0920-0222-23EQ Screening Script

[NCHS] Collaborating Center for Questionnaire Design and Evaluation Research

Attachment 3a-3c- Screening Script 4.28.23

[NCHS] COLLABORATING CENTER FOR QUESTIONNAIRE DESIGN AND EVALUATION RESEARCH

OMB: 0920-0222

Document [docx]

Download: docx | pdf

Attachment 3a – Telephone Screening Script – Adult respondent recruited from the advertisement/flyer

Form Approved

OMB No. 0920-0222

Exp. Date: 01/31/2026

Notice - CDC estimates the average public reporting burden for this collection of information as 5 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0222).

Assurance of Confidentiality: We take your privacy very seriously. All information that relates to or describes identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes. NCHS staff, contractors, and agents will not disclose or release responses in identifiable form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 U.S.C. 242m(d)) and the Confidential Information Protection and Statistical Efficiency Act (44 U.S.C. 3561-3583). In accordance with CIPSEA, every NCHS employee, contractor, and agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you. In addition to the above cited laws, NCHS complies with the Federal Cybersecurity Enhancement Act of 2015 (6 U.S.C. §§ 151 and 151 note) which protects Federal information systems from cybersecurity risks by screening their networks.

Sample screening script for respondent contact by Collaborating Center for Questionnaire Design and Evaluation Research (CCQDER) Recruiter/CCQDER Staff for Testing of Childhood Experiences and Related Questions recruited through the advertisement/flyer

Dial respondent’s telephone number [hereafter referred to as R] as indicated on CCQDER voice mail system.

⁯ Note: Speak only to R. If the number is answered by voice mail, say, “This is [CCQDER staff name] from National Center of Health Statistics returning your call. I will call back at another time.”

CCQDER Recruiter/CCQDER Staff: Good morning/afternoon, may I speak to (name)?

⁯ If R is not available or not at home, say, “Thank you” and try again at another time.

If the person who answered the phone (NOT R) asks, “Who is calling?” or “What’s this about?” say, “I am returning their call to me. I’ll try to reach them at another time.

⁯ If R has been successfully contacted, continue...

...Hello, my name is [CCQDER Recruiter/CCQDER Staff’s name]. I am calling from the National Center for Health Statistics. You may remember that you responded to the advertisement we placed [in [name of newspaper/website] on [date]] or flyer looking for [adults/parents or guardians of children aged 0-17] Is this a safe time to talk? If you are driving, I will call you back. I can also call you back if you are too busy.

⁯ Wait for acknowledgment, such as, “This is a safe time to talk.”

...In order to determine if you are eligible for our study, I’ll need a few minutes of your time to ask some background questions. Answering these questions is completely voluntary and takes about 5 minutes. We are required by law to use your information for statistical research only and to keep it confidential. The law prohibits us from giving anyone any information that may identify you without your consent. The OMB control number for this telephone screener is 0920-0222. Is this a good time to ask the questions or should I call back later?

⁯ If not a good time to talk, schedule a time to call back.

⁯ If good time to talk, continue...

1. Where did you see our advertisement/flyer?

___________________________________________________

2. How old are you? [If under age 18, go to exit script 1]

________________

3. Do you have any children ages 0-17? (How old are they?)

 Yes ________

 No

4. What is the highest level of school you have completed?

 Less than High School (No Diploma or GED)

 High School Diploma or GED

 Associate Degree

 Some College

 Bachelor’s Degree

 Graduate Degree

5. Are you Spanish, Hispanic or Latino?

 Yes

 No

6. What race or races do you consider yourself to be? You may indicate more than one race.

 American Indian or Alaska Native

 Asian

 Black or African American

 Native Hawaiian or Other Pacific Islander

 White

[If the recruitment needs for certain demographic groups have been achieved, go to exit script 3]. Otherwise continue.

FOR INTERVIEWS CONDUCTED ONSITE AT NCHS-- Are you a U.S. citizen? [If No, go to exit script 4]

FOR INTERVIEW CONDUCTED VIRTUALLY— Are you able to access a computer, tablet or cellphone with internet and video capability? [If No, go to exit script 5]

Entry Script for interviews conducted virtually:

...Based on your answers to the questions so far, we would like you to take part in our study. For this study we’d like you to use a computer, tablet, or cellphone to have a video call via Zoom with an interviewer that works at the National Center for Health Statistics. Someone from NCHS will walk you through the process of downloading and setting up Zoom on your device. During the interview, the interviewer will ask you a variety of questions about [you/your child’s positive childhood experiences as well negative experiences, like abuse or bullying]. Then the interviewer will ask you to explain what you were thinking as you answered the questions. The interviewer will also ask you about your opinions of the questions. Your answers will help us find out if the survey questions will be easy for other people to answer. NCHS secures all information we collect, process and store on our systems as required by Federal regulations, Executive Orders, and NCHS confidentiality statutes. However, NCHS cannot secure and protect your personal computing devices, such as personal computer or smart phones, used to complete the NCHS interview.

With your permission, we would like to record your interview. The recording is a record of what we asked and what you said about the questions. Do you give permission to have your interview video recorded? Yes/No. [If no, go to exit script 6. At a minimum video recording is essential for this project].

