Control Factors Database Sheet

Control Factors Database Sheet - History of Mental Illness:...

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Control Variables List Age: 15-20: ___ 21-29: ___ 30-39: ___ 40-49: ___ 50-59: ___ 60+: ___ Race/Ethnicity: White: ___ Black: ___ Hispanic/Latino: ___ Other (specify): ___ Education: High School Dropout (completed grade level): ___ Completed High School: ___ Some College: ___ College Degree (specify): ___ Other (explain) ___ Current Offense: Drug-related Offense (if necessary specify): ___ Alcohol-related Offense (if necessary specify): ___ Other (specify, e.g. under the influence while committing crime): ___ Prior Prison Records: Prior Confinement: ___ Offense History: ___ No Prior Confinement: ___ Drug Use Severity (according to SFS): High: ___ Medium: ___ Low: ___ Mental Health:
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Unformatted text preview: History of Mental Illness: ___ Type (of illness (es)): ___ No History of Mental Illness: ___ Family History: Prior drug/alcohol use among family members: ___ Relationship to participant: ___ No prior drug/alcohol abuse among family members: ___ Completion of program (experimental group): Completion: ___ Did not Complete: ___ Months in Program: ___ Participation in Aftercare: Did participate in aftercare: ___ How many months: ___ Did not participate in aftercare: ___ Participation in Outpatient Counseling: Did participate in outpatient counseling: ___ How many months: ___ Did not participate in outpatient counseling: ___...
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Control Factors Database Sheet - History of Mental Illness:...

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