Appendix B: Child Interview and Assessments
KB – Cognitive Status Assessment: KBIT-2 B-35
BD - Cognitive Status Assessment: BDI B-36
NI – Neurodevelopmental Impairment Assessment: BINS B-37
CO – Communication Assessment: PLS-5 B-70
WJ - Woodcock-Johnson III Assessment B-71
CN - Community Environment B-72
RR - Relationship with Peers B-77
AO – Family Contacts for Adopted Youth B-110
SW – Child Satisfaction with Caseworker Services B-118
FE - Future Expectations B-121
YH – Health and Services B-136
CD – Children’s Depression Inventory 2: CDI-2 B-174
TR – Mental Heatlh: Trauma B-175
ER – Employment/Resources to Live B-226
YI - Young Adult and Emancipated Youth: Income B-246
RC - Relationship with Caregiver(s) B-253
CL - Closeness to Caregiver(s) B-258
EV - Exposure to Violence B-263
VC - Victimization and Adverse Experiences B-313
HT – Human Trafficking Exposure B-321
YL – Involvement with the Law B-327
YM – Discipline and Child Maltreatment B-331
LK – Permission for Data Linkage B-373
VO – Verifications/Change of Address/Payment B-375
===============================================================================
Child Interview
================================================================================
---------------------------------------------------------------------------------
Y_QY_BGN [ YQY_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
---------------------------------------------------------------------------------
Y_QY0a [ YQY0a ] NO LABEL
INTERVIEWER: PRESS 1 FOR @bPERMISSION@b FORMS IN DOCMAN. PLEASE CHOOSE
AND READ THE CORRECT CONSENT OR PERMISSION FORM FROM DOCMAN BASED ON
THE CHILD'S AGE 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
---------------------------------------------------------------------------------
Y_QYCO1 Start CO DocMan
@bSTART DOCMAN PERMISSION 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 Y_QYCO2 else ask Y_QYCO3
Y_QYCO2 [ YQYCO2 ] End CO DocMan
@bDOCMAN PERMISSION FORM IS COMPLETED@b
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
Logic after:
Skip to Y_QY0ab
---------------------------------------------------------------------------------
Y_QYCO3 [ YQYCO3 ] NO LABEL
@bDOCMAN PERMISSION 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 Y_QYCO1
If 4 EXIT interview
IF 3 Ask Y_QYCO4
ELSE GOTO Y_QY0b
---------------------------------------------------------------------------------
Y_QYCO4 [ YQYCO4 ] NO LABEL
@bDOCMAN PERMISSION FORM IS NOT COMPLETED@b
GIVE DETAILS ABOUT THE TECHNICAL PROBLEM:
Question Type: STRING[60]
---------------------------------------------------------------------------------
Y_QY0b [ YQY0b ] NO LABEL
^Fills.Y_QY0b
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
Question Fill: ^FillY_QY0b
need INTERVIEWER: PRESS 1 FOR @bCAREGIVER 2 PERMISSION@b
FORMS IN DOCMAN. PLEASE CHOOSE AND READ THE CORRECT
PERMISSION FORM FROM DOCMAN BASED ON CHILD'S AGE AND
OBTAIN SIGNATURE. AFTER COLLECTING SIGNATURE AND
FINALIZING FORM, YOU WILL THEN BE BROUGHT BACK TO THE
INTERVIEW.
no_need INTERVIEWER: THE @bCAREGIVER 2 CONSENT@b FORM IS NOT
NEEDED FOR THIS CHILD. SELECT “FORM NOT NEEDED” IN
---------------------------------------------------------------------------------
Y_QYC21 Start C2 DocMan
@bSTART DOCMAN CAREGIVER 2 PERMISSION 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 Y_QYCO2 else ask Y_QYCO3
Y_QYC22 [ YQYC22 ] End C2 DocMan
@bDOCMAN PERMISSION FORM CAREGIVER 2 IS COMPLETED@b
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
Logic after:
Skip to Y_QY0ab
---------------------------------------------------------------------------------
Y_QYC23 [ YQYC23 ] NO LABEL
@bDOCMAN PERMISSION FORM CAREGIVER 2 IS NOT COMPLETED@b
Question Type: TDMR3F, noDK, noRF
_1 1 REDO THE FORM IN DOCMAN
_2 2 PAPER FORM USED, WILL SCAN BECAUSE R REFUSED
ELECTRONIC SIGNATURE
_3 3 PAPER FORM USED, WILL SCAN BECAUSE OF TECHNICAL ISSUES
_4 4 NO 2CG SIGNATURE REQUIRED; INCAPACITY
_5 5 NO 2CG SIGNATURE REQUIRED; NOT REASONABLY AVAILABLE
_6 6 NO 2CG SIGNATURE REQUIRED; NOT LG/BIO/ADOP/CG
_7 7 NO 2CG SIGNATURE REQUIRED; HOUSEHOLD SITUATION
_8 8 A TECHNICAL PROBLEM PREVENTED FROM CODING OUT THE
FORM
---------------------------------------------------------------------------------
Y_QYC24 [ YQYC24 ] NO LABEL
@bDOCMAN PERMISSION FORM CAREGIVER 2 IS NOT COMPLETED@b
GIVE DETAILS ABOUT THE TECHNICAL PROBLEM:
Question Type: STRING[60]
---------------------------------------------------------------------------------
Logic before:
IF CHILD IS 7-17 and is not emancipated ASK Y_QY0b. ELSE, GOTO Y_QY0aa.
Y_QY0ab [ YQY0ab ] NO LABEL
^Fills.Y_QY0ab
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
Question Fill: ^FillY_QY0ab
need NTERVIEWER: PRESS 1 FOR @bASSENT@b FORMS IN DOCMAN.
PLEASE CHOOSE AND READ THE CORRECT CONSENT/ASSENT
FORM FROM DOCMAN BASED ON CHILD'S AGE AND OBTAIN
SIGNATURE. AFTER COLLECTING SIGNATURE AND FINALIZING
FORM, YOU WILL THEN BE BROUGHT BACK TO THE INTERVIEW.
no_need INTERVIEWER: THE @bASSENT@b FORM IS NOT NEEDED FOR
THIS CHILD. SELECT “FORM NOT NEEDED” IN DOCMAN.
---------------------------------------------------------------------------------
Y_QYAS1 Start AS DocMan
@bSTART DOCMAN ASSENT 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 Y_QYAS2 else ask Y_QYAS3
Y_QYAS2 [ YQYAS2 ] End AS DocMan
@bDOCMAN ASSENT FORM IS COMPLETED@b
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
---------------------------------------------------------------------------------
Y_QYAS3 [ YQYAS3 ] NO LABEL
@bDOCMAN ASSENT 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 Y_QYAS1
If 4 EXIT interview
IF 3 Ask Y_QYAS4
ELSE GOTO Y_QY0aa
---------------------------------------------------------------------------------
Y_QYAS4 [ YQYAS4 ] NO LABEL
@bDOCMAN ASSENT FORM IS NOT COMPLETED@b
GIVE DETAILS ABOUT THE TECHNICAL PROBLEM:
Question Type: STRING[60]
---------------------------------------------------------------------------------
Logic before:
P_do_CARI
Y_QY0aa [ YQY0aa ] Record interview?
INTERVIEWER: DID R AGREE TO THE USE OF CARI FOR RECORDING THE INTERVIEW?
Question Type: Bconsent
Logic after:
IF Y_QY0aa = Yes GOTO Y_QYEND
---------------------------------------------------------------------------------
Logic before:
P_not_cari
Y_QY0ba [ YQY0ba ] I need to confirm, u do not wnt interview recorded, correct?
I just need to confirm that you do not want this interview to be recorded. Is that correct?
Question Type: TYesNoC, noDK, noRF
Yes 1 YES
No 2 NO
Logic after:
IF Y_QY0ba = No GO BACK TO CORRECT Y_QY0aa
---------------------------------------------------------------------------------
Y_QYEND [ YQYEND ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF CHILD AGE < 5, FILL: ADDRESS PARENT: I'd like to do several activities that involve ^CHILD.
Before we get started, let me verify a few pieces of information in our records.; IF CHILD AGE 5-10,
FILL: ADDRESS PARENT: Before I get started with ^CHILD's interview, I want to verify a few pieces
of information in our records.; IF CHILD AGE > 10, FILL: Hi, my name is _____________. Today
I'm going to ask you some questions about you, your family, friends, and school. If you have a
question or are not sure about something, tell me. The important thing is that you tell me what you
really feel or think. All your answers will be kept private. If you want to take a break, just let me
know. Before we get started, let me verify some of the information I have about you. IF YA+EY,
FILL: Hi, my name is _____________. Today I’m going to ask you some questions about you,
your family, and your life experiences. All your answers will be kept private. Before we get started,
let me verify some of the information I have about you.
Y_CH0 [ YCH0 ] NO LABEL
^Fills.Y_CH0
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
Question Fill: ^FillY_CH0
under5 ADDRESS PARENT: I'd like to do several activities that involve
^Global.Child. Before we get started, let me verify a few pieces of
information in our records.
fivetoten ADDRESS PARENT: Before I get started with ^Global.Child's interview, I
want to verify a few pieces of information in our records.
overten Hi, my name is ___________________. Today I'm going to ask you some
questions about you, your family, friends, and school. If you have a
question or are not sure about something, tell me. The important thing is
that you tell me what you really feel or think. All your answers will be kept
private. If you want to take a break, just let me know. Before we get
started, let me verify some of the information I have about you.
YA_EY Hi, my name is _____________. Today I’m going to ask you some
questions about you, your family, and your life experiences. All your
answers will be kept private. Before we get started, let me verify some of
the information I have about you.
---------------------------------------------------------------------------------
Y_CH0a1 [ YCH0a1 ] NO LABEL
INTERVIEWER: THIS IS FOR VERIFYING THE CHILD'S NAME:
^Fills.Y_CH0a1
FIRST:@|@|@|@B^CHILD_FName@B
MIDDLE INITIAL: @|@B^CHILD_MName@B
LAST: @|@|@|@B^CHILD_LName@B
Is this correct?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Question Fill: ^FillY_CH0a1
lessthan11 ADDRESS PARENT: First, let me verify ^Global.CHILD's name.
elevenmore First, let me verify your name.
Logic after:
IF = 1, GOTO Y_CH1a
---------------------------------------------------------------------------------
Y_CH0b [ YCH0b ] NO LABEL
CORRECT FIRST NAME, AS NEEDED:
FIRST NAME:
Question Type: STRING[20]
---------------------------------------------------------------------------------
Y_CH0c [ YCH0c ] NO LABEL
CORRECT MIDDLE INITIAL, AS NEEDED:
MIDDLE INITIAL:
Question Type: STRING[20], empty
---------------------------------------------------------------------------------
Y_CH0d [ YCH0d ] NO LABEL
CORRECT LAST NAME, AS NEEDED:
LAST NAME:
---------------------------------------------------------------------------------
Logic before:
IF CHILD AGE < 11: ADDRESS PARENT: Let me verify ^CHILD’s date of birth.; ELSE: Let me
verify your date of birth.
Y_CH1a [ YCH1a ] Correct DOB(YN2T)
^Fills.Y_CH1a
@B^DOB_Mo_Txt ^DOB_Dy, ^DOB_Yr@B
IS THIS CORRECT?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Question Fill: ^FillY_CH1a
lessthan11 ADDRESS PARENT: Let me verify ^Global.CHILD's date of birth.
elevenmore Let me verify your date of birth.
Logic after:
IF Y_CH1a = Yes GOTO Y_CH2a
---------------------------------------------------------------------------------
Y_CH1m [ YCH1m ] CH DOB month
INTERVIEWER: CORRECT MONTH OF BIRTH IF NEEDED.
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
---------------------------------------------------------------------------------
Y_CH1d [ YCH1d ] CH DOB day
INTERVIEWER: CORRECT DAY OF BIRTH IF NEEDED.
DAY:
Question Type: 1..31
---------------------------------------------------------------------------------
Y_CH1y [ YCH1y ] CH DOB year
INTERVIEWER: CORRECT YEAR OF BIRTH IF NEEDED.
YEAR:
Question Type: 1980..2013
---------------------------------------------------------------------------------
Logic before:
IF CHILD AGE < 11: ADDRESS PARENT: So ^CHILD is (FILL COMPUTED AGE BASED ON DOB
ENTERED IN Y_CH1a) years old?; ELSE: So you are (FILL COMPUTED AGE BASED ON DOB
ENTERED IN Y_CH1a) years old?
Y_CH2a [ YCH2a ] CH age
^CH2a_Fill
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_CH2a = No GO BACK TO CORRECT Y_CH1a
---------------------------------------------------------------------------------
Logic before:
IF CHILD AGE IS >=11, GOTO Y_CH3b
Y_CH3a [ YCH3a ] CH sex
CODE CHILD'S SEX.
THE CONTROL CARD INDICATES THAT THIS CHILD RESPONDENT IS A ^Fills.Sex. IF THIS
IS NOT CORRECT, VERIFY THAT YOU ARE INTERVIEWING THE CORRECT CHILD BEFORE
CONTINUING.
Question Type: TSexC
male 1 MALE
female 2 FEMALE
Question Fill: ^FillSex
male MALE
female FEMALE
---------------------------------------------------------------------------------
Logic before:
IF CHILD AGE >= 4, GOTO Y_CH5
Y_CH4d [ YCH4d ] Head circumference in centimeters, #1
ADDRESS PARENT: As part of this study, we'd like to find out how tall ^CHILD is, how much
^Fills.HeShe weighs, and the size of ^Fills.HisHer head.
MEASURE AND RECORD HEIGHT, WEIGHT, AND HEAD CIRCUMFERENCE.
@BBE SURE TO USE THE BOTTOM RED ARROW OF THE MEASURING TAPE IN ORDER TO
GET MEASUREMENT IN CENTIMETERS.@B
HEAD SIZE IN @BCENTIMETERS@B:
Question Type: 0..100
---------------------------------------------------------------------------------
Y_CH4D2 [ YCH4D2 ] Head circumference in centimeters, #2
ROUND 2:
ADDRESS PARENT: As part of this study, we'd like to find out how tall ^CHILD is, how much
^Fills.HeShe weighs, and the size of ^Fills.HisHer head.
MEASURE AND RECORD HEIGHT, WEIGHT, AND HEAD CIRCUMFERENCE.
@BBE SURE TO USE THE BOTTOM RED ARROW OF THE MEASURING TAPE IN ORDER TO
GET MEASUREMENT IN CENTIMETERS.@B
HEAD SIZE IN @BCENTIMETERS@B:
Question Type: 0..100
---------------------------------------------------------------------------------
Y_CH4D3 [ YCH4D3 ] Head circumference in centimeters, #3
ROUND 3:
ADDRESS PARENT: As part of this study, we'd like to find out how tall ^CHILD is, how much
^Fills.HeShe weighs, and the size of ^Fills.HisHer head.
MEASURE AND RECORD HEIGHT, WEIGHT, AND HEAD CIRCUMFERENCE.
@BBE SURE TO USE THE BOTTOM RED ARROW OF THE MEASURING TAPE IN ORDER TO
GET MEASUREMENT IN CENTIMETERS.@B
HEAD SIZE IN @BCENTIMETERS@B:
Question Type: 0..100
---------------------------------------------------------------------------------
Logic before:
IF CHILD AGE >= 4, GOTO Y_CH5
Y_CH4a [ YCH4a ] Height, feet, #1
ADDRESS PARENT: As part of this study, we'd like to find out how tall ^CHILD is, how much
^Fills.HeShe weighs, and the size of ^Fills.HisHer head.
MEASURE AND RECORD HEIGHT, WEIGHT, AND HEAD CIRCUMFERENCE.
HEIGHT IN FEET AND INCHES:
ENTER FEET:
Question Type: 1..4
---------------------------------------------------------------------------------
Logic before:
IF CHILD AGE >= 4, GOTO Y_CH5
Y_CH4b [ YCH4b ] Height, inches, #1
ADDRESS PARENT: As part of this study, we'd like to find out how tall ^CHILD is, how much
^Fills.HeShe weighs, and the size of ^Fills.HisHer head.
MEASURE AND RECORD HEIGHT, WEIGHT, AND HEAD CIRCUMFERENCE.
HEIGHT IN FEET AND INCHES:
ENTER INCHES:
Question Type: 0..11
---------------------------------------------------------------------------------
Y_CH4A2 [ YCH4A2 ] Height, feet, #2
ROUND 2:
ADDRESS PARENT: As part of this study, we'd like to find out how tall ^CHILD is, how much
^Fills.HeShe weighs, and the size of ^Fills.HisHer head.
MEASURE AND RECORD HEIGHT, WEIGHT, AND HEAD CIRCUMFERENCE.
HEIGHT IN FEET AND INCHES:
ENTER FEET:
Question Type: 1..4
---------------------------------------------------------------------------------
Y_CH4B2 [ YCH4B2 ] Height, inches, #2
ROUND 2:
ADDRESS PARENT: As part of this study, we'd like to find out how tall ^CHILD is, how much
^Fills.HeShe weighs, and the size of ^Fills.HisHer head.
MEASURE AND RECORD HEIGHT, WEIGHT, AND HEAD CIRCUMFERENCE.
HEIGHT IN FEET AND INCHES:
ENTER INCHES:
Question Type: 0..11
---------------------------------------------------------------------------------
Y_CH4A3 [ YCH4A3 ] Height, feet, #3
ROUND 3:
ADDRESS PARENT: As part of this study, we'd like to find out how tall ^CHILD is, how much
^Fills.HeShe weighs, and the size of ^Fills.HisHer head.
MEASURE AND RECORD HEIGHT, WEIGHT, AND HEAD CIRCUMFERENCE.
HEIGHT IN FEET AND INCHES:
ENTER FEET:
Question Type: 1..4
---------------------------------------------------------------------------------
Y_CH4B3 [ YCH4B3 ] Height, inches, #3
ROUND 3:
ADDRESS PARENT: As part of this study, we'd like to find out how tall ^CHILD is, how much
^Fills.HeShe weighs, and the size of ^Fills.HisHer head.
MEASURE AND RECORD HEIGHT, WEIGHT, AND HEAD CIRCUMFERENCE.
HEIGHT IN FEET AND INCHES:
ENTER INCHES:
Question Type: 0..11
---------------------------------------------------------------------------------
Logic before:
IF CHILD AGE >= 4, GOTO Y_CH5
Y_CH4c [ YCH4c ] Weight in lbs, #1
ADDRESS PARENT: As part of this study, we'd like to find out how tall ^CHILD is, how much
^Fills.HeShe weighs, and the size of ^Fills.HisHer head.
MEASURE AND RECORD HEIGHT, WEIGHT, AND HEAD CIRCUMFERENCE.
WEIGHT:
Question Type: 1..100
---------------------------------------------------------------------------------
Y_CH4C2 [ YCH4C2 ] Weight in lbs, #2
ROUND 2:
ADDRESS PARENT: As part of this study, we'd like to find out how tall ^CHILD is, how much
^Fills.HeShe weighs, and the size of ^Fills.HisHer head.
MEASURE AND RECORD HEIGHT, WEIGHT, AND HEAD CIRCUMFERENCE.
WEIGHT:
Question Type: 1..100
---------------------------------------------------------------------------------
Y_CH4C3 [ YCH4C3 ] Weight in lbs, #3
ROUND 3:
ADDRESS PARENT: As part of this study, we'd like to find out how tall ^CHILD is, how much
^Fills.HeShe weighs, and the size of ^Fills.HisHer head.
MEASURE AND RECORD HEIGHT, WEIGHT, AND HEAD CIRCUMFERENCE.
WEIGHT:
Question Type: 1..100
---------------------------------------------------------------------------------
Y_CH4cka [ YCH4cka ] NO LABEL
INTERVIEWER: YOU HAVE ENTERED THE FOLLOWING MEASUREMENTS FOR ^CHILD:
HEAD SIZE = @|@B^Y_CH4d@B CENTIMETERS
@|@|@|@B^Y_CH4D2@B CENTIMETERS
@|@|@|@B^Y_CH4D3@B CENTIMETERS
HEIGHT = @|@B^Y_CH4a@B FEET, @B^Y_CH4b@B INCHES TALL
@|@|@B^Y_CH4A2@B FEET, @B^Y_CH4B2@B INCHES TALL
@|@|@B^Y_CH4A3@B FEET, @B^Y_CH4B3@B INCHES TALL
WEIGHT = @|@B^Y_CH4c@B POUNDS
@|@|@B^Y_CH4C2@B POUNDS
@|@|@B^Y_CH4C3@B POUNDS
IS THIS INFORMATION CORRECT?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_CH4cka = No GOTO Y_CH4a
---------------------------------------------------------------------------------
Logic before:
IF CHILD AGE < 5, GOTO Y_CH8a; IF CHILD AGE 5-10, GOTO Y_CH5; IF CHILD AGE > 10,
GOTO Y_CH7a; IF YA+EY, GOTO Y_CH8aa
Y_CH5 [ YCH5 ] NO LABEL
Hi, my name is _____________. Today I'm going to ask you some questions about you, your
family, friends, and school.
If you have a question or are not sure about something, tell me. The important thing is that you
tell me what you really feel or think. All your answers will be kept private. If you want to take a
break, just let me know.
PRESS "1" AND [ENTER] TO CONTINUE.
Question Type: TCont
Continue 1 Continue
---------------------------------------------------------------------------------
Y_CH6a [ YCH6a ] CH name(YN2T)
What is your first name?
FIRST NAME:
Question Type: STRING[30]
---------------------------------------------------------------------------------
Y_CH7a [ YCH7a ] CH has nickname(YN2T)
Do you have a nickname you like to be called other than ^CHILD?
INTERVIEWER NOTE: IF NICKNAME IS ENTERED, THEN INTERVIEWER WILL ADDRESS
CHILD BY NICKNAME FOR REMAINDER OF INTERVIEW.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_CH7a = No GOTO Y_CH8aa
---------------------------------------------------------------------------------
Y_CH7b [ YCH7b ] CH nickname
What is it?
NICKNAME:
Question Type: STRING[30]
---------------------------------------------------------------------------------
Logic before:
IF CHILD AGE IS 11 OR OLDER, OR YA+EY, ASK Y_CH8aa. ELSE, GOTO Y_CH8a
Y_CH8aa [ YCH8aa ] CH Spanish Hispanic or Latino?
Are you Spanish, Hispanic, or Latino?
Question Type: TCH8aa
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
---------------------------------------------------------------------------------
Logic before:
IF CHILD AGE < 6, GOTO Y_CH9a
Y_CH8a [ YCH8a ] Labels are in Logic After
USE CARD 0. What race are you?
CODE ALL THAT APPLY.
NOTE: IF CHILD CANNOT REPORT HIS/HER RACE, CODE "DON'T KNOW." @BDO NOT
CODE RACE BASED ON YOUR OBSERVATION@B.
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:
IF YA+EY, GOTO Y_CH9Ya; YCH8TG_1--CH American Indian/Alaskan Native; YCH8TG_2--CH
Asian; YCH8TG_3--CH Black or African American; YCH8TG_4--CH Native Hawaiian/other Pac.
Islander; YCH8TG_5--CH White; YCH8TG_6--DK; YCH8TG_7--RF
---------------------------------------------------------------------------------
Y_CH3b
What sex were you assigned at birth, on your original birth certificate?
1 Female (Girl)
2 Male (Boy)
3) DON’T KNOW
4) PREFER NOT TO ANSWER
IF AGE IS 11-18+ , ASK Y_CH3c. ELSE, SKIP TO Y_CH4d or Y_CH4a.
Y_CH3c
What is your current gender?
1 Female (Girl)
2 Male (Boy)
3 Transgender
4 [IF Y_CH8a =1} Two-Spirit
5) I use a different term
6) DON’T KNOW
7) PREFER NOT TO ANSWER
IF Y_CH3c = 5, ASK Y_CH3cOTH
Y_CH3cOTH
What is the term that you use?
[TEXT BOX]
DON’T KNOW
PREFER NOT TO ANSWER
Logic before:
IF CHILD AGE <5, GOTO Y_CH10a
Y_CH9a [ YCH9a ] CH school status
Do you go to school or do your parents teach you at home?
FR NOTE: ATTENDING SCHOOL VIRTUALLY OR ONLINE SHOULD BE CONSIDERED AS “GOING TO SCHOOL”
NOTE: CODE CHILDREN ON SUMMER BREAK FROM SCHOOL AS "1."
Question Type: TCH9a
inschool 1 GO TO SCHOOL
homeschooled 2 TAUGHT AT HOME
neither 3 NEITHER
Logic after:
IF Y_CH9a = 2 OR 3 GOTO Y_CH9ba; IF RESPONSE <> 1, SCHOOL STATUS = 0 (NO)
---------------------------------------------------------------------------------
Y_CH9aa [ YCH9aa ] CH attends school regularly
Do you go regularly, that is, most school days?
FR NOTE: CHILDREN WHO ATTEND SCHOOL VIRTUALLY OR ONLINE DURING COVID ARE CONSIDERED ENROLLED.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
ASK Y_CH9ba-Y_CH9dn IF CHILD AGE IS 12 OR HIGHER AND NOT EMANCIPATED; ELSE GO
TO Y_CH9Ya
Y_CH9ba [ YCH9c ] Work for pay outside your home in last 4 wks?
In the last 4 weeks, did you work--for pay--for anyone outside your home? This includes both
regular jobs and things like baby-sitting or yard work.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CH9cn [ YCH9cn ] How many hrs do you work for pay in a typical non-summer wk?
How many hours do you spend working for pay in a typical non-summer week?
HOURS:
Question Type: 0..145
---------------------------------------------------------------------------------
Y_CH9dn [ YCH9dn ] How many hrs do you work for pay in a typical summer wk?
How many hours do you spend working for pay in a typical summer week?
HOURS:
Question Type: 0..97
---------------------------------------------------------------------------------
Logic before:
IF AGE IS >=18 OR EMANCIPATED YOUTH, ASK Y_CH9Ya. ELSE, SKIP TO Y_CH10a.
Y_CH9Ya [ YCH9Ya ] Highest Grade compl. in school
What is the highest grade in school @Byou have completed@B? Please include vocational or
technical training and any years in college you may have completed.
Question Type: TCH9Ya
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
---------------------------------------------------------------------------------
Y_CH9Yaa [ YCH9Yaa ] Do you have high school diploma?
Do you have a high school diploma?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CH9Yba [ YCH9Yba ] Do you have a GED?
Do you have a GED?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CH9Yca [ YCH9Yca ] Currently enrolled in school?
Are you currently enrolled in school?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_CH9Yca = No GOTO Y_CH9Yfa
---------------------------------------------------------------------------------
Y_CH9Yda [ YCH9Yda ] What type of school attend?
What type of school do you attend?
Question Type: TCH9Yda
jrhigh 0 Junior High or Middle School
hs 1 High School
voctech 2 Vocational/Technical School
commcoll 3 Community College (2-year)
college 4 4-Year College
---------------------------------------------------------------------------------
Y_CH9Yea [ YCH9Yea ] Part-time/full-time student?
Are you a part-time or full-time student?
Question Type: TCH9Yea
part 1 Part time
full 2 Full time
---------------------------------------------------------------------------------
Y_CH9Yfa [ YCH9Yfa ] How far in school do you think you will get?
As things stand now, how far in school do you think you will get?
Question Type: TCH9Yfa
lessthanhs 1 Less than high school graduation
ged 2 GED or other equivalency only
hs 3 High school graduation only
oneortwoyr 4 Attend or complete a 1- or 2-year program in a community college or
vocational school
somecollege 5 Attend college, but not complete a 4- or 5-year degree
collegegrad 6 Graduate from college (4- or 5-year degree)
masters 7 Obtain a Master's degree or equivalent
doctorate 8 Obtain a Ph.D., M.D., or other advanced degree
---------------------------------------------------------------------------------
Logic before:
IF CHILD IS EMANCIPATED OR YOUNG ADULT (18+), GOTO Y_CH24a.
Y_CH10a [ YCH10a ] CH in OOH care
INTERVIEWER: IS CHILD LIVING IN OUT-OF-HOME CARE (E.G. FOSTER HOME, ETC.)?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_CH10a = No GOTO Y_CH12a
---------------------------------------------------------------------------------
Y_CH11a [ YCH11a ] Type of OOH care
INTERVIEWER: IN WHAT TYPE OF OUT-OF-HOME SETTING IS ^CHILD LIVING?
Question Type: TCH11a
foster 1 FOSTER HOME
relhome 2 KIN-CARE SETTING (RELATIVE'S HOME)
respgm 3 TREATMENT FOSTER CARE, SPECIALIZED FOSTER CARE, OR
FAMILY FOSTER AGENCY
group 4 GROUP HOME OR RESIDENTIAL FACILITY
other 5 SOME OTHER OUT-OF-HOME CARE ARRANGEMENT
Logic after:
IF Y_CH11a = 4 OR 5, GOTO Y_CH12a
---------------------------------------------------------------------------------
Y_CH11aa [ YCH11aa ] Caregiver is CH legal guardian
INTERVIEWER: IS THE CAREGIVER CHILD'S LEGAL GUARDIAN?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CH12a [ YCH12a ] Correct name of primary CG
INTERVIEWER: VERIFY THAT ^CHILD'S PRIMARY CAREGIVER IS:
FIRST:@|@|@|@B^CAREGIVER_A_FName@B
MIDDLE INITIAL:@|@B^CAREGIVER_A_MName@B
LAST:@|@|@|@B^CAREGIVER_A_LName@B
IS THIS CORRECT?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_CH12a = Yes GOTO Y_CH13a
---------------------------------------------------------------------------------
Y_CH12f [ YCH12f ] CH primary CG-first name
INTERVIEWER: CORRECT FIRST NAME IF NEEDED.
FIRST NAME:
Question Type: STRING[30]
---------------------------------------------------------------------------------
Y_CH12m [ YCH12m ] CH primary CG-middle name
INTERVIEWER: CORRECT MIDDLE NAME IF NEEDED.
MIDDLE NAME:
Question Type: STRING[30], empty
---------------------------------------------------------------------------------
Y_CH12l [ YCH12l ] CH primary CD-last name
INTERVIEWER: CORRECT LAST NAME IF NEEDED.
LAST NAME:
Question Type: STRING[40]
---------------------------------------------------------------------------------
Y_CH14a [ YCH14a ] Primary CG relationship to CH
INTERVIEWER: ^CHILD'S PRIMARY CAREGIVER'S RELATIONSHIP TO ^CHILD FROM CID IS
@B^CAREGIVER_A@B.
INTERVIEWER: CODE CURRENT 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:
IF Y_CH14a = 1-14, GOTO Y_CH15prea; IF Y_CH14a = 95, GOTO Y_CH14b; IF Y_CH14a = 96,
GOTO Y_CH14c; RELATIONSHIP BECOMES CAREGIVER_A FILL
---------------------------------------------------------------------------------
Logic before:
IF Y_CH14a = 95, ELSE GOTO Y_CH14c
Y_CH14b [ YCH14b ] Specify CG other relative relationship to CH
SPECIFY OTHER RELATIVE RELATIONSHIP
RELATIONSHIP:
Question Type: STRING[30]
---------------------------------------------------------------------------------
Logic before:
IF Y_CH14a = 96, ELSE GOTO Y_CH15prea
Y_CH14c [ YCH14c ] Specify CG other non-relative relationship to CH
SPECIFY OTHER NON-RELATIVE RELATIONSHIP
RELATIONSHIP:
Question Type: STRING[30]
---------------------------------------------------------------------------------
Y_CH15prea [ YCH5prea ] Is there a secondary CG for CH
INTERVIEWER: IS THERE A SECONDARY CAREGIVER FOR THE CHILD?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_CH15prea = Yes GOTO Y_CH15a. ELSE, GOTO Y_CH18a.
---------------------------------------------------------------------------------
Y_CH15a [ YCH15a ] Correct name of secondary CG
INTERVIEWER: VERIFY THAT ^CHILD'S CURRENT SECONDARY CAREGIVER IS:
FIRST:@|@|@|@B^CAREGIVER_B_FName@B
MIDDLE INITIAL:@|@B^CAREGIVER_B_MName@B
LAST:@|@|@|@B^CAREGIVER_B_LName@B
IS THIS CORRECT?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_CH15a = Yes GOTO Y_CH16a
---------------------------------------------------------------------------------
Y_CH15f [ YCH15f ] CH secondary CG-first name
INTERVIEWER: CORRECT FIRST NAME IF NEEDED.
FIRST NAME:
Question Type: STRING[30]
---------------------------------------------------------------------------------
Y_CH15m [ YCH15m ] CH secondary CG-middle name
INTERVIEWER: CORRECT MIDDLE NAME IF NEEDED.
MIDDLE NAME:
Question Type: STRING[30], empty
---------------------------------------------------------------------------------
Y_CH15l [ YCH15l ] CH secondary CG-last name
INTERVIEWER: CORRECT LAST NAME IF NEEDED.
LAST NAME:
Question Type: STRING[40]
---------------------------------------------------------------------------------
Y_CH17a [ YCH17a ] Secondary CG relationship to CH
^Fills.Y_CH17a @B^CAREGIVER_B@B^Fills.OnlyDot
INTERVIEWER: CODE ^CH17a_Fill 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
Question Fill: ^FillY_CH17a
cg2 INTERVIEWER: CURRENT SECONDARY CAREGIVER'S
RELATIONSHIP TO THE CHILD IS
Logic after:
IF Y_CH17a = 1-14, GOTO Y_CH18n; IF Y_CH17a = 95, GOTO Y_CH17b; IF Y_CH17a = 96,
GOTO Y_CH17c; RELATIONSHIP BECOMES CAREGIVER_B FILL
---------------------------------------------------------------------------------
Logic before:
IF Y_CH17a = 95, ELSE GOTO Y_CH17c
Y_CH17b [ YCH17b ] Specify secondary CG other relative relationship to CH
SPECIFY OTHER RELATIVE RELATIONSHIP
RELATIONSHIP:
Question Type: STRING[30]
---------------------------------------------------------------------------------
Logic before:
IF Y_CH17a = 96, ELSE GOTO Y_CH18a
Y_CH17c [ YCH17c ] Specify secondary CG other non-relative relationship to CH
SPECIFY OTHER NON-RELATIVE RELATIONSHIP
RELATIONSHIP:
Question Type: STRING[30]
---------------------------------------------------------------------------------
Logic before:
[IF CHILD AGE < 11: ADDRESS PARENT/GUARDIAN: How long has ^CHILD lived with you?]
[ELSE: How long have you lived with your [FILL RELATIONSHIP FROM Y_CH14, OR Y_CH12
Y_CH18a [ YCH18a ] How long CH lived with CG
^CH18a_Fill
NUMBER:
Question Type: 0..500
---------------------------------------------------------------------------------
Y_CH18u [ YCH18u ] # of D/W/M/Y CH lived with CG
(Is that the number of days, weeks, months, or years?)
Question Type: TCH18b
days 1 DAYS
weeks 2 WEEKS
months 3 MONTHS
years 4 YEARS
Logic after:
GOTO Y_CH19a
---------------------------------------------------------------------------------
Logic before:
IF Y_CH10a = YES CONTINUE; ELSE GOTO Y_CHEND
Y_CH19a [ YCH19a ] Bio Mother still living
^Fills.Y_CH19a
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Question Fill: ^FillY_CH19a
lessthan11 Is ^Global.CHILD's biological mother still living?
elevenmore ASK IF NECESSARY: Is your biological mother still living?
---------------------------------------------------------------------------------
Y_CH20a [ YCH20a ] Bio Father still living
^Fills.Y_CH20a
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Question Fill: ^FillY_CH20a
lessthan11 Is ^Global.CHILD's biological father still living?
elevenmore ASK IF NECESSARY: Is your biological father still living?
Logic after:
GOTO Y_CHEND
---------------------------------------------------------------------------------
Logic before:
IF CHILD AGE IS 18 OR OLDER OR CHILD IS EMANCIPATED, CONTINUE WITH REAMINING
QUESTIONS. ELSE, GOTO C_CHEND.
Y_CH24a [ YCH24a ] CH Born in US
Were you born in the United States?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_CH24a = 2 GOTO Y_CH27a
---------------------------------------------------------------------------------
Y_CH25a [ YCH25c ] In what city were you born?
In what city and state were you born?
CITY:
Question Type: STRING[30]
---------------------------------------------------------------------------------
Y_CH25b [ YCH25s ] In what state were you born?
(In what city and state were you born?)
STATE:
Question Type: STRING[2]
---------------------------------------------------------------------------------
Y_CH27a [ YCH27a ] First name confirmation
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 ^CHILD. Is that correct?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_CH27a = 1 GOTO Y_CH28a
---------------------------------------------------------------------------------
Y_CH27b [ YCH27aa ] What is your first name?
What is your first name?
FIRST NAME:
Question Type: STRING[20]
---------------------------------------------------------------------------------
Y_CH28a [ YCH28a ] NO LABEL
What are the first names of the other adults, age 18 or over who live here? Not including you, let's
start with the oldest and work down to the youngest adult in this household. (RECORD ON GRID
BELOW.)
Now, I'd like to know the names of all children and teenagers aged 17 and under living in this
household. Let's start with the oldest and work down to the youngest child in this household.
FIRST NAME:
Question Type: TStr_20a, EMPTY
_20 1 String[20]
---------------------------------------------------------------------------------
Logic before:
IF NO OTHER HH MEMBERS IN Y_CH28a, GO TO Y_CH32a. ELSE, CONTINUE. NEXT PERSON
LISTED IN Y_CH28a AS VARIABLE <PERSON>
Y_CH29a [ YCH29ax ] Labels are in Logic After
USE CARD 1. Let's talk about ^PERSON. Looking again at Card 1, what is ^PERSON's
relationship to you? (PROBE TO DETERMINE BIOLOGIC, STEP, ADOPTIVE, FOSTER, ETC.)
Question Type: TCG29aAr
biomom 2 MOTHER (BIOLOGICAL)
biodad 3 FATHER (BIOLOGICAL)
stepmom 4 STEP-MOTHER
stepdad 5 STEP-FATHER
adoptmom 6 ADOPTIVE MOTHER
adoptdad 7 ADOPTIVE FATHER
fostmom 8 FOSTER MOTHER
fostdad 9 FOSTER FATHER
sister 10 FULL SISTER
brother 11 FULL BROTHER
halfsis 12 HALF SISTER
halfbro 13 HALF BROTHER
stepsis 14 STEP-SISTER
stepbro 15 STEP-BROTHER
fostsis 16 FOSTER SISTER
fostbro 17 FOSTER BROTHER
adoptsis 18 ADOPTIVE SISTER
adoptbro 19 ADOPTIVE BROTHER
bioson 20 SON (BIOLOGICAL)
biodaughter 21 DAUGHTER (BIOLOGICAL)
adoptson 22 ADOPTIVE SON
adoptdaughter 23 ADOPTIVE DAUGHTER
stepson 24 STEP-SON
stepdaughter 25 STEP-DAUGHTER
fostson 26 FOSTER SON
fostdaughter 27 FOSTER DAUGHTER
spouse 30 SPOUSE (HUSBAND/WIFE)
partner 31 UNMARRIED PARTNER, BOYFRIEND/GIRLFRIEND
aunt 40 AUNT
uncle 41 UNCLE
greataunt 42 GREAT AUNT
greatuncle 43 GREAT UNCLE
cousin 44 COUSIN
niece 45 NIECE
nephew 46 NEPHEW
matgrandma 50 MATERNAL GRANDMOTHER
patgrandma 51 PATERNAL GRANDMOTHER
matgrandpa 52 MATERNAL GRANDFATHER
patgrandpa 53 PATERNAL GRANDFATHER
matgrgrandma 54 MATERNAL GREAT-GRANDMOTHER
patgrgrandma 55 PATERNAL GREAT-GRANDMOTHER
matgrgrandpa 56 MATERNAL GREAT-GRANDFATHER
patgrgrandpa 57 PATERNAL GREAT-GRANDFATHER
otherrel 60 OTHER BLOOD RELATIVE
partnerrel 70 RELATIVE OF UNMARRIED PARTNER (BOYFRIEND/GIRLFRIEND)
roommate 80 ROOMMATE
othernonrel 81 OTHER NON-RELATIVE
Logic after:
YCH29ax_1 --Relationship of first other adult age 18 or over; YCH29ax_2 --Relationship of second
other adult age 18 or over; YCH29ax_3 --Relationship of third other adult age 18 or over;
YCH29ax_4 --Relationship of fourth other adult age 18 or over; YCH29ax_5 --Relationship of fifth
other adult age 18 or over; YCH29ax_6 --Relationship of sixth other adult age 18 or over;
YCH29ax_7 --Relationship of seventh other adult age 18 or over; YCH29ax_8 --Relationship of
eighth other adult age 18 or over; YCH29ax_9 --Relationship of ninth other adult age 18 or over;
YCH29ax_10 --Relationship of tenth other adult age 18 or over
---------------------------------------------------------------------------------
Y_CH29y [ YCH29y ] Labels are in Logic After
How old is ^PERSON?
YEARS OLD:
Question Type: Array[1..10] of 0..97
Logic after:
YCH29y_1 --Age of first other adult age 18 or over; YCH29y_2 --Age of second other adult age 18
or over; YCH29y_3 --Age of third other adult age 18 or over; YCH29y_4 --Age of fourth other adult
age 18 or over; YCH29y_5 --Age of fifth other adult age 18 or over; YCH29y_6 --Age of sixth other
adult age 18 or over; YCH29y_7 --Age of seventh other adult age 18 or over; YCH29y_8 --Age of
eighth other adult age 18 or over; YCH29y_9 --Age of ninth other adult age 18 or over; YCH29y_10 -
-Age of tenth other adult age 18 or over
---------------------------------------------------------------------------------
Y_CH29ba [ YCH29ba ] 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 Y_CH29a UNTIL ALL ROSTER MEMBERS IN Y_CH28a ARE COVERED.;
YCH29ba_1 --Sex of first other adult age 18 or over; YCH29ba_2 --Sex of second other adult
age 18 or over; YCH29ba_3 --Sex of third other adult age 18 or over; YCH29ba_4 --Sex of
fourth other adult age 18 or over; YCH29ba_5 --Sex of fifth other adult age 18 or over;
YCH29ba_6 --Sex of sixth other adult age 18 or over; YCH29ba_7 --Sex of seventh other
adult age 18 or over; YCH29ba_8 --Sex of eighth other adult age 18 or over; YCH29ba_9 --
Sex of ninth other adult age 18 or over; YCH29ba_10 --Sex of tenth other adult age 18 or over
---------------------------------------------------------------------------------
Y_CH30 [ YCH30 ] NO LABEL
HOUSEHOLD ROSTER ACCURACY CHECK:
RESPONDENT: ^Global.Child, AGE: ^Global.CHILD_AGE, SEX: ^Global.Sex
^HHRoster
Question Type: TCH30F
cont 1 CONTINUE
change 2 MAKE CHANGES
---------------------------------------------------------------------------------
Y_CH32a [ YCH32a ] Marital status
Now I have a few more questions about you. Please look at Card 2. Are you currently...
NOTE: "MARRIED" CAN INCLUDE LEGAL AND COMMON LAW MARRIAGES, DEPENDING ON
WHAT RESPONDENT THINKS HIS/HER MARITAL STATUS IS.
Question Type: TCH32a
married 1 Married,
separated 2 Separated,
divorced 3 Divorced,
widowed 4 Widowed, or
never 5 Have you never been married?
---------------------------------------------------------------------------------
Logic before:
ASK Y_CH33bm-Y_CH33by IF ANY Y_CH29A = 30; ELSE GOTO Y_CH35a
Y_CH33bm [ YCH33bm ] 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
---------------------------------------------------------------------------------
Y_CH33bd [ YCH33bd ] NO LABEL
What is your spouse's date of birth?
DAY:
Question Type: 1..31
---------------------------------------------------------------------------------
Y_CH33by [ YCH33by ] NO LABEL
What is your spouse's date of birth?
YEAR:
Question Type: 1950..2008
Logic after:
GOTO Y_CH35a
---------------------------------------------------------------------------------
Logic before:
IF ANY Y_CH29a = 20 OR 21, GOTO Y_CH36a; ELSE ASK Y_CH35a
Y_CH35a [ YCH35b ] Have any children
Do you have any biological children, including any living outside the household?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_CH35a = 2 GOTO Y_CH41a
---------------------------------------------------------------------------------
Y_CH36a [ YCH36a ] Number of births
How many children have you ^Fills.CH36a? Please include any children living outside the
Question Type: 0..10
Question Fill: ^FillCH36a
female given birth to
male fathered
Logic after:
IF 0 GOTO Y_CH41a
---------------------------------------------------------------------------------
Y_CH36aa [ YCH36aa ] NO LABEL
Please give me the first name of the ^Fills.CH36aa you have ^Fills.CH36a.
Question Type: TStr_20a
_20 1 String[20]
Question Fill: ^FillCH36aa
one child
moreone children
---------------------------------------------------------------------------------
Y_CH_Kids Questions Y_CH37a - Y_CH40a are in Y_CH_Kids
Question Type: ARRAY[1..10] OF BY_CH_Kids
---------------------------------------------------------------------------------
Logic before:
REPEAT Y_CH37a through Y_CH40a FOR EACH CHILD LISTED IN Y_CH36aa
Y_CH37a [ YCH37a ] Labels are in Logic After
CHILD IN QUESTION: ^Y_CH36aa[L]
Does ^Y_CH36aa[L] live with you?
Question Type: TCH37a
yes 1 YES
no 2 NO
deceased 3 CHILD IS DECEASED
Logic after:
IF Y_CH37a = 1 GOTO Y_CH38ca; IF Y_CH37a = 2 GOTO Y_CH38a; IF Y_CH37a = 3 GOTO
Y_CH41a; YCH37aa--Child 1 live with R; YCH37ba--Child 2 live with R; YCH37ca--Child 3 live with
R; YCH37da--Child 4 live with R; YCH37ea--Child 5 live with R; YCH37fa--Child 6 live with R;
YCH37ga--Child 7 live with R; YCH37ha--Child 8 live with R; YCH37ia--Child 9 live with R; YCH37ja-
-Child 10 live with R
---------------------------------------------------------------------------------
Y_CH38a [ YCH38a ] Labels are in Logic After
CHILD IN QUESTION: ^Y_CH36aa[L]
Do you have contact with ^Y_CH36aa[L]?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_CH38a = 1 GOTO Y_CH38aa; IF Y_CH38a = 2 GOTO Y_CH38ba; YCH38aa--R has contact
with child 1; YCH38ba--R has contact with child 2; YCH38ca--R has contact with child 3;
YCH38da--R has contact with child 4; YCH38ea--R has contact with child 5; YCH38fa--R has
contact with child 6; YCH38ga--R has contact with child 7; YCH38ha--R has contact with child 8;
YCH38ia--R has contact with child 9; YCH38ja--R has contact with child 10
---------------------------------------------------------------------------------
Y_CH38aa [ YCH38aa ] Labels are in Logic After
CHILD IN QUESTION: ^Y_CH36aa[L]
How often do you see ^Y_CH36aa[L]? Would you say...
Question Type: TCH38aa
never 1 never,
lessonce 2 less than once a month,
oncetwice 3 once or twice a month,
oncewk 4 about once a week,
sevweek 5 several times a week, or
everyday 6 every day?
Logic after:
YCH38aaa--How often R see child 1; YCH38aba--How often R see child 2; YCH38aca--How often R
see child 3; YCH38ada--How often R see child 4; YCH38aea--How often R see child 5; YCH38afa--
How often R see child 6; YCH38aga--How often R see child 7; YCH38aha--How often R see child 8;
YCH38aia--How often R see child 9; YCH38aja--How often R see child 10
---------------------------------------------------------------------------------
Y_CH38ba [ YCH38bax ] Labels are in Logic After
USE CARD 3. Who does ^Y_CH36aa[L] live with? Looking at Card 3, tell me the person's
relationship to you.
Question Type: TCH29a
biomom 2 MOTHER (BIOLOGICAL)
biodad 3 FATHER (BIOLOGICAL)
stepmom 4 STEP-MOTHER
stepdad 5 STEP-FATHER
adoptmom 6 ADOPTIVE MOTHER
adoptdad 7 ADOPTIVE FATHER
fostmom 8 FOSTER MOTHER
fostdad 9 FOSTER FATHER
sister 10 FULL SISTER
brother 11 FULL BROTHER
halfsis 12 HALF SISTER
halfbro 13 HALF BROTHER
stepsis 14 STEP-SISTER
stepbro 15 STEP-BROTHER
fostsis 16 FOSTER SISTER
fostbro 17 FOSTER BROTHER
adoptsis 18 ADOPTIVE SISTER
adoptbro 19 ADOPTIVE BROTHER
bioson 20 SON (BIOLOGICAL)
biodaughter 21 DAUGHTER (BIOLOGICAL)
adoptson 22 ADOPTIVE SON
adoptdaughter 23 ADOPTIVE DAUGHTER
stepson 24 STEP-SON
stepdaughter 25 STEP-DAUGHTER
fostson 26 FOSTER SON
fostdaughter 27 FOSTER DAUGHTER
spouse 30 SPOUSE (HUSBAND/WIFE)
partner 31 UNMARRIED PARTNER, BOYFRIEND/GIRLFRIEND
aunt 40 AUNT
uncle 41 UNCLE
greataunt 42 GREAT AUNT
greatuncle 43 GREAT UNCLE
cousin 44 COUSIN
niece 45 NIECE
nephew 46 NEPHEW
matgrandma 50 MATERNAL GRANDMOTHER
patgrandma 51 PATERNAL GRANDMOTHER
matgrandpa 52 MATERNAL GRANDFATHER
patgrandpa 53 PATERNAL GRANDFATHER
matgrgrandma 54 MATERNAL GREAT-GRANDMOTHER
patgrgrandma 55 PATERNAL GREAT-GRANDMOTHER
matgrgrandpa 56 MATERNAL GREAT-GRANDFATHER
patgrgrandpa 57 PATERNAL GREAT-GRANDFATHER
otherrel 60 OTHER BLOOD RELATIVE
partnerrel 70 RELATIVE OF UNMARRIED PARTNER (BOYFRIEND/GIRLFRIEND)
roommate 80 ROOMMATE
othernonrel 81 OTHER NON-RELATIVE
Logic after:
YCH38baxa--Relation to R: Person child 1 lives with; YCH38bbxa--Relation to R: Person child 2
lives with; YCH38bcxa--Relation to R: Person child 3 lives with; YCH38bdxa--Relation to R: Person
child 4 lives with; YCH38bexa--Relation to R: Person child 5 lives with; YCH38bfxa--Relation to R:
Person child 6 lives with; YCH38bgxa--Relation to R: Person child 7 lives with; YCH38bhxa--
Relation to R: Person child 8 lives with; YCH38bixa--Relation to R: Person child 9 lives with;
YCH38bjxa--Relation to R: Person child 10 lives with
---------------------------------------------------------------------------------
Y_CH38ca [ YCH38ca ] Labels are in Logic After
CHILD IN QUESTION: ^Y_CH36aa[L]
Do you have legal custody of ^Y_CH36aa[L]?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_CH38ca = 1 GOTO Y_CH39a; IF Y_CH38ca = 2 GOTO Y_CH39a; YCH38caa--R has legal
custody of child 1; YCH38cba--R has legal custody of child 2; YCH38cca--R has legal custody of
child 3; YCH38cda--R has legal custody of child 4; YCH38cea--R has legal custody of child 5;
YCH38cfa--R has legal custody of child 6; YCH38cga--R has legal custody of child 7; YCH38cha--R
has legal custody of child 8; YCH38cia--R has legal custody of child 9; YCH38cja--R has legal
---------------------------------------------------------------------------------
Y_CH39a [ YCH39a ] Labels are in Logic After
CHILD IN QUESTION: ^Y_CH36aa[L]
Are you the primary caregiver for ^Y_CH36aa[L]? That is, are you the person who makes the
decisions about care, including daily routine, health care, and child care?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_CH39a = 1 GOTO Y_CH40a; IF Y_CH39a = 2 GOTO Y_CH39aa; YCH39aa--R primary
caregiver to child 1; YCH39ba--R primary caregiver to child 2; YCH39ca--R primary caregiver to
child 3; YCH39da--R primary caregiver to child 4; YCH39ea--R primary caregiver to child 5;
YCH39fa--R primary caregiver to child 6; YCH39ga--R primary caregiver to child 7; YCH39ha--R
primary caregiver to child 8; YCH39ia--R primary caregiver to child 9; YCH39ja--R primary caregiver
---------------------------------------------------------------------------------
Y_CH39aa [ YCH39aax ] Labels are in Logic After
USE CARD 3. Who is the primary caregiver for ^Y_CH36aa[L]? Looking at Card 3, tell me the
person's relationship to you.
Question Type: TCH29a
biomom 2 MOTHER (BIOLOGICAL)
biodad 3 FATHER (BIOLOGICAL)
stepmom 4 STEP-MOTHER
stepdad 5 STEP-FATHER
adoptmom 6 ADOPTIVE MOTHER
adoptdad 7 ADOPTIVE FATHER
fostmom 8 FOSTER MOTHER
fostdad 9 FOSTER FATHER
sister 10 FULL SISTER
brother 11 FULL BROTHER
halfsis 12 HALF SISTER
halfbro 13 HALF BROTHER
stepsis 14 STEP-SISTER
stepbro 15 STEP-BROTHER
fostsis 16 FOSTER SISTER
fostbro 17 FOSTER BROTHER
adoptsis 18 ADOPTIVE SISTER
adoptbro 19 ADOPTIVE BROTHER
bioson 20 SON (BIOLOGICAL)
biodaughter 21 DAUGHTER (BIOLOGICAL)
adoptson 22 ADOPTIVE SON
adoptdaughter 23 ADOPTIVE DAUGHTER
stepson 24 STEP-SON
stepdaughter 25 STEP-DAUGHTER
fostson 26 FOSTER SON
fostdaughter 27 FOSTER DAUGHTER
spouse 30 SPOUSE (HUSBAND/WIFE)
partner 31 UNMARRIED PARTNER, BOYFRIEND/GIRLFRIEND
aunt 40 AUNT
uncle 41 UNCLE
greataunt 42 GREAT AUNT
greatuncle 43 GREAT UNCLE
cousin 44 COUSIN
niece 45 NIECE
nephew 46 NEPHEW
matgrandma 50 MATERNAL GRANDMOTHER
patgrandma 51 PATERNAL GRANDMOTHER
matgrandpa 52 MATERNAL GRANDFATHER
patgrandpa 53 PATERNAL GRANDFATHER
matgrgrandma 54 MATERNAL GREAT-GRANDMOTHER
patgrgrandma 55 PATERNAL GREAT-GRANDMOTHER
matgrgrandpa 56 MATERNAL GREAT-GRANDFATHER
patgrgrandpa 57 PATERNAL GREAT-GRANDFATHER
otherrel 60 OTHER BLOOD RELATIVE
partnerrel 70 RELATIVE OF UNMARRIED PARTNER (BOYFRIEND/GIRLFRIEND)
roommate 80 ROOMMATE
othernonrel 81 OTHER NON-RELATIVE
Logic after:
YCH39aaxa--Relation to R: prim cg to child 1; YCH39abxa--Relation to R: prim cg to child 2;
YCH39acxa--Relation to R: prim cg to child 3; YCH39adxa--Relation to R: prim cg to child 4;
YCH39aexa--Relation to R: prim cg to child 5; YCH39afxa--Relation to R: prim cg to child 6;
YCH39agxa--Relation to R: prim cg to child 7; YCH39ahxa--Relation to R: prim cg to child 8;
YCH39aixa--Relation to R: prim cg to child 9; YCH39ajxa--Relation to R: prim cg to child 10
---------------------------------------------------------------------------------
Logic before:
ASK Y_CH40a IF Y_CH37a = 2; ELSE GO TO Y_CH37a FOR NEXT CHILD LISTED IN Y_CH36aa
Y_CH40a [ YCH40a ] Labels are in Logic After
During the last 12 months, did you make any child support payments to support ^Y_CH36aa[L]?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
YCH40aa--Make support payments for child 1; YCH40ba--Make support payments for child 2;
YCH40ca--Make support payments for child 3; YCH40da--Make support payments for child 4;
YCH40ea--Make support payments for child 5; YCH40fa--Make support payments for child 6;
YCH40ga--Make support payments for child 7; YCH40ha--Make support payments for child 8;
YCH40ia--Make support payments for child 9; YCH40ja--Make support payments for child 10
---------------------------------------------------------------------------------
Y_CH41a [ YCH41a ] Number times moved in last 12 months
Now let's talk about the place where you're living these days. How many times have you moved in
the last 12 months?
NUMBER:
Question Type: 0..100
---------------------------------------------------------------------------------
Y_CH42a [ YCH42a ] Type of housing
Think about the place that you are currently staying. Do you own that place, rent that place, are
you just staying there, or do you have some other type of arrangement?
Question Type: TCH42a
own 1 Own
rent 2 Rent
staying 3 Just staying there
other 4 Other
Logic after:
IF Y_CH42a = 1, 3 OR 4 GOTO Y_CH45a
---------------------------------------------------------------------------------
Y_CH43a [ YCH43a ] Housing in R name
Is that place in your name? Is your name on the lease or rental agreement?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CH44a [ YCH44a ] Live in public housing
Is your place in a public housing project, is it owned by the local housing authority, or some other
public agency?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF Y_CH29a = 2 GOTO Y_CH47a
Y_CH45a [ YCH45a ] Know bio mother
Now I would like to ask some questions about your biological family. Do you know your biological
mom?
(IF NECESSARY, PROBE: THE MOM WHO GAVE BIRTH TO YOU.)
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_CH45a = 2 GOTO Y_CH47a
---------------------------------------------------------------------------------
Y_CH46a [ YCH46a ] How often have contact with bio mother
About how often do you see or have contact with your biological mom? Would you say...
Question Type: TCH46a
never 1 never,
lessonce 2 less than once a month,
oncetwice 3 once or twice a month,
oncewk 4 about once a week,
sevweek 5 several times a week, or
everyday 6 every day?
deceased 7 BIOLOGICAL MOTHER IS DECEASED
---------------------------------------------------------------------------------
Logic before:
IF Y_CH29a = 3 GOTO Y_CH49a
Y_CH47a [ YCH47a ] Know bio father
Do you know your biological dad?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_CH47a = 2 GOTO Y_CH49a
---------------------------------------------------------------------------------
Y_CH48a [ YCH48a ] How often have contact with bio father
About how often do you see or have contact with your biological dad? Would you say...
Question Type: TCH48a
never 1 never,
lessonce 2 less than once a month,
oncetwice 3 once or twice a month,
oncewk 4 about once a week,
sevweek 5 several times a week, or
everyday 6 every day?
deceased 7 BIOLOGICAL FATHER IS DECEASED
---------------------------------------------------------------------------------
Y_CH49a [ YCH49a ] Have bio siblings
Do you have biological siblings?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_CH49a = 2 GOTO Y_CH51a
---------------------------------------------------------------------------------
Y_CH50a [ YCH50a ] How often have contact with bio siblings
About how often do you see or have contact with your biological siblings? Would you say...
Question Type: TCH50a
never 1 never,
lessonce 2 less than once a month,
oncetwice 3 once or twice a month,
oncewk 4 about once a week,
sevweek 5 several times a week, or
everyday 6 every day?
deceased 7 BIOLOGICAL SIBLINGS ARE DECEASED
---------------------------------------------------------------------------------
Y_CH51a [ YCH51a ] Have contact w/other family members
Are there other members of your family such as aunts, uncles, or cousins, that you like to see?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_CH51a = 2 GOTO Y_CHEND
---------------------------------------------------------------------------------
Y_CH52a [ YCH52a ] How often have contact w/oth fam members
About how often do you see or have contact with them? Would you say...
Question Type: TCH52a
never 1 never,
once 2 once in a while,
sometimes 3 sometimes, or
usually 4 usually?
---------------------------------------------------------------------------------
Y_CH_END [ YCH_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
Source: Kaufman Brief Intelligence Test, Second Edition (KBIT-2): by Alan Kaufman and Nadeen Kaufman; Pearson; copyright 2004. Standardized assessment tool measuring abilities through two scales: a Crystallized (Verbal) Scale containing verbal knowledge and riddles items, and a Fluid (Nonverbal) Scale /Matrices. Not administered for Spanish-language interviews. For children age 4 and above.
Battelle Developmental Inventory & Screening Test, Second Edition (BDI-2): Cognitive Skills. Newborg (2004, 2016); Houghton, Mifflin, Harcourt. Cognitive skills; administered to age 4 and older if K-BIT score=0.
Skip Logic:
IF AGE > 2, SKIP TO NEXT SECTION
---------------------------------------------------------------------------------
Y_NI_BGN [ YNI_BGN ] NoDeliv
CHILD NEURODEVELOPMENTAL IMPAIRMENT: BINS MODULE
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF AGE IS 3 TO 4 MONTHS OLD, CONTINUE. ELSE, SKIP TO Y_NIb1a.
Y_NIa1a [ YNIa1a ] BINS 3-4 Mths Item 1:
@BEyes Follow Ring@B
@BMATERIALS:@B RING WITH STRING
@BPOSITION:@B LYING DOWN, FACE UP
@BADMINISTRATION: @B
- FROM BEHIND INFANT, HOLD STRING SO THAT RING IS 8 INCHES ABOVE INFANT'S
EYES, WITH LOWER EDGE AT MIDLINE.
- ATTRACT HIS/HER GAZE TO RING AND SLOWLY MOVE IT TO HIS/HER RIGHT, THEN
LEFT, AND BACK TO MIDLINE, HORIZONTALLY, KEEPING IT 8 INCHES ABOVE INFANT (1
EXCURSION).
- IF HIS/HER GAZE LEAVES THE RING, GET ATTENTION AGAIN AND PROCEED.
- DO 3 EXCURSIONS MAXIMUM.
@BSCORING: @B
1 = EYES FOLLOW RING @UTHROUGH 1 COMPLETE EXCURSION@U, EVEN IF THEY
BREAK AWAY ONCE OR TWICE DURING EACH EXCURSION.
0 = @UUNABLE@U TO FOLLOW RING @UTHROUGH 1 EXCURSION@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIa1b [ YNIa1b ] BINS 3-4 Mths Item 2:
@BReaches for Hanging Ring@B
@BMATERIALS:@B RING WITH STRING
@BPOSITION:@BLYING DOWN, FACE UP
@BADMINISTRATION:@B
- SCORE THIS ITEM IF INFANT HAS ALREADY REACHED FOR AN OBJECT.
- IF NOT, HOLD RING BY STRING 8 INCHES ABOVE HIS/HER EYES AT HIS/HER MIDLINE.
- MOVE RING SLIGHTLY TO ATTRACT ATTENTION, AND THEN HOLD STILL.
- IF HE/SHE DOES NOT REACH FOR RING, PLACE IT IN HIS/HER HAND AND ALLOW TO
HOLD BRIEFLY, AND THEN RE-ADMINISTER.
@BSCORING:@B
1 = INFANT @UINCREASES HAND MOVEMENT@U, PURPOSELY MOVES ARM(S),
@UOR@U MARKEDLY INCREASES @UARM MOVEMENT IN THE RING'S GENERAL
DIRECTION@U. (CONTACT WITH RING IS NOT NEEDED.)
0 = DOES @UNOT@U DO THE ABOVE, OR ARM @UMOVEMENT IS INCIDENTALLY IN
DIRECTION OF@U RING, @UOR NOT IN DIRECTION OF RING@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIa1c [ YNIa1c ] BINS 3-4 Mths Item 3:
@BHolds Head Erect and Steady for 15 Seconds@B
@BMATERIALS:@B NONE
@BPOSITION:@B HELD TO YOUR SHOULDER
@BADMINISTRATION:@B
- PLACE YOUR FINGERS ALONG BACK OF INFANT'S NECK TO SUPPORT HEAD.
- LIFT TO UPRIGHT POSITION, RESTING HIS/HER HEAD ON YOUR SHOULDER.
- MOVE ONE HAND TO SUPPORT INFANT'S BACK.
- CAREFULLY REMOVE YOUR HAND FROM THE NECK ACCORDING TO HIS/HER ABILITY
TO LIFT HEAD FROM SHOULDER AND HOLD IT ERECT.
@BSCORING:@B
1 = HOLDS HEAD @UERECT AND STEADY@U FOR APPROXIMATELY @U15 SECONDS@U.
0 = DOES @UNOT@U LIFT HEAD, HEAD BOBS OR FLOPS AROUND, OR HEAD IS ERECT
FOR @ULESS THAN 15 SECONDS@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIa1d [ YNIa1d ] BINS 3-4 Mths Item 4:
@BAdjusts Head to Line Up Head with Body@B
@BMATERIALS:@B NONE
@BPOSITION:@B LYING DOWN, FACE DOWN
@BADMINISTRATION: @B
- LIFT INFANT BY SIDES OF CHEST, TO 8-10 INCHES ABOVE EXAM SURFACE.
- HOLD HORIZONTAL TO SURFACE, FACE DOWN.
@BSCORING:@B
1 = BRIEFLY @UADJUSTS HEAD IN LINE WITH BODY@U OR RAISED SLIGHTLY UP.
0 = @UHEAD DROOPS@U TOWARD EXAM SURFACE.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIa1e [ YNIa1e ] BINS 3-4 Mths Item 5:
@BDemonstrates Optimal Muscle Tone in Forearms, Biceps, and Shoulders@B
@BMATERIALS:@B NONE
@BPOSITION:@B LYING DOWN, FACE UP
@BADMINISTRATION:@B
- STAND AT INFANT'S FEET AND LEAN OVER HIM/HER.
- LIGHTLY GRASP THE WRISTS AND EXTEND ARMS UNTIL APPROXIMATELY PARALLEL
TO BODY.
- BEND ARMS UNTIL FOREARMS ARE PRESSED AGAINST BICEPS, THEN EXTEND AGAIN.
- REPEAT 2 OR 3 TIMES TO TEST RESISTANCE.
- THEN MOVE ARMS FROM SIDES TO PERPENDICULAR (AT A 90 DEGREE ANGLE) WITH
BODY, OUT TO SIDES, 2 OR 3 TIMES.
- USE SMOOTH, CONTINUOUS MOTION.
@BSCORING:@B
1 = FOREARMS, BICEPS, SHOULDERS EXERT @UMODERATE RESISTANCE@U WHEN
ARMS ARE EXTENDED BOTH PARALLEL AND PERPENDICULAR (AT A 90 DEGREE ANGLE)
TO BODY.
0 = @ULITTLE OR NO RESISTANCE@U EXERTED BY MUSCLES, @UOR@U THEY ARE
TIGHT AND @UDIFFICULT TO EXTEND@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIa1f [ YNIa1f ] BINS 3-4 Mths Item 6:
@BDemonstrates Optimal Muscle Tone in Legs and Hips@B
@BMATERIALS:@B NONE
@BPOSITION:@B LYING DOWN, FACE UP
@BADMINISTRATION:@B
- STAND AT INFANT'S FEET AND LEAN OVER HIM/HER.
- LIGHTLY GRASP HIS/HER ANKLES AND PUSH LEGS UP, BENDING KNEES, UNTIL YOU
FEEL RESISTANCE.
- GENTLY PULL LEGS TO EXTENDED POSITION AND RELEASE.
- REPEAT 2 OR 3 TIMES.
- PUSH LEGS UP AGAIN, BENDING KNEES, UNTIL RESISTANCE, SLIDE YOUR THUMBS
UP TO THE INSIDE OF KNEES AND PUSH LEGS OUTWARD FROM MIDLINE TO FORM A 120
DEGREE ANGLE.
- THEN EXTEND LEGS AS YOU BRING THEM BACK TO MIDLINE.
- REPEAT 2 OR 3 TIMES WITH A SMOOTH AND CONTINUOUS MOTION.
@BSCORING:@B
1 = LEGS AND HIPS EXERT @UMODERATE RESISTANCE@U WHEN LEGS BENT AND
PUSHED UP AND PUSHED OUT; BENDS LEGS IN @URELAXED@U MANNER WHEN
EXTENDED LEGS ARE @URELEASED@U.
0 = DURING EITHER MANEUVER LEG OR HIP SHOWS @ULITTLE OR NO RESISTANCE@U,
OR SHOWS @UEXAGGERATED OR NO BENDING WHEN RELEASED@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIa2g [ YNIa2g ] BINS 3-4 Mths Item 7:
@BSits with Slight Support for 10 seconds@B
@BMATERIALS:@B NONE
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- SEAT INFANT WITH LEGS SLIGHTLY BENT AND SPREAD TO 45 DEGREE ANGLE.
- SUPPORT THE LOWER BACK AND GRADUALLY LOOSEN YOUR HOLD ON THE INFANT
ACCORDING TO HIS/HER ABILITY TO SIT UNSUPPORTED.
@BSCORING:@B
1 = SITS WITH SUPPORT FOR AT LEAST @U10 SECONDS@U.
0 = SITS WITH SUPPORT @ULESS THAN 10 SECONDS@U OR @UDOESN'T TENSE
MUSCLES@U IN AN EFFORT TO STAY SITTING.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIa2h [ YNIa2h ] BINS 3-4 Mths Item 8:
@BLooks at Pellet with Smooth and Coordinated Eye Movements@B
@BMATERIALS:@B SUGAR PELLET
@BPOSITION:@B SEATED
@BTELL CAREGIVER: This pellet is sugar and won't harm (him/her).@B
@BADMINISTRATION:@B
- OBSERVE ABILITY TO VISUALLY FOCUS ON OBJECTS PLACED BEFORE HIM/HER AND
IF EYE MOVEMENTS ARE SMOOTH AND COORDINATED.
- IF UNABLE TO OBSERVE GAZE, PLACE PELLET ON EXAM SURFACE ABOUT 18 IN.
FROM INFANT.
- IF INFANT DOES NOT IMMEDIATELY REGARD PELLET, TAP NEAR IT AND QUICKLY
MOVE HAND AWAY.
@BSCORING:@B
1 = LOOKS AT PELLET FOR AT LEAST @U3 SECONDS@U. @UBOTH EYES SHOULD BE
COORDINATED@U AND CONVERGE (COME TOGETHER) ON THE PELLET.
0 = EYES @UCROSS@U, OSCILLATE (MOVE BACK AND FORTH), OR @UWANDER@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIa2i [ YNIa2i ] BINS 3-4 Mths Item 9:
@B*Vocalizes Two Different Sounds@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B
- THROUGHOUT THE EXAM LISTEN FOR ANY VOCALIZATIONS (SOUNDS) INFANT
PRODUCES FREELY.
- IF HE/SHE DOES NOT VOCALIZE, ASK CAREGIVER: @BDoes ^CHILD make any sounds?
What are they? Please help me get (him/her) to make these sounds.@B
@BSCORING:@B
1 = VOCALIZES AT LEAST @UTWO DIFFERENT@U SOUNDS.
