Design for Survey of Persons with Mental Retardation and Developmental Disabilities: Summary of Recommendations for Survey Questions and Screening Criteria. Design for Survey of Persons with Mental Retardation and Developmental Disabilities: Summary of Recommendations for Survey Questions and Screening Criteria : Table 15

11/29/1989

: Table 15

Labor Force StatusCurrently have job: yes/no If no, currently looking: yes/no Occupation (covered in NHIS core)
IntegrationSetting: regular job, sheltered workshop, work/day activities center, volunteer, work/study2
Training ProgramIs job part of training program: yes/no2
Supported EmploymentPresence of someone at work who helps person learn the job: yes/no2 Presence of someone at work who person can ask questions: yes/no Who is person: __________ (write-in) parent friend/co-worker (also, is it person's ob to train?) job coach (training program) -- (name of program supervisor (also, does supervisor work for employer versus training program?) Do you pay the person who is helping you?
Hours/WagesDays of week usually at work: Monday-Friday Hours worked most days: ___ ___ . ___ hours per day per week variable Is person paid: yes/no Amount of pay: $___, ___ ___ ___ . ___ ___ per piece per hour per day per week per two weeks/semi-monthly per month combination of rates Frequency of pay: everyday, every week, every two weeks/semi-monthly, every month
Transportation to WorkHow person usually gets to work and back: driven by parents/friends/houseparents picked up in van/car/schoolbus/special bus taxi public bus/other public transportation walk/bicyle drive oneself works at residence no transportation needed other __________ (specify) If driven: Who drives person to work: __________ (write-in) relative friend staff member If picked up by van/bus/car, etc.: Whose vehicle picks person up: __________ (write-in) friend/relative staff member employer Is it friend's job to pick person up: yes/no Where is staff member from: __________ (write-in) If person takes taxi: Who calls taxi: person does by self, someone else does at least sometimes/it is prearranged Who is the person who calls taxi: __________ (write-in) relative friend staff member employer Is it friend's job to call taxi: yes/no Where is staff member from: __________ (write-in)
Satisfaction with ServicesFor each service: very satisfied, satisfied, Services neither satisfied/dissastisfied, dissatisfied, very dissatisfied Why dissatisfied: Receives too little/too much of service Service is not appropriate to needs Not reliable Not timely, too expensive Problem with provider's attitude Problem with transportation Other __________ (specify)
Educational Services Ever ReceivedSpecial school (residential - during academic year only), special school (day), special class in regular school, resource room in regular school, regular class in regular school, regular class in regular school, homebound education, special residential school (out of state), residential facility for persons with disabilities, residential facility for persons with mental illness, challenging behavior, not applicable (no formal education)2
Early Intervention (Service is Defined in Memo)Received services: yes/no (also covered in the In-Home Services Section)2
Current Educational StatusNow in school: yes/no Name of school: __________ (write-in) Is person learning about job and work in school: yes/no How is person learning about work/jobs: classes only, job only, both classes and job Is this same job as previously mentioned: yes/no (if no, ask job questions)
Other Vocational ProgramsAside from previously mentioned job/school programs are there any others which teaches person about jobs/work: yes/no Name of program: __________ (write-in)
Satisfaction With ServicesFor each service: very satisfied, satisfied, neither satisfied or dissatisfied, dissatisfied, very dissatisfied Why dissatisfied: Receives too little/too much of service Service is not appropriate to needs Not reliable Not timely Too expensive Problem with provider's attitude Problem with transportation Other __________ (specify)
Reasons for Not WorkingIf determined person is not working (or looking for work) through job, school, or training program: Health reasons Attending school Retired, homemaker Caring for children Caring for adults Lack of transportation Lack of job skills Discrimination Fear of losing SSI or other benefits Other __________ (specify)