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pdfMathematica Reference No.: 06876.341
National Longitudinal Transition Study
Student Baseline Questionnaire:
CATI Programming Specifications
Dated .07.24.12
Draft Updated to:
Update wording / text for students completing survey beyond the 2011-2012 school year, but
keeping it as the reference point.
Adding in logic for the incentive payment differential to parents.
Modifying the flow of items to move majority of consent items to the final section of the
instrument (for the non-interview components of the study).
Student Baseline Questionnaire: CATI Programming Specifications
ADMINISTRATIVE NOTES:
THIS INSTRUMENT IS DESIGNED TO BE INTERVIEWER-ADMINISTERED OVER THE TELEPHONE
WITH AN ESTIMATED DURATION OF 30 MINUTES.
AT BASELINE, THE STUDENT’S INTERVIEW WILL IMMEDIATELY FOLLOW THE PARENT’S CONSENT
AND INTERVIEW. AT BASELINE, PARENTS WILL ALWAYS BE INTERVIEWED BEFORE STUDENTS.
PROXIES WILL BE ALLOWED AND ASKED OBJECTIVE ITEMS ONLY (AS DESIGNATED AT EACH
ITEM). IF THE STUDENT IS UNABLE TO COMPLETE THE INTERVIEW ON HIS/HER OWN, PROXY WILL
BE PERSON MOST KNOWLEDGEABLE ABOUT THE STUDENT’S EXPERIENCES IN AND OUT OF
SCHOOL.
EACH ITEM DRAWN FROM A PRE-EXISTING INSTRUMENT WILL HAVE, AT THE END OF THE
QUESTION TEXT, THE SOURCE INSTRUMENT AND ITEM REFERENCE NUMBER. IF THE ORIGINAL
SOURCE HAS BEEN MODIFIED, THE TEXT, ‘REV” WILL FOLLOW.
GUIDELINES FOR ADMINISTRATION ARE NOTED THROUGHOUT – ITEMS IN ALL CAPS ARE NOT
READ ALOUD, VERBIAGE UNDERLINED IS EMPHASIZED. STANDARDIZED PROBES AND
DEFINITIONS ARE PROVIDED FOR APPLICABLE ITEMS, AS NEEDED.
DESIGN NOTES:
WHEN AN ITEM IS NOT ASKED OF ALL RESPONDENTS, THE UNIVERSE WILL PRECEDE THE ITEM
NUMBER (E.G. IT IS DESIGNATED AS “IEP ONLY” OR “504 ONLY” OR ONLY FOR STUDENTS OF
SPECIFIC AGE RANGES). CATI SHALL USE AGE FROM PARENT SURVEY FOR ALL APPLICABLE
ITEMS IN STUDENT SURVEY.
CATI WILL DRAW ON VARIABLES FROM THE SAMPLE FILE FOR INITIAL STATUS OF IEP, 504, OR
NOT [IEP, PLAN504]
CATI WILL DRAW ON ITEM J1B TO IDENTIFY WHEN A PROXY INTERVIEW IS BEING CONDUCTED
(J1B=1 CONDUCTED WITH STUDENT HIM/HERSELF J1B=2 CONDUCTED WITH PROXY FOR
STUDENT). WHEN AN ITEM IS NOT ADMINISTERED TO PROXY RESPONDENTS, CATI WILL
AUTOMATICALLY PROCEED TO THE NEXT ITEM IN THE SEQUENCE.
FOR ALL GENDER-RELATED FILLS, CATI WILL DRAW FROM ITEM A11 (WHERE 1= MALE AND
0=FEMALE) AND IF A11= BLANK, FROM SAMPLE FILE ([GENDER], WHERE M= MALE AND F=FEMALE).
ACROSS ALL ITEMS ON NAME AND ADDRESS: DEVIATE FROM BLAISE STANDARD (WHERE
SUBSEQUENT ITEMS SKIPPED IF ANY FIELD = REF / DK ON NAME OR ADDRESS). ANY FIELDS
DESIGNATED AS “D” OR “R” WILL THEN BE CONVERTED TO “.” IN OVERNIGHT TRANSFER.
WHENEVER NAME IS CAPTURED, ALLOW DEVIATION FROM STANDARD (IF IF FIRST NAME = DK,
REF, CONTINUE TO ASK FOR LAST NAME.
WHENEVER A MAILING ADDRESS IS CAPTURED, ALLOW DEVIATION FROM STANDARD (IF IF ONE
SECTION OF ADDRESS FIELD =D, R, CONTINUE TO NEXT FIELD AND DO NO EXIT SERIES).
IN THE OVERNIGHT FILE TRANSFER FIELDS WHERE NAME OR EMAIL ADDRESS = DK, REF IN DATA
WILL BE CONVERTED TO “.” (MISSING).
ADD FIELD DRAWN FROM SMS DATA FLAG TO POPULATE RESPONDENT PAYMENT INFO ON DIAL
SCREEN USING THE TABLE BELOW.
CATI SET UP THE FOLLOWING GROUPS FOR INTERVIEWERS WHO WILL RECEIVE THE FOLLOWING TYPES OF
CASES, BASED ON THEIR GROUP ASSIGNMENT:
2
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
GROUP NAME
SPECIFICATIONS
REFUSAL
CONVERTER:
ENGLISH
ALL NON-SPANISH CASES WHO HAVE ALSO REFUSED TO COMPLETE AN
INTERVIEW AND HAVE A REFUSAL STATUS ELIGIBLE FOR CONVERSION.
SPANISH
ALL CASES WHERE BI-LINGUAL INTERVIEWER IN SPANISH IS REQUESTED. STAFF
ARE ALL CERTIFIED SPANISH-SPEAKING INTERVIEWERS.
ALL CASES FLAGGED AS NEEDING SPANISH-SPEAKING INTERVIEWER WHO HAVE
ALSO REFUSED TO COMPLETE AN INTERVIEW AND HAVE A REFUSAL STATUS
ELIGIBLE FOR CONVERSION.
SPANISH
REFUSAL
ALL CASES WHERE BI-LINGUAL INTERVIEWER IN SPANISH IS REQUESTED. STAFF
ARE ALL CERTIFIED SPANISH-SPEAKING INTERVIEWERS.
SPECIAL MODE ENGLISH
CASES WHERE PARENT ITEM I14 = 1,2, OR 4. OR WHERE STUDENT J1A=1,2, OR 4 /
OR WHERE HARD CODED BY PROGRAMMER TO BE INCLUDED IN THIS GROUP,
UPON SOC STAFF REQUEST FROM INTERACTION WITH PARENT OR YOUTH.
SPECIAL MODE SPANISH
SAME SPECS AS SPECIAL MODE (ABOVE), PLUS INTERVIEWER MUST ALSO BE
MEMBER OF SPANISH GROUP.
NAMES OF SPECIFIC STAFF ELIGIBLE TO RECEIVE CASES IN EACH GROUP WILL BE UPDATED IN BLAISE ON A
FLOW BASIS.
AS OF 05.30.12: PLEASE DISMANTLE FEATURE IN BLAISE THAT CREATES A “SOFT APPT” IN STUDENT SURVEY.
FLAGS FROM SMS: BASED ON DISTRICT-SPECIFIC GUIDELINES ON STUDY IMPLANTATION, WE WILL MODIFY THE
CATI SCRIPT TO ENSURE WE ARE IN ALIGNMENT WITH REQUESTS RELATING TO RESPONDENT PAYMENTS.
THESE FLAGS WILL ALSO TRIGGER THE RESPONDENT PAYMENT VALUE TO POPULATE ON THE “DIAL TAB” FOR
INTERVIEWERS TO CHECK OR REFERENCE WHICH TYPE OF CASE THIS IS. THE FLAG, COMES FROM THE DC TAB
OF THE SMS (DRIVEN BY LEA-LEVEL IDS), WILL ASSIGN THE FOLLOWING VALUES:
FLAG
VALUE
1
2
3
4
5
6
STUDENT RESPONDENT PAYMENT VALUE (INSERT ON
MAKE CALL SCREEN IN STUDENT SURVEY)
Permitted
$10 TO STUDENT
Not permitted, donation can be made to $0 – ($10 PAYMENT GOES TO SCHOOL)
SCHOOL
Not permitted, donation can be made to $0 – ($10 PAYMENT GOES TO DISTRICT)
DISTRICT
Not permitted
$0
Experimental condition A - $5 Pre-pay, $15 $10 TO STUDENT
post pay for parent
Experimental condition B- $5 Pre-pay, $30 $10 TO STUDENT
post pay for parent
DESCRIPTOR
3
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
J. INTRODUCTION AND INFORMED CONSENT
CATI ADD TO SAMPLE REVIEW SCREEN: IF DISTRICT ID = 0691007 INSERT TEXT AT INTRO SCREEN FOR SECTION J: STUDENT INTERVIEW
MUST BE COMPLETED BY PROXY PER SCHOOL DISTRICT REQUEST.
A2 = 1 and A8 ≠ 3
The U.S. Department of Education is sponsoring the National Longitudinal Transition
Study. Through this important project, we hope to learn more about issues youth face
today as they transition from school to adult life and how schools can better support
students in reaching their goals. We are asking you to be part of this study.
CONTINUE .................................................................. 1
Go to A1a
WANTS ANOTHER LETTER ....................................... 2
Go to ReadLetter
NOT A GOOD TIME .................................................... 3
Go to Callback
WANTS MORE INFO .................................................. 4
Go to MoreInfo
HUNG UP DURING INTRODUCTION ......................... 5
Status 640, Exit
REFUSED ................................................................... r
Status 200, Exit
CATI: DO NOT ALLOW DK or REF OPTIONS FOR J1.
J1 = 3
The information we collect will be used to better understand what kinds of
services help youth make a successful transition to adulthood. Your answers to
these questions will be combined with the thousands of others who take part
across the country. Shall we begin?
.................................................................................... CODE ONE ONLY
BEGIN INTERVIEW ..................................................... 1
Go to A1a
WANTS ANOTHER LETTER ....................................... 2
Go to ReadLetter
NOT A GOOD TIME .................................................... 3
Go to Callback
HUNG UP DURING INTRODUCTION ......................... 4
Status 640, Exit
REFUSED ................................................................... r
Status 200, Exit
noletter = 2 or moreinfo = 2
May I read the letter to you and then we can begin?
.................................................................................... CODE ONE ONLY
YES, READ THE LETTER FROM HARD COPY ......... 1
Go to A1a
NO, WANTS ANOTHER LETTER FIRST .................... 2
Go to SendLetter
HUNG UP DURING INTRODUCTION ......................... 3
Status 640, Exit
REFUSED ................................................................... r
Status 200, Exit
4
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
ReadLetter = 2
. I can mail you a letter or send it via e-mail. Which would you prefer?
E-MAIL ........................................................................ 1
Go to SEND LETTER 1A
MAIL ANOTHER LETTER ........................................... 2
Go to SEND LETTER 1B
CATI DO NOT ALLOW DK / REF FOR THIS ITEM
SendLetter = 1
What email address should we send this letter to?
SPECIFY EMAIL: ................................................................... STRING (150) Status 832, Go
toThanks
REFUSED ............................................................................... r
Status 200, Exit
SendLetter = 2
Ok. I'll mail another letter and will call back in a few days
STREET ...................................................................... STRING (25)
CITY ............................................................................ STRING (25)
STATE ......................................................................... STRING (25)
|
|
|
|
|
|-|
|
|
|
|
ZIP CODE ................................................................... Status 831, Go toThanks
00501-99950
0001-9999
DON’T KNOW……………………………………………..d Status 831, Go toThanks
REFUSED………………………………………………….r Status 200, Exit
(Send letter1a=specify, d) or (Send letter1b=specify, d)
Thank you very much for your time.
CONTINUE .................................................................. 1
5
Exit / TERMINATE
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
I14 = 1-6, 99 OR D1A = 6,7,11,16 OR D2_INTRO3 = 6,7,11,16 OR D9 = 2
IF I14= 1-6, 99 FILL ”Your parent or guardian suggested that we use {TECHNOLOGY FROM I14} for
conducting this interview. Would you like to use that or is there something else you would prefer?”
IF I14 = 0,D,R FILL “What assistive technologies, if any, would you like to use for this interview?”
{Your parent or guardian suggested that we use {TECHNOLOGY FROM I14} for
conducting this interview. Would you like to use that or is there something
else you would prefer?} {What assistive technologies, if any, would you like to
use for this interview?}
NO ASSISTIVE TECHNOLOGY .................................. 0
GO TO J1B
VIDEO RELAY............................................................. 1
GO TO J1B
INSTANT MESSAGING (IM) eg- gchat, Skype, AIM ... 2
TTY/ TDD .................................................................... 4
GO TO J1B
VOICE AMPLIFICATION ............................................. 5
GO TO J1B
TACTILE SIGN ............................................................ 6
GO TO J1B
DON’T KNOW ............................................................. d
GO TO J1B
REFUSED ................................................................... r
GO TO J1B
J1a=2
J1a_conf.
INTERVIEWER: IS THE INTERVIEW CURRENTLY BEING COMPLETED OVER
INSTANT MESSENGER (IM)?
YES - CONTINUE........................................................ 1
GO TO J1a_conf1
NO ............................................................................... 0
GO TO J1a1
CATI: DO NOT ENABLE REFUSED OR DON’T KNOW FOR
J1a_conf.=1
J1a_conf1.
Can you please provide the security code we gave your parent or guardian so we
may confirm we are communicating with the correct person?
INTERVIEWER: CODE IS THE MPR ID FOR THE STUDENT CASE. IF UNABLE TO
PROVIDE IT, ASK PERSON ON THE IM TO CONTACT THE PARENT OR GUARDIAN
TO GET THE CODE. IF HE / SHE NO LONGER HAS IT, INSTRUCT THEM TO CALL
THE STUDY TOLL-FREE NUMBER OR SEND AN EMAIL TO THE STUDY EMAIL
ADDRESS.
NUMBER PROVIDED AND MATCHED ....................... 1
GO TO J1b
NOT PROVIDED OR MATCHED................................. 2
TERMINATE, SET CALLBACK.
NEEDS SECURITY SOFTWARE INSTRUCTIONS
RESENT ...................................................................... 3
REFUSED ................................................................... r
TERMINATE, STATUS AS REFUSAL
CATI: DO NOT ENABLE DON’T KNOW FOR
6
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
J1a_conf1=3
J1a_conf2.
Would you like me to resend these instructions so you can complete the survey
over instant messenger?
YES - CONTINUE........................................................ 1
GO TO J1a2
NO ............................................................................... 0
GO TO J1a_conf3
CATI: DO NOT ENABLE REFUSED OR DON’T KNOW FOR
J1a_conf2=0
What assistive technologies, if any, would you like to use for this
interview?
NO ASSISTIVE TECHNOLOGY .................................. 0
GO TO J1B
VIDEO RELAY............................................................. 1
GO TO J1B
TTY/ TDD .................................................................... 4
GO TO J1B
VOICE AMPLIFICATION ............................................. 5
GO TO J1B
TACTILE SIGN ............................................................ 6
GO TO J1B
REFUSED ................................................................... r
TERMINATE, STATUS AS REFUSAL
CATI: DO NOT ENABLE DON’T KNOW FOR
J1a_conf=0
{YOUTH} first name from
J1a1.
We’d be happy to complete the interview using an instant messenger. It is
important that your answers to the questions remain confidential and travel
over a secure connection. To do this, we’ll need you to download some
security software to your computer.
INTERVIEWER: IF RESPONDENT REFUSES THE SOFTWARE, ASK IF THERE
IS ANOTHER WAY THEY’D PREFER TO TAKE PART IN THE SURVEY AND
CONTINUE WITH THAT FORMAT, INSTEAD.
CONTINUE .................................................................. 1
DOES NOT WANT SOFTWARE – COMPLETING
ANOTHER WAY ......................................................... 2
GO TO J1b
REFUSED ................................................................... r
TERMINATE, STATUS AS REFUSAL
CATI: DO NOT ENABLE DON’T KNOW FOR J1a1
7
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
J1a_conf2=1 OR J1a1=1
J1a2.
To what e-mail address should we send the instructions to download this software?
(STRING (500)
EMAIL
REFUSED…………………………………r
TERMINATE, STATUS AS REFUSAL
CATI: DO NOT ENABLE DON’T KNOW FOR J1a2
CATI: THIS VARIABLE WILL TRANSMIT IN THE OVERNIGHT PROCESS AS PART OF THE EMAIL
REQUEST REPORT. WHEN THE EMAIL HAS BEEN SENT, CASE WILL BE UPDATED BY SOC
STAFF AND RELEASED FOR DIALING.
J1a2=SPECIFIED
FILL MPR ID WITH MPR ID ASSIGNED TO STUDENT CASE
J1a3.
I’d like to provide you with the security code you will need when we contact you for
this interview so we can confirm we are speaking with the right person. The code is:
[CATI: FILL MPR ID FOR STUDENT CASE]. We will send you these instructions soon.
What would be the best day and time to reach you, once you have had a chance to
download this software?
INTERVIEWER: ALLOW AT LEAST 3 DAYS FROM TODAY FOR APPOINTMENT TO ALLOW
TIME FOR EMAIL TO BE SENT AND SAMPLE MEMBER TO DOWNLOAD THE SOFTWARE.
CONTINUE BY SETTING APPOINTMENT ................. 1
TERMINATE, SET APPT.
REFUSED ................................................................... r
TERMINATE, STATUS AS 200
CATI: DO NOT ENABLE DON’T KNOW FOR J1a3
ALL
INTERVIEWER RECORD REPONSES WITHOUT READING ALOUD:
IS THIS INTERVIEW BEING CONDUCTED WITH THE YOUTH HIM/HERSELF OR
WITH HIS/HER PROXY?
CONDUCTED WITH STUDENT HIM/HERSELF ......... 1 GO TO J1e
CONDUCTED WITH PROXY FOR STUDENT ............ 2 GO TO J1c
CATI: DO NOT ALLOW DK or REF OPTIONS FOR J1b.
8
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
ALL PROXIES (J1b= 2)
{NAME} from SAMPLE FILE:
INTERVIEWER: WHAT IS THE RELATIONSHIP OF THE PROXY TO THE YOUTH?
IF NEEDED: How are you related to {NAME}?
PARENT ...................................................................... 1
GO TO J1e
SIBLING ...................................................................... 2
GO TO J1e
OTHER FAMILY MEMBER .......................................... 3
GO TO J1e
SOMEONE FROM YOUTH’S SCHOOL ...................... 4
GO TO J1e
SOMEONE FROM AN AGENCY/SERVICE
PROVIDER .................................................................. 5
GO TO J1e
OTHER (SPECIFY) ..................................................... 99
DON’T KNOW ............................................................. d
GO TO J1e
REFUSED ................................................................... r
GO TO J1e
IF OTHER SPECIFY (99): IF NEEDED: What is your relationship to {NAME}?
___________________________ (STRING (150))
SOFT CHECK: IF J1c ≠1-5, 99; How do you know {NAME}?
ALL
J1e.
This interview will be recorded to store your consent and for quality assurance
purposes. Would you please tell me your name for the record? Thank you.
STRING (20)
FIRST NAME
STRING (20)
LAST NAME
REFUSED ...............................................................................
GO TO J2
HUNG UP DURING INTERVIEW ............................................ 2
TERMINATE (STATUS 240)
CATI: DO NOT ALLOW DK or REF OPTION FOR J1e.
