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Supporting
Statement for OMB Clearance Request
Appendix
J: HPOG-Impact 15-month Control Group Member Follow-Up Survey
National
Implementation Evaluation of the Health Profession Opportunity Grants
(HPOG) to Serve TANF Recipients and Other Low-Income Individuals and
HPOG Impact Study
0970-0394
April 24, 2013
Submitted by:
Office of Planning,
Research & Evaluation
Administration for
Children & Families
U.S. Department of
Health
and Human Services
Federal Project
Officers:
Molly Irwin and
Mary Mueggenborg
Appendix
J: HPOG-Impact 15-month Control Group Member Follow-Up Survey
Introduction
Hello, my name is [
]. May I please speak with _____?
Thank you for taking the time to
talk with me today. I work for a company called Abt SRBI. Abt SRBI
is an independent research company and we are helping the
Administration for Children and Families (ACF) in the U.S. Department
of Health and Human Services (HHS) with its evaluation of the Health
Profession Opportunity Grants (HPOG) program. You agreed to be part
of the study around [RAD] (when you signed a consent form to let
researchers collect information from you).
We need to talk with people who
got into the program and those who did not. Your participation in
this study will help policymakers and program operators better
understand how to help people attain educational credentials and find
and keep jobs in the healthcare field. This interview will include
questions on your education activities, your use of services, and
your overall well-being.
The questions will take about 35
minutes to complete, and when we are done, you will receive $30, in
appreciation for your time. Before we begin the survey, I would like
to assure you that all of your responses on this survey will be kept
private; your name will not appear in any written reports we produce.
Your responses to these questions are completely voluntary.
That means you may choose not to answer any question, or you may stop
the interview if you wish, but we hope you don’t. Your
responses to these questions will in no way affect your participation
in any programs or your receipt of any kinds of public benefits or
services. The information you provide will be kept private and
only used for this study.
According to the Paperwork
Reduction Act (PRA), an agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number. The OMB
control number for this collection is 0970-0394 and it expires
xx/xx/xxxx.
If you have comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for
reducing this burden, please send them to [Contact Name]; [Contact
Address]; Attn: OMB-PRA (0970-0397).Do you have any questions before
we begin?
Let’s begin now.
Screener/Verification:
First I just need to verify that
I am speaking with the correct person.
What is your date of birth?
What are the
last 4 digits of your Social Security Number?
-
Topic
|
Source
|
ISIS Item
|
Notes on Coordination
|
Type and amount of vocational and academic training and
degrees/certification received since random assignment
|
My
first set of questions is about any school or training
experiences you have had since [RAD]. To help you remember this
date, our records show that it was about then that you applied
for the [HPOG] program [AT (NAME OF HOST INSITUTION, IF
DIFFERENT FROM PROGRAM NAME)].
Since
[RAD], have you taken any classes or been in an instructional
program of any kind anywhere, even for a short time? This may
have been offered by a community organization, college, high
school, employer, or somewhere else.
YES
NO
REFUSED
DON’T
KNOW
|
ISIS follow-up
|
No change
|
|
Did you
take these classes at one school or organization, or did you
take these classes at more than one place?
IF
MORE THAN ONE: How many places did you take classes?
|
Adapted from ISIS follow-up
|
Did you go to one school or organization, or did you go to more
than one place?
(No change to answer choices)
IF
Yes: How many places did you
go?
|
To make clear that the prior question’s classes are what we
are asking about.
ISIS and HPOG coding will be compatible
|
At what
type of place(s) did you take these classes?
COMPANY
WHERE RESPONDENT WORKS
COMMUNITY
COLLEGE/2 YEAR COLLEGE
4
YR COLLEGE/UNIVERSITY
STATE
UNEMPLOYMENT/EMPLOYMENT OFFICE
ONE-STOP
CENTER
ADULT
ED/ADULT HS/COMMUNITY SCHOOL/NIGHT SCHOOL
PRIVATE
COMPANY THAT PROVIDES TRAINING
COMMUNITY
BASED ORG/NON PROFIT ORG
SOME
PLACE ELSE (SPECIFY)____
REFUSED
DON’T
KNOW
|
Adapted from ISIS follow-up
|
What type of place is this? [Asked per vendor]
(No change to answer choices)
|
We ask this question once in reference to individual’s
entire experience since RAD. HPOG-Impact respondents will note
all that apply. ISIS asks this question more than once in
reference to each of up to three training vendors where
individuals are currently enrolled or have been enrolled since
RAD. In order to make the ISIS responses comparable to the
non-location-specific version of the questions, for the
subsequent questions about respondents’ experiences, we
will aggregate across locations to identify simply whether or not
an individual enrolled/participated in the particular education/
training/service under question. For example, if an ISIS
respondent answers “Yes” to something about Location
1, “No” about Location 2 and “Don’t Know”
about Location 3, we would code that as “Yes”:
the respondent had that experience in at least one location.
A “No,” “No,” “Don’t Know”
set of responses would “sum” to “No.”
|
I’m
going to mention some different types of classes. For each one,
please tell me if it is a type that you are taking or have taken
since [RAD]. I’m interested in any classes you have
taken, even if you only went for a short time.
Classes
to improve your basic reading, writing, or math skills or
prepare for a high school equivalency or college placement test?
Do not count any classes providing regular college credit.(I
will ask you about college credit classes separately)
Classes
to learn English as a Second Language? Again, do not count
regular college classes.
Classes
providing regular college credit?
Classes
providing occupational training, but not for college credit?