0 = VOCALIZES @UFEWER THAN TWO@U SOUNDS.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIa2j [ YNIa2j ] BINS 3-4 Mths Item 10:
@B*Fingers Hands in Play@B
@BMATERIALS:@B NONE
@BPOSITION:@B SITTING OR LYING
@BADMINISTRATION:@B THROUGHOUT EXAM OBSERVE INFANT'S BEHAVIOR WHEN
SITTING OR LYING QUIETLY; FREE TO FOLLOW HIS/HER OWN INTERESTS.
@BSCORING:@B
1 = @UPURPOSELY@U FINGERS ONE HAND WITH THE OTHER.
0 = @UHANDS DON'T@U PLAY WITH EACH OTHER @UOR@U HANDS CONTACT EACH
OTHER @UINCIDENTALLY@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIa2k [ YNIa2k ] BINS 3-4 Mths Item 11:
@B*Demonstrates Coordinated Movement of Arms and Legs@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B THROUGHOUT THE EXAM OBSERVE THE QUALITY OF THE
INFANT'S ARM AND LEG MOVEMENTS.
@BSCORING:@B
1 = MOVEMENTS ARE @USMOOTH@U, MUSCLES ARE NEITHER RIGID NOR FLOPPY,
THERE IS @UBALANCE OF BENDING AND STRAIGHTENING@U.
0 = MOVEMENT IS @UJERKY@U, ERRATIC, OR CLUMSY; MUSCLES ARE EITHER @URIGID
OR FLOPPY@U, OR @UPREDOMINANTLY BENT OR STRAIGHTENED@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
Logic after:
GOTO Y_NIEND
---------------------------------------------------------------------------------
Logic before:
IF AGE IS 5 TO 6 MONTHS OLD, CONTINUE. ELSE, SKIP TO Y_NIc1a.
Y_NIb1a [ YNIb1a ] BINS 5-6 Mths Item 1:
@Blooks at Pellet with Smooth and Coordinated Eye Movements@B
@BMATERIALS:@B SUGAR PELLET
@BPOSITION:@B SEATED
@BTELL CAREGIVER: This pellet is sugar and won't harm (him/her).@B
@BADMINISTRATION:@B
- OBSERVE ABILITY TO VISUALLY FOCUS ON OBJECTS PLACED BEFORE HIM/HER AND
IF EYE MOVEMENTS ARE SMOOTH AND COORDINATED.
- IF UNABLE TO OBSERVE GAZE, PLACE PELLET ON EXAM SURFACE ABOUT 18 IN.
FROM INFANT.
- IF INFANT DOES NOT IMMEDIATELY REGARD PELLET, TAP NEAR IT AND QUICKLY
MOVE HAND AWAY.
@BSCORING:@B
1 = LOOKS AT PELLET FOR AT LEAST @U3 SECONDS@U. @UBOTH EYES SHOULD BE
COORDINATED@U AND CONVERGE (COME TOGETHER) ON THE PELLET.
0 = EYES @UCROSS@U, OSCILLATE (MOVE BACK AND FORTH), OR @UWANDER@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIb1b [ YNIb1b ] BINS 5-6 Mths Item 2:
@BSeparates Thumb from Fingers to grasp Cube (grasps one side of the cube with thumb and a
different side with the fingers)@B
@BMATERIALS:@B CUBE
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- PLACE CUBE ON EXAM SURFACE, IN FRONT OF INFANT AND WITHIN REACH.
- IF HE/SHE DOES NOT IMMEDIATELY GRASP THE CUBE, ATTRACT ATTENTION BY
TAPPING THE CUBE ON THE EXAM SURFACE AND QUICKLY MOVE HAND AWAY.
@BSCORING:@B
1 = GRASPS CUBE WITH HAND SO THAT @UTHUMB IS SEPARATED OR INDEPENDENT
FROM FINGERS OR PALM@U; OR HOLDS CUBE BETWEEN THE PAD OF THUMB AND THE
PADS OF ANY FINGERTIPS.
0 = DOES @UNOT GRASP WITH THUMB SEPARATED OR INDEPENDENT@U FROM
FINGERS OR PALM.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIb1c [ YNIb1c ] BINS 5-6 Mths Item 3:
@B*Bangs in Play@B
@BMATERIALS:@B SPOON, CUBE, OR HARD OBJECT
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- THROUGHOUT THE EXAM OBSERVE INFANT TO SEE IF HE/SHE USES AN OBJECT TO
PURPOSELY BANG ANY SURFACE.
- IF HE/SHE DOES NOT DISPLAY THIS BEHAVIOR, OFFER THE SPOON, CUBE, OR HARD
OBJECT, PLACING IT IN HIS/HER HAND IF NECESSARY.
@BSCORING:@B
1 = @UPURPOSELY@U BANGS IN PLAY WITH AN OBJECT ANY TIME DURING EXAM.
0 = @UONLY INCIDENTALLY@U CONTACTS EXAM SURFACE WITH AN OBJECT, EVEN IF
THAT CONTACT PRODUCES A NOISE, OR ONLY BANGS WITH HANDS.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIb1d [ YNIb1d ] BINS 5-6 Mths Item 4:
@B*Transfers Object from Hand to Hand@B
@BMATERIALS:@B RING, SPOON, OR OTHER OBJECT
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- THROUGHOUT THE EXAM OBSERVE WHETHER THE INFANT TRANSFERS AN OBJECT
FROM ONE HAND TO THE OTHER.
- IF YOU DO NOT OBSERVE THIS, PLACE AN OBJECT IN THE INFANT'S HANDS AND
WATCH FOR TRANSFER FROM HAND TO HAND.
@BSCORING:@B
1 = TRANSFERS OBJECT FROM @UHAND TO HAND@U.
0 = TRANSFER OCCURS ONLY WHEN FREE HAND CONTACTS OBJECT @UBY
CHANCE@U, INFANT @URELEASES@U THE OBJECT FROM HAND @UAND PICKS IT UP
WITH THE OTHER@U, OR USES @UOTHER PART@U OF THE BODY TO FACILITATE
@UTRANSFER@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIb1e [ YNIb1e ] BINS 5-6 Mths Item 5:
@B*Looks for Fallen Spoon@B
@BMATERIALS:@B SPOON
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- THROUGHOUT EXAM OBSERVE WHETHER INFANT VISUALLY SEARCHES FOR
OBJECTS THAT ARE MOVED OUT OF FIELD OF VISION.
- IF YOU DO NOT OBSERVE THIS, PLACE A HARD SURFACE ON CARPET NEXT TO TABLE
EDGE NEAR INFANT.
- PLACE A SPOON ON THE TABLE EDGE ABOVE THE HARD SURFACE; HOLD IT IN
PLACE WITH THE ROUND END OF SPOON EXTENDING PAST THE TABLE EDGE.
- WHEN THE INFANT IS ATTENDING THE SPOON (GET ATTENTION WITH A SOUND IF
NEEDED), LET THE SPOON FALL AND LAND NOISILY.
@BSCORING:@B
1 = SEARCHES FOR FALLEN SPOON BY @ULOOKING TOWARD FLOOR@U WHERE IT
FELL.
0 = @UDOES NOT LOOK IN DIRECTION@U OF FALLEN SPOON.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIb1f [ YNIb1f ] BINS 5-6 Mths Item 6:
@BSits with Slight Support for 10 Seconds@B
@BMATERIALS:@B NONE
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- SEAT INFANT WITH LEGS SLIGHTLY BENT AND SPREAD TO 45 DEGREE ANGLE.
- SUPPORT THE LOWER BACK AND GRADUALLY LOOSEN YOUR HOLD ON THE INFANT
ACCORDING TO HIS/HER ABILITY TO SIT UNSUPPORTED.
@BSCORING:@B
1 = SITS WITH SUPPORT FOR AT LEAST @U10 SECONDS@U.
0 = SITS WITH SUPPORT @ULESS THAN 10 SECONDS@U OR @UDOESN'T TENSE
MUSCLES@U IN AN EFFORT TO STAY SITTING.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIb2g [ YNIb2g ] BINS 5-6 Mths Item 7:
@BMoves Forward Using Prewalking Methods@B
@BMATERIALS:@B BELL
@BPOSITION:@B LYING DOWN, FACE DOWN
@BADMINISTRATION:@B
- PLACE INFANT LYING DOWN, FACE DOWN ON FLOOR AND OBSERVE MODE OF
LOCOMOTION (MOVEMENT OR MOTION).
- IF INFANT DOES NOT BEGIN TO MOVE FORWARD, PLACE A BELL ON THE FLOOR IN
FRONT OF HIM/HER BUT OUT OF REACH.
@BSCORING:@B
1 = MAKES PROGRESS OF @U9 IN. OR MORE@U, ON HANDS AND KNEES, ON STOMACH
USING ARMS TO PULL, @UON HANDS AND FEET@U, @UOR@U ON @UBUTTOCKS@U.
0 = MAKES @UNO ATTEMPT TO MOVE@U IN ANY OF THESE WAYS @UOR@U MOVES
@ULESS THAN 9 INCHES@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIb2h [ YNIb2h ] BINS 5-6 Mths Item 8:
@BDemonstrates Optimal Muscle Tone While Pulling to Sitting Position@B
@BMATERIALS:@B NONE
@BPOSITION:@B LYING DOWN, FACE UP
@BCAUTION: IF INFANT'S HEAD COMPLETELY FALLS BACK WHEN HE/SHE BEGINS TO
PULL UPWARD, DISCONTINUE.@B
@BADMINISTRATION:@B
- STAND AT INFANT'S FEET AND LEAN OVER HIM/HER.
- PLACE YOUR THUMBS IN THE PALMS OF INFANT'S HANDS AND WRAP YOUR FINGERS
AROUND THE BACK OF HIS/HER HANDS.
- ALLOW INFANT TO PULL TO A SITTING POSITION AND STANDING POSITION IF ABLE.
- GRADUALLY RAISE YOUR HANDS AS THE INFANT PULLS UP, BUT DO NOT PULL INFANT
UP.
@BSCORING:@B
1 = FLEXOR TONE IN HIS/HER UPPER BODY (ARMS, SHOULDERS, UPPER BACK)
INCREASES SO THAT YOU @UCAN FEEL HIM/HER PULLING UPWARD@U.
0 = UPPER BODY IS WEAK AND INFANT @UDOES NOT PULL TOWARD YOU@U, @UOR@U
IF HE/SHE PULLS TOWARD YOU BUT UPPER BODY @UTONE IS RIGID@U AND ARMS
AND BACK @ULOCK IN A STIFF POSITION@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIb2i [ YNIb2i ] BINS 5-6 Mths Item 9:
@BDemonstrates Optimal Muscle Tone in Forearms, Biceps, and Shoulders@B
@BMATERIALS:@B NONE
@BPOSITION:@B LYING DOWN, FACE UP
@BADMINISTRATION:@B
- STAND AT INFANT'S FEET AND LEAN OVER HIM/HER.
- LIGHTLY GRASP THE WRISTS AND EXTEND ARMS UNTIL APPROXIMATELY PARALLEL
TO BODY.
- BEND ARMS UNTIL FOREARMS ARE PRESSED AGAINST BICEPS, AND THEN EXTEND
AGAIN.
- REPEAT 2 OR 3 TIMES TO TEST RESISTANCE.
- THEN MOVE ARMS FROM SIDES TO PERPENDICULAR (AT A 90 DEGREE ANGLE) WITH
BODY, OUT TO SIDES, 2 OR 3 TIMES.
- USE SMOOTH, CONTINUOUS MOTION.
@BSCORING:@B
1 = FOREARMS, BICEPS, SHOULDERS EXERT @UMODERATE RESISTANCE@U WHEN
ARMS ARE EXTENDED BOTH PARALLEL AND PERPENDICULAR (AT A 90 DEGREE ANGLE)
TO BODY.
0 = @ULITTLE OR NO RESISTANCE@U EXERTED BY MUSCLES, @UOR@U THEY ARE
TIGHT AND @UDIFFICULT TO EXTEND@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIb2j [ YNIb2j ] BINS 5-6 Mths Item 10:
@BDemonstrates Optimal Muscle Tone in Legs and Hips@B
@BMATERIALS:@B NONE
@BPOSITION:@B LYING DOWN, FACE UP
@BADMINISTRATION:@B
- STAND AT INFANT'S FEET AND LEAN OVER HIM/HER.
- LIGHTLY GRASP THE ANKLES, PUSH LEGS UP, BENDING KNEES, UNTIL YOU FEEL
RESISTANCE.
- GENTLY PULL LEGS TO EXTENDED POSITION AND RELEASE.
- REPEAT 2 OR 3 TIMES.
- PUSH LEGS UP AGAIN, BENDING KNEES, UNTIL RESISTANCE, SLIDE YOUR THUMBS
UP TO THE INSIDE OF KNEES AND PUSH LEGS OUTWARD FROM MIDLINE TO FORM A 120
DEGREE ANGLE.
- THEN EXTEND LEGS AS YOU BRING THEM BACK TO MIDLINE.
- REPEAT 2 OR 3 TIMES WITH A SMOOTH AND CONTINUOUS MOTION.
@BSCORING:@B
1 = LEGS AND HIPS EXERT @UMODERATE RESISTANCE@U WHEN LEGS BENT AND
PUSHED UP AND PUSHED OUT; BENDS LEGS IN @URELAXED@U MANNER WHEN
EXTENDED LEGS ARE @URELEASED@U.
0 = DURING EITHER MANEUVER LEG OR HIP SHOWS @ULITTLE OR NO RESISTANCE@U,
OR SHOWS @UEXAGGERATED OR NO@U BENDING WHEN RELEASED.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIb2k [ YNIb2k ] BINS 5-6 Mths Item 11:
@B*Vocalizes One Vowel Sound@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B
- THROUGHOUT THE EXAM LISTEN FOR ANY DISTINCT VOWEL SOUNDS SUCH AS "AA,
OO, A, AH, UH, EE, EH" THAT INFANT PRODUCES FREELY.
- IF HE/SHE DOES NOT VOCALIZE, ASK CAREGIVER: @B"Does ^CHILD make sounds?
What are they? Please help me get (him/her) to make these sounds."@B
@BSCORING:@B
1 = VOCALIZES AT LEAST @UONE VOWEL@U SOUND. THE SOUND NEED NOT HAVE
MEANING TO THE INFANT.
0 = DOES @UNOT@U VOCALIZE AT LEAST ONE VOWEL SOUND.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIb2l [ YNIb2l ] BINS 5-6 Mths Item 12:
@B*Demonstrates Coordinated Movement of Arms and Legs@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B
THROUGHOUT THE EXAM OBSERVE THE QUALITY OF THE INFANT'S ARM AND LEG
MOVEMENTS.
@BSCORING:@B
1 = MOVEMENTS ARE @USMOOTH@U, MUSCLES ARE NEITHER RIGID NOR FLOPPY,
THERE IS @UBALANCE OF BENDING AND STRAIGHTENING@U.
0 = MOVEMENTS @UJERKY@U, ERRATIC, OR CLUMSY, MUSCLES ARE EITHER @URIGID
OR FLOPPY@U, OR @UPREDOMINANTLY BENT OR STRAIGHTENED@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIb2m [ YNIb2m ] BINS 5-6 Mths Item 13:
@B*Imitates Others@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B
THROUGHOUT THE EXAM OBSERVE WHETHER INFANT IMITATES CAREGIVER'S OR YOUR
BEHAVIOR OR BODY GESTURES, OR SOUND THAT HE/SHE HEARS.
@BSCORING:@B
1 = @UIMITATES@U A FACIAL EXPRESSION, A NOISE, OR A MOVEMENT OR GESTURE
MADE BY YOU, CAREGIVER, OR TOY.
0 = DOES @UNOT@U PRODUCE AT LEAST ONE IMITATION.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
Logic after:
GOTO Y_NIEND
---------------------------------------------------------------------------------
Logic before:
IF AGE IS 7 TO 10 MONTHS OLD, CONTINUE. ELSE, SKIP TO Y_NId1a.
Y_NIc1a [ YNIc1a ] BINS 7-10 Mths Item 1:
@BUses Pads of Fingertips to Grasp Pellet@B
@BMATERIALS:@B SUGAR PELLET
@BPOSITION:@B SEATED
@BTELL CAREGIVER: This pellet is sugar and won't harm (him/her).@B
@BADMINISTRATION:@B
- PLACE THE PELLET ON THE EXAM SURFACE IN FRONT OF INFANT AND WITHIN REACH.
- ATTRACT INFANT'S ATTENTION BY TAPPING NEAR PELLET.
- TIP THE EDGE OF PELLET, MAKING IT ROCK, THEN REMOVE YOUR HAND WHILE IT IS
MOVING.
@BSCORING:@B
1 = USES THE @UPAD OF THUMB AND@U THE @UPADS OF ANY FINGERTIPS@U TO
GRASP PELLET.
0 = DOES @UNOT@U GRASP PELLET @UOR@U GRASPS IT @UWITHOUT@U USING THE
PADS OF THUMB AND FINGERTIPS.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIc1b [ YNIc1b ] BINS 7-10 Mths Item 2:
@BRings Bell Purposely@B
@BMATERIALS:@B BELL
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- HOLD BELL IN FRONT OF INFANT AND SEVERAL INCHES ABOVE EXAM SURFACE.
- GENTLY RING THE BELL WHILE INFANT IS LOOKING AT IT; THEN SET IT DOWN WITHIN
REACH.
- IF INFANT DOES NOT PICK UP BELL, RING IT AGAIN SLIGHTLY HARDER; THEN HAND IT
TO HIM/HER.
- IF HE/SHE BANGS IT ON EXAM SURFACE, MOVE HIM/HER AWAY FROM IT ONCE
HE/SHE HAS BELL.
@BSCORING:@B
1 = HOLDS BELL BY HANDLE AND @UPURPOSELY@U RINGS IT, SHOWING EVIDENCE OF
LISTENING TO SOUND OR OF IMITATIVE SHAKING.
0 = @UONLY ACCIDENTALLY@U RINGS BELL WHEN BANGING IT OR INSPECTING IT.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIc1c [ YNIc1c ] BINS 7-10 Mths Item 3:
@B*Looks for Fallen Spoon@B
@BMATERIALS:@B SPOON
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- THROUGHOUT EXAM OBSERVE WHETHER INFANT VISUALLY SEARCHES FOR
OBJECTS THAT ARE MOVED OUT OF FIELD OF VISION.
- IF YOU DO NOT OBSERVE THIS, PLACE A HARD SURFACE ON CARPET NEXT TO TABLE
EDGE NEAR INFANT.
- PLACE A SPOON ON THE TABLE EDGE ABOVE THE HARD SURFACE; HOLD IT IN
PLACE WITH THE ROUND END OF SPOON EXTENDING PAST THE TABLE EDGE.
- WHEN THE INFANT IS ATTENDING THE SPOON (GET ATTENTION WITH A SOUND IF
NEEDED), LET THE SPOON FALL AND LAND NOISILY.
@BSCORING:@B
1 = SEARCHES FOR FALLEN SPOON BY @ULOOKING TOWARD FLOOR@U WHERE IT
FELL.
0 = DOES @UNOT LOOK IN DIRECTION@U OF FALLEN SPOON.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIc1d [ YNIc1d ] BINS 7-10 Mths Item 4:
@BLifts Inverted Cup@B
@BMATERIALS:@B CUP, BALL, CUBE, OR ANY TOY THAT FITS UNDER CUP
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- PLACE THE CUP AND TOY ON THE EXAM SURFACE WITHIN THE REACH OF INFANT
AND GIVE HIM/HER TIME TO EXPLORE THEM.
- THEN RETRIEVE THEM FROM HIM/HER AND QUICKLY COVER THE TOY WITH THE
INVERTED CUP WITH THE HANDLE TOWARD THE INFANT.
- SAY TO INFANT, @B"Find the toy; you find the toy"@B OR A SIMILAR PHRASE.
@BSCORING:@B
1 = LIFTS THE CUP @UTO FIND HIDDEN OBJECT@U. AN INFANT AWARE THAT THE
OBJECT IS UNDER THE CUP USUALLY @UFOCUSES HIS/HER GAZE ON WHERE OBJECT
IS, NOT CUP@U, AS HE/SHE LIFTS CUP.
0 = PICKS UP CUP TO PLAY WITH IT AND @UONLY INCIDENTALLY@U NOTICES THE TOY.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIc1e [ YNIc1e ] BINS 7-10 Mths Item 5:
@BDemonstrates Optimal Muscle Tone in Forearms, Biceps, and Shoulders@B
@BMATERIALS:@B NONE
@BPOSITION:@B LYING DOWN, FACE UP
@BADMINISTRATION:@B
- STAND AT INFANT'S FEET AND LEAN OVER HIM/HER.
- LIGHTLY GRASP THE WRISTS AND EXTEND ARMS UNTIL APPROXIMATELY PARALLEL
TO BODY.
- BEND ARMS UNTIL FOREARMS ARE PRESSED AGAINST BICEPS, AND THEN EXTEND
AGAIN.
- REPEAT 2 OR 3 TIMES TO TEST RESISTANCE.
- THEN MOVE ARMS FROM SIDES TO PERPENDICULAR (AT A 90 DEGREE ANGLE) WITH
BODY, OUT TO SIDES, 2 OR 3 TIMES.
- USE SMOOTH, CONTINUOUS MOTION.
@BSCORING:@B
1 = FOREARMS, BICEPS, SHOULDERS EXERT @UMODERATE RESISTANCE@U WHEN
ARMS ARE EXTENDED BOTH PARALLEL AND PERPENDICULAR (AT A 90 DEGREE ANGLE)
TO BODY.
0 = @ULITTLE OR NO RESISTANCE@U EXERTED BY MUSCLES, @UOR@U THEY ARE
TIGHT AND @UDIFFICULT TO EXTEND@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIc1f [ YNIc1f ] BINS 7-10 Mths Item 6:
@BDemonstrates Optimal Muscle Tone in Legs and Hips@B
@BMATERIALS:@B NONE
@BPOSITION:@B LYING DOWN, FACE UP
@BADMINISTRATION:@B
- STAND AT INFANT'S FEET AND LEAN OVER HIM/HER.
- LIGHTLY GRASP THE ANKLES, PUSH LEGS UP, BENDING KNEES, UNTIL YOU FEEL
RESISTANCE.
- GENTLY PULL LEGS TO EXTENDED POSITION AND RELEASE.
- REPEAT 2 OR 3 TIMES.
- PUSH LEGS UP AGAIN, BENDING KNEES, UNTIL RESISTANCE, SLIDE YOUR THUMBS
UP TO THE INSIDE OF KNEES AND PUSH LEGS OUTWARD FROM MIDLINE TO FORM A 120
DEGREE ANGLE.
- THEN EXTEND LEGS AS YOU BRING THEM BACK TO MIDLINE.
- REPEAT 2 OR 3 TIMES WITH A SMOOTH AND CONTINUOUS MOTION.
@BSCORING:@B
1 = LEGS AND HIPS EXERT @UMODERATE RESISTANCE@U WHEN LEGS BENT AND
PUSHED UP AND PUSHED OUT; BENDS LEGS IN @URELAXED@U MANNER WHEN
EXTENDED LEGS ARE @URELEASED@U.
0 = DURING EITHER MANEUVER LEG OR HIP SHOWS @ULITTLE OR NO RESISTANCE@U,
OR SHOWS @UEXAGGERATED OR NO@U BENDING)WHEN RELEASED.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIc2g [ YNIc2g ] BINS 7-10 Mths Item 7:
@BSits Alone for 30 Seconds@B
@BMATERIALS:@B NONE
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- SEAT INFANT WITH LEGS SLIGHTLY BENT AND SPREAD TO 45 DEGREE ANGLE.
- SUPPORT THE LOWER BACK AND GRADUALLY LOOSEN YOUR HOLD ON THE INFANT
ACCORDING TO HIS/HER ABILITY TO SIT UNSUPPORTED.
@BSCORING:@B
1 = SITS @UALONE@U STEADILY FOR AT LEAST @U30 SECONDS@U, WITH BACK FAIRLY
STRAIGHT.
0 = @USLUMPS@U EXCESSIVELY, @UPROPS UP WITH ARMS, OR@U SITS WITHOUT
SUPPORT @UFEWER THAN 30 SECONDS@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIc2h [ YNIc2h ] BINS 7-10 Mths Item 8:
@BMoves Forward Using Prewalking Methods@B
@BMATERIALS:@B BELL
@BPOSITION:@B LYING DOWN, FACE DOWN
@BADMINISTRATION:@B
- PLACE INFANT LYING DOWN, FACE DOWN ON FLOOR AND OBSERVE MODE OF
LOCOMOTION (MOVEMENT OR MOTION).
- IF INFANT DOES NOT BEGIN TO MOVE FORWARD, PLACE A BELL ON THE FLOOR IN
FRONT OF HIM/HER BUT OUT OF REACH.
@BSCORING:@B
1 = MAKES PROGRESS OF @U9 IN. OR MORE@U, ON HANDS AND KNEES, ON STOMACH
USING ARMS TO PULL, @UON HANDS AND FEET@U, @UOR@U ON @UBUTTOCKS@U.
0 = MAKES @UNO ATTEMPT TO MOVE@U IN ANY OF THESE WAYS @UOR@U MOVES
@ULESS THAN 9 INCHES@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIc2i [ YNIc2i ] BINS 7-10 Mths Item 9:
@BUses Early Stepping Movements@B
@BMATERIALS:@B NONE
@BPOSITION:@B UPRIGHT
@BADMINISTRATION:@B
HOLD INFANT UNDER HIS/HER ARMS IN AN UPRIGHT POSITION, FACING YOU, SO THAT
HIS/HER FEET TOUCH FLOOR OR EXAM SURFACE.
@BSCORING:@B
1 = MAKES STEPPING MOVEMENTS THAT @UPROPEL HIM/HER FORWARD@U, EVEN IF
HE/SHE DOES NOT FULLY SUPPORT HIS/HER OWN WEIGHT.
0 = INFANT MAKES @UNO@U STEPPING MOVEMENTS.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIc2j [ YNIc2j ] BINS 7-10 Mths Item 10:
@BRaises Self to Standing Position@B
@BMATERIALS:@B BELL, BLANKET OR MAT IF NEEDED
@BPOSITION:@B LYING DOWN, FACE UP
@BADMINISTRATION:@B
LIE THE INFANT ON THE FLOOR CLOSE TO A CHAIR (PLACE A BLANKET OR MAT ON THE
FLOOR IF NEEDED). SHAKE THE BELL AND THEN PLACE IT ON THE EDGE OF THE CHAIR.
@BSCORING:@B
1 = RAISES UP TO A @USTANDING POSITION@U, USING CHAIR OR OTHER OBJECT FOR
SUPPORT.
0 = INFANT DOES @UNOT@U RISE UP TO A STANDING POSITION.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIc2k [ YNIc2k ] BINS 7-10 Mths Item 11:
@B*Vocalizes Three Different Vowel-Consonant Combinations@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B
- THROUGHOUT THE EXAM LISTEN FOR DISTINCT VOWEL-CONSONANT COMBINATIONS
SUCH AS "ADA, MA, BA, GOO, UM, AN" THAT INFANT PRODUCES FREELY.
- IF HE/SHE DOES NOT VOCALIZE, ASK CAREGIVER: @B"Does ^CHILD make sounds?
What are they? Please help me get (him/her) to make these sounds."@B
@BSCORING:@B
1 = VOCALIZES AT LEAST @UONE VOWEL-CONSONANT COMBINATION, AND THE TOTAL
REPORTED BY CAREGIVER PLUS THE TOTAL PRODUCED BY INFANT IS AT LEAST
THREE@U.
0 = @UTOTAL NUMBER@U OF VOWEL-CONSONANT COMBINATIONS BOTH PRODUCED,
AND REPORTED BY CAREGIVER @UEQUALS TWO OR FEWER@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIc2l [ YNIc2l ] BINS 7-10 Mths Item 12:
@B*Responds to Spoken Request@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B
- THROUGHOUT THE EXAM OBSERVE WHETHER THE INFANT RESPONDS TO A SPOKEN
REQUEST.
- IF YOU DO NOT OBSERVE A RESPONSE, HAVE THE CAREGIVER VERBALLY REQUEST
THE INFANT PERFORM AN ACTION WITHOUT GESTURING. ASK CAREGIVER: @BPlease
ask ^CHILD to do something (he/she) knows how to do. Don't make any gestures, just ask with
words.@B
- IF THE CAREGIVER USES GESTURES, HAVE THE CAREGIVER GIVE A DIFFERENT
REQUEST WITHOUT GESTURES.
@BSCORING:@B
1 = @URESPONDS IN APPROPRIATE MANNER@U TO A VERBAL REQUEST, INCLUDING
TEST QUESTIONS YOU'VE ASKED. COMMON EXAMPLES: WAVE BYE, PAT-A-CAKE,
SHOW ME YOUR NOSE.
0 = @UFAILS TO RESPOND@U TO THE SPOKEN REQUEST.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIc2m [ YNIc2m ] BINS 7-10 Mths Item 13:
@B*Demonstrates Coordinated Movement of Arms and Legs@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B
THROUGHOUT THE EXAM OBSERVE THE QUALITY OF THE INFANT'S ARM AND LEG
MOVEMENTS.
@BSCORING:@B
1 = MOVEMENTS ARE @USMOOTH@U, MUSCLES ARE NEITHER RIGID NOR FLOPPY,
THERE IS @UBALANCE OF BENDING AND STRAIGHTENING@U.
0 = MOVEMENTS @UJERKY@U, ERRATIC, OR CLUMSY, MUSCLES ARE EITHER @URIGID
OR FLOPPY@U, OR @UPREDOMINANTLY BENT OR STRAIGHTENED@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
Logic after:
GOTO Y_NIEND
---------------------------------------------------------------------------------
Logic before:
IF AGE IS 11 TO 15 MONTHS OLD, CONTINUE. ELSE, SKIP TO Y_NIe1a.
Y_NId1a [ YNId1a ] BINS 11-15 Mths Item 1:
@BRemoves Pellet from Bottle@B
@BMATERIALS:@B SUGAR PELLET AND BOTTLE
@BPOSITION:@B SEATED
@BTELL CAREGIVER: This pellet is sugar and won't harm (him/her).@B
@BADMINISTRATION:@B
- PLACE THE PELLET AND BOTTLE ON THE EXAM SURFACE IN FRONT OF INFANT.
- WHILE HE/SHE IS WATCHING, PUT THE PELLET IN THE BOTTLE AND SHAKE IT SO
HE/SHE CAN SEE IT THERE.
- HAND BOTTLE TO INFANT. SAY "Now get it out."
@BSCORING:@B
1 = REMOVES PELLET FROM BOTTLE USING SOME FORM OF @UPURPOSEFUL
EFFORT@U LIKE DUMPING PELLET OR SHAKING BOTTLE.
0 = @UUNSUCCESSFUL@U AT REMOVING PELLET @UOR@U ONLY DOES SO
@UACCIDENTALLY@U AS HE/SHE PLAYS WITH BOTTLE.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NId1b [ YNId1b ] BINS 11-15 Mths Item 2:
@BPuts Three Cubes in Cup@B
@BMATERIALS:@B CUP AND SIX CUBES
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- PLACE CUP WITHIN INFANT'S REACH, HANDLE TOWARD YOU.
- PLACE A CUBE IN THE CUP; TAKE IT OUT AND HAND TO INFANT.
- SAY @B"Put the block in the cup. Put it in the cup."@B
- POINT FROM CUBE TO CUP.
- IF THE INFANT RELEASES CUBE INTO THE CUP, GET OUT FIVE MORE CUBES.
- SAY @B"Put the blocks in the cup. Put them all in the cup."@B POINT LIKE BEFORE.
@BSCORING:@B
1 = PUTS AT LEAST @U3 CUBES@U INSIDE THE CUP @U AT ANY ONE TIME@U.
0 = PLACES @UONLY ONE OR TWO CUBES@U IN THE CUP @UAT ANY ONE TIME@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NId1c [ YNId1c ] BINS 11-15 Mths Item 3:
@BImitates Crayon Stroke@B
@BMATERIALS:@B TWO CRAYONS, BLANK SHEET OF WHITE PAPER
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- PLACE THE PAPER ON THE EXAM SURFACE IN FRONT OF THE INFANT.
- PLACE ONE CRAYON ON THE PAPER, WITH TIP POINTING AWAY FROM HIM/HER.
- WITH THE OTHER CRAYON, DRAW A STRAIGHT VERTICAL LINE ON THE PAPER,
MOVING THE CRAYON RAPIDLY TOWARD THE INFANT.
- SAY @B"See? It goes zip! You do it!"@B
@BSCORING:@B
1 = HE/SHE @UPRODUCES A STROKE@U IN ANY DIRECTION.
0 = INFANT DOES @UNOT@U MARK ON THE PAPER.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NId1d [ YNId1d ] BINS 11-15 Mths Item 4:
@BDemonstrates Optimal Muscle Tone in Forearms, Biceps, and Shoulders@B
@BMATERIALS:@B NONE
@BPOSITION:@B LYING DOWN, FACE UP
@BADMINISTRATION:@B
- STAND AT INFANT'S FEET AND LEAN OVER HIM/HER.
- LIGHTLY GRASP THE WRISTS AND EXTEND ARMS UNTIL APPROXIMATELY PARALLEL
TO BODY.
- BEND ARMS UNTIL FOREARMS ARE PRESSED AGAINST BICEPS, AND THEN EXTEND
AGAIN.
- REPEAT 2 OR 3 TIMES TO TEST RESISTANCE.
- THEN MOVE ARMS FROM SIDES TO PERPENDICULAR (AT A 90 DEGREE ANGLE) WITH
BODY, OUT TO SIDES, 2 OR 3 TIMES.
- USE SMOOTH, CONTINUOUS MOTION.
@BSCORING:@B
1 = FOREARMS, BICEPS, SHOULDERS EXERT @UMODERATE RESISTANCE@U WHEN
ARMS ARE EXTENDED BOTH PARALLEL AND PERPENDICULAR (AT A 90 DEGREE ANGLE)
TO BODY.
0 = @ULITTLE OR NO RESISTANCE@U EXERTED BY MUSCLES, @UOR@U THEY ARE
TIGHT AND @UDIFFICULT TO EXTEND@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NId1e [ YNId1e ] BINS 11-15 Mths Item 5:
@BDemonstrates Optimal Muscle Tone in Legs and Hips@B
@BMATERIALS:@B NONE
@BPOSITION:@B LYING DOWN, FACE UP
@BADMINISTRATION:@B
- STAND AT INFANT'S FEET AND LEAN OVER HIM/HER.
- LIGHTLY GRASP THE ANKLES, PUSH LEGS UP, BENDING KNEES, UNTIL YOU FEEL
RESISTANCE.
- GENTLY PULL LEGS TO EXTENDED POSITION AND RELEASE.
- REPEAT 2 OR 3 TIMES.
- PUSH LEGS UP AGAIN, BENDING KNEES, UNTIL RESISTANCE, SLIDE YOUR THUMBS
UP TO THE INSIDE OF KNEES AND PUSH LEGS OUTWARD FROM MIDLINE TO FORM A 120
DEGREE ANGLE.
- THEN EXTEND LEGS AS YOU BRING THEM BACK TO MIDLINE.
- REPEAT 2 OR 3 TIMES WITH A SMOOTH AND CONTINUOUS MOTION.
@BSCORING:@B
1 = LEGS AND HIPS EXERT @UMODERATE RESISTANCE@U WHEN LEGS BENT AND
PUSHED UP AND PUSHED OUT; BENDS LEGS IN @URELAXED@U MANNER WHEN
EXTENDED LEGS ARE @URELEASED@U.
0 = DURING EITHER MANEUVER LEG OR HIP SHOWS @ULITTLE OR NO RESISTANCE@U,
OR SHOWS @UEXAGGERATED OR NO@U BENDING WHEN RELEASED.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NId1f [ YNId1f ] BINS 11-15 Mths Item 6:
@B*Walks Alone@B
@BMATERIALS:@B NONE
@BPOSITION:@B STANDING
@BADMINISTRATION:@B
- THROUGHOUT THE EXAM OBSERVE THE INFANT TO SEE IF SHE WALKS ALONE.
- IF HE/SHE DOES NOT WALK ALONE SPONTANEOUSLY, STAND HIM/HER ON THE
FLOOR WITH ARMS EXTENDED TO SHOULDER HEIGHT.
- MAKE SURE NO SUPPORTING OBJECT IS IN REACH.
- SLOWLY LOOSEN HOLD ACCORDING TO ABILITY TO STAND UNSUPPORTED.
- YOU MAY ENCOURAGE HIM/HER TO WALK BY STANDING IN FRONT AND HOLDING OUT
YOUR ARMS.
- KEEP YOUR HANDS CLOSE TO INFANT IN CASE HE/SHE LOSES BALANCE.
@BSCORING:@B
1 = TAKES AT LEAST @U3 STEPS WITHOUT SUPPORT@U, EVEN IF GAIT (WALK) IS STIFF-
LEGGED AND WOBBLY AND ELBOWS ARE BENT AND HELD AT ELBOW OR SHOULDER
HEIGHT.
0 = DOES @UNOT@U TAKE 3 STEPS WITHOUT SUPPORT, @USTUMBLES@U WHILE
TAKING STEPS, WALKS TIPTOE, @OR HOLDS ARM(S) IN ABNORMAL POSTURE@U (E.G.
UPPER ARMS AT SIDE, ELBOWS BENT, FOREARMS PERPENDICULAR TO SIDES, AND
HANDS FISTED.)
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NId2g [ YNId2g ] BINS 11-15 Mths Item 7:
@B*Imitates Words@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B
- THROUGHOUT THE EXAM OBSERVE WHETHER INFANT IMITATES ANY WORD YOU OR
CAREGIVER SAYS.
- IF THE INFANT HAS NOT, USE A PLAYFUL TONE OF VOICE TO SAY SEVERAL WORDS
SUCH AS@B@IMAMA, DADA, ALL GONE, UH-OH, UP, BALL, THAT, THANK YOU, AND
BABY.@B@I
- THE CAREGIVER MAY ALSO TRY TO ELICIT IMITATION OF WORDS IN THE SAME
MANNER.
@bSCORING:@b
1 = IMITATES AT LEAST @UONE WORD IMMEDIATELY@U AFTER IT IS SAID. (EVEN IF THE
IMITATION CONSISTS OF VOWELS ONLY.)
0 = DOES @UNOT@U IMITATE WORD IMMEDIATELY AFTER SAID @UOR REPEATS@U
ONLY A WORD OR SOUND @UNONSPECIFICALLY THROUGHOUT THE EXAM@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NId2h [ YNId2h ] BINS 11-15 Mths Item 8:
@B*Responds to Spoken Request@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B
- THROUGHOUT THE EXAM OBSERVE WHETHER THE INFANT RESPONDS TO A SPOKEN
REQUEST.
- IF YOU DO NOT OBSERVE A RESPONSE, HAVE THE CAREGIVER VERBALLY REQUEST
THE INFANT PERFORM AN ACTION WITHOUT GESTURING. ASK CAREGIVER: @BPlease
ask ^CHILD to do something (he/she) knows how to do. Don't make any gestures, just ask with
words.@B
- IF THE CAREGIVER USES GESTURES, HAVE THE CAREGIVER GIVE A DIFFERENT
REQUEST WITHOUT GESTURES.
@BSCORING:@B
1 = @URESPONDS IN APPROPRIATE MANNER@U TO VERBAL REQUEST, INCLUDING
TEST QUESTIONS YOU'VE ASKED. COMMON EXAMPLES: WAVE BYE, PAT-A-CAKE,
SHOW ME YOUR NOSE.
0 = @UFAILS TO RESPOND@U TO THE SPOKEN REQUEST.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NId2i [ YNId2i ] BINS 11-15 Mths Item 9:
@B*Listens Selectively to Two Familiar Words@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B
- THROUGHOUT EXAM OBSERVE WHETHER INFANT SELECTIVELY LISTENS TO FAMILIAR
WORDS SUCH AS BABY, KITTY, MAMA, OR SHOE.
- IF THE INFANT DOES NOT SPONTANEOUSLY DO THIS, HAVE CAREGIVER ATTRACT
INFANT'S ATTENTION AND TALK TO HIM/HER USING WORDS UNFAMILIAR TO INFANT.
THEN HAVE CAREGIVER, WITH NO VOLUME CHANGE OR EMPHASIS, USE WORDS THAT
PROBABLY ARE FAMILIAR INTERSPERSED AMONG UNFAMILIAR WORDS.
- TELL CAREGIVER: @BPlease attract ^CHILD's attention and talk to (him/her) using words
(he/she) will not recognize. Then every few words, without changing how loud you say them, say a
word (he/she) does know. Some examples of words (he/she) may know are baby, kitty, mama,
or shoe.@B
- OBSERVE INFANT'S RESPONSE.
@BSCORING:@B
1 = RESPONDS @UDIFFERENTIALLY@U TO AT LEAST @UTWO@U FAMILIAR WORDS BY
@UCHANGING FACIAL EXPRESSION, VOCALIZING, OR IMITATING THE WORDS@U.
0 = @UFAILS TO RESPOND@U TO AT LEAST TWO FAMILIAR WORDS.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NId2j [ YNId2j ] BINS 11-15 Mths Item 10:
@B*Uses Gesture to Make Wants Known@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B
- THROUGHOUT THE EXAM OBSERVE THE INFANT TO SEE IF HE/SHE USES A GESTURE
OR TOY TO TRY TO COMMUNICATE WITH YOU OR CAREGIVER.
- FOR EXAMPLE, NOTICE WHETHER INFANT REACHES FOR, POINTS TOWARD, OR
PUSHES AWAY OBJECTS IN AN EVIDENT GESTURE OF COMMUNICATION.
- IF UNSURE ABOUT WHETHER THE INFANT MADE A PARTICULAR GESTURE, YOU CAN
VERIFY YOUR IMPRESSION WITH THE CAREGIVER.
ASK CAREGIVER: @BI thought I saw ^CHILD (describe gesture you saw child make). Did you
see that or is that something (he/she) does?@B
@BSCORING:@B
1 = USES AT LEAST @UONE@U GESTURE TO MAKE WANTS KNOWN.
0 = MAKES @UNO@U COMMUNICATIVE GESTURE.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NId2k [ YNId2k ] BINS 11-15 Mths Item 11:
@B*Demonstrates Coordinated Movement of Arms and Legs@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B
THROUGHOUT THE EXAM OBSERVE THE QUALITY OF THE INFANT'S ARM AND LEG
MOVEMENTS.
@BSCORING:@B
1 = MOVEMENTS ARE @USMOOTH@U, MUSCLES ARE NEITHER RIGID NOR FLOPPY,
THERE IS @UBALANCE OF BENDING AND STRAIGHTENING@U.
0 = MOVEMENTS @UJERKY@U, ERRATIC, OR CLUMSY, MUSCLES ARE EITHER @URIGID
OR FLOPPY@U, OR @UPREDOMINANTLY BENT OR STRAIGHTENED@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
Logic after:
GOTO Y_NIEND
---------------------------------------------------------------------------------
Logic before:
IF AGE IS 16 TO 20 MONTHS OLD, CONTINUE. ELSE, SKIP TO Y_NIf1a.
Y_NIe1a [ YNIe1a ] BINS 16-20 Mths Item 1:
@BImitates Crayon Stroke@B
@BMATERIALS:@B TWO CRAYONS, BLANK SHEET OF WHITE PAPER
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- PLACE THE PAPER ON THE EXAM SURFACE IN FRONT OF THE INFANT.
- PLACE ONE CRAYON ON THE PAPER, WITH TIP POINTING AWAY FROM HIM/HER.
- WITH THE OTHER CRAYON, DRAW A STRAIGHT VERTICAL LINE ON THE PAPER,
MOVING THE CRAYON RAPIDLY TOWARD THE INFANT.
- SAY @B"See? It goes zip! You do it!"@B
@BSCORING:@B
1 = HE/SHE @UPRODUCES A STROKE@U IN ANY DIRECTION.
0 = INFANT DOES @UNOT@U MARK ON THE PAPER.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIe1b [ YNIe1b ] BINS 16-20 Mths Item 2:
@BRemoves Pellet from Bottle@B
@BMATERIALS:@B SUGAR PELLET AND BOTTLE
@BPOSITION:@B SEATED
@BTELL CAREGIVER: This pellet is sugar and won't harm (him/her).@B
@BADMINISTRATION:@B
- PLACE THE PELLET AND BOTTLE ON THE EXAM SURFACE IN FRONT OF INFANT.
- WHILE HE/SHE IS WATCHING, PUT THE PELLET IN THE BOTTLE AND SHAKE IT SO
HE/SHE CAN SEE IT THERE.
- HAND BOTTLE TO INFANT. SAY "Now get it out."
@BSCORING:@B
1 = REMOVES PELLET FROM BOTTLE USING SOME FORM OF @UPURPOSEFUL
EFFORT@U LIKE DUMPING PELLET OR SHAKING BOTTLE.
0 = @UUNSUCCESSFUL@U AT REMOVING PELLET @UOR@U ONLY DOES SO
@UACCIDENTALLY@U AS HE/SHE PLAYS WITH BOTTLE.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIe1c [ YNIe1c ] BINS 16-20 Mths Item 3:
@BPlaces Three Pieces in Puzzle Board@B
@BMATERIALS:@B BLUE PUZZLE BOARD AND PUZZLE PIECES
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- PLACE ALL PIECES ON EXAM SURFACE IN FRONT OF YOU.
- PLACE THE PUZZLE BOARD (BLUE SIDE UP) ON THE EXAM SURFACE IN FRONT OF
INFANT.
- HAND INFANT A ROUND PIECE.
- MOTION TOWARD HOLES.
- SAY @B"Put the block in its hole. Put it where it belongs."@B
- THEN ALTERNATELY HAND THE INFANT A SQUARE PIECE AND A ROUND PIECE, ONE
AT A TIME, UNTIL HE/SHE HAS PLACED EACH TO HIS/HER SATISFACTION.
@BSCORING:@B
1 = CORRECTLY PLACES AT LEAST @U3 PIECES@U; TO BE CORRECTLY PLACED, THE
PIECE MUST BE @UCOMPLETELY SEATED IN THE PROPER HOLE@U (CHILD MAY NOT
STACK PIECES ON TOP OF OTHERS.).
0 = DOES @UNOT@U CORRECTLY PLACE AT LEAST THREE PIECES.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIe1d [ YNIe1d ] BINS 16-20 Mths Item 4:
@BNames Three Objects@B
@BMATERIALS:@B BALL, CRAYON, SPOON, AND CUP
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- PLACE THE FOUR OBJECTS ON THE EXAM SURFACE WITHIN THE INFANT'S REACH.
- GIVE HIM/HER TIME TO EXPLORE THE OBJECTS.
- AS HE/SHE PICKS UP AN OBJECT, ASK, @B"What is that? What do you have?"@B
- IF INFANT DOES NOT EXPLORE OBJECTS, PICK UP OBJECTS ONE AT A TIME AND ASK,
@B"What is this? What do I have?"@B
@BSCORING:@B
1 = CORRECTLY NAMES AT LEAST @U3 OBJECTS. DISREGARD POOR
PRONUNCIATION@U. YOU MAY VERIFY WITH CAREGIVER THAT NAME GIVEN IS THE
NAME INFANT COMMONLY GIVES OBJECT.
0 = DOES @UNOT@U CORRECTLY NAME AT LEAST 3 OBJECTS, NAME IS
@UUNRECOGNIZABLE@U, @UUSED RANDOMLY@U THROUGHOUT EXAM, @UOR USED
FOR OTHER OBJECTS@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIe1e [ YNIe1e ] BINS 16-20 Mths Item 5:
@BBuilds Tower of Six Cubes@B
@BMATERIALS:@B SIX CUBES
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- PLACE ALL CUBES ON EXAM SURFACE IN FRONT OF YOU.
- STACK THREE OF THE CUBES, ASKING, @B"See my tower?"@B
- PLACE THREE CUBES IN FRONT OF INFANT AND SAY, @B"Use these blocks to make a
big tower."@B
- LEAVE YOUR TOWER STANDING AS A MODEL, BUT ALLOW HIM/HER TO USE CUBES
FROM YOURS.
- IF INFANT CONSTRUCTS A TOWER OF THREE CUBES, UNSTACK THE THREE CUBES IN
YOUR TOWER AND PLACE IN FRONT OF INFANT, SAY, @B"Make your tower as big as you
can. Use all the blocks."@B
- IF INFANT APPEARS CONFUSED BY THE ADDITIONAL CUBES OR BEGINS TO TAKE
CUBES APART, ENCOURAGE HIM/HER AGAIN TO STACK THE CUBES.
- DO NOT DIRECT OR GUIDE THE BUILDING OF THE STRUCTURE IN ANY MANNER.
@BSCORING:@B
1 = @USTACKS ALL 6 CUBES@U TO CONSTRUCT A TOWER.
0 = DOES @UNOT@U STACK ALL 6 CUBES. DO NOT COUNT A CUBE AS PART OF THE
TOWER UNLESS THE INFANT RELEASES IT AND IT REMAINS BALANCED.@U DO NOT
COUNT THE CUBE IF IT CAUSES THE STRUCTURE TO FALL@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIe1f [ YNIe1f ] BINS 16-20 Mths Item 6:
@BPoints to Three of Doll's Body Parts@B
@BMATERIALS:@B DOLL
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- HOLD THE DOLL WITHIN REACH; SAY, @B"Show me the doll's hair", "Where is the doll's
hair?", or "Hair?"@B
- USE THE SAME PROCEDURE FOR:
MOUTH@|@|EYES
EARS@|@|@|FEET
HANDS@|@|NOSE
@BSCORING:@B
1 = CORRECTLY POINTS TO AT LEAST @U3 OF THE DOLL'S BODY PARTS@U IN
RESPONSE TO YOUR REQUESTS.
0 = POINTS TO @UFEWER THAN 3@U BODY PARTS.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIe2g [ YNIe2g ] BINS 16-20 Mths Item 7:
@B*Walks Quickly with Coordination@B
@BMATERIALS:@B BALL
@BPOSITION:@B STANDING
@BADMINISTRATION:@B
- THROUGHOUT THE EXAM OBSERVE INFANT TO SEE IF HE/SHE WALKS QUICKLY
WITHOUT SUPPORT.
- IF THE INFANT DOES NOT, ROLL THE BALL ACROSS THE FLOOR AND ENCOURAGE
HIM/HER TO RUN BY SAYING, @B"Hurry. Get the ball. Run and get it."@B
@BSCORING:@B
1 = TAKES AT LEAST @U6 STEPS WITHOUT SUPPORT@U AND IN A NOTICEABLY
@UFASTER@U SPEED @UTHAN HIS/HER USUAL WALKING SPEED@U.
0 = WALK IS @USTIFF-LEGGED@U AND @UWOBBLY OR@U HE/SHE TAKES @UFEWER
THAN 6 STEPS@U, @USTUMBLES@U WHILE TAKING STEPS, WALKS @UTIPTOE@U,
BENDS ARM(S) WITH FIST(S) HELD AT ELBOW OR SHOULDER HEIGHT, @UMOVES ONE
ARM MORE@U THAN THE OTHER, @UOR@U HOLDS ARM(S) IN @UABNORMAL
POSTURE@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIe2h [ YNIe2h ] BINS 16-20 Mths Item 8:
@BWalks up Stairs with Help@B
@BMATERIALS:@B STAIRS, AND TOY THAT INTERESTS THE INFANT
@BPOSITION:@B STANDING
@BCAUTION: DO NOT USE AN OPEN STAIRCASE OR STAIRCASE WITH AN OPEN
RAILING.@B
@BADMINISTRATION:@B
- PLACE INFANT AT THE BOTTOM OF A SET OF STAIRS.
- IF HE/SHE DOES NOT SPONTANEOUSLY BEGIN TO CLIMB STAIRS, PLACE A TOY ON
THE FOURTH OR FIFTH STEP.
- ENCOURAGE HIM/HER TO RETRIEVE IT.
- STAND CLOSE TO INFANT IN CASE HE/SHE LOSES BALANCE.
- THE INFANT MAY HOLD YOUR HAND OR RAILING FOR SUPPORT.
@BSCORING:@B
1 = WALKS UP AT LEAST @U2 STEPS@U. INFANT @UMAY HOLD THE RAIL OR YOUR
HAND@U FOR SUPPORT. YOU MAY ALSO GIVE CREDIT IF INFANT WALKS UP STAIRS
WITHOUT SUPPORT.
0 = INFANT WALKS UP @UFEWER THAN 2 STEPS@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIe2i [ YNIe2i ] BINS 16-20 Mths Item 9:
@B*Imitates Two-Word Sentence@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B
- THROUGHOUT THE EXAM LISTEN TO HEAR INFANT IMITATE ANY MULTIPLE-WORD
SENTENCES YOU OR CAREGIVER SAY.
- IF NOT, TELL INFANT IN PLAYFUL WAY, @B"Say Mama go, Daddy eat, Baby drink, Go
home, What's this?, Put here,"@B (OR ANY OTHER MULTIPLE-WORD SENTENCE THE
INFANT MAY KNOW).
- YOU MAY REPEAT THE SENTENCE SEVERAL TIMES.
@BSCORING:@B
1 = IMITATES AT LEAST A @UTWO-WORD@U SENTENCE. @UDISREGARD POOR
PRONUNCIATION@U.
0 = VOCALIZATIONS (SOUNDS) ARE USED @UNONSPECIFICALLY OR REPEATEDLY@U
THROUGHOUT THE EXAM @UOR@U HE/SHE IMITATES @UONLY ONE@U WORD.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIe2j [ YNIe2j ] BINS 16-20 Mths Item 10:
@B*Combines Word and Gesture@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B
- THROUGHOUT EXAM OBSERVE WHETHER INFANT SIMULTANEOUSLY AND
APPROPRIATELY USES A GESTURE AND WORD(S) TO EXPRESS HIM/HERSELF.
- FOR EXAMPLE, INFANT SAYS MOMMY AND POINTS TO MOTHER, OR BALL AND
REACHES FOR BALL.
@BSCORING:@B
1 = @UCOMBINES@U A GESTURE AND WORD(S).
0 = DOES @UNOT@U COMBINE A GESTURE AND WORD(S).
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIe2k [ YNIe2k ] BINS 16-20 Mths Item 11:
@B*Absence of Drooling and Motor Overflow (One Hand Mimics the Other Involuntarily)@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B
THROUGHOUT THE EXAM OBSERVE WHETHER INFANT DROOLS AND WHETHER ONE OF
HIS/HER HANDS MIMICS OR MIRRORS, IN AN INVOLUNTARY FASHION, THE ACTIVITIES OF
THE OTHER.
@BSCORING:@B
1 = DOES @UNOT SHOW EXCESSIVE DROOL@U AROUND MOUTH OR ANY DROOLING
AROUND COLLAR, @UAND NEITHER HAND MIMICS OR MIRRORS@U ACTIVITIES OF THE
OTHER MORE THAN HALF THE TIME.
0 = @UDROOLS EXCESSIVELY@U ON CLOTHING, @UOR@U IF @UEITHER OF THE HANDS
MIRRORS OR MIMICS@U THE OTHER MORE THAN HALF THE TIME.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
Logic after:
GOTO Y_NIEND
---------------------------------------------------------------------------------
Logic before:
IF AGE IS 21 TO 24 MONTHS OLD, CONTINUE. ELSE, SKIP TO Y_NIEND.
Y_NIf1a [ YNIf1a ] BINS 21-24 Mths Item 1:
@BPlaces Three Pieces in Puzzle Board@B
@BMATERIALS:@B BLUE PUZZLE BOARD AND PUZZLE PIECES
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- PLACE ALL PIECES ON EXAM SURFACE IN FRONT OF YOU.
- PLACE THE PUZZLE BOARD (BLUE SIDE UP) ON THE EXAM SURFACE IN FRONT OF
INFANT.
- HAND INFANT A ROUND PIECE.
- MOTION TOWARD HOLES.
- SAY @B"Put the block in its hole. Put it where it belongs."@B
- THEN ALTERNATELY HAND THE INFANT A SQUARE PIECE AND A ROUND PIECE, ONE
AT A TIME, UNTIL HE/SHE HAS PLACED EACH TO HIS/HER SATISFACTION.
@BSCORING:@B
1 = CORRECTLY PLACES @UAT LEAST 3 PIECES@U; TO BE CORRECTLY PLACED, THE
PIECE MUST BE @UCOMPLETELY SEATED IN THE PROPER HOLE@U (CHILD MAY NOT
STACK PIECES ON TOP OF OTHERS.).
0 = DOES @UNOT@U CORRECTLY PLACE AT LEAST THREE PIECES.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIf1b [ YNIf1b ] BINS 21-24 Mths Item 2:
@BBuilds Tower of Six Cubes@B
@BMATERIALS:@B SIX CUBES
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- PLACE ALL CUBES ON EXAM SURFACE IN FRONT OF YOU.
- STACK THREE OF THE CUBES, ASKING, @B"See my tower?"@B
- PLACE THREE CUBES IN FRONT OF INFANT AND SAY, @B"Use these blocks to make a
big tower."@B
- LEAVE YOUR TOWER STANDING AS A MODEL, BUT ALLOW HIM/HER TO USE CUBES
FROM YOURS.
- IF INFANT CONSTRUCTS A TOWER OF THREE CUBES, UNSTACK THE THREE CUBES IN
YOUR TOWER AND PLACE IN FRONT OF INFANT, SAY, @B"Make your tower as big as you
can. Use all the blocks."@B
- IF INFANT APPEARS CONFUSED BY THE ADDITIONAL CUBES OR BEGINS TO TAKE
CUBES APART, ENCOURAGE HIM/HER AGAIN TO STACK THE CUBES.
- DO NOT DIRECT OR GUIDE THE BUILDING OF THE STRUCTURE IN ANY MANNER.
@BSCORING:@B
1 = @USTACKS ALL 6 CUBES@U TO CONSTRUCT A TOWER.
0 = DOES @UNOT@U STACK ALL 6 CUBES. DO NOT COUNT A CUBE AS PART OF THE
TOWER UNLESS THE INFANT RELEASES IT AND IT REMAINS BALANCED. @UDO NOT
COUNT THE CUBE IF IT CAUSES THE STRUCTURE TO FALL@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIf1c [ YNIf1c ] BINS 21-24 Mths Item 3:
@BNames Four Pictures@B
@BMATERIALS:@B STIMULUS CARDS A AND B
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- PLACE STIMULUS CARD A FLAT ON EXAM SURFACE, DIRECTLY IN FRONT OF THE
INFANT.
- POINT TO THE DOG, ASK, @B"What is this?"@B OR @B"Tell me what this is."@B
- REGARDLESS OF INFANT'S RESPONSE, POINT TO OTHER PICTURES ON PAGE,
ASKING, @B"What is this?"@B FOR EACH ONE.
- TO ENCOURAGE FURTHER RESPONSES, SHOW PLEASED ACCEPTANCE OF ANY
ANSWER GIVEN.
- RETURN ONCE TO ANY PICTURES NOT NAMED CORRECTLY.
- NOW PLACE STIMULUS CARD B ON EXAM SURFACE, DIRECTLY IN FRONT OF INFANT,
STARTING WITH CLOCK, ASK THE NAME FOR EACH PICTURE.
- RETURN ONCE TO PICTURES NOT NAMED CORRECTLY.
- AFTER GIVING THE INFANT TWO CHANCES TO NAME EACH PICTURE ON EACH CARD,
SAY WITHOUT POINTING, @B"Show me the (name of picture). Put your finger on the (name of
picture)."@B
@BSCORING:@B
1 = @UCORRECTLY@U NAMES @UAT LEAST 4 OF THE PICTURES@U. CORRECT NAMING
INCLUDES GIVING THE CLASS OF OBJECT (E.G. DOG, PUPPY) BUT NOT PROPER NOUNS
(SPOT FOR DOG). @UDISREGARD POOR PRONUNCIATION@U.
0 = CORRECTLY NAMES @UFEWER THAN 4 PICTURES@U.
@B**NOTE ANSWER TO THIS ITEM. YOU WILL NEED TO KNOW IT IN Y_NIf1d@B
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIf1d [ YNIf1d ] BINS 21-24 Mths Item 4:
@BIdentifies Four Pictures@B
@BMATERIALS:@B STIMULUS CARD
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
SCORE THIS ITEM FROM THE PREVIOUS ITEM ADMINISTRATION.
@BSCORING:@B
1 = @UCORRECTLY@U NAMES OR INDICATES @UAT LEAST 4 PICTURES@U. CORRECTLY
NAMING INCLUDES GIVING THE CLASS OF OBJECT (E.G. DOG, PUPPY) BUT NOT
PROPER NOUNS (SPOT FOR DOG). @UDISREGARD POOR PRONUNCIATION@U.
0 = CORRECTLY NAMES OR INDICATES @UFEWER THAN 4 PICTURES@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIf1e [ YNIf1e ] BINS 21-24 Mths Item 5:
@BPoints to Three of Doll's Body Parts@B
@BMATERIALS:@B DOLL
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- HOLD THE DOLL WITHIN REACH; SAY, @B"Show me the doll's hair", "Where is the doll's
hair?", or "Hair?"@B
- USE THE SAME PROCEDURE FOR:
MOUTH@|@|@|@|EYES
EARS@|@|@|@|FEET
HANDS@|@|@|@|NOSE
@BSCORING:@B
1 = CORRECTLY POINTS TO AT LEAST @U3 OF THE DOLL'S BODY PARTS@U IN
RESPONSE TO YOUR REQUESTS.
0 = POINTS TO @UFEWER THAN 3@U BODY PARTS.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIf1f [ YNIf1f ] BINS 21-24 Mths Item 6:
@BNames Three Objects@B
@BMATERIALS:@B BALL, CRAYON, SPOON, AND CUP
@BPOSITION:@B SEATED
@BADMINISTRATION:@B
- PLACE THE FOUR OBJECTS ON THE EXAM SURFACE WITHIN THE INFANT'S REACH.
- GIVE HIM/HER TIME TO EXPLORE THE OBJECTS.
- AS HE/SHE PICKS UP AN OBJECT, ASK, @B"What is that? What do you have?"@B
- IF INFANT DOES NOT EXPLORE OBJECTS, PICK UP OBJECTS ONE AT A TIME AND ASK,
@B"What is this? What do I have?"@B
@BSCORING:@B
1 = @UCORRECTLY@U NAMES @UAT LEAST 3 OBJECTS@U. @UDISREGARD POOR
PRONUNCIATION@U. YOU MAY VERIFY WITH CAREGIVER THAT NAME GIVEN IS THE
NAME INFANT COMMONLY GIVES OBJECT.
0 = DOES @UNOT@U CORRECTLY NAME AT LEAST 3 OBJECTS, NAME IS
@UUNRECOGNIZABLE, USED RANDOMLY@U THROUGHOUT EXAM, @UOR USED FOR
OTHER OBJECTS@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIf2g [ YNIf2g ] BINS 21-24 Mths Item 7:
@B*Runs with Coordination@B
@BMATERIALS:@B BALL
@BPOSITION:@B STANDING
@BADMINISTRATION:@B
- THROUGHOUT THE EXAM OBSERVE INFANT TO SEE IF HE/SHE RUNS WITHOUT
SUPPORT.
- IF THE INFANT DOES NOT, ROLL THE BALL A CROSS THE FLOOR AND ENCOURAGE
HIM/HER TO RUN BY SAYING, @B"Hurry. Get the ball. Run and get it."@B
@BSCORING:@B
1 = TAKES AT LEAST @U6 STEPS WITH GOOD COORDINATION@U, A RAPID, EVEN GAIT
(RUN), AND A NARROW BASE OF SUPPORT (LEGS UNDER TORSO).
0 = RUN IS STIFF-LEGGED AND @UWOBBLY OR@U HE/SHE TAKES @UFEWER THAN 6
STEPS RUNNING@U, @USTUMBLES@U WHILE TAKING STEPS, RUNS @UTIPTOE@U,
BENDS ARM(S) WITH FIST(S) HELD AT ELBOW OR SHOULDER HEIGHT, @UMOVES ONE
ARM MORE@U THAN THE OTHER, OR HOLDS ARM(S) IN @UABNORMAL POSTURE@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIf2h [ YNIf2h ] BINS 21-24 Mths Item 8:
@BKicks Ball@B
@BMATERIALS:@B BALL
@BPOSITION:@B STANDING
@BADMINISTRATION:@B
- PLACE THE BALL ON THE FLOOR IN FRONT OF YOU.
- GENTLY SWING YOUR FOOT BEHIND YOU AND THEN OUT IN FRONT TO KICK THE BALL.
- RETRIEVE THE BALL AND PLACE IT IN FRONT OF INFANT.
- ENCOURAGE THE INFANT TO KICK THE BALL.
@BSCORING:@B
1 = @UMAINTAINS BALANCE@U WHILE KICKING THE BALL FORWARD AT LEAST @UTWO
FEET@U.
0 = DOES @UNOT CONTACT@U BALL WITH FOOT, @ULOSES BALANCE, OR@U KICKS
THE BALL @UFEWER THAN TWO FEET@U.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIf2i [ YNIf2i ] BINS 21-24 Mths Item 9:
@BJumps off Floor@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B
- STAND THE INFANT ON THE FLOOR.
- YOU OR THE CAREGIVER SHOULD TAKE A SMALL JUMP, FEET TOGETHER, WHILE
SAYING TO INFANT, @B"Watch me jump."@B
- THEN ENCOURAGE THE INFANT TO JUMP.
@BSCORING:@B
1 = JUMPS OFF THE FLOOR, EITHER WITH FEET TOGETHER OR LEADING WITH ONE, BUT
@UBOTH FEET ARE IN THE AIR AT SOME POINT@U DURING THE JUMP.
0 = DOES @UNOT SIMULTANEOUSLY RAISE BOTH FEET@U OFF FLOOR.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIf2j [ YNIf2j ] BINS 21-24 Mths Item 10:
@BJumps from Bottom Step@B
@BMATERIALS:@B STAIRS
@BPOSITION:@B STANDING
@BADMINISTRATION:@B
- POSITION THE INFANT ON THE LOWEST STEP, FACING YOU.
- THEN STAND IN FRONT OF THE INFANT AND ASK HIM/HER TO JUMP TO THE FLOOR BY
SAYING, @B"Jump. Jump to me."@B
- BE READY TO CATCH THE INFANT IN CASE HE/SHE LOSES BALANCE, BUT DO NOT
HOLD HIS/HER HAND.
- YOU MAY DEMONSTRATE JUMPING ONCE.
@BSCORING:@B
1 = JUMPS TO FLOOR, EITHER WITH FEET TOGETHER OR LEADING WITH ONE FOOT, AS
LONG AS @UBOTH ARE OFF THE FLOOR AT THE SAME TIME@U.
0 = DOES @UNOT@U JUMP SO THAT @UBOTH FEET@U ARE IN THE AIR AT @UTHE
SAME TIME@U AT SOME POINT @UOR LOSES BALANCE@U WHEN HE/SHE LANDS.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIf2k [ YNIf2k ] BINS 21-24 Mths Item 11:
@B*Uses Two-Word Utterance (Spoken Phrase)@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B
- THROUGHOUT THE EXAM LISTEN FOR INFANT'S MULTIPLE-WORD UTTERANCES
(SPOKEN PHRASES) IN WHICH EACH WORD SIGNIFIES A DIFFERENT CONCEPT.
- SOME COMMON EXAMPLES: WANT JUICE, WHAT THAT?, WHERE DADA? AND GIVE
ME.
@BSCORING:@B
1 = PRODUCES AT LEAST ONE @UTWO-WORD@U UTTERANCE (SPOKEN PHRASE),
EACH DENOTING A DIFFERENT CONCEPT. THEY MUST BE @UUSED IN APPROPRIATE
MANNER AND SEPARATED BY A DISTINCT PAUSE@U.
0 = DOES @UNOT@U PRODUCE A TWO-WORD UTTERANCE (SPOKEN PHRASE),
@UOR@U USES WORDS THAT ONLY DENOTE ONE CONCEPT (E.G. GREAT BIG),
@UOR@U WORDS LEARNED IN ROTE FASHION (E.G. ALL GONE).
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIf2l [ YNIf2l ] BINS 21-24 Mths Item 12:
@B*Speaks Intelligibly (Understandably)@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B
- THROUGHOUT THE EXAM ATTEND TO INFANT'S SPEECH AND YOUR ABILITY TO
UNDERSTAND TO WHAT HE/SHE IS SAYING.
- IF YOU ARE IN DOUBT OF WHAT HE/SHE IS SAYING, VERIFY YOUR INTERPRETATION
WITH THAT OF CAREGIVER. ASK CAREGIVER: @BI thought I heard ^CHILD say (repeat some
things you have heard child say). Is that what she/he was saying or was it something else?@B
@BSCORING:@B
1 = ROUGHLY @U50% OR MORE@U OF SPEECH IS INTELLIGIBLE.
0 = @ULESS THAN 50% OR MORE@U OF SPEECH IS INTELLIGIBLE.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
---------------------------------------------------------------------------------
Y_NIf2m [ YNIf2m ] BINS 21-24 Mths Item 13:
@B*Absence of Drooling and Motor Overflow (One Hand Mimics the Other Involuntarily)@B
@BMATERIALS:@B NONE
@BPOSITION:@B UNSPECIFIED
@BADMINISTRATION:@B
THROUGHOUT THE EXAM OBSERVE WHETHER INFANT DROOLS AND WHETHER ONE OF
HIS/HER HANDS MIMICS OR MIRRORS, IN AN INVOLUNTARY FASHION, THE ACTIVITIES OF
THE OTHER.
@BSCORING:@B
1 = DOES @UNOT SHOW EXCESSIVE DROOL@U AROUND MOUTH OR ANY DROOLING
AROUND COLLAR, @UAND NEITHER HAND MIMICS OR MIRRORS@U ACTIVITIES OF THE
OTHER MORE THAN HALF THE TIME.
0 = @UDROOLS EXCESSIVELY@U ON CLOTHING, @UOR@U IF @UEITHER OF THE HANDS
MIRRORS OR MIMICS@U THE OTHER MORE THAN HALF THE TIME.
Question Type: TNI
optimal 1 OPTIMAL
nonoptimal 0 NON-OPTIMAL
Logic after:
GOTO Y_NIEND
---------------------------------------------------------------------------------
Y_NI_END [ YNI_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
Logic after:
Y_NIEND
Preschool Language Scales, Fifth Edition (PLS-5); Zimmerman, Steiner, & Pond (2011); Pearson; Standardized assessment tool comprised of two scales: expressive communication and auditory comprehension; total language score computed.
Woodcock-Johnson III Tests of Achievement (WJ-III) Woodcock, Mather & McGrew (2004); Houghton, Mifflin, Harcourt.
Children 11 and older are administered the Letter-Word Identification and Applied Problems modules.
Children under age 11 are administered the Letter-Word Identification, Applied Problems, and Passage Comprehension modules.
---------------------------------------------------------------------------------
Logic before:
IF CHILD IS EMANCIPATED OR CHILD IS YOUNG ADULT (18+), CONTINUE. ELSE, GOTO
Y_CNEND.
