SA Protocol 6 Week 111207

Particpant ID ______Interviewer Initials ______Date Performed: ______Beginning Time: ______Thank you for making time to see me today. As you were told when you scheduled this meeting, this is the second of two interviews and will take about an hour to complete. You will be paid $60.00 for your time today. The reason we are doing these interviews is because we want to better understand how women recover over time after sexual assault. I appreciate your willingness to talk to me today about your experiences. The information you provide will be extremely helpful. Before we begin I wanted to ask if it would be OK for me to tape record this interview. It’s going to be hard to get everything down on paper, so the tape can help me later fill in any gaps I may have missed. The only other person who may listen to this tape is my project supervisor. The tape will be destroyed when we have completed checking the interview. Also, everything we discuss today is private. Your name is never connected with anything you say. Your name is not written on this interview and will not be on the tape either. In addition, to help us protect your privacy, we have obtained a Certificate of Confidentiality from the National Institutes of Health, which provides additional protection of any information that may identify you. I also want to stress that during our time together, if you need to take a break or stop, just let me know and we can do that. If there are any questions that you don’t want to answer, just say so, and I will move on to the next section. You do not have to answer all of the questions. The last thing I need to do before we get started is go through the process of informed consent to participate in this interview. [Hand participant the informed consent document; review procedures and obtain signature to complete informed consent]. Do you have any questions before we start? [Write down all questions asked by participant]

2 3 B. OVERVIEW OF INTERVIEW Like I said earlier, not much is known about the recovery process over time after sexual assault, and so I appreciate your willingness to share your experiences with me today. The goal of the Women’s Health Study is to understand more completely all the ways women’s lives may change as a result of sexual assault, and how this changes over time. Knowing this will help better care for women who experience sexual assault in the future. This interview is going to ask about how you have been feeling since the assault, as well as about how you felt before the trauma. There are five main parts to the interview. In the first part, I will be asking about your current health; or how you’ve been feeling since the assault happened. In the second part I am would like to know about any medication and health care services you may have been using. The third part has questions that are about any support you may have and also how you see your life now. The fourth part is concerned with any trauma you have experienced over the course of your entire life. The last part, the fifth part, has questions that help identify what social services you have obtained and how it was for you. At the end of the interview, I would like to ask you about your experience during this interview and with the study, like I did last time. Do you have any questions before we get started?

4 C. CURRENT SYMPTOMS This is the first section of the interview and it has to do with your life now. The questions are about how you are currently feeling. I’d like to start by asking some questions about any pain symptoms you may be feeling in different parts of your body. C. CURRENT SYMPTOMS I. Current Pain Symptoms

Some women feel physical pain after they are assaulted, while others don’t. I would like to know how much pain or aching, if any, you have in different areas of your body during the past week. I’m going to name different areas of your body, and ask you if you have any pain in that area.

In the past week, have you had any pain in your 0-10 rating 1. Head or face? 2. Neck area? 3. Breast area? 4. Arms? 5. Abdomen or stomach area? 6. Back? 7. Genital or pelvic area? 8. Legs? 9. In the past week, have you had any pain in any other area that I didn’t mention? Nurse clinician instructions: Each time, read full question (e.g. Right now, are you having any pain in your breast area?)  If no, record response as “0”.  If yes, ask: On a scale from zero to ten, where zero is no pain and ten is the worst pain you could imagine, how bad was the pain in your XXXX during the past week? Record 0-10 response and allow and record “.5” responses

COMMENT: We don’t need to ask if it got worse after the assault. We have their answers about the month prior to sexual assault from the 1 week interview, and we can calculate this ourselves (less bias)

C. CURRENT SYMPTOMS II. Pain and Somatic Symptoms PILL

5 I am going to ask you about common symptoms or bodily sensations that most people have at one time or another. Please tell me how often you had each symptom during the past month. By past month, I mean the past 4 weeks up till today. Here is a card with the list of possible responses, please pick the one that best describes how often you had each symptom (Hand participant EII (PILL) Answer Card).

Instructions to the interviewer: Read full question each time, e.g. “During the past month, how often did you have watery eyes

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you have: r o 1. Watering eyes 0 1 2 3 4 9 2. Itchy eyes or skin 0 1 2 3 4 9 3. Ringing in your ears 0 1 2 3 4 9 Temporary deafness or hard of 4. hearing 0 1 2 3 4 9 5. Lump in your throat 0 1 2 3 4 9 6. Choking sensation 0 1 2 3 4 9 7. Sneezing spells 0 1 2 3 4 9 8. Running nose 0 1 2 3 4 9 9. Congested nose 0 1 2 3 4 9 10 Bleeding nose . 0 1 2 3 4 9 11 Asthma or wheezing . 0 1 2 3 4 9 12 Coughing . 0 1 2 3 4 9 13 Out of breath . 0 1 2 3 4 9 14 Swollen ankles . 0 1 2 3 4 9 15 Chest pains . 0 1 2 3 4 9 16 Racing heart . 0 1 2 3 4 9 17 Cold hands or feet even in hot water 0 1 2 3 4 9

