Team Nutrition Educational Materials for Summer Meals - SLT (IC1 of 2)

OMB Control # 0584-0524 | Expiration Date: 06/30/2016 |Page 10

Attachment C: Consent Package for Site Operators: Site Operator Letter/Script, Informed Consent Form for Site Operator Participation, Survey for Site Operators

OMB BURDEN STATEMENT:  According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0524. The time to complete this information collection is estimated at 10 minutes, including the time for reviewing instructions and completing the information.

Site Operator Letter/Script

Dear [Site Operator],

My name is [Researcher’s Name] and I work for the Michael Cohen Group (MCG), an applied research firm that specializes in children, education, and media.

The Food and Nutrition Service of the United States Department of Agriculture (USDA) is working to develop activities for summer meals sites to encourage healthy food choices and physical activity during the summer months. USDA is looking for 12 summer meal sites that are willing to use the summer meal nutrition education materials between June and August of this year and provide feedback to help inform refinement of the materials.

MCG is conducting formative research to understand what children and parents/caregivers think of these activities and materials and to obtain feedback from site operators on their experiences implementing the activities.

As a Summer Food Service Program/Seamless Summer Option site operator, you would implement 18 activities (including 3 recipes) over the course of the summer that encourage health, nutrition, and physical activity. These activities are organized around fun summer themes. Each activity will have modifications to scale up or down the activity to fit different scenarios according to the size of the group, age of children, and time and resource restrictions.

You responsibilities would include:

• Leading the education activities (30 minutes per activity)

• Conducting taste tests with 15 children (5 children surveyed after completion of each of the 3 recipes)

• Completing a site operator journal (60 minutes over the course of the summer)

• Participating in an in-depth interview (45 minutes)

• Notifying researchers of any problems or concerns associated with the activities or research project

You will receive a guidebook, for each theme, containing information on how to implement activities, suggested modifications, and ideas on how to promote these activities at your site. You will also receive $360 for supplies and ingredients that you will need to complete the activities and taste tests.

Researchers will be visiting your site at the beginning and end of the summer to: (a) obtain consent from parents and children interested in participating; (b) train you and any other site operators on administering surveys and completing site operator journals; and (c) to answer any questions that you may have. Researchers will interview children, whose parents have consented, at the beginning and end of the summer. Researchers will also conduct focus group interviews with parents/caregivers at the end of the summer. Researchers will make additional visits during the summer to collect data and monitor the project’s progress.

This is not a study or review of meal program compliance and will not impact any funding or other benefits of your program. If you agree to participate, you will be expected to do what was listed in the responsibilities.

If you are interested or have comments or questions, please see the consent form or contact Gerad O’Shea at the Michael Cohen Group at 212-431-2252 or [email protected].

Thank You,

[Researcher’s Name]

Michael Cohen Group

375 West Broadway, Suite 502

New York, NY 10012

(212) 431-2252

Informed Consent Form for Site Operator Participation

STUDY TITLE: Team Nutrition Educational Materials for Summer Meals

PROTOCOL NUMBER: Chesapeake IRB# XXXXXX

PRINCIPAL INVESTIGATOR: Gerad O’Shea

Michael Cohen Group

TELEPHONE: 1-212-431-2252

ADDRESS: 375 West Broadway, Suite 502

New York, NY 10012

OMB BURDEN STATEMENT:  According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0524. The time to complete this information collection is estimated at 10 minutes, including the time for reviewing instructions and completing the information.

BACKGROUND AND PURPOSE:

You are invited to participate in research being conducted by the Michael Cohen Group at <<SUMMER MEALS SITE>> as part of the Food and Nutrition Service (FNS) of the United States Department of Agriculture’s (USDA) sponsored efforts to develop activities and materials for summer meals sites on health, nutrition, and physical activity. The Michael Cohen Group is an applied-research company that specializes in children, education, and media.

Please read this document carefully. It contains important information about this research study. If there is any information that you do not understand, we will be happy to answer your questions.

PROCEDURES:

As part of this formative research, you will implement 18 activities, including 3 recipes; preparation and implementation will take approximately 30 minutes for each activity. A total of 12 sites will be selected across the country. You will asked about your experience with the activities at the site and record this information in a site operator journal; this will take approximately 60 minutes total over the course of the summer. You will administer 3 taste test ballots to up to 25 children, which will take approximately 1 minute each. At the end of the summer, you will be asked to participate in a 45-minute interview.

