Ontario Child Health Study - Selected child (CAPI) - 2014

Selected Child Part 1 (TCD1) - Question identifier:TCD1_R01

(This study is being done with researchers at McMaster University in Hamilton. The study will collect information on the health and well-being of children with a focus on mental health, use of mental health services and the relationship between health, family, neighbourhood and school.

Your answers are collected under the authority of the Statistics Act and will be kept strictly confidential and used only for statistical purposes. While participation is voluntary, your cooperation is essential to ensure the information collected is as accurate and as comprehensive as possible.)

Selected Child Part 1 (TCD1) - Question identifier:TCD1_R01B

(Here is a list of mental health services as well as an information sheet on data sharing and linking. We are providing these to all participating households.)

Child immigration (IMC) - Question identifier:IMC_Q01

In what country was ^FNAME born?

Long Answer Length = 50

Child immigration (IMC) - Question identifier:IMC_Q02

In which province or territory was ^FNAME born?

• 10: Newfoundland and Labrador
• 11: Prince Edward Island
• 12: Nova Scotia
• 13: New Brunswick
• 24: Quebec
• 35: Ontario
• 46: Manitoba
• 47: Saskatchewan
• 48: Alberta
• 59: British Columbia
• 60: Yukon
• 61: Northwest Territories
• 62: Nunavut
• 98: RF
• 99: DK

Child immigration (IMC) - Question identifier:IMC_Q15

In what year did he first come to Canada to live?

Min = 1870; Max = 2100

Child language (LAH) - Question identifier:LAH_Q03

What is the language that he first learned at home in childhood and still understands?

Long Answer Length = 50

Medical/biological (MD3) - Question identifier:MD3_Q01

What was ^FNAME's birth weight, in kilograms or pounds and ounces?

• 1: Kilograms
• 2: Pounds/ounces
• 8: RF
• 9: DK

Medical/biological (MD3) - Question identifier:MD3_N01A

Enter birth weight in kilograms.

Min = 1.00; Max = 7.00

Medical/biological (MD3) - Question identifier:MD3_N01B

Enter birth weight in pounds in this screen and ounces in the next.

Min = 1; Max = 15

Medical/biological (MD3) - Question identifier:MD3_N01C

Enter ounces.

Min = 0; Max = 15

Medical/biological (MD3) - Question identifier:MD3_Q02

Was ^FNAME born before, after or on his due date?

• 1: Before
• 2: After
• 3: On due date
• 8: RF
• 9: DK

Medical/biological (MD3) - Question identifier:MD3_Q03

At how many weeks gestation was he born?

Min = 0; Max = 95

Medical/biological (MD3) - Question identifier:MD3_Q04

Immediately after birth, was he admitted to an intensive care or special care unit?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Medical/biological (MD2) - Question identifier:MD2_Q01A

During the pregnancy with ^FNAME, did [you/her mother/his mother] have any of the following medical conditions or health problems that required [you/her] to take prescription medication for more than 2 weeks or to receive special care (for example, early admission to hospital, added physician visits, bed rest)? Did [you/her mother/his mother] have:

... pregnancy or gestational diabetes?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Medical/biological (MD2) - Question identifier:MD2_Q01B

(During the pregnancy with ^FNAME, did [you/her mother/his mother] have any of the following medical conditions or health problems that required [you/her] to take prescription medication for more than 2 weeks or to receive special care (for example, early admission to hospital, added physician visits, bed rest)? Did [you/her mother/his mother] have:)

... high blood pressure (hypertension)?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Medical/biological (MD2) - Question identifier:MD2_Q01C

(During the pregnancy with ^FNAME, did [you/her mother/his mother] have any of the following medical conditions or health problems that required [you/her] to take prescription medication for more than 2 weeks or to receive special care (for example, early admission to hospital, added physician visits, bed rest)? Did [you/her mother/his mother] have:)

... thyroid problems?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Medical/biological (MD2) - Question identifier:MD2_Q01D

(During the pregnancy with ^FNAME, did [you/her mother/his mother] have any of the following medical conditions or health problems that required [you/her] to take prescription medication for more than 2 weeks or to receive special care (for example, early admission to hospital, added physician visits, bed rest)? Did [you/her mother/his mother] have:)

... depression or anxiety?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Medical/biological (MD2) - Question identifier:MD2_Q01F

(During the pregnancy with ^FNAME, did [you/her mother/his mother] have any of the following medical conditions or health problems that required [you/her] to take prescription medication for more than 2 weeks or to receive special care (for example, early admission to hospital, added physician visits, bed rest)? Did [you/her mother/his mother] have:)

... a urinary tract infection?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Medical/biological (MD2) - Question identifier:MD2_Q01G

(During the pregnancy with ^FNAME, did [you/her mother/his mother] have any of the following medical conditions or health problems that required [you/her] to take prescription medication for more than 2 weeks or to receive special care (for example, early admission to hospital, added physician visits, bed rest)? Did [you/her mother/his mother] have:)

... influenza (flu)?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Medical/biological (MD2) - Question identifier:MD2_Q01H

(During the pregnancy with ^FNAME, did [you/her mother/his mother] have any of the following medical conditions or health problems that required [you/her] to take prescription medication for more than 2 weeks or to receive special care (for example, early admission to hospital, added physician visits, bed rest)? Did [you/her mother/his mother] have:)

... vaginal bleeding?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Height and weight (HWT) - Question identifier:HWT_Q1

The next questions are about height and weight. How tall is ^FNAME without shoes on?

• 1: Feet and inches
• 2: Centimetres
• 8: RF
• 9: DK

Height and weight (HWT) - Question identifier:HWT_N1A

Enter feet only.

Min = 0; Max = 7

Height and weight (HWT) - Question identifier:HWT_N1B

Enter inches only, to the nearest quarter of an inch.

Min = 0.00; Max = 95.75

Height and weight (HWT) - Question identifier:HWT_N1C

Record the height to the nearest half centimetre.

Min = 40.0; Max = 244.0

Height and weight (HWT) - Question identifier:HWT_Q03A

How much does ^FNAME weigh?

Min = 1; Max = 575

Height and weight (HWT) - Question identifier:HWT_N03B

Was that in pounds or kilograms?

• 1: Pounds
• 2: Kilograms

Developmental Conditions (DVC) - Question identifier:DVC_Q01A

Has a doctor or other health professional ever told you that ^FNAME has any of the following conditions:

...a developmental delay or lag?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Developmental Conditions (DVC) - Question identifier:DVC_Q01B

(Has a doctor or other health professional ever told you that ^FNAME has any of the following conditions:)

...an intellectual disability?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Developmental Conditions (DVC) - Question identifier:DVC_Q01C

(Has a doctor or other health professional ever told you that ^FNAME has any of the following conditions:)

...Autism Spectrum Disorder, sometimes called Autism, Asperger's Syndrome or pervasive developmental disorder?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Developmental Conditions (DVC) - Question identifier:DVC_Q01D

(Has a doctor or other health professional ever told you that ^FNAME has any of the following conditions:)

...attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD)?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Developmental Conditions (DVC) - Question identifier:DVC_Q01E

(Has a doctor or other health professional ever told you that ^FNAME has any of the following conditions:)

...a learning disability?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Medical Condition (MDC) - Question identifier:MDC_Q01

Has a health professional diagnosed any of the following long-term conditions for ^FNAME:

• 01: Food or digestive allergies?
• 02: Respiratory allergies such as hay fever?
• 03: Any other allergies?
• 04: Bronchitis?
• 05: Diabetes?
• 06: Heart condition or disease?
• 07: Epilepsy?
• 08: Cerebral palsy?
• 09: Kidney condition or disease?
• 10: Asthma?
• 11: Any other long-term condition?
• 12: None
• 98: RF
• 99: DK

Health: functional limitation (HLT) - Question identifier:HLT_R01

The next set of questions ask about ^FNAME's day to day health. The questions are not about illnesses like colds that affect people for short periods of time.

