BSF - Consent and Description Form

OMB Control No: 0970-0273

Expiration Date: 03/31/2008

Building Strong Families Study

The Building Strong Families Program

The Building Strong Families program helps unmarried couples with a new baby learn how to get along better with each other and be better parents for their children. Couples will learn about marriage, communication, trust, affection, dealing with stress, and relating to their baby. They also can get referrals to employment assistance, health care and mental health services, and other needed services.

WHAT IS THE STUDY ABOUT?

The Building Strong Families program is part of a national study being conducted by a research team from Mathematica Policy Research, Inc. based in Princeton, New Jersey. The study is sponsored by the U.S. Department of Health and Human Services. The study is being done to learn more about which services help couples build better relationships and healthy marriages.

HOW CAN I ENROLL IN THE STUDY?

The Building Strong Families program will not have room for all couples. If you want to be in the program, both of you have to agree to be in the study. If both of you are eligible to be in the study, a lottery will decide whether you can be in the program. Whether or not you are selected for the program, you will still be part of the study. If you are not selected for the Building Strong Families program, you will be given information about other services in your community that you can receive.

WHAT IS EXPECTED OF ME IF I DECIDE TO PARTICIPATE IN THE STUDY?

If you participate in this study, we will ask each of you some questions about yourself, the baby you are expecting or have just had, your living arrangements, your employment, how you are feeling about yourself, and how you are feeling about your relationship with the other parent of your child. Later, the research team will interview each of you two or three times by telephone over the next three to five years. The interviews will be about how things have gone for you as a couple and as parents, and will take about 45 minutes to complete each time. The researchers may also ask you for permission to do some activities with your child in the home to see how your child is growing up. Those activities with your child will take about 30 minutes.

If you are selected for the program, you will be able to attend group sessions with other couples. These group sessions are held weekly, on a schedule that is convenient for you and the other couples. Each session lasts about two hours, and the sessions are held over a period of about five months. You will also be able to meet with other program staff, who can help you with things like employment, housing, child care, substance abuse, and other problems you might have. There is no cost to you for attending these group sessions or meeting with other program staff.

WHAT OTHER INFORMATION ABOUT ME IS SHARED WITH THE STUDY TEAM?

If you agree to be part of the study, it means you are giving permission for the Building Strong Families program to share information with the study team about services you may receive, and for state and local agencies to release information to the study team about earnings and benefits you might get from government programs.

WILL the information I provide Be Kept CONFIDENTIAL?

Everything you tell the research team will be kept strictly confidential and will not be shared with any agency. However, if a person on the study team observes child abuse, it must be reported as required by law. Only the researchers will be able to see information you give them and nothing will ever be said about you as an individual. Instead, information about you will be combined with information about everybody else in the study, so the researchers can say things like “30 percent of couples in the program have two children.”

Is my Participation in the study voluntary?

Your participation in the study is strictly voluntary. You only have to participate in the Building Strong Families study if you want to. If you decide to be in the study, you can withdraw at any time. If you withdraw from the study, you can still receive services from other programs in your community.

what are the benefits and risk of Participating in the study?

There are no known risks of participating in this study, except that you may feel uncomfortable answering some questions in the interviews. You can refuse to answer such questions if you wish, and it will not affect your participation in the study. Your answers could help in providing services in the future to other parents like you, who want to learn more about relationships, marriage, and being parents.

WILL I BE COMPENSATED FOR PARTICIPATING IN THE STUDY?

You will receive $25 for participating in each interview you complete. Your child will receive a small toy for participating in the activities. You will receive these payments as a study participant, whether or not you are selected for the Building Strong Families Program.

Consent to Participate in Building Strong Families Study

I have read the information on the previous pages.

• I understand that the Building Strong Families program will not have space for all couples, and I agree to participate in a lottery to determine whether we can receive services. I understand that if we cannot receive Building Strong Families services, we can still get other program services in my community.

• I agree to complete an information form now, and to participate in later interviews. I understand that I may be asked some questions about personal things, but I will not have to answer any questions that make me feel uncomfortable. I understand that later I may be asked permission for researchers to include my child in the study as well.

• I give permission for the study team to collect information on Building Strong Families services I receive. I give permission for state and local agencies to release information to the study team about earnings and benefits I may receive from government programs

• I understand that all information will be kept strictly confidential, except as required by law or if I request otherwise in writing. Only the research team will be able to look at the information I give. The information will be used only for the study. However, I do understand that if a person on the study team observes child abuse, it must be reported.

• I can call Shawn Marsh toll-free at 1-800-314-4450 at Mathematica Policy Research, Inc. to get an answer about any questions I may have.

• If I have questions about my rights as a research volunteer, I can call Margo Campbell at Public/Private Ventures, toll-free at 1-800-755-4778.

Name of Participant (Printed)
Signature of Participant		Date
Name of Person Administering this Form (Printed)
Signature of Person Administering this Form		Date

Prepared by Mathematica Policy Research, Inc. Page 3

(3-23-06)