Classes
in other skills, such as how to succeed at school, work, or
other areas of life? (Please include any such classes, whether
for college credit or not.)
|
Adapted from ISIS follow-up
|
Now I’m going to mention some different types of
instruction. For each one, please tell me if it is a type that
you are taking or have taken at [PLACE 1] since [RAD]. I’m
interested in any classes you have taken, even if you only went
for a short time.
|
Exchanged “different types of instruction” for
“different types of classes” which we think is more
precise.
We ask this question once in
reference to individual’s entire (non-location-specific)
experience since RAD. ISIS asks this question more than once in
reference to each training vendor. Will sum across ISIS
location-specific responses (see note re: #3).
|
IF BASIC SKILLS
|
I have a
few questions about the basic skills classes. How many basic
skills courses have you taken (including those you may not have
completed) since [RAD]?
|
Adapted from ISIS follow-up
|
Are you
currently taking these classes (or between terms), did you
complete them, or did you stop without completing the classes?
|
Modified questions to fit our overall (non-location-specific)
experience format. We added the number of classes question
because that is an outcome of interest. See note re: #3 on
summing across locations.
|
Are you
currently taking any basic skills courses
YES
NO
REFUSED
DON’T
KNOW
|
Adapted from ISIS follow-up
|
Did you
start any basic skills courses that you did not complete?
YES
NO
REFUSED
DON’T
KNOW
|
Adapted from ISIS follow-up
|
IF ESL
|
Now
I have some questions about the ESL classes. How
many ESL courses have you taken (including those you may not
have completed) since [RAD]?
|
Adapted from ISIS follow-up
|
Are you
currently taking these classes (or between terms), did you
complete them, or did you stop without completing the classes?
|
Modified questions to fit our overall experience format. We added
the number of classes question because that is an output of
interest. See note re: #3 on summing across locations.
|
Are you
currently taking any ESL courses
YES
NO
REFUSED
DON’T
KNOW
|
Adapted from ISIS follow-up
|
Did you
start any ESL courses that you did not complete?
YES
NO
REFUSED
DON’T
KNOW
|
Adapted from ISIS follow-up
|
IF Other (school/work/life) Skills
|
Now I’d
like to ask about the classes you took in other skills, such as
how to succeed at school, work, or other areas of life. Here
I’m interested in any classes you took of this type,
whether or not they were for college credit. How many
other skills courses have you taken (including those you may not
have completed) since [RAD]?
______
|
Adapted from ISIS follow-up
|
Now I’d like to ask about the classes you took in other
skills, such as how to succeed at school, work, or other areas of
life. Here I’m interested in any classes you took of this
type, whether or not they were for college credit.
How
many other skills courses have you taken (including those you may
not have completed) since [RAD]?
______
|
We originally adapted the ISIS text to include this question
regarding the number of other classes because that is an output
of interest. ISIS then added this new question to its follow-up
survey for non-HPOG sites for consistency. Now both the HPOG and
ISIS follow-up surveys include the new question.
|
For about how many days or weeks did you
attend these classes?
|
ISIS follow-up
|
No change
|
|
And about how many hours did you attend
these classes each [day/week]?
|
ISIS follow-up
|
No change
|
|
Are you
currently taking any other skills courses right now?
YES
NO
REFUSED
DON’T
KNOW
|
Adapted from ISIS follow-up
|
ISIS does not ask for “other courses”
|
|
Did you
start any other skills courses that you did not complete?
YES
NO
REFUSED
DON’T
KNOW
|
Adapted from ISIS follow-up
|
ISIS does not ask for “other courses”
|
|
Were they
offered for college credit?
YES
NO
REFUSED
DON’T
KNOW
|
ISIS follow-up
|
|
We ask this question once in reference to individual’s
entire experience since RAD. ISIS asks this question more than
once in reference to each training vendor. See note re: #3 on
summing across locations.
|
I’m going
to read a list of subjects that other skills classes sometimes
cover. For each one, please tell me whether it received a great
deal of attention, some attention, or no attention in any of the
soft skills classes you took:
Career planning
Study skills, such as locating
information, taking notes, and preparing for classes and exams
Finding a job or moving to a
different job
Critical thinking and
problem-solving skills
Finding help with problems at
school, work, or home
Finding and applying for
financial aid for school
Managing time effectively
Working in groups
Communicating well (for
example, good listening and speaking skills)
Managing stress and anger
Staying motivated
Acting professionally (for
example, how to dress, show good attendance habits, be
respectful)
Managing money and personal
finances
Handling parenting and other family responsibilities
|
Adapted from ISIS follow-up
|
I’m going to read a list of subjects that instruction like
this sometimes covers. For each one, please tell me whether it
received a great deal of attention, some attention, or no
attention in the classes you took:
(No change in answer choices)
|
Exchanged “instruction” for “other skills
classes” which we think is more precise.
|
IF REGULAR COLLEGE CREDIT
|
Now I have some questions about classes you
have taken for regular college credit. How many classes for
college credit have you enrolled in (including those you may not
have completed) since [RAD]?
|
Adapted from ISIS follow-up
|
Regardless of whether you finished them, about how many classes
have you ever enrolled in at [PLACE 1] since [RAD]?
|
See rationale and note re: #3 on summing across locations.
|
Have you
earned any regular college credits so far since [RAD]?
YES
NO
REFUSED
DON’T
KNOW
IF
YES: How many credits have
you earned?
|
Adapted from ISIS follow-up
|
Have you earned any regular college credits so far at [PLACE 1]
since [RAD]?
How many credits have you earned?
(No change to answer choices)
|
See rationale and note re: #3 on summing across locations.
|
About
when did you start taking classes for college credit? Please
give me the month and year you started.
|
Adapted from ISIS follow-up
|
About when did you start going to [PLACE 1]? Please give me the
month and year you started. [Asked per vendor]
|
See rationale and note re: #3 on summing across locations.
|
Are you
currently taking any classes for college credit? (Answer “yes”
if you are on a spring, summer, or holiday break.)
