What do you do when you need help?

STUDY INFORMATION FORM

Project Title: Help-Seeking Behavior Among Deaf and Hard of Hearing Individuals
Principal Investigator: Teresa Crowe, PhD
Address: Gallaudet University, 800 Florida Avenue, NE, Washington, DC 20002
Phone: 202-651-5160
E-mail: Teresa.Crowe@gallaudet.edu
Department: Social Work

I am conducting research about when Deaf and Hard of Hearing individuals seek help to solve problems. I would like you to consider participating in this study.

For this study you will:

1. Answer questions about your life experiences.

2. Your participation should take approximately 10 minutes.

Language: If you have questions about a particular question, you can email me to ask for clarification or skip the question.

Risks: There is no more than minimal risk to individuals who participate in this research study.

Benefits: Your participation in this study will create a valuable contribution to the literature by adding information about Deaf and Hard of Hearing people.

Confidentiality: Your information is anonymous. No one, not even the researcher will know your identity. The electronic questionnaire will not track your computer’s IP address.

Voluntary Participation: Your participation in this study is voluntary. If you decide not to participate in the study, you do not need to complete the survey. You may withdraw from the study at any time before or during data collection, for any reason.

Results: You will not be given your individual test results obtained during this study at the end of participation, but if you would like a copy of the final report, please email me.

If you have questions about any risk to you because of participation in this study, Use the phone number or e-mail account at the top of this consent form. You may also contact the Chairperson of the Gallaudet University Institutional Review Board for the Protection of Human Subjects (IRB) at irb@gallaudet.edu.

Intent to Participate:

If you agree to participate, click "next" to begin the survey.

Question Title

* 1. If you had a serious personal or emotional problem TODAY, how likely would you go to this person for help?

	No, definitely would not	No, probably would not	Yes, probably would	Yes, definitely would	N/A
Partner (boyfriend or girlfriend)	Partner (boyfriend or girlfriend) No, definitely would not	Partner (boyfriend or girlfriend) No, probably would not	Partner (boyfriend or girlfriend) Yes, probably would	Partner (boyfriend or girlfriend) Yes, definitely would	Partner (boyfriend or girlfriend) N/A
Friend	Friend No, definitely would not	Friend No, probably would not	Friend Yes, probably would	Friend Yes, definitely would	Friend N/A
Parent	Parent No, definitely would not	Parent No, probably would not	Parent Yes, probably would	Parent Yes, definitely would	Parent N/A
Other family member or relative	Other family member or relative No, definitely would not	Other family member or relative No, probably would not	Other family member or relative Yes, probably would	Other family member or relative Yes, definitely would	Other family member or relative N/A
Mental health professional (social worker, counselor, psychologist)	Mental health professional (social worker, counselor, psychologist) No, definitely would not	Mental health professional (social worker, counselor, psychologist) No, probably would not	Mental health professional (social worker, counselor, psychologist) Yes, probably would	Mental health professional (social worker, counselor, psychologist) Yes, definitely would	Mental health professional (social worker, counselor, psychologist) N/A
Crisis hotline with videophone	Crisis hotline with videophone No, definitely would not	Crisis hotline with videophone No, probably would not	Crisis hotline with videophone Yes, probably would	Crisis hotline with videophone Yes, definitely would	Crisis hotline with videophone N/A
Crisis hotline using VRI	Crisis hotline using VRI No, definitely would not	Crisis hotline using VRI No, probably would not	Crisis hotline using VRI Yes, probably would	Crisis hotline using VRI Yes, definitely would	Crisis hotline using VRI N/A
Doctor	Doctor No, definitely would not	Doctor No, probably would not	Doctor Yes, probably would	Doctor Yes, definitely would	Doctor N/A
Professor	Professor No, definitely would not	Professor No, probably would not	Professor Yes, probably would	Professor Yes, definitely would	Professor N/A
Priest, Rabbi, Imam, Chaplain or other religious person	Priest, Rabbi, Imam, Chaplain or other religious person No, definitely would not	Priest, Rabbi, Imam, Chaplain or other religious person No, probably would not	Priest, Rabbi, Imam, Chaplain or other religious person Yes, probably would	Priest, Rabbi, Imam, Chaplain or other religious person Yes, definitely would	Priest, Rabbi, Imam, Chaplain or other religious person N/A
Social media (Facebook, Twitter, Instagram)	Social media (Facebook, Twitter, Instagram) No, definitely would not	Social media (Facebook, Twitter, Instagram) No, probably would not	Social media (Facebook, Twitter, Instagram) Yes, probably would	Social media (Facebook, Twitter, Instagram) Yes, definitely would	Social media (Facebook, Twitter, Instagram) N/A
I would not seek help from anyone	I would not seek help from anyone No, definitely would not	I would not seek help from anyone No, probably would not	I would not seek help from anyone Yes, probably would	I would not seek help from anyone Yes, definitely would	I would not seek help from anyone N/A

