Concent Forms

Attachment J
National Reach Survey Consent

Informed Consent Form
Evaluation of the National Child Traumatic Stress Initiative
National Reach Survey
The Center for Mental Health Services in the United States Department of Health and Human
Services is sponsoring a national evaluation of the National Child Traumatic Stress Initiative
(NCTSI). The NCTSI funds specialized centers across the nation to develop and use traumainformed services, approaches and systems to meet the special needs of children and
adolescents that have been exposed to traumatic experiences. By traumatic experiences we are
referring to a variety of events including physical, sexual, or emotional abuse; neglect;
community violence; domestic violence; disaster; terrorism; trauma due to war or displacement,
medical trauma, or grief/loss.
The current study is designed to learn about how child-serving organizations/agencies that may
or may not be affiliated with the NCTSI serve children and adolescents that have been exposed
to traumatic experiences.
Your input is important in helping us to understand whether the activities of the NCTSI have had
an impact beyond the communities served by the funded Centers. We are asking you to
participate in this study because we believe your organization plays a vital role in developing or
providing services for children.
Here are some things we want you to know about completing the survey:


Whether you choose to complete the survey or not is completely up to you.



You may stop answering questions at any time, for any reason, and you may choose not
to respond to any items you do not want to respond to.



Completing the survey will take about 30 minutes.



Any information that you provide will be kept strictly private. Your name, or your
agency’s name, will not be used in any reports about this survey, and no quotes or
demographic information will be used that would identify you individually.



There will be no direct benefit to you for completing the survey. The risk may be the
discomfort some people feel when expressing their attitudes and knowledge.



A report that combines what is learned from all of the completed surveys will be sent to
the Center for Mental Health Services. They may share that report with others at their
discretion.

Any questions you have about the study at any time can be answered by Dr. Bhuvana Sukumar
at (404) 321-3211 or at [email protected].
By checking that you agree below, you certify that you have read the above, that you
understand its content, and that you freely agree to participate in this project.
I agree
I do not agree

Attachment K
National Reach Survey Email Invitations

National Reach Survey
E-mail Invitations to Participate
The e-mail process will occur in four stages: (1) an advanced announcement of survey, (2) a
formal invitation that includes the Web-site URL and password, (3) first reminder to nonresponders, and (4) a second reminder to non-responders. The e-mails that will be sent are
included below:

(1) Announcement of National Reach Survey
Dear [Participant]:
The Center for Mental Health Services in the United States Department of Health and Human Services is
sponsoring an evaluation of the National Child Traumatic Stress Initiative (NCTSI). You are being
invited to participate in one of the key components of this evaluation--the National Reach Survey. The
survey was designed to learn about how community and national organizations (i.e., mental health, child
welfare, juvenile justice, schools, hospitals, emergency/crisis response, and law enforcement) have been
impacted by this federally funded initiative to increase access to services and interventions for children
and families affected by trauma.
In the next two weeks we will be sending you a formal invitation to participate in the survey that will take
about 30 minutes, and which can be completed on the web or through mail or through a telephone
interview.
We hope that you will chose to participate because the information you provide will contribute to a better
understanding of the impact of the federally funded National Child Traumatic Stress Initiative.
Sincerely,
Bhuvana Sukumar, Ph.D.
ICF Macro
3, Corporate Square
Atlanta, GA-30329.
404-321-3211
Email: [email protected]

(2) Invitation to National Reach Survey
Dear [Participant]:
The Center for Mental Health Services in the United States Department of Health and Human Services is
sponsoring a cross-site evaluation of the National Child Traumatic Stress Initiative (NCTSI). You are
being invited to participate in one of the key components of this evaluation--the National Reach Survey.
This survey is designed to learn about how community organizations (i.e., mental health, child welfare,
juvenile justice, schools, hospitals, emergency/crisis response, and law enforcement) have been impacted
by this federally funded initiative to increase access to services and interventions for children and families
affected by trauma.
The survey will take about 30 minutes to complete and contains questions about your agency’s familiarity
with the NCTSI, whether you have collaborated with any of the NCTSI centers, and about your agency’s
policies and practices that address the needs of children and adolescents affected by traumatic
experiences.
If you think the survey should be directed to someone else in your organization that specializes in
children's services, such as a Director of Children's Services, please forward this message to that person.
We hope that you will choose to participate in the survey. Depending on your preference, you may
complete the survey in one of three different ways (see instructions below):
 a web-based form, or
 a mail survey, or
 a telephone interview
1. Instructions for Web-based Survey - You can begin the survey by clicking on the web link
below, or by typing or pasting the address in to your browser. You will also be asked to provide the
Password supplied below to log in to the survey.
URL: https://www.nctsi-cross-site-eval.com/fm2/login/start.cfm?code=MJF
Insert Password
2. Instructions for Mail or Telephone Survey – Please send an email indicating your preference to
complete the survey by mail or telephone to me at [email protected] and we will either mail the
survey or call you to schedule an appointment for a telephone interview.
For questions about completing the survey, please feel free to contact me at (404)321-3211; or at
[email protected]. Thank you very much for your assistance.
Sincerely,
Bhuvana Sukumar, Ph.D.
ICF Macro
3, Corporate Square
Atlanta, GA-30329.
404-321-3211
Email: [email protected]

