GONA_Youth_Supporting

Attachment 4 – Key informant GONA Participant – Youth Supporting
Documents
Document A.6: GONA Youth Focus Groups Caregiver Consent
Document A.7: GONA Youth Focus Groups Youth Assent

Evaluation of the Native Aspirations Project
Document A.6: GONA Evaluation – Youth Follow-up Focus Groups
Caregiver Consent
Purpose of the Study
The Substance Abuse and Mental Health Services Administration (SAMHSA) in the United States
Department of Health and Human Services is studying the Native Aspirations Project. American Indian and
Alaska Native tribes across the United States and its Territories have received funding to decrease risks
that contribute to suicide, bullying, school violence among youth and to increase factors that are linked to
the healthy and safe development of children and their families. On behalf of SAMHSA, Macro
International Inc. is holding focus groups with youth who attended the Gathering of Native Americans
(GONA) meeting in order to help SAMHSA better understand the experience and impact of the GONA, and
the impact of the Native Aspirations program on the community
Description of Participation
We have asked your child to participate because of his/her attendance at the GONA. In the focus group
we will ask your child about his/her thoughts and experiences at the GONA as well as get his/her
impressions of the impact of the GONA on your community. Participants may be asked sensitive
questions, including questions about family relationships, suicide, and violence. The group will last about
60-90 minutes.
Risks and Benefits
There are no direct benefits to your child for participating in this discussion group, but s/he is helping to
build better programs for tribal communities. Risks are considered to be minimal and include the
possibility that your child will feel uncomfortable or emotional when answering questions. If a participant
expresses feeling suicidal, homicidal, or emotional distress, the interviewer will refer the participant to a
mental health professional for assistance.
Compensation
If you agree to your child’s participation in this discussion group, s/he will receive a $20 incentive.
Payment will be made to your child upon the completion of the discussion group.
Confidentiality
All responses will be treated confidentially. We will be taking notes during the focus group about what was
said, but we will not link responses to your child’s identity. The interview will be audiotaped by the
researchers unless your child requests not to be audiotaped. The tape will be in the sole possession of the
researchers and will be destroyed at the end of the project. At the end of the study, we will erase the
tapes and throw them away. Your child can choose to participate without being audiotaped. Your child’s
name and answers to these questions will be kept private. To protect your child’s privacy, we will keep the
records and tapes in locked files and only study staff will be allowed to use them. Your child’s name will
not be used in any reports about this study. Only authorized people will have access to the information
your child provides.
Native Aspirations: Evaluation of GONA

Youth Focus Group

9.4.2008

In addition, to help protect the information that your child gives us, we have obtained a Certificate of
Confidentiality from the United States Department of Health and Human Services (DHHS). The Certificate
of Confidentiality will protect the members of the research staff from being forced, even under a
subpoena, to release any information in which your child is identified. Exceptions to the Certificate of
Confidentiality are information on child abuse and neglect, or information regarding imminent danger to
themselves or others, which we will report to the appropriate local and state agency. Additionally, DHHS
may see your child’s information if we are audited. Finally, the Certificate of Confidentiality does not imply
the endorsement or the disapproval of the Department of Health and Human Services.
Rights Regarding Participation
I understand that I or my child will not be in trouble if I do not want my child to be a part of this discussion
group or if I or my child decides to quit after it has started. My child does not have to answer questions
that s/he does not want to answer. If I change my mind about my child’s participation, or if my child
changes her/his mind and quits, all of my child’s answers to questions will be destroyed, if that is what I
want. No one will say that I or my child can’t be in other projects because I don’t want my child to be in
this study or my child does not want to be in this study.
Contact information
If you have any concerns about your child’s participation in this focus group or have any questions about
the evaluation, please contact Christine Walrath at [email protected] or you may call her
collect (646-695-8154) or contact Kara Riehman at [email protected] or you may
call her collect at (404-592-2148).
Caregiver Consent
By signing my name below, I freely agree to allow my child to participate in this discussion and for the
discussion group to be audio-recorded. I have read this form or it has been read to me. I understand what
it says. I have been asked if I have any questions and my questions (if any) have been answered.
I, ______________________________________, have read the above, or it has been read to me. My child
may participate. (Caregiver/Guardian)
Guardian’s Signature: _________________________

