Form CVS

2019-20 National Survey on Drug Use and Health (NSDUH) - CVS and FT

Clinical Validation Study_PDF 2_Attachment 7

Follow-up Clinical Certification

OMB: 0930-0110

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0930-0110 can be found here:

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2020 NSDUH Clinical Validation Study (CVS)
Attachment CVS-7 – Follow-Up Clinical
Certification Recruitment Scripts

Adult Certification Interview Recruitment Screener Scripts
Adult respondents for the Clinical Interviewer certification interviews will be recruited
via telephone and web for interviews conducted over the telephone.

Telephone Screener
Hello, my name is ______________________. Thank you for calling RTI to learn
about our study.
0.1

Your safety is important, so I want to be sure you are not driving or in an area
where you might be distracted. Are you in a place where you can safely talk
on the phone and answer my questions?
YES
NO

0.2

Can you move somewhere now where you can safely talk?
YES
NO

0.3

[GO TO 0.3]
[CONTINUE]

[CONTINUE]
[END CALL AND ENTER NOTES ON CALL FORM]

How did you hear about this study?

[DO WE ALREADY HAVE [XX] Rs WITH APPOINTMENTS?]
YES
NO
1.

[GO TO 1]
[GO TO 2]

I’m sorry, but we have already recruited enough volunteers for our study, so I
can’t set up an appointment for you right now. May I have your name,
telephone number, and the best time to call so that someone from RTI can
contact you in case we have an opening?

[END CALL AND NOTE INFORMATION ON CALL FORM.]
2.

How old are you?

____ ____

IF R IS UNDER 18:
IF STAFF PERSON ALSO RECRUITING FOR YOUTH CERTIFICATION
INTERVIEWS: Since you are younger than 18, I need to speak with a
parent or guardian about your participation.
[SWITCH TO YOUTH CERTIFICATION SCRIPT]
Page 1 of 10

OTHERWISE: I’m sorry but you are not eligible to participate in this study,
but you may be eligible for a similar study we are conducting with youth age
12-17. You may call [project staff] at 800-334-8571, ext. XXXX for more
information. Please make sure a parent or guardian is available to speak with
[project staff] when you call.
[END CALL AND NOTE INFORMATION ON CALL FORM.]
3. Are you currently on active duty in the military?
YES
NO
3.1

[GO TO 8]

Are you currently an employee of RTI International or are you a family
member of a current RTI International employee?
YES
NO

[GO TO 8]

4. Have you used alcohol, including beer, wine, or hard liquor on 6 or more times in
the past 12 months?
YES
NO
5. Have you used marijuana on 6 or more times in the past 12 months?
YES
NO
6. Have you used any other illegal drugs such as cocaine, crack, heroin or ecstasy in
the past 12 months?
YES
NO
[IF NO TO PAST YEAR ALCOHOL, MARIJUANA AND ILLICIT DRUG USE,
GO TO 8]
7. Have you received services from an alcohol or drug use treatment facility or a
substance abuse counselor at any time in the past 12 months?
YES
NO
Page 2 of 10

[GO TO 9]
[GO TO 8]

8. I’m sorry, but you are not eligible to participate in this study. Thank you for your
interest.
[END CALL AND NOTE INFORMATION ON CALL FORM].
9. The purpose of this study is to help train interviewers to administer an interview
that will be used in a study about people’s experiences with the use or nonuse of alcohol and drugs. This study is being conducted for the U.S.
Department of Health and Human Services. We will interview about 70 adults
and youth in the United States.
During the interview you will be asked questions about your experiences with
the use or non-use of alcohol and drugs. Although there is no benefit to you
personally, knowledge gained from this study will improve our ability to
describe and understand alcohol and drug use in the United States.
If you agree to participate in the interview, your name, address, email, and
telephone number will be collected but will be used only for re-contact
purposes. Your name and contact information will not be included on any
interview materials such as any forms on which your answers will be written.
Federal law requires us to keep all of your answers private and confidential.
Any data you provide will only be used by authorized personnel for statistical
purposes according to the Confidential Information Protection and Statistical
Efficiency Act of 2002. The only exception to this promise of confidentiality is
if you tell the interviewer that you intend to seriously harm yourself or
someone else; in this situation RTI may need to notify a mental health
professional or other authorities.
The interview will be conducted over the phone and takes about an hour.
Your participation is voluntary. You may consider some of the questions to be
sensitive and some of the questions may also make you feel certain emotions,
such as sadness. You can refuse to answer any questions that you do not
want to answer, and you can stop the interview at any time. If you become
upset at any time during the interview and wish to speak to a mental
healthcare provider about how you are feeling, the interviewer can provide
you with a toll-free hotline number to call. The information we are collecting
is only for training purposes. The interviewer who will call you back for the
interview will not be providing any psychological diagnosis or any mental
health advice or counseling.
If you have questions about your rights as a study participant, you may call
RTI’s Office of Research Protection, at 1-866-214-2043 (a toll-free number).
You may also visit our project Website: http://nsduhweb.rti.org/ for more
information.

