Attachments O-Q. Consent Forms

Attachment O: Consent Form for Core BSC Team Members

Culture of Continuous Learning Project: A Breakthrough Series Collaborative for Improving Child Care and Head Start Quality

Culture of Continuous Learning Project: Consent Form for Data Use

Core BSC team members. Congratulations on being selected as a participant in the Breakthrough Series Collaborative (BSC)! The BSC is a part of the Culture of Continuous Learning Project: A Breakthrough Series Collaborative for Improving Child Care and Head Start Quality (CCL Project). As you may recall, the BSC is a model designed to support learning and improvement among staff at all levels of an organization. The purpose of the CCL Project is to determine how the BSC can be used in Head Start and child care settings. As part of this project, we are conducting a feasibility study, which will assess program staff’s experience participating in the BSC. The feasibility study will describe how the BSC helps support changes in your Head Start or child care program, as well as classroom practices to support children’s social and emotional learning.

The feasibility study is being paid for by the Administration for Children and Families and will be conducted by Child Trends, an independent organization that does research about children, how children learn, and the education of children. As a part of this study, we are asking to use the information you submit as part of the BSC.

Details about the feasibility study: The feasibility study will use the following information collected through the BSC…

• Materials from pre-work assignments, including team building activities and the data collection spreadsheet

• Plan, Do, Study, Act (PDSA) planning forms and tracker

• Monthly metrics (i.e., data collected throughout the BSC)

• Online BSC discussion forums

• Learning Session participant surveys

• Action planning forms

• Transcripts of Learning Sessions and other BSC meetings

If you choose to allow Child Trends to use the information collected through the BSC, the information will be used to help us (1) describe how the BSC is being used in your program, and (2) understand what “successful participation” in the BSC looks like and what characteristics support success and change in your program. For example, what are the differences and similarities in participants’ experiences with the BSC? What elements of the BSC are most helpful to staff? How are positive changes supported by the BSC “spreading” to other staff and classrooms that are not in a core BSC team? Program and staff names will not be used in the feasibility study, published in any reports, or reported to anyone outside of the research team.

Voluntary Study. Consenting to allow Child Trends to use your BSC information as part of the Feasibility Study is voluntary. You do not have to provide your BSC information to the study team.

If you choose to provide your BSC information now, you may change your mind and withdraw your programs’ information at any time, for any reason. If you refuse to provide your information, or choose to withdraw your information, there is no penalty and any information you had already provided will no longer be used for the study. Your decision will not impact any current or future early care and education programming you take part in, or benefits or scholarships you receive now or in the future.

Risks and Benefits of Being in the Study: Risks and/or Discomforts. If you choose to allow Child Trends to use the information collected through the BSC we will do our best to ensure that the data are kept secure and private; however, even with all protections in place, there is always a small risk of data misuse.

Benefits. There is no direct benefit to allowing your information to be used for the feasibility study. We hope that information you provide may later benefit families and early care and education providers. We want to use what we learn from the feasibility study to inform: (1) how best to support early care and education providers in social and emotional learning practices and (2) how best to prepare children for kindergarten.

Other information: Payment to Take Part. There is no payment for you or your time in completing the BSC materials, beyond the stipend provided to your program for participation in the BSC.

Privacy. All records for the feasibility assessment, including any information you might give us, will be kept as private as possible, but there is always a risk that someone outside the research and implementation staff could see it. We will use codes to connect you to your program’s information. To the extent possible under laws and/or regulations, we will not share your information with others.

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Study records will be kept secure and will be archived with Early Care and Education Research Connections. These records will be deidentified and any characteristics that could be used to identify a program or person will be redacted. These records will be restricted and only those who agree to the terms and conditions of the Research Connections Restricted Data Use Agreement, specify the reasons for the request of each specific dataset, and obtain IRB approval or notice of exemption for their research will be granted access to the data. Research records may only be viewed by the research staff, those who are granted access to the restricted-use dataset, regulatory authorities, and the Institutional Review Board (IRB), which is a group of people who work with researchers to help protect the rights of participants. Any written summary of the findings from the feasibility study will not include any information that would make it possible to identify you or your program.

