Download:
pdf |
pdfOMB CONTROL NUMBER: 0701-XXXX
OMB EXPIRATION DATE: XX/XX/XXXX
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0701-XXXX, is estimated
to average 5 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information. Send comments regarding the
burden estimate or burden reduction suggestions to the Department of Defense,
Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-informationcollections@mail.mil. Respondents should be aware that notwithstanding any other
provision of law, no person shall be subject to any penalty for failing to comply with a
collection of information if it does not display a currently valid OMB control number.
Version 1.1 – Effective 7/18/2017
Response Advocates
How long have you been physically assigned and located at this installation?
o Less than 6 month
o 6-12 months
o 1-2 years
o 2-4 years
o Over 4 years
How many of the following services are housed in one location at your installation?
Sexual Assault Response Coordinator (SARC), Domestic Abuse Victim Advocate (DAVA),
Sexual Assault Victim Advocate, Sexual Harassment, Victim Counsel (VC), Religious Support
Teams (RSTs)
o0
o2
o3
o4
o5
Page 1 of 6
How much do you agree or disagree with the following statements?
Strongly
disagree
Somewhat
disagree
Neither
agree nor
disagree
Somewhat
agree
Strongly
agree
I am clear on
my role within
the office
where I am
physically
located.
o
o
o
o
o
I know who to
go to when
the issue at
hand is not in
my lane.
o
o
o
o
o
I have a
repeatable
standardized
process on
my
installation
for warm
handoffs
o
o
o
o
o
Warm Hand
Offs were
implemented
appropriately
o
o
o
o
o
I am
stretched thin
in my daily
duties
o
o
o
o
o
If Warm Hand Offs were not implemented appropriately, briefly describe why.
________________________________________________________________
Page 2 of 6
How challenging does your physical office location make it for you to collaborate with other
helping agencies?
o No challenge
o A bit of a challenge
o Small challenge
o Large challenge
o Major challenge - impedes my ability to provide appropriate care
How challenging does your physical office location make it for you to maintain victim
confidentiality?
o No challenge
o A bit of a challenge
o Small challenge
o Large challenge
o Major challenge - impedes my ability to provide appropriate care
How would you describe the collaboration with other advocacy service organizations on your
installation? For example, if you are a SARC, how well do you work with the DAVA or SH
advocate?
o Extremely ineffective
o Somewhat ineffective
o Neither effective nor ineffective
o Somewhat effective
o Extremely effective
Page 3 of 6
In my role in advocacy services, I have the _______ to adequately support victims
Extremely
inadequate
Training
Resources
Authority
o
o
o
Somewhat
inadequate
o
o
o
Neither
adequate nor
inadequate
o
o
o
Somewhat
adequate
Extremely
adequate
o
o
o
o
o
o
Do you have an effective mechanism for sharing important information about victims with other
providers, commanders, or others with a need-to-know?
o Yes
o Somewhat
o No
Can you briefly explain how you share information about victims with providers or others with a
need-to-know?
________________________________________________________________
How many victims do you estimate you have served over the last 6 month?
________________________________________________________________
Page 4 of 6
On average in the last six months for the victims that you've served as their advocate, how
involved in the investigation process have they been?
o Not at all involved
o Mostly uninvolved
o Involved
o Very involved
o Extremely involved
In general, how would you rate the quality of communication between you and the victims
you’ve served as advocate for?
o Terrible
o Poor
o Average
o Good
o Excellent
On average, how many times did your victims you’ve served have to retell details of their
experience to someone after they were connected with you as an advocate? Please enter an
estimate number.
________________________________________________________________
If the victims you served did have to share details of their experience multiple times, was it
clearly explained to them why they had to retell their experience to multiple people during the
reporting process?
o No
o Somewhat
o Yes
o N/A; did not have to retell their experience to multiple people
How much do you agree with the following statement?
The Department of the Air Force provides adequate support and resources to Airmen and
Space Professionals who have experienced any form of interpersonal violence or workplace
Page 5 of 6
relation issues.
o Strongly disagree
o Somewhat disagree
o Neither agree nor disagree
o Somewhat agree
o Strongly agree
End of Block: Victim/Survivor Experiences of Support
Page 6 of 6
File Type | application/pdf |
File Modified | 2022-08-23 |
File Created | 2022-07-07 |