appendices

Teen Dating Relationships: Opportunities for Youth to Define What’s Healthy and Unhealthy
OMB Information Collection Request: Appendices
Table of Contents
A. Consent forms
1. Parental Permission Form – Concept Mapping: Brainstorming 11-13
2. Parental Permission Form – Concept Mapping: Brainstorming 14-17
3. Parental Permission Form – Concept Mapping: Sorting and Rating 14-17
4. Parental Permission Form – Concept Mapping: Rating 14-17
5. Web Based Child Assent Form – Brainstorming
6. Web Based Child Assent Form – Sorting and Rating
7. Web Based Child Assent Form – Rating
8. Web Based Adult Consent Form – Brainstorming
9. Web Based Adult Consent Form – Sorting and Rating
10. Web Based Adult Consent Form – Rating
11. Parental Permission Form – Facilitated Discussions
12. Child Assent Form – Facilitated Discussions
13. Adult Consent Form – Facilitated Discussions
B. Recruitment materials
1. Organization and Agency Brainstorming Letter and Instructions
2. Organization and Agency Sorting and Rating Letter and Instructions
3. Organization and Agency Rating Letter and Instructions
4. Master Tracking List
5. Brainstorming Flyer, Youth 11-13
6. Brainstorming Flyer, Youth 14-22
7. Sorting and Rating Flyer
8. Rating Flyer
C. Concept mapping instructions
D. Facilitated discussion instructions
E. Debrief
F. Table of organizations and agencies

Appendix A1
Parental Permission Form – Concept Mapping: Brainstorming 11-13 yr olds
A research team from Concept Systems, Inc. (CSI), with support from the US Department of Justice and
the US Department of Health and Human Services, is asking for input from teens and adults to better
understand teen dating relationships. The purpose of this activity is to gather ideas from youth by asking
them to respond to the following sentence: “A thought, feeling, action or behavior that teens in dating
relationships might have or do is…”
We are asking for your permission to allow your child take part in this activity because your child is
between 11-13 years old. This is the age range from which we are seeking opinions and input. Please
read this form and ask any questions before you allow your child to take part in this activity.
If you agree to allow your child to take part in this activity, your child will be asked to visit a secure
project website where they will complete the sentence above with as many ideas as they choose. This
activity should take your child five to ten minutes.
Your child may feel uncomfortable thinking about teen dating relationship. We do not expect that your
child will face additional risks beyond those that they might come across on a daily basis.
There are no direct benefits to you or your child if he or she takes part in this activity.
Any answers that your child provides in this activity will be completely private. The research team will
not know the identity of your child. We will not ask your child for their name at any point during this
activity, and your child will in no way be connected to the ideas they submit.
Your child’s involvement in this activity is completely optional. Your child can quit at anytime, and will
not have to finish. Your decision whether or not to allow your child to take part will not affect your
relationship with SUNY Cortland or the organization that gave your child this form.
The contact for this activity is Scott Rosas from CSI. You may reach him at 607-272-1206 or
[email protected]. Please ask Scott any questions you have about the project.
If you agree to allow your child to take part in this activity, please fill out the form below and give it to
your child to return to their organizational representative as soon as possible.
If you have any questions or concerns about teen dating relationships, please visit www.breakthecycle.org
for more information.
Your child's name: ________________________________________________
Your signature: ___________________________________________________ Date _____________
Your printed name: ________________________________________________ Date _____________

Appendix A2
Parental Permission Form – Concept Mapping: Brainstorming 14-17 yr olds.
A research team from Concept Systems, Inc. (CSI), with support from the US Department of Justice and
the US Department of Health and Human Services, is asking for input from teens and adults to better
understand teen dating relationships. The purpose of this activity is to gather ideas from youth by asking
them to respond to the following sentence: “A thought, feeling, action or behavior that teens in dating
relationships might have or do is…”
We are asking for your permission to allow your child take part in this activity because your child is
between 14-18 years old. This is the age range from which we are seeking opinions and input. Please
read this form and ask any questions before you allow your child to take part in this activity.
If you agree to allow your child to take part in this activity, your child will be asked to visit a secure
project website where they will complete the sentence above with as many ideas as they choose. This
activity should take your child five to ten minutes.
Your child may feel uncomfortable thinking about teen dating relationship. We do not expect that your
child will face additional risks beyond those that they might come across on a daily basis.
There are no direct benefits to you or your child if he or she takes part in this activity.
Any answers that your child provides in this activity will be completely private. The research team will
not know the identity of your child. We will not ask your child for their name at any point during this
activity, and your child will in no way be connected to the ideas they submit.
Your child’s involvement in this activity is completely optional. Your child can quit at anytime, and will
not have to finish. Your decision whether or not to allow your child to take part will not affect your
relationship with SUNY Cortland or the organization that gave your child this form.
The contact for this activity is Scott Rosas from CSI. You may reach him at 607-272-1206 or
[email protected]. Please ask Scott any questions you have about the project.
If you agree to allow your child to take part in this activity, please fill out the form below and give it to
your child to return to their organizational representative as soon as possible.
If you have any questions or concerns about teen dating relationships, please visit www.breakthecycle.org
for more information.
Your child's name: ________________________________________________
Your signature: ___________________________________________________ Date _____________
Your printed name: ________________________________________________ Date _____________

Appendix A3
Parental Permission Form – Concept Mapping: Sorting and Rating
A research team from Concept Systems, Inc. (CSI), with support from the US Department of Justice and
the US Department of Health and Human Services, is asking for input from teens and adults to better
understand teen dating relationships. A few weeks ago, we asked a sample of adults and teens to provide
us with thoughts, feelings, behaviors, and activities that they thought teens in dating relationships might
have or do.
We are asking for your permission to allow your child take part in this activity because your child is
between 14-18 years old. This is the age range from which we are seeking opinions. Please read this
form and ask any questions before you allow your child to take part in these activities.
If you agree to allow your child to take part in these activities, your child will be asked to visit a secure
project website where they will organize ideas about dating relationships into groups that make sense to
them (the sorting activity). They will also be asked to rate the ideas on how common and how desirable
they think each idea is in teen dating relationships (the rating activity). This activity should take your
child about two hours total to complete. S/he does not need to complete the activities in one sitting. If
your child completes both the sorting and rating activities, s/he will receive a $15 gift card to
Amazon.com.
Your child may feel uncomfortable thinking about teen dating relationship. We do not expect that your
child will face additional risks beyond those that they might come across on a daily basis.
There are no direct benefits to you or your child if he or she takes part in these activities.
Any answers that your child provides in this activity will be completely private. The research team will
not know the identity of your child. We will not ask your child for their name at any point during this
activity, and your child will in no way be connected to the ideas they submit.
Your child’s involvement in this activity is completely optional. Your child can quit at anytime, and will
not have to finish. Your decision whether or not to allow your child to take part will not affect your
relationship with SUNY Cortland or the organization that gave your child this form.
The contact for this activity is Scott Rosas from CSI. You may reach him at 607-272-1206 or
[email protected]. Please ask Scott any questions you have about the project.
If you agree to allow your child to take part in this activity, please fill out the form below and give it to
your child to return to their organizational representative as soon as possible.
If you have any questions or concerns about teen dating relationships, please visit www.breakthecycle.org
for more information.
Your child's name: ________________________________________________
Your signature: ___________________________________________________ Date _____________
Your printed name: ________________________________________________ Date _____________

