Instrument 1- Baseline Youth Survey

OPRE Study: Evaluation of LifeSet [Impact and Implementation Evaluation]

Instrument 1- Baseline Youth Survey

OMB: 0970-0577

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0970-0577 can be found here:

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Instrument 1: Baseline Youth Survey

LifeSet Baseline Survey

This survey is intended to be administered at baseline to all youth in the study by interviewers of the subcontracted survey firm. As this will be the first data collection for the evaluation, the interview will begin with the informed consent process. However, items gathering information to aid in follow-up contact are placed at the end of the survey so that rapport may be built prior to asking for contact information.

Instructions 2

Set Up And Introduction 2

Demographics 3

Living Arrangements 5

Social Support 6

Fertility 8

Education 9

Employment and Earnings 11

Economic Hardships 13

ACASI Set Up 14

Mental Health Services 16

Substance Abuse 17

Criminal Justice Involvement 18

Spouse/Partner Violence 19

Youth Resiliency 21

Social-Emotional Competence 23

LifeSet Services 27

Information for Follow Up Contact 28

Instructions

Thank you for joining us today. We would like to invite you to participate in a survey that will last about 35 minutes. We are conducting this survey as part of the Young Adult Services Study (YASS). The survey contains questions about the services you received during foster care. There are also questions about your experiences leaving foster care such as education and work, places you lived, and the relationships you have with family and friends.

Some questions ask about your emotions, alcohol and drug use, and behavior that might be against the law but are very common for young people your age.

[IF MODE =1] I will read the questions to you and enter your responses into the computer. You may skip over any questions you do not want to answer.

[IF MODE = 2] If you want, you can listen to these questions on headphones and enter your answers on a computer. The interviewer will not see your answers to these questions.

We will use this information to better understand the services that young adults in New Jersey get and what it is like for them leaving foster care.

Your participation in this survey is voluntary. You can choose not to answer any question or not participate in the survey at all. There will be no consequences to you if you choose not to participate. We will keep the information you provide private and will not share it with anyone except for research staff working on the study. Additionally, federal law states that 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 number for this data collection is 0970-0XXX and the expiration date is XX/XX/XXXX.

Set Up And Introduction

intloc (INTERVIEWER: WHERE IS THIS INTERVIEW TAKING PLACE? )

1 RESPONDENT’S HOME [Do not allow if incar1=1]

2 ALTERNATE LOCATION (SPECIFY)

MODE INTERVIEWER: INDICATE MODE OF ADMINISTRATION.

TELEPHONE
IN-PERSON

@1 (1) Agreement to Participate in Survey

1 YES

0 NO

@2 (2) Agreement to Contact for Future Interviews

1 YES

0 NO

GOTO @4 if R is < 18

@3 (3) Agreement to Permit the Use of Administrative Data

1 YES

0 NO

@4 (4) Agreement to Audio Recordings

1 YES

0 NO

Demographics

name_w1 What is your legal name?

(INTERVIEWER: VERIFY SPELLING)

(INTERVIEWER: IF NEEDED, A LEGAL NAME IS THE NAME THAT IDENTIFIES A PERSON FOR LEGAL, ADMINISTRATIVE, AND OTHER OFFICIAL PURPOSES. A PERSON’S LEGAL NAME GENERALLY IS THE NAME OF THE PERSON THAT WAS GIVEN AT BIRTH AND WHICH THEN APPEARS ON A BIRTH CERTIFICATE. A LEGAL NAME MAY CHANGE, FOR EXAMPLE, FOLLOWING MARRIAGE.)

FIRST NAME:

LAST NAME:

rage_w1 What is your date of birth?

ENTER MONTH |_|_| (2-DIGIT)

ENTER DAY |_|_| (2-DIGIT)

ENTER YEAR |_|_|_|_| (4-DIGIT)

D DON’T KNOW

R REFUSED

race1_w1 Are you of Hispanic, Latino, or Spanish origin?

