8 2018 MCH Survey Juris Module_PR_English_Formatted

Puerto Rico

I am going to start by asking you some questions about your child’s health.

[If child reported to have Autism, ASD, Asperger’s Disorder or PDD in core, continue to PR1, else go to PR2.]

1. How old was this child when a doctor or other health care provider FIRST told you that he or she had Autism, ASD, Asperger’s Disorder or PDD?

Age in Years

1. ☐ Do not have a health specialist

77. ☐ Don’t know

99. ☐ Prefer not to answer

2. Has your child ever been diagnosed with spina bifida, anencephaly, or any other neural tube defect?

   1. ☐ Yes

   2. ☐ No

77. ☐ Don’t know

99. ☐ Prefer not to answer

The next few questions are going to ask about your experiences after Hurricanes Irma and Maria.

3. Did your child stop receiving health care services due to Hurricanes Irma or Maria?

   1. ☐ Yes

   2. ☐ No

77. ☐ Don’t know

99. ☐ Prefer not to answer

4. Did your family move to a different town, city, or country due to Hurricanes Irma or Maria?

   1. ☐ Yes

   2. ☐ No

77. ☐ Don’t know

99. ☐ Prefer not to answer

5. Did your family move to a shelter or other place due to Hurricanes Irma or Maria?

   1. ☐ Yes

   2. ☐ No [Go to PR6]

77. ☐ Don’t know [Go to PR6]

99. ☐ Prefer not to answer [Go to PR6]

[If yes] Were you able to return to your home after Hurricane Irma or Maria?

1. ☐ Yes

2. ☐ No

77. ☐ Don’t know

99. ☐ Prefer not to answer

[ONLY ASK THIS QUESTION IF CHILD IS CSHCN]

Now we are going to ask you some questions about services this child may receive.

6. DURING THE PAST 12 MONTHS, did this child see a specialist other than a mental health professional? Specialists are doctors like surgeons, heart doctors, allergy doctors, skin doctors, and others who specialize in one area of health care.

   1. ☐ Yes

   2. ☐ No, but this child needed to see a specialist

   3. ☐ No, this child did not need to see a specialist

77. ☐ Don’t know

99. ☐ Prefer not to answer

7. [ONLY ASK THIS QUESTION IF CHILD IS CSHCN]

DURING THE PAST 12 MONTHS, how often were you frustrated in your efforts to get services for this child?

1. ☐ Never

2. ☐ Sometimes

3. ☐ Usually

4. ☐ Always

77. ☐ Don’t know

99. ☐ Prefer not to answer

8. [ONLY ASK THIS QUESTION IF CHILD IS CSHCN]

Has this child EVER received special services to meet his or her developmental needs such as speech, occupational, or behavioral therapy?

1. ☐ Yes

2. ☐ No

77. ☐ Don’t know

99. ☐ Prefer not to answer

9. [ONLY ASK THIS QUESTION IF CHILD IS CSHCN]

Does this child receive services from a program called Early Intervention Services? Children receiving these services often have an Individualized Family Service Plan.

Early Intervention Services are defined as: family training, counseling, and home visits; health services; medicine; nursing; nutrition; occupational therapy; physical therapy; psychological services; service coordination services; social work services; special instruction; speech-language therapy; transportation, communication or mobility devices; and vision and hearing services.

1. ☐ Yes

2. ☐ No

77. ☐ Don’t know

99. ☐ Prefer not to answer

10. [ONLY ASK THIS QUESTION IF CHILD IS CSHCN]

Does this child receive services from a program called Special Educational Services? Children receiving these services often have an Individualized Education Plan.

Special Education is any kind of special school, classes or tutoring.

1. ☐ Yes

2. ☐ No

77. ☐ Don’t know

99. ☐ Prefer not to answer

Now we are going to ask you some questions about your health insurance and health care.

11. DURING THE PAST 12 MONTHS, were you EVER covered by ANY kind of health insurance or health coverage plan?

    1. ☐ Yes, I was covered all 12 months

    2. ☐ Yes, but I had a gap in coverage

    3. ☐ No

77. ☐ Don’t know

99. ☐ Prefer not to answer

12. Are you CURRENTLY covered by ANY kind of health insurance or health coverage plan?

    1. ☐ Yes

    2. ☐ No

77. ☐ Don’t know

99. ☐ Prefer not to answer

[If yes] Are you covered by any of the following types of health insurance or health coverage plans?

	Yes	No	Don’t Know	Prefer not to answer
Insurance through a current or former employer or union	1 ☐	2 ☐	77 ☐	99 ☐
Insurance purchased directly from an insurance company	1 ☐	2 ☐	77 ☐	99 ☐
Medicaid, Medical Assistance, or any kind of government assistance plan for those with low incomes or a disability	1 ☐	2 ☐	77 ☐	99 ☐
TRICARE or other military health care	1 ☐	2 ☐	77 ☐	99 ☐
Another type, please specify	1 ☐	2 ☐	77 ☐	99 ☐