QCCIIT - All Appendices

Q-CCIIT SSA and SSB Appendices Combined 7.6.18.pdf

Professional Development Tools to Improve the Quality of Infant and Toddler Care (Q-CCIIT PD Tools) Project

QCCIIT - All Appendices

OMB: 0970-0513

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APPENDICES

TABLE OF CONTENTS
A. Research questions and sources ........................................................................................... A.1
B. 60 day federal register notice ................................................................................................. B.1
C. Mathematica confidentiality pledge ........................................................................................C.1
D. Study recruitment materials ....................................................................................................D.1
D.1

State or network informant letter................................................................................D.1.3

D.2

State or network informant email ...............................................................................D.2.3

D.3

Caregiver advance letter ............................................................................................D.3.3

D.4

Center director advance letter ...................................................................................D.4.3

D.5

PD Provider advance letter ........................................................................................D.5.3

D.6

Q-CCIIT recruitment flyer ...........................................................................................D.6.3

D.7

Q-CCIIT trifold recruitment brochure .........................................................................D.7.3

E. Study participant consent forms ............................................................................................. E.1
E.1

Study participant consent form - caregiver ................................................................ E.1.3

E.2

Study participant consent form - PD provider ............................................................ E.2.3

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APPENDIX A
RESEARCH QUESTIONS AND SOURCES

This page has been left blank for double sided copying.

APPENDIX A: RESEARCH QUESTIONS AND SOURCES

Research questions

Constructs

Measures*

Study Instrument

1. Can We Grow Together be used effectively by early childhood professionals to support improvement in caregivers’ interactions with infants and
toddlers? [Primary/Secondary]
a. Is five months’ implementation of
We Grow Together associated
with change in the quality of
caregiver-child interactions, as
measured by Q-CCIIT instrument
scores (fall to spring)? [Primary]

•

Quality of caregiver-child
interactions:
- Support for social-emotional
development
- Support for language and
literacy development
- Support for cognitive
development
- Areas of concern

Q-CCIIT Observation (Atkins-Burnett
et al. 2015)

Q-CCIIT observational measure (fall
2018 and spring 2019)

b. Is five months’ implementation of
We Grow Together associated
with change in caregivers’ and PD
providers’ beliefs and knowledge
about child development and
caregiving (fall to spring)?
[Primary]

•

Knowledge and beliefs about child
development

Background survey (Caregiver, PD
provider): Sections B and D

•

Knowledge of and beliefs about
caregiving

Original (developed for this study)
*Modified Knowledge of Infant
Development Inventory (MacPhee
1981)
*Baby FACES Teacher Survey 2018

Original
*LA Advance Early Educator Survey
2016
*UPCOS-5 Teacher Interview
*National Center for Research on
Early Childhood Education Teacher
Interview (NCRECE) (Pianta et al.
2016)

Background survey (PD provider):
Questions H2 and I6

c. Does the PD Provider perceive
change in his or her own practice
after PD providers’ training and
five months’ implementation of We
Grow Together? [Primary]

•

Change in beliefs about PD and
use of PD strategies

A.3

Feedback survey (Caregiver, PD
provider): Sections A and C

Feedback survey (PD provider):
Questions B2 and K1

APPENDIX A: RESEARCH QUESTIONS AND SOURCES

Research questions
d.1. Do answers to these primary
questions differ by subgroups
(caregivers and PD providers
associated with FCCs versus
center-based settings)? [Primary]

d.2 How are answers to these primary
questions associated with
characteristics of caregivers and
providers (for example,
demographicsa, FCC/classroom
characteristicsb, caregiver mental
healthc, PD provider experience
and beliefs)? [Secondary]

Constructs
•

•

Measures*

Includes all constructs in RQ1
analyzed by respondent type
(e.g., caregivers and PD providers
associated with FCCs or centerbased settings)

Includes all constructs in RQ1
analyzed by relations to
characteristics of caregivers and
PD providers (for example,
demographicsa, FCC/classroom
characteristicsb, caregiver mental
healthc, PD provider experience
and beliefs)

Study Instrument

Original
*Q-CCIIT Caregiver SAQ, 2012
*LA Advance Administrator Survey
2016
*UPCOS-5 Teacher Interview
*Baby FACES Teacher Survey 2018
*SCOPE Coach Survey
*Teacher Opinion Survey (TOS;
Geller and Lynch, 1999)
*Teachers’ Attitudes About
Professional Development (Torff et al.
2005)
Center for Epidemiologic Studies
Depression Scale (CES-D – short
form; Radloff, 1977)
Kessler-6 (K-6: Kessler et al. 2003;
Kessler et al. 2010)

Background survey (Caregiver, PD
provider): Sections B, D, L and
Questions H1, I6

Original
*Q-CCIIT Caregiver SAQ, 2012
*LA Advance Administrator Survey
2016
*UPCOS-5 Teacher Interview
*Baby FACES Teacher Survey 2018
*SCOPE Coach Survey
*Teacher Opinion Survey (TOS;
Geller and Lynch, 1999)
*Teachers’ Attitudes About
Professional Development (Torff et al.
2005)
Center for Epidemiologic Studies
Depression Scale (CES-D – short
form; Radloff, 1977)
Kessler-6 (K-6: Kessler et al. 2003;
Kessler et al. 2010)
Stages of Change (Peterson and
Weber, 2010)

Background survey (Caregiver, PD
provider): Sections B, C, D, L and
Questions H1, I6

A.4

Feedback survey (Caregiver, PD
provider): Sections A, C, B1 and
Question K1
Q-CCIIT observational measure

Feedback survey (Caregiver, PD
provider): Sections A, C, B1 and
Question K1
Q-CCIIT observational measure

APPENDIX A: RESEARCH QUESTIONS AND SOURCES

Research questions

Constructs

e. Does the caregiver perceive
change in his or her own practice
after five months’ implementation
of We Grow Together?
[Secondary]

•

f. Does the caregiver report other
changes after participating in We
Grow Together? [Secondary–
exploratory]

•

Awareness of and access to
resources

•

Administrative and collegial
support

•

Change in self-efficacy

•

Attitudes about professional
development

Self-reported change

Measures*
Original

Study Instrument
Background survey (Caregiver):
Question J3
Feedback survey (Caregiver): Section
E 2, H1

Original
Q-CCIIT Caregiver SAQ, 2012
LA Advance Administrator Survey
2016
*Teacher Opinion Survey (Geller and
Lynch, 1999)
*Teachers’ Attitudes About
Professional Development (Torff et al.
2005)

