1. Washington State University (College of Education, Counseling Psychology) Consent Form
Study Title: Native American Veterans' Perceptions, Knowledge, and Attitudes toward Posttraumatic Stress Disorder and Available Treatment
Dr. Phyllis Erdman, Ph.D, Associate Dean of Academic Affairs, College of Education (509) 335-1738
Greg Urquhart, B.A, co-investigator, graduate student, College of Education
Sarah Sevedge, LMHC, M.A., co-investigator, graduate student, College of Education
Matthew Hale, B.A., co-investigator, graduate student, College of Education

You are being asked to take part in a research study, conducted by Greg Urquhart, Sarah Sevedge,Matthew Hale, Nasreen Shah and ,Dr. Phyllis Erdman. The research team includes Native American veterans and individuals experienced in working with veterans and Native American veterans. This form explains the research study and your part in it, if you decide to participate. Please read the form carefully, taking as much time as you need. If you participate in the study, you can change your mind later or quit at any time. There will be no penalty or loss of services or benefits if you decide not to participate or quit the survey. This study has been reviewed for human subject participation by the Washington State University Institutional Review Board.

What is the study about? This study is being conducted to explore the perceptions, knowledge, and attitudes among active and former Native American service-members of the United States armed services regarding Posttraumatic Stress Disorder (PTSD). You are being asked to participate because we value your opinion, experience, and perceptions as a service-member. You do not need to have experienced any symptoms of PTSD in order to participate. The survey will take about 10-15 minutes. If you choose to participate, you will be asked to answer questions regarding your perceptions, knowledge, and attitudes of PTSD and similar combat stress disorders and their treatment.

* 2. The potential benefits to you for taking part in this survey are: you will be contributing to and increasing the general base of knowledge regarding PTSD and its treatment among Native American Veterans. You will be given the opportunity to contribute your knowledge and opinions to this area of study, and if you choose to share your contact information at the end of the survey, you may be notified of newly developed treatment programs and information as it becomes available. Potential risks to you for taking part in this survey are nothing beyond a typical survey. They could include fatigue and/or irritation.

The data for this study will be kept confidential to the extent allowed by federal and state law. No published results will identify you as you will not be required to disclose your name or other personal identifying information. You will, however, have the opportunity to share your contact information if you wish to be notified of potential treatment programs that may be developed using the information gathered in this survey. If you share identifying information, it will be kept private and will only be used for contact regarding future treatment opportunities. Other researchers from Washington State University's Counseling Program may have access to the survey program, but your information will be kept confidential. The results of this study may be published or presented at professional meetings, but the identities of all research participants will remain anonymous. The data for this study will be kept for three years. There will be no cost to you for taking part in this survey. You will not receive money or any other form of compensation for your participation.

If you have questions about this survey or the information within, please contact any of the researchers listed above. If you have questions about your rights as a research participant, or would like to report a concern or complaint about this study, please contact the Washington State University Institutional Review Board at (509) 335-3668, or e-mail irb@wsu.edu, or regular mail at: Albrook 205, PO Box 643005, Pullman, WA 99164-3005.

Do you agree to participate in this survey?

3. Age

4. Gender

5. Which race or ethnicity do you identify with? Check all that apply.

6. Please complete ONE answer that most closely represents your Native American heritage:

7. To what extent do you identify with your Native culture?

8. In which branch of the military did you or do you serve? Check all that apply.

9. In which theater of operation did you serve? Check all that apply.

10. Length of service:

11. Number of deployments:

12. Which of the following terms are you familiar with? Check all that apply:

13. Which of the following terms do you use most frequently? Check all that apply:

14. How would you rate your overall knowledge of PTSD on the following scale?

15. Who do you think generally experiences symptoms of Posttraumatic Stress Disorder (PTSD)? Check all that apply:

16. Have you experienced any of the following uncomfortable or negative symptoms related to combat or other potentially violent or threatening experiences? Check all that apply:

17. Are you aware of others who have experienced these symptoms?

18. Have you ever been diagnosed with any of the following as a result of your military service, training, and/or combat experiences? Check all that apply:

19. Have you told anyone about this diagnosis? Check all that apply:

20. Who do you think would be most likely to notice someone having the symptoms of Posttraumatic Stress Disorder? Check all the apply:

21. Do you think you qualify for a diagnosis of Posttraumatic Stress Disorder?

22. Are you aware of others who have been diagnosed with Posttraumatic Stress Disorder?

23. Did this change your perception of this person?

24. Did your perception of this person change positively or negatively?

25. Did this person receive any form of treatment for their symptoms?

26. How common do you believe Posttraumatic Stress Disorder is in the Native American veteran population?

27. Do you think that most people who suffer from Posttraumatic Stress Disorder receive adequate treatment?

28. Which of the statements about Posttraumatic Stress Disorder (PTSD) do you agree with? Check all that apply:

29. How likely are Native American veterans to not seek treatment for Posttraumatic Stress Disorder (PTSD) for the following reasons?

  Unlikely Somewhat likely Very likely
Not wanting to appear weak
Treatment does not work
Lack of treatment options
Fear of consequences
Unaware of this diagnosis
Denial that a problem exists
Drug or alcohol use
Fear of what others think
Do not believe in PTSD diagnosis
Discomfort with PTSD diagnosis
Lack of available resources

30. Have you ever sought treatment for Posttraumatic Stress Disorder?

31. Did you try any of the following treatment options? Check all that apply: