HMRE Codebook - Demographics

HMRE STUDY CODEBOOK

DEMOGRAPHICS AND OTHER

FOR OFFICE USE ONLY

Variable Name T1 T2 PP Question (Variable Label) Values

P1_Fed_ID X X X Federal ID: Participant

DyadID X X X Dyad/Couple ID

ClassID X X X Class/Program ID

Fac1_ID X X X Facilitator 1 ID

Fac2_ID X X X Facilitator 2 ID

Fac1_Sex X X X Facilitator 1 Gender

(Note: computed based on ID)

0 = Male; 1 = Female

Fac2_Sex X X X Facilitator 2 Gender

(Note: computed based on ID)

0 = Male; 1 = Female

StrtDate X X X Program Start Date

EndDate X X X Program Completion Date

HrsComp X X X Hours Completed

IDEnt X X X ID # Entered

Partner X X X Which partner is this?

(Note: determined by data

enterer - be consistent)

0 = Single, No Partner

1 = Partner 1 (Male); 2 = Partner 2 (Female)

*If same-sex couple be consistent across

surveys for partner number

ID

Variable Name T1 T2 PP Question (Variable Label) Values

Date X X X Today’s Date

P1_sex X X X Partner 1 Gender 0=Male; 1=Female

P1_BrthMth X X X Partner 1 Month born

P1_BrthDay X X X Partner 1 Day of month born

P1_Last3Nm X X X Partner 1 Last 3 letters last

name

(Note: if only 2or 3 letter last name, type

last letter only to de-identify participant)

P1_BrthYr X X X Partner 1 Year born (Note: use BrthMth and BrthYr to compute

age as of date pre-survey was completed)

P1_Zip X X X Partner 1 Zip Code

P1_ID X X X Partner 1 ID

P2_sex X Partner 2 Gender 0=Male; 1=Female

P2_BrthMth X Partner 2 Month born

P2_BrthDay X Partner 2 Day of month born

P2_Last3Nm X Partner 2 Last 3 letters last

name

P2_BrthYr X Partner 2 Year born

HMRE 1

P2_Zip X Partner 2 Zip Code

P2_ID Partner 2 ID

Variable

Name

Question (Variable Label) Values Source

CStat Are you currently in a

couple/romantic relationship?

0=No; 1=Yes

MStat How would you describe your

current couple/romantic

relationship?

1=Committed (not engaged/married)

2=Engaged to be married

3=Married

Cohab Do you live with your partner 0=No; 1=Yes

Rel_Yr How long have you been in your


(YRS)

Rel_Mn How long have you been in your


(MTHS)

Rel_Lth Length of current couple

relationship (Months)

COMPUTE = (Rel_Yr x 12) + Rel_Mn

P_Class Is your spouse or romantic partner

also taking this class?

0=No; 1=Yes

MarN_S How many times (including your

current marriage) have you been

married?

0, 1, 2, 3, 4, 5+

MarN_P How many times (including your

current marriage to you) has your

partner been married?

0, 1, 2, 3, 4, 5+

AdHshld How many adults (including

yourself) are living in your house at

least 50% of the time?

0, 1, 2, 3, 4, 5+

KidHhd How many children (under 18) are

living in your household at least

50% of the time?

0, 1, 2, 3, 4, 5+

KidBio How many biological (and

adoptive) children do you and your

current partner share? (Do not

include children from a previous

relationship).

0, 1, 2, 3, 4, 5+

KidPr_S How many children do you have

from a previous relationship?

0, 1, 2, 3, 4, 5+

KidPr_P How many children does your

partner have from a previous

relationship?

0, 1, 2, 3, 4, 5+

KidY_Yr What is the age of your youngest

child living in your house?

(YEARS)

HMRE 1

KidY_Mn What is the age of your youngest

child living in your house?

(MONTHS)

Office Use Only

Variable Name Question (Variable Label) Values Source

P1_Fed_ID Federal ID: Participant 1 Office Use

Only

P2_Fed_ID Federal ID: Participant 2 Office Use

Only

UGAFam_ID UGA Family ID: Participant 1

Federal ID- Participant 1 Last

name- Cluster Number

Office Use

Only

PartID Participant ID: UGA Family ID-1

(if P1) or UGA Family ID-2 (if

P2)

Office Use

Only

P1_UGASurv_ID UGA Survey (Back-up) ID:

Participant 1

Office Use

Only

P2_UGASurv_ID UGA Survey (Back-up) ID:

Participant 2 (if applicable)

Office Use

Only

DFCS_Reg DFCS Region/Cluster 1=Cluster 1

2=Cluster 2

3=Cluster 3

Office Use

Only

DFCS_Ref DFCS Referral 1=Reunified foster care case/Court-ordered

referral (RCT eligible, if couple)

2=Family preservation (closed case)

3=Substantiated Closed Investigation

4=Unsubstantiated Closed Investigation

5=Closed Family Support Case

Office Use

Only

RelStat Relationship Status 1=Single

2=Married

3=Couple (> 6mth)

4=Couple (< 6mth)

Office Use

Only

ParStat Parent Status 1=Expectant Parent

2=New Parent (child 0-5)

3=Adoptive Parent

4=Foster Parent

5=Kinship Caregiver

6=Fictive Kin Caregiver

7=Other (Text)

Office Use

Only

ProgElig Program Eligibility 1=Elevate

2=Elevate RCT

3=Elevate Weekend Retreat

4=Together We Can

Office Use

Only

ProgID Program ID (from nFORM, after

enrolled)

Office Use

Only

HMRE 1

Family Engagement Summary


Enroll_Typ Enrollment Type 1=Referral 2=Self-referred 3=Registered at Community event

