Distressed Respondent Protocol

Attachment 13. Distressed Respondent Protocol
Respondents Who Become Distressed
The SCV questionnaire contains questions that may be upsetting for a respondent to answer.
Your job as an interviewer is to ask these questions in a matter-of-fact, non-judgmental manner. Despite
your best efforts, you may still encounter a respondent who is upset by a question or series of questions.
You should try to handle these situations by offering appropriate support. Such occurrences may be very
rare; most interviewers will never encounter this problem. However, if such problems do occur, we have
designed procedures for you to follow. Additional details about the types of emotional distress,
including signs and scripted responses, are provided in Appendix A.
A respondent’s emotional distress may be expressed in different ways and will likely vary as a
function of the age of the respondent. For example, a respondent may be overcome with emotion or
become so agitated or distracted that he/she is temporarily unable to continue with the interview.
Occasionally a respondent may become preoccupied with a powerful memory and give you much more
detail about a particular event than the question requires.
People do not generally have sudden emotional outbursts. There is usually a progression of
verbal and nonverbal cues indicating that a respondent is becoming upset. As you conduct the interview,
(1) observe the respondent for cues that suggest distress if you are conducting a field interview (e.g.,
sudden agitated pacing); (2) listen carefully for cues (e.g., lump in the throat; quivering voice), and (3)
acknowledge the behavior or feelings. For example, if the respondent’s voice becomes soft and frail, you
can say something like “Are you all right?” or “Is this becoming difficult for you?” If you observe a
respondent struggling to maintain composure, or if he/she begins to cry, acknowledge the distress by
saying something like “Would you like to take a short break?” and allow him/her time to regain
composure.
Most often, the respondent will be able to continue. Once the respondent is composed, you
should attempt to finish the interview. However, if he/she is too agitated or upset to continue, arrange to
finish the interview at another time.
When a particular question triggers an emotionally-charged story from a respondent whose other
responses have been to the point, it may be best not to try to redirect him or her as you would ordinarily.
The respondent may need to describe a particular event, and you should wait patiently until you feel
he/she is ready to continue. You may want to help regain focus with a comment such as “I see” and
move on. Remember that you are responsible for getting the interview back on track. When you feel that
the time is right, use a soft, direct manner and say something like, “I have a few more questions. If we
go slowly, do you think we can continue with the interview?”
When a respondent becomes distressed, it may seem hard to avoid taking on the role of
counselor. Regardless of your background, your function on this job is that of an interviewer, not a
counselor. Providing counseling interferes with the interviewer-respondent relationship and
compromises the quality of the data. Additionally, your counseling—despite your good intentions—
could do more harm than good for the respondent. Never adopt the role of “patient advocate.” Some
1

individuals can be manipulative and lead well-intentioned, overly sympathetic interviewers in
undesirable directions.
There are a few helpful “nevers” for you to remember regarding the interviewer-respondent
relationship:
•
•
•
•

Never engage in conversation with the respondent about events, behaviors, or feelings.
Never give advice. Each person has his/her own best answers. Any advice that you give only
means that this is what might work for you. More importantly, you may do harm by giving
advice.
Never tell a person that he/she “should” or “should not” feel a certain way. Feelings are not
right or wrong, they’re just “feelings.”
Never say that you are “surprised” about something that was said or done. This denotes
judgment and criticism.

It is important to trust the respondent’s ability to handle personal feelings or emotions. Most
feelings are transitory. Sometimes just expressing feelings to a nonjudgmental adult helps respondents to
feel better. Although some parts of the interview may have been emotionally trying for the respondent,
an extensive history of survey research on sensitive topics (such as emotional and behavioral problems),
suggests you have not done any harm. Whatever the short-term effect of the interview, it is unlikely to
have any lasting negative effect. In fact, some respondents may be relieved to have a neutral outsider to
listen to the story, knowing there will be no further consequences.
When respondents become emotionally overwhelmed, agitated, or preoccupied, you should be
aware that you may feel emotionally drained after the interview. Just being aware that your reaction is
normal should make it easier for you to deal with the situation. Remember that you cannot discuss
information, even if that information or observation is distressful to you, with your friends or family
members. If you need support – and we all do at one time or another – discuss your situation with your
your supervisor.
If respondents exhibit any kind of threatening behavior or verbal abuse towards you, politely end
the interview and inform your supervisor of the situation.
All instances of distress during the interview should be reported to RTI’s IRB within 48 hours.
Document your experience in an e-mail or distress respondent report to your supervisor – they will
contact the RTI task leader or project director who will report the instance to the IRB.
Respondents Whose Life or Health are in Imminent Danger
During the SCV interviews, there is a very small chance that you could encounter a situation that
causes you to believe that the life or health of the respondent or someone else is in imminent danger.
You must be prepared to handle such a situation, using the procedures outlined below. You may suspect
that a respondent’s life or health, or the life or health of someone else (e.g., the respondent’s spouse or
child) is in imminent danger in their current living situation, even if the respondent does not explicitly
say so.
If you believe that someone’s life or health is in imminent danger, you should (1) offer resource
information to the respondent; and (2) volunteer to make a call to one of the toll-free numbers for
2

him/her while in the interview setting. A more detailed guide for handling emotional distress is in
Appendix A. The following resources should be made available to the respondent:
•
•
•

