B9a: Revised RISE Staff Pre-Test

Attachment b9a: RISE STAFF consent and PRETEST

STAFF PRETEST CONSENT FORM

to be printed on Westat Letterhead

Introduction and PURPOSE OF STUDY

The U. S. Department of Health and Human Services has hired Westat, a research company, to study the RISE program, a new local program working with the Los Angeles County Department of Children and Family Services (DCFS). The program is housed at the Los Angeles Gay and Lesbian Center. The goal of the RISE program is to reduce the number of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) children and youth in long-term foster care in Los Angeles County. RISE is supported by the Permanency Innovations Initiative (PII), a federal initiative that seeks to build the evidence base for innovative intervention to enhance well-being and improve permanency outcomes for children who are in or at risk for long-term foster care.

One part of the study involves examining ways organizations can better support and serve LBGTQ children through a staff survey. We would like your help in assisting us with this part of the study.

Procedures

We invite you to participate in a voluntary, anonymous survey. The survey asks what you know about serving LGBTQ clients. The survey will take no more than 15 minutes to complete.

This is the first of three surveys that we will ask you to complete. At the end of training, you will be asked to participate in a similar survey, and approximately two months later, you will receive another survey.

DIFFERENT WAYS TO PARTICIPATE

There are no alternative ways to participate in the study.

Participant and Data Privacy

Your survey responses will be anonymous and identifiable only by a unique study identification number. We will keep your information private to the extent permitted by law. We will use your information for research purposes only. We will not include information that identifies you in any reports we write.

To help us protect your information, we received a Certificate of Confidentiality from the U. S. Department of Health and Human Services. With this Certificate, no one can force us to share information that could identify you, even in any court or legal proceeding, under a court order or subpoena.

VOLUNTARY PARTICIPATION

You are not required to participate in the RISE study. If you consent to participate, you can choose to end participation at any time. Your decision to participate will not affect your ability to participate the RISE staff trainings.

BENEFITS

There are no direct benefits to you in participating in the survey. However, you will help your organization and others come up with better ways to serve families and children.

INCENTIVES FOR PARTICIPATING IN THE STUDY

You will receive a gift at a value of approximately $10.00 if you return the survey the third time the survey is administered.

RISKS

We do not expect any risks to you in participating in the survey. You can skip questions that you do not want to answer.

treatment for injury related to this study

We do not expect that you will experience any injuries as a result of participating in the study. Therefore, no treatment will be available to address any injuries.

CONFLICT OF INTEREST

Westat has no financial or other relationships with your agency that will affect our role in conducting this study, including interpreting and reporting the study results.

participation decision

To ensure your responses remain anonymous, you will not sign a consent form to indicate your decision to complete the survey. You agree to participate by just completing the survey. Please keep this copy of the consent information form for your records. We are asking for your name and email address so that we can send a follow-up survey. We will remove your name and email address from this form and store it separately from the survey materials.

If you agree to participate, you can proceed with completing the survey. When you are done, please place this form and the survey in the envelope provided.

If you do not agree to participate, please check the box below and place this form and the survey in the envelope provided.

 I do not want to participate in this survey.

QUESTIONS

If you have questions about the survey, you may ask the Westat researcher facilitating the survey data collection. You may also contact the individuals below.

For questions about the RISE study, please contact: Jaymie Lorthridge, Westat Study Contact 1-800-WESTAT1 (937-8281), x5871 [email protected]

You can learn more about your rights as a part of the study from the Research Participant’s Bill of Rights document. For additional questions about your rights as a participant in this study, contact: The State of California Committee for the Protection of Human Subjects, (916) 326-3660

______________________________________ ______________________________________

Name Email address

RISE ORB PRETEST INSTRUMENT

FOR EACH QUESTION BELOW PLACE AN “X” IN THE BOX, INDICATING THE RESPONSE YOU THINK IS BEST.	PLEASE MARK ONLY RESPONSE PER QUESTION
	A	B	C
If a youth refers to themselves as a lesbian, gay, bisexual or heterosexual, that youth is referring to: Sexual orientation Sexual behavior Sexual preference	☐	☐	☐
Which of the following statement about gender expression is true: Gender expression is determined by biological sex Gender expression does not always align with biological sex Gender expression is always an indicator of sexual orientation	☐	☐	☐
A youth identifies as a gender that is different from what is stated on the youth’s paperwork. When speaking to the youth, you should: Use the gender pronoun that the youth prefers Use the gender pronoun that matches what is stated on the paperwork Use the gender pronoun that is most comfortable for you	☐	☐	☐
A youth is being bullied for being a lesbian. This is an example of: Anti-gay bias Anti-transgender bias Sexism	☐	☐	☐
Jordan tells her caseworker that her family does not know she is bisexual. She wants to tell them but is afraid. What is the most appropriate first step for the caseworker to take? Call Jordan’s family to see if they already know Discourage Jordan from telling her family to avoid conflict Talk to Jordan about telling her family.	☐	☐	☐
A staff member hears a coworker make a negative comment about a youth’s gender expression. The staff member should: Read the agency’s policy. If policy does not address gender expression issues, do nothing. Ask the co-worker not to make the comment about gender expression anymore Tell the youth that the youth’s gender expression is making others uncomfortable.	☐	☐	☐

If a youth thinks of themselves as a man, woman and/or transgender person, that internal sense of who they are is defined as: Sexual orientation Gender expression Gender identity	☐	☐	☐
The concept that people should only be attracted to members of the opposite sex is an example of: Normal sexuality Heterosexism Healthy sexual development	☐	☐	☐
Unless legally required, staff should not disclose information about the sexual orientation or gender identity of a youth unless: They are sure other staff already know The youth has agreed that it is okay They are disclosing this information to another LGBTQ (lesbian, gay, bisexual, transgender, and questioning) person they know	☐	☐	☐
When talking to a female youth, asking if she is dating anyone as opposed to asking if the youth has a boyfriend, is an example of: Using the youth’s preferred gender pronoun Talking to the youth about coming out (disclosing his or her LGBTQ identity) Avoiding assumptions about the youth’s sexual orientation	☐	☐	☐
A youth is being bullied due to being born male but identifying as female. The bullying is an example of: Heterosexism Anti-transgender bias Anti-gay bias	☐	☐	☐

For each question below please select all the answers that apply.

1. An individual can take which of the following steps to create a LGBTQ-supportive workplace:

• Use gender neutral language when discussing dating

• Talk with a youth about his/her LGBTQ identity

• Display visible LGBTQ symbols, such as a rainbow poster

• Encourage youth to keep their LGBTQ identity private

2. What should be considered when sharing information about a youth’s sexual orientation?

• Obtaining the youth’s permission

• Risks associated with sharing information

• Whether the youth is going through a phase

• Benefits associated with sharing information

Thank you for completing this survey

_____________________________________________________________________________________The collection of information described in this consent is voluntary. 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 collection is 0970-0408 and it expires XX/XX/XXXX.

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