1 YES

2 NO

D DON’T KNOW

R REFUSED

race2_w1 What race or races do you consider yourself to be? Would you say you are White, Black or African American, American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, or mixed race? You may select one or more.

1 WHITE

2 BLACK OR AFRICAN AMERICAN

3 AMERICAN INDIAN OR ALASKA NATIVE

4 ASIAN

5 NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER

6 MIXED RACE

D DON’T KNOW

R REFUSED

lang_w1 What language is usually spoken in your home?

1 ENGLISH

2 SPANISH

3 CHINESE

4 ARABIC

5 GUJARATI

6 OTHER

D DON’T KNOW

R REFUSED

adopt_w1 Have you ever been adopted?

1 YES

2 NO

D DON’T KNOW

R REFUSED

Living Arrangements

LA1_W1 [IF MODE = 2] USE CARD 1. Please look at Card 1. Where do you live now or where you stay most often?

[IF MODE =1] Where do you live now or where do you stay most often?

1 OWN PLACE WITHOUT A HOUSING VOUCHER (APARTMENT, HOUSE, TRAILER, ETC.)

2 OWN PLACE WITH A HOUSING VOUCHER

3 OWN ROOM IN MOTEL, HOTEL, OR SRO

4 IN THE HOME OF BIRTH PARENT(S)

5 IN THE HOME OF ADOPTIVE PARENT(S)

6 IN THE HOME OF OTHER RELATIVE(S)

7 IN THE HOME OF CURRENT RESOURCE/FOSTER PARENT(S)

8 IN THE HOME OF FORMER RESOURCE/FOSTER PARENT(S)

9 IN THE HOME OF SPOUSE/PARTNER

10 IN THE HOME OF FRIEND(S)

11 IN A TRANSITIONAL LIVING PROGRAM (MAY BE REFERRED TO AS ADOLESCENT HOUSING HUB OR INDEPENDENT LIVING PROGRAM)

12 GROUP QUARTERS (DORMITORY, MILITARY BARRACKS, ETC.)

13 HOSPITAL, TREATMENT OR REHAB FACILITY

14 HOMELESS: (YOU HAVE NO REGULAR PLACE TO STAY)

15 OTHER (PLEASE SPECIFY _______________)

D DON'T KNOW

R REFUSED

LA2_W1 Do you live alone or with others?

1 ALONE

2 WITH OTHERS

D DON’T KNOW

R REFUSED

LA3_W1 How many times have you moved from one living arrangement to another during the past 12 months?

____ 1-15

D DON'T KNOW

R REFUSED

LA4_W1 Have you ever couch surfed—that is, moved from one temporary housing arrangements provided by friends, family, or strangers to another during the past 12 months?

1 YES

0 NO

D DON'T KNOW

R REFUSED

LA5_W1 Have you ever been homeless for at least one night during the past 12 months? That is have you slept in a homeless shelter or in a place where people weren’t meant to sleep because you didn’t have a place to stay?

1 YES

0 NO

D DON'T KNOW

R REFUSED

Social Support

SSN0_W1 Now I am going to ask a few general questions about the amount of support you receive and the amount of stress that comes from your relationships with people that are important to you. These questions are not just about your parents, caregivers, or friends, but about all the people who are important to you.

1 CONTINUE

SSN1_W1 When you need to talk to someone about something personal or private – for instance, if you had something on your mind that was worrying you or making you feel down – are there enough people you can count on, too few people you can count on, or no one you can count on?

1 ENOUGH PEOPLE YOU CAN COUNT ON

2 TOO FEW PEOPLE YOU CAN COUNT ON

3 NO ONE YOU CAN COUNT ON

D DON’T KNOW

R REFUSED

SSN2_W1 When you need someone to lend a hand or give you something you needed or pitch in to help you with something – for instance, run an errand for you, lend you money, food, clothing or drive you somewhere you needed to go – are there enough people you can count on, too few people you can count on, or no one you can count on?

