HPOG-Impact 15-month Control Group Member Follow-Up survey

Supporting Statement for OMB Clearance Request

Appendix J: HPOG-Impact 15-month Control Group Member Follow-Up Survey

National Implementation Evaluation of the Health Profession Opportunity Grants (HPOG) to Serve TANF Recipients and Other Low-Income Individuals and HPOG Impact Study

0970-0394

April 24, 2013

Submitted by:

Office of Planning,
Research & Evaluation

Administration for Children & Families

U.S. Department of Health
and Human Services

Federal Project Officers:

Molly Irwin and Mary Mueggenborg

Appendix J: HPOG-Impact 15-month Control Group Member Follow-Up Survey

Introduction

Hello, my name is [ ]. May I please speak with _____?

Thank you for taking the time to talk with me today. I work for a company called Abt SRBI. Abt SRBI is an independent research company and we are helping the Administration for Children and Families (ACF) in the U.S. Department of Health and Human Services (HHS) with its evaluation of the Health Profession Opportunity Grants (HPOG) program. You agreed to be part of the study around [RAD] (when you signed a consent form to let researchers collect information from you).

We need to talk with people who got into the program and those who did not. Your participation in this study will help policymakers and program operators better understand how to help people attain educational credentials and find and keep jobs in the healthcare field. This interview will include questions on your education activities, your use of services, and your overall well-being.

The questions will take about 35 minutes to complete, and when we are done, you will receive $30, in appreciation for your time. Before we begin the survey, I would like to assure you that all of your responses on this survey will be kept private; your name will not appear in any written reports we produce. Your responses to these questions are completely voluntary. That means you may choose not to answer any question, or you may stop the interview if you wish, but we hope you don’t. Your responses to these questions will in no way affect your participation in any programs or your receipt of any kinds of public benefits or services. The information you provide will be kept private and only used for this study.

According to the Paperwork Reduction Act (PRA), an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is 0970-0394 and it expires xx/xx/xxxx. If you have comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, please send them to [Contact Name]; [Contact Address]; Attn: OMB-PRA (0970-0397).Do you have any questions before we begin?

Let’s begin now.

Screener/Verification:

First I just need to verify that I am speaking with the correct person.

