Appendix A. Male Baseline Survey Instrument
MFS-IP Instrument (Male Baseline)
Table of Contents
PART ONE LIFETIME EXPERIENCES AND FAMILY STRUCTURE 3
Domain A: Demographics 3
Domain B: Incarceration Characteristics 5
Domain C: Criminal History 7
Domain D: Genogram 8
Domain E: Parental and General Family Information 8
Domain F: Relationship Status 12
Domain G: Family Structure 13
PART TWO EXPERIENCES 6 MONTHS PRIOR TO INCARCERATION 17
Domain H: Street Time 17
Domain I: Employment 17
Domain J: Housing 18
Domain K: Income 21
Domain L: Social Support 23
Domain M: Intimate Partner Violence 25
Domain N: Parenting 30
Domain O: Substance Use 31
Domain P: Physical and Mental Health 33
PART THREE EXPERIENCES SINCE INCARCERATION 33
Domain L: Social Support 33
Domain Q: Impact of Incarceration on Relationship with Partner 34
Domain R: Impact of Incarceration on Relationship with Children 38
Domain S: Service Need and Receipt 45
PART SIX PERSONAL CHARACTERISTICS/CURRENT FEELINGS 52
Domain Z: Personal Traits 52
Domain P: Mental and Physical Health 59
Domain V: Partner Relationship Quality 63
Domain N: Parenting and Child Well-Being 70
Domain L: Social Support 77
PART SEVEN EXPECTATIONS FOR POST-RELEASE PERIOD 78
Domain W: Criminal Behavior 78
Domain O: Substance Use 79
Domain L: Social Support 80
Domain K: Income 81
Domain I: Employment 81
Domain J: Housing 82
Domain V: Partner Relationship Quality 82
Domain N: Parenting 84
Locator information 86
MFS-IP Male Baseline Instrument Draft
{Y_bconBEGIN}
BCON1
[INTERVIEWER: LOOK AROUND YOU IN ALL DIRECTIONS. ARE YOU OUT OF EARSHOT OF OTHER PEOPLE, INCLUDING PEOPLE WHO MAY BE IN AN ADJACENT ROOM OR OUTSIDE, AND ARE YOU CONFIDENT THE INTERVIEW SETTING IS PRIVATE?
FOR AN INTERVIEW SETTING TO BE CONSIDERED PRIVATE, YOU MUST BE CERTAIN THAT THE QUESTIONS YOU READ AND THE RESPONDENT’S ANSWERS CANNOT BE (1) OVERHEARD OR (2) ASCERTAINED BY SOMEONE LOOKING THROUGH A WINDOW.]:YES NO
{if BCON1=yes, go on with existing interview; if=no, go to BCON2}
BCON2
[INTERVIEWER: BECAUSE YOU HAVE INDICATED THAT THE INTERVIEW SETTING IS NOT PRIVATE, YOU CANNOT PROCEED WITH THE INTERVIEW. YOU WILL NEED TO BREAK OFF THE INTERVIEW AND RESCHEDULE FOR A TIME WHEN YOU CAN CONDUCT THE INTERVIEW IN PRIVATE.]
{go to Y_bconEND}
{if BCON1=yes}
BCON3
[HAND R INTERVIEW CONSENT FORM. USE THE FACILITY CONSENT FORM FOR INCARCERATED RESPONDENTS AND THE COMMUNITY CONSENT FOR ALL OTHER RESPONDENTS.]
This document is called a consent form, and I’m going to read it out loud to you. It will explain the study and what we are asking you to do. After I’m done reading it, I will answer any questions you may have.
[READ THE CONSENT FORM TO THE RESPONDENT.]
BCON4
[IF R AGREES TO PARTICIPATE IN THE INTERVIEW, HAND R PEN AND INSTRUCT R TO SIGN THE INTERVIEW CONSENT FORM. THEN YOU SHOULD SIGN THE CONSENT FORM.
GIVE R AN {bold}UNSIGNED{normal} COPY OF THE INTERVIEW CONSENT FORM. RETURN YOUR COPY OF THE CONSENT FORM TO YOUR INTERVIEWING MATERIALS FOR LATER SHIPMENT TO YOUR FS.]
[DID R CONSENT TO THE INTERVIEW OR DID R REFUSE THE INTERVIEW?]
(Consent “R CONSENTED TO THE INTERVIEW,”
Refused “R REFUSED THE INTERVIEW”)
IS R CURRENTLY INCARCERATED?
YES
NO
WHAT IS R’S GENDER?
MALE
FEMALE
TRANSGENDER
This first set of questions asks for some basic information about you.
Age
In what month, day, and year were you born?
____/___/____
(MM/DD/YYYY)
So that makes you {fill calculated age} years old. Is this correct?
YES
NO
(If calculated age < 18): I'm sorry. You must be at least 18 years of age to participate in this study.
Educational attainment
NSAF (modified)
What is the highest grade or level of school you have ever completed?
8th grade or less
Some high school
GED
High school diploma
Vocational/tech/business certificate or diploma
Some college
Associate’s degree (AA, AS)
Bachelor’s degree (BA, BS)
Graduate/professional
degree (MA, MS, PhD, EdD,
medicine/MD, dentistry/DDS,
law/JJ/LLB, etc.)
3b (If answer is high school diploma): Do you have a high school diploma or GED?
Race/ethnicity
SHM (modified)
These next questions are about your background. Do you consider yourself Hispanic, Latino(a), or Spanish?
YES
NO
SHM/NSAF/Census 2010
Do you consider yourself…
[SHOW CARD TO RESPONDENT. CHOOSE ONE OR MORE RACES TO INDICATE WHAT THE RESPONDENT REPORTS ABOUT HIM OR HERSELF.]
[IF R SAYS “NATIVE AMERICAN,” VERIFY BY ASKING: “I am recording this as ‘American Indian’—is that right?” (IF Yes, CODE “3”)]
Please check all that apply.
White or Caucasian
Black or African American
American Indian or Alaskan Native
Asian
Native Hawaiian or Other Pacific Islander
Some other race (SPECIFY)_________________________________
Country of birth
NSAF
In what country were you born? What area of the world are you from? For example, Mexico, Central America, South America, Middle East, Asia, Africa, Europe, Caribbean, or Canada.
United States
Puerto Rico
Other U.S.
territory (American Samoa, Guam,
Marshall Islands, Northern
Marianas Islands, or
U.S. Virgin Islands)
Canada
China
Cuba
Dominican Republic
El Salvador
Germany
India
Jamaica
Korea (South)
Mexico
The Philippines
Russia
Vietnam
Other country (SPECIFY) ________________
Language R speaks most often
What language do you speak most often?
English
Spanish
Other (SPECIFY)__________________
Citizenship
Are you a U.S. citizen?
YES
NO
The next set of questions is about your current incarceration.
Incarceration duration
Created
Please tell me the date you were incarcerated for this term of incarceration. I’m asking for the date you entered incarceration this time, not the date of your sentencing. [REFER TO REFERENCE CALENDAR.]
___________ (MM/DD/YYYY)
That means you have been incarcerated for {calculate length of incarceration based on current date and response to above item}. Is this correct?
YES
NO
Created
Do you expect to be released from this incarceration?
YES
NO
(If yes) When do you expect to be released from this incarceration?
___________ (MM/DD/YYYY)
Instant offense
Are you currently serving time because of a parole or probation violation?
YES
NO
(If yes to either parole or probation violation) Was the {parole/probation} violation for a technical violation, like failing to report or having a dirty analysis, for a new crime, or both? [ALLOW BOTH.]
Technical violation
New crime
Both
(If yes to new crime) What crime were you charged with for the new crime? Select all that apply. [USE SHOWCARD.]
Homicide
Rape
Other sex offense (not rape)
Robbery
Assault
Burglary
Theft
Car theft
Fraud or forgery
Weapons offense
Drug dealing
Drug possession
DWI or DUI
Other (SPECIFY)
(If no to parole/probation violation) What crimes were you convicted of for this prison term? Select all that apply. [USE SHOWCARD.]
Homicide
Rape
Other sex offense (not rape)
Robbery
Assault
Burglary
Theft
Car theft
Fraud or forgery
Weapons offense
Drug dealing
Drug possession
DWI or DUI
Other (SPECIFY)
Disciplinary actions
Created
During this term of incarceration, how many disciplinary infractions have you received?
_______ (# of infractions)
During this term of incarceration, how many days have you served in administrative segregation?
This is sometimes referred to as spending time “in the hole.”
_________ (# of times put in segregation)
Institutional transfers
Created
During this incarceration, how many times have you been transferred? By transferred I mean moved from one correctional facility to another or between a jail and a correctional facility. Do not include times you were transferred out for court or medical appointments and returned to the same facility after less than 7 days.
______ (# TRANSFERS)
The next set of questions are about events and experiences in the past.
First, I’m going to ask you some questions about your involvement with the criminal justice system.
Age at first arrest
SVORI
How old were you the first time you were arrested? [REFER TO REFERENCE CALENDAR.]
_____ (years)
Arrest and conviction history
SVORI
How many times in your life have you been arrested? Please count all arrests, not just those that led to a conviction. ( Your best estimate is fine.)
_____ (# arrests)
How many times in your life have you been convicted of a crime?
_____ (# convictions)
Incarceration history – juvenile correctional facilities
In your entire life, have you ever been locked up in a juvenile detention facility or other kind of juvenile correctional facility?
Yes
No
(If R has ever been in juvenile facility) How many times in your life have you been locked up in a juvenile detention facility, a juvenile training school, or in any other kind of juvenile correctional facility?
_____ (# TIMES)
Incarceration history – adult correctional facilities
Not counting your current term of incarceration, have you ever been in a jail or prison for more than 24 hours at one time? Do not include any time you may have spent in a juvenile facility in your answer.
Yes
No
(If yes) Not counting your current term of incarceration, how many times in your life have you been sent to prison or jail? Do not include any time you may have spent in a juvenile facility in your answer.
_____ (# times)
Genogram – charting of family/children
Now, I’d like to make a chart of everyone in your immediate family. First, please tell me who raised you when you were growing up. I’d like to know about your biological parents, but also anyone else who was a parent figure to you. [PROBE FOR ALL PARENTS AND PARENT FIGURES IN THE R’S LIFE FROM BIRTH TO AGE 18, noting the mother/mother figure and father/father figure the r lived with the longest. draw GENOGRAM CIRCLE(S) iNDICATING R’s parents—biological and nonBIOLOGICAL.]
Next, let’s add your current spouse/partner, and any other partners with whom you have children. And does your current spouse/partner have any other children? [DRAW R’s partner, R’s children, non-partner co-parents, and other children of current partner. PROBE FOR ALL BIOLOGICAL CHILDREN AND ANY OTHER CHILDREN R IS OR HAS BEEN INVOLVED IN RAISING.]
R’s childhood parenting arrangement
Now, I’d like to ask you a few questions about the family you grew up in. [REFER TO GENOGRAM.]
Created
While you were growing up—that is, before you turned 18—did you live mostly with...
Two people you considered to be parents
One person you considered to be a parent
No one you considered to be a parent
[REFER TO GENOGRAM.] Just to confirm, while you were growing up, how
many times did you experience a change in the people who were
raising you? For example, one parent could have gotten married, one
parent could have left, or there could have been some other reason
for a change in the people who were raising you?
_________ (#
of changes)
Overall, how stable do you feel your parenting arrangement was during your childhood? [USE SHOWCARD.]
Very stable
Stable
Unstable
Very unstable
R’s childhood relationship with father
Did you ever live with your biological father?
YES
NO
ECLS-B 9-month Resident Father Questionnaire
While you were growing up, how close did you feel to your biological father? [USE SHOWCARD.] Would you say...
Extremely close
Somewhat close
Not very close
Modified from Fragile Families Father Baseline Survey
How involved was your biological father in raising you? [USE SHOWCARD.] Would you say…
Very involved
Somewhat involved
Not at all involved
While you were growing up, did you have someone else whom you considered to be your father? (Someone else besides your biological father.)
YES
NO
(If yes to had someone else considered to be a father): [REFER TO GENOGRAM AND DETERMINE THE MAIN (NONBIOLOGICAL) FATHER FIGURE THAT THE R LIVED WITH MOST.] While you were growing up, how close did you feel to {father figure}? Would you say...
Extremely close
Somewhat close
Not very close
Modified from Fragile Families Father Baseline Survey
How involved was {father figure} in raising you? [USE SHOWCARD.] Would you say…
Very involved
Somewhat involved
Not at all involved
R’s childhood relationship with mother
Created
Did you ever live with your biological mother?
YES
NO
While you were growing up, how close did you feel to your biological mother? Would you say...
Extremely close
Somewhat close
Not very close
How involved was your biological mother in raising you? Would you say…
Very involved
Somewhat involved
Not at all involved
While you were growing up, did you have someone else whom you considered to be your mother? (Someone else besides your biological mother.)
YES
NO
(If yes to had someone else considered to be a mother): [REFER TO GENOGRAM AND DETERMINE THE (NONBIOLOGICAL) MOTHER FIGURE THAT THE R LIVED WITH MOST.] While you were growing up, how close did you feel to {mother figure}? Would you say...
Extremely close
Somewhat close
Not very close
How involved was {mother figure} in raising you? Would you say…
Very involved
Somewhat involved
Not at all involved
Family members’ criminal/AOD involvement
Returning Home
The next set of questions are about your spouse/partner and extended family, including your child(ren), parents, siblings, cousins, grandparents, and other relatives.
