Appx G-2 - Remote Consent and Assent Forms

The Administration for Children and Families (ACF), an agency within the U.S. Department of Health and Human Services, provides funding for activities that support the well-being of children and families. ACF hired RTI International (RTI), a research company in North Carolina, to conduct a national survey of children and families in the child welfare system. RTI works with researchers from the University of North Carolina at Chapel Hill and Washington University in St. Louis to carry out the study.

SELECTION OF PARTICIPANTS

RTI representatives are contacting families of children randomly selected from child welfare agencies throughout the United States. There are 4,000 children and families taking part in this study. You have been identified as the primary caseworker or service provider for one of the participating children. We are following up with sampled children and their current caregivers approximately 36 months after their initial interview.

PURPOSE OF NSCAW CASEWORKER INTERVIEWS

The caseworker interview collects information about the child’s history with the child welfare system and services recommended or provided by the agency. Your answers combined with the answers of others in the study will help us describe the needs of children and their use of available child welfare services. Research reports will summarize the collected information and help policy makers improve the child welfare system. We will not share your answers with the child or the child’s caregiver. They will not know how you responded to the questions.

TYPES OF QUESTIONS FOR CASEWORKERS

The caseworker interview takes about 50 minutes. The interview focuses on the child’s history in the child welfare system and the services the child receives. The interview will take place over the telephone.

YOUR RIGHTS

You can decide to take part in this study or not. You can refuse to answer any questions. Your decision to take part will not affect you, your job, or any services the child may receive. You have the right to stop the interview at any time.

RISKS

Taking part in this study presents no physical risks to you. Some questions might make you feel uneasy or feel various emotions, such as sadness. We have significant protections in place to collect and store your information securely. However, there is a small risk that if someone does not follow the rules we set, someone outside the study team might see your information. We minimize this risk by transferring and storing your information and interview data using a study ID and not your name.

BENEFITS

Taking part in this study presents no direct benefits to you, the caregiver, or to the child. Your input will help us learn about the needs of children and the services available to them.

PRIVACY

We keep your responses private to the extent permitted by law. We keep your answers on a secure computer labeled with an ID number. Your name and that of the child will not be reported with any information you provide. All staff involved in this research have signed a Privacy Pledge.

This research is covered by a federal protection called a Certificate of Confidentiality. This means the researchers cannot share the information they gather that may identify you. The Certificate prevents researchers from revealing this information even if it is subpoenaed by a court.

However, the Certificate does allow researchers to share information in some situations. For example, researchers must follow reporting laws about child and adult abuse. Also, as a part of agreeing to be in this study, you are giving permission for researchers to share information in the rare circumstance that it is needed to prevent serious risk to yourself or others. In addition, the agency that funds this research (the Administration for Children and Families) is permitted to access information to confirm that the research is being conducted properly.

In the future, information from this study may be securely shared with qualified individuals to help learn more about the experiences of children and families with the child welfare system. The information that is shared will only include a study ID number and not your name.

We never identify a single person or family in our reports. Your information will be combined with information from other people taking part in the study. When we write up the study to share it with other researchers, we will write about the combined information. You will not be identified in any published or presented materials.

QUESTIONS

If you have questions, please call Jennifer Keeney at RTI, 1-800-334-8571 extension 23525 (toll-free number). If you have questions about your rights as a study participant, please call RTI's Office of Human Research Protection at 1-866-214-2043 (a toll-free number).

Shape1 Agreement to Participate in NSCAW

Do you agree to participate in today’s interview? You can choose not to participate at any time.

1 = Yes, I agree to participate in the NSCAW interview.

2 = No, I do not agree to participate in the NSCAW interview.

Audio Recordings Statement

We use a laptop quality control (QC) system for this study. The system runs on the computer. This system will make audio recordings of what you and I say to each other during the interview. Neither you nor I will know when the computer records what we say. Project staff at RTI will listen to the recordings only to review my work.

The recordings are securely stored on my computer and transmitted back to RTI within 12 hours after this interview. They are stored on secure computers and only members of the project team can review them. The recordings will be destroyed at the end of the study after data have been cleaned and analyzed.

