Campus - Staff Supporting Documents

Document G.10
OMB No. 0930-0286
Expiration Date: 05/31/10
Reminder E-mail
Subject: Suicide Prevention Survey
Dear Faculty/Staff:
Last week you should have received an e-mail about a Web survey on your exposure,
awareness and knowledge of suicide prevention. You are among a group of Faculty and
Staff on your campus being surveyed. This survey is being conducted as part of the Crosssite Evaluation of the Garrett Lee Smith Suicide Prevention and Early Intervention Program.
Your campus is part of this important federal initiative, which is funded by the Substance
Abuse and Mental Health Services Administration (SAMHSA). We understand that you are
very busy, but we hope that you can find the time to complete this important survey.
You can access the survey by entering the following address into your Web browser:
https://www.suicideprevention-datacenter.com/fm2/login/start.cfm?code=NFG

When you reach this Web site, please log in using the password:
Password: XXXXX
Your password will only be used for security purposes and to track respondents.
Survey responses are anonymous and cannot be linked to respondents. Every effort
has been made to ensure the security of the information you provide in the Web-based
survey. The survey is operated under a secure server and all transmitted information is
encrypted. There are few, if any, risks or benefits associated with participating in this
survey.
Thank you in advance for your participation. As always, please feel free to contact ICF
Macro at [email protected] with any questions.
Sincerely,
Christine Walrath, PhD
Principal Investigator
Cross-site Evaluation of the GLS Suicide Prevention Program
ICF Macro

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Document G.11
OMB No. 0930-0286
Expiration Date: 05/31/10
Final Reminder E-mail
Subject: Suicide Prevention Survey
Dear Faculty/Staff:
Last week, you should have received an email about a Web survey on your exposure,
awareness and knowledge of suicide prevention. You are among a group of faculty and
staff on your campus being surveyed. This survey is being conducted as part of the Crosssite Evaluation of the Garrett Lee Smith Suicide Prevention and Early Intervention Program.
Your campus is part of this important federal initiative, which is funded by the Substance
Abuse and Mental Health Services Administration (SAMHSA). We understand that you are
very busy, but we hope that you can find the time to complete this important survey.
You can access the survey by entering the following address into your Web browser:
https://www.suicideprevention-datacenter.com/fm2/login/start.cfm?code=NFG

When you reach this Web site, please log in using the following password:
Password: XXXXX
Your password will only be used for security purposes and to track respondents.
Survey responses are anonymous and cannot be linked to respondents. Every effort
has been made to ensure the security of the information you provide in the Web-based
survey. The survey is operated under a secure server and all transmitted information is
encrypted. There are few, if any, risks or benefits associated with participating in this
survey.
This will be your final reminder for participating in our survey. We hope that you take the
time to respond to these important questions, so that the systems in place to serve youth
can be better understood. As always, please feel free to contact ICF Macro at [email protected] with any questions.
Sincerely,
Christine Walrath, PhD
Principal Investigator
Cross-site Evaluation of the GLS Suicide Prevention Program
ICF Macro

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Document G.8
OMB No. 0930-0286
Expiration Date: 05/31/10
Advance E-Mail
Subject: Suicide Prevention Survey
Dear Faculty/Staff:
With funding from the Substance Abuse and Mental Health Services Administration
(SAMHSA), Macro International Inc. is conducting a survey of faculty and staff from your
campus on suicide prevention. The survey is part of the cross-site evaluation of the
federally funded Garrett Lee Smith Campus Suicide Prevention Program. Your campus
received federal funds to implement a suicide prevention program. We are surveying
faculty and staff to gain a better understanding of your exposure to these activities, and
your awareness and general knowledge of suicide risk factors.
Because you are part of this important federal project to prevent suicide among college age
students, we would like to ask you some questions related your awareness and knowledge
of suicide risk factors. Within the next few days, you will receive an e-mail with a request to
complete a brief Web-based survey on suicide prevention.
Of course, participation in this survey is completely voluntary. Because this is such an
important aspect of the federal effort to prevent suicide, we hope that you will take a few
minutes to provide your insight about suicide related factors.
The forthcoming e-mail will contain a password that will allow you to log in to a Web site
and complete the survey.
To ensure privacy, your password will only be used for security purposes and to keep track
of response rates. Individual responses will be kept strictly private. If you have any
questions, please contact ICF Macro at [email protected] and we will
arrange for you to complete the survey.
Thank you in advance for your participation.
Sincerely,
Richard McKeon, PhD
Christine Walrath, PhD
Center for Mental Health Services
Principal Investigator
Substance Abuse and Mental Health Cross-site Evaluation of the GLS Suicide
Services Administration
Prevention Program
ICF Macro