After we talk today, you will be sent a confirmation email with the date and time of your interview. Can we have your email address to send the confirmation email? Get e-mail. Attached with the confirmation email will be a consent form. In order to take part in the study you must read the entire consent form. The consent form tells you about the study and what you will be asked to do. If you have any questions about confidentiality, identity protection, procedures or other topics related to the study please contact me [name] at [phone number/email] any time before your interview.

Do you have any questions at this point? Pause to answer questions. If (not/you have no other questions), then let’s get you on the schedule, ok? We will be interviewing (Day, Month/Date) through (Day, Month/Date) from (time to time). Looking at your schedule, when would you be available to participate? Schedule. [If date/times not available go to exit script 7.]

[If remuneration is cash] What is your mailing address? We will use this address to send you $50 cash via FedEx after the completion of the interview. Packages typically take 5 business days to arrive.

[If remuneration is an electronic gift cards] After your interview, we will email you the activation code for your $50 electronic gift card with a “thank you” letter. The email will be sent right after your interview, and you will be able to use your electronic gift card immediately after activation.

Do you have 5 minutes right now to set up Zoom on the device you will be using for the interview? If not, we can schedule another time to do it prior to the interview.

We ask that you be in a quiet, private space, alone with minimal distractions during your interview. To protect your identity, we ask that no photos or personable identifiable items be visible during the interview. To minimize movement and distractions during the interview please place your device on a stable surface.

A reminder call will be made to you a few days in advance. Should you have any questions or need to change your appointment, please feel free to contact me [name] at [phone number]. Thank you for responding to our ad, and I look forward to seeing you through Zoom on (DATE/TIME) Get respondent to cite date & time if possible.

Entry Script for interviews conducted at NCHS or off-site:

...Based on your answers to the questions so far, we would like you to take part in our study. For this study we’d like you to come here to the National Center for Health Statistics in Hyattsville, Maryland/agreed mutual location. An interviewer will ask you to fill out a questionnaire about [your childhood experiences/your child’s experiences]. Then the interviewer will ask you to explain what you were thinking as you answered the questions. The interviewer will also ask you about your opinions of the questions. Your answers will help us find out if the survey questions will be easy for other people to answer. Everything you say will be kept private. With your permission, we would like to record your interview. The recording is a record of what we asked and what you said about the questions. Do you give permission to have your interview video recorded? Yes/No. [If no, ask if for permission to audio record]. Do you give permission to have your interview audio recorded? Yes/No. [If no, go to exit script 6. At a minimum audio recording is essential for this project].

Do you have any questions at this point? Pause to answer questions. If (not/you have no other questions), then let’s get you on the schedule, ok? We will be interviewing (Day, Month/Date) through (Day, Month/Date) from 8 a.m. to 6 p.m. Looking at your schedule, when would you be available to participate? Schedule. [If date/times not available go to exit script 7.]

A reminder call will be made to you a few days in advance. Should you have any questions or need to change your appointment, please feel free to contact me [name] at [phone number]. Thank you for responding to our ad, and I look forward to seeing you here at (DATE/TIME) Get respondent to cite date & time if possible.

---------------------------------------------------------

Exit script 1: I’m sorry, you have to be 18 years of age or older take part in this study and therefore we won’t be able to use you at this time. We appreciate your call and thank you for your interest in our study.

Exit script 2: I’m sorry, you have not met one of the eligibility requirements for this particular study. However, I would like to put your name and the information you gave me into our database so that I can contact you about other studies coming up in the future. Is that ok? If yes, record name & number. If no: OK, thank you for your time.

Exit Script 3: Based upon your answers, it seems that we may already have a number of volunteers with very similar answers to yours. At this point we need to talk with people with some different characteristics. However, if we have cancellations or other slots open up, I may wish to call you back. Would it be okay if I kept your name, telephone number, and the information you provided in response to the eligibility questions until the end of this study? If yes, make notation. If no, Would it be okay if I added your name, telephone number, age, educational level, and race to our database so that I can contact you about other studies coming up in the future? If yes, add to database. If no: OK, thank you for your time. Your name and any information you gave me will not be added to our database.

Exit script 4: I’m sorry, all Federal Government facilities require screening procedures for non U.S. citizens. This process can take more than 30 days. Unfortunately, our study has to be completed before your screening process would be complete. Would you be agreeable to having your interview conducted at an offsite location? If yes, discuss off-site interviewing locations. If no, Would it be okay if I added your name, telephone number, age, educational level, and race to our database so that I can contact you about other studies coming up in the future? If yes, add to database. If no: OK, thank you for your time. Your name and any information you gave me will not be added to our database.

Exit script 5: I’m sorry, these interviews will be conducted over video chat and you need a computer, tablet or cellphone with internet to participate; therefore, we won’t be able to schedule you at this time. Would it be okay if I added your name, telephone number, age, educational level, and race to our database so that I can contact you about other studies coming up in the future? If yes, add to database. If no: OK, thank you for your time. Your name and any information you gave me will not be added to our database.

Exit script 6: I’m sorry, willingness to be [FOR VIRTUAL: video/ FOR INTERVIEWS TO BE CONDUCTED AT NCHS: audio] recorded is required in order to take part in this study and therefore we won’t be able to schedule you at this time. Would it be okay if I added your name, telephone number, age, educational level, and race to our database so that I can contact you about other studies coming up in the future? If yes, add to database. If no: OK, thank you for your time. Your name and any information you gave me will not be added to our database.