YES
NO
REFUSED
DON’T
KNOW
IF
NO: About when did you stop taking college credit courses?
|
Adapted from ISIS follow-up
|
Are you currently taking classes for college credit? (Answer
“yes” if you are on a spring, summer, or holiday
break.)
What [is/was] your main goal in
taking college classes at [PLACE 1]?
Did you complete the courses needed
to reach the goal you just mentioned?
IF NO: Are
you still enrolled or between terms?
IF NO: Did you stop without
completing the program?
IF STOPPED WITHOUT COMPLETING: What was the main reason that
you stopped attending the classes? (No change in answer choices)
|
Modified questions to fit our overall experience format.
|
Did you start any classes for
college credit that you did not complete?
YES
NO
REFUSED
DON’T
KNOW
IF
STOPPED WITHOUT COMPLETING: What was the main reason that you
stopped attending these classes?
POOR
GRADES
COURSES
OR PROGRAM POORLY TAUGHT
STARTED
OTHER SCHOOL/TRAINING
NOT
ENOUGH MONEY TO CONTINUE
NOT
ENOUGH TIME TO CONTINUE
DIDN’T
LIKE PROGRAM
NOT
INTERESTED IN PROGRAM
DIDN’T
THINK IT WOULD HELP ME FIND A JOB
ILLNESS
PREGNANCY
CHILD
CARE ISSUES
OTHER
FAMILY REASONS
TRANSPORTATION/COORDINATION
PROBLEMS
FOUND
JOB/RE-EMPLOYED
OTHER
(SPECIFY)____
REFUSED
DON’T
KNOW
|
Adapted from ISIS follow-up
|
IF OCCUPATIONAL TRAINING (not for college credit)
|
Now I’d like to ask about the
occupational training classes you said you have taken. These
were the job training courses you took that were not for college
credit. How many occupational training courses have you taken
(including those you may not have completed) since [RAD]?
|
Adapted from ISIS follow-up
|
ISIS does not ask for “occupational training”
|
We added the number of classes question because that is an
outcome of interest.
|
About
when did you start taking occupational training courses? Please
give me the month and year you started.
|
Adapted from ISIS follow-up
|
About when did you start going to [PLACE 1]? Please give me the
month and year you started. [Asked per vendor]
|
Modified questions to fit our overall experience format.
|
Are you currently receiving this
occupational training?
YES
NO
REFUSED
DON’T
KNOW
IF
NO: About when did you stop taking occupational training
courses?
|
Adapted from ISIS follow-up
|
Are you currently receiving this training, did you complete the
training, or did you stop without completing training?
CURRENTLY RECEIVING THIS TRAINING
COMPLETED THE TRAINING
STOPPED WITHOUT COMPLETING
REFUSED
DON’T KNOW
IF STOPPED WITHOUT COMPLETING: What was the main reason that you
stopped attending the training? (No change in answer choices)
|
Did you start any occupational
training that you did not complete?
YES
NO
REFUSED
DON’T
KNOW
IF
STOPPED WITHOUT COMPLETING: What was the main reason that you
stopped attending the training?
POOR
GRADES
COURSES
OR PROGRAM POORLY TAUGHT
STARTED
OTHER SCHOOL/TRAINING
NOT
ENOUGH MONEY TO CONTINUE
NOT
ENOUGH TIME TO CONTINUE
DIDN’T
LIKE PROGRAM
NOT
INTERESTED IN PROGRAM
DIDN’T
THINK IT WOULD HELP ME FIND A JOB
ILLNESS
PREGNANCY
CHILD
CARE ISSUES
OTHER
FAMILY REASONS
TRANSPORTATION/COORDINATION
PROBLEMS
FOUND
JOB/RE-EMPLOYED
OTHER
(Please SPECIFY)____
REFUSED
DON’T
KNOW
|
Adapted from ISIS follow-up
|
Academic and industry-recognized credentials earned since
random assignment
|
Now I’m
going to ask you questions about your overall training
experience since [RAD]. [Are/were] you taking classes to prepare
for work in a particular occupation?
YES
NO
REFUSED
DON’T KNOW
IF YES: Are/were you taking
classes to prepare for work in a particular healthcare
occupation?
IF YES HEALTHCARE: I am going
to read you a list of types of healthcare occupations. Please
tell me which type you were preparing for when you took those
classes:
Administrative (such as
Medical Records and Health Information Technicians)
Technical (such as Medical and
Clinical Laboratory Technicians)
Direct personal care (such as
Home Health Aids or Certified Nursing Assistants)
Other, Please specify
|
Adapted from ISIS follow-up
|
Now I’m going to ask you
questions about your overall training experience since [RAD].
[Are/were] you taking classes to prepare for work in a particular
occupation?
YES
NO
REFUSED
DON’T KNOW
Is this occupation in the field of
healthcare?
YES
NO
REFUSED
DON’T KNOW
I am going to read you a list of
types of healthcare occupations. Please tell me which type you
were preparing for when you took those classes:
Administrative (such as Medical
Records and Health Information Technicians)
Technical (such as Medical and
Clinical Laboratory Technicians)
Direct personal care (such as Home
Health Aids or Certified Nursing Assistants)
Other, Please specify ________________
|
We ask this question once in reference to individual’s
entire experience since RAD. ISIS asks this question for college
credit courses.
