Appendix D - Lead Letters-Fact Sheets-Consents

Appendix D
Lead Letters, Fact Sheets, Consent and Data Linkage Forms

Lead Letters

Caseworker Lead Letter
New Agency Caseworker Lead Letter
Caregiver Lead Letter
Legal Guardian Lead Letter
Emancipated Youth Lead Letter
Caregiver of Emancipated Youth Lead Letter
Young Adult Lead Letter

NATIONAL SURVEY OF CHILD AND ADOLESCENT WELL-BEING
RTI • P.O. Box 12194 • Research Triangle Park, North Carolina 27709-2194 USA

[CASEWORKER NAME]
[Address]
[Address #2]
[City, State, Zip]

[Date]

Dear Caseworker,
The National Survey of Child and Adolescent Well-Being (NSCAW) is currently conducting the next round of interviews with
selected children and families. If you took part in one of our earlier rounds of interviews, we would like to thank you for your
participation. If this is the first time you have been contacted about the NSCAW, the study may be new to you. The NSCAW is a
Congressionally mandated study of children and families who have had contact with the child welfare system. The study is
sponsored by The Children’s Bureau and the Administration for Children and Families (ACF), an agency within the U.S.
Department of Health and Human Services. ACF has hired RTI International (RTI), a not-for-profit survey research organization,
to conduct the study.
There are over 5,300 children and families participating in this important study of the child welfare system. You are being contacted
because at least one of the families you work with or worked with in the recent past participated in an earlier round of interviews and
received services through the agency. As the primary caseworker for one of these families, we would like to interview you to learn more
about the services provided to or needed by the family and update the information we collected in our earlier round of interviews.

The NSCAW will make available nationally representative longitudinal data drawn from first-hand reports from children and their
caregivers, service providers, and teachers. This study will provide policy makers and practitioners with information about the
service needs of children and families who enter the child welfare system, the kinds of services provided to them, and outcomes
for children and families who enter the system. Information gathered will be used to improve child welfare policy and practice.
These data are especially important in these times of additional stressors on families due to the economic downturn, and on
agencies trying to handle increased family needs with fewer resources.
Your participation is vital to helping us better understand the issues that face children and families in the child welfare system and how
the system serves children of different ages and with different needs. We recognize that some families receive extensive services, while
others receive few or no services. In order to obtain a complete picture of the service system, it is important that we talk with caseworkers
regardless of the amount or type of services provided or paid for by the agency.

The interview will take about 60 minutes to complete and will be conducted by the professional RTI representative in your area
listed below. Please ask to see her/his personal identification card; an example of the ID card is shown below. We appreciate the
heavy demands on your time and want to stress that the interviewer will work with you to schedule the interview at a time
convenient to your schedule.
The enclosed fact sheet provides additional information about this important study. Please be assured that the information you
share with us will be used for research purposes only and will be completely confidential, as required by law. No individual
participant or family will be identified in reports or data files that are released.
Your help is extremely important to the success of this study, and I thank you in advance for your cooperation.
Sincerely yours,

Mary Bruce Webb, Ph.D., Project Officer
Administration for Children and Families

Name of Interviewer Who Will Contact You:___________________________________
Version 3A June 2011
Sponsored by: Administration for Children and Families
Conducted by: RTI International, ICF Caliber, Walter R. McDonald & Associates, Tufts-New England Medical Center, the Child and Adolescent Services
Research Center, and the University of Illinois at Urbana-Champaign

NATIONAL SURVEY OF CHILD AND ADOLESCENT WELL-BEING
RTI • P.O. Box 12194 • Research Triangle Park, North Carolina 27709-2194 USA

[NEW AGENCY CASEWORKER NAME]
[Address]
[Address #2]
[City, State, Zip]

[Date]

Dear Caseworker,
The National Survey of Child and Adolescent Well-Being (NSCAW) is currently conducting the third round of interviews with selected
children and families. The NSCAW is a Congressionally mandated study of children and families who have had contact with the child
welfare system. The study is sponsored by The Children’s Bureau and the Administration for Children and Families (ACF), an agency
within the U.S. Department of Health and Human Services. ACF has hired RTI International (RTI), a not-for-profit survey research
organization, to conduct the study.
In the first round, RTI worked with a child welfare agency in your area to sample families who had come into contact with the child welfare
system. RTI conducted interviews or assessments with the sampled children and interviews with their caregivers and investigative caseworkers.
In subsequent rounds, we are re-contacting the sampled families and caseworkers to conduct additional interviews that allow researchers to learn
about families’ continuing experiences with the child welfare system and the types of services they may receive over time.
Nationwide, there are over 5,300 children and families participating in this important study. You are being contacted because at least one of these
families is receiving services through your agency. You were named as the primary caseworker or service provider for the child. Because of your
involvement with the child, we would like to interview you to learn more about the services provided to or needed by the child and his/her
family, and update the information we collected in our first round of interviews.

The NSCAW will make available nationally representative longitudinal data drawn from first-hand reports from children and their
caregivers, service providers, and teachers. This study will provide policy makers and practitioners with information about the service
needs of children and families who have contact with the child welfare system, the kinds of services provided to them, and outcomes for
children and families. Information gathered will be used to improve child welfare policy and practice. These data are especially
important in these times of additional stressors on families due to the economic downturn, and on agencies trying to handle increased
family needs with fewer resources.
Your participation is vital to helping us better understand the issues that face children and families in the child welfare system and how the
system serves children of different ages and with different needs. We recognize that some families receive extensive services, while others
receive few or no services. In order to obtain a complete picture of the service system, it is important that we talk with caseworkers
regardless of the amount or type of services provided or paid for by the agency.

The interview will take about 60 minutes to complete and will be conducted by the professional RTI representative in your area listed
below. Please ask to see her/his personal identification card; an example of the ID card is shown below. We appreciate the heavy
demands on your time and want to stress that the interviewer will work with you to schedule the interview at a convenient time.
The enclosed fact sheet provides additional information about this important study. Please be assured that the information you share with
us will be used for research purposes only and will be completely confidential, as required by law. No individual participant or family
will be identified in reports or data files that are released.
Your help is extremely important to the success of this study, and I thank you in advance for your cooperation.
Sincerely yours,

Mary Bruce Webb, Ph.D., Project Officer
Administration for Children and Families

Name of Interviewer Who Will Contact You:___________________________________
Version 3N June 2011
Sponsored by: Administration for Children and Families
Conducted by: RTI International, ICF Caliber, Walter R. McDonald & Associates, Tufts-New England Medical Center, the Child and Adolescent Services Research
Center, and the University of Illinois at Urbana-Champaign

NATIONAL SURVEY OF CHILD AND ADOLESCENT WELL-BEING
RTI • P.O. Box 12194 • Research Triangle Park, North Carolina 27709-2194 USA

[PARENT NAME]
[Address]
[Address #2]
[City, State, Zip]

[Date]

Dear Parent,
The National Survey of Child and Adolescent Well-Being (NSCAW) is currently conducting the next round of
interviews with selected children and families. Your child is among more than 5,300 children randomly selected and
participating in this study The NSCAW is a Congressionally mandated study of children and families who have had
contact with the child welfare system. The study is sponsored by The Children’s Bureau and the Administration for
Children and Families (ACF), an agency within the U.S. Department of Health and Human Services. ACF has hired
RTI International (RTI), a not-for-profit survey research organization, to conduct the study. If you took part in an
earlier round of interviews, we would like to thank you for your participation. If this is the first time you have been
contacted about the NSCAW, the study may be new to you.
By participating in the survey, you will have a unique opportunity to talk about your experiences with the child
welfare system, your level of satisfaction with the services your family may have received, and about your child,
[NAME OF CHILD]. This will help us better understand the issues that affect children and families like yours. The
results of the study will be used to make improvements to the child welfare system. Because your contribution is
important, we will pay you $50 for participating in this round of interviews. We will also give your child a gift
certificate for participating. The amount of the gift certificate is $20 for children age 11 or older and $10 for children
age 10 or younger.
We realize you are busy, taking care of a family, working outside the home, or going to school — possibly all
three. A professional RTI representative in your area will contact you and will conduct the interview whenever it is
convenient for you and your child.
Your help in this study is voluntary, but we urge you to participate. The information you provide will be
completely confidential, as required by law. Neither this project nor the local representative who will contact you is
affiliated with the child welfare agency. No individual participant or family will be identified in reports or data files
released by RTI. Your participation will not affect any benefits or services you or your child receive.
Additional information about the study is in the enclosed fact sheet. A professional RTI representative will try to
reach you by telephone to schedule the interview. However, if the interviewer is not able to reach you by telephone,
she/he will come to your home to explain the survey in person, and will be glad to answer any questions you have.
Please ask to see her/his personal identification card; an example of the ID card is shown below.
Your help is extremely important to the success of this study, and I thank you in advance for your cooperation.
Sincerely yours,

Mary Bruce Webb, Ph.D., Project Officer
Administration for Children and Families

Name of Interviewer Who Will Contact You: ____________________________________
Version 3C June 2011

Sponsored by: Administration for Children and Families
Conducted by: RTI International, ICF Caliber, Walter R. McDonald & Associates, Tufts-New England Medical Center, the Child and Adolescent
Services Research Center, and the University of Illinois at Urbana-Champaign

NATIONAL SURVEY OF CHILD AND ADOLESCENT WELL-BEING
RTI • P.O. Box 12194 • Research Triangle Park, North Carolina 27709-2194 USA

[LEGAL GUARDIAN]
[Address]
[Address #2]
[City, State, Zip]

[Date]

Dear Legal Guardian,
The National Survey of Child and Adolescent Well-Being (NSCAW) is currently conducting the next round of
interviews with selected children and families. The NSCAW is a Congressionally mandated study of children and families
who have had contact with the child welfare system. The study is sponsored by The Children’s Bureau and the
Administration for Children and Families (ACF), an agency within the U.S. Department of Health and Human Services.
ACF has hired RTI International (RTI), a not-for-profit survey research organization, to conduct the study. The results of
this study will be used to make improvements to the child welfare system.
[NAME OF CHILD], a child for whom you (or your state or agency) are the legal guardian, is among more than 5,300
children randomly selected and participating in the study. By participating, respondents have a unique opportunity to talk
about their experiences with the child welfare system. This can help us better understand the issues that affect children and
families. We would like to talk with the child to learn how the system serves children with different needs. Because every
child’s participation is important, we will give each child a gift card for participating. The amount of the gift card is $20
for children age 11 or older and $10 for children age 10 or younger.
We realize you are busy. The professional interviewer who will contact you can meet with you to discuss the consent
for the child interview whenever it is convenient for you.
Your consent for the child’s participation in this study is voluntary, but we urge you to allow the child to participate.
Each child’s participation will help us learn about the child welfare system from a child’s point of view. The information
the child provides will be completely confidential, as required by law. Neither this project nor the local representative who
will contact you and the child is affiliated with the child welfare agency. No individual participant or family will be
identified in reports or data files released by ACF. The child’s participation will not affect any benefits or services the
child or his/her family receives.
Additional information about the study is in the enclosed fact sheet. A professional RTI representative in your area will
contact you by telephone. However, if the interviewer is not able to reach you by telephone, she/he may come to explain
the survey in person, and will be glad to answer any questions you have. Please ask to see her/his personal identification
card; an example of the ID card is shown below.
Your help is extremely important to the success of this survey, and I thank you in advance for your cooperation.
Sincerely yours,

Mary Bruce Webb, Ph.D., Project Officer
Administration for Children and Families

Name of Interviewer Who Will Contact You: ________________________________
Version 3F June 2011
Sponsored by: Administration for Children and Families
Conducted by: RTI International, ICF Caliber, Walter R. McDonald & Associates, Tufts-New England Medical Center, the Child and Adolescent
Services Research Center, and the University of Illinois at Urbana-Champaign

NATIONAL SURVEY OF CHILD AND ADOLESCENT WELL-BEING
RTI • P.O. Box 12194 • Research Triangle Park, North Carolina 27709-2194 USA

[EMANCIPATED YOUTH]
[Address]
[Address #2]
[City, State, Zip]

[Date]

Dear [NAME OF CHILD]
The National Survey of Child and Adolescent Well-Being (NSCAW) is currently conducting the next round of
interviews with participating children and families. You are among more than 5,300 youth randomly selected and
participating in this study. The NSCAW is a Congressionally mandated study of children and families who have had
contact with the child welfare system. The study is sponsored by The Children’s Bureau and the Administration for
Children and Families (ACF), an agency within the U.S. Department of Health and Human Services. ACF has hired RTI
International (RTI), a not-for-profit survey research organization, to conduct the study. The results of this study will be
used to make improvements to the child welfare system. You were interviewed in an earlier round of the study, and we
greatly appreciate your prior participation.
By participating in the survey, you will have a unique opportunity to talk about your experiences with the child welfare
system, and your level of satisfaction with the services you may have received. This will help us better understand the issues
that affect youth like you. The results of the study will be used to make improvements to the child welfare system. Because
your contribution is important, we will pay you $50 for participating in this round of interviews.
We realize you are busy, going to school, working outside the home, or helping to take care of a family — possibly all
three. The professional interviewer who will contact you will conduct the interview whenever it is convenient for you.
Your help in this study is voluntary, but we urge you to participate. The information you provide will be completely
confidential, as required by law. Neither this project nor the local representative who will contact you is affiliated with the
child welfare agency. No individual participant or family will be identified in reports or data files released by ACF. Your
participation will not affect any benefits or services you receive.
Additional information about the study is in the enclosed fact sheet. A professional RTI representative in your area will
try to reach you by telephone to schedule the interview. However, if the interviewer is not able to reach you by telephone,
she/he will come to your home to explain the survey in person, and will be glad to answer any questions you have. Please ask
to see her/his personal identification card; an example of the ID card is shown below.
Your help is extremely important to the success of this survey, and I thank you in advance for your cooperation.
Sincerely yours,

Mary Bruce Webb, Ph.D., Project Officer
Administration for Children and Families

Name of Interviewer Who Will Contact You: ____________________________________
Version 3X June 2011
Sponsored by: Administration for Children and Families
Conducted by: RTI International, ICF Caliber, Walter R. McDonald & Associates, Tufts-New England Medical Center, the Child and Adolescent Services
Research Center, and the University of Illinois at Urbana-Champaign

NATIONAL SURVEY OF CHILD AND ADOLESCENT WELL-BEING
RTI • P.O. Box 12194 • Research Triangle Park, North Carolina 27709-2194 USA

[PARENT OF EMANCIPATED YOUTH NAME]
[Address]
[Address #2]
[City, State, Zip]

[Date]

Dear Parent,
The National Survey of Child and Adolescent Well-Being (NSCAW) is currently conducting the next round of
interviews with selected children and families. Your child is among more than 5,300 children randomly selected and
participating in this study. The NSCAW is a Congressionally mandated study of children and families who have had
contact with the child welfare system. The study is sponsored by The Children’s Bureau and the Administration for
Children and Families (ACF), an agency within the U.S. Department of Health and Human Services. ACF has hired
RTI International (RTI), a not-for-profit survey research organization, to conduct the study. If you took part in an
earlier round of interviews, we would like to thank you for your participation. If this is the first time you have been
contacted about the NSCAW, the study may be new to you.
By participating in the survey, you will have a unique opportunity to talk about your experiences with the child
welfare system, your level of satisfaction with the services your family may have received, and about your child,
[NAME OF CHILD]. This will help us better understand the issues that affect children and families like yours. The
results of the study will be used to make improvements to the child welfare system. Because your contribution is
important, we will pay you $50 for participating in this round of interviews.
We realize you are busy, taking care of a family, working outside the home, or going to school — possibly all
three. A professional RTI representative in your area who will contact you will conduct the interview whenever it is
convenient for you.
Your help in this study is voluntary, but we urge you to participate. The information you provide will be
completely confidential, as required by law. Neither this project nor the local representative who will contact you is
affiliated with the child welfare agency. No individual participant or family will be identified in reports or data files
released by RTI. Your participation will not affect any benefits or services you or your child receive.
Additional information about the study is in the enclosed fact sheet. A professional RTI representative will try to
reach you by telephone to schedule the interview. However, if the interviewer is not able to reach you by telephone,
she/he will come to your home to explain the survey in person, and will be glad to answer any questions you have.
Please ask to see her/his personal identification card; an example of the ID card is shown below.
Your help is extremely important to the success of this study, and I thank you in advance for your cooperation.
Sincerely yours,

Mary Bruce Webb, Ph.D., Project Officer
Administration for Children and Families

Name of Interviewer Who Will Contact You: ____________________________________

Version 3P June 2011

Sponsored by: Administration for Children and Families
Conducted by: RTI International, ICF Caliber, Walter R. McDonald & Associates, Tufts-New England Medical Center, the Child and Adolescent
Services Research Center, and the University of Illinois at Urbana-Champaign