FES

Enroll_RefDate Enrollment: Referral Date FES

Enroll_RefSrc Enrollment: Referral Source FES

Enroll_SelfRefDate Enrollment: Self-referred Date FES

Enroll_CE_Date Enrollment: Registered at Community event Date

FES

Enroll_CE_Met Enrollment: Registered at Community event Location/Person Met

FES

LM Letter Mailed 0=No 1=Yes 2=N/A (Weekend Retreat or Self-referral)

FES

LM_Date (IF Yes) Letter Mailed Date FES

InIntCall_Date Initial Intake Phone Call Date Completed FES

InIntCall_Time Initial Intake Phone Call Time FES

InIntNav Initial Intake Phone Call Completed by FES

LM_HTR Hard to Reach Letter Mailed 0=No; 1=Yes FES

LM_HTR_Date (IF Yes) Hard to Reach Letter Mailed Date FES

LM_HTR_Nav (IF Yes) Hard to Reach Letter Mailed Who Prepped/Mailed

FES

LM_CO Close-Out Letter Mailed 0=No; 1=Yes FES

LM_CO_Date (IF Yes) Close-Out Letter Mailed Date FES

LM_CO_Nav (IF Yes) Close-Out Letter Mailed Who Prepped/Mailed

FES

PIV_Nav1 Navigator 1 FES

PIV_Nav2 Navigator 2 FES

PIV_OS_Date Originally Scheduled: Date FES

PIV_OS_Time Originally Scheduled: Time FES

PIV_Date PIV Completed: Date FES

PIV_Time PIV Completed: Time FES

PIV_XResch # of Times Rescheduled 0, 1, 2, 3+ FES

PIV_Location Location 1=Phone (PIC) 2=Home (PIV) 3=Other

FES

PIV_LocationOth Location- Other: FES

P1_ProgConsDate Program Consent Date FES

P1_ResConsDate Research Consent Date FES

P1_CCareWaivDate Childcare Waiver (if applicable) Date FES

P2_ProgConsDate Program Consent Date FES

P2_ResConsDate Research Consent Date FES

P2_CCareWaivDate Childcare Waiver (if applicable) Date FES

HMRE 1

Hotel_Res Hotel Room Reserved 0=No; 1=Yes FES

CCare_Need Childcare Needed 0=No; 1=Yes FES

NA_Date Needs Assessment Follow-Up Date Completed

FES

NA_Time Needs Assessment Follow-Up Time FES

NA_Nav Needs Assessment Completed by: FES

PAE1_Date PAE (Program Attendance & Engagement) Session 1: Date

FES

P1_PAE1_Attend Session 1: Attended 0=No; 1=Yes FES

P1_PAE1_FUDate Session 1: Follow-up Call Date FES



PAE2_Date PAE Session 2: Date FES






























Evaluation Assessments

HMRE 1


P1_EA1_Typ (Evaluation) Assessment #1 1=Group 2=Home Visit

EA

P1_EA1_SchDate Assessment #1 Scheduled Date EA

P1_EA1_EndDate Assessment #1 Completion Date EA

P1_EA2_Typ Assessment #2 1=Group 2=Home Visit

EA




EA



P2_ EA1_Typ Assessment #1 1=Group 2=Home Visit

EA




EA




EA



P1_nfm_AppChDate Applicant Characteristic (AppC) Date EA

P1_nfm_EntDate Entry Form Date EA

P1_nfm_ExitDate Exit Form Date EA

P2_nfm_AppChDate Applicant Characteristic Date EA

P2_nfm_EntDate Entry Form Date EA

P2_nfm_ExitDate Exit Form Date EA

Phone Call Log and Notes


Call1_Part Phone Call 1: Participant Calling/Called 1=Participant 1 2=Participant 2

Call Log

Call1_Date Phone Call 1: Date Call Log

Call1_Time Phone Call 1: Time Call Log

Call1_Nav Phone Call 1: Project F.R.E.E. Staff Name Call Log

Call1_Nature Phone Call 1: Nature of Call 1=Initial Intake 2=PIV/PIC-related 3=Pre-Assessment 4=Needs Assessment 5=Program reminder/follow-up

Call Log

HMRE 1

6=Post-Assessment 7=Other

Call1_NatureOth Phone Call 1: Nature of Call- Other Call Log

Call1_Result Phone Call 1: Result of Call 1=No Answer/Kept Ringing 2=Hang Up 3=Disconnected 4=Voice Message 5=Spoke to 6=Other

Call Log

Call1_ResultWho Phone Call 1: Result of Call- Spoke to Call Log

Call1_ResultOth Phone Call 1: Result of Call- Other Call Log

Call1_FUNeed Phone Call 1: Follow Up Needed 0=No; 1=Yes Call Log

Call1_Desc Phone Call 1: Yes (describe) Call Log

Call2_Part Phone Call 2: Participant Called 1=Participant 1 2=Participant 2

Call Log


Call2_Time Phone Call 2: Time of Call Call Log


Call2_Nature Phone Call 2: Nature of Call 1=Initial Intake 2=PIV/PIC-related 3=Pre-Assessment 4=Needs Assessment 5=Program reminder/follow-up 6=Post-Assessment 7=Other

Call Log



Call Log





Call3_Part Phone Call 3: Participant Called 1=Participant 1 2=Participant 2

Call Log


Call3_Time Phone Call 3: Time of Call Call Log


Call3_Nature Phone Call 3: Nature of Call 1=Initial Intake 2=PIV/PIC-related 3=Pre-Assessment 4=Needs Assessment 5=Program reminder/follow-up

