Appx C-1_NSCAW Caregiver Remote Interview

Appx C-1_NSCAW Caregiver Remote Interview_May 2022_Clean.docx

OPRE Study: National Survey of Child and Adolescent Well-Being Second Cohort (NSCAW III): Data Collection [Longitudinal Study]

Appx C-1_NSCAW Caregiver Remote Interview

OMB: 0970-0202

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Appendix C-1: Caregiver Interview






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Current Caregiver Interview

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Questionnaire Introduction (CG)

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ADMINISTERED BY PHONE


CHILD STATUS AND FAMILY SETTING


CG_CSTATUS

INTERVIEWER: IS THE CHILD EMANCIPATED?

1 = YES

2 = NO


CG_FSETT

INTERVIEWER: IS THE CHILD LIVING IN A FAMILY SETTING?


A FAMILY SETTING INCLUDES LIVING WITH A BIRTH PARENT, ADOPTIVE PARENT, RELATIVES, FICTIVE KIN, OR FOSTER PARENTS.

1 YES

2 NO



INFORMED CONSENT


CG_RMAT

Before we begin, I would like to remind you of the study details. These study details are also included on the Fact Sheet and Consent Form you received by mail or email. I can send these materials to you again if you did not receive them or have not had a chance to review them yet.

Did you have time to review the materials?

1 = YES (GOTO P_Review)

2 = NO (GOTO P_NoReview)


P_Review

This study is sponsored by the Administration for Children and Families, a part of the U.S. Department of Health and Human Services. We are following up with children and their caregivers roughly 36 months after the initial interview. The caregiver interview takes about 45 minute to complete. There are two parts: first a telephone survey, and then a web survey. The interview asks about your child’s health, learning, behavior, and relationships with friends. We will ask about services your child may receive. Knowledge gained from this study will improve child welfare services and programs. Any data you provide will only be used by qualified individuals for research purposes. The only exceptions to this promise of confidentiality are if you tell me you intend to seriously harm yourself or someone else, or if a child has been or will be seriously harmed. In this situation I may need to notify a mental health professional or other authorities.


Your participation is voluntary. You may consider some of the questions to be sensitive and some of the

questions may also make you feel certain emotions, such as sadness. Remember you can choose not to answer any questions you do not want to answer, and you can stop the interview at any time. If you become upset at any time during the interview and wish to speak to a mental health professional about how you are feeling, I will provide you with the toll-free hotline numbers to call. A $50 electronic gift card will be sent to you after the telephone and web surveys. We may also telephone you in the future to check on the quality of my work during this interview.

Do you have any questions before we begin? ANSWER RESPONDENT QUESTIONS.


Can we go ahead and get started?


1 = YES, AGREES TO STUDY PARTICIPATION

2 = NO, DOES NOT AGREE TO STUDY PARTICIPATION

IF R STILL UNWILLING TO PARTICIPATE: Thank you for your time. END CALL. DOCUMENT THE SITUATION.


P_NoReview

Before we begin, I must review the consent form with you to ensure you are fully informed about study participation and your rights as a respondent. This will take just a few minutes.


Y_NoReview1

[IF P_Setting = 1 GOTO CG_FULLCON]

[IF P_Setting = 2 GOTO CG_INSTICG_FULLCON]

[IF P_CHSTAT = 1 GOTO CG_EY_FULLCON



CG_FULLCON (VERSION 2CL)


CG_INSTFULLCON (VERSION 2GL)


CG_FYFULLCON (VERSION 2P)



PRIVACY


Because you may not want others to hear the responses to some of our questions, I’d like to be sure you’re in a private area. Where are you right now? Are you at home, at work, or somewhere else? Are you in an area where you can answer these questions privately?


YES: PROCEED

NO: Please move to a more private area. Do you need more time?

YES: PAUSE, THEN CONTINUE

NO: CONTINUE



UP-FRONT VERIFICATION MODULE

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Logic before:

Preloads from CMS>ch_eman< [allow 1] [# emancipated kid] >CH_indliv< [allow 1] [# emancipated

kid, living independantly for over 90 days] >ch_wthcg< [allow 1] [# lives with CG] >ch_wthcg90<

[allow 1] [# lived with the CG in the past 90 days - 3 months]

UP-FRONT VERIFICATION MODULE Verification of CID - Case Initiation DataIF CHILD IS

LEGALLY EMANCIPATED, FILL -CHILD IS LEGALLY EMANCIPATED ACCORDING TO THE

GOVERNING STATE LAWS. IF CHILD IS LEGALLY EMANCIPATED AND DOES NOT LIVE WITH

A CAREGIVER, FILL -CHILD DOES@b NOT @bLIVE WITH A CAREGIVER. IF CHILD IS

LEGALLY EMANCIPATED, DOES NOT LIVE WITH A CAREGIVER AND HAS NOT LIVED WITH A

CAREGIVER FOR THE PAST 90 DAYS,FILL -CHILD HAS@b NOT @bLIVED WITH A

CAREGIVER DURING THE PAST 90 DAYS. -CAREGIVER INTERVIEW IS@b NOT

@bREQUIRED.IF CHILD IS LEGALLY EMANCIPATED, DOES NOT LIVE WITH A CAREGIVER

BUT HAS LIVED WITH A CAREGIVER FOR THE PAST 90 DAYS, FILLCHILD HAS LIVED WITH

A CAREGIVER DURING THE PAST 90 DAYS. CAREGIVER INTERVIEW IS REQUIRED. IF

CHILD IS LEGALLY EMANCIPATED BUT LIVES WITH A CAREGIVER, FILL -CHILD LIVES WITH

A CAREGIVER. -CAREGIVER INTERVIEW IS REQUIRED. IF CHILD IS NOT LEGALLY

EMANCIPATED, FILL -CHILD IS@b NOT @bLEGALLY EMANCIPATED ACCORDING TO THE

GOVERNING STATE LAWS. -CAREGIVER INTERVIEW IS REQUIRED.

P_NP0 [ PNP0 ] NO LABEL

INTERVIEWER: PLEASE VERIFY THE CHILD'S EMANCIPATION STATUS FROM THE

CID:@/@/^fills.P_NP01@/ ^fills.P_NP02 @/^fills.P_NP03


IS THE INFORMATION LISTED ABOVE CORRECT?

IF YES, ENTER 1 (YES)

IF NO, YOU MUST BREAKOFF THIS INTERVIEW AND RETURN TO THE CID TO CORRECT

THE EMANCIPATION STATUS OF THE CHILD.

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^fillP_NP01

LE -CHILD IS LEGALLY EMANCIPATED ACCORDING TO THE

GOVERNING STATE LAWS.

NLE -CHILD IS@b NOT @bLEGALLY EMANCIPATED ACCORDING TO THE

GOVERNING STATE LAWS.

-CAREGIVER INTERVIEW IS REQUIRED.

BLANK1

Question Fill: ^fillP_NP02

LE_DNL -CHILD DOES@b NOT @bLIVE WITH A CAREGIVER.

BLANK2

Question Fill: ^fillP_NP03

LE_DNL90M -CHILD HAS@b NOT @bLIVED WITH A CAREGIVER DURING THE

PAST 90 DAYS.

-CAREGIVER INTERVIEW IS@b NOT @bREQUIRED.

LE_LW90L -CHILD HAS LIVED WITH A CAREGIVER DURING THE PAST 90 DAYS.

CAREGIVER INTERVIEW IS REQUIRED.

LE_LW -CHILD LIVES WITH A CAREGIVER.

-CAREGIVER INTERVIEW IS REQUIRED.

blank3

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P_NP1a [ PNP1a ] Does CH live with R

INTERVIEWER: THIS IS THE @bCURRENT CAREGIVER@b INSTRUMENT. DOES ^CHILD

LIVE WITH RESPONDENT?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

1 = YES GO TO P_NP2am

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P_NP1am [ PNP1am ] CH stop living with R - M

When did ^CHILD stop living with you? Please tell me the month and year.


MONTH

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

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P_NP1ay [ PNP1ay ] CH stop living with R - Y

When did ^CHILD stop living with you? Please tell me the month and year.


YEAR

Question Type: 1990..2013

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P_NP2am [ PNP2am ] CH begin living with R - M

When did ^child begin living with you?


INTERVIEWER: IF R CANNOT PROVIDE DAY, ASK FOR MONTH AND YEAR


MONTH

Question Type: TMonth, noDK, noRF

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

---------------------------------------------------------------------------------

P_NP2ad [ PNP2ad ] CH begin living with R - D

When did ^child begin living with you?


INTERVIEWER: IF R CANNOT PROVIDE DAY, ASK FOR MONTH AND YEAR


DAY

Question Type: 1..31

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P_NP2ay [ PNP2ay ] CH begin living with R - Y

When did ^child begin living with you?


INTERVIEWER: IF R CANNOT PROVIDE DAY, ASK FOR MONTH AND YEAR


YEAR

Question Type: 1990..2013, noDK, noRF

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Logic before:

IF MONTH/YEAR IN P_NP1am, P_NP1ay IS MORE THAN 3 MONTHS BEFORE INTERVIEW

MONTH/YEAR, GO TO P_NP3a; ELSE, COMPUTE NUMBER OF DAYSBETWEEN INTERVIEW

DATE AND DATE CHILD BEGAN LIVING WITH R IN (P_NP2am - P_NP2ay) IF DIFFERENCE

CAN BE COMPUTED AS DAYS AND LT 30 DAYS, GO TO P_NP3a; ELSE, IF DIFFERENCE GE

30 DAYS, GO TO P_NPRCHKIF DIFFERENCE CANNOT BE COMPUTED AS DAYS AND

MONTH/YEAR IN P_NP2am, P_NP2ay IS SAME AS MONTH/YEAR OF INTERVIEW OR 1

MONTH BEFORE MONTH/YEAR OF INTERVIEW, GO TO P_NP2chk; ELSE IF P_NP2am,

P_NP2ay IS TWO OR MORE MONTHS BEFORE MONTH/YEAR OF INTERVIEW, GO TO

P_NP2chk [ PNP2chk ] CH begin living with R before/after int date - 30 days

Did ^CHILD begin living with you before or after ^intdateminus30

Question Type: TonAfter

ON_BEFORE 1 ON OR BEFORE

_AFTER 2 AFTER

Logic after:

1 = ON OR BEFORE [fill INTERVIEW DATE MINUS 30 DAYS] GO TO P_NPRCHK

2 = AFTER [fill INTERVIEW DATE MINUS 30 DAYS] GO TO P_NP3a

REF, DK GO TO P_NP3a

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Logic before:

IF CHILD IS EMANCIPATED PER CID AND MONTH/YEAR IN P_NP1am, P_NP1ay IS MORE

THAN 3 MONTHS BEFORE INTERVIEW MONTH/YEAR, fill:INTERVIEWER: THE STUDY

PROTOCOL SPECIFIES THAT A CAREGIVER INTERVIEW IS REQUIRED ONLY IF THE

EMANCIPATED YOUTH CURRENTLY LIVES WITH THE CAREGIVER OR LIVED WITH A

CAREGIVER DURING THE LAST 3 MONTHS.ELSE fill: INTERVIEWER: THE STUDY

PROTOCOL REQUIRES THAT THIS RESPONDENT MUST (1) CURRENTLY LIVE WITH THE

CHILD, AND/OR (2) MUST HAVE LIVED WITH THE CHILD FOR AT LEAST @bONE MONTH@b.

P_NP3a [ PNP3a ] Supervisor authorize interview

^fills.P_NP3A


HAS YOUR SUPERVISOR AUTHORIZED YOU TO CONDUCT THE CURRENT CAREGIVER

INTERVIEW WITH THIS RESPONDENT EVEN THOUGH THE STUDY CRITERIA HAVE NOT

BEEN MET?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^FillP_NP3a

more3 INTERVIEWER: THE STUDY PROTOCOL SPECIFIES THAT A

CAREGIVER INTERVIEW IS REQUIRED ONLY IF THE EMANCIPATED

YOUTH CURRENTLY LIVES WITH THE CAREGIVER OR LIVED WITH A

CAREGIVER DURING THE LAST 3 MONTHS.

else3orless INTERVIEWER: THE STUDY PROTOCOL REQUIRES THAT THIS

RESPONDENT MUST (1) CURRENTLY LIVE WITH THE CHILD, AND/OR

(2) MUST HAVE LIVED WITH THE CHILD FOR AT LEAST @bONE

MONTH@b.

Logic after:

1 = YES GOTO P_NP5a

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P_NP4 [ PNP4 ] NO LABEL

Because ^CHILD doesn't live with you currently, or has lived with you for a short period of time, I

need to talk to my supervisor to see if I should go ahead and interview you. Let me check with my

supervisor and get back to you in case I need to schedule an interview with you at a later date.


Thank you for your time today.


INTERVIEWER: PRESS ENTER TO GO BACK TO CASE MANAGEMENT SYSTEM AND CALL

Question Type: TCont

Continue 1 Continue

Logic after:

GOTO CASE MANAGEMENT SCREEN.

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Logic before:

DISPLAY GRID SHOWING NAME, RELATIONSHIP AND CAREGIVER TYPE FROM CID

(EXAMPLE SHOWN BELOW)Name Relationship to CHILD Caregiver Type from CID

Respondent?FILL NAME FROM CID SCREEN 4 FILL RELATIONSHIP FROM CID SCREEN 4

PrimaryFILL NAME FROM CID SCREEN 5 fILL RELATIONSHIP FROM CID SCREEN 5

P_NPRCHK [ PNPRCHK ] NO LABEL

INTERVIEWER: SELECT WHICH PERSON IS THE RESPONDENT ^cg_info

Question Type: TPNPRCHK, noDK, noRF

_Primary 1 Primary Caregiver: ^cg_cid.cga_first ^cg_cid.cga_initl ^cg_cid.cga_last

^cg_cid.cga_suffx

_Secondary 2 Secondary Caregiver: ^cg_cid.cgb_first ^cg_cid.cgb_initl

^cg_cid.cgb_last ^cg_cid.cgb_suffx

NotListed 3 Respondent is not listed above

Logic after:

IF R IS PRIMARY OR SECONDARY CG, GO TO P_NP5a; ELSE GO TO P_NP5e

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Logic before:

FILL NAME BELOW FROM CID SCREEN (4 OR 5) FOR PERSON IN P_NP5a MARKED AS R

P_NP5a [ PNP5x ] PCG name verification

INTERVIEWER: VERIFY THE PRIMARY CAREGIVER'S NAME:


FIRST: ^pRFIRST

MIDDLE INITIAL: ^pRINITL

LAST: ^pRLAST


IS THIS CORRECT?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

1 = YES GOTO P_NP6a

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P_NP5b [ PNP5b ] Correct PCG first name

INTERVIEWER: CORRECT FIRST NAME AS NEEDED.


FIRST NAME:

Question Type: string[30]

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P_NP5c [ PNP5c ] Correct PCG middle name

INTERVIEWER: CORRECT MIDDLE NAME AS NEEDED.


MIDDLE NAME:

Question Type: string[30], empty

---------------------------------------------------------------------------------

P_NP5d [ PNP5d ] Correct PCG last name

INTERVIEWER: CORRECT LAST NAME AS NEEDED.


LAST NAME:

Question Type: string[30]

Logic after:

GO TO P_NP6a

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P_NP5E1 [ PNP5E1 ] Enter R first name

INTERVIEWER: ENTER THE RESPONDENT'S NAME:


FIRST NAME:

Question Type: string[30]

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P_NP5E2 [ PNP5E2 ] Enter R middle name

INTERVIEWER: ENTER THE RESPONDENT'S NAME:


MIDDLE INITIAL:

Question Type: string[3], empty

---------------------------------------------------------------------------------

P_NP5E3 [ PNP5E3 ] Enter R last name

INTERVIEWER: ENTER THE RESPONDENT'S NAME:


LAST NAME:

Question Type: string[30]

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Logic before:

FILL RELATIONSHIP FROM CID SCREEN 4 OR 5 FOR PERSON IN P_NP5a MARKED AS R IF

R IS PRIMARY OR SECONDARY CG FROM CID; ELSE, IF R IS NOT LISTED ON CID; USE

RELATIONSHIP FROM CID SCREEN 4 OR 5 DEPENDING ON EXPECTED RESPONDENT

FROM CID SCREEN 7

P_NP6a [ PNP6x ] Verify PCG relation to CH

INTERVIEWER: VERIFY THE PRIMARY CAREGIVER'S RELATIONSHIP TO ^CHILD:

^RELATIONSHIP


IS THIS CORRECT?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

1 = YES GOTO P_NP8ac

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P_NP7a [ PNP7x ] PCGs relation to CH

INTERVIEWER: CODE PRIMARY CAREGIVER'S RELATIONSHIP TO ^CHILD.

Question Type: TCH14a

biomom 1 BIOLOGICAL MOTHER

stepmom 2 STEP-MOTHER

adoptmom 3 ADOPTIVE MOTHER

fostmom 4 FOSTER MOTHER

sister 5 SISTER

aunt 6 AUNT

grandma 7 GRANDMOTHER

biodad 8 BIOLOGICAL FATHER

stepdad 9 STEP-FATHER

adoptdad 10 ADOPTIVE FATHER

fostdad 11 FOSTER FATHER

brother 12 BROTHER

uncle 13 UNCLE

grandpa 14 GRANDFATHER

otherrel 95 OTHER RELATIVE

othernonrel 96 OTHER NON-RELATIVE

Logic after:

95 = OTHER RELATIVE (SPECIFY) GOTO P_NP7b

96 = OTHER NON-RELATIVE (SPECIFY) GOTO P_NP7c

ELSE, GOTO P_NP8a

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Logic before:

IF P_NP7a = 95,

P_NP7b [ PNP7b ] Other PCG relative reltionship to CH

PLEASE SPECIFY OTHER RELATIVE RELATIONSHIP.


RELATIONSHIP:

Question Type: string[30]

---------------------------------------------------------------------------------

Logic before:

IF P_NP7a = 96,

P_NP7c [ PNP7c ] Other PCG non-relative reltionship to CH

PLEASE SPECIFY OTHER NON-RELATIVE RELATIONSHIP.


RELATIONSHIP:

Question Type: string[30]

---------------------------------------------------------------------------------

Logic before:

IF R IS PRIMARY CAREGIVER FROM CID, GO TO P_NP8a; ELSE IF R IS SECONDARY CG

FROM CID OR NOT LISTED ON CID, GO TO P_NP10a. FILL NAME BELOW FROM CID SCREEN

P_NP8a [ PNP8x ] SCG name verification

INTERVIEWER: VERIFY THAT ^CHILD's CURRENT SECONDARY CAREGIVER IS:


FIRST: ^pSFirst

MIDDLE INITIAL: ^pSInitl

LAST: ^PSLast


IS THIS CORRECT?

Question Type: TPNP8F, noDk, noRF

YES 1 YES

NO 2 NO

NOCG2 3 CHILD DOES NOT HAVE A SECONDARY CAREGIVER

Logic after:

1 = YES GOTO P_NP9a

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P_NP8b [ PNP8b ] Correct SCG first name

INTERVIEWER: CORRECT FIRST NAME IF NEEDED.


FIRST NAME:


Range: 30

Question Type: string[30]

---------------------------------------------------------------------------------

P_NP8c [ PNP8c ] Correct SCG middle name

INTERVIEWER: CORRECT MIDDLE NAME IF NEEDED.


MIDDLE NAME:

Question Type: string[30], empty

---------------------------------------------------------------------------------

P_NP8d [ PNP8d ] Correct SCG last name

INTERVIEWER: CORRECT LAST NAME IF NEEDED.


LAST NAME:

Question Type: string[30]

---------------------------------------------------------------------------------

P_NP9a [ PNP9x ] Verify SCG relation to CH

INTERVIEWER: VERIFY THAT ^CHILD'S CURRENT SECONDARY CAREGIVER'S

RELATIONSHIP TO ^CHILD IS:


^cg_cid.cgb_reltxt

IS THIS CORRECT?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

1 = YES GOTO P_NP10a

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Logic before:

[IF CHILD DOES NOT LIVE WITH A

CAREGIVER PER CID, FILL: MOST RECENT/ELSE, FILL: CURRENT]

P_NP9b [ PNP9b ] SCGs relation to CH

INTERVIEWER: CODE^fills.currrecent SECONDARY CAREGIVER'S RELATIONSHIP TO ^CHILD.

Question Type: TCH14a

biomom 1 BIOLOGICAL MOTHER

stepmom 2 STEP-MOTHER

adoptmom 3 ADOPTIVE MOTHER

fostmom 4 FOSTER MOTHER

sister 5 SISTER

aunt 6 AUNT

grandma 7 GRANDMOTHER

biodad 8 BIOLOGICAL FATHER

stepdad 9 STEP-FATHER

adoptdad 10 ADOPTIVE FATHER

fostdad 11 FOSTER FATHER

brother 12 BROTHER

uncle 13 UNCLE

grandpa 14 GRANDFATHER

otherrel 95 OTHER RELATIVE

othernonrel 96 OTHER NON-RELATIVE

Logic after:

95 = OTHER RELATIVE GOTO P_NP9c

96 = OTHER NON-RELATIVE GOTO P_NP9d

ELSE, GOTO Y_CH10a

---------------------------------------------------------------------------------

Logic before:

IF P_NP9b = 95, ASK p_NP9C

P_NP9c [ PNP9c ] Other SCG relative reltionship to CH

SPECIFY OTHER RELATIVE RELATIONSHIP


RELATIONSHIP:

Question Type: string[30]

Logic after:

GO TO P_NP10a

---------------------------------------------------------------------------------

Logic before:

IF P_NP9b = 96, ASK P_NP9D

P_NP9d [ PNP9d ] Other SCG non-relative reltionship to CH

SPECIFY OTHER NON-RELATIVE RELATIONSHIP


RELATIONSHIP:

Question Type: string[30]

---------------------------------------------------------------------------------

Logic before:

IF WAVE 1, GOTO P_NP11a. ELSE, ASK P_NP10a.FILL NAME OF CURRENT CAREGIVER

RESPONDENT FROM LAST WAVE

P_NP10a [ PNP10x ] Verify respondent's name

INTERVIEWER: IS RESPONDENT'S NAME DISPLAYED BELOW?


^lastwavenamecur

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------


P_NP11a


INTERVIEWER: IS THE CHILD LIVING IN A FAMILY SETTING?


INTERVIEWER: ^CHILD'S PRIMARY CAREGIVER'S RELATIONSHIP TO ^CHILD FROM CID IS

@B^CAREGIVER_A@B.



A FAMILY SETTING INCLUDES LIVING WITH A BIRTH PARENT, ADOPTIVE PARENT, RELATIVES, FICTIVE KIN, OR FOSTER PARENTS.

Question Type:      TYN

yes                                 1  YES [GO TO P_NP12a]

no                                   2  NO [GO TO P_NP12b]



---------------------------------------------------------------------------------

P_NP12a

INTERVIEWER: ^CHILD'S PRIMARY CAREGIVER'S RELATIONSHIP TO ^CHILD FROM CID IS

@B^CAREGIVER_A@B.

FROM THE CATEGORIES BELOW, WHAT BEST DESCRIBES ^CHILD'S FAMILY SETTING?

  1. With one or both birth parents

  2. With one or both adoptive parents

  3. With relatives oR FICTIVE KIN (E.G. GODPARENTS or FAMILY FRIEND)  

  4. With non-relatives IN A FOSTER HOME


---------------------------------------------------------------------------------

P_NP12b

FROM THE CATEGORIES BELOW, WHAT BEST DESCRIBES ^CHILD'S NON-FAMILY SETTING?

INTERVIEWER: ^CHILD'S PRIMARY CAREGIVER'S RELATIONSHIP TO ^CHILD FROM CID IS

@B^CAREGIVER_A@B.



  1. In an emergency shelter

  2. In a specialized or therapeutic foster home or therapeutic home

  3. In a group home

  4. In a residential treatment facility

  5. IN A psychiatric hospital

  6. In a medical hospital or facility

  7. In a place of detention (e.g., juvenile detention, juvenile or adult corrections)

  8. In transitional independent living Apartment, HOME, OR FACILITY

  9. CHILD LIVES ON OWN (INCLUDES SCHOOL/COLLEGE, MILITARY, ETC.)

  10. Whereabouts unknown, runaway

  11. OTHER


---------------------------------------------------------------------------------

Logic before:

IF P_NP12b =3 or 4, ASK P_NP13a. ELSE, GO TO P_NP14a.

P_NP13a [ PNP13a ] Facility description

USE CARD 0. Please look at Card 0 and tell me which answer best describes this facility.

Question Type: TFacDesc

SMALLFAM 1 SMALL FAMILY GROUP HOME (RUN BY FAMILY WITH HELP OF

ADDITIONAL STAFF, 3-6 BEDS)

GROUP 2 GROUP HOME (3-6 BEDS)

SMALLRES 3 SMALL SIZED RESIDENTIAL FACILITY (7-12 BEDS)

MID 4 MID SIZED RESIDENTIAL FACILITY (13 TO 20 BEDS)

LARGE 5 LARGE SIZED RESIDENTIAL FACILITY (20 TO 49 BEDS)

LARGEST 6 LARGEST RESIDENTIAL FACILITY (50 OR MORE BEDS)

---------------------------------------------------------------------------------

P_NP14a [ PNP14a ] Is R the CHs LG

INTERVIEWER: IS THE RESPONDENT ^CHILD'S LEGAL GUARDIAN, THAT IS, THE PERSON

REQUIRED TO GIVE CONSENT FOR ^CHILD'S INTERVIEW?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

GOTO P_NPEND

HOUSEHOLD ROSTER

---------------------------------------------------------------------------------

IF CHILD SETTING IS GROUP HOME OR RESIDENTIAL FACILITY (P_NP12b = 3 OR 4) THEN GO TO Y_HHEND


Logic before:

IF WAVE = 1, START AT P_HH1. ELSE, START AT P_HH0.

P_HH0a [ PHH0a ] Verify CHs full name

I'd like to begin by updating some of the information in our records about you, ^CHILD, and

^Fills.HisHer household and family.


Is ^CHILD's full name still ^ChildFullName?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Question Fill: ^fillhisher

his his

her her

Logic after:

FILL FIRST, MIDDLE, AND LAST NAME FROM P_HH1a IN PREVIOUS WAVE. If P_HH0a=yes

GOTO P_HH2ca.

---------------------------------------------------------------------------------

P_HH0a1 [ PH0aFN ] NO LABEL

What is ^CHILD's full legal name now?


First:

Question Type: string[20]

---------------------------------------------------------------------------------

P_HH0a2 [ PH0aMN ] NO LABEL

What is ^CHILD's full legal name now?


Middle:

Question Type: string[20], empty

---------------------------------------------------------------------------------

P_HH0a3 [ PH0aLN ] NO LABEL

What is ^CHILD's full legal name now?


Last:

Question Type: string[20]

Logic after:

GOTO P_HH2ca.

September, 2016 Page 18 of 591

---------------------------------------------------------------------------------

P_HH1a [ PHH1a ] Ch full name

I'd like to begin by asking some questions about you, ^CHILD, and ^Fills.HisHer household and

family. Let's start with ^CHILD.


What is ^CHILD's full legal name?


First:

Question Type: string[20]

---------------------------------------------------------------------------------

P_HH1b [ PHH1b ] Ch full name

What is ^CHILD's full legal name?


Middle:

Question Type: string[20], empty

---------------------------------------------------------------------------------

P_HH1c [ PHH1c ] Ch full name

What is ^CHILD's full legal name?


Last:

Question Type: string[20]

---------------------------------------------------------------------------------

P_HH2n [ PHH2a ] CH age in years

How old is ^CHILD?


AGE

Question Type: 0..18, noDK, noRF

---------------------------------------------------------------------------------

P_HH2am [ PHH2amm ] NO LABEL

When was ^CHILD born?


MONTH

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

---------------------------------------------------------------------------------

P_HH2ad [ PHH2add ] NO LABEL

When was ^CHILD born?


DAY

Question Type: 1..31

---------------------------------------------------------------------------------

P_HH2ay [ PHH2ayy ] NO LABEL

When was ^CHILD born?


YEAR

Question Type: 1990..2013

Logic after:

EVALUATE RESPONSES TO P_HH2n AND P_HH2am-y FOR CONSISTENCY. IF CONSISTENT,

GO TO P_HH2ba, OTHERWISE DISPLAY INCONSISTENCY TEXT LISTED BELOW: I have

entered ^CHILD's age as ^P_HH2n and birthday as ^ChildDOB. These are inconsistent. I must

have something wrong. Which one do I need to correct?

---------------------------------------------------------------------------------

Logic before:

EVALUATE RESPONSES TO P_HH2n AND P_HH2am-y FOR CONSISTENCY. IF CONSISTENT,

GO TO P_HH2ba, OTHERWISE DISPLAY INCONSISTENCY TEXT LISTED BELOW.

P_HH2c [ PHH2c ] Inconsistent CH age and CH DOB

I have entered ^CHILD's age as ^P_HH2n and birthday as ^ChildDOB. These are inconsistent. I

must have something wrong. Which one do I need to correct?

Question Type: TCkAge, noDK, noRF

dob 1 CORRECT DATE OF BIRTH

age 2 CORRECT AGE

Logic after:

If 1 GOTO P_HH2am-y

If 2 GOTO P_HH2n

---------------------------------------------------------------------------------

P_HH2ba [ PHH2ba ] CH gender

(IF UNCLEAR, ASK:) Is ^CHILD a boy or girl?


(THE CONTROL CARD INDICATES THAT THE CHILD IS A ^ChildSex. IF THIS IS NOT

CORRECT, VERIFY THAT YOU ARE ASKING ABOUT THE CORRECT CHILD BEFORE

CONTINUING.)

Question Type: TGenderC

male 1 MALE

female 2 FEMALE

---------------------------------------------------------------------------------

P_HH2ca [ PHH2cx ] CH current grade

What grade is ^CHILD currently in?


(IF CHILD ON SUMMER BREAK, RECORD GRADE HE/SHE WILL BE IN WHEN SCHOOL

RESUMES. IF CHILD HAS GRADUATED, ENTER CHILD NOT IN SCHOOL)

Question Type: TgradeC

preschool 44 NURSERY SCHOOL/PRESCHOOL/HEAD START

kindergrtn 55 KINDERGARTEN

first 1 FIRST GRADE

second 2 SECOND GRADE

third 3 THIRD GRADE

fourth 4 FOURTH GRADE

fifth 5 FIFTH GRADE

sixth 6 SIXTH GRADE

seventh 7 SEVENTH GRADE

eighth 8 EIGHTH GRADE

ninth 9 NINTH GRADE

tenth 10 TENTH GRADE

eleventh 11 ELEVENTH GRADE

twelfth 12 TWELFTH GRADE

vocatech 13 VOCATIONAL/TECHNICAL

college 14 ANY YEAR OF COLLEGE

ungraded 17 UNGRADED PLACEMENT

notinschool 18 CHILD NOT IN SCHOOL

tooyoung 19 TOO YOUNG FOR SCHOOL

---------------------------------------------------------------------------------

Logic before:

IF P_HH2ca = 18, DK or REF, GO TO P_HH2cb; ELSE GO TO P_HH2da

P_HH2cb [ PHH2cb ] Highest grade in school CH has completed

What is the highest grade in school ^CHILD has completed?

Question Type: THH2Grd

preschool 44 NURSERY SCHOOL/PRESCHOOL/HEAD START

kindergrtn 55 KINDERGARTEN

first 1 FIRST GRADE

second 2 SECOND GRADE

third 3 THIRD GRADE

fourth 4 FOURTH GRADE

fifth 5 FIFTH GRADE

sixth 6 SIXTH GRADE

seventh 7 SEVENTH GRADE

eighth 8 EIGHTH GRADE

ninth 9 NINTH GRADE

tenth 10 TENTH GRADE

eleventh 11 ELEVENTH GRADE

twelfth 12 TWELFTH GRADE (GED)

vocatech 13 VOCATIONAL/TECHNICAL

college 14 ANY YEAR OF COLLEGE

ungraded 17 UNGRADED PLACEMENT

---------------------------------------------------------------------------------

Logic before:

IF P_HH2ca = 01-12, ASK P_HH2da. ELSE, GOTO P_HH3a.

P_HH2da [ PHH2da ] CH repeated any grades since last interview

Since ^Global.LastInt, has ^CHILD repeated any grades?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If NO GOTO P_HH3a

---------------------------------------------------------------------------------

P_HH2e [ PHH2e ] Labels are in Logic After

Which grades has ^Fills.HeShe repeated?


CODE ALL THAT APPLY.

Question Type: TGrdRepS

kindergrtn 55 KINDERGARTEN

first 1 FIRST GRADE

second 2 SECOND GRADE

third 3 THIRD GRADE

fourth 4 FOURTH GRADE

fifth 5 FIFTH GRADE

sixth 6 SIXTH GRADE

seventh 7 SEVENTH GRADE

eighth 8 EIGHTH GRADE

ninth 9 NINTH GRADE

tenth 10 TENTH GRADE

eleventh 11 ELEVENTH GRADE

twelfth 12 TWELFTH GRADE

Question Fill: ^fillheshe

he he

she she

Logic after:

COMPARE GRADES IN P_HH2e TO GRADE IN P_HH2ca. GRADES REPEATED CANNOT BE

HIGHER THAN CURRENT GRADE. IF INCONSISTENT, DISPLAY: I have recorded that ^CHILD is

currently in the ^P_HH2ca but that ^Fills.HeShe repeated ^P_HH2ea. These are inconsistent. I

must have something wrong. Which one do I need to correct?; PHHTG_55 --Which grades has CH

repeated - kindergarten; PHHTG_1 --Which grades has CH repeated - first grade; PHHTG_2 --

Which grades has CH repeated - second grade; PHHTG_3 --Which grades has CH repeated - third

grade; PHHTG_4 --Which grades has CH repeated - fourth grade; PHHTG_5 --Which grades has

CH repeated - fifth grade; PHHTG_6 --Which grades has CH repeated - sixth grade; PHHTG_7 --

Which grades has CH repeated - seventh grade; PHHTG_8 --Which grades has CH repeated -

eighth grade; PHHTG_9 --Which grades has CH repeated - ninth grade; PHHTG_10 --Which grades

has CH repeated - tenth grade; PHHTG_11 --Which grades has CH repeated - eleventh grade;

PHHTG_12 --Which grades has CH repeated - twelfth grade

---------------------------------------------------------------------------------

Logic before:

COMPARE GRADES IN P_HH2e TO GRADE IN P_HH2ca. GRADES REPEATED CANNOT BE

HIGHER THAN CURRENT GRADE. IF INCONSISTENT, DISPLAY question and fill incorrect

response text from P_HH2ea.

P_HH2ec [ PHH2ecka ] Inconsistent CH grade and CH repeated grades

I have recorded that ^CHILD is currently in the ^P_HH2ca but that ^Fills.HeShe repeated

^P_HH2e[k]. These are inconsistent. I must have something wrong. Which one do I need to

correct?

Question Type: TPHH2ec

hh2ca 1 CURRENT GRADE

hh2ea 2 REPEATED GRADE(S)

Question Fill: ^fillheshe

he he

she she

Logic after:

If 1 GOTO P_HH2ca;

If 2 GOTO P_HH2e

P_HH2fa

What type of grades does ^CHILD typically get in school?

1 Mostly A’s & B’s

2 Mostly B’s & C’s

3 Mostly C’s…& D’s

4 Mostly D’s & lower

5 CHILD’S SCHOOL USES A DIFFERENT GRADING SCALE



P_HH2fb

In general, would you say that ^CHILD does better, worse, or about the same in school as other children?

1 Better

2 Worse

3 About the same



P_HH2fc

Has child ever received a failing grade in any school course or subject?

1 YES

2 NO



P_HH2fd

Has child ever had a behavior or discipline problems at school which resulted in suspension or expulsion?

1 YES

2 NO



P_HH2fe

Did ^CHILD’s school close to in-person learning because of COVID-19 outbreak?

1 YES

2 NO



P_HH2fg

If P_HH2fe = YES: Did ^CHILD’s school offer online learning while closed to in-person learning?

1 YES

2 NO



P_HH2fh

IF P_HH2fg = YES: Has ^CHILD’s school provided any of the following services to support their online learning? [CODE ALL THAT APPLY]

  1. Free home internet access

  2. Free computer or tablet

  3. Free Meals

  4. Tutoring

  5. Learning pods or childcare


---------------------------------------------------------------------------------

Logic before:

IF AGE < 16, GOTO P_HH4a. Fill: IF WAVE > 1:" What is ^CHILD's marital status? Is

^Fills.HeShe ..." ELSE:"USE CARD 1. Please look at Card 1. What is ^CHILD's marital status?

P_HH3a [ PHH3a ] CH marital status

USE CARD 1. Please look at Card 1.


What is ^CHILD's marital status? Is ^Fills.HeShe...

Question Type: TMarSt2F

married 1 Married,

separated 2 Separated,

divorced 3 Divorced,

widowed 4 Widowed, or

nevermarried 5 Has ^Fills.HeShe never been married?

---------------------------------------------------------------------------------

P_HH4a [ PHH4a ] Verify Rs first name

Next, I need to record the first name of ^CHILD’s primary and secondary caregiver in this household. By "living in this

household" I mean caregivers who considers this their current primary residence, or who stays

here at least three nights per week, every week.


Let's start with you. Your first name is ^CAREGIVER1. Is that correct?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If YES GOTO P_HH5

---------------------------------------------------------------------------------

P_HH4a1 [ PHH4aa ] Correct Rs first name

What is your first name?


FIRST NAME:

Question Type: string[20]

---------------------------------------------------------------------------------

P_HH5BEG [ PHH5BEG ] NoDeliv

PLEASE PRESS "1" TO CONTINUE.

Question Type: BCallCARIRouter

---------------------------------------------------------------------------------

Logic before:

FILL IF SECONDARY CAREGIVER HAS BEEN IDENTIFIED IN QP SECTION: In addition to

yourself, I have (FILL NAME OF SECONDARY CAREGIVER FROM QP SECTION).

P_HH5 [ PHH5 ] Labels are in Logic After

What is the first name of the other caregiver who lives

here?^


P_HH5a

Including you, how many adults, age 18 or over are living in this household?


P_HH5b

Including ^CHILD, how many children, age 17 or younger are living in this household?


---------------------------------------------------------------------------------

P_HH6a [ PHH6ax ] Rs relationship to CH

USE CARD 2. Please look at the list on Card 2. What is your relationship to ^CHILD?


(PROBE TO DETERMINE IF BIOLOGIC, STEP, ADOPTIVE, FOSTER, ETC.)

Question Type: TRlCrd2F

_2 2 MOTHER (BIOLOGICAL)

_3 3 FATHER (BIOLOGICAL)

_4 4 STEP-MOTHER

_5 5 STEP-FATHER

_6 6 ADOPTIVE MOTHER

_7 7 ADOPTIVE FATHER

_8 8 FOSTER MOTHER

_9 9 FOSTER FATHER

_10 10 FULL SISTER

_11 11 FULL BROTHER

_12 12 HALF SISTER

_13 13 HALF BROTHER

_14 14 STEP-SISTER

_15 15 STEP-BROTHER

_16 16 FOSTER SISTER

_17 17 FOSTER BROTHER

_18 18 ADOPTIVE SISTER

_19 19 ADOPTIVE BROTHER

_30 30 AUNT

_31 31 UNCLE

_32 32 GREAT AUNT

_33 33 GREAT UNCLE

_34 34 COUSIN

_40 40 MATERNAL GRANDMOTHER

_41 41 PATERNAL GRANDMOTHER

_42 42 MATERNAL GRANDFATHER

_43 43 PATERNAL GRANDFATHER

_44 44 MATERNAL GREAT-GRANDMOTHER

_45 45 PATERNAL GREAT-GRANDMOTHER

_46 46 MATERNAL GREAT-GRANDFATHER

_47 47 PATERNAL GREAT-GRANDFATHER

_94 94 BABYSITTER

_95 95 OTHER BLOOD RELATIVE

_96 96 OTHER NON-RELATIVE

Logic after:

If 2,3,16,17,18,19 then GO TO P_HH6hm; If 95 then GO TO P_HH6as1; If 96 then GO TO

P_HH6as2; else GO TO P_HH6b

---------------------------------------------------------------------------------

Logic before:

IF P_HH6a = 95

P_HH6as1 [ PHH6as1 ] Rs other relative relationship to CH

PLEASE SPECIFY OTHER RELATIVE RELATIONSHIP.


RELATIONSHIP:

Question Type: string[30]

Logic after:

GO TO P_HH6b

---------------------------------------------------------------------------------

Logic before:

IF P_HH6a = 96

P_HH6as2 [ PHH6as2 ] Rs other non-relative relationship to CH

PLEASE SPECIFY OTHER NON-RELATIVE RELATIONSHIP.


RELATIONSHIP:

Question Type: string[30]

Logic after:

GO TO P_HH6b

---------------------------------------------------------------------------------

Logic before:

If ch_eman = yes (Child is EY) ship P_HH6b

P_HH6b [ PHH6b ] Has R legally adopted CH

Have you legally adopted ^CHILD, that is, have you signed court papers to complete an adoption

process for ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If YES then GO TO P_HH6f; if NO then GO TO P_HH6c

---------------------------------------------------------------------------------

P_HH6c [ PHH6c ] Did fstr care/social services agency help

Did anyone from a foster care or social services agency help arrange for you to care for ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_HH6d [ PHH6d ] Regularly talk CW about CH

Do you regularly talk to a caseworker about ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_HH6e [ PHH6e ] Currently receive payments for being CHs foster parent

Do you currently receive payments for being ^CHILD's foster parent?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

Logic before:

ASK P_HH6f if P_HH6a = 6,7,8 or 9; ELSE GO TO P_HH6hm

P_HH6f [ PHH6f ] Is R related to CH

Are you related to ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If NO then GO TO P_HH6hm

---------------------------------------------------------------------------------

P_HH6g [ PHH6g ] Aside from the PHH6a rel, what is your other rel to CHILD

USE CARD 3. Aside from being ^CHILD's ^P_HH6a, what is your relationship to ^CHILD?

Question Type: TRelHH6g

_2 2 MOTHER (BIOLOGICAL)

_3 3 FATHER (BIOLOGICAL)

_10 10 FULL SISTER

_11 11 FULL BROTHER

_12 12 HALF SISTER

_13 13 HALF BROTHER

_14 14 STEP-SISTER

_15 15 STEP-BROTHER

_16 16 FOSTER SISTER

_17 17 FOSTER BROTHER

_18 18 ADOPTIVE SISTER

_19 19 ADOPTIVE BROTHER

_30 30 AUNT

_31 31 UNCLE

_32 32 GREAT AUNT

_33 33 GREAT UNCLE

_34 34 COUSIN

_40 40 MATERNAL GRANDMOTHER

_41 41 PATERNAL GRANDMOTHER

_42 42 MATERNAL GRANDFATHER

_43 43 PATERNAL GRANDFATHER

_44 44 MATERNAL GREAT-GRANDMOTHER

_45 45 PATERNAL GREAT-GRANDMOTHER

_46 46 MATERNAL GREAT-GRANDFATHER

_47 47 PATERNAL GREAT-GRANDFATHER

_95 95 OTHER BLOOD RELATIVE

_96 96 OTHER NON-RELATIVE

Logic after:

IF P_HH6g = 95; GO TO P_HH6gs1; ELSE IF P_HH6g = 96, GO TO P_HH6gs2; ELSE IF P_HH6g

NE 95 OR 96, GO TO P_HH6hm

---------------------------------------------------------------------------------

Logic before:

IF P_HH6g = 95

P_HH6gs1 [ PHH6gs1 ] SPECIFY, OTHER RELATIVE RELATIONSHIP

PLEASE SPECIFY OTHER RELATIVE RELATIONSHIP.


