SECTION SV: SERVICES
|___|___| : |___|___|
Time
Now I would like to ask you some questions about any treatment or help you may have received for problems you were having with your behavior, feelings, or drugs or alcohol. For this section of the interview, when I talk about problems with behavior or feelings, I will also mean any problems with drugs and alcohol.
|
A. |
B. |
C. |
D. |
E. |
F. |
|
|
IF YES, ASK COLUMNS B AND C AFTER SV26 |
How old were you when you first received services from a... | Did you use this within the last year, that is since (DATE 12 MONTHS AGO)?
IF YES, ASK COLUMNS D AND E |
Beginning 12 months ago, when did you first receive services from...? | Are you still using using this service?
IF YES, ASK COLUMN F |
When did you last use this service? | |
|
SV1. Have you ever stayed overnight in a [hospital for problems with behaviors, feelings, drugs or alcohol?] |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
SV2. READ STEM IF NECESSARY: Have you ever stayed overnight in a... ...drug and alcohol treatment unit? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
DRAFT H:\PROJECT\8593\...\August’s files\14 FINAL services.wpd 1 7/13/00 2:44PM H:\PROJECT\8593\...\August’s files\14 FINAL services.wpd 1 7/13/00 2:44PMSV3. READ STEM IF NECESSARY: Have you ever stayed overnight in a... ...residential treatment center? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
SV4. READ STEM IF NECESSARY: Have you ever stayed overnight in a... ...group home? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
SV5. READ STEM IF NECESSARY: Have you ever stayed overnight in a... ...foster home? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
DRAFT H:\PROJECT\8593\...\August’s files\14 FINAL services.wpd 2 7/13/00 2:44PM H:\PROJECT\8593\...\August’s files\14 FINAL services.wpd 2 7/13/00 2:44PMSV6. READ STEM IF NECESSARY: Have you ever stayed overnight in a... ...detention center, prison or jail? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
SV7. READ STEM IF NECESSARY: Have you ever stayed overnight in a... ...emergency shelter for emotional or behavioral problems? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
DRAFT H:\PROJECT\8593\...\August’s files\14 FINAL services.wpd 3 7/13/00 2:44PM H:\PROJECT\8593\...\August’s files\14 FINAL services.wpd 3 7/13/00 2:44PMSV8. READ STEM IF NECESSARY: Have you ever stayed overnight in a... ...any other place like a summer treatment program or boarding school? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
DRAFT H:\PROJECT\8593\...\August’s files\14 FINAL services.wpd 3 7/13/00 2:44PM H:\PROJECT\8593\...\August’s files\14 FINAL services.wpd 3 7/13/00 2:44PMSV9. Have you ever received outpatient help or treatment (not overnight) from a community mental health center or other outpatient mental health clinic? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
SV10. READ STEM IF NECESSARY: Have you ever received outpatient help or treatment (not overnight) from a... ...professional like a psychologist, psychiatrist, social worker, or marriage of family counselor not part of a service or clinic already mentioned? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
SV11. READ STEM IF NECESSARY: Have you ever received outpatient help or treatment (not overnight) from a... ...partial hospitalization or day treatment program? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
DRAFT H:\PROJECT\8593\...\August’s files\14 FINAL services.wpd 4 7/13/00 2:44PM H:\PROJECT\8593\...\August’s files\14 FINAL services.wpd 4 7/13/00 2:44PMSV12. READ STEM IF NECESSARY: Have you ever received outpatient help or treatment (not overnight) from a... ...drug or alcohol clinic? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
SV13. READ STEM IF NECESSARY: Have you ever received outpatient help or treatment (not overnight) from a... ...therapist or counselor or family preservation worker who came to your home? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
SV14. READ STEM IF NECESSARY: Have you ever received outpatient help or treatment (not overnight) from a... ...emergency room for problems with behaviors or feelings? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