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Document G.9
OMB No. 0930-0286
Expiration Date: 05/31/10
Intro Email
Subject: Suicide Prevention Survey
Dear Faculty/Staff:
Last week, you received an e-mail from the cross-site evaluation team at ICF Macro
introducing you to our Suicide Prevention Exposure, Awareness, and Knowledge Survey.
Because you are a faculty or staff member on a campus that received federal funds to
implement a suicide prevention program, you are our best source of information. You were
randomly selected as a potential respondent from the faculty and staff population on your
campus. You were selected as part of a small group of individuals to complete this survey,
which means your response is very important to us. This survey should take about 15
minutes to complete, and we hope you take time to inform us about your exposure,
awareness and knowledge of suicide prevention.
For your convenience, we have made the survey available on the Internet. Over the next
few days, you can complete the survey at the following Internet address:
https://www.suicideprevention-datacenter.com/fm2/login/start.cfm?code=NFG

When you reach this Web-site, you will be asked to log in using a password. Your
password is:
Password: XXXXX
Your password will only be used for security purposes and to track survey completion.
Survey responses will be kept anonymous and will not be linked to individual
respondents. Every effort has been made to ensure the security of the information you
provide through the Web-based survey. The survey is operated under a secure server,
and all transmitted information is encrypted. While your participation in this survey is
completely voluntary, there are some questions that you will be required to answer on
the Web-based survey in order to maintain its flow and ensure the utility of the
information gathered. There are few, if any, risks or benefits associated with
participating in this survey.
This survey is being conducted as part of the Cross-site Evaluation of the Campus Suicide
Prevention Program and is funded by the Substance Abuse and Mental Health Services
Administration (SAMHSA). If you have any questions, please contact ICF Macro at [email protected]. The results from the survey will be made available to
all interested respondents.
Your time and effort are greatly appreciated.

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Document G.9
OMB No. 0930-0286
Expiration Date: 05/31/10
Sincerely,
Richard McKeon, PhD
Christine Walrath, PhD
Center for Mental Health Services
Principal Investigator
Substance Abuse and Mental Health Cross-site Evaluation of the GLS Suicide
Services Administration
Prevention Program
ICF Macro

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Document H.2
OMB No. 0930-0286
Expiration Date: 05/31/10
Cross-site Evaluation of the Garrett Lee Smith Memorial (GLS)
Campus Suicide Prevention Program

