Form Context

The next questions refer to the time-period before you were 18 years of age. Now, looking back before you were 18 years of age… "

Source: (CAHMI) at Johns Hopkins Bloomberg School of Public Health

111772-0 For how much of your childhood was there an adult in your household who made you feel safe and protected?

Observation ID in Form

1

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Form Coding Instructions

This could be any adult in the household, not just a parent

Source: (CAHMI) at Johns Hopkins Bloomberg School of Public Health

Fully-Specified Name

Component
For how much of your childhood was there an adult in your household who made you feel safe and protected
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

For how much of your childhood was there an adult in your household who made you feel safe and protected

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.82
Last Updated
Version 2.82 (ADD)
Order vs. Observation
Observation

Example Answer List LL7295-0

AnswerCodeScoreAnswer ID
Never0LA6270-8
A little of the time0LA14732-4
Some of the time0LA14733-2
Most of the time1LA14734-0
All of the time1LA6154-4
Don't know Copyright http://snomed.info/sct ID:456791000124100 Do not know (qualifier value)0LA12688-0
Refused0LA4389-8

Member of these Panels

LOINCLong Common Name
111771-2Behavioral Risk Factor Surveillance System Adverse Childhood Experiences Module 2021 [ACE.BRFSS]
111804-1Positive Childhood Experiences [Positive Childhood Experiences]

111797-7 How often did you feel that you belonged at your high school?

Observation ID in Form

2

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Form Coding Instructions

If you attended multiple high schools, then respond about the high schools in general

Source: (CAHMI) at Johns Hopkins Bloomberg School of Public Health

Fully-Specified Name

Component
How often did you feel that you belonged at your high school
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

How often did you feel that you belonged at your high school

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.82
Last Updated
Version 2.82 (ADD)
Order vs. Observation
Observation

Example Answer List LL7307-3

AnswerCodeScoreAnswer ID
Never0LA6270-8
Rarely0LA10066-1
Sometimes0LA10082-8
Often1LA10044-8
Very often1LA14985-8
Don't know Copyright http://snomed.info/sct ID:456791000124100 Do not know (qualifier value)0LA12688-0
Refused0LA4389-8

Member of these Panels

LOINCLong Common Name
111804-1Positive Childhood Experiences [Positive Childhood Experiences]

111798-5 How often did you feel supported by your friends?

Observation ID in Form

3

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Form Coding Instructions

If some friends did/didn't, answer more about friends in general

Source: (CAHMI) at Johns Hopkins Bloomberg School of Public Health

Fully-Specified Name

Component
How often did you feel supported by your friends
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

How often did you feel supported by your friends

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.82
Last Updated
Version 2.82 (ADD)
Order vs. Observation
Observation

Example Answer List LL7307-3

AnswerCodeScoreAnswer ID
Never0LA6270-8
Rarely0LA10066-1
Sometimes0LA10082-8
Often1LA10044-8
Very often1LA14985-8
Don't know Copyright http://snomed.info/sct ID:456791000124100 Do not know (qualifier value)0LA12688-0
Refused0LA4389-8

Member of these Panels

LOINCLong Common Name
111804-1Positive Childhood Experiences [Positive Childhood Experiences]

111799-3 How often were there at least two adults, other than your parents, who took a genuine interest in you?

Observation ID in Form

4

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
How often were there at least two adults, other than your parents, who took a genuine interest in you
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

How often were there at least two adults, other than your parents, who took a genuine interest in you

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.82
Last Updated
Version 2.82 (ADD)
Order vs. Observation
Observation

Example Answer List LL7307-3

AnswerCodeScoreAnswer ID
Never0LA6270-8
Rarely0LA10066-1
Sometimes0LA10082-8
Often1LA10044-8
Very often1LA14985-8
Don't know Copyright http://snomed.info/sct ID:456791000124100 Do not know (qualifier value)0LA12688-0
Refused0LA4389-8

Member of these Panels

LOINCLong Common Name
111804-1Positive Childhood Experiences [Positive Childhood Experiences]

111800-9 How often did you feel that you were able to talk to your family about your feelings?

Observation ID in Form

5

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
How often did you feel that you were able to talk to your family about your feelings
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

How often did you feel that you were able to talk to your family about your feelings

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.82
Last Updated
Version 2.82 (ADD)
Order vs. Observation
Observation

Example Answer List LL7307-3

AnswerCodeScoreAnswer ID
Never0LA6270-8
Rarely0LA10066-1
Sometimes0LA10082-8
Often1LA10044-8
Very often1LA14985-8
Don't know Copyright http://snomed.info/sct ID:456791000124100 Do not know (qualifier value)0LA12688-0
Refused0LA4389-8

Member of these Panels

LOINCLong Common Name
111804-1Positive Childhood Experiences [Positive Childhood Experiences]

111801-7 How often did you enjoy participating in your community’s traditions?

Observation ID in Form

6

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
How often did you enjoy participating in your community's traditions
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

How often did you enjoy participating in your community's traditions

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.82
Last Updated
Version 2.82 (ADD)
Order vs. Observation
Observation

Example Answer List LL7307-3

AnswerCodeScoreAnswer ID
Never0LA6270-8
Rarely0LA10066-1
Sometimes0LA10082-8
Often1LA10044-8
Very often1LA14985-8
Don't know Copyright http://snomed.info/sct ID:456791000124100 Do not know (qualifier value)0LA12688-0
Refused0LA4389-8

Member of these Panels

LOINCLong Common Name
111804-1Positive Childhood Experiences [Positive Childhood Experiences]

111802-5 How often did you feel your family stood by you during difficult times?

Observation ID in Form

7

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Form Coding Instructions

If some family members did/didn't, answer more about family in general

Source: (CAHMI) at Johns Hopkins Bloomberg School of Public Health

Fully-Specified Name

Component
How often did you feel your family stood by you during difficult times
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

How often did you feel your family stood by you during difficult times

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.82
Last Updated
Version 2.82 (ADD)
Order vs. Observation
Observation

Example Answer List LL7307-3

AnswerCodeScoreAnswer ID
Never0LA6270-8
Rarely0LA10066-1
Sometimes0LA10082-8
Often1LA10044-8
Very often1LA14985-8
Don't know Copyright http://snomed.info/sct ID:456791000124100 Do not know (qualifier value)0LA12688-0
Refused0LA4389-8

Member of these Panels

LOINCLong Common Name
111804-1Positive Childhood Experiences [Positive Childhood Experiences]

111803-3 Positive Childhood Experiences (PCEs) total score

Term Description

Each item contributes to a PCE score (range: 0-7).
Add together the individual scores for all seven items. The total score should be between 0 and 7.

Observation Required in Panel

Required

Type of Entry

Question - computer calculates response [C]

Form Coding Instructions

Each item contributes to a PCE score (range: 0-7).

Source: (CAHMI) at Johns Hopkins Bloomberg School of Public Health

Fully-Specified Name

Component
Total score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
PCEs

Long Common Name

Total score [Positive Childhood Experiences]

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.82
Last Updated
Version 2.82 (ADD)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
111804-1Positive Childhood Experiences [Positive Childhood Experiences]

Example Units

UnitSource
{score}Example UCUM Units