They are concerned with his abilities relative to other children the same age. You may feel that some of these questions do not apply to him, but it is important that we ask the same questions of everyone.

Health: functional limitation (HLT) - Question identifier:HLT_Q01

Is ^FNAME usually able to see clearly, and without distortion, the words in a (story) book without glasses or contact lenses?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q02

Is he usually able to see clearly, and without distortion, the words in a (story) book with glasses or contact lenses?

• 1: Yes
• 2: No
• 3: Doesn't wear glasses or contact lenses
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q03

Is he able to see at all?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q04

Is he able to see well enough to recognize a friend on the other side of the street without glasses or contact lenses?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q05

Is he usually able to see well enough to recognize a friend on the other side of the street with glasses or contact lenses?

• 1: Yes
• 2: No
• 3: Doesn't wear glasses or contact lenses
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q06

Is he usually able to hear what is said in a group conversation with at least three other people without a hearing aid?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q07

Is he usually able to hear what is said in a group conversation with at least three other people with a hearing aid?

• 1: Yes
• 2: No
• 3: Doesn't wear a hearing aid
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q08

Is he able to hear at all?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q09

Is he usually able to hear what is said in a conversation with one other person in a quiet room without a hearing aid?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q10

Is ^FNAME usually able to hear what is said in a conversation with one other person in a quiet room with a hearing aid?

• 1: Yes
• 2: No
• 3: Doesn't wear a hearing aid
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q11

Is he usually able to be understood completely when speaking with strangers in his own language?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q12

Is he able to be understood partially when speaking with strangers in his own language?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q13

Is he able to be understood completely when speaking with those who know him well?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q14

Is he able to be understood partially when speaking with those who know him well?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q15

Is he usually able to walk without difficulty and without mechanical support such as braces, a cane or crutches?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q16

Is he able to walk at all?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q17

Does he require mechanical support such as braces, a cane or crutches to be able to walk?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q18

Does he require the help of another person to be able to walk?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q19

Does he require a wheelchair to get around?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q20

How often does he use a wheelchair?

• 1: Always
• 2: Often
• 3: Sometimes
• 4: Never
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q21

Does he need the help of another person to get around in the wheelchair?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q22

Is ^FNAME usually able to grasp and handle small objects such as a pencil or scissors?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q23

Does he require the help of another person because of limitations in the use of hands or fingers?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q24

Does he require the help of another person with:

• 1: Some tasks
• 2: Most tasks
• 3: Almost all tasks
• 4: All tasks
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q25

Does he require special equipment, for example, devices to assist in dressing because of limitations in the use of hands or fingers?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q26

Would you describe ^FNAME as being usually:

• 1: Happy and interested in life
• 2: Somewhat happy
• 3: Somewhat unhappy
• 4: Unhappy with little interest in life
• 5: So unhappy that life is not worthwhile
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q27

How would you describe his usual ability to remember things? Is he...?

• 1: Able to remember most things
• 2: Somewhat forgetful
• 3: Very forgetful
• 4: Unable to remember anything at all
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q28

How would you describe his usual ability to think and solve day-to-day problems? Is he...?

• 1: Able to think clearly and solve problems
• 2: Having a little difficulty
• 3: Having some difficulty
• 4: Having a great deal of difficulty
• 5: Unable to think or solve problems
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q29

Is he usually free of pain or discomfort?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q30

How would you describe the usual intensity of his pain or discomfort?

• 1: Mild
• 2: Moderate
• 3: Severe
• 8: RF
• 9: DK

Health: functional limitation (HLT) - Question identifier:HLT_Q31

How many activities does his pain or discomfort prevent him from doing?

• 1: None
• 2: A few
• 3: Some
• 4: Most
• 8: RF
• 9: DK

Relationships (REL) - Question identifier:REL_R01

The next few questions are about ^FNAME's relationships with friends, family and others.

Relationships (REL) - Question identifier:REL_Q01

About how many days a week does he do things with friends?

• 1: Never
• 2: 1 day a week
• 3: 2 or 3 days a week
• 4: 4 or 5 days a week
• 5: 6 or 7 days a week
• 8: RF
• 9: DK

Relationships (REL) - Question identifier:REL_Q02

About how many close friends does he have?

• 1: None
• 2: 1
• 3: 2 or 3
• 4: 4 or 5
• 5: 6 or more
• 8: RF
• 9: DK

Relationships (REL) - Question identifier:REL_R03

Please refer to page [9] of the booklet.

Relationships (REL) - Question identifier:REL_Q03

During the past 6 months, how well has he gotten along with other kids such as friends or classmates?

• 1: Very well, no problems
• 2: Quite well, hardly any problems
• 3: Pretty well, occasional problems
• 4: Not too well, frequent problems
• 5: Not well at all, constant problems
• 6: Not applicable (no friends or classmates)
• 8: RF
• 9: DK

Relationships (REL) - Question identifier:REL_Q05

During the past 6 months, how well has he gotten along with the family?

• 1: Very well, no problems
• 2: Quite well, hardly any problems
• 3: Pretty well, occasional problems
• 4: Not too well, frequent problems
• 5: Not well at all, constant problems
• 8: RF
• 9: DK

Emotional-behavioural Problems- Need for Help (EMB) - Question identifier:EMB_Q01

During the last 6 months, that is, [from [CURRENTDATE - 6 MONTHS] to yesterday], do you think that ^FNAME has had any emotional or behavioural problems?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Emotional-behavioural Problems- Need for Help (EMB) - Question identifier:EMB_Q02

During that time, did he tend to have more emotional or behavioural problems than other [boys/girls] of his age?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Emotional-behavioural Problems- Need for Help (EMB) - Question identifier:EMB_Q03

Do you think that he needs or needed any professional help with these problems?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Rare Experiences Child (REP) - Question identifier:REP_R01

A lot of young people have had stressful or traumatic experiences in their life-time.

