Attachment C-Staff Consent Form Web Survey

Appendix C. Agency Web Survey Consent Form

Contact After Adoption or Guardianship: Child Welfare Agency and Family Interactions

OMB Control Number: xxxx-xxxx

Expiration Date: XX/XX/XXXX

	Contact After Adoption or Guardianship: Child Welfare Agency and Family Interactions
	Case Western Reserve University, Ohio East Carolina University, North Carolina RTI International, North Carolina Sponsored by: Office of Planning, Research and Evaluation, Administration for Children and Families

Attachment C: Agency Web Survey Consent Form – Adoption

Will be sent as an attachment with PAGI Team Staff Follow-Up Email Outreach (Attachment B) and will be included at the beginning of the web survey

Consent to Participate in a Research Study

Who is conducting this research?

The Administration for Children and Families (ACF) Office of Planning, Research, and Evaluation (OPRE) and the Children’s Bureau is funding a study of child welfare agencies across the country. The study is being conducted by RTI International (RTI), a not-for-profit research organization in North Carolina, in partnership with Case Western Reserve University (CWRU) in Ohio and East Carolina University (ECU) in North Carolina. We are contacting staff responsible for the adoption programs for child welfare agencies in every state (a total of 50 adoption program managers).

What is the purpose of this study?

The federal government is funding this study to explore the various ways child welfare agencies are in contact with or receive information about families after adoption from the foster care system.

Specifically, the study explores the extent to which child welfare agencies track information about children and youth who have exited the foster care system to adoption as well as the procedures that identify children and youth who have reentered foster care after adoption. We will also ask about services provided to adoptive families and the systems that track those services.

What will I be asked to do?

We are asking that you complete this web survey. It should take about 20 minutes to complete. The types of questions we will ask include: the nature of contact between your child welfare agency and adoptive families (e.g., do families call a general hotline or call a specific type of worker?). We will also ask if your agency regularly contacts families (e.g., through newsletters or mailings). Finally, we will ask if you track any information about children who exit foster care to adoption, including information about children who reenter foster care after adoption. In sum, we seek to understand both the nature of contact between adoptive families and your agency and the tracking systems (if any) associated with this contact.

Based on results to the web survey, we will ask six child welfare agencies to also participate in video teleconference interviews to learn more about their agency’s post adoption practices. If your agency is selected, you will be contacted separately to see if your agency is interested in participating in the interviews.

What do I need to have on-hand to respond to the survey?

We will ask you about the contact your agency has with families after adoption (e.g., newsletters, or individual letters sent to each family that ask them to provide updates). Please have examples of those materials with you. Also, if you know the number of letters sent, and number of responses received from families, that would be helpful. Additionally, if you have a system for tracking foster care reentries after adoption, please gather information on the processes for tracking that information (if any).

What are the possible risks and discomforts?

We do not anticipate any possible risks or discomforts related to your participation in this survey.

Will I benefit from taking part in this study?

You will not get any personal benefit from taking part in this study. The information obtained from this study will be used to inform and guide federal efforts to support child welfare practices related to post adoption.

Do I have to take part in this study?

Participation in this study is completely voluntary. There will be no penalty and your agency will not lose any funding or program support if you choose not to participate. If you do participate, you can refuse to answer any questions.

What will it cost me to participate?

There are no costs associated with taking part in this study.

Will I receive anything for taking part in this study?

You will not receive any payment for taking part in this study.

Who will see the information I provide?

We will not identify you by name. However, it is possible that our federal partners will be able to discern the identities of respondents based on the states that participate, and the limited number of adoption specific staff in each location. We cannot guarantee confidentiality.

We will be conducting up to six follow-up video teleconference interviews with selected agencies to learn more about their processes. If your agency is selected to participate in the follow-up video teleconference interviews, your agency name will be released to our federal partners, and the research team will be in contact to assess your interest in further participation.

How will my responses be used?

Prior to using or releasing this data for future research, we will de-identify it. “De-identify” means that we will remove or code any personal information that could identify you before files are shared with other researchers to ensure that no one should be able to identify you from the information we share.

In addition to informing the government, the information that we gather from you during this survey may be shared with other researchers. This will not include your personal information (for example, your name or email address will never be shared), but we may share your responses, along with all the other responses. This will allow other researchers to also learn from your experiences.

What if I have questions?

Before you decide whether or not to participate in the study, please ask any questions that come to mind. Later, if you have questions about the study design, goals or purpose, you can contact the researcher, Nancy Rolock at 216-368-6014. If you have any questions about your rights as a research participant, contact the RTI Office of Research Protection at 1-866-214-2043.

Research Participant Statement

I understand that my participation in this research study is voluntary. I may refuse to participate or stop participating without penalty or loss of benefits. By selecting NEXT I acknowledge my approval to participate in the study.

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 information collection is XXXX-XXXX and the expiration date is XX/XX/XXXX.