NATIONAL SURVEY OF CHILD AND ADOLESCENT WELL-BEING
RTI • P.O. Box 12194 • Research Triangle Park, North Carolina 27709-2194 USA

[YOUNG ADULT]
[Address]
[Address #2]
[City, State, Zip]

[Date]

Dear [NAME OF YOUNG ADULT]
The National Survey of Child and Adolescent Well-Being (NSCAW) is currently conducting the next round
of interviews with participating young adults. You are among over 5,300 young adults randomly selected and
participating in this study. You were interviewed in an earlier round of the study, and we greatly appreciate your
prior participation.
NSCAW is the first ever nationwide survey of children and families who have had contact with the child
welfare system. The study is sponsored by the Administration for Children and Families (ACF), an agency within
the United States Department of Health and Human Services. By participating in the survey, you will have a
unique opportunity to talk about your life experiences and transition to adulthood. This will help us better
understand the issues that affect young adults like you. The results of the study will be used to make
improvements to the child welfare system and services available. Because your contribution is important, we will
pay you $50 for participating in this round of interviews.
We realize you are busy, going to school, working outside the home, or helping to take care of a family —
possibly all three. The professional interviewer who will contact you will conduct the interview whenever it is
convenient for you.
Your help in this study is voluntary, but we urge you to participate. The information you provide will be
completely confidential, as required by law. Neither this project nor the local representative who will contact you
is affiliated with the child welfare agency. No individual participant or family will be identified in reports or data
files released by ACF. Your participation will not affect any benefits or services you receive.
Additional information about the survey is in the enclosed fact sheet. A professional RTI representative in
your area will try to reach you by telephone to schedule the interview. However, if the interviewer is not able to
reach you by telephone first, she/he will come to your home to explain the survey in person, and will be glad to
answer any questions you have. Please ask to see her personal identification card; an example of the ID card is
shown below.
Your help is extremely important to the success of this survey, and I thank you in advance for your
cooperation.
Sincerely yours,

Mary Bruce Webb, Ph.D., Project Officer
Administration for Children and Families

Name of Interviewer Who Will Contact You: ____________________________________

Version 3YA June 2011

Sponsored by: Administration for Children and Families
Conducted by: RTI International, ICF Caliber, Walter R. McDonald & Associates, Tufts-New England Medical Center, the Child and Adolescent
Services Research Center, and the University of Illinois at Urbana-Champaign

Fact Sheets

Caseworker Fact Sheet
New Agency Caseworker Fact Sheet
Caregiver Fact Sheet
Legal Guardian Fact Sheet
Emancipated Youth Fact Sheet
Caregiver of Emancipated Youth Fact Sheet
Young Adult Fact Sheet

QUESTIONS AND ANSWERS ABOUT THE
THE NATIONAL SURVEY OF CHILD AND
ADOLESCENT WELL-BEING (NSCAW)
Caseworker Survey

Your agency is participating in an important study called the National Survey of Child and Adolescent Well-Being.
In this fact sheet, you will find answers to some of the most common questions that are asked about the study.
What is the National Survey of Child and Adolescent Well-Being (NSCAW)?
The National Survey of Child and Adolescent Well-Being (NSCAW) is a Congressionally-mandated study designed to
collect nationally representative longitudinal data from children and families in the child welfare system. Information
is also collected from teachers and caseworkers. The data will be used to learn about the needs of children and
families, about the kinds of services used by children and families, and about other services provided by child welfare
agencies. In addition, this national study examines child and family well-being outcomes within the context of their
experience in the child welfare system.
Who is doing this study?
The study is being sponsored by the Administration for Children and Families (ACF) of the U.S. Department of Health
and Human Services. RTI International (RTI) has been hired to conduct the survey and is not affiliated with the child
welfare agency.
Who is RTI International (RTI)?
RTI is a private, not-for-profit research organization located in North Carolina founded in 1958 by the University of
North Carolina at Chapel Hill, Duke University in Durham and North Carolina State University in Raleigh. RTI
conducts research projects for a wide variety of government agencies, universities, and private companies.
How were children chosen to participate?
Most surveys involve drawing a scientific sample from the population of interest and then concentrating the study on
this relatively small sample. This is also the approach used in the NSCAW. A random sample of about 80 county
child welfare agencies was drawn from the entire U.S. Within each of these agencies, we scientifically selected a
sample of children who were the subjects of child abuse investigations (or assessments) conducted by child protective
services (CPS) between February 2008 and April 2009. This resulted in a group of about 5,300 children who are
participating in the study and who represent children in child welfare agencies across the entire U.S.
What is the NSCAW Caseworker Survey?
During the reference period, children were randomly selected from your agency for inclusion in this study. We have
completed an 18-month follow-up with the sampled children and their caregivers approximately and are now following
up with them approximately 36 months after the close of the index investigation. You have been identified as the
primary caseworker or service provider for one of the participating children. The caseworker survey focuses on the
child’s history in the child welfare system and the services he/she receives. In answering these questions, it may be
necessary for you to refer to the child’s service records.
Note that you may be asked to complete interviews for more than one child during this round of interviewing. We will
work with you to find a convenient time to do the interview(s).
How are children involved in NSCAW?
The child’s involvement varies depending on his or her age. Young children are observed by a professional RTI
representative to assess their development and language skills. The interviewer talks with older children about their
development, family experiences, school, and friends. The interviewer obtains permission from the child’s legal
guardian before observing or talking with him or her.

Version 3A June 2011

How are parents/guardians involved in NSCAW?
Parents or caregivers of selected children are asked to answer questions about the child’s development, including his or
her learning, behavior, health, and friendships. They also ask about the services the family receives and their family
environment. Additional questions focus on their attitudes about raising children, family support, involvement with
school and community activities, and their interaction with the selected child.
How was my name associated with this case?
The RTI representative working this case obtained your name from either the child’s current caregiver/legal guardian,
who has agreed to participate in the study, or from the study liaison in the participating local agency. As the primary
caseworker or service provider for the sampled child’s case, you were named as the person most knowledgeable about
the services the sampled child and family may have received.
How is the survey conducted?
A professional RTI representative will contact you in advance to schedule a convenient time to complete the interview.
In conducting the interview, the interviewer will read the questions off of a computer screen and type the answers into
the computer. You may need to refer to your records to answer some questions.
How will I recognize the RTI interviewer?
The interviewer will carry an RTI identification badge with his or her picture on it. The interviewer will also have
letters of authorization from the Children’s Bureau, the U.S. Department of Health and Human Services and RTI.
How long will the interview take?
The services caseworker interview lasts about 60 minutes. We will schedule the interview whenever it is most
convenient for you.
Will the selected child or his/her guardian know my answers?
No. The information you provide is considered strictly private and confidential. The selected child, his/her guardian,
and agency staff will not know any of your responses to the interview questions. The information you provide will be
used for research purposes only and your name will be kept separate from the information.
What happens to the information?
The information the interviewer enters into the computer is sent to RTI by the computer in a way that is safe and
secure. The answers are then combined with other interviews and reported in summary form. Your name is not linked
with the information you provide. They are kept separate from the survey information. Your name, address and other
identifying information are only used when it is time to contact you again for another interview. RTI may also
telephone participants or send a letter to check on the quality of the interviewer’s work.
What about confidentiality?
All RTI staff members and interviewers have signed a Confidentiality Agreement guaranteeing that they will not
reveal any information to anyone other than authorized project staff. In addition, RTI has obtained a federal Certificate
of Confidentiality for this study to protect the identity of the research subjects. All information collected as part of the
study will be held strictly confidential, and nothing you tell us will be reported with your name.
The selected child and his/her guardian, and other agency staff will not know any of your responses to the interview
questions. You do not have to answer any question you do not want to answer and you can stop the interview at any
time.
The information provided by all other study participants, including caregivers, children, and teachers, will be kept
strictly confidential. Answers obtained during all NSCAW interviews will be combined with those from thousands of
others from around the country. The results will be reported only in percentages, averages and other statistics so that
no single participant can be identified.
Where do I get more information?
If you have other questions about this survey, you may call toll-free: Pat Crowley at RTI, 1-877-254-1953, extension
67. If you have questions about your rights as a study participant, call toll-free: RTI’s Office of Human Research
Protections at 1-866-214-2043.

Version 3A June 2011

QUESTIONS AND ANSWERS ABOUT THE
THE NATIONAL SURVEY OF CHILD AND
ADOLESCENT WELL-BEING (NSCAW)
New Agency Caseworker Survey
What is the National Survey of Child and Adolescent Well-Being (NSCAW)?
The National Survey of Child and Adolescent Well-Being (NSCAW) is a Congressionally-mandated study designed to
collect nationally representative longitudinal data from children and families in contact with the child welfare system.
Information is also collected from teachers and caseworkers. The data will be used to learn about the needs of children
and families, about the kinds of services used by children and families, and about other services provided by child welfare
agencies. In addition, this national study examines child and family well-being outcomes within the context of their
experience in the child welfare system. In this fact sheet, you will find answers to some of the most common questions
that are asked about the study.
Who is doing this study?
The study is being sponsored by the Administration for Children and Families (ACF) of the U.S. Department of Health
and Human Services. RTI International (RTI) has been hired to conduct the survey, and is not affiliated with the child
welfare agency.
Who is RTI International (RTI)?
RTI is a private, not-for-profit research organization located in North Carolina founded in 1958 by the University of North
Carolina at Chapel Hill, Duke University in Durham and North Carolina State University in Raleigh. RTI conducts
research projects for a wide variety of government agencies, universities, and private companies.
How were children chosen to participate?
Most surveys involve drawing a scientific sample from the population of interest and then concentrating the study on this
relatively small sample. This is also the approach used in the NSCAW. A random sample of about 80 county child
welfare agencies was drawn from the entire U.S. Within each of these agencies, in 2008-2009 we scientifically selected a
sample of children who were the subjects of child abuse investigations (or assessments) conducted by child protective
services (CPS) between February 2008 and April 2009. This resulted in a group of about 5,300 children who are
participating in the study and who represent children in child welfare agencies across the entire U.S.
What is the NSCAW Caseworker Survey?
The target population for the NSCAW II sample is all children who were subjects of child abuse and neglect
investigations (or assessments) conducted by CPS between February 2008 and April 2009. During this period, children
were randomly selected from a child welfare agency in your area for inclusion in this study. At least one caseworker from
that agency was asked to complete an initial interview that focused on the investigation that led to the family’s inclusion
in the study.
We have completed an 18-month follow-up with the sampled children and their caregivers approximately and are now
following up with them approximately 36 months after the close of the index investigation. You have been identified as
the primary caseworker or service provider for one of the participating children. The caseworker survey focuses on the
child’s history in the child welfare system and the services he/she receives. In answering these questions, it may be
necessary for you to refer to the child’s service records.
Note that you may be asked to complete interviews for more than one child during this round of interviewing. We will
work with you to find a convenient time to do the interview(s).
How are children involved in NSCAW?
The child’s involvement will vary depending on his or her age. Young children will be observed by a professional RTI
representative to assess their development and language skills. The interviewer will talk with older children about their
development, family experiences, school, and friends. The interviewer will obtain permission from the child’s legal
guardian before observing or talking with him or her.
Version 3N June 2011

How are parents/guardians involved in NSCAW?
Parents or caregivers of selected children will be asked to answer questions about the child’s development, including his
or her learning, behavior, health, and friendships. They will also be asked about the services the family receives and their
family environment. Additional questions will focus on their attitudes about raising children, family support, involvement
with school and community activities, and their interaction with the selected child.
How was my name associated with this case?
The RTI representative working this case obtained your name from either the child’s current caregiver, who has agreed to
participate in the study, or from the participating local agency. As the primary caseworker or service provider for the
sampled child’s case, you were named as the person most knowledgeable about the services the sampled child and family
may have received.
Does the local agency approve of NSCAW?
Yes. In 2007-2008, an agency local to your area signed a Letter of Agreement with RTI. The letter outlined the project’s
responsibilities with respect to issues such as data collection and confidentiality of data. The letter also outlined the
agency’s responsibilities with respect to issues such as provision of data for sampling purposes, provision of current
caregiver contact information, and support of caseworker participation in NSCAW.
How is the survey conducted?
A professional RTI representative will contact you in advance to schedule a convenient time to complete the interview. In
conducting the interview, the interviewer will read the questions off of a computer screen and type the answers into the
computer. You may need to refer to your records to answer some questions.
How will I recognize the RTI interviewer?
The interviewer will carry an RTI identification badge with his or her picture on it. The interviewer will also have letters
of authorization from the Children’s Bureau, the U.S. Department of Health and Human Services and RTI.
How long will the interview take?
The services caseworker interview lasts about 60 minutes. We will schedule the interview whenever it is most convenient
for you.
Will the selected child or his/her guardian know my answers?
No. The information you provide is considered strictly private and confidential. The selected child, his/her guardian, and
agency staff will not know any of your responses to the interview questions. The information you provide will be used for
research purposes only and your name will be kept separate from the information. Similarly, we cannot provide you with
any information from either the child’s or caregiver’s interview.
What happens to the information?
The information the interviewer enters into the computer is sent to RTI by the computer in a way that is safe and secure.
The answers are then combined with other interviews and reported in summary form. Your name is not linked with the
information you provide. They are kept separate from the survey information. Your name, address and other identifying
information are only used when it is time to contact you again for another interview. RTI may also telephone participants
or send a letter to check on the quality of the interviewer’s work.
What about confidentiality?
All RTI staff members and interviewers have signed a Confidentiality Agreement guaranteeing that they will not reveal
any information to anyone other than authorized project staff. In addition, RTI has obtained a federal Certificate of
Confidentiality for this study to protect the identity of the research subjects. All information collected as part of the study
will be held strictly confidential, and nothing you tell us will be reported with your name.
The selected child and his/her guardian, and other agency staff will not know any of your responses to the interview
questions. You do not have to answer any question you do not want to answer and you can stop the interview at any time.
The information provided by all other study participants, including caregivers, children, and teachers, will be kept strictly
confidential. Answers obtained during all NSCAW interviews will be combined with those from thousands of others
from around the country. The results will be reported only in percentages, averages and other statistics so that no single
participant can be identified.
Where do I get more information?
If you have other questions about this survey, you may call toll-free: Pat Crowley at RTI, 1-877-254-1953, extension 67.
If you have questions about your rights as a study participant, call toll-free: RTI’s Office of Human Research
Protections at 1-866-214-2043.
Version 3N June 2011

QUESTIONS AND ANSWERS ABOUT THE
THE NATIONAL SURVEY OF CHILD AND
ADOLESCENT WELL-BEING (NSCAW)
Caregiver Survey
The National Survey of Child and Adolescent Well-Being is the first ever nationwide study of children and families who
have come into contact with the child welfare system. In this fact sheet, you will find answers to some of the most common
questions that are asked about the survey.
What is the National Survey on Child and Adolescent Well-Being?
The National Survey of Child and Adolescent Well-Being (NSCAW) is designed to collect data from children and their
parents or caregivers. Information will also be collected from teachers, caseworkers and agency records. The information
will be used to learn about the needs of children and families, about the kinds of services used by children and families, and
about other services provided by child welfare agencies.
Why should I participate?
This is an opportunity to have your voice heard, to talk about your child’s needs from your own point of view, and help other
families in similar situations. The selected child named in the accompanying letter and/or a caregiver were interviewed
sometime between April 2008 and August 2009 and again approximately 18 months later. You may have participated in an
earlier round of interviews. We are now following up with families approximately 36 months after the first interview to see
how things may have changed.
Who is doing this study?
The study is sponsored by the Administration for Children and Families (ACF) of the U.S. Department of Health and Human
Services. RTI International (RTI) is conducting the survey and is not affiliated with the child welfare agency.
Who is RTI International?
RTI International (RTI) is a not-for-profit research organization located in North Carolina. RTI conducts research projects
for a wide variety of government agencies, universities, and private companies. Professional RTI representatives in your area
are conducting the interviews with children, families, and caseworkers.
How was I chosen?
In doing this survey, we cannot talk to everyone in the country. That would cost too much and take too long. So, we
scientifically selected a “sample” of children who had come into contact with the child welfare system. Your child is among
over 5,300 children randomly selected and participating in the study. We want to interview you about your child and your
family. Your contribution is important, and we will pay you $50 for your time and give your child a gift certificate for
participating. The gift certificate is $20 for children age 11 or older and $10 for children age 10 or younger.
How will I be involved?
You will be asked to answer questions about your child’s development, including his or her learning, behavior, health, and
friendships. You will also be asked about the services your family receives and your family’s situation.
To help us understand how the well-being of children changes over time, we or other researchers conducting this study may
contact you and your child in the future to update our information. Each of these additional interviews will also be
completely voluntary.
How will my child be involved?
The interviewer will ask your permission to observe or talk with your child selected for NSCAW. Your child’s involvement
will vary depending on his or her age. Young children are observed by a professional RTI interviewer to assess their
development and language skills. The interviewer talks with older children about their development, family experiences,
school, and friends.
How is the study being conducted?
A professional RTI interviewer will make a personal visit to interview the child’s primary caregiver, the person most
involved with the child on a day to day basis. The interviewer will read the questions off of a computer screen and type the
Version 3C June 2011

answers into the computer. We will ask your permission to use in our research any information we may obtain from child
welfare agency records.
How will I recognize the RTI interviewer?
The interviewer will carry an RTI identification badge with his or her picture on it. The interviewer will also have a letter of
authorization from the Children’s Bureau, U.S. Department of Health and Human Services, and RTI. Please ask to see these
credentials
How long will it take?
The interview length varies by the age of the child and his or her family experiences. The interview with you averages about
100 minutes. The length of the child interview is between 60 and 90 minutes. We will schedule the interviews when it is
most convenient for you and your child.
Are the questions personal?
Some questions may seem a little personal to some people. All answers are confidential; no one else (even other household
members) will know what you say during the interview. You do not have to answer any question that you do not want to
answer.
What happens to the information?
The information the interviewer enters into the computer is sent to RTI by the computer in a way that is safe and secure. The
answers are then combined with other interviews and reported in summary form. Your name and your child’s name will not
be linked with the information you provide. Your names and other identifying information will be kept separate from your
answers, and your name, address and other identifying information will only be used when it is time to contact you again for
another interview. RTI may also telephone you or send a letter to check on the quality of the interviewer’s work, and will
contact you by mail between rounds of interviews, in case you move.
How child welfare agency personnel be contacted?
The caseworker will be asked questions about the child welfare services provided to your child and family and to refer to
your child’s service records.
What about Confidentiality?
All RTI staff members and interviewers have signed a Confidentiality Agreement guaranteeing that they will not reveal any
information to anyone other than authorized project staff. In addition, RTI has obtained a federal Certificate of
Confidentiality for this study to protect the identity of the research subjects. All information collected as part of the study
will be held strictly confidential, and nothing you tell us will be reported with your name.
However, there are two important exceptions. (1) If the interviewer or project staff think that your child’s life or health is in
danger, they will inform the appropriate county or state agency. Also, if they feel that your life or health is in serious danger,
they will contact emergency assistance. (2) At some point in the future this research may be done by another organization. If
that happens, with your consent, we would give contacting information for you and your child to the other organization.
The interviewer will ask for your permission before approaching your child for an interview. At that point, your child may
choose whether or not to participate in the study. To protect your privacy and that of your child, neither of you will know the
other’s answers to the interview questions. Answers obtained during all NSCAW surveys will be combined with those from
thousands of others from around the country. The results will be reported only in percentages, averages and other statistics.
Where do I get more information about the study?
If you have other questions about this survey, you may call toll-free: Pat Crowley at RTI, 1-877-254-1953, extension 67. If
you have questions about your rights as a study participant, call toll-free: RTI’s Office of Human Research Protections at
1-866-214-2043.

Version 3C June 2011

QUESTIONS AND ANSWERS FOR LEGAL GUARDIANS ABOUT THE
THE NATIONAL SURVEY OF CHILD AND
ADOLESCENT WELL-BEING (NSCAW)
The National Survey of Child and Adolescent Well-Being is the first ever nationwide study of children and families
who have come into contact with the child welfare system. In this fact sheet, you will find answers to some of the
most common questions that are asked about the survey.
What is the National Survey on Child and Adolescent Well-Being?
The National Survey of Child and Adolescent Well-Being (NSCAW) is designed to collect data from children and
their parents or other caregiver. Information will also be collected from teachers, caseworkers and child welfare
agency records. The information will be used to learn about the needs of children and families, about the kinds of
services used by children and families, and about other services provided by child welfare agencies.
Who is doing this study?
The survey is being sponsored by the Administrative for Children and Families (ACF) of the U.S. Department of
Health and Human Services. RTI International (RTI) is conducting the survey and is not affiliated with the child
welfare agency.
Who is RTI International?
RTI International (RTI) is a not-for-profit research organization located in North Carolina. RTI conducts research
projects for a wide variety of government agencies, universities, and private companies. Researchers at ACF have
contracted with RTI to conduct data collection for the National Survey of Child and Adolescent Well-Being.
How was the child chosen?
In doing this survey, we cannot talk to everyone in the country. That would cost too much and take too long. So, we
scientifically selected in 2008 and 2009 a “sample” of children who had come into contact with the child welfare
system. The sampled child may have participated in an earlier round of interviews. We want to talk with the child
again to find out how things have changed for him or her and his or her family.
We must have permission from a parent or legal guardian before we observe or talk with the child. At that point, the
child may choose whether or not to participate in the study. We want to interview the child about his or her
experiences with school, friends, and his or her family. Because his or her contribution is important, we will give the
child a gift card for participating in this round of interviews. The amount of the gift certificate is $20 for children age
11 or older and $10 for children younger than 11. We will also pay current caregivers $50 in cash for participating in
this round of interviews.
How will the child be involved?
The child’s involvement will vary depending on his or her age. Young children will be observed by a professional RTI
interviewer to assess their development and language skills. The interviewer will talk with older children about their
development, family experiences, school, and friends. We are asking your permission to observe or talk with the
sampled child; we will ask the caregiver for their (unofficial) permission to talk with the child as well.
How is the study being conducted?
A professional RTI interviewer will make a personal visit to interview the child’s primary caregiver, the person most
involved in the child’s day to day care. The interviewer will read the questions off of a computer screen and type the
answers into the computer.
We will ask your permission to use in our research any information we may obtain from child welfare agency records.
Version 3F June 2011

How long will it take?
The length of the interview varies by the age of the child and his or her family experiences, and averages between 60
and 90 minutes. We will schedule the interview whenever it is most convenient for the child and his or her family.
Are the questions personal?
Some questions may seem a little personal to some people. All answers are confidential; no one else (even other
household members) will know what was said during the interview. Respondents do not have to answer any question
that they do not want to answer.
What happens to the information?
The information the interviewer enters into the computer is sent to RTI. by the computer in a way that is safe and
secure. The answers are then combined with other interviews and reported in summary form. The child’s name will
not be linked with the information he or she provides. Names and other identifying information will be kept separate
from answers, and will only be used when we or other researchers contact the child and his or her family again for
another interview. RTI may also telephone the child’s caregiver or send a letter to check on the quality of the
interviewer’s work.
How will child welfare agency personnel be contacted?
We may obtain information from talking to the child’s caseworker. The caseworker will be asked questions about the
child welfare services provided to the child and his or her family and to refer to the child’s service records.
What about Confidentiality?
To protect the privacy of the child, neither the child nor the caregiver will know the other’s answers to the interview
questions. Answers obtained during all NSCAW surveys will be combined with those from thousands of others from
around the country. The results will be reported only in percentages, averages and other statistics. All information
collected as part of the study will be held strictly confidential. All RTI staff members and interviewers have signed a
Confidentiality Agreement guaranteeing that they will not reveal any information to anyone other than authorized
project staff. In addition, RTI has obtained a federal Certificate of Confidentiality for this study to protect the identity
of the research subjects.
There are two important exceptions. (1) If the interviewer or project staff think that the child’s life or health is in
danger, they will inform the appropriate county or state agency. (2) At some point in the future this research may be
done by another organization. If that happens, with your consent, we would give contacting information for the child
to the other organization.
Where do I get more information about the study?
If you have other questions about this survey, you may call toll-free: Pat Crowley at RTI, 1-877-254-1953, extension
67. If you have any questions about your rights, or that of the child as a study participant, call toll-free: RTI’s Office
of Human Research Protections at 1-866-214-2043.

Version 3F June 2011

QUESTIONS AND ANSWERS ABOUT THE
THE NATIONAL SURVEY OF CHILD AND
ADOLESCENT WELL-BEING (NSCAW)
Emancipated Youth Survey
You have been asked to participate in an important study called the National Survey of Child and Adolescent WellBeing. Here you will find answers to some of the most common questions that are asked about the survey.
What is the National Survey on Child and Adolescent Well-Being?
The National Survey of Child and Adolescent Well-Being (NSCAW) is the first ever nationwide study of children and
families who have come into contact with the child welfare system. NSCAW is designed to follow children as they
grow older to collect data on their health and well-being. The information will be used to learn about the needs of
children and families, and to make improvements to the child welfare system.
Why should I participate?
This is an opportunity to have your voice heard and to talk about your needs and experiences from your own point of
view. You participated in an earlier round of interviews. We are following up with participants approximately 36
months after the first interview to see how things may have changed. Because your contribution is important, we will
pay you $50 for participating in the interview.
Who is doing this study?
The study is being sponsored by the Administration for Children and Families (ACF) of the U.S. Department of Health
and Human Services. RTI International (RTI) is conducting the study and is not affiliated with the child welfare
agency.
Who is RTI International?
RTI is a not-for-profit research organization located in North Carolina. RTI conducts research projects for a wide
variety of government agencies, universities, and private companies. Professional RTI representatives in your area are
conducting the interviews with children, families, and caseworkers.
How was I chosen?
In doing this survey, we cannot talk to everyone in the country. That would cost too much and take too long. So, we
scientifically selected a sample of children who had come into contact with the child welfare system in 2008 or
2009.You are among over 5,300 youths randomly selected and participating in the survey. We want to interview you
about your life experiences, health, behaviors, and transition to adulthood.
How will I be involved?
A professional RTI representative will ask you questions about your life experiences. The questions will focus on your
health, employment, relationships, social support system, behaviors, and use of services. The interviewer will also ask
you about the community in which you live, and about things that may happen in your life like violence in the home,
drug abuse, and other risky behaviors such as drinking, sexual activity, drug use, and involvement with the police.
How is the study being conducted?
A professional RTI representative in your area will contact you to schedule a personal visit to your home (or another
designated location) to interview you. The interviewer will read the questions off of a computer screen and type the
answers into the computer.
Upon completion of the interview, we will request permission to keep and use in our research any information we may
obtain from child welfare agency records. If you have received services since the last interview, we may also
interview your caseworker. If you are currently living with or have lived with a parent, grandparent, or other adult
who took care of you in the last three months, we will request your permission to also talk with that person.
Version 3X June 2011

How will I recognize the RTI interviewer?
The interviewer will carry an RTI identification badge with his or her picture on it. The interviewer will also have a
letter of authorization from the Children’s Bureau, U.S. Department of Health and Human Services, and RTI.
How long will it take?
The interview averages 90 minutes. We will schedule the interview whenever it is most convenient for you.
Are the questions personal?
Some questions may seem a little personal to some people. All answers are confidential; no one else (even other
household members) will know what you say during the interview. You do not have to answer any question that you
do not want to answer.
What happens to the information?
The information the interviewer enters into the computer is sent to RTI by the computer in a way that is safe and
secure. The answers are then combined with other interviews and reported in summary form. Your name will not be
linked with the information you provide. Your name and other identifying information will be kept separate from your
answers. Your name, address and other identifying information will only be used when we or other researchers contact
you again. RTI may also telephone you or send a letter to check on the quality of the interviewer’s work.
How will child welfare personnel and caregivers be contacted?
We will ask permission to keep and use in our research any information we may obtain from child welfare agency
records. The caseworker will be asked questions about the child welfare services provided to you and your family and
will be asked to refer to your service records.
If you are currently living with or have lived with a parent, grandparent, or other adult who took care of you in the last
three months, we will request your permission to also talk with that person. He/she may have been interviewed before
by one of our professional interviewers. This interview will be very similar to the one done before. The person who
took care of you will be asked questions about services your family received, family relationships and support, life
experiences, and involvement with school and community activities. He/she will also be asked about your learning,
behavior, health, and friendships.
What about Confidentiality?
All RTI staff members and interviewers have signed a Confidentiality Agreement guaranteeing that they will not
reveal any information to anyone other than authorized project staff. In addition, RTI has obtained a federal Certificate
of Confidentiality for this study to protect the identity of the research subjects. All information collected as part of the
study will be held strictly confidential, and nothing you tell us will be reported with your name.
However, there are two important exceptions. (1) If the interviewer or project staff think that your life or health, or the
life or health of a child in your care, is in serious danger, they will contact emergency assistance. (2) At some point in
the future this research may be done by another organization. If that happens, with your consent, we would give
contacting information for you to the other organization.
We will ask for your permission before we contact your teacher or caregiver. To protect privacy, answers obtained
during all NSCAW surveys will be combined with those from thousands of others from around the country. The
results will be reported only in percentages, averages and other statistics.
Where do I get more information about the study?
If you have other questions about this survey, you may call toll-free: Pat Crowley at RTI, 1-877-254-1953, extension
67. If you have questions about your rights as a study participant, call toll-free: RTI’s Office of Human Research
Protections at 1-866-214-2043.

Version 3X June 2011

QUESTIONS AND ANSWERS ABOUT THE
THE NATIONAL SURVEY OF CHILD AND
ADOLESCENT WELL-BEING (NSCAW)
Caregiver of Emancipated Youth Survey
The National Survey of Child and Adolescent Well-Being is the first ever nationwide study of children and families
who have come into contact with the child welfare system. In this fact sheet, you will find answers to some of the
most common questions that are asked about the survey.
What is the National Survey on Child and Adolescent Well-Being?
The National Survey of Child and Adolescent Well-Being (NSCAW) is designed to collect data from children and
their parents or guardians. Information will also be collected from teachers, caseworkers and agency records. The
information will be used to learn about the needs of children and families, about the kinds of services used by children
and families, and about other services provided by child welfare agencies.
Why should I participate?
This is an opportunity to have your voice heard, to talk about your child’s needs from your own point of view, and help
other families in similar situations. You may have participated in an earlier round of interviews. We are following up
with families approximately 36 months after the first interview to see how things may have changed.
Who is doing this study?
The study is sponsored by the Administration for Children and Families (ACF) of the U.S. Department of Health and
Human Services. RTI International (RTI) is conducting the survey and is not affiliated with the child welfare agency.
Who is RTI International?
RTI International (RTI) is a not-for-profit research organization located in North Carolina. RTI conducts research
projects for a wide variety of government agencies, universities, and private companies. Professional RTI
representatives in your area are conducting the interviews with children, families, and caseworkers.
How was I chosen?
In doing this survey, we cannot talk to everyone in the country. That would cost too much and take too long. So, we
scientifically selected a sample of children who had come into contact with the child welfare system. A child currently
or very recently in your care is among over 5,300 children randomly selected and participating in the study. This child
has given us permission to contact you. We want to interview you about your child and your family. Your
contribution is important, and we will pay you $50 for your time.
How will I be involved?
You will be asked to answer questions about the child’s development, including his or her learning, behavior, health,
and friendships. You will also be asked about the services your family receives and your family’s situation.
To help us understand how the well-being of children changes over time, we or other researchers conducting this study
may contact your child in the future to update our information. Each of these additional interviews will also be
completely voluntary.
How will I recognize the RTI interviewer?
The interviewer will carry an RTI identification badge with his or her picture on it. The interviewer will also have a
letter of authorization from the Children’s Bureau, U.S. Department of Health and Human Services, and RTI.
How long will it take?
The caregiver interview averages about 100 minutes. We will schedule the interview when it is most convenient for
you.

Version 3P June 2011

Are the questions personal?
Some questions may seem a little personal to some people. All answers are confidential; no one else (even other
household members) will know what you say during the interview. You do not have to answer any question that you
do not want to answer.
What happens to the information?
The information the interviewer enters into the computer is sent to RTI by the computer in a way that is safe and
secure. The answers are then combined with other interviews and reported in summary form. Your name and your
child’s name will not be linked with the information you provide. Your names and other identifying information will
be kept separate from your answers, and your name, address and other identifying information will only be used when
it is time to contact the child again for another interview. RTI may also telephone you or send a letter to check on the
quality of the interviewer’s work.
What about Confidentiality?
All RTI staff members and interviewers have signed a Confidentiality Agreement guaranteeing that they will not
reveal any information to anyone other than authorized project staff. In addition, RTI has obtained a federal Certificate
of Confidentiality for this study to protect the identity of the research subjects. All information collected as part of the
study will be held strictly confidential, and nothing you tell us will be reported with your name.
However, there are two important exceptions. (1) If the interviewer or project staff think that your child’s life or health
is in danger, they will inform the appropriate county or state agency. Also, if they feel that your life or health is in
serious danger, they will contact emergency assistance. (2) At some point in the future this research may be done by
another organization. If that happens, with your consent, we would give contacting information for you and your child
to the other organization.
To protect your privacy and that of your child, neither of you will know the other’s answers to the interview questions.
Answers obtained during all NSCAW surveys will be combined with those from thousands of others from around the
country. The results will be reported only in percentages, averages and other statistics.
Where do I get more information about the study?
If you have other questions about this survey, you may call toll-free: Pat Crowley at RTI, 1-877-254-1953, extension
67. If you have questions about your rights as a study participant, call toll-free: RTI’s Office of Human Research
Protections at 1-866-214-2043.

