RTI International Office of Research Protection
INFORMED CONSENT FOR PARTICIPANTS
9 Month Interview-Female Participant in Facility not Allowing Payment
Multi-site Family Study
About the Study
The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We will be interviewing approximately 2,000 families selected from 5 states nationwide. We are asking you to participate in the study. We are contacting you because an incarcerated person indicated that he has been romantically involved with you or co-parented a child with you at some point during the past 9 months.
Participation in the Study
If you decide to be in the study, we will ask you to meet with an interviewer and complete an interview in a private setting. This interview will take about 1 and ½ hours. The interviewer will read questions from a computer screen and type your answers into the computer. For some questions that are very personal, if conditions allow it you will use earphones to hear the questions from the computer, and you will type your answers into the computer yourself. The interview will ask you questions about your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your physical and mental health, alcohol and drug use, criminal history, and expectations for life after your partner or family member is released.
Voluntary Participation
The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. We will not tell your partner or family members, or any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your partner’s probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.
Benefits
There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.
Risks of Study Participation
There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.
Confidentiality
We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your partner or your partner’s supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.
Exceptions to Confidentiality
There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.
Future Contacts
We may contact you again for one more interview. If so, we would invite you to participate in this interview nine months from today. Each time we do one of these interviews, you will have another chance to read a consent form like this and decide if you want to do the interview.
Payment
We are not allowed to pay you for participating in this interview. But, if your next interview is conducted outside of a correctional facility or inside a facility that allows us to pay you, you will receive a payment of $40 for that interview. If you participate in today’s interview and the next one, you will receive an additional $25 at the next interview if it is conducted outside of a correctional facility or inside a facility that allows us to pay you.
Questions
If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.
Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:
You understand the information about the study in this consent form,
You have had all of your questions answered fully, and
You want to participate in the study.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
Recordings
We are using a special quality control system on this project. The system runs on the computer and will record what you and I say to each other during several different parts of the interview. Neither you nor I will know when the computer is recording what we say. The recording will be reviewed by people at RTI to monitor my work, and will be kept confidential. You may participate in the interview even if you do not consent to the recordings. May we use this quality control system during your interview? By signing below, you are allowing us to use this quality control system.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
INFORMED CONSENT FOR PARTICIPANTS
9 Month Interview-Female Participant in Community or Facility Allowing Payment
Multi-site Family Study
About the Study
The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We will be interviewing approximately 2,000 families selected from 5 states nationwide. We are asking you to participate in the study. We are contacting you because an incarcerated person indicated that he has been romantically involved with you or co-parented a child with you at some point during the past 9 months.
Participation in the Study
If you decide to be in the study, we will ask you to meet with an interviewer and complete an interview in a private setting. This interview will take about 1 and ½ hours. The interviewer will read questions from a computer screen and type your answers into the computer. For some questions that are very personal, if conditions allow it you will use earphones to hear the questions from the computer, and you will type your answers into the computer yourself. The interview will ask you questions about your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your physical and mental health, alcohol and drug use, criminal history, and expectations for life after your partner or family member is released.
Voluntary Participation
The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. We will not tell your partner or family members, or any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your partner’s probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.
Benefits
There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.
Risks of Study Participation
There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.
Confidentiality
We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your partner or your partner’s supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.
Exceptions to Confidentiality
There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.
Future Contacts
We may contact you again for one more interview. If so, we would invite you to participate in this interview nine months from today. Each time we do one of these interviews, you will have another chance to read a consent form like this and decide if you want to do the interview.
Payment
In an effort to thank you for taking the time for the interview, we will give you $40 upon completion of this interview. If your next interview is conducted outside of a correctional facility or inside a facility that allows us to pay you, you will also receive a payment of $40 for that interview. If you participate in today’s interview and the next one, you will receive an additional $25 at the next interview if it is conducted outside of a correctional facility or inside a facility that allows us to pay you.
Questions
If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.
Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:
You understand the information about the study in this consent form,
You have had all of your questions answered fully, and
You want to participate in the study.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
Recordings
We are using a special quality control system on this project. The system runs on the computer and will record what you and I say to each other during several different parts of the interview. Neither you nor I will know when the computer is recording what we say. The recording will be reviewed by people at RTI to monitor my work, and will be kept confidential. You may participate in the interview even if you do not consent to the recordings. May we use this quality control system during your interview? By signing below, you are allowing us to use this quality control system.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
INFORMED CONSENT FOR PARTICIPANTS
9 Month Interview-Female Participant in Facility Allowing Community Designee
Multi-site Family Study
About the Study
The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We will be interviewing approximately 2,000 families selected from 5 states nationwide. We are asking you to participate in the study. We are contacting you because an incarcerated person indicated that he has been romantically involved with you or co-parented a child with you at some point during the past 9 months.