Do we have your permission to run this system during your interview?

1 = Yes, I agree to have parts of this interview recorded by the computer.

2 = No, I do not agree to have parts of this interview recorded by the computer.

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 and expiration date for this collection are OMB #: 0970-0202, Exp: 09/30/2023. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Dr. Melissa Dolan; 230 W. Monroe Street, Suite 2100 Chicago, IL 60606.

The Federal Government has issued a Certificate of Confidentiality (authorized by the Public Health Service Act Section 301(d), 42 U.S.C Section 241 (d), 1988) to the researchers who are conducting this study which authorizes us to protect the privacy of individuals who participate.

Caregiver Informed Consent

National Survey of Child and Adolescent Well-Being (NSCAW)

NSCAW

The Administration for Children and Families (ACF) provides funding for activities that support the well-being of children and families. ACF hired RTI International (RTI), a research company in North Carolina, to conduct a national survey of children and families in the child welfare system. RTI works with researchers at the University of North Carolina at Chapel Hill and Washington University in St. Louis to carry out the study.

SELECTION OF CHILDREN AND OTHER PARTICIPANTS

RTI selected over 4,000 children to take part in this study. Selected children had contact with the child welfare system during a 12-month period. We are following up with children and their caregivers roughly 36 months after the initial interview. The study includes interviews with selected children. The study also includes interviews with the child’s caregiver and caseworker if the child and/or family received services since the last interview. We must have permission from a parent or legal guardian to include the child in the study.

PURPOSE OF THIS NSCAW CAREGIVER INTERVIEW

We want to interview you about your child and your experiences with the child welfare system. Your answers combined with answers of other caregivers in the study will help us describe the needs of children and their use of available child welfare services. What we learn from this information will help policy makers make improvements to the child welfare system.

TYPES OF QUESTIONS FOR CAREGIVERS AND OTHER INFORMATION GATHERED

If you decide to take part, we will ask you some of the questions over the telephone and others you will answer privately on the Internet. The total time for both parts is 45 minutes. The interview includes questions about your child’s learning, health, behavior, and relationships with friends. We will ask about services your family may receive and your level of satisfaction with those services. We also want to learn about your attitudes about raising children, your life experiences, and your involvement with school and community activities. The part of the survey that takes place on the Internet will ask about things that may have happened in your life like drug abuse, and other risky behaviors such as drinking and involvement with the police.

YOUR RIGHTS

You can decide to take part in this study or not. You can refuse to answer any questions. Taking part in this study does not affect any benefits you or your child may receive.

RISKS

Taking part in this study presents no physical risks to you and your child. Some questions might make you feel uneasy or feel various emotions, such as sadness. We have significant protections in place to collect and store our information securely. However, there is a small risk that if someone does not follow the rules we set, someone outside the study team might see your information. We minimize this risk by transferring and storing your information and interview data using a study ID and not your name.

BENEFITS

Taking part presents no direct benefits to you or your child for answering our questions. What we learn from you may help to improve child welfare services and programs. By taking part, you will help us understand the needs of children and the services available to them.

FUTURE CONTACTS

We may contact you again for another round of interviews. This will help us understand changes over time. You can decide whether to talk with us at that time.

PRIVACY

We keep your answers private to the extent allowed by law. We keep your answers on a secure computer labeled with an ID number. We do not identify you or your child by name. All staff involved in this research have signed a Privacy Pledge.

Part of the study will ask you to enter information in a secure website. We anticipate your participation in this study presents no greater risk than everyday use of the Internet. Though we are taking precautions to protect your privacy, you should be aware that if you email information in an unsecure manner, it could be read by a third party before it reaches our secure environment.

In the future, information from this study may be securely shared with qualified individuals to help learn more about the experiences of children and families with the child welfare system. The information that is shared will only include a study ID number and not your name.

QUESTIONS

If you have questions, please call Jennifer Keeney at RTI, 1-800-334-8571 extension 23525 (toll-free number). If you have questions about your rights as a study participant, please call RTI 's Office of Human Research Protections at 1-866-214-2043 (a toll-free number).

