Appendix B. Client Consent

Appendix B. Client Consent.docx

Understanding the Value of Centralized Services Study

Appendix B. Client Consent

OMB: 0970-0587

Document [docx]
Download: docx | pdf



Understanding the Value of Centralized Services

Appendix B





Understanding the Value of Centralized Services

Informed Consent Form to Participate in a Focus Group of Clients


We invited you to be part of a focus group for a study to learn about how [SITE NAME] provides services. This is part of a larger study we are doing about organizations that provide many different services, such as [CUSTOMIZE WITH SERVICES PROVIDED AT SITE], in a single location. This form will help you decide if you want to participate in the focus group.

What is the study about?

The study is funded by the Administration for Children and Families in the U.S. Department of Health and Human Services. Researchers from two companies, MEF Associates and Mathematica, are doing the study. We want to learn about the services that organizations like [SITE NAME] provide to clients and how clients feel about the way services are provided.

What will I need to do?

We are inviting you to be in a focus group. We will have a discussion about your experience receiving services from [SITE NAME]. This focus group will take about 90 minutes, including introductions, background on the study, and consent to participate. It will include other clients served by [SITE NAME]. We want to learn about [SITE NAME]’s services, so it is important for us to learn from the people who use their services. If everyone agrees, we would like to record the group conversation.

If you agree to be in the focus group, we will ask you about:

  • The services you participated in at [SITE NAME]

  • How you learned about the services

  • Your experience participating in more than one service at [SITE NAME]

  • What you liked or did not like about participating in multiple services

  • What would have made it easier for you to participate in services here

You will receive a $50 gift card for participating.

Could bad things happen if I am in the focus group?

Being in the focus group will not affect services you get from [SITE NAME], or any other organizations, and what you share in the focus group will not impact services received or offered to you. You may be uncomfortable answering some questions. If that happens, you do not have to answer them. You can stop participating at any time.

Will the focus group help me?

The focus group will not help you directly. By sharing your thoughts, you may help the [SITE NAME] and organizations like it provide better services to clients like you in the future.

Will you tell people what I say?

Only the study team will see the notes or hear the recordings. We will put everyone’s answers together and will not use any names. We may use some specific quotes without names or other information that identifies you. We will destroy the notes and recordings at the end of the study. We ask that you not repeat what is said today outside of this group. However, we cannot guarantee that others in the focus group will not repeat what is said in this group.

Do I have to be in the focus group?

Being in the focus group is voluntary. You do not have to be in the focus group if you do not want to. Even after the group starts, you can leave at any time if you change your mind or can skip any questions you prefer not to answer.

Questions:

If you have questions about the study, you can call the project director, Mary Farrell at MEF Associates at 703-838-2723.

If you have questions or concerns about your rights as a study participant, you can contact Health Media Labs Institutional Review Board (IRB), a group that reviewed this study for your protection, at 202-549-1982 or by e-mail at [email protected].1

Paperwork Reduction Act Statement: This collection of information is voluntary and will be used to study the advantages, disadvantages, and costs of centralized services. Public reporting burden for this collection of information is estimated to average 90 minutes per response, including time for reviewing instructions, gathering and maintaining the data needed, collaboration, 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 control number for this collection is XXXX-XXXX and it expires XX/XX/XXXX.



Understanding the Value of Centralized Services

Introductory Script And Verbal Consent to Participate in a Focus Group of Clients


Hello, my name is _____ and I’ll be leading our discussion today. My job today is to ask a few questions and learn from you about your experiences. I’ll jump in occasionally to make sure the conversation keeps focused on what we are interested in learning about.

Thank you for being part of this focus group. We are conducting this study to learn more about how programs like [SITE NAME] provide services to clients/families like you. We are especially interested in how providing multiple services at a single location affects services for clients/families. Today, we hope to learn about your experiences participating in services at [SITE NAME]. This study is sponsored by the Office of Planning Research, and Evaluation (OPRE) in the Administration for Children and Families in the U.S. Department of Health and Human Services.

As a gift to thank you for your participation, you will receive a $50 gift card.

OPRE has hired two outside groups, MEF Associates and Mathematica, to conduct the study. I am from _______. I will be your facilitator for this session and _____ will be taking notes. We are taking notes and, if everyone in this room agrees, recording the session to make sure we get everything right, but your answers will not be linked with your name or any other information that makes it easy to identify you. We will use the recording to fill in our written notes, but then the recording will be destroyed. If you want to say something that you do not want to be recorded, just say so and we will turn the recorder off. We will not tell anyone from [SITE NAME] who said what in this meeting. To protect the identity of others, I ask that when talking about someone, you only use their first name, nickname, or call them by a title such as “case manager.”

We will do everything we can to keep everything you tell us private. However, privacy also depends on all of you. We strongly request that you and all other focus group participants not discuss what is said today with others outside of the group. However, we cannot guarantee that everyone here will follow this request. Also, please note that if you tell a member of the study team that you intend to hurt yourself or someone else, we will have to tell appropriate authorities.

Your participation today is voluntary. Your participation in the group will have no effect on the services that you get from [SITE NAME]. Once we begin the focus group, you may choose to leave the group at any time, and you do not have to answer any questions that you do not want to answer.

As the facilitator, I will be asking questions, but I want the interaction to flow among you – let’s have lots of open discussion. I encourage you to talk to and ask questions of each other. There may be times when I need to interrupt the conversation -- either to ask you to clarify something you said or to move the discussion on to another topic. Most people say they enjoy being in these groups.

Do you have any questions for me right now? If you have questions later, the phone numbers for at the study director from MEF Associates and the Institutional Review Board are on the forms we have given you.

Does everyone here agree to participate in the focus group? If you do not want to participate, you are free to go. [By a show of hands make sure everyone agrees to participate.]

Is it okay with everyone in the room to record the focus group? We will only use the recording to fill in our notes and destroy it afterward. [By a show of hands make sure everyone agrees to record the session]

If NO ask: Remember, we can pause the recording if you want to say something that you do not want recorded. Would you be ok with us recording the focus group if you have the choice to stop the recording later?

If still NO: That’s okay. We won’t record the group.





Ground Rules:

Before we begin, let me go over a couple of focus group guidelines.

  • This discussion is meant to be informal and relaxed.

  • We won’t have any breaks, but if you need to get up to use the restroom, stretch or get a drink, please do so as needed. The restrooms are located [xxx].

  • Please only tell us your first name. This will help us keep your information private. Please also refer to each other only by first name.

  • During the discussion, please ask me if something is not clear.

  • There are no right or wrong answers. You can say positive and negative comments about your experiences.

  • It is okay to share your opinions or thoughts even if they are different from what others have said. As I said, there are no right or wrong answers or comments. We want everyone to participate, and the opinions and experiences of everyone in the room are important. We want to hear different perspectives.

  • Please talk one at a time so that I can hear everything that is said.

  • I want to hear from all of you. Some people talk more than others, and I’ll be encouraging everyone to speak up.

  • You do not have to answer any questions you do not want to answer. If at any point, you want to pause the recording while you make a specific comment, please tell me.

  • The discussion today is private. Please do not discuss or share anything you heard after you leave the focus group.

  • If you have a cell phone, please turn it off or put it on vibrate mode.



Do you have any questions before we start?

1 Note to OMB: The VOCS project received research ethics review approval from Health Media Lab on October 5, 2021.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorLawrence, Marie (ACF)
File Modified0000-00-00
File Created2021-12-01

© 2024 OMB.report | Privacy Policy