Yourh Respondent Questionnaire - Closing

CORE QUESTIONNAIRE CLOSING
I would like to thank you very much for helping me. I appreciate the time that you have
taken. I realize that some of these questions may have been upsetting for you to answer,
but it is only by listening to young people like you that that we can really understand
about the health and experiences of children and young people in Baltimore/Maryland.

There may be a time when you would like to talk to someone about your experiences,
either now or in the future. Here is a list of organizations that provide various services
that could be helpful to you. Please contact them if you want to talk about any feelings
or emotions you experienced or just if you want to find out more information on a range
of free programs and services that they offer. You can contact them anytime.
If you would like, I can directly connect you to an on-call social worker now, who is
specially trained to listen and support young people. I can help arrange an opportunity
for you to talk to or meet with them in a safe place. Sometimes having someone listen to
your thoughts and feelings can be very helpful. The social worker can also connect you
to other services in this area that offer support if you want.
If you would like me to put you in touch with the on-call social worker, I will only share
with that person the information you say it’s OK for me to share. Remember that the
information you entered in the tablet is confidential. I will not see your answers and
neither would the on-call social worker if you choose to accept a referral. Please keep in
mind that if you choose to talk to the on-call social worker and you tell them that you are
in immediate danger OR if you tell them that you may hurt yourself or someone else,
OR if you share that someone is hurting you now or in the past, then they may need to
file a report. However, the social worker’s priority will be to make sure you are safe and
to get you the help you need.

Do you think that you would like to talk to the on-call social worker?

YES IF 13-15: Because you are younger than 16, I will need your parent or
guardian’s permission to talk to the on-call social worker. Do you want me to ask them if
I can put you in touch with the social worker?

YES IF 16 OR OLDER: CONTINUE TO SERVICE REFERRAL FORM; OR
CONTACT ON-CALL SOCIAL WORKER FROM RESPONSE TEAM IF RELEVANT )
NO
It is fine that you do not want to speak with a social worker now. However, if you
change your mind at any time in the future, please contact any of the organizations
provided on the list and they can help you. You can go whenever you feel ready, either
soon or later on.

Do you have any questions you would like to ask me?