1 ENOUGH PEOPLE YOU CAN COUNT ON

2 TOO FEW PEOPLE YOU CAN COUNT ON

3 NO ONE YOU CAN COUNT ON

D DON’T KNOW

R REFUSED

SSN3_W1 When you need advice or information – for example, if you didn’t know where to get something or how to do something you needed to do – are there enough people you can count on, too few people you can count on, or no one you can count on?

1 ENOUGH PEOPLE YOU CAN COUNT ON

2 TOO FEW PEOPLE YOU CAN COUNT ON

3 NO ONE YOU CAN COUNT ON

D DON’T KNOW

R REFUSED

SSN4_W1 When it comes to people who have disappointed you – for example, broken promises they’ve made, not come through for you when you most need them, or disappoint you in some other way. Are there many people, some people, a few people, or no one who disappoints you?

1 MANY PEOPLE

2 SOME PEOPLE

3 A FEW PEOPLE

4 NO ONE

D DON’T KNOW

R REFUSED

SSN5_W1 When it comes to people who butt into your business – for example, watch over the things you do, boss you around, or act like they know what’s best for you – are there many people, some people, a few people, or no one butts into your business?

1 MANY PEOPLE

2 SOME PEOPLE

3 A FEW PEOPLE

4 NO ONE

D DON’T KNOW

R REFUSED

SSN6_W1 When it comes to people who criticize you – for instance, put you down or make you feel stupid – are there many people, some people, a few people, or no one who criticizes you?

1 MANY PEOPLE

2 SOME PEOPLE

3 A FEW PEOPLE

4 NO ONE

D DON’T KNOW

R REFUSED

SSN7_W1 When it comes to people who you have fights or strong disagreements with, are there many people, some people, a few people, or no one who you have fights or strong disagreements with?

1 MANY PEOPLE

2 SOME PEOPLE

3 A FEW PEOPLE

4 NO ONE

D DON’T KNOW

R REFUSED

Fertility

F1_W1 How many living biological children do you have, regardless of whether they live with you? By biological children, I mean children that you gave birth to or fathered.

INTERIVEWER INSTRUCTION: IF RESPONDENT SAYS S/HE IS EXPECTING A CHILD, PROBE: “Do you have any biological children other than the child that you are expecting?”

ENTER NUMBER |_| (1-DIGIT; CHECK: MIN=1, MAX=9)

0 NONE [Go to F3_W1]

D DON’T KNOW [Go to F3_W1]

R REFUSED [Go to F3_W1]

F2_W1 [ASK IF F1 >0] How many of your children currently live with you?

ENTER NUMBER |_| (1-DIGIT; CHECK: MIN=1, MAX=9)

0 NONE

D DON’T KNOW

R REFUSED

F3_W1 Are you currently pregnant or expecting a child?

1 YES [Go to F4_W1]

0 NO [Go to EDU1_W1]

D DON’T KNOW [Go to EDU1_W1]

R REFUSED [Go to EDU1_W1]

F4_W1 How many weeks along in the pregnancy are you/your partner?

ENTER MONTHS OR ___ (3-DIGIT; CHECK: MIN=0, MAX=9.5)

ENTER WEEKS |_|_| (2-DIGIT; CHECK: MIN=0, MAX=40)

D DON’T KNOW

R REFUSED

Education

EDU1_W1 The next few questions are about your education.

Are you currently enrolled in school full-time, part-time, or are you not in school?

1 YES, ENROLLLED FULL-TIME [Go to EDU2_W1]

2 YES, ENROLLLED PART-TIME [Go to EDU2_W1]

3 NOT IN SCHOOL [Go to EDU3_W1]

D DON’T KNOW [Go to EDU3_W1]

R REFUSED [Go to EDU3_W1]

EDU2_W1 What type of school are you enrolled in? Would you say high school, G.E.D. classes, vocational school, 2-year or community college, 4-year college, or something else?

