Youth and Parent Voices for Research

Instrument 1: Parent Screener

OMB# 0970-0356, Expiration date 01/31/2027

Youth and Parent Voices for Research Study

Instrument 1: Parent Screener

Thank you for your interest in the Youth and Parent Voices for Research Study! We will start by asking a few demographic questions about you and any of your children to see if you are eligible for the study. The reason we are asking these questions is to make sure that the youth who we invite to participate in this study represent a diverse group in terms of their race, ethnicity, sexual orientation, and gender identity. You can decide whether you want to answer all these questions or not.

Please know that we won't be using this information for anything other than recruitment purposes. Youth who participate in this study won't be asked to answer these questions about themselves, but they may be asked to talk about how people their age might think about different ways to ask about race, ethnicity, sexual orientation, and gender identity.

Please know that you must answer all the questions at one time. If you stop in the middle, the website will log you out and you will need to start over.

These questions will take 5 minutes or less to answer, and any information you provide will remain private.

Do you wish to continue?

1. Yes [CONTINUE TO NEXT PAGE]

2. No [END SURVEY]

[------------ PAGE BREAK --------------]

1. Have you had any involvement with the child welfare system?

   1. Yes [CONTINUE TO QUESTION 2]

   2. No [SKIP TO END]

2. Is your case with the child welfare system now closed?

   1. Yes [CONTINUE]

   2. No [SKIP TO END]

3. About how many years ago did your case close? Your best guess is fine.

   1. ______ [CONTINUE]

4. Do you have a child(ren) between the ages of 11-17 living with you in your home?

   1. Yes [CONTINUE TO QUESTION 5]

   2. No [SKIP TO END]

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN:  The purpose of this information collection is to gather feedback to inform future National Survey of Child and Well-Being data collections. Public reporting burden for this collection of information is estimated to average 5 minutes per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number.  The OMB # is #0970-0356 and the expiration date is 01/31/2027.  If you have any comments on this collection of information, please contact Melissa Dolan: [email protected].

5. [IF Q2=A] How many children between the ages 11-17 currently live in your home?

   1. [Dropdown with numbers 1-10]

6. Do you and your child have access to the internet?

   1. Yes [CONTINUE TO NEXT QUESTION]

   2. No [SKIP TO END]

Now, we would like to ask a little bit more about you.

7. What is your age?

   1. [Dropdown of ages 18-75]

8. What is your race/ethnicity? Please check all that apply.

   1. American Indian or Alaska Native

For example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.

2. Asian

For example, Chinese, Asian Indian, Filipino, Vietnamese, Korean, Japanese, etc.

3. Black or African American

For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.

4. Hispanic or Latino

For example, Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, etc.

5. Middle Eastern or North African

For example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, Israeli, etc.

6. Native Hawaiian or Other Pacific Islander

For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.

7. White

For example, English, German, Irish, Italian, Polish, Scottish, etc.

9. What is your gender identity? Please select all that apply.

   1. Female

   2. Male

   3. Transgender

   4. Other, please specify

   5. Prefer not to answer

10. Do you identify as…

    1. Straight

    2. Gay or Lesbian

    3. Bisexual

    4. An identity not listed here, please describe

    5. Prefer not to answer

Lastly, we’d like to learn more about your child(ren) 11-17 years old who would be eligible to participate in the focus group or interview. If you have multiple children, please start with your oldest child first. [REPEAT THESE QUESTIONS FOR EACH CHILD INDICATED IN Q5]

11. What is your child’s age?

1. [Dropdown of ages 11-17]

12. What is your child’s race/ethnicity? Please check all that apply.

    1. American Indian or Alaska Native

For example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.

2. Asian

For example, Chinese, Asian Indian, Filipino, Vietnamese, Korean, Japanese, etc.

3. Black or African American

For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.

4. Hispanic or Latino

For example, Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, etc.

5. Middle Eastern or North African

For example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, Israeli, etc.

6. Native Hawaiian or Other Pacific Islander

For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijian, Marshallese, etc.

7. White

For example, English, German, Irish, Italian, Polish, Scottish, etc.

13. What is your child’s gender identity?

    1. Female

    2. Male

    3. Transgender

    4. Other, please specify

    5. Prefer not to answer

14. Does your child identify as…

    1. Straight

    2. Gay or Lesbian

    3. Bisexual

    4. An identity not listed here, please describe

    5. I don’t know

    6. Prefer not to answer

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IF ELIGIBLE [ELIGIBLE = Q1, Q2, Q4, and Q6=YES] AND Q3 < 5

You and one or more of your child(ren) are eligible to participate in our study. If you would like to participate, please provide your name, phone number, and email address so we can provide you both an opportunity to consent to participating. You and your eligible children will need to be present for the consent process, which will take approximately 10 minutes. Following that, a member of our project team will reach out to schedule a time to participate.

1. Name: ___________

2. Email Address: ___________

3. Phone Number: ___________ Is it OK to call, text, and leave messages?

In the next few pages, we will tell you more about the study and ask for your consent to participate. You and your child should be present to review the material and you will be asked to provide your consent to participate and your permission for your child to participate. Your child will complete the last page which will ask for their assent to participate.

[LINK TO CONSENT, PERMISSION, AGREEMENT]

OR

IF ELIGIBLE [ELIGIBLE = Q1, Q2, Q4, and Q6=YES] AND Q3 > 5

You and your child(ren) are eligible and may be selected to participate in our study. Please provide your name, phone number, and email address so that we may contact you if you are selected to participate.

1. Name: ___________

2. Email Address: ___________

3. Phone Number: ___________ Is it OK to call, text, and leave messages?

[-------- PAGE BREAK TO END SURVEY --------]

[END: INELIGIBLE] Thank you. Currently, you are not eligible to participate in the Youth and Parent Voices for Research Study.