Page 3 of 10

If you complete the full interview, we will mail you a check for $40 in
appreciation for your time.
To make sure I know you understand the information I just shared with you,
please tell me in your own words what this study is about.
[IF R CANNOT SPEAK ENGLISH PROFICIENTLY, GO TO 8]
[IF R SOUNDS INTOXICATED, GO TO 8]
[IF R SOUNDS INCOHERENT, GO TO 8]
Are you still interested in participating?
YES
NO

[GO TO 10]

That’s fine. Thank you for calling.
[END CALL AND ENTER NOTES ON CALL FORM]
10. It looks as though you may meet the requirements to be included in our study.
Before we schedule an appointment, we need to discuss one more thing. Our
interviewers are required to audio record all interviews they conduct so their
supervisors can make sure they are doing their job correctly. The audio
recording will not contain your name or any information that could be used to
identify you. All audio files will be destroyed within 24 months after the end
of the data collection period. If you think now that you would be willing to be
audio recorded, I will schedule you for an interview. Are you willing to have
your interview audio recorded?
YES
[GO TO 11]
NO, UNSURE
That’s fine. Thank you for calling.
[END CALL AND ENTER NOTES ON CALL FORM]
11. We are scheduling appointments between MONTH, DATE and MONTH, DATE.
Are you available during that time frame for a 1-hour phone interview?
YES
[GO TO 12]
NO, UNSURE
That’s fine. Thank you for calling.
[END CALL AND ENTER NOTES ON CALL FORM]
Page 4 of 10

12. When would be the best time between MONTH, DATE and MONTH, DATE for you
to complete the interview?
[RECORD DATE AND TIME ON CALL FORM]
13. The day before your appointment, on [DATE - 1], we’ll call to remind you of when
the interview will take place. What is the best telephone number where you
can be reached, and the best time to call so that we can remind you of your
interview appointment?
[RECORD TELEPHONE NUMBER AND BEST TIME ON CALL FORM.]
Is this the same telephone number where the interviewer can reach you to
complete the phone interview on [DATE]?
YES
[GO TO 14]
NO, UNSURE
What is the telephone number the interviewer should use to contact you for
the phone interview on [DATE]?
[NOTE TELEPHONE NUMBER ON CALL FORM]
14.

Please provide an email address where we can contact you about this study.
[NOTE EMAIL ON CALL FORM]
15. In order for us to mail you the $40 when the interview is completed, I will need
your name and address. Please remember that this information will never be
connected to your responses and will only be used to mail your check after
the interview is completed.
[NOTE NAME AND ADDRESS ON CALL FORM.]
16. We’ll give you a call on [DATE - 1]. If you need to reschedule your appointment
or have any questions in the meantime, please give me a call at [TELEPHONE
NUMBER]. Thank you and have a nice day.

Page 5 of 10

Web Screener
INTRO1

The purpose of this study is to help train interviewers to administer an
interview that will be used in a study about people’s experiences with the
use or non-use of alcohol and drugs. This study is being conducted for the
U.S. Department of Health and Human Services. We will interview about
70 adults and youth in the United States.
During the interview you will be asked questions about your experiences
with the use or non-use of alcohol and drugs. Although there is no benefit
to you personally, knowledge gained from this study will improve our ability
to describe and understand alcohol and drug use in the United States.
If you agree to participate in the interview, your name, address, email, and
telephone number will be collected but will be used only for re-contact
purposes. Your name and contact information will not be included on any
interview materials such as any forms on which your answers will be
written. Federal law requires us to keep all of your answers private and
confidential. Any data you provide will only be used by authorized personnel
for statistical purposes according to the Confidential Information Protection
and Statistical Efficiency Act of 2002. The only exception to this promise of
confidentiality is if you tell the interviewer that you intend to seriously harm
yourself or someone else; in this situation RTI may need to notify a mental
health professional or other authorities.
The interview will be conducted over the phone and takes about an
hour. Your participation is voluntary. You may consider some of the
questions to be sensitive and some of the questions may also make you
feel certain emotions, such as sadness. You can refuse to answer any
questions you do not want to answer, and you can stop the interview
at any time. If you become upset at any time during the interview and
wish to speak to a mental healthcare provider about how you are
feeling, the interviewer can provide you with a toll-free hotline number
to call. The information we are collecting is only for training purposes.
The interviewer who will call you for the interview will not be providing
any psychological diagnosis or any mental health advice or counseling.
If you have questions about your rights as a study participant, you may
call RTI’s Office of Research Protection, at 1-866-214-2043 (a toll-free
number). You may also visit our project Website:
http://nsduhweb.rti.org/ for more information.
If you complete the full interview, we will mail you a check for $40 in
appreciation for your time.
[CONTINUE]