Exit script 7: I see...ok, we were hoping to complete this particular study between (Month/Date) and (Month/Date), so it looks like we won’t be able to schedule you at this time. Would it be okay if I added your name, telephone number, age, educational level, and race to our database so that I can contact you about other studies coming up in the future? If yes, add to database. If no: OK, thank you for your time. Your name and any information you gave me will not be added to our database.

Attachment 3b – Telephone Screening Script – Adult respondent recruited from CCQDER Respondent Database

Form Approved

OMB No. 0920-0222

Exp. Date: 01/31/2026

Assurance of Confidentiality: We take your privacy very seriously. All information that relates to or describes identifiable characteristics of individuals, a practice, or an establishment will be used only for statistical purposes. NCHS staff, contractors, and agents will not disclose or release responses in identifiable form without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 U.S.C. 242m(d)) and the Confidential Information Protection and Statistical Efficiency Act (44 U.S.C. 3561-3583). In accordance with CIPSEA, every NCHS employee, contractor, and agent has taken an oath and is subject to a jail term of up to five years, a fine of up to $250,000, or both if he or she willfully discloses ANY identifiable information about you. In addition to the above cited laws, NCHS complies with the Federal Cybersecurity Enhancement Act of 2015 (6 U.S.C. §§ 151 and 151 note) which protects Federal information systems from cybersecurity risks by screening their networks.

Sample screening script for respondent contact by CCQDER Recruiter/CCQDER Staff

Person for Testing of Childhood Experiences and Related Questions

recruited through CCQDER Respondent Database

Dial respondent’s telephone number [hereafter referred to as R] as indicated in the CCQDER Respondent Database.

Note: Speak only to R. If the number is answered by voice mail, say, “This is [CCQDER staff name] from National Center of Health Statistics returning your call. I will call back at another time.”

CCQDER Recruiter/CCQDER Staff: Good morning/afternoon, may I speak to (name)?

If R is not available or not at home, say, “Thank you” and try again at another time.

If the person who answered the phone (NOT R) asks, “Who is calling?” or “What’s this about?” say, “I am returning their call to me. I’ll try to reach them at another time.

If R has been successfully contacted, continue...

...Hello, my name is [CCQDER Recruiter/CCQDER Staff name]. I am calling from the National Center for Health Statistics. You may remember that you participated in a research study back in [date] testing questions on [topic]. Is this a safe time to talk? If you are driving, I will call you back. I can also call you back if you are too busy.

Wait for acknowledgment, such as, “This is a safe time to talk.”

…We are in the process of testing a variety of questions about childhood experiences and wondered if you might be interested in participating.

If R indicates they are interested in participating continue…

If R indicates they are NOT interested in participating, go to exit script 1.

...In order to determine if you are eligible for our study, I’ll need a few minutes of your time to ask some background questions. Answering these questions is completely voluntary and takes about 5 minutes. We are required by law to use your information for statistical research only and to keep it confidential. The law prohibits us from giving anyone any information that may identify you without your consent. The OMB control number for this telephone screener is 0920-0222. Is this a good time to ask the questions or should I call back later?

If not a good time to talk, schedule a time to call back.
If good time to talk, continue...

1. How old are you now? [if under age 18, go to exit script 2]

________

2. Do you have any children ages 0-17? (How old are they?)

 Yes ________

 No

3. What is the highest level of school you have completed?

 Less than High School (No Diploma or GED)

 High School Diploma or GED

 Associate Degree

 Some College

 Bachelor’s Degree

 Graduate Degree

4. Are you Spanish, Hispanic or Latino?

 Yes

 No

5. What race or races do you consider yourself to be? You may indicate more than one race.

 American Indian or Alaska Native

 Asian

 Black or African American

 Native Hawaiian or Other Pacific Islander

 White

[If the recruitment needs for certain demographic groups have been achieved, go to exit script 3]. Otherwise continue.

FOR INTERVIEWS CONDUCTED ONSITE AT NCHS-- Are you a U.S. citizen? [If No, go to exit script 5]

FOR INTERVIEW CONDUCTED VIRTUALLY— Are you able to access a computer, tablet or cellphone with internet and video capability? [If No, go to exit script 6]

Entry Script for interviews conducted virtually:

...Based on your answers to the questions so far, we would like you to take part in our study. For this study we’d like you to use a computer, tablet, or cellphone to have a video call via Zoom with an interviewer that works at the National Center for Health Statistics. Someone from NCHS will walk you through the process of downloading and setting up Zoom on your device. During the interview, the interviewer will ask you a variety of questions about [your child’s positive childhood experiences as well negative experiences, like abuse or bullying]. Then the interviewer will ask you to explain what you were thinking as you answered the questions. The interviewer will also ask you about your opinions of the questions. Your answers will help us find out if the survey questions will be easy for other people to answer. NCHS secures all information we collect, process and store on our systems as required by Federal regulations, Executive Orders, and NCHS confidentiality statutes. However, NCHS cannot secure and protect your personal computing devices, such as personal computer or smart phones, used to complete the NCHS interview.