Shape2 You will receive $50 gift card as a thank you for your input. If you skip some of the questions or decide to stop participating, you will still receive the $50. If you take part in future interviews, you will also receive a similar amount for those interviews.

Agreement to Participate in NSCAW

Do you agree to participate in the NSCAW interview? You can choose not to participate at any time.

1 = Yes, I agree to participate in the NSCAW interview.

2 = No, I do not agree to participate in the NSCAW interview.

Release of Contact Information

At some point in the future, a different group of researchers may take over this study. If that happens, with your consent, we would give contacting information for you and your child to the other group. Do you agree to have your contact information given to another research company if they start doing this study?

1 = Yes, I agree to have my contact information given to another research company if they start doing this study.

2 = No, I do not agree to have my contact information given to another research company if they start doing this study.

Audio Recordings Statement

We use a laptop quality control (QC) system for this study. The system runs on the computer and will record what you and I say to each other during parts of the interview. Neither you nor I will know when the computer records what we say. The recordings are used to review my work. The recordings are securely stored on my computer and transmitted back to RTI within 12 hours after this interview. They are stored on secure computers and only members of the project team can review them. The recordings will be destroyed at the end of the study after data have been cleaned and analyzed.

Do we have your permission to run this system during the interview?

1 = Yes, I agree to have parts of this interview recorded by the computer.

2 = No, I do not agree to have parts of this interview recorded by the computer.

Caregiver Permission for Child Participation

National Survey of Child and Adolescent Well-Being (NSCAW)

NSCAW

SELECTION OF CHILDREN AND OTHER PARTICIPANTS

RTI selected 4,000 children to take part in the study. Selected children had contact with the child welfare system over a 12-month period. We are following up with children and their caregivers approximately 36 months after the initial interview. The study includes interviews with selected children and their caregiver. The study also includes interviews with the child’s caseworker if the child and/or family received services since the last interview. We must have permission from a parent or legal guardian to include the child in the study.

PURPOSE OF THIS NSCAW INTERVIEW

We want to interview your child about their experiences with the child welfare system, you, and your family. Your child’s answers combined with the answers of others in the study will help us describe the needs of children and their use of available child welfare services.

TYPES OF QUESTIONS FOR CHILD

The interview with your child will last approximately 45 minutes. The interview with your child will take place over the phone and on the Internet. The interview includes questions about your child’s development, family experiences, school, and relationships with friends.

YOUR CHILD’S RIGHTS

You and your child can decide to take part in this study or not. Your child can refuse to answer any. If your child chooses not to join, this would not affect any benefits or services your family may be receiving. Your child has the right to stop the interview at any time.

RISKS

Taking part in this study presents no physical risks to your child. Some questions might make your child feel uneasy or feel various emotions, such as sadness. We have significant protections in place to collect and store our information securely. However, there is a small risk that if someone does not follow the rules we set, someone outside the study team might see your information. We minimize this risk by transferring and storing your information and interview data using a study ID and not your name.

BENEFITS

What we learn from your child may help to improve child welfare services and programs. By taking part, your child will help us learn more about the needs of children and the services available to them.

FUTURE CONTACTS

We may contact you and your child in the future for another round of interviews. This will help us understand changes over time. You and your child can decide at that time if you want to join.

PRIVACY

We keep your child’s responses private to the extent allowed by the law. We keep your child’s interview answers on a secure computer labeled with an ID number. We keep you and your child’s name private. All staff involved in this research have signed a Privacy Pledge.

Part of the study will ask your child to enter information in a secure website. We anticipate your child’s participation in this study presents no greater risk than everyday use of the Internet. Though we are taking precautions to protect your child’s privacy, you should be aware that if your child emails information in an unsecure manner, it could be read by a third party before it reaches our secure environment.

This research is covered by a federal protection called a Certificate of Confidentiality. This means the researchers cannot share the information they gather that may identify the child. The Certificate prevents researchers from revealing this information even if it is subpoenaed by a court.

