Attachment X: Cognitive Interview Instrument
Section 1. Basic demographic and Incarceration Characteristics
The first section of this interview asks about you and how you came to this facility.
DEM1
What is your date of birth?
(mm, dd, yyyy)
[MONTH RANGE = 1-12, DK, RE]
[DAY RANGE = 1-31, DK, RE]
[YEAR RANGE = 1925-2010, RE]
[MM/DD/YYYY]
[Calculate age based on current date]
DEM1a
That would make you [calculated age] years old. Is that correct?
1 YES
2 NO
DON’T KNOW
REFUSED
[Logic after: If calculated age < 18 then go to 1b, else go to DEM2]
[If DEM1a = no, consistency check should say, "PLEASE CORRECT THE DATE OF BIRTH."]
DEM1b
[IF CALCULATED AGE IS LESS THAN 18, ASK] I'm sorry. You must be at least 18 years of age to participate in this study.
[END INTERVIEW]
DEM2
[PRELOAD ADMISSION DATE (PRADMDATE) FROM ROSTER FILES. DISABLE DK/REF.]
Next I’d like to confirm the date you were admitted to this facility. This means the date you arrived at this facility, not the date of your arrest or sentencing. According to our records, this date was [PRADMDATE]. Is this correct?
1 YES
2 NO
[CREATE DERIVED VARIABLE ADMDATE. IF DEM2=YES, ADMDATE WILL BE THE SAME AS PRADMDATE. IF DEM2=YES, GO TO DEM2B. IF DEM2=NO, GO TO DEM2A.]
DEM2a
[ASK IF DEM2=NO.]
OK. When were you admitted here?
IF RESPONDENT CAN’T REMEMBER THE DAY, ENTER 15.
IF RESPONDENT CAN’T REMEMBER MONTH, ASK THE APPROXIMATE AMOUNT OF TIME THEY HAVE BEEN AT THE FACILITY AND ESTIMATE ADMISSION DATE.
(mm/dd/yyyy)
[MONTH RANGE = 1-12, DK, RE]
[DAY RANGE = 1-31, DK, RE]
[YEAR RANGE = 1950-2017, DK, RE]
[CREATE ADMDATE FROM THE RESPONSE TO DEM2A.]
DEM2b
[PROGRAMMING INSTRUCTION: CALCULATE INCARCERATION DURATION BASED ON ADMDATE AND CURRENT DATE: THIS VARIABLE IS CALLED INCDUR.]
That means you have been in this facility for [INCDUR]. Is that correct?
1 YES
2 NO
DON’T KNOW
REFUSED
[If DEM2b= NO, consistency check should say, "PLEASE CORRECT THE INCARCERATION DATE."]
DEM3
Are you here in this facility…
YES NO
A to stand trial for an offense? 1 2
B to await a hearing for revocation of probation/parole or community
release? 1 2
C To await sentencing for an offense? 1 2
D To serve a sentence in this facility? 1 2
E For another reason? 1 2
DON’T KNOW
REFUSED
[if DEM3e=YES, go to DEM3e1]
DEM3e1
SPECIFY OTHER REASON
DEM4
Are you currently being held in this facility because you have been accused of any of the following offenses?
YES NO
A A violent offense, such as physical or sexual assault, rape, robbery,
manslaughter, attempted murder, or murder? 1 2
B A drug offense, such as possessing, selling, or manufacturing drugs? 1 2
C A property offense, such as burglary, larceny, auto theft, bad checks,
fraud, forgery, or other theft? 1 2
D A gun offense? 1 2
E A probation or parole violation? 1 2
F Some other offense 1 2
DON’T KNOW
REFUSED
[if DEM4e=YES, go to DEM3e1]
DEM4e1
SPECIFY OTHER OFFENSE
DEM5
INTERVIEWER – USING A BLANK CALENDAR PAGE, WRITE THE YEAR AT THE TOP OF THAT PAGE.
In the interview, we are going to refer to this calendar to help you remember certain dates. First, I’m going to circle the date that you were admitted to this facility – [FILL WITH ADMDATE].
Now I’m going to mark the date that was 6 months before you were admitted to this facility. That date would be: [FILL WITH CALCULATED 6MDATE (ADMDATE – 6 MONTHS)]. INTERVIEWER – CIRCLE THIS DATE.
Most of the questions in this interview ask about things that happened the 6 months before you were admitted to this facility, between this date [POINT TO 6MDATE] and the date that you were admitted here [POINT TO ADMDATE]. To help you remember what was going on during this time, let’s think about major events within this period, such as
birthdays,
family events,
changes in your living situation
changes in your job situation
holidays
births
graduations
any other important events you’d like to add.
INTERVIEWER – PAUSE AFTER EACH ITEM AND FILL OUT MAJOR EVENTS ON REFERENCE CALENDAR.
Section 2. Pre-incarceration Housing, Family, and Employment Characteristics
HOU1
Next I’d like to ask where you lived most of the time during the 6 months before you were admitted here. Did you live mostly in one place or did you move around from place to place?
