Attachment B. Study consent form for HMRF staff interviews

IRB Approved on: 2/6/2025

Valid until: 2/5/2026

OMB Control No.: 0970-0531

Expiration Date: 09/30/2025

Strategies To Respond to Intimate Violence Effectively (STRIVE) Project

Consent Form – Staff Interviews

What is this study about?

Child Trends, a research organization, and Futures Without Violence, a non-profit health and social justice organization, are conducting the STRIVE study. The STRIVE study is funded by the Office of Family Assistance (OFA) and overseen by the Office of Planning, Research, and Evaluation (OPRE), both offices within the Administration for Children and Families (ACF) that is part of the United States Department of Health and Human Services (HHS). The goal of this study is to evaluate and support future implementation efforts of the CUES (confidentiality, universal education + empowerment, support) approach, which aims to prevent and address domestic violence (DV) in Healthy Marriage and Responsible Fatherhood (HMRF) programs.

What happens if I join this study?

If you agree to participate, we will conduct a 60-minute interview with you. During the interview, we will ask you about your experience implementing the CUES intervention. Our goal is to understand whether CUES improves staff and program capacity to address DV and to learn about any challenges or success in implementing it. You will receive a $40 token of appreciation for this interview.

Is my participation voluntary?

Yes, participation is completely voluntary. You can stop the interview at any time or choose not to answer specific questions. Your participation will not affect your employment or your organization’s current or future funding.

How will I benefit from participating?

You will not benefit personally from being involved in the study.

What are the risks of participating?

There are two risks from being a part of this research study:

• Feeling uncomfortable. Some questions may be uncomfortable for you to answer. If we come to a question that you do not wish to answer, you can let the interviewer know and they will move on to the next question.

• Loss of privacy. There is a small risk to your privacy. To minimize this risk, we will not include your name in any reports we publish from this study.

What will you do with my information?

We will keep your information private to the extent permitted by law. The interview will be recorded if you agree to it. All recordings will be stored securely, and no one outside the study team will have access to them. Once we transcribe the interviews and finalize our notes, we will delete the recordings.

Your information will not be used for any future research. Findings will be summarized in reports without including your name or the name of your organization.

Have questions?

If you have any comments or concerns about the study, you can contact Sam Ciaravino, Study Director, by calling (240) 223-9291. If you want to know your rights as someone in the study, you can contact the Child Trends’ Institutional Review Board (the group that approved this study) by calling (855) 288-3506 or emailing [email protected].

NOTE: The Paperwork Reduction Act Statement: The described collection of information is voluntary and will be used to better understand approaches to preventing and addressing intimated partner violence in HMRF programs. Public reporting burden for the described collection is estimated to average 75 minutes, including 60 minutes of time for the interview and 15 minutes for scheduling and coordination. 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 the described collection is 0970-0531and it expires on 09/30/2025.