Informed Consent to Participate in Survey

Welcome to the Experiences in Accessing Mental Health Treatment Survey, and thank you so much for participating.

Our names are Kim Hager, LICSW, and Maria Martinez Calderon, LMHC. We both work as outpatient therapists at Children’s Friend, Inc., an affiliate of Seven Hills Foundation. We work with families with children with mental health conditions, medical conditions, and rare diseases. The purpose of this research is to explore the experiences in and barriers to accessing mental health services for parents who are caring for children with mental health conditions, medical conditions, and/or rare disease. In this study, we are defining a barrier as any factor or obstacle that prevents access to mental health services that a child needs. A mental health condition is defined as a disorder that affects one’s mood, thinking, and behavior. A medical condition is defined as a common physical disease that negatively impacts different organs in one’s body and it is not classified as a rare disease. A rare disease is defined as a medical condition that affects fewer than 200,000 people in the United States. By completing this survey, you will add to our understanding of what prevents families from accessing the mental health care their children need.

You are asked to complete this survey if: You are a parent or guardian of a child under the age of 18, with a mental health condition, a medical condition, and/or a rare disease, and the child lives in your home. If you agree to take part in this study, you will be asked questions about different aspects of accessing mental health care. Please be aware that you may find some of the questions sensitive. You do not need to answer questions that make you feel uncomfortable; however, the survey is anonymous. The information gathered from this survey is important in helping us identify ways to make access to mental health care easier for families.

The survey should take approximately 10 to 20 minutes to complete. The questions are adapted from a validated measure called the Barriers to Treatment Participation Scale developed by Alan Kazdin and from a Parental Needs Survey designed by Lemuel Pelentsov. The majority of the questions are multiple-choice, and at the end of the survey, you will have an opportunity to add any other thoughts you have. We encourage you to write in the last question as often your thoughts provide the most valuable information. The information you provide will remain confidential and all results will be de-identified. All data collected will be stored in a secure location. The survey is anonymous. You can withdraw at any time during the survey, up until the time that the “done”’ button is selected at the end of the survey. By completing the survey, you are consenting to participate in the study.

The responses you provide will be very useful in helping us obtain a comprehensive understanding of the experiences of and barriers to accessing mental health care for parents caring for children with a mental health condition, a medical condition, and/or rare disease, regardless of what condition your child has. If you have questions about this project, please contact Kim Hager, LICSW, or Maria Martinez Calderon, LMHC, at Children’s Friend, Inc. at 508-753-5425.

Formal ethics approval has been granted for this survey by the Institutional Review Board at Seven Hills Foundation.

Question Title

* 1. Do you consent to participate based on the information provided?

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