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SPNS COOPERATIVE AGREEMENT EVALUATION
MODULE 26A: CES-D FORM (INTERVIEW FORMAT) INSTRUCTIONS
Citation: Huba, G. J., Melchior, L. A., Staff of The Measurement Group, and HRSA/HAB's SPNS Cooperative Agreement Steering Committee (1995). Module 26A: CES-D Form (Interview). Available: www.TheMeasurementGroup.com. Culver City, California: The Measurement Group.
Source Citations: ORIGINAL 20-ITEM VERSION. Radloff, L. S. (1977). The CES-D scale: A self report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401; SPANISH VERSION (20 ITEMS). Roberts, R. E. (1980). Reliability of the CES-D scale in different ethnic contexts. Psychiatry Research, 2, 125-134. Developed in a sample of Mexican Americans; 8- and 4-ITEM VERSIONS. Melchior, L. A., Huba, G. J., Brown, V. B., and Reback, C. J. (1993). A short depression index for women. Educational and Psychological Measurement, 53(4), 1117-1125.
Answer questions by either filling in a circle, or writing a number or letter in a square box. If the answer goes in a square box, you must use a CAPITAL LETTER or number that does not touch the side of the box. Print only one letter or number in each box. If the letters or numbers that you print touch the sides of the boxes, or if you do not clearly print the information, the computer will "kick out" the form and we will need to return it to you to be completed correctly. If the question asks the answer to be filled in a circle, make sure that the circle is completely darkened. Only darken one circle for each question unless the instructions specifically tell you to darken as many as apply for that question.
Specific Parts of the Module 26A: CES-D Form (Interview Format)
ID Letters/ID Numbers. These boxes are provided for entering the unique identifier your site is using to track client information. The four boxes on the left are to be used for letters, while the ten boxes on the right are reserved for numbers. You may use letters, numbers, or a combination of letters and numbers, for identification purposes. If you use a combination of letters and numbers, however, please use the letters first in your alphanumeric sequence (for example, if your unique identifier is MD-1479, the letters "M" and "D" would be entered in the first two of the four boxes reserved for letters and the numbers "1", "4", "7", and "9" would be entered into the first four of the ten boxes reserved for numbers). If you are unsure about the unique identifier for this client, check with your project director.
Site. This is a code to identify your project in the cross-cutting evaluation. It should be pre-printed on the form.
Sub-Provider. This field may be used to designate specific sites or providers within your project. If appropriate, enter the code of the service provider agency doing the activity. Provider codes can be up to three letters.
Date. Enter the numbers representing today's date (the date of the activity) in these boxes. Enter the month as a number from 01 to 12 for January through December. Enter the day as a two-digit number (01 to 31). Enter the last two digits of the current year (for example, "95" for 1995). Make sure that if a month or day is less than 10, you place a "0" before the number.
Staff Code. Each staff member should be assigned a unique number code (up to 3 digits). Make sure that each new staff member has a unique code. Do not reassign any staff codes that have been previously assigned. Enter the 3-digit code for the person who provided the services. If the staff code is less than 3 digits, place "0"s before the number. For example, 3 is 003.
Client Gender. Darken the circle next to the response that indicates the person's gender.
Items 1 through 20. Read the following statement: "I am going to read a list of the ways you might feel. For each description that I read to you, please tell me how often you have felt this way during the past week." Give the response card to the respondent and read the options that will be used for each item. Then read the items to the respondent exactly as they are written and indicate his or her response to each item. Darken the first circle if the item applies to the respondent "Rarely or none of the time (less than 1 day)." Darken the second circle if the item applies to the respondent "Some or a little of the time (1-2 days)." Darken the third circle if the item applies to the respondent "Occasionally or a moderate amount of the time (3-4 days)." Darken the fourth circle if the item applies to the respondent "Most or all of the time (5-7 days)."
CES-D Card A
Use one of these responses to answer the next questions
During the past week...
Rarely or None of the Time |
Some or a Little of the Time |
Occasionally or a Moderate Amount of the Time |
Most or All of the Time |
Less than 1 day |
1-2 days |
3-4 days |
5-7 days |
Module 26
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