Att_B.2_Adult_consent_script

Attachment B.2

Adult Consent Script

RIViR Study

RIViR Study

Adult Consent Script

[To be read to adults by program staff administering the screening tools prior to the first tool.]

We are inviting you to be part of a research study with [PROGRAM NAME] as part of our involvement with the Administration for Children and Families’ Healthy Marriage and Relationship Education Program. You were chosen because you are part of [PROGRAM NAME].

Before you decide whether you want to take part in this study, we ask that you read this consent form so that you understand what the study is about and what you will be asked to do. I’ll go over it with you now.

The study is sponsored by the federal government and is conducted by RTI in North Carolina. In this study we are testing ways to ask people who are served by programs like [PROGRAM NAME] about their romantic relationships. The study will involve up to 1200 youth and adult participants at multiple locations around the country.

You will be asked to participate in three interviews. The first interview will take place today. The questions will be about your romantic relationships, including experiences with unhealthy relationship behaviors and violence. For one of the interviews, you will receive written information about domestic violence and healthy relationships and you will be asked questions after receiving it. RTI will also receive information about you collected by [PROGRAM NAME], like your age and race/ethnicity.

Participation in the study is voluntary and you don’t have to participate in the study if you don’t want to. You can skip any questions you want, end the interview at any time, and decide not to participate in future interviews.

Each interview will take from about 10 to 15 minutes.

Some of the questions may seem personal or bother you. If you feel uncomfortable or upset during the interview, you may ask the interviewer to take a break or to skip any of the questions. The other risk is that someone might find out what you tell us during the interviews. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. Also, we will handle and store all of the information you provide to us in a secure manner.

There are no direct benefits to you from participating in this study. Your answers are helping us learn more about the kinds of services that might help other adults who participate in healthy marriage and relationship education.

You will receive a $5 gift card after answering each set of interview questions and an additional $5 gift card if you complete all three interviews as a token of appreciation.

We will do our best to keep all of the answers to the interview questions private. Only the people working on the study or with [PROGRAM NAME] will be able to see your answers. No one else, including, for example, your spouse or partner, will be able to find out what you said in the interviews, except with your permission (for example, for us to refer you to [DOMESTIC VIOLENCE PARTNER]).

There are two other exceptions to your privacy: 1) If you tell us that someone’s life or health could be in danger, and 2) if you tell us that a child is being abused or neglected. If this happens, we may need to report to someone whose job it is to see that you and/or others are safe and protected.

After all interviews are completed, a summary will be written that contains information from all participants. The staff doing the study will not use your name in any reports.

The Institutional Review Boards (IRB) at RTI and at [LOCAL IRB INSTITUTION] have reviewed this research.

If you participate in this study, we will contact you to participate in two more interviews, over the course of the next 2 months. We will also ask for your contact information after the first interview so that an RTI staff member may contact you separately to ask for your feedback on this project.

If you have any questions about this study, you can use the numbers on the consent form to contact the [PROGRAM NAME] Project Director, [PROGRAM DIRECTOR], or Tasseli McKay, the study director at RTI. If you have any questions about protecting your privacy in this study, you can contact the local IRB contact.

Do you have any questions for me now? (Answer questions)

If you agree to participate in this study, and for RTI to receive information on your age, race and ethnicity collected by [PROGRAM NAME], please sign and date the last page of the consent form. You can keep the rest of the form, which has the information I just went over with you.

3