Call Log

HMRE 1

6=Post-Assessment 7=Other



Call Log





Form 2A: Contact Information


P1_PriCont Participant 1: Primary Contact 0=No; 1=Yes 2A

P1_LName Last Name 2A

P1_FName First Name 2A

P1_MidIn Middle Initial 2A

P1_StrAd Street Address 2A

P1_Apt Apartment/Unit # 2A

P1_Cnty County 2A

P1_City City 2A

P1_State State 2A

P1_Zip Zip Code 2A

P1_CellPh Cell Phone 2A

P1_CellVoice OK to leave voicemail or text message 0=No; 1=Yes 2A

P1_HmPh Home Phone 2A

P1_HmVoice OK to leave voicemail or text message 0=No; 1=Yes 2A

P1_AltPh Alternate Phone 2A

P1_AltVoice OK to leave voicemail or text message 0=No; 1=Yes 2A

P1_PrefCont Preferred Contact 1=Cell Phone 2=Home Phone 3=Alternate Phone

2A

P1_BestCallDay Best Day(s) to Call 1=Mon 2=Tues 3=Wed 4=Thur 5=Fri

2A

P1_BestCallTime Best Time(s) to Call 1=10AM-12PM 2=12PM-3PM 3=3PM-6PM 4=6PM-8PM

2A

P1_Email Email 2A

HMRE 1

P1_EmailInfo OK to email with class information 0=No; 1=Yes 2A

P2_PriCont Participant 2: Primary Contact 0=No; 1=Yes 2A

P2_LName Last Name 2A

P2_FName First Name 2A

P2_MidIn Middle Initial 2A

P2_P1Address Same address as Participant 1 0=No; 1=Yes 2A

P2_StrAd Street Address 2A

P2_Apt Apartment/Unit # 2A

P2_Cnty County 2A

P2_City City 2A

P2_State State 2A

P2_Zip Zip Code 2A

P2_CellPh Cell Phone 2A

P2_CellVoice OK to leave voicemail or text message 0=No; 1=Yes 2A

P2_HmPh Home Phone 2A

P2_HmVoice OK to leave voicemail or text message 0=No; 1=Yes 2A

P2_AltPh Alternate Phone 2A

P2_AltVoice OK to leave voicemail or text message 0=No; 1=Yes 2A

P2_PrefCont Preferred Contact 1=Cell Phone 2=Home Phone 3=Alternate Phone

2A

P2_BestCallDay Best Day(s) to Call 1=Mon 2=Tues 3=Wed 4=Thur 5=Fri

2A

P2_BestCallTime Best Time(s) to Call 1=10AM-12PM 2=12PM-3PM 3=3PM-6PM 4=6PM-8PM

2A

P2_Email Email 2A

P2_EmailInfo OK to email with class information 0=No; 1=Yes 2A

P1_EmerConNm Emergency Contact Information: Full Name 2A

P1_EmerConPh Emergency Contact Information: Phone Number 2A

P1_EmerConRel Emergency Contact Information: Relationship to you? 2A

P2_EmerConNm Emergency Contact Information: Full Name 2A

P2_EmerConPh Emergency Contact Information: Phone Number 2A

P2_EmerConRel Emergency Contact Information: Relationship to you? 2A

Form 2B: Eligibility Information


RelStat Are you currently in a committed couple relationship? 0=No; 1=Yes 2B

RelStatTyp IF YES: How would you describe your current couple relationship?

1=Dating 2=Engaged

2B

HMRE 1

3=Married 4=Other

RelStatTyp_Oth Current couple relationship- Other 2B

LenMar_Yr If married: How long have you been married (years)? 2B

LenMar_Mth If married: How long have you been married (months)? 2B

LenRel_Yr In total, how long have you been with your partner (years)?

2B

LenRel_Mth In total, how long have you been with your partner (months)?

2B

LvTg Do you and your partner currently live together? 0=No; 1=Yes 2B

HaveCh Excluding children in foster care, how many children do you (and/or your partner) have?

2B

YChAge_Yr Excluding children in foster care, what is the age of your (and/or your partner's) youngest child (years)?

2B

YChAge_Mth Excluding children in foster care, what is the age of your (and/or your partner's) youngest child (months)?

2B

YChSex Youngest Child Gender 0=Female 1=Male

2B

YChRel Youngest Child Relationship 1=Biological 2=Adopted 3=Stepchild 4=Other

2B

YChRel_Oth Youngest Child Relationship- Other 2B

YCh_Part Youngest Child: Whose 1=Part. 1 2=Part. 2 3=Both

2B

OChAge_Yr Excluding children in foster care, what is the age of your (and/or your partner's) oldest child (years)?

2B

OChAge_Mth Excluding children in foster care, what is the age of your (and/or your partner's) oldest child (months)?

2B

OChSex Oldest Child Gender 0=Female 1=Male

2B

OChRel Oldest Child Relationship 1=Biological 2=Adopted 3=Stepchild 4=Other

2B

OChRel_Oth Oldest Child Relationship- Other 2B

OCh_Part Oldest Child: Whose 1=Part. 1 2=Part. 2 3=Both

2B

CurrPreg Are you (or your partner) currently pregnant? 0=No; 1=Yes 2B

FPar Are you an approved and currently active (i.e., eligible for placement) foster parent?

0=No; 1=Yes 2B

Num_FCh In the past 12 months, how many children in foster care have you cared for?

2B

CurrNum_FCh Currently how many children in foster care are living in your home?

2B

LenFPar_Yr How long have you been an approved foster caregiver (years)?

2B

HMRE 1

LenFPar_Mth How long have you been an approved foster caregiver (months)?

2B

AgencyCertU Which agency are you certified under? 1=DFCS 2=CPA 3=Other

2B

AgencyCertU_Oth Agency certified under- Other 2B

FPar_Reg Foster Caregiver registering for weekend retreat? 0=No; 1=Yes 2B

Both_Attend IF YES: Are both you and your partner planning to attend?

0=No; 1=Yes 2B

Prov_CCard Would you be able to provide a credit card to reserve your hotel room?

0=No; 1=Yes 2B

CCare_Need

From your application I see you wanted/needed to bring your children to the retreat, is this correct?