Rare Experiences Child (REP) - Question identifier:REP_Q01A

Has ^FNAME ever had any of the following experiences:

...a head injury with loss of consciousness?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Rare Experiences Child (REP) - Question identifier:REP_Q01B

(Has ^FNAME ever had any of the following experiences:)

...a head injury with symptoms of concussion such as headache, feeling dizzy, faint or disoriented?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Rare Experiences Child (REP) - Question identifier:REP_Q01C

(Has ^FNAME ever had any of the following experiences:)

...a burn or poisoning requiring being admitted to hospital overnight?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Rare Experiences Child (REP) - Question identifier:REP_Q01D

(Has ^FNAME ever had any of the following experiences:)

...a serious accident requiring being admitted to hospital overnight?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Rare Experiences Child (REP) - Question identifier:REP_Q01E

(Has ^FNAME ever had any of the following experiences:)

...the death of a parent or sibling?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Rare Experiences Child (REP) - Question identifier:REP_Q01F

Has ^FNAME ever had any of the following experiences:

...the separation or divorce of a parent?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Rare Experiences Child (REP) - Question identifier:REP_Q01G

(Has ^FNAME ever had any of the following experiences:)

...being placed in care overnight at a foster home or group home by the Children's Aid Society?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Rare Experiences Child (REP) - Question identifier:REP_Q02A

(Has ^FNAME ever had any of the following experiences:)

...being in trouble with the law?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Rare Experiences Child (REP) - Question identifier:REP_Q02B

(Has ^FNAME ever had any of the following experiences:)

...been arrested by the police?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Rare Experiences Child (REP) - Question identifier:REP_Q02C

(Has ^FNAME ever had any of the following experiences:)

...gone to Juvenile Court for something he might have done?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Rare Experiences Child (REP) - Question identifier:REP_Q02D

(Has ^FNAME ever had any of the following experiences:)

...been in a detention centre, prison or jail for something he might have done?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Rare Experiences Child (REP) - Question identifier:REP_Q02E

(Has ^FNAME ever had any of the following experiences:)

...been an overnight patient in a hospital or other setting for problems with emotions, attention or behaviours or use of drugs or alcohol?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Selected Child Part 2 (TCD2) - Question identifier:TCD2_R01

(This study is being done with researchers at McMaster University in Hamilton. The study will collect information on the health and well-being of children with a focus on mental health, use of mental health services and the relationship between health, family, neighbourhood and school.

Your answers are collected under the authority of the Statistics Act and will be kept strictly confidential and used only for statistical purposes. While participation is voluntary, your cooperation is essential to ensure the information collected is as accurate and as comprehensive as possible.)

Regular Family Doctor (RFD) - Question identifier:RFD_R01

The next set of questions asks about professional care or help for ^FNAME. Some of the questions ask about child mental health concerns. These concerns refer to problems children might have with their emotions, attention or behaviour.[ For adolescents these problems might also include use of alcohol or drugs./(blank)]

Regular Family Doctor (RFD) - Question identifier:RFD_Q01

In your family, when you have concerns about your child's health, who, besides yourself, takes ^FNAME to appointments, or talks to professionals about him?

• 1: Child's Mother
• 2: Child's Father
• 3: Child's Grandmother
• 4: Child's Grandfather
• 5: Other - Specify
• 6: No one
• 8: RF
• 9: DK

Regular Family Doctor (RFD) - Question identifier:RFD_Q02

Does ^FNAME have a family doctor?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Regular Family Doctor (RFD) - Question identifier:RFD_R03

In the following questions, when I say 'you', please think of everyone who is involved in ^FNAME's care.

Regular Family Doctor (RFD) - Question identifier:RFD_Q03A

In the past 6 months, that is, [from [CURRENTDATE - 6 MONTHS] to yesterday], how many times in total did you or ^FNAME see or talk to this family doctor about any concerns about his health?

• 1: Enter a value
• 2: Saw or talked to the doctor but not sure how many times
• 8: RF
• 9: DK

Regular Family Doctor (RFD) - Question identifier:RFD_Q03B

(In the past 6 months, that is, [from [CURRENTDATE - 6 MONTHS] to yesterday], how many times in total did you or ^FNAME see or talk to this family doctor about any concerns about his health?)

Min = 0; Max = 200

Regular Family Doctor (RFD) - Question identifier:RFD_Q04

At [any of these visits/this visit], did you discuss any concerns about his mental health?

(To remind you, these concerns refer to problems children might have with their emotions, attention or behaviour.[ For adolescents these problems might also include use of alcohol or drugs./(blank)])

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Regular Family Doctor (RFD) - Question identifier:RFD_Q05

In response to these concerns, which of the following did this family doctor do?

• 1: Prescribed a medication
• 2: Suggested strategies on how to deal with the problem
• 3: Provided reassurance and support but no specific strategies
• 4: Made a referral
• 5: Nothing
• 6: Other - Specify
• 8: RF
• 9: DK

Regular Family Doctor (RFD) - Question identifier:RFD_R06

Please refer to page [3] of the booklet.

Regular Family Doctor (RFD) - Question identifier:RFD_Q06

To what extent did you find this family doctor's response helpful?

• 1: Extremely helpful
• 2: Very helpful
• 3: Somewhat helpful
• 4: A little bit helpful
• 5: Not helpful
• 8: RF
• 9: DK

Regular Family Doctor (RFD) - Question identifier:RFD_Q07

Does ^FNAME have a pediatrician?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Regular Family Doctor (RFD) - Question identifier:RFD_R08

(For the next questions, please remember that when I say 'you', you should include everyone who is involved in ^FNAME's care.)

Regular Family Doctor (RFD) - Question identifier:RFD_Q08A

In the past 6 months (that is, [from [CURRENTDATE - 6 MONTHS] to yesterday]), how many times in total did you or ^FNAME see or talk to this pediatrician about any concerns about his health?

• 1: Enter a value
• 2: Saw or talked to the pediatrician but not sure how many times
• 8: RF
• 9: DK

Regular Family Doctor (RFD) - Question identifier:RFD_Q08B

(In the past 6 months (that is, [from [CURRENTDATE - 6 MONTHS] to yesterday]), how many times in total did you or ^FNAME see or talk to this pediatrician about any concerns about his health?)

Min = 0; Max = 200

Regular Family Doctor (RFD) - Question identifier:RFD_Q09

At [any of these visits/this visit], did you discuss any concerns about his mental health?

(To remind you, these concerns refer to problems children might have with their emotions, attention or behaviour.[ For adolescents these problems might also include use of alcohol or drugs./(blank)])

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Regular Family Doctor (RFD) - Question identifier:RFD_Q10

In response to these concerns, which of the following did this pediatrician do?

• 1: Prescribed a medication
• 2: Suggested strategies on how to deal with the problem
• 3: Provided reassurance and support but no specific strategies
• 4: Made a referral
• 5: Nothing
• 6: Other - Specify
• 8: RF
• 9: DK

Regular Family Doctor (RFD) - Question identifier:RFD_R11

(Please refer to page [3] of the booklet.)

Regular Family Doctor (RFD) - Question identifier:RFD_Q11

To what extent did you find this pediatrician's response helpful?

• 1: Extremely helpful
• 2: Very helpful
• 3: Somewhat helpful
• 4: A little bit helpful
• 5: Not helpful
• 8: RF
• 9: DK

Other Person or Place for Regular Health Care (RHC) - Question identifier:RHC_Q01

Other than a family physician or pediatrician is there another health care provider from which ^FNAME receives ongoing or regular health care?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Other Person or Place for Regular Health Care (RHC) - Question identifier:RHC_Q02

From which type of health care provider does ^FNAME receive this care? Is it:

• 1: ... a general practitioner
• 2: ... another type of physician or specialist
• 3: ... a nurse
• 4: ... another health professional
• 8: RF
• 9: DK

Other Person or Place for Regular Health Care (RHC) - Question identifier:RHC_R03

In the following questions, when I say 'you', please think of everyone who is involved in ^FNAME's care.

Other Person or Place for Regular Health Care (RHC) - Question identifier:RHC_Q03

In the past six months, (that is [from [CURRENTDATE - 6 MONTHS] to yesterday]) how many times in total did you or ^FNAME see or talk to [these health professionals/this health professional] about any concerns about his health?