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18 Leg cramps . 0 1 2 3 4 9 19 Insomnia or difficulty sleeping . 0 1 2 3 4 9 20 Toothaches . 0 1 2 3 4 9 21 Upset stomach . 0 1 2 3 4 9 22 Indigestion . 0 1 2 3 4 9 23 Heartburn or gas . 0 1 2 3 4 9 24 Abdominal pain . 0 1 2 3 4 9 25 Diarrhea . 0 1 2 3 4 9 26 Constipation . 0 1 2 3 4 9 27 Hemorrhoids . 0 1 2 3 4 9 28 Swollen joints . 0 1 2 3 4 9 29 Stiff or sore muscles 0 1 2 3 4 9 . 30 Back pains 0 1 2 3 4 9 . 31 Sensitive or tender skin 0 1 2 3 4 9 . 32 Face flushes 0 1 2 3 4 9 . 33 Tightness in your chest 0 1 2 3 4 9 . 34 Skin breaking out in a rash 0 1 2 3 4 9 . 35 Acne or pimples on your face 0 1 2 3 4 9 .

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you have: o 36 Acne/pimples other than on your face 0 1 2 3 4 9 . 37 Boils 0 1 2 3 4 9 . 38 Sweating even in cold weather 0 1 2 3 4 9 . 39 Strong reactions to insect bites 0 1 2 3 4 9 . 40 Headaches 0 1 2 3 4 9 . 41 Feeling pressure in your head 0 1 2 3 4 9 . 42 Hot flashes 0 1 2 3 4 9 . 43 Chills 0 1 2 3 4 9 . 44 Dizziness 0 1 2 3 4 9 . 45 Feeling faint 0 1 2 3 4 9 . 46 Numbness or tingling in any part of 0 1 2 3 4 9 . body 47 Twitching eyelid 0 1 2 3 4 9 . 48 Twitching other than your eyelid 0 1 2 3 4 9 . 49 Hands tremble or shake 0 1 2 3 4 9 . 50 Stiff joints 0 1 2 3 4 9 . 51 Sore muscles 0 1 2 3 4 9 . 52 Sore throat 0 1 2 3 4 9 . 53 Sunburn 0 1 2 3 4 9 . 54 Nausea 0 1 2 3 4 9

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you have: o

#. I have one last question for you. How much of a problem have you had with persistent fatigue, or tiredness, that does not go away with rest or sleep during the past month? Please rate how much of a problem you have had on a 0-10 scale, where zero means no problem, and 10 means a major problem.

Record 0-10 response ______(allow and record “.5” responses) If need additional prompt: “Zero means no problem with persistent fatigue or tiredness, 10 means that persistent fatigue or tiredness is a major problem.”

9 ****MOVED SF-12 UP BEFORE PSYCH TO MAKE SIMILAR TO 1 WEEK C. CURRENT SYMPTOMS V. General Health and Missed Activities SF12 OK, now these next questions are about how your overall health has been during the last month. For each of the following statements, please respond with the word that best fits your experience.

118. In general, when you think about your health over the past month, would you say your health was:

_[1]_Excellent

_[2]_Very good

_[3]_Good

_[4]_Fair

_[5]_Poor

_[9]_Don’t Know or Refused

119. These next questions are about activities you might do during a typical day. Has your health over the last month limited you in these activities? If so, are you limited a little or a lot?

119a. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf

_[3]_No, not limited at all

_[2]_Yes, limited a little

_[1]_Yes, Limited a lot

119b. Climbing several flights of stairs

_[3]_No, not limited at all

_[2]_Yes, limited a little

_[1]_Yes, Limited a lot

10 _[9]_Don’t Know or Refused

120. How often have you had any of the following problems with your work or other regular daily activities because of your physical health during the past month?

120a. Accomplished less than you would like

_[5]_None of the time

_[4]_A little of the time

_[3]_Some of the time

_[2]_Most of the time

_[1]_All of the time

120b. Were limited in the kind of work or other activities that you wished to do

11 121. How often have you had any of the following problems with your work or other regular daily activities because of any emotional problems you may have experienced during the past month (such as feeling depressed or anxious)?

121a. Accomplished less than you would like

121b. Were limited in the kind of work or other activities that you wished to do

122. So, during the past month, how often would you say that pain interfered with your normal work (including both work outside the home and housework)?

_[1]_No, not at all

_[2]_Yes, a little bit

_[3]_Yes, moderately

_[4]_Yes, quite a bit

_[5]_Yes, extremely

12 _[9]_Don’t Know or Refused

Alright, the next statements are about how you have felt and how things have been for you during the past month. For each statement, please give the one answer that comes closest to the way you have been feeling.

123. How often during the past month:

123a. Have you feel calm and peaceful?

123b. have you had a lot of energy?

13 123c. Have you felt downhearted and depressed?

124. During the past month, how often did your physical health or emotional problems interfere with your social activities (like visiting friends, relatives, etc.)?