We never identify a single person or family in our reports. Your child’s information will be combined with information from other people taking part in the study. When we write up the study to share it with other researchers, we will write about the combined information. Your child will not be identified in any published or presented materials.

QUESTIONS

If you have questions, please call Jennifer Keeney at RTI, 1-800-334-8571 extension 23525 (toll-free number). If you have any questions about your child’s rights as a study participant, you may call RTI's Office of Human Research Protections at 1-866-214-2043 (a toll-free number).

Shape3

We will give your child a gift card for participating. Children ages 11 or older will receive a $20 gift card and a small gift of equal value for taking part. If your child skips some of the questions or decides to stop participating, he or she will still receive the gift card. If your child participates in future interviews, a similar amount will be offered for participating in those interviews.

Agreement to Participate in NSCAW

Do you provide permission for your child to participate in the NSCAW interview?

1 = Yes, I give permission for my child to participate in the NSCAW interview.

2 = No, I do not give permission for my child to participate in the NSCAW interview.

Release of Contact Information Statement

At some point in the future, a different group of researchers may take over this study. If that happens, with your consent we would give contacting information for you and your child to the other group.

Do you agree to have you and your child’s contact information given to another research company if they start doing the study?

1 = Yes, I agree to have my contact information and the child’s contact information given to another research company if they start doing this study.

2 = No, I do not agree to have my contact information or the child’s contact information given to another research company if they start doing this study.

Audio Recordings Statement

We use a laptop quality control (QC) system for this study. The system runs on the computer. This system will make audio recordings of what the child and I say to each other during the interview. Neither the child nor I will know when the computer records what we say. Project staff at RTI will listen to the recordings only to review my work.

The recordings are securely stored on my computer and transmitted back to RTI within 12 hours after this interview. They are stored on secure computers and only members of the project team can review them. The recordings will be destroyed at the end of the study after data have been cleaned and analyzed.

Do we have your permission to run this system during your child’s interview?

1 = Yes, I agree to have parts of my child’s interview recorded by the computer.

2 = No, I do not agree to have parts of my child’s interview recorded by the computer.

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 and expiration date for this collection are OMB #: 0970-0202, Exp:09/30/2023. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Dr. Melissa Dolan; 230 W. Monroe Street, Suite 2100 Chicago, IL 60606.

Legal Guardian Permission for Child Participation

National Survey of Child and Adolescent Well-Being (NSCAW)

NSCAW

SELECTION OF CHILDREN AND OTHER PARTICIPANTS

RTI interviewers are currently conducting the next round of interviews with selected children and families. We are following up with selected children and their caregivers approximately 36 months after the initial interview. The study includes interviews with sampled children, their caregivers, and their caseworkers. A child under your guardianship was one of 4,000 children selected to take part in this study. We must have permission from a parent or legal guardian to include the child in the study. Once we obtain your permission, the child can make the decision to take part in the study.

PURPOSE OF THIS NSCAW INTERVIEW

We want to interview the child, their current caregiver, and their caseworker. Their responses combined with the answers of others in the study will help us describe the needs of children and families and their use of available child welfare services. Research reports will summarize the information collected and assist policy makers in improving the child welfare system.

TYPES OF QUESTIONS FOR CHILD

The interview with the child will last about 45 minutes. The interview with the child will take place over the telephone and on the Internet. We will ask children t about the kinds of things they can do, their experiences at home and at school, and their feelings about family and friends.

THE CHILD’S RIGHTS

The child’s participation in this study is completely voluntary. He or she can refuse to answer any and all questions. Taking part in the study will not affect any benefits the child may receive. The child has the right to stop the interview at any time.

RISKS

Taking part in this study presents no physical risks to the child. Some questions might make the child feel uneasy or feel various emotions, such as sadness. We have significant protections in place to collect and store our information securely. However, there is a small risk that if someone does not follow the rules we set, someone outside the study team might see the child’s information. We minimize this risk by transferring and storing the child’s information and interview data using a study ID and not the child’s name.

BENEFITS

Taking part in this study presents no direct benefits to the child. By taking part, the child will help us learn more about the needs of children and the services available to them.