National Domestic Violence Hotline (NDVH): 1-800-799-SAFE (7233)
Rape, Abuse, and Incest National Network: 1-800-656-HOPE (4673)
National Suicide Hotline: 1-800-237-TALK (8255)

You must also notify the RTI Project Director immediately upon completing the interview so she can
discuss the need for any further action with the RTI IRB.
Handling Differing Levels of Emotional Distress
As soon as you note one or more of the signs of distress, immediately assess the potential for the
distress to elevate and take the appropriate steps to assist the respondent. There are three levels of
distress that require progressively more active interviewer responses.
Level 1 – Mild Distress: Mild symptoms of stress can include a change in tone, volume, and
focus. The interviewer can probe with a question such as, “Is this frustrating?” If the respondent
responds in the affirmative, the interviewer should offer the respondent a break. Below are the signs of
Level 1 distress and the actions that you should take.
LEVEL 1 DISTRESS -- SIGNS OR INDICATORS
LEVEL OF DISTRESS
LEVEL 1
DISTRESS SITUATION

SIGNS OR INDICATORS OF POSSIBLE DISTRESS
• Change in voice tone or volume.
• Changes in focus.
• Hesitancy to answer questions.
• Fidgeting, finger tapping.
• Use of inappropriate language/cursing.
• Provides non-relevant answers to questions asked.
• Displays an unwillingness or hesitancy to continue
Offer the respondent a short break. Then :
“I know that this topic can be stressful. Would you like to continue or would
you like me to call back/schedule another interview later?”

Interviewer Actions

Supervisor Actions

Depending on how they answer you may do the following:
a. YES - CONTINUE WITH SENSITIVITY
b. YES, BUT NOT NOW - Suspend and schedule a callback.
c. NO, DON’T WANT TO CONTINUE EVER – terminate the interview and
thank them.
Supervisor is alerted and will confirm or change, if necessary, the level of
distress based on information from the interviewer.
Supervisor will get the respondent’s information and will inform the
managers about the situation via the Distressed Respondent Report – the
respondent’s case ID, date, time, and a detailed description of the interaction
between the interviewer and the respondent.

3

Level 2 – Moderate Distress: Symptoms of increased stress can include use of inappropriate
language, responding to questions with non-relevant answers, and crying. If the level of distress elevates
significantly or the interviewer notes combinations of these symptoms with others, even after a period of
not focusing on the immediate question at hand, the interviewer should stop the interview, and offer a
resource if needed (National Domestic Violence Hotline; Rape, Abuse, and Incest National Network; or
National Suicide Hotline). Below are the signs of Level 2 distress and the actions that you should take.
LEVEL 2 DISTRESS -- SIGNS AND ACTIONS
LEVEL OF DISTRESS
LEVEL 2
DISTRESS SITUATION

Interviewer Actions

Supervisor Actions

SIGNS OR INDICATORS OF POSSIBLE DISTRESS
Level 1 signs plus any of the following:
• Displays signs of distress that may include long pauses, or
sighing
• Sobbing, weeping, and/or crying on the telephone.
• Displays other obvious signs of agitation.
• Displays flat voice tones.
• Being non-responsive
• Provides nonsensical/bizarre answers.
• Asks to speak with a mental health professional.
You may offer to provide the respondent resource information. If you decide
to provide resource information, state:
“I have a sense that this may be difficult for you. I would like to give you
information about a service(s) that may be helpful to you. This/These
confidential service(s) is/are called the National Domestic Violence Hotline;
Rape, Abuse, and Incest National Network; and/or National Suicide Hotline.
They have experienced counselors who will listen and talk to you about how
you are feeling. In case you need [insert resource name] services in the
future the number is [insert resource phone number]. [INTERVIEWER CAN
REFER R TO THE STUDY BROCHURE TOO, WHICH PROVIDES THESE
NUMBERS.] Thanks.
Supervisor will confirm or change, if necessary, the level of distress based
on information from the interviewer and will provide guidance if needed.
The supervisor must complete a Distressed Respondent Report with SCV
management staff informing them that a referral was given, the respondent’s
case ID, the caller’s name, date, time, details of the interaction, if any hangups or terminated calls occurred, and if the appropriate protocols were
followed. The Project Director will inform the IRB of this report within 24
hours.