Contacts and Questions: You are encouraged to contact someone from the feasibility study if you have questions…

• about this study;

• about your participation;

• if you feel you have been harmed from taking part in the study;

• or if you would like to offer input about your participation in the study

Person in charge of the study: Local study-contact who can help:

Tamara Halle, 240-223-9234, [email protected] Anne Douglass, 617-287-7675, [email protected]

If you do not wish to talk to them, you can contact the Child Trends’ Institutional Review Board (IRB), a group that reviewed this study for your protection. Also, you may contact the IRB if:

• You have any questions, complaints, general questions, or questions about your rights as a research participant;

• Research staff cannot be reached or;

• You wish to talk to someone other than the research staff.

Child Trends’ IRB | 7315 Wisconsin Avenue, Suite 1200W, Bethesda, MD 20814 | [email protected] |1-855-288-3506

You will be given a copy of this information to keep for your records.

Statement of Consent (please check box below)

 I have read both pages of this form and I agree to share my BSC information with the study team.

Print YOUR name

Your signature Date

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. The OMB number for this information collection is 0970-XXXX and the expiration date is XX/XX/XXXX.

Attachment P: Consent Form for Program Directors

Culture of Continuous Learning Project: A Breakthrough Series Collaborative for Improving Child Care and Head Start Quality

Culture of Continuous Learning Project: Consent Form for Data Use

Program directors. Congratulations on being selected as a participant in the Breakthrough Series Collaborative (BSC)! The BSC is a part of the Culture of Continuous Learning Project: A Breakthrough Series Collaborative for Improving Child Care and Head Start Quality (CCL Project). As you may recall, the BSC is a model designed to support learning and improvement among staff at all levels of an organization. The purpose of the CCL Project is to determine how the BSC can be used in Head Start and child care settings. As part of this project, we are conducting a feasibility study, which will assess program staff’s experience participating in the BSC. The feasibility study will describe how the BSC helps support changes in your Head Start or child care program, as well as classroom practices to support children’s social and emotional learning.

The feasibility study is being paid for by the Administration for Children and Families and will be conducted by Child Trends, an independent organization that does research about children, how children learn, and the education of children. As a part of this study, we are asking to use the information you submit as part of the BSC.

Details about the feasibility study: The feasibility study will use the following information collected through the BSC…

• Materials from pre-work assignments, including team building activities and the data collection spreadsheet

• Plan, Do, Study, Act (PDSA) planning forms and tracker

• Monthly metrics (i.e., data collected throughout the BSC)

• Online BSC discussion forums

• Learning Session participant surveys

• Action planning forms

• Transcripts of Learning Sessions and other BSC meetings

Additional feasibility study activities for your program include classroom observations, focus groups, interviews, surveys, requests to observe meetings. These activities are in addition to and separate from the BSC and will be collected for the purpose of addressing questions about feasibility that cannot be answered by only looking at the documents and discussion boards used in the BSC. Individuals will be asked for consent at the start of each feasibility study activity.

If you choose to allow Child Trends to use the information collected through the BSC, the information will be used to help us (1) describe how the BSC is being used in your program, and (2) understand what “successful participation” in the BSC looks like and what characteristics support success and change in your program. For example, what are the differences and similarities in participants’ experiences with the BSC? What elements of the BSC are most helpful to staff? How are positive changes supported by the BSC “spreading” to other staff and classrooms that are not in a core BSC team? Program and staff names will not be used in the feasibility study, published in any reports, or reported to anyone outside of the research team.

Voluntary Study. Consenting to allow Child Trends to use your BSC information and conduct observations as part of the Feasibility Study is voluntary. You do not have to provide your BSC information to the study team.

If you choose to participate in the feasibility study now, you may change your mind and withdraw your programs’ information at any time, for any reason. If you refuse to provide your information, or choose to withdraw your information, there is no penalty and any information you had already provided will no longer be used for the study. Your decision will have no effect on any current or future early care and education programming you take part in. It will also not affect any benefits or scholarships you receive now or in the future.