1. What is your date of birth?

2. What are the last 4 digits of your Social Security Number?

Topic	Source	ISIS Item	Notes on Coordination
Type and amount of vocational and academic training and degrees/certification received since random assignment
My first set of questions is about any school or training experiences you have had since [RAD]. To help you remember this date, our records show that it was about then that you applied for the [HPOG] program [AT (NAME OF HOST INSITUTION, IF DIFFERENT FROM PROGRAM NAME)]. Since [RAD], have you taken any classes or been in an instructional program of any kind anywhere, even for a short time? This may have been offered by a community organization, college, high school, employer, or somewhere else. YES NO REFUSED DON’T KNOW	ISIS follow-up	No change
Did you take these classes at one school or organization, or did you take these classes at more than one place? ONE SCHOOL OR ORGANIZATION MORE THAN ONE SCHOOL OR ORGANIZATION IF MORE THAN ONE: How many places did you take classes?	Adapted from ISIS follow-up	Did you go to one school or organization, or did you go to more than one place? (No change to answer choices) IF Yes: How many places did you go?	To make clear that the prior question’s classes are what we are asking about. ISIS and HPOG coding will be compatible
At what type of place(s) did you take these classes? COMPANY WHERE RESPONDENT WORKS COMMUNITY COLLEGE/2 YEAR COLLEGE 4 YR COLLEGE/UNIVERSITY STATE UNEMPLOYMENT/EMPLOYMENT OFFICE ONE-STOP CENTER ADULT ED/ADULT HS/COMMUNITY SCHOOL/NIGHT SCHOOL PRIVATE COMPANY THAT PROVIDES TRAINING COMMUNITY BASED ORG/NON PROFIT ORG SOME PLACE ELSE (SPECIFY)____ REFUSED DON’T KNOW	Adapted from ISIS follow-up	What type of place is this? [Asked per vendor] (No change to answer choices)	We ask this question once in reference to individual’s entire experience since RAD. HPOG-Impact respondents will note all that apply. ISIS asks this question more than once in reference to each of up to three training vendors where individuals are currently enrolled or have been enrolled since RAD. In order to make the ISIS responses comparable to the non-location-specific version of the questions, for the subsequent questions about respondents’ experiences, we will aggregate across locations to identify simply whether or not an individual enrolled/participated in the particular education/ training/service under question. For example, if an ISIS respondent answers “Yes” to something about Location 1, “No” about Location 2 and “Don’t Know” about Location 3, we would code that as “Yes”:  the respondent had that experience in at least one location.  A “No,” “No,” “Don’t Know” set of responses would “sum” to “No.”
I’m going to mention some different types of classes. For each one, please tell me if it is a type that you are taking or have taken since [RAD]. I’m interested in any classes you have taken, even if you only went for a short time. Classes to improve your basic reading, writing, or math skills or prepare for a high school equivalency or college placement test? Do not count any classes providing regular college credit.(I will ask you about college credit classes separately) Classes to learn English as a Second Language? Again, do not count regular college classes. Classes providing regular college credit? Classes providing occupational training, but not for college credit? Classes in other skills, such as how to succeed at school, work, or other areas of life? (Please include any such classes, whether for college credit or not.)	Adapted from ISIS follow-up	Now I’m going to mention some different types of instruction. For each one, please tell me if it is a type that you are taking or have taken at [PLACE 1] since [RAD]. I’m interested in any classes you have taken, even if you only went for a short time.	Exchanged “different types of instruction” for “different types of classes” which we think is more precise. We ask this question once in reference to individual’s entire (non-location-specific) experience since RAD. ISIS asks this question more than once in reference to each training vendor. Will sum across ISIS location-specific responses (see note re: #3).
IF BASIC SKILLS
I have a few questions about the basic skills classes. How many basic skills courses have you taken (including those you may not have completed) since [RAD]?	Adapted from ISIS follow-up	Are you currently taking these classes (or between terms), did you complete them, or did you stop without completing the classes? Currently taking these classes (or between terms) Completed them Stopped without completing them Refused Don’t know	Modified questions to fit our overall (non-location-specific) experience format. We added the number of classes question because that is an outcome of interest. See note re: #3 on summing across locations.
Are you currently taking any basic skills courses YES NO REFUSED DON’T KNOW	Adapted from ISIS follow-up
Did you start any basic skills courses that you did not complete? YES NO REFUSED DON’T KNOW	Adapted from ISIS follow-up
IF ESL
Now I have some questions about the ESL classes. How many ESL courses have you taken (including those you may not have completed) since [RAD]?	Adapted from ISIS follow-up	Are you currently taking these classes (or between terms), did you complete them, or did you stop without completing the classes? Currently taking these classes (or between terms) Completed them Stopped without completing them Refused Don’t know	Modified questions to fit our overall experience format. We added the number of classes question because that is an output of interest. See note re: #3 on summing across locations.
Are you currently taking any ESL courses YES NO REFUSED DON’T KNOW	Adapted from ISIS follow-up
Did you start any ESL courses that you did not complete? YES NO REFUSED DON’T KNOW	Adapted from ISIS follow-up
IF Other (school/work/life) Skills
Now I’d like to ask about the classes you took in other skills, such as how to succeed at school, work, or other areas of life. Here I’m interested in any classes you took of this type, whether or not they were for college credit. How many other skills courses have you taken (including those you may not have completed) since [RAD]? ______ REFUSED DON’T KNOW	Adapted from ISIS follow-up	Now I’d like to ask about the classes you took in other skills, such as how to succeed at school, work, or other areas of life. Here I’m interested in any classes you took of this type, whether or not they were for college credit. How many other skills courses have you taken (including those you may not have completed) since [RAD]? ______ REFUSED DON’T KNOW	We originally adapted the ISIS text to include this question regarding the number of other classes because that is an output of interest. ISIS then added this new question to its follow-up survey for non-HPOG sites for consistency. Now both the HPOG and ISIS follow-up surveys include the new question.