1 HIGH SCHOOL

2 G.E.D. CLASSES

3 VOCATIONAL SCHOOL

4 2-YEAR OR COMMUNITY COLLEGE

5 4-YEAR COLLEGE

6 OTHER [SPECIFY]

D DON’T KNOW

R REFUSED

EDU3_W1 When were you last enrolled in school--what month and year?

ENTER MONTH |_|_| (2-DIGIT) AND YEAR |_|_|_|_| (4-DIGIT)

D DON’T KNOW

R REFUSED

EDU4_W1 What is the highest grade or year of schooling you have completed? Please include any years of college you have completed even if you do not have a college degree. If you are currently attending school, do not count the grade or year that you are in right now.

INTERVIEWER: CODE RESPONSE PROVIDED

1-12 FIRST THROUGH TWELFTH GRADE

13 FIRST YEAR OF VOCATIONAL/TECHNICAL SCHOOL

14 SECOND YEAR OF VOCATIONAL/TECHNICAL SCHOOL

15 FIRST/FRESHMAN YEAR OF COLLEGE

16 SECOND/SOPHOMORE YEAR OF COLLEGE

17 THIRD/JUNIOR YEAR OF COLLEGE

18 FOURTH/SENIOR YEAR OF COLLEGE

D DON’T KNOW

R REFUSED

EDU5_W1 Do you have a high school diploma, a home school certificate, High School Equivalency Certificate after passing the G.E.D., HiSET, or TASC?

1 HIGH SCHOOL DIPLOMA

2 HOME SCHOOL CERTIFICATE

3 HIGH SCHOOL EQUIVALENCY CERTIFICATE AFTER PASSING GED, HiSET, OR TASC

4 I DO NOT HAVE A HIGH SCHOOL DIPLOMA, G.E.D. OR CERTIFICATE

D DON’T KNOW

R REFUSED

EDU6_W1 Do you have a license or certificate from any vocational training that you received?

1 YES

2 NO

D DON’T KNOW

R REFUSED

EDU7_W1 [If EDU5_W1 = 4, go to EDU8_W1]. Do you have a college degree from a two-year college?

1 YES - ASSOCIATES DEGREE OR TWO-YEAR COLLEGE DEGREE

2 NO - NO COLLEGE DEGREE FROM A TWO-YEAR COLLEGE

D DON’T KNOW

R REFUSED

EDU8_W1 Have you ever repeated a grade or been held back?

1 YES

0 NO

D DON’T KNOW

R REFUSED

EDU9_W1 Have you ever been suspended from school?

1 YES

0 NO

D DON’T KNOW

R REFUSED

EDU10_W1 Were you ever placed in a special education program?

1 YES

0 NO

D DON’T KNOW

R REFUSED

Employment and Earnings

EMP0_W1 Now I’d like to ask you about any work you may have done. I am going to distinguish between two types of work. First, we will talk about formal employment. Formal employment is a job where you had an on-going relationship with a single employer, for example, working in a supermarket or restaurant. Second, we will talk about informal jobs, that is, doing one or a few tasks for several people and not having a "boss", for example, babysitting, mowing lawns, anything under the table, day labor, or work done through an app such as Uber, Doordash, Amazon Flex, or Taskrabbit. Informal jobs are sometimes called freelance, contract, or gig work.

First, let’s talk about any formal work you have done for an employer.

EMP1_W1 Are you currently working at a full or part-time job or jobs?

1 YES [Go to EMP4_W1]

0 NO

D DON’T KNOW

R REFUSED

EMP2_W1 Have you been formally employed in the past 12 months, that is since (Text fill: (CURRENT MONTH)) (Text fill: (CURRENT YEAR MINUS ONE YEAR))?

1 YES [Go to EMP5_W1]

0 NO

D DON’T KNOW

R REFUSED

EMP3_W1 Have you ever been formally employed?

1 YES

0 NO [GO TO EMP7_W1]

D DON’T KNOW

R REFUSED

EMP4_W1 How many hours per week do you usually work at formal employment? (PROBE: DURING WEEKS WHEN YOU WORKED).

