Consent/Recruitment Email CYSHCN Provider Survey

Attachment D. Consent and Recruitment Email for CYSHCN Provider Survey

Dear Provider/Health and Social Service Professional,

You are invited to participate in a web-based online survey because you have had experiences with children with special health care needs including individuals with autism spectrum disorders as a health care provider/other health and social service professional.

Children with special health care needs and individuals 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’s Dornsife School of Public Health will work with partners to study the disaster communication needs of these two understudied populations with unique preparedness and communication challenges. The results of this study will be used to develop tools that can be used for communicating with these 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 and social service professionals to complete a one-time web-based online survey providing demographic information and preparedness and communication needs. We expect that it will take you 15-20 minutes to complete the questionnaire.

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 decline to answer any particular question you do not wish to answer for any reason.

Efforts will be made to limit access to your personal information including research study records, 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 Link>

Thank you for your participation!