Survey of Youth Transitioning from Foster Care

February 2020

OMB #: 0970-0XXX

Expiration Date: XX/XX/XXXX

Survey of Youth Transitioning from Foster Care

The interview will begin immediately following completion of the consent form.

Now, I’m going to ask you some questions about you, your family, and your life experiences.

All of your answers will be kept private to the extent permitted by law. If there is a question you don’t want to answer, you can say, “Skip.”

If there are any questions where you’re not sure of the answer, just let me know. Now we are going to start the interview. The interview should take between 60 to 80 minutes.

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.

Questions	Response Scale
FIELD INTERVIEWER-ADMINISTERED QUESTIONS
DEMOGRAPHICS AND HEALTH
What is your age?	________ (Fill in years) Don’t know / Not sure Choose not to answer
Are you of Hispanic, Latino/a, or Spanish origin?	No, not of Hispanic, Latino/a, or Spanish origin Yes, Mexican, Mexican American, Chicano/a Yes, Puerto Rican Yes, Cuban Yes, Another Hispanic, Latino/a or Spanish origin Don’t know / Not sure Choose not to answer
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 Don’t know / Not sure Choose not to answer
Were you born in the United States? The United States include the 50 states and the District of Columbia, but not U.S. territories.	Yes [Skip to Question A7] No Don’t know / Not sure Choose not to answer
In what country were you born?	Mexico Guatemala Cuba Dominican Republic India China Philippines Japan Korea Vietnam Guam Samoa Other (specify) Don’t know / Not sure Choose not to answer
How many years altogether have you been living in the U.S.?	___ Years Don’t know / Not sure Choose not to answer
Are you a citizen of the United States?	Yes, born in the United States Yes, born in Puerto Rico, Guam, the U.S. Virgin Islands or Northern Marianas Yes, born abroad of American parent or parents Yes, U.S. citizen by naturalization No, not a citizen of the United States Don’t know / Not sure Choose not to answer
Are you currently enrolled in school?	Yes No [Skip to question A10] Don’t know / Not sure Choose not to answer
Are you currently attending school?	Yes [skip to question A13] No Don’t know / Not sure Choose not to answer
Did you receive a high school diploma or a GED for finishing high school?	Yes, high school diploma Yes, GED No [Skip to A12] Don’t know / Not sure Choose not to answer
Have you attended college, community college, or junior college?	Yes No Don’t know / Not sure Choose not to answer
[If question A10 = no] What is the highest level of school you have completed?	Less than 8th grade 9th grade 10th grade 11th grade Other (Specify) Don’t know / Not sure Choose not to answer
[If question A8 = yes] In what grade or level of school are you currently enrolled?	Less than 12th grade 12th grade GED course College Other (Specify) Don’t know / Not sure Choose not to answer
[If question A10 = GED or no) Here are some reasons other people have given for leaving high school. Which of these would you say applied to you?	You missed too many school days. You couldn’t work and go to school at the same time. You did not like school. You were getting behind in your schoolwork or getting poor grades. You thought it would be easier to get a GED or alternative high school credential. You were suspended or expelled. Your friends had dropped out of school. You did not feel like you belonged there. You didn’t need to complete high school for what you wanted to do. You changed schools and did not like the new one. You had to take care of or financially support your family. You had to financially support yourself. You were pregnant. You became the father or mother of a baby. You wanted to gain early admission to a school that provides occupational training or a college. Don’t know / Not sure Choose not to answer
During the past 30 days, where did you sleep most nights? [Provide options via showcard]	In the home of my immediate family (parent or caregiver) At the home I share with my spouse, boyfriend, girlfriend, or partner At another family member’s home At the home of a foster parent At a group home or residential program At my own home (I pay rent) With friends or couch surfing At a shelter (such as a runaway or homeless youth shelter, drop-in center) In a transitional housing program At a treatment facility or center (hospital, detox, etc.) Inside a car, abandoned building, squat, etc. Outside (in the park, on the street, in a tent, etc.) At a transit station (subway or bus station or the airport) In a jail, prison, detention facility, or halfway house At a hotel or motel Other (please specify): Don’t know / Not sure Choose not to answer
[If question A15 is not = don’t know/not sure OR choose not to answer] How safe do you think you were when you slept [fill from question A15, but in second person]?	Very safe Safe Somewhat safe Somewhat unsafe Unsafe Very unsafe Don’t know / Not sure Choose not to answer
[If question A15 = don’t know/not sure OR choose not to answer] During the past 30 days, how safe do you think you were where you’ve slept most nights?	Very safe Safe Somewhat safe Somewhat unsafe Unsafe Very unsafe Don’t know / Not sure Choose not to answer
Would you say that, in general, your health is…?	Excellent Very good Good Fair Poor Don’t know / Not sure Choose not to answer
During the past 30 days: How many days was your physical health, which includes physical illness and injury, not good? For about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, school, work, or hobbies? For about how many days did pain make it hard for you to do your usual activities, such as self-care, school, work, or hobbies? For about how many days have you felt very healthy and full of energy?	0 days 1 – 7 days 8 – 14 days 15 – 21 days 22 – 29 days All 30 days Don’t know / Not sure Choose not to answer
Some people who are deaf or have serious difficulty hearing use assistive devices to communicate by phone. Are you deaf or do you have serious difficulty hearing?	Yes No Don’t know / Not sure Choose not to answer
[If question A23 = yes] How old were you when you were first deaf or had serious difficulty hearing?	______ (Fill in years- - enter 0 if less than one year old) Don’t know / Not sure Choose not to answer
Are you blind or do you have serious difficulty seeing, even when wearing glasses?	Yes No Don’t know / Not sure Choose not to answer
[If question A25 = yes] How old were you when you first went blind or had serious difficulty seeing?	______ (Fill in years) Don’t know / Not sure Choose not to answer
Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?	Yes No Don’t know / Not sure Choose not to answer
[If question A27 = yes] How old were you when you first had serious difficulty concentrating, remembering, or making decisions?	______ (Fill in years) Don’t know / Not sure Choose not to answer
Do you have serious difficulty walking or climbing stairs?	Yes No Don’t know / Not sure Choose not to answer
[If question A29 = yes] How old were you when you first had serious difficulty walking or climbing stairs?	______ (Fill in years) Don’t know / Not sure Choose not to answer
Do you have difficulty dressing or bathing?	Yes No Don’t know / Not sure Choose not to answer
[If question A31 = yes] How old were you when you first had difficulty dressing or bathing?	______ (Fill in years) Don’t know / Not sure Choose not to answer
Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor’s office or shopping?	Yes No Don’t know / Not sure Choose not to answer
[If question A33 = yes] How old were you when you first had difficulty doing errands alone?	______ (Fill in years) Don’t know / Not sure Choose not to answer
What sex was recorded on your original birth certificate?	Male Female Don’t know / Not sure Choose not to answer
How do you describe yourself?	Male Female Transgender male Transgender female Other (for example, non-binary, genderqueer, gender fluid, or intersex) Don’t know / Not sure Choose not to answer
Which of the following best describes you?	Straight, that is, not lesbian or gay Lesbian Gay Bisexual Something else (for example, queer, questioning, pansexual, or asexual) Don’t know / Not sure Choose not to answer
A person’s appearance, style, dress, or the way they walk or talk may affect how people describe them. How do you think other people would describe you?	Very feminine Mostly feminine Somewhat feminine Equally feminine and masculine Somewhat masculine Mostly masculine Very masculine Don’t know / Not sure Choose not to answer
Are you currently married or in a legally recognized domestic partnership?	Yes, married [skip to question A43] Yes, in a domestic partnership [skip to question A43] No Don’t know / Not sure Choose not to answer
Have you ever been married?	Yes No [skip to question A42] Don’t know / Not sure Choose not to answer
Are you…?	Separated Divorced Widowed Don’t know / Not sure Choose not to answer
Are you currently in a dating relationship?	Yes No Don’t know / Not sure Choose not to answer
Have you ever been pregnant, or gotten a partner pregnant?	Yes No Don’t know / Not sure Choose not to answer
How many children currently live with you all or most of the time, where you are a parent or like a parent?	_______ (Fill in number) Don’t know / Not sure Choose not to answer
SYSTEM INVOLVEMENT
The next set of questions ask about foster care. Foster care (also known as out-of-home care) is a temporary service provided by states or counties for children and teens who cannot live with their families. When you were in foster care, you may have lived with relatives or with unrelated foster parents. Foster care also includes other places you may have stayed, such as group homes, residential care facilities, emergency shelters, and supervised independent living. How old were you the very first time you were placed in foster care?	_____ (Years- enter 0 if less than one year old) Don’t know / Not sure Choose not to answer
[If B1 = don’t know/not sure] Were you less than 6 years old (about when you may have been in Kindergarten or 1st grade) or were you 6 years old or older?	Less than 6 years old 6 years old or older Don’t know / Not sure Choose not to answer
Throughout your life, what type of foster care placements have you had? Select all that apply.	With foster parent(s) who are unrelated to me With relatives who were also my foster parents In a group home or residential program In a foster care emergency shelter In an independent living apartment Placed somewhere else (specify) Don’t know / Not sure Choose not to answer
[For each kind of foster care placement selected] How many homes have you been in with foster parents unrelated to you? Count every home or address you have lived in with unrelated foster parents. How many foster homes have you been in with relatives? Count every home or address you have lived in with relatives. How many foster care group homes or residential programs have you been in? How many foster care emergency shelters have you been in? How many independent living apartments have you been in? How many (other specify) have you been in?	1 2-5 6-10 11-20 20+ Don’t know / Not sure Choose not to answer
