?

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

P_LP8a [ PLP8a ] Child welfr agncy help create successful indep plan for CH

Do you think the child welfare agency has helped create a successful independent living plan for

^CHILD?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

GOTO P_LPEND

SD - Social Emotional Development

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

Logic before:

IF CHILD AGE IS 12 MONTHS TO <= 18 months, CONTINUE. ELSE, SKIP TO P_SDEND.

P_SD1a [ PSD1a ] CH12m-18m shows pleasure when he or she succeeds

USE CARD 25. I will read some statements about 12-18 month old children. Many statements

describe normal feelings and behaviors, but some statements describe feelings and behaviors that

may be a problem. Please select the response that best describes your child's behavior in the

@blast month@b. The first statement is...

^CHILD shows pleasure when he or she succeeds (for example, claps for self).

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD2a [ PSD2a ] CH12m-18m gets hurt so often you cant take your eyes off ch

^CHILD gets hurt so often that you can't take your eyes off him or her.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD3a [ PSD3a ] CH12m-18m seems nervous tense or fearful

^CHILD seems nervous, tense, or fearful.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD4a [ PSD4a ] CH12m-18m is restless and cant sit still

^CHILD is restless and can't sit still.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD5a [ PSD5a ] CH12m-18m follows rules

^CHILD follows rules.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD6a [ PSD6a ] CH12m-18m wakes up at night/needs help to fall back asleep

^CHILD wakes up at night and needs help to fall asleep again.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD7a [ PSD7a ] CH12m-18m cries or has tantrums until they are exhausted.

^CHILD cries or has tantrums until he or she is exhausted.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD8a [ PSD8a ] CH12m-18m is afraid of certain places animals or things

^CHILD is afraid of certain places, animals, or things.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD9a [ PSD9a ] CH12m-18m has less fun than other children

^CHILD has less fun than other children.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD10a [ PSD10a ] CH12m-18m looks for you/other parent when upset

^CHILD looks for you (or other parent) when upset.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD11a [ PSD11a ] CH12m-18m cries/hangs onto you when you try to leave

^CHILD cries or hangs onto you when you try to leave.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD12a [ PSD12a ] CH12m-18m worries a lot or is very serious

^CHILD worries a lot or is very serious.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD13a [ PSD13a ] CH12m-18m looks right at you when you say their name

^CHILD looks right at you when you say his or her name.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD14a [ PSD14a ] CH12m-18m does not react when hurt

^CHILD does not react when hurt.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD15a [ PSD15a ] CH12m-18m is affectionate with loves ones

^CHILD is affectionate with loved ones.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD16a [ PSD16a ] CH12m-18m wont touch some objects because of how they feel

^CHILD won't touch some objects because of how they feel.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD17a [ PSD17a ] CH12m-18m has trouble falling alseep or staying asleep

^CHILD has trouble falling asleep or staying asleep.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD18a [ PSD18a ] CH12m-18m runs away in public places

^CHILD runs away in public places.

Question Type: TTrue4F

_Not 0 Not true or rarely

Somewhat 1 Somewhat true or sometimes

Very 2 Very True or often

_NotPub 3 Have not seen child in public places

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

P_SD19a [ PSD19a ] CH12m-18m plays well with other children (not siblings)

^CHILD plays well with other children (not including brother or sister).

Question Type: TTrue3F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

NoContact 3 Child has not had contact with other children

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

P_SD20a [ PSD20a ] CH12m-18m can pay attention for a long time (other than TV)

^CHILD can pay attention for a long time (other than when watching TV).

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD21a [ PSD21a ] CH12m-18m has trouble adjusting to changes

^CHILD has trouble adjusting to changes.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD22a [ PSD22a ] CH12m-18m tries to help when someone is hurt

^CHILD tries to help when someone is hurt (for example, gives a toy).

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD23a [ PSD23a ] CH12m-18m often gets very upset

Please select the one response that best describes your child's behavior in the @blast month@b.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD24a [ PSD24a ] CH12m-18m gags or chokes on food

^CHILD gags or chokes on food.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD25a [ PSD25a ] CH12m-18m imitates playful sounds when you ask them to

^CHILD imitates playful sounds when you ask him or her to.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD26a [ PSD26a ] CH12m-18m refuses to eat

^CHILD refuses to eat.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD27a [ PSD27a ] CH12m-18m hits/shoves/kicks/bites children (not sib.)

^CHILD hits, shoves, kicks, or bites children (not including brother or sister).

Question Type: TTrue3F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

NoContact 3 Child has not had contact with other children

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

P_SD28a [ PSD28a ] CH12m-18m is destructive.

^CHILD is destructive. Breaks or ruins things on purpose.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD29a [ PSD29a ] CH12m-18m points to show you something far away

^CHILD points to show you something far away.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD30a [ PSD30a ] CH12m-18m hits bites or kicks you (or other parent)

^CHILD hits, bites, or kicks you (or other parent).

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD31a [ PSD31a ] CH12m-18m hugs or feeds dolls or stuffed animals

^CHILD hugs or feeds dolls or stuffed animals.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD32a [ PSD32a ] CH12m-18m seems very unhappy sad depressed or withdrawn

^CHILD seems very unhappy, sad, depressed, or withdrawn.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD33a [ PSD33a ] CH12m-18m purposely tries to hurt you (or other parent)

^CHILD purposely tries to hurt you (or other parent).

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD34a [ PSD34a ] When upset CH12m-18m gets very still freezes doesnt move

^CHILD when upset, gets very still, freezes, or doesn't move.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD35a [ PSD35a ] CH12m-18m put things in special order. Upset if interrupted

The following statements describe feelings and behaviors that can be problems for young children.

Some of the descriptions may be a bit hard to understand, especially if you have not seen the

behavior in your child. Please do your best to respond to all statements. Please select one

response that best describes your child’s behavior in the @blast month@b.

^CHILD puts things in a special order over and over and gets upset if he or she is interrupted.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD36a [ PSD36a ] CH12m-18m repeats same action or phrase without enjoyment

^CHILD repeats the same action or phrase over and over without enjoyment.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD37a [ PSD37a ] CH12m-18m repeats particular movement (ie rocking spinning)

^CHILD repeats a particular movement over and over (like rocking, spinning).

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD38a [ PSD38a ] CH12m-18m spaces out totally unaware of surroundings

^CHILD spaces out, is totally unaware of what is happening around him or her.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD39a [ PSD39a ] CH12m-18m does not make eye contact

^CHILD does not make eye contact.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD40a [ PSD40a ] CH12m-18m avoids physical contact

^CHILD avoids physical contact.

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD41a [ PSD41a ] CH12m-18m hurts self on purpose (ie bangs head)

^CHILD hurts self on purpose (for example, bangs his or her head).

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD42a [ PSD42a ] CH12m-18m eats or drinks things that are not edible

^CHILD eats or drinks things that are not edible (like paper or paint).

Question Type: TTrue2F

_Not 0 Not true or rarely

Some 1 Somewhat true or sometimes

Very 2 Very true or often

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

P_SD43a [ PSD43a ] How worried are you about CH12m-18m bhvr/emot/rltnshps

How worried are you about ^CHILD's behavior, emotions, or relationships?

Question Type: THowWor

_Not 0 Not at all worried

Alittle 1 A little worried

Worried 2 Worried

Very 4 Very worried

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

P_SD44a [ PSD44a ] How worried are you about CH12m-18m language development

How worried are you about ^CHILD's language development?

Question Type: THowWor

_Not 0 Not at all worried

Alittle 1 A little worried

Worried 2 Worried

Very 4 Very worried

Logic after:

end P_SD

PS - PROSOCIAL SKILLS: AGES 3-5

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

Logic before:

IF AGE < 3 or > 5, GOTO P_PSEND

P_PS1a [ PPS1a ] CH3-5 follows instructions

USE CARD 26. The next questions ask how often ^child does certain things. Please pick your

answer from Card 26. For each question, tell me whether ^child does this never, sometimes or

very often.

How often does ^child follow your instructions? Would you say ...

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS2a [ PPS2a ] CH3-5 help w/hh tasks

USE CARD 26. How often does ^child help you with household tasks without being asked?

Would you say...

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS3a [ PPS3a ] CH3-5 questions unfair hh rules

USE CARD 26. How often does ^child appropriately question household rules that may be unfair?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS4a [ PPS4a ] CH3-5 attempt hh tasks w/o ask help

USE CARD 26. How often does ^child attempt household tasks before asking for your help?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS5a [ PPS5a ] CH3-5 compliment friends/family

USE CARD 26. How often does ^child give compliments to friends or other children in the family?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS6a [ PPS6a ] CH3-5 participate in org grps

USE CARD 26. How often does ^child participate in organized group activities? (E.G. SPORTS,

CHURCH GROUPS, ART OR MUSIC CLASSES, GYMBOREE, ETC.)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS7a [ PPS7a ] CH3-5 politely ref unreasonable reqs

USE CARD 26. How often does ^child politely refuse unreasonable requests from others?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY."

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS8a [ PPS8a ] CH3-5 introduce self to new people

USE CARD 26. How often does ^child introduce ^fills.himherself to new people without being

told?"

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

Question Fill: ^fillhimherself

himself himself

herself herself

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

P_PS9a [ PPS9a ] CH3-5 makes good use of free time at home

USE CARD 26. How often does ^child use free time at home in an acceptable way?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS10a [ PPS10a ] CH3-5 ask permission to use others property

USE CARD 26. How often does ^child ask permission before using another family member's

property?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS11a [ PPS11a ] CH3-5 resp approp when hit by oth ch

USE CARD 26. How often does ^child respond appropriately when hit or pushed by other

children?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS12a [ PPS12a ] CH3-5 volunteer to help fam w/tasks

USE CARD 26. How often does ^child volunteer to help family members with tasks? (E.G.

HOUSEHOLD CHORES, YARD WORK, ETC.)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS13a [ PPS13a ] CH3-5 invite others to home

USE CARD 26. How often does ^child invite others to your home?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS14a [ PPS14a ] CH3-5 avoid trouble situations

USE CARD 26. How often does ^child avoid situations that are likely to result in trouble?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS15a [ PPS15a ] CH3-5 start conversations

USE CARD 26. How often does ^child start conversations rather than waiting for others to talk

first?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS16a [ PPS16a ] CH3-5 keep room clean w/o reminder

USE CARD 26. How often does ^child keep ^fills.HisHer room clean and neat without being

reminded?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS17a [ PPS17a ] CH3-5 complete hh tasks in time

USE CARD 26. How often does ^child complete household tasks within a reasonable time? (E.G.

HOUSEHOLD CHORES, YARD WORK, ETC.)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS18a [ PPS18a ] CH3-5 control temper in conflict w/R

USE CARD 26. How often does ^child control ^fills.hisher temper in conflict situations with you?

(E.G. ARGUMENTS, DISAGREEMENTS OVER HOUSEHOLD RULES, ETC.)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

Question Fill: ^fillhisher

his his

her her

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

P_PS19a [ PPS19a ] CH3-5 control tempr when argue oth ch

USE CARD 26. How often does ^child control ^fills.hisher temper when arguing with other

children?

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

Question Fill: ^fillhisher

his his

her her

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

P_PS20a [ PPS20a ] CH3-5 approp express feelng when wronged

USE CARD 26. How often does ^child appropriately express ^fills.hisher feelings when wronged?

("WRONGED" MEANS WHEN CHILD WAS TREATED UNFAIRLY, HAD HIS/HER FEELINGS

HURT, ETC.)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

Question Fill: ^fillhisher

his his

her her

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

P_PS21a [ PPS21a ] CH3-5 follow rules when play others

USE CARD 26. How often does ^child follow rules when playing games with others?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS22a [ PPS22a ] CH3-5 listen/follow Rs instructions

USE CARD 26. How often does ^child attend to your instructions? ("ATTEND" MEANS LISTEN

AND FOLLOW)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS23a [ PPS23a ] CH3-5 show intrst in variety of things

USE CARD 26. How often does ^child show interest in a variety of things?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS24a [ PPS24a ] CH3-5 answer telephone approp

USE CARD 26. How often does ^child answer the phone appropriately?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS25a [ PPS25a ] CH3-5 makes friends easily

USE CARD 26. How often does ^child make friends easily?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS26a [ PPS26a ] CH3-5 compromise by changing ideas

USE CARD 26. How often does ^child compromise in conflict situations by changing ^fills.hisher

own ideas to reach agreement? (CONFLICT SITUATIONS INCLUDE ARGUMENTS,

DISAGREEMENTS, ETC.)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

Question Fill: ^fillhisher

his his

her her

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

P_PS27a [ PPS27a ] CH3-5 put away toys/oth hh items

USE CARD 26. How often does ^child put away toys or other household property? ("PROPERTY"

MEANS ANY HOUSEHOLD ITEM)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS28a [ PPS28a ] CH3-5 waits turn in games

USE CARD 26. How often does ^child wait ^fills.hisher turn in games or other activities?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

Question Fill: ^fillhisher

his his

her her

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

P_PS29a [ PPS29a ] CH3-5 receives criticism well

USE CARD 26. How often does ^child receive criticism well?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS30a [ PPS30a ] CH3-5 congrat fam members on accomplishments

USE CARD 26. How often does ^child congratulate family members on accomplishments?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS31a [ PPS31a ] CH3-5 follow hh rules

USE CARD 26. How often does ^child follow household rules?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS32a [ PPS32a ] CH3-5 self-conf in social situations

USE CARD 26. How often is ^child self-confident in social situations such as parties or group

outings?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS33a [ PPS33a ] CH3-5 listen to speakers at meetings

USE CARD 26. How often does ^child listen to speakers at meetings such as in church or youth

groups?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS34a [ PPS34a ] CH3-5 join grp activities on own

USE CARD 26. How often does ^child join group activities without being told?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS35a [ PPS35a ] CH3-5 calmly end disagreements w/R

USE CARD 26. How often does ^child end disagreements with you calmly?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS36a [ PPS36a ] CH3-5 liked by others

USE CARD 26. How often is ^child liked by others?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS37a [ PPS37a ] CH3-5 ask sales clerks for info/help

USE CARD 26. How often does ^child ask sales clerks for information or assistance?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS38a [ PPS38a ] CH3-5 communicate problems to R

USE CARD 26. How often does ^child communicate problems to you?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PS39a [ PPS39a ] CH3-5 speak in approp tone of voice at home

USE CARD 26. How often does ^child speak in an appropriate tone of voice at home?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

Logic after:

GOTO P_PSEND

PT - PROSOCIAL SKILLS: AGES 6-10

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

Logic before:

IF AGE < 6 or > 10, GOTO P_PTEND

P_PT1a [ PPT1a ] CH6-10 Makes gd use of free tme at hme

USE CARD 26. The next questions ask how often ^child does certain things. Please pick your

answer from Card 26. For each question, tell me whether ^child does this never, sometimes or

very often.

How often does ^child use free time at home in an acceptable way? Would you say ...

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT2a [ PPT2a ] CH6-10 keep room clean w/o reminder

USE CARD 26. How often does ^child keep ^fills.HisHer room clean and neat without being

reminded? Would you say ...

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

Question Fill: ^fillhisher

his his

her her

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

P_PT3a [ PPT3a ] CH6-10 speak in approp tone of voice at home

USE CARD 26. How often does ^child speak in an appropriate tone of voice at home?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT4a [ PPT4a ] CH6-10 join grp activities on own

USE CARD 26. How often does ^child join group activities without being told to?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT5a [ PPT5a ] CH6-10 introduce self to new people

USE CARD 26. How often does ^child introduce ^fills.himherself to new people without being

told?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

Question Fill: ^fillhimherself

himself himself

herself herself

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

P_PT6a [ PPT6a ] CH6-10 rspond approp when hit by oth ch

USE CARD 26. How often does ^child respond appropriately when hit or pushed by other

children?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT7a [ PPT7a ] CH6-10 ask sales clerks for info/help

USE CARD 26. How often does ^child ask sales clerks for information or assistance?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT8a [ PPT8a ] CH6-10 listen to speakers at meetings

USE CARD 26. How often does ^child attend to speakers at meetings such as in church or youth

groups?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT9a [ PPT9a ] CH6-10 politely refuse unreasonable reqs

USE CARD 26. How often does ^child politely refuse unreasonable requests from others?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT10a [ PPT10a ] CH6-10 invite others to your home

USE CARD 26. How often does ^child invite others to your home?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT11a [ PPT11a ] CH6-10 congrat fam members on accomplishments

USE CARD 26. How often does ^child congratulate family members on accomplishments?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT12a [ PPT12a ] CH6-10 make friends easily

USE CARD 26. How often does ^child make friends easily?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT13a [ PPT13a ] CH6-10 show interest in variety of things

USE CARD 26. How often does ^child show interest in a variety of things?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT14a [ PPT14a ] CH6-10 avoid trouble situations

USE CARD 26. How often does ^child avoid situations that are likely to result in trouble?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT15a [ PPT15a ] CH6-10 put away toys/hh property

USE CARD 26. How often does ^child put away toys or other household property?

("PROPERTY"MEANS ANY HOUSEHOLD ITEM)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT16a [ PPT16a ] CH6-10 volunteer to help fam members

USE CARD 26. How often does ^child volunteer to help family members with tasks? ("TASKS"

INCLUDE HOUSEHOLD CHORES, YARD WORK, ETC.)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT17a [ PPT17a ] CH6-10 receive criticism well

USE CARD 26. How often does ^child receive criticism well?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT18a [ PPT18a ] CH6-10 answer phone appropriately

USE CARD 26. How often does ^child answer the phone appropriately?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT19a [ PPT19a ] CH6-10 help w/hh tasks

USE CARD 26. How often does ^child help you with household tasks without being asked?

("HOUSEHOLD TASKS" INCLUDE CHORES, YARD WORK, ETC.)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT20a [ PPT20a ] CH6-10 question unfair hh rules

USE CARD 26. How often does ^child appropriately question household rules that may be unfair?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT21a [ PPT21a ] CH6-10 attempt hh tasks w/o ask help

USE CARD 26. How often does ^child attempt household tasks before asking for your help?

("HOUSEHOLD TASKS" INCLUDE CHORES, YARD WORK, ETC.)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT22a [ PPT22a ] CH6-10 control temper when argue oth ch

USE CARD 26. How often does ^child control ^fills.HisHer temper when arguing with other

children?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT23a [ PPT23a ] CH6-10 liked by others

USE CARD 26. How often is ^child liked by others?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT24a [ PPT24a ] CH6-10 start conversations

USE CARD 26. How often does ^child start conversations rather than waiting for others to talk

first?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT25a [ PPT25a ] CH6-10 calmly end disagreement w/R

USE CARD 26. How often does ^child end disagreements with you calmly?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT26a [ PPT26a ] CH6-10 control temper in conflict w/R

USE CARD 26. How often does ^child control ^fills.HisHer temper in conflict situations with you?

("CONFLICT SITUATIONS" INCLUDE ARGUMENTS, DISAGREEMENTS OVER HOUSEHOLD

RULES, ETC.)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT27a [ PPT27a ] CH6-10 give compliments to friends/fam

USE CARD 26. How often does ^child give compliments to friends or other children in the family?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT28a [ PPT28a ] CH6-10 complete hh tsks in reasnble time

USE CARD 26. How often does ^child complete household tasks within a reasonable time?

("HOUSEHOLD TASKS" INCLUDE CHORES, YARD WORK, ETC.)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT29a [ PPT29a ] CH6-10 ask perm to use fam members property

USE CARD 26. How often does ^child ask permission before using another family member's

property? ("PROPERTY" MEANS ANY HOUSEHOLD ITEM BELONGING TO ANOTHER FAMILY

MEMBER)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT30a [ PPT30a ] CH6-10 celf-conf in social situations

USE CARD 26. How often is ^child self-confident in social situations such as parties or group

outings?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT31a [ PPT31a ] CH6-10 request perm to leave house

USE CARD 26. How often does ^child request permission before leaving the house?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT32a [ PPT32a ] CH6-10 resp approp to teasing

USE CARD 26. How often does ^child respond appropriately to teasing from friends or relatives of

^fills.hisher own age?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

Question Fill: ^fillhisher

his his

her her

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

P_PT33a [ PPT33a ] CH6-10 use time approp while wait help

USE CARD 26. How often does ^child use time appropriately while waiting for your help with

homework or some other task?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT34a [ PPT34a ] CH6-10 accept friends ideas for playng

USE CARD 26. How often does ^child accept friends' ideas for playing?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT35a [ PPT35a ] CH6-10 easily change from one activity to another

USE CARD 26. How often does ^child easily change from one activity to another?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT36a [ PPT36a ] CH6-10 coop w/fam members w/o being askd

USE CARD 26. How often does ^child cooperate with family members without being asked to do

so?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT37a [ PPT37a ] CH6-10 acknowledge compliments from friends

USE CARD 26. How often does ^child acknowledge compliments or praise from friends?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PT38a [ PPT38a ] CH6-10 report accidents to approp persons

USE CARD 26. How often does ^child report accidents to appropriate persons? ("ACCIDENTS"

INCLUDE EVERYTHING FROM FRIEND'S INJURY TO OTHER MORE SERIOUS ACCIDENTS.)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

Logic after:

GOTO P_PTEND

PU - PROSOCIAL SKILLS: AGES 11+

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

Logic before:

IF AGE < 11, GOTO P_PUEND

P_PU1a [ PPU1a ] CH11+ Start conversations

USE CARD 26. The next questions ask how often ^child does certain things. Please pick your

answer from Card 26. For each question, tell me whether ^child does this never, sometimes or

very often.

How often does ^child start conversations rather than waiting for others to talk first? Would you

say ...

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU2a [ PPU2a ] CH11+ help w/hh tasks w/o being told

USE CARD 26. How often does ^child help you with household tasks without being told?

("HOUSEHOLD TASKS" INCLUDE CHORES, YARD WORK, ETC.)

Would you say ...

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU3a [ PPU3a ] CH11+ try hh tasks before ask help

USE CARD 26. How often does ^child attempt household tasks before asking for your help?

("HOUSEHOLD TASKS" INCLUDE CHORES, YARD WORK, ETC.)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU4a [ PPU4a ] CH11+ participate in org activities

USE CARD 26. How often does ^child participate in organized activities such as sports or clubs?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU5a [ PPU5a ] CH11+ politely refuse unreason reqs

USE CARD 26. How often does ^child politely refuse unreasonable requests from others?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU6a [ PPU6a ] CH11+ introduce self to new people

USE CARD 26. How often does ^child introduce ^fills.himherself to new people without being

told?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

Question Fill: ^fillhimherself

himself himself

herself herself

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

P_PU7a [ PPU7a ] CH11+ use free time at home in aceptbl way

USE CARD 26. How often does ^child use free time at home in an acceptable way?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU8a [ PPU8a ] CH11+ say nice things about self

USE CARD 26. How often does ^child say nice things about ^Fills.himherself when appropriate?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

Question Fill: ^fillhimherself

himself himself

herself herself

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

P_PU9a [ PPU9a ] CH11+ resp approp to teasing

USE CARD 26. How often does ^child respond appropriately to teasing from friends or relatives of

^fills.hisher own age?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

Question Fill: ^fillhisher

his his

her her

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

P_PU10a [ PPU10a ] CH11+ resp approp when hit by othr ch

USE CARD 26. How often does ^child respond appropriately when hit or pushed by other

children?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU11a [ PPU11a ] CH11+ volunteer to help fam member w/tasks

USE CARD 26. How often does ^child volunteer to help family members with tasks?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU12a [ PPU12a ] CH11+ invite others to your home

USE CARD 26. How often does ^child invite others to your home?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU13a [ PPU13a ] CH11+ avoid trouble situations

USE CARD 26. How often does ^child avoid situations that are likely to result in trouble?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU14a [ PPU14a ] CH11+ make friends easily

USE CARD 26. How often does ^child make friends easily?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU15a [ PPU15a ] CH11+ keep room clean w/o reminder

USE CARD 26. How often does ^child keep ^fills.hisher room clean and neat without being

reminded?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

Question Fill: ^fillhisher

his his

her her

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

P_PU16a [ PPU16a ] CH11+ complete hh taks in reasonable time

USE CARD 26. How often does ^child complete household tasks within a reasonable time?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU17a [ PPU17a ] CH11+ show concrn 4 same age friends/rel

USE CARD 26. How often does ^child show concern for friends and relatives of ^fills.hisher own

age?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

Question Fill: ^fillhisher

his his

her her

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

P_PU18a [ PPU18a ] CH11+ control temper in conflict w/R

USE CARD 26. How often does ^child control ^fills.hisher temper in conflict situations with

you?("CONFLICT SITUATIONS" INCLUDE ARGUMENTS, DISAGREEMENTS OVER

HOUSEHOLD RULES, ETC.)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

Question Fill: ^fillhisher

his his

her her

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

P_PU19a [ PPU19a ] CH11+ calmly end disagreements w/R

USE CARD 26. How often does ^child end disagreements with you calmly?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU20a [ PPU20a ] CH11+ speak in approp tone of voice at home

USE CARD 26. How often does ^child speak in an appropriate tone of voice at home?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU21a [ PPU21a ] CH11+ acknowledge compliments from friends

USE CARD 26. How often does ^child acknowledge compliments or praise from friends?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU22a [ PPU22a ] CH11+ control temper when argue other ch

USE CARD 26. How often does ^child control ^fills.hisher temper when arguing with other

children?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU23a [ PPU23a ] CH11+ approp expr feelings when wronged

USE CARD 26. How often does ^child appropriately express feelings when wronged?

("WRONGED" MEANS WHEN CHILD WAS TREATED UNFAIRLY, HAD HIS/HER FEELINGS

HURT, ETC.)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD?S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU24a [ PPU24a ] CH11+ follow rules when playing games

USE CARD 26. How often does ^child follow rules when playing games with others?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU25a [ PPU25a ] CH11+ listen to Rs instructions

USE CARD 26. How often does ^child attend to your instructions? ("ATTEND" MEANS LISTEN

AND FOLLOW INSTRUCTIONS)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU26a [ PPU26a ] CH11+ join grp activities on own

USE CARD 26. How often does ^child join group activities without being told to?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU27a [ PPU27a ] CH11+ compromise by chnging own ideas

USE CARD 26. How often does ^child compromise in conflict situations by changing ^fills.hisher

own ideas to reach agreement? ("CONFLICT SITUATIONS" INCLUDE ARGUMENTS,

DISAGREEMENTS OVER HOUSEHOLD RULES, ETC.)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU28a [ PPU28a ] CH11+ put away belongings/hh property

USE CARD 26. How often does ^child put away belongings or other household property?

("PROPERTY" MEANS ANY HOUSEHOLD ITEM)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU29a [ PPU29a ] CH11+ wait turn in games/oth actvties

USE CARD 26. How often does ^child wait ^fills.hisher turn in games or other activities?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

Question Fill: ^fillhisher

his his

her her

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

P_PU30a [ PPU30a ] CH11+ use time approp while wait help

USE CARD 26. How often does ^child use time appropriately while waiting for your help with

homework or some other task?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU31a [ PPU31a ] CH11+ receive criticism well

USE CARD 26. How often does ^child receive criticism well?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU32a [ PPU32a ] CH11+ inform you before going out w/frnds

USE CARD 26. How often does ^child inform you before going out with friends?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU33a [ PPU33a ] CH11+ follow hh rules

USE CARD 26. How often does ^child follow household rules?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU34a [ PPU34a ] CH11+ self-conf in social situations

USE CARD 26. How often is ^child self-confident in social situations such as parties or group

outings?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU35a [ PPU35a ] CH11+ show interest in variety to things

USE CARD 26. How often does ^child show interest in a variety of things?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU36a [ PPU36a ] CH11+ report accidents to approp persons

USE CARD 26. How often does ^child report accidents to appropriate persons? ("ACCIDENTS"

INCLUDE EVERYTHING FROM FRIEND'S INJURY TO SERIOUS ACCIDENTS)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU37a [ PPU37a ] CH11+ liked by others

USE CARD 26. How often is ^child liked by others?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU38a [ PPU38a ] CH11+ answer phone approp

USE CARD 26. How often does ^child answer the phone appropriately?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU39a [ PPU39a ] CH11+ ask sales clerks for info/help

USE CARD 26. How often does ^child ask sales clerks for information or assistance?

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

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

P_PU40a [ PPU40a ] CH11+ appear self-conf w/opp sex friends

USE CARD 26. How often does ^child appear self-confident in social interactions with opposite-

sex friends? ("SOCIAL INTERACTIONS" REFERS TO ANY SOCIAL SITUATION LIKE SCHOOL,

INFORMAL SETTING LIKE DANCES AND PARTIES, STRUCTURED EVENTS LIKE SPORTS,

ETC.)

(Would you say...READ CATEGORIES AS NEEDED.)

NOTE: IF RESPONDENT HAS DIFFICULTY ANSWERING DUE TO LIMITED EXPERIENCE WITH

THE CHILD, OR CHILD'S LACK OF OPPORTUNITY TO PERFORM THE BEHAVIOR, PROMPT

R TO ESTIMATE THE DEGREE TO WHICH THE CHILD MAY PERFORM THE BEHAVIOR IF

GIVEN THE OPPORTUNITY.

Question Type: THO4F

never 1 never

sometimes 2 sometimes, or

veryoften 3 very often?

Logic after:

GOTO P_PUEND

TE - EMOTIONAL REGULATION - TEMPERAMENT: AGES 0-3

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

Logic before:

Age = 0 asks questions 1-17 Age= 1 asks questions 18-36 age = 2 or 3 asks questions 37 to end

of section.

P_TE_BGN [ PTE_BGN ] NoDeliv

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

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

Logic before:

IF AGE > 3, GOTO P_TEEND; IF AGE > 1, GOTO P_TE18a

P_TE1a [ PTE1a ] CH0 squirm or kick during feeding

USE CARD 27. During feeding, how often does ^child squirm or kick? Would you say...

Question Type: TNvrAlw

never 1 never/almost never,

lesshalf 2 less than half the time,

halftime 3 half the time,

morehalf 4 more than half the time, or

almostalways 5 almost always?

NA 6 ITEM NOT APPLICABLE

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

P_TE2a [ PTE2a ] CH0 wave arms during feeding

During feeding how often does ^child wave ^fills.hisher arms? Would you say...

Question Type: TNvrAlw

never 1 never/almost never,

lesshalf 2 less than half the time,

halftime 3 half the time,

morehalf 4 more than half the time, or

almostalways 5 almost always?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillhisher

his his

her her

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

P_TE3a [ PTE3a ] CH0 move around crib/bed while sleepng

During sleeping, how often does ^child usually move around the crib or bed? Would you say...

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlw

never 1 never/almost never,

lesshalf 2 less than half the time,

halftime 3 half the time,

morehalf 4 more than half the time, or

almostalways 5 almost always?

NA 6 ITEM NOT APPLICABLE

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

P_TE4a [ PTE4a ] CH0 get sleepy around same time each evening

Some children get sleepy about the same time each evening, give or take 15 minutes. How often

does ^child do this?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

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

P_TE5a [ PTE5a ] CH0 get hungry around same time each evening

Some children get hungry about the same time each evening, give or take 15 minutes. How often

does ^child do this?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

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

P_TE6a [ PTE6a ] CH0 in same mood every morning when wake

When ^child wakes up in the morning, how often is ^fills.heshe in the same mood?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE7a [ PTE7a ] CH0 turn away/cry when see stranger

When ^child sees a stranger, how often does ^fills.heshe turn away or cry as if afraid?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE8a [ PTE8a ] CH0 turn away/cry when see unfam pet

When ^child sees an unfamiliar dog or cat, how often does ^fills.heshe turn away or cry as if

afraid?

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE9a [ PTE9a ] CH0 become upset when R leaves room

When you leave the room and leave ^child alone, how often does ^fills.heshe become upset?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE10a [ PTE10a ] CH0 turn away/cry at doc/dentst/nurse

When you take ^child to the doctor, dentist or nurse, how often does ^fills.heshe turn away or cry

as if afraid?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE11a [ PTE11a ] CH0 smile/laugh when R plays w/ch

When you play with ^child, how often does ^fills.heshe smile or laugh?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE12a [ PTE12a ] CH0 smile/laugh when plays alone

When ^child plays on ^fills.hisher own, how often does ^fills.heshe smile or laugh?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE13a [ PTE13a ] CH0 smile/laugh in bath

When ^child is in the bath, how often does ^fills.heshe smile or laugh?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE14a [ PTE14a ] CH0 cry when hear unexptd loud sound

When ^child hears an unexpected loud sound (for example, a car back-firing or a vacuum cleaner),

how often does ^fills.heshe cry or become upset?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE15a [ PTE15a ] R have trouble calming CH0 when cry

How often do you have trouble soothing or calming ^child when ^fills.heshe is crying or upset?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE16a [ PTE16a ] CH0 get fussy/irritable

During the day how often does ^child get fussy and irritable? Would you say...

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

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

P_TE17a [ PTE17a ] CH0 how often cry compared to other babies

In general compared with most babies, how often does ^child cry and fuss? Would you say...

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Logic after:

GOTO P_TEEND

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

Logic before:

IF AGE IS >= 2, GOTO P_TE37a

P_TE18a [ PTE18a ] CH1 turn away/cry when see stranger

USE CARD 27. When ^child sees a stranger, how often does ^fills.heshe turn away or cry as if

afraid? Would you say...

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlw

never 1 never/almost never,

lesshalf 2 less than half the time,

halftime 3 half the time,

morehalf 4 more than half the time, or

almostalways 5 almost always?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE19a [ PTE19a ] CH1 turn away/cry when see unfam pet

When ^child sees an unfamiliar dog or cat, how often does ^fills.heshe turn away or cry as if

afraid? Would you say...

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlw

never 1 never/almost never,

lesshalf 2 less than half the time,

halftime 3 half the time,

morehalf 4 more than half the time, or

almostalways 5 almost always?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE20a [ PTE20a ] CH1 become upset when R leaves room

When you leave the room and leave ^child alone, how often does ^fills.heshe become upset?

Would you say...

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlw

never 1 never/almost never,

lesshalf 2 less than half the time,

halftime 3 half the time,

morehalf 4 more than half the time, or

almostalways 5 almost always?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE21a [ PTE21a ] CH1 turn away/cry at doc/dentst/nrse

When you take ^child to the doctor, dentist or nurse, how often does ^fills.heshe turn away or cry

as if afraid?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE22a [ PTE22a ] CH1 smile/laugh when R plays w/ch

When you play with ^child, how often does ^fills.heshe smile or laugh?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE23a [ PTE23a ] CH1 smile/laugh when plays alone

When ^child plays alone, how often does ^fills.heshe smile or laugh?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE24a [ PTE24a ] CH1 smile/laugh in bath

When ^child is in the bath, how often does ^fills.heshe smile or laugh?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE25a [ PTE25a ] CH1 cry when hear unexptd loud snd

When ^child hears an unexpected loud sound (for example, a car back-firing or a vacuum cleaner),

how often does ^fills.heshe cry or become upset?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE26a [ PTE26a ] R have trouble calming CH1 when cry

How often do you have trouble soothing or calming ^child when ^fills.heshe is crying or upset?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE27a [ PTE27a ] CH1 get fussy/irritable

During the average day, how often does ^child get fussy and irritable? Would you say...

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlw

never 1 never/almost never,

lesshalf 2 less than half the time,

halftime 3 half the time,

morehalf 4 more than half the time, or

almostalways 5 almost always?

NA 6 ITEM NOT APPLICABLE

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

P_TE28a [ PTE28a ] CH1 how often cry compared to other babies

In general compared with most toddlers, how often does ^child cry and fuss? Would you say...

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlw

never 1 never/almost never,

lesshalf 2 less than half the time,

halftime 3 half the time,

morehalf 4 more than half the time, or

almostalways 5 almost always?

NA 6 ITEM NOT APPLICABLE

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

P_TE29a [ PTE29a ] CH1 play alone w/fav toy >=10 min

How often does ^child play alone with ^fills.hisher favorite toy for 10 minutes or longer?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillhisher

his his

her her

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

P_TE30a [ PTE30a ] CH1 outdoor sights hold atten >=5 min

How often does interesting outdoor sights (such as water sprinklers, birds, or flags) hold ^child's

attention for 5 minutes or longer?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

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

P_TE31a [ PTE31a ] CH1 restless when watch fav tv show

While watching a favorite television program, how often does ^child watch for only a few minutes

before becoming restless?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

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

P_TE32a [ PTE32a ] CH1 lose interest in pic book/mag after looking at 1 part

When looking at picture books or magazines, how often does ^child look at only part of one book

before losing interest?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

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

P_TE33a [ PTE33a ] CH1 try to climb over furniture

When playing inside, how often does ^child try to climb over furniture?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

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

P_TE34a [ PTE34a ] CH1 eager to explore stores

When in a shopping mall or store, how often does ^child seem eager to explore the store?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

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

P_TE35a [ PTE35a ] CH1 sit still in seat/stroller

When placed in a car seat or stroller, how often does ^child sit still?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

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

P_TE36a [ PTE36a ] CH1 play quiet games no moving around

How often during the past month did ^child play quiet games that did not involve moving around

(such as stacking blocks or looking at books)?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Logic after:

GOTO P_TEEND

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

Logic before:

IF AGE IS >2, CONTINUE. ELSE, GOTO P_TEEND

P_TE37a [ PTE37a ] CH2-3 eat what R wants ch to eat at mealtime

USE CARD 27. When it is mealtime, how often does ^child eat what you want ^fills.himher to eat?

Would you say...

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlw

never 1 never/almost never,

lesshalf 2 less than half the time,

halftime 3 half the time,

morehalf 4 more than half the time, or

almostalways 5 almost always?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillhimher

him him

her her

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

P_TE38a [ PTE38a ] CH2-3 obey Rs commands regarding what to eat

When ^child doesn't eat what you want ^fills.himher to eat and you tell ^fills.himher to do so, how

often does ^fills.heshe obey and eat? Would you say...

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlw

never 1 never/almost never,

lesshalf 2 less than half the time,

halftime 3 half the time,

morehalf 4 more than half the time, or

almostalways 5 almost always?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillhimher

him him

her her

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

P_TE39a [ PTE39a ] CH2-3 protst/rsist going to bed at bedtime

When it is ^child's bed-time, how often does ^fills.heshe protest or resist going to bed? Would

you say...

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlw

never 1 never/almost never,

lesshalf 2 less than half the time,

halftime 3 half the time,

morehalf 4 more than half the time, or

almostalways 5 almost always?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE40a [ PTE40a ] CH2-3 obey Rs command to go to bed

When ^fills.heshe does protest and you tell ^fills.himher again, how often does ^fills.heshe then go

to bed?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE41a [ PTE41a ] CH2-3 turn off TV w/o protest

When you tell ^child to turn off the TV, how often does ^fills.heshe do so without protest?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE42a [ PTE42a ] CH2-3 obey Rs command to turn off TV

When ^fills.heshe does protest and you tell ^fills.himher again, how often does ^fills.heshe then

turn off the TV?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillhimher

him him

her her

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

P_TE43a [ PTE43a ] CH2-3 shy around new same-age ch

When ^child meets a new child of about the same age, how often is ^fills.heshe shy at first?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE44a [ PTE44a ] CH2-3 shy around new adult

When ^child first meets an adult ^fills.heshe does not know, how often is ^fills.heshe shy at first?

