Form PPP Parent Curricula Implementer Consent Form for Focus Grou

Attachment PPP:

Parent Curricula Implementer Consent Form for Focus Group Participation

Dating Matters: Strategies to Promote Healthy Teen Relationships™ Initiative

Division of Violence Prevention

National Center for Injury Prevention and Control

Centers for Disease Control and Prevention

Parent Curricula Implementer Consent to Participate in Focus Group Session

What am I being asked to do?

We are asking you to participate in a focus group session in support of the CDC research study (Dating Matters: Strategies to Promote Healthy Teen Relationships™ Initiative) for which you are a Curriculum Implementer. The focus group session will be conducted by NORC at the University of Chicago. The purpose of the focus group is to help us learn more about your experience in providing the curriculum to parents.

What will I be doing?

A focus group is a special group discussion that includes the research staff from NORC at the University of Chicago and about six or seven other Implementers participating in the CDC project. There may be another Implementer from your school or just several from other participating schools in your area. We will meet with a small group of Implementers in a private room to be able to talk about the project. We will ask you what you think about the classroom activities for this project. We will also ask you about whether you think any of the project activities have changed parents’ attitudes or behaviors about violence and harassment in schools or the community.

We will take notes during the group meeting in order to understand your experience with the project activities. Our notes will be locked in a cabinet in the NORC offices. We will destroy our focus group notes as soon as we complete our project report. Our job is to ask you questions, to keep the group focused on the topic we want to discuss, and to make sure we don’t run out of time. We really want you to feel free to talk together as a group, so if the Implementers are talking about the questions we asked, we will mostly just listen to your ideas and take notes. Our discussion will take about one hour to complete.

Do I have to do this?

No, you don’t. Your participation in this focus group is voluntary. You can say that you don’t want to participate in the focus group and that is fine. Your choice will not affect your job as a Curriculum Implementer for this project. You are also free to stop participating at any time without consequences. It is important that you feel comfortable answering the questions honestly. You do not have to answer any questions that you do not want to answer.

How will my privacy be protected?

To protect your privacy, we will not write down your name on any of our notes we take during the focus group. Our research team will keep your private information (your name and your answers to the focus group questions) and our notes from group discussion locked in our research offices in Bethesda, Maryland. We will not record how much you personally talked in the focus group meeting or what you said.

Although we value your participation in this focus group, we understand that you may not be comfortable telling the entire group what you have to say out loud. In these cases, if you prefer, you can write down your idea or thoughts. We will give you several sheets of paper and a pencil so that you can write down any ideas that you do not feel like sharing with the entire group. When you are finished writing down your idea you can put your paper in an envelope that we will give you and seal/close the envelope. Feel free to write down all of your ideas that you do not want to share with the entire group on the provided paper. You do not have to put your name or initials anywhere on the paper or the envelope. At the end of the focus group, you will turn in your envelope to the researcher. No one else will be able to see your idea except for the researchers. We will take steps to assure that the paper documents/envelopes are kept secure in the NORC offices. At the end of each focus group, we will collect any envelopes and place them into a larger manila envelope. We will review and analyze the contents of the envelopes at our office in Bethesda and once completed we will seal the envelopes in the larger manila envelope and secure that in a locked filing cabinet in the Principal Investigator’s (Dr. Bruce Taylor) office.

What are the risks?

Because you will be speaking with us in a group of other Implementers, there is the possibility that your co-participants in the focus group meeting will tell other people about your participation. Group members may repeat what you have said during the meeting to other people. However, we will ask everyone in the group to keep what is said in the group confidential, or secret. We hope you will feel comfortable enough to be open and honest in your responses to our questions.

Are there any benefits to participating?

There are no direct benefits to participating in this research study. However, you may benefit from knowing that your participation has the potential to help future middle school and high school students have healthy and safe relationships with peers and dating partners. Your ideas may help teachers around the country think about how to make their schools safer places.

What will be done with the results of this Focus Group?

We will analyze information from the Focus Group session to assess curriculum delivery. We will document discussion of variation to the curriculum in terms of barriers to delivery, local contextual events with an impact on the curriculum, and parent interest levels. This information will be shared with CDC and <the Technical Assistance Contractor> on an ongoing basis to monitor the fidelity of the intervention and to devise solutions should problems be identified. Annually, we will summarize discussion points from multiple Implementer Focus Group sessions for CDC and <the Technical Assistance Contractor>. We will never write the Implementers’ names in any reports. We will be careful not to include information that could be used to identify the Implementers who participated in the focus group. Only general themes and some direct things you say will be included in our final report. In the event that we use something you said directly, we will only describe those words as coming from “an Implementer in <site name>” instead of using any names.

OTHER INFORMATION

Participation in the Focus Group is completely voluntary. If you decide to not participate or to withdraw from the session at any time, there will be no penalties or consequences. Please keep a copy of this information sheet for your records. Feel free to contact us at <contact email> or <800 number> if you have any questions or concerns. The investigators are also willing to answer any questions or concerns that might arise after the survey and is willing to provide referral information if you would need assistance related to teen dating issues, bullying, or sexual harassment. You may also contact NORC’s Institutional Review Board Office (Michael Kuby, the NORC IRB Manager, toll-free at 1-866-309-0542). We look forward to working with you. We do not anticipate any foreseeable risks to you and we think that our research will be helpful in designing better intervention programs to improve teen dating relationships.

By signing below, I am indicating that I have read and understand the information above and voluntarily agree to participate in this focus group session.

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