A.5

Background survey (Caregiver):
Sections F, G, L5
Feedback survey (Caregiver):
Sections B, D, E1, G

APPENDIX A: RESEARCH QUESTIONS AND SOURCES

Research questions

Constructs

Measures*

Study Instrument

2. What tools and support are required for early childhood professionals to use the responsive caregiving principles covered by We Grow Together
to improve caregiver-child interactions? [Primary/Secondary]
a. How frequently do caregivers and
PD providers make use of We
Grow Together over the
implementation period, and which
tools did they access? [Primary]

•

Frequency of PD tools accessed

•

Average time spent with practices

•

Number of times self-videorecorded

•

Number of meetings

Original
LA Advance Early Educator Survey
2016

Website user data and
implementation data collection
(Caregiver, PD provider)
Pop-up survey (Caregiver, PD
provider)
Feedback survey I1-2, G1
(Caregiver); I5, K (PD provider)

•

Length of meetings

•

Dosage: average time spent per
week working on PD in and
outside of classroom

b. How do caregivers and PD
providers engage with the
technological components of We
Grow Together (that is, usability of
the website, accessing the website
and tools within it, using the
tablets)? [Primary]

•

Access to and ease of use of
website tools, website, video
recording experience

Original
*Administrator Technology Survey
(Burris 2014)
*Perceived Website Usability Items
(Wang and Senecal 2007)
*Computer System Usability
Questionnaire (CSUQ, Lewis 1995)

Background survey Section K
(Caregiver, PD provider)
Feedback survey Questions F1, F2,
F2a, F3, F4, F4_1 (Caregiver, PD
provider)
Website user data and
implementation data collection
(Caregiver, PD provider)

c. Are participants satisfied with We
Grow Together (tool types,
content)? [Primary]

•

Satisfaction with website tools,
activities, resources, and content

Original
*UPCOS-5 Teacher Interview
*LA Advance Early Educator Survey
2016
*NCRECE Teacher Interview (Pianta
et al. 2016)

Feedback survey Questions F10,
F11, F12, F13, F14, F14_1 thru
F14_9, F18 , and G2 (Caregiver, PD
provider)

d. Are participants satisfied with the
We Grow Together process (goal
setting, action planning, practice
and observation, reflection,
feedback, trusting relationship)?
[Primary]

•

Caregiver satisfaction with PD
process/strategies

•

PD satisfaction with supports for
PD strategies

Feedback survey Questions F5, F6,
F7, F8, F9, F12, F15, F16, F17, and
H1 (Caregiver, PD provider)

•

Relationship satisfaction

Original
*Baby FACES Teacher Survey 2018
*SCOPE Coach Survey
*UPCOS-5 Teacher Interview
**NCRECE Teacher Interview (Pianta
et al. 2016

A.6

APPENDIX A: RESEARCH QUESTIONS AND SOURCES

Research questions

Constructs

Measures*

Study Instrument

e. What are challenges and barriers
to We Grow Together
implementation in infant/toddler
settings? [Primary]

•

Challenges and barriers
encountered

Original
*UPCOS-5 Teacher Interview
*ASPIRE Participant Year-End
Survey 2013-2014
*LA Advance Early Educator Survey
2016

Feedback survey Section I3, I4, I5
(Caregiver, PD provider)
Website user data and
implementation data collection
(Caregiver, PD provider)

f.1 Do answers to any of these
questions differ by subgroups
(caregivers and PD providers
associated with FCC versus
center-based settings) [Primary]

•

Includes all constructs in RQ2
analyzed by respondent type
(caregivers and PD providers
associated with FCCs or centerbased settings)

Original
*Q-CCIIT Caregiver SAQ, 2012
*LA Advance Administrator Survey
2016
*UPCOS-5 Teacher Interview
*Baby FACES Teacher Survey 2018
*SCOPE Coach Survey
*TOS (Geller and Lynch, 1999)
*Teachers’ Attitudes About
Professional Development (Torff et al.
2005)
CES-D – short form; Radloff, 1977)
Kessler-6 (K-6: Kessler et al. 2003;
Kessler et al. 2010)

Feedback survey Section F, G, H,
and I3, I4, I5 (Caregiver, PD provider)
Background survey Section K
(Caregiver, PD provider)
Website user data and
implementation data collection
(Caregiver, PD provider)

A.7

APPENDIX A: RESEARCH QUESTIONS AND SOURCES

Research questions
f.2. How are answers to these
primary questions associated with
characteristics of caregivers and
providers (for example,
demographics, FCC/classroom
characteristics, caregiver mental
healthc, PD provider experience
and beliefs)? [Secondary]

Constructs
•

Includes all constructs in RQ2 and
analyzed in relation to
characteristics of caregivers and
providers (for example,
demographics, FCC/classroom
characteristics, caregiver mental
healthc, PD provider experience
and beliefs)?

Measures*

Study Instrument

Original
*Q-CCIIT Caregiver SAQ, 2012
*LA Advance Administrator Survey
2016
*UPCOS-5 Teacher Interview
*Baby FACES Teacher Survey 2018
*SCOPE Coach Survey
*TOS (Geller and Lynch, 1999)
*Teachers’ Attitudes About
Professional Development (Torff et al.
2005)
CES-D – short form; Radloff, 1977)
Kessler-6 (K-6: Kessler et al. 2003;
Kessler et al. 2010)

Feedback survey Section F, G, H,
and I3, I4, I5 (Caregiver, PD provider)
Background survey Section C , L
(Caregiver); Section H, K (Caregiver,
PD provider)
Website user data and
implementation data collection
(Caregiver, PD provider)

Stages of Change (Peterson and
Weber, 2010)
3. Does the Q-CCIIT reliably assess improvements in caregiver-child interactions in different types of care settings serving infants and toddlers?
[Secondary]
a. What is the inter-rater reliability of
the Q-CCIIT measure?
[Secondary]

•

Rater reliability

Q-CCIIT Observation (Atkins-Burnett
et al. 2015)

Q-CCIIT observational measure

b. Does the Q-CCIIT factor structure
hold with a new sample?
[Secondary]

•

Construct validity

Q-CCIIT Observation (Atkins-Burnett
et al. 2015)

Q-CCIIT observational measure

c. Does the measure demonstrate
sensitivity to intervention?
[Secondary]

