PACT Appendix I - Consent for Hispanic RF Sub-study Participants - 2-19-13

Parents and Children Together (PACT) Evaluation

APPENDIX I

CONSENT STATEMENT

fOR PROGRAM PARTICIPANTS in

HISPANIC RESPONSIBLE FATHERHOOD SUB-STUDY

CONSENT TO PARTICIPATE IN THE PARENTS AND CHILDREN TOGETHER (PACT) HISPANIC FATHERHOOD PROGRAM STUDY

What is the PACT Hispanic Fatherhood Program Study?

The PACT Hispanic Fatherhood Program Study is part of a larger evaluation of programs funded in 2011 through the Administration for Children and Families’ (ACF) Responsible Fatherhood and Healthy Marriage grant program. The evaluation will document the program design, implementation, and net impacts of selected grantee programs, as well as produce results from a multi-faceted qualitative study. The PACT Hispanic Fatherhood Program Study focuses on a subset of program grantees that are serving a primarily Hispanic population.

The PACT Hispanic Fatherhood Program study has two broad goals: (1) to identify the principles and concepts that guide organizational leaders’ and staffs’ decisions about various dimensions of these programs, including their structure, curricula, and expected outcomes; and (2) to collect information from participating fathers about themselves and their experiences with the programs and staff. The study will obtain information from up to five program grantees across the country about the ways in which they developed, adapted, and implemented culturally relevant and appropriate programs for Hispanic populations, and gather information from a subset of participants in those programs. The information will be used to strengthen and improve future fatherhood programs. The Office of Planning, Research and Evaluation at the U.S. Department of Health and Human Services sponsors the study. Mathematica Policy Research, a national research and evaluation company, is conducting the study.

Your Participation is Voluntary

You should participate in this study only if you want. If you participate, you will be asked to participate in a focus group and to answer a short questionnaire. If you do not want to be in the focus group or answer the questionnaire, it will not affect your future participation in the program’s services.

What is a Focus Group?

A focus group is a discussion, guided by a leader who asks questions of a group of people. The study team is conducting focus groups with people like you who have participated in fatherhood programs, to learn about your experiences. As part of the group, the leader will ask why you participated and what you thought about the program. The discussion will last about 60-90 minutes. You will not have to answer a question if you do not want to.

What is the Questionnaire About?

The questionnaire asks about your background, beliefs, and experiences as a Hispanic father. The form should take less than 30 minutes to complete, and you may receive help in filling it out. You do not have to answer any question if you do not want to. As a thank-you, you will receive a $25 gift card for participating in the focus group and completing the brief questionnaire.

This collection of information is voluntary and will be used to learn about [RF PROGRAM NAME]. Public reporting burden for this collection of information is estimated to average one-and-a-half hours for the focus group, and 20 minutes for the questionnaire, including the time for reviewing instructions, gathering and maintaining the data needed, 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 [Contact Name]; [Contact Address]; Attn: OMB-PRA (0970-XXXX).

Your Answers will be Kept Private

Everything you tell us, in the focus group or questionnaire, will be kept private and will not be shared with program staff. In the focus group discussion, the leader will ask all participants to keep what others say to themselves. Only the evaluation team will have access to the information you share, whether that is in the focus group or the questionnaire. The evaluation team will not write anything about you as an individual. Your name will not appear in any published reports. In rare cases, information may be released, if required by law. For example, if a person says he or she is abusing a child and the state has laws requiring that child abuse be reported, we will follow the law. We will not videotape the focus group. We will audiotape the group discussion, but the tape will be used only by researchers and the person who types it up.

Risk of Taking Part in the Study

There are no known risks to you if you take part in this study. You may be asked some personal questions. If any questions make you uncomfortable, you should not answer them.

Signing this form means you have read both pages of this form.

• You agree to participate in the focus group and respond to the questionnaire provided by the PACT Hispanic Fatherhood Program study team.

• Your participation will not affect your future role with the program’s services.

• Everything you share will be kept private. Only the evaluation team will have access to what you share, and it will be used only for the study. Information will only be released if required by law.

If you have questions or concerns about your rights as a participant in this study, you may contact the study directors at Mathematica, Sheena McConnell (smconnell@mathematica-mpr.com) or Robin Dion (rdion@mathematica-mpr.com), for any questions you may have about the study. You may also contact Nancye Campbell or Seth Chamberlain at the Office of Planning, Research and Evaluation, Administration for Children and Families, 370 L’Enfant Promenade, SW, Washington, DC 20447 if you have any concerns about this information collection request.

_______________________________________

Name of Participant (Print)

_______________________________________

Signature of Participant

Date ___________________________________

REMINDER: Ask each participant to sign two copies of the consent form. One is for the participant to keep and one is for the evaluation files.

_______________________________________

Name of Person Obtaining Consent (Print)

_______________________________________

Signature of Person Obtaining Consent

Date ___________________________________