Attachment G_Consent Forms

Survey of NSCAW Adopted Youth, Young Adults, and Adoptive Parents

OMB Control Number: 0970-XXXX

Expiration Date: XX/XX/XXXX

Attachment G. Consent Forms for Adult and Adoptive Parent Respondents

National Survey of Child and Adolescent Well-Being

	Survey of Family Well-Being
	RTI International  PO Box 12194  Research Triangle Park, North Carolina 27709l  USA Sponsored by: Administration for Children and Families Conducted by: RTI International

Informed Consent Script for Adult Respondents Interviewed by Telephone

Hi, my name is __________ and I’m calling to follow-up on the call we had about a new research study, the Survey of Family Well-Being about the well-being of youth, young adults, and adults who participated in a previous study many years ago, the National Survey of Child and Adolescent Well-Being (NSCAW). The study is being conducted by RTI International for the Administration for Children and Families, an agency within the U.S. Department of Health and Human Services.

We are contacting adults, young adults, and youth, like you, who participated in NSCAW in 1999 or later. You are among over 500 adults, young adults or youth selected to be interviewed. Now, in this new Survey of Family Well-Being, we are following up with NSCAW participants approximately 7 to 14 years after the last time you or your family were interviewed

By doing this study, we hope to understand the experiences of families who participated in NSCAW – both from the perspective of the adults, young adults, and youth as well as your parents. People with many different backgrounds and types of families will be completing this survey.  For this reason, we try to ask about lots of different possible family members, including birth or biological parents, adoptive parents, grandparents, other relatives and siblings. If you were adopted, we would like to know more about that experience. This will help develop services that may support children and families.

The interview by telephone will take approximately 30 minutes to complete. As the letter I sent you explained, your participation is voluntary, and all information will be kept strictly private, as federal law requires. Your involvement does not affect any benefits or services you receive. You may choose to skip any question in the interview for any reason. The questions will ask about things that may have happened in your life before you were 18 years old, such as experiencing homelessness, time living in foster care, or running away, and the services received at that time.

Some questions might make you feel uneasy or feel various emotions, such as sadness. If so, we will give you a list of resources that you can contact where there are people who may be able to talk with you about your feelings.

There are no costs associated with taking part in this study. You will receive $30 for taking part in this study.

We keep your responses private to the extent permitted by the law. We keep your interview answers on a secure computer, your responses have an ID number instead of your name. We do not identify you by name. Your information will be combined with information from other people taking part in the study. RTI has obtained a federal Certificate of Confidentiality for this study to protect the identity of those participating in this research. This certificate prevents prevent us from releasing any information that would identify you, even from a court order.

There are two important exceptions to the privacy information:

1. If during the interview we think your life or health is in serious danger, we will contact someone qualified to assist you.

2. At some point in the future, a different research company may take over this study. If that happens, with your consent, we would give you and your parent’s contact information to the other company.

If we haven’t contacted your parent yet, we ask for your help locating your mother or father for an interview. At that point, your parent may choose whether to participate in the study. To protect your privacy and that of your parent, neither of you will know the other’s answers to the interview questions.

If you decide to participate, we ask you also for your permission to link the responses you give now with the responses that we collected when you and your parent participated years ago in the National Survey of Child and Adolescent Well-Being study. We may use or share your research data for future research without your name and any personal information. We will not ask for your additional informed consent for these studies. Prior to using or releasing this data for future research, we will de-identify it. “De-identify” means that we will remove or code any personal information that could identify you before files are shared with other researchers to ensure that no one should be able to identify you from the information we share. Despite these measures, we cannot guarantee against the re-identification of your personal data.

This information was described in the Fact Sheet that we send you along with a letter announcing the study. Do you need us to send the Fact Sheet again?

Yes

No

Do you have any questions, or can we go ahead and get started?

[IF PARTICIPANT HAS QUESTIONS AND REQUESTS TALKING WITH THE PROJECT DIRECTOR OR ETHICAL COMMITTEE REPRESENTATIVE, SAY]

For study related questions, please call Data Collection Task Leader (TBD) , toll-free at 800-334-8571 extension 2XXXX. For questions about your rights as a research participant, please contact the RTI Office of Research Protection at 1-866-214-2043.