Version 3P June 2011

QUESTIONS AND ANSWERS ABOUT THE
THE NATIONAL SURVEY OF CHILD AND
ADOLESCENT WELL-BEING (NSCAW)
Young Adult Survey
You have been asked to participate in an important study called the National Survey of Child and Adolescent WellBeing. Here you will find answers to some of the most common questions that are asked about the survey.
What is the National Survey on Child and Adolescent Well-Being?
The National Survey of Child and Adolescent Well-Being (NSCAW) is the first ever nationwide study of children and
families who have come into contact with the child welfare system. NSCAW is designed to follow children and young
adults as they grow older to collect data on their health and well-being. The information will be used to learn about the
needs of children and families, and to make improvements to the child welfare system.
Why should I participate?
You participated in an earlier round of interviews. At that time, we may have also interviewed your parent or
guardian. We are following up with participants approximately 36 months after the initial interview to see how things
may have changed. This is an opportunity to have your voice heard and to talk about your needs and experiences from
your own point of view. Because your contribution is important, we will pay you $50 for participating in this round of
interviews.
Who is doing this study?
The study is being sponsored by the Administration for Children and Families (ACF) of the U.S. Department of Health
and Human Services. RTI International (RTI) is conducting the study and is not affiliated with the child welfare
agency.
Who is RTI International?
RTI is a not-for-profit research organization located in North Carolina. RTI conducts research projects for a wide
variety of government agencies, universities, and private companies. Professional RTI representatives in your area are
conducting the interviews with children, young adults, families, and caseworkers.
How was I chosen?
In doing this survey, we cannot talk to everyone in the country. That would cost too much and take too long. So, we
scientifically selected a sample of children and adolescents who had contact with the child welfare system in 2008 or
2009.You are among over 5,300 youths randomly selected and participating in the survey. We want to interview you
about your life experiences, health, behaviors, and transition to adulthood.
How will I be involved?
A professional RTI representative will ask you questions about your life experiences. The questions will focus on your
health, employment, relationships, social support system, behaviors, and use of services. The interviewer will also ask
you about the community in which you live and about things that may happen in your life. Questions about sensitive
things like violence in the home, drug abuse, and other risky behaviors such as drinking, sexual activity, drug use, and
involvement with the police will be asked directly by the computer, and you will enter your own responses.
How is the study being conducted?
A professional RTI representative in your area will contact you to schedule a personal visit to your home (or another
designated location) to interview you. The interviewer will read the questions off of a computer screen and type the
answers into the computer.

Version 3YA June 2011

Upon completion of the interview, we will request permission to keep and use in our research any information we may
obtain from child welfare agency records. If you have received services since the last interview, we may also
interview your caseworker.
How will I recognize the RTI interviewer?
The interviewer will carry an RTI identification badge with his or her picture on it. The interviewer will also have a
letter of authorization from the Children’s Bureau, U.S. Department of Health and Human Services, and RTI.
How long will it take?
The interview averages 90 minutes. We will schedule the interview whenever it is most convenient for you.
Are the questions personal?
Some questions may seem a little personal to some people. All answers are confidential; no one else (even other
household members) will know what you say during the interview. You do not have to answer any question that you
do not want to answer.
What happens to the information?
The information the interviewer enters into the computer is sent to RTI by the computer in a way that is safe and
secure. The answers are then combined with other interviews and reported in summary form. Your name will not be
linked with the information you provide. Your name and other identifying information will be kept separate from your
answers. Your name, address and other identifying information will only be used when we or other researchers contact
you again. RTI may also telephone you or send a letter to check on the quality of the interviewer’s work.
What about Confidentiality?
All RTI staff members and interviewers have signed a Confidentiality Agreement guaranteeing that they will not
reveal any information to anyone other than authorized project staff. In addition, RTI has obtained a federal Certificate
of Confidentiality for this study to protect the identity of the research subjects. All information collected as part of the
study will be held strictly confidential, and nothing you tell us will be reported with your name.
However, there are two important exceptions. (1) If the interviewer or project staff think that your life or health, or the
life or health of a child in your care, is in serious danger, they will contact emergency assistance. (2) At some point in
the future this research may be done by another organization. If that happens, with your consent, we would give
contacting information for you to the other organization.
To protect privacy, answers obtained during all NSCAW surveys will be combined with those from thousands of
others from around the country. The results will be reported only in percentages, averages and other statistics.
Where do I get more information about the study?
If you have other questions about this survey, you may call toll-free: Pat Crowley at RTI, 1-877-254-1953, extension
67. If you have questions about your rights as a study participant, call toll-free: RTI’s Office of Human Research
Protections at 1-866-214-2043.

Version 3YA June 2011

Consent and Assent Forms

Caseworker Consent
Caregiver Consent (long version)
Caregiver Consent (short version)
Emancipated Youth Consent
Caregiver of Emancipated Youth Consent
Young Adult Consent

Caregiver Permission for Child (long version)
Caregiver Permission for Child (short version)
Second Caregiver Permission for Child (long version)
Legal Guardian Permission for Child
Legal Guardian Permission for Minor Caregiver

Agreement for Youth Age 7-10
Agreement for Youth Age 11 -17

Caregiver Teacher Authorization
Emancipated Youth Teacher Authorization

Caseworker Consent
National Survey of Child and Adolescent Well-Being (NSCAW)
NSCAW
The Administration for Children and Families of the U.S. Department of Health and Human Services is funding a
national longitudinal survey of children and families in the child welfare system. RTI International (RTI), a not-forprofit research organization in North Carolina, and staff at ICF Caliber, Walter R. McDonald & Associates, Inc
(WRMA), Tufts-New England Medical Center, the Child and Adolescent Services Research Center, and the
University of Illinois at Urbana-Champaign are conducting this survey.
SELECTION OF PARTICIPANTS
RTI representatives are contacting families of children randomly selected in 2008 and 2009 from child welfare
agencies throughout the United States. There are over 5,300 children and families participating in this study. You
have been identified as the primary caseworker or service provider for one of the participating children. We are
following up with the sampled children and their current caregivers approximately 36 months after the close of the
index investigation.
CASEWORKER INTERVIEWS
The caseworker interview collects information about the child’s history in the child welfare system and services
recommended or provided by the agency. Your answers combined with the answers of others in the study will help
us describe the needs of children and their use of available child welfare services. The information will be
summarized in research reports and be used to help policy makers improve the child welfare system.
VOLUNTARY PARTICIPATION
Your participation in this study is completely voluntary. You can refuse to answer any and all questions. Your
decision about participation will not affect you, your job, or any services that the child may be receiving. You have
the right to stop the interview at any time.
RISKS
There are no physical risks to you from participating in this interview. It is possible that some questions might make
you uncomfortable or feel various emotions, such as sadness.
BENEFITS
There are no direct benefits to you, to the caregiver, or to the child from answering our questions. However, you will
be helping us learn more about the needs of children and the services available to them.
CONFIDENTIALITY
Your answers will be entered into a computer and labeled with a case identification number. Your name and that of
the child will not be reported with any information you provide. Information you provide will be combined with
answers of thousands of others and reported in a summary form. All staff involved in this research are committed to
confidentiality and have signed a Confidentiality Pledge. In addition, RTI has obtained a federal Certificate of
Confidentiality for this study to protect the identity of the research subjects.
QUESTIONS
If you have any questions about the study, you may call Pat Crowley at RTI, 1-877-254-1953 extension 67 (toll-free
number). If you have any questions about your rights as a study participant, you may call RTI's Office of Human
Research Protection at 1-866-214-2043 (a toll-free number).
You will be given a copy of this consent form to keep.
Page 1 of 2

Disposition: Original to RTI; Copy to Respondent

Version 3A June 2011

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection unless it displays a
valid OMB control number. The valid OMB control number for this information collection is 0970-0202 (Exp Date:
10/31/2012). The time required to complete the initial interview is estimated to be 60 minutes.
The Federal Government has issued a Certificate of Confidentiality (authorized by the Public Health Service Act Section
301(d), 42 U.S.C Section 241 (d), 1988) to the researchers who are conducting this study which authorizes us to protect the
privacy of individuals who participate.

The above information has been explained to me, and my signature below indicates that I give consent for my
interview.

We are using a laptop quality control (QC) system for this study. The system runs on the computer and
may record what you and I say to each other during parts of the interview. Neither you nor I will know
when the computer is recording our conversation. The recording will be reviewed by project staff at RTI to
monitor my work. The recordings will only be used for those purposes and will be kept confidential. The
files will be destroyed after they have been used to review my work. Those project staff who listen to the
recording will know who I am, but will not know who you are. Is it all right with you if this QC system
runs during this interview?
Check one box.
Yes, I consent to having portions of this interview recorded by the computer to test the quality control
system.
No, I do not want any portion of this interview recorded.

Printed Name of Caseworker

Fill in CW Respondent 8-digit ID #

Printed Name of Youth

Signature of Caseworker

Signature of Interviewer

Date

Page 2 of 2

Disposition: Original to RTI; Copy to Respondent

Version 3A June 2011

Caregiver Consent
National Survey of Child and Adolescent Well-Being (NSCAW)
NSCAW
The Administration for Children and Families of the U.S. Department of Health and Human Services is funding a national
longitudinal survey of children and families in contact with the child welfare system. RTI International (RTI), a not-for-profit
research organization in North Carolina, and staff at ICF Caliber, Walter R. McDonald & Associates, Inc (WRMA), Tufts-New
England Medical Center, the Child and Adolescent Services Research Center, and the University of Illinois at Urbana-Champaign
are conducting this survey.
SELECTION OF CHILDREN
RTI representatives are contacting families of children selected in 2008-2009 from child welfare agencies throughout the United
States. Your child is among over 5,300 children selected to be interviewed. We are following up with sampled children and their
caregivers approximately 36 months after the initial interview. We must have permission from a parent or legal guardian before
we observe or talk with the child. At that point, your child may choose whether or not to participate in the study.
PURPOSE OF THIS NSCAW INTERVIEW
We want to interview you about your child and your family. Your answers combined with the answers of other caregivers in the
study will help us describe the needs of children and their use of available child welfare services. The information will be
summarized in research reports and be used to help policy makers improve the child welfare system.
TYPES OF QUESTIONS FOR PARENTS
The caregiver interview takes about 100 minutes, depending on the age of the child and other factors. The interviewer will ask
questions about your child’s learning, behavior at home and at school, health, and relationships with friends. You will also be
asked about services your child or family may receive, including your level of satisfaction with those services. In addition, we will
ask questions about your attitudes about raising children, life experiences, family support, involvement with school and
community activities, your interaction with your child, and things that may happen in your family like violence in the home, drug
abuse, and other risky behaviors such as drinking, drug use, and involvement with the police.
TYPES OF QUESTIONS FOR CHILD
The interview with your child will last about 60-90 minutes, depending on the child's age and personal experiences. You will not
know how your child answers the questions. Children will be observed to assess their language skills and how well they
understand and perform certain tasks. Depending on their age, they will also be interviewed about their abilities, their experiences
at home and at school, their feelings about family and friends, and their exposure to violence.
VOLUNTARY PARTICIPATION
Your participation in this study is completely voluntary. You can refuse to answer any and all questions. Your refusal would not
affect any benefits that you or your child may be receiving. You have the right to stop the interview at any time. Your child’s
participation in this study is also completely voluntary. He or she can refuse to answer any and all questions. His or her refusal
would not affect any benefits or services that he/she may be receiving. Your child has the right to stop the interview at any time.
RISKS
There are no physical risks to you or your child from participating in this interview. It is possible that some questions might make
you or your child uncomfortable or feel various emotions, such as sadness. If we learn during the course of these interviews that
the life or health of the child is in danger, we will share that information with the appropriate county or state agency. More
information is provided in the Confidentiality section below.
BENEFITS
There are no direct benefits to you or your child from answering our questions. However, you will be helping us learn more about
the needs of children and the services available to them.
FUTURE CONTACTS
To help us understand how the well-being of children changes over time, we or other researchers may contact you and your child
in the future to update our information. Each of these additional interviews will also be completely voluntary.
CONFIDENTIALITY
Your answers will be entered into a computer and labeled with a case identification number. Your name and that of your child will
not be reported with any information you provide. Information you provide will be combined with answers of thousands of others
and reported in a summary form. To protect the privacy of both you and your child, neither of you will know the other’s interview
answers. All staff involved in this research are committed to confidentiality and have signed a Confidentiality Pledge. In addition,
RTI has obtained a federal Certificate of Confidentiality for this study to protect the identity of the research subjects.
There are two important exceptions. (1) If the interviewer or project staff think that your child’s life or health is in danger, they
will inform the appropriate county or state agency. Also, if they think that your life or health is in serious danger, they will contact
emergency assistance. (2) At some point in the future this research may be done by another organization. If that happens, with
your consent, we would give contacting information for you and your child to the other organization.

Page 1 of 2

Disposition: Original to RTI; Copy to Respondent

Version 3CL June 2011

QUESTIONS
If you have any questions about the study, you may call Pat Crowley at the RTI, 1-877-254-1953 extension 67 (toll-free number).
If you have any questions about your rights as a study participant, you may call RTI 's Office of Human Research Protections at 1866-214-2043 (a toll-free number).
You will be given a copy of this consent form to keep.
Because your contribution is important, we will pay you $50 in cash for participating in the interview. We will also give your
child a gift certificate for participating. The amount of the gift certificate is $20 for children age 11 or older and $10 for children
age 10 or younger. If you participate in future rounds, you and your child will be paid for participating in the in-person interviews.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection unless it displays a
valid OMB control number. The valid OMB control number for this information collection is 0970-0202 (Exp Date:
10/31/2012). The time required to complete the parent interview is estimated to be 100 minutes. The time required to
complete the child interview is also estimated to be 60-90 minutes, depending on the child’s age and personal experiences.
The Federal Government has issued a Certificate of Confidentiality (authorized by the Public Health Service Act Section
301(d), 42 U.S.C Section 241 (d), 1988) to the researchers who are conducting this study which authorizes us to protect the
privacy of individuals who participate.

The above information has been explained to me, and my signature below indicates that I give consent for my
interview.
I give consent for having contacting information for me and my child given to another research organization if they
start doing this study.

Yes

No

Check one box.

We are using a laptop quality control (QC) system for this study. The system runs on the computer and may record
what you and I say to each other during parts of the interview. Neither you nor I will know when the computer is
recording our conversation. The recording will be reviewed by project staff at RTI to monitor my work. The
recordings will only be used for those purposes and will be kept confidential. The files will be destroyed after they
have been used to review my work. Those project staff who listen to the recording will know who I am, but will not
know who you are. Is it all right with you if this QC system runs during this interview?
Check one box.
Yes, I consent to having portions of this interview recorded by the computer to test the quality control
system.
No, I do not want any portion of this interview recorded.

Printed Name of Parent/Caregiver

Fill in CCG Respondent 8-digit ID #

Printed Name of Youth

Signature of Parent/Caregiver

Signature of Interviewer

Date

Page 2 of 2

Disposition: Original to RTI; Copy to Respondent

Version 3CL June 2011

Caregiver Consent (short version)
National Survey of Child and Adolescent Well-Being (NSCAW)

TYPES OF QUESTIONS FOR PARENTS
The caregiver interview takes about 100 minutes, depending on the age of the child and other factors. The interviewer
will ask questions about your child’s learning, behavior at home and at school, health, and relationships with friends.
You will also be asked about services your child or family may receive, including your level of satisfaction with those
services. In addition, we will ask questions about your attitudes about raising children, life experiences, family
support, involvement with school and community activities, your interaction with your child, and things that may
happen in your family like violence in the home, drug abuse, and other risky behaviors such as drinking, drug use, and
involvement with the police. If you are the child’s legal guardian, we are asking your permission to keep and use in
our research any information we may obtain from child welfare agency records.
The voluntary participation, risks, benefits, and confidentiality of this survey are the same as those described to you on
the consent form you signed before your child’s interview. You will be given a copy of this consent form to keep.
Because your contribution is important, we will pay you $50 in cash for participating in the interview. If you
participate in future rounds, you will be paid for participating in the in-person interviews.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection unless it displays a
valid OMB control number. The valid OMB control number for this information collection is 0970-0202 (Exp Date:
10/31/2012). The time required to complete the parent interview is estimated to be 100 minutes. The time required to
complete the child interview is estimated to be 60-90 minutes, depending on the child’s age and personal experiences.
The Federal Government has issued a Certificate of Confidentiality (authorized by the Public Health Service Act Section
301(d), 42 U.S.C Section 241 (d), 1988) to the researchers who are conducting this study which authorizes us to protect the
privacy of individuals who participate.