Question Title

* 2. If you asked someone to help you with a problem, how important is ...

	Very important	Sort of important	Not very important	Not important at all
The person is Deaf	The person is Deaf Very important	The person is Deaf Sort of important	The person is Deaf Not very important	The person is Deaf Not important at all
The person is Hearing	The person is Hearing Very important	The person is Hearing Sort of important	The person is Hearing Not very important	The person is Hearing Not important at all
The person is Hard of Hearing	The person is Hard of Hearing Very important	The person is Hard of Hearing Sort of important	The person is Hard of Hearing Not very important	The person is Hard of Hearing Not important at all
The person can sign	The person can sign Very important	The person can sign Sort of important	The person can sign Not very important	The person can sign Not important at all
The person is female	The person is female Very important	The person is female Sort of important	The person is female Not very important	The person is female Not important at all
The person is male	The person is male Very important	The person is male Sort of important	The person is male Not very important	The person is male Not important at all
The person is the same racial/ethnic background as you	The person is the same racial/ethnic background as you Very important	The person is the same racial/ethnic background as you Sort of important	The person is the same racial/ethnic background as you Not very important	The person is the same racial/ethnic background as you Not important at all

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* 3. In a few words, describe the worst problem you had in the past year.

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* 4. Who did you go to FIRST to help you deal with that worst problem?

Partner (boyfriend or girlfirend)

Friend

Parent

Family member or other relative

Mental health professional (psychologist, social worker, counselor)

Crisis hotline with videophone

Crisis hotline using VRI

Physician, Medical, or Family Doctor

Priest, Rabbi, Imam, Chaplain or other religious person

Social Media (Facebook, Twitter, Instagram)

I did not seek help from anyone

Other (please specify)

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* 5. Why did you go to that person first?

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* 6. How old are you?

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* 7. You are...

Deaf

Hard of Hearing

Hearing

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* 8. You are...

Female

Male

Other (please specify)

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* 9. You are...

African-American/Black

Latino

Asian

Pacific Islander

White

Middle Eastern

American Indian

Biracial

Other (please specify)

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* 10. Over the PAST TWO WEEKS, how often have you...

