Appendix B. Female Baseline Instrument
MFS-IP Instrument Draft (Female 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 11
Domain G: Family Structure 12
PART TWO EXPERIENCES 6 MONTHS PRIOR TO (MALE PARTNER’S) INCARCERATION 15
Domain K: Income 15
Domain L: Social Support 17
Domain M: Intimate Partner Violence 17
Domain N: Parenting 21
Domain O: Substance Use 22
PART THREE EXPERIENCES SINCE (MALE PARTNER’S) INCARCERATION 25
Domain Q: Impact of Incarceration on Relationship with Partner 25
Domain R: Impact of Incarceration on Relationship with Children 31
Domain S: Service Need and Receipt 40
PART SIX PERSONAL CHARACTERISTICS/CURRENT FEELINGS 47
Domain Z: Personal Traits 47
Domain P: Mental and Physical Health 53
Domain V: Partner Relationship Quality 57
Domain N: Parenting and Child Well-Being 64
Domain L: Social Support 70
Domain I: Employment 72
Domain J: Housing 73
Domain O: Substance Use 76
Domain P: Physical and Mental Health 77
ACASI SEGMENT 78
Domain C: Criminal History 78
Domain J: Housing 79
Domain O: Substance Use 79
Domain V: Partner Relationship Quality 84
Domain M: Intimate Partner Violence 84
PART SEVEN EXPECTATIONS FOR POST-RELEASE PERIOD 90
Domain W: Criminal Behavior 90
Domain O: Substance Use 90
Domain L: Social Support 91
Domain K: Income 91
Domain I: Employment 92
Domain J: Housing 93
Domain V: Partner Relationship Quality 93
Domain N: Parenting 95
Locator information 96
MFS-IP FEMALE 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 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
Transgendered
(if preloadtx=yes, ask): IS R THE SAME PARTNER WHO IS PARTICIPATING IN THE MFS-IP PROGRAM WITH THE MALE STUDY PARTICIPANT?
YES
NO
PART
ONE
LIFETIME EXPERIENCES AND FAMILY STRUCTURE
The first part of this survey is about you, your personal history, and your current family.
First, I’m going to ask 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
NOb
(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.)
(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 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 were 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
Domain B: Incarceration Characteristics
(If R is not incarcerated, skip this domain.)
The next set of questions is about your current incarceration. [REFER TO REFERENCE CALENDAR.]
Incarceration duration
Created
Please tell me the date you were admitted 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 {calculated 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, or for a new crime? [ALLOW BOTH.]
Technical violation
New crime
(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)
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)
(If R is incarcerated)
Next, I’m going to ask you some questions about any involvement you might have had with the criminal justice system during your life.
Arrest and conviction history
SVORI
Have you ever been arrested?
YES
NO
(If ever arrested) 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)
(If ever arrested) How many times in your life have you been convicted of a crime?
_____ (# CONVICTIONS)
Incarceration history – adult correctional facilities
(If ever arrested) 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. (PROBE FOR INCARCERATED Rs ONLY: Please do not count your current incarceration.)
YES
NO
(If ever in prison/jail > 24 hours) 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. (PROBE FOR INCARCERATED Rs ONLY: Please do not count your current incarceration.)
_____ (# 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 non.]
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.]
Domain E: Parental and General Family Information
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 that 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 you and your extended family, including yourself, your spouse/partner, child(ren), parents, siblings, cousins, grandparents, and other relatives.
(If R is not currently incarcerated) Other than (SPOUSE/PARTNER), has anyone in your family ever been arrested, including yourself?
YES
NO
(If yes to above, or if R is incarcerated) Who in your family has ever been arrested, including yourself? [SELECT ALL THAT APPLY.] [USE SHOWCARD.]
You
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, CONFIRM THAT THIS PERSON IS THE OTHER STUDY PARTICIPANT.]
(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, CONFIRM THAT THIS PERSON IS THE OTHER STUDY PARTICIPANT.]
Duration of current relationship
(If in romantic relationship with spouse or someone else) Were you in a relationship with (SPOUSE/PARTNER) before he was 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 his incarceration, were you living with (SPOUSE/PARTNER) at any point? [REFER TO REFERENCE CALENDAR.]
YES
NO
Co-parenting relationships
(If R has any children) How many adults do you share parenting responsibilities with for any of your children? This could include ex-spouses or ex-partners who are fathers of your children, or another adult such as a grandparent with whom you are raising one of your children.
_______ (# COPARENTS)
[QUESTIONS IN SUBSEQUENT SECTIONS MAY BE SKIPPED AT FI DISCRETION IF R BECOMES TOO DISTRESSED.]
Detailed child characteristics (all children) – gender, age, relationship to child, relationship with father, residence with child, financial support, frequency of contact
(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.
The child’s name is (STATE FIRST NAME FROM GENOGRAM), correct? [FILL IN FIRST NAME.]
What is the child’s age? (PROBE IF NEEDED: Your best estimate is fine.)
___________ (AGE IN YEARS)
And (CHILD) is (male/female), correct?
MALE
FEMALE
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
(If other than “child of your spouse”) And just to confirm, what is your relationship to (CHILD)’s father?
You’ve never been married
You’re divorced or separated
You’re currently married
(If other than “child of your partner” or “child of your spouse”) And you (are/are not) currently in a committed romantic relationship with (CHILD)’s father, correct?
IN A COMMITTED RELATIONSHIP
NOT IN A COMMITTED RELATIONSHIP
(If R is not incarcerated) Do you currently live with (CHILD)?
YES
NO
(If R is incarcerated) Did you live with (CHILD) during the 6 months prior to (SPOUSE/PARTNER)’s incarceration? [REFER TO REFERENCE CALENDAR.]
YES
NO
(If R is incarcerated) How far away from (CHILD) were you living during the 6 months prior to (SPOUSE/PARTNER)’s incarceration? Please tell me about how long it would take for you to travel from the place you were living to (CHILD)’s home.
__________(# MINUTES)
More than a 12-hour drive
(If R is not incarcerated and not living with child) How far away from (CHILD) are you currently living? Please tell me about how long it would take for you to travel from the place you are living to (CHILD)’s home.
__________(# MINUTES)
More than a 12-hour drive
(If R is not incarcerated and not living with child) Do you financially support this child in any way?
YES
NO
(If yes) In what way or ways do you provide financial support for (CHILD)? (Please include support you provided to the child directly, as well as support you provided to the child’s other parent or caretaker.)
