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NIMH Data Archive
NDA ABCD CCF OAI NIAAADA AMP SCZ HEAL

Service Utilization and Resources Quarterly Form for Schizophrenia

2,525 Shared Subjects

Service Utilization and Resources Quarterly Form for Schizophrenia
Clinical Assessments
Questionnaire
05/08/2014
surfq01
05/08/2014
View Change History
01
Definition
Submission Template
Query Element Name Data Type Size Required Description Value Range Notes Aliases
subjectkey GUID Required The NDAR Global Unique Identifier (GUID) for research subject NDAR*
src_subject_id String 20 Required Subject ID how it's defined in lab/project CATIEID, bid
interview_date Date Required Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY
interview_age Integer Required Age in months at the time of the interview/test/sampling/imaging. 0::1440 Age is rounded to chronological month. If the research participant is 15-days-old at time of interview, the appropriate value would be 0 months. If the participant is 16-days-old, the value would be 1 month. dema1
sex String 20 Required Sex of subject at birth M;F; O; NR M = Male; F = Female; O=Other; NR = Not reported dema2, gender
Query visitid Integer Recommended MetaTrial Visit ID System variable: unique code for each type of visit -use to merge files
Query visit String 60 Recommended Visit name
Query truncvis Integer Recommended Truncated Visit Number Created variable: provides a numeric visit number for all visits, including unscheduled and end of phase
Query phase_ct String 20 Recommended Current Phase. Phase patient was in at the time of the assessment Phase 4 refers to the follow-up phase. Pre-Rand; Phase 1/1A; Phase 2; Phase 3; Phase 4; Phase 1B; Open-Choice Phase; Screening; Phase 1
Query visday Integer Recommended Number of days from study baseline to date of visit sfqa0b
protocol String 50 Recommended Protocol [Study] name
Query surfqa Integer Recommended A. Earned income (competitive employment) 0;1;3 1 = Yes; 0 = No; 3 = Not known sfq01, sfqa1a1
Query surfqaa Integer Recommended Dollar amount for earned income sfq01a, sfqa1a2
Query surfqb Integer Recommended B. Vocational program (Comprehensive Employment And Training Act [CETA], vocational rehabilitation Sheltered workshop, Goodwill, compensated work Training, incentive therapy) 0;1;3 1 = Yes; 0 = No; 3 = Not known sfq02, sfqa1b1
Query surfqba Integer Recommended B. Dollar amount for vocational program sfq02a, sfqa1b2
Query surfqc Integer Recommended C. Social Security Retirement Benefits (SSA) 0;1;3 1 = Yes; 0 = No; 3 = Not known sfq03, sfqa1c1
Query surfqca Integer Recommended Dollar amount for SSA sfq03a, sfqa1c2
Query surfqd Integer Recommended D. Social Security Disability Income (SSDI) 0;1;3 1 = Yes; 0 = No; 3 = Not known sfq04, sfqa1d1
Query surfqda Integer Recommended Dollar amount for SSDI sfq04a, sfqa1d2
Query surfqe Integer Recommended E. Supplemental Security Income (SSI) 0;1;3 1 = Yes; 0 = No; 3 = Not known sfq05, sfqa1e1
Query surfqea Float Recommended Dollar amount for SSI sfq05a, sfqa1e2
Query surfqf Integer Recommended F. VA Compensation (service connected) 0;1;3 1 = Yes; 0 = No; 3 = Not known sfq06, sfqa1f1
Query surfqfa Integer Recommended Dollar amount for VA Compensation (service-connected) sfq06a, sfqa1f2
Query surfqg Integer Recommended G. VA Pension (non- service connected) 0;1;3 1 = Yes; 0 = No; 3 = Not known sfq07, sfqa1g1
Query surfqga Integer Recommended Dollar amount for VA Pension (non-service-connected) sfq07a, sfqa1g2
Query surfqh Integer Recommended H. Other social welfare benefits state or county (general welfare, Aid to Families with Dependent Children [AFDC]) 0;1;3 1 = Yes; 0 = No; 3 = Not known sfq08, sfqa1h1
Query surfqha Integer Recommended Dollar amount for other social welfare sfq08a, sfqa1h2
Query surfqi Integer Recommended Unemployment compensation 0;1;3 1 = Yes; 0 = No; 3 = Not known sfq09, sfqa1i1
Query surfqia Integer Recommended Dollar amount for Unemployment compensation sfq09a, sfqa1i2
Query surfqj Integer Recommended J. Retirement, investment or savings income 0;1;3 1 = Yes; 0 = No; 3 = Not known sfq10, sfqa1j1