Has (SPOUSE/PARTNER) or anyone in your family ever been arrested, other than yourself?
YES
NO
(If yes) Who in your family has ever been arrested? [SELECT ALL THAT APPLY.] [USE SHOWCARD.]
(SPOUSE/PARTNER)
Your mother/stepmother
Your father/stepfather
Your brother, stepbrother, sister, or stepsister
Your aunt or uncle
Your cousin
Your grandparent
Your child or stepchild
Any of your other relative(s)
Has (SPOUSE/PARTNER) or anyone in your family ever had problems with drugs or alcohol?
YES
NO
(If yes) Who in your family has had problems with drugs or alcohol? [SELECT ALL THAT APPLY.] [USE SHOWCARD.]
(SPOUSE/PARTNER)
Your mother/stepmother
Your father/stepfather
Your brother, stepbrother, sister, or stepsister
Your aunt or uncle
Your cousin
Your grandparent
Your child or stepchild
Any of your other relative(s)
Marital history and current relationship status
Next, I’d like to ask you about some of the relationships you’ve had in your life, using our drawing as a starting point. [REFER TO GENOGRAM.]
Created
So, just to confirm, have you ever been married?
YES
NO
(If ever married) How many times? _____
(If ever married) And just to confirm, are you currently married?
YES
NO
(If currently married) How long have you been married to your current spouse? [REFER TO REFERENCE CALENDAR.]
|___|___| |___|___|
MONTHS YEARS
(If ever married) Just to confirm, have you ever been divorced?
YES
NO
(If ever divorced) How many times have you been divorced? _____
(If currently married) Are you currently romantically involved with your spouse? That is, do you still consider yourselves to be a couple?
YES
NO
(If not romantically involved with spouse) Are you legally separated?
YES
NO
(If romantically involved with spouse) And this person’s name is {name}, correct? [RECORD.] For the rest of the interview, I will use the term “spouse” to refer to this person.
[IF PRELOADED AS MFS-IP PARTICIPANT, CONFIRM THAT THIS IS THE PERSON R WILL BE PARTICIPATING IN TREATMENT WITH.]
(If other than married or separated, or report not being in a romantic relationship with the spouse) And just to confirm, are you in a romantic relationship with anyone? (Do you have a partner, or someone you are in a serious relationship with?)
YES
NO
(If in romantic relationship) And this person’s name is {name}, correct? [RECORD.] For the rest of the interview, I will use the term “partner” to refer to this person.
[IF PRELOADED AS MFS-IP PARTICIPANT, CONFIRM THAT THIS IS THE PERSON R WILL BE PARTICIPATING IN TREATMENT WITH.]
Duration of current relationship
(If in romantic relationship with spouse or someone else) Were you in a relationship with (SPOUSE/PARTNER) before you were incarcerated this time?
YES
NO
(If in romantic relationship) How long have you and (SPOUSE/PARTNER) been together? [REFER TO REFERENCE CALENDAR.]
|___|___| |___|___|
MONTHS YEARS
SVORI (modified)
During the 6 months before your incarceration, were you living with (SPOUSE/PARTNER) at any point? [REFER TO REFERENCE CALENDAR.]
YES
NO
Co-parenting relationship
(If R has any children) How many other adults do you share parenting responsibilities with for any of your children? This could include ex-spouses or ex-partners who are mothers of your children, or another adult such as a grandparent with whom you are raising one of your children.
_______ (# COPARENTS)
Detailed child characteristics (all children) – gender, age, relationship to child, relationship with mother, residence with child, financial support, frequency of contact
61a (If R has children) Next I’m going to ask you some questions about each of the children you have, using our drawing as a starting point. For these questions, we’ll include all children that you are parenting in some way. [REFER TO GENOGRAM.] That would be [number] child(ren) total, correct? [ENTER TOTAL NUMBER OF CHILDREN FROM GENOGRAM.]
___________ (# of children)
Let’s start with your oldest child.
61 The child’s name is (state name from genogram), correct? [FILL IN FIRST NAME.]
62 What is the child’s age? (PROBE IF NEEDED: Your best estimate is fine.)
___________ (AGE IN YEARS)
63. And (CHILD) is (male/female), correct?
Male
Female
64. And just to confirm, (CHILD) is (SELECT RELATIONSHIP FROM BELOW), correct?
Your biological child
A child of your spouse or ex-spouse
A child of your partner or ex-partner
A child of another blood relative
A child of a non-relative
A legally adopted child
65. (If other than “child of your spouse”) And just to confirm, what is your relationship to (fill child name)’s mother?
You’ve never been married
You’re divorced or separated
You’re currently married
66. (If other than “child of your spouse”) And you (are/are not) currently in a committed romantic relationship with (fill child name)’s mother, correct?
In a committed relationship
Not in a committed relationship
67. Did you live with this child during the 6 months prior to this incarceration? [REFER TO REFERENCE CALENDAR.]
YES
NO
68. (If not living with child) How far away from (fill child name) were you living during the 6 months prior to this incarceration? Please tell me about how long it would take for you to travel from the place you were living to (fill child name)’s home.
__________(# MINUTES)
More than a 12-hour drive
69. (If R did not live with child prior to incarceration) Did you financially support this child in any way during the 6 months prior to this incarceration? [REFER TO REFERENCE CALENDAR.]
YES
NO
69a. (If yes) In what way or ways did you provide financial support for (FOCAL CHILD)? Please include support you provided to the child directly as well as support you provided to the child’s other parent or caretaker. [USE SHOWCARD]
Giving (FOCAL CHILD) birthday or holiday gifts
Taking (FOCAL CHILD) shopping for clothing, school supplies, or other
things s/he needs
Helping out occasionally with bills, rent or other expenses in the child’s
household
Providing steady, regular financial support of up to $100 per month
Providing steady, regular financial support of $100-$200 per month
Providing steady, regular financial support of $200-$300 per month
Providing steady, regular financial support of over $300 per month
70.. On average during the 6 months before you were incarcerated, how often did you see (fill child name) in person? [REFER TO REFERENCE CALENDAR.]
Not at all
A few times
Monthly
Weekly
Daily
[REPEAT QUESTIONS ABOVE FOR ALL CHILDREN.]
Child support payments (any children)
(If R has children under 18)
BSF
71. In the 6 months before this incarceration, were you required by a court to pay child support for any of your children? [REFER TO REFERENCE CALENDAR.]
Yes
No
72. (If R is required to pay child support) How many children were you required to pay child support for?
_____(# of children)
73. (If R is required to pay child support) Overall, how many of those court-ordered child support payments did you make?
All required payments
Some required payments
No required payments
SVORI
74. (If R is required to pay child support) Has the court order for child support been changed while you have been in prison?
Yes
No
75. (If R is required to pay child support) Do you owe back child support?
Yes
No
Focal child selection
76. One of your children will be selected by the computer, and I will ask some more specific questions about him or her. (Programming parameters to be determined: randomly selected child (1) biologically in common or being coparented with study participant partner, (2) who lived with R prior to incarceration, (3) who currently lives with study participant partner, (4) who is between 6 and 16 years old if possible, otherwise child who is closest in age to 8.) The computer has selected (FOCAL CHILD) for me to ask about.
Now, I’m going to ask you some questions about your life during the 6 months prior to your admission for this incarceration.
Street time
In the 6 months before this incarceration, how many days were you incarcerated in a prison, jail, or juvenile facility? [REFER TO REFERENCE CALENDAR.]
_____ (# days)
In the 6 months before this incarceration, how many days were you hospitalized in a hospital or mental health institution?
_____ (# days)
In the 6 months before this incarceration, how many days were you in a residential treatment program?
_____ (# days)
Employment statusNSAF
Now I’d like to ask a few questions about your employment.
At any point during the 6 months before you were incarcerated, were you working at a job? [REFER TO REFERENCE CALENDAR.] [IF R HAD A JOB BUT WAS TEMPORARILY NOT WORKING BECAUSE OF SICKNESS, VACATION, STRIKE, BAD WEATHER, ETC., COUNT AS EMPLOYED.]
Yes
No
Full/part time
SVORI
Was your last job...
Part time
Full time
You have never had a job
Type of employment
SVORI
(If R has ever had a job) Was your last job...
Formal pay (a job that has a pay stub)
Self-employment
Casual pay (a job that is “under the table” or “off the books”)
Earnings
SVORI
(If R has ever had a job) How much did you earn from your last job before taxes, including any tips, bonuses, and commissions? Responses could be per hour, per day, per week, per two weeks, per month, or per year.
___________(# dollars)
per hour
per day
per week
every 2 weeks
per month
per year
Benefits
SVORI
(If R has ever had a job) Did your last job provide health insurance coverage?
Yes
No
SVORI
(If R has ever had a job) Were you entitled to any fully paid leave, such as sick leave, paid holidays, or vacation leave from your employer?
Yes
No
Type of housing
Drug court study
At any point during the 6 months prior to incarceration, did you ever live in these places? [REFER TO REFERENCE CALENDAR.] [USE SHOWCARD.] SELECT ALL THAT APPLY.
In your own house or apartment, meaning your name is on the title,
mortgage, or lease
In someone else’s house or apartment
In a transitional housing building or halfway house
In a motel/hotel or rooming house
In a residential treatment facility
In a shelter
On the street
In an outdoor location where you camped out
In an abandoned building or vacant unit
In some other place
(If R lived in more than one place) During the 6 months prior to incarceration, where did you mostly live? SELECT ONE.
In your own house or apartment, meaning your name is on the title,
mortgage, or lease
In someone else’s house or apartment
In a transitional housing building or halfway house
In a motel/hotel or rooming house
In a residential treatment facility
In a shelter
On the street
In an outdoor location where you camped out
In an abandoned building or vacant unit
In some other place
(If R only lived OR mostly lived in own home or someone else’s home) Was the (house/apartment) public housing? Public housing is defined as a unit in a building owned by a public housing authority.
Yes
No
(If no) Was the (house/apartment) Section 8? Section 8 housing is where a Section 8 voucher is being used to pay for part or all of your rent for a privately owned unit.
Yes
No
People living with
Who were you living with? Please list everyone who lived with you at some point during the 6 months before you were incarcerated. SELECT ALL THAT APPLY.
No one else
Spouse or romantic partner (at the time)
Ex-spouse or romantic partner (at the time)
Mother/stepmother
Father/stepfather
Sister/stepsister
Brother/stepbrother
Aunt/uncle, great aunt/uncle
Cousin
Grandparent
Child/stepchild
Friend of R
Friend of R’s partner
Some other person, not a
friend or family member (specify)
_________________________________________________________
Neighborhood characteristics
SVORI/Returning Home
Please tell me whether you strongly disagree, disagree, agree, or strongly agree with the following statements about the neighborhood where you mainly lived during the 6 months prior to incarceration. [REFER TO REFERENCE CALENDAR.]
It was hard to stay out of trouble in your neighborhood or community.
Strongly agree
Agree
Disagree
Strongly disagree
Drug selling was a major problem in your neighborhood or community.
Strongly agree
Agree
Disagree
Strongly disagree
Your neighborhood or community was a good place to live.
Strongly agree
Agree
Disagree
Strongly disagree
Your neighborhood or community was a good place to find a job.
Strongly agree
Agree
Disagree
Strongly disagree
Income sharing with partner
(If R was with partner prior to this incarceration) Do you and (SPOUSE/PARTNER) share income and expenses with each other? This could include sharing rent, splitting bills or other expenses, or sharing assets like a bank account. [REFER TO REFERENCE CALENDAR.]
Yes
NO
Sources of income (R and partner)
BSF (modified)
Next I’m going to read a list of income sources. For each, tell me if you received income from this source in the 6 months prior to your incarceration. [REFER TO REFERENCE CALENDAR.] [USE SHOWCARD.]
Cash welfare, also known as TANF? You may have received this benefit as an electronic transfer, a check, or on a bank or debit card. TANF is Temporary Assistance for Needy Families.
Yes
No
(If partner shares expenses with R) Did (SPOUSE/PARTNER) receive income from this source?
Yes
No
Other public assistance, such as food stamp benefits, support from the Indian Health Service, disability insurance such as Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), or unemployment insurance benefits (UI)? You may have received these benefits as coupons, electronic transfer, or as an EBT or debit card.
Yes
No
(If partner shares expenses with R) Did (SPOUSE/PARTNER) receive income from this source?
Yes
No
Child support payments?
Yes
No
(If partner shares expenses with R) Did (SPOUSE/PARTNER) receive income from this source?
Yes
No
Money from friends or relatives who do not live with you?
Yes
No
(If partner shares expenses with R) Did (SPOUSE/PARTNER) receive income from this source?
Yes
No
Formal employment? By “formal,” we mean a job that you received a pay stub for, and for which taxes were taken out of your pay.
Yes
No
(If partner shares expenses with R) Did (SPOUSE/PARTNER) receive income from this source?
Yes
No
“Under the table” or casual work. By “under the table,” we mean work that you did not receive a pay stub for, for which taxes were not taken out of your pay. This could include things you were paid in cash for, like babysitting or mowing lawns.
Yes
No
(If partner shares expenses with R) Did (SPOUSE/PARTNER) receive income from this source?
Yes
No
Illegal activities, such as selling drugs, breaking and entering , etc.