Giving (CHILD) birthday or holiday gifts
Taking (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
(If R is incarcerated and 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
(If yes) In what way or ways did you provide financial support for (CHILD)? (Please include support you provided to the child directly, as well as support you provided to the child’s other parent or caretaker.)
Giving (CHILD) birthday or holiday gifts
Taking (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
(If R is incarcerated or not living with child) How often do you see (CHILD) in person? [REFER TO REFERENCE CALENDAR.]
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
[Repeat questions above for all children.]
Focal child selection
(If R does not coparent the focal child selected by computer during male partner’s baseline interview, skip this intro text and all subsequent questions about focal child.) Later on in our interview, I’m going to ask you some more questions about one of your children. The computer has selected (FOCAL CHILD) for me to ask about.
PART
TWO
EXPERIENCES 6 MONTHS PRIOR TO (MALE PARTNER’S)
INCARCERATION
This next set of questions deals with the 6 months prior to (SPOUSE/PARTNER)’s incarceration. [USE REFERENCE CALENDAR.]
First, I’d like to know about your finances..
Income sharing with partner
(If R was with spouse/partner prior to his incarceration) Did you and (SPOUSE/PARTNER) share income and expenses with each other during the 6 months before he was incarcerated? This could include sharing rent, splitting bills or other expenses, or sharing assets like a bank account. [REFER TO REFERENCE CALENDAR.]
YES
NO
(If R was with spouse/partner prior to his incarceration) Did you both contribute to the assets you shared? Did both you and (SPOUSE/PARTNER) have money coming in that you used for your shared expenses?
YES
NO
Sources of income
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 his 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,” I 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,” I 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 baby-sitting 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
Partner’s report of father’s negative peer exposure
Now, I’d like you to think about the people (SPOUSE/PARTNER) spent time with during the 6 months before he was incarcerated.
Created
How often did the people he spent time with convince him to do things he knew he shouldn’t be doing?
Often
Sometimes
Rarely
Never
Domain M: Intimate Partner Violence
(If R is incarcerated and was in a relationship with SPOUSE/PARTNER prior to SPOUSE/PARTNER’s incarceration.)
Now, I’m going to ask you some questions about your romantic relationship during the 6 months prior to your spouse/partner’s 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 he was 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 your spouse/partner? Would you say…
Often
Sometimes
Rarely
Never
TX HM
Your spouse/partner became jealous or possessive. Would you say…
Often 1
Sometimes 2
Rarely 3
Never 4
TX HM
Your spouse/partner made 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 your spouse/partner’s incarceration you did the following. Then I’ll ask you how many times in the 6 months prior to his most recent incarceration your spouse/partner did the following. [REFER TO REFERENCE CALENDAR.] [USE SHOWCARD.]
In the 6 months prior to your spouse/partner’s incarceration, how many times did you throw something at him?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to your spouse/partner’s incarceration, how many times did he throw something at you?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to your spouse/partner’s incarceration, how many times did you push, shove, hit, slap, or grab him?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to your spouse/partner’s incarceration, how many times did he 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 your spouse/partner’s incarceration, how many times did you use a knife or gun on him?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to your spouse/partner’s incarceration, how many times did he 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 your spouse/partner’s incarceration, how many times did you choke, slam, kick, burn, or beat him?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to your spouse/partner’s incarceration, how many times did he 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 your spouse/partner’s incarceration, how many times did you use force to make him 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 your spouse/partner’s incarceration, how many times did he 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 your spouse/partner’s incarceration, how many times did you threaten to hurt him?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to your spouse/partner’s incarceration, how many times did he threaten to hurt you?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to your spouse/partner’s incarceration, how many times did you threaten to hurt his 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 your spouse/partner’s incarceration, how many times did he 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 your spouse/partner’s incarceration, how many times did you try to keep him from seeing or talking with his friends or family?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to your spouse/partner’s incarceration, how many times did he 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 your spouse/partner’s incarceration, how many times did you keep money from him, make him ask for money, or take money from him?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to your spouse/partner’s incarceration, how many times did he 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
(If R is not parenting any children, skip to next domain.)
This next set of questions is about your experiences with parenting (FOCAL CHILD) during the 6 months before (SPOUSE/PARTNER)’s 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, hardly ever, or never have arguments about (FOCAL CHILD)?
Often
Sometimes
Rarely
Never
[REFER TO GENOGRAM TO CONFIRM WHETHER FOCAL CHILD IS COPARENTED BY R OR SOMEONE ELSE, AND REFER TO SPOUSE/PARTNER AND R OR OTHER COPARENT.] Who made major decisions about things such as child care and health care for (FOCAL CHILD)? Would you say...
(SPOUSE/PARTNER) and (you/coparent) make most decisions
together
(SPOUSE/PARTNER) makes most decisions himself
(You/coparent) make/makes most decisions (your/her)self
Parental engagement
In a typical week, how many days did you eat at least one meal with (FOCAL CHILD) during the 6 months before (SPOUSE/PARTNER)’s incarceration? [REFER TO REFERENCE CALENDAR.]
ONE DAY
TWO DAYS ……….
THREE DAYS
FOUR DAYS
FIVE DAYS ……….
SIX DAYS
SEVEN DAYS
(If R is incarcerated)
Substance use
Please tell me which of the following substances you used during the 6 months before (SPOUSE/PARTNER)’s 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 {NOT ON SHOWCARD}
(If R reports no alcohol or drug use during 6 months prior to incarceration, skip to Perceptions of spouse/partner substance abuse.)
Which of the following did you use the most during the 6 months before (SPOUSE/PARTNER)’s 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.
Partner report of father’s substance use
Please tell me which of the following substances your spouse/partner used during the 6 months before his 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 {NOT ON SHOWCARD}
(If R reports no partner alcohol or drug use during 6 months prior to incarceration, skip to Physical and Mental Health domain.)
Which of the following did your spouse/partner use the most during the 6 months before his 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.
Partner report of father’s addiction severity
CAGE
Now, I’d like you to think back to your spouse/partner’s drug and alcohol use during the 6 months before he was incarcerated. [REFER TO REFERENCE CALENDAR.]
a. (If R reported any spouse/partner alcohol use) Did he feel he should cut down on his drinking?
YES
NO
b. (If R reported any spouse/partner alcohol use) Did people ever annoy him by complaining about his drinking?
YES
NO
c. (If R reported any spouse/partner alcohol use) Did he ever feel bad or guilty about his drinking?
