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Rates of Parent-Centered Developmental Screening: Disparities and Links to Services Access
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Published paper looking to assess the national and state prevalence of parent-completed developmental screening and evaluate associations between screening and receipt of an early-intervention plan for children at higher risk.
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Guide to Topics & Questions Asked

National Survey of Children's Health 2016

The National Survey of Children’s Health (NSCH) is sponsored by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, and is conducted by the US Census Bureau. In summer 2016, participants were mailed an invitation to complete both a household screener and child-level questionnaire online using a secure, confidential website. Additionally, participants were provided with the opportunity to complete a mailed, paper version of the household screener and questionnaire in lieu of the web-based materials. Below is a guide to the questions asked on the screener and child-level questionnaire.

KEY
^    Denotes that survey item is new to the 2016 NSCH (vs. 2011/12 NSCH or 2009/2010 NS-CSHCN).
•     Bullet points indicate a list of questions under one question stem.
[ ]   Complex skip patters are explained in brackets.
x    Question exists, but no question number is associated with it
-     Question does not exist in this version of the survey
Note: Indented questions are asked if the respondent answered “yes” or gave a response other than “no” or “0” to the primary, non-indented question.

CLICK on the question numbers in blue text below to view the full text of the question and its response options.

   

SECTION 1: Pre-Survey Screener (Completed prior to full survey)

The screener is administered in advance of the full survey. It begins by asking an adult in the household if there are any children 0-17 years old in the home, how many children there are, and what primary language is spoken (English, Spanish, or Other (specified)).

The following questions are then asked about each of (up to) four youngest children living in the home (respondents are asked to provide only name, age, and sex about additional children):

  1. Is child [#] of Hispanic, Latino, or Spanish origin? (C#_HISPANIC)
  2. What is this child's race? [Mark one or more boxes] (C#_RACE)
  3. How old is this child? (C#_AGE_YEARS/C#_AGE_MONTHS)
  4. What is this child's sex? (C#_SEX)
  5. How well does this child speak English? [only asked of children 4+ years old] (C#_ENGLISH)^
  6. Does this child CURRENTLY need or use medicine prescribed by a doctor, other than vitamins? (C#_K2Q10, C#_K2Q11, C#_K2Q12)
  7. Does this child need or use more medical care, mental health, or educational services than is usual for most children of the same age? (C#_K2Q13, C#_K2Q14, C#_K2Q15)
  8. Is this child limited or prevented in any way in his or her ability to do the things most children of the same age can do? (C#_K2Q16, C#_K2Q17, C#_K2Q18)
  9. Does this child need or get special therapy, such as physical, occupational, or speech therapy? (C#_K2Q19, C#_K2Q20, C#_K2Q21)
  10. Does this child have any kind of emotional, developmental, or behavioral problem for which he or she needs treatment or counseling? (C#_K2Q22, C#_K2Q23)

If YES to items 6-10, two follow up questions are asked:

  • Is this because of ANY medical, behavioral, or other health condition?
  • Is this a condition that has lasted or is expected to last 12 months or longer?

After all children are screened, one child is randomly selected.
The remainder of the survey is asked of this randomly selected child.

