Screening and recr Screening and recruitment

Attachment B

Intervention Resources

Focus Group Screening and Recruitment Questionnaire

OMB No. 0930-0196

Expiration Date: 09/30/2019

Public Burden Statement: 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 Office of Management and Budget (OMB) control number. The OMB control number for this project is 0930-0196. The public reporting burden for this collection of information is estimated to average 0.8 minute per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Substance Abuse and Mental Health Services Administration (SAMHSA) Reports Clearance Officer, 5600 Fishers Lane, Room 15E57-B, Rockville, Maryland 20857.

INTERVENTION RESOURCES FOCUS GROUP SCREENING AND RECRUITMENT QUESTIONNAIRE

Target Audiences: Screening and Recruitment Criteria

SAMHSA will conduct six focus groups in two geographical markets: Three in Richmond, Virginia, and three in Oklahoma City, Oklahoma.

For each group, recruit 10 participants, in anticipation of 8 to show.

• Forty-eight participants representing the major racial/ethnic groups in the United States will be screened and recruited.

• PARTICIPANTS SELECTION CRITERIA

• Be parents of young adults from 17 to 25 years old who are currently engaging in or in treatment for substance use;

• Be parents who have lost children ages 17 to 25 years old to a substance use-related overdose death;

• Be a young adult from 17 to 25 years old, who are currently using drugs or in treatment for substance use.

• Parents groups should have the following characteristics:

• Mix of parents belonging to different generations (late Baby Boomers II, Generation X, and Millennials),

• Mix of fathers and mothers,

  • Mix of racial/ethnic groups,

  • Mix of educational levels,

  • Mix of income levels,

  • Mix of geographic distribution (i.e., rural, suburban, urban),

  • Be able to read and write in English.

• Young adults should have the following characteristics:

  • Be at least 17 years of age,

• Mix of males and females,

• Mix of racial/ethnic groups,

• Mix of educational levels,

• Mix of income levels,

• Mix of geographic distribution (i.e., rural, suburban, urban),

• Be able to read and write in English.

PARTICIPANTS’ QUOTA DISTRIBUTION

	FG1	FG2	FG3	FG4	FG5	FG6	TOTAL
	Richmond VA	Richmond VA	Richmond VA	Oklahoma City, OK	Oklahoma City, OK	Oklahoma City, OK	6 FG
GENDER
Female	5	5	5	5	5	5	30
Male	5	5	5	5	5	5	30
PARTICIPANTS’ SEGMENTATION
Parents of 17 to 25 currently using drugs	5			5			10
Parents of 17 to 25 in treatment for S.A	5			5			10
Parents who lost children to overdose death			10		10		20
Young adults 17-25 using drugs		5				5	10
Young adults 17-25 in treatment for S.A.		5				5	10
RACIAL/ETHNIC GROUPS
AI; AN; NH;PI	1	1	0	3	3	3	11
Asian	2	2	1	2	2	1	10
African American/Black	2	2	2	2	2	2	12
Caucasian/White	3	3	5	3	3	3	20
Hispanic/Latino	2	2	1	2	2	1	10
EDUCATION
No HS diploma, no GED	2	2	2	2	2	2	12
HS graduate	2	2	2	2	2	2	12
Some college or technical school	2	2	2	2	2	2	12
College/tech graduate	2	2	2	2	2	2	12
Post-graduate	2	2	2	2	2	2	12
LANGUAGE
English- dominant	8	8	9	8	8	9	50
H/L English-dominant	2	2	1	2	2	1	10
INCOME
	Attempt a mix of income levels per group.
AGE
Late Baby Boomers II	3	3	3	3	3	3	18
Generation X	5	5	5	5	5	5	30
Older Millennials	2	2	2	2	2	2	12

Intervention Resources Focus Group Screening and Recruitment Questionnaire

Intervention Resources Materials Concept Testing

Recruitment Objectives

Recruit 10 individuals (to get 8 participants per group). Individuals are willing and available to participate in a focus group session of 90 minutes. Time will be set at participants’ convenience.

SCREENING QUESTIONNAIRE

Hello. My name is ___________________. I work at _____ (organization’s name).

We’re interested in exploring your opinions, suggestions, and concerns related to materials we are developing for parents of children engaged in substance use, in treatment for substance use, or who have died due to substance use-related overdose. We are beginning development of this product, and we want people with your profile and characteristics to help inform some of the concepts that we are considering. Your feedback will help us to produce materials that are more relevant and appealing for our target populations.

1. Are you interested in participating in this group session?

⃝ Yes

⃝ No [If No, terminate: “Thank you very much for your time. Have a good day/evening, good-bye.”]

2. Are you available to participate in a 90-minute session during the week of

[XXX/XX, 2016, in Richmond, VA or Oklahoma City, OK]?

⃝ Yes

⃝ No [If No, terminate: “Based on your availability, we cannot include you this time. Thank you for your interest.”]

3. Gender [Attempt to recruit an equal number of males and females.]

⃝ Female

⃝ Male

Recruiter: I’m going to ask you some questions that will indicate whether you qualify to participate in this discussion group.

4. Please let me know which one applies: [refer to participant quota]

⃝ a parent of a child of 17 to 25 years old who is currently engaging in or in treatment for substance use

⃝ a parent of a child from 17 to 25 years old who is in treatment for substance use

⃝ a parent who lost his/her child to a substance-related overdose death

⃝ a young adult from 17 to 25 years old who is using drugs

⃝ a young adult from 17 to 25 years old who is in treatment for Substance Abuse

5. Age [Refer to participants quota]

⃝ 17–28

⃝ 29–39

⃝ 40–50

⃝ 51–60

⃝ 61 plus

[Record actual age ________.]

6. Are you of Hispanic, Latino, or Spanish origin?

⃝ Yes [CONTINUE]

⃝ No [CONTINUE]

7. What is your race? Select all that apply. [Do not read; wait for the response.]

⃝ American Indian/Alaska Native

⃝ Asian

⃝ Black/African-American

⃝ Native Hawaiian/Other Pacific Islander

⃝ White

8. Please select the option that best describes you:

⃝ I speak only English. [CONTINUE]

⃝ I am an English-dominant speaker. [CONTINUE]

⃝ I am bilingual in English and Spanish. [CONTINUE]

9. What is the highest degree or level of education you have completed?

⃝ No high school diploma; no General Educational Development test (GED)

⃝ High school graduate or GED

⃝ Some college or technical school

⃝ College/technical school graduate

⃝ Postgraduate

[Attempt to recruit participants with a mix of educational levels. Please refer to the quota for each city.]

10. Income [Recruit a mix; wait for response.]

⃝ Unemployed

⃝ $1,000–$20,000

⃝ $21,000–$45,000

⃝ $46,000–$70,000

⃝ $71,000–$100,000

⃝ $101,000–150,000

⃝ $151,000 and above

[Attempt to recruit participants with a mix of income levels.]

11. Please select the option that best describes the city, town, or county of your residence:

⃝ Urban

⃝ Suburban

⃝ Rural

[Attempt to recruit participants with a mix of geographic distributions]

Recruiter: “Thank you for answering these questions. If you are selected as a group discussion participant, you will receive a call from me and/or an e-mail to confirm your participation and to be informed of the venue, date, and time of the group discussion session. Could you please provide us with information about the best way to contact you?”

Name: __________________________________________________________________

E-mail: ______________________________Phone/Mobile: _______________________

Alternative Recruitment Process will be throughout a CBO/NGO: ex.

• treatment facilities,

• faith communities,

• bereavement organizations

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