Racial Stress and Trauma Interview 071116 English-only FINAL Name:___________________________ Date:_____________________ Ver 1.0 UConn RACIAL/ ETHNIC STRESS & TRAUMA SURVEY (UnRESTS) Guide for Interviewer Interview Questions (Instructions for interviewer are italicized.) A Introduction to the Interview Note the difference between race (the group society puts a person in based on their appearance) and ethnicity (a person’s culture based on their heritage). They may be different or the same. The US Census recognizes several specific racial categories, including Black, White, Asian, and Native American. Hispanic is an ethnic group, but many consider Hispanic/Latino a race, which is acceptable for this interview. A1 Sometimes people have very bad experiences that cause feelings of stress or even trauma. Some people have several difficult experiences over a lifetime that are manageable individually, but together they lead to feelings of stress or trauma. I want to talk to you about some of your experiences of stress or trauma as it relates to your race or ethnicity. If patient’s racial and ethnic group is unclear: How would you describe your race and ethnicity? Ensure that discussion only includes incidents where at least one of the involved factors was race or color. A2 People may be discriminated against or mistreated for many different reasons (e.g., gender, sexual orientation, age, disability, faith, etc.) but I am interested in experiences connected to your race – or your race as perceived by others. However, if you have experienced discrimination due to a combination of factors (i.e., gender+race, such a being called “an angry Black woman” because you stood up for yourself), we can talk about that too. B Racial and Ethnic Identity Development If yes, ask the patient to elaborate. B2 Are there other racial or ethnic groups that people assume you belong to based on your appearance? Ask the patient to describe this. B3 When was the first time you became aware of race or ethnicity? When was the first time you remember feeling different, excluded, or singled out because of your apparent race or ethnicity? Assess for things like positive messages from parents, racial socialization, negative messages from others, media, stereotypes, etc. B4 What sort of things, positive or negative, did you learn about your race and ethnicity growing up? (May not apply to immigrants.) 2 Assess for feelings of ethnic/racial pride and/or stigma/shame. Rate each question (1-6) based on response from patient. For each affirmative answer, solicit an example. For each negative answer, ask “why not?” Ethnic/Racial Identity Score: (B5) Total _____________ B5 I want to understand a bit more about how you feel about being a(n) (enter race & ethnicity here) person. I’m going to ask you a few questions about that. 1. Would you say that you feel strong attachment to your ethnic (or racial) group? Very Much (2) – Somewhat (1) – No (0) 2. Would you say that you have a lot of pride in your ethnic group and its accomplishments? Very Much (2) – Somewhat (1) – No (0) 3. Would you say that you are active in groups that include mostly members of your own ethnic group? Very Much (2) – Somewhat (1) – No (0) 4. Would you say that you have a strong sense of belonging to your ethnic group? Very Much (2) – Somewhat (1) – No (0) 5. Would you say that you think a lot about how life is affected by your group membership? Very Much (2) – Somewhat (1) – No (0) 6. Would you say that you have often talked to others about issues related to your ethnic group? Very Much (2) – Somewhat (1) – No (0) B6 How much of your free time do you spend with people from your own racial/ethnic group? Assess for wish to be White, non- stigmatized, and/or privileged group member. B7 Many people note that it can be difficult to be an ethnic or racial minority. Have you ever wished you were a member of the majority group (i.e., a White person)? Assess for composition of workplace/school and racial climate. B8 What is the ethnic/racial environment like in your place of work/school? How comfortable do you feel there as a ( enter race here ) person? 3 C Experiences of Direct Overt Racism Give examples, if needed. This may include harassment at work, threats, victimization by law enforcement, etc. Elicit a description of the event. C1 Can you share with me a time you were impacted by racism? This could be something that someone else either said or did to you. I am especially interested in any experiences where you were concerned about your safety and the event was very upsetting. If needed: If you can’t think of any instances like that, then any racist experience will be fine (i.e., being followed in stores, called racial slurs, etc.). Determine when the event occurred. C2 How old were you when this happened? Be careful not communicate doubt that this was in fact a racist event. C3 What led you to believe this event happened due to your race? Assess for degree and type of distress experienced, e.g., anger, depression, anxiety. C4 How upset were you by