The above information has been explained to me, and my signature below indicates that I have completed a longversion consent for permission to approach my child for an interview and give consent for my interview.
I give consent for having contacting information for me and my child given to another research organization if they
start doing this study.

Yes

No

Check one box.

We are using a laptop quality control (QC) system for this study. The system runs on the computer and may record
what you and I say to each other during parts of the interview. Neither you nor I will know when the computer is
recording our conversation. The recording will be reviewed by project staff at RTI to monitor my work. The
recordings will only be used for those purposes and will be kept confidential. The files will be destroyed after they
have been used to review my work. Those project staff who listen to the recording will know who I am, but will not
know who you are. Is it all right with you if this QC system runs during this interview?
Check one box.
Yes, I consent to having portions of this interview recorded by the computer to test the quality control
system.
No, I do not want any portion of this interview recorded.

Printed Name of Parent/Caregiver

Fill in CCG Respondent 8-digit ID #

Printed Name of Youth

Signature of Parent/Caregiver

Signature of Interviewer

Date

Page 1 of 1

Disposition: Original to RTI; Copy to Respondent

Version 3C June 2011

Emancipated Youth Consent Form / Permission for Caregiver Interview
National Survey of Child and Adolescent Well-Being (NSCAW)
NSCAW
The federal government is funding a national survey of children and families in contact with the child welfare system. RTI
International (RTI), a not-for-profit research organization in North Carolina, and staff at ICF Caliber, Walter R. McDonald &
Associates, Inc (WRMA), Tufts-New England Medical Center, the Child and Adolescent Services Research Center, and the
University of Illinois at Urbana-Champaign are conducting this survey.
SELECTION OF YOUTH
RTI representatives are contacting families of youth, like you, selected from child welfare agencies throughout the United States.
You are among over 5,300 youth randomly selected to be interviewed. We are following up with participants approximately 36
months after the initial interview.
PURPOSE OF THIS NSCAW INTERVIEW
The interview averages 90 minutes. We want to talk to you about the kinds of things you can do, how you behave at home and at
school, how you feel about your family, your friends, and school, and about people who may help you. We also want to ask you
about things you may do, such as skipping school, smoking, drinking, vandalism, using drugs, sexual activities, and other risky or
illegal behaviors. Your answers, combined with the answers of other youth in the study, will help us describe the needs of children
and adolescents and their use of available child welfare services. The information you give will be summarized in research reports
and be used to help policy makers improve the child welfare system.
If you are currently living with or have lived with a parent, grandparent, or other adult who took care of you in the last three
months, we will request your permission to also talk with that person.
PURPOSE OF THE CAREGIVER INTERVIEW
The interview with the person who took care of you may last up to 100 minutes. He/she will be asked questions about services
your family receives, family relationships and support, life experiences, and involvement with school and community activities.
He/she will also be asked about your learning, behavior, health, and friendships.
VOLUNTARY PARTICIPATION
Your participation in this study is completely voluntary. If you don’t want to be interviewed, that is okay. If you don’t want to
answer a certain question, that is also okay. Your refusal would not affect any benefits that you may be receiving. You have the
right to take a break, or stop the interview at any time.
RISKS
There are no physical risks to you from participating in this interview. It is possible that some questions might make you
uncomfortable or feel various emotions, such as sadness.
BENEFITS
There are no direct benefits to you from answering our questions. However, you will be helping us learn more about the needs of
children and adolescents, and the services available to them.
FUTURE CONTACTS
To help us understand your,needs, and how they change over time, we or other researchers may contact you in the future to update
our information. Each of these additional interviews will also be completely voluntary.
CONFIDENTIALITY
Your answers will be entered into a computer and labeled with a number instead of your name so no one else will know these are
your answers. No one will see your answers to any of these questions. Your name will not be reported with any information you
provide. Information you provide will be combined with answers of many others and reported in a summary form. All staff
involved in this research are committed to confidentiality and have signed a Confidentiality Pledge. In addition, RTI has obtained
a federal Certificate of Confidentiality for this study to protect the identity of the research subjects.
There are two exceptions. (1) If the interviewer or project staff feel that the life or health of a child in your care is in serious
danger, they will inform the appropriate county or state agency. Also, if they feel that your life or health is in serious danger, they
will contact emergency assistance. (2) At some point in the future this research may be done by another organization. If that
happens, with your consent, we would give contacting information for you to the other organization.

Page 1 of 2

Disposition: Original to RTI; Copy to Respondent

Version 3X June 2011

QUESTIONS
If you have any questions about the study, you may call Pat Crowley at RTI, 1-877-254-1953 extension 67 (toll-free number). If
you have any questions about your rights as a study participant, you may call RTI’s Office of Human Research Protections, 1-866214-2043 (toll-free number).
You will be given a copy of this consent form to keep.
Because your contribution is important, we will pay you $50 in cash for participating in the interview. If you participate in future
rounds, you will be paid for participating in the in-person interviews.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection unless it displays a
valid OMB control number. The valid OMB control number for this information collection is 0970-0202 (Exp Date:
10/31/2012). The time required to complete the child interview is estimated to be 120 minutes. The time required to
complete the parent interview is estimated to be 100 minutes.
The Federal Government has issued a Certificate of Confidentiality (authorized by the Public Health Service Act Section
301(d), 42 U.S.C Section 241 (d), 1988) to the researchers who are conducting this study which authorizes us to protect the
privacy of individuals who participate.
The above information has been explained to me, and my signature below indicates that I give consent for my interview.
I give consent for having contacting information for me given to another research organization if they start doing this study.

Yes

No

Check one box.

I am currently living with or have lived with a caregiver in the last three months and give my permission for my current / most
recent caregiver to be approached for an interview.

Yes

No

Check one box.

We are using a laptop quality control (QC) system on this study. The system runs on the computer and may record what you and I
say to each other during parts of the interview. Neither you nor I will know when the computer is recording our conversation.
The recording will be reviewed by project staff at RTI to monitor my work. The recordings will only be used for those purposes
and will be kept confidential. The files will be destroyed after they have been used to review my work. Those project staff who
listen to the recording will know who I am, but will not know who you are. Is it all right with you if this QC system runs during
this interview?
Check one box.
Yes, I consent to having portions of this interview recorded by the computer to test the quality
control system.
No, I do not want any portion of this interview recorded.

Printed Name of Youth

Fill in Youth Respondent 8-digit ID #

Signature of Youth

Signature of Interviewer

Page 2 of 2

Disposition: Original to RTI; Copy to Respondent

Date

Version 3X June 2011

Caregiver of Emancipated Youth Consent
National Survey of Child and Adolescent Well-Being (NSCAW)
NSCAW
The Administration on Children, Youth and Families of the U.S. Department of Health and Human Services is
funding a national longitudinal survey of children and families in the child welfare system. RTI International
(RTI),, a not-for-profit research organization in North Carolina, and staff at ICF Caliber, Walter R. McDonald &
Associates, Inc (WRMA), Tufts-New England Medical Center, the Child and Adolescent Services Research Center,
and the University of Illinois at Urbana-Champaign are conducting this survey.
SELECTION OF CHILDREN
RTI representatives are contacting families of children selected in 2008-2009 from child welfare agencies
throughout the United States. We are following up with sampled children and their caregivers approximately 36
months after the initial interview. A child currently or very recently in your care is among over 5,300children
randomly selected to be interviewed. That child gave us their permission to approach you for an interview.
PURPOSE OF THIS NSCAW INTERVIEW
We want to interview you about the child and your family. Your answers combined with the answers of other care
givers in the study will help us describe the needs of children and their use of available child welfare services. The
information will be summarized in research reports and be used to help policy makers improve the child welfare
system.
TYPES OF QUESTIONS FOR PARENT
The interview averages 100 minutes. The interviewer will ask questions about the child’s learning, behavior at
home and at school, health, and relationships with friends. For older children, we will ask you about their
participation in potentially risky behaviors. You will also be asked about services your family or the youth may
receive, including your level of satisfaction with those services. In addition, we will ask questions about your
attitudes about raising children, life experiences, family support, involvement with school and community activities,
your interaction with the child and things that may happen in your family like violence in the home, drug abuse, and
other risky behaviors such as drinking, drug use, and involvement with the police.
VOLUNTARY PARTICIPATION
Your participation in this study is completely voluntary. You can refuse to answer any and all questions. Your
refusal would not affect any benefits that you or the youth may be receiving. You have the right to stop the
interview at any time.
RISKS
There are no physical risks to you from participating in this interview. It is possible that some questions might
make you uncomfortable or feel various emotions, such as sadness. If we learn during the course of these
interviews that the life or health of a child is in danger, we will share that information with the appropriate county or
state agency. More information is provided in the Confidentiality section below.
BENEFITS
There are no direct benefits to you from answering our questions. However, you will be helping us learn more
about the needs of children and the services available to them.
FUTURE CONTACTS
To help us understand how the well-being of children changes over time, we or other researchers may contact you
and the youth in the future to update our information. Each of these additional interviews will also be completely
voluntary.
CONFIDENTIALITY
Your answers will be entered into a computer and labeled with a case identification number. Your name will not be
reported with any information you provide. Information you provide will be combined with answers of many others
and reported in a summary form. To protect the privacy of both you and the youth, neither of you will know the
other’s interview answers. All staff involved in this research are committed to confidentiality and have signed a
Confidentiality Pledge. In addition, RTI has obtained a federal Certificate of Confidentiality for this study to
protect the identity of the research subjects.
There are two important exceptions. (1) If the interviewer or project staff feel that a child’s life or health is in
danger, they will inform the appropriate county or state agency. Also, if they feel that your life or health is in
serious danger, they will contact emergency assistance. (2) At some point in the future this research may be done by
another organization. If that happens, with your consent, we would give contacting information for you and the
youth to the other organization.

Page 1 of 2

Disposition: Original to RTI; Copy to Respondent

Version 3P June 2011

QUESTIONS
If you have any questions about the study, you may call Pat Crowley at the RTI, 1-877-254-1953 extension 67 (tollfree number). If you have any questions about your rights as a study participant, you may call RTI's Office of
Human Research Protections at 1-866-214-2043 (a toll-free number).
You will be given a copy of this consent form to keep.
Because your contribution is important, we will pay you $50 in cash for participating in the interview. If you
participate in future rounds, you and the youth will be paid for participating in the in-person interviews.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 09700202 (Exp Date: 10/31/2012). The time required to complete the parent interview is estimated to be 100 minutes.
The Federal Government has issued a Certificate of Confidentiality (authorized by the Public Health Service Act
Section 301(d), 42 U.S.C Section 241 (d), 1988) to the researchers who are conducting this study which
authorizes us to protect the privacy of individuals who participate.

The above information has been explained to me, and my signature below indicates that I give consent for
my interview.
I give consent for having contacting information for me given to another research organization if they
start doing this study.

Yes

No

Check one box.

We are using a laptop quality control (QC) system on this study. The system runs on the computer and
may record what you and I say to each other during parts of the interview. Neither you nor I will know
when the computer is recording our conversation. The recording will be reviewed by project staff at RTI
to monitor my work. The recordings will only be used for those purposes and will be kept confidential.
The files will be destroyed after they have been used to review my work. Those project staff who listen
to the recording will know who I am, but will not know who you are. Is it all right with you if this QC
system runs during this interview?
Check one box.
Yes, I consent to having portions of this interview recorded by the computer to test the quality
control system.
No, I do not want any portion of this interview recorded.

Printed Name of Caregiver

Fill in CCG Respondent 8-digit ID #

Printed Name of Youth

Signature of Caregiver

Signature of Interviewer

Date

Page 2 of 2

Disposition: Original to RTI; Copy to Respondent

Version 3P June 2011

Young Adult Consent
National Survey of Child and Adolescent Well-Being (NSCAW)
NSCAW
The federal government is funding a national survey of children, young adults, and families in the child welfare
system. RTI International (RTI), a not-for-profit research organization in North Carolina, and staff at ICF Caliber,
Walter R. McDonald & Associates, Inc (WRMA), Tufts-New England Medical Center, the Child and Adolescent
Services Research Center, and the University of Illinois at Urbana-Champaign are conducting this survey.
SELECTION OF SAMPLE MEMBERS
RTI representatives are contacting young adults, like you, selected from child welfare agencies throughout the United
States in 2008 or 2009. You are among over 5,300 youth randomly selected to be interviewed. We are following up
with participants approximately 36 months after the initial interview.
PURPOSE OF THIS NSCAW INTERVIEW
The interview averages 90 minutes. The interviewer will ask questions about your life experiences. The questions
will focus on your health, employment, relationships, social support system, behaviors, and use of services. The
interviewer will also ask you about the community in which you live, and about things that may happen in your life
like violence in the home, drug abuse, and other risky behaviors such as drinking, sexual activity, drug use, and
involvement with the police. Your answers combined with the answers of other young adults in the study will help
us describe the transition to adulthood and outcomes of young people who have come into contact with the child
welfare system. The information will be summarized in research reports and be used to help policy makers improve
the child welfare system and available services.
VOLUNTARY PARTICIPATION
Your participation in this study is completely voluntary. You can refuse to answer any and all questions. Your
refusal would not affect any benefits that you may be receiving. You have the right to stop the interview at any time.
RISKS
There are no physical risks to you from participating in this interview. It is possible that some questions might make
you uncomfortable or feel various emotions, such as sadness.
BENEFITS
There are no direct benefits to you from answering our questions. However, you will be helping us learn more about
the needs of young adults and the services available to them.
FUTURE CONTACTS
To help us understand how the well-being of young adults changes over time, we or other researchers may contact
you in the future to update our information. Each of these additional interviews will also be completely voluntary.
CONFIDENTIALITY
Your answers will be entered into a computer and labeled with a case identification number. Your name will not be
reported with any information you provide. Information you provide will be combined with answers of many others
and reported in a summary form. All staff involved in this research are committed to confidentiality and have signed
a Confidentiality Pledge. In addition, RTI has obtained a federal Certificate of Confidentiality for this study to
protect the identity of the research subjects.
There are two important exceptions. (1) If the interviewer or project staff feel that the life or health of a child in your
care is in serious danger, they will inform the appropriate county or state agency. Also, if they feel that your life or
health is in serious danger, they will contact emergency assistance. (2) At some point in the future this research may
be done by another organization. If that happens, with your consent, we would give contacting information for you
to the other organization.
QUESTIONS
If you have any questions about the study, you may call Pat Crowley at RTI, 1-877-254-1953 Extension 67 (toll-free
number). If you have any questions about your rights as a study participant, you may call RTI's Office of Human
Research Protections at 1-866-214-2043 (a toll-free number).
You will be given a copy of this consent form to keep.
Page 1 of 2

Disposition: Original to RTI; Copy to Respondent

Version 3YA June 2011

Because your contribution is important, we will pay you $50 in cash for participating in the interview. If you
participate in future rounds, you will be paid for participating in the in-person interviews.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection unless it displays a
valid OMB control number. The valid OMB control number for this information collection is 0970-0202 (Exp Date:
10/31/2012). The time required to complete the interview is estimated to be 90 minutes.
The Federal Government has issued a Certificate of Confidentiality (authorized by the Public Health Service Act Section
301(d), 42 U.S.C Section 241 (d), 1988) to the researchers who are conducting this study which authorizes us to protect the
privacy of individuals who participate.

The above information has been explained to me, and my signature below indicates that I give consent for my
interview.
I give consent for having contacting information for me given to another research organization if they start doing this
study.

Yes

No

Check one box.

We are using a laptop quality control (QC) system for this study. The system runs on the computer and may record
what you and I say to each other during parts of the interview. Neither you nor I will know when the computer is
recording our conversation. The recording will be reviewed by project staff at RTI to monitor my work. The
recordings will only be used for those purposes and will be kept confidential. The files will be destroyed after they
have been used to review my work. Those project staff who listen to the recording will know who I am, but will not
know who you are. Is it all right with you if this QC system runs during this interview?
Check one box.
Yes, I consent to having portions of this interview recorded by the computer to test the quality control
system.
No, I do not want any portion of this interview recorded.

