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Creating a Custom Module

Each CalSCHLS survey can be customized by creating a Custom Module of questions of your own choosing. Working with your CalSCHLS Technical Advisor, a Custom Module can be created with questions of your own selection or, in the case of the CHKS, by selecting questions from existing supplementary modules. Questions can refer to a topic, a program (for evaluation purposes), or almost anything about which additional information is needed. This feature is especially useful for districts seeking to collect data on local LCAP priorities not covered by existing CalSCHLS modules. Districts wishing to develop a Custom Module should consult with their CalSCHLS Regional Center at the beginning of the process.

Tips on creating a custom module:

  • Custom modules cannot be longer than 62 questions. The actual length is related to how many additional questions can be asked within a standard class period along with the regular modules you are administering. Your CalSCHLS TA can help you determine this. To keep the survey length appropriate, we recommend that you consider adding no more than 20 questions.
  • Review the list of sample custom questions districts have previously used.
  • Avoid using the word "or" and do not use "etc." after e.g. or i.e.
  • Adjust the wording to suit the grade level.

CHKS Question Bank

To aid in the process of creating a Custom Module for the CHKS, you can browse questions that districts have previously added to their surveys in the following topical areas. These questions are intended as guides only; no claims are made as to their value or utility.

Academics

  1. School is important for success in life.
    1. Not at all true
    2. A little true
    3. Pretty much true
    4. Very much true
  2. The lessons in school are interesting to me.
    1. Not at all true
    2. A little true
    3. Pretty much true
    4. Very much true
  3. I have cheated within the past 30 days on homework, test or written reports.
    1. Not at all true
    2. A little true
    3. Pretty much true
    4. Very much true
  4. I get most of my homework help from:
    1. A parent
    2. My sister or brother
    3. My friends
    4. After school program
    5. I receive no help on homework
  5. How much time do you spend on your homework each school day?
    1. 1/2 hour to 1 hour
    2. 1 to 2 hours
    3. 2 or more hours
  6. After high school graduation I plan on:
    1. Attending a four-year college
    2. Attending a community college
    3. Attending a trade school
    4. Going to work
    5. Enlisting in the military
    6. I don’t know
  7. During the last 12 months, what have you discussed most with your parents/guardians concerning your options after high school graduation?
    1. Whether or not I should go to college
    2. Which courses I should take and/or admission requirements
    3. Options for more schooling like 4-year university/community college/trade schools
    4. Job possibilities after high school graduation
    5. We haven’t had any discussions

After School Activities

  1. If your community was going to provide new activities for people your age, what would you want?
    1. Organized sports and recreation
    2. Arts, music, dance, and drama
    3. Computer, video production, photography
    4. Volunteering to help others, animals, or the environment
    5. Tutors and mentors
    6. Youth clubs and centers
    7. Job readiness and work internships
    8. Counseling
    9. Alcohol and drug treatment
  2. I feel close to people at my afterschool program.
    1. Strongly disagree
    2. Disagree
    3. Neither disagree nor agree
    4. Agree
    5. Strongly agree
  3. I do not participate in activities during non-school hours because of the cost.
    1. Not true at all
    2. A little true
    3. Pretty much true
    4. Very much true
  4. I do not participate in activities during non-school hours because I do not have transportation.
    1. Not true at all
    2. A little true
    3. Pretty much true
    4. Very much true
  5. During a normal week, how often do you take care of yourself after school because there are no adults around?
    1. 0 times
    2. One day each week
    3. 2-3 days a week
    4. 4-5 days a week
  6. During a normal week, how often do you take care of yourself before school because there are no adults around?
    1. 0 times
    2. One day each week
    3. 2-3 days a week
    4. 4-5 days a week

AOD (Alcohol & Other Drugs)

