[Researcher: “Before we begin, I want to tell you a few things about this study and your participation in it. Please feel free to ask me any questions you might have”. Researcher reads through form, and shares a copy with each participant. “In front of you is a consent form. It covers a lot of what I have just covered including the fact that this is entirely voluntary, your contributions will be kept private, you will receive your $50 gift even if you decide to leave and this conversation will be recorded if you agree to that (and will be destroyed once we have cleaned our notes). Does anyone have any questions about this? And if you consent to participate, please take a moment to sign the form now.”]
PARENT CONSENT FORM
Acknowledgment of Voluntary Participation and Audio Recording
A team of researchers from the Urban Institute, a non-profit research organization in Washington DC, is working with the U.S. Department of Health and Human Services, Administration for Children and Families (ACF) to see if services provided by child welfare agencies are working.
We would like to invite you to participate in a/an [focus group/interview] that will last about [60/90] minutes.
Before we get started, there are several important things for you to understand:
We will use what we learn today and from other interviews and discussion groups to contribute to a public report describing the outcomes of our evaluation and people’s experiences receiving services. Our report will describe people’s experiences in general and will not identify you personally. If you choose to participate today, your input may help shape policies, programs, or services going forward.
We will keep the information you provide private and will not share it with anyone except for research staff working on the study. This includes anything that can identify you such as your full name, address, or telephone number. Information is never repeated with the name of a participant in any reports or in any discussions with program staff or anyone else. When we write our report and discuss our findings, information from all the people we speak with is combined and presented so that no one person can be identified. Everyone on the Urban Institute team who works on this study has signed a document stating we will not reveal any of your personal information and can be severely penalized if we do. The only exception is if you tell us about your intention to harm yourself or someone else. We may be required by law to report this kind of information. In addition, the transcription service who will hear the interviews to transcribe them have also signed a confidentiality pledge.
Everyone who works on this study has signed a confidentiality pledge requiring them not to tell anyone outside the research staff anything you tell us during an interview. The researchers on this study will keep all of the information completely private. Only the people doing the research will see any information that identifies you personally. We will report on the things that you tell us but your name will never be used. We will not report anything that could reveal your identity.
Your participation in this interview is voluntary. You can choose not to answer any question or not participate in the interview at all. There will be no consequences to you if you choose not to participate.
Participating or choosing not to participate in this research will have no effect on your child welfare case or the services you receive.
[FOR FOCUS GROUPS ONLY] We ask that you do not repeat anything heard in this discussion outside the group. We also request that participants do not take screenshots or record the conversation. While the Urban Institute promises to respect your privacy, we must note that your fellow participants may not. We advise you to be mindful in your responses due to the fact that not all participants might follow these guidelines. If possible, please participate in the focus group discussion from a private location where others cannot readily hear the discussion or with headphones if you do not have a private location to respect the privacy of yourself and the others in the discussion.
This research is covered by a Certificate of Confidentiality from the National Institutes of Health. This means that the researchers cannot release or use information that may identify you in any action or suit unless you say it is okay. The Certificate DOES NOT stop reporting that is required by law which includes laws that require reporting of child or elder abuse, some communicable diseases, and threats to harm yourself or others.”
[IF VIRTUAL] If possible, please participate in the discussion from a private location to maintain your privacy of your answers.
[IF IN-PERSON] There are minimal physical risks to you taking part in this study. Since these [focus groups/interviews] are taking place in-person, the research team has taken proper precautions to minimize the risk of COVID-19 infection but cannot eliminate all risk of exposure. All research team members are fully vaccinated and boosted against COVID-19 and have taken COVID-19 tests.]
[if interviewee is masked] To try to make this a comfortable space for everyone, we are wearing masks. Masks are optional for you.
[Only ask the following question if no participants in the group are wearing masks (and if a team member wants the option to unmask as well), otherwise the research team will leave masks on] Would you prefer for us to wear masks during this conversation?
The research team can setup a virtual session for those who are not comfortable or would prefer to not meet in person.
If you agree, we will also record this [interview/focus group] today so that we make sure that we accurately capture the details of everything you tell us. The recording will be used only by the research team and kept on a secure computer drive. Once the project is complete, all recordings will be destroyed. During the discussion, we can also stop the recording if you want to make a particular off-the-record comment. It is okay if you do not wish to be recorded. We will take typed or hand-written notes.
The discussion will last about [an hour/an hour and a half].
You will receive a $50 gift card as a thank you for your time.
While you will not receive any direct benefit for participating in the study, you will be contributing to research that will fill critical gaps in knowledge and help policymakers, practitioners, and advocates understand the full and potentially very valuable impact of services provided for families involved in the child welfare system. The knowledge gained by the study can help inform improvements to services and can further contribute to the growing evidence base for child welfare interventions.
DO YOU HAVE ANY QUESTIONS?
Obtain Written Consent
Based on the information just shared, do you consent to participating in this focus group today?
Yes / No (circle one)
Do we have your permission to record the conversation? [yes/no]
___________________________________________ Signature _______________________________ Date
This information is being collected to inform the evaluation of Project Connect conducted by a research team at the Urban Institute. This information will be used to inform the US Department of Health and Human Services Administration for Children and Families (HHS ACF) to improve the evidence base for programs relevant to the child welfare population. All the information you provide will be kept private to the extent permitted by law.
If you have questions or concerns about the study, please contact:
Michael Pergamit Mark Courtney
Urban Institute The University of Chicago
202-261-5276 773-702-1219
mpergamit@urban.org markc@uchicago.edu
If you agree to participate in this study and feel that your rights have been violated or that you have not been treated fairly, contact:
The Institutional Review Board Administrator
Everett Madden
Urban Institute
500 L’Enfant Plaza SW
Washington, DC 20004
202-261-5632
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Daly, Hannah |
| File Modified | 0000-00-00 |
| File Created | 2023-07-31 |