Yes
No
(If partner shares expenses with R) Did (SPOUSE/PARTNER) receive income from this source?
Yes
No
This next set of questions deals with the kinds of support you received from your friends and family during the 6 months prior to incarceration. [REFER TO REFERENCE CALENDAR.]
Number of friends
Social Capital Community Benchmark Survey
First, I will ask about your friends. Please do not count any family members as you answer these questions.
How many close friends did you have during the 6 months prior to incarceration? These are people you felt at ease with, could talk to about private matters, or could call on for help. Would you say you had no close friend, 1-2, 3-5, 6-10, or more than that?
No close friends
One or two
Three to five
Six to ten
More than ten
Negative/positive peer exposure
Returning Home/SVORI (modified)
Think about the people you spent time with prior to this incarceration, other than (SPOUSE/PARTNER) and other family members.
Of the people you spent time with before you were incarcerated, how many had ever been in prison? [USE SHOWCARD.]
All
Most
Some
None
Of the people you spent time with before you were incarcerated, how many were employed full time?
All
Most
Some
None
Of the people you spent time with before you were incarcerated, how many could you hang out with and know that you wouldn’t get in trouble?
All
Most
Some
None
Of the people you spent time with before you were incarcerated, how many used illegal drugs?
All
Most
Some
None
Created
How often did the people you spent time with convince you to do things you knew you shouldn’t be doing?
Often
Sometimes
Rarely
Never
Number of close family members
Next, I’d like to know about family members other than your spouse/partner or child(ren).
How many close family members did you have during the 6 months prior to incarceration? These are people you felt at ease with, could talk to about private matters, or could call on for help. Would you say you had no close family members, 1-2, 3-5, 6-10, or more than that?
No close family members
One or two
Three to five
Six to ten
More than ten
(Skip this entire domain if R was not with SPOUSE/PARTNER prior to this incarceration)
Now, I’m going to ask you some questions about your romantic relationship during the 6 months prior to this incarceration. [REFER TO REFERENCE CALENDAR.] Please remember that your answers cannot be shared with your family, friends, or acquaintances under any circumstances.
Psychological abuse
Thinking about the 6 months before you were incarcerated, please tell me how much of the time each of these statements was true.
How often did you feel safe in your relationship with (SPOUSE/PARTNER)? Would you say…
Often 1
Sometimes 2
Rarely 3
Never 4
TX HM
How often did (SPOUSE/PARTNER) become jealous or possessive. Would you say…?
Often 1
Sometimes 2
Rarely 3
Never 4
TX HM
How often did (SPOUSE/PARTNER) make you feel like you were not good enough. Would you say…?
Often 1
Sometimes 2
Rarely 3
Never 4
Conflict tactics
SMH/BSF (Modified from Conflict Tactics Scale)
No matter how well a couple gets along, there are times when they disagree or have fights. I am going to read a list of things that might happen when you have differences. First, tell me how many times during the 6 months prior to incarceration you did the following. Then I’ll ask you how many times in the 6 months prior to your most recent incarceration (SPOUSE/PARTNER) did the following. [REFER TO REFERENCE CALENDAR.] [USE SHOWCARD.]
In the 6 months prior to this incarceration, how many times did you throw something at your spouse/partner?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to this incarceration, how many times did your spouse/partner throw something at you?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to this incarceration, how many times did you push, shove, hit, slap, or grab (SPOUSE/PARTNER)?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to this incarceration, how many times did your spouse/partner push, shove, hit, slap, or grab you?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to this incarceration, how many times did you use a knife or gun on your spouse/partner?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to this incarceration, how many times did your spouse/partner use a knife or gun on you?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to this incarceration, how many times did you choke, slam, kick, burn, or beat your spouse/partner?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to this incarceration, how many times did your spouse/partner choke, slam, kick, burn, or beat you?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to this incarceration, how many times did you use force to make your spouse/partner have sex? ( Force means things like hitting, holding down, or using a weapon.)
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to this incarceration, how many times did your spouse/partner use force to make you have sex? ( Force means things like hitting, holding down, or using a weapon.)
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to this incarceration, how many times did you threaten to hurt your spouse/partner?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to this incarceration, how many times did your spouse/partner threaten to hurt you?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to this incarceration, how many times did you threaten to hurt your spouse/partner’s child(ren), family members, or other loved ones?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to this incarceration, how many times did your spouse/partner threaten to hurt your child(ren), family members, or other loved ones?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to this incarceration, how many times did you try to keep your spouse/partner from seeing or talking with her friends or family?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to this incarceration, how many times did your spouse/partner try to keep you from seeing or talking with your friends or family?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to this incarceration, how many times did you keep money from your spouse/partner, make her ask for money, or take money from her?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to this incarceration, how many times did your spouse/partner try to keep money from you, make you ask for money, or take money from you?
None
1 time
2 times
3-5 times
6 or more times
This next set of questions is about your experiences with parenting your child(ren) during the 6 months before this incarceration.
Co-parental conflict about focal child
(If spouse/partner is coparent to focal child) How often did you and (SPOUSE/PARTNER) stand by a discipline or parenting decision, even if one of you did not like the decision? [REFER TO REFERENCE CALENDAR.]
Often
Sometimes
Rarely
Never
Did you and (SPOUSE/PARTNER) often, sometimes, rarely, or never have arguments about (FOCAL CHILD)?
Often
Sometimes
Rarely
Never
Who made major decisions about things such as child care and health care for (FOCAL CHILD)? Would you say...
You and the child's mother or main caretaker made most decisions
together
The child's mother or main caretaker made most decisions herself
You made most decisions yourself
Frequency of eating meals with focal child
In a typical week, how many days did you eat at least one meal with (FOCAL CHILD) during the 6 months before this incarceration? [REFER TO REFERENCE CALENDAR.]
NONE
One day
Two days ……….
Three days
Four days
Five days ……….
Six days
Seven days
Substance use
Please tell me which of the following substances you used during the 6 months before your incarceration, even just once. [REFER TO REFERENCE CALENDAR.] [SELECT ALL THAT APPLY.] [USE SHOWCARD.]
Alcohol
Marijuana or hashish
Powder cocaine
Crack cocaine
Heroin (this includes smoking, sniffing, snorting, and injecting heroin)
Methamphetamine
Other amphetamines, such as monster, crank, or ice
Hallucinogens or designer drugs, such as ecstasy, LSD or acid,
mushrooms, mescaline, peyote, green, PCP, or angel dust
Prescription medication without a prescription or for other reasons
than
were prescribed, or in larger amounts, or more often than
your doctor
ordered. This includes sedatives, tranquilizers,
stimulants, pain
relievers, opiates, or anabolic steroids.
Methadone without a prescription or for other reasons than were
prescribed, or in larger amounts, or more often than your
doctor
ordered.
Did not use any alcohol or drugs
(If R reports no alcohol or drug use during 6 months prior to incarceration, skip to Physical and Mental Health domain.)
Which of the following did you use the most during the 6 months before your incarceration? SELECT ONE. [READ LIST OUT LOUD.] [SHOW ONLY RESPONSE CATEGORIES THAT WERE SELECTED BY THE R IN THE PRIOR QUESTION.]
Alcohol
Marijuana or hashish
Powder cocaine
Crack cocaine
Heroin (this includes smoking, sniffing, snorting, and injecting heroin)
Methamphetamine
Other amphetamines, such as monster, crank, or ice
Hallucinogens or designer drugs, such as ecstasy, LSD or acid,
mushrooms, mescaline, peyote, green, PCP, or angel dust
Prescription medication without a prescription or for other reasons
than
were prescribed, or in larger amounts, or more often than
your doctor
ordered. This includes sedatives, tranquilizers,
stimulants, pain
relievers, opiates, or anabolic steroids.
Methadone without a prescription or for other reasons than were
prescribed, or in larger amounts, or more often than your
doctor
ordered.
Addiction severity
CAGE
In the 6 months prior to your incarceration, [REFER TO REFERENCE CALENDAR.]
(If R reported any alcohol use) Did you feel you should cut down on your drinking?
Yes
No
(If R reported any alcohol use) Did people ever annoy you by complaining about your drinking?
Yes
No
(If R reported any alcohol use) Did you ever feel bad or guilty about your drinking?
Yes
No
(If R reported any alcohol use) Did you ever have a drink first thing in the morning to steady your nerves or get rid of a hangover (“eye-opener”)?
Yes
No
(If R reported any drug use) Did you ever feel you should cut down on your drug use?
Yes
No
(If R reported any drug use) Did people ever annoy you by complaining about your drug use?
Yes
No
(If R reported any drug use) Did you ever feel bad or guilty about your drug use?
Yes
No
Anger and addiction
(If R reported any AOD use) During the 6 months before you were incarcerated, how often did you experience problems with anger when you had been drinking or using drugs? [REFER TO REFERENCE CALENDAR.]
Often
Sometimes
Rarely
Never
(If R reported any AOD use) During the 6 months before you were incarcerated, how often did you physically hurt or get rough with your spouse/partner or other family members when you had been drinking or using drugs?
Often
Sometimes
Rarely
Never
Binge drinking
National Survey on Drug Use and Health
(If R reported any alcohol use) During the 6 months before you were incarcerated, how often did you have 5 or more drinks of beer, wine, or liquor on the same occasion? By “drink,” we mean a bottle or can of beer, a wine cooler or a glass of wine, a shot of liquor, or a mixed drink or cocktail. By “occasion,” we mean at the same time or within a couple of hours of each other. [REFER TO REFERENCE CALENDAR.]
Often
Sometimes
Rarely
Never
The next questions are about health care and health insurance.
Health insurance
During the 6 months before this incarceration, were you covered by Medicaid, (CA: Medi-Cal), Medicare, Champus, Indian Health Services, or any other government program that pays for medical care? [REFER TO REFERENCE CALENDAR.]
YES
NO
During the 6 months before your incarceration, were you covered by health insurance through your or someone else’s employer, or insurance you purchased directly from a private insurance company?
YES
NO
Unmet need
During the 6 months before your incarceration, did you, your spouse/partner or your child(ren) ever need to see a doctor or go to the hospital but couldn’t go because of the cost?
YES
NO
In-prison contact with other family members
SVORI (modified)
How often do you currently receive personal visits from family members other than (SPOUSE/PARTNER) and child(ren)? [REFER TO REFERENCE CALENDAR.]
One or more times a week
A couple of times a month
About once a month
Every couple of months
Only a couple of times
Never
Importance of partner contact during incarceration
The next set of questions is about keeping in touch with your spouse/partner during this incarceration. First, I’d like to know how much you agree or disagree with each of the following statements.
Keeping in touch with (SPOUSE/PARTNER) during this incarceration is very important to you.
Strongly agree
Agree
Disagree
Strongly disagree
Institutional support for partner contact during incarceration
You are satisfied with the amount of help you’ve received with staying in touch with (SPOUSE/PARTNER) during this incarceration. This could be help from outside programs or agencies, program staff at your facility, clergy, correctional officers, or other staff.
Strongly agree
Agree
Disagree
Strongly disagree
Contact with partner during incarceration
Now, I’d like to ask about specific contact you may have had. [REFER TO REFERENCE CALENDAR.] [USE SHOWCARD.]
SVORI (modified)
About how often do you currently talk on the phone with (SPOUSE/PARTNER)?
One or more times a week
A couple of times a month
About once a month
Every couple of months
Only a couple of times
Never
(If R currently talks on the phone with spouse/partner) About how long is your average phone call with (SPOUSE/PARTNER)?
_______ (# MINUTES)
How often do you currently send mail to (SPOUSE/PARTNER)?
One or more times a week
A couple of times a month
About once a month
Every couple of months
Only a couple of times
Never
How often do you currently receive mail from (SPOUSE/PARTNER)?
One or more times a week
A couple of times a month
About once a month
Every couple of months
Only a couple of times
Never
How often do you currently receive personal visits from (SPOUSE/PARTNER)?
One or more times a week
A couple of times a month
About once a month
Every couple of months
Only a couple of times
Never
(If R has received any personal visits from spouse/partner) About how much time do you spend visiting with (SPOUSE/PARTNER) on an average visit?
_______ (# MINUTES)
Barriers to contact with partner during incarceration
Returning Home (modified)
Thinking about your time in prison, please tell me how much you agree or disagree with each of the following statements.
The prison is located too far away for (SPOUSE/PARTNER) to make regular visits or is too hard to get to because of transportation issues.
Strongly agree
Agree
Disagree
Strongly disagree
Visitor admission rules (such as background checks, dress codes, searches, metal detectors) are hard for (SPOUSE/PARTNER) to deal with.
Strongly agree
Agree
Disagree
Strongly disagree
The cost of visiting makes it hard for (SPOUSE/PARTNER) to visit as often as she would like to.
Strongly agree
Agree
Disagree
Strongly disagree
Schedule issues, like limited visiting hours and (SPOUSE/PARTNER)’s work schedule, make it hard for her to find time for visits.
Strongly agree
Agree
Disagree
Strongly disagree
The cost of receiving calls is too high for (SPOUSE/PARTNER), or you do not have access to a phone.
Strongly agree
Agree
Disagree
Strongly disagree
The prison is not a pleasant place to visit, or not a place you want (SPOUSE/PARTNER) to see you.
Strongly agree
Agree
Disagree
Strongly disagree
(SPOUSE/PARTNER) does not want to maintain close contact with you while you are incarcerated.
