Follow up removed - Instrument 1 - Baseline Youth Survey_Clean
OPRE Study: Evaluation of LifeSet [Impact and Implementation Evaluation]
Follow up removed - Instrument 1 - Baseline Youth Survey_Clean
OMB: 0970-0577
Instrument 1: Baseline Youth Survey
LifeSet Baseline Survey
This survey is intended to be administered at baseline to all youth in the study by interviewers of the subcontracted survey firm. As this will be the first data collection for the evaluation, the interview will begin with the informed consent process. However, items gathering information to aid in follow-up contact are placed at the end of the survey so that rapport may be built prior to asking for contact information.
Instructions
Thank you for joining us today. We would like to invite you to participate in a survey that will last about 35 minutes. We are conducting this survey as part of the Young Adult Services Study (YASS). The survey contains questions about the services you received during foster care. There are also questions about your experiences leaving foster care such as education and work, places you lived, and the relationships you have with family and friends.
Some questions ask about your emotions, alcohol and drug use, and behavior that might be against the law but are very common for young people your age.
[IF MODE =1] I will read the questions to you and enter your responses into the computer. You may skip over any questions you do not want to answer.
[IF MODE = 2] If you want, you can listen to these questions on headphones and enter your answers on a computer. The interviewer will not see your answers to these questions.
We will use this information to better understand the services that young adults in New Jersey get and what it is like for them leaving foster care.
Your participation in this survey is voluntary. You can choose not to answer any question or not participate in the survey at all. There will be no consequences to you if you choose not to participate. We will keep the information you provide private and will not share it with anyone except for research staff working on the study. Additionally, federal law states that an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB number for this data collection is 0970-0577 and the expiration date is XX/XX/XXXX.
Set Up And Introduction
prld_age What is your date of birth?
ENTER MONTH |_|_| (2-DIGIT)
ENTER DAY |_|_| (2-DIGIT)
ENTER YEAR |_|_|_|_| (4-DIGIT)
prld_group Treatment Case or Control Group Case (relevant routing in LifeSet Services Section)
TREATMENT
CONTROL
intloc (INTERVIEWER: WHERE IS THIS INTERVIEW TAKING PLACE?)
1 RESPONDENT’S HOME [Do not allow if incar1=1]
2 ALTERNATE LOCATION (SPECIFY)
intloc_specify [IF INTLOC=2] WHERE IS THE INTERVIEW TAKING PLACE?
[TEXT BOX]
VERIFY Case ID: XXXXXXX
Subject Name: Respondent First and Last Name
Respondent DOB: XX/XX/XXXX
INTERVIEWER: PLEASE MAKE SURE YOU HAVE SELECTED THE CORRECT CASE BEFORE ENTERING 1 TO CONTINUE.
MODE INTERVIEWER: INDICATE MODE OF ADMINISTRATION.
TELEPHONE
IN-PERSON
INTRO6
INTERVIEWER: BE SURE TO READ VERBATIM.
Before we begin, I would like to remind you of the study details. These study details are also included on the Study Fact Sheet and [PROGRAMMER: IF R AGE IS >=18, THEN FILL: “Consent”; IF R AGE IS <18, THEN FILL: “Assent”] Form that were provided to you by mail or email. I can send these materials to you again if you did not receive them or have not had a chance to review them yet.
Did you have time to review the materials?
1 YES [GO TO Y_REVIEW]
0 NO [GO TO Y_NOREVIEW]
Y_REVIEW
INTERVIEWER: BE SURE TO READ VERBATIM.
Great, this study is funded by the Administration for Children and Families, an agency within the U.S. Department of Health and Human Services. This interview involves questions about the services you have received while in foster care, as well as questions about education and work, places you have lived, and relationships with family and friends. We are asking over 600 youth in foster care to take part. Your input is needed to understand and improve the services youth and young adults receive before and after they leave care.
Federal law requires us to keep your answers private. Any data you provide will only be used by authorized personnel for statistical purposes. The only exceptions to this promise of privacy are if you tell me you intend to seriously harm yourself or someone else, or if a child has been or will be seriously harmed. In this situation, I may need to notify a mental health professional or other authorities.
Your participation is voluntary. The [FILL IF MODE=1: "telephone interview"; FILL IF MODE=2: "interview"] will take about 35 minutes to complete. You may consider some of the questions to be sensitive and some of the questions may also make you feel certain emotions, such as sadness. Remember you can choose not to answer any questions you do not want to answer, and you can stop the interview at any time. If you become upset at any time during the interview and wish to speak to a mental health professional about how you are feeling, I will provide you with some toll-free hotline numbers to call. A $25 electronic gift card will be sent to you after the [FILL IF MODE=1: "telephone interview"; FILL IF MODE=2: "interview"]. We may also telephone you in the future to check on the quality of my work during this interview. This consists of a brief set of questions for participants to answer to check for professionalism, time to complete the interview, and if data collection procedures were followed.
[PROGRAMMER: IF R AGE>=18: Do you have any questions before we begin?]
[PROGRAMMER: IF R AGE<18: Do you have any questions?]
INTERVIEWER: ANSWER RESPONDENT QUESTIONS.
INTERVIEWER: ENTER 1 TO CONTINUE.
[IF R AGE<18, THEN GO TO M_TB. IF R AGE>=18, THEN GO TO AGREE1.]
Y_NOREVIEW
Before we begin, I must review the [IF R AGE>=18, THEN FILL: “consent”; IF R AGE<18, THEN FILL: “assent”] form with you to ensure you are fully informed about study participation and your rights as a respondent. This will take just a few minutes.
FI: OFFER TO SEND THE FACT SHEET/CONSENT FORM AGAIN.
INTERVIEWER IF NEEDED: Please visit our website YASS.rti.org to view and download a copy of the study fact sheet.
INTERVIEWER: ENTER 1 TO CONTINUE.
CONSENT1
INTERVIEWER: BE SURE TO READ VERBATIM.
We are from RTI International. We have been hired to interview young people as part of a study being conducted by the Urban Institute. The Urban Institute is a non-political nonprofit social policy research organization in Washington DC. The Urban Institute study looks at what it’s like for young adults who are leaving foster care and the services they may receive. This study is funded by the U.S. Department of Health and Human Services, Administration for Children and Families. We are asking over 600 youth in foster care to help us with this study. You have been asked to be in the study because you are a youth in foster care in New Jersey. We call this study the Young Adult Services Study, or YASS.
INTERVIEWER: ENTER 1 TO CONTINUE.
CONSENT2
INTERVIEWER: BE SURE TO READ VERBATIM.
If you decide to participate in this study, we would like to interview you today. We may also ask to interview you again in the future to see how you are doing after leaving foster care. For the interview today, a person from RTI will ask you questions about the services you received during foster care. There are also questions about your experiences leaving foster care such as education and work, places you lived, and the relationships you have with family and friends. The interview today will last about 35 minutes. The interview can be done at a time that works best for you. Some portions of the interview may be recorded to make sure the person asking the questions is doing a good job.
INTERVIEWER: ENTER 1 TO CONTINUE.
INTERVIEWER: BE SURE TO READ VERBATIM.
Some questions ask about your emotions, alcohol and drug use, and behavior that might be against the law. I will read the questions to you and enter your responses into the computer. I will know your answers to these questions. You may skip over any questions you do not want to answer.
INTERVIEWER: ENTER 1 TO CONTINUE.
[IF MODE=IN PERSON] CONSENT3B
INTERVIEWER: BE SURE TO READ VERBATIM.
Some questions ask about your emotions, alcohol and drug use, and behavior that might be against the law. If you want, you can listen to these questions on headphones and enter your answers on a computer. I will not see your answers to these questions. If you do not want to use the computer, I can read you the questions. I will enter your answers into the computer. If you do it this way, I will know your answers to these questions.
INTERVIEWER: ENTER 1 TO CONTINUE.
[IF R AGE>=18] CONSENT4A
INTERVIEWER: BE SURE TO READ VERBATIM.
We would like to ask your permission to allow the YASS research team to review administrative records that might contain information that can be used to see how you are doing. These include the following types of records; public assistance; education; foster care agency; unemployment insurance wages; vital statistics; and criminal justice.
INTERVIEWER: ENTER 1 TO CONTINUE
[IF R AGE<18] CONSENT4B
INTERVIEWER: ENTER 1 TO CONTINUE.
CONSENT5
INTERVIEWER: BE SURE TO READ VERBATIM.
In the future, you may also be asked to participate in a small group discussion or one-on-one interview as part of the study. These discussions will help us better understand how you are experiencing the services offered to you. All opportunities to participate in any future discussion are voluntary and you can choose not to participate at any time.
INTERVIEWER: ENTER 1 TO CONTINUE.
[IF
R AGE>=18] CONSENT6A
INTERVIEWER:
BE SURE TO READ VERBATIM.
You don’t have to be in this study. Being in the study is voluntary. If you don’t want to be in the study just tell me. You can say yes now but you can stop if you change your mind later. You can still be in the study even if you do not give us permission to get information about you from administrative data. Whether or not you choose to be in this study will not change anything for you in terms of the care you receive from the state or any other services you may be eligible for. In other words, it will not change your placement or the services you get.
INTERVIEWER: ENTER 1 TO CONTINUE.
[IF R AGE<18] CONSENT6B
INTERVIEWER: BE SURE TO READ VERBATIM.
You don’t have to be in this study. Being in the study is voluntary. If you don’t want to be in the study just tell me. You can say yes now but you can stop if you change your mind later. Whether or not you choose to be in this study will not change anything for you in terms of the care you receive from the state or any other services you may be eligible for. In other words, it will not change your placement or the services you get.
INTERVIEWER: ENTER 1 TO CONTINUE.
[IF R AGE>=18] CONSENT7A
INTERVIEWER: BE SURE TO READ VERBATIM.
Members of the research team will be able to see your information. Information that could identify you will be removed from the information you share today and any of the data we collect about you in the future. The information may be combined and made available for other researchers to use; these files will not include any information that could identify you and will only be available under password protected secure access. If ACF decides to extend this project, we may share your information with the researchers working on that extension, but they would keep the information that is identifiable private to the same extent we do. One exception to not sharing your identity, is that I may need to tell the appropriate authorities if you report evidence of current abuse or neglect. I may also need to report if you threaten yourself or someone else.
INTERVIEWER: ENTER 1 TO CONTINUE.