9
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
ALL
{NAME} from SAMPLE FILE:
“You are” if self response, “NAME is” if proxy
“you” if self response, “NAME” if proxy
“your” if self response, “NAME’s” if proxy
“your” if self response, “his” or “her” for proxy depending on gender of youth
“you get” if self response, “he gets” or “she gets” for proxy depending on gender of youth.
“your” if self response, “NAME’s” if proxy
“you, school, and your plans for the future” if self response, “him, his school, his plans for the future” or
“her, her school, her plans for the future” for proxy depending on gender of youth
Before we begin, I need to describe some important pieces of the study. Please ask me
any questions as we go along. To begin, this is a voluntary research study. The purpose
is to see what helps students move from school to adulthood. {You are/{NAME} is} one of
18,000 students being asked to take part in the study from across the United States.
{Your/{NAME}’s} parent (or legal guardian) answered questions about {your/his/her}
family, experiences, and supports {you get/ he/she gets} from school and other places.
IF PAYMENT FLAG = 1 OR 5 INSERT: Parents (or legal guardians) will be interviewed again in
2014 and will be paid $20 for each interview.
IF PAYMENT FLAG = 6 INSERT: Parents (or legal guardians) will be interviewed again in 2014
and will be paid $35 for each interview.
CATI IF PAYMENT FLAG = 2,3, OR 4: Parents (or legal guardians) will be interviewed again in
2014.
CATI INSERT IF PAYMENT FLAG = 1 OR 5 OR 6: You will get a $10 gift card for each interview you
complete.
CATI: IF J1B=1 (self interview) INSERT: We already completed an interview with your parent or
guardian who said you could take part in the study. But, you need to decide for yourself if you want
to take part. Your parent (or guardian) can help you answer questions or answer for you, if needed.
CATI: INSERT FOR ALL: If you agree, I will complete {your/{NAME}’s} interview over the telephone. It
takes about 30 minutes. The questions will be about {you, school, and your plans for the future/
him/her, his/her school, and his/her plans for the future}. An interviewer will talk to you again in 2014. If
you feel uncomfortable answering any questions, you can stop and nothing bad will happen to you. The
information you provide will be kept confidential. All reports will be in summary form only {your/{NAME}’s} name will never be used. There are no special risks if you take part in this study.
CATI: INSERT IF AGE < 18 AND J1B = 1: Your parent or legal guardian has agreed for you to be in
this study, but we are asking for your permission, as well.
CATI: INSERT FOR ALL: We’ll mail you a letter describing what we just discussed, so you have it for
your records. Do you agree to take part in this interview?
IF NEEDED: If you’d like to see the consent form in writing before we continue, we can email (or fax) it
to you.
AGREED – CONTINUE………………………1 GO TO J3
DISAGREE/DECLINES THIS PORTION…...2 GO TO END (STATUS 211)
PROVIDE CONSENT FORM BY FAX-EMAIL ............ 3
DECLINES STUDY PARTICIPATION………0
GO TO SENDCONS8
TERMINATE. STATUS 211 - ROUTE TO REFUSAL MODULE.
CATI: DO NOT ALLOW DK or REF OPTION FOR J2.
10
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
J2=3
I can send this form via e-mail or fax, which would you prefer?
E-MAIL ........................................................................ 1
Go to SendCONS8a
FAX ............................................................................. 2
Go to SendCONS8b
REFUSED ................................................................... r
Status 200, Exit
CATI DO NOT ALLOW DK FOR THIS ITEM
SendCONS8=1
What email address should we send a copy of the consent form to?
SPECIFY EMAIL: .................................................................... STRING (150) Status 832, Go toThanks
REFUSED ............................................................................... r
Status 200, Exit
CATI DO NOT ALLOW DK FOR THIS ITEM
SendCONS8=2
. What fax number should we send a copy of the consent form to?
| | | |-| | | |-| | | |
(RANGE)
(RANGE)
(RANGE)
| / Phone (STRING 30) Status 832, Go toThanks
REFUSED ................................................................... r
Status 200, Exit
CATI DO NOT ALLOW DK FOR THIS ITEM
K. STUDENT ENROLLMENT & EXPERIENCES AT SCHOOL
ALL
{NAME} from SAMPLE FILE:
“your” if self response / “his” or “her” if proxy depending on youth’s gender.
The next questions are about {your/his/her} experiences in school and life outside
of school. There are no right or wrong answers, we want to better understand
{your/his/her} experiences.
CONTINUE ................................................................. 1
11
GO TO BOX K_INTRO1
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
BOX KINTRO1
IF PARENT CONFIRMED NAME OF SCHOOL OR PROVIDED NAME
OF SCHOOL (A14=1 OR 14a=SPECIFY) THEN GO TO K1.
ELSE, CONTINUE TO K_INTRO1.
ALL YOUTH AND PROXIES WHERE A14=d, r AND IN SAMPLE IS “UNKNOWN” OR “.”
{SCHOOL NAME} school name from SAMPLE FILE: < SCHOOL NAME >
K_intro1. Our records from the school district show the name of [your / STUDENT]’s school in
the 2011-2012 school year was [SCHOOL NAME], is that correct?
YES ............................................................................ 1
GO TO K1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
GO TO K1
REFUSED ................................................................... r
GO TO K1
ALL YOUTH AND PROXIES WHERE (A14a= d, r) OR K_INTRO1= 0
AND IN SAMPLE FILE IS “UNKNOWN” OR “.”
K_intro1a.What was the name of [your / STUDENT]’s school (in 2011-2012)?
SPECIFY: _________ (STRING 200 CHAR)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
ALL YOUTH AND PROXIES WHERE (A15=d, r)
K_intro1b.
What city and state is that school located in?
(STRING (200)
CITY
(STRING (50)
STATE/TERRITORY
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
CATI: ALLOW DK ON EITHER PART OF THIS RESPONSE, ALLOWING INTERVIEWER TO CONTINUE TO
NEXT FIELD.
ALL
{NAME} from SAMPLE FILE:
“your” if self response. “his” or “her” if proxy depending on youth’s gender.
“Are you” if self response. “Is NAME” if proxy
“Do you” for self response. “Does NAME” for proxy
12
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Student Baseline Questionnaire: CATI Programming Specifications
“you” for self response. “him or “her” if proxy depending on youth’s gender
“Were you” if self response. “Was NAME” if proxy.
“you” for self response. “he or “she” if proxy depending on youth’s gender
K1.
In the 2011-2012 school year, {were you/ was {NAME}} attending or enrolled in middle
school, junior high, or high school? (YTD, A1, REV)
PROBE:
PROBE:
{Do you/Does {NAME}} go to school?
At school they teach {you/him/her} how to do things, like how to read,
write, or do math.
PROBE IF SUMMER: {Are you/Is NAME} off school for the summer? Will
{you/he/she} be going back to school in the fall?
INTERVIEWER: CODE “YES” IF ENROLLED IN SCHOOL BUT ON BREAK/VACATION.
YES ............................................................................. 1
GO TO K2intro
NO ............................................................................... 0
GO TO K1a
DON’T KNOW ............................................................. d
GO TO K2intro
REFUSED ................................................................... r
GO TO K2intro
IF K1=0
“you” if self response. “he or “she” if proxy depending on youth’s gender
K1a.
Why did {you/he/she} leave school?
CODE ALL THAT APPLY
ACADEMIC DIFFICULTY, POOR GRADES, NOT DOING WELL................... 1 GO TO K2INTRO
DISLIKE OF SCHOOL EXPERIENCE ............................................................. 2
GO TO K2INTRO
SCHOOL TOO DANGEROUS ......................................................................... 3
GO TO K2INTRO
FAILED REQUIRED TEST/FAILED GRADUATION EXAM ............................. 4
GO TO K2INTRO
GOT GED ........................................................................................................ 5
GO TO K2INTRO
GRADUATED .................................................................................................. 6
GO TO K2INTRO
LACK OF APPROPRIATE CURRICULUM ...................................................... 7
GO TO K2INTRO
POOR RELATIONSHIPS WITH TEACHERS AND SCHOOL STAFF ............. 8
GO TO K2INTRO
POOR RELATIONSHIPS WITH FELLOW STUDENTS .................................. 9
GO TO K2INTRO
LANGUAGE DIFFICULTY ............................................................................... 10 GO TO K2INTRO
ECONOMIC REASONS .................................................................................. 11 GO TO K2INTRO
LACK OF CHILDCARE .................................................................................... 12 GO TO K2INTRO
LACK OF TRANSPORTATION ....................................................................... 13 GO TO K2INTRO
PROBLEMS WITH BEHAVIOR ....................................................................... 14 GO TO K2INTRO
SUBSTANCE ABUSE...................................................................................... 15 GO TO K2INTRO
ILLNESS/DISABILITY...................................................................................... 16 GO TO K2INTRO
PREGNANCY .................................................................................................. 17 GO TO K2INTRO
ENTERED CRIMINAL JUSTICE SYSTEM/INCARCERATED ......................... 18 GO TO K2INTRO
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Student Baseline Questionnaire: CATI Programming Specifications
NEEDED AT HOME ........................................................................................ 19 GO TO K2INTRO
RELIGION ....................................................................................................... 20 GO TO K2INTRO
MOVED ........................................................................................................... 21 GO TO K2INTRO
PARENT/GUARDIAN INFLUENCE ................................................................. 22 GO TO K2INTRO
FRIENDS WERE DROPPING OUT................................................................. 23 GO TO K2INTRO
MARRIAGE ..................................................................................................... 24 GO TO K2INTRO
MILITARY, JOINED ARMED FORCES ........................................................... 25 GO TO K2INTRO
EMPLOYMENT, SEEK OR ACCEPT JOB ...................................................... 26 GO TO K2INTRO
OTHER (SPECIFY) ......................................................................................... 99 GO TO K1a.other
DON’T KNOW.................................................................................................. d
GO TO K2INTRO
REFUSED ....................................................................................................... r
GO TO K2INTRO
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Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
K1a= 99
“you” if self response. “NAME” if proxy (from SAMPLE FILE: )
K1a.other
What other reasons did {you/{NAME}} have for leaving school?
GO TO K2INTRO
(STRING (500))
DON’T KNOW ............................................................. d
GO TO K2intro
REFUSED ................................................................... r
GO TO K2intro
ALL
“your” if self response. “NAME’s” if proxy (from SAMPLE FILE: )
K2intro.
Next I will read a list of statements about how some students feel about their classes.
For each, please tell me whether you agree or disagree with the statements about
{your/{NAME}’s} classes, overall, in school year 2011-2012.
K2a.
The first statement is, “Class work was hard to learn.” Do you agree a lot, agree a
little, disagree a little or disagree a lot with this statement?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r
ALL
“I” if self response. “NAME” if proxy (from SAMPLE FILE: )
K2b.
The next statement is, “{I/{NAME}} had trouble keeping up with the homework.” Do
you agree a lot, agree a little, disagree a little or disagree a lot with this statement?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r
15
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Student Baseline Questionnaire: CATI Programming Specifications
ALL
“I need” if self response. “NAME needs” if proxy (from SAMPLE FILE: )
K2c.
“{I need/{NAME} needs} more help from my teachers than I get.” Do you agree a lot,
agree a little, disagree a little or disagree a lot with this statement?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r
ALL
“me to do my” if self response. “NAME to do his” or “NAME to do her” if proxy (from SAMPLE FILE:
) depending on youth’s gender.
K2d.
“Teachers encouraged {me to do my/{NAME} to do his/her} best.” Do you agree a lot,
agree a little, disagree a little or disagree a lot with this statement?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r
ALL
“your” if self response. “NAME’s” if proxy (from SAMPLE FILE: )
“I feel” if self response. “NAME feels” if proxy (from SAMPLE FILE: )
K3intro.
How strongly do you agree or disagree with the following statements about
{your/{NAME}’s} school?
K3a.
“{I feel/{NAME}feels} close to people at this school.” Do you agree a lot, agree a little,
disagree a little or disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r
16
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Student Baseline Questionnaire: CATI Programming Specifications
ALL
“I am” if self response. “NAME is” if proxy (from SAMPLE FILE: )
K3b.
“{I am/{NAME} is} happy to be at this school.” Do you agree a lot, agree a little,
disagree a little or disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r
ALL
“I feel” for self response. “NAME feels” for proxy (from SAMPLE FILE: )
“I am” for self response. “He is” or “she is” if proxy depending on youth’s gender.
K3c.
“{I feel/{NAME} feels} like {I am/he/she is} part of this school.” READ IF NECESSARY:
Do you agree a lot, agree a little, disagree a little or disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r
ALL
K3d.
“The teachers at this school treat students fairly.” READ IF NECESSARY: Do you
agree a lot, agree a little, disagree a little or disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r
17
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
ALL
“I feel” for self response. “NAME feels” for proxy (from SAMPLE FILE: )
K3e.
“{I feel/{NAME} feels} safe in {my/his/her} school.” READ IF NECESSARY: Do you
agree a lot, agree a little, disagree a little or disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r
ALL
“your” if self response. “NAME’s” if proxy (from SAMPLE FILE: )
“my” if self response. “his” or “her” if proxy depending on youth’s gender.
“me” if self response. “him” or “her” if proxy depending on youth’s gender.
K4intro
How strongly do you agree or disagree with the following statements about
{your/{NAME}’s} school?
K4a.
“At {my/his/her} school, there is a teacher or some other adult who really cares about
{me/him/her}.” Do you agree a lot, agree a little, disagree a little or disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r
18
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
ALL
“my” if self response. “NAME’s” if proxy (from SAMPLE FILE: )
“me” if self response. “him” or “her” if proxy depending on youth’s gender.
“I do” if self response. “He does” or “She does” if proxy depending on youth’s gender.
K4b.
“At {my/{NAME}’s} school, there is a teacher or some other adult who tells {me/him
her} when {I do/he/she does} a good job.” Do you agree a lot, agree a little, disagree a
little or disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r
ALL
“my” if self response. “his” or “her” if proxy depending on youth’s gender.
“I’m not” if self response. “he isn’t” or “she isn’t” if proxy depending on youth’s gender.
K4c.
“At {my/his/her} school, there is a teacher or some other adult who notices when {I’m
not/he/she isn’t} there.” Do you agree a lot, agree a little, disagree a little or disagree a
lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r
19
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
ALL
“my” if self response. “his” or “her” if proxy depending on youth’s gender.
“me” if self response. “NAME” if proxy (from SAMPLE FILE: )
“my” if self response. “his” or “her” if proxy depending on youth’s gender.
K4d.
“At {my/his/her} school, there is a teacher or some other adult who always wants
{me/{NAME}} to do {my/his/her} best.” Do you agree a lot, agree a little, disagree a
little or disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r
ALL
“my” if self response. “his” or “her” if proxy depending on youth’s gender.
“me” if self response. “NAME” if proxy (from SAMPLE FILE: )
“I have” if self response. “he has” or “she has” if proxy depending on youth’s gender.
K4e.
“At {my/his/her} school, there is a teacher or some other adult who listens to
{me/{NAME}} when {I have/he/she has} something to say.” Do you agree a lot, agree a
little, disagree a little or disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r
20
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
ALL
“my” if self response. “his” or “her” if proxy depending on youth’s gender.
“I” if self response. “he” or “she” if proxy depending on youth’s gender.
K4f.
“At {my/his/her} school, there is a teacher or some other adult who believes that
{I/he/she} will be a success.” Do you agree a lot, agree a little, disagree a little or
disagree a lot?
AGREE A LOT………………………………..1
AGREE A LITTLE…………………………….2
DISAGREE A LITTLE………………………..3
DISAGREE A LOT………………………...…4
DON’T KNOW………………………………..d
REFUSED …………………………………….r
Box K5
IF J1b =1 and K1=1,D,R, GO TO K5INTRO. IF J1b =2 and K1=1,D,R, GO TO K6a.
If K1 ≠ 1,d,r, GO TO BOX L1.
J1b = 1 and k1 = 1, d, r
K5.intro
Did any of the following things happen during school year 2011-2012?
K5a.
Were you teased or called names at school?
PROBE: Has this happened to you during the school year (2011-2012)?
YES…………………………………………..1
NO……………………………………………0
DON’T KNOW………………………………d
REFUSED…………………………………..r
J1b = 1 and k1 = 1, d, r
K5b.
Did students make up something about you to make other students not like you
anymore?
PROBE: Did this happen to you during school year 2011-2012?
YES…………………………………………..1
NO……………………………………………0
DON’T KNOW………………………………d
REFUSED…………………………………..r
21
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Student Baseline Questionnaire: CATI Programming Specifications
J1b = 1 and k1 = 1, d, r
K5c.
Did other students say they would not be your friend unless you did what they told
you to do?
PROBE: Has this happened to you in school year 2011-2012?
YES…………………………………………..1
NO……………………………………………0
DON’T KNOW………………………………d
REFUSED…………………………………..r
J1b = 1 and k1 = 1, d, r
K5d.
Were you teased or threatened through use of email, text messaging, or other
electronic methods? This is sometimes called cyber bullying.
PROBE: Did this happen to you in school year 2011-2012?
YES…………………………………………..1
NO……………………………………………0
DON’T KNOW………………………………d
REFUSED…………………………………..r
J1b = 1 and k1 = 1, d, r
K5e.
Did you have things stolen from your locker, desk, or other places at school?
PROBE: Did this happen to you in school year 2011-2012?
YES…………………………………………..1
NO……………………………………………0
DON’T KNOW………………………………d
REFUSED…………………………………..r
J1b = 1 and k1 = 1, d, r
K5f.
Were you physically attacked or in fights at school or on the way to or from school?
PROBE: Did this happen to you in school year 2011-2012?
YES…………………………………………..1
NO……………………………………………0
DON’T KNOW………………………………d
REFUSED…………………………………..r
22
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Student Baseline Questionnaire: CATI Programming Specifications
J1b = 1 and k1 = 1, d, r
K5g.
Did you bullied or picked on other students?
PROBE: Did this happen in school year 2011-2012?
YES…………………………………………..1
NO……………………………………………0
DON’T KNOW………………………………d
REFUSED…………………………………..r
ALL
“did you” for self response. “did NAME” for proxy (from SAMPLE FILE: )
K6a.
In school year 2011-2012, how often {did you/did {NAME}} go to a class late? Would you
say never, a few times, once a week, almost every day, or every day?
NEVER……………………………………1
A FEW TIMES……………………………2
ONCE A WEEK…………………………..3
ALMOST EVERY DAY…………………..4
EVERY DAY………………………………5
DON’T KNOW…………………………….d
REFUSED…………………………………r
ALL
“have you” for self response. “has NAME” for proxy (from SAMPLE FILE: )
K6b.
In school year 2011-2012, how often {did you/did {NAME}} cut or skip class? Would you
say never, a few times, once a week, almost every day, or every day?
NEVER……………………………………1
A FEW TIMES……………………………2
ONCE A WEEK…………………………..3
ALMOST EVERY DAY…………………..4
EVERY DAY………………………………5
DON’T KNOW…………………………….d
REFUSED…………………………………r
23
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Student Baseline Questionnaire: CATI Programming Specifications
ALL
“were you” for self response. “was NAME” for proxy (from SAMPLE FILE: )
K6c.
In school year 2011-2012, how often {were you/was {NAME}} late for school?
READ IF NECESSARY: Would you say never, a few times, once a week, almost every day,
or every day?