Y_CN1a [ YCN1a ] EmanCH neighborhd-assault/mug
USE CARD 4. 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 4.
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?
---------------------------------------------------------------------------------
Y_CN2a [ YCN2a ] EmanCH neighborhd-gangs
USE CARD 4. 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?
---------------------------------------------------------------------------------
Y_CN3a [ YCN3a ] EmanCH neighborhd-drug use/dealing
USE CARD 4. 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?
---------------------------------------------------------------------------------
Y_CN4a [ YCN4a ] EmanCH neighborhd-unsupervised kids
USE CARD 4. 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?
---------------------------------------------------------------------------------
Y_CN5a [ YCN5a ] EmanCH neighborhd-teenagers
USE CARD 4. 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?
---------------------------------------------------------------------------------
Y_CN6a [ YCN6a ] EmanCH cmpr neighborhd safety
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?
---------------------------------------------------------------------------------
Y_CN7a [ YCN7a ] EmanCH cmpr neighbors help
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?
---------------------------------------------------------------------------------
Y_CN8a [ YCN8a ] EmanCH cmpr 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?
---------------------------------------------------------------------------------
Y_CN9a [ YCN9a ] EmanCH cmpr neighborhd a place to live
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:
Y_CNEND
---------------------------------------------------------------------------------
Logic before:
IF AGE < 6, CHILD IS NOT IN SCHOOL, OR CHILD IS HOME-SCHOOLED, GOTO Y_SEEND. IF
CHILD IS YOUNG ADULT (18+) OR EMANCIPATED, GOTO Y_SEEND. ELSE, CONTINUE.
Y_SE0 [ YSE0 ] NO LABEL
USE CARD 1. Now I'm going to ask you how often you have different types of feelings about
school. For each question, pick @Bone@B answer from this card. You can pick never,
sometimes, often, or almost always. For example, suppose I asked you how often you bring a
lunch from home to school. If you don't ever bring your lunch, you would pick the answer "never."
If you do this every once in a while, you would pick "sometimes." If you do this a lot, you would
pick "often." If you always or almost always do this, you would pick "almost always."
Okay, let's start. Honest answers are important, so please tell me what you really feel or think.
Your answers will be kept private. No one will tell your family or teachers anything about your
answers.
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
---------------------------------------------------------------------------------
Y_SE1a [ YSE1a ] enjoys being in school
USE CARD 1. How often do you enjoy being in school? Would you say...
FR NOTE: IF CHILD SAYS THEY ARE NOT ATTENDING SCHOOL IN PERSON, PLEASE ASK THEM TO THINK ABOUT THEIR CURRENT SITUATION (REMOTE LEARNING EXPERIENCE).
Question Type: TSEFrq1F
never 1 never
sometimes 2 sometimes
often 3 often, or
always 4 almost always
notapp 5 NOT APPLICABLE (IF VOLUNTEERED NOT IN SCHOOL OR "HOME-
SCHOOLED")
Logic after:
IF Y_SE1a = 5 GOTO Y_SEEND
---------------------------------------------------------------------------------
Y_SE2a [ YSE2a ] hates being in school
USE CARD 1. How often do you hate being in school? Would you say...
Question Type: TSEFrq2F
never 1 never
sometimes 2 sometimes
often 3 often, or
always 4 almost always
---------------------------------------------------------------------------------
Y_SE3a [ YSE3a ] try to do best work in school
USE CARD 1. How often do you try to do your best work in school? (Would you say never,
sometimes, often, or almost always?)
Question Type: TSEFrq2C
never 1 NEVER
sometimes 2 SOMETIMES
often 3 OFTEN
always 4 ALMOST ALWAYS
---------------------------------------------------------------------------------
Y_SE4a [ YSE4a ] finds school work too hard
USE CARD 1. How often do you find the school work too hard to understand? (Would you say
never, sometimes, often, or almost always?)
Question Type: TSEFrq2C
never 1 NEVER
sometimes 2 SOMETIMES
often 3 OFTEN
always 4 ALMOST ALWAYS
---------------------------------------------------------------------------------
Y_SE5a [ YSE5a ] finds class interesting
USE CARD 1. How often do you find your classes interesting? (Would you say never,
sometimes, often, or almost always?)
Question Type: TSEFrq2C
never 1 NEVER
sometimes 2 SOMETIMES
often 3 OFTEN
always 4 ALMOST ALWAYS
---------------------------------------------------------------------------------
Y_SE6a [ YSE6a ] fails to complete assignments
USE CARD 1. How often do you fail to complete or turn in your assignments? (Would you say
never, sometimes, often, or almost always?)
Question Type: TSEFrq2C
never 1 NEVER
sometimes 2 SOMETIMES
often 3 OFTEN
always 4 ALMOST ALWAYS
---------------------------------------------------------------------------------
Y_SE7a [ YSE7a ] sent to office/stay after school
USE CARD 1. How often do you get sent to the office, or have to stay after school, because you
misbehaved? (Would you say never, sometimes, often, or almost always?)
Question Type: TSEFrq2C
never 1 NEVER
sometimes 2 SOMETIMES
often 3 OFTEN
always 4 ALMOST ALWAYS
---------------------------------------------------------------------------------
Y_SE8a [ YSE8a ] get along w/ teachers
USE CARD 1. How often do you get along with your teachers? (Would you say never,
sometimes, often, or almost always?)
Question Type: TSEFrq2C
never 1 NEVER
sometimes 2 SOMETIMES
often 3 OFTEN
always 4 ALMOST ALWAYS
---------------------------------------------------------------------------------
Y_SE9a [ YSE9a ] listen carefully in school
USE CARD 1. How often do you listen carefully or pay attention in school? (Would you say
never, sometimes, often, or almost always?)
Question Type: TSEFrq2C
never 1 NEVER
sometimes 2 SOMETIMES
often 3 OFTEN
always 4 ALMOST ALWAYS
---------------------------------------------------------------------------------
Y_SE10a [ YSE10a ] get homework done
USE CARD 1. How often do you get your homework done? (Would you say never, sometimes,
often, or almost always?)
Question Type: TSEFrq2C
never 1 NEVER
sometimes 2 SOMETIMES
often 3 OFTEN
always 4 ALMOST ALWAYS
---------------------------------------------------------------------------------
Y_SE11a [ YSE11a ] get along w/other students
USE CARD 1. How often do you get along with other students? (Would you say never,
sometimes, often, or almost always?)
Question Type: TSEFrq2C
never 1 NEVER
sometimes 2 SOMETIMES
often 3 OFTEN
always 4 ALMOST ALWAYS
Logic after:
GOTO Y_SEEND
---------------------------------------------------------------------------------
Y_SE_END [ YSE_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
Logic after:
Y_SEEND
---------------------------------------------------------------------------------
Logic before:
IF AGE < 7 OR CHILD IS YOUNG ADULT (18+) OR EMANCIPATED, GOTO Y_RREND. ELSE, CONTINUE
Now I’m going to ask you about your relationships with other kids at school and in your neighborhood. Please think about your experiences in the past 12 months.
Y_RR1
Please look at Card #. In the past 12 months, how well did Fill PRIMARY CAREGIVER'S RELATIONSHIP TO ^CHILD know your peers at school? Would you say…
1 Very well
2 Moderately well
3 Not well at all
4 Not at all
Y_RR2
In the past 12 months, how well did Fill PRIMARY CAREGIVER'S RELATIONSHIP TO ^CHILD know your peers in the neighborhood? Would you say…
1 Very well
2 Moderately well
3 Not well at all
4 Not at all
Y_RR3
In the past 12 months, how well did Fill SECONDARY CAREGIVER'S RELATIONSHIP TO ^CHILD know your peers at school? Would you say…
1 Very well
2 Moderately well
3 Not well at all
4 Not at all
Y_RR4
In the past 12 months, how well did Fill SECONDARY CAREGIVER'S RELATIONSHIP TO ^CHILD know your peers in the neighborhood? Would you say…
1 Very well
2 Moderately well
3 Not well at all
4 Not at all
Y_RR5
Please look at Card #. In the past 12 months, what percentage of your peers at school were friendly toward you? Would you say…
1 Very few (LESS THAN 25%)
2 Some (AROUND 25%)
3 About half (50%)
4 Most (AROUND 75%)
5 Almost all (MORE THAN 75%)
Y_RR6
In the past 12 months, what percentage of your peers in the neighborhood were friendly toward you? Would you say…
1 Very few (LESS THAN 25%)
2 Some (AROUND 25%)
3 About half (50%)
4 Most (AROUND 75%)
5 Almost all (MORE THAN 75%)
Y_RR7
In the past 12 months, what percentage of your peers at school were unfriendly toward you? Would you say…
1 Very few (LESS THAN 25%)
2 Some (AROUND 25%)
3 About half (50%)
4 Most (AROUND 75%)
5 Almost all (MORE THAN 75%)
Y_RR8
In the past 12 months, what percentage of your peers in the neighborhood were unfriendly toward you? Would you say…
1 Very few (LESS THAN 25%)
2 Some (AROUND 25%)
3 About half (50%)
4 Most (AROUND 75%)
5 Almost all (MORE THAN 75%)
Y_RR9
In the past 12 months, what percentage of your peers ignored you, or were simply neutral about you? Would you say…
1 Very few (LESS THAN 25%)
2 Some (AROUND 25%)
3 About half (50%)
4 Most (AROUND 75%)
5 Almost all (MORE THAN 75%)
Y_RR10
In the past 12 months, what percentage of your friends were well behaved in school? Would you say…
1 Very few (LESS THAN 25%)
2 Some (AROUND 25%)
3 About half (50%)
4 Most (AROUND 75%)
5 Almost all (MORE THAN 75%)
Y_RR11
In the past 12 months, how often did you spend time with kids who took school seriously and completed their homework? Would you say…
1 Never
2 Hardly ever
3 Sometimes
4 Most of the time
5 Always
Y_RR12
How often did you spend time with kids who were involved in positive school or community activities? Would you say…
1 Never
2 Hardly ever
3 Sometimes
4 Most of the time
5 Always
Y_RR13
Please look at Card #. In the past 12 months, what percentage of your friends misbehaved or broke rules? Would you say…
1 Very few (LESS THAN 25%)
2 Some (AROUND 25%)
3 About half (50%)
4 Most (AROUND 75%)
5 Almost all (MORE THAN 75%)
Y_RR14
In the past 12 months, what percentage of your friends experimented with smoking or other substances? Would you say…
1 Very few (LESS THAN 25%)
2 Some (AROUND 25%)
3 About half (50%)
4 Most (AROUND 75%)
5 Almost all (MORE THAN 75%)
Y_RR15
In the past 12 months, what percentage of your friends dressed or acted like a gang member? Would you say…
1 Very few (LESS THAN 25%)
2 Some (AROUND 25%)
3 About half (50%)
4 Most (AROUND 75%)
5 Almost all (MORE THAN 75%)
Y_RR16
In the past 12 months, what percentage of your friends were older? Would you say…
1 Very few (LESS THAN 25%)
2 Some (AROUND 25%)
3 About half (50%)
4 Most (AROUND 75%)
5 Almost all (MORE THAN 75%)
Y_RR17
In the past 12 months, what percentage of your friends did not attend school? Would you say…
1 Very few (LESS THAN 25%)
2 Some (AROUND 25%)
3 About half (50%)
4 Most (AROUND 75%)
5 Almost all (MORE THAN 75%)
Y_RR18
In the past 12 months, what percentage of your friends spread rumors or set up conflicts with peers? Would you say…
1 Very few (LESS THAN 25%)
2 Some (AROUND 25%)
3 About half (50%)
4 Most (AROUND 75%)
5 Almost all (MORE THAN 75%)
Y_RR19
Has anyone teased you or called you names recently?
1 YES
2 NO
Logic after:
If Y_RR19 = NO, GOTO Y_RR20
Y_RR19a
How often? Would you say…
1 Most days
2 About once a week
3 Less than once a week
Y_RR19b
How upsetting was it that you were teased? Would you say…
1 Not at all
2 A bit
3 I was quite upset
Y_RR20
Has anyone spread rumors about you recently?
1 YES
2 NO
Logic after:
If Y_RR20 = NO, GOTO Y_RR21
Y_RR20a
How often? Would you say…
1 Most days
2 About once a week
3 Less than once a week
Y_RR20b
How upsetting were the rumors? Would you say…
1 Not at all
2 A bit
3 I was quite upset
Y_RR21
Have you been deliberately left out of things recently?
1 YES
2 NO
Logic after:
If Y_RR21 = NO, GOTO Y_RR22
Y_RR21a
How often? Would you say…
1 Most days
2 About once a week
3 Less than once a week
Y_RR21b
How upsetting was it being left out of things? Would you say…
1 Not at all
2 A bit
3 I was quite upset
Y_RR22
Have you been threatened physically or actually hurt by another kid at school recently?
1 YES
2 NO
Logic after:
If Y_RR22 = NO, GOTO Y_RREND
Y_RR22a
How often? Would you say…
1 Most days
2 About once a week
3 Less than once a week
Y_RR22b
How upsetting was it being threatened or hurt? Would you say…
1 Not at all
2 A bit
3 I was quite upset
Y_RREND
---------------------------------------------------------------------------------
Logic before:
IF AGE < 10, GOTO Y_PMEND. IF CHILD IS YOUNG ADULT (18+) OR EMANCIPATED, GOTO
Y_PMEND. NOT FOR EY OR YA. ELSE, CONTINUE.
Y_PM7a [ YPM7a ] How often CG talks about what you do for coming day
Now I'd like to talk with you about how often you and your ^Global.CAREGIVER_A talk about
different things, like your friends, where and when you go out, and when you'll be back.
USE CARD 4. For the next questions, pick your answer from this card. @BIn the past 6
months@B, how often did your ^Global.CAREGIVER_A talk to you about what you were going to
do for the @Bcoming@B day?
Question Type: TPMFreq
almstnvr 1 Almost never
oncinawhl 2 Once in a while
sometimes 3 Sometimes
often 4 Often
almstalwys 5 Almost always
---------------------------------------------------------------------------------
Y_PM8a [ YPM8a ] How often CG talks about what you did during the day
@BIn the past 6 months@B, how often did your ^Global.CAREGIVER_A talk to you about what
you had @Bactually@B done during the day?
Question Type: TPMFreq
almstnvr 1 Almost never
oncinawhl 2 Once in a while
sometimes 3 Sometimes
often 4 Often
almstalwys 5 Almost always
---------------------------------------------------------------------------------
Y_PM9a [ YPM9a ] How often CG talks about how school is going
How often did your ^Global.CAREGIVER_A talk to you about how things were going at school?
FR NOTE; IF THE CHILD SAYS THEY ARE NOT ATTENDING SCHOOL IN PERSON, PROMPT THAT ONLINE/VIRTUAL LEARNING SHOULD BE CONSIDERED.
Question Type: TPMFreq
almstnvr 1 Almost never
oncinawhl 2 Once in a while
sometimes 3 Sometimes
often 4 Often
almstalwys 5 Almost always
---------------------------------------------------------------------------------
Y_PM10a [ YPM10a ] How often do you have set time to be home on school nights
How often do you have a set time to be home on @Bschool nights@B?
Question Type: TPMFreqC
almstnvr 1 ALMOST NEVER
oncinawhl 2 ONCE IN A WHILE
sometimes 3 SOMETIMES
often 4 OFTEN
almstalwys 5 ALMOST ALWAYS
---------------------------------------------------------------------------------
Logic before:
IF Y_PM10a = 2, 3, 4, 5 CONTINUE, ELSE SKIP TO Y_PM12a
Y_PM11 [ YPM11 ] What time school nights? (hour)
What time is that?
HOUR:
Question Type: 1..12
---------------------------------------------------------------------------------
Y_PM11m [ YPM11m ] What time school nights? (minute)
(What time is that?)
MINUTE:
Question Type: 0..59
---------------------------------------------------------------------------------
Y_PM11am [ YPM11am ] What time school nights? (am/pm)
(What time is that?) Is that AM or PM?
Question Type: TAMPM
am 1 AM
pm 2 PM
---------------------------------------------------------------------------------
Y_PM12a [ YPM12a ] How often do you have a set time to be home weekend nights
How often do you have a set time to be home on @Bweekend nights@B?
Question Type: TPMFreqC
almstnvr 1 ALMOST NEVER
oncinawhl 2 ONCE IN A WHILE
sometimes 3 SOMETIMES
often 4 OFTEN
almstalwys 5 ALMOST ALWAYS
---------------------------------------------------------------------------------
Logic before:
IF Y_PM12a = 2, 3, 4, 5 CONTINUE, ELSE SKIP TO Y_PM15a
Y_PM13 [ YPM13 ] What time weekend nights? (hour)
What time is that?
HOUR:
Question Type: 1..12
---------------------------------------------------------------------------------
Y_PM13m [ YPM13m ] What time weekend nights? (minute)
(What time is that?)
MINUTE:
Question Type: 0..59
---------------------------------------------------------------------------------
Y_PM13am [ YPM13am ] What time weekend nights (am/pm)
(What time is that?) Is that AM or PM?
Question Type: TAMPM
am 1 AM
pm 2 PM
---------------------------------------------------------------------------------
Y_PM14a [ YPM14a ] How often CG knows you come home late?
If you did not come home by the time that you were supposed to be in, how often would your
^Global.CAREGIVER_A know?
Question Type: TPMFreqC
almstnvr 1 ALMOST NEVER
oncinawhl 2 ONCE IN A WHILE
sometimes 3 SOMETIMES
often 4 OFTEN
almstalwys 5 ALMOST ALWAYS
---------------------------------------------------------------------------------
Y_PM15a [ YPM15a ] Allowed to leave house of CG is not at home?
If your ^Global.CAREGIVER_A is not at home, are you allowed to leave the house?
Question Type: TPMFreqC
almstnvr 1 ALMOST NEVER
oncinawhl 2 ONCE IN A WHILE
sometimes 3 SOMETIMES
often 4 OFTEN
almstalwys 5 ALMOST ALWAYS
---------------------------------------------------------------------------------
Logic before:
IF Y_PM15a = 2, 3, 4, 5 CONTINUE. ELSE SKIP TO Y_PM18a
Y_PM16a [ YPM16a ] How often leave a note or call CG about where you are going?
How often do you leave a note for your ^Global.CAREGIVER_A or call ^Fills.HimHer about where
you are going?
Question Type: TPMFreqC
almstnvr 1 ALMOST NEVER
oncinawhl 2 ONCE IN A WHILE
sometimes 3 SOMETIMES
often 4 OFTEN
almstalwys 5 ALMOST ALWAYS
---------------------------------------------------------------------------------
Y_PM17a [ YPM17a ] How often your CG knows who you are with when away from home
How often does your ^Global.CAREGIVER_A know @Bwho@B you are with when you are away
from home?
Question Type: TPMFreqC
almstnvr 1 ALMOST NEVER
oncinawhl 2 ONCE IN A WHILE
sometimes 3 SOMETIMES
often 4 OFTEN
almstalwys 5 ALMOST ALWAYS
---------------------------------------------------------------------------------
Y_PM18a [ YPM18a ] How often CG knows when you will be home when you are out
When you are out, how often does your ^Global.CAREGIVER_A know what time you will be home?
Question Type: TPMFreqC
almstnvr 1 ALMOST NEVER
oncinawhl 2 ONCE IN A WHILE
sometimes 3 SOMETIMES
often 4 OFTEN
almstalwys 5 ALMOST ALWAYS
---------------------------------------------------------------------------------
Y_PM19a [ YPM19a ] When CG is not home, hos often you know how to get in touch
When your ^Global.CAREGIVER_A is not home, how often do you know how to get in touch with
^FILLS.himher?
Question Type: TPMFreqC
almstnvr 1 ALMOST NEVER
oncinawhl 2 ONCE IN A WHILE
sometimes 3 SOMETIMES
often 4 OFTEN
almstalwys 5 ALMOST ALWAYS
---------------------------------------------------------------------------------
Y_PM20a [ YPM20a ] Where do you usually go right after school?
Where do you @Busually@B go right after school?
Question Type: TPM20a
supvhome 1 HOME, SUPERVISED (ADULT OR RESPONSIBLE MINOR PRESENT)
unsupvhome 2 HOME, UNSUPERVISED
supvothr 3 SOMEWHERE ELSE, SUPERVISED (ADULT OR RESPONSIBLE
MINOR PRESENT)
unsupvothr 4 SOMEWHERE ELSE, UNSUPERVISED
othrdkifsupv 5 SOMEWHERE ELSE, DON'T KNOW IF SUPERVISED
other 6 OTHER
---------------------------------------------------------------------------------
Y_PM21a [ YPM21a ] Where do you usally stay in the evening
Where do you @Busually@B stay in the evening?
Question Type: TPM20a
supvhome 1 HOME, SUPERVISED (ADULT OR RESPONSIBLE MINOR PRESENT)
unsupvhome 2 HOME, UNSUPERVISED
supvothr 3 SOMEWHERE ELSE, SUPERVISED (ADULT OR RESPONSIBLE
MINOR PRESENT)
unsupvothr 4 SOMEWHERE ELSE, UNSUPERVISED
othrdkifsupv 5 SOMEWHERE ELSE, DON'T KNOW IF SUPERVISED
other 6 OTHER
---------------------------------------------------------------------------------
Y_PM22a [ YPM22a ] Where do you usually stay on the weekends?
Where do you @Busually@B stay on the weekends?
Question Type: TPM20a
supvhome 1 HOME, SUPERVISED (ADULT OR RESPONSIBLE MINOR PRESENT)
unsupvhome 2 HOME, UNSUPERVISED
supvothr 3 SOMEWHERE ELSE, SUPERVISED (ADULT OR RESPONSIBLE
MINOR PRESENT)
unsupvothr 4 SOMEWHERE ELSE, UNSUPERVISED
othrdkifsupv 5 SOMEWHERE ELSE, DON'T KNOW IF SUPERVISED
other 6 OTHER
---------------------------------------------------------------------------------
Y_PM23a [ YPM23a ] When you & CG are home, how often CG knows what you're doing
When you and your ^Global.CAREGIVER_A are both at home, how often does ^Fills.HeShe know
what you are doing?
Question Type: TPMFreqC
almstnvr 1 ALMOST NEVER
oncinawhl 2 ONCE IN A WHILE
sometimes 3 SOMETIMES
often 4 OFTEN
almstalwys 5 ALMOST ALWAYS
---------------------------------------------------------------------------------
Y_PM24a [ YPM24a ] How many of your friends does CG know?
How many of your friends does your ^Global.CAREGIVER_A know?
Question Type: TPM24a
none 0 None
afew 1 A few
several 2 Several
most 3 Most
all 4 All
IF CHILD AGE IS 11 OR OLDER OR CHILD IS A YOUNG ADULT (18+) OR EMANCIPATED YOUTH, CONTINUE. ELSE, GOTO Y_GREND.
Now I’m going to read some sayings. For each one, you can tell me how much the saying describes you.
Y_GR1
New ideas and projects sometimes distract me from previous ones. Would you say…
1=Very much like me
2=Mostly like me
3=Somewhat like me
4=Not much like me
5=Not like me at all
Y_GR2
Setbacks (delays and obstacles) don’t discourage me. I bounce back from disappointments faster than most people. Would you say…
1=Very much like me
2=Mostly like me
3=Somewhat like me
4=Not much like me
5=Not like me at all
Y_GR3
I have been obsessed with a certain idea or project for a short time but later lost interest. Would you say…
1=Very much like me
2=Mostly like me
3=Somewhat like me
4=Not much like me
5=Not like me at all
Y_GR 4
I am a hard worker. Would you say…
1=Very much like me
2=Mostly like me
3=Somewhat like me
4=Not much like me
5=Not like me at all
Y_GR5
I often set a goal but later choose to pursue (follow) a different one. Would you say…
1=Very much like me
2=Mostly like me
3=Somewhat like me
4=Not much like me
5=Not like me at all
Y_GR6
I have difficulty maintaining (keeping) my focus on projects that take more than a few months to complete. Would you say…
1=Very much like me
2=Mostly like me
3=Somewhat like me
4=Not much like me
5=Not like me at all
Y_GR7
I finish whatever I begin. Would you say…
1=Very much like me
2=Mostly like me
3=Somewhat like me
4=Not much like me
5=Not like me at all
Y_GR8
I am diligent (hard working and careful). Would you say…
1=Very much like me
2=Mostly like me
3=Somewhat like me
4=Not much like me
5=Not like me at all
Y_GREND.
IF CHILD AGE IS 11 OR OLDER OR CHILD IS A YOUNG ADULT (18+) OR EMANCIPATED YOUTH, CONTINUE. ELSE, GOTO Y_SFEND.
Now I’m going to read a list of feelings people may have about themselves. For each one, please tell me if you strongly agree, agree, disagree, or strongly disagree.
Y_SF1
I feel that I am a person of worth, at least on an equal plane to others. Would you say that you…
1=Strongly agree
2=Agree
3=Disagree
4=Strongly disagree
Y_SF2
I feel that I have a number of good qualities. Would you say that you…
1=Strongly agree
2=Agree
3=Disagree
4=Strongly disagree
Y_SF3
All in all, I am inclined to feel that I am a failure. Would you say that you…
1=Strongly agree
2=Agree
3=Disagree
4=Strongly disagree
Y_SF4
I am able to do things as well as most other people. Would you say that you…
1=Strongly agree
2=Agree
3=Disagree
4=Strongly disagree
Y_SF5
I feel I do not have much to be proud of. Would you say that you…
1=Strongly agree
2=Agree
3=Disagree
4=Strongly disagree
Y_SF6
I take a positive attitude toward myself. Would you say that you…
1=Strongly agree
2=Agree
3=Disagree
4=Strongly disagree
Y_SF7
On the whole, I’m satisfied with myself. Would you say that you…
1=Strongly agree
2=Agree
3=Disagree
4=Strongly disagree
Y_SF8
I wish I could have more respect for myself. Would you say that you…
1=Strongly agree
2=Agree
3=Disagree
4=Strongly disagree
Y_SF9
I certainly feel useless at times. Would you say that you…
1=Strongly agree
2=Agree
3=Disagree
4=Strongly disagree
Y_SF10
At times, I think I am no good at all. Would you say that you…
1=Strongly agree
2=Agree
3=Disagree
4=Strongly disagree
Y_SFEND
---------------------------------------------------------------------------------
Y_IP_BGN [ YIP_BGN ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF CHILD AGE = 14 OR OLDER OR CHILD IS EMANCIPATED OR CHILD IS YOUNG
ADULT (18+), GOTO Y_IP1. ELSE, GOTO Y_IPEND.Now I would like to ask you about how prepared you feel to live on your own, pursue your educational goals, manage your finances, and a few other things. I am also going to ask you about any services or training that you may have received to prepare you for each of these.
Y_IP1
How prepared do you feel to continue and achieve your education or job training goals? This may include goals like earning your high school diploma or G.E.D., completing a vocational training program, or going to college.
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP2
How prepared do you feel to live independently? This includes day-to-day responsibilities like keeping good hygiene, buying food and preparing meals, doing laundry, cleaning, and maintaining and repairing household items.
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP3
How prepared do you feel to get income assistance, like TANF or SNAP or food stamps?
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP4
How prepared do you feel to use public transportation, like a city bus, subway or metro system?
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP5
How prepared do you feel to manage your physical health? This includes things like following a healthy diet, exercising, accessing your health records, knowing about your health insurance, using first aid to treat minor injuries, recognizing when you become sick and knowing how to make an appointment, following through with your doctor’s instructions, and making regular check-up appointments with your doctor or dentist.
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP6
How prepared do you feel to deal with issues of substance abuse? This includes things like knowing how drugs can be harmful, staying away from situations that make you want to use, hanging out with friends who don’t use, and knowing where to get treatment.
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP7
How prepared do you feel to make decisions about family planning? This includes using contraception to avoid unplanned pregnancy, and waiting to have a child until you are financially and emotionally ready.
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP8a
How prepared do you feel to manage these aspects of your mental health?
Paying attention to changes in your mood, being able to calm yourself down when you get upset, and findings ways to relax when you feel stressed out
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP8b
[How prepared do you feel to manage these aspects of your mental health?]
Talking to others about things that are bothering you
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP8c
[How prepared do you feel to manage these aspects of your mental health?]
Knowing how to make an appointment with a psychiatrist or therapist and following through with your psychiatrist or therapists instructions
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP9a
How prepared do you feel for the following activities that may be helpful in getting and keeping a job?
Knowing where to look for a job
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP9b
[How prepared do you feel for the following activities that may be helpful in getting and keeping a job?]
Writing a resume
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP9c
[How prepared do you feel for the following activities that may be helpful in getting and keeping a job?]
Completing a job application
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP9d
[How prepared do you feel for the following activities that may be helpful in getting and keeping a job?]
Participating in a job interview
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP9e
[How prepared do you feel for the following activities that may be helpful in getting and keeping a job?]
Negotiating job wages and benefits
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP10a
How prepared do you feel for the following activities that may be helpful in finding and keeping a place to live?
Searching for an apartment
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP10b
[How prepared do you feel for the following activities that may be helpful in finding and keeping a place to live?]
Completing an apartment application
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP10c
[How prepared do you feel for the following activities that may be helpful in finding and keeping a place to live?]
Learning about security deposits and utility set-up
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP10d
[How prepared do you feel for the following activities that may be helpful in finding and keeping a place to live?]
Signing a lease
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP10e
[How prepared do you feel for the following activities that may be helpful in finding and keeping a place to live?]
Checking my credit score
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP11a
How prepared do you feel for the following activities that may be helpful in managing your money and making good financial decisions?
Using a checking or savings account
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP11b
[How prepared do you feel for the following activities that may be helpful in managing your money and making good financial decisions?]
Planning a budget to pay bills and buy things you need
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP11c
[How prepared do you feel for the following activities that may be helpful in managing your money and making good financial decisions?]
Completing tax returns
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP11d
[How prepared do you feel for the following activities that may be helpful in managing your money and making good financial decisions?]
Avoiding credit card debt
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP11e
[How prepared do you feel for the following activities that may be helpful in managing your money and making good financial decisions?]
Saving or investing money for the future
1=VERY PREPARED
2=PREPARED
3=SOMEWHAT PREPARED
4=NOT PREPARED
Y_IP26a [ YIP26a ] CW discussed after 18/live independently
[IF LIVING SITUATION = IN-HOME OR YOUNG ADULT] Has anyone (including your parents, caseworker or other trusted adult) ever talked with you about what life will be like when you need to live independently?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Y_IP26b [ YIP26a ] CW discussed after 18/foster care
[IF LIVING SITUATION = OOH, INCLUDING FOSTER CARE, FORMAL KIN, GROUP HOME/RESIDENTIAL OR OTHER OOH.] Has anyone (including a parent, caseworker or other trusted adult) ever talked with you about what life will be like when you leave foster care?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Y_IP28a [ YIP28a ] CG suggested independent living classes
[IF LIVING SITUATION = IN-HOME OR YOUNG ADULT] Has anyone (including a parent, caseworker or other trusted adult) ever suggested any independent living or life skills training programs or classes to help you prepare for being on your own?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Y_IP28b
[IF LIVING SITUATION = OOH, INCLUDING FOSTER CARE, FORMAL KIN, GROUP HOME/RESIDENTIAL OR OTHER OOH] Has anyone (including a parent, caseworker or other trusted adult) ever suggested any independent living or life skills training programs or classes to help you prepare to leave foster care?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_IP30a [ YIP54a ] Ever attend class for living on own
[IF LIVING SITUATION = IN-HOME OR YOUNG ADULT] Have you ever attended any classes or group sessions that were intended to help you get ready for being on your own?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
Y_IP30b [ YIP30a ] CH took independent living class
[IF LIVING SITUATION = OOH, INCLUDING FOSTER CARE, FORMAL KIN, GROUP HOME/RESIDENTIAL OR OTHER OOH] Have you attended any independent living or life skills training programs or classes to help you prepare to leave foster care?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_IP30a = NO, DK, RE, GOTO Y_IP33a
---------------------------------------------------------------------------------
Y_IP70a [ YIP70a ] Have Social Security card
Do you have a Social Security card?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_IP71a [ YIP71a ] Have copy of birth cirtificate
Do you have a copy of your birth certificate?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_IP72a [ YIP72a ] Have drivers license
Do you have a driver's license?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_IP73a [ YIP73a ] Have state-issued photo ID
Do you have a state-issued photo ID?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Y_IP74
Do you have a checking or savings account?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Y_IP75
Do you have a cell phone?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Y_IP76
Do you have regular access to the internet?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Y_IP77
Do you own a working vehicle, such as a car, van, truck, jeep-like vehicle or motorcycle?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
ADMINISTER MODULE IF SETTING IS OOH & (AGE >= 6) & (CHILD is not emancipated or young adult (18+))
Y_OH1a
Now I would like to ask you about your overall experience in the foster care system.
Think about how many different foster homes, group homes, or residential treatment centers you have been in since first entering the foster care system.
First, how many FOSTER HOMES, including foster homes with relatives and nonrelatives, have you been in since first entering the foster care system?
INTERVIEWER: PLACEMENT INTO THE SAME HOME TWICE SHOULD BE COUNTED AS TWO HOMES.
0-30 ZERO THROUGH THIRTY
31 MORE THAN THIRTY
Y_OH1b
How many GROUP HOMES, RESIDENTIAL TREATMENT CENTERS or CHILD CARING INSTITUTIONS have you been in since first entering the foster care system?
INTERVIEWER: PLACEMENT INTO THE SAME HOME TWICE SHOULD BE COUNTED AS TWO HOMES.
0-30 ZERO THROUGH THIRTY
31 MORE THAN THIRTY
Y_OH1c
Have you ever had foster parents who were relatives of yours?
1 YES
2 NO
Y_OH1d
Are you now in a foster placement where the plan of your social worker or your foster parents is that you will be adopted by the family that you are living with?
1 YES
2 NO
Y_OH1e
Have you ever, in the past, been in a foster placement where the plan of your social worker or your foster parents was that you would be adopted by that family, but the adoption didn’t work out?
1 YES
2 NO
Y_OH1f
Have you ever been adopted?
1 YES
2 NO
Y_OH1g
Now I would like to ask you some questions about the people you live with and how it is to live
here.
SHOWCARD #1
Some people feel close to one or more of their caregivers, others don't feel close at all. Think about your current caregiver. Would you say that you feel very close, somewhat close, not very close, or not at all close to your caregiver these days?
INTERVIEWER: IF R SAYS "close to some, not others" PROBE FOR CLOSEST ATTACHMENT AND CODE THAT ONE: "What about the one you feel closest to, do you feel..."
1 VERY CLOSE
2 SOMEWHAT CLOSE
3 NOT VERY CLOSE
4 NOT AT ALL CLOSE
---------------------------------------------------------------------------------
Logic before:
IF Y_CH11a = 1 or 2, ASK Y_OH2a. ELSE, GO TO Y_OH3a.
Y_OH2a [ YOH2a ] Does OOH CH feel like part of family
Do you feel like you're part of this family?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_OH3a [ YOH3a ] Can OOH CH live there until grown up
Can you keep living here until you grow up?
NOTE: THIS QUESTION REFERS TO WHETHER THE CHILD THINKS HE/SHE IS ALLOWED
TO KEEP LIVING HERE, NOT WHETHER THE CHILD WANTS TO KEEP LIVING HERE.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
F Y_CH11a = 4, ASK Y_OH3b. ELSE, GO TO Y_OH4a.
Y_OH3b
Some people feel close to an adult in their group home or residential treatment center, others don't feel close at all. Think about the adults that work at your group home or center, would you say that you feel very close, somewhat close, not very close, or not at all close to those adults these days?
INTERVIEWER: IF R SAYS "close to some, not others" PROBE FOR CLOSEST ATTACHMENT AND CODE THAT ONE: "What about the one you feel closest to, do you feel..."
1 VERY CLOSE
2 SOMEWHAT CLOSE
3 NOT VERY CLOSE
4 NOT AT ALL CLOSE
Logic before:
IF BIO-MOTHER IS DEAD, Y_CH19a = 2, GOTO Y_OH4xa
Y_OH4a [ YOH4a ] Does OOH CH know bio mom
Do you know your biological mom, or birth mom?
(IF NECESSARY, PROBE: I MEAN THE MOM WHO GAVE
BIRTH TO YOU)
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Y_OH4b
Some people feel close to their mother, father or other relatives, others don't feel close at all.
In general, would you say that you feel very close, somewhat close, not very close, or not at all close to your biological mother these days?
1 VERY CLOSE
2 SOMEWHAT CLOSE
3 NOT VERY CLOSE
4 NOT AT ALL CLOSE
---------------------------------------------------------------------------------
Logic before:
IF BIO-FATHER IS DEAD, Y_CH20a = 2, GOTO Y_OH5a
Y_OH4xa [ YOH4xa ] Does OOH CH know bio father
Do you know your biological dad?
(IF NECESSARY, PROBE: I MEAN YOUR BIOLOGICAL DAD)
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Y_OH4c
Some people feel close to their mother, father or other relatives, others don't feel close at all.
In general, would you say that you feel very close, somewhat close, not very close, or not at all close to your biological father these days?
1 VERY CLOSE
2 SOMEWHAT CLOSE
3 NOT VERY CLOSE
4 NOT AT ALL CLOSE
---------------------------------------------------------------------------------
Y_OH5 [ YOH5T ] Labels are in Logic After
USE CARD 5. If you could live with anyone, who would it be? (DO NOT PROBE AFTER INITIAL
RESPONSE.) (CODE ALL THAT APPLY.)
Question Type: TYOH5S
biomom 1 MOTHER (BIOLOGICAL)
biodad 2 FATHER (BIOLOGICAL)
stepmom 3 STEP-MOTHER
stepdad 4 STEP-FATHER
grandma 5 GRANDMOTHER
grgrandma 6 GREAT GRANDMOTHER
grandpa 7 GRANDFATHER
grgrandpa 8 GREAT GRANDFATHER
auntuncle 9 AUNT/UNCLE
grauntuncle 10 GREAT AUNT/UNCLE
biosib 11 BIOLOGICAL SIBLING(S)
fostsib 12 FOSTER SIBLING(S)
otherrel 13 OTHER RELATIVE
neighbor 14 NEIGHBOR
friend 15 FRIEND
boygirlfriend 16 GIRLFRIEND/BOYFRIEND
currfosparent 17 CURRENT FOSTER PARENT
frmrfosparent 18 FORMER FOSTER PARENT
newfosthome 19 NEW (OR UNSPECIFIED) FOSTER HOME
currgrouphome 20 CURRENT GROUP/RESIDENTIAL SETTING
frmrgrouphome 21 FORMER GROUP/RESIDENTIAL SETTING
newgrouphome 22 NEW (OR UNSPECIFIED) GROUP OR RESIDENTIAL TREATMENT
SETTING
juvjustice 23 INCARCERATION/JUVENILE JUSTICE
teacher 24 TEACHER/CHILD CARE/OTHER KNOWN PROVIDER
alone 25 BY MYSELF/ALONE
other 26 OTHER
Logic after:
YOH5T_1 --BIOLOGICAL MOTHER; YOH5T_2 --BIOLOGICAL FATHER; YOH5T_3 --STEP
MOTHER; YOH5T_4 --STEP FATHER; YOH5T_5 --GRANDMOTHER; YOH5T_6 --GREAT
GRANDMOTHER; YOH5T_7 --GRANDFATHER; YOH5T_8 --GREAT GRANDFATHER; YOH5T_9 --
AUNT/UNCLE; YOH5T_10 --GREAT AUNT/UNCLE; YOH5T_11 --BIOLGICAL SIBLING(S);
YOH5T_12 --FOSTER SIBLING(S); YOH5T_13 --OTHER RELATIVE; YOH5T_14 --NEIGHBOR;
YOH5T_15 --FRIEND; YOH5T_16 --GIRLFRIEND/BOYFRIEND; YOH5T_17 --CURRENT FOSTER
PARENT; YOH5T_18 --FORMER FOSTER PARENT; YOH5T_19 --NEW(OR UNSPECIFIED)
FOSTER HOME; YOH5T_20 --CURRENT GROUP OR RES SETTING; YOH5T_21 --FORMER
GROUP OR RES SETTING; YOH5T_22 --NEW GROUP OR RES TREAT. SETTING; YOH5T_23 --
INCARCERATION/JUVENILE JUSTICE; YOH5T_24 --TEACHER/CHILD CARE/OTHER KNOWN
PROV; YOH5T_25 --BY MYSELF/ALONE; YOH5T_26--OTHER; YOH5T_27--DK; YOH5T_28--RF
---------------------------------------------------------------------------------
Y_OH9a [ YOH9a ] OOH CH asked to stop living there
Have you ever asked someone if you could leave here or stop living here?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_OH10a [ YOH10a ] OOH CH tried to leave here before
Have you ever tried to leave here before?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
IF Y_CH11A = 4 THEN GO TO Y_OH20A
Y_OH18a [ YOH18a ] OOH CH moved into diff neigh
When you moved away from your home to a(n) ^Fills.OH_ICC12, different things in your life might
have changed. The next questions ask whether or not certain things changed for you.
Did you move to a different neighborhood when you moved into your ^Fills.OH_ICC12?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Question Fill: ^FillOH_ICC12
fosterhome foster home
grouphome group home
respgm residential program
relhome relative's home
other other home
Logic after:
IF Y_OH18a = 2 GOTO Y_OH20a
---------------------------------------------------------------------------------
Y_OH20a [ YOH20a ] OOH CH goes to diff school
Do you go to a different school than you used to as a result of your move to a(n) ^Fills.OH_ICC12?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Question Fill: ^FillOH_ICC12
fosterhome foster home
grouphome group home
respgm residential program
relhome relative's home
other other home
Logic after:
IF Y_OH20a = 2 GOTO Y_OH22a
---------------------------------------------------------------------------------
Y_OH21a [ YOH21a ] Is OOH CH new school worse/same/better
Is your new school worse, the same, or better than the school you used to go to?
Question Type: TSmBtr
worse 1 WORSE
same 2 SAME
better 3 BETTER
---------------------------------------------------------------------------------
Y_OH22a [ YOH22a ] OOH CH has diff friends
Do you have different friends now as a result of your move to a(n) ^Fills.OH_ICC12?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Question Fill: ^FillOH_ICC12
fosterhome foster home
grouphome group home
respgm residential program
relhome relative's home
other other home
---------------------------------------------------------------------------------
Y_OH23a [ YOH23a ] OOH CH sees old friends
Do you still see any of the friends you had before you came to live here?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_OH25n [ YOH25n ] How long OOH CH gone to current school (#)
How long have you gone to the school you go to now?
NUMBER:
Question Type: 0..1000
---------------------------------------------------------------------------------
Y_OH25u [ YOH25ux ] How long OOH CH @ current school y/m/w/d
Is that the number of years, months, or days?
Question Type: TOH25u
yrs 1 YEARS
mos 2 MONTHS
weeks 3 WEEKS
days 4 DAYS
---------------------------------------------------------------------------------
Logic before:
IF Y_OH20a <> 1, GOTO Y_OH28a
Y_OH26a [ YOH26a ] # schools attended by OOH CH since not w/parents
How many schools have you gone to since you stopped living with your parents?
NUMBER OF SCHOOLS:
Question Type: 0..25
Y_OH26b [ YOH26a ] # schools attended by OOH CH in past 12 mths
How many schools have you gone to in the past 12 months?
NUMBER OF SCHOOLS:
Question Type: 0..25
---------------------------------------------------------------------------------
Y_OH30a [ YOH30a ] OOH CH have contact w/mom
Now I would like to ask you about your biological or birth mom.
About how often do you see or have contact with your biological mom? Would you say...
Question Type: TFrqVst
never 1 never,
lessoncemo 2 less than once a month,
onceamo 3 once or twice a month,
onceawk 4 about once a week,
moreonceawk 5 several times a week, or
everyday 6 everyday?
---------------------------------------------------------------------------------
Logic before:
IF Y_OH30a = 1, GOTO Y_OH38a
Y_OH33 [ YOH33T ] Labels are in Logic After
Where do the visits take place?
CODE ALL THAT APPLY.
Question Type: TYOH33S
currhome 1 PRESENT HOME
wlfragncy 2 CHILD WELFARE AGENCY
txcenter 3 TREATMENT CENTER/AGENCY/PROGRAM
momshome 4 MOTHER'S HOME
othrhome 5 OTHER HOME
othrloc 6 SOME OTHER LOCATION
Logic after:
YOH33T_1 --PRESENT HOME; YOH33T_2 --CHILD WELFARE AGENCY; YOH33T_3 --
TREATMENT CTR/AGENCY/PROG; YOH33T_4 --MOTHERS HOME; YOH33T_5 --OTHER HOME;
YOH33T_6 --SOME OTHER LOCATION; YOH33T_7--DK; YOH33T_8--RF
---------------------------------------------------------------------------------
Y_OH33a
Now I am going to ask you a question about how well your biological mother gets along with your foster family or group home or center staff.
In the past year, did your biological mother ever meet or talk with your current foster family or a member of your group home staff?
1 YES
2 NO
---------------------------------------------------------------------------------
Y_OH40a [ YOH40a ] OOH CH has contact w/dad
Now I would like to ask you about your biological dad.
About how often do you see or have contact with your biological dad? Would you say...
Question Type: TFrqVst
never 1 never,
lessoncemo 2 less than once a month,
onceamo 3 once or twice a month,
onceawk 4 about once a week,
moreonceawk 5 several times a week, or
everyday 6 everyday?
---------------------------------------------------------------------------------
Logic before:
IF Y_OH40a = 1, GOTO Y_OH48a
Y_OH43 [ YOH43T ] Labels are in Logic After
Where do the visits take place?
CODE ALL THAT APPLY.
Question Type: TYOH43S
currhome 1 PRESENT HOME
wlfragncy 2 CHILD WELFARE AGENCY
txcenter 3 TREATMENT CENTER/AGENCY/PROGRAM
dadshome 4 FATHER'S HOME
othrhome 5 OTHER HOME
othrloc 6 SOME OTHER LOCATION
Logic after:
YOH43T_1 --FATHERS HOME; YOH43T_2 --CHILD WELFARE AGENCY; YOH43T_3 --
TREATMENT CTR/AGENCY/PROGRAM; YOH43T_4 --MOTHERS HOME; YOH43T_5 --OTHER
HOME; YOH43T_6 --SOME OTHER LOCATION; YOH43T_7--DK; YOH43T_8--RF
---------------------------------------------------------------------------------
Y_OH43
Now I am going to ask you a question about how well your biological father gets along with your foster family or group home or center staff.
In the past year, did your biological father ever meet or talk with your current foster family or a member of your group home staff?
1 YES
2 NO
---------------------------------------------------------------------------------
Y_OH48a [ YOH48a ] OOH CH has siblings not w/CH now
Do you have any biological or adopted brothers or sisters who do @Bnot@B live with you now?
NOTE: SIBLINGS HERE SHOULD INCLUDE BIOLOGICAL OR ADOPTIVE SIBLINGS. HOWEVER, IF
CHILD FEELS OTHER CHILDREN ARE HIS/HER SIBLINGS (E.G., FOSTER SIBLINGS,
COUSINS), THEY CAN BE INCLUDED TOO.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_OH48a = 2 GO TO Y_OH56
---------------------------------------------------------------------------------
Y_OH53a [ YOH53 ] Labels are in Logic After
About how often do you see or have contact with ^Y_OH49[J]? Would you say...
Question Type: TFqVstAr
never 1 never,
lessoncemo 2 less than once a month,
onceamo 3 once or twice a month,
onceawk 4 about once a week,
moreonceawk 5 several times a week, or
everyday 6 everyday?
Logic after:
YOH531a--CH has contact w/sibling not w/ OOH CH - 1; YOH532a--CH has contact w/sibling not
w/ OOH CH - 2; YOH533a--CH has contact w/sibling not w/ OOH CH - 3; YOH534a--CH has
contact w/sibling not w/ OOH CH - 4; YOH535a--CH has contact w/sibling not w/ OOH CH - 5;
YOH536a--CH has contact w/sibling not w/ OOH CH - 6; YOH537a--CH has contact w/sibling not
w/ OOH CH - 7; YOH538a--CH has contact w/sibling not w/ OOH CH - 8; YOH539a--CH has
contact w/sibling not w/ OOH CH - 9; YOH5310a--CH has contact w/sibling not w/ OOH CH - 10
---------------------------------------------------------------------------------
Y_OH60a [ YOH60a ] OOH CH wants to see other family members
Are there other members of your family such as aunts, uncles, or cousins, that you like to see?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_OH60a = 2 GOTO Y_OH62a
---------------------------------------------------------------------------------
Y_OH61a [ YOH61a ] How often OOH CH sees family
How often do you get to see them? Would you say...
Question Type: TFrqRels
nvr 1 never,
onceinawhl 2 only once in a while,
sometimes 3 sometimes, or
usually 4 usually?
---------------------------------------------------------------------------------
Y_OH63a [ YOH63a ] OOH CH lived w/o parents in other OOH care
Have you lived without your biological parents in any other foster homes, relatives' homes, or places beside
your own home?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_OH63a = 2 GOTO Y_OHEND
---------------------------------------------------------------------------------
Y_OH64a [ YOH64a ] Why OOH CH left last foster home
Think about the @Blast@B foster home, relative's home, or place you lived without your parents.
Why did you leave that place?
Question Type: TWhyLeft
crgvrdied 1 CAREGIVER DIED, MOVED, RETIRED, MARRIED, DIVORCED, GOT
SICK, OR HAD OTHER CHILDREN
crgvrwanted 2 CAREGIVER WANTED CHILD TO LEAVE
childasked 3 CHILD ASKED TO LEAVE
didntgetalong 4 CAREGIVER AND CHILD'S SIBLING(S) DID NOT GET ALONG
childmoved 5 CHILD MOVED TO GET BACK TOGETHER WITH SIBLING(S)
gotintrbl 6 CHILD GOT IN TROUBLE TOO MUCH IN SCHOOL/NEIGHBORHOOD
intrblgnrl 7 CHILD GOT IN TROUBLE TOO MUCH (IN GENERAL)
senthome 8 CHILD WAS SENT HOME (OR TO LIVE WITH RELATIVE)
housingprob 9 SOMETHING HAPPENED TO PHYSICAL STRUCTURE OF HOUSING
(e.g. FIRE, FLOOD, HOME WAS CLOSED, ETC.)
ranaway 10 CHILD RESPONDENT RAN AWAY
childdk 11 NO ONE TOLD CHILD RESPONDENT WHY
other 12 OTHER
---------------------------------------------------------------------------------
Y_OH68a [ YOH68a ] Who decided OOH CH would leave
Who decided that you would leave?
Question Type: TYOH67a
mom 1 MOTHER
dad 2 FATHER
stepmom 3 STEP-MOTHER
stepdad 4 STEP-FATHER
grandma 5 GRANDMOTHER
grandpa 6 GRANDFATHER
aunt 7 AUNT
uncle 8 UNCLE
brother 9 BROTHER
sister 10 SISTER
otherrel 11 OTHER RELATIVE
currfosparent 12 CURRENT FOSTER PARENT/GROUP OR RESIDENTIAL CARE
PROVIDER
caseworker 13 CASEWORKER/THERAPIST
judge 14 JUDGE/COURT
respondent 15 RESPONDENT (e.g. CHILD SAYS "ME/I DID")
other 16 OTHER
---------------------------------------------------------------------------------
Y_OH69a [ YOH69a ] OOH CHs involvement w/decison
How much were you involved in this decision? Would you say ...
Question Type: TInvlved
notatall 1 not at all,
alittle 2 a little,
somewhat 3 somewhat,
quiteabit 4 quite a bit, or
alot 5 a lot?
Y_OH70a
I have some statements here that describe some ideas people have about the foster care system.
Please let me know how much you agree or disagree with the following statements.
SHOWCARD #
Generally I am satisfied with my experience in the foster care system.
(Would you say that you very strongly agree, strongly agree, agree, neither agree nor disagree, disagree, strongly disagree or very strongly disagree?)
1 VERY STRONGLY AGREE
2 STRONGLY AGREE
3 AGREE
4 NEITHER AGREE NOR DISAGREE
5 DISAGREE
6 STRONGLY DISAGREE
7 VERY STRONGLY DISAGREE
Y_OH71a
Overall, social workers have been a help to me while I was in the foster care system.
(Would you say that you very strongly agree, strongly agree, agree, neither agree nor disagree, disagree, strongly disagree or very strongly disagree?)
1 VERY STRONGLY AGREE
2 STRONGLY AGREE
3 AGREE
4 NEITHER AGREE NOR DISAGREE
5 DISAGREE
6 STRONGLY DISAGREE
7 VERY STRONGLY DISAGREE
IF Y_CH11a = 1 THEN ASK Y_OH72A
Y_OH72a
All in all foster parents have been a help to me.
(Would you say that you very strongly agree, strongly agree, agree, neither agree nor disagree, disagree, strongly disagree or very strongly disagree?)
1 VERY STRONGLY AGREE
2 STRONGLY AGREE
3 AGREE
4 NEITHER AGREE NOR DISAGREE
5 DISAGREE
6 STRONGLY DISAGREE
7 VERY STRONGLY DISAGREE
IF Y_CH11a = 4 THEN ASK Y_OH73A
Y_OH73a
All in all the counselors or staff of the group homes, child caring institutions or residential treatment centers have been a help to me.
(Would you say that you very strongly agree, strongly agree, agree, neither agree nor disagree, disagree, strongly disagree or very strongly disagree?)
1 VERY STRONGLY AGREE
2 STRONGLY AGREE
3 AGREE
4 NEITHER AGREE NOR DISAGREE
5 DISAGREE
6 STRONGLY DISAGREE
7 VERY STRONGLY DISAGREE
---------------------------------------------------------------------------------
Y_OH_END [ YOH_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
Logic after:
Y_OHEND
---------------------------------------------------------------------------------
Logic before:
IF CH14a = 3 or 10 AND CHILD AGE IS =>6, CONTINUE. ELSE GOTO END. NOT
ADMINISTERED IF CHILD IS EMANCIPATED OR IS YOUNG ADULT (18+).
Y_AO0a [ YAO0a ] adopted CH knows he/she is adopted
INTERVIEWER: DOES CHILD KNOW THAT HE/SHE IS ADOPTED?
Question Type: TChKnow
Yes 1 YES
No 2 NO
Logic after:
IF Y_AO0a = 2 SKIP TO Y_AOEND
---------------------------------------------------------------------------------
Y_AO1a [ YAO1a ] adopted CH likes people they live with
Now I would like to ask you some questions about the people you live with and how it is to live
here.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF CH11a = 1 or 2, ASK Y_AO2a. ELSE, GOTO Y_AO3a.
Y_AO2a [ YAO2a ] adopted CH feels like part of family
Do you feel like you're part of this family?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_AO3a [ YAO3a ] adopted CH live w/ family until CH grows up
Can you keep living here until you grow up?
NOTE: THIS QUESTION REFERS TO WHETHER THE CHILD THINKS HE/SHE IS ALLOWED
TO KEEP LIVING HERE, NOT WHETHER THE CHILD WANTS TO KEEP LIVING HERE.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF Y_CH19a = 2 [BIOLOGICAL MOTHER DEAD], GOTO Y_AO4xa
Y_AO4a [ YAO4a ] adopted CH knows biological mom
Do you know your biological mom, or birth mom?
(IF NECESSARY, PROBE: I MEAN YOUR BIOLOGICAL MOM, OR THE MOM WHO GAVE
BIRTH TO YOU)
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF Y_CH20a = 2 [BIOLOGICAL FATHER DEAD], GOTO Y_AO5
Y_AO4xa [ YAO4xa ] adopted CH knows biological dad
Do you know your biological dad?
(IF NECESSARY, PROBE: I MEAN YOUR ORIGINAL BIRTH DAD)
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_AO5 [ YAO5TG ] Labels are in Logic After
USE CARD 7. If you could live with anyone, who would it be? (DO NOT PROBE AFTER INITIAL
RESPONSE.) (CODE ALL THAT APPLY.)
Question Type: TLivRelS
biomom 1 MOTHER (BIOLOGICAL)
biodad 2 FATHER (BIOLOGICAL)
stepmom 3 STEP-MOTHER
stepdad 4 STEP-FATHER
grandma 5 GRANDMOTHER
grgrandma 6 GREAT GRANDMOTHER
grandpa 7 GRANDFATHER
grgrandpa 8 GREAT GRANDFATHER
auntuncle 9 AUNT/UNCLE
grauntuncle 10 GREAT AUNT/UNCLE
biosib 11 BIOLOGICAL SIBLING(S)
fossib 12 FOSTER SIBLING(S)
otherrel 13 OTHER RELATIVE
neighbor 14 NEIGHBOR
friend 15 FRIEND
girlboyfriend 16 GIRLFRIEND/BOYFRIEND
currfosparent 17 CURRENT FOSTER PARENT
frmrfosparent 18 FORMER FOSTER PARENT
newfosparent 19 NEW (OR UNSPECIFIED) FOSTER HOME
currgrouphome 20 CURRENT GROUP/RESIDENTIAL SETTING
frmrgrouphome 21 FORMER GROUP/RESIDENTIAL SETTING
newgrouphome 22 NEW (OR UNSPECIFIED) GROUP OR RESIDENTIAL TREATMENT
SETTING
adoptparent 23 ADOPTIVE MOTHER/FATHER
teacher 24 TEACHER/CHILD CARE/OTHER KNOWN PROVIDER
alone 25 BY MYSELF/ALONE
other 26 OTHER
Logic after:
YAO5TG1--CH would like to live w biological mom; YAO5TG2--CH would like to live w biological
dad; YAO5TG3--CH would like to live w step mother; YAO5TG4--CH would like to live w step father;
YAO5TG5--CH would like to live w grandmother; YAO5TG6--CH would like toLive w
greatGrandmother; YAO5TG7--CH would like to live w grandfather; YAO5TG8--CH would like toLive
w greatGrandFather; YAO5TG9--CH would like to live w aunt/uncle; YAO5TG10--CH would like
toLive w great aunt/uncle; YAO5TG11--CH would like to live w bio siblings; YAO5TG12--CH would
like to live w foster siblings; YAO5TG13--CH would like to live w other relative; YAO5TG14--CH
would like to live w neighbor; YAO5TG15--CH would like to live w friend; YAO5TG16--CH would like
to live w girl/boy friend; YAO5TG17--CH would like toLive w curr fostrParent; YAO5TG18--CH would
like live w formerFosterParent; YAO5TG19--CH would like live w new foster home; YAO5TG20--CH
would like live w curr group setting; YAO5TG21--CH would like live w formerGroupSetting;
YAO5TG22--CH would like live w new group setting; YAO5TG23--CH would like live w new adoptv
mom/dad; YAO5TG24--CH would like live w teachr/careProvidr; YAO5TG25--CH would like live
alone; YAO5TG26--CH would like live w other; YAO5TG27--CH would like to live w - DK;
YAO5TG28--CH would like to live w - RF
---------------------------------------------------------------------------------
Y_AO6a [ YAO6a ] adopted CH asked if they could leave
Have you ever asked someone if you could leave here or stop living here?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_AO7a [ YAO7a ] adopted CH has tried to leave
Have you ever tried to leave here before?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_AO8a [ YAO8a ] adopted CH wants this to be permanent home
Do you want this to be your permanent or forever home?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF MOTHER IS DEAD Y_CH19a = 2, OR IF Y_AO4a <> 1, GOTO Y_AO23
Y_AO19 [ YAO19TG ] Labels are in Logic After
Now I would like to ask you about your biological mom.
Please tell me whether or not you do any of the following with your biological mom.
CODE ALL THAT APPLY
Question Type: TDowMomS
visit 1 Spend time with or visit face to face
talk 2 Talk or text on the phone
social media 3 Keep in touch through Facebook, Instagram or other social media site
presents 4 Receive cards or presents
none 5 NONE
Logic after:
IF "NONE" AND ANY OTHER CATEGORY SELECTED, ERROR: "INTERVIEWER: IF "NONE" IS
SELECTED, NO OTHER CATEGORY SHOULD BE SELECTED."; YAO19TG1--CH spend time
with or visit w bio mom; YAO19TG2--CH talk on the phone w bio mom; YAO19TG3--CH receive
cards/presents from bio mom; YAO19TG4--CH does not do anything w bio mom; YAO19TG5--CH
does w bio mom - DK; YAO19TG6--CH does w bio mom - RF
---------------------------------------------------------------------------------
Logic before:
If AO19, 1 = Y CONTINUE, ELSE GOTO AO21
Y_AO20a [ YAO20a ] How often adopted CH visits bio mom
USE CARD 8. About how often do you spend time with or visit with your biological mom? Would
you say…
Question Type: TFrqVst
never 1 never,
lessoncemo 2 less than once a month,
onceamo 3 once or twice a month,
onceawk 4 about once a week,
moreonceawk 5 several times a week, or
everyday 6 everyday?
---------------------------------------------------------------------------------
Logic before:
IF Y_AO19, 2 = Y, CONTINUE. ELSE, GOTO Y_AO22a.
Y_AO21a [ YAO21a ] adopted CH talks with bio mom
USE CARD 8. About how often do you talk on the phone with your biological mom? Would you
Question Type: TFrqVst
never 1 never,
lessoncemo 2 less than once a month,
onceamo 3 once or twice a month,
onceawk 4 about once a week,
moreonceawk 5 several times a week, or
everyday 6 everyday?
---------------------------------------------------------------------------------
Logic before:
IF FATHER IS DEAD, Y_CH20a = 2, OR IF Y_AO4xa <> 1, GOTO Y_AO27a
Y_AO23 [ YAO23TG ] Labels are in Logic After
Now I would like to ask you about your biological dad. Please tell me whether or not you do any of
the following with your biological dad:
CODE ALL THAT APPLY
Question Type: TDowMomS
visit 1 Spend time with or visit face to face
talk 2 Talk or text on the phone
social media 3 Keep in touch through Facebook, Instagram or other social media site
presents 4 Receive cards or presents
none 5 NONE
Logic after:
IF "NONE" AND ANY OTHER CATEGORY SELECTED, ERROR: "INTERVIEWER: IF "NONE" IS
SELECTED, NO OTHER CATEGORY SHOULD BE SELECTED."; YAO23TG1--CH spend time with or visit face to facewith or visit w bio dad; YAO23TG2--CH talk or text on the phone w bio dad; YAO23TG3--CH keep in touch through Facebook, Instagram or other social media site with bio dad;
YAO23TG4--CH receive cards/presents from bio dad; YAO23TG5--CH does not do anything w bio dad; YAO23TG6—CH does w bio dad - DK; YAO23TG7--CH does w bio dad - RF
---------------------------------------------------------------------------------
Logic before:
IF Y_A023, 1 = Y, CONTINUE. ELSE, GOTO Y_AO25a.
Y_AO24a [ YAO24a ] How often adopted CH visits bio dad
USE CARD 8. About how often do you spend time with or visit with your biological dad? Would
you say…
Question Type: TFrqVst
never 1 never,
lessoncemo 2 less than once a month,
onceamo 3 once or twice a month,
onceawk 4 about once a week,
moreonceawk 5 several times a week, or
everyday 6 everyday?
---------------------------------------------------------------------------------
Logic before:
IF AO23, 2 = Y, CONTINUE. ELSE, GOTO Y_AO26a.
Y_AO25a [ YAO25a ] adopted CH talks with bio dad
USE CARD 8. About how often do you talk on the phone with your biological dad? Would you
Question Type: TFrqVst
never 1 never,
lessoncemo 2 less than once a month,
onceamo 3 once or twice a month,
onceawk 4 about once a week,
moreonceawk 5 several times a week, or
everyday 6 everyday?
---------------------------------------------------------------------------------
Y_AO27a [ YAO27a ] Any bio siblings not living w/ adopted CH
Do you have any biological brothers or sisters who do @Bnot@B live with you now?
NOTE: BIOLOGICAL SIBLINGS INCLUDE BIOLOGICAL OR ADOPTIVE SIBLINGS. HOWEVER,
IF CHILD FEELS OTHER CHILDREN ARE HIS/HER Biological SIBLINGS (E.G., FOSTER
SIBLINGS, COUSINS), THEY CAN BE INCLUDED TOO.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_AO27a = 2 GO TO Y_AO36a
---------------------------------------------------------------------------------
Y_AO32 [ YAO32 ] Labels are in Logic After
Now I would like to ask you about ^Y_AO28[J]. Please tell me whether or not you do any of the
following with ^Y_AO28[J]:
CODE ALL THAT APPLY
Question Type: TDowSibS
visit 1 Spend time with or visit face to face
talk 2 Talk or text on the phone
social media 3 Keep in touch through Facebook, Instagram or other social media site
presents 4 Receive cards or presents
none 5 NONE
---------------------------------------------------------------------------------
Logic before:
IF Y_AO32, 2 = Y, CONTINUE. ELSE, GOTO Y_AO35a.
Y_AO34a [ YAO34a ] Labels are in Logic After
USE CARD 8. About how often do you talk on the phone with ^Y_AO28[J]? Would you say…
Question Type: TFrqVst
never 1 never,
lessoncemo 2 less than once a month,
onceamo 3 once or twice a month,
onceawk 4 about once a week,
moreonceawk 5 several times a week, or
everyday 6 everyday?
Logic after:
YAO34aa--adopted CH Sibling #1 - Ch talks w on phone; YAO34ba--adopted CH Sibling #2 - Ch
talks w on phone; YAO34ca--adopted CH Sibling #3 - Ch talks w on phone; YAO34da--adopted CH
Sibling #4 - Ch talks w on phone; YAO34ea--adopted CH Sibling #5 - Ch talks w on phone;
YAO34fa--adopted CH Sibling #6 - Ch talks w on phone; YAO34ga--adopted CH Sibling #7 - Ch
talks w on phone; YAO34ha--adopted CH Sibling #8 - Ch talks w on phone; YAO34ia--adopted CH
Sibling #9 - Ch talks w on phone; YAO34ja--adopted CH Sibling #10 - Ch talks w on phone
---------------------------------------------------------------------------------
Y_AO36a [ YAO36a ] Other bio relative adopted CH like contact with
Are there other members of your biological family such as aunts, uncles, or cousins, that you like
to see, talk to or get a letter from?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_AO36a = 2 GOTO Y_AO41a
---------------------------------------------------------------------------------
Y_AO37a [ YAO37a ] adopted CH sees other bio relatives
How often do you get to see them? Would you say...
Question Type: TFrqRels
nvr 1 never,
onceinawhl 2 only once in a while,
sometimes 3 sometimes, or
usually 4 usually?
---------------------------------------------------------------------------------
Y_AO42a [ YAO42a ] CW talk with adopted CH about being adopted
Did your caseworker talk with you about being adopted by this family?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_AO43a [ YAO43a ] adopted CH want to be adopted by family
Did you want to be adopted by this family?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
GOTO Y_AOEND
---------------------------------------------------------------------------------
Y_AO_END [ YAO_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
Logic after:
Y_AOEND
---------------------------------------------------------------------------------
Logic before:
IF AGE < 13 OR CHILD IS YOUNG ADULT (18+) OR EMANCIPATED, GOTO Y_SWEND. ELSE,
CONTINUE.
Y_SW1a [ YSW1a ] CH met w/CW in past 6M
Now I would like to ask some questions about the experiences that you've had with caseworkers
or social workers from the child welfare agency over the ^Fills.Y_SW1a1. Honest answers are
important, so please tell me what you really feel or think. Your answers will be kept private. No
one will tell your caseworkers or social workers anything about your answers.
Have you met with a caseworker or social worker in the past ^Fills.Y_SW1a2 months?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Question Fill: ^FillY_SW1a1
waveone @Bpast 6 months@B
wavetwo @Bpast 18 months@B
Logic after:
IF Y_SW1a = 2 GOTO Y_SWEND
---------------------------------------------------------------------------------
Y_SW2a [ YSW2a ] How long ago CH met w/CW(#)
About how long ago was the last time you met with a child welfare caseworker or social worker?
NUMBER:
Question Type: 1..130
---------------------------------------------------------------------------------
Y_SW2u [ YSW2u ] # of D/W/M when CH met w/CW
About how long ago was the last time you met with a child welfare caseworker or social worker?
(Is that days, weeks, or months?)
Question Type: TDWM
days 1 DAYS
weeks 2 WEEKS
months 3 MONTHS
---------------------------------------------------------------------------------
Logic before:
IF (Wave = 1 AND ((Y_SW2a > 24 AND Y_SW2u = weeks) OR (Y_SW2a > 6 AND Y_SW2u =
months))) OR (Wave >= 2 AND ((Y_SW2a > 72 AND Y_SW2u = weeks) OR (Y_SW2a > 18 AND
Y_SW2u = months)))
Y_SW2cka [ YSW2cka ] CK for when/how long CH met w/CW(CH3T)
Perhaps I entered something incorrectly into the computer. Earlier you mentioned that you met
with a caseworker or social worker in the past ^Fills.Y_SW1a2 months, however I have entered in
the computer that your last visit with a caseworker or social worker was ^Y_SW2a
^Fills.Y_SW2aa ago. Which information needs to be corrected?
Question Type: TYSW2aa
didmeet 1 DID R MEET WITH CASEWORKER IN PAST 6 (OR 18) MONTHS
time 2 TIME OF LAST VISIT WITH CASEWORKER
Question Fill: ^FillY_SW2aa
days days
weeks weeks
months months
Logic after:
IF Y_SW2cka = 1 GOTO Y_SW1a ("INTERVIEWER: PLEASE RECORD THE ANSWER TO
QUESTION Y_SW1a AGAIN."); IF Y_SW2cka = 2 GOTO Y_SW2a ("INTERVIEWER: PLEASE
RECORD THE ANSWER TO QUESTION Y_SW2a AGAIN.")
Y_SW2d
How many times during the past year, did you have face to face visits with a social worker?
0-50 ZERO THROUGH FIFTY
51 MORE THAN FIFTY
Y_SW2e
How many times during the past year, did a social worker talk to you on the phone?
0-50 ZERO THROUGH FIFTY
51 MORE THAN FIFTY
---------------------------------------------------------------------------------
Y_SW3a [ YSW3a ] past 6M # diff CWs CH met
In the past ^Fills.Y_SW1a2 months, how many different child welfare caseworkers or social
workers have you met with?
NUMBER:
Question Type: 1..20
Question Fill: ^FillY_SW1a2
waveone 6
wavetwo 18
---------------------------------------------------------------------------------
Y_SW4a [ YSW4a ] Did CW listen to CH
Overall, how much do you feel the caseworkers or social workers you met with listened to you?
Would you say they listened to you...
Question Type: TYSW4a
never 1 never
notoften 2 not very often
sometime 3 some of the time, or
alltime 4 all of the time
---------------------------------------------------------------------------------
Y_SW5a [ YSW5a ] Did CW understand CH situation
How well do you feel that the caseworkers or social workers understood you and your situation?
Would you say...