[If more than one type of placement selected) Some young people stay in one foster care placement for a long time, and others may stay for a short time or move between different homes or types of placements. You said you have lived in (fill total number) (fill type of placements). Which kind of placement did you stay in for the longest amount of time?	With foster parent(s) who are unrelated to me With relatives who were also my foster parents In a group home or residential program In a foster care emergency shelter In an independent living apartment Placed somewhere else (specify) Don’t know / Not sure Choose not to answer
Altogether, how much time have you spent in foster care?	3 months or less More than 3 months but less than 1 year More than 1 year but less than 5 years More than 5 years but less than 10 years More than 10 years Don’t know / Not sure Choose not to answer
Do you currently have an open case with [Name of Child Welfare (CW) Agency]? That is, are you living in foster care or receiving other services or assistance provided by [Name of CW Agency]?	Yes [skip to question B12] No Don’t know / Not sure Choose not to answer
[If question B7= no] What was the primary reason that your [CW Agency] case closed?	[Name of CW Agency] closed my case because I turned 18 I voluntarily closed my case after my 18th birthday I was reunited with my biological parent(s) or other relatives I was adopted My caregiver became my permanent legal guardian Other reason, please specify Don’t know / Not sure Choose not to answer
[If question B7= no] Think about the last time you were in foster care. Which of the following best describes your last foster care placement?	With my foster parent(s) who are unrelated to me With relatives who are also my foster parents In a group home or residential program In a foster care emergency shelter In an independent living apartment Placed somewhere else (specify) Don’t know / Not sure Choose not to answer
[If question B7= no] Think about the last time you were in foster care. How long was your last foster care placement? That is, how long had it been since you were living with a parent or guardian? For example: Let’s say you are 18 years old. You went to foster care when you were 10 and back home when you were 12. Then, you went back to foster care when you were 16, went to a few different foster homes but never back to live with a parent or guardian. You’re now 18 and no longer involved with [Name of CW Agency]. You would only count this last time in foster care – so, 2 years.	_______ (Fill in years) _______ (Fill in months) Less than one month Don’t know / Not sure Choose not to answer
[If question B7= no] Think about the last caseworker or social worker you had with [CW Agency]. Would you say that caseworker or social worker listened to you...?	All of the time Most of the time Some of the time Never I never met (in person, or remotely, such as on the phone) my last caseworker. Don’t know / Not sure Choose not to answer
[If question B7= yes] Are you currently living in foster care or another place arranged by [Name of CW Agency]?	Yes No Don’t know / Not sure Choose not to answer
[If question B12= yes] Which of the following best describes your current foster care placement?	With my foster parent(s) who are unrelated to me With relatives who are also my foster parents In a group home or residential program In a foster care emergency shelter In an independent living apartment Placed somewhere else (specify) Don’t know / Not sure Choose not to answer
[If question B12= yes] Think about your current time in foster care. How long have you been in foster care this time? That is, how long has it been since you were living with a parent or guardian? For example: Let’s say you are 19 years old. You went to foster care when you were 10 and back home when you were 12. Then, you went back to foster care when you were 16 and you’re now 19 and living with a foster parent. You would only count this last time in foster care – so, 2 years.	_______ (Fill in years) _______ (Fill in months) Less than a month Don’t know / Not sure Choose not to answer
[If question B7= yes] Overall, how much do you feel your current caseworker or social worker listens to you? Would you say they listen to you...?	All of the time Most of the time Some of the time Never Don’t know / Not sure Choose not to answer
[If question B7= yes] How well do you feel that your current caseworker or social worker understands you and your situation? Would you say...	Not well at all Somewhat well Very well Don’t know / Not sure Choose not to answer
Have you ever been arrested by the police or taken into custody for an illegal or delinquent offense? That is, for violating a law or court order? Please do not include arrests for minor traffic violations.	Yes No [Skip to question C1] Don’t know / Not sure Choose not to answer
In total, how many times have you been arrested or taken into custody by the police?	_______ (Fill in number of times) Don’t know / Not sure Choose not to answer
[If question B18 > 1] How old were you the first time you were arrested or taken into custody by the police? [If question B18 = 1] How old were you when you were arrested or taken into custody by the police?	______ (Fill in years) Don’t know / Not sure Choose not to answer
[If question B18> 1] Thinking about all the times you were arrested or taken into custody, did the police ever charge you with an offense? [If question B18 =1] When you were arrested or taken into custody, did the police charge you with an offense?	Yes No [skip to question C1] Don’t know / Not sure Choose not to answer
[If questions B19or B20 < 18 years] When you were arrested or taken into custody before you turned 18, were you charged as a juvenile, as an adult, or both?	Juvenile Adult Both adult and juvenile Don’t know / Not sure Choose not to answer
[If question B18> 1] Thinking about all the times you have been arrested or taken into custody, did the police ever charge you with… [If question B18= 1] When you were arrested or taken into custody, did the police charge you with … [only if questions B19 or B20 < 18 years] A juvenile status offense, such as running away, skipping school, violating curfew, drinking alcohol while underage, or being “ungovernable” Assault, that is, an attack with a weapon or your hands, such as battery, rape, aggravated assault, or manslaughter? Prostitution or a related offense, such as soliciting or loitering? Robbery, which is taking something from someone using a weapon or force? Burglary or breaking and entering, which is, breaking into private property without permission in order to steal? Theft, that is, stealing something without the use of force, such as auto theft, larceny, or shoplifting? Destruction of property, that is, vandalism, arson, malicious destruction, or shoplifting? Other property offenses, such as, fencing, receiving, possessing or selling stolen property? Possession or use of illicit drugs? The sale or trafficking of illicit drugs? Domestic violence or stalking? Violation of a protective order? Gang-related offense? Child abuse? A major traffic offense, such as, driving under the influence of alcohol or other drugs, reckless driving, or driving without a license? A public order offense, such as, drinking or purchasing alcohol while under the legal age, disorderly conduct, or a sex offense? Any other offense we have not talked about?	Yes No Don’t know / Not sure Choose not to answer
[If question B18 > 1] As a result of any arrest, were you convicted of or did you plead guilty to any charges? [If question B18 =1] As a result of this arrest, were you convicted of or did you plead guilty to any charges?	Yes No Don’t know / Not sure Choose not to answer
[If question B18 >1] As a result of any arrest, were you sent to a pre-court diversion program or to counseling? [If question B18 =1 and question B27 = no] As a result of this arrest, were you sent to a pre-court diversion program or to counseling?	Yes No Don’t know / Not sure Choose not to answer
[If questions B26 or B27 = yes] As a result of being convicted of any charges, were you sentenced to… spend time in a youth correctional institution like juvenile hall, reform school, or training school? spend time in an adult correctional institution such as a prison or jail? perform community service? a different sentence? (specify in youth’s own words)	Yes No Don’t know / Not sure Choose not to answer
[If question B30a = yes] How old were you the first time you were placed in a youth correctional institution, like juvenile hall, reform school or training school?	_______ (Fill in years) Don’t know / Not sure Choose not to answer
[If question B30a = yes] How many different times have you been sentenced to serve time in a youth correctional institution, like juvenile hall, reform school or training school?	_______ (Fill in number) Don’t know / Not sure Choose not to answer
[If question B30a = yes AND question B32 = 1] How many years and/or months did you spend in a youth correctional institution that time? [If question B30a = yes AND question B32> 1] Think about all the times you have been sentenced to serve time in a youth correctional institution. How many years and/or months, altogether, have you spent there?	• _______ (Fill in years) _______ (Fill in months) Less than a month Don’t know / Not sure Choose not to answer
[If question B30b = yes] How old were you the first time you were first placed in an adult correctional institution, like a jail or prison?	______ (Fill in years) Don’t know / Not sure Choose not to answer
[If question B30b = yes] How many different times have you been sentenced to serve time in an adult correctional institution, like a jail or prison?	______ (Fill in number) Don’t know / Not sure Choose not to answer
[If question B30b = yes AND question B36 = 1] How many years and/or months total time did you spent in an adult corrections institution that time? [If question B30b = yes AND question B36 > 1] Think about all the times you have been sentenced to serve time in an adult correctional institution. How many years and/or months, altogether, have you spent there?	_______ (Fill in years) _______ (Fill in months) Less than a month Don’t know / Not sure Choose not to answer
Before you were 18, were you ever placed out of home by [juvenile justice agency] in a group home – that is, a community placement for young people who had committed a delinquent offense?	Yes No Don’t know / Not sure Choose not to answer
[If question B39 = yes] How old were you the first time you were first placed out of home by [juvenile justice agency] or by the police?	______ (Fill in years) Don’t know / Not sure Choose not to answer
[If question B39 = yes] How many different times have you been placed out of home by [juvenile justice agency] or by the police?	______ (Fill in number) Don’t know / Not sure Choose not to answer
