Parent and Guardian Consent

Attachment 3
Parent/Guardian Consent Materials

Table of Contents

I.

Parent/Guardian Consent Package Cover Letter ................................................. 3

II.

Parent/Guardian Consent Form ........................................................................... 4

III.

NSYC-2 Study Description Brochure ................................................................. 5

IV.

Parent/Guardian Consent Script .......................................................................... 7

DATE
Dear Parent or Guardian:
The U.S. Department of Justice is doing a special study called the National Survey of Youth in
Custody (NSYC) to learn more about what it is like for young people living in correctional facilities.
This study was done the first time in 2008, when over 10,000 young people took part.
Beginning in 2011, the NSYC will be done for the second time, and more than 23,000 youth will
be asked to take part in the study. FACILITY NAME is participating in NSYC, and we would like your
permission to ask your child to be in the study.
I have enclosed a consent form that describes the study. Here are a few of the important pieces of
information explained on the consent form:
•

We are asking your permission to ask your child if he/she would like to do the interview. Your
child does not have to take part in the study, even if you give permission for us to ask him/her.

•

If you and your child agree, a researcher will show him/her how to answer questions using a
laptop computer.

•

Youth will be asked questions about what it is like living at the facility, including questions about
staff, other youth who live in the facility, and the health services he/she might have used. Some
youth will also be asked questions about alcohol and drug use, and some will be asked about
sexual experiences that might have happened, including those in this facility.

•

The computer will randomly decide which questions your child is asked; it has nothing to do with
your child’s background or history.

•

Your child’s name will not be put in the computer. No one will be able to connect your child’s
name to his/her answers in the computer. But it’s different if your child directly tells the
researcher about abuse or harm to him/her or another child. If that happens, we have to report it
to the government agency that investigates these problems.

We ask that you read the enclosed brochure and consent form. Please indicate on the form whether or not
you agree to let your child participate in the study, sign the form, and date it. Then return it to FACILITY
CONTACT in the enclosed pre-addressed stamped envelope.
If you have any questions about the objectives and goals of the study, please contact the facility or the
National Survey of Youth in Custody Information Line (1-888-XXX-XXXX). If you have questions
about what your child’s rights would be as a participant, please contact Ms. Sharon Zack (1-800-9378281, extension 8828).
Thank you for helping us with this important study.
Sincerely,
FACILITY CONTACT NAME
FACILITY CONTACT TITLE
Enclosures


ational Survey of Youth in Custody – Parent/Guardian Consent Form

OMB NO.:
EXPIRATION DATE:

RE: ______________________________________________

ame of Youth

The U.S. Department of Justice is doing a special study called the National Survey of Youth in Custody to learn more about
what it is like for young people living in correctional facilities. The government will use the study to see if changes need to
be made at facilities. We will combine the answers that youth from each facility give into a report on the facility. We will
also tell the state agency responsible for protecting youth about answers related to the safety of youth at the facility. No
names will appear in the report.
Young people in every state in the country will be asked to be part of this study, and we would like your permission to ask
your child to be in the study. If you (and your child) agree, he/she will spend about 30 minutes answering questions using a
computer. Youth will be asked questions about what it is like living at the facility, including questions about the staff, other
youth who live in the facility, and the health services he/she might have used. Some youth will also be asked questions
about alcohol and drug use, and some will be asked about sexual experiences that might have happened, including those in
this facility.
The computer will randomly decide which questions your child is asked; it has nothing to do with your child’s background
or history. If your child agrees to be in the study, a researcher will show him/her how to use the computer. He/she will see
the questions on the screen and hear the questions through headphones. Your child will touch the screen to answer the
questions. No one will know which questions your child is asked or what he/she answers.
Your child does not have to do the survey. It is entirely up to you whether we can ask your child, and then it is up to your
child. Your choice will not affect your child’s case or the services that he/she gets in any way. If your child agrees to do the
survey, he/she can stop answering questions at any point. If there is a question that your child does not want to answer,
he/she can skip it.
We will do everything we can to protect your child’s privacy. To help keep everything private:
•
•
•

•

The researcher who meets with your child will not ask for your child’s name, and your child will not be asked to put
his/her name in the computer.
All the answers that he/she puts in the computer will be confidential – that is, no one will know your child’s
answers.
All of the researchers working on this study have signed documents saying that they will protect your child’s
privacy and not to tell anyone anything that he/she has said. Anyone who intentionally breaks this promise would
lose their job and might face criminal charges.
But there is one important exception to the privacy rule. If your child tells the researcher about any abuse or harm
to him/her or another child, it will be reported to the government agency that investigates these kinds of problems.