(3) First Reminder of National Reach Survey
Dear [Participant]:
We apologize if you have already sent us your completed survey, but in case you have not, we wanted to
remind you that you are being invited to participate in the National Reach Survey—one component of the
cross-site evaluation of the National Child Traumatic Stress Initiative (NCTSI). This survey is designed to
learn about how community organizations (i.e., mental health, child welfare, juvenile justice, schools,
hospitals, emergency/crisis response, and law enforcement) have been impacted by this federally funded
initiative to increase access to services and interventions for children and families affected by trauma.
The survey will take about 30 minutes to complete and contains questions about your agency’s familiarity
with the NCTSI, whether you have collaborated with any of the NCTSI centers, and about your agency’s
policies and practices that address the needs of children and adolescents affected by traumatic
experiences.
If you think the survey should be directed to someone else in your organization that specializes in
children's services, such as a Director of Children's Services, please forward this message to that person.
We hope that you will choose to participate in the survey. Depending on your preference, you may
complete the survey in one of three different ways (see instructions below):
 a web-based form, or
 a mail survey, or
 a telephone interview
1. Instructions for Web-based Survey - You can begin the survey by clicking on the web link
below, or by typing or pasting the address in to your browser. You will also be asked to provide the
Password supplied below to log in to the survey.
URL: https://www.nctsi-cross-site-eval.com/fm2/login/start.cfm?code=MJF
Insert Password
2. Instructions for Mail or Telephone Survey – Please send an email indicating your preference to
complete the survey by mail or telephone to me at [email protected] and we will either mail the
survey or call you to schedule an appointment for a telephone interview.
For questions about completing the survey, please feel free to contact me at (404)321-3211; or at
[email protected]. Thank you very much for your assistance.
Sincerely,
Bhuvana Sukumar, Ph.D.
ICF Macro
3, Corporate Square
Atlanta, GA-30329.
404-321-3211
Email: [email protected]

(4) Second Reminder of National Reach Survey
Dear [Participant]
We hope you do not find this e-mail to be intrusive, but we wanted to extend one final opportunity for
you to participate in the National Reach Survey, which is designed to learn about how community
organizations (i.e., mental health, child welfare, juvenile justice, schools, hospitals, emergency/crisis
response, and law enforcement) have been impacted by the federally-funded National Child Traumatic
Stress Initiative.
The survey will take about 30 minutes to complete and contains questions about your agency’s familiarity
with the NCTSI, whether you have collaborated with any of the NCTSI centers, and about your agency’s
policies and practices that address the needs of children and adolescents affected by traumatic
experiences.
If you think the survey should be directed to someone else in your organization that specializes in
children's services, such as a Director of Children's Services, please forward this message to that person.
We hope that you will choose to participate in the survey. Depending on your preference, you may
complete the survey in one of three different ways (see instructions below):
 a web-based form, or
 a mail survey, or
 a telephone interview
1. Instructions for Web-based Survey - You can begin the survey by clicking on the web link
below, or by typing or pasting the address in to your browser. You will also be asked to provide the
Password supplied below to log in to the survey.
URL: https://www.nctsi-cross-site-eval.com/fm2/login/start.cfm?code=MJF
Insert Password
2. Instructions for Mail or Telephone Survey – Please send an email indicating your preference to
complete the survey by mail or telephone to me at [email protected] and we will either mail the
survey or call you to schedule an appointment for a telephone interview.
For questions about completing the survey, please feel free to contact me at (404)321-3211; or at
[email protected]. Thank you very much for your assistance.
Sincerely,
Bhuvana Sukumar, Ph.D.
ICF Macro
3, Corporate Square
Atlanta, GA-30329.
404-321-3211
Email: [email protected]