•

Change in observed interaction
quality

•

Association with self-reported
change

Q-CCIIT Observation (Atkins-Burnett
et al. 2015)
Original

Q-CCIIT observational measure(fall
2018 and spring 2019)
Feedback survey Section E
(Caregiver)

a Demographics

includes cultural and linguistic diversity, education, experience in infant-toddler care, technology literacy
FCC/Classroom characteristics include the ages of children, proportion of male children, group size, adult-child ratio, philosophy and curriculum, support from
administrators and other staff
c Caregiver’s mental health includes the caregiver’s report of self-efficacy, symptoms of anxiety and depression, and openness to change
b

A.8

APPENDIX B
60-DAY FEDERAL REGISTER NOTICE

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382

Federal Register / Vol. 83, No. 2 / Wednesday, January 3, 2018 / Notices
ANNUAL BURDEN ESTIMATES
Total
number of
respondents

sradovich on DSK3GMQ082PROD with NOTICES

Guide for Recruitment with PHA and PCWA Administrators ....................................................................................
Guide to Develop an Evaluation Plan for PCWA FUP
Management .....................................................................
Guide to Develop an Evaluation Plan for PHA FUP Management ............................................................................
Guide for Implementation Study for PCWA Management ..
Guide for Implementation Study for PHA Management ......
Guide for Implementation Study for Referral Provider Administrators .......................................................................
Guide for Implementation Study with PCWA FUP Management (First) .......................................................................
Guide for Implementation Study for PHA FUP Management ..................................................................................
Guide for Implementation Study Focus Groups with Frontline Workers .....................................................................
Guide for Implementation Study Focus Groups with PHA
Frontline Workers .............................................................
Guide for Implementation Study for PCWA FUP Management (Follow Up) ..............................................................
Guide for Implementation Study for Service Provider Management ............................................................................
Referral Form .......................................................................
Randomization Tool .............................................................
Housing Assistance Questionnaire ......................................
Ongoing Services Questionnaire .........................................
Dashboard ............................................................................
Administrative Data List .......................................................

Estimated Total Annual Burden
Hours: 460.
In compliance with the requirements
of Section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the
Administration for Children and
Families is soliciting public comment
on the specific aspects of the
information collection described above.
Copies of the proposed collection of
information can be obtained and
comments may be forwarded by writing
to the Administration for Children and
Families, Office of Planning, Research
and Evaluation, 330 C St SW,
Washington, DC 20201, Attn: OPRE
Reports Clearance Officer. Email
address: OPREinfocollection@
acf.hhs.gov. All requests should be
identified by the title of the information
collection.
The Department specifically requests
comments on (a) whether the proposed
collection of information is necessary
for the proper performance of the
functions of the agency, including
whether the information shall have
practical utility; (b) the accuracy of the
agency’s estimate of the burden of the
proposed collection of information; (c)
the quality, utility, and clarity of the
information to be collected; and (d)
ways to minimize the burden of the
collection of information on

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Number of
responses
per
respondent

Annual
number of
respondents

7

1

1.00

7

10

4

1

1.00

4

10
10
10

4
4
4

1
1
1

1.00
1.00
1.00

4
4
4

4

2

1

1.00

2

10

4

1

1.00

4

10

4

1

1.00

4

320

107

1

1.50

161

30

10

1

1.50

15

10

4

1

1.00

4

8
200
10
200
200
20
30

3
67
4
67
67
7
10

1
6
106
3
3
27
2

1.00
0.17
0.02
0.09
0.09
0.17
5.00

3
68
8
18
18
32
100

Mary Jones,
ACF/OPRE Certifying Officer.
[FR Doc. 2017–28374 Filed 1–2–18; 8:45 am]
BILLING CODE 4184–25–P

DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Administration for Children and
Families
Proposed Information Collection
Activity; Comment Request
Title: Study of We Grow Together:
The Q–CCIIT Professional Development
System.
OMB No.: New Collection
Description: The Administration for
Children and Families (ACF) at the U.S.
Department of Health and Human
Services (HHS) seeks approval to
conduct a field test of We Grow
Together, a system of professional
development supports including webbased resources and exercises to be used
by caregivers/teachers, with the help of
professional development providers, to

Frm 00041

Fmt 4703

Annual
burden
hours

20

respondents, including through the use
of automated collection techniques or
other forms of information technology.
Consideration will be given to
comments and suggestions submitted
within 60 days of this publication.

PO 00000

Average
burden hour
per
response

Sfmt 4703

improve the quality of infant and
toddler care. The study team has
developed We Grow Together: The Q–
CCIIT Professional Development System
based on the research literature to
support caregiver-child interactions in
care settings serving infants and
toddlers. This field test is designed to
(1) examine changes associated with use
of the We Grow Together system and (2)
examine implementation and
participant experiences with the We
Grow Together system. As a secondary
goal, ACF will also further evaluate the
properties of the Q–CCIIT observational
measure. Ultimately, findings from the
field test will provide information about
the experiences of professional
development providers (PD providers)
and caregivers with the We Grow
Together system so that ACF can
improve the system to make the
resources as accessible as possible for
infant-toddler caregivers.
Prior to using the We Grow Together
system, PD providers will complete a
web-based training survey and all
participants will complete a web-based
background survey. Periodically during
the field test, website users will be
asked at log-on to respond to a series of
web-based questions. After system
implementation, participants will
complete a web-based feedback survey.

E:\FR\FM\03JAN1.SGM

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383

Federal Register / Vol. 83, No. 2 / Wednesday, January 3, 2018 / Notices
The study team will also collect
classroom rosters from caregivers before
and after the field test.

Respondents: Early care and
education (ECE) setting representatives
(e.g., directors or owners), caregivers (in

center-based and family child care
settings), and professional development
providers (e.g., coaches).

ANNUAL BURDEN ESTIMATES
Total/annual
number of
respondents

Instrument

sradovich on DSK3GMQ082PROD with NOTICES

ECE setting eligibility screener ........................................................................
Caregiver background survey ..........................................................................
PD provider background survey ......................................................................
Caregiver We Grow Together website user data pop-up questions ...............
PD provider We Grow Together website user pop-up questions ...................
Caregiver feedback survey ..............................................................................
PD provider feedback survey ..........................................................................
Classroom roster .............................................................................................
PD provider training survey .............................................................................