[If question B39 = yes AND question B41 = 1] How many years and/or months total time were you placed out of home by [juvenile justice agency] or by the police? [If question B30b = yes AND question B41 > 1] Think about all the times you were placed out of home by [juvenile justice agency] or by the police. How many years and/or months, altogether, have you been placed out of home?	_______ (Fill in years) _______ (Fill in months) Less than a month Don’t know / Not sure Choose not to answer
SOCIAL SUPPORT
Think of specific people you could go to if you wanted to talk to someone about something personal or private- for instance, if you had something on your mind that was worrying you or making you feel down. How many people could you turn to?	No one 1 2 3 4 5 or more Don’t know / Not sure Choose not to answer
[If question C1 is not = no one] How are these people, the people you could talk to about something personal or private, related to you? Check all that apply.	Biological parent, adoptive parent, or stepparent Foster parent or group home staff person Sibling Another relative My spouse Boyfriend/girlfriend Friend Caseworker or social worker Teacher, school counselor, school staff member or coach Therapist, counselor or doctor Lawyer or court-appointed special advocate (a CASA) Mentor Pastor, priest, rabbi, imam or other religious figure Boss or coworker Other Don’t know / Not sure Choose not to answer
Think of specific people you could to go to if you needed someone to lend or give you something you needed or pitch in to help you with something. These would be people who would run an errand for you, lend you money, food, clothing, or drive you somewhere you needed to go. How many people could you turn to?	No one 1 2 3 4 5 or more Don’t know / Not sure Choose not to answer
[If question C3 is not = no one] How are these people, the people to go to if you needed someone to lend or give you something you needed or pitch in to help you with something you needed to do, related to you? Check all that apply.	Biological parent, adoptive parent, or stepparent Foster parent or group home staff person Sibling Another relative My spouse Boyfriend/girlfriend Friend Caseworker or social worker Teacher, school counselor, school staff member or coach Therapist, counselor or doctor Lawyer or court-appointed special advocate (a CASA) Mentor Pastor, priest, rabbi, imam or other religious figure Boss or coworker Other Don’t know / Not sure Choose not to answer
Think of specific people you could go to if you needed advice or information- for example, if you didn’t know where to get something or how to do something. How many people could you go to?	No one 1 2 3 4 5 or more Don’t know / Not sure Choose not to answer
[If question C5 is not = no one] How are these people, the people you could go to if you needed advice or information, related to you? Check all that apply.	Biological parent, adoptive parent, or stepparent Foster parent or group home staff person Sibling Another relative My spouse Boyfriend/girlfriend Friend Caseworker or social worker Teacher, school counselor, school staff member or coach Therapist, counselor or doctor Lawyer or court-appointed special advocate (a CASA) Mentor Pastor, priest, rabbi, imam or other religious figure Boss or coworker Other Don’t know / Not sure Choose not to answer
When you need to talk to someone about something personal or private – for instance, if you had something on your mind that was worrying you or making you feel down – are there enough people you can count on, too few people, or no one you can count on? When you need someone to lend a hand or give you something you needed or pitch in to help you with something – for instance, run an errand for you, lend you money, food, clothing or drive you somewhere you needed to go – are there enough people you can count on, too few people, or no one you can count on? When you need advice or information – for example, if you didn’t know where to get something or how to do something you needed to do – are there enough people you can count on, too few people, or no one you can count on?	Enough people you can count on Too few people No one you can count on Don’t know / Not sure Choose not to answer
During the past 3 months, that is, since [REFERENCE DATE] how often have you communicated with your parent(s), sibling(s), or other people related to you by birth or adoption, by – for example – speaking, texting, emailing, messaging or posts on social media, or visiting?	Every day Almost every day A few times a week About once a week 1 – 3 days a month Less than once a month Never Don’t know / Not sure Choose not to answer
INTERNAL ASSETS
Please imagine a ladder with steps numbered from 0 at the bottom to 10 at the top. The top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you. On which step of the ladder would you say you personally feel you stand at this time? On which step do you think you will stand about 5 years from now?	______ (Enter number from 1 – 10) Don’t know / Not sure Choose not to answer
The next few sentences describe how people think about themselves and how they do things in general. For each sentence, please think about how you are in most situations. Select the answers that describes YOU the best. There is no right or wrong answer. I think I am doing pretty well. I can think of many ways to get the things in life that are most important to me. I am doing just as well as other people my age. When I have a problem, I can come up with lots of ways to solve it. I think the things I have done in the past will help me in the future. Even when others want to quit, I know that I can find ways to solve the problem.	None of the time A little of the time Some of the time A lot of the time Most of the time All of the time Don’t know / Not sure Choose not to answer
How true are the following things about you? My life has a clear sense of purpose. I have a good sense of what makes my life meaningful. Overall, I expect more good things to happen to me than bad.	Mostly true about me Somewhat true about me A little true about me Not true about me Don’t know / Not sure Choose not to answer
How often are the following things true for you? I pay attention to how I feel. I have no idea how I am feeling. I have difficulty making sense out of my feelings. I am attentive to my feelings. I am confused about how I feel. When I’m upset, I acknowledge my emotions. When I’m upset, I become embarrassed for feeling that way. When I’m upset, I have difficulty getting work done. When I’m upset, I become out of control. When I'm upset, I believe that I will remain that way for a long time. When I'm upset, I believe that I'll end up feeling very depressed. When I'm upset, I have difficulty focusing on other things. When I'm upset, I feel ashamed with myself for feeling that way. When I'm upset, I feel guilty for feeling that way. When I'm upset, I have difficulty concentrating. When I'm upset, I have difficulty controlling my behaviors. When I'm upset, I believe that wallowing in it is all I can do. When I'm upset, I lose control over my behaviors.	Almost Never Sometimes About Half the Time Most of the Time Almost Always Don’t know / Not sure Choose not to answer
EXTERNAL ASSETS
During the last 3 months, that is, since [REFERENCE DATE], have… you been employed full-time for wages, salary, tips or commission? you been employed part-time for wages, salary, tips or commission? During the last 3 months, that is, since [REFERENCE DATE], have you received…? Social Security payments, such as Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI), or dependents’ payments? Assistance payments, such as Temporary Assistance to Needy Families or TANF, general assistance, emergency assistance, or other welfare benefits? Unemployment compensation payments? Food stamps, also known as Supplemental Nutrition Assistance Program or SNAP benefits? WIC benefits, also known as the Women, Infants and Children program? Housing assistance from the government, such as living in public housing or receiving housing vouchers? Payments from [child welfare agency], such as Chafee funds? Educational benefits for living expenses, tuition, or other education expenses, including [state foster care education assistance program]? Supervised Independent Living Placement (SILP) payments? Other benefits or payments, specify_________________________ During the last 3 months, have you received…? Financial help from a relative, friend, partner or spouse Financial help from a community group (for example: a church, community organization, family resource center, etc.) Other financial help, specify______________________________	Yes No Don’t know / Not sure Choose not to answer
Please indicate whether each of the following is very true, a little true, or not true of your financial situation over the last 3 months, that is since [REFERENCE DATE] You don’t have enough money to buy the clothes or household items that you need. You are behind 1-month or more on the rent or mortgage payment. You don’t have enough money to pay the regular bills. You don’t have enough money to go out to dinner or pay for entertainment or recreational activities. It would be hard for you to find the money to cover an unexpected expense, such as a medical bill or repair that was $100 or more.	Very true A little true Not true Not Applicable (for questions E16 and E17) Don’t know / Not sure Choose not to answer
For these statements, please tell me whether the statement was often true, sometimes true, or never true for (you/your household) in the last 12 months—that is, since last [name of current month]. “(I/We) worried whether (my/our) food would run out before (I/we) got money to buy more.” “The food that (I/we) bought just didn’t last, and (I/we) didn’t have money to get more.” “(I/we) couldn’t afford to eat balanced meals.”	Often true Sometimes true Never true Don’t know / Not sure Choose not to answer
COMMUNITY SERVICES
Currently are you on [State Medicaid name]?	Yes No Don’t know / Not sure Choose not to answer
Currently do you have health insurance, other than [State Medicaid name]?	Yes No Don’t know / Not sure Choose not to answer
During the past 12 months, did you get food from a church, food pantry, or food bank? During the past 12 months, did you eat any meals at a soup kitchen or community meal program?	Yes No Don’t know / Not sure Choose not to answer
During the past 12 months, did you spend at least 1 night in a runaway or homeless shelter? During the past 12 months, did you spend at least 1 night in a domestic violence or other emergency shelter? During the past 12 months, did you go to a drop-in center for young people who need a place to be during the day? During the past 12 months, did you get clothes from a church or clothing bank?	Yes No Don’t know / Not sure Choose not to answer
