FOCUS Follow Up Assessment                            (Post Intervention or Services Received)    

Please answer the questions below about your experiences over the past 3 months. Choose the number that best matches your experience. There are no right or wrong answers.

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Please select where or what organization has offered you this assessment:
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Please answer the questions below about your experiences over the past 3 months. Choose the number that best matches your experience. There are no right or wrong answers.
In the past 4-6 weeks, how often have you had to look for a place to stay, for food, deodorant, or soap because sometimes you didn’t have them? *
2. In the past 4-6 weeks, how often have your parent(s)/guardian been unable to take care of you? *
3. In the past 4-6 weeks, how often have your parent(s)/guardian been unable to keep you safe? *
4. In the past 4-6 weeks, how often have you been responsible for taking care of someone? *
5. In the past 4-6 weeks, how often have you been without running water, heat, gas, or food? *
6. In the past 4-6 weeks, how often have you seriously considered running away from home? *
7. How often do you feel anxiety, depression, or stress?
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8. How often have you consumed alcohol in the last month?
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9. In the past 4-6 weeks, how often have you used drugs? *
10. In the last 4-6 weeks, how often did you think about alcohol or drugs? *
11. In the past 4-6 weeks, how often are your friends involved in activities that adults wouldn't approve of? *
12. In the past 4-6 weeks, how often have you felt older than you really are? *
13.  In the past 4-6 weeks, how often do people treat you like you’re older than you really are? *
14. In the last 4-6 weeks, how often have you been around gang members? *
15. Do you know someone that has traded sex for money, food, drugs, alcohol, a place to stay or anything else in the last 4-6 weeks? *
16. Have you traded sex for money, food, drugs, alcohol, a place to stay or anything else in the last 4-6 weeks? *
17. In the past 4-6 weeks, have you worked a job for someone and not gotten paid, but were forced to work anyway? *
18.  In the past 4-6 weeks how many times have you run away? *
19. How many times have you run away in the past 3 months?
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20. How many times have you run away in the past 6 months?
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21. What's the longest time you'd stayed away when you ran?
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22. How many days have you been away from your parent/guardian's home the most recent time you ran away?
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23. Where did you stay when you left home? *
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24. Please check all the reasons you left home.
25. Did you use drugs the most recent time you ran away?
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A copy of your responses will be emailed to the address you provided.
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