Page 207 - QAP Manual 2020

NCI™ ADULT IN-PERSON SURVEY (IPS) 2020-21

Feeling Safe

Now I’m going to ask you some personal questions about your safety.
Remember, you don’t have to answer any questions that you don’t want to.

17. Are there any places where you feel afraid or scared?
[You may read list below. Check ALL THAT APPLY.]

1. Home
2. Day program
3. Work
4. Walking in your neighborhood

5. In transport (on the bus, van, etc.)
6. Other______________________
98. Does not feel afraid anywhere
99. Don’t know, no response, unclear response

18. If you ever feel afraid, is there someone you can talk to?

Please ask question to all respondents.
□ 2. Yes

□ 3. Maybe, not sure
□ 1. No
□ 99. Don’t know, no response, unclear response

Friends & Family

Now I’m going to ask you about friends and family.

19. Do you have friends you like to talk to or do things with?

If the person answers “yes,“ ask who the friends are and try to determine if they
are family, staff, roommates, coworkers, etc. You can use prompts such as: Can
you tell me their names? Are these friends staff or your family?

□ 2. Yes, has friends who are not staff or family

□ 3. Yes, all friends are staff or family, or cannot determine
□ 1. No, does not have friends →Code 20 as ‘No’ and code 22 and 23 as
‘Not applicable’
□ 99. Don’t know, no response, unclear response →Code 20 and 22 – 24
as ‘Don’t know, no response, unclear response’

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