Supplemental Items for the CAHPS Clinician & Group Child Survey 3.0: Interpreter Services

C-IN1. An interpreter is someone who helps you talk with others who do not speak your language. In the last 6 months, did you need an interpreter at this provider's office?

¹__Yes
²__No → If No, go to core question 26

After core question 25

C-IN2. In the last 6 months, during visits to this provider's office, how often did you get an interpreter when you needed one?

¹__Never → If Never, go to C-IN5
²__Sometimes
³__Usually
⁴__Always

After C-IN1

Note: Use with C-IN1

C-IN3. In the last 6 months, how often did this interpreter treat you with courtesy and respect?

¹__Never
²__Sometimes
³__Usually
⁴__Always

After C-IN2

Note: Use with C-IN1 and C-IN2

C-IN4. Using any number from 0 to 10, where 0 is the worst interpreter possible and 10 is the best interpreter possible, what number would you use to rate this interpreter?

__0 Worst interpreter possible
__1
__2
__3
__4
__5
__6
__7
__8
__9
__ 10 Best interpreter possible

After C-IN3

Note: Use with C-IN1 and C-IN2

C-IN5. In the last 6 months, how often did you use a friend or family member as an interpreter when you talked with this provider?

¹__Never → If Never, go to core question 26
²__Sometimes
³__Usually
⁴__Always

After C-IN4

Note: Use with C-IN1

C-IN6. In the last 6 months, did you use a child younger than 18 to help you talk with this provider?

¹__Yes
²__No

After C-IN5

Note: Use with C-IN1 and C-IN5

C-IN7. What language would you like to talk to your child's provider in?

¹__English
²__Spanish
³__[INSERT LANGUAGE]
⁴__[INSERT LANGUAGE]
⁵__Another language

After core question 36