The questionaire follows the informed consent form.
Thanks.
California State University, Long Beach
Master's of Social Work Program
1250 Bellflower Boulevard
Long Beach, CA 90840
Informed Consent
I am David Salyers, a graduate student in the School of Social Work
at California State University, Long Beach (CSULB).
This study will focus on the relationship between American Indian
cultural conceptions of mental health and the utilization of mental health
services and programs. This study will give people working with American
Indians a better understanding of this population and make their work with
them more effective. Individuals who are 18 and older are asked to
participate in this study. Your participation will be valued.
By agreeing to participate in this study you will be interviewed
using an open-ended questionaire. This questionaire will be used to gather
information about your opinions and conceptions of mental health as an
American Indian. Many of these questions will be of a personal nature
asking about your own experiences and opinions. The questionaire will take
approximately 30 - 45 minutes.
There are no known risks involved in your participation in this study
nor are there any direct benefits to you as a result of your
participation. Your participation is voluntary. If you choose to
participate in this study, you may at any time refrain from answering any
question(s); furthermore, you have the option to terminate from
participating in the study at any given time.
If you have any questions regarding this study, or if you would like
a copy of the results of the findings, please contact David Salyers, M.A.
at (310) 925-9624 or his research advisor, Dr. Oliver at (310) 985-8177.
If you have any questions regarding your rights as a research participant,
please contact the California State University, Long Beach Office of
University Research at (310) 985-5314.
To ensure the confidentiality of your questionaire response, your
name will not appear anywhere on the response forms. The collected data
and informed consents will be destroyed after three years.
I have read and/or listened to and understand the
description of the study and agree to participate.
Printed name _______________________
Date __________________________
Salyers American Indian Mental Health Research
School of Social Work
CSU Long Beach
Date:_____________________
Age of Participant:_____
Gender of Participant:____
Tribal affiliation:___________________________
Reservation (rural) or urban:_____________________
American Indian MENTAL HEALTH QUESTIONAIRE
1. Who do you turn to when you are in trouble?
2. What have you done to get help with personal problems?
3. What do you do when you are very sad?
4. Do you know anyone who has used social services?
5. Have you ever utilized mental health services?
(If so, go to question 5A. If not, skip to question 6.)
5A. Why did you decide to utilize mental health services?
(Go to question 5B.)
5B. Could you tell me a little bit about your experiences?
(Probe: How did it make you feel? Were there any
difficulties?)
(Go to question 5C.)
5C. How did your family react to your decision to see a mental
health professional?
(Go to question 5D.)
5D. Do you feel that you benefitted from these experiences? Why
or why not?
6. Would you willingly choose to utilize mental health
services if the need arose? Why or why not?
7. Who do you think should have the primary responsibility of
assisting American Indians who are having difficulties with
stress? depression? family problems?
7A. Do you think that you would go to a mental health
center? If no, why not?
7B. Would you go to an American Indian counseling center? If
no, why not?
8. Do you feel that mental health professionals are sensitive,
nonjudgmental and understanding of American Indian culture and
beliefs? Why or why not?
9. How do you feel about other American Indians who utilize
mental health services?
10. How would you feel if you were sent to see a mental health
professional who was not American Indian? Would you feel more
comfortable with someone who was American Indian?
11. Please describe what role that you feel that the tribe or
American Indian community should play in providing mental health
services to American Indians.
(Probe: Would you feel more comfortable getting mental health
treatment from within your tribe or American Indian
counseling center? Why or why not?)
12. What do you feel are the causes of mental health problems for
American Indians?
13. How could these causes be prevented or addressed, in your
opinion?
14. What do you feel that your culture has to say regarding
mental health?
15. We've talked about quite a few things, but I wonder if there
might be something that we have skipped which you feel might be
important to understanding your views on mental health as a
American Indian. Is there anything that you would like to add to
what we have discussed?