Attachment E.
Lead Letter to Parents
Parent Consent and Student Assent Forms
[RTI Letterhead]
[DATE]
Dear PARENT NAME:
Thanks for your interest in the research study your teen’s school is taking part in to learn about preventing youth violence, including violence between teen dating couples. The study is sponsored by the Centers for Disease Control and Prevention (CDC) and will be conducted by RTI International, a not-for-profit research organization in Durham, North Carolina. As part of the study, RTI would like to conduct student focus groups about experiences with the Safe Dates adolescent dating violence prevention program and ideas for how to adapt the program for schools in cities. The focus groups will take place this summer. Your teen was selected for participation in a focus group because he or she received the Safe Dates Program at school during the 2008-2009 school year and because we value your teen’s opinion.
Participation will involve a 90-minute focus group at [LOCATION]. Each teen who participates will receive a $25 gift card incentive.
The attached permission form asks your permission for your teen to participate in a focus group.
Please complete the enclosed parental permission form below by indicating whether you give permission for your teen to participate and return the form to RTI in the enclosed self-addressed stamped envelope. If you have any questions about the study, contact Dr. Olivia Silber Ashley, the RTI project director, via e-mail at [email protected] or toll free at (800) 334-8571, ext. 2-6427.
Thank you for considering this request.
Sincerely,
Olivia Ashley
Project Director
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COMPLETE AND RETURN THIS FORM
By signing below, you are letting us know that you have read the consent form, received answers to your questions, and freely decided to allow your teen to participate in a focus group. Signing this form or refusing to sign this form will not affect your teen’s grades in school.
[PLEASE PRINT] Teen's name: _____________________________
I have read the permission form and understand it.
[ ] I GIVE PERMISSION for my teen to take part in a focus group for this study.
[ ] I DO NOT GIVE PERMISSION for my teen to take part in a focus group for this study.
[PLEASE PRINT] Parent/Guardian name: ____________________________
Parent/Guardian signature: __________________________
Date: ___________________________________________
KEEP THESE THREE PAGES OF THIS PERMISSION FORM.
Parental Permission Form
Student Focus Groups about the Safe Dates Program
Before you decide whether you want your teen to take part in this study, you need to read this Parental Permission form so that you understand what the study is about and what your teen will be asked to do. This form also tells you who can be in the study, the risks and benefits of the study, how we will protect your teen’s information, and who you can call if you have questions. Please call the study director, Dr. Olivia Ashley of RTI International, at (800) 334-8571, ext. 2-6427 (a toll-free number) about anything you don’t understand before you make your decision. Your teen was selected for the study because he or she received the Safe Dates program at school during the 2008-2009 school year and because we value his/her opinion.
This study, sponsored by the Centers for Disease Control and Prevention (CDC), is being conducted by RTI International, a research organization located in North Carolina. We are conducting focus groups with 40 teens to learn about their opinions about the Safe Dates program and how the program should be changed for schools in cities. A focus group is a group discussion to hear everyone’s opinion.
If you let your teen participate, he or she will be asked to take part in a focus group at [LOCATION]. The focus group will include other teens from your child’s school. The questions will ask teens their opinions about the Safe Dates program and how the Safe Dates program should be changed for schools in cities. We will not ask personal questions about your teen during the focus group sessions. Your teen does not have to have dated to participate in a focus group. We are required to audio record the discussion so that we do not miss anything the participants say. In the room during the focus groups will be one staff asking questions and the other taking notes. The information your teen says will be kept private. Only the research team will use these recordings. If your teen prefers that we do not record something he or she wants to say, your teen may choose not to say those things or may choose to leave the group at any time. The recordings will be destroyed at the end of the study. We will ask your teen to complete a brief form about demographics and when they received the Safe Dates program. Your teen’s name will not appear on the brief form.
The focus group session will last 90 minutes.
