16 - Focus Group Demographic Survey

OMB Control Number: 0970-0519
Expiration Date: 05/31/2020

FOCUS GROUP
DEMOGRAPHIC

Survey

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 National Human Trafficking Training and Technical Assistance Center's
(NHTTAC) training and technical assistance services.
If you have any questions about this focus group or the project, please contact [insert].

1. Which of the following best describes the organization in which you work? (Mark all that apply.)
OTIP grantee
ϒ Academic institution
ϒ Anti-trafficking organization
ϒ Self-employed
ϒ Business/For-profit organization
ϒ Survivor-led organization
ϒ Coalition/Multidisciplinary team/Task
ϒ Tribal government
force
ϒ Union/Worker advocacy organization
ϒ Federal government
ϒ Victim service provider
ϒ Faith-based organization
ϒ Other (please specify):
ϒ State and local government
ϒ Nonprofit/Community-based
organization
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.)
ϒ Behavioral health professional (e.g.,
ϒ Housing (e.g., case worker, shelter
psychologist, psychiatrist, mental
director, public housing authority
health/substance use counselor)
agencies)
ϒ Child welfare (e.g., state agency staff,
ϒ Legal (e.g., immigration, civil and/or
child welfare contractor, nonprofit
rights-based attorney and/or paralegal,
personnel)
clinic)
ϒ Corrections-based services (e.g., parole,
ϒ Public health (e.g., licensure board,
probation)
health department staff, health care
executive, community health workers)
ϒ Criminal justice (e.g., law enforcement,
prosecutor, probation, court, forensic
ϒ Social worker (e.g., case manager,
interviewer)
school counselor, supervisor,
administrator)
ϒ Educator (e.g., teacher, professor, school
administrator)
ϒ Survivor empowerment, mentoring, or
ϒ Health care (e.g., physician, physician
peer to peer
assistant, nurse practitioner, dentist,
nurse, pharmacist)
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.033 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

OMB Control Number: 0970-0519
Expiration Date: 05/31/2020

FOCUS GROUP
DEMOGRAPHIC

Survey
ϒ

ϒ

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 being trafficked, 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
□ Management
□ Other (please specify):

□ Consultant/Trainer
□ Volunteer

□ Administration
□ Peer educator

7. Which of the following best describes your geographic population? (Mark all that apply.)
o Local
o National
o Urban
o State (please specify): _________
o Rural
o Tribal
o Suburban
o International (please specify country):
__________
8. Please select any of the following populations you currently work with in a professional capacity. (Mark all that
apply.)
ϒ Human trafficking
ϒ People with disabilities
ϒ Deaf/Hearing impaired
ϒ Commercial sexual
exploitation of children
ϒ Elderly
ϒ Sex trafficking
ϒ Lesbian, gay, bisexual,
ϒ Adults
transgender, and
questioning
ϒ Minors
ϒ Foreign nationals
ϒ Labor trafficking
(migrant workers,
ϒ Adults
undocumented
ϒ Minors
immigrants, refugees)
ϒ Children/youth
ϒ
People with low incomes
ϒ Out of home/Foster
care/Kinship care
ϒ Juvenile justice
ϒ Runaway/Homeless youth
PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.033 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.

OMB Control Number: 0970-0519
Expiration Date: 05/31/2020

FOCUS GROUP
DEMOGRAPHIC

Survey
ϒ

Racial and ethnic minorities
ϒ American Indian or Alaska
Native
ϒ Asian
ϒ Black or African American
ϒ Native Hawaii or other Pacific
Islander
ϒ White
ϒ Hispanic or Latino ethnicity

ϒ
ϒ

History of substance use
Intimate partner violence (e.g., dating,
domestic violence)
ϒ Gang-related crime Sexual
abuse/Violence
ϒ 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 OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information
collection is to enable NHTTAC to collect recipient and stakeholder feedback to improve NHTTAC’s T/TA service delivery. Public reporting
burden for this collection of information is estimated to average 0.033 hours per respondent, including the time for reviewing instructions,
gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An
agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the
Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. If you have any comments on this collection of
information, please contact the NHTTAC Evaluation Team at [email protected] or 9300 Lee Highway, Fairfax, VA 22031.