Form Screening Protocol Screening Protocol Screening Protocol

Attachment A

Focus Groups for Revised Contact Materials –

Participant Recruitment and Screening Protocol

OMB No. 0930-0290

Expiration Date: 03/31/2011

Public Burden Statement: 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.  The OMB control number for this project is 0930-0290.  Public reporting burden for this collection of information is estimated to average 5 minutes per respondent per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 7-1044, Rockville, Maryland, 20857.

Date/Time of Call ___________________

Hello, this is [NAME] calling from RTI International. (Were you calling about the ad?)

Let me tell you a little about the study. The purpose of the study is to improve the contact materials, such as letters and brochures, which are used in a large national survey. The Substance Abuse and Mental Health Services Administration has hired us to conduct the survey and we are working with them to improve the existing contact materials. We are trying to find people who are interested in helping us by providing their opinions about the materials we want to test. If you are interested and eligible, we would like you to come to a small discussion group that will take about 1 ½ to 2 hours. At the end of the discussion, you will receive $75 in cash in appreciation for your time. To make sure you are eligible for the study, I need to ask you some questions. This will only take about 5 minutes. (Is this a good time?)

[RECORD CANDIDATE’S RESPONSES ON PAPER SCREENING ROSTER.]

1. [RECORD GENDER.] (IF NECESSARY, ASK: ­ Are you male or female?)

1 FEMALE

2 MALE

2. How did you hear about the study?

1 FROM CRAIG’S LIST

2 FROM THE NEWSPAPER

3 FROM A FLYER

4 FROM A FRIEND OR FAMILY MEMBER

5 COMMUNITY ORGANIZATION: ____________

6 SOME OTHER METHOD ___________________

3. And how old are you?

[CHECKPOINT 1: IF CALLER IS UNDER 18, (S)HE IS INELIGIBLE. THANK R AND TERMINATE CALL.]

[CHECKPOINT 2: IF THE QUOTA FOR THIS AGE GROUP IS NOT FILLED, CONTINUE WITH Q4.]

[IF THE QUOTA FOR THE CALLER’S AGE GROUP IS FILLED, THANK AND TERMINATE CALL.]

[CODE AGE RANGE BELOW]

1 18-29

2 30-49

3 50+

4. Are you of Hispanic, Latino, or Spanish origin?

1 YES → CONTINUE

2 NO → GO TO Q6

5. Are you Mexican, Puerto Rican, Cuban, Central or South American, or some other Hispanic, Latino or Spanish origin?

1 Mexican

2 Puerto Rican

3 Cuban, Central or South American

4 Or some other Hispanic, Latino, or Spanish Origin

6. Are you White, Black or African American, American Indian or Alaskan Native, Asian, Native Hawaiian or Other Pacific Islander, or Some other race?

[CAN SELECT MORE THAN 1 RESPONSE.]

1 White

2 Black or African American

3 American Indian or Alaskan Native

4 Asian

5 Native Hawaiian or other Pacific Islander

6 Other

7. What is the highest level of education you have completed?

1 Less than high school

2 High school graduate, including GED

3 Technical or vocational school (attended or graduated) or some college

4 College graduate, including postgraduate degree

8. What was your household’s total income, from all sources, during the past 12 months?

Was it …

1 Less than $50,000

2 More than $50,000 but less than $100,000

3 More than $100,000

9. In what city or town do you live?________________ [TO ASSURE PERSON IS WITHIN DRIVING DISTANCE TO FACILITY]

10. Would you describe where you live as urban, suburban or rural?

1 URBAN

2 SUBURBAN

3 RURAL

11. What is your ZIP code? _________________ [TO GET CENSUS INCOME DATA IF INCOME IS NOT PROVIDED]

[CHECKPOINT 3: IF SCREENER IS IN ENGLISH ASK Q12 AND Q13;

IF SCREENER IS IN SPANISH, GO TO CHECKPOINT 4]

12. Do you speak English as your native (primary) language?

1 YES

2 NO [THANK AND TERMINATE]

13. Can you read English?

1 YES [GO TO CHECKPOINT 4]

2 NO [THANK AND TERMINATE]

[CHECKPOINT 4: IF SCREENER IS IN ENGLISH, GO TO CHECKPOINT 5]

IF SCREENER IS IN SPANISH, CONTINUE WITH Q14-18]

14. Do you speak Spanish as your native (primary) language?

1 YES

2 NO [THANK AND TERMINATE]

15. Can you read Spanish?

1 YES

2 NO [THANK AND TERMINATE]

16. Do you speak English?
1 YES

2 NO [GO TO CHECKPOINT 5]

17. Would you say you speak English …?
1 VERY WELL
2 WELL, OR
3 NOT WELL

18. Would you say you read Spanish…?

1 VERY WELL
2 WELL
3 NOT WELL, OR
4 NOT AT ALL

[CHECKPOINT 5: REFER TO RECRUITMENT GRID. IF THE LIMIT IS REACHED FOR THE CALLER’S AGE GROUP, THANK AND COLLECT PHONE NUMBER TO PUT ON THE WAITING LIST]

[IF ELIGIBLE FOR ONE OF THE GROUPS, CONTINUE]:

You are eligible to participate in our focus group! Taking part in the focus group is voluntary. It will be conducted at [our office/NAME OF FOCUS GROUP FACILITY] in [CITY]. Any remarks from the discussion will remain confidential. As such, we will not share information you give us with anyone other than project staff. We will audio and video record the focus group to help us write a summary report about the findings, but the recordings will be destroyed once we complete our report.

Would you like to take part in the focus group?

1 YES [SCHEDULE FOR GROUP, PROVIDE DATE, TIME, DIRECTIONS]

2 NO [THANK AND TERMINATE CALL]