Question Type: TYSW5a
notwell 1 not well at all
somewhat 2 somewhat, or
verywell 3 very well
Y_SW7a
How many times during the past year did you have face to face visits or phone contact with your attorney or someone from your attorney’s office?
0-30 ZERO THROUGH THIRTY
31 MORE THAN THIRTY
Y_SW8a
Have you ever attended court proceedings regarding your case?
1 YES
2 NO
---------------------------------------------------------------------------------
Y_SW_END [ YSW_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF AGE < 10 OR CHILD IS YOUNG ADULT (18+) OR EMANCIPATED, GOTO Y_FEEND. ELSE,
CONTINUE.
Y_FE1a [ YFE1a ] Chances live to be at least 35
USE CARD 9. The next questions ask about what you think will happen to you in the future. For
each question, pick one of the answers on this card.
What do you think are the chances you will live to be at least 35? Would you say…
Question Type: TChance
noway 1 no chance
maybe 2 some chance
fiftyfifty 3 about 50-50
likely 4 pretty likely, or
willhappen 5 it will happen
Y_FE5a [ YFE5a ] Chances grad from high school
USE CARD 9. What do you think are the chances you will graduate from high school? (Would
you say no chance, some chance, about 50-50, pretty likely, or it will happen?)
Question Type: TChace2C
noway 1 NO CHANCE
maybe 2 SOME CHANCE
fiftyfifty 3 ABOUT 50-50
likely 4 PRETTY LIKELY
willhappen 5 IT WILL HAPPEN
didhappen 6 IT ALREADY HAPPENED
---------------------------------------------------------------------------------
Y_FE6a [ YFE6a ] Chances have a good job by 30
USE CARD 9. What do you think are the chances you will have a good job by age 30? (Would
you say no chance, some chance, about 50-50, pretty likely, or it will happen?)
Question Type: TChanceC
noway 1 NO CHANCE
maybe 2 SOME CHANCE
fiftyfifty 3 ABOUT 50-50
likely 4 PRETTY LIKELY
willhappen 5 IT WILL HAPPEN
---------------------------------------------------------------------------------
Y_FE7a [ YFE7a ] Chances have child/family
USE CARD 9. What do you think are the chances you will have children and raise a family when
you are older? (Would you say no chance, some chance, about 50-50, pretty likely, or it will
Question Type: TChace2C
noway 1 NO CHANCE
maybe 2 SOME CHANCE
fiftyfifty 3 ABOUT 50-50
likely 4 PRETTY LIKELY
willhappen 5 IT WILL HAPPEN
didhappen 6 IT ALREADY HAPPENED
---------------------------------------------------------------------------------
Logic before:
IF WAVE = 1 OR 2 OR 3 AND CHILD IS EMANCIPATED OR IF CHILD IS YOUNG ADULT (18+),
CONTINUE. ELSE, GOTO Y_SUEND.
Y_SU15a [ YSU15a ] Others might do for you or give you (Intro)
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 5. 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: TSU15a
a1 1 1 = I GET MUCH LESS THAN I WOULD LIKE
a2 2 2
a3 3 3
a4 4 4
a5 5 5 = I GET AS MUCH AS I LIKE
---------------------------------------------------------------------------------
Y_SU16a [ YSU16a ] Talk to someone about personal or family problems
Chances to talk to someone I trust about my personal and family problems
Question Type: TSU15a
a1 1 1 = I GET MUCH LESS THAN I WOULD LIKE
a2 2 2
a3 3 3
a4 4 4
a5 5 5 = I GET AS MUCH AS I LIKE
---------------------------------------------------------------------------------
Y_SU17a [ YSU17a ] Talk to someone about problems at work or with housework
Chances to talk to someone I trust about problems at work or with my housework
Question Type: TSU15a
a1 1 1 = I GET MUCH LESS THAN I WOULD LIKE
a2 2 2
a3 3 3
a4 4 4
a5 5 5 = I GET AS MUCH AS I LIKE
---------------------------------------------------------------------------------
Y_SU18a [ YSU18a ] Invitations to go out and do things with other people
Invitations to go out and do things with other people
Question Type: TSU15a
a1 1 1 = I GET MUCH LESS THAN I WOULD LIKE
a2 2 2
a3 3 3
a4 4 4
a5 5 5 = I GET AS MUCH AS I LIKE
---------------------------------------------------------------------------------
Y_SU19a [ YSU19a ] People who care about what happens to me
People who care about what happens to me
Question Type: TSU15a
a1 1 1 = I GET MUCH LESS THAN I WOULD LIKE
a2 2 2
a3 3 3
a4 4 4
a5 5 5 = I GET AS MUCH AS I LIKE
---------------------------------------------------------------------------------
Y_SU20a [ YSU20a ] Chances to talk about money matters
Chances to talk about money matters
Question Type: TSU15a
a1 1 1 = I GET MUCH LESS THAN I WOULD LIKE
a2 2 2
a3 3 3
a4 4 4
a5 5 5 = I GET AS MUCH AS I LIKE
---------------------------------------------------------------------------------
Y_SU21a [ YSU21a ] Useful advice about important things in life
Useful advice about important things in life
Question Type: TSU15a
a1 1 1 = I GET MUCH LESS THAN I WOULD LIKE
a2 2 2
a3 3 3
a4 4 4
a5 5 5 = I GET AS MUCH AS I LIKE
---------------------------------------------------------------------------------
Y_SU22a [ YSU22a ] Help when I need transportation
Help when I need transportation
Question Type: TSU15a
a1 1 1 = I GET MUCH LESS THAN I WOULD LIKE
a2 2 2
a3 3 3
a4 4 4
a5 5 5 = I GET AS MUCH AS I LIKE
---------------------------------------------------------------------------------
Y_SU23a [ YSU23a ] Help when I'm sick in bed
Help when I'm sick in bed
Question Type: TSU15a
a1 1 1 = I GET MUCH LESS THAN I WOULD LIKE
a2 2 2
a3 3 3
a4 4 4
a5 5 5 = I GET AS MUCH AS I LIKE
---------------------------------------------------------------------------------
Y_SU24a [ YSU24a ] Help around the house
Help around the house
Question Type: TSU15a
a1 1 1 = I GET MUCH LESS THAN I WOULD LIKE
a2 2 2
a3 3 3
a4 4 4
a5 5 5 = I GET AS MUCH AS I LIKE
---------------------------------------------------------------------------------
Logic before:
IF R REPORTS HAVING A CHILD CONTINUE, ELSE SKIP TO Y_SUEND
Y_SU25a [ YSU25a ] Help taking care of my child(ren)
Help taking care of my child(ren)
Question Type: TSU15a
a1 1 1 = I GET MUCH LESS THAN I WOULD LIKE
a2 2 2
a3 3 3
a4 4 4
a5 5 5 = I GET AS MUCH AS I LIKE
Logic after:
Y_SUEND
---------------------------------------------------------------------------------
Y_SU_END [ YSU_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF CHILD IS EMANCIPATED OR YOUNG ADULT (18+), CONTINUE. ELSE, GOTO Y_PEEND.
Y_PE1a [ YPE1a ] Eman CH health in general
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: TPE1a
excellent 1 excellent
vgood 2 very good
good 3 good
fair 4 fair, or
poor 5 poor?
---------------------------------------------------------------------------------
Y_PE2a [ YPE2a ] Eman CH health limits 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: TPE2a
alot 1 limited a lot
alittle 2 limited a little, or
notlimited 3 not limited at all?
---------------------------------------------------------------------------------
Y_PE3a [ YPE3a ] Eman CH health limits climb stairs
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: TPE2a
alot 1 limited a lot
alittle 2 limited a little, or
notlimited 3 not limited at all?
---------------------------------------------------------------------------------
Y_PE4a [ YPE4a ] Eman CH health limits work/actv
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: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE5a [ YPE5a ] Eman CH health limits kind of work
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: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE6a [ YPE6a ] Eman CH emotional prob limit work
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: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE7a [ YPE7a ] Eman CH emotional prob limit work quality
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: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE8a [ YPE8a ] Eman CH pain interfere norml work
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: TPE8a
notatall 1 not at all
alittle 2 a little bit
moderately 3 moderately
quite 4 quite a bit, or
extremely 5 extremely?
---------------------------------------------------------------------------------
Y_PE9a [ YPE9a ] Eman CH felt calm and peaceful
USE Card 6. 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 6 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: TPE9a
all 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?
---------------------------------------------------------------------------------
Y_PE10a [ YPE10a ] Eman CH have a lot of energy
USE Card 6. During the past @B4 weeks@B, how much of the time did you have a lot of
energy? Would you say...
Question Type: TPE9a
all 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?
---------------------------------------------------------------------------------
Y_PE11a [ YPE11a ] Eman CH felt downhearted/blue
USE Card 6. During the past @B4 weeks@B, how much of the time have you felt downhearted
and blue? Would you say...
Question Type: TPE9a
all 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?
---------------------------------------------------------------------------------
Y_PE12a [ YPE12a ] Eman CH phy/emo prob lmt socializ
USE Card 6. 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: TPE9a
all 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?
---------------------------------------------------------------------------------
Y_PE13ft [ YPE13ft ] Eman CH Height in feet
Can you tell me approximately what your height is?
FEET:
Question Type: 1..7
---------------------------------------------------------------------------------
Y_PE13in [ YPE13in ] Eman CH Height in inches
Can you tell me approximately what your height is?
INCHES:
Question Type: 0..11
---------------------------------------------------------------------------------
Y_PE14a [ YPE14a ] Eman CH Weight in pounds
Can you tell me approximately what your weight is?
POUNDS:
Question Type: 50..500
---------------------------------------------------------------------------------
Y_PE15a [ YPE15a ] Eman CH over/under wieght
Do you consider yourself now to be...
Question Type: TPE15a
over 1 Overweight
under 2 Underweight, or
right 3 About the right weight?
---------------------------------------------------------------------------------
Y_PE16a [ YPE16a ] Eman CH like to weigh more or less
Would you like to weigh...
Question Type: TPE16a
more 1 more
less 2 less
same 3 stay about the same?
---------------------------------------------------------------------------------
Y_PE17a [ YPE17a ] Eman CH =tTried to lose weight
During the past 12 months have you tried to lose weight?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_PE18a [ YPE18ax ] Eman CH days eat veg/fruit per week
On a typical day, not including potato chips or French fries, how often do you eat vegetables or
drink 100% vegetable juice?
Question Type: TPE18a
threemore 1 Three or more times a day
twice 2 Twice a day
once 3 Once a day
less 4 Less than once a day
---------------------------------------------------------------------------------
Y_PE18aa [ YPE18aa ] how often does Eman CH eat fruit or drink fruit juice
On a typical day, how often do you eat fruit or drink 100% fruit juice?
Question Type: TPE18a
threemore 1 Three or more times a day
twice 2 Twice a day
once 3 Once a day
less 4 Less than once a day
---------------------------------------------------------------------------------
Y_PE19a [ YPE19a ] Days Eman CH exercise 30 min+ per week
In a typical week, how many days do you engage in exercise that lasts 30 minutes or more?
# OF DAYS:
Question Type: 0..7
---------------------------------------------------------------------------------
Y_PE20a1a [ YPE20a1a ] Bst of your knwldg, do you currently have asthma?
To the best of your knowledge, do you currently have any of the following:
Asthma?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a2a [ YPE20a2a ] Bst of your knwldg, do you currently have ADD or ADHD?
(To the best of your knowledge, do you currently have any of the following:)
Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder, that is ADD or ADHD?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a3a [ YPE20a3a ] Bst of your knwldg, do you currently have autism or ASD?
(To the best of your knowledge, do you currently have any of the following:)
Autism, Asperger’s Disorder, pervasive developmental disorder, or other Autism Spectrum Disorder, that is ASD?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
---------------------------------------------------------------------------------
Y_PE20a6a [ YPE20a6a ] Bst of ur knwldg, do u crrntly hve dep/anxiety/eting dis
(To the best of your knowledge, do you currently have any of the following:)
Depression, anxiety, an eating disorder, or other emotional problems?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a7a [ YPE20a7a ] Bst of your knwldg, do you currently have diabetes?
(To the best of your knowledge, do you currently have any of the following:)
Diabetes?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_PE20a7a = 1 GOTO Y_PE20a8a; IF Y_PE20a7a = 2 GOTO Y_PE20a9a)
---------------------------------------------------------------------------------
Y_PE20a8a [ YPE20a8a ] Do you use insulin?
Do you use insulin?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a9a [ YPE20a9a ] Bst of your knwldg, do you currently have heart problem?
(To the best of your knowledge, do you currently have any of the following:)
A heart problem, including congenital heart disease?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a10a [ YPE20a10a ] Bst of your knwldg, do you currently have bld prblms?
(To the best of your knowledge, do you currently have any of the following:)
Blood problems such as anemia or sickle cell disease? Please do not include Sickle Cell Trait.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a11a [ YPE20a11a ] Bst of your knwldg, do you currently have cystic fibrosis?
(To the best of your knowledge, do you currently have any of the following:)
Cystic Fibrosis?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a12a [ YPE20a12a ] Bst of your knwldg, do you currently have cerebral palsy?
(To the best of your knowledge, do you currently have any of the following:)
Cerebral Palsy?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a13a [ YPE20a13a ] Bst of your knwldg, do you currently have mscular dystrophy?
(To the best of your knowledge, do you currently have any of the following:)
Muscular Dystrophy?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a14a [ YPE20a14a ] Bst of ur knwldg, do u crrntly hve eplpsy/othr sezur disord?
(To the best of your knowledge, do you currently have any of the following:)
Epilepsy or other seizure disorder?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a15a [ YPE20a15a ] Bst of your knwldg, do you crrntly have migrane/frnt hdachs?
(To the best of your knowledge, do you currently have any of the following:)
Migraine or frequent headaches?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a16a [ YPE20a16a ] Bst of ur knwldg, do u crrntly hve arthritis/othr jnt prblm?
(To the best of your knowledge, do you currently have any of the following:)
Arthritis or other joint problems?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a19a [ YPE20a19a ] Bst of your knwldg, do you currently have dental prlblms?
(To the best of your knowledge, do you currently have any of the following:)
Dental problems?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a21a [ YPE20a21a ] Bst of your knwldg, do you currently have rptd ear infction?
(To the best of your knowledge, do you currently have any of the following:)
Repeated ear infections?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a24a [ YPE20a24a ] Bst of your knwldg, do you currently have bck/nck prblms?
(To the best of your knowledge, do you currently have any of the following:)
Back or neck problems?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a25a [ YPE20a25a ] Bst of ur knwldg, do u crntly hve hyprtnsion/high bld prsur?
(To the best of your knowledge, do you currently have any of the following:)
Hypertension or high blood pressure?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a26a [ YPE20a26a ] Bst of your knwldg, do you currently have AIDS?
(To the best of your knowledge, do you currently have any of the following:)
AIDS?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a27a [ YPE20a27a ] Bst of your knwldg, do you currently have STD?
(To the best of your knowledge, do you currently have any of the following:)
Sexually transmitted disease, such as Chlamydia or Gonorrhea?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a28a [ YPE20a28a ] Bst of your knwldg, do you currently have chrnic bronchitis?
(To the best of your knowledge, do you currently have any of the following:)
Chronic bronchitis?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a30a [ YPE20a30a ] Bst of your knwldg, do you currently have othr resp prblm?
(To the best of your knowledge, do you currently have any of the following:)
Other respiratory problems?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_PE20a31a [ YPE20a31a ] Bst of your knwldg, do you currently have othr hlth prblm?
(To the best of your knowledge, do you currently have any of the following:)
Other health problems?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_PE20a31a = 1 GOTO Y_PE20a32a; IF Y_PE20a31a = 2 GOTO Y_PE20a
---------------------------------------------------------------------------------
Y_PE20a32 [ YPE20a32 ] What other health problems do you currently have?
What other health problems do you currently have?
PROBLEM:
Question Type: STRING[50]
---------------------------------------------------------------------------------
Logic before:
IF ANY Y_PE20a1a THROUGH Y_PE20a32 = YES, CONTINUE. ELSE, SKIP TO Y_PE21a. ASK
Y_PE20a FOR EACH CONDITION ANSWERED YES in Y_PE20a1a through Y_PE20a32.
Y_PE20a [ YPE20a ] Labels are in Logic After
Does ^Fills.Y_PE20a currently limit you in any way? Would you say...
Question Type: TPE20a
no 1 no, not currently limited by this condition
yeslittle 2 yes, limited a little
yesalot 3 yes, limited a lot
Question Fill: ^FillY_PE20a
asthma asthma
add Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder
autism autism or Autism Spectrum Disorder
depression depression, anxiety, an eating disorder, or another emotional problem
diabetes diabetes
heartprob a heart problem
bloodprob a blood problem such as anemia or sickle cell disease
cysticfib cystic fibrosis
cerpalsy cerebral palsy
muscdystr muscular dystrophy
epilepsy epilepsy or another seizure disorder
migraine migraine or frequent headache
arthritis arthritis or another joint problem
allergies an allergy
dentalprob a dental problem
eczema eczema or another skin disease
earinf repeated ear infection
visionprob a vision problem
hearingprob a hearing problem
backprob a back or neck problem
hypertension hypertension or high blood pressure
AIDS AIDS
std sexually transmitted disease
bronchitis chronic bronchitis
sinusitis sinusitis
otherresp another respiratory problem
otherprob another health problem
Logic after:
REPEAT FOR EACH CONDITION ANSWERED YES IN Y_PE20a1a through Y_PE20a32.;
YPE20a_1 --Currently limited by asthma; YPE20a_2 --Currently limited by ADD; YPE20a_3 --
Currently limited by autism; YPE20a_4 --Currently limited by down syndrome; YPE20a_5 --
Currently limited by mental retardation; YPE20a_6 --Currently limited by depression; YPE20a_7 --
Currently limited by diabetes; YPE20a_8 --Currently limited by heart problems; YPE20a_9 --
Currently limited by blood problem; YPE20a_10 --Currently limited by cystic fibrosis; YPE20a_11 --
Currently limited by cerebral palsy; YPE20a_12 --Currently limited by muscular dystrophy;
YPE20a_13 --Currently limited by epilepsy; YPE20a_14 --Currently limited by migrane; YPE20a_15
--Currently limited by arthritis; YPE20a_16 --Currently limited by allergies; YPE20a_17 --Currently
limited by dental problem; YPE20a_18 --Currently limited by eczema or another skin disease;
YPE20a_19 --Currently limited by repeated ear infection; YPE20a_20 --Currently limited by vision
problem; YPE20a_21 --Currently limited by hearing problem; YPE20a_22 --Currently limited by
back or neck problem; YPE20a_23 --Currently limited by hypertension; YPE20a_24 --Currently
limited by AIDS; YPE20a_25 --Currently limited by STDs; YPE20a_26 --Currently limited by
chronic bronchitis; YPE20a_27 --Currently limited by sinusitis; YPE20a_28 --Currently limited by
another respiratory problem; YPE20a_29 --Currently limited by anotehr health problem
---------------------------------------------------------------------------------
Y_PE21a [ YPE21a ] Eman CH take meds for chron phys/mental cond
Do you, or has a doctor told you to, regularly take medicine or prescription drugs related to a
chronic physical or mental condition?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Logic before:
IF Y_PE21a = 1, CONTINUE. ELSE, SKIP TO Y_PEEND.
Y_PE21aa [ YPE21aa ] Labels are in Logic After
For which of the following conditions do you take prescribed medication? Do you take prescribed
medication for...
CODE ALL THAT APPLY.
Question Type: TPE21aS
diabetes 1 Diabetes
asthma 2 Asthma
hypertension 3 High blood pressure
migraine 4 Migraine headaches
depression 5 Depression
anxiety 6 Anxiety
add 7 Attention Deficit Disorder
pain 8 Pain
epilepsy 9 Epilepsy or seizures
allergies 10 Allergies
thyroid 11 Thyroid problems
acidrflx 12 Acid reflux
cholesterol 13 Cholesterol
heartrelated 14 Heart-related illness
other 15 Other
Logic after:
GOTO Y_PEEND; YPE21a1--Take meds for diabetes; YPE21a2--Take meds for asthma;
YPE21a3--Take meds for high blood pressure; YPE21a4--Take meds for migraine headaches;
YPE21a5--Take meds for depression; YPE21a6--Take meds for anxiety; YPE21a7--Take meds for
attention deficit disorder; YPE21a8--Take meds for pain; YPE21a9--Take meds for epilepsy or
seizures; YPE21a10--Take meds for allergies; YPE21a11--Take meds for thyroid problems;
YPE21a12--Take meds for acid reflux; YPE21a13--Take meds for cholesterol; YPE21a14--Take
meds for heart related illness; YPE21a15--Take meds for other; YPE21a16--Take meds for - DK;
---------------------------------------------------------------------------------
Y_PE_END [ YPE_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
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Y_YH3a33 [ YYH3a33 ] Ever tkn med prsrbd by dr or clin for em/behav prblms?
To your knowledge, have you @Bever taken any medication@B prescribed by a doctor or clinician
for emotional or behavioral problems?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_YH3a34 [ YYH3a34 ] Dr or clinician ever rcmmend you take med for emo/beh prblms
Has a doctor or clinician @Bever recommended you take medication@B for emotional or
behavioral problems?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YH3a34 = 2 GOTO Y_YH4a
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Y_YH3a35 [ YYH3a35 ] Start taking med after dr or clinican recommended you take
After a doctor or clinician recommended you take medication for emotional or behavioral
problems, @Bdid you start taking@B the medication?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YH3a35 = 1 GOTO Y_YH3a38
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Y_YH3a36 [ YYH3a36 ] Labels are in Logic After
I'm going to read a list of reasons why some people sometimes choose not to take medication.
Please respond yes to any of the reasons why you are not taking medication.
CODE ALL THAT APPLY.
Question Type: TYH3a36S
cost 1 Insurance did not cover medication
sideeffects 2 Concerns about side effects of the medication
gotbetter 3 You got better and didn't need medication any more
family 4 Family or friends were concerned about you taking medication
addiction 5 Afraid of getting addicted
badexperience 6 Bad experiences with other clinicians prescribing medications
changeddrs 7 You changed providers
other 8 Other reasons
Logic after:
YYH3a36_1 --Why not taking med - Insurance did not cover medication; YYH3a36_2 --Why not
taking med - Concerns about side effects of the meds; YYH3a36_3 --Why not taking med - Got
better, didn't need med any more; YYH3a36_4 --Why not taking med - Family/friends concerned
about medicatn; YYH3a36_5 --Why not taking med - Afraid of getting addicted; YYH3a36_6 --Why
not taking med - Bad experiences with medications; YYH3a36_7 --Why not taking med - You
changed providers; YYH3a36_8 --Why not taking med - Other reasons; YYH3a36_9--Why not
---------------------------------------------------------------------------------
Logic before:
IF Y_YH3a36 = 8, CONTINUE. ELSE, GOTO Y_YH4a
Y_YH3a37 [ YYH3a37 ] Other reason to choose not to take medications
Please specify other reasons.
REASON:
Question Type: STRING[40]
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Y_YH3a38 [ YYH3a38 ] Taken any meds for emo/behav problems in last 12 months?
@BIn the past 12 months@B, have you taken any medication for emotional or behavioral
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YH3a38 = 2 GOTO Y_YH3a40
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Y_YH3a39 [ YYH3a39 ] Currently taking meds for emo/behav problems?
Are you currently taking any medication for emotional or behavioral problems?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YH3a39 = 1 GOTO Y_YH3a42
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Y_YH3a40 [ YYH3a40 ] Labels are in Logic After
I'm going to read a list of reasons why some people sometimes stop taking medication. Please
respond yes to any of the reasons why you are not still taking medication.
CODE ALL THAT APPLY.
Question Type: TYH3a40S
cost 1 Insurance did not cover medication
sideeffects 2 Concerns about side effects of the medication
gotbetter 3 You got better and didn't need medication any more
family 4 Family or friends were concerned about you taking medication
addiction 5 Afraid of getting addicted
badexperience 6 Bad experiences with other clinicians prescribing medications
changeddrs 7 You changed providers
sitchanged 8 Your living situation changed
drsaidstop 9 Doctor said to stop
drmoved 10 Doctor left or moved away
rxproblems 11 Problems getting prescription from doctor's office
other 12 Other
Logic after:
YYH3a_40_1--Why not still taking med - Insurance did not cover medication; YYH3a_40_2--Why
not still taking med - Concerns about side effects meds; YYH3a_40_3--Why not still taking med -
Got bettr, didn't nd med any more; YYH3a_40_4--Why not still taking med - Family/friends
concerned abt med; YYH3a_40_5--Why not still taking med - Afraid of getting addicted;
YYH3a_40_6--Why not still taking med - Bad experiences with medications; YYH3a_40_7--Why
not still taking med - You changed providers; YYH3a_40_8--Why not still taking med - Your living
situation changed; YYH3a_40_9--Why not still taking med - Doctor said to stop; YYH3a_40_10--
Why not still taking med - Doctor left or moved away; YYH3a_40_11--Why not still taking med -
Probs gettng prscript frm Dr offc; YYH3a_40_12--Why not still taking med - Other reasons;
YYH3a_40_13--Why not still taking med - DK; YYH3a_40_14--Why not still taking med - RF
---------------------------------------------------------------------------------
Logic before:
IF Y_YH3a40 = 12, CONTINUE. ELSE, GOTO Y_YH4a
Y_YH3a41 [ YYH3a41 ] Other reason for stop taking medications.
Please specify other reasons.
REASON:
Question Type: STRING[40]
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Y_YH3a42 [ YYH3a42 ] How many pres meds currently taking for emo/behav prblms
How many prescription medications are you currently taking for emotional or behavioral problems?
Question Type: 1..10
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Y_YH3a43 [ YYH3a43 ] Crrntly taking these name brand meds for emot/behav prblms
INTERVIEWER NOTE: PLEASE ASK CAREGIVER TO GET MEDICATION BOTTLES FOR
REFERENCE. IF MEDICATION BOTTLES ARE AVAILABLE, IT IS OKAY FOR YOU TO FIND
THE NAMES ON THE LISTS AND ANSWER THE QUESTION ACCORDINGLY, JUST
CONFIRMING WITH THE CG.
Please look at Card 7. Are you currently taking any of these brand name medications for
emotional or behavioral problems?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YH3a43 = 1 GOTO Y_YH3a44; IF Y_YH3a43 = 2 GOTO Y_YH3a45
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Y_YH3a44 [ YYH3a44 ] Labels are in Logic After
Please tell me which brand name medications you are currently taking?
CODE ALL THAT APPLY.
Question Type: TYH3a44S
abilify 1 ABILIFY
adderall 2 ADDERALL
anafranil 3 ANAFRANIL
artane 4 ARTANE
asendin 5 ASENDIN
atarax 6 ATARAX
aventil 7 AVENTIL HCL
benadryl 8 BENADRYL
carbatrol 9 CARBATROL
catapres 10 CATAPRES
celexa 11 CELEXA
cibalith 12 CIBALITH
cogentin 13 COGENTIN
compazine 14 COMPAZINE
concerta 15 CONCERTA
cylert 16 CYLERT
cymbalta 17 CYMBALTA
depakene 18 DEPAKENE
depakote 19 DEPAKOTE
desyrel 20 DESYREL
dexedrine 21 DEXEDRINE
effexor 22 EFFEXOR
elavil 23 ELAVIL
eskalith 24 ESKALITH
focalin 25 FOCALIN
geodon 26 GEODON
haldol 27 HALDOL
lamictal 28 LAMICTAL
lexapro 29 LEXAPRO
limbitrol 30 LIMBITROL
lithobid 31 LITHOBID
loxitane 32 LOXITANE
ludiomil 33 LUDIOMIL
luvox 34 LUVOX
melatonin 35 MELATONIN
mellaril 36 MELLARIL
metadate 37 METADATE
methylin 38 METHYLIN
moban 39 MOBAN
navene 40 NAVENE
norpramine 41 NORPRAMINE
orap 42 ORAP
pamelor 43 PAMELOR
paxil 44 PAXIL
pexeva 45 PEXEVA
prolixin 46 PROLIXIN
prozac 47 PROZAC
remeron 48 REMERON
risperdal 49 RISPERDAL
ritalin 50 RITALIN
seroquel 51 SEROQUEL
serzone 52 SERZONE
sinequan 53 SINEQUAN
stelazine 54 STELAZINE
strattera 55 STRATTERA
surmontil 56 SURMONTIL
symbyax 57 SYMBYAX
tegretol 58 TEGRETOL
tenex 59 TENEX
thorazine 60 THORAZINE
tofranil 61 TOFRANIL
topamax 62 TOPAMAX
trilafon 63 TRILAFON
vistaril 64 VISTARIL
wellbutrin 65 WELLBUTRIN
zoloft 66 ZOLOFT
zyprexa 67 ZYPREXA
Logic after:
YYH3a_44_1--Brand Name med currently taking - ABILIFY; YYH3a_44_2--Brand Name med
currently taking - ADDERALL; YYH3a_44_3--Brand Name med currently taking - ANAFRANIL;
YYH3a_44_4--Brand Name med currently taking - ARTANE; YYH3a_44_5--Brand Name med
currently taking - ASENDIN; YYH3a_44_6--Brand Name med currently taking - ATARAX;
YYH3a_44_7--Brand Name med currently taking - AVENTIL HCL; YYH3a_44_8--Brand Name med
currently taking - BENADRYL; YYH3a_44_9--Brand Name med currently taking - CARBATROL;
YYH3a_44_10--Brand Name med currently taking - CATAPRES; YYH3a_44_11--Brand Name med
currently taking - CELEXA; YYH3a_44_12--Brand Name med currently taking - CIBALITH;
YYH3a_44_13--Brand Name med currently taking - COGENTIN; YYH3a_44_14--Brand Name med
currently taking - COMPAZINE; YYH3a_44_15--Brand Name med currently taking - CONCERTA;
YYH3a_44_16--Brand Name med currently taking - CYLERT; YYH3a_44_17--Brand Name med
currently taking - CYMBALTA; YYH3a_44_18--Brand Name med currently taking - DEPAKENE;
YYH3a_44_19--Brand Name med currently taking - DEPAKOTE; YYH3a_44_20--Brand Name med
currently taking - DESYREL; YYH3a_44_21--Brand Name med currently taking - DEXEDRINE;
YYH3a_44_22--Brand Name med currently taking - EFFEXOR; YYH3a_44_23--Brand Name med
currently taking - ELAVIL; YYH3a_44_24--Brand Name med currently taking - ESKALITH;
YYH3a_44_25--Brand Name med currently taking - FOCALIN; YYH3a_44_26--Brand Name med
currently taking - GEODON; YYH3a_44_27--Brand Name med currently taking - HALDOL;
YYH3a_44_28--Brand Name med currently taking - LAMICTAL; YYH3a_44_29--Brand Name med
currently taking - LEXAPRO; YYH3a_44_30--Brand Name med currently taking - LIMBITROL;
YYH3a_44_31--Brand Name med currently taking - LITHOBID; YYH3a_44_32--Brand Name med
currently taking - LOXITANE; YYH3a_44_33--Brand Name med currently taking - LUDIOMIL;
YYH3a_44_34--Brand Name med currently taking - LUVOX; YYH3a_44_35--Brand Name med
currently taking - MELATONIN; YYH3a_44_36--Brand Name med currently taking - MELLARIL;
YYH3a_44_37--Brand Name med currently taking - METADATE; YYH3a_44_38--Brand Name med
currently taking - METHYLIN; YYH3a_44_39--Brand Name med currently taking - MOBAN;
YYH3a_44_40--Brand Name med currently taking - NAVENE; YYH3a_44_41--Brand Name med
currently taking - NORPRAMINE; YYH3a_44_42--Brand Name med currently taking - ORAP;
YYH3a_44_43--Brand Name med currently taking - PAMELOR; YYH3a_44_44--Brand Name med
currently taking - PAXIL; YYH3a_44_45--Brand Name med currently taking - PEXEVA;
YYH3a_44_46--Brand Name med currently taking - PROLIXIN; YYH3a_44_47--Brand Name med
currently taking - PROZAC; YYH3a_44_48--Brand Name med currently taking - REMERON;
YYH3a_44_49--Brand Name med currently taking - RISPERDAL; YYH3a_44_50--Brand Name med
currently taking - RITALIN; YYH3a_44_51--Brand Name med currently taking - SEROQUEL;
YYH3a_44_52--Brand Name med currently taking - SERZONE; YYH3a_44_53--Brand Name med
currently taking - SINEQUAN; YYH3a_44_54--Brand Name med currently taking - STELAZINE;
YYH3a_44_55--Brand Name med currently taking - STRATTERA; YYH3a_44_56--Brand Name med
currently taking - SURMONTIL; YYH3a_44_57--Brand Name med currently taking - SYMBYAX;
YYH3a_44_58--Brand Name med currently taking - TEGRETOL; YYH3a_44_59--Brand Name med
currently taking - TENEX; YYH3a_44_60--Brand Name med currently taking - THORAZINE;
YYH3a_44_61--Brand Name med currently taking - TOFRANIL; YYH3a_44_62--Brand Name med
currently taking - TOPAMAX; YYH3a_44_63--Brand Name med currently taking - TRILAFON;
YYH3a_44_64--Brand Name med currently taking - VISTARIL; YYH3a_44_65--Brand Name med
currently taking - WELLBUTRIN; YYH3a_44_66--Brand Name med currently taking - ZOLOFT;
YYH3a_44_67--Brand Name med currently taking - ZYPREXA; YYH3a_44_68--Brand Name med
currently taking - DK; YYH3a_44_69--Brand Name med currently taking - RF
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Y_YH3a45 [ YYH3a45 ] Currently taking these generic meds for emot/behav prblms
Please look at Card 8. Are you currently taking any of these generic medications for emotional or
behavioral problems?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YH3a45 = 1 GOTO Y_YH3a46; IF Y_YH3a45 = 2 GOTO Y_YH3a47
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Y_YH3a46 [ YYH3a46 ] Labels are in Logic After
Please tell me which generic medications you are currently taking?
CODE ALL THAT APPLY.
Question Type: TYH3a46S
amitriptyline 1 AMITRIPTYLINE
amoxapine 2 AMOXAPINE
amphetamine 3 AMPHETAMINE
aripiprazole 4 ARIPIPRAZOLE
atomoxetine 5 ATOMOXETINE
benztropine 6 BENZTROPINE
buproprion 7 BUPROPRION
carbamazepine 8 CARBAMAZEPINE
chlorpromazine 9 CHLORPROMAZINE
citalopram 10 CITALOPRAM
clomipramine 11 CLOMIPRAMINE
clonidine 12 CLONIDINE
desipramine 13 DESIPRAMINE
dexmethyl 14 DEXMETHYLPHENIDATE
dextro 15 DEXTROAMPHETAMINE
diphen 16 DIPHENHYDRAMINE
divalproex 17 DIVALPROEX SODIUM
doxepine 18 DOXEPINE
duloxetine 19 DULOXETINE
escitalopram 20 ESCITALOPRAM
fluoxetine 21 FLUOXETINE
fluphenazine 22 FLUPHENAZINE
fluvoxamine 23 FLUVOXAMINE
guanfacine 24 GUANFACINE
haloperidol 25 HALOPERIDOL
hydroxyzine 26 HYDROXYZINE
imipramine 27 IMIPRAMINE
lamotrigine 28 LAMOTRIGINE
lithiumcarb 29 LITHIUM CARBONATE
lithiumcitr 30 LITHIUM CITRATE
loxapine 31 LOXAPINE
maprotiline 32 MAPROTILINE
melatonin 33 MELATONIN
methylphenidate 34 METHYLPHENIDATE
mirtazapine 35 MIRTAZAPINE
molindone 36 MOLINDONE
nefazodone 37 NEFAZODONE
nortriptyline 38 NORTRIPTYLINE
olanzapine 39 OLANZAPINE
paroxetine 40 PAROXETINE
pemoline 41 PEMOLINE
perphenazine 42 PERPHENAZINE
pimozide 43 PIMOZIDE
prochlorperazine 44 PROCHLORPERAZINE
quetiapine 45 QUETIAPINE
risperidone 46 RISPERIDONE
sertraline 47 SERTRALINE
thioridazine 48 THIORIDAZINE
thiothixine 49 THIOTHIXINE
topiramate 50 TOPIRAMATE
trazodone 51 TRAZODONE
trifluoperazine 52 TRIFLUOPERAZINE
trihexyphenadyl 53 TRIHEXYPHENADYL
trimipramine 54 TRIMIPRAMINE
valproic 55 VALPROIC ACID
venlafaxine 56 VENLAFAXINE
ziprasidone 57 ZIPRASIDONE
Logic after:
YYH3a_46_1--Generic med currently taking - AMITRIPTYLINE; YYH3a_46_2--Generic med
currently taking - AMOXAPINE; YYH3a_46_3--Generic med currently taking - AMPHETAMINE;
YYH3a_46_4--Generic med currently taking - ARIPIPRAZOLE; YYH3a_46_5--Generic med
currently taking - ATOMOXETINE; YYH3a_46_6--Generic med currently taking - BENZTROPINE;
YYH3a_46_7--Generic med currently taking - BUPROPRION; YYH3a_46_8--Generic med currently
taking - CARBAMAZEPINE; YYH3a_46_9--Generic med currently taking - CHLORPROMAZINE;
YYH3a_46_10--Generic med currently taking - CITALOPRAM; YYH3a_46_11--Generic med
currently taking - CLOMIPRAMINE; YYH3a_46_12--Generic med currently taking - CLONIDINE;
YYH3a_46_13--Generic med currently taking - DESIPRAMINE; YYH3a_46_14--Generic med
currently taking - DEXMETHYLPHENIDATE; YYH3a_46_15--Generic med currently taking -
DEXTROAMPHETAMINE; YYH3a_46_16--Generic med currently taking - DIPHENHYDRAMINE;
YYH3a_46_17--Generic med currently taking - DIVALPROEX SODIUM; YYH3a_46_18--Generic
med currently taking - DOXEPINE; YYH3a_46_19--Generic med currently taking - DULOXETINE;
YYH3a_46_20--Generic med currently taking - ESCITALOPRAM; YYH3a_46_21--Generic med
currently taking - FLUOXETINE; YYH3a_46_22--Generic med currently taking - FLUPHENAZINE;
YYH3a_46_23--Generic med currently taking - FLUVOXAMINE; YYH3a_46_24--Generic med
currently taking - GUANFACINE; YYH3a_46_25--Generic med currently taking - HALOPERIDOL;
YYH3a_46_26--Generic med currently taking - HYDROXYZINE; YYH3a_46_27--Generic med
currently taking - IMIPRAMINE; YYH3a_46_28--Generic med currently taking - LAMOTRIGINE;
YYH3a_46_29--Generic med currently taking - LITHIUM CARBONATE; YYH3a_46_30--Generic
med currently taking - LITHIUM CITRATE; YYH3a_46_31--Generic med currently taking -
LOXAPINE; YYH3a_46_32--Generic med currently taking - MAPROTILINE; YYH3a_46_33--Generic
med currently taking - MELATONIN; YYH3a_46_34--Generic med currently taking -
METHYLPHENIDATE; YYH3a_46_35--Generic med currently taking - MIRTAZAPINE;
YYH3a_46_36--Generic med currently taking - MOLINDONE; YYH3a_46_37--Generic med
currently taking - NEFAZODONE; YYH3a_46_38--Generic med currently taking - NORTRIPTYLINE;
YYH3a_46_39--Generic med currently taking - OLANZAPINE; YYH3a_46_40--Generic med
currently taking - PAROXETINE; YYH3a_46_41--Generic med currently taking - PEMOLINE;
YYH3a_46_42--Generic med currently taking - PERPHENAZINE; YYH3a_46_43--Generic med
currently taking - PIMOZIDE; YYH3a_46_44--Generic med currently taking -
PROCHLORPERAZINE; YYH3a_46_45--Generic med currently taking - QUETIAPINE;
YYH3a_46_46--Generic med currently taking - RISPERIDONE; YYH3a_46_47--Generic med
currently taking - SERTRALINE; YYH3a_46_48--Generic med currently taking - THIORIDAZINE;
YYH3a_46_49--Generic med currently taking - THIOTHIXINE; YYH3a_46_50--Generic med currently
taking - TOPIRAMATE; YYH3a_46_51--Generic med currently taking - TRAZODONE;
YYH3a_46_52--Generic med currently taking - TRIFLUOPERAZINE; YYH3a_46_53--Generic med
currently taking - TRIHEXYPHENADYL; YYH3a_46_54--Generic med currently taking -
TRIMIPRAMINE; YYH3a_46_55--Generic med currently taking - VALPROIC ACID; YYH3a_46_56--
Generic med currently taking - VENLAFAXINE; YYH3a_46_57--Generic med currently taking -
ZIPRASIDONE; YYH3a_46_58--Generic med currently taking - DK; YYH3a_46_59--Generic med
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Y_YH4a [ YYH4a ] CH gone to Dentist or hygienist past 12 months
@BIn the past 12 months@B, have you gone to a dentist or dental hygienist for a cleaning or a
checkup?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YH4a = 1 GOTO Y_YH14a
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Logic before:
IF NO CG COMPLETE IN WAVE 1, CONTINUE. ELSE, GOTO Y_YH14a.
Y_YH5a [ YYH5a ] CH ever gone to dentist for checkup
Have you @Bever@B gone to a dentist or dental hygienist for a cleaning or a checkup?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
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Y_YH14a [ YYH14a ] Ch admtd hosp ovrnght for inj/ill
In the past 12 months, that is, since ^DateYearAgo_Text, have you been admitted to a hospital or
medical facility overnight for an illness or injury?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YH14a = 2 GOTO Y_YH17a
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Y_YH15n [ YYH15a ] # of times CH admtd hosp/med facility
In the past 12 months, how many times have you been admitted?
TIMES:
Question Type: 1..100
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Y_YH16n [ YYH16a ] Total # days CH in hosp/med facility
In the past 12 months, how many total days did you spend in the hospital or medical facility for
these problems?
Please include the admissions you just mentioned.
DAYS:
Question Type: 1..100
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Y_YH17a [ YYH17a ] CH go ER/Urg care for ill/inj past 12 months
@BIn the last 12 months@B, have you gone to an emergency room or urgent care center for an
illness or injury?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YH17a = 2 GOTO Y_YH19a
---------------------------------------------------------------------------------
Y_YH18n [ YYH18a ] # of times CH gone to ER/Urg care
In the last 12 months, how many times have you gone to an emergency room or urgent care
center (for an illness or injury)?
TIMES:
Question Type: 1..100
---------------------------------------------------------------------------------
Y_YH19a [ YYH19a ] CH had inj/acc/poisn req doc/nurse past 12 months
In the last 12 months, have you had a serious injury, accident, or poisoning that needed the care
of a doctor or nurse?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YH19a = 2 GOTO Y_YH26a
---------------------------------------------------------------------------------
Y_YH20a [ YYH20a ] What happened in CH most recnt serious inj/acc/poison
I'd like to ask a few questions about your @Bmost recent@B serious injury, accident, or
poisoning. What happened?
NOTE: CODE CATEGORY THAT BEST FITS RESPONSE GIVEN.
Question Type: TYH20a
mva_occup 1 MOTOR VEHICLE COLLISION AS OCCUPANT
mva_pedes 2 MOTOR VEHICLE COLLISION AS PEDESTRIAN
bike 3 RIDING A WHEELED TOY OR BIKE
othrtoy 4 OTHER TOY OR ITEM INTENDED FOR CHILD USE
outdoorplay 5 OUTDOOR PLAY INJURY
poisoning 6 POISONING
burn 7 BURN/SMOKE INHALATION
fall 8 FALL
farminjury 9 INJURY WITH AGRICULTURAL EQUIPMENT
equipment 10 EQUIPMENT OR DEVICE NOT INTENDED FOR A CHILD
domviolence 11 DOMESTIC VIOLENCE IN HOUSEHOLD
othrviolence 12 NON-RESIDENT ACT OF VIOLENCE OR CRIME-RELATED
selfinflicted 13 SELF-INFLICTED
animal 14 ANIMAL OR INSECT-INFLICTED
roughhousing 15 ROUGH HOUSING WITH OTHER KIDS/PEERS
drowning 16 NEAR DROWNING
parentinj 17 CHILD INJURED BY PARENT/OTHER ADULT
childinj 18 CHILD INJURED BY OTHER CHILD
other 19 SOMETHING ELSE
---------------------------------------------------------------------------------
Y_YH21m [ YYH21m ] CH most recnt serious inj/acc/poison - month
In what month and year did this happen?
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
---------------------------------------------------------------------------------
Y_YH21y [ YYH21y ] CH most recnt serious inj/acc/poison - year
In what month and year did this happen?
YEAR:
Question Type: 2006..2013
---------------------------------------------------------------------------------
Y_YH21a [ YYH21CKa ] NO LABEL
We are interested in serious accidents, injuries, or poisonings that occurred in the last 12
months. The date I entered for your most recent injury was more than 12 months ago. Is that the
correct date for your most recent serious accident, injury, or poisoning?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YH21a = 1 GOTO Y_YH19a AND CHANGE ANSWER TO "NO"; IF Y_YH21a = 2 GOTO
Y_YH21m AND ENTER CORRECT DATE
---------------------------------------------------------------------------------
Y_YH22 [ YYH22 ] Labels are in Logic After
What kind of injuries occurred? (PROBE: ANYTHING ELSE?)
CODE ALL THAT APPLY.
Question Type: TYH22S
brkenbone 1 BROKEN BONES OR DISLOCATED JOINTS
sprain 2 SPRAIN, STRAIN OR PULLED MUSCLE
cut 3 WOUND: CUTS, SCRAPES, PUNCTURE
concussion 4 HEAD INJURY, CONCUSSION
bruise 5 BRUISE, CONTUSION, INTERNAL BLEEDING
burn 6 BURN, SCALD
poisoning 7 ILLNESS OF EFFECT FROM POISONS, MEDICINES
substabuse 8 DRUGS, ALCOHOL ABUSE, ETC.
unconscious 9 LOST CONSCIOUSNESS (FOR MORE THAN 30 SECONDS)
choking 10 LODGED OBJECT IN THROAT
teeth 11 INJURY TO TEETH
eyes 12 INJURY TO EYES
shock 13 ELECTRICAL SHOCK
bite 14 STING, BITE
seizure 15 SEIZURE
internal 16 INTERNAL ORGAN INJURY
other 17 SOME OTHER INJURY
Logic after:
YYH22_1 --Broken bones or dislocated joints; YYH22_2 --Sprain strain or pulled muscle; YYH22_3
--Wound: cuts scrapes puncture; YYH22_4 --Head injury concussion; YYH22_5 --Bruise contusion
internal bleeding; YYH22_6 --Burn scald; YYH22_7 --Illness of effect from poisons medicine;
YYH22_8 --Drugs alcohol abuse etc.; YYH22_9 --Lost consciousness (> 30 seconds); YYH22_10 -
-Lodged object in throat; YYH22_11 --Injury to teeth; YYH22_12 --Injury to eyes; YYH22_13 --
Electrical shock; YYH22_14 --Sting bite; YYH22_15 --Seizure; YYH22_16 --Internal organ injury;
YYH22_17 --Some other injury; YYH22_18--DK; YYH22_19--RF
---------------------------------------------------------------------------------
Logic before:
IF WAVE > 1, GOTO Y_YH24a
Y_YH23a [ YYH23a ] Where CH when most recnt serious inj/acc/poison happened
Where were you when this happened?
Question Type: TYH23a
athome 1 OWN HOME (INDOORS OR OUTDOORS)
daycare 2 DAY CARE/BABYSITTER/OTHER HOME (INDOORS OR OUTDOORS)
school 3 AT SCHOOL (INDOORS OR OUTDOORS)
other 4 SOMEWHERE ELSE (PARK, ETC.)
---------------------------------------------------------------------------------
Y_YH24a [ YYH24a ] CH stay ovrnight in hosp for most recnt serious inj/acc
Did you have to stay overnight in the hospital?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YH24a = 2 GOTO Y_YH30a
---------------------------------------------------------------------------------
Y_YH25n [ YYH25a ] Nights CH in hosp for most recnt serious inj/acc (#)
How many nights did you spend in the hospital?
NIGHTS:
Question Type: 1..365
ADMINISTER Y_Y30a – Y_YH41 TO EMANCIPATED YOUTH AND YOUNG ADULTS WHO ARE ATTENDING HIGH SCHOOL (Y_CHYda = 1).
---------------------------------------------------------------------------------
Logic before:
IF Y_CH9Yda = 1, CONTINUE. ELSE GOTO Y_YH43a
Y_YH30a [ YYH30a ] Tstd for lrning prob, spec nds, or dev dsblty in lst 12 mnth
@BIn the past 12 months@B have you been tested for learning problems, special needs, or
developmental disabilities by an education or health professional (E.G. SCHOOL
PSYCHOLOGIST, DOCTOR, SPEECH THERAPIST, ETC.)?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YH30a = 1 GOTO Y_YH35a; IF Y_YH30a = 2 GOTO Y_YH32a
---------------------------------------------------------------------------------
Y_YH32a [ YYH32a ] Thnk u need to be tstd for lrnng prblms/spec needs/dev dis
How much do you think you @Bneed@B to be tested for learning problems, special needs, or
developmental disabilities? Would you say...
Question Type: TYH32a
alot 1 a lot,
somewhat 2 somewhat,
alittle 3 a little, or
notatall 4 not at all?
---------------------------------------------------------------------------------
Y_YH33 [ YYH33 ] Labels are in Logic After
Why have you @Bnot been@B tested for learning problems, special needs, or developmental
disabilities?
CODE ALL THAT APPLY.
Question Type: TYH33S
notavail 1 SERVICE NOT AVAILABLE IN THE AREA
waitlist 2 WAIT-LISTED FOR SERVICE
ineligible 3 INELIGIBLE FOR SERVICE
cost 4 SERVICES COULD NOT BE FINANCED
scheduling 5 SCHEDULING PROBLEM OR PROBLEM FINDING CHILD CARE
transportation 6 TRANSPORTATION PROBLEM
other 7 SOME OTHER REASON
Logic after:
YYH33_1 --Why not tstd lrnng prb/spcl nds/dev dis - Not avlble in area; YYH33_2 --Why not tstd
lrnng prb/spcl nds/dev dis - Wait-listed for; YYH33_3 --Why not tstd lrnng prb/spcl nds/dev dis -
Ineligible for; YYH33_4 --Why not tstd lrnng prb/spcl nds/dev dis - Financing problem; YYH33_5 --
Why not tstd lrnng prb/spcl nds/dev dis - Schdling/chld care; YYH33_6 --Why not tstd lrnng
prb/spcl nds/dev dis - Transportation prb; YYH33_7 --Why not tstd lrnng prb/spcl nds/dev dis -
Some other reason; YYH33_8--Why not tstd lrnng prb/spcl nds/dev dis - DK; YYH33_9--Why not
tstd lrnng prb/spcl nds/dev dis - RF
---------------------------------------------------------------------------------
Y_YH35a [ YYH35a ] Ever told by ed or hlth prof that you have lrning prblms
Have you @Bever@B been told by an education or health professional that you have learning
problems, special needs, or developmental disabilities?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_YH36a [ YYH36a ] Classified in lst 12 mnths as needing special education
Children may qualify for special education services for many reasons, such as autism or the need
for speech or physical therapy.
@BIn the past 12 months@B have you been classified as needing special education? That is,
have you been given an Individual Education Plan (I.E.P.) or an Individual Family and Service Plan
(I.F.S.P.)?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YH36a = 2 GOTO Y_YH38ab
---------------------------------------------------------------------------------
Y_YH36ab [ YYH36ab ] Crrntly have IEP or rcvng spcl ed or othr srvces for dsablty
Do you currently have an Individual Education Plan (I.E.P) or are you receiving special education
or other services for a special need or disability?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YH36ab = 2 GOTO Y_YH40a
---------------------------------------------------------------------------------
Y_YH37a [ YYH37a ] Labels are in Logic After
What special learning problems or special needs were you told that you have? (PROBE:
ANYTHING ELSE)
CODE ALL THAT APPLY.
Question Type: TYH37aS
autism 1 AUTISM
deafness 2 DEAFNESS
behavioral 3 EMOTIONAL DISTURBANCE (BEHAVIORAL DISORDER)
hearing 4 HEARING IMPAIRMENT
mentalret 5 MENTAL RETARDATION
multdisab 6 MULTIPLE DISABILITIES (COMBINED IMPAIRMENTS THAT
TOGETHER CAUSE SEVERE EDUCATIONAL IMPAIRMENTS, SUCH
AS MENTAL RETARDATION-BLINDNESS)
orthopedic 7 ORTHOPEDIC IMPAIRMENT (PHYSICALLY DISABLING CONDITION,
SUCH AS MISSING LIMB, CEREBRAL PALSY, SPINA BIFIDA,
MUSCULAR DYSTROPHY)
specificld 8 SPECIFIC LEARNING DISABILITY
speech 9 SPEECH OR LANGUAGE IMPAIRMENT
tbi 10 TRAUMATIC BRAIN INJURY
visual 11 VISUAL IMPAIRMENT INCLUDING BLINDNESS
other 12 OTHER PROBLEM/NEED (ADHD, ASTHMA)
developmental 13 DEVELOPMENTAL DELAY
Logic after:
YYH37a_1 --Special learning problems/needs - AUTISM; YYH37a_2 --Special learning
problems/needs - DEAFNESS; YYH37a_3 --Special learning problems/needs - EMOTIONAL
DISTURBANCE; YYH37a_4 --Special learning problems/needs - HEARING IMPAIRMENT;
YYH37a_5 --Special learning problems/needs - MENTAL RETARDATION; YYH37a_6 --Special
learning problems/needs - MULTIPLE DISABILITIES; YYH37a_7 --Special learning problems/needs
- ORTHOPEDIC IMPAIRMENT; YYH37a_8 --Special learning problems/needs - SPECIFIC
LEARNING DISABLTY; YYH37a_9 --Special learning problems/needs - SPEECH/LANGUAGE
IMPAIRMENT; YYH37a_10 --Special learning problems/needs - TRAUMATIC BRAIN INJURY;
YYH37a_11 --Special learning problems/needs - VISUAL IMPAIRMENT; YYH37a_12 --Special
learning problems/needs - OTHER PROBLEM/NEED; YYH37a_13 --Special learning
problems/needs - DEVELOPMENTAL DELAY; YYH37a_14--Special learning problems/needs - DK;
YYH37a_15--Special learning problems/needs - RF
---------------------------------------------------------------------------------
Y_YH40a [ YYH40a ] Think you need special educations services/classes
How much do you think you @Bneed@B special education services or classes? Would you
Question Type: TYH32a
alot 1 a lot,
somewhat 2 somewhat,
alittle 3 a little, or
notatall 4 not at all?
---------------------------------------------------------------------------------
Y_YH41 [ YYH41 ] Labels are in Logic After
Why are you @Bnot@B receiving special education services or classes?
CODE ALL THAT APPLY.
Question Type: TYH41S
notavail 1 SERVICE NOT AVAILABLE IN THE AREA
waitlist 2 WAIT-LISTED FOR SERVICE
ineligible 3 INELIGIBLE FOR SERVICE
cost 4 SERVICES COULD NOT BE FINANCED
scheduling 5 SCHEDULING PROBLEM OR PROBLEM FINDING CHILD CARE
transportation 6 TRANSPORTATION PROBLEM
alreadyrecvd 7 CHILD ALREADY RECEIVED/COMPLETED SERVICE
other 8 SOME OTHER REASON
Logic after:
YYH41_1 --Why not receiving specl ed - Not avlble in area; YYH41_2 --Why not receiving specl ed -
Wait-listed for; YYH41_3 --Why not receiving specl ed - Ineligible for; YYH41_4 --Why not receiving
specl ed - Financing problem; YYH41_5 --Why not receiving specl ed - Schdling/chld care;
YYH41_6 --Why not receiving specl ed - Transportation prb; YYH41_7 --Why not receiving specl ed
- Already recvd service; YYH41_8 --Why not receiving specl ed - Some other reason; YYH41_9--
Why not receiving specl ed - DK
---------------------------------------------------------------------------------
Y_YH1ia [ YYH1ia ] Place CH usually goes when sick
Is there a place that you usually go when you are sick or you need advice about your health?
Question Type: TYH1ia
yes 1 YES
no 2 THERE IS NO PLACE
yesmore 3 THERE IS MORE THAN ONE PLACE
---------------------------------------------------------------------------------
Logic before:
IF Y_YH1ia = 2, CONTINUE. ELSE, GOTO Y_YH1ja.
Y_YH1ib [ YYH1ib ] Main reason you do not have a usual source of health care
What is the @Bmain@B reason you do not have a usual source of health care?
Question Type: TYH1ib
neversick 1 SELDOM OR NEVER GETS SICK
newtoarea 2 RECENTLY MOVED INTO AREA
dkwhere 3 DON'T KNOW WHERE TO GO FOR CARE
unavail 4 USUAL SOURCE OF MEDICAL CARE IN THIS AREA IS NO LONGER
AVAILABLE
language_ 5 CAN'T FIND A PROVIDER WHO SPEAKS SAME LANGUAGE
different 6 LIKES TO GO TO DIFFERENT PLACES FOR DIFFERENT HEALTH
NEEDS
newinsurance 7 JUST CHANGED INSURANCE PLANS
selftreat 8 DON'T USE DOCTORS/TREAT MYSELF
cost 9 COST OF MEDICAL CARE
other 10 OTHER REASON
Logic after:
GOTO Y_YH1la
---------------------------------------------------------------------------------
Logic before:
[IF Y_YH1ia = 1]: What kind of place is it –- a clinic, doctor’s office, emergency room, or some
other place?
[IF Y_YH1ia = 3]: What kind of place do you go to most often -– a clinic, doctor’s office,
emergency room, or some other place?
Y_YH1ja [ YYH1ja ] Kind of place CH goes when sick
^Fills.YH1ja
Question Type: TYH1ja
clinic 1 CLINIC OR HEALTH CENTER
droffice 2 DOCTOR'S OFFICE OR HMO
er 3 HOSPITAL EMERGENCY ROOM
hospout 4 HOSPITAL OUTPATIENT DEPARTMENT
other 5 SOME OTHER PLACE
noplace 6 DOESN'T GO TO ONE PLACE MOST OFTEN
Question Fill: ^FillYH1ja
oneplace What kind of place is it -- a clinic, doctor's office, emergency room, or
some other place?
moreone What kind of place do you go to most often -- a clinic, doctor's office,
emergency room, or some other place?
---------------------------------------------------------------------------------
Y_YH1ka [ YYH1ka ] Place CH goes when sick same for preventative care
Is that ^Fills.YH1ka the same place you usually go when you need routine or preventive care,
such as a physical examination?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Question Fill: ^FillYH1ka
clinic clinic or health center
droffice doctor's office or HMO
er hospital emergency room
hospout hospital outpatient department
Logic after:
IF Y_YH1ka = 1 GOTO Y_YH1lb
---------------------------------------------------------------------------------
Y_YH1la [ YYH1la ] Kind of place CH goes for prevntatve care
What kind of place do you @Uusually@U go when you need routine or preventive care, such as a
physical examination?
Question Type: TYH1la
doesntget 1 DOESN'T GET PREVENTIVE CARE ANYWHERE
clinic 2 CLINIC OR HEALTH CENTER
droffice 3 DOCTOR'S OFFICE OR HMO
er 4 HOSPITAL EMERGENCY ROOM
hospout 5 HOSPITAL OUTPATIENT DEPARTMENT
other 6 SOME OTHER PLACE
noplace 7 DOESN'T GO TO ONE PLACE MOST OFTEN
---------------------------------------------------------------------------------
Y_YH1lb [ YYH1lb ] See a particular prvder where u usually go for routine care
Do you usually see a @Bparticular provider@B at the place where you usually go for routine or
preventive care, such as a physical examination?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_YH1ma [ YYH1ma ] CH rcv general check-up last 12 months
@BDuring the past 12 months@B did you receive a general check-up when you were not sick or
injured?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_YH1na [ YYH1na ] CH see Dr because sick or injured last 12 months
@BDuring the past 12 months@B, did you see a doctor or other health professional because you
were sick or injured?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_YH1ob [ YYH1ob ] Labels are in Logic After
@BDuring the past 12 months@B, was there any time when you needed any of the following but
couldn't get it because you couldn't afford it...
CODE ALL THAT APPLY.
Question Type: TYH1obS
rxmeds 1 Prescription medicines
mentalhlth 2 Mental health care or counseling
dental 3 Dental care (including check-ups)
glasses 4 Eyeglasses
NONE 5 NONE OF THE ABOVE
Logic after:
YYH1ob_1 --Needed but could not afford - Prescription medicines; YYH1ob_2 --Needed but could
not afford - Mental health care/counseling; YYH1ob_3 --Needed but could not afford - Dental
care(incldng check-ups); YYH1ob_4 --Needed but could not afford - Eyeglasses; YYH1ob_5 --
Needed but could not afford - None of the above; YYH1ob_6--Needed but could not afford - DK;
YYH1ob_7--Needed but could not afford - RF
---------------------------------------------------------------------------------
Y_YH49 [ YYH49 ] NO LABEL
USE CARD 9. Next, I'm going to go through a list of places where you might have gotten help for
emotional, behavioral, learning, attention, or substance abuse problems. Please look at the list of
places on Card 9.
NOTE: "EMOTIONAL, BEHAVIORAL, LEARNING, AND ATTENTION PROBLEMS" INCLUDE
SUICIDE ATTEMPTS, ADD, DEPRESSION, ALCOHOL/DRUG-RELATED PROBLEMS,
INJURING SELF/OTHER, BIPOLAR DISORDER, AGGRESSIVE BEHAVIOR, ETC.
PRESS "1" AND [ENTER] TO CONTINUE.
Question Type: TCont
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF NO CG COMPLETE IN WAVE 1, ELSE GOTO Y_YH50a1a: Have you ever been to...
Y_YH50aa [ YYH50a ] CH ever been psych hosp/unit
Have you ever been to a @Bpsychiatric hospital or a psychiatric unit in a medical hospital@B for
emotional, behavioral, learning, attention, or substance abuse problems?
NOTE: A PSYCHIATRIC HOSPITAL PROVIDES CARE ONLY FOR PSYCHIATRIC PROBLEMS.
A PSYCHIATRIC UNIT PROVIDES PSYCHIATRIC CARE IN A SPECIALIZED UNIT THAT IS
WITHIN A MEDICAL HOSPITAL OFFERING CARE FOR A WIDE RANGE OF ILLNESSES.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF (Y_YH50aa = 1) OR (WAVE >= 2) FILL: In the past 12 months, have you been to...
Y_YH50a1a [ YYH50aa ] Past 12M, been to psych hosp or unit in medical hosp for...?
In the past 12 months, have you been to a @Bpsychiatric hospital or a psychiatric unit in a
medical hospital@B for emotional, behavioral, learning, attention, or substance abuse problems?
NOTE: A PSYCHIATRIC HOSPITAL PROVIDES CARE ONLY FOR PSYCHIATRIC PROBLEMS.
A PSYCHIATRIC UNIT PROVIDES PSYCHIATRIC CARE IN A SPECIALIZED UNIT THAT IS
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF NO CG COMPLETE IN WAVE 1, ELSE GOTO Y_YH50b1a: Have you ever been to...
Y_YH50ba [ YYH50b ] CH ever been detox/drg/alc unit
Have you ever been to a @Bdetox unit or inpatient drug or alcohol unit@B for emotional,
behavioral, learning, attention, or substance abuse problems?
(INCLUDE EMOTIONAL, BEHAVIORAL, LEARNING, ATTENTION, AND SUBSTANCE ABUSE
PROBLEMS.)
NOTE: AN INPATIENT DETOX UNIT OR DRUG/ALCOHOL UNIT PROVIDES INPATIENT
SPECIALIZED TREATMENT FOR SUBSTANCE USE/ABUSE. CAN OCCUR IN A STAND-
ALONE TREATMENT UNIT, A PSYCHIATRIC HOSPITAL, OR A GENERAL HOSPITAL.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF (Y_YH50ba = 1) OR (WAVE >= 2) FILL: In the past 12 months, have you been to...
Y_YH50b1a [ YYH50ba ] Past 12M, been t detox unit or inptnt drg or alc unt for...?
In the past 12 months, have you been to a @Bdetox unit or inpatient drug or alcohol unit@B for
emotional, behavioral, learning, attention, or substance abuse problems? (INCLUDE
EMOTIONAL, BEHAVIORAL, LEARNING, ATTENTION, AND SUBSTANCE ABUSE
PROBLEMS.)
NOTE: AN INPATIENT DETOX UNIT OR DRUG/ALCOHOL UNIT PROVIDES INPATIENT
SPECIALIZED TREATMENT FOR SUBSTANCE USE/ABUSE. CAN OCCUR IN A STAND-
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF NO CG COMPLETE IN WAVE 1, ELSE GOTO Y_YH50c1a: Have you ever been to...
Y_YH50ca [ YYH50c ] CH ever been hosp med inpatient unit
Have you ever been to a @Bhospital medical inpatient unit@B for emotional, behavioral, learning,
attention, or substance abuse problems? (INCLUDE EMOTIONAL, BEHAVIORAL, LEARNING,
ATTENTION, AND SUBSTANCE ABUSE PROBLEMS.)
NOTE: A HOSPITAL MEDICAL INPATIENT UNIT IS A GENERAL HOSPITAL UNIT NOT
SPECIALLY DESIGNATED FOR TREATMENT OF PSYCHIATRIC OR SUBSTANCE USE
PROBLEMS. TREATMENT, THOUGH, MUST BE FOR MENTAL HEALTH OR SUBSTANCE
ABUSE PROBLEMS.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF (Y_YH50ca = 1) OR (WAVE >= 2) FILL: In the past 12 months, have you been to...
Y_YH50c1a [ YYH50ca ] Past 12M, been to a hospital medical inpatient unit for...?
In the past 12 months, have you been to a @Bhospital medical inpatient unit@B for emotional,
behavioral, learning, attention, or substance abuse problems? (INCLUDE EMOTIONAL,
BEHAVIORAL, LEARNING, ATTENTION, AND SUBSTANCE ABUSE PROBLEMS.)
NOTE: A HOSPITAL MEDICAL INPATIENT UNIT IS A GENERAL HOSPITAL UNIT NOT
SPECIALLY DESIGNATED FOR TREATMENT OF PSYCHIATRIC OR SUBSTANCE USE
PROBLEMS. TREATMENT, THOUGH, MUST BE FOR MENTAL HEALTH OR SUBSTANCE
ABUSE PROBLEMS.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF NO CG COMPLETE IN WAVE 1, ELSE GOTO Y_YH50d1a: Have you ever been to...
Y_YH50da [ YYH50d ] CH ever been res trtmnt cntr or group home
Have you ever been to a @Bresidential treatment center or group home@B for emotional,
behavioral, learning, attention, or substance abuse problems? (INCLUDE EMOTIONAL,
BEHAVIORAL, LEARNING, ATTENTION, AND SUBSTANCE ABUSE PROBLEMS.)
NOTE: A RESIDENTIAL TREATMENT CENTER IS A SELF-CONTAINED TREATMENT FACILITY
(I.E., RESIDENCE IS NOT WITHIN THE COMMUNITY AND CHILD RECEIVES EDUCATION
WITHIN THE CENTER). INCLUDE WILDERNESS CAMPS AND COTTAGES ON THE GROUNDS
OF A SELF-CONTAINED TREATMENT FACILITY. DO NOT INCLUDE DETENTION CENTERS,
TRAINING SCHOOLS, AND JAILS. A GROUP HOME IS A SMALLER RESIDENTIAL
TREATMENT CENTER.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF (Y_YH50da = 1) OR (WAVE >= 2) FILL: In the past 12 months, have you been to...
Y_YH50d1a [ YYH50da ] Past 12M, bn to residntl trtmnt centr or group home for...?
In the past 12 months, have you been to a @Bresidential treatment center or group home@B for
emotional, behavioral, learning, attention, or substance abuse problems? (INCLUDE
EMOTIONAL, BEHAVIORAL, LEARNING, ATTENTION, AND SUBSTANCE ABUSE
PROBLEMS.)
NOTE: A RESIDENTIAL TREATMENT CENTER IS A SELF-CONTAINED TREATMENT FACILITY
(I.E., RESIDENCE IS NOT WITHIN THE COMMUNITY AND CHILD RECEIVES EDUCATION
WITHIN THE CENTER). INCLUDE WILDERNESS CAMPS AND COTTAGES ON THE GROUNDS
OF A SELF-CONTAINED TREATMENT FACILITY. DO NOT INCLUDE DETENTION CENTERS,
TRAINING SCHOOLS, AND JAILS. A GROUP HOME IS A SMALLER RESIDENTIAL
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF NO CG COMPLETE IN WAVE 1, ELSE GOTO Y_YH50g1a: Have you ever been to...
Y_YH50ga [ YYH50g ] CH ever been day trtmnt
Have you ever been to @Bday treatment@B for emotional, behavioral, learning, attention, or
substance abuse problems? By "day treatment," we mean that you go to a program @Bevery
day or almost every day@B but don't stay overnight.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF Y_YH50ga = 1 OR (WAVE >= 2) FILL: In the past 12 months, have you been to...
Y_YH50g1a [ YYH50ga ] Past 12M, been to day treatment for...?
In the past 12 months, have you been to @Bday treatment@B for emotional, behavioral, learning,
attention, or substance abuse problems? By "day treatment," we mean that you go to a program
@Bevery day or almost every day@B but don't stay overnight.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF NO CG COMPLETE IN WAVE 1, ELSE GOTO Y_YH50h1a: Have you ever been to...
Y_YH50ha [ YYH50h ] CH ever been outpatient drg/alc clinic
Have you ever been to an @Boutpatient drug or alcohol clinic@B for emotional, behavioral,
learning, attention, or substance abuse problems? (INCLUDE EMOTIONAL, BEHAVIORAL,
LEARNING, ATTENTION, AND SUBSTANCE ABUSE PROBLEMS.)
NOTE: AN OUTPATIENT DRUG/ALCOHOL CLINIC IS A SUBSTANCE ABUSE TREATMENT
FACILITY THAT PROVIDES OUTPATIENT SERVICES. DO NOT INCLUDE SUBSTANCE ABUSE
SERVICES RECEIVED AT A MENTAL HEALTH CENTER.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF (Y_YH50ha = 1) OR (WAVE >= 2) FILL: In the past 12 months, have you been to...
Y_YH50h1a [ YYH50ha ] Past 12M, been to outpatient drug or alcohol clinic for...?
In the past 12 months, have you been to an @Boutpatient drug or alcohol clinic@B for any of
these problems? (INCLUDE EMOTIONAL, BEHAVIORAL, LEARNING, ATTENTION, AND
SUBSTANCE ABUSE PROBLEMS.)
NOTE: AN OUTPATIENT DRUG/ALCOHOL CLINIC IS A SUBSTANCE ABUSE TREATMENT
FACILITY THAT PROVIDES OUTPATIENT SERVICES. DO NOT INCLUDE SUBSTANCE ABUSE
SERVICES RECEIVED AT A MENTAL HEALTH CENTER.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF NO CG COMPLETE IN WAVE 1, ELSE GOTO Y_YH50i1a: Have you ever been to...