We also originally adapted the ISIS text to include the
healthcare specification to fit HPOG. ISIS then included this
question in its survey for HPOG sites for consistency. Now both
the HPOG and ISIS/HPOG follow-up surveys include the new
healthcare question.
|
Overall, what
[is/was] your main goal in taking classes? Would you say it
[is/was](CHOOSE ONE):
To complete specific courses
needed for a job (not to get a certificate/degree)
To earn a certificate,
license, or credential
To earn an Associate’s
Degree
To earn a Bachelor’s
degree or higher
Other reason (please specify)
REFUSED
DON’T KNOW
|
Adapted from ISIS follow-up
|
What [is/was] your main goal in taking college classes at [PLACE
1]? Would you say it [is/was](CHOOSE ONE): [Only asked for
“college credit classes”]
To complete specific courses
needed for a job (not to get a certificate/degree)
To earn a certificate
requiring less than a full year’s worth of credit
To earn a certificate
requiring a full year or more’s worth of credit (but less
than an Associate’s Degree)
To earn an Associate’s
Degree
To earn a Bachelor’s
degree or higher
Other reason (specify)
REFUSED
DON’T KNOW
Did you take/are you taking this training to prepare you to
earn a certificate, license or credential?
|
We ask this question once in reference to individual’s
entire experience since RAD. ISIS asks separate questions for
college credit courses and occupational training.
The ISIS college credit answer choices “To earn a
certificate requiring less than a full year’s worth of
credit,” “To earn a certificate requiring a full year
or more’s worth of credit (but less than an Associate’s
Degree)” and a “Yes” response to the ISIS
occupational training question will be coded to equal our “To
earn a certificate, license, or credential” answer.
|
[Did you/Will
you] receive a [INSERT FROM QUESTION ABOVE] after completing the
training?
IF YES, specify the type of
certificate/license/credential/degree
|
Adapted from ISIS follow-up
|
[IF MAIN GOAL IN TAKING COLLEGE CLASSES WAS TO EARN A
DIPLOMA/CERTIFICATE OR HIGHER]: What is the name of the
diploma/certificate or degree you earned?
[IF RECEIVED/ EXPECT TO RECEIVE A
DIPLOMA OR CERTIFICATE AFTER COMPLETE OCCUPATIONAL TRAINING: What
is the name of the diploma/or certificate you earned?
|
We ask this question once in reference to individual’s
entire experience since RAD. ISIS asks separate questions for
regular college credit and occupational training.
|
As
of right now, what is the highest degree or level of education
that you have completed?
Grade
1 through 12 (no high school degree/GED)
High
school diploma
GED
or alternative credential
Certificate
requiring less than one full year of training after high school
Certificate
requiring a year or more of training after high school
Associate’s
degree
Bachelor’s
degree or above
REFUSED
DON’T
KNOW
|
ISIS follow-up
|
What is the highest degree or level of education that you have
completed?
|
|
Knowledge of/access to financial resources necessary for
continued education
|
|
|
In the next set
of questions we are interested in the types of services and
assistance you may have received since [RAD]. During your
training experience since [RAD], have you needed to find money
outside of your own income to help pay for some or all of the
direct costs of education and training – that is, things
like tuition and fees – or were these costs already
handled for you?
|
Adapted from ISIS follow-up
|
First, at [PLACE 1], have you needed to find outside money to
help pay for some or all of the direct costs of education and
training – that is, things like tuition and fees – or
were these costs already handled for you? [Asked at the vendor
level]
Change to answer choice: NEEDED TO FIND OUTSIDE MONEY
|
Modified to clarify definition of “outside money.”
See also note re: #3.
|
IF NEEDED TO
FIND OUTSIDE MONEY (e.g., in addition to your own income): Now
I’m going to read a list of sources of income that can
help pay for either living expenses or direct school costs.
Please let me know if any of the following sources help pay for
the direct and indirect costs of education and training.
Income from a spouse, parent
or other family member
Pell grant or other government
grant or scholarship—not counting loans that you have to
pay back
Grant or scholarship from any
non-government source--not counting loans that you do not have
to pay back
Loans
|
Adapted from ISIS follow-up
|
IF ‘NEEDED TO FIND OUTSIDE MONEY’: Now I’m
going to read a list of sources of income that can help pay for
either living expenses or direct school costs. For each, please
let me know if it has helped to pay for either training or living
expenses while you have attended [PLACE 1].
IF ‘COSTS ALREADY HANDLED’
ONLY ASK FOR LIVING EXPENSES: Now I’m going to read a list
of sources of income that can help pay for living expenses. For
each, please let me know if it has helped to pay for living
expenses while you have attended [PLACE 1].
Next, did income from a spouse,
parent or other family member help to pay for:
Tuition?
Other school-related expenses?
Living expenses?
Did you receive a Pell Grant or
other government grant or scholarship—not counting loans
that you have to pay back—to help pay for:
Tuition?
Other school-related expenses?
Living expenses?
Did you receive a grant or
scholarship from any non-government source---not counting loans
that you do not have to pay back—to help pay for:
Tuition?
Other school-related expenses?
Living expenses?
Finally, did you receive any loans
to help pay for:
Tuition?
Other school-related expenses?
Living expenses?
|
Truncated ISIS question because we are only interested to know if
individuals used outside money to pay for the direct and indirect
costs of training as well as the type of outside money. We do not
need to know the type of expense the outside money covered.
Also, we ask this question once in
reference to individual’s entire experience since RAD. ISIS
asks this question more than once in reference to each training
vendor. See note re: #3.
A “Yes” response to at least one of the expense
types for each ISIS outside income source question will be coded
as a “Yes” response to our outside income source
question.
|
Would you say
that it has been very difficult, somewhat difficult, or not very
difficult to obtain enough financial support for school?
