Assent form

Attachment 4. Youth Assent Materials

4A. Assent form

4B. Assent script

4A. Assent form

4B. Assent script

OMB NO.: ID# _____________________

EXPIRATION DATE

NSYC Assent Script

INTERVIEWER NAME: ____________________________________

DATE: _____________________________

ASSENT START TIME: __________________AM/PM

Hello: My name is (NAME). Please don’t tell me your last name, but tell me your first name or a nickname I can call you. Before we get started, I’d like to ask you a few quick questions.

First, what is your date of birth? __________________________

COMPARE DATE TO STATUS REPORT. RECONCILE, IF NEEDED.

1. Why do you think I asked to see you? IF DK GO TO Q3.

2. (IF RESPONDENT SAYS A “STUDY”) What do you think the study is about?

3. Are other people in this place talking about who I am and what I am doing here? (IF YES) What are they saying?

GIVE THE YOUTH THE OFFICE COPY OF THE ASSENT FORM AND ENCOURAGE HIM/HER TO READ ALONG WHILE YOU INTRODUCE THE STUDY.

I work for a research firm named Westat outside of Washington, DC and…We are doing a special study for the U.S. Department of Justice to find out more about what it’s like for young people living in places like this. The study is called the National Survey of Youth in Custody.

The government will use the study to see if there needs to be changes in places like this. We will combine the answers that people from this place give into one report. No names will appear in the report and it won’t say anything about who said what.

We’re asking people in every state in the country to be part of this study and we would like you to be part of the study. If you agree to be part of the study, you’ll answer some questions using this computer.

• Answering the questions takes about 30 minutes.

• You will be asked questions about what it is like living at the facility, including questions about the staff, other youth who live in the facility, and some of the health services you might have used.

• You might be asked questions about alcohol and drug use before you came here. Or you might be asked about sexual experiences, including those that might have happened in this facility.

• The computer will randomly decide which questions you are asked; it has nothing to do with why you are at this place or what you might have told someone.

• Answering is easy. You’ll see the questions on the screen and hear the questions in the headphones. You touch the computer screen to answer the questions.

• Nobody, not even me, will know which questions you get or what you answer.

Before I go on, let me make sure that what I’m telling you makes sense. Based on what I’ve said so far…

4. Do you think I will be asking you the questions or do you think the questions will be asked by the computer?

INTERVIEWER  1

COMPUTER  2

5. Do you think I will decide which questions to ask you or do you think the computer will decide?

INTERVIEWER  1

COMPUTER  2

6. Do you believe that anyone, even me, will know which questions you are asked or what you answer?

YES  1

NO  2

PROBE AS NEEDED TO FIND OUT THE SOURCE OF ANY CONFUSION. CLARIFY AS NEEDED.

Ok, that’s good. Is it ok if we keep going?

• You don’t have to do this study. It’s entirely up to you. No matter what you decide, your case will not be affected in anyway. You can start the interview and then decide to quit at any time. Just tell me that you want to stop and I’ll tell you what to do. If you want to skip a question, that’s ok too.

7. Now, if someone asked you whether you had to do the interview or whether it was voluntary, what would you say?

HAD TO DO IT  1

VOLUNTARY  2

PROBE AS NEEDED TO FIND OUT THE SOURCE OF ANY CONFUSION. CLARIFY AS NEEDED.

And these paragraphs are very important.

• Everyone working on this project is required by law to protect your privacy. Your answers will always be kept private. I will not ask your name and you will not be asked to put your name in the computer. No one on the project or on staff here will ever know your answers.

• There is one important exception to this privacy rule. If you tell me that you or anyone else has been abused or neglected, I will report it to the government agency that investigates these reports.

• So again, if you answer on the computer, even if it is about being abused or neglected, no one will know your answer, not even me. But, if you tell me directly that you or anyone else has been abused or neglected, I will report it to the government agency that investigates these reports.

Just so I’m absolutely sure you understand this…

8. If you tell me that you or anyone else has been abused or neglected, will I have to report it to a government agency?

YES  1

NO  2

9. If you answer on the computer that you or anyone else has been abused or neglected, will I have to report it to a government agency?

YES  1

NO  2

• If thinking about the questions upsets you or makes you sad, I can arrange for to you to talk with a counselor who works here. If you don’t want to talk to a counselor who works here, I can arrange for you to talk with a counselor who does not work here. Just let me know.

If you have any questions, you can ask me anytime while I’m here. After I leave,

• If you have any questions about your rights as a study participant, you can call Carol Haines (1-800-937-8281). She works for the same company that I work for.

• If you have questions about how the study works, call the National Survey of Youth in Custody at Westat (1-866-YOUTH-66) or (1-866-968-8466).

So that’s it. I hope that you’ll be willing to take part in this important study. No matter what experiences you have had, your answers will help us understand what it’s like for young people in places like this.

IF THE YOUTH UNDERSTANDS THE ASSENT CONCEPTS AND AGREES TO PARTICIPATE, BEGIN INTERVIEW.

IF THE YOUTH UNDERSTANDS THE ASSENT CONCEPTS AND REFUSES TO PARTICIPATE, THANK YOUTH AND CODE REFUSAL.

IF YOUTH DOES NOT UNDERSTAND ASSENT CONCEPTS, ACTIVIATE INTERVIEWER SMS AND SELECT THE FACILITY/UNIT. GO TO THE “UPDATE YOUTH DISPOSITION” SCREEN, ENTER THE YOUTH ID, AND SAY…

Now, I’m going to enter your number into the computer. The computer will decide what questions you will be asked or if you will be asked any questions at all.

DISPOSITION CODE 205 AND SAY…

According to the computer, you do not have to answer anymore questions. But I really appreciate that you took the time to help us.

COMPLETE A NIRF AND DETAIL THE ISSUES.

ASSENT END TIME: __________________AM/PM