CYFAR Surveys

Children, Youth and Families at Risk (CYFAR) Year End Report

Survey Screenshots Updated for Readability

OMB: 0524-0043

Document [pdf]

Download: pdf | pdf

CYFAR COMMON MEASURES COVER PAGE

Directions for Developing Participant Identification (ID) Numbers:
Answer the following prompts to develop a participant-specific ID number. Note
that each participant should be assigned his/her own specific ID number because
this ID will be used to link a participant’s pre-survey and post-survey. (For
additional information, see the example provided in the text box below)

First 2 letters
of
participant’s
LAST NAME

(DATE )
PARTICIPANT
WAS BORN
(2 digits)

First 2 letters
of
participant’s
FIRST NAME

EXAMPLE: Developing an ID Number for Jane Doe
Name: Jane Doe
Date of Birth: 04/15/08

Adult test - Post Survey
ADULT RESILIENCE MEASURE-REVISED (ARM-R)
To what extent do the following statements apply to you? There are no right or wrong
answers.
#

Item

Not at all

A little

Somewhat

1. I cooperate with people around me.
2. Getting and improving qualifications or skills is
important to me.
3. I know how to behave in different social
situations.
4. My family has usually supported me through life.
5. My family knows a lot about me.
6. If I am hungry, I can get food to eat.
7. People like to spend time with me.
8. I talk to my family/partner about how I feel.
9. I feel supported by my friends.
10. I feel that I belong in my community.
11. My family/partner stands by me during difficult
times.
12. My friends stand by me during difficult times.
13. I am treated fairly in my community.
14. I have opportunities to show others that I can act
responsibly.
15. I feel secure when I am with my family/partner.
16. I have opportunities to apply my abilities in life
(like skills, a job, caring for others).
17. I enjoy my family's/partner's cultural and family
traditions.

(Post)

Page 1

ID:

Quite a bit

A lot

ADULT - SKILLS FOR EVERYDAY LIVING
#

Item

Never

Rarely

Sometimes

1. When I have a decision to make: I look for
information to help me understand the problem.
2. When I have a decision to make: I think before
making a choice.
3. When I have a decision to make: I consider the
risks of a choice before making a decision.
4. When I have a decision to make: I think about all
the information I have about the different
choices.
5. When I have a decision to make: I think of past
choices when making new decisions.
6. When I think: I can easily express my thoughts
on a problem.
7. When I think: I usually have more than one
source of information before making a decision.
8. When I think: I compare ideas when thinking
about a topic.
9. When I think: I keep my mind open to different
ideas when planning to make a decision.
10. When I think: I am able to tell the best way of
handling a problem.
11. When I communicate with others: I try to keep
eye contact.
12. When I communicate with others: I recognize
when two people are trying to say the same
thing, but in different ways.
13. When I communicate with others: I try to see the
other person's point of view.
14. When I communicate with others: I change the
way I talk to someone based on my relationship
with them (i.e. friend, parent, teacher, etc.).
15. When I communicate with others: I organize
thoughts in my head before speaking.
16. When I communicate with others: I make sure I
understand what another person is saying before
I respond.
17. When setting a goal: I look at the steps needed
to achieve the goal.
18. When setting a goal: I think about how and when
I want to achieve the goal.
19. When setting a goal: After setting a goal, I break
goals down into steps so I can check my
progress.
20. When setting a goal: Both positive and negative
feedback helps me work towards my goal.
21. When solving a problem: I first figure out exactly
what the problem is.
22. When solving a problem: I try to determine what
caused the problem.
23. When solving a problem: I do what I have done
in the past to solve it.
24. When solving a problem: I compare each
possible solution with the others to find the best
one.

(Post)

Page 2

ID:

Often

Always

25. When solving a problem: After selecting a
solution, I think about it for a while before putting
it into action.
26. When solving a problem: Once I have solved a
problem, I think about how my solution worked.

