Consent Letter

PORTlAND STATE
lJNIVERSITY

Regional Research Institute
for Human Services

Informed Consent
Social Network Analysis of Clark County
Washington Youth Transition Network

Post OfficeBox751
Portland,Oregon97207-0751
1600 SWFourth Avenue,Suite900
PHONE: 503-725-4040
FAX: 503-725-4180
WEB: hup://www.rri.pdx.edu
The Regional Research Institute is affiliated
with the Graduate School of Social Work

What is being done. The Regional Research Institute for Human Services at Portland State University
and the University of Massachusetts Medical School are partnering to conduct a research project in Clark
County, Washington. Your agency has been identified as one that may provide services that can include
individuals aged 14-25 who have serious mental health conditions and have been served by the Regional
Services Network (RSN) as adolescents. We refer to this group of services and supports as the Clark
County transition system. The purpose of the study is to describe the changes in the transition system
and the interconnectedness of the organizations it contains as a result of the Options Project which was
designed to enhance the system. We will ask questions about the degree to which the organization shares
referrals and information with other organizations in the network, evaluation of the quality of the program
and the system, and the degree to which the program's and system's practices are consistent with current
guidelines for serving this population as they transition into adulthood.
What is being asked of you. You have been nominated to provide information for your program. The
data collection has two parts: response to an on-line survey which takes about 20 minutes and a face to
face interview which takes less than an hour. We would like to include you because you are familiar both
with the workings of your program/agency and with its relationship to other program/agencies in Clark
County. You will be answering the questions as a representative of your program/agency. You are free
to keep the $10 Starbuck gift card whether or not you chose to participate.
Will the information I provide be confidential? The name of each agency or program that participates
will appear in the report. Individuals who provide data will be given the option to have their names
included in an Appendix. Even if you choose not to have your name listed, it may be possible for some
readers to guess who from your agency was interviewed. Participation in this research is voluntary and
you may withdraw at anytime without affecting your agencies relationship to the Departmmt of
Community Services or Portland State University.
Will we see the results? The end product of this series of interviews is called a network analysis, which
will describe changes in the strength and direction of the relationships between all of the relevant agencies
in the Clark County area. This information will be used to help the RSN and the Clark County
Department of Community Services continue to improve services for youth with serious emotional
disturbance as they mature from ages 14 to 25. Results of the study will also be made available to your
agency/program.
Who can provide more information? If you have questions right now, the interviewer can answer
them for you. If at any time you have questions please feel free to contact the priooipal investigators of
this project; Nancy Koroloff, Ph.D., here at PSU (503) 725-4157 or Maryann Davis, Ph.D. (508) 8568718, and the University of Massachusetts. If you have questions or concerns about the ethical conduct
of this research, you may contact the Compliance Officer at the Office of Research and Sponsored
Projects, Portland State University, 503-725-4288. The interviewer will give you a copy ofthis consent
form so you can remember these numbers.
I agree to participate in this interview:
!

Signature
_My
name c~ be included in the appendix of the report
_I
prefer that my name not appear in the report.

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