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 XXXX-XXXX and the expiration date is XX/XX/XXXX.

The Federal Government has issued a Certificate of Confidentiality (authorized by the Public Health Service Act Section 301(d), 42 U.S.C Section 241 (d), 1988) to the researchers who are conducting this study which authorizes us to protect the privacy of individuals who participate.

National Survey of Child and Adolescent Well-Being

	Survey of Family Well-Being
	RTI International  PO Box 12194  Research Triangle Park, North Carolina 27709l  USA Sponsored by: Administration for Children and Families Conducted by: RTI International

[Adult Respondent Consent Form for Web Administrations]

Consent to Participate in a Research Study

What Is the Research About?

The federal government is funding a survey of adults, young adults, youth and their parents who participated a previous study many years ago, the National Survey of Child and Adolescent Well-Being (NSCAW). RTI International (RTI), a not-for-profit research organization in North Carolina, is conducting this survey.

We are contacting adults, young adults, and youth, like you, who participated in NSCAW in 1999 or later. You are among over 500 adults, young adults or youth selected to be interviewed. RTI talked to you or your parent as a part of NSCAW. Now, in this new Survey of Family Well-Being, we are following up with NSCAW participants approximately 7 to 14 years after the last time you or your family were interviewed.

What Is the Purpose of This New Study on Family Well-Being?

By doing this study, we hope to understand the experiences of families who participated in NSCAW – both from the perspective of the adults, young adults, and youth as well as your parents. People with many different backgrounds and types of families will be completing this survey.  For this reason, we try to ask about lots of different possible family members, including birth or biological parents, adoptive parents, grandparents, other relatives and siblings. If you were adopted, we would like to know more about that experience. This will help develop services that may support children and families.

What Will I Be Asked to Do?

Participation is voluntary. If you decide to participate, we will ask you to complete a web or telephone survey. Your survey may last about 30 minutes. The questions will ask about places you’ve lived, and the services you receive now or received in the past. The questions will ask about your work and education, health, behaviors, and social support system. Additional questions will focus on things that may have happened in your life, such as experiencing homelessness and running away.

You may skip over any questions or stop your participation in this study at any time and for any reason.

We will also be asking your parent(s) to participate in a separate web or telephone survey. However, we will not share your survey responses with them, and we will not share their responses with you, as all responses are private.

What Are the Possible Risks and Discomforts?

Some questions might make you feel uneasy or feel various emotions, such as sadness. We will give you a list of resources/agencies that you can contact where there are professionals you may talk with about your feelings.

Will I Benefit from Taking Part in This Study?

You will not get any personal benefit from taking part in this study. What we learn from you may help to improve government services and programs.

Do I Have to Take Part in this Study?

You can decide to take part in the study or not. There will be no penalty and you will not lose any benefits or rights you would normally have if you choose not to participate. If you do participate, you can refuse to answer any questions.

What Will It Cost Me to Participate?

There are no costs associated with taking part in this study.

Will I Receive Anything for Taking Part in this Study?

You will receive $30 for taking part in this study.

Who Will See the Information I Give?

We keep your responses private to the extent permitted by the law. We keep your survey answers on a secure computer, and your responses have an ID number instead of your name. We do not identify you by name. We combine your answers with results from other interviews and report them together in summary form. When we write up the results from the study to share with other researchers, we will write about the combined information. You will not be identified in any published or presented materials. We do not link your name or your parent’s name to the information you provide. We keep your names and other identifiers separate from your answers. We only use your name and address to contact you in the future for another interview.

All staff involved in this research signed a Privacy Pledge. In addition, RTI has obtained a federal Certificate of Confidentiality for this study to protect the identity of the research participants. This certificate prevents prevent us from releasing any information that would identify you, even from a court order.

We keep all information private to the extent permitted by law and we never identify a single person or family in our reports. There are two important exceptions to the privacy information above to note:

3. If the interviewer or project staff think your life or health is in serious danger, they will contact someone qualified to assist you.