Printed Name of Young Adult

Fill in YA Respondent 8-digit ID #

Signature of Young Adult

Signature of Interviewer

Page 2 of 2

Disposition: Original to RTI; Copy to Respondent

Date

Version 3YA June 2011

Caregiver Permission for Child Interview
National Survey of Child and Adolescent Well-Being (NSCAW)

NSCAW
The Administration for Children and Families of the U.S. Department of Health and Human Services is funding a
national longitudinal survey of children and families in the child welfare system. RTI International (RTI), a not-forprofit research organization in North Carolina, and staff at ICF Caliber, Walter R. McDonald & Associates, Inc
(WRMA), Tufts-New England Medical Center, the Child and Adolescent Services Research Center, and the University
of Illinois at Urbana-Champaign are conducting this survey.
SELECTION OF CHILDREN
RTI representatives are contacting families of children selected from child welfare agencies throughout the United
States. Your child is among over 5,300 children selected to be interviewed. We are following up with sampled
children and their caregivers approximately 36 months after the initial interview. We must have permission from a
parent or legal guardian before we observe or talk with the child. At that point, your child may choose whether or not
to participate in the study.
PURPOSE OF THIS NSCAW INTERVIEW
We want to interview your child about their experiences with the child welfare system, you, and your family. The
child’s answers combined with the answers of other children in the study will help us describe the needs of children
and their use of available child welfare services. The information will be summarized in research reports and be used
to help policy makers improve the child welfare system.
TYPES OF QUESTIONS FOR CHILD
The interview with your child will last about 60-90 minutes, depending on the child's age and personal experiences.
You will not know how your child answers the questions. Children will be observed to assess their language skills and
how well they understand and perform certain tasks. Depending on their age, they will also be interviewed about their
abilities, their experiences at home and at school, their feelings about family and friends, and their exposure to
violence.
VOLUNTARY PARTICIPATION
Your child’s participation in this study is also completely voluntary. He or she can refuse to answer any and all
questions. His or her refusal would not affect any benefits or services that he/she may be receiving. Your child has the
right to stop the interview at any time.
RISKS
There are no physical risks to your child from participating in this interview. It is possible that some questions might
make your child uncomfortable or feel various emotions, such as sadness. If we learn during the course of these
interviews that the life or health of the child is in danger, we will share that information with the appropriate county or
state agency. More information is provided in the Confidentiality section below.
BENEFITS
There are no direct benefits to your child from answering our questions. However, he or she will be helping us learn
more about the needs of children and the services available to them.
FUTURE CONTACTS
To help us understand how the well-being of children changes over time, we or other researchers may contact you and
your child in the future to update our information. Each of these additional interviews will also be completely
voluntary.
CONFIDENTIALITY
Your answers will be entered into a computer and labeled with a case identification number. Your name and that of
your child will not be reported with any information your child provides. Information your child provides will be
combined with answers of many others and reported in a summary form. To protect the privacy of both you and your
child, neither of you will know the other’s interview answers. All staff involved in this research are committed to
confidentiality and have signed a Confidentiality Pledge. In addition, RTI has obtained a federal Certificate of
Confidentiality for this study to protect the identity of the research subjects.
There are two important exceptions. (1) If the interviewer or project staff feel that your child’s life or health is in
danger, they will inform the appropriate county or state agency. Also, if they feel that your life or health is in serious
danger, they will contact emergency assistance. (2) At some point in the future this research may be done by another
organization. If that happens, with your consent, we would give contacting information for you and your child to the
other organization.
Page 1 of 2

Disposition: Original to RTI; Copy to Respondent

Version 3DL June 2011

QUESTIONS
If you have any questions about the study, you may call Pat Crowley at the RTI, 1-877-254-1953 extension 67 (tollfree number). If you have any questions about your rights as a study participant, you may call RTI's Office of Human
Research Protections at 1-866-214-2043 (a toll-free number).
You will be given a copy of this consent form to keep.
Because your child’s contribution is important, we will give your child a gift certificate for participating. The amount
of the gift certificate is $20 for children age 11 or older and $10 for children age 10 or younger. If your child
participates in future rounds, he or she will be paid for participating in the in-person interviews.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection unless it displays a
valid OMB control number. The valid OMB control number for this information collection is 0970-0202 (Exp Date:
10/31/2012). The time required to complete the parent interview is estimated to be 100 minutes. The time required to
complete the child interview is estimated to be 60-90 minutes, depending on the child’s age and personal experiences.
The Federal Government has issued a Certificate of Confidentiality (authorized by the Public Health Service Act Section
301(d), 42 U.S.C Section 241 (d), 1988) to the researchers who are conducting this study which authorizes us to protect the
privacy of individuals who participate.

The above information has been explained to me, and my signature below indicates that I give my permission for my
child to be approached for an interview.
I give consent for having contacting information for my child given to another research organization if they start doing
this study.

Yes

No

Check one box.

We are using a laptop quality control (QC) system for this study. The system runs on the computer and may record
what you and I say to each other during parts of the interview. Neither you nor I will know when the computer is
recording our conversation. The recording will be reviewed by project staff at RTI to monitor my work. The
recordings will only be used for those purposes and will be kept confidential. The files will be destroyed after they
have been used to review my work. Those project staff who listen to the recording will know who I am, but will not
know who you are. Is it all right with you if this QC system runs during this interview?
Check one box.
Yes, I consent to having portions of this interview recorded by the computer to test the quality control
system.
No, I do not want any portion of this interview recorded.

Printed Name of Parent/Caregiver

Fill in CCG Respondent 8-digit ID #

Printed Name of Youth

Signature of Parent/Caregiver

Signature of Interviewer

Date

Page 2 of 2

Disposition: Original to RTI; Copy to Respondent

Version 3DL June 2011

Caregiver Permission for Child Interview (short version)
National Survey of Child and Adolescent Well-Being (NSCAW)

TYPES OF QUESTIONS FOR CHILD
The interview with your child will last about 60-90 minutes, depending on the child's age and personal experiences.
You will not know how your child answers the questions. Children will be observed to assess their language skills and
how well they understand and perform certain tasks. Depending on their age, they will also be interviewed about their
abilities, their experiences at home and at school, their feelings about family and friends, and their exposure to
violence.
.
The voluntary participation, risks, benefits, and confidentiality of this survey are the same as those described to you on
the consent form you signed before your interview.
Because your child’s contribution is important, we will give your child a gift card for participating. The amount of the
gift card is $20 for children age 11 or older and $10 for children age 10 or younger. If your child participates in future
rounds, he or she will be paid for participating in the in-person interviews.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection unless it displays a
valid OMB control number. The valid OMB control number for this information collection is 0970-0202 (Exp Date:
10/31/2012). The time required to complete the parent interview is estimated to be 100 minutes. The time required to
complete the child interview is estimated to be 60-90 minutes, depending on the child’s age and personal experiences.
The Federal Government has issued a Certificate of Confidentiality (authorized by the Public Health Service Act Section
301(d), 42 U.S.C Section 241 (d), 1988) to the researchers who are conducting this study which authorizes us to protect the
privacy of individuals who participate.

The above information has been explained to me, and my signature below indicates that I have completed my longversion consent form for my interview and that I give my permission for my child to be approached for an interview.
We are using a laptop quality control (QC) system for this study. The system runs on the computer and may record
what you and I say to each other during parts of the interview. Neither you nor I will know when the computer is
recording our conversation. The recording will be reviewed by project staff at RTI to monitor my work. The
recordings will only be used for those purposes and will be kept confidential. The files will be destroyed after they
have been used to review my work. Those project staff who listen to the recording will know who I am, but will not
know who you are. Is it all right with you if this QC system runs during this interview?
Check one box.
Yes, I consent to having portions of this interview recorded by the computer to test the quality control
system.
No, I do not want any portion of this interview recorded.

You will be given a copy of this consent form to keep.

Printed Name of Parent/Caregiver

Fill in CCG Respondent 8-digit ID #

Printed Name of Youth

Signature of Parent/Caregiver

Signature of Interviewer

Date

Page 1 of 1

Disposition: Original to RTI; Copy to Respondent

Version 3DS June 2011

Second Parent/Guardian Permission for Child Interview
National Survey of Child and Adolescent Well-Being (NSCAW)

NSCAW
The Administration for Children and Families of the U.S. Department of Health and Human Services is funding a
national longitudinal survey of children and families in the child welfare system. RTI International (RTI), a not-forprofit research organization in North Carolina, and staff at ICF Caliber, Walter R. McDonald & Associates, Inc
(WRMA), Tufts-New England Medical Center, the Child and Adolescent Services Research Center, and the University
of Illinois at Urbana-Champaign are conducting this survey.
SELECTION OF CHILDREN
RTI representatives are contacting families of children selected in 2008-2009 from child welfare agencies throughout
the United States. Your child is among over 5,300 children selected to be interviewed. We are following up with
sampled children and their caregivers approximately 36 months after the initial interview. We must have permission
from a parent or legal guardian before we observe or talk with the child. At that point, your child may choose whether
or not to participate in the study.
PURPOSE OF THIS NSCAW INTERVIEW
We want to interview your child about their experiences with you and your family. The child’s answers combined with
the answers of other children in the study will help us describe the needs of children and their use of available child
welfare services. The information will be summarized in research reports and be used to help policy makers improve
the child welfare system.
TYPES OF QUESTIONS FOR CHILD
The interview with your child will last about 60-90 minutes, depending on the child's age and personal experiences.
You will not know how your child answers the questions. Children will be observed to assess their language skills and
how well they understand and perform certain tasks. Depending on their age, they will also be interviewed about their
abilities, their experiences at home and at school, their feelings about family and friends, and their exposure to
violence.
VOLUNTARY PARTICIPATION
Your child’s participation in this study is also completely voluntary. He or she can refuse to answer any and all
questions. His or her refusal would not affect any benefits or services that he/she may be receiving. Your child has the
right to stop the interview at any time.
RISKS
There are no physical risks to your child from participating in this interview. It is possible that some questions might
make your child uncomfortable or feel various emotions, such as sadness. If we learn during the course of these
interviews that the life or health of the child is in danger, we will share that information with the appropriate county or
state agency. More information is provided in the Confidentiality section below.
BENEFITS
There are no direct benefits to your child from answering our questions. However, he or she will be helping us learn
more about the needs of children and the services available to them.
FUTURE CONTACTS
To help us understand how the well-being of children changes over time, we or other researchers may contact you and
your child in the future to update our information. Each of these additional interviews will also be completely
voluntary.
CONFIDENTIALITY
Your answers will be entered into a computer and labeled with a case identification number. Your name and that of
your child will not be reported with any information your child provides. Information your child provides will be
combined with answers of many others and reported in a summary form. To protect the privacy of both you and your
child, neither of you will know the other’s interview answers. All staff involved in this research are committed to
confidentiality and have signed a Confidentiality Pledge. In addition, RTI has obtained a federal Certificate of
Confidentiality for this study to protect the identity of research subjects.
There are two important exceptions. (1) If the interviewer or project staff feel that your child’s life or health is in
danger, they will inform the appropriate county or state agency. Also, if they feel that your life or health is in serious
danger, they will contact emergency assistance. (2) At some point in the future this research may be done by another
organization. If that happens, with your consent, we would give contacting information for you and your child to the
other organization.
Page 1 of 2

Disposition: Original to RTI; Copy to Respondent

Version 3E June 2011

QUESTIONS
If you have any questions about the study, you may call Pat Crowley at the RTI, 1-877-254-1953 extension 67 (tollfree number). If you have any questions about your rights as a study participant, you may call RTI's Office of Human
Research Protections at 1-866-214-2043 (a toll-free number).
You will be given a copy of this consent form to keep.
Because your child’s contribution is important, we will give your child a gift card for participating. The amount of the
gift card is $20 for children age 11 or older and $10 for children age 10 or younger. If your child participates in future
rounds, he or she will be paid for participating in the in-person interviews.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection unless it displays a
valid OMB control number. The valid OMB control number for this information collection is 0970-0202 (Exp Date:
10/31/2012). The time required to complete the parent interview is estimated to be 100 minutes. The time required to
complete the child interview is estimated to be 60-90 minutes, depending on the child’s age and personal experiences.
The Federal Government has issued a Certificate of Confidentiality (authorized by the Public Health Service Act Section
301(d), 42 U.S.C Section 241 (d), 1988) to the researchers who are conducting this study which authorizes us to protect the
privacy of individuals who participate.

The above information has been explained to me, and my signature below indicates that I give my permission for my
child to be approached for an interview.
I give consent for having contacting information for my child given to another research organization if they start doing
this study.

Yes

No

Check one box.

We are using a laptop quality control (QC) system for this study. The system runs on the computer and may record
what your child and I say to each other during parts of the interview. Neither your child nor I will know when the
computer is recording our conversation. The recording will be reviewed by project staff at RTI to monitor my work.
The recordings will only be used for those purposes and will be kept confidential. The files will be destroyed after
they have been used to review my work. Those project staff who listen to the recording will know who I am, but will
not know who your child is. Is it all right with you if this QC system runs during this interview?
Check one box.
Yes, I consent to having portions of my child’s interview recorded by the computer to test the quality
control system.
No, I do not want any portion of my child’s interview recorded.

Printed Name of Parent/Caregiver

Fill in CCG Respondent 8-digit ID #

Printed Name of Youth

Signature of Parent/Caregiver

Signature of Interviewer

Date

Page 2 of 2

Disposition: Original to RTI; Copy to Respondent

Version 3E June 2011

Legal Guardian Permission for Child Interview
National Survey of Child and Adolescent Well-Being (NSCAW)
NSCAW
The Administration for Children and Families of the U.S. Department of Health and Human Services is funding a national
longitudinal survey of children and families in contact with the child welfare system. RTI International (RTI), a not-for-profit
research organization in North Carolina, and staff at ICF Caliber, Walter R. McDonald & Associates, Inc (WRMA), Tufts-New
England Medical Center, the Child and Adolescent Services Research Center, and the University of Illinois at UrbanaChampaign are conducting this survey.
SELECTION OF CHILDREN
RTI representatives are contacting families of children selected from child welfare agencies throughout the United States. We
are following up with sampled children and their caregivers approximately 36 months after the initial interview. We must have
permission from a parent or legal guardian before we observe or talk with the child. At that point, the child may choose whether
or not to participate in the study. A child under your guardianship is among over 5,300 children selected to be interviewed.
PURPOSE OF THIS NSCAW INTERVIEW
The data we obtain from the child and about the child from his/her current caregiver, caseworker, and teacher will be combined
with the answers of others in the study to help us describe the needs of children and families and their use of available child
welfare services. The information will be summarized in research reports and be used to help policy makers improve the child
welfare system.
TYPES OF QUESTIONS FOR CHILD
The interview with the child will last about 60-90 minutes, depending on the child's age and personal experiences. You will not
know how the child answers the questions. Children will be observed to assess their language skills and how well they
understand and perform certain tasks. Depending on their age, they will also be interviewed about their abilities, their
experiences at home and at school, their feelings about family and friends, and their exposure to violence.
VOLUNTARY PARTICIPATION
The child’s participation in this study is completely voluntary. He or she can refuse to answer any and all questions. His or her
decision about participation will not affect any benefits or services that he/she may be receiving. The child has the right to stop
the interview at any time.
RISKS
There are no physical risks to the child from participating in this interview. It is possible that some questions might make the
child uncomfortable or feel various emotions, such as sadness. It is also possible that some answers to questions will require that
we share that information with the appropriate county or state agency. More information is provided in the Confidentiality
section below.
BENEFITS
There are no direct benefits to the child from the child answering our questions. However, the child will be helping us learn
more about the needs of children and the services available to them.
FUTURE CONTACTS
To help us understand how the well-being of children changes over time, we or other researchers may contact the child and
his/her family in the future to update our information. Each of these additional interviews will be completely voluntary.
CONFIDENTIALITY
The child’s answers will be entered into a computer and labeled with a case identification number. The name of the child and
other respondents will not be reported with any responses provided. Information we obtain will be combined with answers of
many others and reported in a summary form. To protect the privacy of the child, neither the child nor the caregiver will know
the other’s interview answers. All staff involved in this research are committed to confidentiality and have signed a
Confidentiality Pledge. In addition, RTI has obtained a federal Certificate of Confidentiality for this study to protect the identity
of the research subjects.
There are two important exceptions. (1) If the interviewer or project staff feel that the child’s life or health is in danger, they
will inform the appropriate county or state agency. (2) At some point in the future, this research may be done by another
organization. If that happens, with your consent, we would give contacting information for the child to the other organization.

Page 1 of 2

Disposition: Original to RTI; Copy to Respondent

Version 3F June 2011

QUESTIONS
If you have any questions about the study, you may call Pat Crowley at the RTI, 1-877-254-1953 extension 67 (toll-free
number). If you have any questions about your rights as a study participant, you may call RTI's Office of Human Research
Protections at 1-866-214-2043 (a toll-free number).
You will be given a copy of this consent form to keep.
Because each respondent’s contribution is important, we will pay the current caregiver $50 in cash for participating in the
interview. We will also give the child a gift card for participating. The amount of the gift card is $20 for children age 11 or
older and $10 for children age 10 or younger.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection unless it displays a valid
OMB control number. The valid OMB control number for this information collection is 0970-0202 (Exp Date: 10/31/2012).
The time required to complete the child interview is estimated to be 60-90 minutes, depending on the child’s age and personal
experiences.
The Federal Government has issued a Certificate of Confidentiality (authorized by the Public Health Service Act Section 301(d),
42 U.S.C Section 241 (d), 1988) to the researchers who are conducting this study which authorizes us to protect the privacy of
individuals who participate.

