ATTACHMENT A_Interview Consent Form

OMB Control No.: 0970-xxxx

Expiration Date: xx/xx/20xx

ATTACHMENT A: INTERVIEW CONSENT FORM

INTERVIEW: PARTICIPANT INFORMED CONSENT

Study Title: Home Visiting Career Trajectories

Principal Investigator: Heather Sandstrom, Ph.D

Funder: The Office of Planning, Research, and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services

Introduction/Purpose

You are invited to participate in the “Home Visiting Career Trajectories” study. The Office of Planning, Research, and Evaluation in the Administration for Children and Families, in collaboration with the Health Resources and Services Administration, in the U.S. Department of Health and Human Services is funding the study and hired the Urban Institute to conduct it. The Urban Institute research team is conducting interviews with home visitor program managers and supervisors. You were asked to participate in the study because you are a home visitor program manager and/or supervisor.

The goal of this study is to learn more about the size, characteristics, and career trajectories of the home visiting workforce, as well as the kinds of professional development and training available to home visitors. Before you decide to be a part of this study, you need to know the benefits and risks of joining the study.

Procedure

We will ask you a series of questions in a semi-structured interview. There are no “right” or “wrong” answers, and you don’t have to answer any questions you don’t know the answer to or don’t want to answer. We will take notes during the interview and our conversation will be audio recorded with your permission. The interview will not exceed 90 minutes.

Benefits

Your answers will help us learn how home visitors come into this field, why they stay or why they leave, how they can be better supported in their roles, and about their medium- and long-term career trajectories. You will not benefit directly from participating in this interview.

Risks

There are no known risks to you for taking part in this study.

Privacy

The research team will keep information that you share private as we develop notes and reports about the study. Our reports will not include your name or any other information that could be used to identify you. Recordings from the interview will be stored in a secure digital folder that can be used by only the researchers in this study. Notes from the interview will be locked in an office. We will keep all records that we produce private to the extent permitted by law.

Participation is Voluntary

Your participation in this study, if you agree to take part, is voluntary. You have the right to stop your participation at any time without penalty.

Questions

If you have any questions about this focus group, including those about your rights as a member of the study, you may contact the Principal Investigator: Heather Sandstrom (202-261-5833 or HSandstrom@urban.org) or the Institutional Review Board that approved this research: Everett Madden (202–261–5632 or EMadden@urban.org). You may also contact the Federal Project Officer, in the Office of Planning, Research, and Evaluation: Tia Zeno (202-401-5079 or Tia.Zeno@acf.hhs.gov)

Agreement Statement

Do you agree to participate in the Home Visiting Career Trajectories study?

Yes________ No________

Do you agree to have this interview audio recorded?

Yes________ No________

Date of consent:___________________________________________

Name of interviewer (print):___________________________________________________

Participant signature:________________________________________________________________

Participant name (print):__________________________________________________________________

This information collection is voluntary. 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: Urban Institute (Attn: Heather Sandstrom), 2100 M Street, NW, Washington, D.C. 20037

All participants will receive a copy of this consent form for their records.

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Home Visiting Career Trajectories OMB Supporting Documents: Interview Consent Form