0=No Child Care Needed 1=Yes Child Care Needed

2B

CCare_ChAges IF Yes: Ages of each child you would need to bring with you:

2B

Form 2C-1: Relationship Safety Screening (Partner)


P1_2C1_RSS1 In general, how would you describe your relationship? 0=No tension 1=Some tension 2=A lot of tension

2C-1

P1_2C1_RSS2 Do you and your partner work out arguments with… 0=No difficulty 1=Some difficulty 2=Great difficulty

2C-1

P1_2C1_RSS3 Do arguments ever result in you feeling down or bad about yourself?

0=Never 1=Sometimes 2=Often

2C-1

P1_2C1_RSS4 Do arguments ever result in hitting, kicking or pushing?


2C-1

P1_2C1_RSS5 Do you ever feel frightened by what your partner says or does?


2C-1


2C-1


2C-1



2C-1



2C-1

HMRE 1



2C-1

Form 2C-2: Relationship Safety Screening (Co-Parent)



2C-2


2C-2



2C-2



2C-2



2C-2

Form 2D: Engagement with DFCS/Additional Social Services


SNAP_Recv Food Stamps or Supplemental Nutritional Assistance Program

0=No 1=Yes Past 2=Yes Current

2D

WIC_Recv Women, Infants, and Children 0=No 1=Yes Past 2=Yes Current

2D

TANF_Recv Temporary Assistance for Needy Families 0=No 1=Yes Past 2=Yes Current

2D

Medicaid_Recv Medicaid 0=No 1=Yes Past 2=Yes Current

2D

OthDFCSSer_Recv Other services from DFCS or the Health Department 0=No 1=Yes Past 2=Yes Current

2D

CurrOC_FC DFCS Open Case: Foster Care 0=No 1=Yes Past 2=Yes Current

2D

CurrOC_FamPres DFCS Open Case: Family Preservation 0=No 1=Yes Past 2=Yes Current

2D

HMRE 1

CurrOC_Investig DFCS Open Case: Open DFCS Investigation 0=No 1=Yes Past 2=Yes Current

2D

CurrOC_FamSup DFCS Open Case: Family Support Case 0=No 1=Yes Past 2=Yes Current

2D

CurrOC_ActCrtInv DFCS Open Case: Active Court Involvement 0=No 1=Yes Past 2=Yes Current

2D

CurrOC_Oth DFCS Open Case: Other 0=No 1=Yes Past 2=Yes Current

2D

CMngr_Nm DFCS Case Manager Name 2D

CMngr_Ph DFCS Case Manager Phone Number 2D

FrstStps_Recv First Steps 0=No 1=Yes Past 2=Yes Current

2D

ParAsTeach_Recv Parents as Teachers 0=No 1=Yes Past 2=Yes Current

2D

HFamGa_Recv Healthy Families Georgia 0=No 1=Yes Past 2=Yes Current

2D

GenHmSer_Recv General counseling, parenting, early intervention, or other types of home services

0=No 1=Yes Past 2=Yes Current

2D

HdStrt_Recv Early Head Start or Head Start 0=No 1=Yes Past 2=Yes Current

2D

OthHmVSer_Recv Other service where someone comes to your home 0=No 1=Yes Past 2=Yes Current

2D

SSI_Recv Supplemental Security Income 0=No 1=Yes Past 2=Yes Current

2D

SSDI_Recv Social Security Disability Insurance 0=No 1=Yes Past 2=Yes Current

2D

UnempIns_Recv Unemployment Insurance 0=No 1=Yes Past 2=Yes Current

2D

VITA_Recv Voluntary Income Tax Assistance 0=No 1=Yes Past 2=Yes Current

2D

FreeFinCnsl_Recv Free financial Counseling 0=No 1=Yes Past 2=Yes Current

2D

HousEdc_Recv Housing Education 0=No 1=Yes Past

2D

HMRE 1

2=Yes Current

HousVouch_Recv Housing choice voucher 0=No 1=Yes Past 2=Yes Current

2D

HousAthy_Recv Housing Authority 0=No 1=Yes Past 2=Yes Current

2D

FinAssist_Recv Financial Assistance 0=No 1=Yes Past 2=Yes Current

2D

FreeCCare_Recv Free or subsidized childcare resources 0=No 1=Yes Past 2=Yes Current

2D

FreeEmpSer_Recv Free job coaching or employment services 0=No 1=Yes Past 2=Yes Current

2D

OthFinSer_Recv Other financial support service 0=No 1=Yes Past 2=Yes Current

2D

ProjSafe_Recv Project Safe 0=No 1=Yes Past 2=Yes Current

2D

UGAExt_Recv UGA Extension 0=No 1=Yes Past 2=Yes Current

2D

OthAddSer_Recv Other support service 0=No 1=Yes Past 2=Yes Current

2D

GenNeeds What, if any, are potential obstacles that might prevent you and your family from participating in this program?

2D

ExistingRes What, if any, are existing resources that might assist you and your family in participating in this program?

2D

Form 3A: Relationship and Family Information


P1_MarStat Currently married 0=No; 1=Yes 3A

P1_RelHist_SPar If single: Have you ever been married? 0=No; 1=Yes 3A

P1_XMar All: How many times (if married: including your current marriage), have you been married?

3A

P1_NumAdH How many adults, including yourself, live in the home at least half of the time?

3A

P1_NumChH How many children under the age of 18 are living in the house at least half of the time?

3A

P1_NumBioCh_Cpl If couple: How many biological children do you and your current partner share?

3A

P1_NumBioCh_SPar If single: How many biological children do you have? 3A

HMRE 1

P1_NumAdpCh_Cpl If couple: How many adoptive children do you and your current partner share?

3A

P1_NumAdpCh_SPar If single: How many adoptive children do you currently have?

3A

P1_NumChPrvRelH How many children do you have from a previous relationship living with you in the household?