(5) Second Reminder of National Reach Survey Modified:
Dear [Participant]
We hope you do not find this e-mail to be intrusive, but we wanted to extend one final opportunity for
you to participate in the National Reach Survey, which is designed to learn about how community
organizations (i.e., mental health, child welfare, juvenile justice, schools, hospitals, emergency/crisis
response, and law enforcement) have been impacted by the federally-funded National Child Traumatic
Stress Initiative.
The survey will take about 30 minutes to complete and contains questions about your agency’s familiarity
with the NCTSI, whether you have collaborated with any of the NCTSI centers, and about your agency’s
policies and practices that address the needs of children and adolescents affected by traumatic
experiences.
If you think the survey should be directed to someone else in your organization that specializes in
children's services, such as a Director of Children's Services, please forward this message to that person.
We hope that you will choose to participate in the survey. Depending on your preference, you may
complete the survey in one of two different ways (see instructions below):
 a web-based form, or
 a mail survey, or
 a telephone interview
1. Instructions for Web-based Survey - You can begin the survey by clicking on the web link
below, or by typing or pasting the address in to your browser. You will also be asked to provide the
Password supplied below to log in to the survey.
URL: https://www.nctsi-cross-site-eval.com/fm2/login/start.cfm?code=MJF
Insert Password
2. Instructions for Mail or Telephone Survey – Please send an email indicating your preference to
complete the survey by mail or telephone to me at [email protected] and we will either mail the
survey or call you to schedule an appointment for a telephone interview.
For questions about completing the survey, please feel free to contact me at (404)321-3211; or at
[email protected]. Thank you very much for your assistance.
Sincerely,
Bhuvana Sukumar, Ph.D.
ICF Macro
3, Corporate Square
Atlanta, GA-30329.
404-321-3211
Email: [email protected]

Attachment L
ETSC Invitation

Evidence-based Practice (EBP) and Trauma-informed System Change Survey
E-mail Invitations to Participate
The e-mail process will occur in four stages: (1) an advanced announcement of survey, (2) a
formal invitation that includes the Web-site URL and password, (3) first reminder to nonresponders, and (4) a second reminder to non-responders. The e-mails that will be sent are
included below:

(1) Announcement of ETSC Survey
Dear [Participant]:
The Center for Mental Health Services in the United States Department of Health and Human Services is
sponsoring an evaluation of the National Child Traumatic Stress Initiative (NCTSI). You are being
invited to participate in one of the key components of this evaluation--the National Impact Survey. The
survey was designed to learn about how community and national organizations (i.e., mental health, child
welfare, juvenile justice, schools, hospitals, emergency/crisis response, and law enforcement) have been
impacted by this federally funded initiative to increase access to services and interventions for children
and families affected by trauma.
In the next two weeks we will be sending you a formal invitation to participate in the survey that will take
about 30 minutes, and which can be completed on the web or through mail or through a telephone
interview.
We hope that you will chose to participate because the information you provide will contribute to a better
understanding of the impact of the federally funded National Child Traumatic Stress Initiative.
Sincerely,
Bhuvana Sukumar, Ph.D.
ICF Macro
3, Corporate Square
Atlanta, GA-30329.
404-321-3211
Email: [email protected]

