Interviews

Form Approved

OMB No. 0990-

Exp. Date XX/XX/20XX

KEY INFORMANT INTERVIEW INSTRUMENT

Assessment of the Impact of Energy Development on Behavioral Health of Women in Western North Dakota and Eastern Montana

Informed Consent Script

Thank you for taking the time out of your day to meet with me. As I wrote in my invitation, I work for a non-profit public health organization called Health Resources in Action. My company was hired by the Region VIII Office of the Assistant Secretary for Health, Office on Women’s Health to assess how energy development activities have affected the behavioral health of women in western North Dakota and eastern Montana. Our assessment is collecting information to quantify and describe this impact. Our study includes surveys, focus groups, and interviews with stakeholders like yourself. Throughout the project, our assessment is emphasizing community engagement. Our work is guided by community organizations, tribes, and state partners to ensure the assessment produces evidence that will benefit women living in “boomtown” and surrounding communities.

Before we get started, I want to review the informed consent form with you. The interview should last approximately 45 to 60 minutes. I want to remind you that this interview is voluntary and confidential. Your specific responses will not be shared with anyone—not with your employer, not with the government, or anyone else—so feel free to share your opinion openly and honestly. You may choose not to answer any questions during the interview and we can stop at any time. Your interview answers will be summarized in a report along with the interviews from approximately 40 other key stakeholders participating in our study. I will not identify your name or your organization/community/tribe next to your responses in my notes or in any public results from this study.

• Do you have any questions about the study or the interview?

• Are you okay with me going forward with the interview?

Request to Record Interview

I would also like to record our conversation today so I can check the accuracy of my notes after our conversation. I will be deleting the recording as soon as I write up my notes. Are you okay with me recording our discussion?

Note whether respondent has given permission to record the interview.

Let’s get started with the interview.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-XXXX. The time required to complete this information collection is estimated to average 60 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, to review and complete the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

[NOTE: QUESTIONS FOR THE INTERVIEW GUIDE ARE INTENDED TO SERVE AS A GUIDE, NOT A SCRIPT.]

1. THEIR AGENCY/ORGANIZATION (5 minutes)

1. Can you tell me a bit about your organization/agency and your role? [TAILOR PROBES DEPENDING ON ORGANIZATION]

1. [PROBE ON ORGANIZATION: What is your organization’s mission/programs/services? What communities do you work in? Who are the clients/patients? How are clients/patients referred to you? What other organizations/institutions do you collaborate with?]

1. What are some of the biggest challenges your organization faces in providing these programs/services in the community?

2. PERCEPTIONS OF COMMUNITY ISSUES

2. How would you describe the community that your organization serves?

1. What do you consider to be the community’s strongest assets? What are the most positive aspects about the community?

2. What are some of its biggest concerns/issues in general in the community? What challenges do residents face day-to-day?

1. Why do you think these issues are happening in your community?

2. How do these issues affect women in particular? [PROBE ON SUB-POPULATIONS OF INTEREST – PREGNANT WOMEN, YOUNG WOMEN 18-25YO, ELDERLY WOMEN, AI WOMEN, SURVIVORS OF DV AND TRAFFICKING]

3. How has the boom in energy development affected these community issues?

4. What do you think would help solve these problems?

3. What do you think are the most pressing health concerns in the community? Why? [PROBE ON SPECIFICS]

1. How have these health issues affected your community? In what way?

2. Why do you think these issues are happening?

3. How have these issues affected women in your community? [PROBE ON SUB-POPULATIONS OF INTEREST – PREGNANT WOMEN, YOUNG WOMEN 18-25YO, ELDERLY WOMEN, AI WOMEN, SURVIVORS OF DV AND TRAFFICKING]

4. How has energy development affected these issues?

5. What do you think would help solve these problems?

6. How big of an issue is mental health? What about substance abuse?

3. PERCEPTIONS OF BEHAVIORAL HEALTH

4. Let’s talk about behavioral health issues. What do you think are the most pressing behavioral health concerns in your community? [IF NEEDED, PROBE ON SPECIFIC ISSUES SUCH AS SUBSTANCE ABUSE, ANXIETY, DEPRESSION, ETC.]

1. What populations (age, race, gender, income/education, etc.) do you see as being most affected by these issues?

   1. How have these issues affected women in particular? [PROBE ON SUB-POPULATIONS OF INTEREST – PREGNANT WOMEN, YOUNG WOMEN 18-25YO, ELDERLY WOMEN, AI WOMEN, SURVIVORS OF DV AND TRAFFICKING]

2. How have these behavioral health issues affected the community? In what way?

3. Why do you think you are seeing these issues in your community?

1. How has the energy development boom affected these issues?

4. From your experience, what are residents’ biggest challenges to addressing these behavioral health issues?

1. [PROBE ON RANGE OF CHALLENGES: E.g., Various barriers to accessing treatment and services, socioeconomic factors, lack of community resources, social/community norms, etc.]

5. What challenges do residents in your community face in accessing behavioral health services? [PROBE ON BARRIERS: LACK OF AWARENESS AND SCREENING, INSURANCE ISSUES, LACK OF SERVICES AVAILABLE, LACK OF TRANSPORTATION, ETC.]

1. What do you think needs to happen in your community to help residents overcome or address these challenges?

4. PERCEPTIONS OF HEALTH CARE/ BEHAVIORAL HEALTH SERVICES

5. Let’s talk about the services that are available to address a few of the health issues you mentioned previously. What services are you aware of in the community that currently focusing on [INSERT ISSUE HERE]?

   1. In your opinion, how available or accessible are these services to the people who need them?

2. What’s missing? What services are currently not available that you think should be?

[REPEAT Q5 FOR TOP 2-3 ISSUES MENTIONED]

5. CLOSING

Thank you so much for your time. That’s it for my questions. Is there anything else that you would like to mention that we didn’t discuss today?

Just as a reminder, we will be writing a summary report of the general opinions that have come up across all of the discussions we’re having with community leaders and residents. In that report, we might provide some general information on what we discussed today, but we will not include any names or identifying information. Your responses will be kept private to the extent allowed by law. In the report, nothing you said here will be connected to your name.

Thank you again.

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DRAFT—9/13/16