Risk and Benefits of Being in the Study: Risks and/or Discomforts. If you choose to allow Child Trends to use the information collected through the BSC and conduct observations at your program, we will do our best to ensure that the data are kept secure and private; however, even with all protections in place, there is always a small risk of data misuse.

Benefits. There is no direct benefit to participating in the feasibility study. We hope that information you provide may later benefit families and early care and education providers. We want to use what we learn from the feasibility study to inform: (1) how best to support early care and education providers in social and emotional learning practices and (2) how best to prepare children for kindergarten.

CONTINUED ON NEXT PAGE 

Other Information: Payment to Take Part. There is no payment for you or your time in completing the BSC materials, beyond the stipend provided to your program for participation in the BSC. However, focus group participants, teachers receiving classroom observations, and survey respondents will receive $25 honoraria in the form of a gift card for completing data collection activities.

Privacy. All records for the feasibility assessment, including any information you might give us, will be kept as private as possible, but there is always a risk that someone outside the research and implementation staff could see it. We will use codes to connect you to your program’s information. To the extent possible under laws and/or regulations, we will not share your information with others.

Study records will be kept secure and will be archived with Early Care and Education Research Connections. These records will be deidentified and any characteristics that could be used to identify a program or person will be redacted. These records will be restricted and only those who agree to the terms and conditions of the Research Connections Restricted Data Use Agreement, specify the reasons for the request of each specific dataset, and obtain IRB approval or notice of exemption for their research will be granted access to the data. Research records may only be viewed by the research staff, those who are granted access to the restricted-use dataset, regulatory authorities, and the Institutional Review Board (IRB), which is a group of people who work with researchers to help protect the rights of participants.

Any written summary of the findings from the feasibility study will not include any information that would make it possible to identify you or your program.

Contacts and Questions: You are encouraged to contact someone from the feasibility study if you have questions…

• about this study;

• about your participation;

• if you feel you have been harmed from taking part in the study;

• or if you would like to offer input about your participation in the study

Person in charge of the study: Local study-contact who can help:

Tamara Halle, 240-223-9234, [email protected] Anne Douglass, 617-287-7675, [email protected]

If you do not wish to talk to them, you can contact the Child Trends’ Institutional Review Board (IRB), a group that reviewed this study for your protection. Also, you may contact the IRB if:

• You have any questions, complaints, general questions, or questions about your rights as a research participant;

• Research staff cannot be reached or;

• You wish to talk to someone other than the research staff.

Child Trends’ IRB | 7315 Wisconsin Avenue, Suite 1200W, Bethesda, MD 20814 |[email protected] |1-855-288-3506.

You will be given a copy of this information to keep for your records.

Statement of Consent (please check box below)

 I have read both pages of this form and I agree to participate in the feasibility study and share my program’s BSC information with the feasibility study team and allow the feasibility study team to conduct observations at my program.

Print YOUR name

Your signature Date

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. The OMB number for this information collection is 0970-XXXX and the expiration date is XX/XX/XXXX.

Attachment Q: Consent Form for All BSC Applicants

Culture of Continuous Learning Project: A Breakthrough Series Collaborative for Improving Child Care and Head Start Quality

Culture of Continuous Learning Project: Consent Form for Data Use, All BSC Applicants

You have submitted a selection packet to be a participant in the Breakthrough Series Collaborative (BSC) as a part of the Culture of Continuous Learning Project: A Breakthrough Series Collaborative for Improving Child Care and Head Start Quality (CCL Project). As you may recall, the BSC is a model designed to support learning and improvement among staff at all levels of an organization. The purpose of the CCL Project is to determine how the BSC can be used in Head Start and child care settings. As part of this project, we are conducting a feasibility study, which will assess program staff’s experience participating in the BSC. The feasibility study will describe how the BSC helps support changes in your Head Start or child care program, as well as classroom practices to support children’s social and emotional learning.

The feasibility study is being paid for by the Administration for Children and Families and will be conducted by Child Trends, an independent organization that does research about children, how children learn, and the education of children. As a part of this study, we are asking to use the information you submit as part of the BSC.

