Attachment 2 - HHMI - Focus Group Consent Form

CONSENT TO PARTICIPATE IN FOCUS GROUP: HISPANIC HEALTHY MARRIAGE INITIATIVE GRANTEE IMPLEMENTATION EVALUATION

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CONSENT TO PARTICIPATE IN FOCUS GROUP: HISPANIC HEALTHY MARRIAGE INITIATIVE GRANTEE IMPLEMENTATION EVALUATION

What is the Hispanic Healthy Marriage Initiative Grantee Implementation Evaluation Study?

Hispanic families and youth are a growing part of the target service population for a range of social service programs, including those aimed at strengthening families. The federally funded Hispanic Healthy Marriage Initiative (HHMI) seeks to identify the unique cultural, linguistic, demographic, and other factors that need to be considered in designing and delivering family strengthening services to Hispanics.

The HHMI Grantee Implementation Evaluation will document and explore lessons about diverse programmatic approaches to improve Hispanic family well-being through healthy marriage education programs. The evaluation will obtain information from approximately nine grantees across the country about the ways in which they are developing, adapting, and implementing culturally relevant and appropriate healthy marriage programs for Hispanic populations. The evaluation will also explore the extent to which grantees are working with partners in the community to provide a range of supportive services to their participants. The U.S. Department of Health and Human Services sponsors the study. The Lewin Group, a national research and evaluation company is conducting the study.

What is a Focus Group?

A focus group is a discussion, guided by a leader who asks questions of a group of people. The evaluation team is conducting focus groups with people like you who have participated in relationship strengthening classes, to learn about your experiences. As part of the group, the leader will ask why you participated and what you thought about the program. The discussion will last about 60-90 minutes. You will not have to answer a question, if you do not want to. You will receive a $20 gift card for participating in the group.

Your Answers will be kept Private

Everything you tell us will be kept private. What you say during the focus group will not be shared with program staff. Additionally, the leader will ask all participants to keep what others say to themselves. Only the evaluation team will have access to the information you share. The evaluation team will not write anything about you as an individual. Your name will not appear in any reports published. In rare cases, information may be released, if required by law. For example, if a person says he or she is abusing a child and the state has laws requiring that child abuse be reported, we will follow the law. We will not videotape focus groups. We will audiotape the group, but the tape will be used only by the evaluation team to verify information gathered during the group and will be destroyed after the study.

Your Participation is Voluntary

You should participate only if you want. If you do not want to be in the focus group, it will not affect your future participation in the program’s services.

Risk of Taking Part in the Study

There are no known risks to you if you take part in this study. You may be asked some personal questions. If any questions make you uncomfortable, you should not answer them.

Signing this form means you have read both pages of this form.

• You agree to participate in the focus group being conducted by the HHMI Grantee Implementation Study evaluation team.

• Your participation will not affect your future role with the program site’s services.

• Everything you share will be kept private. Only the evaluation team will have access to what you share, and it will be used only for the study. Information will only be released if required by law.

If you have questions or concerns about your rights as a participant in this study, you may contact the study director at The Lewin Group, Karen Gardiner ([email protected]), for any questions you may have about the study.

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Name of Participant (Print)

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Signature of Participant

Date __________________________________

REMINDER: Ask each participant to sign two copies of the consent form. One is for the participant to keep and one is for the evaluation files.

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Name of Person Obtaining Consent (Print)

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Signature of Person Obtaining Consent

Date __________________________________