With your permission, we would like to record your interview. The recording is a record of what we asked and what you said about the questions. Do you give permission to have your interview video recorded? Yes/No. [If no, go to exit script 7. At a minimum video recording is essential for this project].

[If remuneration is an electronic gift cards] After your interview, we will email you the activation code for your $50 electronic gift card with a “thank you” letter. The email will be sent right after your interview, and you will be able to use your electronic gift card immediately after activation.

Do you have 5 minutes right now to set up Zoom on the device you will be using for the interview? If not, we can schedule another time to do it prior to the interview.

Entry Script for interviews conducted onsite at NCHS or off-site:

...Based on your answers to the questions so far, we would like you to take part in our study. For this study we’d like you to come here to the National Center for Health Statistics in Hyattsville, Maryland/agreed mutual location. An interviewer will ask you to fill out a questionnaire about [your childhood experiences/your child’s experiences]. Then the interviewer will ask you to explain what you were thinking as you answered the questions. The interviewer will also ask you about your opinions of the questions. Your answers will help us find out if the survey questions will be easy for other people to answer. Everything you say will be kept private. With your permission, we would like to record your interview. The recording is a record of what we asked and what you said about the questions. Do you give permission to have your interview video recorded? Yes/No. [If no, ask if for permission to audio record]. Do you give permission to have your interview audio recorded? Yes/No. [If no, go to exit script 7. At a minimum audio recording is essential for this project].

Do you have any questions at this point? Pause to answer questions. If (not/you have no other questions), then let’s get you on the schedule, ok? We will be interviewing (Day, Month/Date) through (Day, Month/Date) from 8 a.m. to 6 p.m. Looking at your schedule, when would you be available to participate? Schedule. [If date/times not available go to exit script 8.]

A reminder call will be made to you a few days in advance. Should you have any questions or need to change your appointment, please feel free to contact me [name] at [phone number]. Thank you for responding to our ad, and I look forward to seeing you here at (DATE/TIME) Get respondent to cite date & time if possible.

---------------------------------------------------------

Exit script 1: I see...ok. Would it be okay if I kept your name, telephone number, age, educational level, and race to our database so that I can contact you about other studies coming up in the future? If yes, keep in database. If no: OK, thank you for your time. Your name and any information you gave me will be deleted from our database.

Exit script 2: I’m sorry, you have to be 18 years of age or older to take part in this study and therefore we won’t be able to use you at this time. We appreciate your call and thank you for your interest in our study.

Exit script 3: I’m sorry, you have not met one of the eligibility requirements for this particular study. Would it be okay if I kept your name, telephone number, age, educational level, and race in our database so that I can contact you about other studies coming up in the future? If yes, keep in database. If no: OK, thank you for your time. Your name and any information you gave me will be deleted from our database.

Exit Script 4: Based upon your answers, it seems that we may already have a number of volunteers with very similar answers to yours. At this point we need to talk with people with some different characteristics. However, if we have cancellations or other slots open up, I may wish to call you back. Would it be okay if I kept your name, telephone number, and the information you provided in response to the eligibility questions until the end of this study? If yes, make notation. If no, Would it be okay if I kept your name, telephone number, age, educational level, and race in our database so that I can contact you about other studies coming up in the future? If yes, keep in database. If no: OK, thank you for your time. Your name and any information you gave me will be deleted from our database.

Exit script 5: I’m sorry, all Federal Government facilities require screening procedures for non U.S. citizens. This process can take more than 30 days. Unfortunately, our study has to be completed before your screening process would be complete. Would you be agreeable to having your interview conducted at an offsite location? If yes, discuss off-site interviewing locations. If no, Would it be okay if I kept your name, telephone number, age, educational level, and race in our database so that I can contact you about other studies coming up in the future? If yes, keep in database. If no: OK, thank you for your time. Your name and any information you gave me will be deleted from our database.

Exit script 6: I’m sorry, these interviews will be conducted over video chat and you need a computer, tablet or cellphone with internet to participate; therefore, we won’t be able to schedule you at this time. Would it be okay if I added your name, telephone number, age, educational level, and race to our database so that I can contact you about other studies coming up in the future? If yes, add to database. If no: OK, thank you for your time. Your name and any information you gave me will not be added to our database.

Exit script 7: I’m sorry, willingness to be [FOR VIRTUAL: video/ FOR INTERVIEWS TO BE CONDUCTED AT NCHS: audio] recorded is required in order to take part in this study and therefore we won’t be able to use you at this time. Would it be okay if I kept your name, telephone number, age, educational level, and race in our database so that I can contact you about other studies coming up in the future? If yes, keep in database. If no: OK, thank you for your time. Your name and any information you gave me will be deleted from our database.

Exit script 8: I see...ok, we were hoping to complete this particular study between (Month/Date) and (Month/Date), so it looks like we won’t be able to schedule you at this time. Would it be okay if I kept your name, telephone number, age, educational level, and race in our database so that I can contact you about other studies coming up in the future? If yes, keep in database. If no: OK, thank you for your time. Your name and any information you gave me will be deleted from our database.

Attachment 3c– Telephone Screening Script – Minor respondent recruited from advertisement/ flyer/ CCQDER database

Form Approved

OMB No. 0920-0222

Exp. Date: 01/31/2026

Notice - CDC estimates the average public reporting burden for this collection of information as 7 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0222).