(2) Invitation to ETSC
Dear [Participant]:
The Center for Mental Health Services in the United States Department of Health and Human Services is
sponsoring a cross-site evaluation of the National Child Traumatic Stress Initiative (NCTSI). You are
being invited to participate in one of the key components of this evaluation--the National Impact Survey.
This survey is designed to learn about how community organizations (i.e., mental health, child welfare,
juvenile justice, schools, hospitals, emergency/crisis response, and law enforcement) have been impacted
by this federally funded initiative to increase access to services and interventions for children and families
affected by trauma.
The survey will take about 30 minutes to complete and contains questions about your agency’s familiarity
with the NCTSI, whether you have collaborated with any of the NCTSI centers, and about your agency’s
policies and practices that address the needs of children and adolescents affected by traumatic
experiences.
If you think the survey should be directed to someone else in your organization that specializes in
children's services, such as a Director of Children's Services, please forward this message to that person.
We hope that you will choose to participate in the survey. Depending on your preference, you may
complete the survey in one of three different ways (see instructions below):
 a web-based form, or
 a mail survey, or
 a telephone interview
1. Instructions for Web-based Survey - You can begin the survey by clicking on the web link
below, or by typing or pasting the address in to your browser. You will also be asked to provide the
Password supplied below to log in to the survey.
URL: https://www.nctsi-cross-site-eval.com/fm2/login/start.cfm?code=MJF
Insert Password
2. Instructions for Mail or Telephone Survey – Please send an email indicating your preference to
complete the survey by mail or telephone to me at [email protected] and we will either mail the
survey or call you to schedule an appointment for a telephone interview.
For questions about completing the survey, please feel free to contact me at (404)321-3211; or at
[email protected]. Thank you very much for your assistance.
Sincerely,
Bhuvana Sukumar, Ph.D.
ICF Macro
3, Corporate Square
Atlanta, GA-30329.
404-321-3211
Email: [email protected]

(3) First Reminder of ETSC Survey
Dear [Participant]:
We apologize if you have already sent us your completed survey, but in case you have not, we wanted to
remind you that you are being invited to participate in the National Impact Survey—one component of the
cross-site evaluation of the National Child Traumatic Stress Initiative (NCTSI). This survey is designed to
learn about how community organizations (i.e., mental health, child welfare, juvenile justice, schools,
hospitals, emergency/crisis response, and law enforcement) have been impacted by this federally funded
initiative to increase access to services and interventions for children and families affected by trauma.
The survey will take about 30 minutes to complete and contains questions about your agency’s familiarity
with the NCTSI, whether you have collaborated with any of the NCTSI centers, and about your agency’s
policies and practices that address the needs of children and adolescents affected by traumatic
experiences.
If you think the survey should be directed to someone else in your organization that specializes in
children's services, such as a Director of Children's Services, please forward this message to that person.
We hope that you will choose to participate in the survey. Depending on your preference, you may
complete the survey in one of three different ways (see instructions below):
 a web-based form, or
 a mail survey, or
 a telephone interview
1. Instructions for Web-based Survey - You can begin the survey by clicking on the web link
below, or by typing or pasting the address in to your browser. You will also be asked to provide the
Password supplied below to log in to the survey.
URL: https://www.nctsi-cross-site-eval.com/fm2/login/start.cfm?code=MJF
Insert Password
2. Instructions for Mail or Telephone Survey – Please send an email indicating your preference to
complete the survey by mail or telephone to me at [email protected] and we will either mail the
survey or call you to schedule an appointment for a telephone interview.
For questions about completing the survey, please feel free to contact me at (404)321-3211; or at
[email protected]. Thank you very much for your assistance.
Sincerely,
Bhuvana Sukumar, Ph.D.
ICF Macro
3, Corporate Square
Atlanta, GA-30329.
404-321-3211
Email: [email protected]

(4) Second Reminder of ETSC Survey
Dear [Participant]
We hope you do not find this e-mail to be intrusive, but we wanted to extend one final opportunity for
you to participate in the National Impact Survey, which is designed to learn about how community
organizations (i.e., mental health, child welfare, juvenile justice, schools, hospitals, emergency/crisis
response, and law enforcement) have been impacted by the federally-funded National Child Traumatic
Stress Initiative.
The survey will take about 30 minutes to complete and contains questions about your agency’s familiarity
with the NCTSI, whether you have collaborated with any of the NCTSI centers, and about your agency’s
policies and practices that address the needs of children and adolescents affected by traumatic
experiences.
If you think the survey should be directed to someone else in your organization that specializes in
children's services, such as a Director of Children's Services, please forward this message to that person.
We hope that you will choose to participate in the survey. Depending on your preference, you may
complete the survey in one of three different ways (see instructions below):
 a web-based form, or
 a mail survey, or
 a telephone interview
1. Instructions for Web-based Survey - You can begin the survey by clicking on the web link
below, or by typing or pasting the address in to your browser. You will also be asked to provide the
Password supplied below to log in to the survey.
URL: https://www.nctsi-cross-site-eval.com/fm2/login/start.cfm?code=MJF
Insert Password
2. Instructions for Mail or Telephone Survey – Please send an email indicating your preference to
complete the survey by mail or telephone to me at [email protected] and we will either mail the
survey or call you to schedule an appointment for a telephone interview.
For questions about completing the survey, please feel free to contact me at (404)321-3211; or at
[email protected]. Thank you very much for your assistance.
Sincerely,
Bhuvana Sukumar, Ph.D.
ICF Macro
3, Corporate Square
Atlanta, GA-30329.
404-321-3211
Email: [email protected]

(5) Second Reminder of ETSC Survey Modified:
Dear [Participant]
We hope you do not find this e-mail to be intrusive, but we wanted to extend one final opportunity for
you to participate in the National Impact Survey, which is designed to learn about how community
organizations (i.e., mental health, child welfare, juvenile justice, schools, hospitals, emergency/crisis
response, and law enforcement) have been impacted by the federally-funded National Child Traumatic
Stress Initiative.
The survey will take about 30 minutes to complete and contains questions about your agency’s familiarity
with the NCTSI, whether you have collaborated with any of the NCTSI centers, and about your agency’s
policies and practices that address the needs of children and adolescents affected by traumatic
experiences.
If you think the survey should be directed to someone else in your organization that specializes in
children's services, such as a Director of Children's Services, please forward this message to that person.
We hope that you will choose to participate in the survey. Depending on your preference, you may
complete the survey in one of two different ways (see instructions below):
 a web-based form, or
 a mail survey, or
 a telephone interview
1. Instructions for Web-based Survey - You can begin the survey by clicking on the web link
below, or by typing or pasting the address in to your browser. You will also be asked to provide the
Password supplied below to log in to the survey.
URL: https://www.nctsi-cross-site-eval.com/fm2/login/start.cfm?code=MJF
Insert Password
2. Instructions for Mail or Telephone Survey – Please send an email indicating your preference to
complete the survey by mail or telephone to me at [email protected] and we will either mail the
survey or call you to schedule an appointment for a telephone interview.
For questions about completing the survey, please feel free to contact me at (404)321-3211; or at
[email protected]. Thank you very much for your assistance.
Sincerely,
Bhuvana Sukumar, Ph.D.
ICF Macro
3, Corporate Square
Atlanta, GA-30329.
404-321-3211
Email: [email protected]

Attachment M
ETSC Consent

Informed Consent Form
National Child Traumatic Stress Initiative Evaluation
EBP AND TRAUMA-INFORMED SYSTEM CHANGE SURVEY
The Center for Mental Health Services in the Substance Abuse and Mental Health Services
Administration (SAMHSA) of the United States Department of Health and Human Services is
sponsoring a national evaluation of the National Child Traumatic Stress Initiative (NCTSI), which
includes the National Child Traumatic Stress Network (NCTSN). You are invited to participate in
this evaluation because you recently collaborated with or received training from a Federallyfunded NCTSN center.
Your input is important in improving understanding of how the NCTSN is working to collaborate
with other child-serving systems, and to provide trauma-related training to human service
providers across services disciplines throughout the country (human service providers include a
wide range of community-based professionals who interact frequently with children and engage
in multiple activities, from prevention to screening, early identification, and the provision of
clinical interventions; such providers may include mental health professionals, teachers, child
welfare staff, juvenile justice staff, health care providers and first responders). These same
questions are being asked of other collaborating agencies and training participants.
Here are some things we want you to know about completing the survey:














Whether you choose to complete the survey or not is completely up to you.
Upon completion of the survey, you will receive a $20 gift certificate to thank you for your
time and attention to this important matter.
You may stop answering questions at any time, for any reason, and you may choose not
to respond to any items that you do not want to respond to.
Completing the survey will take about 30 minutes.
The information gathered in this survey will be kept private and your responses will not
be linked back to you.
There will be no direct benefit to you from participating in this evaluation. There are no
foreseeable risks associated with participation in this survey.
A report that combines what is learned from all of the completed surveys will be sent to
the children’s mental health services program director at the center that provided training
to you and other program partners. They may share that report with others at their
discretion.
Any questions you have about the study can be answered by Bhuvana Sukumar of ICF
Macro in Atlanta, Georgia. Contact at (404) 321-3211 or by emailing:
[email protected].

By completing and submitting the survey, you certify that you have read the above, that
you understand its content, and that you freely agree to participate in this survey.
Thank you in advance for your willingness to participate.