Y_YH50ia [ YYH50i ] CH ever been mntl hlth/comm hlth cntr
Have you ever been to a @Bmental health or community health center@B for emotional,
behavioral, learning, attention, or substance abuse problems? (INCLUDE EMOTIONAL,
BEHAVIORAL, LEARNING, ATTENTION, AND SUBSTANCE ABUSE PROBLEMS.)
NOTE: A COMMUNITY HEALTH CENTER IS PUBLICLY FUNDED AND PROVIDES GENERAL
HEALTH SERVICES.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF (Y_YH50ia = 1) OR (WAVE >= 2) FILL: In the past 12 months, have you been to...
Y_YH50i1a [ YYH50ia ] Past 12M, bn to a mentl hlth or community hlth centr for...?
In the past 12 months, have you been to a @Bmental health or community health center@B for
any of these problems? (INCLUDE EMOTIONAL, BEHAVIORAL, LEARNING, ATTENTION, AND
SUBSTANCE ABUSE PROBLEMS.)
NOTE: A COMMUNITY HEALTH CENTER IS PUBLICLY FUNDED AND PROVIDES GENERAL
HEALTH SERVICES.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF Y_YH50ia = 1, FILL: Not counting help received from a mental health or community health
center, have you ever gotten private professional help from a @Bpsychiatrist, psychologist, social
worker, or psychiatric nurse@B for emotional, behavioral, learning, attention, or substance abuse
Y_YH50ja [ YYH50ja ] CH ever rcv priv prof help
^Fills.YH50ja you ever gotten private professional help from a @Bpsychiatrist, psychologist, social
worker, or psychiatric nurse@B for emotional, behavioral, learning, attention, or substance abuse
problems?
NOTE: CODE "NO" IF CHILD SEES THE PROFESSIONAL THROUGH AN AGENCY FUNDED
BY PUBLIC FUNDS, SUCH AS A PRIVATE PROFESSIONAL WHO SEES PATIENTS AT A
MENTAL HEALTH CENTER WITH WHICH HE/SHE IS AFFILIATED.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Question Fill: ^FillYH50ja
yesrcvd Not counting help received from a mental health or community health
center, have
norcvd Have
---------------------------------------------------------------------------------
Logic before:
IF (Y_YH50ja = 1) OR (WAVE >= 2) CONTINUE. ELSE GOTO Y_YH50ka.
Y_YH50j1a [ YYH50j1a ] CH rcv priv prof help in last 12 months
^Fills.YH50j1a the past 12 months, have you gotten private professional help from a
@Bpsychiatrist, psychologist, social worker, or psychiatric nurse@B for emotional, behavioral,
learning, attention, or substance abuse problems?
NOTE: CODE "NO" IF CHILD SEES THE PROFESSIONAL THROUGH AN AGENCY FUNDED
BY PUBLIC FUNDS, SUCH AS A PRIVATE PROFESSIONAL WHO SEES PATIENTS AT A
MENTAL HEALTH CENTER WITH WHICH HE/SHE IS AFFILIATED.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Question Fill: ^FillYH50j1a
yesrcvd Not counting help received from a mental health or community health
center, in
norcvd In
---------------------------------------------------------------------------------
Logic before:
IF NO CG COMPLETE IN WAVE 1, ELSE GOTO Y_YH50k1a: Have you ever...
Y_YH50ka [ YYH50k ] CH ever rcv in-home counslng/crisis svc
Have you ever received any @Bin-home counseling or in-home crisis services@B for emotional,
behavioral, learning, attention, or substance abuse problems? (INCLUDE EMOTIONAL,
BEHAVIORAL, LEARNING, ATTENTION, AND SUBSTANCE ABUSE PROBLEMS.)
NOTE: THESE INCLUDE SERVICES PROVIDED IN THE FAMILY'S HOME BY PROFESSIONAL
OR PARAPROFESSIONAL IN-HOME WORKERS. MUST BE PART OF A RECOGNIZED IN-
HOME SERVICE PROGRAM. DO NOT INCLUDE HOME VISITS BY CASEWORKERS OR
ISOLATED HOME VISITS BY CASE MANAGERS OR OTHER MENTAL HEALTH CLINICIANS.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF (Y_YH50ka = 1) OR (WAVE >= 2) FILL: In the past 12 months, have you...
Y_YH50k1a [ YYH50ka ] Past 12M, recvd any in-home counslng or crisis srvcs for...?
In the past 12 months, have you received any @Bin-home counseling or in-home crisis
services@B for any of these problems? (INCLUDE EMOTIONAL, BEHAVIORAL, LEARNING,
ATTENTION, AND SUBSTANCE ABUSE PROBLEMS.)
NOTE: THESE INCLUDE SERVICES PROVIDED IN THE FAMILY'S HOME BY PROFESSIONAL
OR PARAPROFESSIONAL IN-HOME WORKERS. MUST BE PART OF A RECOGNIZED IN-
HOME SERVICE PROGRAM. DO NOT INCLUDE HOME VISITS BY CASEWORKERS OR
ISOLATED HOME VISITS BY CASE MANAGERS OR OTHER MENTAL HEALTH CLINICIANS.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF NO CG COMPLETE IN WAVE 1, ELSE GOTO Y_YH50l1a: Have you ever...
Y_YH50la [ YYH50l ] CH ever seen fam doc/othr med doc
Have you ever seen your @Bfamily doctor or any other medical doctor@B for emotional,
behavioral, learning, attention, or substance abuse problems?
NOTE: INCLUDE SERVICES RECEIVED FROM A NON-PSYCHIATRIC MD. INCLUDE ANY
VISITS TO PEDIATRICIAN OR FAMILY DOCTOR IN PRIVATE OR GROUP PRACTICE DURING
WHICH THE PARENT/CHILD SOUGHT HELP FOR EMOTIONAL, BEHAVIORAL, SUBSTANCE
ABUSE PROBLEMS.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF (Y_YH50la = 1) OR (WAVE >= 2) FILL: In the past 12 months, have you...
Y_YH50l1a [ YYH50la ] Past 12M, seen your family dr or any other medicl dr for...?
In the past 12 months, have you seen your @Bfamily doctor or any other medical doctor@B for
emotional, behavioral, learning, attention, or substance abuse problems?
NOTE: INCLUDE SERVICES RECEIVED FROM A NON-PSYCHIATRIC MD. INCLUDE ANY
VISITS TO PEDIATRICIAN OR FAMILY DOCTOR IN PRIVATE OR GROUP PRACTICE DURING
WHICH THE PARENT/CHILD SOUGHT HELP FOR EMOTIONAL, BEHAVIORAL, SUBSTANCE
ABUSE PROBLEMS.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF NO CG COMPLETE IN WAVE 1, ELSE GOTO Y_YH50m1a: Have you ever...
Y_YH50ma [ YYH50m ] CH ever been to hosp emer room
Have you ever been to a @Bhospital emergency room@B for emotional, behavioral, learning,
attention, or substance abuse problems? (INCLUDE EMOTIONAL, BEHAVIORAL, LEARNING,
ATTENTION, AND SUBSTANCE ABUSE PROBLEMS.)
NOTE: ONLY CODE ER VISITS IF THEY WERE RELATED TO MENTAL HEALTH/SUBSTANCE
ABUSE (E.G., BREAKING AN ARM DURING A TANTRUM, HARM DURING A SUICIDE
ATTEMPT, CAR ACCIDENT WHILE CHILD WAS INTOXICATED, BROKEN NOSE DURING
SERIOUS PHYSICAL FIGHT, ETC.). ALSO INCLUDE VISITS TO ER AS PART OF ADMISSIONS
PROCESS TO INPATIENT FACILITY.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF (Y_YH50ma = 1) OR (WAVE >= 2) FILL: In the past 12 months, have you...
Y_YH50m1a [ YYH50ma ] Past 12M, been to a hospital emergency room for...?
In the past 12 months, have you been to a @Bhospital emergency room@B for any of these
problems? (INCLUDE EMOTIONAL, BEHAVIORAL, LEARNING, ATTENTION, AND
SUBSTANCE ABUSE PROBLEMS.)
NOTE: ONLY CODE ER VISITS IF THEY WERE RELATED TO MENTAL HEALTH/SUBSTANCE
ABUSE (E.G., BREAKING AN ARM DURING A TANTRUM, HARM DURING A SUICIDE
ATTEMPT, CAR ACCIDENT WHILE CHILD WAS INTOXICATED, BROKEN NOSE DURING
SERIOUS PHYSICAL FIGHT, ETC.). ALSO INCLUDE VISITS TO ER AS PART OF ADMISSIONS
PROCESS TO INPATIENT FACILITY.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF NO CG COMPLETE IN WAVE 1 AND Y_CH9Yda = 1, ELSE GOTO Y_YH50n1a: Have you ever…
Y_YH50na [ YYH50na ] Ever seen school cnselor, psych, social worker
Have you ever seen a @Bschool guidance counselor, school psychologist, or school social
worker@B for emotional, behavioral, learning, attention, or substance abuse problems or gotten
any other sort of help for these problems at school?
NOTE: ONLY INCLUDE VISITS RELATED TO MENTAL HEALTH/SUBSTANCE ABUSE. DO NOT
INCLUDE VISITS RELATED TO SCHOOL CURRICULUM OR COLLEGE/CAREER
COUNSELING. SCHOOL PERSONNEL WHO HANDLE ATTENDANCE ISSUES CAN ALSO BE
INCLUDED HERE IF THEY HAVE DIRECT CONTACT WITH THE CHILD.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF (Y_YH50na = 1 AND EMANCIPATED YOUTH) OR (WAVE >= 2)
Y_YH50n1a [ YYH50n1a ] Seen school cnselor, psych, social worker in last 12 months
In the past 12 months, have you seen a @Bschool guidance counselor, school psychologist, or
school social worker@B for emotional, behavioral, learning, attention, or substance abuse
problems or gotten any other sort of help for these problems at school?
FR NOTE: ONLINE VIRTUAL MEETINGS WITH SCHOOL GUIDANCE COUNSELORS, SCHOOL PSYCHOLOGISTS, OR SCHOOL SOCIAL WORKERS SHOULD BE INCLUDED.
NOTE: ONLY INCLUDE VISITS RELATED TO MENTAL HEALTH/SUBSTANCE ABUSE. DO NOT
INCLUDE VISITS RELATED TO SCHOOL CURRICULUM OR COLLEGE/CAREER
COUNSELING. SCHOOL PERSONNEL WHO HANDLE ATTENDANCE ISSUES CAN ALSO BE
INCLUDED HERE IF THEY HAVE DIRECT CONTACT WITH THE CHILD.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF NO CG COMPLETE IN WAVE 1 AND EMANCIPATED YOUTH, ELSE GOTO Y_YH50o1a: Have you ever...
Y_YH50oa
Have you ever received services in a special classroom in a regular school for emotional, behavioral, learning or substance abuse problems?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Logic before:
IF (Y_YH50oa = 1 AND EMANCIPATED YOUTH) OR (WAVE >= 2) FILL: In the past 12 months, have you...
Y_YH50o1a
In the past 12 months, have you received services in a special classroom in a regular school for emotional, behavioral, learning or substance abuse problems?
Question Type: TYN
yes 1 YES
no 2 NO
--------------------------------------------------------------------------------
Logic before:
F NO CG COMPLETE IN WAVE 1 AND EMANCIPATED YOUTH, ELSE GOTO Y_YH50p1a: Have you ever...
Y_YH50pa
Have you ever received special help or tutoring in the regular classroom for emotional, behavioral, learning or substance abuse problems?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Logic before:
IF (Y_YH50pa = 1 AND EMANCIPATED YOUTH) OR (WAVE >= 2) FILL: In the past 12 months, have you...
Y_YH50p1a
In the past 12 months, have you received special help or tutoring in the regular classroom for emotional, behavioral, learning or substance abuse problems?
FR NOTE: ONLINE HELP OR TUTORING SHOULD BE COUNTED.
Question Type: TYN
yes 1 YES
no 2 NO
--------------------------------------------------------------------------------
Logic before:
F NO CG COMPLETE IN WAVE 1 AND EMANCIPATED YOUTH, ELSE GOTO Y_YH50q1a: Have you ever...
Y_YH50qa
Have you ever received services in a special school for students with emotional, behavioral, learning, attention, or substance abuse problems?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Logic before:
IF (Y_YH50qa = 1 AND EMANCIPATED YOUTH) OR (WAVE >= 2) FILL: In the past 12 months, have you...
Y_YH50q1a
In the past 12 months, have you received services in a special school for students with emotional, behavioral, learning, attention, or substance abuse problems?
FR NOTE: ONLINE HELP OR SERVICES OFFERED VIRTUALLY SHOULD BE INCLUDED.
Question Type: TYN
yes 1 YES
no 2 NO
--------------------------------------------------------------------------------
Logic before:
F NO CG COMPLETE IN WAVE 1, ELSE GOTO Y_YH50r1a: Have you ever...
Y_YH50ra
Have you ever received outpatient help or treatment from an in-person or online self-help or support group (like peer counseling or Alcoholics Anonymous)?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Logic before:
IF (Y_YH50ra = 1) OR (WAVE >= 2) FILL: In the past 12 months, have you...
Y_YH50r1a
received outpatient help or treatment from an in-person or online self-help or support group (like peer counseling or Alcoholics Anonymous)?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Logic before:
IF WAVE = 1 AND IF NO RESPONSES Y_YH50aa to Y_YH50na = 1, GO TO Y_YH166a. ELSE,
CONTINUE.
IF WAVE >= 2 AND NO RESPONSES Y_YH50a1a to Y_YH50n1a = 1, GO TO Y_YH166a. ELSE,
CONTINUE.
Y_YH51 [ YYH51 ] NO LABEL
Now I want to ask you some questions about the types of services you received for emotional,
behavioral, learning, attention, or substance abuse problems.
PRESS "1" AND [ENTER] TO CONTINUE.
Question Type: TCont
Continue 1 Continue
---------------------------------------------------------------------------------
Y_YH52 [ YYH52 ] NO LABEL
In the past 12 months, has a caseworker or agency helped you receive support or assistance for
an alcohol or drug problem?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_YH140 Questions Y_YH140m - Y_YH146 are in Y_YH140m
Question Type: ARRAY[1..5] OF BY_YH140
---------------------------------------------------------------------------------
Logic before:
PROGRAMMER: IF WAVE = 1 REPEAT Y_YH140m TO Y_YH146 FOR EACH 'YES' RESPONSE
TO Y_YH50aa, Y_YH50ba, Y_YH50ca, Y_YH50da, Y_YH50ea, IF WAVE = 2 REPEAT
Y_YH140m TO Y_YH146 FOR EACH 'YES' RESPONSE TO Y_YH50a1a, Y_YH50b1a,
Y_YH50c1a, Y_YH50d1a, Y_YH50e1a, Use the corresponding fill for each outpatient venue as
follows: WAVE 1/Y_YH50aa FILL: psychiatric hospital or a psychiatric unit in a medical hospital
Y_YH50ba FILL: detox unit or inpatient drug or alcohol unit Y_YH50ca FILL: hospital medical
inpatient unit Y_YH50da FILL: residential treatment center or group home Y_YH50ea FILL:
emergency shelter WAVE 2/Y_YH50a1a FILL: psychiatric hospital or a psychiatric unit in a
medical hospital Y_YH50b1a FILL: detox unit or inpatient drug or alcohol unit Y_YH50c1a FILL:
hospital medical inpatient unit Y_YH50d1a FILL: residential treatment center or group home
---------------------------------------------------------------------------------
Y_YH141 [ YYH141 ] Labels are in Logic After
In the last 12 months, how many times have you been admitted to a @B^Fills.YH140m@B?
TIMES:
Question Type: 0..100
Question Fill: ^FillYH140m
psych psychiatric hospital or a psychiatric unit in a medical hospital
detox detox unit or inpatient drug or alcohol unit
inpatient hospital medical inpatient unit
resid residential treatment center or group home
shelter emergency shelter
Logic after:
YYH141_1 --How many times admitted in last 12 months?; YYH141_2 --How many times admitted
in last 12 months?; YYH141_3 --How many times admitted in last 12 months?; YYH141_4 --How
many times admitted in last 12 months?; YYH141_5 --How many times admitted in last 12 months?
Y_YH141a
THIS QUESTION IS NOT ASKED FOR THERAPUTIC FOSTER CARE
Now I am going to read a list of the types of treatment, services, and counseling programs that might be provided in @b^fills.Y_YH_Venue@b. In your most recent admission to a @b^fills.Y_YH_Venue@b, did you…
CODE ALL THAT APPLY
1=Receive therapy or counseling
2=Have case management or a contact person who coordinated his/her services
3=Receive medications
4=Receive evaluations or testing
---------------------------------------------------------------------------------
---------------------------------------------------------------------------------
Logic before:
IF Y_YH141 >1 FILL: "admitted this most recent time." ELSE FILL:"admitted."
Y_YH144 [ YYH144 ] Labels are in Logic After
USE CARD 10. Please look at Card 10 and tell me why you were ^Fills.YH144
CODE ALL THAT APPLY.
Question Type: TYH144S
Emotional 1 EMOTIONAL OR BEHAVIORAL HEALTH PROBLEMS
AlcoholDrug 2 ALCOHOL OR DRUG ABUSE PROBLEMS
Question Fill: ^FillYH144
once admitted.
moreonce admitted this most recent time.
---------------------------------------------------------------------------------
Y_YH142 [ YYH142 ] Labels are in Logic After
Are you still there?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
YYH142_1 --Still where you were admitted?; YYH142_2 --Still where you were admitted?;
YYH142_3 --Still where you were admitted?; YYH142_4 --Still where you were admitted?;
YYH142_5 --Still where you were admitted?
Y_YH146 [ YYH146 ] Labels are in Logic After
Why did you leave this facility?
CODE ALL THAT APPLY.
Question Type: TYH146S
planned 1 PLANNED TERMINATION OF TREATMENT
wasnthelping 2 DIDN'T THINK IT WAS HELPING
improved 3 IMPROVED SO STOPPED GOING
didntunderstand 4 FELT "PROVIDER" DID NOT UNDERSTAND WHAT THE PROBLEM
WAS
disagreed 5 DISAGREED WITH "PROVIDER" ABOUT WHAT SHOULD BE DONE
badexperience 6 HAD A BAD EXPERIENCE WITH THIS "PROVIDER"
discriminated 7 FELT DISCRIMINATED AGAINST
prvdrmoved 8 "PROVIDER" WAS NO LONGER AVAILABLE (MOVED OR LEFT
SETTING)
refused 9 REFUSED TO GO
inslimited 10 INSURANCE/MANAGED CARE COMPANY LIMITED TREATMENT
cost 11 TOO EXPENSIVE
moved 12 MOVED
other 13 OTHER
Logic after:
YYH146_1_1 --Adm #1, why left facility - PLANNED TERMINATION OF TREATMENT;
YYH146_1_10 --Adm #1, why left facility - INS/MANAGED CARE CO LIMITED TRT; YYH146_1_11
--Adm #1, why left facility - TOO EXPENSIVE; YYH146_1_12 --Adm #1, why left facility - MOVED;
YYH146_1_13 --Adm #1, why left facility - OTHER; YYH146_1_2 --Adm #1, why left facility -
DIDN'T THINK IT WAS HELPING; YYH146_1_3 --Adm #1, why left facility - IMPROVED SO
STOPPED GOING; YYH146_1_4 --Adm #1, why left facility - PROVIDER DID NOT UNDRSTND
PRB; YYH146_1_5 --Adm #1, why left facility - DISAGRD W PROVIDER ABT SERVICE;
YYH146_1_6 --Adm #1, why left facility - BAD EXPERIENCE WITH PROVIDER; YYH146_1_7 --
Adm #1, why left facility - FELT DISCRIMINATED AGAINST; YYH146_1_8 --Adm #1, why left
facility - PROVIDER NO LONGER AVAILABLE; YYH146_1_9 --Adm #1, why left facility -
REFUSED TO GO; YYH146_2_1 --Adm #2, why left facility - PLANNED TERMINATION OF
TREATMENT; YYH146_2_10 --Adm #2, why left facility - INS/MANAGED CARE CO LIMITED TRT;
YYH146_2_11 --Adm #2, why left facility - TOO EXPENSIVE; YYH146_2_12 --Adm #2, why left
facility - MOVED; YYH146_2_13 --Adm #2, why left facility - OTHER; YYH146_2_2 --Adm #2, why
left facility - DIDN'T THINK IT WAS HELPING; YYH146_2_3 --Adm #2, why left facility -
IMPROVED SO STOPPED GOING; YYH146_2_4 --Adm #2, why left facility - PROVIDER DID NOT
UNDRSTND PRB; YYH146_2_5 --Adm #2, why left facility - DISAGRD W PROVIDER ABT
SERVICE; YYH146_2_6 --Adm #2, why left facility - BAD EXPERIENCE WITH PROVIDER;
YYH146_2_7 --Adm #2, why left facility - FELT DISCRIMINATED AGAINST; YYH146_2_8 --Adm
#2, why left facility - PROVIDER NO LONGER AVAILABLE; YYH146_2_9 --Adm #2, why left
facility - REFUSED TO GO; YYH146_3_1 --Adm #3, why left facility - PLANNED TERMINATION
OF TREATMENT; YYH146_3_10 --Adm #3, why left facility - INS/MANAGED CARE CO LIMITED
TRT; YYH146_3_11 --Adm #3, why left facility - TOO EXPENSIVE; YYH146_3_12 --Adm #3, why
left facility - MOVED; YYH146_3_13 --Adm #3, why left facility - OTHER; YYH146_3_2 --Adm #3,
why left facility - DIDN'T THINK IT WAS HELPING; YYH146_3_3 --Adm #3, why left facility -
IMPROVED SO STOPPED GOING; YYH146_3_4 --Adm #3, why left facility - PROVIDER DID NOT
UNDRSTND PRB; YYH146_3_5 --Adm #3, why left facility - DISAGRD W PROVIDER ABT
SERVICE; YYH146_3_6 --Adm #3, why left facility - BAD EXPERIENCE WITH PROVIDER;
YYH146_3_7 --Adm #3, why left facility - FELT DISCRIMINATED AGAINST; YYH146_3_8 --Adm
#3, why left facility - PROVIDER NO LONGER AVAILABLE; YYH146_3_9 --Adm #3, why left
facility - REFUSED TO GO; YYH146_4_1 --Adm #4, why left facility - PLANNED TERMINATION
OF TREATMENT; YYH146_4_10 --Adm #4, why left facility - INS/MANAGED CARE CO LIMITED
TRT; YYH146_4_11 --Adm #4, why left facility - TOO EXPENSIVE; YYH146_4_12 --Adm #4, why
left facility - MOVED; YYH146_4_13 --Adm #4, why left facility - OTHER; YYH146_4_2 --Adm #4,
why left facility - DIDN'T THINK IT WAS HELPING; YYH146_4_3 --Adm #4, why left facility -
IMPROVED SO STOPPED GOING; YYH146_4_4 --Adm #4, why left facility - PROVIDER DID NOT
UNDRSTND PRB; YYH146_4_5 --Adm #4, why left facility - DISAGRD W PROVIDER ABT
SERVICE; YYH146_4_6 --Adm #4, why left facility - BAD EXPERIENCE WITH PROVIDER;
YYH146_4_7 --Adm #4, why left facility - FELT DISCRIMINATED AGAINST; YYH146_4_8 --Adm
#4, why left facility - PROVIDER NO LONGER AVAILABLE; YYH146_4_9 --Adm #4, why left
facility - REFUSED TO GO; YYH146_5_1 --Adm #5, why left facility - PLANNED TERMINATION
OF TREATMENT; YYH146_5_10 --Adm #5, why left facility - INS/MANAGED CARE CO LIMITED
TRT; YYH146_5_11 --Adm #5, why left facility - TOO EXPENSIVE; YYH146_5_12 --Adm #5, why
left facility - MOVED; YYH146_5_13 --Adm #5, why left facility - OTHER; YYH146_5_2 --Adm #5,
why left facility - DIDN'T THINK IT WAS HELPING; YYH146_5_3 --Adm #5, why left facility -
IMPROVED SO STOPPED GOING; YYH146_5_4 --Adm #5, why left facility - PROVIDER DID NOT
UNDRSTND PRB; YYH146_5_5 --Adm #5, why left facility - DISAGRD W PROVIDER ABT
SERVICE; YYH146_5_6 --Adm #5, why left facility - BAD EXPERIENCE WITH PROVIDER;
YYH146_5_7 --Adm #5, why left facility - FELT DISCRIMINATED AGAINST; YYH146_5_8 --Adm
#5, why left facility - PROVIDER NO LONGER AVAILABLE; YYH146_5_9 --Adm #5, why left
facility - REFUSED TO GO; YYH146_1_14--Adm #1, why left facility - DK; YYH146_1_15--Adm #1,
why left facility - RF; YYH146_2_14--Adm #2, why left facility - DK; YYH146_2_15--Adm #2, why
left facility - RF; YYH146_3_14--Adm #3, why left facility - DK; YYH146_3_15--Adm #3, why left
facility - RF; YYH146_4_14--Adm #4, why left facility - DK; YYH146_4_15--Adm #4, why left facility
- RF; YYH146_5_14--Adm #5, why left facility - DK; YYH146_5_15--Adm #5, why left facility - RF
---------------------------------------------------------------------------------
Y_YH153 Questions Y_YH153m - Y_YH161 are in Y_YH153m
Question Type: ARRAY[1..7] OF BY_YH153
---------------------------------------------------------------------------------
Logic before:
PROGRAMMER: IF WAVE = 1 REPEAT Y_YH153m TO Y_YH161 FOR EACH 'YES' RESPONSE
TO Y_YH50ga, Y_YH50ha, Y_YH50ia, Y_YH50ja, Y_YH50ka, Y_YH50la, IF WAVE = 2 REPEAT
Y_YH153m TO Y_YH161 FOR EACH 'YES' RESPONSE TO Y_YH50g1a, Y_YH50h1a,
Y_YH50i1a, Y_YH50j1a, Y_YH50k1a, Y_YH50la. Use the corresponding fill for each outpatient
venue as follows: IF Y_YH50ga = 1, FILL "day treatment"; IF Y_YH50ha = 1, FILL "an outpatient
drug or alcohol clinic"; IF Y_YH50ia = 1, FILL "a mental health or community health center"; IF
Y_YH50ja = 1, FILL "a psychiatrist, psychologist, social worker, or psychiatric nurse"; IF
Y_YH50ka = 1, FILL "in-home counseling or in-home crisis services"; IF Y_YH50la = 1, FILL "a
family doctor or any other medical doctor"; IF Y_YH50na = 1, FILL "a school guidance counselor,
school psychologist, or school social worker"; IF Y_YH50g1a = 1, FILL "day treatment"; IF
Y_YH50h1a = 1, FILL "an outpatient drug or alcohol clinic"; IF Y_YH50i1a = 1, FILL "a mental
health or community health center"; IF Y_YH50j1a = 1, FILL "a psychiatrist, psychologist, social
worker, or psychiatric nurse"; IF Y_YH50k1a = 1, FILL "in-home counseling or in-home crisis
services"; IF Y_YH50l1a = 1, FILL "a family doctor or any other medical doctor"; IF Y_YH50n1a =
1, FILL "a school guidance counselor, school psychologist, or school social worker"
---------------------------------------------------------------------------------
Y_YH154 [ YYH154 ] Labels are in Logic After
Have you ^Fills.YH153m1 @Bin the last 12 months@B^Fills.YH153m2?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Question Fill: ^FillYH153m1
daytx been to day treatment
outpatnt been to an outpatient drug or alcohol clinic
mental been to a mental health or community health center
psych gotten private professional help from a psychiatrist, psychologist, social
worker, or psychiatric nurse
inhome received in-home counseling or in-home crisis services
familydr seen a family doctor or any other medical doctor
school seen a school guidance counselor, school psychologist, or school social
worker
Question Fill: ^FillYH153m2
for_ ·for emotional, behavioral, learning, attention, or substance abuse
not_for ·
Logic after:
IF Y_YH154 = 2 GOTO Y_YH156m; YYH154_1 --Have you had this service in the last 12 months?;
YYH154_2 --Have you had this service in the last 12 months?; YYH154_3 --Have you had this
service in the last 12 months?; YYH154_4 --Have you had this service in the last 12 months?;
YYH154_5 --Have you had this service in the last 12 months?; YYH154_6 --Have you had this
service in the last 12 months?; YYH154_7 --Have you had this service in the last 12 months?
---------------------------------------------------------------------------------
Y_YH154a [ YYH154a ] Labels are in Logic After
In the last 12 months, how many times have you @B^Fills.YH153m1@B^Fills.YH153m2?
NUMBER:
Question Type: 1..365
Question Fill: ^FillYH153m1
daytx been to day treatment
outpatnt been to an outpatient drug or alcohol clinic
mental been to a mental health or community health center
psych gotten private professional help from a psychiatrist, psychologist, social
worker, or psychiatric nurse
inhome received in-home counseling or in-home crisis services
familydr seen a family doctor or any other medical doctor
school seen a school guidance counselor, school psychologist, or school social
worker
Question Fill: ^FillYH153m2
for_ ·for emotional, behavioral, learning, attention, or substance abuse
not_for ·
Logic after:
YYH154a_1 --How many times had this service in the last 12 months?; YYH154a_2 --How many
times had this service in the last 12 months?; YYH154a_3 --How many times had this service in
the last 12 months?; YYH154a_4 --How many times had this service in the last 12 months?;
YYH154a_5 --How many times had this service in the last 12 months?; YYH154a_6 --How many
times had this service in the last 12 months?; YYH154a_7 --How many times had this service in
Y_YH154b
DO NOT ADMINISTER Y_YH154b FOR THE FOLLOWING:
FAMILY DOCTOR (YYH50la),
A SPECIAL CLASSROOM (YYH50oa),
SPECIAL HELP/TUTORING (YYH50pa),
SERVICES IN A SPECIAL SCHOOL (YYH50qa), OR
IN-PERSON OR ONLINE SUPPORT GROUP (YYH50ra).
Now I am going to read a list of the types of treatment, services, and counseling program that might be provided in @b^fills.Y_YH_Venue@b. When you received services from the @b^fills.Y_YH_Venue@b, did you
CODE ALL THAT APPLY
1=Receive therapy or counseling
2=Have case management or contact person who coordinated his/her services
3=Receive medications DO NOT INCLUDE CATEGORY FOR SCHOOL-BASED PROVIDERS
4=Receive evaluations or testing
---------------------------------------------------------------------------------
Logic before:
Are you still {FILL AS DESCRIBED ABOVE AS WELL AS LEAD-IN}: going to day treatment;
going to an outpatient drug or alcohol clinic; going to a mental health or community health center;
getting private professional help from a psychiatrist, psychologist, social worker, or psychiatric
nurse; receiving in-home counseling or in-home crisis services; seeing a family doctor or any other
medical doctor; seen a school guidance counselor, school psychologist, or school social worker }
for {if Y_YH50ga/g1a, Y_YH50ha/h1a, Y_YH50ia/i1a, Y_YH50ja/j1a, Y_YH50ka/k1a,
Y_YH50la/l1a, FILL: emotional, behavioral, learning, attention, or substance abuse problems}?
Y_YH155 [ YYH155 ] Labels are in Logic After
DO NOT ADMINISTER Y_YH155 FOR THE FOLLOWING:
A SPECIAL CLASSROOM (YYH50oa),
SPECIAL HELP/TUTORING (YYH50pa),
SERVICES IN A SPECIAL SCHOOL (YYH50qa), OR
IN-PERSON OR ONLINE SUPPORT GROUP (YYH50ra).
Are you still ^Fills.YH155^Fills.YH153m2?
Question Type: TYesNoC
Yes 1 YES {GO TO Y_YH158}
No 2 NO
Question Fill: ^FillYH155
daytx going to day treatment
outpatnt going to an outpatient drug or alcohol clinic
mental going to a mental health or community health center
psych getting private professional help from a psychiatrist, psychologist, social
worker, or psychiatric nurse
inhome receiving in-home counseling or in-home crisis services
school seeing a school guidance counselor, school psychologist, or school
social worker
Logic after:
IF Y_YH155 = 1 GOTO Y_YH158; YYH155_1 --Are you still receiving this service?; YYH155_2 --
Are you still receiving this service?; YYH155_3 --Are you still receiving this service?; YYH155_4 --
Are you still receiving this service?; YYH155_5 --Are you still receiving this service?; YYH155_6 --
Are you still receiving this service?; YYH155_7 --Are you still receiving this service?
---------------------------------------------------------------------------------
Y_YH157 [ YYH157 ] Labels are in Logic After
DO NOT ADMINISTER Y_YH157 FOR THE FOLLOWING:
A SPECIAL CLASSROOM (YYH50oa),
SPECIAL HELP/TUTORING (YYHS50pa),
SERVICES IN A SPECIAL SCHOOL (YYH50qa), OR
IN-PERSON OR ONLINE SUPPORT GROUP (YYH50ra).
What were the reasons you stopped treatment?
CODE ALL THAT APPLY.
Question Type: TYH157S
planned 1 PLANNED TERMINATION OF TREATMENT
wasnthelping 2 DIDN'T THINK IT WAS HELPING
improved 3 IMPROVED SO STOPPED GOING
didntunderstand 4 FELT "PROVIDER" DID NOT UNDERSTAND WHAT THE PROBLEM
WAS
disagreed 5 DISAGREED WITH "PROVIDER" ABOUT WHAT SHOULD BE DONE
badexperience 6 HAD A BAD EXPERIENCE WITH THIS "PROVIDER"
discriminated 7 FELT DISCRIMINATED AGAINST
prvdrmoved 8 "PROVIDER" WAS NO LONGER AVAILABLE (MOVED OR LEFT
SETTING)
refused 9 REFUSED TO GO
inslimited 10 INSURANCE/MANAGED CARE COMPANY LIMITED TREATMENT
cost 11 TOO EXPENSIVE
moved 12 CHILD MOVED
other 13 OTHER
Logic after:
YYH157_1_1 --Trt #1, Why stopped trt - PLANNED TERMINATION OF TREATMENT;
YYH157_1_10 --Trt #1, Why stopped trt - INS/MANAGED CARE CO LIMITED TRTMNT;
YYH157_1_11 --Trt #1, Why stopped trt - TOO EXPENSIVE; YYH157_1_12 --Trt #1, Why stopped
trt - CHILD MOVED; YYH157_1_13 --Trt #1, Why stopped trt - OTHER; YYH157_1_2 --Trt #1, Why
stopped trt - DIDN'T THINK IT WAS HELPING; YYH157_1_3 --Trt #1, Why stopped trt -
IMPROVED SO STOPPED GOING; YYH157_1_4 --Trt #1, Why stopped trt - PROVIDER DID NOT
UNDRSTND PROBLM; YYH157_1_5 --Trt #1, Why stopped trt - DISAGRD W PROVIDER ABOUT
SERVICE; YYH157_1_6 --Trt #1, Why stopped trt - BAD EXPERIENCE WITH PROVIDER;
YYH157_1_7 --Trt #1, Why stopped trt - FELT DISCRIMINATED AGAINST; YYH157_1_8 --Trt #1,
Why stopped trt - PROVIDER NO LONGER AVAILABLE; YYH157_1_9 --Trt #1, Why stopped trt -
REFUSED TO GO; YYH157_2_1 --Trt #2, Why stopped trt - PLANNED TERMINATION OF
TREATMENT; YYH157_2_10 --Trt #2, Why stopped trt - INS/MANAGED CARE CO LIMITED
TRTMNT; YYH157_2_11 --Trt #2, Why stopped trt - TOO EXPENSIVE; YYH157_2_12 --Trt #2,
Why stopped trt - CHILD MOVED; YYH157_2_13 --Trt #2, Why stopped trt - OTHER; YYH157_2_2
--Trt #2, Why stopped trt - DIDN'T THINK IT WAS HELPING; YYH157_2_3 --Trt #2, Why stopped
trt - IMPROVED SO STOPPED GOING; YYH157_2_4 --Trt #2, Why stopped trt - PROVIDER DID
NOT UNDRSTND PROBLM; YYH157_2_5 --Trt #2, Why stopped trt - DISAGRD W PROVIDER
ABOUT SERVICE; YYH157_2_6 --Trt #2, Why stopped trt - BAD EXPERIENCE WITH PROVIDER;
YYH157_2_7 --Trt #2, Why stopped trt - FELT DISCRIMINATED AGAINST; YYH157_2_8 --Trt #2,
Why stopped trt - PROVIDER NO LONGER AVAILABLE; YYH157_2_9 --Trt #2, Why stopped trt -
REFUSED TO GO; YYH157_3_1 --Trt #3, Why stopped trt - PLANNED TERMINATION OF
TREATMENT; YYH157_3_10 --Trt #3, Why stopped trt - INS/MANAGED CARE CO LIMITED
TRTMNT; YYH157_3_11 --Trt #3, Why stopped trt - TOO EXPENSIVE; YYH157_3_12 --Trt #3,
Why stopped trt - CHILD MOVED; YYH157_3_13 --Trt #3, Why stopped trt - OTHER; YYH157_3_2
--Trt #3, Why stopped trt - DIDN'T THINK IT WAS HELPING; YYH157_3_3 --Trt #3, Why stopped
trt - IMPROVED SO STOPPED GOING; YYH157_3_4 --Trt #3, Why stopped trt - PROVIDER DID
NOT UNDRSTND PROBLM; YYH157_3_5 --Trt #3, Why stopped trt - DISAGRD W PROVIDER
ABOUT SERVICE; YYH157_3_6 --Trt #3, Why stopped trt - BAD EXPERIENCE WITH PROVIDER;
YYH157_3_7 --Trt #3, Why stopped trt - FELT DISCRIMINATED AGAINST; YYH157_3_8 --Trt #3,
Why stopped trt - PROVIDER NO LONGER AVAILABLE; YYH157_3_9 --Trt #3, Why stopped trt -
REFUSED TO GO; YYH157_4_1 --Trt #4, Why stopped trt - PLANNED TERMINATION OF
TREATMENT; YYH157_4_10 --Trt #4, Why stopped trt - INS/MANAGED CARE CO LIMITED
TRTMNT; YYH157_4_11 --Trt #4, Why stopped trt - TOO EXPENSIVE; YYH157_4_12 --Trt #4,
Why stopped trt - CHILD MOVED; YYH157_4_13 --Trt #4, Why stopped trt - OTHER; YYH157_4_2
--Trt #4, Why stopped trt - DIDN'T THINK IT WAS HELPING; YYH157_4_3 --Trt #4, Why stopped
trt - IMPROVED SO STOPPED GOING; YYH157_4_4 --Trt #4, Why stopped trt - PROVIDER DID
NOT UNDRSTND PROBLM; YYH157_4_5 --Trt #4, Why stopped trt - DISAGRD W PROVIDER
ABOUT SERVICE; YYH157_4_6 --Trt #4, Why stopped trt - BAD EXPERIENCE WITH PROVIDER;
YYH157_4_7 --Trt #4, Why stopped trt - FELT DISCRIMINATED AGAINST; YYH157_4_8 --Trt #4,
Why stopped trt - PROVIDER NO LONGER AVAILABLE; YYH157_4_9 --Trt #4, Why stopped trt -
REFUSED TO GO; YYH157_5_1 --Trt #5, Why stopped trt - PLANNED TERMINATION OF
TREATMENT; YYH157_5_10 --Trt #5, Why stopped trt - INS/MANAGED CARE CO LIMITED
TRTMNT; YYH157_5_11 --Trt #5, Why stopped trt - TOO EXPENSIVE; YYH157_5_12 --Trt #5,
Why stopped trt - CHILD MOVED; YYH157_5_13 --Trt #5, Why stopped trt - OTHER; YYH157_5_2
--Trt #5, Why stopped trt - DIDN'T THINK IT WAS HELPING; YYH157_5_3 --Trt #5, Why stopped
trt - IMPROVED SO STOPPED GOING; YYH157_5_4 --Trt #5, Why stopped trt - PROVIDER DID
NOT UNDRSTND PROBLM; YYH157_5_5 --Trt #5, Why stopped trt - DISAGRD W PROVIDER
ABOUT SERVICE; YYH157_5_6 --Trt #5, Why stopped trt - BAD EXPERIENCE WITH PROVIDER;
YYH157_5_7 --Trt #5, Why stopped trt - FELT DISCRIMINATED AGAINST; YYH157_5_8 --Trt #5,
Why stopped trt - PROVIDER NO LONGER AVAILABLE; YYH157_5_9 --Trt #5, Why stopped trt -
REFUSED TO GO; YYH157_6_1 --Trt #6, Why stopped trt - PLANNED TERMINATION OF
TREATMENT; YYH157_6_10 --Trt #6, Why stopped trt - INS/MANAGED CARE CO LIMITED
TRTMNT; YYH157_6_11 --Trt #6, Why stopped trt - TOO EXPENSIVE; YYH157_6_12 --Trt #6,
Why stopped trt - CHILD MOVED; YYH157_6_13 --Trt #6, Why stopped trt - OTHER; YYH157_6_2
--Trt #6, Why stopped trt - DIDN'T THINK IT WAS HELPING; YYH157_6_3 --Trt #6, Why stopped
trt - IMPROVED SO STOPPED GOING; YYH157_6_4 --Trt #6, Why stopped trt - PROVIDER DID
NOT UNDRSTND PROBLM; YYH157_6_5 --Trt #6, Why stopped trt - DISAGRD W PROVIDER
ABOUT SERVICE; YYH157_6_6 --Trt #6, Why stopped trt - BAD EXPERIENCE WITH PROVIDER;
YYH157_6_7 --Trt #6, Why stopped trt - FELT DISCRIMINATED AGAINST; YYH157_6_8 --Trt #6,
Why stopped trt - PROVIDER NO LONGER AVAILABLE; YYH157_6_9 --Trt #6, Why stopped trt -
REFUSED TO GO; YYH157_7_1 --Trt #7, Why stopped trt - PLANNED TERMINATION OF
TREATMENT; YYH157_7_10 --Trt #7, Why stopped trt - INS/MANAGED CARE CO LIMITED
TRTMNT; YYH157_7_11 --Trt #7, Why stopped trt - TOO EXPENSIVE; YYH157_7_12 --Trt #7,
Why stopped trt - CHILD MOVED; YYH157_7_13 --Trt #7, Why stopped trt - OTHER; YYH157_7_2
--Trt #7, Why stopped trt - DIDN'T THINK IT WAS HELPING; YYH157_7_3 --Trt #7, Why stopped
trt - IMPROVED SO STOPPED GOING; YYH157_7_4 --Trt #7, Why stopped trt - PROVIDER DID
NOT UNDRSTND PROBLM; YYH157_7_5 --Trt #7, Why stopped trt - DISAGRD W PROVIDER
ABOUT SERVICE; YYH157_7_6 --Trt #7, Why stopped trt - BAD EXPERIENCE WITH PROVIDER;
YYH157_7_7 --Trt #7, Why stopped trt - FELT DISCRIMINATED AGAINST; YYH157_7_8 --Trt #7,
Why stopped trt - PROVIDER NO LONGER AVAILABLE; YYH157_7_9 --Trt #7, Why stopped trt -
REFUSED TO GO; YYH157_1_14--Trt #1, Why stopped trt - DK; YYH157_1_15--Trt #1, Why
stopped trt - RF; YYH157_2_14--Trt #2, Why stopped trt - DK; YYH157_2_15--Trt #2, Why stopped
trt - RF; YYH157_3_14--Trt #3, Why stopped trt - DK; YYH157_3_15--Trt #3, Why stopped trt -
RF; YYH157_4_14--Trt #4, Why stopped trt - DK; YYH157_4_15--Trt #4, Why stopped trt - RF;
YYH157_5_14--Trt #5, Why stopped trt - DK; YYH157_5_15--Trt #5, Why stopped trt - RF;
YYH157_6_14--Trt #6, Why stopped trt - DK; YYH157_6_15--Trt #6, Why stopped trt - RF;
YYH157_7_14--Trt #7, Why stopped trt - DK; YYH157_7_15--Trt #7, Why stopped trt - RF
---------------------------------------------------------------------------------
Logic before:
How many days per week [IF Y_YH155 = 1, FILL: do you {FILL AS DESCRIBED ABOVE AS
WELL AS LEAD-IN}:; go to day treatment; go to an outpatient drug or alcohol clinic; go to a mental
health or community health center; get private professional help from a psychiatrist, psychologist,
social worker, or psychiatric nurse; receive in-home counseling or in-home crisis services; see a
family doctor or any other medical doctor; seen a school guidance counselor, school psychologist,
or school social worker } for {if Y_YH50ga/g1a, Y_YH50ha/h1a, Y_YH50ia/i1a, Y_YH50ja/j1a,
Y_YH50ka/k1a, Y_YH50la/l1a, FILL: emotional, behavioral, learning, attention, or substance abuse
problems}?/IF Y_YH155=2, FILL: did you {FILL AS DESCRIBED ABOVE AS WELL AS LEAD-IN}:
go to day treatment; go to an outpatient drug or alcohol clinic; go to a mental health or community
health center; get private professional help from a psychiatrist, psychologist, social worker, or
psychiatric nurse; receive in-home counseling or in-home crisis services; see a family doctor or any
other medical doctor; seen a school guidance counselor, school psychologist, or school social
worker }] in the past 12 months for {if Y_YH50ga/g1a, Y_YH50ha/h1a, Y_YH50ia/i1a,
Y_YH50ja/j1a, Y_YH50ka/k1a, Y_YH50la/l1a, FILL: emotional, behavioral, learning, attention, or
substance abuse problems}?
Y_YH158 [ YYH158 ] Labels are in Logic After
How many days per week ^Fills.YH158^Fills.YH153m2?
NOTE: AS NEEDED, PROMPT R TO THINK OF AVERAGE NUMBER OF DAYS PER WEEK
DURING WEEKS WHEN SERVICES WERE RECEIVED.
DAYS:
Question Type: 0..7
Question Fill: ^FillYH158
currdaytx do you go to day treatment
curroutpatnt do you go to an outpatient drug or alcohol clinic
currmental do you go to a mental health or community health center
currpsych do you get private professional help from a psychiatrist, psychologist,
social worker, or psychiatric nurse
currinhome do you receive in-home counseling or in-home crisis services
currfamilydr do you see a family doctor or any other medical doctor
currschool do you see a school guidance counselor, school psychologist, or school
social worker
daytx did you go to day treatment
outpatnt did you go to an outpatient drug or alcohol clinic
mental did you go to a mental health or community health center
psych did you get private professional help from a psychiatrist, psychologist,
social worker, or psychiatric nurse
inhome did you receive in-home counseling or in-home crisis services
familydr did you see a family doctor or any other medical doctor
school did you see a school guidance counselor, school psychologist, or school
social worker
Logic after:
YYH158_1 --Days per week do/did you rcve this srvce in past 12 months?; YYH158_2 --Days per
week do/did you rcve this srvce in past 12 months?; YYH158_3 --Days per week do/did you rcve
this srvce in past 12 months?; YYH158_4 --Days per week do/did you rcve this srvce in past 12
months?; YYH158_5 --Days per week do/did you rcve this srvce in past 12 months?; YYH158_6 --
Days per week do/did you rcve this srvce in past 12 months?; YYH158_7 --Days per week do/did
you rcve this srvce in past 12 months?
---------------------------------------------------------------------------------
Logic before:
How many hours per day [IF Y_YH155 = 1, FILL: are/IF Y_YH155 = 2, FILL: were] you {FILL AS
DESCRIBED ABOVE AS WELL AS LEAD-IN}: going to day treatment; going to an outpatient drug
or alcohol clinic; going to a mental health or community health center; getting private professional
help from a psychiatrist, psychologist, social worker, or psychiatric nurse; receiving in-home
counseling or in-home crisis services; seeing a family doctor or any other medical doctor; seen a
school guidance counselor, school psychologist, or school social worker } for {if Y_YH50ga/g1a,
Y_YH50ha/h1a, Y_YH50ia/i1a, Y_YH50ja/j1a, Y_YH50ka/k1a, Y_YH50la/l1a, FILL: emotional,
behavioral, learning, attention, or substance abuse problems}?
Y_YH159 [ YYH159 ] Labels are in Logic After
How many hours per day ^Fills.YH159^Fills.YH153m2?
NOTE: ENTER AVERAGE LENGTH OF EACH SESSION IN NUMBER OF HOURS.
HOURS PER DAY:
Question Type: 0..24
Question Fill: ^FillYH159
daytxcurr are you going to day treatment
outpatntcurr are you going to an outpatient drug or alcohol clinic
mentalcurr are you going to a mental health or community health center
psychcurr are you getting private professional help from a psychiatrist, psychologist,
social worker, or psychiatric nurse
inhomecurr are you receiving in-home counseling or in-home crisis services
familydrcurr are you seeing a family doctor or any other medical doctor
schoolcurr are you seeing a school guidance counselor, school psychologist, or
school social worker
daytx were you going to day treatment
outpatnt were you going to an outpatient drug or alcohol clinic
mental were you going to a mental health or community health center
psych were you getting private professional help from a psychiatrist,
psychologist, social worker, or psychiatric nurse
inhome were you receiving in-home counseling or in-home crisis services
familydr were you seeing a family doctor or any other medical doctor
school were you seeing a school guidance counselor, school psychologist, or
school social worker
Logic after:
YYH159_1 --Hours per day are/were you receiving this service?; YYH159_2 --Hours per day
are/were you receiving this service?; YYH159_3 --Hours per day are/were you receiving this
service?; YYH159_4 --Hours per day are/were you receiving this service?; YYH159_5 --Hours per
day are/were you receiving this service?; YYH159_6 --Hours per day are/were you receiving this
service?; YYH159_7 --Hours per day are/were you receiving this service?
---------------------------------------------------------------------------------
Y_YH161 [ YYH161 ] Labels are in Logic After
USE CARD 10. Please look at Card 10. Please tell me why you ^Fills.YH161.
CODE ALL THAT APPLY.
Question Type: TYH161S
Emotional 1 EMOTIONAL OR BEHAVIORAL HEALTH PROBLEMS
AlcoholDrug 2 ALCOHOL OR DRUG ABUSE PROBLEMS
Question Fill: ^FillYH161
current are receiving this service
past received this service the most recent time
---------------------------------------------------------------------------------
Y_YH163 [ YYH163 ] Been in treatmnt for any of these problems in last 12 mnths
Have you been there for any of these problems in the last 12 months?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YH163 = 2 GOTO Y_YH166
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Y_YH164 [ YYH164 ] Times in hosp emerg room for emot, behav, learn, subst abuse
In the last 12 months, how many times have you been to a hospital emergency room for
emotional, behavioral, learning, attention, or substance abuse problems?
NOTE: ONLY CODE ER VISITS IF THEY WERE RELATED TO MENTAL HEALTH/SUBSTANCE
ABUSE (E.G., BREAKING AN ARM DURING A TANTRUM, HARM DURING A SUICIDE
ATTEMPT, CAR ACCIDENT WHILE CHILD WAS INTOXICATED, BROKEN NOSE DURING
SERIOUS PHYSICAL FIGHT, ETC.). ALSO INCLUDE VISITS TO ER AS PART OF ADMISSIONS
PROCESS TO INPATIENT FACILITY.
TIMES:
Question Type: 0..300
---------------------------------------------------------------------------------
Y_YH165 [ YYH165 ] Labels are in Logic After
USE CARD 10. Please look at Card 10 and tell me why you went to the emergency room the
@Blast time@B.
CODE ALL THAT APPLY.
Question Type: TYH165S
Emotional 1 EMOTIONAL OR BEHAVIORAL HEALTH PROBLEMS
AlcoholDrug 2 ALCOHOL OR DRUG ABUSE PROBLEMS
---------------------------------------------------------------------------------
Logic before:
IF NO RESPONSE OF 'YES' IN Y_YH50g1a/ga, Y_YH50h1a/ha, Y_YH50i1a/ia, Y_YH50j1a/ja,
Y_YH50k1a/ka, Y_YH50l1a/la, Y_YH50m1a/ma, CONTINUE. ELSE SKIP TO Y_YH168a
Y_YH166 [ YYH166 ] Referred to any outpatient prof. treatment in last 12 months
In the last 12 months have you been @Breferred to@B any outpatient professional treatment for
emotional, behavioral, learning, attention, or substance abuse problems?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF = 2, SKIP TO 168a
---------------------------------------------------------------------------------
Logic before:
IF WAVE = 2, GO TO Y_YH168a
Y_YH167 [ YYH167 ] Labels are in Logic After
Why are you not receiving this professional treatment?
CODE ALL THAT APPLY.
Question Type: TYH33S
notavail 1 SERVICE NOT AVAILABLE IN THE AREA
waitlist 2 WAIT-LISTED FOR SERVICE
ineligible 3 INELIGIBLE FOR SERVICE
cost 4 SERVICES COULD NOT BE FINANCED
scheduling 5 SCHEDULING PROBLEM OR PROBLEM FINDING CHILD CARE
transportation 6 TRANSPORTATION PROBLEM
other 7 SOME OTHER REASON
Logic after:
YYH167_1 --Why not receiving this prof trt - Not avlble in area; YYH167_2 --Why not receiving this
prof trt - Wait-listed for; YYH167_3 --Why not receiving this prof trt - Ineligible for; YYH167_4 --Why
not receiving this prof trt - Financing problem; YYH167_5 --Why not receiving this prof trt -
Schdling/chld care; YYH167_6 --Why not receiving this prof trt - Transportation prb; YYH167_7 --
Why not receiving this prof trt - Some other reason; YYH167_8--Why not receiving this prof trt - DK;
YYH167_9--Why not receiving this prof trt - RF
---------------------------------------------------------------------------------
Y_YH168a [ YYH168a ] Currently covered by some type of military health insurance?
The next questions are about health care plans.
Are you currently covered by some type of military health insurance, such as CHAMPUS,
CHAMP-VA, TRICARE, or VA care?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_YH169a [ YYH169a ] Covered by health plan obtained through employer or union?
^Fills.YH141a health insurance plan obtained through a current or past employer or union?
Please remember to include coverage you may have through another family member's plan.
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Question Fill: ^FillYH141a
yesmil Other than military health insurance, are you covered by any other
nomil Are you covered by a
---------------------------------------------------------------------------------
Y_YH170a [ YYH170a ] At this time, are you covered by Medicaid?
Medicaid is a program for health care for persons in need. It is different from Medicare, which is a
health insurance program for persons 65 and older and some disabled persons under 65. The
Medicaid program in ^Fills.Y_YH_State is also called
^Fills.Y_YH_MediFill^Fill_or^Fills.Y_YH_CHIPFill.
At this time, are you covered by Medicaid?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Question Fill: ^FillYH142a
statehas The Medicaid program in ^Fills.Y_YH_State is also called
^Fills.Y_YH_MediFill or ^Fills.Y_YH_CHIPFill.
Logic after:
IF Y_YH170a = 2, DK OR REF, GO TO Y_YH171a; ELSE GO TO Y_YH172a
---------------------------------------------------------------------------------
Y_YH172a [ YYH172a ] Are you covered by the Indian Health Service?
Are you covered by the Indian Health Service?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_YH173a [ YYH173a ] Covered by any other type of health insurance
Are you covered by any other type of health insurance that I have not mentioned, such as
Medicare or insurance purchased directly from an insurance company?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF Y_YH168a = 2 AND Y_YH169a = 2 AND Y_YH170a = 2 AND Y_YH171a = 2 AND Y_YH172a =
2 AND Y_YH173a = 2 AND Y_YH174a = 2, CONTINUE. ELSE, GOTO Y_YH176a
Y_YH175a [ YYH175a ] What is the main reason you do not have health insurance?
Please look at Card 11. What is the main reason you do not have health insurance?
Question Type: TYH149a
lostjob 1 Person in family with health insurance lost job or changed employers
divorced 2 Got divorced or separated/death of spouse or parent
ineligible 3 Became ineligible because of age/left school
notoffered 4 Employer does not offer coverage/or not eligible for coverage
cost 5 Cost is too high
refused 6 Insurance company refused coverage
postpreg 7 Medicaid/Medical plan stopped after pregnancy
newjob 8 Lost Medicaid/Medical plan because of new job or increase in income
lostmedicaid 9 Lost Medicaid (other)
other 10 Other
Logic after:
GOTO Y_YHEND
---------------------------------------------------------------------------------
Y_YH176a [ YYH176a ] Same insurance for all of past 12 months
Did you have this same insurance for all of the past 12 months?
[IF MORE THAN ONE PLAN, ANSWER YES IF COVERAGE FOR ANY ONE PLAN WAS FOR
ALL 12 MONTHS.]
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_YH177 [ YYH177 ] Any time without health insurance in last 12 months
During the past 12 months, was there any time when you did not have any health insurance?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
GOTO Y_YHEND
---------------------------------------------------------------------------------
Y_YH_END [ YYH_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
Children’s Depression Inventory 2 (CDI-2), Kovacs (2011), MHS, Inc. Administered to children age 7 and older.
---------------------------------------------------------------------------------
Y_TR_BGN [ YTR_BGN ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF AGE < 8 GOTO Y_TREND; IF EMANCIPATED OR YOUNG ADULT (18+), GOT TO Y_TR11a
Y_TR1a [ YTR1a ] Trauma Symptom Chklist :bad dreams or nightmares
USE CARD 17. Now I am going to ask you how often different things happen to you. Pick your
answer from this card.
Tell me whether these things happen never, sometimes, lots of times, or almost all of the time.
Bad dreams or nightmares. Would you say this happens to you...
Question Type: Toften
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR2a [ YTR2a ] Trauma Symptom Chklist: scary ideas
USE CARD 17. Scary ideas or pictures just pop into my head. Would you say this happens to
Question Type: Toften
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR3a [ YTR3a ] Trauma Symptom Chklist: rmbrng thngs CH doesn't like
USE CARD 17. Remembering things that happened that I didn't like. (How often does this
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR4a [ YTR4a ] Trauma Symptom Chklist: going away in CH mind
USE CARD 17. Going away in my mind, trying not to think. (How often does this happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR5a [ YTR5a ] Trauma Symptom Chklist: rmbrng scary thngs
USE CARD 17. Remembering scary things. (How often does this happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR6a [ YTR6a ] Trauma Symptom Chklist: feeling scared of men
USE CARD 17. Feeling scared of men. (How often does this happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR7a [ YTR7a ] Trauma Symptom Chklist: feeling scared of women
USE CARD 17. Feeling scared of women. (How often does this happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR8a [ YTR8a ] Trauma Symptom Chklist: can't stop thnkng of something bad
USE CARD 17. Can't stop thinking about something bad that happened to me. (How often does
this happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR9a [ YTR9a ] Trauma Symptom Chklist: rmbrng thngs I don't want to
USE CARD 17. Remembering things I don't want to remember. (How often does this happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR10a [ YTR10a ] Trauma Symptom Chklist: wshng bad thngs never happened
USE CARD 17. Wishing bad things had never happened. (How often does this happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
Logic after:
Y_TREND
---------------------------------------------------------------------------------
Logic before:
IF CHILD IS EMANCIPATED OR YOUNG ADULT (18+), CONTINUE. ELSE, GOTO Y_TREND
Y_TR11a [ YTR11a ] YA Trauma Symptom Chklist: bad dreams or nightmares
USE Card 12. Now I am going to ask you how often different things happen to you. Pick your
answer from this card. Tell me whether these things happen never, sometimes, lots of times, or
almost all of the time.
Nightmares or bad dreams. Would you say this happens to you…
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR12a [ YTR12a ] YA Trauma Symptom Chklist: flashbacks or sudden memories
USE Card 12. Flashbacks or sudden memories or images of upsetting things. Would you say this
happens to you…
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR13a [ YTR13a ] YA Trauma Symptom Chklist: feeling like outside body
USE Card 12. Feeling like you were outside of your body. (How often does this happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR14a [ YTR14a ] YA Trauma Symptom Chklist: sudden disturbing memories
USE Card 12. Sudden disturbing memories when you were not expecting them. (How often does
this happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR15a [ YTR15a ] YA Trauma Symptom Chklist: mind going blank
USE Card 12. Your mind going blank. (How often does this happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR16a [ YTR16a ] YA Trauma Symptom Chklist: feel wtchng self frm far away
USE Card 12. Feeling like you were watching yourself from far away. (How often does this
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR17a [ YTR17a ] YA Trauma Symptom Chklist: not feeling like real self
USE Card 12. Not feeling like your real self. (How often does this happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR18a [ YTR18a ] YA Trauma Symptom Chklist: not being able to feel emotions
USE Card 12. Not being able to feel your emotions. (How often does this happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR19a [ YTR19a ] YA Trauma Symptom Chklist: absent-mindedness
USE Card 12. Absent-mindedness. (How often does this happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR20a [ YTR20a ] YA Trauma Symptom Chklist: sdnly rmbrng smthng upstng in pst
USE Card 12. Suddenly remembering something upsetting from your past. (How often does this
happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR21a [ YTR21a ] YA Trauma Symptom Chklist: sdnly rmnded of smthng bad
USE Card 12. Suddenly being reminded of something bad. (How often does this happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR22a [ YTR22a ] YA Trauma Symptom Chklist: violent dreams
USE Card 12. Violent dreams. (How often does this happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR23a [ YTR23a ] YA Trauma Symptom Chklist: seng/hrng smthng upstng erlyr lfe
USE Card 12. Just for a moment, seeing or hearing something upsetting that happened earlier in
your life. (How often does this happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR24a [ YTR24a ] YA Trauma Symptom Chklist: frghtng/upstng thghts pop nto mnd
USE Card 12. Frightening or upsetting thoughts popping into your mind. (How often does this
happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR25a [ YTR25a ] YA Trauma Symptom Chklist: flng like thngs not real
USE Card 12. Feeling like things weren't real. (How often does this happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR26a [ YTR26a ] YA Trauma Symptom Chklist: flng like in dream
USE Card 12. Feeling like you were in a dream. (How often does this happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR27a [ YTR27a ] YA Trauma Symptom Chklist: daydreaming
USE Card 12. Daydreaming. (How often does this happen?)
Question Type: TOftenC
never 1 never
sometimes 2 sometimes
lotsoftimes 3 lots of times, or
allthetime 4 almost all of the time
---------------------------------------------------------------------------------
Y_TR_END [ YTR_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF AGE < 11 GOTO Y_YAEND. IF CHILD IS YOUNG ADULT (18+) OR EMANCIPATED YOUTH,
GOTO Y_YAEND.
Y_YA1a [ YYA1a ] YSR Activities:Participate sports
Are there any sports that you like to participate in? (IF NECESSARY: For example: swimming,
baseball, skating, skate boarding, bike riding, fishing, etc.)
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YA1a = NO, DK, RE, GOTO Y_YA5a
---------------------------------------------------------------------------------
Y_YA3a [ YYA3a ] YSR Activities:Participate sports - time
Compared to others your age, about how much time do you spend taking part in these sports?
Would you say the time you spend is...
Question Type: TTime
lessavg 1 less than average
avg 2 average, or
moreavg 3 more than average
---------------------------------------------------------------------------------
Y_YA5a [ YYA5a ] YSR Activities:Hobbies/Activities/Games
Are there any hobbies, activities, and games, other than sports that you like to do? (IF
NECESSARY: For example: cards, books, piano, cars, crafts, etc.)
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YA5a = NO, DK, RE, GOTO Y_YA9a
---------------------------------------------------------------------------------
Y_YA7a [ YYA7a ] YSR Activities:Hobbies/Activities/Games - time
Compared to others your age, how much time do you spend doing these hobbies, activities and
games? Would you say the time you spend is...
Question Type: TTime
lessavg 1 less than average
avg 2 average, or
moreavg 3 more than average
---------------------------------------------------------------------------------
Y_YA9a [ YYA9a ] YSR Activities:Orgnztns/Clubs/Teams/Groups
Do you belong to any organizations, clubs, teams, or groups?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YA9a = NO, DK, RE, GOTO Y_YA12a
---------------------------------------------------------------------------------
Y_YA11a [ YYA11a ] YSR Activities:Orgnztns/Clubs/Teams/Groups - how active
Compared to others your age, how active are you in these groups? Would you say you are...
Question Type: TActive
lessactv 1 less active
avg 2 average, or
moreactv 3 more active
---------------------------------------------------------------------------------
Y_YB_BGN [ YYB_BGN ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF AGE < 11 GOTO Y_YBEND. IF CHILD IS YOUNG ADULT (18+) OR EMANCIPATED, GOTO
Y_YB113A.
Y_YB1a [ YYB1a ] CH acts too young for age
USE CARD 18. Now I am going to read you different sentences that sometimes describe kids.
Tell me how true each sentence has been for you in the past @B6 months@B. Pick an answer
from this card: not true, somewhat or sometimes true, or very true or often true. Remember to tell
me what you really think. Your answers will be kept private.
I act too young for my 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?
---------------------------------------------------------------------------------
Y_YB2a [ YYB2a ] CH has allergy
I have an allergy. 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?
---------------------------------------------------------------------------------
Y_YB2aa [ YYB2aa ] CH drink alcohol without parents approval
I drink alcohol without my 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?
---------------------------------------------------------------------------------
Y_YB3a [ YYB3a ] CH argues a lot
I argue a lot. (Would you say this is not true, somewhat or sometimes true, or very true or often
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB4a [ YYB4a ] CH has asthma
I have asthma. (Would you say this is not true, somewhat or sometimes true, or very true or often
true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB4aa [ YYB4aa ] CH failes to finish things started
I fail to finish things that I start. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB5a [ YYB5a ] CH acts like opposite sex
I act like the opposite sex. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB5aa [ YYB5aa ] Very little CH enjoys
There is very little that I enjoy. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB6a [ YYB6a ] CH likes animals
I like animals. (Would you say this is not true, somewhat or sometimes true, or very true or often
true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB7a [ YYB7a ] CH likes to brag
I brag. (Would you say this is not true, somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB8a [ YYB8a ] CH has trbl concentrating or paying attention
I have trouble concentrating or paying attention. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB9a [ YYB9a ] CH can't get mind off certain things
I can't get my mind off certain thoughts. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB10a [ YYB10a ] CH has trble sitting still
I have trouble sitting still. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB11a [ YYB11a ] CH is too dpndnt on adults
I'm too dependent on adults. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB12a [ YYB12a ] CH feels lonley
I feel lonely. (Would you say this is not true, somewhat or sometimes true, or very true or often
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB13a [ YYB13a ] CH feels confused or in a fog
I feel confused or in a fog. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB14a [ YYB14a ] CH crys a lot
I cry a lot. (Would you say this is not true, somewhat or sometimes true, or very true or often
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB15a [ YYB15a ] CH is pretty honest
I am pretty honest. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB16a [ YYB16a ] CH is mean to others
I am mean to others. (Would you say this is not true, somewhat or sometimes true, or very true
or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB17a [ YYB17a ] CH day dreams a lot
I daydream a lot. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB18a [ YYB18a ] CH deliberately trys to hurt/kill self
I deliberately try to hurt or kill myself. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
Logic after:
IF Y_YB18a = 1, GOTO Y_YB19a
---------------------------------------------------------------------------------
Y_YB18aa [ YYB18aa ] CH had thoughts to hurt/kill self in past 2 wks
Have you had these thoughts in the past 2 weeks?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_YB18ba [ YYB18ba ] CH has plan to carry out thoughts to hurt/kill self
Do you have a plan to carry out these thoughts?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_YB19a [ YYB19a ] CH trys to get a lot of attention
I try to get a lot of attention. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB20a [ YYB20a ] CH detroys own things
I destroy my own things. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB21a [ YYB21a ] CH detroys things belonging to others
I destroy things belonging to others. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB22a [ YYB22a ] CH disobeys parents
I disobey my parents. (Would you say this is not true, somewhat or sometimes true, or very true
or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB23a [ YYB23a ] CH disobeys at school
I disobey at school. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
FR NOTE: IF CHILD SAYS THEY DID NOT PHYSICALLY ATTEND SCHOOL, ASK THE CHILD TO RESPOND THINKING ABOUT THEIR ONLINE/VIRTUAL EXPERIENCE.
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB24a [ YYB24a ] CH doesn't eat as well as CH should
I don't eat as well as I should. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB25a [ YYB25a ] CH doesn't get along with other kids
I don't get along with other kids. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB26a [ YYB26a ] CH doesn't feel quilty aftr doing something CH shouldn't
I don't feel guilty after doing something I shouldn't. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB27a [ YYB27a ] CH is jealous of othrs
I am jealous of others. (Would you say this is not true, somewhat or sometimes true, or very true
or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB28a [ YYB28a ] CH help othrs if they need help
I am willing to help others when they need help. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB28aa [ YYB28aa ] CH breaks rules at home school or elsewhere
I break rules at home, school, or elsewhere. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB29a [ YYB29a ] CH afraid crtn animals, situations. places othr thn school
I am afraid of certain animals, situations, or places, other than school. (Would you say this is not
true, somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB30a [ YYB30a ] CH afraid of going to school
I am afraid of going to school. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB31a [ YYB31a ] CH afraid might thnk/do something bad
I am afraid I might think or do something bad. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB32a [ YYB32a ] CH feels has to be perfect
I feel that I have to be perfect. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB33a [ YYB33a ] CH feels no on loves CH
I feel that no one loves me. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB34a [ YYB34a ] CH feels othrs out to get CH
I feel that others are out to get me. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB35a [ YYB35a ] CH feels worthless/inferior
I feel worthless or inferior. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB36a [ YYB36a ] CH accidently gets hurt a lot
I accidentally get hurt a lot. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB37a [ YYB37a ] CH gets in many fights
I get in many fights. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB38a [ YYB38a ] CH gets teased a lot
I get teased a lot. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB39a [ YYB39a ] CH hangs with kids who get in trbl
I hang around with kids who get in trouble. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB40a [ YYB40a ] CH hears sounds/voices
I hear sounds or voices that other people think aren't there. (Would you say this is not true,
somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB41a [ YYB41a ] CH acts without stopping to think
I act without stopping to think. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB42a [ YYB42a ] CH rather be alone than w/ othrs
I would rather be alone than with others. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB43a [ YYB43a ] CH lies or cheats
I lie or cheat. (Would you say this is not true, somewhat or sometimes true, or very true or often
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB44a [ YYB44a ] CH bites fingernails
I bite my fingernails. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB45a [ YYB45a ] CH nervous or tense
I am nervous or tense. (Would you say this is not true, somewhat or sometimes true, or very true
or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB46a [ YYB46a ] Parts of CH body twitch or mk nrvous mvmnts
Parts of my body twitch or make nervous movements. (Would you say this is not true, somewhat
or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB47a [ YYB47a ] CH has nightmares
I have nightmares. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB48a [ YYB48a ] CH not liked by othr kids
I am not liked by other kids. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB49a [ YYB49a ] CH does crtn thngs better than most kids
I can do certain things better than most kids. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB50a [ YYB50a ] CH too fearful/anxious
I am too fearful or anxious. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB51a [ YYB51a ] CH feels dizzy
I feel dizzy. (Would you say this is not true, somewhat or sometimes true, or very true or often
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB52a [ YYB52a ] CH feels quilty
I feel too guilty. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB53a [ YYB53a ] CH eats too much
I eat too much. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB54a [ YYB54a ] CH feels over tired
I feel overtired. (Would you say this is not true, somewhat or sometimes true, or very true or often
true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB55a [ YYB55a ] CH is overweight
I am overweight. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB56aa [ YYB56aa ] CH has aches/pains w/out med cause
I have aches or pains (not stomach or headaches) without a known medical cause. (Would you
say this is not true, somewhat or sometimes true, or very true or often true.)