Participation in the Study
If you decide to be in the study, we will ask you to meet with an interviewer and complete an interview in a private setting. This interview will take about 1 and ½ hours. The interviewer will read questions from a computer screen and type your answers into the computer. For some questions that are very personal, if conditions allow it you will use earphones to hear the questions from the computer, and you will type your answers into the computer yourself. The interview will ask you questions about your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your physical and mental health, alcohol and drug use, criminal history, and expectations for life after your partner or family member is released.
Voluntary Participation
The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. We will not tell your partner or family members, or any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your partner’s probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.
Benefits
There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.
Risks of Study Participation
There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.
Confidentiality
We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your partner or your partner’s supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.
Exceptions to Confidentiality
There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.
Future Contacts
We may contact you again for one more interview. If so, we would invite you to participate in this interview nine months from today. Each time we do one of these interviews, you will have another chance to read a consent form like this and decide if you want to do the interview.
Payment
We are not allowed to pay you for participating in this interview. But, you can name someone living in the community that you would like to receive a $40 money order, and we will mail this person a money order using the address that you provide. If your next interview is conducted outside of a correctional facility or inside a facility that allows us to pay you, you will receive a payment of $40 for that interview. If you participate in today’s interview and the next one, you will receive an additional $25 at the next interview if it is conducted outside of a correctional facility or inside a facility that allows us to pay you.
Questions
If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.
Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:
You understand the information about the study in this consent form,
You have had all of your questions answered fully, and
You want to participate in the study.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
Recordings
We are using a special quality control system on this project. The system runs on the computer and will record what you and I say to each other during several different parts of the interview. Neither you nor I will know when the computer is recording what we say. The recording will be reviewed by people at RTI to monitor my work, and will be kept confidential. You may participate in the interview even if you do not consent to the recordings. May we use this quality control system during your interview? By signing below, you are allowing us to use this quality control system.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
INFORMED CONSENT FOR PARTICIPANTS
9-Month Interview-Male Participant in Bureau of Prisons Federal Facility
Multi-site Family Study
About the Study
The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We will be interviewing approximately 2,000 families selected from 5 states nationwide. We are asking you to participate in the study. Your spouse or romantic partner will also be asked to participate.
Participation in the Study
You may remember that you first enrolled in the study about nine months ago. At that time, you completed a computer interview with one of our interviewers. If you now agree to continue to be in the study, we will ask you to complete a follow up interview. This interview will take about 1 and ½ hours. Like last time, the interviewer will read questions from a computer screen and type your answers into the computer. For some questions that are very personal, if conditions allow it you will use earphones to hear the questions from the computer, and you will type your answers into the computer yourself. The interview will ask you questions about your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your criminal history, physical and mental health, alcohol and drug use, and expectations for life in the community after your release. We will also ask you for the contact information of your spouse or romantic partner so we can invite her to participate in an interview.
Voluntary Participation
The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. Aside from your spouse or partner, we will not tell any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.
Benefits
There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.
Risks of Study Participation
There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.
Confidentiality
We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your spouse or partner or your supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.
Exceptions to Confidentiality
There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.
Future Contacts
We may contact you again for one more interview. If so, we would invite you to participate in this interview nine months from today. At that time, you will have another chance to read a consent form like this and decide if you want to do the interview.
Payment
We
are not allowed to pay you for participating in this interview. But,
if your next interview is conducted outside of a correctional
facility or inside a facility that allows us to pay you, you will
receive a payment of $40 for that interview. If you participate in
today’s interview and the next one, you will receive an
additional $25 at the next interview if it is conducted outside of a
correctional facility or inside a facility that allows us to pay you.
Questions
If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.
Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:
You understand the information about the study in this consent form,
You have had all of your questions answered fully, and
You want to participate in the study.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
Recordings
We are using a special quality control system on this project. The system runs on the computer and will record what you and I say to each other during several different parts of the interview. Neither you nor I will know when the computer is recording what we say. The recording will be reviewed by people at RTI to monitor my work, and will be kept confidential. You may participate in the interview even if you do not consent to the recordings. May we use this quality control system during your interview? By signing below, you are allowing us to use this quality control system.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
INFORMED CONSENT FOR PARTICIPANTS
9-Month Interview-Male Participant in Facility Allowing Community Designee
Multi-site Family Study
About the Study
The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We will be interviewing approximately 2,000 families selected from 5 states nationwide. We are asking you to participate in the study. Your spouse or romantic partner will also be asked to participate.