Page 6 of 10

INTRO2

To determine if you are eligible, we must ask you a few questions
about your alcohol and drug use. All responses to the survey will
remain confidential. We will not share information you give us with
anyone other than necessary project staff.
If you are eligible for the study, a staff person will call or email
you to schedule a time for the interview.
[CONTINUE]

AGE

What is your age?
____ [RANGE: 0 to 110]
[IF AGE ≥ 18, CONTINUE TO MILIT]
[ELSE, GO TO TERM]

MILIT

Are you currently on active duty in the military?
1
Yes [GO TO TERM]
2 No

RTI

Are you currently an employee of RTI International or are you a
family member of a current RTI International employee?
1 Yes [GO TO TERM]
2
No

ALCOHOL

Have you used alcohol, including beer, wine, or hard liquor on 6 or
more times in the past 12 months?
1
2

MARIJU

Have you used marijuana on 6 or more times in the past 12 months?
1
2

OTHERD

Yes
No

Have you used any other illegal drugs such as cocaine, crack, heroin or
ecstasy in the past 12 months?
1
2

Page 7 of 10

Yes
No

NOELIG

[IF ALCOHOL+MARIJU+OTHERD = NO, GO TO TERM]

TRTMT

Have you received services from an alcohol or drug use treatment
facility or a substance abuse counselor at any time in the past 12
months?
1
2

Yes
No [GO TO TERM]

TERM

Thank you, but you are not eligible to participate in this study.

YELIG

IF [IF ALCOHOL OR MARIJU OR OTHERD = YES AND TRTMT = YES]
It looks as though you may meet the requirements to be included in
our study.
Our interviewers are required to audio record all interviews they
conduct so their supervisors can make sure they are doing their job
correctly. The audio recording will not contain your name or any
information that could be used to identify you. All audio files will be
destroyed within 24 months after the end of the data collection period.
Are you willing to have your interview audio recorded?
1
2

AVAB

We are scheduling appointments between MONTH, DATE and MONTH,
DATE. The interview will last about an hour and you will receive $40
after completing the interview. Are you available during that time frame
for a phone interview?
1
2

NAME

Yes
No [GO TO TERM]

Yes
No [GO TO TERM]
Please provide your first name or a nickname.
NAME: _______________________________

Please provide an email address where we can contact you about this
study.
__________________________

PHONE

Page 8 of 10

Please provide a phone number where we can contact you about this
study.

PHONE 1: _ _ _ - _ _ _ - _ _ _ _
PHONE 2: _ _ _ - _ _ _ - _ _ _ _
WHEN

When is the best time to contact you?
_____________________________________

THANK

We will contact you soon to schedule an interview. When we reach out
to you, we will only say that we are contacting you about a health
study for RTI International.

[WHEN CONTACTING R TO SCHEDULE APPOINTMENT, USE SCRIPT
BELOW]
1.

Hi, my name is _________ from RTI International. I’m reaching out to you
regarding a health study. I understand that you responded to an
advertisement we placed for study participants age 18 and over, is that
correct?
YES
NO

Our records show you are eligible for the study. Are you still interested in
participating in the study?
YES
NO

[GO TO 2]
[GO TO 3]

[GO TO 4]
[GO TO 3]

That is fine, thank you for your time.

[END CALL AND ENTER NOTES ON CALL FORM]
4.

We would like to schedule an interview with you. When would be the best
time between MONTH, DATE and MONTH, DATE for you to complete the
interview?

[RECORD DATE AND TIME ON CALL FORM]
5.

The day before your appointment, on [DATE - 1], we’ll call to remind you of
when the interview will take place. What is the best telephone number where
you can be reached, and the best time to call so that we can remind you of
your interview appointment?

[RECORD TELEPHONE NUMBER AND BEST TIME ON CALL FORM]

Page 9 of 10

Is this the same telephone number where the interviewer can reach you to
complete the phone interview on [DATE]?
YES
NO

[GO TO 7]
[GO TO 6A]

6A. What is the telephone number the interviewer should use to contact you
for the phone interview on [DATE]?
[NOTE TELEPHONE NUMBER ON CALL FORM]
7.

In order for us to mail you the $40 when the interview is completed, I will
need your name and address. Please remember that this information will
never be connected to your responses and will only be used to mail your
check after the interview is completed.

[NOTE NAME AND ADDRESS ON CALL FORM]
8.