YES
NO
d. (If R reported any spouse/partner alcohol use) Did he ever have a drink first thing in the morning to steady his nerves or get rid of a hangover (“eye-opener”)?
YES
NO
e. (If R reported any spouse/partner drug use) Did he ever feel he should cut down on his drug use?
YES
NO
f. (If R reported any spouse/partner drug use) Did people ever annoy him by complaining about his drug use?
YES
NO
g. (If R reported any spouse/partner drug use) Did he ever feel bad or guilty about his drug use?
YES
NO
Partner report of father’s anger and addiction
During the 6 months before he was incarcerated, how often did your spouse/partner experience problems with anger when he had been drinking or using drugs? [REFER TO REFERENCE CALENDAR.]
Often
Sometimes
Rarely
Never
How often did your spouse/partner physically hurt or get rough with you or other family members when he had been drinking or using drugs?
Often
Sometimes
Rarely
Never
Partner report of father’s binge drinking
National Survey on Drug Use and Health
How often did your spouse/partner 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
PART
THREE
EXPERIENCES SINCE (MALE PARTNER’S) INCARCERATION
The next set of questions is about your experiences since (SPOUSE/PARTNER) was incarcerated.
Domain Q: Impact of Incarceration on Relationship with Partner
First, I’d like to know how much you agree or disagree with each of the following statements about keeping in touch with (SPOUSE/PARTNER)..
Importance of partner contact during incarceration
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 the correctional 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 during this incarceration. [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 your 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 is incarcerated and reports ever sending mail) Is (SPOUSE/PARTNER) able to receive the mail you have sent?
YES
NO
How often do you currently receive mail from your 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 is not incarcerated) How often do you currently visit your spouse/partner in person?
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 made any personal visits) About how much time do you spend visiting with (SPOUSE/PARTNER) on an average visit?
_______ [MINUTES]
Barriers to contact with partner during incarceration
(If R is not incarcerated)
Returning Home (modified)
Thinking about (SPOUSE/PARTNER)’s 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 you 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 you to deal with.
Strongly agree
Agree
Disagree
Strongly disagree
The cost of visiting makes it hard for you to visit (SPOUSE/PARTNER) as often as you would like.
Strongly agree
Agree
Disagree
Strongly disagree
Schedule issues, like limited visiting hours and your work schedule, make it hard for you to find time for visits.
Strongly agree
Agree
Disagree
Strongly disagree
The cost of receiving (SPOUSE/PARTNER)’s calls is too high for you, 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 to see (SPOUSE/PARTNER).
Strongly agree
Agree
Disagree
Strongly disagree
(SPOUSE/PARTNER) does not want to maintain close contact with you while he is incarcerated.
Strongly agree
Agree
Disagree
Strongly disagree
You do not want to maintain close contact with (SPOUSE/PARTNER) while he is incarcerated.
Strongly agree
Agree
Disagree
Strongly disagree
What would you say are the two biggest difficulties in staying in touch with (SPOUSE/PARTNER) during his incarceration? [SHOW ONLY ITEMS FOR WHICH R ANSWERED “STRONGLY AGREE” OR “AGREE” ABOVE.]
The prison is located too far away for you 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 you to deal with
The cost of visiting makes it hard for you to visit (SPOUSE/PARTNER)
as often
as you would like.
Schedule issues, like limited visiting hours and your work schedule,
make it hard
for you to find time for visits.
The cost of receiving (SPOUSE/PARTNER)’s calls is too high for
you, or you
do not have access to a phone.
The prison is not a pleasant place to visit, or not a place you want to see (SPOUSE/PARTNER).
(SPOUSE/PARTNER) does not want to maintain close contact with you while he is incarcerated.
You do not want to maintain close contact with (SPOUSE/PARTNER) while he is incarcerated.
Barriers to contact with partner during joint incarceration
(If R is incarcerated)
Returning Home (modified)
Thinking about this time period when you and (SPOUSE/PARTNER) have been in prison, please tell me how much you agree or disagree with each of the following statements.
Prison regulations make it hard for you and (SPOUSE/PARTNER) to talk to one another on the phone.
Strongly agree
Agree
Disagree
Strongly disagree
Prison regulations make it hard for you and (SPOUSE/PARTNER) to send each other mail.
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
(SPOUSE/PARTNER) does not want to maintain close contact with you 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 his incarceration? [SHOW ONLY ITEMS FOR WHICH R ANSWERED “STRONGLY AGREE” OR “AGREE” ABOVE.]
Prison regulations make it hard for you and (SPOUSE/PARTNER) to talk
to one
another on the phone.
Prison regulations make it hard for you and (SPOUSE/PARTNER) to send each other mail.
You do not want to maintain close contact with (SPOUSE/PARTNER) while you are incarcerated.
(SPOUSE/PARTNER) does not want to maintain close contact with you while you are incarcerated.
Impact of incarceration on partner relationship
(If R is not incarcerated, and was with PARTNER prior to his incarceration) How has (SPOUSE/PARTNER)’s time in prison changed your relationship with him, 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
(If R is incarcerated, and was with PARTNER prior to the 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
(If R is not incarcerated) What concerns or worries do you have about your relationship with (SPOUSE/PARTNER) during his incarceration? MARK ALL THAT APPLY.
His time in prison will make you drift apart
It is hard for you to know what his place in your life is when he is in
prison
Sometimes you can’t accept collect charges for his calls or be at home
when he calls
You are concerned about his lifestyle in prison
You may not be able to forgive him for problems or conflicts you’ve had
Being in prison makes it hard for him to open up to you or let himself get
close to you
You don’t know whether he will get involved with someone else while
he is in prison
You have become or might become involved with someone else while he
is in prison
Or some other concern that I haven’t mentioned (SPECIFY) _____________________________________
(If R is not incarcerated) Of the concerns you mentioned, which one is your biggest concern? MARK ONE ONLY. [SHOW ONLY RESPONSE OPTIONS THAT WERE SELECTED ABOVE.]
His time in prison will make you drift apart
It is hard for you to know what his place in your life is when he is
in
prison
Sometimes you can’t accept collect charges for his calls or be
at home
when he calls
You are concerned about his lifestyle in prison
You may not be able to forgive him for problems or conflicts you’ve had
Being in prison makes it hard for him to open up to you or let
himself get
close to you
You don’t know whether he will get involved with someone else
while
he is in prison
You have become or might become involved with someone else while he
is in prison
Or some other concern that I haven’t mentioned (SPECIFY) _____________________________________
(If R is incarcerated) What concerns or worries do you have about your relationship with (SPOUSE/PARTNER) during this incarceration? MARK ALL THAT APPLY.