NOTE: "WITHOUT KNOWN MEDICAL CAUSE" MEANS FOR UNKNOWN OR UNDIAGNOSED
REASONS.
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB56ba [ YYB56ba ] CH has headaches w/out med cause
I have headaches without a known medical cause. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
NOTE: "WITHOUT KNOWN MEDICAL CAUSE" MEANS FOR UNKNOWN OR UNDIAGNOSED
REASONS.
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB56ca [ YYB56ca ] CH has nausea/feels sick w/out med cause
I have nausea or feel sick without a known medical cause. (Would you say this is not true,
somewhat or sometimes true, or very true or often true.)
NOTE: "WITHOUT KNOWN MEDICAL CAUSE" MEANS FOR UNKNOWN OR UNDIAGNOSED
REASONS.
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB56da [ YYB56da ] CH has prblms w/ eyes w/out med cause not fxd by glasses
I have problems with my eyes that are not corrected by glasses and do not have a known medical
cause. (Would you say this is not true, somewhat or sometimes true, or very true or often true.)
NOTE: "WITHOUT KNOWN MEDICAL CAUSE" MEANS FOR UNKNOWN OR UNDIAGNOSED
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB56ea [ YYB56ea ] CH has rashes/skin prblms w/out med cause
I have rashes or other skin problems without a known medical cause. (Would you say this is not
true, somewhat or sometimes true, or very true or often true.)
NOTE: "WITHOUT KNOWN MEDICAL CAUSE" MEANS FOR UNKNOWN OR UNDIAGNOSED
REASONS.
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB56fa [ YYB56fa ] CH has stomach aches/craps w/out med cause
I have stomach aches or cramps without a known medical cause. (Would you say this is not
true, somewhat or sometimes true, or very true or often true.)
NOTE: "WITHOUT KNOWN MEDICAL CAUSE" MEANS FOR UNKNOWN OR UNDIAGNOSED
REASONS.
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB56ga [ YYB56ga ] CH vomits w/out med cause
I have vomiting, throwing up without a known medical cause. (Would you say this is not true,
somewhat or sometimes true, or very true or often true.)
NOTE: "WITHOUT KNOWN MEDICAL CAUSE" MEANS FOR UNKNOWN OR UNDIAGNOSED
REASONS.
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB56ha [ YYB56ha ] CH has othr phys prblms w/out med cause
I have other physical problems without a known medical cause. (Would you say this is not true,
somewhat or sometimes true, or very true or often true.)
NOTE: "WITHOUT KNOWN MEDICAL CAUSE" MEANS FOR UNKNOWN OR UNDIAGNOSED
REASONS.
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB57a [ YYB57a ] CH physically attacks people
I physically attack people. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB58a [ YYB58a ] CH picks skin or othr body parts
I pick my skin or other parts of my body. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB59a [ YYB59a ] CH can be pretty friendly
I can be pretty friendly. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB60a [ YYB60a ] CH trys new things
I like to try new things. (Would you say this is not true, somewhat or sometimes true, or very true
or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB61a [ YYB61a ] CH school work is poor
My school work is poor. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB62a [ YYB62a ] CH is poorly coordinated and clumsy
I am poorly coordinated or clumsy. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB63a [ YYB63a ] CH rather be w/ oldr kds than kds own age
I would rather be with older kids than with kids my own age. (Would you say this is not true,
somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB64a [ YYB64a ] CH rather w/ yngr kds thn kds own age
I would rather be with younger kids than with kids my own age. (Would you say this is not true,
somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB65a [ YYB65a ] CH refuses to talk
I refuse to talk. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB66a [ YYB66a ] CH repeats certain acts over and over
I repeat certain acts over and over. (Would you say this is not true, somewhat or sometimes true,
or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB67a [ YYB67a ] CH runs away from home
I run away from home. (Would you say this is not true, somewhat or sometimes true, or very true
or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB68a [ YYB68a ] CH screams a lot
I scream a lot. (Would you say this is not true, somewhat or sometimes true, or very true or often
true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB69a [ YYB69a ] CH is secretive
I am secretive or keep things to myself. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB70a [ YYB70a ] CH see thngs othrs thnk are not there
I see things that other people think aren't there. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB71a [ YYB71a ] CH is self-concious or esily embrassed
I am self-conscious or easily embarrassed. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB72a [ YYB72a ] CH sets fires
I set fires. (Would you say this is not true, somewhat or sometimes true, or very true or often
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB73a [ YYB73a ] CH works well w/ hands
I can work well with my hands. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB74a [ YYB74a ] CH shows off
I show off or clown. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB75a [ YYB75a ] CH is shy
I am shy. (Would you say this is not true, somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB76a [ YYB76a ] CH sleeps less than most kids
I sleep less than most kids. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB77a [ YYB77a ] CH sleeps more than most kids during day and/or night
I sleep more than most kids during the day and/or night. (Would you say this is not true,
somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB78a [ YYB78a ] CH has good imagination
I have a good imagination. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB78aa [ YYB78aa ] CH is inattentive or easily distracted
I am inattentive or easily distracted. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB79a [ YYB79a ] CH has speech prblm
I have a speech problem. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB80a [ YYB80a ] CH stands up for rights
I stand up for my rights. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB81a [ YYB81a ] CH steals at home
I steal at home. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB82a [ YYB82a ] CH steals from places othr than home
I steal from places other than home. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB83a [ YYB83a ] CH stores up things not needed
I store up things I don't need. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB84a [ YYB84a ] CH does things othrs think are strange
I do things other people think are strange. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB85a [ YYB85a ] CH has thoughts that othrs think are strange
I have thoughts that other people would think are strange. (Would you say this is not true,
somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB86a [ YYB86a ] CH is stubborn
I am stubborn. (Would you say this is not true, somewhat or sometimes true, or very true or often
true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB87a [ YYB87a ] CH moods/feelings change suddenly
My moods or feelings change suddenly. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
---------------------------------------------------------------------------------
Y_YB88a [ YYB88a ] CH enjoys being with othrs
I enjoy being with other people. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB89a [ YYB89a ] CH is suspicious
I am suspicious. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB90a [ YYB90a ] CH swears/uses dirty language
I swear or use dirty language. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB91a [ YYB91a ] CH thinks about killing self
I think about killing myself. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
Logic after:
IF Y_YB91a = 1, GOTO Y_YB92a)
---------------------------------------------------------------------------------
Y_YB91aa [ YYB91aa ] CH had thoughts of killing self in past 2 wks
Have you had these thoughts in the past 2 weeks?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_YB91ba [ YYB91ba ] CH plans to carry out thoughts of killing self
Do you have a plan to carry out these thoughts?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_YB92a [ YYB92a ] CH makes othrs laugh
I like to make others laugh. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB93a [ YYB93a ] CH talks too much
I talk too much. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB94a [ YYB94a ] CH teases othrs a lot
I tease others a lot. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB95a [ YYB95a ] CH has a hot temper
I have a hot temper. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB96a [ YYB96a ] CH thinks about sex too much
I think about sex too much. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB97a [ YYB97a ] CH threatens to hurt people
I threaten to hurt people. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB98a [ YYB98a ] CH likes to help othrs
I like to help others. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB99a [ YYB99a ] CH too concerned about being neat/clean
I am too concerned about being neat or clean. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB99aa [ YYB99aa ] CH smokes chew or sniff tobacco
I smoke, chew, or sniff tobacco. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB100a [ YYB100a ] CH has trbl sleeping
I have trouble sleeping. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB101a [ YYB101a ] CH cuts classes or skips school
I cut classes or skip school. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB102a [ YYB102a ] CH doesn't have much money
I don't have much energy. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB103a [ YYB103a ] CH is unhappy/sad/depressed
I am unhappy, sad, or depressed. (Would you say this is not true, somewhat or sometimes true,
or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB104a [ YYB104a ] CH is louder than othr kids
I am louder than other kids. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB105a [ YYB105a ] CH used alcohol/drugs for non-med purposes
I use alcohol or drugs for non-medical purposes. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB106a [ YYB106a ] CH tries to be fair to othrs
I try to be fair to others. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB107a [ YYB107a ] CH enjoys a good joke
I enjoy a good joke. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB108a [ YYB108a ] CH lkes to take life easy
I like to take life easy. (Would you say this is not true, somewhat or sometimes true, or very true
or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB109a [ YYB109a ] CH tris to help othrs when CH can
I try to help other people when I can. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB110a [ YYB110a ] CH wishes CH was opposite sex
I wish I were of the opposite sex. (Would you say this is not true, somewhat or sometimes true,
or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB111a [ YYB111a ] CH keeps from getting involved with othrs
I keep from getting involved with others. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB112a [ YYB112a ] CH worries a lot
I worry a lot. (Would you say this is not true, somewhat or sometimes true, or very true or often
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
Logic after:
GOTO Y_YBEND
---------------------------------------------------------------------------------
Logic before:
IF CHILD IS EMANCIPATED OR YOUNG ADULT (18+), CONTINUE. ELSE, GOTO Y_YBEND.
Y_YB113a [ YYB113a ] YA is too forgetfull
USE Card 13. Now I am going to read you different sentences that may sometimes describe you.
Tell me how true each sentence has been for you in the past @B6 months@B. Pick an answer
from this card: not true, somewhat or sometimes true, or very true or often true. Remember to tell
me what you really think. Your answers will be kept private.
I am too forgetful. 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?
---------------------------------------------------------------------------------
Y_YB114a [ YYB114a ] YA makes good use of opportunities
I make good use of my opportunities. 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?
---------------------------------------------------------------------------------
Y_YB115a [ YYB115a ] YA argues a lot
I argue a lot. 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?
---------------------------------------------------------------------------------
Y_YB116a [ YYB116a ] YA works up to ability
I work up to my ability. (Would you say this is not true, somewhat or sometimes true, or very true
or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB117a [ YYB117a ] YA blames others for own problems
I blame others for my problems. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB118a [ YYB118a ] YA uses drugs for non-med purposes
I use drugs (other than alcohol and nicotine) for nonmedical purposes. (Would you say this is not
true, somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB119a [ YYB119a ] YA brags
I brag. (Would you say this is not true, somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB120a [ YYB120a ] YA has trbl concentrating/paying attention
I have trouble concentrating or paying attention for long. (Would you say this is not true,
somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB121a [ YYB121a ] YA can't get mind off certain things
I can't get my mind off certain thoughts. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB122a [ YYB122a ] YA has trbl sitting still
I have trouble sitting still. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB123a [ YYB123a ] YA is too dependent on others
I am too dependent on others. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB124a [ YYB124a ] YA feels lonely
I feel lonely. (Would you say this is not true, somewhat or sometimes true, or very true or often
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB125a [ YYB125a ] YA feels confused
I feel confused or in a fog. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB126a [ YYB126a ] YA crys a lot
I cry a lot. (Would you say this is not true, somewhat or sometimes true, or very true or often
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB127a [ YYB127a ] YA is pretty honest
I am pretty honest. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB128a [ YYB128a ] YA is mean to othrs
I am mean to others. (Would you say this is not true, somewhat or sometimes true, or very true
or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB129a [ YYB129a ] YA daydreams a lot
I daydream a lot. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB130a [ YYB130a ] YA deliberately tries to hurt/kill self
I deliberately try to hurt or kill myself. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB131a [ YYB131a ] YA tries to get attention
I try to get a lot of attention. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB132a [ YYB132a ] YA damages or destroys own things
I damage or destroy my things. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB133a [ YYB133a ] YA damages or destroys othrs things
I damage or destroy things belonging to others. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB134a [ YYB134a ] YA worries about future
I worry about my future. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB135a [ YYB135a ] YA breaks rules at work and elsewhere
I break rules at work or elsewhere. (Would you say this is not true, somewhat or sometimes true,
or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB136a [ YYB136a ] YA doesn't eat as well as should
I don't eat as well as I should. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB137a [ YYB137a ] YA doesn't get along well with othrs
I don't get along well with other people. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB138a [ YYB138a ] YA doesn't feel guilty after doing something shouldn't
I don't feel guilty after doing something I shouldn't. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB139a [ YYB139a ] YA jealous of othrs
I am jealous of others. (Would you say this is not true, somewhat or sometimes true, or very true
or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB140a [ YYB140a ] YA gets along badly with family
I get along badly with my family. (Would you say this is not true, somewhat or sometimes true,
or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB141a [ YYB141a ] YA afraid of certain animals/situations/places
I am afraid of certain animals, situations, or places. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB142a [ YYB142a ] YA has poor relationships with opposite sex
My relations with the opposite sex are poor. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB143a [ YYB143a ] YA afraid might think/do something bad
I am afraid I might think or do something bad. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB144a [ YYB144a ] YA feels need to be perfect
I feel that I have to be perfect. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB145a [ YYB145a ] YA feels no one loves YA
I feel that no one loves me. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB146a [ YYB146a ] YA feels othrs are out to get YA
I feel that others are out to get me. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB147a [ YYB147a ] YA feels worthless/inferior
I feel worthless or inferior. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB148a [ YYB148a ] YA accidentally gets hurt a lot/accident prone
I accidentally get hurt a lot, accident prone. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB149a [ YYB149a ] YA gets in many fights
I get in many fights. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB150a [ YYB150a ] YA has poor relations with neighbors
My relations with neighbors are poor. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB151a [ YYB151a ] YA hangs around people who get into trbl
I hang around people who get in trouble. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB152a [ YYB152a ] YA hears sounds/voices others don't
I hear sounds or voices that other people think aren't there. (Would you say this is not true,
somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB153a [ YYB153a ] YA is impulsive
I am impulsive or act without thinking. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB154a [ YYB154a ] YA would rather be alone than w/t othrs
I would rather be alone than with others. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB155a [ YYB155a ] YA lies/cheats
I lie or cheat. (Would you say this is not true, somewhat or sometimes true, or very true or often
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB156a [ YYB156a ] YA feels overwhelmed by responsibilities
I feel overwhelmed by my responsibilities. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB157a [ YYB157a ] YA is nervous/tense
I am nervous or tense. (Would you say this is not true, somewhat or sometimes true, or very true
or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB158a [ YYB158a ] Parts of YA body twitch/makes nervous movements
Parts of my body twitch or make nervous movements. (Would you say this is not true, somewhat
or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB159a [ YYB159a ] YA lacks self-confidence
I lack self-confidence. (Would you say this is not true, somewhat or sometimes true, or very true
or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB160a [ YYB160a ] YA is not liked by othrs
I am not liked by others. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB161a [ YYB161a ] YA can do certain things better than othr people
I can do certain things better than other people. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB162a [ YYB162a ] YA feels fearful/anxious
I am too fearful or anxious. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB163a [ YYB163a ] YA feels dizzy/lightheaded
I feel dizzy or lightheaded. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB164a [ YYB164a ] YA feels guilty
I feel too guilty. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB165a [ YYB165a ] YA has trbl planning for future
I have trouble planning for the future. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB166a [ YYB166a ] YA feels tired w/out good reason
I feel tired without good reason. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB167a [ YYB167a ] YA moods swing between elation and depression
My moods swing between elation and depression. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB168a [ YYB168a ] YA has aches/pains w/out med cause
I have aches and pains without known medical cause. (Would you say this is not true, somewhat
or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB169a [ YYB169a ] YA has headachese w/out med cause
I have headaches without known medical cause. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB170a [ YYB170a ] YA has nausea/feels sick w/out med cause
I have nausea, feel sick without known medical cause. (Would you say this is not true,
somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB171a [ YYB171a ] YA prblms w/ eyes w/out med cause not fixed by glasses
I have problems with eyes (not if corrected by glasses) without known medical cause. (Would
you say this is not true, somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB172a [ YYB172a ] YA has rashes/skin prblms w/out med cause
I have rashes or other skin problems without known medical cause. (Would you say this is not
true, somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB173a [ YYB173a ] YA has stomachaches w/out med cause
I have stomachaches without known medical cause. (Would you say this is not true, somewhat
or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB174a [ YYB174a ] YA vomits w/out med cause
I have vomiting, throwing up without known medical cause. (Would you say this is not true,
somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB175a [ YYB175a ] YA has heart pounding/racing w/out med cause
I have heart pounding or racing without known medical cause. (Would you say this is not true,
somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB176a [ YYB176a ] YA has numbness/tingling in body parts w/out med cause
I have numbness or tingling in body parts without known medical cause. (Would you say this is
not true, somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB177a [ YYB177a ] YA physically attacks people
I physically attack people. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB178a [ YYB178a ] YA picks skin/othr body parts
I pick my skin or other parts of my body. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB179a [ YYB179a ] YA fails to finish things
I fail to finish things I should do. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB180a [ YYB180a ] Very little that YA enjoys
There is very little that I enjoy. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB181a [ YYB181a ] YA work performance is poor
My work performance is poor. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB182a [ YYB182a ] YA is poorly coordinated/clumsy
I am poorly coordinated or clumsy. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB183a [ YYB183a ] YA would rather be with older people than people own age
I would rather be with older people than with people my own age. (Would you say this is not true,
somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB184a [ YYB184a ] YA has trbl setting priorities
I have trouble setting priorities. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB185a [ YYB185a ] YA refuses to talk
I refuse to talk. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB186a [ YYB186a ] YA repeats certain acts over and over
I repeat certain acts over and over. (Would you say this is not true, somewhat or sometimes true,
or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB187a [ YYB187a ] YA has trbl making friends
I have trouble making or keeping friends. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB188a [ YYB188a ] YA screams/yells a lot
I scream or yell a lot. (Would you say this is not true, somewhat or sometimes true, or very true
or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB189a [ YYB189a ] YA is secretive/keeps things to self
I am secretive or keep things to myself. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB190a [ YYB190a ] YA sees things othrs think aren't there
I see things that other people think aren't there. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB191a [ YYB191a ] YA is self-concious/easily embarrassed
I am self-conscious or easily embarrassed. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB192a [ YYB192a ] YA worris about family
I worry about my family. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB193a [ YYB193a ] YA meets responsibilities to family
I meet my responsibilities to my family. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB194a [ YYB194a ] YA shows off
I show off or clown. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB195a [ YYB195a ] YA is too shy/timid
I am too shy or timid. (Would you say this is not true, somewhat or sometimes true, or very true
or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB196a [ YYB196a ] YA behavior is irresponsible
My behavior is irresponsible. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB197a [ YYB197a ] YA sleeps more than most othrs during day and/or night
I sleep more than most other people during day and/or night. (Would you say this is not true,
somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB198a [ YYB198a ] YA has trbl making decisions
I have trouble making decisions. (Would you say this is not true, somewhat or sometimes true,
or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB199a [ YYB199a ] YA has speech prblm
I have a speech problem. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB200a [ YYB200a ] YA stands up for rights
I stand up for my rights. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB201a [ YYB201a ] YA behavior is very changable
My behavior is very changeable. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB202a [ YYB202a ] YA steals
I steal. (Would you say this is not true, somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB203a [ YYB203a ] YA eaisly bored
I am easily bored. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB204a [ YYB204a ] YA does things that othrs think are strange
I do things that other people think are strange. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB205a [ YYB205a ] YA has thoughts othrs would think are stange
I have thoughts that other people would think are strange. (Would you say this is not true,
somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB206a [ YYB206a ] YA is stubborn/sullen/irritable
I am stubborn, sullen, or irritable. (Would you say this is not true, somewhat or sometimes true,
or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB207a [ YYB207a ] YA moods/feelings change suddenly
My moods or feelings change suddenly. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB208a [ YYB208a ] YA enjoys being w/ othr people
I enjoy being with people. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB209a [ YYB209a ] YA rushes into things w/out considering risks
I rush into things without considering the risks. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB210a [ YYB210a ] YA drinks too much alcohol/gets drunk
I drink too much alcohol or get drunk. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB211a [ YYB211a ] YA thinks about killing self
I think about killing myself. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB212a [ YYB212a ] YA does things that may cause trbl with law
I do things that may cause me trouble with the law. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB213a [ YYB213a ] YA talks too much
I talk too much. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB214a [ YYB214a ] YA tease othrs a lot
I tease others a lot. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB215a [ YYB215a ] YA has a hot temper
I have a hot temper. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB216a [ YYB216a ] YA thinks about sex too much
I think about sex too much. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB217a [ YYB217a ] YA threatens to hurt people
I threaten to hurt people. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB218a [ YYB218a ] YA likes to help others
I like to help others. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB219a [ YYB219a ] YA dislikes staying in one place for very long
I dislike staying in one place for very long. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB220a [ YYB220a ] YA has trbl sleeping
I have trouble sleeping. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB221a [ YYB221a ] YA stays away from job even when not sick/on vacation
I stay away from my job even when I'm not sick or not on vacation. (Would you say this is not
true, somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB222a [ YYB222a ] YA doesn't have much energy
I don't have much energy. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB223a [ YYB223a ] YA is unhappy/sad/depressed
I am unhappy, sad, or depressed. (Would you say this is not true, somewhat or sometimes true,
or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB224a [ YYB224a ] YA louder than othrs
I am louder than others. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB225a [ YYB225a ] Othrs think YA is disorganized
People think I am disorganized. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB226a [ YYB226a ] YA tries to be fair to othrs
I try to be fair to others. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB227a [ YYB227a ] YA feels can't succeed
I feel that I can't succeed. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB228a [ YYB228a ] YA tends to lose things
I tend to lose things. (Would you say this is not true, somewhat or sometimes true, or very true
or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB229a [ YYB229a ] YA likes to try new things
I like to try new things. (Would you say this is not true, somewhat or sometimes true, or very true
or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB230a [ YYB230a ] YA wishes was opposite sex
I wish I were of the opposite sex. (Would you say this is not true, somewhat or sometimes true,
or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB231a [ YYB231a ] YA keeps from getting involved with othrs
I keep from getting involved with others. (Would you say this is not true, somewhat or sometimes
true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB232a [ YYB232a ] YA worries a lot
I worry a lot. (Would you say this is not true, somewhat or sometimes true, or very true or often
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB233a [ YYB233a ] YA worries about relations with opposite sex
I worry about my relations with the opposite sex. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB234a [ YYB234a ] YA fails to pay debts/meet financial responsibilities
I fail to pay my debts or meet other financial responsibilities. (Would you say this is not true,
somewhat or sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB235a [ YYB235a ] YA feels restless/fidgety
I feel restless or fidgety. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB236a [ YYB236a ] YA gets upset easily
I get upset too easily. (Would you say this is not true, somewhat or sometimes true, or very true
or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB237a [ YYB237a ] YA has trbl managing money/credit cards
I have trouble managing money or credit cards. (Would you say this is not true, somewhat or
sometimes true, or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB238a [ YYB238a ] YA is too impatient
I am too impatient. (Would you say this is not true, somewhat or sometimes true, or very true or
often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB239a [ YYB239a ] YA not good at details
I am not good at details. (Would you say this is not true, somewhat or sometimes true, or very
true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB240a [ YYB240a ] YA drives too fast
I drive too fast. (Would you say this is not true, somewhat or sometimes true, or very true or often
true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB241a [ YYB241a ] YA tends to be late to appointments
I tend to be late for appointments. (Would you say this is not true, somewhat or sometimes true,
or very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB242a [ YYB242a ] YA has trbl keeping a job
I have trouble keeping a job. (Would you say this is not true, somewhat or sometimes true, or
very true or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB243a [ YYB243a ] YA is a happy person
I am a happy person. (Would you say this is not true, somewhat or sometimes true, or very true
or often true.)
Question Type: TTrueC
nottrue 1 NOT TRUE
sometrue 2 SOMEWHAT OR SOMETIMES TRUE
vtrue 3 VERY TRUE OR OFTEN TRUE?
---------------------------------------------------------------------------------
Y_YB_END [ YYB_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF CHILD IS EMANCIPATED OR YOUNG ADULT (18+), CONTINUE, ELSE GOTO Y_EREND
Y_ER0a [ YER0a ] NO LABEL
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 work you may have done for an employer; that is a job
where you had an on-going relationship with a particular employer, for example, working in a
supermarket or restaurant. Then 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 or mowing lawns.
First, let's talk about any work you have done for an employer.
Question Type: TCont
Continue 1 Continue
---------------------------------------------------------------------------------
Y_ER1a [ YER1a ] CH currently working full/pt job or jobs
Are you currently working at a full or part-time job or jobs?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_ER1a = 1 GOTO Y_ER3a
---------------------------------------------------------------------------------
Y_ER2a [ YER2a ] CH employed in last 12 months
Have you been employed in the past 12 months?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_ER2a = 2 GOTO Y_ER35a
---------------------------------------------------------------------------------
Y_ER3m [ YER3m ] CH when start job - month
In what month and year did you start this job?
ENTER 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
---------------------------------------------------------------------------------
Y_ER3y [ YER3y ] CH when start job - year
(In what month and year did you start this job?)
ENTER YEAR
Question Type: 1990..2013
---------------------------------------------------------------------------------
Logic before:
IF Y_ER1a = 1, GOTO Y_ER5a
Y_ER4m [ YER4m ] CH when leave job - month
In what month and year did you leave this job?
ENTER 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
---------------------------------------------------------------------------------
Y_ER4y [ YER4y ] CH when leave job - year
(In what month and year did you leave this job?)
ENTER YEAR
Question Type: 1990..2013
---------------------------------------------------------------------------------
Y_ER5a [ YER5a ] CH know the person who hired you
At the time you started this job, did you know the person who hired you?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_ER5a = 2 GOTO Y_ER7a
---------------------------------------------------------------------------------
Y_ER6a [ YER6a ] Relationship to person who hired CH
Which of the following best describes your relationship to the person who hired you for this job?
Question Type: TER6a
rel 1 Relative
friend 2 Friend of yours
famfriend 3 Friend of your family's
neighbor 4 Neighbor
acquaint 5 Acquaintance
other 6 OTHER
none 7 NONE
---------------------------------------------------------------------------------
Y_ER7a [ YER7a ] CH recommended job by other person
Was there someone who recommended you, other than the person who hired you?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_ER7a = 2 GOTO Y_ER9a
---------------------------------------------------------------------------------
Y_ER8a [ YER8a ] Relationship to person who recommended CH
What was that person's relationship to you?
Question Type: TER8a
casewrkr 1 CASEWORKER
ilc 2 INDEPENDENT LIVING COORDINATOR
mentor 3 MENTOR
teacher 4 TEACHER
clergy 5 CLERGYPERSON
parent 6 PARENT
fosparent 7 FOSTER PARENT
otherrel 8 OTHER RELATIVE
friend 9 FRIEND OF YOURS
famfriend 10 FRIEND OF YOUR FAMILY'S
neighbor 11 NEIGHBOR
acquaint 12 ACQUAINTANCE
other 13 OTHER
none 14 NONE
---------------------------------------------------------------------------------
Y_ER9a [ YER9a ] Category of CH current or recent job
USE CARD 14. Please look at Card 14 and tell me which of the categories best describes your
^Fills.ER9a job or occupation.
Question Type: TER9a
office 1 OFFICE WORKER
trade 2 TRADESPERSON
farmer 3 FARMER, FARM MANAGER
laborer 4 LABORER
manager 5 MANAGER
military 6 MILITARY
operator 7 OPERATOR
owner 8 OWNER
prof1 9 PROFESSIONAL 1
prof2 10 PROFESSIONAL 2
protective 11 PROTECTIVE SERVICE
sales 12 SALES
teacher 13 SCHOOL TEACHER
service 14 SERVICE WORKER
technical 15 TECHNICAL
other 16 OTHER
Question Fill: ^FillER9a
present current
past most recent
---------------------------------------------------------------------------------
Y_ER10a [ YER10a ] Hours/week CH usually worked at this job
How many hours per week ^Fills.ER10n at this job?
Question Type: 0..168
Question Fill: ^FillER10n
present do you @Busually@B work
past did you @Busually@B work
---------------------------------------------------------------------------------
Y_ER11a [ YER11a ] Days CH worked in typical week
In a usual week, on how many days ^Fills.ER11n?
Question Type: 0..7
Question Fill: ^FillER11n
present do you work
past did you work
---------------------------------------------------------------------------------
Y_ER12a [ YER12a ] Of days CH worked number of weekdays
How many of these days ^Fills.ER12n weekdays?
Question Type: 0..5
Question Fill: ^FillER12n
present are
past were
---------------------------------------------------------------------------------
Logic before:
IFY_ER12a = 0, GOTO Y_ER15a
Y_ER13a [ YER13a ] Hours CH worked per day on weekdays
How many hours per day ^Fills.ER13n on weekdays?
Question Type: 0..24
Question Fill: ^FillER13n
present do you usually work
past did you usually work
---------------------------------------------------------------------------------
Y_ER14a [ YER14a ] Time of day for CH weekday work
^Fills.ER14a the most common time of day for you to work on weekdays?
Question Type: TER14a
morning 1 In the morning (between 6 A.M. and 2 P.M.)
afternoon 2 In the afternoon (between 12 P.M. and 8 P.M.)
evening 3 Evening (between 5 P.M and 11 P.M.)
night 4 Night time (after 11 P.M. before 6 A.M.)
nosingle 5 No single time of day
other 6 Other
Question Fill: ^FillER14a
present What is
past What was
---------------------------------------------------------------------------------
Y_ER15a [ YER15a ] CH usually work on weekends
^Fills.ER15a on the weekend?
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillER15a
present Do you usually work
past Did you usually work
Logic after:
IF Y_ER15a = 2 GO TO Y_ER17a
---------------------------------------------------------------------------------
Y_ER16a [ YER16a ] Hours CH usually worked on both wknd days
How many total hours ^Fills.ER16n on the weekend? Please include both days in your estimate.
Question Type: 0..48
Question Fill: ^FillER16n
present do you usually work
past did you usually work
---------------------------------------------------------------------------------
Y_ER17a [ YER17a ] CH unit of payment
^Fills.ER17a by the hour, by the day, the week, or something else?
Question Type: TER17a
hourly 1 Per hour
daily 2 Per day
weekly 3 Per week
biweekly 4 Bi-weekly (every two weeks)
semimonthly 5 Semi-monthly (twice a month)
monthly 6 Per month
yearly 7 Per year
other 8 Other
Question Fill: ^FillER17a
present Are you paid
past Were you paid
Logic after:
IF Y_ER17a = 8, DK, or REF GO TO Y_ER21a
---------------------------------------------------------------------------------
Y_ER18a [ YER18a ] Amount CH earned per unit of payment
How much ^Fills.ER18n1 per ^Fills.ER18n2?
ENTER DOLLAR AMOUNT
Question Type: 0..200000
Question Fill: ^FillER18n1
present do you usually earn
past did you usually earn
Question Fill: ^FillER18n2
perhr hour
perday day
perwk week
per2wks two weeks
perhalfmo half-month
permo month
peryr year
---------------------------------------------------------------------------------
Y_ER19a [ YER19a ] CH usually receive OT tips bonus
^Fills.ER19a any overtime pay, tips, commissions, bonuses, or other types of pay?
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillER19a
present Do you usually receive
past Did you usually receive
Logic after:
IF Y_ER19a = 2 GOTO Y_ER21a
---------------------------------------------------------------------------------
Y_ER20a [ YER20a ] CH overtime tips bonus - amount
How much ^Fills.ER20an from overtime pay, tips, commissions, bonuses, or other types of pay?
ENTER DOLLAR AMOUNT
Question Type: 0..200000
Question Fill: ^FillER20an
present do you usually earn
past did you usually earn
---------------------------------------------------------------------------------
Y_ER20b [ YER20b ] CH overtime tips bonus - freq
(How much ^Fills.ER20an from overtime pay, tips, commissions, bonuses, or other types of pay?)
Question Type: TER20ba
perhr 1 Per hour
perday 2 Per day
perwk 3 Per week
other 4 Other
Question Fill: ^FillER20an
present do you usually earn
past did you usually earn
---------------------------------------------------------------------------------
Y_ER21a [ YER21a ] How do/did CH feel about job
Which of the following best describes how you ^Fills.ER21a about your job?
Question Type: TER21a
verymuch 1 Like it very much
fairlywell 2 Like it fairly well
itsokay 3 Think it is okay
dislikesome 4 Dislike it somewhat
dislikevery 5 Dislike it very much
Question Fill: ^FillER21a
present feel
past felt
---------------------------------------------------------------------------------
Y_ER22a [ YER22a ] CH trouble getting along w/ boss
Please look at Card 15. ^Fills.ER22a1, how often ^Fills.ER22a2 trouble:
Getting along with your supervisor?
Question Type: TEROften
never 0 Never
fewtimes 1 Just a few times
onceawk 2 About once a week
almstdaily 3 Almost everyday
everyday 4 Everyday
Question Fill: ^FillER22a1
present Since you started this job
past When you worked at this job
Question Fill: ^FillER22a2
present have you had
past did you have
---------------------------------------------------------------------------------
Y_ER23a [ YER23a ] CH trouble pay attention at work
Please look at Card 15. ^Fills.ER22a1, how often ^Fills.ER22a2 trouble:
Paying attention at work?
Question Type: TEROften
never 0 Never
fewtimes 1 Just a few times
onceawk 2 About once a week
almstdaily 3 Almost everyday
everyday 4 Everyday
Question Fill: ^FillER22a1
present Since you started this job
past When you worked at this job
Question Fill: ^FillER22a2
present have you had
past did you have
---------------------------------------------------------------------------------
Y_ER24a [ YER24a ] CH trouble get along w/ coworker
Please look at Card 15. ^Fills.ER22a1, how often ^Fills.ER22a2 trouble:
Getting along with your co-workers?
Question Type: TEROften
never 0 Never
fewtimes 1 Just a few times
onceawk 2 About once a week
almstdaily 3 Almost everyday
everyday 4 Everyday
Question Fill: ^FillER22a1
present Since you started this job
past When you worked at this job
Question Fill: ^FillER22a2
present have you had
past did you have
---------------------------------------------------------------------------------
Y_ER25a [ YER25a ] CH trouble dealing with customer
Please look at Card 15. ^Fills.ER22a1, how often ^Fills.ER22a2 trouble:
Dealing with customers?
Question Type: TEROften
never 0 Never
fewtimes 1 Just a few times
onceawk 2 About once a week
almstdaily 3 Almost everyday
everyday 4 Everyday
Question Fill: ^FillER22a1
present Since you started this job
past When you worked at this job
Question Fill: ^FillER22a2
present have you had
past did you have
---------------------------------------------------------------------------------
Y_ER26a [ YER26a ] CH trouble arrive ontime to work
Please look at Card 15. ^Fills.ER22a1, how often ^Fills.ER22a2 trouble:
Arriving on time for work?
Question Type: TEROften
never 0 Never
fewtimes 1 Just a few times
onceawk 2 About once a week
almstdaily 3 Almost everyday
everyday 4 Everyday
Question Fill: ^FillER22a1
present Since you started this job
past When you worked at this job
Question Fill: ^FillER22a2
present have you had
past did you have
---------------------------------------------------------------------------------
Logic before:
IF Y_ER1a = 1, GOTO Y_ER31a
Y_ER27a [ YER27a ] Reason why CH left job
Please look at Card 16. Which of the reasons on this card best describes why you left your most
recent job?
Question Type: TER27a
layoff 1 LAYOFF
closed 2 PLANT CLOSED
seasonal 3 END OF TEMPORARY OR SEASONAL JOB
fired 4 DISCHARGED OR FIRED
ended 5 PROGRAM ENDED
didntlike 6 DIDN'T LIKE JOB
preg 7 QUIT FOR PREGNANCY OR FAMILY REASONS
quittolook 8 QUIT TO LOOK FOR ANOTHER JOB
tookanother 9 QUIT TO TAKE ANOTHER JOB
schoolwork 10 QUIT TO DEVOTE MORE TIME TO SCHOOL WORK
backtoschool 11 QUIT TO RETURN TO SCHOOL
other 12 QUIT FOR OTHER REASONS
---------------------------------------------------------------------------------
Y_ER28a [ YER28a ] CH finding work in past 4 wks
Have you been doing anything to find work during the last 4 weeks?
Question Type: TER28a
yes 1 Yes
no 2 No
disabled 3 DISABLED
unable 4 UNABLE TO WORK
Logic after:
IF Y_ER28a = 2 GOTO Y_ER30; IF Y_ER28a = 3 GOTO Y_ER31a; IF Y_ER28a = 4 GOTO
---------------------------------------------------------------------------------
Y_ER29 [ YER29 ] Labels are in Logic After
USE CARD 17. What are all the things you have done to find work during the last 4 weeks?
INTERVIEWER: PROBE AFTER EACH RESPONSE: Anything else?
[INTERVIEWER: CODE ALL THAT APPLY]
Question Type: TER29S
interview 1 CONTACTED EMPLOYER DIRECTLY/INTERVIEW
pubempagncy 2 CONTACTED PUBLIC EMPLOYMENT AGENCY
privempagncy 3 CONTACT PRIVATE EMPLOYMENT AGENCY
friends 4 CONTACTED FRIENDS OR RELATIVES
school 5 CONTACTED SCHOOL/UNIVERSITY EMPLOYMENT CENTER
resumes 6 SENT OUT RESUMES/FILLED OUT APPLICATIONS
ads 7 PLACED OR ANSWERED ADS
checked 8 CHECKED UNION/PROFESSIONAL REGISTERS
looked 9 LOOKED AT ADS
attended 10 ATTENDED JOB TRAINING PROGRAMS/COURSES
other 11 OTHER
nothing 12 NOTHING OR NO JOB SEARCH ACTIVITY
Logic after:
YER29_1 --Find work: contact employer directly; YER29_2 --Find work: contact public emplymt
agcy; YER29_3 --Find work: contact priv emplymt agcy; YER29_4 --Find work: contact friends or
relative; YER29_5 --Find work: contact sch/univ emplymt ctr; YER29_6 --Find work: sent resume
filled applction; YER29_7 --Find work: placed answered ads; YER29_8 --Find work: checked
union/prof registers; YER29_9 --Find work: looked at ads; YER29_10 --Find work: attend job trning
prgms/cours; YER29_11 --Find work: other; YER29_12 --Find work: nothing/no job search actvty;
YER29_13--Find work: DK; YER29_14--Find work: RF
---------------------------------------------------------------------------------
Logic before:
IF Y_ER28a <> 2 GOTO Y_ER31a
Y_ER30a [ YER30a ] Main reason CH not look for work
USE CARD 18. What is the main reason you were not looking for work during the @Blast 4
weeks@B?
Question Type: TER30F
believed 1 BELIEVED NO WORK AVAILABLE IN LINE OF WORK OR AREA
couldntfind 2 COULDN'T FIND ANY WORK
lacks 3 LACKS NECESSARY SCHOOLING, TRAINING, SKILLS, OR
EXPERIENCE
age 4 EMPLOYERS THINK TOO YOUNG OR TOO OLD
discrimination 5 OTHER TYPES OF DISCRIMINATION
childprobs 6 CHILD CARE PROBLEMS
family 7 FAMILY RESPONSIBILITIES
inschool 8 IN SCHOOL OR OTHER TRAINING
health 9 ILL HEALTH, PHYSICAL DISABILITY
transprobs 10 TRANSPORTATION PROBLEMS
disabled 11 DISABLED
unable 12 UNABLE TO WORK
other 13 OTHER
---------------------------------------------------------------------------------
Logic before:
IF Y_ER2a = 2, GOTO Y_ER35a
Y_ER31a [ YER31a ] CH had other jobs past 12 months
Have you had any other jobs in the past 12 months?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_ER31a = 2 GOTO Y_ER35a
---------------------------------------------------------------------------------
Y_ER32a [ YER32a ] CH had other jobs past 12 months (#)
Other than the job you have already told me about, how many jobs have you had in the past 12
months?
Question Type: 0..97
---------------------------------------------------------------------------------
Logic before:
IF Y_ER32a = 0, GOTO Y_ER35a. IF Y_ER32n= 0, GO TO Y_ER35a] In the past 12 months, how
much did you earn from {FILL: this 1 job (IF Y_ER32a = 1); these [FILL: Y_ER32a] jobs (IF
Y_ER32a > 1)
Y_ER33a [ YER33a ] Amount CH earned at other jobs
In the past 12 months, how much did you earn from ^Y_ER33a_Fill?
Question Type: 0..200000
---------------------------------------------------------------------------------
Logic before:
IF Y_ER33a = REF OR DK
Y_ER34a [ YER34a ] Range amount CH earned at other jobs
Would you say it was...
Question Type: TER34a
a1 1 Less than $50
a2 2 More than $50 but less than $100
a3 3 More than $100 but less than $500
a4 4 More than $500
a5 5 More than $1000
a6 6 More than $5000
---------------------------------------------------------------------------------
Y_ER35a [ YER35a ] Freq of CH informal jobs
Now let's talk about informal jobs such as baby-sitting or lawn mowing.
About how often do you do these types of informal jobs? Would you say it is...
Question Type: TER35a
sevxwk 1 Several times a week
onceawk 2 Once a week
twoto3awk 3 2-3 times a month
onceamo 4 Once a month
lessonceamo 5 Less than once a month
never 6 Never
Logic after:
IF Y_ER35a = 6 GO TO Y_ER39a
---------------------------------------------------------------------------------
Y_ER36m [ YER36m ] Date CH performed informal job - month
When did you last do this kind of work?
ENTER 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
---------------------------------------------------------------------------------
Y_ER36y [ YER36y ] Date CH performed informal job - year
(When did you last do this kind of work?)
ENTER YEAR
Question Type: 1970..2013
---------------------------------------------------------------------------------
Y_ER37a [ YER37a ] Amt CH earned all informal jobs
In the past 12 months, how much have you earned from all the informal jobs?
Question Type: 0..200000
---------------------------------------------------------------------------------
Logic before:
IF Y_ER37a = REF or DK
Y_ER38a [ YER38a ] Range of amt CH earned informal jobs
Would you say it was...
Question Type: TER34a
a1 1 Less than $50
a2 2 More than $50 but less than $100
a3 3 More than $100 but less than $500
a4 4 More than $500
a5 5 More than $1000
a6 6 More than $5000
---------------------------------------------------------------------------------
Y_ER39 [ YER39 ] NO LABEL
Now I'd like to ask you about other ways you may have made money or gotten help.
For these next questions we are interested in different kinds of payments that might have been
made directly to you. For these questions, please do not include any payments that were made
to other members of your family or household, even if the payments were used to help pay for
your support.
Question Type: TCont
Continue 1 Continue
---------------------------------------------------------------------------------
Y_ER40a [ YER40a ] CH received unemplymt comp pymt - past 12 months
In the past 12 months, have you received any unemployment compensation payments?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_ER47a [ YER47a ] CH received financial hlp frm agncy/ILP - past 12 months
In the past 12 months, have you received any financial help from the child welfare agency or your
caseworker, mentor, or Independent Living Program?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_ER48a [ YER48a ] CH received financial help rel or friend - past 12 months
In the past 12 months, have you received any financial help from a relative or friend?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_ER49a [ YER49a ] CH received financial hlp community group - past 12 months
In the past 12 months, have you received any financial help from a community group, such as a
church, a community organization, or a family resource center?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_ER50a [ YER50a ] CH panhandled begged for money - past 12 months
In the past 12 months, have you panhandled or begged for money?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_ER51a [ YER51a ] CH recycld cans/bottles - past 12 months
In the past 12 months, have you made money by recycling cans, bottles, or other items?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_ER52a [ YER52a ] CH sold blood or plasma - past 12 months
In the past 12 months, have you sold your blood or plasma?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_ER53a [ YER53a ] CH sold/pawned possessions - past 12 months
In the past 12 months, have you sold or pawned any personal possessions?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_ER56a [ YER56a ] CH has credit cards in CH name
Do you have any credit cards in your name?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_ER56a = 2 GOTO Y_ER58a
---------------------------------------------------------------------------------
Y_ER57a [ YER57a ] How often CH pay off credit cards
How often do you pay them off at the end of the month? Would you say...
Question Type: TER57a
never 1 Never
sometimes 2 Sometimes
mostoftime 3 Most of the time
always 4 Always
---------------------------------------------------------------------------------
Y_ER58a [ YER58a ] How going CH making ends meet
When it comes to money and making ends meet, how do you think things are going for you?
Would you say you are able to save a little money each month, just getting by, or struggling to
Question Type: TER58a
save 1 Save a little money each month
gettingby 2 Just getting by
struggling 3 Struggling to make it
---------------------------------------------------------------------------------
Y_ER59a [ YER59a ] Housing that CH paid rent/mortgage - last 12 months
Now let's talk about the place where you're living these days.
In the last 12 months, did you ever stay in a place where you were supposed to pay rent or
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_ER59a = 2 GOTO Y_ER62a
---------------------------------------------------------------------------------
Y_ER60a [ YER60a ] CH ever unable to pay rent/mortgage - last 12 months
Was there ever a time in the last 12 months when you couldn't pay your rent or mortgage on
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_ER60a = 2 GOTO Y_ER62a
---------------------------------------------------------------------------------
Y_ER61a [ YER61a ] CH unable to pay rent/mortgage ontime - freq
How many times did that happen in the last 12 months?
ENTER TIMES
Question Type: 1..12
---------------------------------------------------------------------------------
Y_ER62a [ YER62a ] CH evicted/moved b/c couldn't pay - last 12 months
At any time in the last 12 months, were you ever evicted or did you ever have to move out of a
place because you couldn't pay to stay there?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_ER63a [ YER63a ] Gas/elect cut off b/c CH not pay bill - last 12 months
In the last 12 months, was the gas or electricity ever turned off because you couldn't pay the bill?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_ER64a [ YER64a ] CH had telephone where living - last 12 months
During the last 12 months have you ever had a telephone where you were living?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_ER64a = 1 GOTO Y_ER66a
---------------------------------------------------------------------------------
Y_ER65a [ YER65a ] No phone b/c CH couldn't afford/other
Was that because you couldn't afford to get a phone or because of some other reason?
Question Type: TER65a
yes 1 Yes, could not afford a phone
no 2 No, some other reason
---------------------------------------------------------------------------------
Y_ER66a [ YER66a ] Phone cut off b/c CH couldnt pay bill - last 12 months
During the last 12 months, was the phone ever shut off or disconnected because you couldn't pay
the bill?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_ER67a [ YER67a ] CH stayed in home of relative - last 12 months
Have you stayed in the home of a relative (in the last 12 months)?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Logic before:
IF Y_ER67a = 1, CONTINUE. ELSE GOTO Y_ER69a
Y_ER68a [ YER68a ] CH stayed in home of relative - time
How much time have you stayed in the homes of relatives in the last 12 months?
Question Type: TER68a
a1 1 Less than 2 weeks
a2 2 At least two weeks, but less than one month
a3 3 At least a month, but less than six months
a4 4 At least six months, but less than 12 months
a5 5 Twelve months
---------------------------------------------------------------------------------
Y_ER69a [ YER69a ] CH stayed in home of friend - last 12 months
Have you stayed in the home of a friend (in the last 12 months)?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Logic before:
IF Y_ER69a = 1, CONTINUE. ELSE GOTO Y_ER71a
Y_ER70a [ YER70a ] Time CH stayed in home of friend - last 12 months
Altogether, in the last 12 months, how much time did you spend staying in the homes of friends?
Question Type: TER68a
a1 1 Less than 2 weeks
a2 2 At least two weeks, but less than one month
a3 3 At least a month, but less than six months
a4 4 At least six months, but less than 12 months
a5 5 Twelve months
---------------------------------------------------------------------------------
Y_ER71a [ YER71a ] CH stayed in hotel/motel/SRO
Have you stayed in your own rented room in a motel, hotel, or Single Room Occupancy (in the
last 12 months)?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Logic before:
IF Y_ER71a = 1, CONTINUE. ELSE GOTO Y_ER73a
Y_ER72a [ YER72a ] Time CH stayed in hotel/motel/SRO - last 12 months
Altogether, in the last 12 months, how much time did you spend in your own rented room in a
hotel, or SRO (Single Room Occupancy)?
Question Type: TER68a
a1 1 Less than 2 weeks
a2 2 At least two weeks, but less than one month
a3 3 At least a month, but less than six months
a4 4 At least six months, but less than 12 months
a5 5 Twelve months
---------------------------------------------------------------------------------
Y_ER73a [ YER73a ] CH stayed in car/truck/oth vehicle - last 12 months
Have you stayed in a car, truck, or some other type of vehicle (in the last 12 months)?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Logic before:
IF Y_ER73a = 1, CONTINUE. ELSE GOTO Y_ER75a
Y_ER74a [ YER74a ] Time CH stayed in car/truck/oth vehicle - last 12 months
Altogether, in the last 12 months, how much time did you spend staying in a car, truck, or some
other type of vehicle?
Question Type: TER68a
a1 1 Less than 2 weeks
a2 2 At least two weeks, but less than one month
a3 3 At least a month, but less than six months
a4 4 At least six months, but less than 12 months
a5 5 Twelve months
---------------------------------------------------------------------------------
Y_ER75a [ YER75a ] CH stayed in abdoned bldg/outside - last 12 months
Have you stayed in an abandoned building, on the street, or outside somewhere (in the last 12
months)?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Logic before:
IF Y_ER75a = 1, CONTINUE. ELSE GOTO Y_ER77a
Y_ER76a [ YER76a ] Time CH stayed in abdoned bldg/outside - last 12 months
Altogether, in the last 12 months, how long did you stay in an abandoned building, on the street,
or outside somewhere?
Question Type: TER68a
a1 1 Less than 2 weeks
a2 2 At least two weeks, but less than one month
a3 3 At least a month, but less than six months
a4 4 At least six months, but less than 12 months
a5 5 Twelve months
---------------------------------------------------------------------------------
Logic before:
IF RESPONDENT IS MALE, GOTO Y_ER79a. ELSE CONTINUE
Y_ER77a [ YER77a ] CH stayed in battered womens shelter - last 12 months
Have you stayed in a shelter for battered women (in the last 12 months)?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Logic before:
IF Y_ER77a = 1, CONTINUE. ELSE GOTO Y_ER79a
Y_ER78a [ YER78a ] Time CH in battered womens shelter - last 12 months
Altogether, in the last 12 months, how long did you stay in a battered women's shelter?
Question Type: TER68a
a1 1 Less than 2 weeks
a2 2 At least two weeks, but less than one month
a3 3 At least a month, but less than six months
a4 4 At least six months, but less than 12 months
a5 5 Twelve months
Y_ER78b [ YYD21 ] How much R needed domestic violence svcs - past 12M
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: TYYV13a
alot 1 a lot,
somewhat 2 somewhat,
alittle 3 a little, or
notatall 4 not at all?
---------------------------------------------------------------------------------
Y_ER79a [ YER79a ] CH stayed in homeless shelter - last 12 months
Have you stayed in a shelter for the homeless (in the last 12 months)?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Logic before:
IF Y_ER79a = 1, CONTINUE. ELSE GOTO Y_ER81a
Y_ER80a [ YER80a ] Time CH stayed in homeless shelter - last 12 months
Altogether, in the last 12 months, how much time did you spend in a homeless shelter?
Question Type: TER68a
a1 1 Less than 2 weeks
a2 2 At least two weeks, but less than one month
a3 3 At least a month, but less than six months
a4 4 At least six months, but less than 12 months
a5 5 Twelve months
---------------------------------------------------------------------------------
Y_ER81a [ YER81a ] CH get food or money from friend/rel - last 12 months
In the last 12 months, did you ever get food or borrow money from friends or relatives?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_ER81a = 2 GOTO Y_ER83a
---------------------------------------------------------------------------------
Y_ER82a [ YER82a ] Freq CH get food or money from friend/rel - last 12 months
How often did this happen? Would you say...
Question Type: TER82a
a1 1 Almost every month
a2 2 Some months but not every month
a3 3 In only 1 or 2 months
---------------------------------------------------------------------------------
Y_ER83a [ YER83a ] CH get food from church/pantry - last 12 months
In the last 12 months, did you ever get emergency food from a church, a food pantry, or food bank?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_ER83a = 2 GOTO Y_ER85a
---------------------------------------------------------------------------------
Y_ER84a [ YER84a ] Freq CH get food from church/pantry - last 12 months
How often did this happen? Would you say...
Question Type: TER82a
a1 1 Almost every month
a2 2 Some months but not every month
a3 3 In only 1 or 2 months
---------------------------------------------------------------------------------
Y_ER85a [ YER85a ] CH eat meals at soup kitchen - last 12 months
In the last 12 months, did you ever eat any meals at a soup kitchen?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_ER85a = 2 GOTO Y_ER87a
---------------------------------------------------------------------------------
Y_ER86a [ YER86a ] Freq CH eat meals at soup kitchen - last 12 months
How often did this happen? Would you say...
Question Type: TER82a
a1 1 Almost every month
a2 2 Some months but not every month
a3 3 In only 1 or 2 months
---------------------------------------------------------------------------------
Y_ER87a [ YER87a ] CH hungry but couldnt buy food - last 12 months
In the last 12 months, were you ever hungry but didn't eat because you couldn't afford enough food?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_ER87a = 2 GOTO Y_ER89a
---------------------------------------------------------------------------------
Y_ER88a [ YER88a ] Freq CH hungry but couldnt buy food - last 12 months
How often did this happen? Would you say...
Question Type: TER82a
a1 1 Almost every month
a2 2 Some months but not every month
a3 3 In only 1 or 2 months
ADMINISTER Y_ER89 – Y_ER110 TO EMANCIPATED YOUTH AND TO YOUNG ADULTS FROM STATES WITH EXTENDED FOSTER CARE PROGRAMS
Y_ER89 [ YER89 ] NO LABEL
In the last 12 months, has a caseworker or agency helped you to find a job, prepare for your
education, find a place to live, or help with day-to-day activities such as managing finances?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_ER90 [ YER90 ] NO LABEL
In the past 12 months, has a caseworker or agency helped you find services to help you handle
stress or cope with things that come up in your life?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF WAVE >= 2, ASK.
IF Y_YH36ab = yes or Y_YH36a = yes or Y_YH43a = yes or Y_YH45a = yes or Y_YH50k1a = yes
or (Y_ER7=yes and Y_ER8="Caseworkrer") or Y_ER47=yes or Y_YH52=yes or Y_ER89=yes or
Y_ER90=yes ASK
ELSE IF none of above =yes, GOTO Y_ER108a
Y_ER108 [ YER108 ] NO LABEL
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 Y_ER108 = yes then GOTO Y_ER109
if Y_ER108 = NO then GOTO Y_ER108a
---------------------------------------------------------------------------------
Y_ER108a [ YER108a ] Services paid for by agency
USE CARD 19. Please look at the list of services on Card 19. Since ^lstintdate, have you received
any of these services from the child welfare agency? The agency may have provided the services
directly or paid for you 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
In-home counseling or in-home crisis services
Family counseling
Therapeutic nursery 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
Case manager visits or other types of contacts with case manager
---------------------------------------------------------------------------------
Logic before:
IF Y_ER108=yes or Y_ER108a = yes then ASK Y_ER109
ELSE SKIP TO Y_ER_END
Y_ER109 [ YER109 ] NO LABEL
What is the name of the caseworker who is most knowledgeable about the services you have
received?
NAME:
Question Type: string[50]
---------------------------------------------------------------------------------
Y_ER110 [ YER110 ] NO LABEL
What is the caseworker's telephone number?
PHONE
Question Type: TPHONE
---------------------------------------------------------------------------------
Y_ER_END [ YER_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF CHILD IS EMANCIPATED OR YOUNG ADULT (18+) YEARS OLD, CONTINUE. ELSE GO TO
Y_YIEND
Y_YI1an [ YYI1an ] Available income and income assitance to HH during past 12M
The next questions are about income or income assistance available to your 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 @Btotal combined income of your family@B from all sources @Bin the
past 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.
Question Type: TCont
Continue 1 Continue
---------------------------------------------------------------------------------
Y_YI2n [ YYI2n ] Best estimate of total family income before taxes past 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 Y_YI2n = DK or REF, GO TO Y_YI3aa. ELSE GO TO Y_YI2an
---------------------------------------------------------------------------------
Y_YI2r
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
---------------------------------------------------------------------------------
Y_YI2an [ YYI2an ] How many people contributed to total combined family income
How many people contributed to this total combined family income?
Question Type: 1..30
---------------------------------------------------------------------------------
Y_YI3_1n [ YYI3_1n ] How many adults including yourself depend on this income
How many adults, including yourself, depend on this income?
NOTE: QUESTION REFERS TO ALL ADULTS, INCLUDING THOSE WHO MAY LIVE IN A
DIFFERENT HOUSEHOLD.
NUMBER OF ADULTS:
Question Type: 1..30
---------------------------------------------------------------------------------
Logic before:
IF CH35a = 1, CONTINUE. ELSE, GOTO Y_YI5
Y_YI3_2n [ YYI3_2n ] How many children depend on this income
How many children depend on this income?
NOTE: QUESTION REFERS TO ALL CHILDREN, INCLUDING THOSE WHO MAY LIVE IN A
DIFFERENT HOUSEHOLD.
NUMBER OF CHILDREN:
Question Type: 0..30
---------------------------------------------------------------------------------
Y_YI5 [ YYI5 ] Labels are in Logic After
In the last 12 months, did anyone in this household receive...
CODE ALL THAT APPLY.
Question Type: TYI5S
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 Y_YI5 = 2, ASK Y_YI6 – Y_YI7.
Y_YI6
How many months did you receive help from [NAME OF STATE SNAP PROGRAM] in the last twelve months?
Y_YI7
Approximately how much did you receive the last month you received [NAME OF STATE SNAP PROGRAM]?
IF Y_YI5 = 3, ASK Y_YI8 – Y_YI10.
Y_YI8
How many months did you receive help from welfare or TANF in the last twelve months?
Y_YI9
Approximately how much did you receive the last month you received welfare or TANF?
Y_YI10
Do the TANF benefits provide for ...
1 = you and other household members,
2 = you only, or
3 = other household members only and not you?
IF Y_YI5 = 5, ASK Y_YI11.
Y_YI11
Is the disability check (SSI) to provide for ...
1 = you and other household members,
2 = you only, or
3 = other household members only and not you?
Y_YI12.
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
Y_YI13
How difficult is it for you to pay your 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
Y_YI14
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
Y_YI15
[I/My family and I] [have/has] enough money to afford the kind of home [I/we] need. Do you…
1 Strongly disagree
2 Disagree
3 Agree
4 Strongly agree
Y_YI16
[I/My family and I] [have/has] enough money to afford the kind of clothing [I/we] need. Do you…
1 Strongly disagree
2 Disagree
3 Agree
4 Strongly agree
Y_YI17
[I/My family and I] [have/has] enough money to afford the kind of food [I/we] need. Do you…
1 Strongly disagree
2 Disagree
3 Agree
4 Strongly agree
Y_YI18
[I/My family and I] [have/has] enough money to afford the kind of medical care [I/we] need. Do you…
1 Strongly disagree
2 Disagree
3 Agree
4 Strongly agree
---------------------------------------------------------------------------------
Logic before:
IF AGE 11 OR OLDER, CONTINUE. IF CHILD IS YOUNG ADULT (18+) OR EMANCIPATED,
CONTINUE. ELSE, GOTO Y_ACEND.
Y_AC0 [ YAC0 ] 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
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
---------------------------------------------------------------------------------
Y_AC1 [ YAC1 ] 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
---------------------------------------------------------------------------------
Y_AC2a [ YAC2a ] Month CH was born
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
---------------------------------------------------------------------------------
Y_AC3a [ YAC3a ] Birth month entered correctly(YN2T)
The computer has recorded that you were born in ^Fills.Y_AC3a. Is this correct?
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_AC3a
jan January
feb February
mar March
apr April
may May
jun June
jul July
aug August
sep September
oct October
nov November
dec December
Logic after:
IF Y_AC3a = 2 GOTO Y_AC2a ("PLEASE RE-ENTER YOUR ANSWER TO QUESTION Y_AC2a.")
---------------------------------------------------------------------------------
Y_AC4 [ YAC4 ] NO LABEL
The next practice questions will show you some of the different types of answers you can choose
during this part of the interview. Please pay close attention to the answer choices that are given
for each question.
Press "1" and the [Enter] key to continue.
Question Type: TCont
Continue 1 Continue
---------------------------------------------------------------------------------
Y_AC5a [ YAC5a ] # days ate ice cream past 30 days(DAY1T)
In the @Blast 30 days@B, on how many days did you eat ice cream?
Question Type: TAC5a
one 1 1 day
two 2 2 days
threetofive 3 3 to 5 days (about 1 day a week)
sixtoeleven 4 6 to 11 days (about 2 days a week)
tentonineteen 5 10 to 19 days (about 3 or 4 days a week)
twentymore 6 20 days or more (5 days a week or more)
notdone 8 I have not done this in the past 30 days
---------------------------------------------------------------------------------
Y_AC6a [ YAC6a ] # times to movies past 6 months(TIME2T)
How many times in the @Bpast 6 months@B did you go to the movies?
Question Type: TAC6a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourxs 4 4 times
fivemore 5 5 or more times
notdone 8 I have not done this in the past 6 months
---------------------------------------------------------------------------------
Y_AC7a [ YAC7a ] # times to museum past 12 months(TIME3T)
In the @Bpast 12 months@B, how many times have you watched TV?
Question Type: TAC7a
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notin6mos 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_AC8 [ YAC8 ] 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 children
experience and how it affects their lives. This will allow us to help others get as good as possible
at helping children like you in the future.
Press "1" and [Enter] to continue.
Question Type: TCont
Continue 1 Continue
---------------------------------------------------------------------------------
Y_AC10 [ YAC10 ] 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 finish the interview. You can listen to the questions and put your answers into
the computer in complete privacy. You can also skip any question you don't want to answer.
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 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 experiences.
Please press "1" and [Enter] now to hear and see the questions.
Question Type: TCont
Continue 1 Continue
Logic after:
GOTO Y_ACEND
---------------------------------------------------------------------------------
Y_RC_BGN [ YRC_BGN ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF AGE < 11, GOTO Y_RCEND. IF CHILD IS YOUNG ADULT (18+) OR EMANCIPATED, GOTO
Y_RCEND. ELSE, CONTINUE.
Y_RC1a [ YRC1a ] CH feels good w/CG-A
Now I want to ask you about your relationship with your ^CAREGIVER_A. I am going to read a list
of different statements and for each one I want you to tell me how true the statement is about
you. Remember that your answers are private. Please tell me what you really feel or think.
When I'm with my ^CAREGIVER_A, I feel good. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC2a [ YRC2a ] CH feels mad w/CG-A
When I'm with my ^CAREGIVER_A, I feel mad. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC3a [ YRC3a ] CH feels unhappy w/CG-A
When I'm with my ^CAREGIVER_A, I feel unhappy. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC4a [ YRC4a ] CG-A enjoys time w/CH
My ^CAREGIVER_A enjoys spending time with me. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC5a [ YRC5a ] CG-A does a lot to help CH
My ^CAREGIVER_A does a lot to help me. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC6a [ YRC6a ] CG-A doesn't have time for CH
My ^CAREGIVER_A doesn't seem to have enough time for me. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC7a [ YRC7a ] CG-A DK how CH feels
My ^CAREGIVER_A doesn't seem to know how I feel about things. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC8a [ YRC8a ] CG-A trusts CH
My ^CAREGIVER_A trusts me. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC9a [ YRC9a ] CG-A doesn't let CH make decisions
My ^CAREGIVER_A doesn't let me make any of my own decisions. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC10a [ YRC10a ] CG-A is fair w/ CH
My ^CAREGIVER_A is fair with me. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC11a [ YRC11a ] CG-A thinks CH can't do much
My ^CAREGIVER_A doesn't think I can do very much. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC12a [ YRC12a ] CH DK what CG-A wants
I don't know what my ^CAREGIVER_A wants from me. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Logic before:
IF CAREGIVER_B IS BLANK, GOTO RCEND
Y_RC13a [ YRC13a ] CH feels good w/CG-B
Now I want to ask you about your relationship with your ^CAREGIVER_B. I am going to read a list
of different statements and for each one I want you to tell me how true the statement is about
you. Remember that your answers are private. Please tell me what you really feel or think.
When I'm with my ^CAREGIVER_B, I feel good. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC14a [ YRC14a ] CH feels mad w/CG-B
When I'm with my ^CAREGIVER_B, I feel mad. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC15a [ YRC15a ] CH feels unhappy w/CG-B
When I'm with my ^CAREGIVER_B, I feel unhappy. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC16a [ YRC16a ] CG-B enjoys time w/CH
My ^CAREGIVER_B enjoys spending time with me. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC17a [ YRC17a ] CG-B does a lot to help CH
My ^CAREGIVER_B does a lot to help me. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC18a [ YRC18a ] CG-B doesn't have time for CH
My ^CAREGIVER_B doesn't seem to have enough time for me. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC19a [ YRC19a ] CG-B DK how CH feels
My ^CAREGIVER_B doesn't seem to know how I feel about things. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC20a [ YRC20a ] CG-B trusts CH
My ^CAREGIVER_B trusts me. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC21a [ YRC21a ] CG-B doesn't let CH make decisions
My ^CAREGIVER_B doesn't let me make any of my own decisions. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC22a [ YRC22a ] CG-B is fair w/ CH
My ^CAREGIVER_B is fair with me. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC23a [ YRC23a ] CG-B thinks CH can't do much
My ^CAREGIVER_B doesn't think I can do very much. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
---------------------------------------------------------------------------------
Y_RC24a [ YRC24a ] CH DK what CG-B wants
I don't know what my ^CAREGIVER_B wants from me. How true is this?
Question Type: THowTrue
nottrue 1 not at all true
notvtrue 2 not very true
sorttrue 3 sort of true, or
verytrue 4 very true?
Logic after:
GOTO Y_RCEND
---------------------------------------------------------------------------------
Y_RC_END [ YRC_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
Logic after:
Y_RCEND
---------------------------------------------------------------------------------
Logic before:
IF CHILD IS EMANCIPATED OR YOUNG ADULT (18+), GOTO Y_CLEND
Y_CL_BGN [ YCL_BGN ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF AGE < 11, GOTO Y_CLEND. IF CAREGIVER_A IS BLANK, GOTO Y_CL3a
Y_CL1a [ YCL1a ] How close CH feels to CG-A
How close do you feel to your ^CAREGIVER_A? Would you say...
Question Type: TCL1a
notatall 1 not at all
littlebit 2 a little bit
somewhat 3 somewhat
quiteabit 4 quite a bit, or
vclose 5 very close?
---------------------------------------------------------------------------------
Y_CL2a [ YCL2a ] How much CG-A cares about CH
How much do you think ^Fills.HeShe cares about you? Would you say...
Question Type: TCL2a
notatall 1 not at all
vlittle 2 very little
somewhat 3 somewhat
quiteabit 4 quite a bit, or
vmuch 5 very much?
Question Fill: ^fillheshe
he he
she she
---------------------------------------------------------------------------------
Logic before:
IF CAREGIVER_B IS BLANK, GOTO Y_CL5aa
Y_CL3a [ YCL3a ] How close CH feels to CG-B
How close do you feel to your ^CAREGIVER_B? Would you say...
Question Type: TCL1a
notatall 1 not at all
littlebit 2 a little bit
somewhat 3 somewhat
quiteabit 4 quite a bit, or
vclose 5 very close?
---------------------------------------------------------------------------------
Y_CL4a [ YCL4a ] How much CG-B cares about CH
How much do you think ^Fills.HeShe cares about you? Would you say...
Question Type: TCL2a
notatall 1 not at all
vlittle 2 very little
somewhat 3 somewhat
quiteabit 4 quite a bit, or
vmuch 5 very much?
Question Fill: ^fillheshe
he he
she she
---------------------------------------------------------------------------------
Logic before:
IF CAREGIVER_A IS BLANK, GOTO Y_CL6aa
Y_CL5aa [ YCL5aa ] CH went shopping w/CG-A past 4 wks
Next, I'm going to read a list of things you may have done with your ^CAREGIVER_A. For each
one, please tell me if you have done it with your ^CAREGIVER_A @Bin the past 4 weeks@B.
In the past 4 weeks, have you gone shopping with your ^CAREGIVER_A?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CL5ba [ YCL5ba ] CH played sport w/CG-A past 4 wks
In the past 4 weeks, have you played a sport with your ^CAREGIVER_A?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CL5ca [ YCL5ca ] CH gone to religious service w/CG-A past 4 wks
In the past 4 weeks, have you gone to a religious service or church-related event with your
^CAREGIVER_A?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CL5da [ YCL5da ] CH talked to CG-A re: dating past 4 wks
In the past 4 weeks, have you talked with your ^CAREGIVER_A about someone you're dating or a
party you went to?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CL5ea [ YCL5ea ] CH gone to events w/CG-A past 4 wks
In the past 4 weeks, have you gone to a movie, play, museum, concert, or sports event with your
^CAREGIVER_A?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CL5fa [ YCL5fa ] CH talked w/CG-A re: problem past 4 wks
In the past 4 weeks, have you had a talk with your ^CAREGIVER_A about a personal problem you
were having?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CL5ga [ YCL5ga ] CH argued w/CG-A re: behavior past 4 wks
In the past 4 weeks, have you had a serious argument with your ^CAREGIVER_A about your
behavior?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CL5ha [ YCL5ha ] CH talked about school work/grades w/CG-A past 4 wks
In the past 4 weeks, have you talked about your school work or grades with your ^CAREGIVER_A?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CL5ia [ YCL5ia ] CH worked on school proj w/CG-A past 4 wks
In the past 4 weeks, have you worked on a project for school with your ^CAREGIVER_A?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CL5ja [ YCL5ja ] CH talked w/CG-A re:othr school things past 4 wks
In the past 4 weeks, have you talked with your ^CAREGIVER_A about other things you're doing in
school?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Logic before:
IF CAREGIVER_B = IS BLANK, GOTO Y_CLEND
Y_CL6aa [ YCL6aa ] CH went shopping w/CG-B past 4 wks
Next, I'm going to read a list of things you may have done with your ^CAREGIVER_B. For each
one, please tell me if you have done it with your ^CAREGIVER_B @Bin the past 4 weeks@B.