14 C. CURRENT SYMPTOMS III. Depressive and Anxiety Symptoms DASS For these next questions, I’d like you to think about how you were feeling this past week. I will give you a card with a rating scale to help you give the most accurate response to the statements as I read them (Hand participant CIII (DASS) Answer Card). There are no right or wrong answers. a e e e d

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i p l d p p e i p A l A p e p A m i 5 t 0 1 2 3 9 5. I found it hard to wind down 5 0 1 2 3 9 6. I was aware of dryness of my mouth 5 I couldn't seem to experience any 0 1 2 3 9 7. positive feeling at all 5 I experienced breathing difficulty (e.g., 8. excessively rapid breathing, 0 1 2 3 9 breathlessness in the absence of physical exertion) 5 I found it difficult to work up the 0 1 2 3 9 9. initiative to do things 6 0 1 2 3 9 0. I tended to over-react to situations 6 I experienced trembling (e.g., in the 0 1 2 3 9

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i p l d p p e i p A l A p e p A m i hands) t 6 I felt that I was using a lot of nervous 0 1 2 3 9 2. energy 6 I was worried about situations in which 0 1 2 3 9 3. I might panic and make a fool of myself 6 I felt that I had nothing to look forward 0 1 2 3 9 4. to 6 0 1 2 3 9 5. I found myself getting agitated 6 0 1 2 3 9 6. I found it difficult to relax 6 0 1 2 3 9 7. I felt down-hearted and blue 6 I was intolerant of anything that kept 8. me from getting on with what I was 0 1 2 3 9 doing 6 0 1 2 3 9 9. I felt I was close to panic 7 I was unable to become enthusiastic 0 1 2 3 9 0. about anything 7 0 1 2 3 9 1. I felt I wasn't worth much as a person 7 0 1 2 3 9 2. I felt that I was rather touchy 7 I was aware of the action of my heart 0 1 2 3 9

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i p l d p p e i p A l A p e p A m i in the absence of physical exertion t (e.g., sense of heart rate increase, heart missing a beat) 7 0 1 2 3 9 4. I felt scared without any good reason 7 0 1 2 3 9 5. I felt that life was meaningless

17 C. CURRENT SYMPTOMS IV. PTSD Symptoms (PSS-I) OK, the next questions I am going to ask are about symptoms you have had related to the sexual assault in [NAMED MONTH]. These questions are about any symptoms related to the sexual assault that you have experienced during the past 2 weeks. Probe all positive responses (e.g., "How often has this been happening?" in order to answer the frequency questions) Hand participant PSS-I Answer Card). l

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During the past 2 weeks, how y r often e V 101. Have you had recurrent or intrusive distressing thoughts or recollections about 0 1 2 3 9 the assault? 102. Have you been having recurrent bad 0 1 2 3 9 dreams or nightmares about the assault? 103. Have you had the experience of suddenly reliving the assault, flashbacks of it, acting 0 1 2 3 9 or feeling as if it were re-occurring? 104. Have you been intensely EMOTIONALLY 0 1 2 3 9 upset when reminded of the assault? 105. Have you been having intense PHYSICAL reactions (e.g., sweaty, heart palpitations) 0 1 2 3 9 when reminded of the assault? 106. Have you persistently been making efforts to avoid thoughts or feelings associated 0 1 2 3 9 with the assault? 107. Have you persistently been making efforts to avoid activities, situations, or places that 0 1 2 3 9 remind you of the assault? 108. Are there any important aspects about the 0 1 2 3 9

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During the past 2 weeks, how y r often e V assault that you still cannot recall? 109. Have you markedly lost interest in free time 0 1 2 3 9 activities since the assault? 110. Have you felt detached or cut off from 0 1 2 3 9 others around you since the assault? 111. Have you felt that your ability to experience the whole range of emotions is impaired 0 1 2 3 9 (e.g., unable to have loving feelings) since the assault? 112. Have you felt that any future plans or hopes have changed because of the assault (e.g., 0 1 2 3 9 no career, marriage, children, or long life)? 113. Have you had persistent difficulty falling or 0 1 2 3 9 staying asleep since the assault? 114. Have you been continuously irritable or 0 1 2 3 9 have outbursts of anger since the assault? 115. Have you had persistent difficulty 0 1 2 3 9 concentrating since the assault? 116. Are you overly alert (e.g., check to see who 0 1 2 3 9 is around you, etc.) since the assault? 117. Have you been jumpier, more easily startled, since the assault? 0 1 2 3 9

19 C. CURRENT SYMPTOMS VI. Missed Work & Activities Alright, these next two questions are about your involvement in your usual activities after the sexual assault. For some women participating in these activities after assault is initially difficult, because of physical or emotional health problems.

125. After your SANE visit on ______(date), were you unable to perform your usual activities because of injuries or other health problems that were caused by your assault?