[IF R AGE<18] CONSENT7B
INTERVIEWER: BE SURE TO READ VERBATIM.
Members of the research team will be able to see your information. Information that could identify you will be removed from the information you share today and any of the data we collect about you in the future. The information will be combined and made available for other researchers to use; these files will not include your name and will only be available under password protected secure access. If ACF decides to extend this project, we may share your information with the researchers working on that extension, but they would keep the information that is identifiable private to the same extent that we do. One exception to not sharing your identity, is that I may need to tell the appropriate authorities if you report evidence of current abuse or neglect. I may also need to report if you threaten to hurt yourself or someone else.
INTERVIEWER: ENTER 1 TO CONTINUE.
CONSENT8
INTERVIEWER: BE SURE TO READ VERBATIM.
We will do many things to keep your information private. We will only let the research team see your information. We will store information about you either in a locked drawer or on a secure computer. The computer will be password protected. We will also not use your name in any reports or papers.
We also have a Certificate of Confidentiality from the government to protect your privacy. This Certificate of Confidentiality strictly limits when we can share identifiable information collected through our research. For example, we cannot be forced to give a court information about you. However, you should know that the Certificate does not stop reporting that federal, state or local laws require, for example reporting child or elder abuse, some communicable diseases, and threats to harm yourself or others.
INTERVIEWER: ENTER 1 TO CONTINUE.
[IF R AGE>=18] CONSENT9A
INTERVIEWER: BE SURE TO READ VERBATIM.
Some of the questions you are asked may make you feel uneasy. You do not have to answer any questions that you do not want to answer. Additionally, any administrative data you may agree to provide us access to could be compromised in a breach of data and the answers you may provide in the interview could be revealed. As mentioned, we have taken precautions to minimize the risk of any data being compromised.
INTERVIEWER: ENTER 1 TO CONTINUE.
[IF R AGE<18] CONSENT9B
INTERVIEWER: BE SURE TO READ VERBATIM.
Some of the questions you are asked may make you feel uneasy. You do not have to answer any questions that you do not want to answer. Additionally, any data you may agree to provide us access to could be compromised in a breach of data and the answers you may provide in the interview could be revealed. As mentioned, we have taken precautions to minimize the risk of any data being compromised.
INTERVIEWER: ENTER 1 TO CONTINUE.
CONSENT10
INTERVIEWER: BE SURE TO READ VERBATIM.
You will not benefit directly from this study. But data we get from the study is important. Being in this study will let you tell officials about your experiences during and after foster care. This information may be used to improve the services that youth receive before and after they leave care. Many youth in foster care appreciate the chance to tell their story and be listened to.
INTERVIEWER: ENTER 1 TO CONTINUE.
CONSENT11
INTERVIEWER: BE SURE TO READ VERBATIM.
For helping me with this study, you will receive a $25 gift card for this survey. If you decide to stop being in the study or skip some of the questions today you still get $25. It’s all up to you.
INTERVIEWER: ENTER 1 TO CONTINUE.
CONSENT12
INTERVIEWER: BE SURE TO READ VERBATIM.
This study is being done by the Urban Institute, the University of Chicago, and the Survey Firm, RTI International. The US Department of Health and Human Services is paying for this study. The people in charge of the study are Dr. Michael Pergamit and Dr. Mark Courtney. If you have any questions or concerns about this study, I can give you the necessary contact information.
INTERVIEWER, IF NECESSARY:
Dr. Michael Pergamit
Dr. Mark Courtney
Jennifer Keeney
RTI
International
919-316-3525
1-800-334-8571 extension 23525
INTERVIEWER: ENTER 1 TO CONTINUE.
[ASK ONLY IF R AGE<18; IF R AGE >=18, THEN GO TO AGREE1]
M_TB. I want to make sure I was clear when I talked to you about the survey and went through the assent process. I would like to ask you a few questions to make sure you understand what agreeing to take part means. This is a way for me to review with you anything where you might still have questions.
INTERVIEWER: ENTER 1 TO CONTINUE
M_TB1. First, please tell me what you think is involved in joining this study?
INTERVIEWER: CODE RESPONSE
1. CORRECT RESPONSE: SURVEYS/ANSWERING QUESTIONS/35-MINUTE SURVEY
2. INCORRECT RESPONSE OR MINOR SAYS DON’T KNOW
M.TB2. Are you required to join and complete this survey?
INTERVIEWER: CODE RESPONSE
1 = CORRECT RESPONSE: NO
2 = INCORRECT RESPONSE: YES OR DON’T KNOW RESPONSE.
M__TB3. What will happen if you do not answer all of the survey questions or want to stop the survey early?
INTERVIEWER: CODE RESPONSE
1 = CORRECT RESPONSE: NOTHING. I CAN DECLINE/REFUSE TO ANSWER ANY QUESTION OR LEAVE AT ANY TIME.
2 = INCORRECT RESPONSE OR MINOR SAYS DON’T KNOW
M_TB4. We will not tell anyone that you are taking part in this survey or share your information. There is an exception to this. Can you tell me what that is?
INTERVIEWER: CODE RESPONSE
1 = CORRECT RESPONSE: SELF-HARM OR HARM TO OTHERS
2 = INCORRECT RESPONSE OR MINOR SAYS DON’T KNOW
LOGIC before: IF R answered items M_TB1 – M_TB4 correctly (=1) GOTO M_TB5.
M_TB5. INTERVIEWER: THIS RESPONDENT SUCCESSFULLY COMPLETED THE ASSENT COMPREHENSION ASSESSMENT. PRESS 1 TO CONTINUE.
IF R answered any items incorrectly for M_TB1-M_TB4 (=2), GOTO M_TB6.
M_TB6.
Based on your responses, I will need to review the assent form with you again to make sure you understand what agreeing to take part means.
INTERVIEWER: BACK UP AND REVIEW M_TB1 THROUGH M_TB4. FOR ALL THE DETAILS, MAKE SURE INTRO6 IS A ‘NO’
1 = TRY AGAIN
2 = DO NOT CONTINUE: MINOR NOT ABLE TO PASS COMPREHENSON ASSESSMENT
AFTER THREE ATTEMPTS
PROGRAMMER: USE POP-UP WINDOW TO ALLOW INTERVIEWER TO GO BACK TO INTRO6. POP-UP WINDOW SHOULD SAY: “INTERVIEWER: CLICK ON Goto BELOW AND PLEASE SELECT ‘NO’ WHEN YOU REACH INTRO6 TO REVIEW THE FULL ASSENT STATEMENT WITH THIS PARTICIPANT.”
IF M_TB6 = 2
M_TBEND. Thank you for taking the time to discuss the survey with me. There are many reasons people are eligible or not eligible to complete the survey. Unfortunately, we will not be able to continue with the survey.
AGREE1
Do you agree to participate in today’s survey?
1 = YES, AGREES TO STUDY PARTICIPATION [GO TO AGREE 3]
0 = NO, DOES NOT AGREE TO STUDY PARTICIPATION [GO TO DISAGREE]
AGREE3
We may want to contact you again for another interview in the future to see how you are doing. The interviews may be done at a time that works best for you. You can choose not to participate in future interviews at those times.
Do
you agree to be contacted for future interviews?
1 YES, AGREES TO CONTACT FOR FUTURE INTERVIEWS [GO TO AGREE4]
0 NO, DOES NOT AGREE TO CONTACT FOR FUTURE INTERVIEWS [GO TO AGREE4]
DISAGREE
Thank you for your time.
INTERVIEWER: END CALL/INTERVIEW. DOCUMENT THE SITUATION.
AGREE4
We also use a laptop quality control system on this study. The system runs on the computer and will record what you and I say to each other during parts of the survey. Neither you nor I will know when the computer records what we say. My bosses will listen to the recordings to monitor my work. We keep the recordings for those purposes only and we keep them private. We will destroy the files after this review.
Do we have your okay to run this system during the interview?
1 YES, AGREES TO HAVING PARTS OF THE SURVEY RECORDED FOR QUALITY REVIEWS [GO TO PRIVACY1 IF MODE=TELEPHONE; GO TO RESOURCES IF MODE=IN-PERSON]
0 NO, DOES NOT AGREE TO HAVING PARTS OF THE SURVEY RECORDED [GO TO PRIVACY1 IF MODE=TELEPHONE; GO TO RESOURCES IF MODE=IN-PERSON]
[IF MODE=TELEPHONE] PRIVACY1
Because you may not want others to hear the responses to some of our questions, I would like to be sure you are in a private area. Are you in an area where you can answer these questions privately?
1 YES [GO TO RESOURCES]
0 NO [GO TO PRIVACY2]
PRIVACY2
Please move to a more private area. Do you need more time?
1 YES [GO TO PRIVACY3]
0 NO [GO TO RESOURCES]
PRIVACY3
INTERVIEWER: GIVE THE RESPONDENT TIME TO MOVE TO A MORE PRIVATE AREA. WHEN THE RESPONDENT IS READY, ENTER 1 TO CONTINUE.
RESOURCES
If you are feeling upset by the issues discussed in this survey, the [FILL IF R AGE>=18: “consent”; FILL IF R AGE<18: “assent”] form provides some resources that you can access. I can provide these again at the end of the survey.
INTERVIEWER, IF NECESSARY:
IF THE RESPONDENT HAS ANY QUESTIONS OR CONCERNS ABOUT THIS STUDY, THEY CAN CONTACT:
Jennifer Keeney
RTI
International
3040 Cornwallis Road
Research Triangle Park, NC 27709
919-316-3525
1-800-334-8571 extension 23525
IF THE RESPONDENT AGREES TO BE IN THIS STUDY AND FEELS THAT THEY WERE NOT TREATED FAIRLY, THEY CAN CONTACT:
The Institutional Review Board Administrator
Everett Madden
Urban Institute
500 L’Enfant Plaza SW
Washington, DC 20004
202.261.5632
emadden@urban.org
IF THE RESPONDENT IS FEELING UPSET BY THE ISSUES DISCUSSED IN THIS SURVEY AND WOULD LIKE TO TALK WITH SOMEONE ABOUT THEIR FEELINGS, WE SUGGEST THEY CALL THEIR CURRENT CLINICIAN OR REACH OUT TO ANOTHER PROVIDER ORGANIZATION.
IF NOT, BELOW ARE SOME NUMBERS THEY CAN CALL.