Sample screening script for respondent contacted by Collaborating Center for Questionnaire Design and Evaluation Research (CCQDER) Staff for Cognitive Testing of Childhood Experiences and Related Questions through the advertisement/flyer

Dial telephone number as indicated on CCQDER voice mail system.

Note: those calling in will be directed to indicate on the voice mail system if they are calling in for themselves and to leave their name, age and school grade, or if they are calling in for their child and to leave their name, the age of their child.

Note: Speak only to R. If the number is answered by voice mail, say, “This is [CCQDER staff name] from National Center of Health Statistics returning your call. I will call back at another time.” If the person who called in a minor ask to speak with parent/guardian for permission before asking screener questions.

CCQDER Staff: Good morning/afternoon, may I speak to (name)?

If person who called in is not available or not at home, say, “Thank you” and try again at another time.

If person who called in is a parent/guardian and the person who answered the phone (NOT

Person who called in) asks, “Who is calling?” or “What’s this about?” say, “I am returning their call to me. I’ll try to reach them at another time.”

If person who called in is a minor and has called in for themself, but the parent/guardian asks why you are calling or what the call is about, say…

“…Hello, my name is [CCQDER staff name]. I am calling from the National Center for Health Statistics. Your child responded to an advertisement/flyer we placed looking for 14-17 year-olds to participate in one on one interviews to help us test some survey questions about Childhood Experiences. To determine if your child is eligible for our study, I’ll need a few minutes of your child’s time to ask some background questions and then a few minutes of your time to ask some additional background questions. May I speak with [minor child name] about the study and ask the background questions. Yes/No. If Yes, say, Is this a good time to speak to [minor child name]? May I speak to [minor child name] at this time? If No, say, without your explicit permission to talk with [name of minor] I cannot ask him/her the background questions to determine if he/she might be eligible to take part in our study. Thank parent/guardian and end call. If parent/guardian has questions about the study, answer all questions.

If person who called in answers the phone: if minor respondent, Go to Intro A; if parent/guardian of minor, Go to Intro B.

Intro A – If minor respondent

“Hello, my name is [NAME]. I am calling from the National Center for Health Statistics. [You may remember that you / Your parent/guardian] responded to the [advertisement/flyer/email] we [placed/sent] looking for 14- 17 year-olds to participate in one-on-one interviews to help us test some survey questions about childhood experiences. Is this a safe time to talk? If you are too busy (or driving), I can call you back.”

Wait for acknowledgment, such as, “This is a safe time to talk.”

“...In order to determine if you are eligible for our study, I’ll need a few minutes of your time to ask some background questions. Answering these questions is completely voluntary and takes about 7 minutes. We are required by law to use your information for statistical research only and to keep it confidential. The law prohibits us from giving anyone any facts that would identify you without your consent.

If already spoken with parent/guardian and obtained permission to ask screener questions, go to Respondent Screener Questions.
If not spoken with parent /guardian say:

But first I need to speak with your parent or guardian to get their permission for me to ask you the background questions. Would you please put your parent/guardian on the phone at this time?

If not a good time to talk with parent/guardian schedule a time to call back (Recruiters cannot collect screening information from minor before obtaining parent/guardian verbal consent to do so).
Otherwise continue to parental script for minors

If not a good time to talk, schedule a time to call back.
If good time to talk, continue with respondent screener questions...

Intro B – If parent/guardian of minor

“Hello, my name is [NAME]. I am calling from the National Center for Health Statistics. You may remember that you responded to the/an [advertisement/flyer/email] we [placed/sent] looking for 14-17 year-olds to participate one-on-one interviews to help us test some survey questions about childhood experiences. Is this a safe time to talk? If you are too busy or driving, I can call you back.

Wait for acknowledgment, such as, “This is a safe time to talk.”

“...In order to determine if your child is eligible for our study, I’ll need a few minutes of your child’s time (with your permission) to answer some background questions. I will also then need a few minutes of your time to answer some background questions and provide your permission for your child to take part. Answering these questions is completely voluntary and takes about 7 minutes. We are required by law to use your information for statistical research only and to keep it confidential. The law prohibits us from giving anyone any facts that would identify you or your child without your consent. The OMB control number for this telephone screener is 0920-0222.

(All parents/guardians except those on CCQDER respondent database)

(Briefly, may I just check,) Where did you see our advertisement/flyer?

___________________________________________________

(May I just check,) are you [name of child]’s parent or legal guardian?

If no, ask to speak with parent/guardian or call back later.

According to the message left on our voice mail system your child is _______ years old and in school grade______. Is that correct? [If either fills not left as part of message ask for the information.]

If child is under age 14 or over age 17 go to exit script 1.

With your permission, is now a good time to talk with your child? If not I can call back later. I will also need to ask some further questions of you after I have spoken with your child.

⁯ If not a good time to talk with child, schedule a time to call back and talk to child.

⁯ If good time to talk to child, Go to Intro A

Respondent screener questions (DO NOT COLLECT THIS INFORMATION FROM A MINOR WITHOUT PARENTAL/GAURIDAN PERMISSION)

Where did you see our advertisement/flyer?

___________________________________________________

According to the message left on our voice mail system you are _______ years old and in school

grade______. Is that correct? [If either fills not left as part of message ask for the information.]