	None	A day or two	Several days	More than one week	Nearly every day	N/A
Felt stressed, worried, or anxious	Felt stressed, worried, or anxious None	Felt stressed, worried, or anxious A day or two	Felt stressed, worried, or anxious Several days	Felt stressed, worried, or anxious More than one week	Felt stressed, worried, or anxious Nearly every day	Felt stressed, worried, or anxious N/A
Felt sad, unhappy, or depressed	Felt sad, unhappy, or depressed None	Felt sad, unhappy, or depressed A day or two	Felt sad, unhappy, or depressed Several days	Felt sad, unhappy, or depressed More than one week	Felt sad, unhappy, or depressed Nearly every day	Felt sad, unhappy, or depressed N/A
Wanted to use drugs or alcohol	Wanted to use drugs or alcohol None	Wanted to use drugs or alcohol A day or two	Wanted to use drugs or alcohol Several days	Wanted to use drugs or alcohol More than one week	Wanted to use drugs or alcohol Nearly every day	Wanted to use drugs or alcohol N/A
Had relationship problems	Had relationship problems None	Had relationship problems A day or two	Had relationship problems Several days	Had relationship problems More than one week	Had relationship problems Nearly every day	Had relationship problems N/A
Had academic or school problems	Had academic or school problems None	Had academic or school problems A day or two	Had academic or school problems Several days	Had academic or school problems More than one week	Had academic or school problems Nearly every day	Had academic or school problems N/A
Been sexually assaulted or abused	Been sexually assaulted or abused None	Been sexually assaulted or abused A day or two	Been sexually assaulted or abused Several days	Been sexually assaulted or abused More than one week	Been sexually assaulted or abused Nearly every day	Been sexually assaulted or abused N/A
Been physically assaulted or abused	Been physically assaulted or abused None	Been physically assaulted or abused A day or two	Been physically assaulted or abused Several days	Been physically assaulted or abused More than one week	Been physically assaulted or abused Nearly every day	Been physically assaulted or abused N/A
Been emotionally abused	Been emotionally abused None	Been emotionally abused A day or two	Been emotionally abused Several days	Been emotionally abused More than one week	Been emotionally abused Nearly every day	Been emotionally abused N/A
Felt you were discriminated against because of RACE	Felt you were discriminated against because of RACE None	Felt you were discriminated against because of RACE A day or two	Felt you were discriminated against because of RACE Several days	Felt you were discriminated against because of RACE More than one week	Felt you were discriminated against because of RACE Nearly every day	Felt you were discriminated against because of RACE N/A
Felt you were discriminated against because you are DEAF	Felt you were discriminated against because you are DEAF None	Felt you were discriminated against because you are DEAF A day or two	Felt you were discriminated against because you are DEAF Several days	Felt you were discriminated against because you are DEAF More than one week	Felt you were discriminated against because you are DEAF Nearly every day	Felt you were discriminated against because you are DEAF N/A
Felt you were discriminated against because of your religious beliefs	Felt you were discriminated against because of your religious beliefs None	Felt you were discriminated against because of your religious beliefs A day or two	Felt you were discriminated against because of your religious beliefs Several days	Felt you were discriminated against because of your religious beliefs More than one week	Felt you were discriminated against because of your religious beliefs Nearly every day	Felt you were discriminated against because of your religious beliefs N/A
Felt you were discriminated against because you are from another country	Felt you were discriminated against because you are from another country None	Felt you were discriminated against because you are from another country A day or two	Felt you were discriminated against because you are from another country Several days	Felt you were discriminated against because you are from another country More than one week	Felt you were discriminated against because you are from another country Nearly every day	Felt you were discriminated against because you are from another country N/A

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* 11. How do you feel about...

	Very NEGATIVE	Negative	Neutral	Positive	Very POSITIVE
Your racial or ethnic identity	Your racial or ethnic identity Very NEGATIVE	Your racial or ethnic identity Negative	Your racial or ethnic identity Neutral	Your racial or ethnic identity Positive	Your racial or ethnic identity Very POSITIVE
Your gender identity	Your gender identity Very NEGATIVE	Your gender identity Negative	Your gender identity Neutral	Your gender identity Positive	Your gender identity Very POSITIVE
Your deaf identity	Your deaf identity Very NEGATIVE	Your deaf identity Negative	Your deaf identity Neutral	Your deaf identity Positive	Your deaf identity Very POSITIVE
Your religious identity	Your religious identity Very NEGATIVE	Your religious identity Negative	Your religious identity Neutral	Your religious identity Positive	Your religious identity Very POSITIVE
Your nationality (home-country)	Your nationality (home-country) Very NEGATIVE	Your nationality (home-country) Negative	Your nationality (home-country) Neutral	Your nationality (home-country) Positive	Your nationality (home-country) Very POSITIVE
Your family relationships	Your family relationships Very NEGATIVE	Your family relationships Negative	Your family relationships Neutral	Your family relationships Positive	Your family relationships Very POSITIVE
Your friend relationships	Your friend relationships Very NEGATIVE	Your friend relationships Negative	Your friend relationships Neutral	Your friend relationships Positive	Your friend relationships Very POSITIVE
Yourself	Yourself Very NEGATIVE	Yourself Negative	Yourself Neutral	Yourself Positive	Yourself Very POSITIVE

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* 12. TODAY, rate how you feel about the following statements.