4. At some point in the future, a different research company may take over this study. If that happens, with your consent, we would give you and your parent’s contact information to the other company. At any future time, you will always have the choice about whether you want to participate in any new study.

How Will My Responses be Used?

Prior to using or releasing this data for future research, we will de-identify it. “De-identify” means that we will remove or code any personal information that could identify you before files are shared with other researchers to ensure that no one should be able to identify you from the information we share. Despite these measures, we cannot guarantee against the re-identification of your personal data.

In addition to informing the government, the information that we gather from you during this survey may be shared with other researchers. This will not include your personal information (for example, your name and the names of your parents will never be shared), but we may share your responses, along with all the other responses. This will allow other researchers to also learn from your experiences.

We will also allow some researchers to do studies that combine your survey data with the information we collect from other sources. We will not ask for your additional informed consent for these studies. The researchers will use the data to write reports, and to better understand experiences of you, your family, and families like yours.

What If I Have Questions?

Before you decide whether to participate in the study, please ask any questions that come to mind. Later, if you have questions about the study, you can contact the researcher, Heather Ringeisen, toll-free at 800-334-8571 extension 26931. If you have any questions about your rights as a research participant, contact the RTI Office of Research Protection at 1-866-214-2043.

Research Participant Statement

I understand that my participation in this research study is voluntary. I may refuse to participate or stop participating without penalty or loss of benefits. By selecting NEXT, I acknowledge my approval to participate in the study.

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 XXXX-XXXX and the expiration date is XX/XX/XXXX.

The Federal Government has issued a Certificate of Confidentiality (authorized by the Public Health Service Act Section 301(d), 42 U.S.C Section 241 (d), 1988) to the researchers who are conducting this study which authorizes us to protect the privacy of individuals who participate.

F	National Survey of Child and Adolescent Well-Being

	Survey of Family Well-Being
	RTI International  PO Box 12194  Research Triangle Park, North Carolina 27709l  USA Sponsored by: Administration for Children and Families Conducted by: RTI International

Informed Consent Script for Parents Interviewed by Telephone

Hi, my name is __________ and I’m calling to follow-up on the call we had about a new research study, the Survey of Family Well-Being about the well-being of youth, young adults, and adults who were involved with the child welfare system as children. In this new study, we are interviewing the parents of children who were adopted.  

The study is being conducted by RTI International for the Administration on Children, Youth, and Families, an agency within the U.S. Department of Health and Human Services.

RTI talked to you or your child as a part of a previous study many years ago, the National Survey of Child and Adolescent Well-Being (NSCAW). Now, in this new Survey of Family Well-Being, we are following up with NSCAW participants approximately 7 to 14 years after the last time you or your family were interviewed for NSCAW.

By doing this study, we hope to understand the experiences of families who have been involved with the child welfare system – both from the perspective of the parents as well as your child. We would like to learn more about families’ experiences with adoption. We hope that child welfare agencies will use this information to make improvements and better support families.

The interview by telephone will take approximately 30 minutes to complete. As the letter I sent you explained, your participation is voluntary, and all information will be kept strictly private, as federal law requires. Your involvement does not affect any benefits or services you or your child receive. You may choose to skip any question in the interview for any reason. The questions will ask about things that may have happened in your child’s life, such as experiencing homelessness, time living in foster care, or running away, and the services received at that time.

Some questions might make you feel uneasy or feel various emotions, such as sadness. If so, we will give you a list of resources that you can contact where there are people who may be able to talk with you about your feelings.

There are no costs associated with taking part in this study. You will receive $30 for taking part in this study.

We keep your responses private to the extent permitted by the law. We keep your interview answers on a secure computer, your responses have an ID number instead of your name. We do not identify you by name. Your information will be combined with information from other people taking part in the study. RTI has obtained a federal Certificate of Confidentiality for this study to protect the identity of the research subjects. This certificate prevents the release of information that would identify you with anyone, even from a court order.

There are two important exceptions to the privacy information:

5. If during the interview we think your life or health is in serious danger, we will contact someone qualified to assist you.