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE45a [ PTE45a ] CH2-3 cry when hurt a little bit

How often does ^child cry when ^fills.heshe hurts ^fills.himherself a little bit?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE46a [ PTE46a ] CH2-3 laugh/smile easily

How often does ^fills.heshe laugh and smile easily, for example when no one is touching

^fills.himher?

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE47a [ PTE47a ] CH2-3 fight/hit oth same-age ch

When ^child is with other children ^fills.hisher own age, how often does ^fills.heshe fight, take

toys, hit, etc.?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillhisher

his his

her her

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

P_TE48a [ PTE48a ] CH2-3 willingly share toys w/same age ch

When ^child is with other children ^fills.hisher own age, how often does ^fills.heshe willingly share

most toys?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillhisher

his his

her her

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

P_TE49a [ PTE49a ] R have trouble calming CH2-3 when upset

How often do you have trouble soothing or calming ^child when ^fills.heshe is upset?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE50a [ PTE50a ] CH2-3 stay close to R when playing

When ^child is playing, how often does ^fills.heshe stay close to you and make sure that

^fills.heshe can still see you?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE51a [ PTE51a ] CH2-3 try to copy what R does/how acts

How often does ^fills.heshe try to copy what you do or how you act? You may not always allow

^fills.himher to do this.

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE52a [ PTE52a ] CH2-3 get upset when R leaves room

When you leave the room and leave ^child alone, how often does ^fills.heshe get upset?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE53a [ PTE53a ] CH2-3 demanding and impatient

How often is ^child demanding and impatient even when you are busy?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

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

P_TE54a [ PTE54a ] CH2-3 get worried/try help when R upset

When you get upset about something, how often does ^child get worried or try to help or make

you feel better?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

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

P_TE55a [ PTE55a ] CH2-3 wants Rs help w/things

How often does ^child want you to help with the things ^fills.heshe is doing?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE56a [ PTE56a ] CH2-3 slept thru night during past year

During the past year, how often has ^child slept through the night?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

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

P_TE57a [ PTE57a ] CH2-3 play alone w/fav toy >=30 min

How often does ^child play alone with ^fills.hisher favorite toy for 30 minutes or longer?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillhisher

his his

her her

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

P_TE58a [ PTE58a ] CH2-3 occupied by 1 actvty when play solo

When you tell ^child that ^fills.heshe will have to play alone for a short time, how often does just

one activity or object keep ^fills.himher occupied?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

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

P_TE59a [ PTE59a ] CH2-3 restless when watch fav tv show

While watching a favorite television program, how often does ^child watch for only a few minutes

before becoming restless?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

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

P_TE60a [ PTE60a ] CH2-3 lose interest in pic book/mag after looking at 1 part

When looking at picture books or magazines, how often does ^child look at only part of one book

before losing interest?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

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

P_TE61a [ PTE61a ] CH2-3 try to climb over furniture

When playing inside, how often does ^child try to climb over furniture?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

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

P_TE62a [ PTE62a ] CH2-3 eager to explore stores

When in a shopping mall or store, how often does ^child seem eager to explore the store?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

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

P_TE63a [ PTE63a ] CH2-3 sit still in seat/stroller

When placed in a car seat or stroller, how often does ^child sit still?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

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

P_TE64a [ PTE64a ] CH2-3 keep up w/ most energetic/active ch

When ^child joins in an active game with other children (for example, one that involved running or

jumping), how often does ^fills.heshe keep up with the most energetic and active children?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNvrAlwC

never 1 NEVER/ALMOST NEVER,

lesshalf 2 LESS THAN HALF THE TIME,

halftime 3 HALF THE TIME,

morehalf 4 MORE THAN HALF THE TIME, OR

almostalways 5 ALMOST ALWAYS?

NA 6 ITEM NOT APPLICABLE

Question Fill: ^fillheshe

he he

she she

Logic after:

GOTO P_TEEND

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

P_TEEND [ PTEEND ] NoDeliv

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

TC - YOUTH BEHAVIOR (CHECKLIST FOR AGES 1.5-5)

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

Logic before:

IF AGE <18 months OR > 5, GOTO P_TCEND

P_TC1a [ PTC1a ] CBCL Age 1.5-5 : Item 1

USE CARD 28. Now I am going to read you different sentences that sometimes describe children

and youth. Please look at card 28 and tell me how true each sentence has been for ^CHILD in

the past @b2 months@b. Remember to tell me what you really think. Your answers will be kept

private.

^CHILD has aches or pains without a known medical cause.

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC2a [ PTC2a ] CBCL Age 1.5-5 : Item 2

(^CHILD) acts too young for ^fills.hisher age.

(IF R DOES NOT UNDERSTAND "ACTS TOO YOUNG", ASK: Acts younger than kids of the

same age.)

Would you say...

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_TC3a [ PTC3a ] CBCL Age 1.5-5 : Item 3

(^CHILD)

Is afraid to try new things.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC4a [ PTC4a ] CBCL Age 1.5-5 : Item 4

(^CHILD)

Avoids looking others in the eye.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC5a [ PTC5a ] CBCL Age 1.5-5 : Item 5

(^CHILD)

Can't concentrate or can't pay attention for long.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC6a [ PTC6a ] CBCL Age 1.5-5 : Item 6

(^CHILD)

Can't sit still or is restless.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC7a [ PTC7a ] CBCL Age 1.5-5 : Item 7

(^CHILD)

Can't stand having things out of place.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC8a [ PTC8a ] CBCL Age 1.5-5 : Item 8

(^CHILD)

Can't stand waiting or wants everything now.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC9a [ PTC9a ] CBCL Age 1.5-5 : Item 9

(^CHILD)

Chews on things that aren't edible.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC10a [ PTC10a ] CBCL Age 1.5-5 : Item 10

(^CHILD)

Clings to adults or is too dependent.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC11a [ PTC11a ] CBCL Age 1.5-5 : Item 11

(^CHILD)

Constantly seeks help.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC12a [ PTC12a ] CBCL Age 1.5-5 : Item 12

(^CHILD)

Gets constipated or doesn't move ^fills.hisher bowels.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_TC13a [ PTC13a ] CBCL Age 1.5-5 : Item 13

(^CHILD)

Cries a lot.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC14a [ PTC14a ] CBCL Age 1.5-5 : Item 14

(^CHILD)

Is cruel to animals.

(IF R DOES NOT UNDERSTAND "CRUEL", ASK: Mean to animals.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC15a [ PTC15a ] CBCL Age 1.5-5 : Item 15

(^CHILD)

Is defiant (rebellious).

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC16a [ PTC16a ] CBCL Age 1.5-5 : Item 16

(^CHILD's)

Demands must be met immediately.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC17a [ PTC17a ] CBCL Age 1.5-5 : Item 17

(^CHILD)

Destroys ^fills.hisher own things.

(IF R DOES NOT UNDERSTAND "DESTROYS", ASK: Ruins or wrecks things. CODE YES FOR

BOTH ACCIDENTAL AND DELIBERATE DESTRUCTION.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_TC18a [ PTC18a ] CBCL Age 1.5-5 : Item 18

(^CHILD)

Destroys things belonging to ^fills.hisher family or other children.

(IF R DOES NOT UNDERSTAND "DESTROYS", ASK: Ruins or wrecks things. CODE YES FOR

BOTH ACCIDENTAL AND DELIBERATE DESTRUCTION.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC19a [ PTC19a ] CBCL Age 1.5-5 : Item 19

(^CHILD)

Has diarrhea or loses ^fills.hisher bowels when not sick.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC20a [ PTC20a ] CBCL Age 1.5-5 : Item 20

(^CHILD)

Is disobedient.

(IF R DOES NOT UNDERSTAND "DISOBEDIENT", ASK: Doesn't do what you tell him/her to do.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC21a [ PTC21a ] CBCL Age 1.5-5 : Item 21

(^CHILD)

Is disturbed by any change in routine.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC22a [ PTC22a ] CBCL Age 1.5-5 : Item 22

(^CHILD)

Doesn't want to sleep alone.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC23a [ PTC23a ] CBCL Age 1.5-5 : Item 23

(^CHILD)

Doesn't answer when people talk to ^fills.himher.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhimher

him him

her her

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

P_TC24a [ PTC24a ] CBCL Age 1.5-5 : Item 24

(^CHILD)

Doesn't eat well.

(IF R DOES NOT UNDERSTAND "DOESN'T EAT WELL", ASK: Child will only eat one or two

kinds of food.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC25a [ PTC25a ] CBCL Age 1.5-5 : Item 25

(^CHILD)

Doesn't get along with other kids.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC26a [ PTC26a ] CBCL Age 1.5-5 : Item 26

(^CHILD)

Doesn't know how to have fun, or acts like a little adult.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC27a [ PTC27a ] CBCL Age 1.5-5 : Item 27

(^CHILD)

Doesn't seem to feel guilty after misbehaving.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC28a [ PTC28a ] CBCL Age 1.5-5 : Item 28

(^CHILD)

Doesn't want to go out of the house.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC29a [ PTC29a ] CBCL Age 1.5-5 : Item 29

(^CHILD)

Is easily frustrated.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC30a [ PTC30a ] CBCL Age 1.5-5 : Item 30

(^CHILD)

Is easily jealous.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC31a [ PTC31a ] CBCL Age 1.5-5 : Item 31

(^CHILD)

Eats or drinks things that are not food.

(DO NOT COUNT JUNK FOOD OR SWEETS)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC32a [ PTC32a ] CBCL Age 1.5-5 : Item 32

(^CHILD)

Fears certain animals, situations, or places, other than school.

(IF R DOES NOT UNDERSTAND "CERTAIN", ASK: Some.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC33a [ PTC33a ] CBCL Age 1.5-5 : Item 33

(^CHILD's)

Feelings are easily hurt.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC34a [ PTC34a ] CBCL Age 1.5-5 : Item 34

(^CHILD)

Gets hurt a lot, or is accident-prone.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC35a [ PTC35a ] CBCL Age 1.5-5 : Item 35

(^CHILD)

Gets in many fights.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC36a [ PTC36a ] CBCL Age 1.5-5 : Item 36

(^CHILD)

Gets into everything.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC37a [ PTC37a ] CBCL Age 1.5-5 : Item 37

(^CHILD)

Gets too upset when separated from ^fills.hisher parents.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_TC38a [ PTC38a ] CBCL Age 1.5-5 : Item 38

(^CHILD)

Has trouble getting to sleep.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC39a [ PTC39a ] CBCL Age 1.5-5 : Item 39

(^CHILD)

Has headaches without a known medical cause.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC40a [ PTC40a ] CBCL Age 1.5-5 : Item 40

(^CHILD)

Hits others.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC41a [ PTC41a ] CBCL Age 1.5-5 : Item 41

(^CHILD)

Holds ^fills.hisher breath.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_TC42a [ PTC42a ] CBCL Age 1.5-5 : Item 42

(^CHILD)

Hurts animals or people without meaning to.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC43a [ PTC43a ] CBCL Age 1.5-5 : Item 43

(^CHILD)

Looks unhappy without good reason.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC44a [ PTC44a ] CBCL Age 1.5-5 : Item 44

(^CHILD)

Has angry moods.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC45a [ PTC45a ] CBCL Age 1.5-5 : Item 45

(^CHILD)

Has nausea, or feels sick without a known medical cause.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC46a [ PTC46a ] CBCL Age 1.5-5 : Item 46

(^CHILD)

Makes nervous movements or twitches.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC47a [ PTC47a ] CBCL Age 1.5-5 : Item 47

(^CHILD)

Is nervous, highstrung, or tense.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC48a [ PTC48a ] CBCL Age 1.5-5 : Item 48

(^CHILD)

Has nightmares.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC49a [ PTC49a ] CBCL Age 1.5-5 : Item 49

(^CHILD)

Overeats.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC50a [ PTC50a ] CBCL Age 1.5-5 : Item 50

(^CHILD)

Gets overtired.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC51a [ PTC51a ] CBCL Age 1.5-5 : Item 51

(^CHILD)

Is overweight.

(IF R SAYS THE DOCTOR SAID CHILD IS OVERWEIGHT, ASK R TO RESPOND BASED ON

WHAT R THINKS.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC51aa [ PTC51aa ] CBCL Age 1.5-5 : Item 51a

(^CHILD)

Shows panic for no good reason.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC52a [ PTC52a ] CBCL Age 1.5-5 : Item 52

(^CHILD)

Has painful bowel movements.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC53a [ PTC53a ] CBCL Age 1.5-5 : Item 53

(^CHILD)

Physically attacks people.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC54a [ PTC54a ] CBCL Age 1.5-5 : Item 54

(^CHILD)

Picks ^fills.hisher nose, skin or other parts of the body.

(THIS DOES NOT INCLUDE NORMAL NOSE-PICKING.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_TC55a [ PTC55a ] CBCL Age 1.5-5 : Item 55

(^CHILD)

Plays with ^fills.hisher own sex parts too much.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_TC56a [ PTC56a ] CBCL Age 1.5-5 : Item 56

(^CHILD)

Is poorly coordinated or clumsy.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC57a [ PTC57a ] CBCL Age 1.5-5 : Item 57

(^CHILD)

Has problems with ^fills.hisher eyes without a known medical cause.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_TC58a [ PTC58a ] CBCL Age 1.5-5 : Item 58

Punishment doesn't change ^CHILD's behavior.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC59a [ PTC59a ] CBCL Age 1.5-5 : Item 59

(^CHILD)

Quickly shifts from one activity to another.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC60a [ PTC60a ] CBCL Age 1.5-5 : Item 60

(^CHILD)

Has rashes or other skin problems without a known medical cause.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC61a [ PTC61a ] CBCL Age 1.5-5 : Item 61

(^CHILD)

Refuses to eat.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC62a [ PTC62a ] CBCL Age 1.5-5 : Item 62

(^CHILD)

Refuses to play active games.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC63a [ PTC63a ] CBCL Age 1.5-5 : Item 63

(^CHILD)

Repeatedly rocks ^fills.hisher head or body.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_TC64a [ PTC64a ] CBCL Age 1.5-5 : Item 64

(^CHILD)

Resists going to bed at night.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC65a [ PTC65a ] CBCL Age 1.5-5 : Item 65

(^CHILD)

Resists toilet training.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC66a [ PTC66a ] CBCL Age 1.5-5 : Item 66

(^CHILD)

Screams a lot.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC67a [ PTC67a ] CBCL Age 1.5-5 : Item 67

(^CHILD)

Seems unresponsive to affection.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC68a [ PTC68a ] CBCL Age 1.5-5 : Item 68

(^CHILD)

Is self-conscious or easily embarrassed.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC69a [ PTC69a ] CBCL Age 1.5-5 : Item 69

(^CHILD)

Is selfish or won't share.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC70a [ PTC70a ] CBCL Age 1.5-5 : Item 70

(^CHILD)

Shows little affection toward people.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC71a [ PTC71a ] CBCL Age 1.5-5 : Item 71

(^CHILD)

Shows little interest in things around ^fills.himher.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_TC72a [ PTC72a ] CBCL Age 1.5-5 : Item 72

(^CHILD)

Shows too little fear of getting hurt.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC73a [ PTC73a ] CBCL Age 1.5-5 : Item 73

(^CHILD)

Is too shy or timid.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC74a [ PTC74a ] CBCL Age 1.5-5 : Item 74

(^CHILD)

Sleeps less than most children during the day and/or night.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC75a [ PTC75a ] CBCL Age 1.5-5 : Item 75

(^CHILD)

Smears or plays with bowel movements.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC76a [ PTC76a ] CBCL Age 1.5-5 : Item 76

(^CHILD)

Has a speech problem.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC77a [ PTC77a ] CBCL Age 1.5-5 : Item 77

(^CHILD)

Stares into space or seems preoccupied.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC78a [ PTC78a ] CBCL Age 1.5-5 : Item 78

(^CHILD)

Has stomachaches or cramps without a known medical cause.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC79a [ PTC79a ] CBCL Age 1.5-5 : Item 79

(^CHILD)

Stores up many things ^fills.heshe doesn't need.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillheshe

he he

she she

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

P_TC79aa [ PTC79aa ] CBCL Age 1.5-5 : Item 79a

(^CHILD)

Has rapid shifts between sadness and excitement.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC80a [ PTC80a ] CBCL Age 1.5-5 : Item 80

(^CHILD)

Behaves strangely.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC81a [ PTC81a ] CBCL Age 1.5-5 : Item 81

(^CHILD)

Is stubborn, sullen, or irritable.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC82a [ PTC82a ] CBCL Age 1.5-5 : Item 82

(^CHILD)

Has sudden changes in mood or feelings.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC83a [ PTC83a ] CBCL Age 1.5-5 : Item 83

(^CHILD)

Sulks (pouts) a lot.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC84a [ PTC84a ] CBCL Age 1.5-5 : Item 84

(^CHILD)

Talks or cries out in sleep.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC85a [ PTC85a ] CBCL Age 1.5-5 : Item 85

(^CHILD)

Has temper tantrums or a hot temper.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC86a [ PTC86a ] CBCL Age 1.5-5 : Item 86

(^CHILD)

Is too concerned with neatness or cleanliness.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC87a [ PTC87a ] CBCL Age 1.5-5 : Item 87

(^CHILD)

Is too fearful or anxious.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC88a [ PTC88a ] CBCL Age 1.5-5 : Item 88

(^CHILD)

Is uncooperative.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC89a [ PTC89a ] CBCL Age 1.5-5 : Item 89

(^CHILD)

Is underactive, slow moving, or lacks energy.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC90a [ PTC90a ] CBCL Age 1.5-5 : Item 90

(^CHILD)

Is unhappy, sad, or depressed.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC91a [ PTC91a ] CBCL Age 1.5-5 : Item 91

(^CHILD)

Is unusually loud.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC92a [ PTC92a ] CBCL Age 1.5-5 : Item 92

(^CHILD)

Is upset by new people or situations.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC93a [ PTC93a ] CBCL Age 1.5-5 : Item 93

(^CHILD)

Vomits or throws up without a known medical cause.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC94a [ PTC94a ] CBCL Age 1.5-5 : Item 94

(^CHILD)

Wakes up often at night.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC95a [ PTC95a ] CBCL Age 1.5-5 : Item 95

(^CHILD)

Wanders away from home.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC96a [ PTC96a ] CBCL Age 1.5-5 : Item 96

(^CHILD)

Wants a lot of attention.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC97a [ PTC97a ] CBCL Age 1.5-5 : Item 97

(^CHILD)

Whines.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC98a [ PTC98a ] CBCL Age 1.5-5 : Item 98

(^CHILD)

Is withdrawn, or doesn't get involved with others.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC99a [ PTC99a ] CBCL Age 1.5-5 : Item 99

(^CHILD)

Worries.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_TC100a [ PTC100a ] CBCL Age 1.5-5 : Item 100

(^CHILD)

Has other problems that were not already mentioned.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Logic after:

GOTO P_TCEND

BC - YOUTH BEHAVIOR (CHECKLIST FOR AGES 6-18)

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

Logic before:

IF AGE < 6 GOTO P_BCEND

P_BC1a [ PBC1a ] CBCL Age 6-18 : Item 1

USE CARD 28. Now I am going to read you different sentences that sometimes describe children

and youth. Looking at card 28 please tell me how true each sentence has been for ^child in the

last @b6 months@b. Remember to tell me what you really think. Your answers will be kept

private.

^child acts too young for ^fills.hisher age.

(IF R DOES NOT UNDERSTAND "ACTS TOO YOUNG", ASK: Acts younger than kids of the

same age.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_BC2a [ PBC2a ] CBCL Age 6-18 : Item 2

^child has an allergy.

NOTE: DO NOT INCLUDE "ASTHMA" HERE.

Would you say...

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC2aa [ PBC2aa ] CBCL Age 6-18 : Item 2a

^child drinks alcohol without parents' approval.

Would you say...

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC3a [ PBC3a ] CBCL Age 6-18 : Item 3

(^child)

Argues a lot.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC4a [ PBC4a ] CBCL Age 6-18 : Item 4

(^child)

Has asthma.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC4aa [ PBC4aa ] CBCL Age 6-18 : Item 4a

(^child)

Fails to finish things ^fills.heshe starts.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillheshe

he he

she she

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

P_BC5a [ PBC5a ] CBCL Age 6-18 : Item 5

(^child)

Behaves like the opposite sex.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC5aa [ PBC5aa ] CBCL Age 6-18 : Item 5a

(^child)

There is very little ^fills.heshe enjoys.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillheshe

he he

she she

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

P_BC6a [ PBC6a ] CBCL Age 6-18 : Item 6

(^child)

Has bowel movements outside the toilet.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC7a [ PBC7a ] CBCL Age 6-18 : Item 7

(^child)

Brags or boasts.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC8a [ PBC8a ] CBCL Age 6-18 : Item 8

(^child)

Can't concentrate, or can't pay attention for long.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC9a [ PBC9a ] CBCL Age 6-18 : Item 9

(^child)

Can't get ^fills.hisher mind off certain thoughts or obsessions.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

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

P_BC10a [ PBC10a ] CBCL Age 6-18 : Item 10

(^child)

Can't sit still, or is restless or hyperactive.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC11a [ PBC11a ] CBCL Age 6-18 : Item 11

(^child)

Clings to adults or is too dependent. (IF R DOES NOT UNDERSTAND "DEPENDENT", ASK:

Needs extra help from adults or is helpless.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC12a [ PBC12a ] CBCL Age 6-18 : Item 12

(^child)

Complains of loneliness.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC13a [ PBC13a ] CBCL Age 6-18 : Item 13

(^child)

Is confused or seems to be in a fog.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC14a [ PBC14a ] CBCL Age 6-18 : Item 14

(^child)

Cries a lot.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC15a [ PBC15a ] CBCL Age 6-18 : Item 15

(^child)

Is cruel to animals. (IF R DOES NOT UNDERSTAND "CRUEL", ASK: Mean to animals.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC16a [ PBC16a ] CBCL Age 6-18 : Item 16

(^child)

Is cruel, bullying, or mean to others.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC17a [ PBC17a ] CBCL Age 6-18 : Item 17

(^child)

Daydreams or gets lost in ^fills.hisher thoughts.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_BC18a [ PBC18a ] CBCL Age 6-18 : Item 18

(^child)

Deliberately harms ^fills.himherself or attempts suicide.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhimherself

himself himself

herself herself

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

P_BC19a [ PBC19a ] CBCL Age 6-18 : Item 19

(^child)

Demands a lot of attention. (IF R DOES NOT UNDERSTAND "DEMANDS A LOT OF

ATTENTION", ASK: Things child wants you to do.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC20a [ PBC20a ] CBCL Age 6-18 : Item 20

(^child)

Destroys ^Fills.hisher own things. (IF R DOES NOT UNDERSTAND "DESTROYS", ASK: Ruins or

wrecks things.)

(CODE YES FOR BOTH ACCIDENTAL AND DELIBERATE DESTRUCTION.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_BC21a [ PBC21a ] CBCL Age 6-18 : Item 21

(^child)

Destroys things belonging to ^Fills.hisher family or others. (IF R DOES NOT UNDERSTAND

"DESTROYS", ASK: Ruins or wrecks things.)

(CODE YES FOR BOTH ACCIDENTAL AND DELIBERATE DESTRUCTION.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_BC22a [ PBC22a ] CBCL Age 6-18 : Item 22

(^child)

Is disobedient at home. (IF R DOES NOT UNDERSTAND "DISOBEDIENT", ASK: Doesn't do what

you tell him/her to do.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC23a [ PBC23a ] CBCL Age 6-18 : Item 23

(^child)

Is disobedient at school.(IF R DOES NOT UNDERSTAND "DISOBEDIENT", ASK: Doesn't do

what he/she is told.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC24a [ PBC24a ] CBCL Age 6-18 : Item 24

(^child)

Doesn't eat well. (IF R DOES NOT UNDERSTAND "DOESN'T EAT WELL", ASK: Child will only

eat one or two kinds of food.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC25a [ PBC25a ] CBCL Age 6-18 : Item 25

(^child)

Doesn't get along with other kids.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC26a [ PBC26a ] CBCL Age 6-18 : Item 26

(^child)

Doesn't seem to feel guilty after misbehaving.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC27a [ PBC27a ] CBCL Age 6-18 : Item 27

(^child)

Is easily jealous.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC28a [ PBC28a ] CBCL Age 6-18 : Item 28

(^child)

Eats or drinks things that are not food. (DO NOT INCLUDE JUNK FOOD OR SWEETS).

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC28aa [ PBC28aa ] CBCL Age 6-18 : Item 28a

(^child)

Breaks rules at home, school, or elsewhere.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC29a [ PBC29a ] CBCL Age 6-18 : Item 29

(^child)

Fears certain animals, situations, or places, other than school. (IF R DOES NOT UNDERSTAND

"CERTAIN", ASK: Some.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC30a [ PBC30a ] CBCL Age 6-18 : Item 30

(^child)

Fears going to school.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC31a [ PBC31a ] CBCL Age 6-18 : Item 31

(^child)

Fears ^Fills.heshe might think or do something bad.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillheshe

he he

she she

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

P_BC32a [ PBC32a ] CBCL Age 6-18 : Item 32

(^child)

Feels ^Fills.heshe has to be perfect.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillheshe

he he

she she

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

P_BC33a [ PBC33a ] CBCL Age 6-18 : Item 33

(^child)

Feels or complains that no one loves ^Fills.himher.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhimher

him him

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

P_BC34a [ PBC34a ] CBCL Age 6-18 : Item 34

(^child)

Feels others are out to get ^Fills.himher.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhimher

him him

her her

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

P_BC35a [ PBC35a ] CBCL Age 6-18 : Item 35

(^child)

Feels worthless or inferior.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC36a [ PBC36a ] CBCL Age 6-18 : Item 36

(^child)

Gets hurt a lot, or is accident-prone.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC37a [ PBC37a ] CBCL Age 6-18 : Item 37

(^child)

Gets in many fights.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC38a [ PBC38a ] CBCL Age 6-18 : Item 38

(^child)

Gets teased a lot.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC39a [ PBC39a ] CBCL Age 6-18 : Item 39

(^child)

Hangs around with others who get in trouble.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC40a [ PBC40a ] CBCL Age 6-18 : Item 40

(^child)

Hears sounds or voices that aren't there.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC41a [ PBC41a ] CBCL Age 6-18 : Item 41

(^child)

Is impulsive or acts without thinking.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC42a [ PBC42a ] CBCL Age 6-18 : Item 42

(^child)

Would rather be alone than with others.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC43a [ PBC43a ] CBCL Age 6-18 : Item 43

(^child)

Lies or cheats.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC44a [ PBC44a ] CBCL Age 6-18 : Item 44

(^child)

Bites ^Fills.hisher fingernails.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_BC45a [ PBC45a ] CBCL Age 6-18 : Item 45

(^child)

Is nervous, highstrung, or tense.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC46a [ PBC46a ] CBCL Age 6-18 : Item 46

(^child)

Makes nervous movements or twitches.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC47a [ PBC47a ] CBCL Age 6-18 : Item 47

(^child)

Has nightmares.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC48a [ PBC48a ] CBCL Age 6-18 : Item 48

(^child)

Is not liked by other kids.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC49a [ PBC49a ] CBCL Age 6-18 : Item 49

(^child)

Gets constipated or doesn't move ^Fills.hisher bowels.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_BC50a [ PBC50a ] CBCL Age 6-18 : Item 50

(^child)

Is too fearful or anxious.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC51a [ PBC51a ] CBCL Age 6-18 : Item 51

(^child)

Feels dizzy.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC52a [ PBC52a ] CBCL Age 6-18 : Item 52

(^child)

Feels too guilty.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC53a [ PBC53a ] CBCL Age 6-18 : Item 53

(^child)

Overeats.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC54a [ PBC54a ] CBCL Age 6-18 : Item 54

(^child)

Gets overtired.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC55a [ PBC55a ] CBCL Age 6-18 : Item 55

(^child)

Is overweight. (IF R SAYS THE DOCTOR SAID CHILD IS OVERWEIGHT, ASK R TO RESPOND

BASED ON WHAT R THINKS.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC56aa [ PBC56aax ] CBCL Age 6-18 : Item 56A

(^child)

Has aches or pains (not stomach or headaches) without a known medical cause. (IF R DOES

NOT UNDERSTAND "WITHOUT MEDICAL CAUSE", ASK: When not sick.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC56ba [ PBC56ba ] CBCL Age 6-18 : Item 56B

(^child)

Has headaches without a known medical cause.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC56ca [ PBC56ca ] CBCL Age 6-18 : Item 56C

(^child)

Has nausea or feels sick without a known medical cause.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC56da [ PBC56da ] CBCL Age 6-18 : Item 56D

(^child)

Has problems with ^fills.hisher eyes without a known medical cause.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_BC56ea [ PBC56ea ] CBCL Age 6-18 : Item 56E

(^child)

Has rashes or other skin problems without a known medical cause.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC56fa [ PBC56fa ] CBCL Age 6-18 : Item 56F

(^child)

Has stomachaches or cramps without a known medical cause.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC56ga [ PBC56ga ] CBCL Age 6-18 : Item 56G

(^child)

Has vomiting or throwing up without a known medical cause.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC56ha [ PBC56ha ] CBCL Age 6-18 : Item 56H

(^child)

Has other physical problems without a known medical cause.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC57a [ PBC57a ] CBCL Age 6-18 : Item 57

(^child)

Physically attacks people.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC58a [ PBC58a ] CBCL Age 6-18 : Item 58

(^child)

Picks ^fills.hisher nose, skin, or other parts of ^Fills.hisher body. (THIS DOES NOT INCLUDE

NORMAL NOSE-PICKING.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_BC59a [ PBC59a ] CBCL Age 6-18 : Item 59

(^child)

Plays with ^fills.hisher own sex parts in public.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_BC60a [ PBC60a ] CBCL Age 6-18 : Item 60

(^child)

Plays with ^fills.hisher own sex parts too much.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_BC61a [ PBC61a ] CBCL Age 6-18 : Item 61

(^child)

Does poor school work.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC62a [ PBC62a ] CBCL Age 6-18 : Item 62

(^child)

Is poorly coordinated or clumsy.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC63a [ PBC63a ] CBCL Age 6-18 : Item 63

(^child)

Prefers being with older kids.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC64a [ PBC64a ] CBCL Age 6-18 : Item 64

(^child)

Prefers being with younger kids.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC65a [ PBC65a ] CBCL Age 6-18 : Item 65

(^child)

Refuses to talk. (IF R DOES NOT UNDERSTAND "REFUSES", ASK: Will not talk.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC66a [ PBC66a ] CBCL Age 6-18 : Item 66

(^child)

Repeats certain acts over and over.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC67a [ PBC67a ] CBCL Age 6-18 : Item 67

(^child)

Runs away from home.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC68a [ PBC68a ] CBCL Age 6-18 : Item 68

(^child)

Screams a lot.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC69a [ PBC69a ] CBCL Age 6-18 : Item 69

(^child)

Is secretive or keeps things to ^fills.himherself.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_BC70a [ PBC70a ] CBCL Age 6-18 : Item 70

(^child)

Sees things that aren't there.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC71a [ PBC71a ] CBCL Age 6-18 : Item 71

(^child)

Is self-conscious or easily embarrassed.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC72a [ PBC72a ] CBCL Age 6-18 : Item 72

(^child)

Sets fires. (INCLUDES PLAYING WITH MATCHES OR LIGHTER. IF R SAYS THAT IT

HAPPENED ONCE IN LAST 6 MONTHS BUT SAYS "1", CODE AS "2".)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC73a [ PBC73a ] CBCL Age 6-18 : Item 73

(^child)

Has sexual problems.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC74a [ PBC74a ] CBCL Age 6-18 : Item 74

(^child)

Shows off or clowns.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC75a [ PBC75a ] CBCL Age 6-18 : Item 75

(^child)

Is shy or timid.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC76a [ PBC76a ] CBCL Age 6-18 : Item 76

(^child)

Sleeps less than most kids.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC77a [ PBC77a ] CBCL Age 6-18 : Item 77

(^child)

Sleeps more than most kids during the day and/or night.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC78a [ PBC78a ] CBCL Age 6-18 : Item 78

(^child)

Smears or plays with bowel movements.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC78aa [ PBC78aa ] CBCL Age 6-18 : Item 78a

(^child)

Is inattentive or easily distracted.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC79a [ PBC79a ] CBCL Age 6-18 : Item 79

(^child)

Has a speech problem.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC80a [ PBC80a ] CBCL Age 6-18 : Item 80

(^child)

Stares blankly.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC81a [ PBC81a ] CBCL Age 6-18 : Item 81

(^child)

Steals at home.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC82a [ PBC82a ] CBCL Age 6-18 : Item 82

(^child)

Steals outside the home.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC83a [ PBC83a ] CBCL Age 6-18 : Item 83

(^child)

Stores up things ^fills.heshe doesn't need.

(IF R DOES NOT UNDERSTAND "STORES UP", ASK: Collects things ^fills.heshe doesn't need.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillheshe

he he

she she

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

P_BC84a [ PBC84a ] CBCL Age 6-18 : Item 84

(^child)

Behaves strangely.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC85a [ PBC85a ] CBCL Age 6-18 : Item 85

(^child)

Has strange ideas.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC86a [ PBC86a ] CBCL Age 6-18 : Item 86

(^child)

Is stubborn, sullen, or irritable.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC87a [ PBC87a ] CBCL Age 6-18 : Item 87

(^child)

Has sudden changes in mood or feelings.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC88a [ PBC88a ] CBCL Age 6-18 : Item 88

(^child)

Sulks (pouts) a lot.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC89a [ PBC89a ] CBCL Age 6-18 : Item 89

(^child)

Is suspicious.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC90a [ PBC90a ] CBCL Age 6-18 : Item 90

(^child)

Swears or uses obscene language.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC91a [ PBC91a ] CBCL Age 6-18 : Item 91

(^child)

Talks about killing ^fills.himherself. (IF R NOTES THAT IT HAPPENED ONCE IN THE LAST 6

MONTHS BUT SAYS "1", CODE "2".)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhimherself

himself himself

herself herself

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

P_BC92a [ PBC92a ] CBCL Age 6-18 : Item 92

(^child)

Talks or walks in ^Fills.hisher sleep.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_BC93a [ PBC93a ] CBCL Age 6-18 : Item 93

(^child)

Talks too much.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC94a [ PBC94a ] CBCL Age 6-18 : Item 94

(^child)

Teases a lot.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC95a [ PBC95a ] CBCL Age 6-18 : Item 95

(^child)

Has temper tantrums or a hot temper.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC96a [ PBC96a ] CBCL Age 6-18 : Item 96

(^child)

Thinks about sex too much.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC97a [ PBC97a ] CBCL Age 6-18 : Item 97

(^child)

Threatens people.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC98a [ PBC98a ] CBCL Age 6-18 : Item 98

(^child)

Sucks ^Fills.hisher thumb.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

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

P_BC99a [ PBC99a ] CBCL Age 6-18 : Item 99

(^child)

Is too concerned with neatness or cleanliness.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC99aa [ PBC99aa ] CBCL Age 6-18 : Item 99a

(^child)

Smokes, chews, or sniffs tobacco.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC100a [ PBC100a ] CBCL Age 6-18 : Item 100

(^child)

Has trouble sleeping.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC101a [ PBC101a ] CBCL Age 6-18 : Item 101

(^child)

Is truant or skips school.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC102a [ PBC102a ] CBCL Age 6-18 : Item 102

(^child)

Is underactive, slow moving, or lacks energy.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC103a [ PBC103a ] CBCL Age 6-18 : Item 103

(^child)

Is unhappy, sad, or depressed.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC104a [ PBC104a ] CBCL Age 6-18 : Item 104

(^child)

Is unusually loud.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC105a [ PBC105a ] CBCL Age 6-18 : Item 105

(^child)

Uses alcohol or drugs for non-medical purposes.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC106a [ PBC106a ] CBCL Age 6-18 : Item 106

(^child)

Vandalizes.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC107a [ PBC107a ] CBCL Age 6-18 : Item 107

(^child)

Wets ^Fills.himherself during the day.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhimherself

himself himself

herself herself

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

P_BC108a [ PBC108a ] CBCL Age 6-18 : Item 108

(^child)

Wets the bed.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC109a [ PBC109a ] CBCL Age 6-18 : Item 109

(^child)

Whines.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC110a [ PBC110a ] CBCL Age 6-18 : Item 110

(^child)

Wishes to be of the opposite sex.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC111a [ PBC111a ] CBCL Age 6-18 : Item 111

(^child)

Is withdrawn, or doesn't get involved with others.(IF R DOES NOT UNDERSTAND HOW TO

ANSWER QUESTION, EMPHASIZE: Does not get involved.)

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC112a [ PBC112a ] CBCL Age 6-18 : Item 112

(^child)

Worries.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

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

P_BC113a [ PBC113a ] CBCL Age 6-18 : Item 113

(^child)

Has other problems that were not already mentioned.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Logic after:

P_BCEND

IN - INCOME

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

P_IN1an [ PIN1an ] NO LABEL

The next questions are about income or income assistance available to ^CHILD's household

during the past 12 months. By household, I mean all of the people who live here. Please

remember that all information you provide will be kept private.

First, I need to know the @B total combined income of your family@B from all sources in the

@bpast 12 months@b. Please include your own income and the income of everyone living with

you. This includes money from jobs, net income from business or rent, pensions, dividends,

interest, social security, public assistance programs, welfare, food stamps, child support and

income from any other source such as family or friends and activities such as work "off the books"

or "under the table". If you don't know exactly, your best guess is okay.

PRESS 1 TO CONTINUE

Question Type: TCont

Continue 1 Continue

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

P_IN2n [ PIN2n ] Best est total inc of all family membrs bfr txs pst 12m

In the past twelve months, what was the total income of your household from all sources before taxes and other deductions? Please include your own income and the income of everyone living with you.

Question Type: 0..999997

Logic after:

IF P_IN2n = DK or REF, GO TO P_IN3aa. ELSE GO TO P_IN2an

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

P_IN2r

I just need to have a range. Can you tell me if it was . . .

Less than $5,000, ............................................................. 1

$5,001 to $10,000, ............................................................ 2

$10,001 to $15,000, .......................................................... 3

$15,001 to $20,000, .......................................................... 4

$20,001 to $25,000, .......................................................... 5

$25,001 to $30,000, .......................................................... 6

$30,001 to $40,000, .......................................................... 7

$40,001 to $50,000, or ...................................................... 8

More than $50,000? .......................................................... 9

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

P_IN2an [ PIN2an ] # people contributed to total family income

How many people contributed to this total family income?

Question Type: 1..30

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

P_IN3_1n [ PIN31n ] # adults including yourself depend on this income

How many adults, including yourself, depend on this income?

NUMBER OF ADULTS:

NOTE: QUESTION REFERS TO ALL ADULTS, INCLUDING THOSE WHO MAY LIVE IN A

DIFFERENT HOUSEHOLD.

Question Type: 1..30

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

P_IN3_2n [ PIN32n ] # children depend on this income

How many children depend on this income?