1 ONE PLACE WHERE R MOSTLY LIVED
2 MOVED AROUND FROM PLACE TO PLACE
DON’T KNOW
REFUSED
HOU1a
[ASK HOU1A IF HOU1=ONE PLACE. ELSE, SKIP TO HOU2A.]
Did you mostly live…
REFER TO SHOWCARD 1.
[ALLOW ONLY ONE RESPONSE]
1 In your own house or apartment, meaning your name was on the title, mortgage, or lease
2 In someone else’s house or apartment, including your parents’ or other family member’s place
3 In a group home or transitional housing facility where you were free to come and go without permission
4 In a shelter
5 In a hospital, nursing home, or rest home
6 In a residential drug or alcohol treatment facility;
7 In a residential facility for people with disabilities or mental health care needs
8 In an adult or juvenile correctional facility, including a jail or prison
9 In another type of place where you were not free to come and go without permission, such as a halfway house
10 On the street or some other place like an abandoned building, a park, or car
DON’T KNOW
REFUSED
HOU1b
About how many days did you live in this place during this 6-month period?
[REFER TO REFERENCE CALENDAR. CALCULATE ANSWER IN DAYS]
____ DAYS [1-185]
[IF TOTAL NUMBER OF DAYS IN HOU1B IS GE180, SKIP TO HOU4. ELSE, GO TO HOU1C.]
HOU1c
Did you live anywhere else in the 6 months before coming here?
1 YES
2 NO
DON’T KNOW
REFUSED
[IF HOU1C=1, ASK HOU2A. ELSE GO TO HOU4.]
HOU2A
[ASK IF HOU1=2 OR (HOU1C=YES and HOU1A NE 1)] Did you live in any of the following types of places at any point during the 6 months before coming here? Please answer yes to all that apply, even if you just lived there for s short period of time.
Your own house or apartment, meaning your name was on the title, mortgage, or lease?
1 YES
2 NO
DON’T KNOW
REFUSED
HOU2B
[ASK IF HOU2A=YES]
About how many days did you live in your own place during this time period?
[REFER TO REFERENCE CALENDAR. HELP RESPONDENT CALCULATE ANSWER IN DAYS]
____ DAYS [1-185]
HOU3A
[ASK IF HOU1=2 OR (HOU1C=YES and HOU1A NE 2)]
In someone else’s house or apartment, including your parents’ or other family members’ place?
1 YES
2 NO
DON’T KNOW
REFUSED
HOU3B
[ASK IF HOU3A=YES]
About how many days did you live in someone else’s place during this time period?
[REFER TO REFERENCE CALENDAR. HELP RESPONDENT CALCULATE ANSWER IN DAYS]
____ DAYS [1-185]
HOU4A
[ASK IF HOU1=2 OR (HOU1C=YES and HOU1A NE 3)]
In a group home or transitional housing facility where you were free to come and go without permission?
1 YES
2 NO
DON’T KNOW
REFUSED
HOU4B
[ASK IF HOU4A=YES]
How many days did you live in this type of place during this time period?
[REFER TO REFERENCE CALENDAR. HELP RESPONDENT CALCULATE ANSWER IN DAYS]
____ DAYS [1-185]
HOU5A
[ASK IF HOU1=2 OR (HOU1C=YES and HOU1A NE 4)]
In a shelter?
1 YES
2 NO
DON’T KNOW
REFUSED
HOU5B
[ASK IF HOU5A=YES]
How many days did you live in shelter during this time period?
[REFER TO REFERENCE CALENDAR. HELP RESPONDENT CALCULATE ANSWER IN DAYS]
____ DAYS [1-185]
HOU6A
[ASK IF HOU1=2 OR (HOU1C=YES and HOU1A NE 5)]
In a hospital, nursing home, or rest home?
1 YES
2 NO
DON’T KNOW
REFUSED
HOU6B
[ASK IF HOU6A=YES]
How many days did you spend in a hospital, nursing home, or rest home during this time period?
[REFER TO REFERENCE CALENDAR. HELP RESPONDENT CALCULATE ANSWER IN DAYS]
____ DAYS [1-185]
HOU7A
[ASK IF HOU1=2 OR (HOU1C=YES and HOU1A NE 6)]
In a residential drug or alcohol treatment facility?
1 YES
2 NO
DON’T KNOW
REFUSED
HOU7B
[ASK IF HOU7A=YES]
How many days did you live in a residential drug or alcohol treatment facility during this time period?
[REFER TO REFERENCE CALENDAR. HELP RESPONDENT CALCULATE ANSWER IN DAYS]
____ DAYS [1-185]
HOU8A
[ASK IF HOU1=2 OR (HOU1C=YES and HOU1A NE 7)]
In a residential facility for people with disabilities or mental health care needs?
1 YES
2 NO
DON’T KNOW
REFUSED
HOU8B
[ASK IF HOU8A=YES]
How many days did you live in this type of place during this time period?
[REFER TO REFERENCE CALENDAR. HELP RESPONDENT CALCULATE ANSWER IN DAYS]
____ DAYS [1-185]
HOU9A
[ASK IF HOU1=2 OR (HOU1C=YES and HOU1A NE 8)]
In an adult or juvenile correctional facility, including a jail or prison?
