Appendix B. Question-by-question justification for baseline survey

Appendix B. Question-by-question justification for baseline survey

This document provides the sources and justifications for each question on the Baseline Survey (Instrument 1).

Item	Question text	Source	Justification
SECTION B: DEMOGRAPHIC AND SOCIOECONOMIC CHARACTERISTICS
B01	Are you Hispanic, Latino/a, or Spanish origin? 1. No, not of Hispanic, Latino/a, or Spanish origin 2. Yes, Mexican, Mexican American, Chicano/a 3. Yes, Puerto Rican 4. Yes, Cuban 5. Yes, Another Hispanic, Latino/a, or Spanish origin	Adapted from Building Evidence on Employment Strategies (BEES) (OMB No. 0970-0537)	These items measure demographic and socioeconomic characteristics. We will use them to (1) describe the characteristics of study participants and check that random assignment has created treatment and control groups with similar characteristics, (2) define subgroups, 3) provide control variables for regression models that will increase statistical precision, (4) construct weights to adjust for survey nonresponse, and (5) support analysis of the mediating factors driving program impacts.
B02	What is your race? 1. AMERICAN INDIAN OR ALASKA NATIVE 2. ASIAN 3. BLACK OR AFRICAN AMERICAN 4. NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER 5. WHITE 99. OTHER (SPECIFY)	Adapted from BEES (OMB No. 0970-0537)
B03	What is the primary language spoken in your home? Is it… 1. English, 2. Spanish, or 99. Some other language?	BEES (OMB No. 0970-0537)
B04	Are you currently in high school?	New; Developed by Mathematica
B05	What is the highest degree or year of school that you have attained? 1. LESS THAN A HIGH SCHOOL DIPLOMA 2. GED or GENERAL EDUCATION DEVELOPMENT 3. REGULAR HIGH SCHOOL DIPLOMA (NOT A GED) 4. SOME COLLEGE 5. A TWO-YEAR DEGREE (ASSOCIATE’S DEGREE) 6. A FOUR-YEAR DEGREE (BACHELOR’S DEGREE) 7. A GRADUATE OR PROFESSIONAL DEGREE OR HIGHER	Adapted from BEES (OMB No. 0970-0537)
B06	What is your current marital status—are you now married, separated, divorced, widowed, or have you never been married?	Adapted from BEES (OMB No. 0970-0537)
B07	Do you have a spouse or partner who lives in your household?	BEES (OMB No. 0970-0537)
B07a	How many children under the age of 18 are in your household?	BEES (OMB No. 0970-0537)
B07b	How many adults age 18 or older, including yourself, are in your household?	BEES (OMB No. 0970-0537)
B08	Do you currently care for someone in your household with a disability?	Subsidized and Transitional Employment Demonstration (STED) (OMB No. 0970-0413)
B09	Which of the following best describes your housing during the past month? 1. own your own home or apartment, 2. rent your home or apartment, 3. homeless or live in emergency or temporary housing, such as a shelter, 4. live in a halfway house, sober house, or other transitional housing, 5. live in a group home 6. live with friends or relatives and pay rent to them 7. live with friends or relatives and not pay rent to them, or 99. some other arrangement? (SPECIFY: __________)	Adapted from BEES (OMB No. 0970-0537)
B09a	Which of the following best describes your housing during the past month? 1. live with a parent or guardian, 2. rent your home or apartment, 3. homeless or live in emergency or temporary housing, such as a shelter, 4. live in a halfway house, sober house, or other transitional housing, 5. live in a group home 6. live with friends or relatives and pay rent to them 7. live with friends or relatives and not pay rent to them, or 99. some other arrangement? (SPECIFY: __________)	Adapted from BEES (OMB No. 0970-0537)
B10	Have you been homeless at any time in the last three months?	Adapted from Rural Welfare to Work (OMB No. 0970-0246)
B10a	If you add up all the days you have been homeless in the last three months, about how many days have you been homeless? Your best guess is fine.	Adapted from HUD's Point-In-Time Survey
B11	Are you currently receiving child support?	STED (OMB No. 0970-0413)
B12	Are you currently expected to pay child support?	STED (OMB No. 0970-0413)
B13	During the past year, did you or anyone in your household receive income or assistance from any of the following sources? 1. Disability benefits from the Social Security Administration. These are also called Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) 2. Temporary Assistance for Needy Families (TANF) or [STATE SPECIFIC TANF NAME] 3. Unemployment Insurance 4. Worker’s Compensation 5. Short-term disability 6. Food Stamps/Supplemental Nutrition Assistance Program (SNAP)/ [STATE-SPECIFIC PROGRAM] 7. Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) 8. Housing Choice Voucher, also known as Section 8 or Public Housing 9. Veterans Benefits 10. Medicaid or [STATE SPECIFIC MEDICAID] or Children’s Health Insurance Program (CHIP) 0. NONE OF THE ABOVE	Adapted from BEES (OMB No. 0970-0537)