Date:

_________________

THANK YOU

Native Aspirations: Evaluation of GONA

Youth Focus Group

9.4.2008

Evaluation of the Native Aspirations Project
Document A.7: GONA Evaluation – Youth Follow-up Focus Groups
Youth Assent
Purpose of the Study
The Substance Abuse and Mental Health Services Administration (SAMHSA) in the United States
Department of Health and Human Services is studying the Native Aspirations Project. American Indian and
Alaska Native tribes across the United States and its Territories have received funding to decrease risks
that contribute to suicide, bullying, school violence among youth and to increase factors that are linked to
the healthy and safe development of children and their families. On behalf of SAMHSA, Macro
International Inc. is holding focus groups with youth who attended a Gathering of Native Americans
(GONA) meeting in order to help SAMHSA better understand the experience and impact of the GONA, and
the impact of the Native Aspirations program on the community
Description of the Focus Group
We are asking you to be part of this focus group because you attended the GONA. We will ask you about
what you did at the GONA, how you felt about it, and if you think it will help your community. You may be
asked sensitive questions, including questions about family relationships, suicide, and violence. The group
will last about 60-90 minutes.
Risks and Benefits
There are no direct benefits to you for participating in this discussion group, but you are helping to build
better programs for tribal communities. Risks may include feeling uncomfortable or emotional when
answering questions. If anyone in the discussion group says they feel like they want to hurt themselves or
someone else or gets upset by being part of the group, the interviewer will refer them to a mental health
professional on-site for immediate assistance.
Payment
If you agree to participate in this discussion group, you will receive a $20 incentive. Payment will be made
to you upon completion of the discussion group.
Confidentiality
All responses will be treated confidentially. We will be taking notes during the focus group about what was
said, but we will not link responses to your identity. The focus group will be audio taped by the
researchers unless you request not to be audiotaped. The tape will be in the sole possession of the
researchers and will be destroyed at the end of the project. At the end of the study, we will erase the
tapes and throw them away. You can choose to participate without being audiotaped. Your name and
answers to these questions will be kept private. To protect your privacy, we will keep the records and
tapes in locked files and only study staff will be allowed to use them. Your name will not be used in any
reports about this study. Only authorized people will have access to the information you provide.
In addition, to help protect the information that you give us, we have obtained a Certificate of
Confidentiality from the United States Department of Health and Human Services (DHHS). The Certificate
Native Aspirations Evaluation

GONA Youth Focus Group – Youth Assent

9.4.2008

of Confidentiality will protect the members of the research staff from being forced, even under a
subpoena, to release any information in which you are identified. Exceptions to the Certificate of
Confidentiality are information on child abuse and neglect, or information regarding imminent danger to
yourself or others, which we will report to the appropriate local and state agency. Additionally, DHHS may
see your information if we are audited. Finally, the Certificate of Confidentiality does not imply the
endorsement or the disapproval of the Department of Health and Human Services.
Contact information
If you have any concerns about your participation in this discussion group or have any questions about the
evaluation, please contact Christine Walrath at [email protected] or you may call her
collect (646-695-8154) or contact Kara Riehman at [email protected] or you may
call her collect at (404-592-2148).
Rights Regarding Participation
I understand that I will not be in trouble if I do not want to be a part of this focus group or if I decide to
quit after it has started. I do not have to answer questions that I do not want to answer. If I change my
mind and quit, all of my answers to questions will be destroyed, if that is what I want. No one will say that
I can’t be in other projects because I don’t want to be in this study.
Voluntary Assent
I read this form or it has been read to me. I understand what it says. My questions (if any) have been
answered. A copy of this form will be given to me. By signing my name below, I freely agree to be in the
project.
______ Please check here if you are willing to have the interview audiotaped.

Print your name:

_________________________

Date:

__________________

Signature:

_________________________

Witness: __________________

THANK YOU

Native Aspirations Evaluation

GONA Youth Focus Group – Youth Assent

9.4.2008