Attachment D4 RISE ORB Summative Posttest Consent

RISE Posttest Consent Information Sheet

Introduction and PURPOSE OF STUDY

The U. S. Department of Health and Human Services has hired Westat, a research company, to study the RISE program, a new local program working with the Los Angeles County Department of Children and Family Services (DCFS). The program is housed at the Los Angeles Gay and Lesbian Center. The goal of the RISE program is to reduce the number of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) children and youth in long-term foster care in Los Angeles County. RISE is supported by the Permanency Innovations Initiative (PII), a federal initiative that seeks to build the evidence base for innovative intervention to enhance well-being and improve permanency outcomes for children who are in or at risk for long-term foster care.

One part of the study involves examining ways organizations can better support and serve LBGTQ children through a staff survey. We would like your help in assisting us with this part of the study.

Procedures

At the first Outreach and Relationship Building (ORB) training, we invited staff from your organization to complete a voluntary, anonymous survey. We are now inviting you to participate in a second round of surveys. You are eligible to complete the survey regardless of whether you participated in the first round of surveys. All staff receiving (or who have previously received) ORB training are invited to participate.

The survey asks about your views and experiences with LGBTQ clients and the availability of agency resources to facilitate your work with this population. Reading this consent sheet and completing the survey will take no more than 10 minutes.

DIFFERENT WAYS TO PARTICIPATE

There are no alternative ways to participate in the study.

Participant and Data Privacy

Your survey responses will be anonymous and identifiable only by a unique study identification number. We will keep your information private to the extent permitted by law. We will use your information for research purposes only. We will not include information that identifies you in any reports we write.

To help us protect your information, we received a Certificate of Confidentiality from the U. S. Department of Health and Human Services. With this Certificate, no one can force us to share information that could identify you, even in any court or legal proceeding, under a court order or subpoena.

BENEFITS

There are no direct benefits to you in participating in the survey. However, you will help your organization and others come up with better ways to serve families and children. You will receive a token of appreciation for participating in the study valued at approximately $10.

VOLUNTARY PARTICIPATION

You are not required to participate in the RISE study. If you consent to participate, you can choose to end participation at any time. Your decision to participate will not affect your ability to participate the RISE staff trainings.

RISKS

We do not expect any risks to you in participating in the surveys. You can skip questions that you do not want to answer.

treatment for injury related to this study

We do not expect that you will experience any injuries as a result of participating in the study. Therefore, no treatment will be available to address any injuries.

CONFLICT OF INTEREST

Westat has no financial or other relationships with your agency that will affect our role in conducting this study, including interpreting and reporting the study results.

participation decision

To ensure your responses remain anonymous, you will not sign a consent form to indicate your decision to complete the survey. You agree to participate by just completing the survey. Please keep one copy of the consent information sheet for your records.

If you agree to participate, you can proceed with completing the survey. When you are done, please mail the other copy of the consent sheet and the survey in the envelope provided.

If you do not agree to participate, please check the box below and place this copy of the consent sheet and the survey in the envelope provided.

 I do not want to participate in this survey.

QUESTIONS

If you have questions about the survey, you may ask the Westat researcher facilitating the survey data collection. You may also contact the individuals below.

For questions about the RISE study, please contact: Jaymie Lorthridge, Westat Study Contact 1-800-WESTAT1 (937-8281), x5871 JaymieLorthridge@westat.com

You can learn more about your rights as a part of the study from the Research Participant’s Bill of Rights document that was distributed at the pretest. For additional questions about your rights as a participant in this study, contact: The State of California Committee for the Protection of Human Subjects, (916) 326-3660

Date of IRB approval of this consent: 11/30/12

Expiration date of IRB approval of this consent: 10/1/13

OMB NO: xxxx-xxxx
EXPIRATION DATE: xx/xx/xxxx
Burden Statement: This collection of information is voluntary and will be used to evaluate the Permanency Innovations Initiative. Public reporting burden of the collection of information described in this Information Sheet is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Reports Clearance Officer (Attn: OMB/PRA 0970-0355), Office of Planning, Research and Evaluation, Administration for Children and Families, Department of Health and Human Services, 370 L’Enfant Promenade S.W., Washington DC 20447.

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