Att 11_Example Youth Verbal Consent Language

Attachment 11

Example Youth Verbal Consent Language

Student Focus Group Verbal Assent Statement

Hi, my name is [moderator’s name] and I work for a company called ICF International. Thank you for meeting with me today. My company is helping your school district learn more about students’ health classes and how teachers talk with students about lessons related to abstinence, pregnancy prevention and STD prevention. Because you are taking health this year, we would like you to be a part of a focus group, which is a group discussion where you get to share your opinions and class experiences.

If you agree to take part in the focus group, you will be in a group with other students from your school. As you can see, we have separate groups for guys and girls. I will be leading the group and will ask a lot of different questions. There are no right or wrong answers, so please answer honestly. You can also decide not to answer any question that you choose. The focus group will take about 90 minutes. The discussion will be audio-recorded so we do not miss what is said by the group. We will keep what you say private. Although we may share information about what the groups as a whole have told us, we will never use your name when we talk about what we learned. We also ask you to help us keep this information private and not talk with people outside this group about what we discussed.

Doing the focus group should not harm you in any way. If you decide to voluntarily share anything that we may have to report to the authorities, we will work with you and school staff to make the report. Let me explain what that means. There are some times when we cannot promise to keep information private. If you tell us that you plan to hurt yourself or someone else, we will have to tell someone that can help, like the police. We also have to obey laws about reporting child abuse and neglect to the authorities. Child abuse means someone hurting your body, forcing you to do something that hurts you, or leaving you with no place to live, or no food or things you need to be safe and healthy. If you tell us that you are having any kind of sex with someone older than you, we might also have to report that. But there are some benefits to being in this group. We believe what you tell us today is likely to help improve future health classes at your school.

Your parent has already said it is okay for you to take part in the focus group. But if you don’t want to be a part of the discussion, you do not have to be. If you decide not to participate, your grades will not be affected and no one will be upset with you. If you want to be a part of the focus group and then change your mind later, that is okay too. You can stop at any time.

If you decide to be in the focus group, we will give you a $30 Target gift card to say thank you. If you don’t want to answer all the questions or if you want to stop, you can still get the $30 Target gift card.

If there is anything that you do not understand, please let me know and I will explain it. Do you have any questions for me? Would you like to be a part of this focus group?

Note to Moderator: The student should answer “Yes” or “No.” Only a definite “Yes” may be taken as assent to participate in the focus group.

Thank you!