For about how many days or weeks did you attend these classes?	ISIS follow-up	No change
And about how many hours did you attend these classes each [day/week]?	ISIS follow-up	No change
Are you currently taking any other skills courses right now? YES NO REFUSED DON’T KNOW	Adapted from ISIS follow-up	ISIS does not ask for “other courses”
Did you start any other skills courses that you did not complete? YES NO REFUSED DON’T KNOW	Adapted from ISIS follow-up	ISIS does not ask for “other courses”
Were they offered for college credit? YES NO REFUSED DON’T KNOW	ISIS follow-up		We ask this question once in reference to individual’s entire experience since RAD. ISIS asks this question more than once in reference to each training vendor. See note re: #3 on summing across locations.
I’m going to read a list of subjects that other skills classes sometimes cover. For each one, please tell me whether it received a great deal of attention, some attention, or no attention in any of the soft skills classes you took: Career planning Study skills, such as locating information, taking notes, and preparing for classes and exams Finding a job or moving to a different job Critical thinking and problem-solving skills Finding help with problems at school, work, or home Finding and applying for financial aid for school Managing time effectively Working in groups Communicating well (for example, good listening and speaking skills) Managing stress and anger Staying motivated Acting professionally (for example, how to dress, show good attendance habits, be respectful) Managing money and personal finances Handling parenting and other family responsibilities	Adapted from ISIS follow-up	I’m going to read a list of subjects that instruction like this sometimes covers. For each one, please tell me whether it received a great deal of attention, some attention, or no attention in the classes you took: (No change in answer choices)	Exchanged “instruction” for “other skills classes” which we think is more precise.
IF REGULAR COLLEGE CREDIT
Now I have some questions about classes you have taken for regular college credit. How many classes for college credit have you enrolled in (including those you may not have completed) since [RAD]?	Adapted from ISIS follow-up	Regardless of whether you finished them, about how many classes have you ever enrolled in at [PLACE 1] since [RAD]?	See rationale and note re: #3 on summing across locations.
Have you earned any regular college credits so far since [RAD]? YES NO REFUSED DON’T KNOW IF YES: How many credits have you earned?	Adapted from ISIS follow-up	Have you earned any regular college credits so far at [PLACE 1] since [RAD]? How many credits have you earned? (No change to answer choices)	See rationale and note re: #3 on summing across locations.
About when did you start taking classes for college credit? Please give me the month and year you started.	Adapted from ISIS follow-up	About when did you start going to [PLACE 1]? Please give me the month and year you started. [Asked per vendor]	See rationale and note re: #3 on summing across locations.
Are you currently taking any classes for college credit? (Answer “yes” if you are on a spring, summer, or holiday break.) YES NO REFUSED DON’T KNOW IF NO: About when did you stop taking college credit courses?	Adapted from ISIS follow-up	Are you currently taking classes for college credit? (Answer “yes” if you are on a spring, summer, or holiday break.) What [is/was] your main goal in taking college classes at [PLACE 1]? Did you complete the courses needed to reach the goal you just mentioned? IF NO: Are you still enrolled or between terms? IF NO: Did you stop without completing the program? IF STOPPED WITHOUT COMPLETING: What was the main reason that you stopped attending the classes? (No change in answer choices)	Modified questions to fit our overall experience format.
Did you start any classes for college credit that you did not complete? YES NO REFUSED DON’T KNOW IF STOPPED WITHOUT COMPLETING: What was the main reason that you stopped attending these classes? POOR GRADES COURSES OR PROGRAM POORLY TAUGHT STARTED OTHER SCHOOL/TRAINING NOT ENOUGH MONEY TO CONTINUE NOT ENOUGH TIME TO CONTINUE DIDN’T LIKE PROGRAM NOT INTERESTED IN PROGRAM DIDN’T THINK IT WOULD HELP ME FIND A JOB ILLNESS PREGNANCY CHILD CARE ISSUES OTHER FAMILY REASONS TRANSPORTATION/COORDINATION PROBLEMS FOUND JOB/RE-EMPLOYED OTHER (SPECIFY)____ REFUSED DON’T KNOW	Adapted from ISIS follow-up
IF OCCUPATIONAL TRAINING (not for college credit)
Now I’d like to ask about the occupational training classes you said you have taken. These were the job training courses you took that were not for college credit. How many occupational training courses have you taken (including those you may not have completed) since [RAD]?	Adapted from ISIS follow-up	ISIS does not ask for “occupational training”	We added the number of classes question because that is an outcome of interest.
About when did you start taking occupational training courses? Please give me the month and year you started.	Adapted from ISIS follow-up	About when did you start going to [PLACE 1]? Please give me the month and year you started. [Asked per vendor]	Modified questions to fit our overall experience format.
Are you currently receiving this occupational training? YES NO REFUSED DON’T KNOW IF NO: About when did you stop taking occupational training courses?	Adapted from ISIS follow-up	Are you currently receiving this training, did you complete the training, or did you stop without completing training? CURRENTLY RECEIVING THIS TRAINING COMPLETED THE TRAINING STOPPED WITHOUT COMPLETING REFUSED DON’T KNOW IF STOPPED WITHOUT COMPLETING: What was the main reason that you stopped attending the training? (No change in answer choices)
Did you start any occupational training that you did not complete? YES NO REFUSED DON’T KNOW IF STOPPED WITHOUT COMPLETING: What was the main reason that you stopped attending the training? POOR GRADES COURSES OR PROGRAM POORLY TAUGHT STARTED OTHER SCHOOL/TRAINING NOT ENOUGH MONEY TO CONTINUE NOT ENOUGH TIME TO CONTINUE DIDN’T LIKE PROGRAM NOT INTERESTED IN PROGRAM DIDN’T THINK IT WOULD HELP ME FIND A JOB ILLNESS PREGNANCY CHILD CARE ISSUES OTHER FAMILY REASONS TRANSPORTATION/COORDINATION PROBLEMS FOUND JOB/RE-EMPLOYED OTHER (Please SPECIFY)____ REFUSED DON’T KNOW	Adapted from ISIS follow-up