  1. If you drink alcohol, what type do you most often drink?
    1. I don’t drink alcohol
    2. Beer
    3. Hard liquor
    4. Wine or wine coolers
    5. ‘Alco-pops’
    6. Other
  2. Where do most students at your school who use drugs get them?
    1. At school
    2. At parties or events outside of school
    3. At home
    4. In the neighborhood
    5. Don’t know
  3. In the past 12 months, have you talked calmly with your parents/guardians about the dangers of marijuana use?
    1. No
    2. Yes
  4. How do you think your parents/guardians would feel about you drinking alcohol?
    1. Would strongly disapprove
    2. Would somewhat disapprove
    3. Would not disapprove

Depression, Suicide, Mental Health

  1. Have you ever taken part in a support group?
    1. No
    2. Yes
  2. Have you ever received any type of school counseling?
    1. No
    2. Yes
  3. If you felt stressed or depressed, who would you most likely talk to for advice or information?
    1. Friend
    2. Brother/Sister
    3. Parent/Guardian
    4. Teacher/Counselor
    5. Other Adult
    6. Internet
    7. Hotline/Agency
    8. Other
  4. Have you ever called a hotline for help with problems you are having at school, home, or elsewhere?
    1. Yes
    2. No

Gang Prevention

  1. Are there gang members at your school?
    1. A lot
    2. Some
    3. Few
    4. None
    5. Don’t know
  2. Are there gang members in your neighborhood?
    1. A lot
    2. Some
    3. Few
    4. None
    5. Don’t know
  3. How many of your friends are in a gang?
    1. A lot
    2. Some
    3. Few
    4. None
  4. At your school, have gang members done the following:…Gotten into fights? Provided protection for each other? Stolen things? Damaged property? Sold drugs? Carried weapons?
    1. Often
    2. Sometimes
    3. Never
    4. Don’t know

General/Other

  1. Where do you most often access the internet?
    1. I never access the internet
    2. Home
    3. School
    4. Pay-for-use computer facility
    5. Community center
    6. Elsewhere
  2. How much time do you spend on the internet each week?
    1. None/Less than an hour
    2. 1 to 5 hours
    3. 5 to 10 hours
    4. More than 10 hours
  3. Have you ever done an internet search to help you with problems you are having at school, home or elsewhere?
    1. Yes
    2. No
  4. Does the information you read online help you to change or think about changing your behavior?
    1. Yes
    2. No

Harassment/Bullying

  1. If you saw another student being bullied, what would you do?
    1. Tell an adult at school
    2. Laugh or join in
    3. Nothing
  2. Have you ever threatened anyone at school?
    1. No
    2. Yes
  3. Is there an adult at your school who you feel you can trust?
    1. No
    2. Yes
  4. During the past 12 months, how many times have you been afraid of being beaten up at school?
    1. None
    2. Once
    3. Twice
    4. Three times or more
  5. During the past 12 months, how many times have you been harassed or bullied because of your race, ethnicity, or national origin on school property?
    1. None
    2. Once
    3. Twice
    4. Three times or more
  6. During the past 12 months, how many times on school property have you been harassed or bullied because you are gay or lesbian, or because someone thought you were?
    1. None
    2. Once
    3. Twice
    4. Three times or more

Health Care Access

  1. Have you ever taken part in a support group?
    1. No
    2. Yes
  2. Have you ever received any type of school counseling?
    1. No
    2. Yes
  3. Do you know where to go in your community to get advice on personal problems?
    1. No
    2. Yes
  4. If you needed advice on personal problems, who would you talk to first?
    1. Counselor
    2. Doctor/Nurse
    3. Friend
    4. No one
  5. In the past year, where did you usually get counseling for help with stress, depression, or family problems?
    1. School Health Center/School Nurse
    2. Kaiser
    3. Dr’s office/Community clinic
    4. Emergency room
    5. Don’t know/remember
  6. In the past year, how often did get medical care when you needed it when you were sick or hurt?
    1. Always
    2. Sometimes
    3. Never
    4. Don’t know/remember
    5. Didn’t need care
  7. In the past year, where did you usually get medical care when you were sick or hurt?
    1. School Health Center/School Nurse
    2. Kaiser
    3. Dr’s office/Community clinic
    4. Emergency room
    5. Don’t know/remember

Parent-School Involvement

  1. Does your parent or guardian ever help or volunteer in your classroom?
    1. No
    2. Yes
  2. Does your parent or guardian come to school activities?
    1. No
    2. Yes
  3. Does your parent or guardian check your homework?
    1. No
    2. Yes
  4. Does your parent or guardian read with you at home?
    1. No
    2. Yes
  5. Does your parent or guardian talk with you about your goals for the future?
    1. No
    2. Yes
  6. Does your parent or guardian talk with you about your problems?
    1. No
    2. Yes
  7. Has your parent or guardian visited your school this year?
    1. No
    2. Yes
  8. Has your parent or guardian ever met any of your teachers?
    1. No
    2. Yes

Physical Health (Physical Activity/Nutrition)

  1. Do you participate in any type of exercise after school is finished?
    1. Yes
    2. No
    3. I’m not sure
  2. In your opinion, how is your overall health?
    1. I am as healthy in mind and body as I could be
    2. I could be healthier, and plan to do what it takes to get healthier
    3. I could be healthier, but don’t know what to do about it
    4. I am not healthy
    5. I am not sure
  3. Would you like the cafeteria to offer lower fat meal options?
    1. Yes
    2. No
    3. I’m not sure
  4. Would you like the vending machines to offer healthier choices for snacks and drinks?
    1. Yes
    2. No
    3. I’m not sure
  5. Have you and your parents sought counseling due to fear that you may have an eating disorder?
    1. Yes
    2. No
    3. I’m not sure

Prevention Programs

  1. During the past 12 months, have you had a separate course on alcohol/drugs at school?
    1. Yes
    2. No
    3. Not sure
  2. During the past 12 months, have you received information as part of another course, such as health education, life skills, or science at school?
    1. Yes
    2. No
    3. Not sure
  3. During the past 12 months, did you participate in clubs or prevention activities that promote lifestyles that are free from alcohol, tobacco, or other drugs?
    1. Yes
    2. No
    3. Not sure
  4. During the past 12 months, did you participate in a support group at school or in the community that addressed alcohol, tobacco, or other drug use?
    1. Yes
    2. No
    3. Not sure
  5. During the past 12 months at school, have you been taught lessons about alcohol and drugs and their effects on the body?
    1. Yes
    2. No
    3. Not sure
  6. During the past 12 months at school, have you been taught lessons about the effects of drugs and addiction on the brain?
    1. Yes
    2. No
    3. Not sure
  7. How much do you think random student drug-testing prevents student drug use?
    1. A lot
    2. Some
    3. Not much
    4. Not at all
  8. During the past 12 months, have you participated in activities to promote respect between racial and ethnic groups at school?
    1. Yes
    2. No
    3. Not sure

Resilience/Connectedness

  1. I feel like I am a part of my afterschool program.
    1. Not at all true
    2. A little true
    3. Pretty much true
    4. Very much true
    5. Don’t know
    6. I am not part of an afterschool program
  2. I do interesting activities
    1. Not at all true
    2. A little true
    3. Pretty much true
    4. Very much true
    5. Don’t know
  3. I help decide things like class activities or rules
    1. Not at all true
    2. A little true
    3. Pretty much true
    4. Very much true
    5. Don’t know
  4. I do things that make a difference
    1. Not at all true
    2. A little true
    3. Pretty much true
    4. Very much true
    5. Don’t know
  5. I feel included by other students at my school.
    1. Not at all true
    2. A little true
    3. Pretty much true
    4. Very much true
    5. Don’t know
  6. My school offers opportunities to work with people who are different from me.
    1. Not at all true
    2. A little true
    3. Pretty much true
    4. Very much true
    5. Don’t know
  7. My teachers really care about me.
    1. Not at all true
    2. A little true
    3. Pretty much true
    4. Very much true
    5. Don’t know
  8. I know an adult I can talk to when I have problem at school.
    1. Not at all true
    2. A little true
    3. Pretty much true
    4. Very much true
    5. Don’t know