_[1]_ Yes, was unable to perform usual activities _[2]_ No _[9]_Don’t Know or Refused

If yes, how many days were you unable to perform your usual activities? ______days

126. After your SANE visit on ______(date), did you miss any work because of injuries or other physical or emotional health problems that were caused by your assault? _[1]_ Yes, missed work _[2]_ No, working and did not miss _[3]_ No, not working right now _[9]_Don’t Know or Refused

If yes, how many days did you miss? ______days

20 D. CURRENT MEDICATIONS AND HEALTH CARE UTILIZATION I. Medication Use Okay, this second section is about what medication you are taking and any health care you have had since the assault. First, I am going to read the list of medicines you were taking at the time of your SANE visit on ______(date). Please tell me if since that time there has been any change in your medications. For example, are you taking any new medications or have you stopped taking any medications I have read.

Instructions to the interviewer: Be sure to ask about dosage and frequency of each medication.

127. Medication Frequen When Don’t Name and cy of Starte Is it know dosage use d Reason for Taking helpful? or refused

128. Since the assault, have you taken any over-the-counter pain medicines, such as Tylenol, Motrin, or Advil, because of pain or health problems related to the assault? _[0]_ No _[1]_ Yes _[9]_Don’t Know or Refused

127b. If yes, about much did you take, and for how long? Daily Dosage: ______Number of Days: ______

21 I took out the question on out of pocket costs. This has not yielded much (any) interesting info and is hard to figure because of insurance issues. With all that we are asking I say we drop

22 D. CURRENT MEDICATIONS AND HEALTH CARE UTILIZATION II. Treatment/ Health Service utilization Thanks, now in this next part, I am going to ask you about any doctor’s visits or treatment you may have had because of your assault. Please think about any visits or treatments you have had between your assault and today.

129. After your SANE visit on ______(date), did you go to a doctor or other health professional, or have you received any kind of treatment or care because of injuries or other health problems that were related to your assault ? _[0]_ No (skip questions 131-139) _[1]_ Yes (continue to question 131) _[9]_Don’t Know or Refused (skip questions 131-139)

130. Since your SANE visit on ______(date), have you been to a primary care doctor (general practitioner, family doctor) because of injuries or other health problems that were related to your assault?

_[0]_ No _[1]_ Yes _[9]_Don’t Know or Refused

130a. If yes, what problem did you go for? ______(Examples of problem would be “Headache” “Back Pain”, “Anxiety”, etc.)

130b. If yes, how many times did you go? ______[code number of times]

130c. If yes, did you discuss your sexual assault? _[0]_ No _[1]_ Yes _[9]_Don’t Know or Refused

131. Since your SANE visit on ______(date), have you seen a psychiatrist, psychologist, social worker, or other mental health counselor because of injuries or other health problems that were related to your assault ? _[0]_ No _[1]_ Yes _[9]_Don’t Know or Refused

131a. If yes, how many times? ______

23 131b. If yes, did you discuss your sexual assault? _[0]_ No _[1]_ Yes _[9]_Don’t Know or Refused

132. Since your SANE visit on ______(date), have you had any additional follow-up testing, such as blood work testing for HIV or sexually transmitted infections, or x-rays or CT scans, because of injuries or other health problems that were related to your assault? _[0]_ No _[1]_ Yes _[9]_Don’t Know or Refused

132a. If yes, what tests have you had? ______

REMOVED SPECIALIST QUESTION

133. After your SANE visit on ______(date), did you use alternative medicine such as acupuncture, special diet, or herbal remedies because of injuries or other health problems that were related to your assault ? _[0]_ No _[1]_ Yes _[9]_Don’t Know or Refused

133a. If yes, what kind of treatment did you use? ______

133b. If yes, how many times? ______

134. How much money have you had to pay out of your own pocket to cover costs related to your sexual assault? (For each question, list for what, and how much)

134a. Initial evaluation costs (for example, Rape Kit) FOR WHAT ______

HOW MUCH______

134b. Costs of medicine you had to take (for example, antibiotics or other medications)

24 FOR WHAT ______

HOW MUCH______

134c. Anything else

FOR WHAT ______

HOW MUCH______

E. CURRENT SOCIAL SUPPORT

OK, so this is the third part of the interview and the section about how people have responded to you when you have spoken to them about the assault. E. CURRENT SOCIAL SUPPORT I. SRQ So, for this first part, I’m going to read some statements about how people may have responded to you when you have spoken to them about the assault. I would like you to use this card (Hand participant EI (SRQ) Answer Card) to tell me how often over the last month, these reactions happened from any of the people you may have told about the assault. 135. Have you told anyone about the assault? _[0]_ No [skip to section EII] _[1]_ Yes _[9]_Don’t Know or Refused [skip to section EII]

Instructions to the interviewer: If she told no one, mark each of these 99 and continue to section EII