Appendix A4
Parental Permission Form – Concept Mapping: Rating
A research team from Concept Systems, Inc. (CSI), with support from the US Department of Justice and
the US Department of Health and Human Services, is asking for input from teens and adults to better
understand teen dating relationships. A few weeks ago, we asked a sample of adults and teens to provide
us with thoughts, feelings, behaviors, and activities that they thought teens in dating relationships might
have or do.
We are asking for your permission to allow your child take part in this activity because your child is
between 14-18 years old. This is the age range from which we are seeking opinions. Please read this
form and ask any questions before you allow your child to take part in this activity.
If you agree to allow your child to take part in these activities, your child will be asked to visit a secure
project website where they will rate ideas about dating relationships on how common and how desirable
they think each idea is in teen dating relationships. This activity should take your child about one hour
total to complete. S/he does not need to complete the activity in one sitting. If your child finishes the
activity, s/he will receive a $10 gift card to Amazon.com.
Your child may feel uncomfortable thinking about teen dating relationship. We do not expect that your
child will face additional risks beyond those that they might come across on a daily basis.
There are no direct benefits to you or your child if he or she takes part in this activity.
Any answers that your child provides in this activity will be completely private. The research team will
not know the identity of your child. We will not ask your child for their name at any point during this
activity, and your child will in no way be connected to the ideas they submit.
Your child’s involvement in this activity is completely optional. Your child can quit at anytime, and will
not have to finish. Your decision whether or not to allow your child to take part will not affect your
relationship with SUNY Cortland or the organization that gave your child this form.
The contact for this activity is Scott Rosas from CSI. You may reach him at 607-272-1206 or
[email protected]. Please ask Scott any questions you have about the project.
If you agree to allow your child to take part in this activity, please fill out the form below and give it to
your child to return to their organizational representative as soon as possible.
If you have any questions or concerns about teen dating relationships, please visit www.breakthecycle.org
for more information.
Your child's name: ________________________________________________
Your signature: ___________________________________________________ Date _____________
Your printed name: ________________________________________________ Date _____________

Appendix A5
Web-Based Child Assent Form – Brainstorming
We are doing a study to learn about what kids your age think about dating and relationships. This study is
being funded by the US Department of Justice and the US Department of Health and Human Services.
We are asking you to help because we don’t know very much about how kids your age think about teen
dating relationships.
If you want to be in our study, we are going to ask you to go to a website where we will ask you to give
us as many ideas as you would like that finish the sentence, “A thought, feeling, behavior, or activity that
teens in dating relationships might have or do is…” This activity is called brainstorming.
The questions we will ask are only about what you think. There are no right or wrong answers because
this is not a test. We will never ask you for your name, and we will never know which answers you
wrote.
You can ask questions about this study at any time by emailing [email protected].
If at any time you feel like you don’t want to be in the study, you can stop.
If you click “Accept” below, it means that you have read this and that you want to be in the study. If you
don’t want to be in the study, you can exit this site or click “Reject” below. Once you click “Reject,”
you will not be able to participate. Being in the study is up to you, and no one will be upset if you don’t
click “Accept” below or if you change your mind later.
After you click “Accept,” you will be taken to the project homepage where you will start the
brainstorming activity.

Appendix A6
Web-Based Child Assent Form – Sorting and Rating
We are doing a study to learn about how kids your age think about dating and relationships. This study is
being funded by the US Department of Justice and the US Department of Health and Human Services.
We are asking you to help because we don’t know very much about how kids your age think about teen
dating relationships.
A few weeks ago, we asked a group of kids and adults to give us their ideas about thoughts, feelings,
behaviors or activities that they thought teens in dating relationships might have or do.
Now we need your help to sort their ideas into groups that make the most sense to you. If you want to be
in our study, we will ask you to go to a website where we will ask you to move the ideas into piles that
make sense to you. These piles could be themes, topics or categories. This activity is called sorting.
After you sort the ideas into piles, we will ask you to give us your opinions about how common and how
desirable you think each idea is in teen dating relationships. These opinions are called ratings.
We will never ask you for your name, and we will never know which piles or ratings belong to you.
If you finish the sorting and the rating activities, you will get a $15 gift card to Amazon.com.
You can ask questions about this study at any time by emailing [email protected].
If you at any time you feel like you don’t want to be in the study, you can stop.
If you click “Accept” below, it means that you have read this and that you want to be in the study. If you
don’t want to be in the study, you can simply exit this site or click “Reject” below. Once you click
“Reject,” you will not be able to participate. Being in the study is up to you, and no one will be upset if
you don’t click “Accept” below or if you change your mind later.
After you click “Accept,” you will be taken to the project homepage where you can start the sorting and
rating activities.

Appendix A7
Web-Based Child Assent Form – Rating
We are doing a study to learn about how kids your age think about dating and relationships. This study is
being funded by the US Department of Justice and the US Department of Health and Human Services.
We are asking you to help because we don’t know very much about how kids your age think about teen
dating relationships.
A few weeks ago, we asked a group of kids and adults to give us their ideas about thoughts, feelings,
behaviors or activities that they thought teens in dating relationships might have or do.
Now we need you to give us your opinions about how important you think each idea is to teen dating
relationships. If you agree to be in our study, we will ask you to go to a website where we will ask you
how common and how desirable you think each idea is in teen dating relationships. These opinions are
called ratings.
We will never ask you for your name, and we will never know which answers belong to you.
If you finish the rating activity, you will get a $10 gift card to Amazon.com.
You can ask questions about this study at any time by emailing [email protected].
If you at any time you feel like you don’t want to be in the study, you can stop.
If you click “Accept” below, it means that you have read this and that you want to be in the study. If you
don’t want to be in the study, you can simply exit this site or click “Reject” below. Once you click
“Reject,” you will not be able to participate. Being in the study is up to you, and no one will be upset if
you don’t click “Accept” below or if you change your mind later.
After you click “Accept,” you will be taken to the project homepage where you can start the rating
activity.

Appendix A8
Web-Based Adult Consent Form - Brainstorming
You are being asked to take part in a research study about how teens and adults think about teen dating
relationships. This study is being funded by US the Department of Justice and the US Department of
Health and Human Services. We are asking you to take part because we believe that your thoughts about
teen dating relationships will be important contributions to this study.
If you agree to be in this study, we will ask you to visit the project website, and to provide us with as
many ideas as you choose to that can complete the sentence, “A thought, feeling, behavior, or activity that
teens in dating relationships might have or do is…”
All of your answers will be completely anonymous. We will never ask you for your name, and we will
never know which answers are yours.
You can decide to stop taking part in this study at any time without penalty.
At any time during this study, you can direct questions to [email protected].
By clicking “Accept” below, you indicate that you have read the above information and consent to take
part in the study.
After you click “Accept,” you will be sent directly to the brainstorming website where you will be able to
submit your ideas.

Appendix A9
Web-Based Adult Consent Form – Sorting and Rating
You are being asked to take part in a research study about how teens and adults think about teen dating
relationships. This study is being funded by the US Department of Justice and the US Department of
Health and Human Services. We are asking you to take part because we believe that your thoughts about
teen dating relationships will be important contributions to this study.
A few weeks ago, we asked a sample of adults and teens to provide us with thoughts, feelings, behaviors,
and activities that they thought teens in dating relationships might have or do. If you agree to be in this
part of the study, we will ask you to visit the project website to sort the ideas into similar themes (the
sorting activity). We will also ask you to rate the ideas on how common and how desirable you think
each idea is in teen dating relationships (the rating activity).
All of your answers will be completely confidential. If the results of this study are published, data will be
presented in group form and individuals will not be identified.
At any time during this study, you can direct questions to [email protected].
By clicking “Accept” below, you indicate that you have read the above information and agree to take part
in the study.
After you click “Accept”, you will be sent directly to the project website where you can complete the
sorting and rating activities.

Appendix A10
Web-Based Adult Consent Form –Rating
You are being asked to take part in a research study about how teens and adults think about teen dating
relationships. This study is being funded by the US Department of Justice and the US Department of
Health and Human Services. We are asking you to take part because we believe that your thoughts about
teen dating relationships will be important contributions to this study.
A few weeks ago, we asked a sample of adults and teens to provide us with thoughts, feelings, behaviors,
and activities that they thought teens in dating relationships might have or do. If you agree to be in this
part of the study, we will also ask you to rate the ideas on how common and how desirable you think each
idea is in teen dating relationships (the rating activity).
All of your answers will be completely confidential. If the results of this study are published, data will be
presented in group form and individuals will not be identified.
At any time during this study, you can direct questions to [email protected].
By clicking “Accept” below, you indicate that you have read the above information and agree to take part
in the study.
After you click “Accept”, you will be sent directly to the project website where you can complete the
rating activity.

