Post-Training Consent FormSurvey

6__Attachment 6 - MHFA Evaluation consent form for post-training survey 02 24 16.pdf

Evaluation of the Mental Health First Aid Program

Post-Training Consent FormSurvey

OMB: 0930-0371

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MHFA/YMHFA Trainee Survey (Post-Training)
1. Welcome to the MHFA/YMHFA Trainee Survey
Mental Health First Aid/Youth Mental Health First Aid (MHFA/YMHFA) is an important component in several grant programs funded by the
Substance Abuse and Mental Health Services Administration (SAMHSA) to increase mental health literacy. This survey is administered as
part of a cross-site evaluation conducted on behalf of SAMHSA by the American Institutes for Research (AIR), a private, nonprofit research 
organization. The survey includes questions about mental health literacy and related behaviors that MHFA/YMHFA trainees may engage in
(e.g., encouraing referrals).  
You are being invited to take this survey as part of this study. You already completed a pre-training survey, and you will also be asked
to complete a follow-up survey at three and six months post-training. We will use the data we collect to better understand how mental
health literacy and associated behaviors may change subsequent to participation in MHFA/YMHFA training. This information will, in turn, be
used by SAMHSA to make data-informed decisions about MHFA/YMHFA in future grant opportunities.
Participation is voluntary and you may stop at any time without penalty. It generally takes 15 minutes to complete this survey.  

All of your responses will be confidential. Your responses will be combined with others’ to learn more about how MHFA/YMHFA is best
implemented in district, school, or other community-based sites.
If you have questions about the evaluation or the survey, you may contact Kimberly Kendziora at [email protected] or (202) 403-5391. If you 
have any questions about your rights as a research participant, you may contact AIR’s Institutional Review Board at [email protected], or toll free at 
1­800­634­0797.

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1. Do you agree to have your confidential responses included in this study?

j Yes, I agree to have my responses included in the study.
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j No, I do not wish to be included in this study.
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