Consent Form

Attachment B

FGD Recruitment and Screening

OMB No. 0930-0196

Expiration Date: 09/30/16

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  The OMB control number for this project is 0930-0196.  Public reporting burden for this collection of information is estimated to average 90 minutes per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 5600 Fishers Lane, Room 15E57-B, Rockville, MD 20857.

FGD RECRUITMENT INSTRUCTIONS

• Scott County Partnership will participate in this phase of data collection process.

• Scott County Partnership will reach out to, individuals (males and females) who are dealing recently or long term with IV use, family members of individuals who are dealing with IV use, and individuals who are not using IV drugs but are at risk.

• The goal is to assemble groups of 8-10 individuals who belong to the categories stated above and retain eight individuals by group.

• Partner organization will receive a screening questionnaire and recruiting criteria, including exclusion criteria.

• Recruiters will complete a screening questionnaire with each person contacted.

• The screening will take place the week of February 15, 2016.

POTENTIAL FGD IMPLEMENTATION DATES
FGD with females who are dealing with IV drug use (recently and longtime)	Week of February 23
FGD with males who are dealing with IV drug use (recently and longtime)	Week of February 23
FGD with family members of individuals dealing with IV drug use	Week of February 23
FGD with individuals who are not using IV drugs but are at risk to use them	Week of February 23

• Previous recruitment experience involving the Scott County Partnership showed that a creative and different strategy is needed to be able to contact individuals who are currently dealing with IV drug use. The strategy involved a local faith community that is trusted and has the ability to reach and engage with this population.

• Our target population probe to be more likely homeless and highly mobile, we will work through the Hope of Others Church to help us complete the screener questionnaire and to recruit the focus groups participants. Because of their mobility it is very likely that our partners will have a face-to-face screening and that the recruiting process will possibly happened on the same day of the FG implementation.

• Recruitment for family members of people dealing with IV drug use will be relayed also with partners at the local health department and local social services. We will use social media as appropriate.

• A very simple not wordy flyer will be developed and requested to be distributed and placed on highly visible places (stop buses, laundromats, local stores, market places, outpatients waiting rooms, court houses) and on local organizations including Community-Based Organizations and Nonprofit organizations.

• We will request our partners to follow the screening questionnaire items sequentially, during the screening process. On sections marked Recruiter, read or paraphrase the statement. On all other sections, read the questions and possible responses exactly as they appear.

• Mark the interviewees’ responses in the spaces provided.

• Note that some responses prompt termination of the questionnaire and the screening process. In those cases, read the thank-you script provided in the questionnaire and say goodbye.

SCREENING QUESTIONNAIRE

RECRUITMENT PURPOSE

Recruit 10 individuals from different sites of Scott County, to retain 8 by group.

RECRUITMENT CRITERIA

• Female/male who are currently dealing with IV use (recent and longtime users)

• Family members of individuals who are dealing with IV use

• Individuals who are not using IV drugs but are at risk of using them

• Mix of ages between 18 years to 65 years old

• (Mix of education, income)

EXCLUSION CRITERIA

• Individuals who are not dealing with IV use

• Individuals who have no family members dealing with IV use

• Individuals who are not feeling vulnerable to use IV drugs

• Individuals younger than 18 years old

• Individuals who are not living at Scott County, Indiana

• Individuals in recovery for IV drug use

See below ideal quota of participants.

PARTICIPANTS’ DESIRED DISTRIBUTION –

	FG1	FG2	FG3	FG4	TOTAL
	Females dealing with IV use	Males dealing with IV use	Family member of IV users	Individuals at risk of IV use	32
	Scott County, Indiana
Gender
Female	8	0	4	4	16
Male	0	8	4	4	16
Ages
18–28	x	x		x	8
29–39	x	x		x	8
40–50	x	x		x	6
51–60	x	x		x	6
61 +	x	x		x	4
Ethnicity	Attempt a mix of ethnicities, if possible				32
Race1	Attempt of mix of races, if possible				32
Education	Attempt a mix of educational levels, if possible				32
Language
English	8	8	8	8	32

SCREENING/RECRUITING QUESTIONNAIRE

The goal for each organization is to recruit 8-10 individuals; to retain eight by group.

(RECRUIT 10 for a SHOW of 8)

Recruiter’s Name: _______________________________________________________________

Recruiter’s Organization: _________________________________________________________

Recruiter’s Telephone/Mobile: ____________________________________________________

Hello. My name is ___________________. I am calling you on behave of ____(name pf the organization’)________. We are exploring your interest in participating on a group discussion with people that are dealing with IV drug use (????????). We are developing a public service announcement and want your opinions …..

I am not a police, I am not a …… >>>>>>>>>>>>>>>>>>>>>>>>>>>>

(TALK WITH PARTNERS TO EXPLORE POSSIBLE LANGUAGE TO THE SCREENING QUESTIONAIRE)

1. Are you interested in participating in this group session?

⃝ Yes ⃝ No [if No, terminate: “Thank you very much for your time. Have a good day/evening, goodbye.”]

2. Are you available to participate in a 90-minute session during the week of:

[TBA – February 23/16 - include dates and time.]

⃝ Yes ⃝ No [if No, terminate “Based on your availability, we cannot include you this time. Thank you for your interest.”]

Recruiter: I am going to ask you some questions that will indicate whether you qualify to participate in this discussion group.

3. Gender: ⃝ Female ⃝ Male [recruit 8M and 8F]

4. Please let me know which one applies:

(Recruit a mix of at least three of the categories below)

⃝ I am actually dealing with IV drug use [attempt to recruit 8 males and 8 females]

⃝ I am a family member of an individual dealing with IV drug use (father/mother, daughter/son, brother/sister, etc.) [attempt to recruit a mix]

⃝ I am not using IV drugs but I am/think/feel at risk [attempt to recruit 8]

⃝ I am not use IV drugs and do not feel at risk [Thank and terminate]

⃝ other, please explain

5. What is your age? [Recruiter: Mark in the appropriate range.]

⃝ 18–28

⃝ 29–39

⃝ 40–50

⃝ 51–60

⃝ 61+

[Attempt to recruit a mix. Refer to the quota by group]

6. Are you of Hispanic, Latino, or Spanish origin?

⃝ Yes

⃝ No

7. What is your race? Select all that apply. [Do not read, wait for the response.]

⃝ American Indian/Alaska Native

⃝ Asian

⃝ Black/African American

⃝ Native Hawaiian/Other Pacific Islander

⃝ White

8. What is the highest degree or level of education you have completed?

⃝ No high school diploma, nor GED

⃝ HS graduate or GED

⃝ Some college or tech school

⃝ College/Tech graduate

Recruiter: “Thank you for answering these questions. Could you please provide us with information about the best way to contact you?”

Name: ___________________________________________________________________________

Best time to be contacted: ___________________________________________________________________________

Recruiter: “Again, thank you for your collaboration. Goodbye.”

1 Scott County has a population of 24,000, from which 98% of the county are White.

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