We’ll give you a call on [DATE - 1]. If you need to reschedule your
appointment or have any questions in the meantime, please give me a call at
[TELEPHONE NUMBER]. Thank you and have a nice day.

Page 10 of 10

Adult CS Certification Interview Recruitment Screener Scripts
Adult respondents for the Clinical Supervisor certification interviews will be recruited
via telephone and web for interviews conducted over the telephone.

Telephone Screener
Hello, my name is ______________________. Thank you for calling RTI to learn
about our study.
0.1

0.2

Can you move somewhere now where you can safely talk?
YES
NO

0.3

[GO TO 0.3]
[CONTINUE]

[CONTINUE]
[END CALL AND ENTER NOTES ON CALL FORM]

How did you hear about this study?

[DO WE ALREADY HAVE [XX] Rs WITH APPOINTMENTS?]
YES
NO
1.

[GO TO 1]
[GO TO 2]

[END CALL AND NOTE INFORMATION ON CALL FORM.]
2.

How old are you?

____ ____

3.1

Are you currently on active duty in the military?
YES
[GO TO 8]
NO
Are you currently an employee of RTI International or are you a family
member of a current RTI International employee?
YES
NO

[GO TO 8]

Have you used alcohol, including beer, wine, or hard liquor on 6 or more times
in the past 12 months?
YES
NO
Have you used marijuana on 6 or more times in the past 12 months?
YES
NO

Have you used any other illegal drugs such as cocaine, crack, heroin or ecstasy
in the past 12 months?
YES
NO
[IF NO TO PAST YEAR ALCOHOL, MARIJUANA AND ILLICIT DRUG USE,
GO TO 8]

Have you received services from an alcohol or drug use treatment facility or a
substance abuse counselor at any time in the past 12 months?
YES
NO

Page 2 of 10

[GO TO 9]
[GO TO 8]

I’m sorry, but you are not eligible to participate in this study. Thank you for
your interest.
[END CALL AND NOTE INFORMATION ON CALL FORM].
The purpose of this study is to help train interviewers to administer an interview
that will be used in a study about people’s experiences with the use or nonuse of alcohol and drugs. This study is being conducted for the U.S.
Department of Health and Human Services. We will interview about 70 adults
and youth in the United States.
During the interview you will be asked questions about your experiences with
the use or non-use of alcohol and drugs. Although there is no benefit to you
personally, knowledge gained from this study will improve our ability to
describe and understand alcohol and drug use in the United States.
If you agree to participate in the interview, your name, email, and telephone
number will be collected but will be used only for re-contact purposes. Your
name and contact information will not be included on any interview materials
such as any forms on which your answers will be written. Federal law requires us
to keep all of your answers private and confidential. Any data you provide will
only be used by authorized personnel for statistical purposes according to the
Confidential Information Protection and Statistical Efficiency Act of 2002. The only
exception to this promise of confidentiality is if you tell the interviewer that you
intend to seriously harm yourself or someone else; in this situation RTI may need
to notify a mental health professional or other authorities.
The interview will be conducted over the phone and takes about an hour.
Your participation is voluntary. You may consider some of the questions to be
sensitive and some of the questions may also make you feel certain emotions,
such as sadness. You can refuse to answer any questions you do not want to
answer, and you can stop the interview at any time. If you become upset at
any time during the interview and wish to speak to a mental healthcare
provider about how you are feeling, the interviewer can provide you with a
toll-free hotline number to call. The information we are collecting is only for
training purposes. The interviewer who will call you back for the interview will
not be providing any psychological diagnosis or any mental health advice or
counseling.
If you have questions about your rights as a study participant, you may call
RTI’s Office of Research Protection, at 1-866-214-2043 (a toll-free number).
You may also visit our project Website: http://nsduhweb.rti.org/ for more
information.
If you complete the full interview, we will mail you a check for $40 in
appreciation for your time.

Page 3 of 10

To make sure I know you understand the information I just shared with you,
please tell me in your own words what this study is about.
[IF R CANNOT SPEAK ENGLISH PROFICIENTLY, GO TO 8]
[IF R SOUNDS INTOXICATED, GO TO 8]
[IF R SOUNDS INCOHERENT, GO TO 8]
Are you still interested in participating?
YES
NO

[GO TO 10]

That’s fine. Thank you for calling.
[END CALL AND ENTER NOTES ON CALL FORM]
10. Before we schedule an appointment, we need to discuss one more thing. This
interview will be conducted as a part of a training session. Our interviewers
are required to audio record all interviews they conduct so their supervisors
can make sure they are doing their job correctly. The audio recording will not
contain your name or any information that could be used to identify you. All
audio files will be destroyed within 24 months after the end of the data
collection period. If you think now that you would be willing to be audio
recorded, I will schedule you for an interview. Are you willing to have your
interview audio recorded?