Query surfqja Integer Recommended Dollar amount for retirement, investment or saving income sfq10a, sfqa1j2
Query surfqk Integer Recommended K. Rent supplements (including HUD, Section 8 Certificates, living programs receiving public Support) 0;1;3 1 = Yes; 0 = No; 3 = Not known sfq11, sfqa1k1
Query surfqka Integer Recommended Dollar amount for rent supplements sfq11a, sfqa1k2
Query surfql Integer Recommended L. Food stamps 0;1;3 1 = Yes; 0 = No; 3 = Not known sfq12, sfqa1l1
Query surfqla Integer Recommended Dollar amount for Food stamps sfq12a, sfqa1l2
Query surfqm Float Recommended M. How much money did you receive during the past month from all of these sources? -9999 = Missing sfq13, sfqa2
Query surfqn Integer Recommended N. Would you say that the amount of money you received during the past month was more than or less than usual? 1::3;98 1 = More than usual; 2 = Same as usual; 3 = Less than usual; 98 = Don't know sfq14, sfqa3
Query dworked Integer Recommended How many days in the past month have you actually worked for pay? sfq17, sfqa4
Query hworked Integer Recommended About how many hours a week do/did you usually work? 999 = Missing sfq18, sfqa5
Query earnweek Integer Recommended About how much did you earn per week? (round to dollars, no cents) sfq19, sfqa6
Query surfq2 Integer Recommended IB. In addition to the above earnings, during the past month, have you done any casual employment or day jobs, such as yard work or babysitting over a few days for which you got paid? 0;1 0 = No; 1 = Yes sfq20, sfqa7
Query surfq2a Integer Recommended About how much did you earn doing day jobs in the past month? (round to dollars, no cents) sfq20a, sfqa7a
Query surfq3 Integer Recommended During the past month, have you done any kind of volunteer work (such as working at a hospital or a school)? 0;1 0 = No; 1 = Yes sfq21, sfqa8
Query surfq3a Integer Recommended About how many days did you do volunteer work? sfq21a, sfqa8a
Query surfq3b Integer Recommended On a day that you did volunteer work, about how many hours per day did you do volunteer work? sfq21b, sfqa8b
Query surfq4a Integer Recommended In the past month, did your wages include: Health benefits 0::2 0 = No; 1 = Yes; 2 = Not working sfq22, sfqa9a
Query surfq4b Integer Recommended In the past month, did your wages include: Retirement benefits (including Social Security) 0::2 0 = No; 1 = Yes; 2 = Not working sfq23, sfqa9b
Query surfq4c Integer Recommended In the past month, did your wages include: Paid Sick Leave 0::2 0 = No; 1 = Yes; 2 = Not working sfq24, sfqa9c
Query surfq4d Integer Recommended In the past month, did your wages include: Other fringe benefits 0::2 0 = No; 1 = Yes; 2 = Not working sfq25, sfqa9d
Query surfq4e Integer Recommended If you did not work in the past month, were you looking for work? 0::2 0 = No; 1 = Yes; 2 = Working sfqa10
Query arrest Integer Recommended If you had any contacts with the police in the past month, how many resulted in your being picked up or arrested for any criminal activity in the past month? sfqa11
Query police Integer Recommended How many times in the past month have you had contact with police other than arrests (e.g., loitering)? sfqaa12
Query court Integer Recommended How many times in the past month did you go to court? (Include only court appearances for offenses listed above). sfqa13
Query nitejail Integer Recommended How many nights in the past month did you spend in jail? sfqa14
Query parole Integer Recommended Are you currently on probation or parole? 0;1 0 = No; 1 = Yes sfqa15
Query officer Integer Recommended How many times in the past month did you see your probation or parole officer? sfqa15a
Query timeoff Integer Recommended When you see your probation or parole officer, how much time do you usually spend with him or her? sfqa15b
Query income Integer Recommended During the past YEAR approximately how much income before taxes and deductions was received by all family members who live with you, excluding yourself. Please include money from all sources. 0::5 0 = Do not live with any family members; 1 = $0-$15000; 2 = $15001-$30000; 3 = $30001-$50000; 4 = $50001-$75000; 5 = Greater than $75000 sfq26, sfqa16
