TLP Youth Consent

Young Adult Consent Form for Participation in the

Evaluation of the Transitional Living Program

Successful Transitions to Adulthood Research Study (STARS)

The Successful Transitions to Adulthood Research Study (STARS) is a study about a program called the Transitional Living Program, like <<Name of TLP>>. The study is being run by a company called Abt Associates and its partner Abt SRBI. It is paid for by the Administration for Children and Families in the U.S. Department of Health and Human Services. This form gives information about the study and your role as a study participant. At the end of the form, you can tell us whether or not you want to be in the study. It is really important that you read the entire form.

What is the study about? The study focuses on young adults like you and how well programs like <<Name of TLP>> can help them find a place to live, build relationships, find education and employment, and feel good about themselves. The information learned from the study will help improve programs for young adults like you. Over 1,200 young adults will be part of this important study.

How long will the study last? Your participation in the study will last for about 12 months. It is possible that the Administration for Children and Families may extend the study for 6 more months. If that happens, your participation in the study could be about 18 months.

Will all youth in the study get into the <<Name of TLP>>? No. Some people who agree to be in the study will get into this program. But some will not. Who gets into the program is decided by chance, like flipping a coin. A computer will “flip the coin” so that everyone is treated fairly. This means that the staff at <<Name of TLP>> do not choose who gets into the program. If the computer does not select you for the program, you will get a list of other services in the community to help you. You can re-apply to the <<Name of TLP>> when you are done with the study in about 12 to 18 months.

Do I have to be in the study? No. Being in the study is completely up to you. This means you get to decide if you want to be in the study or not. It also means you can decide to quit the study at any time. If you decide to leave the study in the future, it is okay. Leaving the study will not harm you in any way or result in the loss of services, including services provided by <<Name of TLP>>.

What will I be asked to do if I am in the study? Everyone who agrees to be in the study will be asked to take 3 surveys and 2 short contact updates. Everything is done online. Even if you don’t get into the <<Name of TLP>>, we will still ask you to do the surveys and contact updates. The survey and contact updates take different amounts of time. The surveys take about 40minutes, and contact updates take about 10 minutes. If the study is extended, you may be asked after 15 months and 18 months for an additional contact update and survey.

Do I receive anything for completing the surveys and contact updates? Each time you finish a survey or online contact update, you will get an electronic gift card (e-gift card) to Amazon.com to thank you for your time. You can get up to a total of $120 in e-gift cards to Amazon.com if you complete all the surveys and contact updates. For the first two surveys, you will get a $30 e-gift card for each survey. For the last survey, at the end of the study, you will get a $40 e-gift card. Each time you complete a contact update, you will get a $10 e-gift card. You will receive additional e-gift cards if the study is extended.

Where will I take the surveys? The first time you take a survey will be right after you agree to be in the study. You will do it by yourself on a computer at the <<Name of TLP>>. After you finish the first survey, the computer will “flip the coin” to decide if you get into the program or not. The answers you give on the survey have no effect on whether you get into the program.

The other surveys and contact updates are done online. The study team (Abt and its research partner, Abt SRBI) will send you a link to a secure website, so you can do them wherever you choose, like a library, school, or at the <<Name of TLP>>. The study team may also call you to remind you about the surveys. If you have trouble doing the survey online, you can complete the surveys by phone. If the study team has trouble contacting you, we may use the contact information you provide for a friend or relative to help us reach you. If you agree, one of the ways the study may contact you is through Facebook, Twitter, or another form other social media. We would only send you private messages on social media.

What kinds of questions are on the surveys? The surveys have some general questions about your background. The surveys also ask about your experiences, feelings, thoughts, and opinions on different parts of your life, like your housing, education, employment, and relationships. Some of the questions are sensitive and ask about your feelings and behaviors, including actions that are unlawful, alcohol and drug use, sexual experiences, mental health care, violence, and trauma. All questions are completely voluntary. This means that you can skip any question you do not want to answer.

What are the possible benefits if I agree? By being in the study, you will help us learn more about the issues affecting young adults and the kinds of programs and services that can help them build strong futures. The information learned from the study will improve services for young adults like you. There are no direct benefits to you.

What are the possible risks if I agree? There is very little risk for you to participate in this study. All your answers to the survey will be kept private. Only the STARS team and authorized researchers will see your answers. You may feel uncomfortable answering some questions on the survey. But you can skip any survey question you do not want to answer, and you can stop the survey at any time.

Privacy. The study team will keep your answers to the survey private, as much as the law allows. This means that the staff at the <<Name of TLP>>, your family members, guardians, friends, teachers, and other service providers will never see your answers. Only the STARS research team and authorized study team members can see your answers to the survey.

We train all the people who work on the study to follow strict rules to protect your privacy. There is very little risk of your survey answers and personal information being seen by people who do not have permission. We have many safety measures to prevent this from happening.

The study team will write reports about what was learned from the study. When we write a report, the information you give us will be combined and reported with information from all the other people in the study. Your name will never be used in a report. It is possible that at the end of the study, a data file with all the answers to all the surveys will be made available to the funder of the study (Administration for Children and Families) and authorized researchers. If so, all names and other identifying information would be deleted.

To help us protect your privacy, we have a special certificate called a Certificate of Confidentiality. It adds special protection to your information. It says that we do not have to tell anyone who you are or that you are in the study. Even under a court order from a judge, we can say “no” to the request. The only time that we may have to tell someone is if we find out that you or someone else could be hurt or in danger.

Who should I contact if I have any questions about the study? If you have any questions about the study, contact the STARS team at 855-579-6654 (toll-free call) or [email protected]. You can also contact Alvaro Cortes, Abt Associates Study Director. You can call him at 301-634-1857 (toll call) or email him at [email protected]. For questions about your rights in the study, contact Katie Speanburg at Abt Associates. You can call her at 877-520-6835 (toll-free call) or email her at [email protected].

Consent: Here, you tell us if you agree to be in the study. Please read this carefully and ask a staff member if you have any questions about what you are agreeing to.

Young Adult Statement:

• I have read the description of the Successful Transitions to Adulthood Research Study (STARS) being conducted by Abt Associates and its research partners.

Please select one:

 Yes, I agree to be in the study and have a chance to get into the program. I allow the researchers conducting this study to contact me about the study or invite me to participate in a survey or contact update.

 No, I do not agree to be in the study. I do not want a chance to get into the program.

To confirm your selection, please enter your full legal name.

First Name: ____________________________

Middle Name (leave blank if you do not have a middle name): __________

Last Name: ____________________________

OMB Control No: 0970-0383

Expiration Date: 07/31/2018

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)

Public reporting burden of this collection of information is estimated to average 0.62 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 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.

Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to DHHS/ACF Reports Clearance Officer; 330 C Street SW., Washington DC 20201. Email address: [email protected].

TLP Youth Consent Form Page 1