If child is under age 14 or over age 17 go to exit script 1.

What is your gender?

 Male  Female  Other _____________  Prefer not to say _____________

Are you Spanish, Hispanic or Latino?

 Yes

 No

What race or races do you consider yourself to be? You may indicate more than one race.

 American Indian or Alaska Native

 Asian

 Black or African American

 Native Hawaiian or Other Pacific Islander

 White

If the recruitment needs for certain demographic groups have been achieved, go to exit script 3. Otherwise continue.

FOR INTERVIEWS CONDUCTED ONSITE AT NCHS—Are you a U.S. citizen? If No, go to exit script 4

FOR INTERVIEWS CONDUCTED VIRTUALLY— Are you able to access a computer, tablet or cellphone with internet and video capability? If No, go to exit script 5

Entry Script for interviews conducted virtually: “...Based on your answers to the questions so far, we may like to invite you to take part in our study. For this study we’d like you to use a computer, tablet, or cellphone to have a video call via [Skype / Zoom] with an interviewer that works at the National Center for Health Statistics (NCHS). Someone from NCHS will walk you through the process of downloading and setting up [Skype/Zoom] on your device. During the interview, the interviewer will ask you a variety of questions about childhood experiences. Then the interviewer will ask you to explain what you were thinking as you answered the questions. Your answers will help us to find out how people understand and answer the survey questions and if the survey questions will be easy for other people to answer. NCHS secures all information we collect, process and store on our systems as required by Federal regulations, Executive Orders, and NCHS confidentiality statutes. However, NCHS cannot secure and protect your personal computing devices, such as personal computer or smart phones, used to complete the NCHS interview.

With your permission, we would like to video record your interview. The recording is a record of our discussion and helps the interviewer to concentrate on what you say rather than take detailed notes. We will only save and use the audio part of the recording. We will not save the video part of the recording. Do you give permission to have your interview recorded? Yes/No [If no, go to exit script 6. At a minimum video recording is essential for this project].

Do you have any questions? Pause to answer questions. “…In order to determine if you are eligible for our study, I need to ask your parent/guardian a few questions. Would you please put your parent/guardian on the phone at this time. [GO TO parental script for minors, below].

Entry Script for interviews conducted at NCHS or off-site “...Based on your answers to the questions so far, we [would/may] like to invite you to take part in our study. For this study we’d like you to come here to the National Center for Health Statistics in Hyattsville, Maryland/agreed mutual location. An interviewer will ask you questions about childhood experiences. Then the interviewer will ask you to explain what you were thinking as you answered the questions. Your answers will help us to find out how young people understand and answer the survey questions and if the survey questions will be easy for other people to answer. Everything you say will be kept private. With your permission, we would like to audio record your interview. The recording is a record of our discussion and helps the interviewer to concentrate on what you say rather than take detailed notes. Your parent will not be allowed to watch/listen to the interview while it is being recorded, or listen to the recording at a later time.”

Do you give permission to have your interview audio recorded? Yes/No. [If no, go to exit script 6. [At a minimum audio recording is essential for this project].

Do you have any questions at this point? Pause to answer questions.

Parental script for minors

If already spoken with parent/guardian go to parental screener questions, below.

If first time talking with parent say…

“Hello, my name is [NAME]. I am calling from the National Center for Health Statistics. Your child responded to an [advertisement/flyer] we placed looking for [fill] to participate in one-on-one interviews to help us test some survey questions about childhood experiences. Is this a safe time to talk? If you are too busy or driving, I can call you back.

Wait for acknowledgment, such as, “This is a safe time to talk.”

“In order to determine if your child is eligible for our study, I’ll need a few minutes of your time to ask some background questions and for your permission for them to take part. I’ll also need a few minutes of your child’s time to answer some background questions to determine eligibility for the study. Answering these questions is completely voluntary and takes about 7 minutes. We are required by law to use your information for statistical research only and to keep it confidential. The law prohibits us from giving anyone any facts that may identify you or your child without your consent. The OMB control number for this telephone screener is 0920-0222. Is this a good time to ask the questions or should I call back later? “

⁯ If not a good time to talk, schedule a time to call back.

⁯ If good time to talk, continue...

(May I just check,) are you [name of child]’s parent or legal guardian?

If no, ask to speak with parent/guardian or call back later.

How old is your child? ______

If child age is less than 14 or over 17 go to exit script 1.

May I speak with your child to ask some background questions? If Yes go to Respondent Screener questions. If No, ask if parent is refusing consent for child to be screened or simply not a good time to talk with child and you will need to call back.

Parental screener questions

What is the highest level of school you have completed?

 Less than High School (No Diploma or GED)

 High School Diploma or GED

 Associate Degree

 Some College

 Bachelor’s Degree

 Graduate Degree

[Parental screener questions]

[If the recruitment needs for certain demographic groups have been achieved, go to exit script 3.