3A

P1_NumChPrvRelNH How many children do you have from your previous relationships who are not living in the household?

3A

P1_Preg Expecting/Pregnant 0=No; 1=Yes 3A

P1_FrstPreg If Expectant Parent: Is this your first child? 0=No; 1=Yes 3A

P1_LenPreg If Expectant Parent: How many months are you (your partner) into your pregnancy?

3A

P1_CaredFCh In the past 12 months, have you (and your partner) cared for a child in foster care?

0=No; 1=Yes 3A

P1_NumFCh If Foster Caregiver: In the past 12 months, how many children in foster care have you care for?

3A

P1_CurrNumFCh If Foster Caregiver: Currently how many children in foster care are living in your home?

3A

P1_LenFPar_Yr If Foster Caregiver: How long have you been an approved foster caregiver (years)?

3A

P1_LenFPar_Mth If Foster Caregiver: How long have you been an approved foster caregiver (months)?

3A

P2_MarStat Currently married 0=No; 1=Yes 3A

P2_XMar All: How many times (if married: including your current marriage), have you been married?

3A

P2_NumAdH How many adults, including yourself, live in the home at least half of the time?

3A

P2_NumChH How many children under the age of 18 are living in the house at least half of the time?

3A

P2_NumBioCh_Cpl If couple: How many biological children do you and your current partner share?

3A

P2_NumAdpCh_Cpl If couple: How many adoptive children do you and your current partner share?

3A

P2_NumChPrvRelH How many children do you have from a previous relationship living with you in the household?

3A

P2_NumChPrvRelNH How many children do you have from your previous relationships who are not living in the household?

3A

P2_Preg Expecting/Pregnant 0=No; 1=Yes 3A

P2_FrstPreg If Expectant Parent: Is this your first child? 0=No; 1=Yes 3A

P2_LenPreg If Expectant Parent: How many months are you (your partner) into your pregnancy?

3A

P2_CaredFCh In the past 12 months, have you (and your partner) cared for a child in foster care?

0=No; 1=Yes 3A

P2_NumFCh If Foster Caregiver: In the past 12 months, how many children in foster care have you care for?

3A

P2_CurrNumFCh If Foster Caregiver: Currently how many children in foster care are living in your home?

3A

P2_LenFPar_Yr If Foster Caregiver: How long have you been an approved foster caregiver (years)?

3A

HMRE 1

P2_LenFPar_Mth If Foster Caregiver: How long have you been an approved foster caregiver (months)?

3A

Form 3B: About You


Part1 Participant 1 1=Participant 1 2=Participant 2

3B

P1_DOB Date of Birth 3B

P1_Age Age (in years) 3B

P1_Sex What is your gender? 0=Female 1=Male 2=Other

3B

P1_SexOth Gender Other 3B

P1_SexOr How would you describe your sexual orientation?

1=Heterosexual 2=Gay/Lesbian 3=Bisexual 4=Other

3B

P1_SexOrOth Sexual orientation Other 3B

P1_Race How would you describe your race? 1=White/Caucasian 2=African-American/Black 3=Asian-American 4=Native-American/Alaskan Native 5=Native Hawaiian/Other Pacific Islander 6=Other

3B

P1_RaceOth Race Other 3B

P1_Eth How would you describe your ethnicity? 1=Non-Hispanic 2=Hispanic 3=Other

3B

P1_EthOth Ethnicity Other 3B

P1_Student Are you currently in school or college? 0=No 1=Yes, Full-time 2=Yes, Part-time

3B

P1_Edc What is the highest level of education you have completed?

1=High School General Education Development 2=Attended high school, but did not earn diploma 3=High school diploma 4=Vocational/technical school certification 5=Some college but no degree completion 6=Associate’s degree 7=Bachelor’s degree 8=Master’s degree/Advanced degree

3B

HMRE 1

P1_EmpStat What is your current employment status? 1=Not currently employed 2=Full-time (35+ hours/week) 3=Part-time (1-34 hours/week) 4=Temporary, occasional, seasonal, or odd jobs for pay

3B

P1_UnempStat If unemployed, are you: 1=Actively looking for work 2=Disabled 3=Retired 4=None of the above

3B

P1_EmpBen If employed, do you have benefits through your job such as paid vacation, sick leave, or life insurance?

0=No 1=Yes 2=I don’t know

3B

P1_Occp If employed, what is your occupation? 3B

P1_HH_AnnInc What is your total household annual income? (if married or living together)

1=Less than $7,000 2=$7,000-$13,999 3=$14,000 – $24,999 4=$25,000 – $39,999 5=$40,000 – $74,999 6=$75,000 – $99,999 7=$100,000+

3B

P1_Last30_Inc In the past 30 days, how much money did you make?

1= Less than $500 2=$500 - $1,000 3=$1,001 - $2,000 4=$2,001 - $3,000 5=$3,001 - $4,000 6=$4,001 - $5,000 7= More than $5,000

3B

P1_LvStat What is your current living situation? 1=Home Owner 2=Rent 3=Other

3B

P1_LvStatOth Living situation Other 3B

P1_DietRes Do you have any dietary restrictions? 0=No 1=Vegetarian 2=Vegan 3=Nut Allergy 4=Other

3B

P1_DietResOth Dietary restrictions Other 3B

P1_Transp Do you have access to transportation that would allow you and your family to attend classes for this program?

0=No; 1=Yes 3B

P1_SNeed Do you have any special needs that impair your daily functioning?

0=No 1=Have a physical disability 2=Have a learning disability 3=Have a developmental disability 4=Have been diagnosed with a mental illness 5=Have a medical illness 6=Other

3B

HMRE 1

P1_SNeedOth Special needs Other 3B

P1_GNeed Which of the following, if any, do you feel describe your greatest needs right now?