Some of the questions on the computer might ask about private and sensitive things and may bother your child. If thinking
about the questions upsets or makes your child sad, he/she will be able to talk to a counselor at the facility. If he/she does
not want to talk to a counselor who works there, arrangements can be made to talk with a counselor who does not work at
the facility or for him/her to call the ChildHelp National Hotline (1-800-4-A-Child or 1-800-422-4453).
If you have any questions about the study, you can call (FACILITY CONTACT NAME) at (FACILITY NAME) at
(FACILITY PHONE NUMBER) or you can call the National Survey of Youth in Custody Information Line (1-888-6119273). If you have questions about (NAME OF YOUTH) rights as a study participant, you can call Sharon Zack at 1-800937-8281, ext. 8828.
Please indicate your choice by checking one of the boxes below and signing and dating the form. Then return it in the
enclosed self-addressed stamped envelope.
Yes, I give my permission for you to ask my child to take part in this study.

o, I do not give you permission to ask my child to take part in this study.

________________________________________________
Your signature

_____________________________________
Date
PGC-021408

Parent’s Guide to the

National Survey
of Youth in
Custody (NSYC)

The National Survey of Youth in
Custody (NSYC) is a study that will help
describe what it is like for young people
living in correctional facilities. The U.S.
Department of Justice did the first NSYC
study in 2008, and over 10,000 young
people from almost 200 facilities across
America took part. The second NSYC
study will begin in 2011, and over 23,000
young people will be asked to take part
in the study.
The study will ask young people to
answer questions about themselves, their
feelings, and their experiences. Their
answers will be combined to show what
it is like to live in juvenile facilities in
America.

Sponsored by
Bureau of Justice Statistics
U.S. Department of Justice

Your child may or may not be picked
for the study. Your child has a chance to
be a part of the study because he or she
is now staying in a facility that has
agreed to participate. It is important for
the NSYC to give a true picture of the
experiences and needs of all young
people—male
and female, all
different races
and ethnic
groups, all ages,
from all parts of
the country, and
living in all types
of facilities. The
study will give the
best information if
every selected child

completes the survey.
The NSYC interview is done on a
computer. If your child is selected and
you give your permission, he or she will
be invited to spend about 30 minutes
completing the survey on a laptop
computer. Youth who agree to take part
will be seated in front of the computer
and will put on a pair of headphones.
The computer will start by explaining
how to listen to the survey questions and
how to choose answers. Youth will also
be told how to skip a question if they
don’t want to answer it.
The survey questions and possible
answer choices will appear on the
computer screen. At the same time, your
child can listen through the headphones
to a recorded voice reading what’s on the
screen. Your child will touch the
computer screen to select an answer for
each question, moving along at his or her
own pace.
The questions will ask about what it is
like living at the facility. This includes
questions about the staff, the health
services he or she might have used, and
other youth who live in the facility.
Some youth will also be asked questions
about alcohol and drug use, and some
will be asked about any sexual
experiences that might have happened in
the facility.

Your child’s answers will be private
and anonymous. Your child’s answers
will not be shared with anyone—not the
facility staff, not even you. The room will
be set up so that no one can see the
answers your child selects. The survey
team will not know any child’s name,
and we will combine the responses from
all the youth who take part. The study
reports will give only totals and
percentages, never any individual child’s
answers.
Your child’s answers will be
safeguarded by a Federal law that
protects the information from any use
other than for research. Federal law will
protect the answers that your child gives,
and no one, not even a court of law, can
force the survey team to release
information about your child’s identity
to anyone. But there is one important
exception to the privacy rule. If your
child tells the researcher about any abuse
or harm
occurring in
the facility,
it will be
reported to
the state or
local
government
agency that investigates these kinds of
problems.

The NSYC interview is voluntary. Even
if you allow your child to participate, he
or she will still have a choice. Before the
interview starts, a member of the survey
team will explain the survey. Youth who
don’t want to take part can quit before
the interview starts or at any time during
the interview. They can also skip any
questions that they don’t want to
answer. No matter what you or your
child decides about taking part in the
survey, there will be no consequences.
Your child will not get into any trouble if
he or she chooses to not participate or
quits early. Also, your child will not
receive anything for participating or get
any special services as a result.

The NSYC is sponsored by the Bureau of
Justice Statistics, an agency within the
U.S. Department of Justice.

Facilities are selected randomly for the
survey. There are more than 2,900
juvenile facilities in the country. About
500 of them will be randomly selected to
be in the survey. This means that the
facilities were selected by chance, similar
to conducting a lottery. Your child lives
in a facility that was selected. All youth
living in the smaller facilities are
automatically selected to be in the
survey. If your child’s facility is larger,
then the survey team will randomly
select youth for the study from the codename list of everyone living there.