ENTER HOURS |_|_|_| (5-DIGITS; CHECK: MIN=1, MAX=168)

D DON’T KNOW

R REFUSED

EMP5_W1 In the past 12 months, how much, in total, did you earn from formal employment?

ENTER AMOUNT $_ _ _,_ _ _. _ _

D DON’T KNOW

R REFUSED

EMP6_W1 [ASK IF EMP5_W1 = D OR R] Would you say it is …

1 Less than $1,000

2 $1,000 but less than $5,000

3 $5,000 but less than $15,000

4 $15,000 but less than $20,000

5 $20,000 but less than $25,000

6 MORE THAN $25,000

D DON’T KNOW

R REFUSED

EMP7_W1 Now let’s talk about informal jobs such as baby-sitting, lawn mowing, day labor, work done through an app such as Uber or Amazon Flex, or work that is done “under the table”. Have you had any informal jobs in the past 12 months?

1 YES

0 NO [GO TO EMPEND]

D DON’T KNOW

R REFUSED

EMP8_W1 In the past 12 months, how much did you earn from informal employment, in total?

ENTER AMOUNT $_ _ _,_ _ _. _ _

D DON’T KNOW

R REFUSED

EMP9_W1 (ASK IF EMP8_W1 = D OR R) Would you say it is …

1 Less than $1,000

2 $1,000 but less than $5,000

3 $5,000 but less than $15,000

4 $15,000 but less than $20,000

5 $20,000 but less than $25,000

6 MORE THAN $25,000

D DON’T KNOW

R REFUSED

EMPEND

Economic Hardships

ECON1_W1 The next few questions are about financial challenges you may have experienced.

Was there ever a time during the past 12 months when you did not buy clothing or shoes that you needed because you did not have enough money?

1 YES

0 NO

D DON'T KNOW

R REFUSED

ECON2_W Was there ever a time during the past 12 months when you could not pay your rent or mortgage because you did not have enough money?

1 YES

0 NO

2 DOES NOT APPLY TO ME, I DO NOT PAY FOR HOUSING

D DON'T KNOW

R REFUSED

ECON3_W1 Was there ever a time during the past 12 months when you could not pay a utility bill because you did not have enough money? By utility bill, I mean a bill for gas, electricity or telephone service.

1 YES

0 NO

2 DOES NOT APPLY TO ME, I DO NOT PAY FOR UTILITIES

D DON'T KNOW

R REFUSED

ACASI Set Up

IF MODE = 1. GOTO ACASI_PHONE

IF MODE = 2 GOTO ACASI_Intro

ACASI_Phone.

The next set of questions may seem more personal to you. Some questions ask about your emotions, alcohol or drug use, or behavior that might be against the law. Please remember that everything you tell me will be kept private in the ways that we talked about at the beginning of the survey. You may refuse to answer any question you do not want to answer.

GOTO sex_W1

IF MODE = 2

ACASI_Intro (INTERVIEWER: THIS IS THE BEGINNING OF THE FIRST PART OF THE AUDIO SELF INTERVIEW)

For this next section of questions, I’m going to hand the laptop over to you so that you can enter your answers yourself. I have headphones for you to use so that you can listen to questions being read to you. You can keep the headphones as a gift. I will not be able to hear the questions or see the answers you type into the laptop. Some of the questions might be sensitive, so this way, you can listen and answer privately.

This section is very important – that is why it is set up this way using the laptop with the headphones. Please settle in and take your time to listen to the questions and give your answers. This section will take 5 to 10 minutes or so. If you have any questions for me during this section, just let me know.

1 CONTINUE

ACASI_Start INTERVIEWER: HELP THE RESPONDENT GET SET UP AT THE LAPTOP AND USE THE HEADPHONES

ADJUST VOLUME

IF THERE IS A REASON WHY THE AUDIO PORTION CAN NOT BE ADMINISTERED (I.E. CONDITIONS WILL NOT ALLOW, ETC), ENTER 'X' AND SPECIFY THE REASON.