NEVER……………………………………1
A FEW TIMES……………………………2
ONCE A WEEK…………………………..3
ALMOST EVERY DAY…………………..4
EVERY DAY………………………………5
DON’T KNOW…………………………….d
REFUSED…………………………………r
ALL
“did you” for self response. “ did NAME” for proxy (from SAMPLE FILE: )
K6d.
In school year 2011-2012, how often {did you/ did {NAME}} get in trouble for acting out in
class?
READ IF NECESSARY: Would you say never, a few times, once a week, almost every day,
or every day?
NEVER……………………………………1
A FEW TIMES……………………………2
ONCE A WEEK…………………………..3
ALMOST EVERY DAY…………………..4
EVERY DAY………………………………5
DON’T KNOW…………………………….d
REFUSED…………………………………r
24
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
D5 = 1 OR D2 ANY PART = 1 OR D2_INTRO1 = 1
“were you” for self response. “was NAME” for proxy (from SAMPLE FILE: )
“you were” for self response. “NAME was” for proxy (from SAMPLE FILE: )
K6e.
In school year 2011-2012, how often {were you/was {NAME}} held or restrained by a
teacher or classroom aide because {you were/NAME was} misbehaving in class?
READ IF NECESSARY: Would you say never, a few times, once a week, almost every day,
or every day?
NEVER……………………………………1
A FEW TIMES……………………………2
ONCE A WEEK…………………………..3
ALMOST EVERY DAY…………………..4
EVERY DAY………………………………5
DON’T KNOW…………………………….d
REFUSED…………………………………r
K1= 1, d or r and J1b= 1
K7.
In school year 2011-2012, how often did a health or emotional problem cause you to
miss a day of school? Would you say…
CODE ONE ONLY
Never, ......................................................................... 1
1-2 times, .................................................................... 2
3-5 times, .................................................................... 3
6-10 times, or ............................................................. 4
More than 10 times? .................................................. 5
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
25
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
K1 = 1
“did you” if self response. “did NAME” if proxy (from SAMPLE FILE: )
K8.
About how many hours per week {did you/did {NAME}} usually spend completing
homework (in school year 2011-2012)? (NEW)
IF NEEDED: ANY LOCATION, HOME OR STUDY HALL. FOR FRACTIONS OF AN
HOUR, ROUND UP IF 30 MINUTES OR MORE. ROUND DOWN IF FEWER THAN 30
MINUTES.
| | |
(0-168)
| HOURS
DOES NOT HAVE HOMEWORK ASSIGNED ............. 998
CHOOSES NOT TO DO HOMEWORK ASSIGNED .... 996
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
SOFT CHECK: IF HOURS GT 20 or LT 2: I recorded that you usually spend {HOURS} hours a week doing
homework. Is this correct?
HARD CHECK: IF HOURS GT 168 That is more hours than there are in a week. How many hours {do you/
does he/she} usually spend doing homework in a week?
J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 14))
K9a1.
My next questions are about school activities and services. For each, please tell me
whether you have received the following kinds of instruction or help from school staff
in the school year 2011-2012. Have school staff provided you with extra help before or
after school in academic subjects?
YES………………………….…..1
GO TO K9a2
NO……………………………….2
GO TO K9b1
DON’T KNOW………………….d
GO TO K9b1
REFUSED……………………….r
GO TO K9b1
K9A1 = 1
K9a2.
How useful was extra help before or after school in academic subjects either in
helping you stay in school or prepare for life after school? Was it very useful,
somewhat useful, or not useful to you?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r
26
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 14))
K9b1.
In school year 2011-2012, did school staff provide you with academic instruction on
weekends?
PROBE: Did you receive this kind of instruction or help from school staff last year?
YES………………………….…..1
GO TO K9b2
NO……………………………….0
GO TO K9c1
DON’T KNOW………………….d
GO TO K9c1
REFUSED……………………….r
GO TO K9c1
K9B1 = 1
K9b2.
How useful was academic instruction on weekends?
PROBE: How useful was this kind of instruction or help from school staff last year?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r
J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 14))
K9c1.
In school year 2011-2012, did school staff provide you with help completing college
applications?
PROBE: Did you receive this kind of instruction or help from school staff?
YES………………………….…..1
GO TO K9c2
NO……………………………….0
GO TO K9d1
DON’T KNOW………………….d
GO TO K9d1
REFUSED……………………….r
GO TO K9d1
K9C1 = 1
K9c2.
How useful was help completing college applications?
PROBE: How useful was this kind of instruction or help from school staff?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r
27
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 14))
K9d1. In school year 2011-2012, did school staff provide you with guidance about which
courses to take?
PROBE: Did you receive this kind of instruction or help from school staff?
YES………………………….…..1
GO TO K9d2
NO……………………………….0
GO TO K9e1
DON’T KNOW………………….d
GO TO K9e1
REFUSED……………………….r
GO TO K9e1
K9D1 = 1
K9d2.
How useful was the guidance about which courses to take?
PROBE: How useful was this kind of instruction or help from school staff?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r
J1B = 1 AND B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 15)
K9e1.
In school year 2011-2012, did school staff provide you with help reviewing college
entrance test results or suggested re-testing, if necessary?
PROBE: Did you receive this kind of instruction or help from school staff?
YES………………………….…..1
GO TO K9e2
NO……………………………….0
GO TO K9f1
DON’T KNOW………………….d
GO TO K9f1
REFUSED……………………….r
GO TO K9f1
K9E1 = 1
K9e2.
How useful was help reviewing college entrance test results and suggesting retesting if necessary?
PROBE: How useful was this kind of instruction or help from school staff?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r
J1B = 1 AND B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 15)
28
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
K9f1.
In school year 2011-2012, did school staff provide you with help arranging or taking
you on visits to colleges or college fairs?
PROBE: Did you receive this kind of instruction or help from school staff?
YES………………………….…..1
GO TO K9f2
NO……………………………….0
GO TO K9g1
DON’T KNOW………………….d
GO TO K9g1
REFUSED……………………….r
GO TO K9g1
K9F1 = 1
K9f2.
How useful was the help arranging or taking you on visits to colleges or college fairs?
PROBE: How useful was this kind of instruction or help from school staff?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r
J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 14))
K9g1.
In school year 2011-2012, did school staff provide you with help identifying possible
career options?
PROBE: Did you receive this kind of instruction or help from school staff?
YES………………………….…..1
GO TO K9g2
NO……………………………….0
GO TO K9h1
DON’T KNOW………………….d
GO TO K9h1
REFUSED……………………….r
GO TO K9h1
K9G1 = 1
K9g2.
How useful was this help identifying possible career options?
PROBE: How useful was this kind of instruction or help from school?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r
J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 14))
29
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
K9h1.
In school year 2011-2012, did school staff provide you with help learning to manage
money?
PROBE: Did you receive this kind of instruction or help from school staff?
YES………………………….…..1
GO TO K9h2
NO……………………………….0
GO TO K9i1
DON’T KNOW………………….d
GO TO K9i1
REFUSED……………………….r
GO TO K9i1
K9H1 = 1
K9h2.
How useful was help learning to manage money?
PROBE: How useful was this kind of instruction or help from school staff?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r
J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 14))
K9i1.
In school year 2011-2012, did school staff provide you with reproductive health or
pregnancy prevention education or services?
PROBE: Did you receive this kind of instruction or help from school staff?
YES………………………….…..1
GO TO K9i2
NO……………………………….0
GO TO K9j1
DON’T KNOW………………….d
GO TO K9j1
REFUSED……………………….r
GO TO K9j1
K9I1 = 1
K9i2.
How useful were the reproductive health or pregnancy prevention education or
services?
PROBE: How useful was this kind of instruction or help from school staff?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r
J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A
>= 14))
30
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Student Baseline Questionnaire: CATI Programming Specifications
K9j1.
In school year 2011-2012, did school staff provide you with teen parenting
instruction?
PROBE: Did you receive this kind of instruction or help from school staff?
YES………………………….…..1
GO TO K9j2
NO……………………………….0
GO TO K9k1
DON’T KNOW………………….d
GO TO K9k1
REFUSED……………………….r
GO TO K9k1
K9J1 = 1
K9j2.
How useful was the teen parenting instruction?
PROBE: How useful was this kind of instruction or help from school staff?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r
J1B = 1 AND G6 = 1
K9k1.
In school year 2011-2012, did school staff provide you with child care for your child?
PROBE: Did you receive this kind of help from school staff?
YES………………………….…..1
GO TO K9k2
NO……………………………….0
GO TO K9l1
DON’T KNOW………………….d
GO TO K9l1
REFUSED……………………….r
GO TO K9l1
K9K1 = 1
K9k2.
How useful was the child care?
PROBE: How useful was this kind of help from school staff?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r
J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 14))
31
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
K9l1.
In school year 2011-2012, did school staff provide you with substance abuse
counseling or education?
PROBE: This includes both drugs and alcohol.
PROBE: Did you receive this kind of instruction or help from school staff?
YES………………………….…..1
GO TO K9l2
NO……………………………….0
GO TO K9m1
DON’T KNOW………………….d
GO TO K9m1
REFUSED……………………….r
GO TO K9m1
K9L1 = 1
K9l2.
How useful was substance abuse counseling or education?
PROBE: How useful was this kind of instruction or help from school staff?
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r
J1B = 1 AND (B2 OR B4A = 9-13 OR (B2 OR B4 = 0,14, 99 AND YOUTH AGE FROM A12 OR A12A >= 14))
K9m1.
In school year 2011-2012, did school staff provide you with instruction on appropriate
use of social networking sites?
PROBE: Have you received this kind of instruction or help from school staff?
PROBE: Social networking sites are ones like Facebook, Yahoo groups, and MySpace.
YES………………………….…..1
GO TO K9m2
NO……………………………….0
GO TO K10
DON’T KNOW………………….d
GO TO K10
REFUSED……………………….r
GO TO K10
32
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
K9M1 = 1
K9m2.
How useful was instruction on appropriate use of social networking sites?
PROBE: How useful was this kind of instruction or help from school?
PROBE: Social networking sites are ones like Facebook, Yahoo groups, and MySpace.
VERY USEFUL………………………….1
SOMEWHAT USEFUL……………..…..2
NOT USEFUL……………………………3
DON’T KNOW……………………………d
REFUSED………………………………...r
K1 = 1
“you” if self response. “NAME” if proxy (from SAMPLE FILE: )
“you plan” for self response. “he plans” or “she plans” for proxy depending on gender of youth
K10.
In school year 2011-2012, did anyone provided guidance on the classes {you/{NAME}}
should take to prepare for what {you plan/he/she plans} to do after high school.
YES ............................................................................. 1
GO TO K10a
NO ............................................................................... 0
GO TO K11
DON’T KNOW ............................................................. d
GO TO K11
REFUSED ................................................................... r
GO TO K11
K10= 1
K10a.
Is there a written plan summarizing this list of high school classes?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
33
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
YOUTH AGE FROM A12 OR A12A IS >16 YRS OLD
“Have you” if self response. “Has NAME” if proxy (from SAMPLE FILE: )
K11.
{Have you / Has {NAME}} taken any of the following college placement tests… (HSLS
student, rev)
CATI: PLEASE ACTIVATE THE F1 FEATURE TO ENABLE INFORMATION BAR, AS NEEDED.
CODE ONE PER ROW
YES
NO
DK
REF
a. The PSAT? ..........................................................................................
1
0
d
r
b. The ACT? ............................................................................................
1
0
d
r
c. The SAT?.............................................................................................
1
0
d
r
d. The placement test for a local college, such as Accuplacer or
other tests used for community colleges? ......................................
1
0
d
r
INTERVIEWER CHECK POINT:
DOES THE RESPONDENT SEEM FATIGUED, CONFUSED, OR NEED REINFORCEMENT?
FATIGUE PROBE:
1. Are you feeling tired or can we continue?
2. Would you like to take a break? I can hold on.
3. Would you like to continue the interview another time?
REINFORCEMENT PROBE:
1. Your answers are very helpful for this study.
2. You are doing very well.
INTERVIEWER ACTION:
NOT FATIGUED, NO REINFORCEMENT NEEDED................ 01 (BOX L1)
FATIGUED AND WANTS TO BE CALLED BACK..................... 02 (appt tab)
FATIGUED, BUT CAN CONTINUE............................................ 03 (BOX L1)
GAVE REINFORCEMENT, CAN CONTINUE........................... 04 (BOX L1)
GAVE REINFORCEMENT, WANTS TO BE CALLED BACK.... 05 (appt tab)
L. STUDENT’S IEP EXPERIENCE
BOX L1
( D5 = 1) OR (IEP IN SAMPLE = Y) OR D2_INTRO1 = 1 -> GO TO L1.
ELSE, GO TO M1
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Student Baseline Questionnaire: CATI Programming Specifications
( D5 = 1) OR (IEP IN SAMPLE = Y) OR D2_INTRO1 = 1
“you” for self response. “he” or “she” if proxy depending on gender of youth
L1.
During this last school year, did {you/he/she} go to a meeting at school about an
Individualized Education Program, or IEP, for special education programs or
services?
IF NEEDED: That would be during the 2010-2011 or 2011-2012 school years.
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
YOUTH AGE IN A12 OR A12A >16 AND
(IEP IN SAMPLE = Y) OR D5 = 1 OR D2 ANY PART a-u= 1 OR D2_INTRO1 = 1)
“you” for self response. “NAME of youth” for proxy (from sample file )
“you” for self response. “he” or “she” if proxy depending on gender of youth
L2.
Did {you/NAME of youth} meet with adults at school to set goals for what
{you/he/she} will do after high school and make a plan for how to achieve them?
Sometimes this is called a transition plan.
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
35
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
J1B= 1 AND (L1= 1 OR L2 = 1)
“your” if self response. “NAME’s” if proxy (from sample file )
“IEP and transition planning” if L1=1 and L2 = 1. “IEP Planning” if L1=1 and L2 ≠ 1. “transition planning” if L1 ≠1
a d L2 = 1.
L2a.
Which of the following best describes {your/{NAME}’s} role in your {IEP and transition
planning /IEP planning}?
CODE ONE ONLY
You did not participate ................................................. 1
You were present in discussions but participated very
little or not at all ........................................................... 2
You provided some input, or ........................................ 3
You took a leadership role, helping set the direction of
the discussions, goals and plans ................................. 4
DOESN’T KNOW ABOUT ANY GOALS ...................... 5
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
BOX L3
IF K1 = 1, GO TO M1. IF K1≠1, GO TO L3
(D5 = 1 OR D2 ANY PART = 1 OR D2_INTRO1 = 1) AND K1≠1
“you” if self response. “NAME” if proxy (from sample file )
“your” if self response. “his” or her” if proxy depending on gender of youth
“you” if self response. “him” or “her” if proxy depending on gender of youth
L3.
Before {you/{NAME}} left school, did someone from {your/his/her} school meet with
{you/him/her} to make a short summary of {your/his/her} goals, skills, and any needs
for support? This list would be created to help {you/{NAME}} pursue {your/his/her}
goals after leaving school. (NEW)
YES ............................................................................. 1
GO TO L3a
NO ............................................................................... 0
GO TO M1
DON’T KNOW ............................................................. d
GO TO M1
REFUSED ................................................................... r
GO TO M1
36
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
L3=1
“you” if self response. “he” or “she” if proxy depending on the gender of the youth
“you have” if self response. “he has” or “she has” if proxy depending on the gender of the youth
L3a.
How often would {you/he/she} say {you have/he/she has} used this summary? Would
you say {you have/he/she has} not used it, {you have/he/she has} used it a little, or
{you have/he/she has} used it a lot? (NEW)
NOT USED IT AT ALL ................................................. 1
GO TO M1
USED IT A LITTLE ...................................................... 2
GO TO L3b
USED IT A LOT ........................................................... 3
GO TO L3b
DON’T KNOW ............................................................. d
GO TO M1
REFUSED ................................................................... r
GO TO M1
L3a= 2 OR 3
“you” if self response. “student’s NAME” if proxy (from sample file )
L3b.
How did {you/{NAME}} use this summary since leaving school?
CODE ALL THAT APPLY
APPLY FOR JOB/TALK TO EMPLOYERS .................. 1
GO TO M2
APPLY FOR EDUCATION OR TRAINING PROGRAMS
2
WORKING WITH VOC REHAB OR OTHER
EMPLOYMENT COUNSELOR .................................... 3
GO TO M2
GETTING SUPPORT SERVICES ................................ 4
GO TO M2
GO TO M2
OTHER (SPECIFY) ..................................................... 99 GO TO L3b.other
(STRING (500))
DON’T KNOW ............................................................. d
GO TO M2
REFUSED ................................................................... r
GO TO M2
IF OTHER SPECIFY (99): What other way did you use the summary since leaving school?
37
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
K1 = 1
“DATE” FILL CURRENT MONTH AND PRIOR YEAR
“have you” for self response. “has he” or “has she” for proxy depending on gender of youth
M1.
During past 12 months, that is from {date} until now, {have you/ has he/she}
participated in any of the following school activities outside of class?
CODE ALL THAT APPLY
School sports team ................................................... 1
Music, dance, art, or theater ..................................... 2
Student government .................................................. 3
Academic subject matter club (math, science,
computer) ................................................................... 4
Volunteer or community service group ................... 5
Vocational or career-focused student
organization, or .......................................................... 6
Other school-sponsored clubs or activities ............ 7
NONE OF THESE ....................................................... 8
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
ALL
“have you” if self response. “has he” or “has she” for proxy depending on gender of youth
M2.
During the past 12 months, {have you/ has he/she} taken part in any of the following
non-school activities?
CODE ALL THAT APPLY
Organized sports supervised by an adult ................ 1
Music, dance, art, or theater lessons ....................... 2
A religious youth group or religious instruction ..... 3
Math, science, or computer camps or lessons ........ 4
Volunteer or community service group ................... 5
Scouting or another group or club activity .............. 6
Another camp or type of non-school activity .......... 7
NONE OF THESE ....................................................... 8
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
38
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
ALL
“you” if self response. “he” or “she” if proxy depending on gender of youth
M3.
During the past 12 months, about how many days a week did {you/he/she} usually get
together with friends outside of school and outside of organized activities or groups?
CODE ONE ONLY
Never, ......................................................................... 1
Sometimes, but not every week, ............................... 2
1 day a week,.............................................................. 3
2 or 3 days a week, .................................................... 4
4 or 5 days a week, or ................................................ 5
6 or 7 days a week? ................................................... 6
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
J1b= 1
For “fill item” loop through and fill in the text from the rows below.
M4.
How often do you use each of the following to communicate with friends? How about
[FILL ITEM]? Do you use that several times a day, once a day, several times a week,
once a week or less, or never?
CODE ONE PER ROW
Several
times a
day
Once a
day
Several
times a
week
Once a
week, or
less
Never?
DK
REF
a. Texting...............................................
1
2
3
4
5
d
r
b. Instant messaging ............................
1
2
3
4
5
d
r
c. Email ..................................................
1
2
3
4
5
d
r
d. Talking on a telephone (either cellular,
landline, Skype, or video phone) ....
1
2
3
4
5
d
r
e. Facebook, Twitter (sending or
receiving tweets) and other social
media .................................................
1
2
3
4
5
d
r
39
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
J1b= 1
For “fill item” loop through and fill in the text from the rows below.
M5.
How often do you use a computer for {FILL ITEM}. Would you say, several times a
day, once a day, several times a week, once a week or less, or never?
CODE ONE PER ROW
Several
times a
day a
day
Once a
day
Several
times a
week
Once a
week, or
less
Never?
DK
REF
a. Homework and school assignments?