Appendix A11
Parental Permission Form – Facilitated Discussions
Your child is invited to take part in a group discussion about the results of a study to better understand
how youth think about teen dating relationships. We are asking that your child take part in the discussion
because your child falls into the age group (14-17) from which we are seeking opinions. Please read this
form and ask any questions you may have before you agree to allow your child to take part in this
discussion.
Over the past several months, a research team from Concept Systems, Inc. (CSI), with support from the
US Department of Justice and the US Department of Health and Human Services, conducted a study with
teens and adults to develop a shared understanding of teen dating relationships. The purpose of this
discussion is to review the findings, and to gather ideas about what the results mean and how they should
be used. We hope that the opinions we gather from youth will add to the accuracy of the results.
If you agree to allow your child to take part in this discussion, your child will be asked to attend a four
hour meeting at XYZ LOCATION. The discussion will include a small group of adult researchers, as
well as about 20 other youth ages 14-17. The youth will receive an overview of the study and the results,
and will be asked to comment on discussion questions. These questions may include:
1. What do these results tell us?
2. When you think of people you know, who do you think should know about this information?
3. Are there other issues or topics that are not a part of these results that you want to make sure
that we talk about?
Youth will not be asked to share information about their personal dating experiences (although some may
choose to). The discussions will be focused only on feedback and thoughts on the research findings.
Your child may find teen dating relationships to be a sensitive topic for discussion. We do not anticipate
that your child will face additional risks other than those they might come across on a daily basis.
There are no direct benefits to you or your child if he or she takes part in the facilitated discussion.
Your child will be reimbursed for the travel expenses required for him or her to attend the discussion.
The records of this discussion will be kept private. Youth who take part in the discussion will only be
known to one another by name tags that display first names only. Any comments recorded from the
discussions will be recorded in a way that does not identify your child. If any comments from the
discussions are used in future publications, your child will in no way be connected to their responses.
Your child’s choice to take part in this discussion is completely optional. Your child may withdraw or
leave the conversation at anytime, and will not be asked to answer any questions he or she doesn't feel
comfortable answering. Your decision whether or not to allow your child to take part will not affect your
current or future relationship with SUNY Cortland or the affiliate organization that aided in recruiting
your child for this activity. You are free to withdraw your child at any time without affecting your
relationship with the University or the affiliate organization.

The contact for this study is Scott Rosas. You may reach him at 607-272-1206, or
[email protected]. Please feel free to ask any questions you have now, or at any point in the
future. If you have any questions or concerns about your child's rights as a research subject, you may
contact the SUNY Cortland Institutional Review Board (IRB) at 607-753-2511 or at [email protected], or
you may access their website at www.cortland.irb.edu. You will be given a copy of this agreement form
for your records.
If you have any questions or concerns about teen dating relationships, please visit www.breakthecycle.org
for more information.
Please enter your child's name and sign below if you give permission for your child to take part in this
discussion. Your child should return this completed form to the organizational representative that gave it
to them.
Your child's name: ________________________________________________
Your signature: ___________________________________________________ Date _____________
Your printed name: ________________________________________________ Date _____________
This consent form will be kept by the researcher for at least seven years beyond the end of the study
and was approved by the SUNY Cortland IRB on April 12, 2011.

Appendix A12
Child Assent Form – Facilitated Discussions
You are invited to take part in a discussion with other teens about the results of a study that help adults to
better understand how youth think about teen dating relationships. We are asking that you take part in
this discussion because you are between the ages 14 and 17. This is the age range from which we are
seeking opinions. Please read this form and ask any questions before you agree to take part in this
discussion.
Over the past several months, researchers from Concept Systems, Inc. (CSI), with support from the US
Department of Justice and the US Department of Health and Human Services, conducted a study with
teens and adults to develop a shared understanding of teen dating relationships. The purpose of this
discussion is to review the findings and hear your ideas about what the results mean and we should use
them. If you agree to take part in this discussion, you will be asked to attend a four hour meeting at XYZ
LOCATION. The discussion will include of a small group of adults from the research team, as well as
about 20 other youth ages 14-17. You will listen to an overview of the study and the results. You will
then be asked to comment on discussion questions, which may include:
1. What do these results tell us?
2. Think of the people you know. Who do you think needs to know about this information?
3. Are there other issues or topics that are not included in these results that you want to make
sure that we talk about?
You will not be asked to share personal dating experiences (although you may choose to). The
discussions will focus on gathering your reactions to and reflections on the research results.
Your may find teen dating relationships to be an uncomfortable topic to discuss. We do not expect that
you will face additional risks other than those you might come across on a daily basis.
There are no direct benefits to you if you choose to take part in the discussion.
We will pay you back for the cost of traveling to the meeting.
Anything you say during the discussion will be kept private. Other people in the room will only know
you by your first name (name tag). If any comments from the discussions are used in future publications,
you will in no way be connected to what you say.
Taking part in this discussion is completely optional. You can choose to not take part in the conversation
at anytime, and you will not be pressured to answer any questions that you do not feel comfortable
answering. Your decision whether or not to take part will not affect your relationship with any person or
group involved in this project. You are free to leave the discussion at any time without penalty.
The contact for this study is Scott Rosas. You may reach him at 607-272-1206, or
[email protected]. Please feel free to ask any questions you have now, or at any point in the
future. If you have any questions or concerns about your rights as a research subject, you may contact the
SUNY Cortland Institutional Review Board (IRB) at 607-753-2511 or at [email protected], or you may
access their website at www.cortland.irb.edu. You will be given a copy of this form to keep.

If you have any questions or concerns about teen dating relationships, please visit www.breakthecycle.org
for more information.
Please write and sign your name below if you agree to take part in this discussion. Please return this
completed form to the meeting leader.
Your signature: ___________________________________________________ Date _____________
Your printed name: ________________________________________________ Date _____________
This consent form will be kept by the researcher for at least seven years beyond the end of the study
and was approved by the SUNY Cortland IRB on April 12, 2011.

Appendix A13
Adult Consent Form – Facilitated Discussions
You are invited to take part in a group discussion about how youth and adults think about teen dating
relationships. This project is being funded by the US Department of Justice and the US Department of
Health and Human Services. We are asking that you take part in this discussion because we believe it is
critical to capture the input and feedback from individuals with your professional background. We ask
that you read this form and ask any questions you may have before agreeing to take part in this group
discussion.
Over the past several months, a research team from Concept Systems, Inc. (CSI), with support from the
US Department of Justice and the US Department of Health and Human Services, conducted a study with
teens and adults to develop a shared understanding of teen dating relationships. The purpose of this
discussion is to review the findings and hear your ideas about what the results mean and how they should
be used. We hope that the input we gather from you and other adults will add to the understanding of the
findings.
If you agree to take part in this discussion, you will be asked to attend a four hour meeting at XYZ
LOCATION. The discussion will include of a small group of adult facilitators from the research team, as
well as approximately 20 other researchers, advocates, and practitioners. You will listen to an overview
of the study and the results, and will be asked to comment on discussion questions. These questions may
include:
1. What does this information tell us?
2. Among the people you know, who else needs to know about this information?
3. Are there other issues or topics that are not included in this material that you want to make
sure that we address?
Participants will not be asked to share information about their personal dating or relationship experiences
(although some may choose to). The content of the discussions will be focused only on feedback and
reflections on the research findings.
You may find teen dating relationships to be an uncomfortable topic for discussion. We do not expect
that you will face additional risks other than those that you might come across on a daily basis.
There are no direct benefits to you if you choose to take part in the discussion.
You will be reimbursed for the travel expenses that you incur in attending the discussion.
Anything that you say during this discussion will be kept private. You will only be known to other people
at the meeting by a name tag that will display your first name only If any comments from the discussions
are used in future publications, you will in no way be connected with what you say.
Taking part in this discussion is completely optional. You can choose to not take part in the conversation
at anytime, and you will not be pressured to answer any questions that you do not feel comfortable
answering. Your decision whether or not to take part will not affect your relationship with any person or
group involved in this project. You are free to leave the discussion at any time without penalty.