(Post)

Page 3

ID:

ADULT PROGRAM QUALITY INSTRUMENT
The following statements describe how your program may work.
#

Item

Never

Rarely

Sometimes

1. Participants feel safe when they are at the
program.
2. Participants spread rumors about others.
3. Participants keep others from being part of
activities or groups.
4. Staff in this program are good listeners.
5. Staff are eager to help participants.
6. Participants are willing to help each other.
7. The program has rules about what sorts of
behaviors are expected.
8. Staff treat participants fairly.
9. Participants are kind to one another.
10. Participants and staff work together to plan
activities.
11. Participants choose the activities they want to
do.
12. Participants are encouraged to be leaders.
13. Participants learn from activities that are
challenging.
14. Participants learn about different cultures.
15. Participants learn new ways to communicate
their ideas.
16. Participants follow the rules of the program.
17. Staff explain the rules to everyone.
18. Guidelines and rules are enforced daily.
19. Everyone's family gets invited to come to the
program's activities.
20. Participants learn about community resources
(e.g., libraries, parks, and health department).
21. Participants contribute to the community by
helping others.
22. Participants feel accepted.
23. Participants feel like they can be themselves.
24. Staff get to know participants by interacting with
them.

(Post)

Page 4

ID:

A lot

Always

ADULT ENGAGEMENT SURVEY
#

Item

Not at all

A little

Somewhat

1. How much choice did you have about this
activity?
2. How important was this activity to you?
3. Was it interesting?
4. Was it challenging?
5. Did you enjoy what you were doing?
6. How hard were you concentrating?
7. Were you using your skills?
8. Do you wish you were doing something else?

(Post)

Page 5

ID:

Very much

ADULT PARTICIPATION LEVEL
1. How many of the sessions did you attend?

Item

Less than 1
hour

1 hour

2-3 hours

4-5 hours

6 or more hours

2. How many hours per session did you participate
in this program?

Item
Less than
1 year

1 year

2-3 years

4-5 years

6-7 years

10 or more
8-9 years
years

I do not
know

This is not
a 4-H
program

3. How long have you
participated in 4-H, either
as a participant or
volunteer?

Item

Yes

4. Are you involved in any other
community/volunteer activities (e.g., civic, faithbased, sports, clubs)?

5. If yes, how many other community/volunteer activities (e.g., civic, faith-based, sports, clubs) are you
involved in?

(Post)

Page 6

ID:

ADULT DEMOGRAPHIC DATA
1. I am a:
Male
Female
2. How old are you?

3. What is your ethnicity? (Select one)
Hispanic or Latino
Not Hispanic or Latino
4. What is your race? (Select one or more)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
5. What is your highest level of education completed?
Less than high school
High school diploma/GED
Post-secondary technical training
Some college
Associate's degree
Bachelor's degree
Graduate degree
6. If you have ever served in the military, please specify the branch:
I have not served in the military.
Air Force
Army
Guard
Marine Corps
Navy
Reserve

(Post)

Page 7

ID:

CYFAR COMMON MEASURES COVER PAGE

First 2 letters
of
participant’s
LAST NAME

(DATE )
PARTICIPANT
WAS BORN
(2 digits)

First 2 letters
of
participant’s
FIRST NAME

EXAMPLE: Developing an ID Number for Jane Doe
Name: Jane Doe
Date of Birth: 04/15/08

Adult test - Pre Survey
ADULT RESILIENCE MEASURE-REVISED (ARM-R)
To what extent do the following statements apply to you? There are no right or wrong
answers.
#

Item

Not at all

A little

Somewhat

(Pre)

Page 1

ID:

Quite a bit

A lot

ADULT - SKILLS FOR EVERYDAY LIVING
#

Item

Never

Rarely

Sometimes

(Pre)

Page 2

ID:

Often

Always

(Pre)

Page 3

ID:

ADULT DEMOGRAPHIC DATA
1. I am a:
Male
Female
2. How old are you?

(Pre)

Page 4

ID:

CYFAR COMMON MEASURES COVER PAGE

First 2 letters
of
participant’s
LAST NAME

(DATE )
PARTICIPANT
WAS BORN
(2 digits)

First 2 letters
of
participant’s
FIRST NAME

EXAMPLE: Developing an ID Number for Jane Doe
Name: Jane Doe
Date of Birth: 04/15/08

Test for OMB - Post Survey
CHILD & YOUTH RESILIENCE MEASURE-REVISED (CYRM-R)
Please choose one answer for each question. There are no right or wrong answers.
#

Item

Not at all

A little

Somewhat

1. Do you share with people around you?

2. Is doing well in school important to you?

3. Do you know how to behave/act in different
situations (such as school, home, holy places)?
4. Do you feel that your parent(s)/caregiver(s) know
where you are and what you are doing all of the
time?
5. Do you feel that your parent(s)/caregiver(s) know
a lot about you (for example, what makes you
happy, what makes you scared)?
6. Is there enough to eat in your home when you
are hungry?
7. Do other children like to play with you?