B14	For these next questions, please consider only yourself, not anyone else in your household. Have you received a check or electronic payment from the Social Security Administration because of a disability in the past year as an adult?	Adapted from BEES (OMB No. 0970-0537)	These items measure demographic and socioeconomic characteristics. We will use them to (1) describe the characteristics of study participants and check that random assignment has created treatment and control groups with similar characteristics, (2) define subgroups, 3) provide control variables for regression models that will increase statistical precision, (4) construct weights to adjust for survey nonresponse, (5) support analysis of the mediating factors driving program impacts, and (6) determine the target population of interest to the Social Security Administration (namely, individuals who are not currently receiving SSI or awaiting a pending claim).
B15	Are you currently receiving checks or electronic payments from the Social Security Administration because of a disability?	Adapted from BEES (OMB No. 0970-0537)
B16	As an adult, in the past five years, have you applied to the Social Security Administration to receive checks or electronic payments because of a disability?	New; Developed by Mathematica
B17	Are you currently awaiting a decision by the Social Security Administration on a pending disability application?	Adapted from BEES (OMB No. 0970-0537)
B18	If you had an emergency, would you be able to count on someone to help you?	Adapted from Building Strong Families Evaluation (BSF) (OMB No. 0970-0304)	These items measure social supports for economic well-being. We will use them to (1) describe the characteristics of study participants and check that random assignment has created treatment and control groups with similar characteristics, (2) define subgroups, (3) provide control variables for regression models that will increase statistical precision, (4) construct weights to adjust for survey nonresponse, and (5) support analysis of the mediating factors driving program impacts.
B19	Is there someone you could turn to if you suddenly needed to borrow $100?	Adapted from BSF (OMB No. 0970-0304)
SECTION C: EMPLOYMENT STATUS AND CHALLENGES
C0	Have you ever worked for pay?	New; Developed by Mathematica	These items measure baseline employment status. We will use them to (1) describe the characteristics of study participants and check that random assignment has created treatment and control groups with similar characteristics, (2) define subgroups, (3) provide control variables for regression models that will increase statistical precision, (4) construct weights to adjust for survey nonresponse, and (5) support analysis of the mediating factors driving program impacts.
C01	Are you currently working for pay?	BEES (OMB No. 0970-0537)
C02	In total, how many months did you work for pay during the past year (including current job)?	BEES (OMB No. 0970-0537)
C03	In what month and year did you last work for pay?	Adapted from Parents and Children Together Evaluation (PACT) (OMB No. 0970-0403)
C03a	How much [do/did] you get paid before taxes and deductions, at your [current/most recent] job?	Evaluation of Employment Coaching for TANF and Other Related Populations (Coaching) (OMB No. 0970-0506)
C04-C04a	How many hours per week, including regular overtime hours, did you usually work on your [current/most recent] job? Your best estimate is fine.	Adapted from BEES (OMB No. 0970-0537)
C05	Does a physical, mental, or emotional condition limit the kind or amount of work you can do?	Adapted from BEES (OMB No. 0970-0537)	These items measure baseline barriers to employment. We will use them to (1) describe the characteristics of study participants and check that random assignment has created treatment and control groups with similar characteristics, (2) define subgroups, (3) provide control variables for regression models that will increase statistical precision, (4) construct weights to adjust for survey nonresponse, and (5) support analysis of the mediating factors driving program impacts.