Min = 0; Max = 94

Other Person or Place for Regular Health Care (RHC) - Question identifier:RHC_Q04

At [any of these visits/this visit], did you discuss any concerns about ^FNAME's mental health?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Other Person or Place for Regular Health Care (RHC) - Question identifier:RHC_R06

(Please refer to page [3] of the booklet.)

Other Person or Place for Regular Health Care (RHC) - Question identifier:RHC_Q06

To what extent did you find the response to these concerns of [these health professionals/this health professional] helpful?

• 1: Extremely helpful
• 2: Very helpful
• 3: Somewhat helpful
• 4: A little bit helpful
• 5: Not helpful
• 8: RF
• 9: DK

Walk-in clinic (WIC) - Question identifier:WIC_R01

(In the following questions, when I say 'you', please think of everyone who is involved in ^FNAME's care.)

Walk-in clinic (WIC) - Question identifier:WIC_Q01

In the past 6 months, (that is, [from [CURRENTDATE - 6 MONTHS] to yesterday]) how many times in total did you or ^FNAME go to a walk-in clinic for any concerns about his health?

Min = 0; Max = 200

Walk-in clinic (WIC) - Question identifier:WIC_Q02

Did [any of these visits/this visit] involve concerns about ^FNAME's mental health?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Walk-in clinic (WIC) - Question identifier:WIC_R04

(Please refer to page [3] of the booklet.)

Walk-in clinic (WIC) - Question identifier:WIC_Q04

To what extent did you find this health professional's response to these concerns helpful? Would you say...?

• 1: Extremely helpful
• 2: Very helpful
• 3: Somewhat helpful
• 4: A little bit helpful
• 5: Not helpful
• 8: RF
• 9: DK

Urgent care and Emergency room (UCE) - Question identifier:UCE_Q01

In the past 6 months, (that is [from [CURRENTDATE - 6 MONTHS] to yesterday]) how many times in total did ^FNAME go to an urgent care facility or hospital emergency room for any concerns about his health?

Min = 0; Max = 94

Urgent care and Emergency room (UCE) - Question identifier:UCE_Q02

Did [any of these visits/this visit] involve concerns about ^FNAME's mental health?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Urgent care and Emergency room (UCE) - Question identifier:UCE_R04

(Please refer to page [3] of the booklet.)

Urgent care and Emergency room (UCE) - Question identifier:UCE_Q04

To what extent did you find this health professional's response to these concerns helpful?

• 1: Extremely helpful
• 2: Very helpful
• 3: Somewhat helpful
• 4: A little bit helpful
• 5: Not helpful
• 8: RF
• 9: DK

Mental health services (MHS) - Question identifier:MHS_R01

Next I will show you a list of agencies that provide mental health or addiction services for children and adolescents.

Mental health services (MHS) - Question identifier:MHS_Q01

In the past six months, (that is, [from [CURRENTDATE - 6 MONTHS] to yesterday]) did you, another family member or ^FNAME see or talk to anyone from one of these agencies because of concerns about his mental health?

(To remind you, these concerns refer to problems children might have with their emotions, attention or behaviour.[ For adolescents these problems might also include use of alcohol or drugs./(blank)])

• 1: List of agencies is dynamic based on respondent's census division

Mental health services (MHS) - Question identifier:MHS_Q02A

In the past six months, (that is, [from [CURRENTDATE - 6 MONTHS] to yesterday]) did you, another family member or ^FNAME see or talk to anyone from [any other/any] mental health or addictions agency because of concerns about his mental health?

(To remind you, these concerns refer to problems children might have with their emotions, attention or behaviour.[ For adolescents these problems might also include use of alcohol or drugs./(blank)])

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Mental health services (MHS) - Question identifier:MHS_Q02B

What is the name of the agency?

Mental health services (MHS) - Question identifier:MHS_N02C

Are there other agencies to enter?

If necessary, ask: (Did you see or talk to anyone from any other agency?)

• 1: Yes
• 2: No

Mental health services (MHS) - Question identifier:MHS_Q03

In the past six months, (that is, [from [CURRENTDATE - 6 MONTHS] to yesterday]) how many times in total did you, another family member or ^FNAME see or talk to anyone from [these agencies/this agency] about your concerns?

Min = 0; Max = 500

Mental health services (MHS) - Question identifier:MHS_R04

(Please refer to page [3] of the booklet.)

Mental health services (MHS) - Question identifier:MHS_Q04

To what extent do you feel that the response of [these agencies/this agency] to these concerns was helpful? Would you say...?

• 1: Extremely helpful
• 2: Very helpful
• 3: Somewhat helpful
• 4: A little bit helpful
• 5: Not helpful
• 8: RF
• 9: DK

Mental health services (MHS) - Question identifier:MHS_Q05

Are you currently on a waitlist for any services?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Mental health services (MHS) - Question identifier:MHS_Q06

Have you ever stopped your contact with [these agencies/this agency]?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Mental health services (MHS) - Question identifier:MHS_Q07

Was it because...?

• 1: The waitlist was too long
• 2: The service was not helping
• 3: Transportation problems
• 4: Scheduling problems
• 5: ^FNAME refused to go
• 6: Some other reason
• 8: RF
• 9: DK

Help from individual mental health providers (FFS) - Question identifier:FFS_Q01

In the past six months, that is [from [CURRENTDATE - 6 MONTHS] to yesterday], have you or ^FNAME seen any of the following types of health care providers because of concerns about ^FNAME's mental health? Please include any providers you would have seen at the places mentioned before.

(To remind you, these concerns refer to problems children might have with their emotions, attention or behaviour.[ For adolescents these problems might also include use of alcohol or drugs./(blank)])

• 1: A psychiatrist
• 2: A psychologist
• 3: A social worker
• 4: Some other type of counsellor (Specify)
• 5: None
• 8: RF
• 9: DK

Help from individual mental health providers (FFS) - Question identifier:FFS_R02

(Please refer to page [3] of the booklet.)

Help from individual mental health providers (FFS) - Question identifier:FFS_Q02

To what extent do you feel that the response of [these people/this person] to your concerns about ^FNAME was helpful?

• 1: Extremely helpful
• 2: Very helpful
• 3: Somewhat helpful
• 4: A little bit helpful
• 5: Not helpful
• 8: RF
• 9: DK

Help from individual mental health providers (FFS) - Question identifier:FFS_Q03

In the past six months (that is [from [CURRENTDATE - 6 MONTHS] to yesterday]) did you ever have to use your health benefits or pay out-of-pocket to [these people/this person] or any other mental health provider to get help for ^FNAME's mental health? Please consider any cost that was not reimbursed.

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Children's aid society (CAS) - Question identifier:CAS_R01

When children are having difficulties, it is common for many different types of people to get involved. The next few questions ask about other people you or your family may have been involved with.

Children's aid society (CAS) - Question identifier:CAS_Q01

In the past six months, (that is [from [CURRENTDATE - 6 MONTHS] to yesterday]) have you seen or talked to anyone from the Children's Aid Society (CAS) about ^FNAME?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Children's aid society (CAS) - Question identifier:CAS_Q02

Have you ever seen or talked to anyone from the Children's Aid Society (CAS) about ^FNAME?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Juvenile Justice (JJU) - Question identifier:JJU_R01

The next few questions ask about contact with the police and justice system.

