ATTACHMENT
c
adult baseline SURVEY Question BY Question JUSTIFICATION
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This document lists each question on the STREAMS baseline survey, along with its source(s). Many questions are required to be collected for either the Applicant Characteristics Survey (ACS) or the Pre-Program Survey (PPS) of the Fatherhood and Marriage Local Evaluation and (FaMLE) Cross-Site Project (OMB control number 0970-0460). New questions added for the STREAMS baseline survey beyond the required ACS and PPS items are indicated in the table and justified under the “Additional Information” column.
Baseline Q# |
Question text |
Required for FaMLE Cross-Site |
Question added for STREAMS |
Additional information |
Section A |
||||
A1a-b |
What is your name? |
X |
|
Source: Required item A1 from FaMLE Cross-Site ACS. |
A1c |
Are you male or female? |
x |
|
Source: Required item A1 from FaMLE Cross-Site ACS. |
A2 |
What is your date of birth |
x |
|
Source: Required item A2 from FaMLE Cross-Site ACS. |
A3 |
Are you Hispanic, Latino, or of Spanish origin? |
x |
|
Source: Required item A4 from FaMLE Cross-Site ACS. |
A4 |
What is your race |
X |
|
Source: Required item A3 from FaMLE Cross-Site ACS. |
A5 |
Do you consider yourself to be straight, gay, lesbian, bisexual, or are you not sure? |
|
X |
Source: Adapted from the National Coalition for LGBT Health. Added as a potential moderator of relationship education impacts. |
A6 |
What country were you born in? |
X |
|
Source: Required item A5a from FaMLE Cross-Site ACS. |
A7 |
What country was your mother born in? |
X |
|
Source: Required item A5b from FaMLE Cross-Site ACS. |
A8 |
What country was your father born in? |
X |
|
Source: Required item A5c from FaMLE Cross-Site ACS. |
A9 |
What language is spoken in your home most of the time? |
X |
|
Source: Required item A6a from FaMLE Cross-Site ACS. |
A10 |
How well would you say you speak English? Would you say… |
X |
|
Source: Required item A6b from FaMLE Cross-Site ACS. |
A11 |
Are you currently enrolled in school or college? |
X |
|
Source: Required item B3 from FaMLE Cross-Site ACS. |
A12 |
What is your current grade? |
X |
|
Source: Required item B4 from FaMLE Cross-Site ACS. |
A13 |
What is the highest level of education you have completed? |
X |
|
Source: Required item B5 from FaMLE Cross-Site ACS. |
Section B |
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B1a |
A good couple relationship is based on mutual respect. |
|
X |
Source: Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added as a measure of attitudes toward healthy relationships, an outcome relationship education programs aim to influence. |
B1b |
In a good couple relationship, you don’t always get your own way. |
|
X |
Source: Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added as a measure of attitudes toward healthy relationships, an outcome relationship education programs aim to influence. |
B1c |
Relationships go better if partners make decisions together. |
|
X |
Source: Recommended by Stanley and Rhoades (experts on adult HMRE programs). Added as a measure of attitudes toward healthy relationships, an outcome relationship education programs aim to influence. |
B1d |
People are more likely to succeed in their relationships if they take things slowly. |
|
X |
Source: Recommended by Stanley and Rhoades (experts on adult HMRE programs). Added as a measure of attitudes toward healthy relationships, an outcome relationship education programs aim to influence. |
B1e |
It is important to know a person well before having sex with them. |
|
X |
Source: Recommended by Stanley and Rhoades (experts on adult HMRE programs). Added as a measure of attitudes toward healthy relationships, an outcome relationship education programs aim to influence. |
B1f |
Having a casual sexual relationship with someone is no big deal. |
|
X |
Source: Recommended by Stanley and Rhoades (experts on adult HMRE programs). Added as a measure of attitudes toward healthy relationships, an outcome relationship education programs aim to influence. |
B1g |
If you are really in love, you can stop working on your relationship. |
|