The next set of questions are about trying to get help for various reasons. Here, think about trying to get help from community resources. In this survey, community resources mean organizations that serve a particular area or group of people by providing help and tools to help the community grow and improve the quality of life for people in that community. When you answer these questions, think about trying to get help from organizations – for example, calling a homeless or runaway shelter, trying to get services at hospital or other community health or mental health organization, and talking with someone at or filling out an application for a social service program like TANF (financial assistance program) or SNAP (food supplement program). During the past 12 months, did you try to get help with finding a place to stay for a few nights During the past 12 months, did you try to get help with finding transitional or long-term housing? During the past 12 months, did you try to get help with getting money to live on? During the past 12 months, did you try to get help with school or a GED program? During the past 12 months, did you try to get help with finding a job or training for a job? During the past 12 months, have you tried to get medical care for a serious injury or illness? During the past 12 months, have you tried to get medical care for a sexually transmitted disease, like HIV or AIDS, chlamydia, or gonorrhea? During the past 12 months, have you tried to get medical care for birth control or pregnancy? During the past 12 months, have you tried to get help for problems with your use of alcohol or drugs? During the past 12 months, have you tried to get help for your emotional or mental health problems?	Yes No Don’t know / Not sure Choose not to answer
[For each “yes” response to questions F9-18] How much help were you able to get with [Fill type of need from questions F9-18]?	No help at all A little bit of help Some help, but not much A great deal of help All the help that I needed Don’t know / Not sure Choose not to answer
SWITCH TO AUDIO COMPUTER-ASSISTED SELF-INTERVIEW SOFTWARE Interviewer: Now I'd like you to use the headphones to listen to some questions and enter your answers into the computer yourself.  This will allow you to answer the questions in complete privacy.  I will not be able to hear the questions or see the answers you type into the computer.  I can help you do the first few, and I'd like you to finish the rest on your own. I’ll show you how to use the computer. INTERVIEWER: MOVE COMPUTER SO RESPONDENT CAN USE IT AND POINT OUT THE FOLLOWING:     - NUMBER KEYS     - ENTER KEY (TO ACCEPT AND STORE THE RESPONSE)     - FUNCTION KEYS CAUTION RESPONDENT ABOUT ON/OFF SWITCH. ADJUST HEADPHONES FOR RESPONDENT AND DEMONSTRATE VOLUME CONTROL. WHEN RESPONDENT IS READY, PRESS "1" AND [ENTER] TO CONTINUE.
MENTAL HEALTH
During the past 30 days, about how often did you feel … nervous? hopeless? restless or fidgety? so depressed that nothing could cheer you up? that everything was an effort? worthless?	None of the time A little of the time Some of the time A lot of the time Most of the time All of the time Don’t know / Not sure Choose not to answer
The last six questions asked about feelings that might have occurred during the past 30 days, that is, since [REFERENCE DATE]. Taking them altogether, did these feelings occur: more often in the past 30 days than is usual for you, about the same as usual, or less often than usual?	A lot more than usual Some more than usual A little more than usual About the same as usual A little less than usual Some less than usual A lot less than usual Don’t know / Not sure Choose not to answer
[If all questions G1a-G1f are not = none of the time] During the past 30 days, how many days out of 30 were you totally unable to work, go to school, or carry out your normal activities because of these feelings? [If question G3 > 0] Not counting the [FILL from question G3] you were totally unable to work, go to school, or carry out your normal activities because of these feelings, how many days in the past 30 were you able to do only half or less of what you would normally have been able to do, because of these feelings? [If question G3 = 0] How many days in the past 30 were you able to do only half or less of what you would normally have been able to do because of these feelings?	______ (Fill in days) Don’t know / Not sure Choose not to answer
[If all questions G1a-G1f are not = none of the time] During the past 30 days since [REFERENCE DATE], how many times did you meet with a doctor or other health professional about these feelings?	______ (Fill in number) Don’t know / Not sure Choose not to answer
[If all questions G1a-G1f are not = none of the time] During the past 30 days, how often have physical health problems been the main cause of these feelings?	All of the time Most of the time A lot of the time Some of the time A little of the time None of the time Don’t know / Not sure Choose not to answer
The next questions are about problems and complaints that people sometimes have in response to stressful life experiences. Please indicate how much you have been bothered by each problem in the past 30 days. Repeated, disturbing memories, thoughts, or images of a stressful experience from the past? Feeling very upset when something reminded you of a stressful experience from the past? Avoided activities or situations because they reminded you of a stressful experience from the past? Feeling distant or cut off from other people? Feeling irritable or having angry outbursts? Difficulty concentrating?	Not at all A little bit Moderately Quite a bit Extremely Don’t know / Not sure Choose not to answer
RUNAWAY AND BEING KICKED OUT
The next set of questions ask about times you may have run away from your parent or guardian’s home for at least one night. These are times that you left without your parent or guardian’s permission (or knowledge). We recognize leaving home can be complicated – another set of questions will ask about times you may have been kicked out or told to leave a parent or guardian’s home. Have you ever run away from your parent or caregiver’s home for at least one night? This would be the home of a parent or other relative that usually took care of you, but not a place that [child welfare agency] arranged for you.	Yes No [skip to question H11] Don’t know / Not sure Choose not to answer
How old were you the first time you ran away from your parent or caregiver’s home?	_____ (Fill in years) Don’t know / Not sure Choose not to answer
[If H2 = Don’t know/not sure] Were you less than 12 years old, or 12 years old or older?	Less than 12 years old 12 years or older Don’t know / Not sure Choose not to answer
About how many times have you run away from your parent or caregiver’s home?	1 – 5 times 6 – 10 times 11 or more times Don’t know / Not sure Choose not to answer
What influenced you to run away? Sometimes there is one reason and sometimes there are multiple reasons. Select all that apply.	You wanted to be on your own You wanted to be with a friend(s) You wanted to be with a sibling(s) You wanted to be with another family member, like an aunt or grandparent You wanted to be with a boyfriend, girlfriend or dating partner Parent(s) or caregiver(s) kicked you out or told you to leave Your home was not a safe place You didn’t get along with your parent(s) or caregiver(s) Someone at home hit, slapped or beat you (or some other form of physical aggression) Someone called you names or said mean things to you (or some other form of verbal abuse) Someone forced you (or tried to force you) to do sexual things You felt like you had too many rules you were supposed to follow Your parent or caregiver chose their partner/spouse over you You didn’t like your parent’s partner or spouse You weren’t accepted for who you are Your parent or caregiver was always drunk or on drugs You didn’t get along with the other kids you lived with Your parent(s) or caregiver(s) could not afford to take care of you You wanted to make money You were forced to work You were not allowed to go to school or work You were forced to follow religious practices you did not agree with Your neighborhood was not safe Someone threatened to hurt you or told you that you would be in trouble if you did not run away. Other (please specify): Don’t know / Not sure Choose not to answer
When you ran away from your parent or caregiver’s home, what type of place did you sleep most often	A house or apartment A shelter (such as a runaway or homeless youth shelter, drop-in center) Inside a car, abandoned building, squat, etc. Outside in the park, on the street, in a tent, etc. A transit station (subway or bus station or the airport) A hotel or motel A hospital A church, temple, mosque or other place of worship A school A place of business (such as a massage parlor, beauty salon, tax preparation service) A house or apartment that is mainly used for sex, like a brothel Other (please specify): Don’t know / Not sure Choose not to answer
How safe do you think you were when you slept [fill response from question H6]?	Very safe Safe Somewhat safe Somewhat unsafe Unsafe Very unsafe Don’t know / Not sure Choose not to answer
If your usual place wasn’t available when you ran away from your parent or caregiver’s home, what was your first back-up?	A house or apartment A shelter (such as a runaway or homeless youth shelter, drop-in center) Inside a car, abandoned building, squat, etc. Outside in the park, on the street, in a tent, etc. A transit station (subway or bus station or the airport) A hotel or motel A hospital A church, temple, mosque or other place of worship A school A place of business (such as a massage parlor, beauty salon, tax preparation service) A house or apartment that is mainly used for sex, like a brothel Other (please specify): I didn’t have a back-up Don’t know / Not sure Choose not to answer
When you ran away from your parent or caregiver’s home, did you go to anyone? Check all that apply. Who did you go to most often?	No, I was on my own A current or former boyfriend/girlfriend or dating partner A friend or a friend’s family – this friend is someone with whom I never had a sexual or dating relationship A sibling Another family member who is related to me by blood or marriage (for example, an aunt, grandmother, or father who did not have custody) A former foster parent(s) or group home staff person A teacher, school counselor, school staff member or coach “Fam” or people who are like family to me Someone who lets me stay in exchange for sex or doing things for them A boss Other (please specify): Don’t know / Not sure Choose not to answer
The next set of questions ask about times you may have been kicked out or told to leave your parent or caregiver’s home. Think about times you were kicked out or told to leave and you were gone for at least one night. Have you ever been kicked out of your own home? This would be the home of a parent or other relative that usually took care of you, but not a place that [child welfare agency] arranged for you.	Yes No [skip to question H22] Don’t know / Not sure Choose not to answer
How old were you the first time you were kicked out of your home by your parent or caregiver?	______ (Fill in years) Don’t know / Not sure Choose not to answer
[If H12 = Don’t know/not sure] Were you less than 12 years old, or 12 years old or older?	Less than 12 years old 12 years or older Don’t know / Not sure Choose not to answer