C06a	Please indicate if each of the following has made it not at all hard, a little hard, somewhat hard, very hard, or extremely hard for you to work or pursue education or training in the past 3 months. NOT HAVING RELIABLE TRANSPORTATION	Adapted from Child Support Noncustodial Parent Employment Demonstration (CSPED) (OMB No. 0970-0439)
C06b	Please indicate if each of the following has made it not at all hard, slightly hard, moderately hard, or very hard for you to work or pursue education or training in the past 3 months. NOT HAVING DRIVER’S LICENSE OR A VALID DRIVER’S LICENSE	Adapted from CSPED (OMB No. 0970-0439)
C06c	Please indicate if each of the following has made it not at all hard, slightly hard, moderately hard, or very hard for you to work or pursue education or training in the past 3 months. NOT HAVING STABLE HOUSING	Adapted from CSPED (OMB No. 0970-0439)
C06d	Please indicate if each of the following has made it not at all hard, slightly hard, moderately hard, or very hard for you to work or pursue education or training in the past 3 months. A PREGNANCY OR A RECENT CHILDBIRTH	Adapted from Rural Welfare to Work (OMB No. 0970-0246)
C06e	Please indicate if each of the following has made it not at all hard, slightly hard, moderately hard, or very hard for you to work or pursue education or training in the past 3 months. NOT HAVING GOOD ENOUGH CARE FOR A CHILD OR SOMEONE ELSE IN YOUR HOUSEHOLD WHO NEEDS CARE	Adapted from CSPED (OMB No. 0970-0439)
C06f	Please indicate if each of the following has made it not at all hard, slightly hard, moderately hard, or very hard for you to work or pursue education or training in the past 3 months. NOT HAVING RIGHT CLOTHES OR TOOLS FOR WORK	Adapted from CSPED (OMB No. 0970-0439)
C06g	Please indicate if each of the following has made it not at all hard, slightly hard, moderately hard, or very hard for you to work or pursue education or training in the past 3 months. NOT HAVING RIGHT SKILLS OR EDUCATION	Adapted from CSPED (OMB No. 0970-0439)
C06h	Please indicate if each of the following has made it not at all hard, slightly hard, moderately hard, or very hard for you to work or pursue education or training in the past 3 months. HAVING DIFFICULTY SPEAKING OR READING ENGLISH	Adapted from CSPED (OMB No. 0970-0439)
C06i	Please indicate if each of the following has made it not at all hard, slightly hard, moderately hard, or very hard for you to work or pursue education or training in the past 3 months. HAVING DIFFICULTY COMPLETING JOB APPLICATIONS ON MY OWN	Adapted from CSPED (OMB No. 0970-0439)
C06j	Please indicate if each of the following has made it not at all hard, slightly hard, moderately hard, or very hard for you to work or pursue education or training in the past 3 months. HAVING A CRIMINAL RECORD	Adapted from CSPED (OMB No. 0970-0439)
C06k	Please indicate if each of the following has made it not at all hard, slightly hard, moderately hard, or very hard for you to work or pursue education or training in the past 3 months. HAVING PROBLEMS WITH ALCOHOL OR DRUGS	Adapted from CSPED (OMB No. 0970-0439)
C06l	Please indicate if each of the following has made it not at all hard, slightly hard, moderately hard, or very hard for you to work or pursue education or training in the past 3 months. HAVING A GAP IN EMPLOYMENT	New; Developed by Mathematica
C06m	Please indicate if each of the following has made it not at all hard, slightly hard, moderately hard, or very hard for you to work or pursue education or training in the past 3 months. LACK OF SUPPORT OR RESISTANCE FROM FRIENDS OR RELATIVES RELATED TO FINDING A JOB OR WORKING	Adapted from Rural Welfare to Work (OMB No. 0970-0246)
C06n	Please indicate if each of the following has made it not at all hard, slightly hard, moderately hard, or very hard for you to work or pursue education or training in the past 3 months. EXPERIENCING ABUSE BY A SPOUSE OR PARTNER	Adapted from Rural Welfare to Work (OMB No. 0970-0246)
C06o	Please indicate if each of the following has made it not at all hard, slightly hard, moderately hard, or very hard for you to work or pursue education or training in the past 3 months. A LEARNING DISABILITY	Adapted from Rural Welfare to Work (OMB No. 0970-0246)