The above information has been explained to me, and my signature below indicates that as legal guardian I give
permission for the child named below to be approached for an interview.
I give consent for having contacting information for the child given to another research organization if they start
doing this study.

Yes

No

Check one box.

We are using a laptop quality control system for this study. The system runs on the computer and may record what
the child and I say to each other during parts of the interview. Neither the child nor I will know when the computer is
recording our conversation. The recording will be reviewed by project staff at RTI to monitor my work. The
recordings will only be used for those purposes and will be kept confidential. The files will be destroyed after they
have been used to review my work. Those project staff who listen to the recording will know who I am, but will not
know who the child is. Is it all right with you if this quality control system runs during this interview?
Check one box.
Yes, I consent to having portions of the child’s interview recorded by the computer.
No, I do not want any portion of the child’s interview recorded.

Printed Name of Legal Guardian

Fill in Child Respondent 8-digit ID #

Printed Name of Child

Signature of Legal Guardian

Signature of Interviewer

Date

Page 2 of 2

Disposition: Original to RTI; Copy to Respondent

Version 3F June 2011

Legal Guardian Permission for Minor Caregiver Interview
National Survey of Child and Adolescent Well-Being (NSCAW)
NSCAW
The Administration for Children and Families of the U.S. Department of Health and Human Services is funding a national
longitudinal survey of children and families in contact with the child welfare system. RTI International (RTI), a not-for-profit
research organization in North Carolina, and staff at ICF Caliber, Walter R. McDonald & Associates, Inc (WRMA), Tufts-New
England Medical Center, the Child and Adolescent Services Research Center, and the University of Illinois at UrbanaChampaign are conducting this survey.
SELECTION OF CHILDREN
RTI representatives are contacting families of children selected from child welfare agencies throughout the United States. There
are over 5,300 children and families participating in this study. We are following up with sampled children and their caregivers
approximately 36 months after the initial interview. Because a minor is the caregiver of the sampled child, we must have
permission from a parent or legal guardian before we talk with the minor caregiver. At that point, the minor caregiver may
choose whether or not to participate in the study, and whether or not the sampled child can also participate.
PURPOSE OF THIS NSCAW INTERVIEW
The data we obtain from the minor caregiver will be combined with the answers of other caregivers in the study to help us
describe the needs of children and families and their use of available child welfare services. The information will be summarized
in research reports and be used to help policy makers improve the child welfare system.
TYPES OF QUESTIONS FOR THE MINOR CAREGIVER
The interview with the minor caregiver will last about 100 minutes. The interviewer will ask the minor caregiver questions
about the sampled child’s learning, behavior at home, health, and relationships with friends. The minor caregiver will also be
asked about services the sampled child or the family may receive, including level of satisfaction with those services. In addition,
we will ask questions about attitudes about raising children, life experiences, family support, involvement with school and
community activities, the minor caregiver’s interactions with the sampled child, and things that may happen in the family like
violence in the home, drug abuse, and other risky behaviors such as drinking, drug use, and involvement with the police. You
will not know how the minor caregiver answers the questions.
VOLUNTARY PARTICIPATION
The minor caregiver’s participation in this study is completely voluntary. He or she can refuse to answer any and all questions.
His or her decision about participation will not affect any benefits or services that he/she or the sampled child may be receiving.
The minor caregiver has the right to stop the interview at any time.
RISKS
There are no physical risks to the minor caregiver from participating in this interview. It is possible that some questions might
make the minor caregiver uncomfortable or feel various emotions, such as sadness. It is also possible that some of the minor
caregiver’s answers to questions about violence or maltreatment will require that we share that information with the appropriate
county or state agency. More information is provided in the Confidentiality section below.
BENEFITS
There are no direct benefits to the minor caregiver for answering our questions. However, the minor caregiver will be helping us
learn more about the needs of children and the services available to them.
FUTURE CONTACTS
To help us understand how the well-being of children changes over time, we or other researchers may contact the sampled child,
minor caregiver, and his/her family in the future to update our information about the sampled child. Each of these additional
interviews will be completely voluntary.
CONFIDENTIALITY
The minor caregiver’s answers and the information about the sampled child will be entered into a computer and labeled with a
case identification number. The names of the minor caregiver and the sampled child will not be reported with any responses
provided. Information we obtain will be combined with answers of many others and reported in a summary form. To protect the
privacy of the minor caregiver and sampled child, you will not know either the minor caregiver’s or the sampled child’s answers.
All staff involved in this research are committed to confidentiality and have signed a Confidentiality Pledge. In addition, RTI
has obtained a federal Certificate of Confidentiality for this study to protect the identity of the research subjects.
There are two important exceptions. (1) If the interviewer or project staff feel that the sampled child’s life or health is in danger,
they will inform the appropriate county or state agency. Also, if they think that the minor caregiver’s life or health is in serious
danger, they will contact emergency assistance. (2) At some point in the future, this research may be done by another
organization. If that happens, with your permission, we would give contacting information for the minor caregiver to the other
organization.

Page 1 of 2

Disposition: Original to RTI; Copy to Respondent

Version 3F June 2011

QUESTIONS
If you have any questions about the study, you may call Pat Crowley at the RTI, 1-877-254-1953 extension 67 (toll-free
number). If you have any questions about the rights of the minor caregiver or sampled child as study participants, you may call
RTI's Office of Human Research Protections at 1-866-214-2043 (a toll-free number).
You will be given a copy of this permission form to keep.
Because each respondent’s contribution is important, we will pay the minor caregiver $50 in cash for participating in the
interview. We will also give the sampled child a gift certificate for participating. The amount of the gift certificate is $20 for
children age 11 or older and $10 for children age 10 or younger.

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection unless it displays a valid
OMB control number. The valid OMB control number for this information collection is 0970-0202 (Exp Date: 10/31/2012).
The time required to complete the minor caregiver interview is estimated to be 100 minutes
The Federal Government has issued a Certificate of Confidentiality (authorized by the Public Health Service Act Section 301(d),
42 U.S.C Section 241 (d), 1988) to the researchers who are conducting this study which authorizes us to protect the privacy of
individuals who participate.

The above information has been explained to me, and my signature below indicates that as legal guardian I give
permission for the minor caregiver named below to be approached for an interview.
I give consent for having contacting information for the minor caregiver given to another research organization if
they start doing this study.

Yes

No

Check one box.

We are using a laptop quality control system for this study. The system runs on the computer and may record what
the minor caregiver and I say to each other during parts of their interviews. Neither the youth nor I will know when
the computer is recording our conversation. The recording will be reviewed by project staff at RTI to monitor my
work. The recordings will only be used for those purposes and will be kept confidential. The files will be destroyed
after they have been used to review my work. Those project staff who listen to the recording will know who I am,
but will not know who the minor caregiver is. Is it all right with you if this quality control system runs during this
interview?
Check one box.
Yes, I consent to having portions of the minor caregiver’s interview recorded by the computer.
No, I do not want any portion of the minor caregiver’s interview recorded.

Printed Name of Legal Guardian

Fill in Minor Caregiver 8-digit ID #

Printed Name of Minor Caregiver

Signature of Legal Guardian

Signature of Interviewer

Date

Page 2 of 2

Disposition: Original to RTI; Copy to Respondent

Version 3F June 2011

Agreement for Youth Aged 7 to 10
National Survey of Child and Adolescent Well-Being (NSCAW)
PRINTED NAME OF
YOUTH:
PRINTED NAME OF
PARENT/CAREGIVER:
My name is
I work for a company called RTI International (RTI). We are talking to some kids across the
United States. The questions we will ask you are about the kinds of things you can do, how
you behave at home and at school, how you feel about your family, your friends, and school,
and about people who may help you. There are also some questions about things that may
have happened in your home that scared or hurt you. You may also find that some of these
questions bring back sad or frightening memories.
_______________________________ said it was okay for you to talk with me about these
things. If it is okay with you, I would like to ask you some questions. Our talk today will last
between one and two hours, depending on how much you have to say. We may contact you
again in the future.
I am going to enter your answers into a computer I carry with me. Your answers will be
labeled with a special number instead of your name so no one else will know these are your
answers. No one will see your answers. There is one special case where I can’t promise
not to tell anyone. If during our talk today I learn that your life or health is in danger, I will
have to tell someone whose job it is to see that you are safe and protected.
If you don't want to talk to me, that is okay. If you don't want to answer a certain question,
that is okay too. If you want to take a break at any time, just tell me.
You will be given a copy of this consent form to keep. When we finish I will give your
parent/guardian a $10 gift card for you to say thanks for taking the time to talk with me.

Page 1 of 2

Disposition: Original to RTI; Copy to Respondent

Version 3H June 2011

May I ask you the questions?
YOUTH AGREES -----> Would you like to sign your name on this form?
YOUTH DOES NOT AGREE
YOUTH DID NOT APPEAR TO UNDERSTAND EXPLANATION

The above information has been explained to me, and my signature below means that I
agree to participate in this study.

We are using a recording system on the computer. The system may record what you
and I say to each other during parts of the interview. Neither of us will know when the
computer is recording what we say. The recording will be listened to by people at RTI to
check on my work. The files will be destroyed after they have been used to review my
work. The people who listen to the recording will know who I am, but will not know who
you are. Is it all right with you if the recording system runs during this interview?
Check one box.
Yes, I agree to having portions of this interview recorded by the computer.
No, I do not want any portion of this interview recorded.

Fill in Child Respondent 8-digit ID #

Signature of Youth

Page 2 of 2

Signature of Interviewer

Disposition: Original to RTI; Copy to Respondent

Date

Version 3H June 2011

Agreement for Youth Aged 11 to 17
National Survey of Child and Adolescent Well-Being (NSCAW)

PRINTED NAME OF YOUTH:
PRINTED NAME OF
PARENT/CAREGIVER:
My name is
I work for a company called RTI International (RTI). We are talking to kids all over the
United States about this study. The questions we will ask you are about the kinds of
things you can do, how you behave at home and at school, how you feel about your
family, your friends, and school, and about people who may help you. We also want to
ask you about things you may do that your parents don’t know about or don’t like for you
to do, such as skipping school, smoking, drinking, vandalism, using drugs, sexual
activities, and other risky or illegal behaviors. There are also some questions about
things that may have happened in your home that scared or hurt you. You may also
find that some of these questions bring back sad or frightening memories.
_______________________________ has given permission for you to talk with me
about these things. If it is okay with you, I would like to ask you some questions. Our
talk today will last between one and two hours, depending on your experiences. We
may contact you again in the future.
I am going to enter your answers into a computer. Your name will be kept private. Your
answers will be labeled with a special number instead of your name so no one else will
know these are your answers. No one will see your answers to any of these questions.
We have a paper from the government, called a Federal Certificate of Confidentiality,
that guarantees we do not have to give your information to anyone. There is one
exception. If I learn during our talk that your life or health could be in danger, I will tell
someone whose job it is to see that you are safe and protected.
If you don't want to talk to me, that is okay. If you don't want to answer a certain
question, that is okay too. If you want to take a break at any time, just tell me.
You will be given a copy of this consent form to keep. When we finish I will give you a
$20 gift card to thank you for taking time to talk to me.

Page 1 of 2

Disposition: Original to RTI; Copy to Respondent

Version 3I June 2011

May I talk to you and ask you the questions?
YOUTH AGREES
YOUTH DOES NOT AGREE
YOUTH DID NOT APPEAR TO UNDERSTAND EXPLANATION

The above information has been explained to me, and my signature below means that I
agree to participate in this study.
We are using a laptop quality control (QC) system. The system runs on the computer
and may record what you and I say to each other during parts of the interview. Neither
you or I will know when the computer is recording what we say. The recording will be
reviewed by people at RTI to monitor my work. The recordings will only be used for
those purposes and will be kept confidential. The files will be destroyed after they have
been used to review my work. Those project staff who listen to the recording will know
who I am, but will not know who you are. Is it all right with you if this QC system runs
during this interview?
Check one box.

Yes, I agree to having portions of this interview recorded by the computer.
No, I do not want any portion of this interview recorded.

Fill in Child Respondent 8-digit ID #

Signature of Youth

Page 2 of 2

Signature of Interviewer

Disposition: Original to RTI; Copy to Respondent

Date

Version 3I June 2011

Authorization for Teacher to Release Information
Teacher Authorization Form
National Teacher Survey of Children and Adolescents
Name of Child:______________________________________

Case ID#:

Fill in Child Respondent 8-digit ID #

By signing this form, I give permission to RTI International (RTI) to contact my child’s primary teacher, language arts teacher,
special education teacher, or other classroom instructor who has taught my child for at least two months within the current or last
school year. I understand that information regarding my child’s behavior during class time, interactions with classmates,
teachers, and peers, and involvement in school-related activities such as sports and clubs will be collected. I further understand
that school performance and attendance information will also be obtained.
The purpose or need for such disclosure is to obtain information for a research study my child and I are participating in to learn
more about the behavior, learning, development, and needs of children up to 18 years of age. The study is being funded by the
U.S. Department of Health and Human Services (DHHS) and is being conducted by RTI.
I understand that this information will be kept strictly confidential. Any information released because I have signed this consent
will be seen only by research personnel and will be used only for research purposes. This information will not be given to
anyone else and will not be used in any way other than that explained in this form without my specific written permission. The
time period covered by this authorization is one year, ending on ___________________________________.
Print Date One Year From Today Above

______________________________________________________________________________________________
The above information has been explained to me and I give permission to my child’s teacher to release information to the
researchers involved in this study.

PLEASE PRINT CLEARLY
Parent/Guardian’s Name:

________________________________________________________
FIRST
LAST

Name of Child’s Teacher (if known):
Mr/Ms __________________________________________________
FIRST
LAST
Name of Principal (if known):

Mr/Ms __________________________________________________
FIRST
LAST

Name of School (if known):
Address of School (if known):

________________________________________________________
________________________________________________________
NUMBER AND STREET
________________________________________________________
CITY
STATE ZIP

School Phone Number (if known):

(

)___________________________________________________

___________________________________
Signature of Parent (if applicable)

______________________
Date

__________________________________________
Signature of Legal Guardian

______________________
Date

Disposition: Original and copy to RTI; copy to respondent

Version 3 June 2011

Legally Emancipated Youth Authorization for Teacher to Release Information
Teacher Authorization Form
National Teacher Survey of Children and Adolescents
Name of Youth:______________________________________

Case ID#:

Fill in Youth Respondent 8-digit ID #

By signing this form, I give permission to the Research Triangle Institute (RTI) to contact my primary teacher, language arts
teacher, special education teacher, or other classroom instructor who has taught me for at least two months within the current or
last school year. I understand that information about my behavior during class time, relationships with classmates, teachers,
peers, and involvement in school-related activities such as sports and clubs will be collected. I further understand that questions
about school performance and attendance will also be asked.
This information is being requested for a research study I am participating in to learn more about the behavior, learning,
development, and needs of children. The study is being funded by the U.S. Department of Health and Human Services (DHHS)
and is being conducted by RTI.
I understand that this information will be kept strictly confidential. Any information released because I have signed this consent
will be seen only by research personnel and will be used only for research purposes. This information will not be given to anyone
else and will not be used in any way other than that explained in this form without my specific written permission. The time
period covered by this authorization is one year, ending on ___________________________________.
Print Date One Year From Today Above

______________________________________________________________________________________________
The above information has been explained to me and I give permission to my teacher to release information to the researchers
involved in this study.