The time in prison will make you drift apart
It is hard for you to know what your place in each other’s lives is when you are incarcerated
You are concerned about his lifestyle in prison
You may not be able to forgive him for problems or conflicts you’ve had
He may not be able to forgive you for problems or conflicts you’ve had
You don’t know whether he will get involved with someone else while
you are in prison
You have become or might become involved with someone else while
you are in prison
Or some other concern that I haven’t mentioned (SPECIFY) _____________________________________
(If R is incarcerated) Of the concerns you mentioned, which one is your biggest concern? MARK ONE ONLY. [Show only response options that were selected above.]
The time in prison will make you drift apart
It is hard for you to know what your place in each other’s lives is when you are incarcerated
You are concerned about his lifestyle in prison
You may not be able to forgive him for problems or conflicts you’ve had
He may not be able to forgive you for problems or conflicts you’ve had
You don’t know whether he will get involved with someone else while
you are in prison
You have become or might become involved with someone else while
you are in prison
Or some other concern that I haven’t mentioned (SPECIFY) _____________________________________
Domain R: Impact of Incarceration on Relationship with Children
(If R is incarcerated) 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.
Importance of child contact during incarceration
Keeping in touch with your child(ren) during your incarceration is very important to you.
Strongly agree
Agree
Disagree
Strongly disagree
Institutional support for child contact 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.
Strongly agree
Agree
Disagree
Strongly disagree
Contact with focal child during incarceration
Now, I’d like to ask about specific contact you may have had with (FOCAL CHILD) during this incarceration. [REFER TO REFERENCE CALENDAR.] [USE SHOWCARD.]
SVORI (modified)
How often do you currently talk on the phone with (FOCAL CHILD)?
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 ahead to question about sending mail.
(If R currently talks on the phone with focal child) About how long is your average phone call with (FOCAL CHILD)?
_______ (# MINUTES)
How often do you currently send mail to (FOCAL CHILD)?
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 ahead to question about sending audiotapes.
Have you been able to send any audiotapes to (FOCAL CHILD)?
YES
NO
How often do you currently receive mail from (FOCAL CHILD)?
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
Have you received any photographs or audiotapes of (FOCAL CHILD)?
YES
NO
How often do you currently receive personal visits from (FOCAL CHILD)?
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
(Ask of all Rs) The next set of questions is about (SPOUSE/PARTNER) keeping in touch with (FOCAL CHILD) during his incarceration.
Partner report of importance of father’s contact with focal child during incarceration
First, I’d like to know how much you agree or disagree with the following statement.
It’s very important to you that (SPOUSE/PARTNER) keep in touch with (FOCAL CHILD) during this incarceration.
Strongly agree
Agree
Disagree
Strongly disagree
Partner report of father’s contact with focal child during incarceration
Now, I’d like to ask about specific contact (SPOUSE/PARTNER) may have had with (FOCAL CHILD) during this incarceration. [REFER TO REFERENCE CALENDAR.] [USE SHOWCARD.]
SVORI (modified)
How often does (SPOUSE/PARTNER) currently talk on the phone with (FOCAL CHILD)?
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 ahead to question about sending mail.
(If spouse/partner currently talks on the phone with focal child) About how long is his average phone call with (FOCAL CHILD)?
_______ (# MINUTES)
How often does (SPOUSE/PARTNER) currently send mail to (FOCAL CHILD)?
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 ahead to question about sending audiotapes.
Has (SPOUSE/PARTNER) been able to send any audiotapes to (FOCAL CHILD)?
YES
NO
How often does (FOCAL CHILD) 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
As far as you know, has (SPOUSE/PARTNER) received any photographs or audiotapes of (FOCAL CHILD)?
YES
NO
How often does (FOCAL CHILD) visit (SPOUSE/PARTNER) in person?
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
Parental warmth
(If R is incarcerated and reports having no contact with focal child during incarceration, skip Parental Warmth.)
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).
On average, how often do you do each of the following with (FOCAL CHILD) when you communicate with him/her? [USE SHOWCARD.]
(If R is not incarcerated or if R is incarcerated and reports visiting with focal child during this incarceration) Hug or show physical affection to your child?
Always
Usually
Sometimes
Never
PHYSICAL CONTACT NOT PERMITTED BY FACILITY
Tell (FOCAL CHILD) that you love (him/her)?
Always
Usually
Sometimes
Never
Communicate with (FOCAL CHILD) about things s/he is interested in?
Always
Usually
Sometimes
Never
Praise (FOCAL CHILD)? By praise, I mean tell (FOCAL 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
(If R is incarcerated)
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 (FOCAL CHILD) to have regular visits, or is too hard for his/her 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 (FOCAL CHILD) to deal with.
Strongly agree
Agree
Disagree
Strongly disagree
The cost of visiting is too high for (FOCAL CHILD)’s caretaker to bring him/her as often as s/he would like to.
Strongly agree
Agree
Disagree
Strongly disagree
Schedule issues, like limited visiting hours and the child’s caretaker’s work schedule, 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 (FOCAL CHILD) to see you.
Strongly agree
Agree
Disagree
Strongly disagree
(FOCAL CHILD)’s caretaker does not want him/her 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 (FOCAL CHILD) while you are incarcerated.
Strongly agree
Agree
Disagree
Strongly disagree
(FOCAL CHILD) does not want to maintain close contact with you.
Strongly agree
Agree
Disagree
Strongly disagree
You were not in close contact with (FOCAL CHILD) 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 (FOCAL CHILD) to have regular visits, or is too hard for his/her caretaker to get to because of transportation issues.
Visitor admission rules (such as background checks, dress codes, searches, metal detectors) are hard for (FOCAL CHILD) to deal with.
The cost of visiting is too high for (FOCAL CHILD)’s caretaker to bring him/her as often as s/he would like to. .
Schedule issues, like limited visiting hours and the child’s caretaker’s work schedule, 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 (FOCAL CHILD) to see you.
(FOCAL CHILD)’s caretaker does not want him/her to maintain close contact with you while you are incarcerated
You do not want to maintain close contact with (FOCAL CHILD) while you are incarcerated.
(FOCAL CHILD) does not want to maintain close contact with you.
You were not in close contact with (FOCAL CHILD) before this incarceration.
