Empowerment Self Defense Program for Adult Native Women Survivors of Sexual Violence (ESD)

Eksperymentalny: Open Pilot Trial

Empowerment self-defense curriculum and practical skills training for Indigenous women survivors.

Behawioralne: Empowerment self-defense training

Participants will take part in the empowerment self-defense (ESD) program delivered in a small-group format. Sessions will be facilitated by trained facilitators and will focus on empowerment, personal safety skills, boundary setting, communication strategies, and trauma-informed discussions relevant to survivors of sexual violence.

Sessions will follow a structured curriculum designed to provide participants with practical skills for recognizing risk, setting boundaries, and responding to potentially harmful situations.

Facilitators delivering the program receive training in trauma-informed practice and are already certified to teach the ESD curriculum.

Depression

Participant responses to depressive symptoms in the past two weeks using items from the Patient Health Questionnaire (PHQ-9). The 9-item scale includes likert options ranging from 0 = Not at all to 3 = Nearly every day. Higher scores indicate more depressive symptoms.

PTSD

Participant responses to items from the PTSD checklist for DSM-5 to measure post traumatic stress disorder behaviors in the past month. The 20-item scale includes likert response options ranging from 0 = Not at all to 4 = Extremely with higher scores indicating more trauma related stress.

Suicidal Ideation

Participants will respond to items on the Suicidal Ideation Attributes Scale. This is a five measure with a slider scale from 0=never to 10=always. A score greater or equal to 21 is an elevated suicide risk. A score of 0 - 20: Indicates the presence of suicidal thoughts but generally reflects a lower behavioral risk. A score of 21 or higher: Indicates a higher risk of suicidal thoughts and behavior.

Alcohol Misuse

Participants will respond to items on the Alcohol Use Disorders Identification Test. This measures the participants alcohol use. This is a 10 item multiple choice option scale. For items 1-8, 0=never, 1=monthly or less, 2=2-4 times a month, 3=2-3 times a week, 4=4 or more times a week/daily/almost daily. For item 2 (special response) 0=1 or 2 drinks, 1=3 or 4 drinks, 2=5 or 6 drinks, 3=7 to 9 drinks, 4=10 or more drinks. For items 9-10, choices are 0=No, 2=Yes, but not in the last month, 4=Yes, during the last month.

The AUDIT (a 10-question survey) is scored from 0 to 40 with higher scores indicating hazardous or harmful alcohol consumption and a higher probability of alcohol dependence.

Drug Use

Participants will respond to items on the Drug Use Disorders Identification Test. This measures the participants use of drugs other than alcohol. This is a 11 items measure with multiple choice options. For items 1-2 the options are 0=Never, 1=Once a month or less often, 2=2-4 times month, 3=2-3 times a week, 4=4 times a week or more often. For item 3, the choices are 0=0, 1=1-2, 2=3-4, 3=5-6, 4=7 or more. For items 4-9, the choices are 0=never, 1=Less often than once a month, 2=Every month, 3=Every week, 4=Daily or almost every day. For items 10-11, the choices are 0=no, 1=Yes, but not over the past month, 2=Yes, over the past month.

A higher score on the DUDIT (Drug Use Disorders Identification Test) indicates a higher likelihood of harmful drug use, substance abuse, or drug dependence.

Suicide

Participant responses to items from the Columbia Suicide Severity Rating Scale (C-SSRS) Self Report to measure suicide and life-threatening behavior in the past month. The 6-item scale includes two response options ranging from 0 = No to 1 = Yes with higher scores indicating severity of suicidal ideation. Low risk : score of 1-2; Moderate risk: score of 3 or certain history; High risk: score of 4-6 A higher score indicates increased levels of suicide risk and future suicidal behavior.

Intimate Partner Violence

Participants will respond to items on the Conflict Tactics Scale Revised including subscales: psychological aggression, physical assault, sexual coercion or injury. This scale measures the participant's relationship with their partner in the past month. The scale is an 78 item multiple choice scale with the ranges of 0=Once in the past month, 1=Once in the past month, 2=Twice in the past month, 3=3-5 times in the past month, 4=6-10 times in the past month, 5=11-20 times in the past month, and 6=More than 20 times int he past month.

A higher score indicates a higher frequency and severity of intimate partner violence. A higher score on the negotiation subscale indicates better outcomes to resolve relationship conflicts.

