School Associated Violent Deaths Surveillance System

Attachment 9

Telephone Consent Script

Telephone Script for Obtaining Consent Prior to Interviewing a School or Law Enforcement Official:

Hello, my name is ___________________ and I’m with the Division of Violence Prevention at the Centers for Disease Control and Prevention in Atlanta, Georgia. We are working with the United States Department of Education and Justice, to complete a study that involves research of suicides and homicides that occur in and around schools. This is not a criminal investigation. The purpose of this study is to identify the common features of these events and to estimate the level of risk for violent death that occurs in or around schools.

The interview will take approximately 1 hour and your participation is voluntary. You are free to decline to be interviewed or to terminate the interview at any time. If you do so, there will be no loss to you or anyone you associate with. All of the data we collect will be safeguarded against disclosure by removing all personal identifiers, restricting access to the data, and storing the information in a secure area. Your identity will not be revealed in any published report of the study findings--nor will the identities of the victims, alleged offenders, their schools, nor their communities. You may decide that you are unable or unwilling to answer some of the questions asked of you. If so, you have the right refuse to answer any question or terminate the interview at any time you wish. In order to maintain confidentiality, it is important that you do not identify yourself, the school involved, or any other individuals involved in this event.

While there are no obvious risks for you in assisting us with this study, answering some of the questions may make you uneasy. But as we said, you can tell us if there are questions that you do not want to answer.

There will be no direct benefit for you, your family members or for the school if you agree to help us with this study. But assisting us with this study may tell us a lot about why murders and suicide happen in schools.

You should understand that there is no cost to you for helping us with this study. At the same time, you will not be paid for helping with this study.

All identifiable information that CDC gathers in this study will be kept confidential. This is assured under Section 308(d) of the Public Health Service Act (42 U.S.C. 242 m(d)). The Confidentiality Assurance under this law protects the privacy of people and organizations taking part in this study. It keeps their names and other facts that can identify them from anyone who is not on the study staff. We may only give out information provided for this study if we receive written consent from those providing the information. Only CDC will have data that can identify you.

NOTE: Participants should have been given a copy of the formal 308(d) Assurance of Confidentiality Statement prior to the interview.

You should have received a copy of the formal 308(d) Assurance of Confidentiality Statement that summarizes this information. Did you receive a copy of this statement?

If they did not receive a copy, ask if they would like to be sent a copy prior to being interviewed.

Do you have any questions about it?

Do you understand this information?

The questions are grouped into four sections: in the first and second sections, you will be asked a series of questions about the school involved and about the event itself. You will then be asked questions about the victims involved. In the final section, you will be asked about any offenders that might have been involved. If you wish more information about the purpose of the study or particular questions, please ask the interviewer. Some of the questions might seem repetitive; we hope that you will understand the importance of getting complete information for each item. Your assistance is very important so that we can get accurate information about each incident.

Please do not consult official student records when answering these questions.

Do you have any questions before we start the interview?

If, at a later date, you have any questions about the study, contact Dr. Mark Anderson at 1-800-447-4784, extension 498-0821, and leave a message. We will return your call as soon as possible.

If you have questions about your rights in the study, contact Dr. Deborah Holtzman, head of CDC’s Human Subject Office, at 1-800-584-8814 and leave a message. Your call will be returned as soon as possible.

With your permission I would like to begin the interview at this time. May we begin?

Thank You.

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