RELATIONSHIP:

Question Type: string[30]

---------------------------------------------------------------------------------

Logic before:

IF P_HH6g = 96

P_HH6gs2 [ PHH6gs2 ] SPECIFY, OTHER NON-RELATIVE RELATIONSHIP

PLEASE SPECIFY OTHER NON-RELATIVE RELATIONSHIP.


RELATIONSHIP:

Question Type: string[30]



---------------------------------------------------------------------------------

P_HH6hm [ PHH7am ] NO LABEL

What is your date of birth?


MONTH

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

---------------------------------------------------------------------------------

P_HH6hd [ PHH7ad ] NO LABEL

What is your date of birth?


DAY

Question Type: 1..31

---------------------------------------------------------------------------------

P_HH6hy [ PHH7ay ] NO LABEL

What is your date of birth?


YEAR

Question Type: 1913..1996

---------------------------------------------------------------------------------

P_HH6hn [ PHH7bb ] Caregivers age

How old are you now?


YEARS OLD

Question Type: 15..95

Logic after:

COMPARE AGE CALCULATED FROM DATE OF BIRTH IN P_HH6hm-y TO AGE REPORTED IN

P_HH6hn. IF AGES AGREE OR INCOMPLETE INFORMATION MAKES THE CHECK

IMPOSSIBLE TO PERFORM, GOTO P_HH6i. IF AGES DISAGREE, FILL: Based on the date of

birth I entered, the computer has calculated that you are FILL CALCULATED AGE FROM

P_HH6hm-y YEARS OLD. This is different from the age I entered for you. Which of these needs

to be corrected? Your date of birth or your age?

---------------------------------------------------------------------------------

Logic before:

COMPARE AGE CALCULATED FROM DATE OF BIRTH IN P_HH6hm-y TO AGE REPORTED IN

P_HH6hn. IF AGES AGREE OR INCOMPLETE INFORMATION MAKES THE CHECK

IMPOSSIBLE TO PERFORM, GOTO P_HH6i. IF AGES DISAGREE

P_HH6hc [ PHH7bcka ] age-DOB check

Based on the date of birth I entered, the computer has calculated that you are ^Rage years old.

This is different from the age I entered for you. Which of these needs to be corrected? Your date

of birth or your age?

Question Type: TCkAge, noDK, NoRF

dob 1 CORRECT DATE OF BIRTH

age 2 CORRECT AGE

Logic after:

If 1 GO BACK TO P_HH6hm-y

If 2 GO BACK TO P_HH6hn

---------------------------------------------------------------------------------

Logic before:

IF P_HH6a = 2-33, 40-47 gender can be determined so set P_HH6i accordingly and skip P_HH6i

else, ask P_HH7a.

P_HH6i [ PHH8c ] CGs gender

INTERVIEWER: RECORD SEX OF R.

Question Type: TGenderC

male 1 MALE

female 2 FEMALE

---------------------------------------------------------------------------------

Logic before:

ASK P_HH7a THROUGH P_HH7c FOR EACH PERSON LISTED IN P_HH5. SET NEXT PERSON

LISTED IN P_HH5 AS VARIABLE <PERSON>

P_HH7a [ PHH7a ] Labels are in Logic After

USE CARD 4. Let's talk about ^SECONDARY CAREGIVER Looking at Card 4, what is ^PERSON's relationship to

^CHILD? (PROBE TO DETERMINE BIOLOGIC, STEP, ADOPTIVE, FOSTER, ETC.)

Question Type: TReld2Ar

_2 2 MOTHER (BIOLOGICAL)

_3 3 FATHER (BIOLOGICAL)

_4 4 STEP-MOTHER

_5 5 STEP-FATHER

_6 6 ADOPTIVE MOTHER

_7 7 ADOPTIVE FATHER

_8 8 FOSTER MOTHER

_9 9 FOSTER FATHER

_10 10 FULL SISTER

_11 11 FULL BROTHER

_12 12 HALF SISTER

_13 13 HALF BROTHER

_14 14 STEP-SISTER

_15 15 STEP-BROTHER

_16 16 FOSTER SISTER

_17 17 FOSTER BROTHER

_18 18 ADOPTIVE SISTER

_19 19 ADOPTIVE BROTHER

_30 30 AUNT

_31 31 UNCLE

_32 32 GREAT AUNT

_33 33 GREAT UNCLE

_34 34 COUSIN

_40 40 MATERNAL GRANDMOTHER

_41 41 PATERNAL GRANDMOTHER

_42 42 MATERNAL GRANDFATHER

_43 43 PATERNAL GRANDFATHER

_44 44 MATERNAL GREAT-GRANDMOTHER

_45 45 PATERNAL GREAT-GRANDMOTHER

_46 46 MATERNAL GREAT-GRANDFATHER

_47 47 PATERNAL GREAT-GRANDFATHER

_94 94 BABYSITTER

_95 95 OTHER BLOOD RELATIVE

_96 96 OTHER NON-RELATIVE

Logic after:

PHH7a_1 --Other adult in HH relationship to CH - 1; PHH7a_2 --Other adult in HH relationship to

CH - 2; PHH7a_3 --Other adult in HH relationship to CH - 3; PHH7a_4 --Other adult in HH

relationship to CH - 4; PHH7a_5 --Other adult in HH relationship to CH - 5; PHH7a_6 --Other adult

in HH relationship to CH - 6; PHH7a_7 --Other adult in HH relationship to CH - 7; PHH7a_8 --Other

adult in HH relationship to CH - 8; PHH7a_9 --Other adult in HH relationship to CH - 9; PHH7a_10 --

Other adult in HH relationship to CH - 10

---------------------------------------------------------------------------------

Logic before:

IF P_HH7a = 95

P_HH7as1 [ PHH7as1 ] Labels are in Logic After

PLEASE SPECIFY OTHER RELATIVE RELATIONSHIP.


RELATIONSHIP:

Question Type: Tstr30Ar

_30 1 STRING[30]

Logic after:

PHH7as1_1 --Other adult in HH othr rltve relationship to CH - 1; PHH7as1_2 --Other adult in HH

othr rltve relationship to CH - 2; PHH7as1_3 --Other adult in HH othr rltve relationship to CH - 3;

PHH7as1_4 --Other adult in HH othr rltve relationship to CH - 4; PHH7as1_5 --Other adult in HH

othr rltve relationship to CH - 5; PHH7as1_6 --Other adult in HH othr rltve relationship to CH - 6;

PHH7as1_7 --Other adult in HH othr rltve relationship to CH - 7; PHH7as1_8 --Other adult in HH

othr rltve relationship to CH - 8; PHH7as1_9 --Other adult in HH othr rltve relationship to CH - 9;

PHH7as1_10 --Other adult in HH othr rltve relationship to CH - 10

---------------------------------------------------------------------------------

Logic before:

IF P_HH7a = 96

P_HH7as2 [ PHH7as2 ] Labels are in Logic After

PLEASE SPECIFY OTHER NON-RELATIVE RELATIONSHIP.


RELATIONSHIP:

Question Type: Tstr30Ar

_30 1 STRING[30]

Logic after:

PHH7as2_1 --Other adult in HH othr non-rltve relationship to CH - 1; PHH7as2_2 --Other adult in

HH othr non-rltve relationship to CH - 2; PHH7as2_3 --Other adult in HH othr non-rltve relationship

to CH - 3; PHH7as2_4 --Other adult in HH othr non-rltve relationship to CH - 4; PHH7as2_5 --Other

adult in HH othr non-rltve relationship to CH - 5; PHH7as2_6 --Other adult in HH othr non-rltve

relationship to CH - 6; PHH7as2_7 --Other adult in HH othr non-rltve relationship to CH - 7;

PHH7as2_8 --Other adult in HH othr non-rltve relationship to CH - 8; PHH7as2_9 --Other adult in

HH othr non-rltve relationship to CH - 9; PHH7as2_10 --Other adult in HH othr non-rltve relationship

---------------------------------------------------------------------------------

P_HH7bn [ PHHGE ] Labels are in Logic After

How old is ^PERSON?


YEARS OLD

Question Type: TInt095Ar

_0_95 1 0..95

Logic after:

PHHGE_1 --Age HH member 1; PHHGE_2 --Age HH member 2; PHHGE_3 --Age HH member 3;

PHHGE_4 --Age HH member 4; PHHGE_5 --Age HH member 5; PHHGE_6 --Age HH member 6;

PHHGE_7 --Age HH member 7; PHHGE_8 --Age HH member 8; PHHGE_9 --Age HH member 9;

PHHGE_10 --Age HH member 10

---------------------------------------------------------------------------------

Logic before:

IF P_HH7a = 2-33, 40-47 the gender can be determined so fill P_HH7c appropriately and GOTO

P_HH7 for the next HH member until all have been asked about.

P_HH7c [ PHHEX ] Labels are in Logic After

IF SEX UNCLEAR, ASK: Is ^PERSON male or female?

Question Type: TGenr10F

male 1 MALE

female 2 FEMALE

---------------------------------------------------------------------------------

Logic before:

IF ALL OTHER HH MEMBERS ARE AGES 0-17 GO TO P_HH9a; ELSE, GO TO HH8aa. IF A 2nd

CG WAS IDENTIFIED IN CID AND CONFIRMED IN NP SECTION, ASK HH8aa.

P_HH8aa [ PHH8aa ] Other adult in HH responsible for CH

Aside from yourself, is there another adult in the household who is responsible for ^CHILD's

health, education and well-being?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If NO then GO TO P_HH9a

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

IF P_HH7a FOR CAREGIVER2 = 2,3,16,17,18 or 19, GO TO P_HH8f; ELSE GO TO P_HH8b

P_HH8b [ PHH8b ] Has CG legally adopted CH

Has ^CAREGIVER2 legally adopted ^CHILD, that is, has ^Fills.HeShe signed court papers to

complete an adoption process for ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If YES then GO TO P_HH8f

---------------------------------------------------------------------------------

Logic before:

IF P_HH6c = 1 OR P_HH6d = 1 OR P_HH6e = 1; GO TO P_HH8f; ELSE ASK P_HH8c

P_HH8c [ PHH8b2 ] Foster care/soc serv agency hlp arrng CAREGIVER2 for CHILD?

Did anyone from a foster care or social services agency help arrange for ^CAREGIVER2 to care

for ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_HH8d [ PHH8d ] Does CG regularly talk to caseworker about CH

Does ^CAREGIVER2 regularly talk to a caseworker about ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_HH8e [ PHH8e ] Does CG rcv payments for bing CHs foster parent

I understand that ^CAREGIVER2 is ^CHILD's ^CAREGIVER2_Rel.


Does ^CAREGIVER2 currently receive any payments for being ^CHILD's foster parent?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

Logic before:

ASK P_HH8f if P_HH7a = 6,7,8 or 9; ELSE GO TO P_HH8hm

P_HH8f [ PHH8f ] Is CG related to CH

Is ^CAREGIVER2 related to ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If NO then GO TO P_HH8hm

---------------------------------------------------------------------------------

Logic before:

if P_HH7a = 6,7,8 or 9 set fills.p_hh8g to _6, _7, _8, _9 (adoptive or foster mom or dad)

P_HH8g [ PHH8g ] Aside from the P_HH8g rel, what is CARGIVER2s rel to CHILD

USE CARD 5. Aside from being ^CHILD's ^Fills.P_HH8g, what is ^CAREGIVER2's relationship to

^CHILD?

Question Type: TRelHH6g

_2 2 MOTHER (BIOLOGICAL)

_3 3 FATHER (BIOLOGICAL)

_10 10 FULL SISTER

_11 11 FULL BROTHER

_12 12 HALF SISTER

_13 13 HALF BROTHER

_14 14 STEP-SISTER

_15 15 STEP-BROTHER

_16 16 FOSTER SISTER

_17 17 FOSTER BROTHER

_18 18 ADOPTIVE SISTER

_19 19 ADOPTIVE BROTHER

_30 30 AUNT

_31 31 UNCLE

_32 32 GREAT AUNT

_33 33 GREAT UNCLE

_34 34 COUSIN

_40 40 MATERNAL GRANDMOTHER

_41 41 PATERNAL GRANDMOTHER

_42 42 MATERNAL GRANDFATHER

_43 43 PATERNAL GRANDFATHER

_44 44 MATERNAL GREAT-GRANDMOTHER

_45 45 PATERNAL GREAT-GRANDMOTHER

_46 46 MATERNAL GREAT-GRANDFATHER

_47 47 PATERNAL GREAT-GRANDFATHER

_95 95 OTHER BLOOD RELATIVE

_96 96 OTHER NON-RELATIVE

Question Fill: ^FillP_HH8g

_6 ADOPTIVE MOTHER

_7 ADOPTIVE FATHER

_8 FOSTER MOTHER

_9 FOSTER FATHER

---------------------------------------------------------------------------------

Logic before:

IF P_HH8g = 95

P_HH8gs1 [ PHH8gs1 ] SPECIFY, OTHER RELATIVE RELATIONSHIP

PLEASE SPECIFY OTHER RELATIVE RELATIONSHIP.


RELATIONSHIP:

Question Type: string[30]

---------------------------------------------------------------------------------

Logic before:

IF P_HH8g = 96

P_HH8gs2 [ PHH8gs2 ] SPECIFY, OTHER NON-RELATIVE RELATIONSHIP

PLEASE SPECIFY OTHER NON-RELATIVE RELATIONSHIP.


RELATIONSHIP:

Question Type: string[30]

---------------------------------------------------------------------------------

P_HH8hm [ PHH8hm ] CAREGIVER2s date of birth - MONTH

What is ^CAREGIVER2's date of birth?


MONTH

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

---------------------------------------------------------------------------------

P_HH8hd [ PHH8hd ] CAREGIVER2s date of birth - DAY

What is ^CAREGIVER2's date of birth?


DAY

Question Type: 1..31

---------------------------------------------------------------------------------

P_HH8hy [ PHH8hy ] CAREGIVER2s date of birth - YEAR

What is ^CAREGIVER2's date of birth?


YEAR

Question Type: 1913..1996

Logic after:

COMPARE AGE CALCULATED FROM DATE OF BIRTH IN P_HH8hm-y TO AGE REPORTED IN

P_HH7bn. IF AGES AGREE OR INCOMPLETE INFORMATION MAKES THE CHECK

IMPOSSIBLE TO PERFORM, GOTO P_HH9a. IF AGES DISAGREE, FILL: Based on the date of

birth I entered, the computer has calculated that CAREGIVER2 is FILL CALCULATED AGE FROM

P_HH8hm-y YEARS OLD. This is different from the age I entered for (him/her). Which of these

needs to be corrected? (His/Her) date of birth or (his/her) age?

---------------------------------------------------------------------------------

Logic before:

COMPARE AGE CALCULATED FROM DATE OF BIRTH IN P_HH8hm-y TO AGE REPORTED IN

P_HH7bn. IF AGES AGREE OR INCOMPLETE INFORMATION MAKES THE CHECK

IMPOSSIBLE TO PERFORM, GOTO P_HH9a. IF AGES DISAGREE

P_HH8i [ PHH8i ] CAREGIVER2 date of birth and age do not match

Based on the date of birth I entered, the computer has calculated that ^CAREGIVER2 is ^RAge

years old. This is different from the age I entered for ^Fills.HimHer. Which of these needs to be

corrected? ^Fills.HisHer date of birth or ^Fills.HisHer age?

Question Type: TCkAge, NoDK, NoRF

dob 1 CORRECT DATE OF BIRTH

age 2 CORRECT AGE

Logic after:

If 1 GO BACK TO P_HH8hm-y

If 2 GO BACK TO P_HH8hn

---------------------------------------------------------------------------------

Logic before:

IF RESPONDENT OR CAREGIVER2 IS BIOLOGICAL PARENT (P_HH6a = 2,3 OR P_HH6g = 2,3

OR P_HH7a = 2,3 OR P_HH8g = 2,3) OR RESPONDENT OR CAREGIVER2 IS ADOPTIVE HAS

ADOPTED CHILD (P_HH6b = 1 OR P_HH8b = 1), GO TO HH11a; ELSE ASK P_HH9a - P_HH10A

P_HH9a [ PHH9a ] Are you CHs LG

Are you ^CHILD's legal guardian?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If YES then GO TO P_HH10a

---------------------------------------------------------------------------------

Logic before:

IF NO CAREGIVER2, GO TO P_HH9d

P_HH9c [ PHH9c ] Is CG CHs LG

Is ^CAREGIVER2 ^CHILD's legal guardian?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

IF YES then GO TO P_HH10a

---------------------------------------------------------------------------------

P_HH9d [ PHH9d ] Does CH have a LG living in the HH

Does ^CHILD have a legal guardian living in the household?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If NO then GO TO P_HH10a

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HH10a [ PHH10a ] Consider your home to be CHs permanent home

Do you consider your home to be ^CHILD's permanent home?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_HH11a [ PHH12a ] Rs marital status

USE CARD 6. Now I have a few more questions about you. Please look at Card 6. Are you

currently...


NOTE: "MARRIED" CAN INCLUDE LEGAL AND COMMON LAW MARRIAGES, DEPENDING ON

Question Type: TMStat

married 1 Married,

separated 2 Separated,

divorced 3 Divorced,

widowed 4 Widowed, or

nevermarried 5 Have you never been married?

---------------------------------------------------------------------------------

Logic before:

IF P_HH5 IS BLANK, THAT IS "R LIVES ALONE", GO TO HH15a; ASK P_HH12a FOR

CAREGIVER 2

P_HH12a [ PHH12x ] Labels are in Logic After

USE CARD 7. Please look at the list on Card 7. What is ^PERSON's relationship to you?

Question Type: TReHH12a

_1 1 SPOUSE

_2 2 UNMARRIED PARTNER, BOYFRIEND/GIRLFRIEND

_3 3 CHILD (BIOLOGICAL)

_4 4 CHILD (ADOPTIVE)

_5 5 CHILD (STEP)

_6 6 CHILD (FOSTER)

_7 7 GRANDCHILD

_8 8 MOTHER (BIRTH/ADOPTIVE/STEP/FOSTER/OTHER)

_9 9 FATHER (BIRTH/ADOPTIVE/STEP/FOSTER/OTHER)

_10 10 BROTHER/SISTER

_11 11 GRANDFATHER/GRANDMOTHER

_12 12 NIECE/NEPHEW

_13 13 AUNT/UNCLE

_14 14 COUSIN

_15 15 GREAT GRANDCHILD

_16 16 HOUSEMATE/ROOMMATE

_17 17 ROOMER/BOARDER

_18 18 OTHER RELATIVE

_19 19 OTHER NONRELATIVE

_20 20 UNRELATED LEGAL GUARDIAN

Logic after:

IF P_HH12a = 18 GO TO P_HH12as1; ELSE IF P_HH12a = 19, GO TO P_HH12as2; ELSE

CONTINUE TO NEXT PERSON UNTIL ALL RELATIONSHIPS TO R HAVE BEEN DETERMINED;

THEN GO TO P_HH13am; PHH12x_1 --R 2 marital status; PHH12x_2 --R 3 marital status;

PHH12x_3 --R 4 marital status; PHH12x_4 --R 5 marital status; PHH12x_5 --R 6 marital status;

PHH12x_6 --R 7 marital status; PHH12x_7 --R 8 marital status; PHH12x_8 --R 9 marital status;

PHH12x_9 --R 10 marital status; PHH12x_10 --R 11 marital status

---------------------------------------------------------------------------------

Logic before:

IF P_HH12a = 18

P_HH12as1 [ PHH12as1 ] Labels are in Logic After

PLEASE SPECIFY OTHER RELATIVE RELATIONSHIP.


RELATIONSHIP:

Question Type: Tstr30Ar

_30 1 STRING[30]

Logic after:

PHH12as1_1 --Other relative 2 reltionship; PHH12as1_2 --Other relative 3 reltionship; PHH12as1_3

--Other relative 4 reltionship; PHH12as1_4 --Other relative 5 reltionship; PHH12as1_5 --Other

relative 6 reltionship; PHH12as1_6 --Other relative 7 reltionship; PHH12as1_7 --Other relative 8

reltionship; PHH12as1_8 --Other relative 9 reltionship; PHH12as1_9 --Other relative 10 reltionship;

PHH12as1_10 --Other relative 11 reltionship

---------------------------------------------------------------------------------

Logic before:

IF P_HH12a = 19

P_HH12as2 [ PHH12as2 ] Labels are in Logic After

PLEASE SPECIFY OTHER NON-RELATIVE RELATIONSHIP.


RELATIONSHIP:

Question Type: Tstr30Ar

_30 1 STRING[30]

Logic after:

PHH12as2_1 --Other non-relative 2 reltionship; PHH12as2_2 --Other non-relative 3 reltionship;

PHH12as2_3 --Other non-relative 4 reltionship; PHH12as2_4 --Other non-relative 5 reltionship;

PHH12as2_5 --Other non-relative 6 reltionship; PHH12as2_6 --Other non-relative 7 reltionship;

PHH12as2_7 --Other non-relative 8 reltionship; PHH12as2_8 --Other non-relative 9 reltionship;

PHH12as2_9 --Other non-relative 10 reltionship; PHH12as2_10 --Other non-relative 11 reltionship

---------------------------------------------------------------------------------

Logic before:

IF SPOUSE HAS BEEN IDENTIFIED (P_HH12a = 1), ASK P_HH13am - ay; ELSE GO TO

P_HH13am [ PHH13bm ] NO LABEL

What is your spouse's date of birth?


MONTH

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

---------------------------------------------------------------------------------

P_HH13ad [ PHH13bd ] NO LABEL

What is your spouse's date of birth?


DAY

Question Type: 1..31

---------------------------------------------------------------------------------

P_HH13ay [ PHH13by ] NO LABEL

What is your spouse's date of birth?


YEAR

Question Type: 1913..1993

---------------------------------------------------------------------------------

Logic before:

ASK P_HH15A -- P_HH29E FOR RESPONDENT - ASK P_HH15AC -- P_HH29EC FOR

CAREGIVER2

P_HH15a [ PHH15x ] Rs highest degree

USE CARD 8. Please look at Card 8. What is the highest grade in school you have completed?

Please include vocational or technical training and any years in college you may have completed.

Question Type: TGraH15F

LESS 0 LESS THAN FIRST GRADE

FIRST 1 FIRST GRADE

SECON 2 SECOND GRADE

THIRD 3 THIRD GRADE

FOURT 4 FOURTH GRADE

FIFTH 5 FIFTH GRADE

SIXTH 6 SIXTH GRADE

SEVEN 7 SEVENTH GRADE

EIGHT 8 EIGHTH GRADE

NINTH 9 NINTH GRADE

TENTH 10 TENTH GRADE

ELEVE 11 ELEVENTH GRADE

TWELFTH 12 TWELFTH GRADE

VOCATIO 13 VOCATIONAL/TECHNICAL

SOMECOL 14 SOME COLLEGE CREDIT, LESS THAN 1 YEAR

col1_3 15 1 TO 3 YEARS OF COLLEGE

col4MO 16 4 OR MORE YEARS OF COLLEGE

UNGRAD 17 UNGRADED PLACEMENT

---------------------------------------------------------------------------------

P_HH16a [ PHH16x ] Rs highest grade completed

USE CARD 9. Please look at Card 9. What is the highest degree, diploma, or certificate you hold?

Question Type: TGraH16F

NONE 1 NONE

HIGH 2 HIGH SCHOOL EQUIVALENCY (for example: GED)

H_S 3 H.S. DIPLOMA

VOCA 4 VOCATIONAL TECH CERTIFICATE/DIPLOMA (for example: DENTAL

TECHNICIAN, COSMETOLOGY LICENSE, ETC.)

NURS 5 NURSING DIPLOMA/CERTIFICATE

ASSO 6 ASSOCIATE DEGREE (for example: AA, AS, ASN)

BACH 7 BACHELOR'S DEGREE (for example: BA, AB, BS, BSN)

MAST 8 MASTERS DEGREE (for example MA, MS, MEng, Med, MSW, MBA)

GRAD 9 GRADUATE OR PROFESSIONAL DEGREE (for example MD, DDS,

DVM, LLB, JD, PhD, EdD)

OTHER 10 OTHER

---------------------------------------------------------------------------------

P_HH17a [ PHH17a ] R currently enrolled in school

Are you currently enrolled in school?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_HH18n [ PHH18a ] Rs # bio children

How many children have you ^Fills.P_HH18?


NUMBER OF BIRTHS:

Question Type: 0..20

Question Fill: ^fillP_HH18

male fathered

female given birth to

Logic after:

FILL BASED ON SUBJECT'S GENDER: given birth to/fathered

---------------------------------------------------------------------------------

P_HH21a [ PHH21a ] Rs current employment situation

USE CARD 10. Please look at Card 10. Which of the categories on the card best describes your

current employment situation?


NOTE: DO NOT INCLUDE VOLUNTEER WORK (ONLY "PAID" WORK.)

Question Type: TWKCRD6F

_1 1 REGULARLY WORK FULL-TIME, 35 OR MORE HOURS/WEEK

_2 2 REGULARLY WORK PART-TIME, LESS THAN 35 HOURS/WEEK

_3 3 WORK SOMETIMES, WHEN WORK'S AVAILABLE

_4 4 UNEMPLOYED, LOOKING FOR WORK

_5 5 DON'T WORK BECAUSE OF FAMILY RESPONSIBILITIES

_6 6 DON'T WORK BECAUSE RETIRED

_7 7 DON'T WORK BECAUSE OF ILLNESS OR DISABILITY

_8 8 DON'T WORK BECAUSE DON'T WANT TO WORK

_9 9 DON'T WORK BECAUSE CURRENTLY A STUDENT

_10 10 OTHER

---------------------------------------------------------------------------------

Logic before:

IF P_HH21a = 1-2 GO TO P_HH24a; ELSE, CONTINUE.

P_HH22a [ PHH22a ] R worked for pay in last 6 mos

Have you worked for pay any time in the @blast 6 months@b?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If NO then GOTO P_HH26ac

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HH24a [ PHH24a ] R currently has >1 job?

Do you @bcurrently@b have more than one job?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HH26a [ PHH26x ] R Spanish/Hispanic/Latino

Are you Spanish, Hispanic, or Latino?

Question Type: TRaceGrp

no 1 No, not Spanish/Hispanic/Latino

mex 2 Yes, Mexican, Mexican-American, Chicano

pr 3 Yes, Puerto Rican

cuba 4 Yes, Cuban

other 5 Yes, Other

---------------------------------------------------------------------------------

P_HH27a [ PHH27a ] Labels are in Logic After

USE CARD 12. Please look at Card 12. What is your race? You may pick one or more groups

from the card.

Question Type: TRaceC

amerind 1 AMERICAN INDIAN OR ALASKA NATIVE

asian 2 ASIAN

black 3 BLACK OR AFRICAN AMERICAN

pacislandr 4 NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER

white 5 WHITE

Logic after:

PHH7TG_1 --CCG Amer Indian/Alaskan Native; PHH7TG_2 --CCG Asian; PHH7TG_3 --CCG Black

or African American; PHH7TG_4 --CCG Native Hawaiian/othr Pac Islander; PHH7TG_5 --CCG

White; PHH7TG_7 --CCG Race DK; PHH7TG_8 --CCG Race RF

---------------------------------------------------------------------------------

P_HH28a [ PHH28a ] R born in the US

Were you born in the United States? The United States includes the 50 states and the District of

Columbia, but not US territories.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If NO then GOTO P_HH28a3

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

ASK IF P_HH28a = 2

P_HH28a3


In what country were you born?



MEXICO..................................................................................................1

GUATEMALA..........................................................................................2

CUBA.....................................................................................................3

DOMINICAN REPUBLIC........................................................................................ ... 4

INDIA......................................................................................................5

CHINA....................................................................................................6

PHILIPPINES.........................................................................................7

JAPAN....................................................................................................8

KOREA...................................................................................................9

VIETNAM...............................................................................................10

GUAM.....................................................................................................11

SAMOA..................................................................................................12

OTHER (SPECIFY)................................................................................13


---------------------------------------------------------------------------------



P_HH29n [ PHH29a ] Total years R lived in US

How many years all together have you been living in the U.S.?


(COUNT THE SUM OF ALL TIME SPENT IN THE U.S., EVEN IF NOT CONTINUOUS.)


YEARS:

Question Type: 0..95

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

ASK P_HH15Ac -- P_HH29Ec FOR CAREGIVER2, IF APPLICABLE

P_HH15ac [ PHH15xc ] Highest grade CG2 completed

USE CARD 8. Please look at Card 8. What is the highest grade in school ^CAREGIVER2 has

completed? Please include vocational or technical training and any years in college

^CAREGIVER2 may have completed.

Question Type: TGraH15F

LESS 0 LESS THAN FIRST GRADE

FIRST 1 FIRST GRADE

SECON 2 SECOND GRADE

THIRD 3 THIRD GRADE

FOURT 4 FOURTH GRADE

FIFTH 5 FIFTH GRADE

SIXTH 6 SIXTH GRADE

SEVEN 7 SEVENTH GRADE

EIGHT 8 EIGHTH GRADE

NINTH 9 NINTH GRADE

TENTH 10 TENTH GRADE

ELEVE 11 ELEVENTH GRADE

TWELFTH 12 TWELFTH GRADE

VOCATIO 13 VOCATIONAL/TECHNICAL

SOMECOL 14 SOME COLLEGE CREDIT, LESS THAN 1 YEAR

col1_3 15 1 TO 3 YEARS OF COLLEGE

col4MO 16 4 OR MORE YEARS OF COLLEGE

UNGRAD 17 UNGRADED PLACEMENT

---------------------------------------------------------------------------------

P_HH16ac [ PHH16xc ] Highest degree CG2 holds

USE CARD 9 . Please look at Card 9. What is the highest degree, diploma, or certificate

^CAREGIVER2 holds?

Question Type: TGraH16F

NONE 1 NONE

HIGH 2 HIGH SCHOOL EQUIVALENCY (for example: GED)

H_S 3 H.S. DIPLOMA

VOCA 4 VOCATIONAL TECH CERTIFICATE/DIPLOMA (for example: DENTAL

TECHNICIAN, COSMETOLOGY LICENSE, ETC.)

NURS 5 NURSING DIPLOMA/CERTIFICATE

ASSO 6 ASSOCIATE DEGREE (for example: AA, AS, ASN)

BACH 7 BACHELOR'S DEGREE (for example: BA, AB, BS, BSN)

MAST 8 MASTERS DEGREE (for example MA, MS, MEng, Med, MSW, MBA)

GRAD 9 GRADUATE OR PROFESSIONAL DEGREE (for example MD, DDS,

DVM, LLB, JD, PhD, EdD)

OTHER 10 OTHER

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HH21ac [ PHH21ac ] CG2 current employment situation

USE CARD 10 Please look at Card 10. Which of the categories on the card best describes

^CAREGIVER2's current employment situation?


NOTE: DO NOT INCLUDE VOLUNTEER WORK (ONLY "PAID" WORK.)

Question Type: TWKCRD6F

_1 1 REGULARLY WORK FULL-TIME, 35 OR MORE HOURS/WEEK

_2 2 REGULARLY WORK PART-TIME, LESS THAN 35 HOURS/WEEK

_3 3 WORK SOMETIMES, WHEN WORK'S AVAILABLE

_4 4 UNEMPLOYED, LOOKING FOR WORK

_5 5 DON'T WORK BECAUSE OF FAMILY RESPONSIBILITIES

_6 6 DON'T WORK BECAUSE RETIRED

_7 7 DON'T WORK BECAUSE OF ILLNESS OR DISABILITY

_8 8 DON'T WORK BECAUSE DON'T WANT TO WORK

_9 9 DON'T WORK BECAUSE CURRENTLY A STUDENT

_10 10 OTHER

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HH26ac [ PHH26xc ] Is CG2 Spanish/Hispanic/Latino?

Is ^CAREGIVER2 Spanish, Hispanic, or Latino?

Question Type: TRaceGrp

no 1 No, not Spanish/Hispanic/Latino

mex 2 Yes, Mexican, Mexican-American, Chicano

pr 3 Yes, Puerto Rican

cuba 4 Yes, Cuban

other 5 Yes, Other

---------------------------------------------------------------------------------

P_HH27ac [ PHH27ac ] Labels are in Logic After

USE CARD 12. Please look at Card 12. What is ^CAREGIVER2's race? You may pick one or

more groups from the card.

Question Type: TRaceC

amerind 1 AMERICAN INDIAN OR ALASKA NATIVE

asian 2 ASIAN

black 3 BLACK OR AFRICAN AMERICAN

pacislandr 4 NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER

white 5 WHITE

Logic after:

PHH27ac_1 --What is CGs race - American Indian/Alaskan Native; PHH27ac_2 --What is CGs race

- Asian; PHH27ac_3 --What is CGs race - Black or African American; PHH27ac_4 --What is CGs

race - Native HA/Othr Pac Islander; PHH27ac_5 --What is CGs race - White; PHH27ac_7 --What is

CGs race - DK; PHH27ac_8 --What is CGs race - RF

---------------------------------------------------------------------------------

P_HH28ac [ PHH28ac2 ] CG2 born in the US

Was ^CAREGIVER2 born in the United States? The United States includes the 50 states and the

District of Columbia, but not US territories.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If NO then GOTO P_HH28a3c

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------


Logic before:

ASK IF P_HH28ac = 2


P_HH28a3c


In what country was ^CAREGIVER2 born?



MEXICO..................................................................................................1

GUATEMALA..........................................................................................2

CUBA.....................................................................................................3

DOMINICAN REPUBLIC........................................................................................ ... 4

INDIA......................................................................................................5

CHINA....................................................................................................6

PHILIPPINES.........................................................................................7

JAPAN....................................................................................................8

KOREA...................................................................................................9

VIETNAM...............................................................................................10

GUAM.....................................................................................................11

SAMOA..................................................................................................12

OTHER (SPECIFY)................................................................................13


---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HH29nc [ PHH29ac ] Total years CG2 lived in US

How many years all together has ^CAREGIVER2 been living in the U.S.?


(COUNT THE SUM OF ALL TIME SPENT IN THE U.S., EVEN IF NOT CONTINUOUS.)


YEARS:

Question Type: 0..95

---------------------------------------------------------------------------------

P_HH30a [ PHH30a ] Labels are in Logic After

Has ^CHILD's birth ^Fills.FatherMother had any contact with ^Fills.HimHer in the @bpast 12

months@b? By contact, we mean seeing ^CHILD in person, talking with ^Fills.HimHer over the

telephone, or having some other contact with ^Fills.HimHer.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Question Fill: ^FillFatherMother

male father

female mother

Logic after:

If YES then GOTO P_HH30ba; PHH30a_1 --CH contact w/mother; PHH30a_2 --CH cntct w/Parent

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HH30ba [ PHH30ba ] Labels are in Logic After

Is ^CHILD's biological ^Fills.FatherMother currently living in town, out of town, out of state, out of

the country, in the hospital, in an institution or residential treatment facility, or in jail or a detention

Question Type: TPHH30ba

IN_TOWN 1 IN TOWN

OUTOFTOWN 2 OUT OF TOWN

OUTOFSTAT 3 OUT OF STATE

OUTOFCONT 4 OUT OF THE COUNTRY

INHOSP 5 IN THE HOSPITAL

ININST 6 IN AN INSTITUTION OR RESIDENTIAL TREATMENT

INJAIL 7 OR IN JAIL OR A DETENTION CENTER

DECEASED 8 DECEASED

Question Fill: ^FillFatherMother

male father

female mother

Logic after:

IF 8 GOTO P_HH44a; PHH30ba_1 --Where mother live?; PHH30ba_2 --Where Parent 2 live?

(LOC1T)


---------------------------------------------------------------------------------


---------------------------------------------------------------------------------

P_HH31a [ PHH31a ] Labels are in Logic After

During the last 12 months, did ^CHILD's birth ^Fills.FatherMother make any child support

payments to support ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Question Fill: ^FillFatherMother

male father

female mother

Logic after:

PHH31a_1 --Mother make child support payments to suport CH; PHH31a_2 --Name of Parent 2

---------------------------------------------------------------------------------

Logic before:

FILL BIODAD2 VARIABLE WITH NAME GIVEN IN P_HH31 OR NAME OF BIOLOGICAL FATHER

IN HH WHO IS NOT R OR CAREGIVER2. IF (P_HH31 = DK or RE) OR BIOLOGICAL FATHER IS

R OR CAREGIVER2) CONTINUE BELOW; FILL BIOMOM2 VARIABLE WITH NAME GIVEN IN

P_HH31 OR NAME OF BIOLOGICAL MOTHER IN HH WHO IS NOT R OR CAREGIVER2. IF

(P_HH31 = DK or RE) OR BIOLOGICAL MOTHER IS R OR CAREGIVER2 GO TO P_HH44a

---------------------------------------------------------------------------------

P_HH42a [ PHH42a ] Labels are in Logic After

Was ^BIODAD_MOM2 born in the United States?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If YES then GOTO P_HH43n---------------------------------------------------------------------------------

P_HH42b


In what country was ^BIODAD_MOM2 born?



MEXICO..................................................................................................1

GUATEMALA..........................................................................................2

CUBA.....................................................................................................3

DOMINICAN REPUBLIC........................................................................................ ... 4

INDIA......................................................................................................5

CHINA....................................................................................................6

PHILIPPINES.........................................................................................7

JAPAN....................................................................................................8

KOREA...................................................................................................9

VIETNAM...............................................................................................10

GUAM.....................................................................................................11

SAMOA..................................................................................................12

OTHER (SPECIFY)................................................................................13


---------------------------------------------------------------------------------


P_HH43n [ PHH43n ] Labels are in Logic After

How many years all together has ^BIODAD_MOM2 been living in the U.S.?


(COUNT THE SUM OF ALL TIME SPENT IN THE U.S., EVEN IF NOT CONTINUOUS.)


YEARS:

Question Type: 0..95

Logic after:

PHH43n_1 --# years mother has been living in the US; PHH43n_2 --How many years all together

has ^BIODAD_MOM2 been living in

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HH44a [ PHH44x ] CH Spanish/Hispanic/Latino

Now, thinking about ^CHILD, is ^Fills.HeShe Spanish, Hispanic, or Latino?

Question Type: TRaceGrp

no 1 No, not Spanish/Hispanic/Latino

mex 2 Yes, Mexican, Mexican-American, Chicano

pr 3 Yes, Puerto Rican

cuba 4 Yes, Cuban

other 5 Yes, Other

---------------------------------------------------------------------------------

Logic before:

fill if have BIODAD2/BIOMOM2 (P_HH41 <> empty): again

P_HH45 [ PHH45 ] Labels are in Logic After

USE CARD 17. Please look^Fills.P_HH45 at Card 17. What is ^CHILD's race? You may pick

one or more groups from the card.

Question Type: TRaceC

amerind 1 AMERICAN INDIAN OR ALASKA NATIVE

asian 2 ASIAN

black 3 BLACK OR AFRICAN AMERICAN

pacislandr 4 NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER

white 5 WHITE

Question Fill: ^FillP_HH45

again ·again

Logic after:

PHH5TG_1 --CH race - Amer Indian/Alaskan Native; PHH5TG_2 --CH race - Asian; PHH5TG_3 --

CH race - Black or African American; PHH5TG_4 --CH race - Native Hawaiian/Other Pac Islander;

PHH5TG_5 --CH race - White; PHH5TG_7 --CH race - DK; PHH5TG_8 --CH race - RF

---------------------------------------------------------------------------------

P_HH46a [ PHH46a ] CH born in US

Was ^CHILD born in the United States?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Question Fill: ^FillP_HH45

again ·again

Logic after:

IF P_HH46a = 1 then GOTO P_HH47n

---------------------------------------------------------------------------------

P_HH47b


In what country was ^CHILD born?



MEXICO..................................................................................................1

GUATEMALA..........................................................................................2

CUBA.....................................................................................................3

DOMINICAN REPUBLIC........................................................................................ ... 4

INDIA......................................................................................................5

CHINA....................................................................................................6

PHILIPPINES.........................................................................................7

JAPAN....................................................................................................8

KOREA...................................................................................................9

VIETNAM...............................................................................................10

GUAM.....................................................................................................11

SAMOA..................................................................................................12

OTHER (SPECIFY)................................................................................13


---------------------------------------------------------------------------------



P_HH47n [ PHH47a ] # years CH living in US

How many years all together has ^CHILD been living in the U.S.?


(COUNT THE SUM OF ALL TIME SPENT IN THE U.S., EVEN IF NOT CONTINUOUS.)


YEARS:

Question Type: 0..18

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HH48a [ PHH48a ] R regularly speak non-English lang at home

Do you speak a language other than English at home on a regular basis?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If NO then GOTO P_HH50a

---------------------------------------------------------------------------------

P_HH48aa [ PHH48ax ] What language R regularly speak at home

What language is that?

Question Type: TLangC

SPANIS 1 SPANISH

CHINES 2 CHINESE

FRENCH 3 FRENCH

GERMAN 4 GERMAN

TAGALO 5 TAGALOG

VIETNA 6 VIETNAMESE

ITALIA 7 ITALIAN

KOREAN 8 KOREAN

RUSSIA 9 RUSSIAN

POLIS 10 POLISH

ARABI 11 ARABIC

PORTU 12 PORTUGUESE

JAPAN 13 JAPANESE

OTHER 14 OTHER

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1 Fill: ,has ^CHILD ever been/ IF WAVE >1 Fill: , since DATE OF LAST INTERVIEW,

P_HH51a [ PHH51a ] CH ever removed from Rs care

Not counting changes in custody due to separation or divorce^Fills.P_HH51a^Global.LastInt, has

^CHILD ^Fills.EverBeen removed from your care?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Question Fill: ^FillP_HH51a

waveMore1 , since·

Logic after:

If NO then GOTO P_HH53a

---------------------------------------------------------------------------------

Logic before:

IF WAVE > 1, FILL: since DATE OF LAST INTERVIEW?

P_HH52n [ PHH52a ] # times CH removed from Rs care

How many times has ^Fills.HeShe been removed from your care^Fills.P_HH52n^Global.LastInt?


TIMES

Question Type: 0..100

Question Fill: ^FillP_HH52n

waveMore1 ·since·

---------------------------------------------------------------------------------

Logic before:

IF R IS NOT BIOLOGICAL PARENT, GOTO P_HHEND. IF R IS BIOLOGICAL PARENT AND

P_HH18n > 1, ASK P_HH53a. ELSE, GOTO P_HHEND. IF WAVE = 1: Have any of the children

you have (FILL BASED ON GENDER: given birth to/fathered) ever been removed from your care? /

IF WAVE >1: Since (DATE OF LAST INTERVIEW), have any of the children you have (FILL

BASED ON GENDER: given birth to/fathered) been removed from your care?

P_HH53a [ PHH53a ] Any other bio ch ever removed

^Fills.Since^Global.LastInt^Fills.P_HH53a1 any of the children you have ^Fills.P_HH53a2 removed

from your care?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Question Fill: ^FillP_HH53a1

wave1 Have

wavemore1 , have

Question Fill: ^FillP_HH53a2

wave1male fathered ever been

wave1female given birth to ever been

wavemore1male fathered been

wavemore1female given birth to been

Logic after:

If NO then GO TO P_HHEND

---------------------------------------------------------------------------------

P_HH54n [ PHH54a ] # other bio ch removed

Not counting ^CHILD, how many of your biological children have been removed from your care?

NUMBER:

Question Type: 0..20

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------


P_HH57

Has ^CHILD lost a family member or caregiver due to COVID-19?


Yes 1 YES

No 2 NO



P_HH57a


If P_HH57 YES


Home many family members or caregivers has ^CHILD lost?