VERY DIFFICULT
SOMEWHAT DIFFICULT
NOT VERY DIFFICULT
REFUSED
DON’T KNOW
|
ISIS follow-up
|
No change
|
|
Type and amount of social services received since random
assignment
|
|
|
During your
overall training experience since [RAD], have you received
[SERVICE FROM BELOW] from any source? [WHERE YES: About how
frequently did you receive [SERVICE FROM BELOW] (weekly;
monthly; every six months; annually)?
Academic advising (help
choosing courses)
Financial aid advising
Tutoring in subjects where
you needed extra help
Career counseling
Job search or placement
assistance
Help arranging for supports
to help you manage school or work (for example, child care,
transportation, housing, counseling/treatment for
personal/family problems – sometimes called “case
management”)
Comprehensive assessments (to
learn about your skills sets , such as WorkKeys, COMPASS, or
ACCUPLACER)
Personal counseling
Peer support groups
Emergency assistance
Incentives (for example, a gift card for completing a
course)
|
Adapted from ISIS follow-up
|
While going to [PLACE 1] have you received SERVICE FROM BELOW]
from any source? [WHERE YES: About how many times did you
receive [SERVICE FROM BELOW]? [Asked at the vendor level]
Academic advising (help
choosing courses)
Financial aid advising
Tutoring in subjects where you
needed extra help
Career counseling
Job search or placement
assistance
Help arranging for supports to help you manage school or
work (for example, child care, transportation, housing,
counseling/treatment for personal/family problems)
|
We ask this question once in reference to individual’s
entire experience since RAD. ISIS asks this question more than
once in reference to each training vendor. See note re: #3.
We added additional services of interest.
|
During your
overall training experience since [RAD], did you receive
assistance from a program, school, or other organization to pay
for:
Child care costs
Transportation-related costs
School supplies or fees
Work-related clothes or tools
Any other important needs (Please specify)
|
Adapted from ISIS follow-up
|
While going to [PLACE 1], did you received help assistance from a
program, school, or other organization to paying for:: [Asked per
vendor]
(No changes to answer choices)
|
We ask this question once in reference to individual’s
entire experience since RAD. ISIS asks this question more than
once in reference to each training vendor. See note re: #3.
Otherwise, any revision to language was coordinated between HPOG
& ISIS.
|
During your
overall training experience since [RAD], have you been offered
any of the following opportunities for direct experiences with
occupations related to your studies or career goals?
Work study job
Clinical experience or
practicum
Arranged visits from or to
learn about individual employers
Class taught by instructors
from local employer or offered on-site at local employer
An apprenticeship
Other work experience (Please specify: __________)
|
Adapted from ISIS follow-up
|
While at [PLACE 1], have you been offered any of the following
opportunities for direct experiences with occupations related to
your studies or career goals? [Asked at the vendor level]
(No changes to answer choices)
|
We ask this question once in reference to individual’s
entire experience since RAD. ISIS asks this question more than
once in reference to each training vendor. See note re: #3.
|
|
Newly developed
|
|
|
Aspirations/expectations re: education
|
|
|
Now I’d like to talk to you a
bit about your education goals. IF NO E&T SINCE RAD: I’m
going to read a list of possible reasons why people may not have
enrolled in school. For each one, please tell me whether it is
a very important, somewhat important, or unimportant reason in
your case. First,
You
don’t feel you need more education right now?
You
are waiting to apply for a particular program?
You
aren’t sure what would be the best program for you?
You
don’t think you have strong enough academic
skills/credentials?
You
don’t have enough time due to work?
You
don’t have enough time due to family responsibilities?
You
don’t think you could get enough financial aid to afford
to go?
You
haven’t been able to get into the kind of program you
wanted?
Some
other reason? (Please specify)
|
ISIS Follow-Up
|
No change
|
|
IF NOT CURRENTLY ENROLLED: Are you
planning to go back to school at some point?
YES
NO
REFUSED
DON’T
KNOW
|
ISIS Follow-Up
|
No change
|
|
What is the highest level of
education that you eventually expect to complete?
Grades
1-12 (no high school degree/GED)
High
school diploma
GED
Certificate
requiring less than one full year of training
Certificate
requiring a year or more of training
Associate’s
degree
Bachelor’s
degree
Graduate
degree
REFUSED
DON’T KNOW
|
ISIS follow-up
|
No change
|
|
Have you achieved this educational
goal yet?
YES
NO
REFUSED
DON’T
KNOW
IF NO: Would you say you
strongly agree, somewhat agree, somewhat disagree, or strongly
disagree with the following statement: I am making progress
towards my long-range educational goals?
Strongly agree
Somewhat agree
Somewhat disagree
Strongly disagree
REFUSED
DON’T KNOW
|
ISIS follow-up
|
No change
|
|
Healthcare and employment experience
|
This next set of
questions is about your current employment. Are you currently
working at a job for pay?
YES
NO
REFUSED
DON’T
KNOW
IF NO: Have you worked at a
job since [RAD]?
YES
NO
REFUSED
DON’T
KNOW
IF YES WORKING OR WORKED: Do
you/did work for a healthcare employer?
YES
NO
REFUSED
DON’T
KNOW
IF YES WORKING OR WORKED:
Are/were you employed in a healthcare job?
YES
NO
REFUSED
DON’T
KNOW
IF YES WORKING IN HEALTHCARE
OCCUPATION: I am going to read you a list of types of
healthcare occupations. Please tell me which type best
describes your [current/most recent] job:
Administrative (such as
Medical Records and Health Information Technicians)
Technical (such as Medical
and Clinical Laboratory Technicians)
Direct personal care (such
as Home Health Aids or Certified Nursing Assistants)
Other, Please specify
IF YES WORKING OR WORKED: How
many hours per week on average are/were you currently working?