SECTION 2: Survey Questions

Survey Questions (variable name in public use data file) Survey Question Number
0-5 Years Survey 6-11 Years Survey 12-17 Years Survey
A. This Child's Health
In general, how would you describe this child’s health? (K1Q02) A1 A1 A1
How would you describe the condition of this child’s teeth (K2Q01_D) A2 A2 A2
How well do each of the following phrases describe this child? A3 A3 A3
  • This child is affectionate and tender with you (K6Q70_R)
  • A3a - -
  • This child bounces back quickly when things do not go his or her way (K6Q73_R)
  • A3b
    - -
  • This child shows interest and curiosity in learning new things (K6Q71_R)
  • A3c
    A3a
    A3a
  • This child smiles and laughs a lot (K6Q72_R)
  • A3d
    - -
  • This child works to finish tasks he or she starts (K7Q84_R)
  • - A3b
    A3b
  • This child stays calm and in control when faced with a challenge (K7Q85_R)
  • - A3c
    A3c
  • This child cares about doing well in school (K7Q82_R)
  • - A3d
    A3d
  • This child does all required homework (K7Q83_R)
  • - A3e
    A3e
  • This child is bullied, picked on, or excluded by other children (BULLIED)^
  • - A3f
    A3f
  • This child bullies others, picks on them, or excludes them (K7Q71_R)
  • - A3g
    A3g
  • This child argues too much (K7Q70_R)
  • - A3h
    A3h
    DURING THE PAST 12 MONTHS, has this child had FREQUENT or CHRONIC difficulty with any of the following? A4 A4
    A4
  • Breathing or other respiratory problems (such as wheezing or shortness of breath) (BREATHING)
  • A4a
    A4a A4a
  • Eating or swallowing because of a health condition (SWALLOWING)
  • A4b
    A4b
    A4b
  • Digesting food, including stomach/intestinal problems, constipation, or diarrhea (STOMACH)
  • A4c
    A4c
    A4c
  • Repeated or chronic physical pain, including headaches or other back or body pain (PHYSICALPAIN)
  • A4d
    A4d
    A4d
  • Using his or her hands (HANDS)
  • A4e
    - -
  • Coordination or moving around (COORDINATION)
  • A4f
    - -
  • Toothaches (TOOTHACHES)
  • A4g
    A4e
    A4e
  • Bleeding gums (GUMBLEED)^
  • A4h
    A4f
    A4f
  • Decayed teeth or cavities (CAVITIES)
  • A4i
    A4g
    A4g
     Does this child have any of the following? A5 A5
    A5
  • Serious difficulty concentrating, remembering, or making decisions because of a physical, mental, or emotional condition (MEMORYCOND)^
  • - A5a
    A5a
  • Serious difficulty walking or climbing stairs (WALKSTAIRS)
  • - A5b
    A5b
  • Difficulty dressing or bathing (DRESSING)
  • - A5c
    A5c
  • Difficulty doing errands alone, such as visiting a doctor’s office or shopping, because of a physical, mental, or emotional condition (ERRANDALONE)^
  • - - A5d
  • Deafness or problems with hearing (K2Q43B)
  • A5a
    A5d
    A5e
  • Blindness or problems with seeing, even when wearing glasses (BLINDNESS)
  • A5b
    A5e
    A5f
     Has a doctor or other health care provider EVER told you that this child has: x x x
  • Allergies (including food, drug, insect, or other)? (ALLEGRIES)
  • A6 A6 A6
  • Arthritis? (ARTHRITIS)
  • A7 A7 A7
  • Asthma? (K2Q40A)
  • A8 A8 A8
  • Blood Disorders (such as Sickle Cell Disease, Thalassemia, or Hemophilia)? (BLOOD)
  • A9 A9 A9
  • Brain Injury, Concussion or Head Injury? (K2Q46A)
  • A10 A10 A10
  • Cerebral Palsy? (K2Q61A)
  • A11 A11 A11
  • Cystic Fibrosis? (CYSTFIB)
  • A12 A12 A12
  • Diabetes? (K2Q41A)
  • A13 A13 A13
  • Down Syndrome? (DOWNSYN)
  • A14 A14 A14
  • Epilepsy or Seizure Disorder? (K2Q42A)
  • A15 A15 A15
  • Heart Condition? (HEART)
  • A16 A16 A16
  • Frequent or Severe Headaches, including Migraine? (HEADACHE)
  • A17 A17 A17
  • Tourette Syndrome? (K2Q38A)
  • A18 A18 A18
  • Anxiety Problems? (K2Q33A)
  • A19 A19 A19
  • Depression? (K2Q32A)
  • A20 A20 A20
  • Other Genetic or Inherited Condition? (GENETIC)
  • A21 A21 A21
    Has a doctor, other health care provider, or educator EVER told you that this child has: x x x
  • Behavioral or Conduct Problems? (K2Q34A)
  • A22 A22 A22
  • Substance Abuse Disorder? (SUBABUSE)^
  • - A23 A23
  • Developmental Delay? (K2Q36A)
  • A23 A24 A24
  • Intellectual Disability (also known as Mental Retardation)? (K2Q60A)
  • A24 A25 A25
  • Speech or Other Language Disorder? (K2Q37A)
  • A25 A26 A26
  • Learning Disability? (K2Q30A)
  • A26 A27 A27
    Has a doctor or other health care provider EVER told you that this child has any other mental health condition? If yes, specify (ANYOTHER)^ A27 A28 A28
    If YES to any of the items from A6 to this point, two follow up questions are asked: x x x
  • Does this child CURRENTLY have the condition? (variable name differs based on condition)
  • x x x
  • If YES, Is it Mild, Moderate, or Severe? (variable name differs based on condition)
  • x x x
    Has a doctor or other health care provider EVER told you that this child has Autism or Autism Spectrum Disorder (ASD)? Include diagnoses of Asperger’s Disorder or Pervasive Developmental Disorder (PDD). (K2Q35A) A28

    A29

    A29

    Does this child CURRENTLY have the condition? (K2Q35B)
    If yes, is it Mild, Moderate, or Severe? (K2Q35C)
    How old was this child when a doctor or other health care provider FIRST told you that he or she had Autism, ASD, Asperger’s Disorder or PDD? (K2Q35A_1_YEARS) A29 A30 A30
    What type of doctor or other health care provider was the FIRST to tell you that this child had Autism, ASD, Asperger’s Disorder or PDD? (K2Q35D) A30 A31 A31
    Is this child CURRENTLY taking medication for Autism, ASD, Asperger’s Disorder or PDD? (AUTISMMED) A31 A32 A32
    At any time DURING THE PAST 12 MONTHS, did this child receive behavioral treatment for Autism, ASD, Asperger’s Disorder or PDD, such as training or an intervention that you or this child received to help with his or her behavior? (AUTISMTREAT)^ A32 A33 A33
    Has a doctor or other health care provider EVER told you that this child has Attention Deficit Disorder or Attention Deficit/Hyperactivity Disorder, that is, ADD or ADHD? (K2Q31A) A33