8. Do you talk to your family/caregiver(s) about how
you feel (for example, when you are hurt or
feeling scared)?
9. Do you have friends that care about you?

10. Do you feel you fit in with other children?

11. Do you think your family/caregiver(s) cares about
you when times are hard (for example, if you are
sick or have done something wrong)?
12. Do you think your friends care about you when
times are hard (for example, if you are sick or
have done something wrong)?
13. Are you treated fairly?

14. Do you have chances to show others that you
are growing up and can do things by yourself?
15. Do you feel safe when you are with your
family/caregiver(s)?
16. Do you have chances to learn things that will be
useful when you are older (like cooking, working,
and helping others)?
17. Do you like the way your family/caregiver(s)
celebrates things (like holidays or learning about
your culture)?

(Post)

Page 1

ID:

Quite a bit

A lot

LIFE SKILLS - CHILD
#

Item

Never

Rarely

Sometimes

Often

Always

Never

Rarely

Sometimes

Often

Always

Never

Rarely

Sometimes

Often

Always

Item

6. When I think: I can easily express my thoughts
on a problem.
7. When I think: I usually have more than one
source of information before making a decision.
8. When I think: I compare ideas when thinking
about a topic.
9. When I think: I keep my mind open to different
ideas when planning to make a decision.
10. When I think: I am able to tell the best way of
handling a problem.

Item

11. When I communicate with others: I try to keep
eye contact.
12. When I communicate with others: I recognize
when two people are trying to say the same
thing, but in different ways.
13. When I communicate with others: I try to see the
other person's point of view.
14. When I communicate with others: I change the
way I talk to someone based on my relationship
with them (i.e. friend, parent, teacher, etc.)
15. When I communicate with others: I organize
thoughts in my head before speaking.
16. When I communicate with others: I make sure I
understand what another person is saying before
I respond.

(Post)

Page 2

ID:

Item

Never

Rarely

Sometimes

Often

Always

Never

Rarely

Sometimes

Often

Always

17. When setting a goal: I look at the steps needed
to achieve the goal.
18. When setting a goal: I think about how and when
I want to achieve the goal.
19. When setting a goal: After setting a goal, I break
goals down into steps so I can check my
progress.
20. When setting a goal: Both positive and negative
feedback helps me work towards my goal.

Item

21. When solving a problem: I first figure out exactly
what the problem is.
22. When solving a problem: I try to determine what
caused the problem.
23. When solving a problem: I do what I have done
in the past to solve it.
24. When solving a problem: I compare each
possible solution with the others to find the best
one.
25. When solving a problem: After selecting a
solution, I think about it for a while before putting
it into action.
26. When solving a problem: Once I have solved a
problem, I think about how my solution worked.

(Post)

Page 3

ID:

CHILD PROGRAM QUALITY INSTRUMENT
The following statements describe how your program may work.
#

Item

Never

Rarely

Sometimes

1. Young people feel safe when they are at the
program.
2. Young people spread rumors about others.

3. Young people keep others from being part of
activities or groups.
4. Adults in this program are good listeners.

5. Adults are eager to help young people.

6. Young people are willing to help each other.

7. The program has rules about what sorts of
behaviors are expected.
8. Adults treat young people fairly.

9. Young people are kind to one another.

10. Young people and adults work together to plan
activities.
11. Young people choose the activities they want to
do.
12. Young people are encouraged to be leaders.

13. Young people learn from activities that are
challenging.
14. Young people learn about different cultures.

15. Young people learn new ways to communicate
their ideas.
16. Young people follow the rules of the program.

17. Adults explain the rules to everyone.

18. Guidelines and rules are enforced daily.

19. Everyone's family gets invited to come to the
program's activities.
20. Young people learn about community resources
(e.g., libraries, parks, and health department).
21. Young people contribute to the community by
helping others.

(Post)

Page 4

ID:

A lot

Always

22. Young people feel accepted.

23. Young people feel like they can be themselves.

24. Adults get to know young people by interacting
with them.

(Post)

Page 5

ID:

CYFAR COMMON MEASURES COVER PAGE

First 2 letters
of
participant’s
LAST NAME

(DATE )
PARTICIPANT
WAS BORN
(2 digits)

First 2 letters
of
participant’s
FIRST NAME

EXAMPLE: Developing an ID Number for Jane Doe
Name: Jane Doe
Date of Birth: 04/15/08

Test for OMB - Pre Survey
CHILD & YOUTH RESILIENCE MEASURE-REVISED (CYRM-R)
Please choose one answer for each question. There are no right or wrong answers.
#

Item

Not at all

A little

Somewhat

1. Do you share with people around you?

2. Is doing well in school important to you?

8. Do you talk to your family/caregiver(s) about how
you feel (for example, when you are hurt or
feeling scared)?
9. Do you have friends that care about you?