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often would you say you that someone: r o 136 Told you that you were not to blame 0 1 2 3 4 9 . 137 Told you that you did not do anything 0 1 2 3 4 9 . wrong 138 Told you that it was not your fault 0 1 2 3 4 9 . 139 Reassured you that you were a good 0 1 2 3 4 9 . person 140 Held you or told you that you are loved 0 1 2 3 4 9 . 141 Comforted you by telling you it would 0 1 2 3 4 9 . be all right or by holding you 142 Spent time with you 0 1 2 3 4 9 . 143 Listened to your feelings 0 1 2 3 4 9 . 144 Showed understanding of your 0 1 2 3 4 9 . experience 145 Reframed your experience as a clear case of victimization 0 1 2 3 4 9 . 146 Saw your side of things and did not 0 1 2 3 4 9 . make judgments 147 Was able to really accept your account 0 1 2 3 4 9 . of your experience 148 Told you he/she felt sorry for you 0 1 2 3 4 9 . Believed your account of what 149 happened 0 1 2 3 4 9 . 150 Seemed to understand how you were 0 1 2 3 4 9 . feeling 151 Helped you get medical care 0 1 2 3 4 9 . 152 Provided information and discussed 0 1 2 3 4 9

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often would you say you that someone: r o options 153 Helped you get information of any kind 0 1 2 3 4 9 . about coping with the experience. 154 Took you to the police 0 1 2 3 4 9 . 155 Encouraged you to seek counseling. 0 1 2 3 4 9 .

Removed Post-Traumatic Growth, keep at the 3 month and 6 month time points.

27 F. HISTORY OF TRAUMA

Now I want to move on to the fourth section. This section has questions about traumatic events that may have happened to you over the course of your lifetime. I am going to ask you about personal experiences with violence and also about other kinds of trauma such as natural disasters. Just like everything else you have shared, this information is private and will not be shared. F. HISTORY OF TRAUMA I. Intimate Partner Violence Conflict Tactics Scale -2 Alright, for this first group of statements I would like you to think back over your life as an adult. Please tell me how often during that time did an intimate partner (e.g., a date, a boyfriend, a husband) use the following behaviors against you. The choices are 0, 1 time, 2 times, 3-5 times, 6-10 times, 11-20 times or over 20 times. Here is a card to help if you need it. (Hand participant FI (CTS-2) Answer Card)

During your adult lifetime, an intimate partner has...

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i T t 0 0 ’ e T m m 0 2 s i i r n i - 5 1 T T o o - - 1 h 1 2 3 6 1 M D T 156 Grabbed, pushed, shoved, or 0 1 2 3 4 5 6 9 . slapped you 157 0 1 2 3 4 5 6 9 . Punched or kicked you 158 Tried to hit or actually hit you 0 1 2 3 4 5 6 9 . with an object 159 0 1 2 3 4 5 6 9 . Physically restrained you 160 0 1 2 3 4 5 6 9 . Threatened you with a weapon

28 161 Put you down, threaten, or . intimidate you to win an 0 1 2 3 4 5 6 9 argument 162 Get physically angry and . jealous if you talk to someone 0 1 2 3 4 5 6 9 else, or accuse you of having affairs?

29 F. HISTORY OF TRAUMA II. Modified Sexual Assault Experiences

Alright, these next questions are about experiences of sexual violence. I am going to read scenarios about occasions where nonconsensual sexual behavior happens. I am going to read the statement and would like you to tell me if it happened to you in your lifetime. If it has, please tell me if it was: when you were under 13 years old; 14-17 years old; or over 18 years old. Sometimes these things happen to people at more than one time in their lives so it is possible to answer yes to more than one age bracket. Don’t know or No Yes, when refused

Under 13 yrs Have you ever been fondled, kissed, or 14-17 yrs. 16 touched sexually when you didn’t want to 3. because you were overwhelmed by a Over 18 man’s continual arguments and pressure? [0] year [9]

Under 13 yrs Have you ever been fondled, kissed, or touched sexually when you didn’t want to 14-17 yrs. 16 because a man used his position of 4. authority (boss, teacher, camp counselor, Over 18 supervisor, etc.) to make you? [0] year [9]

Under 13 yrs Have you ever been fondled, kissed, or touched sexually when you didn’t want to 14-17 yrs. 16 because a man threatened or used some 5. degree of physical force (twisting your Over 18 arm, holding you down, etc.) to make you? [0] year [9] Have you given in to sexual intercourse [0] [9] when you didn’t want to because you were Under 13 overwhelmed by a man’s continual yrs arguments and pressure? 14-17 yrs.

30 16 6. Over 18 year

Under 13 yrs Have you had sexual intercourse when you didn’t want to because a man used his 14-17 yrs. 16 position of authority (boss, teacher, camp 7. counselor, and/or supervisor) to make Over 18 you? [0] year [9]

Don’t know or No Yes, when refused

Under 13 yrs Have you had a man attempt to insert his penis (but intercourse did not occur) when 14-17 yrs. 16 you didn’t want to by threatening or using 8. some degree of force (twisting your arm, Over 18 holding you down, etc)? [0] year [9]

Under 13 yrs Have you ever had a man attempt to insert his penis (but intercourse did not occur) 14-17 yrs. 16 when you didn’t want him to by getting 9. you intoxicated on alcohol or drugs Over 18 without your knowledge or consent? [0] year [9]

Under 13 yrs

Have you had sexual intercourse when you 14-17 yrs. 17 didn’t want to because a man made you 0. intoxicated by giving you alcohol or drugs Over 18 without your knowledge or consent? [0] year [9] Have you been in a situation in which you [0] [9] were incapacitated due to alcohol or drugs Under 13 (that is, passed out or unaware of what yrs was happening) and were not able to prevent unwanted sexual intercourse from 14-17 yrs. 17 taking place?