NUMBER:


P_HHEND [ PHHEND ] NoDeliv

PLEASE PRESS "1" TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue



GROUP HOME HOUSEHOLD ROSTER

---------------------------------------------------------------------------------

Logic before:

IF THE SETTING IS GROUP HOME OR RESIDENTIAL TREATMENT FACILITY (P_NP12b = 3 or 4), COMPLETE SECTION GH. ELSE, ADMINISTER OTHER HOUSEHOLD

ROSTER MODULE (SECTION HH). Fill: IF WAVE = 1: I'd like to begin by asking some questions

about you,/Else: I'd like to begin by updating some of the information in our records about you,

P_GH1a [ PGH1F ] CH First Name

^Fills.P_GH1a ^CHILD, and other residents of this group home.


What is ^CHILD's full legal name now?


First:

Question Type: string[20]

Question Fill: ^FillP_GH1a

wave1 I'd like to begin by asking some questions about you,

wavemore1 I'd like to begin by updating some of the information in our records about

you,

---------------------------------------------------------------------------------

P_GH1b [ PGH1M ] CH Middle Name

What is ^CHILD's full legal name now?


Middle:

Question Type: string[20], empty

---------------------------------------------------------------------------------

P_GH1c [ PGH1L ] CH Last Name

What is ^CHILD's full legal name now?


Last:

Question Type: string[20]

---------------------------------------------------------------------------------

P_GH2n [ PGH2a ] CH Age in Years

How old is ^CHILD?


AGE

Question Type: 0..18

---------------------------------------------------------------------------------

P_GH3m [ PGH3m ] CH Birth Month

When was ^CHILD born?


MONTH

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

---------------------------------------------------------------------------------

P_GH3d [ PGH3d ] CH Birth Day of Month

When was ^CHILD born?


DAY

Question Type: 1..31

---------------------------------------------------------------------------------

P_GH3y [ PGH3y ] CH Birth Year

When was ^CHILD born?


YEAR

Question Type: 1990..2013

---------------------------------------------------------------------------------

Logic before:

EVALUATE RESPONSES TO P_GH2n AND P_GH3m-y FOR CONSISTENCY. IF CONSISTENT,

GO TO P_GH4a; OTHERWISE DISPLAY INCONSISTENCY TEXT LISTED BELOW.

P_GH4c [ PGH4c ] Confirm CHs age

I have entered ^CHILD's age as ^P_GH2n and birthday as ^ChildDOB. These are inconsistent. I

must have something wrong. Which one do I need to correct?

Question Type: TCkAge

dob 1 CORRECT DATE OF BIRTH

age 2 CORRECT AGE

Logic after:

if age GOTO P_GH2n; If dob GOTO P_GH3m-y

---------------------------------------------------------------------------------

P_GH4a [ PGH4a ] Is CH male or female

(IF UNCLEAR, ASK:) Is ^CHILD a boy or girl?


(THE CONTROL CARD INDICATES THAT THE CHILD IS A ^ChildSex. IF THIS IS NOT

CORRECT, VERIFY THAT YOU ARE ASKING ABOUT THE CORRECT CHILD BEFORE

CONTINUING.)

Question Type: TGenderC, NoDK, NoRF

male 1 MALE

female 2 FEMALE

---------------------------------------------------------------------------------

P_GH5m [ PGH5m ] Month CH began living in facility

In what month and year did ^CHILD begin living here?


(NOTE: IF CHILD HAS HAD MULTIPLE PLACEMENTS IN THE FACILITY, RECORD THE DATE

THE MOST RECENT PLACEMENT OCCURRED.)


MONTH

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

---------------------------------------------------------------------------------

P_GH5y [ PGH5y ] Year CH began living in facility

In what month and year did ^CHILD begin living here?


(NOTE: IF CHILD HAS HAD MULTIPLE PLACEMENTS IN THE FACILITY, RECORD THE DATE

THE MOST RECENT PLACEMENT OCCURRED.)


YEAR

Question Type: 1990..2013

---------------------------------------------------------------------------------

P_GH6a [ PGH6x ] CH current school grade

What grade is ^CHILD currently in?

FR NOTE: REMOTE LEARNING, SUCH AS ATTENDING SCHOOL ONLINE, COUNTS AS BEING ENROLLED.


(IF CHILD ON SUMMER BREAK, RECORD GRADE HE/SHE WILL BE IN WHEN SCHOOL

RESUMES. IF CHILD HAS GRADUATED, ENTER CHILD NOT IN SCHOOL.)

Question Type: TgradeC

preschool 44 NURSERY SCHOOL/PRESCHOOL/HEAD START

kindergrtn 55 KINDERGARTEN

first 1 FIRST GRADE

second 2 SECOND GRADE

third 3 THIRD GRADE

fourth 4 FOURTH GRADE

fifth 5 FIFTH GRADE

sixth 6 SIXTH GRADE

seventh 7 SEVENTH GRADE

eighth 8 EIGHTH GRADE

ninth 9 NINTH GRADE

tenth 10 TENTH GRADE

eleventh 11 ELEVENTH GRADE

twelfth 12 TWELFTH GRADE

vocatech 13 VOCATIONAL/TECHNICAL

college 14 ANY YEAR OF COLLEGE

ungraded 17 UNGRADED PLACEMENT

notinschool 18 CHILD NOT IN SCHOOL

tooyoung 19 TOO YOUNG FOR SCHOOL

Logic after:

IF P_GH6a = 18, DK or REF, GO TO P_GH6aa; ELSE GO TO P_GH7a

---------------------------------------------------------------------------------

P_GH6aa [ PGH6aa ] Highest grade CH completed?

What is the highest grade in school ^CHILD has completed?

Question Type: THH2Grd

preschool 44 NURSERY SCHOOL/PRESCHOOL/HEAD START

kindergrtn 55 KINDERGARTEN

first 1 FIRST GRADE

second 2 SECOND GRADE

third 3 THIRD GRADE

fourth 4 FOURTH GRADE

fifth 5 FIFTH GRADE

sixth 6 SIXTH GRADE

seventh 7 SEVENTH GRADE

eighth 8 EIGHTH GRADE

ninth 9 NINTH GRADE

tenth 10 TENTH GRADE

eleventh 11 ELEVENTH GRADE

twelfth 12 TWELFTH GRADE (GED)

vocatech 13 VOCATIONAL/TECHNICAL

college 14 ANY YEAR OF COLLEGE

ungraded 17 UNGRADED PLACEMENT

---------------------------------------------------------------------------------

Logic before:

IF AGE < 16, GOTO P_GH8n.

P_GH7a [ PGH7a ] CH Marital Status

USE CARD 6. Please look at Card 6. What is ^CHILD's marital status? Is ^Fills.HeShe...

Question Type: TMarSt2F

married 1 Married,

separated 2 Separated,

divorced 3 Divorced,

widowed 4 Widowed, or

nevermarried 5 Has ^Fills.HeShe never been married?

---------------------------------------------------------------------------------

P_GH8n [ PGH8a ] # Adults resp for CH care in 24hr period

How many adults, in total, are regularly responsible for ^CHILD's care during a 24 hour period?


ADULTS

Question Type: 0..40

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_GH11n [ PGH11a ] Total # children living in facility

In total, how many children live in the facility?


(RECORD THE TOTAL NUMBER OF CHILDREN IN THE HOME/FACILITY, NOT JUST THOSE

LIVING IN THE COTTAGE OR ON THE SAME FLOOR WITH THE CHILD.)


NUMBER:

Question Type: 0..100

---------------------------------------------------------------------------------

P_GH12n [ PGH12a ] # children living w/CH in residence/cottage

How many children live in the cottage/residence with ^CHILD?


NUMBER

Question Type: 0..100

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_GH16a [ PGH16a ] R name correct

Next, I need to record some information about you. Your first name is ^CAREGIVER1. Is that

correct?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

If YES GOTO P_GH18m

---------------------------------------------------------------------------------

P_GH17 [ PGH17a ] R first name

What is your first name?


FIRST NAME:

Question Type: string[20]

---------------------------------------------------------------------------------

P_GH18m [ PGH18m ] R Birth Month

What is your date of birth?


MONTH

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

---------------------------------------------------------------------------------

P_GH18d [ PGH18d ] R Birth Day of Month

What is your date of birth?


DAY

Question Type: 1..31

---------------------------------------------------------------------------------

P_GH18y [ PGH18y ] R Birth Year

What is your date of birth?


YEAR

Question Type: 1913..1990

---------------------------------------------------------------------------------

P_GH19n [ PGH19a ] R Current Age

How old are you now?


YEARS OLD

Question Type: 18..95

---------------------------------------------------------------------------------

Logic before:

COMPARE AGE CALCULATED FROM DATE OF BIRTH IN P_GH18m-y TO AGE REPORTED IN

P_GH19n. IF AGES AGREE OR INCOMPLETE INFORMATION MAKES THE CHECK

IMPOSSIBLE TO PERFORM, GOTO P_GH20a. IF AGES DISAGREE, FILL

P_GH20c [ PGH20cka ] Is R Age or DOB wrong

Based on the date of birth I entered, the computer has calculated that you are ^iAge years old.

This is different from the age I entered for you. Which of these needs to be corrected? Your date

of birth or your age?

Question Type: TCkAge, noDK, noRF

dob 1 CORRECT DATE OF BIRTH

age 2 CORRECT AGE

Logic after:

if 1 GO BACK TO P_GH18m-y ; If 2 GO BACK TO P_GH19n

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_GH21a [ PGH21a ] R Gender

INTERVIEWER: RECORD SEX OF CAREGIVER RESPONDENT.

Question Type: TGenderC

male 1 MALE

female 2 FEMALE

---------------------------------------------------------------------------------

P_GH22a [ PGH22x ] R Highest Degree

USE CARD 8. Please look at Card 8. What is the highest grade in school you have completed?

Please include vocational or technical training and any years in college you may have completed.

Question Type: TGraH15F

LESS 0 LESS THAN FIRST GRADE

FIRST 1 FIRST GRADE

SECON 2 SECOND GRADE

THIRD 3 THIRD GRADE

FOURT 4 FOURTH GRADE

FIFTH 5 FIFTH GRADE

SIXTH 6 SIXTH GRADE

SEVEN 7 SEVENTH GRADE

EIGHT 8 EIGHTH GRADE

NINTH 9 NINTH GRADE

TENTH 10 TENTH GRADE

ELEVE 11 ELEVENTH GRADE

TWELFTH 12 TWELFTH GRADE

VOCATIO 13 VOCATIONAL/TECHNICAL

SOMECOL 14 SOME COLLEGE CREDIT, LESS THAN 1 YEAR

col1_3 15 1 TO 3 YEARS OF COLLEGE

col4MO 16 4 OR MORE YEARS OF COLLEGE

UNGRAD 17 UNGRADED PLACEMENT

---------------------------------------------------------------------------------

P_GH23a [ PGH23x ] R Highest Grade in School

USE CARD 9. Please look at Card 9. What is the highest degree, diploma, or certificate you

Question Type: TGraH16F

NONE 1 NONE

HIGH 2 HIGH SCHOOL EQUIVALENCY (for example: GED)

H_S 3 H.S. DIPLOMA

VOCA 4 VOCATIONAL TECH CERTIFICATE/DIPLOMA (for example: DENTAL

TECHNICIAN, COSMETOLOGY LICENSE, ETC.)

NURS 5 NURSING DIPLOMA/CERTIFICATE

ASSO 6 ASSOCIATE DEGREE (for example: AA, AS, ASN)

BACH 7 BACHELOR'S DEGREE (for example: BA, AB, BS, BSN)

MAST 8 MASTERS DEGREE (for example MA, MS, MEng, Med, MSW, MBA)

GRAD 9 GRADUATE OR PROFESSIONAL DEGREE (for example MD, DDS,

DVM, LLB, JD, PhD, EdD)

OTHER 10 OTHER

---------------------------------------------------------------------------------

P_GH24a [ PGH24a ] R Educ cmpr to other GH CG

In general, how would you compare your educational achievement to that of other staff that work

with ^CHILD? Would you say...

Question Type: TWEduc

same 1 Your educational achievement is about the same as the other staff that

work with the child,

higher 2 You have higher education than most of the other staff, or

lower 3 You have lower education than most of the other staff?

---------------------------------------------------------------------------------

P_GH25a [ PGH25a ] R Currently In School

Are you currently enrolled in school?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_GH26a [ PGH26a ] R Employment Situation

USE CARD 10. Please look at Card 10. Which of the categories on the card best describes your

current employment situation?


NOTE: DO NOT INCLUDE VOLUNTEER WORK (ONLY "PAID" WORK.)

Question Type: TWKCRD6F

_1 1 REGULARLY WORK FULL-TIME, 35 OR MORE HOURS/WEEK

_2 2 REGULARLY WORK PART-TIME, LESS THAN 35 HOURS/WEEK

_3 3 WORK SOMETIMES, WHEN WORK'S AVAILABLE

_4 4 UNEMPLOYED, LOOKING FOR WORK

_5 5 DON'T WORK BECAUSE OF FAMILY RESPONSIBILITIES

_6 6 DON'T WORK BECAUSE RETIRED

_7 7 DON'T WORK BECAUSE OF ILLNESS OR DISABILITY

_8 8 DON'T WORK BECAUSE DON'T WANT TO WORK

_9 9 DON'T WORK BECAUSE CURRENTLY A STUDENT

_10 10 OTHER

---------------------------------------------------------------------------------

P_GH27a [ PGH27a ] R Employment Position

What is your position at the group home?

Question Type: TGpPos

_1 1 GROUP HOME DIRECTOR (ACROSS ALL COTTAGES OR UNITS OF

PROGRAM)

_2 2 CLINICAL SUPERVISOR (ACROSS ALL COTTAGES OR UNITS OF

PROGRAM)

_3 3 COTTAGE SUPERVISOR(ACROSS ALL SHIFTS)

_4 4 SHIFT SUPERVISOR (MOST SENIOR PERSON ON THIS SHIFT)

_5 5 LINE/MILEU STAFF

---------------------------------------------------------------------------------

P_GH28n [ PGH28a ] R Length of Employment at facility

How long have you been working at this facility?


NUMBER:

Question Type: 1..40

---------------------------------------------------------------------------------

P_GH28a [ PGH28u ] R Length of Employment M/Y code

(Is that months or years?)

Question Type: TMMsYrs

Months 1 MONTHS

Years 2 YEARS

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_GH30a [ PGH30x ] R Spanish/Hispanic/Latino

Are you Spanish, Hispanic, or Latino?

Question Type: TRaceGrp

no 1 No, not Spanish/Hispanic/Latino

mex 2 Yes, Mexican, Mexican-American, Chicano

pr 3 Yes, Puerto Rican

cuba 4 Yes, Cuban

other 5 Yes, Other

---------------------------------------------------------------------------------

P_GH32 [ PGH32 ] Labels are in Logic After

USE CARD 12. Please look at Card 12. What is your race? You may pick one or more groups

from the card.

Question Type: TRaceC

amerind 1 AMERICAN INDIAN OR ALASKA NATIVE

asian 2 ASIAN

black 3 BLACK OR AFRICAN AMERICAN

pacislandr 4 NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER

white 5 WHITE

Logic after:

PGH2TG_1 --R race - American Indian or Alaskan; PGH2TG_2 --R race - Asian; PGH2TG_3 --R

race - Black or African American; PGH2TG_4 --R race - Hawaiian or Pac Islander; PGH2TG_5 --R

race - White; PGH2TG_6--R race - DK; PGH2TG_7--R race - RF

---------------------------------------------------------------------------------

P_GH33a [ PGH33a ] CH cntct bio mthr from fac

Has ^CHILD had any contact with ^Fills.HisHer biological mother since ^Fills.HeShe began living

here in ^P_GH5m ^P_GH5y? By contact, we mean seeing her in person, talking with her over the

telephone, or having some other contact with her.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_GH35a [ PGH35x ] CH birth mother location

Is ^CHILD's biological mother currently living in town, out of town, out of state, out of the country,

in the hospital, in an institution or residential treatment facility, or in jail or a detention center?

Question Type: TPHH30ba

IN_TOWN 1 IN TOWN

OUTOFTOWN 2 OUT OF TOWN

OUTOFSTAT 3 OUT OF STATE

OUTOFCONT 4 OUT OF THE COUNTRY

INHOSP 5 IN THE HOSPITAL

ININST 6 IN AN INSTITUTION OR RESIDENTIAL TREATMENT

INJAIL 7 OR IN JAIL OR A DETENTION CENTER

DECEASED 8 DECEASED

---------------------------------------------------------------------------------

P_GH36a [ PGH36a ] CH cntct bio fthr from fac

Has ^CHILD had any contact with ^Fills.HisHer biological father since ^Fills.HeShe began living

here in ^P_GH5m ^P_GH5y? By contact, we mean seeing him in person, talking with him over

the telephone, or having some other contact with him.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_GH38a [ PGH38x ] CH birth father location

Is ^CHILD's biological father currently living in town, out of town, out of state, out of the country, in

the hospital, in an institution or residential treatment facility, or in jail or a detention center?

Question Type: TPHH30ba

IN_TOWN 1 IN TOWN

OUTOFTOWN 2 OUT OF TOWN

OUTOFSTAT 3 OUT OF STATE

OUTOFCONT 4 OUT OF THE COUNTRY

INHOSP 5 IN THE HOSPITAL

ININST 6 IN AN INSTITUTION OR RESIDENTIAL TREATMENT

INJAIL 7 OR IN JAIL OR A DETENTION CENTER

DECEASED 8 DECEASED

Logic after:

GOTO P_GHEND



CHILD’S LIVING ENVIRONMENT

IF CHILD SETTING IS GROUP HOME OR RESIDENTIAL FACILITY (P_NP12b = 3 OR 4) THEN GO TO Y_LEEND


P_LE_BEG [ PLE_BEG ] NoDeliv

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue


Logic before:

IF WAVE > 1, FILL: Since (DATE OF LAST INTERVIEW)

P_LE1aa [ PLE1aa ] Some1 othr than R prmrly rspnsbl for CHs luv/support 1

The next few questions ask about the people who have provided care and support for ^CHILD at different times during ^CHILD's life.


^Fills.Since^tempDate^Fills.P_LE1a there a time when someone other than you was primarily

responsible for providing ^CHILD with care and support?


[NOTE: This might include times the child was in the care of someone else, or times that you were

unavailable to ^CHILD for several weeks or months, or when things in your life kept you from

having time for being a caregiver. Do not include very short periods like a weekend away.]

Question Type: TYN

yes 1 YES

no 2 NO {GO TO P_LE7a }

Question Fill: ^FillP_LE1a

wave1 Was

wavemore1 , was

Logic after:



P_LE1b. How many different caregivers has [CHILD] lived with Since (DATE OF LAST INTERVIEW)?



__________ caregivers


---------------------------------------------------------------------------------

P_LE1AB [ PLE1AB ] Labels are in Logic After

USE CARD 4. During this time, who was the person primarily responsible for providing ^CHILD

with care and support? What is this person’s relationship to ^CHILD?

Question Type: TRlCrd2F

_2 2 MOTHER (BIOLOGICAL)

_3 3 FATHER (BIOLOGICAL)

_4 4 STEP-MOTHER

_5 5 STEP-FATHER

_6 6 ADOPTIVE MOTHER

_7 7 ADOPTIVE FATHER

_8 8 FOSTER MOTHER

_9 9 FOSTER FATHER

_10 10 FULL SISTER

_11 11 FULL BROTHER

_12 12 HALF SISTER

_13 13 HALF BROTHER

_14 14 STEP-SISTER

_15 15 STEP-BROTHER

_16 16 FOSTER SISTER

_17 17 FOSTER BROTHER

_18 18 ADOPTIVE SISTER

_19 19 ADOPTIVE BROTHER

_30 30 AUNT

_31 31 UNCLE

_32 32 GREAT AUNT

_33 33 GREAT UNCLE

_34 34 COUSIN

_40 40 MATERNAL GRANDMOTHER

_41 41 PATERNAL GRANDMOTHER

_42 42 MATERNAL GRANDFATHER

_43 43 PATERNAL GRANDFATHER

_44 44 MATERNAL GREAT-GRANDMOTHER

_45 45 PATERNAL GREAT-GRANDMOTHER

_46 46 MATERNAL GREAT-GRANDFATHER

_47 47 PATERNAL GREAT-GRANDFATHER

_94 94 BABYSITTER

_95 95 OTHER BLOOD RELATIVE

_96 96 OTHER NON-RELATIVE

Logic after:

PLE1AB_1 --Rltnshp 2 CH of othr prmrly rspnsbl for CHs luv/spprt 1; PLE1AB_2 --Rltnshp 2 CH of

othr prmrly rspnsbl for CHs luv/spprt 2; PLE1AB_3 --Rltnshp 2 CH of othr prmrly rspnsbl for CHs

luv/spprt 3; PLE1AB_4 --Rltnshp 2 CH of othr prmrly rspnsbl for CHs luv/spprt 4; PLE1AB_5 --

Rltnshp 2 CH of othr prmrly rspnsbl for CHs luv/spprt 5; PLE1AB_6 --Rltnshp 2 CH of othr prmrly

rspnsbl for CHs luv/spprt 6; PLE1AB_7 --Rltnshp 2 CH of othr prmrly rspnsbl for CHs luv/spprt 7;

PLE1AB_8 --Rltnshp 2 CH of othr prmrly rspnsbl for CHs luv/spprt 8; PLE1AB_9 --Rltnshp 2 CH of

othr prmrly rspnsbl for CHs luv/spprt 9; PLE1AB_10 --Rltnshp 2 CH of othr prmrly rspnsbl for CHs

---------------------------------------------------------------------------------

Logic before:

DISPLAY THE FOLLOWING ON SCREEN FOR EACH TIME PERIOD REPORTED

PERIOD 1:BEGIN DATE: P_LE1sm P_LE1sy END DATE: P_LE36fm P_LE36fy RELATIONSHIP

TO CHILD: P_LE1ab

PERIOD 2:BEGIN DATE: P_LE1sm P_LE1sy END DATE: P_LE36fm P_LE36fy RELATIONSHIP

TO CHILD: P_LE1ab

..

PERIOD #: BEGIN DATE: P_LE1sm P_LE1sy END DATE: P_LE36fm P_LE36fy RELATIONSHIP

TO CHILD: P_LE1ab

IF WAVE > 1, FILL: Since (DATE OF LAST INTERVIEW ELSE FILL EMPTY


HOUSING STABILITY SECTION





P_LE7a


Since (DATE OF LAST INTERVIEW) has CHILD or the family been homeless? By homeless we mean 1) living on the streets or in a shelter, or (2) staying someplace on a temporary basis because you could not afford to live elsewhere.


  1. YES

  2. NO



P_LE7b


IF P_LE7=1


What was the main reason for ^CHILD or the family been homeless?




1. Evicted

2. Landlord / property management problems

3. Couldn't afford

4. Job loss/Lack of work

5. Asked to leave/household disagreement

6. Personal safety concerns/victimized/domestic violence

7. Too crowded/needed more space

8. Building problems (repairs, fire, drug dealers, tec.)

9. Neighborhood problems (crime, safety, etc.)

10. Too far from work/school

11. Too far from family/friends

12. Health or mental health problem (disability)

13. Break up with significant other

14. Trouble with the law or being arrested

15. Entered hospital/treatment center/program

16. Better landlord / property management

17. More affordable option

18. Job opportunity/New job

19. Invited to stay with family/friends

20. Safer home environment

21. More space/less crowded

22. Physical quality of building/unit

23. Neighborhood quality (safety, schools, walkability, etc.)

24. Closer to work/school

25. Closer to family/friends

26. To be on one's own/be independent

27. To reside with significant other

28. Released from jail/prison

29. Left hospital/treatment center/program


30. don’t know

31. Other








GO TO P_LEEND AFTER P_LE8A – P_LE11 HAVE BEEN ASKED FOR ALL PRIOR ADDRESSES.




{P_LEEND}



P_LEEND [ PLEEND ] NoDeliv

PLEASE PRESS "1" AND ENTER TO CONTINUE

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

Logic after:

GOTO P_LEEND


COMMUNITY ENVIRONMENT

---------------------------------------------------------------------------------

IF CHILD SETTING IS GROUP HOME OR RESIDENTIAL FACILITY (P_NP12b = 3 OR 4) THEN GO TO Y_CEEND


---------------------------------------------------------------------------------

P_CE6a [ PCE6a ] Nghbrhd cmprs to othrs - how safe

For these next items, please think about how your neighborhood compares to most other

neighborhoods.


Is your neighborhood ...

Question Type: TSafe

safer 1 safer,

assafe 2 about the same, or

notsafe 3 not as safe as most neighborhoods?

---------------------------------------------------------------------------------

Logic after:

P_CEEND



HS - Child Health and Services (CG)

---------------------------------------------------------------------------------

Logic before:

P_HS1aaa


Has [CHILD] lived with you for most or all of the past 12 months?

1=YES {GO TO P_HS1a}

2=NO


P_HS1bbb

For how many consecutive months has [CHILD] lived with you?

Number of months____ RANGE 1 - 11


PROGRAMMER INFO:

Time in Household” is length of time that CHILD has lived with CAREGIVER. It is the difference between the "number of months" and interview date.

If "Time in Household" >= 12 months (meaning 1 year) and number of months <= DOB (meaning since birth) then Group = 1

Else If "Time in Household" >= 12 months (meaning 1 year) and Number of months > DOB then Group = 2

Else if "Time in Household" < 12 months then group = 3

Other assumptions:

if group 3, meaning the child has been living there less than a year, and child has been living there since birth, then the fills "Since the child has lived with you" can be replaced by the word "birth". Example questions are P_HS45a, P_HS50aa, etc..




[IF WAVE = 1:] Now I’d like to ask you some questions about ^CHILD’s health and the services [fill

he/she] is receiving.


[IF WAVE > 1]: The next questions are about ^CHILD’s health and the services [fill he/she] has

received in the past 12 months.


[ALL:] Overall, would you say ^CHILD’s health is…

P_HS1a [ PHS1a ] CH overall health

^fills.p_hs1a1 ^child's health and the services ^fills.heshe ^fills.p_hs1a2.


Overall, would you say ^CHILD's health is. . .

Question Type: THealth

exclnt 1 excellent

vgood 2 very good

good 3 good

fair 4 fair, or

poor 5 poor

Question Fill: ^FillP_HS1A1

Wave1_1 Now I’d like to ask you some questions about

Wave2_1 The next questions are about

Question Fill: ^FillP_HS1A2

Wave1_2 is receiving.

Wave2_2 has received in the past 12 months.

---------------------------------------------------------------------------------

P_HS1aa [ PHS1aa ] CH up-to-date w/immunizations

Is ^CHILD up-to-date with ^fills.hisher immunizations or shots?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HS1h16a [ PHS1h16a ] CH rcv srvcs such as phys/occ/speech thrpy

Does ^CHILD now receive services such as physical therapy, occupational therapy, speech or

language therapy, or orientation and mobility training on a regular basis?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HS1h38a [ PHS1h38a ] Except occsnal wrds CH has trbl undrstndng smpl instrctions

Except for occasional words, does ^CHILD have trouble understanding simple instructions?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HS1h39a [ PHS1h39a ] Except occsnal wrds othrs otsde fam have trbl undrstndng CH

Except for occasional words, when ^CHILD talks, do others outside the family have trouble

understanding ^fills.himher?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HS1h40nf [ PHS1h40nf ] CHs approximate height - feet

Can you tell me approximately what ^CHILD's height is?


FEET:

Question Type: 0..6

---------------------------------------------------------------------------------

P_HS1h40ni [ PHS1h40ni ] CHs approximate height - inches

Can you tell me approximately what ^CHILD's height is?


INCHES:

Question Type: 0..11

---------------------------------------------------------------------------------

P_HS1h41n [ PHS1h41n ] CHs approximate weight - pounds

Can you tell me approximately what ^CHILD's weight is?


POUNDS:

Question Type: 0..350

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HS3a1a [ PHS3a1a ] CH currently have asthma

To the best of your knowledge, does ^CHILD currently have any of the following:


Asthma?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HS3a2a [ PHS3a2a ] CH currently have ADD or ADHD

(To the best of your knowledge, does ^CHILD currently have any of the following:)


Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder, that is ADD or ADHD?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HS3a3a [ PHS3a3a ] CH currently have autism or ASD

(To the best of your knowledge, does ^CHILD currently have any of the following:)


Autism, Asperger’s Disorder, pervasive developmental disorder, or other Autism Spectrum Disorder, that is ASD?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HS3a5a [ PHS3a5a ] CH currently have intellectual disability or developmental delay

(To the best of your knowledge, does ^CHILD currently have any of the following:)


Intellectual disability, also known as mental retardation or developmental delay?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HS3a6a [ PHS3a6a ] CH currently have dprsion/anxty/etng dsrdr/othr emot prblm

(To the best of your knowledge, does ^CHILD currently have any of the following:)


Depression, anxiety, an eating disorder, or other emotional problems?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HS3a9a [ PHS3a9a ] CH currently have heart problem

(To the best of your knowledge, does ^CHILD currently have any of the following:)


A heart problem, including Congenital Heart Disease?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HS3a10a [ PHS3a10a ] CH currently have blood problems

(To the best of your knowledge, does ^CHILD currently have any of the following:)


Blood problems such as Anemia or Sickle Cell Disease? Please do not include Sickle Cell Trait.

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HS3a14a [ PHS3a14a ] CH currently have epilepsy/seizure disorder

(To the best of your knowledge, does ^CHILD currently have any of the following:)


Epilepsy or other seizure disorder?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HS3a15a [ PHS3a15a ] CH currently have migraine/frq headaches

(To the best of your knowledge, does ^CHILD currently have any of the following:)


Migraine or frequent headaches?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HS3a16a [ PHS3a16a ] CH currently have arthritis/joint problems

(To the best of your knowledge, does ^CHILD currently have any of the following:)


Arthritis or other joint problems?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HS3a19a [ PHS3a19a ] CH currently have dental problems

(To the best of your knowledge, does ^CHILD currently have any of the following:)


Dental problems?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HS3a21a [ PHS3a21a ] CH currently have repeated ear infections

(To the best of your knowledge, does ^CHILD currently have any of the following:)


Repeated ear infections?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HS3a24a [ PHS3a24a ] CH currently have back/neck problems

(To the best of your knowledge, does ^CHILD currently have any of the following:)


Back or neck problems?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HS3a25a [ PHS3a25a ] CH currently have hypertension/high blood pressure

(To the best of your knowledge, does ^CHILD currently have any of the following:)


Hypertension or high blood pressure?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HS3a28a [ PHS3a28a ] CH currently have chronic bronchitis

(To the best of your knowledge, does ^CHILD currently have any of the following:)


Chronic bronchitis?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HS3a31a [ PHS3a31a ] CH currently have other health problems

(To the best of your knowledge, does ^CHILD currently have any of the following:)


Other health problems?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 1. GOTO P_HS3a32a

IF = 2, GOTO P_HS3a33

---------------------------------------------------------------------------------

P_HS3a32 [ PHS3a32 ] What other health problems does CH currently have

What other health problems does ^CHILD currently have?


PROBLEM:

Question Type: string[50]

P_HS3a33 [ PHS3a33 ] CH ever taken any med prescribed by Dr for emot/behav prblm

To your knowledge, has ^CHILD @bever taken any medication@b prescribed by a doctor or

clinician for emotional or behavioral problems?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

Logic before:

IF GROUP = 2 FILL: in the last 12 months/IF GROUP = 3, FILL: since child has lived with you

P_HS3a34 [ PHS3a34 ] Dr evr rcmnd CH take med for emot/behav prblms

^fills.haspastsince^tempLivArrDate^fills.commahas a doctor or clinician^fills.evereverbold

@Brecommended ^CHILD take medication@b for emotional or behavioral problems?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Question Fill: ^FillHasPastSince

Has Has

past @bIn the past 12 months@b, has

since @bSince·@b

sincebirth @bSince birth@b, has

haslow has

sincelow @bsince·@b

sincebirthlow @bsince birth@b, has

pastlow @bin the past 12 months@b, has

Logic after:

if no GOTO P_HS4a

---------------------------------------------------------------------------------

P_HS3a35 [ PHS3a35 ] CH take med rcmnd by Dr for emot/behav prblms

After a doctor or clinician recommended ^CHILD take medication for emotional or behavioral

problems, did ^CHILD @bstart taking@b the medication?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if yes GOTO P_HS3a38

---------------------------------------------------------------------------------

P_HS3a36 [ PHS3a36 ] Labels are in Logic After

I'm going to read a list of reasons why some people sometimes choose not to take medication.

Please respond yes to any of the reasons why ^CHILD is not taking medication.


CODE ALL THAT APPLY

Question Type: TRsn36S

_1 1 Insurance did not cover medication

_2 2 Concerns about side effects of the medication

_3 3 ^Global.CHILD got better and didn't need medication any more

_4 4 Family or friends were concerned about ^Global.CHILD taking medication

_5 5 Afraid of ^Global.CHILD getting addicted

_6 6 Bad experiences with other clinicians prescribing medications

_7 7 ^Global.CHILD changed providers

_8 8 Other reasons

Logic after:

PHS3a36_1 --CH not take med-Insurance did not cover medication; PHS3a36_2 --CH not take

med-Concerns about side effects of the med; PHS3a36_3 --CH not take med-CH got better and

didn't need med; PHS3a36_4 --CH not take med-Fmly/Frnds concerned about CH taking med;

PHS3a36_5 --CH not take med-Afraid of CH getting addicted; PHS3a36_6 --CH not take med-Bad

exprnc w/ othr clncn prescrib med; PHS3a36_7 --CH not take med-CH changed providers;

PHS3a36_8 --CH not take med-Other reason; PHS3a36_9--CH not take med-DK

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

[IF WAVE = 1 AND GROUP = 3, FILL: Since child started living with you, ELSE

FILL:@bIn the past 12 months@b}, ]

P_HS3a38 [ PHS3a38 ] CH taken any med for emot/behav prblms

^fills.P_HS_TimePeriod^tempLivArrDate, has ^CHILD taken any medication for emotional or

behavioral or concentration problems?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Question Fill: ^FillP_HS_TimePeriod

wave1_group1 @bIn the past 12 months@b

wave1_group2 @bIn the past 12 months@b

wave1_group3_birt Since @bbirth@b

h

wave1_group3_afte @bSince·@b

r

wave2 @bIn the past 12 months@b

Logic after:

if no GOTO P_HS4a

---------------------------------------------------------------------------------

Logic before:

IF P_HS3a35 = 1 OR P_HS3a38 = YES, CONTINUE. ELSE, GOTO P_HS3a40

P_HS3a39 [ PHS3a39 ] CH currently taking any med for emot/behav prblms

Is ^CHILD currently taking any medication for emotional or behavioral or concentration problems?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if yes GOTO P_HS3a42

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HS3a42 [ PHS3a42 ] # prescription med CH currently taking

How many prescription medications is ^CHILD currently taking for emotional or behavioral

or concentration problems?


Question Type: 1..10

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

IF CHILD AGE < 2, GOTO P_HS11a. IF WAVE = 1, FILL:@bSince [fill CONTACT DATE]@b/IF

WAVE = 2, FILL: @bSince [FILL DATE OF LAST INTERVIEW]

P_HS4a [ PHS4a ] CH gone to Dentist or hygienist since contact

^fills.P_HS_TimePeriod^tempLivArrDate, has ^CHILD gone to a dentist or dental hygienist for a

cleaning or a checkup?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^FillP_HS_TimePeriod

wave1_group1 @bIn the past 12 months@b

wave1_group2 @bIn the past 12 months@b

wave1_group3_birt Since @bbirth@b

h

wave1_group3_afte @bSince·@b

r

wave2 @bIn the past 12 months@b

Logic after:

1 = YES GOTO P_HS6a

---------------------------------------------------------------------------------

Logic before:

IF WAVE > 1, GOTO P_HS11a.

P_HS5a [ PHS5a ] CH ever gone to Dentist or hygienist

Has ^CHILD @bever@b gone to a dentist or dental hygienist for a cleaning or a checkup?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

2 = NO GOTO P_HS11a

---------------------------------------------------------------------------------

P_HS6a [ PHS6a ] How often CH go to dentist or hygienist

How often does ^CHILD go to the dentist or dental hygienist?

Question Type: T2Dntst

sixmon 1 ABOUT EVERY 6 MONTHS

year 2 ONCE A YEAR

twoyr 3 EVERY TWO YEARS

less2yr 4 LESS OFTEN THAN EVERY TWO YEARS

nosched 5 NO REGULAR SCHEDULE

onlyfew 6 ONLY A FEW TIMES

onlyonce 7 HAS ONLY BEEN ONCE

---------------------------------------------------------------------------------

Logic before:

IF P_NP12a = 4, GOTO P_HS14a

IF Last Interview Date (pr_lstdate) is empty, ask ELSE GOTO P_HS14a

P_HS11a [ PHS11a ] CH admtd hosp ovrnght for inj/ill before contact

@bBefore ^lastdate@b, was ^CHILD admitted to a hospital or medical facility overnight for an

illness or injury?


NOTE: IF ASKED:


IF INVESTIGATION START DATE: ^lastdate IS THE DATE THE CHILD WELFARE AGENCY BEGAN THIS INVESTIGATION.


IF ALTERNATIVE PATHWAY CASE: ^lastdate IS THE DATE THE CHILD ENTERED LEGAL CUSTODY.


Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 2, [ GOTO P_HS14a]

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HS14a [ PHS14a ] CH admtd hosp ovrnght for inj/ill

^fills.P_HS_TimePeriod@b^tempLivArrDate@b, has ^CHILD been admitted to a hospital or

medical facility overnight for an illness or injury?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^FillP_HS_TimePeriod

wave1_group1 @bIn the past 12 months@b

wave1_group2 @bIn the past 12 months@b

wave1_group3_birt Since @bbirth@b

h

wave1_group3_afte @bSince·@b

r

wave2 @bIn the past 12 months@b

Logic after:

IF = 2, GOTO P_HS17a

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1 AND CHILD AGE >= 1 @bIn the last 12 months@b, has ^CHILD gone to an

emergency room or urgent care center for an illness or injury? IF WAVE = 1 AND CHILD AGE < 1:

Has ^CHILD ever gone to an emergency room or urgent care center for an illness or injury? IF

WAVE = 2: @bSince DATE OF LAST INTERVIEW@b, has ^CHILD gone to an emergency room or

urgent care center for an illness or injury?

P_HS17a [ PHS17a ] CH go ER/Urg care for ill/inj

^fills.P_HS_timePeriod^tempLivArrDate, has ^child gone to an emergency room or urgent care

center for an illness or injury?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^FillP_HS_TimePeriod

wave1_group1 @bIn the past 12 months@b

wave1_group2 @bIn the past 12 months@b

wave1_group3_birt Since @bbirth@b

h

wave1_group3_afte @bSince·@b

r

wave2 @bIn the past 12 months@b

Logic after:

IF = 2, GOTO P_HS19a

---------------------------------------------------------------------------------


---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1 AND CHILD AGE >= 1 @bIn the last 12 months@b, has ^CHILD gone to an

emergency room or urgent care center for an illness or injury?

IF WAVE = 1 AND CHILD AGE < 1: Has ^CHILD ever gone to an emergency room or urgent care

center for an illness or injury?

IF WAVE >= 2: @bSince DATE OF LAST INTERVIEW@b, has ^CHILD gone to an emergency

room or urgent care center for an illness or injury?

P_HS19a [ PHS19a ] CH had inj/acc/poisn req doc/nurse

^fills.P_HS_timePeriod^tempLivArrDate, has ^child had a serious injury, accident, or poisoning

that needed the care of a doctor or nurse?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^FillP_HS19a1

Wave1AgeGTZero_1 In the last 12 months

Wave1Age0_1 Has

Wave2_1 Since

Question Fill: ^FillP_HS19a2

Wave1AgeGTZero_2 , has

Wave1Age0_2

Wave2_2 , has

Logic after:

IF = 2, GOTO P_HS26a1

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------



Logic before:

IF CHILD AGE >= 6, GOTO P_HS30a


P_HS26a [ PHS29a ] CH ever been in any type day care prog

Has ^CHILD @bever@b been in any type of preschool or early childhood development program, such as Head Start or Early Head Start?

Question Type: TYN

yes 1 YES

no 2 NO


Logic after:

IF P_HS26a=NO GOTO P_HS30a


P_HS26b Does ^CHILD currently attend preschool or early childhood development program, such as Head Start or Early Head Start?

Question Type: TYN

Yes 1 YES

No 2 NO


---------------------------------------------------------------------------------


P_HS26c What type of program is it?


1 HEAD START

2 EARLY HEAD START

3 PRESCHOOL

4 OTHER




P_HS26a1 [ PSR26a ] Rcvd ch care on reg basis-past 12m

In addition to a child’s primary caregiver, a child may be cared for by other adults in the household, by relatives or friends outside of the household, or by a childcare professional in a center or someone’s home.


In the last 12 months, has ^CHILD received care on a regular basis? That is, at least five hours each week? Please do not count preschool or early childhood development programs such as Head Start or Early Head Start.


NOTE: "REGULAR" DOES NOT INCLUDE OCCASIONAL, OR AD HOC BABYSITTING.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

IF P_HS26a1 = NO then GOTO P_HS30a


---------------------------------------------------------------------------------




P_HS26c1

Is the care usually provided in your home, in someone else’ home, or in a child care center?

1 CAREGIVER’s HOME

2 SOMEONE ELSE’S HOME

3 CHILD CARE CENTER

4 MIX OF HOME AND CENTER-BASED CARE




P_HS26e1

What is your relationship to the care provider?

1 FORMER SPOUSE OR PARTNER

2 PARENT OR STEPPARENT

3 BROTHER OR SISTER OR BROTHER-IN-LAW OR SISTER-IN-LAW

4 CHILD OR SON-IN-LAW OR DAUGTHER-IN-LAW

5 OTHER RELATIVE

6 FRIEND

7 NEIGHBOR




---------------------------------------------------------------------------------

Logic before:

IF WAVE >= 2, FILL: @bSince DATE OF LAST INTERVIEW has @b] IF WAVE = 1, FILL:Has

^CHILD IF WAVE = 1, FILL: @bever@b

P_HS30a [ PHS30a ] CH tested for lrnng prblms/spcial nds/dev dsbltes

^fills.haspastsince^tempLivArrDate^fills.commahas ^CHILD^fills.evereverbold been tested for

learning problems, special needs, or developmental disabilities by an education or health

professional (E.G. SCHOOL PSYCHOLOGIST, DOCTOR, SPEECH THERAPIST, ETC.)?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^FillHasPastSince

Has Has

past @bIn the past 12 months@b, has

since @bSince·@b

sincebirth @bSince birth@b, has

haslow has

sincelow @bsince·@b

sincebirthlow @bsince birth@b, has

pastlow @bin the past 12 months@b, has

Logic after:

IF = 2, GOTO P_HS32a

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

IF WAVE > 1, GOTO P_HS35

P_HS32a [ PHS32a ] How much CH nds tstd for lrnng prblms/spcial nds/dev dsbltes

How much do you think ^CHILD @bneeds@b to be tested for learning problems, special needs, or

developmental disabilities? Would you say...

Question Type: THMNeed

alot 1 a lot,

somewhat 2 somewhat,

alittle 3 a little, or

notatall 4 not at all?

Logic after:

IF = 4, GOTO P_HS35.

---------------------------------------------------------------------------------

P_HS33 [ PHS33 ] Labels are in Logic After

Why has ^fills.heshe @bnot been@b tested for learning problems, special needs, or

developmental disabilities?


CODE ALL THAT APPLY.