    A34

    A34

    Does this child CURRENTLY have the condition? (K2Q31B)
    If yes, is it Mild, Moderate, or Severe? (K2Q31C)
    Is this child CURRENTLY taking medication for ADD or ADHD? (K2Q31D) A34 A35 A35
    At any time DURING THE PAST 12 MONTHS, did this child receive behavioral treatment for ADD or ADHD, such as training or an intervention that you or this child received to help with his or her behavior? (ADDTREAT) A35 A36 A36
    DURING THE PAST 12 MONTHS, how often have this child’s health conditions or problems affected his or her ability to do things other children his or her age do? (HCABILITY) A36 A37 A37
    To what extent do this child’s health conditions or problems affect his or her ability to do things? (HCEXTENT) A37 A38 A38
    B. This Child as an Infant
    Was this child born more than 3 weeks before his or her due date? (K2Q05) B1 B1 B1
    How much did he or she weigh when born? (K2Q04R) B2 B2 B2
    What was the age of the mother when this child was born? (MOMAGE) B3 B3 B3
    Was this child EVER breastfed or fed breast milk? (K6Q40) B4 - -
    If yes, how old was this child when he or she COMPLETELY stopped breastfeeding or being fed breast milk? (K6Q41R) B5 - -
    How old was this child when he or she was FIRST fed formula? (K6Q42R) B6 - -
    How old was this child when he or she was FIRST fed anything other than breast milk or formula? (K6Q43R) B7 - -
    C. Health Care Services
    Health Care Visits
    DURING THE PAST 12 MONTHS, did this child see a doctor, nurse, or other health care professional for sick-child care, well-child check-ups, physical exams, hospitalizations or other kind of medical care? (S4Q01)
    C1 C1 C1
    If yes, DURING THE PAST 12 MONTHS, how many times did this child visit a doctor, nurse, or other health care professional to receive a PREVENTIVE check-up? (K4Q20R) C2 C2 C2
    Thinking about the LAST TIME you took this child for a preventive check-up, about how long was the doctor or health care provider who examined this child in the room with you? (DOCROOM)^ C3 C3 C3
    At his or her LAST preventive check-up, did this child have a chance to speak with a doctor or other health care provider privately, without you or another adult in the room? (DOCPRIVATE)^ - - C4
    Height and Weight
    What is this child’s CURRENT height? (HEIGHT) C4 C4 C5
    How much does this child CURRENTLY weight? (WEIGHT) C5 C5 C6
    Are you concerned about this child’s weight? (WGTCONC)^ C6 C6 C7
    Developmental Concerns & Screening
    DURING THE PAST 12 MONTHS, did this child’s doctors or other health care providers ask if you have concerns about this child’s learning, development, or behavior? (K6Q10)
    [If child is <9 months, skip to C9]
    C7 - -
    DURING THE PAST 12 MONTHS, did a doctor or other health care provider have you or another caregiver fill out a questionnaire about specific concerns or observations you may have about this child’s development, communications, or social behaviors? (K6Q12) C8 - -
    If yes, mark which types of questions were asked about. (K6Q31A, K6Q31B, K6Q14A, K6Q14B) x - -
    Usual Source of Care
    Is there a place that this child USUALLY goes when he or she is sick or you or another caregiver needs advice about his or her health? (K4Q01) C9 C7 C8
    If yes, where does this child USUALLY go? (K4Q02_R) C10 C8 C9
    Is there a place that this child USUALLY goes when he or she needs routine preventive care, such as a physical examination or well-child check-up? (USUALGO) C11 C9 C10
    If yes, is this the same place this child goes when he or she is sick? (USUALSICK) C12 C10 C11
    Vision Testing
    Has this child [EVER (0-5)/DURING THE PAST 2 YEARS (6-17)] had his or her vision tested with pictures, shapes, or letters? (K4Q31_R) C13 C11 C12
    If yes, what kind of place or places did this child have his or her vision tested? (K4Q32X) C14 C12 C13
    Dental Health Care
    DURING THE PAST 12 MONTHS, did this child see a dentist or other oral health care provider for any kind of dental or oral health care? (K4Q30R) C15 C13 C14
    If yes, DURING THE PAST 12 MONTHS, did this child see a dentist or other oral health care provider for preventive dental care, such as check-ups, dental cleanings, dental sealants, or fluoride treatments? (DENTISTVISIT) C16 C14 C15
    If yes, DURING THE PAST 12 MONTHS, what preventive dental services did this child receive? (DENTALSERV)^ C17 C15 C16
    Mental Health Care and Other Types of Care
    DURING THE PAST 12 MONTHS, has this child received any treatment or counseling from a mental health professional? (K4Q22_R) C18 C16 C17
    How much of a problem was it to get the mental health treatment or counseling that this child needed? (TREATNEED) C19 C17 C18
    DURING THE PAST 12 MONTHS, has this child taken any medication because of difficulties with his or her emotions, concentration, or behavior? (K4Q23) C20 C18 C19