The contact for this study is Scott Rosas. You may reach him at 607-272-1206, or
[email protected]. Please feel free to ask any questions you have now, or at any point in the
future. If you have any questions or concerns about your rights as a research subject, you may contact the
SUNY Cortland Institutional Review Board (IRB) at 607-753-2511 or at [email protected], or you may
access their website at www.cortland.irb.edu. You will be given a copy of this consent form for your
records.
If you have any questions or concerns about teen dating relationships, please visit www.breakthecycle.org
for more information.
Please print and sign your name below if you agree to take part in this discussion.
Your signature: ___________________________________________________ Date _____________
Your printed name: ________________________________________________ Date _____________
This consent form will be kept by the researcher for at least seven years beyond the end of the study
and was approved by the SUNY Cortland IRB on April 12, 2011.

Appendix B1
Recruitment Organization Brainstorming Letter and Instructions
Dear Organization Representative:
Thank you in advance for dedicating your time and attention to assisting us with the recruitment process
of this important initiative to further our understanding of how youth conceptualize teen dating
relationships. A critical component of this initiative is gathering the input and perspectives from youth
themselves. In order to generate a collection of ideas, we have set up separate processes for youth ages
11-13 and 14-22 to brainstorm ideas in response to the sentence, “A thought, feeling, action or behavior
that teens in dating relationships might have or do is…” online via a secure project website. The
statements that the participants generate will become a critical component for the subsequent project
activities.
My colleagues and I will manage the entire online data collection process; however, we request your help
in informing youth within your organization about this activity, and providing them with the instructions
they need to log on to the project website.
In order to facilitate this process, we have enclosed a packet of recruitment flyers that will provide
youth participants with information about the project, including the website and how to contact me with
any questions. All we ask is that you please distribute the enclosed permission slips to any youth under
the age of 18 within your organization who might be interested in participating. Those participants who
return a signed permission slip should then receive one of the enclosed flyers that will direct them to the
project brainstorming website.
Please note that participants ages 18-22 are welcome to participate, but do not need parental permission.
They can receive a flyer and go directly to the project website.
Please feel free to contact me with any questions. Thank you again for assisting us in our recruitment
efforts.

Sincerely,
Scott Rosas, PhD
Principal Investigator

Enclosed

Appendix B2
Recruitment Organization Sorting and Rating Letter and Instructions
Dear Organization Representative:
Thank you in advance for dedicating your time and attention to assisting us with the recruitment process
of this important initiative to further our understanding of how youth conceptualize teen dating
relationships. A critical component of this initiative is gathering the input and perspectives from youth
themselves. A few months ago, we asked youth and adults to generate ideas that completed the sentence,
“A thought, feeling, action or behavior that teens in dating relationships might have or do is…”
Our next step is to ask individuals ages 14-22 to sort the final set of statements into thematically similar
groups, and to rate the statements on how often each idea occurs and how desirable they feel that each
idea is within the context of a teen dating relationship. The entire activity will be conducted online via a
secure project website, and should take youth no more than 90 minutes to complete. Those participants
who successfully complete both the sorting and ratings activities will receive a $15 gift card to
Amazon.com.
My colleagues and I will manage the entire online data collection process; however, because it is critical
to conduct this process anonymously, and because want to ensure that participants are compensated for
their effort; we request your help in recording the names of the individuals that to whom you distribute
the enclosed flyers on the enclosed Master Tracking List.
We recognize that your time is valuable, and have tried to make this process as easy as possible. Below
please find the instructions for administering this recruitment effort, and please feel free to contact me at
any time with any questions.
To clarify any questions about these materials, we will be hosting a conference call with all organization
representatives for these recruitment efforts on DATE XYZ TIME XYZ.
Thank you again for assisting us in our recruitment efforts.
Sincerely,
Scott Rosas, PhD
Principal Investigator

Enclosed

Instructions for Administering Sorting and Rating Recruitment:
1. Distribute the enclosed flyer to X number youth ages 14-22 in your organization who you believe
should participate in this study. This flyer will direct interested individuals to obtain an enclosed
parental permission slip from you. Please note that individuals 18 and older do not need to
obtain parental permission, and can receive a flyer, username and password directly.
2. Once an individual returns a signed permission slip to you, you may assign them a username and
password from the enclosed Master Tracking List. Each flyer contains a space for a youth
participant to record their unique username and password.
3. As you distribute the usernames and passwords, please note the name of the individual on the
Master Tracking List next to the username and password that they receive. Accurate recording of
names associated with each username and password is critical to ensuring that participants are
compensated for their effort.
4. At the conclusion of the sorting and rating activities (INSERT DATE HERE), we will mail you a
list of the usernames that have successfully completed the activity, along with a $15 gift card for
each of these participants.
5. Please use your Master Tracking List as a reference to distribute the gift cards only to those
individuals whose usernames we list as having successfully completed the activity.
6. Please remember that the Master Tracking List is for your use only, and is not to be shared at
anytime with myself, my colleagues, or anyone else associated with this project. We will notify
you when it is okay to discard this list.
7. If you have any questions about managing this process, please contact my colleague, Alyssa
Goldman, at [email protected] or at (607) 272-1206.

Thank you!

Appendix B3
Recruitment Organization Rating Letter and Instructions
Dear Organization Representative:
Thank you in advance for dedicating your time and attention to assisting us with the recruitment process
of this important initiative to further our understanding of how youth conceptualize teen dating
relationships. A critical component of this initiative is gathering the input and perspectives from youth
themselves. A few months ago, we asked youth and adults to generate ideas that completed the sentence,
“A thought, feeling, action or behavior that teens in dating relationships might have or do is…”
Our next step is to ask individuals ages 14-22 to rate the final set of statements on how often each idea
occurs and how desirable they feel that each idea is within the context of a teen dating relationship. The
entire activity will be conducted online via a secure project website, and should take youth no more than
30 minutes to complete. Those participants who successfully complete the ratings activity will receive a
$10 gift card to Amazon.com.
My colleagues and I will manage the entire online data collection process; however, because it is critical
to conduct this process anonymously, and because want to ensure that participants are compensated for
their effort; we request your help in recording the names of the individuals to whom you distribute the
enclosed flyers on the enclosed Master Tracking List.
We recognize that your time is valuable, and have tried to make this process as easy as possible. Below
please find the instructions for administering this recruitment effort, and please feel free to contact me at
any time with any questions.
To clarify any questions about these materials, we will be hosting a conference call with all organization
representatives for these recruitment efforts on DATE XYZ TIME XYZ.
Thank you again for assisting us in our recruitment efforts.

Sincerely,

Scott Rosas, PhD
Principal Investigator

Enclosed

Instructions for Administering Rating Recruitment:
1. Distribute the enclosed flyer to X number of youth ages 14-22 in your organization who you
believe should participate in this study. This flyer will direct interested individuals to obtain an
enclosed parental permission slip from you. Please note that interested individuals 18 and older
do not need to obtain parental permission, and can receive a flyer, username and password
immediately.
2.

Once an individual returns a signed permission slip to you, you may assign them a username and
password from the enclosed Master Tracking List. Each flyer contains a space for a youth
participant to record their unique username and password.