NUMBER OF CHILDREN:

NOTE: QUESTION REFERS TO ALL CHILDREN, INCLUDING THOSE WHO MAY LIVE IN A

DIFFERENT HOUSEHOLD.

Question Type: 1..30

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

P_IN4a [ PIN4a ] Anyone in HH curr rcv ch support for CH

In the last twelve months, did anyone in this household receive child support for ^CHILD?

NOTE: THIS INCLUDES CHILD SUPPORT RECEIVED FROM THE STATE FROM GARNISHED

WAGES.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

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

P_IN5 [ PINTG5 ] Labels are in Logic After

In the last 12 months, did anyone in this household receive ...

CODE ALL THAT APPLY.

Question Type: TAidS

1 = WIC (Women Infants, and Children),

2 = [NAME OF STATE SNAP PROGRAM], [NAME OF STATE EBT CARD] Electronic Bank Transfer (EBT) card, or Food Stamps,

3 = Welfare or TANF (PROBE: By welfare or TANF, we mean temporary assistance to needy families, AFDC, or cash welfare) or other public assistance

4 = Housing Support, such as public housing, a voucher or assistance from Section 8),

5 = A disability check (SSI)?

6 = Child care assistance

7 = NONE OF THE ABOVE.

IF P_IN5 = 2, ASK P_IN6 – P_IN7.

P_IN6

How many months did you receive help from [NAME OF STATE SNAP PROGRAM] in the last twelve months?

P_IN7

Thinking about the last month you received a [NAME OF STATE SNAP PROGRAM] payment, how much did you receive?

IF P_IN5 = 3, ASK P_IN8 – P_IN10.

P_IN8

How many months did you receive help from welfare or TANF in the last twelve months?

P_IN9

Thinking about the last month you received a welfare or TANF payment, about how much did you receive?

P_IN10

Do the TANF benefits provide for ...

1 = ^CHILD and other household members,

2 = ^CHILD only, or

3 = other household members only (and not ^CHILD)?

IF P_IN5 = 5, ASK P_IN11.

P_IN11

Is the disability check (SSI) to provide for ...

1 = ^CHILD and other household members,

2 = ^CHILD only, or

3 = other household members only (and not ^CHILD)?

P_IN12.

Did you receive the Earned Income Tax Credit, or EITC, or any tax refund within the last 12 months?

PROBE IF DON’T KNOW WHAT EITC IS: The federal government has a special rule that allows working people who make less than about $29,000 a year to get a tax refund. It’s called the Earned Income Credit or EIC. Sometimes, if the IRS thinks that someone is eligible for the EIC they send out a letter asking that person to fill out a special form so that they can claim the EIC.

YES ....................................................................... 1

NO ........................................................................ 2

The following questions ask about your household’s activities in the past 12 months.

P_IN13

How difficult is it for you to pay your household’s bills each month? Would you say you have a…

1 Great deal of difficulty

2 Quite a bit of difficulty

3 Some difficulty

4 A little difficulty

5 No difficulty at all

P_IN14

Generally, at the end of each month do you end up with…

1 Not enough to make ends meet

2 Almost enough to make ends meet

3 Just enough to make ends meet

4 Some money left over

5 More than enough money left over

P_IN15

We have enough money to afford the kind of home we need. Do you…

1 Strongly disagree

2 Disagree

3 Agree

4 Strongly agree

P_IN16

We have enough money to afford the kind of clothing we need. Do you…

1 Strongly disagree

2 Disagree

3 Agree

4 Strongly agree

P_IN17

We have enough money to afford the kind of food we need. Do you…

1 Strongly disagree

2 Disagree

3 Agree

4 Strongly agree

P_IN18

We have enough money to afford the kind of medical care we need. Do you…

1 Strongly disagree

2 Disagree

3 Agree

4 Strongly agree

SR - Services Received by Caregiver

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

Logic before:

This section should be skipped in the following caregiver situations:

- Licensed Foster Home, Living with a Family Friend, or all non-family settings

(P_NP12a >= 3, 4, or 6) OR (P_NP12b .>= 1) OR

- Primary CG is a Foster Mother or Father

(P_HH6a = 8 or 9 OR P_HH6g = 8 or 9) OR

- Primary CG currently receives payments for being a foster parent

(P_HH6e = 1)

P_SR_BEG [ PSR_BEG ] NoDeliv

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

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

Logic before:

IF WAVE 1 OR (WAVE =2 AND GROUP = 4), CONTINUE. ELSE GOTO P_SR1a

P_SR1 [ PSR1 ] Have you ever been referred to or offered legal aid

The next questions are about services you may have received in the community.

Have you ever been referred to or offered legal aid?

NOTE: "IN THE COMMUNITY" MEANS SERVICES NOT PROVIDED DIRECTLY BY THE

AGENCY, ALTHOUGH THE AGENCY COULD ARRANGE THE SERVICES. "LEGAL AID" IS

LEGAL HELP/SERVICES NOT RELATED TO CHILD WELFARE CUSTODY OR CPS ISSUES.

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

if P_SR1 = no GOTO P_SR2

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

Logic before:

IF WAVE 2 AND GROUP NE 4:The next questions are about services you may have received in

the community. IF WAVE 2 AND GROUP NE 4: NOTE: "IN THE COMMUNITY" MEANS

SERVICES NOT PROVIDED DIRECTLY BY THE AGENCY, ALTHOUGH THE AGENCY COULD

ARRANGE THE SERVICES. "LEGAL AID" IS LEGAL HELP/SERVICES NOT RELATED TO

CHILD WELFARE CUSTODY OR CPS ISSUES.

P_SR1a [ PSR1a ] Referred/offered legal aid-past 12m

^fills.P_SR1a_1 have you been referred to or offered legal aid?

^fills.P_SR1A_2

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Question Fill: ^fillp_sr1a_1

blank1 In the last 12 months,

text1 The next questions are about services you may have received in the

community. In the last 12 months,

Question Fill: ^fillp_sr1a_2

blank2

text2 NOTE: "IN THE COMMUNITY" MEANS SERVICES NOT PROVIDED

DIRECTLY BY THE AGENCY, ALTHOUGH THE AGENCY COULD

ARRANGE THE SERVICES. "LEGAL AID" IS LEGAL HELP/SERVICES

NOT RELATED TO CHILD WELFARE CUSTODY OR CPS ISSUES.

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

Logic before:

IF WAVE 1 OR WAVE =2 AND GROUP = 4, CONTINUE. ELSE GOTO P_SR2a

P_SR2 [ PSR2 ] Have you ever received legal aid?

Have you ever @breceived@b legal aid?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_sr2 = NO GOTO P_SR6

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

P_SR2a [ PSR2a ] Rcvd legal aid-past 12m

In the last 12 months, have you received legal aid?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

IF = 2, GOTO P_SR4.

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

P_SR3a [ PSR3aa ] R still receiving legal aid

Are you still receiving legal aid?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

GOTO P_SR6

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

P_SR4 [ PSR4a ] How much need legal aid-past 12m

In the last 12 months, how much have you needed legal aid? Would you say...

Question Type: THMNeed

alot 1 a lot,

somewhat 2 somewhat,

alittle 3 a little, or

notatall 4 not at all?

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

Logic before:

IF WAVE 1 OR WAVE =2 AND GROUP = 4, CONTINUE. ELSE GOTO P_SR6a1

P_SR6 [ PSR6 ] Have you ever rcvd food from cmmnty source like soup ktchn

Have you ever received food from a community source like a soup kitchen or a food bank?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

IF P_SR6 = NO GOTO P_SR8

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

P_SR6a1 [ PSR6a ] Rcvd food from community source-past 12m

In the last 12 months, have you received food from a community source like a soup kitchen or a

food bank?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if p_sr6a1 =NO GOTO P_SR8

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

P_SR7 [ PSR7a ] Number times rcv food aid-past 12m

In the last 12 months, how many times did you receive food from a community source?

NUMBER OF TIMES

Question Type: 1..1000

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

P_SR7a [ PSR7aa ] R still gets food from community source

Are you still receiving food from a community source?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

GOTO P_SR10

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

P_SR8 [ PSR8a ] Needed food at any time-past 12m

In the last 12 months, have you needed food at any time?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

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

Logic before:

IF WAVE 1 OR WAVE =2 AND GROUP = 4, CONTINUE. ELSE GOTO P_SR10a1

P_SR10 [ PSR10 ] R ever rcvd emergency shelter or emergency housing

Have you ever received emergency shelter or emergency housing? For example, have you ever

stayed in a homeless shelter?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if p_sr10 = NO GOTO P_SR11

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

P_SR10a1 [ PSR10a ] Rcvd emergency shelter/housing-past 12m

In the last 12 months, have you received emergency shelter or emergency housing? For example,

have you stayed in a homeless shelter?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if p_sr10 = NO GOTO P_SR11

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

P_SR10a [ PSR10aa ] R curr living in emergency shelter

INTERVIEWER: IS RESPONDENT CURRENTLY LIVING IN EMERGENCY SHELTER OR

HOUSING?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

GOTO P_SR14

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

P_SR11 [ PSR11a ] Needed emerg shelter/housing-past 12m

In the last 12 months, have you needed emergency shelter or emergency housing?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if p_sr11 = NO GOTO P_SR14

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

Logic before:

IF WAVE 1 OR WAVE =2 AND GROUP = 4, CONTINUE. ELSE GOTO P_SR14a1

P_SR14 [ PSR14 ] Have you ever received any job-related services?

Have you ever @breceived@b any job-related services?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if p_sr14 = NO GOTO P_SR21

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

P_SR14a1 [ PSR14a ] Rcvd job-related services-past 12m

In the last 12 months, have you @breceived@b any job-related services?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if p_sr14a1 = NO GOTO P_SR21

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

P_SR15 [ PSR15a ] # Weeks services rcvd

For how many weeks were these services received?

(IF SERVICE WAS ONLY RECEIVED 1 TIME, ENTER "1".)

NUMBER OF WEEKS

Question Type: 1..52

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

P_SR17a [ PSR17aa ] R still rcvng job-related services

Are you still receiving job-related services?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

GOTO P_SR21

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

Logic before:

IF WAVE 1 OR WAVE =2 AND GROUP = 4, CONTINUE. ELSE GOTO P_SR21a1

P_SR21 [ PSR21 ] R ever attended any organized support/self-help groups

Have you ever @battended@b any organized support groups or self-help groups, including

Alcoholics Anonymous, Parents Anonymous, or other support groups? These groups might meet

at a community center or a church to discuss issues that concern them.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if p_sr21 = no GOTO P_SR23

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

P_SR21a1 [ PSR21a ] Attended any orgnized supp grps-past 12m

In the last 12 months, have you @battended@b any organized support groups or self-help groups,

including Alcoholics Anonymous, Parents Anonymous, or other support groups? These groups

might meet at a community center or a church to discuss issues that concern them.

FR NOTE: ATTENDING ONLINE/VIRTUAL MEETINGS OR SUPPORT GROUPS SHOULD BE INCLUDED.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

IF p_sr21a1= 2 GOTO P_SR23

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

P_SR22a [ PSR22aa ] R still attending support group

Are you still attending meetings with this support group?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

GOTO P_SR25

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

P_SR23 [ PSR23a ] How much needed supp grp-past 12m

In the last 12 months, how much have you needed a support group or self-help group? Would you

say...

Question Type: THMNeed

alot 1 a lot,

somewhat 2 somewhat,

alittle 3 a little, or

notatall 4 not at all?

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

P_SR25 [ PSR25ax ] R rqred by Ch Wlfr to atnd support/slf-hlp grps-past 12m

In the last 12 months, were you required by the Child Welfare Agency or the court to attend any

peer support groups or self-help groups? This could include Alcoholics Anonymous, Parents

Anonymous, or other support groups.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

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

Logic before:

IF WAVE 1 OR WAVE =2 AND GROUP = 4, CONTINUE. ELSE GOTO P_SR31a1

P_SR31 [ PSR31 ] R ever been admitted to a hsptl/med facility over night

Have you ever been admitted to a hospital or medical facility overnight for any reason?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR31= NO GOTO P_SR39

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

P_SR31a1 [ PSR31a1 ] R been admitted to a hsptl/med facility over night-past 12m

In the last 12 months, have you been admitted to a hospital or medical facility overnight for any

reason?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR31a= NO GOTO P_SR39

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

Logic before:

RESPONSE OF 4 = Y CANNOT BE INCLUDED WITH RESPONSE OF 1-3 = Y

P_SR32 [ PSR32 ] Labels are in Logic After

Why were you admitted (to a hospital or medical facility overnight)?

CODE ALL THAT APPLY.

Question Type: TPSR32S

drug 1 ALCOHOL/DRUG PROBLEM

mental 2 EMOTIONS, NERVES, OR MENTAL HEALTH PROBLEM (E.G.

DEPRESSION, SCHIZOPHRENIA, BIPOLAR DISORDER, SUICIDE

ATTEMPTS, ETC.)

ill 3 ILLNESS OR INJURY

none_ 4 NONE OF THE ABOVE

Logic after:

PSR32T_1--Why admtd to hsptl/med fac-Alcohol/drug problem; PSR32T_2--Why admtd to

hsptl/med fac-Mental health problem; PSR32T_3--Why admtd to hsptl/med fac-Illness/injury;

PSR32T_4--Why admtd to hsptl/med fac-None of the above; PSR32T_5--Why admtd to hsptl/med

fac-DK; PSR32T_6--Why admtd to hsptl/med fac-RF

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

Logic before:

IF P_SR32 RESPONSE CHOICE 1 <> Y, GOTO P_SR35. ELSE, CONTINUE.

P_SR33 [ PSR33 ] #Xs admitted to a hsptl/med facility over night-past 12m

In the last 12 months, how many times have you been admitted overnight for an @balcohol or

drug problem@b?

TIMES

Question Type: 1..997

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

P_SR34 [ PSR34a ] Total # days in hsptl for alc/drug prob-past 12m

In the last 12 months, how many @btotal@b days did you spend in the hospital or medical facility

for an alcohol or drug problem?

DAYS:

Question Type: 1..2000

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

Logic before:

IF P_SR32 RESPONSE CHOICE 2 <> Y, GOTO P_SR37. ELSE, CONTINUE.

P_SR35 [ PSR35a ] #Xs admit hsptl ovrnight for mntl hlth prob

In the last 12 months, how many times have you been admitted overnight for emotions, nerves or

a @bmental health problem@b?

NOTE: INCLUDES DEPRESSION, SCHIZOPHRENIA, BIPOLAR DISORDER, SUICIDE

ATTEMPTS, ETC.

TIMES

Question Type: 1..997

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

P_SR36 [ PSR36a ] Total # days in hsptl for mntl hlth prob

In the last 12 months, how many @btotal@b days did you spend in the hospital or medical facility

for a mental health problem?

NOTE: INCLUDES DEPRESSION, SCHIZOPHRENIA, BIPOLAR DISORDER, SUICIDE

ATTEMPTS, ETC.

DAYS

Question Type: 0..365

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

Logic before:

IF P_SR32 RESPONSE CHOICE 3 <> Y, GOTO P_SR39. ELSE, CONTINUE.

P_SR37 [ PSR37a ] #Xs admit hsptl ovrnight for ill/inj

In the last 12 months, how many times have you been admitted overnight for an @billness or

injury@b?

TIMES

Question Type: 0..997

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

P_SR38 [ PSR38a ] Total # days in hsptl for ill/inj

In the last 12 months, how many @btotal@b days did you spend in the hospital or medical facility

for an illness or injury?

DAYS

Question Type: 0..366

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

Logic before:

IF WAVE 1 OR WAVE =2 AND GROUP = 4, CONTINUE. ELSE GOTO P_SR39a1 IF P_SR32

RESPONSE OPTION 1 = YES, FILL: Not counting treatment you reported receiving at the hospital

or medical facility, have you ever stayed overnight in a program that provides alcohol or drug

treatment? elsefill H

P_SR39 [ PSR39 ] R ever overnight in prgrm for alc/drug prblm (not hsptl)

^fills.P_sr39 you ever stayed overnight in a program that provides alcohol or drug treatment?

NOTE: INCLUDES PROGRAMS AT ALCOHOL OR DRUG TREATMENT FACILITIES.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Question Fill: ^fillp_sr39

w1 Have

w2 Not counting treatment you reported receiving at the hospital or medical

facility, have

Logic after:

if P_sr39 = no then GOTO P_SR42a1

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

P_SR39a1 [ PSR39a ] Stayed ovrnight in prog for alc/drug-past 12m (not hsptl)

In the last 12 months, have you stayed overnight in a program that provides alcohol or drug

treatment?

NOTE: INCLUDES PROGRAMS AT ALCOHOL OR DRUG TREATMENT FACILITIES

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_sr39a1 = no then GOTO P_SR42a1

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

P_SR40 [ PSR40a ] Total # days in these kinds of programs (not hsptl)

In the last 12 months, how many @btotal@b days have you spent at these kinds of programs?

DAYS

Question Type: 0..366

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

P_SR41 [ PSR41a ] Any Rs ch stay ovrnight w/R

Did any of your children stay with you overnight at the program while you were there?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

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

P_SR42a1 [ PSR42a ] Been to ER for any reason

In the last 12 months, have you been to an emergency room for any reason?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_sr42a1 = no then GOTO P_SR47a1

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

Logic before:

RESPONSE OF 4 = Y CANNOT BE INCLUDED WITH RESPONSE OF 1-3 = Y

P_SR43 [ PSR43 ] Labels are in Logic After

Why did you go to the emergency room?

CODE ALL THAT APPLY.

Question Type: TPSR32S

drug 1 ALCOHOL/DRUG PROBLEM

mental 2 EMOTIONS, NERVES, OR MENTAL HEALTH PROBLEM (E.G.

DEPRESSION, SCHIZOPHRENIA, BIPOLAR DISORDER, SUICIDE

ATTEMPTS, ETC.)

ill 3 ILLNESS OR INJURY

none_ 4 NONE OF THE ABOVE

Logic after:

PSR3TG_1--Alcohol/drug problem; PSR3TG_2--Mental health problem; PSR3TG_3--Illness or

injury; PSR3TG_4--None of the above; PSR3TG_5--DK; PSR3TG_6--RF

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

Logic before:

IF P_SR43 RESPONSE CHOICE 1 <> Y, GOTO P_SR45. ELSE, CONTINUE.

P_SR44 [ PSR44a ] #Xs been ER b/c alc/drug problem

In the last 12 months, how many times have you been to an emergency room because of a

problem with @bdrugs or alcohol@b?

TIMES

Question Type: 1..997

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

Logic before:

IF P_SR43 RESPONSE CHOICE 2 <> Y, GOTO P_SR46. ELSE, CONTINUE.

P_SR45 [ PSR45a ] #Xs been ER b/c mntl hlth problem

In the last 12 months, how many times have you been to an emergency room for emotions,

nerves or a @bmental health problem@b?

NOTE: INCLUDES DEPRESSION, SCHIZOPHRENIA, BIPOLAR DISORDER, SUICIDE

ATTEMPTS, ETC.

TIMES

Question Type: 1..997

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

Logic before:

IF P_SR43 RESPONSE CHOICE 3 <> Y, GOTO P_SR47a1. ELSE, CONTINUE.

P_SR46 [ PSR46a ] #Xs been ER b/c ill/inj

In the last 12 months, how many times have you been to an emergency room for an @billness or

injury@b?

TIMES

Question Type: 1..997

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

P_SR47a1 [ PSR47ax ] R visited a clnc/doctor about phys hlth-past 12m

In the last 12 months, have you visited a clinic or doctor about your physical health?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR47 = no then GOTO P_SR47b1

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

P_SR47a [ PSR47ax1 ] #Xs R visited a clnc/doctor about phys hlth-past 12m

How many times?

NUMBER OF TIMES

Question Type: 1..366

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

Logic before:

IF WAVE 1 OR WAVE =2 AND GROUP = 4, CONTINUE. ELSE GOTO P_SR47c

P_SR47b1 [ PSR47b1 ] R ever visited a clnc/doctor about an alc/drug prblm

Have you ever visited a clinic or doctor about an alcohol or drug problem?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR47b1 = no then GOTO P_SR47e

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

P_SR47c [ PSR47c ] R visited a clnc/doctor about an alc/drug prblm-past 12m

In the last 12 months, have you visited a clinic or doctor about an alcohol or drug problem?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR47c = no then GOTO P_SR47e

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

P_SR47d [ PSR47d ] #Xs R visited a clnc/doctor about an alc/drug prblm-past 12m

How many times?

NUMBER OF TIMES

Question Type: 1..366

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

Logic before:

IF WAVE 1 OR WAVE =2 AND GROUP = 4, CONTINUE. ELSE GOTO P_SR47f

P_SR47e [ PSR47e ] R ever had one or more sessions of psych counseling

Have you ever had one or more sessions of psychological counseling or therapy for emotional

problems with any type of professional?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR47e = no then GOTO P_SR47h

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

P_SR47f [ PSR47f ] R had one or more sessions of psych counseling-past 12m

In the last 12 months, have you had one or more sessions of psychological counseling or therapy

for emotional problems with any type of professional?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR47f = no then GOTO P_SR47h

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

P_SR47g [ PSR47g ] #Xs R had one or more sessions of psych counseling-past 12m

How many times?

NUMBER OF TIMES

Question Type: 1..366

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

Logic before:

IF WAVE 1 OR WAVE =2 AND GROUP = 4, CONTINUE. ELSE GOTO P_SR47i

P_SR47h [ PSR47h ] R ever used a prescription medicine for emotions

Have you ever used a prescription medicine for your emotions, nerves or mental health from any

type of professional?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR47h = no then GOTO P_SR47j

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

P_SR47i [ PSR47i ] R used a prescription medicine for emotions-past 12m

In the last 12 months, have you used a prescription medicine for your emotions, nerves or mental

health from any type of professional?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

Logic before:

IF P_SR47f OR P_SR47i = 1, ASK. ELSE, GOTO P_SR54.

P_SR47j [ PSR47j ] Labels are in Logic After

Which of the following types of professionals did you see in the last 12 months about problems

with your emotions or nerves or mental health?

CODE ALL THAT APPLY.

Question Type: theadmdS

PSY_MD 1 Psychiatrist

MD 2 General physician or family doctor

MS_SP 3 Any other Medical Doctor, like a gynecologist or cardiologist

PSY 4 Psychologist

SOC 5 Social Worker

COUN 6 Counselor

mental 7 Any other mental health professional, such as a mental health nurse

nurse 8 A nurse, occupational therapist or other general health professional

relig 9 A religious or spiritual advisor, like a minister, priest or rabbi

Logic after:

PSR47j_1 --Type of prof R saw past 12m for emot prblms-Psychiatrist; PSR47j_2 --Type of prof R

saw past 12m for emot prblms-Gen Phys/Fam Dr; PSR47j_3 --Type of prof R saw past 12m for

emot prblms-Othr Med Dr; PSR47j_4 --Type of prof R saw past 12m for emot prblms-Psychologist;

PSR47j_5 --Type of prof R saw past 12m for emot prblms-Social Worker; PSR47j_6 --Type of prof R

saw past 12m for emot prblms-Counselor; PSR47j_7 --Type of prof R saw past 12m for emot

prblms-Othr Mntl Hlth; PSR47j_8 --Type of prof R saw past 12m for emot prblms-Nurse/Occ Thrpst;

PSR47j_9 --Type of prof R saw past 12m for emot prblms-Religious/Sprtal; PSR47j_10--Type of

prof R saw past 12m for emot prblms-DK; PSR47j_11--Type of prof R saw past 12m for emot

---------------------------------------------------------------------------------

Logic before:

fill based on P_SR47j. LOOP THIS FOR EVERY ANSWER = YES IN P_SR47j

P_SR47k [ PSR47k ] Labels are in Logic After

How many visits did you make to a ^fills.P_SR47k in the past 12 months?

NUMBER

Question Type: array[1..9] of 1..100

Question Fill: ^fillp_sr47k

psy_md Psychiatrist

md General physician or family doctor

ms_sp Any other Medical Doctor, like a gynecologist or cardiologist

psy Psychologist

soc Social Worker

coun Counselor

mental Any other mental health professional, such as a mental health nurse

nurse A nurse, occupational therapist or other general health professional

relig A religious or spiritual advisor, like a minister, priest or rabbi

Logic after:

PSR47k_1 --# visits - past 12m to Psychiatrist; PSR47k_2 --# visits - past 12m to Gen Physician;

PSR47k_3 --# visits - past 12m to Othr Med Dr; PSR47k_4 --# visits - past 12m to Psychologist;

PSR47k_5 --# visits - past 12m to Social Worker; PSR47k_6 --# visits - past 12m to Counselor;

PSR47k_7 --# visits - past 12m to Othr Ment Hlth Prof; PSR47k_8 --# visits - past 12m to Nurse;

PSR47k_9 --# visits - past 12m to Religious/Spiritual

---------------------------------------------------------------------------------

Logic before:

IF WAVE 1 OR WAVE =2 AND GROUP = 4, CONTINUE. ELSE GOTO P_SR54a1

P_SR54 [ PSR54 ] R ever rcv day trtmnt for mntl hlth prblm

Have you ever received day treatment or partial hospitalization for a mental health problem? By

day treatment or partial hospitalization, we mean a program that you went to every day or almost

every day that did not require you to stay overnight.

NOTE: "MENTAL HEALTH PROBLEMS" INCLUDE DEPRESSION, SCHIZOPHRENIA, BIPOLAR

DISORDER, SUICIDE ATTEMPTS, ETC.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if p_sr54 = no then GOTO P_SR57

---------------------------------------------------------------------------------

P_SR54a1 [ PSR54a ] R rcv day trtmnt for mntl hlth prblm-past 12m

In the last 12 months, have you received day treatment or partial hospitalization for a mental

health problem? By day treatment or partial hospitalization, we mean a program that you went to

every day or almost every day that did not require you to stay overnight.

NOTE: "MENTAL HEALTH PROBLEMS" INCLUDE DEPRESSION, SCHIZOPHRENIA, BIPOLAR

DISORDER, SUICIDE ATTEMPTS, ETC.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if p_sr54a1 = no then GOTO P_SR57

---------------------------------------------------------------------------------

P_SR55 [ PSR55a ] # Weeks rcv day trtmnt-past 12m

In the last 12 months, for how many weeks did you receive this type of service?

(IF SERVICE WAS ONLY RECEIVED 1 TIME, ENTER "1".)

NUMBER OF WEEKS

Question Type: 1..52

---------------------------------------------------------------------------------

Logic before:

IF P_SR55 = 1, FILL: In that week, IF P_SR55 > 1, FILL: During those FILL NUMBER FROM

P_SR55

P_SR55X [ PSR55xa ] # Days/Wk rcv day trtmnt

(IF SERVICE WAS ONLY RECEIVED ONE TIME, ENTER "1", AND CONTINUE WITH NEXT

QUESTION.)

^fills.P_SR16_1^tempnum^fills.p_sr16_2 how many days were these services ^fills.usual received?

(PROMPT R TO THINK OF AVERAGE NUMBER OF DAYS PER WEEK DURING WEEKS

WHEN SERVICES WERE RECEIVED.)

Question Type: 1..7

Question Fill: ^fillp_sr16_1

sing1 In that

plural1 During those·

Question Fill: ^fillp_sr16_2

sing2 ·week,

plural2 ·weeks,

Question Fill: ^fillp_sr16_3

perwk ·per week

Logic after:

IF P_SR55 = 1, GOTO P_SR57

---------------------------------------------------------------------------------

Logic before:

IF P_SR32 RESPONSE CHOICE 2 = Y OR P_SR43 RESPONSE CHOICE 2 = Y OR P_SR54 =

1, GOTO P_SR59. ELSE, CONTINUE.

P_SR57 [ PSR57a ] How much needed help for mntl hlth prblm

In the last 12 months, how much have you needed help for a mental health problem? Would you

say...

Question Type: THMNeed

alot 1 a lot,

somewhat 2 somewhat,

alittle 3 a little, or

notatall 4 not at all?

---------------------------------------------------------------------------------

P_SR59 [ PSR59a ] Req by agcy to rcv mntl hlth svcs

At any time in the last 12 months, were you required by the Child Welfare Agency or the court to

receive any mental health services?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

Logic before:

IF P_SR32 RESPONSE CHOICE 1 = Y OR P_SR39 = 1 OR P_SR43 RESPONSE CHOICE 1 =

Y, GOTO P_SR63. ELSE, CONTINUE.

P_SR61 [ PSR61a ] How much needed help for alc/drug prob

In the last 12 months, how much have you needed help for an alcohol or drug problem? Would

you say...

Question Type: THMNeed

alot 1 a lot,

somewhat 2 somewhat,

alittle 3 a little, or

notatall 4 not at all?

---------------------------------------------------------------------------------

P_SR63 [ PSR63ax ] R required by Ch Wlfr Agncy to rcv alc/drug srvcs-past 12m

At any time in the last 12 months, were you required by the Child Welfare Agency or the court to

receive services for an alcohol or drug problem?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

Logic before:

IF WAVE 1 OR WAVE =2 AND GROUP = 4, CONTINUE. ELSE GOTO P_SR64a

P_SR64 [ PSR64 ] R ever rfrd to parenting skills trng

The next questions will ask about services you may have received either at home or somewhere

else.

Have you ever been referred to or offered any training in parenting skills? This could include

services focused on learning about appropriate expectations for your child, effective parent-child

discipline or communication. This could occur in a group format or in services delivered just to you

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR64 = no then GOTO P_SR65

---------------------------------------------------------------------------------

P_SR64a [ PSR64a ] Rfrd/offrd trng in parentng skill-inst date

^fills.P_SR65^lstintdate, have you ever been referred to or offered any training in parenting skills?

This could include services focused on learning about appropriate expectations for your child,

effective parent-child discipline or communication. This could occur in a group format or in

services delivered just to you.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1: In the last 12 months, IF WAVE = 2: Since FILL DATE OF LAST INTERVIEW

P_SR65 [ PSR65a ] Rcvd any parenting skill training-inst date/past 12m

^fills.P_SR65^lstintdate, have you @breceived@b any parenting skills training?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Question Fill: ^fillp_sr65

W1 In the last 12 months

w2 Since·

Logic after:

if P_SR65 = no then GOTO P_SR70

---------------------------------------------------------------------------------

Logic before:

If WAVE =1, ASK. ELSE, GOTO P_SR66.

P_SR65a1 [ PSR65a1 ] Parenting skills training begin before/after contact date

Did this parenting skills training begin before or after ^ContactDate, when you came into contact

with child welfare services?

Question Type: tPSR5a1F

_before 1 BEFORE

_after 2 AFTER

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1: In the last 12 months, IF WAVE = 2: Since FILL DATE OF LAST INTERVIEW

P_SR66 [ PSR66a ] # weeks rcv parenting skills trning since contact date

^fills.P_SR65^lstintdate, for how many weeks did you receive this skills training?

(IF SERVICE WAS ONLY RECEIVED 1 TIME, ENTER "1".)

NUMBER OF WEEKS

Question Type: 1..52

---------------------------------------------------------------------------------

P_SR66a [ PSR66aHrs ] # hours/day rcv parenting skills trning since contact date

During the weeks when you received this skills training, how many hours per week were these

services usually received?

HOURS

Question Type: 1..24

---------------------------------------------------------------------------------

P_SR67 [ PSR67 ] Labels are in Logic After

Where did you receive these services?

CODE ALL THAT APPLY

Question Type: TPSR67S

home 1 AT HOME

agency 2 AT AN AGENCY OR COMMUNITY ORGANIZATION

other 3 SOMEWHERE ELSE

Logic after:

PSR67T_1--Where did R rcv srvcs - At home; PSR67T_2--Where did R rcv srvcs - At an agency or

community org; PSR67T_3--Where did R rcv srvcs - Somewhere else; PSR67T_4--Where did R rcv

srvcs - DK; PSR67T_5--Where did R rcv srvcs - RF

---------------------------------------------------------------------------------

P_SR68 [ PSR68 ] Was this formal or informal parenting skills training?

Was this formal or informal parenting skills training?

Question Type: TPSR68F

formal 1 Formal, provided by your caseworker or someone else from the child

welfare agency or other agency

informal 2 Informal, provided by a relative or friend, someone from the community,

like from a church, a community organization, or a family resource

---------------------------------------------------------------------------------

P_SR68a [ PSR68ax ] Who came to Rs home for trning

Were these parent training services primarily delivered to you and/or your family individually, or in

a group format with other parents/families?

Question Type: tPSR68a

you 1 YOU AND/OR YOUR FAMILY INDIVIDUALLY

group 2 GROUP FORMAT WITH OTHER PARENTS/FAMILIES

---------------------------------------------------------------------------------

P_SR68b [ PSR68b ] Labels are in Logic After

During the period you received training in parenting skills, which of the following things would you

say occurred for at least 10 minutes on many of the days in which you received these services?

CODE ALL THAT APPLY.

Question Type: TPSR68bS

_1 1 You watched videotaped examples of parents and children doing things

together (e.g., playing, working, solving problems, disciplining, etc.) as

a way of learning and talking about parenting skills.

2.You watched videotape of yourself doing things together with your

child/children.

_2 3 You were coached by someone directly as you practiced skills with

your child or children.

_3 4 You listened to a presentation of information about parenting skills or

child development.

_4 5 You practiced skills with other parents in role-play situations.

_5 6 You completed or reviewed homework assignments that involved things

to practice.

_6 7 You read or learned things about parenting on a computer.

Logic after:

PSR68b_1 --R prntng skls trng-Watched video tapes; PSR68b_2 --R prntng skls trng-Coached by

someone; PSR68b_3 --R prntng skls trng-Listened to presentation; PSR68b_4 --R prntng skls trng-

Practiced skills with other parents; PSR68b_5 --R prntng skls trng-Completed/reviewed homework;

PSR68b_6 --R prntng skls trng-Read/learned on a computer; PSR68b_7--R prntng skls trng-DK;

PSR68b_8--R prntng skls trng-RF

P_SR68c [ PSR68c ] Labels are in Logic After

During the period you received training in parenting skills, which of the following topics would you

say were discussed in a substantial way (e.g., on at least 2 of the days you received those

services)?

Question Type: TPSR68cS

_1 1 How to play effectively with one's child.

_2 2 How to praise and reward positive behavior

_3 3 How to ignore misbehavior

_4 4 Non-violent approaches to discipline

_5 5 Establishing daily routines for children

_6 6 Feeding, sleeping, or toilet training habits

_7 7 Communication and/or problem-solving with children

_8 8 Supporting children's success in school

_9 9 Providing medical care for children

_10 10 Maintaining a child-safe home environment

Logic after:

PSR68c_1 --Tpcs drng R prntng skls trng-How 2 play efctvly w/ child.; PSR68c_2 --Tpcs drng R

prntng skls trng-How 2 praise & rwrd pstv beh; PSR68c_3 --Tpcs drng R prntng skls trng-How to

ignore misbehavior; PSR68c_4 --Tpcs drng R prntng skls trng-Nonviolent aprchs to discipline;

PSR68c_5 --Tpcs drng R prntng skls trng-Est daily routines for children; PSR68c_6 --Tpcs drng R

prntng skls trng-Fdng/slpng/toilet trng habits; PSR68c_7 --Tpcs drng R prntng skls trng-Comm

and/or prblm-slvng w/ ch; PSR68c_8 --Tpcs drng R prntng skls trng-Sprtng ch success in school;

PSR68c_9 --Tpcs drng R prntng skls trng-Prvdng med care for children; PSR68c_10 --Tpcs drng R

prntng skls trng-Mntnng child-safe home environ; PSR68c_11--Tpcs drng R prntng skls trng-DK;

PSR68c_12--Tpcs drng R prntng skls trng-RF

---------------------------------------------------------------------------------

P_SR69a [ PSR69aa ] R still receiving this service

Are you still receiving this service?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

GOTO P_SR71x

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1: In the last 12 months, IF WAVE = 2: Since FILL DATE OF LAST INTERVIEW

P_SR70 [ PSR70a ] How much R need parntng skills trng

^fills.P_SR65^lstintdate, how much have you needed to receive training in parenting skills? Would

you say...

Question Type: THMNeed

alot 1 a lot,

somewhat 2 somewhat,

alittle 3 a little, or

notatall 4 not at all?

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1: in the last 12 months, IF WAVE = 2: since FILL DATE OF LAST INTERVIEW

P_SR71x [ PSR71xax ] R required by Ch Wlfr Agncy to rcv parenting skills trng

At any time ^fills.P_SR71x^lstintdate were you required by the Child Welfare Agency or the court

to receive parenting skills training?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Question Fill: ^fillP_sr71x

W1 in the last 12 months,·

W2 since·

---------------------------------------------------------------------------------

Logic before:

IF WAVE 1 OR WAVE =2 AND GROUP = 4, CONTINUE. ELSE GOTO P_SR74a1

P_SR74 [ PSR74 ] R ever received training in home management

Have you ever @breceived@b any training in home management, for example, budgeting or

planning meals?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR74 = no then GOTO P_SR80x

---------------------------------------------------------------------------------

P_SR74a1 [ PSR74a ] Rcvd any home management trning-past 12m

In the last 12 months, have you @breceived@b any training in home management, for example,

budgeting or planning meals?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR74a1 = no then GOTO P_SR80x

---------------------------------------------------------------------------------

P_SR80x [ PSR80xax ] R required by Ch Wlfr Agncy to rcv home management trng

At any time in the last 12 months, were you required by the Child Welfare Agency or the court to

receive any training in home management, like budgeting or planning meals?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

Logic before:

IF WAVE 1 OR WAVE =2 AND GROUP = 4, CONTINUE. ELSE GOTO P_SR81a1

P_SR81 [ PSR81 ] Anyone ever provide respite ch care

The next questions are about services you may have received in your home.

Has anyone ever come to your home to provide respite care for a child or provided respite care

outside of the home for a child so that you could have a break from child care? Do @bnot@b

include family, friends, or other informal child care.

NOTE: RESPITE CARE IS CARE FOR THE CHILD (PROVIDED IN THE HOME OR

SOMEWHERE ELSE) SO THAT THE FAMILY CAN HAVE A BREAK FROM ONGOING CARE

OF THE CHILD. IT CAN BE THOUGHT OF AS CHILD CARE OR BABYSITTING BY AN

INDIVIDUAL OR PROGRAM TRAINED TO MEET THE SPECIAL NEEDS OF THE CHILD.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR81 = no then GOTO P_SR98

---------------------------------------------------------------------------------

P_SR81a1 [ PSR81a ] Anyone provide respite ch care-past 12m

In the last 12 months, has anyone come to your home to provide respite care for a child or

provided respite care outside of the home for a child so that you could have a break from child

care?

NOTE: RESPITE CARE IS CARE FOR THE CHILD (PROVIDED IN THE HOME OR

SOMEWHERE ELSE) SO THAT THE FAMILY CAN HAVE A BREAK FROM ONGOING CARE

OF THE CHILD. IT CAN BE THOUGHT OF AS CHILD CARE OR BABYSITTING BY AN

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR81a1 = no then GOTO P_SR98

---------------------------------------------------------------------------------

Logic before:

IF P_SR81a1 = 1, CONTINUE. ELSE, GOTO P_SR84

P_SR83 [ PSR83a ] # Weeks rcv respite ch care-past 12m

In the last 12 months, for how many weeks did someone come to your home to provide respite

care for a child so that you could have a break from child care?