    DURING THE PAST 12 MONTHS, did this child see a specialist other than a mental health professional? (K4Q24_R) C21 C19 C20
    How much of a problem was it to get the specialist care that this child needed? (K4Q26) C22 C20 C21
    DURING THE PAST 12 MONTHS, did this child use any type of alternative health care or treatment? (ALTHEALTH) C23 C21 C22
    Unmet Need for Health Care
    DURING THE PAST 12 MONTHS, was there any time when this child needed health care but it was not received? (K4Q27) C24 C22 C23
    Which types of care were not received? (K4Q28X) C25 C23 C24
    Which of the following contributed to this child not receiving needed health services:  C26 C24 C25
  • This child was not eligible for the services? (NOTELIG)
  • C26a C24a C25a
  • The services this child needed were not available in your area? (AVAILABLE)
  • C26b C24b C25b
  • There were problems getting an appointment when this child needed one? (APPOINTMENT)
  • C26c C24c C25c
  • There were problems with getting transportation or child care? (TRANSPORTCC)^
  • C26d C24d C25d
  • The (clinic/doctor’s) office wasn’t open when this child needed care? (NOTOPEN)^
  • C26e C24e C25e
  • There were issues related to cost? (ISSUECOST)
  • C26f C24f C25f
    DURING THE PAST 12 MONTHS, how often were you frustrated in your efforts to get services for this child? (C4Q04) C27 C25 C26
    ER Use
    DURING THE PAST 12 MONTHS, how many times did this child visit a hospital emergency room? (HOSPITALER) C28 C26 C27
    Educational & Developmental Services
    Has this child EVER had a special education or early intervention plan? (K6Q15) C29 C27 C28
    How old was this child at the time of the FIRST plan? (SESPLANMO)^ C30 C28 C29
    Is this child CURRENTLY receiving services under one of these plans? (SESCURRSVC)^ C31 C29 C30
    Has this child EVER received special services to meet his or her developmental needs such as speech, occupational, or behavioral therapy? (K4Q36) C32 C30 C31
    How old was this child when he or she began receiving these special services? (K4Q37) C33 C31 C32
    Is this child CURRENTLY receiving these special services? (K4Q38) C34 C32 C33
    D. Experience with This Child's Health Care Providers
    Personal Doctor or Nurse
    Do you have one or more persons you think of as this child’s personal doctor or nurse? (K4Q04_R) D1 D1 D1
    Referrals for Care
    DURING THE PAST 12 MONTHS, did this child need a referral to see any doctors or receive any services? (K5Q10) D2 D2 D2
    If yes, how much of a problem was it to get referrals? (K5Q11) D3 D3 D3
    Family-Centered Care
    [Only answer questions D4-D12 if child had a health care visit in the past 12 months] DURING THE PAST 12 MONTHS, how often did this child’s doctors or other health care providers: D4
    D4 D4
  • Spend enough time with this child? (K5Q40)
  • D4a
    D4a
    D4a
  • Listen carefully to you? (K5Q41)
  • D4b D4b D4b
  • Show sensitivity to your family’s values and customs? ( K5Q42)
  • D4c
    D4c
    D4c
  • Provide the specific information you needed concerning this child? (K5Q43)
  • D4d
    D4d
    D4d
  • Help you feel like a partner in this child’s care? (K5Q44)
  • D4e
    D4e
    D4e
    Shared Decision Making
    DURING THE PAST 12 MONTHS, were any decisions needed about this child’s health care services or treatment, such as whether to start or stop a prescription or therapy services, get a referral to a specialist, or have a medical procedure? (DECISIONS)^ D5 D5 D5
    If yes, DURING THE PAST 12 MONTHS, how often did this child’s doctors or other health care providers: D6 D6 D6
  • Discuss with you the range of options to consider for his or her health care or treatment? (DISCUSSOPT)
  • D6a
    D6a
    D6a
  • Make it easy for you to raise concerns or disagree with recommendations for the child’s health care? (RAISECONC)
  • D6b
    D6b
    D6b
  • Work with you to decide together which health care and treatment choices would be best for this child? (BESTFORCHILD)
  • D6c
    D6c
    D6c
    Care Coordination
    Does anyone help you arrange or coordinate this child’s care among the different doctors or services that this child uses? (K5Q20_R) [If child did not see more than one health care provider in past 12 months, skip to D11] D7 D7 D7
    DURING THE PAST 12 MONTHS, have you felt that you could have used extra help arranging or coordinating this child’s care among the different health care providers or services? (K5Q21) D8 D8 D8
    If yes, DURING THE PAST 12 MONTHS, how often did you get as much help as you wanted with arranging or coordinating this child’s health care? (K5Q22) D9 D9 D9
    Overall, how satisfied are you with the communication among this child’s doctors and other health care providers? (K5Q30) D10 D10 D10