FUTURE CONTACTS

We may contact the child again in the future. This will help us understand changes over time.

PRIVACY

We will keep the child’s responses private to the extent permitted by law. We keep the child’s interview answers on a secure computer labeled with an ID number. We do not identify the child by name. All staff involved in this research have signed a Privacy Pledge

Part of the study will ask the child to enter information in a secure website. We anticipate the child’s participation in this study presents no greater risk than everyday use of the Internet. Though we are taking precautions to protect the child’s privacy, you should be aware that if the child emails information in an unsecure manner, it could be read by a third party before it reaches our secure environment.

This research is covered by a federal protection called a Certificate of Confidentiality. This means the researchers cannot share the information they gather that may identify the child. The Certificate prevents researchers from revealing this information even if it is subpoenaed by a court.

We never identify a single person or family in our reports. The child’s information will be combined with information from other people taking part in the study. When we write up the study to share it with other researchers, we will write about the combined information. The child will not be identified in any published or presented materials.

QUESTIONS

Shape4 If you have questions, please call Jennifer Keeney at RTI, 1-800-334-8571 extension 23525 (toll-free number). If you have questions about the child’s rights as a study participant, please call RTI's Office of Human Research Protections at 1-866-214-2043 (a toll-free number).

The current caregiver will receive $50 in cash in appreciation of their input. We will also give each child a gift card for taking part in the study. If the child skips some of the questions or decides to stop participating, he or she will still receive the gift card. Children ages 11 or older will receive a $20 gift card and a small gift of equal value.

Agreement for Child’s Participation in NSCAW

Do you give permission for this child to participate in the NSCAW interview?

1= Yes, I give permission for this child to participate in the NSCAW interview.

2 = No, I do not give permission for this child to participate in the NSCAW interview.

Release of Contact Information Statement

At some point in the future, a different group of researchers may take over this study. If that happens, with your permission, we would give contacting information for the child to the other group.

Do you agree to have the child’s contact information given to another research company if they start doing this study?

1 = Yes, I agree to have this child’s contact information given to another research company if they start doing this study.

2 = No, I do not agree to have this child’s contact information given to another research company if they start doing the study.

Audio Recordings Statement

Do we have your permission to run this system during the child’s interview?

1 = Yes, I agree to have parts of this child’s interview recorded by the computer.

2 = No, I do not agree to have parts of this child’s interview recorded by the computer.

Caregiver of Emancipated Youth Informed Consent

National Survey of Child and Adolescent Well-Being (NSCAW)

NSCAW

The Administration for Children and Families (ACF) provides funding for activities that support the well-being of children and families. ACF has hired RTI International (RTI), a research company in North Carolina, to conduct a national survey of children and families in the child welfare system. RTI works with researchers at the University of North Carolina at Chapel Hill and Washington University in St. Louis to carry out the study.

SELECTION OF CHILDREN AND OTHER PARTICIPANTS

RTI selected over 4,000 children to take part in this study. We selected a child currently or very recently in your care to take part in the study. That child gave us their permission to approach you for an interview. Selected children had contact with the child welfare system during a 12-month period. We are following up with children and their caregivers roughly 36 months after the initial interview. The study also includes interviews with the child’s caseworker if the child and/or family received services since the last interview.

PURPOSE OF THIS NSCAW INTERVIEW

We want to interview you about the child, your experiences with the child welfare system and your family. Your answers combined with the answers of other caregivers in the study will help us describe the needs of children and their use of available child welfare services. What we learn from this information will help policy makers make improvements to the child welfare system.

TYPES OF QUESTIONS FOR PARENT

If you decide to take part, we will ask you some of the questions over the phone and others you will answer privately on the Internet. The total time for both parts is 45 minutes. The interview includes questions about the child’s learning, health, behavior, and relationships with friends. For older children, we ask about their involvement in potentially risky behaviors. We also ask about services your family may receive and your satisfaction with those services. We want to learn about your attitude towards raising children, your life experiences, and your involvement with school and community activities. The interview also includes questions about the community in which you live, and about things that may happen in your life like violence in the home, involvement with police and risky behaviors such as sexual activity and drug use.