YES
[GO TO 11]
NO, UNSURE
That’s fine. Thank you for calling.
[END CALL AND ENTER NOTES ON CALL FORM]
11. We are scheduling appointments between MONTH, DATE and MONTH, DATE.
Are you available during that time frame for a 1-hour phone interview?
YES
[RECORD APPOINTMENT TIME ON CALL FORM, GO TO 12]
NO, UNSURE That’s fine. Thank you for calling. [END CALL AND ENTER
NOTES ON CALL FORM]
12.

The day before your appointment, on [DATE – 1], we’ll call to remind you of
when the interview will take place. What is the best telephone number where
you can be reached, and the best time to call so we can remind you of your
interview appointment?

Page 4 of 10

[RECORD TELEPHONE NUMBER AND BEST TIME ON CALL FORM.]
Is this the same telephone number where the interviewer can reach you to complete
the phone interview on [DATE]?
YES [GO TO 14]
NO, UNSURE
What is the telephone number the interviewer should use to contact you for the
phone interview on [DATE]?
[NOTE TELEPHONE NUMBER ON CALL FORM]
13.

Please provide an email address where we can contact you about this study.

[NOTE EMAIL ON CALL FORM]
14.

[NOTE NAME AND ADDRESS ON CALL FORM.]
15. We’ll give you a call on [DATE - 1]. If you need to reschedule your
appointment or have any questions in the meantime, please give me a call at
[TELEPHONE NUMBER]. Thank you and have a nice day.

Page 5 of 10

Web Screener
INTRO1

The purpose of this study is to help train interviewers to administer an
interview that will be used in a study about people’s experiences with the
use or non-use of alcohol and drugs. This study is being conducted for the
U.S. Department of Health and Human Services. We will interview about
70 adults and youth in the United States.
During the interview you will be asked questions about your experiences
with the use or non-use of alcohol and drugs. Although there is no benefit
to you personally, knowledge gained from this study will improve our ability
to describe and understand alcohol and drug use in the United States.
If you agree to participate in the interview, your name, email, and
telephone number will be collected but will be used only for re-contact
purposes. Your name and contact information will not be included on any
interview materials such as any forms on which your answers will be
written. Federal law requires us to keep all of your answers private and
confidential. Any data you provide will only be used by authorized
personnel for statistical purposes according to the Confidential Information
Protection and Statistical Efficiency Act of 2002. The only exception to this
promise of confidentiality is if you tell the interviewer that you intend to
seriously harm yourself or someone else; in this situation RTI may need to
notify a mental health professional or other authorities.
The interview will be conducted over the phone and takes about an
hour. Your participation is voluntary. You may consider some of the
questions to be sensitive and some of the questions may also make you
feel certain emotions, such as sadness. You can refuse to answer any
questions you do not want to answer, and you can stop the interview
at any time. If you become upset at any time during the interview and
wish to speak to a mental healthcare provider about how you are
feeling, the interviewer can provide you with a toll-free hotline number
to call. The information we are collecting is only for training purposes.
The interviewer will not be providing any psychological diagnosis or any
mental health advice or counseling.
If you have questions about your rights as a study participant, you may
call RTI’s Office of Research Protection, at 1-866-214-2043 (a toll-free
number). You may also visit our project Website:
http://nsduhweb.rti.org/ for more information.
If you complete the full interview, we will give you $40 in appreciation
for your time.
[CONTINUE]

Page 6 of 10

INTRO2

AGE

What is your age?
____ [RANGE: 0 to 110]
[IF AGE ≥ 18, CONTINUE TO MILIT]
[ELSE, GO TO TERM]

MILIT

Are you currently on active duty in the military?
1
2

RTI

Yes [GO TO TERM]
No

Are you currently an employee of RTI International or are you a
family member of a current RTI International employee?
1 Yes [GO TO TERM]
2
No

ALCOHOL

Have you used alcohol, including beer, wine, or hard liquor on 6 or
more times in the past 12 months?
1
2

MARIJU

Have you used marijuana on 6 or more times in the past 12 months?
1
2

OTHERD

Yes
No

Have you used any other illegal drugs such as cocaine, crack, heroin or
ecstasy in the past 12 months?
1
2

Page 7 of 10

Yes
No

NOELIG

[IF ALCOHOL+MARIJU+OTHERD = NO, GO TO TERM]

TRTMT

Have you received services from an alcohol or drug use treatment
facility or a substance abuse counselor at any time in the past 12
months?
1
2

Yes
No [GO TO TERM]

TERM

Thank you, but you are not eligible to participate in this study.