(IF SERVICE WAS ONLY RECEIVED 1 TIME, ENTER "1".)

NUMBER OF WEEKS

Question Type: 1..52

---------------------------------------------------------------------------------

P_SR84a [ PSR84aa ] R still receiving ch care service

Are you still receiving this service?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

GOTO SR98

---------------------------------------------------------------------------------

Logic before:

IF WAVE 1 OR WAVE =2 AND GROUP = 4, CONTINUE. ELSE GOTO P_SR98a1

P_SR98 [ PSR98 ] Family ever counseled together as a group

Was the family ever counseled together as a group, either at home or somewhere else?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR98 = no then GOTO P_SR108

---------------------------------------------------------------------------------

P_SR98a1 [ PSR98a ] Was family counseled as a group-past 12m

At any time in the last 12 months, was the family counseled together as a group, either at home

or somewhere else?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR98a1 = no then GOTO P_SR108

---------------------------------------------------------------------------------

P_SR99 [ PSR99a ] Family members incl in counseling who do not live w/ CH

Were family members included who do not live with ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR99 = no then GOTO P_SR101

---------------------------------------------------------------------------------

P_SR100 [ PSR100a ] # family members not live w/ CH included in counseling

How many family members not living with ^CHILD were included?

NUMBER

Question Type: 1..25

---------------------------------------------------------------------------------

P_SR101 [ PSR101a ] # Weeks family counseled together

In the last 12 months, for how many weeks did the family get counseled together?

(IF SERVICE WAS ONLY RECEIVED 1 TIME, ENTER "1".)

NUMBER OF WEEKS

Question Type: 1..52

---------------------------------------------------------------------------------

Logic before:

IF P_SR101 = 1, FILL: In that week, how many days were these services received? IF P_SR101 >

1, FILL: During those FILL NUMBER FROM P_SR101

P_SR101a [ PSR101aa ] # Days/Wk usually rcv fam-grp counslng

(IF SERVICE WAS ONLY RECEIVED ONE TIME, ENTER "1", AND CONTINUE WITH NEXT

QUESTION.)

^fills.P_SR16_1^tempnum ^fills.p_sr16_2 how many days were these services^fills.usual received?

(PROMPT R TO THINK OF AVERAGE NUMBER OF DAYS PER WEEK DURING WEEKS

WHEN SERVICES WERE RECEIVED.)

Question Type: 1..7

Logic after:

IF P_SR101 = 1, GOTO P_SR101c. ELSE CONTINUE

---------------------------------------------------------------------------------

P_SR101b [ PSR101ba ] Max # Days/Wk fam counseled together

What was the maximum number of days during any of those weeks that the family got counseled

together?

MAX DAYS PER WEEK

Question Type: 1..7

---------------------------------------------------------------------------------

P_SR101c [ PSR101ca ] R still rcv family counseling

Are you still receiving family counseling?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

Logic before:

IF WAVE >= 2 THEN

IF HS36a, HS36aa, HS36ab, HS50ka, HS50k1a HS50fa, HS50f1a, HS137, SR14a1, SR21a1,

SR26a1,SR63, SR59, SR64a, SR65, SR71x, SR74a1, SR80x, SR81a1, SR93a1, SR98a1 = YES,

OR IF HS130 OR HS136, RESPONSE 1 = YES, OR IF HS130 OR HS136, RESPONSE 2 = YES,

OR IF HS130 OR HS136, RESPONSE 3 = YES, OR IF HS130 OR HS136, RESPONSE 4 = YES,

ASK P_SR108

IF NONE OF THE ABOVE = YES GO TO P_SR108a

P_SR108 [ PSR108a ] Services paid for by agency

Were any of the services you just reported receiving @bprovided or paid for@b by the child welfare

agency?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR108 = yes then GOTO P_SR109

if P_SR108 = NO then GOTO P_SR108a

---------------------------------------------------------------------------------

P_SR108a [ PSR108aa ] Referred to Srve by Ch Welfare/CW

USE CARD 30. Please look at the list of services on Card 30. Since ^lstintdate, have you,

^CHILD, or any other member of your family received any of these services from the child welfare

agency? The agency may have provided the services directly or paid for you, your child, or your

family to receive the services somewhere else.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

CARD 30 CONTENTS:

Foster care or kinship care services

Individualized Education Plan (IEP)

Individualized Family Service Plan (IFSP)

Special Education Services

Tutoring

In-home counseling or in-home crisis services

Family counseling

Therapeutic nursery care

Therapeutic foster care

Mental health services or treatment

Job-related services

Organized support groups: Alcoholics Anonymous, Parents Anonymous, etc.

Child care services

Services for alcohol or drug problems

Parenting skills training

Training on ways to discipline child

Home management training (e.g., budgeting or planning meals)

Respite care for a child

Transportation help

Help with applying for income support/emergency financial assistance

Help with applying for housing assistance Medical exam

Dental Exam

Immunizations

Hearing or vision screening

Domestic violence services

Legal services

Financial planning

---------------------------------------------------------------------------------

Logic before:

IF P_SR108 = yes or P_SR108a = yes then ASK P_SR109 ELSE SKIP TO P_SR111.

P_SR109 [ PSR109 ] Name CW who is most knowledgeable about srvc rcvd

What is the name of the caseworker who is most knowledgeable about the services you and your

family have received?

NAME:

Question Type: string[50]

---------------------------------------------------------------------------------

P_SR110 [ PSR110 ] CW telephone number

What is the caseworker's telephone number?

PHONE

Question Type: TPHONE

---------------------------------------------------------------------------------

P_SR111 [ PSR111 ] Labels are in Logic After

Now we would like to know about your insurance coverage. What is your current insurance

status? Are you covered by...

Question Type: TPSR111S

_1 1 Military health insurance, such as CHAMPUS, CHAMP-VA, TRICARE,

or VA care,

_2 2 A health insurance plan through a current or past employer or union,

_3 3 Medicaid or another state-funded program,

_4 4 Indian Health Service,

_5 5 Medicare,

_6 6 Health insurance bought directly from an insurance company, or

_7 7 Do you not have insurance of any kind (completely self pay)?

Logic after:

GOTO P_SREND; PSR111_1 --R crnt ins cvrag-Mil hlth ins CHAMPUS/CHAMP-VA; PSR111_2 --

R crnt ins cvrag-A hlth ins plan thru crnt/past employer; PSR111_3 --R crnt ins cvrag-Medicaid or

another state-funded program,; PSR111_4 --R crnt ins cvrag-Indian Health Service,; PSR111_5 --R

crnt ins cvrag-Medicare,; PSR111_6 --R crnt ins cvrag-Hlth ins bought directly from ins company;

PSR111_7 --R crnt ins cvrag-Do you not have insurance of any kind; PSR111_8--R crnt ins cvrag-

DK; PSR111_9--R crnt ins cvrag-RF

---------------------------------------------------------------------------------

P_SREND [ PSREND ] NoDeliv

ENTER 1 TO CONTINUE

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

SS - Social Support

---------------------------------------------------------------------------------

Logic before:

This section should be skipped in the following caregiver situations:

- Licensed Foster Home, Living with a Family Friend, or all non-family settings

(P_NP12a >= 3, 4, or 6) OR (P_NP12b .>= 1) OR

- Primary CG is a Foster Mother or Father

(P_HH6a = 8 or 9 OR P_HH6g = 8 or 9) OR

- Primary CG currently receives payments for being a foster parent

(P_HH6e = 1)

Programmer note: According to author’s showcard, there are verbal "anchors" only for the scale

end points 1 and 5. There are no verbal anchors for response options 2, 3, and 4. On screen we

can only display numbers for response options 2, 3, 4.

P_SS15a [ PSS15a ] I get love and affection

Now I'm going to ask you about some things that other people might do for you or give you that

may be helpful or supportive.

USE CARD 31. As I read each statement, please tell me which answer is closest to your

situation. Here is an example: I get enough free time. If you answer '4 ', it means that you get

@balmost as much@b free time as you would like, but @bnot quite as much@b as you would

like.

Answer each statement as best you can. Remember, there are no right or wrong answers. Here is

the first statement:

I get love and affection.

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS16a [ PSS16a ] Chance to talk 2 someone I trust about my prsnl/fmly prblms

Chances to talk to someone I trust about my personal and family problems

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS17a [ PSS17a ] Chance to talk 2 someone I trust about prblms @ wrk/housewrk

Chances to talk to someone I trust about problems at work or with my housework

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS18a [ PSS18a ] Invitations to go out and do things with other people

Invitations to go out and do things with other people

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS19a [ PSS19a ] People who care about what happens to me

People who care about what happens to me

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS20a [ PSS20a ] Chances to talk about money matters

Chances to talk about money matters

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS21a [ PSS21a ] Useful advice about important things in life

Useful advice about important things in life

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS22a [ PSS22a ] Help when I need transportation

Help when I need transportation

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS23a [ PSS23a ] Help when Im sick in bed

Help when I'm sick in bed

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS24a [ PSS24a ] Help around the house

Help around the house

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS25a [ PSS25a ] Help taking care of my child(ren)

Help taking care of my child(ren)

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

Logic after:

Y_SSEND

PH - PHYSICAL HEALTH

---------------------------------------------------------------------------------

P_PH1a [ PPH1a ] General health status

The next questions are about your health and the activities you might do. This information will be

used to keep track of how you feel and how well you are able to do your usual activities. If you are

unsure about how to answer a question, please give the best answer you can.

In general, would you say your health is...

Question Type: THealth

exclnt 1 excellent

vgood 2 very good

good 3 good

fair 4 fair, or

poor 5 poor

---------------------------------------------------------------------------------

P_PH2a [ PPH2a ] Hlth lmt R in moderate activities

How much does your health now limit you in @bmoderate activities@b, such as moving a table,

pushing a vacuum cleaner, bowling, or playing golf? Would you say you are...

Question Type: TLimit

alot 1 limited a lot

alittle 2 limited a little, or

notlimited 3 not limited at all?

---------------------------------------------------------------------------------

P_PH3a [ PPH3a ] Health limit R in stair climbing

How much does your health now limit you in climbing @bseveral@b flights of stairs? Would you

say you are...

NOTE: "SEVERAL" MEANS TWO OR MORE.

Question Type: TLimit

alot 1 limited a lot

alittle 2 limited a little, or

notlimited 3 not limited at all?

---------------------------------------------------------------------------------

P_PH4a [ PPH4a ] Hlth limit accomplishments

During the past @b4 weeks@b, have you accomplished less than you would like in your work or

other regular daily activities as a result of your @bphysical@b health?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_PH5a [ PPH5a ] Hlth limit kind of wrk could do

During the past @b4 weeks@b, were you limited in the @bkind@b of work or other activities you

could do as a result of your physical health?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_PH6a [ PPH6a ] Emot prob limit accomplish

During the past @b4 weeks@b, have you accomplished less than you would like in your work or

other regular daily activities as a result of any @bemotional@b problems such as feeling

depressed or anxious?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_PH7a [ PPH7a ] Emot prob make R less careful

During the past @b4 weeks@b, did you feel you didn't do work or other activities as carefully as

usual as a result of any emotional problems such as feeling depressed or anxious?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_PH8a [ PPH8a ] Pain interfere w/norm wrk

During the past @b4 weeks@b, how much did @bpain@b interfere with your normal work,

including both work outside the home and housework? Would you say...

Question Type: TPain

notatall 1 not at all

littlebit 2 a little bit

moderate 3 moderately

quiteabit 4 quite a bit, or

extremely 5 extremely?

---------------------------------------------------------------------------------

P_PH9a [ PPH9a ] Felt calm/peaceful

USE CARD 32. The next questions are about how you feel and how things have been with you

during the past @b4 weeks@b. For each question, please look at Card 32 and tell me which

answer comes closest to the way you have been feeling.

During the past @b4 weeks@b, how much of the time have you felt calm and peaceful? Would

you say…

Question Type: THowMch

alltime 1 all of the time

most 2 most of the time

goodbit 3 a good bit of the time

some 4 some of the time

little 5 a little of the time, or

none 6 none of the time?

---------------------------------------------------------------------------------

P_PH10a [ PPH10a ] Had a lot of energy

USE CARD 32. During the past @b4 weeks@b, how much of the time did you have a lot of

energy? Would you say…

Question Type: THowMch

alltime 1 all of the time

most 2 most of the time

goodbit 3 a good bit of the time

some 4 some of the time

little 5 a little of the time, or

none 6 none of the time?

---------------------------------------------------------------------------------

P_PH11a [ PPH11a ] Felt downhearted/blue

USE CARD 32. During the past @b4 weeks@b, how much of the time have you felt downhearted

and blue? Would you say…

Question Type: THowMch

alltime 1 all of the time

most 2 most of the time

goodbit 3 a good bit of the time

some 4 some of the time

little 5 a little of the time, or

none 6 none of the time?

---------------------------------------------------------------------------------

P_PH12a [ PPH12a ] Hlth/emot prob intrfre w/soc act

USE CARD 32. During the past @b4 weeks@b, how much of the time has your physical health

or emotional problems interfered with your social activities (like visiting with friends, relatives,

etc.)? Would you say...

Question Type: THowMch

alltime 1 all of the time

most 2 most of the time

goodbit 3 a good bit of the time

some 4 some of the time

little 5 a little of the time, or

none 6 none of the time?

Logic after:

GOTO P_PHEND

FC - Services Received by Foster Caregivers

---------------------------------------------------------------------------------

Logic before:

[IF P_HH6c <> 1 AND P_HH6d <> 1 AND P_HH6e <> 1 AND P_HH8c <> 1 AND P_HH8d <> 1

AND P_HH8e <> 1 THEN GO TO P_FCEND.]

{IF WAVE = 1 , FILL: since {FILL START DATE OF LIVING ARRANGEMENT}/IF WAVE > 1, FILL:

in the last 6 months, that is, since {FILL DATE 6 MONTHS PRIOR TO INTERVIEW DATE}.

Time in Household is length of time that CHILD has lived with CAREGIVER. It is calculated from

variables P_NP2am, P_NP2ad and P_NP2ay, found in the NP - Up-Front Verification Module (CG)

Start of living arrangement is obtained by subtracting the Time in Household (e.g., 5 weeks, 14

months, 2 years) from Interview Date.

P_FC1a [ PFC1a ] R given essntial info when CH placed

Now I'd like to ask a few questions about services that you^Fills.P_FC1a2CG^P_HH.Caregiver2

may have received as a foster parent or alternative care provider ^FILLS.P_FC1A ^DATEFILLSTR1.

Do you feel like you were given essential information about ^CHILD when ^Fills.heshe was

placed?

READ IF NECESSARY: We define a foster care situation as a household where one of the

caregivers identified as being responsible for care for the child is not a biological or adoptive parent

AND fits at least one of the following 3 criteria:

@|@|1. Someone from a foster care or social service agency helped to arrange for the person to

care for the child.

@|@|2. The person regularly talks to a caseworker about the child.

@|@|3. The person currently receives payments for being the child’s foster parent.

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^FillP_FC1a

wave1 since

wave2plus in the last 6 months, that is, since

Question Fill: ^FillP_FC1a2CG

CG2 ·and/or·

---------------------------------------------------------------------------------

Logic before:

[{IF WAVE = 1, FILL: Since {FILL START DATE OF LIVING ARRANGEMENT}/IF WAVE > 1, FILL:

In the last 6 months}]

P_FC2a [ PFC2a ] R had input into the service plan

^Fills.P_FC2a ^DATEFILLSTR2 have you had input into the service plan?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^FillP_FC2a

wave1 Since

wave2plus In the last 6 months,

---------------------------------------------------------------------------------

P_FC3a [ PFC3a ] CW returned phone calls in 24 hrs

Has the caseworker returned phone calls within 24 hours?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_FC4a [ PFC4a ] Felt like rspcted member of svc team

Have you felt like a respected member of the team of people providing service to this foster child?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, FILL: Since {FILL START DATE OF LIVING ARRANGEMENT}/IF WAVE > 1, FILL:

In the last 6 months

P_FC5a [ PFC5a ] Rcvd any special foster P trning

^Fills.P_FC2a ^DATEFILLSTR2 have you received any special instruction or training in skills you

need to be a foster parent? This would include things like how to deal with problems your foster

child may have or behavior management techniques.

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

Logic before:

[{IF WAVE = 1, FILL: Since {FILL START DATE OF LIVING ARRANGEMENT}/IF WAVE > 1, FILL:

In the last 6 months}]

P_FC6a [ PFC6a ] Involved in any peer support grps

^Fills.P_FC2a ^DATEFILLSTR2 have you been involved with any organized peer support groups?

By this we mean a group of adults who meet to discuss shared issues that concern them. These

groups might meet at a community center or a church, for example.

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

Logic before:

[{IF WAVE = 1, FILL: Since {FILL START DATE OF LIVING ARRANGEMENT}/IF WAVE > 1, FILL:

In the last 6 months}]

P_FC7a [ PFC7a ] Rcvd any respite care

^Fills.P_FC2a ^DATEFILLSTR2 have you received respite care? (Respite care is care for the child

provided in the home or somewhere else so that the family can have a break from ongoing care of

the child. It can be thought of as child care or babysitting by an individual or program trained to

meet the special needs of the child.)

Question Type: TYN

yes 1 YES

no 2 NO

P_FC7aa [ PFC7aa ] R a licensed foster care provider

Are you a licensed, certified, or approved foster care provider?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_FC7aa = YES GOTO P_FC9a

---------------------------------------------------------------------------------

~~Question Type:~~ ~~TYN~~

~~yes~~ 1 ~~YES~~

no 2 NO

~~---------------------------------------------------------------------------------~~

P_ FC7ca

Did you ever apply to become licensed, certified, or approved as a foster care provider for the children in your care?

1=YES [Go to P_FC7da]

2=NO [Go to P_FC7ga]

P_FC7da

What factors influenced your decision to apply? [Code all that apply]

1=I thought it was a requirement in order to continue to care for my children.

2=I would receive more financial assistance if I became licensed or approved.

3=I thought it would provide me with the services my child needs, such as Medicaid or help with school.

4=I wanted to learn more about becoming a better parent, and the parenting classes helped me.

5=Other.

3=ADD TO LIST

P_FC7ea

Was your application approved or denied to become a licensed, certified or approved foster care provider?

1=Approved [GO TO P_FC8b]

2=Denied

3=Pending/Under Review

4=Did not apply

P_FC7fa

What were the reasons your application was denied?

1=Some members of my home did not pass criminal background checks. [GO TO P_FC8b]

2=I didn’t complete all of the training. [GO TO P_FC8b]

3=My house/home did not meet the space/requirements necessary.

4=I did not have all the necessary medical documentation for me or other adults in the home.

5= Some members of my home did not pass safety background checks because of past child abuse, neglect, or maltreatment investigations.

6= I was missing other necessary documentation. Explain.

7=Other

3=ADD TO LIST. [GO TO P_FC8b]

P_FC7ga

Why haven’t you applied to become licensed, certified, or approved as a foster care provider?

CODEALL THAT APPLY

1=I wasn’t informed that I could become a licensed, certified or approved as a foster care provider.

2=I don’t want to submit to the health exams,

3=I don’t want to submit to the fingerprinting, and

4= I don’t want to submit to the criminal background checks.

5=I don’t have the time to complete all of the training and other requirements.

6 =I don’t see any benefits to becoming licensed, certified or approved as a foster care provider.

7=Other.

Logic before:

IF HH6e = 1, CONTINUE. ELSE, GOTO P_FC9a.]

P_FC8b [ PFC8b ] Amount of last monthly foster care payment you rcvd for CH

Earlier you told me that you received payments for being ^CHILD's foster parent.

What was the amount of the last monthly foster care payment you received for ^CHILD?

Question Type: 0..9996

---------------------------------------------------------------------------------

Logic before:

IF HH6e = 1, CONTINUE. ELSE, GOTO P_FC12a

P_FC9a [ PFC9a ] FC $ cover basic liv expnses of ch

Does the money you receive for foster care cover ^CHILD's basic living expenses?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

Logic before:

[{IF WAVE = 1, FILL: In the time since {FILL START DATE OF LIVING ARRANGEMENT}/IF WAVE

> 1, FILL: In the last 6 months}]

P_FC10a [ PFC10a ] Ever supplemented FC $ w/own funds

^Fills.P_FC2a ^DATEFILLSTR2 have you ever supplemented the foster care payment with your

own funds?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_FC10a = NO GOTO P_FC12a

---------------------------------------------------------------------------------

P_FC11a [ PFC11a ] Amount of own $ used to meet ch needs

^Fills.P_FC2a ^DATEFILLSTR2 how much of your own money on average @bper month@b have

you used to help meet the needs of this child?

AMOUNT:

Question Type: 0..5000

---------------------------------------------------------------------------------

P_FC12a [ PFC12n ] How long R been FP(number)

For how long have you been a foster parent/residential care provider?

NUMBER

Question Type: 0..97

---------------------------------------------------------------------------------

P_FC12b [ PFC12u ] How long R been FP(unit)

(Is that the number of months or years?)

Question Type: TMmYr

Months 1 Months

years 2 Years

---------------------------------------------------------------------------------

P_FC13a [ PFC13a ] Total # FCH R has cared for

For approximately how many foster children have you cared, including ^CHILD?

NUMBER OF CHILDREN

Question Type: 1..500

---------------------------------------------------------------------------------

P_FC14a [ PFC14a ] R wish they could raise CH

Now I'd like to ask you a few questions about your relationship with ^CHILD.

Do you ever wish you could raise ^CHILD?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_FC15A [ PFC15A ] How much would you miss CH if they had to leave

How much would you miss ^CHILD if ^FILLS.HESHE had to leave? Would you say…

Question Type: THMNeed

alot 1 a lot,

somewhat 2 somewhat,

alittle 3 a little, or

notatall 4 not at all?

---------------------------------------------------------------------------------

P_FC16A [ PFC16A ] How mch do u think ur rltnshp with CH is afctng them now

How much do you think your relationship with ^CHILD is affecting ^FILLS.HIMHER right now?

Would you say...

Question Type: THMNeed

alot 1 a lot,

somewhat 2 somewhat,

alittle 3 a little, or

notatall 4 not at all?

---------------------------------------------------------------------------------

P_FC17A [ PFC17A ] How mch do u think ur rltnshp with CH will affect in future

How much do you think your relationship with ^CHILD will affect ^FILLS.HIMHER in the future?

Would you say...

Question Type: THMNeed

alot 1 a lot,

somewhat 2 somewhat,

alittle 3 a little, or

notatall 4 not at all?

AP - ADOPTION MODULE FOR FOSTER PARENTS

---------------------------------------------------------------------------------

Logic before:

IF WAVE > 1 and (P_AP1a <> YES IN PREVIOUS WAVE) and (CAREGIVER = FOSTER

PARENT OR ADOPTIVE PARENT), CONTINUE. ELSE GO TO NEXT MODULE

P_AP1a [ PAP1a ] R legally adopted CH

Now I'm going to ask you some questions about adoption possibilities for ^CHILD. Have you

legally adopted ^CHILD?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF RESPONSE = 1 (YES) GOTO P_AP3a

---------------------------------------------------------------------------------

P_AP2a [ PAP2a ] Ever considered adopting CH

Have you ever considered adopting ^CHILD if ^FILLS.HESHE cannot return to ^FILLS.HISHER

family?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^fillhisher

his his

her her

Logic after:

IF RESPONSE = 2 (NO) GOTO P_APEND

---------------------------------------------------------------------------------

P_AP3a [ PAP3a ] Labels are in Logic After

What factors contributed to wanting to adopt ^CHILD?

CODE ALL THAT APPLY.

Question Type: TAdpFacS

partoffam 1 FEELING THAT CHILD IS PART OF RESPONDENT'S FAMILY

samerace 2 CHILD'S RACE/ETHNICITY IS SAME AS RESPONDENT'S FAMILY

feellove 3 FEELINGS OF LOVE/AFFECTION FOR CHILD

safety 4 DESIRE FOR CHILD TO GROW UP IN SAFE ENVIRONMENT

havesib 5 HAVING ALREADY ADOPTED CHILD'S SIBLING(S)

parnotcare 6 FEELING THAT CHILD'S BIOLOGICAL PARENTS CANNOT

ADEQUATELY CARE FOR CHILD

related 7 CHILD IS RELATED TO RESPONDENT OR RESPONDENT'S FAMILY

noconcerned 8 NOT CONCERNED THAT CHILD'S RACE/ETHNICITY DIFFERS FROM

RESPONDENT OR RESPONDENT'S FAMILY'S RACE

anotherfam 9 CONCERNED THAT CHILD WOULD OTHERWISE BE PLACED WITH

ANOTHER FAMILY

other 10 OTHER

Logic after:

PAPTG_1 --Fctr R adpt CH-Feeling ch is part of Rs family; PAPTG_2 --Fctr R adpt CH-Ch

race/ethnicity = Rs family; PAPTG_3 --Fctr R adpt CH-Love/affection for ch; PAPTG_4 --Fctr R

adpt CH-Desire for ch to grow up in safe env; PAPTG_5 --Fctr R adpt CH-Already adopted ch

sibling; PAPTG_6 --Fctr R adpt CH-Feel that ch bio Ps cannot care for ch; PAPTG_7 --Fctr R adpt

CH-Ch related to R/Rs family; PAPTG_8 --Fctr R adpt CH-Not concerned that ch race <> Rs/Rs

fam; PAPTG_9 --Fctr R adpt CH-Concern that ch be placed w/other fam; PAPTG_10 --Fctr R adpt

CH-Other; PAPTG_11--Fctr R adpt CH-DK; PAPTG_12--Fctr R adpt CH-RF

---------------------------------------------------------------------------------

P_AP4a [ PAP4a ] Labels are in Logic After

What factors discouraged you from wanting to adopt ^CHILD?

IF R INDICATES THERE WERE NO DISCOURAGING FACTORS, CODE 6 = YES.

OTHERWISE, CODE ALL THAT APPLY.

Question Type: TDisFacS

norights 1 BIOLOGICAL PARENT HAS NOT RELINQUISHED RIGHTS, OR

RIGHTS HAVE NOT BEEN TERMINATED BY COURT

diffrace 2 CHILD'S RACE/ETHNICITY DIFFERS FROM RESPONDENT'S FAMILY

disabil 3 CHILD HAS DISABILITIES THAT RESPONDENT MAY NOT BE ABLE

TO HANDLE IN A LONG-TERM SITUATION

probfam 4 PROBLEMS BETWEEN CHILD AND OTHER MEMBERS OF

RESPONDENT'S FAMILY

finance 5 FINANCIAL CONCERNS

nofactor 6 NO DISCOURAGING FACTORS

other 7 OTHER

Logic after:

HARDCHECK (DO NOT ALLOW RESPONSE 6 = YES WITH ANY OTHERS =Y) '"Warning: ""No

Discouraging Factors (6)"" cannot be selected when selecting the discouraging factors (1-5,7)

please return and correct your response"; PAP4TG_1 --Fctr dscrg R adpt CH-Bio P still has rights

to ch; PAP4TG_2 --Fctr dscrg R adpt CH-Ch race/ethnicity <> Rs/Rs fam; PAP4TG_3 --Fctr dscrg

R adpt CH-Ch has disabilities R not handle; PAP4TG_4 --Fctr dscrg R adpt CH-Problems btwn

ch/Rs fam; PAP4TG_5 --Fctr dscrg R adpt CH-Financial concerns; PAP4TG_6 --Fctr dscrg R adpt

CH-Other; PAP4TG_7 --Fctr dscrg R adpt CH-No discouraging factors; PAP4TG_8--Fctr dscrg R

adpt CH-DK; PAP4TG_9--Fctr dscrg R adpt CH-RF

---------------------------------------------------------------------------------

Logic before:

IF P_AP1a = 1 , FILL: Did you ever talk IF P_AP2a = 1, fill: Have you talked

P_AP5a [ PAP5a ] Ever talk to CW about adopting CH

^Fills.havedidyou with your caseworker about the possibility of adopting ^CHILD?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^FillHaveDidyou

Haveyou Have you talked

Didyou Did you ever talk

Logic after:

IF RESPONSE = 2 (NO) GOTO P_APEND

---------------------------------------------------------------------------------

P_AP6a [ PAP6a ] CW response to Rs desire to adopt CH

How did your caseworker respond to your willingness to adopt ^CHILD? Would you say your

caseworker...

Question Type: TCWRes

strongdis 1 strongly discouraged you,

discour 2 discouraged you,

encour 3 encouraged you, or

StrongEnc 4 strongly encouraged you?

Logic after:

IF RESPONSE <> 1 OR 2, GOTO P_APEND

---------------------------------------------------------------------------------

P_AP7a [ PAP7a ] Labels are in Logic After

Why do you think this was?

CODE ALL THAT APPLY.

Question Type: TWyCWRsp

expectret 1 CASEWORKER STILL EXPECTS THAT CHILD WILL RETURN HOME

diffrace 2 CHILD'S RACE/ETHNICITY DIFFERS FROM RESPONDENT'S

FAMILY'S RACE/ETHNICITY

famrel 3 CASEWORKER HAS A FAMILY RELATED TO CHILD IN MIND

faminmind 4 CASEWORKER HAS A FAMILY NOT RELATED TO CHILD IN MIND

notbest 5 CASEWORKER DOES NOT THINK RESPONDENT WOULD BE BEST

ABLE TO MEET CHILD'S NEEDS

other 6 OTHER

Logic after:

GOTO P_APEND; PAP7TG_1 --CW rspns to R adpt CH-CW still expects ch will return home;

PAP7TG_2 --CW rspns to R adpt CH-Ch race/ethnicity differs from Rs fam; PAP7TG_3 --CW rspns

to R adpt CH-CW has fam related to ch in mind; PAP7TG_4 --CW rspns to R adpt CH-CW has

nonrelated fam in mind; PAP7TG_5 --CW rspns to R adpt CH-CW doesnt think R best for ch

needs; PAP7TG_6 --CW rspns to R adpt CH-Other; PAP7TG_7--CW rspns to R adpt CH-DK;

PAP7TG_8--CW rspns to R adpt CH-RF

---------------------------------------------------------------------------------

P_APEND [ PAPEND ] NoDeliv

PLEASE PRESS "1" TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

PP - Permanency Planning for Foster and Adoptive Caregivers

---------------------------------------------------------------------------------

Logic before:

IF WAVE > 1 and (P_AP1a <> YES IN PREVIOUS WAVE) and (CAREGIVER = FOSTER

PARENT OR ADOPTIVE PARENT), CONTINUE. ELSE GO TO NEXT MODULE

P_PPBGN [ PPPBGN ] NoDeliv

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

---------------------------------------------------------------------------------

Logic before:

IF P_HH6b=1 OR P_HH6c = 1 OR P_HH6d = 1 OR P_HH6e = 1, CONTINUE ELSE SKIP TO THE

NEXT MODULE.

P_PP2m [ PPP2m ] Month R legally adopted CH

Earlier you told me that you legally adopted ^CHILD.

In what month and year did you adopt ^CHILD?

MONTH:

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

---------------------------------------------------------------------------------

P_PP2y [ PPP2y ] Year R legally adopted CH

In what month and year did you adopt ^CHILD?

YEAR:

Question Type: 1970..2013

---------------------------------------------------------------------------------

P_PP3 [ PPP3 ] Labels are in Logic After

What agencies were involved in the adoption?

CODE ALL THAT APPLY.

Question Type: TAdptAgS

public 1 CHILD WELFARE/OTHER PUBLIC AGENCY

church 2 CHURCH-AFFILIATED AGENCY/ORGANIZATION

minority 3 AGENCY PROMOTING ADOPTION OF MINORITY CHILDREN

private 4 PRIVATE AGENCY/ORGANIZATION

Logic after:

PPP3TG_1--Agncy invlvd in adption-Ch Wlfr/othr pub agcy involved adopt; PPP3TG_2--Agncy invlvd

in adption-Church Aff Agcy/org involved adopt; PPP3TG_3--Agncy invlvd in adption-Agcy Promot

adpt minority ch inv adp; PPP3TG_4--Agncy invlvd in adption-Private agency involved in adoption;

PPP3TG_5--Agncy invlvd in adption-DK; PPP3TG_6--Agncy invlvd in adption-RF

---------------------------------------------------------------------------------

P_PP4a [ PPP4a ] CH in foster wth R before adopt

Was ^CHILD in foster care with you prior to adoption?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

2 = no GO TO P_PP8a

---------------------------------------------------------------------------------

P_PP5a [ PPP5a ] How long CH in foster care with R yr/month

How long was ^Fills.HeShe in foster care with you?

Question Type: TMmYr

Months 1 Months

years 2 Years

---------------------------------------------------------------------------------

Logic before:

IF P_PP5a = 1 ask P_PP5m

P_PP5m [ PPP5m ] How long CH in foster care with R - months

(How long was ^Fills.HeShe in foster care with you?)

ENTER NUMBER OF MONTHS

MONTHS:

Question Type: 1..24

---------------------------------------------------------------------------------

Logic before:

IF P_PP5a = 2

P_PP5y [ PPP5y ] How long CH in foster care with R - years

(How long was ^Fills.HeShe in foster care with you?)

ENTER NUMBER OF YEARS

YEARS:

Question Type: 1..5

---------------------------------------------------------------------------------

P_PP8a [ PPP8a ] R or spouse blood rel of CH

Are you or your spouse/partner a blood relative of ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

Logic before:

Adoption Subsidies

IF P_HH6b=1, CONTINUE. ELSE, GOTO P_PP31m.

P_PP18a [ PPP18a ] Ever rcv adopt subsidy for CH

Have you ever received an adoption subsidy -- that is, a monthly payment from the state or county

for ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

IF = 2, GOTO P_PP25

---------------------------------------------------------------------------------

P_PP19a [ PPP19a ] Currently recieve adopt subsidy

Do you currently receive an adoption subsidy?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

IF P_PP19a = 2 GOTO P_PP25

---------------------------------------------------------------------------------

Logic before:

IF PP_19a = 1 ELSE SKIP TO P_PP25

P_PP20n [ PPP20a ] Amt adopt subsdy per month rec for CH

What is the amount per month of the adoption subsidy you are currently receiving for ^CHILD?

Question Type: 0..9997

Logic after:

IF $0, GO BACK TO P_PP19a

---------------------------------------------------------------------------------

Logic before:

Open Adoption

P_PP25 [ PPP25a ] Pre-Adpt agmt on biol prnt info

Were you involved in any kind of pre-adoption agreement in which you agreed to provide

information about ^CHILD to one or both of ^Fills.HisHer biological parents?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

IF P_PP25 = 2 GO TO P_PP27_1a1

---------------------------------------------------------------------------------

P_PP26 [ PPP26a ] Pre-Adpt agmt wrtn or verbal

Was this agreement written or verbal?

Question Type: TPreAdpt

WRITTEN 1 WRITTEN

VERBAL 2 VERBAL

---------------------------------------------------------------------------------

P_PP27_1a1 [ PPP27x1 ] Child contact with Birth Mother since adopt

Since the adoption, has ^CHILD had contact with ^Fills.HisHer birth mother?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_PP27_1a2 [ PPP27x2 ] Child Contact with Birth Father since adopt

Since the adoption, has ^CHILD had contact with ^Fills.HisHer birth father?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_PP27_1a3 [ PPP27x3 ] Child Contact with Siblings since adopt

Since the adoption, has ^CHILD had contact with ^Fills.HisHer siblings?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

Logic before:

Post-Adoption Services

P_PP28intro [ PPP28intro ] NO LABEL

USE CARD 33. The next questions are about post-adoption counseling or support for adoption

you or your family have received since beginning the adoption process. Please look at the list of

services on Card 33 and tell me which ones you have received since starting the adoption

process.

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

P_PP28_1a [ PPP28_1a ] Labels are in Logic After

Have you received...

CODE ALL THAT APPLY.

Question Type: TPstAdpt

PARENTS 1 SUPPORT GROUP FOR ADOPTIVE PARENTS

CHILD 2 SUPPORT GROUP FOR ADOPTED CHILDREN

BOOKS 3 BOOKS OR ARTICLES ON ADOPTION

LECTURES 4 LECTURES OR SEMINARS ON ADOPTION

CLASSES 5 CLASSES OR WORKSHOPS ON UNDERSTANDING YOUR

ADOPTED CHILD

PARENCOUNSEL 6 COUNSELING FOR PARENTS (RESPONDENT)

CHILDCOUNSEL 7 COUNSELING FOR ^Global.Child

INFORMATION 8 INFORMATION ON ^Global.Child'S SOCIAL, MEDICAL, AND/OR

GENETIC HISTORY

LEGAL 9 LEGAL ADVICE

RELATIVE 10 INFORMATION ON HOW TO SEARCH FOR BIRTH RELATIVES

THERAPY 11 FAMILY THERAPY

CARE 12 RESIDENTIAL CARE FOR ^Global.Child

PSYCH 13 PSYCHIATRIC PLACEMENT OR CRISIS SERVICES FOR

Logic after:

PPP28T1--R rcved-Support group for adopt parents; PPP28T2--R rcved-Support group for adopted

children; PPP28T3--R rcved-Books/articles on adoption; PPP28T4--R rcved-Lectures/seminars on

adoption; PPP28T5--R rcved-Class/workshops on underst adopted ch; PPP28T6--R rcved-

Counselling for parents - R recieved; PPP28T7--R rcved-Counselling for CH; PPP28T8--R rcved-Info

on CH social/med/genetic hstry; PPP28T9--R rcved-Legal Advice; PPP28T10--R rcved-Info on how

to find birth relatives; PPP28T11--R rcved-Family therapy; PPP28T12--R rcved-Residential care for

CH; PPP28T13--R rcved-Psyc placement/crisis serv for CH; PPP28T14--R rcved-DK; PPP28T15--R

rcved-RF

---------------------------------------------------------------------------------

P_PP29 [ PPP29a ] Post adopt svcs meet needs

Overall, how well have these services met your needs? Would you say...

Question Type: THwlMet

Very 1 Very well,

Somewhat 2 Somewhat well,

Notvery 3 Not very well, or

Notatall 4 Not well at all?

Logic after:

GO TO P_PP62

---------------------------------------------------------------------------------

Logic before:

IF P_NP14a = yes, CONTINUE. ELSE, GOTO P_PP42.

P_PP31m [ PPP31m ] R became Legal Guardian - month

Earlier you told me that you are ^CHILD's legal guardian.

In what month and year did you become ^Fills.HisHer legal guardian?

MONTH:

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

---------------------------------------------------------------------------------

P_PP31y [ PPP31y ] R became Legal Guardian - year

(In what month and year did you become ^Fills.HisHer legal guardian?)

YEAR:

Question Type: 1980..2013

---------------------------------------------------------------------------------

P_PP32 [ PPP32a ] CH your fstr care bef legl grd

Was ^CHILD in foster care with you before you became ^Fills.HisHer legal guardian?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

IF = 2, GO TO P_PP42

---------------------------------------------------------------------------------

P_PP33y [ PPP33y ] How long was CH in foster care with you

How long was ^Fills.HeShe in foster care with you?