1 PROCEED TO AUDIO SECTION AFTER RESPONDENT IS SEATED AND READY TO CONTINUE

X SKIP AUDIO SECTION (SPECIFY REASON)

ACint2 ENTER 1 TO BEGIN AUDIO PORTION

1 BEGIN AUDIO PORTION

ac1a For these next questions, please listen to the questions and answers. Type the number associated with your answer and then press Enter.

If at any time you do not want to answer the question, please type "r" for "refused" and press Enter. If you do not know the answer, please give your best estimate. If you're still not sure, type "d" for "don't know" and press Enter.

When you are ready to continue type “1” and press Enter.

1 CONTINUE

ac1a2 For example, here is a practice question:

Today, the weather is nice.

Would you agree or disagree?

Enter 1 for AGREE or 2 for DISAGREE.

1 AGREE

2 DISAGREE

D DON’T KNOW

R REFUSED

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

ac1c That ends our example question. If you would like to listen to the question again, enter “q”. If you would like to listen to the answers again, enter “h”. If you would like to turn off the audio for the questions enter “y”. To turn the audio for the questions back on enter “y” again. If you would like to turn off the audio for the answers enter “s”. To turn the audio for the answers back on enter “s” again. If you have any questions before we begin, please ask the interviewer now. When you are ready, enter 1 to continue.

1 CONTINUE

ACpause Please sit comfortably and adjust your headphones. This section will take about 5 to 10 minutes. If at any time you would like the interviewer to read these questions instead of listening to the audio, just let the interviewer know.

Enter 1 to continue.

Demographics

sex_w1 What sex were you assigned at birth, on your original birth certificate?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 MALE

2 FEMALE

D DON’T KNOW

R REFUSED

IF MODE=2, THEN REPSONSE OPTION FORMATTING:

Male
Female

D DON’T KNOW

R REFUSED

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

gender_w1 What gender do you identify as?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

[INTERVIEWER: If needed, definitions noted in brackets]

1 GENDERQUEER/NONBINARY [do not identify as either a woman nor a man]

2 TRANSGENDER MAN [assigned female at birth but identify as a man]

3 TRANSGENDER WOMAN [assigned male at birth but identify as a woman]

4 CISGENDER WOMAN [assigned female at birth and identify as a woman]

5 CISGENDER MAN [assigned male at birth and identify as a man]

6 I IDENTIFY AS, SPECIFY

D DON’T KNOW

R REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Genderqueer/Nonbinary (do not identify as either a woman nor a man)

2 Transgender man (assigned female at birth but identify as a man)

3 Transgender woman (assigned male at birth but identify as a woman)

4 Cisgender woman (assigned female at birth and identify as a woman)

5 Cisgender man (assigned male at birth and identify as a man)

6 I identify as, specify: [TEXT BOX]

D DON’T KNOW

R REFUSED

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

sorient_w1 What is your sexual orientation?

IF MODE=1, THEN REPSONSE OPTION FORMATTING:

[INTERVIEWER: If needed, definitions noted in brackets]

1 GAY [you identify as a man and are attracted to men]

2 LESBIAN [you identify as a woman and are attracted to women]

3 BISEXUAL [you are attracted to men and women]

4 PANSEXUAL [you are attracted to people regardless of their sex or gender identity]

5 ASEXUAL [you do not experience sexual attraction]

6 STRAIGHT [you identify as a woman and are attracted to men, or you identify as a man and are attracted to women, also called heterosexual]

7 I IDENTIFY AS, SPECIFY

D DON’T KNOW

R REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Gay (you identify as a man and are attracted to men)

2 Lesbian (you identify as a woman and are attracted to women)

3 Bisexual (you are attracted to men and women)

4 Pansexual (you are attracted to people regardless of their sex or gender identity)

5 Asexual (you do not experience sexual attraction)

6 Straight (you identify as a woman and are attracted to men, or you identify as a man and are attracted to women, also called heterosexual)