YELIG

IF [IF ALCOHOL OR MARIJU OR OTHERD = YES, AND TRTMT = YES,
AND OBSRV = YES]
It looks as though you may meet the requirements to be included in
our study.
Our interviewers are required to audio record all interviews they
conduct so their supervisors can make sure they are doing their job
correctly. The audio recording will not contain your name or any
information that could be used to identify you. All audio files will be
destroyed within 24 months after the end of the data collection period.
Are you willing to have your interview audio recorded?
1
2

AVAB

We are scheduling appointments between MONTH, DATE and MONTH,
DATE. The interview will last about an hour and you will receive $40
after the interview is completed. Are you available during that time
frame for a phone interview?
1
2

LATR

NAME

Yes
No [GO TO TERM]

Yes [GO TO NAME]
No [GO TO LATR]

Since you are not available during the time the interviews will be
conducted, you are not eligible to participate in the study at this time.
However additional opportunities to participate in a similar study
conducted over the phone will be available between MONTH, DATE and
MONTH, DATE. We will contact you at that time to determine if you are
interested and available.
Please provide your first name or a nickname.
NAME: _______________________________

Page 8 of 10

Please provide an email address where we can contact you about this
study.
__________________________

PHONE

Please provide a phone number where we can contact you about this
study.
PHONE 1: _ _ _ - _ _ _ - _ _ _ _
PHONE 2: _ _ _ - _ _ _ - _ _ _ _

WHEN

When is the best time to contact you?
_____________________________________

THANK

We will contact you soon to schedule an interview. When we reach out
to you, we will only say that we are contacting you about a health
study for RTI International.

[WHEN CONTACTING R TO SCHEDULE APPOINTMENT, USE SCRIPT
BELOW]
1.

[GO TO 3]

Our records show that you are eligible for the study. Are you still interested in
participating in the study?
YES
NO

[GO TO 4]
[GO TO 3]

That is fine, thank you for your time.
[END CALL AND ENTER NOTES ON CALL FORM]

We would like to schedule an interview with you. When would be the best
time between MONTH, DATE and MONTH, DATE for you to complete the
interview?

[RECORD DATE AND TIME ON CALL FORM]
Page 9 of 10

[RECORD TELEPHONE NUMBER AND BEST TIME ON CALL FORM]
6.

Is this the same telephone number where the interviewer can reach you to
complete the phone interview on [DATE]?
YES
NO

[GO TO 7]
[GO TO 6A]

6A. What is the telephone number the interviewer should use to contact you
for the phone interview on [DATE]?
7.

[NOTE NAME AND ADDRESS ON CALL FORM]
8.

We’ll give you a call on [DATE - 1]. If you need to reschedule your
appointment or have any questions in the meantime, please give me a call at
[TELEPHONE NUMBER]. Thank you and have a nice day.

Page 10 of 10

Youth Certification Interview Recruitment Screener Script
Youth respondents for the Clinical Supervisor and Clinical Interviewer certification
interviews will be recruited via telephone for interviews conducted over the telephone.

Telephone Screener
Hello, my name is ______________________. Thank you for calling RTI to learn
about our study.
0.1

0.2

Can you move somewhere now where you can safely talk?
YES
NO

0.3

[GO TO 0.3]
[CONTINUE]

[CONTINUE]
[END CALL AND ENTER NOTES ON CALL FORM]

How did you hear about this study?
[IF NEEDED] What is your first name? [RECORD ON FORM]

How old are you?

____ ____

[IF R IS OVER 18]: Are you calling on behalf of yourself or your child?
[IF CALLING FOR SELF: SWITCH TO ADULT CERTIFICATION SCRIPT]
[IF CALLING FOR CHILD: CONTINUE]
2.

[DO WE ALREADY HAVE [XX] Rs WITH APPOINTMENTS?]
YES I’m sorry, but we have already recruited enough volunteers for our
study, so I can’t set up an appointment for you right now. May I have your
name, telephone number, and the best time to call so that someone from RTI
can contact you in case we have an opening?
[END CALL AND NOTE INFORMATION ON CALL FORM.]
NO AND TALKING TO YOUTH
NO AND TALKING TO PARENT

Page 1 of 4

[GO TO 3]
[GO TO 4]

For youth age 12 – 17 to participate, we first need to speak with a parent or
legal guardian to describe what the study is about and get their permission to
talk with you. May I speak with one of your parents?
[IF PARENT NOT AVAILABLE] I’m sorry, but I first need to speak with your
parent about the study and get permission to talk with you. Please call back
at a time when your parent is also available to speak with me. Thank you for
your interest.
[END CALL AND NOTE INFORMATION ON CALL FORM]
[IF PARENT AVAILABLE] Your child responded to a recruitment flyer to test
a questionnaire for use in a future national study, so I need to first speak to a
parent about their participation.