Academic and industry-recognized credentials earned since random assignment
Now I’m going to ask you questions about your overall training experience since [RAD]. [Are/were] you taking classes to prepare for work in a particular occupation? YES NO REFUSED DON’T KNOW IF YES: Are/were you taking classes to prepare for work in a particular healthcare occupation? IF YES HEALTHCARE: I am going to read you a list of types of healthcare occupations. Please tell me which type you were preparing for when you took those classes: Administrative (such as Medical Records and Health Information Technicians) Technical (such as Medical and Clinical Laboratory Technicians) Direct personal care (such as Home Health Aids or Certified Nursing Assistants) Other, Please specify	Adapted from ISIS follow-up	Now I’m going to ask you questions about your overall training experience since [RAD]. [Are/were] you taking classes to prepare for work in a particular occupation? YES NO REFUSED DON’T KNOW Is this occupation in the field of healthcare? YES NO REFUSED DON’T KNOW I am going to read you a list of types of healthcare occupations. Please tell me which type you were preparing for when you took those classes: Administrative (such as Medical Records and Health Information Technicians) Technical (such as Medical and Clinical Laboratory Technicians) Direct personal care (such as Home Health Aids or Certified Nursing Assistants) Other, Please specify ________________	We ask this question once in reference to individual’s entire experience since RAD. ISIS asks this question for college credit courses. We also originally adapted the ISIS text to include the healthcare specification to fit HPOG. ISIS then included this question in its survey for HPOG sites for consistency. Now both the HPOG and ISIS/HPOG follow-up surveys include the new healthcare question.
Overall, what [is/was] your main goal in taking classes? Would you say it [is/was](CHOOSE ONE): To complete specific courses needed for a job (not to get a certificate/degree) To earn a certificate, license, or credential To earn an Associate’s Degree To earn a Bachelor’s degree or higher Other reason (please specify) REFUSED DON’T KNOW	Adapted from ISIS follow-up	What [is/was] your main goal in taking college classes at [PLACE 1]? Would you say it [is/was](CHOOSE ONE): [Only asked for “college credit classes”] To complete specific courses needed for a job (not to get a certificate/degree) To earn a certificate requiring less than a full year’s worth of credit To earn a certificate requiring a full year or more’s worth of credit (but less than an Associate’s Degree) To earn an Associate’s Degree To earn a Bachelor’s degree or higher Other reason (specify) REFUSED DON’T KNOW Did you take/are you taking this training to prepare you to earn a certificate, license or credential?	We ask this question once in reference to individual’s entire experience since RAD. ISIS asks separate questions for college credit courses and occupational training. The ISIS college credit answer choices “To earn a certificate requiring less than a full year’s worth of credit,” “To earn a certificate requiring a full year or more’s worth of credit (but less than an Associate’s Degree)” and a “Yes” response to the ISIS occupational training question will be coded to equal our “To earn a certificate, license, or credential” answer.
[Did you/Will you] receive a [INSERT FROM QUESTION ABOVE] after completing the training? YES NO Not applicable, will not complete training REFUSED DON’T KNOW IF YES, specify the type of certificate/license/credential/degree	Adapted from ISIS follow-up	[IF MAIN GOAL IN TAKING COLLEGE CLASSES WAS TO EARN A DIPLOMA/CERTIFICATE OR HIGHER]: What is the name of the diploma/certificate or degree you earned? [IF RECEIVED/ EXPECT TO RECEIVE A DIPLOMA OR CERTIFICATE AFTER COMPLETE OCCUPATIONAL TRAINING: What is the name of the diploma/or certificate you earned?	We ask this question once in reference to individual’s entire experience since RAD. ISIS asks separate questions for regular college credit and occupational training.
As of right now, what is the highest degree or level of education that you have completed? Grade 1 through 12 (no high school degree/GED) High school diploma GED or alternative credential Certificate requiring less than one full year of training after high school Certificate requiring a year or more of training after high school Associate’s degree Bachelor’s degree or above REFUSED DON’T KNOW	ISIS follow-up	What is the highest degree or level of education that you have completed?
Knowledge of/access to financial resources necessary for continued education
In the next set of questions we are interested in the types of services and assistance you may have received since [RAD]. During your training experience since [RAD], have you needed to find money outside of your own income to help pay for some or all of the direct costs of education and training – that is, things like tuition and fees – or were these costs already handled for you? NEEDED TO FIND MONEY OUTSIDE OF OWN INCOME COSTS ALREADY HANDLED REFUSED DON’T KNOW	Adapted from ISIS follow-up	First, at [PLACE 1], have you needed to find outside money to help pay for some or all of the direct costs of education and training – that is, things like tuition and fees – or were these costs already handled for you? [Asked at the vendor level] Change to answer choice: NEEDED TO FIND OUTSIDE MONEY	Modified to clarify definition of “outside money.” See also note re: #3.