Participation in the Study
You may remember that you first enrolled in the study about nine months ago. At that time, you completed a computer interview with one of our interviewers. If you now agree to continue to be in the study, we will ask you to complete a follow up interview. This interview will take about 1 and ½ hours. Like last time, the interviewer will read questions from a computer screen and type your answers into the computer. For some questions that are very personal, if conditions allow it you will use earphones to hear the questions from the computer, and you will type your answers into the computer yourself. The interview will ask you questions about your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your criminal history, physical and mental health, alcohol and drug use, and expectations for life in the community after your release. We will also ask you for the contact information of your spouse or romantic partner so we can invite her to participate in an interview.
Voluntary Participation
The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. Aside from your spouse or partner, we will not tell any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.
Benefits
There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.
Risks of Study Participation
There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.
Confidentiality
We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your spouse or partner or your supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.
Exceptions to Confidentiality
There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.
Future Contacts
We may contact you again for one more interview. If so, we would invite you to participate in this interview nine months from today. At that time, you will have another chance to read a consent form like this and decide if you want to do the interview.
Payment
We are not allowed to pay you for participating in this interview. But, you can name someone living in the community that you would like to receive a $35 money order, and we will mail this person a money order using the address that you provide. If your next interview is conducted outside of a correctional facility or inside a facility that allows us to pay you, you will receive a payment of $40 for that interview. If you participate in today’s interview and the next one, you will receive an additional $25 at the next interview if it is conducted outside of a correctional facility or inside a facility that allows us to pay you.
Questions
If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.
Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:
You understand the information about the study in this consent form,
You have had all of your questions answered fully, and
You want to participate in the study.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
Recordings
We are using a special quality control system on this project. The system runs on the computer and will record what you and I say to each other during several different parts of the interview. Neither you nor I will know when the computer is recording what we say. The recording will be reviewed by people at RTI to monitor my work, and will be kept confidential. You may participate in the interview even if you do not consent to the recordings. May we use this quality control system during your interview? By signing below, you are allowing us to use this quality control system.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
INFORMED CONSENT FOR PARTICIPANTS
9-Month Interview-Male Participant in Facility Not Allowing Payment
Multi-site Family Study
About the Study
The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We will be interviewing approximately 2,000 families selected from 5 states nationwide. We are asking you to participate in the study. Your spouse or romantic partner will also be asked to participate.
Participation in the Study
You may remember that you first enrolled in the study about nine months ago. At that time, you completed a computer interview with one of our interviewers. If you now agree to continue to be in the study, we will ask you to complete a follow up interview. This interview will take about 1 and ½ hours. Like last time, the interviewer will read questions from a computer screen and type your answers into the computer. For some questions that are very personal, if conditions allow it you will use earphones to hear the questions from the computer, and you will type your answers into the computer yourself. The interview will ask you questions about your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your criminal history, physical and mental health, alcohol and drug use, and expectations for life in the community after your release. We will also ask you for the contact information of your spouse or romantic partner so we can invite her to participate in an interview.
Voluntary Participation
The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. Aside from your spouse or partner, we will not tell any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.
Benefits
There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.
Risks of Study Participation
There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.
Confidentiality
We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your spouse or partner or your supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.
Exceptions to Confidentiality
There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.
Future Contacts
We may contact you again for one more interview. If so, we would invite you to participate in this interview nine months from today. At that time, you will have another chance to read a consent form like this and decide if you want to do the interview.
Payment
We are not allowed to pay you for participating in this interview. But, if your next interview is conducted outside of a correctional facility or inside a facility that allows us to pay you, you will receive a payment of $40 for that interview. If you participate in today’s interview and the next one, you will receive an additional $25 at the next interview if it is conducted outside of a correctional facility or inside a facility that allows us to pay you.
Questions
If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.
Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:
You understand the information about the study in this consent form,
You have had all of your questions answered fully, and
You want to participate in the study.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
Recordings
We are using a special quality control system on this project. The system runs on the computer and will record what you and I say to each other during several different parts of the interview. Neither you nor I will know when the computer is recording what we say. The recording will be reviewed by people at RTI to monitor my work, and will be kept confidential. You may participate in the interview even if you do not consent to the recordings. May we use this quality control system during your interview? By signing below, you are allowing us to use this quality control system.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
Case ID Number: __ __ __ __ __ __ __ __
INFORMED CONSENT FOR PARTICIPANTS
9 Month Interview-Male Participant in PAPI Interviews
Multi-site Family Study
About the Study
The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We will be interviewing approximately 2,000 families selected from 5 states nationwide. We are asking you to participate in the study. Your spouse or romantic partner will also be asked to participate.
Participation in the Study
You may remember that you first enrolled in the study about nine months ago. At that time, you completed an interview with one of our interviewers. If you now agree to continue to be in the study, we will ask you to complete a follow-up interview. This interview will take about 2 hours. Like last time, the interviewer will read questions from a booklet and enter your answers. The interviewer will ask you questions about your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your criminal history, physical and mental health, alcohol and drug use, and expectations for life in the community after your release. We will also ask you for the contact information of your spouse or romantic partner so we can invite her to participate in an interview.
Voluntary Participation
The choice of whether to participate in this study is completely up to you, even if you have already signed another form saying you would participate. No one will be upset or angry if you decide not to participate. Aside from your spouse or partner, we will not tell any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.
Benefits
There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.
Risks of Study Participation
There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.
Confidentiality
We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your spouse or partner or your supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.
Exceptions to Confidentiality
There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.
Future Contacts
We may contact you again for one more interview. If so, we would invite you to participate in this interview nine months from today. At that time, you will have another chance to read a consent form like this and decide if you want to do the interview.
Payment
We are not allowed to pay you for participating in this interview. But, if your next interview is conducted outside of a correctional facility or inside a facility that allows us to pay you, you will receive a payment of $40 for that interview. If you participate in today’s interview and the next one, you will receive an additional $25 at the last interview if it is conducted outside of a correctional facility or inside a facility that allows us to pay you.
Questions
If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194 . If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.
Do you have any questions that might help you decide whether or not you want to participate in the study? By checking the box below, you are agreeing to participate in the study. Please check the box only if:
You understand the information about the study in this consent form,
You have had all of your questions answered fully, and
You want to participate in the study.
□Check here if the above statements are true.
Interviewer’s Signature: ______________________________________________ Date: _________
INFORMED CONSENT FOR PARTICIPANTS
9-Month Interview-Male Participant in Community or Facility Allowing Payment
Multi-site Family Study
About the Study
The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We will be interviewing approximately 2,000 families selected from 5 states nationwide. We are asking you to participate in the study. Your spouse or romantic partner will also be asked to participate.
Participation in the Study
You may remember that you first enrolled in the study about nine months ago. At that time, you completed a computer interview with one of our interviewers. If you now agree to continue to be in the study, we will ask you to complete a follow up interview. This interview will take about 1 and ½ hours. Like last time, the interviewer will read questions from a computer screen and type your answers into the computer. For some questions that are very personal, if conditions allow it you will use earphones to hear the questions from the computer, and you will type your answers into the computer yourself. The interview will ask you questions about your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your criminal history, physical and mental health, alcohol and drug use, and expectations for life in the community after your release. We will also ask you for the contact information of your spouse or romantic partner so we can invite her to participate in an interview.
Voluntary Participation
The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. Aside from your spouse or partner, we will not tell any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.
Benefits
There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.
Risks of Study Participation
There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.
Confidentiality
We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your spouse or partner or your supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.
Exceptions to Confidentiality
There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.
Future Contacts
We may contact you again for one more interview. If so, we would invite you to participate in this interview nine months from today. At that time, you will have another chance to read a consent form like this and decide if you want to do the interview.
Payment
In an effort to thank you for taking the time for the interview, we will give you $35 upon completion of this interview. If your next interview is conducted outside of a correctional facility or inside a facility that allows us to pay you, you will also receive a payment of $40 for that interview. If you participate in today’s interview and the next one, you will receive an additional $25 at the next interview if it is conducted outside of a correctional facility or inside a facility that allows us to pay you.
Questions
If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.
Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:
You understand the information about the study in this consent form,
You have had all of your questions answered fully, and
You want to participate in the study.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
Recordings
We are using a special quality control system on this project. The system runs on the computer and will record what you and I say to each other during several different parts of the interview. Neither you nor I will know when the computer is recording what we say. The recording will be reviewed by people at RTI to monitor my work, and will be kept confidential. You may participate in the interview even if you do not consent to the recordings. May we use this quality control system during your interview? By signing below, you are allowing us to use this quality control system.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
INFORMED CONSENT FOR PARTICIPANTS
18/34 Month Interview-Female Participant in Facility Allowing Community Designee
Multi-site Family Study
About the Study
The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We will be interviewing approximately 2,000 families selected from 5 states nationwide. We are asking you to participate in the study. We are contacting you because an incarcerated person indicated that he has been romantically involved with you or co-parented a child with you at some point during the past 18 months.
Participation in the Study
If you decide to be in the study, we will ask you to meet with an interviewer and complete an interview in a private setting. This interview will take about 1 and ½ hours. The interviewer will read questions from a computer screen and type your answers into the computer. For some questions that are very personal, if conditions allow it you will use earphones to hear the questions from the computer, and you will type your answers into the computer yourself. The interview will ask you questions about your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your physical and mental health, alcohol and drug use, criminal history, and expectations for life after your partner or family member is released.
Voluntary Participation
The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. We will not tell your partner or family members, or any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your partner’s probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.
Benefits
There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.
Risks of Study Participation
There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.
Confidentiality
We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your partner or your partner’s supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.
Exceptions to Confidentiality
There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.
Future Contacts
At this point, we do not plan to contact you again for any more interviews. But if we do, you will have another chance to read a consent form like this and decide if you want to do the interview.
Payment
We are not allowed to pay you for participating in this interview. But, you can name someone living in the community that you would like to receive a $40 money order, and we will mail this person a money order using the address that you provide.
Questions
If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.
Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:
You understand the information about the study in this consent form,
You have had all of your questions answered fully, and
You want to participate in the study.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
Recordings
We are using a special quality control system on this project. The system runs on the computer and will record what you and I say to each other during several different parts of the interview. Neither you nor I will know when the computer is recording what we say. The recording will be reviewed by people at RTI to monitor my work, and will be kept confidential. You may participate in the interview even if you do not consent to the recordings. May we use this quality control system during your interview? By signing below, you are allowing us to use this quality control system.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
INFORMED CONSENT FOR PARTICIPANTS
18/34 Month Interview-Female Participant in Facility not Allowing Payment
Multi-site Family Study
About the Study
The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We will be interviewing approximately 2,000 families selected from 5 states nationwide. We are asking you to participate in the study. We are contacting you because an incarcerated person indicated that he has been romantically involved with you or co-parented a child with you at some point during the past 18 months.
Participation in the Study
If you decide to be in the study, we will ask you to meet with an interviewer and complete an interview in a private setting. This interview will take about 1 and ½ hours. The interviewer will read questions from a computer screen and type your answers into the computer. For some questions that are very personal, if conditions allow it you will use earphones to hear the questions from the computer, and you will type your answers into the computer yourself. The interview will ask you questions about your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your physical and mental health, alcohol and drug use, criminal history, and expectations for life after your partner or family member is released.
Voluntary Participation
The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. We will not tell your partner or family members, or any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your partner’s probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.
Benefits
There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.
Risks of Study Participation
There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.
Confidentiality
We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your partner or your partner’s supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.
Exceptions to Confidentiality
There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.
Future Contacts
At this point, we do not plan to contact you again for any more interviews. But if we do, you will have another chance to read a consent form like this and decide if you want to do the interview.
Payment
We are not allowed to pay you for participating in this interview.
Questions
If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.
Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:
You understand the information about the study in this consent form,
You have had all of your questions answered fully, and
You want to participate in the study.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
Recordings
We are using a special quality control system on this project. The system runs on the computer and will record what you and I say to each other during several different parts of the interview. Neither you nor I will know when the computer is recording what we say. The recording will be reviewed by people at RTI to monitor my work, and will be kept confidential. You may participate in the interview even if you do not consent to the recordings. May we use this quality control system during your interview? By signing below, you are allowing us to use this quality control system.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
INFORMED CONSENT FOR PARTICIPANTS
18/34 Month Interview-Female Participant in Community or Facility Allowing Payment
Multi-site Family Study
About the Study
The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We will be interviewing approximately 2,000 families selected from 5 states nationwide. We are asking you to participate in the study. We are contacting you because an incarcerated person indicated that he has been romantically involved with you or co-parented a child with you at some point during the past 18 months.
