Addressing Substance Use Disorders Among Families Involved with the Child Welfare System: A Cross-Agency Collaboration

OMB control Number

Expiration Date: October 12, 2020

Attachment E: informed consent MATHEMATICA POLICY RESEARCH

ADDRESSING SUBSTANCE USE DISORDERS AMONG FAMILIES INVOLVED WITH THE CHILD WELFARE SYSTEM: CHALLENGES AND PROMISING STRATEGIES IN RURAL COMMUNITIES

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0421. The time required to complete this information collection is estimated to average ___hours/ minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to:  U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201,   Attention: PRA Reports Clearance Officer

Directions for Interviewers:

Send each respondent the informed consent before the interview (email copy for telephone interviews; hard copy for site visits).

Ask the respondent(s) if they read and understood the informed consent, and offer to read aloud the informed consent.

Then ask each respondent to respond verbally to two requests:

1. Do you agree to participate in the study?

2. Do you agree to the audio-recording of the discussion?

Do not start recording until after the respondent consents. Do not record the interview if the respondent declines consent to record.

Please adapt as appropriate based on whether they are participating in a key informant interview or a site visit interview.

INFORMED CONSENT

Study: Addressing substance use disorders among families involved with the child welfare system: challenges and promising strategies in rural communities

Sponsor: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation

Mathematica Policy Research is conducting a study for the Office of the Assistant Secretary for Planning and Evaluation (ASPE) to learn about challenges, promising strategies, and opportunities to better address substance use among parents who live in rural communities and are involved in the child welfare system.

We are asking you to participate in this [60-minute or 90-minute] interview to learn your professional perspective on (1) the challenges of families in the child welfare system whose parents have substance use disorders, (2) promising strategies and programs, and (3) opportunities to improve services for child-welfare-involved families in rural communities.

For this study, Mathematica researchers will be conducting up to 12 key informant telephone interviews and 6 site visits across the country to learn about promising models. Informants were selected based on their expertise or knowledge about substance use, child welfare, and rural communities.

The information that we collect for this study will be analyzed and shared as part of two publicly available issue briefs. These briefs will summarize key challenges, promising strategies, and implementation suggestions. The briefs will not identify you by name or specific job title. We will highlight programs or strategies you share with us, so a reader will be able to identify your program and location.

There are no known risks to this study. Participating in the study may not provide a direct benefit to you, but information you provide will be helpful to inform federal, state, and local practices and policies regarding how to better meet the needs of rural families in the child welfare system and struggling with substance use.

Participation in the study is completely voluntary, and you may end participation at any time, or refuse to answer specific questions. Your refusal to participate or withdraw from the study will not result in any penalty. There is no compensation for participating.

We would also like your consent to record the discussion as a backup to our notetaking. If you do not agree to the recording, you can still participate in the interview. All recordings will be stored on Mathematica’s secure network, and only the Mathematica research team will have access to them. We will destroy the audio files at the end of this study.

If you have any questions about the study now or at a later time, you can contact your [interviewer/site liaison] at [contact email and phone number] or Elizabeth Weigensberg, the study’s lead researcher at Mathematica, at 312-585-3287.

Thank you for your participation.

2