Form 1 Three Month Email

SOAR to Health and Wellness Pilot Training THREE-MONTH FOLLOW-UP Evaluation Form

Please indicate whether you believe each of the following statements is TRUE or FALSE by placing an X in the corresponding column. If you are unsure place and X in the “I do not know” column. Your responses and comments are extremely valuable to assist us in evaluating this training and planning how to better train healthcare providers to respond to the needs of victims of human trafficking.

		True	False	I Do Not Know
1.	Human trafficking involves the use of force, fraud, or coercion to exploit a person over the age of 18 for commercial sex or forced labor.
2.	A 16-year old child induced into commercial sex by an adult is a victim of human trafficking.
3.	The U.S. is one of the top receiving countries of foreign nationals who are victims of trafficking.
4.	A U.S. citizen can be a victim of human trafficking.
5.	Poverty, young age, and a history of abuse and neglect are three of the factors that increase vulnerability to human trafficking.

Please indicate your agreement with the following items on a scale from “Completely Disagree” to “Completely Disagree”. Place an X in the column that corresponds to your response.

		Completely Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Completely Agree
1.	Healthcare providers should play an important role in strengthening and enhancing human trafficking prevention and intervention efforts.
2.	All persons in commercial sex are willing participants.
3.	Health providers have to act immediately to assist the victim if they suspect human trafficking.
4.	I am confident that I can identify victims of human trafficking.
5.	Isolating the patient from the accompanying person may be an appropriate tactic in identifying potential victims of human trafficking.
6.	It is helpful to ask questions about mobility, contact with family or friends, or location of their identification documents if I suspect human trafficking.
7.	Victims of human trafficking will immediately self-identify and ask for help or assistance.
8.	I know of at least two resources to access if I suspect that my patient is a victim of human trafficking.
9.	I am able to respond to potential victims of human trafficking in trauma informed ways.
10.	My institution has a protocol to refer victims of human trafficking for additional services.

Finally, please answer the following questions:

1. How many potential victims have you identified in the past 3 months?

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2. What additional readings or trainings have you done since the training?

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3. Name two things you have done differently in your practice when it comes to identifying or serving victims of human trafficking since the training.

1. ________________________________________________________

2. ________________________________________________________

4. Has your health care facility made any changes to better serve victims of human trafficking since you attended the training?

My health care facility

1. ____does not plan on making any changes.

2. ____has explored the possibility of making changes.

3. ____has committed to making changes.

4. ____has already made changes.

5. ____may have made changes but I do not know what they are.

Optional: Please describe __________________________________________________________

If there is anything else you wish to share about your experience with this training, please do so below.

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Thank you for your time!