Juvenile Justice (JJU) - Question identifier:JJU_Q01

In the past 6 months, (that is, [from [CURRENTDATE - 6 MONTHS] to yesterday]) have you or ^FNAME talked with the police or been involved with the justice system about him because of something he might have done?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Juvenile Justice (JJU) - Question identifier:JJU_Q02

Did you or ^FNAME ever talk with the police about him because of something he might have done?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Juvenile Justice (JJU) - Question identifier:JJU_Q03

Did you or ^FNAME ever go to Juvenile Court because of something he might have done?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Other Sources of Help (OSH) - Question identifier:OSH_R01

The next questions ask about sources of help and information people may turn to, other than seeking professional help.

Other Sources of Help (OSH) - Question identifier:OSH_Q01

In the past six months, (that is [from [CURRENTDATE - 6 MONTHS] to yesterday]) have you ever obtained help or advice from the following sources due to concerns about ^FNAME's mental health?

(To remind you, these concerns refer to problems children might have with their emotions, attention or behaviour.[ For adolescents these problems might also include use of alcohol or drugs./(blank)])

• 01: Family member or relative
• 02: Friend or partner
• 03: Teacher or other adult at school
• 04: Someone on a phone helpline or crisis hotline
• 05: Internet
• 06: A minister, priest, rabbi, Imam, or other spiritual leader
• 07: Naturopath, herbalist or alternative practitioner
• 08: Some other person or place
• 09: None
• 98: RF
• 99: DK

Perceived Barriers (PBA) - Question identifier:PBA_Q01

In the past 6 months, (that is [from [CURRENTDATE - 6 MONTHS] to yesterday]) was there ever a time when you or ^FNAME felt that ^FNAME might need professional help for his mental health concerns but you did not seek help?

(To remind you, these concerns refer to problems children might have with their emotions, attention or behaviour.[ For adolescents these problems might also include use of alcohol or drugs./(blank)])

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Perceived Barriers (PBA) - Question identifier:PBA_Q02

Please look at your response booklet on page [5].

What are the reasons you did not seek help?

• 01: I thought we could manage it ourselves
• 02: I didn't know where to get help
• 03: I never got around to it (e.g., too busy)
• 04: It would have been too hard to schedule
• 05: I tried but the wait was too long
• 06: I didn't think professional help would do any good
• 07: It was going to cost too much
• 08: Getting there was a problem
• 09: I was afraid of what others would think of me or my child
• 10: My child refused to go
• 11: Other - Specify
• 98: RF
• 99: DK

Perceived Barriers (PBA) - Question identifier:PBA_Q04

What was the main reason you did not seek help?

• 01: I thought we could manage it ourselves
• 02: I didn't know where to get help
• 03: I never got around to it (e.g., too busy)
• 04: It would have been too hard to schedule
• 05: I tried but the wait was too long
• 06: I didn't think professional help would do any good
• 07: It was going to cost too much
• 08: Getting there was a problem
• 09: I was afraid of what others would think of me or my child
• 10: My child refused to go
• 11: Other
• 98: RF
• 99: DK

Prescribed Medications (PME) - Question identifier:PME_R01

Now, I'd like to ask a few questions about ^FNAME's use of prescription medication over the past four weeks.

Prescribed Medications (PME) - Question identifier:PME_Q01

Has ^FNAME taken any prescribed medication in the past four weeks, that is, [from [CURRENTDATE - 28 days] to yesterday]?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Prescribed Medications (PME) - Question identifier:PME_R02

We will be collecting the names and drug identification numbers (DINs) of any prescribed medication ^FNAME took over the past four weeks. It would help us record this information more quickly if you would go and get all the bottles and containers for these products.

Prescribed Medications (PME) - Question identifier:PME_Q02A

Is a Drug Identification number (DIN) available for this medication?

• 1: Yes
• 2: No

Prescribed Medications (PME) - Question identifier:PME_Q02B

What is the DIN of this medication?

Min = 200; Max = 9999999

Prescribed Medications (PME) - Question identifier:PME_N02C

The name associated with DIN ^PME_Q02B is ^DT_MEDNAME. Please confirm.

• 1: Yes
• 2: No

Prescribed Medications (PME) - Question identifier:PME_Q02D

What is the exact name of the medication?

Long Answer Length = 200

Prescribed Medications (PME) - Question identifier:PME_N02E

Is there another medication to enter?

If necessary, ask: (Is there another medication?)

• 1: Yes
• 2: No

Prescribed Medications (PME) - Question identifier:PME_Q03

In the past four weeks (that is [from [CURRENTDATE - 28 days] to yesterday]), has ^FNAME taken:

... fish oil or omega-3 or DHA fatty acid supplements?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Prescribed Medications (PME) - Question identifier:PME_Q04

(In the past four weeks (that is [from [CURRENTDATE - 28 days] to yesterday]), has ^FNAME taken:)

... melatonin?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Diet (DIE) - Question identifier:DIE_R01

Next are some questions about ^FNAME's diet. When answering these questions, please think about how many times rather than how many portions.

Diet (DIE) - Question identifier:DIE_Q01A

During the past 24 hours, how many times did ^FNAME:

...eat fast food (such as Taco Bell, McDonald's, KFC, Tim Hortons)?

• 0: None (zero times)
• 1: Once
• 2: Twice
• 3: Three times
• 4: Four times
• 5: Five times or more
• 8: RF
• 9: DK

Diet (DIE) - Question identifier:DIE_Q01B

(During the past 24 hours, how many times did ^FNAME:)

...drink milk or eat yogurt in any form, including in cereal?

• 0: None (zero times)
• 1: Once
• 2: Twice
• 3: Three times
• 4: Four times
• 5: Five times or more
• 8: RF
• 9: DK

Diet (DIE) - Question identifier:DIE_Q01C

(During the past 24 hours, how many times did ^FNAME:)

...drink a glass or can of sweetened pop or soda (like Coke or Pepsi), a sports drink (like Gatorade) or other sweetened drink (like Snapple)?

• 0: None (zero times)
• 1: Once
• 2: Twice
• 3: Three times
• 4: Four times
• 5: Five times or more
• 8: RF
• 9: DK

Diet (DIE) - Question identifier:DIE_Q01D

(During the past 24 hours, how many times did ^FNAME:)

...drink 100% fruit juices, such as orange, apple or grape? Do not count punch, Kool-Aid, sports drinks (like Gatorade), and fruit flavoured drinks.

• 0: None (zero times)
• 1: Once
• 2: Twice
• 3: Three times
• 4: Four times
• 5: Five times or more
• 8: RF
• 9: DK

Diet (DIE) - Question identifier:DIE_Q01E

(During the past 24 hours, how many times did ^FNAME:)

...eat french fries, potato chips or other fried potatoes?

• 0: None (zero times)
• 1: Once
• 2: Twice
• 3: Three times
• 4: Four times
• 5: Five times or more
• 8: RF
• 9: DK

Diet (DIE) - Question identifier:DIE_Q01F

(During the past 24 hours, how many times did ^FNAME:)

...eat raw or whole fruit? Do not count fruit juice.

• 0: None (zero times)
• 1: Once
• 2: Twice
• 3: Three times
• 4: Four times
• 5: Five times or more
• 8: RF
• 9: DK

Diet (DIE) - Question identifier:DIE_Q01G

(During the past 24 hours, how many times did ^FNAME:)

...eat vegetables, for example, green salads, green beans, carrots or potatoes that are not fried?

• 0: None (zero times)
• 1: Once
• 2: Twice
• 3: Three times
• 4: Four times
• 5: Five times or more
• 8: RF
• 9: DK

Engagement in Activities Outside of School (EAS) - Question identifier:EAS_R01

The next few questions are about ^FNAME's interests and activities outside of school.