IF NEEDED TO FIND OUTSIDE MONEY (e.g., in addition to your own income): Now I’m going to read a list of sources of income that can help pay for either living expenses or direct school costs. Please let me know if any of the following sources help pay for the direct and indirect costs of education and training. Income from a spouse, parent or other family member Pell grant or other government grant or scholarship—not counting loans that you have to pay back Grant or scholarship from any non-government source--not counting loans that you do not have to pay back Loans	Adapted from ISIS follow-up	IF ‘NEEDED TO FIND OUTSIDE MONEY’: Now I’m going to read a list of sources of income that can help pay for either living expenses or direct school costs. For each, please let me know if it has helped to pay for either training or living expenses while you have attended [PLACE 1]. IF ‘COSTS ALREADY HANDLED’ ONLY ASK FOR LIVING EXPENSES: Now I’m going to read a list of sources of income that can help pay for living expenses. For each, please let me know if it has helped to pay for living expenses while you have attended [PLACE 1]. Next, did income from a spouse, parent or other family member help to pay for: Tuition? Other school-related expenses? Living expenses? Did you receive a Pell Grant or other government grant or scholarship—not counting loans that you have to pay back—to help pay for: Tuition? Other school-related expenses? Living expenses? Did you receive a grant or scholarship from any non-government source---not counting loans that you do not have to pay back—to help pay for: Tuition? Other school-related expenses? Living expenses? Finally, did you receive any loans to help pay for: Tuition? Other school-related expenses? Living expenses?	Truncated ISIS question because we are only interested to know if individuals used outside money to pay for the direct and indirect costs of training as well as the type of outside money. We do not need to know the type of expense the outside money covered. Also, we ask this question once in reference to individual’s entire experience since RAD. ISIS asks this question more than once in reference to each training vendor. See note re: #3. A “Yes” response to at least one of the expense types for each ISIS outside income source question will be coded as a “Yes” response to our outside income source question.
Would you say that it has been very difficult, somewhat difficult, or not very difficult to obtain enough financial support for school? VERY DIFFICULT SOMEWHAT DIFFICULT NOT VERY DIFFICULT REFUSED DON’T KNOW	ISIS follow-up	No change
Type and amount of social services received since random assignment
During your overall training experience since [RAD], have you received [SERVICE FROM BELOW] from any source? [WHERE YES: About how frequently did you receive [SERVICE FROM BELOW] (weekly; monthly; every six months; annually)? Academic advising (help choosing courses) Financial aid advising Tutoring in subjects where you needed extra help Career counseling Job search or placement assistance Help arranging for supports to help you manage school or work (for example, child care, transportation, housing, counseling/treatment for personal/family problems – sometimes called “case management”) Comprehensive assessments (to learn about your skills sets , such as WorkKeys, COMPASS, or ACCUPLACER) Personal counseling Peer support groups Emergency assistance Incentives (for example, a gift card for completing a course)	Adapted from ISIS follow-up	While going to [PLACE 1] have you received SERVICE FROM BELOW] from any source? [WHERE YES: About how many times did you receive [SERVICE FROM BELOW]? [Asked at the vendor level] Academic advising (help choosing courses) Financial aid advising Tutoring in subjects where you needed extra help Career counseling Job search or placement assistance Help arranging for supports to help you manage school or work (for example, child care, transportation, housing, counseling/treatment for personal/family problems)	We ask this question once in reference to individual’s entire experience since RAD. ISIS asks this question more than once in reference to each training vendor. See note re: #3. We added additional services of interest.
During your overall training experience since [RAD], did you receive assistance from a program, school, or other organization to pay for: Child care costs Transportation-related costs School supplies or fees Work-related clothes or tools Any other important needs (Please specify)	Adapted from ISIS follow-up	While going to [PLACE 1], did you received help assistance from a program, school, or other organization to paying for:: [Asked per vendor] (No changes to answer choices)	We ask this question once in reference to individual’s entire experience since RAD. ISIS asks this question more than once in reference to each training vendor. See note re: #3. Otherwise, any revision to language was coordinated between HPOG & ISIS.
During your overall training experience since [RAD], have you been offered any of the following opportunities for direct experiences with occupations related to your studies or career goals? Work study job Clinical experience or practicum Arranged visits from or to learn about individual employers Class taught by instructors from local employer or offered on-site at local employer An apprenticeship Other work experience (Please specify: __________)	Adapted from ISIS follow-up	While at [PLACE 1], have you been offered any of the following opportunities for direct experiences with occupations related to your studies or career goals? [Asked at the vendor level] (No changes to answer choices)	We ask this question once in reference to individual’s entire experience since RAD. ISIS asks this question more than once in reference to each training vendor. See note re: #3.
Now thinking of your general training experience since [RAD], including all of the courses you took and supports services you received, how satisfied are you with your whole training experience? Very satisfied Somewhat satisfied Not satisfied Refused Don’t know	Newly developed
Aspirations/expectations re: education
Now I’d like to talk to you a bit about your education goals. IF NO E&T SINCE RAD: I’m going to read a list of possible reasons why people may not have enrolled in school. For each one, please tell me whether it is a very important, somewhat important, or unimportant reason in your case. First, You don’t feel you need more education right now? You are waiting to apply for a particular program? You aren’t sure what would be the best program for you? You don’t think you have strong enough academic skills/credentials? You don’t have enough time due to work? You don’t have enough time due to family responsibilities? You don’t think you could get enough financial aid to afford to go? You haven’t been able to get into the kind of program you wanted? Some other reason? (Please specify)	ISIS Follow-Up	No change
IF NOT CURRENTLY ENROLLED: Are you planning to go back to school at some point? YES NO REFUSED DON’T KNOW	ISIS Follow-Up	No change
What is the highest level of education that you eventually expect to complete? Grades 1-12 (no high school degree/GED) High school diploma GED Certificate requiring less than one full year of training Certificate requiring a year or more of training Associate’s degree Bachelor’s degree Graduate degree REFUSED DON’T KNOW	ISIS follow-up	No change
