Survivor Survey for Rural Step 1 of 2 50% This survey is to better understand how Eastern El Paso and Teller County can serve residents who have experienced domestic violence, sexual assault, stalking, and/or human trafficking. This survey should take 15 minutes to complete and your feedback is completely anonymous. You will not be asked for your name or contact information during the survey.1. What is your current age?2. What is your zip code?3. What is your gender? Female Male Non-binary/third gender Transgender Prefer to describe Prefer not to answer 4. Do you currently have a significant other? Yes No Prefer not to answer 5. Which of the following best describes your current relationship status? Single/never married Living with partner/significant other Married Divorced/separated Widowed Prefer not to answer 6. Do you identify as a member of the LGBTQ+ community Yes No Prefer not to answer 7. How many children under the age of 18 live in your household? 0 1 2 3 4+ 8. Do you have any children under the age of 18 who live in your household? If so, please select which of the following age ranges the children fall into. Select all that apply. 0-9 years old 10-14 years old 15-17 years old There are no children under the age of 18 living in my home 9. What is your military status? I currently serve in the US Military I previously served in the US Military I have never served in the US Military 10. What is your spouse/partner's military status? My spouse/partner currently serves in the US Military My spouse/partner formerly served in the US Military My spouse/partner never served in the US Military Not applicable 11. Which of the following best describes your ethnicity? Select all that apply American Indian or Alaska Native Asian Black or African American Hispanic, Latino or Spanish Native Hawaiian or Pacific Islander White or Caucasian Prefer to describe Prefer not to answer 11b. Describe ethnicity below if checked prefer to describe above 12. What is your total annual household income? Less than $20,000 $20,000 to $34,999 $35,000 to $49,999 $50,000 to $74,999 $75,000 to $99,999 Over $100,000 total annual household income 13. What is the highest level of education you have completed? Some high school or less High school/GED Post-high school technical training Some college Associates Degree Bachelor's Degree Master's or professional degree Prefer not to answer 14. Which of the following represents your current employment status? Employed full-time Employed part-time Self-employed Retired Unemployed Student Homemaker Disabled Prefer not to answer These questions will cover your personal experiences. We understand this may be difficult to answer. Eastern El Paso and Teller County will be better able to meet residents’ needs if they understand the types of situations people have experienced, and your responses are confidential. Please know you can skip any question you aren’t comfortable answering and continue in the survey.15. Have you experienced any of the following? Select all that apply. Physical violence from my partner/spouse – hitting/pushing, grabbing, biting, strangling (hands, forearm, object around neck), shaking, slapping, etc. Sexual violence from my partner/spouse – attempted or completed sexual contact without consent, coerced consent, or you did not feel safe saying no, etc Sexual assault/violence from someone who was not my partner/spouse – attempted or completed sexual contact without consent, coerced consent, or you did not feel safe saying no, etc. Emotional abuse from my partner/spouse – insulting, name calling, controlling, ignoring, humiliating, etc. Threats and/or intimidation from my partner/spouse – destroying property, abusing pets, displaying weapons, threats to kill, etc. Financial/economic abuse from my partner/spouse – limiting access to funds, preventing from getting a job, taking your money, controlling how you spend money, etc. Isolation from my partner/spouse – controlling your daily life, using jealousy to justify the isolation, not allowing you to talk to friends or family, etc. Your partner/spouse uses your children to hurt you – making you feel guilty about your parenting, using the children to relay messages, threats to take away your children, harming your children, etc. Stalking (in-person or online) – following, harassing, electronic tracking, excessive text messages/calls/emails, etc. Forced or pressured into performing sexual acts for money, drugs, or other items I haven’t experienced any of these situations 16. Who perpetrated these actions against you? Select all that apply, if multiple perpetrators. Boyfriend Girlfriend Husband Wife Common-law spouse Friend/acquaintance Family member Stranger Other, please describe Please describe if other perpetrator that listed above 17. Do you identify any of the following as barriers for you when seeking services? Select all that apply. Lack of financial resources/opportunities Physical/mental disabilities Isolation by partner or location Lack of education, resources to seek educational opportunities Mental Health Substance use Gambling Language barriers Transportation 18.Thinking about your experiences, would you say Eastern El Paso or Teller County have adequate resources for survivors of domestic violence, sexual assault, stalking and human trafficking? Strongly disagree Disagree Neutral Agree Strongly Agree 19. Thinking about your experiences, which kinds of services would be helpful for you when navigating domestic violence, sexual assault, stalking, and/or human trafficking in your area? Select all that apply. Crisis/Response Support (increased resources for faster response, emergency action team, crisis intervention, help with protective orders, lock or window replacement, 24/7 hotlines) Legal Support (legal aid/assistance, legal representation, legal advocates/advice, expert testimony) Housing Support (safe/transitional housing, pet-friendly housing/boarding, assistance affording/securing long-term housing, additional section 8 housing) Medical Care/Mental Health/Substance abuse (medical or