(include all jobs)
IF YES WORKING OR WORKED:
About how much do/did you typically earn per hour before taxes
in your current/most recent job? (Answer for your main job if
more than one)
[IF R DOESN’T KNOW
HOURLY RATE] Can you tell me how much you earned for some
other time period besides hourly, such as per day, per week,
every two weeks, or month?
IF YES WORKING OR WORKED: At
your current/most recent job, does/did your employer offer
health insurance (regardless of whether you take/took it from
them)?
YES
NO
REFUSED
DON’T
KNOW
IF
YES INSURANCE: Did you receive insurance through your
employer?
YES
NO
REFUSED
DON’T
KNOW
IF
NO EMPLOYER INSURANCE: Did you receive insurance from another
source?
YES
NO
REFUSED
DON’T
KNOW
What
kind of work [do you do/did you do in your last job], that is,
what [is/was] your occupation?
What
[are/were] your usual activities or duties at this job? (For
example, keeping account books, filing, selling cars, operating
printing press, taking blood samples)
What
is/was your [current/most recent] job title?
|
Adapted from ISIS follow-up
|
Are you currently working at a job for pay?
IF YES: How many hours per week on
average are you currently working? (include all jobs)
Did you work before?
IF “YES” WORKING OR
WORKED BEFORE: About how much do/did you typically earn per hour
before taxes in your current or most recent job? (Answer for your
main job if more than one)
IF “YES” WORKING OR
WORKED BEFORE: At your current/last job, does/did your employer
offer health insurance (regardless of whether you take/took it
from them)?
IF YES INSURANCE: Did you receive insurance through your
employer?
IF NO: Did you receive insurance from another source?
What kind of work [do you do/did
you do in your last job], that is, what [is/was] your occupation?
What [is/was] your [current/most
recent] job title?
What
[are/were] your usual activities or duties at this job? (For
example, typing, keeping account books, filing, selling cars,
operating printing press, taking blood samples)
.ASK IF NOT
OBVIOUS FROM E4: Is this occupation in the field of healthcare?
YES
NO
REFUSED
DON’T KNOW
I am going to
read you a list of types of healthcare occupations. Please tell
me which type best describes your [current/most recent] job:
Administrative (such as Medical
Records and Health Information Technicians)
Technical (such as Medical and
Clinical Laboratory Technicians)
Direct personal care (such as Home
Health Aids or Certified Nursing Assistants)
Other, Please specify: ________________
|
We originally adapted the ISIS text to include the
healthcare-specific questions because these are outcomes of
interest. ISIS then added these questions for non-HPOG sites for
consistency. Now both the HPOG and ISIS surveys include the new
healthcare specific questions.
|
Aspirations/expectations re: employment
|
|
|
Now I’d like to talk to you a
bit about your career goals. Would you say you strongly agree,
somewhat agree, somewhat disagree, or strongly disagree with the
following statements:
I
am making progress towards my long-range employment goals.
I
see myself on a career path.
|
ISIS follow-up
|
No change
|
|
Do you expect to
be working for pay in the next few months?
IF
YES: How many hours do you expect to be working in a typical
week?
IF
YES: Do you expect to be working in a healthcare job or for a
healthcare employer?
|
Supplemental Baseline
|
|
|
How strongly do you agree/disagree
with the following statements about your work preferences:
(Strongly agree, Agree, Disagree, Strongly disagree)
How
much do you agree that you:
…will
take any job even if the pay is low?
… want only the kind of job that is related to
your training/education?
|
Adapted from the U.S. Department of Labor’s Green
Jobs-Health Care Evaluation
|
|
|
How
much must a job pay per hour for it to make sense for you to
take it?
|
Supplemental Baseline
|
|
|
How important is each of the
following to you in your life (not, somewhat, very)?
Being successful in your
line of work
Having lots of money
Being able to find steady
work
Becoming an expert in your
field of work
Getting a good job
|
(from:
http://nces.ed.gov/surveys/els2002/pdf/EarlyGrad_followup1.pdf
- partial item)
|
|
|
Knowledge of career opportunities in healthcare
|
|
|
IF NOT CURRENTLY WORKING: Do you
envision yourself working in a healthcare job?
|
Newly developed
|
|
|
a. If yes, would you say you know the
kind of careers that are available in healthcare in your local
area?
IF
YES: What type of credential or degree do you need to qualify
for a job like the kinds that you just reported to be
available in your local area?
Certificate/license
Associate’s
Degree
Bachelor’s
degree or higher
Work
experience/on-the-job training
Other
reason (please specify)
|
|
|
|
IF CURRENTLY WORKING: In your
current job, are there promotion opportunities?
IF
YES: Would you need additional education or training to be
promoted?
IF
YES: What type of credential or degree do you need to be
promoted?
IF
YES KNOW REQUIREMENTS: About how long would it take you to
earn the credential or degree?
0-3
months
4-6
months
6
months to a year
More
than a year
|
Newly developed
|
|
|
Barriers to employment
|
|
|
The next few questions are about
things like your financial situation and your health. In the
past 12 months, please note how often each of the following
situations interfered with your school, work, job search, or
family responsibilities: (Never, Almost never, Sometimes, Fairly
often, Very often)
Child
care arrangements?
Transportation?
Alcohol
or drug use?
An
illness or health condition?
Other,
please specify
|
Adapted from ISIS follow-up (and supplemental baseline)
|
ISIS answer choices:
Child care arrangements?
Transportation?
Alcohol or drug use?
An illness or health condition?
Spending time with friends?
Argument with a family member?
Physical threats/violence from a family member?
|
We did not include several answer choices. A “Yes”
response to these answer choices for ISIS will be coded to equal
the “other” answer choice for our question in order
to allow us to use data from both the ISIS and HPOG versions of
the survey.
|
IF CURRENTLY EMPLOYED: How difficult
was it for you to find your current job?