Engagement in Activities Outside of School (EAS) - Question identifier:EAS_Q01A

In the past 12 months, outside of school, how often has ^FNAME:

... taken part in organized sports or physical activities with a coach or instructor?

• 1: Most days
• 2: A few times a week
• 3: About once a week
• 4: About once a month
• 5: Almost never
• 8: RF
• 9: DK

Engagement in Activities Outside of School (EAS) - Question identifier:EAS_Q01B

(In the past 12 months, outside of school, how often has ^FNAME:)

... taken part in unorganized sports or physical activities without a coach or instructor?

• 1: Most days
• 2: A few times a week
• 3: About once a week
• 4: About once a month
• 5: Almost never
• 8: RF
• 9: DK

Engagement in Activities Outside of School (EAS) - Question identifier:EAS_Q01C

(In the past 12 months, outside of school, how often has ^FNAME:)

... taken lessons or instructions in music, art or other non-sport activities?

• 1: Most days
• 2: A few times a week
• 3: About once a week
• 4: About once a month
• 5: Almost never
• 8: RF
• 9: DK

Engagement in Activities Outside of School (EAS) - Question identifier:EAS_Q01E

(In the past 12 months, outside of school, how often has ^FNAME:)

... taken part in any clubs, groups or community programs with leadership, such as Beavers, Sparks or church groups?

• 1: Most days
• 2: A few times a week
• 3: About once a week
• 4: About once a month
• 5: Almost never
• 8: RF
• 9: DK

Physical Activity (CPA) - Question identifier:CPA_R01

For these next two questions, add up all the time he spends in physical activity each day. Physical activity is any activity that increases your heart rate and makes you get out of breath some of the time. It can be done in sports, school activities, playing with friends, walking to school or playing active video games such as Wii Sports or Wii Fit. Please include both school and non-school activities.

Physical Activity (CPA) - Question identifier:CPA_Q02

Over the past 7 days, on how many days was ^FNAME physically active for a total of at least 60 minutes per day?

Min = 0; Max = 7

Physical Activity (CPA) - Question identifier:CPA_Q03

Over a typical or usual week, on how many days is ^FNAME physically active for a total of at least 60 minutes per day?

Min = 0; Max = 7

Physical Activity (CPA) - Question identifier:CPA_R05

Now, I will ask you first about TV watching and then about computer use.

Physical Activity (CPA) - Question identifier:CPA_Q05

Over the past 7 days, on average how many hours per day did ^FNAME sit and watch TV, movies or videos, including on YouTube?

• 1: Less than 1 hour
• 2: 1 hour to less than 2 hours
• 3: 2 hours to less than 3 hours
• 4: 3 hours to less than 4 hours
• 5: 4 hours to less than 5 hours
• 6: 5 hours or more
• 7: you does not watch TV or videos
• 8: RF
• 9: DK

Physical Activity (CPA) - Question identifier:CPA_Q06

Over the past 7 days, on average how many hours per day did ^FNAME spend outside of school on a computer, laptop, tablet or smart-phone (working, playing games, e-mailing, chatting, surfing the Internet)?

Include Playstation, Nintendo DS or other portable video games. Please exclude time reported in the previous question.

• 0: Less than 1 hour
• 1: 1 hour to less than 2 hours
• 2: 2 hours to less than 3 hours
• 3: 3 hours to less than 4 hours
• 4: 4 hours to less than 5 hours
• 5: 5 hours or more
• 6: you does not use these devices outside of school
• 8: RF
• 9: DK

Sleep (SLE) - Question identifier:SLE_R01

The next few questions are about your child's usual or typical sleep in the past six months, that is, [from [CURRENTDATE - 6 MONTHS] to yesterday].

Sleep (SLE) - Question identifier:SLE_Q01A

On weekdays when ^FNAME goes to school, what time does he usually go to bed?

Min = 0; Max = 24

Sleep (SLE) - Question identifier:SLE_Q01B

(On weekdays when ^FNAME goes to school, what time does he usually go to bed?)

Min = 0; Max = 59

Sleep (SLE) - Question identifier:SLE_N02

If necessary, please ask: Is that am or pm?

• 1: AM
• 2: PM

Sleep (SLE) - Question identifier:SLE_Q03A

What time does ^FNAME usually wake on school days?

Min = 0; Max = 24

Sleep (SLE) - Question identifier:SLE_Q03B

(What time does ^FNAME usually wake on school days?)

Min = 0; Max = 59

Sleep (SLE) - Question identifier:SLE_N03

If necessary, please ask: Is that am or pm?

• 1: AM
• 2: PM

Sleep (SLE) - Question identifier:SLE_R04

The next few questions have to do with your child's usual sleep on most days, including both weekdays and weekends.

Sleep (SLE) - Question identifier:SLE_Q04

How long does it usually take ^FNAME to fall asleep at night?

• 1: [He/She] falls asleep very quickly; less than 5 minutes
• 2: A few minutes; 5 to 10 minutes
• 3: A little while; 11 to 30 minutes
• 4: A long time; more than 30 minutes
• 8: RF
• 9: DK

Sleep (SLE) - Question identifier:SLE_Q05

After ^FNAME has gone to sleep at night, how often does he usually wake up during the night?

• 1: Almost every night; 5 to 7 times per week
• 2: Several times a week; 1 to 4 times per week
• 3: Every now and then; 2 or 3 times per month
• 4: [He/She] almost never wakes up during the night
• 5: Never
• 8: RF
• 9: DK

Sleep (SLE) - Question identifier:SLE_Q06

How long does it usually take ^FNAME to go back to sleep after he wakes up during the night?

• 1: [He/She] falls asleep very quickly; less than 5 minutes
• 2: A few minutes; 5 to 10 minutes
• 3: A little while; 11 to 30 minutes
• 4: A long time; more than 30 minutes
• 8: RF
• 9: DK

Sleep (SLE) - Question identifier:SLE_Q07A

How much sleep does ^FNAME usually get during the night on school days? Do not include any time that your child is in bed but awake.

Min = 0; Max = 24

Sleep (SLE) - Question identifier:SLE_Q07B

(How much sleep does ^FNAME usually get during the night on school days? Do not include any time that your child is in bed but awake.)

Min = 0; Max = 59

Sleep (SLE) - Question identifier:SLE_Q08A

On school days, does he nap during the day?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Sleep (SLE) - Question identifier:SLE_Q08B

How long does ^FNAME usually nap for?

Min = 0; Max = 9

Sleep (SLE) - Question identifier:SLE_Q08C

(How long does ^FNAME usually nap for?)

Min = 0; Max = 59

Sleep (SLE) - Question identifier:SLE_Q09A

On weekends or vacations when ^FNAME doesn't go to school, what time does he usually go to bed?

Min = 0; Max = 24

Sleep (SLE) - Question identifier:SLE_Q09B

(On weekends or vacations when ^FNAME doesn't go to school, what time does he usually go to bed?)

Min = 0; Max = 59

Sleep (SLE) - Question identifier:SLE_N09

If necessary, please ask: Is that am or pm?

• 1: AM
• 2: PM

Sleep (SLE) - Question identifier:SLE_Q10A

What time does he usually wake on weekends?

Min = 0; Max = 24

Sleep (SLE) - Question identifier:SLE_Q10B

(What time does he usually wake on weekends?)

