Informed Consent Agreement

Parent 2 Parent Project Parent Survey

Please read this consent agreement carefully before you decide to participate in this project.

Purpose of the Project: This purpose of the Parent 2 Parent Project is to develop, refine and disseminate up-to-date resources and education to parents of sexually abusive youth, which is designed to increase parent knowledge of healthy sexual exploration and inappropriate or harmful sexual behaviors for children and teens. You are a critical piece of this process and your willingness to collaborate with the New England Adolescent Research Institute (NEARI) on this project will truly enhance the quality and utility of the Parent 2 Parent materials for parents.

Completing this survey is estimated to take 10-15 minutes.

Risks: If talking about these issues causes emotional distress, please discuss your feelings with your clinician or provider, and/or your own support network. If you have questions about the project or the process of participating, please contact Project Coordinator Krysten E. Lobisch (contact information below). You will also be provided with a list of resources for counseling and help regarding child sexual abuse, if you choose.  

Benefits: As an incentive for the completing the survey, each participating parent will receive a $10 Amazon Gift Card. We must confirm all survey submissions are complete and genuine before distributing gift cards. All survey questions must be completed satisfactorily with relevant information, must be legible and understandable, and we must be able to contact you directly. Additional benefits of the study include the contributing to the development of in-person trainings, online support and trainings, and prevention materials.

Confidentiality: The information that you provide will be handled confidentially. Your information will be de-identified by assigning a code name. The list connecting your name to this code will be kept in a password-protected file on a password-protected server. When the study is complete and the data has been analyzed, this list will be destroyed. All hard copy files will be kept in a locked cabinet. Your name will not be used in any report.

Voluntary participation: Your participation in the survey is completely voluntary. You have the right to withdraw from the survey at any time without penalty. If you decide to withdraw, your data will be destroyed.

There is no penalty for withdrawing. You may skip specific questions at any time. If you would like to withdraw after your materials have been submitted or have questions about the project, contact:

Ms. Krysten E. Lobisch, M.Ed.,
Project Coordinator

413.540.0712 x60
klobisch@neari.com

Please complete your name (or initials, alias, etc.), the date, and an email address for gift card dissemination below to continue. Thank you! 

* 1. Name (you may choose to stay anonymous or be identified in some other way, such as initials only):

* 2. Date:

* 3. Email Address (optional): 

* 4. What is your gender? 

* 5. What race do you primarily identify as?

* 6. What is the primary language you speak at home?

* 7. What is your age?

* 8. What religion do you practice?

* 9. What is the highest level of education you have completed?

T