Query support Integer Recommended During the past month how much money did family members provide you for your support? sfq27, sfqa17
Query priv1a Integer Recommended Which of the following types of health insurance coverage do you have? Private Insurance 0;1; 3 0 = No; 1 = Yes; 3= DK sfq28
Query privatea Integer Recommended Private Insurance: Through your own employment 0;1 0 = No; 1 = Yes sfq28a
Query privateb Integer Recommended Private Insurance: Through spouse or family members employment 0;1 0 = No; 1 = Yes sfq28b
Query privatec Integer Recommended Private Insurance: Directly purchased (i.e. not through employment) 0;1 0 = No; 1 = Yes sfq28c
Query privated Integer Recommended Private Insurance: Paid by someone not in family 0;1 0 = No; 1 = Yes sfq28d
Query public1b Integer Recommended Which of the following types of health insurance coverage do you have? Public Insurance 0;1 0 = No; 1 = Yes sfq29
Query publica Integer Recommended Public Insurance: Medicare 0;1;-7; 3 0 = No; 1 = Yes; -7 = Refused; 3=DK sfq29a
Query publicb Integer Recommended Public Insurance: Traditional Medicare 0;1 0 = No; 1 = Yes
Query publicc Integer Recommended Public Insurance: Traditional medicare plus supplemental insurance 0;1 0 = No; 1 = Yes
Query publicd Integer Recommended Public Insurance: Medicare HMO 0;1 0 = No; 1 = Yes
Query medcaid Integer Recommended Which of the following types of health insurance coverage do you have? Medicaid 0;1; 3 0 = No; 1 = Yes; 3=DK
Query medcaida Integer Recommended Medicaid: Traditional Medicaid 0;1 0 = No; 1 = Yes
Query medcaidb Integer Recommended Medicaid: Medicaid managed care 0;1 0 = No; 1 = Yes
Query medcaidc Integer Recommended Medicaid: All medical care 0;1 0 = No; 1 = Yes
Query medcaidd Integer Recommended Medicaid: Behavioral health only 0;1 0 = No; 1 = Yes
Query insur2 Integer Recommended Does your plan require signing up with a primary care doctor or clinic for routine medical care ? 0;1 0 = No; 1 = Yes sfq31
Query insur2a Integer Recommended Does your plan require approval or referral to see a specialist for medical care? 0;1 0 = No; 1 = Yes sfq32
Query insur2b Integer Recommended Does your plan require approval or referral to see a specialist for behavioral health services? 0;1 0 = No; 1 = Yes sfq33
Query insur2c Integer Recommended Does your plan require choosing doctor or clinic from a book, directory or list for medical care? 0;1 0 = No; 1 = Yes sfq34
Query insur2d Integer Recommended Does your plan require choosing a doctor or clinic from a book, directory or list for behavioral health services? 0;1 0 = No; 1 = Yes sfq35
Query insur2e Integer Recommended Does your plan pay for out of network care for medical care? 0;1 0 = No; 1 = Yes sfq36
Query insur2f Integer Recommended Does your plan pay for out of network care for behavioral health services? 0;1 0 = No; 1 = Yes sfq37
Query insur2g Integer Recommended Does your plan pay for prescription drugs? 0::4 0 = No; 1 = Yes; 2=Yes fully; 3=Yes partially, copay; 4=DK sfq38
Query insur2ga Integer Recommended Are there deductibles? 0;1 0 = No; 1 = Yes sfq38a
Query insur2gb Integer Recommended Co insurance? 0;1 0 = No; 1 = Yes sfq38b
Query insur2gc Integer Recommended Maximum benefit amount sfq38c
Query insur2gd Integer Recommended Unknown 0;1 0 = No; 1 = Yes sfq38d
Query fseqno Integer Recommended Sequence Number 0::999 The FSEQNO variable in the ADJ form has a special interpretation compared to other forms. For example, ADJ FSEQNO of '1' can be thought of as being '001', FSEQNO of '2' can be thought of as being '002', and FSEQNO of '3' can be thought of as being '003'. The first digit of FSEQNO relates to the corresponding ENF sequence number at that visit and the third digit relates to the specific adjudicator who completed the adjudication form.
version_form String 121 Recommended Form used/assessment name
Query sfq15 Integer Recommended Did [patient] work for pay, at a temporary or day job, or as a volunteer in the past month? 0;1 0=No; 1=Yes
Query sfq16 Integer Recommended If [patient] did not work in the past month, was he/she looking for work? 0;1;2 0=No; 1=Yes; 2=Working
