Appendix B_CIP Interview, Consent Form

Appendix B_CIP Interview, Consent Form_092520_clean.docx

Formative Data Collections for ACF Research

Appendix B_CIP Interview, Consent Form

OMB: 0970-0356

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Judicial Decision-Making and Hearing Quality in Child Welfare Research Study:

Follow-Up Telephone Interview with CIP Administrators

Consent to Participate


You are invited to participate in a telephone interview about your responses on the survey you recently completed and/or the information you provided in the CIP self-assessment report submitted to the Children’s Bureau. The interview will focus on your survey responses and on your CIP projects on hearing quality and how judges make decisions. The information collected in this interview will help us plan for a future study or studies that will examine the factors associated with judicial decision-making and hearing quality in child welfare cases, and the influence those factors may have on judges’ reasonable efforts decisions and case outcomes. The study is funded by the Office of Planning, Research, and Evaluation (OPRE) and the Children’s Bureau and is being conducted by James Bell Associates, the American Bar Association Center on Children and the Law, and Co-Principal Investigators Drs. Alicia Summers and Sophie Gatowski.


This collection of information is voluntary and will be used to help us understand which sites may be appropriate for a future research study or studies that will examine hearing quality and judicial decision-making in child abuse and neglect cases. Public reporting burden for this collection of information is estimated to average 30 minutes per interview, including the time for reviewing instructions, gathering and maintaining the data needed, and completing the interview. 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 and expiration date for this collection are OMB #: 0970-0356, Exp: 06/30/2021. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Anne Fromknecht; [email protected].


You may refuse to take part in this research or end the interview at any time without penalty. You are free to decline to answer any particular question for any reason. There are no foreseeable risks involved to your participation in the interview. Although you may receive no direct benefit from participating in this research study; you will be contributing to the broad body of knowledge regarding what works to improve child welfare court practice. Your responses will help us learn more about child welfare practices in your state and understand which potential sites are appropriate for participating in future research about how hearing quality factors affect judicial decisions and outcomes in child welfare cases. Your name or any other personally identifying information will not appear in any report of the information provided in the interview so your responses to this interview will remain private to the extent permitted by law. However, the name of your state may be associated with responses you provide and included in a report prepared for OPRE and the Administration for Children and Families.

A member of our study team will join the interview to take notes. We would like to record our discussion so we can refer to it when writing up our notes. No one besides our research team will listen to the recording. If you want to say anything that you do not want recorded, please let us know and we will be glad to pause the recording. Interview recordings will be transcribed and entered into a qualitative data analysis program (Dedoose) for review. We will destroy the recording once project reports are released. Your answers will be stored in a password protected electronic database and will only be accessible to the research team. The information you provide during this interview will be used to help the researchers understand child welfare court practice to inform a study of hearing quality and judicial decision-making and may be shared within OPRE and the Administration for Children and Families (ACF). ACF will use the data to inform future research and planning. Information from this study may be securely shared with qualified researchers to help guide future research and support program improvement.


If you have questions or any concerns about the interview or study, you may contact Co-Principal Investigators Dr. Alicia Summers and Dr. Sophia Gatowski or Project Director Anne Fromknecht.


Co-Principal Investigator

Alicia Summers, Ph.D.

Data Savvy Consulting

682 Talus Way, Reno, NV 89503

(775) 686-8545


Co-Principal Investigator

Sophia Gatowski, Ph.D.

Systems Change Solutions Inc.

2-6988 177 Street, Surrey, BC., Canada, V3S 2K1

(604) 807-4617


Project Director

Anne Fromknecht, M.P.H.

James Bell Associates

3033 Wilson Boulevard, Suite 650

Arlington, VA 22201

(703) 247-2631

[email protected]

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The Paperwork Reduction Act Statement: This collection of information is voluntary and will be used to help us understand which sites would be appropriate for a future study or studies that will examine hearing quality and judicial decision-making in child abuse and neglect cases. Public reporting burden for this collection of information is estimated at 30 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. 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 and expiration date for this collection are OMB #: 0970-0356, Exp: 06/30/2021. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Anne Fromknecht; [email protected]


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleSample Consent Form for Online Surveys
AuthorRoundy, Tammy
File Modified0000-00-00
File Created2021-01-13

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