For further information call
1•888•XXX•XXXX or contact:

The survey is being conducted by
Westat, an independent research
organization that is not affiliated with
any of the facilities in this study.

Susan Cross
NSYC Team Leader
Westat
1600 Research Boulevard
Rockville, MD 20850-3195
240-453-2664
susancross@westat.com

Common Script With ChildHelp Reference and Youth ame
Consent Request
OMB o:
Expiration Date:

(PARET AME)
RE: (YOUTH AME)

Hello, may I speak with (PARET/GURADIA)?

My name is (AME). I am working for a company called Westat and we are calling on behalf of
(FACILITY) for a special study that is being conducted for the U.S. Department of Justice.
We sent a packet of information to you about the ational Survey of Youth in Custody, a special study
being done by the U.S. Department of Justice to learn more about what it is like for young people living
in correctional facilities.
Did you receive the packet?
For quality control reasons, I’m recording this phone call.
I’m calling today to discuss the study with you and ask if you plan to return the consent form to
(LOCATION).
So let me tell you a bit more about the study. The government will use the study to see if changes need to be
made at facilities. We will combine the answers that youth from each facility give into a report on the facility.
We will also tell the state agency responsible for protecting youth about answers related to the safety of youth
at the facility. No names will appear in the report.
Young people in every state in the country will be asked to be part of this study and we would like your
permission to ask your child, (NAME OF YOUTH), to be in the study. If you and (YOUTH FIRST
NAME) agree, (he/she) will spend about 30 minutes answering questions using a computer. Youth will
be asked questions about what it is like living at the facility, including questions about the staff, other
youth who live in the facility, and the health services (he/she) might have used. Some youth will also be
asked questions about alcohol and drug use, and some will be asked about sexual experiences that might
have happened, including those in the facility.
The computer will randomly decide which questions (YOUTH FIRST NAME) is asked; it has nothing to
do with (his/her) background or history. If (he/she) agrees to be in the study, a researcher will show
(him/her) how to use the computer. (He/she) will see the questions on the screen and hear the questions
through headphones. (He/She) will touch the screen to answer the questions. No one will know which
questions (he/she) is asked or what (he/she) answers.
Do you have any questions so far?
(YOUTH FIRST NAME) does not have to do the survey. It is entirely up to you whether we can ask
(him/her), and then it is up to (him/her). Your choice will not affect (his/her) case or the services that
(he/she) gets in any way. If (he/she) agrees to do the survey, (he/she) can stop answering questions at any
point. If there is a question (he/she) does not want to answer, (he/she) can skip it.

We will do everything we can to protect your child’s privacy. To keep everything private:
•
•
•

The researcher who meets with (YOUTH FIRST NAME) will not know or ask for (his/her) name
and (he/she) will not be asked to put (his/her) name in the computer.
All the answers that (he/she) puts in the computer will be confidential – that is, no one will know
(his/her) answers.
All of the researchers working on this study have signed documents saying that they will protect
your child’s privacy and promising not to tell anyone anything that (he/she) has said. Anyone
who intentionally breaks this promise would lose their job and might face criminal charges.

But there is one important exception to the privacy rule.
•

If (YOUTH FIRST NAME) directly tells the researcher about any abuse or harm to (him/her) or
another child, it will be reported to the government agency that investigates these kinds of
problems.

Is it clear to you when something will be reported to the government agency that investigates these kinds
of problems? (If needed: Is it clear to you that the answers your child puts into the computer won’t be
reported to the government agency that investigates these kinds of problems?)
Some of the questions on the computer might ask about private and sensitive things and may bother your
child. If thinking about the questions upsets or makes (YOUTH FIRST NAME) sad, (he/she) may want
to talk with a counselor at the facility. If (he/she) does not want to talk to a counselor who works there,
arrangements can be made to talk with a counselor who does not work at the facility or with someone
from the ChildHelp National Hotline (1-800-4-A-Child or 1-800-422-4453).
If you have any questions about the study, you can call (FACILITY CONTACT NAME) at (FACILITY
NAME) at (FACILITY PHONE NUMBER) or you can call the National Survey of Youth in Custody
Information Line (1-888-XXX-XXXX). If you have questions about (NAME OF YOUTH) rights as a
study participant, you can call Sharon Zack at 1-800-937-8281, ext. 8828. (Do you want me to repeat the
telephone number?)
Ok, that summarizes the study. Do you have any questions?
Do you give your permission for us to ask (AME OF YOUTH) to be part of this important study?
YES, GIVES PERMISSION.
NO, DOES NOT GIVE PERMISSION.
OTE: ITERVIEWER AME WILL BE RETAIED I THE DATABASE I WHICH COSET
RECORDS ARE MAITAIED.