YOUR RIGHTS

You can decide to take part in this study or not. You can refuse to answer any question. Taking part in the study does not affect any benefits you or the youth may receive. You have the right to stop the interview at any time.

RISKS

Taking part in the study presents no physical risks to you. Some questions might make you feel uneasy or feel emotions like sadness. We have significant protections in place to collect and store our information securely. However, there is a small risk that if someone does not follow the rules we set, someone outside the study team might see your information. We minimize this risk by transferring and storing your information and interview data using a study ID and not your name.

If we learn a child’s life or health may be in danger during your interview, we will share this information with the appropriate authorities. The Privacy section provides more detail below.

BENEFITS

What we learn from you can help to improve child welfare services and programs. By taking part, you will help us understand the needs of children and services available to them.

FUTURE CONTACTS

To help us understand changes over time, we may contact your child in in the future for another round of interviews.

PRIVACY

We keep your responses private to the extent allowed by the law. We keep your interview answers on a secure computer labeled with an ID number. We never identify you by name. All staff involved in this research have signed a Privacy Pledge.

QUESTIONS

Shape5 If you have questions, please call Jennifer Keeney at RTI, 1-800-334-8571 extension 23525 (toll-free number). If you have any questions about your rights as a study participant, please call RTI's Office of Human Research Protections at 1-866-214-2043 (a toll-free number).

You will receive a $50 gift card as a thank you for your input. If you skip some of the questions or decide to stop participating, you will still receive the $50 gift card. If you participate in future rounds, we will provide a similar amount in appreciation of your participation in those interviews.

Agreement to Participate in NSCAW

Do you agree to participate in the NSCAW interview? You can choose not to participate at any time.

1 = Yes, I agree to participate in the NSCAW interview.

2 = No, I do not agree to participate in the NSCAW interview.

Release of Contact Information Statement

At some point in the future, a different group of researchers may take over this study. If that happens, with your consent, we would give your contact information to the other group. Do you agree to have your contact information given to another research company if they start doing the study?

1 = Yes, I agree to have my contact information given to another research company if they start doing this study.

2 = No, I do not agree to have my contact information given to another if they start doing the study.

Audio Recordings Statement

Do we have your permission to run this system during the interview?

1 = Yes, I agree to have parts of this interview recorded by the computer.

2 = No, I do not agree to have parts of this interview recorded by the computer.

Emancipated Youth Consent Form / Permission for Caregiver Interview

Shape6 National Survey of Child and Adolescent Well-Being (NSCAW)

NSCAW

SELECTION OF YOUTH AND OTHER PARTICIPANTS

RTI interviewers will contact families of youth, like you, selected from child welfare agencies throughout the United States. We selected over 4,000 youth to participate in this study. We are following up with youth approximately 36 months after the initial interview. The study also includes interviews with caregivers and caseworkers.

PURPOSE OF THIS NSCAW INTERVIEW

By doing this study, your answers, combined with answers of other youth in the study, will help us describe the needs of children and their use of available child welfare services. If you decide to take part, we will ask you some questions over the phone and others you will answer privately on the Internet. The total time for both parts is 45 minutes.

We want to interview you about the kinds of things you can do, how you behave at home and at school, and your feelings about family and friends. We want to learn about people who may help you. We also want to ask about things your parents don’t know about or don’t like for you to do. This includes skipping school, smoking, drinking, vandalism, using drugs, sexual activities, and other risky or illegal behaviors. If you live with or have lived with a parent, grandparent, or other adult who took care of you in the last three months, we will request your permission to speak with that person.

PURPOSE OF THE NSCAW CAREGIVER INTERVIEW

The interview with the person who took care of you may last up to 45 minutes. We will ask them questions about services your family receives, family relationships and support, life experiences, and involvement with school and community activities. We will also ask questions about your learning, behavior, health, and friendships.

YOUR RIGHTS

You can decide to take part in the study or not. You can refuse to answer any and all questions. Taking part does not affect any benefits you may receive. You have the right to take a break, or stop the interview at any time.