About how many times have you been kicked out of your home by your parent or caregiver?	1 – 5 times 6 – 10 times 11 or more times Don’t know / Not sure Choose not to answer
From your understanding, why did your parent or caregiver kick you out? Select all that apply.	You didn’t follow their rules Your parent or caregiver chose their partner/spouse over you They didn’t accept you for who you are You refused to do something your family wanted you to do (for example, sell your body, have sex with someone you did not want to) Your family hurt you and you tried to stop them or fight back Your parents or caregiver could not afford to take care of you Don’t know / Not sure Other (please specify)
When you were kicked out of your parent or caregiver’s home, what type of place did you sleep most often?	A house or apartment A shelter (such as a runaway or homeless youth shelter, drop-in center) Inside a car, abandoned building, squat, etc. Outside in the park, on the street, in a tent, etc. A transit station (subway or bus station or the airport) A hotel or motel A hospital A church, temple, mosque or other place of worship A school A place of business (such as a massage parlor, beauty salon, tax preparation service) A house or apartment that is mainly used for sex, like a brothel Other (please specify): Don’t know / Not sure Choose not to answer
How safe do you think you were when you slept [fill response from question H16]?	Very safe Safe Somewhat safe Somewhat unsafe Unsafe Very unsafe Don’t know / Not sure Choose not to answer
And if your usual place wasn’t available when you were kicked out of your home by your parent or caregiver, what was your first back-up?	A house or apartment A shelter (such as a runaway or homeless youth shelter, drop-in center) Inside a car, abandoned building, squat, etc. Outside in the park, on the street, in a tent, etc. A transit station (subway or bus station or the airport) A hotel or motel A hospital A church, temple, mosque or other place of worship A school A place of business (such as a massage parlor, beauty salon, tax preparation service) A house or apartment that is mainly used for sex, like a brothel Other (please specify): I didn’t have a backup Don’t know / Not sure Choose not to answer
When you were kicked out of your parent or caregiver’s home, did you go to anyone? Check all that apply. Who did you go to most often?	No, I was on my own A current or former boyfriend/girlfriend or dating partner A friend or a friend’s family – this friend is someone I never had a sexual or dating relationship A sibling Another family member who is related to me by blood or marriage (for example, an aunt, grandmother, or father who did not have custody) A former foster parent(s) or group home staff person A teacher, school counselor, school staff member or coach “Fam” or people who are like family to me Someone who lets me stay in exchange for sex or doing things for them A boss Other (please specify): Don’t know / Not sure Choose not to answer
What is the longest time you spent away from home because you ran away or you were kicked out or told to leave? Think about a single episode, or a single time you spent away before you went back home or someone else made you go back (e.g., parent, police).	1 to 3 days 4 to 6 days 1 to 3 weeks 1 to 2 months 3 to 6 months Longer than 6 months Don’t know / not sure Choose not to answer
The next set of questions ask about times you may run away, or when you left your foster care home, a group home, or another place that [child welfare agency] arranged for you. Think about times you ran away for at least one night. These are times that you left without permission of your foster parent or residential or group home staff. We recognize leaving can be complicated – another set of questions will ask about times where you were kicked out or told to leave your foster care placement. Have you ever run away from foster care, a group home, or another place that [child welfare agency] arranged for you?	Yes No [skip to question H32] Don’t know / Not sure Choose not to answer
How old were you the first time you ran away from foster care?	_____ (Fill in years) Don’t know / Not sure Choose not to answer
[If H23 = Don’t know/Not sure] Were you less than 15 years old, or 15 years old or older?	Less than 15 years old (if DK/NS of age) 15 years or older (if DK/NS of age) Don’t know / Not sure Choose not to answer
About how many times have you run away from foster care?	1 – 5 times 6 – 10 times 11 or more times Don’t know / Not sure Choose not to answer
What influenced you to run away? Sometimes there is one reason and sometimes there are multiple reasons. Select all that apply.	You wanted to be on your own You wanted to be with a friend(s) You wanted to be with a sibling(s) You wanted to be with another family member, like an aunt or grandparent You wanted to be with a boyfriend, girlfriend or dating partner Foster parent kicked you out or told you to leave Your foster home or other placement was not a safe place You didn’t get along with your foster parent or residential or group home staff Someone in your foster care placement hit, slapped or beat you (or some other form of physical aggression) Someone in your foster care placement called you names or said mean things to you (or some other form of verbal abuse) Someone forced you (or tried to force you) to do sexual things that you did not want to do You felt like you had too many rules you were supposed to follow Your foster parent chose their partner/spouse over you You didn’t like your foster parent’s partner or spouse You weren’t accepted for who you are Your foster parent was always drunk or on drugs You didn’t get along with the other kids you lived with You were going to get moved to a different foster home or group home and you didn’t want to go You wanted to make money You were forced to work You were not allowed to go to school or work You were forced to follow religious practices you did not agree with Your neighborhood was not safe Someone threatened to hurt you or told you that you would be in trouble if you did not run away. Other (please specify):
When you ran away from foster care, what type of place did you sleep most often?	A house or apartment A shelter (such as a runaway or homeless youth shelter, drop-in center) Inside a car, abandoned building, squat, etc. Outside in the park, on the street, in a tent, etc. A transit station (subway or bus station or the airport) A hotel or motel At a hospital A church, temple, mosque or other place of worship A school A place of business (such as a massage parlor, beauty salon, tax preparation service) A house or apartment that is mainly used for sex, like a brothel Other (please specify): Don’t know / Not sure Choose not to answer
How safe do you think you were when you slept [fill response from question H27]?	Very safe Safe Somewhat safe Somewhat unsafe Unsafe Very unsafe Don’t know / Not sure Choose not to answer
If your usual place wasn’t available when were ran away from foster care, what was your first back-up?	A house or apartment A shelter (such as a runaway or homeless youth shelter, drop-in center) Inside a car, abandoned building, squat, etc. Outside in the park, on the street, in a tent, etc. A transit station (subway or bus station or the airport) A hotel or motel At a hospital A church, temple, mosque or other place of worship A school A place of business (such as a massage parlor, beauty salon, tax preparation service) A house or apartment that is mainly used for sex, like a brothel Other (please specify): I didn’t have a back-up Don’t know / Not sure Choose not to answer
When you ran away from foster care, did you go to anyone? Check all that apply. Who did you go to most often?	No, I was on my own A current or former boyfriend/girlfriend or dating partner A friend or a friend’s family – this friend is someone with whom I never had a sexual or dating relationship A parent A sibling Another family member who is related to me by blood or marriage (for example, an uncle or grandmother) A former foster parent(s) or group home staff person A teacher, school counselor, school staff member or coach “Fam” or people who are like family to me Someone who lets me stay in exchange for sex or doing things for them A boss Other (please specify): Don’t know / Not sure Choose not to answer
The next set of questions ask about times you may have been kicked or told to leave foster care – this could be a foster care home, group home, or another place that [child welfare agency] arranged for you. Think about times you were kicked out or told to leave and you were gone for at least one night. Have you ever been kicked out of a foster care placement, such as a foster home or group home?	Yes No [skip to question I1] Don’t know/ Not sure Choose not to answer
How old were you the first time you were kicked out of foster care?	______ (Fill in years) Don’t know / Not sure Choose not to answer
[If H33 = Don’t Know/Not Sure] Were you less than 15 years old, or 15 years old or older?	Less than 15 years old 15 years or older Don’t know / Not sure Choose not to answer
About how many times have you been kicked out of a foster care placement?	1 – 5 times 6 – 10 times 11 or more times Don’t know / Not sure Choose not to answer
From your understanding, why were you kicked out of a foster care placement? Select all that apply.	You didn’t follow their rules You didn’t get along with your foster parent or group home or residential staff Your foster parent chose their partner/spouse over you Your foster parent or group home or residential staff didn’t accept you for who you are You didn’t get along with the other kids there You refused to do something your family wanted you to do (for example, sell your body, have sex with someone you did not want to) Your family hurt you and you tried to stop them or fight back Don’t know / Not sure Other (please specify)
When you were kicked out of foster care, what type of place did you sleep most often?	A house or apartment A shelter (such as a runaway or homeless youth shelter, drop-in center) Inside a car, abandoned building, squat, etc. Outside in the park, on the street, in a tent, etc. A transit station (subway or bus station or the airport) A hotel or motel At a hospital A church, temple, mosque or other place of worship A school A place of business (such as a massage parlor, beauty salon, tax preparation service) A house or apartment that is mainly used for sex, like a brothel Other (please specify): Don’t know / Not sure Choose not to answer
How safe do you think you were when you slept [fill response from question H37]?	Very safe Safe Somewhat safe Somewhat unsafe Unsafe Very unsafe Don’t know / Not sure Choose not to answer
If your usual place wasn’t available when you were kicked out of your foster care placement, what was your first back-up?	A house or apartment A shelter (such as a runaway or homeless youth shelter, drop-in center) Inside a car, abandoned building, squat, etc. Outside in the park, on the street, in a tent, etc. A transit station (subway or bus station or the airport) A hotel or motel At a hospital A church, temple, mosque or other place of worship A school A place of business (such as a massage parlor, beauty salon, tax preparation service) A house or apartment that is mainly used for sex, like a brothel Other (please specify): I didn’t have a back-up Don’t know / Not sure Choose not to answer