Min = 0; Max = 59

Sleep (SLE) - Question identifier:SLE_N10

If necessary, please ask: Is that am or pm?

• 1: AM
• 2: PM

Sleep (SLE) - Question identifier:SLE_Q11A

How much sleep does he usually get during the night on weekends or vacations? Do not include any time that your child is in bed but awake.

Min = 0; Max = 24

Sleep (SLE) - Question identifier:SLE_Q11B

(How much sleep does he usually get during the night on weekends or vacations? Do not include any time that your child is in bed but awake.)

Min = 0; Max = 59

Sleep (SLE) - Question identifier:SLE_Q12A

On the weekends, does he nap during the day?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Sleep (SLE) - Question identifier:SLE_Q12B

How long does he usually nap for?

Min = 0; Max = 9

Sleep (SLE) - Question identifier:SLE_Q12C

(How long does he usually nap for?)

Min = 0; Max = 59

Sleep (SLE) - Question identifier:SLE_Q13

Do you consider your child's sleep a problem?

• 1: No problem
• 2: Mild problem
• 3: Moderate problem
• 4: Severe problem
• 8: RF
• 9: DK

Academic basic (ACA) - Question identifier:ACA_R01

Now here are a few questions about school.

Academic basic (ACA) - Question identifier:ACA_Q01

Does ^FNAME go to school?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Academic basic (ACA) - Question identifier:ACA_Q02

Why doesn't ^FNAME go to school?

• 1: [Empty/Too young]
• 2: Schooled at home
• 3: Health reason
• 4: Other
• 8: RF
• 9: DK

Academic basic (ACA) - Question identifier:ACA_Q03

What school grade is ^FNAME in?

• 01: Grade 1 (Elementary)
• 02: Grade 2 (Elementary)
• 03: Grade 3 (Elementary)
• 04: Grade 4 (Elementary)
• 05: Grade 5 (Elementary)
• 06: Grade 6 (Elementary)
• 07: Grade 7
• 08: Grade 8
• 09: Grade 9
• 10: Grade 10
• 11: Grade 11
• 12: Grade 12
• 13: Post-secondary (for example college or university)
• 14: Junior Kindergarten (generally 2 years before grade 1)
• 15: Senior Kindergarten (generally 1 year before grade 1)
• 16: Ungraded
• 98: RF
• 99: DK

Academic basic (ACA) - Question identifier:ACA_Q04

What is the highest grade in school which ^FNAME has completed successfully?

• 01: Grade 1 (Elementary)
• 02: Grade 2 (Elementary)
• 03: Grade 3 (Elementary)
• 04: Grade 4 (Elementary)
• 05: Grade 5 (Elementary)
• 06: Grade 6 (Elementary)
• 07: Grade 7
• 08: Grade 8
• 09: Grade 9
• 10: Grade 10
• 11: Grade 11
• 12: Grade 12
• 13: Post-secondary (for example college or university)
• 14: Junior Kindergarten (generally 2 years before grade 1)
• 15: Senior Kindergarten (generally 1 year before grade 1)
• 16: Ungraded
• 98: RF
• 99: DK

Special Student Status (SSS) - Question identifier:SSS_Q01

Does ^FNAME receive enhanced instruction at school because of exceptionally advanced intellectual, athletic or artistic abilities?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Special Student Status (SSS) - Question identifier:SSS_Q02

Does ^FNAME receive special education or resource help because of a learning disability or a physical, emotional, behavioural or other problem?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Special Student Status (SSS) - Question identifier:SSS_Q03

Has he ever been placed in a special school or special class because of a learning disability or a physical, emotional, behavioural or other problem?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Current achievement (CAC) - Question identifier:CAC_Q01

During the past six months, which of the statements best describes how well ^FNAME has been doing in school?

• 1: Very well, excellent student
• 2: Quite well, good student
• 3: Pretty well, average student
• 4: Not too well, below average student
• 5: Not well at all, poor student
• 8: RF
• 9: DK

Current achievement (CAC) - Question identifier:CAC_Q02A

Based on your knowledge of his school work and most recent report card, how well is ^FNAME doing in the following subjects?

... language including reading, writing and oral communication

• 1: 80-100%
• 2: 70-79%
• 3: 60-69%
• 4: <60%
• 5: Not applicable
• 8: RF
• 9: DK

Current achievement (CAC) - Question identifier:CAC_Q02B

(Based on your knowledge of his school work and most recent report card, how well is ^FNAME doing in the following subjects?)

... mathematics

• 1: 80-100%
• 2: 70-79%
• 3: 60-69%
• 4: <60%
• 5: Not applicable
• 8: RF
• 9: DK

Current achievement (CAC) - Question identifier:CAC_Q02C

How is ^FNAME doing overall?

• 1: 80-100%
• 2: 70-79%
• 3: 60-69%
• 4: <60%
• 8: RF
• 9: DK

Current achievement (CAC) - Question identifier:CAC_Q03

How far in school do you think he will get?

• 1: Complete primary/elementary school (e.g. grade 8)
• 2: Go to high school, but not graduate
• 3: Graduate from high school
• 4: Get a diploma or certificate from trade, technical or vocational school or business college
• 5: Graduate from a community college or other non-university certificate
• 6: Graduate from university
• 7: Graduate from law, medical or graduate school
• 8: RF
• 9: DK

Current achievement (CAC) - Question identifier:CAC_R04

Please refer to page [9] of the booklet.

Current achievement (CAC) - Question identifier:CAC_Q04

During the past six months, how well has he gotten along with his teachers at school?

• 1: Very well, no problems
• 2: Quite well, hardly any problems
• 3: Pretty well, occasional problems
• 4: Not too well, frequent problems
• 5: Not well at all, constant problems
• 8: RF
• 9: DK

Victimization (VIC) - Question identifier:VIC_Q01A

To what extent do the following descriptions apply to ^FNAME? These things could happen at school or outside of school.

^FNAME is picked on by other children.

• 1: Not at all
• 2: A little
• 3: A lot
• 8: RF
• 9: DK

Victimization (VIC) - Question identifier:VIC_Q01B

(To what extent do the following descriptions apply to ^FNAME? These things could happen at school or outside of school.)

^FNAME is called names by peers.

• 1: Not at all
• 2: A little
• 3: A lot
• 8: RF
• 9: DK

Victimization (VIC) - Question identifier:VIC_Q01C

(To what extent do the following descriptions apply to ^FNAME? These things could happen at school or outside of school.)

^FNAME has peers who say negative things about him to other children.

• 1: Not at all
• 2: A little
• 3: A lot
• 8: RF
• 9: DK

Victimization (VIC) - Question identifier:VIC_Q01D

(To what extent do the following descriptions apply to ^FNAME? These things could happen at school or outside of school.)

^FNAME is hit or kicked by other children.

• 1: Not at all
• 2: A little
• 3: A lot
• 8: RF
• 9: DK

Victimization (VIC) - Question identifier:VIC_Q01E

(To what extent do the following descriptions apply to ^FNAME? These things could happen at school or outside of school.)

^FNAME is teased or made fun of by peers.

• 1: Not at all
• 2: A little
• 3: A lot
• 8: RF
• 9: DK

Suspension (SUS) - Question identifier:SUS_Q01

Since the beginning of this school year, how many times has ^FNAME been suspended from school?