3. As you distribute the usernames and passwords to youth, please note the name of the individual
on the Master Tracking List next to the username and password that they receive. Accurate
recording of names associated with each username and password is critical to ensuring that
participants are compensated for their effort.
4. At the conclusion of the ratings activity (INSERT DATE HERE), we will mail you a list of the
usernames that have successfully completed the activity, along with a $10 gift card for each of
these participants.
5. Please use your Master Tracking List as a reference to distribute the gift cards only to those
individuals whose usernames we list as having successfully completed the activity.
6. Please remember that the Master Tracking List is for your use only, and is not to be shared at
anytime with myself, my colleagues, or anyone else associated with this project. We will notify
you when it is okay to discard this list.
7. If you have any questions about managing this process, please contact my colleague, Alyssa
Goldman, at [email protected] or at (607) 272-1206.

Thank you!

Appendix B4
Master Tracking List
Please carefully record the name of each individual to whom you distribute a flyer next to the
corresponding username and password listed below. Each username and password below will match a
username and password found on the flyers.
USERNAME
User123

PASSWORD
Abc456

RECIPIENT NAME
John Smith

Appendix B5
Are you between the ages of 11 and 13?
Do you want to help adults understand more about teen dating?
Do you have access to the Internet?
If you answered YES to these questions, you may be able to participate in a study about teen dating
relationships.
The purpose of this study is to develop a better understanding of how youth and young adults think about
teen dating. This study is being funded by the US Department of Justice and the US Department of
Health and Human Services. If you choose to take part in this study, we will ask you to give us some
ideas in response to the following statement, “A thought, feeling, action or behavior that teens in dating
relationships might have or do is…”
Your answers will be completely anonymous – we won’t know who you are. We will never ask you for
your name, and we will never know your identity.
If you would like to take part in this study, please visit the website below for further instructions to get
started:

www.conceptsystemsglobal.com/TD/brainstorm/1113

If you have any questions, please contact Scott Rosas at [email protected] or at (607) 2721206. If you have any questions or concerns about teen dating relationships, please visit
www.breakthecycle.org for more information.

Appendix B6
Are you between the ages of 14 and 22?
Do you want to help adults understand more about teen dating?
Do you have access to the Internet?
If you answered YES to these questions, you may be able to participate in a study about teen dating
relationships.

The purpose of this study is to develop a better understanding of how youth and young adults think about
teen dating. This study is being funded by the US Department of Justice and the US Department of
Health and Human Services. If you choose to take part in this study, we will ask you to give us some
ideas in response to the following statement, “A thought, feeling, action or behavior that teens in dating
relationships might have or do is…”
Your answers will be completely anonymous – we won’t know who you are. We will never ask you for
your name, and we will never know your identity.
If you would like to take part in this study, please visit the website below for further instructions to get
started:

www.conceptsystemsglobal.com/TD/brainstorm

If you have any questions, please contact Scott Rosas at [email protected] or at (607) 2721206. If you have any questions or concerns about teen dating relationships, please visit
www.breakthecycle.org for more information.

Appendix B7
Are you between the ages of 14 and 22?
Do you want to help adults understand more about teen dating?
Do you have access to the Internet?
If you answered YES to these questions, you may be able to participate in a study about teen dating
relationships.
The purpose of this study is to develop a better understanding of how adolescents and young adults think
about teen dating. This study is being funded by the US Department of Justice and the US Department of
Health and Human Services. If you choose to take part in this study, we will ask you to sort a set of ideas
into groups that make sense to you. We will also ask you to rate each idea on how common and how
desirable you think each idea is in teen dating relationships. Your answers will be completely
anonymous. We will never ask you for your name, and we will never know your identity.
If you would like to take part in this study, please see the individual who gave you this flyer. He/she will
give you a unique username and password. Use the space below to record this important information that
you will need to log on to the study website.
Username: _______________________
Password: _______________________
Once you have your username and password, please visit the website below for further instructions to get
started:
www.conceptsystemsglobal.com/TD/sortandrate
If you complete both the sorting and rating activities, you will receive a $15 gift card to Amazon.com.
If you have any questions, please contact Scott Rosas at [email protected] or at (607) 2721206. If you have any questions or concerns about teen dating relationships, please visit
www.breakthecycle.org for more information.

Appendix B8
Are you between the ages of 14 and 22?
Do you want to help adults understand more about teen dating?
Do you have access to the Internet?
If you answered YES to these questions, you may be able to participate in a study about teen dating
relationships.
The purpose of this study is to develop a better understanding of how adolescents and young adults think
about teen dating. This study is being funded by the US Department of Justice and the US Department of
Health and Human Services. If you choose to take part in this study, we will ask you to rate a set of idea
on and how frequent and how desirable you think each idea is in teen dating relationships. Your answers
will be completely anonymous. We will never ask you for your name, and we will never know your
identity.
If you would like to take part in this study, please see the organizational coordinator who gave you this
flyer. He/she will give you a permission slip that you must return with a parent or guardian’s signature.
Once you return the signed permission slip, your organizational coordinator will provide you with a
unique username and password. Use the space below to record this important information that you will
need to log on to the study website.
Username: ___________
Password: ___________
Once you have your username and password, please visit the website below for further instructions to get
started:
www.conceptsystemsglobal.com/TD/rate
If you complete the rating activity, you will receive a $10 gift card to Amazon.com.
If you have any questions, please contact Scott Rosas at [email protected] or at (607) 2721206. If you have any questions or concerns about teen dating relationships, please visit
www.breakthecycle.org for more information.

Appendix C
CS Global© Concept Mapping Instructions
This document features the concept mapping instructions as they will appear to the respective activity
participants on the CS Global© project website.
Brainstorming Instructions:
We need your help to identify some things that teen dating and romantic relationships might include.
These things may be similar or different than adult relationships. You don't need to have had a
boyfriend/girlfriend to respond. Please read the statement below, and then type in something that
you feel completes the sentence.
You may add as many statements as you wish (For the pilot, please add only one or two statements).
Please keep each statement brief, just one thought. Select "add this statement" after each statement or
idea. Your statement will then be saved and added to the list of collected statements at the bottom of the
page. You can scroll through the list see what others have said.
FOCUS PROMPT: A thought, feeling, behavior, or activity that teens in dating relationships might
have or do is...

Character Count:

0

Maximum size is 250 characters

Sorting Instructions:
In this activity, you will categorize the statements, according to your view of their meaning or
theme. To do this, you will sort each statement into piles in a way that makes sense to you. First, read
through the statements in the Unsorted Statements column below.
Next, sort each statement into a pile you create. Group the statements for how similar in meaning or
theme they are to one another. Give each pile a name that describes its theme or contents.
Do NOT create piles according to priority, or value, such as 'Important', or 'Hard To Do.'
Do NOT create piles such as 'Miscellaneous' or “Other” that group together dissimilar statements. Put a
statement alone in its own pile if it is unrelated to all the other statements. Make sure every statement is
put somewhere. Do not leave any statements in the Unsorted Statements column.
People vary in how many piles they create. Usually 5 to 20 piles works well to organize this number of
statements.