	Not true at all	Sometimes true	Often true	Always true
I can always solve difficult problems if I try hard enough	I can always solve difficult problems if I try hard enough Not true at all	I can always solve difficult problems if I try hard enough Sometimes true	I can always solve difficult problems if I try hard enough Often true	I can always solve difficult problems if I try hard enough Always true
If someone opposes or disagrees with me, I can find a way to get what I want anyway.	If someone opposes or disagrees with me, I can find a way to get what I want anyway. Not true at all	If someone opposes or disagrees with me, I can find a way to get what I want anyway. Sometimes true	If someone opposes or disagrees with me, I can find a way to get what I want anyway. Often true	If someone opposes or disagrees with me, I can find a way to get what I want anyway. Always true
It is easy for me to stay with my goals even if others discourage me.	It is easy for me to stay with my goals even if others discourage me. Not true at all	It is easy for me to stay with my goals even if others discourage me. Sometimes true	It is easy for me to stay with my goals even if others discourage me. Often true	It is easy for me to stay with my goals even if others discourage me. Always true
I am confident that I can deal with unexpected problems.	I am confident that I can deal with unexpected problems. Not true at all	I am confident that I can deal with unexpected problems. Sometimes true	I am confident that I can deal with unexpected problems. Often true	I am confident that I can deal with unexpected problems. Always true
I am confident in my skills at finding a solution to any unexpected problem.	I am confident in my skills at finding a solution to any unexpected problem. Not true at all	I am confident in my skills at finding a solution to any unexpected problem. Sometimes true	I am confident in my skills at finding a solution to any unexpected problem. Often true	I am confident in my skills at finding a solution to any unexpected problem. Always true
I can solve most of my problems.	I can solve most of my problems. Not true at all	I can solve most of my problems. Sometimes true	I can solve most of my problems. Often true	I can solve most of my problems. Always true
I can stay calm when I have problems because I have good coping skills.	I can stay calm when I have problems because I have good coping skills. Not true at all	I can stay calm when I have problems because I have good coping skills. Sometimes true	I can stay calm when I have problems because I have good coping skills. Often true	I can stay calm when I have problems because I have good coping skills. Always true
When I have a problem, I can find several solutions to solve it.	When I have a problem, I can find several solutions to solve it. Not true at all	When I have a problem, I can find several solutions to solve it. Sometimes true	When I have a problem, I can find several solutions to solve it. Often true	When I have a problem, I can find several solutions to solve it. Always true
If I am in trouble, I can usually find a way out of the problem.	If I am in trouble, I can usually find a way out of the problem. Not true at all	If I am in trouble, I can usually find a way out of the problem. Sometimes true	If I am in trouble, I can usually find a way out of the problem. Often true	If I am in trouble, I can usually find a way out of the problem. Always true
I can handle any type of problem that happens to me.	I can handle any type of problem that happens to me. Not true at all	I can handle any type of problem that happens to me. Sometimes true	I can handle any type of problem that happens to me. Often true	I can handle any type of problem that happens to me. Always true

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* 13. What is your HIGHEST education level?

High school diploma

Bachelor's (BA or BS) degree

Graduate (MA, MS, PhD) degree

Other (please specify)

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* 14. What is your current income?

Under $15,000

Between $15,000 and $29,999

Between $30,000 and $49,999

Between $50,000 and $74,999

Between $75,000 and $99,999

Between $100,000 and $150,000

Over $150,000

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* 15. What is your current employment?

Full-time (32 hrs a week or more)

Part-time (1 - 32 hours a week)

Occasional employment

Unemployed

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* 16. How supportive is your social network (friends)?

Very strong, I can always depend on them

Somewhat strong, I can sometimes depend on them

Not very strong, my friends are not very supportive

Not strong at all, I don't have many friends

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* 17. How do your parents communicate with you?

Both use sign language fluently

One parent can sign fluently

Neither parent can sign fluently

You communicate orally with them

Other (please specify)

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* 1. If you had a serious personal or emotional problem TODAY, how likely would you go to this person for help?

Question Title

* 2. If you asked someone to help you with a problem, how important is ...

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* 3. In a few words, describe the worst problem you had in the past year.

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* 4. Who did you go to FIRST to help you deal with that worst problem?

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* 5. Why did you go to that person first?

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* 6. How old are you?

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* 7. You are...

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* 8. You are...

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* 9. You are...

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* 10. Over the PAST TWO WEEKS, how often have you...

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* 11. How do you feel about...

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* 12. TODAY, rate how you feel about the following statements.

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* 13. What is your HIGHEST education level?

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* 14. What is your current income?

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* 15. What is your current employment?

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* 16. How supportive is your social network (friends)?

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* 17. How do your parents communicate with you?

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* 18. Is there anything else you would like to share?