Estimated Total Annual Burden
Hours: 1,402.
In compliance with the requirements
of Section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the
Administration for Children and
Families is soliciting public comment
on the specific aspects of the
information collection described above.
Copies of the proposed collection of
information can be obtained and
comments may be forwarded by writing
to the Administration for Children and
Families, Office of Planning, Research,
and Evaluation, 330 C Street SW,
Washington, DC 20201, Attn: OPRE
Reports Clearance Officer. Email
address: OPREinfocollection@
acf.hhs.gov. All requests should be
identified by the title of the information
collection.
The Department specifically requests
comments on (a) whether the proposed
collection of information is necessary
for the proper performance of the
functions of the agency, including
whether the information shall have
practical utility; (b) the accuracy of the
agency’s estimate of the burden of the
proposed collection of information; (c)
the quality, utility, and clarity of the
information to be collected; and (d)
ways to minimize the burden of the
collection of information on
respondents, including through the use
of automated collection techniques or
other forms of information technology.
Consideration will be given to
comments and suggestions submitted
within 60 days of this publication.
Mary Jones,
ACF/OPRE Certifying Officer.
[FR Doc. 2017–28375 Filed 1–2–18; 8:45 am]
BILLING CODE 4184–22–P

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300
175
300
175
300
175
300
175

DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Food and Drug Administration
[Docket No. FDA–2017–D–6759]

Establishing Effectiveness for Drugs
Intended To Treat Male
Hypogonadotropic Hypogonadism
Attributed to Non-Structural Disorders;
Draft Guidance for Industry;
Availability
AGENCY:

Food and Drug Administration,

HHS.
ACTION:

Notice of availability.

The Food and Drug
Administration (FDA or Agency) is
announcing the availability of a draft
guidance for industry entitled
‘‘Establishing Effectiveness for Drugs
Intended to Treat Male
Hypogonadotropic Hypogonadism
Attributed to Non-Structural Disorders.’’
This draft guidance provides key design
considerations, including
recommendations for patient enrollment
criteria and efficacy endpoints, for
clinical trials to establish effectiveness
for drugs intended to treat male
hypogonadotropic hypogonadism
associated with obesity and other
conditions that do not cause intrinsic
damage to the hypothalamus or
pituitary gland. This draft guidance is
consistent with recommendations FDA
received at the December 2014 advisory
committee meeting on the appropriate
indicated population for testosterone
replacement therapy, and the December
2016 advisory committee meeting on
hypogonadotropic hypogonadism.
DATES: Submit either electronic or
written comments on the draft guidance
by March 5, 2018 to ensure that the
Agency considers your comment on this
draft guidance before it begins work on
the final version of the guidance.
SUMMARY:

PO 00000

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Number of
responses per
respondent
1
1
1
6
5
1
1
2
1

Average
burden hours
per response
.25
.75
.50
.17
.10
1.0
.75
.08
.17

Annual burden
hours
186
225
88
306
88
300
131
48
30

You may submit comments
on any guidance at any time as follows:

ADDRESSES:

Electronic Submissions
Submit electronic comments in the
following way:
• Federal eRulemaking Portal:
https://www.regulations.gov. Follow the
instructions for submitting comments.
Comments submitted electronically,
including attachments, to https://
www.regulations.gov will be posted to
the docket unchanged. Because your
comment will be made public, you are
solely responsible for ensuring that your
comment does not include any
confidential information that you or a
third party may not wish to be posted,
such as medical information, your or
anyone else’s Social Security number, or
confidential business information, such
as a manufacturing process. Please note
that if you include your name, contact
information, or other information that
identifies you in the body of your
comments, that information will be
posted on https://www.regulations.gov.
• If you want to submit a comment
with confidential information that you
do not wish to be made available to the
public, submit the comment as a
written/paper submission and in the
manner detailed (see ‘‘Written/Paper
Submissions’’ and ‘‘Instructions’’).
Written/Paper Submissions
Submit written/paper submissions as
follows:
• Mail/Hand delivery/Courier (for
written/paper submissions): Dockets
Management Staff (HFA–305), Food and
Drug Administration, 5630 Fishers
Lane, Rm. 1061, Rockville, MD 20852.
• For written/paper comments
submitted to the Dockets Management
Staff, FDA will post your comment, as
well as any attachments, except for
information submitted, marked and

E:\FR\FM\03JAN1.SGM

03JAN1

APPENDIX C
MATHEMATICA CONFIDENTIALITY PLEDGE

This page has been left blank for double sided copying.

APPENDIX C: MATHEMATICA CONFIDENTIALITY PLEDGE

CONFIDENTIALITY PLEDGE

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I agree to promptly notify the cognizant Mathematica Project Director or Project Manager, the Survey
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Name:

Signature:
Date:

C.3

Revised April 2013

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APPENDIX D
STUDY RECRUITMENT MATERIALS

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APPENDIX D1: STATE OR NETWORK INFORMANT LETTER

330 C Street, S.W., Washington, DC 20201 | www.acf.hhs.gov

[DATE]

Dear [STATE/NETWORK CONTACT NAME],
Your assistance is requested for an important study of We Grow Together: The Q-CCIIT
Professional Development System. The We Grow Together study is sponsored by the Administration
for Children and Families in the U.S. Department of Health and Human Services and is being conducted
by Mathematica Policy Research, a nationally recognized, nonpartisan research organization. We Grow
Together includes a website that houses various materials, videos, classroom exercises and aids that are
designed to support individual child care providers who work with infants and toddlers. It also includes
supports for professional development providers (e.g., coaches, technical assistance specialists, mentors)
who work with caregivers (teachers of infants and toddlers in center-based care or in family child care
homes). Findings from the study will inform improvements to the professional development tools to help
caregivers support infant and toddler development.
To ensure that these professional development resources are tested across the full range of care
settings, we are hoping to recruit a diverse set of child care providers serving infants and toddlers in
centers and family child care homes to participate in this field test. I am hoping you can help us identify
potential providers in [FILL AREA] that Mathematica could invite to participate. This contact
information will only be used for recruitment efforts for We Grow Together, and participation in the
study is completely voluntary and all information you share will remain private to the extent permitted
by law. The Administration for Children and Families, including the Office of Child Care and the Office
of Head Start, fully supports this endeavor and encourages the participation of early child care programs
and their local PD providers. Mathematica will contact you to provide more details on the project and to
answer any questions you might have.
On behalf of the Administration for Children and Families, I thank you in advance for your help. Should
you have any concerns regarding the study, please feel free to contact me 202-401-5506 at the Office of
Planning, Research, and Evaluation; Administration for Children and Families; U.S. Department of
Health and Human Services.
Sincerely,
Ann Rivera, Project Officer
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection
displays a valid OMB control number. The valid OMB control number for this information collection is 0970-XXXX and the expiration date is
XX/XX/XXXX.

