Form 1 Pre Test

SOAR to Health and Wellness Pilot Training—PRE-TEST Evaluation Form

Please indicate whether you believe each of the following statements is “True” or “False” by placing an X in the corresponding column. If you are unsure place and X in the “I do not know” column. Your responses and comments are extremely valuable to assist us in evaluating this training and planning how to better train healthcare providers to respond to the needs of victims of human trafficking.

		True	False	I Do Not Know
1.	Human trafficking involves the use of force, fraud, or coercion to exploit a person over the age of 18 for commercial sex or forced labor.
2.	A 16-year old child induced into commercial sex without the use of force, fraud, or coercion is a victim of human trafficking.
3.	The U.S. is one of the top receiving countries of foreign nationals who are victims of trafficking.
4.	A U.S. citizen can be a victim of human trafficking.
5.	Poverty, young age, and a history of abuse and neglect are three of the factors that increase vulnerability to human trafficking.

Please indicate your agreement with the following items on a scale from “Completely Disagree” to “Completely Agree”. Place an X in the column that corresponds to your response.

		Completely Disagree	Somewhat Disagree	Neither Agree nor Disagree	Somewhat Agree	Completely Agree
1.	Healthcare providers should play an important role in strengthening and enhancing human trafficking prevention and intervention efforts.
2.	All persons in commercial sex are willing participants.
3.	Health providers have to act immediately to assist the victim if they suspect human trafficking.
4.	I am confident that I can identify potential victims of human trafficking.
5.	Isolating the patient from the accompanying person may be an appropriate tactic in identifying potential victims of human trafficking.
6.	It is helpful to ask questions about mobility, contact with family or friends, or location of their identification documents if I suspect human trafficking.
7.	Victims of human trafficking will immediately self-identify and ask for help or assistance.
8.	I know of at least two resources to access if I suspect that my patient is a victim of human trafficking.
9.	I am able to respond to potential victims of human trafficking in trauma informed ways.
10.	My institution has a protocol to refer victims of human trafficking for additional services.

Finally, please answer the following questions:

1. How many potential victims of human trafficking have you identified in the past three months?

_____________________________________________

2. How would you rate your awareness of human trafficking now?

____ Completely Uninformed ___Somewhat Informed ____ Well Informed ____Completely Informed

Thank you for your time!