Attachment N
Sustainability Survey Invitation

Introduction E-mail: Affiliate Center Survey
Dear [insert Center Director]:
As part of the national evaluation of the National Child Traumatic Stress Initiative (NCTSI), funded by
the Substance Abuse and Mental Health Services Administration (SAMHSA), the national evaluation is
conducting a special study on sustaining National Child Traumatic Stress Network (NCTSN) centers.
The study is designed to assess factors impacting the ability of federally funded NCTSN centers to
maintain their center activities after Federal funding ends. The goal is to provide information that will be
useful to NCTSN centers, as well as to Federal, State, and local policymakers, to enhance sustainability.
The study approach involves learning from the experience of affiliate centers in order to assist current and
future grantees to maximize the likelihood that their centers will be maintained over time.
The study method will involve a Web-based survey to be completed by key stakeholders at centers that
received Federal funding from SAMHSA. Two stakeholders in each community will be asked to
complete the Web-based survey: the current or former center project director and the current or former
lead evaluator. The Web-based survey should take no more than 60 minutes to complete. You will be able
to stop and restart the survey, if you do not have enough time to finish the survey at one time.
If you choose to participate in our survey, you will be entered into a contest to receive a $50 Amazon gift
card. If you have any questions regarding this study, please contact me at the information provided below.
Very truly yours,

CONTACT

E-mail Sent With Affiliate Center Survey Link
Thank you again for agreeing to participate in this study on sustainability of National Child Traumatic
Stress Network (NCTSN) centers. As a key member of your center familiar with service delivery, your
help will allow us to better understand factors and strategies for maintaining center activities after Federal
grant funding ends. The national evaluation of the National Child Traumatic Stress Initiative (NCTSI),
needs your help to understand these issues and is interested in your answers to questions related to your
center.
This survey is being conducted by ICF Macro as part of the NCTSI funded by the Substance Abuse and
Mental Health Services Administration (SAMHSA).
This important Federal effort is working hard to improve trauma-informed mental health services for
children and families, and gathering information from you, is critical to this mission. This survey should
take about 60 minutes to complete. However, you will be able to stop and restart the survey, if you do not
have enough time to finish the survey at one time.While the completion of this survey is voluntary, a true
understanding of experiences from the field is difficult without your information.
For your convenience, we have made the survey available on the Web. You can complete the survey at
the following Internet address:
https://secure.macrointernational.com/SustainabilityV/
When you reach this Web site, you will be asked to type in a username and password. These will insure
that only those selected can participate in the survey. Your username and password are:
Username: ________
Password: ________
We will only use the username and password for security and for keeping track of response rates. All
responses will be kept private.
Thank you in advance for your willingness to participate in this study and to share your experience and
insights related to the critical issue of maintaining NCTSN centers. For agreeing to participate in our
survey, you will be entered into a contest to receive a $50 Amazon gift card.
Sincerely,

CONTACT

First Reminder E-mail
Recently we wrote to you about a survey on sustaining National Child Traumatic Stress Network
(NCTSN) centers and sent you the Internet address, username, and password to the survey. This study is
being conducted as part of the national evaluation of the National Child Traumatic Stress Initiative
(NCTSI), and is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA).
We sent the survey to you as a member of a select group of individuals familiar with NCTSN center
activities. To the best of our knowledge, you have not yet completed the survey. Completing the survey
will take about 60 minutes. You will be able to stop and restart the survey, if you do not have enough time
to finish the survey at one time. We understand that you are busy and may not have had the time to
complete it. Yet, we would greatly appreciate hearing from you. For agreeing to participate in our survey,
you will be entered into a contest to receive a $50 Amazon gift card.
If you have any questions, please contact CONTACT at ICF Macro at (404) 321-3211 or at CONTACT
E-MAIL.
If you have already completed the sustainability survey, please accept our sincere thanks. If not, please
consider doing so today. We are very grateful for your help.
Again, if you have any questions, or need additional information, please do not hesitate to contact us.
Sincerely,

CONTACT

Second Reminder – E-mail
About two weeks ago, we wrote you about a survey on sustaining National Child Traumatic Stress
Network (NCTSN) centers. This survey is being conducted as part of the national evaluation of the
National Child Traumatic Stress Initiative (NCTSI). This important Federal effort to improve traumainformed mental health services for children and families is funded by Substance Abuse and Mental
Health Services Administration (SAMHSA). To the best of our knowledge, you have not yet completed
the survey.
As a reminder, you can complete the survey at the following Internet address (just click on this link or
copy the address into your Internet browser):
https://secure.macrointernational.com/SustainabilityV/
When you reach this Web site, you will be asked to type in your username and password. Your username
and password are:
Username: ____
Password: ____
If you have already completed the sustainability survey, please accept our sincere thanks. If not, please
consider doing so today—it will only take 60 minutes. You will be able to stop and restart the survey, if
you do not have enough time to finish the survey at one time. Although your completion of this survey is
completely voluntary, we are very grateful for your help. As a token of our appreciation for your
participation, you will be entered into a contest to receive a $50 Amazon gift card.
If you have any questions, or need additional information, please contact me at (404) 321-3211 or at
CONTACT E-MAIL.