X |
Source: Child Trends 3M Project. Added as a measure of attitudes toward healthy relationships, an outcome relationship education programs aim to influence. |
B1h |
Ending a bad romantic relationship is a good thing. |
|
X |
Source: Recommended by Stanley and Rhoades (experts on adult HMRE programs). Added as a measure of attitudes toward healthy relationships, an outcome relationship education programs aim to influence. |
B1i |
There are times when hitting or pushing between people who are in a couple is okay. |
|
X |
Source: Acceptance of general dating violence scale (Foshee et al. 1992). Added as a measure of attitudes toward intimate partner violence, an outcome relationship education programs aim to influence. |
B1j |
Violence between partners can improve a couple’s relationship. |
|
X |
Source: Acceptance of general dating violence scale (Foshee et al. 1992). Added as a measure of attitudes toward intimate partner violence, an outcome relationship education programs aim to influence. |
B1k |
Some couples need to use violence to solve their problems. |
|
X |
Source: Acceptance of general dating violence scale (Foshee et al. 1992). Added as a measure of attitudes toward intimate partner violence, an outcome relationship education programs aim to influence. |
B1l |
Sometimes violence is the only way to express your feelings. |
|
X |
Source: Acceptance of general dating violence scale (Foshee et al. 1992). Added as a measure of attitudes toward intimate partner violence, an outcome relationship education programs aim to influence. |
B1m |
Violence in a couple’s relationship is a personal matter and people should not interfere. |
|
X |
Source: Acceptance of general dating violence scale (Foshee et al. 1992). Added as a measure of attitudes toward intimate partner violence, an outcome relationship education programs aim to influence. |
B2a |
I believe I will be able to effectively deal with conflicts that arise in my relationships. |
|
X |
Source: Relationship Confidence Subscale, Relationship Deciding Scale (Vennum and Fincham 2011). Added as a measure of perceived romantic relationship skills, an outcome relationship education programs aim to influence. |
B2b |
I feel good about my prospects for making a romantic relationship last. |
|
X |
Source: Relationship Confidence Subscale, Relationship Deciding Scale (Vennum and Fincham 2011). Added as a measure of perceived romantic relationship skills, an outcome relationship education programs aim to influence. |
B2c |
I can recognize the signs of a violent or unhealthy couple relationship. |
|
X |
Source: Baylor Evaluation of ARYA. Added as a measure of perceived romantic relationship skills, an outcome relationship education programs aim to influence. |
B2d |
I am very confident when I think of having a stable, long term relationship. |
|
X |
Source: Relationship Confidence Subscale, Relationship Deciding Scale (Vennum and Fincham 2011). Added as a measure of perceived romantic relationship skills, an outcome relationship education programs aim to influence. |
B2e |
I have the skills needed for a lasting stable romantic relationship. |
|
X |
Source: Relationship Confidence Subscale, Relationship Deciding Scale (Vennum and Fincham 2011). Added as a measure of perceived romantic relationship skills, an outcome relationship education programs aim to influence. |
B2f |
I have the skills to leave a violent or unhealthy relationship. |
|
X |
Source: Child Trends 3M Project. Added as a measure of perceived romantic relationship skills, an outcome relationship education programs aim to influence. |
B3a |
Living together is just the same as being married |
X |
|
Source: Required item C1a from FaMLE Cross-Site PPS. |
B3b |
It is better for children if their parents are married |
X |
|
Source: Required item C1b from FaMLE Cross-Site PPS. |
B4a |
Admitting that you might be wrong during an argument. |
|
X |
Source: Conflict Management Subscale, Interpersonal Competence Questionnaire (Buhrmester et al. 1988). Added as a measure of perceived general relationship skills, an outcome relationship education programs aim to influence. |
B4b |
