R. Connecticut Evaluation Consent Form

Appendix R. Connecticut Evaluation Consent Form

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FOR SNAP COACH ONLY:

Case ID #: | | | | | | | | |

CONSENT TO PARTICIPATE IN

RAPID CYCLE EVALUATION OF OPERATIONAL IMPROVEMENTS IN SNAP EMPLOYMENT AND TRAINING PROGRAMS

You are being asked to participate in a study being conducted by the U.S. Department of Agriculture, Food and Nutrition Services (FNS). The U.S. Department of Agriculture, Food and Nutrition Service (FNS) is testing new approaches in Supplemental Nutrition Assistance Program (SNAP) Employment and Training (E&T) operations and service delivery. Connecticut Community Colleges is one of eight sites seeking to understand how changes to SNAP E&T Programs impact SNAP participants’ engagement with E&T services. A team of researchers at Mathematica are working with the Connecticut Community Colleges to conduct the study. By signing this form, you agree to take part in this important study.

WHAT IS THE STUDY ABOUT?

The study is being done to help FNS and SNAP E&T agencies learn more about ways to improve SNAP E&T programs for participants. Your participation could help improve services offered to you and other people like you.

HOW ARE PROGRAM PARTICIPANTS CHOSEN?

Only students who have applied to participate in SNAP E&T at one of the community college campuses may participate in this part of the study.

WHAT DOES PARTICIPATION INVOLVE?

After agreeing to participate, you will attend an intake meeting with your SNAP coach. Your coach will enter your name, SNAP case identification number and the name of the community college you attend into a computer, which will put you in one of three groups. This is a little like a lottery—your group will be decided completely by chance. Every person has an equal chance of getting into each of the groups. The three groups will receive different kinds of assessments from SNAP coaches and reminders about appointments.

• One group will receive a new type of assessment in which they identify areas in their life where they need help and areas in which they are thriving. They will work with their coach to identify barriers they may be facing and to set goals that address these barriers. The coach will use this information to determine what, if any, referrals and support services might be needed. Students who get a referral to receive support services will receive a one-time text message to remind them of the referral information.

• A second group will receive the new type of assessment but, if they receive a referral, will not receive a text message reminder for the referral appointment(s).

• A third group will receive an existing type of assessment based on different approaches that may include conversations, completion of an intake form, or other tools currently used by SNAP coaches. Students who get a referral will not receive a text message reminder.

WHAT INFORMATION WILL BE COLLECTED ABOUT YOU AFTER TODAY?

As part of the evaluation, Mathematica will collect data from you and from the Connecticut Department of Social Services (DSS) and the Connecticut Community Colleges. The following information will be collected as part of the study in order to assess the impact of the changes on SNAP participants’ outcomes:

• Survey. Over the next few months, researchers from Mathematica will contact you about a 15-minute survey that can be completed online or by phone. The survey will ask about your experience with your SNAP coach and any referrals you may have received. Participation in this survey is voluntary. If you complete the survey, you will get a $30 gift card.

• In-person interviews or focus groups. Researchers from Mathematica may also ask you to do an in-person interview or be in a focus group discussion. The interviews and focus groups will explore why people do and do not participate in E&T activities, their opinions about the services offered or received, and the types of barriers they face that could prevent them from participating in E&T or finding a job. These could take about 90 minutes. All of these activities are voluntary but are very important for the study. You will get $50 for each interview or focus group you complete.

• Other information collected. Mathematica will send DSS a list of students who consented to participate in the evaluation. Using this list, DSS will then provide Mathematica with information including your name, home address, your enrollment in SNAP E&T including the types of services you received (if applicable); employment status and financial information; and demographic information including your age gender, and race and ethnicity if you have provided this to DSS This information will be used to randomly assign you to a research group and to assess how the effects of the effectiveness of the intervention differs by demographic characteristics.

Connecticut Community Colleges will provide Mathematica results of the assessment administered by coaches and referral information, if applicable. Referral information might include the type of referral, the name of the organization, and the organization’s contact information (name, telephone/email, physical address). The research team will use this information to assess the effects of the intervention on outcomes related to the assessment. The research team will collect this information for a period that covers up to 6 months after today. The research team will hold this information, for study purposes only, for up to five years. If you are part of the group that will receive text messages, Connecticut Community Colleges will share your name, phone number, college name, and referral information with the third party texting platform, Signal Vine, for the purpose of sending text message reminders about referrals.

WILL MY PRIVACY BE PROTECTED?

All information the research team gets about you will be used for research only. Study reports will summarize all participants’ findings. Your name will not be used in any reports and no information will be reported in any way that can identify you. All confidential information will be stored safely and destroyed at the end of the study.

WHAT ARE THE RISKS OF PARTICIPATING IN THE STUDY?

You may feel uncomfortable answering some questions. You can refuse to answer those questions if you wish, and it will not change your participation in the study or program.

WHAT ARE THE BENEFITS OF PARTICIPATING IN THE STUDY?

Through this study we will learn if the new assessment process works and if the text message reminders are helpful, and that may help you and others like you to improve SNAP E&T programs. Participants will receive $30 for completing the survey and $50 for completing the focus group or in-depth interviews.

DO I HAVE TO PARTICIPATE?

Participation is voluntary. It is up to you to decide to take part in the study. If you do not want to take part, you will only be able to receive the existing assessment but this will have no effect on your SNAP benefits or your ability to participate in SNAP E&T programs. If you take part in the study, you may be referred to potentially different E&T services based on the new assessment. If you agree to take part in the study and later wish to leave the study, you can do so at any time by calling the study toll-free number at ##. You can also leave the study by notifying your SNAP coach who will then notify the research team.

 By selecting this option, I agree that I have read this consent form (or it has been read to me). I understand the information provided, including the disclosure of my personal information to Mathematica, and voluntarily agree to participate. If I have questions, I can call the study toll-free number at ##.

 By selecting this option, I am indicating that I do NOT agree to be part of this study.

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Public Burden Statement

This information is being collected to assist the Food and Nutrition Service in evaluating operational improvements in Supplemental Nutrition Assistance Program (SNAP) Employment and Training (E&T) programs that aim to improve delivery of services and program outcomes. This is a voluntary collection and FNS will use the information to assess the effectiveness of changes made to the SNAP E&T program. This collection does request any personally identifiable information under the Privacy Act of 1974. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0584-[xxxx]. The time required to complete this information collection is estimated to average 5 minutes (0.0833 hours) per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support, 1320 Braddock Place, 5th Floor, Alexandria, VA 22306 ATTN: PRA (0584-xxxx). Do not return the completed form to this address.