Sincerely,

CONTACT

Third Reminder E-mail
About three weeks ago, we sent you the Internet address, username, and password to a survey on
sustaining National Child Traumatic Stress Network (NCTSN) centers. This survey is being conducted as
part of the national evaluation of the National Child Traumatic Stress Initiative (NCTSI) funded by
Substance Abuse and Mental Health Services Administration (SAMHSA). To the best of our knowledge,
you have not yet completed the survey.
You may recall that you can complete the survey at the following Internet address (just type the address
into your Internet browser):
https://secure.macrointernational.com/SustainabilityV/
When you reach this Web site, you will be asked to type in a username and password. These will insure
that only those selected can participate in the survey. Your username and password are:
Username: ______
Password: ______
If you have already completed the sustainability survey, please accept our sincere thanks. If not, please
consider doing so today—it will only take 60 minutes. You will be able to stop and restart the survey, if
you do not have enough time to finish the survey at one time. Your participation in this study is
completely voluntary, and your responses will be kept private. The username and password are used only
for security and to keep track of response rates. As a token of our appreciation for your participation, you
will be entered into a contest to receive a $50 Amazon gift card.
If you have already completed the sustainability survey, please accept our sincere thanks. If not, please
consider doing so today. Once again, we would be happy to address any questions or concerns you have
about this survey. Please feel free to contact me at (404) 321-3211 or at CONTACT E-MAIL. We truly
appreciate your participation in this study.
Sincerely,

CONTACT

Survey Log-in Page
Thank you again for agreeing to participate in this study on sustainability of National Child Traumatic
Stress Network (NCTSN) centers. You are a key member of your center familiar with service delivery.
We are interested in your answers to questions about your center. Your help will allow us to better
understand factors and strategies for maintaining center activities after Federal grant funding ends.
This survey is being conducted by ICF Macro as part of the National Child Traumatic Stress Initiative
(NCTSI) funded by the Substance Abuse and Mental Health Services Administration (SAMHSA).
This important Federal effort is working to improve trauma-informed mental health services for children
and families. Gathering information from you is critical to this mission. Completing the survey will take
about 60 minutes. You can stop and restart the survey, if you do not have enough time to finish the survey
at one time. Completing the survey is voluntary. You can stop at any time. However, a true understanding
of experiences in each community will be difficult without your information.
Entering your Username and Password
Completing this survey is limited to selected individuals who have been assigned a username and
password. Usernames and passwords are for security purposes. They ensure that only people meeting
survey requirements complete the survey, and that only people who have not completed the survey
receive reminder letters. Every effort has been made to ensure the security of the information you provide
in this survey. Your responses to the survey are not stored on your personal computer. The survey is
operated under a secure server and all information provided is encrypted.
Survey responses will be kept private and will only be reported along with other responses. No
individuals will be identified in reports.
To begin the survey, enter your username and password (provided in the email you received about the
survey) in the fields below.
By entering your username and password, you agree to participate in this study.
Username: ______
Password: ______
When you click on Enter, you will be directed to the Informed Consent Form screen where you will be
given a choice to continue with the survey or to decline to participate.
If you have any questions about the survey, please CONTACT at ICF Macro by telephone 404-321-3211,
or by email: CONTACT E-MAIL.