1=Unstable housing 2=Rent/mortgage assistance 3=Immediate shelter 4=Utilities assistance 5=Access to phone 6=Connection to educational resources 7=Unemployment 8=Childcare 9=Career/vocational training 10=Food 11=Clothing 12=Access to medical care 13=Social support 14=Physical safety 15=Access to mental health treatment 16=Access to transportation 17=Child(ren)’s developmental needs

3B

Part2 Participant 2 1=Participant 1 2=Participant 2

3B

P2_DOB Date of Birth 3B

P2_Age Age (in years) 3B

P2_Sex What is your gender? 0=Female 1=Male 2=Other

3B

P2_SexOth Gender Other 3B

P2_SexOr How would you describe your sexual orientation?

1=Heterosexual 2=Gay/Lesbian 3=Bisexual 4=Other

3B

P2_SexOrOth Sexual orientation Other 3B

P2_Race How would you describe your race? 1=White/Caucasian 2=African-American/Black 3=Asian-American 4=Native-American/Alaskan Native 5=Native Hawaiian/Other Pacific Islander 6=Other

3B

P2_RaceOth Race Other 3B

P2_Eth How would you describe your ethnicity? 1=Non-Hispanic 2=Hispanic 3=Other

3B

P2_EthOth Ethnicity Other 3B

P2_Student Are you currently in school or college? 0=No 1=Yes, Full-time

3B

HMRE 1

2=Yes, Part-time

P2_Edc What is the highest level of education you have completed?

1=High School General Education Development 2=Attended high school, but did not earn diploma 3=High school diploma 4=Vocational/technical school certification 5=Some college but no degree completion 6=Associate’s degree 7=Bachelor’s degree 8=Master’s degree/Advanced degree

3B

P2_EmpStat What is your current employment status? 1=Not currently employed 2=Full-time (35+ hours/week) 3=Part-time (1-34 hours/week) 4=Temporary, occasional, seasonal, or odd jobs for pay

3B

P2_UnempStat If unemployed, are you: 1=Actively looking for work 2=Disabled 3=Retired 4=None of the above

3B

P2_EmpBen If employed, do you have benefits through your job such as paid vacation, sick leave, or life insurance?


3B

P2_Occp If employed, what is your occupation? 3B

P2_HH_AnnInc What is your total household annual income? (if married or living together)

1=Less than $7,000 2=$7,000-$13,999 3=$14,000 – $24,999 4=$25,000 – $39,999 5=$40,000 – $74,999 6=$75,000 – $99,999 7=$100,000+

3B

P2_Last30_Inc In the past 30 days, how much money did you make?

1= Less than $500 2=$500 - $1,000 3=$1,001 - $2,000 4=$2,001 - $3,000 5=$3,001 - $4,000 6=$4,001 - $5,000 7= More than $5,000

3B

P2_LvStat What is your current living situation? 1=Home Owner 2=Rent 3=Other

3B

P2_LvStat Living situation Other 3B

P2_DietRes Do you have any dietary restrictions? 0=No 1=Vegetarian 2=Vegan 3=Nut Allergy

3B

HMRE 1

4=Other

P2_DietResOth Dietary restrictions Other 3B

P2_Transp Do you have access to transportation that would allow you and your family to attend classes for this program?

0=No; 1=Yes 3B

P2_SNeed Do you have any special needs that impair your daily functioning?

0=No 1=Have a physical disability 2=Have a learning disability 3=Have a developmental disability 4=Have been diagnosed with a mental illness 5=Have a medical illness 6=Other

3B

P2_SNeedOth Special needs Other 3B

P2_GNeed Which of the following, if any, do you feel describe your greatest needs right now?

1=Unstable housing 2=Rent/mortgage assistance 3=Immediate shelter 4=Utilities assistance 5=Access to phone 6=Connection to educational resources 7=Unemployment 8=Childcare 9=Career/vocational training 10=Food 11=Clothing 12=Access to medical care 13=Social support 14=Physical safety 15=Access to mental health treatment 16=Access to transportation 17=Child(ren)’s developmental needs

3B

Form 3C-1: Your Relationship Experiences (Partner)


P1_3C1_YE1 How safe do you feel in your current relationship? 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 3C-1

P1_3C1_YE2 My partner never admits when she or he is wrong. 1, 2, 3, 4, 5 3C-1

P1_3C1_YE3 My partner is unwilling to adapt to my needs and expectations.

1, 2, 3, 4, 5 3C-1

P1_3C1_YE4 My partner is more insensitive than caring. 1, 2, 3, 4, 5 3C-1

P1_3C1_YE5 I am often forced to sacrifice my own needs to meet my partner's needs.

1, 2, 3, 4, 5 3C-1

P1_3C1_YE6 My partner refuses to talk about problems that make him or her look bad.

1, 2, 3, 4, 5 3C-1

HMRE 1

P1_3C1_YE7 My partner withholds affection unless it would benefit her or him.

1, 2, 3, 4, 5 3C-1

P1_3C1_YE8 It is hard to disagree with my partner because she or he gets angry.

1, 2, 3, 4, 5 3C-1

P1_3C1_YE9 My partner resents being questioned about the way he or she treats me.

1, 2, 3, 4, 5 3C-1

P1_3C1_YE10 My partner builds himself or herself up by putting me down.

1, 2, 3, 4, 5 3C-1

P1_3C1_YE11 My partner retaliates when I disagree with him or her. 1, 2, 3, 4, 5 3C-1

P1_3C1_YE12 My partner is always trying to change me. 1, 2, 3, 4, 5 3C-1

P1_3C1_YE13 My partner believes he or she has the right to force me to do things.