In the past 4 weeks, have you gone shopping with your ^CAREGIVER_B?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CL6ba [ YCL6ba ] CH played sport w/CG-B past 4 wks
In the past 4 weeks, have you played a sport with your ^CAREGIVER_B?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CL6ca [ YCL6ca ] CH gone to religious service w/CG-B past 4 wks
In the past 4 weeks, have you gone to a religious service or church-related event with your
^CAREGIVER_B?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CL6da [ YCL6da ] CH talked to CG-B re: dating past 4 wks
In the past 4 weeks, have you talked with your ^CAREGIVER_B about someone you're dating or a
party you went to?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CL6ea [ YCL6ea ] CH gone to events w/CG-B past 4 wks
In the past 4 weeks, have you gone to a movie, play, museum, concert, or sports event with your
^CAREGIVER_B?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CL6fa [ YCL6fa ] CH talked w/CG-B re: problem past 4 wks
In the past 4 weeks, have you had a talk with your ^CAREGIVER_B about a personal problem you
were having?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CL6ga [ YCL6ga ] Ch argued w/CG-B re: behavior past 4 wks
In the past 4 weeks, have you had a serious argument with your ^CAREGIVER_B about your
behavior?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CL6ha [ YCL6ha ] CH talked about school work/grades w/CG-B past 4 wks
In the past 4 weeks, have you talked about your school work or grades with your ^CAREGIVER_B?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CL6ia [ YCL6ia ] CH worked on school proj w/CG-B past 4 wks
In the past 4 weeks, have you worked on a project for school with your ^CAREGIVER_B?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CL6ja [ YCL6ja ] CH talked w/CG-B re:othr school things past 4 wks
In the past 4 weeks, have you talked with your ^CAREGIVER_B about other things you're doing in
school?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_CL_END [ YCL_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
Skip Logic:
IN THIS SECTION, CERTAIN SENTENCES IN THE QUESTIONS ARE SHOWN ONLY TO KIDS
UNDER 11 (AND OVER 8). THE REMAINDER OF THE QUESTION TEXT IS SHOWN TO ALL
KIDS IN THE SECTION -- I.E., KIDS AGE 8 AND UP.
---------------------------------------------------------------------------------
Logic before:
IF AGE < 8 OR CHILD IS YOUNG ADULT (18+) OR EMANCIPATED, GOTO Y_EVEND. ELSE,
CONTINUE.
Y_EV1a [ YEV1a ] #Xs CH eats ice cream during Summer
^Fills.Y_EV1
Let's try answering an easy question using these different answers. During the summer, how
many times do you eat ice cream?
If you never eat ice cream during the summer, you would say "never."
If you eat ice cream once during the summer, you would say "one time."
If you eat ice cream a few times during the summer, you would say "a few times."
If you eat ice cream lots of times during the summer, you would say "lots of times."
So, during the summer how many times do you eat ice cream?
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV1
lessthan11 USE CARD 19. I am going to show you some pictures that tell about a
child whose name is Chris. I will show you one picture at a time and tell
you what is happening in that picture. Afterwards, I will ask you how
often you may have seen things that are like what Chris saw or things
that may have happened to you that are like what happened to Chris. For
each question, I want you to pick one of the following answers: never,
one time, a few times, or lots of times.
elevenmore I am going to ask you how often you may have seen things or how often
things may have happened to you. For each question, I want you to pick
one of the following answers: never, one time, a few times, or lots of
---------------------------------------------------------------------------------
Logic before:
IF AGE < 11
Y_EV2 [ YEV2 ] NO LABEL
I am going to show you some pictures of things that Chris really saw or that really happened to
Chris. They are not things that Chris imagined or made up. They are not stories that Chris heard
or things that Chris saw on TV or in the movies or on video. The pictures show things that Chris
really saw or that really happened to Chris.
INTERVIEWER: EMPHASIZE WITH THE FIRST FEW PICTURES THAT CHRIS REALLY SAW
THESE THINGS HAPPEN AND THEY ARE NOT THINGS CHRIS WATCHED IN A MOVIE OR
ON VIDEO OR TV.
USE CARD 20: This is Chris.
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF AGE < 11
Y_EV3a [ YEV3a ] #Xs CH saw kid on Santas lap
USE CARD 21. Chris sees a kid sitting on Santa's lap. How many times have you seen a kid
sitting on Santa's lap? Would you say. . .
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
---------------------------------------------------------------------------------
Logic before:
IF AGE < 11
Y_EV4a0 NO LABEL
Now, I'd like you to put on these headphones and listen to the rest of the questions about Chris.
By wearing the headphones, no one else will be able to hear the questions that you are asked. I
will show you the pictures of Chris while you listen to the questions. After you hear each
question, please point to your answer on the card I will be holding. Do not say your answer out
loud. Just point to your answer on the card and I will type it into the computer. When answering
these questions, please remember that if I learn that your life or health is in danger, I will have to
tell someone whose job it is to see that you are safe and protected.
Let's get started.
INTERVIEWER: PUT HEADPHONES ON CHILD
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, empty
Continue 1 Continue
---------------------------------------------------------------------------------
Y_EV4a [ YEV4a ] #Xs CH saw adult yell at others
^Fills.Y_EV4a2 How many times have you seen an adult yell at another person in a home you've
lived in? (Would you say never, one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV4a2
lessthan11 USE CARD 22. Chris is at home. Chris sees an adult yell at another
person at home.
elevenmore Let's get started.@/@/@/
Logic after:
IF RESPONSE = 1, DK, RE, GOTO Y_EV5a
---------------------------------------------------------------------------------
Y_EV4aa [ YEV4aa ] CH saw adult yelling at others in past M
Have you seen this happen in the last month?
^Fills.Y_EV4
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV4
lessthan11 USE CARD 22A.
---------------------------------------------------------------------------------
Y_EV4xa [ YEV4xa ] CH saw yelling w/curr residents
Have you seen this happen with the people you live with now?
^Fills.Y_EV4
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV4
lessthan11 USE CARD 22A.
---------------------------------------------------------------------------------
Y_EV5a [ YEV5a ] #Xs CH yelled at by adult
^Fills.Y_EV5a How many times has an adult yelled at you in a home you've lived in? (Would you
say never, one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV5a
lessthan11 USE CARD 23. At home, an adult yells at Chris.
elevenmore
Logic after:
IF RESPONSE = 1, DK, RE, GOTO Y_EV6a
---------------------------------------------------------------------------------
Y_EV5aa [ YEV5aa ] CH yelled at by adult in past M
Has this happened in the last month?
^Fills.Y_EV5
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV5
lessthan11 USE CARD 23A.
---------------------------------------------------------------------------------
Y_EV5xa [ YEV5xa ] CH yelled at by curr res
Has this happened with the people you live with now?
^Fills.Y_EV5
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV5
lessthan11 USE CARD 23A.
---------------------------------------------------------------------------------
Y_EV6a [ YEV6a ] #Xs CH saw adult throw at others
^Fills.Y_EV6a How many times have you seen an adult throw something at another person in a
home you've lived in? (Would you say never, one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV6a
lessthan11 USE CARD 24. Chris sees an adult throw something at another person
at home.
elevenmore
Logic after:
IF RESPONSE = 1, DK, RE, GOTO Y_EV7a
---------------------------------------------------------------------------------
Y_EV6aa [ YEV6aa ] CH saw adult throw at others in past M
Have you seen this happen in the last month?
^Fills.Y_EV6
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV6
lessthan11 USE CARD 24A.
---------------------------------------------------------------------------------
Y_EV6xa [ YEV6xa ] CH saw adult throw w/curr residents
Have you seen this happen with the people you live with now?
^Fills.Y_EV6
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV6
lessthan11 USE CARD 24A.
---------------------------------------------------------------------------------
Y_EV7a [ YEV7a ] #Xs adult thrown something at CH
^Fills.Y_EV7a How many times has an adult thrown something at you in a home you've lived in?
(Would you say never, one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV7a
lessthan11 USE CARD 25. At home, an adult throws something at Chris.
elevenmore
Logic after:
IF RESPONSE = 1, DK, RE, GOTO Y_EV8a
---------------------------------------------------------------------------------
Y_EV7aa [ YEV7aa ] Adult threw at CH in past M
Has this happened in the last month?
^Fills.Y_EV7
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV7
lessthan11 USE CARD 25A.
---------------------------------------------------------------------------------
Y_EV7xa [ YEV7xa ] Adult threw at CH w/curr residents
Has this happened with the people you live with now?
^Fills.Y_EV7
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV7
lessthan11 USE CARD 25A.
---------------------------------------------------------------------------------
Y_EV8a [ YEV8a ] #Xs CH saw adult shove others
^Fills.Y_EV8a How many times have you seen an adult push or shove another person really hard
in a home you've lived in? (Would you say never, one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV8a
lessthan11 USE CARD 26. Chris is at home. Chris sees an adult push or shove
another person really hard.
elevenmore
Logic after:
IF RESPONSE = 1, DK, RE, GOTO Y_EV9a
---------------------------------------------------------------------------------
Y_EV8aa [ YEV8aa ] CH saw adult shove others in past M
Have you seen this happen in the last month?
^Fills.Y_EV8
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV8
lessthan11 USE CARD 26A.
---------------------------------------------------------------------------------
Y_EV8xa [ YEV8xa ] CH saw adult shove others w/curr residents
Have you seen this happen with the people you live with now?
^Fills.Y_EV8
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV8
lessthan11 USE CARD 26A.
---------------------------------------------------------------------------------
Y_EV9a [ YEV9a ] #Xs adult shoved CH
^Fills.Y_EV9a How many times has an adult pushed or shoved you really hard in a home you've
lived in? (Would you say never, one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV9a
lessthan11 USE CARD 27. Chris is at home. An adult pushes or shoves Chris really
hard.
elevenmore
Logic after:
IF RESPONSE = 1, DK, RE, GOTO Y_EV10a
---------------------------------------------------------------------------------
Y_EV9aa [ YEV9aa ] Adult shoved CH in past M
Has this happened in the last month?
^Fills.Y_EV9
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV9
lessthan11 USE CARD 27A.
---------------------------------------------------------------------------------
Y_EV9xa [ YEV9xa ] Adult shoved CH w/curr residents
Has this happened with the people you live with now?
^Fills.Y_EV9
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV9
lessthan11 USE CARD 27A.
---------------------------------------------------------------------------------
Logic before:
IF AGE >=11, GOTO Y_EV11a
Y_EV10a [ YEV10a ] #Xs CH watched cartoons
USE CARD 28. Chris watches cartoons on TV. How many times have you watched cartoons on
TV? (Would you say never, one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
---------------------------------------------------------------------------------
Y_EV11a [ YEV11a ] #Xs CH saw adult slap other adult
^Fills.Y_EV11a How many times have you seen an adult slap another person really hard in a
home you've lived in? (Would you say never, one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV11a
lessthan11 USE CARD 29. Chris is at home. Chris sees an adult slap another
person really hard at home.
elevenmore
Logic after:
IF RESPONSE = 1, DK, RE, GOTO Y_EV12a
---------------------------------------------------------------------------------
Y_EV11aa [ YEV11aa ] CH saw adult slap other in past M
Have you seen this happen in the last month?
^Fills.Y_EV11
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV11
lessthan11 USE CARD 29A.
---------------------------------------------------------------------------------
Y_EV11xa [ YEV11xa ] CH saw adult slap other w/curr residents
Have you seen this happen with the people you live with now?
^Fills.Y_EV11
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV11
lessthan11 USE CARD 29A.
---------------------------------------------------------------------------------
Y_EV12a [ YEV12a ] #Xs adult slapped CH
^Fills.Y_EV12a How many times has an adult slapped you really hard in a home you've lived in?
(Would you say never, one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV12a
lessthan11 USE CARD 30. At home, an adult slaps Chris really hard.
elevenmore
Logic after:
IF RESPONSE = 1, DK, RE, GOTO Y_EV13a
---------------------------------------------------------------------------------
Y_EV12aa [ YEV12aa ] Adult slap CH in past M
Has this happened in the last month?
^Fills.Y_EV12
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV12
lessthan11 USE CARD 30A.
---------------------------------------------------------------------------------
Y_EV12xa [ YEV12xa ] Adult slap CH w/curr residents
Has this happened with the people you live with now?
^Fills.Y_EV12
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV12
lessthan11 USE CARD 30A.
---------------------------------------------------------------------------------
Y_EV13a [ YEV13a ] #Xs CH saw adult beat up other
^Fills.Y_EV13a How many times have you seen an adult beat-up another person in a home you've
lived in? (Would you say never, one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV13a
lessthan11 USE CARD 31. Chris is at home. Chris sees an adult beat-up another
person at home.
elevenmore
Logic after:
IF RESPONSE = 1, DK, RE, GOTO Y_EV14a
---------------------------------------------------------------------------------
Y_EV13aa [ YEV13aa ] CH saw adult beat other in past M
Have you seen this happen in the last month?
^Fills.Y_EV13
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV13
lessthan11 USE CARD 31A.
---------------------------------------------------------------------------------
Y_EV13xa [ YEV13xa ] CH saw adlt beat other w/curr occup
Have you seen this happen with the people you live with now?
^Fills.Y_EV13
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV13
lessthan11 USE CARD 31A.
---------------------------------------------------------------------------------
Y_EV14a [ YEV14a ] #Xs adult beat up CH
^Fills.Y_EV14a How many times has an adult beaten you up in a home you've lived in? (Would
you say never, one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV14a
lessthan11 USE CARD 32. At home, an adult beats Chris up.
elevenmore
Logic after:
IF RESPONSE = 1, DK, RE, GOTO Y_EV15a
---------------------------------------------------------------------------------
Y_EV14aa [ YEV14aa ] Adult who beat up CH responsible for CH care
Was that someone who was responsible for taking care of you?
^Fills.Y_EV14
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV14
lessthan11 USE CARD 32A.
---------------------------------------------------------------------------------
Y_EV14ba [ YEV14ba ] CH beat up by responsible adult in last W
Has this happened in the last week?
^Fills.Y_EV14
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV14
lessthan11 USE CARD 32A.
Logic after:
IF RESPONSE = 1, GOTO Y_EV14xa
---------------------------------------------------------------------------------
Y_EV14ca [ YEV14ca ] CH beat up by responsible adult in last M
Has this happened in the last month?
^Fills.Y_EV14
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV14
lessthan11 USE CARD 32A.
Logic after:
IF RESPONSE = 1, GOTO Y_EV14xa
---------------------------------------------------------------------------------
Y_EV14da [ YEV14da ] CH beat up by responsible adult in last 3M
Has this happened in the last 3 months?
^Fills.Y_EV14
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV14
lessthan11 USE CARD 32A.
---------------------------------------------------------------------------------
Y_EV14xa [ YEV14xa ] CH beat up by responsible adult w/curr residents
Has this happened with the people you live with now?
^Fills.Y_EV14
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV14
lessthan11 USE CARD 32A.
---------------------------------------------------------------------------------
Y_EV15a [ YEV15a ] #Xs CH saw persib steal in home where lived
^Fills.Y_EV15 How many times have you seen a person steal stuff from another person in a home
you've lived in? (Would you say never, one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV15
lessthan11 USE CARD 33. Chris is at home. Chris sees a person steal stuff from
another person at home.
elevenmore
Logic after:
IF RESPONSE = 1, DK, RE, GOTO Y_EV16a
---------------------------------------------------------------------------------
Y_EV15aa [ YEV15aa ] CH saw adult steal in home where live in last M
Have you seen this happen in the last month?
^Fills.Y_EV15a
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV15a
lessthan11 USE CARD 33A.
---------------------------------------------------------------------------------
Y_EV15xa [ YEV15xa ] CH saw adult steal in home where lived w/current residents
Have you seen this happen with the people you live with now?
^Fills.Y_EV15a
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV15a
lessthan11 USE CARD 33A.
---------------------------------------------------------------------------------
Y_EV16a [ YEV16a ] #Xs CH saw adult point gun/knife at other
^Fills.Y_EV16a How many times have you seen a person point a knife or a real gun at another
person in a home you've lived in? (Would you say never, one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV16a
lessthan11 USE CARD 34. Chris is at home. Chris sees an adult point a knife or a
real gun at another person at home.
elevenmore
Logic after:
IF RESPONSE = 1, DK, RE, GOTO Y_EV17a
---------------------------------------------------------------------------------
Y_EV16aa [ YEV16aa ] CH saw adult point gun/knife at other in last M
Have you seen this happen in the last month?
^Fills.Y_EV16
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV16
lessthan11 USE CARD 34A.
---------------------------------------------------------------------------------
Y_EV16xa [ YEV16xa ] CH saw adult point gun/knife at other w/curr residents
Have you seen this happen with the people you live with now?
^Fills.Y_EV16
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV16
lessthan11 USE CARD 34A.
---------------------------------------------------------------------------------
Y_EV17a [ YEV17a ] #Xs adult pointed gun/knife at CH
^Fills.Y_EV17a How many times has an adult pointed a knife or a real gun at you in a home
you've lived in? (Would you say never, one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV17a
lessthan11 USE CARD 35. At home, an adult points a knife or a real gun at Chris.
elevenmore
Logic after:
IF RESPONSE = 1, DK, RE, GOTO Y_EV18a
---------------------------------------------------------------------------------
Y_EV17aa [ YEV17aa ] Adlt who pointed gun/knife responsible for CH care
Was that someone who was responsible for taking care of you?
^Fills.Y_EV17
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV17
lessthan11 USE CARD 35A.
---------------------------------------------------------------------------------
Y_EV17ba [ YEV17ba ] Adult point gun/knife at CH this W
Has this happened in the last week?
^Fills.Y_EV17
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV17
lessthan11 USE CARD 35A.
Logic after:
IF RESPONSE = 1, GOTO Y_EV17xa
---------------------------------------------------------------------------------
Y_EV17ca [ YEV17ca ] Adult point gun/knife at CH in last M
Has this happened in the last month?
^Fills.Y_EV17
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV17
lessthan11 USE CARD 35A.
Logic after:
IF RESPONSE = 1, GOTO Y_EV17xa
---------------------------------------------------------------------------------
Y_EV17da [ YEV17da ] Adult point gun/knife at CH in past 3M
Has this happened in the last 3 months?
^Fills.Y_EV17
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV17
lessthan11 USE CARD 35A.
---------------------------------------------------------------------------------
Y_EV17xa [ YEV17xa ] Adult point gun/knife at CH w/curr residents
Has this happened with the people you live with now?
^Fills.Y_EV17
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV17
lessthan11 USE CARD 35A.
---------------------------------------------------------------------------------
Logic before:
IF AGE >=11, GOTO Y_EV19a
Y_EV18a [ YEV18a ] #Xs CH went shopping
USE CARD 36. Chris goes shopping. How many times have you gone shopping? (Would you
say never, one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
---------------------------------------------------------------------------------
Y_EV19a [ YEV19a ] #Xs CH saw adult stab other adult
^Fills.Y_EV19 How many times have you seen a person stab another person with a knife in a
home you've lived in? (Would you say never, one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV19
lessthan11 USE CARD 37. Chris is at home. Chris sees an adult stab another
person with a knife at home.
elevenmore
Logic after:
IF RESPONSE = 1, DK, RE, GOTO Y_EV20a
---------------------------------------------------------------------------------
Y_EV19aa [ YEV19aa ] CH saw adult stab other in last M
Have you seen this happen in the last month?
^Fills.Y_EV19a
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV19a
lessthan11 USE CARD 37A.
---------------------------------------------------------------------------------
Y_EV19xa [ YEV19xa ] CH saw adult stab other w/curr residents
Have you seen this happen with the people you live with now?
^Fills.Y_EV19a
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV19a
lessthan11 USE CARD 37A.
---------------------------------------------------------------------------------
Y_EV20a [ YEV20a ] #Xs CH saw adult shoot another person
^Fills.Y_EV20a How many times have you seen a person shoot another person with a real gun in
a home you've lived in? (Would you say never, one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV20a
lessthan11 USE CARD 38. Chris is at home. Chris sees an adult shoot another
person with a real gun at home.
elevenmore
Logic after:
IF RESPONSE = 1, DK, RE, GOTO Y_EV21a
---------------------------------------------------------------------------------
Y_EV20aa [ YEV20aa ] CH saw adult shoot other in last M
Have you seen this happen in the last month?
^Fills.Y_EV20
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV20
lessthan11 USE CARD 38A.
---------------------------------------------------------------------------------
Y_EV20xa [ YEV20xa ] CH saw adult shoot other w/curr residents
Have you seen this happen with the people you live with now?
^Fills.Y_EV20
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV20
lessthan11 USE CARD 38A.
---------------------------------------------------------------------------------
Y_EV21a [ YEV21a ] #Xs CH saw person arrested at home
^Fills.Y_EV21 How many times have you seen a person being arrested in a home you've lived in?
(Would you say never, one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV21
lessthan11 USE CARD 39. Chris is at home. Chris sees a person being arrested at
home.
elevenmore
Logic after:
IF RESPONSE = 1, DK, RE, GOTO Y_EV22a
---------------------------------------------------------------------------------
Y_EV21aa [ YEV21aa ] CH saw person arrested in last M
Have you seen this happen in the last month?
^Fills.Y_EV21a
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV21a
lessthan11 USE CARD 39A.
---------------------------------------------------------------------------------
Y_EV21xa [ YEV21xa ] CH saw person arrested w/curr residents
Have you seen this happen with the people you live with now?
^Fills.Y_EV21a
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV21a
lessthan11 USE CARD 39A.
---------------------------------------------------------------------------------
Y_EV22a [ YEV22a ] #Xs saw persn deal drugs at home
^Fills.Y_EV22a How many times have you seen a person dealing drugs in a home you've lived in?
(Would you say never, one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV22a
lessthan11 USE CARD 40. Chris is at home. Chris sees a person dealing drugs at
home.
elevenmore
Logic after:
IF RESPONSE = 1, DK, RE, GOTO Y_EV23a
---------------------------------------------------------------------------------
Y_EV22aa [ YEV22aa ] CH saw person deal drugs in last M
Have you seen this happen in the last month?
^Fills.Y_EV22
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV22
lessthan11 USE CARD 40A.
---------------------------------------------------------------------------------
Y_EV22xa [ YEV22xa ] CH saw person deal drugs w/curr residents
Have you seen this happen with the people you live with now?
^Fills.Y_EV22
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV22
lessthan11 USE CARD 40A.
---------------------------------------------------------------------------------
Y_EV23a [ YEV23a ] #Xs CH saw kid getting spanked
^Fills.Y_EV23a How many times have you seen a kid getting spanked? (Would you say never,
one time, a few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV23a
lessthan11 USE CARD 41. Chris sees a kid getting spanked.
elevenmore
Logic after:
IF RESPONSE = 1, DK, RE, GOTO Y_EV24a
---------------------------------------------------------------------------------
Y_EV23aa [ YEV23aa ] CH saw kid getting spanked in last M
Have you seen this happen in the last month?
^Fills.Y_EV23
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV23
lessthan11 USE CARD 41A.
---------------------------------------------------------------------------------
Y_EV23xa [ YEV23xa ] CH saw kid getting spanked w/curr residents
Have you seen this happen with the people you live with now?
^Fills.Y_EV23
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV23
lessthan11 USE CARD 41A.
---------------------------------------------------------------------------------
Y_EV24a [ YEV24a ] #Xs CH was spanked
^Fills.Y_EV24a How many times has a person spanked you? (Would you say never, one time, a
few times, or lots of times?)
Question Type: THO3F
nvr 1 Never
once 2 One time
fewtms 3 A few times
lots 4 Lots of times
Question Fill: ^FillY_EV24a
lessthan11 USE CARD 42. A person spanks Chris.
elevenmore
Logic after:
IF RESPONSE = 1, DK, RE, GOTO Y_EVEND
---------------------------------------------------------------------------------
Y_EV24aa [ YEV24aa ] CH was spanked in last M
Has this happened in the last month?
^Fills.Y_EV24
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV24
lessthan11 USE CARD 42A.
---------------------------------------------------------------------------------
Y_EV24xa [ YEV24xa ] CH was spanked w/curr residents
Has this happened with the people you live with now?
^Fills.Y_EV24
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_EV24
lessthan11 USE CARD 42A.
Logic after:
Y_EVEND
---------------------------------------------------------------------------------
Y_EV_END [ YEV_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
Logic after:
Y_IPEND
---------------------------------------------------------------------------------
Logic before:
IF AGE < 11 OR CHILD IS YOUNG ADULT (18+) OR EMANCIPATED, GOTO Y_SVEND. ELSE,
CONTINUE.
Y_SV0 [ YSV0 ] NO LABEL
The following questions ask about services you may have received from different places in the
past 6 months.
Press "1" and the [Enter] key to continue.
Question Type: TCont
Continue 1 Continue
---------------------------------------------------------------------------------
Y_SV1a [ YSV1a ] CH went to peer support groups
A peer support group is a group of young people who meet to talk about things that are important
to them. Usually an adult leads the group, and they might meet at school or a community center.
In the @Bpast 6 months@B have you gone to any peer support groups?
FR NOTE: ONLINE OR VIRTUAL MEETINGS SHOULD BE INCLUDED.
NOTE: PEER SUPPORT GROUPS (LIKE ALATEEN) ARE COMPRISED OF CHILDREN WITH
SIMILAR MEDICAL, EMOTIONAL, PHYSICAL, OR MENTAL HEALTH PROBLEMS (E.G.,
CHILDREN WHO HAVE BEEN ADOPTED, ABUSED, ETC.).
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_SV2a [ YSV2a ] CH went to comm youth ctr
In the @Bpast 6 months@B have you gone to a "drop-in" or community youth center? (These
include community recreation centers, Boys/Girls Clubs, YMCA/YWCA, kids clubs, etc.)
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_SV3a [ YSV3a ] CH recd family plan services
In the @Bpast 6 months@B, have you received any family planning services - like birth control
pills, condoms, or information on making decisions about having sex?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_SV4a [ YSV4a ] CH recd trtmnt for drug/alc probs
In the @Bpast 6 months@B, did you get any kind of professional treatment for an alcohol or drug
problem?
NOTE: TREATMENT SHOULD HAVE BEEN PROVIDED BY A MENTAL HEALTH, MEDICAL, OR
OTHER ALCOHOL/DRUG TREATMENT PROFESSIONAL, NOT BY A CASEWORKER.
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_SV5a [ YSV5a ] CH went to hosp ER
In the @Bpast 6 months@B, did you go to the hospital emergency room for any reason?
NOTE: DO NOT INCLUDE VISITS TO URGENT CARE CENTERS.
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_SV5a = No GOTO Y_SV9a
---------------------------------------------------------------------------------
Y_SV6a [ YSV6a ] CH went to hosp ER for drug/alc prbs
In the @Bpast 6 months@B, did you go to the hospital emergency room because of a problem
with drugs or alcohol?
NOTE: DO NOT INCLUDE VISITS TO URGENT CARE CENTERS.
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_SV6a = No GOTO Y_SV7a
---------------------------------------------------------------------------------
Y_SV6aa [ YSV6aa ] #Xs CH went to ER for DA probs
How many times in the past 6 months have you gone to the hospital emergency room because of
a problem with drugs or alcohol?
NOTE: DO NOT INCLUDE VISITS TO URGENT CARE CENTERS.
Question Type: TSV6aa
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourxs 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't gone to the emergency room for this in the past 6 months
---------------------------------------------------------------------------------
Y_SV7a [ YSV7a ] Did CH go to ER for illness
In the @Bpast 6 months@B, did you go to the hospital emergency room for an illness or an
injury?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_SV7a = No GOTO Y_SV8a
---------------------------------------------------------------------------------
Y_SV7aa [ YSV7aa ] #Xs CH went to ER for illness
How many times in the past 6 months have you gone to the hospital emergency room for an
illness or injury?
NOTE: DO NOT INCLUDE VISITS TO URGENT CARE CENTERS.
Question Type: TSV6aa
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourxs 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't gone to the emergency room for this in the past 6 months
---------------------------------------------------------------------------------
Y_SV8a [ YSV8a ] Did CH go to ER for depression
In the @Bpast 6 months@B, did you go to the hospital emergency room because you felt
depressed or blue?
NOTE: DO NOT INCLUDE VISITS TO URGENT CARE CENTERS.
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_SV8a = No GOTO Y_SV9a
---------------------------------------------------------------------------------
Y_SV8aa [ YSV8aa ] #Xs CH went to ER for depression
How many times in the past 6 months have you gone to the hospital emergency room because
you felt depressed or blue?
NOTE: DO NOT INCLUDE VISITS TO URGENT CARE CENTERS.
Question Type: TSV6aa
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourxs 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't gone to the emergency room for this in the past 6 months
---------------------------------------------------------------------------------
Y_SV9a [ YSV9a ] CH got counsel to deal w/depress
In the @Bpast 6 months@B, did you get any kind of counseling from a school counselor, doctor,
or therapist to help you deal with feeling depressed or blue?
NOTE: DO NOT INCLUDE COUNSELING FROM A CASEWORKER.
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
GOTO Y_SVEND
---------------------------------------------------------------------------------
Logic before:
IF AGE >= 11, OR CHILD IS EMACIPATED OR YOUNG ADULT (18+), GOTO Y_SA0. ELSE, GO
TO Y_SAEND.
Y_SA0 [ YSA0 ] NO LABEL
The following questions ask about alcohol, different drugs, and tobacco.
Please remember that all your answers are private.
Press "1" and the [Enter] key to continue.
Question Type: TCont
Continue 1 Continue
Y_SA1
During the past 12 months, have you used any alcohol, marijuana, cocaine, heroin, or other substances?
1=YES
2=NO [GO TO Y_SA5]
Y_SA1a
[During the past 12 months,]
Have you tried to hide that you were using alcohol, marijuana, or other drugs?
1=YES
2=NO
Y_SA1b
[During the past 12 months,]
Have your parents, family, partner, co-workers, classmates, or friends complained about your alcohol, marijuana, or other drug use?
1=YES
2=NO
Y_SA1c
[During the past 12 months,]
Have you used alcohol, marijuana, or other drugs weekly?
1=YES
2=NO
Y_SA1d
[During the past 12 months,]
Has alcohol, marijuana, or other drug use caused you to feel depressed, nervous, suspicious, uninterested in things, reduced your sexual desire or caused other psychological problems?
1=YES
2=NO
Y_SA1e
[During the past 12 months,]
Has alcohol, marijuana, or other drug use caused you to have numbness, tingling, shakes, blackouts, hepatitis, TB, sexually transmitted disease or any other health problems?
1=YES
2=NO
Y_SA2a
[During the past 12 months,]
Have you kept using alcohol, marijuana, or other drugs even though you knew it was keeping you from meeting your responsibilities at work, school, or home?
1=YES
2=NO
Y_SA2b
[During the past 12 months,]
Have you used alcohol, marijuana, or other drugs where it made the situation unsafe or dangerous for you, such as when you were driving a car, using a machine, or where you might have been forced into sex or hurt?
1=YES
2=NO
Y_SA2c
[During the past 12 months,]
Has alcohol, marijuana, or other drug use caused you to have repeated problems with the law?
1=YES
2=NO
Y_SA2d
[During the past 12 months,]
Have you kept using alcohol, marijuana, or other drugs even after you knew it could get you into fights or other kinds of legal trouble?
1=YES
2=NO
Y_SA3a
[During the past 12 months,]
Have you needed more alcohol, marijuana, or other drugs to get the same high or found that the same amount did not get you as high as it used to?
1=YES
2=NO
Y_SA3b
[During the past 12 months,]
Have you had withdrawal problems from alcohol, marijuana, or other drugs like shaking hands, throwing up, having trouble sitting still or sleeping, or have you used any alcohol, marijuana, or other drugs to stop being sick or avoid withdrawal problems?
1=YES
2=NO
Y_SA3c
[During the past 12 months,]
Have you used alcohol, marijuana, or other drugs in larger amounts more often or for a longer time than you meant to?
1=YES
2=NO
Y_SA3d
[During the past 12 months,]
Have you been unable to cut down or stop using alcohol, marijuana, or other drugs?
1=YES
2=NO
Y_SA3e
[During the past 12 months,]
Have you spent a lot of time either getting alcohol, marijuana, or other drugs, using them, or feeling the effects of them (high, sick)?
1=YES
2=NO
Y_SA3f
[During the past 12 months,]
Has alcohol, marijuana, or other drugs caused you to give up, reduce or have problems at important activities as work, school, home or social events?
1=YES
2=NO
Y_SA3g
[During the past 12 months,] Have you kept using alcohol, marijuana, or other drugs even after you knew it was causing or adding to medical, psychological or emotional problems you were having?
1=YES
2=NO
For the next set of questions, please answer for the last 90 days that you lived in the community. Do not count days when you were living in a jail, hospital, or other place where you could not use alcohol, marijuana, or other drugs.
Y_SA4b
During the last 90 days that you lived in the community, how many days did you drink beer, wine, or any kind of alcohol?
NUMBER OF DAYS _______
Y_SA4c
[During the last 90 days that you lived in the community, how many days did you]
Get drunk or have 5 or more drinks at one time?
NUMBER OF DAYS _______
Y_SA4d
[During the last 90 days that you lived in the community, how many days did you]
Smoke or use any kind of marijuana, blunts, or hashish?
NUMBER OF DAYS _______
Y_SA4e
[During the last 90 days that you lived in the community, how many days did you]
Use LSD, cocaine, heroin, ecstasy, inhalants, or any other kind of drug?
NUMBER OF DAYS _______ IF NUMBER OF DAYS > 0 THEN ASK Y_SA4EA
Y_SA4ea
What did you use? CODE ALL THA APPLY
1=Cocaine
2=Heroin
3=Ecstasy
4=Inhalants
5=Other kind of drug
Y_SA4f
[During the last 90 days that you lived in the community, how many days did you]
Go without using any alcohol, marijuana, or other drug?
NUMBER OF DAYS _______
Y_SA5
[During the last 90 days that you lived in the community, how many days did you]
On how many days did you smoke any kind of tobacco?
NUMBER OF DAYS _______
---------------------------------------------------------------------------------
IF AGE < 11, GOTO Y_SXEND. IF CHILD IS YOUNG ADULT (18+) OR EMANCIPATED, CONTINUE.
The next questions are about sexual activity. Please remember that your answers are private.
---------------------------------------------------------------------------------
Y_SX1a
During your life, with whom, if anyone, have you had sexual contact?
1=I have never had sexual contact
2=Females
3=Males
4=Females and males
---------------------------------------------------------------------------------
Logic before:
Y_SX10a [ YSX20a ] Have you ever had sex or sexual intercourse?
Have you ever had sex or sexual intercourse?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_SX10a = 2 GO TO Y_SXEND
---------------------------------------------------------------------------------
Y_SX11a [ YSX21a ] Frst time u had sex, was it frcd or not frcd?
Think about the first time you had sex, would you say it was forced or not forced? "Forced"
means that the sex was against your will, and "not forced" means it was something that you
wanted to happen or that it was okay with you.
Question Type: TYSX11a
forced 1 Forced (it was against my will)
notforced 2 Not forced (I wanted it to happen, or it was okay with me)
---------------------------------------------------------------------------------
Y_SX12a [ YSX22a ] How old were you this first time you had sex?
How old were you this @Bfirst@B time you had sex?
Question Type: TYSX12a
eight 8 8 years old or younger
nine 9 9 years old
ten 10 10 years old
eleven 11 11 years old
twelve 12 12 years old
thirteen 13 13 years old
fourteen 14 14 years old
fifteen 15 15 years old
sixteen 16 16 years old
seventeen 17 17 years old
eighteen 18 18 years old or older
---------------------------------------------------------------------------------
Logic before:
IF Y_SX11a = DK/REF, FOLLOW SAME SKIP PATTERN AS IF SX11a = NO.
Y_SX13a [ YSX23a ] Had sex you wntd to hpn/was forced?
^Fills.Y_SX13a
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_SX13a
forced Have you ever had sex that you wanted to happen or that was okay with
you?
notforced Have you ever had sex that was forced -- that is, that was against your
Logic after:
IF Y_SX13a = 2 GO TO Y_SX15a
---------------------------------------------------------------------------------
Logic before:
IF Y_SX11a = 1 fill: sex that you wanted to happen or that was okay with you; IF Y_SX11a = 2 OR
DK/REF fill: sex that was forced or against your will
Y_SX14a [ YSX24a ] How old were you the frst time you had sex you wntd/was frcd
How old were you the first time you had ^Fills.Y_SX14a?
Question Type: TYSX12a
eight 8 8 years old or younger
nine 9 9 years old
ten 10 10 years old
eleven 11 11 years old
twelve 12 12 years old
thirteen 13 13 years old
fourteen 14 14 years old
fifteen 15 15 years old
sixteen 16 16 years old
seventeen 17 17 years old
eighteen 18 18 years old or older
Question Fill: ^FillY_SX14a
forced sex that you wanted to happen or that was okay with you
notforced sex that was forced or against your will
---------------------------------------------------------------------------------
Logic before:
IF R IS MALE fill: Counting all your female partners, even those you had sex with only once, how
many females have you had sex with @Bin your life@B?; IF R IS FEMALE fill: Counting all your
male partners, even those you had sex with only once, how many males have you had sex with
@Bin your life@B?
Y_SX15a [ YSX25a ] How mny females/males hve you had sex with in ur life?
^Fills.Y_SX15a
Question Type: TYSX15a
one 1 1 partner
two 2 2 partners
threefive 3 3 - 5 partners
sixnine 4 6 - 9 partners
tenormore 5 More than 10 partners
Question Fill: ^FillY_SX15a
male Counting all your female partners, even those you had sex with only
once, how many females have you had sex with @Bin your life@B?
female Counting all your male partners, even those you had sex with only once,
how many males have you had sex with @Bin your life@B?
---------------------------------------------------------------------------------
Y_SX15b
The last time you had sexual intercourse, did you or your partner use a condom?
1 YES
2 NO
---------------------------------------------------------------------------------
Y_SX15c
Did you drink alcohol or use drugs before you had sexual intercourse the last time?
1 YES
2 NO
---------------------------------------------------------------------------------
Y_SX16a [ YSX26a ] Have you had sex anytime in the past 12 months?
Have you had sex anytime in the past 12 months?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_SX16a = 2 GO TO Y_SX18a
---------------------------------------------------------------------------------
Logic before:
IF R IS MALE: In the past 12 months, how many females have you had sex with? Please count
every female sexual partner, even those you had sex with only once, or if you did not know her
well.; IF R IS FEMALE fill: In the past 12 months, how many males have you had sex with?
Please count every male sexual partner, even those you had sex with only once, or if you did not
Y_SX17a [ YSX27a ] Pst 12 mnths, how mny F/M have you had sex with?
^Fills.Y_SX17a
Question Type: TYSX15a
one 1 1 partner
two 2 2 partners
threefive 3 3 - 5 partners
sixnine 4 6 - 9 partners
tenormore 5 More than 10 partners
Question Fill: ^FillY_SX17a
male In the past 12 months, how many females have you had sex with? Please
count every female sexual partner, even those you had sex with only
once, or if you did not know her well.
female In the past 12 months, how many males have you had sex with? Please
count every male sexual partner, even those you had sex with only once,
or if you did not know him well.
---------------------------------------------------------------------------------
Y_SX18a [ YSX28a ] Labels are in Logic After
The most recent time you had sex, what method or methods did you or your partner use to
prevent a pregnancy? Please check all methods you or your partner used that time.
TO CHOOSE MORE THAN ONE OPTION, PRESS THE SPACE BAR BETWEEN YOUR
ANSWERS OR USE THE MOUSE TO CHOOSE YOUR OPTIONS.
Question Type: TYSX18aS
none 1 We did not use any method
condom 2 Condom
withdrwl 3 Withdrawal ("pulling out")
bcp 4 Birth control pill
shot_ring_patch 5 A shot (such as Depo-Provera), patch (such as Ortho Evra), or birth control ring (such as NuvaRing) patch
iud 6 An IUD (such as Mirena or ParaGard) or implant (such as Implanon or Nexplanon)
other 7 Other methods
Logic after:
YSX18a_1 --Birth control used last time had sex - None; YSX18a_2 --Birth control used last time
had sex - Male condom; YSX18a_3 --Birth control used last time had sex - Withdrawal; YSX18a_4 --Birth control used last time had sex - Birth control pill; YSX18a_5 --Birth control used last time
had sex - Birth control injectn; YSX18a_6 --Birth control used last time had sex - Birth control
patch; YSX18a_7 --Birth control used last time had sex - Other methods; YSX18a_8--Birth control used last time had sex - DK; YSX18a_9--Birth control used last time had sex - RF
---------------------------------------------------------------------------------
Logic before:
IF R IS MALE fill: gotten someone pregnant; IF R IS FEMALE fill: been pregnant
Y_SX19a [ YSX29a ] How many times have you ever been/gttn someone prgnt?
How many times have you ever ^Fills.Y_SX19a?
Question Type: TYSX19a
never 0 I have never (gotten anyone pregnant/gotten pregnant)
once 1 once
twice 2 two times
thrice 3 three times
fourmore 4 four or more times
Question Fill: ^FillY_SX19a
male gotten someone pregnant
female been pregnant
Logic after:
IF Y_SX19a = 0 GO TO Y_SX22a
---------------------------------------------------------------------------------
Logic before:
IF R IS FEMALE fill: you got pregnant?; IF R IS MALE fill: you got someone pregnant?
Y_SX20a [ YSX30a ] How old wre u the time/frst time you got/got someone prgnt?
How old were you the^Fills.Y_SX20a1 time ^Fills.Y_SX20a2?
Question Type: TYSX20a
ten 10 10 years old
eleven 11 11 years old
twelve 12 12 years old
thirteen 13 13 years old
fourteen 14 14 years old
fifteen 15 15 years old
sixteen 16 16 years old
seventeen 17 17 years old
eighteen 18 18 years old or older
Question Fill: ^FillY_SX20a1
once
moreonce ·first
Question Fill: ^FillY_SX20a2
male you got someone pregnant
female you got pregnant
---------------------------------------------------------------------------------
Y_SX21a [ YSX31a ] How mny chldrn have you had (lvng with you or not)?
How many children have you had, including all children living with you or not?
Question Type: TYSX21a
none 0 I have never had a child
one 1 1 child
two 2 2 children
threemore 3 3 or more children
---------------------------------------------------------------------------------
IF AGE11-18+, ASK Y_SX32a. ELSE, SKIP TO Y_SX_END.
Y_SX32a [ YSX32a ] NO LABEL
Which of the following best represents how you think of yourself?
Question Type: Tsexor
_1 1 Lesbian or gay
_2 2 Straight, that is, not gay or lesbian
_3 3 Bisexual
_4 4 [IF Y_CH8a = 1] Two-Spirit 5 5 I use a different term
6) DON’T KNOW
7) PREFER NOT TO ANSWER
IF Y_SX32a = 5, ASK Y_SX3OTH
Y_SX3OTH
What is the term that you use?
[TEXT BOX]
DON’T KNOW
PREFER NOT TO ANSWER
Y_SX_END [ YSX_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
Y_DE_BGN [ YDE_BGN ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF AGE <11, GOTO Y_DEEND. IF CHILD IS YOUNG ADULT (18+) OR EMANCIPATED, GOTO
Y_DE7. ELSE, CONTINUE.
Y_DE1a [ YDE1a ] CH run away from home - past 6M
The next questions are about your behavior. Please tell me the number of times you've done each
of these things during the past @B6 months@B. Your best guess will do. No one will tell your
family or teachers anything about your answers. Your answers are private.
In the @Bpast 6 months@B, have you run away from home?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE1a = 2 GOTO Y_DE3a
---------------------------------------------------------------------------------
Y_DE2a [ YDE2a ] # Xs CH ran away from home - past 6M
How many times in the past 6 months have you run away from home?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
Logic after:
IF ANSWER OPTION 8 = HAVE NOT RUN AWAY, GOTO Y_DE3a.
---------------------------------------------------------------------------------
Y_DE2aa [ YDE2aa ] Labels are in Logic After
Why did you run away from home?
CODE ALL THAT APPLY. TO CHOOSE MORE THAN ONE OPTION, PRESS THE SPACE BAR
BETWEEN YOUR ANSWERS OR USE THE MOUSE TO CHOOSE YOUR OPTIONS.
Question Type: TDE2aaS
getaway 1 To get away from parents
forfun 2 For fun and adventure
hadfight 3 Had fight with parents
other 4 Other
Logic after:
YDE2aa_1 --Why did you run away from home? - To get away from parents; YDE2aa_2 --Why did
you run away from home? - For fun and adventure; YDE2aa_3 --Why did you run away from home?
- Had fight with parents; YDE2aa_4 --Why did you run away from home? - Other; YDE2aa_5--Why
did you run away from home? - DK; YDE2aa_6--Why did you run away from home? - RF
---------------------------------------------------------------------------------
Y_DE2bn [ YDE2bn ] How long were you gone from home (number)?
How long were you gone from home?
NUMBER:
Question Type: 0..500
---------------------------------------------------------------------------------
Y_DE2ba [ YDE2ba ] How long were you gone from home (hrs/days/wks/yrs)?
(Is that the number of hours, days, weeks, or months?)
Question Type: THDWMY
hours 1 Hours
days 2 Days
weeks 3 Weeks
months 4 Months
years 5 Years
---------------------------------------------------------------------------------
Y_DE2ca [ YDE2ca ] Were you gone overnight?
Were you gone overnight?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_DE2da [ YDE2da ] Where did you run to?
Where did you run to?
Question Type: TDE2da
relatives 1 Relative's
friends 2 Friend's place
other 3 Other
---------------------------------------------------------------------------------
Y_DE2fa [ YDE2fa ] Were you alone or with others?
Were you alone or with others?
Question Type: TDE2fa
alone 1 Alone
wothers 2 With others
---------------------------------------------------------------------------------
Y_DE3a [ YDE3a ] Past 6M CH skipped classes/sch.
In the @Bpast 6 months@B, have you skipped classes or school without an excuse?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE3a = 2 GOTO Y_DE5a
---------------------------------------------------------------------------------
Y_DE4a [ YDE4a ] # Xs CH skipped classes/sch past 6M
How many times in the past 6 months have you skipped classes or school without an excuse?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE5a [ YDE5a ] Past 6M CH lied about age for movie
In the @Bpast 6 months@B, have you lied about your age to get into some place or to buy
something, for example lying about your age to get into a movie or to buy alcohol?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE5a = 2 GOTO Y_DE7a
---------------------------------------------------------------------------------
Y_DE6a [ YDE6a ] # Xs CH lied about age for movie past 6M
How many times in the past 6 months have you lied about your age to get into some place or to
buy something, for example lying about your age to get into a movie or to buy alcohol?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Logic before:
[READ INTRO ONLY IF AGE IS >=18 OR EMANCIPATED.]
Y_DE7a [ YDE7a ] Past 6M CH hitchhiked
^Fills.Y_DE7a In the @Bpast 6 months@B, have you hitchhiked where it was illegal to do so?
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_DE7a
forya_ey The next questions are about your behavior. Please tell me the number of
times you’ve done each of these things during the past @B6 months@B.
Your best guess will do. No one will tell anyone about your answers.
Your answers are private.
·
notya_ey
Logic after:
IF Y_DE7a = 2 GOTO Y_DE9a
---------------------------------------------------------------------------------
Y_DE8a [ YDE8a ] # Xs CH hitchicked past 6M
How many times in the past 6 months have you hitchhiked where it was illegal to do so?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE9a [ YDE9a ] Past 6M CH carried hidden weapon
In the @Bpast 6 months@B, have you carried a hidden weapon?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE9a = 2 GOTO Y_DE11a
---------------------------------------------------------------------------------
Y_DE10a [ YDE10a ] # Xs CH carried hidden weapon past 6M
How many times in the past 6 months have you carried a hidden weapon?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE11a [ YDE11a ] Past 6M CH unruly in public
In the @Bpast 6 months@B, have you been loud, rowdy, or unruly in a public place so that
people complained about it or you got in trouble?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE11a = 2 GOTO Y_DE13a
---------------------------------------------------------------------------------
Y_DE12a [ YDE12a ] # Xs CH unruly in public past 6M
How many times in the past 6 months have you been loud, rowdy, or unruly in a public place so
that people complained about it or you got in trouble?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE13a [ YDE13a ] Past 6M CH begged $/things
In the @Bpast 6 months@B, have you begged for money or things from strangers?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE13a = 2 GOTO Y_DE15a
---------------------------------------------------------------------------------
Y_DE14a [ YDE14a ] # Xs CH begged $/things past 6M
How many times in the past 6 months have you begged for money or things from strangers?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE15a [ YDE15a ] Past 6M CH was drunk in pub
In the @Bpast 6 months@B, have you been drunk in a public place?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE15a = 2 GOTO Y_DE16aa
---------------------------------------------------------------------------------
Y_DE16a [ YDE16a ] # Xs CH drunk in public past 6M
How many times in the past 6 months have you been drunk in a public place?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE16aa [ YDE16aa ] Past 6MC CH painted graffiti or signs
In the @Bpast 6 months@B, have you painted graffiti or signs on someone else's property or in a
public place?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE16aa = 2 GOTO Y_DE17a
---------------------------------------------------------------------------------
Y_DE16ba [ YDE16ba ] # Xs CH painted graffit past 6M
How many times in the past 6 months have you painted graffiti or signs on someone else's
property or in a public place?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE17a [ YDE17a ] Past 6M CH damaged property
In the @Bpast 6 months@B, have you purposely damaged or destroyed property that did not
belong to you, for example, painting, breaking, cutting, or marking up something?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE17a = 2 GOTO Y_DE19a
---------------------------------------------------------------------------------
Y_DE18a [ YDE18a ] # Xs CH damaged property past 6M
How many times in the past 6 months have you purposely damaged or destroyed property that
did not belong to you, for example, painting, breaking, cutting, or marking up something?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE19a [ YDE19a ] Past 6M CH set fire to house/prop
In the @Bpast 6 months@B, have you purposely set fire to a house, building, car, or other
property or tried to do so?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE19a = 2 GOTO Y_DE21a
---------------------------------------------------------------------------------
Y_DE20a [ YDE20a ] # Xs CH set fire to house/prop past 6M
How many times in the past 6 months have you purposely set fire to a house, building, car, or
other property or tried to do so?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE21a [ YDE21a ] Past 6M CH avoided paying
In the @Bpast 6 months@B, have you avoided paying for things such as movies, bus or subway
rides, food, or clothing?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE21a = 2 GOTO Y_DE23a
---------------------------------------------------------------------------------
Y_DE22a [ YDE22a ] # Xs CH avoided paying past 6M
How many times in the past 6 months have you avoided paying for things such as movies, bus, or
subway rides, food, or computer services?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE23a [ YDE23a ] Past 6M CH went in bldg to steal
In the @Bpast 6 months@B, have you gone into or tried to go into a building to steal something?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE23a = 2 GOTO Y_DE25a
---------------------------------------------------------------------------------
Y_DE24a [ YDE24a ] # Xs CH went in bldg to steal past 6M
How many times in the past 6 months have you gone into or tried to go into a building to steal
something?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE25a [ YDE25a ] Past 6M CH stole things < $5
In the @Bpast 6 months@B, have you stolen or tried to steal things worth $5 or less?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE25a = 2 GOTO Y_DE27a
---------------------------------------------------------------------------------
Y_DE26a [ YDE26a ] # Xs CH stole things < $5 past 6M
How many times in the past 6 months have you stolen or tried to steal things worth $5 or less?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE27a [ YDE27a ] Past 6M CH stole items < $5+ > $50
In the @Bpast 6 months@B, have you stolen or tried to steal things worth between $5 and $50?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE27a = 2 GOTO Y_DE29a
---------------------------------------------------------------------------------
Y_DE28a [ YDE28a ] # Xs CH stole items < $5+ > $50 past 6M
How many times in the past 6 months have you stolen or tried to steal things worth between $5
and $50?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE29a [ YDE29a ] Past 6M CH stole items < $50+ > $100
In the @Bpast 6 months@B, have you stolen or tried to steal things worth between $50 and
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE29a = 2 GOTO Y_DE31a
---------------------------------------------------------------------------------
Y_DE30a [ YDE30a ] # Xs CH stole items < $50+ > $100 past 6M
How many times in the past 6 months have you stolen or tried to steal things worth between $50
and $100?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE31a [ YDE31a ] Past 6M CH stole items > $100
In the @Bpast 6 months@B, have you stolen or tried to steal something worth $100 or more?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE31a = 2 GOTO Y_DE33a
---------------------------------------------------------------------------------
Y_DE32a [ YDE32a ] # Xs CH stole items worth > $100 past 6M
How many times in the past 6 months have you stolen or tried to steal something worth $100 or
more?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE33a [ YDE33a ] Past 6M CH took fr store w/o pay
In the @Bpast 6 months@B, have you taken something from a store without paying for it? This
includes times that you have already told about for other questions.
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE33a = 2 GOTO Y_DE35a
---------------------------------------------------------------------------------
Y_DE34a [ YDE34a ] # Xs CH took fr store w/o pay past 6M
How many times in the past 6 months have you taken something from a store without paying for
it? This includes times that you have already told about for other questions.
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE35a [ YDE35a ] Past 6M CH snatched wallet/purse
In the @Bpast 6 months@B, have you snatched someone's purse or wallet or picked someone's
pocket?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE35a = 2 GOTO Y_DE37a
---------------------------------------------------------------------------------
Y_DE36a [ YDE36a ] # Xs CH snatched wallet/purse past 6M
How many times in the past 6 months have you snatched someone's purse or wallet or picked
someone's pocket?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE37a [ YDE37a ] Past 6M CH took item fr car
In the @Bpast 6 months@B, have you taken something from a car that did not belong to you?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE37a = 2 GOTO Y_DE39a
---------------------------------------------------------------------------------
Y_DE38a [ YDE38a ] # Xs CH took item fr car past 6M
How many times in the past 6 months have you taken something from a car that did not belong to
you?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE39a [ YDE39a ] Past 6M CH bought/sld stolen goods
In the @Bpast 6 months@B, have you knowingly bought, sold or held stolen goods or tried to do
any of these things?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE39a = 2 GOTO Y_DE41a
---------------------------------------------------------------------------------
Y_DE40a [ YDE40a ] # Xs CH bought/sld stolen goods past 6M
How many times in the past 6 months have you knowingly bought, sold or held stolen goods or
tried to do any of these things?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE41a [ YDE41a ] Past 6M CH went joyriding
In the @Bpast 6 months@B, have you gone joyriding, that is, taken a motor vehicle, such as a
car or motorcycle, for a ride or drive without the owner's permission?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE41a = 2 GOTO Y_DE43a
---------------------------------------------------------------------------------
Y_DE42a [ YDE42a ] # Xs CH went joyriding past 6M
How many times in the past 6 months have you gone joyriding, that is, taken a motor vehicle,
such as a car or motorcycle, for a ride or drive without the owner's permission?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE43a [ YDE43a ] Past 6M CH stole vehicle
In the @Bpast 6 months@B, have you stolen or tried to steal a motor vehicle such as a car or
motorcycle?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE43a = 2 GOTO Y_DE45a
---------------------------------------------------------------------------------
Y_DE44a [ YDE44a ] # Xs CH stole vehicle past 6M
How many times in the past 6 months have you stolen or tried to steal a motor vehicle such as a
car or motorcycle?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE45a [ YDE45a ] Past 6 M CH used false checks/$
In the @Bpast 6 months@B, have you used checks illegally or used a slug or fake money to pay
for something?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE45a = 2 GOTO Y_DE47a
---------------------------------------------------------------------------------
Y_DE46a [ YDE46a ] # Xs CH used false checks/$ past 6M
How many times in the past 6 months have you used checks illegally or used a slug or fake
money to pay for something?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE47a [ YDE47a ] Past 6M CH used cr cards w/o perm
In the @Bpast 6 months@B, have you used or tried to use credit cards or bank cards without the
owner's permission?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE47a = 2 GOTO Y_DE49a
---------------------------------------------------------------------------------
Y_DE48a [ YDE48a ] # Xs CH used cr cards w/o perm past 6M
How many times in the past 6 months have you used or tried to use credit cards or bank cards
without the owner's permission?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE49a [ YDE49a ] Past 6M CH sell item above value
In the @Bpast 6 months@B, have you tried to cheat someone by selling them something that
was worthless or not what you said it was?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE49a = 2 GOTO Y_DE51a
---------------------------------------------------------------------------------
Y_DE50a [ YDE50a ] # Xs CH sold item above value past 6M
How many times in the past 6 months have you tried to cheat someone by selling them
something that was worthless or not what you said it was?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE51a [ YDE51a ] Past 6M CH attacked w/intent to hurt
In the @Bpast 6 months@B, have you attacked someone with a weapon or with the idea of
seriously hurting or killing them?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE51a = 2 GOTO Y_DE53a
---------------------------------------------------------------------------------
Y_DE52a [ YDE52a ] # Xs CH attacked w/intent to hurt past 6M
How many times in the past 6 months have you attacked someone with a weapon or with the idea
of seriously hurting or killing them?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE53a [ YDE53a ] Past 6M CH hit to hurt
In the @Bpast 6 months@B, have you hit someone with the idea of hurting them^Fills.Y_DE53a?
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_DE53a
donebefore ·other than the events you just mentioned
notbefore
Logic after:
IF Y_DE53a = 2 GOTO Y_DE55a
---------------------------------------------------------------------------------
Y_DE54a [ YDE54a ] # Xs CH hit to hurt past 6M
How many times in the past 6 months have you hit someone with the idea of hurting
them^Fills.Y_DE53a?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
Question Fill: ^FillY_DE53a
donebefore ·other than the events you just mentioned
notbefore
---------------------------------------------------------------------------------
Y_DE55a [ YDE55a ] Pst6M CH usdd threat/weapon to take $
In the @Bpast 6 months@B, have you used a weapon, force, or strong-arm methods like threats
to get money or things from people?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE55a = 2 GOTO Y_DE57a
---------------------------------------------------------------------------------
Y_DE56a [ YDE56a ] # Xs CH usdd threat/weapon to take $ past 6M
How many times in the past 6 months have you used a weapon, force, or strong-arm methods like
threats to get money or things from people?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE57a [ YDE57a ] Past 6M CH threw rocks/bottles
In the @Bpast 6 months@B, have you thrown objects such as rocks or bottles at people other
than the events that you already mentioned?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE57a = 2 GOTO Y_DE59a
---------------------------------------------------------------------------------
Y_DE58a [ YDE58a ] # Xs CH threw rocks/bottles past 6M
How many times in the past 6 months have you thrown objects such as rocks or bottles at people
other than the events that you already mentioned?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE59a [ YDE59a ] Past 6M CH involved in gang fight
In the @Bpast 6 months@B, have you been involved in a gang fight?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE59a = 2 GOTO Y_DE61a
---------------------------------------------------------------------------------
Y_DE60a [ YDE60a ] # Xs CH involved in gang fight past 6M
How many times in the past 6 months have you been involved in a gang fight?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE61a [ YDE61a ] Past 6M CH paid for having sex
In the @Bpast 6 months@B, have you been paid for having sexual relations with someone?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE61a = 2 GOTO Y_DE63a
---------------------------------------------------------------------------------
Y_DE62a [ YDE62a ] # Xs CH paid for having sex past 6M
How many times in the past 6 months have you been paid for having sexual relations with
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE63a [ YDE63a ] Past 6M CH threat other to have sex
In the @Bpast 6 months@B, have you physically hurt or threatened to hurt someone to get them
to have sex with you?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE63a = 2 GOTO Y_DE65a
---------------------------------------------------------------------------------
Y_DE64a [ YDE64a ] # Xs CH threat other to have sex past 6M
How many times in the past 6 months have you physically hurt or threatened to hurt someone to
get them to have sex with you?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE65a [ YDE65a ] Past 6M CH tried sex against will
In the @Bpast 6 months@B, have you had or tried to have sexual relations with someone against
their will? ^Fills.Y_DE65a
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_DE65a
donebefore Do not include the times you just mentioned in the last question.
notbefore
Logic after:
IF Y_DE65a = 2 GOTO Y_DE67a
---------------------------------------------------------------------------------
Y_DE66a [ YDE66a ] # Xs CH tried sex against will past 6M
How many times in the past 6 months have you had or tried to have sexual relations with
someone against their will? ^Fills.Y_DE65a
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
Question Fill: ^FillY_DE65a
donebefore Do not include the times you just mentioned in the last question.
notbefore
---------------------------------------------------------------------------------
Y_DE67a [ YDE67a ] Past 6M CH sold pot/hash
In the @Bpast 6 months@B, have you sold marijuana or hashish (pot, grass, hash)?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE67a = 2 GOTO Y_DE69a
---------------------------------------------------------------------------------
Y_DE68a [ YDE68a ] # Xs CH sold pot/hash past 6M
How many times in the past 6 months have you sold marijuana or hashish (pot, grass, hash)?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE69a [ YDE69a ] Past 6M CH sold hard drugs
In the @Bpast 6 months@B, have you sold hard drugs such as heroin, cocaine, or crack?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE69a = 2 GOTO Y_DE71a
---------------------------------------------------------------------------------
Y_DE70a [ YDE70a ] # Xs CH sold hard drugs past 6M
How many times in the past 6 months have you sold hard drugs such as heroin, cocaine, or crack?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Y_DE71a [ YDE71a ] Past 6M CH arrested
In the @Bpast 6 months@B, have you been arrested or picked up by the police for something
other than a minor traffic offense?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE71a = 2 GOTO Y_DEEND
---------------------------------------------------------------------------------
Y_DE72a [ YDE72a ] # Xs CH arrested past 6M
How many times in the past 6 months have you been arrested or picked up by the police for
something other than a minor traffic offense?
Question Type: TDE2a
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourx 4 4 times
fivemore 5 5 or more times
notin6mos 8 I haven't done this in the past 6 months
---------------------------------------------------------------------------------
Logic before:
IF Y_DE72a = 8, GOTO Y_DEEND. ELSE, CONTINUE.
Y_DE73a [ YDE73a ] CH arrested/picked up for assault
^Fills.Y_DE73a
Were you arrested or picked up for assault, that is, battery, rape, aggravated assault, or
manslaughter?
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_DE73a
onetime Next, we’d like to know why you were arrested or picked up by the police
in the past 6 months.
moreonetime Next, we’d like to know all of the reasons you have been arrested or
picked up by the police in the past 6 months.
notonce
---------------------------------------------------------------------------------
Y_DE74a [ YDE74a ] CH arrested/picked up for robbery
Were you arrested or picked up for robbery, that is, taking something using a weapon or physical
force?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_DE75a [ YDE75a ] CH arrested/picked up for theft
Still thinking about the last 6 months, were you arrested or picked up for theft or taking something
without using force, such as burglary, larceny or shoplifting?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_DE76a [ YDE76a ] CH arrested/picked up stolen prop
Were you arrested or picked up for receiving, possessing, or selling stolen property?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_DE77a [ YDE77a ] CH arrested destroy prop
Were you arrested or picked up for destroying property, such as vandalism or arson, or another
property offense, such as trespassing or breaking and entering?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_DE78a [ YDE78a ] CH arrested/picked up for drugs
Still thinking about the last 6 months, were you arrested or picked up for a drug related offense,
such as possessing or selling drugs?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_DE78a = 2 GOTO Y_DE79a
---------------------------------------------------------------------------------
Y_DE78aa [ YDE78aa ] CH arrested possessing marijuana
Were you arrested or picked up for possessing or using marijuana or hashish?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_DE78ba [ YDE78ba ] CH arrested for selling marijuana
Were you arrested or picked up for selling marijuana or hashish?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_DE78ca [ YDE78ca ] CH arrested for illegal drugs
Were you arrested or picked up for possessing or using other illegal drugs?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_DE78da [ YDE78da ] CH arrested selling illegal drugs
Were you arrested or picked up for selling or manufacturing other illegal drugs?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_DE79a [ YDE79a ] CH arrested major traffic offense
Were you arrested or picked up for a major traffic offense, such as driving while impaired, reckless
driving, or driving without a license?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_DE80a [ YDE80a ] CH arrested underage drinking
Still thinking about the last 6 months, were you arrested or picked up for drinking or purchasing
alcohol while under the legal age?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_DE81a [ YDE81a ] CH arrested animal abuse/neglect
Were you arrested or picked up for animal abuse or neglect?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_DE82a [ YDE82a ] CH arrested for illegal firearm
Were you arrested or picked up for possessing or selling an illegal firearm?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_DE83a [ YDE83a ] CH arrested for prostitution
Were you arrested or picked up for solicitation or prostitution?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_DE84a [ YDE84a ] Past year, were you a member of a youth or street gang?
In the past year, were you a member of a youth or street gang?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
GOTO Y_DEEND
---------------------------------------------------------------------------------
Y_DE_END [ YDE_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF CHILD IS YOUNG ADULT (18+), CONTINUE. ELSE, GOTO Y_VCEND.
Y_VC7a [ YVC7a ] NO LABEL
Now I would like to ask you some questions about events that may have happened during your childhood. All questions refere to the time before you were 18 years of age. I would like you to remember that your answers to these questions will be completely private.
Press ""1"" and the [Enter] key to continue.
Question Type: TCont
Continue 1 Continue
---------------------------------------------------------------------------------
Y_VC8a [ YVC8a ] CH have illness/inj ignored by CG
Did you ever have a serious illness or injury or physical disability, but your caregivers ignored it or
failed to obtain necessary medical or remedial treatment for it? For example, pneumonia that
became serious because it was not treated soon enough, untreated broken bones, or hearing or
vision problems that were not treated with glasses or hearing aids?
Question Type: TYN
yes 1 YES
no 2 NO
Y_VC8aa
What about for less serious illnesses like the flu or an ear infection. Was there someone to take you to the doctor if you needed it?
1 YES
2 NO
---------------------------------------------------------------------------------
Y_VC9a [ YVC9a ] CG not help with washing/grooming CH
Did your caregivers fail to help you with washing and grooming so that you were often dirty, had
uncombed hair, or wore dirty clothes?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_VC10a [ YVC10a ] CG fail to provide regular meals for CH
Did your caregivers often fail to provide regular meals for you so that you had to go hungry or ask
other people for food?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_VC11a [ YVC11a ] Go w/o needed things b/c CG got other things
Did you ever have to go without things that you needed, for example clothes, shoes, school
supplies, food, etc., because your family's paycheck was spent on the adult's interests? For
example, a parent spending money on alcohol, gambling, drugs, fancy cars or clothes, so that
there was little money left over for the children?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_VC12a [ YVC12a ] CH does chores that were difficult/dangerous
Were you ever required to do chores that were too difficult or dangerous for you? For example,
cooking at the stove when you were too small to do it safely, or operating farm machinery that
could have been dangerous?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_VC13a [ YVC13a ] CH ever abandoned by CG
Were you ever abandoned by a caregiver?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_VC13b
Were your parents or caregivers ever separated or divorced?
Question Type: TYN
yes 1 YES
no 2 NO
3 NOT APPLICABLE - DID NOT HAVE MARRIED PARENTS/CAREGIVERS
---------------------------------------------------------------------------------
Y_VC13c
Were any of your caregivers or other adults in your home ever depressed, mentally ill, or suidical?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_VC13d
Were any of your caregivers or other adults in your home problem drinkers or alcoholics, users of illegal drugs, or abusers of prescription medications?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_VC13e
Did any of your caregivers or other adults in your home ever serve time or were sentenced to serve time in a prison, jail, or other correctional facility?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_VC13f
How often did your caregivers or other adults in your home ever slap, hit, kick, punch, or beat each other up? Would you say…
0 Never
1 Once or twice
2 Sometimes
3 Often
4 Very often
Y_VC13g
Before age 18, how often did a caregiver or other adult in your home ever hit, beat, kick, or physically hurt you in any way? Do not include spanking. Would you say…
0 Never
1 Once or twice
2 Sometimes
3 Often
4 Very often
Y_VC13h
How often did a caregiver or adult in your home ever swear at you, insult you, or put you down? Would you say…
0 Never
1 Once or twice
2 Sometimes
3 Often
4 Very often
---------------------------------------------------------------------------------
Y_VC15a [ YVC15a ] CH miss sch to take care of CG/do chores
Did you ever miss school because you had to stay home to take care of a parent, grandparent,
brother or sister, or to do chores?
Question Type: TYN
yes 1 YES
---------------------------------------------------------------------------------
Y_VC16a [ YVC16a ] CG fail to protect CH from being harmed
Did any of your caregivers ever fail to protect you from being physically harmed by someone else?
For example, one parent watching while the other parent or a brother or sister beat you?
THIS QUESTION DOES NOT APPLY TO A PARENT'S OR CAREGIVER'S FAILURE TO
PROTECT FROM SEXUAL MALTREATMENT.
Question Type: TYN
yes 1 YES
no 2 NO
Y_VC16b
Would you say the following statement is true before you were 18 years old: Someone in your family helped you feel important or special, you felt loved, people in your family looked out for each other and felt close to each other, and your family was a source of strength and support?
1 YES, TRUE
2 NO, NOT TRUE
---------------------------------------------------------------------------------
---------------------------------------------------------------------------------
---------------------------------------------------------------------------------
Y_VC24a [ YVC24a ] Anyone ever touch/kiss CH against will
Now we're going to move on to another topic. We'd like to ask you some questions about sexual
abuse. Once again I'd like to remind you that your answers will be private.
First, did anyone at least five years older than you or an adult ever touch or kiss you against your will?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_VC24a = 2 GOTO Y_VC28a
---------------------------------------------------------------------------------
Y_VC25a [ YVC25a ] Who touched/kissed CH against will
Who did this? Was it a parent, another adult relative, a brother or sister, a non-relative adult, or
other youths?
Question Type: TVC25a
parent 1 Parent
adultrel 2 Another adult relative
sibling 3 Brother or sister
stepparent 4 Step-parent
liveinboygrlfrnd 5 Live-in boyfriend/girlfriend
boygrlfrnd 6 Non-live-in boyfriend/girlfriend
otheradult 7 Other non-relative adult
otheryouth 8 Other youths
Y_VC25b
How often did this happen? Would you say…
1 Once or twice
2 Sometimes
3 Often
4 Very often
---------------------------------------------------------------------------------
Y_VC26a [ YVC26a ] Anyone else touch/kiss CH against will
Did anyone @Belse@B at least five years older than you or an adult ever touch or kiss you against your will?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_VC26a = 2, DK, OR REF, GOTO Y_VC28a
---------------------------------------------------------------------------------
Y_VC27a [ YVC27a ] Who else touched/kissed CH against will
Who did this?
Question Type: TVC25a
parent 1 Parent
adultrel 2 Another adult relative
sibling 3 Brother or sister
stepparent 4 Step-parent
liveinboygrlfrnd 5 Live-in boyfriend/girlfriend
boygrlfrnd 6 Non-live-in boyfriend/girlfriend
otheradult 7 Other non-relative adult
otheryouth 8 Other youths
---------------------------------------------------------------------------------
Y_VC27b
How often did this happen? Would you say…
1 Once or twice
2 Sometimes
3 Often
4 Very often
---------------------------------------------------------------------------------
Logic before:
ASK ONLY IF Y_VC24a = 2 OR VC26a = 2. ELSE, GOTO Y_VC30a.
Y_VC28a [ YVC28a ] Anyone ever try touch/kiss CH against will
Did anyone ever @Btry@B to touch or kiss you against your will?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_VC28a = 2 GOTO Y_VC30a
---------------------------------------------------------------------------------
Y_VC29a [ YVC29a ] Who tried to touch/kiss CH against will
Who did this? Was it a parent, another adult relative, a brother or sister, a non-relative adult, or
other youths?