Strongly agree
Agree
Disagree
Strongly disagree
You do not want to maintain close contact with (SPOUSE/PARTNER) while you are incarcerated.
Strongly agree
Agree
Disagree
Strongly disagree
What would you say are the two biggest difficulties in staying in touch with (SPOUSE/PARTNER) during your incarceration? [SHOW ONLY ITEMS FOR WHICH R ANSWERED “STRONGLY AGREE” OR “AGREE” ABOVE.]
The prison is located too far away for (SPOUSE/PARTNER) to make
regular visits or is too hard to get to because of
transportation issues
Visitor admission rules (such as background checks, dress codes,
searches, metal detectors) are hard for (SPOUSE/PARTNER)
to
deal with
The cost of visiting makes it hard for (SPOUSE/PARTNER) to visit as
often as she would like to.
Schedule issues, like limited visiting hours and (SPOUSE/PARTNER)’s
work schedule, make it hard for her to find time for visits.
The cost of receiving calls is too high for (SPOUSE/PARTNER), or you
do not have access to a phone.
The prison is not a pleasant place to visit, or not a place you want
(SPOUSE/PARTNER) to see you.
(SPOUSE/PARTNER) does not want to maintain close contact with
you
while you are incarcerated.
You do not want to maintain close contact with (SPOUSE/PARTNER)
while you are incarcerated.
Impact of incarceration on partner relationship
(If R was with partner prior to this incarceration) How has your time in prison changed your relationship with (SPOUSE/PARTNER), if at all? Has it made you closer, has it made you drift apart, or has there been no change?
Made you closer
Made you drift apart
No change
What concerns or worries do you have about your relationship with (SPOUSE/PARTNER)during your incarceration? Mark all that apply.
Your time in prison will make you drift apart
It is hard for you to know what your place in her life is when you’re
in
prison
You don’t know whether she will accept collect charges for your
calls or
be at home when you call
She is concerned about your lifestyle in prison
She won’t forgive you for problems or conflicts you’ve had
Being in prison makes it hard to open up to her or let yourself get
close to her
You don’t know whether she will get involved with someone else
while
you’re in prison
Or do you have another concern that I haven’t listed? (SPECIFY) _____________________________________
Of the concerns you mentioned, which one is your biggest concern? Mark one only. [SHOW ONLY RESPONSE OPTIONS THAT WERE SELECTED ABOVE.]
Your time in prison will make you drift apart
It is hard for you to know what your place in her life is when you’re
in
prison
You don’t know whether she will accept collect charges for your
calls or
be at home when you call
She is concerned about your lifestyle in prison
She won’t forgive you for problems or conflicts you’ve had
Being in prison makes it hard to open up to her or let yourself get
close
to her
You don’t know whether she will get involved with someone else
while
you’re in prison
Other (specify) _____________________________________
Importance of child contact during incarceration
The next set of questions is about keeping in touch with your child(ren) during this incarceration. First, I’d like to know how much you agree or disagree with each of the following statements.
Keeping in touch with your child(ren) during your incarceration is very important to you. Do you...
Strongly agree
Agree
Disagree
Strongly disagree
Institutional support for contact with children during incarceration
You are satisfied with amount of help you’ve received with staying in touch with your child(ren) during this incarceration. This could be help from outside programs or agencies, program staff at your facility, clergy, correctional officers, or other staff. Do you...
Strongly agree
Agree
Disagree
Strongly disagree
Contact with children during incarceration
Contact with focal child during incarceration
Now, I’d like to ask about specific contact you may have had. [REFER TO REFERENCE CALENDAR.] [USE SHOWCARD.]
SVORI (modified)
How often do you currently talk on the phone with (your child/any of your children)?
One or more times a week
A couple of times a month
About once a month
Every couple of months
Only a couple of times
Never
(If never, skip to question about sending mail.)
(If R has more than 1 child) How many of your children do you currently talk on the phone with?
[RECORD NUMBER.] ______________
(If R has more than 1 child) Do you currently talk on the phone with (FOCAL CHILD)?
YES
NO
(If R currently talks on the phone with any children) About how long is your average phone call with (your child/any of your children)?
_______ (# MINUTES)
How often do you currently send mail to (your child/any of your children)?
One or more times a week
A couple of times a month
About once a month
Every couple of months
Only a couple of times
Never
(If never, skip to question about sending audiotapes.)
(If R has more than 1 child) How many of your children do you currently send mail to?
_______ (# of children)
(If R has more than 1 child) Do you currently send mail to (FOCAL CHILD)?
YES
NO
Have you been able to send any audiotapes to (your child/any of your children)?
YES
NO
How often do you currently receive mail from (your child/any of your children)?
One or more times a week
A couple of times a month
About once a month
Every couple of months
Only a couple of times
Never
(If never, skip to question about receiving photographs.)
(If R has more than 1 child) How many of your children do you currently receive mail from?
_______ (# of children)
(If R has more than 1 child) Do you currently receive mail from (FOCAL CHILD)?
YES
NO
Have you received any photographs or audiotapes of (your child/any of your children)?
YES
NO
How often do you currently receive personal visits from (your child/any of your children)?
One or more times a week
A couple of times a month
About once a month
Every couple of months
Only a couple of times
Never
(If never, skip to Impact of Incarceration domain.)
(If R has more than 1 child) How many of your children do you currently receive personal visits from?
_______ (# of children)
(If R has more than 1 child) Do you currently receive personal visits from (FOCAL CHILD)?
YES
NO
Parental warmth
(If R has no contact with focal child during this incarceration, skip this subsection)
For the next set of questions, I’d like you to think about what things are like when you see or communicate with (FOCAL CHILD) now, during this incarceration.
On average, how often do you do each of the following with (FOCAL CHILD) when you communicate with him/her? [USE SHOWCARD.]
(Ask only if R reports visiting with focal child during this incarceration) Hug or show physical affection to your child?
Always
Usually
Sometimes
Never
Physical contact is not permitted during visits at your facility
Tell (FOCAL CHILD) that you love (him/her)?
Always
Usually
Sometimes
Never
Communicate with (FOCAL CHILD) about things (he/she) is interested in?
Always
Usually
Sometimes
Never
Praise (FOCAL CHILD)? By praise, we mean tell the child that s/he is good in some way or that s/he has done something well.
Always
Usually
Sometimes
Never
Barriers to contact with children during incarceration
Returning Home (modified)
Thinking about your time in prison, please tell me how much you agree or disagree with each of the following statements.
The prison is located too far away for your child(ren) to have regular visits, or is too hard for the child(ren)’s mother or caretaker to get to because of transportation issues.
Strongly agree
Agree
Disagree
Strongly disagree
Visitor admission rules (such as background checks, dress codes, searches, metal detectors) are hard for your child(ren) to deal with.
Strongly agree
Agree
Disagree
Strongly disagree
The cost of visiting is too high for the child(ren)’s mother or caretaker to bring them as often as she would like to.
Strongly agree
Agree
Disagree
Strongly disagree
Schedule issues, like limited visiting hours and the child(ren)’s mother’s or caretaker’s work schedules, make it hard to find time for visits.
Strongly agree
Agree
Disagree
Strongly disagree
The cost of calling or receiving calls is too high, or you do not have access to a phone.
Strongly agree
Agree
Disagree
Strongly disagree
The prison is not a pleasant place to visit, or not a place you want your child(ren) to see you.
Strongly agree
Agree
Disagree
Strongly disagree
Your child(ren)’s mother or caretaker does not want (him/her/them) to maintain close contact with you while you are incarcerated.
Strongly agree
Agree
Disagree
Strongly disagree
You do not want to maintain close contact with your child(ren) while you are incarcerated.
Strongly agree
Agree
Disagree
Strongly disagree
Your child(ren)(do/does) not want to maintain close contact with you.
Strongly agree
Agree
Disagree
Strongly disagree
You were not in close contact with your child(ren) before this incarceration.
Strongly agree
Agree
Disagree
Strongly disagree
What are the two biggest challenges in staying in touch with your child(ren) while you are incarcerated? [MARK TWO ONLY.] [SHOW ONLY OPTIONS FOR WHICH THE R ANSWERED “Yes” ABOVE, PLUS THE “OTHER, SPECIFY” OPTION.]
The prison is located too far away for your child(ren) to have
regular visits,
or is too hard for the child(ren)’s
mother or caretaker to get to because of
transportation
issues
Visitor admission rules (such as background checks, dress codes,
searches, metal detectors) are hard for your child(ren) to deal
with.
The cost of visiting is too high for the child(ren)’s mother or
caretaker
to bring them as often as she would like to. .
Schedule issues, like limited visiting hours and the child(ren)’s
mother’s
or caretaker’s work schedules, make it
hard to find time for visits.
The cost of calling or receiving calls is too high, or you do not
have
access to a phone
The prison is not a pleasant place to visit, or not a place you want
your child(ren) to see you
Your child(ren)’s mother or caretaker does not want
(him/her/them)
to maintain close contact with you while you are
incarcerated
You do not want to maintain close contact with your child(ren) while
you are incarcerated
Your child(ren) (do/does) not want to maintain close contact with you
You were not in close contact with your child(ren) before the
incarceration
Some other reason (SPECIFY) _______________________________
Impact of incarceration on relationship with focal child
How has your time in prison changed your relationship with (FOCAL CHILD), if at all? Has it made you closer, has it made you drift apart, or has there been no change?
Made you closer
Made you drift apart
No change
What concerns or worries do you have about (FOCAL CHILD) during your incarceration? MARK ALL THAT APPLY. [USE SHOWCARD.]
Concerns about there being enough money to support him/her
Concerns about how s/he is doing in school
Concerns about his/her happiness
Concerns about him/her getting teased or threatened by peers
Concerns that you will not be as close emotionally as you were before
this incarceration
Concerns that s/he won’t have a male role model
Concerns that s/he will get in trouble
Other (specify)
What is your biggest concern or worry about (FOCAL CHILD) during your incarceration? MARK ONE ONLY. [(SHOW ONLY RESPONSE OPTIONS THAT WERE SELECTED ABOVE.]
Concerns about there being enough money to support him/her
Concerns about how s/he is doing in school
Concerns about his/her happiness
Concerns about him/her getting teased or threatened by peers
Concerns that you will not be as close emotionally as you were before
this incarceration
Concerns that s/he won’t have a male role model
Concerns that s/he will get in trouble
Other (specify)
Now, I’m going to ask you about services you might have received and programs you might have participated in since you’ve been incarcerated. [REFER TO REFERENCE CALENDAR.] I will also ask you which services you might have wanted or needed. We are asking these questions for research purposes only; your answers will not affect the services you receive.
Marriage education (need, receipt, attendance with partner, duration, completion, reasons for not completing)
Created
During this incarceration, have you attended any group classes or workshops on healthy marriage or romantic relationships? These sessions would have included other people, not just you or your spouse/partner.
Yes
No
Have you wanted or felt that you needed to attend any group classes or workshops on healthy marriage or romantic relationships?
Yes
No
(If received marriage education) How many times have you attended any group classes or workshops on healthy marriage or romantic relationships during this incarceration?
Number of times |___|___|
Created
(If received marriage education) During this incarceration, how many times have you and (SPOUSE/PARTNER) gone together to any group classes or workshops on healthy marriage or romantic relationships?
Number of times |___|___|
BSF
(If received marriage education) About how long did each class, workshop, or group session usually last?
In other words, for how many hours did you meet each time?
Number of hours |___|___|
(FI confirmation: So, you had about X sessions each lasting about Y hours?)
Created
(If received marriage education) Did you attend some or all of the classes or workshops that were offered or did you stop attending before the classes were over?
Attended all
Attended most
Attended a few
(If other than “attended all”) Why did you stop
attending the classes or workshops?
MARK ALL THAT APPLY. [USE
SHOWCARD.]
You were not interested in the classes/workshops
The classes/workshops were not helpful
(SPOUSE/PARTNER) objected
(SPOUSE/PARTNER) lacked transportation, child care, or had
conflicts
with her work schedule and couldn’t attend with
you
The location of the classes was not convenient
You or (SPOUSE/PARTNER) had a conflict with the instructor
You or (SPOUSE/PARTNER) had a conflict with participants
You or (SPOUSE/PARTNER) did not agree with discussions/message
You got released or transferred to another institution
You got kicked out
Some other reason (specify) _____________________________
Marriage/relationship counseling (need, receipt, attendance with partner, duration)
BSF/SMH
During this incarceration, have you met with a counselor, therapist, or social worker to work on your relationship with (SPOUSE/PARTNER) in sessions that were not part of a workshop, class, or group? In other words, individual or couple’s counseling sessions that did not include other people besides you or (SPOUSE/PARTNER).
Yes
No
Have you wanted or felt that you needed to participate in individual or couple’s counseling sessions to work on your relationship with (SPOUSE/PARTNER)?
Yes
No
BSF
(If received marriage counseling) During this incarceration, about how many times have you had these counseling sessions to work on your (marriage/relationship)?
Number of times |___|___|
Created
(If received marriage counseling) During this incarceration, about how many times have you and (SPOUSE/PARTNER) attended these counseling sessions together?
Number of times |___|___|
BSF
(If received marriage counseling) About how long did each session usually last?
Number of hours |___|___|
(FI confirmation: So, you had about X sessions each lasting about Y hours?)
How heard of relationship strengthening services
Created
(If received any marriage education or counseling) How did
you hear about the relationship strengthening activities in which
you participated? Who told you about the classes?