Have you achieved this educational goal yet? YES NO REFUSED DON’T KNOW IF NO: Would you say you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with the following statement: I am making progress towards my long-range educational goals? Strongly agree Somewhat agree Somewhat disagree Strongly disagree REFUSED DON’T KNOW	ISIS follow-up	No change
Healthcare and employment experience
This next set of questions is about your current employment. Are you currently working at a job for pay? YES NO REFUSED DON’T KNOW IF NO: Have you worked at a job since [RAD]? YES NO REFUSED DON’T KNOW IF YES WORKING OR WORKED: Do you/did work for a healthcare employer? YES NO REFUSED DON’T KNOW IF YES WORKING OR WORKED: Are/were you employed in a healthcare job? YES NO REFUSED DON’T KNOW IF YES WORKING IN HEALTHCARE OCCUPATION: I am going to read you a list of types of healthcare occupations. Please tell me which type best describes your [current/most recent] job: Administrative (such as Medical Records and Health Information Technicians) Technical (such as Medical and Clinical Laboratory Technicians) Direct personal care (such as Home Health Aids or Certified Nursing Assistants) Other, Please specify IF YES WORKING OR WORKED: How many hours per week on average are/were you currently working? (include all jobs) IF YES WORKING OR WORKED: About how much do/did you typically earn per hour before taxes in your current/most recent job? (Answer for your main job if more than one) [IF R DOESN’T KNOW HOURLY RATE] Can you tell me how much you earned for some other time period besides hourly, such as per day, per week, every two weeks, or month? IF YES WORKING OR WORKED: At your current/most recent job, does/did your employer offer health insurance (regardless of whether you take/took it from them)? YES NO REFUSED DON’T KNOW IF YES INSURANCE: Did you receive insurance through your employer? YES NO REFUSED DON’T KNOW IF NO EMPLOYER INSURANCE: Did you receive insurance from another source? YES NO REFUSED DON’T KNOW What kind of work [do you do/did you do in your last job], that is, what [is/was] your occupation? What [are/were] your usual activities or duties at this job? (For example, keeping account books, filing, selling cars, operating printing press, taking blood samples) What is/was your [current/most recent] job title?	Adapted from ISIS follow-up	Are you currently working at a job for pay? IF YES: How many hours per week on average are you currently working? (include all jobs) Did you work before? IF “YES” WORKING OR WORKED BEFORE: About how much do/did you typically earn per hour before taxes in your current or most recent job? (Answer for your main job if more than one) IF “YES” WORKING OR WORKED BEFORE: At your current/last job, does/did your employer offer health insurance (regardless of whether you take/took it from them)? IF YES INSURANCE: Did you receive insurance through your employer? IF NO: Did you receive insurance from another source? What kind of work [do you do/did you do in your last job], that is, what [is/was] your occupation? What [is/was] your [current/most recent] job title? What [are/were] your usual activities or duties at this job? (For example, typing, keeping account books, filing, selling cars, operating printing press, taking blood samples) .ASK IF NOT OBVIOUS FROM E4: Is this occupation in the field of healthcare? YES NO REFUSED DON’T KNOW I am going to read you a list of types of healthcare occupations. Please tell me which type best describes your [current/most recent] job: Administrative (such as Medical Records and Health Information Technicians) Technical (such as Medical and Clinical Laboratory Technicians) Direct personal care (such as Home Health Aids or Certified Nursing Assistants) Other, Please specify: ________________	We originally adapted the ISIS text to include the healthcare-specific questions because these are outcomes of interest. ISIS then added these questions for non-HPOG sites for consistency. Now both the HPOG and ISIS surveys include the new healthcare specific questions.
Aspirations/expectations re: employment
Now I’d like to talk to you a bit about your career goals. Would you say you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with the following statements: I am making progress towards my long-range employment goals. I see myself on a career path.	ISIS follow-up	No change
Do you expect to be working for pay in the next few months? Yes No REFUSED DON’T KNOW IF YES: How many hours do you expect to be working in a typical week? IF YES: Do you expect to be working in a healthcare job or for a healthcare employer? Yes No REFUSED DON’T KNOW	Supplemental Baseline
How strongly do you agree/disagree with the following statements about your work preferences: (Strongly agree, Agree, Disagree, Strongly disagree) How much do you agree that you: …will take any job even if the pay is low? … want only the kind of job that is related to your training/education?	Adapted from the U.S. Department of Labor’s Green Jobs-Health Care Evaluation
How much must a job pay per hour for it to make sense for you to take it?	Supplemental Baseline
How important is each of the following to you in your life (not, somewhat, very)? Being successful in your line of work Having lots of money Being able to find steady work Becoming an expert in your field of work Getting a good job	(from: http://nces.ed.gov/surveys/els2002/pdf/EarlyGrad_followup1.pdf - partial item)
Knowledge of career opportunities in healthcare
IF NOT CURRENTLY WORKING: Do you envision yourself working in a healthcare job? Yes No REFUSED DON’T KNOW	Newly developed
a. If yes, would you say you know the kind of careers that are available in healthcare in your local area? Yes No REFUSED DON’T KNOW IF YES: What type of credential or degree do you need to qualify for a job like the kinds that you just reported to be available in your local area? Certificate/license Associate’s Degree Bachelor’s degree or higher Work experience/on-the-job training Other reason (please specify)
IF CURRENTLY WORKING: In your current job, are there promotion opportunities? Yes No REFUSED DON’T KNOW IF YES: Would you need additional education or training to be promoted? Yes No REFUSED DON’T KNOW IF YES: What type of credential or degree do you need to be promoted? Certificate/license Associate’s Degree Bachelor’s degree or higher Work experience/on-the-job training Other reason (specify) IF YES KNOW REQUIREMENTS: About how long would it take you to earn the credential or degree? 0-3 months 4-6 months 6 months to a year More than a year	Newly developed
Barriers to employment
