Inst 2_Adoptive Parent Instrument, SAP_02.05.2021_Clean_NonSubChange

OPRE Study: Survey of National Survey of Child and Adolescent Well-Being (NSCAW) Adopted Youth, Young Adults, Adults and Adoptive Parents [Descriptive Study]

Inst 2_Adoptive Parent Instrument, SAP_02.05.2021_Clean_NonSubChange

OMB: 0970-0555

Document [docx]
Download: docx | pdf

OMB #: 0970-0555

Expiration Date: 09/30/2021

National Survey of Child and Adolescent Well-Being



Survey of Family Well-Being

RTI International PO Box 12194 Research Triangle Park, North Carolina 27709l USA

Sponsored by: Administration for Children and Families

Conducted by: RTI International



Instrument 2: Survey of Adoptive Parents (SAP)

Note: This survey will begin immediately following the consent procedure included in Attachment H.

Section A: Demographics

INTROA: This first set of questions will ask some basic information about you and your adopted child.

A1. What is your age?

_____________ years old

A1a. Are you Spanish, Hispanic, or Latino?

1. Yes

2. No


A1b. What is your race? Select all that apply.

1. American Indian or Alaska Native

2. Asian

3. Black or African American

4. Native Hawaiian or other Pacific Islander

5. White

6. Other


In this survey, we’d like to ask some questions about your adopted child, [CHILD].


A2. How old is [CHILD]?

_____________ years old


A2a. Is [CHILD] Spanish, Hispanic, or Latino?

1. Yes

2. No


A2b. What is [CHILD]’s race? Select all that apply.

1. American Indian or Alaska Native

2. Asian

3. Black or African American

4. Native Hawaiian or other Pacific Islander

5. White

6. Other


A2c. Which pronoun does [CHILD] use to describe themselves, he, she, or they? We will use refer to [CHILD] using this pronoun throughout the survey.


  1. He

  2. She

  3. They


A3. What is your relationship to [CHILD]?


  1. Adoptive mother

  2. Adoptive father

  3. Birth or biological grandmother

  4. Birth or biological grandfather

  5. Birth or biological mother

  6. Birth or biological father

  7. Other relative (please specify): ___________________

  8. Other non-relative (please specify): ___________________



A4. Where does [CHILD] live now?


  1. At our family’s house, apartment, or condo

  2. At [his/her/their] own house, apartment, condo, dormitory, or military barracks

  3. At another adoptive family member’s house, apartment, or condo

  4. At a birth or biological family member’s house, apartment, or condo

  5. With friends

  6. At a foster parent’s house, apartment, or condo

  7. At a group home or residential treatment facility

  8. At a prison, jail, or juvenile detention center

  9. Does not have a home right now, for example, [he/she/they] [is/are] living inside [his/her/their] car, in an abandoned building, on the street, in a park, in a shelter, or [is/are] couch surfing

  10. I don’t know where [he/she/they] [live/lives]

  11. Other (please specify): _____________________

[If A4 >1]

A5. How old was [CHILD] when [he/she/they] left your home for the first time to live someplace else?

______________________ years old


[If A4= >1]

A6. Why did [CHILD] leave your home the first time? Please answer Yes or No for each option. Answer “Yes” if it was one of the main reasons.

Yes

No

A6a. For a job, to join the military, or to attend school, college, or another educational program



A6b. To get married or move in with a boyfriend, girlfriend, or significant other



A6c. We asked [him/her/them] to leave our home, apartment, or condo



A6d. [He/she/they] preferred to live with [his/her/their] birth or biological family



A6e. [He/she/they] preferred to live with another adoptive family member



A6f. [He/she/they] needed group home or residential services to manage emotions, behaviors, drug, and/or alcohol problems



A6g. [He/she/they] didn’t feel that [his/her/their] gender identity or sexual orientation was accepted



A6h. [He/she/they] did not feel [his/her their] racial or ethnic identity was accepted



A6i. Other (please specify): _____________





Please give a brief description of what was going on when [CHILD] left home:


[TEXT BOX FOR AN OPEN-ENDED RESPONSE]

A8. Who else lives with you now? Please answer Yes or No for each option.


Yes

No

A8a. Spouse, romantic partner, or significant other



[IF A3=5 DO NOT SHOW] A8b. [CHILD]’s birth or biological mother



[IF A3=6 DO NOT SHOW] A8c. [CHILD]’s birth or biological father



[IF A3=1 DO NOT SHOW] A8d. [CHILD]’s adoptive mother



[IF A3=2 DO NOT SHOW] A8e. [CHILD]’s adoptive father



A8f. [CHILD]’s own child(ren)



A8g. Another adopted son(s)



A8h. Birth or biological son(s)



A8i. Another adopted daughter(s)



A8j. Birth or biological daughter(s)



A8k. Other relative (please specify): ______________



A8l. Other non-relative (please specify): ______________




A9. Are you currently…?

  1. Married

  2. Separated

  3. Divorced

  4. Widowed

  5. Never married


A10. [If A9=2 or 3] How old was [CHILD] at the time of your divorce or separation?

___________________ years old



Section B: Adoption History

INTROB: Now I would like to ask you about your overall experience with [CHILD].



B11. [IF A3≠5 OR 6] Adoption is a process where a person legally assumes the parenting of another child born to someone else. Have you legally adopted [CHILD], that is, have you signed court papers to complete [CHILD]’s adoption process?

  1. Yes

  2. No

B12. [If A9=1 and A8b=no or A8c=no] Has your spouse legally adopted [CHILD], that is, have they signed court papers to complete [CHILD]’s adoption process?

  1. Yes

  2. No

B13. [If B11 =2 and A3≠5 OR 6, and A4=1] How many years have you lived with [CHILD]?

___________________ years

B13a. [If B11 =2, A3≠5 OR 6, and A4≠] How many years did you live with [CHILD]?



[If B13=0 or B13a=0 display: “Please ask [CHILD]’s adoptive parent or adult who raised [CHILD] to complete the rest of the survey”/ask to speak to the adoptive parent or adult who raised [CHILD] to complete interview. If adoptive parent or adult who raised [CHILD] is not available or cannot complete the survey, continue with interview. If B13 >0, continue]

B14. [If B11=1] How old was [CHILD] at the time of their adoption?

______________years old

B15. [If A3≠5 OR 6] Before [his/her/their] adoption, what was your relationship to [CHILD]?

  1. Grandparent

  2. Aunt or uncle

  3. Sister or brother

  4. Stepmother or stepfather

  5. Other relative

  6. Other non-relative

  7. Foster parent

  8. I had no prior relationship to [him/her/them]

B16. [If A3≠5 OR 6] How long did you know [CHILD] before the adoption process started?

  1. I did not know [him/her/them] before the adoption process started

  2. Less than 6 months

  3. 6 months to 1 year

  4. More than 1 year to 3 years

  5. More than 3 years

  6. All [his/her/their] life

B17. [If A3≠5 OR 6 and B16 ≠1] How close did you feel to [CHILD] before the adoption process started?