Rating Instructions:
INSTRUCTIONS: Please rate the following statements, in the range indicated below.
Frequency [commonplace; often; regular; accepted; usual; typical]. On a scale of 1 to 5, please rate
how common you think each idea is in a teen dating relationship, where 1=very uncommon,
2=uncommon, 3=neither common nor uncommon, 4=common, 5= very common.
1
Very uncommon;
never occurs

2

3

4

5
Very common;
almost always
occurs
Desirability [preferred; favored; wanted]. On a scale of 1 to 5, please rate how desirable or wanted
each idea is in a teen dating relationship, where 1=not at all desirable, 2=not very desirable, 3=would not
care, 4=a little desirable, 5=very desirable.
1
Not at all
desirable

2

3

4

5
Very desirable

Participant Questions:
These screens contain a series of questions that will be used as part of the project analysis. This
information will not be used to personally identify you. Follow the instructions to respond to each
question, then select the Continue button to continue or Cancel to exit. Please choose only one answer to
each question unless otherwise indicated.
Age (for all respondents)
Please indicate your age.
• Continuous (11-99)
Grade (for all youth respondents)
Please indicate your grade.
• 4
• 5
• 6
• 7
• 8
• 9
• 10
• 11
• 12
• Attending college/post-high school education
• Does not apply/not in school
Gender (for all respondents)
Please indicate your gender.
• Female
• Male

Race (for all sorting and rating respondents)
Please indicate your race.
• American Indian or Alaska Native
• Asian
• Black or African American
• Native Hawaiian or Other Pacific Islander
• White
• Two or more races
• Prefer not to answer
Ethnicity (for all sorting and rating respondents)
Please indicate your ethnicity.
• Hispanic or Latino
• Not Hispanic or Latino
Geography (for all sorting and rating respondents)
Please enter your 5-digit zip code.
• _____
Dating experience (for youth sorting and rating respondents)
Please indicate how much experience you have in dating relationship behaviors.
• A lot
• Some
• None
Professional orientation (for adult sorting and rating respondents)
Please select the category that best describes your professional orientation.
• Researcher
• Practitioner
• Advocate
Parent (for adult sorting and rating respondents)
Are you currently a parent, guardian or caretaker of an 11-18 year old?
• Yes
• No
Are you currently a parent, guardian or caretaker of a 19-22 year old?
• Yes
• No

Appendix D
Facilitated Discussion Instructions
Facilitated Discussion Purpose
The research team will conduct eight facilitated discussions: 4 with adults (federal employees, advocates,
practitioners and researchers) and 4 with youth and young adults (ages 15-22). At each meeting, the 20
invited attendees will briefly review the concept map framework. The primary focus of the meeting is to
solicit input from attendees by eliciting contributions to the discussions’ three main purposes:
¾ Gathering input from the participants’ experiences and perspectives to complement the conceptual
framework of the map.
¾ Building a comprehensive framework of the issues.
¾ Bringing together a broad and varied group of teens and adults to engage them in defining their
perspectives of healthy and unhealthy aspects of teen dating relationships.
Participants’ input will contribute to strengthening our understanding of how teens and adults
conceptualize teen dating relationships.
Discussion questions should be structured to invite participants to:
¾ Comment upon their experience and knowledge.
¾ Make recommendations about opportunities to further enhance the concept map.
Discussion Questions to Consider
¾
¾
¾
¾
¾

What does this concept map tell us?
How do you think the information in this map can be used?
What priorities do you see for yourself?
Among the people you know, who do you think needs to know this information?
Are there other concerns or issues that believe should be reflected in the map or otherwise
incorporated into this framework? Is anything missing?
¾ How might teens (adults) understand this framework differently?
¾ For adults discussion participants only: How might this framework be useful in informing teen
dating violence prevention programs?

Appendix E
Debrief
The following text will appear in a highly visible place on the project website at the beginning and end of
each concept mapping activity, and will also be distributed in hard copy to all facilitated discussion
participants at the conclusion of the meetings:
“If you have any questions or concerns about teen dating relationships, please visit
www.breakthecycle.org for more information.”
Upon visiting the website, participants will have access to a list of resources, including websites and
phone numbers that participants can use to learn more about healthy teen dating behaviors and what to do
if they feel that they are in an unhealthy relationship, including:
•
•

•
•
•

If you're in immediate crisis, call 911 or the National Teen Dating Abuse Helpline at
1.866.331.9474
Everyone, regardless of age, has the right to a safe and healthy relationship, free from violence
and free from fear. To learn more about how young people can prevent, diagnose and escape
unhealthy relationships, visit thesafespace.org
Learn the facts about dating abuse and how to recognize if your relationship is unhealthy:
http://www.thesafespace.org/the-basics/
Find out what you can do to protect yourself or someone you know, including the legal options:
http://www.thesafespace.org/stay-safe/
Ask confidential, anonymous questions about dating violence:
http://www.thesafespace.org/ask-anything-2/

Appendix F
Potential Organizations and Agencies for Recruitment

#

Organization/Agency

1

4-H

Individual
Contact(s)
Name(s)
Suzanne
LeMenestrel

Contact Phone and/or email

USDA

Brief description of organization/agency,
including scope of services provided (e.g.
national, regional, local)
National
http://www.4-h.org/

Nominated
By
Jen Brown

4-H prepares young people to step up to the
challenges in their community and the world. Using
research-based programming around positive youth
development, 4-H youth get the hands-on real world
experience they need to become leaders.
Through America’s 109 land-grant universities and
its Cooperative Extension System, 4-H reaches
every corner of our nation—from urban
neighborhoods to suburban schoolyards to rural
farming communities. With a network of more than
6 million youth, 540,000 volunteers, 3,500
professionals, and more than 60 million alumni, 4-H
helps shape youth to move our country and the
world forward in ways that no other youth
organization can.
2

ACT for Youth Center
of Excellence (Assets
Coming Together for
Youth)

Jane Levine
Powers, PhD
Project Director

[email protected]
(607) 255-3993

Regional/Local (New York State)
http://actforyouth.net/

Cornell University
Family Life Development Center
Beebe Hall
Ithaca, NY 14853

ACT (Assets Coming Together) for Youth connects
positive youth development resources and research
to practice in New York State and beyond. The ACT
for Youth Center of Excellence provides:
• Technical support, training, and evaluation for
youth-serving programs funded by the NYS
Department of Health
• New resources for New York State teens on
nysyouth.net, including sexual health, leadership
development, youth rights on the job, and

Anna
Kindermann
(Sabrina
MatoffStepp)

#

Organization/Agency

Individual
Contact(s)
Name(s)

Contact Phone and/or email

Brief description of organization/agency,
including scope of services provided (e.g.
national, regional, local)
managing stress.
• Youth development and adolescent sexual health
resources housed on the ACT for Youth website
• A home base for the ACT Youth Network,
which connects young community activists
across New York State.

Nominated
By

(from Jane Powers) let Mary know that we also
work with adolescent sexual health providers across
NYS (65+) --- so have a lot of reach in different
communities and corners of the state.
3

Boston Public Health
Commission/Start
Strong Boston

Casey Corcoran
Director, Start
Strong Boston

(617) 534-5674

Regional/Local (Boston)
The Boston Public Health Commission (BPHC)
provides wide-ranging public health services to the
residents of the city of Boston. Start Strong Boston
is housed of the BPHC Division of Violence
Prevention and is part of the 11 site national Start
Strong Initiative. As part of the Start Strong
Initiative, we are working intensely on in-school,
out of school, influencer, social marketing and
policy issues related to teen dating violence
prevention and healthy relationship promotion.
Each summer, over the course of seven weeks, we
train 24 older teens to be peer educators around the
issue of teen dating violence prevention and healthy
relationship promotion. These teen peer educators
are then placed at community centers throughout
Boston and work ten hours a week each leading
workshops and trainings for their younger peers.

