4. CAPE-Youth Phase 2 Consent Form

Center for Advancing Policy on Employment for Youth (CAPE-Youth) Data Collection

4. CAPE-Youth Phase 2 Consent Form

OMB: 1230-0015

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OMB Control No: 1230-0NEW

Expiration Date: XX/XX/20XX


Project Title: Youth and Adult Systems Collaboration Study, Phase 2 Interviews


Principal Investigators:


Matthew Saleh, Ph.D., Cornell University, Yang-Tan Institute on Employment and Disability

Leslie Shaw, Ph.D., Cornell University, Yang-Tan Institute on Employment and Disability


You are invited to take part in a research study of best practices in interagency collaboration among state agencies serving transitioning youth and young adults with disabilities (i.e., vocational rehabilitation, social security, education, mental health agencies, developmental disabilities agencies, juvenile justice, foster care, and other agencies likely to serve youth with one of WIOA’s defined “barriers to employment”). This study, titled “the Youth and Adult Systems Collaboration Study,” is a research initiative of The Center for Advancing Policy on Employment for Youth (CAPE-Youth). CAPE-Youth is a U.S. Department of Labor, Office of Disability Employment Policy-funded policy development and technical assistance center supporting the development, implementation, and integration of evidence-based effective practices and policies for improving transition outcomes for youth and young adults with disabilities. As part of this study, you will be asked to participate in an in-depth interview. The research project will occur in two phases during the dates of [dates of Phase 1] and [dates of Phase 2]. This consent form is for Phase 2 of the study, interviews with supervisors and direct service providers working for state-level governmental agencies providing services to transitioning youth and young adults with disabilities. The overall goal of the study is to develop technical assistance and professional development tools and resources to support state-level interagency collaboration and service coordination best practices.


You have been selected from the Phase 1 questionnaire respondents to engage in the Phase 2 interviews outreach during [dates], inviting them to participate in Phase 2 of the study, which entails participation in interviews (5-6 individuals in each interview session). The interview questions will assess: (a) transition coordination practices between systems; (b) methods for facilitating external partnerships; (c) understanding of other agencies’ policies, procedures, and eligibility criteria; (d) existing organizational attitudes and experiences; and (e) the frequency and success in serving diverse populations of youth and young adults with disabilities. The interviews will take approximately 1.5 hours to complete. Additionally, one-on-one phone or virtual interviews will be offered in some cases to accommodate participants who cannot make the scheduled sessions. The discussions will be audio recorded and transcribed, but transcription records will be anonymized. Reporting efforts will take steps to ensure that participants are not identifiable during reporting of qualitative findings.


Taking part in this study is voluntary. You may refuse to participate before the study begins, discontinue at any time, or skip any questions/procedures that may make you feel uncomfortable, with no penalty, and no effect on the compensation earned before withdrawing, or on your academic standing, record, or relationship with the university or other organization or service that may be involved with the research.


The interview poses no risks greater than those encountered in day-to-day life. All of your responses will be kept private and reporting of results will be done in aggregate form only. In order to keep the information private, it is important that participants today do not share information discussed with others outside of the interview session. The interview will be recorded for transcription purposes. De-identified data from this study may be shared with the research community at large to advance science and health. We will remove or code any personal information that could identify you before files are shared with other researchers to ensure that, by current scientific standards and known methods, no one will be able to identify you from the information we share. Despite these measures, we cannot guarantee anonymity of your personal data.


The interview will take up to one hour. You have the right to not to answer a question or end your participation at any point. Please note: there are no “right” or “wrong” answers to any of the questions. You can choose whether or not to participate in the interview, and you may stop at any time during the course of the study. At the end of your participation, you will also be compensated with a $25 gift card.


The main researcher conducting this study is Dr. Matthew Saleh, a Research Associate at Cornell University. Please ask any questions you have now. If you have questions later, you may contact Matthew Saleh [email protected] or at 203-722-2826. If you have any questions or concerns regarding your rights as a subject in this study, you may contact the Institutional Review Board (IRB) for Human Participants at 607-255-5138 or access their website at http://www.irb.cornell.edu. You may also report your concerns or complaints anonymously through Ethicspoint online at www.hotline.cornell.edu or by calling toll free at 1-866-293-3077. Ethicspoint is an independent organization that serves as a liaison between the University and the person bringing the complaint so that anonymity can be ensured.


Verbal consent: Please tell the researcher your decision regarding whether or not to participate in the described research. You could include a yes or no on the form to check off.



Privacy Act Statement
Collection and Use of Personal Information


The following statement is made in accordance with the Privacy Act of 1974 (5. U. S. C. 552a). Information collected will be handled and stored in compliance with the Freedom of Information Act and the Privacy Act of 1974, as amended (5 U.S.C. 552a). Furnishing the data requested is voluntary.


We will use the data you provide for the CAPE-Youth Research Project, funded by The United States Department of Labor, Office of Disability Employment Policy. In accordance with the Confidential Information Protection and Statistical Efficiency Act of 2002 (Title 5 of Public Law 107-347) and other applicable Federal laws, your responses will not be disclosed in identifiable form without your informed consent. Per the Federal Cybersecurity Enhancement Act of 2015, Federal information systems are protected from malicious activities through cybersecurity screening of transmitted data.



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AuthorMatthew C Saleh
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File Created2021-08-09

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