Question Type: TwhynotS

notavail 1 SERVICE NOT AVAILABLE IN THE AREA

waitlist 2 WAIT-LISTED FOR SERVICE

inelig 3 INELIGIBLE FOR SERVICE

notfinanced 4 SERVICES COULD NOT BE FINANCED

schedule 5 SCHEDULING PROBLEM OR PROBLEM FINDING CHILD CARE

transportation 6 TRANSPORTATION PROBLEM

otherreason 7 OTHER REASON

covid 8  NOT AVAILABLE DUE TO COVID-19 PANDEMIC

Logic after:

PHS33T_1 --Why CH not tstd 4 lrng prblms-Service not available in area; PHS33T_2 --Why CH not

tstd 4 lrng prblms-Wait listed for service; PHS33T_3 --Why CH not tstd 4 lrng prblms-Ineligible for

service; PHS33T_4 --Why CH not tstd 4 lrng prblms-Services could not be financed; PHS33T_5 --

Why CH not tstd 4 lrng prblms-Scheduling/ch care problem; PHS33T_6 --Why CH not tstd 4 lrng

prblms-Transportation problem; PHS33T_7 --Why CH not tstd 4 lrng prblms-Some other reason;

PHS33T_8--Why CH not tstd 4 lrng prblms-DK; PHS33T_9--Why CH not tstd 4 lrng prblms-RF

---------------------------------------------------------------------------------

Logic before:

IF WAVE > 1, GOTO P_HS43a

P_HS35 [ PHS35a ] Profsnl says CH has lrng prb/disab

Have you @bever@b been told by an education or health professional that ^CHILD has learning

problems, special needs, or developmental disabilities?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HS35a

Does ^CHILD now have a 504 plan for classroom accommodations because of {his/her} special needs?  [IF NEEDED: By a 504 plan, we mean a documented program of instructional and/or assessment provisions to assist students with special needs who are in a regular education setting, as required by Section 504 of the Vocational Rehabilitation Act.]

Question Type:      TYN

yes                                 1  YES

no                                   2  NO



Logic before:

IF WAVE > 1: @bIn the past 12 months@b] Has ^CHILD [IF WAVE = 1, FILL:@bever@b] been

classified as needing special education? That is, has [fill he/she] [IF WAVE = 1, FILL:@bever@b]

been given an Individualized Education Program (I.E.P.) or an Individualized Family and Service Plan (I.F.S.P.)?

P_HS36a [ PHS36a ] CH been classified as needing spec ed

Children may qualify for special education services for many reasons, such as learning problems,

autism, or the need for speech or physical therapy.


^fills.HasPastSince ^CHILD^fills.evereverbold been classified as needing special education? That

is, has ^fills.heshe^fills.evereverbold been given an Individualized Education Program (I.E.P.) or an

Individualized Family and Service Plan (I.F.S.P.)?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^FillHasPastSince

Has Has

past @bIn the past 12 months@b, has

since @bSince·@b

sincebirth @bSince birth@b, has

haslow has

sincelow @bsince·@b

sincebirthlow @bsince birth@b, has

pastlow @bin the past 12 months@b, has

Logic after:

IF = 2, GOTO P_HS40

---------------------------------------------------------------------------------

Logic before:

[IF CHILD AGE IS <37 MONTHS, CONTINUE. ELSE, GOTO _HS36ab.]

P_HS36aa [ PHS36aa ] CH currently have IFSP

Does ^CHILD currently have an Individualized Family and Service Plan (I.F.S.P) or is ^fills.heshe

receiving special education or other services for a special need or disability?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

---------------------------------------------------------------------------------

Logic before:

[IF CHILD AGE IS >36 MONTHS, CONTINUE. ELSE GOTO P_HS36ad.]

P_HS36ab [ PHS36ab ] CH currently have IEP

Does ^CHILD currently have an Individualized Education Program (I.E.P) or is ^fills.heshe receiving special

education or other services for a special need or disability?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:




P_HS36ac


Which of the following services is CHILD or family receiving? Select all that apply.


1 Speech-language pathology and/or audiology services

2 Psychological services, counseling or behavior therapy

3 Physical and/or occupational therapy

5 Special education or instruction in school

6 Personal assistant/or an in-the-home or in-the classroom aide

7 Tutor

8 Social work services

9 Serivce coordination or case management


P_HS36ad


Overall, do you believe CHILD is receiving the appropriate special education and related services needed to address his/her disability?


1 Yes, definitely

2 This child is receiving some education and services, but they could be improved

3 No, this child is not receiving the education and services he/she needs

---------------------------------------------------------------------------------

P_HS37 [ PHS37 ] Labels are in Logic After

What special learning problems or special needs were you told that ^CHILD has?


(PROBE: ANYTHING ELSE)


CODE ALL THAT APPLY.

Question Type: TSplNdS

autism 1 AUTISM, Asperger’s Disorder, pervasive developmental disorder, or other Autism Spectrum Disorder

deaf 2 DEAFNESS

emotional 3 EMOTIONAL DISTURBANCE (BEHAVIORAL DISORDER)

hear 4 HEARING IMPAIRMENT

mental 5 INTELLECTUAL DISABILITY, ALSO KNOWN AS MENTAL RETARDATION

multiple 6 MULTIPLE DISABILITIES (COMBINED IMPAIRMENTS THAT

TOGETHER CAUSE SEVERE EDUCATIONAL IMPAIRMENTS, SUCH

AS MENTAL RETARDATION-BLINDNESS)

orthopedic 7 ORTHOPEDIC IMPAIRMENT (PHYSICALLY DISABLING CONDITION,

SUCH AS MISSING LIMB, CEREBRAL PALSY, SPINA BIFIDA,

MUSCULAR DYSTROPHY)

learning 8 SPECIFIC LEARNING DISABILITY

speech 9 SPEECH OR LANGUAGE IMPAIRMENT

brain 10 TRAUMATIC BRAIN INJURY

vision 11 VISUAL IMPAIRMENT INCLUDING BLINDNESS

other 12 OTHER PROBLEM/NEED (ADHD, ASTHMA)

devDelay 13 DEVELOPMENTAL DELAY

Logic after:

PHS37T1 --R told CH has lrng prblm-Autism; PHS37T2 --R told CH has lrng prblm-Deafness;

PHS37T3 --R told CH has lrng prblm-Emotional dstrbnce (beh disorder); PHS37T4 --R told CH has

lrng prblm-Hearing impairment; PHS37T5 --R told CH has lrng prblm-Mental retardation; PHS37T6 --

R told CH has lrng prblm-Multiple disabilities; PHS37T7 --R told CH has lrng prblm-Orthopedic

impairment; phs37T8 --R told CH has lrng prblm-Specific learning disability; phs37T9 --R told CH

has lrng prblm-Speech or language impairment; PHS37T10 --R told CH has lrng prblm-Traumatic

brain injury; PHS37T11 --R told CH has lrng prblm-Visual impairment incldng blindness; PHS37T12

--R told CH has lrng prblm-Other problem/need; PHS37T13 --R told CH has lrng prblm-DK;

PHS37T14 --R told CH has lrng prblm-RF; PHS37T15 --R told CH has lrng prblm-Developmental

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HS40a [ PHS40a ] How much R thinks CH nds spec ed svcs

How much do you think ^CHILD @bneeds@b special education services or classes? Would you

say...

Question Type: THMNeed

alot 1 a lot,

somewhat 2 somewhat,

alittle 3 a little, or

notatall 4 not at all?

Logic after:

IF = 4, GOTO P_HS1ia

---------------------------------------------------------------------------------

P_HS41 [ PHS41 ] Labels are in Logic After

Why is ^CHILD @bnot@b receiving special education services or classes?


CODE ALL THAT APPLY.

Question Type: TNtRecvS

notavail 1 SERVICE NOT AVAILABLE IN THE AREA

waitlist 2 WAIT-LISTED FOR SERVICE

inelig 3 INELIGIBLE FOR SERVICE

notfinanced 4 SERVICES COULD NOT BE FINANCED

schedule 5 SCHEDULING PROBLEM OR PROBLEM FINDING CHILD CARE

transportation 6 TRANSPORTATION PROBLEM

alreadyreceived 7 SOME CHILD ALREADY RECEIVED/COMPLETED SERVICE

otherreason 8 SOME OTHER REASON

covid 9 NOT AVAILABLE DUE TO COVID-19 PANDEMIC


Logic after:

PHS41T1 --Why CH not rcvng ed srvcs-Service NA in the area; PHS41T2 --Why CH not rcvng ed

srvcs-Wait listed for service; PHS41T3 --Why CH not rcvng ed srvcs-Ineligible for service; PHS41T4

--Why CH not rcvng ed srvcs-Services could not be financed; PHS41T5 --Why CH not rcvng ed

srvcs-Problem w/ scheduling/ch care; PHS41T6 --Why CH not rcvng ed srvcs-Transportation

problem; PHS41T7 --Why CH not rcvng ed srvcs-Ch already rcvd/compltd srvc; PHS41T8 --Why CH

not rcvng ed srvcs-Some other reason; PHS41T9--Why CH not rcvng ed srvcs-DK

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HS1ia [ PHS1ia ] Place CH goes when sick

Is there a place that ^CHILD @uusually@u goes when ^fills.heshe is sick or you need advice

about ^fills.hisher health?

Question Type: THlthAd

YES 1 YES

NOPLACE 2 THERE IS NO PLACE

MOREONE 3 THERE IS MORE THAN ONE PLACE

Logic after:

IF = 2, place GOTO P_HS1la

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

IF P_HS1ia = 1: is it - a clinic, doctor’s office, emergency room, or some other place?(tempchild =

emty)IF P_HS1ia = 3: What kind of place does ^tempchild (tempchild = child) go to most often - a

clinic, doctor’s office, emergency room, or some other place?

P_HS1ja [ PHS1ja ] Kind of place CH goes to most often for hlth care

What kind of place ^fills.P_HS1ja1 ^tempchild ^fills.P_HS1ja2

Question Type: TSckCare

clinic 1 CLINIC OR HEALTH CENTER

droffice 2 DOCTOR'S OFFICE OR HMO

emergency 3 HOSPITAL EMERGENCY ROOM

outpatient 4 HOSPITAL OUTPATIENT DEPARTMENT

other 5 SOME OTHER PLACE

notusualplace 6 DOESN'T GO TO ONE PLACE MOST OFTEN

Question Fill: ^fillP_Hs1ja1

EQONE_1 is it - a clinic, doctor’s office, emergency room, or some other place?

EQTHREE_1 does

Question Fill: ^fillP_Hs1ja2

EQONE_2

EQTHREE_2 go to most often - a clinic, doctor’s office, emergency room, or some

other place?

Logic after:

IF=6 GOTO P_HS1la

---------------------------------------------------------------------------------

Logic before:

IF P_HS1ja = 1-4, FILL RESPONSE FROM P_HS1Ja

P_HS1ka [ PHS1ka ] Same place CH goes for ckup

Is that^fills.P_HS1ka1 the same place ^CHILD usually goes when ^fills.heshe needs routine or

preventive care, such as a physical examination or well child check-up?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^fillP_HS1KA1

clinic ·clinic or health center

droffice ·doctor's office or HMO

emergency ·hospital emergency room

outpatient ·hospital outpatient department

_EMPTY

Logic after:

IF = 1 GOTO P_HS1m

---------------------------------------------------------------------------------

P_HS1la [ PHS1la ] Kind of place CH goes for check-up

What kind of place does ^CHILD @uusually@u go when ^fills.heshe needs routine or preventive

care, such as a physical examination or well child check-up?

Question Type: TRtnCre

doesnotget 1 DOESN'T GET PREVENTIVE CARE ANYWHERE

clinic 2 CLINIC OF HEALTH CENTER

droffice 3 DOCTOR'S OFFICE OR HMO

emergency 4 HOSPITAL EMERGENCY ROOM

outpatient 5 HOSPITAL OUTPATIENT DEPARTMENT

other 6 SOME OTHER PLACE

notusualplace 7 DOESN'T GO TO ONE PLACE MOST OFTEN

---------------------------------------------------------------------------------

Logic before:

fill DATE 12 MONTHS PRIOR TO INTERVIEW DATE

P_HS1m [ PHS1ma ] In past 12 mths CH recv check-up

@bDuring the past 12 months@b, did ^CHILD receive a well child check-up, that is, a general

check-up when ^fills.heshe was not sick or injured?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HS1na [ PHS1na ] In past 12 mths CH see a Dr when not sick/inj

@bDuring the past 12 months@b, did ^CHILD see a doctor or other health professional because

^fills.heshe was sick or injured?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_HS1ob [ PHS1ob ] Labels are in Logic After

@bDuring the past 12 months@b, was there any time when ^CHILD needed any of the following

but couldn't get it because you couldn't afford it?


CODE ALL THAT APPLY.

Question Type: TNdHS1S

Meds 1 Prescription medicines

Mental 2 Mental health care or counseling

Dental 3 Dental care (including check-ups)

Vision 4 Eyeglasses

NONE 5 NONE OF THE ABOVE

Logic after:

PHS1ob_1 --CH nded/couldnt get (not afford) last 12m-Prescription med; PHS1ob_2 --CH

nded/couldnt get (not afford) last 12m-Mental hlth care; PHS1ob_3 --CH nded/couldnt get (not

afford) last 12m-Dental care; PHS1ob_4 --CH nded/couldnt get (not afford) last 12m-Eyeglasses;

PHS1ob_5 --CH nded/couldnt get (not afford) last 12m-None of the above; PHS1ob_6--CH

nded/couldnt get (not afford) last 12m-DK; PHS1ob_7--CH nded/couldnt get (not afford) last 12m-RF

---------------------------------------------------------------------------------

P_HS49 [ PHS49 ] NO LABEL

USE CARD 20. Next, I'm going to go through a list of places where ^CHILD might have gotten help

for emotional, behavioral, learning, attention, or substance abuse problems. Please look at the

list of places on Card 20.


NOTE: "EMOTIONAL, BEHAVIORAL, LEARNING, AND ATTENTION PROBLEMS" INCLUDE

SUICIDE ATTEMPTS, ADD, DEPRESSION, ALCOHOL/DRUG-RELATED PROBLEMS,

INJURING SELF/OTHER, BIPOLAR DISORDER, AGGRESSIVE BEHAVIOR, ETC.


PRESS "1" and [ENTER] TO CONTINUE.

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

Logic before:

Ask this if and only if it is wave=1 and (Group=1 or 3)


In General -- in the 50 series, the aa questions are for wave1 and groups 1 and 3.

the a1a questions are for

wave = 1 and P_HS_Group = 1 and P_HS50aa=yes) or

(WAVE = 1 and P_HS_Group = 2) or

(WAVE = 2) then ask the a1a questions







P_HS50aa1 [ PHS50aa ] CH ever been psych hosp/unit



[IF WAVE = 1 AND GROUP=1 FILL: Has ^CHILD @bever@b been to…]

[IF WAVE = 1 AND GROUP= 3 FILL: Since [CHILD] has lived with you, has ^CHILD been to…]


a @bpsychiatric hospital or a psychiatric unit in a medical hospital, a hospital medical inpatient unit, or an emergency room @b for emotional, behavioral,

learning, attention, or substance abuse problems?


NOTE: A PSYCHIATRIC HOSPITAL PROVIDES CARE ONLY FOR PSYCHIATRIC PROBLEMS.

A PSYCHIATRIC UNIT PROVIDES PSYCHIATRIC CARE IN A SPECIALIZED UNIT THAT IS

WITHIN A MEDICAL HOSPITAL OFFERING CARE FOR A WIDE RANGE OF ILLNESSES.

Question Type: TYN

yes 1 YES

no 2 NO




---------------------------------------------------------------------------------

Logic before:

if (WAVE = 1 and P_HS_Group = 1 and P_HS50aa=yes) or

(WAVE = 1 and P_HS_Group = 2) or

(WAVE >= 2) then

ask P_HS50a1a


P_HS50a1a1 [ PHS50a1a ] CH been psych hosp/unit-last 12 m


[IF (WAVE = 1 AND (P_HS50aa = 1 AND GROUP=1) OR IF GROUP = 2) OR (WAVE =2) FILL: In the past 12 months, has ^CHILD been to...]

a @bpsychiatric hospital or a psychiatric unit in a medical hospital, a hospital medical inpatient unit, or an emergency room @b for emotional, behavioral,

learning, attention, or substance abuse problems?


NOTE: A PSYCHIATRIC HOSPITAL PROVIDES CARE ONLY FOR PSYCHIATRIC PROBLEMS.

A PSYCHIATRIC UNIT PROVIDES PSYCHIATRIC CARE IN A SPECIALIZED UNIT THAT IS

WITHIN A MEDICAL HOSPITAL OFFERING CARE FOR A WIDE RANGE OF ILLNESSES.

Question Type: TYN

yes 1 YES

no 2 NO



---------------------------------------------------------------------------------

Logic before:

IF CHILD AGE < 10, GOTO P_HS50ca. ELSE, CONTINUE.IF WAVE = 1, FILL: (Has ^CHILD ever

been to...)IF WAVE >= 2, FILL: In the past 12 months, has ^CHILD been to...)

P_HS50ba [ PHS50ba ] CH ever been detox/drg/alc unit


[IF WAVE = 1 AND GROUP=1 FILL: Has ^CHILD @bever@b been to…]

[IF WAVE = 1 AND GROUP= 3 FILL: Since [CHILD] has lived with you, has ^CHILD been to…]

a @bdetox unit or inpatient drug or alcohol unit@b for any of these problems? (INCLUDE

EMOTIONAL, BEHAVIORAL, LEARNING, ATTENTION, AND SUBSTANCE ABUSE

PROBLEMS.)



NOTE: AN INPATIENT DETOX UNIT OR DRUG/ALCOHOL UNIT PROVIDES INPATIENT

SPECIALIZED TREATMENT FOR SUBSTANCE USE/ABUSE. CAN OCCUR IN A STAND-

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, CONTINUE. ELSE, GOTO P_HS50ca.IF WAVE >= 2, In the past 12 months, has

^CHILD been to...)

P_HS50b1a [ PHS50b1a ] CH been detox/drg/alc unit-last 12 m


[IF (WAVE = 1 AND (P_HS50ba = 1 AND GROUP=1) OR IF GROUP = 2) OR (WAVE =2) FILL: In the past 12 months, has ^CHILD been to...]

a @bdetox unit or inpatient drug or alcohol unit@b for any of these problems? (INCLUDE

EMOTIONAL, BEHAVIORAL, LEARNING, ATTENTION, AND SUBSTANCE ABUSE

PROBLEMS.)


NOTE: AN INPATIENT DETOX UNIT OR DRUG/ALCOHOL UNIT PROVIDES INPATIENT

SPECIALIZED TREATMENT FOR SUBSTANCE USE/ABUSE. CAN OCCUR IN A STAND-

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, FILL: (Has ^CHILD ever been to...)IF WAVE >= 2 FILL: In the past 12 months), has

^CHILD been to...)

P_HS50da [ PHS50da ] CH ever been res trtmnt cntr or grp hme


[IF WAVE = 1 AND GROUP=1 FILL: Has ^CHILD @bever@b been to…]

[IF WAVE = 1 AND GROUP= 3 FILL: Since [CHILD] has lived with you, has ^CHILD been to…]


a @b residential treatment center or group home @b for any of these problems? (INCLUDE

EMOTIONAL, BEHAVIORAL, LEARNING, ATTENTION, AND SUBSTANCE ABUSE

PROBLEMS.)


NOTE: A RESIDENTIAL TREATMENT CENTER IS A SELF-CONTAINED TREATMENT FACILITY

(I.E., RESIDENCE IS NOT WITHIN THE COMMUNITY AND CHILD RECEIVES EDUCATION

WITHIN THE CENTER). INCLUDE WILDERNESS CAMPS AND COTTAGES ON THE

GROUNDS OF A SELF-CONTAINED TREATMENT FACILITY. DO NOT INCLUDE DETENTION

CENTERS, TRAINING SCHOOLS, AND JAILS. A GROUP HOME IS A SMALLER RESIDENTIAL

TREATMENT CENTER.

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^FillHasPastSince

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, CONTINUE. ELSE, GOTO P_HS50ea.

P_HS50d1a [ PHS50d1a ] CH been res trtmnt cntr or grp hme-last 12 m


[IF (WAVE = 1 AND (P_HS50da = 1 AND GROUP=1) OR IF GROUP = 2) OR (WAVE =2) FILL: In the past 12 months, has ^CHILD been to...]

a @bresidential treatment center or group home@b for any of these problems? (INCLUDE

EMOTIONAL, BEHAVIORAL, LEARNING, ATTENTION, AND SUBSTANCE ABUSE

PROBLEMS.)


NOTE: A RESIDENTIAL TREATMENT CENTER IS A SELF-CONTAINED TREATMENT FACILITY

(I.E., RESIDENCE IS NOT WITHIN THE COMMUNITY AND CHILD RECEIVES EDUCATION

WITHIN THE CENTER). INCLUDE WILDERNESS CAMPS AND COTTAGES ON THE

GROUNDS OF A SELF-CONTAINED TREATMENT FACILITY. DO NOT INCLUDE DETENTION

CENTERS, TRAINING SCHOOLS, AND JAILS. A GROUP HOME IS A SMALLER RESIDENTIAL

TREATMENT CENTER.

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, FILL: (Has ^CHILD ever been in...)IF WAVE >= 2, FILL: In the past 12 months), has

^CHILD been in...)

P_HS50f2a [ PHS50f2a ] CH ever been therapeutic foster care



[IF WAVE = 1 AND GROUP=1 FILL: Has ^CHILD @bever@b been to…]

[IF WAVE = 1 AND GROUP= 3 FILL: Since [CHILD] has lived with you, has ^CHILD been to…]


@btherapeutic foster care@b for any of these problems? (INCLUDE EMOTIONAL,

BEHAVIORAL, LEARNING, ATTENTION, AND SUBSTANCE ABUSE PROBLEMS.)


NOTE: A THERAPEUTIC FOSTER CARE IS AN ARRANGEMENT WHERE THE CHILD LIVES IN

THE HOME OF PROFESSIONAL PARENTS WHO ARE TRAINED AND SUPERVISED TO

UTILIZE PARENT MANAGEMENT SKILLS AND TO PROVIDE A SUPPORTIVE RELATIONSHIP

FOR THE CHILD. MAY ALSO BE REFERRED TO AS SPECIALIZED FOSTER CARE,

TREATMENT FOSTER CARE, OR PROFESSIONAL PARENTING HOME.

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, CONTINUE. ELSE, GOTO P_HS50ga.

P_HS50f3a [ PHS50f3a ] CH been therapeutic foster care-last 12 m


[IF (WAVE = 1 AND (P_HS50f2a = 1 AND GROUP=1) OR IF GROUP = 2) OR (WAVE =2) FILL: In the past 12 months, has ^CHILD been to...]

@btherapeutic foster care@b for any of these problems? (INCLUDE EMOTIONAL,

BEHAVIORAL, LEARNING, ATTENTION, AND SUBSTANCE ABUSE PROBLEMS.)


NOTE: A THERAPEUTIC FOSTER CARE IS AN ARRANGEMENT WHERE THE CHILD LIVES IN

THE HOME OF PROFESSIONAL PARENTS WHO ARE TRAINED AND SUPERVISED TO

UTILIZE PARENT MANAGEMENT SKILLS AND TO PROVIDE A SUPPORTIVE RELATIONSHIP

FOR THE CHILD. MAY ALSO BE REFERRED TO AS SPECIALIZED FOSTER CARE,

TREATMENT FOSTER CARE, OR PROFESSIONAL PARENTING HOME.

Question Type: TYN

yes 1 YES

no 2 NO


Logic before:

IF CHILD AGE < 6, GOTO P_HS50ia. ELSE, CONTINUE.IF WAVE = 1, FILL: (Has ^CHILD ever

been to...)IF WAVE >= 2FILL: In the past 12 months), has ^CHILD been to...)

P_HS50ga1 [ PHS50ga ] CH ever been day trtmnt for emot/beh/lrng/substnc prblm



[IF WAVE = 1 AND GROUP=1 FILL: Has ^CHILD @bever@b been to…]

[IF WAVE = 1 AND GROUP= 3 FILL: Since [CHILD] has lived with you, has ^CHILD been to…]


@bDay treatment or an outpatient drug or alcohol clinic @b for emotional, behavioral, learning, attention, or substance abuse problems?

By "day treatment", we mean that ^CHILD goes to a program @bevery day or almost every

day@b but doesn't stay overnight.

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, CONTINUE. ELSE, GOTO P_HS50g2a.

P_HS50g1a1 [ PHS50g1a ] CH been day trtmnt for emot/beh/lrng/substnc prblm-last 12 m


[IF (WAVE = 1 AND (P_HS50ga = 1 AND GROUP=1) OR IF GROUP = 2) OR (WAVE =2) FILL: In the past 12 months, has ^CHILD been to...]

@bday treatment or an outpatient drug or alcohol clinic @b for emotional, behavioral, learning, attention, or substance abuse problems?

By "day treatment", we mean that ^CHILD goes to a program @bevery day or almost every

day@b but doesn't stay overnight.

Question Type: TYN

yes 1 YES

no 2 NO


---------------------------------------------------------------------------------

---------------------------------------------------------------------------------


Logic before:

IF WAVE = 1, FILL: (Has ^CHILD ever been to...)IF WAVE >= 2, FILL: In the past 12 months, that

is, since fill DATE 12 MONTHS PRIOR TO INTERVIEW DATE), has ^CHILD been to...)

P_HS50ia1 [ PHS50ia ] CH ever been mntl hlth/comm hlth cntr


[IF WAVE = 1 AND GROUP=1 FILL: Has ^CHILD @bever@b been to…]

[IF WAVE = 1 AND GROUP= 3 FILL: Since [CHILD] has lived with you, has ^CHILD been to…]


a @bmental health or community health center, a psychiatrist, psychologist, social worker, or psychiatric

nurse @b for any of these problems? (INCLUDE

EMOTIONAL, BEHAVIORAL, LEARNING, ATTENTION, AND SUBSTANCE ABUSE

PROBLEMS.)


NOTE: A COMMUNITY HEALTH CENTER IS PUBLICLY FUNDED AND PROVIDES GENERAL

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, CONTINUE. ELSE, GOTO P_HS50i2a.

P_HS50i1a1 [ PHS50i1a ] CH been mntl hlth/comm hlth cntr-last 12 m


[IF (WAVE = 1 AND (P_HS50ia = 1 AND GROUP=1) OR IF GROUP = 2) OR (WAVE =2) FILL: In the past 12 months, has ^CHILD been to...]


a @bmental health or community health center, a psychiatrist, psychologist, social worker, or psychiatric

nurse @b or received in-home counseling for any of these problems? (INCLUDE

EMOTIONAL, BEHAVIORAL, LEARNING, ATTENTION, AND SUBSTANCE ABUSE

PROBLEMS.)



NOTE: A COMMUNITY HEALTH CENTER IS PUBLICLY FUNDED AND PROVIDES GENERAL

Question Type: TYN

yes 1 YES

no 2 NO






---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, FILL: Has ^CHILD ever... IF WAVE >= 2, FILL: In the past 12 months, has

P_HS50la [ PHS50la ] CH ever seen fam doc/othr doc for emot/beh/lrng/substnc


[IF WAVE = 1 AND GROUP=1 FILL: Has ^CHILD @bever@b …]

[IF WAVE = 1 AND GROUP= 3 FILL: Since [CHILD] has lived with you, has ^CHILD …]


Seen your @bfamily doctor or any other medical doctor@b for emotional, behavioral, learning,

attention, or substance abuse problems?


NOTE: INCLUDE SERVICES RECEIVED FROM A NON-PSYCHIATRIC MD. INCLUDE ANY

VISITS TO PEDIATRICIAN OR FAMILY DOCTOR IN PRIVATE OR GROUP PRACTICE DURING

WHICH THE PARENT/CHILD SOUGHT HELP FOR EMOTIONAL, BEHAVIORAL, SUBSTANCE

ABUSE PROBLEMS.

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, ask P_HS50l1a. ELSE, GOTO P_HS50l2a.

P_HS50l1a [ PHS50l1a ] CH seen fam doc/othr doc for emot/beh/lrng/substnc-last 12 m


[IF (WAVE = 1 AND (P_HS50la = 1 AND GROUP=1) OR IF GROUP = 2) OR (WAVE =2) FILL: In the past 12 months, has ^CHILD...]

seen your @bfamily doctor or any other medical doctor@b for emotional, behavioral, learning,

attention, or substance abuse problems?


NOTE: INCLUDE SERVICES RECEIVED FROM A NON-PSYCHIATRIC MD. INCLUDE ANY

VISITS TO PEDIATRICIAN OR FAMILY DOCTOR IN PRIVATE OR GROUP PRACTICE DURING

WHICH THE PARENT/CHILD SOUGHT HELP FOR EMOTIONAL, BEHAVIORAL, SUBSTANCE

ABUSE PROBLEMS.

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, FILL: (Has ^CHILD ever...)IF WAVE >= 2, FILL: (In the past 12 months, has

P_HS50na [ PHS50na ] CH ever seen school guid coun/psych/sw


[IF WAVE = 1 AND GROUP=1 FILL: Has ^CHILD @bever@b …]

[IF WAVE = 1 AND GROUP= 3 FILL: Since [CHILD] has lived with you, has ^CHILD…]


Seen a @bschool guidance counselor, school psychologist, or school social worker@b for

emotional, behavioral, learning, attention, or substance abuse problems or gotten any other sort of

help for these problems at school?


FR NOTE: ONLINE/VIRTUAL MEETINGS WITH SCHOOL GUIDANCE COUNSELORS, SCHOOL PSYCHOLOGISTS, OR SCHOOL SOCIAL WORKERS SHOULD BE INCLUDED.


NOTE: ONLY INCLUDE VISITS RELATED TO MENTAL HEALTH/SUBSTANCE ABUSE. DO

NOT INCLUDE VISITS RELATED TO SCHOOL CURRICULUM OR COLLEGE/CAREER

COUNSELING. SCHOOL PERSONNEL WHO HANDLE ATTENDANCE ISSUES CAN ALSO BE

INCLUDED HERE IF THEY HAVE DIRECT CONTACT WITH THE CHILD.

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1,ask P_HS50o1a. ELSE, GOTO P_HS50oa.

P_HS50n1a [ PHS50n1a ] CH ever seen school guid coun/psych/sw-lastd 12 m


[IF (WAVE = 1 AND (P_HS50na = 1 AND GROUP=1) OR IF GROUP = 2) OR (WAVE =2) FILL: In the past 12 months, has ^CHILD...]

seen a @bschool guidance counselor, school psychologist, or school social worker@b for

emotional, behavioral, learning, attention, or substance abuse problems or gotten any other sort of

help for these problems at school?


FR NOTE: ONLINE/VIRTUAL MEETINGS WITH SCHOOL GUIDANCE COUNSELORS, SCHOOL PSYCHOLOGISTS, OR SCHOOL SOCIAL WORKERS SHOULD BE INCLUDED.


NOTE: ONLY INCLUDE VISITS RELATED TO MENTAL HEALTH/SUBSTANCE ABUSE. DO

NOT INCLUDE VISITS RELATED TO SCHOOL CURRICULUM OR COLLEGE/CAREER

COUNSELING. SCHOOL PERSONNEL WHO HANDLE ATTENDANCE ISSUES CAN ALSO BE

INCLUDED HERE IF THEY HAVE DIRECT CONTACT WITH THE CHILD.

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------


Logic before:

IF WAVE = 1, FILL: (Has ^CHILD ever...)IF WAVE >= 2, FILL: (In the past 12 months, has


P_HS50oa


[IF WAVE = 1 AND GROUP=1 FILL: Has ^CHILD @bever@b …]

[IF WAVE = 1 AND GROUP= 3 FILL: Since [CHILD] has lived with you, has ^CHILD…]


received services in a special classroom in a regular school for emotional, behavioral, learning or substance abuse problems?

FR NOTE; SPECIAL ONLINE VIRTUAL CLASSROOMS SHOULD BE INCLUDED.

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1,ask P_HS50o1a. ELSE, GOTO P_HS51pa.


P_HS50o1a


[IF (WAVE = 1 AND (P_HS50oa = 1 AND GROUP=1) OR IF GROUP = 2) OR (WAVE =2) FILL: In the past 12 months, has ^CHILD...]


received services in a special classroom in a regular school for any of these problems? (INCLUDE EMOTIONAL, BEHAVIORAL, LEARNING OR SUBSTANCE ABUSE PROBLEMS)

FR NOTE; SPECIAL ONLINE VIRTUAL CLASSROOMS SHOULD BE INCLUDED.

Question Type: TYN

yes 1 YES

no 2 NO

--------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, FILL: (Has ^CHILD ever...)IF WAVE >= 2, FILL: (In the past 12 months, has

P_HS50pa

[IF WAVE = 1 AND GROUP=1 FILL: Has ^CHILD @bever@b …]

[IF WAVE = 1 AND GROUP= 3 FILL: Since [CHILD] has lived with you, has ^CHILD…]


received special help or tutoring in the regular classroom for any of these problems? (INCLUDE EMOTIONAL, BEHAVIORAL, LEARNING OR SUBSTANCE ABUSE PROBLEMS)


FR NOTE: SPECIAL HELP OR TUTORING CONDUCTED ONLINE/VIRTUALLY SHOULD BE INCLUDED.

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1,ask P_HS50o1a. ELSE, GOTO P_HS51qa.

P_HS50p1a


[IF (WAVE = 1 AND (P_HS50pa = 1 AND GROUP=1) OR IF GROUP = 2) OR (WAVE =2) FILL: In the past 12 months, has ^CHILD...]


received special help or tutoring in the regular classroom for any of these problems? (INCLUDE EMOTIONAL, BEHAVIORAL, LEARNING OR SUBSTANCE ABUSE PROBLEMS)

Question Type: TYN

yes 1 YES

no 2 NO


--------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, FILL: (Has ^CHILD ever...)IF WAVE >= 2, FILL: (In the past 12 months, has

P_HS50qa

[IF WAVE = 1 AND GROUP=1 FILL: Has ^CHILD @bever@b …]

[IF WAVE = 1 AND GROUP= 3 FILL: Since [CHILD] has lived with you, has ^CHILD…]


received services in a special school for students for any of these problems? (INCLUDE EMOTIONAL, BEHAVIORAL, LEARNING OR SUBSTANCE ABUSE PROBLEMS)

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1,ask P_HS50o1a. ELSE, GOTO P_HS51ra.

P_HS50q1a


[IF (WAVE = 1 AND (P_HS50qa = 1 AND GROUP=1) OR IF GROUP = 2) OR (WAVE =2) FILL: In the past 12 months, has ^CHILD...]


received services in a special school for students for any of these problems? (INCLUDE EMOTIONAL, BEHAVIORAL, LEARNING OR SUBSTANCE ABUSE PROBLEMS)



Question Type: TYN

yes 1 YES

no 2 NO

--------------------------------------------------------------------------------


---------------------------------------------------------------------------------

Logic before:

IF CHILD AGE < 6, GOTO P_ P­_HS168a . ELSE, ASK P_HS125a.IF WAVE = 1, FILL: In the last 12

months/IF WAVE > 1, fill: Since FILL DATE OF LAST INTERVIEW

P_HS125a [ PHS125a ] CH gone to court for misbehaving

My next questions are about visits to court or other steps that may have been taken to deal with

any behavior problems for ^CHILD. ^fills.P_HS_TimePeriod^tempLivArrDate, has ^CHILD gone to

court for misbehaving - for example, for delinquency, running away, truancy, or other offenses?

Please do not include probation review hearings.

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^FillP_HS_TimePeriod

wave1_group1 @bIn the past 12 months@b

wave1_group2 @bIn the past 12 months@b

wave1_group3_birt Since @bbirth@b

h

wave1_group3_afte @bSince·@b

r

wave2 @bIn the past 12 months@b

Logic after:

2 = NO GOTO P_HS131a

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HS127a [ PHS127a ] CH placed on probation b/c of offense

MOST RECENT COURT VISIT:

MOST RECENT COURT VISIT DATE: ^P_HS126M / ^P_HS126Y


Was ^CHILD placed on probation for this offense?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 1, GOTO P_HS129a

---------------------------------------------------------------------------------

P_HS128a [ PHS128a ] CH spend time in detcntr/corctnl fclty b/c of offense

MOST RECENT COURT VISIT:

MOST RECENT COURT VISIT DATE: ^P_HS126M / ^P_HS126Y


Did ^fills.heshe spend time in a detention center or correctional facility for this offense?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^fillheshe

he he

she she

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HS130 [ PHS130 ] Labels are in Logic After

MOST RECENT COURT VISIT:

MOST RECENT COURT VISIT DATE: ^P_HS126M / ^P_HS126Y


What kind of services were ordered for ^CHILD?


CODE ALL THAT APPLY.

Question Type: TSrvcS

counsel 1 FAMILY COUNSELING

individual 2 INDIVIDUAL MENTAL HEALTH TREATMENT

alcohol 3 ALCOHOL ABUSE TREATMENT

drugabuse 4 DRUG ABUSE TREATMENT

other 5 OTHER SERVICES

Logic after:

PHS130T1 --Srvc ordrd by court for CH-Family counseling; PHS130T2 --Srvc ordrd by court for CH-

Indvdul mental health treatment; PHS130T3 --Srvc ordrd by court for CH-Alcohol abuse treatment;

PHS130T4 --Srvc ordrd by court for CH-Drug abuse treatment; PHS130T5 --Srvc ordrd by court for

CH-Other services; PHS130T6--Srvc ordrd by court for CH-DK; PHS130T7--Srvc ordrd by court for

CH-RF

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_HS168a [ PHS168a ] CH crntly cvrd by mltry hlth insrnc-CHAMPUS/CHAMP-VA/TRICARE

The next questions are about health care plans.


Is ^CHILD currently covered by some type of military health insurance, such as CHAMPUS,

CHAMP-VA, TRICARE, or VA care?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

Logic before:

[IF P_HS168a = 1: Other than military health insurance, is ^CHILD covered by any other] / [IF

P_HS168a <> 1 Is ^CHILD covered by a]

P_HS169a [ PHS169a ] CH cvrd by hlth insrnc plan cvrd thru crnt/pst employer

^fills.P_HS169a ^CHILD ^fills.P_HS169b health insurance plan obtained through a current or past

employer or union? Please remember to include coverage ^CHILD may have through another

family member's plan.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Question Fill: ^fillP_HS169A

EQONE Other than military health insurance, is

NOTEQONE Is

Question Fill: ^fillP_HS169B

EQONE covered by any other

NOTEQONE covered by a

---------------------------------------------------------------------------------

Logic before:

(IF MEDIFILL NE NONE) The Medicaid program in (STATE FILL) is also called (MEDIFILL).

P_HS170a [ PHS170a ] At this time, is CHILD covered by Medicaid?

Medicaid is a program for health care for persons in need. It is different from Medicare, which is a

health insurance program for persons 65 and older and some disabled persons under 65.

^fills.P_HS170a ^fills.P_HS_State ^fills.P_HS170b ^fills.P_HS_MediFill^fills.P_HS170c


At this time, is ^CHILD covered by Medicaid?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Question Fill: ^fillP_HS170a

GotVal The Medicaid program in

None

Question Fill: ^fillP_HS170b

GotVal is also called

None

Question Fill: ^fillP_HS170c

GotVal .

None

Logic after:

if yes GO TO P_HS172a

IF P_HS170a = 2, DK OR REF AND CHILD, GO TO P_HS171A; ELSE GO TO P_HS172a

---------------------------------------------------------------------------------

P_HS171a [ PHS171a ] CH covered by state health plan for uninsured

Is ^CHILD covered by ^fills.P_HS_ChipFILL, the state health insurance plan for uninsured

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_HS172a [ PHS172a ] CH covered by the Indian Health Service

Is ^CHILD covered by the Indian Health Service?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_HS173a [ PHS173a ] CH covered by any other type of health insurance

Is ^CHILD covered by @bany other@b type of health insurance that I have not mentioned, such as

Medicare or insurance purchased directly from an insurance company?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

P_HS177a [ PHS177a ] CH did not have hlth insurance at any time past 12 months

During the past 12 months was there any time when ^CHILD did not have any health insurance?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_HSEND [ PHSEND ] NoDeliv

PLEASE PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue



Independent Living Module for CG of EY (CG)

---------------------------------------------------------------------------------

Logic before:

IF CHILD SETTING IS GROUP HOME OR RESIDENTIAL FACILITY (P_NP12b = 3 OR 4) THEN GO TO Y_LPEND


[ADMINISTER SECTION LP TO PERMANENT AND NON-PERMANENT CAREGIVERS OF

EMANCIPATED YOUTH WHO RESIDE OUTSIDE THE CAREGIVER’S HOME. IF CHILD IS

EMANCIPATED AND DOES NOT CURRENTLY LIVE WITH A CAREGIVER PER CID, CONTINUE.

ELSE, GOTO P_LPEND.]

P_LP1a [ PLP1a ] CH discussed emancipation plans w/ CG

Next, we would like to ask a few questions about ^CHILD's plans to emancipate, that is, to live

independently.


Before ^CHILD began living independently, did ^Fills.heshe discuss ^Fills.hisher plans to leave

with you, or did ^Fills.heshe make ^Fills.hisher own plans?

Question Type: TPlans

DISCUSS 1 DISCUSSED PLANS WITH CAREGIVER

MADE 2 MADE OWN PLANS

---------------------------------------------------------------------------------

P_LP2a [ PLP2a ] CH had job when beg indep living

At the time ^CHILD began living independently, did ^Fills.heshe have a job?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_LP4a [ PLP4a ] Where emancipated CH planned to live

Where was ^CHILD planning to live?

Question Type: TLivWith

Relative 1 WITH BIOLOGICAL RELATIVES

BoyGirlFrnd 2 WITH A BOYFRIEND OR GIRLFRIEND

Friends 3 WITH OTHER FRIENDS

Military 4 PLANNED TO JOIN MILITARY

JobCorp 5 PLANNED TO JOIN JOB CORP/JOB TRAINING PROGRAM

College 6 PLANNED TO GO TO COLLEGE

OthPlace 7 OTHER PLACE

Question Fill: ^FillBoyGirlFrnd

BOYFRIEND BOYFRIEND

GIRLFRIEND GIRLFRIEND

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_LP8a [ PLP8a ] Child welfr agncy help create successful indep plan for CH

Do you think the child welfare agency has helped create a successful independent living plan for

^CHILD?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

GOTO P_LPEND








YOUTH BEHAVIOR (CHECKLIST FOR AGES 1.5-5)

---------------------------------------------------------------------------------

Logic before:

IF AGE <18 months OR > 5, GOTO P_TCEND

P_TC1a [ PTC1a ] CBCL Age 1.5-5 : Item 1

USE CARD 25. Now I am going to read you different sentences that sometimes describe children

and youth. Please look at card 25 and tell me how true each sentence has been for ^CHILD in

the past @b2 months@b. Remember to tell me what you really think. Your answers will be kept

private.


^CHILD has aches or pains without a known medical cause.


Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC2a [ PTC2a ] CBCL Age 1.5-5 : Item 2

(^CHILD) acts too young for ^fills.hisher age.


(IF R DOES NOT UNDERSTAND "ACTS TOO YOUNG", ASK: Acts younger than kids of the

same age.)


Would you say...

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_TC3a [ PTC3a ] CBCL Age 1.5-5 : Item 3

(^CHILD)


Is afraid to try new things.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC4a [ PTC4a ] CBCL Age 1.5-5 : Item 4

(^CHILD)


Avoids looking others in the eye.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC5a [ PTC5a ] CBCL Age 1.5-5 : Item 5

(^CHILD)


Can't concentrate or can't pay attention for long.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC6a [ PTC6a ] CBCL Age 1.5-5 : Item 6

(^CHILD)


Can't sit still or is restless.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC7a [ PTC7a ] CBCL Age 1.5-5 : Item 7

(^CHILD)


Can't stand having things out of place.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC8a [ PTC8a ] CBCL Age 1.5-5 : Item 8

(^CHILD)


Can't stand waiting or wants everything now.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC9a [ PTC9a ] CBCL Age 1.5-5 : Item 9

(^CHILD)


Chews on things that aren't edible.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC10a [ PTC10a ] CBCL Age 1.5-5 : Item 10

(^CHILD)


Clings to adults or is too dependent.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC11a [ PTC11a ] CBCL Age 1.5-5 : Item 11

(^CHILD)


Constantly seeks help.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC12a [ PTC12a ] CBCL Age 1.5-5 : Item 12

(^CHILD)


Gets constipated or doesn't move ^fills.hisher bowels.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_TC13a [ PTC13a ] CBCL Age 1.5-5 : Item 13

(^CHILD)


Cries a lot.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC14a [ PTC14a ] CBCL Age 1.5-5 : Item 14

(^CHILD)


Is cruel to animals.


