2. CAPE-Youth Phase 1 Consent Form

OMB Control No: 1230-0NEW

Expiration Date: XX/XX/20XX

Project Title: Youth and Adult Systems Collaboration Study, Phase 1 Collaboration Questionnaire

Principal Investigators:

Matthew Saleh, Ph.D., Cornell University, Yang-Tan Institute on Employment and Disability

Leslie Shaw, Ph.D., Cornell University, Yang-Tan Institute on Employment and Disability

You are invited to take part in a research study of best practices in interagency collaboration among state agencies serving transitioning youth and young adults with disabilities (i.e., vocational rehabilitation, social security, education, mental health agencies, developmental disabilities agencies, juvenile justice, foster care, and other agencies likely to serve youth with one of WIOA’s defined “barriers to employment”). This study, titled “the Youth and Adult Systems Collaboration Study,” is a research initiative of The Center for Advancing Policy on Employment for Youth (CAPE-Youth). CAPE-Youth is a U.S. Department of Labor, Office of Disability Employment Policy-funded policy development and technical assistance center supporting the development, implementation, and integration of evidence-based effective practices and policies for improving transition outcomes for youth and young adults with disabilities. The research project will occur in two phases during the dates of [dates of Phase 1] and [dates of Phase 2]. This consent form is for Phase 1 of the study in which you will be asked to participate in an online questionnaire. The collaboration questionnaire is for supervisors and direct service providers working for state-level governmental agencies providing services to transitioning youth and young adults with disabilities. The overall goal of the study is to develop technical assistance and professional development tools and resources to support state-level interagency collaboration and service coordination best practices.

You are being asked to participate in an online questionnaire that will open on [date] and close on [date] during Phase 1 of the study. The questionnaire will take approximately 25-30 minutes to complete, and will ask you questions about the levels of interagency collaboration and service coordination with other agencies in your state and/or local area (e.g., vocational rehabilitation, social security, education, mental health agencies, developmental disabilities agencies, juvenile justice, foster care, and other agencies likely to serve youth with one of WIOA’s defined “barriers to employment”) who are also providing services to transitioning youth and young adults with disabilities. Questions will target appropriate collaborations based on your job role as direct service provider or supervisor. The questionnaire will also assess the frequency that your agency engages in certain types of collaborative practices, and your levels of confidence in serving diverse groups of youth with disabilities and coordinating services across agencies. Questionnaire responses will be anonymous, and results of the questionnaire will be stored in secure, encrypted data format for five years [insert date that data will be destroyed], accessed only by study personnel, and reported only in aggregate form.

Taking part in this study is voluntary. You may refuse to participate before the study begins, discontinue at any time, or skip any questions/procedures that may make you feel uncomfortable, with no penalty, and no effect on the compensation earned before withdrawing, or on your academic standing, record, or relationship with the university or other organization or service that may be involved with the research.

The questionnaire poses no risks greater than those encountered in day-to-day life. All of your responses will be kept private and reporting of results will be done in aggregate form only. De-identified data from this study may be shared with the research community at large to advance science and health. We will remove or code any personal information that could identify you before files are shared with other researchers to ensure that, by current scientific standards and known methods, no one will be able to identify you from the information we share. Despite these measures, we cannot guarantee anonymity of your personal data. There are no incentives or direct benefits for participating in this questionnaire. However, as the objective of the study and analysis is to inform the development of state-level technical assistance and guidance on improving interagency collaboration for transitioning youth with disabilities, it is possible that you will experience professional benefits related to guidance on how to best serve youth across different systems. You have the right to not to answer a question or end your participation at any point.

The main researcher conducting this study is Dr. Matthew Saleh, a Research Associate at Cornell University. Please ask any questions you have now. If you have questions later, you may contact Matthew Saleh mcs378@cornell.edu or at 203-722-2826. If you have any questions or concerns regarding your rights as a subject in this study, you may contact the Institutional Review Board (IRB) for Human Participants at 607-255-5138 or access their website at http://www.irb.cornell.edu. You may also report your concerns or complaints anonymously through Ethicspoint online at www.hotline.cornell.edu or by calling toll free at 1-866-293-3077. Ethicspoint is an independent organization that serves as a liaison between the University and the person bringing the complaint so that anonymity can be ensured.

I agree to participate in the research study. I understand the purpose and nature of this study and I am participating voluntarily. I understand that I can withdraw from the study at any time, without any penalty or consequences.

Yes

No

Privacy Act Statement
Collection and Use of Personal Information

The following statement is made in accordance with the Privacy Act of 1974 (5. U. S. C. 552a). Information collected will be handled and stored in compliance with the Freedom of Information Act and the Privacy Act of 1974, as amended (5 U.S.C. 552a). Furnishing the data requested is voluntary.

We will use the data you provide for the CAPE-Youth Research Project, funded by The United States Department of Labor, Office of Disability Employment Policy. In accordance with the Confidential Information Protection and Statistical Efficiency Act of 2002 (Title 5 of Public Law 107-347) and other applicable Federal laws, your responses will not be disclosed in identifiable form without your informed consent. Per the Federal Cybersecurity Enhancement Act of 2015, Federal information systems are protected from malicious activities through cybersecurity screening of transmitted data.