10. Do you feel you fit in with other children?

(Pre)

Page 1

ID:

Quite a bit

A lot

LIFE SKILLS - CHILD
#

Item

Never

Rarely

Sometimes

Often

Always

Never

Rarely

Sometimes

Often

Always

Never

Rarely

Sometimes

Often

Always

Item

(Pre)

Page 2

ID:

Item

Never

Rarely

Sometimes

Often

Always

Never

Rarely

Sometimes

Often

Always

Item

(Pre)

Page 3

ID:

CYFAR COMMON MEASURES COVER PAGE

First 2 letters
of
participant’s
LAST NAME

(DATE )
PARTICIPANT
WAS BORN
(2 digits)

First 2 letters
of
participant’s
FIRST NAME

EXAMPLE: Developing an ID Number for Jane Doe
Name: Jane Doe
Date of Birth: 04/15/08

Test 4 Survey - Post Survey
YOUTH RESILIENCE MEASURE-REVISED (CYRM-R)
To what extent do the following statements apply to you? There are no right or wrong
answers.
#

Item

Not at all

A little

Somewhat

1. I cooperate with people around me.
2. Getting an education is important to me.
3. I know how to behave in different social
situations.
4. My parent(s)/caregiver(s) really look out for me.
5. My parent(s)/caregiver(s) know a lot about me.
6. If I am hungry, there is enough to eat.
7. People like to spend time with me.
8. I talk to my family/caregiver(s) about how I feel.
9. I feel supported by my friends.
10. I feel that I belong/belonged at my school.
11. My family/caregiver(s) stand by me during
difficult times.
12. My friends stand by me during difficult times.
13. I am treated fairly in my community.
14. I have opportunities to show others that I am
becoming an adult and can act responsibly.
15. I feel safe when I am with my family/caregiver(s).
16. I have opportunities to develop skills that will be
useful later in life (like job skills and skills to care
for others).
17. I enjoy my family's/caregiver's cultural and family
traditions.

(Post)

Page 1

ID:

Quite a bit

A lot

YOUTH PROGRAM QUALITY INSTRUMENT
The following statements describe how your program may work.
#

Item

Never

Rarely

Sometimes

1. Young people feel safe when they are at the
program.
2. Young people spread rumors about others.
3. Young people keep others from being part of
activities or groups.
4. Adults in this program are good listeners.
5. Adults are eager to help young people.
6. Young people are willing to help each other.
7. The program has rules about what sorts of
behaviors are expected.
8. Adults treat young people fairly.
9. Young people are kind to one another.
10. Young people and adults work together to plan
activities.
11. Young people choose the activities they want to
do.
12. Young people are encouraged to be leaders.
13. Young people learn from activities that are
challenging.
14. Young people learn about different cultures.
15. Young people learn new ways to communicate
their ideas.
16. Young people follow the rules of the program.
17. Adults explain the rules to everyone.
18. Guidelines and rules are enforced daily.
19. Everyone's family gets invited to come to the
program's activities.
20. Young people learn about community resources
(e.g., libraries, parks, and health department).
21. Young people contribute to the community by
helping others.
22. Young people feel accepted.
23. Young people feel like they can be themselves.
24. Adults get to know young people by interacting
with them.

(Post)

Page 2

ID:

A lot

Always

YOUTH ENGAGEMENT SURVEY
#

Item

Not at all

A little

Somewhat

Very much

Item

Yes

9. Do you participate in any other after-school
activities?

(Post)

Page 3

ID:

YOUTH DEMOGRAPHIC DATA
1. I am a:
Male
Female
2. How old are you?