• 1: Never
• 2: 1 or 2 times
• 3: 3 or 4 times
• 4: 5 or more times
• 8: RF
• 9: DK

School Services (SSE) - Question identifier:SSE_Q01

Since the beginning of the school year, have you or ^FNAME ever spoken to a teacher, guidance counsellor, principal or other school professional because of concerns about ^FNAME's mental health?

To remind you, these concerns refer to problems children might have with their emotions, attention or behaviour.[ For adolescents these problems might also include use of alcohol or drugs./(blank)]

Please include any encounters with school professionals you may have reported in previous questions.

• 1: Yes
• 2: No
• 8: RF
• 9: DK

School Services (SSE) - Question identifier:SSE_Q02

Since the beginning of the school year, did ^FNAME receive any individual or group counselling, or any other help at school for these concerns?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

School Engagement (CSA) - Question identifier:CSA_R01

The next three questions are about extra-curricular activities that ^FNAME may have participated in, which were school-based.

School Engagement (CSA) - Question identifier:CSA_Q01A

During this school year, how often has ^FNAME participated in individual or team sports with a coach or instructor before school, at lunch or after school?

• 1: Most days
• 2: A few times a week
• 3: About once a week
• 4: About once a month
• 5: Almost never
• 8: RF
• 9: DK

School Engagement (CSA) - Question identifier:CSA_Q01B

During this school year, how often has ^FNAME participated in individual or team sports without a coach or instructor before school, at lunch or after school?

• 1: Most days
• 2: A few times a week
• 3: About once a week
• 4: About once a month
• 5: Almost never
• 8: RF
• 9: DK

School Engagement (CSA) - Question identifier:CSA_Q01C

During this school year, how often has ^FNAME participated at his school in any activities such as choir or drama or clubs such as an environmental club, a library club, a computer or games club?

• 1: Most days
• 2: A few times a week
• 3: About once a week
• 4: About once a month
• 5: Almost never
• 8: RF
• 9: DK

School Collection (SC) - Question identifier:SC_R01A

Teachers are uniquely placed to provide important information about students' behaviour, academic achievement and social development. Since children spend much of their time at school, your co-operation would be appreciated to allow us to send a questionnaire to ^FNAME's teacher.

School Collection (SC) - Question identifier:SC_R01B

In the questionnaire, the teacher will be asked about ^FNAME's school achievements, behaviour and about his classroom environment.

School Collection (SC) - Question identifier:SC_Q01A

Will you allow us to gather information from ^FNAME's teacher?

• 1: Yes
• 2: No
• 8: RF

School Collection (SC) - Question identifier:SC_Q01B

Is there a particular reason why you do not want us to contact the teacher(s)?

• 1: The parent does not want child to be identified as part of the survey
• 2: The parent does not want teacher(s) to provide information on the child
• 3: The parent thinks the school is busy enough
• 4: The child does not want a questionnaire sent to the school
• 5: The parent believes Statistics Canada has enough information
• 6: The parent refuses for no apparent reason
• 7: Other
• 8: RF
• 9: DK

School Collection (SC) - Question identifier:SC_Q02A

^FNAME ^LNAME. Is this the name ^FNAME is known by at school?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

School Collection (SC) - Question identifier:SC_N02B

Update first name, if necessary.

Original First Name: ^FNAME
Original Last Name: ^LNAME

Long Answer Length = 25

School Collection (SC) - Question identifier:SC_N02C

Update last name, if necessary.

Original First Name: ^FNAME
Original Last Name: ^LNAME

Long Answer Length = 25

School Collection (SC) - Question identifier:SC_R04

Transcribe the following information to an informed consent form for contacting the teacher, then ask the respondent to sign the informed consent form.

Child ID : ^SAMPLEID + ^PERSONID
Date : ^DT_DATE
Child's First Name : [SC_N02B/FNAME]
Child's Last Name : [SC_N02C/LNAME]
Parent/Guardian's First Name: ^DT_FNAMEPPF
Parent/Guardian's Last Name: ^DT_LNAMEPPF

School Collection (SC) - Question identifier:SC_N04

Did the respondent sign the informed consent form?

• 1: Respondent signed consent form
• 2: Respondent refused consent

School Collection (SC) - Question identifier:SC_N05A

Enter the form ID from the informed consent form by typing it in.

Long Answer Length = 9

School Collection (SC) - Question identifier:SC_N05B

Please re-enter the form ID from the informed consent form.

Long Answer Length = 9

School Collection (SC) - Question identifier:SC_R07

[Thank you for your cooperation. We will be mailing a package to ^FNAME's school within the next few months./Thank you. We will not be contacting ^FNAME's school.]

School Collection (SC) - Question identifier:SC_N08

Record the status of the consent form.

• 1: Consent form not started
• 2: Consent form started
• 3: Consent form refused
• 4: Consent form completed

School Contact (SCH) - Question identifier:SCH_Q01

What is the name of the school that ^FNAME attends?

School Contact (SCH) - Question identifier:SCH_Q02

So, ^FNAME attends...

[SchoolLookUpList.SCHNAME]
[SchoolLookUpList.SCHADDRESS]
[SchoolLookUpList.SCHCITY], ON [SchoolLookUpList.SCHPOST]

• 1: Yes
• 2: No
• 8: RF
• 9: DK

School Contact (SCH) - Question identifier:SCH_Q03

What is the full name of the school that ^FNAME attends?

Long Answer Length = 80

School Contact (SCH) - Question identifier:SCH_Q03B

What is the complete address of this school?

Long Answer Length = 50

School Contact (SCH) - Question identifier:SCH_Q04

Does this school belong to a school board or school district?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

School Contact (SCH) - Question identifier:SCH_Q05

What is the full name of the school board or district?

Long Answer Length = 80

School Contact (SCH) - Question identifier:SCH_Q06

What is the telephone number of the school that ^FNAME attends?

Long Answer Length = 20

School Contact Teacher (SCP) - Question identifier:SCP_Q01

What is the first name of your child's teacher?

Long Answer Length = 25

School Contact Teacher (SCP) - Question identifier:SCP_Q02

What is the last name of your child's teacher?

Long Answer Length = 25

Linkage (LI2) - Question identifier:LI2_Q01

Your responses from this study will be combined with information from other surveys and from administrative data sources.

This includes information from the Ontario Ministry of Education about ^FNAME's education and information from the Ontario Ministry of Health and Long-Term Care about his use of health services.

• 1: Continue
• 2: Respondent does not want his/her responses combined with other sources

Linkage (LI2) - Question identifier:LI2_Q02A

Having a provincial health number will assist with the linkage to his health records.

Does ^FNAME have an Ontario Health Insurance Plan (OHIP) number?

• 1: Yes
• 2: No
• 8: RF
• 9: DK

Linkage (LI2) - Question identifier:LI2_Q02B

What is ^FNAME's Ontario Health Insurance Plan number?

Long Answer Length = 10

Linkage (LI2) - Question identifier:LI2_N03

Re-enter the Ontario Health Insurance Plan number.

Long Answer Length = 10

Linkage (LI2) - Question identifier:LI2_R04

Sharing ^FNAME's personal information, such as name, address, birth date and school name with the Ontario Ministry of Education will allow us to link his education records. The ministry has agreed to keep this information strictly confidential and use it only for statistical purposes.

Linkage (LI2) - Question identifier:LI2_Q04

Do you agree to share ^FNAME's information with the Ontario Ministry of Education?

• 1: Yes
• 2: No