    DURING THE PAST 12 MONTHS, did this child’s health care provider communicate with the child’s school, child care provider, or special education program? (K5Q31_R) D11 D11 D11
    If yes, overall, how satisfied are you with the health care provider’s communication with the school, child care provider, or special education program? (K5Q32) D12 D12 D12
    Transition to Adulthood
    Do any of this child’s doctors or other health care providers treat only children? (TREATCHILD) - - D13
    If yes, have they talked with you about having this child eventually see doctors or other health care providers who treat adults? (TREATADULT) - - D14
    Has this child’s doctor or other health care provider actively worked with this child to: - - D15
  • Think about and plan for his or her future? (PLANFUTURE)^
  • - - D15a
  • >Make positive choices about his or her heath? (POSCHOICE)^
  • - - D15b
  • Gain skills to manage his or her health and health care? (GAINSKILLS)
  • - - D15c
  • Understand the changes in health care that happen at age 18? (CHANGEAGE)^
  • - - D15d
    Have this child’s doctors or other health care providers worked with you and this child to create a written plan to meet his or her health goals and needs? (WRITEPLAN)^ - - D16
    Does this plan identify specific health goals for this child and any health needs or problems this child and any health needs or problems this child may have and how to get these needs met? (PLANNEEDS)^ - - D17
    Did you and this child receive a written copy of this plan of care? (RECEIVECOPY)^ - - D18
    Is this plan CURRENTLY up-to-date for this child? (PLANUTD)^ - - D19
    Eligibility for health insurance often changes in young adulthood. Do you know how this child will be insured as he or she becomes an adult? (HEALTHKNOW)^ - - D20
    If no, has anyone discussed with you how to obtain or keep some type of health insurance coverage as this child becomes an adult? (KEEPINSADULT) - - D21
    E. This Child's Health Insurance Coverage
    DURING THE PAST 12 MONTHS, was this child EVER covered by ANY kind of health insurance or health coverage plan? (K3Q04_R) [If child was covered all 12 months, skip to E4] E1 E1 E1
    Indicate whether any of the following is a reason this child was not covered by health insurance DURING THE PAST 12 MONTHS: E2 E2 E2
  • Change in employer or employment status (K12Q01_A)
  • E2a
    E2a
    E2a
  • Cancellation due to overdue premiums (K12Q01_B)
  • E2b
    E2b
    E2b
  • Dropped coverage because it was unaffordable (K12Q01_C)
  • E2c
    E2c
    E2c
  • Dropped coverage because benefits were inadequate (K12Q01_D)^
  • E2d
    E2d
    E2d
  • Dropped coverage because choice of health care providers was inadequate (K12Q01_E)
  • E2e
    E2e
    E2e
  • Problems with application or renewal process (K12Q01_F)
  • E2f
    E2f
    E2f
  • Other, specify (K12Q01_G)
  • E2g
    E2g
    E2g
    Is this child CURRENTLY covered by ANY kind of health insurance or health coverage plan? (CURRCOV) E3 E3 E3
    Is this child covered by any of the following types of health insurance or health coverage plans? E4 E4 E4
  • Insurance through a current or former employer or union (K12Q03)
  • E4a
    E4a
    E4a
  • Insurance purchased directly from an insurance company (K12Q04)
  • E4b
    E4b
    E4b
  • Medicaid, Medical Assistance, or any kind of government assistance plan for those with low incomes or a disability (K12Q12)
  • E4c
    E4c
    E4c
  • TRICARE or other military health care (TRICARE)
  • E4d
    E4d
    E4d
  • Indian Health Service (K11Q03R)
  • E4e
    E4e
    E4e
  • Other, specify (HCCOVOTH)
  • E4f
    E4f
    E4f
    How often does this child’s health insurance offer benefits or cover services that meet this child’s needs? (K3Q20) E5 E5 E5
    How often does this child’s health insurance allow him or her to see the health care providers he or she needs? (K3Q22) E6 E6 E6
    Thinking specifically about this child’s mental or behavioral health needs, how often does this child’s health insurance offer benefits or cover services that meet these needs? (MENBEVCOV)^ E7 E7 E7
    F. Providing for This Child's Health
    How much money did you pay for this child’s medical, health, dental, and vision care DURING THE PAST 12 MONTHS? (K3Q21A) F1 F1 F1
    How often are these costs reasonable? (K3Q21B) F2 F2 F2
    DURING THE PAST 12 MONTHS, did your family have problems paying for any of this child’s medical or health care bills? ( K3Q25) F3 F3 F3
    DURING THE PAST 12 MONTHS, have you or other family members: F4 F4 F4
  • Stopped working because of this child’s health or health conditions? (STOPWORK)
  • F4a
    F4a
    F4a
  • Cut down on the hours you work because of this child’s health or health conditions? (CUTHOURS)
  • F4b
    F4b
    F4b
  • Avoided changing jobs because of concerns about maintaining health insurance for this child? (AVOIDCHG)
  • F4c
    F4c
    F4c