...........................................................
1
2
3
4
5
d
r
b. Playing games? ................................
1
2
3
4
5
d
r
c. Using the internet - to read a book,
news-related website, or search for
information? .....................................
1
2
3
4
5
d
r
ALL
“your” if self response. “his” or “her” if proxy depending on gender of youth
N1_INTRO. Now I would like to ask a few questions about {your/his/her} work experience.
ALL
“have you” if self response. “has NAME” if proxy (from sample file )
N1.
In the past 12 months, {have you/has {NAME}} taken part in any school-sponsored
work activities, like a work-study or co-op job, an internship, or a school-based
business?
PROBE:
This may include working in the school store, bank, or café.
YES ............................................................................. 1
GO TO N1a
NO ............................................................................... 0
GO TO BOX N5
DON’T KNOW ............................................................. d
GO TO BOX N5
REFUSED ................................................................... r
GO TO BOX N5
N1=1
“you” if self response. “he” or “she” if proxy depending on gender of youth
N1a.
Did {you/he/she} get school credit for that work activity?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
40
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N1=1
“you” if self response. “he” or “she” if proxy depending on gender of youth
N1b.
Did {you/he/she} get paid for that work activity?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N1=1
“have you” if self response. “has he” of “has she” if proxy depending on gender of youth
N2.
About how many hours a week {have you/has he/she} usually worked in this schoolsponsored job? (NLTS2, T2c, REV)
IF MORE THAN ONE JOB, COMBINE ALL JOBS.
IF WORKED LESS THAN 1 HOUR PER WEEK, CODE AS 1 HOUR.
|
|
| NUMBER (1-80)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
SOFT CHECK: IF HOURS GT 30: Let me verify I have recorded this correctly. Did you say {NUMBER}
hours per week?
HARD CHECK: IF HOURS GT 80. I must have recorded something incorrectly. Help me correct this
response.
N1=1
“have you” if self response. “has he” or “has she” if proxy depending on gender of youth.
N3.
About how long {have you/ has he/she} worked in this school sponsored job?
IF UNSURE, PROBE FOR SEASONS, HOLIDAYS, ETC.
|
|
| NUMBER (1-52)
WEEKS ....................................................................... 1
MONTHS ..................................................................... 2
YEARS ........................................................................ 3
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
41
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
SOFT CHECK: IF NUMBER IS GT20 AND NOT=1 (WEEKS). Please verify that I have recorded
this correctly. I recorded {NUMBER UNIT}
N1=1
“you” if self response. “NAME” if proxy (from sample file )
N4.
Is that work activity related to a particular job or
career {you/{NAME}} are interested in?
YES ............................................................................. 1
NO - THE WORK IS NOT IN A CAREER/JOB I’M
INTERESTED IN. ........................................................ 0
I DON’T HAVE A PARTICULAR JOB/CAREER
INTEREST ................................................................... 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
BOX N5
IF B1 OR B4 = 1, GO TO N5. ELSE IF B9 <= 1 YEAR AGO, GO TO N29.
ELSE GO TO N55.
B1 OR B4 = 1
“you” if self response. “NAME” if proxy (from sample file )
IF N1=1 FILL “or a school sponsored job”
N5.
My next questions are about paid work other than school-sponsored jobs. At any time in
the past 12 months, did {you/NAME} do any work for pay, other than work around the
house {IF N1 = 1: or a school-sponsored job}? That could include being a babysitter or
working for a neighbor.
YES ............................................................................. 1
GO TO N6
NO ............................................................................... 0
GO TO N55
DON’T KNOW ............................................................. d
GO TO N55
REFUSED ................................................................... r
GO TO N55
42
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N5 = 1
“you” if self response. “he” or she” if proxy depending on gender of youth
N6.
Did {you/he/she} do this work only during the summer, the school year, or both?
IF ASKED, THE SCHOOL YEAR IS FROM SEPTEMBER TO MAY AND SUMMER IS FROM
JUNE TO AUGUST.
CODE ONE ONLY
ONLY DURING THE SUMMER ................................... 1
GO TO N6a
ONLY DURING THE SCHOOL YEAR ......................... 2
GO TO N6b
BOTH .......................................................................... 3
GO TO N6a
DON’T KNOW ............................................................. d
GO TO N7
REFUSED ................................................................... r
GO TO N7
N6 = 1,3
“have you” if self response. “has he” or “has she” if proxy depending on gender of youth
N6A.
About how many hours a week {have you/has he/she} usually worked during the
summer?
IF MORE THAN ONE JOB, COMBINE ALL JOBS. IF YOUTH IS WORKING THIS SUMMER
AND LAST SUMMER, CODE THIS SUMMER. IF WORKED LESS THAN 1 HOUR PER
WEEK, CODE AS 1 HOUR.
|
| | NUMBER
(0-80)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
IF N6 = 1, GO TO N7. IF N6 = 3, GO TO N6b.
SOFT CHECK: IF HOURS IS LT 10 OR GT 40 I recorded that you usually worked {HOURS} a week.
Is that correct?
43
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N6=2, 3
“have you” if self response. “has he” or “has she” for proxy depending on gender of youth.
N6b.
How many hours a week {have you/has he/she} usually worked during the school
year?
IF MORE THAN ONE JOB, COMBINE ALL JOBS. IF NO LONGER IN SCHOOL AND
ASKED, WE MEAN DURING SEPTEMBER TO MAY. IF WORKED DIFFERENT HOURS IN
2 SCHOOL YEARS, CODE MOST RECENT SCHOOL YEAR. IF WORKED LESS THAN 1
HOUR PER WEEK, CODE AS 1 HOUR.
| | | HOURS
(0-60)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
SOFT CHECK: IF HOURS IS LT 5 OR GT 30 I recorded that you worked {HOURS} a week. Is that
correct?
N5 = 1
“Do you” if self response. “Does NAME” if proxy (from sample file )
IF N1 = 1:FILL” or a school sponsored job”
N7.
{Do you/Does {NAME}} have a paid job now, other than work around the house {IF N1
= 1: or a school sponsored job}? That could include being a babysitter or working for
a neighbor.
YES ............................................................................. 1
GO TO N8
NO ............................................................................... 0
GO TO N19
DON’T KNOW ............................................................. d
GO TO N19
REFUSED ................................................................... r
GO TO N19
N7=1
“do you” if self response. “does he” or “does she” if proxy depending on youth’s gender
N8.
How many different paid jobs {do you/ does he/she} have now?
|
|
| NUMBER
(0-10)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
SOFT CHECK: IF GT 2. I recorded {NUMBER} jobs right now. Is that correct?
44
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N7=1
IF N8=1: FILL “the job” IF N8>1, d, r: FILL “all the jobs”`
“you have” if self response. “he has” or “she has” if proxy depending on youth’s gender
IF N1 = 1: FILL: “not counting {your/his/her} school sponsored job” “your” if self response. “his” or “her”
if proxy depending on youth’s gender.
“do you” if self response. “does he” or “does she” if proxy depending on youth’s gender.
N9.
Thinking about [IF N8=1: the job] [IF N8>1, d, r: all the jobs] {you have/he/she has}
now {IF N1 = 1: ,not counting {your/his/her} school sponsored job}, about how many
hours a week {do you/ does he/she} usually work?
|
|
| HOURS
GO TO N10
(0-80)
DON’T KNOW ............................................................. d
GO TO N9a
REFUSED ................................................................... r
GO TO N9a
SOFT CHECK: IF HOURS LT 5 OR GT 30 I recorded work about {NUMBER} hours a week. Is that
correct?
N9 = d,r
IF N8=1: FILL “In the job {you have/he/she has} now” “you have” if self response. “he has” or “she has” if
proxy.
IF N8>1, d, r, FILL “Taking all {your/his/her} jobs together” “your” if self response. “his” or “her” if proxy
depending on youth’s gender.
IF N1 = 1: FILL “not counting {your/his/her} school sponsored job” “your” if self response. “his” or “her” if
proxy depending on youth’s gender.
“do you” if self response. “does he” or “does she” if proxy depending on youth’s gender.
N9a.
[IF N8=1: In the job {you have/he/she has} now] [IF N8>1, d, r: Taking all {your/his/her}
jobs together], {IF N1 = 1: not counting {your/his/her} school sponsored job}, {do you/
does he/she} usually work 35 hours or more per week?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
45
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N7=1
N8 >1 FILL: “Thinking about the job where you work the most hours”
“have you” if self response. “has he” or “has she” if proxy depending on youth’s gender.
N10.
{Thinking about the job where you work the most hours} About how long {have you/
has he/she} worked there? IF UNSURE, PROBE FOR SEASONS, HOLIDAYS, ETC.
|
| | NUMBER
(0-52)
WEEKS ....................................................................... 1
MONTHS ..................................................................... 2
YEARS ........................................................................ 3
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N7=1
“you do” if self response. “NAME does” if proxy (from sample file )
N11.
What kind of job is this? Is it an informal job {you do/{NAME} does} for family or
friends (such as babysitting or yard work), or is formal job for an employer at a
business, government agency, or other organization?
INFORMAL – WITHIN HOUSEHOLD OR FOR FAMILY
1
FORMAL EMPLOYMENT ............................................ 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
46
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N7=1
“are you” if self response. “is NAME” if proxy (from sample file )
N12.
About how much {are you/is {NAME}} paid for this job, before taxes or deductions are
taken out? PROBE: Is that per hour?
|
|
|,|
|
|
|.|
|
|
(.01-99999.99)
PER HOUR.................................................................. 1
PER WEEK.................................................................. 2
PER MONTH ............................................................... 3
PER YEAR .................................................................. 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
NOTE: ENTER A DECIMAL IF NEEDED. DO NOT ENTER A DOLLAR SIGN.
SOFT CHECK: IF <$7.25 AN HOUR (MINIMUM WAGE) OR >$20 AN HOUR: I recorded ${AMOUNT} per hour. Did I record
that correctly?
SOFT CHECK: IF <$100 A WEEK OR >$400 A WEEK: I recorded ${AMOUNT} per week. Did I record that correctly?
SOFT CHECK: IF <$1000 A MONTH OR >$1600 A MONTH: I recorded ${AMOUNT} per month. Did I record that
correctly?
SOFT CHECK: IF <$10,000 A YEAR OR >$20,000 A YEAR: I recorded ${AMOUNT} per year. Did I record that correctly?
47
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N7=1
“do you” if self response. “does he” or “does she” if proxy.
N13.
How {do you/does he/she} usually get to this job?
INTERVIEWER: IF MENTIONS MORE THAN ONE, PROBE FOR MOST COMMON
MODE OF TRANSPORTATION TO WORK.
CODE ONE ONLY
WALKS OR RIDES A BIKE ......................................... 1
DRIVES HIM/HERSELF .............................................. 2
GETS RIDE FROM FAMILY MEMBER ........................ 3
GETS RIDE FROM FRIEND/COWORKER.................. 4
CARPOOLS................................................................. 5
TAKES PUBLIC TRANSPORTATION, E.G., BUS,
TRAIN, SUBWAY, TAXI............................................... 6
SERVICE AGENCY PROVIDES TRANSPORTATION 7
USES DIAL-A-VAN SERVICE ..................................... 8
OTHER (SPECIFY) ..................................................... 99
(STRING 500)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
IF OTHER SPECIFY (99): What form of transportation was used?
BOX N14
IF N7 = 1 AND N11 ≠ 1 AND (D5 = 1 OR D2 ANY PART = 1 OR
D2_INTRO1 = 1 OR D6B = 1), GO TO N14. ELSE, GO TO N55.
48
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N7= 1 (WORKING) AND N11 =2 (FORMAL JOB) AND
[ IN SAMPLE=Y], OR [<504 PLAN> IN SAMPLE = Y] OR [ IN SAMPLE = N AND
D2 ANY ITEM A-U=1] OR [<504 IN SAMPLE = N AND D5b=8 OR D6b=1]
N14.
Did {you/he/she} tell {your/his/her} employer that {you have/ he/she has} any kind of
learning problem, disability, or other special need…
CODE ONE ONLY
Before {you/he/she} got {your/his/her} job, ............. 1
GO TO N16
After {you/he/she} started the job, or ....................... 2
GO TO N16
{Have you/ Has he/she} not told them at all? ........... 3
GO TO N15
DON’T KNOW ............................................................. d
GO TO N15
REFUSED ................................................................... r
GO TO N15
N14 = 3,d, r
N15.
Do you think your employer is aware that you have any kind of learning problem,
disability, or other special need?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N14=1, 2, 3, d, r
“your" if self response” “his” or “her” if proxy depending on youth’s gender.
N16.
At {your/his/her} job, do most of the other workers have disabilities?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
49
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N14=1, 2, 3, d, r
“your” if self response” “his” or her” if proxy depending on youth’s gender
“you” if self response” “him” or her” if proxy depending on youth’s gender
N17.
Was there someone, either from {your/his/her} school or from an agency, who went
with {you/him/her} to this job, who helped {you/him/her} to learn {your/his/her} job?
(NEW)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N14=1, 2, 3, d, r
“Have you” if self response. “Has he” or “has she” if proxy depending on youth’s gender
“your” if self response” “his” or her” if proxy depending on youth’s gender
“you have” if self response. “he has” or She has” if proxy depending on youth’s gender
N18.
{Have you/ Has/{he/she}} received any accommodations or other help from
{your/his/her} employer because {you have/he has/she has} any kind of learning
problem, disability, or other special need?
YES ............................................................................. 1
GO TO N18a
NO ............................................................................... 0
GO TO N55
DON’T KNOW ............................................................. d
GO TO N55
REFUSED ................................................................... r
GO TO N55
50
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N18=1
“you” if self response” “he” or “she” if proxy depending on youth’s gender
N18a.
What accommodations or other help have {you/he/she} received?
CODE ALL THAT APPLY
NONE ............................................................................................................................................................................ 0
LARGE PRINT OR BRAILLE MATERIALS OR LARGE PRINT COMPUTER ............................................................... 1
WRITTEN MATERIALS ON TAPE ................................................................................................................................. 2
COMPUTER HARDWARE ADAPTED FOR YOUTH’S NEEDS (E.G., ALTERNATIVE KEYBOARD, SWITCH
INTERFACE, SPEECH RECOGNITION SOFTWARE, COMPUTER PERIPHERALS) ................................................. 3
HEADSETS TO ALLOW HANDS-FREE PHONE USE OR TO MAGNIFY SOUND ...................................................... 4
DIFFERENT EQUIPMENT (OTHER THAN COMPUTER) OR CHANGES TO EQUIPMENT USED ON THE JOB ...... 5
TTY, TTD, OR VIDEOPHONE AVAILABLE ................................................................................................................... 6
ALTERED WORK STATION .......................................................................................................................................... 7
A READER OR INTERPRETER .................................................................................................................................... 8
JOB COACH—HELPS MONITOR PROGRESS, OFFERS ADVICE TO IMPROVE PERFORMANCE ......................... 9
A PERSONAL AIDE OR ASSISTANT TO HELP ON THE JOB ..................................................................................... 10
MORE TRAINING, TRAINING TAILORED TO INDIVIDUAL NEEDS ............................................................................ 11
MORE OR DIFFERENT SUPERVISION OR MENTORING .......................................................................................... 12
DIFFERENT EXPECTATIONS FOR PRODUCTIVITY OR PERFORMANCE ............................................................... 13
INSTRUCTIONS ARE MODIFIED IN FORM OR IN THE WAY THEY ARE COMMUNICATED (E.G., PICTORIAL
INSTRUCTIONS, VERBAL INSTRUCTIONS INSTEAD OF/IN ADDITION TO WRITTEN) ........................................... 14
FLEXIBLE TIMES FOR ARRIVING AT AND LEAVING WORK ..................................................................................... 15
SLOWER PACE FOR GETTING THE JOB DONE ........................................................................................................ 16
MORE BREAKS, LONGER BREAKS ............................................................................................................................ 17
MORE PAID SICK LEAVE OR PAID TIME OFF FOR MEDICAL NEEDS, THERAPY APPOINTMENTS, ETC. .......... 18
REARRANGED EQUIPMENT OR FURNITURE TO IMPROVE ACCESSIBILITY ........................................................ 19
MADE CHANGES TO THE BUILDING (E.G., WIDENED DOORS, MADE RESTROOMS ACCESSIBLE) ................... 20
TRANSPORTATION ASSISTANCE (E.G., TO GET BETWEEN BUILDINGS AT THE WORK SITE) ........................... 21
PARKING ACCOMMODATIONS ................................................................................................................................... 22
EMERGENCY PLAN ACCOUNTS FOR DISABLED WORKER (E.G., EVACUATION PLAN) ...................................... 23
OTHER (SPECIFY) What
other accommodations were received? .......................................................... 99
(STRING 500)
DON’T KNOW ................................................................................................................................................................ d
REFUSED ...................................................................................................................................................................... r
CATI: ALL RESPONSES FROM N18a GO TO N55
51
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
SOFT CHECK 1: IF N18 = 0,D,R OR NO RESPONSES IN 9,11-14. Have there been any accommodations in
the training or supervision {you/{NAME}} receive or in {your/his/her} work assignments?
SOFT CHECK 2: IF N18 = 0,D,R OR NO RESPONSES IN 15-18: Have there been any accommodations in
{your/{NAME}’s} work schedule, like getting to arrive or leave work at flexible times, or getting more time
to get {your/his/her} work done?
SOFT CHECK 3: IF N18 = 0,D,R OR (D1a = 3,4,5, 7,8, 12,14,15, 17,18,19,20 OR D2_INTRO3 = 3,4,5, 7,8,
12,14,15, 17,18,19,20 AND NO RESPONSES IN 8-10): Has there been any person assigned to help
{you/{NAME}}, like a person who helps {you/him/her} get around {your/his/her} work site, reads materials
to {you/him/her}, or helps {you/him/her} do {your/his/her} job?
SOFT CHECK 4: IF N18 = 0,D,R OR (D1a = 4,5,6,7,11,14,15,16,18,19,20 OR D2_INTRO3 =
4,5,6,7,11,14,15,16,18,19,20 AND NO RESPONSES IN 1-7): Have there been any adaptations to the
equipment {you use/{NAME} uses}, like giving {you/him/her} a special workstation or different computers
or other equipment, because of {your/his/her} disability?
SOFT CHECK 5: IF N18 = 0,D,R OR (D1a = 4,5,7,12,15,17,18,19 OR D2_INTRO3 = 4,5,7,12,15,17,18,19 AND
NO RESPONSES IN 19-20): Have there been any adaptations to {your/{NAME}’s} workplace, like
rearranging furniture or changing doorways or restrooms because of {your/his/her} disability?
SOFT CHECK 6: IF N18 = 0,D,R OR (D1a = 4,5,7,12,15,17,18,19 OR D2_INTRO3 = 4,5,7,12,15,17,18,19AND
NO RESPONSES IN 21-23): {Have you/Has {NAME}} had any services or supports to help {you/him/her}
get around at work, like help with transportation or parking?
SOFT CHECK7: IF N18 = 0,D,R OR (D1a = 6,7,11,16 OR D2_INTRO3 = 6,7,11,16 AND NO RESPONSES IN
CATEGORY 8). Has there been any person assigned to assist with communication, like a sign language
interpreter?
B1 OR B4 = 1 AND N7 = 0,D,R AND N5 =1
“did you” if self response. “did he” or “did she” if proxy depending on youth’s gender.
“your” if self response. “his” or “her” if proxy depending on youth’s gender.
N19.