Otherwise, if child aged 13 or 14 and interview on site at NCHS continue. Else go to parental entry script]

If child aged 14…

FOR INTERVIEWS CONDUCTED ONSITE AT NCHS—Are you a U.S. citizen? [If No, go to exit script 4]

If yes, continue with parental entry script

Parental Entry Script (virtual interviews): “…Based your answers and those of your child, your child is eligible to participate in our study about your child’s positive childhood experiences as well negative experiences, like abuse or bullying. The interview will last no more than 60 minutes and your child will receive $50. The interview is carried out via video call [Skype/Zoom] with an interviewer that works at the National Center for Health Statistics. Your child can use a computer, tablet, or cellphone to take part in the video call. Someone from NCHS will walk your child through the process of [downloading] and setting up [Skype/Zoom] on the device. During the interview the interviewer will ask questions about childhood experiences. Then the interviewer will ask your child to explain what he/she was thinking as he/she answered the questions. This will help us to find out how young people understand and answer the survey questions. Your child’s answers will help us find out if the survey questions will be easy for other young people to answer. NCHS secures all information we collect, process and store on our systems as required by Federal regulations, Executive Orders, and NCHS confidentiality statutes. However, NCHS cannot secure and protect your personal computing devices, such as personal computer or smart phones, used to complete the NCHS interview.

With your permission [and that of your child,] we would like to video record the interview. The recording is a record of our discussion and helps the interviewer to concentrate on what is said rather than take detailed notes. We will only use the audio part of the recording. We will not save the video part of the recording.

Do you give permission to have your child’s interview recorded? Yes/No [If no, go to exit script 6. At a minimum video recording is essential for this project]. So that your child feels comfortable answering the questions, we ask you not to sit in on or listen to the interview. You will not be allowed listen to the recording at a later time.

Do you have any questions at this point? Pause to answer questions.

To let you know that after we talk today, we will send your child, and copied to you, a confirmation email with the date and time of the interview. Can we have your email address to send a copy of the confirmation email? Get e-mail. Attached with the confirmation email will be a consent form for you to complete. In order for your child to take part in the study you must read the entire consent form. You must sign and return the consent form before your child’s scheduled interview. You will also be asked to complete a personal information sheet. The forms can be completed and signed electronically. The consent form tells you about the study and what your child will be asked to do. If you have any questions about confidentiality, identity protection, procedures or other topics related to the study please contact me [YOUR NAME] at [YOUR PHONE NUMBER/EMAIL] any time before your interview. An assent form will also be sent for your child to read. Your child does not need to sign or complete anything in advance of the interview. The interviewer will explain the assent form to your child at the start of the interview.

We ask that your child be in a quiet, private space, alone with minimal distractions during the interview. To protect their identity, we ask that no photos or personable identifiable items be visible during the interview.

If you have no (more) questions for me, may I speak with your child in order to schedule a time for the interview? Should you have any questions, please feel free to contact me [YOUR NAME] at [YOUR PHONE NUMBER].

If parental screening is completed

Your parent/guardian has given their permission for me to schedule a time for the interview, is that OK? We will be interviewing (Day, Month/Date) through (Day, Month/Date) from (time to time). Looking at your schedule, when would you be available to participate? Schedule. [If date/times not available go to exit script 7.] If respondent agreed to follow-up discussion, schedule that call as well. If not, move to next paragraph. We will be conducting follow-up calls from (Day, Month/Date) through (Day, Month/Date) from (time to time). Looking at your schedule for those days, when would you be available to participate? Schedule. If date/times not available for follow-up call, the respondent can still participate in the interview without participating in a follow-up call.

We ask that you be in a quiet, private space, alone with minimal distractions during the interview. To protect your identity, we ask that no photos or personable identifiable items be visible during the interview.

Do you have 5 minutes right now to set up [Skype/Zoom] on the device you will be using for the interview? If not, we can schedule another time to do it before the interview.

May I confirm your mailing address? We will use this address to you the $50 cash via FedEx after the completion of the interview. Packages typically take 5 business days to arrive.

A reminder call/email will be made a few days in advance, copied to your parent/guardian. Should you have any questions or need to change your appointment, please feel free to contact me [name] at [phone number]. I look forward to seeing you through [Skype/Zoom] on (DATE/TIME) Get respondent to cite date & time if possible.

Parental Entry Script (for interviews conducted at NCHS or off-site): “…Based your child’s and your answers to the background questions, your child is eligible to participate in our study about your child’s positive childhood experiences as well negative experiences, like abuse or bullying. The interview will last no more than 60 minutes and your child will receive $50. For this study we would like your child to come [here to the National Center for Health Statistics in Hyattsville, MD/mutual location]. An interviewer will ask your child a variety of questions about their experiences. Then the interviewer will ask your child to explain what he/she was thinking as he/she answered the questions. Their answers will help us to find out how young people understand and answer the survey questions. Your child’s answers will help us find out if the survey questions will be easy for other children to answer. Everything your child says will be kept private. With your permission, we would like to audio record your child’s interview. The recording is a record of our discussion and helps the interviewer to concentrate on what you say rather than take detailed notes. Do you give permission to have your child’s interview audio recorded? Yes/No [If no, go to exit script 6. Audiotaping is essential for this project].

If child aged 14, say, Because your child’s age we will require that you accompany your child to the interview.

If child aged 15-17, say, Do you agree that your child can attend the interview on their own or will you accompany your child?