Avoiding saying things that could turn a disagreement into a fight. |
|
X |
Source: Conflict Management Subscale, Interpersonal Competence Questionnaire (Buhrmester et al. 1988). Added as a measure of perceived general relationship skills, an outcome relationship education programs aim to influence. |
B4c |
Accepting another person’s point of view even if you don’t agree with it. |
|
X |
Source: Conflict Management Subscale, Interpersonal Competence Questionnaire (Buhrmester et al. 1988). Added as a measure of perceived general relationship skills, an outcome relationship education programs aim to influence. |
B4d |
Listening to another person’s opinion during a disagreement. |
|
X |
Source: Conflict Management Subscale, Interpersonal Competence Questionnaire (Buhrmester et al. 1988). Added as a measure of perceived general relationship skills, an outcome relationship education programs aim to influence. |
B4e |
Working through problems without arguing. |
|
X |
Source: Conflict Management Subscale, Interpersonal Competence Questionnaire (Buhrmester et al. 1988). Added as a measure of perceived general relationship skills, an outcome relationship education programs aim to influence. |
Section C |
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C1 |
Next, we’re going to ask you some questions about your relationships. In the past year, how many romantic partners have you been involved with? |
|
X |
Developed for STREAMS. Added as a measure of relationship stability and relationship churning, an outcome relationship education programs aim to influence. |
C2a |
Thinking about the X romantic relationship[s] you have had in the past year, have any of your partners …tried to keep you from seeing or talking with your friends? |
|
X |
Source: Supporting Healthy Marriages (SHM) Evaluation. Added as a measure of exposure to unhealthy relationships, an outcome relationship education programs aim to influence. |
C2b |
Made you feel stupid? |
|
X |
Source: Supporting Healthy Marriages (SHM) Evaluation. Added as a measure of exposure to unhealthy relationships, an outcome relationship education programs aim to influence. |
C2c |
Kept money from you or taken your money without asking? |
|
X |
Source: Supporting Healthy Marriages (SHM) Evaluation. Added as a measure of exposure to unhealthy relationships, an outcome relationship education programs aim to influence. |
C2d |
Made you feel afraid that they might hurt you? |
|
X |
Source: Supporting Healthy Marriages (SHM) Evaluation. Added as a measure of exposure to unhealthy relationships, an outcome relationship education programs aim to influence. |
C2e |
Pushed, hit, slapped, or kicked you? |
|
X |
Source: Supporting Healthy Marriages (SHM) Evaluation. Added as a measure of exposure to unhealthy relationships, an outcome relationship education programs aim to influence. |
C3 |
Now I’d like to ask about your current relationships. What is your current marital status? Are you … |
X |
|
Source: Required item C1 from FaMLE Cross-Site ACS. |
C3a |
When are you planning to get married? |
|
X |
Source: Building Strong Families (BSF) Evaluation. Added to confirm how firm engagement plans are. |
C4 |
Which of the following best describes your relationship status? |
X |
|
Source: Required item C2 from FaMLE Cross-Site ACS. |
C5 |
I would like to ask you a few questions about your [spouse/partner]. What is your [spouse/partner]’s first name? |
|
X |
Source: Parents and Children Together (PACT) Evaluation. Added to facilitate the asking of subsequent questions concerning the partner. |
C5a |
Is [partner name] a man or a woman? |
|
X |
Source: Adapted from PACT Evaluation. Added to facilitate the asking of subsequent questions concerning the partner. |
C6 |
How much of the time do you live with [PARTNER NAME]? Would you say… |
X |
|
Source: Required item C3 from FaMLE Cross-Site ACS. |
C7 |
Now I would like to ask about how you feel about your relationship with [PARTNER NAME]. On a scale from 0 to 10, where 0 is not at all happy and 10 is completely happy, taking all things together, how happy would you say your relationship with [PARTNER NAME] is? |
|
X |