[IF NEEDED] What is your child’s first name? [RECORD ON FORM]
Are you the parent who has legal custody of [CHILD’s NAME], or are you this
child’s legal guardian?
YES
NO

4.1

[CONTINUE]
[ASK FOR PARENT/GUARDIAN, THEN REPEAT TEXT]

Are you currently an employee of RTI International or are you a family
member of a current RTI International employee?
YES

Your child is not eligible for this study. Thank you for your time.
[END CALL AND ENTER NOTES ON CALL FORM]

[CONTINUE]

The purpose of this study is to help train interviewers to administer an interview
that will be used in a study about people’s experiences with the use or nonuse of alcohol and drugs. Has your child received services for substance abuse
treatment at any time during the past 12 months?
YES
NO

Page 2 of 7

[CONTINUE]
Your child is not eligible for this study. Thank you for your time.
[END CALL AND ENTER NOTES ON CALL FORM]

This study is being conducted for the U.S. Department of Health and Human
Services. We will interview about 70 adults and youth in the United States. The
interview will be conducted over the telephone and will take about an hour.
For this study, we are interested in interviewing a wide variety of individuals
to learn more about how different people think and talk about their use or
non-use of alcohol and drugs. The interview will include questions about your
child’s knowledge of and experiences with alcohol and drugs. Participation in
this interview is voluntary.
All of your child’s answers will be private and confidential and used only for
statistical purposes. There are two exceptions to this promise. If your child
tells me that they intend to seriously harm themselves or someone else, I may
need to notify you or a mental health professional or another authority. If
your child tells me that they are at risk of serious harm by someone else, I
may also need to notify you or another authority.
Your child may consider some of the questions to be sensitive and some of
the questions may also make them feel certain emotions, such as sadness.
Your child can refuse to answer any questions that they do not want to
answer, and can stop the interview at any time. If your child becomes upset
during the interview and wishes to speak to a mental health professional
about how they are feeling, I will provide toll-free hotline numbers.
If you agree to allow your child to participate, they will receive a check for $40
after the interview is completed.
To make sure I know you understand the information I just shared with you,
please tell me in your own words what this study is about.
[IF NEEDED REVIEW DETAILS OF STUDY AGAIN]

When I talk with your child, I will ask a few questions about your child’s use or
non-use of alcohol and drugs to determine eligibility for this study. Do I have
your permission to talk with your child about the study and ask your child to
participate?
YES
NO

[CONTINUE]
Thank you for your time. [END CALL AND ENTER NOTES ON
CALL FORM]

Before I ask your child some questions to determine their eligibility, there is one
more thing we need to discuss. Our interviewers are required to audio record
all interviews they conduct so their supervisors can make sure they are doing
their job correctly. The audio recording will not contain your child’s name or
any information that could be used to identify them. The audio recording will

Page 3 of 7

be destroyed within 24 months of the end of the project. If you are willing to
allow your child to be audio recorded, I will ask your child if they are
interested in participating and whether it is okay to audio record the interview.
Are you willing to let us audio record your child’s interview?
YES
NO

[CONTINUE]
Thank you for your time. [END CALL AND ENTER NOTES ON
CALL FORM]

Thanks for agreeing to allow me to talk with your child about the study. Should
your child decide that they want to participate, I will ask you for contact
information and work to set up a convenient time to complete the interview.
[IF NEEDED] And what is your first name? [RECORD ON FORM]
May I please speak with [CHILD’S FIRST NAME]?

10. [TO YOUTH] I have a few questions to determine if you are eligible for the
interview. The questions that ask about your use or non-use of alcohol and
drugs and your answers will not be shared with your parents. Is that OK with
you?
YES
NO

10.1

[CONTINUE]
I’m sorry, but you are not eligible to participate in this study.
Thank you for your interest.
[END CALL AND ENTER NOTES ON CALL FORM]

[GO TO 10.2]
[CONTINUE]

10.1.1 Can you move somewhere now where you can safely talk?
YES
NO

10.2

[CONTINUE]
[END CALL AND ENTER NOTES ON CALL FORM]

[TO YOUTH] Have you used alcohol, including beer, wine, or hard liquor on 6
or more times in the past 12 months?
Have you used marijuana on 6 or more times in the past 12 months?