6. At some point in the future, a different research company may take over this study. If that happens, with your consent, we would give you and your parent’s contact information to the other company.

[FOR PARENTS OF ADULT CHILDREN] If we haven’t contacted your child yet, we ask for your help locating your child for an interview. At that point, your child may choose whether to participate in the study. To protect your privacy and that of your child, neither of you will know the other’s answers to the interview questions. When we contact your child, we will not say that they are being contacted as an adopted individual. We will not disclose their adoption status. The interview will ask your child if she/he is adopted and if the response is “no,” no interview questions will reference adoption.

[FOR PARENTS OF MINOR CHILDREN]

As your child is a minor, we will ask you for your permission to do a phone interview with him/her after you have completed your interview. Please assure that if [CHILD] wants to participate in the study, that he/she completes the phone interview in a private place and that he/she cannot be overhead by anybody.

[FOR PARENTS OF BOTH ADULT AND MINOR CHILDREN]

If you decide to participate, we ask you also for your permission to link the responses you give now with the responses that we collected when you and your child participated years ago in the National Survey of Child and Adolescent Well-Being study. We may use or share your research data for future research without your name and any personal information. Prior to using or releasing this data for future research, we will de-identify it. “De-identify” means that we will remove or code any personal information that could identify you or your child before files are shared with other researchers to ensure that no one should be able to identify you from the information we share. Despite these measures, we cannot guarantee against the re-identification of your personal data. We will not ask for your additional informed consent for these studies.

This information was described in the Fact Sheet that we sent you along with a letter announcing the study. Do you need us to send the Fact Sheet again?

Yes

No

Do you have any questions, or can we go ahead and get started?

[IF PARTICIPANT HAS QUESTIONS AND REQUESTS TALKING WITH THE PROJECT DIRECTOR OR ETHICAL COMMITTEE REPRESENTATIVE, SAY]

For study related questions, please call Heather Ringeisen, toll-free at 800-334-8571 extension 26931. For questions about your rights as a research participant, please contact the RTI Office of Research Protection at 1-866-214-2043.

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 XXXX-XXXX and the expiration date is XX/XX/XXXX.

The Federal Government has issued a Certificate of Confidentiality (authorized by the Public Health Service Act Section 301(d), 42 U.S.C Section 241 (d), 1988) to the researchers who are conducting this study which authorizes us to protect the privacy of individuals who participate.

National Survey of Child and Adolescent Well-Being

	Survey of Family Well-Being
	RTI International  PO Box 12194  Research Triangle Park, North Carolina 27709l  USA Sponsored by: Administration for Children and Families Conducted by: RTI International

[Parent Consent Form for Web Administrations]

Consent to Participate in a Research Study

What Is the Research About?

The federal government is funding a national survey of children and young adults who were adopted from the child welfare system and their adoptive parents. RTI International (RTI), a not-for-profit research organization in North Carolina, is conducting this survey.

We are contacting the parents of adults, young adults, and youth who were involved with child welfare agencies during childhood throughout the United States beginning in 1999 or later. Your child is among over 500 youth, young adults or adults selected to be interviewed. RTI talked to you or your child as a part of a previous study many years ago, the National Survey of Child and Adolescent Well-Being (NSCAW). Now, in this new Survey of Family Well-Being, we are following up with NSCAW participants approximately 7 to 14 years after the last time you or your child were interviewed for NSCAW.

[If youth under 18 years old] We must have permission from a parent or legal guardian before we contact youth. At that point, your child may choose whether to participate in the study.

What Is the Purpose of This New Study on Family Well-Being?

By doing this study, we hope to understand the experiences of families who have adopted children after involvement with the child welfare system – both from the perspective of the youth, young adults, and adults, as well as their adoptive parents. We would like to learn more about families’ experiences with adoption. This will help develop services that may support adopted children and their families. We hope that child welfare agencies will use this information to make improvements and better support families.

What Will I Be Asked to Do?

Participation is voluntary. If you decide to participate, we will ask you to complete a web or telephone survey. Your interview may last about 30 minutes. The questions will ask about your child’s adoption and places your child may have lived, and the services you and your child may have received. The questions will ask about your social support system. Additional questions will focus on things that may have happened in your child’s life, such as experiencing homelessness and running away.