MARK ALL
THAT APPLY.
Heard about it at an orientation or information session
Heard about it from a friend or fellow inmate
Heard about it from PARTNER/SPOUSE
Saw poster, brochure, or other ad
Referred by case manager or other staff member
Referred by other service agency
Other (specify) ____________________________________
Skills learned from relationship strengthening services
CHMI
(If received any marriage education or counseling) What knowledge or skills did you learn in relationship classes or relationship counseling that helped you improve your relationship with (SPOUSE/PARTNER)? Please select all that apply. [USE SHOWCARD.]
How to talk with (SPOUSE/PARTNER) about things that matter
How to work through problems calmly and fairly
How to calm down when things get heated
How to work together on caring for the child(ren)
How to build and keep each other’s trust
How to work with each other’s feelings about other family
members,
ex-partners, and friends
How to deal with stress and life changes together
Other (specify) ___________________________________
(If R selects more than 1 response above) What would you say is the most important skill you learned in your relationship classes or relationship counseling?
How to talk with (SPOUSE/PARTNER) about things that matter
How to work through problems calmly and fairly
How to calm down when things get heated
How to work together on caring for the child(ren)
How to build and keep each other’s trust
How to work with each other’s feelings about other family members,
ex-partners, and friends
How to deal with stress and life changes together
Other (specify) ___________________________________
Created
(If received any marriage education or counseling) How much has your relationship with (SPOUSE/PARTNER) improved as a result of the classes or workshops? Would you say…
A lot
A little
Not at all
Parenting education (need, receipt, duration)
Modified from BSF
During this incarceration, have you attended any classes, groups, or workshops to help you improve your parenting skills or learn to be a better parent?
Yes
No
Have you wanted or felt that you needed this service?
Yes
No
(If received parenting) How many times have you attended any parenting classes, groups, or workshops during this incarceration?
Number of times |___|___|
BSF
(If received parenting) About how long did each class, workshop, or group session usually last? In other words, for how many hours did you meet each time?
Number of hours |___|___|
(FI confirmation: So, you had about X sessions each lasting about Y hours?)
Case management (need, receipt, duration, referrals, follow-up)
SVORI
During this incarceration, have you met with a staff member who talks with you about issues or needs you have, tries to get you into services or programs, helps you get benefits or assistance, and/or monitors your progress? These services are called case management and the person might be called a case manager, case worker, social worker, transition coordinator, or systems navigator.
Yes
No
Have you wanted or felt that you needed this service?
Yes
No
(If received case management) How many sessions of case management have you received during this incarceration?
NUMBER OF SESSIONS ______
(If received case management) Has a case manager referred you to any of the following kinds of services or benefits? Please select all that apply. [USE SHOWCARD.]
Marriage or relationship education
Parenting education
Job training or employment readiness
Money management training
Other life skills training
Support groups
Marriage or relationship counseling
Mental health treatment
Substance abuse treatment
Other counseling
Housing program
Health benefits program
Public assistance, such as TANF or food stamps
Legal services
(If received case management) Has a case manager followed up to make sure you received those services?
Yes
No
Substance abuse and mental health treatment (need, receipt)
Modified from BSF
During this incarceration, have you received counseling, therapy, or other treatment to help you deal with an emotional or mental health problem?
Yes
No
Have you wanted or felt that you needed this service?
Yes
No
During this incarceration, have you received counseling, self-help groups, group sessions, or other treatment to help you deal with alcohol or substance abuse?
Yes
No
Have you wanted or felt that you needed this service?
Yes
No
Other support services (need, receipt)
BSF modified
During this incarceration, have you received services or taken a course to help you manage anger?
Yes
No
Have you wanted or felt that you needed this service?
Yes
No
Created
During this incarceration, have you received services or taken a course for men to learn how to avoid hurting or abusing their partners?
Yes
No
Have you wanted or felt that you needed this service?
Yes
No
Created
During this incarceration, have you participated in any GED, adult basic education, or college courses?
Yes
No
Have you wanted or felt that you needed this service?
Yes
No
SVORI
During this incarceration, have you participated in any employment readiness, vocational or job training programs?
Yes
No
Have you wanted or felt that you needed this service?
Yes
No
Created
During this incarceration, have you participated in any money management or financial planning programs?
Yes
No
Have you wanted or felt that you needed this service?
Yes
No
During this incarceration, have you participated in any other life skills education?
Yes
No
Have you wanted or felt that you needed this service?
Yes
No
During this incarceration, have you received any help finding housing or paying for housing for when you are released?
Yes
No
Have you wanted or felt that you needed this service?
Yes
No
During this incarceration, have you received any assistance with retaining your parental rights or changing child custody arrangements?
Yes
No
Have you wanted or felt that you needed this service?
Yes
No
During this incarceration, have you participated in any family group conferencing or family mediation? We mean meetings with your family members, such as your spouse/partner, child(ren), or other family members to discuss issues and set goals for the future.
Yes
No
Have you wanted or felt that you needed this service?
Yes
No
During this incarceration, have you participated in any support groups? We mean a group of individuals who meet regularly to discuss personal or interpersonal issues.
Yes
No
Have you wanted or felt that you needed this service?
Yes
No
During this incarceration, have you received spiritual or religious assistance from any faith-based organizations or people? For example, this would include meeting with a chaplain, minister, or other clergy member.
Yes
No
Have you wanted or felt that you needed this service?
Yes
No
These next questions deal with your feelings, attitudes, and how things are going for you currently. [USE SHOWCARD.]
Locus of control
How often do you feel that you are not able to control the important things in your life?
Often
Sometimes
Rarely
Never
Anger management
Created
How often do you feel angry or mad? Would you say....
Often
Sometimes
Rarely
Never
In general, how much of the time does your anger cause problems in your relationships?
Often
Sometimes
Rarely
Never
How much of the time does your anger cause problems in your job or work life?
Often
Sometimes
Rarely
Never
Emotional reactivity
Reactive Responding Measure
For each of the following items, please tell me how much you agree or disagree. There are no correct or incorrect answers. [USE SHOWCARD.]
You often respond quickly and emotionally when something happens.
Strongly agree
Agree
Disagree
Strongly disagree
You let your emotions cool before you act.
Strongly agree
Agree
Disagree
Strongly disagree
Spirituality
These next questions are about the role that religion or spirituality plays in your life. Please tell me how much you agree or disagree with each of these statements.
SVORI
You find strength in your religion or spirituality.
Strongly agree
Agree
Disagree
Strongly disagree
You pray or meditate regularly.
Strongly agree
Agree
Disagree
Strongly disagree
You read the Bible, Koran, or other religious books regularly.
Strongly agree
Agree
Disagree
Strongly disagree
The religious services or groups you participate in matter a great deal to you.
Strongly agree
Agree
Disagree
Strongly disagree
Not applicable
Self-efficacy
SVORI
The next questions are about how you currently feel about your life.
You can do just about anything you really set your mind to.
Strongly agree
Agree
Disagree
Strongly disagree
Sometimes you feel like you’re being pushed around in your life.
Strongly agree
Agree
Disagree
Strongly disagree
You often feel helpless dealing with the problems of life.
Strongly agree
Agree
Disagree
Strongly disagree
Goal orientation
Shelley Taylor
It’s important for you to take time to plan out where you’re going in life.
Strongly agree
Agree
Disagree
Strongly disagree
You have many goals that you will work to achieve.
Strongly agree
Agree
Disagree
Strongly disagree
Attachment
Collins & Read 1991, partial
For each of the following statements, please tell me how much you agree or disagree when it comes to close relationships.
You find it difficult to allow yourself to depend on others.
Strongly agree
Agree
Disagree
Strongly disagree
You find it difficult to trust others completely.
Strongly agree
Agree
Disagree
Strongly disagree
You are nervous when anyone gets too close to you emotionally.
Strongly agree
Agree
Disagree
Strongly disagree
Cooperation
Cloninger Temperament Scale
You often consider another person’s feelings as much as your own.
Strongly agree
Agree
Disagree
Strongly disagree
People involved with you have to learn how to do things your way.
Strongly agree
Agree
Disagree
Strongly disagree
Relationship skills/knowledge
These next questions are about your opinions about romantic relationships. Please tell me how much you agree or disagree.
Once a couple starts to have problems, it usually is not possible to fix them.
Strongly agree
Agree
Disagree
Strongly disagree
Couples should not have to work on their relationships in order to have a happy relationship.
Strongly agree
Agree
Disagree
Strongly disagree
Most people can learn to communicate better with their spouse.
Strongly agree
Agree
Disagree
Strongly disagree
When one spouse says something mean or hurtful, it is OK for the other spouse to say something mean or hurtful back.
Strongly agree
Agree
Disagree
Strongly disagree
When wives and husbands have very different views about important things in the family, it is best to not talk about those things.
Strongly agree
Agree
Disagree
Strongly disagree
People can learn to avoid situations where they might be tempted to cheat on their spouse/partner.
Strongly agree
Agree
Disagree
Strongly disagree
It is sometimes OK for couples to get a little rough physically, like pushing or hitting.
Strongly agree
Agree
Disagree
Strongly disagree
Learning problems
Created
The next set of questions is about reading, writing, and doing math.
How easy or hard is it for you to do math, such as figuring out a tip, adding up your bills, or counting change? [USE SHOWCARD.]
Very easy
Pretty easy
Pretty hard
Very hard
How fast are you at doing math in your daily life, such as figuring out a tip, adding up your bills, or counting change? [USE SHOWCARD.]
Very fast
Pretty fast
Pretty slow
Very slow
How easy or hard is it for you to read a newspaper or magazine?
Very easy
Pretty easy
Pretty hard
Very hard
How fast are you at reading a newspaper or magazine?
Very fast
Pretty fast
Pretty slow
Very slow
How easy or hard is writing for you, such as writing letters and filling out forms?
Very easy
Pretty easy
Pretty hard
Very hard
How fast are you at writing, such as writing letters and filling out forms?
Very fast
Pretty fast
Pretty slow
Very slow
Wender Utah Rating Scale, Wender AQCC
Thinking back to when you were a child in school, please tell me how much you agree or disagree with the following statement.
As a child in school, overall you were a good student.
Strongly agree
Agree
Disagree
Strongly disagree
Created
As a child in school, did you ever...
Repeat any grades?
YES
NO
Get suspended or expelled?
YES
NO
Now I’d like to ask you some questions about your health and how you have been feeling over the last 1 month. [REFER TO REFERENCE CALENDAR.]
Overall physical health
CIDI-SF WHO Composite International Diagnostic Interview Short Form–edited
In general, how is your health? Would you say it is . . .
Excellent
Very good
Good
Fair
Poor
Physical health limitations
CIDI-SF WHO Composite International Diagnostic Interview Short Form–edited
Do you have a serious health problem that limits the amount or kind of work you can do?
YES
NO
Overall mental health
Created
In general, would you say your current emotional or psychological health is excellent, very good, good, fair, or poor?
Excellent
Very good
Good
Fair
Poor
ADHD
Copeland Symptom Checklist for Attention Deficit Disorders
Thinking about the past 1 month, please tell me how much you agree or disagree with each of the following statements.
You are easily distracted.
Strongly agree
Agree
Disagree
Strongly disagree
You get frustrated easily.
Strongly agree
Agree
Disagree
Strongly disagree
You do not think before acting.
Strongly agree
Agree
Disagree
Strongly disagree
PTSD
PC-PTSD
In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past 1 month, you have had nightmares about it or thought about it when you did not want to?
YES
NO
In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past 1 month, you tried hard not to think about it or went out of your way to avoid situations that reminded you of it?
YES
NO
In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past 1 month, you were constantly on guard, watchful, or easily startled?
YES
NO
In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past 1 month, you felt numb or detached from others, activities, or your surroundings?
YES
NO
Depression
CES-D Short
Below is a list of ways you might have felt or behaved recently. Please tell me how often you have felt this way during the past week. [USE SHOWCARD.] [REFER TO REFERENCE CALENDAR.]
During the past week….
You were bothered by things that don’t usually bother you.
All of the time
Most of the time
Some of the time
A little of the time
None of the time
You had trouble keeping your mind on what you were doing.
All of the time
Most of the time
Some of the time
A little of the time
None of the time
You felt depressed.
All of the time
Most of the time
Some of the time
A little of the time
None of the time
You felt that everything you did was an effort.
All of the time
Most of the time
Some of the time
A little of the time
None of the time
You felt hopeful about the future.
All of the time
Most of the time
Some of the time
A little of the time
None of the time
You felt fearful.
All of the time
Most of the time
Some of the time
A little of the time
None of the time
Your sleep was restless.
All of the time
Most of the time
Some of the time
A little of the time
None of the time
You were happy.
All of the time
Most of the time
Some of the time
A little of the time
None of the time
You felt lonely.
All of the time
Most of the time
Some of the time
A little of the time
None of the time
Now, I’m going to ask you some questions about your romantic relationship with (SPOUSE/PARTNER). Please remember that all information you provide will be kept strictly confidential.
Happiness with relationship
DAS-8
On a scale from 1 to 10 where 1 means not at all happy and 10 means perfectly happy, which number best describes your happiness with your relationship now, since you have been incarcerated? [USE SHOWCARD.]
_______ [ALLOW 1-10.]
Dyadic adjustment
DAS-8
How often do you and (SPOUSE/PARTNER) agree on displays of affection? By displays of affection, I mean holding hands, hugging, kissing, or other kinds of physical affection. [USE SHOWCARD.]