PLEASE PRINT CLEARLY
Youth’s Name:

________________________________________________________
FIRST
LAST

Name of Youth’s Teacher:
Mr/Ms __________________________________________________
FIRST
LAST
Name of Principal:

Mr/Ms __________________________________________________
FIRST
LAST

Name of School:
Address of School:

________________________________________________________
________________________________________________________
NUMBER AND STREET
________________________________________________________
CITY
STATE ZIP

School Phone Number:

(

___________________________________
Signature of Legally Emancipated Youth

)___________________________________________________
______________________
Date

Note: The above youth is legally emancipated according to governing state laws and has the authority to consent to this
information release.
Disposition: Original and copy to RTI; copy to respondent

Version 3X June 2011

Data Linkage Forms

Caregiver Data Linkage
Legal Guardian Permission for Child Data Linkage
Youth Age 13-17 Data Linkage
Emancipated Youth Data Linkage
Caregiver of Emancipated Youth Data Linkage
Young Adult Data Linkage
Caregiver HIPAA Authorization

Caregiver Permission Form for Combining NSCAW Data with Other Research Data
Why should I grant permission for my NSCAW data to be combined with other data?
All of the information we have collected from or about you and your child during the NSCAW interviews can be even
more valuable to researchers if it can be combined with other information on you and your child that we obtain from
sources outside this survey— information that exists now, as well as information in the future. We are requesting your
permission to add other sources of information to you and your child’s interview data.
There are two types of data that could be linked to your interview data once it gets back to RTI International. First, we
would link you and your child’s interview data to records collected from participating child welfare services agencies.
Adding this information will help us to learn more about any foster care, adoption, or other services that you and your
child receive. Second, at some point in the future, researchers interested in the NSCAW data may wish to add other
information, such as data on state child welfare policies, to you and your child’s interview data. Your permission would
allow these researchers to combine this new information to you and your child’s interview data. However, your
permission for combining your child’s information only applies until the time your child becomes an adult (usually at age
18). At that time, we will not combine your child’s information until we have your child’s direct approval to do that.
How will the data be combined and who will it be released to?
The information we obtain from these sources will be combined with the information you give us in the interviews and
made available to researchers on a very restricted basis. No personally identifying information about you or your child
will be included. Before receiving data, researchers must complete an application that gives good reason for their use of
the information. Applications will be reviewed and either approved or denied by a group of individuals whose job it is to
protect the rights of people like you who participate in research studies. The information will only be used for reports.
Your name and your child’s name will not appear in any of these reports.
What are the risks and benefits associated with granting permission for this request?
The only risk you are taking by allowing your NSCAW data to be combined with other information is the small risk that
some people who do research and get your information might not follow the rules we set for using your information.
There are also no direct benefits for allowing your or your child’s NSCAW information to be combined with other types
of information. Your decision with regard to this request will not affect any services you or your child may be receiving
now or in the future. By answering “yes”, you are giving permission for all of your and your child’s NSCAW information
we have ever collected in our interviews to be used in the future for other important research studies that may be
approved.
What are my rights with regard to this request?
You have the right to refuse this request. However, we hope you will give us your permission to use your and your
child’s data in this way. If in the future should you decide that you no longer want your or your child’s information
combined with other records, you should contact Pat Crowley at RTI International (toll-free at 877-254-1953, extension
67) to record your request.
Check one box.
Yes, I consent to having all of my family’s NSCAW information ever collected in interviews to be added
in the future to information in other important research studies. This permission will take effect when
RTI releases information from this round to researchers.
No, I do not want any of my NSCAW information ever collected in interviews to be added to other
information. This refusal request will take effect when RTI releases information from this round to
researchers.

Printed Name of Child

Printed Name of Current Caregiver

Fill in CCG Respondent 8-digit ID #

Fill in Child Respondent 8-digit ID

Signature of Current Caregiver

Date

Disposition: Original to RTI; Copy to Respondent

Version 3B/C June 2011

Legal Guardian Permission Form for Combining Child’s NSCAW Data with Other
Research Data
Why should I grant permission for the child’s NSCAW data to be combined with other data?
All of the information we have collected from or about the child during the NSCAW interviews can be even more
valuable to researchers when combined with other information on the child that we obtain from sources outside this
survey— information that exists now, as well as information in the future.
We are requesting your permission to add other sources of information to your child’s interview data.
There are two types of data that could be linked to your child’s interview data once it gets back to RTI International.
First, we would link your child’s interview data to records collected from participating child welfare services agencies.
Adding this information will help us to learn more about any foster care, adoption, or other services that the child
receives. Second, at some point in the future, researchers interested in the NSCAW data may wish to add other
information, such as data on state child welfare policies, to your child’s interview data. Your permission would allow
these researchers to combine this new information to your child’s interview data. However, your permission for
combining your child’s information only applies until the time your child becomes an adult (usually at age 18). At that
time, we will not combine your child’s information until we have your child’s direct approval to do that.
How will the data be combined and who will it be released to?
The information we obtain from these sources will be combined with the information the child and their caregiver give us
in the interviews and made available to researchers on a very restricted basis. No personally identifying information about
your child will be included. Before receiving data, researchers must complete an application that gives good reason for
their use of the information. Applications will be reviewed and either approved or denied by a group of individuals whose
job it is to protect the rights of people like you who participate in research studies. The information will only be used for
reports. Your name and your child’s name will not appear in any of these reports. .
What are the risks and benefits associated with granting permission for this request?
The only risk you are taking by allowing the child’s NSCAW data to be combined with other information is the small risk
that some people who do research and get your information might not follow the rules we set for using the child’s
information. There are also no direct benefits for allowing the child’s NSCAW information to be combined with other
types of information. Your decision with regard to this request will not affect any services the child or the caregiver may
be receiving now or in the future. By answering “yes”, you are giving permission for all the child’s NSCAW information
we have ever collected in our interviews to be used in the future for other important research studies that may be
approved.
What are my rights with regard to this request?
You have the right to refuse this request. However, we hope you will give us your permission to use the child’s data in
this way. If in the future should you decide that you no longer want the child’s information combined with other records,
you should contact Pat Crowley at RTI International (toll-free at 877-254-1953, extension 67) to record your request.
Check one box.
Yes, I consent to having all of the child’s NSCAW information ever collected in interviews to be added in
the future to information in other important research studies. This permission will take effect when RTI
releases information from this round to researchers.
No, I do not want any of the child’s NSCAW information ever collected in interviews to be added to
other information. This refusal request will take effect when RTI releases information from this round to
researchers.
Printed Name of Child

Printed Name of Legal Guardian

Fill in Child Respondent 8-digit ID

Signature of Legal Guardian

Disposition: Original to RTI; Copy to Respondent

Date

Version 3F

June 2011

Adolescent (Aged 13 to 17) Consent Request for Combining NSCAW Information
with Other Research Information
What does “combining information” mean?
The information we are getting from you during the NSCAW interviews is very important. It can be even more important
when other information about you and your family is added to it. This includes information available now and other
information that might become available in the future. We are asking for your okay to add other types of information to
the answers you are giving us as part of the interview.
There are two types of information that could be added to your interview answers. First, we would add information
collected from the county agency taking part in this study. Adding this information will help us to learn more about any
services that you receive. It will also help us learn more about changes in where you live or in the people who care for
you. Second, researchers interested in this study may want to add other information to your answers sometime in the
future. For example, information on state laws could be added.
Your permission is only good until the time you become an adult (usually at age 18). After that time, we will not allow
other researchers to use your NSCAW information until we have gotten your okay to do that.
How will the information be added and who will be able to use it?
We have a plan for protecting what you have told me, so that the information will not be used against you in any way.
Your information would only be used by researchers who request to use it. These requests must be approved by a group of
people whose job is to protect the rights of young people like you. We will only share your information with people who
can show that they: (1) have a good reason to use the information, (2) will only use the information in their scientific
reports, and (3) will not use your name in any of the reports.
What are the risks and benefits for saying it’s OK to do this?
The only risk you are taking by giving permission for your NSCAW information to be added to other information is the
small risk that some researchers might not follow the rules we set for using your information. There are no direct benefits
to you in giving permission for your NSCAW information to be combined with other types of information. Your decision
will not change any services you or your family may be receiving now or in the future. By answering “yes”, you are
giving permission for all of the NSCAW information we have ever gotten about you and your family in our interviews to
be used in the future for other important research studies.
What are my choices?
You have the right to say “no” to this request. However, we hope you will let us use your information in this way. In the
future, if you change your mind about this, you should call Pat Crowley at RTI International (RTI) (toll-free at 877-2541953, extension 67) to ask that your NSCAW information no longer be used in this way.
Check one box.
Yes, it’s OK for all of my NSCAW information ever gotten from interviews to be added in the future to
information in other important research studies. This permission will take effect when RTI releases
information from this round to researchers.
No, I do not want any of my NSCAW information ever gotten from interviews to be added to other
information. This refusal request will take effect when RTI releases information from this round to
researchers.

Printed Name of Youth

Fill in Youth Respondent 8-digit ID #

Signature of Youth

Date

Disposition: Original to RTI; Copy to Respondent

Version 3I June 2011

Emancipated Youth Consent Request for Combining
NSCAW Information with Other Research Information
What does “combining information” mean?
The information we are getting from you during the NSCAW interviews is very important. It can be even more important
when other information about you and your family is added to it. This includes information available now and other
information that might become available in the future. We are asking for your okay to add other types of information to
the answers you are giving us as part of the interview.
There are two types of information that could be added to your interview answers. First, we would add information
collected from the county agency taking part in this study. Adding this information will help us to learn more about any
services that you receive. It will also help us learn more about changes in where you live or in the people who care for
you. Second, researchers interested in this study may want to add other information to your answers sometime in the
future. For example, information on state laws could be added.
How will the information be added and who will be able to use it?
We have a plan for protecting what you have told me, so that the information will not be used against you in any way.
Your information would only be used by researchers who request to use it. These requests must be approved by a group of
people whose job is to protect the rights of young people like you. We will only share your information with people who
can show that they: (1) have a good reason to use the information, (2) will only use the information in their scientific
reports, and (3) will not use your name in any of the reports.
What are the risks and benefits for saying it’s OK to do this?
The only risk you are taking by giving permission for your NSCAW information to be added to other information is the
small risk that some researchers might not follow the rules we set for using your information. There are no direct benefits
to you in giving permission for your NSCAW information to be combined with other types of information. Your decision
will not change any services you or your family may be receiving now or in the future. By answering “yes”, you are
giving permission for all of the NSCAW information we have ever gotten about you and your family in our interviews to
be used in the future for other important research studies.
What are my choices?
You have the right to say “no” to this request. However, we hope you will let us use your information in this way. In the
future, if you change your mind about this, you should call Pat Crowley at RTI International (RTI) (toll-free at 877-2541953 extension 67) to ask that your NSCAW information no longer be used in this way.
Check one box.
Yes, it’s OK for all of my NSCAW information ever gotten from interviews to be added in the future to
information in other important research studies. This permission will take effect when RTI releases
information from this round to researchers.
No, I do not want any of my NSCAW information ever gotten from interviews to be added to other
information. This refusal request will take effect when RTI releases information from this round to
researchers.

Printed Name of Youth

Fill in Youth Respondent 8-digit ID #

Signature of Youth

Date

Disposition: Original to RTI; Copy to Respondent

Version 3X June 2011

Caregiver of Emancipated Youth Permission Form for
Combining NSCAW Data with Other Research Data
Why should I grant permission for my NSCAW data to be combined with other data?
All of the information we have collected from or about you during the NSCAW interviews can be even more valuable to
researchers if it can be combined with other information on you that we obtain from sources outside this survey –
information that exists now, as well as information in the future. We are requesting your permission to add other sources
of information to your interview data.
There are two types of data that could be linked to your interview data once it gets back to RTI International. First, we
would link your interview data to records collected from participating child welfare services agencies. Adding this
information will help us to learn more about any services that you receive. Second, at some point in the future,
researchers interested in the NSCAW data may wish to add other information, such as data on state child welfare policies,
to your interview data. Your permission would allow these researchers to combine this new information to your interview
data.
How will the data be combined and who will it be released to?
The information we obtain from these sources will be combined with the information you give us in the interviews and
made available to researchers on a very restricted basis. No personally identifying information about you will be included.
Before receiving data, researchers must complete an application that gives good reason for their use of the information.
Applications will be reviewed and either approved or denied by a group of individuals whose job it is to protect the rights
of people like you who participate in research studies. The information will only be used for reports. Your name will not
appear in any of these reports.
What are the risks and benefits associated with granting permission for this request?
The only risk you are taking by giving permission for your NSCAW information to be combined with other information is
the small risk that some people who do research and get your information might not follow the rules we set for using your
information. There are also no direct benefits for allowing your NSCAW information to be combined with other types of
information. Your decision with regard to this request will not affect any services you may be receiving now or in the
future. By answering “yes”, you are giving permission for all of the NSCAW information we have ever collected in our
interviews to be used in the future for other important research studies that may be approved.
What are my rights with regard to this request?
You have the right to refuse this request. However, we hope you will give us your permission to use your information in
this way. If in the future should you decide that you no longer want your information combined with other records, you
should contact Pat Crowley at RTI International (RTI) (toll-free at 877-254-1953, extension 67) to record your request.
Check one box.
Yes, I consent to having all of my NSCAW information ever collected in interviews to be added in the
future to information in other important research studies. This permission will take effect when RTI
releases information from this round to researchers.
No, I do not want any of my NSCAW data ever collected in interviews to be added to other information.
This refusal request will take effect when RTI releases information from this round to researchers.

Printed Name of Caregiver

Fill in CCG Respondent 8-digit ID #

Signature of Caregiver

Date

Disposition: Original to RTI; Copy to Respondent

Version 3P June 2011

Young Adult Consent for Combining
NSCAW Information with Other Research Information
Why should I grant permission for my NSCAW data to be combined with other data?
All of the information we have collected from or about you during the NSCAW interviews can be even more valuable to
researchers if it can be combined with other information on you that we obtain from sources outside this survey –
information that exists now, as well as information in the future. We are requesting your permission to add other sources
of information to your interview data.
There are two types of data that could be linked to your interview data once it gets back to RTI International. First, we
would link your interview data to records collected from participating child welfare services agencies. Adding this
information will help us to learn more about any foster care or other services that you receive. Second, at some point in
the future, researchers interested in the NSCAW data may wish to add other information, such as data on state child
welfare policies, to your interview data. Your permission would allow these researchers to combine this new information
to your interview data.
How will the information be added and who will be able to use it?
The information we obtain from these sources will be combined with the information you give us in the interviews and
made available to researchers on a very restricted basis. No personally identifying information about you will be included.
Before receiving data, researchers must complete an application that gives good reason for their use of the information.
Applications will be reviewed and either approved or denied by a group of individuals whose job it is to protect the rights
of people like you who participate in research studies. The information will only be used for reports. Your name will not
appear in any of these reports.
What are the risks and benefits associated with granting permission for this request?
The only risk you are taking by giving permission for your NSCAW information to be added to other information is the
small risk that some researchers might not follow the rules we set for using your information. There are no direct benefits
to you in giving permission for your NSCAW information to be combined with other types of information. Your decision
will not change any services you may be receiving now or in the future. By answering “yes”, you are giving permission
for all of the NSCAW information we have ever collected in our interviews with you to be used in the future for other
important research studies.
What are my choices?
You have the right to refuse this request.. However, we hope you will let us use your information in this way. In the
future, if you change your mind about this, you should call Pat Crowley at RTI International (RTI) (toll-free at 877-2541953 extension 67) to ask that your NSCAW information no longer be used in this way.
Check one box.
Yes, I consent to having all of my NSCAW information ever collected in interviews to be added in the
future to information in other important research studies. This permission will take effect when RTI
releases information from this round to researchers.
No, I do not want any of my NSCAW information ever collected in interviews to be added to other
information. This refusal request will take effect when RTI releases information from this round to
researchers.

Printed Name of Young Adult

Fill in Young Adult Respondent 8-digit ID #

Signature of Young Adult

Date

Disposition: Original to RTI; Copy to Respondent

Version 3YA June 2011

Case ID#: _____________________
Caregiver Authorization for Use or Disclosure of Health Information
National Survey of Child and Adolescent Well-Being (NSCAW)

Child Name:
First

Child's Date of Birth:

Middle

Last

_____/___/____
Month/Day/Year

I, the undersigned, authorize the disclosure of individually identifiable health information about my child
for research, as described below.
Description of information to be disclosed, including dates of service related to such information:
Information about Medicaid services that
have received, including:
•
•
•
•
•

may
(Child Name – First, Middle, Last)

Date of Service
Type of Inpatient or Outpatient Service
Type of Provider or Health Care Professional (e.g., physician, nurse, psychologist, etc.)
Medications Prescribed
Insurance Coverage

Provider authorized to disclose my child’s health information (provider name and address):
U.S. Department of Health and Human Services
Centers for Medicare and Medicaid Services

Persons or class of persons to whom my child’s health information may be disclosed:
NSCAW research staff at RTI International, Research Triangle Park, NC

Purpose for this disclosure of my child’s health information:
We would like to better understand the types of services that your child may be receiving. Linking your
child’s survey data to information on Medicaid services will allow researchers to have a more complete
picture of the types of services used and who is providing those services. Only NSCAW research staff at
RTI International will have access to your child’s health information. All identifying information will be
destroyed after data files are electronically merged for research purposes.

This authorization expires:
18 months after the date of this interview: _____/___/____
Month/Day/Year
Page 1 of 2

2011

Disposition: Original to RTI; Copy to Respondent

Version 3B/C June

I understand that I may revoke this authorization at any time by notifying RTI International in writing at
the following address:
3040 Cornwallis Road
Post Office Box 12194
Research Triangle Park, NC 27709-2194
I also understand that I may refuse to sign this authorization and that my refusal will in no way affect my
or my child’s treatment, payment, enrollment in a health plan, or eligibility for benefits.
By signing below, I give permission to the provider named above to release health information about my
child to NSCAW staff at RTI International.
Printed Name of Child’s Parent/Guardian:
First

Middle

Last

Signature of Child’s Parent/Guardian:

Date:

_____/___/____
Month/Day/Year

Page 2 of 2

2011

Disposition: Original to RTI; Copy to Respondent

Version 3B/C June