When you were kicked out of your parent or caregiver’s home, did you go to anyone? Check all that apply. Who did you go to most often?	No, I was on my own A current or former boyfriend/girlfriend or dating partner A friend or a friend’s family – this friend is someone I never had a sexual or dating relationship A parent A sibling Another family member who is related to me by blood or marriage (for example, an uncle or grandmother) A former foster parent(s) or group home staff person A teacher, school counselor, school staff member or coach “Fam” or people who are like family to me Someone who lets me stay in exchange for sex or doing things for them A boss Other (please specify): Don’t know / Not sure Choose not to answer
What is the longest time you spent away from a foster care placement because you ran away or you were kicked out or told to leave? Think about a single episode, or a single time you spent away before you went back to your foster care placement or someone else made you go back (e.g., foster parent, caseworker, police).	1 to 3 days 4 to 6 days 1 to 3 weeks 1 to 2 months 3 to 6 months Longer than 6 months Don’t know / not sure Choose not to answer
VICTIMIZATION AND TRAFFICKING-RELATED RISKS
Not including spanking on your bottom, before you turned 18, did an adult in your life hit, beat, kick, or physically hurt you in any way? Before you turned 18, did you get scared or feel really bad because adults in your life called you names, said mean things to you, or said they didn’t want you? When someone is neglected, it means that the adults in their life don’t take care of them the way they should. They might not get them enough food, take them to the doctor when they are sick, or make sure they have a safe place to stay. Before you turned 18, were you neglected? Before you turned 18, did a group of kids or a gang hit, jump, or attack you? Before you turned 18, were you hit or attacked because someone said you were gay, lesbian or transgender? Before you turned 18, did an adult you know touch your private parts when they shouldn’t have or make you touch their private parts? Or did an adult you know force you to have sex? Before you turned 18, did an adult you did not know touch your private parts when they shouldn’t have, make you touch their private parts or force you to have sex with them? Before you turned 18, did another child or teenager make you do sexual things? Before you turned 18, did anyone try to force you to have sex; that is, sexual intercourse of any kind, even if it didn’t happen? Before you turned 18, did you do sexual things with anyone 18 or older, even things you both wanted? Before you turned 18, did you SEE a parent get pushed, slapped, hit, punched, or beat up by another parent, or by their boyfriend or girlfriend? Before you turned 18, were you in any place in real life where you could see or hear people being shot, bombs going off, or street riots?	Yes No Don’t know / Not Sure Choose not to answer
[After each question I1-12 = yes] How many times did this happen to you, before you turned 18?	Once Two or three times More than three times Don’t know/ Not Sure Choose not to answer
[After each question I1-12= yes] How old were you (the first time/when) this happened?	______ (Fill in years) Don’t know/ Not Sure Choose not to answer
[After each question I1-12= yes AND question I13 = ‘Two or three times’ or ‘More than three times’] How old were you the most recent time this happened?	______ (Fill in years) Don’t know/ Not Sure Choose not to answer
Have you ever engaged in sexual acts with someone because another person (a partner, family member, or someone who was important to you) asked you to, or because you felt you had to, or because someone made you feel like you had to?	Yes No Don’t know / Not sure Choose not to answer
[If I16 = Yes] How old were you the first time you engaged in sexual acts with someone because another person (a partner, family member, or someone who was important to you) asked you to, or because you felt you had to, or because someone made you feel like you had to?	______ (Fill in years) Don’t know / Not sure Choose not to answer
[If I16 = Yes] How old were you the most recent time you engaged in sexual acts with someone because another person (a partner, family member, or someone who was important to you) asked you to, or because you felt you had to, or because someone made you feel like you had to?	_____ (Fill in years) Don’t know / Not sure Choose not to answer
Have you ever taken part in nude or sexually explicit dancing, modeling, massage, or virtual sexual services (such as web camming, games, phone sex, premium Snap Chat) in exchange for food, money, shelter, favors, or other things that you needed?	Yes No Don’t know/ Not Sure Choose not to answer
[If I19 = yes] How old were you the first time you took part in dancing, modeling, or videos in exchange for something?	______ (Fill in years) Don’t know/ Not Sure Choose not to answer
[If I19 = yes] How old were you the most recent time you took part in dancing, modeling, or videos in exchange for something?	______ (Fill in years) Don’t know/ Not Sure Choose not to answer
How many members of your family have traded sexual acts or used sexual acts to earn food, clothing, money, shelter, favors, or other things they need?	None of them Very few of them Some of them Most or all of them Don’t know/ Not Sure Choose not to answer
Thinking about the last 12 months, how many of your friends have traded sexual acts or used sexual acts to earn food, clothing, money, shelter, favors, or other things they need?	None of them Very few of them Some of them Most of them All of them Don’t know/ Not Sure Choose not to answer
Thinking about the last 12 months, have any of your friends ever suggested that you trade or use sexual acts to earn money, food, or other things you need?	Yes No Don’t know/ Not Sure Choose not to answer
Since you turned 18, have you traded sex or used sex to earn money, food, or anything else? Please do not count times when you were working for someone else.	Yes No [skip to question J1] Don’t know/ Not Sure Choose not to answer
Where did you sleep most nights at that time?	A house or apartment A shelter (such as a runaway or homeless youth shelter, drop-in center) Inside a car, abandoned building, squat, etc. Outside in the park, on the street, in a tent, etc. A transit station (subway or bus station or the airport) A hotel or motel At a hospital A church, temple, mosque or other place of worship A school A place of business (such as a massage parlor, beauty salon, tax preparation service) A house or apartment that is mainly used for sex, like a brothel Other (please specify): Don’t know / Not sure Choose not to answer
SUBSTANCE USE
Have you ever, even once, had a drink of any type of alcoholic beverage?	Yes No Don’t know/ Not Sure Choose not to answer
[If question J1 = yes] How old were you the first time you had a drink of any type of alcoholic beverage?	______ (Fill in years) Don’t know/ Not Sure Choose not to answer
Have you ever, even once, used marijuana?	Yes No Don’t know/ Not Sure Choose not to answer
[If question J3 = yes] How old were you the first time you used marijuana?	______ (Fill in years) Don’t know/ Not Sure Choose not to answer
Not including marijuana, have you ever used illegal drugs? For example, ecstasy or molly, heroin, crack, cocaine?	Yes No Don’t know/ Not Sure Choose not to answer
[If question J5 = yes] How old were you the first time that you used any type of illegal drug such as cocaine, heroin, ecstasy, or LSD?	______ (Fill in years) Don’t know/ Not Sure Choose not to answer
The next question asks about using prescription pain relievers and other prescription medicines in any way a doctor did not direct you to use them. When you answer this question, please think only about your use of the drug in any way a doctor did not direct you to use it, including: Using it without a prescription of your own Using it in greater amounts, more often, or longer than you were told to take it Using it in any other way a doctor did not direct you to use it Have you ever, even once, used any prescription pain reliever in any way a doctor did not direct you to use it?” Please do not include “over-the-counter” pain relievers such as aspirin, Tylenol, Advil, or Aleve. Have you ever, even once, used any other prescription medicines in any way a doctor did not direct you to use it?	Yes No Don’t know/ Not Sure Choose not to answer
[If question J1 = yes] How old were you the first time that you used a prescription medication in a way a doctor did not direct you to use it?	______ (Fill in years) Don’t know/ Not Sure Choose not to answer
[If yes to J1, 3, 5 or 9 ] When was the last time that…? You used alcohol or other drugs weekly or more often? You spent a lot of time either getting alcohol or other drugs, using alcohol or other drugs, or feeling the effects of alcohol or other drugs? You kept using alcohol or other drugs even through it was causing social problems, leading to fights, or getting you into trouble with other people? Your use of alcohol or other drugs cause you to give up, reduce or have problems at important activities, at work, school, home, or social events? You had withdrawal problems from alcohol or other drugs like shaky hands, throwing up, having trouble sitting still or sleeping, or that you used alcohol or other drugs to stop being sick or avoid withdrawal problems?	Past month 2 to 12 months ago 1+ years ago Never Don’t know/ Not Sure Choose not to answer
SEXUAL EXPERIENCES
I’m going to ask you some detailed questions about times in your life when you may have ever experienced sexual situations with anyone. This may include strangers or someone you knew such as a romantic or sexual partner, a family member, a friend, teacher, co-worker or supervisor, or someone you have known for only a short time These may be things you wanted to happen, didn’t want to happen, changed your mind about as they were happening, or maybe part of you wanted it to happen at the time and part of you didn’t want it to happen. These questions are detailed and the language is explicit, which some people may find upsetting. It’s okay if you need to take a break while you are answering the questions. It is important that I ask the questions this way so that you understand what I mean. Your answers will help us to learn how often these things happen. You can skip questions you don’t want to answer and you can stop at any time. In these questions, “sex” means oral, vaginal, or anal sex. Oral sex refers to stimulating someone’s genitals with the mouth. Vaginal sex refers to putting a penis or an object in someone’s vagina. Anal sex refers to putting a penis or object in someone’s anus or butt.
