Partner Home Rainbow Homes Project Rainbow Homes Research Quant Survey Step 1 of 4 25% Part 11. Choose Rainbow Homes (RH) CityBengaluruChennaiDelhiHyderabadPatnaRanchi2. Enter RH Home Code 3. Choose Participant Research ID (Bengaluru)BNG01BNG02BNG03BNG04BNG05BNG06BNG07BNG08BNG09BNG10BNG11BNG12BNG13BNG14BNG15BNG16BNG17BNG18BNG19BNG20BNG21BNG22BNG23BNG24BNG25BNG26BNG27BNG28BNG29BNG30BNG31BNG32BNG33BNG34BNG35BNG36BNG37BNG383. Choose Participant Research ID (Chennai)CHE01CHE02CHE03CHE04CHE05CHE06CHE07CHE08CHE09CHE10CHE11CHE12CHE13CHE14CHE15CHE17CHE18CHE19CHE20CHE213. Choose Participant Research ID (Delhi)DEL01DEL02DEL03DEL04DEL05DEL06DEL07DEL08DEL09DEL10DEL11DEL12DEL13DEL14DEL15DEL16DEL17DEL18DEL19DEL20DEL21DEL22DEL23DEL24DEL25DEL26DEL27DEL28DEL29DEL30DEL31DEL323. Choose Participant Research ID (Hyderabad)HBD01HBD02HBD03HBD04HBD05HBD06HBD07HBD08HBD09HBD10HBD11HBD12HBD13HBD14HBD15HBD16HBD17HBD18HBD19HBD20HBD21HBD22HBD23HBD24HBD25HBD26HBD27HBD28HBD29HBD30HBD31HBD32HBD33HBD34HBD35HBD36HBD37HBD38HBD39HBD40HBD41HBD42HBD43HBD44HBD45HBD46HBD47HBD48HBD49HBD50HBD51HBD52HBD53HBD54HBD55HBD56HBD57HBD58HBD59HBD60HBD61HBD62HBD63HBD64HBD65HBD66HBD67HBD68HBD69HBD70HBD71HBD72HBD73HBD74HBD75HBD76HBD77HBD78HBD79HBD80HBD81HBD82HBD83HBD84HBD85HBD86HBD87HBD88HBD89HBD90HBD91HBD92HBD93HBD94HBD95HBD96HBD97HBD98HBD99HBD100HBD101HBD102HBD103HBD104HBD105HBD106HBD107HBD108HBD109HBD110HBD111HBD112HBD113HBD1143. Choose Participant Research ID (Patna)PAT01PAT02PAT03PAT04PAT05PAT06PAT07PAT08PAT09PAT10PAT11PAT12PAT13PAT14PAT15PAT16PAT17PAT18PAT19PAT20PAT21PAT22PAT23PAT24PAT25PAT26PAT27PAT28PAT29PAT30PAT31PAT32PAT33PAT34PAT35PAT36PAT37PAT38PAT39PAT40PAT41PAT42PAT43PAT44PAT45PAT463. Choose Participant Research ID (Ranchi)RAN01RAN02RAN03RAN04RAN05RAN06RAN07RAN08RAN09RAN10RAN11Upload Consent FormMax. file size: 2 GB.4.a. Family History Available? (To be answered by Rainbow Home Staff) Yes No 4.b.1. Parents availableTo be answered by Rainbow Home Staff. Both the parents are available One parent is available No parents 4.b.2. Siblings availableTo be answered by Rainbow Home Staff. Siblings available No siblings 4.c.a. Parents / Siblings visit the childTo be answered by Rainbow Home Staff. Yes No 4.c.b. Parents / Siblings visit the child - how often?Frequency of Visit Weekly Monthly Yearly No Visit Other 5. Self Identified Gender Male Female Third Gender Prefer not to say Other 6. AgeYear of Birth2003200420052006200720082009201020112012201320142015Month of BirthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember7. How long have you been residing in Rainbow Homes?YearsPlease enter a number from 0 to 19.MonthsPlease enter a number from 0 to 11.8. Where did you stay during COVID 19?8.A.a. Where did you stay during COVID 19? (WAVE 1) Within residential facilities of RH Home Other 8.A.b For how long?YearsPlease enter a number from 0 to 19.MonthsPlease enter a number from 0 to 11.Mention details (if any)8.A.c Could you rate your spending time during this period? Excellent Very good Good Average Not Good Bad Very Bad Don't Know 8.B.a. Where did you stay during COVID 19? (WAVE 2) Within residential facilities of RH Home Other 8.B.b For how long?YearsPlease enter a number from 0 to 19.MonthsPlease enter a number from 0 to 11.Mention details (if any)8.B.c Could you rate your spending time during this period? Excellent Very good Good Average Not Good Bad Very Bad Don't Know 9. Class studying in school / degree and year in college?Class 1Class 2Class 3Class 4Class 5Class 6Class 7Class 8Class 9Class 10Class 11Class 12College year 1College year 2College year 3College year 4Other9. Other (Class studying in school / degree and year in college?) 