Some other reason (SPECIFY) _______________________________
Partner report of barriers to father’s contact with focal child during incarceration
Returning Home (modified)
Thinking about (SPOUSE/PARTNER)’s 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 (FOCAL CHILD) to have regular visits with (SPOUSE/PARTNER), or is too hard for you to bring (FOCAL CHILD) 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 (FOCAL CHILD) to deal with.
Strongly agree
Agree
Disagree
Strongly disagree
The cost of visiting is too high for you to bring (FOCAL CHILD) as often as you would like to.
Strongly agree
Agree
Disagree
Strongly disagree
Schedule issues, like limited visiting hours and your work schedule, make it hard for you to find time to bring (FOCAL CHILD) for visits.
Strongly agree
Agree
Disagree
Strongly disagree
The cost of (SPOUSE/PARTNER)’s calls with (FOCAL CHILD) 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 (FOCAL CHILD) to see (SPOUSE/PARTNER).
Strongly agree
Agree
Disagree
Strongly disagree
You do not want (FOCAL CHILD) to maintain close contact with (SPOUSE/PARTNER) while he is incarcerated.
Strongly agree
Agree
Disagree
Strongly disagree
(SPOUSE/PARTNER) does not want to maintain close contact with (FOCAL CHILD) while he is incarcerated.
Strongly agree
Agree
Disagree
Strongly disagree
(FOCAL CHILD) does not want to maintain close contact with (SPOUSE/PARTNER).
Strongly agree
Agree
Disagree
Strongly disagree
(SPOUSE/PARTNER) was not in close contact with (FOCAL CHILD) before this incarceration.
Strongly agree
Agree
Disagree
Strongly disagree
Partner report of impact of incarceration on father’s relationship with focal child
How has (SPOUSE/PARTNER)’s time in prison changed his relationship with (FOCAL CHILD), if at all? Has it made them closer, has it made them drift apart, or has there been no change?
Made them closer
Made them drift apart
No change
Other (specify) ___________________________________________
What concerns or worries do you have about (FOCAL CHILD) during (SPOUSE/PARTNER)’s 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 (SPOUSE/PARTNER)’s 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)
Domain S: Service Need and Receipt
Now, I’m going to ask you about services you might have received and programs you might have participated in since (SPOUSE/PARTNER) has 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 (SPOUSE/PARTNER)’s 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 (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?
# TIMES |___|___|
Created
(If received marriage education) During (SPOUSE/PARTNER)’s incarceration, how many times have you and your partner gone together to any group classes or workshops on healthy marriage or romantic relationships?
# 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?
# 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
Created
(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 his 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 and relationship counseling (need, receipt, attendance with partner, duration)
BSF/SMH
During (SPOUSE/PARTNER)’s 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 (SPOUSE/PARTNER)’s incarceration, about how many times have you had these counseling sessions to work on your (marriage/relationship)?
# TIMES |___|___|
Created
(If received marriage counseling) During (SPOUSE/PARTNER)’s incarceration, about how many times have you and (SPOUSE/PARTNER) attended these counseling sessions together?
# TIMES |___|___|
BSF
(If received marriage counseling) About how long did each session usually last?
# 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
HEARD ABOUT IT FROM SPOUSE/PARTNER
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 your 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
Anything else? (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 your 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
Anything else? (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 (SPOUSE/PARTNER)’s 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 (SPOUSE/PARTNER)’s incarceration?
# 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?
# HOURS |___|___|
(FI confirmation: So, you had about X sessions each lasting about Y hours?)
Case management (need, receipt, duration, referrals, follow-up)
SVORI
During (SPOUSE/PARTNER)’s 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 (SPOUSE/PARTNER)’s incarceration?
___ # 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 (SPOUSE/PARTNER)’s 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 (SPOUSE/PARTNER)’s 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 (SPOUSE/PARTNER)’s 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 (SPOUSE/PARTNER)’s 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 (SPOUSE/PARTNER)’s 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 (SPOUSE/PARTNER)’s 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 (SPOUSE/PARTNER)’s 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 (SPOUSE/PARTNER)’s 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 (SPOUSE/PARTNER)’s 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 (SPOUSE/PARTNER)’s incarceration, have you participated in any family group conferencing or family mediation? I 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 (SPOUSE/PARTNER)’s incarceration, have you participated in any support groups? I 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 (SPOUSE/PARTNER)’s 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
PART
SIX
PERSONAL CHARACTERISTICS/CURRENT FEELINGS
These next questions deal with your feelings, attitudes, and how things are going for you currently.
First, I’d like to know whether each of the following is true for you often, sometimes, rarely or never. [USE SHOWCARD.]
Locus of control
How often do you feel that you are not able to control the important things in your life? Would you say…
Often
Sometimes
Rarely
Never
Anger management
Created
How often do you feel angry or mad? Would you say…
Often
Sometimes
Rarely
Never
DK
R
In general, how much of the time does your anger cause problems in your relationships?
Often
Sometimes
Rarely
Never
DK
R
How much of the time does your anger cause problems in your job or work life?
Often
Sometimes
Rarely
Never
DK
R
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
Please tell me how much you agree or disagree with each of the following statements.
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
Domain P: Mental and Physical Health
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
Domain V: Partner Relationship Quality
[QUESTIONS IN SUBSEQUENT SECTIONS MAY BE SKIPPED AT FI DISCRETION IF R BECOMES TOO DISTRESSED.]
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 with (SPOUSE/PARTNER) now, since he has 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, we 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, we 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
Created
Does (SPOUSE/PARTNER) confide in you? By confide, I mean share secrets or personal, sensitive information.
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 him. 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
(If R is incarcerated)
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, I 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
Relationship commitment
Here are some more statements about your relationship with (SPOUSE/PARTNER). For each one, please tell me if you strongly agree, agree, disagree, or strongly disagree.
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
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 each 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 his financial situation change if you split up? Would it get...
Better
Worse
Stay the same
Can’t predict
How would his 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
Domain N: Parenting and Child Well-Being
The next items ask about your relationship with (FOCAL CHILD).
Residence of focal child
With whom does (FOCAL CHILD) currently live? [USE SHOWCARD.]
(If R is not incarcerated) With you
(If R is not focal child’s bio mother) With his/her biological mother
(If incarcerated male is not focal child’s bio father) With his/her biological
father
With the child’s maternal grandparent(s)
With the child’s paternal grandparent(s)
With the child’s stepgrandparent(s)
With the child’s other blood relatives
With the child’s stepparent
With 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
(If R is incarcerated)
Does (FOCAL CHILD) know that you are incarcerated?
