Attachment D_Participant_Informed_Consent_Screens_Adolescent

Attachment D

Participant Informed Consent Screens (Adolescent)

YCON1 [IF AGE = 12-17] If you are using a mobile device, turn your device horizontally for best display.

Before you begin, please ensure you are at home in a private location where no one else can see your responses. It is recommended you complete the entire interview in one sitting, which takes about 30 minutes, depending on your answers.

About 420 people across the nation will complete this interview. We are testing some questions about experiences with alcohol, drugs, and drug treatment as well as experiences with mental health and mental health treatment. You may choose not to take part in this study, but if you do take part, when you finish the interview, you will receive [INSERT INCENTIVE AMOUNT BASED ON PLATFORM CODE]. The data you provide are confidential. The data you provide are confidential. Only the combined responses from all 420 people will be reported, not just one person's answers. We will combine the answers from all respondents in this study, and compare them to existing data, to see if [INSERT PLATFORM NAME] could be used for question testing recruitment in the future.

While the interview has some personal questions, federal law keeps your answers private. Your participation is voluntary. You can quit the interview at any time by closing your browser window and you can refuse to answer any questions.

If you have to stop the interview, after 15 minutes you will be logged out automatically and will need your Participant Code to resume the interview at the point where you exited. However, if you stop the interview and do not resume within 24 hours, all of your answers will be removed for security purposes to protect your privacy – you will still be able to complete the interview and receive [INCENTIVE] but you will need to start over.

Click Next to continue.

YCON2 [IF AGE = 12-17] You may consider some of the questions to be sensitive in nature and some questions may also make you feel certain emotions, such as sadness. For example, the interview asks questions about drug use, depression, and other topics. Remember, you can refuse to answer any questions and you can stop the interview at any time.

If you become upset during the interview and wish to speak to a mental health professional about how you are feeling, you can call the toll-free helpline number below.

Substance Abuse and Mental Health Services Administration’s Treatment Referral Helpline (24-hour service for local treatment options)

1-800-662 HELP (4357)

1-800-487-4889 (TTY)

http://findtreatment.samhsa.gov

If you have any questions about the study, call 1-800-848-4079. If you have questions about your rights as a study participant, call RTI’s Office of Research Protection at 1-866-214-2043 (a toll-free number).

To start the interview, please check the acceptance box below to indicate you have read and understand the information provided to you about your participation.

Then click “Next” to begin the interview.

If you do not wish to proceed with the interview, exit this screen by closing your browser window.

[CHECK BOX] I’ve read the information above and agree to proceed with the interview.

YPARENT [IF AGE = 12-17] Is your parent or guardian at home?

1 Yes

2 No

YNOPAR [IF YPARENT = 2] Please wait to complete this interview until your parent or guardian is at home.

Click on Exit to exit the interview.

YPRIV [IF AGE = 12-17] Are you at home in a private location?

1 Yes

2 No

YNOPRIV [IF YPRIV = 2] Please move to a private location before beginning this interview.

Click Next to continue when you are in a private location.