D1.3

This page has been left blank for double-sided copying.

APPENDIX D2: STATE OR NETWORK INFORMANT EMAIL

WE GROW TOGETHER: THE Q-CCIIT PROFESSIONAL DEVELOPMENT SYSTEM
STATE OR NETWORK INFORMANT EMAIL
Subject Line: ACF study of We Grow Together: The Q-CCIIT Professional Development System

Dear [STATE/NETWORK CONTACT NAME],
Your assistance is requested for an important study of We Grow Together: The Q-CCIIT Professional
Development System. The We Grow Together study is sponsored by the Administration for Children and
Families in the U.S. Department of Health and Human Services and is being conducted by Mathematica
Policy Research, a nationally recognized, nonpartisan research organization. We Grow Together includes
a website that houses various materials, videos, classroom exercises and aids that are designed to support
individual caregivers (teachers and child care providers) who work with infants and toddlers. We Grow
Together also provides supports for the professional development providers (e.g., coaches, technical
assistance specialists, mentors) who work with infant-toddler caregivers in center-based care or in family
child care homes. Findings from the study will inform improvements to We Grow Together and related
efforts to help caregivers support infant and toddler development.
Mathematica will be recruiting caregivers serving infants and toddlers in centers and family child care
homes nationwide to use We Grow Together over the 2018/2019 program year. Additional information
about the study is attached to this email.
We would greatly appreciate your help to identify potential early child care providers in your area that
Mathematica could contact to see if they are interested in participating in this study. This list will only be
used for recruitment in the We Grow Together study, and participation in the study is completely
voluntary. All information you share will remain private to the extent permitted by law.
Mathematica will contact you in a few days to provide more details about We Grow Together and to
answer any questions you might have. If you would like to speak with someone before then, please
contact us by phone toll-free at 844-934-7692 (844-WEGROW2) or by email at
wegrowtogetherstudy@mathematica-mpr.com.
Thanks in advance for your help with this important study!
Sincerely,
FILL NAME

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such
collection displays a valid OMB control number. The valid OMB control number for this information collection is 0970-XXXX and
the expiration date is XX/XX/XXXX.

D.2.3

This page has been left blank for double-sided copying.

Mathematica Policy Research
1100 1st Street, NE 12th Floor
Washington, DC 20002-4221
Telephone (202) 484-9220
Fax (202) 863-1763
www.mathematica-mpr.com

Timothy Bruursema
Survey Director

Dear [CAREGIVER NAME or / Early Childhood Caregiver],
I am pleased to invite you to be part of an important study of We Grow Together: The Q-CCIIT
Professional Development System. We Grow Together includes resources that are designed to help
caregivers (teachers in center-based care or in family child care homes) like you serving infants and
toddlers.
We would like to invite you to use We Grow Together with your professional development provider
(for example, coach, technical assistance specialist, mentor) and participate in an important study sponsored
by the Administration for Children and Families in the U.S. Department of Health and Human Services.
Mathematica Policy Research, a nationally recognized research organization is conducting the study.
Findings will inform improvements to We Grow Together and related efforts to help caregivers support
infant and toddler development. Additional information about We Grow Together can be found on the other
side of this letter.
Participating in this study includes:
1.

Allowing observers to conduct two observations in your classroom (center-based classroom or
family child care home). One observation will be conducted in fall 2018 and one in spring 2019.
On the day of the observation, we will ask you to fill out a 5-minute questionnaire about your
classroom.

2.

Working with your own professional development provider to use We Grow Together for
approximately five months. All materials are available online and the study will provide you with
an iPad mini, tripod, and case so you can access the resources and also video-record and reflect on
your interactions with children as you implement key practices (see the next page for more details).

3.

Completing a 30-minute web-based survey about your background (for example, education and
experience, knowledge about child development and caregiving, and professional development
beliefs and experiences) in fall 2018.

4.

Complete a 60-minute web-based survey about your experiences using We Grow Together.

If you wish to participate or if you have any questions, please feel free to call Timothy Bruursema by
phone at 800-XXX-XXXX or by email at xxxxxxxx@mathematica-mpr.com. Thank you in advance for
your time and consideration.
Sincerely,

The We Grow Together modules are research-based and focus on supporting children’s language
development, social-emotional development, or cognitive development. Each module explores several key
practices.
We Grow Together includes the following:
•

Brief presentations: Short narrated presentations will introduce the key
practices that caregivers can use when interacting with infants and
toddlers to support their development.

•

Handouts: The handouts are 1- to 2-page documents that provide a
summary of key practices. You could share these with colleagues or
families to help the entire caregiving team work together in supporting
children with these practices.

•

Step-by-step guides and checklists: These guides and checklists can be
used to help you track how you are using a new practice or changing a
current practice.

•

Brief videos of caregivers implementing practices: Our video library
shows caregivers using these practices in their everyday care to support
children’s development. We encourage you to think about how the
caregivers implement these practices and how you can apply the strategies
to your practice.

•

Activities and self-refection exercises: These exercises encourage you to
think about the key practices and consider ways to change or improve
practice.

•

Classroom supports: These supports include handouts, posters, and key
rings that provide ongoing reminders of new practices.

•

Progress chart: These visuals help you track children’s progress in
response to the practices.

This page has been left blank for double-sided copying.

APPENDIX D4: CENTER DIRECTOR ADVANCE LETTER

Mathematica Policy Research
1100 1st Street, NE 12th Floor
Washington, DC 20002-4221
Telephone (202) 484-9220
Fax (202) 863-1763
www.mathematica-mpr.com