(IF R DOES NOT UNDERSTAND "CRUEL", ASK: Mean to animals.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC15a [ PTC15a ] CBCL Age 1.5-5 : Item 15

(^CHILD)


Is defiant (rebellious).


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC16a [ PTC16a ] CBCL Age 1.5-5 : Item 16

(^CHILD's)


Demands must be met immediately.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC17a [ PTC17a ] CBCL Age 1.5-5 : Item 17

(^CHILD)


Destroys ^fills.hisher own things.


(IF R DOES NOT UNDERSTAND "DESTROYS", ASK: Ruins or wrecks things. CODE YES FOR

BOTH ACCIDENTAL AND DELIBERATE DESTRUCTION.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_TC18a [ PTC18a ] CBCL Age 1.5-5 : Item 18

(^CHILD)


Destroys things belonging to ^fills.hisher family or other children.


(IF R DOES NOT UNDERSTAND "DESTROYS", ASK: Ruins or wrecks things. CODE YES FOR

BOTH ACCIDENTAL AND DELIBERATE DESTRUCTION.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC19a [ PTC19a ] CBCL Age 1.5-5 : Item 19

(^CHILD)


Has diarrhea or loses ^fills.hisher bowels when not sick.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC20a [ PTC20a ] CBCL Age 1.5-5 : Item 20

(^CHILD)


Is disobedient.


(IF R DOES NOT UNDERSTAND "DISOBEDIENT", ASK: Doesn't do what you tell him/her to do.)



Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC21a [ PTC21a ] CBCL Age 1.5-5 : Item 21

(^CHILD)


Is disturbed by any change in routine.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC22a [ PTC22a ] CBCL Age 1.5-5 : Item 22

(^CHILD)


Doesn't want to sleep alone.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC23a [ PTC23a ] CBCL Age 1.5-5 : Item 23

(^CHILD)


Doesn't answer when people talk to ^fills.himher.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhimher

him him

her her

---------------------------------------------------------------------------------

P_TC24a [ PTC24a ] CBCL Age 1.5-5 : Item 24

(^CHILD)


Doesn't eat well.


(IF R DOES NOT UNDERSTAND "DOESN'T EAT WELL", ASK: Child will only eat one or two

kinds of food.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC25a [ PTC25a ] CBCL Age 1.5-5 : Item 25

(^CHILD)


Doesn't get along with other kids.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC26a [ PTC26a ] CBCL Age 1.5-5 : Item 26

(^CHILD)


Doesn't know how to have fun, or acts like a little adult.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC27a [ PTC27a ] CBCL Age 1.5-5 : Item 27

(^CHILD)


Doesn't seem to feel guilty after misbehaving.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC28a [ PTC28a ] CBCL Age 1.5-5 : Item 28

(^CHILD)


Doesn't want to go out of the house.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC29a [ PTC29a ] CBCL Age 1.5-5 : Item 29

(^CHILD)


Is easily frustrated.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC30a [ PTC30a ] CBCL Age 1.5-5 : Item 30

(^CHILD)


Is easily jealous.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC31a [ PTC31a ] CBCL Age 1.5-5 : Item 31

(^CHILD)


Eats or drinks things that are not food.


(DO NOT COUNT JUNK FOOD OR SWEETS)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC32a [ PTC32a ] CBCL Age 1.5-5 : Item 32

(^CHILD)


Fears certain animals, situations, or places, other than school.


(IF R DOES NOT UNDERSTAND "CERTAIN", ASK: Some.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC33a [ PTC33a ] CBCL Age 1.5-5 : Item 33

(^CHILD's)


Feelings are easily hurt.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC34a [ PTC34a ] CBCL Age 1.5-5 : Item 34

(^CHILD)


Gets hurt a lot, or is accident-prone.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC35a [ PTC35a ] CBCL Age 1.5-5 : Item 35

(^CHILD)


Gets in many fights.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC36a [ PTC36a ] CBCL Age 1.5-5 : Item 36

(^CHILD)


Gets into everything.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC37a [ PTC37a ] CBCL Age 1.5-5 : Item 37

(^CHILD)


Gets too upset when separated from ^fills.hisher parents.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_TC38a [ PTC38a ] CBCL Age 1.5-5 : Item 38

(^CHILD)


Has trouble getting to sleep.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC39a [ PTC39a ] CBCL Age 1.5-5 : Item 39

(^CHILD)


Has headaches without a known medical cause.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC40a [ PTC40a ] CBCL Age 1.5-5 : Item 40

(^CHILD)


Hits others.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC41a [ PTC41a ] CBCL Age 1.5-5 : Item 41

(^CHILD)


Holds ^fills.hisher breath.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_TC42a [ PTC42a ] CBCL Age 1.5-5 : Item 42

(^CHILD)


Hurts animals or people without meaning to.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC43a [ PTC43a ] CBCL Age 1.5-5 : Item 43

(^CHILD)


Looks unhappy without good reason.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC44a [ PTC44a ] CBCL Age 1.5-5 : Item 44

(^CHILD)


Has angry moods.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC45a [ PTC45a ] CBCL Age 1.5-5 : Item 45

(^CHILD)


Has nausea, or feels sick without a known medical cause.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC46a [ PTC46a ] CBCL Age 1.5-5 : Item 46

(^CHILD)


Makes nervous movements or twitches.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC47a [ PTC47a ] CBCL Age 1.5-5 : Item 47

(^CHILD)


Is nervous, highstrung, or tense.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC48a [ PTC48a ] CBCL Age 1.5-5 : Item 48

(^CHILD)


Has nightmares.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC49a [ PTC49a ] CBCL Age 1.5-5 : Item 49

(^CHILD)


Overeats.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC50a [ PTC50a ] CBCL Age 1.5-5 : Item 50

(^CHILD)


Gets overtired.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC51a [ PTC51a ] CBCL Age 1.5-5 : Item 51

(^CHILD)


Is overweight.


(IF R SAYS THE DOCTOR SAID CHILD IS OVERWEIGHT, ASK R TO RESPOND BASED ON

WHAT R THINKS.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC51aa [ PTC51aa ] CBCL Age 1.5-5 : Item 51a

(^CHILD)


Shows panic for no good reason.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC52a [ PTC52a ] CBCL Age 1.5-5 : Item 52

(^CHILD)


Has painful bowel movements.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC53a [ PTC53a ] CBCL Age 1.5-5 : Item 53

(^CHILD)


Physically attacks people.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC54a [ PTC54a ] CBCL Age 1.5-5 : Item 54

(^CHILD)


Picks ^fills.hisher nose, skin or other parts of the body.


(THIS DOES NOT INCLUDE NORMAL NOSE-PICKING.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_TC55a [ PTC55a ] CBCL Age 1.5-5 : Item 55

(^CHILD)


Plays with ^fills.hisher own sex parts too much.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_TC56a [ PTC56a ] CBCL Age 1.5-5 : Item 56

(^CHILD)


Is poorly coordinated or clumsy.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC57a [ PTC57a ] CBCL Age 1.5-5 : Item 57

(^CHILD)


Has problems with ^fills.hisher eyes without a known medical cause.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_TC58a [ PTC58a ] CBCL Age 1.5-5 : Item 58

Punishment doesn't change ^CHILD's behavior.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC59a [ PTC59a ] CBCL Age 1.5-5 : Item 59

(^CHILD)


Quickly shifts from one activity to another.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC60a [ PTC60a ] CBCL Age 1.5-5 : Item 60

(^CHILD)


Has rashes or other skin problems without a known medical cause.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC61a [ PTC61a ] CBCL Age 1.5-5 : Item 61

(^CHILD)


Refuses to eat.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC62a [ PTC62a ] CBCL Age 1.5-5 : Item 62

(^CHILD)


Refuses to play active games.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC63a [ PTC63a ] CBCL Age 1.5-5 : Item 63

(^CHILD)


Repeatedly rocks ^fills.hisher head or body.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_TC64a [ PTC64a ] CBCL Age 1.5-5 : Item 64

(^CHILD)


Resists going to bed at night.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC65a [ PTC65a ] CBCL Age 1.5-5 : Item 65

(^CHILD)


Resists toilet training.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC66a [ PTC66a ] CBCL Age 1.5-5 : Item 66

(^CHILD)


Screams a lot.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC67a [ PTC67a ] CBCL Age 1.5-5 : Item 67

(^CHILD)


Seems unresponsive to affection.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC68a [ PTC68a ] CBCL Age 1.5-5 : Item 68

(^CHILD)


Is self-conscious or easily embarrassed.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC69a [ PTC69a ] CBCL Age 1.5-5 : Item 69

(^CHILD)


Is selfish or won't share.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC70a [ PTC70a ] CBCL Age 1.5-5 : Item 70

(^CHILD)


Shows little affection toward people.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC71a [ PTC71a ] CBCL Age 1.5-5 : Item 71

(^CHILD)


Shows little interest in things around ^fills.himher.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_TC72a [ PTC72a ] CBCL Age 1.5-5 : Item 72

(^CHILD)


Shows too little fear of getting hurt.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC73a [ PTC73a ] CBCL Age 1.5-5 : Item 73

(^CHILD)


Is too shy or timid.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC74a [ PTC74a ] CBCL Age 1.5-5 : Item 74

(^CHILD)


Sleeps less than most children during the day and/or night.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC75a [ PTC75a ] CBCL Age 1.5-5 : Item 75

(^CHILD)


Smears or plays with bowel movements.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC76a [ PTC76a ] CBCL Age 1.5-5 : Item 76

(^CHILD)


Has a speech problem.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC77a [ PTC77a ] CBCL Age 1.5-5 : Item 77

(^CHILD)


Stares into space or seems preoccupied.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC78a [ PTC78a ] CBCL Age 1.5-5 : Item 78

(^CHILD)


Has stomachaches or cramps without a known medical cause.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC79a [ PTC79a ] CBCL Age 1.5-5 : Item 79

(^CHILD)


Stores up many things ^fills.heshe doesn't need.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillheshe

he he

she she

---------------------------------------------------------------------------------

P_TC79aa [ PTC79aa ] CBCL Age 1.5-5 : Item 79a

(^CHILD)


Has rapid shifts between sadness and excitement.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC80a [ PTC80a ] CBCL Age 1.5-5 : Item 80

(^CHILD)


Behaves strangely.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC81a [ PTC81a ] CBCL Age 1.5-5 : Item 81

(^CHILD)


Is stubborn, sullen, or irritable.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC82a [ PTC82a ] CBCL Age 1.5-5 : Item 82

(^CHILD)


Has sudden changes in mood or feelings.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC83a [ PTC83a ] CBCL Age 1.5-5 : Item 83

(^CHILD)


Sulks (pouts) a lot.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC84a [ PTC84a ] CBCL Age 1.5-5 : Item 84

(^CHILD)


Talks or cries out in sleep.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC85a [ PTC85a ] CBCL Age 1.5-5 : Item 85

(^CHILD)


Has temper tantrums or a hot temper.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC86a [ PTC86a ] CBCL Age 1.5-5 : Item 86

(^CHILD)


Is too concerned with neatness or cleanliness.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC87a [ PTC87a ] CBCL Age 1.5-5 : Item 87

(^CHILD)


Is too fearful or anxious.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC88a [ PTC88a ] CBCL Age 1.5-5 : Item 88

(^CHILD)


Is uncooperative.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC89a [ PTC89a ] CBCL Age 1.5-5 : Item 89

(^CHILD)


Is underactive, slow moving, or lacks energy.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC90a [ PTC90a ] CBCL Age 1.5-5 : Item 90

(^CHILD)


Is unhappy, sad, or depressed.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC91a [ PTC91a ] CBCL Age 1.5-5 : Item 91

(^CHILD)


Is unusually loud.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC92a [ PTC92a ] CBCL Age 1.5-5 : Item 92

(^CHILD)


Is upset by new people or situations.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC93a [ PTC93a ] CBCL Age 1.5-5 : Item 93

(^CHILD)


Vomits or throws up without a known medical cause.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC94a [ PTC94a ] CBCL Age 1.5-5 : Item 94

(^CHILD)


Wakes up often at night.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC95a [ PTC95a ] CBCL Age 1.5-5 : Item 95

(^CHILD)


Wanders away from home.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC96a [ PTC96a ] CBCL Age 1.5-5 : Item 96

(^CHILD)


Wants a lot of attention.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC97a [ PTC97a ] CBCL Age 1.5-5 : Item 97

(^CHILD)


Whines.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC98a [ PTC98a ] CBCL Age 1.5-5 : Item 98

(^CHILD)


Is withdrawn, or doesn't get involved with others.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC99a [ PTC99a ] CBCL Age 1.5-5 : Item 99

(^CHILD)


Worries.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_TC100a [ PTC100a ] CBCL Age 1.5-5 : Item 100

(^CHILD)


Has other problems that were not already mentioned.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Logic after:

GOTO P_TCEND



YOUTH BEHAVIOR (CHECKLIST FOR AGES 6-18)

---------------------------------------------------------------------------------

Logic before:

IF AGE < 6 GOTO P_BCEND

P_BC1a [ PBC1a ] CBCL Age 6-18 : Item 1

USE CARD 25. Now I am going to read you different sentences that sometimes describe children

and youth. Looking at card 25 please tell me how true each sentence has been for ^child in the

last @b6 months@b. Remember to tell me what you really think. Your answers will be kept

private.


^child acts too young for ^fills.hisher age.


(IF R DOES NOT UNDERSTAND "ACTS TOO YOUNG", ASK: Acts younger than kids of the

same age.)


Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_BC2a [ PBC2a ] CBCL Age 6-18 : Item 2

^child has an allergy.


NOTE: DO NOT INCLUDE "ASTHMA" HERE.

Would you say...

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC2aa [ PBC2aa ] CBCL Age 6-18 : Item 2a

^child drinks alcohol without parents' approval.


Would you say...

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC3a [ PBC3a ] CBCL Age 6-18 : Item 3

(^child)


Argues a lot.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC4a [ PBC4a ] CBCL Age 6-18 : Item 4

(^child)


Has asthma.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC4aa [ PBC4aa ] CBCL Age 6-18 : Item 4a

(^child)


Fails to finish things ^fills.heshe starts.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillheshe

he he

she she

---------------------------------------------------------------------------------

P_BC5a [ PBC5a ] CBCL Age 6-18 : Item 5

(^child)


Behaves like the opposite sex.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC5aa [ PBC5aa ] CBCL Age 6-18 : Item 5a

(^child)


There is very little ^fills.heshe enjoys.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillheshe

he he

she she

---------------------------------------------------------------------------------

P_BC6a [ PBC6a ] CBCL Age 6-18 : Item 6

(^child)


Has bowel movements outside the toilet.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC7a [ PBC7a ] CBCL Age 6-18 : Item 7

(^child)


Brags or boasts.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC8a [ PBC8a ] CBCL Age 6-18 : Item 8

(^child)


Can't concentrate, or can't pay attention for long.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC9a [ PBC9a ] CBCL Age 6-18 : Item 9

(^child)


Can't get ^fills.hisher mind off certain thoughts or obsessions.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

---------------------------------------------------------------------------------

P_BC10a [ PBC10a ] CBCL Age 6-18 : Item 10

(^child)


Can't sit still, or is restless or hyperactive.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC11a [ PBC11a ] CBCL Age 6-18 : Item 11

(^child)


Clings to adults or is too dependent. (IF R DOES NOT UNDERSTAND "DEPENDENT", ASK:

Needs extra help from adults or is helpless.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC12a [ PBC12a ] CBCL Age 6-18 : Item 12

(^child)


Complains of loneliness.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC13a [ PBC13a ] CBCL Age 6-18 : Item 13

(^child)


Is confused or seems to be in a fog.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC14a [ PBC14a ] CBCL Age 6-18 : Item 14

(^child)


Cries a lot.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC15a [ PBC15a ] CBCL Age 6-18 : Item 15

(^child)


Is cruel to animals. (IF R DOES NOT UNDERSTAND "CRUEL", ASK: Mean to animals.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC16a [ PBC16a ] CBCL Age 6-18 : Item 16

(^child)


Is cruel, bullying, or mean to others.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC17a [ PBC17a ] CBCL Age 6-18 : Item 17

(^child)


Daydreams or gets lost in ^fills.hisher thoughts.

(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_BC18a [ PBC18a ] CBCL Age 6-18 : Item 18

(^child)


Deliberately harms ^fills.himherself or attempts suicide.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhimherself

himself himself

herself herself

---------------------------------------------------------------------------------

P_BC19a [ PBC19a ] CBCL Age 6-18 : Item 19

(^child)


Demands a lot of attention. (IF R DOES NOT UNDERSTAND "DEMANDS A LOT OF

ATTENTION", ASK: Things child wants you to do.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC20a [ PBC20a ] CBCL Age 6-18 : Item 20

(^child)


Destroys ^Fills.hisher own things. (IF R DOES NOT UNDERSTAND "DESTROYS", ASK: Ruins or

wrecks things.)


(CODE YES FOR BOTH ACCIDENTAL AND DELIBERATE DESTRUCTION.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_BC21a [ PBC21a ] CBCL Age 6-18 : Item 21

(^child)


Destroys things belonging to ^Fills.hisher family or others. (IF R DOES NOT UNDERSTAND

"DESTROYS", ASK: Ruins or wrecks things.)


(CODE YES FOR BOTH ACCIDENTAL AND DELIBERATE DESTRUCTION.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_BC22a [ PBC22a ] CBCL Age 6-18 : Item 22

(^child)


Is disobedient at home. (IF R DOES NOT UNDERSTAND "DISOBEDIENT", ASK: Doesn't do what

you tell him/her to do.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC23a [ PBC23a ] CBCL Age 6-18 : Item 23

(^child)


Is disobedient at school.(IF R DOES NOT UNDERSTAND "DISOBEDIENT", ASK: Doesn't do

what he/she is told.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC24a [ PBC24a ] CBCL Age 6-18 : Item 24

(^child)


Doesn't eat well. (IF R DOES NOT UNDERSTAND "DOESN'T EAT WELL", ASK: Child will only

eat one or two kinds of food.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC25a [ PBC25a ] CBCL Age 6-18 : Item 25

(^child)


Doesn't get along with other kids.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC26a [ PBC26a ] CBCL Age 6-18 : Item 26

(^child)


Doesn't seem to feel guilty after misbehaving.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC27a [ PBC27a ] CBCL Age 6-18 : Item 27

(^child)


Is easily jealous.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC28a [ PBC28a ] CBCL Age 6-18 : Item 28

(^child)


Eats or drinks things that are not food. (DO NOT INCLUDE JUNK FOOD OR SWEETS).


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC28aa [ PBC28aa ] CBCL Age 6-18 : Item 28a

(^child)


Breaks rules at home, school, or elsewhere.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC29a [ PBC29a ] CBCL Age 6-18 : Item 29

(^child)


Fears certain animals, situations, or places, other than school. (IF R DOES NOT UNDERSTAND

"CERTAIN", ASK: Some.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC30a [ PBC30a ] CBCL Age 6-18 : Item 30

(^child)


Fears going to school.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC31a [ PBC31a ] CBCL Age 6-18 : Item 31

(^child)


Fears ^Fills.heshe might think or do something bad.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillheshe

he he

she she

---------------------------------------------------------------------------------

P_BC32a [ PBC32a ] CBCL Age 6-18 : Item 32

(^child)


Feels ^Fills.heshe has to be perfect.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillheshe

he he

she she

---------------------------------------------------------------------------------

P_BC33a [ PBC33a ] CBCL Age 6-18 : Item 33

(^child)


Feels or complains that no one loves ^Fills.himher.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhimher

him him

---------------------------------------------------------------------------------

P_BC34a [ PBC34a ] CBCL Age 6-18 : Item 34

(^child)


Feels others are out to get ^Fills.himher.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhimher

him him

her her

---------------------------------------------------------------------------------

P_BC35a [ PBC35a ] CBCL Age 6-18 : Item 35

(^child)


Feels worthless or inferior.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC36a [ PBC36a ] CBCL Age 6-18 : Item 36

(^child)


Gets hurt a lot, or is accident-prone.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC37a [ PBC37a ] CBCL Age 6-18 : Item 37

(^child)


Gets in many fights.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC38a [ PBC38a ] CBCL Age 6-18 : Item 38

(^child)


Gets teased a lot.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC39a [ PBC39a ] CBCL Age 6-18 : Item 39

(^child)


Hangs around with others who get in trouble.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC40a [ PBC40a ] CBCL Age 6-18 : Item 40

(^child)


Hears sounds or voices that aren't there.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC41a [ PBC41a ] CBCL Age 6-18 : Item 41

(^child)


Is impulsive or acts without thinking.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC42a [ PBC42a ] CBCL Age 6-18 : Item 42

(^child)


Would rather be alone than with others.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC43a [ PBC43a ] CBCL Age 6-18 : Item 43

(^child)


Lies or cheats.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC44a [ PBC44a ] CBCL Age 6-18 : Item 44

(^child)


Bites ^Fills.hisher fingernails.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_BC45a [ PBC45a ] CBCL Age 6-18 : Item 45

(^child)


Is nervous, highstrung, or tense.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC46a [ PBC46a ] CBCL Age 6-18 : Item 46

(^child)


Makes nervous movements or twitches.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC47a [ PBC47a ] CBCL Age 6-18 : Item 47

(^child)


Has nightmares.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC48a [ PBC48a ] CBCL Age 6-18 : Item 48

(^child)


Is not liked by other kids.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC49a [ PBC49a ] CBCL Age 6-18 : Item 49

(^child)


Gets constipated or doesn't move ^Fills.hisher bowels.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_BC50a [ PBC50a ] CBCL Age 6-18 : Item 50

(^child)


Is too fearful or anxious.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC51a [ PBC51a ] CBCL Age 6-18 : Item 51

(^child)


Feels dizzy.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC52a [ PBC52a ] CBCL Age 6-18 : Item 52

(^child)


Feels too guilty.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC53a [ PBC53a ] CBCL Age 6-18 : Item 53

(^child)


Overeats.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC54a [ PBC54a ] CBCL Age 6-18 : Item 54

(^child)


Gets overtired.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC55a [ PBC55a ] CBCL Age 6-18 : Item 55

(^child)


Is overweight. (IF R SAYS THE DOCTOR SAID CHILD IS OVERWEIGHT, ASK R TO RESPOND

BASED ON WHAT R THINKS.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC56aa [ PBC56aax ] CBCL Age 6-18 : Item 56A

(^child)


Has aches or pains (not stomach or headaches) without a known medical cause. (IF R DOES

NOT UNDERSTAND "WITHOUT MEDICAL CAUSE", ASK: When not sick.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC56ba [ PBC56ba ] CBCL Age 6-18 : Item 56B

(^child)


Has headaches without a known medical cause.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC56ca [ PBC56ca ] CBCL Age 6-18 : Item 56C

(^child)


Has nausea or feels sick without a known medical cause.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC56da [ PBC56da ] CBCL Age 6-18 : Item 56D

(^child)


Has problems with ^fills.hisher eyes without a known medical cause.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_BC56ea [ PBC56ea ] CBCL Age 6-18 : Item 56E

(^child)


Has rashes or other skin problems without a known medical cause.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC56fa [ PBC56fa ] CBCL Age 6-18 : Item 56F

(^child)


Has stomachaches or cramps without a known medical cause.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC56ga [ PBC56ga ] CBCL Age 6-18 : Item 56G

(^child)


Has vomiting or throwing up without a known medical cause.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC56ha [ PBC56ha ] CBCL Age 6-18 : Item 56H

(^child)


Has other physical problems without a known medical cause.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC57a [ PBC57a ] CBCL Age 6-18 : Item 57

(^child)


Physically attacks people.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC58a [ PBC58a ] CBCL Age 6-18 : Item 58

(^child)


Picks ^fills.hisher nose, skin, or other parts of ^Fills.hisher body. (THIS DOES NOT INCLUDE

NORMAL NOSE-PICKING.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_BC59a [ PBC59a ] CBCL Age 6-18 : Item 59

(^child)


Plays with ^fills.hisher own sex parts in public.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_BC60a [ PBC60a ] CBCL Age 6-18 : Item 60

(^child)


Plays with ^fills.hisher own sex parts too much.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_BC61a [ PBC61a ] CBCL Age 6-18 : Item 61

(^child)


Does poor school work.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC62a [ PBC62a ] CBCL Age 6-18 : Item 62

(^child)


Is poorly coordinated or clumsy.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC63a [ PBC63a ] CBCL Age 6-18 : Item 63

(^child)


Prefers being with older kids.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC64a [ PBC64a ] CBCL Age 6-18 : Item 64

(^child)


Prefers being with younger kids.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC65a [ PBC65a ] CBCL Age 6-18 : Item 65

(^child)


Refuses to talk. (IF R DOES NOT UNDERSTAND "REFUSES", ASK: Will not talk.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC66a [ PBC66a ] CBCL Age 6-18 : Item 66

(^child)


Repeats certain acts over and over.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC67a [ PBC67a ] CBCL Age 6-18 : Item 67

(^child)


Runs away from home.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC68a [ PBC68a ] CBCL Age 6-18 : Item 68

(^child)


Screams a lot.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC69a [ PBC69a ] CBCL Age 6-18 : Item 69

(^child)


Is secretive or keeps things to ^fills.himherself.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_BC70a [ PBC70a ] CBCL Age 6-18 : Item 70

(^child)


Sees things that aren't there.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC71a [ PBC71a ] CBCL Age 6-18 : Item 71

(^child)


Is self-conscious or easily embarrassed.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC72a [ PBC72a ] CBCL Age 6-18 : Item 72

(^child)


Sets fires. (INCLUDES PLAYING WITH MATCHES OR LIGHTER. IF R SAYS THAT IT

HAPPENED ONCE IN LAST 6 MONTHS BUT SAYS "1", CODE AS "2".)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC73a [ PBC73a ] CBCL Age 6-18 : Item 73

(^child)


Has sexual problems.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC74a [ PBC74a ] CBCL Age 6-18 : Item 74

(^child)


Shows off or clowns.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC75a [ PBC75a ] CBCL Age 6-18 : Item 75

(^child)


Is shy or timid.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC76a [ PBC76a ] CBCL Age 6-18 : Item 76

(^child)


Sleeps less than most kids.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC77a [ PBC77a ] CBCL Age 6-18 : Item 77

(^child)


Sleeps more than most kids during the day and/or night.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC78a [ PBC78a ] CBCL Age 6-18 : Item 78

(^child)


Smears or plays with bowel movements.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC78aa [ PBC78aa ] CBCL Age 6-18 : Item 78a

(^child)


Is inattentive or easily distracted.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC79a [ PBC79a ] CBCL Age 6-18 : Item 79

(^child)


Has a speech problem.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC80a [ PBC80a ] CBCL Age 6-18 : Item 80

(^child)


Stares blankly.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC81a [ PBC81a ] CBCL Age 6-18 : Item 81

(^child)


Steals at home.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC82a [ PBC82a ] CBCL Age 6-18 : Item 82

(^child)


Steals outside the home.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC83a [ PBC83a ] CBCL Age 6-18 : Item 83

(^child)


Stores up things ^fills.heshe doesn't need.


(IF R DOES NOT UNDERSTAND "STORES UP", ASK: Collects things ^fills.heshe doesn't need.)


Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillheshe

he he

she she

---------------------------------------------------------------------------------

P_BC84a [ PBC84a ] CBCL Age 6-18 : Item 84

(^child)


Behaves strangely.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC85a [ PBC85a ] CBCL Age 6-18 : Item 85

(^child)


Has strange ideas.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC86a [ PBC86a ] CBCL Age 6-18 : Item 86

(^child)


Is stubborn, sullen, or irritable.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC87a [ PBC87a ] CBCL Age 6-18 : Item 87

(^child)


Has sudden changes in mood or feelings.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC88a [ PBC88a ] CBCL Age 6-18 : Item 88

(^child)


Sulks (pouts) a lot.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC89a [ PBC89a ] CBCL Age 6-18 : Item 89

(^child)


Is suspicious.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC90a [ PBC90a ] CBCL Age 6-18 : Item 90

(^child)


Swears or uses obscene language.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC91a [ PBC91a ] CBCL Age 6-18 : Item 91

(^child)


Talks about killing ^fills.himherself. (IF R NOTES THAT IT HAPPENED ONCE IN THE LAST 6

MONTHS BUT SAYS "1", CODE "2".)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhimherself

himself himself

herself herself

---------------------------------------------------------------------------------

P_BC92a [ PBC92a ] CBCL Age 6-18 : Item 92

(^child)


Talks or walks in ^Fills.hisher sleep.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_BC93a [ PBC93a ] CBCL Age 6-18 : Item 93

(^child)


Talks too much.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC94a [ PBC94a ] CBCL Age 6-18 : Item 94

(^child)


Teases a lot.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC95a [ PBC95a ] CBCL Age 6-18 : Item 95

(^child)


Has temper tantrums or a hot temper.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC96a [ PBC96a ] CBCL Age 6-18 : Item 96

(^child)


Thinks about sex too much.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC97a [ PBC97a ] CBCL Age 6-18 : Item 97

(^child)


Threatens people.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC98a [ PBC98a ] CBCL Age 6-18 : Item 98

(^child)


Sucks ^Fills.hisher thumb.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhisher

his his

her her

---------------------------------------------------------------------------------

P_BC99a [ PBC99a ] CBCL Age 6-18 : Item 99

(^child)


Is too concerned with neatness or cleanliness.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC99aa [ PBC99aa ] CBCL Age 6-18 : Item 99a

(^child)


Smokes, chews, or sniffs tobacco.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC100a [ PBC100a ] CBCL Age 6-18 : Item 100

(^child)


Has trouble sleeping.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC101a [ PBC101a ] CBCL Age 6-18 : Item 101

(^child)


Is truant or skips school.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC102a [ PBC102a ] CBCL Age 6-18 : Item 102

(^child)


Is underactive, slow moving, or lacks energy.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC103a [ PBC103a ] CBCL Age 6-18 : Item 103

(^child)


Is unhappy, sad, or depressed.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC104a [ PBC104a ] CBCL Age 6-18 : Item 104

(^child)


Is unusually loud.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC105a [ PBC105a ] CBCL Age 6-18 : Item 105

(^child)


Uses alcohol or drugs for non-medical purposes.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC106a [ PBC106a ] CBCL Age 6-18 : Item 106

(^child)


Vandalizes.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC107a [ PBC107a ] CBCL Age 6-18 : Item 107

(^child)


Wets ^Fills.himherself during the day.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Question Fill: ^fillhimherself

himself himself

herself herself

---------------------------------------------------------------------------------

P_BC108a [ PBC108a ] CBCL Age 6-18 : Item 108

(^child)


Wets the bed.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC109a [ PBC109a ] CBCL Age 6-18 : Item 109

(^child)


Whines.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC110a [ PBC110a ] CBCL Age 6-18 : Item 110

(^child)


Wishes to be of the opposite sex.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC111a [ PBC111a ] CBCL Age 6-18 : Item 111

(^child)


Is withdrawn, or doesn't get involved with others.(IF R DOES NOT UNDERSTAND HOW TO

ANSWER QUESTION, EMPHASIZE: Does not get involved.)


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC112a [ PBC112a ] CBCL Age 6-18 : Item 112

(^child)


Worries.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

---------------------------------------------------------------------------------

P_BC113a [ PBC113a ] CBCL Age 6-18 : Item 113

(^child)


Has other problems that were not already mentioned.


(Would you say...READ CATEGORIES AS NEEDED.)

Question Type: TTrue

not_true 1 not true,

some_true 2 somewhat or sometimes true, or

very_true 3 very true or often true?

Logic after:

P_BCEND



INCOME

---------------------------------------------------------------------------------

IF CHILD SETTING IS GROUP HOME OR RESIDENTIAL FACILITY (P_NP12b = 3 OR 4) THEN GO TO Y_INEND


P_IN1an [ PIN1an ] NO LABEL

The next questions are about income or income assistance available to ^CHILD's household

during the past 12 months. By household, I mean all of the people who live here. Please

remember that all information you provide will be kept private.


First, I need to know the @B total combined income of your family@B from all sources in the

@bpast 12 months@b. Please include your own income and the income of everyone living with

you. This includes money from jobs, net income from business or rent, pensions, dividends,

interest, social security, public assistance programs, welfare, food stamps, child support and

income from any other source such as family or friends and activities such as work "off the books"

or "under the table". If you don't know exactly, your best guess is okay.


PRESS 1 TO CONTINUE

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

P_IN2n [ PIN2n ] Best est total inc of all family membrs bfr txs pst 12m


In the past twelve months, what was the total income of your household from all sources before taxes and other deductions? Please include your own income and the income of everyone living with you.

Question Type: 0..999997

Logic after:

IF P_IN2n = DK or REF, GO TO P_IN3aa. ELSE GO TO P_IN2an

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_IN3_1n [ PIN31n ] # adults including yourself depend on this income

How many adults, including yourself, depend on this income?


NUMBER OF ADULTS:


NOTE: QUESTION REFERS TO ALL ADULTS, INCLUDING THOSE WHO MAY LIVE IN A

DIFFERENT HOUSEHOLD.

Question Type: 1..30

---------------------------------------------------------------------------------

P_IN3_2n [ PIN32n ] # children depend on this income

How many children depend on this income?


NUMBER OF CHILDREN:


NOTE: QUESTION REFERS TO ALL CHILDREN, INCLUDING THOSE WHO MAY LIVE IN A

DIFFERENT HOUSEHOLD.

Question Type: 1..30

---------------------------------------------------------------------------------

P_IN4a [ PIN4a ] Anyone in HH curr rcv ch support for CH

In the last twelve months, did anyone in this household receive child support for ^CHILD?


NOTE: THIS INCLUDES CHILD SUPPORT RECEIVED FROM THE STATE FROM GARNISHED

WAGES.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_IN5 [ PINTG5 ] Labels are in Logic After

In the last 12 months, did anyone in this household receive ...


CODE ALL THAT APPLY.

Question Type: TAidS



1 = WIC (Women Infants, and Children),

2 = [NAME OF STATE SNAP PROGRAM], [NAME OF STATE EBT CARD] Electronic Bank Transfer (EBT) card, or Food Stamps,

3 = Welfare or TANF (PROBE: By welfare or TANF, we mean temporary assistance to needy families, AFDC, or cash welfare) or other public assistance

4 = Housing Support, such as public housing, a voucher or assistance from Section 8),

5 = A disability check (SSI)?

6 = Child care assistance

7 = NONE OF THE ABOVE.



P_IN12.

Did you receive the Earned Income Tax Credit, or EITC, or any tax refund within the last 12 months?

PROBE IF DON’T KNOW WHAT EITC IS: The federal government has a special rule that allows working people who make less than about $29,000 a year to get a tax refund. It’s called the Earned Income Credit or EIC. Sometimes, if the IRS thinks that someone is eligible for the EIC they send out a letter asking that person to fill out a special form so that they can claim the EIC.


YES ....................................................................... 1

NO ........................................................................ 2


P_IN12a

Did you or anyone in your household received a “stimulus payment,” that is a coronavirus or COVID-19 related Economic Impact Payment from the Federal Government?

1 YES

2 NO


The following questions ask about your household’s activities in the past 12 months.


P_IN13

How difficult is it for you to pay your household’s bills each month? Would you say you have a…

1 Great deal of difficulty

2 Quite a bit of difficulty

3 Some difficulty

4 A little difficulty

5 No difficulty at all


P_IN14

Generally, at the end of each month do you end up with…

1 Not enough to make ends meet

2 Almost enough to make ends meet

3 Just enough to make ends meet

4 Some money left over

5 More than enough money left over



P_IN15

We have enough money to afford the kind of home we need. Do you…

1 Strongly disagree

2 Disagree

3 Agree

4 Strongly agree


P_IN16

We have enough money to afford the kind of clothing we need. Do you…

1 Strongly disagree

2 Disagree

3 Agree

4 Strongly agree


P_IN17

We have enough money to afford the kind of food we need. Do you…

1 Strongly disagree

2 Disagree

3 Agree

4 Strongly agree


P_IN18

We have enough money to afford the kind of medical care we need. Do you…

1 Strongly disagree

2 Disagree

3 Agree

4 Strongly agree


P_IN19

Since the coronavirus or COVID-19 outbreak that began in March of 2020, has covering your expenses and paying all your bills become more difficult, less difficult or stayed about the same?    

1 More difficult

2 Less difficult

3 Stayed about the same



Services Received by Caregiver

---------------------------------------------------------------------------------

Logic before:

This section should be skipped in the following caregiver situations:

- Licensed Foster Home or all non-family settings

(P_NP12a = 4)  OR (P_NP12b >= 1) OR

-           Primary CG is a Foster Mother or Father 

(P_HH6a = 8 or 9 OR P_HH6g = 8 or 9) OR

-           Primary CG currently receives payments for being a foster parent

(P_HH6e = 1)

P_SR_BEG [ PSR_BEG ] NoDeliv

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

---------------------------------------------------------------------------------


P_SR_INTRO


The next questions are about services you may have received in the community. In the last 12 months,

text2 NOTE: "IN THE COMMUNITY" MEANS SERVICES NOT PROVIDED

DIRECTLY BY THE AGENCY, ALTHOUGH THE AGENCY COULD

ARRANGE THE SERVICES. "LEGAL AID" IS LEGAL HELP/SERVICES

NOT RELATED TO CHILD WELFARE CUSTODY OR CPS ISSUES.



---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_SR2a [ PSR2a ] Rcvd legal aid-past 12m

In the last 12 months, have you received legal aid?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_SR6a1 [ PSR6a ] Rcvd food from community source-past 12m

In the last 12 months, have you received food from a community source like a soup kitchen or a

food bank?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if p_sr6a1 =NO GOTO P_SR8

P_SR7 [ PSR7a ] Number times rcv food aid-past 12m

In the last 12 months, how many times did you receive food from a community source?


NUMBER OF TIMES

Question Type: 1..1000

---------------------------------------------------------------------------------

P_SR7a [ PSR7aa ] R still gets food from community source

Are you still receiving food from a community source?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

GOTO P_SR10

---------------------------------------------------------------------------------

P_SR8 [ PSR8a ] Needed food at any time-past 12m

In the last 12 months, have you needed food at any time?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

------------------------------------------------------------------------------------------------------------------------------------------------------------------

P_SR10a1 [ PSR10a ] Rcvd emergency shelter/housing-past 12m

In the last 12 months, have you received emergency shelter or emergency housing? For example,

have you stayed in a homeless shelter?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_SR14a1 [ PSR14a ] Rcvd job-related services-past 12m

In the last 12 months, have you @breceived@b any job-related services?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_SR21a1 [ PSR21a ] Attended any orgnized supp grps-past 12m

In the last 12 months, have you @battended@b any organized support groups or self-help groups,

including Alcoholics Anonymous, Parents Anonymous, or other support groups? These groups

might meet at a community center or a church to discuss issues that concern them.


FR NOTE; ATTENDING ONLINE/VIRTUAL MEETINGS FOR SUPPORT GROUPS SHOULD BE INCLUDED.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_SR31a1 [ PSR31a1 ] R been admitted to a hsptl/med facility over night-past 12m

In the last 12 months, have you been admitted to a hospital or medical facility overnight for any

reason?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR31a= NO GOTO P_SR39

---------------------------------------------------------------------------------

Logic before:

RESPONSE OF 4 = Y CANNOT BE INCLUDED WITH RESPONSE OF 1-3 = Y

P_SR32 [ PSR32 ] Labels are in Logic After

Why were you admitted (to a hospital or medical facility overnight)?


CODE ALL THAT APPLY.

Question Type: TPSR32S

drug 1 ALCOHOL/DRUG PROBLEM

mental 2 EMOTIONS, NERVES, OR MENTAL HEALTH PROBLEM (E.G.

DEPRESSION, SCHIZOPHRENIA, BIPOLAR DISORDER, SUICIDE

ATTEMPTS, ETC.)

ill 3 ILLNESS OR INJURY

none_ 4 NONE OF THE ABOVE

Logic after:

PSR32T_1--Why admtd to hsptl/med fac-Alcohol/drug problem; PSR32T_2--Why admtd to

hsptl/med fac-Mental health problem; PSR32T_3--Why admtd to hsptl/med fac-Illness/injury;

PSR32T_4--Why admtd to hsptl/med fac-None of the above; PSR32T_5--Why admtd to hsptl/med

fac-DK; PSR32T_6--Why admtd to hsptl/med fac-RF

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_SR39a1 [ PSR39a ] Stayed ovrnight in prog for alc/drug-past 12m (not hsptl)

In the last 12 months, have you stayed overnight in a program that provides alcohol or drug

treatment?


NOTE: INCLUDES PROGRAMS AT ALCOHOL OR DRUG TREATMENT FACILITIES

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_SR42a1 [ PSR42a ] Been to ER for any reason

In the last 12 months, have you been to an emergency room for any reason?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_sr42a1 = no then GOTO P_SR47a1

---------------------------------------------------------------------------------

Logic before:

RESPONSE OF 4 = Y CANNOT BE INCLUDED WITH RESPONSE OF 1-3 = Y

P_SR43 [ PSR43 ] Labels are in Logic After

Why did you go to the emergency room?


CODE ALL THAT APPLY.

Question Type: TPSR32S

drug 1 ALCOHOL/DRUG PROBLEM

mental 2 EMOTIONS, NERVES, OR MENTAL HEALTH PROBLEM (E.G.

DEPRESSION, SCHIZOPHRENIA, BIPOLAR DISORDER, SUICIDE

ATTEMPTS, ETC.)

ill 3 ILLNESS OR INJURY

none_ 4 NONE OF THE ABOVE

Logic after:

PSR3TG_1--Alcohol/drug problem; PSR3TG_2--Mental health problem; PSR3TG_3--Illness or

injury; PSR3TG_4--None of the above; PSR3TG_5--DK; PSR3TG_6--RF

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_SR47a1 [ PSR47ax ] R visited a clnc/doctor about phys hlth-past 12m

In the last 12 months, have you visited a clinic or doctor about your physical health?

Question Type: TYesNoC

Yes 1 YES

No 2 NO


IF P_SR47a1=1

P_SR47a2

Was the visit to a clinic or doctor about your physical health done virtually?

Question Type: TYesNoC

Yes 1 YES

No 2 NO


---------------------------------------------------------------------------------

P_SR47c [ PSR47c ] R visited a clnc/doctor about an alc/drug prblm-past 12m

In the last 12 months, have you visited a clinic or doctor about an alcohol or drug problem?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR47c = no then GOTO P_SR47e

IF P_SR47c=1

P_SR47c1

Was the visit to a clinic or doctor about an alcohol or drug problem done virtually?

Question Type: TYesNoC

Yes 1 YES

No 2 NO


---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_SR47f [ PSR47f ] R had one or more sessions of psych counseling-past 12m

In the last 12 months, have you had one or more sessions of psychological counseling or therapy

for emotional problems with any type of professional?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

IF P_SR47f=1

P_SR47f1

Were the sessions of psychological counseling or therapy for emotional problems done virtually?

Question Type: TYesNoC

Yes 1 YES

No 2 NO


---------------------------------------------------------------------------------

P_SR47i [ PSR47i ] R used a prescription medicine for emotions-past 12m

In the last 12 months, have you used a prescription medicine for your emotions, nerves or mental

health from any type of professional?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

Logic before:

IF P_SR47f OR P_SR47i = 1, ASK. ELSE, GOTO P_SR54.

P_SR47j [ PSR47j ] Labels are in Logic After

Which of the following types of professionals did you see in the last 12 months about problems

with your emotions or nerves or mental health?