1, 2, 3, 4, 5 3C-1

P1_3C1_YE14 My partner is too possessive or jealous. 1, 2, 3, 4, 5 3C-1

P1_3C1_YE15 My partner tries to isolate me from family and friends. 1, 2, 3, 4, 5 3C-1

P1_3C1_YE16 Sometimes my partner physically hurts me. 1, 2, 3, 4, 5 3C-1

P2_3C1_YE1 How safe do you feel in your current relationship? 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 3C-1

P2_3C1_YE2 My partner never admits when she or he is wrong. 1, 2, 3, 4, 5 3C-1

P2_3C1_YE3 My partner is unwilling to adapt to my needs and expectations.

1, 2, 3, 4, 5 3C-1

P2_3C1_YE4 My partner is more insensitive than caring. 1, 2, 3, 4, 5 3C-1

P2_3C1_YE5 I am often forced to sacrifice my own needs to meet my partner's needs.

1, 2, 3, 4, 5 3C-1

P2_3C1_YE6 My partner refuses to talk about problems that make him or her look bad.

1, 2, 3, 4, 5 3C-1

P2_3C1_YE7 My partner withholds affection unless it would benefit her or him.

1, 2, 3, 4, 5 3C-1

P2_3C1_YE8 It is hard to disagree with my partner because she or he gets angry.

1, 2, 3, 4, 5 3C-1

P2_3C1_YE9 My partner resents being questioned about the way he or she treats me.

1, 2, 3, 4, 5 3C-1

P2_3C1_YE10 My partner builds himself or herself up by putting me down.

1, 2, 3, 4, 5 3C-1

P2_3C1_YE11 My partner retaliates when I disagree with him or her. 1, 2, 3, 4, 5 3C-1

P2_3C1_YE12 My partner is always trying to change me. 1, 2, 3, 4, 5 3C-1

P2_3C1_YE13 My partner believes he or she has the right to force me to do things.

1, 2, 3, 4, 5 3C-1

P2_3C1_YE14 My partner is too possessive or jealous. 1, 2, 3, 4, 5 3C-1

P2_3C1_YE15 My partner tries to isolate me from family and friends. 1, 2, 3, 4, 5 3C-1

P2_3C1_YE16 Sometimes my partner physically hurts me. 1, 2, 3, 4, 5 3C-1

Form 3C-2: Your Relationship Experiences (Co-Parent)


P1_3C2_YE1 How safe do you feel in your relationship with your child(ren)’s other parent?

1, 2, 3, 4, 5, 6, 7, 8, 9, 10 3C-2

P1_3C2_YE2 My co-parent never admits when she or he is wrong.

1, 2, 3, 4, 5 3C-2

HMRE 1

P1_3C2_YE3 My co-parent is unwilling to adapt to my needs and expectations.

1, 2, 3, 4, 5 3C-2

P1_3C2_YE4 My co-parent is more insensitive than caring. 1, 2, 3, 4, 5 3C-2

P1_3C2_YE5 I am often forced to sacrifice my own needs to meet my co-parent's needs.

1, 2, 3, 4, 5 3C-2

P1_3C2_YE6 My co-parent refuses to talk about problems that make him or her look bad.

1, 2, 3, 4, 5 3C-2

P1_3C2_YE7 My co-parent withholds affection unless it would benefit her or him.

1, 2, 3, 4, 5 3C-2

P1_3C2_YE8 It is hard to disagree with my co-parent because she or he gets angry.

1, 2, 3, 4, 5 3C-2

P1_3C2_YE9 My co-parent resents being questioned about the way he or she treats me.

1, 2, 3, 4, 5 3C-2

P1_3C2_YE10 My co-parent builds himself or herself up by putting me down.

1, 2, 3, 4, 5 3C-2

P1_3C2_YE11 My co-parent retaliates when I disagree with him or her.

1, 2, 3, 4, 5 3C-2

P1_3C2_YE12 My co-parent is always trying to change me. 1, 2, 3, 4, 5 3C-2

P1_3C2_YE13 My co-parent believes he or she has the right to force me to do things.

1, 2, 3, 4, 5 3C-2

P1_3C2_YE14 My co-parent is too possessive or jealous. 1, 2, 3, 4, 5 3C-2

P1_3C2_YE15 My co-parent tries to isolate me from family and friends.

1, 2, 3, 4, 5 3C-2

P1_3C2_YE16 Sometimes my co-parent physically hurts me. 1, 2, 3, 4, 5 3C-2

Form 3D-1: Resident Child Information


RC1 Resident Child #1 (RC2 = Resident Child #2)

3D-1

RC1_LName Last Name 3D-1

RC1_FName First Name 3D-1

RC1_MidIn Middle Initial 3D-1

RC1_Part Whose child is this? 1=Participant 1 2=Participant 2 3=Both 4=Fostered

3D-1

RC1_Rel What is your relationship to this child? 1=Biological Parent 2=Step-Parent 3=Adoptive Parent 4=Foster Parent 5=Kinship Care Provider

3D-1

RC1_DOB Date of Birth 3D-1

RC1_Age_Yr Age (years) 3D-1

HMRE 1

RC1_Age_Mth Age (months) 3D-1

RC1_Sex Child's Sex 0=Female 1=Male 2=Other

3D-1

RC1_SexOth Child's Sex Other 3D-1

RC1_Race How would you describe your child's race?

1=White/Caucasian 2=African-American/Black 3=Asian-American 4=Native-American/Alaskan Native 5=Native Hawaiian/Other Pacific Islander 6=Other

3D-1

RC1_RaceOth Race Other 3D-1

RC1_Eth How would you describe your child's ethnicity?

1=Non-Hispanic 2=Hispanic 3=Other

3D-1

RC1_EthOth Ethnicity Other 3D-1

RC1_Grade What grade is your child currently in? -1=Pre-K 0=Kindergarten 1=1st 2=2nd 3=3rd 4=4th 5=5th 6=6th 7=7th 8=8th 9=9th 10=10th 11=11th 12=12th

3D-1

RC1_HIns Does your child have health insurance?

0=No; 1=Yes 3D-1

RC1_HInsTyp If yes, what kind of health insurance does your child have?