    IN AN AVERAGE WEEK, how many hours do you or other family members spend providing health care at home for this child? (ATHOMEHC) F5 F5 F5
    IN AN AVERAGE WEEK, how many hours do you or other family members spend arranging or coordinating health or medical care for this child, such as making appointments or locating services? (ARRANGEHC) F6 F6 F6
    G. This Child's Learning (0-5 years)
    Has this child started school? (STARTSCHOOL) [If child is <3 years, skip to section H]  G1  -  -
    How well is this child learning to do things for him or herself? (K6Q08_R)  G2  -  -
    How confident are you that this child will be successful in elementary or primary school? (CONFIDENT)  G3  -  -
    How often can this child recognize the beginning sound of a word? (RECOGBEGIN)^  G4  -  -
    About how many letters of the alphabet can this child recognize? (RECOGABC)^  G5  -  -
    Can this child rhyme words? (RHYMEWORD)^  G6  -  -
    How often can this child explain things he or she has seen or done so that you get a very good idea what happened? (CLEAREXP)^  G7  -  -
    How often can this child write his or her first name, even if some of the letters aren’t quite right or are backwards? (WRITENAME)^  G8  -  -
    How high can this child count? (COUNTTO)^  G9  -  -
    How often can this child identify basic shapes such as a triangle, circle, or square? (RECSHAPES)^  G10  -  -
    How often is this child easily distracted? (DISTRACTED)^  G11  -  -
    How often does this child keep working at something until he or she is finished? (WORKTOFIN)^  G12  -  -
    When he or she is paying attention, how often can this child follow instructions to complete a simple task? (SIMPLEINST)^  G13  -  -
    When this child holds a pencil, does he or she use fingers to hold, or does he or she grip it in his or her fist? (USEPENCIL)^  G14  -  -
    How often does this child play well with others? (PLAYWELL)^  G15  -  -
    This child becomes angry or anxious when going from one activity to another. (NEWACTIVITY)^  G16  -  -
    This child shows concern when others are hurt or unhappy. (HURTSAD)^  G17  -  -
    This child can calm down when excited or all wound up. (CALMDOWN)  G18  -  -
    This child loses control of his or her temper when things do not go his or her way. (TEMPER)^  G19  - -
    Compared to other children his or her age, how much difficulty does this child have making or keeping friends? (MAKEFRIEND)  G20  G7  G7
    Compared to other children his or her age, how often is this child able to sit still? (SITSTILL)^  G21  -  -
    IN THE PAST 12 MONTHS, were you ever asked to keep your child home from any child care or preschool because of their behavior? (EXPULSION)^  G22  -  -
    G. This Child's Learning (6-17 years)
    DURING THE PAST 12 MONTHS, about how many days did this child miss school because of illness or injury? (K7Q02R_R)  -  G1  G1
    DURING THE PAST 12 MONTHS, how many times has this child’s school contacted you or another adult in your household about any problems he or she is having with school? (K7Q04R_R)  -  G2  G2
    SINCE STARTING KINDERGARTEN, has this child repeated any grades? (REPEATED)  -  G3  G3
    DURING THE PAST 12 MONTHS, did this child participate in:  -  G4  G4
  • A sports team or did he or she take sports lessons after school or on weekends? (K7Q30)
  •  -  G4a  G4a
  • Any clubs or organizations after school or on weekends? (K7Q31)
  •  -  G4b  G4b
  • Any other organized activities or lessons, such as music, dance, language, or other arts? (K7Q32)
  •  -  G4c  G4c
  • Any type of community service or volunteer work at school, church, or in the community? (K7Q37)
  •  -  G4d  G4d
  • Any paid work, including regular jobs as well as babysitting, cutting grass, or other occasional work? (K7Q38)
  •  -  G4e  G4e
    DURING THE PAST 12 MONTHS, how often did you attend events or activities that this child participated in? (K7Q33)  -  G5  G5
    DURING THE PAST WEEK, on how many days did this child exercise, play a sport, or participate in physical activity for at least 60 minutes? (PHYSACTIV)  -  G6  G6
    Compared to other children his or her age, how much difficulty does this child have making or keeping friends? (MAKEFRIEND)  G20  G7  G7
    H. About You and This Child
    Was this child born in the United States? (BORNUSA) H1 H1 H1
    If no, how long has this child been living in the United States? (LIVEUSA_YR/LIVEUSA_MO) H2 H2 H2
    How many times has this child moved to a new address since he or she was born? (K11Q43R) H3 H3 H3
    How often does this child go to bed at about the same time on weeknights? (BEDTIME)^ H4 H4 H4
    DURING THE PAST WEEK, how many hours of sleep did this child get [during an average day (count both nighttime sleep and naps)/on an average weeknight]? (HOURSLEEP) H5 H5 H5
    In which position do you most often lay this baby down to sleep now? [<12 months only] (SLEEPPOS)^ H6