At any time in your life, have you ever had sex with another person? This could be oral, vaginal, or anal sex. Remember that this could be something you wanted to happen, didn’t want to happen, or part of you wanted it to happen at the time and part of you didn’t want it to happen.	Yes No [skip to question L1]] Don’t know/ Not Sure Choose not to answer
3.2. The very first time that sex happened, how old were you?	______ (Fill in years) Don’t know/ Not Sure Choose not to answer
[If K2 = Don’t know/Not sure] Were you less than 13 years old or were you 13 years or older?	Less than 13 years old 13 years or older Don’t know/ Not Sure Choose not to answer
That first time that sex happened, was the other person older than you, younger than you, or about the same age?	Older Younger About the same age Don’t know/not sure Choose not to answer
[If K4 = “older” or “younger”] By how many years?	1-2 years 3-5 years 6-10 years More than 10 years Don’t know/not sure Choose not to answer
Think back to the very first time that sex happened. This could be oral, vaginal, or anal sex. Which would you say comes closest to describing how much you wanted that to happen?	I really didn’t want it to happen at the time I had mixed feelings -- part of me wanted it to happen at the time and part of me didn’t I really wanted it to happen at the time Don’t know/not sure Choose not to answer
Sometimes sex happens even though you might not have consented, you changed your mind, or you may have had mixed feelings.  Sometimes people choose to have sex, but the situation is complicated. That first time that sex happened, did you do what the other person said because they were bigger than you or a grown-up, and you were young?	Yes No Don’t know/not sure Choose not to answer
Sometimes sex happens after a person is pressured into it, such as through verbal and emotional pressure and other nonphysical kinds of pressure. For example, people may have made promises about the future they knew were untrue, threatened to end the relationship, threatened to spread rumors about you, or used their influence or authority over you. That first time that sex happened, did the other person use verbal or emotional pressure?	Yes No Don’t know/not sure Choose not to answer
Sometimes sex happens when a person is unable to consent to it or stop it from happening because they are too drunk, high, drugged, or passed out from alcohol, drugs, or medications.  This can include times when they voluntarily consumed alcohol or drugs or times when they were given alcohol or drugs without their knowledge or consent.  Please remember that even if someone uses alcohol or drugs, what happens to them is not their fault. That first time that sex happened, were you unable to consent to it or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol, drugs, or medications?	Yes No Don’t know/not sure Choose not to answer
Sometimes people are threatened with harm or physically forced to have sex when they don’t want to. Examples of physical force are being pinned or held down, using violence or threats of violence to you or another person, or not physically stopping after you said no. To be clear, we are now asking only about times in your life when you did not want sex to happen. That first time that sex happened, did the other person threaten you with harm or physically force you to do this? Remember that this could be oral, vaginal, or anal sex.	Yes No Don’t know/not sure Choose not to answer
Sometimes sex happens because of the circumstances that people are in. This can include times when they choose to have sex in order to get a place to sleep, food, money or other things they need, or to do a favor for another person, or to keep their place in a relationship, gang, group or house. That first time that sex happened, did you choose to do it because you needed something, or needed to do it for another person or group?	Yes No Don’t know/not sure Choose not to answer
The next questions are about how many times these things may have happened when you had sex in the past 12 months (since [date]). Remember that this could be oral, vaginal or anal sex. During the past 12 months, how many times did another person use verbal or emotional pressure to get you to have sex?	Never 1 time 2 to 4 times 5 or more times
During the past 12 months, how many times did sex happen when you were unable to consent to it or stop it from happening because you were too drunk, high, drugged, or passed out from alcohol, drugs, or medications? Please remember that even if someone uses alcohol or drugs, what happens to them is not their fault.	Never 1 time 2 to 4 times 5 or more times
During the past 12 months, how many times did another person threaten you with harm or physically force you to have sex? Remember that this could be oral, vaginal, or anal sex.	Never 1 time 2 to 4 times 5 or more times
During the past 12 months, how many times did you choose to have sex because you needed a place to sleep, food, money or other things, to do a favor for another person, or to keep your place in a relationship, gang, group or house?	Never 1 time 2 to 4 times 5 or more times
RELATIONSHIP VIOLENCE
During the last 12 months, have you been involved in a dating or romantic relationship? This could include a hook up, having a boyfriend or girlfriend, or husband or wife.	Yes No [Skip to question M1] Don’t know/ Not Sure Choose not to answer
Think about the dating or romantic relationships you’ve been in during the last 12 months as you answer these next questions. Answer the next questions about any hook-up, boyfriend, girlfriend, husband, or wife you have had, including exes, regardless of the length of the relationship, in the last 12 months. Not including horseplay or joking around… someone threatened to hurt me, and I thought I might really get hurt. someone pushed, grabbed, or shook me. someone hit me. someone beat me up. someone stole or destroyed my property someone can scare me without laying a hand on me. I threatened to hurt the person and I meant it. I pushed, grabbed, or shook the person. I hit the person. I beat up the person. I stole or destroyed the person’s property. I can scare this person without laying a hand on them.	Never Once or Twice Sometimes Often Many Times Don’t know/ Not Sure Choose not to answer
HUMAN TRAFFICKING
The next questions are about work or other activities you may have done in exchange for money, food, housing, drugs, or anything else, or things that enabled you to earn money for someone else. For the purposes of this survey, work can be something like cooking in a restaurant or cleaning houses, or something like selling drugs or trading sex. Work can include things that are legal or not, and things you may do for someone else even though you didn’t want to or had mixed feelings about it (part of you was OK with it and part of you was not).
