Attachment C8 DCFS Youth FAQ Letter and Assent Form

OMB NO: 0970-0408
EXPIRATION DATE: xxxxx

C8. DCFS Youth FAQ Letter and Assent Form

Youth FAQ Letter (ages 11-16)

This document will be on Illinois Department of Children and Family Services Letterhead

Westat, a research company, is inviting you to take part in a research study about services you are getting from the Illinois Department of Children and Family Services (DCFS). You do not have to be in the study. It is up to you. This letter describes some information about the study. A Westat researcher or your caseworker will contact you soon to see if you are interested in meeting with a Westat researcher to learn more about the study.

What is a research study?

A study collects information so people can understand something better.

Why is Westat doing this study?

We want to find out if the services you receive help you and your family. If they do, they may also help other children and families.

What will happen if I am in this study?

If you are okay with taking part in the study, you will meet in a private place with a researcher to answer questions about yourself and your family. The researcher will then come back 6 months later and you will be asked similar questions. The questions will take about 45 minutes to answer. There are no right and wrong answers.

For your privacy, you will use a computer to answer the questions. If you need help using the computer or answering the questions, you can ask the researcher questions at any time during the interview.

What am I being asked to do now?

Nothing. A Westat researcher or your caseworker you or your caregiver soon to schedule a meeting between you and a Westat researcher to help you to learn more about the study.

Do I have to be in the study?

The DCFS guardian has given consent for us to talk to you, but you can choose not to talk to us. Once you meet with the researcher to learn more about the study, you can decide if you want to take part or not. No one will get mad at you if you do not want to be in the study. Your decision will not change the services you currently get.

Do I get anything for being in the study?

Yes. You will get a $20 gift card each time you take part in an interview.

Are there any risks to being in the study?

Talking about family can sometimes make people feel sad. If any of the questions make you feel upset or sad, you can ask to skip those questions. You can also talk with your caseworker if you are still feeling sad or upset after your meeting with the researcher. You can end the meeting with the researcher at any time.

Will what I share during the study be kept private?

We will keep what you tell us private to the extent permitted by law. We will combine what you tell us with what other kids tell us when we write reports about the study. No names will be in these reports.

To help protect your privacy, the government has provided the research team a Certificate of Confidentiality. With this Certificate, we do not have to tell people that you took part in the study or share with others any of the information that you tell us. However, if you tell us that someone has hurt you or that you want to hurt yourself or someone else, we have to tell the authorities. We may also need to share some of your answers with your therapist so that he or she can better serve you.

To make sure the researchers are following rules when asking you questions, someone may ask to sit in on your interview. If someone wants to sit in, the researcher will let you know and ask you to agree first.

What if I have questions?

If you have any questions about the study, please call Raquel Ellis 1-800-WESTAT1 (937-8281), x5173, or raquelellis@westat.com. If you have any questions about your rights as a person taking part in the study, please contact the Westat Institutional Review Board (IRB) Administrator at 1-800-WESTAT1 (937-8281), x8828.

Youth Assent (ages 11-16)

Westat, a research company, is inviting you to take part in a research study about services you are getting from the Illinois Department of Children and Family Services (DCFS). You do not have to be in the study. It is up to you. A researcher will review this form with you before you decide whether to take part or not.

What is a research study?

A study collects information so people can understand something better.

Why is Westat doing this study?

We want to find out if the services you receive help you and your family. If they do, they may also help other children and families.

What will happen if I am in this study?

If you are okay with taking part in the study, you will meet in a private place with a researcher to answer questions about yourself and your family. The researcher will then come back 6 months later and you will be asked similar questions. The questions will take about 45 minutes to answer. There are no right and wrong answers.

For your privacy, you will use a computer to answer the questions. If you need help using the computer or answering the questions, you can ask the researcher questions at any time during the interview.

Do I get anything for being in the study?

Yes. You will get a $20 gift card each time you take part in an interview.

There are no direct benefits to you in taking part in the interviews. But, taking part will help DCFS come up with better ways to serve children and families.

Are there any risks to being in the study?

Talking about family can sometimes make people feel sad. If any of the questions make you feel upset or sad, you can ask to skip those questions. You can also talk with your caseworker if you are still feeling sad or upset after your meeting with the researcher. You can end the meeting with the researcher at any time.

Will what I share during the study be kept private?

We will keep what you tell us private to the extent permitted by law. We will combine what you tell us with what other kids tell us when we write reports about the study. No names will be in these reports.

To help protect your privacy, the government has provided the research team a Certificate of Confidentiality. With this Certificate, we do not have to tell people that you took part in the study or share with others any of the information that you tell us. However, if you tell us that someone has hurt you or that you want to hurt yourself or someone else, we have to tell the authorities. We may also need to share some of your answers with your therapist so that he or she can better serve you.

To make sure the researchers are following rules when asking you questions, someone may ask to sit in on your interview. If someone wants to sit in, the researcher will let you know and ask you to agree first.

Do I have to be in the study?

The DCFS guardian has given consent for us to talk to you, but you can choose not to talk to us. No one will get mad at you if you do not want to be in the study. Your decision will not change the services you currently get.

What if I have questions?

If you have questions right now, please talk to the person who reviews this form with you. You can also call the people below.

If you have any questions about the study, please contact: Raquel Ellis, Westat Study Contact 1-800-WESTAT1 (937-8281), x5173 raquelellis@westat.com

For questions about the your rights as a participant in this study, contact: The Westat Institutional Review Board (IRB) Administrator, 1-800-WESTAT1 (937-8281), x8828

Signature

Signing this form means that you read or listened to someone read this form to you, you understand what it says, and you agree to take part in the study. You will receive a copy of this form. If you do not want to take part in the study, please let the researcher know.

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Child’s Signature

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Print Name

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Child’s Signature

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Print Name

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Date

FOR RESEARCH STAFF USE ONLY
Youth declined to participate in data collection.

Burden Statement: This collection of information is voluntary and will be used to evaluate the Permanency Innovations Initiative. Public reporting burden of the collection of information described in this FAQ is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing 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 Reports Clearance Officer (Attn: OMB/PRA 0970-0355), Office of Planning, Research and Evaluation, Administration for Children and Families, Department of Health and Human Services, 370 L’Enfant Promenade S.W., Washington DC 20447.