POSSIBLE RISKS AND BENEFITS:

We do not anticipate any risks associated with being in this study. We do not promise that you or your site will receive any direct benefits from this study. However, we do anticipate that most people will enjoy participating in the research process, and the result of the research will be a free resource available for summer meals sites.

STIPEND:

Site operators will receive guidebooks containing information on how to implement the activities. They will also be provided with a stipend in the amount of $360 in order to purchase materials necessary for administering the activities and ingredients to make the recipes.

PARTICIPANTS’ RIGHTS:

Participation in this study is voluntary. We will not work with you unless you give your consent. You have the right to change your mind and withdraw your consent at any time without any penalty or loss of the benefits to which you and your site are otherwise entitled. You have the right to refuse to answer particular questions. Your comments will be kept secure and only used for research purposes, except as otherwise required by law.

Your name, participants/attendees at your site, and your site’s name will only be used to group respondents according to site. Names will be replaced with identification numbers at the conclusion of the study. Names will not be divulged in any reports of this research or given to anyone else for other purposes.

CONTACT INFORMATION:

If you have any questions, concerns or complaints about this research study, its procedures, risks and benefits, please contact the Principal Investigator, at the telephone number listed on the first page of this form.

If you have any questions or complaints about your rights as a research subject, contact:

Mail: Study Subject Adviser, Chesapeake Research Review, Inc. 7063 Columbia Gateway Drive, Suite 110, Columbia, MD 21046. Call collect: 410-884-2900 Email: [email protected]

Please complete and return the section below if you agree to participate. Please keep the previous pages for your records.

I, _____________________________________, agree to participate in this research

[Your Name]

project with the Michael Cohen Group. I understand that I may stop participation at any time.

_______________________________________________ _________________

Signature Date

_______________________________________________

Phone Number (for scheduling purposes only)

_______________________________________________

Email Address (for scheduling purposes only)

Survey for Site Operators

OMB BURDEN STATEMENT:  According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-0524. The time to complete this information collection is estimated at 10 minutes, including the time for reviewing instructions and completing the information.

Please choose the option that best answers each question for your site.

1. Where is your site located?

( ) School

( ) Community-Based Organization (e.g. YMCA, Boys and Girls Club)

( ) Park

( ) Library

( ) Pool

( ) Other _____________

2. Which meal(s) do you serve? (select all that apply)

( ) Breakfast

( ) Lunch

( ) Dinner

( ) Snack

3. Do you prepare your own meals?

( ) Yes

( ) No

If no, who prepares the meals? ___________________

4. What kitchen equipment is available at your site? (select all that apply)

( ) Refrigerator

( ) Coolers

( ) Oven/Toaster

( ) Cooktop/Range

( ) Microwave

( ) Blender

5. How many staff and/or volunteers are at the site on average each day?

Staff #_______

Volunteers #_______

6. Select the types of resources that you have regular access to. (select all that apply)

( ) Photocopier

( ) Printer

( ) Art supplies (crayons, markers, paper, glue, paint)

( ) Toys and games (blocks, board games, dolls, etc.)

( ) Sports Equipment (balls, rackets)

( ) Water activities (pool, sprinkler, hose)

( ) Electricity

( ) Internet

7. What year was this summer meals site opened? _____________

8. Approximately how many children attended last summer daily, on average? ________________

9. Do you receive additional grants for your site?

( ) Yes

( ) No

If so, which one(s)? _________________________

10. Approximately how many parents attended with their children last summer daily, on average? _________

11. Do parents at your site prefer materials in English?

( ) Yes

( ) No

If No, what percentages of parents speak a language other than English? ___________ What percentage of parents are Spanish-speaking? ___________

Please choose the option that best answers each question for you, the site operator.

12. What is your gender?

( ) Female

( ) Male

13. What is your current age?

( ) Under 20

( ) 20-29

( ) 30-39

( ) 40-49

( ) 50+

14. What is your ethnicity?

( ) Hispanic or Latino

( ) Not Hispanic or Latino

15. What is your race (select one or more)?

( ) American Indian or Alaskan Native

( ) Asian

( ) Black or African American

( ) Native Hawaiian or Other Pacific Islander

( ) White

16. Which of the following represents the level of formal education you have completed to this point?

( ) Have completed some high school

( ) Have a high school diploma

( ) Have completed some college

( ) Have a college degree

( ) Have completed some graduate work

( ) Have a graduate degree or more