2nd Floor Youth Helpline: Call or text 1-888-222-2228.
Children’s System of Care: Call or text 1-877-652-7624.
INTERVIEWER: ENTER 1 TO CONTINUE.
Demographics
name_w1_fn What is your legal name?
(INTERVIEWER: VERIFY SPELLING)
(INTERVIEWER: IF NEEDED, A LEGAL NAME IS THE NAME THAT IDENTIFIES A PERSON FOR LEGAL, ADMINISTRATIVE, AND OTHER OFFICIAL PURPOSES. A PERSON’S LEGAL NAME GENERALLY IS THE NAME OF THE PERSON THAT WAS GIVEN AT BIRTH AND WHICH THEN APPEARS ON A BIRTH CERTIFICATE. A LEGAL NAME MAY CHANGE, FOR EXAMPLE, FOLLOWING MARRIAGE.)
FIRST NAME:
name_w1_lna LAST NAME:
rage_w1 What is your date of birth?
ENTER MONTH |_|_| (2-DIGIT)
ENTER DAY |_|_| (2-DIGIT)
ENTER YEAR |_|_|_|_| (4-DIGIT)
F3 DON’T KNOW
F4 REFUSED
race1_w1 Are you of Hispanic, Latino, or Spanish origin?
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
race2_w1 What race or races do you consider yourself to be? Would you say you are White, Black or African American, American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, or mixed race? You may select one or more.
1 WHITE
2 BLACK OR AFRICAN AMERICAN
3 AMERICAN INDIAN OR ALASKA NATIVE
4 ASIAN
5 NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER
6 MIXED RACE
F3 DON’T KNOW
F4 REFUSED
lang_w1 What language is usually spoken in your home?
1 ENGLISH
2 SPANISH
3 CHINESE
4 ARABIC
5 GUJARATI
6 OTHER
F3 DON’T KNOW
F4 REFUSED
adopt_w1 Have you ever been adopted?
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
Living Arrangements
LA1_W1 [IF MODE = 2] USE CARD 1. Please look at Card 1. Where do you live now or where you stay most often?
[IF MODE =1] Where do you live now or where do you stay most often?
1 OWN PLACE WITHOUT A HOUSING VOUCHER (APARTMENT, HOUSE, TRAILER, ETC.)
2 OWN PLACE WITH A HOUSING VOUCHER
3 OWN ROOM IN MOTEL, HOTEL, OR SRO
4 IN THE HOME OF BIRTH PARENT(S)
5 IN THE HOME OF ADOPTIVE PARENT(S)
6 IN THE HOME OF OTHER RELATIVE(S)
7 IN THE HOME OF CURRENT RESOURCE/FOSTER PARENT(S)
8 IN THE HOME OF FORMER RESOURCE/FOSTER PARENT(S)
9 IN THE HOME OF SPOUSE/PARTNER
10 IN THE HOME OF FRIEND(S)
11 IN A TRANSITIONAL LIVING PROGRAM (MAY BE REFERRED TO AS ADOLESCENT HOUSING HUB OR INDEPENDENT LIVING PROGRAM)
12 GROUP QUARTERS (DORMITORY, MILITARY BARRACKS, ETC.)
13 HOSPITAL, TREATMENT OR REHAB FACILITY
14 HOMELESS: (YOU HAVE NO REGULAR PLACE TO STAY)
15 OTHER
F3 DON'T KNOW
F4 REFUSED
LA1_W1_OT [IF LA1_W1=15] PLEASE SPECIFY
[TEXT BOX]
F3 DON’T KNOW
F4 REFUSED
LA2_W1 Do you live alone or with others?
1 ALONE
2 WITH OTHERS
F3 DON’T KNOW
F4 REFUSED
LA3_W1 How many times have you moved from one living arrangement to another during the past 12 months?
____ 0-15
F3 DON'T KNOW
F4 REFUSED
LA4_W1 Have you ever couch surfed—that is, moved from one temporary housing arrangement provided by friends, family, or strangers to another during the past 12 months?
1 YES
0 NO
F3 DON'T KNOW
F4 REFUSED
LA5_W1 [IF LA1_W1=14, GO TO SSN0_W1] Have you ever been homeless for at least one night during the past 12 months? That is have you slept in a homeless shelter or in a place where people weren’t meant to sleep because you didn’t have a place to stay?
1 YES
0 NO
F3 DON'T KNOW
F4 REFUSED
Social Support
SSN0_W1 Now I am going to ask a few general questions about the amount of support you receive and the amount of stress that comes from your relationships with people that are important to you. These questions are not just about your parents, caregivers, or friends, but about all the people who are important to you.
1 CONTINUE
SSN1_W1 When you need to talk to someone about something personal or private – for instance, if you had something on your mind that was worrying you or making you feel down – are there enough people you can count on, too few people you can count on, or no one you can count on?
1 ENOUGH PEOPLE YOU CAN COUNT ON
2 TOO FEW PEOPLE YOU CAN COUNT ON
3 NO ONE YOU CAN COUNT ON
F3 DON’T KNOW
F4 REFUSED
SSN2_W1 When you need someone to lend a hand or give you something you needed or pitch in to help you with something – for instance, run an errand for you, lend you money, food, clothing or drive you somewhere you needed to go – are there enough people you can count on, too few people you can count on, or no one you can count on?
1 ENOUGH PEOPLE YOU CAN COUNT ON
2 TOO FEW PEOPLE YOU CAN COUNT ON
3 NO ONE YOU CAN COUNT ON
F3 DON’T KNOW
F4 REFUSED
SSN3_W1 When you need advice or information – for example, if you didn’t know where to get something or how to do something you needed to do – are there enough people you can count on, too few people you can count on, or no one you can count on?
1 ENOUGH PEOPLE YOU CAN COUNT ON
2 TOO FEW PEOPLE YOU CAN COUNT ON
3 NO ONE YOU CAN COUNT ON
F3 DON’T KNOW
F4 REFUSED
SSN4_W1 When it comes to people who have disappointed you – for example, broken promises they’ve made, not come through for you when you most need them, or disappoint you in some other way. Are there many people, some people, a few people, or no one who disappoints you?
1 MANY PEOPLE
2 SOME PEOPLE
3 A FEW PEOPLE
4 NO ONE
F3 DON’T KNOW
F4 REFUSED
SSN5_W1 When it comes to people who butt into your business – for example, watch over the things you do, boss you around, or act like they know what’s best for you – are there many people, some people, a few people, or no one who butts into your business?
1 MANY PEOPLE
2 SOME PEOPLE
3 A FEW PEOPLE
4 NO ONE
F3 DON’T KNOW
F4 REFUSED
SSN6_W1 When it comes to people who criticize you – for instance, put you down or make you feel stupid – are there many people, some people, a few people, or no one who criticizes you?
1 MANY PEOPLE
2 SOME PEOPLE
3 A FEW PEOPLE
4 NO ONE
F3 DON’T KNOW
F4 REFUSED
SSN7_W1 When it comes to people who you have fights or strong disagreements with, are there many people, some people, a few people, or no one who you have fights or strong disagreements with?
1 MANY PEOPLE
2 SOME PEOPLE
3 A FEW PEOPLE
4 NO ONE
F3 DON’T KNOW
F4 REFUSED
Fertility
F1_W1 How many living biological children do you have, regardless of whether they live with you? By biological children, I mean children that you gave birth to or fathered.
INTERVIEWER INSTRUCTION: IF RESPONDENT SAYS S/HE IS EXPECTING A CHILD, PROBE: “Do you have any biological children other than the child that you are expecting?”
ENTER NUMBER |_| (1-DIGIT; CHECK: MIN=0, MAX=9)
F3 DON’T KNOW [Go to F3_W1]
F4 REFUSED [Go to F3_W1]
PROGRAMMER: IF F1_W1=0, THEN GO TO F3_W1
F2_W1 [ASK IF F1 >0] How many of your children currently live with you?
ENTER NUMBER |_| (1-DIGIT; CHECK: MIN=0, MAX=9)
F3 DON’T KNOW
F4 REFUSED
PROGRAMMER: ADD ERROR MESSAGE IF F2_W1>F1_W1:
INTERVIEWER: THE RESPONSE CANNOT BE GREATER THAN [FILL WITH F1_W1], WHICH IS THE NUMBER OF CHILDREN THE RESPONDENT HAS.
F3_W1 Are you currently pregnant or expecting a child?
1 YES [Go to F4_W1]
0 NO [Go to EDU1_W1]
F3 DON’T KNOW [Go to EDU1_W1]
F4 REFUSED [Go to EDU1_W1]
F4_W1 How many weeks along in the pregnancy are you/is your partner?
INTERVIEWER: ENTER WEEKS OR MONTHS.
ENTER MONTHS OR ___ (3-DIGIT; CHECK: MIN=0, MAX=9.5)
ENTER WEEKS |_|_| (2-DIGIT; CHECK: MIN=0, MAX=40)
F3 DON’T KNOW
F4 REFUSED
PROGRAMMER: IF INTERVIEWER ENTERS WEEKS AND MONTHS, ADD A POP-UP ERROR: “INTERVIEWER: ENTER WEEKS OR MONTHS”
Education
EDU1_W1 The next few questions are about your education.
Are you currently enrolled in school full-time, part-time, or are you not in school?
1 YES, ENROLLED FULL-TIME [Go to EDU2_W1]
2 YES, ENROLLED PART-TIME [Go to EDU2_W1]
3 NOT IN SCHOOL [Go to EDU3_W1]
F3 DON’T KNOW [Go to EDU3_W1]
F4 REFUSED [Go to EDU3_W1]
EDU2_W1 What type of school are you enrolled in? Would you say high school, G.E.D. classes, vocational school, 2-year or community college, 4-year college, or something else?
1 HIGH SCHOOL
2 G.E.D. CLASSES
3 VOCATIONAL SCHOOL
4 2-YEAR OR COMMUNITY COLLEGE
5 4-YEAR COLLEGE
6 OTHER
F3 DON’T KNOW
F4 REFUSED
EDU2_W1_O [IF EDU2_W1=6] PLEASE SPECIFY
[TEXT BOX]
F3 DON’T KNOW
F4 REFUSED
EDU3_W1_M [IF EDU_W1=1 OR 2, GO TO EDU4_W1] When were you last enrolled in school--what month and year?
