Informed Consent Statement

Attachment A: Informed Consent Statement

On behalf of the Centers for Disease Control and Prevention’s (CDC) Division of Violence Prevention’s (DVP), the Karna Team (Abt Associates Inc. and Karna LLC.) is conducting evaluability assessment site visits of promising hospital-based violence prevention programs that seek to prevent or reduce violence-related injuries, including morbidity and mortality rates, and decrease future involvement in the criminal justice system among youth between the ages of 10-24 years that are ready for rigorous evaluation. .

• Through the evaluability assessment we hope to learn from your program and, where possible, provide insights by suggesting areas to strengthen your evaluation capacity.

• These visits will help CDC to understand what programs have the potential for improving outcomes related to youth violence and inform future updates to CDC guidance on best available approaches to prevent youth violence.

We are conducting this interview to better understand how your program is seeking to reduce/prevent youth violence. We consider you the expert and look forward to the information that you will share.

There are no right or wrong answers. The interview is a discussion, not an evaluation. Our goal is to learn and observe some of the work that you’re doing.

This interview will be kept private. Any information that identifies you will not be shared with anyone beyond the CDC-Karna team members. We will only include your title/role in reports. We will never associate your comments by name, unless we have received direct written permission from you, in advance. Additionally, we will not share interview notes from this, or any of the other interviews, with anyone outside of the CDC-Karna Team.

Your participation is voluntary. You may choose not to answer any question, or you may choose not to participate without penalty. You can choose to discontinue the interview at any time for any reason. If you have questions about your rights as a participant you may contact the EA Site Visit Director, Tara Earl, at 866-455-3777 or [email protected] or the CDC Project Lead, Khiya Mullins, at 770-488-3911 or by email at [email protected].

Notes will be taken to accurately capture our discussion, and they will be destroyed upon conclusion of the project. Do you have any questions before we get started? You may keep a copy of this for your records.