3. What grade are you in school?

4. What is your ethnicity? (Select one)
Hispanic or Latino
Not Hispanic or Latino
5. What is your race? (Select one or more)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
6. If one (or both) of your parents is involved in the military, please specify the branch:
My parent is not involved in the military.
Air Force
Army
Guard
Marine Corps
Navy
Reserve

(Post)

Page 4

ID:

YOUTH - SKILLS FOR EVERYDAY LIVING
#

Item

Never

Rarely

Sometimes

1. When I have a decision to make: I look for
information to help me understand the problem.
2. When I have a decision to make: I think before
making a choice.
3. When I have a decision to make: I consider the
risks of a choice before making a decision.
4. When I have a decision to make: I think about all
the information I have about the different
choices.
5. When I have a decision to make: I think of past
choices when making new decisions.
6. When I think: I can easily express my thoughts
on a problem.
7. When I think: I usually have more than one
source of information before making a decision.
8. When I think: I compare ideas when thinking
about a topic.
9. When I think: I keep my mind open to different
ideas when planning to make a decision.
10. When I think: I am able to tell the best way of
handling a problem.
11. When I communicate with others: I try to keep
eye contact.
12. When I communicate with others: I recognize
when two people are trying to say the same
thing, but in different ways.
13. When I communicate with others: I try to see the
other person's point of view.
14. When I communicate with others: I change the
way I talk to someone based on my relationship
with them (i.e., friend, parent, teacher, etc.).
15. When I communicate with others: I organize
thoughts in my head before speaking.
16. When I communicate with others: I make sure I
understand what another person is saying before
I respond.
17. When setting a goal: I look at the steps needed
to achieve the goal.
18. When setting a goal: I think about how and when
I want to achieve the goal.
19. When setting a goal: After setting a goal, I break
goals down into steps so I can check my
progress.
20. When setting a goal: Both positive and negative
feedback helps me work towards my goal.
21. When solving a problem: I first figure out exactly
what the problem is.
22. When solving a problem: I try to determine what
caused the problem.
23. When solving a problem: I do what I have done
in the past to solve it.
24. When solving a problem: I compare each
possible solution with the others to find the best
one.

(Post)

Page 5

ID:

Often

Always

(Post)

Page 6

ID:

CYFAR COMMON MEASURES COVER PAGE

First 2 letters
of
participant’s
LAST NAME

(DATE )
PARTICIPANT
WAS BORN
(2 digits)

First 2 letters
of
participant’s
FIRST NAME

EXAMPLE: Developing an ID Number for Jane Doe
Name: Jane Doe
Date of Birth: 04/15/08

Test 4 Survey - Pre Survey
YOUTH RESILIENCE MEASURE-REVISED (CYRM-R)
To what extent do the following statements apply to you? There are no right or wrong
answers.
#

Item

Not at all

A little

Somewhat

(Pre)

Page 1

ID:

Quite a bit

A lot

YOUTH DEMOGRAPHIC DATA
1. I am a:
Male
Female
2. How old are you?

3. What grade are you in school?

(Pre)

Page 2

ID:

YOUTH - SKILLS FOR EVERYDAY LIVING
#

Item

Never

Rarely

Sometimes

1. When I have a decision to make: I look for
information to help me understand the problem.
2. When I have a decision to make: I think before
making a choice.
3. When I have a decision to make: I consider the
risks of a choice before making a decision.
4. When I have a decision to make: I think about all
the information I have about the different
choices.
5. When I have a decision to make: I think of past
choices when making new decisions.
6. When I think: I can easily express my thoughts
on a problem.
7. When I think: I usually have more than one
source of information before making a decision.
8. When I think: I compare ideas when thinking
about a topic.
9. When I think: I keep my mind open to different
ideas when planning to make a decision.
10. When I think: I am able to tell the best way of
handling a problem.
11. When I communicate with others: I try to keep
eye contact.
12. When I communicate with others: I recognize
when two people are trying to say the same
thing, but in different ways.
13. When I communicate with others: I try to see the
other person's point of view.
14. When I communicate with others: I change the
way I talk to someone based on my relationship
with them (i.e., friend, parent, teacher, etc.).
15. When I communicate with others: I organize
thoughts in my head before speaking.
16. When I communicate with others: I make sure I
understand what another person is saying before
I respond.
17. When setting a goal: I look at the steps needed
to achieve the goal.
18. When setting a goal: I think about how and when
I want to achieve the goal.
19. When setting a goal: After setting a goal, I break
goals down into steps so I can check my
progress.
20. When setting a goal: Both positive and negative
feedback helps me work towards my goal.
21. When solving a problem: I first figure out exactly
what the problem is.
22. When solving a problem: I try to determine what
caused the problem.
23. When solving a problem: I do what I have done
in the past to solve it.
24. When solving a problem: I compare each
possible solution with the others to find the best
one.

(Pre)

Page 3

ID:

Often

Always

(Pre)

Page 4

ID:

File Type	application/pdf
File Modified	2024-01-31
File Created	2024-01-31