10. Do you have any problem in paying attention in school? Yes No Don't Know 10. If 'No', could you please share the reasons11. How much school-related work do you think you are able to complete? Fully Partially Not at all Don't Know 12. What do you want to become later in life?13. How many close friends do you have?14. Are you spending time with your friends and others as much as you usually do before the pandemic? (Eg. Playing) Yes No Occasionally 15. Is anything making you feel scared? Yes No No answer 15. If yes, could you share, what you feel scared of?16. Do you have any health problems? (eg. aches/pain/disease/illness) Yes No No Answer 16. If yes, could you share the problem?17. Social connectedness (0 being the lowest to 10 being the highest)0 - Not at all connected 10 - Extremely Connected01234567891018. Do you think you are withdrawing yourself from those around you?(probe with examples - not spending time with others, being by oneself more than earlier etc.) Yes No Don't Know 18. If yes, could you share the reasons?19.a. Have your sleeping habits changed after COVID? Yes No To Some Extent Don't Know 19.a. If yes, could you share the changes? Have problem in falling asleep Waking up in the middle of night Other 19.a. Mention other changes here19.b. Do you get any dream? Yes No No answer 19.b. If yes, could you share the nature of dream? Happy Scary Disturbing Other 19.c. Present Quality of Sleep Very Bad Bad Average Good Very Good 20. Appetite Increased Decreased No Change Don't Know 21. Satisfaction in Life Fully Satisfied Satisfied Not Satisfied Very Dissatisfied Don't Know 22. Mood (during pandemic)01234567891023. Mood (currently)01234567891024.a. Do you get angry? (most of the time) Yes No No answer 24.b. Indicate your answer01234567891025.a. Rate the level of stress (most of the time)01234567891025.b. Are there any other stressful challenges you had / have during: 25.b. During COVID19 pandemic / lock downs? Yes No 25.b. Mention the challenges (during lock downs)25.b. After lockdowns? Yes No 25.b. Mention the challenges (after lock downs)25.c. What are things that reduced your stress / made you feel better during the lock downs / COVID19 pandemic and afterwards? Talk to friends or family Exercise Participate in creative activities or hobbies (Reading, writing, arts and crafts) Other 25.c. Mention Other26. Do you feel Anxious? Yes No No Answer 26. If yes, could you share the reasons?27. Do you always look forward to the next day? Always Sometimes Rarely Not at all Other 28. Draw a picture of how your future will be? (Upload the picture)Max. file size: 2 GB.29. Who was the person you reached out to when you needed any help?30. Name two Rainbow Home’s interventions that helped you to overcome these challenges? Part 2Over the last two weeks:All of the timeMost of the timeMore than half the timeLess than half the timeSome of the timeAt no timeI have felt cheerful in good spiritsI have felt calm and relaxedI have felt active and vigorousI woke up feeling fresh and restedMy daily life has been filled with the things that interest me Part 3In the last 2 weeks:None of the timeRarelySome of the timeOftenAll the timeI've been feeling optimistic about the futureI've been feeling usefulI've been feeling relaxedI've been feeling interested in other peopleI've had energy to spareI've been dealing with problems wellI've been thinking clearlyI've been feeling good about myselfI've been feeling close to other peopleI've been feeling confidentI've been able to make up my own mind about thingsI've been feeling lovedI've been interested in new thingsI've been feeling cheerful Survey Conducted by:Enter Name Date MM slash DD slash YYYY Δ