Participation in the Study
If you decide to be in the study, we will ask you to meet with an interviewer and complete an interview in a private setting. This interview will take about 1 and ½ hours. The interviewer will read questions from a computer screen and type your answers into the computer. For some questions that are very personal, if conditions allow it you will use earphones to hear the questions from the computer, and you will type your answers into the computer yourself. The interview will ask you questions about your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your physical and mental health, alcohol and drug use, criminal history, and expectations for life after your partner or family member is released.
Voluntary Participation
The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. We will not tell your partner or family members, or any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your partner’s probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.
Benefits
There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.
Risks of Study Participation
There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.
Confidentiality
We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your partner or your partner’s supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.
Exceptions to Confidentiality
There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.
Future Contacts
At this point, we do not plan to contact you again for any more interviews. But if we do, you will have another chance to read a consent form like this and decide if you want to do the interview.
Payment
In an effort to thank you for taking the time for the interview, we will give you $40 upon completion of this interview.
Questions
If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.
Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:
You understand the information about the study in this consent form,
You have had all of your questions answered fully, and
You want to participate in the study.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
Recordings
We are using a special quality control system on this project. The system runs on the computer and will record what you and I say to each other during several different parts of the interview. Neither you nor I will know when the computer is recording what we say. The recording will be reviewed by people at RTI to monitor my work, and will be kept confidential. You may participate in the interview even if you do not consent to the recordings. May we use this quality control system during your interview? By signing below, you are allowing us to use this quality control system.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
INFORMED CONSENT FOR PARTICIPANTS
18/34-Month Interview-Male Participant in Bureau of Prisons Federal Facility
Multi-site Family Study
About the Study
The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We will be interviewing approximately 2,000 families selected from 5 states nationwide. We are asking you to participate in the study. Your spouse or romantic partner will also be asked to participate.
Participation in the Study
You may remember that you first enrolled in the study about 18 months ago. At that time, you completed a computer interview with one of our interviewers. If you now agree to continue to be in the study, we will ask you to complete a final follow up interview. This interview will take about 1 and ½ hours. Like last time, the interviewer will read questions from a computer screen and type your answers into the computer. For some questions that are very personal, if conditions allow it you will use earphones to hear the questions from the computer, and you will type your answers into the computer yourself. The interview will ask you questions about your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your criminal history, physical and mental health, alcohol and drug use, and expectations for life in the community after your release. We will also ask you for the contact information of your spouse or romantic partner so we can invite her to participate in an interview.
Voluntary Participation
The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. Aside from your spouse or partner, we will not tell any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.
Benefits
There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.
Risks of Study Participation
There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.
Confidentiality
We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your spouse or partner or your supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.
Exceptions to Confidentiality
There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.
Future Contacts
At this point, we do not plan to contact you again for any more interviews. But if we do, you will have another chance to read a consent form like this and decide if you want to do the interview.
Payment
We
are not allowed to pay you for participating in this interview.
Questions
If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.
Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:
You understand the information about the study in this consent form,
You have had all of your questions answered fully, and
You want to participate in the study.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
Recordings
We are using a special quality control system on this project. The system runs on the computer and will record what you and I say to each other during several different parts of the interview. Neither you nor I will know when the computer is recording what we say. The recording will be reviewed by people at RTI to monitor my work, and will be kept confidential. You may participate in the interview even if you do not consent to the recordings. May we use this quality control system during your interview? By signing below, you are allowing us to use this quality control system.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
INFORMED CONSENT FOR PARTICIPANTS
18/34-Month Interview-Male Participant in Facility Allowing Community Designee
Multi-site Family Study
About the Study
The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We will be interviewing approximately 2,000 families selected from 5 states nationwide. We are asking you to participate in the study. Your spouse or romantic partner will also be asked to participate.
Participation in the Study
You may remember that you first enrolled in the study about 18 months ago. At that time, you completed a computer interview with one of our interviewers. If you now agree to continue to be in the study, we will ask you to complete a final follow up interview. This interview will take about 1 and ½ hours. Like last time, the interviewer will read questions from a computer screen and type your answers into the computer. For some questions that are very personal, if conditions allow it you will use earphones to hear the questions from the computer, and you will type your answers into the computer yourself. The interview will ask you questions about, your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your criminal history, physical and mental health, alcohol and drug use, and expectations for life in the community after your release. We will also ask you for the contact information of your spouse or romantic partner so we can invite her to participate in an interview.
Voluntary Participation
The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. Aside from your spouse or partner, we will not tell any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.