YES
NO
Partner report of whether focal child knows father is incarcerated
Does (FOCAL CHILD) know that (SPOUSE/PARTNER) is 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
[REFER TO GENOGRAM TO CONFIRM WHETHER FOCAL CHILD IS COPARENTED BY R OR SOMEONE ELSE, AND REFER TO SPOUSE/PARTNER AND R OR OTHER COPARENT.] Who makes major decisions about things such as child care and health care for (FOCAL CHILD)? Would you say...
(SPOUSE/PARTNER) and (you/coparent) make most decisions
together
(SPOUSE/PARTNER) makes most decisions himself
(You/coparent) make/makes most decisions (your/her)self
Focal child’s relationship with father
Please rate (FOCAL CHILD)’s relationship with his/her father. Would you say it is excellent, good, fair, or poor?
Excellent
Good
Fair
Poor
Partner’s role as coparent to focal child
Does (SPOUSE/PARTNER) coparent (FOCAL CHILD) with you? By coparent, I 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 s/he 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 s/he 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
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
This next set of questions deals with the kinds of support you receive from your friends and family. [REFER TO REFERENCE CALENDAR.]
Number of close family members
How many close family members do you have? These are people you feel at ease with, could talk to about private matters, or could call on for help. Would you say you have no close family members, one or two, 3-5, 6-10, or more than that?
No close family members
One or two
Three to five
Six to ten
More than ten
Emotional support from extended family
SVORI/Returning Home (modified)
Now I’d like to ask how you currently feel about your relationships with your family members other than (SPOUSE/PARTNER) or your child(ren). 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
Number of close friends
Social Capital Community Benchmark Survey
Next, I would like to know about your friends. Please do not count SPOUSE/PARTNER or any family members as you answer these questions.
How many close friends do you have? These are people you feel at ease with, could talk to about private matters, or could call on for help. Would you say you have no close friend, one or two, 3-5, 6-10, or more than that?
No close friends
One or two
Three to five
Six to ten
More than ten
(If R is not incarcerated)
This next set of questions deals with your current employment.
Employment statusNSAF
Are you currently 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
(If R has a job) Is your current job…
Part time
Full time
Type of employment
SVORI
(If R has a job) Is your current 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 a job) How much do you earn from your current job before taxes, including any tips, bonuses, and commissions? Responses could be per hour, per day, per week, per 2 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 a job) Does your current job provide health insurance coverage?
YES
NO
SVORI
(If R has a job) Were/are you entitled to any fully paid leave, such as sick leave, paid holidays, or vacation leave from your employer?
YES
NO
(If R is not incarcerated)
Now, I have some questions about your current living situation.
Type of housing
Drug court study
Are you currently living in any of 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 camp out
In an abandoned building or vacant unit
In some other place
(If R lives in more than one place) Which of these places do 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 camp out
In an abandoned building or vacant unit
In some other place
(If R only lives OR mostly lives in own home or someone else’s home) Is 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) Is 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
Are you currently living with (FOCAL CHILD)?
Yes
No
Are you currently living with (CHILD)?
Yes
No
Repeat above question for each of R’s remaining children.
Who else are you currently living with? Please list everyone. [SELECT ALL THAT APPLY.]
NO ONE ELSE
A CURRENT ROMANTIC PARTNER OTHER THAN (SPOUSE/PARTNER)
A FORMER ROMANTIC PARTNER OTHER THAN (SPOUSE/PARTNER)
MOTHER/STEPMOTHER
FATHER/STEPFATHER
Sister/stepsister
Brother/stepbrother
Aunt/Uncle, Great Aunt/Uncle
Cousin
Grandparent
other Children/stepchildren
Friend OF R
FRIEND OF spouse/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 currently live. [REFER TO REFERENCE CALENDAR.]
It is hard to stay out of trouble in your neighborhood or community.
Strongly agree
Agree
Disagree
Strongly disagree
Drug selling is a major problem in your neighborhood or community.
Strongly agree
Agree
Disagree
Strongly disagree
Your neighborhood or community is a good place to live.
Strongly agree
Agree
Disagree
Strongly disagree
Your neighborhood or community is a good place to find a job.
Strongly agree
Agree
Disagree
Strongly disagree
(If R is incarcerated)
Addiction severity
CAGE
Now, I’d like you to think about your current drug and alcohol use. [REFER TO REFERENCE CALENDAR.]
(If R reported any alcohol use) Do you feel you should cut down on your drinking?
YES
NO
(If R reported any alcohol use) Do people ever annoy you by complaining about your drinking?
YES
NO
(If R reported any alcohol use) Do you ever feel bad or guilty about your drinking?
YES
NO
(If R reported any alcohol use) Do 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) Do you ever feel you should cut down on your drug use?
YES
NO
(If R reported any drug use) Do people ever annoy you by complaining about your drug use?
YES
NO
(If R reported any drug use) Do you ever feel bad or guilty about your drug use?
YES
NO
Anger and addiction
How often do you experience problems with anger when you have been drinking or using drugs? [REFER TO REFERENCE CALENDAR.]
Often
Sometimes
Rarely
Never
How often do you physically hurt or get rough with your spouse/partner or other family members when you have been drinking or using drugs?
Often
Sometimes
Rarely
Never
Binge drinking
National Survey on Drug Use and Health
How often do 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
Domain P: Physical and Mental Health
The next questions are about health care and health insurance.
Health insurance
Are you covered by Medicaid, (CA: Medi-Cal), Medicare, Champus, Indian Health Services, or any other government program that pays for medical care?
YES
NO
Are 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 past 6 months, did you or your child(ren) ever need to see a doctor or go to the hospital but couldn’t go because of the cost? [REFER TO REFERENCE CALENDAR.]
YES
NO
(If R is not incarcerated)
Next, I’m going to ask you some questions about any involvement you might have had with the criminal justice system during your life.
Arrest and conviction history
SVORI
Have you ever been arrested?
YES
NO
(If ever arrested) 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)
(If ever arrested) How many times in your life have you been convicted of a crime?
_____ (# CONVICTIONS)
Incarceration history – adult correctional facilities
(If ever arrested) 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. (PROBE FOR INCARCERATED Rs ONLY: Please do not count your current incarceration.)