this experience? If distress was present: Are you still upset by it? Determine if experience was a trauma. C5 Did you fear for your life, health, or safety? If yes: In what way? Assess for adaptive versus maladaptive coping strategies. C6 How did you cope with this experience? Assess for availability and use of support system. C7 How did other important people in your life respond when you told them about this? Ask about other experiences of racism. C8 Can you tell me about another experience of racism like that? If necessary: This can be any other situation where you were fearful, concerned about your safety, or if the event was very upsetting. Determine when the event occurred. C9 How old were you when this happened? Be careful not communicate doubt that this was in fact a racist event. C10 What led you to believe this event happened due to your race? Assess for degree and type of distress experienced, e.g., anger, depression, anxiety. C11 How upset were you by this experience? If distress was present: Are you still upset by it? Determine if experience was a trauma. C12 Did you fear for your life, health, or safety? If yes: In what way? Assess for adaptive versus maladaptive coping strategies. C13 How did you cope with this experience? Assess for availability and use of support system. C14 How did other important people in your life respond when you told them about this? 4 D Experiences of Racism by Loved Ones Elicit a description of the event. D1 Can you share with me a time you were impacted by racism as a result of something that happened to someone close to you? Determine when the event occurred. D2 How old were you when this happened? Be careful not communicate doubt that this was in fact a racist event. D3 What led you to believe this event happened due to race? Assess for degree and type of distress experienced, e.g., anger, depression, anxiety. D4 How upset were you by this experience? If distress was present: Are you still upset by it? Determine if experience was a trauma. D5 Did you fear for the life, health, or safety of that person? Assess for adaptive versus maladaptive coping strategies. D6 How did you cope with this experience? Assess for availability and use of support system. D7 How did other important people in your life react to this? Elicit a description of the event. D8 Can you share with me another time you were impacted by racism as a result of something that happened to someone close to you? Determine when the event occurred. D9 How old were you when this happened? Be careful not communicate doubt that this was in fact a racist event. D10 What led you to believe this event happened due to race? Assess for degree and type of distress experienced, e.g., anger, depression, anxiety. D11 How upset were you by this experience? If distress was present: Are you still upset by it? Determine if experience was a trauma. D12 Did you fear for the life, health, or safety of that person? Assess for adaptive versus maladaptive coping strategies. D13 How did you cope with this experience? Assess for availability and use of support system. D14 How did other important people in your life react to this? 5 E Experiences of Vicarious Racism Give examples as needed, e.g., shooting of unarmed Black teen, racially-motivated hate crime, wars due to ethnic cleansing, etc. E1 Can you share with me a time you were impacted by racism as a result of something you learned about – for example, on the news or in your community – that involved someone you did not know personally? Determine when the event occurred. E2 How old were you when this happened? Be careful not communicate doubt that this was in fact a racist event. E3 What led you to believe this event happened due to racism? Assess for degree and type of distress experienced, e.g., anger, depression, anxiety. E4 How upset were you by this experience? If distress was present: Are you still upset by it? Determine if experience was personally traumatic. E5 Did this event make you worry about your own well-being, health, or sense of safety? Assess for adaptive versus maladaptive coping strategies. E6 How did you cope with this experience? Assess for availability and use of support system. E7 How did other important people in your life react to this? F Experiences of Covert Racism Microaggressions include brief, exchanges, in the form of seemingly innocent and innocuous comments, subtle or dismissive gestures, and tones that send denigrating messages to people of color because they belong to a minority group. F1 Often minorities are the target of subtle or covert racist experiences in the form of what we sometimes call “microaggressions.” Define if needed. How often would you say that you experience these? Elicit a description of the event. F2 Can you give me a recent example? Elicit a description of the event. F3 Can you give another example? Elicit a description of the event. F4 Can you give another example? F5 How stressful is it for you when these sorts of things happen to you? Assess for adaptive versus maladaptive coping strategies. F6 How do you cope with these experiences? F7 Have you experienced any changes in your ability to manage microaggressions? Note: Sections C-F may be duplicated to capture additional events. 