1 YES
2 NO
DON’T KNOW
REFUSED
HOU9B
[ASK IF HOU9A=YES]
How many days did you live in a correctional facilityduring this time period?
[REFER TO REFERENCE CALENDAR. HELP RESPONDENT CALCULATE ANSWER IN DAYS]
____ DAYS [1-185]
HOU10A
[ASK IF HOU1=2 OR (HOU1C=YES and HOU1A NE 9)]
In another type of place where you were not free to come and go without permission, such as a halfway house?
1 YES
2 NO
DON’T KNOW
REFUSED
HOU10B
[ASK IF HOU10A=YES]
How many days did you live in this type of place during this time period?
[REFER TO REFERENCE CALENDAR. HELP RESPONDENT CALCULATE ANSWER IN DAYS]
____ DAYS [1-185]
HOU11A
[ASK IF HOU1=2 OR (HOU1C=YES and HOU1A NE 10)]
On the street or some other place like an abandoned building, a park, or car?
1 YES
2 NO
DON’T KNOW
REFUSED
HOU11B
[ASK IF HOU11A=YES]
How many days did you spend in this type of place during this time period?
[REFER TO REFERENCE CALENDAR. HELP RESPONDENT CALCULATE ANSWER IN DAYS]
____ DAYS [1-185]
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YES |
NO |
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2 |
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1 |
2 |
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1 |
2 |
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1 |
2 |
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1 |
2 |
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1 |
2 |
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1 |
2 |
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1 |
2 |
[IF NO YES RESPONSES WERE PROVIDED TO HOU2A-J, SKIP TO HOU4]
HOU12
[USE INFORMATION FROM HOU1A AND HOU3A-J TO CALCULATING DERIVED VARIABLE “STREETTIME”. STREETTIME= NO IF:
(HOU1=5 or 6 OR 7 OR 8 OR 9) AND TOTAL NUMBER OF DAYS IN HOU1B IS GE 180; or
TOTAL NUMBER OF DAYS IN HOU3E, HOU3F, HOU3G, HOU3H, AND HOU3I GE 180 DAYS.
ELSE, STREETTIME=YES.]
HOU13
[ASK IF HOU2=A, B, D, OR J. ELSE SKIP TO HOU8.]
Thinking about the place where you lived most of the time during the 6 months before coming here, were you mostly living alone or with others?
ALONE
WITH OTHERS
DON’T KNOW
REFUSED
HOU13a
Who were you living with?
YES NO
A Your spouse, boyfriend, girlfriend, or ex? 1 2
B Your mother or father? 1 2
C Your children or stepchildren? 1 2
D Your friends? 1 2
E Other relatives? 1 2
F Other people who were not family? 1 2
DON’T KNOW
REFUSED
HOU8
Are you currently…
1 Married,
2 Separated,
3 Divorced,
4 Widowed, or
5 Never married?
DON’T KNOW
REFUSED
HOU9
[If HOU8 NE 1)
Are you currently involved in a relationship with an intimate partner such as a boyfriend or girlfriend?
1 YES
2 NO
DON’T KNOW
REFUSED
HOU11
How many children do you have under the age of 18? Please count all children that you consider yourself to be a parent of even if you are not biologically related.
[RANGE 0-25]
DON’T KNOW
REFUSED
HOU12
[If HOU11 GE1]
During the 6 months before coming here, how many of your children lived with you?
REFER TO REFERENCE CALENDAR
[RANGE 1-25]
DON’T KNOW
REFUSED
HOU13
In the 6 months before coming, how did you support yourself?
REFER TO REFERENCE CALENDAR.
YES NO
A Support from family? 1 2
B Support from friends? 1 2
C A government program or public assistance like Food Stamps
(SNAP), Social Security, or Disability? 1 2
D Illegal income? 1 2
E A job? 1 2
DON’T KNOW
REFUSED
HOU13A
[If HOU13E NE 1)
Just to confirm, at any point in the 6 months before coming here did you have a job?
1 YES
2 NO
DON’T KNOW
REFUSED
HOU14
[if HOU13A=1]
SHOWCARD 4
What were the main reasons you were not working?
[CODE ALL THAT APPLY]
YES NO
1 Could not find work? 1 2
2 Were ill or disabled and unable to work? 1 2
3 Were retired? 1 2
4 Were taking care of home or family? 1 2
5 Were going to school? 1 2
6 Could not get transportation? 1 2
7 Did not want to work? 1 2
8 Were incarcerated? 1 2
9 Had some other reason? 1 2
DON’T KNOW
REFUSED
[DK AND RE SHOULD NOT BE ALLOWED IF THE INTERVIEWER PICKS ANY OTHER RESPONSE CATEGORY]
HOU15
How many of the months were you employed during this 6 month period?
REFER TO REFERENCE CALENDAR. IF R WAS EMPLOYED LESS THAN A MONTH, RECORD AS 0.
____ MONTHS [0-6]
DON’T KNOW
REFUSED
HOU16
[if HOU13=1]
About how much did you earn per month, before taxes were taken out? Include any tips, bonuses, or commissions. If you had more than one job, please include income from all of your jobs combined.
1 less than $500
2 $500-$999
3 $1000-$1499
4 $1500-$1999
5 $2000-$2499
6 $2500-$2999
7 $3000 or higher
DON’T KNOW
REFUSED
HOU18
How many people, other than yourself, were dependent on you for housing and food during the 6 months before coming here?
______ PEOPLE [RANGE 0-50]
DON’T KNOW
REFUSED
HOU18A
[ASK IF HOU11 GE 1 AND HOU18 GE1]
How many of these people were your children?
______ PEOPLE [RANGE 0-50]
DON’T KNOW
REFUSED
Section 3. Violent Crimes: Prevalence and Incidence
VCRIMINTRO
The next questions ask about crimes that may have happened to you during the 6 months before you were admitted to this facility. [REFER TO REFERENCE CALENDAR.]
The first few questions ask about times when a person used violence or threatened violence against you. These incidents may have happened to you at home, on the street, at work or school, or somewhere else, and they may have been committed by someone you know, a stranger, or even a family member.
Remember that your answers to all survey questions will be kept completely confidential. [PRESS 1 TO CONTINUE]
[FI NOTE: DURING THE INTERVIEW, IF THE RESPONDENT BRINGS UP VICTIMIZATION THAT HAPPENED WHILE IN JAIL, PLEASE SAY SOMETHING LIKE “I’M SORRY TO HEAR ABOUT THIS EXPERIENCE. THIS INTERVIEW FOCUSES ON THINGS THAT HAPPENED TO YOU DURING THE 6 MONTHS BEFORE YOU WERE ADMITTED HERE, SO PLEASE THINK ABOUT THAT 6 MONTH PERIOD.”]
VCRIM1
During the 6 months before coming here, did anyone physically attack you or try to physically attack you? Include times when:
someone attacked you or tried to attack you with a gun, knife, or some other weapon
someone forced you or tried to force you to do something sexual that you didn’t want to do
someone took something or tried to take something from you by using force or by threatening to harm you
someone physically attacked you or tried to physically attack you in some other way
1 YES
2 NO
DON’T KNOW
REFUSED
[IF VCRIM1=NO, DK OR REF, GO TO THEFTINTRO. ELSE, ASK VCTIM1A]
VCRIM2
[ASK IF VCRIM1=YES]
How many times did someone physically attack you or try to physically attack you during those 6 months? Remember, we are talking about times when someone did any of these things to you [REFER TO SHOWCARD 2].
____ TIMES [1-100]
DON’T KNOW
REFUSED
[IF R SAYS “TOO MANY TO COUNT”, CODE AS DK]
[WRITE THE TOTAL NUMBER OF TIMES ON SHOWCARD 2]
VCRIM2A
[ASK IF VCRIM2=DK]
Did it happen fewer than 6 times or did it happen 6 or more times?
1 FEWER THAN 6 TIMES
2 6 OR MORE TIMES
[WRITE “LESS THAN 6 TIMES” OR “6 OR MORE TIMES” ON SHOWCARD 2]
VCRIM3
[ASK IF VCRIM1=YES]
The next questions ask about these times [REFER TO SHOWCARD 2] that you told me about.
How many of these incidents did the police know about? This could be because you reported it or because they found out about it another way.
____ TIMES [0-100]
DON’T KNOW
REFUSED
VCRIM3A
[ASK IF VCRIM3=DON’T KNOW]
Were the police told about all of the incidents, most of the incidents, a few of them, or none of them?
1 ALL
2 MOST
3 A FEW
4 NONE
VCRIM3B
[ASK IF VCRIM3=0 OR VCTIM3A=NONE]
Why weren’t the police told?
|
YES 1 |
NO 2 |
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1 |
2 |
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1 |
2 |
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1 |
2 |
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1 |
2 |
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1 |
2 |
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1 |
2 |
VCRIM4
For how many of these incidents did you suffer any physical injuries?
____ TIMES [0-100]
DON’T KNOW
REFUSED
VCRIM5
For how many of these incidents did you seek any professional or medical help, such as counseling, visiting a doctor or clinic, or other types of professional care?
____ TIMES [0-100]
DON’T KNOW
REFUSED
VCTIM5A
[ASK IF VCRIM5=0]
Why didn’t you seek any professional or medical help? Was it because…
YES NO
A You did not need any services? 1 2
B You were not aware of any available services? 1 2
C You could not access services because of lack of insurance or money? 1 2
D You could not access services because of transportation barriers? 1 2
E You could not access services because of language barriers? 1 2
F You did not want anyone to know about what happened to you? 1 2
G Doctors, nurses, or counselors would not be able to help you? 1 2
H Doctors, nurses, or counselors would treat you poorly or not
understand? 1 2
I You thought that someone might find out and cause problems for you? 1 2
J You might get in trouble with the police or the police
would be notified? 1 2
VCRIM6
[REFER TO SHOWCARD 2]
For how many of these incidents did you seek any assistance for people who experience crimes, such as shelter, financial assistance, or legal aid?