Benefits
There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.
Risks of Study Participation
There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.
Confidentiality
We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your spouse or partner or your supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.
Exceptions to Confidentiality
There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.
Future Contacts
At this point, we do not plan to contact you again for any more interviews. But if we do, you will have another chance to read a consent form like this and decide if you want to do the interview.
Payment
We are not allowed to pay you for participating in this interview. But, you can name someone living in the community that you would like to receive a $40 money order, and we will mail this person a money order using the address that you provide.
Questions
If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.
Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:
You understand the information about the study in this consent form,
You have had all of your questions answered fully, and
You want to participate in the study.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
Recordings
We are using a special quality control system on this project. The system runs on the computer and will record what you and I say to each other during several different parts of the interview. Neither you nor I will know when the computer is recording what we say. The recording will be reviewed by people at RTI to monitor my work, and will be kept confidential. You may participate in the interview even if you do not consent to the recordings. May we use this quality control system during your interview? By signing below, you are allowing us to use this quality control system.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
INFORMED CONSENT FOR PARTICIPANTS
18/34-Month Interview-Male Participant in Facility Not Allowing Payment
Multi-site Family Study
About the Study
The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We will be interviewing approximately 2,000 families selected from 5 states nationwide. We are asking you to participate in the study. Your spouse or romantic partner will also be asked to participate.
Participation in the Study
You may remember that you first enrolled in the study about 18 months ago. At that time, you completed a computer interview with one of our interviewers. If you now agree to continue to be in the study, we will ask you to complete a final follow up interview. This interview will take about 1 and ½ hours. Like last time, the interviewer will read questions from a computer screen and type your answers into the computer. For some questions that are very personal, if conditions allow it you will use earphones to hear the questions from the computer, and you will type your answers into the computer yourself. The interview will ask you questions about your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your criminal history, physical and mental health, alcohol and drug use, and expectations for life in the community after your release. We will also ask you for the contact information of your spouse or romantic partner so we can invite her to participate in an interview.
Voluntary Participation
The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. Aside from your spouse or partner, we will not tell any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.
Benefits
There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.
Risks of Study Participation
There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.
Confidentiality
We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your spouse or partner or your supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.
Exceptions to Confidentiality
There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.
Future Contacts
At this point, we do not plan to contact you again for any more interviews. But if we do, you will have another chance to read a consent form like this and decide if you want to do the interview.
Payment
We are not allowed to pay you for participating in this interview.
Questions
If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.
Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:
You understand the information about the study in this consent form,
You have had all of your questions answered fully, and
You want to participate in the study.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
Recordings
We are using a special quality control system on this project. The system runs on the computer and will record what you and I say to each other during several different parts of the interview. Neither you nor I will know when the computer is recording what we say. The recording will be reviewed by people at RTI to monitor my work, and will be kept confidential. You may participate in the interview even if you do not consent to the recordings. May we use this quality control system during your interview? By signing below, you are allowing us to use this quality control system.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
Case ID Number: __ __ __ __ __ __ __ __
INFORMED CONSENT FOR PARTICIPANTS
18/34 Month Interview-Male Participant in PAPI Interviews
Multi-site Family Study
About the Study
The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We will be interviewing approximately 2,000 families selected from 5 states nationwide. We are asking you to participate in the study. If you participate in the study, your spouse or romantic partner will also be asked to participate in an interview covering the same types of questions.
Participation in the Study
You may remember that you first enrolled in the study about nine months ago. At that time, you completed an interview with one of our interviewers. If you now agree to continue to be in the study, we will ask you to complete a final follow up interview. This interview will take about 2 hours. Like last time, the interviewer will read questions from a booklet and enter your answers. The interviewer will ask you questions about your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your criminal history, physical and mental health, alcohol and drug use, and expectations for life in the community after your release. We will also ask you for the contact information of your spouse or romantic partner so we can invite her to participate in an interview.
Voluntary Participation
The choice of whether to participate in this study is completely up to you, even if you have already signed another form saying you would participate. No one will be upset or angry if you decide not to participate. Aside from your spouse or partner, we will not tell any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.
Benefits
There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.
Risks of Study Participation
There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.
Confidentiality
We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your spouse or partner or your supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.
Exceptions to Confidentiality
There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.
Future Contacts
At this point, we do not plan to contact you again for any more interviews. But if we do, you will have another chance to read a consent form like this and decide if you want to do the interview.