1. Extremely close

2. Very close

3. Moderately close

4. Slightly close

5. Not at all close


B18. [If A3≠5 OR 6] Did you adopt other birth or biological siblings of [CHILD]?

  1. Yes

  2. No

B19. Open adoption is when adoptive parents allow contact between birth or biological parents and child. Is [CHILD]’s adoption an “open adoption”?

  1. Yes

  2. No

B20. [if B19=1]

[IF A2<18 years- “With whom does your child have contact? Please answer Yes or No for each option.

OR

[IF A2>18 years] When [he/she/they] was/were a child, with whom did [he/she/they] have contact? Please answer Yes or No for each option.

Yes

No

B20a. Birth or biological mother



B20b. Birth or biological father



B20c. Other birth or biological relatives





B20d. [if B20a=yes] [If A2>=18 years- “Before [he/she/they] turned 18”], How supportive [If A2<18 years- “are” /If A2>=18 years- “were”] you of the contact between [CHILD] and [his/her/their] birth or biological mother?

1. Very supportive

2. Supportive

3. Not very supportive

4. We never discussed contact with [his/her/their] birth or biological mother


B21. [If B20d=1, 2, or 3] Tell us more about why you [If A2<18 years and B20d=1 or 2, “are supportive”; If A2>=18 and B20d=1 or 2, “were supportive”; If A2<18 and B20d=3, “are not supportive”; If A2>=18 and B20d=3, “were not supportive”] about [CHILD]’s contact with [his/her/their] birth or biological mother.

[TEXT BOX FOR AN OPEN-ENDED RESPONSE]

B21b. [if B20b=yes] [If A2>=18 years- “Before he/she/they turned 18”], How supportive [If A2<18 years- “are” /If A2>=18 years- “were”] you of the contact between [CHILD] and [his/her/their] birth or biological father?

1. Very supportive

2. Supportive

3. Not very supportive

4. We never discussed contact with [his/her/their] birth or biological father


B21c. [If B21b=1, 2, or 3] Tell us more about why you [If A2<18 years and B21b=1 or 2, “are supportive”; If A2>=18 and B21b=1 or 2, “were supportive”; If A2<18 and B21b=3, “are not supportive”; If A2>=18 and B21b=3, “were not supportive”] about your [CHILD]’s contact with [his/her/their] birth or biological father.

[TEXT BOX FOR AN OPEN-ENDED RESPONSE]

Note: These childhood family structure and characteristics will be gathered from available NSCAW I or NSCAW II secondary data. For this reason, these constructs are not included in the current survey.

  • Primary parents/caregivers during childhood

  • Number of siblings during childhood

  • Household income during childhood

  • Size of household during childhood

  • Birth vs. adopted relationship to family members

Note: These characteristics of adoptive parent(s) will be gathered from available NSCAW I or NSCAW II secondary data. For this reason, these constructs are not included in the current survey.

  • Sex/race/ethnicity

  • Prior relationship to adoptive parent before adoption (only information on kin vs. non-kin available)



Section C: Post Adoption Instability Experiences

INTROC: [If A2>=18 years] Next, we want to ask about some life experiences after [CHILD]’s adoption. We are interested in learning whether there were times when [he/she/they] did not live with you after [his/her/their adoption], but before he/she/they turned 18.



C22. [If A2>=18 years] First, think about important events in your life before [CHILD] turned 18. What is one event in your life before he/she/they turned 18 that you remember well? Please provide a brief description, for example, moved to a new home, started a new job, or bought a new car.

[TEXT BOX FOR AN OPEN-ENDED RESPONSE]



C23. [If A2>=18 years] Now, think about important events in your life that happened after [CHILD]’s adoption, but before he/she/they turned 18. What is one event in your life after his/her/their adoption, but before he/she/they turned 18 that you remember well? Please provide a brief description, for example, first day of school or their first birthday as part of your family.

[TEXT BOX FOR AN OPEN-ENDED RESPONSE]



[If A2<18 years] Next, we want to ask about some life experiences after [CHILD]’s adoption. We are interested in learning whether there were times when he/she/they did not live with you after their adoption.

C24. [If A2<18 years] First, think about important events in your life that happened after [CHILD]’s adoption. What is one event in your life after his/her/their adoption that you remember well? Please provide a brief description, for example, first day of school or bought a new house.

[TEXT BOX FOR AN OPEN-ENDED RESPONSE]

Now, we want to ask about times when [CHILD] may have stopped living with you. We will ask you separately about times [he/she/they] may have left your home to live in foster care, a group home or residential treatment center, juvenile detention, or to live with other relatives. We realize that your child may have lived in many of these places before coming to live with you or before [his/her/their] adoption was finalized. But, for this survey,

[DISPLAY BEFORE C25 and if A2>=18]: we are only interested in learning whether there were times when [CHILD] did not live with you after his/her/their adoption was finalized, but before he/she/they turned 18.

[DISPLAY BEFORE C25 and if A2<18]: we are only interested in learning whether there were times when [CHILD] did not live with you after his/her/their adoption was finalized.

C25. First, I want to ask you about time in foster care. Here, foster care refers to a child living with a foster parent who is not related to the child, for example, not living with their grandparent or some other relative and not living in a group home. After [CHILD]’s adoption, did [he/she/they] live in foster care?

  1. Yes

  2. No

C26. How many different foster families has [CHILD] lived with after [his/her/their] adoption?

__________ families

C27. [If C25=1; If C26>1, insert “first”] How old was [CHILD] when [he/she/they] [first] moved from your home to live with a foster family?

_______ years old


C28. [If C25=1; If C26>1, insert “first”] How long did [CHILD] live with this [first] foster family after [he/she/they moved] from your home?

  1. Less than 2 months

  2. 2 to 6 months

  3. More than 6 months to 1 year

  4. More than 1 year to 3 years

  5. More than 3 years to 5 years

  6. More than 5 years



C30. [If C25=1; If C26>1, insert “first”] When [CHILD] [first] moved from your home to a foster family, did you still have contact with [him/her/them]?


  1. Yes

  2. No

C31. [If C25=1; If C26>1, insert “first”] Next, we would like to understand what was going on in your family when [CHILD] [first] moved from your home to live with a foster family. Which of the following describes your family situation at that time? Please answer Yes or No for each option.

Yes

No

C31a. We did not feel safe at home because of [CHILD]’s behavior, for example, [he/she/they] was/were harming me or my spouse, siblings, or pets



C31b. [He/she/they] needed help to manage emotions or behaviors, such as school problems, not following rules, being disruptive to family life, or having suicidal thoughts



C31c. [He/she/they] needed help to manage [his/her/their] drinking or drug use



C31d. We could not afford services [he/she/they] needed



C31e. We told [him/her/them] that [he/she/they] could not live with us anymore because of his/her/their behavior



C31f. [He/she/they] did not feel accepted as part of our family



C31g. [He/she/they] did not feel his/her/their ethnic or racial identity was accepted



C31h. He/she/they did not feel safe at home because there were other family member difficulties, such as mental health or drug or alcohol problems



C31i. [He/she/they] did not feel his/her/their gender identity or sexual orientation was accepted



C31j. Other (please specify):





C32. [If C25=1; If C26>1, insert “first”] During the time when [CHILD] [first] moved from your home to live with a foster family, did you, your family, or [CHILD] receive any of the following services? Please answer Yes or No for each option.

Yes

No

C32a. Mental health services, for example, individual, group, or family therapy, inpatient care, or home-based services



C32b. Educational supports, for example, Individualized Education Plan, 504 plan, special education classes, tutoring, or support to help [CHILD] with changing schools



C32c. Adoption support services from the child welfare system



C32d. Support group, in-person, online, or by phone with other adoptive parents or children



C32e. Drug or alcohol treatment services



C32f. Financial assistance from an agency or program to provide care or support for [CHILD]. This includes receiving an adoption subsidy.



C32g. Other (please specify): ______________





C33. [If C25=1] Did [CHILD] ever return to live with your family?


  1. Yes

  2. No


C34. [IF C33=2] Did [CHILD] keep in contact with anyone from your family?


  1. Yes

  2. No


C29. [If C25=1; If C26>1] How much total time did [CHILD] spend in foster care after [he/she/they] moved from your home? If [he/she/they] has lived with more than one foster family, consider the total amount of time [he/she/they] have spent in foster care after [his/her/their] adoption.

  1. Less than 2 months

  2. 2 to 6 months

  3. More than 6 months to 1 year

  4. More than 1 year to 3 years

  5. More than 3 years to 5 years

  6. More than 5 years


[If A3=3 or 4, use “another”]


C35. After [CHILD]’s adoption, did [he/she/they] ever live without you in a [another] grandparent’s home? [If A2>18 years, Please think only about the times before [he/she/they] turned 18 years old].

  1. Yes

  2. No

C36. [If C35=1] Was this grandparent [CHILD]’s adoptive grandparent or birth or biological grandparent?

  1. Adoptive grandparent

  2. Birth or biological grandparent


C37. [If C35=1] How many times has [CHILD] gone to live without you in a grandparent’s home?

________________ times

C38. [C35=1; if C37>1 insert “the first time” otherwise use “when”] How old was [CHILD] [the first time/when] [he/she/they] left your home to live in a grandparent’s home?

__________________ years old

C39. [If C35=Yes; if C37>1, insert “first”] When [CHILD] [first] moved from your home to a grandparent’s home, did you still have contact with [him/her/them]?


  1. Yes

  2. No

C40. [If C35=1; if C37>1, insert “first”] Next, we would like to understand what was going on in your family when [CHILD] [first] went to live in a grandparent’s home without you. Which of the following describes your family situation at that time? Please answer Yes or No for each option.

Yes

No

C40a. We did not feel safe at home because of [CHILD]’s behavior, for example, [he/she/they] was/were harming me or my spouse, siblings, or pets



C40b. [He/she/they] needed help to manage emotions or behaviors, such as school problems, not following rules, being disruptive to family life, or having suicidal thoughts



C40c. [He/she/they] needed help to manage [his/her/their] drinking or drug use



C40d. We could not afford services [he/she/they] needed



C40e. We told [him/her/them] that [he/she/they] could not live with us anymore because of his/her/their behavior



C40f. [He/she/they] did not feel accepted as part of our family



C40g. [He/she/they] did not feel his/her/their ethnic or racial identity was accepted



C40h. He/she/they did not feel safe at home because there were other family member difficulties, such as mental health or drug or alcohol problems



C40i. [He/she/they] did not feel his/her/their gender identity or sexual orientation was accepted



C40j. Other (please specify):





C41. [If C35=1; if C37>1, insert “first”] During the time when [CHILD] [first] moved from your home to a grandparent’s home, did you, your family, or [CHILD] receive any of the following services? Please answer Yes or No for each option.

Yes

No

C41a. Mental health services, for example, individual, group, or family therapy, inpatient care, or home-based services



C41b. Educational supports, for example, Individualized Education Plan, 504 plan, special education classes, tutoring, or support to help [CHILD] with changing schools



C41c. Adoption support services from the child welfare system



C41d. Support group, in-person, online, or by phone with other adoptive parents or children



C41e. Drug or alcohol treatment services



C41f. Financial assistance from an agency or program to provide care or support for [CHILD]. This includes receiving an adoption subsidy



C41g. Other (please specify): ______________




C42. [If C35=1] Did [CHILD] ever return to live with your family?


  1. Yes

  2. No


C43. [if C42=2] Did [CHILD] keep in contact with anyone from your family?

  1. Yes

  2. No

C44. After [CHILD]’s adoption, did [he/she/they] ever live without you in (a) [another] relative’s home? This includes relatives related to the child by birth or adoption. Please do not include [CHILD]’s grandparent’s home. [If A2>=18 years: Please think only about those times that happened before your child turned 18 years old.]

  1. Yes

  2. No



C45. [If C44=1] Who was this relative?


  1. Adoptive aunt, uncle or cousin

  2. Birth or biological aunt, uncle or cousin

  3. Birth or biological sister or brother

  4. Adoptive sister or brother

  5. Birth or biological parent

  6. Another relative (please specify): ______________

C46. [If C44=1] How many times has [CHILD] gone to live without you to live in this relative’s home?

___________________ times

C47. [If C44=1; If C46>1 insert “the first time” otherwise use “when”]

How old was [CHILD] [the first time/when] [he/she/they] moved from your home to this relative’s home?

____________________ years old


C48. [If C42=1; If C45>1 insert “first”] When [CHILD] [first] moved from your home to this relative’s home, did you still have contact with [him/her/them]?


  1. Yes

  2. No

C49. [If C44=1; If C46>1 insert “first”] Next, we would like to understand what was going on in your family when [CHILD] [first] moved from your home to this relative’s home. Which of the following describes your family situation at that time? Please answer Yes or No for each option.

Yes

No

C40a. We did not feel safe at home because of [CHILD]’s behavior, for example, [he/she/they] was/were harming me or my spouse, siblings, or pets



C40b. [He/she/they] needed help to manage emotions or behaviors, such as school problems, not following rules, being disruptive to family life, or having suicidal thoughts



C40c. [He/she/they] needed help to manage [his/her/their] drinking or drug use



C40d. We could not afford services [he/she/they] needed



C40e. We told [him/her/them] that [he/she/they] could not live with us anymore because of his/her/their behavior



C401f. [He/she/they] did not feel accepted as part of our family



C40g. [He/she/they] did not feel his/her/their ethnic or racial identity was accepted



C40h. He/she/they did not feel safe at home because there were other family member difficulties, such as mental health or drug or alcohol problems



C40i. [He/she/they] did not feel his/her/their gender identity or sexual orientation was accepted



C40j. Other (please specify):





C50. [If C44=1; If C46>1, insert “first”] During the time when [CHILD] [first] moved from your home to this relative’s home, did you, your family, or [CHILD] receive any of the following services? Please answer Yes or No for each option.

Yes

No

C50a. Mental health services, for example, individual, group, or family therapy, inpatient care, or home-based services



C50b. Educational supports, for example, Individualized Education Plan, 504 plan, special education classes, tutoring, or support to help [CHILD] with changing schools



C50c. Adoption support services from the child welfare system



C50d. Support group, in-person, online, or by phone with other adoptive parents or children



C50e. Drug or alcohol treatment services



C50f. Financial assistance from an agency or program to provide care or support for [CHILD]. This includes receiving an adoption subsidy



C50g. Other (please specify): ______________




C51. [If C39=1] Did [CHILD] ever return to live with your family?

  1. Yes

  2. No

C52. [If C51=2] Did [CHILD] keep in contact with anyone from your family?

  1. Yes

  2. No

C53. After [CHILD]’s adoption, did [he/she/they] ever live without you at another adult’s home, for example, an older friend’s home, with a friend’s family or parent(s), with a boyfriend or girlfriend or romantic partner’s parent(s), or in a neighbor’s home? [A2>=18 years: Please think only about the times before your child turned 18 years old.]

  1. Yes

  2. No

C54. [If C53=1] How many times has [CHILD] gone to live at another adult’s home without you?

________________________times

C55. [If C53=1; If C54>1 insert “first”] How old was [CHILD] when [he/she/they] [first] went to live in another adult’s home without you?

____________________ years old

C56. [If C53=1; If C54>1 insert “first”] When [CHILD] [first] moved from your home to another adult’s home without you, did you still have contact with [him/her/them]?


  1. Yes

  2. No

C57. [If C53=1; If C54>1 insert “first”] Next, we would like to understand what was going on in your family when [CHILD] [first] moved from your home to another adult’s home without you. Which of the following describes your family situation at that time? Please answer Yes or No for each option.

Yes

No

C57a. We did not feel safe at home because of [CHILD]’s behavior, for example, [he/she/they] was/were harming me or my spouse, siblings, or pets



C57b. [He/she/they] needed help to manage emotions or behaviors, such as school problems, not following rules, being disruptive to family life, or having suicidal thoughts



C57c. [He/she/they] needed help to manage [his/her/their] drinking or drug use



C57d. We could not afford services [he/she/they] needed



C57e. We told [him/her/them] that [he/she/they] could not live with us anymore because of his/her/their behavior



C57f. [He/she/they] did not feel accepted as part of our family



C57g. [He/she/they] did not feel his/her/their ethnic or racial identity was accepted



C57h. He/she/they did not feel safe at home because there were other family member difficulties, such as mental health or drug or alcohol problems



C57i. [He/she/they] did not feel his/her/their gender identity or sexual orientation was accepted



C57j. Other (please specify):





C58. [If C53=1; If C54>1, insert “first”] During the time when [CHILD] [first] moved from your home to another adult’s home, did you, your family, or [CHILD] receive any of the following services? Please answer Yes or No for each option.

Yes

No

C58a. Mental health services, for example, individual, group, or family therapy, inpatient care, or home-based services



C58b. Educational supports, for example, Individualized Education Plan, 504 plan, special education classes, tutoring, or support to help [CHILD] with changing schools



C58c. Adoption support services from the child welfare system



C58d. Support group, in-person, online, or by phone with other adoptive parents or children



C58e. Drug or alcohol treatment services



C58f. Financial assistance from an agency or program to provide care or support for [CHILD]. This includes receiving an adoption subsidy



C58g. Other (please specify): ______________





C59. [If C54=1] Did [CHILD] ever return to live with your family?


  1. Yes

  2. No


C60. [If 59=2] Did [CHILD] keep in contact with anyone from your family?


  1. Yes

  2. No

C61. Running away is defined in the following way: a minor leaving home for over 24 hours or going missing for more than 24 hours and their parent or guardian not knowing where [he/she/they] [was/were]. After [CHILD]’s adoption, did [he/she/they] ever run away from your home? [A2>=18 years: Please think only about the times before [he/she/they] turned 18 years old].

  1. Yes

  2. No

C62. [If C61=1] After [CHILD]’s adoption, how many times has [he/she/they] run away from your home?

____________________ times

C63. [If C61=1; If C62>1 insert “the first time” otherwise use “when”] How old was [CHILD] [the first time/when] [he/she/they] ran away from your home?

_____________________ years old

C64. [If C61=1; If C62>1 insert “first”] When [CHILD] [first] ran away from your home, did you still have contact with [him/her/them]?


  1. Yes

  2. No

C65. [If C61=1; If C62>1 insert “for the first time”] Next, we would like to understand what was going on in your family when [CHILD] ran away [for the first time]. Which of the following describes your family situation at that time? Please answer Yes or No for each option.



Yes

No

C65a. We did not feel safe at home because of [CHILD]’s behavior, for example, [he/she/they] was/were harming me or my spouse, siblings, or pets



C65b. [He/she/they] needed help to manage emotions or behaviors, such as school problems, not following rules, being disruptive to family life, or having suicidal thoughts



C65c. [He/she/they] needed help to manage [his/her/their] drinking or drug use



C65d. We could not afford services [he/she/they] needed



C65e. We told [him/her/them] that [he/she/they] could not live with us anymore because of his/her/their behavior



C65f. [He/she/they] did not feel accepted as part of our family



C65g. [He/she/they] did not feel his/her/their ethnic or racial identity was accepted



C65h. He/she/they did not feel safe at home because there were other family member difficulties, such as mental health or drug or alcohol problems



C65i. [He/she/they] did not feel his/her/their gender identity or sexual orientation was accepted



C65j. Other (please specify):




C66. [If C61=1; If C62>1 insert “first”] During the time when [CHILD] [first] ran away, did you, your family, or [CHILD] receive any of the following services? Please answer Yes or No for each option.

Yes

No

C66a. Mental health services, for example, individual, group, or family therapy, inpatient care, or home-based services



C66b. Educational supports, for example, Individualized Education Plan, 504 plan, special education classes, tutoring, or support to help [CHILD] with changing schools



C66c. Adoption support services from the child welfare system



C66d. Support group, in-person, online, or by phone with other adoptive parents or children



C66e. Drug or alcohol treatment services



C66f. Financial assistance from an agency or program to provide care or support for [CHILD]. This includes receiving an adoption subsidy



C66g. Other (please specify): ______________





C67. [If C61=1] Did [CHILD] ever return to live with your family?


  1. Yes

  2. No

C68. [if C67=2] Did [CHILD] keep in contact with anyone from your family?


  1. Yes

  2. No

C69. After [CHILD]’s adoption, was there ever a time when [he/she/they] spent one or more nights homeless without you, for example, living inside a car, in an abandoned building, on the street, in a park, in a shelter, or couch surfing? [A2>=18 years: Please think only about the times that happened before [he/she/they] turned 18 years old].

  1. Yes

  2. No


C70. [If C69=1] To the best of your knowledge, how many separate times has [CHILD] spent one or more nights homeless without you?

_________________ times

C71. [If C69=1; If C70>1 insert “the first time,” otherwise, insert “when”] How old was [CHILD] [the first time/when] [he/she/they] spent a night homeless without you?

___________________ years old

C72. [If C69=1; if C70>1 insert “first”] When [CHILD] [first] spent a night homeless without you, did you still have contact with [him/her/them]?


  1. Yes

  2. No

C73. [If C69=1; if C70>1 insert “for the first time”] Next, we would like to understand what was going on in your family when [CHILD] became homeless [for the first time]. Which of the following describes your family situation at that time? Please answer Yes or No for each option.

Yes

No

C73a. We did not feel safe at home because of [CHILD]’s behavior, for example, [he/she/they] was/were harming me or my spouse, siblings, or pets



C73b. [He/she/they] needed help to manage emotions or behaviors, such as school problems, not following rules, being disruptive to family life, or having suicidal thoughts



C73c. [He/she/they] needed help to manage [his/her/their] drinking or drug use



C73d. We could not afford services [he/she/they] needed



C73e. We told [him/her/them] that [he/she/they] could not live with us anymore because of his/her/their behavior



C73f. [He/she/they] did not feel accepted as part of our family



C73g. [He/she/they] did not feel his/her/their ethnic or racial identity was accepted



C73h. He/she/they did not feel safe at home because there were other family member difficulties, such as mental health or drug or alcohol problems



C73i. [He/she/they] did not feel his/her/their gender identity or sexual orientation was accepted



C73j. Other (please specify):




C74. [If C69=1; If C70>1, insert “first”] During the time when [CHILD] [first] became homeless, did you, your family, or [CHILD] receive any of the following services? Please answer Yes or No for each option.

Yes

No

C74a. Mental health services, for example, individual, group, or family therapy, inpatient care, or home-based services



C74b. Educational supports, for example, Individualized Education Plan, 504 plan, special education classes, tutoring, or support to help [CHILD] with changing schools



C74c. Adoption support services from the child welfare system



C74d. Support group, in-person, online, or by phone with other adoptive parents or children



C74e. Drug or alcohol treatment services



C74f. Financial assistance from an agency or program to provide care or support for [CHILD]. This includes receiving an adoption subsidy



C74g. Other (please specify): ______________




C75. [If C69=1] Did [CHILD] ever return to live with your family?


  1. Yes

  2. No

C76. [If C75=2] Did [CHILD] keep in contact with anyone from your family?


  1. Yes

  2. No

C77. After [CHILD]’s adoption, did [he/she/they] ever spend at least one night in juvenile detention or was [he/she/they] ever taken into custody for an illegal or delinquent offense? [A2>=18 years: Please think only about the times before [he/she/they] turned 18 years old].

  1. Yes

  2. No

C78. [If C77=1] How many times has [CHILD] spent at least one night in detention?

_______________ times

C79. How many times has [CHILD] been taken into custody?

_______________ times

C80. [If C77=1; If C78 or C79>1 insert “the first time”] How old was [CHILD] [the first time] [he/she/they] spent at least one night in detention or was taken into custody?

_________________ years old

C81. [If C77=1; If C78 or C79>1 insert “first”] When [CHILD] [first] spent at least one night in detention or was taken into custody, did you still have contact with [him/her/them]?


  1. Yes

  2. No

C82. [If C77=1; If C78 or C79>1 insert “first”] Next, we would like to understand what was going on in your family when [CHILD] spent at least one night in detention or was taken into custody. Which of the following describes your family situation at that time? Please answer Yes or No for each option.



Yes

No

C82a. We did not feel safe at home because of [CHILD]’s behavior, for example, [he/she/they] was/were harming me or my spouse, siblings, or pets



C82b. [He/she/they] needed help to manage emotions or behaviors, such as school problems, not following rules, being disruptive to family life, or having suicidal thoughts



C82c. [He/she/they] needed help to manage [his/her/their] drinking or drug use



C82d. We could not afford services [he/she/they] needed



C82e. We told [him/her/them] that [he/she/they] could not live with us anymore because of his/her/their behavior



C82f. [He/she/they] did not feel accepted as part of our family



C82g. [He/she/they] did not feel his/her/their ethnic or racial identity was accepted



C82h. He/she/they did not feel safe at home because there were other family member difficulties, such as mental health or drug or alcohol problems



C82i. [He/she/they] did not feel his/her/their gender identity or sexual orientation was accepted



C82j. Other (please specify):




C83. [If C77=1; If C78 or C79>1 insert “first”] During the [first] time when [CHILD] spent at least one night in detention or was taken into custody, did you, your family, or [CHILD] receive any of the following services? Please answer Yes or No for each option.

Yes

No

C83a. Mental health services, for example, individual, group, or family therapy, inpatient care, or home-based services



C83b. Educational supports, for example, Individualized Education Plan, 504 plan, special education classes, tutoring, or support to help [CHILD] with changing schools



C83c. Adoption support services from the child welfare system



C83d. Support group, in-person, online, or by phone with other adoptive parents or children



C83e. Drug or alcohol treatment services



C83f. Financial assistance from an agency or program to provide care or support for [CHILD]. This includes receiving an adoption subsidy



C83g. Other (please specify): ______________




C84. [If C77=1] Did [CHILD] ever return to live with your family?


  1. Yes

  2. No

C85. [If C84=2] Did [CHILD] keep in contact with anyone from your family?


  1. Yes

  2. No

C86. Transitional housing is a temporary accommodation before permanent housing. After [CHILD]’s adoption, did [he/she/they] ever live in a transitional housing program without you? [A2>=18 years: Please think only about the times before [he/she/they] turned 18 years old.]

  1. Yes

  2. No


C87. [If C86=1] How many times has [CHILD] gone to live in a transitional housing program without you?

___________________ Number of times

C88. [If C86=1; if C87>1 insert “first”] How old was [CHILD] when [he/she/they] [first] moved from your home to live in a transitional housing program?


___________________ years old

C89. [If C86=1; If C87>1 insert “first”] When [CHILD] [first] moved from your home to transitional housing program, did you still have contact with your child?


  1. Yes

  2. No

C90. [If C86=1; If C87>1 insert “first”] Next, we would like to understand what was going on in your family when [CHILD] [first] moved from your home to a transitional housing program. Which of the following describes your family situation at that time? Please answer Yes or No for each option.

Yes

No

C90a. We did not feel safe at home because of [CHILD]’s behavior, for example, [he/she/they] was/were harming me or my spouse, siblings, or pets



C90b. [He/she/they] needed help to manage emotions or behaviors, such as school problems, not following rules, being disruptive to family life, or having suicidal thoughts



C90c. [He/she/they] needed help to manage [his/her/their] drinking or drug use



C90d. We could not afford services [he/she/they] needed



C90e. We told [him/her/them] that [he/she/they] could not live with us anymore because of his/her/their behavior



C90f. [He/she/they] did not feel accepted as part of our family



C90g. [He/she/they] did not feel his/her/their ethnic or racial identity was accepted



C90h. He/she/they did not feel safe at home because there were other family member difficulties, such as mental health or drug or alcohol problems



C90i. [He/she/they] did not feel his/her/their gender identity or sexual orientation was accepted



C90j. Other (please specify):





C91. [If C86=1; If C87>1 insert “first”] During the time when [CHILD] [first] moved from your home to a transitional housing program, did you, your family, or [CHILD] receive any of the following services? Please answer Yes or No for each option.

Yes

No

C91a. Mental health services, for example, individual, group, or family therapy, inpatient care, or home-based services



C91b. Educational supports, for example, Individualized Education Plan, 504 plan, special education classes, tutoring, or support to help [CHILD] with changing schools



C91c. Adoption support services from the child welfare system



C91d. Support group, in-person, online, or by phone with other adoptive parents or children



C91e. Drug or alcohol treatment services



C91f. Financial assistance from an agency or program to provide care or support for [CHILD]. This includes receiving an adoption subsidy



C91g. Other (please specify): ______________





C92. [If C86=1] Did [CHILD] ever return to live with your family?


  1. Yes

  2. No

C93. [if C92=2] Did [CHILD] keep in contact with anyone from your family?


  1. Yes

  2. No

C94. A group home is a residence intended to serve as an alternative to a family foster home. Homes normally house 4 to 12 youth, offering the use of community resources, including employment, health care, education, and recreational opportunities. A residential treatment center is a 24-hour inpatient facility that provides a range of therapeutic and support services for children by a professional, interdisciplinary team. After [CHILD]’s adoption, has [he/she/they] ever lived in a group home or a residential treatment center? [A2>=18 years: Please think only about the times before he/she/they turned 18 years old.]

  1. Yes

  2. No

C95. [If C94=1] How many separate times has [CHILD] lived in a group home or residential treatment center after [his/her/their] adoption? Please include any stay that lasted more than 1 night. Do not include time spent in a juvenile detention.

____________________ times

C96. [If C94=1; If C95>1 insert “first”] How old was [CHILD] when [he/she/they] [first] moved from your home to a group home or residential treatment center?

___________________ years old

C97. [If C94=1; If C95>1 insert “first”] When [CHILD] [first] moved from your home to a group home or residential treatment center, did you still have contact with [him/her/them]?


  1. Yes

  2. No

C98. [If C94=1; If C95>1 insert “first”] Next, we would like to understand what was going on in your family when [CHILD] [first] moved from your home to a group home or residential treatment center. Which of the following describes your family situation at that time? Please answer Yes or No for each option.



Yes

No

C98a. We did not feel safe at home because of [CHILD]’s behavior, for example, [he/she/they] was/were harming me or my spouse, siblings, or pets



C98b. [He/she/they] needed help to manage emotions or behaviors, such as school problems, not following rules, being disruptive to family life, or having suicidal thoughts



C98c. [He/she/they] needed help to manage [his/her/their] drinking or drug use



C98d. We could not afford services [he/she/they] needed



C98e. We told [him/her/them] that [he/she/they] could not live with us anymore because of his/her/their behavior



C98f. [He/she/they] did not feel accepted as part of our family



C98g. [He/she/they] did not feel his/her/their ethnic or racial identity was accepted



C98h. He/she/they did not feel safe at home because there were other family member difficulties, such as mental health or drug or alcohol problems



C98i. [He/she/they] did not feel his/her/their gender identity or sexual orientation was accepted



C98j. Other (please specify):





C99. [If C94=1; If C95>1, insert “first”] During the time when [CHILD] [first] moved from your home to a group home or residential treatment center, did you, your family, or [CHILD] receive any of the following services? Please answer Yes or No for each option.

Yes

No

C99a. Mental health services, for example, individual, group, or family therapy, inpatient care, or home-based services



C99b. Educational supports, for example, Individualized Education Plan, 504 plan, special education classes, tutoring, or support to help [CHILD] with changing schools



C99c. Adoption support services from the child welfare system



C99d. Support group, in-person, online, or by phone with other adoptive parents or children



C99e. Drug or alcohol treatment services



C99f. Financial assistance from an agency or program to provide care or support for [CHILD]. This includes receiving an adoption subsidy



C99g. Other (please specify): ______________





C100. [If C94=1] Did [CHILD] ever return to live with your family?

  1. Yes

  2. No

C101. [if C100=2] Did [CHILD] keep in contact with anyone from your family?


  1. Yes

  2. No

[If for any instability episode “Did [CHILD] keep in contact with anyone from your family? = Yes]

C102. When we asked you about things that may have happened in [CHILD]’s life, you mentioned that [he/she/they] stopped living with you at some point but that [he/she/they] kept in contact with someone from your family. Tell us more about this contact with [him/her/them].

[TEXT BOX FOR AN OPEN-ENDED RESPONSE]



[If for any instability episode “Did [CHILD] ever return to live with your family” = Yes]

C103. When we asked you about things that may have happened in [CHILD]’s life, you mentioned that [he/she/they] stopped living with you at some point but that [he/she/they] returned to live with you.

Tell us more about why [CHILD] returned to live with you?

[TEXT BOX FOR AN OPEN-ENDED RESPONSE]





Section D: Post Adoption Services and Support

INTROD1: The next questions will ask you about services and supports that you or [CHILD] may have needed or received.

[If A2>=18 insert “but before he/she turned 18”]

D104. After [CHILD]’s adoption, [but before he/she/they turned 18], did you feel that you, your family or [CHILD] needed any of the following services, regardless of whether they were offered to you? Please answer Yes or No for each option.

Yes

No

D104a. Mental health services, for example, individual, group, or family therapy, inpatient care, or home-based services



D104b. Educational supports, for example, Individualized Education Plan, 504 plan, special education classes, tutoring, or support to help [CHILD] with changing schools



D104c. Adoption support services from the child welfare system



D104d. Support group, in-person, online, or by phone with other adoptive parents or children



D104e. Drug or alcohol treatment services



D104f. Healthcare services, for example from a pediatrician or primary care physician



D104g. Financial assistance from an agency or program to provide care or support for your child, such as an adoption subsidy



D104h. Job training or support with independent living or other life skills



D104i. Other (please specify):





[If A2>=18 insert “but before he/she turned 18”]

D105. After [CHILD’s] adoption, [but before he/she/they turned 18], did you, your family, or [CHILD] receive any of the following services? Please answer Yes or No for each option.

Yes

No

D105a. Mental health services, for example, individual, group, or family therapy, inpatient care, or home-based services



D105b. Educational supports, for example, Individualized Education Plan, 504 plan, special education classes, tutoring, or support to help [CHILD] with changing schools



D105c. Adoption support services from the child welfare system



D105d. Support group, in-person, online, or by phone with other adoptive parents or children



D105e. Drug or alcohol treatment services



D105f. Healthcare services, for example from a pediatrician or primary care physician



D105g. Financial assistance from an agency or program to provide care or support for your child



D105h. Job training or help with independent living skills



D105i. Other (please specify):





D105a. [IF YES to financial support/adoption subsidy in D105] How helpful did you find the financial assistance, or amount of the adoption subsidy, in meeting [CHILD]’s needs?

  1. Very Helpful

  2. Helpful

  3. Not helpful

D106. [If yes to any type of service in D105] How helpful were the services overall?

  1. Very Helpful

  2. Helpful

  3. Not helpful

D107. Were there any other services you would have liked to have received? If so, describe them here.