____ TIMES [0-100]
DON’T KNOW
REFUSED
VCTIM6A
[ASK IF VCRIM6=0]
Why didn’t you seek any assistance for people who experience crimes? Was it because…
YES NO
A You did not need any such services? 1 2
B You were not aware of any available services? 1 2
C You could not access services because of transportation barriers? 1 2
D You could not access services because of language barriers? 1 2
E You did not want anyone to know about what happened to you? 1 2
F Service providers would not be able to help you? 1 2
G Service providers would treat you poorly or not understand? 1 2
H You thought that someone might find out and cause problems for you? 1 2
I You might get in trouble with the police or the police
would be notified? 1 2
VCRIM7
[REFER TO SHOWCARD 2]
How many of these incidents did you tell a family member or friend about?
____ TIMES [0-100]
DON’T KNOW
REFUSED
VCRIM8
[REFER TO SHOWCARD 2]
How many of these incidents were committed by a spouse, ex-spouse, boyfriend, girlfriend, or ex-boyfriend or ex-girlfriend of yours ?
____ TIMES [0-100]
DON’T KNOW
REFUSED
VCRIM9
How many of these incidents were committed by a family member other than a spouse?
____ TIMES [0-100]
DON’T KNOW
REFUSED
VCRIM10
… a friend or someone you knew casually at the time of the incident?
____ TIMES [0-100]
DON’T KNOW
REFUSED
VCRIM11
…a stranger or someone you did not know in any way at the time of the incident?
____ TIMES [0-100]
DON’T KNOW
REFUSED
VCRIM12
How many of these incidents [POINT TO SHOWCARD 2] involved someone attacking you with a gun or a knife, or something else used as a weapon?
____ TIMES [0-100]
DON’T KNOW
REFUSED
[IF R SAYS “TOO MANY TO COUNT”, CODE AS DK]
VCRIM12A
[ASK IF VCRIM12=DK]
Did it happen fewer than 6 times or did it happen 6 or more times?
1 FEWER THAN 6 TIMES
2 6 OR MORE TIMES
VCRIM13
How many of these incidents [POINT TO SHOWCARD 2] involved someone forcing you or trying to force you to do something sexual that you didn’t want to do?
____ TIMES [0-100]
DON’T KNOW
REFUSED
[IF R SAYS “TOO MANY TO COUNT”, CODE AS DK]
VCRIM13A
[ASK IF VCRIM13=DK]
Did it happen fewer than 6 times or did it happen 6 or more times?
1 FEWER THAN 6 TIMES
2 6 OR MORE TIMES
VCRIM14
How many of these incidents [POINT TO SHOWCARD 2] involved someone physically taking something or trying to take something from you by using force or by threatening to harm you?
____ TIMES [0-100]
DON’T KNOW
REFUSED
[IF R SAYS “TOO MANY TO COUNT”, CODE AS DK]
VCRIM14A
[ASK IF VCRIM14=DK]
Did it happen fewer than 6 times or did it happen 6 or more times?
1 FEWER THAN 6 TIMES
2 6 OR MORE TIMES
Section 4. Property Crimes: Prevalence and Incidence
THEFTINTRO
The next questions ask about other types of incidents you may have experienced in the 6 months before you were admitted here. [IF YES TO VCRIM1, FILL “Do not include any of these incidents that you already told us about [POINT TO SHOWCARD 2].”
[PRESS 1 TO CONTINUE]
THEFT1
During the 6 months before you were admitted here, did anyone steal, or try to steal something that belonged to you, like money or possessions, but without using force? This could include times when someone stole something when you weren’t looking, picked your pocket, or took something from your home or car.
1 YES
2 NO
DON’T KNOW
REFUSED
[IF THEFT1=NO, DK, OR REF, GO TO THEFT2. ELSE, GO TO THEFT1A.]
THEFT1A
[ASK IF THEFT1=1(YES)]
How many times did this happen to you during those 6 months?
____ TIMES [1-100]
DON’T KNOW
REFUSED
[IF R SAYS “TOO MANY TO COUNT”, CODE AS DK]
[WRITE THE TOTAL NUMBER OF TIMES ON SHOWCARD 3]
THEFT1B
[ASK IF THEFT1A=DK]
Did it happen fewer than 6 times or did it happen 6 or more times?
1 FEWER THAN 6 TIMES
2 6 OR MORE TIMES
[WRITE “LESS THAN 6 TIMES” OR “6 OR MORE TIMES” ON SHOWCARD 3]
THEFT1C
[ASK IF THEFT1=1 (YES)]
How many of these incidents [REFER TO SHOWCARD 3] did the police know about? This could be because you reported it or because they found out about in another way.
____ TIMES [0-100]
DON’T KNOW
REFUSED
THEFT1D
[ASK IF THEFT1C=DON’T KNOW]
Were the police told about all of the incidents, most of the incidents, a few of them, or none of them?