ENTER MONTH |_|_| (2-DIGIT)
F3 DON’T KNOW
F4 REFUSED
EDU3_W1_Y When were you last enrolled in school--what month and year?
AND YEAR |_|_|_|_| (4-DIGIT)
F3 DON’T KNOW
F4 REFUSED
PROGRAMMER: ADD CONSISTENCY CHECK. YEAR CANNOT BE GREATER THAN CURRENT YEAR.
EDU4_W1 What is the highest grade or year of schooling you have completed? Please include any years of college you have completed even if you do not have a college degree. If you are currently attending school, do not count the grade or year that you are in right now.
INTERVIEWER: CODE RESPONSE PROVIDED
1-12 FIRST THROUGH TWELFTH GRADE
13 FIRST YEAR OF VOCATIONAL/TECHNICAL SCHOOL
14 SECOND YEAR OF VOCATIONAL/TECHNICAL SCHOOL
15 FIRST/FRESHMAN YEAR OF COLLEGE
16 SECOND/SOPHOMORE YEAR OF COLLEGE
17 THIRD/JUNIOR YEAR OF COLLEGE
18 FOURTH/SENIOR YEAR OF COLLEGE
F3 DON’T KNOW
F4 REFUSED
EDU5_W1 Do you have a high school diploma, a home school certificate, or a High School Equivalency Certificate after passing the G.E.D., HiSET, or TASC?
1 HIGH SCHOOL DIPLOMA
2 HOME SCHOOL CERTIFICATE
3 HIGH SCHOOL EQUIVALENCY CERTIFICATE AFTER PASSING GED, HiSET, OR TASC
4 I DO NOT HAVE A HIGH SCHOOL DIPLOMA, G.E.D. OR CERTIFICATE
F3 DON’T KNOW
F4 REFUSED
EDU6_W1 Do you have a license or certificate from any vocational training that you received?
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
EDU7_W1 [If EDU5_W1 = 4, go to EDU8_W1]. Do you have a college degree from a two-year college?
1 YES - ASSOCIATES DEGREE OR TWO-YEAR COLLEGE DEGREE
0 NO - NO COLLEGE DEGREE FROM A TWO-YEAR COLLEGE
F3 DON’T KNOW
F4 REFUSED
EDU8_W1 Have you ever repeated a grade or been held back?
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
EDU9_W1 Have you ever been suspended from school?
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
EDU10_W1 Were you ever placed in a special education program?
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
Employment and Earnings
EMP0_W1 Now I’d like to ask you about any work you may have done. I am going to distinguish between two types of work. First, we will talk about formal employment. Formal employment is a job where you had an on-going relationship with a single employer, for example, working in a supermarket or restaurant. Second, we will talk about informal jobs, that is, doing one or a few tasks for several people and not having a "boss", for example, babysitting, mowing lawns, anything under the table, day labor, or work done through an app such as Uber, Doordash, Amazon Flex, or Taskrabbit. Informal jobs are sometimes called freelance, contract, or gig work.
First, let’s talk about any formal work you have done for an employer.
EMP1_W1 Are you currently working at a full or part-time job or jobs?
1 YES [Go to EMP4_W1]
0 NO
F3 DON’T KNOW
F4 REFUSED
EMP2_W1 Have you been formally employed in the past 12 months, that is since (Text fill: (CURRENT MONTH)) (Text fill: (CURRENT YEAR MINUS ONE YEAR))?
1 YES [Go to EMP4_W1]
0 NO
F3 DON’T KNOW
F4 REFUSED
EMP3_W1 Have you ever been formally employed?
1 YES
0 NO [GO TO EMP7_W1]
F3 DON’T KNOW
F4 REFUSED
EMP4_W1 How many hours per week [FILL IF EMP1_W1=1: “do”; FILL IF EMP1_W1=0: “did”] you usually work at formal employment? (PROBE: DURING WEEKS WHEN YOU WORKED).
ENTER HOURS |_|_|_| (5-DIGITS; CHECK: MIN=1, MAX=168)
F3 DON’T KNOW
F4 REFUSED
EMP5_W1 In the past 12 months, how much, in total, did you earn from formal employment?
ENTER AMOUNT $_ _ _,_ _ _. _ _
F3 DON’T KNOW
F4 REFUSED
EMP6_W1 [ASK IF EMP5_W1 = D OR R] Would you say it is …
1 Less than $1,000
2 $1,000 but less than $5,000
3 $5,000 but less than $15,000
4 $15,000 but less than $20,000
5 $20,000 but less than $25,000
6 More than $25,000
F3 DON’T KNOW
F4 REFUSED
EMP7_W1 Now let’s talk about informal jobs such as baby-sitting, lawn mowing, day labor, work done through an app such as Uber or Amazon Flex, or work that is done “under the table”. Have you had any informal jobs in the past 12 months?
1 YES
0 NO [GO TO EMPEND]
F3 DON’T KNOW
F4 REFUSED
EMP8_W1 In the past 12 months, how much did you earn from informal employment, in total?
ENTER AMOUNT $_ _ _,_ _ _. _ _
F3 DON’T KNOW
F4 REFUSED
EMP9_W1 (ASK IF EMP8_W1 = D OR R) Would you say it is …
1 Less than $1,000
2 $1,000 but less than $5,000
3 $5,000 but less than $15,000
4 $15,000 but less than $20,000
5 $20,000 but less than $25,000
6 More than $25,000
F3 DON’T KNOW
F4 REFUSED
EMPEND
Economic Hardships
ECON1_W1 The next few questions are about financial challenges you may have experienced.
Was there ever a time during the past 12 months when you did not buy clothing or shoes that you needed because you did not have enough money?
1 YES
0 NO
F3 DON'T KNOW
F4 REFUSED
ECON2_W1 Was there ever a time during the past 12 months when you could not pay your rent or mortgage because you did not have enough money?
1 YES
0 NO
2 DOES NOT APPLY TO ME, I DO NOT PAY FOR HOUSING
F3 DON'T KNOW
F4 REFUSED
ECON3_W1 Was there ever a time during the past 12 months when you could not pay a utility bill because you did not have enough money? By utility bill, I mean a bill for gas, electricity or telephone service.
1 YES
0 NO
2 DOES NOT APPLY TO ME, I DO NOT PAY FOR UTILITIES
F3 DON'T KNOW
F4 REFUSED
ACASI Set Up
IF MODE = 1. GOTO ACASI_PHONE
IF MODE = 2 GOTO ACASI_Intro
PROGRAMMER: THROUGHOUT THE ACASI SECTION, THERE SHOULD BE HOT KEYS FOR THE FOLLOWING OPTIONS:
F11 REPLAY QUESTION/RESPONSES
Ctrl+F11 TURN QUESTION/RESPONSE AUDIO ON/OFF
ACASI_Phone.
The next set of questions may seem more personal to you. Some questions ask about your emotions, alcohol or drug use, or behavior that might be against the law. Please remember that everything you tell me will be kept private in the ways that we talked about at the beginning of the survey. You may refuse to answer any question you do not want to answer.
GOTO sex_W1
IF MODE = 2
ACASI_Intro (INTERVIEWER: THIS IS THE BEGINNING OF THE FIRST PART OF THE AUDIO SELF INTERVIEW)
For this next section of questions, I’m going to hand the laptop over to you so that you can enter your answers yourself. I have headphones for you to use so that you can listen to questions being read to you. You can keep the headphones as a gift. I will not be able to hear the questions or see the answers you type into the laptop. Some of the questions might be sensitive, so this way, you can listen and answer privately.
This section is very important – that is why it is set up this way using the laptop with the headphones. Please settle in and take your time to listen to the questions and give your answers. This section will take 5 to 10 minutes or so. If you have any questions for me during this section, just let me know.
1 CONTINUE
ACASI_Start INTERVIEWER: HELP THE RESPONDENT GET SET UP AT THE LAPTOP AND USE THE HEADPHONES
ADJUST VOLUME
IF THERE IS A REASON WHY THE AUDIO PORTION CAN NOT BE ADMINISTERED (I.E. CONDITIONS WILL NOT ALLOW, ETC), ENTER '2' AND SPECIFY THE REASON.
1 PROCEED TO AUDIO SECTION AFTER RESPONDENT IS SEATED AND READY TO CONTINUE
2 SKIP AUDIO SECTION (SPECIFY REASON)
ACASI_SPECI [IF ACASI_START=2] WHY IS ACASI BEING SKIPPED?
[TEXT BOX]
ACint2 ENTER 1 TO BEGIN AUDIO PORTION
1 BEGIN AUDIO PORTION
ac1a For these next questions, please listen to the questions and answers. Type the number associated with your answer and then press Enter.
If at any time you do not want to answer the question, please press the “F4” key for "refused" and press Enter. If you do not know the answer, please give your best estimate. If you're still not sure, press the “F3” key for "don't know" and press Enter.
When you are ready to continue type “1” and press Enter.
1 CONTINUE
ac1a2 For example, here is a practice question:
Today, the weather is nice.
Would you agree or disagree?
Enter 1 for AGREE or 2 for DISAGREE.
1 AGREE
2 DISAGREE
F3 DON’T KNOW
F4 REFUSED
ac1c That ends our example question. If you would like to listen to the question and answers again, please press “F11”. If you would like to turn off the audio for the questions and answers, please press “Ctrl” and “F11” at the same time. To turn the audio for the questions and answers back on, please press “Ctrl” and “F11” at the same time again. If you have any questions before we begin, please ask the interviewer now. When you are ready, enter 1 to continue.
1 CONTINUE
ACpause Please sit comfortably and adjust your headphones. This section will take about 5 to 10 minutes. If at any time you would like the interviewer to read these questions instead of listening to the audio, just let the interviewer know.
Enter 1 to continue.
Demographics
sex_w1 What sex were you assigned at birth, on your original birth certificate?
IF MODE=1, THEN RESPONSE OPTION FORMATTING:
1 MALE
2 FEMALE
F3 DON’T KNOW
F4 REFUSED
IF MODE=2, THEN REPSONSE OPTION FORMATTING:
Male
Female
F3 DON’T KNOW
F4 REFUSED
gender_w1 What gender do you identify as?