Payment
We are not allowed to pay you for participating in this interview.
Questions
If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194 . If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.
Do you have any questions that might help you decide whether or not you want to participate in the study? By checking the box below, you are agreeing to participate in the study. Please check the box only if:
You understand the information about the study in this consent form,
You have had all of your questions answered fully, and
You want to participate in the study.
□Check here if the above statements are true.
Interviewer’s Signature: ______________________________________________ Date: _________
INFORMED CONSENT FOR PARTICIPANTS
18-Month/34-Month Interview-Male Participant in Community or Facility Allowing Payment
Multi-site Family Study
About the Study
The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We will be interviewing approximately 2,000 families selected from 5 states nationwide. We are asking you to participate in the study. Your spouse or romantic partner will also be asked to participate.
Participation in the Study
You may remember that you first enrolled in the study about 18 months ago. At that time, you completed a computer interview with one of our interviewers. If you now agree to continue to be in the study, we will ask you to complete a final follow up interview. This interview will take about 1 and ½ hours. Like last time, the interviewer will read questions from a computer screen and type your answers into the computer. For some questions that are very personal, if conditions allow it you will use earphones to hear the questions from the computer, and you will type your answers into the computer yourself. The interview will ask you questions about your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your criminal history, physical and mental health, alcohol and drug use, and expectations for life in the community after your release. We will also ask you for the contact information of your spouse or romantic partner so we can invite her to participate in an interview.
Voluntary Participation
The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. Aside from your spouse or partner, we will not tell any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.
Benefits
There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.
Risks of Study Participation
There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.
Confidentiality
We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your spouse or partner or your supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.
Exceptions to Confidentiality
There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.
Future Contacts
At this point, we do not plan to contact you again for any more interviews. But if we do, you will have another chance to read a consent form like this and decide if you want to do the interview.
Payment
In an effort to thank you for taking the time for the interview, we will give you $40 upon completion of this interview.
Questions
If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.
Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:
You understand the information about the study in this consent form,
You have had all of your questions answered fully, and
You want to participate in the study.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
Recordings
We are using a special quality control system on this project. The system runs on the computer and will record what you and I say to each other during several different parts of the interview. Neither you nor I will know when the computer is recording what we say. The recording will be reviewed by people at RTI to monitor my work, and will be kept confidential. You may participate in the interview even if you do not consent to the recordings. May we use this quality control system during your interview? By signing below, you are allowing us to use this quality control system.
Respondent’s Signature: ______________________________________________ Date: _________
Interviewer’s Signature: ______________________________________________ Date: _________
Consent for Release of Information
Multi-Site Family Study
My signature(s) below indicates that I authorize RTI International to share (in a secure manner) my social security number, date of birth, and name with the following agencies in order for the agencies to release (in a secure manner) my private information or records to RTI International for research purposes:
Office of Child Support Enforcement (OCSE) within the U.S. Department of Health and Human Services’ Administration for Children and Families
[State unemployment insurance agency]
[State TANF agency]
[State SSI agency]
[State child welfare agency]
[State law enforcement agency]
[State department of corrections]
Federal Bureau of Investigation within the U.S. Department of Justice
I understand that these agencies have agreed not to take any enforcement action as a result of this record request.
I understand that the following types of information may be obtained from the child support, child welfare, and employment agencies: information about child support orders, custodial parent information, formal employment status, unemployment insurance, and wages.
I understand that the following types of information may be obtained from the law enforcement or correctional agencies: arrest information, incarceration information.
I agree that the access I am granting shall cover all previous records as well as future records for a period of up to five years from now.
I agree that this private information may be released to RTI International at the following address:
NAME ADDRESS
Multi-Site Family Study (0210412) Hill Building 418, P.O. Box 12194, 3040 Cornwallis Road
RTI International Research Triangle Park, NC 27709-2194
I agree to this release of information voluntarily. I understand that this information will be used only for research purposes and that my information will be combined with the information from the other study participants. I also understand that my name will not be released by RTI International when the results from this research are published. I may withdraw my consent to the release of these records at any time by contacting RTI International in writing at the address above. If I withdraw my consent, any records received during the course of the project relating to me will be destroyed by RTI International.
Signature: ______________________ Witness: _________________________
Date: ___________________________ Date: ___________________________
| File Type | application/msword |
| Author | tmckay |
| Last Modified By | Linda.Mellgren |
| File Modified | 2011-10-18 |
| File Created | 2011-10-18 |