new informed consent for participants

0990-0331_appendix B_consent forms.docx

Evaluation of The Marriage and Family Strengthening Grants

new informed consent for participants

OMB: 0990-0331

Document [docx]
Download: docx | pdf

NEW INFORMED CONSENT FOR PARTICIPANTS (USED IN QUALITATIVE FOLLOW BACK)

Male Cross-Sectional Participant

Multi-site Family Study


About the Study

The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. As part of this study, we will be doing open-ended interviews with approximately 64 couples. We are asking you to participate in the study because you and a study partner both participated in a previous survey as part of this study.


Participation in the Study

If you decide to be in the study, we will ask you to complete an interview in a private setting. This interview will take about 1 and ½ hours. These will be open-ended interviews and will be audio recorded with your permission. I may also take some notes as we are talking. The interview will ask you questions about your relationships with your spouse or partner, children, and other family and friends, services you may have received or needed, and experiences around the time you were released from prison.


Voluntary Participation

The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. We will not tell anyone else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your study partner receives in any way. Your participation will not affect your probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell me you want to skip a question and I will go on to the next question. You can stop the interview at any time.


Audio Recording

In order to be sure that the ideas and experiences shared during this interview are captured accurately, we will audio record the interview using a small, handheld audio recording device. We will use the audiorecording to create interview notes in a secure electronic file that does not contain your name or the names of anyone in your family. The audio file will be permanently erased once these notes are finalized.


Benefits

There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are navigating a father’s reentry after incarceration.


Risks of Study Participation

There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask me to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.


Confidentiality

We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your study partner or a probation or parole officer or case manager (if you have one), will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. At the end of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.

Exceptions to Confidentiality

There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.


Future Contacts

At this point, we do not plan to contact you again for any more interviews. But if we do, you will have another chance to read a consent form like this and decide if you want to do the interview.


Payment

In an effort to thank you for your time, we will give you a $75 gift card upon completion of this interview.


Questions

If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25706 or 919-485-5706 or you can write to RTI International, MFS Study (0210412), Hill Building 408, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.



Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:


  • You understand the information about the study in this consent form,

  • You have had all of your questions answered fully, and

  • You want to participate in the study.


Respondent’s Signature: ______________________________________________ Date: _________


Interviewer’s Signature: ______________________________________________ Date: _________







OLD INFORMED CONSENT FOR PARTICIPANTS (USED IN QUANTITATIVE INTERVIEW)

Male 34M Participant (non-incarcerated)

Multi-site Family Study


About the Study

The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We enrolled approximately 2,000 families from 5 states nationwide in the study, and are now doing another round of interviews with approximately 1,400 families from 2 states. We are asking you to participate in the study. Your spouse or romantic partner will also be asked to participate.


Participation in the Study

You may remember that you first enrolled in the study about 3 years ago. At that time, you completed a computer interview with one of our interviewers. If you now agree to continue to be in the study, we will ask you to complete a final follow up interview. This interview will take about 1 and ½ hours. Like last time, the interviewer will read questions from a computer screen and type your answers into the computer. For some questions that are very personal, if conditions allow it you will use earphones to hear the questions from the computer, and you will type your answers into the computer yourself. The interview will ask you questions about your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your criminal history, physical and mental health, alcohol and drug use, and expectations for life in the community after your release. We will also ask you for the contact information of your spouse or romantic partner so we can invite her to participate in an interview.


Voluntary Participation

The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. Aside from your spouse or partner, we will not tell any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.


Benefits

There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.


Risks of Study Participation

There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.


Confidentiality

We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your spouse or partner or your supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.


Exceptions to Confidentiality

There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.


Future Contacts

At this point, we do not plan to contact you again for any more interviews. But if we do, you will have another chance to read a consent form like this and decide if you want to do the interview.


Payment

In an effort to thank you for taking the time for the interview, we will give you $75 upon completion of this interview.


Questions

If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.



Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:


  • You understand the information about the study in this consent form,

  • You have had all of your questions answered fully, and

  • You want to participate in the study.