Campus Infrastructure Interview
PHONE SCRIPT AND VERBAL CONSENT
Hello, my name is [INSERT NAME] and I work for ICF Macro, a research and consulting firm.
ICF Macro is conducting a cross-site evaluation of the federally funded Garrett Lee Smith
Campus Suicide Prevention Program on behalf of SAMHSA. As part of this study, ICF Macro is
conducting qualitative interviews with five key stakeholders on campus at two time points during
the grant period with one administrator, one counseling center staff member, one human services
faculty member, one non-human services faculty member, and one student leader (18 years of
age or older) on each campus. We would like to interview you for both administrations in order
to gather information on changes in campus infrastructure and knowledge around suicide
prevention and related efforts. Specifically, these interviews are being conducted to obtain
feedback from key campus stakeholders about the Campus Suicide Prevention Program, how
grant funds are used to support suicide prevention, program activities, and your role in the
program in order to create a picture of the suicide prevention project’s impact on your campus.
You have been chosen to be an interview respondent to discuss your campus’ suicide prevention
effort because of your position as a [INSERT CAMPUS POSITION] at [INSERT CAMPUS
NAME]. We are asking that you participate in these phone interviews which will take no more
than 45 minutes of your time for each administration. If you agree to be interviewed, here are
some things you should know:
Confidentiality: Your answers to the interview questions will be kept confidential except as
otherwise required by law. There is no link between your name and the information you will be
providing. Identifying information will not be disclosed to anyone but the researchers
conducting this evaluation. The information that we report to SAMHSA will not contain any
identifying information and your name will not be used in any reports about this evaluation.
Procedures: We are conducting interviews with five members of each campus community: one
administrator, one counseling center staff member, one human services faculty member, one
non-human services faculty member, and one student leader (18 years of age or older) with each
of the 38 Campuses that were funded as part of the Garrett Lee Smith Campus Suicide
Prevention Program. Each administration will be completed with same participants. Therefore,
your input is very important to understand the impact of the campus suicide prevention program
over time. We will call to interview you at a time that is most convenient for you. The interview
questions ask you about your role and participation in the suicide prevention efforts at [INSERT
CAMPUS NAME].

Campus Infrastructure Interview

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Document H.2
Risks: This interview poses few, if any, risks to you. You may choose to stop the interview at
any time or not answer a question, for whatever reason. If you stop the interview, at your request,
we will destroy your survey.
Your participation is voluntary. Refusal to participate involves no penalty or loss of benefits. If
you agree to be interviewed, here are some additional things you should know:
•

You may discontinue participation in the interview at any time without penalty or
consequence.

•

You may chose to not answer a question at any time without penalty or consequence.

•

We would like to get your permission to record this interview to ensure that we
accurately capture details that you provide. However, if you do not agree to be recorded,
we will not record the interview. If you agree to be recorded, only ICF Macro staff will
be able to use the recording. To protect your privacy, we will keep the notes and
recordings in private files and only ICF Macro study staff will be allowed to use them.
All tapes will be destroyed at the end of the evaluation, approximately three years from
now. Your name and other information linking your name to what is said during the
groups will not be reported when we present this study or publish its results. Do I have
your permission to record the interview?

YES
NO

•

ICF Macro staff will take notes during the interview.

•

Any questions you have about this study will be answered before the interview begins.
We will provide you contact information for the Project Director who you may contact
with any questions that arise after your participation in this interview.

•

You will receive a copy of this consent form via email or regular mail.

•

Your name will not be used in any reports about this interview.

Contact information: If you have any concerns about your participation in this study or have any
questions about the research, please contact Christine Walrath-Greene at 646-695-8154.
Do you agree to participate in the interview?
[INTERVIEW INSTRUCTION: Record answer, provide a signature and follow the
procedures outlined]
‰ YES (Verbal Consent Provided)
‰ NO
[INTERVIEWER INSTRUCTION: RECORD THE FOLLOWING]
Date of consent obtained:
Campus Infrastructure Interview

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Document H.2
Time of consent obtained:
Site ID:
Participant ID:
Interviewer Signature: ___________________________________________________________
[INTERVIEWER INSTRUCTION: - IF “NO” ABOVE THEN THANK THE PERSON
FOR THEIR TIME AND END THE CALL. IF “YES” ABOVE THEN STATE THE
FOLLOWING: I’m glad that you consent to be interviewed. Let’s set up a date and time most
convenient for you to conduct the 45-minute interview.
DATE
TIME
[INTERVIEWER INSTRUCTION: SCHEDULE DATE/TIME FOR THE INTERVIEW]
Also I would like to send you an electronic reminder before our interview. Can you please
confirm your name, address, phone number, and e-mail?
[INTERVIEWER INSTRUCTION: RECORD THE FOLLOWING]
NAME
MAILING ADDRESS
WORK TELEPHONE
CELL PHONE:
E-MAIL
Please contact me at [PHONE NUMBER] if your schedule changes so that we can reschedule a
time to talk. Otherwise, I look forward to talking with you on [MONTH/DAY/YEAR] AT
[TIME].
Thank you!

Campus Infrastructure Interview

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