dental assistance/care, additional mental health professionals, substance abuse programs, homes, treatment centers) Technology to Increase Victim Safety (devices to alert when abuser is approaching, security system/video doorbell, panic button/recorded to police station) Transportation Assistance (secure transport to/from needed services, counseling, or court) Child/Youth Services (childcare so victims can get needed services or work, special social services, camps, or counseling for child affected by domestic violence/sexual assault) Career Skills/Job Placement (job training, resume assistance, job placement, professional attire) Help Navigating the System (advocates, apps/websites, tools to help you know your rights, walk through the process, and educate on available services) Counseling/Support Groups (individual, family counseling, support groups) Multilingual Support (more bilingual advocates, therapists, and specialists available; immigrant survivor support) Financial Support (emergency funds, financial literacy, credit assistance, financial advice) Prefer to describe, Please type description below None of these Please describe from above if different 20. Now out of these services, which three would be most helpful for you when navigating domestic violence, sexual assault, stalking, and/or human trafficking? Crisis/Response Support (increased resources for faster response, emergency action team, crisis intervention, help with protective orders, lock or window replacement, hotlines) Legal Support (legal aid/assistance, legal representation, legal advocates/advice, expert testimony) Housing Support (safe/transitional housing, pet-friendly housing/boarding, assistance affording/securing long-term housing, additional section 8 housing) Medical Care/Mental Health/Substance abuse (medical or dental assistance/care, additional mental health professionals, substance abuse programs, homes, treatment centers) Technology to Increase Victim Safety (devices to alert when abuser is approaching, security system/video doorbell, panic button/recorded to police station) Transportation Assistance (secure transport to/from needed services, counseling, or court) Child/Youth Services (childcare so victims can get needed services or work, special social services, camps, or counseling for child affected by domestic violence/sexual assault) Career Skills/Job Placement (job training, resume assistance, job placement, professional attire) Help Navigating the System (advocates, apps/websites, tools to help you know your rights, walk through the process, and educate on available services) Counseling/Support Groups (individual, family counseling, support groups) Multilingual Support (more bilingual advocates, therapists, and specialists available; immigrant survivor support) Financial Support (emergency funds, financial literacy, credit assistance, financial advice) Prefer to describe, please type description below None of these Please describe from above if different 21. Now out of the three services you choose please describe which would be the most helpful for you when navigating domestic violence, sexual assault, stalking and human trafficking and why.22. Now, which of the following agencies/organizations have you interacted with when seeking help with domestic violence, sexual assault, stalking and/or human trafficking? Select all that apply Sheriff's Office Police Department Military Advocacy, Support and Assistance Programs TESSA Court System District Attorney's Office DHS (Department of Human Services) I have not interacted with these agencies/organizations 23. Please rate how satisfied you are with your overall interaction(s) with the following organization(s).Sheriff's Office Not at all satisfied Not very satisfied Somewhat satisfied Very satisfied Extremely satisfied (Please write in which County's Sheriff's Department) Police Department Not at all satisfied Not very satisfied Somewhat satisfied Very satisfied Extremely satisfied (Please write in which City's Police Department) Military Advocacy, Support and Assistance Programs Not at all satisfied Not very satisfied Somewhat satisfied Very satisfied Extremely satisfied TESSA Not at all satisfied Not very satisfied Somewhat satisfied Very satisfied Extremely satisfied Court System Not at all satisfied Not very satisfied Somewhat satisfied Very satisfied Extremely satisfied (Please write in which County's Court House) District Attorney's Office Not at all satisfied Not very satisfied Somewhat satisfied Very satisfied Extremely satisfied Department of Human Services (DHS) Not at all satisfied Not very satisfied Somewhat satisfied Very satisfied Extremely satisfied Other agency: Not at all satisfied Not very satisfied Somewhat satisfied Very satisfied Extremely satisfied Please write in other agency name here: 24. Which of the following possible challenges have you experienced when seeking support/taking action with domestic violence, sexual assault, stalking and/or human trafficking? Select all that apply. Had to tell/re-tell my story multiple times Received different information/advice from different agencies Sensed that agencies/service providers didn’t believe me/my story Bias – stereotyping based on race, age, income, military status, sexual orientation, or other reason Prefer to describe: I have not experienced any challenges Use this space to describe or elaborate on above question 25. Which organization(s)/agency(s), if any, made you feel that you weren’t believed? Please explain what happened:26. Which organization(s)/agency(s), if any, exhibited bias or stereotyping behavior? Please explain what happened:27. Do you have any last suggestions or feedback you would like to share about your experiences or needs overall?Thank you for providing your feedback. TESSA has Rural Advocates in your area to provide support, and a 24/7 Safeline 24/7 Safeline – 719-633-3819 Eastern El Paso Advocate – Cindy 719-243-4833 Teller Advocate – Rebecca 719-822-3033 Co-located Rural Advocate – Melanie ENTER TO WIN a $25 Target Gift Card!Name First Last Phone