DRAFT H:\PROJECT\8593\...\August’s files\14 FINAL services.wpd 5 7/13/00 2:44PM H:\PROJECT\8593\...\August’s files\14 FINAL services.wpd 5 7/13/00 2:44PMSV15. READ STEM IF NECESSARY: Have you ever received outpatient help or treatment (not overnight) from a... ...pediatrician or family doctor for problems with behaviors or feelings? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
SV16. READ STEM IF NECESSARY: Have you ever received outpatient help or treatment (not overnight) from a... ...probation or juvenile corrections officer or a court counselor? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
SV17. READ STEM IF NECESSARY: Have you ever received outpatient help or treatment (not overnight) from a... ...priest, minister, rabbi for problems with behaviors and feelings? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
DRAFT H:\PROJECT\8593\...\August’s files\14 FINAL services.wpd 6 7/13/00 2:44PM H:\PROJECT\8593\...\August’s files\14 FINAL services.wpd 6 7/13/00 2:44PMSV18. READ STEM IF NECESSARY: Have you ever received outpatient help or treatment (not overnight) from a... ...healer, shaman, or spiritualist? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
SV19. READ STEM IF NECESSARY: Have you ever received outpatient help or treatment (not overnight) from a... ...acupuncturist or chiropractor? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
SV20. READ STEM IF NECESSARY: Have you ever received outpatient help or treatment (not overnight) from a... ...crisis hotline? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
SV21. READ STEM IF NECESSARY: Have you ever received outpatient help or treatment (not overnight) from a... ...any self-help group like Alcoholics Anonymous or peer counseling? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
DRAFT H:\PROJECT\8593\...\August’s files\14 FINAL services.wpd 7 7/13/00 2:44PM H:\PROJECT\8593\...\August’s files\14 FINAL services.wpd 7 7/13/00 2:44PMSV22. READ STEM IF NECESSARY: Have you ever received outpatient help or treatment (not overnight) from a... ...respite care provider? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
SV23. Have you ever received any services at school such as being placed in a special school for students with problems with behavior or feelings? |
YES 1
NO 2 PROBE: Would you say yes or no? |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
SV24. READ STEM IF NECESSARY: Have you ever received any services at school such as... ...being placed in a special classroom for problems with behavior, feelings, or drugs or alcohol? PROBE: Would you say yes or no? |
YES 1
NO 2 |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
SV25. READ STEM IF NECESSARY: Have you ever received any services at school such as... ...getting special help (such as tutoring or training) in the regular classroom for problems with behavior or feelings? PROBE: Would you say yes or no? |
YES 1
NO 2 |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
|
DRAFT H:\PROJECT\8593\...\August’s files\14 FINAL services.wpd 9 7/13/00 2:44PM H:\PROJECT\8593\...\August’s files\14 FINAL services.wpd 9 7/13/00 2:44PMSV26. READ STEM IF NECESSARY: Have you ever received any services at school such as... ...other counseling or therapy in school, related to problems with behavior, feelings, or drugs or alcohol? PROBE: Would you say yes or no? |
YES 1
NO 2 |
|___|___| YEARS |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
YES 1
NO 2 |
|___|___| MONTH |___|___|___|___| YEAR |
AFTER COLUMN A:
IF NO SERVICES CODED ‘YES’ IN SV1-SV26, ASK:
|
S27. So you have never received any services for your behaviors, feelings, or drug or alcohol problems? |
That is correct (GOTO SU1) 01
Incorrect (CHANGE COLUMN A) 02 |
IF ANY SERVICES CODED "YES":
"Let’s talk about the services you just mentioned..."
FOR EACH SERVICE CODED "YES":
ASK COLUMN B AND C
AFTER COLUMN C IS COMPLETED:
|
SV28. COUNT HOW MANY SERVICES USED IN THE PAST 12 MONTHS: |
0 services used (GOTO SU1) 00
1-3 services used 01 4 or more services used 02 |
IF ANY SERVICES USED IN THE PAST 12 MONTHS:
ASK COLUMN D AND E
IF COLUMN E IS NO, ASK COLUMN F: "When did you last use this service?