ENTER NUMBER OF YEARS

YEARS:

Question Type: 1..5

Logic before:

IF P_HH9a = no (CAREGIVER IS NOT CHILD”S LEGAL GUARDIAN)

P_PP34a

Would you ever consider adopting or becoming the permanent legal guardian of ^CHILD?

1=YES

2=NO

P_PP34b

What options have been discussed with you about adopting or becoming the permanent legal guardian?

1=No options have been discussed.

2=Only adoption has been discussed.

3=Only legal guardianship has been discussed.

4=Both adoption and legal guardianship have been discussed.

--------------------------------------------------------------------------------

Logic before:

Guardianship Payments

P_PP42 [ PPP42A ] R rcv guardianshp payment for CH

Have you ever received a guardianship payment or subsidy -- that is, a monthly payment from the

state or county -- for ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

IF = 2, GO TO P_PP44a

---------------------------------------------------------------------------------

P_PP43 [ PPP43A ] R currenly rcv monthly guardianshp payment

Do you currently receive a monthly payment?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

IF = 2, GO TO P_PP48_1a1

---------------------------------------------------------------------------------

P_PP44 [ PPP44A ] Amt monthly guardianshp payment R rcv for CH

What is the amount of the monthly payment you are currently receiving for ^CHILD?

Question Type: 0..9997

Logic after:

IF $0, GO BACK TO P_PP43

---------------------------------------------------------------------------------

[ASK P_PP44a ONLY OF RESPONDENTS RESIDING IN STATES WITH GUARDIANSHIP ASSISTANCE PROGRAM]:

P_PP44a

Did your caseworker talk to you about the guardianship assistance program?

1 YES

2 NO

---------------------------------------------------------------------------------

Logic before:

IF P_NP14a = yes, CONTINUE. ELSE, GOTO P_PP49intro.

P_PP48_1a1 [ PPP48x1 ] CH had contact with bio mom since R became LG

Has ^CHILD had contact with ^Fills.HisHer birth mother since you've become legal guardian?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_PP48_1a2 [ PPP48x2 ] CH had contact with bio dad since R became LG

Has ^CHILD had contact with ^Fills.HisHer birth father since you've become legal guardian?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_PP48_1a3 [ PPP48x3 ] CH had contact w CH siblings since R became LG

Has ^CHILD had contact with ^Fills.HisHer siblings since you've become legal guardian?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

Logic before:

Post-Guardianship Services

P_PP49intro [ PPP49intro ] NO LABEL

USE CARD 34. The next questions are about counseling or support you or your family have

received since beginning the guardianship process. Please look at the list of services on Card 34

and tell me which ones you have received since starting the guardianship process.

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

P_PP49 [ PPP49 ] Labels are in Logic After

Have you received...

CODE ALL THAT APPLY.

Question Type: TguarecS

guardians 1 support group for guardians?

children 2 support group for children in guardianship?

books 3 books or articles on guardianship?

lectures 4 lectures or seminars on guardianship?

counselguard 5 counseling for guardians (respondent)?

counselchild 6 counseling for ^Global.Child?

information 7 information on ^Global.CHILD's social, medical, and/or genetic history?

legal 8 legal advice?

relative 9 information on how to search for birth relatives?

family 10 family therapy?

rescare 11 residential care for ^Global.Child?

psych 12 psychiatric placement or crisis services for ^Global.Child?

Logic after:

PPP49T1--R rcvd-guardian support group; PPP49T2--R rcvd-suppt grp for CH in guardianshp;

PPP49T3--R rcvd-guardianship books/articles; PPP49T4--R rcvd-guardianship lectures/seminars;

PPP49T5--R rcvd-counseling for guardians; PPP49T6--R rcvd-counseling for CH; PPP49T7--R rcvd-

CH social/medical/genetic hist; PPP49T8--R rcvd-legal advice; PPP49T9--R rcvd-search for birth

reltv info; PPP49T10--R rcvd-family therapy; PPP49T11--R rcvd-residential care for child;

PPP49T12--R rcvd-CH psych placement/crisis serv; PPP49T13--R rcvd-DK; PPP49T14--R rcvd-RF

---------------------------------------------------------------------------------

Logic before:

Status of Child's Placement

IF P_HH6b = 1, FILL: adoption/IF P_NP14a = yes, FILL: guardianship arrangement

P_PP62 [ PPP62A ] R ok w/ how CH situation going

The next questions are about how the ^Fills.TypeCare is going.

How satisfied are you with how this ^Fills.TypeCare is going? Would you say you are...

Question Type: TFlAdpt

vrysat 1 Very satisfied,

smwsat 2 Somewhat satisfied,

smwdis 3 Somewhat dissatisfied, or

vrydis 4 Very dissatisfied?

Question Fill: ^FillTypeCare

adoption adoption

guardianship guardianship arrangement

---------------------------------------------------------------------------------

Logic before:

IF P_HH6b = 1, FILL: adoption/IF P_NP14a = yes, FILL: guardianship arrangement

P_PP63 [ PPP63A ] R informed about CH bckgd before

How informed were you about ^CHILD's background before ^Fills.TypeCare2? By background, we

mean ^Fills.HisHer family, medical, school, or behavioral history. Would you say you were...

Question Type: Tinfrmed

Very 1 Very informed,

Somewhat 2 Somewhat informed,

Notvery 3 Not very informed, or

Notatall 4 Not at all informed?

Question Fill: ^FillTypeCare2

adoption adoption

guardianship guardianship arrangement

---------------------------------------------------------------------------------

P_PP64 [ PPP64A ] CH relationship w Rs family

Thinking about ^CHILD's relationship with your family, would you say things are...

Question Type: TRelFam

Better 1 Better than you expected,

About 2 About what you expected, or

Worse 3 Worse than you expected?

---------------------------------------------------------------------------------

Logic before:

[IF P_HH6b = 1, FILL: adoption/IF P_NP14a = yes, FILL: guardianship arrangement]

P_PP65 [ PPP65A ] R taken action to end CHsituation

Have you ever taken any action to end this ^Fills.TypeCare?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Question Fill: ^FillTypeCare

adoption adoption

guardianship guardianship arrangement

Logic after:

2 = no GO TO P_PPEND

---------------------------------------------------------------------------------

P_PP66 [ PPP66A ] Labels are in Logic After

What actions have you taken?

CODE ALL THAT APPLY.

Question Type: Tactaken

SPOKECW 1 SPOKE TO CASEWORKER ABOUT IT

SPOKEATTY 2 SPOKE WITH ATTORNEY ABOUT IT

OTHER 3 OTHER

Logic after:

PPP66A_1 --Rs actions to end CH situation-Spoke to CW about it; PPP66A_2 --Rs actions to end

CH situation-Spoke w/ attrny about it; PPP66A_3 --Rs actions to end CH situation-Other;

PPP66A_4--Rs actions to end CH situation-DK; PPP66A_5--Rs actions to end CH situation-RF

---------------------------------------------------------------------------------

P_PP68 [ PPP68 ] Labels are in Logic After

What were your reasons for wanting to end it?

CODE ALL THAT APPLY.

Question Type: Twantend

BEHAV 1 CHILD BEHAVIORAL OR EDUCATIONAL PROBLEMS

GETALONG 2 CHILD DID NOT GET ALONG WITH SIBLINGS

OTHFAM 3 OTHER FAMILY PROBLEMS NOT ASSOCIATED WITH CHILD

INSURANCE 4 INSURANCE WOULD NOT PAY FOR CHILD'S SERVICES

FINANCIAL 5 FINANCIAL REASONS

MEDICAL 6 CHILD'S MEDICAL PROBLEMS

OTHREASONS 7 OTHER REASONS

Logic after:

PPP68TG1--R wanted end CH situation bc - CH behav/educ problems; PPP68TG2--R wanted end

CH situation bc - CH/siblings problems; PPP68TG3--R wanted end CH situation bc - family

problems; PPP68TG4--R wanted end CH situation bc - insurance not cover CH; PPP68TG5--R

wanted end CH situation bc - financial reasons; PPP68TG6--R wanted end CH situation bc - CH

medical problems; PPP68TG7--R wanted end CH situation bc - other reasons; PPP68TG8--R

wanted end CH situation bc - DK; PPP68TG9--R wanted end CH situation bc - RF

---------------------------------------------------------------------------------

P_PPEND [ PPPEND ] NoDeliv

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

AZ - ACASI Introduction

---------------------------------------------------------------------------------

Logic before:

ACASI sections should be skipped in the following caregiver situations:

- Licensed Foster Home, Living with a Family Friend, or all non-family settings

(P_NP12a = 3, 4, or 6) OR (P_NP12b .>= 1) OR

- Primary CG is a Foster Mother or Father

(P_HH6a = 8 or 9 OR P_HH6g = 8 or 9) OR

- Primary CG currently receives payments for being a foster parent

(P_HH6e = 1)

P_AZ0 [ PAZ0 ] NO LABEL

Now I'd like you to use the headphones to listen to some questions and enter your answers into

the computer yourself. This will allow you to answer the questions in complete privacy. I will not

be able to hear the questions or see the answers you type into the computer. I'll help you do the

first few, and I'd like you to finish the rest on your own. Let me explain how to use the computer.

MOVE COMPUTER SO RESPONDENT CAN USE IT AND POINT OUT THE FOLLOWING:

- NUMBER KEYS

- ENTER KEY (TO ACCEPT AND STORE THE RESPONSE)

- FUNCTION KEYS

- EXPLAIN THAT THE AUDIO FOR THE DISCIPLINE SECTION WILL NOT SAY THE FOCAL

CHILD'S NAME, ALTHOUGH IT WILL APPEAR ON THE SCREEN.

CAUTION RESPONDENT ABOUT ON/OFF SWITCH. ADJUST HEADPHONES FOR

RESPONDENT AND DEMONSTRATE VOLUME CONTROL.

WHEN RESPONDENT IS READY, PRESS "1" AND [ENTER] TO CONTINUE

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

P_AZ1 [ PAZ1 ] NO LABEL

The next questions are for practice. The interviewer is going to help you do this.

Press "1" and the large [Enter] key on the right side of the keyboard to see the first question.

The [Enter] key is the one with the <-- symbol on it.

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

P_AZ2a [ PAZ2a ] Month of Rs birth(MONTHT)

In what month were you born?

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

---------------------------------------------------------------------------------

P_AZ3a [ PAZ3a ] Birth month check (YN2T)

The computer has recorded that you were born in ^P_AZ2a. Is this correct?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

if no GOTO Y_AZ2a

---------------------------------------------------------------------------------

P_AZ4 [ PAZ4 ] NO LABEL

The next set of practice questions will show you some of the different types of response choices

that you will see as you answer questions on your own. It is important that you pay close

attention to the response choices given for each question in choosing and entering your response.

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

P_AZ5a [ PAZ5a ] Pst 12M how oft eat out in rest(TIME14T)

In the @bpast 12 months@b, how often did you eat out at a restaurant?

Question Type: TEatOut

oncetwice 1 Once or twice

three_5 2 Between 3 and 5 times

six_10 3 Between 6 and 10 times

eleven_20 4 Between 11 and 20 times

more20 5 More than 20 times

never 6 Never

---------------------------------------------------------------------------------

P_AZ6a [ PAZ6a ] Past 12M how oft attend concert(TIME15T)

In the @bpast 12 months@b, how many times did you go to the grocery store?

Question Type: Tgrocery

onetime 1 1 time

twotimes 2 2 times

three_5 3 3-5 times

six_10 4 6-10 times

eleven_20 5 11-20 times

more20 6 More than 20 times

NoPast12 7 Not in the past @b12 months@b, but it happened before

Never 8 This has never happened

---------------------------------------------------------------------------------

P_AZ7 [ PAZ7 ] NO LABEL

Thank you. If you have any questions about how to use the computer, please ask your interviewer

now.

These last questions are about things that may have happened to you, and are personal

questions that may make you feel uncomfortable or a little sad. Please remember that your

honest answers to our questions are important and will help us understand what different people

experience and how it affects their lives. This will allow us to help others get as good as possible

at helping children like yours in the future.

Press "1" and the [Enter] key to continue.

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

P_AZ8 [ PAZ8 ] NO LABEL

In past studies, some people have told us that they did not feel comfortable talking to an

interviewer about personal topics, so we have developed the recorded interview procedure that you

are using now to complete this part of our questionnaire. You can listen to the questions and put

your answers into the computer in complete privacy. Your interviewer will not know how you

answer and will not ask you any questions about your answers. However, as your interviewer told

you at the beginning of the interview, if your answers to these questions indicate that your life or

health or your child's life or health is in danger, we will have to tell someone whose job it is to see

that you and others are safe and protected.

Thank you for helping us with our effort to understand your family's experiences.

Please press "1" and the [Enter] key now to hear and see the questions.

Question Type: TCont

Continue 1 Continue

Logic after:

P_AZEND

DP - Depression

---------------------------------------------------------------------------------

This section should be skipped in the following caregiver situations:

- Licensed Foster Home, Living with a Family Friend, or all non-family settings

(P_NP12a >= 3, 4, or 6) OR (P_NP12b .>= 1) OR

- Primary CG is a Foster Mother or Father

(P_HH6a = 8 or 9 OR P_HH6g = 8 or 9) OR

- Primary CG currently receives payments for being a foster parent

(P_HH6e = 1)

P_DP1

[IF AGE = 18 OR OLDER] Have you ever in your life had a period of time lasting several days or longer when most of the day you felt sad, empty or depressed?

Question Type: TYESNOCAPS

P_DP2

[IF P_DP1 = 2 OR Blank] Have you ever had a period of time lasting several days or longer when most of the day you were very discouraged about how things were going in your life?

Question Type: TYESNOCAPS

P_DP3

[IF P_DP2 = 2 or Blank] Have you ever had a period of time lasting several days or longer when you lost interest in most things you usually enjoy like work, hobbies, and personal relationships?

Question Type: TYESNOCAPS

P_DP4

[IF P_DP1 =1] During times when you felt sad, empty, or depressed most of the day, did you ever feel discouraged about how things were going in your life?

Question Type: TYESNOCAPS

P_DP5

[IF P_DP4 = 1] During the times when you felt sad, empty, or depressed, did you ever lose interest in most things like work, hobbies, and other things you usually enjoy?

Question Type: TYESNOCAPS

P_DP6

[IF P_DP4 = 2 OR Blank] During the times when you felt sad, empty, or depressed, did you ever lose interest in most things like work, hobbies, and other things you usually enjoy?

Question Type: TYESNOCAPS

P_DP7

[IF P_DP2 = 1] During times when you felt discouraged about how things were going in your life, did you ever lose interest in most things like work, hobbies, and other things you usually enjoy?

Question Type: TYESNOCAPS

P_DP8

[IF P_DP3= 1] Did you ever have a period of time like this that lasted most of the day nearly every day for two weeks or longer?

Question Type: TYESNOCAPS

DEFINE FEELFILL:

IF (P_DP5 = 1), THEN FEELFILL = “were sad, discouraged, or lost interest in most things”

IF (P_DP5 = 2 OR DK/REF), THEN FEELFILL = “were sad or discouraged”

IF (P_DP6 = 1), THEN FEELFILL = “were sad or lost interest in most things”

IF (P_DP6 = 2 OR DK/REF) THEN FEELFILL = “were sad”

IF (P_DP7 = 1), THEN FEELFILL = “were discouraged or lost interest in most things”

IF (P_DP7 = 2 OR DK/REF), THEN FEELFILL = “were discouraged about the way things were going in your life”

IF (P_DP8 = 1), THEN FEELFILL = “lost interest in most things”

ELSE, FEELFILL = BLANK

DEFINE FEELNOUN:

IF (P_DP5 = 1), THEN FEELNOUN = “sadness, discouragement, or lack of interest”

IF (P_DP5 = 2 OR DK/REF), THEN FEELNOUN = “sadness or discouragement”

IF (P_DP6 = 1), THEN FEELNOUN = “sadness or lack of interest”

IF (P_DP6 = 2 OR DK/REF), THEN FEELNOUN = “sadness”

IF (P_DP7 = 1), THEN FEELNOUN = “discouragement or lack of interest”

IF (P_DP7 = 2 OR DK/REF), THEN FEELNOUN = “discouragement”

IF (P_DP8 = 1), THEN FEELNOUN = “lack of interest in most things”

ELSE FEELNOUN = BLANK

DEFINE NUMPROBS

IF P_DP5 NE BLANK OR P_DP6 = 1 OR P_DP7 = 1, THEN NUMPROBS = “these problems”

IF P_DP6 = (2 OR DK/REF) OR P_DP7 = (2 OR DK/REF) OR P_DP8 = 1, THEN

NUMPROBS = “this problem”

ELSE NUMPROBS = BLANK

DEFINE WASWERE:

IF P_DP5 NE BLANK OR P_DP6 = 1 OR P_DP7 = 1, THEN WASWERE = “were”

IF P_DP6 = (2 OR DK/REF) OR P_DP7 = (2 OR DK/REF) OR P_DP8 = 1, THEN

WASWERE = “was”

ELSE WASWERE = BLANK

P_DP9

[IF P_DP5 NE BLANK OR P_DP6 NE BLANK OR P_DP7 NE BLANK] Think about the times when you [FEELFILL]. Did you ever have a period of time like this that lasted most of the day, nearly every day, for two weeks or longer?

Question Type: TYESNOCAPS

P_DP10

[IF P_DP8 = 1 OR P_DP9 = 1] Think of times lasting two weeks or longer when [NUMPROBS] with your mood [WASWERE] most severe and frequent.

During those times, how long did your [FEELNOUN] usually last?

Question Type: Hour Range

1 Less than 1 hour

2 At least 1 hour but no more than 3 hours

3 At least 3 hours but no more than 5 hours

4 5 hours or more

P_DP11

[IF P_DP10 = 2, 3, 4, OR Blank] Still thinking of times lasting two weeks or longer when [NUMPROBS] with your mood [WASWERE] most severe and frequent, how severe was your emotional distress during those times?

Question Type: Severe Range

1 Mild

2 Moderate

3 Severe

4 Very severe

P_DP12

[IF P_DP10 = 2, 3, 4, OR Blank] Again, think of times lasting two weeks or longer when [NUMPROBS] with your mood [WASWERE] most severe and frequent.

How often, during those times, was your emotional distress so severe that nothing could cheer you up?

Question Type: Often Range 3

1 Often

2 Sometimes

3 Rarely

4 Never

P_DP13

[IF P_DP10 = 2, 3, 4, OR Blank] Once again, please think of times lasting two weeks or longer when [NUMPROBS] with your mood [WASWERE] most severe and frequent.

How often, during those times, was your emotional distress so severe that you could not carry out your daily activities?

Question Type: Often Range 3

P_DP14

[IF S1 AD16 = (2, 3, 4 OR Blank) AND NOT (P_DP11 = 1 AND P_DP12 = 4 AND P_DP13 = 4) AND (P_DP1=1 OR P_DP2=1 OR P_DP3=1) AND P_DP8 NE (2 OR Blank)] People who have problems with their mood often have other problems at the same time. These problems may include things like changes in:

• sleep

• appetite

• energy

• the ability to concentrate and remember

• feelings of low self-worth

Did you ever have any of these problems during a period of time when you [FEELFILL] for two weeks or longer?

Question Type: TYESNOCAPS

P_DP15

[IF P_DP14 = 1] Think again about these other problems we just mentioned. They include things like changes in

• sleep

• appetite

• energy

• the ability to concentrate and remember

• feelings of low self-worth

Please think of a time when you [FEELFILL] for two weeks or longer and you also had the largest number of these other problems at the same time.

Is there one particular time like this that stands out in your mind as the worst one you ever had?

Question Type: TYESNOCAPS

P_DP16

[IF P_DP15 = 1] How old were you when that worst period of time started?

AGE:

Question Type: Numeric Range [1 – 110]

[RANGE: 1-110]

P_DP17

[IF P_DP15 = 2 OR Blank] Then think of the most recent time when you [FEELFILL] for two weeks or longer and you also had the largest number of these other problems at the same time. How old were you when that time started?

AGE:

Question Type: Numeric Range [1 – 110]

DEFINE TIMEFILL:

IF P_DP16 NE BLANK, THEN TIMEFILL = ‘worst’

IF P_DP17 NE BLANK, THEN TIMEFILL = ‘most recent’

P_DP18

[IF P_DP16 NE BLANK] In answering the next questions, think about the period of time when your [FEELNOUN] and other problems were the worst. [IF P_DP17 NE BLANK] In answering the next questions, think about the most recent period of time when you [FEELFILL] and had other problems at the same time.

During that time, did you feel sad, empty, or depressed most of the day nearly every day?

Question Type: TYESNOCAPS

P_DP19

[IF P_DP16 NE BLANK OR P_DP17 NE BLANK] During that [TIMEFILL] period of time, did you feel discouraged about how things were going in your life most of the day nearly every day?

Question Type: TYESNOCAPS

P_DP20

[IF P_DP16 NE BLANK OR P_DP17 NE BLANK] During that [TIMEFILL] period of time, did you lose interest in almost all things like work and hobbies and things you like to do for fun?

Question Type: TYESNOCAPS

P_DP21

[IF P_DP16 NE BLANK OR P_DP17 NE BLANK] During that [TIMEFILL] period of time, did you lose the ability to take pleasure in having good things happen to you, like winning something or being praised or complimented?

Question Type: TYESNOCAPS

P_DP22

[IF ANY P_DP18– P_DP21 = 1] The next questions are about changes in appetite and weight. [IF P_DP16 NE BLANK] In answering the next questions, think about the period of time when your [FEELNOUN] and other problems were the worst. [IF P_DP17 NE BLANK] In answering the next questions, think about the most recent period of time when you [FEELFILL] and had other problems at the same time.

Did you have a much smaller appetite than usual nearly every day during that time?

Question Type: TYESNOCAPS

P_DP23

[IF P_DP22 = 2 OR Blank] Did you have a much larger appetite than usual nearly every day?

Question Type: TYESNOCAPS

P_DP24

[IF P_DP22 = 2 OR Blank] Did you gain weight without trying to during that [TIMEFILL] period of time?

Question Type: TYESNOCAPS

P_DP25

[IF P_DP24 = 1 AND (P_DP16 ≤ 21 OR P_DP17 ≤ 21)] Did you gain weight without trying to because you were growing?

Question Type: TYESNOCAPS

P_DP26

[IF P_DP24 = 1 AND P_DP25 NE YES AND S1QD01 = 2] Did you gain weight without trying to because you were pregnant?

Question Type: TYESNOCAPS

P_DP27

[IF P_DP24 = 1 AND P_DP25 NE YES AND P_DP26 NE YES] How many pounds did you gain? Please enter your answer as a whole number.

# OF POUNDS:

Question Type: Numeric Range [0 – 200]

__________ [RANGE: 0-200]

DK/REF

P_DP28

[IF (P_DP22 = 1 OR P_DP24=(2 OR Blank)] Did you lose weight without trying to?

Question Type: TYESNOCAPS

P_DP29

[IF P_DP28 = 1] Did you lose weight without trying to because you were sick or on a diet?

Question Type: TYESNOCAPS

P_DP30

[IF P_DP29 = 2 OR Blank] How many pounds did you lose?

Please enter your answer as a whole number.

# OF POUNDS:

Question Type: Numeric Range [0 – 200]

P_DP31

[IF P_DP22 NE BLANK] [IF P_DP16 NE BLANK] Again, please think about the period of time when your [FEELNOUN] and other problems were the worst.

[IF P_DP17 NE BLANK] Again, please think about the most recent period of time when you [FEELFILL] and had other problems at the same time.

Did you have a lot more trouble than usual falling asleep, staying asleep, or waking too early nearly every night during that [TIMEFILL] period of time?

Question Type: TYESNOCAPS

P_DP32

[IF P_DP31 = 2 OR Blank] During that [TIMEFILL] period of time, did you sleep a lot more than usual nearly every night?

Question Type: TYESNOCAPS

P_DP33

[IF P_DP22 NE BLANK] During that [TIMEFILL] period of time, did you feel tired or low in energy nearly every day, even when you had not been working very hard?

Question Type: TYESNOCAPS

P_DP34

[IF P_DP22 NE BLANK] Did you talk or move more slowly than is normal for you nearly every day?

Question Type: TYESNOCAPS

P_DP35

[IF P_DP34 = 1] Did anyone else notice that you were talking or moving slowly?

Question Type: TYESNOCAPS

P_DP36

[IF P_DP34 = 2 OR Blank] Were you so restless or jittery nearly every day that you paced up and down or couldn't sit still?

Question Type: TYESNOCAPS

P_DP37

[P_DP36 = 1] Did anyone else notice that you were restless?

Question Type: TYESNOCAPS

P_DP38

[IF P_DP22 NE BLANK] The next questions are about changes in your ability to concentrate, and your feelings about yourself.

[IF P_DP16 NE BLANK] Again, in answering these questions, think about the period of time when your [FEELNOUN] and other problems were the worst.

[IF P_DP17 NE BLANK] Again, in answering these questions, think about the most recent period of time when you [FEELFILL] and had other problems at the same time.

During that [TIMEFILL] time, did your thoughts come much more slowly than usual or seem confused nearly every day?

Question Type: TYESNOCAPS

P_DP39

[IF P_DP22 NE BLANK] Did you have a lot more trouble concentrating than usual nearly every day?

Question Type: TYESNOCAPS

P_DP40

[IF P_DP22 NE BLANK] Were you unable to make decisions about things you ordinarily have no trouble deciding about?

Question Type: TYESNOCAPS

P_DP41

[IF P_DP22 NE BLANK] Did you feel that you were not as good as other people nearly every day?

Question Type: TYESNOCAPS

P_DP42

[IF P_DP41 = 1] Did you feel totally worthless nearly every day?

Question Type: TYESNOCAPS

P_DP43

[IF P_DP22 NE BLANK] The next questions are about thoughts of death or suicide.

[IF P_DP16 NE BLANK] Again, in answering these questions, think about the period of time when your [FEELNOUN] and other problems were the worst.

[IF P_DP17 NE BLANK] Again, in answering these questions, think about the most recent period of time when you [FEELFILL] and had other problems at the same time.

Did you often think a lot about death, either your own, someone else’s, or death in general?

Question Type: TYESNOCAPS

P_DP44

[IF P_DP22 NE BLANK] During that period, did you ever think that it would be better if you were dead?

Question Type: TYESNOCAPS

P_DP45

[IF P_DP22 NE BLANK] Did you think about committing suicide?

Question Type: TYESNOCAPS

P_DP46

[IF P_DP45 = 1] Did you make a suicide plan?

Question Type: TYESNOCAPS

P_DP47

[IF P_DP45 = 1] Did you make a suicide attempt?

Question Type: TYESNOCAPS

DEFINE S1D_MDEA1:

IF P_DP18= 1 OR P_DP19 = 1, THEN S1D_MDEA1= 1

ELSE IF P_DP18= 2 AND P_DP19 = 2, THEN S1D_MDEA1= 2

ELSE IF P_DP18= DK OR P_DP19 = DK, THEN S1D_MDEA1= DK

ELSE IF P_DP18= REF OR P_DP19 = REF, THEN S1D_MDEA1= REF

ELSE S1D_MDEA1= BLANK

DEFINE S1D_MDEA2:

IF P_DP20 = 1 OR P_DP21 = 1, THEN S1D_MDEA2= 1

ELSE IF P_DP20 = 2 AND P_DP21 = 2, THEN S1D_MDEA2= 2

ELSE IF P_DP20 = DK OR P_DP21 = DK, THEN S1D_MDEA2= DK

ELSE IF P_DP20 = REF OR P_DP21 = REF, THEN S1D_MDEA2= REF

ELSE S1D_MDEA2= BLANK

DEFINE S1D_MDEA3:

IF P_DP22 = 1 OR P_DP23 = 1 OR P_DP27 ≥10 OR P_DP30 ≥10, THEN S1D_MDEA3= 1

ELSE IF P_DP22 = 2 AND P_DP23 = 2 AND ((P_DP27 < 10 OR P_DP30 < 10) OR

(P_DP24 = (2 OR BLANK) AND P_DP28 = (2 OR BLANK)) OR (P_DP24 = 1 AND

(P_DP25 = 1 OR P_DP26 = 1)) OR (P_DP28 = 1 AND P_DP29 = 1)), THEN

S1D_MDEA3= 2

ELSE IF P_DP22 = DK OR P_DP23 = DK OR P_DP24 = DK OR P_DP27 = DK OR

P_DP28 = DK OR P_DP30 = DK, THEN S1D_MDEA3= DK

ELSE IF P_DP22 = REF OR P_DP23 = REF OR P_DP24 = REF OR P_DP27 = REF OR

P_DP28 = REF OR P_DP30 = REF, THEN S1D_MDEA3= REF

ELSE S1D_MDEA3= BLANK

DEFINE S1D_MDEA4:

IF P_DP31 = 1 OR P_DP32 = 1, THEN S1D_MDEA4= 1

ELSE IF P_DP31 = 2 AND P_DP32 = 2, THEN S1D_MDEA4= 2

ELSE IF P_DP31 = DK OR P_DP32 = DK, THEN S1D_MDEA4= DK

ELSE IF P_DP31 = REF OR P_DP32 = REF, THEN S1D_MDEA4= REF

ELSE S1D_MDEA4= BLANK

DEFINE S1D_MDEA5:

IF P_DP35 = 1 OR P_DP37 = 1, THEN S1D_MDEA5= 1

ELSE IF (P_DP34 = (2 OR DK/REF) AND (P_DP36 = (2 OR DK/REF) OR P_DP37 = 2))

OR P_DP35 = 2, THEN S1D_MDEA5= 2

ELSE IF P_DP34 = DK OR P_DP35 = DK OR P_DP36 = DK OR P_DP37 = DK, THEN

S1D_MDEA5= DK

ELSE IF P_DP34 = REF OR P_DP35 = REF OR P_DP36 = REF OR P_DP37 = REF,

THEN S1D_MDEA5= REF

ELSE S1D_MDEA5= BLANK

DEFINE S1D_MDEA6:

S1D_MDEA6= AD26J

DEFINE S1D_MDEA7:

IF P_DP42 = 1, THEN S1D_MDEA7= 1

ELSE IF P_DP41 = (2 OR DK/REF) OR P_DP42 = 2, THEN S1D_MDEA7= 2

ELSE S1D_MDEA7= P_DP42

ELSE S1D_MDEA7= BLANK

DEFINE S1D_MDEA8:

IF P_DP38 = 1 OR P_DP39 = 1 OR P_DP40 = 1, THEN S1D_MDEA8= 1

ELSE IF P_DP38 = 2 AND P_DP39 = 2 AND P_DP40 = 2, THEN S1D_MDEA8= 2

ELSE IF P_DP38 = DK OR P_DP39 = DK OR P_DP40 = DK, THEN S1D_MDEA8= DK

ELSE IF P_DP38 = REF OR P_DP39 = REF OR P_DP40 = REF, THEN S1D_MDEA8=

REF

ELSE S1D_MDEA8= BLANK

DEFINE S1D_MDEA9:

IF P_DP43 = 1 OR S1D26BB = 1 OR P_DP45 = 1 OR P_DP46 = 1 OR P_DP47 = 1,

THEN S1D_MDEA9= 1

ELSE IF P_DP43 = 2 AND P_DP44 = 2 AND P_DP45 = 2, THEN S1D_MDEA9= 2

ELSE IF P_DP43 = DK OR P_DP44 = DK OR P_DP45 = DK OR P_DP46 = DK

OR P_DP47 = DK, THEN S1D_MDEA9= DK

ELSE IF P_DP43 = REF OR P_DP44 = REF OR P_DP45 = REF OR P_DP46 =

REF OR P_DP47 = REF, THEN S1D_MDEA9= REF

ELSE S1D_MDEA9= BLANK

DEFINE S1DSMMDEA2:

IF SUM (S1D_MDEA1 = 1, S1D_MDEA2 = 1, S1D_MDEA3 = 1, S1D_MDEA4 = 1, S1D_MDEA5

= 1, S1D_ S1MDEA6 = 1, S1D_MDEA7 = 1, S1D_MDEA8 = 1, S1D_MDEA9 = 1) ≥ 5, THEN

S1DSMMDEA2 = 1

ELSE IF SUM (S1D_MDEA1 = (1 OR DK/REF), S1D_MDEA2 = (1 OR DK/REF),

S1D_MDEA3 = (1 OR DK/REF), S1D_MDEA4 = (1 OR DK/REF), S1D_MDEA5 = (1 OR

DK/REF), S1D_MDEA6 = (1 OR DK/REF), S1D_MDEA7 = (1 OR DK/REF), S1D_MDEA8 =

(1 OR DK/REF), S1D_MDEA9 = (1 OR DK/REF)) < 5 AND N(OF S1D_MDEA1-

S1D_MDEA9) > 0, THEN S1DSMMDEA2 = 2

ELSE IF S1D_MDEA1 = DK OR S1D_MDEA2 = DK OR S1D_MDEA3 = DK OR S1D_MDEA4

= DK OR S1D_MDEA5 = DK OR S1D_MDEA6 = DK OR S1D_MDEA7 = DK OR

S1D_MDEA8 = DK OR S1D_MDEA9 = DK, THEN S1DSMMDEA2 = DK

ELSE IF S1D_MDEA1 = REF OR S1D_MDEA2 = REF OR S1D_MDEA3 = REF OR

S1D_MDEA4 = REF OR S1D_MDEA5 = REF OR S1D_MDEA6 = REF OR S1D_MDEA7 = REF

OR S1D_MDEA8 = REF OR S1D_MDEA9 = REF, THEN S1DSMMDEA2 = REF

P_DP48

[IF S1D_MDEA9 = 1 OR S1DSMMDEA2 = 1] You mentioned having some of the problems I just asked you about.

During that [TIMEFILL] period of time, how much did your [FEELNOUN] and these other problems interfere with your work, your social life, or your personal relationships?

Question Type: Often Range 4

1 Not at all

2 A little

3 Some

4 A lot

5 Extremely

P_DP49

[IF P_DP48 NE BLANK ] In the past 12 months, did you have a period of time when you felt [FEELNOUN] for two weeks or longer while also having some of the other problems we asked about?

Question Type: TYESNOCAPS

P_DP50

At any time in the past 12 months, did you seriously think about trying to kill yourself?

Question Type: TYESNOCAPS

PD - Psychological Distress

---------------------------------------------------------------------------------

The next few questions ask how you have been feeling during the past 30 days.

P_PD1a

During the past 30 days, about how often did you feel nervous?

1 = All of the time

2 = Most of the time

3 = Some of the time

4 = A little of the time

5 = None of the time

P_PD1b

During the past 30 days, about how often did you feel hopeless?

1 = All of the time

2 = Most of the time

3 = Some of the time

4 = A little of the time

5 = None of the time

P_PD1c

During the past 30 days, about how often did you feel restless or fidgety?

1 = All of the time

2 = Most of the time

3 = Some of the time

4 = A little of the time

5 = None of the time

P_PD1d

During the past 30 days, about how often did you feel so sad or depressed that nothing could cheer you up?

1 = All of the time

2 = Most of the time

3 = Some of the time

4 = A little of the time

5 = None of the time

P_PD1e

During the past 30 days, about how often did you feel that everything was an effort?

1 = All of the time

2 = Most of the time

3 = Some of the time

4 = A little of the time

5 = None of the time

P_PD1f

During the past 30 days, how often did you feel down on yourself, no good or worthless?

1 = All of the time

2 = Most of the time

3 = Some of the time

4 = A little of the time

5 = None of the time

P_PD1g The last questions asked about how you have been feeling during the past

30 days. Now think about the past 12 months. Was there a month in the

past 12 months when you felt more depressed, anxious, or emotionally

stressed than you felt during the past 30 days?

1 Yes

2 No

PROGRAMMER: SHOW 12 MONTH CALENDAR

P_PD1h [IF P_MA1g=1] Think of one month in the past 12 months when you were the most depressed, anxious, or emotionally stressed.

During that month, how often did you feel nervous?

1 All of the time

2 Most of the time

3 Some of the time

4 A little of the time

5 None of the time

PROGRAMMER: SHOW 12 MONTH CALENDAR

P_PD1i [IF P_PD1g=1] During that same month when you were at your worst emotionally . . .how often did you feel hopeless?

1 All of the time

2 Most of the time

3 Some of the time

4 A little of the time

5 None of the time

P_PD1j [IF P_PD1g=1] During that same month when you were at your worst emotionally . . . how often did you feel restless or fidgety?

1 All of the time

2 Most of the time

3 Some of the time

4 A little of the time

5 None of the time

P_PD1k [IF P_PD1g=1] During that same month when you were at your worst emotionally . . . how often did you feel so sad or depressed that nothing could cheer you

up?

1 All of the time

2 Most of the time

3 Some of the time

4 A little of the time

5 None of the time

P_PD1l [IF P_PD1g=1] During that same month when you were at your worst emotionally . . . how often did you feel that everything was an effort?

1 All of the time

2 Most of the time

3 Some of the time

4 A little of the time

5 None of the time

P_PD1m [IF CHILD AGE = 18 OR OLDER AND P_PD1g=1] During that

same month when you were at your worst emotionally . . .

how often did you feel down on yourself, no good, or worthless?

1 All of the time

2 Most of the time

3 Some of the time

4 A little of the time

5 None of the time

DEFINE DISTRESS: IF P_PD1a = 1-4 OR P_PD1b = 1-4 OR P_PD1c= 1-4, OR P_PD1d = 1-4 OR P_PD1e= 1-4 OR P_PD1f = 1-4, OR P_PD1h = 1-4 OR P_PD1i = 1-4 OR P_PD1j = 1-4 OR P_PD1k = 1-4 OR P_PD1l = 1-4 OR P_PD1m = 1-4, THEN DISTRESS = 1 ELSE, DISTRESS = 2

HF – Mental Health and functioning

---------------------------------------------------------------------------------

ONLY ADMINISTER THIS MODULE IF DISTRESS=1

The next questions are about how much your emotions, nerves or mental health caused you to have difficulties in daily activities.

In answering, think of the one month in the past 12 months when your emotions, nerves or mental health interfered most with your daily activities.

P_HF2

[IF DISTRESS=1] During that one month when your emotions, nerves or mental health interfered most with your daily activities, how much difficulty did you have remembering to do things you needed to do?

Question Type: Difficulty Range

1 No difficulty

2 Mild difficulty

3 Moderate difficulty

4 Severe difficulty

P_HF3

[IF DISTRESS=1] During that one month when your emotions, nerves or mental health interfered most with your daily activities,

…how much difficulty did you have concentrating on doing something important when other things were going on around you?

Question Type: Difficulty Range

1 No difficulty

2 Mild difficulty

3 Moderate difficulty

4 Severe difficulty

P_HF4

[IF DISTRESS=1] During that one month when your emotions, nerves or mental health interfered most with your daily activities,

…how much difficulty did you have going out of the house and getting around on your own?

Question Type: Difficulty Range House

1 No difficulty

2 Mild difficulty

3 Moderate difficulty

4 Severe difficulty

5 You didn’t leave the house on your own

P_HF4a [IF P_HF4 = 5] Did problems with your emotions, nerves, or mental health keep you from leaving the house on your own?