Question Type: TVC25a
parent 1 Parent
adultrel 2 Another adult relative
sibling 3 Brother or sister
stepparent 4 Step-parent
liveinboygrlfrnd 5 Live-in boyfriend/girlfriend
boygrlfrnd 6 Non-live-in boyfriend/girlfriend
otheradult 7 Other non-relative adult
otheryouth 8 Other youths---------------------------------------------------------------------------------
Y_VC29aa [ YVC29aa ] Anyone else try touch/kiss CH against will
Did anyone @Belse@B ever @Btry@B to touch or kiss you against your will?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_VC29aa = 2 GOTO Y_VC30a
---------------------------------------------------------------------------------
Y_VC29ba [ YVC29ba ] Who else tried to touch/kiss CH against will
Who did this?
Question Type: TVC25a
parent 1 Parent
adultrel 2 Another adult relative
sibling 3 Brother or sister
stepparent 4 Step-parent
liveinboygrlfrnd 5 Live-in boyfriend/girlfriend
boygrlfrnd 6 Non-live-in boyfriend/girlfriend
otheradult 7 Other non-relative adult
otheryouth 8 Other youths
---------------------------------------------------------------------------------
Y_VC30a [ YVC30a ] Anyone ever have sex w/ CH against will
Did anyone at least five years older than you or an adult ever have intercourse, oral sex, or anal sex with you against your will?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_VC30a = 2 GOTO Y_VC32a
---------------------------------------------------------------------------------
Y_VC31a [ YVC31a ] Who had sex w/ CH against will
Who did this? Was it a parent, another adult relative, a brother or sister, a non-relative adult, or
other youths?
Question Type: TVC25a
parent 1 Parent
adultrel 2 Another adult relative
sibling 3 Brother or sister
stepparent 4 Step-parent
liveinboygrlfrnd 5 Live-in boyfriend/girlfriend
boygrlfrnd 6 Non-live-in boyfriend/girlfriend
otheradult 7 Other non-relative adult
otheryouth 8 Other youths
---------------------------------------------------------------------------------
Y_VC31b
How often did this happen? Would you say…
1 Once or twice
2 Sometimes
3 Often
4 Very often
---------------------------------------------------------------------------------
Y_VC31aa [ YVC31aa ] Anyone else ever have sex w/ CH against will
Did anyone @Belse@B at least five years older than you or an adult ever have intercourse, oral sex, or anal sex with you against your will?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_VC31aa = 2, DK, OR REF, GOTO Y_VC32a
---------------------------------------------------------------------------------
Y_VC31ba [ YVC31ba ] Who else had sex w/ CH against will
Who did this?
Question Type: TVC25a
parent 1 Parent
adultrel 2 Another adult relative
sibling 3 Brother or sister
stepparent 4 Step-parent
liveinboygrlfrnd 5 Live-in boyfriend/girlfriend
boygrlfrnd 6 Non-live-in boyfriend/girlfriend
otheradult 7 Other non-relative adult
otheryouth 8 Other youths
---------------------------------------------------------------------------------
Y_VC31ca
How often did this happen? Would you say…
1 Once or twice
2 Sometimes
3 Often
4 Very often
---------------------------------------------------------------------------------
Logic before:
ASK IF Y_VC30a = 2 OR VC31aa = 2. ELSE, GOTO Y_VC34a.
Y_VC32a [ YVC32a ] Anyone ever try to have sex w/ CH against will
Did anyone ever @Btry@B to have intercourse, oral sex, or anal sex with you against your will?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_VC32a = 2 GOTO Y_VC34a
---------------------------------------------------------------------------------
Y_VC33a [ YVC33a ] Who tried to have sex w/ CH against will
Who did this? Was it a parent, another adult relative, a brother or sister, a non-relative adult, or
other youths?
Question Type: TVC25a
parent 1 Parent
adultrel 2 Another adult relative
sibling 3 Brother or sister
stepparent 4 Step-parent
liveinboygrlfrnd 5 Live-in boyfriend/girlfriend
boygrlfrnd 6 Non-live-in boyfriend/girlfriend
otheradult 7 Other non-relative adult
otheryouth 8 Other youths
---------------------------------------------------------------------------------
Y_VC33aa [ YVC33aa ] Anyone else try to have sex w/ CH against will
Did anyone @Belse@B ever @Btry@B to have intercourse, oral sex, or anal sex with you against
your will?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_VC33aa = 2 GOTO Y_VC34a
---------------------------------------------------------------------------------
Y_VC33ba [ YVC33ba ] Who else tried to have sex w/ CH against will
Who did this?
Question Type: TVC25a
parent 1 Parent
adultrel 2 Another adult relative
sibling 3 Brother or sister
stepparent 4 Step-parent
liveinboygrlfrnd 5 Live-in boyfriend/girlfriend
boygrlfrnd 6 Non-live-in boyfriend/girlfriend
otheradult 7 Other non-relative adult
otheryouth 8 Other youths
---------------------------------------------------------------------------------
Y_VC34a [ YVC34a ] CH Robbed past 12 months
The next questions are about things that may have happened to you in the past 12 months.
In the past 12 months, has someone robbed you?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_VC35a [ YVC35a ] CH Attacked or beaten up past 12 months
In the past 12 months, has someone attacked or beaten you up?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_VC36a [ YVC36a ] CH Victimized sexually past 12 months
In the past 12 months, has someone victimized you sexually?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
Y_VCEND
IF CHILD AGE IS 13 OR OLDER OR CHILD IS A YOUNG ADULT (18+) OR EMANCIPATED YOUTH, CONTINUE. ELSE, GOTO Y_HTEND.
Some people experience difficult situations at work or in other places. I’d like to know if you have ever had any of these experiences.
Y_HT1
Have you ever been unable to leave a place you worked or talk to people you wanted to talk to, even when you weren’t working, because the person you worked for threatened or controlled you?
1=YES
2=NO
Y_HT2
Did someone you work for ever refuse to pay what they promised and keep all or most of the money you made?
1=YES
2=NO
Y_HT3
Were you ever physically beaten, slapped, hit, kicked, punched, burned or harmed in any way by someone you work for?
1=YES
2=NO
Y_HT4
Did you ever feel emotionally abused by someone you worked for?
1=YES
2=NO
Y_HT5
Did someone you work for ever ask, pressure, or force you to do something sexually that you did not feel comfortable doing?
1=YES
2=NO
Y_HT6
Were you ever forced to engage in sexual acts with family, friends, clients, or business associates for money or favors, by someone you work for?
1=YES
2=NO
Y_HT7
Did you ever trade sexual acts for food, clothing, money, shelter, favors, or other necessities for survival before you reached the age of 18?
1=YES
2=NO
Y_HTEND
---------------------------------------------------------------------------------
Logic before:
IF AGE < 11, GOTO Y_IJEND. ELSE, CONTINUE. IF CHILD IS EMANCIPATED OR YOUNG
ADULT (18+), CONTINUE
Y_IJ1a [ YIJ1a ] Past 12M CH had bad scrape
The next questions ask about some injuries that you might have had in the past @B12
months@B.
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_IJ1a = No GOTO Y_IJ3a
---------------------------------------------------------------------------------
Y_IJ2a [ YIJ2a ] CH saw doc/RN for scrape - past 12M
Did you see a doctor or nurse for this injury?
Please consider online or telehealth visits.
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_IJ3a [ YIJ3a ] Past 12M CH had sprain
In the past @B12 months@B, have you had a bad sprain or torn ligament?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_IJ3a = No GOTO Y_IJ5a
---------------------------------------------------------------------------------
Y_IJ4a [ YIJ4a ] CH saw doc/RN for sprain - past 12M
Did you see a doctor or nurse for this injury?
Please consider online or telehealth visits.
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_IJ5a [ YIJ5a ] Past 12M CH had broken bone/nose
In the past @B12 months@B, have you had a broken bone, dislocated joint, or broken nose?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_IJ5a = No GOTO Y_IJ7a
---------------------------------------------------------------------------------
Y_IJ6a [ YIJ6a ] CH saw doc/RN for broken bone/nose - past 12M
Did you see a doctor or nurse for this injury?
Please consider online or telehealth visits.
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_IJ7a [ YIJ7a ] Past 12M CH had head inj/concuss
In the past @B12 months@B, have you had a bad head injury or concussion?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_IJ7a = No GOTO Y_IJ9a
---------------------------------------------------------------------------------
Y_IJ8a [ YIJ8a ] CH saw doc/RN fr head inj/concuss - past 12M
Did you see a doctor or nurse for this injury?
Please consider online or telehealth visits.
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_IJ9a [ YIJ9a ] Past 12M CH had gun/stab wound
In the past @B12 months@B, have you had a gun shot wound or stab wound?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_IJ9a = No GOTO Y_IJ11a
---------------------------------------------------------------------------------
Y_IJ10a [ YIJ10a ] CH saw doc/RN fr gun/stab wound - past 12M
Did you see a doctor or nurse for this injury?
Please consider online or telehealth visits.
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_IJ11a [ YIJ11a ] Past 12M CH got bitten
In the past @B12 months@B, have you had a bite from another person or animal?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_IJ11a = No GOTO Y_IJ13a
---------------------------------------------------------------------------------
Y_IJ12a [ YIJ12a ] CH saw doc/RN for bite - past 12M
Did you see a doctor or nurse for this injury?
Please consider online or telehealth visits.
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_IJ13a [ YIJ13a ] Past 12M CH was burned
In the past @B12 months@B, have you had a bad burn?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_IJ13a = No GOTO Y_IJ15a
---------------------------------------------------------------------------------
Y_IJ14a [ YIJ14a ] CH saw doc/RN for burn - past 12M
Did you see a doctor or nurse for this injury?
Please consider online or telehealth visits.
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_IJ15a [ YIJ15a ] # Xs CH was hurt phys
In the past @B12 months@B, how many times has someone physically hurt you on purpose?
Question Type: TIJ15a
none 0 0 times
once 1 1 time
twice 2 2 times
thrice 3 3 times
fourmore 4 4 or more times
Logic after:
IF Y_IJ15a = none GOTO Y_IJEND
---------------------------------------------------------------------------------
Y_IJ15aa [ YIJ15aa ] Physically hurt you in the last week?
Has this happened in the last week?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_IJ15aa = Yes GOTO Y_IJ15da
---------------------------------------------------------------------------------
Y_IJ15ba [ YIJ15ba ] Physically hurt you in the last month?
Has this happened in the last month?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_IJ15ba = Yes GOTO Y_IJ15da
---------------------------------------------------------------------------------
Y_IJ15ca [ YIJ15ca ] Physically hurt you in the last 3 months?
Has this happened in the last 3 months?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Logic before:
IF Y_IJ15ca = 2, FILL: Thinking of the most recent time that someone physically hurt you on
Y_IJ15da [ YIJ15da ] Where did this happen (physically hurt you)?
^Fills.IJ15da did this happen?
Question Type: TIJ15da
school 1 At school
neighborhood 2 In my neighborhood
mall 3 At a mall or other place where I was hanging out with friends
home 4 At home
friends 5 At a friend's or relative's home
other 6 Somewhere else
Question Fill: ^FillIJ15da
recent Thinking of the most recent time that someone physically hurt you on
purpose, where
notrecent Where
---------------------------------------------------------------------------------
Y_IJ16a [ YIJ16a ] CH knew person who hurt them
Did you know any of the people who hurt you?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_IJ16a = No GOTO Y_IJ17a
---------------------------------------------------------------------------------
Y_IJ16ba [ YIJ16ba ] Who was involved?
Who was involved?
Question Type: TIJ16ba
friend 1 A friend
schoolkid 2 A kid from school
neighborkid 3 A kid in the neighborhood
sibling 4 My brother or sister
respadult 5 Someone responsible for taking care of me
other 6 Someone else
unknown 7 Someone I don't know
---------------------------------------------------------------------------------
Y_IJ17a [ YIJ17a ] CH had phys inj
Did you have a physical injury?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_IJ17a = No GOTO Y_IJ18a
---------------------------------------------------------------------------------
Y_IJ17aa [ YIJ17aa ] Labels are in Logic After
What kind of injuries occurred?
CODE ALL THAT APPLY.
Question Type: TIJ17aaS
brokenbone 1 BROKEN BONES OR DISLOCATED JOINTS
sprain 2 SPRAIN, STRAIN OR PULLED MUSCLE
cuts 3 WOUND: CUTS, SCRAPES, PUNCTURE
headinj 4 HEAD INJURY, CONCUSSION
bruise 5 BRUISE, CONTUSION, INTERNAL BLEEDING
burn 6 BURN, SCALD
unconscious 7 LOST CONSCIOUSNESS (FOR MORE THAN 30 SECONDS)
dental 8 INJURY TO TEETH
eyeinj 9 INJURY TO EYES
internalinj 10 INTERNAL ORGAN INJURY
othinjury 11 SOME OTHER INJURY
Logic after:
YIJ17aa_1 --Type of physical injuries - BROKEN BONES, DISLOCATED JOINTS; YIJ17aa_2 --Type
of physical injuries - SPRAIN, STRAIN OR PULLED MUSCLE; YIJ17aa_3 --Type of physical
injuries - WOUND: CUTS, SCRAPES, PUNCTURE; YIJ17aa_4 --Type of physical injuries - HEAD
INJURY, CONCUSSION; YIJ17aa_5 --Type of physical injuries - BRUISE, CONTUSION, INTERNL
BLDNG; YIJ17aa_6 --Type of physical injuries - BURN, SCALD; YIJ17aa_7 --Type of physical
injuries - LOST CONSCIOUSNESS(GT30 SECONDS); YIJ17aa_8 --Type of physical injuries -
INJURY TO TEETH; YIJ17aa_9 --Type of physical injuries - INJURY TO EYES; YIJ17aa_10 --Type
of physical injuries - INTERNAL ORGAN INJURY; YIJ17aa_11 --Type of physical injuries - SOME
OTHER INJURY; YIJ17aa_12--Type of physical injuries - DK; YIJ17aa_13--Type of physical injuries
---------------------------------------------------------------------------------
Y_IJ18a [ YIJ18a ] CH got trtmnt by doc/RN for hurt
Did you get medical treatment from a doctor or nurse because you were hurt by someone on
purpose?
Please consider online or telehealth visits.
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_IJ19a [ YIJ19a ] CH had changed feelings after hurt
Did being hurt on purpose by someone cause a change in your feelings -- like making you afraid
or depressed?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_IJ20a [ YIJ20a ] CH had changed actions after hurt
Did being hurt on purpose by someone cause a change in what you do -- like where you go and
how you act?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
GOTO Y_IJEND
---------------------------------------------------------------------------------
Y_IJ_END [ YIJ_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF CHILD IS EMANCIPATED OR YOUNG ADULT (18+), CONTINUE. ELSE, GOTO Y_YLEND.
Y_YL1a [ YYL1a ] CH ever been arrested for any offense
The next questions are about your involvement with the ^Fills.Y_YL1a1
^Fills.Y_YL1a2
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_YL1a1
waveone law.
wavetwo law in the last 12 months.
Question Fill: ^FillY_YL1a2
waveone Have you @Bever@B been arrested for any offense?
wavetwo @BIn the last 12 months@B, have you been arrested for any offense?
Logic after:
IF Y_YL1a = 2 GOTO Y_YLEND
---------------------------------------------------------------------------------
Y_YL2a [ YYL2a ] # of times CH arrested
How many ^Fills.Y_YL2n have you been arrested?
TIMES ARRESTED:
Question Type: 0..10
Question Fill: ^FillY_YL2n
waveone times
wavetwo times in the last 12 months
---------------------------------------------------------------------------------
Logic before:
IF WAVE > 1, GOTO Y_YL5a. ELSE, IF WAVE = 1, ASK Y_YL3y THROUGH Y_YL8a FOR
EACH ARREST.
Y_YL3y [ YYL3 ] Labels are in Logic After
In what year were you arrested^Fills.Y_YL3y1^Fills.FirstSecond^Fills.Y_YL3y2?
ENTER 4-DIGIT YEAR
Question Type: 1990..2013
Question Fill: ^FillY_YL3y1
moreonea ·the·
onlyone
Question Fill: ^FillY_YL3y2
moreoneb ·time
onlyone
Logic after:
YYL3_1a--Y CH arrested; YYL3_2a--Y CH arrested - 2; YYL3_3a--Y CH arrested - 3; YYL3_4a--Y
CH arrested - 4; YYL3_5a--Y CH arrested - 5; YYL3_6a--Y CH arrested - 6; YYL3_7a--Y CH
arrested - 7; YYL3_8a--Y CH arrested - 8; YYL3_9a--Y CH arrested - 9; YYL3_10a--Y CH arrested -
---------------------------------------------------------------------------------
Logic before:
IF Y_YL3y = RESPONSE, THEN Y_YL3y_year = response to Y_YL3y; IF Y_YL3y = RF/DK,
THEN Y_YL3y_year = "that year"
Y_YL4m [ YYL4 ] Labels are in Logic After
In what month in ^Y_YL3y_year were you
arrested^Fills.Y_YL3y1^Fills.FirstSecond^Fills.Y_YL3y2?
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: ^FillY_YL3y1
moreonea ·the·
onlyone
Question Fill: ^FillY_YL3y2
moreoneb ·time
onlyone
Logic after:
YYL4_1a--M CH arrested; YYL4_2a--M CH arrested - 2; YYL4_3a--M CH arrested - 3; YYL4_4a--M
CH arrested - 4; YYL4_5a--M CH arrested - 5; YYL4_6a--M CH arrested - 6; YYL4_7a--M CH
arrested - 7; YYL4_8a--M CH arrested - 8; YYL4_9a--M CH arrested - 9; YYL4_10a--M CH arrested
- 10
---------------------------------------------------------------------------------
Logic before:
IF WAVE > 1, ASK Y_YL5a THROUGH Y_YL8a FOR EACH ARREST.
Y_YL5a [ YYL5 ] Labels are in Logic After
^Fills.Y_YL5a1^Fills.FirstSecond^Fills.Y_YL5a2
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_YL5a1
waveone Were you convicted?
wavetwo Thinking about your·
Question Fill: ^FillY_YL5a2
waveone
wavetwo ·arrest, were you convicted?
Logic after:
IF Y_YL5a = 2 GOTO Y_YL3y; YYL5_1a--CH convicted; YYL5_2a--CH convicted - 2; YYL5_3a--CH
convicted - 3; YYL5_4a--CH convicted - 4; YYL5_5a--CH convicted - 5; YYL5_6a--CH convicted - 6;
YYL5_7a--CH convicted - 7; YYL5_8a--CH convicted - 8; YYL5_9a--CH convicted - 9; YYL5_10a--
CH convicted - 10
---------------------------------------------------------------------------------
Y_YL_Arrest Questions Y_YL3y - Y_YL8a are in Y_YL_Arrest
Question Type: ARRAY[1..10] OF BY_YL_Arrest
---------------------------------------------------------------------------------
Y_YL6a [ YYL6 ] Labels are in Logic After
Were you placed on probation?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_YL6a = 1 GOTO Y_YL3y; YYL6_1a--CH placed on probation; YYL6_2a--CH placed on
probation - 2; YYL6_3a--CH placed on probation - 3; YYL6_4a--CH placed on probation - 4;
YYL6_5a--CH placed on probation - 5; YYL6_6a--CH placed on probation - 6; YYL6_7a--CH placed
on probation - 7; YYL6_8a--CH placed on probation - 8; YYL6_9a--CH placed on probation - 9;
YYL6_10a--CH placed on probation - 10
---------------------------------------------------------------------------------
Y_YL7a [ YYL7 ] Labels are in Logic After
Did you spend time in prison as a result of that ^Fills.FirstSecond^Fills.Y_YL7a
Question Type: TYN
yes 1 YES
no 2 NO
Question Fill: ^FillY_YL7a
waveone ·arrest?
Logic after:
IF Y_YL7a = 2 GOTO Y_YL3y; YYL7_1a--CH spend time in prison as result of arrest; YYL7_2a--
CH spend time in prison as result of arrest - 2; YYL7_3a--CH spend time in prison as result of
arrest - 3; YYL7_4a--CH time in prison as result of arrest - 4; YYL7_5a--CH time in prison as result
of arrest - 5; YYL7_6a--CH time in prison as result of arrest - 6; YYL7_7a--CH time in prison as
result of arrest - 7; YYL7_8a--CH time in prison as result of arrest - 8; YYL7_9a--CH time in prison
as result of arrest - 9; YYL7_10a--CH time in prison as result of arrest - 10
---------------------------------------------------------------------------------
Y_YL8a [ YYL8 ] Labels are in Logic After
How long were you in prison?
Question Type: TYYL8a
less1mo 1 Less than 1 month
onetothree 2 1 to 3 months
fourtosix 3 4 to 6 months
seventoyr 4 7 months to 1 year
moreyr 5 ^Fills.TY_YL8a
Question Fill: ^FillTY_YL8a
waveone More than 1 year
wavetwo
Logic after:
YYL8_1a--Length of time CH in prison; YYL8_2a--Length of time CH in prison - 2; YYL8_3a--Length
of time CH in prison - 3; YYL8_4a--Length of time CH in prison - 4; YYL8_5a--Length of time CH in
prison - 5; YYL8_6a--Length of time CH in prison - 6; YYL8_7a--Length of time CH in prison - 7;
YYL8_8a--Length of time CH in prison - 8; YYL8_9a--Length of time CH in prison - 9; YYL8_10a--
Length of time CH in prison - 10
---------------------------------------------------------------------------------
Logic before:
IF RESPONSE = YES SET ILEXIT FLAG SO THIS SUBMODULE WILL NOT BE INVOKED AGAIN
Y_YL_MORE [ YYLMORE ] Labels are in Logic After
Were there more arrests?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
REPEAT LOOP FOR NEXT ARREST, STARTING AT Y_YL3y IF WAVE = 1 OR Y_YL5a IF
WAVE > 1.
GOTO Y_YLEND; YYLMORE_1 --Were there more CH arrests - 1; YYLMORE_2 --Were there
more CH arrests - 2; YYLMORE_3 --Were there more CH arrests? - 3; YYLMORE_4 --Were there
more CH arrests? - 4; YYLMORE_5 --Were there more CH arrests? - 5; YYLMORE_6 --Were there
more CH arrests? - 6; YYLMORE_7 --Were there more CH arrests? - 7; YYLMORE_8 --Were
there more CH arrests? - 8; YYLMORE_9 --Were there more CH arrests? - 9; YYLMORE_10 --
Were there more CH arrests? - 10
---------------------------------------------------------------------------------
Y_YL_END [ YYL_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF CHILD IS EMANCIPATED OR YOUNG ADULT (18+), AND R HAS CHILDREN LIVING WITH
THEM, CONTINUE.
FOR OREGON CASES ONLY ADD a FILL (if rtiagnid = 948 or uppercase(sj_state) = ‘OR’ )
Y_YM0 [ YYM0 ] NO LABEL
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 or children did
something wrong or made you upset or angry.
^Fills.Y_YM0
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."
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
Question Fill: ^FillY_YM0
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.@/
---------------------------------------------------------------------------------
Y_YM1a [ YYM1a ] # Xs explained to your ch why something was wrong - past 12M
In the past @B12 months@B, how many times have you explained to your child or children why
something was wrong?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM2a [ YYM2a ] Put your ch in time-out/sent to room - past 12M
In the past @B12 months@B, how many times have you put your child or children in "time out" or
sent your child or children to his/her room?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM3a [ YYM3a ] Shaken your ch - past 12M
In the past @B12 months@B, how many times have you shaken your child or children?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM4a [ YYM4a ] Hit your ch on bottom w/hard object - past 12M
In the past @B12 months@B, how many times have you hit your child or children on the bottom
with something like a belt, hairbrush, a stick or some other hard object?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM5a [ YYM5a ] Redirect your ch - past 12M
In the past @B12 months@B, how many times have you given your child or children something
else to do instead of what he/she was doing wrong?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM6a [ YYM6a ] Shouted/yelled/screamed your ch - past 12M
In the past @B12 months@B, how many times have you shouted, yelled, or screamed at your
child or children?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM7a [ YYM7a ] Hit your ch w/ fist/kicked hard - past 12M
In the past @B12 months@B, how many times have you hit your child or children with a fist or
kicked him/her hard?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM8a [ YYM8a ] Spanked your ch on bottomw w/bare hand - past 12M
In the past @B12 months@B, how many times have you spanked your child or children on the
bottom with your bare hand?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM9a [ YYM9a ] Grabbed your ch around neck and choked - past 12M
In the past @B12 months@B, how many times have you grabbed your child or children around
the neck and choked him/her?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
Logic after:
IF ANSWER IS 7, 8, DK, OR REF, GOTO Y_YM10a
---------------------------------------------------------------------------------
Y_YM9aa [ YYM9aa ] Grabbed your ch around neck and choked - reported - past 12M
Was this reported?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_YM9a = 1 GOTO Y_YM10a
---------------------------------------------------------------------------------
Y_YM9ca [ YYM9ca ] Grabbed your ch around neck and choked - reported - past W
Did this happen in the past week?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_YM9ca = 1 GOTO Y_YM10a
---------------------------------------------------------------------------------
Y_YM9da [ YYM9da ] Grabbed your ch around neck and choked - reported - past M
Did this happen in the past month?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_YM9da = 1 GOTO Y_YM10a
---------------------------------------------------------------------------------
Y_YM9ea [ YYM9ea ] Grabbed your ch around neck and choked - reported - past 3M
Did this happen in the last 3 months?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_YM9ea = 1 GOTO Y_YM10a
---------------------------------------------------------------------------------
Y_YM10a [ YYM10a ] Sworn/cursed at ch - past 12M
In the past @B12 months@B, how many times have you sworn or cursed at your child or children?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM11a [ YYM11a ] Beat ch hit hard over and over - past 12M
In the past @B12 months@B, how many times have you beat your child or children up by hitting
him/her over and over as hard as you could?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
Logic after:
IF ANSWER IS 7, 8, DK, REF GOTO Y_YM12a.
---------------------------------------------------------------------------------
Y_YM11aa [ YYM11aa ] Beat ch hit hard over and over - reported - past 12M
Was this reported?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_YM11aa = 1 GOTO Y_YM12a
---------------------------------------------------------------------------------
Y_YM11ca [ YYM11ca ] Beat ch hit hard over and over - reported - past W
Did this happen in the past week?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_YM11ca = 1 GOTO Y_YM12a
---------------------------------------------------------------------------------
Y_YM11da [ YYM11da ] Beat ch hit hard over and over - reported - past M
Did this happen in the past month?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_YM11da = 1 GOTO Y_YM12a
---------------------------------------------------------------------------------
Y_YM11ea [ YYM11ea ] Beat ch hit hard over and over - reported - past 3M
Did this happen in the last 3 months?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_YM11ea = 1 GOTO Y_YM12a
---------------------------------------------------------------------------------
Y_YM12a [ YYM12a ] Said ch will be sent away/kicked out - past 12M
In the past @B12 months@B, how many times have you said your child or children would be sent
away or kicked out of the house?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM13a [ YYM13a ] Burned/scalded ch on purpose - past 12M
In the past @B12 months@B, how many times have you burned or scalded your child or children
on purpose?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
Logic after:
IF ANSWER IS 7, 8, DK, OR REF, GOTO Y_YM14A.
---------------------------------------------------------------------------------
Y_YM13aa [ YYM13aa ] Burned/scalded ch on purpose - reported - past 12M
Was this reported?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_YM13aa = 1 GOTO Y_YM14a
---------------------------------------------------------------------------------
Y_YM13ca [ YYM13ca ] Burned/scalded ch on purpose - reported - past W
Did this happen in the past week?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_YM13ca = 1 GOTO Y_YM14a
---------------------------------------------------------------------------------
Y_YM13da [ YYM13da ] Burned/scalded ch on purpose - reported - past M
Did this happen in the past month?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_YM13da = 1 GOTO Y_YM14a
---------------------------------------------------------------------------------
Y_YM13ea [ YYM13ea ] Burned/scalded ch on purpose - reported - past 3M
Did this happen in the last 3 months?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_YM13ea = 1 GOTO Y_YM14a
---------------------------------------------------------------------------------
Y_YM14a [ YYM14a ] Threaten to spank/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 or
children but did not actually do it?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM15a [ YYM15a ] Hit on oth prt of bdy w/hrd obj - past 12M
In the past @B12 months@B, how many times have you hit your child or children 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: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM16a [ YYM16a ] Slapped ch on hand/arm/leg - past 12M
In the past @B12 months@B, how many times have you slapped your child or children on the
hand, arm, or leg?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM17a [ YYM17a ] Taken away priveleges/grounded - past 12M
In the past @B12 months@B, how many times have you taken away privileges or grounded your
child or children?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM18a [ YYM18a ] Pinched ch - past 12M
In the past @B12 months@B, how many times have you pinched your child or children?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM19a [ YYM19a ] Threatened ch w/knife or gun - past 12M
In the past @B12 months@B, how many times have you threatened your child or children with a
knife or gun?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM20a [ YYM20a ] Thrown/knocked ch down - past 12M
In the past @B12 months@B, how many times have you thrown or knocked your child or children
down?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM21a [ YYM21a ] Called ch dumb/lazy/other name - past 12M
In the past @B12 months@B, how many times have you called your child or children dumb or
lazy or some other name like that?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM22a [ YYM22a ] Slapped ch on face/head/ears - past 12M
In the past @B12 months@B, how many times have you slapped your child or children on the
face or head or ears?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM23 [ YYM23 ] 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.
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
---------------------------------------------------------------------------------
Y_YM24a [ YYM24a ] 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 or children
home alone, even when you thought some adult should be with him/her?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM25a [ YYM25a ] 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 or children that you loved him/her?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM26a [ YYM26a ] 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 or
children got the food he/she needed?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM27a [ YYM27a ] 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 or
children got to a doctor or hospital when he/she needed it?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM28a [ YYM28a ] Cdnt take care of ch b/c drunk/high - 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 or children?
Question Type: TYYMHM
once 1 1 time
twice 2 2 times
threetofive 3 3-5 times
sixtoten 4 6-10 times
eleventotwenty 5 11-20 times
twentymore 6 More than 20 times
notinpastyr 7 Not in the past @B12 months@B, but it happened before
never 8 This has never happened
---------------------------------------------------------------------------------
Y_YM29a [ YYM29a ] Your ch forced sexual contact by adult/oldr ch - past 12M
In the past @B12 months@B, has your child, or children, been touched in a sexual way by an
adult or older child when he/she did not want to be touched that way? Or has he/she 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
Logic after:
IF Y_YM29a = 2 GOTO Y_YM31a
---------------------------------------------------------------------------------
Y_YM29aa [ YYM29aa ] Your ch forced sexual contact occur w/a person 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
---------------------------------------------------------------------------------
Y_YM29ba [ YYM29ba ] Your ch forced sexual contact reported
Was this reported?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Logic before:
IF Y_YM29a = 1
Y_YM30a [ YYM30a ] Your ch forced sexual contact past 12M > 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 Y_YM30a = 2 GOTO Y_YM32a
---------------------------------------------------------------------------------
Y_YM30aa [ YYM30aa ] Your ch forced sexual contact past 12M in past W
Did this happen in the past week?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_YM30aa = 1 GOTO Y_YM32a
---------------------------------------------------------------------------------
Y_YM30ca [ YYM30ca ] Your ch forced sexual contact past 12M in past M
Did this happen in the past month?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_YM30ca = 1 GOTO Y_YM32a
---------------------------------------------------------------------------------
Y_YM30da [ YYM30da ] Your ch forced sexual contact past 12M last 3 months
Did this happen in the last 3 months?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_YM30da = 1 OR 2 GOTO Y_YM32a
---------------------------------------------------------------------------------
Logic before:
IF Y_YM29a = 2, DK, RE
Y_YM31a [ YYM31a ] Your ch forced sexual contact ever happened
Has it @Bever@B happened?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_YM32a [ YYM32a ] Your ch forced sex by adult/older ch - past 12M
In the past @B12 months@B, has your child or children 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 Y_YM32a = 2 GOTO Y_YM34a
---------------------------------------------------------------------------------
Y_YM32aa [ YYM32aa ] Your ch forced sex occur w/a person 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
---------------------------------------------------------------------------------
Y_YM32ba [ YYM32ba ] Your ch forced sex reported
Was this reported?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_YM32ca [ YYM32ca ] Your ch forced sex past 12M in past W
Did this happen in the past week?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_YM32ca = 1 GOTO Y_YM33a
---------------------------------------------------------------------------------
Y_YM32da [ YYM32da ] Your ch forced sex past 12M in past M
Did this happen in the past month?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_YM32da = 1 GOTO Y_YM33a
---------------------------------------------------------------------------------
Y_YM32ea [ YYM32ea ] Your ch forced sex past 12M in past 3M
Did this happen in the last 3 months?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_YM32ea = 1 GOTO Y_YM33a
---------------------------------------------------------------------------------
Logic before:
IF Y_YM32a = 1
Y_YM33a [ YYM33a ] Your ch forced sex > once in past 12M
Has it happened more than once in the past @B12 months@B?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_YM33a = 1 OR 2 GOTO Y_YMEND
---------------------------------------------------------------------------------
Logic before:
IF Y_YM32 = 2, DK, RE
Y_YM34a [ YYM34a ] Your ch forced sex ever happened
Has it @Bever@B happened?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
GOTO Y_YMEND
---------------------------------------------------------------------------------
Y_YM_END [ YYM_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF WAVE > 1 AND CHILD IS YOUNG ADULT (18+), CONTINUE. ELSE, GOTO Y_YDEND.
The next questions ask about your experiences with dating. By dating, we mean spending time with someone you are seeing or going out with. The term date includes both one-time dates and time together as part of longer-term relationships.
Y_YD1
Have you dated someone in the past 12 months?
1 YES
2 NO
Logic after:
If Y_YD1 = NO, GOTO END
Please think about things that may have happened during a conflict or argument with someone you are or were dating in the last 12 months. During a conflict or argument, did the following things happen never, seldom, sometimes or often...
Y_YD2
I spoke to him/her in a hostile or mean tone of voice
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YD3
He/she spoke to me in a hostile or mean tone of voice
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YD4
I insulted him/her with put-downs
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YD5
He/she insulted me with put-downs
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YD6
I said things to his/her friends to try and turn them against him/her
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YD7
He/she said things to my friends to try and turn them against me
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YD8
I kicked, hit, or punched him/her
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YD9
He/she kicked, hit, or punched me
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YD10
I slapped or pulled his/her hair
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YD11
He/she slapped or pulled my hair
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YD12
I threatened to hurt him/her
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YD13
He/she threatened to hurt me
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YD14
I threatened to hit or throw something at him/her
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YD15
He/she threatened to hit or throw something at me
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YD16
I spread rumors about him/her
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YD17
He/she spread rumors about me
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YD18
I touched him/her sexually when they didn’t want me to
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YD18
He/she touched me sexually when I didn’t want them to
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YD19
I forced my partner to have sex when they didn’t want to
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YD19
He/she forced me to have sex when I didn’t want to
0 NEVER
1 SELDOM
3 SOMETIMES
4 OFTEN
Y_YDEND
---------------------------------------------------------------------------------
Logic before:
IF AGE < 11, GOTO Y_AFEND. ELSE, CONTINUE. IF CHILD IS EMANCIPATED OR YOUNG
ADULT (18+), CONTINUE.
Y_AF1 [ YAF1 ] NO LABEL
Please tell the interviewer you are done.
INTERVIEWER: PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
Logic after:
GOTO Y_AFEND
---------------------------------------------------------------------------------
Y_AF_END [ YAF_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF AGE < 11 OR CHILD IS EMANCIPATED OR YOUNG ADULT (18+), GOTO Y_CMEND. ELSE,
CONTINUE.
Y_CM1a [ YCM1a ] # Xs parents/adult exp why something was wrng - past 12M
Sometimes parents get angry at their children or lose their tempers. These questions are about
your parents and other adults who have taken care of you and what they did when they got angry
or when you did something they did not like.
For each of the following questions 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 your parents or other adults who lived with
you explained 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
---------------------------------------------------------------------------------
Y_CM2a [ YCM2a ] # Xs parents/othr put CH in time out - past 12M
In the past @B12 months@B, how many times have your parents or other adults who lived with
you put you in "time out" or sent you to your 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
---------------------------------------------------------------------------------
Y_CM3a [ YCM3a ] # Xs parents/othr shook CH
In the past @B12 months@B, how many times have your parents or other adults who lived with
you shaken 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
---------------------------------------------------------------------------------
Y_CM4a [ YCM4a ] # Xs parents/othr hit CH on bottom w/ hard object - past 12M
In the past @B12 months@B, how many times have your parents or other adults who lived with
you hit you 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
---------------------------------------------------------------------------------
Y_CM5a [ YCM5a ] # Xs parents gave CH something else to do - past 12M
In the past @B12 months@B, how many times have your parents or other adults who lived with
you given you something else to do instead of what you were 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
---------------------------------------------------------------------------------
Y_CM6a [ YCM6a ] # Xs parents/othr yelled at CH - past 12M
In the past @B12 months@B, how many times have your parents or other adults who lived with
you shouted, yelled, or screamed at 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
---------------------------------------------------------------------------------
Y_CM7a [ YCM7a ] # Xs parents/othr hit/kicked CH - past 12M
In the past @B12 months@B, how many times have your parents or other adults who lived with
you hit you with a fist or kicked you 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
Logic after:
IF Y_CM7a = 7 or 8 GOTO Y_CM8a
---------------------------------------------------------------------------------
Y_CM7aa [ YCM7aa ] Parents/othr kicked/hit CH - past W
Did this happen in the last week?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_CM7aa = 1 GOTO Y_CM8a
---------------------------------------------------------------------------------
Y_CM7ba [ YCM7ba ] Parents/othr kicked/hit CH in last M
Did this happen in the last month?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_CM7ba = 1 GOTO Y_CM8a
---------------------------------------------------------------------------------
Y_CM7ca [ YCM7ca ] Parents/othr kicked/hit CH in last 3M
Did this happen in the last 3 months?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_CM8a [ YCM8a ] # Xs parents/othr spanked CH w/hands
In the past @B12 months@B, how many times have your parents or other adults who lived with
you spanked you on the bottom barehanded?
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
---------------------------------------------------------------------------------
Y_CM9a [ YCM9a ] # Xs parents/othr choked CH
In the past @B12 months@B, how many times have your parents or other adults who lived with
you grabbed you around the neck and 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
Logic after:
IF Y_CM9a = 7/8/RF/DK GOTO Y_CM10a
---------------------------------------------------------------------------------
Y_CM9aa [ YCM9aa ] Parents/othr choked CH in last W
Did this happen in the last week?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_CM9aa = 1 GOTO Y_CM10a
---------------------------------------------------------------------------------
Y_CM9ba [ YCM9ba ] Parents/othr choked CH in last M
Did this happen in the last month?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_CM9ba = 1 GOTO Y_CM10a
---------------------------------------------------------------------------------
Y_CM9ca [ YCM9ca ] Parents/othr choked CH in last 3M
Did this happen in the last 3 months?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_CM10a [ YCM10a ] # Xs parents/othr cursed at CH
In the past @B12 months@B, how many times have your parents or other adults who lived with
you sworn or cursed at 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
---------------------------------------------------------------------------------
Y_CM11a [ YCM11a ] # Xs parents/othr hit CH repeatedly
In the past @B12 months@B, how many times have your parents or other adults who lived with
you beat you up by hitting you over and over as hard as possible?
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 Y_CM11a = 7/8/RF/DK GOTO Y_CM12a
---------------------------------------------------------------------------------
Y_CM11aa [ YCM11aa ] Parents/othr hit CH over + overn last W
Did this happen in the last week?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_CM11aa = 1 GOTO Y_CM12a
---------------------------------------------------------------------------------
Y_CM11ba [ YCM11ba ] Parents/othr hit CHover + over last M
Did this happen in the last month?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_CM11ba = 1 GOTO Y_CM12a
---------------------------------------------------------------------------------
Y_CM11ca [ YCM11ca ] Parents/othr hit CH over + over last 3M
Did this happen in the last 3 months?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_CM12a [ YCM12a ] # Xs parents/othr threat to kick CH out
In the past @B12 months@B, how many times have your parents or other adults who lived with
you said you 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
---------------------------------------------------------------------------------
Y_CM13a [ YCM13a ] # Xs parents/othr burned CH
In the past @B12 months@B, how many times have your parents or other adults who lived with
you 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
Logic after:
IF Y_CM13a = 7/8/RF/DK GOTO Y_CM14a
---------------------------------------------------------------------------------
Y_CM13aa [ YCM13aa ] Parents/othr burned CH last W
Did this happen in the last week?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_CM13aa = 1 GOTO Y_CM14a
---------------------------------------------------------------------------------
Y_CM13ba [ YCM13ba ] Parents/othr burned CH last M
Did this happen in the last month?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_CM13ba = 1 GOTO Y_CM14a
---------------------------------------------------------------------------------
Y_CM13ca [ YCM13ca ] Parents/othr burned CH last 3M
Did this happen in the last 3 months?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_CM14a [ YCM14a ] # Xs parents/othr threat to spank CH
In the past @B12 months@B, how many times have your parents or other adults who lived with
you threatened to spank or hit you 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
---------------------------------------------------------------------------------
Y_CM15a [ YCM15a ] # Xs parents/othr hit CH on body
In the past @B12 months@B, how many times have your parents or other adults who lived with
you hit you on some other part of the body besides your 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
---------------------------------------------------------------------------------
Y_CM16a [ YCM16a ] # Xs parents/othr slapped CH on body
In the past @B12 months@B, how many times have your parents or other adults who lived with
you slapped you 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
---------------------------------------------------------------------------------
Y_CM17a [ YCM17a ] # Xs parents/othr grounded CH
In the past @B12 months@B, how many times have your parents or other adults who lived with
you taken away privileges or grounded 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
---------------------------------------------------------------------------------
Y_CM18a [ YCM18a ] # Xs parents/othr pinched CH
In the past @B12 months@B, how many times have your parents or other adults who lived with
you pinched 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
---------------------------------------------------------------------------------
Y_CM19a [ YCM19a ] # Xs parents/othr threat CH w /gun/knife
In the past @B12 months@B, how many times have your parents or other adults who lived with
you 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
Logic after:
IF Y_CM19a = 7/8/RF/DK GOTO Y_CM20a
---------------------------------------------------------------------------------
Y_CM19aa [ YCM19aa ] Parents/othr threat.w/gun/knife in last W
Did this happen in the last week?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_CM19aa = 1 GOTO Y_CM20a
---------------------------------------------------------------------------------
Y_CM19ba [ YCM19ba ] Parents/othr threat.w/gun/knife in last M
Did this happen in the last month?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_CM19ba = 1 GOTO Y_CM20a
---------------------------------------------------------------------------------
Y_CM19ca [ YCM19ca ] Parents/othr threat.w/gun/knife in last 3M
Did this happen in the last 3 months?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_CM20a [ YCM20a ] # Xs parents/othr threw down CH
In the past @B12 months@B, how many times have your parents or other adults who lived with
you thrown or knocked you 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
Logic after:
IF Y_CM20a = 7/8/RF/DK GOTO Y_CM21a
---------------------------------------------------------------------------------
Y_CM20aa [ YCM20aa ] Parents/othr threw down CH in last W
Did this happen in the last week?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_CM20aa = 1 GOTO Y_CM21a
---------------------------------------------------------------------------------
Y_CM20ba [ YCM20ba ] Parents/othr threw down CH in last M
Did this happen in the last month?
Question Type: TYN
yes 1 YES
no 2 NO
Logic after:
IF Y_CM20ba = 1 GOTO Y_CM21a
---------------------------------------------------------------------------------
Y_CM20ca [ YCM20ca ] Parents/othr threw down CH in last 3M
Did this happen in the last 3 months?
Question Type: TYN
yes 1 YES
no 2 NO
---------------------------------------------------------------------------------
Y_CM21a [ YCM21a ] # Xs parents/othr called CH dumb
In the past @B12 months@B, how many times have your parents or other adults who lived with
you called you 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
---------------------------------------------------------------------------------
Y_CM22a [ YCM22a ] # Xs parents/othr slapped CH on face
In the past @B12 months@B, how many times have your parents or other adults who lived with
you slapped you 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
Logic after:
GOTO Y_CMEND
---------------------------------------------------------------------------------
Logic before:
IF CHILD IS EMANCIPATED OR IS AGE 16+ (INCLUDING YOUNG ADULTS), ASK Y_LO1.
ELSE, GOTO Y_LOEND.
Y_LO1 [ YLO1 ] NO LABEL
To help us understand how the well-being of youth changes over time, we @Bmay@B contact
you 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: @|@B^CHILD_FName@B
MIDDLE NAME:@|@B^CHILD_MName@B
LAST NAME:@|@|@B^CHILD_LName@B
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_LO1 = 1 GOTO Y_LO2a; IF Y_LO1 = 2 GOTO Y_LO1a
---------------------------------------------------------------------------------
Y_LO1a [ YLO1a ] Eman CH legal first name
INTERVIEWER: CORRECT FIRST NAME AS NEEDED.
FIRST NAME:
Question Type: STRING[20]
---------------------------------------------------------------------------------
Y_LO1b [ YLO1b ] Eman CH legal middle name
INTERVIEWER: CORRECT MIDDLE NAME AS NEEDED.
MIDDLE NAME:
Question Type: STRING[20], empty
---------------------------------------------------------------------------------
Y_LO1c [ YLO1c ] Eman CH legal last name
INTERVIEWER: CORRECT LAST NAME AS NEEDED.
LAST NAME:
Question Type: STRING[30]
---------------------------------------------------------------------------------
Logic before:
IF SEX = FEMALE, ASK Y_LO2a. ELSE, GOTO Y_LO3a.
Y_LO2a [ YLO2a ] Eman CH maiden name
What is your maiden name?
MAIDEN NAME:
Question Type: STRING[30]
---------------------------------------------------------------------------------
Y_LO3a [ YLO3a ] Eman CH any other names/nicknames(YN2T)
Do you go by any other names or nicknames?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_LO3a = 2 GOTO Y_LO5a
---------------------------------------------------------------------------------
Y_LO4a [ YLO4a ] Eman CH alias #1
What are they?
ALIAS 1:
Question Type: STRING[40]
---------------------------------------------------------------------------------
Y_LO4b [ YLO4b ] Eman CH alias #2
What are they?
ALIAS 2:
Question Type: STRING[40], EMPTY
---------------------------------------------------------------------------------
Y_LO4c [ YLO4c ] Eman CH alias #3
What are they?
ALIAS 3:
Question Type: STRING[40], EMPTY
---------------------------------------------------------------------------------
Y_LO5 [ YLO5 ] NO LABEL
Let me confirm your street address. (VERIFY INFORMATION DISPLAYED ON SCREEN.)
STREET ADDRESS@|@B^Street@B
CITY:@|@|@|@B^City@B
STATE:@|@|@B^State@B
ZIP:@|@|@|@B^Zip@B
Is this correct?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_LO5 = 1 GOTO Y_LO6a; IF Y_LO5 = 2 GOTO Y_LO5a
---------------------------------------------------------------------------------
Y_LO5a [ YLO5a ] Eman CH address - street
INTERVIEWER: CORRECT STREET ADDRESS IF NEEDED.
STREET ADDRESS:
Question Type: STRING[50]
---------------------------------------------------------------------------------
Y_LO5b [ YLO5b ] Eman CH address - city
INTERVIEWER: CORRECT CITY IF NEEDED.
CITY:
Question Type: STRING[30]
---------------------------------------------------------------------------------
Y_LO5c [ YLO5c ] Eman CH address - state
INTERVIEWER: CORRECT STATE IF NEEDED.
STATE:
Question Type: STRING[2]
---------------------------------------------------------------------------------
Y_LO5d [ YLO5d ] Eman CH address - zip
INTERVIEWER: CORRECT ZIP IF NEEDED.
ZIP:
Question Type: TZip
---------------------------------------------------------------------------------
Y_LO6a [ YLO6a ] EmanCH at same address in 6mo(ADDRES1T)
Do you expect to be living at this same address or at a different address 6 months from now?
Question Type: TLO6a
same 1 SAME ADDRESS
different 2 DIFFERENT ADDRESS
Logic after:
IF Y_LO6a = 1 GOTO Y_LO10an
---------------------------------------------------------------------------------
Logic before:
IF Y_L06a = DK/RE, ASK Y_LO6aa. ELSE, GOTO Y_LO7.
Y_LO6aa [ YLO6aa ] Better address to contact emanCH (YN2T)
Is there a better address we can use to contact you in the future?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_LO6aa = 2 GOTO Y_LO10an
---------------------------------------------------------------------------------
Y_LO7a [ YLO7a ] EmanCH best future address - street
What is the best address for us to use in the future?
STREET ADDRESS:
NOTE: IF R PLANS TO MOVE, COLLECT AS MUCH INFORMATION AS POSSIBLE ABOUT
NEW LOCATION.
Question Type: STRING[50]
---------------------------------------------------------------------------------
Y_LO7b [ YLO7b ] EmanCH best future address - city
What is the best address for us to use in the future?
CITY:
Question Type: STRING[30]
---------------------------------------------------------------------------------
Y_LO7c [ YLO7c ] EmanCH best future address - state
What is the best address for us to use in the future?
STATE:
Question Type: STRING[2]
---------------------------------------------------------------------------------
Y_LO7d [ YLO7d ] EmanCH best future address - zip code
What is the best address for us to use in the future?
ZIP:
Question Type: TZip
---------------------------------------------------------------------------------
Y_LO8a [ YLO8a ] BestFuture addres emanCH/other(ADRES1T)
Is that your address or the address of another person or place?
Question Type: TLO8a
rsadd 1 RESPONDENT'S ADDRESS
othradd 2 ADDRESS OF SOME OTHER PERSON/PLACE
Logic after:
IF Y_LO8a = 1 GOTO Y_LO10an
---------------------------------------------------------------------------------
Y_LO9a [ YLO9a ] Whose best future address
Whose address is it? (ENTER NAME)
NAME:
Question Type: STRING[40]
---------------------------------------------------------------------------------
Y_LO9b [ YLO9b ] Best future address person relationship
Whose address is it? (ENTER RELATIONSHIP TO RESPONDENT)
RELATIONSHIP:
Question Type: STRING[30]
---------------------------------------------------------------------------------
Y_LO10an [ YLO10an ] NO LABEL
What is your home phone number?
PHONE:
NOTE: ENTER R'S CURRENT HOME PHONE NUMBER. IF R DOES NOT HAVE A PHONE
NUMBER, ENTER 000-000-0000.
Question Type: TPhone
---------------------------------------------------------------------------------
Y_LO10ba [ YLO10ba ] Best curr phone#-day/evening(PHONE1T)
Is this your day or evening phone number?
Question Type: TLO10ba
day 1 DAY
evening 2 EVENING
both 3 BOTH
---------------------------------------------------------------------------------
Y_LO10cn [ YLO10cn ] 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
---------------------------------------------------------------------------------
Y_LO11a [ YLO11a ] Another phone# for emanCH(YN2T)
Is there another phone number, beeper, or pager number to use to reach you?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_LO11a = 2 GOTO Y_LO12ea
---------------------------------------------------------------------------------
Y_LO12aa [ YLO12aa ] Another phone# for eman CH
What is that number?
PHONE:
NOTE: IF R HAS MORE THAN 1 ALTERNATIVE NUMBER, ENTER THE ONE HE/SHE CAN BE
REACHED AT MOST OFTEN.
Question Type: TPhone
---------------------------------------------------------------------------------
Y_LO12ba [ YLO12ba ] Another phone#-day/evening (PHONE1T)
And is that your day or evening number?
Question Type: TLO10ba
day 1 DAY
evening 2 EVENING
both 3 BOTH
---------------------------------------------------------------------------------
Y_LO12ca [ YLO12ca ] Type another phone# emanCH (PHONE2T)
Is this your home phone number, a work number, or some other number?
Question Type: TLO12ca
home 1 HOME NUMBER
work 2 WORK NUMBER
friend 3 FRIEND/RELATIVE'S NUMBER
beeper 4 BEEPER/PAGER/CELL PHONE NUMBER
other 5 OTHER (SPECIFY)
Logic after:
IF Y_LO12ca = other GOTO Y_LO12cb
---------------------------------------------------------------------------------
Logic before:
IF Y_LO12ca = 5, CONTINUE. ELSE, GOTO Y_LO12ea.
Y_LO12cb [ YLO12cb ] Other-specify type another phone#
Please specify what number this is.
NUMBER IS:
Question Type: STRING[40]
Logic after:
IF Y_LO12ca = 5, CONTINUE. ELSE, GOTO Y_LO12ea
---------------------------------------------------------------------------------
Y_LO12ea [ YLO12ea ] NO LABEL
Do you have an email address?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_LO12ea = 2 GOTO Y_LO13a
---------------------------------------------------------------------------------
Y_LO12f [ YLO12f ] 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]
---------------------------------------------------------------------------------
Y_LO13a [ YLO13a ] EmanCH provide 1st contact info (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: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_LO13a = 2 GOTO Y_LO19a
---------------------------------------------------------------------------------
Y_LO14a [ YLO14a ] EmanCH contact #1 name
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]
---------------------------------------------------------------------------------
Y_LO14b [ YLO14b ] EmanCH contact #1 relationship
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]
---------------------------------------------------------------------------------
Y_LO14c [ YLO14c ] EmanCH contact #1 address-street/POBox
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]
---------------------------------------------------------------------------------
Y_LO14d [ YLO14d ] EmanCH contact #1 address - 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]
---------------------------------------------------------------------------------
Y_LO14e [ YLO14e ] EmanCH contact #1 address - state
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]
---------------------------------------------------------------------------------
Y_LO14f [ YLO14f ] End emanCH contact #1 info
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
---------------------------------------------------------------------------------
Y_LO14g [ YLO14g ] EmanCH contact #1 address - phone
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
---------------------------------------------------------------------------------
Y_LO15a [ YLO15a ] EmanCH provide 2nd contact info (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: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_LO15a = 2 GOTO Y_LO19a
---------------------------------------------------------------------------------
Y_LO16a [ YLO16a ] EmanCH contact #2 name
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]
---------------------------------------------------------------------------------
Y_LO16b [ YLO16b ] EmanCH contact #2 relationship
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]
---------------------------------------------------------------------------------
Y_LO16c [ YLO16c ] EmanCH contact #2 address-street/POBox
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]
---------------------------------------------------------------------------------
Y_LO16d [ YLO16d ] EmanCH contact #2 address - 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]
---------------------------------------------------------------------------------
Y_LO16e [ YLO16e ] EmanCH contact #2 address - state
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]
---------------------------------------------------------------------------------
Y_LO16f [ YLO16f ] End emanCH contact #2 info
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
---------------------------------------------------------------------------------
Y_LO16g [ YLO16g ] EmanCH contact #2 address - phone
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
---------------------------------------------------------------------------------
Y_LO17a [ YLO17a ] EmanCH provide 3rd contact info (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: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_LO17a = 2 GOTO Y_L019a
---------------------------------------------------------------------------------
Y_LO18a [ YLO18a ] EmanCH contact #3 name
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]
---------------------------------------------------------------------------------
Y_LO18b [ YLO18b ] EmanCH contact #3 relationship
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]
---------------------------------------------------------------------------------
Y_LO18c [ YLO18c ] EmanCH contact #3 address-street/POBox
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]
---------------------------------------------------------------------------------
Y_LO18d [ YLO18d ] EmanCH contact #3 address - 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]
---------------------------------------------------------------------------------
Y_LO18e [ YLO18e ] EmanCH contact #3 address - state
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]
---------------------------------------------------------------------------------
Y_LO18f [ YLO18f ] End emanCH contact #3 info
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
---------------------------------------------------------------------------------
Y_LO18g [ YLO18g ] EmanCH contact #3 address - phone
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 before:
IF WAVE > 1 AND RESPONDENT IS SAME FROM PREVIOUS INTERVIEW, VERIFY
PRELOADED SSN IN Y_LO19a IF AVAILABLE. ELSE, ASK FOR SSN.
Y_LO19a [ YLO19a ] Eman CH social security number
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
Question Fill: ^FillY_LO19n
donthave I’d also like to get your Social Security Number. This information will only
be used in case we need to contact you again in the future. What is your
social security number? (PROMPT R TO GET NUMBER FROM SSN
CARD, IF NEEDED.)
have 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.)
---------------------------------------------------------------------------------
Logic before:
IF VERIFYING PRELOADED SSN
Y_LO19b [ YLO19b ] NO LABEL
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 ^CHILD_SSN
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF = 1, GOTO P_LO20a
---------------------------------------------------------------------------------
Y_LO19c [ YLO19c ] 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
Y_LO20a [ YLO20a ] Eman CH drivers license number
What is your driver's license number? Again, this will only be used in case we need to contact
you again in the future. (PROMPT R TO GET NUMBER FROM DRIVER'S LICENSE, IF
NEEDED.)
LICENSE:
Question Type: STRING[15]
Logic after:
IF Y_LO20a = 00 GOTO Y_LO21. ELSE, GOTO LO20b.
---------------------------------------------------------------------------------
Logic before:
IF VERIFYING PRELOADED NUMBER
Y_LO20a1 [ YLO20a1 ] NO LABEL
I also need to verify your driver's license number. Is it...(READ DISPLAYED NUMBER AND
STATE. CORRECT AS NEEDED.)
LICENSE#: ^License_no
STATE: ^License_st
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_LO20a2 [ YLO20a2 ] NO LABEL
What is your correct driver's license number?
LICENSE#
NOTE: IF R DOES NOT HAVE DL NUMBER, ENTER 00.
Question Type: STRING[15]
Logic after:
[IF NO DL#, GOTO Y_LO21.]
---------------------------------------------------------------------------------
Y_LO20b [ YLO20b ] Eman CH drivers license state
What state is the driver's license issued in?
STATE:
Question Type: STRING[2]
---------------------------------------------------------------------------------
Y_LO21 [ YLO21 ] NO LABEL
We're almost finished. Remember, this information is voluntary and private and will only be
used in case we need to contact you again in the future.
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
---------------------------------------------------------------------------------
Logic before:
IF R IS MARRIED ASK Y_LO22a. ELSE, GOTO Y_LO23a.
Y_LO22a [ YLO22a ] EmanCH spouse social security #
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
---------------------------------------------------------------------------------
Y_LO23a [ YLO23a ] EmanCH name change next 6 months (YN2T)
Do you think your name could change in the next 6 months?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
IF Y_LO23a = 2 GOTO Y_LO25
---------------------------------------------------------------------------------
Y_LO24a [ YLO24a ] EmanCH future first name
What do you think your 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]
---------------------------------------------------------------------------------
Y_LO24b [ YLO24b ] EmanCH future middle name
INTERVIEWER: UPDATE MIDDLE NAME AS NEEDED.
MIDDLE NAME:
Question Type: STRING[20]
---------------------------------------------------------------------------------
Y_LO24c [ YLO24c ] EmanCH future last name
INTERVIEWER: UPDATE LAST NAME AS NEEDED.
LAST NAME:
Question Type: STRING[30]
IF (AGE >= 13) ASK Y_LOSM1 OTHERWISE GOTO Y_LO25
Y_LOSM1
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. Private messages sent to you through these platforms will only contain information about how you can reach the research team to schedule your next interview. We will never post anything on your profile and your profile will only be viewed if it is necessary to confirm your identity. We will keep your information private but social media websites may, per the terms of use and site policies, be able to access, read, and retain all messages sent through their private messaging platforms.
At some point in the future, a different group of researchers may take over the study. If that happens, with your consent, we will provide this information to the other organization. We would only provide your profile name to other organization. The other organization would only contact you using the social media platform’s private messaging features.
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 SAMPLE 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
Y_LOSM2 [IF Y_LOSM1=2] [TEXT BOX FOR THE NAME]
F3 DON’T KNOW
F4 REFUSED
Y_LOSM3 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 SAMPLE 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
Y_LOSM4 [IF Y_LOSM3=2] [TEXT BOX FOR THE NAME]
F3 DON’T KNOW
F4 REFUSED
Y_LOSM5 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 SAMPLE 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
Y_LOSM6 [IF Y_LOSM5=2] [TEXT BOX FOR NAME]
F3 DON’T KNOW
F4 REFUSED
Y_LOSM7 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 SAMPLE 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
Y_LOSM8 [IF Y_LOSM7=2] [TEXT BOX FOR NAME]
F3 DON’T KNOW
F4 REFUSED
---------------------------------------------------------------------------------
Y_LO25 [ YLO25 ] NO LABEL
Thank you very much for this information.
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
Logic after:
GOTO Y_LOEND
---------------------------------------------------------------------------------
Logic before:
IF (AGE >= 13 AND AGE <= 17) or (Child = YA) or (Child = EA) ask Y_LK1 else goto Y_LK1a
Y_LK1 [ YLK1 ] 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, there is one more form I need to read to you. 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
---------------------------------------------------------------------------------
Logic before:
IF (AGE >= 13 AND AGE <= 17) or (Child = YA) or (Child = EA) then fill: "Form needed" Else fill
"Form not Needed"
Y_LK1a [ YLK1a ] NO LABEL
^Fills.Y_LK1a
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
Question Fill: ^FillY_LK1a
need INTERVIEWER: PRESS 1 FOR @bLINKAGE ASSENT@b FORMS IN
DOCMAN. PLEASE CHOOSE AND READ THE CORRECT ASSENT
FORM FROM DOCMAN BASED ON CHILD'S AGE AND OBTAIN
SIGNATURE. AFTER COLLECTING SIGNATURE AND FINALIZING
FORM, YOU WILL THEN BE BROUGHT BACK TO THE INTERVIEW.
no_need INTERVIEWER: THE @bLINKAGE ASSENT@b FORM IS NOT NEEDED
FOR THIS CHILD. SELECT “FORM NOT NEEDED” IN DOCMAN.
---------------------------------------------------------------------------------
Y_LKLA1 Start AS DocMan
@bSTART DOCMAN LINKAGE ASSENT FORM@b
INTERVIEWER: PRESS UP ARROW IF YOU WANT TO GO TO PREVIOUS SCREEN.
Question Type: BDocMan
---------------------------------------------------------------------------------
Logic before:
If status from DocMan=491 OR (Status = 457 AND Form is "Coded Out") then ask ask Y_LKLA2
else ask Y_LKLA3
Y_LKLA2 [ YLKLA2 ] End AS DocMan
@bDOCMAN LINKAGE ASSENT FORM IS COMPLETED@b
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
Logic after:
GOTO Y_LK2a
---------------------------------------------------------------------------------
Y_LKLA3 [ YLKLA3 ] NO LABEL
@bDOCMAN LINKAGE ASSENT FORM 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 Y_LKLA1
If 4 GOTO Y_LK_END
IF 3 OR 5 Ask Y_LKLA4
ELSE GOTO Y_LK2a
---------------------------------------------------------------------------------
Y_LKLA4 [ YLKLA4 ] NO LABEL
@bDOCMAN LINKAGE ASSENT FORM IS NOT COMPLETED@b
GIVE DETAILS ABOUT THE TECHNICAL PROBLEM:
Question Type: STRING[60]
---------------------------------------------------------------------------------
Logic before:
IF Y_LKLA1.Status = 491 OR Y_LKLA3 = 2 OR Y_LKLA3 = 3 OR Y_LKLA3 = 5 THEN then ask
Y_LK2a
Y_LK2a [ YLK2a ] Child data linkage permission
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: TYesNoC
Yes 1 YES
No 2 NO
Logic after:
GOTO Y_LKEND
---------------------------------------------------------------------------------
Y_LK_END [ YLK_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
Logic after:
Y_LKEND
---------------------------------------------------------------------------------
Logic before:
IF CHILD IS LEGALLY EMANCIPATED PER CID OR AGE IS 18+, CONTINUE. ELSE, GOTO
Y_VOEND.
Y_VO1 [ YVO1 ] 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
---------------------------------------------------------------------------------
Y_VO2a [ YVO2a ] Eman CH agree to verification call
WAS R AGREEABLE TO A VERIFICATION CALL?
Question Type: TYesNoC
Yes 1 YES
No 2 NO
---------------------------------------------------------------------------------
Y_VO3 [ YVO3 ] 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 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
---------------------------------------------------------------------------------
Y_VO4 [ YVO4 ] 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 RECEIPT 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
---------------------------------------------------------------------------------
Y_VOIN1 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 Y_VOIN2 else ask Y_VOIN3
Y_VOIN2 [ YVOIN2 ] 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 Y_VO_END
---------------------------------------------------------------------------------
Y_VOIN3 [ YVOIN3 ] 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 Y_VOIN1
If 4 EXIT form
IF 3 Ask Y_VOIN4
ELSE GOTO Y_VO_END
---------------------------------------------------------------------------------
Y_VOIN4 [ YVOIN4 ] NO LABEL
@bDOCMAN INCENTIVE RECEIPT FORM IS NOT COMPLETED@b
GIVE DETAILS ABOUT THE TECHNICAL PROBLEM:
Question Type: STRING[60]
---------------------------------------------------------------------------------
Y_VO_END [ YVO_END ] NoDeliv
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont, NoDK, NoRF
Continue 1 Continue
---------------------------------------------------------------------------------
IF CHILD AGE IS 4 OR OLDER, administer the test of executive functioning: the Shape Go-NoGo Task.
The Shape Go-NoGo task consists of a series of single shapes that “flash” on the laptop screen. The child is instructed to press a button on the laptop as quickly as possible for all shapes except a circle; the child tries not to press the key anytime the circle appears.
---------------------------------------------------------------------------------
Logic before:
IF CHILD AGE < 11 AND NOT EY, FILL: ADDRESS PARENT:
IF YA+EY, SKIP to Y_CC1 Else CONTINUE.
Y_CC03a [ YCC03a ] Incentive accepted by R/parent(YN2T)
^Fills.Y_CC0Fill@a@aHere is a gift certificate as a thank you for your participation.
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 I have given you the gift certificate. This copy is for your records.
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
Question Fill: ^FillY_CC0Fill
under11 ADDRESS PARENT:·
---------------------------------------------------------------------------------
Y_CCIN1 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 Y_CCIN2 else ask Y_CCIN3
Y_CCIN2 [ YCCIN2 ] End IN DocMan
@bDOCMAN INCENTIVE RECEIPT FORM IS COMPLETED@b
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
Logic after:
---------------------------------------------------------------------------------
Y_CCIN3 [ YCCIN3 ] 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 Y_CCIN1
If 4 EXIT form
IF 3 Ask Y_CCIN4
ELSE GOTO Y_CC1/Y_CC2
---------------------------------------------------------------------------------
Y_CCIN4 [ YCCIN4 ] NO LABEL
@bDOCMAN INCENTIVE RECEIPT FORM IS NOT COMPLETED@b
GIVE DETAILS ABOUT THE TECHNICAL PROBLEM:
Question Type: STRING[60]
---------------------------------------------------------------------------------
Y_CC03b [ YCC03b ] NO LABEL
INTERVIEWER: SELECT "FORM NOT NEEDED" IN DOCMAN.
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
---------------------------------------------------------------------------------
Y_CCLG1 Start -L DocMan
@bSTART DOCMAN @b
INTERVIEWER: PRESS UP ARROW IF YOU WANT TO GO TO PREVIOUS SCREEN.
Question Type: BDocMan
---------------------------------------------------------------------------------
Logic before:
If status from DocMan=491 ask Y_QYAS2 else ask Y_QYAS3
Y_CCLG2 [ YCCLG2 ] End -L DocMan
@bDOCMAN IS COMPLETED@b
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
---------------------------------------------------------------------------------
Y_CCLG3 [ YCCLG3 ] NO LABEL
@bDOCMAN 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 Y_QYAS1
If 4 EXIT interview
IF 3 Ask Y_QYAS4
ELSE GOTO Y_QY0aa
---------------------------------------------------------------------------------
Y_CCLG4 [ YCCLG4 ] NO LABEL
@bDOCMAN IS NOT COMPLETED@b
GIVE DETAILS ABOUT THE TECHNICAL PROBLEM:
Question Type: STRING[60]
---------------------------------------------------------------------------------
Logic before:
IF AGE < 5, CONTINUE. ELSE, GOTO Y_CC2.
if RTIAGNID = '605' (The digits 2, 3, and 4 of the zrid is the RTIAGNID) then define fill Y_CC605
Y_CC1 [ YCC1 ] NO LABEL
^Fills.Y_CC605@a@aADDRESS PARENT: That is all we need to do involving ^CHILD. Thank you
for helping with these tests. This will help us a great deal in our research.
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
Question Fill: ^FillY_CC605
_605 SAY TO CAREGIVER: I appreciate your help with this important study.
Summit County Children Services Board requires that we get your written
permission before we interview a staff person about your child. Let me go
over the release form with you. READ FORM VERBATIM.@/@/@/
Logic after:
GOTO Y_CCEND
---------------------------------------------------------------------------------
Logic before:
if RTIAGNID = '605' (The digits 2, 3, and 4 of the zrid is the RTIAGNID) then define fill Y_CC605
Y_CC2 [ YCC2 ] NO LABEL
Those are all the questions I have for you. Thank you very much for answering these questions.
This will help us a great deal in our research.
^Fills.Y_CC605@a@aPRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
Question Fill: ^FillY_CC605
_605 SAY TO CAREGIVER: I appreciate your help with this important study.
Summit County Children Services Board requires that we get your written
permission before we interview a staff person about your child. Let me go
over the release form with you. READ FORM VERBATIM.@/@/@/
---------------------------------------------------------------------------------
Logic before:
DISPLAY Y_CC3 NOTICE TO INTERVIEWER IF: Y_CD9aa AND Y_CD9ba = 1, OR Y_YB18aa
AND Y_YB18ba = 1, OR Y_YB91aa AND Y_YB91ba = 1. ELSE, GOTO Y_CCEND.
Y_CC3a [ YCC3a ] Instructions if CH is suicidal
INTERVIEWER: CHILD INDICATED HE/SHE HAS SUICIDE INTENTIONS EARLIER IN
INTERVIEW (CHILD HAD SUICIDE THOUGHTS IN LAST 2 WEEKS AND A PLAN FOR
CARRYING OUT THOUGHTS).
SAY: Earlier, you gave me some answers that caused me to worry about your safety. I need to
talk with someone about my concerns.
FOLLOW REQUIRED STUDY PROCEDURES FOR FOLLOW-UP ACTION. DO NOT LEAVE
CHILD/HOME UNTIL APPROPRIATE ACTIONS HAVE BEEN TAKEN.
AFTER RETURNING HOME, REMEMBER TO COMPLETE AN ADVERSE EVENT REPORT
AND SUBMIT IT TO RTI AS SOON AS POSSIBLE.
PRESS "1" AND ENTER TO CONTINUE.
Question Type: TCont
Continue 1 Continue
Logic after:
GOTO Y_CCEND
---------------------------------------------------------------------------------
Y_CC_END [ YCC_END ] NoDeliv
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 | 2023-08-28 |