RISKS

Taking part in this study presents no physical risks to you. Some questions might make you feel uneasy or feel various emotions, such as sadness. We have significant protections in place to collect and store our information securely. However, there is a small risk that if someone does not follow the rules we set, someone outside the study team might see your information. We minimize this risk by transferring and storing your information and interview data using a study ID and not your name.

BENEFITS

Taking part presents no direct benefits to you for answering our questions. What we learn from you may help to improve child welfare services and programs.

FUTURE CONTACTS

We may contact you again in the future for another interview. This will help us understand changes over time. You can decide to join at that time.

PRIVACY

We keep your responses private to the extent allowed by the law. We keep your interview answers on a secure computer labeled with an ID number. We do not identify you by name. All staff involved in this research signed a Privacy Pledge.

QUESTIONS

If you have any questions, please call Jennifer Keeney at RTI, 1-800-334-8571 extension 23525 (toll-free number). If you have any questions about your rights as a study participant, please call RTI’s Office of Human Research Protections, 1-866-214-2043 (toll-free number).

You will receive a $50 gift card for taking part in the survey. If you skip some of the questions or decide to stop participating, you will still receive the $50 gift card. If you participate in future interviews, we will provide a similar amount in appreciation of your participation in those interviews.

Agreement to Participate in NSCAW

Do you agree to participate in the NSCAW interview?

1 = Yes, I agree to participate in the NSCAW interview.

2 = No, I do not agree to participate in the NSCAW interview.

Release of Contact Information Statement

At some point in the future, a different group of researchers may take over this study. If that happens, with your consent, we would give contact information for you to the other group.

Do you agree to have your contact information given to another research company if they start doing the study?

1= Yes, I agree to have my contact information given to another research company if they start doing the study.

2= No, I do not agree to have my contact information given to another research company if they start doing the study.

Agreement to Contact Current/Most Recent Caregiver

For youth that have lived with a caregiver in the last three months, we would like to contact this person for an interview with your permission.

Do you give permission for an interviewer to approach your current caregiver or most recent caregiver for an interview?

1= Yes, I give permission for an interviewer to approach my current/most recent caregiver for an interview.

2 = No, I do not give permission for an interviewer to approach my current/most recent caregiver for an interview.

Audio Recordings Statement

Do we have your permission to run this system during the interview?

1 = Yes, I agree to have parts of the interview recorded by the computer.

2 = No, I do not agree to have parts of the interview recorded by the computer.

Assent Agreement for Youth Aged 11 to 17

National Survey of Child and Adolescent Well-Being (NSCAW)

Hello, my name is __________________. ______________ has given permission for you to talk with me today.

Introduction

We would like to invite you to join a research study. A research study is a way to find out new information about something. You can take part or not. Either way is fine. Please ask any questions before you decide.

Purpose

The government wants to learn about the needs of children like yourself and to help improve programs and services for children. We are talking to over 4,000 kids across the United States about this study. We want to follow up with children about 36 months after the initial interview to see how things have changed over time. We are also talking to one of your parents or the person who take cares of you the most. The government hired a research company in North Carolina to do this study of children and families. I work for this research company.

Types of Questions

If you agree to join, we will ask questions about the kinds of things you can do, how you behave at home and at school, how you feel about your family and friends, and about people who may help you. We also want to ask you about things you may do that your parents don’t know about or don’t like for you to do. This includes things like skipping school, smoking, drinking, vandalism, using drugs, sexual activities, and other risky or illegal behaviors. We also ask questions about things that may have happened in your life like violence in the home. You may find that some of these questions bring back sad or frightening memories.

Time Involved

Our talk today will last around 30 minutes. We will also ask you to complete some questions online where you will have more privacy.

Possible Risks or Discomforts

We ask questions that might make you feel uneasy or sad. You do not have to answer questions you do not want to answer. If you want to stop, then all you have to do is tell me. If you want to take a break at any time, just tell me.

Possible Benefits

What we learn from this study might help children like you across the U.S.