Respondent’s Signature: ______________________________________________ Date: _________


Interviewer’s Signature: ______________________________________________ Date: _________



Recordings

We are using a special quality control system on this project.  The system runs on the computer and will record what you and I say to each other during several different parts of the interview.  Neither you nor I will know when the computer is recording what we say.  The recording will be reviewed by people at RTI to monitor my work, and will be kept confidential.  You may participate in the interview even if you do not consent to the recordings.  May we use this quality control system during your interview? By signing below, you are allowing us to use this quality control system.


Respondent’s Signature: ______________________________________________ Date: _________


Interviewer’s Signature: ______________________________________________ Date: _________


NEW INFORMED CONSENT FOR PARTICIPANTS (USED IN QUALITATIVE FOLLOW BACK)

Female Cross-Sectional Participant

Multi-site Family Study


About the Study

The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect families who are separated due to incarceration. As part of this study, we will be doing open-ended interviews with approximately 64 couples. We are asking you to participate in the study because you and a study partner both participated in a previous survey as part of this study.


Participation in the Study

If you decide to be in the study, we will ask you to complete an interview in a private setting. This interview will take about 1 and ½ hours. These will be open-ended interviews and will be audio recorded with your permission. I may also take some notes as we are talking. The interview will ask you questions about your relationships with your spouse or partner, children, and other family and friends, services you may have received or needed, and experiences around the time your study partner was released from prison.


Voluntary Participation

The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. Aside from your study partner, we will not tell anyone else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your study partner receives in any way. Your participation will not affect the probation, parole, or post-release supervision of your study partner in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell me you want to skip a question and I will go on to the next question. You can stop the interview at any time.


Audio Recording

In order to be sure that the ideas and experiences shared during this interview are captured accurately, we will audio record the interview using a small, handheld audio recording device. We will use the audiorecording to create interview notes in a secure electronic file that does not contain your name or the names of anyone in your family. The audio file will be permanently erased once these notes are finalized.


Benefits

There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are navigating a father’s reentry after incarceration.


Risks of Study Participation

There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask me to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.


Confidentiality

We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your study partner or any service providers, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.

Exceptions to Confidentiality

There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.


Future Contacts

At this point, we do not plan to contact you again for any more interviews. But if we do, you will have another chance to read a consent form like this and decide if you want to do the interview.


Payment

In an effort to thank you for your time, we will give you a $75 gift card upon completion of this interview.


Questions

If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25706 or 919-485-5706 or you can write to RTI International, MFS Study (0210412), Hill Building 408, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.



Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:


  • You understand the information about the study in this consent form,

  • You have had all of your questions answered fully, and

  • You want to participate in the study.


Respondent’s Signature: ______________________________________________ Date: _________


Interviewer’s Signature: ______________________________________________ Date: _________










OLD INFORMED CONSENT FOR PARTICIPANTS (USED IN QUANTITATIVE INTERVIEW)

Female 34M Participant (non-incarcerated)

Multi-site Family Study


About the Study

The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We enrolled approximately 2,000 families from 5 states nationwide in the study, and are now doing another round of interviews with approximately 1,400 families from 2 states. We are asking you to participate in the study. We are contacting you because an incarcerated person indicated that he has been romantically involved with you or co-parented a child with you at some point during the past 3 years.


Participation in the Study

If you decide to be in the study, we will ask you to meet with an interviewer and complete an interview in a private setting. This interview will take about 1 and ½ hours. The interviewer will read questions from a computer screen and type your answers into the computer. For some questions that are very personal, if conditions allow it you will use earphones to hear the questions from the computer, and you will type your answers into the computer yourself. The interview will ask you questions about your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your physical and mental health, alcohol and drug use, criminal history, and expectations for life after your partner or family member is released.


Voluntary Participation

The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. We will not tell your partner or family members, or any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your partner’s probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.


Benefits

There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.


Risks of Study Participation

There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.


Confidentiality

We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your partner or your partner’s supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.



Exceptions to Confidentiality

There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.


Future Contacts

At this point, we do not plan to contact you again for any more interviews. But if we do, you will have another chance to read a consent form like this and decide if you want to do the interview.