Page 4 of 7

Have you used any other illegal drugs such as cocaine, crack, heroin or
ecstasy in the past 12 months?
YES TO ANY [CONTINUE]
NO TO ALL I’m sorry, but you are not eligible to participate in this study.
Thank you for your interest.
[END CALL AND ENTER NOTES ON CALL FORM]
11. Have you received services from an alcohol or drug use treatment facility or a
substance abuse counselor at any time during the past 12 months?
YES
NO

[CONTINUE]
I’m sorry, but you are not eligible to participate in this study.
Thank you for your interest.
[END CALL AND ENTER NOTES ON CALL FORM]

12. The purpose of this study is to help train interviewers to administer an interview
that will be used in a study about people’s experiences with the use or nonuse of alcohol and drugs. This study is being conducted for the U.S.
Department of Health and Human Services. We will interview about 70 adults
and youth in the United States. The interview will be conducted over the
telephone and will take about an hour.
This study asks questions about how different people think and talk about
their use or non-use of alcohol and drugs. The interview will include questions
about your knowledge of and experiences with alcohol and drugs. Your parent
said you can take part in this interview if you want to. It is your choice
whether you take part in this study.
Federal law requires us to keep all of your answers private and confidential.
This is true except if you tell me you plan to seriously harm yourself or
someone else, or if you say someone is harming you. Then I may need to tell
your parent, a counselor, or another adult who can help. I would also need to
tell an adult if you tell me that someone is harming you. All other information
you share is private.
If you agree to participate, you will receive $40 in the mail after the interview.
I will collect some contact information from your parent today, and an
interviewer will call you back to explain more about the interview.
To make sure I know you understand the information I just shared with you,
please tell me in your own words what this study is about.
[IF NEEDED REVIEW DETAILS OF STUDY AGAIN]
Page 5 of 7

Do you want to participate in this study?
YES
NO

[CONTINUE]
Thank you for your time.
[END CALL AND ENTER NOTES ON CALL FORM]

13. Before we move forward with scheduling a time for the interviewer to call back, we
need to discuss one more thing. Our interviewers are required to audio record all
interviews they conduct so their supervisors can make sure they are doing their job
correctly. The audio recording will not contain your name or any information that
could be used to identify you. The recording will be destroyed within 24 months of
the end of the project. Are you willing to let us audio record your interview?
YES
NO

[GO TO 15]
That’s fine. Thank you for calling.
[END CALL AND ENTER NOTES ON CALL FORM]

14. It appears you are eligible for the study. To accommodate your schedule, an
interviewer will be available to call at a time that is convenient for you to
conduct the interview.
We are scheduling appointments between MONTH, DATE and MONTH, DATE.
Are you available during that time frame for a 1-hour phone interview?
YES
NO

[GO TO 15]
That’s fine. Thank you for calling.
[END CALL AND ENTER NOTES ON CALL FORM]

15. Thank you for your interest. At this point I need to ask your parent for some
information. May I please speak with them again?
[TO PARENT] Your child has agreed to complete the interview.
Will you want the interview to take place at a time when you are home with
the child, or is it OK for the interviewer calling your child to complete this
interview when you are not home?
[NOTE RESPONSE ON CALL FORM]
16. When would be the best time between MONTH, DATE and MONTH, DATE for
your child to complete the interview?
[RECORD DATE AND TIME ON CALL FORM]

Page 6 of 7

17. The day before the appointment, on [DATE - 1], we’ll call to remind you and
your child of when the interview will take place. What is the best telephone
number where you can be reached, and the best time to call so that we can
remind you of the interview appointment?
[RECORD PARENT TELEPHONE NUMBER AND BEST TIME ON CALL FORM.
DO NOT COLLECT TELEPHONE NUMBER FOR A YOUTH’S PERSONAL CELL
PHONE.]
Is this the same telephone number where the interviewer can reach your child
to complete the phone interview on [DATE]?
YES
NO

[GO TO 18]
What is the telephone number the interviewer should use to
contact your child for the phone interview on [DATE]?

[NOTE TELEPHONE NUMBER ON CALL FORM. DO NOT COLLECT TELEPHONE
NUMBER FOR A YOUTH’S PERSONAL CELL PHONE.]
18.

Please provide an email address where we can send you information about this
study.

[NOTE PARENT EMAIL ON CALL FORM]
We also need an email address for your child, to share study details with
them. We can include you on any emails sent to your child.
[NOTE CHILD EMAIL ON CALL FORM]
19. In order for us to mail the $40 check to your child when the interview is
completed, I will need your child’s last name and address. Please remember
this information will never be connected to their responses and will only be
used to mail the check after the interview is completed.
[NOTE CHILD LAST NAME AND ADDRESS ON CALL FORM.]
20. We’ll give you a call on [DATE - 1]. If you need to reschedule the appointment
or have any questions in the meantime, please give me a call at [TELEPHONE
NUMBER]. Thank you and have a nice day.

Page 7 of 7

File Type	application/pdf
File Title	Microsoft Word - Electronic Attachment Dividers_CVS PDF 2.doc
Author	lchilds
File Modified	2019-09-04
File Created	2019-09-04