IF MODE=1, THEN RESPONSE OPTION FORMATTING:
[INTERVIEWER: If needed, definitions noted in brackets]
1 GENDERQUEER/NONBINARY [DO NOT IDENTIFY AS EITHER A WOMAN NOR A MAN]
2 TRANSGENDER MAN [ASSIGNED FEMALE AT BIRTH BUT IDENTIFY AS A MAN]
3 TRANSGENDER WOMAN [ASSIGNED MALE AT BIRTH BUT IDENTIFY AS A WOMAN]
4 CISGENDER WOMAN [ASSIGNED FEMALE AT BIRTH AND IDENTIFY AS A WOMAN]
5 CISGENDER MAN [ASSIGNED MALE AT BIRTH AND IDENTIFY AS A MAN]
6 SOMETHING ELSE
F3 DON’T KNOW
F4 REFUSED
IF MODE=2, THEN RESPONSE OPTION FORMATTING:
1 Genderqueer/Nonbinary (do not identify as either a woman nor a man)
2 Transgender man (assigned female at birth but identify as a man)
3 Transgender woman (assigned male at birth but identify as a woman)
4 Cisgender woman (assigned female at birth and identify as a woman)
5 Cisgender man (assigned male at birth and identify as a man)
6 SOMETHING ELSE
F3 DON’T KNOW
F4 REFUSED
gender_w1_ [IF gender_W1=6 AND MODE=1]
Please specify your gender identity if you would like to.
INTERVIEWER: ENTER RESPONDENT’S GENDER IDENTITY.
F3 DON’T KNOW
F4 REFUSED
[IF gender_W1=6 AND MODE=2] Please specify your gender identity if
you would like to:
[TEXT BOX]
F3 DON’T KNOW
F4 REFUSED
sorient_w1 Which of the following best represents how you think of yourself?
IF MODE=1, THEN REPSONSE OPTION FORMATTING:
[INTERVIEWER: If needed, definitions noted in brackets]
1 Gay or lesbian
2 Bisexual
3 Pansexual
4 Asexual
5 Straight or heterosexual
6 Something else
F3 DON’T KNOW
F4 REFUSED
IF MODE=2, THEN RESPONSE OPTION FORMATTING:
1 Gay or lesbian
2 Bisexual
3 Pansexual
4 Asexual
5 Straight or heterosexual
6 Something else
F3 DON’T KNOW
F4 REFUSED
sorient_w1_m [IF sorient_W1=6 AND MODE=1] Please specify your sexual orientation if you would like to.
INTERVIEWER: ENTER RESPONDENT’S SEXUAL ORIENTATION
F3 DON’T KNOW
F4 REFUSED
[IF sorient_W1=6 AND MODE=2] Please specify your sexual orientation if you would like to.
[TEXT BOX]
F3 DON’T KNOW
F4 REFUSED
Mental Health Services
MH1_W1 Do you have an emotional problem that occasionally causes you to miss a day of school, work, or social or recreational activities?
IF MODE=1, THEN RESPONSE OPTION FORMATTING:
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
IF MODE=2, THEN RESPONSE OPTION FORMATTING:
1 Yes
0 No
F3 DON’T KNOW
F4 REFUSED
MH2_W1 In the past 12 months, have you received psychological or emotional counseling?
IF MODE=1, THEN RESPONSE OPTION FORMATTING:
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
IF MODE=2, THEN RESPONSE OPTION FORMATTING:
1 Yes
0 No
F3 DON’T KNOW
F4 REFUSED
MH3_W1 In the past 12 months did you receive medication for a psychological or emotional problem?
IF MODE=1, THEN RESPONSE OPTION FORMATTING:
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
IF MODE=2, THEN RESPONSE OPTION FORMATTING:
1 Yes
0 No
F3 DON’T KNOW
F4 REFUSED
MH4_W1 In the past 12 months were you in a psychiatric hospital?
IF MODE=1, THEN RESPONSE OPTION FORMATTING:
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
IF MODE=2, THEN RESPONSE OPTION FORMATTING:
1 Yes
0 No
F3 DON’T KNOW
F4 REFUSED
Substance Abuse
SA1_W1 In the past 30 days, have you had a drink of an alcoholic beverage? By a drink we mean a can or bottle of beer, a glass of wine, a mixed drink, or a shot of liquor.
IF MODE=1, THEN RESPONSE OPTION FORMATTING:
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
IF MODE=2, THEN RESPONSE OPTION FORMATTING:
1 Yes
0 No [Go to SA3_W1]
F3 DON’T KNOW [Go to SA3_W1]
F4 REFUSED [Go to SA3_W1]
SA2_W1 On how many days did you have five or more drinks on the same occasion during the past 30 days? By occasion we mean at the same time or within hours of each other.
IF MODE=1, THEN RESPONSE OPTION FORMATTING:
ENTER DAYS: |_|_| (2=DIGIT; CHECK: MIN=0, MAX=30)
F3 DON’T KNOW
F4 REFUSED
IF MODE=2, THEN RESPONSE OPTION FORMATTING:
Enter Days: |_|_| (2-DIGIT; CHECK: MIN=0, MAX=30)
F3 DON’T KNOW
F4 REFUSED
SA3_W1 In the past 30 days, have you used any illegal drugs? This includes marijuana, heroin, cocaine, amphetamines (uppers, speed, etc.), barbiturates (downers), sniffing/huffing, hallucinogens (mushrooms, LSD, acid), or club drugs (Ecstasy, Special K, GHB)?
IF MODE=1, THEN RESPONSE OPTION FORMATTING:
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
IF MODE=2, THEN RESPONSE OPTION FORMATTING:
1 Yes
0 No
F3 DON’T KNOW
F4 REFUSED
SA4_W1 In the past 30 days, have you used any prescription drugs without a doctor’s permission, or beyond what your prescription requires?
IF MODE=1, THEN RESPONSE OPTION FORMATTING:
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
IF MODE=2, THEN RESPONSE OPTION FORMATTING:
1 Yes
0 No
F3 DON’T KNOW
F4 REFUSED
SA5_W1 In the past 12 months, did you get any kind of treatment for an alcohol or drug problem?
IF MODE=1, THEN RESPONSE OPTION FORMATTING:
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
IF MODE=2, THEN RESPONSE OPTION FORMATTING:
1 Yes
0 No
F3 DON’T KNOW
F4 REFUSED
Criminal Justice Involvement
CRM1_W1 Have you ever been arrested?
IF MODE=1, THEN RESPONSE OPTION FORMATTING:
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
IF MODE=2, THEN RESPONSE OPTION FORMATTING:
1 Yes
0 No
F3 DON’T KNOW
F4 REFUSED
CRM2_W1 Have you ever spent at least one night in a jail, prison, juvenile hall, or
another correctional facility?
IF MODE=1, THEN RESPONSE OPTION FORMATTING:
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
IF MODE=2, THEN RESPONSE OPTION FORMATTING:
1 Yes
0 No
F3 DON’T KNOW
F4 REFUSED
Spouse/Partner Violence
REL0_W1 The next set of questions is about romantic relationships you might currently have.
REL1_W1 Are you currently married or involved in a dating or romantic relationship?
IF MODE=1, THEN RESPONSE OPTION FORMATTING:
YES [Go to CTS0_W1]
NO [Go to CTSEND]
F3 DON’T KNOW [Go to CTSEND]
F4 REFUSED [Go to CTSEND]
IF MODE=2, THEN RESPONSE OPTION FORMATTING:
1 Yes [Go to CTS0_W1]
0 No [Go to CTSEND]
F3 DON’T KNOW [Go to CTSEND]
F4 REFUSED [Go to CTSEND]
CTS0_W1 No matter how well a couple gets along, there are times when they disagree or fight. Couples may also have different ways of dealing with conflicts when they occur. I am going to read you a list of things that might have happened in your relationship with your partner. Please tell me how many times each of these things happened during the past year: never, once, twice, three to five times, six to ten times, eleven to twenty times or more than twenty times.
CTS1_W1 How often has your spouse/partner slapped, hit, choked, or kicked, pushed or shoved you, or thrown something at you that could hurt during the past year?
IF MODE=1, THEN RESPONSE OPTION FORMATTING:
INTERVIEWER: READ RESPONSES, IF NECESSARY
0 NEVER IN THE PAST YEAR
1 ONCE IN THE PAST YEAR
2 TWICE IN THE PAST YEAR
3 3-5 TIMES IN THE PAST YEAR
4 6-10 TIMES IN THE PAST YEAR
5 11-20 TIMES IN THE PAST YEAR
6 MORE THAN 20 TIMES IN THE PAST YEAR
F3 DON’T KNOW
F4 REFUSED
IF MODE=2, THEN RESPONSE OPTION FORMATTING:
0 Never in the past year
1 Once in the past year
2 Twice in the past year
3 3-5 times in the past year
4 6-10 times in the past year
5 11-20 times in the past year
6 More than 20 times in the past year
F3 DON’T KNOW
F4 REFUSED
CTS2_W1 How often has your spouse/partner insisted on or made you have sexual relations with them when you didn’t want to during the past year?
IF MODE=1, THEN RESPONSE OPTION FORMATTING:
INTERVIEWER: READ RESPONSES, IF NECESSARY
0 NEVER IN THE PAST YEAR
1 ONCE IN THE PAST YEAR
2 TWICE IN THE PAST YEAR
3 3-5 TIMES IN THE PAST YEAR
4 6-10 TIMES IN THE PAST YEAR
5 11-20 TIMES IN THE PAST YEAR
6 MORE THAN 20 TIMES IN THE PAST YEAR
F3 DON’T KNOW
F4 REFUSED
IF MODE=2, THEN RESPONSE OPTION FORMATTING:
0 Never in the past year
1 Once in the past year
2 Twice in the past year
3 3-5 times in the past year
4 6-10 times in the past year
5 11-20 times in the past year
6 More than 20 times in the past year
F3 DON’T KNOW
F4 REFUSED
CTS3_W1 How often have you slapped, hit, choked, or kicked, pushed or shoved, or thrown something at your spouse/partner that could hurt during the past year?