Not
difficult
Somewhat
difficult
Very
difficult
IF
SOMEWHAT OR VERY DIFFICULT: Did any of the following situations
make it difficult?
|
Newly developed
|
|
|
IF NOT EMPLOYED: How difficult do
you think it will be to get a job in your chosen field or
occupation?
Not
difficult
Somewhat
difficult
Very
difficult
IF
SOMEWHAT OR VERY DIFFICULT: Do you think any of the following
situations will make it difficult?
|
Newly developed
|
|
|
Perceived self-efficacy and
motivation
|
|
|
In
general, some people have an easier or harder time with these
kinds of problems or difficulties. How true do you believe are
the following statements: (1 = Not at all true, 2 = Somewhat
true, 3 = Mostly true, 4 = Entirely true)
I can
always manage to solve difficult problems if I try hard enough.
If
someone opposes me, I can find the means and ways to get what I
want.
It is
easy for me to stick to my aims and accomplish my goals.
I am
confident that I could deal efficiently with unexpected events.
Thanks
to my resourcefulness, I know how to handle unforeseen
situations.
I can
solve most problems if I invest the necessary effort.
I can
remain calm when facing difficulties because I can rely on my
coping abilities.
When I
am confronted with a problem, I can usually find several
solutions.
If I am
in trouble, I can usually think of a solution.
I can usually handle whatever comes
my way.
|
Supplemental Baseline
|
|
|
Income, participant and total household
|
Now
I’d like to talk to you about your family and your current
household. What is your current marital status?
Currently
married
Widowed
Divorced/separated
Never
married
Don’t
know
|
HPOG ISO, PRS baseline
|
|
|
For
the past 12 months, what has been the approximate total earnings
from your
work, including tips and overtime pay (this is for you, alone;
do not include earnings from others in your family or
household).
$0
$1
to $4,999
$5,000
to $9,999
$10,000
to $14,999
$15,000
to $19,999
$20,000
to $24,999
$25,000
to $29,999
$30,000
to $34,999
$35,000
to $39,000
$40,000
to $44,999
$45,000
to $49,999
$50,000
to $59,999
$60,000
to $69,999
$70,000
or over
|
Adapted from HPOG ISO, PRS baseline
|
|
Adaptation involves adding more income categories in order to
capture greater distinctions above poverty (the maximum PRS
category is “$35,000 or over,” and the U.S. median
income is ~50K). The new categories mirror the PRS answer options
for household income. There is no strict need for the categories
to be the same. We will work with Abt SRBI to ensure that the
format works well in pre-testing and may modify as needed.
|
For
the past 12 months, what has been your household TOTAL family
income? Include your earnings and other income and earnings and
other income of all household members.
$0
$1
to $4,999
$5,000
to $9,999
$10,000
to $14,999
$15,000
to $19,999
$20,000
to $24,999
$25,000
to $29,999
$30,000
to $34,999
$35,000
to $39,999
$40,000
to $44,999
$45,000
to $49,999
$50,000
to $59,999
$60,000
to $69,999
$70,000
or over
Don’t
know
Refused
|
HPOG ISO, PRS baseline
|
|
|
Besides
you, who among the following live in your household at least
half the time? (CHECK ALL THAT APPLY)
Your
spouse
Your
unmarried partner
Your
biological or adopted children
Other
persons under age 18
Your
mother or father
Your
other relatives
Your
spouse or partner’s mother or father
Your
spouse or partner’s other relatives
Friends
Others
|
Adapted from ISIS follow-up
|
Besides
you, which of the following live in your household at least half
the time? (CHECK ALL THAT APPLY)
Your
spouse
Your
unmarried partner
Your
biological or adopted children
Other
persons aged 19 or younger
Your
mother or father
Your
spouse or partner’s mother or father
Your
spouse or partner’s other relatives
Friends
Others
|
ISIS uses <=19 because in some states child support continues
for 19-year-olds. This is not relevant to HPOG, especially in a
distinction made about other individuals in the household. We
would prefer to know whether there are other children/adults in
the household and believe that using the conventional
age-of-majority threshold is relevant. If we would choose to
combine data from these two categories, we expect very minor
measurement error.
|
Are
you or your partner/spouse currently pregnant?
YES
NO
Refused
Don’t
know
|
ISIS follow-up
|
No
change
|
|
Have
you or your partner/spouse had a baby since [RAD]?
|
ISIS follow-up
|
No change
|
|
How
many persons aged 18 or younger live with you at least half the
time? (Include biological, adopted, foster, step, and any other
children.)
|
Adapted from ISIS follow-up
|
How many persons aged 19 or younger live with you at least half
the time? (Include biological, adopted, foster, step, and any
other children.)
|
See note re: #60.
|
For
how many of these children are you [or your spouse/partner] the
legal guardian?
|
ISIS follow-up
|
No change
|
|
Benefit receipt (type and amount, participant and total
household)
|
|
|
Now,
I am going to ask you some questions about your household
income, for everyone who lived in your household in (PRIOR
MONTH). I will ask you first about your personal income and
then about the combined income from all the other people who
lived with you. Again, I want to assure you that none of your
answers will be discussed with anyone. In [PRIOR MONTH], did
you personally have income or benefits from any of the following
sources? (For each yes, about how much was it per month?)