	Contact After Adoption or Guardianship: Child Welfare Agency and Family Interactions
	Case Western Reserve University, Ohio East Carolina University, North Carolina RTI International, North Carolina Sponsored by: Office of Planning, Research and Evaluation, Administration for Children and Families

Attachment C: Agency Web Survey Consent Form – Adoption & Guardianship

Will be sent as an attachment with PAGI Team Staff Follow-Up Email Outreach (Attachment B) and will be included at the beginning of the web survey

Who is conducting this research?

The Administration for Children and Families (ACF) Office of Planning, Research, and Evaluation (OPRE) and the Children’s Bureau, is funding a study of child welfare agencies across the country. RTI International (RTI), a not-for-profit research organization in North Carolina, in partnership with Case Western Reserve University (CWRU) in Ohio and East Carolina University (ECU) in North Carolina, are conducting this web survey. We are contacting staff responsible for the adoption or guardianship programs for child welfare agencies in every state (a total of up to 50 managers).

What is the purpose of this study?

The federal government is funding this study to explore the various ways child welfare agencies are in contact with or receive information about families after adoption or guardianship through the foster care system. Specifically, the study explores the extent to which child welfare agencies track information about children and youth who have exited the foster care system to adoption or guardianship as well as the procedures that identify children and youth who have reentered foster care after adoption or guardianship. We will also ask about services provided to adoptive or guardianship families and the systems that track those services.

What will I be asked to do?

We are asking that you complete two web surveys – one for contact after adoption and the one for contact after guardianship placement. It should take about 35 minutes to complete. The types of questions we will ask include: the nature of contact between your child welfare agency and adoptive or guardianship families (e.g., do families call a general hotline or call a specific type of worker?). We will also ask if your agency regularly contacts families (e.g., through newsletters or mailings). Finally, we will ask if you track any information about children who exit foster care to adoption or guardianship, including information about children who reenter foster care after adoption or guardianship. In sum, we seek to understand both the nature of contact between adoptive and guardianship families and your agency, and the tracking systems (if any) associated with this contact.

Based on results to the web survey, we will ask six child welfare agencies to also participate in video teleconference interviews to learn more about their agency’s post adoption and guardianship practices. If your agency is selected, you will be contacted separately to see if your agency is interested in participating in the interviews.

What do I need to have on-hand to respond to the survey?

We will ask you about the contact your agency has with families after adoption or guardianship (e.g., newsletters, or individual letters sent to each family that ask them to provide updates). Please have examples of those materials with you. Also, if you know the number of letters sent, and number of responses received from families, that would be helpful. Additionally, if you have a system for tracking foster care reentries after adoption or guardianship, please gather information on the processes for tracking that information (if any).

What are the possible risks and discomforts?

We do not anticipate any possible risks or discomforts related to your participation in this survey.

Will I benefit from taking part in this study?

You will not get any personal benefit from taking part in this study. The information obtained from this study will be used to inform and guide federal efforts to support child welfare practices related to post adoption and guardianship.

Do I have to take part in this study?

Participation in this study is completely voluntary. There will be no penalty and your agency will not lose any funding or program support if you choose not to participate. If you do participate, you can refuse to answer any questions.

What will it cost me to participate?

There are no costs associated with taking part in this study.

Will I receive anything for taking part in this study?

You will not receive any payment for taking part in this study.

Who will see the information I provide?

We will not identify you by name. However, it is possible that our federal partners will be able to discern the identities of respondents based on the states that participate, and the limited number of adoption and guardianship specific staff in each location. We cannot guarantee confidentiality.

We will be conducting up to six follow-up video teleconference interviews with selected agencies to learn more about their processes. If your agency is selected to participate in the follow-up video teleconference interviews, your agency name will be released to our federal partners, and the research team will be in contact to assess your interest in further participation.

How will my responses be used?

Prior to using or releasing this data for future research, we will de-identify it. “De-identify” means that we will remove or code any personal information that could identify you before files are shared with other researchers to ensure that no one should be able to identify you from the information we share.

In addition to informing the government, the information that we gather from you during this survey may be shared with other researchers. This will not include your personal information (for example, your name or email address will never be shared), but we may share your responses, along with all the other responses. This will allow other researchers to also learn from your experiences.

What if I have questions?

Before you decide whether or not to participate in the study, please ask any questions that come to mind. Later, if you have questions about the study design, goals or purpose, you can contact the researcher, Nancy Rolock at 216-368-6014. If you have any questions about your rights as a research participant, contact the RTI Office of Research Protection at 1-866-214-2043.

Research Participant Statement

I understand that my participation in this research study is voluntary. I may refuse to participate or stop participating without penalty or loss of benefits. By selecting NEXT I acknowledge my approval to participate in the study.

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 information collection is XXXX-XXXX and the expiration date is XX/XX/XXXX.