Electronic Informed Consent For Survey Participation

Contact information:  Michelle Scott, Ph.D., mscott@monmouth.edu


Dear NJ PTA Member,

You are invited to participate in a research study of the mental health and suicide prevention needs of youth and their parents. This research project looks to gain valuable insight from parents on their experiences and needs regarding youth mental health challenges and/or suicide risk. Questions are focused on learning what your needs are as parents/caregivers regarding your knowledge, experience, and needed supports regarding mental health and suicide risk of your children or youth, in general.  You do not need to have had personal experience with mental health or suicide risk to participate in the survey.  The procedure includes competing a 10-20 minute web-based survey.

The Monmouth University Institutional Review Board approved the study and procedures. The study involves no foreseeable risks or harm to you. However, you may experience feelings of anxiety, guilt, or worry about your child’s mental health or suicide risk; these feelings are not expected to be any greater than anything participants encounter in ordinary life. This research project looks to recognize the needs of parents and caregivers regarding youth mental health and suicide risk. There are no direct benefits to you by completing the survey.  However, the goals of this survey include obtaining parental perspective as it relates to identifying the emotional needs of children, seeking treatment, and finding support for these emotional needs. Your responses will help us to create and provide resources for parents and other key resources such as primary care/pediatricians to address the important gaps in education and awareness related to mental health and suicide risk. 

You are free to ask any questions about the study by contacting Michelle Scott, mscott@monmouth.edu. For questions about your rights as a research participant, please contact Deborah Smith of the Institutional Review Board (IRB) by phone at (732) 263-5726 or via e-mail at irb@monmouth.edu.

Your participation in this study is voluntary; you are under no obligation to participate. You may stop answering questions or skip questions at any time if you feel uncomfortable.

Data will be collected using the Internet; no guarantees can be made regarding the interception of data sent via the Internet by any third party.  Confidentiality will be maintained to the degree permitted by the technology used. The data you provide will be held in the strictest confidence. The completed study will not include individual results or responses. Confidentiality will be maintained. All data will be collected by Michelle Scott and stored in a secure place, data, with any personal identifiers removed, will be held indefinitely on a secure, password protected computer.

If your participation in our survey has caused you to feel uncomfortable in any way, or if our survey prompted you to consider personal matters (for yourself or someone you care about) about which you are concerned, we encourage you to contact any of the following resources: the National Suicide Prevention Lifeline (1-800-273-8255), 2nd Floor Youth Line (1-888-222-2228), the New Jersey Hopeline (1-855-654-6735), or the Crisis Text Line (741741 or www.crisistextline.org/). Additionally, immediate and local resources and support for your child and family can be provided through the New Jersey Children’s System of Care (Perform Care) by calling (877) 652-7624.

By clicking “Agree” below you voluntarily consent to participate in this study. You may print this form for your records.

Question Title

* 1. ELECTRONIC CONSENT: Please select your choice below.

Clicking on the "agree" button below indicates that:

· you have read the above information

· you voluntarily agree to participate

· you are at least 18 years of age

If you do not wish to participate in the research study, please decline participation by clicking on the "disagree" button.