Introduction and Informed Consent 2025

Attachment J_Introduction and Informed Consent 2025.pdf

National Household Survey on Behavioral Health (NHSBH)

Introduction and Informed Consent 2025

OMB: 0930-0110

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ADULT RESPONDENTS:
INTRO TO CAI -- INTRODUCTION AND INFORMED CONSENT FOR
INTERVIEW RESPONDENTS AGE 18+
INTRODUCE YOURSELF AND STUDY AS NECESSARY: Hello, I’m ________, and
I’m working on a nationwide study sponsored by the U.S. Department of Health and
Human Services. You should have received a letter about this study. (SHOW LEAD
LETTER, IF NECESSARY.)
READ THE BOXED INFORMATION BELOW
BEFORE STARTING EVERY INTERVIEW

This year, we are interviewing about 70,000 people across the nation. You have been
randomly chosen to take part. You will represent over 4,500 other people who are
similar to you. You may choose not to take part in this study, but no one else can take
your place. We will give you $30 when you finish the interview.
GIVE STUDY DESCRIPTION TO R IF YOU HAVE NOT ALREADY DONE SO.
This study asks about tobacco, alcohol, and drug use or non-use, knowledge and
attitudes about drugs, mental health, and other health issues. It takes about an hour.
You will answer most of the questions on the computer, so I will not see your answers.
We are only interested in the combined responses from all 70,000 people, not just one
person’s answers. This is why we do not ask for your name and we keep your
answers separate from your address. RTI may contact you to ask a few questions
about the quality of my work. This is why we ask for your phone number and current
address at the end of the interview.
You may consider some of the questions to be sensitive in nature and some questions
may also make you feel certain emotions, such as sadness. For example, the interview
asks questions about criminal history, depression, suicide and other topics. If you
become upset during the interview and wish to speak to a mental health professional
about how you are feeling, I can provide you with a toll-free helpline number.
While the interview has some personal questions, federal law keeps your answers
private. We hope that protecting your privacy will help you to give accurate answers.
You can quit the interview at any time and you can refuse to answer any questions.
If it is all right with you, let’s get started.
(Can we find a private place to complete the interview?)

YOUTH RESPONDENTS:
PARENTAL PERMISSION SCRIPT, PART OF INTRODUCTION AND INFORMED
CONSENT FOR INTERVIEW RESPONDENTS AGE 12-17
A TRANSLATOR CANNOT BE USED FOR ANY PORTION OF THE
PARENTAL PERMISSION AND YOUTH INFORMED CONSENT PROCESS
READ THE SCRIPT BELOW AND OBTAIN PERMISSION FROM THE
PARENT/GUARDIAN

Your (AGE) year-old child has been selected to be in this study. Your child’s
participation is voluntary. This interview asks about tobacco, alcohol, and drug use
or non-use, knowledge and attitudes about drugs, mental health, and other health
related issues.
Your child may consider some of the questions to be sensitive in nature and some
questions may also make your child feel certain emotions, such as sadness. For
example, the interview asks questions about criminal history, depression, suicide
and other topics. Your child can refuse to answer any questions and can stop the
interview at any time. If your child becomes upset during the interview and wishes
to speak to a mental health professional about how they are feeling, I can provide
you with a toll-free helpline number.
All of your child’s answers will be confidential and used only for statistical purposes.
Since your child will answer most of the questions on the computer, I will never see
the answers, and you are not allowed to see them either. If it is all right with you,
we’ll get started.
(Can we find a private place to complete the interview?)

ONCE PARENTAL PERMISSION HAS BEEN GIVEN, CONFIRM THE
PARENT/GUARDIAN OR ANOTHER ADULT WILL BE PRESENT FOR THE
DURATION OF THE INTERVIEW
THEN, READ THE BOXED INFORMATION ON THE NEXT PAGE BEFORE
STARTING EVERY INTERVIEW WITH A 12-17 YEAR OLD

YOUTH RESPONDENTS:
INTRO TO CAI -- INTRODUCTION AND INFORMED CONSENT FOR
INTERVIEW RESPONDENTS AGE 12-17 (CONTINUED)
READ THE BOXED INFORMATION BELOW BEFORE STARTING EVERY
INTERVIEW WITH A 12-17 YEAR OLD
This year, we are interviewing about 70,000 people across the nation. You have been
randomly chosen to take part. You will represent over 1,000 young people in this
country who are similar to you. You may choose not to take part in this study, but no
one else can take your place. We will give you $30 when you finish the interview.
GIVE STUDY DESCRIPTION TO R IF YOU HAVE NOT ALREADY DONE SO.
This study asks about tobacco, alcohol, and drug use or non-use, knowledge and
attitudes about drugs, mental health, and other health issues. It takes about an hour.
You will answer most of the questions on the computer, so I will not see your answers.
Your answers will never be seen by either your parents or your school. We are only
interested in the combined responses from all 70,000 people, not just one person’s
answers. This is why we do not ask for your name and we keep your answers
separate from your address. RTI may contact you to ask a few questions about the
quality of my work. This is why we ask for a phone number and your current address
at the end of the interview.
You may consider some of the questions to be sensitive in nature and some questions
may also make you feel certain emotions, such as sadness. For example, the interview
asks questions about criminal history, depression, suicide and other topics. If you
become upset during the interview and wish to speak to a mental health professional
about how you are feeling, I can provide you with a toll-free helpline number.
While the interview has some personal questions, federal law keeps your answers
private. We hope that protecting your privacy will help you to give accurate answers.
You can quit the interview at any time and you can refuse to answer any questions.
If it is all right with you, let’s get started.


File Typeapplication/pdf
File TitleMicrosoft Word - Attachment J_Introduction and Informed Consent 2025
Authorcjewett
File Modified2024-07-26
File Created2024-07-26

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