1 Yes

2 No

DK/REF

P_HF5

[IF DISTRESS=1] During that one month when your emotions, nerves or mental health interfered most with your daily activities,

…how much difficulty did you have dealing with people you did not know well?

Question Type: Difficulty Range People

1 No difficulty

2 Mild difficulty

3 Moderate difficulty

4 Severe difficulty

5 You didn’t deal with people you did not know well

P_HF5a [IF P_HF5 = 5] Did problems with your emotions, nerves, or mental health keep you from dealing with people you did not know well?

1 Yes

2 No

DK/REF

P_HF6

[IF DISTRESS=1] During that one month when your emotions, nerves or mental health interfered most with your daily activities,

…how much difficulty did you have participating in social activities, like visiting friends or going to parties?

Question Type: Difficulty Range Social

1 No difficulty

2 Mild difficulty

3 Moderate difficulty

4 Severe difficulty

5 You didn’t participate in social activities

P_HF6a [IF P_HF6=5] Did problems with your emotions, nerves, or mental health keep you from participating in social activities?

1 Yes

2 No

DK/REF

P_HF7

[IF DISTRESS=1] During that one month when your emotions, nerves or mental health interfered most with your daily activities,

…how much difficulty did you have taking care of household responsibilities?

Question Type: Difficulty Range Household

1 No difficulty

2 Mild difficulty

3 Moderate difficulty

4 Severe difficulty

5 You didn’t take care of household responsibilities

P_HF7a [IF P_HF7=5] Did problems with your emotions, nerves, or mental health keep you from taking care of household responsibilities?

1 Yes

2 No

DK/REF

P_HF8

[IF DISTRESS=1] During that one month when your emotions, nerves or mental health interfered most with your daily activities,

…how much difficulty did you have taking care of your daily responsibilities at work or school?

Question Type: Difficulty Range Work

1 No difficulty

2 Mild difficulty

3 Moderate difficulty

4 Severe difficulty

5 You didn’t work or go to school {GO TO P_HFEND}

P_HF8a [IF P_HF8=5] Did problems with your emotions, nerves, or mental health keep you from working or going to school?

1 Yes

2 No

DK/REF

P_HF9

[IF DISTRESS=1] During that one month when your emotions, nerves or mental health interfered most with your daily activities,

…how much difficulty did you have getting your daily work or school work done as quickly as needed?

Question Type: Difficulty Range

1 No difficulty

2 Mild difficulty

3 Moderate difficulty

4 Severe difficulty

AD - ALCOHOL DEPENDENCE

---------------------------------------------------------------------------------

Logic before:

This section should be skipped in the following caregiver situations:

- Licensed Foster Home, Living with a Family Friend, or all non-family settings

(P_NP12a >= 3, 4, or 6) OR (P_NP12b .>= 1) OR

- Primary CG is a Foster Mother or Father

(P_HH6a = 8 or 9 OR P_HH6g = 8 or 9) OR

- Primary CG currently receives payments for being a foster parent

(P_HH6e = 1)

P_AD1a [ PAD1ax ] How often do you have a drink containing alcohol?

Now I'm going to ask you some questions about your use of alcoholic beverages during this past

year. By alcoholic beverages, we mean beer, wine, wine coolers, shots of liquor, or mixed drinks.

Question Type: TAlcFreq

Never 0 Never

Monthly 1 Monthly or less

TwoFourMn 2 2 to 4 times a month

TwoThreeWk 3 2 to 3 times a week

FourMoreWk 4 4 or more times a week

---------------------------------------------------------------------------------

P_AD2a [ PAD2ax ] # drinks you have on a typical day when you are drinking?

How many drinks containing alcohol do you have on a typical day when you are drinking?

Question Type: TNumDrks

onetwo 0 1 or 2

threefour 1 3 or 4

fivesix 2 5 or 6

seven_9 3 7, 8, or 9

tenmore 4 10 or more

---------------------------------------------------------------------------------

P_AD3a [ PAD3ax ] How often do you have six or more drinks on one occasion?

How often do you have six or more drinks on one occasion?

Question Type: THO5F

never 0 Never

lessmn 1 Less than monthly

monthly 2 Monthly

weekly 3 Weekly

daily 4 Daily or almost daily

---------------------------------------------------------------------------------

Logic before:

IF P_AD2a AND P_AD3a = 0, GOTO P_AD9a.

P_AD4a [ PAD4ax ] How often in lst yr were unable stop drinkng once u startd?

How often during the last year have you found that you were not able to stop drinking once you

had started?

Question Type: THO5F

never 0 Never

lessmn 1 Less than monthly

monthly 2 Monthly

weekly 3 Weekly

daily 4 Daily or almost daily

---------------------------------------------------------------------------------

P_AD5a [ PAD5ax ] How often in lst yr, failed what was expected due to drinkng

How often during the last year have you failed to do what was normally expected from you

because of drinking?

Question Type: THO5F

never 0 Never

lessmn 1 Less than monthly

monthly 2 Monthly

weekly 3 Weekly

daily 4 Daily or almost daily

---------------------------------------------------------------------------------

P_AD6a [ PAD6ax ] How often in lst yr, needed 1st drnk n mrnng aftr heavy drnk

How often during the last year have you needed a first drink in the morning to get yourself going

after a heavy drinking session?

Question Type: THO5F

never 0 Never

lessmn 1 Less than monthly

monthly 2 Monthly

weekly 3 Weekly

daily 4 Daily or almost daily

---------------------------------------------------------------------------------

P_AD7a [ PAD7ax ] How often in lst yr, felt guilt or remorse after drinking?

How often during the last year have you had a feeling of guilt or remorse after drinking?

Question Type: THO5F

never 0 Never

lessmn 1 Less than monthly

monthly 2 Monthly

weekly 3 Weekly

daily 4 Daily or almost daily

---------------------------------------------------------------------------------

P_AD8a [ PAD8ax ] How often in lst yr, unable to remember nght befre due to dr

How often during the last year have you been unable to remember what happened the night before

because you had been drinking?

Question Type: THO5F

never 0 Never

lessmn 1 Less than monthly

monthly 2 Monthly

weekly 3 Weekly

daily 4 Daily or almost daily

---------------------------------------------------------------------------------

P_AD9a [ PAD9a ] Have you or someone else been injured cause of your drinking

Have you or someone else been injured as a result of your drinking?

Question Type: TNYY

no 0 No

yesmoryr 2 Yes, but not in the last year

yesduryr 4 Yes, during the last year

---------------------------------------------------------------------------------

P_AD10a [ PAD10a ] Has rel/frnd/Dr/healthworker been concrnd/asked u to cut dwn

Has a relative or friend or a doctor or another health worker been concerned about your drinking or

suggested you cut down?

Question Type: TNYY

no 0 No

yesmoryr 2 Yes, but not in the last year

yesduryr 4 Yes, during the last year

---------------------------------------------------------------------------------

P_ADEND [ PADEND ] NoDeliv

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

DD - DRUG DEPENDENCE

---------------------------------------------------------------------------------

Logic before:

This section should be skipped in the following caregiver situations:

- Licensed Foster Home, Living with a Family Friend, or all non-family settings

(P_NP12a >= 3, 4, or 6) OR (P_NP12b .>= 1) OR

- Primary CG is a Foster Mother or Father

(P_HH6a = 8 or 9 OR P_HH6g = 8 or 9) OR

- Primary CG currently receives payments for being a foster parent

(P_HH6e = 1)

P_DD1a [ PDD1a ] Pst 12M, used drgs other than those required for med reasons

The following questions ask about your potential involvement with drugs, not including alcoholic

beverages, during the last 12 months. The term "drug abuse" refers to the use of prescribed or

over-the-counter drugs in excess of the directions and/or any non-medical use of drugs.

During the past 12 months, have you used drugs other than those required for medical reasons?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD2a [ PDD2a ] Pst 12M, have you abused prescription drugs?

During the past 12 months, have you abused prescription drugs?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD3a [ PDD3ax ] Pst 12M, have you abused more than one drug at a time?

During the past 12 months, have you abused more than one drug at a time?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD4a [ PDD4ax ] Pst 12M, could you get through the week without using drugs?

During the past 12 months, could you get through the week without using drugs?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD5a [ PDD5ax ] Pst 12M, always been able to stop using drugs when u wanted?

During the past 12 months, have you always been able to stop using drugs when you wanted to?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD6a [ PDD6ax ] Pst 12M, have u had blackouts or flashbacks due to drug use?

During the past 12 months, have you had blackouts or flashbacks as a result of drug use?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD7a [ PDD7ax ] Pst 12M, have u ever felt bad or guilty about your drug use?

During the past 12 months, have you ever felt bad or guilty about your drug use?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD8a [ PDD8ax ] Pst 12M, have spouse(or parents) complained about drug use?

During the past 12 months, has your spouse (or parents) ever complained about your involvement

with drugs?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD9a [ PDD9ax ] Pst 12M, drg abuse created probs between u & spouse/parents?

During the past 12 months, has drug abuse created problems between you and your spouse or

your parents?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD10a [ PDD10a ] Past 12m has R lost friends because of drg use

During the past 12 months, have you lost friends because of your use of drugs?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD11a [ PDD11a ] Past 12m has R neglctd family because of drg use

During the past 12 months, have you neglected your family because of your use of drugs?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD12a [ PDD12a ] Past 12m has R been in trouble at work because of drg use

During the past 12 months, have you been in trouble at work because of drug abuse?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD13a [ PDD13a ] Past 12m has R lost a job because of drug use

During the past 12 months, have you lost a job because of drug abuse?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD14a [ PDD14a ] Past 12m has R gotten into fghts whn undr inflnce of drgs

During the past 12 months, have you gotten into fights when under the influence of drugs?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD15a [ PDD15a ] Past 12m has R engaged in illegal actvtes to obtain drgs

During the past 12 months, have you engaged in illegal activities in order to obtain drugs?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD16a [ PDD16a ] Past 12m has R been arrested for possession of ilgl drgs

During the past 12 months, have you been arrested for possession of illegal drugs?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD17a [ PDD17a ] Past 12m has R exprncd wthdrwl symptoms when stpd tkng drgs

During the past 12 months, have you ever experienced withdrawal symptoms (felt sick) when you

stopped taking drugs?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD18a [ PDD18a ] Past 12m has R had medical problems as result of drug use

During the past 12 months, have you had medical problems as a result of your drug use (such as

memory loss, hepatitis, convulsions, bleeding, etc)?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD19a [ PDD19a ] Past 12m has R gone to anyone for help for drug prblm

During the past 12 months, have you gone to anyone for help for a drug problem?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD20a [ PDD20a ] Past 12m has R been invlvd in yreatment prgm rltd to drg use

During the past 12 months, have you been involved in a treatment program specifically related to

drug use?

Question Type: TYN

yes 1 YES

no 2 NO

Now I’d like to ask you about smoking cigarettes.

P_DD21a

Have you smoked at least 100 cigarettes in your entire life?

1=Yes

2=No

ASK P_DD22a IF P_DD21a = 1.

P_DD22a

Do you now smoke cigarettes every day, some days, or not at all?

1=Everyday

2=Some days

3=Not at all

IL - INVOLVEMENT WITH THE LAW

---------------------------------------------------------------------------------

Logic before:

This section should be skipped in the following caregiver situations:

- Licensed Foster Home, Living with a Family Friend, or all non-family settings

(P_NP12a >= 3, 4, or 6) OR (P_NP12b .>= 1) OR

- Primary CG is a Foster Mother or Father

(P_HH6a = 8 or 9 OR P_HH6g = 8 or 9) OR

- Primary CG currently receives payments for being a foster parent

(P_HH6e = 1)

P_IL1a [ PIL1a ] Ever been arrested for any offense

The next questions are about your involvement with the law.

Have you @bever@b been arrested for any offense?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF IL_1A = NO THEN GO TO P_ILEND

---------------------------------------------------------------------------------

P_IL2n [ PIL2a ] # of times arrested

How many times have you been arrested?

NUMBER

Question Type: 0..10

---------------------------------------------------------------------------------

Logic before:

COLLECT ARREST INFORMATION ON UP TO 10 ARRESTS - DO NOT LOOP BY COUNT

PROVIDED. ASK AN "ARE THERE MORE ARRESTS" AND TERMINATE LOOP EARLY WHEN

THE RESPONSE IS NO.

P_IL_ARREST Questions P_IL3Y - P_IL8a

Question Type: ARRAY[1..10] OF BP_IL_ARREST

---------------------------------------------------------------------------------

Logic before:

FILL " ?, the second time?,"the third", etc.. BASED ON RESPONSE IN P_IL2 FILL ONLY

QUESTION MARK FOR 1 ARREST

P_IL3y [ PIL3y ] Labels are in Logic After

In what year were you arrested^fills.ordinal1_10

Question Type: 1930..2013

Question Fill: ^fillordinal1_10

first the @bfirst@b time?

second the @bsecond@b time?

third the @bthird@b time?

fourth the @bfourth@b time?

fifth the @bfifth@b time?

sixth the @bsixth@b time?

seventh the @bseventh@b time?

eighth the @beighth@b time?

ninth the @bninth@b time?

tenth the @btenth@b time?

qmark ?

Logic after:

PIL31a--Y 1st arrest; PIL32a--Y 2nd arrest; PIL33a--Y 3rd arrest; PIL34a--Y 4th arrest; PIL35a--Y

5th arrest; PIL36a--Y 6th arrest; PIL37a--Y 7th arrest; PIL38a--Y 8th arrest; PIL39a--Y 9th arrest;

PIL310a--Y 10th arrest

---------------------------------------------------------------------------------

Logic before:

FILL "?, the second time?,"the third", etc.. BASED ON RESPONSE IN P_IL2 FILL ONLY

QUESTION MARK FOR 1 ARREST.

P_IL4m [ PIL4m ] Labels are in Logic After

In what month in ^P_IL3y were you arrested^fills.ordinal1_10

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

Question Fill: ^fillordinal1_10

first the @bfirst@b time?

second the @bsecond@b time?

third the @bthird@b time?

fourth the @bfourth@b time?

fifth the @bfifth@b time?

sixth the @bsixth@b time?

seventh the @bseventh@b time?

eighth the @beighth@b time?

ninth the @bninth@b time?

tenth the @btenth@b time?

qmark ?

Logic after:

Check: "MONTH AND YEAR ENTERED CANNOT BE EARLIER THAN RESPONDENT'S MONTH

AND YEAR OF BIRTH."; PIL41a--M 1st arrest; PIL42a--M 2nd arrest; PIL43a--M 3rd arrest; PIL44a-

-M 4th arrest; PIL45a--M 5th arrest; PIL46a--M 6th arrest; PIL47a--M 7th arrest; PIL48a--M 8th

arrest; PIL49a--M 9th arrest; PIL410a--M 10th arrest

---------------------------------------------------------------------------------

Logic before:

FILL " ", "second", etc. BASED ON RESPONSE TO P_IL2 BLANK IF P_IL2 = 1 No fill for the first

arrest.

P_IL5a [ PIL5a ] Labels are in Logic After

Thinking about your^fills.ordinal arrest, were you convicted?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^fillordinal

first first

second second

third third

fourth fourth

fifth fifth

sixth sixth

seventh seventh

eighth eighth

ninth ninth

tenth tenth

blank

qmark ?

Logic after:

IF = 2, REPEAT LOOP FOR NEXT ARREST; PIL51a--R convicted for 1st arrest; PIL52a--R

convicted for 2nd arrest; PIL53a--R convicted for 3rd arrest; PIL54a--R convicted for 4th arrest;

PIL55a--R convicted for 5th arrest; PIL56a--R convicted for 6th arrest; PIL57a--R convicted for 7th

arrest; PIL58a--R convicted for 8th arrest; PIL59a--R convicted for 9th arrest; PIL510a--R convicted

---------------------------------------------------------------------------------

P_IL6a [ PIL6a ] Labels are in Logic After

Were you placed on probation?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 2, REPEAT LOOP FOR NEXT ARREST; PIL61a--R placed on probation for 1st arrest; PIL62a--

Placed on probation for 2nd arrest; PIL63a--Placed on probation for 3rd arrest; PIL64a--Placed on

probation for 4th arrest; PIL65a--Placed on probation for 5th arrest; PIL66a--Placed on probation for

6th arrest; PIL67a--Placed on probation for 7th arrest; PIL68a--Placed on probation or 8th arrest;

PIL69a--Placed on probation for 9th arrest; PIL610a--Placed on probation for 10th arrest

---------------------------------------------------------------------------------

Logic before:

FILL " ", "second", etc. BASED ON RESPONSE TO P_IL2 BLANK IF P_IL2 = 1 No fill for the first

arrest.

P_IL7a [ PIL7a ] Labels are in Logic After

Did you spend time in prison as a result of that^fills.ordinal arrest?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^fillordinal

first first

second second

third third

fourth fourth

fifth fifth

sixth sixth

seventh seventh

eighth eighth

ninth ninth

tenth tenth

blank

qmark ?

Logic after:

PIL71a--Time in prison as result of 1st arrest; PIL72a--Time in prison as result of 2nd arrest;

PIL73a--Time in prison as result of 3rd arrest; PIL74a--Time in prison as result of 4th arrest; PIL75a-

-Time in prison as result of 5th arrest; PIL76a--Time in prison as result of 6th arrest; PIL77a--Time

in prison as result of 7th arrest; PIL78a--Time in prison as result of 8th arrest; PIL79a--Time in

prison as result of 9th arrest; PIL710a--Time in prison as result of 10th arrest

---------------------------------------------------------------------------------

Logic before:

IF P_IL7A = YES THEN ASK P_IL8A ELSE REPEAT P_IL3y TO P_IL8a FOR EACH ARREST

BASED ON ANSWER TO P_IL2n

P_IL8a [ PIL8a ] Labels are in Logic After

How long were you in prison?

Question Type: THowLong

Less_1 1 Less than 1 month

_1to3 2 1 to 3 months

_4_6 3 4 to 6 months

_7_1yr 4 7 months to 1 year

More_1 5 More than 1 year

Logic after:

REPEAT P_IL3y TO P_IL8a FOR EACH ARREST BASED ON ANSWER TO P_IL2n; PIL81a--

Length of time in prison for 1st arrest; PIL82a--Length of time in prison for 2nd arrest; PIL83a--

Length of time in prison for 3rd arrest; PIL84a--Length of time in prison for 4th arrest; PIL85a--

Length of time in prison for 5th arrest; PIL86a--Length of time in prison for 6th arrest; PIL87a--

Length of time in prison for 7th arrest; PIL88a--Length of time in prison for 8th arrest; PIL89a--

Length of time in prison for 9th arrest; PIL810a--Length of time in prison for 10th arrest

---------------------------------------------------------------------------------

P_IL_More [ PILMore ] Labels are in Logic After

Were there more arrests?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

if response = yes set ILEXIT flag so this submodule will not be invoked again; PILMore_1 --Were

there more arrests? 1; PILMore_2 --Were there more arrests? 2; PILMore_3 --Were there more

arrests? 3; PILMore_4 --Were there more arrests? 4; PILMore_5 --Were there more arrests? 5;

PILMore_6 --Were there more arrests? 6; PILMore_7 --Were there more arrests? 7; PILMore_8 --

Were there more arrests? 8; PILMore_9 --Were there more arrests? 9; PILMore_10 --Were there

---------------------------------------------------------------------------------

P_ILEND [ PILEND ] NoDeliv

PRESS "1" AND ENTER TO CONTINUE

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

DS - DISCIPLINE & CHILD MALTREATMENT

---------------------------------------------------------------------------------

Logic before:

ONLY ADMINISTER THIS MODULE IF P_NP12 = 1 OR 2 (BIRTH OR ADOPTIVE PARENTS).

P_DS1a [ PDS1a ] #Xs exp to ch why something was wrong-past 12m

Children sometimes do things that are wrong, disobey, or make their parents angry. For the next

set of questions, we would like to know what you have done when your child @b^child@b did

something wrong or made you upset or angry.

^Fills.P_DS1a

For each question pick an answer that says how many times this has happened in the past @b12

months@b. If it hasn't happened in the past @b12 months@b, but it did happen before that, pick

the answer "not in the past @b12 months@b, but it happened before." If it has never happened,

pick the answer "this has never happened".

In the past @b12 months@b, how many times have you explained to your child @b^child@b why

something was wrong?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

Question Fill: ^FillP_DS1a

OREGON @/Please note that if I learn that your child’s life or health is in danger, I

have to tell someone whose job it is to see that your child is safe and

protected.@/

---------------------------------------------------------------------------------

P_DS2a [ PDS2a ] Put ch in time-out/sent to room-past 12m

In the past @b12 months@b, how many times have you put your child @b^child@b in "time out"

or sent your child @b^child@b to ^fills.hisher room?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

Question Fill: ^fillhimher

him him

her her

---------------------------------------------------------------------------------

P_DS3a [ PDS3a ] Shaken ch-past 12m

In the past @b12 months@b, how many times have you shaken your child @b^child@b?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS4a [ PDS4a ] Hit on bottom w/hard object-past 12m

In the past @b12 months@b, how many times have you hit your child @b^child@b on the bottom

with something like a belt, hairbrush, a stick or some other hard object?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS5a [ PDS5a ] Redirect ch-past 12m

In the past @b12 months@b, how many times have you given your child @b^child@b something

else to do instead of what ^fills.heshe was doing wrong?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

Question Fill: ^fillheshe

he he

she she

---------------------------------------------------------------------------------

P_DS6a [ PDS6a ] Shouted/yelled/screamed at ch-past 12m

In the past @b12 months@b, how many times have you shouted, yelled, or screamed at your

child @b^child@b?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS7a [ PDS7a ] Hit ch w/fist/kicked hard-past 12m

In the past @b12 months@b, how many times have you hit your child @b^child@b with a fist or

kicked ^fills.himher hard?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

Question Fill: ^fillhimher

him him

her her

---------------------------------------------------------------------------------

P_DS8a [ PDS8a ] Spanked on bottomw w/bare hand-past 12m

In the past @b12 months@b, how many times have you spanked your child @b^child@b on the

bottom with your bare hand?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS9a [ PDS9a ] Grabbed ch around neck and choked-past 12m

In the past @b12 months@b, how many times have you grabbed your child @b^child@b around

the neck and choked ^fills.himher?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

Question Fill: ^fillhimher

him him

her her

Logic after:

if p_ds9a = 7 or 8 or DK or REF GOTO P_DS10a

---------------------------------------------------------------------------------

P_DS9aa [ PDS9aa ] Report grabbed ch around neck and choked-past 12m

Was this reported?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_DS9aa = 1 GOTO P_DS10a

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 2 GOTO P_DS9ca

P_DS9ba [ PDS9ba ] Grabbed ch around neck and choked occur snce close of invest

Did this happen since ^strInvedate, that is, since the close of the investigation?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DS9ca [ PDS9ca ] Grabbed ch around neck and choked happened in past week

Did this happen in the past week?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_DS9ca = 1 GOTO P_DS10a

---------------------------------------------------------------------------------

P_DS9da [ PDS9da ] Grabbed ch around neck and choked happened in past month

Did this happen in the past month?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_DS9da = 1 GOTO P_DS10a

---------------------------------------------------------------------------------

P_DS9ea [ PDS9ea ] Grabbed ch around neck and choked happened in last 3 months

Did this happen in the last 3 months?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_DS9ea = 1 GOTO P_DS10a

---------------------------------------------------------------------------------

P_DS10a [ PDS10a ] Sworn/cursed at ch-past 12m

In the past @b12 months@b, how many times have you sworn or cursed at your child

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS11a [ PDS11a ] Beat ch/hit hard over and over-past 12m

In the past @b12 months@b, how many times have you beat your child @b^child@b up by hitting

^fills.himher over and over as hard as you could?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

Question Fill: ^fillhimher

him him

her her

Logic after:

IF P_DS11a = 7 or P_DS11a = 8 or DK or REF then GOTO P_DS12a

---------------------------------------------------------------------------------

P_DS11aa [ PDS11aa ] Report beat ch/hit hard over and over-past 12m

Was this reported?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_DS11aa = 1 GOTO P_DS12a

---------------------------------------------------------------------------------

Logic before:

IF WAVE 2, GOTO P_DS11ca.

P_DS11ba [ PDS11ba ] Beat ch/hit hard over and over occur snce close of invest

Did this happen since ^strInvedate, that is, since the close of the investigation?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DS11ca [ PDS11ca ] Beat ch/hit hard over and over happened in past week

Did this happen in the past week?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_DS11ca = 1 GOTO P_DS12a

---------------------------------------------------------------------------------

P_DS11da [ PDS11da ] Beat ch/hit hard over and over happened in past month

Did this happen in the past month?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_DS11da = 1 GOTO P_DS12a

---------------------------------------------------------------------------------

P_DS11ea [ PDS11ea ] Beat ch/hit hard over and over happened in last 3 months

Did this happen in the last 3 months?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_DS11ea = 1 GOTO P_DS12a

---------------------------------------------------------------------------------

P_DS12a [ PDS12a ] Said ch will be sent away/kckd out-past 12m

In the past @b12 months@b, how many times have you said your child @b^child@b would be

sent away or kicked out of the house?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS13a [ PDS13a ] Burned/scalded ch on purpose-past 12m

In the past @b12 months@b, how many times have you burned or scalded your child

@b^child@b on purpose?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

Logic after:

IF P_DS13a = 7 or P_DS13a = 8 then GOTO P_DS14a

---------------------------------------------------------------------------------

P_DS13aa [ PDS13aa ] Report urned/scalded ch on purpose-past 12m

Was this reported?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_DS13aa = 1 GOTO P_DS14a

---------------------------------------------------------------------------------

Logic before:

IF WAVE 2, GOTO P_DS13ca.

P_DS13ba [ PDS13ba ] Burned/scalded ch on purpose occur snce close of invest

Did this happen since ^strInvedate, that is, since the close of the investigation?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DS13ca [ PDS13ca ] Burned/scalded ch on purpose happened in past week

Did this happen in the past week?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_DS13ca = 1 GOTO P_DS14a

---------------------------------------------------------------------------------

P_DS13da [ PDS13da ] Burned/scalded ch on purpose happened in past month

Did this happen in the past month?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_DS13da = 1 GOTO P_DS14a

---------------------------------------------------------------------------------

P_DS13ea [ PDS13ea ] Burned/scalded ch on purpose happened in last 3 months

Did this happen in the last 3 months?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_DS13ea = 1 GOTO P_DS14a

---------------------------------------------------------------------------------

P_DS14a [ PDS14a ] Threaten to hit but not do it-past 12m

In the past @b12 months@b, how many times have you threatened to spank or hit your child

@b^child@b but did not actually do it?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS15a [ PDS15a ] Hit on other part of body w/hard obj-past 12m

In the past @b12 months@b, how many times have you hit your child @b^child@b on some other

part of the body besides the bottom with something like a belt, hairbrush, a stick or some other

hard object?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS16a [ PDS16a ] Slapped ch on hand/arm/leg-past 12m

In the past @b12 months@b, how many times have you slapped your child @b^child@b on the

hand, arm, or leg?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS17a [ PDS17a ] Taken away priveleges/grounded-past 12m

In the past @b12 months@b, how many times have you taken away privileges or grounded your

child @b^child@b?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS18a [ PDS18a ] Pinched ch-past 12m

In the past @b12 months@b, how many times have you pinched your child @b^child@b?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS19a [ PDS19a ] Threatened ch w/knife or gun-past 12m

In the past @b12 months@b, how many times have you threatened your child @b^child@b with a

knife or gun?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS20a [ PDS20a ] Thrown/knocked ch down-past 12m

In the past @b12 months@b, how many times have you thrown or knocked your child

@b^child@b down?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS21a [ PDS21a ] Called ch dumb/lazy/oth name-past 12m

In the past @b12 months@b, how many times have you called your child @b^child@b dumb or

lazy or some other name like that?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS22a [ PDS22a ] Slapped ch on face/head/ears-past 12m

In the past @b12 months@b, how many times have you slapped your child @b^child@b on the

face or head or ears?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS23 [ PDS23 ] NO LABEL

Sometimes things can get in the way of caring for your child the way you would like to: for

example, money problems, personal problems, or having a lot to do. For the next set of items,

please tell me how many times in the past @b12 months@b this has happened to you in trying to

care for your child.

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

P_DS24a [ PDS24a ] Leave ch home alone when shouldnt-past 12m

In the past @b12 months@b, how many times have you ever had to leave your child @b^child@b

home alone, even when you thought some adult should be with ^fills.himher?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

Question Fill: ^fillhimher

him him

her her

---------------------------------------------------------------------------------

P_DS25a [ PDS25a ] Not show/tell ch love him/her-past 12m

In the past @b12 months@b, how many times were you so caught up with problems that you

were not able to show or tell your child @b^child@b that you loved ^fills.himher?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

Question Fill: ^fillhimher

him him

her her

---------------------------------------------------------------------------------

P_DS26a [ PDS26a ] Unable to ensure ch get food needed-past 12m

In the past @b12 months@b, how many times were you not able to make sure that your child

@b^child@b got the food ^fills.heshe needed?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

Question Fill: ^fillheshe

he he

she she

---------------------------------------------------------------------------------

P_DS27a [ PDS27a ] Unable to get ch to doc as needed-past 12m

In the past @b12 months@b, how many times were you unable to make sure your child

@b^child@b got to a doctor or hospital when ^fills.heshe needed it?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

Question Fill: ^fillheshe

he he

she she

---------------------------------------------------------------------------------

P_DS28a [ PDS28a ] Couldnt take care of CH b/c drnk/hgh-past 12m

In the past @b12 months@b, how many times were you so drunk or high that you had a problem

taking care of your child @b^child@b?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS29a [ PDS29a ] Forced sexual contact-past 12m

In the past @b12 months@b, has your child ^child been touched in a sexual way by an adult or

older child when ^fills.heshe did not want to be touched that way? Or has ^fills.heshe been forced

to touch an adult or older child in a sexual way -- including anyone who was a member of your

family, or anyone outside the family?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^fillheshe

he he

she she

Logic after:

If p_ds29a = 2 GOTO P_DS31a

---------------------------------------------------------------------------------

P_DS29aa [ PDS29aa ] Forced sexual contact occur w/a persn resp for CH

Was the person responsible for taking care of the child when the incident occurred?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DS29ba [ PDS29ba ] Forced sexual contact reported

Was this reported?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

Logic before:

IF P_DS29a = 1

P_DS30a [ PDS30a ] Forced sexual contact happen >once in past 12M

Has it happened more than once in the past @b12 months@b?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DS30aa [ PDS30aa ] Forced sexual contact happened in past week

Did this happen in the past week?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_DS30aa = 1 GOTO P_DS32a

---------------------------------------------------------------------------------

P_DS30ca [ PDS30ca ] Forced sexual contact happened in past month

Did this happen in the past month?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_DS30ca = 1 THEN GOTO P_DS32A

---------------------------------------------------------------------------------

P_DS30da [ PDS30da ] Forced sexual contact happened in last 3 months

Did this happen in the last 3 months?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

if p_ds30da = 1 GOTO P_DS32a

If p_ds30da = 2 GOTO P_DS32a

---------------------------------------------------------------------------------

Logic before:

IF P_DS29a = 2, DK, RF

P_DS31a [ PDS31a ] Forced sexual contact ever happened

Has it @bever@b happened?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DS32a [ PDS32a ] Forced sex by adult/older ch-past 12m

In the past @b12 months@b, has your child @b^child@b been forced to have sex by an adult or

an older child -- including anyone who was a member of the family?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

If p_ds32a = 2 GOTO P_DS34a

---------------------------------------------------------------------------------

P_DS32aa [ PDS32aa ] Forced sex by adult/older ch occur w/a persn resp for CH

Was the person responsible for taking care of the child when the incident occurred?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DS32ba [ PDS32ba ] Forced sex by adult/older ch reported

Was this reported?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DS32ca [ PDS32ca ] Forced sex by adult/older ch happened in past week

Did this happen in the past week?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

If p_ds32ca = 1 GOTO P_DS34a

---------------------------------------------------------------------------------

P_DS32da [ PDS32da ] Forced sex by adult/older ch happened in past month

Did this happen in the past month?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

If p_ds32da = 1 GOTO P_DS34a

---------------------------------------------------------------------------------

P_DS32ea [ PDS32ea ] Forced sex by adult/older ch happened in last 3 months

Did this happen in the last 3 months?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_DS32da = 1 GOTO P_DS34a

---------------------------------------------------------------------------------

Logic before:

IF DS32a = 1

P_DS33a [ PDS33a ] Forced sex by adult/older ch happen >once in past 12M

Has it happened more than once in the past @b12 months@b?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

if p_ds33a = 1 GOTO P_DSEND

if p_ds33a = 2 GOTO P_DSEND

---------------------------------------------------------------------------------

Logic before:

IF P_DS32a = 2, DK, RE

P_DS34a [ PDS34a ] Forced sex by adult/older ch ever happened

Has it @bever@b happened?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DSEND [ PDSEND ] NoDeliv

PRESS "1" AND ENTER TO CONTINUE

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

DV - DOMESTIC VIOLENCE

---------------------------------------------------------------------------------

Logic before:

This section should be skipped in the following caregiver situations:

The caregiver is male AND

- Licensed Foster Home, Living with a Family Friend, or all non-family settings

(P_NP12a >= 3, 4, or 6) OR (P_NP12b .>= 1) OR

- Primary CG is a Foster Mother or Father

(P_HH6a = 8 or 9 OR P_HH6g = 8 or 9) OR

- Primary CG currently receives payments for being a foster parent

(P_HH6e = 1)

For OREGON CASES: goto END of section IF Respondent < 19

P_DV1a [ PDV1ax ] Partner thrown something at R-past 12m

No matter how well a couple gets along, there are times when they disagree, get annoyed with

the other person, want different things from each other, or just have spats or fights because they

are in a bad mood, are tired, or for some other reason. Couples also have many different ways of

trying to settle their differences. I am going to ask you about things that might happen when you

have differences.

For each question pick an answer that says how many times a partner of yours did them in the

past @b12 months@b. If a partner of yours did not do one of these things in the past @b12

months@b, but it happened before that, please pick the answer "Not in the past @b12

months@b, but it happened before". If it has never happened, pick the answer "This has never

happened".

In the past @b12 months@b, how many times has a partner of yours thrown something at you

that could hurt?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DV2a [ PDV2ax ] Partner pushed/grabbed/shoved R-past 12m

In the past @b12 months@b, how many times has a partner of yours pushed or shoved you?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DV3a [ PDV3a ] Partner slapped R-past 12m

In the past @b12 months@b, how many times has a partner of yours slapped you?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DV4a [ PDV4ax ] Partner kicked R-past 12m

In the past @b12 months@b, how many times has a partner of yours kicked you?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DV5a [ PDV5ax ] Partner hit/tried to hit R w/something-past 12m

In the past @b12 months@b, how many times has a partner of yours punched or hit you with

something that could hurt?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DV6a [ PDV6a ] Partner beat up R-past 12m

In the past @b12 months@b, how many times has a partner of yours beat you up?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DV7a [ PDV7a ] Partner choked R-past 12m

In the past @b12 months@b, how many times has a partner of yours choked you?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DV8a [ PDV8a ] Partner threatened R w/knife or gun-past 12m

In the past @b12 months@b, how many times has a partner of yours threatened you with a knife

or gun?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DV9a [ PDV9a ] Partner used knife/gun on R-past 12m

In the past @b12 months@b, how many times has a partner of yours used a knife or fired a gun

on you?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DV16A [ PDV16A ] Partner twisted your arm-past 12m

In the past @b12 months@b, how many times has a partner of yours twisted your arm or hair?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DV17A [ PDV17A ] Partner slammed you against a wall-past 12m

In the past @b12 months@b, how many times has a partner of yours slammed you against a wall?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DV18A [ PDV18A ] Partner burned/scaled you on purpose-past 12m

In the past @b12 months@b, how many times has a partner of yours burned or scalded you on

purpose?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DV19A [ PDV19A ] Partner grabbed you-past 12m

In the past @b12 months@b, how many times has a partner of yours grabbed you?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DV10a [ PDV10a ] R refrd to domest violence srvcs

The following questions will ask about services you may have received in the last 12 months. In

the last 12 months, have you been referred to domestic violence services, like a battered women's

shelter or a program to help you deal with an abusive partner?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DV11a [ PDV11a ] Stayd in/used domest violence srvcs

In the last 12 months, have you stayed in a battered women's shelter or received any other

domestic violence services to help you deal with an abusive partner?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

If P_DV11a = 2 then GOTO P_DV13a

---------------------------------------------------------------------------------

P_DV12a [ PDV12a ] How hlpfl were domest viol srvcs

How helpful were these services? Would you say...

Question Type: THowpful

Very 1 very helpful,

somewhat 2 somewhat helpful, or

notatall 3 not at all helpful?

Logic after:

GOTO P_DV15a

---------------------------------------------------------------------------------

P_DV13a [ PDV13a ] How much needed domestic viol srvcs

In the last 12 months, how much have you needed domestic violence services or help to deal with

an abusive partner? Would you say...

Question Type: THMNeed

alot 1 a lot,

somewhat 2 somewhat,

alittle 3 a little, or

notatall 4 not at all?

Logic after:

IF P_DV13a = 4 THEN GOTO P_DV15a

---------------------------------------------------------------------------------

P_DV14a [ PDV14a ] NO LABEL

You answered that you have needed domestic violence services or help in the last 12 months but

did not receive it. The next questions list out reasons why you may not have received this

service. Please answer yes or no to each item to indicate if this was a reason for your @bnot@b

receiving domestic violence services or help in the last 12 months.

Please press "1" and ENTER to continue.

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

P_DV14aa [ PDV14aa ] Domestic viol srvcs NA in the area

Why did you not receive domestic violence services or help? Was it because the service was not

available in the area?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DV14ba [ PDV14ba ] Domestic viol srvcs wait-listed

Were you wait-listed for the domestic violence services?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DV14ca [ PDV14ca ] Ineligible for Domestic viol srvcs

Were you ineligible for the domestic violence services?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DV14da [ PDV14da ] Domestic viol srvcs could not be financed

Was it because the domestic violence services could not be financed or paid for?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DV14ea [ PDV14ea ] Domestic viol srvcs not rcvd-prblm fndng ch care/scheduling

Still thinking about the reasons why you did not receive domestic violence services or help in the

last 12 months. Was it because of a scheduling problem or a problem with finding child care?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DV14fa [ PDV14fa ] Domestic viol srvcs not rcvd-transportation problem

Was it because of a transportation problem?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DV14ga [ PDV14ga ] Domestic viol srvcs not rcvd-some other reason

Was it because of some other reason?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DV15 [ PDV15 ] NO LABEL

Please tell the interviewer you are done.

Question Type: TCont

Continue 1 Continue

Logic after:

P_DVEND

SF - SATISFACTION WITH CASEWORKER

---------------------------------------------------------------------------------

Logic before:

This section should be skipped in the following caregiver situations:

- Licensed Foster Home, Living with a Family Friend, or all non-family settings

(P_NP12a >= 3, 4, or 6) OR (P_NP12b .>= 1) OR

- Primary CG is a Foster Mother or Father

(P_HH6a = 8 or 9 OR P_HH6g = 8 or 9) OR

- Primary CG currently receives payments for being a foster parent

(P_HH6e = 1)

WAVE = 1: IF CONTACT DATE IS NOT

AVAILABLE, FILL DATE OF REPORT WHERE APPLICABLE. WAVE = 2: IF DATE OF LAST

INTERVIEW IS NOT AVAILABLE (BECAUSE NO PRIOR INTERVIEWS WERE COMPLETED),

FILL CONTACT DATE WHERE APPLICABLE.

P_SF1a [ PSF1a ] Has R talked to CW

Now I would like to ask some questions about the experiences that you've had with caseworkers

from the child welfare agency. Since ^strLastDate, have you talked with a caseworker?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

if SF1A = 2 = NO GOTO P_SFEND

---------------------------------------------------------------------------------

P_SF2n [ PSF2a ] # Ds/Ws/Ms since last talked to CW - #

How long ago did you last talk with a caseworker?

NUMBER:

Question Type: 0..97

---------------------------------------------------------------------------------

P_SF2a [ PSF2u ] # Ds/Ws/Ms since last talked to CW - d/w/m

(Is that the number of days, weeks, or months?)

Question Type: TDWM

days 1 DAYS

weeks 2 WEEKS

months 3 MONTHS

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, FILL: Since (fill CONTACT DATE)/IF WAVE = 2, FILL: Since (DATE OF LAST

INTERVIEW)

P_SF3n [ PSF3a ] # diff CWs met/talked to

Since ^strLastDate, how many different caseworkers from the child welfare agency have you met

or talked with?

NUMBER OF CASEWORKERS:

Question Type: 0..97

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, FILL: Since (fill CONTACT DATE)/IF WAVE = 2, FILL: Since (DATE OF LAST

INTERVIEW)

P_SF4a [ PSF4a ] CW/agency met w/R re:need/concerns

Since ^strLastDate, has your caseworker or someone else from the child welfare agency met with

you and your family to talk about how best to deal with your family's needs, concerns, and/or

problems? This meeting would have included getting your family's thoughts about a plan of action

to deal with your needs and concerns.

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, FILL: Since (fill CONTACT DATE)/IF WAVE = 2, FILL: Since (DATE OF LAST

INTERVIEW) IF P_SF3n>1, FILL: caseworkers else fill caseworker

P_SF5a [ PSF5a ] CW listened to Rs concerns

In all your meetings or talks since ^strLastDate do you feel the ^fills.P_SF5A listened to your

concerns...

Question Type: TFreq3F

never 1 never,

notv 2 not very often,

some 3 some of the time, or

all 4 all of the time?

Question Fill: ^FillP_SF5A

CWRKR caseworker

CWRKRS caseworkers

---------------------------------------------------------------------------------

P_SF7a [ PSF7a ] CW treated R w/respect

Do you feel the ^fills.P_SF5A treated you with respect...

Question Type: TFreq3F

never 1 never,

notv 2 not very often,

some 3 some of the time, or

all 4 all of the time?

Question Fill: ^FillP_SF5A

CWRKR caseworker

CWRKRS caseworkers

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, FILL: Since (fill CONTACT DATE)/IF WAVE = 2, FILL: Since (DATE OF LAST

INTERVIEW) IF SF3n = 1, FILL: has the caseworker/IF SF3>1, FILL: have the caseworkers

P_SF9a [ PSF9a ] How well CW exp prob/trnmnt/svcs

Since ^strLastDate how well^fills.havehaslc the ^fills.P_SF5A explained problems, treatments,

and/or services to you? Would you say...

Question Type: THowWell

_not 1 not well,

some 2 somewhat well, or

very 3 very well?

Question Fill: ^FillP_SF5A

CWRKR caseworker

CWRKRS caseworkers

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, FILL: (fill CONTACT DATE)/IF WAVE = 2, FILL: (DATE OF LAST INTERVIEW) IF

P_SF3n>1, FILL: caseworkers else fill caseworker

P_SF10a [ PSF10a ] Way CW maintained contact w/R

Since ^strLastDate, how satisfied have you been with the extent to which the ^fills.P_SF5A

maintained contact with you? Would you say you have been...

Question Type: THwSat

verydis 1 very dissatisfied,

diss 2 dissatisfied,

sati 3 satisfied, or

verysat 4 very satisfied?

Question Fill: ^FillP_SF5A

CWRKR caseworker

CWRKRS caseworkers

---------------------------------------------------------------------------------

Logic before:

IF P_SF3n>1, FILL: caseworkers else fill caseworker

P_SF11a [ PSF11a ] Way CW invitd R to relevnt mtgs

How satisfied have you been with the extent to which the ^fills.P_SF5A invited you to relevant

meetings about ^CHILD? Would you say you have been...

Question Type: THwSatna

verydis 1 very dissatisfied,

diss 2 dissatisfied,

sati 3 satisfied, or

verysat 4 very satisfied?

NA 5 NOT APPLICABLE

Question Fill: ^FillP_SF5A

CWRKR caseworker

CWRKRS caseworkers

---------------------------------------------------------------------------------

Logic before:

IF P_SF3n>1, FILL: caseworkers else fill caseworker

P_SF12a [ PSF12a ] Way CW invlvd R in decisn-makng

How satisfied have you been with the extent to which the ^fills.P_SF5A involved you in decision-

making regarding the care of ^CHILD? Would you say you have been...

Question Type: THwSatna

verydis 1 very dissatisfied,

diss 2 dissatisfied,

sati 3 satisfied, or

verysat 4 very satisfied?

NA 5 NOT APPLICABLE

Question Fill: ^FillP_SF5A

CWRKR caseworker

CWRKRS caseworkers

---------------------------------------------------------------------------------

P_SF15a [ PSF15a ] I should have been given more time to change

I should have been given more time to make the changes expected of me. Would you say you...

Question Type: TAgree

strdisagree 1 strongly disagree,

disagr 2 disagree,

neithe 3 neither agree nor disagree,

agree 4 agree, or

stragree 5 strongly agree?

---------------------------------------------------------------------------------

P_SF17a [ PSF17a ] Svcs shouldve been more helpful

The services I was told to use should have been more helpful.

(Would you say you...READ CATEGORIES AS NEEDED.)

Question Type: TAgree

strdisagree 1 strongly disagree,

disagr 2 disagree,

neithe 3 neither agree nor disagree,

agree 4 agree, or

stragree 5 strongly agree?

---------------------------------------------------------------------------------

P_SF18a [ PSF18a ] I shldve been offered more svcs

I should have been offered more services.

(Would you say you...READ CATEGORIES AS NEEDED.)

Question Type: TAgree

strdisagree 1 strongly disagree,

disagr 2 disagree,

neithe 3 neither agree nor disagree,

agree 4 agree, or

stragree 5 strongly agree?

Logic after:

GOTO P_SFEND

---------------------------------------------------------------------------------

P_SFEND [ PSFEND ] NO LABEL

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont

HO - HOME SCALES

---------------------------------------------------------------------------------

P_HOBGN [ PHOBGN ] NO LABEL

PRESS "1" AND ENTER TO CONTINUE

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

Logic after:

Hard CHECK:

"VALUES CAN BE FROM 0 TO 24 OR 95 ONLY."

---------------------------------------------------------------------------------

Logic before:

[IF CHILD AGE < 3 YEARS CONTINUE. ELSE SKIP TO P_HO16a]

P_HO1a [ PHO1a ] CH<3 chances to get out of house

My next questions are about your family's lifestyle and rules. About how often does ^CHILD have

a chance to get out of the house, either by ^Fills.himherself or with an older person? Would you

Question Type: THO7F

_Not 1 Not at all,

MonthLess 2 About once a month or less,

FewTimes 3 A few times a month,

OnceMonth 4 About once a month,

FewTimesWk 5 A few times a week,

_4TimesWk 6 4 or more times a week, or

Everyday 7 Every day

Question Fill: ^fillhimherself

himself himself

herself herself

---------------------------------------------------------------------------------

P_HO2a [ PHO2a ] # childrens books CH<3 has of his/her own

About how many children's books does ^CHILD have of ^Fills.hisher own?

Question Type: THMBK

NONE 1 NONE

One_2 2 1 OR 2 BOOKS

Three_9 3 3 TO 9 BOOKS

Ten 4 10 OR MORE BOOKS

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_HO3a [ PHO3a ] R gets chance to read stories to CH<3

How often do you get a chance to read stories to ^CHILD? Would you say...

Question Type: THO8F

Never 1 Never,

SevTimesYr 2 Several times a year,

SevTimesMon 3 Several times a month,

OnceWk 4 Once a week,

_3TimesWk 5 About 3 times a week, or

Everyday 6 Every day?

---------------------------------------------------------------------------------

P_HO4a [ PHO4a ] R takes CH<3 to grocery store

About how often do you take ^CHILD to the grocery store? Would you say...

Question Type: THO9F

TwiceWk 1 Twice a week or more,

OnceWk 2 Once a week,

OnceMon 3 Once a month, or

Hardly 4 Hardly ever?

---------------------------------------------------------------------------------

P_HO5n [ PHO5a ] # soft/role-playing toys CH<3 has

About how many, if any, cuddly, soft, or role-playing toys, like a doll, does ^CHILD have? (Toys

may be shared with sister or brother.)

Question Type: 0..500

---------------------------------------------------------------------------------

P_HO6n [ PHO6a ] # push/pull toys CH<3 has

About how many, if any, push or pull toys does ^CHILD have? (Toys may be shared with sister or

brother.)

Question Type: 0..500

---------------------------------------------------------------------------------

P_HO7a [ PHO7a ] Rs attitde toward Ps teachng CH<3

Some parents spend time teaching their children new skills while other parents believe children

learn best on their own. Which of the following best describes @byour@b attitude?

(READ LIST)

Question Type: TTeach

Always 1 Parents should @balways spend time@b teaching their children.

Usually 2 Parents should @busually spend time@b teaching their children.

UsuallyAllow 3 Parents should @busually allow@b their children to learn on their own.

AlwaysAllow 4 Parents should @balways allow@b their children to learn on their own.

---------------------------------------------------------------------------------

P_HO13a [ PHO13a ] How often CH<3 eat meal w/M&F

How often does ^CHILD eat a meal with @bboth@b mother and father (or stepfather or father-

figure)? Would you say...

Question Type: THO10F

MoreOnceDay 1 More than once a day,

OnceDay 2 Once a day,

SevTimesWk 3 Several times a week,

OnceWk 4 Once a week,

OnceMon 5 Once a month or less often, or

Never 6 Never?

---------------------------------------------------------------------------------

P_HO14a [ PHO14a ] How often R talk to CH<3 while working

Children seem to demand attention when their parents are busy, doing housework, for example.

How often do you talk to ^CHILD while you are working? Would you say you...

Question Type: TTalk

Always 1 Always talk to ^Fills.himher when you're working,

Often 2 Often talk to ^Fills.himher when you're working,

Sometimes 3 Sometimes talk to ^Fills.himher when you're working,

Rarely 4 Rarely talk to ^Fills.himher when you're working, or

Never 5 Never talk to ^Fills.himher when you're working?

Question Fill: ^fillhimher

him him

her her

---------------------------------------------------------------------------------

P_HO15n [ PHO15a ] #Xs have to spank CH<3 in last W

Sometimes kids mind pretty well and sometimes they don't. @bIn the past week@b, about how

many times, if any, have you had to spank ^CHILD?

Question Type: 0..500

---------------------------------------------------------------------------------

P_HO15aa [ PHO15aa ] Hug/show phys affection for CH<3

About how many times in the past month did you hug or show physical affection to ^CHILD?

Would you say...

Question Type: TNum2F

Never 1 Never in the past month,

LessOnceWk 2 Less than once a week,

OnceWk 3 About once a week,

SevTimesWk 4 Several times a week, or

Everyday 5 Every day?

---------------------------------------------------------------------------------

P_HO15ba [ PHO15ba ] Tell CH<3 you love him/her

About how many times in the past month did you tell ^CHILD you love ^Fills.himher? Would you

Question Type: TNum2F

Never 1 Never in the past month,

LessOnceWk 2 Less than once a week,

OnceWk 3 About once a week,

SevTimesWk 4 Several times a week, or

Everyday 5 Every day?

---------------------------------------------------------------------------------

P_HO15ca [ PHO15ca ] Tell CH<3 you apprec something CH<3 did

About how many times in the past month did you tell ^CHILD you appreciated something

^Fills.heshe did?

READ RESPONSE CATEGORIES AS NEEDED.

Question Type: TNum2C

Never 1 NEVER IN THE PAST MONTH

LessOnceWk 2 LESS THAN ONCE A WEEK

OnceWk 3 ABOUT ONCE A WEEK

SevTimesWk 4 SEVERAL TIMES A WEEK

Everyday 5 EVERY DAY

Question Fill: ^fillheshe

he he

she she

---------------------------------------------------------------------------------

Logic before:

[IF (CHILD AGE = 3 YEARS) OR (( CHILD AGE > 3 YEARS) AND (CHILD AGE < 6 YEARS)),

CONTINUE. ELSE GO TO P_HO32a]

P_HO16a [ PHO16a ] How often read stories to CH3-6

About how often do you read stories to ^CHILD? Would you say...

Question Type: THO18F

Never 1 Never,

SevTimesYr 2 Several times a year,

SevTimesMon 3 Several times a month,

OnceWk 4 Once a week,

_3TimesWk 5 At least 3 times a week, or

Everyday 6 Every day?

---------------------------------------------------------------------------------

P_HO17a [ PHO17a ] # books CH3-6 has of his/her own

About how many children's books does ^CHILD have of ^Fills.hisher own?

Question Type: THMBK

NONE 1 NONE

One_2 2 1 OR 2 BOOKS

Three_9 3 3 TO 9 BOOKS

Ten 4 10 OR MORE BOOKS

---------------------------------------------------------------------------------

P_HO18a [ PHO18a ] # magazines fam gets regularly

About how many magazines does your family get regularly?

Question Type: TNumMag

None 0 NONE

One 1 ONE

Two 2 TWO

Three 3 THREE

FourMore 4 FOUR OR MORE

---------------------------------------------------------------------------------

P_HO19a [ PHO19a ] CH3-6 have use of rec/play dev-media

Does ^CHILD have the use of a CD player, tape deck, tape recorder, record player, or mp3 player

(here) at home @Band@B at least 5 children's records, tapes, or CD's? (May be shared with

sister or brother.)

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HO20 [ PHO20 ] Labels are in Logic After

Which of the following things have you, or another adult or older child, helped ^CHILD learn (here)

at home?

CODE ALL THAT APPLY.

Question Type: TLearnS

Numbers 1 Numbers?

Alphabet 2 The alphabet?

Colors 3 Colors?

Shapes 4 Shapes and sizes?

Logic after:

PHO0TG_1 --Helped CH learn-Numbers; PHO0TG_2 --Helped CH learn-The alphabet; PHO0TG_3 --

Helped CH learn-Colors; PHO0TG_4 --Helped CH learn-Shapes and sizes; PHO0TG_5--Helped CH

learn-DK; PHO0TG_6--Helped CH learn-RF

---------------------------------------------------------------------------------

P_HO21a [ PHO21a ] Amt of choice CH3-6 gets bfst/lnch

How much choice is ^CHILD allowed in deciding what foods ^Fills.heshe eats at breakfast and

lunch? Would you say...

Question Type: TChoice

GreatDeal 1 A great deal of choice,

Some 2 Some choice,

Little 3 Little choice, or

NoChoice 4 No choice?

---------------------------------------------------------------------------------

P_HO22n [ PHO22a ] # hrs TV on in home each day

About how many hours is the TV on in your home each day?

HOURS

0 = LESS THAN 1 HOUR PER DAY

95 = DO NOT HAVE A TV

Question Type: 0..97

---------------------------------------------------------------------------------

P_HO25 [ PHO25 ] Labels are in Logic After

Most children get angry at their parents from time to time. If ^CHILD got so angry that

^Fills.heshe hit you, what would you do?

CODE ALL THAT APPLY.

Question Type: THitSet

Hit 1 HIT ^Fills.HimHerALLCAP BACK

Room 2 SEND ^Fills.HimHerALLCAP TO ^Fills.HisHerALLCAP ROOM

Spank 3 SPANK ^Fills.HimHerALLCAP

Talk 4 TALK TO ^Fills.HimHerALLCAP

Ignore 5 IGNORE IT

Chore 6 GIVE ^Fills.HimHerALLCAP HOUSEHOLD CHORE

NoAllowance 7 TAKE AWAY ^Fills.HisHerALLCAP ALLOWANCE

Calm 8 HOLD CHILD'S HANDS UNTIL ^Fills.HeSheALLCAP WAS CALM

Other 9 OTHER

Logic after:

PHOTG_1 --What would R do if CH hit R-Hit him/her back; PHOTG_2 --What would R do if CH hit

R-Send ch to room; PHOTG_3 --What would R do if CH hit R-Spank ch; PHOTG_4 --What would R

do if CH hit R-Talk to ch; PHOTG_5 --What would R do if CH hit R-Ignore it; PHOTG_6 --What

would R do if CH hit R-Give ch a household chore; PHOTG_7 --What would R do if CH hit R-Take

away allowance; PHOTG_8 --What would R do if CH hit R-Hold chs hand until calm; PHOTG_9 --

What would R do if CH hit R-Other; PHOTG_10--What would R do if CH hit R-DK; PHOTG_11--

What would R do if CH hit R-RF

---------------------------------------------------------------------------------

P_HO26a [ PHO26a ] Freq fam member takes CH3-6 on outng

How often does a family member get a chance to take ^CHILD on any kind of outing (shopping,

park, picnic, movie, and so on)? Would you say...

Question Type: THO11F

FewTimesYr 1 A few times a year or less,

OnceMon 2 About once a month,

Two_3TimesMon 3 About 2 or 3 times a month,

SevTimesWk 4 Several times a week, or

OnceDay 5 About once a day?

---------------------------------------------------------------------------------

P_HO27a [ PHO27a ] Pst Y frq fam take CH3-6 to museum

@bIn the past year@b, how often has a family member taken or arranged to take ^CHILD to any

type of museum (children's, scientific, art, historical, etc.)? Would you say...

Question Type: THO12F

Never 1 Never,

OnceTwice 2 Once or twice,

Several 3 Several times,

OnceMon 4 About once a month, or

Often 5 About once a week or more often?

---------------------------------------------------------------------------------

P_HO30a [ PHO30a ] Freq CH3-6 eat meal w/ both M & F

How often does ^CHILD eat a meal with @Bboth@B mother and father (or stepfather or father-

figure)? Would you say...

Question Type: THO30a

moreonce 1 More than once a day,

onceday 2 Once a day,

sevweek 3 Several times a week,

onceweek 4 Once a week,

oncemo 5 Once a month or less often, or

never 6 Never?

---------------------------------------------------------------------------------

P_HO31n [ PHO31n ] #Xs R had to spank CH3-6

Sometimes kids mind pretty well and sometimes they don't. @bIn the past week@b, about how

many times, if any, have you had to spank ^CHILD?

Question Type: TNumTm3F

Never 1 Never in the past week,

LessOnceWk 2 Less than once a week,

OnceWk 3 About once a week,

SevTimesWk 4 Several times a week, or

Everyday 5 Every day?

---------------------------------------------------------------------------------

P_HO31aa [ PHO31aa ] Hug/show phys affection for CH3-6

About how many times in the past month did you hug or show physical affection to ^CHILD?

Would you say...

Question Type: TNum2F

Never 1 Never in the past month,

LessOnceWk 2 Less than once a week,

OnceWk 3 About once a week,

SevTimesWk 4 Several times a week, or

Everyday 5 Every day?

---------------------------------------------------------------------------------

P_HO31ba [ PHO31ba ] Tell CH3-6 you love him/her

About how many times in the past month did you tell ^CHILD you love ^Fills.himher? Would you

Question Type: TNum2F

Never 1 Never in the past month,

LessOnceWk 2 Less than once a week,

OnceWk 3 About once a week,

SevTimesWk 4 Several times a week, or

Everyday 5 Every day?

---------------------------------------------------------------------------------

P_HO31ca [ PHO31ca ] Tell CH3-6 you apprec something CH3-6 did

About how many times in the past month did you tell ^CHILD you appreciated something

^Fills.heshe did?

(READ RESPONSE CATEGORIES AS NEEDED.)

Question Type: TNum2C

Never 1 NEVER IN THE PAST MONTH

LessOnceWk 2 LESS THAN ONCE A WEEK

OnceWk 3 ABOUT ONCE A WEEK

SevTimesWk 4 SEVERAL TIMES A WEEK

Everyday 5 EVERY DAY

---------------------------------------------------------------------------------

Logic before:

IF 6 YEARS ≤ CHILD AGE < 10 YEARS CONTINUE. ELSE GO TO P_HOEND

P_HO32a [ PHO32a ] # books CH6-10 has of his/her own

About how many books does ^CHILD have?

Question Type: THMBK

NONE 1 NONE

One_2 2 1 OR 2 BOOKS

Three_9 3 3 TO 9 BOOKS

Ten 4 10 OR MORE BOOKS

---------------------------------------------------------------------------------

P_HO33a [ PHO33a ] How often R reads stories to CH6-10

About how often do you read stories to ^CHILD? Would you say...

Question Type: THO18F

Never 1 Never,

SevTimesYr 2 Several times a year,

SevTimesMon 3 Several times a month,

OnceWk 4 Once a week,

_3TimesWk 5 At least 3 times a week, or

Everyday 6 Every day?

---------------------------------------------------------------------------------

P_HO34aa [ PHO34aa ] Freq CH6-10 expcted make own bed

USE CARD 35. Please look at Card 35. How often is ^CHILD expected to do each of the

following?

Question Type: THO13F

Never 1 Almost never,

LessHalf 2 Less than half the time,

Half 3 Half the time,

MoreHalf 4 More than half the time, or

Always 5 Almost always?

---------------------------------------------------------------------------------

P_HO34ba [ PHO34ba ] Freq CH6-10 expcted clean own room

(USE CARD 35. How often is ^CHILD expected to...)

Clean ^Fills.hisher room? Would you say…

Question Type: THO13F

Never 1 Almost never,

LessHalf 2 Less than half the time,

Half 3 Half the time,

MoreHalf 4 More than half the time, or

Always 5 Almost always?

---------------------------------------------------------------------------------

P_HO34ca [ PHO34ca ] Frq CH6-10 expctd cln up aftr splls

(USE CARD 35. How often is ^CHILD expected to...)

Clean up after spills?

Question Type: THO13C

Never 1 ALMOST NEVER,

LessHalf 2 LESS THAN HALF THE TIME,

Half 3 HALF THE TIME,

MoreHalf 4 MORE THAN HALF THE TIME, OR

Always 5 ALMOST ALWAYS?

---------------------------------------------------------------------------------

P_HO34da [ PHO34da ] Freq CH6-10 expcted bathe self

(USE CARD 35. How often is ^CHILD expected to...)

Bathe ^Fills.himherself?

Question Type: THO13C

Never 1 ALMOST NEVER,

LessHalf 2 LESS THAN HALF THE TIME,

Half 3 HALF THE TIME,

MoreHalf 4 MORE THAN HALF THE TIME, OR

Always 5 ALMOST ALWAYS?

---------------------------------------------------------------------------------

P_HO34ea [ PHO34ea ] Frq CH6-10 expctd pck up aftr self

(USE CARD 35. How often is ^CHILD expected to...)

Pick up after ^Fills.himherself?

Question Type: THO13C

Never 1 ALMOST NEVER,

LessHalf 2 LESS THAN HALF THE TIME,

Half 3 HALF THE TIME,

MoreHalf 4 MORE THAN HALF THE TIME, OR

Always 5 ALMOST ALWAYS?

---------------------------------------------------------------------------------

P_HO35a [ PHO35a ] Musical instrumnt CH6-10 can use @home

Is there a musical instrument, for example, a piano, drums, or guitar, that ^CHILD can use (here)

at home?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HO36a [ PHO36a ] Fam get a daily newspaper

Does your family get a daily newspaper?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HO37a [ PHO37a ] How often CH6-10 read for enjoyment

About how often does ^CHILD read for enjoyment? Would you say...

Question Type: THO14F

Everyday 1 Every day,

SevTimesWk 2 Several times a week,

SevTimesMon 3 Several times a month,

SevTimesYr 4 Several times a year, or

Never 5 Never?

---------------------------------------------------------------------------------

P_HO38a [ PHO38a ] Fam encourg CH6-10 to strt/kp hobbies

Does your family encourage ^CHILD to start and keep doing hobbies?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HO39a [ PHO39a ] CH6-10 partcpate arts/sport activities

Does ^CHILD get special lessons or belong to any organization that encourages activities such as

sports, music, art, dance, drama, etc?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HO40a [ PHO40a ] Past Y take CH6-10 to museum

@bIn the past year@b, how often has a family member taken or arranged to take ^CHILD to any

type of museum (children's, scientific, art, historical, etc.)? Would you say...

Question Type: THO12F

Never 1 Never,

OnceTwice 2 Once or twice,

Several 3 Several times,

OnceMon 4 About once a month, or

Often 5 About once a week or more often?

---------------------------------------------------------------------------------

P_HO41a [ PHO41a ] Past Y take CH6-10 to music/thtr perf

@bIn the past year@b, how often has a family member taken or arranged to take ^CHILD to any

type of musical or theatrical performance? Would you say...

Question Type: THO15F

Never 1 Never,

OnceTwice 2 Once or twice,

Several 3 Several times,

OnceMon 4 About once a month, or

OnceWk 5 About once a week or more?

---------------------------------------------------------------------------------

P_HO42a [ PHO42a ] How often fam visit w/rel/frnds

About how often does your whole family get together with relatives or friends?

Question Type: THO16F

OnceYr 1 Once a year or less,

FewTimesYr 2 A few times a year,

OnceMon 3 Once a month,

Two_3TimesMon 4 Two or three times a month, or

OnceWk 5 Once a week or more?

---------------------------------------------------------------------------------

P_HO44a [ PHO44a ] How often CH6-10 spend time w/F or F fig

About how often does ^Fills.heshe spend time with ^Fills.hisher father or father-figure? Would you

say...

Question Type: THO17F

OnceDay 1 Once a day or more often,

FourTimesWk 2 At least 4 times a week,

OnceWk 3 Once a week,

OnceMon 4 Once a month, or

FewTimesYr 5 A few times a year or less?

---------------------------------------------------------------------------------

P_HO45a [ PHO45a ] How often outdoor act w/F/F figur

About how often does ^CHILD spend time with ^Fills.hisher father or father-figure in outdoor

activities? Would you say...

Question Type: THO17F

OnceDay 1 Once a day or more often,

FourTimesWk 2 At least 4 times a week,

OnceWk 3 Once a week,

OnceMon 4 Once a month, or

FewTimesYr 5 A few times a year or less?

---------------------------------------------------------------------------------

P_HO46a [ PHO46a ] How often CH6-10 eat meal w/bth M&F

How often does ^CHILD eat a meal with @bboth@b mother and father (or stepfather or father-

figure)? Would you say...

Question Type: THO10F

MoreOnceDay 1 More than once a day,

OnceDay 2 Once a day,

SevTimesWk 3 Several times a week,

OnceWk 4 Once a week,

OnceMon 5 Once a month or less often, or

Never 6 Never?

---------------------------------------------------------------------------------

P_HO47a [ PHO47a ] Discuss TV prog w/ CH6-10

When your family watches TV together, do you or ^CHILD's father or father-figure discuss TV

programs with ^Fills.himher?

Question Type: TYNTV

Yes 1 YES

No 2 NO

NoTV 3 DO NOT HAVE A TV

---------------------------------------------------------------------------------

P_HO48 [ PHO48 ] Labels are in Logic After

Sometimes children get so angry at their parents that they say things like "I hate you" or swear in

a temper tantrum. What actions would you take if this happened?

READ LIST. CODE ALL THAT APPLY.

Question Type: TActionS

Grounding 1 Grounding?

Spank 2 Spanking?

Talk 3 Talk with child?

Chore 4 Give ^Fills.himher household chore?

Ignore 5 Ignore it?

Room 6 Send ^Fills.himher to ^Fills.hisher room for more than 1 hour? Or

Something 7 Something else?

Logic after:

PHO8TG_1 --What would R do if CH said they hate R-Grounding; PHO8TG_2 --What would R do if

CH said they hate R-Spanking; PHO8TG_3 --What would R do if CH said they hate R-Talk w/ch;

PHO8TG_4 --What would R do if CH said they hate R-Give ch hh chore; PHO8TG_5 --What would

R do if CH said they hate R-Ignore it; PHO8TG_6 --What would R do if CH said they hate R-Send

ch to room hour+; PHO8TG_7 --What would R do if CH said they hate R-Something else;

PHO8TG_8--What would R do if CH said they hate R-DK; PHO8TG_9--What would R do if CH said

---------------------------------------------------------------------------------

P_HO48aa [ PHO48aa ] If CH brght hm rprt crd w/ lwr grade-contact tchr/prncpl

USE CARD 36. If ^CHILD brought home a report card with grades lower than expected, how likely

would you be to contact ^Fills.hisher teacher or principal?

Question Type: TLikely

_Not 1 Not at all likely

Unlikely 2 Somewhat unlikely

NotSure 3 Not sure how likely

Likely 4 Somewhat likely

Very 5 Very likely

---------------------------------------------------------------------------------

P_HO48ba [ PHO48ba ] If CH brght hm rprt crd w/ lwr grade-lecture CH

USE CARD 36. If ^CHILD brought home a report card with grades lower than expected, how likely

would you be to lecture ^Fills.himher?

Question Type: TLikely

_Not 1 Not at all likely

Unlikely 2 Somewhat unlikely

NotSure 3 Not sure how likely

Likely 4 Somewhat likely

Very 5 Very likely

---------------------------------------------------------------------------------

P_HO48ca [ PHO48ca ] If CH brght hm rprt crd w/ lwr grade-keep closer eye on CH

USE CARD 36. If ^CHILD brought home a report card with grades lower than expected, how likely

would you be to keep a closer eye on ^Fills.hisher activities?

Question Type: TLikely

_Not 1 Not at all likely

Unlikely 2 Somewhat unlikely

NotSure 3 Not sure how likely

Likely 4 Somewhat likely

Very 5 Very likely

---------------------------------------------------------------------------------

P_HO48da [ PHO48da ] If CH brght hm rprt crd w/ lwr grade-punish CH

USE CARD 36. If ^CHILD brought home a report card with grades lower than expected, how likely

would you be to punish ^Fills.himher?

Question Type: TLikely

_Not 1 Not at all likely

Unlikely 2 Somewhat unlikely

NotSure 3 Not sure how likely

Likely 4 Somewhat likely

Very 5 Very likely

---------------------------------------------------------------------------------

P_HO48ea [ PHO48ea ] If CH brght hm rprt crd w/ lwr grade-talk with CH

USE CARD 36. If ^CHILD brought home a report card with grades lower than expected, how likely

would you be to talk with ^Fills.himher?

Question Type: TLikely

_Not 1 Not at all likely

Unlikely 2 Somewhat unlikely

NotSure 3 Not sure how likely

Likely 4 Somewhat likely

Very 5 Very likely

---------------------------------------------------------------------------------

P_HO48fa [ PHO48fa ] If CH brght hm rprt crd w/ lwr grade-wait & see if CH imprvs

USE CARD 36. If ^CHILD brought home a report card with grades lower than expected, how likely

would you be to wait and see if ^Fills.heshe improves on ^Fills.hisher own?

Question Type: TLikely

_Not 1 Not at all likely

Unlikely 2 Somewhat unlikely

NotSure 3 Not sure how likely

Likely 4 Somewhat likely

Very 5 Very likely

---------------------------------------------------------------------------------

P_HO48ga [ PHO48ga ] If CH brght hm rprt crd w/ lwr grade-spnd mre tme on schlwrk

USE CARD 36. If ^CHILD brought home a report card with grades lower than expected, how likely

would you be to tell ^Fills.himher to spend more time on schoolwork?

Question Type: TLikely

_Not 1 Not at all likely

Unlikely 2 Somewhat unlikely

NotSure 3 Not sure how likely

Likely 4 Somewhat likely

Very 5 Very likely

---------------------------------------------------------------------------------

P_HO48ha [ PHO48ha ] If CH brght hm rprt crd w/ lwr grade-spnd mre tme hlpng CH

USE CARD 36. If ^CHILD brought home a report card with grades lower than expected, how likely

would you be to spend more time helping ^Fills.himher with schoolwork?

Question Type: TLikely

_Not 1 Not at all likely

Unlikely 2 Somewhat unlikely

NotSure 3 Not sure how likely

Likely 4 Somewhat likely

---------------------------------------------------------------------------------

P_HO48ia [ PHO48ia ] If CH brght hm rprt crd w/ lwr grade-lmt non-schl actvts

USE CARD 36. If ^CHILD brought home a report card with grades lower than expected, how likely

would you be to limit or reduce ^Fills.hisher non-school activities, such as play, sports, clubs?

Question Type: TLikely

_Not 1 Not at all likely

Unlikely 2 Somewhat unlikely

NotSure 3 Not sure how likely

Likely 4 Somewhat likely

Very 5 Very likely

---------------------------------------------------------------------------------

P_HO49n [ PHO49a ] # times spank CH in last W

Sometimes kids mind pretty well and sometimes they don't. @BIn the past week@B, about how

many times, if any, have you had to spank ^CHILD?

TIMES

Question Type: 0..20

---------------------------------------------------------------------------------

P_HO49an [ PHO49an ] # times grounded CH in last W

@bIn the past week@b, about how many times, if any, have you grounded ^CHILD?

Question Type: 0..500

---------------------------------------------------------------------------------

P_HO49bn [ PHO49bn ] # times taken away tv from CH in last W

@bIn the past week@b, about how many times, if any, have you taken away TV or other

Question Type: 0..500

---------------------------------------------------------------------------------

P_HO49cn [ PHO49cn ] # times praised CH in last W

@bIn the past week@b, about how many times, if any, have you praised ^CHILD for doing

something worthwhile?

Question Type: 0..500

---------------------------------------------------------------------------------

P_HO49dn [ PHO49dn ] # times taken away CH allowance in last W

@bIn the past week@b, about how many times, if any, have you taken away ^CHILD's allowance?

Question Type: 0..500

---------------------------------------------------------------------------------

P_HO49en [ PHO49en ] # times shown CH physical affection in last W

@bIn the past week@b, about how many times, if any, have you shown ^CHILD physical affection

such as a kiss, hug, hair stroke?

Question Type: 0..500

---------------------------------------------------------------------------------

P_HO49fn [ PHO49fn ] # times sent CH to their room in last W

@bIn the past week@b, about how many times, if any, have you sent ^CHILD to ^Fills.hisher

Question Type: 0..500

---------------------------------------------------------------------------------

P_HO49gn [ PHO49gn ] # times told othr adult smthng positive about CH in last W

@bIn the past week@b, about how many times, if any, have you told another adult something

positive about ^CHILD?

Question Type: 0..500

---------------------------------------------------------------------------------

P_HO49aa [ PHO49aa ] Hug/show phys affection for CH - past M

About how many times in the past month did you hug or show physical affection to ^CHILD?

Would you say...

Question Type: TNum2F

Never 1 Never in the past month,

LessOnceWk 2 Less than once a week,

OnceWk 3 About once a week,

SevTimesWk 4 Several times a week, or

Everyday 5 Every day?

---------------------------------------------------------------------------------

P_HO49ba [ PHO49ba ] Tell CH you love him/her - past M

About how many times in the past month did you tell ^CHILD you love ^Fills.himher? Would you

Question Type: TNum2F

Never 1 Never in the past month,

LessOnceWk 2 Less than once a week,

OnceWk 3 About once a week,

SevTimesWk 4 Several times a week, or

Everyday 5 Every day?

---------------------------------------------------------------------------------

P_HO49ca [ PHO49ca ] Tell CH you apprec someth CH did - past M

About how many times in the past month did you tell ^CHILD you appreciated something

^Fills.heshe did?

Question Type: TNum2F

Never 1 Never in the past month,

LessOnceWk 2 Less than once a week,

OnceWk 3 About once a week,

SevTimesWk 4 Several times a week, or

Everyday 5 Every day?

Logic after:

P_HOEND

---------------------------------------------------------------------------------

P_HOEND [ PHOEND ] NO LABEL

PRESS "1" AND ENTER TO CONTINUE

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

ee – EXPRESSED EMOTION

---------------------------------------------------------------------------------

P_EE1

Now I’d like to hear your thoughts and feelings about ^CHILD, in your own words and without my interrupting with any questions or comments. When I ask you to begin I’d like you to speak for 5 minutes, telling me what kind of person ^CHILD is and how the two of you get along together. After you begin to speak, I prefer not to answer any questions until after the 5 minutes.

Do not say anything while the respondent is speaking, not even “Mm-hmm.”

Do not use leading prompts, such as, “Could you tell me a little bit more about how you and ^CHILD get along?” or, “Could you tell me more about what type of person ^CHILD is?”

Avoid eye contact as much as possible.

LF - Locator Form

---------------------------------------------------------------------------------

P_LFBEG [ PLFBEG ] NoDeliv

PLEASE PRESS "1" TO CONTINUE.

Question Type: BCallCARIRouter

---------------------------------------------------------------------------------

P_LF1a [ PLF1a ] NO LABEL

To help us understand how the well-being of children changes over time, we may contact you and

your child in the future to update our information. I'd like to ask a few questions to help us locate

you in case you move.

Please remember that everything you tell me will be kept private in the ways that were

explained to you at the beginning of the interview.

I'd like to verify your full legal name. Is your full legal name...(READ DISPLAYED NAME.

CORRECT AS NEEDED.)

FIRST NAME: ^main_case.sj_first

MIDDLE NAME: ^main_case.sj_initl

LAST NAME: ^main_case.sj_last

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

if YES GOTO P_LF2

if NO GOTO P_LF1aa

---------------------------------------------------------------------------------

Logic before:

Prefill the names from preload data or if this answer was changed and then a breakoff was done

after that preserve the changed value when interview is resumed.

P_LF1aa [ PLF1aa ] NO LABEL

INTERVIEWER: CORRECT FIRST NAME AS NEEDED.

FIRST NAME: ^main_case.sj_first

Question Type: string[20]

---------------------------------------------------------------------------------

P_LF1ab [ PLF1ab ] NO LABEL

INTERVIEWER: CORRECT MIDDLE NAME AS NEEDED.

MIDDLE NAME: ^main_case.sj_initl

Question Type: string[20], EMPTY

---------------------------------------------------------------------------------

P_LF1ac [ PLF1ac ] NO LABEL

INTERVIEWER: CORRECT LAST NAME AS NEEDED.

LAST NAME: ^main_case.sj_last

Question Type: string[30]

---------------------------------------------------------------------------------

Logic before:

IF SEX NOT FEMALE, GOTO P_LF3a

P_LF2 [ PLF2 ] NO LABEL

What is your maiden name?