Payment

In an effort to thank you for taking the time for the interview, we will give you $75 upon completion of this interview.


Questions

If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.



Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:


  • You understand the information about the study in this consent form,

  • You have had all of your questions answered fully, and

  • You want to participate in the study.


Respondent’s Signature: ______________________________________________ Date: _________


Interviewer’s Signature: ______________________________________________ Date: _________



Recordings

We are using a special quality control system on this project.  The system runs on the computer and will record what you and I say to each other during several different parts of the interview.  Neither you nor I will know when the computer is recording what we say.  The recording will be reviewed by people at RTI to monitor my work, and will be kept confidential.  You may participate in the interview even if you do not consent to the recordings.  May we use this quality control system during your interview? By signing below, you are allowing us to use this quality control system.


Respondent’s Signature: ______________________________________________ Date: _________


Interviewer’s Signature: ______________________________________________ Date: _________







NEW INFORMED CONSENT FOR PARTICIPANTS (USED FOR QUALITATIVE FOLLOW BACK INTERVIEW)

Male Longitudinal Time 1 Participant

Multi-site Family Study



About the Study

The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to incarceration. As part of this study, we will be doing open-ended interviews with approximately 64 couples. We are asking you to participate in the study because you and a study partner both participated in a previous survey as part of this study.


Participation in the Study

If you decide to be in the study, we will ask you to complete an interview in a private setting. This interview will take about 1 and ½ hours. These will be open-ended interviews and will be audio recorded with your permission. I may also take some notes as we are talking. The interview will ask you questions about your relationships with your spouse or partner, children, and other family and friends, services you may have received or needed, challenges such as substance abuse, and your expectations about life in the community after release.


Voluntary Participation

The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. Aside from your study partner, we will not tell anyone else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your study partner receives in any way. Your participation will not affect your probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell me you want to skip a question and I will go on to the next question. You can stop the interview at any time.


Audio Recording

In order to be sure that the ideas and experiences shared during this interview are captured accurately, we will audio record the interview using a small, handheld audio recording device. We will use the audiorecording to create interview notes in a secure electronic file that does not contain your name or the names of anyone in your family. The audio file will be permanently erased once these notes are finalized.


Benefits

There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are navigating a father’s reentry after incarceration.


Risks of Study Participation

There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask me to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.


Confidentiality

We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your study partner or correctional staff or case managers, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.


Exceptions to Confidentiality

There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.


Future Contacts

We may contact you again for one more interview. If so, we would invite you to participate in this interview shortly after your release. At that time, you would have another chance to read a consent form like this and decide if you want to do the interview.


Payment

We are not allowed to pay you for participating in this interview. However, for any future interviews conducted outside of a correctional facility, you will receive a payment of $75.


Questions

If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25706 or 919-485-5706 or you can write to RTI International, MFS Study (0210412), Hill Building 408, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.



Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:


  • You understand the information about the study in this consent form,

  • You have had all of your questions answered fully, and

  • You want to participate in the study.


Respondent’s Signature: ______________________________________________ Date: _________


Interviewer’s Signature: ______________________________________________ Date: _________








OLD INFORMED CONSENT FOR PARTICIPANTS (USED FOR QUANTITATIVE INTERVIEW)

Male 34 Month Interview (Incarcerated in Facility not allowing Payment)

Multi-site Family Study


About the Study

The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We enrolled approximately 2,000 families from 5 states nationwide in the study, and are now doing another round of interviews with approximately 1,400 families from 2 states. We are asking you to participate in the study. Your spouse or romantic partner will also be asked to participate.


Participation in the Study

You may remember that you first enrolled in the study about 3 years ago. At that time, you completed a computer interview with one of our interviewers. If you now agree to continue to be in the study, we will ask you to complete a final follow up interview. This interview will take about 1 and ½ hours. Like last time, the interviewer will read questions from a computer screen and type your answers into the computer. For some questions that are very personal, if conditions allow it you will use earphones to hear the questions from the computer, and you will type your answers into the computer yourself. The interview will ask you questions about your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your criminal history, physical and mental health, alcohol and drug use, and expectations for life in the community after your release. We will also ask you for the contact information of your spouse or romantic partner so we can invite her to participate in an interview.