Often
Sometimes
Rarely
Never
How often have you discussed or considered divorce, separation, or ending your current relationship?
Often
Sometimes
Rarely
Never
In general, how often do you think that things between you and (SPOUSE/PARTNER) are going well?
Often
Sometimes
Rarely
Never
Do you confide in (SPOUSE/PARTNER)? By confide, I mean share secrets or personal, sensitive information.
Often
Sometimes
Rarely
Never
Do you ever regret getting into your current relationship?
Often
Sometimes
Rarely
Never
How often do you and (SPOUSE/PARTNER) calmly discuss something?
Often
Sometimes
Rarely
Never
How often do you and (SPOUSE/PARTNER) work together on something?
Often
Sometimes
Rarely
Never
Communication
BSF
Even when arguing, you and (SPOUSE/PARTNER) can keep a sense of humor. Would you say…
Often
Sometimes
Rarely
Never
Your arguments get very heated. Would you say…
Often
Sometimes
Rarely
Never
BSF
Small issues suddenly become big arguments. Would you say…
Often
Sometimes
Rarely
Never
You are good at working out your differences with each other. Would you say…
Often
Sometimes
Rarely
Never
Communication skills
Stanley and Markman
When discussing issues, you repeat back what (SPOUSE/PARTNER) says to make sure you understand her. Would you say…
Often
Sometimes
Rarely
Never
When your talks begin to get out of hand, you agree to stop them and talk later. Would you say…
Often
Sometimes
Rarely
Never
When discussing issues you allow (SPOUSE/PARTNER) to finish talking before you respond. Would you say…
Often
Sometimes
Rarely
Never
(SPOUSE/PARTNER) interrupts you when you are talking. Would you say…
Often
Sometimes
Rarely
Never
Forgiveness
KY BHMP
You are usually able to forgive (SPOUSE/PARTNER). Would you say…
Often
Sometimes
Rarely
Never
Relationship fidelity
CHMI (modified)
How often are you tempted to have sexual or romantic contact with someone other than your spouse/partner?
Often
Sometimes
Rarely
Never
Created
During your relationship with your spouse/partner, was there ever a time when you had sexual or romantic contact with someone else?
Yes
No
Maybe
How much do you agree or disagree with the following statements?
You know you can count on your spouse/partner to remain faithful to you. By faithful, we mean never having sexual contact with anyone except you.
Strongly agree
Agree
Disagree
Strongly disagree
You know how to avoid situations where you might be tempted to cheat on your spouse/partner.
Strongly agree
Agree
Disagree
Strongly disagree
Here are some statements about your relationship with (SPOUSE/PARTNER). For each one, please tell me if you strongly agree, agree, disagree, or strongly disagree.
Relationship commitment
BSF
It is very important to you to be completely faithful to your spouse/partner. By faithful, we mean never having sexual contact with anyone except your spouse/partner.
Strongly agree
Agree
Disagree
Strongly disagree
It is very important to you that your spouse/partner be completely faithful to you.
Strongly agree
Agree
Disagree
Strongly disagree
You may not want to be with your spouse/partner a few years from now.
Strongly agree
Agree
Disagree
Strongly disagree
Positive connections, bonding, friendship
Stanley and Markman
You and (SPOUSE/PARTNER) have fun together. Would you say…
Strongly agree
Agree
Disagree
Strongly disagree
Stanley and Markman
You believe you and (SPOUSE/PARTNER) can handle whatever conflicts will arise in the future. Would you say…
Strongly agree
Agree
Disagree
Strongly disagree
You feel good about your chances to make this relationship work for a lifetime.
Strongly agree
Agree
Disagree
Strongly disagree
Intimacy and support
BSF
Your (SPOUSE/PARTNER) encourages or helps you to do things that are important to you.
Strongly agree
Agree
Disagree
Strongly disagree
BSF
For this next question, I’d like you to tell me how often the following is true for you.
When you have problems, (SPOUSE/PARTNER) really understands what you’re going through. [USE SHOWCARD.] Would you say…
Often
Sometimes
Rarely
Never
Attitudes about marriage
The next questions are about your opinions on marriage. Please tell me how much you agree or disagree with this statement.
(If R is unmarried or no longer romantically involved with spouse) Getting and staying married is an important goal for you.
Strongly agree
Agree
Disagree
Strongly disagree
(If R is married and still romantically involved with spouse) Staying married to your spouse for the rest of your life is an important goal for you.
Strongly agree
Agree
Disagree
Strongly disagree
The next questions are about your thoughts on what could happen in your relationship with (SPOUSE/PARTNER) in the future. No one knows what the future holds, but we would like your best guess about what you expect. Please answer based on your realistic expectations, rather than what you wish for or hope will happen.
Marriage plans
(If R is in a romantic relationship with someone other than a spouse): What do you think the chances are that you will marry (PARTNER) in the future? Would you say…
No chance
A little chance
A 50–50 chance
A pretty good chance
An almost certain chance
Perceived life changes if split up
NSFH-90, Sec. SE-7, Q.13-14 (modified)
Even though it may be very unlikely, think for a moment about how various areas of your life might be different if you and (SPOUSE/PARTNER) split up. Then, I’ll ask how you think things might be different for (SPOUSE/PARTNER). For each of the following areas, please tell me whether you would you expect it to get better, worse, or stay the same if you split up? Let’s start with you.
How would your financial situation change if you split up? Would it get....
Better
Worse
Stay the same
CAN’T PREDICT
How would your overall happiness change if you split up? Would it get...
Better
Worse
Stay the same
CAN’T PREDICT
Now, let’s think about (SPOUSE/PARTNER).
How would her financial situation change if you split up? Would it get...
Better
Worse
Stay the same
CAN’T PREDICT
How would her overall happiness change if you split up? Would it get...
Better
Worse
Stay the same
CAN’T PREDICT
(If R has any children) Next, let’s think about your child(ren). How would your child(ren)’s overall happiness change if you and (SPOUSE/PARTNER) split up? Would it get...
Better
Worse
Stay the same
CAN’T PREDICT
Perceptions of support from R’s parents for continuing the relationship
Created
Please tell me how much you agree or disagree with the following statements about your parents’ feelings about your relationship with (SPOUSE/PARTNER).
Your parents want you and (SPOUSE/PARTNER) to stay together as a couple.
Strongly agree
Agree
Disagree
Strongly disagree
(SPOUSE/PARTNER)’s parents want you and (SPOUSE/PARTNER) to stay together as a couple.
Strongly agree
Agree
Disagree
Strongly disagree
Residence of focal child
The next items ask about your relationship with (FOCAL CHILD).
With whom does (FOCAL CHILD) currently live? [USE SHOWCARD.]
The child’s mother
The child’s maternal grandparent(s)
The child’s paternal grandparent(s)
The child’s step-grandparent(s)
Other blood relatives of the child
The child’s stepparent
Other non-blood relatives
The child is in custody of social services
Other (SPECIFY)
Parental efficacy (focal child)
Fragile Families
Please think about how you feel about yourself as a parent to (FOCAL CHILD). Would you say you are...
An excellent parent
A very good parent
A good parent
Not a very good parent
Quality of relationship with focal child
Parent-Child Relational Quality Scale (Umbersome, 1989)
Would you say your current relationship with (FOCAL CHILD) is excellent, good, fair, or poor?
Excellent
Good
Fair
Poor
Does focal child know R is incarcerated
Does (FOCAL CHILD) know that you are incarcerated?
YES
NO
Co-parental conflict about focal child
ECLS-B, 9 and 24-Month Surveys Resident Father Questionnaires
Parenting with another person can be challenging.
Do you and (SPOUSE/PARTNER) have arguments about (FOCAL CHILD) often, sometimes, rarely, or never?
Often
Sometimes
Rarely
Never
Shared decision making about focal child
NLSY-97
Who makes major decisions about things such as child care and health care for (FOCAL CHILD)? .
You and the child's mother or main caretaker make most decisions
together
The child's mother or main caretaker makes most decisions
herself/
himself
You make most decisions yourself
Focal child’s relationship with mother
Please rate (FOCAL CHILD)’s relationship with his/her mother or main caretaker. Would you say it is...
Excellent
Good
Fair
Poor
Partner’s role as coparent to focal child
Does (SPOUSE/PARTNER) coparent (FOCAL CHILD) with you? By coparent, we mean that (SPOUSE/PARTNER) is involved in raising (FOCAL CHILD).
YES
NO
Focal child’s school attendance & performance
(If focal child is 4 years or older) Does (FOCAL CHILD) attend school? ( By school I mean kindergarten through college.)
YES
NO
Created
(If focal child does attend school) What grade is (FOCAL CHILD) in?
KINDERGARTEN
1st GRADE
2nd GRADE
3RD GRADE
4TH GRADE
5TH GRADE
6TH GRADE
7TH GRADE
8TH GRADE
9TH GRADE
10TH GRADE
11TH GRADE
12th GRADE
COLLEGE
OTHER, SPECIFY: _________________________________
(If focal child does attend school) Based on your knowledge of (FOCAL CHILD)’s school work, including (HIS/HER) most recent report cards, how is (HE/SHE) doing in school overall? Would you say...
Well below average
Below average
Average
Above average
Well above average
Focal child’s extracurricular participation
(If focal child does attend school) Based on your knowledge, does (HE/SHE) participate in any sports, clubs, organizations, or programs after school or on weekends?
YES
NO
Focal child’s social skills/behavior
NSCH
I’m going to read a list of behaviors that sometimes describe children. For each item, please tell me how often this is true for (FOCAL CHILD) during the past 1 month. [REFERENCE CALENDAR] [USE SHOWCARD.]
(If focal child is older than 4 years) (FOCAL CHILD) bullies, or is cruel or mean to others. Would you say…
Always
Usually
Sometimes
Never
Don’t know
(If focal child is older than 4 years) (FOCAL CHILD) shows respect for teachers and neighbors
Always
Usually
Sometimes
Never
Don’t know
(If focal child is older than 4 years) …gets along well with other children
Always
Usually
Sometimes
Never
Don’t know
(If focal child is older than 4 years) …is disobedient
Always
Usually
Sometimes
Never
Don’t know
(If focal child is older than 4 years) …is stubborn, sullen, or irritable
Always
Usually
Sometimes
Never
Don’t know
(If focal child is older than 4 years) …feels worthless or inferior
Always
Usually
Sometimes
Never
Don’t know
(If focal child is older than 4 years) …is unhappy, sad, or depressed
Always
Usually
Sometimes
Never
Don’t know
(If focal child is older than 4 years) …is withdrawn, and does not get involved with others
Always
Usually
Sometimes
Never
Don’t know
New Hope (modified)
Raising children can be difficult these days. Has (FOCAL CHILD) ever had any of the following problems?
(If focal child does attend school) Being suspended or expelled from school?
YES
NO
(If focal child does attend school) Needing to repeat a grade in school?
YES
NO
(If focal child is 10 or older) Running away?
YES
NO
Being placed in foster care, or being sent to live with a friend or relative?
YES
NO
(If focal child is 10 or older) Getting into trouble for using alcohol or drugs?
YES
NO
(If focal child is 10 or older) Getting into trouble with the police?
YES
NO
Attitudes about children and fatherhood
Here are some statements that men have made about their role as fathers. For each of the following statements, please indicate how strongly you agree or disagree.
CHMI (ECLS-B Fathers SAQ Q16))
It’s hard for men to act loving toward children.
Strongly agree
Agree
Disagree
Strongly disagree
Fathers should spend as much time taking care of their children as mothers.
Strongly agree
Agree
Disagree
Strongly disagree
The way a father treats his child will affect the child later in life.
Strongly agree
Agree
Disagree
Strongly disagree
The activities a father does with his children don’t matter. What matters more is whether he supports them financially.
Strongly agree
Agree
Disagree
Strongly disagree
It is sometimes OK for fathers to physically discipline their children, such as hitting or spanking them.
Strongly agree
Agree
Disagree
Strongly disagree
Created
Incarcerated fathers can still be good role models for their children.
Strongly agree
Agree
Disagree
Strongly disagree
Incarcerated fathers can still be involved in making decisions about their children’s lives.
Strongly agree
Agree
Disagree
Strongly disagree
Emotional support from extended family
SVORI/Returning Home (modified)
Now I’d like to ask about how you currently feel about your relationships with your family members other than (SPOUSE/PARTNER) or children. This would mean your parents, siblings, cousins, or other family members. Please tell me whether you strongly agree, agree, disagree, or strongly disagree with the following statements.
You feel close to your family.
Strongly agree
Agree
Disagree
Strongly disagree
You have family members who will stand by you no matter what.
Strongly agree
Agree
Disagree
Strongly disagree
You want your family to be involved in your life.
Strongly agree
Agree
Disagree
Strongly disagree
You are criticized a lot or put down by your family.
Strongly agree
Agree
Disagree
Strongly disagree
You have someone in your family to talk to about yourself or your problems.
Strongly agree
Agree
Disagree
Strongly disagree
You have someone in your family to love you and make you feel wanted.
Strongly agree
Agree
Disagree
Strongly disagree
(If R reported serving a life sentence with no expectation of release, skip to end)
The next set of questions deals with your release from prison and transition back into the community. No one knows what the future holds, but we would like your best guess about what you expect. Please answer based on your realistic expectations, rather than what you wish for or hope will happen.