1 ALL
2 MOST
3 A FEW
4 NONE
THEFT1E
[ASK IF THEFT1C=0 OR THEFT1D=DON’T KNOW]
Why weren’t the police told?
|
YES 1 |
NO 2 |
|
1 |
2 |
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1 |
2 |
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1 |
2 |
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1 |
2 |
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1 |
2 |
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1 |
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1 |
2 |
THEFT1F
[ASK IF THEFT1=1 (YES)]
How many of these incidents [REFER TO SHOWCARD 3] involved someone stealing something, or trying to steal something of yours after they broke into a place where you were staying?
____ TIMES [0-100]
DON’T KNOW
REFUSED
[IF R SAYS “TOO MANY TO COUNT”, CODE AS DK]
THEFT1G
[ASK IF THEFT1F=DK]
Did it happen fewer than 6 times or did it happen 6 or more times?
1 FEWER THAN 6 TIMES
2 6 OR MORE TIMES
THEFT1H
[ASK IF THEFT1=1 (YES)]
How many of these incidents [REFER TO SHOWCARD 3] involved someone stealing something from you, or trying to steal something, while you were out in public?
____ TIMES [0-100]
DON’T KNOW
REFUSED
[IF R SAYS “TOO MANY TO COUNT”, CODE AS DK]
THEFT1I
[ASK IF THEFT1H=DK]
Did it happen fewer than 6 times or did it happen 6 or more times?
1 FEWER THAN 6 TIMES
2 6 OR MORE TIMES
THEFT2
During the 6 months before coming here, did anyone intentionally damage or vandalize something belonging to you?
1 YES
2 NO
DON’T KNOW
REFUSED
THEFT2A
[ASK IF THEFT2=1(YES)]
How many times did this happen to you during those 6 months?
____ TIMES [0-100]
DON’T KNOW
REFUSED
[IF R SAYS “TOO MANY TO COUNT”, CODE AS DK]
THEFT2B
[ASK IF THEFT2A=DK]
Did it happen fewer than 6 times or did it happen 6 or more times?
1 FEWER THAN 6 TIMES
2 6 OR MORE TIMES
Section 5. Resource Utilization, Availability, and Neighborhood Characteristics before Incarceration
These next few questions ask more about what things were like in the 6 months before you were admitted to this facility.
RESOURCE1
[IF YES TO VCRIM1, FILL “Other than any injuries you may have already told me about,”] were there any times during that 6 month period that you were hurt and/or needed medical care? Include any injuries from accidents, car wrecks, drug overdoses, work related accidents, or other injuries.
REFER TO REFERENCE CALENDAR.
1 YES
2 NO
DON’T KNOW
REFUSED
RESOURCE1A
[ASK IF YES TO RESOURCE1]
Did you receive professional medical care for any of these injuries, such as at a hospital, emergency room, doctor’s office, or urgent care facility?
1 YES
2 NO
DON’T KNOW
REFUSED
RESOURCE1B
[ASK IF NO TO RESOURCE1A]
Why didn’t you seek any medical help? Was it because…
YES NO
A You felt that you did not need any services? 1 2
B You got sufficient medical care from a family member or friend? 1 2
C You were not aware of any services that might have been available? 1 2
D You could not access services because of lack of insurance or money? 1 2
E You could not access services because of transportation barriers? 1 2
F You could not access services because of language barriers 1 2
G You did not want anyone to know about what happened to you? 1 2
H You felt that doctors or service providers would not be able to help you? 1 2
I You felt that doctors or service providers would treat you poorly or not
understand? 1 2
J You thought that someone might find out and cause problems for you? 1 2
K You felt that you might get in trouble with the police or that the police
would be notified? 1 2
RESOURCE2
At any time during the 6 month period did you receive help for a drug or alcohol problem?
REFER TO REFERENCE CALENDAR.
1 YES
2 NO
DON’T KNOW
REFUSED
RESOURCE2A
[ASK IF YES TO RESOURCE2]
At any time during the 6 month period did you try to find help for a drug or alcohol problem, but you were unable to get it?
1 YES
2 NO
DON’T KNOW
REFUSED
RESOURCE3
At any time during the 6 month period did you receive help for a mental health problem?
REFER TO REFERENCE CALENDAR.
1 YES
2 NO
DON’T KNOW
REFUSED
RESOURCE3B
[ASK IF RESOURCE2=NO]
At any time during the 6 month period did you try to obtain help for a possible mental health problem, but were unable to get the help you wanted?
1 YES
2 NO
DON’T KNOW
REFUSED
RESOURCE4
During the 6 months before you were admitted here, did you feel stressed out because of …?
YES NO
A Money/Financial issues? 1 2
B Employment issues? 1 2
C Difficulties with illness or injury? 1 2
D Problems with a partner or spouse, boyfriend or girlfriend? 1 2
E Problems with children or other family responsibilities? 1 2
F Problems with having a regular place to live? 1 2
G Not feeling safe in your neighborhood? 1 2
RESOURCE5
Think about the community where you mostly lived during the 6 months before coming here. Were there places like churches, hospitals, shelters, or community services where people could get help or support if they needed it because they experienced violence or some other form of crime?