YES
NO
(If ever in prison/jail > 24 hours) 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. (PROBE FOR INCARCERATED Rs ONLY: Please do not count your current incarceration.)
_____ (# TIMES)
Criminal/AOD behavior of people living with
Has anyone you are currently living with ever been to jail, prison, or some other correctional institution?
Yes
No
Do any of the people you are currently living with use illegal drugs?
Yes
No
Addiction severity
CAGE
Now, I’d like you to think about your current drug and alcohol use. [REFER TO REFERENCE CALENDAR.]
a. (If R reported any alcohol use) Do you feel you should cut down on your drinking?
YES
NO
b. (If R reported any alcohol use) Do people ever annoy you by complaining about your drinking?
YES
NO
c. (If R reported any alcohol use) Do you ever feel bad or guilty about your drinking?
YES
NO
d. (If R reported any alcohol use) Do you ever have a drink first thing in the morning to steady your nerves or get rid of a hangover (“eye-opener”)?
YES
NO
e. (If R reported any drug use) Do you ever feel you should cut down on your drug use?
YES
NO
f. (If R reported any drug use) Do people ever annoy you by complaining about your drug use?
YES
NO
g. (If R reported any drug use) Do you ever feel bad or guilty about your drug use?
YES
NO
Anger and addiction
How often do you experience problems with anger when you have been drinking or using drugs? [REFER TO REFERENCE CALENDAR.]
Often
Sometimes
Rarely
Never
How often do you physically hurt or get rough with your spouse/partner or other family members when you have been drinking or using drugs?
Often
Sometimes
Rarely
Never
Binge drinking
National Survey on Drug Use and Health
How often do 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
Substance use
Please tell me which of the following substances you used during the 6 months before your spouse/partner’s 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 {NOT ON SHOWCARD}
(If R reports no alcohol or drug use during 6 months prior to incarceration, skip to Perceptions of spouse/partner substance abuse.)
Which of the following did you use the most during the 6 months before your spouse/partner’s 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.
Partner report of father’s substance use
Please tell me which of the following substances your spouse/partner used during the 6 months before his 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 {NOT ON SHOWCARD}
(If R reports no partner alcohol or drug use during 6 months prior to incarceration, skip to Physical and Mental Health domain.)
Which of the following did your spouse/partner use the most during the 6 months before his 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.
Partner report of father’s addiction severity
CAGE
Now, I’d like you to think back to your spouse/partner’s drug and alcohol use during the 6 months before he was incarcerated. [REFER TO REFERENCE CALENDAR.]
a. (If R reported any spouse/partner alcohol use) Did he feel he should cut down on his drinking?
YES
NO
b. (If R reported any spouse/partner alcohol use) Did people ever annoy him by complaining about his drinking?
YES
NO
c. (If R reported any spouse/partner alcohol use) Did he ever feel bad or guilty about his drinking?
YES
NO
d. (If R reported any spouse/partner alcohol use) Did he ever have a drink first thing in the morning to steady his nerves or get rid of a hangover (“eye-opener”)?
YES
NO
e. (If R reported any spouse/partner drug use) Did he ever feel he should cut down on his drug use?
YES
NO
f. (If R reported any spouse/partner drug use) Did people ever annoy him by complaining about his drug use?
YES
NO
g. (If R reported any spouse/partner drug use) Did he ever feel bad or guilty about his drug use?
YES
NO
Partner report of father’s anger and addiction
During the 6 months before he was incarcerated, how often did your spouse/partner experience problems with anger when he had been drinking or using drugs? [REFER TO REFERENCE CALENDAR.]
Often
Sometimes
Rarely
Never
How often did your spouse/partner physically hurt or get rough with you or other family members when he had been drinking or using drugs?
Often
Sometimes
Rarely
Never
Partner report of father’s binge drinking
National Survey on Drug Use and Health
How often did your spouse/partner 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
Partner expectations about father’s substance use
How likely is it that your spouse/partner will use any illegal drugs after his release?
Very likely
Likely
Unlikely
Very unlikely
Domain V: Partner Relationship Quality
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, I 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
Domain M: Intimate Partner Violence
(If R was in a relationship with SPOUSE/PARTNER prior to SPOUSE/PARTNER’s incarceration.)
Now, I’m going to ask you some questions about your romantic relationship during the 6 months prior to your spouse/partner’s 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 he was 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 your spouse/partner? Would you say…
Often
Sometimes
Rarely
Never
TX HM
Your spouse/partner became jealous or possessive. Would you say…
Often
Sometimes
Rarely
Never
TX HM
Your spouse/partner made you feel like you were not good enough. Would you say…
Often
Sometimes
Rarely
Never
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 your spouse/partner’s incarceration you did the following. Then I’ll ask you how many times in the 6 months prior to his most recent incarceration your spouse/partner did the following. [REFER TO REFERENCE CALENDAR.] [USE SHOWCARD.]
In the 6 months prior to your spouse/partner’s 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 your spouse/partner’s 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 your spouse/partner’s incarceration, how many times did you push, shove, hit, slap, or grab your spouse/partner?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to your spouse/partner’s 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 your spouse/partner’s 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 your spouse/partner’s 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 your spouse/partner’s 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 your spouse/partner’s 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 your spouse/partner’s 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 your spouse/partner’s 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 your spouse/partner’s 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 your spouse/partner’s 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 your spouse/partner’s 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 your spouse/partner’s 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 your spouse/partner’s incarceration, how many times did you try to keep your spouse/partner from seeing or talking with his friends or family?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to your spouse/partner’s 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 your spouse/partner’s incarceration, how many times did you keep money from your spouse/partner, make him ask for money, or take money from him?
None
1 time
2 times
3-5 times
6 or more times
In the 6 months prior to your spouse/partner’s 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
PART
SEVEN
EXPECTATIONS FOR POST-RELEASE PERIOD
(If R’s partner reported serving life sentence with no expectation of release, skip to Locator Information.)
Next, I am going to ask you about your expectations for what your life will be like once (SPOUSE/PARTNER) is released. 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.]
Partner knowledge of release date
When do you expect that (SPOUSE/PARTNER) will be released?
___________ (MM/DD/YYYY)
Partner expectations about father’s reincarceration
Do you think (SPOUSE/PARTNER) will ever be sent back to jail or prison again, after he is released from this incarceration?
YES
NO
(If R is incarcerated)
Partner expectations about father’s substance use
How likely is it that (SPOUSE/PARTNER) will use any illegal drugs after his release?