School Activities/Programs

  1. During the past 12 months, did you participate in a sober or drug-free event?
    1. No
    2. Yes
    3. Not sure
  2. I participate in the following activities this school year. (Mark all that apply)
    1. Fall sport
    2. Spring sport
    3. Instrumental music
    4. Vocal music
    5. Drama
  3. Have you participated in a school-based service club or group since the beginning of this school year?
    1. Yes
    2. No
    3. We don’t have this
  4. Would you like an opportunity to meet with other students to learn about and discuss the results of this survey?
    1. Yes
    2. No
  5. During the past 12 months, have you had classes or other training in how to resolve conflicts at school?
    1. No
    2. Yes
    3. Not sure
  6. During the past 12 months, have you had activities to promote respect between racial and ethnic groups at school?
    1. No
    2. Yes
    3. Not sure
  7. During the past 12 months, have you provided community service at school?
    1. No
    2. Yes
    3. Not sure

Sexual Behavior

  1. During the past year in school, how often did you get help with confidential issues like birth control, condoms, or STDs?
    1. Always
    2. Sometimes
    3. Never
    4. Don’t know/remember
    5. Didn’t need care
  2. The last time you had sexual intercourse, did you or your partner use a condom?
    1. Never had sexual intercourse
    2. No
    3. Yes
  3. Have you ever been forced to have sexual intercourse when you did not want to?
    1. No
    2. Yes
    3. Don’t know
  4. How much do you agree/disagree that for teens your age, abstinence is a better choice than having sexual intercourse?
    1. Strongly agree
    2. Agree
    3. Disagree
    4. Strongly disagree
    5. Don’t know
  5. Have you ever talked with a parent, guardian, or another adult in your family about sex?
    1. No
    2. Yes
  6. Who would you most likely talk to or get advice/information from about dating/relationships?
    1. Friend
    2. Brother/Sister
    3. Parent/Guardian
    4. Teacher/Counselor
    5. Other Adult
    6. Internet
    7. Hotline/Agency
    8. Other

Tobacco

  1. How would your parent(s) or guardian(s) feel if you smoked or used any tobacco products?
    1. Feel it was fine
    2. No feeling about it
    3. Feel it was wrong
    4. Don’t know
  2. How would your brother(s)/sister(s) feel if you smoked or used any tobacco products?
    1. Feel it was fine
    2. No feeling about it
    3. Feel it was wrong
    4. Don’t know
    5. Don’t have brother(s)/sister(s)
  3. How much do you agree/disagree with the following statement? Cigarette advertisements make young people want to start smoking.
    1. Very much agree
    2. Agree
    3. Disagree
    4. Very much disagree
    5. Don’t know
  4. Why do most kids your age use tobacco?
    1. Curious to see what it is like
    2. Because their friends use it
    3. It is part of having fun
    4. Bored, nothing else to do
    5. Because they need it
    6. Keeps weight down
    7. It relaxes them
    8. It is a way to appear older
    9. It is a way to rebel
    10. Don’t know
  5. Do you have friends who smoke cigarettes?
    1. No
    2. Yes
    3. Don’t know
  6. Do you have friends who use smokeless tobacco?
    1. Yes
    2. No
    3. Don’t know

Violence/Crime

  1. How many adults do you feel close to who…use illegal drugs? are gang members? have gotten into trouble with police? sell or deal drugs? would approve of you hanging out with gang members? would approve of you becoming a gang member?
    1. None
    2. Some
    3. Many
    4. Most or all
    5. Don’t know
  2. How much do you agree/disagree with the following statement?…I would welcome having police on my school campus.
    1. Very much agree
    2. Agree
    3. Disagree
    4. Very much disagree
    5. Don’t know
  3. How much do you agree/disagree with the following statement?…Police can generally be trusted to treat people fairly.
    1. Very much agree
    2. Agree
    3. Disagree
    4. Very much disagree
    5. Don’t know
  4. In the past 30 days, how often did you not go to school because you felt unsafe on the way to, at, or coming home from school?
    1. 0 days
    2. 1 day
    3. 2 or 3 days
    4. 4 or more days
  5. If you wanted to get a gun, how difficult would it be to get one?
    1. Very hard
    2. Fairly hard
    3. Fairly easy
    4. Very easy
    5. Don’t know