Source: BSF Evaluation. Added as a measure of relationship quality, an outcome relationship education programs aim to influence. |
C8a |
How much do you agree or disagree with this statement? [PARTNER NAME] is honest and truthful with me. |
|
X |
Source: BSF Evaluation. Added as a measure of relationship quality, an outcome relationship education programs aim to influence. |
C8b |
I can trust [PARTNER NAME] completely. |
X |
|
Source: Required item C9a from FaMLE Cross-Site PPS. |
C8c |
[PARTNER NAME] can be counted on to help me. |
X |
|
Source: Required item C9b from FaMLE Cross-Site PPS. |
C8d |
[PARTNER NAME] knows and understands me. |
X |
|
Source: Required item C9c from FaMLE Cross-Site PPS. |
C8e |
[PARTNER NAME] listens to me when I need someone to talk to. |
|
X |
Source: BSF Evaluation. Added as a measure of relationship quality, an outcome relationship education programs aim to influence. |
C8f |
[PARTNER NAME] respects me. |
|
X |
Source: BSF Evaluation. Added as a measure of relationship quality, an outcome relationship education programs aim to influence. |
C8g |
[PARTNER NAME] shows love and affection. |
X |
|
Source: Required item C9e from FaMLE Cross-Site PPS. |
C8h |
I feel appreciated by [PARTNER NAME]. |
X |
|
Source: Required item C9d from FaMLE Cross-Site PPS. |
C8i |
I view our [marriage/relationship] as lifelong. Do you… |
X |
|
Source: Required item C12 from FaMLE Cross-Site PPS. |
C9a |
[PARTNER NAME] and I are good at working out our differences. |
X |
|
Source: Required item C5a from FaMLE Cross-Site PPS. |
C9b |
I feel respected even when [PARTNER NAME] and I disagree. |
X |
|
Source: Required item C5b from FaMLE Cross-Site PPS. |
C9c |
[PARTNER NAME] is rude or mean to me when we disagree. |
X |
|
Source: Required item C6a from FaMLE Cross-Site PPS. |
C9d |
When [PARTNER NAME] and I have a serious disagreement, we work on it together to find a solution. |
X |
|
Source: Required item C5c from FaMLE Cross-Site PPS. |
C9e |
When [PARTNER NAME] and I have a serious disagreement, we discuss our disagreements respectfully. |
X |
|
Source: Required item C5d from FaMLE Cross-Site PPS. |
C9f |
[PARTNER NAME] seems to view my words or actions more negatively than I mean them to be. |
X |
|
Source: Required item C6b from FaMLE Cross-Site PPS. |
C9g |
During arguments, [PARTNER NAME] and I are good at taking breaks when we need them. |
X |
|
Source: Required item C5e from FaMLE Cross-Site PPS. |
C9h |
When [PARTNER NAME] and I argue, past hurts get brought up again. |
X |
|
Source: Required item C5f from FaMLE Cross-Site PPS. |
C9i |
[PARTNER NAME] understands that there are times when I do not feel like talking and times when (he/she) does. |
X |
|
Source: Required item C5g from FaMLE Cross-Site PPS. |
C9j |
Our arguments become very heated. |
X |
|
Source: Required item C6c from FaMLE Cross-Site PPS. |
C9k |
[PARTNER NAME] is good at calming me when I get upset. |
|
X |
Source: BSF Evaluation. Added as a measure of relationship quality, an outcome relationship education programs aim to influence. |
C9l |
Small issues suddenly become big arguments. |
X |
|
Source: Required item C6d from FaMLE Cross-Site PPS. |
C9m |
We are pretty good listeners, even when we have different positions on things. |
|
X |
Source: BSF Evaluation. Added as a measure of relationship quality, an outcome relationship education programs aim to influence. |
C9n |
[PARTNER NAME] or I stay mad at one another after an argument. |
X |
|
Source: Required item C6e from FaMLE Cross-Site PPS. |
C9o |
Even when arguing, we can keep a sense of humor. |
|
X |
Source: BSF Evaluation. Added as a measure of relationship quality, an outcome relationship education programs aim to influence. |
C9p |
When we argue, one of us withdraws and refuses to talk about it anymore. |
|
X |
Source: BSF Evaluation. Added as a measure of relationship quality, an outcome relationship education programs aim to influence. |
C10 |
How satisfied are you with the way you and [PARTNER NAME] handle conflict? Would you say… |
X |
|
Source: Required item C8 from FaMLE Cross-Site PPS. |
C11 |
Have you ever been married ([to someone else] besides [PARTNER])? (Please do not count your current engagement.) |