    ON AN AVERAGE WEEKDAY, about how much time does this child usually spend in front of a TV watching TV programs, videos, or playing video games? (K7Q60_R) H7 H6 H6
    ON AN AVERAGE WEEKDAY, about how much time does this child usually spend with computers, cell phones, handheld video games, and other electronic devices doing things other than schoolwork? (K7Q91_R) H8 H7 H7
    DURING THE PAST WEEK, how many days did you or other family members read to this child? (K6Q60_R) H9 - -
    DURING THE PAST WEEK, how many days did you or other family members tell stories or sing songs to this child? (K6Q61_R) H10 - -
    How well can you and this child share ideas or talk about things that really matter? (K8Q21) - H8 H8
    How well do you think you are handling the day-to-day demands or raising children? (K8Q30) H11 H9 H9
    DURING THE PAST MONTH, how often have you felt:  H12 H10 H10
  • That this child is much harder to care for than most children his or her age? (K8Q31)
  • H12a
    H10a
    H10a
  • That this child does things that really bother you a lot? (K8Q32)
  • H12b
    H10b
    H10b
  • Angry with this child? (K8Q34)
  • H12c
    H10c
    H10c
    DURING THE PAST 12 MONTHS, was there someone that you could turn to for day-to-day emotional support with parenting or raising children? (K8Q35) H13 H11 H11
    If yes, did you receive emotional support from: ^ H14 H12 H12
  • Spouse? (EMOSUPSPO)^
  • H14a
    H12a
    H12a
  • Other family member or close friend? (EMOSUPOFM)
  • H14b
    H12b
    H12b
  • Health care provider? (EMOSUPHCP)^
  • H14c
    H12c
    H12c
  • Place of worship or religious leader? (EMOSUPWOR)^
  • H14d
    H12d
    H12d
  • Support or advocacy group related to specific health condition? (EMOSUPADV)^
  • H14e
    H12e
    H12e
  • Peer support group? (EMOSUPPEER)^
  • H14f
    H12f
    H12f
  • Counselor or other mental health professional? (EMOSUPMHP)
  • H14g
    H12g
    H12g
  • Other person, specify (EMOSUPOTH)^
  • H14h
    H12h
    H12h
    Does this child receive care for at least 10 hours per week from someone other than his or her parent or guardian? (K6Q20) H15 - -
    DURING THE PAST 12 MONTHS, did you or anyone in the family have to quit a job, not take a job, or greatly change your job because of problems with child care for this child? (K6Q27) H16 - -
    I. About Your Family and Household
    DURING THE PAST WEEK, on how many days did all the family members who live in the household eat a meal together? (K8Q11) I1 I1 I1
    Does anyone living in your household use cigarettes, cigars, or pipe tobacco? (K9Q40) I2 I2 I2
    If yes, does anyone smoke inside your home? (K9Q41) I3 I3 I3
    When your family faces problems, how often are you likely to do each of the following?^ I4 I4 I4
  • Talk together about what to do (TALKABOUT)^
  • I4a
    I4a
    I4a
  • Work together to solve our problems (WKTOSOLVE)
  • I4b
    I4b
     I4b
  • Know we have strengths to draw on (STRENGTHS)^
  • I4c
    I4c
    I4c
  • Stay hopeful even in difficult times (HOPEFUL)^
  • I4d
    I4d
    I4d
    SINCE THIS CHILD WAS BORN, how often has it been very hard to get by on your family’s income – hard to cover the basics like food or housing? (ACE1) I5 I5 I5
    The next question is about whether you were able to afford the food you need. Which of these statements best describes the food situation in your household IN THE PAST 12 MONTHS? (FOODSIT)^ I6 I6 I6
    At any time DURING THE PAST 12 MONTHS, even for one month, did anyone in your family receive: I7 I7 I7
  • Cash assistance from a government welfare program? (K11Q60)
  • I7a
    I7a
    I7a
  • Food Stamps or Supplemental Nutrition Assistance Program benefits (SNAP) (K11Q61)?
  • I7b
    I7b
    I7b
  • Free or reduced-cost breakfasts or lunches at school? (K11Q62)
  • I7c
    I7c
    I7c
  • Benefits from the Women, Infants, and Children (WIC) Program? (S9Q34)
  • I7d
    I7d
    I7d
    In your neighborhood, is/are there:  I8 I8 I8
  • Sidewalks or walking paths? (K10Q11)
  • I8a
    I8a
    I8a
  • A park or playground? (K10Q12)
  • I8b
    I8b
    I8b
  • A recreation center, community center, or boys’ and girls’ club? (K10Q13)
  • I8c
    I8c
    I8c
  • A library or bookmobile? (K10Q14)
  • I8d