C06p	Please indicate if each of the following has made it not at all hard, slightly hard, moderately hard, or very hard for you to work or pursue education or training in the past 3 months. NOT FINDING THE RIGHT KIND OF DISABILITY-RELATED SUPPORTS OR ACCOMMODATIONS	New; Developed by Mathematica
C06q	Please indicate if each of the following has made it not at all hard, slightly hard, moderately hard, or very hard for you to work or pursue education or training in the past 3 months. LOSING BENEFITS YOU NEED SUCH AS SOCIAL SECURITY, DISABILITY INSURANCE, WORKERS' COMPENSATION, OR MEDICAID IF YOU TOOK A JOB OR WORKED MORE HOURS	New; Developed by Mathematica
C06r	Please indicate if each of the following has made it not at all hard, slightly hard, moderately hard, or very hard for you to work or pursue education or training in the past 3 months. OTHER SPECIFY	Adapted from Rural Welfare to Work (OMB No. 0970-0246)
C07a	I set long-term employment goals that I hope to achieve within a year, such as finding a job, finding a better job, getting promoted, or enrolling in further education. 1. STRONGLY DISAGREE 2. DISAGREE 3. AGREE 4. STRONGLY AGREE	Goal Setting Questionnaire, adapted from Coaching (OMB No. 0970-0506)	These items measure goal setting and goal pursuit in the context of employment. We will use them to (1) describe the characteristics of study participants and check that random assignment has created treatment and control groups with similar characteristics, (2) define subgroups, (3) provide control variables for regression models that will increase statistical precision, (4) construct weights to adjust for survey nonresponse, and (5) support analysis of the mediating factors driving program impacts.
C07b	I set specific short-term goals that will allow me to achieve my long-term employment goals. 1. STRONGLY DISAGREE 2. DISAGREE 3. AGREE 4. STRONGLY AGREE	Goal Setting Questionnaire, adapted from Coaching (OMB No. 0970-0506)
C07c	I think I should work on finding a job or a better job. 1. STRONGLY DISAGREE 2. DISAGREE 3. AGREE 4. STRONGLY AGREE	LASER Questionnaire, adapted from Coaching (OMB No. 0970-0506)
C07d	I think there is nothing I can do being out of work right now. 1. STRONGLY DISAGREE 2. DISAGREE 3. AGREE 4. STRONGLY AGREE	LASER Questionnaire, adapted from Coaching (OMB No. 0970-0506)
C08	Have you ever been arrested?	Adapted from BEES (OMB No. 0970-0537)	These items measure past involvement with the criminal justice system. We will use them to (1) describe the characteristics of study participants and check that random assignment has created treatment and control groups with similar characteristics, (2) define subgroups, (3) provide control variables for regression models that will increase statistical precision, (4) construct weights to adjust for survey nonresponse, and (5) support analysis of the mediating factors driving program impacts.
C09	Have you ever been convicted of a crime?	BEES (OMB No. 0970-0537)
C10	Are you currently on parole or probation?	BEES (OMB No. 0970-0537)
C11	Have you ever been incarcerated in a juvenile or adult facility, such as a detention center, jail, or prison?	Adapted from BEES (OMB No. 0970-0537)
C12	What is the total amount of time you have spent in incarceration?	New Developed by Mathematica
SECTION D: PHYSICAL AND MENTAL HEALTH
D01-D09	SF-12v2 Questionnaire	SF-12 Instrument Also used on BEES (OMB No. 0970-0537)	This questionnaire measures functional health status. We will use them to (1) describe the characteristics of study participants and check that random assignment has created treatment and control groups with similar characteristics, (2) define subgroups, (3) provide control variables for regression models that will increase statistical precision, (4) construct weights to adjust for survey nonresponse, and (5) support analysis of the mediating factors driving program impacts.
D10	Are you deaf or do you have serious difficulty hearing?	American Community Survey (ACS) disability questions Also used on BEES (OMB No. 0970-0537)	These items measure disability. We will use them to (1) describe the characteristics of study participants and check that random assignment has created treatment and control groups with similar characteristics, (2) define subgroups, (3) provide control variables for regression models that will increase statistical precision, (4) construct weights to adjust for survey nonresponse, and (5) support analysis of the mediating factors driving program impacts.