Very likely
Likely
Unlikely
Very unlikely
Expectations about support from “other family members”
These next questions are about your expectations for your relationships with family members other than your spouse/partner or child(ren) after (SPOUSE/PARTNER)’s 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 (SPOUSE/PARTNER)’s 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 expectations for your financial situation after (SPOUSE/PARTNER) is released.
Partner expectations about father providing financial support
When (SPOUSE/PARTNER) is released from prison, do you expect that he will provide any financial support to you?
YES
NO
Expectations about sources of financial support
Returning Home
What sources of financial support do you expect to have in the first 1 month following (SPOUSE/PARTNER)’s release? [USE SHOWCARD.]
None
Pay from a job
Your own savings
Money from (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______________)
Partner’s perceptions of father’s difficulty supporting himself
How easy or hard do you think it will be for (SPOUSE/PARTNER) to make enough money to support himself?
Very easy
Pretty easy
Pretty hard
Very hard
Partner expectations of father finding/keeping a job
Based on past experience, how easy or hard do you think it will be for (SPOUSE/PARTNER) 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 for (SPOUSE/PARTNER) 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 his release?
YES
NO
Partner expectations about father living with focal child
Created
Do you expect (SPOUSE/PARTNER) to live with [FOCAL CHILD] after his release?
YES
NO
Expectations about living with anyone else
Created
(If R expects to live with spouse/partner after his release) Do you expect that you and (SPOUSE/PARTNER) will live with anyone else after he is released?
YES
NO
Domain V: Partner Relationship Quality
Intentions for continuing relationship
Do you want to remain in a committed romantic relationship with (SPOUSE/PARTNER) after he is released?
Yes
No
Don’t know
Do you think (SPOUSE/PARTNER) wants to remain in a committed romantic relationship with you after he is released?
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 he gets 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 (SPOUSE/PARTNER) is released, what do you expect will be the biggest challenges in your relationship with him? [MARK ALL THAT APPLY.]
Finding him
Being able to feel close to him again after his time in prison
Being able to trust him after his time in prison
Problems or new situations that have come up since he was incarcerated
His having missed out on so much that happened in your life while he was
incarcerated
His trying to meet your expectations related to finding a job, staying clean,
helping you financially
Being angry at him or not wanting to see him
Him 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 he is released.
After he is released, you will stand by (SPOUSE/PARTNER) no matter what.
Strongly agree
Agree
Disagree
Strongly disagree
You will love (SPOUSE/PARTNER) and make him feel wanted.
Strongly agree
Agree
Disagree
Strongly disagree
You will help (SPOUSE/PARTNER) with whatever problems he faces.
Strongly agree
Agree
Disagree
Strongly disagree
After he is 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
Partner expectations about father’s interaction with focal child
(If R reports spouse/partner will not live with focal child) How often do you think (SPOUSE/PARTNER) will see (FOCAL CHILD) in person after he is 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
Partner expectations about father’s financial support for focal child
Do you expect that (SPOUSE/PARTNER) will financially support (FOCAL CHILD) in any way after he is released?
YES
NO
(If yes) In what way or ways do you expect (SPOUSE/PARTNER) will provide financial support for (FOCAL CHILD) after he is released? Include support provided to the child directly, as well as support provided to the child’s other parent or caretaker.
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
[REFER TO GENOGRAM TO CONFIRM WHETHER FOCAL CHILD IS COPARENTED BY R OR SOMEONE ELSE, AND REFER TO SPOUSE/PARTNER AND R OR OTHER COPARENT.] Who will make major decisions about things such as child care and health care for (FOCAL CHILD)? Would you say...
(SPOUSE/PARTNER) and (you/coparent) will make most decisions
together
(SPOUSE/PARTNER) will make most decisions himself
(You/coparent) will make most decisions (your/her)self
Partner’s perceptions about father’s difficulty with relationship with children
Returning Home
How easy or hard do you think it will be for (SPOUSE/PARTNER) to have good relationships with his child(ren) after he gets out?
Very easy
Pretty easy
Pretty hard
Very hard
Created
Thinking about when (SPOUSE/PARTNER) is released, what do you expect will be the biggest challenges in his relationship(s) with his child(ren)? (If spouse/partner has more than one child) Please consider only the child(ren) he was in contact with before he was incarcerated. [MARK ALL THAT APPLY.]
Finding them
Having missed out on so much that happened with him/her/them while he was incarcerated
Getting them to trust him or open up to him after the time apart
Finding transportation for visits or activities
Dealing with people who don’t want him to see them
Not being in a stable enough housing and financial situation to be
able to
spend time with them
His lifestyle not being a healthy one for kids
His child(ren) being angry at him or not wanting to see him
Some other challenge (SPECIFY)___________________________
SVORI
(If R is incarcerated) BHOU1
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?
(If R is incarcerated) BHOU2
DOES THE R HAVE A SPECIFIC ADDRESS?
Yes-> RECORD ADDRESS, CITY, STATE, PHONE
NO-> SKIP TO BHOU3
(If R is incarcerated) 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
(If R is incarcerated) 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?
(If R is incarcerated) BHOU5
DOES THE R HAVE A SPECIFIC ADDRESS?
Yes-> RECORD ADDRESS, CITY, STATE, PHONE
NO-> SKIP
(If R is not incarcerated) BHOU1
So that we can contact you for follow-up interviews, please tell me where you expect to be living 9 months from now.
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?
(If R is not incarcerated) BHOU2
DOES THE R HAVE A SPECIFIC ADDRESS?
YES-> RECORD ADDRESS, CITY, STATE, PHONE
NO-> SKIP TO BHOU3
(If R is not incarcerated) BHOU4
Where else might you be living 9 months from now?
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?
(If R is not incarcerated) BHOU5
DOES THE R HAVE A SPECIFIC ADDRESS?
YES-> RECORD ADDRESS, CITY, STATE, PHONE
NO-> SKIP
(If R is employed) Where do you work? In other words, what is the name of the company or organization you work for? We will not contact you at work unless we cannot get in touch with you at your home.
{allow 30}
(If R is not incarcerated) BHOU11i2
And in what city is that?
{allow 30}
(If R is not incarcerated) 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}
(If R is not incarcerated) BHOU11i4
Do you have a work phone number?
YNDKRF
{if BHOU11i4=yes, ask BHOU11i5}
(If R is not incarcerated) 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}
BHOU9a
In the event that you are not living where you expect to live, 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.
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 |