Child will attend unaccompanied
Parent/guardian will accompany child

If child aged 15 or over and accompanied…

FOR INTERVIEWS CONDUCTED ONSITE AT NCHS—Are you a U.S. citizen? [If No, go to exit script 4]

So that your child feels comfortable answering the questions, you will not be allowed to listen to the interview while it is being recorded or listen to the recording at a later time.

Do you have any questions at this point? Pause to answer questions.

After we talk today, [you/and your child] will be sent a confirmation email with the date and time of the interview. Can we have your email address to send the confirmation email? Get e-mail. Attached with the confirmation email will be a consent form for you to complete. In order for your child to take part in the study you must read the entire consent form. You must sign and return the consent form before your child’s scheduled interview. You will also be asked to complete a personal information sheet. The consent form tells you about the study and what your child will be asked to do. The forms can be completed and signed electronically. If you have any questions about confidentiality, identity protection, procedures or other topics related to the study please contact me [name] at [phone number/email] any time before your interview. A consent form will also be sent for your child to read. Your child does not need to sign or complete anything in advance of the interview. The interviewer will explain the consent form to your child at the start of the interview. Alternatively I can mail the forms to you and you can return the forms by mail or deliver them in person. You may also send the completed forms back through your child in a sealed envelope provided by us. However, if you send the completed forms back through your minor child, you MUST be available by phone to verify that you have given permission for your child to participate in the focus group/interview. If the completed forms are not received before the start of the interview, and in the case of completed forms being returned by the child you have not been reached to confirm permission for your child to participate, your child will not be allowed to participate in the study and will not receive the $50. [Record method of getting the forms to the parent of the minor.]

If child unaccompanied schedule with child. If child accompanied schedule with parent. If you have no other questions, then let’s get you on the schedule, ok? We will be holding [the one-on-one interviews (Day, Month/Date) through (Day, Month/Date) from 8 a.m. to 6 p.m. Looking at your schedule, when would [you/you and your child] be available to participate in a one-on-one interview? Schedule. [If date/times not available go to exit script 7.]

A reminder call will be made to you/you and your child a few days in advance. Should you have any questions, please feel free to contact me [name] at [phone number]. Thank you for responding to our ad/flyer, and I look forward to seeing you here at (DATE/TIME) Get respondent to cite date & time if possible.

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Exit script 1: I’m sorry, [you have/your child has] to be age xx-xx to take part in this study and therefore we won’t be able to include [you/your child] at this time. We appreciate your call and thank you for your interest in our study. If parent/guardian, say, However, I would like to [add/keep] your name, telephone number, age, [educational level,] and race [to/in] our database so that I can contact you about other studies coming up in the future. Is that ok? If yes, record information. If no: OK, thank you for your time. [Your name and any information about you will be deleted from our database.]

Exit script 2: I’m sorry, you have not met one of the eligibility requirements for this particular study. We appreciate your call and thank you for your interest in our study. If parent/guardian, say, However, I would like to [add/keep] your name, telephone number, age, [educational level,] and race [to/in] our database so that I can contact you about other studies coming up in the future. Is that ok? If yes, record information. If no: OK, thank you for your time. [Your name and any information about you will be deleted from our database.]

Exit Script 3: Based upon your answers, it seems that we may already have a number of volunteers with very similar answers [to yours]. At this point we need to talk with people with some different characteristics. However, if we have cancellations or other slots open up, I may wish to call you back. Would it be okay if I kept your name, telephone number, and the information you provided in response to the eligibility questions until the end of this study? If yes, make notation. If no and parent/guardian, say Would it be okay if I [added/kept] your name, telephone number, age, [educational level,] and race to our database so that I can contact you about other studies coming up in the future? If yes, add to database. If no: OK, thank you for your time. Your name and any information you gave me will [not be added to/be deleted from] our database.

Exit script 4: I’m sorry, all Federal Government facilities require screening procedures for non U.S. citizens. This process can take more than 30 days. Unfortunately, [you will need to accompany your child to the interview and] our study has to be completed before your screening process would be complete. For non-U.S. citizens we can conduct the interview off site if you [and your child] are agreeable. If yes, discuss off-site interviewing locations. If no and parent/guardian say Would it be okay if I [added/kept] your name, telephone number, age, [educational level,] and race to our database so that I can contact you about other studies coming up in the future? If yes, add to database. If no: OK, thank you for your time. Your name and any information you gave me will [not be added to/be deleted from] our database.

Exit script 6: I’m sorry, willingness to be [FOR VIRTUAL: video/ FOR INTERVIEWS TO BE CONDUCTED AT NCHS: audio] recorded is required in order to take part in this study and therefore we won’t be able to schedule you at this time. If parent/guardian say, Would it be okay if I [added/kept] your name, telephone number, age, [educational level,] and race to our database so that I can contact you about other studies coming up in the future? If yes, add to database. If no: OK, thank you for your time. Your name and any information you gave me will [not be added to/be deleted from] our database.

Exit script 7: I see...ok, we were hoping to complete this particular study between (Month/Date) and (Month/Date), so it looks like we won’t be able to schedule [you/your child] at this time. If parent/guardian say, Would it be okay if I [added/kept] your name, telephone number, age, [educational level,] and race to our database so that I can contact you about other studies coming up in the future? If yes, add to database. If no: OK, thank you for your time. Your name and any information you gave me will [not be added to/be deleted from] our database.

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