Possible Risks or Discomforts
Participating in the study will pose little risk to your teen. Your teen might feel embarrassed during the group discussion. Some of the topics may bring back sad or scary memories. Nothing that will be discussed in the focus group requires your teen to talk about any experiences with dating violence, since we will only be talking about how your teen feels about the Safe Dates program. There is a very small chance that another teen might reveal what your teen says in the focus group to people outside the study. This could create stigma among the adolescent’s friends. If your teen accidentally discloses information about a dating violence incident, then other people, including the person who was violent, could find out that your teen shared this information. This is why we will remind teens not to talk about any personal experiences. It is okay if your teen does not want to answer any questions. Your teen will be able to take a break at any time.
Your Benefits
There are no direct benefits to your teen from participating in this study. However, your teen’s answers will help us plan programs to help prevent dating violence in cities.
Benefits
for Other People
Results from the study could help improve youth violence prevention programs.
Your teen will receive a $25 gift card for participating in the focus group.
All of the data collected in this focus group will be protected under the Privacy Act and will be handled in a secure manner. The staff running this focus group will not tell your teen’s name to anyone. Your teen’s name will not be used in any reports. Information will be used only for research purposes by researchers who have signed an agreement to keep all information private and secure. To participate, your teen must also agree not to share the things we talk about in the discussion with anyone else. We will prepare a summary report of the responses which will combine information provided from all participants so that it would be impossible to identify what any individual said. There are three situations in which we have to report to the right person information your teen tells us: 1) If your teen says that someone’s life or health could be in danger, we are required to share this information with someone who can help. 2) If we learn that someone is planning to harm your teen or that your teen plans to harm somebody else. 3) If we learn that your teen is being abused or neglected, or if your teen is abusing someone else. In any of these cases, we will tell someone whose job it is to see that your teen and/or others are safe and protected.
Information from these consent/assent forms will be stored in separate locked files from the information collected in the group discussion. The forms will be destroyed after the study ends. The audio recordings of this interview will be destroyed after the study ends.
The Institutional Review Board (IRB) at RTI has reviewed this research. An IRB is a group of people who are responsible for making sure that the rights of participants in research are protected.
Future Contacts
We will not contact you in the future about this study.
Your Rights
You may decline to have your teen participate. In order for your teen to participate in the study, BOTH you and your teen must agree to participation. Your decision for your teen to take part in this research study is completely voluntary. Teens will be told that participation is voluntary. Even if you give permission, your teen may decline to participate at any time. Teens will also be told that they can refuse to answer any questions.
Parents may withdraw their permission at any time by contacting Dr. Olivia Ashley at (800) 334-8571, ext. 2-6427 (a toll-free number) or (919) 541-6427. No action will be taken against the school, you, or your teen if your teen does not participate in the study.
Your Questions
If you have any questions about this study, you may call Dr. Olivia Ashley of RTI International at (800) 334-8571, ext. 2-6427 (a toll-free number) or (919) 541-6427. If you have any questions about your teen’s rights as a study participant, you may call RTI’s Office of Research Protection at 1-866-214-2043 (a toll-free number). By agreeing to participate in this research, your teen is not giving up any of his or her legal rights.
Student Assent Form
Student Focus Groups about the Safe Dates Program
Before you decide whether you want to take part in this study, you need to read this Student Assent form so that you understand what the study is about and what you will be asked to do. This form also tells you who can be in the study, the risks and benefits of the study, how we will protect your information, and who you can call if you have questions. Please feel free to ask the focus group leader about anything you don’t understand before you make your decision. You were selected for the study because you received the Safe Dates adolescent dating violence prevention program at school last year.
This study, sponsored by the Centers for Disease Control and Prevention (CDC), is being conducted by RTI International, a research organization located in North Carolina. We are conducting focus groups with 40 students to learn their opinions about the Safe Dates program and whether the program should be changed for schools in cities. A focus group is a group discussion to hear everyone’s opinion.
If you agree to participate, you will be asked to take part in a focus group. The focus group will include other teens from your school. The questions will ask your opinions about the Safe Dates program and whether the Safe Dates program should be changed for schools in cities. We will not ask personal questions about you during the focus group session. You do not have to have dated to participate in the focus group. We are required to audio record the discussion so that we do not miss anything you and the other participants say. In the room during the focus group will be one staff asking questions and the other taking notes. The information you say will be kept private. Only the research team will use these recordings. If you prefer that we do not record something you want to say, you may choose not to say those things or may choose to leave the group at any time. The recordings will be destroyed at the end of the study. We will also ask you to complete a brief form about yourself and when you received the Safe Dates program. Your name will not appear on the brief form.
