Appendix D. Parent Focus Group Consent Form

Appendix D. Parent Focus Group Consent Form

OMB Control No: 0970-0531

Expiration Date: 07/31/2022

Youth Empowerment IDEAS Parent Focus Group Consent Form

On behalf of the Administration for Children and Families (ACF) of the U.S. Department of Health and Human Services, Mathematica is conducting voluntary focus group discussions with parents of teens who recently participated in the [INSERT PROGRAM NAME] program at [LOCATION]. The purpose of the focus groups is to get parent feedback about the [PROGRAM NAME], and to learn more about parents’ opinion on sexual risk avoidance, sexual health, and relationship education programs.

The focus group will take place through QualBoard. QualBoard is an online bulletin board where you will be able to see and respond to questions as well as read and respond to your fellow participant’s answers. You will be asked to log in for three sessions, each lasting approximately 30 minutes. At the start you will enter your name, initials or an alias (fake name). This will help us track the conversation. Please do not enter your full name here. The research team will write a public report which summarizes the findings across all of the focus groups at the end of the study. No participants’ names or feedback will be disclosed or used, in identifiable form, for any other purpose except as required by law. Your consent to participate will be exported from Qualboard and sent to Mathematica via secure data exchange. All materials will be destroyed at the end of the research study.

Your participation is entirely voluntary. You do not have to participate if you do not want to. The discussion will cover topics that may be uncomfortable for some people to discuss, including opinions about teen sexual behavior and sexual education. You do not need to answer any question or discuss a topic if you do not want to. The study team will also ask all participants in the group to keep the information discussed private. There is a chance others might share information from the discussion with people who did not participate. We ask all participants to respect the privacy of others in the group by not discussing specifics with others outside the group.

The feedback received from parents will provide ACF and Mathematica with valuable information to improve relationship education programs for youth. You will be given a $10 gift card after each of the three sessions you complete as a thank you for your participation. Additionally, if you complete all three sessions you will be given a $5 bonus, for a total of $35. Your gift card will be emailed to you after all three sessions are completed.

If you have any questions about the focus groups, please contact Tiffany Waits, the Youth Empowerment IDEAS focus group director, at twaits@mathematica-mpr.com or (202) 264-3498. If you have any questions or concerns about your rights as a study participant, please contact the Health Media Lab Institutional Review Board at (202) 753-5040.

If you agree to participate, please select “yes” below and you can begin the first session of the online focus group. If you do not agree, please select “No” and you will exit the focus group.

 Yes 1

 No 2

THE PAPERWORK REDUCTION ACT OF 1995

The described collection of information is voluntary and will be used to provide the Administration for Children and Families with information to help develop and refine program and grantee processes in the area of adolescent pregnancy prevention. Public reporting burden for the described collection of information is estimated to average 90 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. 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 the described collection are OMB #: 0970-0531, Exp: 07/31/2022. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to Caryn Blitz at Caryn.Blitz@acf.hhs.gov.

Mathematica 1