    I8d
    I8d
  • Litter or garbage on the street or sidewalk? (K10Q20)
  • I8e
    I8e
    I8e
  • Poorly kept or rundown housing? (K10Q22)
  • I8f
    I8f
    I8f
  • Vandalism such as broken windows or graffiti? (K10Q23)
  • I8g
    I8g
    I8g
    To what extent do you agree with these statements about your neighborhood or community? I9 I9 I9
  • People in this neighborhood help each other out (K10Q30)
  • I9a
    I9a
    I9a
  • We watch out for each other’s children in this neighborhood (K10Q31)
  • I9b
    I9b
    I9b
  • This child is safe in our neighborhood (K10Q40_R)
  • I9c
    I9c
    I9c
  • When we encounter difficulties, we know where to go for help in our community (GOFORHELP)^
  • I9d
    I9d
    I9d
  • This child is safe at school (K10Q41_R )
  • - I9e
    I9e
    Other than you or other adults in your home, is there at least one other adult in this child’s school, neighborhood, or community who knows this child well and who he or she can rely on for advice or guidance? (K9Q96) - I10 I10
    To the best of your knowledge, has this child EVER experienced any of the following?  I10 I11 I11
  • Parent or guardian divorced or separated (ACE3)
  • I10a
    I11a
    I11a
  • Parent or guardian died (ACE4)
  • I10b
    I11b
    I11b
  • Parent or guardian served time in jail (ACE5)
  • I10c
    I11c
    I11c
  • Saw or heard parents or adults slap, hit, kick punch one another in the home (ACE6)
  • I10d
    I11d
    I11d
  • Was a victim of violence or witnessed violence in neighborhood (ACE7)
  • I10e
    I11e
    I11e
  • Lived with anyone who was mentally ill, suicidal, or severely depressed (ACE8)
  • I10f
    I11f
    I11f
  • Lived with anyone who had a problem with alcohol or drugs (ACE9)
  • I10g
    I11g
    I11g
  • Treated or judged unfairly because of his or her race or ethnic group (ACE10)
  • I10h
    I11h
    I11h
    J. About You
    These questions are to be completed for each of the two adults in the household who are this child’s primary caregivers. If there is just one adult, provide answers for that adult.
    How are you related to this child? (A#_RELATION) J1/J11 J1/J11
    J1/J11
    What is your sex? (A#_SEX) J2/J12 J2/J12
    J2/J12
    What is your age? (A#_AGE)^ J3/J13 J3/J13
    J3/J13
    Where were you born? (A#_BORN) J4/J14 J4/J14
    J4/J14
    [If outside of the U.S.] When did you come to live in the United States? (A#_LIVEUSA) J5/J15 J5/J15
    J5/J15
    What is the highest grade or year of school you have completed? (A#_GRADE) J6/J16 J6/J16
    J6/J16
    What is your marital status? (A#_MARITAL) J7/J17 J7/J17
    J7/J17
    In general, how is your physical health? (A#_PHYSHEALTH) J8/J18 J8/J18
    J8/J18
    In general, how is your mental or emotional health? (A#_MENTHEALTH) J9/J19 J9/J19
    J9/J19
    Were you employed at least 50 out of the past 52 weeks? (A#_K11Q50_R) J10/J20 J10/J20
    J10/J20
    K. Household Information
    How many people are living or staying at this address? (HHCOUNT) K1 K1 K1
    How many of these people in your household are family members? (FAMCOUNT) K2 K2 K2
    Income IN THE LAST CALENDAR YEAR (2015). Mark Yes or No for each type, and give best estimate of total amount for those types marked Yes.^ K3 K3 K3
  • Wages, salary, commissions, bonuses, or tips from all jobs? (INCWAGES)^
  • K3a
    K3a
    K3a
  • Self-employment income from own nonfarm businesses or farm businesses, including proprietorships and partnerships? (INCSELFEMP)^
  • K3b
    K3b
    K3b
  • Interest, dividends, net rental income, royalty income, or income from estates and trusts? (INCINTDIV)^
  • K3c
    K3c
    K3c
  • Social security or railroad retirement; retirement, survivor, or disability pensions? (INCSSRR)^
  • K3d
    K3d
    K3d
  • Supplemental security income (SSI); any public assistance or welfare payments from the state or local welfare office? (INCSSIPA)
  • K3e
    K3e
    K3e
  • Any other sources of income received regularly such as Veterans’ (VA) payments, unemployment compensation, child support, or alimony? (INCOTHER)^
  • K3f
    K3f
    K3f
    Think about your total combined family income IN THE LAST CALENDAR YEAR for all members of the family. What is that amount before taxes? (TOTINCOME)^ K4 K4 K4