  1. Yes

  2. No

[If D107=Yes] Could you please describe them?

[TEXT BOX FOR AN OPEN-ENDED RESPONSE]

D108. [If “yes” to service need in D104 and “no” to service receipt in D105] Why do you think you did not get the services you, your family, or [CHILD] needed? 

[TEXT BOX FOR AN OPEN-ENDED RESPONSE]

D109. [If “yes” to service receipt in D105] What do you think helped you, your family, or [CHILD] get the services you needed?

[TEXT BOX FOR AN OPEN-ENDED RESPONSE]

INTROD2. The next section is about help or support for YOU.

D110. After the adoption, who helped or supported you? Please answer Yes or No for each option.

Yes

No

D110a. Your relatives



D110b. Your adoptive child’s relatives



D110c. Friends, neighbors, coworkers, or faith or church members



D110d. In-person or online adoptive parents’ group



D110e. Your counselor or therapist



D110f. Caseworker or adoption agency staff



D110g. Other (please specify)





D114. After the adoption, did a caseworker from the child welfare agency ever visit your home?

  1. Yes

  2. No

D117. Was [CHILD]’s adoption ever terminated or legally ended by a court order?

    1. Yes, my parental rights were terminated

    2. Yes, my child was legally emancipated with a court order before he/she/they turned 18 years old

    3. No, my parental rights were not terminated, instead we just ended our relationship on our own

    4. No



D118. [If D117=1 or 2 or 3] When was the adoption terminated? Please provide an approximate date.

___________________ (Fill date – MM/DD/YYYY)



Section E: Family Relationships

INTROE: These next several questions are about your current relationship with [CHILD] and your relationship with [him/her/them].

E119. How close do you currently feel to [CHILD]?

  1. Extremely close

  2. Very close

  3. Moderately close

  4. Slightly close

  5. Not at all close

E120. About how often do you see or have contact with your [CHILD]?

  1. Never

  2. A few times a year

  3. Once or twice a month

  4. About once a week

  5. Several times a week

  6. Every day

E121. How much do you feel that [CHILD] belongs in your family?

  1. Completely

  2. Very much

  3. A moderate amount

  4. A little

  5. Not at all



E122. [If A2>=18, insert “During [CHILD’s] childhood, before he/she turned 18”] how close did you feel to [him/her/them]?

  1. Extremely close

  2. Very close

  3. Moderately close

  4. Slightly close

  5. Not at all close



E123. [If A3_PRE=1,2,3,4,7, ELSE SKIP to Section G] Does [CHILD] know that [he/she/they] [is/are] adopted?

  1. Yes

  2. No




E124. [If A3≠5 or 6 and E123=No, SKIP to F136] As children grow up, their questions about adoption often change. What sort of questions has [CHILD] asked you about [his/her/their] birth or biological parents or family over the years? Please answer Yes or No for each option.

Yes

No

E124a. Questions about [his/her/their] birth or biological mother



E124b. Questions about [his/her/their] birth or biological father



E124c. Questions about [his/her/their] birth or biological siblings or other birth or biological family members



E124d. Questions about why [his/her/their] birth or biological parents could not take care of [him/her/them]




E125. How often do you encourage [CHILD] to talk about [his/her/their] adoption? [If A2>=18 years: “Before [CHILD] turned 18 years old, how often did you encourage [he/she/them] to talk about [his/her/their] adoption?”]

  1. Never

  2. Very rarely

  3. Rarely

  4. About half the time

  5. Frequently

  6. Very frequently

  7. Always


E127. Do you think [CHILD] ever worries about being adopted? [If A2>=18 years: “Before [CHILD] turned 18 years old, do you think [he/she/they] worried about being adopted?”]


  1. No

  2. Yes


E128. Has [CHILD] ever been bullied because [he/she/they] was adopted?


  1. Yes

  2. No



[If A3_PRE=1 or 2, ELSE SKIP TO SECTION G]



Section F: Adoption Motivation/Experience

INTROF: Now we would like to understand more about your adoption experience.

F136. There are many reasons why people decide to adopt a child. What are some reasons why you chose adoption? Please answer Yes or No for each option.

Yes

No

F136a. I loved [CHILD]



F136b. [CHILD] was already part of our family as a relative or foster child



F136c. My spouse, romantic partner, or significant other and I were unable to have a birth or biological child



F136d. I wanted to expand our family



F136e. I felt called to adopt [CHILD] for religious or spiritual reasons



F136f. I wanted a sibling for my birth or biological child(ren)



F136g. I already adopted [CHILD]’s sibling(s)



F136h. I knew [CHILD] and wanted to help him/her/them



F136i. I, or someone close to me, had previously been adopted



F136j. I wanted to help a child in need of a permanent family



F136k. My family would be aided financially by an adoption subsidy



F136l. Other reason (please specify): _____________





F137. Looking back, how well do you think [CHILD] matched the perception you had about [him/her/them] at the start of their adoption process?

  1. Poor match

  2. Reasonable match

  3. Good match


F138. Did you receive training in preparation for their adoption?


  1. Yes

  2. No


F139. [If F138=Yes] What kind of training did you receive in preparation for their adoption?


[TEXT BOX FOR AN OPEN-ENDED RESPONSE]

F140. [If F138=Yes] About how many hours of training did you receive in preparation for the adoption?


________________hours


F141. Looking back, how well prepared do you think you were to adopt [CHILD]?


  1. Not at all prepared

  2. Somewhat prepared

  3. Very well prepared


F142. How concerned were you about your readiness to be an adoptive parent to [CHILD] when you first heard details about [his/her/their] child welfare case and history?


  1. I had major concerns

  2. I had some concerns

  3. I did not have any concerns

F143. [If F142=1 or 2] Did you talk to the child welfare agency staff or adoption specialist about your concerns before the adoption process?


  1. Yes, I was open and truthful about any concerns

  2. Yes, but I downplayed my concerns

  3. No, I did not discuss my concerns



Section G: Perceptions of Family Cohesion/Functioning During Childhood

[If A2>=18, use ‘during his/her childhood’ and ‘was’]



INTROG1: For the next set of statements, think of your experiences with [CHILD] [if A2>=18- “during his/her/their childhood, before he/she/they turned 18 years old”]. Please think about all members of your family when answering these questions. Select how often each statement is [if A2>=18- “was”] true for your family.

G145. In my family, we talk about problems. [If A2>=18 years: In my family, we talked about problems.]

  1. Never

  2. Very rarely

  3. Rarely

  4. About half of the time

  5. Frequently

  6. Very frequently

  7. Always

G146. When we argue, my family listens to “both sides of the story.” [If A2>=18 years: When we argued, my family listened to “both sides of the story.”]

  1. Never

  2. Very rarely

  3. Rarely

  4. About half of the time

  5. Frequently

  6. Very frequently

  7. Always

G147. In my family, we take time to listen to each other. [If A2>=18 years: In my family, we took time to listen to each other.]

  1. Never

  2. Very rarely

  3. Rarely

  4. About half of the time

  5. Frequently

  6. Very frequently

  7. Always

G148. My family pulls together when things are stressful. [If A2>=18 years: My family pulled together when things were stressful.]