|
X |
PACT Evaluation. Added as a measure of relationship status and stability, an outcome relationship education programs aim to influence. |
C12 |
[Including your current marriage,] in total, how many times have you been married? |
|
X |
PACT Evaluation. Added as a measure of relationship status and stability, an outcome relationship education programs aim to influence. |
C13 |
Sometimes couples are not always faithful to each other. Has [PARTNER] cheated on you with someone else in the past 12 months? Would you say… |
|
X |
BSF Evaluation. Added as a measure of relationship quality, an outcome relationship education programs aim to influence. |
C14 |
In the past 12 months, have you cheated on [PARTNER] with someone else? |
|
X |
BSF Evaluation. Added as a measure of relationship quality, an outcome relationship education programs aim to influence. |
Section D |
||||
D1 |
How many children do you have? |
|
X |
Developed for STREAMS. Added to facilitate the asking of subsequent required questions. |
D2 |
How many of these children are under 21 years old? |
X |
|
Source: Required item C5 from FaMLE Cross-Site ACS. |
D2a |
Is this child under 21 years old? |
x |
|
Source: Required item C5 from FaMLE Cross-Site ACS. |
D3 |
(Is this child/Are these [FILL D2 NUMBER] children) all your legally adopted or biological children? |
X |
|
Source: Required item C6 from FaMLE Cross-Site ACS. |
D4 |
How many of these are your biological or legally adopted children? |
X |
|
Source: Required item C6 from FaMLE Cross-Site ACS. |
D5 |
Of these [FILL NUMBER] children, how many live with you all or most of the time? |
X |
|
Source: Required item C7 from FaMLE Cross-Site ACS |
D5a |
Does this child live with you all or most of the time? |
X |
|
Source: Required item C7 from FaMLE Cross-Site ACS |
D6 |
Does [PARTNER NAME] have any children with other partners? |
|
X |
Source: Developed for STREAMS. Added to facilitate the asking of subsequent required questions. |
D7 |
Are you a [mother/father] figure to any of [PARTNER]’s children? |
x |
|
Source: Required item C8 from FaMLE Cross-Site ACS |
D8 |
Please spell this child’s first and last name for me. |
x |
|
Source: Required item A1b/c & A4a from FaMLE Cross-Site PPS |
D9 |
Do you call [CHILD] by a different name? |
|
X |
Source: BSF Evaluation. Added to facilitate the asking of subsequent required questions. |
D9a |
Please spell that name for me. |
|
X |
Source: BSF Evaluation. Added to facilitate the asking of subsequent required questions. |
D10 |
Is [CHILD] a boy or girl? |
|
X |
Source: PACT Evaluation. Added to facilitate the asking of subsequent questions. |
D11 |
How old is [CHILD FIRST NAME]? |
X |
|
Source: Required item A1d & A4b from FaMLE Cross-Site PPS |
D12 |
Does [CHILD FIRST NAME] live with you... |
X |
|
Source: Required item A1e & A4c from FaMLE Cross-Site PPS |
D13 |
In the past month, how often have you spent time with [CHILD FIRST NAME] in person? |
|
X |
Source: BSF Evaluation. Added to measure quality of the parenting-child relationship, an outcome relationship education programs aim to influence. |
D14a-d |
For each statement, tell me how often you have felt or acted this way toward [CHILD] in the past month. a. I am happy being with [CHILD]. b. [CHILD] and I are very close to each other. c. I try to comfort [CHILD] when [he/she] is upset. d. I spend time with [CHILD] doing what [he/she] likes to do. |
X |
|
Source: Required item A2a & A5a from FaMLE Cross-Site PPS |
D15a-c |
Over the past month, how often did you… a. …yell, shout, or scream at [CHILD] because you were mad at him/her b. …talk to [CHILD] about what he/she did wrong? c. …hit, spank, grab, or use physical punishment with [CHILD]? |
X |
|
Source: Required item A2b & A5b from FaMLE Cross-Site PPS |
D16 |
Is [PARTNER NAME] the (father/mother) of [CHILD FIRST NAME]? |
|
X |
Source: Developed for STREAMS. Added to facilitate the asking of subsequent questions. |
D17 |
Is [CHILD 1, D18 NAME] the (father/mother) of [CHILD FIRST NAME 2]? |
|
X |
Source: Developed for STREAMS. Added to facilitate the asking of subsequent questions. |
D18 |