Timothy Bruursema
Survey Director

[MONTH, YEAR]
[Center’s Name]
[Address 1
Address 2]
[City, State Zip]
Dear [CENTER DIRECTOR NAME/ Center Director]:
I am pleased to invite your child care setting (center-based early care and education settings or
family child care homes) to be part of an important study of We Grow Together: The Q-CCIIT
Professional Development System. We Grow Together is a website that houses a collection of
materials, videos, classroom exercises, and aids that are designed to support caregivers (teachers of
infants and toddlers in center-based care or in family child care homes) and their professional
development providers (e.g., coaches, technical assistance providers, mentors) improve care provided
to infants and toddlers.
Study participants will access We Grow Together on a website during the 2018/2019 program
year. Training will be provided for professional development providers to use We Grow Together in
their work with participating caregivers. We will also provide caregivers with an iPad mini so they
can easily access We Grow Together online and use the iPad to video-record and reflect on their
interactions with children. Additional information about the study is provided in the brochure
included with this letter.
The study of We Grow Together is sponsored by the Administration for Children and Families
in the U.S. Department of Health and Human Services and is being conducted by Mathematica
Policy Research, an independent policy research organization. Findings from this study will inform
improvements to We Grow Together and related efforts to help caregivers support infant and toddler
development. Additional information about We Grow Together can be found on the other side of this
letter.
A We Grow Together site coordinator will call you soon to discuss the project, answer any
questions you might have, and assess whether you have a caregiver and professional development
provider who may be interested and eligible to participate. Participation in the study is completely
voluntary and all information you share will remain private to the extent permitted by law. If you
have any questions in the meantime, please feel free to contact me, either by email at
wegrowtogetherstudy@mathematica-mpr.com or by phone toll-free at 844-934-7692
(844-WEGROW2). For more information about Mathematica Policy Research, please visit our
website at http://www.mathematica-mpr.com. I thank you in advance for your role in this important
study.
Sincerely,

D.4.3

An Affirmative Action/Equal Opportunity Employer

APPENDIX D4: CENTER DIRECTOR ADVANCE LETTER

The We Grow Together modules are research-based and focus on supporting children’s
language development, cognitive development, or social-emotional development. Each module
focuses on several key practices. We Grow Together allows for individualization of the
professional development for each caregiver, with different materials in the module available for
each key practice. Caregivers and professional development providers select a key practice goal
and prepare a plan for how to work toward that key practice goal. As caregivers make progress,
additional key practices might be added and plans updated.
We Grow Together includes the following:
•

Brief presentations: Short narrated presentations will introduce the key
practices that caregivers can use when interacting with infants and
toddlers to support their development.

•

Handouts: The handouts are 1- to 2-page documents that provide a
summary of key practices. Caregivers could share these handouts with
colleagues or families to help the entire caregiving team work together in
supporting children with these practices.

•

Step-by-step guides and checklists: These guides and checklists can be
used to help caregivers track how they are using a new practice or
changing a practice.

•

Brief videos of caregivers implementing practices: Our video library
shows caregivers using these practices in their everyday care to support
children’s development.

•

Activities and self-refection exercises: These exercises encourage
caregivers to think about the key practices and consider ways to change or
improve practice.

•

Classroom supports: These supports include handouts, posters, and key
rings that serve as ongoing reminders of new practices that caregivers can
try throughout the day.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such
collection displays a valid OMB control number. The valid OMB control number for this information collection is 0970-XXXX and
the expiration date is XX/XX/XXXX.

D.4.4

APPENDIX D5: PD PROVIDER ADVANCE LETTER

Mathematica Policy Research
1100 1st Street, NE 12th Floor
Washington, DC 20002-4221
Telephone (202) 484-9220
Fax (202) 863-1763
www.mathematica-mpr.com

Timothy Bruursema
Survey Director

Dear [PD PROVIDER NAME/ Professional Development Provider],
I am pleased to invite you to be part of an important study of We Grow Together: The Q-CCIIT
Professional Development System. We Grow Together is a website that houses various materials, videos,
classroom exercises and aids that are designed to support professional development providers (e.g., coaches,
technical assistance specialists, mentors) like you who work with caregivers (teachers in center-based care
or in family child care homes) serving infants and toddlers.
We would like to invite you to use We Grow Together with one or two of the caregivers you work
with and participate in an important study sponsored by the Administration for Children and Families in
the U.S. Department of Health and Human Services. Mathematica Policy Research, a nationally recognized,
nonpartisan research organization, is conducting the study. Findings will inform improvements to We Grow
Together and related efforts to help caregivers support infant and toddler development. Additional
information about We Grow Together can be found on the other side of this letter.
All participating professional development providers will:
1. Receive training to learn about We Grow Together in fall 2018. Training modules will be available
on the We Grow Together website. The training will take approximately 3 hours a week over four
weeks (12 hours total), and will include three webinars to allow for discussion of the training
materials. Each training module can be completed at a flexible time and pace over the course of a
given week.
2. Complete a 30-minute web-based survey about your background (for example, education and
experience, knowledge about child development and caregiving, and professional development
beliefs and experiences) in fall 2018.
3. Work with 1 or 2 caregivers using the We Grow Together for approximately five months;
4. Complete a 45-minute web-based survey about your experiences with We Grow Together.
Participation in the study is completely voluntary and all information you share will remain private to
the extent permitted by law. If you would like to participate or if you have any questions, please feel free
to contact Tim Bruursema by phone toll-free at 844-934-7692 (844-WEGROW2) or by email at
wegrowtogetherstudy@mathematica-mpr.com. Thank you in advance for your time and consideration.
Sincerely,

D.5.3

An Affirmative Action/Equal Opportunity Employer

APPENDIX D5: PD PROVIDER ADVANCE LETTER

The We Grow Together modules are research-based and focus on supporting children’s language
development, cognitive development, or social-emotional development. Each module focuses on several
key practices. We Grow Together allows for individualization of the professional development for each
caregiver, with different materials in the module available for each key practice. Caregivers and
professional development providers select a key practice goal and develop a plan for how to work toward
that key practice goal. As caregivers make progress, additional key practices may be added and plans
updated.
We Grow Together includes:
•

Brief presentations: Short narrated presentations will introduce the key
practices that caregivers can use when interacting with infants and
toddlers to support their development.

•

Handouts: The handouts are 1- to 2-page documents that provide a
summary of key practices. Caregivers could share these handouts with
colleagues or families to help the entire caregiving team work together in
supporting children with these practices.

•

Step-by-step guides and checklists: These guides and checklists can be
used to help caregivers track how they are using a new practice or
changing a practice.

•

Brief videos of caregivers implementing practices: Our video library
shows caregivers using these practices in their everyday care to support
children’s development. We encourage caregivers to consider how other
caregivers implement these practices and how caregivers might apply
these strategies to their own practice.

•

Activities and self-refection exercises: These exercises encourage
caregivers to think about the key practices and consider ways to change or
improve practice.

•

Classroom supports: These supports include handouts, posters, and key
rings that serve as ongoing reminders of new practices that caregivers can
use throughout the day.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such
collection displays a valid OMB control number. The valid OMB control number for this information collection is 0970-XXXX and
the expiration date is XX/XX/XXXX.