7 I identify as, specify: [TEXT BOX]

D DON’T KNOW

R REFUSED

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

Mental Health Services

MH1_W1 Do you have an emotional problem that occasionally causes you to miss a day of school, work, or social or recreational activities?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

D DON’T KNOW

R REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No

D DON’T KNOW

R REFUSED

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

MH2_W1 In the past 12 months, have you received psychological or emotional counseling?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

D DON’T KNOW

R REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No

D DON’T KNOW

R REFUSED

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

MH3_W1 In the past 12 months did you receive medication for a psychological or emotional problem?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

D DON’T KNOW

R REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No

D DON’T KNOW

R REFUSED

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

MH4_W1 In the past 12 months were you in a psychiatric hospital?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

D DON’T KNOW

R REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No

D DON’T KNOW

R REFUSED

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

Substance Abuse

SA1_W1 In the past 30 days, have you had a drink of an alcoholic beverage? By a drink we mean a can or bottle of beer, a glass of wine, a mixed drink, or a shot of liquor.

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

D DON’T KNOW

R REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No [Go to SA3_W1]

D DON’T KNOW [Go to SA3_W1]

R REFUSED [Go to SA3_W1]

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

SA2_W1 On how many days did you have five or more drinks on the same occasion during the past 30 days? By occasion we mean at the same time or within hours of each other.

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

ENTER DAYS: |_|_| (2=DIGIT; CHECK: MIN=0, MAX=30)

D DON’T KNOW

R REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

Enter Days: |_|_| (2-DIGIT; CHECK: MIN=0, MAX=30)

D DON’T KNOW

R REFUSED

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

SA3_W1 In the past 30 days, have you used any illegal drugs? This includes marijuana, heroin, cocaine, amphetamines (uppers, speed, etc.), barbiturates (downers), sniffing/huffing, hallucinogens (mushrooms, LSD, acid), or club drugs (Ecstasy, Special K, GHB)?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

D DON’T KNOW

R REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No

D DON’T KNOW

R REFUSED

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

SA4_W1 In the past 30 days, have you used any prescription drugs without a doctor’s permission, or beyond what your prescription requires?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

D DON’T KNOW

R REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No

D DON’T KNOW

R REFUSED

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

SA5_W1 In the past 12 months, did you get any kind of treatment for an alcohol or drug problem?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

D DON’T KNOW

R REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No

D DON’T KNOW

R REFUSED

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

Criminal Justice Involvement

CRM1_W1 Have you ever been arrested?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

D DON’T KNOW

R REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No

D DON’T KNOW

R REFUSED

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

CRM2_W1 Have you ever spent at least one night in a jail, prison, juvenile hall, or

another correctional facility?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

1 YES

0 NO

D DON’T KNOW

R REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes

0 No

D DON’T KNOW

R REFUSED

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

Spouse/Partner Violence

REL0_W1 The next set of questions is about romantic relationships you might currently have.

REL1_W1 Are you currently married or involved in a dating or romantic relationship?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

D DON’T KNOW

R REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

1 Yes [Go to CTS0_W1]

0 No [Go to CTSEND]

D DON’T KNOW [Go to CTSEND]

R REFUSED [Go to CTSEND]

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

CTS0_W1 No matter how well a couple gets along, there are times when they disagree or fight. Couples may also have different ways of dealing with conflicts when they occur. I am going to read you a list of things that might have happened in your relationship with your partner. Please tell me how many times each of these things happened during the past year: never, once, twice, three to five times, six to ten times, eleven to twenty times or more than twenty times.