Details about the feasibility study: If you choose to allow Child Trends to use the information collected in the selection packet…

• The information provided will be used as a secondary data source for the feasibility assessment.

• The information will be used to describe early care and education programs that applied for selection in the BSC.

• Program characteristics provided in the section packer will be compiled and a comparison of program characteristics will be developed to better understand what ensures a program is ready to participate in the BSC.

• Program and staff names will not be used in the feasibility study nor reported to anyone outside of the research team.

If you choose to provide your program’s selection packet information now, you may change your mind and withdraw your programs’ information at any time, for any reason. If you refuse to provide your program’s information, or choose to withdraw your information, there is no penalty and any information you had already provided will no longer be used for the study. It will have no effect on any current or future early care and education programming you take part in. It will also not affect any benefits or scholarships you receive now or in the future. Consenting or not consenting to the use of the selection packet in the feasibility study data collection will not influence whether your program is chosen to participate in the BSC.

Voluntary Study. Consenting to allow Child Trends to use your program’s information in the selection packet as part of the Feasibility Study is voluntary. Your alternative is not to share the information with members of the feasibility study team. You do not have to provide your program’s selection packet information.

Risks and Benefits of Being in the Study: Risks and/or Discomforts. If you choose to allow Child Trends to use the information collected in the selection packet we will do our best to ensure that the data are kept secure and private; however, even with all protections in place, there is always a small risk of data misuse.

Benefits: There is no direct benefit to allowing your program information to be used for the feasibility study. We hope that information you provide may later benefit families and early care and education providers. We want to use what we learn from the feasibility study to inform:

• how best to support early care and education providers in social and emotional learning practices

• how best to prepare children for kindergarten

Other Information: Payment to Take Part. There is no payment for you or your time in completing the selection packet.

Privacy: All records for the feasibility assessment, including any information you might give us, will be kept as private as possible, but there is always a risk that someone outside the research staff may see it. We will not include your name with any of the information collected from you or your program staff. We will use coded numbers to connect you to your program’s information. To the extent possible under laws and/or regulations, we will not share your information with others.

Study records will be kept secure and will be archived with Early Care and Education Research Connections. These records will be deidentified and any characteristics that could be used to identify a program or person will be redacted. These records will be restricted and only those who agree to the terms and conditions of the Research Connections Restricted Data Use Agreement, specify the reasons for the request of each specific dataset, and obtain IRB approval or notice of exemption for their research will be granted access to the data.

CONTINUED ON NEXT PAGE 

Research records may only be viewed by the research staff, those who are granted access to the restricted-use dataset, regulatory authorities, and the Institutional Review Board (IRB), which is a group of people who work with researchers to help protect the rights of participants. Any written summary of the findings from the feasibility study will not include any information that would make it possible to identify you or your program.

Contacts and Questions: You are encouraged to contact someone from the feasibility assessment if you have questions…

• about this study;

• about your participation;

• if you feel you have been injured from taking part in the study;

• or if you would like to offer input about your participation in the study

Person in charge of the study: Local study-contact who can help:

Tamara Halle, 240-223-9234, [email protected] Anne Douglass, 617-287-7675, [email protected]

If you do not wish to talk to them, you can contact the Child Trends’ Institutional Review Board (IRB), a group that reviewed this study for your protection. Also, you may contact the IRB if:

• You have any questions, complaints, general questions, or questions about your rights as a research participant;

• Research staff cannot be reached or;

• You wish to talk to someone other than the research staff.

Child Trends’ IRB | 7315 Wisconsin Avenue, Suite 1200W, Bethesda, MD 20814 | [email protected] |1-855-288-3506

You will be given a copy of this information to keep for your records.

Statement of Consent (please check box below)

 I have read all 3 pages of this form and I agree to share my program’s selection packet information with the feasibility study team.

___________________________________________________________________________________

Print YOUR name

_____________________________________________________ ___________________________

Your signature Date

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. The OMB number for this information collection is 0970-XXXX and the expiration date is XX/XX/XXXX.