Sexual Victimization

Participants will respond to selected items on the Sexual Experiences Survey Victimization Version-Acts Collapsed. This is a scale divided into 4 sections: Non-contact, Cybersex, Contact and Sexual Pressure. Non-contact is 3 items with a scale from 0-10+ times since participant's 14th birthday, Cybersex is 2 items with a scale from 0-10+ times since participant's 14th birthday, Contact is 9 items with 4 subitems each with a scale from 0-10+ times since participant's 14th birthday, and Sexual Pressure is 3 items with 4 subitems each with a scale from 0-10+ times since participant's 14th birthday.

A higher score indicates a higher lifetime prevalence, frequency, or severity of unwanted sexual experiences or sexual exploitation.

(Intermediary Outcome) Difficulty in Emotional Regulation

The Difficulty in Emotion Regulation Scale 18 is an 18 item measure with a 5 point scale ranging from 1=Almost never to 5=Almost always. It will include subscales of Awareness: Items 1, 4, 6 (reverse scored); Clarity: Items 2, 3, 5; Goals: Items 8, 12, 15; Impulse: Items 9, 16, 18; Nonacceptance: Items 7, 13, 14; Strategies: Items 10, 11, 17. Sum items within each subscale to obtain subscale scores. Score of 8 - 35: Low difficulties. Score of 36 - 62: Moderate difficulties. Score of 63 - 90: High difficulties.

A higher score indicates a greater difficulty managing emotions, meaning you likely struggle more to recognize, accept, and manage your feelings.

(Intermediary Outcome) Fear of future sexual assault

Participants will respond to items on the Fear of Sexual Assault Scale. This is a 31 measure with a Likert scale ranging from 1=always to 5=never for items 1-26 and a Likert scale ranging from 1=very safe to 5 very unsafe for items 27-31.

A higher score indicates an elevated level of anxiety, apprehension, or perceived vulnerability to becoming a victim of sexual violence.

(Intermediary Outcome) Self Blame

Participants will respond to items on the Rape Attribution Questionnaire. The Questionnaire uses multiple subscales: Behavioral self-blame, characterological self-blame, perpetrator blame, and external/societal blame. This is a 20 item measure with a Likert scale ranging from 1=strongly disagree to 6=strongly agree. A higher score indicates greater endorsement of blame or cause of sexual assault to a specific factor.

(Intermediary Outcome) Empowerment

Participants will respond to items on the Personal Progress scale. Participants will respond to statements that identify feelings or experiences and how each statement applies to them. The scale consists of a 28 items with a slider scale ranging from 1=almost never, 4=sometimes true, 7=almost always. This scale measures perceptions of power and competence, self-nurturance and resource access, interpersonal assertiveness, awareness of cultural discrimination, expression of anger and confrontation, autonomy, and personal strength and social activism. A higher score indicates positive increased personal Empowerment and Coping.

(Intermediary Outcome) Cultural Identity

Participants will respond to items on the Cultural Connectedness Scale which consists of three parts. The first part is a 15 item likart scale with range from 1=Strongly disagree to 5=Strongly agree. The second items are the frequency items, with 3 items with multiple choices of never, once in the past month, 2-3 times in the past month, about once a week, several times a week, and every day or almost every day. The last items are the Yes/No items. These are 11 statements with either Yes or No answers. A higher scores indicates a stronger, more positive engagement with one's heritage culture, encompassing cultural identity, traditions, and spirituality. Higher scores are strongly associated with protective, strength-based health outcomes, including: Improved Mental Health, Substance Abuse Protection, Better Physical Health, and Social and Academic Success.

(Intermediary) Social Support

Participants will respond to items on the Medical Outcome Study Social Support Survey Instrument to measure types of support available to the participant. This is a 19 item likert scale with 0=none of the time to 4=all of the time. Subscales measure Emotional/Informational support (2, 3, 7, 8, 12, 15, 16, 18), Tangible Support (1, 4, 11, 14), Affectionate support (5, 9, 19), and Positive social interaction (6, 10, 17). A higher scores indicates a greater availability of functional social support. Scores are typically transformed onto a 0-100 scale: Higher scores denote more positive perceived, available support. Lower scores denote a lack of or lower support or social isolation.