IF MODE=1, THEN RESPONSE OPTION FORMATTING:
INTERVIEWER: READ RESPONSES, IF NECESSARY
0 NEVER IN THE PAST YEAR
1 ONCE IN THE PAST YEAR
2 TWICE IN THE PAST YEAR
3 3-5 TIMES IN THE PAST YEAR
4 6-10 TIMES IN THE PAST YEAR
5 11-20 TIMES IN THE PAST YEAR
6 MORE THAN 20 TIMES IN THE PAST YEAR
F3 DON’T KNOW
F4 REFUSED
IF MODE=2, THEN RESPONSE OPTION FORMATTING:
0 Never in the past year
1 Once in the past year
2 Twice in the past year
3 3-5 times in the past year
4 6-10 times in the past year
5 11-20 times in the past year
6 More than 20 times in the past year
F3 DON’T KNOW
F4 REFUSED
CTS4_W1 How often have you insisted on or made your spouse/partner have sexual relations with you when they didn’t want to during the past year?
IF MODE=1, THEN RESPONSE OPTION FORMATTING:
INTERVIEWER: READ RESPONSES, IF NECESSARY
0 NEVER IN THE PAST YEAR
1 ONCE IN THE PAST YEAR
2 TWICE IN THE PAST YEAR
3 3-5 TIMES IN THE PAST YEAR
4 6-10 TIMES IN THE PAST YEAR
5 11-20 TIMES IN THE PAST YEAR
6 MORE THAN 20 TIMES IN THE PAST YEAR
F3 DON’T KNOW
F4 REFUSED
IF MODE=2, THEN RESPONSE OPTION FORMATTING:
0 Never in the past year
1 Once in the past year
2 Twice in the past year
3 3-5 times in the past year
4 6-10 times in the past year
5 11-20 times in the past year
6 More than 20 times in the past year
F3 DON’T KNOW
F4 REFUSED
[CTSEND]
[END ACASI]. [IF MODE= 2]. Please tell the interviewer you are done.
PASSWORD [IF MODE=2] INTERVIEWER: ENTER PASSWORD TO CONTINUE.
[TEXT BOX FOR PASSWORD]
PROGRAMMER: FOR TESTING PURPOSES, THE PASSWORD CAN BE LIFESET
Youth Resiliency
YR0_W1 Please use the answer choices to tell us how much each statement is—or is not—like you. The answer choices are not at all like me, a little like me, sort of like me, a lot like me, or very much like me.
YR1_W1 I learn from my mistakes.
Not at all like me
A little like me
Sort of like me
A lot like me
Very much like me
F3 DON’T KNOW
F4 REFUSED
YR2_W1 I believe I will be okay even when bad things happen.
Not at all like me
A little like me
Sort of like me
A lot like me
Very much like me
F3 DON’T KNOW
F4 REFSUED
YR3_W1 I do a good job in handling problems in my life.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
YR4_W1 I try new things even if they are hard.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
YR5_W1 When I have a problem, I come up with ways to solve it.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
YR6_W1 I give up when things get hard.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
YR7_W1 I deal with my problems in a positive way, like asking for help.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
YR8_W1 I keep trying to solve problems even when things don’t go my way.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
YR9_W1 Failure just makes me try harder.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
YR10_W1 No matter how bad things get, I know the future will be better.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
Social-Emotional Competence
SEC1_W1 I think about my choices before making a decision.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
SEC2_W1 I ask for advice from someone I trust before making an important decision.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
SEC3_W1 I make plans and work hard to reach my goals.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
SEC4_W1 I get along well with different types of people.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
SEC5_W1 I am easily distracted.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
SEC6_W1 I stand up for what I believe even if other people don’t agree with me.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
SEC7_W1 If I make a promise, I try to keep it.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
SEC8_W1 I care about other people.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
SEC9_W1 I am an honest person.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
SEC10_W1 I have difficulty controlling my anger.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
SEC11_W1 I am a dependable person.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
SEC12_W1 I know how to act in different social situations, such as school, home, work and church, mosque, or temple.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
SEC13_W1 I try to imagine how someone might feel before criticizing them.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
SEC14_W1 I feel bad when people I know are upset.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
SEC15_W1 I can express my positive feelings to other people.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
SEC16_W1 I am sad most of the time.
INTERVIEWER: READ RESPONSES, IF NECESSARY.
NOT AT ALL LIKE ME
A LITTLE LIKE ME
SORT OF LIKE ME
A LOT LIKE ME
VERY MUCH LIKE ME
F3 DON’T KNOW
F4 REFUSED
LifeSet Services
FOR LifeSet TREATMENT GROUP ONLY
[IF COMMUNITY SERVICES/CONTROL GROUP: GO TO CON0_W1]
LSS1_W1 The next questions are about a service you may be receiving.
Have you been contacted by someone to participate in a program called LifeSet?
1 YES [GO TO LSS2_W1]
0 NO [GO TO NEXT SECTION]
F3 DON’T KNOW [GO TO NEXT SECTION]
F4 REFUSED [GO TO NEXT SECTION]
LSS2_W1 Have you met with someone in order to enroll in LifeSet?
1 YES [GO TO LSS3_W1]
0 NO [GO TO NEXT SECTION]
F3 DON’T KNOW [GO TO NEXT SECTION]
F4 REFUSED [GO TO NEXT SECTION]
LSS3_W1 Do you have an assigned LifeSet Specialist?
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
Information for Follow Up Contact
CON0_W1 Here are the last few questions in the interview.
Now I would like to ask you some questions that will help us to contact you in the future when we interview you again. Please remember that we will only use the information that you give us in order to find you. We will not be asking any of these people for any other information about you. Also please remember that what you have told me will be kept private and that we will not be sharing any of your answers to today's questions with any of these other people.
INTERVIEWER: ENTER “1” TO CONTINUE
1 CONTINUE
CON1_W1 First, do you have a nickname or other name that you are commonly known by?
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
CON1_W1_N [IF CON1_W1=1] [TEXT BOX FOR NAME]
CON14_W1 [ASK IF adopt_W1 = 1, ELSE GO TO CON26_W1] Is your adoptive mother still alive?
1 YES [Go to CON15_W1]
0 NO [Go to CON20_W1]
F3 DON’T KNOW [Go to CON20_W1]
F4 REFUSED [Go to CON20_W1]
CON15_W1 Do you know your adoptive mother's name?
1 YES [Go to CON16_W1]
0 NO [Go to CON20_W1]
F3 DON’T KNOW [Go to CON20_W1]
F4 REFUSED [Go to CON20_W1]
CON16_W1 What is your adoptive mother’s first and last name?
[TEXT BOX FOR NAME]
F3 DON’T KNOW
F4 REFUSED
CON17_W1 Do you know where your adoptive mother is living right now?
1 YES [Go to CON18_W1]
0 NO [Go to CON19_W1]
F3 DON’T KNOW [Go to CON19_W1]
F4 REFUSED [Go to CON19_W1]
CON18_W1 What is your adoptive mother's full address?
[FIELDS FOR ADDRESS]
F3 DON’T KNOW
F4 REFUSED
CON19_W1 What is your adoptive mother's telephone number?
[TEXT BOX FOR PHONE NUMBER]
F3 DON’T KNOW
F4 REFUSED
CON20_W1 Is your adoptive father still alive?
1 YES [Go to CON21_W1]
0 NO [Go to CON26_W1]
F3 DON’T KNOW [Go to CON26_W1]
F4 REFUSED [Go to CON26_W1]
CON21_W1 Do you know your adoptive father's name?
1 YES [Go to CON22_W1]
0 NO [Go to CON26_W1]
F3 DON’T KNOW [Go to CON26_W1]
F4 REFUSED [Go to CON26_W1]
CON22_W1 What is your adoptive father’s first and last name?
[TEXT
BOX FOR NAME]
F3 DON’T KNOW
F4 REFUSED
CON23_W1 Do you know where your adoptive father is living right now?
1 YES [Go to CON24_W1]
0 NO [Go to CON25_W1]
F3 DON’T KNOW [Go to CON25_W1]
F4 REFUSED [Go to CON25_W1]
CON24_W1 What is your adoptive father's full address?
[FIELDS FOR ADDRESS]
F3 DON’T KNOW
F4 REFUSED
CON25_W1 What is your adoptive father's telephone number?
[TEXT BOX FOR PHONE NUMBER]
F3 DON’T KNOW
F4 REFUSED
CON26_W1 [IF adopt_W1=2] Do you have any brothers or sisters? Include half-brothers or half-sisters and stepbrothers and stepsisters.
[IF adopt_W1=1] Do you have any brothers or sisters? Include half-brothers or half-sisters, stepbrothers or stepsisters, and adoptive brothers and sisters.
1 YES [GO TO CON27_W1]
0 NO [GO TO CON31_W1]
F3 DON’T KNOW [GO TO CON31_W1]
F4 REFUSED [GO TO CON31_W1]
CON27_W1 How many brothers and sisters do you have?
[TEXT BOX FOR NUMBER; MIN=1; MAX=?]
[IF adopt_W1=2] INTERVIEWER, IF NEEDED: “Include half-brothers or half-sisters and stepbrothers and stepsisters.”
[IF adopt_W1=1] INTERVIEWER, IF NEEDED: Include half-brothers or half-sisters, stepbrothers or stepsisters, and adoptive brothers and sisters.
F3 DON’T KNOW [GO TO CON31_W1]
F4 REFUSED [GO TO CON31_W1]
CON27A_W1 [PROGRAMMER: FOR FIRST SIBLING, IF R HAS MORE THAN ONE SIBLING] Let’s start with your oldest sibling. What is this sibling’s first and last name?
[PROGRAMMER: IF R HAS ONE SIBLING] What is this sibling’s first and last name?
[PROGRAMMER: FOR ALL OTHER SIBLINGS AFTER THE FIRST, IF R HAS MORE THAN ONE SIBLING] And the next oldest sibling. What is this sibling’s first and last name?
[TEXT BOX]
F3 DON’T KNOW
CON27B_W1 What is [FILL: CON27A_W1]’s relationship to you?
1 BROTHER
2 SISTER
3 HALF-BROTHER
4 HALF-SISTER
5 STEP BROTHER
6 STEP SISTER
7 ADOPTIVE BROTHER
8 ADOPTIVE SISTER
F3 DON’T KNOW
F4 REFUSED
CON27C_W1 INTERVIEWER: IF NEEDED, “Any other siblings?”
1 YES [LOOP BACK TO CON27A_W1]
0 NO [GO
TO CON28_W1]
PROGRAMMER NOTE: LOOP THROUGH FOR CON27_W1 NUMBER OF SIBLINGS
PROGRAMMER: IF RESPONDENT HAS 9 SIBLINGS, DON’T ASK CON27C_W1 AFTER THE NINTH SIBLING.