Query sfq29b Integer Recommended Type of medicare 1;2;3 1 = Traditional medicare; 2 = Traditional Medicare plus supplemental i; 3 = Medicare HMO
Query sfq30 Integer Recommended Medicaid 1; 0 1=Yes; 0=No
Query sfq30a Integer Recommended Type of medicaid 1;2 1 = Traditional Medicaid; 2 = Medicaid managed care
Query sfq30b Integer Recommended 2nd type of medicaid 1;2 1 = All medical Care; 2 = Behavioral Health only eos04d
Query monthsbl Float Recommended Actual number of months from Baseline
Query days_baseline Integer Recommended Days since baseline
Query surq011 String 50 Recommended Is there a person or organization that helps you manage your money? 1;2 1=Yes; 2=No
Query surq012 Integer Recommended Is this person a ... 1::6 1=Family member; 2=Friend; 3=Landlord; 4=Lawyer, banker or accountant; 5=Mental health provider or other clinician; 6=Other
surq012a String 100 Recommended Is this person a ...Other (specify)
Query surq013 Integer Recommended Are any of your checks mailed directly to this person? 1;2 1=Yes; 2=No
Query surq014 Integer Recommended Does this person serve as a...Someone who receives your social security check and provides you with funds as you need them (Representative payee for Social Security) 1;2; 9 1=Yes; 2=No; 9=DK
Query surq015 Integer Recommended Does this person serve as a...Someone who receives your VA disability check and provides you with funds as you need them. (Fiduciary for VA benefits)
Query surq016 Integer Recommended Does this person serve as a...Someone a court has appointed to manage your funds or help make decisions for you. (Conservator) 1;2; 9 1=Yes; 2=No; 9=DK
Query surq017 Integer Recommended Does this person serve as a...Other money manager 1;2; 9 1=Yes; 2=No; 9=DK
surq017a String 50 Recommended Other money manager (Specify)
Query surq018 Integer Recommended If you had any contacts with the police in the past month, how many resulted in your being picked up or arrested for any criminal activity in the past month? (Do not include police escort to hospital) 1;2 1=Yes; 2=No
Query surq019 Integer Recommended If you had contacts with police, how many times in the past month have you had contact with them other than arrests (e.g., loitering)? 1;2 1=Yes; 2=No
Query surq020 Integer Recommended If you went to court, how many times in the past month did you go to court? (Include only court appearances for offenses listed above). 1;2 1=Yes; 2=No
Query surq021 Integer Recommended If you were in jail or prison, how many nights In the past month did you spend in jail or prison? 1;2 1=Yes; 2=No
Query surq026 Integer Recommended Public Insurance SCHIP (Federal Healthcare for children, name may vary from by state) 1;2; 3 1=Yes; 2=No; 3=DK
Query surq027 Integer Recommended Public Insurance Veterans Health Administration (VA) 1;2; 3 1=Yes; 2=No; 3=DK
Query instype Integer Recommended Type of Insurance 1;2; 3 1=Private; 2= Public; 3=Uninsured
Data Structure

This page displays the data structure defined for the measure identified in the title and structure short name. The table below displays a list of data elements in this structure (also called variables) and the following information:

  • Element Name: This is the standard element name
  • Data Type: Which type of data this element is, e.g. String, Float, File location.
  • Size: If applicable, the character limit of this element
  • Required: This column displays whether the element is Required for valid submissions, Recommended for valid submissions, Conditional on other elements, or Optional
  • Description: A basic description
  • Value Range: Which values can appear validly in this element (case sensitive for strings)
  • Notes: Expanded description or notes on coding of values
  • Aliases: A list of currently supported Aliases (alternate element names)
  • For valid elements with shared data, on the far left is a Filter button you can use to view a summary of shared data for that element and apply a query filter to your Cart based on selected value ranges

At the top of this page you can also:

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