1 YES
2 NO
DON’T KNOW
REFUSED
RESOURCE6
Were there people or places in the community where people could turn to if they needed help because they were being hurt, hassled or threatened by others? People or places such as community police, clergy, community organizations, social workers, or others.
1 YES
2 NO
DON’T KNOW
REFUSED
RESOURCE7
For some types of crime, there may be agencies to help reimburse people for some of the costs associated with being a victim of crime. Are you aware of any groups or agencies that provide help with some of these financial costs?
1 YES
2 NO
DON’T KNOW
REFUSED
RESOURCE8
In the community where you lived, were there any areas that felt dangerous at night?
1 YES
2 NO
DON’T KNOW
REFUSED
RESOURCE9
In the community where you lived, did you ever hear gunshots?
1 YES
2 NO
DON’T KNOW
REFUSED
RESOURCE9A
[ASK IF RESOURCE9=YES]
About how often did you hear gunshots? Would you say it was…
1 Once in the 6 month period
2 2-5 times
3 6 or more times
RESOURCE10
Not including any violence that directly involved you, did you see any violence against people in the community where you lived? Only include violence that you saw with your own eyes.
1 YES
2 NO
DON’T KNOW
REFUSED
RESOURCE10B
[ASK IF RESOURCE10=YES]
Did you ever call the police when you saw violence?
1 YES
2 NO
DON’T KNOW
REFUSED
RESOURCE11
Would the police have been helpful if you or someone else in your community experienced a crime?
1 YES
2 NO
DON’T KNOW
REFUSED
RESOURCE12
Did you have friends or family that you could turn to if you needed help because you experienced a crime?
1 YES
2 NO
DON’T KNOW
REFUSED
Section 6. Gun Use/Victimization before Incarceration
WEAP1
The next set of questions ask about protecting yourself. People often own guns and other weapons for self-protection and for other reasons. During the 6 months before coming here, did you have access to any guns?
1 YES
2 NO
DON’T KNOW
REFUSED
WEAP2
Has anyone ever shot a gun at you?
1 YES
2 NO
DON’T KNOW
REFUSED
WEAP2A
[ASK IF WEAP2=YES]
When was the last time someone shot at you?
[SELECT ONE]
1 During the 6 months before you were admitted here
2 About 7-12 months before you were admitted here
3 Between one and two years before you were admitted here
4 Between two and five years before you were admitted here
5 More than five years before you were admitted here
WEAP2D
[ASK IF WEAP2=YES]
Were you ever hit by any bullets when someone shot at you?
1 YES
2 NO
DON’T KNOW
REFUSED
WEAP2E
[ASK IF WEAP2D=YES]
When you were shot, did you ever receive medical care for your injuries at a hospital?
1 YES
2 NO
DON’T KNOW
REFUSED
WEAP2F
[ASK IF WEAP2E=NO]
When you were shot, did you ever receive medical care from someone at a place other than a hospital or doctor’s office?
1 YES
2 NO
DON’T KNOW
REFUSED
WEAP2G
[ASK IF WEAP2D=YES]
Did the police find out about the time(s) you were shot?
1 YES
2 NO
DON’T KNOW
REFUSED
WEAP2I
[IF WEAP2=YES, fill “Aside from the incident(s) you just told me about,] Have you ever been threatened, but not shot, by someone who was pointing a gun at you?
1 YES
2 NO
DON’T KNOW
REFUSED
WEAP2J
[ASK IF WEAP2I=YES]
When was the last time you were threatened with a gun?
[SELECT ONE]
1 During the 6 months before you were admitted here
2 About 7-12 months before you were admitted here
3 Between one and two years before you were admitted here
4 Between two and five years before you were admitted here
5 More than five years before you were admitted here
WEAP2K
[ASK IF WEAP2I=YES]
Did the police find out about this incident?
1 YES
2 NO
DON’T KNOW
REFUSED
Section 7. Attitudes
RESPV1
Please indicate how much you agree or disagree with the following statements.
When people tell you what to do, you become aggressive.
1 Strongly disagree
2 Disagree
3 Uncertain
4 Agree
5 Strongly agree
DON’T KNOW
REFUSED
RESPV2
When not in control of a situation, you feel the need to exert power over others.
1 Strongly disagree
2 Disagree
3 Uncertain
4 Agree
5 Strongly agree
DON’T KNOW
REFUSED
RESPV3
You argue with others over relatively trivial matters.
1 Strongly disagree
2 Disagree
3 Uncertain
4 Agree
5 Strongly agree
DON’T KNOW
REFUSED
RESPV4
If someone disrespects you then you have to straighten them out, even if you have to get physical.
1 Strongly disagree
2 Disagree
3 Uncertain
4 Agree
5 Strongly agree
DON’T KNOW
REFUSED
RESPV5
You like to be in control.
1 Strongly disagree
2 Disagree
3 Uncertain
4 Agree
5 Strongly agree
DON’T KNOW
REFUSED
RESPV6
You think you have to pay back people who mess with you.
1 Strongly disagree
2 Disagree
3 Uncertain
4 Agree
5 Strongly agree
DON’T KNOW
REFUSED
RESPV7
The only way to protect yourself is to be ready to fight.