6 G . Racial Trauma Assessment Assess for PTSD if any experiences previously described qualify for DSM-5 Criterion A event. Think about all of the experiences we discussed concerning racism and discrimination as you answer the following questions: Note: For each positive response, ask for an example and note frequency. Re-Experiencing (Need 1 for PTSD diagnosis) G1. Have you had reoccurring, unwanted distressing memories about racism-related experiences? YES NO G2. Have you been having bad dreams or nightmares related to racism, or about feeling powerless or excluded? YES NO G3. Have you had the experience of feeling as if a past racism-related event was happening to you all over again (like a flashback)? YES NO G4. Do you get very emotionally upset when reminded of racism-related experiences? YES NO G5. Have you had negative physical reactions when reminded of racism- related experiences (e.g., stomach ache, heart racing, shaking)? YES NO Avoidance (Need 1 for PTSD diagnosis) G6. Have you been trying hard not to think about upsetting racist experiences you’ve had? YES NO G7a. Have you tried to avoid activities, places, things, or situations that remind you of the racism-related experiences you have had? YES NO G7b. Have you tried to avoid certain types of people because you worry they will behave in a racist way (i.e., White people, law enforcement, bosses, etc.)? YES NO Negative Changes in Cognition & Mood (Need 2 for PTSD diagnosis – count only one from #9 and/or #10) G8. Are there any important parts of your experiences with racism that you cannot remember? YES NO G9a. Have you been viewing yourself in a more negative way because of racism (e.g., “I should be a stronger person”)? YES NO 7 G9b. Have you been viewing others in a more negative way due to racism (e.g., ”I can’t trust White people”)? YES NO G9c. Do you feel as if the world is a dangerous place because of your experiences with racism? YES NO G10a. Have you blamed yourself for your experiences of racism, or for things that may have happened afterwards due to racism? YES NO G10b. Have you blamed others who were not involved for your experience, or for things that may have happened afterwards? YES NO G11. Have you had ongoing negative feelings such as fear, horror, anger, guilt or shame because of your racism-related experiences? YES NO G12. Have you lost interest in activities you used to enjoy? YES NO G13. Have you been feeling detached, cut-off, or alienated from other people? YES NO G14. Have you had difficulty experiencing positive feelings? Or do you feel emotionally numb? YES NO Physiological Arousal & Reactivity (Need 2 for PTSD diagnosis) G15. Have you been more irritable or (physically or verbally) aggressive? YES NO G16. Have you been taking more risks or doing things that might harm you or others (e.g., reckless driving, taking drugs, having unprotected sex)? YES NO G17. Have you been overly alert or on-guard (e.g., checking to see who is around you, sitting in places where you can see everyone, etc.)? YES NO G18. Have you been jumpy or more easily startled? YES NO G19. Have you had a hard time staying focused or concentrating? YES NO G20. Have you had a hard time falling asleep or staying asleep? YES NO Dissociative Symptoms (Need 0 for PTSD diagnosis) Note: These may be more likely when you get upset or stressed, esp. when triggered by experiences of racism. G21. Do you ever have times that you feel detached from your body, disconnected from your sense of self, or like a robot? (depersonalization) YES NO 8 G22. Do you ever have times that everything seems rather unreal, dreamlike, distant, or distorted? (derealization) YES NO Distress & Interference (Need 1 for PTSD diagnosis) Clinically significant Not clinically significant G23. Have these difficulties been upsetting for you? (all symptoms discussed so far) YES NO G24. Have these difficulties been getting in the way of your everyday life (e.g., relationships, work, school, parenting, or other important activities)? YES NO Duration of Disturbance (Need 1 month or more for PTSD diagnosis) 1 month or more Less than 1 month G25. How long have you been feeling these things? YES NO For a DSM-5 diagnosis of PTSD, the examinee must have: q at least 1 symptom in the Re-Experiencing category, q at least 1 symptom in the Avoidance category, q at least 2 symptoms in the Negative Changes in Cognition & Mood category (count only one from #9 and only one from #10), q at least 2 symptoms in the Physiological Arousal & Reactivity category, q at least 0 symptoms in the Dissociative Symptoms category, q at least 1 symptom from the Distress & Interference category q The Duration of Disturbance must be a YES answer. Reference the DSM-5 for exclusion criteria. LIKELY DIAGNOSES: _____________________________________________________________________________________________