IF NEEDED, REPEAT THIS STATEMENT (We would like your best guess about what you expect. Please answer based on your realistic expectations.) AS A PROBE FOR ITEMS IN THIS SECTION.
Post-release supervision
Created
When you are released from this incarceration, will you be on some type of post-release supervision, such as parole?
YES
NO
Readiness for change regarding criminal behavior
SVORI
Please tell me whether you strongly agree, agree, disagree, or strongly disagree with the following statements.
You will give up friends and hangouts that get you into trouble after you are released.
Strongly agree
Agree
Disagree
Strongly disagree
You are willing to accept help to not commit crimes after you are released.
Strongly agree
Agree
Disagree
Strongly disagree
Expectations about reincarceration
Do you think you will ever be sent back to jail or prison again, after you are released from this incarceration?
YES
NO
Expectations about substance use
How likely is it that you will use any illegal drugs after release?
Very likely
Likely
Unlikely
Very unlikely
Expectations about support from “other family members”
The next set of questions are about your expectations for your relationships with family members other than your spouse/partner or child(ren) after your release from prison.
Created
Do you have a family member who will loan you money if you need it?
YES
NO
Do you have a family member who will provide you with a place to live if you need it?
YES
NO
Do you have a family member who will help you with transportation to work or other appointments if you need it?
YES
NO
Expectations about support from friends
Next, I’d like to know about your expectations for your relationships with friends after your release from prison.
Created
Do you have a friend who will loan you money if you need it?
YES
NO
Do you have a friend who will provide you with a place to live if you need it?
YES
NO
Do you have a friend who will help you with transportation to work or other appointments if you need it?
YES
NO
Next, I’d like to know more about your plans for your financial and living situation when you are released.
Expectations about sources of financial support
Returning Home
What sources of financial support do you expect to have in the first 1 month following your release? [USE SHOWCARD.]
None
Pay from a job
Your own savings
Money from your spouse/partner’s job or savings
Money from other family members
Money from your friends
Public assistance
Money from illegal sources
Some other source (SPECIFY______________)
Perceived difficulty of supporting oneself
How easy or hard do you think it will be to make enough money to support yourself?
Very easy
Pretty easy
Pretty hard
Very hard
Perceived difficulty finding/keeping a job
Based on past experience, how easy or hard do you think it will be to find a decent job?
Very easy
Pretty easy
Pretty hard
Very hard
Based on past experience, how easy or hard do you think it will be to keep a job?
Very easy
Pretty easy
Pretty hard
Very hard
Expectations about living with partner
Created
Do you expect to live with (SPOUSE/PARTNER) after release?
YES
NO
Expectations about living with focal child and other children
Created
Do you expect to live with (FOCAL CHILD) after release?
YES
NO
(Ask for each child): Do you plan to live with (CHILD) after you are released?
YES
NO
Unsure
Expectations about living with anyone else
Created
Do you expect to live with anyone else after you are released?
YES
NO
Intentions for continuing relationship
Do you want to remain in a committed romantic relationship with (SPOUSE/PARTNER) after you are released? Would you say...
Yes
No
Don’t know
Do you think (SPOUSE/PARTNER) wants to remain in a committed romantic relationship with you after you are released? Would you say...
Yes
No
Don’t know
Perceived difficulty establishing/re-establishing relationship with partner
Returning Home
(If R answers “yes” or “don’t know” to intentions for continuing relationship) How easy or hard do you think it will be to have a good relationship with (SPOUSE/PARTNER) after you get out?
Very easy
Pretty easy
Pretty hard
Very hard
(If R answers “yes” or “don’t know” to intentions for continuing relationship) Thinking about when you are released, what do you expect will be the biggest challenges in your relationship with your partner? MARK ALL THAT APPLY.
Finding her
Being able to feel close to her again after the time in prison
Being able to trust her after the time in prison
Problems or new situations that have come up since you were incarcerated
Having missed out on so much that happened in her life while you were
incarcerated
Trying to meet her expectations for you related to finding a job,
staying clean,
helping her financially
Being angry at her or not wanting to see her
Her being angry at you or not wanting to see you
Some other challenge (SPECIFY)___________________________
Expectations about support to/from partner
(If R answers “yes” or “don’t know” to intentions for continuing relationship)
Please tell me whether you strongly agree, agree, disagree, or strongly disagree with the following statements about your expectations about how you and (SPOUSE/PARTNER) will treat one another after you are released.
After you are released, you will stand by (SPOUSE/PARTNER) no matter what.
Strongly agree
Agree
Disagree
Strongly disagree
You will love (SPOUSE/PARTNER) and make her feel wanted.
Strongly agree
Agree
Disagree
Strongly disagree
You will help (SPOUSE/PARTNER) with whatever problems she faces.
Strongly agree
Agree
Disagree
Strongly disagree
After you are released, you think (SPOUSE/PARTNER) will stand by you no matter what.
Strongly agree
Agree
Disagree
Strongly disagree
You think (SPOUSE/PARTNER) will love you and make you feel wanted.
Strongly agree
Agree
Disagree
Strongly disagree
You think (SPOUSE/PARTNER) will help you with whatever problems you face.
Strongly agree
Agree
Disagree
Strongly disagree
Expectations about interaction with focal child
(If R does not plan to live with focal child) How often do you think you will see (FOCAL CHILD) in person after you are released?
One or more times a week
A couple of times a month
About once a month
Every couple of months
A couple of times a year or less
Never
Expectations about financial support for focal child
(If R does not plan to live with focal child) Do you expect to financially support (FOCAL CHILD) in any way after you are released?
YES
NO
(If yes) In what way or ways do you expect to provide financial support for (FOCAL CHILD)? Please include support you expect to provide to the child directly as well as support you will provide to the child’s other parent or caretaker. [USE SHOWCARD]
Giving (FOCAL CHILD) birthday or holiday gifts
Taking (FOCAL CHILD) shopping for clothing, school supplies, or other
things s/he needs
Helping out occasionally with bills, rent or other expenses in the child’s
household
Providing steady, regular financial support of up to $100 per month
Providing steady, regular financial support of $100-$200 per month
Providing steady, regular financial support of $200-$300 per month
Providing steady, regular financial support of over $300 per month
Expectations about decision-making about focal child
Who will make major decisions about things such as child care and health care for (FOCAL CHILD)? Would you say...
You and the child's mother or main caretaker will make most decisions
together
The child's mother or main caretaker will make most decisions herself/
himself
You will make most decisions yourself
Perceived difficulty establishing/re-establishing relationship with children
Returning Home
How easy or hard do you think it will be to have (a) good relationship(s) with your child(ren) after you get out?
Very easy
Pretty easy
Pretty hard
Very hard
Created
Thinking about when you are released, what do you expect will be the biggest challenges in your relationship(s) with your child(ren)? (If R has more than one child) Please consider only the child(ren) you were in contact with before you were incarcerated. MARK ALL THAT APPLY.
Finding them
Having missed out on so much that happened with him/her/them while
you
were incarcerated
Getting them to trust you or open up to you after the time apart
Finding transportation for visits or activities
Dealing with people who don’t want you to see your kids
Not being in a stable enough housing and financial situation to be
able to
spend time with your kids
Your lifestyle not being a healthy one for kids
Your child(ren) being angry at you or not wanting to see you
Some other challenge (SPECIFY)___________________________
SVORI
BHOU1
Finally, so that we can contact you once you are released, please tell me where you are going to stay immediately after release. Where is the very first place you will go as you are getting back on your feet?
INTERVIEWER: PROBE FOR DETAILS:
WHAT CITY
WILL THEY LIVE IN?
WHERE WILL THEY LIVE, MORE SPECIFICALLY?
WHO WILL THE R LIVE WITH?
WHAT TYPE OF STRUCTURE WILL THEY LIVE IN?
HOW LONG WILL THEY STAY?
BHOU2
DOES THE R HAVE A SPECIFIC ADDRESS?
Yes-> RECORD ADDRESS, CITY, STATE, PHONE
NO-> SKIP TO BHOU3
BHOU3
Do you think you will stay there indefinitely, or will that be a temporary situation?
STAY-> SKIP TO BHOU6
ONLY TEMPORARY->GO TO BHOU4
BHOU4
Where do you think you will live next?
INTERVIEWER: PROBE FOR DETAILS:
WHAT CITY
WILL THEY LIVE IN?
WHERE WILL THEY LIVE, MORE SPECIFICALLY?
WHO WILL THE R LIVE WITH?
WHAT TYPE OF STRUCTURE WILL THEY LIVE IN?
HOW LONG WILL THEY STAY?
BHOU5
DOES THE R HAVE A SPECIFIC ADDRESS?
Yes-> RECORD ADDRESS, CITY, STATE, PHONE
NO-> SKIP
BHOU9a
In the event that you are not living where you expect to live once you are released, I need to collect contact information on three people who would know your whereabouts and who could help us contact you to be interviewed, if necessary.
@/@/@/
What is the name of the first person who would know how to reach you?
@/@/@/
{green}ENTER FIRST NAME{normal}
{allow 30}
{if BHOU9a=dk or rf, go to BHOU12}
BHOU9b
{green}ENTER MIDDLE NAME{normal}
{allow 30; not a required response}
BHOU9c
{green}ENTER LAST NAME{normal}
{allow 30}
BHOU9d
What is this person's address? If you don’t know the exact address, please tell me a street name or a neighborhood.
@/@/@/
{green)INTERVIEWER: BE SURE TO PROBE FOR A BLDG AND/OR APT NUMBER.{normal}
{allow 100}
BHOU9e
And in what city is that?
{allow 30}
BHOU9f
And in what state is that?
@/@/@/
{green}INTERVIEWER: CODE THE STATE USING THE LookUp TABLE BY EITHER PRESSING <BACKSPACE> OR STARTING TO TYPE THE NAME OF THE STATE.{normal}
{lookup list of states}
BHOU9g
Does this person have a phone number?
YNDKRF
{if BHOU9g=yes, ask BHOU9g1; if=no, dk, or rf, go to BHOU9i}
BHOU9g1
What is that phone number, starting with the area code?
@/@/@/
{green}INTERVIEWER: IF R DOES NOT KNOW THE NUMBER, CODE “DON’T KNOW”.{normal}
{three separate numeric fields presented together: field1, allow 3; field2, allow 3; field3, allow 4}
BHOU9h
{if BHOU9g=yes, ask BHOU9h} Does this person have a second phone number, such as a cell phone?
YNDKRF
{if BHOU9h=yes, ask BHOU9h1}
BHOU9h1
What is that phone number, starting with the area code?
@/@/@/
{green}INTERVIEWER: IF R DOES NOT KNOW THE NUMBER, CODE “DON’T KNOW”.{normal}
{three separate numeric fields presented together: field1, allow 3; field2, allow 3; field3, allow 4}
BHOU9i
Does this person work outside of the home?
YNDKRF
{if BHOU9i=yes, ask BHOU9i1; else ask BHOU9j}
BHOU9i1
Where does this person work? In other words, what is the name of the company or organization this person works for? We will not contact them at work unless we’ve tried all other possible means of locating you.
{allow 30}
BHOU9i2
And in what city is that?
{allow 30}
BHOU9i3
And in what state is that?
@/@/@/
{green}INTERVIEWER: CODE THE STATE USING THE LookUp TABLE BY EITHER PRESSING <BACKSPACE> OR STARTING TO TYPE THE NAME OF THE STATE.{normal}
{lookup list of states}
BHOU9i4
Does this person have a work phone number?
YNDKRF
{if BHOU9i4=yes, ask BHOU9i5; if no, dk, or rf, go to BHOU9j}
BHOU9i5
What is that phone number, starting with the area code?
@/@/@/
{green}INTERVIEWER: IF R DOES NOT KNOW THE NUMBER, CODE “DON’T KNOW”.{normal}
{three separate numeric fields presented together: field1, allow 3; field2, allow 3; field3, allow 4}
BHOU9j
What is this person's relationship to you?
RELATION
{if BHOU9j=Other, ask BHOU9j1}
BHOU9j1
{green}DESCRIBE THE RELATIONSHIP OF THE PERSON TO R, RECORDING THE R’S ANSWER VERBATIM.{normal}
{allow 100}
BHOU9k
Thank you. Please let this person know that you would like them to tell me where I can find you when it is time for your next interview.
BHOU10a
What is the name of another person who would know how to reach you?
@/@/@/
{green}ENTER FIRST NAME{normal}
{allow 30}
{if BHOU10a=dk or rf, go to BHOU12}
BHOU10b
{green}ENTER MIDDLE NAME{normal}
{allow 30; not a required response}
BHOU10c
{green}ENTER LAST NAME{normal}
{allow 30}
BHOU10d
What is this person's address? If you don’t know the exact address, please tell me a street name or a neighborhood.
@/@/@/
{green)INTERVIEWER: BE SURE TO PROBE FOR A BLDG AND/OR APT NUMBER.{normal}
{allow 100}
BHOU10e
And in what city is that?
{allow 30}
BHOU10f
And in what state is that?
@/@/@/
{green}INTERVIEWER: CODE THE STATE USING THE LookUp TABLE BY EITHER PRESSING <BACKSPACE> OR STARTING TO TYPE THE NAME OF THE STATE.{normal}
{lookup list of states}
BHOU10g
Does this person have a phone number?
YNDKRF
{if BHOU10g=yes, ask BHOU10g1; if=no, dk, or rf, go to BHOU10i }
BHOU10g1
What is that phone number, starting with the area code?
