Appendix A-8 Staff Consent Form

OMB Control No.: 0970-xxxx

Expiration Date: xx/xx/20xx

Appendix A-8: 2

Home Visiting: Approaches to Father Engagement and Fathers’ Experiences

Informed Consent for Participation: [Name of Program] Administrators and Staff

• You are being invited to participate in a research study called “Home Visiting: Approaches to Father Engagement and Fathers’ Experiences,” conducted by Elizabeth Peters and Heather Sandstrom at the Urban Institute, a non-profit research organization in Washington, D.C. This study is currently funded by the U.S. Department of Health and Human Services.

• The purpose of this study is to learn: 1) the strategies that a few selected home visiting programs use to effectively engage fathers; 2) the perspectives and experiences of staff in these programs; 3) the experiences and views of mothers and fathers who have participated in the selected programs; and 4) lessons for other programs that are interested in more fully engaging fathers with young children in their services and activities.

• Participation in this study is completely voluntary. You may choose to not answer any question and may stop the interview at any time. There are no consequences for choosing not to participate or not to answer any question.

• The interview will last about 90 minutes.

• Although you may not benefit directly from this study, some participants may find it useful to reflect on and share their experiences in designing and implementing father engagement strategies.

• Your participation will help us understand the experiences of home visiting programs, which may inform future federal policies and research, and technical assistance efforts.

• The study was designed in a way that minimizes the risks to participants; however, you may still experience some discomfort when discussing personal and potentially sensitive information.

The research team will take the following steps to protect your privacy:

• Everyone who works on this study has signed a Staff Confidentiality Pledge prohibiting disclosure of anything you say during the interview that would allow someone outside the research team, including government staff and officials, to identify you. The only exception is a researcher may be required by law to report suspicion of immediate harm to yourself, to children, or to others.

• Your name and other identifying information, such as [Name of Program]’s name and specific location, will be removed from the data to protect your privacy. Despite all procedures that will be used to maintain privacy, there is risk that the descriptive about [Name of Program] information provided in reports or other dissemination activities would allow the identity of the program to be discerned.

• The researchers plan to publish the results of this study in a final report and research briefs, and present the results during several government briefings and national conferences. Your answers will be kept private, meaning your identity will never be revealed in the results.

• With your permission, we will audio record the session. The recording will serve as a back-up tool to ensure that we capture all your comments in our notes in as close to your words as possible. The digital recording will be kept in secured files at the Urban Institute accessible only to project staff. Once the project is complete, all recordings will be destroyed.

This information collection is voluntary and will be used to learn how home visiting programs engage fathers. 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 number for this collection is 0970-XXXX and expires XX/XX/XXX.

If you have questions, comments, or concerns about this study, you may contact Co-Principal Investigator Heather Sandstrom at the Urban Institute, 2100 M Street NW Washington, DC 20037, at (202) 261-5833 or hsandstrom@urban.org or the Institutional Review Board Administrator who approved this research, Everett Madden, Madden, Everett at (202) 261-5632 or EMadden@urban.org. You may also contact the Federal Project Officer, Lauren Supplee, in the Office of Planning, Research, and Evaluation at (202) 401-5434 or Lauren.Supplee@acf.hhs.gov.

Signing this consent form indicates that you understand the study procedures and are willing to participate in this interview.

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Respondent’s Name (PLEASE PRINT)

_________________________________________ _________________________

Respondent’s Signature Date

□ Checking this box indicates that you agree to have the interview audio recorded.

You will be given a copy of this form for your records.