Please tell me [CHILD FIRST NAME]’s (mother/father)’s first name so I can refer to (him/her) in the next questions. |
|
X |
Source: Developed for STREAMS. Added to facilitate the asking of subsequent questions. |
D18a |
Do you have more than one child with [CHILD 1, PARENT NAME]? |
|
X |
Source: Developed for STREAMS. Added to facilitate the asking of subsequent questions. |
D19 |
How much do you agree or disagree with the following statement? [PARENT] and I work well together as parents. |
X |
|
Source: Required item A3 & A6 from FaMLE Cross-Site PPS |
D20 |
[PARENT] and I communicate well about our (child/children). |
|
X |
Source: Parenting Alliance Measure (PAM). Added to measure quality of the co-parenting relationship, an outcome relationship education programs aim to influence. |
D21 |
When there is a problem with our child, [PARENT] and I work out a good solution together. Would you say you strongly agree, agree, disagree, or strongly disagree? |
|
X |
Source: Parenting Alliance Measure (PAM). Added to measure quality of the co-parenting relationship, an outcome relationship education programs aim to influence. |
D22 |
Are you expecting a baby (with anyone) now? |
x |
|
Source: Required item C4a & C4b from FaMLE Cross-Site ACS |
D23 |
When is your baby due? |
|
X |
Source: PACT Evaluation. Added as a potential moderator of the effects of HMRE programming. |
D24 |
Is the (mother/father) of this baby [PARTNER NAME] or another partner? |
|
X |
Source: Developed for STREAMS. Added as a potential moderator of the effects of HMRE programming. |
D25 |
Right before the pregnancy, did you want to have a baby with [PARTNER NAME/that partner]? |
|
X |
Source: PACT Evaluation. Added as a potential moderator of the effects of HMRE programming. |
D26 |
Would you say this pregnancy came sooner than you wanted, at about the right time, or later than you wanted? |
|
X |
Source: PACT Evaluation. Added as a potential moderator of the effects of HMRE programming. |
Section E |
||||
E1 |
In the past month, have you or anyone in your household received any income from… |
X |
|
Source: Required item B1 from FaMLE Cross-Site ACS |
E2 |
Do you currently own your home, rent it, pay some amount toward rent, live rent free with a friend or relative, or do you have some other arrangement? |
X |
|
Source: Required item B2 from FaMLE Cross-Site ACS |
E3 |
Work can be any regular paid jobs, odd jobs, temporary jobs, work done in your own business, “under the table” work, “informal” work, or any other types of work you have done for pay. Thinking of all of these types of work, in the past 30 days, have you worked for pay? |
X |
|
Source: Required item B6a from FaMLE Cross-Site ACS |
E4 |
In what month and year did you last work for pay? |
|
X |
Source: Work First New Jersey (WFNJ). Added to augment the required measures of employment and earnings. |
E5 |
Is this work seasonal or temporary? |
X |
|
Source: Required item B6a from FaMLE Cross-Site ACS |
E6 |
How many hours do you usually work in a week? |
X |
|
Source: Required item B6a from FaMLE Cross-Site ACS |
E7 |
Including tips, bonuses, commissions, regular pay, and overtime pay from all of the jobs you worked in the past 30 days, how much money did you make before taxes and other deductions? |
X |
|
Source: Required item B7 from FaMLE Cross-Site ACS |
E7a |
Can you tell me if it was less than $500, $500 to $1,000, $1,001 to $2,000, $2,001 to $3,000, $3,001 to $4,000, $4,001 to $5,000, or more than $5,000? |
|
X |
Source: Work First New Jersey (WFNJ). Added to improve data quality on reported earnings. |
E8 |
Do you have health insurance? |
X |
|
Source: Required item B8 from FaMLE Cross-Site ACS |
E8a |
Do you get health insurance through your job? |
X |
|
Source: Required item B8 from FaMLE Cross-Site ACS |
E8b |
Does your employer offer health insurance? |
X |
|
Source: Required item B8 from FaMLE Cross-Site ACS |
E9 |
Do you have other benefits through your job, such as paid vacation, paid sick leave, or life insurance? |
X |
|
Source: Required item B9 from FaMLE Cross-Site ACS |
E10 |
When did you first start working in the job you have now? |
X |
|
Source: Required item B10 from FaMLE Cross-Site ACS |
