Consent/Recruitment Email CYSHCN Family/Caregiver Survey

Attachment C. Consent and Recruitment Email for CYSHCN Families/Caregivers Survey

Dear Parent/Caregiver,

You are being asked to complete an online survey because you are the parent or caregiver of a child with special health care needs/an autism spectrum disorder, or you have an autism spectrum disorder.

Children with special health care needs and people of all ages with autism spectrum disorders are at-risk for severe outcomes during disasters. The Center for Public Health Readiness and Communication at the Drexel University will work with partners to study the disaster communication needs of these two understudied populations. The results of this study will be used to develop tools that can be used for communicating with at-risk communities during emergencies and disasters.

We are asking families and caregivers of children and youth with special health care needs, health care providers, and other health professionals to complete an online survey providing information about themselves and their preparedness and communication needs. The survey should take 15 minutes to complete.

Participation in this research study is voluntary. You may refuse to take part in the research or exit the survey at any time without penalty. You are free to skip any particular question you do not wish to answer for any reason.

Any personal information you provide will only be shown to people who have a need to review this information. No names or identifying information would be included in any publications or presentations based on these data, and your responses to this survey will remain private.

If you have questions, concerns, or complaints, talk to the research team:

Dr. Renee Turchi, MD, MPH

Dornsife School of Public Health

Drexel University
3215 Market Street

Philadelphia, PA 19104

Phone: 267-359-6051

Email: [email protected]

Dr. Esther Chernak, MD, MPH

Dornsife School of Public Health

Drexel University
3215 Market Street

Philadelphia, PA 19104

Phone: 267-359-6038

Email: [email protected]

Jennifer Plumb, DSW/LSW
Drexel A.J. Autism Institute
3020 Market St
Philadelphia, PA 19104
Phone: 215-571-3438
Email: [email protected]

ELECTRONIC CONSENT: You may print a copy of this consent form for your records. Clicking on the survey link below indicates that:

• You have read the above information

• You voluntarily agree to participate

• You are 18 years of age or older

<Insert Survey Link>

Thank you for your participation!