About how long {did you/he/she} work at {your/his/her} last job?
INTERVIEWER: IF UNSURE, PROBE FOR SEASONS, HOLIDAYS, ETC.
|
|
| NUMBER (0-52)
WEEKS ....................................................................... 1
MONTHS ..................................................................... 2
YEARS ........................................................................ 3
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
B1 OR B4 = 1 AND N7 = 0,D,R AND N5 =1
“you did” if self response. “NAME did” for proxy (from sample file )
N21.
What kind of job was this? Was it an informal job {you did/{NAME} did} for family or
friends (such as babysitting or yard work), or was it a formal job for an employer at a
business, government agency, or other organization?
INFORMAL – WITHIN HOUSEHOLD OR FOR FAMILY
1
FORMAL EMPLOYMENT ............................................ 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
52
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
B1 OR B4 = 1 AND N7 = 0,D,R AND N5 =1
“were you” if self response. “was NAME” if proxy (from sample file )
N22.
About how much {were you/was {NAME}} paid for this job, before taxes or deductions
were taken out?
PROBE:
|
|
Is that per hour?
|,|
|
|
|.|
|
|
(.01-99999.99)
PER HOUR.................................................................. 1
PER WEEK.................................................................. 2
PER MONTH ............................................................... 3
PER YEAR .................................................................. 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
NOTE: PLEASE ENTER A DECIMAL IF NEEDED. DO
NOT ENTER A DOLLAR SIGN.
SOFT CHECK: IF < $7.25 (MINIMUM WAGE) OR >$20 AN HOUR: I recorded ${NUMBER} per hour. Is that
correct?
SOFT CHECK: IF <$100 A WEEK OR >$400 A WEEK: I recorded ${AMOUNT} per week. Did I record that
correctly?
SOFT CHECK: IF <$1000 A MONTH OR >$1600 A MONTH: I recorded ${AMOUNT} per month. Did I record
that correctly?
SOFT CHECK: IF <$10,000 A YEAR OR >$20,000 A YEAR: I recorded ${AMOUNT} per year. Did I record that
correctly?
53
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
B1 OR B4 = 1 AND N7 = 0,D,R AND N5 =1
“you” if self response. “he” or “she” if proxy depending on youth’s gender.
N23.
How did {you/he/she} usually get to this job?
INTERVIEWER: IF MENTIONS MORE THAN ONE, PROBE FOR MOST COMMON MODE
OF TRANSPORTATION TO WORK.
CODE ONE ONLY
WALKS OR RIDES A BIKE ......................................... 1
DRIVES HIM/HERSELF .............................................. 2
GETS RIDE FROM FAMILY MEMBER ........................ 3
GETS RIDE FROM FRIEND/COWORKER.................. 4
CARPOOLS................................................................. 5
TAKES PUBLIC TRANSPORTATION, E.G., BUS,
TRAIN, SUBWAY, TAXI............................................... 6
SERVICE AGENCY PROVIDES TRANSPORTATION 7
USES DIAL-A-VAN SERVICE ..................................... 8
OTHER (SPECIFY) ..................................................... 99
(STRING 500)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
IF OTHER SPECIFY (99): What form of transportation was used?
BOX N24
IF B1 OR B4 = 1 AND N7 = 0,D,R AND N5 =1 AND N21 ≠ 1 AND (D5 = 1 OR D2 ANY PART = 1
OR D2_INTRO1 = 1 OR D6B = 1), GO TO N24. ELSE GO TO N55.
54
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
B1 OR B4 = 1 (ENROLLED IN SCHOOL THIS YEAR) AND
N7 = 0,D,R (NOT WORKING / NOT RESPONDED TO WORKING NOW) AND N5 =1 (HAS
WORKED IN PAST 12 MO) AND N21=2 (FORMAL JOB) AND
[ IN SAMPLE=Y], OR [<504 PLAN> IN SAMPLE = Y] OR [ IN SAMPLE = N AND
D2 ANY ITEM A-U=1] OR [<504 IN SAMPLE = N AND D5b=8 OR D6b=1]
N24.
Did you tell your employer that you have any kind of learning problem, disability, or
other special need…
CODE ONE ONLY
Before you got your job, ........................................... 1
GO TO N26
After you started the job, or ...................................... 2
GO TO N26
Have you not told them at all? .................................. 3
GO TO N25
DON’T KNOW ............................................................. d
GO TO N25
REFUSED ................................................................... r
GO TO N25
N24 = 3,D,R
N25.
Do you think your employer is aware that you have any kind of learning problem,
disability, or other special need? (NLTS T8j2, REV)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N24=1,2,3,d,r
“your” if self response. “his” or “her” if proxy depending on youth’s gender
N26.
At {your/his/her} job, did most of the other workers have disabilities?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
55
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N24=1,2,3,d,r
“your” if self response. “his” or “her” if proxy depending on youth’s gender.
“you” if self response. “him” or “her” if proxy depending on youth’s gender.
N27.
Was there someone, either from {your/his/her} school or from an agency, who went
with {you/him/her} to this job, who helped {you/him/her} learn {your/his/her} job?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N24=1,2,3,d,r
“you” if self response. “he” or “she” if proxy depending on youth’s gender.
“you have” if self response. “he has” or” she has” if proxy depending on youth’s gender.
N28.
Did {you/he/she} receive any accommodations or other help from your employer
because {you have/he has/she has} any kind of learning problem, disability, or other
special need?
YES ............................................................................. 1
GO TO N28a
NO ............................................................................... 0
GO TO N55
DON’T KNOW ............................................................. d
GO TO N55
REFUSED ................................................................... r
GO TO N55
56
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N28 = 1
“you” if self response. “he” or “she” if proxy.
N28a.
What accommodations or other help did {you/he/she} receive?
CODE ALL THAT APPLY
NONE .............................................................................................................................................................................. 0
LARGE PRINT OR BRAILLE MATERIALS OR LARGE PRINT COMPUTER ................................................................. 1
WRITTEN MATERIALS ON TAPE ................................................................................................................................... 2
COMPUTER HARDWARE ADAPTED FOR YOUTH’S NEEDS (E.G., ALTERNATIVE KEYBOARD, SWITCH
INTERFACE, SPEECH RECOGNITION SOFTWARE, COMPUTER PERIPHERALS) ................................................... 3
HEADSETS TO ALLOW HANDS-FREE PHONE USE OR TO MAGNIFY SOUND ........................................................ 4
DIFFERENT EQUIPMENT (OTHER THAN COMPUTER) OR CHANGES TO EQUIPMENT USED ON THE JOB ........ 5
TTY, TTD, OR VIDEOPHONE AVAILABLE ..................................................................................................................... 6
ALTERED WORK STATION ............................................................................................................................................ 7
A READER OR INTERPRETER ...................................................................................................................................... 8
JOB COACH—HELPS MONITOR PROGRESS, OFFERS ADVICE TO IMPROVE PERFORMANCE ........................... 9
A PERSONAL AIDE OR ASSISTANT TO HELP ON THE JOB ....................................................................................... 10
MORE TRAINING, TRAINING TAILORED TO INDIVIDUAL NEEDS .............................................................................. 11
MORE OR DIFFERENT SUPERVISION OR MENTORING ............................................................................................ 12
DIFFERENT EXPECTATIONS FOR PRODUCTIVITY OR PERFORMANCE ................................................................. 13
INSTRUCTIONS ARE MODIFIED IN FORM OR IN THE WAY THEY ARE COMMUNICATED (E.G., PICTORIAL
INSTRUCTIONS, VERBAL INSTRUCTIONS INSTEAD OF/IN ADDITION TO WRITTEN) ............................................. 14
FLEXIBLE TIMES FOR ARRIVING AT AND LEAVING WORK ....................................................................................... 15
SLOWER PACE FOR GETTING THE JOB DONE .......................................................................................................... 16
MORE BREAKS, LONGER BREAKS .............................................................................................................................. 17
MORE PAID SICK LEAVE OR PAID TIME OFF FOR MEDICAL NEEDS, THERAPY APPOINTMENTS, ETC. ............. 18
REARRANGED EQUIPMENT OR FURNITURE TO IMPROVE ACCESSIBILITY .......................................................... 19
MADE CHANGES TO THE BUILDING (E.G., WIDENED DOORS, MADE RESTROOMS ACCESSIBLE) ..................... 20
TRANSPORTATION ASSISTANCE (E.G., TO GET BETWEEN BUILDINGS AT THE WORK SITE) ............................. 21
PARKING ACCOMMODATIONS ..................................................................................................................................... 22
EMERGENCY PLAN ACCOUNTS FOR DISABLED WORKER (E.G., EVACUATION PLAN) ........................................ 23
OTHER (SPECIFY) .......................................................................................................................................................... 99
(STRING 500
DON’T KNOW .................................................................................................................................................................. d
REFUSED ........................................................................................................................................................................ r
IF OTHER SPECIFY (99): What other accommodations were received?
CATI: ALL RESPONSES FROM N28 GO TO N55
57
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
SOFT CHECK 1: IF N28 = 0,D,R OR NO RESPONSES IN 9,11-14. Have there been any accommodations in
the training or supervision {you/{NAME}} receive or in {your/his/her} work assignments?
SOFT CHECK 2: IF N28 = 0,D,R OR NO RESPONSES IN 15-18: Have there been any accommodations in
{your/{NAME}’s} work schedule, like getting to arrive or leave work at flexible times, or getting more time
to get {your/his/her} work done?
SOFT CHECK 3: IF N28 = 0,D,R OR (D1a = 3,4,5, 7,8, 12,14,15, 17,18,19,20 OR D2_INTRO3 = 3,4,5, 7,8,
12,14,15, 17,18,19,20 AND NO RESPONSES IN 8-10): Has there been any person assigned to help
{you/{NAME}}, like a person who helps {you/him/her} get around {your/his/her} work site, reads materials
to {you/him/her}, or helps {you/him/her} do {your/his/her} job?
SOFT CHECK 4: IF N28 = 0,D,R OR (D1a = 4,5,6,7,11,14,15,16,18,19,20 OR D2_INTRO3 =
4,5,6,7,11,14,15,16,18,19,20 AND NO RESPONSES IN 1-7): Have there been any adaptations to the
equipment {you use/{NAME} uses}, like giving {you/him/her} a special workstation or different computers
or other equipment, because of {your/his/her} disability?
SOFT CHECK 5: IF N28 = 0,D,R OR (D1a = 4,5,7,12,15,17,18,19 OR D2_INTRO3 = 4,5,7,12,15,17,18,19 AND
NO RESPONSES IN 19-20): Have there been any adaptations to {your/{NAME}’s} workplace, like
rearranging furniture or changing doorways or restrooms because of {your/his/her} disability?
SOFT CHECK 6: IF N28 = 0,D,R OR (D1a = 4,5,7,12,15,17,18,19 OR D2_INTRO3 = 4,5,7,12,15,17,18,19AND
NO RESPONSES IN 21-23): {Have you/Has {NAME}} had any services or supports to help {you/him/her}
get around at work, like help with transportation or parking?
SOFT CHECK7: IF N28 = 0,D,R OR (D1a = 6,7,11,16 OR D2_INTRO3 = 6,7,11,16 AND NO RESPONSES IN
CATEGORY 8). Has there been any person assigned to assist with communication, like a sign language
interpreter?
B1 AND B4 ≠ 1 AND B9 <= 1 YEAR AGO
“Do you” if self response. “Does NAME” if proxy (from sample file )
IF N1= 1: “or a school sponsored job”
N29.
{Do you/ Does {NAME}} have a paid job now, other than work around the house {IF
N1= 1: or a school sponsored job}? That could include being a babysitter or working
for a neighbor.
YES ............................................................................. 1
GO TO N30
NO ............................................................................... 0
GO TO N44
DON’T KNOW ............................................................. d
GO TO N44
REFUSED ................................................................... r
GO TO N44
N29 = 1
“Did you” if self response. “NAME’ if proxy (from sample file )
N30.
Did {you/{NAME}} have this job while in high school?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
58
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N29 = 1
“do you” if self response. “does he” or “does she” if proxy depending on youth’s gender.
N31.
How many different paid jobs {do you/does he/she} have now?
|
|
| NUMBER
(0-10)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
SOFT CHECK: IF GT 2 I recorded {NUMBER} jobs right now. Is that correct?
N29 = 1
IF N31=1:FILL “ the job” IF N31>1, d, r: FILL “all the jobs”
“you have” if self response.. “he has” or “she has” if proxy depending on youth’s gender.
IF N1 = 1:FILL” not counting {your/his/her} school sponsored job.” “your” if self response. “his”
or “her” if proxy depending on youth’s gender.
“do you” if self response. “does he” or “does she” ” if proxy depending on youth’s gender.
N32.
Thinking about [IF N31=1: the job] [IF N31>1, d, r: all the jobs] {you have/he/she has}
now {IF N1 = 1: not counting {your/his/her} school sponsored job}, about how many
hours a week {do you/ does he/she} usually work?
|
| | HOURS
(0-80)
GO TO N33
DON’T KNOW ............................................................. d
GO TO N32a
REFUSED ................................................................... r
GO TO N32a
SOFT CHECK: IF HOURS LT 5 OR GT 30 I recorded usually work is about {HOURS} hours a week. Is that
correct?
59
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N32= D, R
IF N31 =1:FILL “ In the job {you have/he/she has} now” “you have” if self response. “he has” or
“she has” if proxy depending on youth’s gender.
IF N31 >1, d, r: FILL “Taking all {your/his/her} jobs together” “your” if self response. “his” or “her” if
proxy depending on youth’s gender.
IF N1= 1:FILL “ not counting {your/his/her} school sponsored job” “your” if self response. his” or
“her” if proxy depending on youth’s gender.
“do you” if self response. “does he” or “does she” if proxy depending on youth’s gender.
N32a.
[IF N31 =1: In the job {you have/he/she has} now] [IF N31 >1, d, r: Taking all
{your/his/her} jobs together], {IF N1= 1: not counting {your/his/her} school sponsored
job}, {do you/ does he/she} usually work 35 hours or more per week?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N29 = 1
N31 > 1, FILL: “Thinking about the job where you work the most hours”
“have you” if self response. “has he” or “has she” if proxy depending on youth’s gender.
N33.
{N31 > 1, FILL: Thinking about the job where you work the most hours} About how
long {have you/ has he/she} worked there?
INTERVIEWER: IF UNSURE, PROBE FOR SEASONS, HOLIDAYS, ETC.
|
|
| NUMBER (1-52)
WEEKS ....................................................................... 1
MONTHS ..................................................................... 2
YEARS ........................................................................ 3
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N29 = 1 AND (N30 = 1 OR N31 ≠ 1)
“have you” if self response. “has he” or “has she” if proxy depending on youth’s gender.
N34.
Since leaving school, how many hours a week {have you/has he/she} usually worked
at that job?
|
|
| HOURS
(1-80)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
60
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
SOFT CHECK: IF HOURS LT 10 OR GT 40 I recorded {HOURS} hours a week at that job. Is that
correct?
N29 = 1
“you do” if self response. “he does” or “she does” depending on youth’s gender
N35.
What kind of job is this? Is it an informal job {you do/he/she does} for family or
friends (such as babysitting or yard work), or is it a formal job for an employer at a
business, government agency, or other organization?
INFORMAL – WITHIN HOUSEHOLD OR FOR FAMILY
1
FORMAL EMPLOYMENT ............................................ 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N29 = 1
“are you” if self response. “is NAME” if proxy (from sample file )
N36.
About how much {are you/is {NAME}} paid for this job, before taxes or deductions are
taken out? PROBE:
Is that per hour?
|
|
|,|
|
|
|.|
|
|
(.01-99999.99)
PER HOUR.................................................................. 1
PER WEEK.................................................................. 2
PER MONTH ............................................................... 3
PER YEAR .................................................................. 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
NOTE: PLEASE ENTER A DECIMAL IF NEEDED. DO NOT ENTER A DOLLAR SIGN.
SOFT CHECK: IF < $7.25 AN HOUR (MINIMUM WAGE) OR >$20 AN HOUR: I recorded ${response} per hour. Is that
correct?
SOFT CHECK: IF <$100 A WEEK OR >$400 A WEEK: I recorded ${AMOUNT} per week. Did I record that correctly?
SOFT CHECK: IF <$1000 A MONTH OR >$1600 A MONTH: I recorded ${AMOUNT} per month. Did I record that
correctly?
SOFT CHECK: IF <$10,000 A YEAR OR >$20,000 A YEAR: I recorded ${AMOUNT} per year. Did I record that
correctly?
61
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N29 = 1
“do you” if self response. “does NAME” if proxy (from sample file )
N37.
How {do you/does {NAME}] usually get to this job?
INTERVIEWER: IF MENTIONS MORE THAN ONE, PROBE FOR MOST COMMON
MODE OF TRANSPORTATION TO WORK.
CODE ONE ONLY
WALKS OR RIDES A BIKE ......................................... 1
DRIVES HIM/HERSELF .............................................. 2
GETS RIDE FROM FAMILY MEMBER ........................ 3
GETS RIDE FROM FRIEND/COWORKER.................. 4
CARPOOLS................................................................. 5
TAKES PUBLIC TRANSPORTATION, E.G., BUS,
TRAIN, SUBWAY, TAXI............................................... 6
SERVICE AGENCY PROVIDES TRANSPORTATION 7
USES DIAL-A-VAN SERVICE ..................................... 8
OTHER (SPECIFY) ..................................................... 99
(STRING 500)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
IF OTHER SPECIFY (99): What form of transportation was used?
BOX N38
IF N29 = 1 AND (D1 = 1 OR D3 =1 OR D6 = 1 OR D5 = 1
OR D2 ANY PART = 1 OR D2_INTRO1 = 1) AND N35 ≠ 1, GO
TO N38. ELSE, GO TO N55.
N29 = 1 (WORKING PD JOB NOW) AND N35 =2 (FORMAL JOB) AND
[ IN SAMPLE=Y], OR [<504 PLAN> IN SAMPLE = Y] OR [ IN SAMPLE = N AND
D2 ANY ITEM A-U=1] OR [<504 IN SAMPLE = N AND D5b=8 OR D6b=1]
N38.
Did you tell your employer that you have any kind of learning problem, disability, or
other special need
CODE ONE ONLY
Before you got your job, ........................................... 1
GO TO N40
After you started the job, or ...................................... 2
GO TO N40
Have you not told them at all? .................................. 3
GO TO N39
DON’T KNOW ............................................................. d
GO TO N39
REFUSED ................................................................... r
GO TO N39
62
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N38 = 3,D,R
N39.
Do you think your employer is aware that you have any kind of learning problem,
disability, or other special need?
YES ............................................................................. 1
GO TO N40
NO ............................................................................... 0
GO TO N40
DON’T KNOW ............................................................. d
GO TO N40
REFUSED ................................................................... r
GO TO N40
N38=1, 2, 3, d, r
“your” if self response. “his” or “her” if proxy depending on youth’s gender.
N40.
At {your/his/her} job, do most of the other workers have disabilities?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N38=1, 2, 3, d, r
“your” if self response. “his” or “her” if proxy depending on youth’s gender.`
“you” if self response. “him” or “her” if proxy depending on youth’s gender.`
“you” if self response. “him” or “her” if proxy depending on youth’s gender.`
“your” if self response. “his” or “her” if proxy depending on youth’s gender.`
N41.