CON28_W1 [ASK IF R HAS MORE THAN ONE SIBLING] Which of these brothers and/or sisters are you closest to?
PROGRAMMER: FILL WITH SIBLINGS LISTED IN CON27A_W1
INTERVIEWER: PLEASE SELECT ONE AND ENTER FIRST AND LAST NAME
F3 DON’T KNOW [GO TO CON31_W1]
F4 REFUSED [GO TO CON31_W1]
CON29_W1 What is [FILL: SIBLING NAME]'s full address?
[FIELDS FOR ADDRESS]
F3 DON’T KNOW
F4 REFUSED
CON30_W1 What is [FILL: SIBLING NAME]'s telephone number?
[TEXT BOX FOR PHONE NUMBER]
F3 DON’T KNOW
F4 REFUSED
CON31_W1 Which adult relative, other than your parents and siblings, have you seen the most often in the last 5 years?
INTERVIEWER: PLEASE ENTER A NAME. IF THE R IS NOT CLOSE TO ANY RELATIVE, ENTER ‘999’.
[TEXT BOX FOR FIRST AND LAST NAME]
999 NO RELATIVE [GO TO CON2_W1]
F3 DON’T KNOW [GO TO CON2_W1]
F4 REFUSED [GO TO CON2_W1]
CON31A_W1 What is [FILL RELATIVE’S NAME]’s relationship to you?
[PROGRAMMER: LIST OF RELATIONSHIP TYPES ARE:
1 AUNT
2 UNCLE
3 GRANDMOTHER
4 GRANDFATHER
5 COUSIN
6 NIECE
7 NEPHEW
8 BROTHER-IN-LAW
9 SISTER-IN-LAW
10 MOTHER-IN-LAW
11 FATHER-IN-LAW
12 OTHER, SPECIFY]
F3 DON’T KNOW
F4 REFUSED
CON31B_W1 [IF CON31A_W1=12] ENTER RELATIONSHIP.
[TEXT BOX]
F3 DON’T KNOW
F4 REFUSED
CON32_W1 What is [FILL RELATIVE’S NAME]'s full address?
[FIELDS FOR ADDRESS]
F3 DON’T KNOW
F4 REFUSED
CON33_W1 What is [FILL RELATIVE’S NAME]'s telephone number?
[TEXT BOX FOR PHONE NUMBER]
F3 DON’T KNOW
F4 REFUSED
CON2_W1 The next set of items ask about your bio-parents’ contact information. Some people find it upsetting to talk about their bio-parents. If you would prefer not to talk about one or both of your bio-parents, just let me know and we can skip those items.
Is your biological mother still alive?
1 YES
0 NO [Go to CON8_W1]
F3 DON’T KNOW [Go to CON8_W1]
F4 REFUSED [Go to CON8_W1]
CON3_W1 Do you know your biological mother's name?
1 YES [Go to CON4_W1]
0 NO [Go to CON8_W1]
F3 DON’T KNOW [Go to CON8_W1]
F4 REFUSED [Go to CON8_W1]
CON4_W1 What is your biological mother's first and last name?
[TEXT BOX]
F3 DON’T KNOW
F4 REFUSED
CON5_W1 Do you know where your biological mother is living right now?
1 YES [Go to CON6_W1]
0 NO [Go to CON7_W1]
F3 DON’T KNOW [Go to CON7_W1]
F4 REFUSED [Go to CON7_W1]
CON6_W1 What is your biological mother's full address?
[FIELDS FOR ADDRESS]
F3 DON’T KNOW
F4 REFUSED
CON7_W1 What is your biological mother's telephone number?
[TEXT BOX FOR PHONE NUMBER]
F3 DON’T KNOW
F4 REFUSED
CON8_W1
INTERVIEWER: ENTER REFUSED (F4) HERE IF THE RESPONDENT DOES NOT WANT TO PROVIDE INFO ABOUT EITHER BIO PARENT
Is your biological father still alive?
1 YES [Go to CON9_W1]
0 NO [Go to CON34_W1]
F3 DON’T KNOW [Go to CON34_W1]
F4 REFUSED [Go to CON34_W1]
CON9_W1 Do you know your biological father's name?
1 YES [Go to CON10_W1]
0 NO [Go to CON34_W1]
F3 DON’T KNOW [Go to CON34_W1]
F4 REFUSED [Go to CON34_W1]
CON10_W1 What is your biological father’s first and last name?
[TEXT BOX FOR NAME]
F3 DON’T KNOW
F4 REFUSED
CON11_W1 Do you know where your biological father is living right now?
1 YES [Go to CON12_W1]
0 NO [Go to CON13_W1]
F3 DON’T KNOW [Go to CON13_W1]
F4 REFUSED [Go to CON13_W1]
CON12_W1 What is your biological father's full address?
[FIELDS FOR ADDRESS]
F3 DON’T KNOW
F4 REFUSED
CON13_W1 What is your biological father's telephone number?
[TEXT BOX FOR PHONE NUMBER]
F3 DON’T KNOW
F4 REFUSED
CON34_W1 Other
than the people you have already told me about, is there another
person that you are close with and who would be able to help us
contact you in the future?
INTERVIEWER: IF THE R IS NOT CLOSE TO ANY OTHERS, ENTER ‘999’.
[TEXT BOX FOR FIRST AND LAST NAME]
999 NO OTHERS [GO TO CON37_W1]
F3 DON’T KNOW [GO TO CON37_W1]
F4 REFUSED [GO TO CON37_W1]
CON34B_W1 What is [FILL PERSON’S NAME]’s relationship to you?
[PROGRAMMER: LIST OF RELATIONSHIP TYPES ARE:
STEP-MOTHER
FOSTER MOTHER
STEP-FATHER
FOSTER FATHER
SPOUSE/PARTNER
CLOSE FRIEND
BROTHER-IN-LAW
SISTER-IN-LAW
MOTHER-IN-LAW
FATHER-IN-LAW
OTHER, SPECIFY
F3 DON’T KNOW
F4 REFUSED
CON34C_W1 [IF CON34B_W1=11] ENTER RELATIONSHIP.
[TEXT BOX]
F3 DON’T KNOW
F4 REFUSED
CON35_W1 What is [FILL PERSON’S NAME]'s full address?
[FIELDS FOR ADDRESS]
F3 DON’T KNOW
F4 REFUSED
CON36_W1 What is [FILL PERSON’S NAME]'s telephone number?
[TEXT BOX FOR PHONE NUMBER]
F3 DON’T KNOW
F4 REFUSED
CON37_W1 The next few questions are about your use of social media. We want to make sure we are able to invite you to participate in the next round. We may use information you provide to help us contact you in the future using the social media platform’s private messaging features. We will never post anything on your profile.
Some people use a name other than their full name on Facebook. What is your profile name on Facebook?
NAME ON FILE: [FILL WITH: name_w1_fn name_w1_lna; IF name_w1_fn OR name_w1_lna=DK OR R, THEN FILL WITH RESPONDENT FIRST AND LAST NAME FROM AGENCY FILE]
1 R USES NAME ON FILE
2 R USES ANOTHER NAME (SPECIFY)
3 R DOES NOT USE FACEBOOK
F3 DON’T KNOW
F4 REFUSED
CON37_W1_NAME [IF CON37_W1=2] [TEXT BOX FOR THE NAME]
F3 DON’T KNOW
F4 REFUSED
CON38_W1 Some people use a name other than their full name on Instagram. What is your profile name on Instagram?
(IF NEEDED: We want to make sure we are able to invite you to participate in the next round. We may use this to help us contact you in the future using the platform’s private messaging features. We will never post anything on your profile.)
NAME ON FILE: [FILL WITH: name_w1_fn name_w1_lna; IF name_w1_fn OR name_w1_lna=DK OR R, THEN FILL WITH RESPONDENT FIRST AND LAST NAME FROM AGENCY FILE]
1 R USES NAME ON FILE
2 R USES ANOTHER NAME (SPECIFY)
3 R DOES NOT USE INSTAGRAM
F3 DON’T KNOW
F4 REFUSED
CON38_W1_NAME [IF CON38_W1=2] [TEXT BOX FOR THE NAME]
F3 DON’T KNOW
F4 REFUSED
CON39_W1 Some people use a name other than their full name on Snapchat. What is your profile name on Snapchat?
(IF NEEDED: We want to make sure we are able to invite you to participate in the next round. We may use this to help us contact you in the future using the platform’s private messaging features. We will never post anything on your profile.)
NAME ON FILE: [FILL WITH: name_w1_fn name_w1_lna; IF name_w1_fn OR name_w1_lna=DK OR R, THEN FILL WITH RESPONDENT FIRST AND LAST NAME FROM AGENCY FILE]
1 R USES NAME ON FILE
2 R USES ANOTHER NAME (SPECIFY)
3 R DOES NOT USE SNAPCHAT
F3 DON’T KNOW
F4 REFUSED
CON39_W1_NAME [IF CON39_W1=2] [TEXT BOX FOR NAME]
F3 DON’T KNOW
F4 REFUSED
CON40_W1 Some people use a name other than their full name on TikTok. What is your profile name on TikTok?
(IF NEEDED: We want to make sure we are able to invite you to participate in the next round. We may use this to help us contact you in the future using the platform’s private messaging features. We will never post anything on your profile.)
NAME ON FILE: [FILL WITH: name_w1_fn name_w1_lna; IF name_w1_fn OR name_w1_lna=DK OR R, THEN FILL WITH RESPONDENT FIRST AND LAST NAME FROM AGENCY FILE]
1 R USES NAME ON FILE
2 R USES ANOTHER NAME (SPECIFY)
3 R DOES NOT USE TIKTOK
F3 DON’T KNOW
F4 REFUSED
CON40_W1_NAME [IF CON40_W1=2] [TEXT BOX FOR NAME]
F3 DON’T KNOW
F4 REFUSED
CON41_W1 [IF R AGE>21, THEN GO TO CON42_W1] Do you plan to move once you are no longer involved with Child Protection and Permanency, or CP&P?
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
CON41B_W1 [IF CON41_W1=1] Could you tell me where you plan to move?
[ADDRESS FIELDS]
F3 DON’T KNOW
CON42_W1 Do you intend to join the armed forces?
