Appendix C1 - GCM Consent Form - Confidential Route

Using Concept Mapping to Develop a Theory to Describe the Work of the National Domestic Violence Hotline with Family and Friends of Victims/Survivors – Formative Data Collection

Formative Data Collections for Program Support

0970 - 0531

APPENDIX C.1: GCM Online Consent Form – Confidential Route

July 2020

Submitted By:

Office of Planning, Research, and Evaluation

Administration for Children and Families

U.S. Department of Health and Human Services

4^th Floor, Mary E. Switzer Building

330 C Street, SW

Washington, D.C. 20201

Project Officers: Tia Brown and Kriti Jain

What is the SAF-T project?

The National Domestic Violence Hotline Services Assessment Framework based on Theory (SAF-T) is a project funded by the Administration for Children and Families (ACF) on behalf of the Family and Youth Service Bureau’s Family Violence Prevention and Services Program and the Office of Planning, Research and Evaluation. The SAF-T project will be developing a theoretical framework to describe the work of the National Domestic Violence Hotline (The Hotline) as it relates to family and friends of victims/survivors. To develop this framework, the SAF-T project is using a method called group concept mapping (GCM) to learn more about ways in which The Hotline can support family and friends who contact The Hotline through its adult helpline and its youth-focused loveisrespect helpline.

What will participation involve?

If you choose to participate, you could be eligible to complete in up to three online concept mapping activities and participate in one group webinar discussion.

1. Brainstorming Activity: You will be asked to identify ways in which you think The Hotline can support family and friends who contact The Hotline. This activity will take 20 minutes or less to complete and will take place in [INSERT MONTH AND YEAR].

2. Sorting Activity: You will be asked to sort statements into categories that make sense to you. This activity will take approximately 20 minutes to complete and will take place [INSERT MONTH AND YEAR].

3. Rating Activity: You will be asked to rate each statement on how IMPORTANT and how USEFUL you think it is in supporting family and friends who contact The Hotline. This activity will take approximately 20 minutes to complete and will take place in [INSERT MONTH AND YEAR].

4. Group Webinar Discussion: You will be asked to participate in a group webinar where we will share combined results and get feedback from all participants through discussion. This activity will take approximately 60 minutes to complete and will take place in [INSERT MONTH AND YEAR].

While we are not able to provide financial incentives for participation, your input is very important and we appreciate you sharing your ideas and opinions.

Before moving ahead, please remember that:

• You must be at least 18 years old to participate in this study.  

• Computer use can be monitored and is impossible to be completely clear. If you are concerned about your safety related to this project, exit the webpage and clear your browser history.

• Your participation is voluntary, and you can withdraw at any time without penalty.

• There is the possible risk that you may feel some emotional discomfort when participating in the group concept mapping activities. You do not have to answer any questions or provide any information that makes you feel uncomfortable.

• There are no direct benefits to participating in this study. However, participating may indirectly help improve services provided by The Hotline, which would benefit future contactors.

• Brainstorming activity responses are collected anonymously and cannot be connected with your name, email address, or any other personally identifiable information. Any responses you provide during the sorting, rating, or group webinar discussion activities will be kept as confidential (private) as possible, and no personally identifying information will be linked to your responses. Information you provide will be combined with information from other participants for research purposes and will only be used in reports or scientific papers in summary form. Your responses will not be attributed to your name. We may use quotes from you or other participants in our reports, but we will not link participants’ names to any responses.

• All records related to your involvement in this project will be stored securely on a password-protected computer or network drive that is only accessible by the SAF-T project team.

• If you have questions about this study, please contact Carol Hagen, Project Director at carolhagen@westat.com or (301) 294-3877. If you have questions about your role as a research subject, contact the Human Subjects Protections Office at IRB@westat.com or (888) 920-7631. In your message, please include your name, name of the study (SAF-T project), and email address or phone number.

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to inform the development of a theoretical framework to explain the work of The Hotline as it relates to friends and families of domestic violence victims/survivors. Public reporting burden for this collection of information is estimated to average between 20 minutes to 1 hours per activity per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0531 and the expiration date is XX/XX/XXXX. If you have any comments on this collection of information, please contact Tia Z. Brown, PhD, MPH (Tia.Brown@acf.hhs.gov) or Kriti M. Jain, PhD, MSPH (Kriti.Jain@acf.hhs.gov).