Sally
Schaeffer

#

Organization/Agency

4

Boys and Girls Clubs
of America

5

Boy Scouts of
America

Individual
Contact(s)
Name(s)
Les Nichols, AIA,
CPP
Vice President,
Club Safety &
Design

Willie Iles

Contact Phone and/or email

404 487-5746
[email protected]
1275 Peachtree Street, NE
Atlanta, GA 30309

972-580-2105
[email protected]

Brief description of organization/agency,
including scope of services provided (e.g.
national, regional, local)
National

Nominated
By
Mitru
Ciarlante

The BGCA is a national community service
organization with 4.8 million youth members and
more than 50,000 staff and 147,000 volunteers in
4,800 community locations.
National

Scott
Williams

The Boy Scouts of America is one of the nation's
largest and most prominent values-based youth
development organizations. The BSA provides a
program for young people that builds character,
trains them in the responsibilities of participating
citizenship, and develops personal fitness.
6

Break the Cycle

Marjorie Gilberg

310-286-3382, ext. 804
National
[email protected] http://www.breakthecycle.org/

Stephanie
Nilva

Break the Cycle is a national organization that
engages, educates and empowers young people to
build lives and communities free from domestic and
dating violence. Break the Cycle works directly with
young people, ages 12 to 24, providing innovative
prevention education in Los Angeles and legal
services in Washington, D.C. Break the Cycle
advocates for policy change nationally and trains
adults so that teens and those they care about have
access to the help they need.
7

Center for Court
Innovation

Liberty Aldrich

646-386-4180
[email protected]

Regional/Local (New York City)
http://www.courtinnovation.org/

Stephanie
Nilva

#

Organization/Agency

8

CHANA: Counseling
Helpline and Aid
Network for Abused
women
CHANA is a program
of The Associated
Jewish Community
Federation of
Baltimore

9

Delta Research and
Educational
Foundation

Individual
Contact(s)
Name(s)

Contact Phone and/or email

Brief description of organization/agency,
including scope of services provided (e.g.
national, regional, local)
The Center for Court Innovation is a non-profit
think tank that helps courts and criminal justice
agencies aid victims, reduce crime and improve
public trust in justice. The Center combines action
and reflection to spark problem-solving innovation
both locally and nationally.

Nominated
By

Regional/Local (Baltimore area)

Donna
Howard

Nancy F. Aiken,
PhD Executive
Director

410-234-0030
[email protected]

Barbi Hyman, RJE,
Youth Coordinator

410-234-0030
[email protected]

LaVerne Davis

323.303.2390
[email protected]

National
http://www.deltafoundation.net/about-us

1703 New Hampshire Ave, NW
Washington, DC 20009

Delta Sigma Theta Sorority, Inc. established the
Delta Research and Educational Foundation, as a
public charity supporting scholastic achievement,
public service programs, and research initiatives
focused upon African American women.

CHANA is a comprehensive domestic violence
program serving the Jewish community of Central
Maryland. Services include a full range if treatment,
advocacy and prevention services that reach a wide
range of Jewish and non Jewish victims and youth.
The staff serve on state and national task forces that
provide leadership on issues related to intimate
partner violence.

Four decades ago, Delta Sigma Theta Sorority, Inc.
established the Delta Research and Educational
Foundation, as a public charity supporting scholastic
achievement, public service programs, and research
initiatives focused upon African American women.

Aleisha
Langhorne
(Frances
AsheGoins)

#

Organization/Agency

10 Demoiselle 2 Femme,
NFP
Girls with a Voice
Empowered (GWAVE)

Individual
Contact(s)
Name(s)

Contact Phone and/or email

Sherida Morrison,
CEO

9415 South Western Avenue - Suite
200
Chicago, IL 60643

Tori Tyler, M.S.
G-WAVE
Program Director

[email protected]

Brief description of organization/agency,
including scope of services provided (e.g.
national, regional, local)
Today, the Foundation remains strong, vibrant, and
poised to meet 21st century challenges with the
same unwavering spirit and dedication the Sorority
originally envisioned. Our charge to realize social
and economic equality for future generations of
African American women continues as our guiding
principle.

Nominated
By

Aleisha
Regional/Local (Chicagoland)
Langhorne
http://www.demoiselle2femme.org/home
http://www.demoiselle2femme.org/programs#gwave (Frances
AsheGoins)
Demoiselle 2 Femme (D2F), French for “Young
Ladies to Women” is a 501-(c)-(3) not-for-profit
organization with a rich history of providing
community-based programs for girls on the far south
side of Chicago as well as the south suburbs. The
mission of D2F is to provide holistic services,
education, instruction and training to assist
adolescent females in a successful transition to
womanhood.
G-WAVE (Girls With A Voice Empowered)
An HIV/AIDS and violence prevention program
which empowers girls to share the power of their
voice within their school and community. Utilizing a
holistic youth development approach the program
employs gender-responsive strategies to reduce the
risk of HIV infection and juvenile delinquency
among adolescent girls while increasing their role in
community action. G-WAVE implements
evidenced-based curricula and an empowerment
model which includes the development of

#

Organization/Agency

11 The Door

Individual
Contact(s)
Name(s)

Contact Phone and/or email

No contact known

Brief description of organization/agency,
including scope of services provided (e.g.
national, regional, local)
community awareness projects which promote
social, sexual and academic health among teen girls.

Nominated
By

Regional/Local (New York City)
www.door.org

Stephanie
Nilva

The Door – A Center of Alternatives, Inc. was
founded in 1972 as a multi-service youth
development agency providing a full range of
integrated services at a single site, free of charge
to anyone between the ages of 12 and 21. The
Door’s mission is to empower young people to
reach their potential by providing
comprehensive youth services in a caring,
diverse environment.
12 Girls' Empowerment
Mission (GEM)

13 Girl Scouts of
America

Debbi Weinberg

410-952-8826
[email protected]

Christine Truett

410-685-0295, ext 212
[email protected]

Sharon Gleason,
CFRE, Director of
Development, Girl

202-274-3330
[email protected]

Regional/Local (Baltimore)

Donna
Howard

GEM is a local program in Baltimore County,
Maryland. It is one of the many programs of the
Living Classrooms Foundation, 802 S. Caroline
Street, Baltimore, MD 21231. GEMs mission is to
empower high school girls from underserved
communities, by providing opportunities and growth
experiences which, in turn, will enable them to
become independent, self-sufficient, and confident
young women.
National
www.gscnc.org

Aleisha
Langhorne
(Frances

#

Organization/Agency

14 Healthy Tomorrows
for Teens

Individual
Contact(s)
Name(s)
Scout Council of
the Nation’s
Capital

Jayme Hannay

Contact Phone and/or email

Brief description of organization/agency,
including scope of services provided (e.g.
national, regional, local)

AsheGoins)

[email protected]

Unknown
(from Jayme Hannay) Healthy Tomorrows for Teens
might be a good resource for recruiting for this
project. We are working with a group from
Wesleyan University doing a workshop for our teens
on healthy relationships dating etc. Please have Ms.
Kindermann contact me and then I can connect her
with the Wesleyan group or other partners. We can
also recruit directly through HTT.

15 Idaho Federation of
Families for
Children’s Mental
Health

Courtney Santillan,
MPA
Executive Director

16 Linkage to Education

Whitney Rhodes
Program Manager

Nominated
By

[email protected]
704 N 7th Street
Boise, ID 83702

[email protected]

Regional/Local (Idaho)
www.idahofederation.org
The Idaho Federation of Families works to develop
a coalition of groups and individuals to educate
policy makers, professional organizations,
legislators, educators, and the public about the needs
of children with emotional, behavioral, and mental
disorders and their families.
Regional/Local (Sacramento)
Local Sacramento program serving youth in foster
care as they age out, and need support going to

Anna
Kindermann
(Sabrina
MatoffStepp)

Anna
Kindermann
(Sabrina
MatoffStepp)

Elizabeth
Miller

#

Organization/Agency

17 Men’s Health
Network

Individual
Contact(s)
Name(s)

Scott Williams

Contact Phone and/or email

202-543-6461 ext. 103
[email protected]

Brief description of organization/agency,
including scope of services provided (e.g.
national, regional, local)
college, finding housing, etc.

Nominated
By

National

Scott
Williams

Men's Health Network (MHN) is a national nonprofit organization whose mission is to reach men
and their families where they live, work, play, and
pray with health prevention messages and tools,
screening programs, educational materials, advocacy
opportunities, and patient navigation.
18 National Center for
Victims of Crime

Mitru Ciarlante,
director

Youth Initiative

19 National Council of
Negro Women

202-467-8743
[email protected]
2000 M ST NW, STE 480
Washington, DC 20036

National
The National Center for Victims of Crime’s Youth
Initiative works with youth and local, state, tribal,
national, and federal partners to identify and fill the
gaps in interventions for youth victims of crime.
We have provided intensive support to 100 local
communities building outreach and programs for
youth victims.