CTS1_W1 How often has your spouse/partner slapped, hit, choked, or kicked, pushed or shoved you, or thrown something at you that could hurt during the past year?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

INTERVIEWER: READ RESPONSES, IF NECESSARY

0 NEVER IN THE PAST YEAR

1 ONCE IN THE PAST YEAR

2 TWICE IN THE PAST YEAR

3 3-5 TIMES IN THE PAST YEAR

4 6-10 TIMES IN THE PAST YEAR

5 11-20 TIMES IN THE PAST YEAR

6 MORE THAN 20 TIMES IN THE PAST YEAR

D DON’T KNOW

R REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

0 Never in the past year

1 Once in the past year

2 Twice in the past year

3 3-5 times in the past year

4 6-10 times in the past year

5 11-20 times in the past year

6 More than 20 times in the past year

D DON’T KNOW

R REFUSED

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

CTS2_W1 How often has your spouse/partner insisted on or made you have sexual relations with them when you didn’t want to during the past year?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

INTERVIEWER: READ RESPONSES, IF NECESSARY

0 NEVER IN THE PAST YEAR

1 ONCE IN THE PAST YEAR

2 TWICE IN THE PAST YEAR

3 3-5 TIMES IN THE PAST YEAR

4 6-10 TIMES IN THE PAST YEAR

5 11-20 TIMES IN THE PAST YEAR

6 MORE THAN 20 TIMES IN THE PAST YEAR

D DON’T KNOW

R REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

0 Never in the past year

1 Once in the past year

2 Twice in the past year

3 3-5 times in the past year

4 6-10 times in the past year

5 11-20 times in the past year

6 More than 20 times in the past year

D DON’T KNOW

R REFUSED

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

CTS3_W1 How often have you slapped, hit, choked, or kicked, pushed or shoved, or thrown something at your spouse/partner that could hurt during the past year?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

INTERVIEWER: READ RESPONSES, IF NECESSARY

0 NEVER IN THE PAST YEAR

1 ONCE IN THE PAST YEAR

2 TWICE IN THE PAST YEAR

3 3-5 TIMES IN THE PAST YEAR

4 6-10 TIMES IN THE PAST YEAR

5 11-20 TIMES IN THE PAST YEAR

6 MORE THAN 20 TIMES IN THE PAST YEAR

D DON’T KNOW

R REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING: 0 Never in the past year

1 Once in the past year

2 Twice in the past year

3 3-5 times in the past year

4 6-10 times in the past year

5 11-20 times in the past year

6 More than 20 times in the past year

D DON’T KNOW

R REFUSED

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

CTS4_W1 How often have you insisted on or made your spouse/partner have sexual relations with you when they didn’t want to during the past year?

IF MODE=1, THEN RESPONSE OPTION FORMATTING:

INTERVIEWER: READ RESPONSES, IF NECESSARY

0 NEVER IN THE PAST YEAR

1 ONCE IN THE PAST YEAR

2 TWICE IN THE PAST YEAR

3 3-5 TIMES IN THE PAST YEAR

4 6-10 TIMES IN THE PAST YEAR

5 11-20 TIMES IN THE PAST YEAR

6 MORE THAN 20 TIMES IN THE PAST YEAR

D DON’T KNOW

R REFUSED

IF MODE=2, THEN RESPONSE OPTION FORMATTING:

0 Never in the past year

1 Once in the past year

2 Twice in the past year

3 3-5 times in the past year

4 6-10 times in the past year

5 11-20 times in the past year

6 More than 20 times in the past year

D DON’T KNOW

R REFUSED

Q REPLAY QUESTION

H REPLAY RESPONSES

Y TURN QUESTION AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

S TURN RESPONSE AUDIO ON/OFF – (SOUND IS NOW ON/OFF)

[CTSEND]

[END ACASI]. [IF MODE= 2]. Please tell the interviewer you are done.

Youth Resiliency

YR0_W1 Please use the answer choices to tell us how much each statement is—or is not—like you. The answer choices are not at all like me, a little like me, sort of like me, a lot like me, or very much like me.

YR1_W1 I learn from my mistakes.

Not at all like me
A little like me
Sort of like me
A lot like me
Very much like me

D DON’T KNOW

R REFUSED

YR2_W1 I believe I will be okay even when bad things happen.

Not at all like me
A little like me
Sort of like me
A lot like me
Very much like me

D DON’T KNOW

R REFSUED

YR3_W1 I do a good job in handling problems in my life.