The next few questions are about things like your financial situation and your health. In the past 12 months, please note how often each of the following situations interfered with your school, work, job search, or family responsibilities: (Never, Almost never, Sometimes, Fairly often, Very often) Child care arrangements? Transportation? Alcohol or drug use? An illness or health condition? Other, please specify	Adapted from ISIS follow-up (and supplemental baseline)	ISIS answer choices: Child care arrangements? Transportation? Alcohol or drug use? An illness or health condition? Spending time with friends? Argument with a family member? Physical threats/violence from a family member?	We did not include several answer choices. A “Yes” response to these answer choices for ISIS will be coded to equal the “other” answer choice for our question in order to allow us to use data from both the ISIS and HPOG versions of the survey.
IF CURRENTLY EMPLOYED: How difficult was it for you to find your current job? Not difficult Somewhat difficult Very difficult IF SOMEWHAT OR VERY DIFFICULT: Did any of the following situations make it difficult? Child care arrangements? Transportation? Alcohol or drug use? An illness or health condition? Lack of required education? Lack of experience? Lack of job openings? Other? Please specify	Newly developed
IF NOT EMPLOYED: How difficult do you think it will be to get a job in your chosen field or occupation? Not difficult Somewhat difficult Very difficult IF SOMEWHAT OR VERY DIFFICULT: Do you think any of the following situations will make it difficult? Child care arrangements? Transportation? Alcohol or drug use? An illness or health condition? Lack of required education? Lack of experience? Lack of job openings? Other (Please specify)	Newly developed
Perceived self-efficacy and motivation
In general, some people have an easier or harder time with these kinds of problems or difficulties. How true do you believe are the following statements: (1 = Not at all true, 2 = Somewhat true, 3 = Mostly true, 4 = Entirely true) I can always manage to solve difficult problems if I try hard enough. If someone opposes me, I can find the means and ways to get what I want. It is easy for me to stick to my aims and accomplish my goals. I am confident that I could deal efficiently with unexpected events. Thanks to my resourcefulness, I know how to handle unforeseen situations. I can solve most problems if I invest the necessary effort. I can remain calm when facing difficulties because I can rely on my coping abilities. When I am confronted with a problem, I can usually find several solutions. If I am in trouble, I can usually think of a solution. I can usually handle whatever comes my way.	Supplemental Baseline
Income, participant and total household
Now I’d like to talk to you about your family and your current household. What is your current marital status? Currently married Widowed Divorced/separated Never married Don’t know	HPOG ISO, PRS baseline
For the past 12 months, what has been the approximate total earnings from your work, including tips and overtime pay (this is for you, alone; do not include earnings from others in your family or household). $0 $1 to $4,999 $5,000 to $9,999 $10,000 to $14,999 $15,000 to $19,999 $20,000 to $24,999 $25,000 to $29,999 $30,000 to $34,999 $35,000 to $39,000 $40,000 to $44,999 $45,000 to $49,999 $50,000 to $59,999 $60,000 to $69,999 $70,000 or over Don’t know Refused	Adapted from HPOG ISO, PRS baseline		Adaptation involves adding more income categories in order to capture greater distinctions above poverty (the maximum PRS category is “$35,000 or over,” and the U.S. median income is ~50K). The new categories mirror the PRS answer options for household income. There is no strict need for the categories to be the same. We will work with Abt SRBI to ensure that the format works well in pre-testing and may modify as needed.
For the past 12 months, what has been your household TOTAL family income? Include your earnings and other income and earnings and other income of all household members. $0 $1 to $4,999 $5,000 to $9,999 $10,000 to $14,999 $15,000 to $19,999 $20,000 to $24,999 $25,000 to $29,999 $30,000 to $34,999 $35,000 to $39,999 $40,000 to $44,999 $45,000 to $49,999 $50,000 to $59,999 $60,000 to $69,999 $70,000 or over Don’t know Refused	HPOG ISO, PRS baseline
Besides you, who among the following live in your household at least half the time? (CHECK ALL THAT APPLY) Your spouse Your unmarried partner Your biological or adopted children Other persons under age 18 Your mother or father Your other relatives Your spouse or partner’s mother or father Your spouse or partner’s other relatives Friends Others	Adapted from ISIS follow-up	Besides you, which of the following live in your household at least half the time? (CHECK ALL THAT APPLY) Your spouse Your unmarried partner Your biological or adopted children Other persons aged 19 or younger Your mother or father Your spouse or partner’s mother or father Your spouse or partner’s other relatives Friends Others	ISIS uses <=19 because in some states child support continues for 19-year-olds. This is not relevant to HPOG, especially in a distinction made about other individuals in the household. We would prefer to know whether there are other children/adults in the household and believe that using the conventional age-of-majority threshold is relevant. If we would choose to combine data from these two categories, we expect very minor measurement error.
Are you or your partner/spouse currently pregnant? YES NO Refused Don’t know	ISIS follow-up	No change
Have you or your partner/spouse had a baby since [RAD]? YES NO Refused Don’t know	ISIS follow-up	No change
How many persons aged 18 or younger live with you at least half the time? (Include biological, adopted, foster, step, and any other children.)	Adapted from ISIS follow-up	How many persons aged 19 or younger live with you at least half the time? (Include biological, adopted, foster, step, and any other children.)	See note re: #60.
For how many of these children are you [or your spouse/partner] the legal guardian?	ISIS follow-up	No change
Benefit receipt (type and amount, participant and total household)