Lisa Brito Greene,
TTA Manager

202-467-8747
[email protected]

Avis JonesDeWeever

202.383.9433
[email protected]

National
http://www.ncnw.org/about/index.htm

633 Pennsylvania Avenue, NW
Washington, DC 200004
202.368.1877
[email protected]

Today, the National Council of Negro Women, Inc.
(NCNW) is a council of 39 affiliated national
African American women's organizations and over
240 sections - connecting nearly 4 million women
worldwide!

Tammy Henry

Mitru
Ciarlante

Our mission is to lead, develop and advocate for
women of African descent as they support their
families and communities. We fulfill our mission

Aleisha
Langhorne
(Frances
AsheGoins)

#

Organization/Agency

Individual
Contact(s)
Name(s)

20 National Teen Dating
Abuse Helpline

21 National
Organizations for
Youth Safety
(NOYS)

Contact Phone and/or email

Brief description of organization/agency,
including scope of services provided (e.g.
national, regional, local)
through research, advocacy and national and
community-based health, education and economic
empowerment services and programs in the United
States and Africa. Through section and affiliate
volunteers in 34 states, NCNW addresses local
needs while impacting communities nationwide.

1-866-331-9474 (helpline)

Sandy Spavone
Executive Director

[email protected]

Nominated
By

Stephanie
Nilva (no
contact
known)
National
www.noys.org
NOYS is a collaborative network of national
organizations and federal agencies that serve youth
and focus on youth safety and health. NOYS was
created in 1994 as a coalition of national nonprofit
organizations and federal agencies to promote
collaboration of youth member and youth serving
organizations and agencies. Through this
network, NOYS influences more than 80 million
young people, ages 5 to 24 and adult advisors.
Our vision is to be the premier national youth health
and safety coalition. Our mission is to promote
youth empowerment and leadership and build
partnerships that will save lives, prevent injuries,
and promote safe and healthy lifestyles among all
youth.

Anna
Kindermann
(Sabrina
MatoffStepp)

#

Organization/Agency

22 Peace Over Violence

Individual
Contact(s)
Name(s)

Contact Phone and/or email

Emily Austin

[email protected]
213-955-9090

Trina Greene

[email protected]
213-955-9090

Lili Herrera

[email protected]
213-955-9090

Brief description of organization/agency,
including scope of services provided (e.g.
national, regional, local)

Regional/Local (Los Angeles/Pasadena)
Peace Over Violence is a non-profit, multicultural,
volunteer social services/social change organization
dedicated to building healthy relationships, families
and communities free from sexual, domestic and
interpersonal violence. The organization provides
local direct services to victims of domestic and
sexual violence through a 24 hour hotline,
counseling sessions, legal advocacy, community
education, and self-defense instruction. Peace Over
Violence also has a robust prevention services
department with a focus on preventing and
educating about teen dating violence and sexual
violence. The organization works in over 10
different schools in the Los Angeles and Pasadena
areas providing TDV prevention education,
organizing youth-informed prevention campaigns,
and advocating for local policy change around TDV
issues. Also, Peace Over Violence recruits and
trains youth from middle school to college age to be
leaders in healthy relationships and violence
prevention through the Youth Over Violence

Nominated
By

Sally
Schaeffer

#

Organization/Agency

23 Safe Place

24 Start Strong
Indianapolis

Individual
Contact(s)
Name(s)

Contact Phone and/or email

[email protected]
Barbara D. Ball
Project
512-356-1623
Director/Evaluation
Specialist
P.O. Box 19454
Austin, TX 78760-9449
512-267-7233
Barri Rosenbluth
Project Director,
School-Based
Services

[email protected]
512-356-1628

Kelly Bremer
Program
Coordinator

[email protected]
317-924-0904
317-765-491-6985 (c)

Bonnie Allen
Supervisor
TAPSS Program

Nominated
By

Regional/Local (Austin)
http://www.safeplace.org/

Shari Miller

• Provides Safety for individuals and families
affected by sexual and domestic violence.
• Helps victims in their Healing so they can move
beyond being defined by the crimes committed
against them, and become Survivors.
• Promotes safe and healthy relationships for the
Prevention of sexual and domestic violence.
• Works with others to create Change in attitudes,
behaviors and policies that perpetuate the
acceptance of, and impact our understanding and
responses to, sexual and domestic violence.
Regional/Local (Indianapolis)
http://www.startstrongindy.com/

Shari Miller

targeting 11-14 year olds to promote healthy
relationships as a way to prevent teen dating
violence and abuse.

Community
Outreach and
Engagement,
Clarian Health
25 SPCC (formerly
known as Society for
the Protection and
Care of Children)

Brief description of organization/agency,
including scope of services provided (e.g.
national, regional, local)
training and Violence Prevention Specialist training.
Further the organization is an active leader in TDV
policy development in California and federally.

325-6101, ext. 204

Regional/Local (Rochester NY)
http://www.spcc-roch.org/

148 South Fitzgerald Street
Rochester, NY 14608
SPCC's mission is to cultivate a strong, healthy and

Anna
Kindermann
(Sabrina
MatoffStepp)

#

Organization/Agency

Individual
Contact(s)
Name(s)

Contact Phone and/or email

Brief description of organization/agency,
including scope of services provided (e.g.
national, regional, local)
thriving community by providing exceptional
services to children and families.

Nominated
By

SPCC empowers children and families to develop a
positive sense of self. We provide quality services
that respect diversity, family strength and encourage
families to become all they are capable of. Our
clients are our best testimonial.
(from Bonnie Allen) SPCC provides teen parent
services and domestic violence services to adults
and teens.
26 United Native Indian
Tribal Youth
(UNITY)

Russell Coker

27 UCLA School of
Public Health

Faye J. Holmes
Program
Coordinator

Maternal and Child
Health Training
Programs

[email protected]

National

Stephanie
Bryn

Youth from across the US meet together (in DC in
February – Stephanie Bryn on program Feb. 11)

Volunteer
Coordinator, The
National Children’s
Study

310-312-9219
[email protected]

Regional/Local (Los Angeles)
(from Faye Homes) I am interested in learning more
about the Teen Dating Concept Mapping Project.
This coming spring a few of my undergraduate
students will begin working with a local public K-12
school to raise awareness about teen dating
violence. The UCLA students are trainees of the
Pathways for Students into Health Professions
(PSHP), a program funded by HRSA MCHB.

Anna
Kindermann
(Sabrina
MatoffStepp)

#

Organization/Agency

28 Wind Youth Services

Individual
Contact(s)
Name(s)

Ellyne Bell (ED)

Contact Phone and/or email

[email protected]

Brief description of organization/agency,
including scope of services provided (e.g.
national, regional, local)

Regional/Local (Sacramento)

Nominated
By

Elizabeth
Miller

Local Sacramento program serving youth in foster
care as they age out, and need support going to
college, finding housing, etc.
29 Visionary Vanguard
Group, Inc.
Full of Myself

Lauren Josephs

[email protected]
1392 Lake Baldwin Lane Suite B
Orlando, FL 32814

Regional/Local (Orlando/Central FL?)
http://vvgroup.net/VVG/index.html
http://vvgroup.net/VVG/full_of_myself.html
Full of MYSELF™ is a gender-responsive program
for teen girls funded by the Office of Women's
Health. Our aim is to empower girls to make
physically and emotionally healthy choices. The
program meets on a weekly basis for 9-months, with
one field trip or special activity per month. Full of
MYSELF™ cultivates and supports "femaleness" as
a positive identity with innate strengths. The
program focuses on providing education on
women’s health, female development, pregnancy,
contraception, HIV and sexually transmitted
infections and prevention and building positive
relationships. Girls actively contribute to the design,
implementation and evaluation of the program. They
also work on projects designed to allow them an
opportunity to improve their community.

Aleisha
Langhorne
(Frances
AsheGoins)