1 Strongly disagree
2 Disagree
3 Uncertain
4 Agree
5 Strongly agree
DON’T KNOW
REFUSED
RESPV8
Next, I’d like to know how you feel about the police in your community. How much do you agree or disagree with the following statements.
The police in your community treat people respectfully.
1 Strongly disagree
2 Disagree
3 Uncertain
4 Agree
5 Strongly agree
DON’T KNOW
REFUSED
RESPV9
The police in your community treat people fairly, regardless of who they are.
1 Strongly disagree
2 Disagree
3 Uncertain
4 Agree
5 Strongly agree
DON’T KNOW
REFUSED
RESPV10
The police in your community can be trusted to make decisions that are right.
1 Strongly disagree
2 Disagree
3 Uncertain
4 Agree
5 Strongly agree
DON’T KNOW
REFUSED
RESPV11
The police in your community are good at solving crimes that are reported to them.
.
1 Strongly disagree
2 Disagree
3 Uncertain
4 Agree
5 Strongly agree
DON’T KNOW
REFUSED
RESPV12
Now, thinking about other persons who work in the criminal justice system, please tell me how much you agree or disagree.
Prosecutors are good at resolving cases fairly.
1 Strongly disagree
2 Disagree
3 Uncertain
4 Agree
5 Strongly agree
DON’T KNOW
REFUSED
RESPV13
Defense attorneys are good at resolving cases fairly.
1 Strongly disagree
2 Disagree
3 Uncertain
4 Agree
5 Strongly agree
DON’T KNOW
REFUSED
Section 8. Criminal History and System Contact Before Incarceration
CRIMH1
The next questions ask about your contact with the criminal or juvenile justice system.
How old were you the first time you were arrested?
[RANGE - 7-99]
DON’T KNOW
REFUSED
CRIMH2
How many times in your life have you been arrested?
[RANGE - 0-100]
CRIMH3
How many times have you been convicted of a crime or plead guilty or no contest to a crime?
[RANGE - 0-100]
DON’T KNOW
REFUSED
CRIMH4
In your entire life, have you ever been locked up in any kind of juvenile detention or correctional facility?
1 YES
2 NO
DON’T KNOW
REFUSED
CRIMH5
[IF CRIMH4 = 1]
How many times have you been locked up in any kind of juvenile detention or correctional facility?
[RANGE - 0-100]
DON’T KNOW
REFUSED
CRIMH6
Not counting this most recent time you were admitted to this facility, how many times in your life have you been to prison or jail? Do not include any times you were sent to a juvenile facility in your answer.
[RANGE - 0-100]
DON’T KNOW
REFUSED
CRIMH7
Thinking just about the 6 months before you were admitted here, how many times were you arrested during that period?
REFER TO REFERENCE CALENDAR.
____ ARRESTS [0-100]
CRIMH8
Were you on probation, parole, or any other type of community supervision at any time during this 6 months?
1 YES
2 NO
DON’T KNOW
REFUSED
CRIMH8A
[ASK IF CRIMH8=YES]
How many months were you on probation, parole, or any other type of community supervision during this time?
REFER TO REFERENCE CALENDAR.
____ MONTHS [0-6]
Section 9. Additional Demographics
ADEM1a
Was your sex assigned as male or female at birth?
1 Male
2 Female
ADEM1b
Do you currently describe yourself as male, female, or transgender?
1 Male
2 Female
3 Transgender
4 Do not identify as male, female or transgender
ADEM1c
Just to confirm, you were assigned [male/ female] at birth and now describe yourself as [male/female/transgender/does not identify]. Is that correct?
1 Yes, that is correct
2 No, that is not correct
[IF ADEM1c=2, RETURN TO ADEM1a. ELSE GO TO ADEM2]
ADEM2
Are you of Hispanic, [IF ADEM1=1 OR 3, FILL “Latina”; else, fill “Latino”], or Spanish origin?
1 YES
2 NO
DON’T KNOW
REFUSED
ADEM3
Which of the following best describes you? Please select all that apply. Would you say you are:
(SELECT ALL THAT APPLY)
1 White
2 Black or African American
3 American Indian or Alaska Native
4 Asian
5 Native Hawaiian or other Pacific Islander
6 Other
ADEM3A
[ASK IF ADEM3=6]
SPECIFY
ADEM4
In what country were you born?
1 UNITED STATES
2 OTHER
DON’T KNOW
REFUSED
ADEM4a [If ADEM4=2]
SPECIFY OTHER COUNTRY
ALLOW 30
ADEM5
Have you ever been in foster care?
1 YES
2 NO
DON’T KNOW
REFUSED
ADEM6
Have you ever served in the U.S. military?
1 YES
2 NO
DON’T KNOW
REFUSED
ADEM6a [IF YES TO ADEM5]
How long did you serve?
____ YEARS
ADEM7
What is the highest level of education you have completed?
(SELECT ONE)
1 Less than high school diploma
2 High school diploma or GED
3 Trade/vocational school
4 Some college
5 College degree
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |