First follow-up survey – participants
Next Generation of Enhanced Employment Strategies Project [Impact, Descriptive, and Cost Studies]
Instrument 3. NextGen first follow-up survey - revised August 2024
First follow-up survey – participants
OMB: 0970-0545
Instrument 3. NextGen first follow-up survey – revised
Next Generation of Enhanced Employment Strategies Project
First Follow-up Survey
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to evaluate innovative programs serving individuals facing challenges to employment and economic independence to expand the evidence base. Public reporting burden for this collection of information is estimated to average 50 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0545 and the expiration date is 04/30/2023. If you have any comments on this collection of information, please contact Mathematica at NextGenProject@mathematica-mpr.com. |
COMPUTER ASSISTED WEB INTERVIEW (CAWI) ALL
COMPUTER ASSISTED TELEPHONE INTERVIEW (CATI) ALL
Intro1.* [IF CATI: My name is [fill Interviewer Name] and I’m calling on behalf of the U.S. Department of Health and Human Services.] Recently, you should have received a letter about a survey Mathematica is conducting for the U.S. Department of Health and Human Services. The [NEXTGEN PROGRAM] is participating in the Next Generation of Enhanced Employment Strategies Project and this survey is part of that study. To inform the study, we need to hear about your experiences including your use of employment services, your jobs, your health, and your receipt of assistance. Your participation in this study will help policymakers and program staff better understand how to improve programs like [NEXTGEN PROGRAM]. Mathematica will mail you a [$50/$55] gift card when the survey is completed.
You agreed to be part of the study around [RA MONTH/YEAR] when you talked with staff from [NEXTGEN PROGRAM].
All of your responses will be kept private; your name will not appear in any written reports we produce. Your responses to these questions are completely voluntary. That means you may choose not to answer any question, or you may stop the survey at any time.
According to the Paperwork Reduction Act (PRA), this collection of information is voluntary. Public reporting burden for this collection of information is estimated to average 50 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. A government agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB number and expiration date for this collection are OMB #: 0970-0545, Exp: 04/30/2023. If you later have any questions about the study, you can email us at NextGenProject@mathematica-mpr.com.
[IF CATI: Do you have any questions before we begin?]
COMPUTER ASSISTED WEB INTERVIEW (CAWI) ALL
COMPUTER ASSISTED TELEPHONE INTERVIEW (CATI) DO NOT DISPLAY
How to complete the survey
Thank you for taking the time to complete this survey.
There are no right or wrong answers.
To answer a question, click the box that indicates your response or fill in your response.
To continue to the next webpage, press the "Next" button.
To go back to the previous webpage, click the "Back" button. Please note that this command is only available in some sections.
Do not use the navigation arrows in your browser.
If you need to stop before you have finished, you can close the survey and come back to it at any time. The responses you gave before leaving will be securely stored and available when you return to complete the survey.
Select “Next” to begin the survey.
CATI/CAWI: ALL |
CATI: First we are going to ask you some questions to check that we are speaking with the correct person.
CAWI: First we are going to ask you some questions to check that we are surveying the correct person.
IF PROGRAM= Bridges: DO NOT ask fast: ASK ips: ask moms: ASK PhillyWIns: ASK
IF CAWI DO NOT SHOW DK OR REF |
Intro2. When you enrolled in [NEXTGEN PROGRAM] program in [RA MONTH/YEAR], what was your marital status?
MARRIED 1
SEPARATED 2
DIVORCED 3
WIDOWED 4
NEVER MARRIED 5
DON’T KNOW d
REFUSED r
CATI/CAWI HARD CHECK: AN ANSWER MUST BE PROVIDED FOR THIS QUESTION, IF ASKED |
PROGRAMMER BOX
IF SSN EXISTS AT BASELINE, GO TO INTRO3. IF SSN DOES NOT EXIST AT BASELINE, GO TO INTRO4. |
CATI/CAWI: ALL with SSN at baseline IF CAWI DO NOT SHOW DK OR REF |
Intro3.* And what are the last 4-digits of your Social Security number?
| | | | | LAST FOUR
(0000-9999)
DON’T KNOW d GO TO INTRO4
REFUSED r GO TO INTRO4
CATI HARD CHECK: AN ANSWER MUST BE PROVIDED FOR THIS QUESTION.
CAWi hard check: an anSwer must be provided to go to the next question. this is to protect your privacy to make sure no one accesses the information provided in the survey. |
PROGRAMMER BOX
IF INTRO2 (MARITAL STATUS) MATCHES RECORDS AND INTRO3 (SSN) MATCHES, GO TO A1. OTHERWISE GO TO INTRO4 |
IF CAWI DO NOT SHOW DK OR REF |
INTRO4.* What is your date of birth?
| | | / | | | / | | | | |
MONTH DAY YEAR
(1-12) (1-31) (MIN-MAX)
DON’T KNOW d
REFUSED r
CATI HARD CHECK: AN ANSWER MUST BE PROVIDED FOR THIS QUESTION.
CAWi hard check: an anSwer must be provided to go to the next question. this is to protect your privacy to make sure no one accesses the information provided in the survey. |
PROGRAMMER BOX
IF PROGRAM= fast ips moms phillywins: IF INTRO2 (MARITAL STATUS) MATCHES AND INTRO3 (SSN) DOES NOT MATCH AND INTRO4 (DOB) DOES NOT MATCH THEN FLAG CASE FOR FOLLOW-UP VERIFICATION CALL. IF INTRO2 (MARITAL STATUS) DOES NOT MATCH AND INTRO3 (SSN) DOES MATCH AND INTRO4 (DOB) DOES NOT MATCH THEN FLAG CASE FOR FOLLOW-UP VERIFICATION CALL. IF INTRO2 (MARITAL STATUS) DOES NOT MATCH AND INTRO3 (SSN) DOES NOT MATCH AND INTRO4 (DOB) DOES NOT MATCH THEN FLAG CASE FOR FOLLOW-UP VERIFICATION CALL. IF INTRO2 (MARITAL STATUS) DOES NOT MATCH AND INTRO3 (SSN) DOES NOT MATCH AND INTRO4 (DOB) DOES MATCH THEN FLAG CASE FOR FOLLOW-UP VERIFICATION CALL. GO TO A1.
IF PROGRAM=BRIDGES IF INTRO3 (SSN) DOES MATCH AND INTRO4 (DOB) DOES NOT MATCH THEN FLAG CASE FOR FOLLOW-UP VERIFICATION CALL. IF INTRO3 (SSN) DOES NOT MATCH AND INTRO4 (DOB) DOES MATCH THEN FLAG CASE FOR FOLLOW-UP VERIFICATION CALL. IF INTRO3 (SSN) DOES NOT MATCH AND INTRO4 (DOB) DOES NOT MATCH THEN FLAG CASE FOR FOLLOW-UP VERIFICATION CALL. GO TO A1. |
A. EMPLOYMENT AND EARNINGS
CATI/CAWI: ALL IF CAWI DO NOT SHOW DK OR REF |
CATI: First I would like to ask some questions about work.
CAWI: The first set of questions are about work.
A1.* Are you currently working for pay?
Working for pay can include regular paid jobs, odd jobs, temporary jobs, work done in your own business, jobs or tasks you find using a web or mobile app, “under the table” work, “off the books” work, paid work experience, apprenticeships, or any other types of work you have done for pay.
YES 1 A2A
NO 0 A2
DON’T KNOW d A2
REFUSED r A2
CATI/CAWI: A1 NE= 1 IF CAWI DO NOT SHOW DK OR REF |
A2. Have you worked for pay at any time since [RA MONTH YEAR]?
YES 1 A2A
NO 0 A11
DON’T KNOW d A11
REFUSED r A11
CATI/CAWI: A1=1 or A2=1 if coronavirus pandemic challenges remain ask A2a. else skip A2A. IF CAWI DO NOT SHOW DK OR REF |
A2a. Since [RA MONTH YEAR], have any of the following changes happened to you at work because of COVID-19?
Select one per row
-
NO
YES
DK
REF
a. Were your hours cut?
0 m
1 m
d m
r m
b. Were you asked to work more hours than usual?
0 m
1 m
d m
r m
c. Were you temporarily laid off or furloughed?
0 m
1 m
d m
r m
d. Did you lose your job?
0 m
1 m
d m
r m
e. Did you quit your job because of the risk of exposure to COVID-19?
0 m
1 m
d m
r m
PROGRAMMER BOX
IF A1=1 GO TO A3 IF A2=1 GO TO A4A |
PROGRAMMER: SET LIMIT OF 10 (CURRENT OR FORMER, TOTAL) JOBS
|
JOB 1 |
JOB 2 |
|
A1 =1 IF CAWI DO NOT SHOW DK OR REF CATI FILL “FIRST I AM GOING TO ASK ABOUT YOUR CURRENT JOB OR JOBS” FOR JOB 1 ONLY. CAWI FILL “THE NEXT QUESTIONS ARE ABOUT YOUR CURRENT JOB OR JOBS.” FOR JOB 1 ONLY. A3. CATI: [First I am going to ask about your current job or jobs.] Please tell me who you work for. CAWI: [The next questions are about your current job or jobs.] Please tell us who you work for. CATI/CAWI: This could include the names of regular paid jobs, odd jobs, temporary jobs, work done in your own business, jobs or tasks you find using a web or mobile app, “under the table” work, “off the books” work, paid work experiences, apprenticeships, or any other types of work you have done for pay. If you currently work at more than one job, please start with the job where you usually work the most hours. |
JOB NAME (SPECIFY) 1 (STRING 50) SELF EMPLOYED 2 DON’T KNOW d REFUSED r PROGRAMMER: IF A3 = d, r, make [JOB NAME] be “Job 1” for Job 1, “Job 2” for Job 2, etc. INTERVIEWER: IF A3=d, r, THEN SAY: That’s okay, we’ll just refer to this job as “Job 1” in the next few questions. |
JOB NAME (SPECIFY) 1 (STRING 50) SELF EMPLOYED 2 DON’T KNOW d REFUSED r
|
|
CATI/CAWI A1=1 (CURRENTLY EMPLOYED) IF CAWI DO NOT SHOW DK OR REF A4. Including all types of jobs, do you currently have any other paid jobs? Working for pay can include regular paid jobs, odd jobs, temporary jobs, work done in your own business, “under the table” work, “off the books” work, paid work experiences, apprenticeships, or any other types of work you have done for pay. |
YES 1 GO TO A3, JOB 2 NO 0 GO TO A4b DON’T KNOW d GO TO A4b REFUSED r GO TO A4b
IFA1=1 LOOP A4 JOBS UNTIL A4=(0,d, r). WHEN A4= 0,d,or r GO TO A4b JOB 1. |
YES 1 GO TO A3, JOB 3 NO 0 GO TO A4b DON’T KNOW d GO TO A4b REFUSED r GO TO A4b
IFA1=1 LOOP A4 JOBS UNTIL A4=(0,d, r). WHEN A4= 0,d,or r GO TO A4b JOB 1. |
|
A2=1 (NOT CURRENTLY EMPLOYED) IF CAWI DO NOT SHOW DK OR REF A4a. CATI: Since [RA MONTH YEAR], please tell me who you worked for. CAWI: Since [RA MONTH YEAR], please indicate who you worked for. CATI/CAWI: This could include the names of regular paid jobs, odd jobs, temporary jobs, work done in your own business, jobs or tasks you found using a web or mobile app, “under the table” work, “off the books” work, paid work experiences, apprenticeships, or any other types of work you have done for pay. If you had more than one job, please start with the job where you worked the most hours. |
JOB NAME (SPECIFY) 1 (STRING 50) SELF EMPLOYED 2 DON’T KNOW d REFUSED r |
JOB NAME (SPECIFY) 1 (STRING 50) SELF EMPLOYED 2 DON’T KNOW d REFUSED r |
|
If TOLD INTERVIEWER THAT NO MORE CURRENT JOBS or NOT CURRENTLY EMPLOYED BUT EMPLOYED SINCE RA MONTH YEAR
IF CAWI DO NOT SHOW DK OR REF
A4b. CATI: Have you had any other paid jobs since [RA MONTH YEAR] that you haven’t told me about? CAWI: Have you had any other paid jobs since [RA MONTH YEAR]?
|
YES 1 GO TO A4a, JOB 2 NO 0 GO TO A5 DON’T KNOW d GO TO A5 REFUSED r GO TO A5 IF A4b=1 LOOP A4a AND A4b UNTIL A4b=0,d, or r. WHEN A4b=0, d, or r GO TO A5.
|
YES 1 GO TO A4a, JOB 3 NO 0 GO TO B5 DON’T KNOW d GO TO B5 REFUSED r GO TO B5 IF A4b=1 LOOP A4a AND A4b UNTIL A4b=0,d, or r. WHEN A4b=0, d, or r GO TO A5.
|
|
CATI/CAWI A1=1 OR A2=1 IF CAWI DO NOT SHOW DK OR REF
IF A3 or A4a = 2, FILL “YOURSELF;” ELSE FILL “[JOB NAME 1]” A5. When did you start working for [[JOB NAME 1]/yourself]? INTERVIEWER: RECORD MONTH AND YEAR. NOTE: ALLOW SKIP ON MONTH. |
| | | / | | | | | MONTH YEAR (1-12) (1970-current year) DON’T KNOW d REFUSED r |
| | | / | | | | | MONTH YEAR (1-12) (1970-current year) DON’T KNOW d REFUSED r |
|
CATI/CAWI A1=1 OR A2=1 IF CAWI DO NOT SHOW DK OR REF
If A3 = 2 or A4a = 2 FILL “YOURSELF,” ELSE FILL JOB NAME
A6. Are you still working for [JOB NAME/yourself]? |
YES 1 GO TO A7 NO 0 GO TO A6a DON’T KNOW d REFUSED r |
YES 1 GO TO A7 NO 0 GO TO A6a DON’T KNOW d REFUSED r |
|
CATI/CAWI A6 =0 IF CAWI DO NOT SHOW DK OR REF A6a. When did you stop working at this job? INTERVIEWER: RECORD MONTH AND YEAR. |
| | | / | | | | | MONTH YEAR (1-12) (1970-current year) STILL AT JOB 98 DON’T KNOW d REFUSED r |
| | | / | | | | | MONTH YEAR (1-12) (1970-current year) STILL AT JOB 98 DON’T KNOW d REFUSED r |
|
CATI/CAWI A1=1 OR A2=1 IF CAWI DO NOT SHOW DK OR REF
IF A6=1 FILL “DO,” ELSE FILL “DID” A7. How many hours [do/did] you usually work in a week at this job? Your best estimate is fine. |
| | | HOURS PER WEEK (0-98) 99 OR MORE HOURS PER WEEK 99 DON’T KNOW d REFUSED r
|
| | | HOURS PER WEEK (0-98) 99 OR MORE HOURS PER WEEK 99 DON’T KNOW d REFUSED r
|
|
CATI/CAWI A1=1 OR A2=1 IF CAWI DO NOT SHOW DK OR REF
If A3 = 2 or A4a = 2 FILL “being self-employed” ELSE FILL “your job at [job name]”
FILL ”DO” IF A6=1, ELSE FILL ”DID” FILL “VARIES” / “ARE” / “MAKE” IF A6=1. ELSE FILL “VARIED” / “WERE” / “MADE”
A8. Now thinking about [being self-employed/your job at [JOB NAME]], how much [do/did] you get paid before taxes and deductions, at this job? Please include tips, commissions, and regular overtime. Your best estimate is fine.
CATI: PROBE: If your pay [varies/varied], please provide an average amount. If you [are/were] paid per job or for completing a particular task, please tell us the total amount you usually [make/made] while doing this type of work.
CAWI: SOFTCHECK: If your pay [varies/varied], please provide an average amount. If you [are/were] paid per job or for completing a particular task, please tell us the total amount you usually [make/made] while doing this type of work.
IF THE RESPONDENT DOES NOT PROVIDE A PAY PERIOD THEN PROBE: And, is that per hour, per week, per month, once every two weeks, twice a month, per year, or something else? ACCEPT MOST CONVENIENT PAY PERIOD. SOFT CHECK: IF ANSWER IS GREATER THAN $50 PER HOUR, $2000 PER WEEK, $4000 ONCE EVERY 2 WEEKS, $4000 TWICE A MONTH, $100,000 PER YEAR,, OR $8000 MONTH, SAY: “I recorded [A8 and A8 amount answer]. Is that correct?” |
$ | | | |,| | | |.| | | AVERAGE (0-999,999.99) AMOUNT PER HOUR 1 PER WEEK 2 PER MONTH 3 ONCE EVERY TWO WEEKS 4 TWICE A MONTH 5 PER YEAR 6 OTHER (SPECIFY) 99 (STRING (100)) DON’T KNOW d REFUSED r
|
$ | | | |,| | | |.| | | AVERAGE (0-999,999.99) AMOUNT PER HOUR 1 PER WEEK 2 PER MONTH 3 ONCE EVERY TWO WEEKS 4 TWICE A MONTH 5 PER YEAR 6 OTHER (SPECIFY) 99 (STRING (100)) DON’T KNOW d REFUSED r
|
|
CATI/CAWI IF CAWI DO NOT SHOW DK OR REF
FILL WAGE AND HOUR/UNIT FROM B8. IF A8 = 99, D, R, or M, FILL “YOUR CURRENT WAGE” A9. Did you always earn [[A8 WAGE] per [HOUR/UNIT FROM A8]/your current wage] at this job?
|
YES 1 NO 0 DON’T KNOW d REFUSED r
|
YES 1 NO 0 DON’T KNOW d REFUSED r |
|
CATI/CAWI If A9= no IF CAWI DO NOT SHOW DK OR REF FILL “VARIES” IF A6=1. ELSE FILL “VARIED”.
A10. How much were you paid when you started working at this job before taxes and deductions? Your best estimate is fine. If your pay [varies/varied], please provide an average amount. ACCEPT MOST CONVENIENT PAY PERIOD.
IF THE RESPONDENT DOES NOT PROVIDE A PAY PERIOD THEN PROBE: And, is that per hour, per week, per month, once every two weeks, twice a month, per year, or something else?
SOFT CHECK: IF ANSWER IS GREATER THAN $50 PER HOUR, $2000 PER WEEK, $4000 ONCE EVERY 2 WEEKS, $4000 TWICE A MONTH, $100,000 PER YEAR, OR $8000 MONTH, SAY: “I recorded [A10 and A10 amount answer]. Is that correct?” |
$ | | | |,| | | |.| | | AVERAGE (0-999,999.99) AMOUNT PER HOUR 1 PER WEEK 2 PER MONTH 3 ONCE EVERY TWO WEEKS 4 TWICE A MONTH 5 PER YEAR 6 OTHER (SPECIFY) 99 (STRING (100)) DON’T KNOW d REFUSED r |
$ | | | |,| | | |.| | | AVERAGE (0-999,999.99) AMOUNT PER HOUR 1 PER WEEK 2 PER MONTH 3 ONCE EVERY TWO WEEKS 4 TWICE A MONTH 5 PER YEAR 6 OTHER (SPECIFY) 99 (STRING (100)) DON’T KNOW d REFUSED r |
|
CATI/CAWI: all
if a1=0 and a2=0 do not display “else,” display “or,” and do not display “or any other type of work] if a1=1 or a2=1 display “else”, do not display “or”, and display “or any other type of work] if cawi display “that you haven’t reported” if cati display “that we haven’t already talked about” IF CAWI DO NOT SHOW DK OR REF |
A11.* Since [RA MONTH YEAR], was there anything [else] you did for pay, such as odd jobs, temporary jobs, work done in your own business, jobs or tasks you found using a web or mobile app, “under the table” work, “off the books” work, paid work experience, [or] apprenticeships, [or any other type of work], [that you haven’t reported/that we haven’t already talked about]?
YES 1 A12
NO 0 A13
DON’T KNOW d A13
REFUSED r A13
CATI/CAWI: A11=1 IF CAWI DO NOT SHOW DK OR REF |
A12. CATI: What is your best guess of how much money you received from these activities in a typical month since [RA MONTH YEAR]? Please do not include money you made from jobs we talked about earlier. We just need your best guess for how much money you’ve received from these activities.
CAWI: What is your best guess of how much money you received from these activities in a typical month since [RA MONTH YEAR]? Please do not include money you made from jobs you reported earlier. Just make your best guess for how much money you’ve received from these activities.
$| | | , | | | |
(0-99,999)
DON’T KNOW d
REFUSED r
CATI/CAWI: ask A13 only if # of current jobs >1 OR there are no current jobs but multiple prior jobs. else skip to A13a
(A1=1 AND (number of Current (A6=1) jobs > 1) OR (A2=1 AND (number of nonCurrent (A6=0/d/r) jobs > 1) AND number of Current (A6=1) jobs = 0
DISPLAY [JOBNAME/SELF-EMPLOYED] FROM A3 IF (A1=1 AND (number of Current (A6=1) jobs > 1) DISPLAY [JOBNAME/SELF-EMPLOYED] FROM A4A IF (A2=1 AND (number of nonCurrent (A6=0/d/r) jobs > 1) AND number of Current (A6=1) jobs = 0
IF CAWI DO NOT SHOW DK OR REF |
A13. For the next questions, please think about the job at which you [currently / most recently] work[ed] the most hours. What is the name of that job? Is it…
[A3JOBNAME1/A3SELF-EMPLOYED1] / [A4AJOBNAME1/A4ASELF-EMPLOYED1] 1
[A3JOBNAME2/A3SELF-EMPLOYED2] / [A4AJOBNAME1/A4ASELF-EMPLOYED2] 2
[A3JOBNAME3/A3SELF-EMPLOYED3] / [A4AJOBNAME1/A4ASELF-EMPLOYED3] 3
[A3JOBNAME4/A3SELF-EMPLOYED4] / [A4AJOBNAME4/A4ASELF-EMPLOYED4] 4
[A3JOBNAME5/A3SELF-EMPLOYED5] / [A4AJOBNAME5/A4ASELF-EMPLOYED5] 5
DON’T KNOW d
REFUSED r
PROGRAMMER BOX to set [jobname]
IF A13 1 TO 5 SET [JOBNAME]=A13JOBNAME.
IF (A13=D or R) AND (number of Current (A6=1) jobs > 1) SET [JOBNAME]= “CURRENT main” IF (A13=D or R) AND (A2=1) AND (number of nonCurrent (A6=0/d/r) jobs > 1) AND number of Current (A6=1) jobs = 0 SET [JOBNAME]=“MOST RECENT main”
IF A13 = LOGICAL SKIP AND NUMBER OF CURRENT JOBS (A6) = 1, SET [JOBNAME] = “Current”
if A13 = logical skip and (number of nonCurrent (A6=0/d/r) jobs > 1) AND number of Current (A6=1) jobs = 0, SET [JOBNAME] = “most recent”
|
PROGRAMMER BOX to set SELFEMPLOYEDFLAG
IF A13 = 1 TO 5 AND A13 PREFILL FOR selected A13 = SELF-EMPLOYED, SET SELFEMPLOYEDFLAG=1
IF A13 = LOGICAL SKIP AND NUMBER OF CURRENT JOBS (A6) = 1 AND A3=2 (SELF-EMPLOYED), SET SELFEMPLOYEDFLAG=1
IF A13 = LOGICAL SKIP AND (number of nonCurrent (A6=0/d/r) jobs > 1) AND number of Current (A6=1) jobs = 0 AND A4a=2 (SELF-EMPLOYED), SET SELFEMPLOYEDFLAG=1
oTHERWISE SET SELFEMPLOYEDFLAG=0
|
CATI/CAWI: A1=1 OR A2=1 if no jobs reported skip to A21
IF CAWI DO NOT SHOW DK OR REF |
A13a. For the next questions, please think about your [JOBNAME] job.
Which of the following best describes your employment at that job? [Were/Are] you working . . .
CATI: PROBE: A temporary help agency supplies workers to other companies on an as needed basis.
PROBE: Independent contractors, independent consultants, and freelance workers obtain customers on their own to provide a product or service and can have other employees working for them.
PROBE: Day laborers are people who work as needed. For example, day laborers may get work by waiting at a place where employers pick up people to work for a day or by posting paper or electronic job wanted ads and responding on a day-by-day basis.
PROBE: Some workers find short, in-person jobs or tasks through companies that connect them directly with customers using a website or mobile app. These companies also coordinate payment for the service through the app. Other workers select short, paid tasks through companies that maintain online lists of tasks.
CODE ONE ONLY
as a regular full-time or part-time employee, 1
for a temporary help agency, 2
for an occasional job or task service that relies on a website or mobile app that connects you to customers (such as Uber or Lyft) 3
as an independent contractor, independent consultant, or freelance worker, 4
in your own business, 5
as a day laborer, 6
or something else (PLEASE SPECIFY)? 99
_________________________________________(STRING (100))
DON’T KNOW d
REFUSED r
CATI/CAWI: A1=1 OR A2=1 IF CAWI DO NOT SHOW DK OR REF |
A13b. (Is/Was) this job a seasonal or temporary job?
PROBE: (Is/Was) this a job that you knew from the beginning would only last a few weeks or months?
YES 1
NO 0
DON’T KNOW d
REFUSED r
CATI/CAWI: A1=1 OR A2=1 IF CAWI DO NOT SHOW DK OR REF |
A14. (Do/did) you usually work a daytime schedule or some other schedule at your [JOBNAME] job?
PROBE: By daytime schedule, (I/we) mean that you work anytime between 6 A.M. and 6 P.M.
A DAYTIME SCHEDULE (ANYTIME BETWEEN 6 A.M. TO 6 P.M.) 1
SOME OTHER SCHEDULE 2
DON’T KNOW d
REFUSED r
CATI/CAWI: A14=2 IF CAWI DO NOT SHOW DK OR REF |
A15. Which of the following best describes the hours you usually work(ed) at your [JOB NAME] job?
CODE ONE ONLY
An evening shift (anytime between 2 P.M. and midnight) 1
A night shift (anytime between 9 P.M. and 8 A.M.) 2
A rotating shift (one that changes periodically from days to evenings or night) 3
A split shift (one consisting of two distinct periods each day) 4
An irregular schedule 5
Some other shift (specify) 99
_________________________________________(STRING (100))
DON’T KNOW d
REFUSED r
CATI/CAWI: A1=1 OR A2=1 if program= Bridges: do not ask fast: ask ips: ask moms: ask phillywins: ask
IF CAWI DO NOT SHOW DK OR REF |
A16. Which of the following benefits [are/were] available to you at your [JOB NAME] job? (READ EACH ITEM) . . .
CODE ALL THAT APPLY
Health insurance or membership in a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plan? 1
Paid leave for vacation, illness, or holidays? 2
None of the above 0
DON’T KNOW d
REFUSED r
CATI/CAWI: (A1=1 OR A2=1) and selfemployedflag=0 IF CAWI DO NOT SHOW DK OR REF |
A17. [Have/Had] you been promoted to a higher position with greater responsibility while working at this job?
YES 1
NO 0
DON’T KNOW d
REFUSED r
CATI/CAWI: (A1=1) and selfemployedflag=0 IF CAWI DO NOT SHOW DK OR REF |
A18. How likely do you think it is that you will be promoted at your [JOBNAME] job in the next 12 months?
Very likely, 1
somewhat likely, 2
not very likely, or 3
not likely at all? 4
DON’T KNOW d
REFUSED r
CATI/CAWI: (A1=1 OR A2=1) AND A13A = (1, 2, 99, D, or R) IF PROGRAM = Bridges: do not ask fast: ask ips: ASK, but do not ask A19a or A19d moms: DO NOT ask phillywins: DO NOT ASK
IF CAWI DO NOT SHOW DK OR REF |
A19. Please tell me whether or not your [JOBNAME] employer has made any of the following changes because of a physical or mental health condition. Has your employer, because of any physical or mental health condition…
-
CODE ONE RESPONSE PER ROW
YES
NO
N/A
DK
REF
a. provided you with any special equipment or assistive technology? (PROBE: For example, special tools or equipment, software, or devices to accommodate your condition in the workplace.)
1
0
n
d
r
b. made any changes in your work schedule? (PROBE: For example, working fewer hours, changing the time you arrive or leave, or taking more breaks to accommodate your condition in the workplace.)
1
0
n
d
r
c. made any changes to the tasks you were assigned or how they are performed? (PROBE: For example, a light duty job or less demanding job tasks to accommodate your condition in the workplace.)
1
0
n
d
r
d. made any changes to the physical work environment to make things easier for you? (PROBE: For example, modifying your work area, allowing tele-work, improving accessibility in the building, or providing assigned parking to accommodate your condition in the workplace.)
1
0
n
d
r
e. arranged for co-workers or others to assist you? (PROBE: For example, providing a personal care attendant, interpreter, or job coach while at work.)
1
0
n
d
r
-
CATI/CAWI: A1=1
IF CAWI DO NOT SHOW DK OR REF
A20. How satisfied are you with your [JOBNAME] job? Would you say very satisfied, somewhat satisfied, or not satisfied?
VERY SATISFIED 1
SOMEWHAT SATISFIED 2
NOT SATISFIED 3
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL IF CAWI DO NOT SHOW DK OR REF |
A21.* Are you currently looking for a job?
PROBE: Some people look for work even when they have a job.
YES 1
NO 0
DON’T KNOW d
REFUSED r
CATI/CAWI: A1=0,d,r AND A2= 0,D,R
if PROGRAM=bridges do not display retired=2 IF CAWI DO NOT SHOW DK OR REF |
A21a. How would you describe your current employment status? Are you . . .
CODE ALL THAT APPLY
Temporarily laid off, 1
Retired, 2
In school or training, 3
Unable to work because of caring for another family member, 4
Unable to work because of pregnancy 5
Unable to work due to illness, disability, or ongoing mental health or substance use issues or treatment, 6
Gave up looking for work 7
Incarcerated, or 8
Something else? (SPECIFY) 99
(STRING (NUM))
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL IF CAWI DO NOT SHOW DK OR REF |
A22.* The next questions are about things that some people find challenging when they try to work. First, does a physical, mental, or emotional condition limit the kind or amount of work you can do?
Select one only
YES 1 A22A
NO 0 A23
DON’T KNOW d A23
REFUSED r A23
CATI/CAWI: A22=1 IF CAWI DO NOT SHOW DK OR REF |
A22a.* Is the physical, mental, or emotional condition that limits the kind or amount of work you can do related to COVID-19 or its effects?
Select one only
m YES 1
m NO 0
m DON’T KNOW d
m REFUSED r
CATI/CAWI: ALL if coronavirus pandemic challenges remain ask A23. otherwise do not ask A23.
IF CAWI DO NOT SHOW DK OR REF |
A23.*
Now, 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 in the past three months. CATI: If something I say does not apply to you, you can say “does not apply.”
Would you say that [FILL a-r] made it not at all hard, slightly hard, moderately hard, or very hard for you to work in the last three months?
Select one per row
|
NOT AT ALL HARD |
SLIGHTLY HARD |
MODERATELY HARD |
VERY HARD |
DOES NOT APPLY |
DK |
REF |
a. Not having good enough care for a child or someone else in your household who needs care due to COVID-19 or its effects |
0 |
1 |
2 |
3 |
n |
d |
r |
b. Not having good enough care for a child who is learning at home due to COVID-19 |
0 m |
1 m |
2 m |
3 m |
n m |
d m |
r m |
c. The risk that you will get sick from COVID-19 |
0 m |
1 m |
2 m |
3 m |
n m |
d m |
r m |
d. The risk that someone in your household or family will get sick from COVID-19 |
0 m |
1 m |
2 m |
3 m |
n m |
d m |
r m |
CATI/CAWI: ALL IF currently employed (A1=1) then do not ask A24d. IF PROGRAM = Bridges: ask all fast: ask all ips: do not ask moms: ask all phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
A24. The next questions are about work goals and looking for jobs.
Please indicate if you strongly disagree, disagree, agree, or strongly agree with the following statements.
Select one per row
-
STRONGLY DISAGREE
DISAGREE
AGREE
STRONGLY AGREE
DK
REF
a. 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
2
3
4
d
r
b. I set specific short-term goals that will allow me to achieve my long-term employment goals.
1
2
3
4
d
r
c. I think I should work on finding a job or a better job1.
1
2
3
4
d
r
d. I think there is nothing I can do about being out of work right now2…………………………………….
1
2
3
4
d
r
CATI/CAWI: ALL IF PROGRAM= Bridges: ask fast: do not ask ips: do not ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
A25. Now please indicate how confident you are that you can do each of the following activities.
Would you say that you are confident, somewhat confident, or not confident in your ability to [FILL a-h] by yourself?
Select one per row
-
CONFIDENT
SOMEWHAT CONFIDENT
NOT CONFIDENT
DK
REF
a. look for jobs.
1
2
3
d
r
b. fill out job applications.
1
2
3
d
r
c. create or update a resume.
1
2
3
d
r
d. do a job interview.
1
2
3
d
r
e. fill out forms that are needed to start work….
1
2
3
d
r
f. get along with coworkers or customers………….
1
2
3
d
r
g. ask a manager or supervisor for changes to your schedule, time off, or other necessary changes.……………….
1
2
3
d
r
h. offer advice to family or friends about things like searching for jobs, doing job interviews, or getting along with coworkers……………………….
1
2
3
d
B. SERVICE RECEIPT
CATI: Next, we are going to ask you about services you may have received to help you find or keep a job.
CAWI: The next set of questions are about services you may have received to help you find or keep a job.
CATI/CAWI: ALL IF PROGRAM= Bridges: do not ask b1i, b1j, b1n, b1o fast: do not ask B1E, b1i ips: do not ask B1E, b1j moms: do not ask B1E, b1i, b1o phillywins: do not ask B1e, b1i, b1j, b1n
IF CAWI DO NOT SHOW DK OR REF |
B1. CATI: I would like you to tell me about help you may have received since [RA MONTH/YEAR] from organizations in your community to help you find or keep a job or to help you deal with problems that made it hard for you to find or keep a job.
CAWI: We would like to ask you about help you may have received since [RA MONTH/YEAR] from organizations in your community to help you find or keep a job or to help you deal with problems that made it hard for you to find or keep a job.
PROBE: [RA MONTH/YEAR] is the date you applied to get into the [NEXTGEN PROGRAM].
[IF TREATMENT GROUP] Please include both help you may have received from [NEXTGEN PROGRAM] and help you may have received from other programs or organizations in the community.
[IF CONTROL] Please include help you may have received from any programs or organizations in the community.
Since [RA MONTH/YEAR], did you receive help with…
CODE ONE PER ROW
|
YES |
NO |
DK |
REF |
a. …planning your future career, which could include an assessment of your interests and skills? |
1 |
0 |
d |
r |
b. …preparing a resume or filling out job applications? |
1 |
0 |
d |
r |
c. …preparing for job interviews? |
1 |
0 |
d |
r |
d. …getting referrals to available jobs or setting up interviews for specific job openings? |
1 |
0 |
d |
r |
e. …obtaining a valid drivers’ license? |
1 |
0 |
d |
r |
f. …obtaining documents you need to work, such as a social security card or photo identification? |
1 |
0 |
d |
r |
g. …how to talk with an employer about a disability and any changes they need to make to accommodate it? |
1 |
0 |
d |
r |
h. …how to act when you are at work? This includes being on time, managing your tasks, getting along with your supervisor, and handling conflicts. |
1 |
0 |
d |
r |
i. …communicating your legal history to an employer, clearing or sealing criminal records, or other legal help? |
1 |
0 |
d |
r |
j. … finding or paying for child care or care for other dependents? |
1 |
0 |
d |
r |
k. … finding, using, or paying for transportation? |
1 |
0 |
d |
r |
l. …paying for clothing, tools, or other supplies for work? |
1 |
0 |
d |
r |
m. …meeting your employer’s COVID-19-related requirements such as the need to wear masks or be vaccinated? |
1 |
0 |
d |
r |
n. …finding or paying for temporary, transitional, or permanent housing? |
1 |
0 |
d |
r |
o. …understanding how work may affect your eligibility for benefits such as Social Security, disability insurance, TANF, or Medicaid? |
1 |
0 |
d |
r |
p. …any other employment help? (Please specify: ______________) |
1 |
0 |
d |
r |
CATI/CAWI: ALL iF PROGRAM= Bridges: do not ask fast: do not ask ips: do not ask moms: ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
B2. Since [RA MONTH/YEAR] did you participate or attend any organizations or activities where people provided advice or support in a group setting?
PROBE: [RA MONTH/YEAR] is the date you applied for the [NEXTGEN PROGRAM].
[IF TREATMENT GROUP] Please include both help you may have received in a group from [NEXTGEN PROGRAM] and help you may have received in a group from other programs or organizations.
YES 1
NO 0
DON’T KNOW d
REFUSED r
CATI/CAWI: IF B1 OR B2 HAS AT LEAST ONE YES RESPONSE IF CAWI DO NOT SHOW DK OR REF |
B3. You said that you received help related to finding or keeping a job since [RA MONTH/YEAR]. Where did you receive most of this help from? Would you say you received the most help from the…
Select one only
[NAME OF LOCAL WELFARE PROGRAM], 1
[NAME OF AMERICAN JOB CENTERS IN STATE] or an unemployment office, 2
Food Stamp Program or SNAP, 3
[NAME OF LOCAL VOCATIONAL REHABILITATION PROGRAM] 4
[NEXTGEN PROGRAM] 5
[NAME OF SITE-SPECIFIC PROVIDER 1] 6
[NAME OF SITE-SPECIFIC PROVIDER 2] 7
[NAME OF SITE-SPECIFIC PROVIDER 3] 8
[NAME OF SITE-SPECIFIC PROVIDER 4] 9
[NAME OF SITE-SPECIFIC PROVIDER 5] 10
Or some other place (SPECIFY: __________) 11
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL IF PROGRAM= BRIDGES: DO NOT ASK FAST: ASK IPS: ASK MOMS: ASK phillywins: ASK
IF CAWI DO NOT SHOW DK OR REF |
The next questions ask you about your participation in education and training programs. First [we/I] will ask about education programs.
B4. Since [RA MONTH YEAR], did you attend any school or education program? This includes high school, adult basic education or GED courses, English as a Second Language classes, online courses, and college or other types of schools. Do not include training programs to develop skills for a particular job or occupation. [We/I] will ask you about those later.
YES 1 B4A
NO 0 B5
DON’T KNOW d B5
REFUSED r B5
CATI/CAWI: B4=1 IF PROGRAM= BRIDGES: DO NOT ASK FAST: ASK IPS: ASK MOMS: ASK phillywins: ASK
IF CAWI DO NOT SHOW DK OR REF |
B4a. Are you attending any of these education programs now?
YES 1
NO 0
DON’T KNOW d
REFUSED r
CATI/CAWI: B4=1 IF PROGRAM= BRIDGES: DO NOT ASK FAST: ASK IPS: ASK MOMS: ASK phillywins: ASK
IF CAWI DO NOT SHOW DK OR REF |
B4b. Since [RA MONTH YEAR], did you receive any diploma or degree?
YES 1 B4c
NO 0 B5
DON’T KNOW d B5
REFUSED r B5
CATI/CAWI: B4B=1 IF PROGRAM= BRIDGES: DO NOT ASK FAST: ASK IPS: ASK MOMS: ASK phillywins: ASK
IF CAWI DO NOT SHOW DK OR REF |
B4c. What specific diploma or degree did you receive? If you received more than one, please [select all that apply/let me know about all of them].
SELECT ALL THAT APPLY
GED OR GENERAL EDUCATION DEVELOPMENT 1
REGULAR HIGH SCHOOL DIPLOMA (NOT A GED) 2
ASSOCIATE’S DEGREE 3
BACHELOR’S DEGREE 4
GRADUATE DEGREE OR PROFESSIONAL DEGREE 5
OTHER (SPECIFY:__________) 6
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL IF PROGRAM= BRIDGES: DO NOT ASK FAST: ASK IPS: ASK MOMS: ASK phillywins: ASK
IF CAWI DO NOT SHOW DK OR REF |
The next questions ask you about your participation in training programs. Do not include any programs [we already discussed / you already reported] or any training program you received from your employer.
B5. Since [RA MONTH YEAR], did you particpate in any training program to build skills for a particular job or occupation?
YES 1 B5A
NO 0 B9
DON’T KNOW d B9
REFUSED r B9
CATI/CAWI: B5=1 IF PROGRAM= BRIDGES: DO NOT ASK FAST: ASK IPS: ASK MOMS: ASK phillywins: ASK
IF CAWI DO NOT SHOW DK OR REF |
B5a. Are you attending any of these training programs now?
YES 1
NO 0
DON’T KNOW d
REFUSED r
CATI/CAWI: B5=1 IF PROGRAM= BRIDGES: DO NOT ASK FAST: ASK IPS: ASK MOMS: ASK phillywins: ASK
IF CAWI DO NOT SHOW DK OR REF |
B5b. Since [RA MONTH YEAR], did you receive any professional certificate or state or industry license?
PROBE: A professional certificate or license shows you are qualified to perform a specific job and includes things like Certified Medical Assistant, Certified Construction Manager, a Project Management Professional certification, or an IT certification.
YES 1 B9
NO 0 B9
DON’T KNOW d B9
REFUSED r B9
CATI/CAWI: all IF PROGRAM= BRIDGES: ASK FAST: DO NOT ASK IPS: DO NOT ASK MOMS: DO NOT ASK phillywins: DO NOT ASK
IF CAWI DO NOT SHOW DK OR REF |
The next questions ask you about your participation in education and training programs.
B6. Are you currently in high school?
YES 1 B7
NO 0 B6a
DON’T KNOW d B6a
REFUSED r B6a
CATI/CAWI: B6=0,d,r IF PROGRAM= BRIDGES: ASK FAST: DO NOT ASK IPS: DO NOT ASK MOMS: DO NOT ASK phillywins: DO NOT ASK
IF CAWI DO NOT SHOW DK OR REF |
B6a. Do you have a high school diploma? Do not count a GED or General Education Development credential.
YES 1 B7
NO 0 B6b
DON’T KNOW d B6b
REFUSED r B6b
CATI/CAWI: B6=0,d,r and B6a=0,D,R IF PROGRAM= BRIDGES: ASK FAST: DO NOT ASK IPS: DO NOT ASK MOMS: DO NOT ASK phillywins: DO NOT ASK
IF CAWI DO NOT SHOW DK OR REF |
B6b. Since [RA MONTH YEAR], did you attend any program to earn a GED or General Education Development credential?
YES 1 B6c
NO 0 B7
DON’T KNOW d B7
REFUSED r B7
CATI/CAWI: B6=0,d,r and B6a=0,D,R and B6b=1 IF PROGRAM= BRIDGES: ASK FAST: DO NOT ASK IPS: DO NOT ASK MOMS: DO NOT ASK phillywins: DO NOT ASK
IF CAWI DO NOT SHOW DK OR REF |
B6c. Are you attending any GED program now?
YES 1 B7
NO 0 B6d
DON’T KNOW d B6d
REFUSED r B6d
CATI/CAWI: B6=0,d,r and B6a=0,D,R and B6b=1 and B6c=0,d,r IF PROGRAM= BRIDGES: ASK FAST: DO NOT ASK IPS: DO NOT ASK MOMS: DO NOT ASK phillywins: DO NOT ASK
IF CAWI DO NOT SHOW DK OR REF |
B6d. Since [RA MONTH YEAR], did you receive a GED or General Education Development credential?
YES 1
NO 0
DON’T KNOW d
REFUSED r
CATI/CAWI: all IF PROGRAM= BRIDGES: ASK FAST: DO NOT ASK IPS: DO NOT ASK MOMS: DO NOT ASK phillywins: DO NOT ASK
IF CAWI DO NOT SHOW DK OR REF |
B7. Since [RA MONTH YEAR], did you attend any [other] school or education program? This includes adult basic education, English as a Second Language classes, online courses, and college. Do not include high school or GED programs. Do not include any training programs to build skills for a particular job or occupation. [We/I] will ask you about those later.
YES 1 B7a
NO 0 B8
DON’T KNOW d B8
REFUSED r B8
CATI/CAWI: B7=1 IF PROGRAM= BRIDGES: ASK FAST: DO NOT ASK IPS: DO NOT ASK MOMS: DO NOT ASK phillywins: DO NOT ASK
IF CAWI DO NOT SHOW DK OR REF |
B7a. Are you attending any of these education programs now?
YES 1 B7b
NO 0 B7c
DON’T KNOW d B7c
REFUSED r B7c
CATI/CAWI: B7a=1 IF PROGRAM= BRIDGES: ASK FAST: DO NOT ASK IPS: DO NOT ASK MOMS: DO NOT ASK phillywins: DO NOT ASK
IF CAWI DO NOT SHOW DK OR REF |
B7b. Are you attending any college or university now?
YES 1
NO 0
DON’T KNOW d
REFUSED r
CATI/CAWI: B7=1 IF PROGRAM= BRIDGES: ASK FAST: DO NOT ASK IPS: DO NOT ASK MOMS: DO NOT ASK phillywins: DO NOT ASK
IF CAWI DO NOT SHOW DK OR REF |
B7c. Since [RA MONTH YEAR], did you receive a diploma or degree? Do not include high school diplomas or GEDs.
YES 1 B7d
NO 0 B8
DON’T KNOW d B8
REFUSED r B8
CATI/CAWI: B7=1 and B7c=1 IF CAWI DO NOT SHOW DK OR REF |
B7d. What specific diploma or degree did you receive? If you received more than one, please [select all that apply/let me know about all of them].
SELECT ALL THAT APPLY
ASSOCIATE’S DEGREE 1
BACHELOR’S DEGREE 2
GRADUATE DEGREE OR PROFESSIONAL DEGREE 3
OTHER (SPECIFY:__________) 4
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL IF PROGRAM= BRIDGES: ASK FAST: DO NOT ASK IPS: DO NOT ASK MOMS: DO NOT ASK phillywins: DO NOT ASK
IF CAWI DO NOT SHOW DK OR REF |
The next questions ask you about your participation in training programs. Do not include any programs [we already discussed / you already reported] or any training program you received from your employer.
B8. Since [RA MONTH YEAR], did you particpate in any training program to build skills for a particular job or occupation?
YES 1 B8A
NO 0 B9
DON’T KNOW d B9
REFUSED r B9
CATI/CAWI: B8=1 IF PROGRAM= BRIDGES: ASK FAST: DO NOT ASK IPS: DO NOT ASK MOMS: DO NOT ASK phillywins: DO NOT ASK
IF CAWI DO NOT SHOW DK OR REF |
B8a. Are you attending any of these training programs now?
YES 1
NO 0
DON’T KNOW d
REFUSED r
CATI/CAWI: B8=1 IF PROGRAM= BRIDGES: ASK FAST: DO NOT ASK IPS: DO NOT ASK MOMS: DO NOT ASK phillywins: DO NOT ASK
IF CAWI DO NOT SHOW DK OR REF |
B8b. Since [RA MONTH YEAR], did you receive a professional certificate or state or industry license?
PROBE: A professional certificate or license shows you are qualified to perform a specific job and includes things like Certified Medical Assistant, Certified Construction Manager, a Project Management Professional certification, or an IT certification.
YES 1
NO 0
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL IF PROGRAM = Bridges: DO NOT asK fast: do not ASK ips: ASK moms: DO NOT ASK phillywins: DO NOT ASK
IF CAWI DO NOT SHOW DK OR REF |
B9. The next question is about services you may have received related to drug or alcohol use. Since [RA MONTH YEAR], have you received help for problems related to drug or alcohol use?
YES 1 B9A
NO 0 B10
DON’T KNOW d B10
REFUSED r B10
CATI/CAWI: B9=1 IF PROGRAM= Bridges: DO NOT asK fast: do not ASK ips: ASK moms: DO NOT ASK phillywins: DO NOT ASK
IF CAWI DO NOT SHOW DK OR REF |
B9a. At what type of place did you receive help for problems related to drug or alcohol use? Was it…
SELECT ALL THAT APPLY
A hospital or clinic with overnight stays, 1
A hospital or clinic without overnight stays, 2
A residential substance treatment program with overnight stays, 3
A non-residential substance treatment program without overnight stays, 4
A support group, such as Alcoholics Anonymous or Narcotics Anonymous 5
[NEXTGEN PROGRAM, if relevant] facilities, or 6
Some other type place? SPECIFY (__________) 7
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL IF PROGRAM= Bridges: DO NOT asK fast: ASK ips: ASK moms: ASK phillywins: ASK
IF CAWI DO NOT SHOW DK OR REF |
The next few questions are about services you may have received related to your health and well-being in the last six months.
B10. In the last six months, have you received help for problems related to emotions, nerves, anger management or mental health? This would include help dealing with depression, anxiety, or other conditions from a mental health center, a therapist, a psychologist or psychiatrist, social worker, counselor, doctor, or other provider.
YES 1 B10A
NO 0 B11
DON’T KNOW d B11
REFUSED r B11
CATI/CAWI: B10=1 IF PROGRAM= Bridges: do not ask fast: ask ips: ask moms: ask phillywins: ask
IF CAWI DO NOT SHOW DK OR REF IF PROGRAM = FAST OR MOMS DISPLAY OPTION 6. OTHERWISE DO NOT DISPLAY OPTION 6. |
B10a. Where did you receive help with problems related to emotions, nerves, anger management or mental health? Was it…
SELECT ALL THAT APPLY
A mental health agency 1
A clinic or doctor’s office 2
A hospital with overnight stays 3
A hospital without overnight stays, or 4
Some other type of place (please specify) 5
[NEXTGEN PROGRAM] 6
DON’T KNOW d
REFUSED r
CATI/CAWI: B10=1 IF PROGRAM = Bridges: DO NOT ask fast: ASK ips: ask moms: ASK phillywins: ASK
IF CAWI DO NOT SHOW DK OR REF |
B10b. In the last six months, how many times did you visit a mental health agency, clinic, doctor’s office, hospital, or other type of place for treatment for problems related to emotions, nerves, anger management or mental health? Do not include visits for physical medical conditions or substance use.
NUMBER OF VISTS
(1-99)
DON’T KNOW d
REFUSED r
-
CATI/CAWI: ALL
IF PROGRAM =
Bridges: DO NOT asK
fast: ASK
ips: DO NOT ASK
moms: DO NOT ASK
phillywins: DO NOT ASK
IF CAWI DO NOT SHOW DK OR REF
B11. In the last six months, have you received any treatment for any physical medical condition at a hospital, clinic, or doctor’s office? Do not include visits for mental health or substance use.
YES 1 B11a
NO 2 B12
DON’T KNOW d B12
REFUSED r B12
CATI/CAWI: B11=1 IF PROGRAM = Bridges: DO NOT asK fast: ASK ips: DO NOT ASK moms: DO NOT ASK phillywins: DO NOT ASK
IF CAWI DO NOT SHOW DK OR REF |
B11a. In the last six months, how many times did you visit a hospital, clinic, or doctor’s office for treatment for any physical medical condition? Your best estimate is fine.
Do not include visits for mental health or substance use.
NUMBER OF VISTS
(1-99)
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL IF PROGRAM = Bridges: DO NOT asK fast: ASK ips: DO NOT ASK moms: DO NOT ASK phillywins: DO NOT ASK
IF CAWI DO NOT SHOW DK OR REF |
The next questions are about services your child (or children) may have received related to their health and well-being. CATI: If you do not have children under the age of 18, just let me know.
B12. In the last six months, have any of your children under the age of 18 received help for problems related to their emotions, nerves, anger management or mental health? This would include help dealing with their depression, anxiety, or other conditions from a mental health center, a therapist, a psychologist or psychiatrist, social worker, counselor, doctor, or other provider.
YES 1 B12A
NO 0 C1
DO NOT HAVE ANY CHILDREN UNDER AGE 18 2 C1
DON’T KNOW d C1
REFUSED r C1
CATI/CAWI: B12=1 IF PROGRAM = Bridges: DO NOT asK fast: ASK ips: DO NOT ASK moms: DO NOT ASK phillywins: DO NOT ASK
IF CAWI DO NOT SHOW DK OR REF |
B12a. Where did your child (or children) receive help with their problems related to emotions, nerves, anger management or mental health? Was it…
SELECT ALL THAT APPLY
A mental health agency 1
A clinic or doctor’s office 2
A hospital with overnight stays 3
A hospital without overnight stays, or 4
Some other type of place (please specify) 5
[NEXTGEN PROGRAM] 6
DON’T KNOW d
REFUSED r
C. ECONOMIC INDEPENDENCE AND WELL-BEING
Now, [I’d/we’d] like to ask you some questions about your living situation.
CATI/CAWI: ALL IF PROGRAM= Bridges: do not ask fast: ask ips: ask moms: ask phillywins: ask
IF CAWI DO NOT SHOW DK OR REF |
C1. Which of the following best describes your housing during the past month?
PROBE: Tell me about the housing you spent the most time at in the last month.
Select one only
Own your own home or apartment, 1
Rent your home or apartment, 2
Homeless or live in emergency or temporary housing, such as a shelter, 3
Live in a halfway house, sober house, or other transitional housing, 4
Live in a group home 5
Live with friends or relatives and pay rent 6
Live with friends or relatives and not pay rent, or 7
Or some other arrangement? (SPECIFY: __________) 99
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL IF PROGRAM= Bridges: ask fast: do not ask ips: do not ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
C1a. Which of the following best describes your housing during the past month?
PROBE: Tell me about the housing you spent the most time at in the last month.
Select one only
Live with a parent or guardian and pay rent, 1
Live with a parent or guardian and do not pay rent, 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 7
Live with friends or relatives and not pay rent, or 8
Or some other arrangement? (SPECIFY: __________) 99
DON’T KNOW d
REFUSED r
CATI/CAWI: C1 NE 3 OR C1A NE 4 IF CAWI DO NOT SHOW DK OR REF |
C2. Have you been homeless at any time in the last three months? Include living on the street, in your car, in an abandoned building, in a homeless or domestic violence shelter, or staying at someone else’s home because you have nowhere else to go.
YES 1
NO 0
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL IF PROGRAM= Bridges: do not ask fast: ask ips: ask moms: ask phillywins: ask
IF C1 = (4 OR 5) OR c1a = (5 OR 6), DO NOT DISPLAY “OR ANYONE IN YOUR HOUSEHOLD” if program=ips do not display c3_2 or C3_5 IF CAWI DO NOT SHOW DK OR REF |
C3. During the past year, did you [or anyone in your household] receive income or assistance from any of the following sources?
Select all that apply
Disability benefits from the Social Security Administration. These are also called Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) 1
Temporary Assistance for Needy Families (TANF) or
[STATE SPECIFIC TANF NAME] 2
Unemployment Insurance 3
Food Stamps/Supplemental Nutrition Assistance Program (SNAP)/
[STATE-SPECIFIC PROGRAM] 4
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) 5
Medicaid or [STATE SPECIFIC MEDICAID] or Children’s Health Insurance Program (CHIP) 6
NONE OF THE ABOVE 0
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL if program= Bridges: do not ask fast: ask ips: ask moms: ask phillywins: ASK
IF program=moms, do not ask c4h IF CAWI DO NOT SHOW DK OR REF |
C4. Now [I/we] have some questions about your current financial situation. [As I read each question, please let me/ please let us] know if you have faced any of the following situations.
In the last six months, has there been a time when…
Select one per row
|
YES |
NO |
N/A |
DK |
REF |
a. …you did not pay the full amount of the rent or mortgage because you could not afford it? |
1 |
0 |
2 |
d |
r |
b. …you were evicted from your home or apartment for not paying the rent or mortgage? |
1 |
0 |
2 |
d |
r |
c. …you filed in court for bankruptcy? |
1 |
0 |
2 |
d |
r |
d. …you did not pay the full amount of the gas, oil, or electricity bills? |
1 |
0 |
2 |
d |
r |
e. …you had service turned off by the gas or electric company, or the oil company would not deliver oil? |
1 |
0 |
2 |
d |
r |
f. …you had cellular or land telephone service turned off because payments were not made? |
1 |
0 |
2 |
d |
r |
g. …you could not fill or had to wait to fill a prescription for medicine when they were needed because you could not afford it? |
1 |
0 |
2 |
d |
r |
h. …you did not pay the full amount of child support payments because you could not afford it? |
1 |
0 |
2 |
d |
r |
i. …you did not pay the full amount of other bills? |
1 |
0 |
2 |
d |
r |
CATI/CAWI: ALL
IF CAWI DO NOT SHOW DK/R |
C4a.* Getting enough food can be a problem for some people. Which of these statements best describes the food eaten in your household in [PRIOR MONTH]? Would you say there was…
enough of the kinds of food you want, 1
enough, but not always the kinds of food you want, 2
sometimes not enough to eat, or 3
often not enough to eat? 4
DON’T KNOW d
REFUSED r
CATI/CAWI: All IF PROGRAM= Bridges: ask fast: do not ask ips: do not ask moms: do not ask phillywins: do not ask
IF PROGRAM=BRIDGES DISPLAY FIRST SENTENCE. ELSE DO NOT DISPLAY FIRST SENTENCE. IF CAWI DO NOT SHOW DK/R |
C4b. [Now [I/we] have some questions about your current financial situation.] Do you currently receive any financial help from your parents, relatives, friends, or neighbors in paying for transportation or rides to places you need to be?
Select one only
YES 1 C4B1
NO 0 C4C
DON’T KNOW d C4C
REFUSED r C4C
CATI/CAWI: C4b=1 IF PROGRAM= Bridges: ask fast: do not ask ips: do not ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK/R |
C4b1. About how much financial help do you currently receive from your parents, relatives, friends, or neighbors in paying for transportation or for rides to places you need to be? Would you say they pay for…
Select one only
all, 1
most, 2
or a little of your transportation or rides? 3
DON’T KNOW d
REFUSED r
CATI/CAWI: All IF PROGRAM= Bridges: ask fast: do not ask ips: do not ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK/R |
C4c. Do you currently receive any financial help from your parents, relatives, friends, or neighbors in paying for food, meals, or groceries?
Select one only
YES 1 C4C1
NO 0 C4D
DON’T KNOW d C4D
REFUSED r C4D
CATI/CAWI: C4C=1 IF PROGRAM= Bridges: ask fast: do not ask ips: do not ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK/R |
C4c1. About how much financial help do you currently receive from your parents, relatives, friends, or neighbors in paying for food, meals, or groceries? Would you say they pay for…
Select one only
all, 1
most, 2
or a little of your food, meals, or groceries? 3
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL IF PROGRAM= Bridges: ask fast: do not ask ips: do not ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK/R |
C4d. Do you currently receive any financial help from your parents, relatives, friends, or neighbors in paying for some or all of your cellular phone service?
Select one only
YES 1 C4D1
NO 0 C4E
DON’T KNOW d C4E
REFUSED r C4E
CATI/CAWI: C4D=1 IF PROGRAM= Bridges: ask fast: do not ask ips: do not ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK/R |
C4d1. About how much financial help do you currently receive from your parents, relatives, friends, or neighbors in paying for your cellular phone service? Would you say they pay for…
Select one only
all, 1
most, 2
or a little of your cellular phone service? 3
DON’T KNOW d
REFUSED r
CATI/CAWI: all IF PROGRAM= Bridges: ask fast: do not ask ips: do not ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK/R |
C4e. Do you currently receive any cash gifts or money from your parents, relatives, friends, or neighbors on a regular basis?
Select one only
YES 1 C4E1
NO 0 C5
DON’T KNOW d C5
REFUSED r C5
CATI/CAWI: C4E=1 IF PROGRAM= Bridges: ask fast: do not ask ips: do not ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK/R |
C4e1. About how much do your parents, relatives, friends, or neighbors provide in the form of money or cash gifts on a regular basis? Your best estimate is fine.
$| | | , | | | |
(0-99,999)
Is this amount per day, per week, per month, once every two weeks, per year, or a one-time payment? If you receive this amount occasionally or not on a regular basis, please provide your best estimate as to how often you received it during the past few months.
Select one only
PER DAY 1
PER WEEK 2
PER MONTH 3
ONCE EVERY TWO WEEKS 4
PER YEAR 5
A ONE-TIME PAYMENT 6
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL IF PROGRAM= Bridges: ask fast: do not ask ips: do not ask moms: ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
C5. If you had an emergency, about how many people would you be able to count on to help you? Would you say…
Select one only
m None, 1
m One to two, 2
m Three to five, or 3
m More than five? 4
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL IF PROGRAM= Bridges: ask fast: do not ask ips: do not ask moms: ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
C6.* About how many people could you turn to if you suddenly needed to borrow $100? Would you say…
Select one only
m None, 1
m One to two, 2
m Three to five, or 3
m More than five? 4
DON’T KNOW d
REFUSED r
CATI/CAWI: all IF PROGRAM= Bridges: ask fast: do not ask ips: do not ask moms: ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
C7a. About how many people could you talk to for help or advice?
Select one only
m None, 1
m One to two, 2
m Three to five, or 3
m More than five? 4
m DON’T KNOW d
m REFUSED r
CATI/CAWI: all IF PROGRAM = Bridges: do not ask fast: do not ask ips: do not ask moms: ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
C7b. Generally speaking, would you say most people can be trusted?
Select one only
m YES 1
m NO 0
m DON’T KNOW d
m REFUSED r
CATI/CAWI: all IF PROGRAM = Bridges: do not ask fast: do not ask ips: do not ask moms: ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
C7c. Would you say you trust most people in your neighborhood?
Select one only
m YES 1
m NO 0
m DON’T KNOW d
m REFUSED r
CATI/CAWI: ALL IF PROGRAM= Bridges: do not ask fast: do not ask ips: do not ask moms: ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
C8. CATI: Now I will read you a list of statements about being a parent. Please tell me if the following statements apply to you rarely or never, a little of the time, some of the time, a good part of the time, or always or most of the time.
CAWI: Please choose the one answer that best fits for you. 3
Select one per row
|
RARELY OR NEVER |
A LITTLE OF THE TIME |
SOME OF THE TIME |
GOOD PART OF THE TIME |
ALWAYS OR MOST OF THE TIME |
DK |
REF |
a. I feel I’m doing an excellent job as a parent. |
1 |
2 |
3 |
4 |
5 |
d |
r |
b. I am proud of myself as a parent. |
1 |
2 |
3 |
4 |
5 |
d |
r |
c. I am more effective than most parents. |
1 |
2 |
3 |
4 |
5 |
d |
r |
d. I have set goals about how I want to raise my child. |
1 |
2 |
3 |
4 |
5 |
d |
r |
e. I am a good example to other parents. |
1 |
2 |
3 |
4 |
5 |
d |
r |
f. I learn new parenting skills and use them with my child |
1 |
2 |
3 |
4 |
5 |
d |
r |
CATI/CAWI: all IF PROGRAM= Bridges: ask fast: do not ask ips: do not ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK/R |
C9a. Now [I/we] have some questions about your future financial situation. Would you say that you are confident, somewhat confident, or not confident that in five years’ time you will earn enough to support yourself without financial help from your parents, relatives, friends, or neighbors?
Select one only
CONFIDENT 1
SOMEWHAT CONFIDENT 2
NOT CONFIDENT 3
DON’T KNOW d
REFUSED r
CATI/CAWI: all IF PROGRAM= Bridges: ask fast: do not ask ips: do not ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK/R |
C9b. Would you say that you are confident, somewhat confident, or not confident that in five years’ time you will be working at a paid job?
Select one only
CONFIDENT 1
SOMEWHAT CONFIDENT 2
NOT CONFIDENT 3
DON’T KNOW d
REFUSED r
CATI: Now, I’d like to ask you some questions about your health.
CAWI: Now, we have some questions about your health. 4
-
CATI/CAWI: ALL
IF CAWI DO NOT SHOW DK OR REF
C10.* In general, would you say your health is:
Excellent, 1
Very good, 2
Good, 3
Fair, or 4
Poor? 5
DON’T KNOW d
REFUSED r
-
CATI/CAWI: ALL
IF CAWI DO NOT SHOW DK OR REF
C10a.* Are you fully vaccinated against COVID-19? Fully vaccinated means you got all the required shots.
Select one only
m YES 1
m NO 0
m DON’T KNOW d
m REFUSED r
-
CATI/CAWI: ALL
IF PROGRAM=
Bridges: do not ask
fast: ask
ips: do not ask
moms: do not ask
phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF
C10b. Are you currently covered by any type of health insurance plan, either private or government, including Medicare or Medicaid?
Select one only
m YES 1
m NO 0
m DON’T KNOW d
m REFUSED r
-
CATI/CAWI: ALL
IF CAWI DO NOT SHOW DK OR REF
C11.* The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?
CATI: The first question is about…
Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf.
CATI: Would you say you are limited a lot, limited a little, or not at all?
YES, LIMITED A LOT 1
YES, LIMITED A LITTLE 2
NO, NOT LIMITED AT ALL 3
DON’T KNOW d
REFUSED r
-
CATI/CAWI: ALL
IF CAWI DO NOT SHOW DK OR REF
C12.* CATI: The second question is about…
Climbing several flights of stairs. Would you say you are limited a lot, limited a little, or not at all?
YES, LIMITED A LOT 1
YES, LIMITED A LITTLE 2
NO, NOT LIMITED AT ALL 3
DON’T KNOW d
REFUSED r
-
CATI/CAWI: ALL
IF CAWI DO NOT SHOW DK OR REF
C13.* During the past 4 weeks how much of the time have you had any of the following problems with your work or other regular daily activities as a result of your physical health?
CATI: The first statement is that you…
Accomplished less than you would like.
CATI: Would you say that you accomplished less than you would like all of the time, most of the time, some of the time, a little of the time, or none of the time as a result of your physical health?
ALL OF THE TIME 1
MOST OF THE TIME 2
SOME OF THE TIME 3
A LITTLE OF THE TIME 4
NONE OF THE TIME 5
DON’T KNOW d
REFUSED r
-
CATI/CAWI: ALL
IF CAWI DO NOT SHOW DK OR REF
C14.* CATI: The second statement is that you…
Were limited in the kind of work or other activities.
CATI: Would you say that you were limited in the kind of work or other activities all of the time, most of the time, some of the time, a little of the time, or none of the time as a result of your physical health?
ALL OF THE TIME 1
MOST OF THE TIME 2
SOME OF THE TIME 3
A LITTLE OF THE TIME 4
NONE OF THE TIME 5
DON’T KNOW d
REFUSED r
-
CATI/CAWI: ALL
IF CAWI DO NOT SHOW DK OR REF
C15.* During the past 4 weeks, how much of the time have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)?
CATI: The first item is that you…
Accomplished less than you would like.
CATI: Would you say that you accomplished less than you would like all of the time, most of the time, some of the time, a little of the time, or none of the time as a result of any emotional problems?
ALL OF THE TIME 1
MOST OF THE TIME 2
SOME OF THE TIME 3
A LITTLE OF THE TIME 4
NONE OF THE TIME 5
DON’T KNOW d
REFUSED r
-
CATI/CAWI: ALL
IF CAWI DO NOT SHOW DK OR REF
C16.* CATI: The second item is that you…
Did work or other activities less carefully than usual.
CATI: Would you say that did work or other activities less carefully than usual all of the time, most of the time, some of the time, a little of the time, or none of the time as a result of any emotional problems?
ALL OF THE TIME 1
MOST OF THE TIME 2
SOME OF THE TIME 3
A LITTLE OF THE TIME 4
NONE OF THE TIME 5
DON’T KNOW d
REFUSED r
-
CATI/CAWI: ALL
IF CAWI DO NOT SHOW DK OR REF
C17.* During the past 4 weeks, how much did pain interfere with your normal work (including both work outside the home and housework)? Would you say…
Not at all, 1
A little bit, 2
Moderately, 3
Quite a bit, or 4
Extremely 5
DON’T KNOW d
REFUSED r
-
CATI/CAWI: ALL
IF CAWI DO NOT SHOW DK OR REF
C18.* These next questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks:
have you felt calm and peaceful?
All of the time, 1
Most of the time, 2
Some of the time, 3
A little of the time, or 4
None of the time 5
DON’T KNOW d
REFUSED r
-
CATI/CAWI: ALL
IF CAWI DO NOT SHOW DK OR REF
C19.* How much of the time during the past 4 weeks did you have a lot of energy?
All of the time, 1
Most of the time, 2
Some of the time, 3
A little of the time, or 4
None of the time 5
DON’T KNOW d
REFUSED r
-
CATI/CAWI: ALL
IF CAWI DO NOT SHOW DK OR REF
C20.* How much of the time during the past 4 weeks have you felt downhearted and depressed?
All of the time, 1
Most of the time, 2
Some of the time, 3
A little of the time, or 4
None of the time 5
DON’T KNOW d
REFUSED r
-
CATI/CAWI: ALL
IF CAWI DO NOT SHOW DK OR REF
C21.* During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting with friends, relatives, etc.)? Would you say…
All of the time, 1
Most of the time, 2
Some of the time, 3
A little of the time, or 4
None of the time 5
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL IF PROGRAM= Bridges: ask fast: ask ips: ask moms: do not ask phillywins: ask
IF CAWI DO NOT SHOW DK OR REF |
CATI: Now I will read you a list of statements about the last 30 days. Please tell me if the following applies to you all of the time, most of the time, some of the time, a little of the time, or none of the time.
C22. During the last 30 days, about how often did you…5
Select one per row
|
ALL THE TIME |
MOST OF THE TIME |
SOME OF THE TIME |
A LITTLE OF THE TIME |
NONE OF THE TIME |
DK |
REF |
a. feel so depressed that nothing could cheer you up? |
4 |
3 |
2 |
1 |
0 |
d |
r |
b. feel hopeless? |
4 |
3 |
2 |
1 |
0 |
d |
r |
c. feel restless or fidgety? |
4 |
3 |
2 |
1 |
0 |
d |
r |
d. feel that everything was an effort? |
4 |
3 |
2 |
1 |
0 |
d |
r |
e. feel worthless? |
4 |
3 |
2 |
1 |
0 |
d |
r |
f. feel nervous? |
4 |
3 |
2 |
1 |
0 |
d |
r |
CATI/CAWI: ALL IF PROGRAM = Bridges: do not ask fast: do not ask ips: do not ask moms: ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
C22a. CATI: Now I will read you a list of the ways you might have felt or behaved. Please tell me how often you have felt this way in the past week or so. Please tell me if you felt this way not at all or less than one day, one to two days, three to four days, five to seven days, or nearly everyday for the last two weeks.
CAWI: Below is a list of the ways you might have felt or behaved. Please select the boxes to let us know how often you have felt this way in the past week or so.6
Select one per row
|
NOT AT ALL OR LESS THAN 1 DAY |
1-2 DAYS |
3-4 DAYS |
5-7 DAYS |
NEARLY EVERY DAY FOR 2 WEEKS |
DK |
REF |
a. My appetite was poor. |
1 |
2 |
3 |
4 |
5 |
d |
r |
b. I could not shake off the blues. |
1 |
2 |
3 |
4 |
5 |
d |
r |
c. I had trouble keeping my mind on what I was doing. |
1 |
2 |
3 |
4 |
5 |
d |
r |
d. I felt depressed. |
1 |
2 |
3 |
4 |
5 |
d |
r |
e. My sleep was restless.. |
1 |
2 |
3 |
4 |
5 |
d |
r |
f. I felt sad. |
1 |
2 |
3 |
4 |
5 |
d |
r |
g. I could not get going. |
1 |
2 |
3 |
4 |
5 |
d |
r |
h. Nothing made me happy. |
1 |
2 |
3 |
4 |
5 |
d |
r |
i. I felt like a bad person. |
1 |
2 |
3 |
4 |
5 |
d |
r |
j. I lost interest in my usual activities. |
1 |
2 |
3 |
4 |
5 |
d |
r |
k. I slept much more than usual.. |
1 |
2 |
3 |
4 |
5 |
d |
r |
l. I felt like I was moving too slowly. |
1 |
2 |
3 |
4 |
5 |
d |
r |
m. I felt fidgety. |
1 |
2 |
3 |
4 |
5 |
d |
r |
n. I wished I were dead. |
1 |
2 |
3 |
4 |
5 |
d |
r |
o. I wanted to hurt myself. |
1 |
2 |
3 |
4 |
5 |
d |
r |
p. I was tired all the time.. |
1 |
2 |
3 |
4 |
5 |
d |
r |
q. I did not like myself. |
1 |
2 |
3 |
4 |
5 |
d |
r |
r. I lost a lot of weight without trying to. |
1 |
2 |
3 |
4 |
5 |
d |
r |
s. I had a lot of trouble getting to sleep. |
1 |
2 |
3 |
4 |
5 |
d |
r |
t. I could not focus on the important things. |
1 |
2 |
3 |
4 |
5 |
d |
r |
CATI/CAWI: ALL IF CAWI DO NOT SHOW DK OR REF |
C23.* Taken all together, how would you say things are going these days? Would you say that you are…
Very happy, 1
Pretty happy, or 2
Not too happy? 3
DON’T KNOW d
REFUSED r
CATI: The next questions are about alcohol use. If you do not drink alcohol at all, just say so.
CAWI: The next questions are about your use of alcohol.
CATI/CAWI: ALL IF PROGRAM= Bridges: do not ask fast: do not ask ips: ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
C24. How often do you have a drink containing alcohol, such as beer, wine or liquor? Would you say…7
Never, 1 C25
Monthly or less, 2 C23
2 to 4 times a month, 3 C23
2 to 3 times a week, or 4 C23
4 or more times a week 5 C23
DON’T KNOW d C25
REFUSED r C25
CATI/CAWI: c24 = 2, 3, 4, or 5 IF CAWI DO NOT SHOW DK OR REF |
C25. How many drinks containing alcohol do you have on a typical day when you are drinking? Would you say …
PROBE: A standard drink is a 5-ounce glass of wine, a 12-ounce can of beer, or a 1.5-ounce shot.
1 or 2 per day, 1
3 or 4, 2
5 or 6, 3
7 to 9, or 4
10 or more per day 5
DON’T KNOW d
REFUSED r
CATI/CAWI: c24 = 2, 3, 4, or 5 IF CAWI DO NOT SHOW DK OR REF |
C26. How often do you have six or more drinks on one occasion? Would you say…
Never, 1
Less than monthly, 2
Monthly, 3
Weekly, or 4
Daily or almost daily 5
DON’T KNOW d
REFUSED r
CATI: Next, I would like to ask you about your use of drugs, not including alcohol, in the past 6 months. For these questions, using drugs means taking more of a prescription drug than prescribed, taking more of an over-the-counter drug than the directions say, or using any drug for nonmedical reasons. The types of drugs may include cannabis (such as marijuana or hashish), inhalants (such as paint thinner), tranquilizers (such as Valium), barbiturates (such as downers), cocaine (such as crack), stimulants (such as Ritalin or speed), hallucinogens (such as LSD, peyote), or narcotics (such as heroin or pain killers).
Remember, do not include alcohol.
If you have difficulty with a yes or no statement, let me know the response that is mostly right.
CAWI: The following questions ask about your use of drugs (not including alcohol) in the past 6 months.
For these questions, using drugs means (1) taking more of a prescription than prescribed, (2) taking more of an over‐the‐counter drug than the directions say, or (2) using any drug for nonmedical reasons.
The types of drugs may include cannabis (e.g., marijuana, hashish), inhalants (e.g., paint thinner), tranquilizers (e.g., Valium), barbiturates (e.g., downers), cocaine (e.g., crack), stimulants (e.g., Ritalin, speed), hallucinogens (e.g., LSD, peyote), or narcotics (e.g., heroin, pain killers).
Remember, do not include alcohol.
Please answer every question. If you have difficulty with a statement, then choose the response that is mostly right.
CATI/CAWI: ALL IF PROGRAM= Bridges: do not ask fast: do not ask ips: ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
C27. In the past 6 months have you used drugs other than those required for medical reasons? 8
YES 1 C28
NO 2 C37
DON’T KNOW d C37
REFUSED r C37
CATI/CAWI: C27=1 IF CAWI DO NOT SHOW DK OR REF |
C28. Do you use more than one drug at a time?
PROBE: Consider your use of drugs, not including alcohol, in the past 6 months.
YES 1
NO 2
DON’T KNOW d
REFUSED r
CATI/CAWI: C27=1 IF CAWI DO NOT SHOW DK OR REF |
C29. Are you always able to stop using drugs when you want to?
PROBE: Consider your use of drugs, not including alcohol, in the past 6 months.
YES 1
NO 2
DON’T KNOW d
REFUSED r
CATI/CAWI: C27=1 IF CAWI DO NOT SHOW DK OR REF |
C30. Have you ever had blackouts or flashbacks as a result of drug use?
PROBE: Consider your use of drugs, not including alcohol, in the past 6 months.
YES 1
NO 2
DON’T KNOW d
REFUSED r
CATI/CAWI: C27=1 IF CAWI DO NOT SHOW DK OR REF |
C31. Do you ever feel bad or guilty about your drug use?
PROBE: Consider your use of drugs, not including alcohol, in the past 6 months.
YES 1
NO 2
DON’T KNOW d
REFUSED r
CATI/CAWI: C27=1 IF CAWI DO NOT SHOW DK OR REF |
C32. Does anyone ever complain about your involvement with drugs?
PROBE: Consider your use of drugs, not including alcohol, in the past 6 months.
YES 1
NO 2
DON’T KNOW d
REFUSED r
CATI/CAWI: C27=1 IF CAWI DO NOT SHOW DK OR REF |
C33. Have you neglected your family because of your drug use?
PROBE: Consider your use of drugs, not including alcohol, in the past 6 months.
YES 1
NO 2
DON’T KNOW d
REFUSED r
CATI/CAWI: C27=1 IF CAWI DO NOT SHOW DK OR REF |
C34. Have you engaged in illegal activities in order to obtain drugs?
PROBE: Consider your use of drugs, not including alcohol, in the past 6 months.
YES 1
NO 2
DON’T KNOW d
REFUSED r
CATI/CAWI: C27=1 IF CAWI DO NOT SHOW DK OR REF |
C35. Have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs?
PROBE: Consider your use of drugs, not including alcohol, in the past 6 months.
YES 1
NO 2
DON’T KNOW d
REFUSED r
CATI/CAWI: C27=1 IF CAWI DO NOT SHOW DK OR REF |
C36. Have you had medical problems as a result of your drug use (for example, memory loss, hepatitis, convulsions, or bleeding)?
PROBE: Consider your use of drugs, not including alcohol, in the past 6 months.
YES 1
NO 2
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL IF PROGRAM= Bridges: do not ask fast: do not ask ips: ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
C37. 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?
YES 1
NO 0
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL IF PROGRAM = Bridges: do not ask fast: do not ask ips: ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
C38. Now [I/we] have some questions about your experiences with the criminal justice system. Are you currently under some form of court-ordered supervision?
m Yes, parole 1
m Yes, probation 2
m Yes, diversion or alternative sentencing to avoid incarceration (such as, alternative court, drug court, mental health court, or community sentencing) 3
m Yes, something else, or (SPECIFY) 99
Specify (STRING 100)
m No, not under some form of supervision 0
m DON’T KNOW d
CATI/CAWI: ALL
IF PROGRAM = ips, do not display “Now [I/we] have some questions about your experiences with the criminal justice system” and display “Do not include any arrests for violating the terms of court-ordered supervision.” IF CAWI DO NOT SHOW DK OR REF |
C39.* [Now [I/we] have some questions about your experiences with the criminal justice system.]
Since [RA MONTH YEAR], have you been arrested? [Do not include any arrests for violating the terms of court-ordered supervision.]
YES 1
NO 0
DON’T KNOW d
REFUSED r
programmer box IF PROGRAM = ips go to c40. For all other programs go to D1. |
CATI/CAWI: C39=1 IF PROGRAM= Bridges: do not ask fast: do not ask ips: ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
C40. Since [RA MONTH YEAR], how many times have you been arrested? Do not include any arrests for violating the terms of court-ordered supervision.
NUMBER OF ARRESTS
(1-99)
DON’T KNOW d
REFUSED r
CATI/CAWI: C39=1 IF PROGRAM= Bridges: do not ask fast: do not ask ips: ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
C41. How many of these arrests since [RA MONTH YEAR] resulted in at least one conviction?
NUMBER OF ARRESTS LEADING TO A CONVICTION
C41=0 C43
(0-99) C41>0 C42
DON’T KNOW d C43
REFUSED r C43
CATI/CAWI: C39=1 and c41>0 IF PROGRAM= Bridges: do not ask fast: do not ask ips: ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
C42. How many of these convictions since [RA MONTH YEAR] were felony convictions?
NUMBER OF FELONY CONVICTIONS
(0-99)
DON’T KNOW d
REFUSED r
CATI/CAWI: C39=1,D,R IF PROGRAM= Bridges: do not ask fast: do not ask ips: ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
C43. Since [RA MONTH YEAR], have you been incarcerated in a detention center, jail, or prison? Do not include any incarcerations for violating the terms of court-ordered supervision.
YES 1
NO 0
DON’T KNOW d
REFUSED r
CATI/CAWI: All IF PROGRAM= Bridges: do not ask fast: do not ask ips: ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
C44. Since [RA MONTH YEAR], have you been incarcerated in a detention center, jail, or prison for violating the terms of court-ordered supervision?
YES 1
NO 0
DON’T KNOW d
REFUSED r
programmer box IF PROGRAM = IPS and c43=1 or c44=1 go to c45. IF PROGRAM = IPS and c43=0,D,R and c44=0,D,R go to D1. |
CATI/CAWI: c43=1 OR C44 =1 IF PROGRAM= Bridges: do not ask fast: do not ask ips: ask moms: do not ask phillywins: do not ask
IF CAWI DO NOT SHOW DK OR REF |
C45. What is the total time you have spent in incarceration since [RA MONTH YEAR]? If less than 1 month, please record 1 month. Include any incarceration for any reason.
Your best estimate is fine.
| | | YEARS AND | | | MONTHS
DON’T KNOW d
REFUSED r
D. PROGRAM SATISFACTION
ALL ITEMS IN THIS SECTION ONLY ASKED ON FIRST FOLLOW-UP
PROGRAM GROUP ONLY
CATI: Now, I’m going to ask you some questions about your experiences with [NEXTGEN PROGRAM].
CAWI: Next are some questions about your experiences with [NEXTGEN PROGRAM].
-
CATI/CAWI: PROGRAM GROUP ONLY
IF CAWI DO NOT SHOW DK OR REF
D1. Since [RA MONTH YEAR], have you received any services from [NEXTGEN PROGRAM] or participated in any [NEXTGEN PROGRAM] activities?
YES 1 D2
NO 2 D5
DON’T KNOW d D5
REFUSED r D5
CATI/CAWI: D1=1 and program group only IF PROGRAM= BRIDGES: ASK D2B, D2C, AND D2D FAST: ASK D2A TO D2C IPS: ASK D2B AND D2C MOMS: ASK D2A TO D2C phillywins: ASK D2B AND D2C
IF CAWI DO NOT SHOW DK OR REF |
D2. How much has your experience with [NEXTGEN PROGRAM] helped you in the following areas?
Would you say [NEXTGEN PROGRAM] helped you very much, somewhat, a little or not at all with…
Select one per row
-
VERY MUCH
SOMEWHAT
A LITTLE
NOT AT ALL
DK
REF
a. …setting career goals?
1
2
3
4
d
r
b. …getting information about job opportunities?
1
2
3
4
d
r
c. …getting a job?
1
2
3
4
d
r
d. …having a trusted person to turn to for job-related advice?
1
2
3
4
d
r
-
CATI/CAWI: D1=1
IF CAWI DO NOT SHOW DK OR REF
D3. Overall, how would you rate your experience at [NEXTGEN PROGRAM]? Would you say it was very good, good, fair, or poor?
VERY GOOD 1
GOOD 2
FAIR 3
POOR 4
DON’T KNOW d
REFUSED r
-
CATI/CAWI: D1=1
IF CAWI DO NOT SHOW DK OR REF
D4. Are you still receiving any services from [NEXTGEN PROGRAM] or participating in any [NEXTGEN PROGRAM] activities?
YES 1 E1
NO 2 D5
DON’T KNOW d D5
REFUSED r D5
-
CATI/CAWI: D1=2,d,r Or D4=2,d,r
IF CAWI DO NOT SHOW DK OR REF
if D1=2,d,r display “did not participate”
if D4=2,d,r display “stopped going”
D5. What was the primary reason you (did not participate in / stopped going to) [NEXTGEN PROGRAM]?
you didn’t have transportation or had issues with transportation 1
YOu were incarcerated 2
you didn’t have the time 3
you got a job 4
you moved 5
you were expecting a child 6
you had child care problems 7
you had health problems or an injury 8
because a family member became ill 9
you had pressure from your family 10
you did not like the program 11
you did not like or get along with the program staff 12
you no longer wanted to find employment 13
you completed the [NEXTGEN PROGRAM] program, or 14
For some other reason? (SPECIFY: __________) 99
DON’T KNOW d
REFUSED r
E. UPDATED CONTACT INFORMATION
CATI/CAWI: ALL |
E1.* Next, we would like to ask for some contact information. Mathematica will contact you in about X [FILL ACCORDING TO THE TIME BETWEEN FIRST AND SECOND FOLLOW-UP SURVEYS] months to see how you are doing and conduct another survey.