1 YES
0 NO
F3 DON’T KNOW
F4 REFUSED
[IF CON42_W1=1, THEN GO TO CON43_W1. ELSE, GO TO TY_TINCEN IF MODE=1 OR TY_PINCEN IF MODE=2]
CON43_W1 Which branch of the armed forces do you intend to join?
1 ARMY
2 NAVY
3 MARINES
4 AIR FORCE
5 OTHER (ENTER BRANCH)
F3 DON’T KNOW
F4 REFUSED
CON43_W1_ [IF CON43_W1=5] [TEXT BOX FOR BRANCH]
[IF R AGE>=18] AGREE2
INTERVIEWER: BE SURE TO READ VERBATIM
We will also ask you to allow us to look at different kinds of administrative data. Administrative data are information about you collected by government or other agencies. Examples of this kind of data include:
college records, such as attendance and graduation;
public assistance records, such as WorkFirst New Jersey or food stamps;
unemployment insurance wage records, such as dates of employment and wages;
foster care agency records, such as how many and what types of placements you were in;
birth, marriage, and death records;
criminal justice records, such as arrests or convictions; and
consumer/credit databases that may have your phone number and address.
We may use any information we get from these sources to help us better understand what has happened to you after you left foster care. For example, it may tell us the number of jobs you’ve had or the dollar amount of food stamps you receive. This information will give a fuller picture of youth’s circumstances when they leave foster care.
Do you agree to allow the YASS study research team to review the records that were described for researchpurposes?
1 YES, AGREES TO THE USE OF ADMINISTRATIVE DATA
0 NO, DOES NOT AGREE TO THE USE OF ADMINISTRATIVE DATA
TY_TINCEN [IF MODE = 1]
To show our appreciation for completing the survey, we would like to send you a link to an Amazon gift card for $25. If you do not want to receive this gift card, please let us know.
Allow about a week for delivery.
1 = ACCEPTS INCENTIVE
2 = DECLINES INCENTIVE
TY_EMAIL
[IF TYINCEN = 1] ELSE T_VER
Please provide the e-mail address for where you would like us to send the gift card.
INTERVIEWER NOTE: EMAIL ADDRESS MUST CONTAIN 2 @@ SIGNS (i.e., janedoe@@yahoo.com).
EMAIL:
TY_EMAIL_Va
INTERVIEWER: VERIFY EMAIL ADDRESS.
The email address I recorded is: <FILL EMAIL>. Is this correct?
1 YES [GO TO T_VER]
0 NO [GO TO TY_EMAIL_Vb]
TY_EMAIL_Vb
INTERVIEWER: ENTER CORRECT EMAIL. EMAIL ADDRESS MUST CONTAIN 2 @@ SIGNS (i.e., janedoe@@yahoo.com).
EMAIL:
TY_PINCEN [IF MODE =2]
To show our appreciation for completing the survey, we would like to give you a gift card in the amount of $25.
This form states that you have received the gift card. This copy is for your records.
1 = ACCEPTS INCENTIVE
2 = DECLINES INCENTIVE
T_VER.
As part of RTI’s quality program, we plan to contact a portion of the persons taking part 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. In advance, I appreciate your help if you are selected to verify my work.
Are you agreeable to a call to verify my work?
1 = YES
0 = NO
T_RESOURCE. Lastly, if you are feeling upset by the issues discussed in this survey and would like to talk with someone about your feelings, we suggest you call your current clinician or reach out to another provider organization. If not, please refer to the consent form you received for a list of numbers that you can call. I can also provide these numbers to you now if you would like.
INTERVIEWER: IF NEEDED
2nd Floor Youth Helpline: Call or text 1-888-222-2228
Children’s System of Care: Call or text 1-877-652-7624
END_W1 This is the end of the survey. Thank you for your time and help. We appreciate your patience.
INTERVIEWER: PLEASE REMIND THE RESPONDENT OF THE FOLLOWING BEFORE ENDING THE INTERVIEW:
WE WILL CALL THEM IN ROUGHLY 4 MONTHS TO CHECK IN TO SEE IF THEY HAVE ANY UPDATES TO THEIR CONTACT INFORMATION.
THEIR NEXT INTERVIEW WILL BE IN ANOTHER 12 MONTHS WHERE THEY WILL RECEIVE $50 FOR THEIR PARTICIPATION.
THEY CAN REACH US ANY TIME BETWEEN NOW AND THEIR NEXT INTERVIEW THROUGH OUR EMAIL ADDRESS, YASS@@rti.org OR BY TEXT, 1-919-289-1205, IF THEY HAVE ANY UPDATES TO THEIR CONTACT INFORMATION.
INTERVIEWER: ENTER “1” TO CONTINUE
1 CONTINUE
The
Paperwork Reduction Act Statement: This collection of information is
voluntary and will be used to evaluate the programs and services
provided to young adults who are currently or were previously in
foster care. Public reporting burden for this collection of
information is estimated to average 35 minutes per response,
including the time for reviewing instructions, gathering and
maintaining the data needed, and reviewing the collection of
information. An agency may not conduct or sponsor, and a person is
not required to respond to, a collection of information unless it
displays a currently valid OMB control number. The OMB number and
expiration date for this collection are OMB #: 0970-0577, Exp:
09/30/2024. Send comments regarding this burden estimate or any
other aspect of this collection of information, including
suggestions for reducing this burden to Michael Pergamit at
mpergamit@urban.org.
YASS: Interviewer Debriefing Questions
INT_MODE2
IF MODE = 2 (INTERVIEW COMPLETED IN PERSON)
INTERVIEWER: IF INTERVIEW WAS CONDUCTED IN PERSON, PLEASE BREAK OFF THE INTERVIEW AT THIS POINT. ONCE YOU RETURN HOME, RETURN TO THE INTERVIEW AND COMPLETE THE FOLLOWING DEBRIEFING QUESTIONS. PLEASE COMPLETE THE FOLLOWING DEBRIEFING QUESTIONS. THIS SECTION SHOULD BE COMPLETED AFTER YOU HAVE LEFT THE RESPONDENT. DO NOT COMPLETE WHILE IN THE RESPONDENT’S PRESENCE.
INT_MODE1
IF MODE = 1 (INTERVIEW COMPLETED BY PHONE)
INTERVIEWER: PLEASE COMPLETE THE FOLLOWING DEBRIEFING QUESTIONS AFTER FINISHING THE INTERVIEW WITH THE RESPONDENT. THIS SECTION SHOULD BE COMPLETED IN PRIVATE.
DB_0. Did the initial contact information you received for this case lead to the respondent? Was the contact information you received for this respondent accurate and up to date?
1 = YES
0 = NO
DB_00. Did you need locating assistance from the agency to locate this respondent?
1 = YES
0 = NO
DB_1. How many contact attempts did it take to schedule and complete the interview?
1 = Between 1-3 attempts
2 = Between 4-6 attempts
3 = Between 6-8 attempts
4 = More than 8 attempts
DB_2. When you did reach and schedule the interview with this respondent, what time of day did you reach them?
1. Early morning (Between 8 a.m. – 9:59 a.m.)
2. Mid-morning (Between 10 a.m. – 11: 59 a.m.)
3. Early afternoon (Noon – 3 p.m.)
4. Late afternoon (Between 3:01 p.m. – 4:59 p.m.)
5. Early evening (Between 5 p.m. – 7 p.m.)
6. Late evening (After 7 p.m.)
DB_3. When you reached the respondent, were you able to conduct the interview on the spot or did you need to schedule an appointment?
1. When I reached the respondent, I was able to conduct the interview on the spot
2. When I reached the respondent, we scheduled an appointment.
IF MODE = 2, ASK DB_4, IF MODE = 1, GOTO DB_8.
DB_4. Where did you conduct this interview?
1. At the respondent’s current residence, either inside or outside
2. At a friend’s home
3. At a family member’s home
4. Restaurant
5. Library
6. Public Park
7. Social Worker’s office
8. School or Work
9. Residential Drug/Alcohol/MH Treatment Facility
10. Transitional Housing/Halfway House
11. Shelter
12. Other
12A. Specify: [100 characters]
IF MODE = 2, ASK DB_5 OTHERWISE GOTO DB_8.
DB_5. Please estimate for how much of the ACASI interview the respondent used the headphones.
1. NONE/RESPONDENT TOOK HEADPHONES OFF IMMEDATELY
2. LESS THAN HALF OF THE ACASI INTERVIEW
3. ABOUT HALF OF THE ACASI INTERVIEW
4. MORE THAN HALF OF THE ACASI INTERVIEW
5. ALL OF THE ACASI INTERVIEW
IF MODE = 2, ASK DB_6
DB_6. Please indicate how private the interview was. Do not count yourself or a project observer as another person in the room.
COMPLETELY PRIVATE – NO ONE WAS IN THE ROOM OR COULD OVERHEAR ANY PART OF THE INTERVIEW
MINOR DISTRACTIONS – PERSON(S) IN THE ROOM OR LISTENING LESS THAN 1/3 OF THE TIME
PERSON(S) IN THE ROOM OR LISTENING ABOUT 1/3 OF THE TIME
SERIOUS INTERRUPTIONS OF PRIVACY MORE THAN HALF THE TIME
CONSTANT PRESENCE OF OTHER PERSON(S)
IF DB_6 = 2-5, THEN ASK DB_7.
DB_7. Not including yourself, who were the other people present or listening to the interview? Check all that apply.
1. PARENT(S)
2. SPOUSE
3. LIVE-IN PARTNER/BOYFRIEND/GIRLFRIEND
4 OTHER ADULT RELATIVE(S)
5. OTHER ADULT(S)
6. CHILD(REN) UNDER 18
7. OTHER
DB_8. Did the respondent express any concerns about the length of the survey?
1 = YES
0 = NO
DB_9. Did the respondent have trouble understanding or answering any questions asked during the interview?
1 = YES GO TO DB_10.
0 = NO
DB_10. Please describe the question or screen and a brief explanation of what the respondent struggled to understand or answer. [150 characters]
DB_11. Please record anything else you think would be helpful for the research team to know about your experience interviewing this respondent or information that might be helpful in tracking this respondent for future surveys.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0970-0577 (Exp Date: XX/XX/XXXX). The time required to complete the interview is estimated to be 35 minutes.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Loveless, Annelise |
| File Modified | 0000-00-00 |
| File Created | 2023-08-30 |
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