D.5.4

Participate in the study of We Grow Together

We Grow Together helps early childhood caregivers (teachers working in centerbased care or in family child care homes) support infant and toddler cognitive,
language, and socio-emotional development. Caregivers work with their professional
development providers (e.g., coaches, technical assistance providers, or mentors) on
web-based materials that include brief presentations, handouts, step-by-step guides,
checklists, self-reflection exercises, and a variety of other supports.
We are looking for early childhood caregivers of infants and toddlers (less than 36
months old) and their professional development providers to use We Grow Together
over the 2018/2019 program year. Participating caregivers will be provided with an
iPad mini to access and use the online resources.

Participation in We Grow
Together involves:

•	 Caregivers will be provided with an
iPad mini, tripod and iPad case to
facilitate participation.

•	 Use of We Grow Together for about
five months during the 2018/2019
program year for approximately 1.5
hours a week

What are the benefits of
participating?

•	 Two online surveys: once in fall 2018
and once in spring 2019
•	 Caregivers will be observed at the
early childhood classroom (centerbased classroom or family child care
home) once in fall 2018 and once in
spring 2019.
•	 Professional development providers will
attend an online training (approximately
12 hours) over four weeks to learn how
to support caregivers’ use of the We
Grow Together online resources.

•	 The opportunity to learn about
evidence-based practices for
supporting infants’ and toddlers’
development and improve caregiving
practices.
•	 Participation will help us improve We
Grow Together and help caregivers
support the development of infants
and toddlers in the future.

The We Grow Together study will give us important information on how to help
programs and staff deliver high-quality services that promote positive outcomes for
young children.
Mathematica Policy Research and its partners are conducting the We Grow Together
study for the Administration for Children and Families in the U.S. Department of
Health and Human Services. Mathematica is a nationally recognized, nonpartisan
policy research organization that conducts studies in early childhood care and
education and other public policy areas.
For information about participating in this study, please contact:
Tim Bruursema
Mathematica Policy Research
wegrowtogetherstudy@mathematica-mpr.com
1-844-934-7692 (844-WEGROW2)
According to the Paperwork Reduction Act of 1995, no persons
are required to respond to a collection of information unless such
collection displays a valid OMB control number. The valid OMB
control number for this information collection is 0970-XXXX and
the expiration date is XX/XX/XXXX.

What is We
Grow Together?
We Grow Together is a set
of professional development
materials that help early
childhood caregivers support
infant and toddler cognitive,
language, and socio-emotional
development. Caregivers
(teachers of infants and toddlers
in center-based care or in family
child care homes) work with
their professional development
providers (e.g., coaches, technical
assistance providers, or mentors)
on web-based materials that
include brief presentations,
handouts, step-by-step guides,
checklists, self-reflection
exercises, and a variety of other
supports. The We Grow Together
study will give us important
information on how
to help programs and staff
deliver high-quality services that
promote positive outcomes for
young children.

Who is conducting the
Q-CCIIT PD Tools Study?
Mathematica Policy Research is conducting
the study under contract to the Administration
for Children and Families, U.S. Department of
Health and Human Services. Staff members
working on the Q-CCIIT PD Tools study have
a great deal of experience conducting research
in child care and Early Head Start settings and
have been fully trained for this study.
If you would you would like more
information about We Grow Together,
please contact the survey director,
Timothy Bruursema, at Mathematica, by
phone at 1-844-934-7692 (844-WEGROW2)
or by email at wegrowtogetherstudy@
mathematica-mpr.com.

A Study of We
Grow Together:
The Q-CCIIT
Professional
Development
System

Who will participate in
We Grow Together?

What kind of information will
be collected?

What are the benefits of
participating?

About 300 early childhood caregivers serving
infants and toddlers and their professional
development providers will be invited to
participate. Participation in the study is
completely voluntary.

•	 Information on caregiver-child interactions will
be collected during the observations.

•	 The opportunity to learn about evidence-based
practices for supporting infants’ and toddlers’
development and improve caregiving practices.

What do caregivers and
professional development
providers need to do?
•	 Use We Grow Together for about five
months during the 2018/2019 program year
for approximately 1.5 hours a week
•	 Two online surveys: once in fall 2018 and
once in spring 2019
•	 Caregivers will be observed in their early
childhood classroom (center-based
classroom or family child care home) once
in fall 2018 and once in spring 2019.
•	 Professional development providers will
attend an online training (approximately
12 hours) over four weeks to learn how to
support caregivers’ use of the We Grow
Together online resources.
•	 Caregivers will be provided with an iPad
mini, tripod and iPad case to facilitate
participation.

According to the Paperwork Reduction Act of 1995,
no persons are required to respond to a collection
of information unless such collection displays a
valid OMB control number. The valid OMB control
number for this information collection is 0970XXXX and the expiration date is XX/XX/XXXX.

•	 The first survey will ask about participants’
background (for example, education and
experience, knowledge about child
development and caregiving, and professional
development beliefs and experiences).
•	 The second survey will ask about participants’
experiences using We Grow Together.
•	 Information you share will remain private
to the extent permitted by law. Individual
responses and names will never be
associated with or identified in study reports.

•	 Participation will help us improve We Grow
Together and help caregivers support the
development of infants and toddlers in
the future.

APPENDIX E
STUDY PARTICIPANT CONSENT FORMS

This page has been left blank for double sided copying.

APPENDIX E1: STUDY PARTICIPANT CONSENT FORM - CAREGIVER

A STUDY OF WE GROW TOGETHER: THE Q-CCIIT PROFESSIONAL DEVELOPMENT SYSTEM

CAREGIVER CONSENT FORM
What is the purpose of the
research study?

We Grow Together helps early childhood caregivers (teachers of infants
and toddlers in center-based care or in family child care homes) support
the development of children between birth and age three. This study will
help us to improve We Grow Together in its effort to support caregivers in
their interactions with infants and toddlers.

Who is being invited to
participate in the research
study?

This study will involve 300 pairs of early childhood caregivers and their
local professional development providers. Participation is voluntary; refusal
to participate in the study will not negatively affect your relationship with
your program. Even if you agree to participate in the study, you may
withdraw at any time.

When will the research
study be conducted?

The study activities will take place between summer 2018 and spring 2019.

What will be asked of staff
who agree to participate?