Voluntary Participation

The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. Aside from your spouse or partner, we will not tell any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.


Benefits

There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.


Risks of Study Participation

There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.


Confidentiality

We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your spouse or partner or your supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.


Exceptions to Confidentiality

There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.


Future Contacts

At this point, we do not plan to contact you again for any more interviews. But if we do, you will have another chance to read a consent form like this and decide if you want to do the interview.


Payment

We are not allowed to pay you for participating in this interview.


Questions

If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.



Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:


  • You understand the information about the study in this consent form,

  • You have had all of your questions answered fully, and

  • You want to participate in the study.


Respondent’s Signature: ______________________________________________ Date: _________


Interviewer’s Signature: ______________________________________________ Date: _________




Recordings

We are using a special quality control system on this project.  The system runs on the computer and will record what you and I say to each other during several different parts of the interview.  Neither you nor I will know when the computer is recording what we say.  The recording will be reviewed by people at RTI to monitor my work, and will be kept confidential.  You may participate in the interview even if you do not consent to the recordings.  May we use this quality control system during your interview? By signing below, you are allowing us to use this quality control system.


Respondent’s Signature: ______________________________________________ Date: _________


Interviewer’s Signature: ______________________________________________ Date: _________



NEW INFORMED CONSENT FOR PARTICIPANTS (USED FOR QUALITATIVE FOLLOW BACK INTERVIEW)

Female Longitudinal Time 1 Participant

Multi-site Family Study


About the Study

The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to incarceration. As part of this study, we will be doing open-ended interviews with approximately 64 couples. We are asking you to participate in the study because you and a study partner both participated in a previous survey as part of this study.


Participation in the Study

If you decide to be in the study, we will ask you to complete an interview in a private setting. This interview will take about 1 and ½ hours. These will be open-ended interviews and will be audio recorded with your permission. I may also take some notes as we are talking. The interview will ask you questions about your relationships with your spouse or partner, children, and other family and friends, services you may have received or needed, and expectations about life after your study partner is released from prison.


Voluntary Participation

The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. Aside from your study partner, we will not tell anyone else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your study partner receives in any way. Your participation will not affect the probation, parole, or post-release supervision of your study partner in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell me if you want to skip a question and I will go on to the next question. You can stop the interview at any time.


Audio Recording

In order to be sure that the ideas and experiences shared during this interview are captured accurately, we will audio record the interview using a small, handheld audio recording device. We will use the audiorecording to create interview notes in a secure electronic file that does not contain your name or the names of anyone in your family. The audio file will be permanently erased once these notes are finalized.


Benefits

There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are navigating a father’s reentry after incarceration.


Risks of Study Participation

There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask me to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.


Confidentiality

We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your study partner or any service providers, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.

Exceptions to Confidentiality

There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.


Future Contacts

We may contact you again for one more interview. If so, we would invite you to participate in this interview shortly after the release of your study partner. If we do contact you again, you will have another chance to read a consent form like this and decide if you want to do the interview.


Payment

In an effort to thank you for your time, we will give you a $75 gift card upon completion of this interview.


Questions

If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25706 or 919-485-5706 or you can write to RTI International, MFS Study (0210412), Hill Building 408, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.



Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:


  • You understand the information about the study in this consent form,

  • You have had all of your questions answered fully, and

  • You want to participate in the study.


Respondent’s Signature: ______________________________________________ Date: _________


Interviewer’s Signature: ______________________________________________ Date: _________









OLD INFORMED CONSENT FOR PARTICIPANTS

Female 34 Month Interview (non-incarcerated)

Multi-site Family Study


About the Study

The Multi-Site Family Study is a research study that is being conducted by RTI International and paid for by the U.S. Department of Health and Human Services. We are hoping that this evaluation will help us understand the kinds of services that might affect the families who are separated due to the incarceration of one of its members. We enrolled approximately 2,000 families from 5 states nationwide in the study, and are now doing another round of interviews with approximately 1,400 families from 2 states. We are asking you to participate in the study. We are contacting you because an incarcerated person indicated that he has been romantically involved with you or co-parented a child with you at some point during the past 3 years.