Was there someone, either from {your/his/her} school or from an agency, who went
with {you/him/her} to this job, who helped {you/him/her} learn {your/his/her} job?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
63
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N38=1, 2, 3, d, r
“Have you” if self response. “Has he” or “Has she” if proxy depending on youth’s gender.
“your” if self response. “His or “her” if proxy depending on youth’s gender.
“you have” if self response. “he has” or “she has” if proxy depending on youth’s gender.
N42.
{Have you/Has/{he/she}} received any accommodations or other help from
{your/his/her} employer because {you have/he has/she has} any kind of learning
problem, disability, or other special need?
YES ............................................................................. 1
GO TO N43
NO ............................................................................... 0
GO TO N55
DON’T KNOW ............................................................. d
GO TO N55
REFUSED ................................................................... r
GO TO N55
64
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N42 = 1
“you” if self response. “he” or “she” if proxy depending on youth’s gender.
N43.
What accommodations or other help have {you/he/she} received?
CODE ALL THAT APPLY
NONE .............................................................................................................................................................. 0
LARGE PRINT OR BRAILLE MATERIALS OR LARGE PRINT COMPUTER ................................................. 1
WRITTEN MATERIALS ON TAPE .................................................................................................................. 2
COMPUTER HARDWARE ADAPTED FOR YOUTH’S NEEDS (E.G., ALTERNATIVE KEYBOARD,
SWITCH INTERFACE, SPEECH RECOGNITION SOFTWARE, COMPUTER PERIPHERALS) ................... 3
HEADSETS TO ALLOW HANDS-FREE PHONE USE OR TO MAGNIFY SOUND ........................................ 4
DIFFERENT EQUIPMENT (OTHER THAN COMPUTER) OR CHANGES TO EQUIPMENT USED ON
THE JOB ......................................................................................................................................................... 5
TTY, TTD, OR VIDEOPHONE AVAILABLE .................................................................................................... 6
ALTERED WORK STATION ........................................................................................................................... 7
A READER OR INTERPRETER...................................................................................................................... 8
JOB COACH—HELPS MONITOR PROGRESS, OFFERS ADVICE TO IMPROVE PERFORMANCE .......... 9
A PERSONAL AIDE OR ASSISTANT TO HELP ON THE JOB ...................................................................... 10
MORE TRAINING, TRAINING TAILORED TO INDIVIDUAL NEEDS ............................................................. 11
MORE OR DIFFERENT SUPERVISION OR MENTORING ............................................................................ 12
DIFFERENT EXPECTATIONS FOR PRODUCTIVITY OR PERFORMANCE................................................. 13
INSTRUCTIONS ARE MODIFIED IN FORM OR IN THE WAY THEY ARE COMMUNICATED (E.G.,
PICTORIAL INSTRUCTIONS, VERBAL INSTRUCTIONS INSTEAD OF/IN ADDITION TO WRITTEN) ........ 14
FLEXIBLE TIMES FOR ARRIVING AT AND LEAVING WORK ...................................................................... 15
SLOWER PACE FOR GETTING THE JOB DONE ......................................................................................... 16
MORE BREAKS, LONGER BREAKS .............................................................................................................. 17
MORE PAID SICK LEAVE OR PAID TIME OFF FOR MEDICAL NEEDS, THERAPY APPOINTMENTS,
ETC. ................................................................................................................................................................ 18
REARRANGED EQUIPMENT OR FURNITURE TO IMPROVE ACCESSIBILITY .......................................... 19
MADE CHANGES TO THE BUILDING (E.G., WIDENED DOORS, MADE RESTROOMS ACCESSIBLE) .... 20
TRANSPORTATION ASSISTANCE (E.G., TO GET BETWEEN BUILDINGS AT THE WORK SITE) ............ 21
PARKING ACCOMMODATIONS .................................................................................................................... 22
EMERGENCY PLAN ACCOUNTS FOR DISABLED WORKER (E.G., EVACUATION PLAN) ........................ 23
OTHER (SPECIFY) ......................................................................................................................................... 99
(STRIN
G 50)
DON’T KNOW ................................................................................................................................................. d
REFUSED ....................................................................................................................................................... r
IF OTHER SPECIFY (99): What other accommodations were received?
CATI: ALL RESPONSE OPTIONS FROM N43 GO TO N55
65
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
SOFT CHECK 1: IF N42 = 0,D,R OR NO RESPONSES IN 9,11-14. Have there been any
accommodations in the training or supervision {you/{NAME}} receive or in {your/his/her} work
assignments?
SOFT CHECK 2: IF N42 = 0,D,R OR NO RESPONSES IN 15-18: Have there been any
accommodations in {your/{NAME}’s} work schedule, like getting to arrive or leave work at
flexible times, or getting more time to get {your/his/her} work done?
SOFT CHECK 3: IF N42 = 0,D,R OR (D1a = 3,4,5, 7,8, 12,14,15, 17,18,19,20 OR D2_INTRO3 = 3,4,5,
7,8, 12,14,15, 17,18,19,20 AND NO RESPONSES IN 8-10): Has there been any person assigned to
help {you/{NAME}}, like a person who helps {you/him/her} get around {your/his/her} work site,
reads materials to {you/him/her}, or helps {you/him/her} do {your/his/her} job?
SOFT CHECK 4: IF N42 = 0,D,R OR (D1a = 4,5,6,7,11,14,15,16,18,19,20 OR D2_INTRO3 =
4,5,6,7,11,14,15,16,18,19,20 AND NO RESPONSES IN 1-7): Have there been any adaptations to
the equipment {you use/{NAME} uses}, like giving {you/him/her} a special workstation or
different computers or other equipment, because of {your/his/her} disability?
SOFT CHECK 5: IF N42 = 0,D,R OR (D1a = 4,5,7,12,15,17,18,19 OR D2_INTRO3 =
4,5,7,12,15,17,18,19 AND NO RESPONSES IN 19-20): Have there been any adaptations to
{your/{NAME}’s} workplace, like rearranging furniture or changing doorways or restrooms
because of {your/his/her} disability?
SOFT CHECK 6: IF N42 = 0,D,R OR (D1a = 4,5,7,12,15,17,18,19 OR D2_INTRO3 =
4,5,7,12,15,17,18,19AND NO RESPONSES IN 21-23): {Have you/Has {NAME}} had any services or
supports to help {you/him/her} get around at work, like help with transportation or parking?
SOFT CHECK7: IF N42 = 0,D,R OR (D1a = 6,7,11,16 OR D2_INTRO3 = 6,7,11,16 AND NO
RESPONSES IN CATEGORY 8). Has there been any person assigned to assist with
communication, like a sign language interpreter?
B9 <= 1 YEAR AND N29 ≠ 1
“Have you” if self response. “Has he” or “Has she” if proxy depending on youth’s gender.
N44.
{Have you/has he/she} had a paid job since leaving school?
YES ............................................................................. 1
GO TO N45
NO ............................................................................... 0
GO TO N55
DON’T KNOW ............................................................. d
GO TO N55
REFUSED ................................................................... r
GO TO N55
66
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N44 = 1
“you” if self response. “he” or she” if proxy depending on youth’s gender.
N45.
About how long did {you/he/she} work there? IF UNSURE, PROBE FOR SEASONS,
HOLIDAYS, ETC.
|
|
| NUMBER
(0-52)
WEEKS ....................................................................... 1
MONTHS ..................................................................... 2
YEARS ........................................................................ 3
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N44 = 1
“you” if self response. “he” or she” if proxy depending on youth’s gender.
N46.
How many hours a week did {you/he/she} usually work at that job since leaving
school?
|
|
| HOURS
(0-80)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
SOFT CHECK: IF HOURS LT 10 OR GT 40 I recorded {HOURS} hours a week at that job. Is that
correct?
N44 = 1
“you do” if self response. “he does” or “she does” depending on youth’s gender
N47.
What kind of job was this? Was it an informal job {you did/he/she did} for family or
friends (such as babysitting or yard work), or was it a formal job for an employer at a
business, government agency, or other organization?
INFORMAL – WITHIN HOUSEHOLD OR FOR FAMILY
1
FORMAL EMPLOYMENT ............................................ 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
67
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N44 = 1
“were you” if self response. “was NAME” if proxy (from sample file )
N48.
About how much {were you/was {NAME}} paid for this job, before taxes or deductions
were taken out?
PROBE:
|
|
Is that per hour?
|,|
|
|
|.|
|
|
(.01-99999.99)
PER HOUR.................................................................. 1
PER WEEK.................................................................. 2
PER MONTH ............................................................... 3
PER YEAR .................................................................. 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
NOTE: ENTER A DECIMAL IF NEEDED. DO NOT ENTER A DOLLAR SIGN.
SOFT CHECK: IF < $7.25 AN HOUR (MINIMUM WAGE) OR >$20 AN HOUR: I recorded ${NUMBER} per hour. Is that correct?
SOFT CHECK: IF <$100 A WEEK OR >$400 A WEEK: I recorded ${AMOUNT} per week. Did I record that correctly?
SOFT CHECK: IF <$1000 A MONTH OR >$1600 A MONTH: I recorded ${AMOUNT} per month. Did I record that correctly?
SOFT CHECK: IF <$10,000 A YEAR OR >$20,000 A YEAR: I recorded ${AMOUNT} per year. Did I record that correctly?
68
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N44 = 1
“you” if self response. “he” or “she” if proxy depending on youth’s gender.
N49.
How did {you/he/she} usually get to this job?
INTERVIEWER: IF MENTIONS MORE THAN ONE, PROBE FOR MOST COMMON
MODE OF TRANSPORTATION TO WORK.
CODE ONE ONLY
WALKS OR RIDES A BIKE ......................................... 1
DRIVES HIM/HERSELF .............................................. 2
GETS RIDE FROM FAMILY MEMBER ........................ 3
GETS RIDE FROM FRIEND/COWORKER.................. 4
CARPOOLS................................................................. 5
TAKES PUBLIC TRANSPORTATION, E.G., BUS,
TRAIN, SUBWAY, TAXI............................................... 6
SERVICE AGENCY PROVIDES TRANSPORTATION 7
USES DIAL-A-VAN SERVICE ..................................... 8
OTHER (SPECIFY) ..................................................... 99
________________________________(STRING 500)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
IF OTHER SPECIFY (99): What form of transportation was used?
N44 = 1 (HAD JOB SINCE LEAVING SCHOOL) AND N47 =2 (FORMAL JOB) AND
[ IN SAMPLE=Y], OR [<504 PLAN> IN SAMPLE = Y] OR [ IN SAMPLE = N AND D2 ANY
ITEM A-U=1] OR [<504 IN SAMPLE = N AND D5b=8 OR D6b=1]
N50.
Did you tell your employer that you have any kind of learning problem, disability, or
other special need…
CODE ONE ONLY
Before you got your job, ........................................... 1
GO TO N52
After you started the job, or ...................................... 2
GO TO N52
Have you not told them at all? .................................. 3
GO TO N51
DON’T KNOW ............................................................. d
GO TO N51
REFUSED ................................................................... r
GO TO N51
69
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
J1B=1 AND N50=3,d,r
N51.
Do you think your employer was aware that you have any kind of learning problem,
disability, or other special need?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N50=1,2,3, d, r
“your” if self response. “his” or “her” if proxy depending on youth’s gender.
N52.
At {your/his/her} job, did most of the other workers have disabilities? (NLTS2, T8I)
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N50=1,2,3, d, r
“your” if self response. “NAME” if proxy (from sample file )
“you” if self response. “him” or “her” if proxy depending on youth’s gender.`
“you” if self response. “him” or “her” if proxy depending on youth’s gender.`
“your” if self response. “his” or “her” if proxy depending on youth’s gender.`
N53.
Was there someone, either from {your/{NAME}’s} school or from an agency, who went
with {you/him/her} to this job, who helped {you/him/her} learn {your/his/her} job?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
N50=1,2,3, d, r
“ you” if self response. “he” or “she” if proxy depending on youth’s gender.
“you have” if self response. “he has” or “she has” if proxy depending on youth’s gender.
N54.
Did {you/he/she} receive any accommodations or other help from your employer
because {you have/he has/she has} any kind of learning problem, disability, or other
special need?
YES ............................................................................. 1
GO TO N54a
NO ............................................................................... 0
GO TO N55
DON’T KNOW ............................................................. d
GO TO N55
REFUSED ................................................................... r
GO TO N55
70
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
N54=1
“you” if self response. “he” or “she” if proxy depending on youth’s gender
N54a.
What accommodations or other help did {you/he/she} receive?
CODE ALL THAT APPLY
NONE ................................................................................................................................................... 0
LARGE PRINT OR BRAILLE MATERIALS OR LARGE PRINT COMPUTER ...................................... 1
WRITTEN MATERIALS ON TAPE ....................................................................................................... 2
COMPUTER HARDWARE ADAPTED FOR YOUTH’S NEEDS (E.G., ALTERNATIVE
KEYBOARD, SWITCH INTERFACE, SPEECH RECOGNITION SOFTWARE, COMPUTER
PERIPHERALS) ............................................................................................................................ 3
HEADSETS TO ALLOW HANDS-FREE PHONE USE OR TO MAGNIFY SOUND ............................. 4
DIFFERENT EQUIPMENT (OTHER THAN COMPUTER) OR CHANGES TO EQUIPMENT USED
ON THE JOB ................................................................................................................................. 5
TTY, TTD, OR VIDEOPHONE AVAILABLE.......................................................................................... 6
ALTERED WORK STATION ................................................................................................................. 7
A READER OR INTERPRETER ........................................................................................................... 8
JOB COACH—HELPS MONITOR PROGRESS, OFFERS ADVICE TO IMPROVE
PERFORMANCE ........................................................................................................................... 9
A PERSONAL AIDE OR ASSISTANT TO HELP ON THE JOB ............................................................ 10
MORE TRAINING, TRAINING TAILORED TO INDIVIDUAL NEEDS ................................................... 11
MORE OR DIFFERENT SUPERVISION OR MENTORING ................................................................. 12
DIFFERENT EXPECTATIONS FOR PRODUCTIVITY OR PERFORMANCE ...................................... 13
INSTRUCTIONS ARE MODIFIED IN FORM OR IN THE WAY THEY ARE COMMUNICATED
(E.G., PICTORIAL INSTRUCTIONS, VERBAL INSTRUCTIONS INSTEAD OF/IN ADDITION
TO WRITTEN) ............................................................................................................................... 14
FLEXIBLE TIMES FOR ARRIVING AT AND LEAVING WORK ............................................................ 15
SLOWER PACE FOR GETTING THE JOB DONE ............................................................................... 16
MORE BREAKS, LONGER BREAKS ................................................................................................... 17
MORE PAID SICK LEAVE OR PAID TIME OFF FOR MEDICAL NEEDS, THERAPY
APPOINTMENTS, ETC. ................................................................................................................ 18
REARRANGED EQUIPMENT OR FURNITURE TO IMPROVE ACCESSIBILITY ............................... 19
MADE CHANGES TO THE BUILDING (E.G., WIDENED DOORS, MADE RESTROOMS
ACCESSIBLE) ............................................................................................................................... 20
TRANSPORTATION ASSISTANCE (E.G., TO GET BETWEEN BUILDINGS AT THE WORK
SITE) ............................................................................................................................................. 21
PARKING ACCOMMODATIONS .......................................................................................................... 22
EMERGENCY PLAN ACCOUNTS FOR DISABLED WORKER (E.G., EVACUATION PLAN) ............. 23
OTHER (SPECIFY)............................................................................................................................... 99
___________________________________________________________________(STRING 50)
DON’T KNOW ....................................................................................................................................... d
REFUSED............................................................................................................................................. r
IF OTHER SPECIFY (99): What other accommodations were received?
71
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
SOFT CHECK 1: IF N54 = 0,D,R OR NO RESPONSES IN 9,11-14. Have there been any accommodations in
the training or supervision {you/{NAME}} receive or in {your/his/her} work assignments?
SOFT CHECK 2: IF N54 = 0,D,R OR NO RESPONSES IN 15-18: Have there been any accommodations in
{your/{NAME}’s} work schedule, like getting to arrive or leave work at flexible times, or getting more time
to get {your/his/her} work done?
SOFT CHECK 3: IF N54 = 0,D,R OR (D1a = 3,4,5, 7,8, 12,14,15, 17,18,19,20 OR D2_INTRO3 = 3,4,5, 7,8,
12,14,15, 17,18,19,20 AND NO RESPONSES IN 8-10): Has there been any person assigned to help
{you/{NAME}}, like a person who helps {you/him/her} get around {your/his/her} work site, reads materials
to {you/him/her}, or helps {you/him/her} do {your/his/her} job?
SOFT CHECK 4: IF N54 = 0,D,R OR (D1a = 4,5,6,7,11,14,15,16,18,19,20 OR D2_INTRO3 =
4,5,6,7,11,14,15,16,18,19,20 AND NO RESPONSES IN 1-7): Have there been any adaptations to the
equipment {you use/{NAME} uses}, like giving {you/him/her} a special workstation or different computers
or other equipment, because of {your/his/her} disability?
SOFT CHECK 5: IF N54 = 0,D,R OR (D1a = 4,5,7,12,15,17,18,19 OR D2_INTRO3 = 4,5,7,12,15,17,18,19 AND
NO RESPONSES IN 19-20): Have there been any adaptations to {your/{NAME}’s} workplace, like
rearranging furniture or changing doorways or restrooms because of {your/his/her} disability?
SOFT CHECK 6: IF N54 = 0,D,R OR (D1a = 4,5,7,12,15,17,18,19 OR D2_INTRO3 = 4,5,7,12,15,17,18,19AND
NO RESPONSES IN 21-23): {Have you/Has {NAME}} had any services or supports to help {you/him/her}
get around at work, like help with transportation or parking?
SOFT CHECK7: IF N54 = 0,D,R OR (D1a = 6,7,11,16 OR D2_INTRO3 = 6,7,11,16 AND NO RESPONSES IN
CATEGORY 8). Has there been any person assigned to assist with communication, like a sign language
interpreter?
AGE IN A12 OR A12A >= 15
“Have you” if self response. “Has he” or “Has she” if proxy depending on youth’s gender.
“you don’t” if self response. “he doesn’t” or “she doesn’t” if proxy depending on youth’s gender.
N55.
{Have you/Has he/she} had a job in the past that {you don’t/he/she doesn’t} work at
anymore?
YES ............................................................................. 1
GO TO N55a
NO ............................................................................... 0
GO TO O_Intro
DON’T KNOW ............................................................. d
GO TO O_Intro
REFUSED ................................................................... r
GO TO O_Intro
72
Draft Dated 07.24.12
Student Baseline Questionnaire: CATI Programming Specifications
AGE IN A12 OR A12A >= 15 AND N55 = 1
“you” if self response. “he” or “she” if proxy depending on youth’s gender.
“your” if self response. “his” or “her” if proxy depending on youth’s gender.
ANSWER CHOICE1 “you” if self response. “he” or “she” if proxy depending on youth’s gender.
ANSWER CHOICE 2 “Were you” if self response. “Was he” or “Was she” if proxy depending on youth’s gender.
ANSWER CHOICE 3 “Were you” if self response. “Was he” or “Was she” if proxy depending on youth’s gender.
N55a.
When {you/he/she} left {your/his/her} most recent former job
CODE ONE ONLY
Did {you/he/she} quit, ................................................ 1
GO TO N55b
{Were you/Was he/she} fired,.................................... 2
GO TO O _Intro
{Were you/Was he/she} laid off, or ........................... 3
GO TO O _Intro
Was it a temporary job that ended? ......................... 4
GO TO O _Intro
HAVE NOT LEFT A JOB ............................................. 5
GO TO O _Intro
DON’T KNOW ............................................................. d
GO TO O _Intro
REFUSED ................................................................... r
GO TO O _Intro
N55a=1
“you” if self response. “he” or “she” if proxy depending on youth’s gender.