31 Over 18 year

Under 13 yrs Have you had sexual intercourse when you didn’t want to because a man threatened 14-17 yrs. 17 or used some degree of physical force 2. (twisting your arm, holding you down, Over 18 etc.) to make you? [0] year [9]

Have you had sex acts (anal or oral Under 13 intercourse or penetration by objects yrs other than the penis) when you didn’t want to because a man threatened or used 14-17 yrs. 17 some degree of physical force (twisting 3. your arm, holding you down, etc.) to make Over 18 you? [0] year [9]

32 F. HISTORY OF TRAUMA III. Life Events Checklist OK, this is the last part of this section. Now I want to ask you about other kinds of difficult or stressful things that sometimes happen to people over their lifetime. I am going to read a series of events. For each one I read I want to know if: it happened to you personally, you witnessed it happening to someone else, you learned about it happening to someone close to you, or you’re not sure if it fits, or it doesn’t apply to you. Because there are so many possible answers I am going to give you list of categories. Hand participant FIII (Life Events Checklist) Answer Card). Also, like before, it is possible that an event could have happened to a person at more than one time in their lives so it is possible to have more than one response category. Remember; think about your entire life (growing up as well as adulthood) as I read each event. You should not include your recent sexual assault on ______(date) in this checklist. t t d d d ’ w o e e e n o s N n n s n s r e e e k r e a

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e b s o t a u f e r

r o 17 Natural disaster (for example, 4. flood, 4 3 2 1 0 9 hurricane, tornado, earthquake) 17 Fire or explosion 4 3 2 1 0 9 5. 17 Transportation accident (for 6. example, car accident, boat accident, train 4 3 2 1 0 9 wreck, plane crash) 17 Serious accident at work, 7. home, or during 4 3 2 1 0 9 recreational activity

33 8. 18 7. 18 6. 18 5. 18 4. 18 3. 18 2. 18 1. 18 0. 18 9. 17 8. 17 someone unexpecteddeath Sudden, of suicide)homicide, example, death violent Sudden, (for suffering human Severe injury or Life-threatening illness war) of prisonerhostage, abducted,held kidnapped, being Captivity(for example, civilian) a the (inmilitary asor zone war- to a Combat exposure or experience sexual uncomfortable unwantedor Other harm) threatof forceor through actsexual typeofto anyperform made attemptedrape, Sexual assault (rape, bomb) gun, witha threatenedknife, beingshot, stabbed, example, weapon Assault with a (for up) beaten kicked, attacked,hit,slapped, being (for example, Physical assault radiation) chemicals, dangerous example, (for toxicsubstance to Exposure 4 4 4 4 4 4 4 4 4 4 4 to meHappened 3 3 3 3 3 3 3 3 3 3 3 itWitnessed 2 2 2 2 2 2 2 2 2 2 2 about itLearned 1 1 1 1 1 1 1 1 1 1 1 SureNot 0 0 0 0 0 0 0 0 0 0 0 applyDoesn’t 34 9 9 9 9 9 9 9 9 9 9 9 or refusedDon’t know 0. 19 9. 18 NEEDED THIS WHEN WE WERE ASSESSING PAST PTSD SYMPTOMS PTSD PAST WERE ASSESSING THIS WE WHEN NEEDED WE ONLY MOST TRAUMATIC. WHAT WAS QUESTION ABOUT REMOVED experience or other stressful Any event very else someone caused you to deathor harm, injury, Serious toyou close

4 4 to meHappened

3 3 itWitnessed

2 2 about itLearned

1 1 SureNot

0 0 applyDoesn’t 35 9 9 or refusedDon’t know G. POST-ASSAULT EXPERIENCES WITH SYSTEMS

Thanks for answering so many personal questions. I appreciate your honesty. They are important questions and your expertise is valued. We are going to move on to the last section of the interview. This section is about how you think about your experiences with SANE nurse and also with the justice system. This information is not shared with them on an individual basis and won’t in any way be linked with our name. G. POST-ASSAULT EXPERIENCES WITH SYSTEMS I. Medical System Alright, these questions are about what happened at the SANE program in the Emergency Department. I am going to ask you specifically about some things that may have happened to get a sense of how the medical professionals responded.