Job
earnings (including tips)
Child
Support (official or unofficial)
Family
and friends (outside the household)
Grants
or loans for school
Temporary
Assistance for Needy Families (TANF)
General
Assistance (GA)
Supplemental
Nutrition Assistance Program (SNAP) / Food Stamps
Women,
Infants and Children Program (WIC)
Social
Security Insurance (SSI)
Social
Security Disability Insurance (SSDI)
Unemployment
Insurance (UI) or Worker’s Compensation
Refugee
Cash Assistance (RCA)
Medicaid
Subsidized
Child Care
Section
8 / Public Housing
Low
Income Home Energy Assistance Program (LIHEAP)
Free
or reduced lunch program
Was
there any other source of income you received last month that we
haven’t talked about?
IF
YES: What was that other income?
|
Supplemental Baseline
|
In [PRIOR MONTH], did you personally have income or benefits from
any of the following sources? (For each yes, about how much was
it per month?)
Was there any other source of
income you received last month that we haven’t talked
about?
What was that other income?
|
We originally added this question to our survey and ISIS then
added an adapted version of this question to its survey. We then
modified our wording to match the ISIS version.
|
Now,
let’s go through the same list of income sources for other
household members who lived with you in your household at least
two nights a week last month. In [PRIOR MONTH] did any of your
other household members have income or benefits from any of the
following sources? (For each yes, about how much was it per
month?)
Job
earnings (including tips)
Child
Support (official or unofficial)
Family
and friends (outside the household)
Grants
or loans for school
Temporary
Assistance for Needy Families (TANF)
General
Assistance (GA)
Supplemental
Nutrition Assistance Program (SNAP) / Food Stamps
Women,
Infants and Children Program (WIC)
Social
Security Insurance (SSI)
Social
Security Disability Insurance (SSDI)
Unemployment
Insurance (UI) or Worker’s Compensation
Refugee
Cash Assistance (RCA)
Medicaid
Subsidized
Child Care
Section
8 / Public Housing
Low
Income Home Energy Assistance Program (LIHEAP)
Free
or reduced lunch program
Was
there any other source of income received by other people in
your household that we haven’t talked about?
IF
YES: What was the other income?
-
|
Supplemental Baseline
|
Now, let’s go through the same list of income sources for
other household members who live with you in your household at
least two nights a week last month. In [PRIOR MONTH], In the past
month, did any of your other household members have income or
benefits from any of the following sources? (For each yes, about
how much was it per month?)
Was there any other source of
income received by other people in your household that we haven’t
talked about?
What was that other income?
|
ISIS added this question. We modified our wording to match ISIS.
|
[For
each “No” response in question above, ask]: I know
that you have not received [INSERT BENEFIT] in the last month,
but have you or anyone in your household had income or benefits
from (INSERT ITEM) at any time since [RAD]?
[If
No TANF in last month or since RAD]: Have you ever received TANF
benefits?
|
Adapted from Green Jobs
|
|
Will need to have Abt SRBI structure this for optimal flow.
|
Contact Information
|
Before
we complete this portion of the interview, I would also like to
make sure I have your contact information recorded correctly.
Your
first name:
Your
last name:
|
ISIS follow-up
|
|
|
Do
you have a mailing address? This could be an address like a PO
Box or a place where you get mail regularly.
IF
YES:
What
is the street address or PO box number?
Is
there a complex or building name?
Is
there an apartment number?
In
what city?
In
what state?
What
is the zip code?
|
ISIS follow-up
|
|
|
Do
you have a phone number where we can reach you? This can be your
cell phone or work number.
IF
YES: What is the number, starting with the area code?
IF
YES: Is that a home, cell, shelter, work, or other number?
Home
Cell
Shelter
Work
Other
|
ISIS follow-up
|
|
|
Do
you have another phone number where we can reach you? This can
be your cell phone or work number. [REPEAT 70A-B FOR ALL
AVAILABLE NUMBERS]
|
ISIS follow-up
|
|
|
Do
you have an email address?
YES
NO
Refused
Don’t
know
IF
YES: What is your email address?
|
ISIS follow-up
|
|
|
Thank
you very much for your time today. To help us be able to get
back in touch with you in the future, we would like to review
the names, telephone numbers and addresses of the two people you
previously mentioned who will always know how to reach you. This
information will be kept strictly private and will only be used
if we are unable to contact you.
When
you applied for [PROGRAM NAME] you said that [CONTACT #1] was a
person who would always know where you are and how to reach you.
Is [CONTACT#1] still a person who does not live with you and will
always know how to contact you?
IF
NO: Could you please tell me the name of a person who does not
live with you and will always know how to contact you?
YES
NO
Refused
Don’t
know
IF
YES:
What
is his/her first name?
What
is his/her middle name?
What
is his/her last name?
Does
his/her name have a suffix?
What
is the street address or PO box number?
Is
there a complex or building name?
Is
there an apartment number?
In
what city?
In
what state?
What
is the zip code?
What
is [his/her] home phone number, starting with the area code?
What
is [his/her] cell phone number, starting with the area code?
What
is [his/her] email address?
What
is [his/her] relationship to you?
Friend
Relative
Other
(Specify:)
Refused
Do
not know
REFUSED
DON’T
KNOW
|
Adapted from ISIS follow-up
|
Thank you very much for your time today. To help us be able to
get back in touch with you in the future, we would like to review
the names, telephone numbers and addresses of the two people you
provided when you applied for [PROGRAM NAME] who will always know
how to reach you. This information will be kept strictly
confidential and will only be used if we are unable to contact
you.
|
|
When
you applied for [PROGRAM NAME] you said that [CONTACT #2] was a
person who would always know where you are and how to reach you.
Is [CONTACT#2] still a person who does not live with you and
will always know how to contact you?
IF
NO: REPEAT 80a
Thank
you very much for your time today.
|
Adapted from ISIS follow-up
|
|
|
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Jennifer Lewis |
File Modified | 0000-00-00 |
File Created | 2021-01-27 |