N55b.
What was the main reason {you/he/she} quit?
CODE ONE ONLY
FOUND A BETTER JOB........................................................ 1
GO TO O _Intro
WANTED TO LOOK FOR A BETTER JOB ............................ 2
GO TO O _Intro
WANTED TO START OWN BUSINESS/WORK FOR SELF .. 3
GO TO O _Intro
DIDN’T LIKE THE HOURS/KIND OF WORK/ CONDITIONS . 4
GO TO O _Intro
WAGES TOO LOW ............................................................... 5
GO TO O _Intro
DIDN’T GET ALONG WITH COWORKERS OR BOSS.......... 6
GO TO O _Intro
WENT BACK TO SCHOOL.................................................... 7
GO TO O _Intro
JOB INTERFERED WITH SCHOOL ...................................... 8
GO TO O _Intro
ILLNESS OR DISABILITY INTERFERED WITH JOB ............ 9
GO TO O _Intro
EMPLOYER WOULDN’T PROVIDE ACCOMMODATION ..... 10 GO TO O _Intro
PARENTS DIDN’T WANT YOUTH TO WORK....................... 11 GO TO O _Intro
FAMILY REASONS (PREGNANCY, CARE FOR FAMILY) .... 12 GO TO O _Intro
MOVED ................................................................................. 13 GO TO O _Intro
TRANSPORTATION PROBLEMS/HARD TO GET TO JOB .. 14 GO TO O _Intro
CAN MAKE MORE MONEY ON DISABILITY ......................... 15 GO TO O _Intro
DON’T KNOW ....................................................................... d
GO TO O _Intro
REFUSED .......................................................................................... r
GO TO O _Intro
73
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Student Baseline Questionnaire: CATI Programming Specifications
SECTION O. INDEPENDENT LIVING SKILLS
ALL YOUTH AND PROXIES
“your” if self response. “NAME’s” if proxy (from sample file )
“your” if self response. “his” or “her” if proxy depending on youth’s gender.
O_INTRO. The next questions ask about {your/NAME’s} life today and {your/his/her}
expectations for {your/his/her} future. Remember, there are no right or wrong
answers.
ALL YOUTH AND PROXIES
“Do you” if self response. “Does he” or “Does she” if proxy depending on youth’s gender.
PROBE: “your” if self response. “NAME’s” if proxy (from sample file )
PROBE: “your” if self response. “his” or “her” if proxy depending on youth’s gender.
ITEM A: “you” if self response. “he” or “she” if proxy depending on youth’s gender.
ITEM C: “you write” if self response. “he writes” or “she writes” if proxy depending on youth’s gender.
“s” on uses if proxy
O1.
(Do you/Does he/she) have…
PROBE: This question is about {your/NAME’s} life today and {your/his/her} expectations for
{your/his/her} future.
CODE ONE PER ROW
YES
NO
DK
REF
a. an allowance, or have other money {you/he/she} can
decide how to spend? This could include money earned
from a job. .........................................................................
1
0
d
r
b. a savings account? ...........................................................
1
0
d
r
c. a checking account where {you write/ he/she writes}
checks or use{s} a debit card? (NLTS2, P16c) ...............
1
0
d
r
BOX O2
IF O1C = 1, GO TO O2. ELSE, GO TO O3.
J1B=1 AND O1C=1
O2.
Have you ever overdrawn this checking account?
PROBE: By this we mean have you ever spent more than was available in the account
and it resulted in a balance that was less than zero.
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
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ALL YOUTH AND PROXIES
“Do you” if self response. “Does NAME” if proxy (from sample file )
“your” if self response. “his” or “her” if proxy depending on youth’s gender.
“you are” if self response. “he is” or “she is” if proxy depending on youth’s gender.
O3.
{Do you/Does {NAME}} get any bills in {your/his/her} own name that {you are/he/she
is} responsible for paying?
PROBE: This could include a bill for a cell phone, electricity, internet access, credit
card, rent, or a magazine subscription.
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
YOUTH AGE IN A12 OR A12A >= 15 AND D1A ≠ 4,7,19.
O4.
{Do you/Does he/she} have a driver’s license or learner’s permit?
YES ............................................................................. 1
GO TO O5
NO ............................................................................... 0
GO TO O4a
DON’T KNOW ............................................................. d
GO TO O5
REFUSED ................................................................... r
GO TO O5
YOUTH AGE IN A12 OR A12A >= 15 AND D1A ≠ 4,7,19 AND J1B = 1 AND O4 = 0
O4a.
How likely do you think it is that you will get a driver’s license? Do you think you…
CODE ONE ONLY
Definitely will,............................................................. 1
Probably will, ............................................................. 2
Probably won’t, or ..................................................... 3
Definitely won’t? ........................................................ 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
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YOUTH AGE FROM A12 OR A12A >= 18
“Are you” if self response. “Is NAME” if proxy (from sample file )
O5.
{Are you/Is {NAME}} registered to vote?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
J1b = 1
INTERVIEWER CHECKPOINT:
DOES THE RESPONDENT SEEM FATIGUED, CONFUSED, OR
NEED REINFORCEMENT?
FATIGUE PROBE:
1. Are you feeling tired or can we continue?
2. Would you like to take a break? I can hold on.
3. Would you like to continue the interview another time?
REINFORCEMENT PROBE:
1. Your answers are very helpful for this study.
2. You are doing very well.
INTERVIEWER ACTION:
NOT FATIGUED, NO REINFORCEMENT NEEDED................ 01 (P1_INTRO)
FATIGUED AND WANTS TO BE CALLED BACK..................... 02 (appt tab)
FATIGUED, BUT CAN CONTINUE........................................... 03 (P1_INTRO)
GAVE REINFORCEMENT, CAN CONTINUE........................... 04 (P1_INTRO)
GAVE REINFORCEMENT, WANTS TO BE CALLED BACK.... 05 (appt tab)
SECTION P. STUDENT’S SELF-ADVOCACY
J1b = 1
P1_INTRO
Now I am going read some statements. For each, please tell me the answer that
best tells how you act in that situation. There are no right or wrong answers.
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J1b = 1
P1a.
“My friends and I choose activities that we want to do.” The choices are, I do not do,
even if I have the chance; I do sometimes when I have the chance; I do most of the
time I have a chance; or I do every time I have the chance.
PROBE:
Tell me the answer that best tells how you act in this situation.
PROBE:
There are no right or wrong answers
PROBE:
If your disability limits you from actually performing the activity, but you have control
over the activity – such as a personal care attendant, answer as if you performed that
activity.
I DO NOT DO EVEN IF I HAVE THE CHANCE………………….1
I DO SOMETIMES WHEN I HAVE THE CHANCE………………2
I DO MOST OF THE TIME I HAVE THE CHANCE……………..3
I DO EVERY TIME I HAVE THE CHANCE……………………....4
DON’T KNOW………………………………………………………..d
REFUSED…………………………………………………………….r
J1b = 1
P1b.
“I write letters, texts, or talk on the phone to friends and family.” The choices are, I do
not do, even if I have the chance; I do sometimes when I have the chance; I do most
of the time I have a chance; or I do every time I have the chance.
PROBE:
Tell me the answer that best tells how you act in this situation.
PROBE:
There are no right or wrong answers
PROBE:
If your disability limits you from actually performing the activity, but you have control
over the activity – such as a personal care attendant, answer as if you performed that
activity.
I DO NOT DO EVEN IF I HAVE THE CHANCE………………….1
I DO SOMETIMES WHEN I HAVE THE CHANCE………………2
I DO MOST OF THE TIME I HAVE THE CHANCE……………..3
I DO EVERY TIME I HAVE THE CHANCE……………………....4
DON’T KNOW………………………………………………………..d
REFUSED…………………………………………………………….r
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J1b = 1
P1c.
“I go to restaurants that I like.” The choices are, I do not do, even if I have the chance;
I do sometimes when I have the chance; I do most of the time I have a chance; or I do
every time I have the chance.
PROBE:
Tell me the answer that best tells how you act in this situation.
PROBE:
There are no right or wrong answers
PROBE:
If your disability limits you from actually performing the activity, but you have control over the
activity – such as a personal care attendant, answer as if you performed that activity.
I DO NOT DO EVEN IF I HAVE THE CHANCE………………….1
I DO SOMETIMES WHEN I HAVE THE CHANCE………………2
I DO MOST OF THE TIME I HAVE THE CHANCE……………..3
I DO EVERY TIME I HAVE THE CHANCE……………………....4
DON’T KNOW………………………………………………………..d
REFUSED…………………………………………………………….r
J1b = 1
P1d.
“I choose gifts to give to family and friends.”
The choices are, I do not do, even
if I have the chance; I do sometimes when I have the chance; I do most of the time I
have a chance; or I do every time I have the chance.
PROBE:
Tell me the answer that best tells how you act in this situation.
PROBE:
There are no right or wrong answers
PROBE:
If your disability limits you from actually performing the activity, but you have control over the
activity – such as a personal care attendant, answer as if you performed that activity.
I DO NOT DO EVEN IF I HAVE THE CHANCE………………….1
I DO SOMETIMES WHEN I HAVE THE CHANCE………………2
I DO MOST OF THE TIME I HAVE THE CHANCE……………..3
I DO EVERY TIME I HAVE THE CHANCE…………………….....4
DON’T KNOW………………………………………………………..d
REFUSED…………………………………………………………….r
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J1b = 1
P1e.
“I go to movies, concerts, and dances.” The choices are, I do not do, even if I have the
chance; I do sometimes when I have the chance; I do most of the time I have a
chance; or I do every time I have the chance.
PROBE:
Tell me the answer that best tells how you act in this situation.
PROBE:
There are no right or wrong answers
PROBE:
If your disability limits you from actually performing the activity, but you have control over the
activity – such as a personal care attendant, answer as if you performed that activity.
I DO NOT DO EVEN IF I HAVE THE CHANCE………………….1
I DO SOMETIMES WHEN I HAVE THE CHANCE………………2
I DO MOST OF THE TIME I HAVE THE CHANCE……………..3
I DO EVERY TIME I HAVE THE CHANCE…………………….....4
DON’T KNOW………………………………………………………..d
REFUSED…………………………………………………………….r
J1b = 1
P1f.
“I plan weekend activities that I like to do.” The choices are, I do not do, even if I have
the chance; I do sometimes when I have the chance; I do most of the time I have a
chance; or I do every time I have the chance.
PROBE:
Tell me the answer that best tells how you act in this situation.
PROBE:
There are no right or wrong answers
PROBE:
If your disability limits you from actually performing the activity, but you have control over the
activity – such as a personal care attendant, answer as if you performed that activity.
I DO NOT DO EVEN IF I HAVE THE CHANCE………………….1
I DO SOMETIMES WHEN I HAVE THE CHANCE………………2
I DO MOST OF THE TIME I HAVE THE CHANCE……………..3
I DO EVERY TIME I HAVE THE CHANCE…………………….....4
DON’T KNOW………………………………………………………..d
REFUSED…………………………………………………………….r
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J1b = 1
P1g.
“I volunteer in things that I am interested in.” The choices are, I do not do, even if I
have the chance; I do sometimes when I have the chance; I do most of the time I have
a chance; or I do every time I have the chance.
PROBE:
Tell me the answer that best tells how you act in this situation.
PROBE:
There are no right or wrong answers
PROBE:
If your disability limits you from actually performing the activity, but you have control over the
activity – such as a personal care attendant, answer as if you performed that activity.
I DO NOT DO EVEN IF I HAVE THE CHANCE………………….1
I DO SOMETIMES WHEN I HAVE THE CHANCE………………2
I DO MOST OF THE TIME I HAVE THE CHANCE……………..3
I DO EVERY TIME I HAVE THE CHANCE…………………….....4
DON’T KNOW………………………………………………………..d
REFUSED…………………………………………………………….r
J1b = 1
P2.
Next, I am going to read you two statements. I want you to tell me the one that best
describes you. Choose only one answer. There are no right or wrong answers. Which
of the following statements best describes you?
CODE ONE ONLY
Trying hard at school doesn't do me much good, or
1
Trying hard at school will help me get a good job .. 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
J1b = 1
P3.
Which of the following statements best describes you?
PROBE: Choose only one answer. PROBE: There are no right or wrong answers.
CODE ONE ONLY
It is no use to keep trying because that won't change
things, or .................................................................... 1
I keep trying even after I get something wrong ....... 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
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J1b = 1
P4.
Which of the following statements best describes you?
PROBE: Choose only one answer. PROBE: There are no right or wrong answers.
CODE ONE ONLY
I don't know how to make friends, or ....................... 1
I know how to make friends ...................................... 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
J1b = 1
P5.
READ IF NECESSARY: Which of the following statements best describes you?
PROBE: Choose only one answer. PROBE: There are no right or wrong answers.
CODE ONE ONLY
I do not make good choices, or ................................ 1
I can make good choices .......................................... 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
J1b = 1
P6.
READ IF NECESSARY: Which of the following statements best describes you?
PROBE: Choose only one answer. PROBE: There are no right or wrong answers.
CODE ONE ONLY
My choices will not be honored, or .......................... 1
I will be able to make choices that are important to
me ............................................................................... 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
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Student Baseline Questionnaire: CATI Programming Specifications
J1b = 1
P7.
READ IF NECESSARY: Which of the following statements best describes you?
PROBE: Choose only one answer. PROBE: There are no right or wrong answers.
CODE ONE ONLY
I will have a hard time making new friends, or ........ 1
I will be able to make friends in new situations ....... 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
J1b = 1
P8.
READ IF NECESSARY: Which of the following statements best describes you?
PROBE: Choose only one answer. PROBE: There are no right or wrong answers.
CODE ONE ONLY
I usually agree with people when they tell me I can't
do something, or........................................................ 1
I tell people when I think I can do something that
they tell me I can’t...................................................... 2
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
J1b = 1
P9.
Now I am going to read some statements. Please tell me whether you think each of
these describes how you feel about yourself or not. There are no right or wrong
answers. Choose the answer that best fits you.
PROBE: You agree or you don’t agree?
CODE ONE PER ROW
AGREE
DON’T
AGREE
DON’T
KNOW
REFUSED
a. I know what I do best ............................................
1
2
d
r
b. I like myself .............................................................
1
2
d
r
c. I am confident in my abilities ...............................
1
2
d
r
d. Other people like me . ............................................
1
2
d
r
e. It is better to be yourself than to be popular ......
1
2
d
r
f. I know how to make up for my limitations ..........
1
2
d
r
g. I am loved because I give love .............................
1
2
d
r
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Q. EXPECTATIONS FOR THE FUTURE
J1B=1
Q1.
As things stand now, how far do you think you will get in school?
CODE ONE ONLY
LESS THAN HIGH SCHOOL (WILL NOT GRADUATE
OR GET GED) ............................................................. 1
HIGH SCHOOL DIPLOMA OR GED ............................ 2
TECHNICAL OR TRADE SCHOOL ............................. 3
2 YEAR COLLEGE ..................................................... 4
4-YEAR COLLEGE ...................................................... 5
MASTER’S DEGREE, PHD, OR OTHER ADVANCED
DEGREE ..................................................................... 6
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
J1B=1 AND [D1 = 1 OR D2_INTRO1 = 1 OR D3=1 OR (D5B=8 OR D6B=1)] AND [ N5=0,D,R] AND [N55= 0,D,R]
Q2
How likely do you think it is that you will get a paid job by the time you are 30 years
old? Do you think you … (NLTS2, V13, REV)
IF ASKED: MEANS ANY PAID JOB, DOES NOT NEED TO MAKE ENOUGH TO SUPPORT
SELF. (READ CATEGORIES IF NECESSARY)
CODE ONE ONLY
Definitely will,............................................................. 1
Probably will, ............................................................. 2
Probably won’t, or ..................................................... 3
GO TO Q4
Definitely won’t? ........................................................ 4
GO TO Q4
DON’T KNOW ............................................................. d
GO TO Q4
REFUSED ................................................................... r
GO TO Q4
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J1B=1 AND (STUDENT Q2=1,2 OR N5 = 1 OR N55 = 1) AND (PARENT D1 = 1 OR D2_INTRO1 = 1 OR D2 ANY
FROM A-U = 1, OR D3 = 1 OR (D5B=8 OR D6B=1)]
Q3.
By the time you are 30 years old, how likely do you think it is that you will earn
enough to support yourself without financial help from your family or government
benefit programs? Do you think you… (NLTS2, V14)
CODE ONE ONLY
Definitely will,............................................................. 1
Probably will, ............................................................. 2
Probably won’t, or ..................................................... 3
Definitely won’t? ........................................................ 4
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
J1B=1
Q4.
When you are 30 years old, do you think you will be living: (NEW)
CODE ONE ONLY
On your own - without friends or family,.................. 1
At home with parents, ............................................... 2
With a relative, ........................................................... 3
With friends, ............................................................... 4
With a spouse or partner, .......................................... 5
In military housing, .................................................... 6
In a group home or with supervision, ...................... 7
In a larger facility with paid staff (an institution), or 8
Somewhere else? (SPECIFY) .................................... 99
(STRING 150)
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
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Student Baseline Questionnaire: CATI Programming Specifications
J1B=1 AND YOUTH AGE >=15
Q5.
People sometimes face challenges deciding what to do after high school. Please tell
me if you agree or disagree with each of the following. (NEW)
AGREE
DISAGREE
DK
REF
a. I know what kinds of jobs I would like or what I would
be good at doing. .........................................................
1
0
d
r
b. I am getting enough help from school staff in learning
about different careers. ................................................
1
0
d
r
I know what further education is needed for jobs I
might want. ...................................................................
1
0
d
r
d. I am getting enough help from my teachers or school
counselors about schools I might want to attend after
high school. ..................................................................
1
0
d
r
e. I know where to get help paying for college or other
types of schools. ..........................................................
1
0
d
r
1
0
d
r
c.
f.
Are there any other challenges you face in deciding
what to do after high school?
INTERVIEWER: CODE “DISAGREE” IF ANSWER IS NO
(SPECIFY) ..........................................................................
_______________________________(STRING 500)
R. CONTACT INFORMATION FOR FOLLOW UP & REMAINDER OF CONSENT QUESTIONS
This concludes the main part of the interview. I will need just a few more minutes
to learn how to best contact you in the future and see which addition parts of the
study you would be willing to take part in.
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ALL YOUTH OR THEIR PROXIES. ASSUMES PROXY WILL BE SENT YOUTH’S GIFT CARD / THANK YOU
MAILING
“you live” if self response. “NAME lives” if proxy ( from SAMPLE FILE: )
“you” if self response. “him” or “her” if proxy depending on youth’s gender.
“you get” if self response. “he gets” or “she gets” if proxy depending on youth’s gender.
“your” if self response. “his” or “her” if proxy depending on youth’s gender.
IF G4= 1,2 AND A9=1,D,R, FILL WITH ADDRESS FILLED IN A9.
IF G4= 1,2 AND A9=0 , FILL WITH ADDRESS COLLECTED IN A9A.
ELSE FILL Student’s address from sample file variable [STU_ADDR_LINE, STU_ADDR_LINE2, STU_CITY,
STU_STATE, STU_ZIP]
J9. Let’s start with the address where you get your mail.