If you agree to participate, we will ask you to (1) allow us to observe your
classroom (center-based classroom or family child care home) for
approximately 3 hours and complete a brief paper-and-pencil classroom
roster in fall 2018 and spring 2019. The observation will help personalize
your experience with We Grow Together by suggesting modules that will
help you the most; (2) complete a 45-minute web-based survey about your
background in fall 2018; (3) work with your professional development
provider and use We Grow Together materials for approximately 1.5 hours
per week for about five months (the materials are available online). You will
also be provided with an iPad mini, tripod and iPad case to facilitate
participation; and (4) complete a 60-minute web-based survey about your
experiences using We Grow Together in spring 2019. All the information
we collect will be used for research and educational purposes only.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such
collection displays a valid OMB control number. The valid OMB control number for this information collection is 0970-XXXX and the
expiration date is XX/XX/XXXX.

E.1.3

Approved by HML IRB on 12/12/17

APPENDIX E1: STUDY PARTICIPANT CONSENT FORM - CAREGIVER

Who is conducting the
research study?

Mathematica Policy Research and its partners are conducting the study
for the Administration for Children and Families in the U.S. Department of
Health and Human Services. Mathematica is a nationally recognized,
nonpartisan policy research organization that conducts studies in early
childhood education and other public policy areas.
Additional information about Mathematica is available online at
http://www.mathematica-mpr.com.

How will Mathematica
protect the privacy of
research study
participants?

Mathematica is committed to respecting the privacy of everyone who
contributes to this study. A code number will be used on all information
we collect from you so that you cannot be identified. If you agree to take
part in the study, all information you share will remain private to the extent
permitted by law. No one from your program will see or hear your
individual responses, and your name will never be associated with or
identified in study reports. The information we get will be used for
research and educational purposes to make We Grow Together better.
We have a Certificate of Confidentiality from the National Institutes of
Health. The Certificate helps us protect your privacy. This means no one
can force the study team to give out information that identifies you, even
in court. However, we may need to share your information if it shows a
serious threat to you or to others, including reporting to authorities when
required by law. The United States government may still request
information for an audit.

How can I get more
information about the
research study?

If you have any questions or would like more information about the study,
please contact Tim Bruursema at Mathematica by phone toll-free at 844934-7692 (844-WEGROW2) or by email at
wegrowtogetherstudy@mathematica-mpr.com.

Please read the following statements, check the appropriate box, and complete the bottom section.
 Yes, I wish to participate in this study. I agree to allow an observer to observe my classroom once
in fall 2018 and again in spring 2019. As part of each observation, I will complete a short classroom
roster form. I will work with my professional development provider and use We Grow Together tools
and materials for approximately five months. I will complete a background survey at the start of the
study and a feedback survey at the end of the study. I may withdraw this consent at any time.
I have read this form and have received a copy for my records.
 No, I do not wish to participate in this study.
I have read this form and have received a copy for my records.
Printed Name ___________________________________________________________________
Signature _______________________________________________________________________
Date __________________________________________________________________________

E.1.4

APPENDIX E2: STUDY PARTICIPANT CONSENT FORM – PD PROVIDER

A STUDY OF WE GROW TOGETHER: THE Q-CCIIT PROFESSIONAL DEVELOPMENT SYSTEM

PROFESSIONAL DEVELOPMENT PROVIDER CONSENT FORM
What is the purpose of
the research study?

We Grow Together helps early childhood caregivers (teachers of infants
and toddlers in center-based care or in family child care homes) support
the development of children between birth and age three. This study will
help us to improve We Grow Together in its effort to support caregivers in
their interactions with infants and toddlers.

Who is being invited to
participate in the
research study?

This study will involve 300 pairs of early childhood caregivers and local
professional development providers. Participation is voluntary; refusal to
participate in the study will not negatively affect your relationship with
your program. Even if you agree to participate in the study, you may
withdraw at any time.

When will the research
study be conducted?

The study activities will take place between summer 2018 and spring
2019.

What will be asked of
staff who agree to
participate?

If you agree to participate, we will ask you to (1) participate in a
professional development provider training to learn about We Grow
Together and to support caregivers’ use of the system. The training will
take place in fall 2018 and will include online modules and webinars; (2)
complete a 30-minute web-based survey about your background in fall
2018; (3) work with one or two caregivers and support their use of We
Grow Together materials for approximately five months (the materials are
available online); and (4) complete a 45-minute web-based survey about
your experiences working with the system. All the information we collect
will be used for research and educational purposes only.

Who is conducting the
research study?

Mathematica Policy Research and its partners are conducting the study
for the Administration for Children and Families in the U.S. Department of
Health and Human Services. Mathematica is a nationally recognized,
nonpartisan policy research organization that conducts studies in early
childhood education and other public policy areas.
Additional information about Mathematica is available online at
http://www.mathematica-mpr.com.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such
collection displays a valid OMB control number. The valid OMB control number for this information collection is 0970-XXXX and the
expiration date is XX/XX/XXXX.

E.2.3

Approved by HLM IRB on 12/12/17

APPENDIX E2: STUDY PARTICIPANT CONSENT FORM – PD PROVIDER

How will Mathematica
protect the privacy of
research study
participants?

Mathematica is committed to respecting the privacy of everyone who
contributes to this study. A code number will be used on all information we
collect from you so that you cannot be identified. If you agree to take part
in the study, all information you share will remain private to the extent
permitted by law. No one from your program will see or hear your
individual responses, and your name will never be associated with or
identified in study reports. The information we get will be used for research
and educational purposes to make We Grow Together better.
We have a Certificate of Confidentiality from the National Institutes of
Health. The Certificate helps us protect your privacy. This means no one
can force the study team to give out information that identifies you, even in
court. However, we may need to share your information if it shows a
serious threat to you or to others, including reporting to authorities when
required by law. The United States government may still request
information for an audit.

How can I get more
information about the
research study?

If you have any questions or would like more information about the study,
please contact Tim Bruursema at Mathematica by phone toll-free at 844934-7692 (844-WEGROW2) or by email at
wegrowtogetherstudy@mathematica-mpr.com.

Please read the following statements, check the appropriate box, and complete the bottom section.
 Yes, I wish to participate in this study. I agree to complete the online professional development
provider training. I will work with an early childhood caregiver(s) to support their use of the Q-CCIIT
PD Tools and materials for approximately five months. I will complete a survey at the start of the study
and at the end of the study. I may withdraw this consent at any time.
I have read this form and have received a copy for my records.
 No, I do not wish to participate in this study.
I have read this form and have received a copy for my records.
Printed Name ___________________________________________________________________
Signature _______________________________________________________________________
Date __________________________________________________________________________

E.2.4


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AuthorAyesha De Mond
File Modified2018-07-06
File Created2018-02-22

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