CODE ALL THAT APPLY.

Question Type: theadmdS

PSY_MD 1 Psychiatrist

MD 2 General physician or family doctor

MS_SP 3 Any other Medical Doctor, like a gynecologist or cardiologist

PSY 4 Psychologist

SOC 5 Social Worker

COUN 6 Counselor

mental 7 Any other mental health professional, such as a mental health nurse

nurse 8 A nurse, occupational therapist or other general health professional

relig 9 A religious or spiritual advisor, like a minister, priest or rabbi

Logic after:

PSR47j_1 --Type of prof R saw past 12m for emot prblms-Psychiatrist; PSR47j_2 --Type of prof R

saw past 12m for emot prblms-Gen Phys/Fam Dr; PSR47j_3 --Type of prof R saw past 12m for

emot prblms-Othr Med Dr; PSR47j_4 --Type of prof R saw past 12m for emot prblms-Psychologist;

PSR47j_5 --Type of prof R saw past 12m for emot prblms-Social Worker; PSR47j_6 --Type of prof R

saw past 12m for emot prblms-Counselor; PSR47j_7 --Type of prof R saw past 12m for emot

prblms-Othr Mntl Hlth; PSR47j_8 --Type of prof R saw past 12m for emot prblms-Nurse/Occ Thrpst;

PSR47j_9 --Type of prof R saw past 12m for emot prblms-Religious/Sprtal; PSR47j_10--Type of

prof R saw past 12m for emot prblms-DK; PSR47j_11--Type of prof R saw past 12m for emot



IF P_SR47j=1

P_SR47j1

Were the visits with [TYPE OF PROFFESIONAL] for problems with your emotions or nerves or mental health done virtually?

Question Type: TYesNoC

Yes 1 YES

No 2 NO


---------------------------------------------------------------------------------

Logic before:

IF WAVE 1 OR WAVE =2 AND GROUP = 4, CONTINUE. ELSE GOTO P_SR54a1

P_SR54 [ PSR54 ] R ever rcv day trtmnt for mntl hlth prblm

Have you ever received day treatment or partial hospitalization for a mental health problem? By

day treatment or partial hospitalization, we mean a program that you went to every day or almost

every day that did not require you to stay overnight.


NOTE: "MENTAL HEALTH PROBLEMS" INCLUDE DEPRESSION, SCHIZOPHRENIA, BIPOLAR

DISORDER, SUICIDE ATTEMPTS, ETC.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if p_sr54 = no then GOTO P_SR57

---------------------------------------------------------------------------------

P_SR54a1 [ PSR54a ] R rcv day trtmnt for mntl hlth prblm-past 12m

In the last 12 months, have you received day treatment or partial hospitalization for a mental

health problem? By day treatment or partial hospitalization, we mean a program that you went to

every day or almost every day that did not require you to stay overnight.


NOTE: "MENTAL HEALTH PROBLEMS" INCLUDE DEPRESSION, SCHIZOPHRENIA, BIPOLAR

DISORDER, SUICIDE ATTEMPTS, ETC.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

In the last 12 months,

P_SR65 [ PSR65a ] Rcvd any parenting skill training-inst date/past 12m

have you @breceived@b any parenting skills training?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

if P_SR65 = no then GOTO P_SR74a1

---------------------------------------------------------------------------------

Logic before:

If WAVE =1, ASK. ELSE, GOTO P_SR66.

P_SR65a1 [ PSR65a1 ] Parenting skills training begin before/after contact date

Did this parenting skills training begin before or after ^ContactDate, when you came into contact

with child welfare services?

Question Type: tPSR5a1F

_before 1 BEFORE

_after 2 AFTER

P_SR67 [ PSR67 ] Labels are in Logic After

Where did you receive these services?


CODE ALL THAT APPLY

Question Type: TPSR67S

home 1 AT HOME

agency 2 AT AN AGENCY OR COMMUNITY ORGANIZATION

other 3 SOMEWHERE ELSE

virtually 4 VIRTUALLY


Logic after:

PSR67T_1--Where did R rcv srvcs - At home; PSR67T_2--Where did R rcv srvcs - At an agency or

community org; PSR67T_3--Where did R rcv srvcs - Somewhere else; PSR67T_4--Where did R rcv

srvcs - DK; PSR67T_5--Where did R rcv srvcs - RF

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_SR68b [ PSR68b ] Labels are in Logic After

During the period you received training in parenting skills, which of the following things would you

say occurred for at least 10 minutes on many of the days in which you received these services?


CODE ALL THAT APPLY.

Question Type: TPSR68bS

_1 1 You watched videotaped examples of parents and children doing things

together (e.g., playing, working, solving problems, disciplining, etc.) as

a way of learning and talking about parenting skills.

2.You watched videotape of yourself doing things together with your

child/children.

_2 3 You were coached by someone directly as you practiced skills with

your child or children.

_3 4 You listened to a presentation of information about parenting skills or

child development.

_4 5 You practiced skills with other parents in role-play situations.

_5 6 You completed or reviewed homework assignments that involved things

to practice.

_6 7 You read or learned things about parenting on a computer.

Logic after:

PSR68b_1 --R prntng skls trng-Watched video tapes; PSR68b_2 --R prntng skls trng-Coached by

someone; PSR68b_3 --R prntng skls trng-Listened to presentation; PSR68b_4 --R prntng skls trng-

Practiced skills with other parents; PSR68b_5 --R prntng skls trng-Completed/reviewed homework;

PSR68b_6 --R prntng skls trng-Read/learned on a computer; PSR68b_7--R prntng skls trng-DK;

PSR68b_8--R prntng skls trng-RF


P_SR68c [ PSR68c ] Labels are in Logic After

During the period you received training in parenting skills, which of the following topics would you

say were discussed in a substantial way (e.g., on at least 2 of the days you received those

services)?


Question Type: TPSR68cS

_1 1 How to play effectively with one's child.

_2 2 How to praise and reward positive behavior

_3 3 How to ignore misbehavior

_4 4 Non-violent approaches to discipline

_5 5 Establishing daily routines for children

_6 6 Feeding, sleeping, or toilet training habits

_7 7 Communication and/or problem-solving with children

_8 8 Supporting children's success in school

_9 9 Providing medical care for children

_10 10 Maintaining a child-safe home environment

Logic after:

PSR68c_1 --Tpcs drng R prntng skls trng-How 2 play efctvly w/ child.; PSR68c_2 --Tpcs drng R

prntng skls trng-How 2 praise & rwrd pstv beh; PSR68c_3 --Tpcs drng R prntng skls trng-How to

ignore misbehavior; PSR68c_4 --Tpcs drng R prntng skls trng-Nonviolent aprchs to discipline;

PSR68c_5 --Tpcs drng R prntng skls trng-Est daily routines for children; PSR68c_6 --Tpcs drng R

prntng skls trng-Fdng/slpng/toilet trng habits; PSR68c_7 --Tpcs drng R prntng skls trng-Comm

and/or prblm-slvng w/ ch; PSR68c_8 --Tpcs drng R prntng skls trng-Sprtng ch success in school;

PSR68c_9 --Tpcs drng R prntng skls trng-Prvdng med care for children; PSR68c_10 --Tpcs drng R

prntng skls trng-Mntnng child-safe home environ; PSR68c_11--Tpcs drng R prntng skls trng-DK;

PSR68c_12--Tpcs drng R prntng skls trng-RF

---------------------------------------------------------------------------------

P_SR69a [ PSR69aa ] R still receiving this service

Are you still receiving this service?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

GOTO P_SR71x

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1: In the last 12 months, IF WAVE = 2: Since FILL DATE OF LAST INTERVIEW

P_SR70 [ PSR70a ] How much R need parntng skills trng

^fills.P_SR65^lstintdate, how much have you needed to receive training in parenting skills? Would

you say...

Question Type: THMNeed

alot 1 a lot,

somewhat 2 somewhat,

alittle 3 a little, or

notatall 4 not at all?

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1: in the last 12 months, IF WAVE = 2: since FILL DATE OF LAST INTERVIEW

P_SR71x [ PSR71xax ] R required by Ch Wlfr Agncy to rcv parenting skills trng

At any time ^fills.P_SR71x^lstintdate were you required by the Child Welfare Agency or the court

to receive parenting skills training?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Question Fill: ^fillP_sr71x

W1 in the last 12 months,·

W2 since·

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_SR74a1 [ PSR74a ] Rcvd any home management trning-past 12m

In the last 12 months, have you @breceived@b any training in home management, for example,

budgeting or planning meals?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_SR81a1 [ PSR81a ] Anyone provide respite ch care-past 12m

In the last 12 months, has anyone come to your home to provide respite care for a child or

provided respite care outside of the home for a child so that you could have a break from child

care?


NOTE: RESPITE CARE IS CARE FOR THE CHILD (PROVIDED IN THE HOME OR

SOMEWHERE ELSE) SO THAT THE FAMILY CAN HAVE A BREAK FROM ONGOING CARE

OF THE CHILD. IT CAN BE THOUGHT OF AS CHILD CARE OR BABYSITTING BY AN

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_SR98a1 [ PSR98a ] Was family counseled as a group-past 12m

At any time in the last 12 months, was the family counseled together as a group, either at home

or somewhere else?

Question Type: TYesNoC

Yes 1 YES

No 2 NO


IF P_SR98a1=1

P_SR98a2

Was the family counseling done virtually?

Question Type: TYesNoC

Yes 1 YES

No 2 NO


---------------------------------------------------------------------------------

P_SR108a [ PSR108aa ] Referred to Srve by Ch Welfare/CW

USE CARD 26. Please look at the list of services on Card 26. Since ^lstintdate, have you,

^CHILD, or any other member of your family received any of these services from the child welfare

agency? The agency may have provided the services directly or paid for you, your child, or your

family to receive the services somewhere else.

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

CARD 26 CONTENTS:

Foster care or kinship care services

Individualized Education Plan (IEP)

Individualized Family Service Plan (IFSP)

Special Education Services

Tutoring

In-home counseling or in-home crisis services

Family counseling

Therapeutic nursery care

Therapeutic foster care

Mental health services or treatment

Job-related services

Organized support groups: Alcoholics Anonymous, Parents Anonymous, etc.

Child care services

Services for alcohol or drug problems

Parenting skills training

Training on ways to discipline child

Home management training (e.g., budgeting or planning meals)

Respite care for a child

Transportation help

Help with applying for income support/emergency financial assistance

Help with applying for housing assistance Medical exam

Dental Exam

Immunizations

Hearing or vision screening

Domestic violence services

Legal services

Financial planning

---------------------------------------------------------------------------------

Logic before:

IF P_SR108 = yes or P_SR108a = yes then ASK P_SR109 ELSE SKIP TO P_SR111.

P_SR109 [ PSR109 ] Name CW who is most knowledgeable about srvc rcvd

What is the name of the caseworker who is most knowledgeable about the services you and your

family have received?


NAME:

Question Type: string[50]

---------------------------------------------------------------------------------

P_SR110 [ PSR110 ] CW telephone number

What is the caseworker's telephone number?


PHONE

Question Type: TPHONE

---------------------------------------------------------------------------------

P_SR111 [ PSR111 ] Labels are in Logic After

Now we would like to know about your insurance coverage. What is your current insurance

status? Are you covered by...

Question Type: TPSR111S

_1 1 Military health insurance, such as CHAMPUS, CHAMP-VA, TRICARE,

or VA care,

_2 2 A health insurance plan through a current or past employer or union,

_3 3 Medicaid or another state-funded program,

_4 4 Indian Health Service,

_5 5 Medicare,

_6 6 Health insurance bought directly from an insurance company, or

_7 7 Do you not have insurance of any kind (completely self pay)?

Logic after:

GOTO P_SREND; PSR111_1 --R crnt ins cvrag-Mil hlth ins CHAMPUS/CHAMP-VA; PSR111_2 --

R crnt ins cvrag-A hlth ins plan thru crnt/past employer; PSR111_3 --R crnt ins cvrag-Medicaid or

another state-funded program,; PSR111_4 --R crnt ins cvrag-Indian Health Service,; PSR111_5 --R

crnt ins cvrag-Medicare,; PSR111_6 --R crnt ins cvrag-Hlth ins bought directly from ins company;

PSR111_7 --R crnt ins cvrag-Do you not have insurance of any kind; PSR111_8--R crnt ins cvrag-

DK; PSR111_9--R crnt ins cvrag-RF

---------------------------------------------------------------------------------

P_SREND [ PSREND ] NoDeliv

ENTER 1 TO CONTINUE

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

Social Support (CG)

---------------------------------------------------------------------------------

Logic before:

This section should be skipped in the following caregiver situations:

- Licensed Foster Home or all non-family settings

(P_NP12a = 4)  OR (P_NP12b >= 1) OR

-           Primary CG is a Foster Mother or Father 

(P_HH6a = 8 or 9 OR P_HH6g = 8 or 9) OR

-           Primary CG currently receives payments for being a foster parent

(P_HH6e = 1)

Programmer note: According to author’s showcard, there are verbal "anchors" only for the scale

end points 1 and 5. There are no verbal anchors for response options 2, 3, and 4. On screen we

can only display numbers for response options 2, 3, 4.

P_SS15a [ PSS15a ] I get love and affection

Now I'm going to ask you about some things that other people might do for you or give you that

may be helpful or supportive.


USE CARD 27. As I read each statement, please tell me which answer is closest to your

situation. Here is an example: I get enough free time. If you answer '4 ', it means that you get

@balmost as much@b free time as you would like, but @bnot quite as much@b as you would

like.


Answer each statement as best you can. Remember, there are no right or wrong answers. Here is

the first statement:


I get love and affection.

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS16a [ PSS16a ] Chance to talk 2 someone I trust about my prsnl/fmly prblms

Chances to talk to someone I trust about my personal and family problems

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS17a [ PSS17a ] Chance to talk 2 someone I trust about prblms @ wrk/housewrk

Chances to talk to someone I trust about problems at work or with my housework

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS18a [ PSS18a ] Invitations to go out and do things with other people

Invitations to go out and do things with other people

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS19a [ PSS19a ] People who care about what happens to me

People who care about what happens to me

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS20a [ PSS20a ] Chances to talk about money matters

Chances to talk about money matters

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS21a [ PSS21a ] Useful advice about important things in life

Useful advice about important things in life

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS22a [ PSS22a ] Help when I need transportation

Help when I need transportation

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS23a [ PSS23a ] Help when Im sick in bed

Help when I'm sick in bed

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS24a [ PSS24a ] Help around the house

Help around the house

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

---------------------------------------------------------------------------------

P_SS25a [ PSS25a ] Help taking care of my child(ren)

Help taking care of my child(ren)

Question Type: Tgetmuch

_1 1 1 - I GET MUCH LESS THAN I WOULD LIKE

_2 2 2 -

_3 3 3 -

_4 4 4 -

_5 5 5 - I GET AS MUCH AS I LIKE

Logic after:

Y_SSEND



PHYSICAL HEALTH

---------------------------------------------------------------------------------

IF CHILD SETTING IS GROUP HOME OR RESIDENTIAL FACILITY (P_NP12b = 3 OR 4) THEN GO TO Y_PHEND


P_PH1a [ PPH1a ] General health status

The next questions are about your health and the activities you might do. This information will be

used to keep track of how you feel and how well you are able to do your usual activities. If you are

unsure about how to answer a question, please give the best answer you can.


In general, would you say your health is...

Question Type: THealth

exclnt 1 excellent

vgood 2 very good

good 3 good

fair 4 fair, or

poor 5 poor

---------------------------------------------------------------------------------

P_PH2a [ PPH2a ] Hlth lmt R in moderate activities

How much does your health now limit you in @bmoderate activities@b, such as moving a table,

pushing a vacuum cleaner, bowling, or playing golf? Would you say you are...

Question Type: TLimit

alot 1 limited a lot

alittle 2 limited a little, or

notlimited 3 not limited at all?

---------------------------------------------------------------------------------

P_PH3a [ PPH3a ] Health limit R in stair climbing

How much does your health now limit you in climbing @bseveral@b flights of stairs? Would you

say you are...


NOTE: "SEVERAL" MEANS TWO OR MORE.

Question Type: TLimit

alot 1 limited a lot

alittle 2 limited a little, or

notlimited 3 not limited at all?

---------------------------------------------------------------------------------

P_PH4a [ PPH4a ] Hlth limit accomplishments

During the past @b4 weeks@b, have you accomplished less than you would like in your work or

other regular daily activities as a result of your @bphysical@b health?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_PH5a [ PPH5a ] Hlth limit kind of wrk could do

During the past @b4 weeks@b, were you limited in the @bkind@b of work or other activities you

could do as a result of your physical health?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_PH6a [ PPH6a ] Emot prob limit accomplish

During the past @b4 weeks@b, have you accomplished less than you would like in your work or

other regular daily activities as a result of any @bemotional@b problems such as feeling

depressed or anxious?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_PH7a [ PPH7a ] Emot prob make R less careful

During the past @b4 weeks@b, did you feel you didn't do work or other activities as carefully as

usual as a result of any emotional problems such as feeling depressed or anxious?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_PH8a [ PPH8a ] Pain interfere w/norm wrk

During the past @b4 weeks@b, how much did @bpain@b interfere with your normal work,

including both work outside the home and housework? Would you say...

Question Type: TPain

notatall 1 not at all

littlebit 2 a little bit

moderate 3 moderately

quiteabit 4 quite a bit, or

extremely 5 extremely?

---------------------------------------------------------------------------------

P_PH9a [ PPH9a ] Felt calm/peaceful

USE CARD 28. The next questions are about how you feel and how things have been with you

during the past @b4 weeks@b. For each question, please look at Card 28 and tell me which

answer comes closest to the way you have been feeling.


During the past @b4 weeks@b, how much of the time have you felt calm and peaceful? Would

you say…

Question Type: THowMch

alltime 1 all of the time

most 2 most of the time

goodbit 3 a good bit of the time

some 4 some of the time

little 5 a little of the time, or

none 6 none of the time?

---------------------------------------------------------------------------------

P_PH10a [ PPH10a ] Had a lot of energy

USE CARD 28. During the past @b4 weeks@b, how much of the time did you have a lot of

energy? Would you say…

Question Type: THowMch

alltime 1 all of the time

most 2 most of the time

goodbit 3 a good bit of the time

some 4 some of the time

little 5 a little of the time, or

none 6 none of the time?

---------------------------------------------------------------------------------

P_PH11a [ PPH11a ] Felt downhearted/blue

USE CARD 28. During the past @b4 weeks@b, how much of the time have you felt downhearted

and blue? Would you say…

Question Type: THowMch

alltime 1 all of the time

most 2 most of the time

goodbit 3 a good bit of the time

some 4 some of the time

little 5 a little of the time, or

none 6 none of the time?

---------------------------------------------------------------------------------

P_PH12a [ PPH12a ] Hlth/emot prob intrfre w/soc act

USE CARD 28. During the past @b4 weeks@b, how much of the time has your physical health

or emotional problems interfered with your social activities (like visiting with friends, relatives,

etc.)? Would you say...

Question Type: THowMch

alltime 1 all of the time

most 2 most of the time

goodbit 3 a good bit of the time

some 4 some of the time

little 5 a little of the time, or

none 6 none of the time?

Logic after:

GOTO P_PHEND



Services Received by Foster Caregivers (CG)

---------------------------------------------------------------------------------

Logic before:

[IF P_HH6c <> 1 AND P_HH6d <> 1 AND P_HH6e <> 1 AND P_HH8c <> 1 AND P_HH8d <> 1

AND P_HH8e <> 1 THEN GO TO P_FCEND.]

{IF WAVE = 1 , FILL: since {FILL START DATE OF LIVING ARRANGEMENT}/IF WAVE > 1, FILL:

in the last 6 months, that is, since {FILL DATE 6 MONTHS PRIOR TO INTERVIEW DATE}.

Time in Household is length of time that CHILD has lived with CAREGIVER. It is calculated from

variables P_NP2am, P_NP2ad and P_NP2ay, found in the NP - Up-Front Verification Module (CG)

Start of living arrangement is obtained by subtracting the Time in Household (e.g., 5 weeks, 14

months, 2 years) from Interview Date.

P_FC1a [ PFC1a ] R given essntial info when CH placed

Now I'd like to ask a few questions about services that you^Fills.P_FC1a2CG^P_HH.Caregiver2

may have received as a foster parent or alternative care provider ^FILLS.P_FC1A ^DATEFILLSTR1.

Do you feel like you were given essential information about ^CHILD when ^Fills.heshe was

placed?


READ IF NECESSARY: We define a foster care situation as a household where one of the

caregivers identified as being responsible for care for the child is not a biological or adoptive parent

AND fits at least one of the following 3 criteria:

@|@|1. Someone from a foster care or social service agency helped to arrange for the person to

care for the child.

@|@|2. The person regularly talks to a caseworker about the child.

@|@|3. The person currently receives payments for being the child’s foster parent.

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^FillP_FC1a

wave1 since

wave2plus in the last 6 months, that is, since

Question Fill: ^FillP_FC1a2CG

CG2 ·and/or·

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_FC4a [ PFC4a ] Felt like rspcted member of svc team

Have you felt like a respected member of the team of people providing service to this foster child?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, FILL: Since {FILL START DATE OF LIVING ARRANGEMENT}/IF WAVE > 1, FILL:

In the last 6 months

P_FC5a [ PFC5a ] Rcvd any special foster P trning

^Fills.P_FC2a ^DATEFILLSTR2 have you received any special instruction or training in skills you

need to be a foster parent? This would include things like how to deal with problems your foster

child may have or behavior management techniques.

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

Logic before:

[{IF WAVE = 1, FILL: Since {FILL START DATE OF LIVING ARRANGEMENT}/IF WAVE > 1, FILL:

In the last 6 months}]

P_FC6a [ PFC6a ] Involved in any peer support grps

^Fills.P_FC2a ^DATEFILLSTR2 have you been involved with any organized peer support groups?

By this we mean a group of adults who meet to discuss shared issues that concern them. These

groups might meet at a community center or a church, for example.

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

Logic before:

[{IF WAVE = 1, FILL: Since {FILL START DATE OF LIVING ARRANGEMENT}/IF WAVE > 1, FILL:

In the last 6 months}]

P_FC7a [ PFC7a ] Rcvd any respite care

^Fills.P_FC2a ^DATEFILLSTR2 have you received respite care? (Respite care is care for the child

provided in the home or somewhere else so that the family can have a break from ongoing care of

the child. It can be thought of as child care or babysitting by an individual or program trained to

meet the special needs of the child.)

Question Type: TYN

yes 1 YES

no 2 NO


P_FC7aa [ PFC7aa ] R a licensed foster care provider

Are you a licensed, certified, or approved foster care provider?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_FC7aa = YES GOTO P_FC9a

---------------------------------------------------------------------------------

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------


P_ FC7ca

Did you ever apply to become licensed, certified, or approved as a foster care provider for the children in your care?

1=YES [Go to P_FC7da]

2=NO [Go to P_FC7ga]


P_FC7da

What factors influenced your decision to apply? [Code all that apply]

1=I thought it was a requirement in order to continue to care for my children.

2=I would receive more financial assistance if I became licensed or approved.

3=I thought it would provide me with the services my child needs, such as Medicaid or help with school.

4=I wanted to learn more about becoming a better parent, and the parenting classes helped me.

5=Other.


P_FC7ea

Was your application approved or denied to become a licensed, certified or approved foster care provider?

1=Approved [GO TO FC9a]

2=Denied

3=Pending/Under Review

4=Did not apply


P_FC7fa

USE CARD 28A. Look at Card 28A. What were the reasons your application was denied?

1=SOME MEMBERS OF MY HOME DID NOT PASS CRIMINAL BACKGROUND CHECKS [GO TO FC9a]

2=I DIDN’T COMPLETE ALL OF THE TRAINING. [GO TO FC9a]

3=MY HOUSE/HOME DID NOT MEET THE SPACE/REQUIREMENTS NECESSARY. . [GO TO FC9a]

4=I DID NOT HAVE ALL THE NECESSARY MEDICAL DOCUMENTATION FOR ME OR OTHER ADULTS IN THE HOME. . [GO TO FC9a]

5= SOME MEMBERS OF MY HOME DID NOT PASS SAFETY BACKGROUND CHECKS BECAUSE OF PAST CHILD ABUSE, NEGLECT, OR MALTREATMENT INVESTIGATIONS. [GO TO FC9a]

6= I WAS MISSING OTHER NECESSARY DOCUMENTATION [GO TO FC9a]

7=OTHER



IF P_FC7fa = 7, ASK P_FC7faoth


P_FC7faoth

SPECIFY OTHER:


P_FC7ga

USE CARD 28B. Look at Card 28B. Why haven’t you applied to become licensed, certified, or approved as a foster care provider?

CODEALL THAT APPLY

1=I WASN’t INFORMED THAT I COULD BECOME A LICENSED, CERTIFIED, OR APPROVED AS A FOSTER CARE PROVIDER. 2=I DON’T WANT TO SUBMIT TO THE HEALTH EXAMS.

3=I DON’T WANT TO SUBMIT TO THE FINGERPRINTING.

4=I DON’T WANT TO SUBMIT TO THE CRIMINAL BACKGROUND CHECKS.

5=I DON’T HAVE THE TIME TO COMPLETE ALL OF THE TRAINING AND OTHER REQUIREMENTS.

6 =I DON’T SEE ANY BENEFITS TO BECOMING A LICENSED, CERTIFIED, OR APPROVED AS A FOSTER CARE PROVIDER.

7=OTHER




---------------------------------------------------------------------------------


Logic before:

IF HH6e = 1, CONTINUE. ELSE, GOTO P_FC12a

P_FC9a [ PFC9a ] FC $ cover basic liv expnses of ch

Does the money you receive for foster care cover ^CHILD's basic living expenses?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_FC12a [ PFC12n ] How long R been FP(number)

For how long have you been a foster parent/residential care provider?


NUMBER

Question Type: 0..97

---------------------------------------------------------------------------------

P_FC12b [ PFC12u ] How long R been FP(unit)

(Is that the number of months or years?)

Question Type: TMmYr

Months 1 Months

years 2 Years

---------------------------------------------------------------------------------

P_FC13a [ PFC13a ] Total # FCH R has cared for

For approximately how many foster children have you cared, including ^CHILD?


NUMBER OF CHILDREN

Question Type: 1..500

---------------------------------------------------------------------------------

P_FC14a [ PFC14a ] R wish they could raise CH

Now I'd like to ask you a few questions about your relationship with ^CHILD.


Do you ever wish you could raise ^CHILD?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_FC15A [ PFC15A ] How much would you miss CH if they had to leave

How much would you miss ^CHILD if ^FILLS.HESHE had to leave? Would you say…

Question Type: THMNeed

alot 1 a lot,

somewhat 2 somewhat,

alittle 3 a little, or

notatall 4 not at all?

---------------------------------------------------------------------------------

ADOPTION MODULE FOR FOSTER PARENTS

---------------------------------------------------------------------------------

Logic before:

IF WAVE > 1 and (P_AP1a <> YES IN PREVIOUS WAVE) and (CAREGIVER = FOSTER

PARENT OR ADOPTIVE PARENT: P_NP12a = 2 OR 4), CONTINUE. ELSE GO TO NEXT MODULE

P_AP1a [ PAP1a ] R legally adopted CH

Now I'm going to ask you some questions about adoption possibilities for ^CHILD. Have you

legally adopted ^CHILD?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF RESPONSE = 1 (YES) GOTO P_AP3a

---------------------------------------------------------------------------------

P_AP2a [ PAP2a ] Ever considered adopting CH

Have you ever considered adopting ^CHILD if ^FILLS.HESHE cannot return to ^FILLS.HISHER

family?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^fillhisher

his his

her her

Logic after:

IF RESPONSE = 2 (NO) GOTO P_APEND

---------------------------------------------------------------------------------

P_AP3a [ PAP3a ] Labels are in Logic After

What factors contributed to wanting to adopt ^CHILD?


CODE ALL THAT APPLY.

Question Type: TAdpFacS

partoffam 1 FEELING THAT CHILD IS PART OF RESPONDENT'S FAMILY

samerace 2 CHILD'S RACE/ETHNICITY IS SAME AS RESPONDENT'S FAMILY

feellove 3 FEELINGS OF LOVE/AFFECTION FOR CHILD

safety 4 DESIRE FOR CHILD TO GROW UP IN SAFE ENVIRONMENT

havesib 5 HAVING ALREADY ADOPTED CHILD'S SIBLING(S)

parnotcare 6 FEELING THAT CHILD'S BIOLOGICAL PARENTS CANNOT

ADEQUATELY CARE FOR CHILD

related 7 CHILD IS RELATED TO RESPONDENT OR RESPONDENT'S FAMILY

noconcerned 8 NOT CONCERNED THAT CHILD'S RACE/ETHNICITY DIFFERS FROM

RESPONDENT OR RESPONDENT'S FAMILY'S RACE

anotherfam 9 CONCERNED THAT CHILD WOULD OTHERWISE BE PLACED WITH

ANOTHER FAMILY

other 10 OTHER

Logic after:

PAPTG_1 --Fctr R adpt CH-Feeling ch is part of Rs family; PAPTG_2 --Fctr R adpt CH-Ch

race/ethnicity = Rs family; PAPTG_3 --Fctr R adpt CH-Love/affection for ch; PAPTG_4 --Fctr R

adpt CH-Desire for ch to grow up in safe env; PAPTG_5 --Fctr R adpt CH-Already adopted ch

sibling; PAPTG_6 --Fctr R adpt CH-Feel that ch bio Ps cannot care for ch; PAPTG_7 --Fctr R adpt

CH-Ch related to R/Rs family; PAPTG_8 --Fctr R adpt CH-Not concerned that ch race <> Rs/Rs

fam; PAPTG_9 --Fctr R adpt CH-Concern that ch be placed w/other fam; PAPTG_10 --Fctr R adpt

CH-Other; PAPTG_11--Fctr R adpt CH-DK; PAPTG_12--Fctr R adpt CH-RF

---------------------------------------------------------------------------------

P_AP4a [ PAP4a ] Labels are in Logic After

What factors discouraged you from wanting to adopt ^CHILD?


IF R INDICATES THERE WERE NO DISCOURAGING FACTORS, CODE 6 = YES.


OTHERWISE, CODE ALL THAT APPLY.

Question Type: TDisFacS

norights 1 BIOLOGICAL PARENT HAS NOT RELINQUISHED RIGHTS, OR

RIGHTS HAVE NOT BEEN TERMINATED BY COURT

diffrace 2 CHILD'S RACE/ETHNICITY DIFFERS FROM RESPONDENT'S FAMILY

disabil 3 CHILD HAS DISABILITIES THAT RESPONDENT MAY NOT BE ABLE

TO HANDLE IN A LONG-TERM SITUATION

probfam 4 PROBLEMS BETWEEN CHILD AND OTHER MEMBERS OF

RESPONDENT'S FAMILY

finance 5 FINANCIAL CONCERNS

nofactor 6 NO DISCOURAGING FACTORS

other 7 OTHER

Logic after:

HARDCHECK (DO NOT ALLOW RESPONSE 6 = YES WITH ANY OTHERS =Y) '"Warning: ""No

Discouraging Factors (6)"" cannot be selected when selecting the discouraging factors (1-5,7)

please return and correct your response"; PAP4TG_1 --Fctr dscrg R adpt CH-Bio P still has rights

to ch; PAP4TG_2 --Fctr dscrg R adpt CH-Ch race/ethnicity <> Rs/Rs fam; PAP4TG_3 --Fctr dscrg

R adpt CH-Ch has disabilities R not handle; PAP4TG_4 --Fctr dscrg R adpt CH-Problems btwn

ch/Rs fam; PAP4TG_5 --Fctr dscrg R adpt CH-Financial concerns; PAP4TG_6 --Fctr dscrg R adpt

CH-Other; PAP4TG_7 --Fctr dscrg R adpt CH-No discouraging factors; PAP4TG_8--Fctr dscrg R

adpt CH-DK; PAP4TG_9--Fctr dscrg R adpt CH-RF

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_APEND [ PAPEND ] NoDeliv

PLEASE PRESS "1" TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

Permanency Planning for Foster and Adoptive (CG)

---------------------------------------------------------------------------------

Logic before:

IF WAVE > 1 and (P_AP1a <> YES IN PREVIOUS WAVE) and (CAREGIVER = FOSTER

PARENT OR ADOPTIVE PARENT: P_NP12a = 2 OR 4), CONTINUE. ELSE GO TO NEXT MODULE

P_PPBGN [ PPPBGN ] NoDeliv

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue

---------------------------------------------------------------------------------

Logic before:

IF P_HH6b=1 OR P_HH6c = 1 OR P_HH6d = 1 OR P_HH6e = 1, CONTINUE ELSE SKIP TO THE

NEXT MODULE.

P_PP2m [ PPP2m ] Month R legally adopted CH

Earlier you told me that you legally adopted ^CHILD.


In what month and year did you adopt ^CHILD?


MONTH:

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

---------------------------------------------------------------------------------

P_PP2y [ PPP2y ] Year R legally adopted CH

In what month and year did you adopt ^CHILD?


YEAR:

Question Type: 1970..2013

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_PP4a [ PPP4a ] CH in foster wth R before adopt

Was ^CHILD in foster care with you prior to adoption?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

2 = no GO TO P_PP8a

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

IF P_PP5a = 1 ask P_PP5m

P_PP5m [ PPP5m ] How long CH in foster care with R - months

(How long was ^Fills.HeShe in foster care with you?)


ENTER NUMBER OF MONTHS


MONTHS:

Question Type: 1..24

---------------------------------------------------------------------------------

Logic before:

IF P_PP5a = 2

P_PP5y [ PPP5y ] How long CH in foster care with R - years

(How long was ^Fills.HeShe in foster care with you?)


ENTER NUMBER OF YEARS


YEARS:

Question Type: 1..5

---------------------------------------------------------------------------------

P_PP8a [ PPP8a ] R or spouse blood rel of CH

Are you or your spouse/partner a blood relative of ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

Logic before:

Adoption Subsidies

IF P_HH6b=1, CONTINUE. ELSE, GOTO P_PP31m.

P_PP18a [ PPP18a ] Ever rcv adopt subsidy for CH

Have you ever received an adoption subsidy -- that is, a monthly payment from the state or county

for ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

IF = 2, GOTO P_PP25

---------------------------------------------------------------------------------

P_PP19a [ PPP19a ] Currently recieve adopt subsidy

Do you currently receive an adoption subsidy?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

IF P_PP19a = 2 GOTO P_PP25

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

Open Adoption

P_PP25 [ PPP25a ] Pre-Adpt agmt on biol prnt info

Were you involved in any kind of pre-adoption agreement in which you agreed to provide

information about ^CHILD to one or both of ^Fills.HisHer biological parents?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

IF P_PP25 = 2 GO TO P_PP27_1a1

---------------------------------------------------------------------------------

P_PP26 [ PPP26a ] Pre-Adpt agmt wrtn or verbal

Was this agreement written or verbal?

Question Type: TPreAdpt

WRITTEN 1 WRITTEN

VERBAL 2 VERBAL

---------------------------------------------------------------------------------

P_PP27_1a1 [ PPP27x1 ] Child contact with Birth Mother since adopt

Since the adoption, has ^CHILD had contact with ^Fills.HisHer birth mother?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_PP27_1a2 [ PPP27x2 ] Child Contact with Birth Father since adopt

Since the adoption, has ^CHILD had contact with ^Fills.HisHer birth father?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_PP27_1a3 [ PPP27x3 ] Child Contact with Siblings since adopt

Since the adoption, has ^CHILD had contact with ^Fills.HisHer siblings?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

Logic before:

Post-Adoption Services

P_PP28intro [ PPP28intro ] NO LABEL

USE CARD 29. The next questions are about post-adoption counseling or support for adoption

you or your family have received since beginning the adoption process. Please look at the list of

services on Card 29 and tell me which ones you have received since starting the adoption

process.


Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

P_PP28_1a [ PPP28_1a ] Labels are in Logic After

Have you received...


CODE ALL THAT APPLY.

Question Type: TPstAdpt

PARENTS 1 SUPPORT GROUP FOR ADOPTIVE PARENTS

CHILD 2 SUPPORT GROUP FOR ADOPTED CHILDREN

BOOKS 3 BOOKS OR ARTICLES ON ADOPTION

LECTURES 4 LECTURES OR SEMINARS ON ADOPTION

CLASSES 5 CLASSES OR WORKSHOPS ON UNDERSTANDING YOUR

ADOPTED CHILD

PARENCOUNSEL 6 COUNSELING FOR PARENTS (RESPONDENT)

CHILDCOUNSEL 7 COUNSELING FOR ^Global.Child

INFORMATION 8 INFORMATION ON ^Global.Child'S SOCIAL, MEDICAL, AND/OR

GENETIC HISTORY

LEGAL 9 LEGAL ADVICE

RELATIVE 10 INFORMATION ON HOW TO SEARCH FOR BIRTH RELATIVES

THERAPY 11 FAMILY THERAPY

CARE 12 RESIDENTIAL CARE FOR ^Global.Child

PSYCH 13 PSYCHIATRIC PLACEMENT OR CRISIS SERVICES FOR CHILD

Logic after:

PPP28T1--R rcved-Support group for adopt parents; PPP28T2--R rcved-Support group for adopted

children; PPP28T3--R rcved-Books/articles on adoption; PPP28T4--R rcved-Lectures/seminars on

adoption; PPP28T5--R rcved-Class/workshops on underst adopted ch; PPP28T6--R rcved-

Counselling for parents - R recieved; PPP28T7--R rcved-Counselling for CH; PPP28T8--R rcved-Info

on CH social/med/genetic hstry; PPP28T9--R rcved-Legal Advice; PPP28T10--R rcved-Info on how

to find birth relatives; PPP28T11--R rcved-Family therapy; PPP28T12--R rcved-Residential care for

CH; PPP28T13--R rcved-Psyc placement/crisis serv for CH; PPP28T14--R rcved-DK; PPP28T15--R

rcved-RF

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

IF P_NP14a = yes, CONTINUE. ELSE, GOTO P_PP42.

P_PP31m [ PPP31m ] R became Legal Guardian - month

Earlier you told me that you are ^CHILD's legal guardian.


In what month and year did you become ^Fills.HisHer legal guardian?


MONTH:

Question Type: TMonth

jan 1 January

feb 2 February

mar 3 March

apr 4 April

may 5 May

jun 6 June

jul 7 July

aug 8 August

sep 9 September

oct 10 October

nov 11 November

dec 12 December

---------------------------------------------------------------------------------

P_PP31y [ PPP31y ] R became Legal Guardian - year

(In what month and year did you become ^Fills.HisHer legal guardian?)


YEAR:

Question Type: 1980..2013

---------------------------------------------------------------------------------

P_PP32 [ PPP32a ] CH your fstr care bef legl grd

Was ^CHILD in foster care with you before you became ^Fills.HisHer legal guardian?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

IF = 2, GO TO P_PP42

---------------------------------------------------------------------------------

Logic before:

IF P_HH9a = no (CAREGIVER IS NOT CHILD”S LEGAL GUARDIAN)


P_PP34a

Would you ever consider adopting or becoming the permanent legal guardian of ^CHILD?

1=YES

2=NO



--------------------------------------------------------------------------------

Logic before:

Guardianship Payments

P_PP42 [ PPP42A ] R rcv guardianshp payment for CH

Have you ever received a guardianship payment or subsidy -- that is, a monthly payment from the

state or county -- for ^CHILD?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

IF = 2, GO TO P_PP44a

---------------------------------------------------------------------------------

P_PP43 [ PPP43A ] R currenly rcv monthly guardianshp payment

Do you currently receive a monthly payment?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Logic after:

IF = 2, GO TO P_PP48_1a1

---------------------------------------------------------------------------------


---------------------------------------------------------------------------------

Logic before:

IF P_NP14a = yes, CONTINUE. ELSE, GOTO P_PP49intro.

P_PP48_1a1 [ PPP48x1 ] CH had contact with bio mom since R became LG

Has ^CHILD had contact with ^Fills.HisHer birth mother since you've become legal guardian?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_PP48_1a2 [ PPP48x2 ] CH had contact with bio dad since R became LG

Has ^CHILD had contact with ^Fills.HisHer birth father since you've become legal guardian?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

P_PP48_1a3 [ PPP48x3 ] CH had contact w CH siblings since R became LG

Has ^CHILD had contact with ^Fills.HisHer siblings since you've become legal guardian?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

---------------------------------------------------------------------------------

Logic before:

Post-Guardianship Services

P_PP49intro [ PPP49intro ] NO LABEL

USE CARD 30. The next questions are about counseling or support you or your family have

received since beginning the guardianship process. Please look at the list of services on Card 30

and tell me which ones you have received since starting the guardianship process.


PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

P_PP49 [ PPP49 ] Labels are in Logic After

Have you received...


CODE ALL THAT APPLY.

Question Type: TguarecS

guardians 1 support group for guardians?

children 2 support group for children in guardianship?

books 3 books or articles on guardianship?

lectures 4 lectures or seminars on guardianship?

counselguard 5 counseling for guardians (respondent)?

counselchild 6 counseling for ^Global.Child?

information 7 information on ^Global.CHILD's social, medical, and/or genetic history?

legal 8 legal advice?

relative 9 information on how to search for birth relatives?

family 10 family therapy?

rescare 11 residential care for ^Global.Child?

psych 12 psychiatric placement or crisis services for ^Global.Child?

Logic after:

PPP49T1--R rcvd-guardian support group; PPP49T2--R rcvd-suppt grp for CH in guardianshp;

PPP49T3--R rcvd-guardianship books/articles; PPP49T4--R rcvd-guardianship lectures/seminars;

PPP49T5--R rcvd-counseling for guardians; PPP49T6--R rcvd-counseling for CH; PPP49T7--R rcvd-

CH social/medical/genetic hist; PPP49T8--R rcvd-legal advice; PPP49T9--R rcvd-search for birth

reltv info; PPP49T10--R rcvd-family therapy; PPP49T11--R rcvd-residential care for child;

PPP49T12--R rcvd-CH psych placement/crisis serv; PPP49T13--R rcvd-DK; PPP49T14--R rcvd-RF

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

IF P_HH6b = 1, FILL: adoption/IF P_NP14a = yes, FILL: guardianship arrangement

P_PP63 [ PPP63A ] R informed about CH bckgd before

How informed were you about ^CHILD's background before ^Fills.TypeCare2? By background, we

mean ^Fills.HisHer family, medical, school, or behavioral history. Would you say you were...

Question Type: Tinfrmed

Very 1 Very informed,

Somewhat 2 Somewhat informed,

Notvery 3 Not very informed, or

Notatall 4 Not at all informed?

Question Fill: ^FillTypeCare2

adoption adoption

guardianship guardianship arrangement

---------------------------------------------------------------------------------

P_PP64 [ PPP64A ] CH relationship w Rs family

Thinking about ^CHILD's relationship with your family, would you say things are...

Question Type: TRelFam

Better 1 Better than you expected,

About 2 About what you expected, or

Worse 3 Worse than you expected?

---------------------------------------------------------------------------------

Logic before:

[IF P_HH6b = 1, FILL: adoption/IF P_NP14a = yes, FILL: guardianship arrangement]

P_PP65 [ PPP65A ] R taken action to end CHsituation

Have you ever taken any action to end this ^Fills.TypeCare?

Question Type: TYesNoC

Yes 1 YES

No 2 NO

Question Fill: ^FillTypeCare

adoption adoption

guardianship guardianship arrangement

Logic after:

2 = no GO TO P_PPEND

---------------------------------------------------------------------------------

P_PP66 [ PPP66A ] Labels are in Logic After

What actions have you taken?


CODE ALL THAT APPLY.

