Consent Form
The purpose of the questionnaire below is to help mental health professionals get a clearer understanding of how to respond to traumatic events and losses. This survey contains questions about such events. Please consider that there can be increases in distress or discomfort any time people think about painful events. If you decide to continue participating, please do so with awareness of that fact. If the events asked about cause a greater level of disturbance than you think is necessary, whether or not the disturbance is related to the survey, please contact a local mental health professional. It is also possible you may benefit from answering the questions in this survey.
Focus on the time immediately after the event. If there were responses made to you minutes, hours or even days afterward please report on that. If there were no such immediate helpful or harmful responses, but there was one after a longer period of time, however long that was, please respond on that.
If you would like to participate in this survey please do one of the two following:
Summaries of the results of the survey will be made available at www.whathelpssurvey.com.
Thank you,
Howard Lipke, PhD
116A, WH Survey
VA Medical Center
North Chicago, IL 60064
Please do not include your name or identifying information.