191. Was a rape exam performed and an evidence collection kit done? _[0]_ No _[1]_ Yes _[9]_Don’t Know or Refused

192. Were you given any information by the nurse about the possible risk of pregnancy from the assault? _[0]_ No _[1]_ Yes _[9]_Don’t Know or Refused

193. Were you given the morning-after pill? _[0]_ No _[1]_ Yes _[9]_Don’t Know or Refused

194. Were you given any information by the nurse about the possible risk of exposure to sexually transmitted infections from the assault? _[0]_ No _[1]_ Yes _[9]_Don’t Know or Refused

195. Were you given any information by the nurse about the possible risk of exposure to HIV/AIDS from the assault? _[0]_ No

36 _[1]_ Yes _[9]_Don’t Know or Refused

196. Were you given a preventative dose of antibiotics to treat any STIs that may have been contracted from the assault? _[0]_ No _[1]_ Yes _[9]_Don’t Know or Refused

197. Were you given any information about community resources by the nurse? _[0]_ No _[1]_ Yes _[9]_Don’t Know or Refused

198. Were you seen by anyone else besides the SANE nurse? _[0]_ No _[1]_ Yes _[9]_Don’t Know or Refused

199. Were there students or other medical professionals ( for example a nurse or doctor in training) with the SANE nurse when you were being cared for? _[0]_ No _[1]_ Yes _[9]_Don’t Know or Refused

I’m going to list off some things about your exam with the SANE nurse in the emergency department. This is to help us understand how the exam went for you. We’d like to know if any of these things occurred and if so, how often. You can use the card to help answer (Hand participant GIa (SANE) Answer Card) *Options seem weird to me??

37 d y l e s e t u t f e l l l a e p a e r h

t t r m w t a o i o e

m w o f A o o o N

S n t K o

During and after your interaction with the A n

nurse o 200 The nurse explained what was going to happen D 0 1 2 3 9 . next in the exam 201 The nurse asked if you had questions 0 1 2 3 9 . 202 You had a choice about the order in which the 0 1 2 3 9 . exam was conducted. 203 The nurse told you how parts of the exam might 0 1 2 3 9 . feel before she did them 204 The nurse took your needs and concerns seriously 0 1 2 3 9 . 205 The nurse listened to you 0 1 2 3 9 . 206 You felt you could take a break during the exam 0 1 2 3 9 . or say no to any part of the exam 207 The nurse explained why each part of the exam 0 1 2 3 9 . was important 208 How much care and compassion did you feel that 0 1 2 3 9 . the nurse showed? 209 How much control did you feel that you had during 0 1 2 3 9 . the exam? 210 How informed did you feel about what was 0 1 2 3 9 . happening in the exam? 211 How clear were the nurse’s instructions about the 0 1 2 3 9 . medications? 212 How informed did you feel about where to go for 0 1 2 3 9 . follow-up medical care? 213 How much pressure did you feel from the nurse to 0 1 2 3 9 . go through with prosecution?

These next statements are about various experiences with medical professionals that some women report having when they seek care for an assault in hospital emergency rooms. I’m going to list some things and I’d like to know if you felt that way when you were seen by the Sexual Assault Nurse Examiner (SANE Nurse) in the emergency

38 department. If you did experience it; we would also like to know how distressing or upsetting it was for you, if at all. Again, I will give you a card with the possible answers Hand participant GIb (Empowering Care) Answer Card). d e e s c u n f e e i r r

e r p If Yes, o

How Distressed o e

A Quite n h k S

A great t ’ d i None Little Some a bit n D Victim Experiences deal o D 214 Felt as though SANE nurse No 0 1 2 3 . blamed you for the assault Yes 9 4 [0] [1] 215 Felt as though SANE nurse was No 0 1 2 3 . doubting you Yes 9 4 [0] [1] 216 Felt violated by rape exam No 0 1 2 3 . procedures Yes 9 4 [0] [1] 217 SANE nurse did not adequately No 0 1 2 3 . explain the rape exam Yes 9 4 [0] [1] 218 SANE nurse did not adequately No 0 1 2 3 . explain risk of pregnancy Yes 9 4 [0] [1] 219 SANE nurse did not adequately No 0 1 2 3 . explain risk of exposure to Yes 9 4 sexually transmitted infections [0] [1] 220 SANE nurse rushed you No . through the exam process. Yes 0 1 2 3 9 [0] [1] 4

39 I. PARTICIPANT FEEDBACK Before we end, I would like to get some feedback from you about your participation in the interview. e e r e g e a r s i g D A

e y y l l l e a r g g r e g n n t e a o o u When you think about participating in this r r r s e i g t t

interview, do you think: S D N A S 149. The research made me think about things I didn’t want to think about. 0 1 2 3 4 150. Participating upset me more than I expected. 0 1 2 3 4 151. Had I known in advance what participating would be like for me I still would have agreed. 0 1 2 3 4 152. Participating in this project was worth it, despite any inconvenience I experienced. 0 1 2 3 4 153. I felt like I couldn’t say ‘no’ to participating 0 1 2 3 4 154. I felt free to skip questions or parts of the study 0 1 2 3 4 155. I felt I could stop at any time. 0 1 2 3 4 156. I understood the consent form. 0 1 2 3 4 157. I gained something positive from participating. 0 1 2 3 4 158. Volunteering made me feel good about myself. 0 1 2 3 4

159. Is there anything about this interview that we could do better?

160. What do you think is most important for interviewers like me to understand about what the experience of surviving a sexual assault is like for you right now?