Question Type: Tactaken

SPOKECW 1 SPOKE TO CASEWORKER ABOUT IT

SPOKEATTY 2 SPOKE WITH ATTORNEY ABOUT IT

OTHER 3 OTHER

Logic after:

PPP66A_1 --Rs actions to end CH situation-Spoke to CW about it; PPP66A_2 --Rs actions to end

CH situation-Spoke w/ attrny about it; PPP66A_3 --Rs actions to end CH situation-Other;

PPP66A_4--Rs actions to end CH situation-DK; PPP66A_5--Rs actions to end CH situation-RF

---------------------------------------------------------------------------------

P_PP68 [ PPP68 ] Labels are in Logic After

What were your reasons for wanting to end it?


CODE ALL THAT APPLY.

Question Type: Twantend

BEHAV 1 CHILD BEHAVIORAL OR EDUCATIONAL PROBLEMS

GETALONG 2 CHILD DID NOT GET ALONG WITH SIBLINGS

OTHFAM 3 OTHER FAMILY PROBLEMS NOT ASSOCIATED WITH CHILD

INSURANCE 4 INSURANCE WOULD NOT PAY FOR CHILD'S SERVICES

FINANCIAL 5 FINANCIAL REASONS

MEDICAL 6 CHILD'S MEDICAL PROBLEMS

OTHREASONS 7 OTHER REASONS

Logic after:

PPP68TG1--R wanted end CH situation bc - CH behav/educ problems; PPP68TG2--R wanted end

CH situation bc - CH/siblings problems; PPP68TG3--R wanted end CH situation bc - family

problems; PPP68TG4--R wanted end CH situation bc - insurance not cover CH; PPP68TG5--R

wanted end CH situation bc - financial reasons; PPP68TG6--R wanted end CH situation bc - CH

medical problems; PPP68TG7--R wanted end CH situation bc - other reasons; PPP68TG8--R

wanted end CH situation bc - DK; PPP68TG9--R wanted end CH situation bc - RF

---------------------------------------------------------------------------------


P_PPEND [ PPPEND ] NoDeliv

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue


THE LOCATOR MODULE HAS BEEN MOVED. IT WILL BE THE LAST MODULE ADMINISTERED BY PHONE.


LF - Locator Form (CG)

---------------------------------------------------------------------------------

P_LFBEG [ PLFBEG ] NoDeliv

PLEASE PRESS "1" TO CONTINUE.

Question Type: BCallCARIRouter

---------------------------------------------------------------------------------

P_LF1a [ PLF1a ] NO LABEL

To help us understand how the well-being of children changes over time, we may contact you and

your child in the future to update our information. I'd like to ask a few questions to help us locate

you in case you move.


Please remember that everything you tell me will be kept private in the ways that were

explained to you at the beginning of the interview.


I'd like to verify your full legal name. Is your full legal name...(READ DISPLAYED NAME.

CORRECT AS NEEDED.)


FIRST NAME: ^main_case.sj_first

MIDDLE NAME: ^main_case.sj_initl

LAST NAME: ^main_case.sj_last

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

if YES GOTO P_LF2

if NO GOTO P_LF1aa

---------------------------------------------------------------------------------

Logic before:

Prefill the names from preload data or if this answer was changed and then a breakoff was done

after that preserve the changed value when interview is resumed.

P_LF1aa [ PLF1aa ] NO LABEL

INTERVIEWER: CORRECT FIRST NAME AS NEEDED.


FIRST NAME: ^main_case.sj_first

Question Type: string[20]

---------------------------------------------------------------------------------

P_LF1ab [ PLF1ab ] NO LABEL

INTERVIEWER: CORRECT MIDDLE NAME AS NEEDED.


MIDDLE NAME: ^main_case.sj_initl

Question Type: string[20], EMPTY

---------------------------------------------------------------------------------

P_LF1ac [ PLF1ac ] NO LABEL

INTERVIEWER: CORRECT LAST NAME AS NEEDED.


LAST NAME: ^main_case.sj_last

Question Type: string[30]

---------------------------------------------------------------------------------

Logic before:

IF GENDER NOT FEMALE, GOTO P_LF3a

P_LF2 [ PLF2 ] NO LABEL

What is your maiden name?


MAIDEN NAME:

Question Type: string[30]

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_LF5a [ PLF5a ] NO LABEL

Let me confirm your street address. (VERIFY INFORMATION DISPLAYED ON SCREEN.

CORRECT AS NEEDED.)


STREET ADDRESS: ^Main_case.sj_stnum ^Main_case.sj_addr ^Main_case.sj_aptnum

CITY: ^Main_case.sj_City

STATE: ^Main_case.sj_state

ZIP: ^Main_case.sj_Zip


Is this correct?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

1 = YES GOTO P_LF6a else 2 = NO GOTO P_LF5aa

---------------------------------------------------------------------------------

P_LF5aa1 [ PLF5aa1 ] NO LABEL

INTERVIEWER: CORRECT IF NEEDED.


STREET NUMBER:

Question Type: string[10]

---------------------------------------------------------------------------------

P_LF5aa2 [ PLF5aa2 ] NO LABEL

INTERVIEWER: CORRECT IF NEEDED.


STREET NAME

Question Type: STRING[30]

---------------------------------------------------------------------------------

P_LF5aa3 [ PLF5aa3 ] NO LABEL

INTERVIEWER: CORRECT IF NEEDED.


APARTMENT NUMBER

Question Type: STRING[20], empty

---------------------------------------------------------------------------------

P_LF5ab [ PLF5ab ] NO LABEL

INTERVIEWER: CORRECT CITY IF NEEDED.


CITY:

Question Type: string[30]

---------------------------------------------------------------------------------

P_LF5ac [ PLF5ac ] NO LABEL

INTERVIEWER: CORRECT STATE IF NEEDED.


STATE:

Question Type: string[2]

---------------------------------------------------------------------------------

P_LF5ad [ PLF5ad ] NO LABEL

INTERVIEWER: CORRECT ZIP IF NEEDED.


ZIP:

Question Type: tzip

---------------------------------------------------------------------------------

P_LF6a [ PLF6a ] Where R will live in 6 Ms(ADDRES1T)

Do you expect to be living at this same address or at a different address 6 months from now?

Question Type: TSamAddr

Same 1 SAME ADDRESS

Diff 2 DIFFERENT ADDRESS

Logic after:

IF = 1, GOTO P_LF10an

---------------------------------------------------------------------------------

Logic before:

IF P_LF6a = DK/RE, ASK P_LF6aa. ELSE, GOTO P_LF7.

P_LF6aa [ PLF6aa ] Better address for future contact(YN2T)

Is there a better address we can use to contact you in the future?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 2, GOTO P_LF10an

---------------------------------------------------------------------------------

P_LF7 [ PLF7 ] NO LABEL

What is the best address for us to use in the future?


NOTE: IF R PLANS TO MOVE, COLLECT AS MUCH INFORMATION AS POSSIBLE ABOUT

NEW LOCATION.


STREET ADDRESS:

Question Type: string[50]

---------------------------------------------------------------------------------

P_LF7a [ PLF7a ] NO LABEL

What is the best address for us to use in the future?


CITY:

Question Type: string[30]

---------------------------------------------------------------------------------

P_LF7b [ PLF7b ] NO LABEL

What is the best address for us to use in the future?


STATE:

Question Type: string[2]

---------------------------------------------------------------------------------

P_LF7c [ PLF7c ] City

What is the best address for us to use in the future?


ZIP:

Question Type: Tzip

---------------------------------------------------------------------------------

P_LF8A [ PLF8a ] Whose address

Is that your address or the address of another person or place?

Question Type: TYouAddr

Resp 1 RESPONDENT'S ADDRESS

Other 2 SOME OTHER PERSON'S ADDRESS

Logic after:

IF = 1, GOTO P_LF10an

---------------------------------------------------------------------------------

P_LF9 [ PLF9 ] NO LABEL

Whose address is it? (ENTER NAME)


NAME:

Question Type: string[40]

---------------------------------------------------------------------------------

P_LF9a [ PLF9a ] NO LABEL

Whose address is it? (ENTER RELATIONSHIP TO RESPONDENT)


RELATIONSHIP:

Question Type: string[30]

---------------------------------------------------------------------------------

P_LF10an [ PLF10an ] NO LABEL

What is your home phone number? NOTE: ENTER R'S CURRENT HOME PHONE NUMBER.


PHONE :


IF R DOES NOT HAVE A PHONE NUMBER, ENTER 000-000-0000.

Question Type: Tphone

Logic after:

Allow 12, including pre-filled hyphens (xxx-xxx-xxxx).

---------------------------------------------------------------------------------

Logic before:

IF P_LF10an - DK/REF OR 000-000-0000, GOTO P_LF10cn.

P_LF10ba [ PLF10ba ] NO LABEL

Is this your day or evening phone number?

Question Type: TDayEvn

day 1 DAY

evening 2 EVENING

both 3 BOTH

---------------------------------------------------------------------------------

P_LF10cn [ PLF10cn ] NO LABEL

What is your cell phone number?


PHONE:


NOTE: IF R DOES NOT HAVE A CELL NUMBER, ENTER 000-000-0000.

Question Type: Tphone

Logic after:

Allow 12, including pre-filled hyphens (xxx-xxx-xxxx).

---------------------------------------------------------------------------------

P_LF11a [ PLF11a ] Other # to use to reach R?(YN2T)

Is there another phone number to use to reach you?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 2, GOTO P_LF12ea

---------------------------------------------------------------------------------

P_LF12an [ PLF12an ] NO LABEL

What is that number?


NOTE: IF R HAS MORE THAN 1 ALTERNATIVE NUMBER, ENTER THE ONE HE/SHE CAN BE

REACHED AT MOST OFTEN.


PHONE :

Question Type: Tphone

Logic after:

Allow 12, including pre-filled hyphens (xxx-xxx-xxxx).

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_LF12ea [ PLF12ea ] NO LABEL

Do you have an email address?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 2, GOTO P_LF13a

---------------------------------------------------------------------------------

P_LF12f [ PLF12f ] NO LABEL

What is your current email address?


EMAIL:


NOTE: EMAIL ADDRESS MUST CONTAIN 2 @@@@ SIGNS (i.e., janedoe@@@@yahoo.com).

Question Type: string[50]

---------------------------------------------------------------------------------

P_LF13a [ PLF13a ] R can give frnd/rel name as cntct(YN2T)

We'd also like the names of tworelatives or friends @bwho do not live with you@b but would

always know how to reach you if you moved.


Can you give me the name, address, and telephone number of a relative or friend who would

always know how to reach you if you moved?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 1, GOTO P_LF15

IF = 2, GOTO P_LF20a

---------------------------------------------------------------------------------

P_LF15 [ PLF15 ] NO LABEL

What is the first person's name?


VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.


@bCONTACT PERSON 1:@b

NAME:

Question Type: string[40]

---------------------------------------------------------------------------------

P_LF15a [ PLF15a ] NO LABEL

What is the first person's relationship to you?


VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.


@bCONTACT PERSON 1:@b

RELATIONSHIP:

Question Type: string[30]

---------------------------------------------------------------------------------

P_LF15b [ PLF15b ] NO LABEL

What is the first person's street address?


VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.


@bCONTACT PERSON 1:@b

STREET ADDRESS:

Question Type: string[50]

---------------------------------------------------------------------------------

P_LF15c [ PLF15c ] 1st contacts city

What is the first person's city?


VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.


@bCONTACT PERSON 1:@b

CITY:

Question Type: string[30]

---------------------------------------------------------------------------------

P_LF15d [ PLF15d ] NO LABEL

What is the first person's state?


VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.


@bCONTACT PERSON 1:@b

STATE:

Question Type: string[2]

---------------------------------------------------------------------------------

P_LF15e [ PLF15e ] NO LABEL

What is the first person's zip code?


VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.


@bCONTACT PERSON 1:@b

ZIP:

Question Type: Tzip

---------------------------------------------------------------------------------

P_LF15f [ PLF15f ] NO LABEL

What is the first person's telephone number?


VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.


@bCONTACT PERSON 1:@b


PHONE:


NOTE: IF DOES NOT HAVE A PHONE NUMBER, ENTER 000-000-0000.

Question Type: TPhone

Logic after:

Allow 12, including pre-filled hyphens (xxx-xxx-xxxx)

---------------------------------------------------------------------------------

P_LF16a [ PLF16a ] Oth rel/frnd who can contact R(YN2T)

Is there another relative or friend who would always know how to reach you?


NOTE: THIS INFORMATION IS VERY IMPORTANT! ENCOURAGE R TO PROVIDE ADDITIONAL

CONTACT PERSON.

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF = 2, GOTO P_LF20a

---------------------------------------------------------------------------------

P_LF17 [ PLF17 ] NO LABEL

What is the second person's name?


VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.


@bCONTACT PERSON 2:@b

NAME:

Question Type: string[40]

---------------------------------------------------------------------------------

P_LF17a [ PLF17a ] NO LABEL

What is the second person's relationship to you?


VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.


@bCONTACT PERSON 2:@b

RELATIONSHIP:

Question Type: string[30]

---------------------------------------------------------------------------------

P_LF17b [ PLF17b ] NO LABEL

What is the second person's street address?


VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.


@bCONTACT PERSON 2:@b

STREET ADDRESS:

Question Type: string[50]

---------------------------------------------------------------------------------

P_LF17c [ PLF17c ] 2nd contacts city

What is the second person's city?


VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.


@bCONTACT PERSON 2:@b

CITY:

Question Type: string[30]

---------------------------------------------------------------------------------

P_LF17d [ PLF17d ] NO LABEL

What is the second person's state?


VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.


@bCONTACT PERSON 2:@b

STATE:

Question Type: string[2]

---------------------------------------------------------------------------------

P_LF17e [ PLF17e ] NO LABEL

What is the second person's zip code?


VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.


@bCONTACT PERSON 2:@b

ZIP:

Question Type: Tzip

---------------------------------------------------------------------------------

P_LF17f [ PLF17f ] NO LABEL

What is the second person's telephone number?


VERIFY SPELLING. ENCOURAGE R TO PROVIDE ALL REQUESTED INFORMATION.


@bCONTACT PERSON 2:@b


PHONE:


NOTE: IF DOES NOT HAVE A PHONE NUMBER, ENTER 000-000-0000.

Question Type: TPhone

Logic after:

Allow 12, including pre-filled hyphens (xxx-xxx-xxxx)

---------------------------------------------------------------------------------

Logic before:

[IF WAVE 1 OR SSN IS NOT AVAILABLE PRELOAD IN LATER WAVES, CONTINUE. IF

PRELOAD FROM PREVIOUS WAVE IS AVAILABLE, GOTO P_LF21na]:

[USE AD HEALTH MODULE FOR COLLECTING AN ENCRYPED SSN FOR THE FOLLOWING QUESTIONS.]


P_LF21n [ PLF21a ] NO LABEL

I’d also like to get your Social Security Number. This information will only be used for two things: 1) to help us locate you if you move, and 2) to help us combine your interview data with other data if you give us permission to do so. We will ask you for that permission at the end of the interview. What is your social security number? (PROMPT R TO GET NUMBER

FROM SSN CARD, IF NEEDED.)


SSN:


NOTE: IF R DOES NOT HAVE SSN NUMBER, ENTER 000-00-0000.

Question Type: TSSN

Logic after:

Allow 11, including pre-filled hyphens (xxx-xx-xxxx).

IF REF, GOTO P_LF21ref


P_LF21ref

Can you tell me the last four digits of your Social Security Number? Again, this information is only used to help us locate you if you move or to help us combine your interview data with other data if you give us permission to do so.


Logic after:

Allow 4


---------------------------------------------------------------------------------

P_LF21NA [ PLF21NA ] NO LABEL

IF VERIFYING PRELOADED SSN: I also need to verify your social security number. This

information will only be used for two things: 1) to help us locate you if you move, and 2) to help us combine your interview data with other data if you give us permission to do so. We will ask you for that permission at the end of the interview. Is it...(READ DISPLAYED

NUMBER. CORRECT AS NEEDED.)


PRELOADED SSN: ^MAIN_CASE.SJ_SSN

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_LF21NA = YES (1) THEN SKIP TO P_LF22N

---------------------------------------------------------------------------------

P_LF21NB [ PLF21NB ] NO LABEL

What is your correct social security number? (This will only be used for two things: 1) to help us locate you if you move, and 2) to help us combine your interview data with other data if you give us permission to do so. We will ask you for that permission at the end of the interview.)


SSN:


NOTE: IF R DOES NOT HAVE SSN NUMBER, ENTER 000-00-0000.

Question Type: TSSN

---------------------------------------------------------------------------------

Logic before:

# IF P_HH13 = 1 (SPOUSE LIVES IN HH), ASK P_LF23n. ELSE, GOTO P_LF24n.

P_LF23n [ PLF23a ] NO LABEL

What is your spouse's social security number? (This will only be used for two things: 1) to help us locate you if you move, and 2) to help us combine your interview data with other data if you give us permission to do so. We will ask you for that permission at the end of the interview.)

SPOUSE SSN:


NOTE: IF SPOUSE DOES NOT HAVE SSN NUMBER, ENTER 000-00-0000.

Question Type: TSSN

Logic after:

Allow 11, including pre-filled hyphens (xxx-xx-xxxx).

IF REF, GOTO P_LF23ref


P_LF23ref

Can you tell me the last four digits of your spouse’s Social Security Number?


Logic after:

Allow 4



---------------------------------------------------------------------------------

Logic before:

[IF WAVE 1 OR SSN IS NOT AVAILABLE PRELOAD IN LATER WAVES, CONTINUE. IF

PRELOAD FROM PREVIOUS WAVE IS AVAILABLE, GOTO P_LF24a]:

P_LF24n [ PLF24n ] NO LABEL

What is ^GLOBAL.CHILD's social security number? (This will only be used for two things: 1) to help us locate you if you move, and 2) to help us combine your interview data with other data if you give us permission to do so. We will ask you for that permission at the end of the interview.) (PROMPT R TO GET NUMBER FROM

SSN CARD, IF NEEDED.)


CHILD SSN:

NOTE: IF CHILD DOES NOT HAVE SSN NUMBER, ENTER 000-00-0000.

Question Type: TSSN

Logic after:

Type: Allow 11, including pre-filled hyphens (xxx-xx-xxxx). GOTO P_LF25

IF REF, GOTO P_LF24ref


P_LF24ref

Can you tell me the last four digits of ^GLOBAL. CHILD’s social security number?


Logic after:

Allow 4


---------------------------------------------------------------------------------

Logic before:

[IF VERIFYING PRELOADED CHILD SSN]:

P_LF24A [ PLF24A ] Chs social security number

I also need to verify ^GLOBAL.CHILD's social security number. (This will only be used for two things: 1) to help us locate you if you move, and 2) to help us combine your interview data with other data if you give us permission to do so. We will ask you for that permission at the end of the interview.) Is it... (READ DISPLAYED

NUMBER. CORRECT AS NEEDED.)


PRELOADED SSN: ^MAIN_CASE.CH_SSN

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF P_LF24A = YES (1) THEN GO TO P_LF25

---------------------------------------------------------------------------------

P_LF24B [ PLF24B ] NO LABEL

What is ^GLOBAL.CHILD's social security number? (This will only be used for two things: 1) to help us locate you if you move, and 2) to help us combine your interview data with other data if you give us permission to do so. We will ask you for that permission at the end of the interview.)


CHILD SSN:


NOTE: IF CHILD DOES NOT HAVE SSN NUMBER, ENTER 000-00-0000.

Question Type: TSSN

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------


P_LFSM1

The next few questions are about your use of social media. We want to make sure we are able to invite you to participate in the next round. We may use information you provide to help us contact you in the future using the social media platform’s private messaging features. Private messages sent to you through these platforms will only contain information about how you can reach the research team to schedule your next interview. We will never post anything on your profile and your profile will only be viewed if it is necessary to confirm your identity. We will keep your information private but social media websites may, per the terms of use and site policies, be able to access, read, and retain all messages sent through their private messaging platforms.



At some point in the future, a different group of researchers may take over the study. If that happens, with your consent, we will provide this information to the other organization. We would only provide your profile name to other organization. The other organization would only contact you using the social media platform’s private messaging features.



Some people use a name other than their full name on Facebook. What is your profile name on Facebook?



NAME ON FILE: [FILL WITH: name_w1_fn name_w1_lna; IF name_w1_fn OR name_w1_lna=DK OR R, THEN FILL WITH RESPONDENT FIRST AND LAST NAME FROM SAMPLE FILE]



1 R USES NAME ON FILE

2 R USES ANOTHER NAME (SPECIFY)

3 R DOES NOT USE FACEBOOK

F3 DON’T KNOW

F4 REFUSED



P_LFSM2 [IF P_LFSM1=2] [TEXT BOX FOR THE NAME]



F3 DON’T KNOW

F4 REFUSED



P_LFSM3 Some people use a name other than their full name on Instagram. What is your profile name on Instagram?



(IF NEEDED: We want to make sure we are able to invite you to participate in the next round. We may use this to help us contact you in the future using the platform’s private messaging features. We will never post anything on your profile.)



NAME ON FILE: [FILL WITH: name_w1_fn name_w1_lna; IF name_w1_fn OR name_w1_lna=DK OR R, THEN FILL WITH RESPONDENT FIRST AND LAST NAME FROM SAMPLE FILE]



1 R USES NAME ON FILE

2 R USES ANOTHER NAME (SPECIFY)

3 R DOES NOT USE INSTAGRAM

F3 DON’T KNOW

F4 REFUSED



P_LFSM4 [IF P_LFSM3=2] [TEXT BOX FOR THE NAME]



F3 DON’T KNOW

F4 REFUSED



P_LFSM5 Some people use a name other than their full name on Snapchat. What is your profile name on Snapchat?



(IF NEEDED: We want to make sure we are able to invite you to participate in the next round. We may use this to help us contact you in the future using the platform’s private messaging features. We will never post anything on your profile.)



NAME ON FILE: [FILL WITH: name_w1_fn name_w1_lna; IF name_w1_fn OR name_w1_lna=DK OR R, THEN FILL WITH RESPONDENT FIRST AND LAST NAME FROM SAMPLE FILE]



1 R USES NAME ON FILE

2 R USES ANOTHER NAME (SPECIFY)

3 R DOES NOT USE SNAPCHAT

F3 DON’T KNOW

F4 REFUSED



P_LFSM6 [IF P_LFSM5=2] [TEXT BOX FOR NAME]



F3 DON’T KNOW

F4 REFUSED



P_LFSM7 Some people use a name other than their full name on TikTok. What is your profile name on TikTok?



(IF NEEDED: We want to make sure we are able to invite you to participate in the next round. We may use this to help us contact you in the future using the platform’s private messaging features. We will never post anything on your profile.)



NAME ON FILE: [FILL WITH: name_w1_fn name_w1_lna; IF name_w1_fn OR name_w1_lna=DK OR R, THEN FILL WITH RESPONDENT FIRST AND LAST NAME FROM SAMPLE FILE]



1 R USES NAME ON FILE

2 R USES ANOTHER NAME (SPECIFY)

3 R DOES NOT USE TIKTOK

F3 DON’T KNOW

F4 REFUSED



P_LFSM8 [IF P_LFSM7=2] [TEXT BOX FOR NAME]

F3 DON’T KNOW

F4 REFUSED




P_LF27 [ PLF27 ] NO LABEL

Thank you very much for this information.


PRESS "1" and ENTER TO CONTINUE.

Question Type: TCont

Continue 1 Continue

Logic after:

P_LFEND

---------------------------------------------------------------------------------

P_LFEND [ PLFEND ] NoDeliv

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue







TRANSITION TO WEB MODULES


For the next part of the survey, we would like you to read the questions and answer them online. You can enter your answers directly into the survey using a phone or computer. The information you provide will be stored in a secure website. You will not be asked to enter any identifying information, such as your name or birthdate. It is important that you complete this part of the survey someplace private, where no one else can see your answers on the screen of your phone or computer. The website is set up so that it will close the survey if you do not enter a response after five minutes. If you are logged out of the survey due to inactivity, you will use a personal identification number to re-enter the survey. Also, you cannot go back and change an answer. These are ways we protect the privacy of your answers.


I will provide you with the web address to access the survey along with your personal identification number .


The website for the survey is: NSCAW3.rti.org

Your personal identification number is: <INSERT PIN>


I can also provide the link to the survey and your personal identification number by email, text message, or both. If you choose text message, it is important that no one else uses the phone where they can see your private information.


Would you prefer to receive the survey link by email, text message, or both?

01 = E-MAIL

02 = TEXT MESSAGE (GOTO TEXT_PREFER)

03 = BOTH


EMAIL_PREFER.

IF Web_Transition = 01 or 03

Please tell me what e-mail address to use.


TEXT_PREFER.

IF Web_Transition = 02 or 03


Please tell me the phone number to use. By doing this, you are confirming that I have your permission to send the survey link to you this way.


PHONE:


Sometimes the personal issues we have discussed cause people to become upset and in need of speaking with a counselor. If you are feeling upset or disturbed by the personal issues we have discussed in this interview and would like to talk with someone about your feelings, we suggest you call your doctor, counselor, or other treatment provider if you are currently under someone’s care. If not, there is also a National Lifeline Network number you can call. We would like to give you the hotline number for the National Lifeline Network, where counselors are available to talk at any time of the day or night. They can also give you information about (additional) mental health services in your area. Their toll-free

number is 1-800-273-8255.


PROGRAMMER NOTE: For web, include “Don’t know/Not sure” AND “Choose not to answer” AS RESPONSE OPTIONS IF A RESPONDENT MOVES FORWARD WITHOUT SELECTING AN ANSWER.

[REVIEW ELEMENTS OF CONSENT FOR PARTICIPATION


---------------------------------------------------------------------------------------------------------------------




START OF WEB SURVEY


This is the a web survey we would like you to complete.


You may consider some of the questions to be sensitive and some of the questions may also make you feel certain emotions, such as sadness.


Remember you can choose not to answer any questions you do not want to answer, and you can stop the interview at any time.


Remember to complete this survey in a private area where others cannot see your screen.


A $50 Amazon gift card will be sent to you after this web survey.


By clicking Next, you agree to move forward with the survey.




Depression

---------------------------------------------------------------------------------

This section should be skipped in the following caregiver situations:

- Licensed Foster Home or all non-family settings

(P_NP12a = 4)  OR (P_NP12b >= 1) OR

-           Primary CG is a Foster Mother or Father 

(P_HH6a = 8 or 9 OR P_HH6g = 8 or 9) OR

-           Primary CG currently receives payments for being a foster parent

(P_HH6e = 1)


P_DP1

[IF AGE = 18 OR OLDER] Have you ever in your life had a period of time lasting several days or longer when <b>most of the day</b> you felt <b>sad, empty or depressed</b>?

Question Type: TYESNOCAPS


P_DP2

[IF P_DP1 = 2 OR DK/REF] Have you ever had a period of time lasting several days or longer when <b>most of the day</b> you were very <b>discouraged</b> about how things were going in your life?

Question Type: TYESNOCAPS


P_DP3

[IF P_DP2 = 2 or OR DK/REF] Have you ever had a period of time lasting several days or longer when you <b>lost interest</b> in most things you usually enjoy like work, hobbies, and personal relationships?

Question Type: TYESNOCAPS


P_DP4

[IF P_DP1 =1] During times when you felt <b>sad, empty, or depressed</b> most of the day, did you ever feel <b>discouraged</b> about how things were going in your life?

Question Type: TYESNOCAPS


P_DP5

[IF P_DP4 = 1] During the times when you felt sad, empty, or depressed, did you ever <b>lose interest</b> in most things like work, hobbies, and other things you usually enjoy?

Question Type: TYESNOCAPS


P_DP6

[IF P_DP4 = 2 OR DK/REF] During the times when you felt sad, empty, or depressed, did you ever <b>lose interest</b> in most things like work, hobbies, and other things you usually enjoy?

Question Type: TYESNOCAPS


P_DP7

[IF P_DP2 = 1] During times when you felt discouraged about how things were going in your life, did you ever <b>lose interest</b> in most things like work, hobbies, and other things you usually enjoy?

Question Type: TYESNOCAPS


P_DP8

[IF P_DP3= 1] Did you ever have a period of time like this that lasted <b>most of the day nearly every day</b> for <b>two weeks or longer</b>?

Question Type: TYESNOCAPS


DEFINE FEELFILL:

IF (P_DP5 = 1), THEN FEELFILL = “were sad, discouraged, or lost interest in most things”

IF (P_DP5 = 2 OR DK/REF), THEN FEELFILL = “were sad or discouraged”

IF (P_DP6 = 1), THEN FEELFILL = “were sad or lost interest in most things”

IF (P_DP6 = 2 OR DK/REF) THEN FEELFILL = “were sad”

IF (P_DP7 = 1), THEN FEELFILL = “were discouraged or lost interest in most things”

IF (P_DP7 = 2 OR DK/REF), THEN FEELFILL = “were discouraged about the way things were going in your life”

IF (P_DP8 = 1), THEN FEELFILL = “lost interest in most things”

ELSE, FEELFILL = BLANK


DEFINE FEELNOUN:

IF (P_DP5 = 1), THEN FEELNOUN = “sadness, discouragement, or lack of interest”

IF (P_DP5 = 2 OR DK/REF), THEN FEELNOUN = “sadness or discouragement”

IF (P_DP6 = 1), THEN FEELNOUN = “sadness or lack of interest”

IF (P_DP6 = 2 OR DK/REF), THEN FEELNOUN = “sadness”

IF (P_DP7 = 1), THEN FEELNOUN = “discouragement or lack of interest”

IF (P_DP7 = 2 OR DK/REF), THEN FEELNOUN = “discouragement”

IF (P_DP8 = 1), THEN FEELNOUN = “lack of interest in most things”

ELSE FEELNOUN = BLANK


DEFINE NUMPROBS

IF P_DP5 NE BLANK OR P_DP6 = 1 OR P_DP7 = 1, THEN NUMPROBS = “these problems”

IF P_DP6 = (2 OR DK/REF) OR P_DP7 = (2 OR DK/REF) OR P_DP8 = 1, THEN

NUMPROBS = “this problem”

ELSE NUMPROBS = BLANK


DEFINE WASWERE:

IF P_DP5 NE BLANK OR P_DP6 = 1 OR P_DP7 = 1, THEN WASWERE = “were”

IF P_DP6 = (2 OR DK/REF) OR P_DP7 = (2 OR DK/REF) OR P_DP8 = 1, THEN

WASWERE = “was”

ELSE WASWERE = BLANK


P_DP9

[IF P_DP5 NE BLANK OR P_DP6 NE BLANK OR P_DP7 NE BLANK] Think about the times when you [FEELFILL]. Did you ever have a period of time like this that lasted <b>most of the day, nearly every day</b>, for <b>two weeks or longer</b>?

Question Type: TYESNOCAPS


P_DP10

[IF P_DP8 = 1 OR P_DP9 = 1] Think of times lasting <b>two weeks or longer</b> when [NUMPROBS] with your mood [WASWERE] most <b>severe and frequent</b>.

During those times, how long did your [FEELNOUN] usually last?

Question Type: Hour Range

1 Less than 1 hour

2 At least 1 hour but no more than 3 hours

3 At least 3 hours but no more than 5 hours

4 5 hours or more


P_DP11

[IF P_DP10 = 2, 3, 4, OR DK/REF] Still thinking of times lasting two weeks or longer when [NUMPROBS] with your mood [WASWERE] most <b>severe and frequent</b>, how severe was your <b>emotional distress</b> during those times?

Question Type: Severe Range

1 Mild

2 Moderate

3 Severe

4 Very severe


P_DP12

[IF P_DP10 = 2, 3, 4, OR DK/REF] Again, think of times lasting two weeks or longer when [NUMPROBS] with your mood [WASWERE] most <b>severe and frequent</b>.

How often, during those times, was your emotional distress so severe that <b>nothing could cheer you up</b>?

Question Type: Often Range 3

1 Often

2 Sometimes

3 Rarely

4 Never


P_DP13

[IF P_DP10 = 2, 3, 4, OR DK/REF] Once again, please think of times lasting two weeks or longer when [NUMPROBS] with your mood [WASWERE] most <b>severe and frequent</b>.

How often, during those times, was your emotional distress so severe that you <b>could not carry out your daily activities</b>?

Question Type: Often Range 3


P_DP14

[IF S1 AD16 = (2, 3, 4 OR DK/REF) AND NOT (P_DP11 = 1 AND P_DP12 = 4 AND P_DP13 = 4) AND (P_DP1=1 OR P_DP2=1 OR P_DP3=1) AND P_DP8 NE (2 OR DK/REF)] People who have problems with their mood often have other problems at the same time. These problems may include things like changes in:

sleep

appetite

energy

the ability to concentrate and remember

feelings of low self-worth

Did you ever have any of these problems during a period of time when you [FEELFILL] for <b>two weeks or longer</b>?

Question Type: TYESNOCAPS


P_DP15

[IF P_DP14 = 1] Think again about these other problems we just mentioned. They include things like changes in

sleep

appetite

energy

the ability to concentrate and remember

feelings of low self-worth

Please think of a time when you [FEELFILL] for <b>two weeks or longer</b> and you also had the <b>largest number</b> of these other problems at the same time.

Is there one particular time like this that stands out in your mind as the <b>worst</b> one you ever had?

Question Type: TYESNOCAPS


P_DP16

[IF P_DP15 = 1] How old were you when that worst period of time started?

AGE:

Question Type: Numeric Range [1 – 110]

[RANGE: 1-110]


P_DP17

[IF P_DP15 = 2 OR DK/REF] Then think of the <b>most recent</b> time when you [FEELFILL] for <b>two weeks or longer</b> and you also had the <b>largest number</b> of these other problems at the same time. How old were you when that time started?

AGE:

Question Type: Numeric Range [1 – 110]


DEFINE TIMEFILL:

IF P_DP16 NE BLANK, THEN TIMEFILL = ‘worst’

IF P_DP17 NE BLANK, THEN TIMEFILL = ‘most recent’


P_DP18

[IF P_DP16 NE BLANK] In answering the next questions, think about the period of time when your [FEELNOUN] and other problems were the <b>worst</b>. [IF P_DP17 NE BLANK] In answering the next questions, think about the <b>most recent</b> period of time when you [FEELFILL] and had other problems at the same time.

During that time, did you feel sad, empty, or depressed <b>most of the day nearly every day</b>?

Question Type: TYESNOCAPS


P_DP19

[IF P_DP16 NE BLANK OR P_DP17 NE BLANK] During that <b>[TIMEFILL]</b> period of time, did you feel discouraged about how things were going in your life <b>most of the day nearly every day</b>?

Question Type: TYESNOCAPS


P_DP20

[IF P_DP16 NE BLANK OR P_DP17 NE BLANK] During that <b>[TIMEFILL]</b> period of time, did you lose interest in almost all things like work and hobbies and things you like to do for fun?

Question Type: TYESNOCAPS


P_DP21

[IF P_DP16 NE BLANK OR P_DP17 NE BLANK] During that <b>[TIMEFILL]</b> period of time, did you lose the ability to take pleasure in having good things happen to you, like winning something or being praised or complimented?

Question Type: TYESNOCAPS


P_DP22

[IF ANY P_DP18– P_DP21 = 1] The next questions are about changes in appetite and weight. [IF P_DP16 NE BLANK] In answering the next questions, think about the period of time when your [FEELNOUN] and other problems were the <b>worst</b>. [IF P_DP17 NE BLANK] In answering the next questions, think about the <b>most recent</b> period of time when you [FEELFILL] and had other problems at the same time.

Did you have a much smaller appetite than usual nearly every day during that time?

Question Type: TYESNOCAPS


P_DP23

[IF P_DP22 = 2 OR DK/REF] Did you have a much <b>larger</b> appetite than usual nearly every day?

Question Type: TYESNOCAPS


P_DP24

[IF P_DP22 = 2 OR DK/REF] Did you gain weight without trying to during that <b>[TIMEFILL]</b> period of time?

Question Type: TYESNOCAPS


P_DP25

[IF P_DP24 = 1 AND (P_DP16 21 OR P_DP17 21)] Did you gain weight without trying to because you were growing?

Question Type: TYESNOCAPS


P_DP26

[IF P_DP24 = 1 AND P_DP25 NE YES AND S1QD01 = 2] Did you gain weight without trying to because you were pregnant?

Question Type: TYESNOCAPS


P_DP27

[IF P_DP24 = 1 AND P_DP25 NE YES AND P_DP26 NE YES] How many pounds did you gain? Please enter your answer as a whole number.

# OF POUNDS:

Question Type: Numeric Range [0 – 200]

__________ [RANGE: 0-200]

DK/REF


P_DP28

[IF (P_DP22 = 1 OR P_DP24=(2 OR DK/REF)] Did you <b>lose</b> weight without trying to?

Question Type: TYESNOCAPS


P_DP29

[IF P_DP28 = 1] Did you lose weight without trying to because you were sick or on a diet?

Question Type: TYESNOCAPS


P_DP30

[IF P_DP29 = 2 OR DK/REF] How many pounds did you lose?

Please enter your answer as a whole number.

# OF POUNDS:

Question Type: Numeric Range [0 – 200]


P_DP31

[IF P_DP22 NE BLANK] [IF P_DP16 NE BLANK] Again, please think about the period of time when your [FEELNOUN] and other problems were the <b>worst</b>.

[IF P_DP17 NE BLANK] Again, please think about the <b>most recent</b> period of time when you [FEELFILL] and had other problems at the same time.

Did you have a lot more trouble than usual falling asleep, staying asleep, or waking too early nearly every night during that <b>[TIMEFILL]</b> period of time?

Question Type: TYESNOCAPS


P_DP32

[IF P_DP31 = 2 OR DK/REF] During that <b>[TIMEFILL]</b> period of time, did you sleep a lot more than usual nearly every night?

Question Type: TYESNOCAPS


P_DP33

[IF P_DP22 NE BLANK] During that <b>[TIMEFILL]</b> period of time, did you feel tired or low in energy nearly every day, even when you had not been working very hard?

Question Type: TYESNOCAPS


P_DP34

[IF P_DP22 NE BLANK] Did you talk or move more slowly than is normal for you nearly every day?

Question Type: TYESNOCAPS


P_DP35

[IF P_DP34 = 1] Did anyone else notice that you were talking or moving slowly?

Question Type: TYESNOCAPS


P_DP36

[IF P_DP34 = 2 OR DK/REF] Were you so restless or jittery nearly every day that you paced up and down or couldn't sit still?

Question Type: TYESNOCAPS


P_DP37

[P_DP36 = 1] Did anyone else notice that you were restless?

Question Type: TYESNOCAPS


P_DP38

[IF P_DP22 NE BLANK] The next questions are about changes in your ability to concentrate, and your feelings about yourself.

[IF P_DP16 NE BLANK] Again, in answering these questions, think about the period of time when your [FEELNOUN] and other problems were the <b>worst</b>.

[IF P_DP17 NE BLANK] Again, in answering these questions, think about the <b>most recent</b> period of time when you [FEELFILL] and had other problems at the same time.

During that <b>[TIMEFILL]</b> time, did your thoughts come much more slowly than usual or seem confused nearly every day?

Question Type: TYESNOCAPS


P_DP39

[IF P_DP22 NE BLANK] Did you have a lot more trouble concentrating than usual nearly every day?

Question Type: TYESNOCAPS


P_DP40

[IF P_DP22 NE BLANK] Were you unable to make decisions about things you ordinarily have no trouble deciding about?

Question Type: TYESNOCAPS


P_DP41

[IF P_DP22 NE BLANK] Did you feel that you were not as good as other people nearly every day?

Question Type: TYESNOCAPS


P_DP42

[IF P_DP41 = 1] Did you feel totally worthless nearly every day?

Question Type: TYESNOCAPS


P_DP43

[IF P_DP22 NE BLANK] The next questions are about thoughts of death or suicide.

[IF P_DP16 NE BLANK] Again, in answering these questions, think about the period of time when your [FEELNOUN] and other problems were the <b>worst</b>.

[IF P_DP17 NE BLANK] Again, in answering these questions, think about the <b>most recent</b> period of time when you [FEELFILL] and had other problems at the same time.

Did you often think a lot about death, either your own, someone else’s, or death in general?

Question Type: TYESNOCAPS


P_DP44

[IF P_DP22 NE BLANK] During that period, did you ever think that it would be better if you were dead?

Question Type: TYESNOCAPS


P_DP45

[IF P_DP22 NE BLANK] Did you think about committing suicide?

Question Type: TYESNOCAPS


P_DP46

[IF P_DP45 = 1] Did you make a suicide plan?

Question Type: TYESNOCAPS


P_DP47

[IF P_DP45 = 1] Did you make a suicide attempt?