Now, I am going to ask you some questions about your household income, for everyone who lived in your household in (PRIOR MONTH). I will ask you first about your personal income and then about the combined income from all the other people who lived with you. Again, I want to assure you that none of your answers will be discussed with anyone. In [PRIOR MONTH], did you personally have income or benefits from any of the following sources? (For each yes, about how much was it per month?) Job earnings (including tips) Child Support (official or unofficial) Family and friends (outside the household) Grants or loans for school Temporary Assistance for Needy Families (TANF) General Assistance (GA) Supplemental Nutrition Assistance Program (SNAP) / Food Stamps Women, Infants and Children Program (WIC) Social Security Insurance (SSI) Social Security Disability Insurance (SSDI) Unemployment Insurance (UI) or Worker’s Compensation Refugee Cash Assistance (RCA) Medicaid Subsidized Child Care Section 8 / Public Housing Low Income Home Energy Assistance Program (LIHEAP) Free or reduced lunch program Was there any other source of income you received last month that we haven’t talked about? Yes No REFUSED DON’T KNOW IF YES: What was that other income?	Supplemental Baseline	In [PRIOR MONTH], did you personally have income or benefits from any of the following sources? (For each yes, about how much was it per month?) Was there any other source of income you received last month that we haven’t talked about? Yes No REFUSED DON’T KNOW What was that other income?	We originally added this question to our survey and ISIS then added an adapted version of this question to its survey. We then modified our wording to match the ISIS version.
Now, let’s go through the same list of income sources for other household members who lived with you in your household at least two nights a week last month. In [PRIOR MONTH] did any of your other household members have income or benefits from any of the following sources? (For each yes, about how much was it per month?) Job earnings (including tips) Child Support (official or unofficial) Family and friends (outside the household) Grants or loans for school Temporary Assistance for Needy Families (TANF) General Assistance (GA) Supplemental Nutrition Assistance Program (SNAP) / Food Stamps Women, Infants and Children Program (WIC) Social Security Insurance (SSI) Social Security Disability Insurance (SSDI) Unemployment Insurance (UI) or Worker’s Compensation Refugee Cash Assistance (RCA) Medicaid Subsidized Child Care Section 8 / Public Housing Low Income Home Energy Assistance Program (LIHEAP) Free or reduced lunch program Was there any other source of income received by other people in your household that we haven’t talked about? Yes No REFUSED DON’T KNOW IF YES: What was the other income?	Supplemental Baseline	Now, let’s go through the same list of income sources for other household members who live with you in your household at least two nights a week last month. In [PRIOR MONTH], In the past month, did any of your other household members have income or benefits from any of the following sources? (For each yes, about how much was it per month?) Was there any other source of income received by other people in your household that we haven’t talked about? Yes No REFUSED DON’T KNOW What was that other income?	ISIS added this question. We modified our wording to match ISIS.
[For each “No” response in question above, ask]: I know that you have not received [INSERT BENEFIT] in the last month, but have you or anyone in your household had income or benefits from (INSERT ITEM) at any time since [RAD]? [If No TANF in last month or since RAD]: Have you ever received TANF benefits? Yes No REFUSED DON’T KNOW	Adapted from Green Jobs		Will need to have Abt SRBI structure this for optimal flow.
Contact Information
Before we complete this portion of the interview, I would also like to make sure I have your contact information recorded correctly. Your first name: Your last name:	ISIS follow-up
Do you have a mailing address? This could be an address like a PO Box or a place where you get mail regularly. YES NO Refused Don’t know IF YES: What is the street address or PO box number? Is there a complex or building name? Is there an apartment number? In what city? In what state? What is the zip code?	ISIS follow-up
Do you have a phone number where we can reach you? This can be your cell phone or work number. YES NO Refused Don’t know IF YES: What is the number, starting with the area code? IF YES: Is that a home, cell, shelter, work, or other number? Home Cell Shelter Work Other	ISIS follow-up
Do you have another phone number where we can reach you? This can be your cell phone or work number. [REPEAT 70A-B FOR ALL AVAILABLE NUMBERS]	ISIS follow-up
Do you have an email address? YES NO Refused Don’t know IF YES: What is your email address?	ISIS follow-up
Thank you very much for your time today. To help us be able to get back in touch with you in the future, we would like to review the names, telephone numbers and addresses of the two people you previously mentioned who will always know how to reach you. This information will be kept strictly private and will only be used if we are unable to contact you. When you applied for [PROGRAM NAME] you said that [CONTACT #1] was a person who would always know where you are and how to reach you. Is [CONTACT#1] still a person who does not live with you and will always know how to contact you? YES (VERIFY CONTACT INFORMATION) NO Refused Don’t know IF NO: Could you please tell me the name of a person who does not live with you and will always know how to contact you? YES NO Refused Don’t know IF YES: What is his/her first name? What is his/her middle name? What is his/her last name? Does his/her name have a suffix? What is the street address or PO box number? Is there a complex or building name? Is there an apartment number? In what city? In what state? What is the zip code? What is [his/her] home phone number, starting with the area code? What is [his/her] cell phone number, starting with the area code? What is [his/her] email address? What is [his/her] relationship to you? Friend Relative Other (Specify:) Refused Do not know REFUSED DON’T KNOW	Adapted from ISIS follow-up	Thank you very much for your time today. To help us be able to get back in touch with you in the future, we would like to review the names, telephone numbers and addresses of the two people you provided when you applied for [PROGRAM NAME] who will always know how to reach you. This information will be kept strictly confidential and will only be used if we are unable to contact you.
When you applied for [PROGRAM NAME] you said that [CONTACT #2] was a person who would always know where you are and how to reach you. Is [CONTACT#2] still a person who does not live with you and will always know how to contact you? YES (VERIFY CONTACT INFORMATION) NO Refused Don’t know IF NO: REPEAT 80a Thank you very much for your time today.	Adapted from ISIS follow-up