1 FG Demographic Survey

Focus Group OMB#: ####-####

Supplement Date of Expiration:

Background

Please complete the following information to describe your demographics.

• All of the information you share with us today will be kept CONFIDENTIAL. What you say will not be identified with your name.

• This form is OPTIONAL and will only be used to help describe the types of people who participated in this focus group to help inform NHTTAC’s training and technical assistance services.

• If you have any questions about this focus group or the project, please contact [insert point of contact].

1. Which of the following best describes the organization in which you work? (Mark all that apply.)

• Academic institution

• Anti-trafficking organization

• Business/For-profit organization

• Coalition/Multidisciplinary team/Task force

• Federal government

• Faith-based organization

• State and local government

• Nonprofit/Community-based organization

• OTIP grantee

• Self-employed

• Survivor-led organization

• Tribal government

• Union/Worker advocacy organization

• Victim service provider

• Other (please specify): _____________________

2. Is your organization responsible for working with people who are currently being trafficked or have been trafficked? □ Yes □ No

3. Which of the following best describes your professional capacity or types of services you provide? (Mark all that apply.)

• Behavioral health professional (e.g., psychologist, psychiatrist, mental health/substance use counselor)

• Child welfare (e.g., state agency staff, child welfare contractor, nonprofit personnel)

• Corrections-based services (e.g., parole, probation)

• Criminal justice (e.g., law enforcement, prosecutor, probation, court, forensic interviewer)

• Educator (e.g., teacher, professor, school administrator)

• Health care (e.g., physician, physician assistant, nurse practitioner, dentist, nurse, pharmacist)

• Housing (e.g., case worker, shelter director, public housing authority agencies)

• Legal (e.g., immigration, civil and/or rights-based attorney and/or paralegal, clinic)

• Public health (e.g., licensure board, health department staff, health care executive, community health workers)

• Social worker (e.g., case manager, school counselor, supervisor, administrator)

• Survivor empowerment, mentoring, or peer to peer

• Violence prevention (e.g., child abuse and neglect, elder abuse, domestic violence, sexual violence, youth violence)

• Other (please specify): _______________________________

4. In your professional capacity, how frequently do you come into contact with a person who is currently being trafficked, at risk of trafficking, or has been trafficked?

1	2	3	4
Never	Occasionally	Frequently	Daily

5. Which of the following best describes the number of years of experience you have in your current field of work?

□ Less than 3 years □ 3–5 years □ 6–10 years □ More than 10 years

6. Which of the following best describes your primary role in your current position?

□ Direct delivery/Frontline staff □ Consultant/Trainer □ Administration

□ Management □ Volunteer □ Peer educator

□ Other (please specify): _______________

7. Which of the following best describes your geographic population? (Mark all that apply.)

□ National □ Local

□ State (please specify): ______________ □ Urban

□ Tribal □ Rural

□ International (please specify country): □ Suburban

_________________________________

8. Please select any of the following populations you currently work with in a professional capacity. (Mark all that apply.)

• Human trafficking

  • Commercial sexual exploitation of children

  • Sex trafficking

• Adults

• Minors

• Labor trafficking

• Adults

• Minors

• Children/youth

  • Out of home/Foster care/Kinship care

  • Juvenile justice

  • Runaway/Homeless youth

• People with disabilities

• Deaf/Hearing impaired

• Elderly

• Lesbian, gay, bisexual, transgender, and questioning

• Foreign nationals (migrant workers, undocumented immigrants, refugees)

• People with low incomes

• Racial and ethnic minorities

  • American Indian or Alaska Native

  • Asian

  • Black or African American

  • Native Hawaii or other Pacific Islander

  • White

  • Hispanic or Latino ethnicity

• History of substance use

• Intimate partner violence (e.g., dating, domestic violence)

• Gang-related crime

• Sexual abuse/Violence

• Other (please specify): __________________

9. What is your race? (Mark all that apply.)

 American Indian or Alaska Native

 Asian

 Black or African American

 Native Hawaii or other Pacific Islander

 White

 Other (please specify): _______________________________________

10. What is your ethnicity? (Mark all that apply.)

 Hispanic or Latino

 Middle Eastern or North African

 Other (please specify): ________________________________________

11. What is your gender? (Mark all that apply.)

 Male

 Female

 Transgender

 Other (please specify): ________________________________________

Thank you for taking the time to complete this form and helping to improve NHTTAC/SOAR activities.

Paperwork Reduction Act Notice

Under the Paperwork Reduction Act, a person is not required to respond to a collection of information unless it displays a valid OMB control number. The estimated average time to complete this form is 2 minutes. If you have comments regarding the accuracy of this estimate or additional suggestions, please write to the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.