Study participants quarterly interviews

Confidential

SHIPS
Page 1

Quarterly Work & Housing Interview
Record ID.

REDCap Username.

__________________________________

__________________________________

Quarterly Work and Housing Interview
Reminder about resources to help you cope with distress.  
When you enrolled in this study, you were provided with a list of resources to help you cope
with negative feelings and reactions to these interviews.  These resources can also help you
with other problems in your life not related to the study.
If you do not remember receiving this information, we will provide it to you immediately
following this interview.
Data Entry Date

Interview Date

__________________________________

__________________________________

Employment. We will now ask you about employment services and any jobs you held in the
past three months.
During the past three months, in which of these
employment services have you participated?

You indicated that you participated in employment
services other than Worksource Centers, Individual
Placement and Support, or Chrysalis. What service or
services did you participate in?
How many times did you meet with a provider of the
employment services in which you participated?

Have you worked at a job or business for pay since the
last interview/in the last three months?

12/05/2024 1:37pm

Worksource Center Services (WCS)
Individual Placement and Support (IPS)
Chrysalis
Other
None
I do not know
(If the participant is unsure, locations of WCS or
names of IPS employment specialists can be used as
references.)

__________________________________

1 time
2 to 5 times
5 to 10 times
more than 10 times
(If more than one service, an estimate of the total
number of meetings with all providers.)
Yes
No

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How many jobs have you held in the last three months?

MAIN Job: Who is/was your employer?

MAIN Job: What is/was your hourly wage?

MAIN Job: About how many hours per day did you work?

MAIN Job: About how many days per week did you work?

MAIN Job: How many weeks have you worked during the
past three months?

1
2
3

__________________________________
(employer name)

__________________________________
(Please enter a number with 2 decimal places (i.e.
12.50).)

__________________________________
(Please enter an integer from 1 to 24)

__________________________________
(Please enter an integer from 1 to 7)

__________________________________
(Please enter an integer from 1 to 12.)

MAIN Job: Are you still working there?

Yes
No

MAIN Job: What was the nature of the job ending?

quit
fired
laid off
time-limited
reassignment
other

SECOND Job: Who is/was your employer?

SECOND Job: What is/was your hourly wage?

SECOND Job: About how many hours per day did you work?

SECOND Job: About how many days per week did you work?

SECOND Job: How many weeks have you worked during the
past three months?

SECOND Job: Are you still working there?

12/05/2024 1:37pm

__________________________________
(employer name)

__________________________________
(Please enter a number with 2 decimal places (i.e.
12.50).)

__________________________________
(Please enter an integer from 1 to 24)

__________________________________
(Please enter an integer from 1 to 7)

__________________________________
(Please enter an integer from 1 to 12.)
Yes
No

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SECOND Job: What was the nature of the job ending?

THIRD Job: Who is/was your employer?

THIRD Job: What is/was your hourly wage?

THIRD Job: About how many hours per day did you work?

THIRD Job: About how many days per week did you work?

THIRD Job: How many weeks have you worked during the
past three months?

quit
fired
laid off
time-limited
reassignment
other

__________________________________
(employer name)

__________________________________
(Please enter a number with 2 decimal places (i.e.
12.50).)

__________________________________
(Please enter an integer from 1 to 24)

__________________________________
(Please enter an integer from 1 to 7)

__________________________________
(Please enter an integer from 1 to 12.)

THIRD Job: Are you still working there?

Yes
No

THIRD Job: What was the nature of the job ending?

quit
fired
laid off
time-limited
reassignment
other

Current Housing. We will now ask you about your housing in the past three months.
During the past three months, how many different
supportive housing units have you lived in?

1
2
3

Are you currently living in your supportive housing
unit?

Yes
No
Prefer not to answer

Please indicate any other place you have slept for at
least one night during the past three months:

Someone else's apartment or home
In a shelter, emergency, temporary housing
Hotel/motel provided by an agency
Outside on the street, park, or beach
Tent or makeshift shelter
In a bus station, train station, airport
Abandoned building
In a vehicle (car, van, RV, truck)
An institution, hospital, or facility
None of these

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What type of institution, hospital, or facility did
you stay in? (select all that apply)

12/05/2024 1:37pm

Hospital
Substance abuse treatment, detox, or recovery
center/rehab
Jail, prison, or juvenile detention facility
Foster home or group home
Long-term care facility, nursing home, or Board
and Care
Prefer not to answer

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