What is your address?
PROBE: Where do you receive your mail?
PROBE: Is there an apartment number?
Street Address 1: (STRING (NUM))
Street Address 2: (STRING (NUM))
City: (STRING (NUM))
State: (STRING (NUM))
Zip: (STRING (NUM))
DON’T KNOW d
REFUSED r
CATI/CAWI: NO SSN AT BASELINE IF CAWI DO NOT SHOW DK OR REF |
E1a. What is your Social Security number?
We will use your Social Security number to collect important information for the study such as earnings, new addresses, or benefit information. This information will help policymakers better understand how to improve programs. It will be used for research purposes only and will not be used to make decisions about whether you get benefits or the amount of benefits you get, now or in the future. All of your responses to this survey will be kept private and secure on Mathematica’s servers for the duration of the study, unless the law requires otherwise, or you request release of your information in writing. Once the study is over, your identifying information will be securely deleted from Mathematica’s servers.
SOCIAL SECURITY NUMBER
(NUMERIC 9)
DON’T HAVE ONE 0
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL |
E2.* What is your email address?
EMAIL ADDRESS
(STRING 50)
DON’T HAVE ONE 0
DON’T KNOW d
REFUSED r
CATI/CAWI: all |
E3.* What is your home telephone number?
HOME TELEPHONE
(201-989) (200-999) (0000-9999)
NO LANDLINE 1
DON’T KNOW d
REFUSED r
CATI/CAWI: all |
E3a.* Do you have a cell phone?
YES 1 E3b
NO 0 E4
DON’T KNOW d E4
REFUSED r E4
CATI/CAWI: E3a=01 |
E3b. What is your cell phone number?
CELL PHONE
(201-989) (200-999) (0000-9999)
DON’T KNOW d
REFUSED r
CATI/CAWI: E3a=01 |
E3c. Is it okay for us to text you at this number? Message and data rates may apply.
YES 1
NO 0
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL |
E4.* What is another phone number where you can be reached?
PHONE NUMBER
(201-989) (200-999) (0000-9999)
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL |
E5.* May we contact you through Facebook?
YES 1 E5a
NO/DON’T HAVE ACCOUNT 0 E6
DON’T KNOW d E6
REFUSED r E6
CATI/CAWI: E5 = 1 |
E5a. What name do you use on Facebook?
USER NAME
(STRING 50)
DON’T KNOW d
REFUSED r
CATI/CAWI: E5 = 1 |
E5b. What is your Facebook url?
USER NAME
(STRING 50)
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL |
E6.* May we contact you through LinkedIn?
YES 1 E6a
NO/DON’T HAVE ACCOUNT 0 E7
DON’T KNOW d E7
REFUSED r E7
CATI/CAWI: E6 = 1 |
E6a. What name do you use on LinkedIn?
USER NAME
(STRING 50)
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL |
E7.* May we contact you through Instagram?
YES 1 E7a
NO/DON’T HAVE ACCOUNT 0 E8
DON’T KNOW d E8
REFUSED r E8
CATI/CAWI: E7 = 1 |
E7a. What username do you use on Instagram?
USER NAME
(STRING 50)
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL |
E8.* As we mentioned, Mathematica will contact you in about X [FILL ACCORDING TO THE TIME BETWEEN FIRST AND SECOND FOLLOW-UP SURVEYS] months to see how you are doing and conduct another survey. In case Mathematica has trouble reaching you, we would like to have the names of three people who would most likely know where you are or who you keep in close contact with, such as a grandmother or grandfather, other relative, or friend. Mathematica will not contact these people for any other reason.
What is the full name of the first person we should contact?
FIRST NAME
(STRING 50)
MIDDLE INITIAL
(STRING 1)
LAST NAME
(STRING 50)
DON’T KNOW d END
REFUSED r END
CATI/CAWI: E8 NE D OR R |
E8a. What is (his/her) address?
PROBE: Is there an apartment number?
Street Address 1: (STRING (NUM))
Street Address 2: (STRING (NUM))
City: STRING (NUM))
State: (STRING (NUM))
Zip: (STRING (NUM))
DON’T KNOW d
REFUSED r
CATI/CAWI: E8 NE D OR R |
E8b. What is (his/her) relationship to you?
Select one only
SPOUSE/PARTNER 1
MOTHER 2
FATHER 3
SISTER/BROTHER 4
GRANDMOTHER/GRANDFATHER 5
SON/DAUGHTER 6
FRIEND 7
OTHER (SPECIFY) 99
Specify (STRING 50)
DON’T KNOW d
REFUSED r
IF OTHER SPECIFY (99): ENTER OTHER RELATIONSHIP TYPE |
CATI/CAWI: E8 NE D OR R |
E8c. What is (his/her) home telephone number?
HOME TELEPHONE
(201-989) (200-999) (0000-9999)
NO LANDLINE 1
DON’T KNOW d
REFUSED r
CATI/CAWI: E8 NE D OR R |
E8d. Does (he/she) have a cell phone?
YES 1
NO 0 E8F
DON’T KNOW d E8F
REFUSED r E8F
CATI/CAWI: e8D=1 |
E8e. Can I have that number?
TELEPHONE
(201-989) (200-999) (0000-9999)
DON’T KNOW d
REFUSED r
CATI/CAWI: E8 NE D OR R |
E8f. What is (his/her) work telephone number?
TELEPHONE
(201-989) (200-999) (0000-9999)
NO WORK NUMBER 1
DON’T KNOW d
REFUSED r
CATI/CAWI: E8 NE D OR R |
E8g. What is (his/her) email address?
EMAIL ADDRESS
(STRING 50)
DON’T HAVE ONE 0 E9
DON’T KNOW d E9
REFUSED r E9
CATI/CAWI: E8g NE 0, D, OR R |
E8h. Does (he/she) have another email address?
EMAIL ADDRESS
(STRING 50)
NO 0
DON’T KNOW d
REFUSED r
SECOND CONTACT
CATI/CAWI: E8 NE D OR R |
E9. What is the full name of the second person we should contact?
FIRST NAME
(STRING 50)
MIDDLE INITIAL
(STRING 1)
LAST NAME
(STRING 50)
DON’T KNOW d END
REFUSED r END
CATI/CAWI: E9 NE D OR R |
E9a. What is (his/her) address?
PROBE: Is there an apartment number?
Street Address 1: (STRING (NUM))
Street Address 2: (STRING (NUM))
City: STRING (NUM))
State: (STRING (NUM))
Zip: (STRING (NUM))
DON’T KNOW d
REFUSED r
CATI/CAWI: E9 NE D OR R |
E9b. What is (his/her) relationship to you?
Select one only
SPOUSE/PARTNER 1
MOTHER 2
FATHER 3
SISTER/BROTHER 4
GRANDMOTHER/GRANDFATHER 5
SON/DAUGHTER 6
FRIEND 7
OTHER (SPECIFY) 99
Specify (STRING 50)
DON’T KNOW d
REFUSED r
CATI/CAWI: E9 NE D OR R |
E9c. What is (his/her) home telephone number?
HOME TELEPHONE
(201-989) (200-999) (0000-9999)
NO LANDLINE 1
DON’T KNOW d
REFUSED r
CATI/CAWI: E9 NE D OR R |
E9d. Does (he/she) have a cell phone?
YES 1
NO 0 E9F
DON’T KNOW d E9F
REFUSED r E9F
CATI/CAWI: E9D=1 |
E9e. Can I have that number?
TELEPHONE
(201-989) (200-999) (0000-9999)
DON’T KNOW d
REFUSED r
CATI/CAWI: E9 NE D OR R |
E9f. What is (his/her) work telephone number?
(201-989) (200-999) (0000-9999)
NO WORK NUMBER 1
DON’T KNOW d
REFUSED r
CATI/CAWI: E9 NE D OR R |
E9g. What is (his/her) email address?
EMAIL ADDRESS
(STRING 50)
DON’T HAVE ONE 0 E10
DON’T KNOW d E10
REFUSED r E10
CATI/CAWI: E9G NE D OR R |
E9h. Does (he/she) have another email address?
EMAIL ADDRESS
(STRING 50)
NO 0
DON’T KNOW d
REFUSED r
THIRD CONTACT
CATI/CAWI: E9 NE D OR R |
E10. What is the full name of the third person we should contact?
FIRST NAME
(STRING 50)
MIDDLE INITIAL
(STRING 1)
LAST NAME
(STRING 50)
DON’T KNOW d END
REFUSED r END
CATI/CAWI: E10 NE d OR r |
E10a. What is (his/her) address?
PROBE: Is there an apartment number?
Street Address 1: (STRING (NUM))
Street Address 2: (STRING (NUM))
City: STRING (NUM))
State: (STRING (NUM))
Zip: (STRING (NUM))
DON’T KNOW d
REFUSED r
CATI/CAWI: E10 NE d OR r |
E10b. What is (his/her) relationship to you?
Select one only
SPOUSE/PARTNER 1
MOTHER 2
FATHER 3
SISTER/BROTHER 4
GRANDMOTHER/GRANDFATHER 5
SON/DAUGHTER 6
FRIEND 7
OTHER (SPECIFY) 99
Specify (STRING 50)
DON’T KNOW d
REFUSED r
CATI/CAWI: E10 NE d OR r |
E10c. What is (his/her) home telephone number?
HOME TELEPHONE
(201-989) (200-999) (0000-9999)
NO LANDLINE 1
DON’T KNOW d
REFUSED r
CATI/CAWI: E10 NE d OR r |
E1d. Does (he/she) have a cell phone?
YES 1
NO 0 E10F
DON’T KNOW d E10F
REFUSED r E10F
CATI/CAWI: E10e=1 |
E10e. Can I have that number?
TELEPHONE
(201-989) (200-999) (0000-9999)
DON’T KNOW d
REFUSED r
CATI/CAWI: E10 NE d OR r |
E10f. What is (his/her) work telephone number?
TELEPHONE
(201-989) (200-999) (0000-9999)
NO WORK NUMBER 0
DON’T KNOW d
REFUSED r
CATI/CAWI: E10 NE d OR r |
E10g. What is (his/her) email address?
EMAIL ADDRESS
(STRING 50)
DON’T HAVE ONE 0 END
DON’T KNOW d END
REFUSED r END
CATI/CAWI: E10g NE 0, d, OR r |
E10h. Does (he/she) have another email address?
EMAIL ADDRESS
NO 0
DON’T KNOW d
REFUSED r
CATI/CAWI: ALL |
Completed.* This completes the survey. Thank you for your participation in this survey and continued participation in the Next Generation of Enhanced Employment Strategies Project. We appreciate you taking the time to share this information with us. It is a very important contribution to our study. We will send your [$50/$55] gift card in the mail in the next two weeks.
As a reminder, we will contact you again in [TIME UNTIL SECOND FOLLOW-UP] to check in. You will receive another gift card for participating in that second survey. Thank you again.
1,2 A24a, A24b: Noonan, P.M., & Gaumer Erickson, A.S. (2017). The skills that matter: Teaching intrapersonal and interpersonal competencies in any classroom. Thousand Oaks, CA: Corwin.
3 Healthy Families Parenting Inventory (HFPI), Parenting Efficacy questions, Copyright LeCroy & Milligan Associates, Inc. 2004.
4 © C10, C11 to C21 is the SF-12v2, 1994, 2002 by QualityMetric Inc. and Medical Outcomes Trust. All Rights Reserved.
5 K-6 Distress Scale: https://www.hcp.med.harvard.edu/ncs/k6_scales.php
6 Center for Epidemiologic Studies Depression Scale Revised (CESD-R)
8 Skinner HA (1982). The Drug Abuse Screening Test. Addictive Behavior. 7(4):363-371. Note that the follow-up survey asks for a 6 month reference period whereas the baseline asks about a 12 month reference period. This is to avoid overlap in the time period being asked about.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Alicia Harrington |
| File Modified | 0000-00-00 |
| File Created | 2024-09-06 |
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