MAIDEN NAME:

Question Type: string[30]

---------------------------------------------------------------------------------

P_LF3a [ PLF3a ] Any other names/nicknames

Do you go by any other names or nicknames?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

if no GOTO P_LF5a

---------------------------------------------------------------------------------

Logic before:

Allow 3 names with up to 40 characters each.

P_LF4_ALIAS SUBMODULE FOR LF4 (UP TO 3 ALIASES)

Question Type: array [1..3] of BP_LF4_ALIAS

---------------------------------------------------------------------------------

Logic before:

Allow 3 names with up to 40 characters each.

P_LF4 [ PLF4 ] NO LABEL

What are they?

ALIAS ^pI:

Question Type: string[40]

---------------------------------------------------------------------------------

P_LF4MORE [ PLF4more ] NO LABEL

Do you go by any other names or nicknames?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF YES COLLECT ANOTHER NAME UNTIL 3 NAMES COLLECTED.

---------------------------------------------------------------------------------

P_LF5a [ PLF5a ] NO LABEL

Let me confirm your street address. (VERIFY INFORMATION DISPLAYED ON SCREEN.

CORRECT AS NEEDED.)

STREET ADDRESS: ^Main_case.sj_stnum ^Main_case.sj_addr ^Main_case.sj_aptnum

CITY: ^Main_case.sj_City

STATE: ^Main_case.sj_state

ZIP: ^Main_case.sj_Zip

Is this correct?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

1 = YES GOTO P_LF6a else 2 = NO GOTO P_LF5aa

---------------------------------------------------------------------------------

P_LF5aa1 [ PLF5aa1 ] NO LABEL

INTERVIEWER: CORRECT IF NEEDED.

STREET NUMBER:

Question Type: string[10]

---------------------------------------------------------------------------------

P_LF5aa2 [ PLF5aa2 ] NO LABEL

INTERVIEWER: CORRECT IF NEEDED.

STREET NAME

Question Type: STRING[30]

---------------------------------------------------------------------------------

P_LF5aa3 [ PLF5aa3 ] NO LABEL

INTERVIEWER: CORRECT IF NEEDED.

APARTMENT NUMBER

Question Type: STRING[20], empty

---------------------------------------------------------------------------------

P_LF5ab [ PLF5ab ] NO LABEL

INTERVIEWER: CORRECT CITY IF NEEDED.

CITY:

Question Type: string[30]

---------------------------------------------------------------------------------

P_LF5ac [ PLF5ac ] NO LABEL

INTERVIEWER: CORRECT STATE IF NEEDED.

STATE:

Question Type: string[2]

---------------------------------------------------------------------------------

P_LF5ad [ PLF5ad ] NO LABEL

INTERVIEWER: CORRECT ZIP IF NEEDED.

ZIP:

Question Type: tzip

---------------------------------------------------------------------------------

P_LF6a [ PLF6a ] Where R will live in 6 Ms(ADDRES1T)

Do you expect to be living at this same address or at a different address 6 months from now?

Question Type: TSamAddr

Same 1 SAME ADDRESS

Diff 2 DIFFERENT ADDRESS

Logic after:

IF = 1, GOTO P_LF10an

---------------------------------------------------------------------------------

Logic before:

IF P_LF6a = DK/RE, ASK P_LF6aa. ELSE, GOTO P_LF7.

P_LF6aa [ PLF6aa ] Better address for future contact(YN2T)

Is there a better address we can use to contact you in the future?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 2, GOTO P_LF10an

---------------------------------------------------------------------------------

P_LF7 [ PLF7 ] NO LABEL

What is the best address for us to use in the future?

NOTE: IF R PLANS TO MOVE, COLLECT AS MUCH INFORMATION AS POSSIBLE ABOUT

NEW LOCATION.

STREET ADDRESS:

Question Type: string[50]

---------------------------------------------------------------------------------

P_LF7a [ PLF7a ] NO LABEL

What is the best address for us to use in the future?

CITY:

Question Type: string[30]

---------------------------------------------------------------------------------

P_LF7b [ PLF7b ] NO LABEL

What is the best address for us to use in the future?

STATE:

Question Type: string[2]

---------------------------------------------------------------------------------

P_LF7c [ PLF7c ] City

What is the best address for us to use in the future?

ZIP:

Question Type: Tzip

---------------------------------------------------------------------------------

P_LF8A [ PLF8a ] Whose address

Is that your address or the address of another person or place?

Question Type: TYouAddr

Resp 1 RESPONDENT'S ADDRESS

Other 2 SOME OTHER PERSON'S ADDRESS

Logic after:

IF = 1, GOTO P_LF10an

---------------------------------------------------------------------------------

P_LF9 [ PLF9 ] NO LABEL

Whose address is it? (ENTER NAME)

NAME:

Question Type: string[40]

---------------------------------------------------------------------------------

P_LF9a [ PLF9a ] NO LABEL

Whose address is it? (ENTER RELATIONSHIP TO RESPONDENT)

RELATIONSHIP:

Question Type: string[30]

---------------------------------------------------------------------------------

P_LF10an [ PLF10an ] NO LABEL

What is your home phone number? NOTE: ENTER R'S CURRENT HOME PHONE NUMBER.

PHONE :

IF R DOES NOT HAVE A PHONE NUMBER, ENTER 000-000-0000.

Question Type: Tphone

Logic after:

Allow 12, including pre-filled hyphens (xxx-xxx-xxxx).

---------------------------------------------------------------------------------

Logic before:

IF P_LF10an - DK/REF, GOTO P_LF10cn.

P_LF10ba [ PLF10ba ] NO LABEL

Is this your day or evening phone number?

Question Type: TDayEvn

day 1 DAY

evening 2 EVENING

both 3 BOTH

---------------------------------------------------------------------------------

P_LF10cn [ PLF10cn ] NO LABEL

What is your cell phone number?

PHONE:

NOTE: IF R DOES NOT HAVE A CELL NUMBER, ENTER 000-000-0000.

Question Type: Tphone

Logic after:

Allow 12, including pre-filled hyphens (xxx-xxx-xxxx).

---------------------------------------------------------------------------------

P_LF11a [ PLF11a ] Other # to use to reach R?(YN2T)

Is there another phone number, beeper, or pager number to use to reach you?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 2, GOTO P_LF12ea

---------------------------------------------------------------------------------

P_LF12an [ PLF12an ] NO LABEL

What is that number?

NOTE: IF R HAS MORE THAN 1 ALTERNATIVE NUMBER, ENTER THE ONE HE/SHE CAN BE

REACHED AT MOST OFTEN.

PHONE :

Question Type: Tphone

Logic after:

Allow 12, including pre-filled hyphens (xxx-xxx-xxxx).

---------------------------------------------------------------------------------

Logic before:

IF P_LF12an = DK/REF, GOTO P_LF12ea.

P_LF12ba [ PLF12ba ] NO LABEL

And is that your day or evening number?

Question Type: TDayEvn

day 1 DAY

evening 2 EVENING

both 3 BOTH

---------------------------------------------------------------------------------

P_LF12ca [ PLF12ca ] NO LABEL

Is this your home phone number, a work number, or some other number?

Question Type: TTPhone

home 1 HOME NUMBER

Work 2 WORK NUMBER

friend 3 FRIEND/RELATIVE'S NUMBER

beeper 4 BEEPER/PAGER/CELL PHONE NUMBER

Other 5 OTHER

---------------------------------------------------------------------------------

Logic before:

IF P_LF12ca = 5, CONTINUE. ELSE, GOTO P_LF12ea.

P_LF12d [ PLF12d ] NO LABEL

Please specify what number this is.

NUMBER IS:

Question Type: string[40]

---------------------------------------------------------------------------------

P_LF12ea [ PLF12ea ] NO LABEL

Do you have an email address?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 2, GOTO P_LF13a

---------------------------------------------------------------------------------

P_LF12f [ PLF12f ] NO LABEL

What is your current email address?

EMAIL:

NOTE: EMAIL ADDRESS MUST CONTAIN 2 @@@@ SIGNS (i.e., janedoe@@@@yahoo.com).

Question Type: string[50]

---------------------------------------------------------------------------------

P_LF13a [ PLF13a ] R can give frnd/rel name as cntct(YN2T)

We'd also like the names of three relatives or friends @bwho do not live with you@b but would

always know how to reach you if you moved.

Can you give me the name, address, and telephone number of a relative or friend who would

always know how to reach you if you moved?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 1, GOTO P_LF15

IF = 2, GOTO P_LF20a

---------------------------------------------------------------------------------

P_LF15 [ PLF15 ] NO LABEL

What is the first person's name?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 1:@b

NAME:

Question Type: string[40]

---------------------------------------------------------------------------------

P_LF15a [ PLF15a ] NO LABEL

What is the first person's relationship to you?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 1:@b

RELATIONSHIP:

Question Type: string[30]

---------------------------------------------------------------------------------

P_LF15b [ PLF15b ] NO LABEL

What is the first person's street address?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 1:@b

STREET ADDRESS:

Question Type: string[50]

---------------------------------------------------------------------------------

P_LF15c [ PLF15c ] 1st contacts city

What is the first person's city?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 1:@b

CITY:

Question Type: string[30]

---------------------------------------------------------------------------------

P_LF15d [ PLF15d ] NO LABEL

What is the first person's state?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 1:@b

STATE:

Question Type: string[2]

---------------------------------------------------------------------------------

P_LF15e [ PLF15e ] NO LABEL

What is the first person's zip code?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 1:@b

ZIP:

Question Type: Tzip

---------------------------------------------------------------------------------

P_LF15f [ PLF15f ] NO LABEL

What is the first person's telephone number?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 1:@b

PHONE:

NOTE: IF DOES NOT HAVE A PHONE NUMBER, ENTER 000-000-0000.

Question Type: TPhone

Logic after:

Allow 12, including pre-filled hyphens (xxx-xxx-xxxx)

---------------------------------------------------------------------------------

P_LF16a [ PLF16a ] Oth rel/frnd who can contact R(YN2T)

Is there another relative or friend who would always know how to reach you?

NOTE: THIS INFORMATION IS VERY IMPORTANT! ENCOURAGE R TO PROVIDE ADDITIONAL

CONTACT PERSON.

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 2, GOTO P_LF20a

---------------------------------------------------------------------------------

P_LF17 [ PLF17 ] NO LABEL

What is the second person's name?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 2:@b

NAME:

Question Type: string[40]

---------------------------------------------------------------------------------

P_LF17a [ PLF17a ] NO LABEL

What is the second person's relationship to you?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 2:@b

RELATIONSHIP:

Question Type: string[30]

---------------------------------------------------------------------------------

P_LF17b [ PLF17b ] NO LABEL

What is the second person's street address?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 2:@b

STREET ADDRESS:

Question Type: string[50]

---------------------------------------------------------------------------------

P_LF17c [ PLF17c ] 2nd contacts city

What is the second person's city?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 2:@b

CITY:

Question Type: string[30]

---------------------------------------------------------------------------------

P_LF17d [ PLF17d ] NO LABEL

What is the second person's state?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 2:@b

STATE:

Question Type: string[2]

---------------------------------------------------------------------------------

P_LF17e [ PLF17e ] NO LABEL

What is the second person's zip code?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 2:@b

ZIP:

Question Type: Tzip

---------------------------------------------------------------------------------

P_LF17f [ PLF17f ] NO LABEL

What is the second person's telephone number?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 2:@b

PHONE:

NOTE: IF DOES NOT HAVE A PHONE NUMBER, ENTER 000-000-0000.

Question Type: TPhone

Logic after:

Allow 12, including pre-filled hyphens (xxx-xxx-xxxx)

---------------------------------------------------------------------------------

P_LF18a [ PLF18a ] Oth rel/frnd who can contact R(YN2T)

Is there another relative or friend who would always know how to reach you?

NOTE: THIS INFORMATION IS VERY IMPORTANT! ENCOURAGE R TO PROVIDE ADDITIONAL

CONTACT PERSON.

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 2, GOTO P_LF20a

---------------------------------------------------------------------------------

P_LF19 [ PLF19 ] NO LABEL

What is the third person's name?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 3:@b

NAME:

Question Type: string[40]

---------------------------------------------------------------------------------

P_LF19a [ PLF19a ] NO LABEL

What is the third person's relationship to you?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 3:@b

RELATIONSHIP:

Question Type: string[30]

---------------------------------------------------------------------------------

P_LF19b [ PLF19b ] NO LABEL

What is the third person's street address?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 3:@b

STREET ADDRESS:

Question Type: string[50]

---------------------------------------------------------------------------------

P_LF19c [ PLF19c ] 3rd contacts city

What is the third person's city?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 3:@b

CITY:

Question Type: string[30]

---------------------------------------------------------------------------------

P_LF19d [ PLF19d ] NO LABEL

What is the third person's state?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 3:@b

STATE:

Question Type: string[2]

---------------------------------------------------------------------------------

P_LF19e [ PLF19e ] NO LABEL

What is the third person's zip code?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 3:@b

ZIP:

Question Type: TZIP

---------------------------------------------------------------------------------

P_LF19f [ PLF19f ] NO LABEL

What is the third person's telephone number?

VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.

@bCONTACT PERSON 3:@b

PHONE:

NOTE: IF DOES NOT HAVE A PHONE NUMBER, ENTER 000-000-0000.

Question Type: Tphone

Logic after:

Allow 12, including pre-filled hyphens (xxx-xxx-xxxx)

---------------------------------------------------------------------------------

P_LF20a [ PLF20a ] Past 3 Ys live any other city

In the past three years, have you lived in any city other than ^P_LF5ab?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 2, GOTO P_LF21n

---------------------------------------------------------------------------------

P_LF20aa_CS NO LABEL

In what cities or towns did you live? ENTER THREE MOST RECENT CITIES/TOWNS AND

STATE FOR EACH.

Question Type: ARRAY [1..3] OF BP_LF20AA_CS

Logic after:

Allow 3 CITY/STATE ENTIRES WITH 30 CHARACTERS PER CITY AND 2 CHARACTERS PER

STATE.

---------------------------------------------------------------------------------

Logic before:

fill 1,2, or 3

P_LF20aaC [ PLF20aaC ] NO LABEL

CITY ^pI:

Question Type: string[40]

Logic after:

Allow 3 CITY/STATE ENTIRES WITH 30 CHARACTERS PER CITY AND 2 CHARACTERS PER

STATE.

---------------------------------------------------------------------------------

Logic before:

fill 1,2, or 3

P_LF20AAS [ PLF20aas ] NO LABEL

STATE ^pI:

Question Type: string[2]

Logic after:

Allow 3 CITY/STATE ENTIRES WITH 30 CHARACTERS PER CITY AND 2 CHARACTERS PER

STATE.

---------------------------------------------------------------------------------

P_LF20aamore [ PLF20aamore ] Labels are in Logic After

Is there another city or town?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

Allow 3 CITY/STATE ENTIRES WITH 30 CHARACTERS PER CITY AND 2 CHARACTERS PER

STATE.; PLF20aamore_1 --Another city or town 1; PLF20aamore_2 --Another city or town 2;

PLF20aamore_3 --Another city or town 3

---------------------------------------------------------------------------------

Logic before:

[IF WAVE 1 OR SSN IS NOT AVAILABLE PRELOAD IN LATER WAVES, CONTINUE. IF

PRELOAD FROM PREVIOUS WAVE IS AVAILABLE, GOTO P_LF21na]:

P_LF21n [ PLF21a ] NO LABEL

I’d also like to get your Social Security Number. This information will only be used to help us

locate you if you move. What is your social security number? (PROMPT R TO GET NUMBER

FROM SSN CARD, IF NEEDED.)

SSN:

NOTE: IF R DOES NOT HAVE SSN NUMBER, ENTER 000-00-0000.

Question Type: TSSN

Logic after:

Allow 11, including pre-filled hyphens (xxx-xx-xxxx).

---------------------------------------------------------------------------------

P_LF21NA [ PLF21NA ] NO LABEL

IF VERIFYING PRELOADED SSN: I also need to verify your social security number. This

information will only be used to help us locate you if you move. Is it...(READ DISPLAYED

NUMBER. CORRECT AS NEEDED.)

PRELOADED SSN: ^MAIN_CASE.SJ_SSN

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_LF21NA = YES (1) THEN SKIP TO P_LF22N

---------------------------------------------------------------------------------

P_LF21NB [ PLF21NB ] NO LABEL

What is your correct social security number?

SSN:

NOTE: IF R DOES NOT HAVE SSN NUMBER, ENTER 000-00-0000.

Question Type: TSSN

---------------------------------------------------------------------------------

Logic before:

[IF WAVE 1 OR DL# IS NOT AVAILABLE PRELOAD IN LATER WAVES, CONTINUE. IF

PRELOAD FROM PREVIOUS WAVE IS AVAILABLE, GOTO P_LF22na]:

P_LF22n [ PLF22s ] NO LABEL

What is your driver's license number? Again, this will only be used to help us locate you if you

move. (PROMPT R TO GET NUMBER FROM DRIVER’S LICENSE, IF NEEDED.)

NOTE: IF R DOES NOT HAVE DL NUMBER, ENTER 00.

Question Type: string[15]

Logic after:

IF P_LF22N ASKED THEN GOTO P_LF22A

---------------------------------------------------------------------------------

Logic before:

[IF VERIFYING PRELOADED NUMBER]:@/

P_LF22NA [ PLF22NA ] NO LABEL

I also need to verify your driver’s license number. Is it ..^Main_case_add.drvlic (READ

DISPLAYED NUMBER. CORRECT AS NEEDED.)

LICENSE#:

NOTE: IF R DOES NOT HAVE DL NUMBER, ENTER 00.

Question Type: STRING[15]

Logic after:

IF P_LF22NA = YES (1) GOTO P_LF22A

---------------------------------------------------------------------------------

P_LF22a [ PLF22a ] Rs drivers license number

What state is the driver's license issued in?

STATE:

Question Type: string[2]

---------------------------------------------------------------------------------

P_LF22x [ PLF22x ] NO LABEL

We're almost finished. Remember, this information is voluntary and private and will only be

used to help us locate you if you move.

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

Logic before:

# IF P_HH13 = 1 (SPOUSE LIVES IN HH), ASK P_LF23n. ELSE, GOTO P_LF24n.

P_LF23n [ PLF23a ] NO LABEL

What is your spouse's social security number? (This will only be used to help us locate your

family if you move.)

SPOUSE SSN:

NOTE: IF SPOUSE DOES NOT HAVE SSN NUMBER, ENTER 000-00-0000.

Question Type: TSSN

Logic after:

Allow 11, including pre-filled hyphens (xxx-xx-xxxx).

---------------------------------------------------------------------------------

Logic before:

[IF WAVE 1 OR SSN IS NOT AVAILABLE PRELOAD IN LATER WAVES, CONTINUE. IF

PRELOAD FROM PREVIOUS WAVE IS AVAILABLE, GOTO P_LF24a]:

P_LF24n [ PLF24n ] NO LABEL

What is ^GLOBAL.CHILD's social security number? (PROMPT R TO GET NUMBER FROM

SSN CARD, IF NEEDED.)

CHILD SSN:

NOTE: IF CHILD DOES NOT HAVE SSN NUMBER, ENTER 000-00-0000.

Question Type: TSSN

Logic after:

Type: Allow 11, including pre-filled hyphens (xxx-xx-xxxx). GOTO P_LF25

---------------------------------------------------------------------------------

Logic before:

[IF VERIFYING PRELOADED CHILD SSN]:

P_LF24A [ PLF24A ] Chs social security number

I also need to verify ^GLOBAL.CHILD's social security number. Is it... (READ DISPLAYED

NUMBER. CORRECT AS NEEDED.)

PRELOADED SSN: ^MAIN_CASE.CH_SSN

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_LF24A = YES (1) THEN GO TO P_LF25

---------------------------------------------------------------------------------

P_LF24B [ PLF24B ] NO LABEL

What is ^GLOBAL.CHILD's social security number?

CHILD SSN:

NOTE: IF CHILD DOES NOT HAVE SSN NUMBER, ENTER 000-00-0000.

Question Type: TSSN

---------------------------------------------------------------------------------

P_LF25 [ PLF25 ] NO LABEL

Do you think ^GLOBAL.CHILD's name could change in the next 6 months?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

2 = NO GOTO P_LFEND

---------------------------------------------------------------------------------

P_LF26 [ PLF26 ] NO LABEL

What do you think ^GLOBAL.CHILD's name would be changed to? Please tell me the first,

middle, and last name.

(IF RESPONDENT DOES NOT KNOW, PRESS F3 -- DON'T KNOW --FOR ALL 3 NAME

FIELDS.)

INTERVIEWER: UPDATE FIRST NAME AS NEEDED.

Question Type: string[20]

---------------------------------------------------------------------------------

P_LF26a [ PLF26a ] NO LABEL

INTERVIEWER: UPDATE MIDDLE NAME AS NEEDED.

MIDDLE NAME: ^main_case.ch_initl.

Question Type: string[20], EMPTY

---------------------------------------------------------------------------------

P_LF26b [ PLF26b ] NO LABEL

INTERVIEWER: UPDATE LAST NAME AS NEEDED.

LAST NAME: ^main_case.ch_last

Question Type: string[30]

---------------------------------------------------------------------------------

P_LF27 [ PLF27 ] NO LABEL

Thank you very much for this information.

PRESS "1" and ENTER TO CONTINUE.

Question Type: TCont

Continue 1 Continue

Logic after:

P_LFEND

---------------------------------------------------------------------------------

P_LFEND [ PLFEND ] NoDeliv

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

LK - Permission for Data Linkage

---------------------------------------------------------------------------------

P_LK1 [ PLK1 ] NO LABEL

In the future, other researchers may want to use your NSCAW data for various types of research.

However, for this to happen, your written permission is required. To help you make an informed

decision about this, I need to read to you the data linkage form. After I have read the form to you,

you can decide if you would like other researchers to use your NSCAW data.

INTERVIEWER: PRESS 1 FOR LINKAGE FORMS IN DOCMAN. PLEASE CHOOSE AND READ

THE CORRECT LINKAGE FORM FROM DOCMAN AND OBTAIN SIGNATURE. AFTER

COLLECTING SIGNATURE AND FINALIZING FORM, YOU WILL THEN BE BROUGHT BACK TO

THE INTERVIEW.

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

P_LKLN1 Start LN DocMan

@bSTART DOCMAN LINKAGE FORM @b

INTERVIEWER: PRESS UP ARROW IF YOU WANT TO GO TO PREVIOUS SCREEN.

Question Type: BDocMan

---------------------------------------------------------------------------------

Logic before:

If status from DocMan=491 ask P_LKLN2 else ask P_LKLN3

P_LKLN2 [ PLKLN2 ] End LN DocMan

@bDOCMAN LINKAGE FORM IS COMPLETED@b

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont

Continue 1 Continue

Logic after:

Skip to P_LK2a

---------------------------------------------------------------------------------

P_LKLN3 [ PLKLN3 ] NO LABEL

@bDOCMAN LINKAGE FORM IS NOT COMPLETED@b

Question Type: TDMR4F, noDK, noRF

_1 1 REDO THE FORM IN DOCMAN

_2 2 RESPONDENT REFUSED TO COMPLETE ELECTRONIC FORM BUT

SIGNED PAPER FORM

_3 3 A TECHNICAL PROBLEM PREVENTED THE ELECTRONIC FORM

FROM BEING COMPLETED BUT RESPONDENT SIGNED PAPER

FORM

_4 4 RESPONDENT REFUSES SO THERE'S NO FORM

Logic after:

If 1 GOTO P_LKLN1

If 4 EXIT form

IF 3 Ask P_LKLN4

ELSE GOTO P_LK2a

---------------------------------------------------------------------------------

P_LKLN4 [ PLKLN4 ] NO LABEL

@bDOCMAN LINKAGE FORM IS NOT COMPLETED@b

GIVE DETAILS ABOUT THE TECHNICAL PROBLEM:

Question Type: STRING[60]

---------------------------------------------------------------------------------

P_LK2a [ PLK2a ] Linkage permission indicator

Here is a copy of this form for your records.

Do we have permission for your NSCAW data to be combined with other research data?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_LK2A 2 = NO GOTO P_LKEND

---------------------------------------------------------------------------------

Logic before:

IF (P_HS170a=1 OR P_HS171a=1) AND P_HS173a <> 1 AND P_HH9a=1 THEN fill "need" else fill

"no_need"

P_LK2b [ PLK2b ] NO LABEL

^Fills.P_LK2b

Question Type: TCont

Continue 1 Continue

Question Fill: ^FillP_LK2b

need INTERVIEWER: PRESS 1 FOR MEDICAID DATA LINKAGE FORM IN

DOCMAN. PLEASE CHOOSE AND READ THE CORRECT MEDICAID

DATA LINKAGE FORM FROM DOCMAN AND OBTAIN SIGNATURE.

AFTER COLLECTING SIGNATURE AND FINALIZING FORM, YOU WILL

THEN BE BROUGHT BACK TO THE INTERVIEW.

no_need INTERVIEWER: BASED ON THE EARLIER QUESTIONS, THE

MEDICAID DATA LINKAGE IS NOT NEEDED FOR THIS CHILD.

SELECT “FORM NOT NEEDED” IN DOCMAN.

---------------------------------------------------------------------------------

P_LKHI1 Start HIPAA DocMan

@bSTART DOCMAN MEDICAID DATA LINKAGE FORM (HIPAA)@b

INTERVIEWER: PRESS UP ARROW IF YOU WANT TO GO TO PREVIOUS SCREEN.

Question Type: BDocMan

Logic after:

If status from DocMan=491 or (457 and "form is not needed") ask P_LKHI2 else ask P_LKHI3

---------------------------------------------------------------------------------

P_LKHI2 [ PLKHI2 ] End HIPAA DocMan

@bDOCMAN MEDICAID DATA LINKAGE FORM (HIPAA) IS COMPLETED@b

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont

Continue 1 Continue

Logic after:

Skip to P_LK2c

---------------------------------------------------------------------------------

P_LKHI3 [ PLKHI3 ] NO LABEL

@bDOCMAN MEDICAID DATA LINKAGE FORM (HIPAA) IS NOT COMPLETED@b

Question Type: TDMR2F, noDK, noRF

_1 1 REDO THE FORM IN DOCMAN

_2 2 RESPONDENT REFUSED TO COMPLETE ELECTRONIC FORM BUT

SIGNED PAPER FORM

_3 3 A TECHNICAL PROBLEM PREVENTED THE ELECTRONIC FORM

FROM BEING COMPLETED BUT RESPONDENT SIGNED PAPER

FORM

_4 4 RESPONDENT REFUSES SO THERE'S NO FORM

_5 5 A TECHNICAL PROBLEM PREVENTED FROM CODING OUT THE

FORM

Logic after:

If 1 GOTO P_LKHI1

If 4 EXIT form

IF 3 Ask P_LKHI4

ELSE GOTO P_LK2c

---------------------------------------------------------------------------------

P_LKHI4 [ PLKHI4 ] NO LABEL

@bDOCMAN MEDICAID DATA LINKAGE FORM (HIPAA) IS NOT COMPLETED@b

GIVE DETAILS ABOUT THE TECHNICAL PROBLEM:

Question Type: STRING[60]

---------------------------------------------------------------------------------

P_LK2c [ PLK2c ] NO LABEL

Here is a copy of this form for your records.

DID RESPONDENT SIGN THE AUTHORIZATION FORM?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

Logic before:

IF P_SR108 = YES OR SR108a = YES, CONTINUE. ELSE, GO TO P_LK4

P_LK3 [ PLK3 ] NO LABEL

INTERVIEWER: A CASEWORKER INTERVIEW IS REQUIRED FOR THIS CASE. YOU MUST

ENTER THE CID AND CODE "YES" FOR THE SERVICE UTILIZATION QUESTION SINCE THE

CHILD/FAMILY HAS RECEIVED SERVICES PROVIDED OR PAID FOR BY THE AGENCY

SINCE THE LAST INTERVIEW. YOU WILL NEED TO CONDUCT THE CASEWORKER

INTERVIEW WITH THE PERSON SPECIFIED BY THE CAREGIVER.

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

Logic before:

IF CHILD AGE <10, CONTINUE. ELSE, GOTO LKEND.

P_LK4 NO LABEL

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

P_LKEND [ PLKEND ] NoDeliv

PLEASE PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

VF - Verifications

---------------------------------------------------------------------------------

Logic before:

h1 This is a placeholder until DocMan process is final.

P_VF1 [ PVF1 ] NO LABEL

As part of RTI's quality program, we plan to contact a portion of the persons participating in this

survey to verify that interviewers, including me, have done our work correctly. The questions you

would be asked, if you are selected, are general. This is only to verify my work.

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

P_VF3 [ PVF3 ] NO LABEL

It may be necessary to verify the interview of your youth as well.

Due to the age of your child, we would contact you to ask the verification questions.

In advance, I appreciate your help if you are selected to verify my work.

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

P_VF4a [ PVF4a ] R agree to verification call

WAS R AGREEABLE TO A VERIFICATION CALL?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_VF5 [ PVF5 ] NO LABEL

We sincerely appreciate your participation in this important research project. To help us

understand how the well-being of children changes over time, we may contact you and your child

in the future to update our information.

Here is a Change of Address Card in case you move. GIVE CARD TO R. It is already stamped

and addressed to RTI. All you have to do is record both your old and new addresses and drop the

card in the mail.

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

P_VF6 [ PVF6 ] NO LABEL

To show our appreciation for your time and effort, we're offering you cash in the amount of $50.00

for participating in the interview.

Here is an envelope with the cash.

INTERVIEWER: PRESS 1 FOR INCENTIVE RECEIPTS IN DOCMAN. PLEASE CHOOSE THE

CORRECT INCENTIVE RECEIPT FROM DOCMAN AND OBTAIN SIGNATURE. AFTER

COLLECTING SIGNATURE AND FINALIZING FORM, YOU WILL THEN BE BROUGHT BACK TO

THE INTERVIEW.

This form states that you have received the money. This copy is for your records.

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

P_VFIN1 Start IN DocMan

@bSTART DOCMAN INCENTIVE RECEIPT FORM @b

INTERVIEWER: PRESS UP ARROW IF YOU WANT TO GO TO PREVIOUS SCREEN.

Question Type: BDocMan

---------------------------------------------------------------------------------

Logic before:

If status from DocMan=491 ask P_VFIN2 else ask P_VFIN3

P_VFIN2 [ PVFIN2 ] End IN DocMan

@bDOCMAN INCENTIVE RECEIPT FORM IS COMPLETED@b

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont

Continue 1 Continue

Logic after:

Skip to P_VF7a

---------------------------------------------------------------------------------

P_VFIN3 [ PVFIN3 ] NO LABEL

@bDOCMAN INCENTIVE RECEIPT FORM IS NOT COMPLETED@b

Question Type: TDMR4F, noDK, noRF

_1 1 REDO THE FORM IN DOCMAN

_2 2 RESPONDENT REFUSED TO COMPLETE ELECTRONIC FORM BUT

SIGNED PAPER FORM

_3 3 A TECHNICAL PROBLEM PREVENTED THE ELECTRONIC FORM

FROM BEING COMPLETED BUT RESPONDENT SIGNED PAPER

FORM

_4 4 RESPONDENT REFUSES SO THERE'S NO FORM

Logic after:

If 1 GOTO P_VFIN1

If 4 EXIT form

IF 3 Ask P_VFIN4

ELSE GOTO P_VF7a

---------------------------------------------------------------------------------

P_VFIN4 [ PVFIN4 ] NO LABEL

@bDOCMAN INCENTIVE RECEIPT FORM IS NOT COMPLETED@b

GIVE DETAILS ABOUT THE TECHNICAL PROBLEM:

Question Type: STRING[60]

---------------------------------------------------------------------------------

P_VF7a [ PVF7a ] R accept cash incentive

DID RESPONDENT ACCEPT THE CASH INCENTIVE?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

GOTO P_VFEND

---------------------------------------------------------------------------------

P_VFEND [ PVFEND ] NoDeliv

^Fills.P_VFEND

PRESS "1" AND ENTER TO CONTINUE

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

Question Fill: ^FillP_VFEnd

less10 INTERVIEWER: BREAK OFF THE INTERVIEW AT THIS POINT. ONCE

YOU RETURN HOME, GET BACK INTO THIS INTERVIEW AND

COMPLETE SECTION IO (HOME - OBSERVATION)

IO - HOME Observational

---------------------------------------------------------------------------------

P_IOStart [ PIOStart ] NoDeliv

PLEASE PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

---------------------------------------------------------------------------------

Logic before:

IF CHILD AGE < 3 YEARS ASK QUESTIONS P_IO1A THROUGH P_IO3F

IF 3 YEARS <= CHILD AGE < 6 YEARS ASK QUESTIONS P_IO4A THROUGH P_IO7E

IF 6 YEARS <= CHILD AGE < 10 YEARS ASK QUESTIONS P_IO8A THROUGH P_IO11B

P_IO1a [ PIO1a ] Observed CH & R together - Ch age < 3

Did you observe this child and caregiver together at any time?

Question Type: TYN , nodk,norf

yes 1 YES

no 2 NO

Logic after:

P_IO1a 2 = NOSKIP TO P_IO3f

---------------------------------------------------------------------------------

P_IO1c [ PIO1c ] R spontaneously spoke to child - Ch age < 3

Caregiver spontaneously spoke to child twice or more (excluding scolding)?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO1e [ PIO1e ] R responded verbally to CH speech - Ch age < 3

Caregiver responded verbally to child's speech?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO1g [ PIO1g ] R caressed/kissed/hugged child - Ch age < 3

Caregiver caressed, kissed, or hugged child at least once?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO2d [ PIO2d ] R slapped/spanked CH at least once - Ch age < 3

Caregiver slapped or spanked child at least once?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO2e [ PIO2e ] R interfered with CH actions - Ch age < 3

Caregiver interfered with child's actions or restricted child from exploring more than 3 times?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO2f [ PIO2f ] R had toys/activities for CH - Ch age < 3

Caregiver provided toys or interesting activities for child?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO2g [ PIO2g ] R looked at CH often - Ch age < 3

Caregiver kept child in view, could see child, looked at ^Fills.himher often?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

Question Fill: ^fillhimher

him him

her her

---------------------------------------------------------------------------------

P_IO3f [ PIO3f ] Childs play environment is safe - Ch age < 3

Child's play environment is safe, no potentially dangerous health or structural hazards within a

toddler's or infant's range (e.g., falling plaster, peeling paint, rodents, glass, poisons and cleaning

materials, flames and heat, frayed electrical wires)?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

Logic after:

goto IOEND

---------------------------------------------------------------------------------

Logic before:

IF 3 YEARS <= CHILD AGE < 6 YEARS ASK ALL QUESTIONS THROUGH P_IO7E

P_IO4a [ PIO4a ] Observed CH & R together - Ch age 3 to 6

Did you observe this child and caregiver together at any time?

Question Type: TYN , nodk,norf

yes 1 YES

no 2 NO

Logic after:

IF P_IO4a 2 = NO SKIP TO P_IO6a

Programmer: Do not allow DK or REF for P_IO4a

---------------------------------------------------------------------------------

P_IO4b [ PIO4b ] R conversed with CH at least twice - Ch age 3 to 6

Caregiver conversed with child at least twice (excluding scolding or suspicious comments)?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO4d [ PIO4d ] R answer CH quest/request verbally - Ch age 3 to 6

Caregiver answered child's questions or requests verbally?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO4e [ PIO4e ] R caressed/kissed/hugged CH 1 time - Ch age 3 to 6

Caregiver caressed, kissed, or hugged child at least once?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO5a [ PIO5a ] R introduced interviewer to CH - Ch age 3 to 6

Caregiver introduced interviewer to child by name?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO5c [ PIO5c ] R physically restricted/shook CH - Ch age 3 to 6

Caregiver physically restricted or shook/grabbed child?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO5d [ PIO5d ] R slapped/spanked CH at least once - Ch age 3 to 6

Caregiver slapped or spanked child at least once?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO6a [ PIO6a ] R voice convey pos feeling abt CH - Ch age 3 to 6

Caregiver's voice conveyed positive feeling about this child?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO6f [ PIO6f ] Childs play environment is safe - Ch age 3 to 6

Child's play environment is safe with no potentially dangerous structural or health hazards within a

preschooler's range (e.g., falling plaster, peeling paint, rodents, glass, poisons and cleaning

materials, flames and heat, frayed electrical wires)?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO7c [ PIO7c ] Interior of home dark/monotonous - Ch age 3 to 6

Interior of the home is dark or perceptually monotonous?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO7d [ PIO7d ] Visible rooms are reasonably clean - Ch age 3 to 6

All visible rooms of house/apartment are reasonably clean?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO7e [ PIO7e ] Visible rooms minimally cluttered - Ch age 3 to 6

All visible rooms of house/apartment are minimally cluttered?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

Logic after:

goto IOEND

---------------------------------------------------------------------------------

Logic before:

IF 6 YEARS <= CHILD AGE < 10 YEARS ASK QUESTIONS TO END OF THIS SECTION

P_IO8a [ PIO8a ] Observed CH & R together - Ch age 6 to 10

Did you observe this child and caregiver together at any time?

Question Type: TYN , nodk,norf

yes 1 YES

no 2 NO

Logic after:

2 = NO (SKIP TO P_IO9b)

Programmer: Do not allow DK or REF for P_IO8a

---------------------------------------------------------------------------------

P_IO8b [ PIO8b ] R encourage CH contrib to convers - Ch age 6 to 10

Caregiver encouraged child to contribute to the conversation?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO8c [ PIO8c ] R answer CH quest/request verbally - Ch age 6 to 10

Caregiver answered child's questions or requests verbally?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO8d [ PIO8d ] R conversed with CH (no scolding) - Ch age 6 to 10

Caregiver conversed with child (excluding scolding or suspicious comments)?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO8g [ PIO8g ] R introduced interviewer to CH - Ch age 6 to 10

Caregiver introduced interviewer to child by name?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO9b [ PIO9b ] R voice convey pos feeling abt CH - Ch age 6 to 10

Caregiver's voice conveyed positive feeling about this child?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO10b [ PIO10b ] Home interior dark/monotonous - Ch age 6 to 10

Interior of the home is dark or perceptually monotonous?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO10c [ PIO10c ] All visible rooms reasonably clean - Ch age 6 to 10

All visible rooms of house/apartment are reasonably clean?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO10e [ PIO10e ] Visible rooms minimally cluttered - Ch age 6 to 10

All visible rooms of house/apartment are minimally cluttered?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

---------------------------------------------------------------------------------

P_IO11b [ PIO11b ] No dangerous struct/health hazards - Ch age 6 to 10

Building has no potentially dangerous structural or health hazards within a school-aged child's

range (e.g., falling plaster, peeling paint, rodents, glass, poisons and cleaning materials, flames

and heat, frayed electrical wires)?

Question Type: TYNObs

yes 1 YES

no 2 NO

notobs 3 NOT OBSERVED

Logic after:

P_IOEND

---------------------------------------------------------------------------------

P_IOEND [ PIOEND ] NoDeliv

PLEASE PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Smith, Keith R.
File Modified	0000-00-00
File Created	2021-10-15