E11 |
Please tell me the names of your two most recent employers. |
X |
|
Source: Required item B11 from FaMLE Cross-Site ACS |
E12a-c |
Please tell me if any of the following apply to you. Are you… a. Actively looking for work? b. Retired? c. Disabled? |
x |
|
Source: Required item B6b from FaMLE Cross-Site ACS |
E13a-b |
Please tell me how much you agree or disagree with the following statements. a. I would like to get a job b. I would like to get a better job |
X |
|
Source: Required item B3g-h from FaMLE Cross-Site PPS |
E14a-g |
Now I am going to read you a list of things that can make it hard to find or keep a good job. Please tell me if the following has made it not at all hard, a little hard, or very hard for you to find or keep a good job in the past year. |
X |
|
Source: Required item B12 from FaMLE Cross-Site ACS |
Section F |
||||
F1 |
In general, how would you describe your health? |
X |
|
Source: Required item D1 from FaMLE Cross-Site ACS |
F2a-h |
Over the last two weeks, how often have you been bothered by any of the following problems: a) Little interest or pleasure in doing things? b) Feeling down, depressed, or hopeless? c) Trouble falling or staying asleep, or sleeping too much? d) Feeling tired or having little energy? e) Poor appetite or overeating? f) Feeling bad about yourself—or that you are a failure or have let yourself or your family down? g) Trouble concentrating on things, such as reading the newspaper or watching television? h) Moving or speaking so slowly that other people could have noticed? Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual? |
|
X |
Source: Patient Health Questionnaire (PHQ-8). Added to measure the potential influence of HMRE programming on mental health. Also added as a potential moderator of the effects of HMRE programming. |
F3 |
Have you ever been convicted of a crime? |
|
X |
Source: BSF Evaluation. Added as both a potential moderator of the effects of HMRE programming and a potential outcome influenced by the intervention. |
F4 |
Please think of the longest time that you were in an adult correctional institution like a county, state or federal jail or prison. During that time period, how long were you in an adult correctional institution? |
|
X |
Child Support Noncustodial Parent Employment Demonstration (CSPED). Added as both a potential moderator of the effects of HMRE programming and a potential outcome influenced by the intervention. |
F5 |
Are you currently on parole or probation? |
|
X |
Source: BSF Evaluation. Added as a potential moderator of the effects of HMRE programming. |
F6 |
When you were growing up—that is before you turned 18—did you live most of the time with . . . |
|
X |
Source: BSF Evaluation. Added as a potential moderator of the effects of HMRE programming. |
F7 |
Did you always live with both of your biological parents until you turned 18? |
|
X |
Source: BSF Evaluation. Added as a potential moderator of the effects of HMRE programming. |
F8 |
Were your biological parents ever married to each other? |
|
X |
Source: BSF Evaluation. Added as a potential moderator of the effects of HMRE programming. |
F9 |
Have you ever been in foster care? |
X |
|
Source: Required item C9 from FaMLE Cross-Site ACS |
F10 |
Are you currently in foster care? |
X |
|
Source: Required item C9 from FaMLE Cross-Site ACS |
F11 |
Did you leave foster care in the past 6 months? |
X |
|
Source: Required item C9 from FaMLE Cross-Site ACS |
Section G |
||||
G1 |
People apply for programs like [FILL PROGRAM NAME] for different reasons. I’m going to read you a list of reasons people sometimes give for applying for [FILL PROGRAM NAME]…
|
|
X |
Source: Child Support Noncustodial Parent Employment Demonstration (CSPED). Added as a potential moderator of the effects of HMRE programming. |
G2 |
How did you hear about [FILL PROGRAM NAME]? |
X |
|
Source: Required item E1 from FaMLE Cross-Site ACS |
G3 |
Why did you choose to apply to this program? |
X |
|
Source: Required item E2 from FaMLE Cross-Site ACS |
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | BCollette |
File Modified | 0000-00-00 |
File Created | 2021-01-15 |