4

Level 3 – Severe Distress: At this level, the respondent may display combinations of all of the
symptoms, but usually will be very agitated and/or crying openly, and may be very inappropriate in all
of his or her responses to the interviewer. The respondent may openly state an intention to hurt
themselves or others. If the interviewer feels that there is an imminent risk of harm or danger to the
respondent or someone else, or if the respondent indicates that he/she needs help, the interviewer should
connect the respondent to a resource (National Domestic Violence Hotline; Rape, Abuse, and Incest
Hotline; or National Suicide Hotline) and request immediate aid.
LEVEL 3 DISTRESS -- SIGNS OR INDICATORS
LEVEL OF DISTRESS
LEVEL 3
DISTRESS SITUATION

SIGNS OR INDICATORS OF POSSIBLE DISTRESS
• Talks about passive or active suicidal thoughts with or without
a plan
• Talks about wishing another person was dead with or without a
plan to kill the person
• Respondent asks to speak with his/her mental health provider
• If distress level falls between levels 2-3
• Respondent asks for immediate help from emergency services
or 911
Respondent poses an immediate threat to themselves or someone else
IMPORTANT NOTE: MOST LEVEL 3 RESPONDENTS WILL BE
OFFERED A CONNECTION TO REFERRAL RESOURCE, THE PRIMARY
RESPONSE TO A LEVEL 3 EVENT.
IF THE RESPONDENT TALKS ABOUT “SUICIDE”, OR “WISHING
ANOTHER PERSON WAS DEAD”, OR “LIFE IS NOT WORTH LIVING
ANYMORE”, OR ASKS TO BE CONNECTED WITH THEIR MENTAL
HEALTH PROVIDER, OR ANYTHING SIMILAR, you should contact a
supervisor or project staff member immediately.
If the respondent would like assistance in contacting the proposed resource,
say:

Interviewer Actions

“I can conference them in/contact them so that they can tell you more. Do I
have your permission to call/ connect you to [insert resource name]?”

a.

IF YES (TO RESOURCE CONNECTION):

Tell respondent: “Let me contact [insert resource name].”
Keep talking to the respondent, explaining what is happening.
Once you have the referral resource and the respondent connected.
Introduce the resource worker to the respondent. You can say:
“(Respondent’s name), I have (resource worker’s name) from [insert name of
resource]. S/he would like to talk with you about how you are feeling. I will
be getting off the line now/leaving now so that you can talk privately about
how you are feeling.”

5

TELEPHONE ONLY: Place the receiver on the desk but do not hang up
while the resource person is talking with the respondent or excuse yourself
and go to another area of the room if conducting a field interview. The call
should not be terminated until the respondent and the resource worker
are through talking.
b.

Interviewer Actions
(Con’t.)

IF RESPONDENT DOES NOT WANT TO BE CONNECTED TO
REFERRAL RESOURCE:

Tell respondent:
“We will not call if you would prefer us not to. However, it’s important for us
that we make sure you have information that could help you. I’d like to give
you the [insert name of resource] number again, if you would like to write it
down. [When respondent is ready:] The number for [insert name of
resource] is [insert phone number for resource]. [INTERVIEWER CAN
REFER R TO THE STUDY BROCHURE TOO, WHICH PROVIDES THESE
NUMBERS.]
Offer the respondent a short break. Then state:
“I know that this topic may be stressful. Would you like to continue or would
you like me to contact you later?”
Depending on how they answer you may do the following:
YES - CONTINUE WITH SENSITIVITY
YES, BUT NOT NOW - Suspend and schedule a callback.
NO, DON’T WANT TO CONTINUE EVER – terminate the contact and
thank them.
The supervisor will confirm or change, if necessary, the level of distress
based on information from the caller.

Supervisor Actions

ƒ

IF THE RESPONDENT TALKS ABOUT “SUICIDE”, OR
“WISHING ANOTHER PERSON WAS DEAD”, OR “LIFE IS NOT
WORTH LIVING ANYMORE”, OR ASKS TO BE CONNECTED
WITH THEIR MENTAL HEALTH PROVIDER OR ANYTHING
SIMILAR AND THE RESPONDENT IS CONNECTED TO
REFERRAL RESOURCE: The supervisor will provide assistance as
needed.

ƒ

TELEPHONE INTERVIEWS ONLY: Remind the caller to stay on
the line with the respondent until you instruct him/her to disconnect.

File a Distressed Respondent Report with SCV management staff informing
them that a referral was given, the respondent’s case ID, the caller’s name,
date, time, details of the interaction, if any hang-up occurred, and if the
appropriate protocols were followed.
The report needs to be filled out as soon as possible after the incident. If a
level 3 situation is encountered it should immediately be reported to the SCV
Project Director. The Project Director will inform the IRB of this report within
24 hours.

6

SCV Distressed Respondent Report
Case ID:____________
Interviewer ID:___________
Household Respondent or Individual Respondent:______________________________
Respondent Initials:______________________________________________________
Distress Level (Mild-Level 1, Moderate-Level 2, Severe-Level 3):__________________
Distress Description:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
__________________________________________________
Interviewer Actions:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
__________________________________________________
Supervisor Actions/Comments:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
__________________________________________________

Date Reported to Project Director/IRB:___________________________

7