D11	Are you blind or do you have serious difficulty seeing even when wearing glasses?	ACS disability questions Also used on BEES (OMB No. 0970-0537)
D12	Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?	ACS disability questions Also used on BEES (OMB No. 0970-0537)
D13	Do you have serious difficulty walking or climbing stairs?	ACS disability questions Also used on BEES (OMB No. 0970-0537)
D14	Do you have difficulty dressing or bathing?	ACS disability questions Also used on BEES (OMB No. 0970-0537)
D15	Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor’s office or shopping?	ACS disability questions Also used on BEES (OMB No. 0970-0537)
D16	Have you ever been treated for any mental health condition?	New Developed by Mathematica	These items measure physical and mental health status. We will use them to (1) describe the characteristics of study participants and check that random assignment has created treatment and control groups with similar characteristics, (2) define subgroups, (3) provide control variables for regression models that will increase statistical precision, (4) construct weights to adjust for survey nonresponse, and (5) support analysis of the mediating factors driving program impacts.
D17	What physical, mental, or emotional condition is the main reason you are limited?	Adapted from National Beneficiary Survey (NBS) (OMB No. 0960-0800)
D18a	During the last 30 days about how often did you feel so depressed that nothing could cheer you up? 0. NONE OF THE TIME 1. A LITTLE OF THE TIME 2. SOME OF THE TIME 3. MOST OF THE TIME 4. ALL THE TIME	K-6 Distress Scale Also used on BEES (OMB No. 0970-0537)	This questionnaire assesses mental health and distress. We will use these items to (1) describe the characteristics of study participants and check that random assignment has created treatment and control groups with similar characteristics, (2) define subgroups, (3) provide control variables for regression models that will increase statistical precision, (4) construct weights to adjust for survey nonresponse, and (5) support analysis of the mediating factors driving program impacts.
D18b	During the last 30 days about how often did you feel hopeless? 0. NONE OF THE TIME 1. A LITTLE OF THE TIME 2. SOME OF THE TIME 3. MOST OF THE TIME 4. ALL THE TIME	K-6 Distress Scale Also used on BEES (OMB No. 0970-0537)
D18c	During the last 30 days about how often did you feel restless or fidgety? 0. NONE OF THE TIME 1. A LITTLE OF THE TIME 2. SOME OF THE TIME 3. MOST OF THE TIME 4. ALL THE TIME	K-6 Distress Scale Also used on BEES (OMB No. 0970-0537)
D18d	During the last 30 days about how often did you feel that everything was an effort? 0. NONE OF THE TIME 1. A LITTLE OF THE TIME 2. SOME OF THE TIME 3. MOST OF THE TIME 4. ALL THE TIME	K-6 Distress Scale Also used on BEES (OMB No. 0970-0537)
D18e	During the last 30 days about how often did you feel worthless? 0. NONE OF THE TIME 1. A LITTLE OF THE TIME 2. SOME OF THE TIME 3. MOST OF THE TIME 4. ALL THE TIME	K-6 Distress Scale Also used on BEES (OMB No. 0970-0537)
D18f	During the last 30 days about how often did you feel nervous? 0. NONE OF THE TIME 1. A LITTLE OF THE TIME 2. SOME OF THE TIME 3. MOST OF THE TIME 4. ALL THE TIME	K-6 Distress Scale Also used on BEES (OMB No. 0970-0537)
D19-D21	AUDIT-C questionnaire	AUDIT-C Questionnaire	This questionnaire measures alcohol dependency. We will use the items to (1) describe the characteristics of study participants and check that random assignment has created treatment and control groups with similar characteristics, (2) define subgroups, (3) provide control variables for regression models that will increase statistical precision, (4) construct weights to adjust for survey nonresponse, and (5) support analysis of the mediating factors driving program impacts.
D22-D31	DAST-10 questionnaire	DAST-10 Questionnaire	This questionnaire measures drug dependency. We will use the items to (1) describe the characteristics of study participants and check that random assignment has created treatment and control groups with similar characteristics, (2) define subgroups, (3) provide control variables for regression models that will increase statistical precision, (4) construct weights to adjust for survey nonresponse, and (5) support analysis of the mediating factors driving program impacts.
D32	The next question asks about using prescription pain relievers 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 Are you currently taking a prescription painkiller (such as OxyContin, Percocet, or Vicodin) without a prescription or in any way not directed by a doctor?	Adapted from BEES (OMB No. 0970-0537)	This item measures opioid use. We will use it to (1) describe the characteristics of study participants and check that random assignment has created treatment and control groups with similar characteristics, (2) define subgroups, (3) provide control variables for regression models that will increase statistical precision, (4) construct weights to adjust for survey nonresponse, and (5) support analysis of the mediating factors driving program impacts.