1. Informed Consent

Title of Project: The School Mental Health Collaboration Instrument: Development and Initial Psychometrics

Principal Investigator:
Elizabeth Mellin, Ph.D., LPC (Principal Investigator)
The Pennsylvania State University
327 CEDAR Building
University Park, PA 16802
814-863-2414; eam20@psu.edu

Mark Weist, Ph.D., University of South Carolina
Leslie Taylor, Ph.D., University of South Carolina

1. Purpose of the study: The purpose of the study is to explore influences on, involvement in, and benefits of collaboration between school professionals and mental health professionals from collaborating agencies.

2. Procedures to be followed: You will be asked questions about your perceptions of what facilitates and impedes collaboration, how involved you are in collaborative activities, and what you observe to be the benefits of collaboration.

3. Duration: It will take about 15 minutes to complete the instrument and the deadline to complete the study is Monday, April 9.

4. Statement of confidentiality: No names will be collected so that neither the researchers nor others will have any record of your individual responses. The results of this study will be analyzed and disseminated as collective statistics without directly discussing any individual response. During the study, the data will be stored and secured in 310 CEDAR Building, University Park, PA 16802 or in a password-protected file. Your confidentiality will be kept to the degree permitted by the technology used. No guarantees can be made regarding interception of data sent via the Internet by any third parties.

5. Right to ask questions: Please contact Elizabeth Mellin at 814-863-2414 or eam20@psu.edu with questions or concerns about this study.

6. Payment for participation: Each participant in this study will have the opportunity to enter a drawing for $15 Starbucks gift cards. Winners of the drawing will be notified within 7 days of the deadline to participate in this study and will receive their gift card within 14 days of that notification.

7. Voluntary participation: Your decision to be included in this research study is voluntary. You can stop at any time. You do not have to answer any questions you do not want to answer.

You must be 18 years of age or older and a practicing school professional or mental health professional from a collaborating agency to take part in this research study. If you agree to participate and you have read the information outlined above, please indicate your consent by proceeding with this survey. If you are not interested in participating in this study or do not meet the criteria described previously, please do not complete the survey.

Please print this form to keep for your records.

17% of survey complete.