@/@/@/
{green}INTERVIEWER: IF R DOES NOT KNOW THE NUMBER, CODE “DON’T KNOW”{normal}
{three separate numeric fields presented together: field1, allow 3; field2, allow 3; field3, allow 4}
BHOU10h
{if BHOU10g=yes, ask BHOU10h} Does this person have a second phone number, such as a cell phone?
YNDKRF
{if BHOU10h=yes, ask BHOU10h1}
BHOU10h1
What is that phone number, starting with the area code?
@/@/@/
{green}INTERVIEWER: IF R DOES NOT KNOW THE NUMBER, CODE “DON’T KNOW”.{normal}
{three separate numeric fields presented together: field1, allow 3; field2, allow 3; field3, allow 4}
BHOU10i
Does this person work outside of the home?
YNDKRF
{if BHOU10i=yes, ask BHOU10i1 else ask BHOU10j }
BHOU10i1
Where does this person work? In other words, what is the name of the company or organization this person works for? Remember, we will not contact them at work unless we’ve tried all other possible means of locating you.
{allow 30}
BHOU10i2
And in what city is that?
{allow 30}
BHOU10i3
And in what state is that?
@/@/@/
{green}INTERVIEWER: CODE THE STATE USING THE LookUp TABLE BY EITHER PRESSING <BACKSPACE> OR STARTING TO TYPE THE NAME OF THE STATE.{normal}
{lookup list of states}
BHOU10i4
Does this person have a work phone number?
YNDKRF
{if BHOU10i4=yes, ask BHOU10i5}
BHOU10i5
What is that phone number, starting with the area code?
@/@/@/
{green}INTERVIEWER: IF R DOES NOT KNOW THE NUMBER, CODE “DON’T KNOW”.{normal}
{three separate numeric fields presented together: field1, allow 3; field2, allow 3; field3, allow 4}
BHOU10j
What is this person's relationship to you?
RELATION
{if BHOU10j=Other, ask BHOU10j1}
BHOU10j1
{green}DESCRIBE THE RELATIONSHIP OF THE PERSON TO R, RECORDING THE R’S ANSWER VERBATIM.{normal}
{allow 100}
BHOU10k
Thank you. Please let this person know that you would like them to tell me where I can find you when it is time for your next interview.
BHOU11a
What is the name of a third person who would know how to reach you?
@/@/@/
{green}ENTER FIRST NAME{normal}
{allow 30}
{if BHOU11a=dk or rf, go to BHOU12}
BHOU11b
{green}ENTER MIDDLE NAME{normal}
{allow 30; not a required response}
BHOU11c
{green}ENTER LAST NAME{normal}
{allow 30}
BHOU11d
What is this person's address? If you don’t know the exact address, please tell me a street name or a neighborhood.
@/@/@/
{green)INTERVIEWER: BE SURE TO PROBE FOR A BLDG AND/OR APT NUMBER.{normal}
{allow 100}
BHOU11e
And in what city is that?
{allow 30}
BHOU11f
And in what state is that?
@/@/@/
{green}INTERVIEWER: CODE THE STATE USING THE LookUp TABLE BY EITHER PRESSING <BACKSPACE> OR STARTING TO TYPE THE NAME OF THE STATE.{normal}
{lookup list of states}
BHOU11g
Does this person have a phone number?
YNDKRF
{if BHOU11g=yes, ask BHOU11g1; if=no, dk, or rf, go to BHOU11i }
BHOU11g1
What is that phone number, starting with the area code?
@/@/@/
{green}INTERVIEWER: IF R DOES NOT KNOW THE NUMBER, CODE “DON’T KNOW”.{normal}
{three separate numeric fields presented together: field1, allow 3; field2, allow 3; field3, allow 4}
BHOU11h
{if BHOU11g=yes, ask BHOU11h} Does this person have a second phone number, such as a cell phone?
YNDKRF
{if BHOU11h=yes, ask BHOU11h1}
BHOU11h1
What is that phone number, starting with the area code?
@/@/@/
{green}INTERVIEWER: IF R DOES NOT KNOW THE NUMBER, CODE “DON’T KNOW”.{normal}
{three separate numeric fields presented together: field1, allow 3; field2, allow 3; field3, allow 4}
BHOU11i
Does this person work outside of the home?
YNDKRF
{if BHOU11i=yes, ask BHOU11i1; else ask BHOU11j}
BHOU11i1
Where does this person work? In other words, what is the name of the company or organization this person works for? Again, we will not contact them at work unless we’ve tried all other possible means of locating you.
{allow 30}
BHOU11i2
And in what city is that?
{allow 30}
BHOU11i3
And in what state is that?
@/@/@/
{green}INTERVIEWER: CODE THE STATE USING THE LookUp TABLE BY EITHER PRESSING <BACKSPACE> OR STARTING TO TYPE THE NAME OF THE STATE.{normal}
{lookup list of states}
BHOU11i4
Does this person have a work phone number?
YNDKRF
{if BHOU11i4=yes, ask BHOU11i5}
BHOU11i5
What is that phone number, starting with the area code?
@/@/@/
{green}INTERVIEWER: IF R DOES NOT KNOW THE NUMBER, CODE “DON’T KNOW”.{normal}
{three separate numeric fields presented together: field1, allow 3; field2, allow 3; field3, allow 4}
BHOU11j
What is this person's relationship to you?
RELATION
{if BHOU11j=Other, ask BHOU11j1}
BHOU11j1
{green}DESCRIBE THE RELATIONSHIP OF THE PERSON TO R, RECORDING THE R’S ANSWER VERBATIM.{normal}
{allow 100}
BHOU11k
Thank you. Please let this person know that you would like them to tell me where I can find you when it is time for your next interview.
Now, if you are still OK with providing it, I’d like to get your spouse/partner’s name and contact information so that we can contact her and ask whether she would like to participate in the partner interview.
BHOU12a
What is your spouse/partner’s name?
IBHOU12d
What is (SPOUSE/PARTNER)'s address? If you don’t know the exact address, please tell me a street name or a neighborhood.
@/@/@/
{green)INTERVIEWER: BE SURE TO PROBE FOR A BLDG AND/OR APT NUMBER.{normal}
{allow 100}
BHOU12e
And in what city is that?
{allow 30}
BHOU12f
And in what state is that?
@/@/@/
{green}INTERVIEWER: CODE THE STATE USING THE LookUp TABLE BY EITHER PRESSING <BACKSPACE> OR STARTING TO TYPE THE NAME OF THE STATE.{normal}
{lookup list of states}
BHOU12g
Does (SPOUSE/PARTNER) have a phone number?
YNDKRF
{if BHOU11g=yes, ask BHOU11g1; if=no, dk, or rf, go to BHOU11i }
BHOU12g1
What is that phone number, starting with the area code?
@/@/@/
{green}INTERVIEWER: IF R DOES NOT KNOW THE NUMBER, CODE “DON’T KNOW”.{normal}
{three separate numeric fields presented together: field1, allow 3; field2, allow 3; field3, allow 4}
BHOU12h
{if BHOU11g=yes, ask BHOU11h} Does (SPOUSE/PARTNER) have a second phone number, such as a cell phone?
YNDKRF
{if BHOU11h=yes, ask BHOU11h1}
BHOU12h1
What is that phone number, starting with the area code?
@/@/@/
{green}INTERVIEWER: IF R DOES NOT KNOW THE NUMBER, CODE “DON’T KNOW”.{normal}
{three separate numeric fields presented together: field1, allow 3; field2, allow 3; field3, allow 4}
BHOU12i
Does (SPOUSE/PARTNER) work outside of the home?
YNDKRF
{if BHOU11i=yes, ask BHOU11i1; else ask BHOU11j}
BHOU12i1
Where does (SPOUSE/PARTNER) work? In other words, what is the name of the company or organization (she) works for? Again, we will not contact her at work unless we’ve tried all other possible means of locating her.
{allow 30}
BHOU12i2
And in what city is that?
{allow 30}
BHOU12i3
And in what state is that?
@/@/@/
{green}INTERVIEWER: CODE THE STATE USING THE LookUp TABLE BY EITHER PRESSING <BACKSPACE> OR STARTING TO TYPE THE NAME OF THE STATE.{normal}
{lookup list of states}
BHOU12i4
Does (SPOUSE/PARTNER) have a work phone number?
YNDKRF
{if BHOU11i4=yes, ask BHOU11i5}
BHOU12i5
What is that phone number, starting with the area code?
@/@/@/
{green}INTERVIEWER: IF R DOES NOT KNOW THE NUMBER, CODE “DON’T KNOW”.{normal}
{three separate numeric fields presented together: field1, allow 3; field2, allow 3; field3, allow 4}
BHOU12k
Thank you. Please let (SPOUSE/PARTNER) know that you would like them to tell me where I can find you when it is time for your next interview.
BHOU13
If I’m really having difficulty finding where you live, can you tell me where you spend your time when you are not at home and not at work? What local places do you like to spend time at?
___________________________________________________________(description of places)
Social security number
What is your social security number?
___-__-____
Name
And just to confirm, do you still go by (R FIRST AND LAST NAME)?
YES
NO
(If no) What name or names do you go by?
_________________(FIRST)
_________________(LAST)
_________________(FIRST)
_________________(LAST)
Other info R would like to share
Finally, is there anything else you think we should know about how incarceration has affected you or your family?
That was our last question. Thank you for your participation in this study! Someone from RTI might contact you by phone or by mail to briefly verify the quality of my work.
We will also contact you again in 9 months to invite you to participate in a follow-up interview. You can decide at that time whether or not you wish to participate.
Before I leave, I want to give you this card with toll-free helpline numbers. Some people have found these to be useful.
I also need to give you your incentive payment, and I need to ask you to initial a receipt.
Incentive
WAS THE R ELIGIBLE FOR THE $5 BONUS?
YES
NO
HOW WAS THE INCENTIVE PAID?
1. INMATE ACCOUNT
2. DESIGNEE
3. INCENTIVE NOT PERMITTED BY FACILITY
4. OTHER (SPECIFY)
INTERVIEWER OBSERVATIONS
BFIO1
“HOW COOPERATIVE WAS THE RESPONDENT?”
(Verycoop “VERY COOPERATIVE,”
Faircoop “FAIRLY COOPERATIVE,”
Notcoop “NOT VERY COOPERATIVE,”
Hostile “OPENLY HOSTILE”)
BFIO2
“ESTIMATE THE RESPONDENT’S LEVEL OF UNDERSTANDING OF THE INTERVIEW QUESTIONS.”
(Nodiff “NO DIFFICULTY UNDERSTANDING QUESTIONS,”
Litdiff “JUST A LITTLE DIFFICULTY UNDERSTANDING QUESTIONS,”
Fairdiff “A FAIR AMOUNT OF DIFFICULTY UNDERSTANDING QUESTIONS,”
Alotdiff “A LOT OF DIFFICULTY UNDERSTANDING QUESTIONS”)
BFIO3
“HOW MUCH TROUBLE DID THE RESPONDENT HAVE REMEMBERING PAST EVENTS?”
(Notrob “NO TROUBLE,”
Littrob “JUST A LITTLE TROUBLE,”
Fairtrob “A FAIR AMOUNT OF TROUBLE,”
Alottrob “A LOT OF TROUBLE”)
BFIO4
“ESTIMATE THE RESPONDENT’S LEVEL OF TRUTHFULNESS/MISPRESENTATION.”
(Verytrth “VERY TRUTHFUL,”
Fairtrth “FAIRLY TRUTHFUL,”
Nottrth “NOT VERY TRUTHFUL,”
Lying “OPENLY LYING”)
BFIO5
“IN GENERAL, HOW ENGAGED/INTERESTED WAS THE RESPONDENT DURING THE INTERVIEW?”
(Veryengd “VERY ENGAGED AND INTERESTED,”
Fairengd “FAIRLY ENGAGED AND INTERESTED,”
Notengd “NOT VERY ENGAGED AND INTERESTED,”
Totuneng “TOTALLY UNENGAGED AND DISINTERESTED”)
BFIO6
“IN GENERAL, HOW IRRITABLE OR MOODY WAS THE RESPONDENT DURING THE INTERVIEW?”
(Veryengd “VERY IRRITABLE/MOODY,”
Fairengd “FAIRLY IRRITABLE/MOODY,”
Notengd “NOT VERY IRRITABLE/MOODY”
Totuneng “NOT AT ALL IRRITABLE/MOODY”)
BFIO7
“INDICATE THE DEGREE OF DISTRACTIONS OR INTERRUPTIONS DURING THE INTERVIEW.”
(None “NO DISTRACTIONS OR INTERRUPTIONS,”
Afew “JUST A FEW DISTRACTIONS OR INTERRUPTIONS,”
Fairnumb “A FAIR NUMBER OF DISTRACTIONS OR INTERRUPTIONS,”
Alot “A LOT OF DISTRACTIONS OR INTERRUPTIONS”)
BFIO8
“HOW MUCH EYE CONTACT DID THE RESPONDENT USE DURING YOUR INTERACTION?”
(“R MOSTLY AVOIDED EYE CONTACT,”
“R OCCASIONALLY MADE EYE CONTACT,”
“R MOSTLY MADE EYE CONTACT.”
| File Type | application/msword |
| File Modified | 2008-02-15 |
| File Created | 2008-02-15 |