Parental Consent Form

Appendix A-1

AGREEMENT TO TAKE PART IN THE EHS STUDY

You are invited to take part in an important study of Early Head Start (EHS). The study will examine how well EHS programs help children by using developmentally focused curriculum and help parents by setting goals and providing referrals that may enhance self-sufficiency (for example, referrals to services that may help parents find and keep jobs). A research company called MDRC is doing the study with funding from the federal government.

Currently, there are more eligible families who want to access EHS services than there are available program slots. Therefore, families will be chosen to participate in EHS through a process called random assignment. Random assignment is like picking names out of a hat. The decision about who goes to which program has nothing to do with personal traits like your age, race, or background. Random assignment is considered a fair way to choose who will receive program services when there are not enough slots to serve all eligible families.

Who is being invited to be in the study?

The EHS study will include families who apply for EHS services, are determined eligible to receive EHS services, and agree to take part in the study by signing this form. The study will include families who are chosen to receive EHS services and those that are not. Even if you are not chosen to receive EHS services, you will eventually be able to enroll your child in Head Start when your child is old enough and if you meet other eligibility criteria. Refusal to participate in the study does not mean that you will not be randomly assigned, but it does mean that we will not collect information about you. If you decide that you do not want to be involved in the random assignment process, you can choose to withdraw your application for EHS services.

What does it mean to be in the study?

If you agree to be in the study, MDRC will collect several kinds of data about you to help understand how well EHS programs are working:

• EHS program records. EHS will give MDRC information about your participation in the program, including the types of services you access, and will share the information you provide during an assessment interview today.

• Interviews. During the study, you will be contacted several times by a survey firm so that they can ask questions about your education, work, family, and your children. Interviewers will also ask your permission to conduct assessments directly with your children. Participation in these efforts is completely voluntary and your decision to participate will not affect any program services you are eligible to receive. If you decide to participate, you will receive a gift certificate to thank you for your time. You can refuse to answer any question on the survey.

• Other data. If you agree to be in the study, MDRC will use your social security number and other identifiers to collect data from government agencies. We will collect data about such things as your quarterly earnings in jobs covered by unemployment insurance, new jobs you start, and your child’s welfare records. These data will be collected for up to five years.

All data that MDRC collects will be used only for the study and related research. All of the information will be kept private to the extent allowed by law and MDRC will not share individually identifiable data about you with government agencies. Ethical and legal obligations put some limits on the researchers’ ability to maintain your confidentiality. If we learn that keeping information confidential would put you or someone else we know about in serious danger, then we will have to tell the appropriate agencies to protect you or the other person.

Any paper information that includes your name will be kept in a locked storage area, and any computer files with your name will be protected by a password. Your name will never appear in any public document produced as part of the study.

What are the benefits and risks of being in the study?

By participating in the study, you will help EHS and other programs around the country learn about the best way to help parents and children. The study involves very little risk. You can refuse to answer any question that is asked, and you do not have to do anything to help MDRC obtain the other data mentioned above.

Participation in the research study is voluntary

Participation in the research study is voluntary. However, as discussed above, the only way to enroll into EHS is through the random assignment process. You may withdraw from the research study at any time. Refusing to be in the research study or withdrawing from the research study later will not affect your eligibility for any services at EHS or elsewhere. If you withdraw, MDRC may continue to use information that was collected about you during the period you were in the research study.

Effective Dates

This agreement is effective from the date you sign it (shown below) until the end of the study.

Statement

“I have read this form and agree for me and my child to be in the EHS study. I know that my participation is voluntary and that all information about me will be kept private to the extent allowed by law. I know that I can refuse to answer any questions in the study’s interviews, or stop being in the study at any time without penalty. I also know that I can refuse to have my child participate in the study. I understand that MDRC will get information about me and my child from EHS and government agencies, as described above.”

________________________________ ________________________

Study Participant Child’s Name Printed SSN

________________________________ ________________________

Signature of Child’s Legal Parent or Guardian Date

________________________________ ________________________

Study Participant Name Printed SSN

(Primary parent/guardian)

________________________________ ________________________

Signature of Study Participant Date

(Primary parent/guardian)

Two-parent families please complete the following.

________________________________ ________________________

Study Participant Name Printed SSN

(Other parent/guardian)

________________________________ ________________________

Signature of Study Participant Date

(Other parent/guardian)

If you have questions about the study, please contact Pamela Morris, MDRC Senior Research Associate, or David Butler, MDRC Vice-President, at 212-532-3200. If you have questions about EHS’s programs, ask a member of the EHS staff.

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