Payment

When we finish, we will provide you with a $20 gift card and a small gift of equal value for taking part. If you skip some of the questions or decide to stop participating, you will still receive the gift card.

Privacy

We do many things to make sure your answers stay private. I am going to enter your answers into a laptop computer. We have a paper from the government that promises that we do not have to give your information to anyone. We will not tell anyone your answers unless we are worried about you or someone else’s safety. For example, if you tell us you might hurt yourself or someone else, we may tell someone. If you tell us someone hurts you, we may tell authorities to keep people safe.

Future Contacts

We may contact you again in the future. This is to see if you want to talk with us again. You can decide at that time if you want to talk to us again.

Agreement to Participate in NSCAW

Do you agree to take part in the NSCAW interview?

1= Yes, I agree to take part in the NSCAW interview.

2 = No, I do not agree to take part in the NSCAW interview.

Audio Recording Statement

We use a quality control (QC) system on the computer. The system runs on the computer and may record what you and I say to each other. You and I will not know when the computer records what we say. My bosses will listen to the recordings to monitor my work. We keep the recordings for those purposes only and we keep them private. We destroy the files after this review. Project staff who listen to the recording will know who I am but will not know who you are.

Do we have your okay to run this system during the interview?

1 = Yes, I agree to have parts of this interview recorded by the computer.

2 = No, I do not want any parts of this interview recorded.

Young Adult Informed Consent

National Survey of Child and Adolescent Well-Being (NSCAW)

NSCAW

SELECTION OF YOUNG ADULTS

RTI interviewers will contact young adults, like you, selected from child welfare agencies throughout the United States. We selected over 4,000 youth to take part in this study. We want to follow up with youth 36 months after the initial interview to see how things may have changed.

PURPOSE OF THIS NSCAW INTERVIEW

Your interview will take 45 minutes. We want to interview you about your life experiences. The questions will focus on your health, employment, relationships, social support system, behaviors, and use of services. The interview will also ask questions about the community in which you live, and about things that may happen in your life like involvement with the police, and risky behaviors such as sexual activity and drug use. Your answers, combined with the answers of other youth in the study, will help us describe the needs of children and their use of available child welfare services. What we learn from this information will help policy makers make improvements to the child welfare system.

YOUR RIGHTS

RISKS

Taking part in this study presents no physical risks to you. Some questions may make you feel uneasy or feel various emotions, such as sadness. We have significant protections in place to collect and store our information securely. However, there is a small risk that if someone does not follow the rules we set, someone outside the study team might see your information. We minimize this risk by transferring and storing your information and interview data using a study ID and not your name.

BENEFITS

Taking part presents no direct benefits to you for answering our questions. What we learn from you may help to improve child welfare services and programs.

FUTURE CONTACTS

To help us understand changes over time, we or other researchers may contact you in the future to update our information. You can decide to join at that time.

PRIVACY

QUESTIONS

Shape7 If you have any questions, please call Jennifer Keeney at RTI, 1-800-334-8571 Extension 23525 (toll-free number). If you have any questions about your rights as a study participant, please call RTI's Office of Human Research Protections at 1-866-214-2043 (a toll-free number).

You will receive a $50 gift card for taking part in the survey. If you skip some of the questions or decide to stop participating, you will still receive the $50 gift card.

Agreement to Participate in NSCAW

Do agree to participate in the NSCAW interview?

1 = Yes, I agree to participate in the NSCAW interview.

2 = No, I do not agree to participate in the NSCAW interview.

Release of Contact Information Statement

At some point in the future, a different group of researchers may take over this study. If that happens, with your consent, we would give contact information for you to the other group.

Do you agree to have your contact information given to another research company if they start doing the study?

1= Yes, I agree to have my contact information given to another research company if they start doing the study.

2 = No, I do not agree to have my contact information given to another research company if they start doing the study.

Audio Recordings Statement

Do we have your permission to run this system during the interview?

1 = Yes, I agree to have parts of the interview recorded by the computer.

2 = No, I do not agree to have parts of the interview recorded by the computer.

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
Author	Keeney, Jennifer
File Modified	0000-00-00
File Created	2022-05-19