Question Type: TYESNOCAPS


DEFINE S1D_MDEA1:

IF P_DP18= 1 OR P_DP19 = 1, THEN S1D_MDEA1= 1

ELSE IF P_DP18= 2 AND P_DP19 = 2, THEN S1D_MDEA1= 2

ELSE IF P_DP18= DK OR P_DP19 = DK, THEN S1D_MDEA1= DK

ELSE IF P_DP18= REF OR P_DP19 = REF, THEN S1D_MDEA1= REF

ELSE S1D_MDEA1= BLANK


DEFINE S1D_MDEA2:

IF P_DP20 = 1 OR P_DP21 = 1, THEN S1D_MDEA2= 1

ELSE IF P_DP20 = 2 AND P_DP21 = 2, THEN S1D_MDEA2= 2

ELSE IF P_DP20 = DK OR P_DP21 = DK, THEN S1D_MDEA2= DK

ELSE IF P_DP20 = REF OR P_DP21 = REF, THEN S1D_MDEA2= REF

ELSE S1D_MDEA2= BLANK


DEFINE S1D_MDEA3:

IF P_DP22 = 1 OR P_DP23 = 1 OR P_DP27 10 OR P_DP30 10, THEN S1D_MDEA3= 1

ELSE IF P_DP22 = 2 AND P_DP23 = 2 AND ((P_DP27 < 10 OR P_DP30 < 10) OR

(P_DP24 = (2 OR BLANK) AND P_DP28 = (2 OR BLANK)) OR (P_DP24 = 1 AND

(P_DP25 = 1 OR P_DP26 = 1)) OR (P_DP28 = 1 AND P_DP29 = 1)), THEN

S1D_MDEA3= 2

ELSE IF P_DP22 = DK OR P_DP23 = DK OR P_DP24 = DK OR P_DP27 = DK OR

P_DP28 = DK OR P_DP30 = DK, THEN S1D_MDEA3= DK

ELSE IF P_DP22 = REF OR P_DP23 = REF OR P_DP24 = REF OR P_DP27 = REF OR

P_DP28 = REF OR P_DP30 = REF, THEN S1D_MDEA3= REF

ELSE S1D_MDEA3= BLANK


DEFINE S1D_MDEA4:

IF P_DP31 = 1 OR P_DP32 = 1, THEN S1D_MDEA4= 1

ELSE IF P_DP31 = 2 AND P_DP32 = 2, THEN S1D_MDEA4= 2

ELSE IF P_DP31 = DK OR P_DP32 = DK, THEN S1D_MDEA4= DK

ELSE IF P_DP31 = REF OR P_DP32 = REF, THEN S1D_MDEA4= REF

ELSE S1D_MDEA4= BLANK


DEFINE S1D_MDEA5:

IF P_DP35 = 1 OR P_DP37 = 1, THEN S1D_MDEA5= 1

ELSE IF (P_DP34 = (2 OR DK/REF) AND (P_DP36 = (2 OR DK/REF) OR P_DP37 = 2))

OR P_DP35 = 2, THEN S1D_MDEA5= 2

ELSE IF P_DP34 = DK OR P_DP35 = DK OR P_DP36 = DK OR P_DP37 = DK, THEN

S1D_MDEA5= DK

ELSE IF P_DP34 = REF OR P_DP35 = REF OR P_DP36 = REF OR P_DP37 = REF,

THEN S1D_MDEA5= REF

ELSE S1D_MDEA5= BLANK


DEFINE S1D_MDEA6:

S1D_MDEA6= AD26J


DEFINE S1D_MDEA7:

IF P_DP42 = 1, THEN S1D_MDEA7= 1

ELSE IF P_DP41 = (2 OR DK/REF) OR P_DP42 = 2, THEN S1D_MDEA7= 2

ELSE S1D_MDEA7= P_DP42

ELSE S1D_MDEA7= BLANK


DEFINE S1D_MDEA8:

IF P_DP38 = 1 OR P_DP39 = 1 OR P_DP40 = 1, THEN S1D_MDEA8= 1

ELSE IF P_DP38 = 2 AND P_DP39 = 2 AND P_DP40 = 2, THEN S1D_MDEA8= 2

ELSE IF P_DP38 = DK OR P_DP39 = DK OR P_DP40 = DK, THEN S1D_MDEA8= DK

ELSE IF P_DP38 = REF OR P_DP39 = REF OR P_DP40 = REF, THEN S1D_MDEA8=

REF

ELSE S1D_MDEA8= BLANK


DEFINE S1D_MDEA9:

IF P_DP43 = 1 OR S1D26BB = 1 OR P_DP45 = 1 OR P_DP46 = 1 OR P_DP47 = 1,

THEN S1D_MDEA9= 1

ELSE IF P_DP43 = 2 AND P_DP44 = 2 AND P_DP45 = 2, THEN S1D_MDEA9= 2

ELSE IF P_DP43 = DK OR P_DP44 = DK OR P_DP45 = DK OR P_DP46 = DK

OR P_DP47 = DK, THEN S1D_MDEA9= DK

ELSE IF P_DP43 = REF OR P_DP44 = REF OR P_DP45 = REF OR P_DP46 =

REF OR P_DP47 = REF, THEN S1D_MDEA9= REF

ELSE S1D_MDEA9= BLANK


DEFINE S1DSMMDEA2:

IF SUM (S1D_MDEA1 = 1, S1D_MDEA2 = 1, S1D_MDEA3 = 1, S1D_MDEA4 = 1, S1D_MDEA5

= 1, S1D_ S1MDEA6 = 1, S1D_MDEA7 = 1, S1D_MDEA8 = 1, S1D_MDEA9 = 1) 5, THEN

S1DSMMDEA2 = 1

ELSE IF SUM (S1D_MDEA1 = (1 OR DK/REF), S1D_MDEA2 = (1 OR DK/REF),

S1D_MDEA3 = (1 OR DK/REF), S1D_MDEA4 = (1 OR DK/REF), S1D_MDEA5 = (1 OR

DK/REF), S1D_MDEA6 = (1 OR DK/REF), S1D_MDEA7 = (1 OR DK/REF), S1D_MDEA8 =

(1 OR DK/REF), S1D_MDEA9 = (1 OR DK/REF)) < 5 AND N(OF S1D_MDEA1-

S1D_MDEA9) > 0, THEN S1DSMMDEA2 = 2

ELSE IF S1D_MDEA1 = DK OR S1D_MDEA2 = DK OR S1D_MDEA3 = DK OR S1D_MDEA4

= DK OR S1D_MDEA5 = DK OR S1D_MDEA6 = DK OR S1D_MDEA7 = DK OR

S1D_MDEA8 = DK OR S1D_MDEA9 = DK, THEN S1DSMMDEA2 = DK

ELSE IF S1D_MDEA1 = REF OR S1D_MDEA2 = REF OR S1D_MDEA3 = REF OR

S1D_MDEA4 = REF OR S1D_MDEA5 = REF OR S1D_MDEA6 = REF OR S1D_MDEA7 = REF

OR S1D_MDEA8 = REF OR S1D_MDEA9 = REF, THEN S1DSMMDEA2 = REF


P_DP48

[IF S1D_MDEA9 = 1 OR S1DSMMDEA2 = 1] You mentioned having some of the problems I just asked you about.

During that <b>[TIMEFILL]</b> period of time, how much did your [FEELNOUN] and these other problems interfere with your work, your social life, or your personal relationships?

Question Type: Often Range 4

1 Not at all

2 A little

3 Some

4 A lot

5 Extremely


P_DP49

[IF P_DP48 NE BLANK ] <b>In the past 12 months</b>, did you have a period of time when you felt [FEELNOUN] for <b>two weeks or longer</b> while also having some of the other problems we asked about?

Question Type: TYESNOCAPS


P_DP50

At any time in the past 12 months, did you seriously think about trying to kill yourself?

Question Type: TYESNOCAPS




Psychological Distress

---------------------------------------------------------------------------------


IF CHILD SETTING IS GROUP HOME OR RESIDENTIAL FACILITY (P_NP12b = 3 OR 4) THEN GO TO Y_PDEND


The next few questions ask how you have been feeling during the past 30 days.


P_PD1a

During the past 30 days, about how often did you feel nervous?

1 = All of the time

2 = Most of the time

3 = Some of the time

4 = A little of the time

5 = None of the time


P_PD1b

During the past 30 days, about how often did you feel hopeless?

1 = All of the time

2 = Most of the time

3 = Some of the time

4 = A little of the time

5 = None of the time


P_PD1c

During the past 30 days, about how often did you feel restless or fidgety?

1 = All of the time

2 = Most of the time

3 = Some of the time

4 = A little of the time

5 = None of the time


P_PD1d

During the past 30 days, about how often did you feel so sad or depressed that nothing could cheer you up?

1 = All of the time

2 = Most of the time

3 = Some of the time

4 = A little of the time

5 = None of the time


P_PD1e

During the past 30 days, about how often did you feel that everything was an effort?

1 = All of the time

2 = Most of the time

3 = Some of the time

4 = A little of the time

5 = None of the time


P_PD1f

During the past 30 days, how often did you feel down on yourself, no good or worthless?

1 = All of the time

2 = Most of the time

3 = Some of the time

4 = A little of the time

5 = None of the time





P_PD1g The last questions asked about how you have been feeling during the past

30 days. Now think about the past 12 months. That is, between [FILL: CALCULATE 12 MONTHS PRIOR TO CURRENT DATE] and now, was there a month in the

past 12 months when you felt more depressed, anxious, or emotionally

stressed than you felt during the past 30 days?


1 Yes

2 No

PROGRAMMER: SHOW 12 MONTH CALENDAR


P_PD1h [IF P_MA1g=1] Think of one month in the past 12 months when you were the most depressed, anxious, or emotionally stressed.


During that month, how often did you feel nervous?


1 All of the time

2 Most of the time

3 Some of the time

4 A little of the time

5 None of the time

PROGRAMMER: SHOW 12 MONTH CALENDAR


P_PD1i [IF P_PD1g=1] During that same month when you were at your worst emotionally . . .how often did you feel hopeless?


1 All of the time

2 Most of the time

3 Some of the time

4 A little of the time

5 None of the time



P_PD1j [IF P_PD1g=1] During that same month when you were at your worst emotionally . . . how often did you feel restless or fidgety?


1 All of the time

2 Most of the time

3 Some of the time

4 A little of the time

5 None of the time



P_PD1k [IF P_PD1g=1] During that same month when you were at your worst emotionally . . . how often did you feel so sad or depressed that nothing could cheer you

up?


1 All of the time

2 Most of the time

3 Some of the time

4 A little of the time

5 None of the time



P_PD1l [IF P_PD1g=1] During that same month when you were at your worst emotionally . . . how often did you feel that everything was an effort?


1 All of the time

2 Most of the time

3 Some of the time

4 A little of the time

5 None of the time


P_PD1m [IF CHILD AGE = 18 OR OLDER AND P_PD1g=1] During that

same month when you were at your worst emotionally . . .

how often did you feel down on yourself, no good, or worthless?

1 All of the time

2 Most of the time

3 Some of the time

4 A little of the time

5 None of the time


DEFINE DISTRESS: IF P_PD1a = 1-4 OR P_PD1b = 1-4 OR P_PD1c= 1-4, OR P_PD1d = 1-4 OR P_PD1e= 1-4 OR P_PD1f = 1-4, OR P_PD1h = 1-4 OR P_PD1i = 1-4 OR P_PD1j = 1-4 OR P_PD1k = 1-4 OR P_PD1l = 1-4 OR P_PD1m = 1-4, THEN DISTRESS = 1 ELSE, DISTRESS = 2




Mental Health and Functioning

---------------------------------------------------------------------------------


IF CHILD SETTING IS GROUP HOME OR RESIDENTIAL FACILITY (P_NP12b = 3 OR 4) THEN GO TO Y_HFEND


ONLY ADMINISTER THIS MODULE IF DISTRESS=1


The next questions are about how much your emotions, nerves or mental health caused you to have difficulties in daily activities.


In answering, think of the one month in the past 12 months when your emotions, nerves or mental health interfered most with your daily activities.


P_HF2


[IF DISTRESS=1] During that one month when your emotions, nerves or mental health interfered <b>most</b> with your daily activities, how much difficulty did you have <b>remembering to do things you needed to do</b>?

Question Type: Difficulty Range

1 No difficulty

2 Mild difficulty

3 Moderate difficulty

4 Severe difficulty


P_HF3

[IF DISTRESS=1] During that one month when your emotions, nerves or mental health interfered <b>most</b> with your daily activities,

how much difficulty did you have <b>concentrating on doing something important when other things were going on around you</b>?

Question Type: Difficulty Range

1 No difficulty

2 Mild difficulty

3 Moderate difficulty

4 Severe difficulty



P_HF4

[IF DISTRESS=1] During that one month when your emotions, nerves or mental health interfered <b>most</b> with your daily activities,

how much difficulty did you have <b>going out of the house and getting around on your own</b>?

Question Type: Difficulty Range House

1 No difficulty

2 Mild difficulty

3 Moderate difficulty

4 Severe difficulty

5 You didn’t leave the house on your own


P_HF4a [IF P_HF4 = 5] Did problems with your emotions, nerves, or mental health keep you from leaving the house on your own?

1 Yes

2 No

DK/REF



P_HF5

[IF DISTRESS=1] During that one month when your emotions, nerves or mental health interfered <b>most</b> with your daily activities,

how much difficulty did you have <b>dealing with people you did not know well</b>?

Question Type: Difficulty Range People

1 No difficulty

2 Mild difficulty

3 Moderate difficulty

4 Severe difficulty

5 You didn’t deal with people you did not know well



P_HF5a [IF P_HF5 = 5] Did problems with your emotions, nerves, or mental health keep you from dealing with people you did not know well?

1 Yes

2 No

DK/REF



P_HF6

[IF DISTRESS=1] During that one month when your emotions, nerves or mental health interfered <b>most</b> with your daily activities,

how much difficulty did you have <b>participating in social activities, like visiting friends or going to parties</b>?

Question Type: Difficulty Range Social

1 No difficulty

2 Mild difficulty

3 Moderate difficulty

4 Severe difficulty

5 You didn’t participate in social activities


P_HF6a [IF P_HF6=5] Did problems with your emotions, nerves, or mental health keep you from participating in social activities?

1 Yes

2 No

DK/REF


P_HF7

[IF DISTRESS=1] During that one month when your emotions, nerves or mental health interfered <b>most</b> with your daily activities,

how much difficulty did you have <b>taking care of household responsibilities</b>?

Question Type: Difficulty Range Household

1 No difficulty

2 Mild difficulty

3 Moderate difficulty

4 Severe difficulty

5 You didn’t take care of household responsibilities


P_HF7a [IF P_HF7=5] Did problems with your emotions, nerves, or mental health keep you from taking care of household responsibilities?


1 Yes

2 No

DK/REF


P_HF8

[IF DISTRESS=1] During that one month when your emotions, nerves or mental health interfered <b>most<b/> with your daily activities,

how much difficulty did you have <b>taking care of your daily responsibilities at work or school<b/>?

Question Type: Difficulty Range Work

1 No difficulty

2 Mild difficulty

3 Moderate difficulty

4 Severe difficulty

5 You didn’t work or go to school {GO TO P_HFEND}


P_HF8a [IF P_HF8=5] Did problems with your emotions, nerves, or mental health keep you from working or going to school?


1 Yes

2 No

DK/REF


P_HF9

[IF DISTRESS=1] During that one month when your emotions, nerves or mental health interfered <b>most</b> with your daily activities,

how much difficulty did you have <b>getting your daily work or school work done as quickly as needed<b/>?

Question Type: Difficulty Range

1 No difficulty

2 Mild difficulty

3 Moderate difficulty

4 Severe difficulty








ALCOHOL DEPENDENCE (ACASI)

---------------------------------------------------------------------------------

Logic before:

This section should be skipped in the following caregiver situations:

- Licensed Foster Home or all non-family settings

(P_NP12a = 4) OR (P_NP12b >= 1) OR

-           Primary CG is a Foster Mother or Father 

(P_HH6a = 8 or 9 OR P_HH6g = 8 or 9) OR

-           Primary CG currently receives payments for being a foster parent

(P_HH6e = 1)



P_AD1a [ PAD1ax ] How often do you have a drink containing alcohol?

Now I'm going to ask you some questions about your use of alcoholic beverages during this past

year. By alcoholic beverages, we mean beer, wine, wine coolers, shots of liquor, or mixed drinks.



Question Type: TAlcFreq

Never 0 Never

Monthly 1 Monthly or less

TwoFourMn 2 2 to 4 times a month

TwoThreeWk 3 2 to 3 times a week

FourMoreWk 4 4 or more times a week

---------------------------------------------------------------------------------

P_AD2a [ PAD2ax ] # drinks you have on a typical day when you are drinking?

How many drinks containing alcohol do you have on a typical day when you are drinking?

Question Type: TNumDrks

onetwo 0 1 or 2

threefour 1 3 or 4

fivesix 2 5 or 6

seven_9 3 7, 8, or 9

tenmore 4 10 or more

---------------------------------------------------------------------------------

P_AD3a [ PAD3ax ] How often do you have six or more drinks on one occasion?

How often do you have six or more drinks on one occasion?

Question Type: THO5F

never 0 Never

lessmn 1 Less than monthly

monthly 2 Monthly

weekly 3 Weekly

daily 4 Daily or almost daily

---------------------------------------------------------------------------------

Logic before:

IF P_AD2a AND P_AD3a = 0, GOTO P_AD9a.

P_AD4a [ PAD4ax ] How often in lst yr were unable stop drinkng once u startd?

How often during the last year have you found that you were not able to stop drinking once you

had started?

Question Type: THO5F

never 0 Never

lessmn 1 Less than monthly

monthly 2 Monthly

weekly 3 Weekly

daily 4 Daily or almost daily

---------------------------------------------------------------------------------

P_AD5a [ PAD5ax ] How often in lst yr, failed what was expected due to drinkng

How often during the last year have you failed to do what was normally expected from you

because of drinking?

Question Type: THO5F

never 0 Never

lessmn 1 Less than monthly

monthly 2 Monthly

weekly 3 Weekly

daily 4 Daily or almost daily

---------------------------------------------------------------------------------

P_AD6a [ PAD6ax ] How often in lst yr, needed 1st drnk n mrnng aftr heavy drnk

How often during the last year have you needed a first drink in the morning to get yourself going

after a heavy drinking session?

Question Type: THO5F

never 0 Never

lessmn 1 Less than monthly

monthly 2 Monthly

weekly 3 Weekly

daily 4 Daily or almost daily

---------------------------------------------------------------------------------

P_AD7a [ PAD7ax ] How often in lst yr, felt guilt or remorse after drinking?

How often during the last year have you had a feeling of guilt or remorse after drinking?

Question Type: THO5F

never 0 Never

lessmn 1 Less than monthly

monthly 2 Monthly

weekly 3 Weekly

daily 4 Daily or almost daily

---------------------------------------------------------------------------------

P_AD8a [ PAD8ax ] How often in lst yr, unable to remember nght befre due to dr

How often during the last year have you been unable to remember what happened the night before

because you had been drinking?

Question Type: THO5F

never 0 Never

lessmn 1 Less than monthly

monthly 2 Monthly

weekly 3 Weekly

daily 4 Daily or almost daily

---------------------------------------------------------------------------------

P_AD9a [ PAD9a ] Have you or someone else been injured cause of your drinking

Have you or someone else been injured as a result of your drinking?

Question Type: TNYY

no 0 No

yesmoryr 2 Yes, but not in the last year

yesduryr 4 Yes, during the last year

---------------------------------------------------------------------------------

P_AD10a [ PAD10a ] Has rel/frnd/Dr/healthworker been concrnd/asked u to cut dwn

Has a relative or friend or a doctor or another health worker been concerned about your drinking or

suggested you cut down?

Question Type: TNYY

no 0 No

yesmoryr 2 Yes, but not in the last year

yesduryr 4 Yes, during the last year

---------------------------------------------------------------------------------

P_ADEND [ PADEND ] NoDeliv

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue



DRUG DEPENDENCE (ACASI)

---------------------------------------------------------------------------------




Logic before:

This section should be skipped in the following caregiver situations:

- Licensed Foster Home or all non-family settings

(P_NP12a = 4)  OR (P_NP12b >= 1) OR

-           Primary CG is a Foster Mother or Father 

(P_HH6a = 8 or 9 OR P_HH6g = 8 or 9) OR

-           Primary CG currently receives payments for being a foster parent

(P_HH6e = 1)




P_DD1a [ PDD1a ] Pst 12M, used drgs other than those required for med reasons

The following questions ask about your potential involvement with drugs, not including alcoholic

beverages, during the last 12 months. The term "drug abuse" refers to the use of prescribed or

over-the-counter drugs in excess of the directions and/or any non-medical use of drugs.


During the past 12 months, have you used drugs other than those required for medical reasons?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD2a [ PDD2a ] Pst 12M, have you abused prescription drugs?

During the past 12 months, have you abused prescription drugs?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD3a [ PDD3ax ] Pst 12M, have you abused more than one drug at a time?

During the past 12 months, have you abused more than one drug at a time?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD4a [ PDD4ax ] Pst 12M, could you get through the week without using drugs?

During the past 12 months, could you get through the week without using drugs?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD5a [ PDD5ax ] Pst 12M, always been able to stop using drugs when u wanted?

During the past 12 months, have you always been able to stop using drugs when you wanted to?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD6a [ PDD6ax ] Pst 12M, have u had blackouts or flashbacks due to drug use?

During the past 12 months, have you had blackouts or flashbacks as a result of drug use?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD7a [ PDD7ax ] Pst 12M, have u ever felt bad or guilty about your drug use?

During the past 12 months, have you ever felt bad or guilty about your drug use?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD8a [ PDD8ax ] Pst 12M, have spouse(or parents) complained about drug use?

During the past 12 months, has your spouse (or parents) ever complained about your involvement

with drugs?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD9a [ PDD9ax ] Pst 12M, drg abuse created probs between u & spouse/parents?

During the past 12 months, has drug abuse created problems between you and your spouse or

your parents?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD10a [ PDD10a ] Past 12m has R lost friends because of drg use

During the past 12 months, have you lost friends because of your use of drugs?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD11a [ PDD11a ] Past 12m has R neglctd family because of drg use

During the past 12 months, have you neglected your family because of your use of drugs?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD12a [ PDD12a ] Past 12m has R been in trouble at work because of drg use

During the past 12 months, have you been in trouble at work because of drug abuse?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD13a [ PDD13a ] Past 12m has R lost a job because of drug use

During the past 12 months, have you lost a job because of drug abuse?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD14a [ PDD14a ] Past 12m has R gotten into fghts whn undr inflnce of drgs

During the past 12 months, have you gotten into fights when under the influence of drugs?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD15a [ PDD15a ] Past 12m has R engaged in illegal actvtes to obtain drgs

During the past 12 months, have you engaged in illegal activities in order to obtain drugs?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD16a [ PDD16a ] Past 12m has R been arrested for possession of ilgl drgs

During the past 12 months, have you been arrested for possession of illegal drugs?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD17a [ PDD17a ] Past 12m has R exprncd wthdrwl symptoms when stpd tkng drgs

During the past 12 months, have you ever experienced withdrawal symptoms (felt sick) when you

stopped taking drugs?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD18a [ PDD18a ] Past 12m has R had medical problems as result of drug use

During the past 12 months, have you had medical problems as a result of your drug use (such as

memory loss, hepatitis, convulsions, bleeding, etc)?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD19a [ PDD19a ] Past 12m has R gone to anyone for help for drug prblm

During the past 12 months, have you gone to anyone for help for a drug problem?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DD20a [ PDD20a ] Past 12m has R been invlvd in yreatment prgm rltd to drg use

During the past 12 months, have you been involved in a treatment program specifically related to

drug use?

Question Type: TYN

yes 1 YES

no 2 NO


Now I’d like to ask you about smoking cigarettes.


P_DD21a

Have you smoked at least 100 cigarettes in your entire life?

1=Yes

2=No




ASK P_DD22a IF P_DD21a = 1.


P_DD22a

Do you now smoke cigarettes every day, some days, or not at all?

1=Everyday

2=Some days

3=Not at all



INVOLVEMENT WITH THE LAW (ACASI)

---------------------------------------------------------------------------------

Logic before:

This section should be skipped in the following caregiver situations:

- Licensed Foster Home or all non-family settings

(P_NP12a = 4)  OR (P_NP12b >= 1) OR

-           Primary CG is a Foster Mother or Father 

(P_HH6a = 8 or 9 OR P_HH6g = 8 or 9) OR

-           Primary CG currently receives payments for being a foster parent

(P_HH6e = 1)




P_IL1a [ PIL1a ] Ever been arrested for any offense

The next questions are about your involvement with the law.


Have you @bever@b been arrested for any offense?


Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

IF IL_1A = NO THEN GO TO P_ILEND

---------------------------------------------------------------------------------

P_IL2n [ PIL2a ] # of times arrested

How many times have you been arrested?



NUMBER

Question Type: 0..10


P_IL2o [ PIL2o ] Past 6M CH arrested

Since [last interview], have you been arrested or picked up by the police for something

other than a minor traffic offense?

Question Type: TYN

yes 1 YES

no 2 NO


---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

FILL " ", "second", etc. BASED ON RESPONSE TO P_IL2 BLANK IF P_IL2 = 1 No fill for the first

arrest.

P_IL7a1 [ PIL7a ] Labels are in Logic After

Did you spend time in prison as a result of anarrest since [LAST INTERVIEW DATE]?

Question Type: TYN

yes 1 YES

no 2 NO

Question Fill: ^fillordinal

first first

second second

third third

fourth fourth

fifth fifth

sixth sixth

seventh seventh

eighth eighth

ninth ninth

tenth tenth

blank

qmark ?

Logic after:

PIL71a--Time in prison as result of 1st arrest; PIL72a--Time in prison as result of 2nd arrest;

PIL73a--Time in prison as result of 3rd arrest; PIL74a--Time in prison as result of 4th arrest; PIL75a-

-Time in prison as result of 5th arrest; PIL76a--Time in prison as result of 6th arrest; PIL77a--Time

in prison as result of 7th arrest; PIL78a--Time in prison as result of 8th arrest; PIL79a--Time in

prison as result of 9th arrest; PIL710a--Time in prison as result of 10th arrest

---------------------------------------------------------------------------------

Logic before:

IF P_IL7A = YES THEN ASK P_IL8A ELSE REPEAT P_IL3y TO P_IL8a FOR EACH ARREST

BASED ON ANSWER TO P_IL2n

P_IL8a1 [ PIL8a ] Labels are in Logic After

How long were you in prison?

Question Type: THowLong

Less_1 1 Less than 1 month

_1to3 2 1 to 3 months

_4_6 3 4 to 6 months

_7_1yr 4 7 months to 1 year

More_1 5 More than 1 year

Logic after:

REPEAT P_IL3y TO P_IL8a FOR EACH ARREST BASED ON ANSWER TO P_IL2n; PIL81a--

Length of time in prison for 1st arrest; PIL82a--Length of time in prison for 2nd arrest; PIL83a--

Length of time in prison for 3rd arrest; PIL84a--Length of time in prison for 4th arrest; PIL85a--

Length of time in prison for 5th arrest; PIL86a--Length of time in prison for 6th arrest; PIL87a--

Length of time in prison for 7th arrest; PIL88a--Length of time in prison for 8th arrest; PIL89a--

Length of time in prison for 9th arrest; PIL810a--Length of time in prison for 10th arrest

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_ILEND [ PILEND ] NoDeliv

PRESS "1" AND ENTER TO CONTINUE

Question Type: TCont, NoDK, NoRF

Continue 1 Continue



DISCIPLINE & CHILD MALTREATMENT (ACASI)

---------------------------------------------------------------------------------

Logic before:

This section should be skipped in the following caregiver situations:

- Licensed Foster Home or all non-family settings

(P_NP12a = 4)  OR (P_NP12b >= 1) OR

-           Primary CG is a Foster Mother or Father 

(P_HH6a = 8 or 9 OR P_HH6g = 8 or 9) OR

-           Primary CG currently receives payments for being a foster parent

(P_HH6e = 1)


P_DS1a [ PDS1a ] #Xs exp to ch why something was wrong-past 12m

Children sometimes do things that are wrong, disobey, or make their parents angry. For the next

set of questions, we would like to know what you have done when your child @b^child@b did

something wrong or made you upset or angry.

^Fills.P_DS1a

For each question pick an answer that says how many times this has happened in the past @b12

months@b. If it hasn't happened in the past @b12 months@b, but it did happen before that, pick

the answer "not in the past @b12 months@b, but it happened before." If it has never happened,

pick the answer "this has never happened".


In the past @b12 months@b, how many times have you explained to your child @b^child@b why

something was wrong?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

Question Fill: ^FillP_DS1a

OREGON @/Please note that if I learn that your child’s life or health is in danger, I

have to tell someone whose job it is to see that your child is safe and

protected.@/

---------------------------------------------------------------------------------

P_DS2a [ PDS2a ] Put ch in time-out/sent to room-past 12m

In the past @b12 months@b, how many times have you put your child @b^child@b in "time out"

or sent your child @b^child@b to ^fills.hisher room?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

Question Fill: ^fillhimher

him him

her her

---------------------------------------------------------------------------------

P_DS3a [ PDS3a ] Shaken ch-past 12m

In the past @b12 months@b, how many times have you shaken your child @b^child@b?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS4a [ PDS4a ] Hit on bottom w/hard object-past 12m

In the past @b12 months@b, how many times have you hit your child @b^child@b on the bottom

with something like a belt, hairbrush, a stick or some other hard object?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS5a [ PDS5a ] Redirect ch-past 12m

In the past @b12 months@b, how many times have you given your child @b^child@b something

else to do instead of what ^fills.heshe was doing wrong?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

Question Fill: ^fillheshe

he he

she she

---------------------------------------------------------------------------------

P_DS6a [ PDS6a ] Shouted/yelled/screamed at ch-past 12m

In the past @b12 months@b, how many times have you shouted, yelled, or screamed at your

child @b^child@b?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_DS8a [ PDS8a ] Spanked on bottomw w/bare hand-past 12m

In the past @b12 months@b, how many times have you spanked your child @b^child@b on the

bottom with your bare hand?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS9a [ PDS9a ] Grabbed ch around neck and choked-past 12m

---------------------------------------------------------------------------------

P_DS10a [ PDS10a ] Sworn/cursed at ch-past 12m

In the past @b12 months@b, how many times have you sworn or cursed at your child

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_DS12a [ PDS12a ] Said ch will be sent away/kckd out-past 12m

In the past @b12 months@b, how many times have you said your child @b^child@b would be

sent away or kicked out of the house?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_DS14a [ PDS14a ] Threaten to hit but not do it-past 12m

In the past @b12 months@b, how many times have you threatened to spank or hit your child

@b^child@b but did not actually do it?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_DS16a [ PDS16a ] Slapped ch on hand/arm/leg-past 12m

In the past @b12 months@b, how many times have you slapped your child @b^child@b on the

hand, arm, or leg?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS17a [ PDS17a ] Taken away priveleges/grounded-past 12m

In the past @b12 months@b, how many times have you taken away privileges or grounded your

child @b^child@b?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

P_DS18a [ PDS18a ] Pinched ch-past 12m

In the past @b12 months@b, how many times have you pinched your child @b^child@b?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_DS21a [ PDS21a ] Called ch dumb/lazy/oth name-past 12m

In the past @b12 months@b, how many times have you called your child @b^child@b dumb or

lazy or some other name like that?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_DS23 [ PDS23 ] NO LABEL

Sometimes things can get in the way of caring for your child the way you would like to: for

example, money problems, personal problems, or having a lot to do. For the next set of items,

please tell me how many times in the past @b12 months@b this has happened to you in trying to

care for your child.


Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

P_DS24a [ PDS24a ] Leave ch home alone when shouldnt-past 12m

In the past @b12 months@b, how many times have you ever had to leave your child @b^child@b

home alone, even when you thought some adult should be with ^fills.himher?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

Question Fill: ^fillhimher

him him

her her

---------------------------------------------------------------------------------

P_DS25a [ PDS25a ] Not show/tell ch love him/her-past 12m

In the past @b12 months@b, how many times were you so caught up with problems that you

were not able to show or tell your child @b^child@b that you loved ^fills.himher?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

Question Fill: ^fillhimher

him him

her her

---------------------------------------------------------------------------------

P_DS26a [ PDS26a ] Unable to ensure ch get food needed-past 12m

In the past @b12 months@b, how many times were you not able to make sure that your child

@b^child@b got the food ^fills.heshe needed?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

Question Fill: ^fillheshe

he he

she she

---------------------------------------------------------------------------------

P_DS27a [ PDS27a ] Unable to get ch to doc as needed-past 12m

In the past @b12 months@b, how many times were you unable to make sure your child

@b^child@b got to a doctor or hospital when ^fills.heshe needed it?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

Question Fill: ^fillheshe

he he

she she

---------------------------------------------------------------------------------

P_DS28a [ PDS28a ] Couldnt take care of CH b/c drnk/hgh-past 12m

In the past @b12 months@b, how many times were you so drunk or high that you had a problem

taking care of your child @b^child@b?

Question Type: THMTimes

once 1 1 time

twice 2 2 times

threetofive 3 3-5 times

sixtoten 4 6-10 times

eleventotwenty 5 11-20 times

moretwenty 6 More than 20 times

notpast12mos 7 Not in the past @B12 months@B, but it happened before

never 8 This has never happened

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_DSEND [ PDSEND ] NoDeliv

PRESS "1" AND ENTER TO CONTINUE

Question Type: TCont, NoDK, NoRF

Continue 1 Continue



DOMESTIC VIOLENCE (ACASI)

---------------------------------------------------------------------------------

Logic before:

This section should be skipped in the following caregiver situations:


  • The caregiver is male (P_HH6i = 1) AND


- Licensed Foster Home or all non-family settings

(P_NP12a = 4) OR (P_NP12b >= 1) OR

-           Primary CG is a Foster Mother or Father 

(P_HH6a = 8 or 9 OR P_HH6g = 8 or 9) OR

-           Primary CG currently receives payments for being a foster parent

(P_HH6e = 1)



P_DV1aaWithin the last year, have you been hit, slapped, kicked or otherwise physically hurt by your partner?

1 YES

2 NO


---------------------------------------------------------------------------------

P_DV10a [ PDV10a ] R refrd to domest violence srvcs

The following questions will ask about services you may have received in the last 12 months. In

the last 12 months, have you been referred to domestic violence services, like a battered women's

shelter or a program to help you deal with an abusive partner?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DV11a [ PDV11a ] Stayd in/used domest violence srvcs

In the last 12 months, have you stayed in a battered women's shelter or received any other

domestic violence services to help you deal with an abusive partner?

Question Type: TYN

yes 1 YES

no 2 NO

P_DV13a [ PDV13a ] How much needed domestic viol srvcs

In the last 12 months, how much have you needed domestic violence services or help to deal with

an abusive partner? Would you say...

Question Type: THMNeed

alot 1 a lot,

somewhat 2 somewhat,

alittle 3 a little, or

notatall 4 not at all?

Logic after:

IF P_DV13a = 4 THEN GOTO P_DV15a

---------------------------------------------------------------------------------

P_DV14a [ PDV14a ] NO LABEL

You answered that you have needed domestic violence services or help in the last 12 months but

did not receive it. The next questions list out reasons why you may not have received this

service. Please answer yes or no to each item to indicate if this was a reason for your @bnot@b

receiving domestic violence services or help in the last 12 months.


Please press "1" and ENTER to continue.

Question Type: TCont

Continue 1 Continue

---------------------------------------------------------------------------------

P_DV14aa [ PDV14aa ] Domestic viol srvcs NA in the area

Why did you not receive domestic violence services or help? Was it because the service was not

available in the area?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DV14ba [ PDV14ba ] Domestic viol srvcs wait-listed

Were you wait-listed for the domestic violence services?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DV14ca [ PDV14ca ] Ineligible for Domestic viol srvcs

Were you ineligible for the domestic violence services?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DV14da [ PDV14da ] Domestic viol srvcs could not be financed

Was it because the domestic violence services could not be financed or paid for?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DV14ea [ PDV14ea ] Domestic viol srvcs not rcvd-prblm fndng ch care/scheduling

Still thinking about the reasons why you did not receive domestic violence services or help in the

last 12 months. Was it because of a scheduling problem or a problem with finding child care?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DV14fa [ PDV14fa ] Domestic viol srvcs not rcvd-transportation problem

Was it because of a transportation problem?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DV14ga [ PDV14ga ] Domestic viol srvcs not rcvd-some other reason

Was it because of some other reason?

Question Type: TYN

yes 1 YES

no 2 NO

---------------------------------------------------------------------------------

P_DV15 [ PDV15 ] NO LABEL

Please tell the interviewer you are done.

Question Type: TCont

Continue 1 Continue

Logic after:

P_DVEND



SATISFACTION WITH CASEWORKER

---------------------------------------------------------------------------------

Logic before:

This section should be skipped in the following caregiver situations:

- Licensed Foster Home or all non-family settings

(P_NP12a = 4) OR (P_NP12b >= 1) OR

-           Primary CG is a Foster Mother or Father 

(P_HH6a = 8 or 9 OR P_HH6g = 8 or 9) OR

-           Primary CG currently receives payments for being a foster parent

(P_HH6e = 1)


WAVE = 1: IF CONTACT DATE IS NOT

AVAILABLE, FILL DATE OF REPORT WHERE APPLICABLE. WAVE = 2: IF DATE OF LAST

INTERVIEW IS NOT AVAILABLE (BECAUSE NO PRIOR INTERVIEWS WERE COMPLETED),

FILL CONTACT DATE WHERE APPLICABLE.

P_SF1a [ PSF1a ] Has R talked to CW

Now I would like to ask some questions about the experiences that you've had with caseworkers

from the child welfare agency. Since ^strLastDate, have you talked with a caseworker?

Question Type: TYN

yes 1 YES

no 2 NO

Logic after:

if SF1A = 2 = NO GOTO P_SFEND

---------------------------------------------------------------------------------

P_SF2n [ PSF2a ] # Ds/Ws/Ms since last talked to CW - #

How long ago did you last talk with a caseworker?


NUMBER:

Question Type: 0..97

---------------------------------------------------------------------------------

P_SF2a [ PSF2u ] # Ds/Ws/Ms since last talked to CW - d/w/m

(Is that the number of days, weeks, or months?)

Question Type: TDWM

days 1 DAYS

weeks 2 WEEKS

months 3 MONTHS

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, FILL: Since (fill CONTACT DATE)/IF WAVE = 2, FILL: Since (DATE OF LAST

INTERVIEW)

P_SF3n [ PSF3a ] # diff CWs met/talked to

Since ^strLastDate, how many different caseworkers from the child welfare agency have you met

or talked with?


NUMBER OF CASEWORKERS:

Question Type: 0..97

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

IF WAVE = 1, FILL: Since (fill CONTACT DATE)/IF WAVE = 2, FILL: Since (DATE OF LAST

INTERVIEW) IF P_SF3n>1, FILL: caseworkers else fill caseworker

P_SF5a [ PSF5a ] CW listened to Rs concerns

In all your meetings or talks since ^strLastDate do you feel the ^fills.P_SF5A listened to your

concerns...

Question Type: TFreq3F

never 1 never,

notv 2 not very often,

some 3 some of the time, or

all 4 all of the time?

Question Fill: ^FillP_SF5A

CWRKR caseworker

CWRKRS caseworkers

---------------------------------------------------------------------------------

P_SF7a [ PSF7a ] CW treated R w/respect

Do you feel the ^fills.P_SF5A treated you with respect...

Question Type: TFreq3F

never 1 never,

notv 2 not very often,

some 3 some of the time, or

all 4 all of the time?

Question Fill: ^FillP_SF5A

CWRKR caseworker

CWRKRS caseworkers

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

Logic before:

IF P_SF3n>1, FILL: caseworkers else fill caseworker

P_SF12a [ PSF12a ] Way CW invlvd R in decisn-makng

How satisfied have you been with the extent to which the ^fills.P_SF5A involved you in decision-

making regarding the care of ^CHILD? Would you say you have been...

Question Type: THwSatna

verydis 1 very dissatisfied,

diss 2 dissatisfied,

sati 3 satisfied, or

verysat 4 very satisfied?

NA 5 NOT APPLICABLE

Question Fill: ^FillP_SF5A

CWRKR caseworker

CWRKRS caseworkers

---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_SFEND [ PSFEND ] NO LABEL

PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont



Permission for Data Linkage (CG)

---------------------------------------------------------------------------------

P_LK1 [ PLK1 ] NO LABEL



The information you have provided so far is very helpful to the study. The NSCAW interviews with you and your child can be more valuable to researchers when your answers are combined with other data. This includes information that exists now as well as future information. This section of the survey asks for your approval to add other sources of information about you and your child to your interview data.


We would add three types of information to you and your child’s survey data.

  • We would add records collected from child welfare services agencies taking part in the study. Adding this information will help us learn about foster care, adoption, or other services you and your child receive.

  • We would add data about your household’s income, such as wages and disability benefits from the Social Security Administration and from data available to the Administration for Children and Families---the agency funding the study.

  • Researchers interested in NSCAW may wish to add other types of information in the future. For example, in the past, data on county or state child welfare policies have been added to NSCAW interviews.



Your permission allows us to add these other types of information to you and your child’s survey data. We will add this information to you and your child’s interview data until your child becomes an adult (turns 18 years old). We can add some of the information about you and your child now. Some of the information we will add in the future.

Your permission to add other information will stop when your child turns 18 years old. When your child turns 18 years old, we will ask your child’s permission to add new information. Your child’s permission will allow us to add information about your child’s adult life.

How will combine the data and who will have access?

We will allow researchers to do studies that combine your NSCAW survey with the information we collect from other sources. We created a well-defined plan to protect the data shared with other researchers. The study must first be approved by persons responsible for protecting the rights of those who take part in research studies. The researchers will use the data to write reports. None of these reports will include your name or your child’s name.

What are the risks and benefits with granting permission for this request?

We have significant protections in place to collect and store your information securely. However, there is a small risk that if someone does not follow the rules we set, someone outside the study team might see your information. We minimize this risk by transferring and storing your information and interview data using a study ID and not your name.


Combining your interview data with other information presents no direct benefits to you. Your decision will not affect any services you receive now or in the future.



By answering yes, you give permission for us to link you and your child’s NSCAW data with other information and share it with researchers for other approved research studies. You have the right to say yes or no to this request. If in the future you decide you no longer want you or your child’s interview data combined with other records, you can opt out of this request and stop further collection from outside sources.


01 = Yes, I agree to link and share my NSCAW information to other sources like those described above. Your approval takes effect when RTI releases information from this round to researchers.

02 = No, I do not want to add the other types of information described above to my first NSCAW interview.


[Click here] if you would like to download a copy of this form that you can print.



P_LK1b

We would also like to better understand the types of health care your child may receive. Linking interview data from you and your child to information on Medicaid services your child receives helps researchers have a complete picture of the services your child receives. Only NSCAW researchers at RTI International will have access to your child’s health information.

If you agree to this request, you give consent to the U.S. Department of Health and Human Services (DHHS) and the Centers for Medicare and Medicaid Services (CMS) to use or release your health information. This includes the release of your child’s personal identifiable health information for research.

The health information we may use or release for this research includes Medicaid services that the child may receive including:

  • Type of Inpatient or Outpatient Services

  • Diagnoses

  • Medications Prescribed

  • Payments for Services or Medications



My agreement authorizes the release of my child’s health information to the following group:

NSCAW researchers at RTI International, Research Triangle Park, NC.

The law requires DHHS and CMS to protect your child’s health information. Your agreement to this request allows DHHS and CMS to use and/or release your child’s health information for this research.

DHHS or CMS cannot withhold or refuse treatment, payment, or enrollment in a health plan. Agreeing to this request will not affect your eligibility for benefits.

Your child’s information may be provided, as part of this research, to persons who may not be required by Federal privacy laws (such as HIPAA) to protect it and may further share your information with others without your permission, if permitted by laws governing them.

You may change your mind and cancel this agreement at any time. If you decide to withdraw your approval in the future, CMS and DHHS will not provide new health information to the research project. The health information already provided will continue to be part of the research process.

To withdraw your approval, you must contact:

RTI International

Attention: RTI Privacy Officer

3040 E. Cornwallis Road

P.O. Box 12194 Research Triangle Park, NC 27709-2194

(800) 334-8571 extension 22742


[Click here] if you would like to download a copy of this form that you can print.


P_LK2.

By answering yes, you give consent to the U.S. Department of Health and Human Services (DHHS) and the Centers for Medicare and Medicaid Services (CMS) to use or release your health information.

01 = Yes, I agree to give consent to the U.S. Department of Health and Human Services (DHHS) and the Centers for Medicare and Medicaid Services (CMS) to use or release my health information.


02 = No, I do not give consent to the U.S. Department of Health and Human Services (DHHS) and the Centers for Medicare and Medicaid Services (CMS) to use or release my health information.


IF P_LK2 = 1

Please enter your child’s date of birth.


This agreement will expire at the end of this research study or when your child turns 18 and reaches the age of legal consent.


If you have any questions about this request, please contact Jennifer Keeney at RTI International (toll-free at 800-334-8571 extension 23525) or RTI's Office of Human Research Protections at 1-866-214-2043 (a toll-free number) to record this request.




---------------------------------------------------------------------------------

P_LKEND [ PLKEND ] NoDeliv

PLEASE PRESS "1" AND ENTER TO CONTINUE.

Question Type: TCont, NoDK, NoRF

Continue 1 Continue



Verifications (CG)

---------------------------------------------------------------------------------

P_VF1a [ PVF1 ] NO LABEL

As part of RTI's quality program, we plan to contact a portion of the persons participating in this

survey to verify the work of our interviewers. The questions you

would be asked, if you are selected, are general. This is only to verify the work of our interviewers,


Would you be agreeable to a verification call from our team?

1 = Yes

2 = No



---------------------------------------------------------------------------------

---------------------------------------------------------------------------------

P_VF5a [ PVF5 ] NO LABEL


This is the end of the survey. Thank you so much for your input.

To show our appreciation for your time and effort, we would like to send you a link to an Amazon gift card for $50. for participating in the interview.If you do not wish to receive this gift card, please click the box below. Please provide a valid e-mail address for where you would like us to send the gift card.


Allow a week for delivery.


E-mail:

Retype e-mail:

Please click “Next”.

  • I do not want to receive an Amazon gift card for completing this survey.

Finally, sometimes the personal issues brought up in this survey can cause people to become upset and in need of speaking with a counselor. If you are feeling upset or disturbed by the personal issues in this survey and would like to talk with someone about your feelings, we suggest you call your doctor, counselor, or other treatment provider if you are currently under someone’s care.

If not, there is also a National Lifeline Network number you can call where counselors are available to talk at any time of the day or night. They can also give you information about additional mental health services in your area.

Their toll-free number is 1-800-273-8255.

Thank you for participating in this survey!



i


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorSmith, Keith R.
File Modified0000-00-00
File Created2023-08-28

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