CATI INSERT IF PAYMENT FLAG=1 OR 5 or 6: We will send the $10 gift card to this address.
CATI INSERT FOR ALL: The school district listed it as [ADDRESS]. Is that address correct?
YES ............................................................................. 1
GO TO J11
NO ............................................................................... 0
GO TO J10
DON’T KNOW ............................................................. d
GO TO J11
REFUSED ................................................................... r
GO TO J11
J9= 0
“your” if self response. “NAME’s” if proxy ( from SAMPLE FILE: )
“do you” if self response. “does he” or “does she” if proxy depending on youth’s gender.
J10.
What is your mailing address?
PROBE FOR AND RECORD BOTH P.O. BOX AND STREET ADDRESS
PROBE: Where do you stay most often?
(STRING (150))
ADDRESS 1
(STRING (150))
ADDRESS 2
(STRING (150))
CITY
(STRING (30))
STATE/TERRITORY
| | | | | |-| | |
ZIP CODE (+ 4 IF NEEDED)
|
|
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
SOFT CHECK: IF J10=d,r; At what address can {NAME} receive {his/her} gift card?
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Student Baseline Questionnaire: CATI Programming Specifications
ALL
J11.
What is the best telephone number at which to reach you?
| | | |-| | | |-| | | |
(RANGE)
(RANGE)
(RANGE)
|
DOES NOT HAVE A TELEPHONE NUMBER ............. 0
GO TO
DON’T KNOW ............................................................. d
GO TO
REFUSED ................................................................... r
GO TO
International Phone (STRING 30)
NOTE: ENTER “0” IF THE PERSON DOES NOT HAVE A TELEPHONE.
Jll ≠ 1,d,r
J11a.
Is that number a land line or cell phone?
LANDLINE ................................................................... 1
GO TO
CELL PHONE .............................................................. 0
GO TO J11b
DON’T KNOW ............................................................. d
GO TO
REFUSED ................................................................... r
GO TO
J11a = 0
“you” if self response. “him” or “her” if proxy depending on youth’s gender.
J11b.
Would it be ok for us to send you a text message when we try to contact you for the
next survey?
YES ............................................................................. 1
GO TO
NO - DOES NOT USE TEXT MESSAGING ................. 2
GO TO
NO ............................................................................... 0
GO TO
DON’T KNOW ............................................................. d
GO TO
REFUSED ................................................................... r
GO TO
J11 ≠ 1,d,r
“you” if self response. “him” or “her” if proxy depending on youth’s gender.
R1.
Is there another telephone number where we can reach {you/him/her} besides [CATI:
FILL NUMBER FROM J11]?
YES ............................................................................. 1
NO ............................................................................... 0
GO TO R2
DON’T KNOW ............................................................. d
GO TO R2
REFUSED ................................................................... r
GO TO R2
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Student Baseline Questionnaire: CATI Programming Specifications
R1=1
R1a.
What is that number?
| | | |-| | | |-| | | |
(RANGE)
(RANGE)
(RANGE)
|
DON’T KNOW ............................................................. d
GO TO R2
REFUSED ................................................................... r
GO TO R2
International Phone (STRING (NUM))
R1A ≠ d,r
R1b.
Is that a land line or cell phone?
LANDLINE ................................................................... 1
GO TO R2
CELL PHONE .............................................................. 2
DON’T KNOW ............................................................. d
GO TO R2
REFUSED ................................................................... r
GO TO R2
R1b = 2
“you” if self response. “him” or “her” if proxy depending on youth’s gender.
R1c.
Would it be ok for us to send {you/him/her} a text message when we try to contact
{you/him/her} for the next survey?
YES ............................................................................. 1
DOES NOT USE TEXT MESSAGING ON PHONE ..... 2
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
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Student Baseline Questionnaire: CATI Programming Specifications
ALL
“do you” if self response. “does he” or “does she” if proxy depending on youth’s gender.
“you” if self response. “him” or “her” if proxy depending on youth’s gender.
“your” if self response. “his” or “her” if proxy depending on youth’s gender.
R2.
How about email – {do you/ does he/she} have an e-mail address where we can send
study related information to {you/him/her}?
IF NEEDED: This may include things like an email to verify {your/his/her} contact
information, an invitation to complete the survey, or a reminder about the survey.
YES ............................................................................. 1
NO ............................................................................... 0
GO TO R3
DON’T KNOW ............................................................. d
GO TO R3
REFUSED ................................................................... r
GO TO R3
R2 = 1
“you” if self response. “he” or “she” if proxy depending on youth’s gender.
“check” if self response. “checks” if proxy
R2a.
What is the email address {you/he/she} check{s} most often?
(STRING (500))
EMAIL
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
ALL
“Do you” if self response. “Does he” or “Does she” if proxy depending on youth’s gender.
R3.
{Do you/ Does he/she} have a Facebook account?
YES ............................................................................. 1
NO ............................................................................... 0
GO TO R4
DON’T KNOW ............................................................. d
GO TO R4
REFUSED ................................................................... r
GO TO R4
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R3 = 1
“you” if self response. “him” or “her” if proxy depending on youth’s gender.
“your” if self response. “his” or “her” if proxy depending on youth’s gender.
R3a.
May we send {you/him/her} a message through Facebook if we are unable to reach
{you/him/her} by mail, phone, or {your/his/her} regular email address?
YES ............................................................................. 1
NO ............................................................................... 0
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
ALL
“you” if self response. “him” or “her” if proxy depending on youth’s gender.
“you” if self response. “he” or “she” if proxy depending on youth’s gender.
“move” if self response. “moves” if proxy.
“change” if self response. “changes” if proxy.
“your” if self response. “his” or “her” if proxy, depending on youth’s gender.
R4.
In case we have trouble reaching {you/him/her} directly when we do the next survey, we
would like to get the contact information for another person who will always be able to
reach {you/him/her}.
Can you give me the name of a friend or relative who does not live with {you/him/her} and
would know how to reach {you/him/her} if {you/he/she} move{s} or change{s}
{your/his/her} telephone number? What is that person’s name?
(STRING 100)
FIRST NAME
(STRING 100)
MIDDLE INITIAL/NAME
(STRING 100)
LAST NAME
DON’T KNOW ............................................................. d
GO TO R10
REFUSED ................................................................... r
GO TO R10
CATI: ALLOW DK or REF FOR ANY PORTION OF NAME AND ALLOW INTERVIEWER TO CAPTURE/OFFER NEXT FIELD.
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Student Baseline Questionnaire: CATI Programming Specifications
R4 ≠ d,r
“your” if self response. “his” or “her” if proxy, depending on youth’s gender.
R4a.
What is {your/his/her} relationship with this person? IF NEEDED: Is this person a
relative, a friend, or some other person in {your/his/her} life?
NOTE: CODE STEPPARENTS AS MOTHER OR FATHER.
CODE ONE ONLY
MOTHER/FATHER ...................................................... 1
BROTHER/SISTER ..................................................... 2
GRAND MOTHER/GRANDFATHER ........................... 3
AUNT/UNCLE.............................................................. 4
COUSIN ...................................................................... 5
OTHER RELATIVE ...................................................... 6
FRIEND ....................................................................... 7
CASE MANAGER – SPECIFY NAME OF AGENCY .... 8
(STRING 150)
OTHER NON-RELATIVE ............................................. 98
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
R4 ≠ d,r
Fill first name from R4
R5.
What is {NAME FROM R4}’s mailing address?
COLLECT/CONFIRM CURRENT CONTACT INFORMATION FOR RESPONDENT
(STRING 100)
ADDRESS 1
(STRING 100)
ADDRESS 2
(STRING 200)
CITY
(STRING 30)
STATE/TERRITORY
| | | | | |-| | |
ZIP CODE (+ 4 IF NEEDED)
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|
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
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Student Baseline Questionnaire: CATI Programming Specifications
R4 ≠ d,r
Fill first name from R4
R6.
What is the best telephone number at which to reach {NAME FROM R4}?
|
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|-|
(RANGE)
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|
|-|
|
(RANGE)
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|
(RANGE)
DOES NOT HAVE A TELEPHONE NUMBER ............. 1
GO TO R7
DON’T KNOW ............................................................. d
GO TO R7
REFUSED ................................................................... r
GO TO R7
International Phone (STRING 30)
R6 ≠ 1,d,r
Fill first name from R4
R7.
Is there another telephone number where we can reach {NAME FROM R4}?
YES ............................................................................. 1
NO ............................................................................... 0
GO TO R8
DON’T KNOW ............................................................. d
GO TO R8
REFUSED ................................................................... r
GO TO R8
R7 = 1
R7a.
What is that number?
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(RANGE)
|-|
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(RANGE)
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(RANGE)
DON’T KNOW ............................................................. d
GO TO R8
REFUSED ................................................................... r
GO TO R8
International Phone (STRING (NUM))
R4 ≠ d,r
Fill first name from R4
R8.
Does {NAME FROM R4} have an email address we can use in case we need help
contacting you for the next part of the study?
YES ............................................................................. 1
NO ............................................................................... 0
GO TO R10
DON’T KNOW ............................................................. d
GO TO R10
REFUSED ................................................................... r
GO TO R10
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Student Baseline Questionnaire: CATI Programming Specifications
R8=1
Fill first name from R4
R9.
What is the email address {NAME FROM R4} checks most often?
(STRING (500))
EMAIL
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
A3 = 1
{NAME} from SAMPLE FILE:
“your” if self response, “Name’s” “his/her” if proxy depending on gender of youth
Now, let’s talk about other parts of this study. I’ll describe each part one at a time. Then
I’ll ask you if you give your permission for that part or not. Each student’s math or
language arts teacher would be asked to do a survey to learn more about {your/{his/her}}
class. Do we have your permission to contact {your/{NAME}’s} math or language arts
teacher for that survey?
CATI: ACTIVATE THE F1 FEATURE TO ENABLE INFORMATION BAR, AS NEEDED.
AGREED - CONTINUE ............................................................. 1
DISAGREE/DECLINES THIS PORTION .................................. 2
DECLINES STUDY PARTICIPATION....................................... 0
GO TO J4
TERMINATE. STATUS AS 211 -
ROUTE TO REFUSAL MODULE.
CATI: DO NOT ALLOW DK or REF OPTION FOR J3.
A3a = d,r
“math” if MATH_LA calls for math teacher (MATH_LA=1), “language arts” if MATH_LA calls for language arts
teacher (MATH_LA=2)
“your” if self response, “his” or “her” if proxy depending on youth’s gender
J3a.
Can you provide the name of this [math / language arts] teacher?
STRING (20) (IF FIRST NAME = D,R, GO TO LAST NAME)
FIRST NAME
STRING (50)
LAST NAME
DON’T KNOW EITHER NAME .................................... d
REFUSED TO PROVIDE EITHER NAME ................... r
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Student Baseline Questionnaire: CATI Programming Specifications
A3b = d,r or “.” OR J3a=d, r OR J3a=d, r
“math” if MATH_LA calls for math teacher (MATH_LA=1), “language arts” if MATH_LA calls for language arts
teacher (MATH_LA=2)
If J3a = 1 “teacher’s”
“your” if self response, “his” or “her” if proxy depending on youth’s gender
J3b.
Can you provide this {teacher’s} email address?
YES – SPECIFY: _______________________ ........... 1
DON’T KNOW ............................................................. d
REFUSED TO PROVIDE EMAIL ................................. r
A4 = 1 or A4.5 = 1 OR D2_INTRO2 = 1 OR D2.5 = 1
“your” if self response, “Name’s” if proxy ( from SAMPLE FILE: )
“your” if self response, “his” or “her” if proxy depending on youth’s gender
We’d like to ask a staff member from {your/{NAME}’s} school to do two surveys to
learn about {your/his/her} IEP. These would be completed by the person who knows
most about {your/his/her} IEP. One will be completed now and the next will be in 2014.
Do we have your permission to contact this staff person?
IF NEEDED: An IEP is an Individualized Education Program that describes how a student learns
best and what teachers should do to help the student learn most effectively.)
CATI: ACTIVATE THE F1 FEATURE TO ENABLE INFORMATION BAR, AS NEEDED.
AGREED – CONTINUE………………………..1
GO TO J4a
DISAGREE/DECLINES THIS PORTION…….2
DOES NOT HAVE AN IEP…………………….3
GO TO J4.5
GO TO J4.5
DECLINES STUDY PARTICIPATION………..0
TERMINATE. STATUS AS 211 - ROUTE TO
REFUSAL MODULE.
CATI: DO NOT ALLOW DK or REF OPTION FOR J4.
(A4 = 1 or A4.5 = 1) AND J4 =2 OR 3
“you” if self response, “STUDENT” if proxy ( from SAMPLE FILE: )
J4.5.
Maybe another name is used for these services. The school said you get some type of
accommodations or help in school. Do you give us permission to contact the staff
person who could complete a survey about any services {you/ STUDENT NAME} may
receive?
AGREED - CONTINUE ................................................ 1
GO TO J4a
DISAGREE / DECLINES THIS PORTION ................... 2
GO TO J5
DECLINES STUDY PARTICIPATION ......................... 0
TERMINATE. STATUS AS 211 -
ROUTE TO REFUSAL MODULE.
CATI: DO NOT ALLOW DK or REF OPTION FOR J4.5.
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Student Baseline Questionnaire: CATI Programming Specifications
J4=1 OR J4.5 = 1
J4a.
Can you provide the name of this staff person who is most knowledgeable about
services provided at school?
YES – SPECIFY: ......................................................... 1
STRING (20) (IF FIRST NAME UNKNOWN, GO TO LAST NAME)
FIRST NAME
STRING (50)
LAST NAME
DON’T KNOW EITHER NAME .................................... d
REFUSED TO PROVIDE EITHER NAME ................... r
J4a = 1 OR J4.5 = 1 or J4a=d, r
If J4a = SPECIFIED, FILL WITH TEACHER’S NAME
J4b.
Can you provide this person’s email address?
IF NEEDED: For the person who is most knowledgeable about services provided at
school.
YES – SPECIFY: _________ (STRING 200 CHAR) .... 1
DON’T KNOW ............................................................. d
REFUSED ................................................................... r
A5 = 1
“your” if self response, “Name’s” if proxy ( from SAMPLE FILE: )
“you have” if self response. “she has” or “he has” if proxy depending on youth’s gender.
“your” if self response, “his” or “her” if proxy depending on youth’s gender
In 2014, the researchers will look at students’ school transcripts to see what courses
they have taken. Do you give permission for them to access {your / his / her} school
records?
AGREED - CONTINUE ................................................ 1
GO TO J6
DISAGREE/DECLINES THIS PORTION ..................... 2
GO TO J6
DECLINES STUDY PARTICIPATION.......................... 0
TERMINATE. STATUS AS 211 -
ROUTE TO REFUSAL MODULE.
CATI: DO NOT ALLOW DK or REF OPTION FOR J5.
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Student Baseline Questionnaire: CATI Programming Specifications
A6 = 1
“you are” if self response. “NAME is” if proxy ( from SAMPLE FILE: )
“you” if self response. “him” or “her” if proxy depending on youth’s gender.
“your” if self response. “his” or “her” if proxy depending on youth’s gender.
“you are” if self response. “NAME is” if proxy ( from SAMPLE FILE: )
“you” if self response. “him” or “her” if proxy depending on youth’s gender.
If {you are/ {NAME} is} around 16 to 18 years old in 2014, we may ask {you/him/her} to
take a special test called an academic assessment. This test is only for this study and
will not count towards any of {your/his/her} classes in school. Do we have your
permission to complete that assessment?
IF NEEDED: The test will take between 15 and 45 minutes.
CATI: ACTIVATE THE F1 FEATURE TO ENABLE INFORMATION BAR, AS NEEDED. DO NOT ALLOW DK or REF OPTION
FOR J6.
AGREED - CONTINUE ................................................ 1
GO TO J7
DISAGREE/DECLINES THIS PORTION ..................... 2
GO TO J7
DECLINES STUDY PARTICIPATION.......................... 0
TERMINATE. STATUS AS 211 -
ROUTE TO REFUSAL MODULE.
A7 =1, 2, or 3
“your” if self response. “NAME’s” if proxy ( from SAMPLE FILE: )
“your” if self response. “his” or “her” if proxy depending on youth’s gender.
To learn more about how students are doing in the future, the researchers may want to
look at databases on college enrollment, financial aid for college, vocational
rehabilitation agency services or the Social Security Administration’s records about jobs
or benefits. Do you grant permission for the researchers to look at these data?
AGREED, CONTINUE ............................................................ 1
GO TO J8
DECLINES STUDY PARTICIPATION ..................................... 0
TERMINATE. STATUS AS 211 - ROUTE TO
REFUSAL MODULE.
CATI: DO NOT ALLOW DK or REF OPTION FOR J7.
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Student Baseline Questionnaire: CATI Programming Specifications
ALL
“your” if self response. “NAME’s” if proxy ( from SAMPLE FILE: )
If you have any questions about your rights as a research volunteer, you can call the New
England Institutional Review Board (IRB). They looked at this study to make sure your rights are
protected. You can ask questions or drop out of the study at any time by calling Mathematica
Policy Research.
IF NEEDED: Mathematica’s toll-free number is 866-964-7962. New England IRB’s telephone
number is 617-243-3924.
AGREES TO TAKE PART - CONTINUE ......................... 1
DECLINES STUDY PARTICIPATION ......................... 0
TERMINATE. STATUS AS 211 AND
ROUTE TO REFUSAL MODULE.
LOAD FOR ALL, BUT NOT POPULATED FOR INTERVIEWER – CATI VARIABLE ONLY IN BLAISE
BLIND TO INTERVIEWERS
IF J8 = 1, RECORD INTERVIEWER ID (A WINDOWS ENVIRONMENT VARIABLE) OF THE
INTERVIEWER WHO GOT THE CONSENT AND THE DATE SO IT MAY BE FILLED ON THE CONSENT FORM
THAT IS MAILED TO THE RESPONDENT.
PAYMENT FLAG = 1 OR 5 or 6
R10.
Thank you for answering all these questions. As I said earlier, we will send a $10 gift card
as a thank you. Would {you/he/she} prefer a gift card to amazon.com (where {you/he/she}
can make a purchase or download music), a $10 gift card to Target, or a $10 gift card to
AMC movie theaters? (NEW)
CODE ONE ONLY
A $10 CARD FOR AMAZON.COM, ............................. 1
A $10 CARD FOR USE AT TARGET........................... 2
A $10 CARD FOR AMC MOVIE THEATRES............... 3
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Student Baseline Questionnaire: CATI Programming Specifications
ALL
This is the end of our survey.
CATI INSERT IF PAYMENT FLAG= (1 OR 5 OR 6) AND J1B=1: You should receive the $10 gift
card in the next few weeks.
CATI INSERT IF PAYMENT FLAG= (1 OR 5 OR 6) AND RESPONDENT IS A PROXY (J1B=2): We
are sending you a $10 gift card to give to or use for [STUDENT]. You should receive it in the
next few weeks.
CATI INSERT FOR ALL: If (you have/ he has/ she has} any questions about the study, or if
{your/his/her} contact information changes, please call us toll-free at 866-964-7962. Thanks for
taking time to answer these questions today.
IF NEEDED: {You/he/she} can also visit our website at: http://ies.ed.gov/ncee/nlts.
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| File Type | application/pdf |
| Author | Daniel Friend |
| File Modified | 2012-07-24 |
| File Created | 2012-07-24 |