Survey Requirements
Secondary Student Surveys (Grades 7 and higher)
Elementary Student Survey (Grade 5)
Staff School Climate Survey
Last updated August 26, 2004. Version 7. Copyright 2003, WestEd.
SECONDARY STUDENT SURVEYS
Module A. Core
Required
The secondary (modular) surveys are intended for use in grades 7 through 12. The required Core module collects demographic background data (age, sex, race/ethnicity, height, weight) and covers key questions in five priority areas: alcohol and drug use, tobacco use, violence and school safety, physical activity, and diet. It provides a comprehensive overview to health-related behavior and attitudes, and meets the requirements of the No Child Left Behind Act, including items assessing the Safe and Drug Free Schools and Communities Act (Title IV) Performance Indicators recommended by the California Department of Education. In addition, it includes one item that assesses the reliability of answers.
» Middle School Module A (81 items): English (PDF) or Spanish (PDF)
» High School Module A (88 items): English (PDF) or Spanish (PDF)
Module B. Resilience and Youth Development
Questions 1-23 Required, 24-56 Optional
The growing popularity of resilience- or asset-based prevention and youth development programs has created a need for a comprehensive assessment tool that is theoretically sound, developmentally and culturally appropriate, reliable, and valid. The HKS Resilience & Youth Development Module fills this void. Developed with the assistance of a national panel of experts, it measures 11 external assets and 6 internal assets. The external assets include caring relationships, high expectations, and opportunities for meaningful participation in the school, home, community, and peer group. Internal assets consist of cooperation and communication, empathy, problem-solving, self-efficacy, self-awareness, and goals and aspirations. The survey also contains a school connectedness scale used in the National Longitudinal Study of Adolescent Health. (More on Resilience...)
The RYDM school- and community- related items (questions 1 - 23) are required for California school districts accepting funding from Safe and Drug Free Schools and Communities (SDFSC) under the No Child Left Behind Act (NCLB). The rest of the module is optional (questions 24 - 56), but may not be administered independent of the first part. Please be sure to reproduce only those parts you wish to administer.
» Middle School Module B (full module, 56 items): English (PDF) or Spanish (PDF)
» Required items 1-23 only: English (PDF) or Spanish (PDF)
» High School Module B (full module, 56 items): English (PDF) or Spanish (PDF)
» Required items 1-23 only: English (PDF) or Spanish (PDF)
Module C. Alcohol & Other Drug Use and Safety, Including Violence & Suicide
Optional
This module consists largely of additional items from the California Student Survey relating to AOD use and violence. The suicide-related items were derived from the YRBS. Less school-specific than the Core, it includes general questions about frequency of AOD use in the past six months, AOD-related problems, drug sale, perceived use by adults, fighting, bullying, and weapons. It can help you understand the dynamics of these problems and provides greater comparability to state norms.
» Middle School Module C (19 items): English (PDF) or Spanish (PDF)
» High School Module C (39 items): English (PDF) or Spanish (PDF)
Module D. Tobacco
Required for competitive TUPE grantees, otherwise Optional
This module provides a more comprehensive picture of tobacco use and attitudes and enhances the surveyís value for the California state Tobacco Use Prevention Education (TUPE) program. Whereas the Core focuses primarily on cigarette smoking prevalence, perceived harm, and availability, Module D assesses a wider range of tobacco-related behaviors and attitudes in greater depth, and provides program-related data, including peer norms, approval, and behavioral intentions. LEA recipients of TUPE competitive grants (grades six through eight Promising grants or grades nine through twelve High School grants) are required to administer this module.
» Middle School Module D (24 items): English (PDF) or Spanish (PDF)
» High School Module D (24 items): English (PDF) or Spanish (PDF)
Module E. Physical Health
Optional
This module provides detailed information on physical activity in and out of school, body image, behaviors related to weight loss or maintenance, physical risks associated with sports and motor vehicles, and general health, including doctor visits. The majority of the items have been derived from the Youth Risk Behavior Survey (YRBS). To fully assess and understand substance use and violence, and promote positive youth development, it is essential to examine overall physical and mental health. Many of the behaviors assessed by this module have also been linked to school performance.
» Middle School Module E (20 items): English (PDF) or Spanish (PDF)
» High School Module E (21 items): English (PDF) or Spanish (PDF)
Module F. Sexual Behavior, Including Pregnancy & HIV/AIDS Risk
Optional
The items in this module, the majority derived from the Youth Risk Behavior Survey (YRBS), assess sexual experience, patterns, and attitudes, pregnancy history, and HIV-related risk behaviors. They cover number of partners (a main HIV risk factor), perception of peer behavioral norms, use of contraception, AOD use before sexual intercourse, family discussion, and exposure to HIV/AIDS education.
» Middle School Module F (14 items): English (PDF) or Spanish (PDF)
» High School Module F (19 items): English (PDF) or Spanish (PDF)
Module G. Custom Module
Optional
You can create a module of your own design of up to 60 items with as many as 13 response options. This module is especially useful for LEAs that have trend data from previous surveys not covered by HKS items, that want to add items specific to their programs as part of an evaluation effort, or that wish to integrate the HKS with other ongoing data collection efforts. Please contact your HKS Regional Center regarding custom modules.
ELEMENTARY STUDENT SURVEY
Required
The single (nonmodular) elementary school version is built around HKS Core and Resilience & Youth Development items. It is intended for use in grade 5, but it is also appropriate for grades 4 and 6. It provides baseline data to support the implementation of comprehensive, developmentally appropriate K-12 prevention and health programs. It contains many of the same or similar items as the middle school version in order to have cross-survey comparability, though item wording is simpler and developmentally appropriate. It is focused less on assessing behavior than on the risk and resilience factors that influence behavior. This is because most risk behaviors are very uncommon among youth under grade 7.
The instrument, now required for California school districts, covers: lifetime use of alcohol, tobacco, marijuana, and inhalants, as well as intoxication while at school, perceived harm, and availability (providing data for the state-identified Title-IV Performance Indicators); harassment and bullying at school, carrying weapons on campus, and perceived school safety; physical activity, diet, and body image; health-related out-of-school activities; and developmental assets, using shorter scales than the secondary school Resilience & Youth Development Module.
» Elementary Survey (59 items): English: One-column format (PDF), English: Two-column format* (PDF) or Spanish/Bilingual (PDF)
* The one- and two-column formats contain exactly the same questions. The two-column format was created to help ease printing costs, but may be confusing to students.
STAFF SURVEY
Required
The California Department of Education now requires school districts that accept Title IV or TUPE funds to conduct the staff School Climate Survey in conjunction with the HKS. The survey gathers information from school staff that, in conjunction with HKS student data, will enrich a school district's ability to understand and address the impact of substance use and violence on the students and the school. Second, to further enhance the survey's value to school improvement efforts, it includes general school-climate questions relevant to school connectedness, learning supports, and health-related learning barriers. Districts may also add questions of their own choosing as a custom feature.
The current version of the staff School Climate Survey is provided here for your review. To learn more about the survey, including when, where, and how the survey must be administered, read Part III of the Guidebook for the California Healthy Kids Survey.
» Staff School Climate Survey (PDF; DO NOT ADMINISTER WITHOUT PERMISSION)