The focus group session will last 90 minutes.
Possible Risks or Discomforts
There are a few risks to taking part in the study. You might feel embarrassed during the group discussion. Some of the topics may bring back sad or scary memories. Nothing that will be discussed in the focus group requires you to talk about any experiences with dating violence, since we will only be talking about how you feel about the Safe Dates program. There is also a very small chance that someone might reveal information about you to people outside the study. This could make you uncomfortable or cause problems for you with teachers and/or other students. If you accidentally tell information about a dating violence incident, then other people, including the person who was violent, could find out that you shared this information. This is why we will remind everyone in the focus group not to talk about any personal experiences. It is okay if you do not want to answer any questions. You can also take a break at any time.
Your Benefits
There are no direct benefits to you from participating in this study. However, your answers will help us plan programs to help prevent dating violence in cities.
Benefits
for Other People
Results from the study could help improve youth violence prevention programs.
You will receive a $25 gift card for participating in the focus group.
All of the data collected in this focus group will be protected by the Privacy Act and will be handled in a secure manner. Your name will not be used in any reports. Information will be used only for research purposes by researchers who have signed an agreement to keep all information private and handled in a secure manner. We will prepare a summary report of the responses which will combine information provided from all participants so that it would be impossible to identify what any individual said. There are three situations in which we have to report to the right person information you tell us: 1) If we learn during our talk that your life or health or the life or health of another person could be in danger. 2) If we learn that someone is planning to harm you or that you plan to harm somebody else. 3) If we learn that you are being abused or neglected, or if you are abusing someone else. In any of these cases, we will tell someone whose job it is to see that you and/or others are safe and protected.
Anyone who is working with any of the information you give us has to sign an agreement not to share what you tell us. To participate, you must also agree not to share the things that we talk about in this discussion or talk about who is in the group with anyone else. The staff running this focus group will not tell your name to anyone. In any reports from this research, your answers will always be grouped with answers from other people or disguised so no one can tell it is you. Information from these consent/assent forms will be stored in separate locked files from the information collected in the group discussion. The forms will be destroyed after the study ends. The audio recordings of this interview will be destroyed after the study ends.
Future Contacts
We will not contact you in the future about this study.
Your Rights
Your decision to take part in this research study is your choice. In order for you to participate in the study, BOTH you and your parent/guardian must agree to participation. Even if your parent gave permission for you to participate, you may refuse to participate at any time. If you do agree to participate in the study, you can skip any questions. No action will be taken against the school, you, or your parent if you do not participate in the study. If you have any questions about your rights as a study participant, you can call RTI's Office of Research Protection at (919) 316-3358 in Durham, NC or 1-866-214-2043 (a toll-free number).
Your Questions
If you have any questions about your rights as a study participant, you may call RTI’s Office of Research Protection at 1-866-214-2043 (a toll-free number). If you have any questions about this study, you may call Dr. Olivia Ashley of RTI International at (800) 334-8571, ext. 2-6427 (a toll-free number) or (919) 541-6427.
Indicating Consent or Assent.
We have given you a lot of information. Tell me if you have any questions.
By signing this form, you are letting us know that you have read the information about the Safe Dates study and that you agree to participate in the focus group and to audio recording. I will give you an unsigned copy of this form.
________________________________________
__________
Student’s
Signature
Date
________________________________________ __________
Signature of Focus Group Leader Date
________________________________________ __________
Printed Name of Focus Group Leader Date
COMPLETE AND RETURN THIS PAGE TO THE FOCUS GROUP LEADER. KEEP THE REST OF THIS ASSENT FORM.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Billing Code: 4163-18-P |
| Author | Sonjuia L. Robinson |
| File Modified | 0000-00-00 |
| File Created | 2021-02-01 |