Have you ever been unable to leave a place you worked or talk to people you wanted to talk to, even when you weren’t working, because the person you worked for threatened or controlled you? Did someone you work for ever refuse to pay what they promised and keep all or most of the money you made? Were you ever physically beaten, slapped, hit, kicked, punched, burned, or harmed in any way by someone you work for? Did someone you work for ever ask, pressure, or force you to do something sexually that you did not feel comfortable doing? Were you ever forced to engage in sexual acts with family, friends, clients, or business associates for money or favors, by someone you work for? Did you ever trade sexual acts for food, clothing, money, shelter, favors, or other necessities for survival before you reached the age of 18? Did someone you work for ever keep most or all of your pay in exchange for housing, transportation, or food?	Yes No [If no to all, skip to question N1] Don’t know / Not Sure Choose not to answer
The next questions ask about times these things happened to you. Your answers will help us to learn when and how often these things happen – including when they first happened and for how long they happened. You can skip questions you don’t want to answer, and you can stop at any time. [IF M7 = YES] What kind of work were you doing at the time that someone you worked for kept most or all of your pay in exchange for housing, transportation or food? Serving food or doing other types of work in a restaurant or café Mowing lawns, shoveling sidewalks, or other yard work Selling items door-to-door Cleaning someone’s house or taking care of children or older people Shoplifting or stealing things Selling items, or asking for change or donations on the street, in shopping centers, or in the subway Doing nails or braiding hair Trading sex for money, clothes, shelter, or other things at a party, hotel, or someone’s home Trading sex for money, clothes, shelter, or other things with someone you met outdoors or in a public place Trading sex for money, clothes, shelter, or other things in a house or apartment that is mainly used for sex, like a brothel Talking or acting in a sexual way on webcams, chats, apps or the phone Doing construction work or other home repairs such as painting, plumbing, or electricity Dancing or performing on the street or in the subways Selling or carrying drugs Performing massages in a sexual way Performing naked or sexually explicit dancing Participating in sexual videos or photos for money, clothes, shelter, or other things Doing sexual acts with one person on an ongoing basis, in exchange for money (such as paying off your or someone else’s debt), clothes, shelter, or other things given to you or to someone else Working on a farm where vegetables, fruit, or animals are raised Working in a place where things are manufactured, like a factory or processing plant I was not working at the time. Some other type of work (please specify)	Yes No Don’t know / Not Sure Choose not to answer
[IF M7 = YES] How old were you the first time that someone you worked for kept most or all of your pay in exchange for housing, transportation or food?	______ (Fill in years) Don’t know/ Not Sure Choose not to answer
[If M11 = Don’t know/Not sure] Were you less than 15 years old or were you 15 years or older? [If M1-6 = no and M7=yes, Skip to N1]	Less than 15 years old 15 years or older Don’t know/ Not Sure Choose not to answer
[If any questions M1-6 = yes] How old were you the first time [Fill in with short version of items endorsed in questions M1-6, separated by ‘or’]? [Short version of each of the 6 HTSF items for fill text are the following: You were unable to leave a place you worked or talk to people Someone you worked for refused to pay you or kept your money Someone you worked for hurt you Someone you worked for wanted you to do something sexual you weren’t comfortable with Someone you worked for forced you to do engage in a sexual act with someone else You traded sexual acts for something before you were 18]	______ (Fill in years) Don’t know/ Not Sure Choose not to answer
[If M11 = Don’t know/Not sure] Were you less than 15 years old or were you 15 years or older?	Less than 15 years old 15 years or older Don’t know/ Not Sure Choose not to answer
Where were you staying most nights at the first time [this/any of those things] happened to you?	A house or apartment A shelter (such as a runaway or homeless youth shelter, drop-in center) Inside a car, abandoned building, squat, etc. Outside in the park, on the street, in a tent, etc. A transit station (subway or bus station or the airport) A hotel or motel At a hospital A church, temple, mosque or other place of worship A school A place of business (such as a massage parlor, beauty salon, tax preparation service) A house or apartment that is mainly used for sex, like a brothel Other (please specify): Don’t know / Not sure Choose not to answer
Were you in foster care at the time that [you /someone you worked for] first [Fill in with short version of items endorsed in questions M1-6, separated by ‘or’]? Had you run away or been kicked out of foster care at the time that [you /someone you worked for] first [Fill in with short version of items endorsed in questions M1-6, separated by ‘or’]? Had you run away or been kicked out of your home (with a parent or guardian) at the time that [you /someone you worked for] first [Fill in with short version of items endorsed in questions M1-6, separated by ‘or’]?	Yes No Don’t know/ Not Sure Choose not to answer
[If any questions M1-5= YES] What kind of work were you doing at the time that [you/someone you worked for] first [Fill in with short version of items endorsed in questions M1-5 separated by ‘or’]? Serving food or doing other types of work in a restaurant or café Mowing lawns, shoveling sidewalks, or other yard work Selling items door-to-door Cleaning someone’s house or taking care of children or older people Shoplifting or stealing things Selling items, or asking for change or donations on the street, in shopping centers, or in the subway Doing nails or braiding hair Trading sex for money, clothes, shelter, or other things at a party, hotel, or someone’s home Trading sex for money, clothes, shelter, or other things with someone you met outdoors or in a public place Trading sex for money, clothes, shelter, or other things in a house or apartment that is mainly used for sex, like a brothel Talking or acting in a sexual way on webcams, chats, apps or the phone Doing construction work or other home repairs such as painting, plumbing, or electricity Dancing or performing on the street or in the subways Selling or carrying drugs Performing massages in a sexual way Performing naked or sexually explicit dancing Participating in sexual videos or photos for money, clothes, shelter, or other things Doing sexual acts with one person on an ongoing basis, in exchange for money (such as paying off your or someone else’s debt), clothes, shelter, or other things given to you or to someone else Working on a farm where vegetables, fruit, or animals are raised Working in a place where things are manufactured, like a factory or processing plant I was not working at the time. Some other type of work (please specify)	Yes No Don’t know/ Not Sure Choose not to answer
[If any question M4-6 = yes] You mentioned [Fill with short version of items endorsed in questions M4-6, separated by “and”]. [THE ABOVE ITEMS STAY ON THE SCREEN FOR M18- M21] The next questions continue to focus on the first time this/those things happened. Did someone else set up dates for you the first time this/any of those things first happened?	Yes No Don’t know / Not Sure Choose not to answer
[If any question M4-6 = yes] The first time this/any of those things happened, did someone give you a phone, computer or other resources (for example, a VISA gift card) so that you could set up your own dates?	Yes No Don’t know / Not sure Choose not to answer
The first time [this/any of those things] happened, did you give the money (or part of the money, like a fee) you earned to someone else?	Yes No Don’t know / Not sure • Choose not to answer
[If question M18 or M19 = yes] How did you consider the person or persons who [set up dates for you and/or gave you things to set up your own dates]? Check all	Biological parent or another legal guardian (e.g., grandmother who is a legal guardian) Foster parent Boyfriend Girlfriend House mother Master Dom Pack leader or alpha Landlord Other (please specify) Don’t know/ Not Sure Choose not to answer
[If any questions M1-6= yes] How old were you the most recent time [Fill in with short version of items endorsed in questions M1-6, separated by ‘or’]?	______ (Fill in years) The first was the most recent time. Don’t know/ Not Sure Choose not to answer
[If M22 = Don’t Know/Not Sure] Were you less than 15 years old, or 15 years old or older?	Less than 15 years old 15 years or older Don’t know/ Not Sure Choose not to answer
Between the time you were [FILL age for first time] and [FILL age for most recent time] years old, how often did [fill with items M1-6] happen to you?	Very Frequently Frequently Occasionally Rarely Very Rarely Don’t know/ Not Sure Choose not to answer
[If Yes to more than one item M1-6] Did some of these things happen most often?	Yes No Don’t know/ Not Sure Choose not to answer
[If Yes to M25] Which of these happened most often? (check all that apply)	[Fill with short version of items endorsed in questions M1-6].
The next questions about all the times these things happened to you. Your answers are important to understanding things that happen to young people. Remember that you can skip questions you don’t want to answer, and you can stop at any time. Please think about all the times that [FILL IN SHORT FORMS OF ITEM ENDORSED IN M1-6]: You were ever unable to leave a place or talk to people Someone you worked for ever refused to pay you or kept your money Someone you worked for ever hurt you Someone you worked for ever wanted you to do something sexual you weren’t comfortable with Someone you worked for ever forced you to do engage in a sexual act with someone else You ever traded sexual acts for something before you were 18] [THE ABOVE ITEMS STAY ON THE SCREEN FOR M27-29] The next questions are about all the times these things happened to you. You can skip questions you don’t want to answer, and you can stop at any time.
Did you ever have those experiences while you were in foster care? Did you ever have those experiences during times that you had run away or been kicked out of foster care? Did you ever have those experiences during times that you had run away or been kicked out of your home (with a parent/guardian)?	Yes No Don’t know/ Not Sure Choose not to answer
[If any question M4-6 = yes] The next questions are about all of the times that [fill from items endorsed M4-6] happened. How often did someone else set up dates for you?	Always Very Often Sometimes Rarely Never Don’t know / Not Sure Choose not to answer
[If any question M4-6 = yes] How often did someone give you a phone, computer or other resources (for example, a VISA gift card) so that you could set up your own dates?	Always Very Often Sometimes Rarely Never Don’t know / Not Sure Choose not to answer
How often did you give the money (or part of the money, like a fee) you earned to someone else?	Never Rarely Often All the time Don’t know / Not Sure Choose not to answer
[If M30 and M31 do not = never] How did you consider the person or persons who (set up dates for you and/or gave you things to set up your own dates)? Check all that apply.	Biological parent or another legal guardian (e.g., grandmother who is a legal guardian) Foster parent Boyfriend Girlfriend House mother Master Dom Pack leader or alpha Landlord Other (please specify) Don’t know / Not Sure Choose not to answer
[If any questions M1-6= yes] Did you ever tell anyone at the [child welfare agency name] that [Fill in with short version of items endorsed questions M1-6, separated by ‘or’]?	Yes [skip to question M36] No
What are the reasons why you didn’t tell anyone at the [child welfare agency name] that [this was happening to you/these things were happening to you]? Was it because…? You didn’t think they needed to know? You didn’t want to get in trouble? You didn’t think it would make a difference? You didn’t think about it? You were told not to tell anyone? You didn’t want the other person to get in trouble? You didn’t feel like you could trust them? Some other reason?	Yes No Don’t know / Not Sure Choose not to answer
Did anyone at the [child welfare agency name] ever ask if [this was happening to you/these things were happening to you]?	Yes No Don’t know / Not Sure Choose not to answer
OPEN-ENDED QUESTIONS
Is there anything you’d like to tell me about your experiences related to the questions you’ve just answered? Think about the challenges you’ve experienced. What would you say have been the things that have most helped you get through? What are the most important things [child welfare agency name] could do to support young people leaving foster care?	Allow young person to enter text or audio-record response

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