  1. Never

  2. Very rarely

  3. Rarely

  4. About half of the time

  5. Frequently

  6. Very frequently

  7. Always

G149. My family is able to solve our problems. [If A2>=18 years: My family was able to solve our problems.]

  1. Never

  2. Very rarely

  3. Rarely

  4. About half of the time

  5. Frequently

  6. Very frequently

  7. Always


[If A2>=18, use ‘during his/her childhood’ and ‘was’]

INTROG2: For the next set of statements, think of your experiences with [CHILD] [if A2>=18- “during [his/her/their] childhood, before he/she/they turned 18 years”]. Please indicate how often each of the following is [if A2>=18- “was”] true for you when you are [if A2>=18- “were”] with [him/her/them].


G150. I am happy being with my child. [If A2>=18 years: I was happy being with my child.]


  1. Never

  2. Very rarely

  3. Rarely

  4. About half of the time

  5. Frequently

  6. Very frequently

  7. Always


G151. My child and I are very close to each other. [If A2>=18 years: My child and I were very close to each other.]


  1. Never

  2. Very rarely

  3. Rarely

  4. About half of the time

  5. Frequently

  6. Very frequently

  7. Always


G152. I am able to soothe my child when [he/she/they] [is/are] upset. [If A2>=18 years: I was able to soothe my child when he/she/they was upset.]


  1. Never

  2. Very rarely

  3. Rarely

  4. About half of the time

  5. Frequently

  6. Very frequently

  7. Always



G153. I spend time with my child doing what [he/she/they] likes to do. [If A2>=18 years: I spent time with my child doing what [he/she/they] liked to do.]

  1. Never

  2. Very rarely

  3. Rarely

  4. About half of the time

  5. Frequently

  6. Very frequently

  7. Always


G154. Overall, how would you rate the impact of [CHILD]’s adoption on your family?


  1. Extremely negative

  2. Moderately negative

  3. Slightly negative

  4. Neither positive nor negative

  5. Slightly positive

  6. Moderately positive

  7. Extremely positive


G155. If you knew everything about [CHILD] before the adoption that you now know, do you think you would still have adopted [him/her/them]?


  1. Definitively not

  2. Probably not

  3. Maybe

  4. Probably

  5. Definitely


G156. [If D117=4] How often do you think about ending [CHILD]’s adoption?


  1. Never

  2. Rarely

  3. Sometimes

  4. Usually

  5. Always



Section H: Child Mental Health Status and Parenting Stress/Burden


INTROH: The next questions ask about your health and parenting experience.


H157. Overall, would you say [CHILD]’s current health is…?


  1. Excellent

  2. Very good

  3. Good

  4. Fair

  5. Poor

H158. Do you think [CHILD] has a current problem with [his/her/their] mental health? Please include any emotional, behavioral, learning, or attention problems.

  1. Yes

  2. No

H159. Do you think [CHILD] has a current problem with[ his/her/their] drug or alcohol use? Please include any alcohol or drug abuse problems.

  1. Yes

  2. No

H160. Do you think [CHILD] has a current problem with attachment or trouble allowing [him/her/themselves] to be loved?


  1. Yes

  2. No

H161. [If A2>=18] During [CHILD]’s childhood, did [he/she/they] have a problem with [his/her/their] mental health? Please include any emotional, behavioral, learning, or attention problems.


  1. Yes

  2. No

H162. [If A2>=18] During [CHILD]’s childhood, did [he/she/they] have a problem with [his/her/their] drug or alcohol use? Please include any alcohol or drug abuse problem.


  1. Yes

  2. No




H164. How difficult [IF A2= <18, insert “is”/IF A2>=18, insert “was”] it to be the parent of [CHILD]?

  1. Not at all difficult

  2. A little difficult

  3. Difficult

  4. Very difficult

  5. Extremely difficult


H166. [If H164=2, 3, 4, or 5] Please select the kind of difficulties you experienced with [CHILD]? Please answer Yes or No for each option.

Yes

No

H166a. Defiance or not following family rules



H166b. Verbal aggression



H166c. Physical aggression



H166d. Running away



H166e. Threatening to or harming [himself/herself/themselves]



H166f. Academic or behavioral problems in school



H166g. Difficulties making friends



H166h. Committing a crime



H166i. Alcohol or drug misuse



H166j. Sexualized behaviors



H166k. Depression or anxiety



H166l. Sleep problems or night terrors



H166m. Other (please specify):





H167. [If H164=2, 3, 4, or 5] In what ways did the difficulties you had with [CHILD] affect you? Please answer Yes or No for each option.

Yes

No

H167a. Did not affect me



H167b. Mental health problems



H167c. Physical health problems



H167d. Problems with social life



H167e. Relationship problems with my spouse or partner



H167f. Financial difficulties



H167g. Employment difficulties



H167h. Other (please specify):





H168. Now I have a few questions about your personal experiences with COVID-19, the disease caused by the novel coronavirus.


How much has COVID-19 changed your family income or employment situation?


  1. No change.

  2. Mild. There has been a small change, but I can still meet my basic needs and pay bills.

  3. Moderate. I have had to make cuts, but I can still meet my basic needs and pay my bills.

  4. Severe. I am unable to meet my basic needs or pay my bills.


H169. How much has COVID-19 changed your access to extended family and non-family social supports?


  1. No change.

  2. Mild. I continue my visits with social distancing, regular phone calls, video calls or social media contacts.

  3. Moderate. I have lost in-person and remote contact with a few people, but not all of my supports.

  4. Severe. I have lost all in-person and remote contact with my supports.



H170. How much stress have you experienced due to COVID-19?


  1. None.

  2. Mild. I worry occasionally or experience minor stress-related symptoms such as feeling a little anxious, sad, or angry; or having mild trouble sleeping.

  3. Moderate. I worry frequently or experience moderate stress-related symptoms such as feeling moderately anxious, sad, or angry; or having moderate or occasional trouble sleeping.

  4. Severe. I worry all the time or experience severe stress-related symptoms such as feeling extremely anxious, sad or angry; or having severe or frequent trouble sleeping.



H171. How much stress or disagreement is there in your family due to COVID-19?


  1. None.

  2. Mild. My family members are occasionally short-tempered with one another; but there is no physical violence.

  3. Moderate. My family members are frequently short-tempered with one another; or children my home get in physical fights with one another.

  4. Severe. My family members are frequently short-tempered with one another; or adults my home throw things at one another, knock over furniture, hit or harm one another.



Section I: Open Ended Question

[IF A3=5 or 6 GO TO END]

INTROI: This is our last question.

I172. Is there anything else about your adoption experience that you would like to share?

1 Yes

2 No

[IF YES] What would you like to share?



[TEXT BOX FOR AN OPEN-ENDED RESPONSE]





SAP, Page 43 WEB DISPLAY: HELP-CRISIS LINE 1-800-273-TALK (8255)


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorDomanico, Rose
File Modified0000-00-00
File Created2021-05-03
© 2024 OMB.report | Privacy Policy