Participation in the Study

If you decide to be in the study, we will ask you to meet with an interviewer and complete an interview in a private setting. This interview will take about 1 and ½ hours. The interviewer will read questions from a computer screen and type your answers into the computer. For some questions that are very personal, if conditions allow it you will use earphones to hear the questions from the computer, and you will type your answers into the computer yourself. The interview will ask you questions about your attitudes about and relationships with your spouse or partner, children, and other family and friends. It will also ask about services you may have received, employment, income, your physical and mental health, alcohol and drug use, criminal history, and expectations for life after your partner or family member is released.


Voluntary Participation

The choice of whether to participate in this study is completely up to you. No one will be upset or angry if you decide not to participate. We will not tell your partner or family members, or any one else outside of the RTI research staff whether or not you decide to participate. Whether or not you decide to participate, it will not affect the services you or your partner receive in any way. Your participation will not affect your partner’s probation, parole, or post-release supervision in any way. If you decide to participate in the study, you can refuse to answer any of the questions asked in the interview. Just tell the interviewer you want to skip a question and the interviewer will go on to the next question. You can stop the interview at any time.


Benefits

There are no direct benefits to you from participating in this study. However, by participating, you are helping us learn more about the kinds of services that might help families who are separated due to incarceration.


Risks of Study Participation

There are two risks involved in study participation. One risk is that the questions we ask might make you feel uncomfortable or be upsetting. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interview. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner, which will prevent anyone from finding out what your answers were.


Confidentiality

We will keep what you tell us in the interview confidential. Only the people working on the study will be able to see your answers. No one else, including, for example, your partner or your partner’s supervision officer or case manager, will be able to find out what you said in the interview. As an extra way to protect you we got a Federal Certificate of Confidentiality. This means that we can keep your name secret even if a judge asks us who participated in our study. Also, we will not use your name in connection with any of your answers to the interview questions. We will combine your information with information from all of the other participants to create group statistics. Within one year of the completion of the study, we will destroy any information that identifies you as a participant or links you to the data you provide.



Exceptions to Confidentiality

There are some exceptions to our promise of confidentiality. We may need to inform the appropriate authorities according to state and local law if you tell me that you are in immediate danger or that you intend to harm yourself or someone else or if I learn that a child is being abused or neglected or at risk for being abused or neglected.


Future Contacts

At this point, we do not plan to contact you again for any more interviews. But if we do, you will have another chance to read a consent form like this and decide if you want to do the interview.


Payment

In an effort to thank you for taking the time for the interview, we will give you $75 upon completion of this interview.


Questions

If you have any questions about the study, you may call a member of the research team toll free at 1-800-334-8571 EXT 25531 or 919-541-1261 or you can write to RTI International, MFS Study (0210412), Hill Building 418, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194. If you have questions about your rights as a project participant, you can call RTI's Office of Research Protection toll free at 1-866-214-2043 or you can write to them at RTI International Office of Human Subject Protections, PO Box 12194, Research Triangle Park, North Carolina, 27709-2194.



Do you have any questions that might help you decide whether or not you want to participate in the study? By signing below, you are agreeing to participate in the study. Please sign only if:


  • You understand the information about the study in this consent form,

  • You have had all of your questions answered fully, and

  • You want to participate in the study.


Respondent’s Signature: ______________________________________________ Date: _________


Interviewer’s Signature: ______________________________________________ Date: _________



Recordings

We are using a special quality control system on this project.  The system runs on the computer and will record what you and I say to each other during several different parts of the interview.  Neither you nor I will know when the computer is recording what we say.  The recording will be reviewed by people at RTI to monitor my work, and will be kept confidential.  You may participate in the interview even if you do not consent to the recordings.  May we use this quality control system during your interview? By signing below, you are allowing us to use this quality control system.


Respondent’s Signature: ______________________________________________ Date: _________


Interviewer’s Signature: ______________________________________________ Date: _________




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorLexie Grove
File Modified0000-00-00
File Created2021-01-24

© 2024 OMB.report | Privacy Policy