1=Medicaid 2=PeachCare for Kids 3=Through employer 4=Other

3D-1

RC1_HInsTyp_Oth Health Insurance Type Other: 3D-1

RC1_SNeed Does your child have any special needs?

0=No 1=Has a physical disability 2=Has a developmental disability 3=Has a medical illness 4=Has a learning disability 5=Has an individualized Education Plan (IEP) 6=Struggles to make good grades 7=Has been diagnosed with a mental illness

3D-1

HMRE 1

8=Other

RC1_SNeedOth Special Needs Other 3D-1

RC1_NRP_Have Does this child have a parent who does not live in the home?

0=No; 1=Yes 3D-1

RC1_NRP_DPW On average, how many days per week does the non-resident parent see this child?

1, 2, 3, 4, 5, 6, 7 3D-1

RC1_NRP_WPM How many weekends per month does the non-resident parent see this child?

0=0 1=1 2=2 3=3 4=Every

3D-1

RC1_NRP_Consult How often do you consult with the non-resident parent on matters relating to this child?

1=Most of the time 2=Some of the time 3=Seldom 4=Never

3D-1

RC1_NRP_ContFin Does the non-resident parent contribute financially to support for this child?

0=No; 1=Yes 3D-1

RC1_TimeHH_Yr What is the length of time this child has spent in your household (years)?

3D-1

RC1_TimeHH_Mth What is the length of time this child has spent in your household (months)?

3D-1

RC1_P1_Rel What is your (P1) relationship to this child?

1=Foster Parent 2=Grandmother 3=Grandfather 4=Aunt 5=Uncle 6=Niece 7=Nephew 8=Sister 9=Brother 10=Cousin 11=Family Friend 12=Other

3D-1

RC1_P1_RelOth P1 relationship to this child Other 3D-1

RC1_P2_Rel What is your (P2) relationship to this child?

1=Foster Parent 2=Grandmother 3=Grandfather 4=Aunt 5=Uncle 6=Niece 7=Nephew 8=Sister 9=Brother 10=Cousin 11=Family Friend 12=Other

3D-1

RC1_P2_RelOth P2 relationship to this child Other 3D-1

HMRE 1

RC1_P1_Adopt If this child were free to be legally adopted, would you plan to adopt this child?


3D-1

RC1_P2_Adopt If this child were free to be legally adopted, would you plan to adopt this child?


3D-1

RC1_Attend To attend the Project F.R.E.E. program would you need to bring this child with you?

0=No; 1=Yes 3D-1

RC1_DietRes Does your child have any dietary restrictions?

0=No 1=Vegetarian 2=Vegan 3=Nut allergy 4=Dairy allergy 5=Other

3D-1

RC1_DietResOth Dietary Restrictions Other 3D-1

RC1_Notes Is there anything else you would like to share that would be helpful to our child care providers?

3D-1

RC1_CarSeat Do you have access to a car seat or booster seat for your child?

0=No; 1=Yes 3D-1

Form 3D-2: Non-Resident Child Information


NRC1 Non-Resident Child #1 (NRC2 = Non-Resident Child #2)

3D-2

NRC1_LName Last Name 3D-2

NRC1_FName First Name 3D-2

NRC1_MidIn Middle Initial 3D-2

NRC1_Part Whose child is this? 1=Participant 1 2=Participant 2

3D-2

NRC1_Rel What is your relationship to this child? 1=Biological Parent 2=Step-Parent 3=Adoptive Parent

3D-2

NRC1_DOB Date of Birth 3D-2

NRC1_Age_Yr Age (years) 3D-2

NRC1_Age_Mth Age (months) 3D-2

NRC1_Sex Child's Sex 0=Female 1=Male 2=Other

3D-2

NRC1_SexOth Child's Sex Other 3D-2

NRC1_Race How would you describe your child's race?

1=White/Caucasian 2=African-American/Black 3=Asian-American 4=Native-American/Alaskan Native

3D-2

HMRE 1

5=Native Hawaiian/Other Pacific Islander 6=Other

NRC1_RaceOth Child's Race Other 3D-2

NRC1_Eth How would you describe your child's ethnicity?

1=Non-Hispanic 2=Hispanic 3=Other

3D-2

NRC1_EthOth Child's Ethnicity Other 3D-2

NRC1_Grade What grade is your child currently in? -1=Pre-K 0=Kindergarten 1=1st 2=2nd 3=3rd 4=4th 5=5th 6=6th 7=7th 8=8th 9=9th 10=10th 11=11th 12=12th

3D-2

NRC1_HIns Does your child have health insurance? 0=No; 1=Yes 3D-2

NRC1_HInsTyp If yes, what kind of health insurance does your child have?

1=Medicaid 2=PeachCare for Kids 3=Through employer 4=Other

3D-2

NRC1_HInsTyp_Oth Health Insurance Type Other 3D-2

NRC1_SNeed Does your child have any special needs? 0=No 1=Has a physical disability 2=Has a developmental disability 3=Has a medical illness 4=Has a learning disability 5=Has an individualized Education Plan (IEP) 6=Struggles to make good grades 7=Has been diagnosed with a mental illness 8=Other

3D-2

NRC1_SNeedOth Special Needs Other 3D-2

NRC1_DPW On average, how many days per week to you see this child?

1, 2, 3, 4, 5, 6, 7 3D-2

NRC1_WPM How many weekends per month do you see this child?

0=0 1=1 2=2 3=3 4=Every

3D-2

HMRE 1

NRC1_PRP_Consult How often do you consult with the primary residential parent on matters relating to this child?

1=Most of the time 2=Some of the time 3=Seldom 4=Never

3D-2

NRC1_ContFin Do you contribute financially to support for this child?

0=No; 1=Yes 3D-2

HMRE 1

Documents

HMRE Codebook - Demographics