Informed Consent Form
The Substance Abuse and Mental Health Services Administration (SAMHSA) in the United States
Department of Health and Human Services (HHS) is sponsoring a national evaluation of the National
Child Traumatic Stress Initiative (NCTSI). As you may know, the NCTSI funds specialized centers
across the nation to develop and use trauma-informed services, approaches and systems to meet the
special needs of children and adolescents that have been exposed to traumatic experiences.
The current study will assess factors impacting the ability of federally funded NCTSN centers to maintain
their center activities after Federal funding ends. The goal is to provide information that will be useful to
NCTSN centers, as well as to Federal, State, and local policymakers, to enhance sustainability. The study
approach involves learning from the experience of affiliate centers in order to assist current and future
grantees to maximize the likelihood that their centers will be maintained over time.
We are asking you to participate in this study because as a key member of your center familiar with
service delivery, your help will allow us to better understand factors and strategies for maintaining center
activities after Federal grant funding ends. The national evaluation of the National Child Traumatic Stress
Initiative (NCTSI) needs your help to understand these issues and is interested in your answers to
questions related to your center.
Here are some things we want you to know about completing this survey:
 Completing this survey is completely voluntary.
 You may choose not to answer any question or to stop answering questions at any time, for any
reason.
 Completing the survey will take approximately 60 minutes. You may stop and restart the survey.
You can stop the survey by closing your internet browser. All of your responses to that point will
be saved. To continue the survey, reenter your name and password on the survey website to
continue the survey where you left off.
 Any information that you provide will be kept strictly private. No one other than project staff will
know who you are and what answers you gave. Any reports from this survey will report results in
group form. Your name will not be used in any reports about this survey, and no quotes will be
used that will identify you individually.
 There will be no direct benefit to you from participating in this evaluation. There are no
foreseeable risks associated with participation in this survey.
 A report that combines what is learned from all of the completed surveys will be sent to the
children's mental health services program director and other program partners. They may share
that report with others at their discretion.
Any questions you have about the study can be answered at anytime by CONTACT at ICF Macro at
(404) 321-3211, or at CONTACT E-MAIL.

Thank You Note
Thank you so much for completing the recent survey on sustainability efforts of National Child Traumatic
Stress Network (NCTSN) centers. Your participation in this study is much appreciated, and your valuable
feedback will be used to provide information that will be useful to NCTSN centers, as well as to Federal,
State, and local policymakers, to enhance sustainability.
You will be entered into a drawing to receive a $50 Amazon gift card as a small token of thanks for
participating in the survey. feel free to contact me if you have any questions or concerns about the study.
Thanks again for your help in understanding factors and strategies for maintaining center activities!
Sincerely,

CONTACT

Attachment O
Sustainability Survey Consent

Sustainability Survey - Informed Consent Form
The Substance Abuse and Mental Health Services Administration (SAMHSA) in the United States
Department of Health and Human Services (HHS) is sponsoring a national evaluation of the National
Child Traumatic Stress Initiative (NCTSI). As you may know, the NCTSI funds specialized centers
across the nation to develop and use trauma-informed services, approaches and systems to meet the
special needs of children and adolescents that have been exposed to traumatic experiences.
The current study will assess factors impacting the ability of federally funded NCTSN centers to maintain
their center activities after Federal funding ends. The goal is to provide information that will be useful to
NCTSN centers, as well as to Federal, State, and local policymakers, to enhance sustainability. The study
approach involves learning from the experience of affiliate centers in order to assist current and future
grantees to maximize the likelihood that their centers will be maintained over time.
We are asking you to participate in this study because as a key member of your center familiar with
service delivery, your help will allow us to better understand factors and strategies for maintaining center
activities after Federal grant funding ends. The national evaluation of the National Child Traumatic Stress
Initiative (NCTSI) needs your help to understand these issues and is interested in your answers to
questions related to your center.
Here are some things we want you to know about completing this survey:
 Completing this survey is completely voluntary.
 You may choose not to answer any question or to stop answering questions at any time, for any
reason.
 Completing the survey will take approximately 60 minutes. You may stop and restart the survey.
You can stop the survey by closing your internet browser. All of your responses to that point will
be saved. To continue the survey, reenter your name and password on the survey website to
continue the survey where you left off.
 Any information that you provide will be kept strictly private. No one other than project staff will
know who you are and what answers you gave. Any reports from this survey will report results in
group form. Your name will not be used in any reports about this survey, and no quotes will be
used that will identify you individually.
 There will be no direct benefit to you from participating in this evaluation. There are no
foreseeable risks associated with participation in this survey.
 A report that combines what is learned from all of the completed surveys will be sent to the
children's mental health services program director and other program partners. They may share
that report with others at their discretion.
Any questions you have about the study can be answered at anytime by CONTACT at ICF Macro at
(404) 321-3211, or at CONTACT E-MAIL.