Att_B.6_Youth_assent_script

Attachment B.6

Youth Assent Script

RIViR Study

RIViR Study

Youth Assent Script (for Youth Under Age 18)

[To be read to youth by program staff administering the screening tools prior to the first tool.]

We are inviting you to be part of a research study with [PROGRAM NAME] as part of our involvement with the Administration for Children and Families’ Office of Family Assistance, Healthy Marriage and Relationship Education Program. You were chosen because you are part of [PROGRAM NAME].

Before you decide whether you want to take part in this study, we ask that you read this assent form so that you understand what the study is about and what you will be asked to do. I’ll go over it with you now.

The study is sponsored by the federal government and is conducted by RTI in North Carolina. In this study we are testing ways to ask teens who are served by programs like [PROGRAM NAME] about their romantic relationships. About 1200 youth and adults will participate in this study from around the country.

You will be asked to participate in two surveys and one interview at three different times over the course of 2 months. You will be asked the first set of questions today. The questions will be about things like your relationships with boyfriends or girlfriends or other people that you are romantic with, and what your romantic relationships are like, including any complicated experiences you may have had, like violence in a relationship. For the interview, you will also receive some written information about teen dating violence and healthy relationships and be asked some questions after receiving it. RTI will also receive information on your age, race and ethnicity, and other personal characteristics collected by [PROGRAM NAME]. There are no right or wrong answers. You will not have to be in a relationship or seeing anyone to be in the study.

Participation in the study is voluntary and you don’t have to participate in the study if you don’t want to. You can skip any questions you want, end the study at any time, and decide not to participate in future surveys or interviews.

Each survey will take about 10 minutes, and the interview will take about 15 minutes.

Some of the questions may seem personal or bother you. If you feel uncomfortable or upset during the interview, you may take a break or skip any of the questions. The other risk is that someone might find out your answers to the questions. In order to avoid that, we will do the interview in a private setting where no one can overhear the answers. We will try to make sure that no one can see your answers when you take the surveys. Also, we will handle and store all of the information you provide to us in a secure manner.

There are no direct benefits to you from participating in this study. Your answers are also helping us learn more about the kinds of services that might help other teens in programs like these.

You will receive a $5 gift card after answering each set of interview questions as a token of appreciation.

We will do our best to keep all of the answers to the interview questions private. Only the people working on the study or with [PROGRAM NAME] will be able to see your answers. No one else, including, for example, your parents, other teens in the program, or your boyfriend or girlfriend, will be able to find out what you said in the interviews.

We will not allow people outside the study staff know which answers are yours unless you give permission for this (for example, for us to refer you to [DOMESTIC VIOLENCE PARTNER]). There are two other exceptions: 1) if you tell us that someone’s life or health could be in danger or 2) if you reveal a child is being hurt or not taken care of. In either of these cases, we must report it to the authorities. This includes if you are being hurt or not taken care of, or if you a friend of yours is being hurt or not taken care of. If this happens, we may need to report to someone whose job it is to see that you and/or others are safe and protected.

After all interviews are completed, a summary will be written that contains information from all participants. The staff doing the study will not use your name in any reports.

The Institutional Review Boards (IRB) at RTI and at [LOCAL IRB INSTITUTION] has reviewed this research.

If you participate in this study, we will contact you to complete two more surveys or interviews, over the course of the next 2 months.

If you have any questions about this study, you can use the numbers on the form to contact the [PROGRAM NAME] Project Director, [PROGRAM DIRECTOR], or Tasseli McKay, the study director at RTI. If you have any questions about protecting your privacy in this study, you can contact the local IRB contact.

Do you have any questions for me now? (Answer questions. If administering assent in a group, offer youth the opportunity to ask questions privately.)

If you agree to participate in this study, and for RTI to receive information on your age, race and ethnicity collected by [PROGRAM NAME], please sign and date the last page of the assent form. You can keep the rest of the form, which has the information I just went over with you.

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