You may skip over any questions or stop your participation in this study at any time and for any reason.

If you and your child agree for him/her to participate in a separate web or telephone survey, we will conduct that survey with your child. However, we will not share your survey responses with them, and we will not share their responses with you, as all responses are private

If your child is a minor (under the age of 18 years), we will ask you for your permission to do a telephone interview with him/her. Children under 18 years will not complete the interview by the web, only telephone. Please assure that if [CHILD] wants to participate in the study, that he/she completes the phone interview in a private place and that he/she cannot be overhead by anybody.

What Are the Possible Risks and Discomforts?

Some questions might make you feel uneasy or feel various emotions, such as sadness. We will give you a list of resources/agencies that you can contact where there are professionals with whom you may talk with about your feelings.

Will I Benefit from Taking Part in This Study?

You will not get any personal benefit from taking part in this study. What we learn from you may help to improve services and programs for adoptive families.

Do I Have to Take Part in this Study?

You can decide to take part in the study or not. There will be no penalty and you will not lose any benefits or rights you would normally have if you choose not to participate. If you do participate, you can refuse to answer any questions.

What Will It Cost Me to Participate?

There are no costs associated with taking part in this study.

Will I Receive Anything for Taking Part in this Study?

You will receive $30 for taking part in this study.

Who Will See the Information I Give?

We keep your responses private to the extent permitted by the law. We keep your survey answers on a secure computer, and your responses have an ID number instead of your name. We do not identify you by name. We combine your answers with results from other interviews and report them together in summary form. When we write up the results from the study to share with other researchers, we will write about the combined information. You will not be identified in any published or presented materials. We do not link your name or your child’s name to the information you provide. We keep your names and other identifiers separate from your answers. We only use your name and address to contact you in the future for another interview.

All staff involved in this research signed a Privacy Pledge. In addition, RTI has obtained a federal Certificate of Confidentiality for this study to protect the identity of the research participants. This certificate prevents prevent us from releasing any information that would identify you or your child, even from a court order.

We keep all information private to the extent permitted by law and we never identify a single person or family in our reports. There are two important exceptions to the privacy information above to note:

1. If the interviewer or project staff think your life or health is in serious danger, they will contact someone qualified to assist you.

2. At some point in the future, a different research company may take over this study. If that happens, with your consent, we would give you and your parent’s contact information to the other company.

How Will My Responses be Used?

Prior to using or releasing this data for future research, we will de-identify it. “De-identify” means that we will remove or code any personal information that could identify you or your child before files are shared with other researchers to ensure that no one can identify you from the information we share. Despite these measures, we cannot guarantee against the re-identification of your personal data.

In addition to informing the government, the information that we gather from you and your child during this survey may be shared with other researchers. This will not include your personal information (for example, your name and the name of your child will never be shared), but we may share your responses, along with all of the other responses. This will allow other researchers to also learn from your experiences.

We will also allow some researchers to do studies that combine your survey data with the information we collect from other sources. We will not ask for your additional informed consent for these studies. The researchers will use the data to write reports, and to better understand experiences of you, your family, and families like yours.

What If I Have Questions?

Before you decide whether or not to participate in the study, please ask any questions that come to mind. Later, if you have questions about the study, you can contact the researcher, Heather Ringeisen, toll-free at 800-334-8571 extension 26942. If you have any questions about your rights as a research participant, contact the RTI Office of Research Protection at 1-866-214-2043.

Research Participant Statement

I understand that my participation in this research study is voluntary. I may refuse to participate or stop participating without penalty or loss of benefits. By selecting NEXT, I acknowledge my approval to participate in the study.

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 XXXX-XXXX and the expiration date is XX/XX/XXXX.

The Federal Government has issued a Certificate of Confidentiality (authorized by the Public Health Service Act Section 301(d), 42 U.S.C Section 241 (d), 1988) to the researchers who are conducting this study which authorizes us to protect the privacy of individuals who participate.