40 This information is really helpful and can really help our team with interviewing and also help improve services for survivors. I appreciate your honesty. Is there anything else you’d like to talk about right now? Is there anything you’d like to ask me about the study or something else? [Write down all questions participant asks]

OK, so I need your signature here to verify that you have received the $60.00 stipend to thank you for sharing your experience and taking time out of your day to meet with me. [Hand participant form; obtain signature to complete paperwork]

□Participant received stipend □Participant completed paperwork______interviewer initials

41 J. REQUEST FOR ADDITIONAL INTERVIEW Well, that completes the interview. Thanks so much for answering all these questions; I really appreciate your time. Like I told you when we first spoke on the phone that we are looking for women who are willing to speak about with us over time so that we can understand how to help women as time goes by. There is an opportunity to continue your participation by being interviewed two more times. We are looking for women who are willing to speak with us in about 6 weeks from now and then again 3 months after that. There is still so much that is not understood about how assault impacts women over time and so these interviews are extremely helpful in figuring out the best ways to assist women. We would like to know if you would be willing to meet again and share your experience and expertise. There are two more interviews times. Like I said, the first one would take place about 6 weeks from now and would last about the same amount of time, maybe a bit less. The second opportunity would be about 3 months after that. I would still be able to meet you wherever you want. You would be paid $70 and then $80 for sharing your time and experience. 221. Do you think you are still interested in being a part? _[0]_ No [skip to section I. closing] _[1]_ Yes [follow to obtain necessary information]

42 The Women’s Health Group will protect your privacy. Because there is such a long period of time until we see you again, we want to make sure things are alright with you in the meantime. The next series of questions are about how you would like us to contact you and how we should refer ourselves to you. 222. In the next 6 weeks, do you plan on living where you live right now? _[0]_ No _[1]_ Yes

279a. what is the best way to get in touch with you? [Examples: email, cell phone, landline, work, mail] ______

______

223. Would it be helpful if I call to touch base in the next couple of weeks? _[0]_ No _[1]_ Yes

224. If someone besides you answers the phone : 170a. Should I identify myself? _[0]_ No _[1]_ Yes [What should I say; what should I not say] ______

170b. Should I leave a message? _[0]_ No _[1]_ Yes [What should it say; what should it not say]

43 ______

44 225. If there is no answer is it OK to leave a message? _[0]_ No _[1]_ Yes [What should it say; what should it not say] ______

226. Can I send you an email? _[0]_ No _[1]_ Yes [What should it read; what should it not read] ______

227. Can I come to your house if I can’t get a hold of you? _[0]_ No _[1]_ Yes

228. Can I leave a note if you are not home? _[0]_ No _[1]_ Yes [What should it read; what should it not read] ______

229. Can I send a letter to your house? _[0]_ No _[1]_ Yes [What should it read; what should it not read] ______

230. Is there any chance that you would not be living where you are living now?

45 _[0]_ No _[1]_ Yes

231. If you were to move or I couldn’t get a hold of you; who would know how to reach you? [An example could be mother, sister, employer, best friend] [Record name and relationship] ______

______

232. If I couldn’t find you, would you allow them to tell me how to reach you? _[0]_ No _[1]_ Yes

288a. If Yes, I have a form called a release of information memo and it basically says that you are helping out MSU and you give them permission to update your contact information for our files in case you have moved or changed your number. It doesn’t say what we are doing and I will only tell them what you say I can. I’d like to have you fill out a form for ______(name of each person as listed above). This is so they can see you have given permission for them to speak with me and to share your contact information.

Instructions to the interviewer: Hand participant a form for each person listed; ensure she completes all information fields as required (Today’s date, name, address, and phone number of contact, ending date); collect completed information.

46 I. CLOSING Well, I think we are done. If something comes up for you, please feel free to call me. Here is the Women’s Health Group’s card [hand participant the project card]. It is a private and confidential phone line that only I/Heather will answer and you can call at any time; not just business hours. If there is no answer, I /Heather might be in class or something so just leave a message and I/Heather will call as soon as I can or if you leave a specific time, I can plan around that too. I also have with me some information about community resources offered in Ingham, Eaton, and Clinton counties. If you would like I can leave them for you. You can also call me at any time if you need information about any community resources. Unless there is something else, I think we are finished. It was nice to meet you.

47 F. INTERVIEWER FEEDBACK

COMPLETE REMAINING QUESTIONS AFTER ENDING THE INTERVIEW

233. How would you (the interviewer) rate the quality of the information obtained in this interview? 1. □Excellent (no problems at all) 2. □Good (A few problems but overall comprehension good) 3. □Fair (a number of problems, but overall acceptable) 4. □Poor (many problems, overall quality open to question) 5. □Inadequate (interview was terminated by interviewer, or quality judged too poor to be included in data set)

289a. (If NOT excellent) What were the reasons the quality of information was less than excellent? (Check all that apply) 1. □Interviewer not in respondent’s native language 2. □hearing (hearing loss or background noise) 3. □Interruptions or distractions 4. □Infirm (Age, weak, sick) 5. □Intoxication 6. □Respondent was rushed 7. □Respondent did not take interview seriously 8. □Respondent did not understand the meaning of the questions 9. □Respondent was offended by the interview 10. □Respondent may have not been truthful because someone else was listening 11. □Other (Please Specify) ______