CONSENT FORM
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Examining the Relationship between Traumatic Brain Injury and the Onset of Schizophrenia-Like Symptoms: A Case Control Study
I have been referred to participate in a research study that is attempting to gain a better understanding of the relationship between Traumatic Brain Injury (TBI) and schizophrenic-like symptoms. The research study in which I will be participating is part of the principal investigator’s requirement to complete a doctoral degree. I was provided this referral to be a possible participant because I am client at a participating private practice office. There is no other reason for requesting my participation other than my diagnosis of a TBI and schizophrenia. A total of seven participants will be recruited for this study. The purpose of this study is to examine the relationship between TBI and schizophrenic-like symptoms in order to aid in more efficient treatment, diagnosis, and overall level of care. Further, this study will examine TBI victims with a subsequent presentation of schizophrenia-like symptoms and no history of psychosis to identify any unique neuropsychological pattern and profiles in terms of relative strengths and weaknesses in each cognitive domain.
If I agree to be in this study I will be asked to fill out a survey anonymously. I understand that I can chose to provide my contact information at the end of the survey to participate in a neuropsychological assessment at no cost if I qualify based on my responses to the questions in the survey. If I agree to be in this study I will be asked to complete a clinical interview and nine neuropsychological tests. No audio or video taping will occur over the course of this study. The length of time for participation will vary based on my individual needs but will last an estimated 8 hours. This can occur over several sessions. Each session will consist at a minimum of 2 hours per session over the course of no longer than 7 days to complete testing in its entirety. The risks associated with the study are potential fatigue and is time consuming. There are no immediate benefits expected from participating in this study. Mental health, group support, and a Crisis referral will be provided as part of my participation in the study.
I understand I will receive no monetary compensation from participating in this study as well as it will not cost me anything to participate in this study. The records of this study will be kept private. The information/data I provide for this research will be treated confidentially and all raw data will be kept in a secure lock box by the principal investigator. All raw test data will be destroyed after the completion of this study and the data will not be used for any outside purposes. No words linking me to this study will be included in any sort of report that might be published. Research records will be stored securely and will only be accessible by the principal investigator, Denise Romanow, and Dr. Frank Mordini, Dr. John Tirado, Dr. Andrew Suth, Dr. Christopher Rector, the Committee members of this study at ISPP at Argosy University. I have the right to get a summary of the results of this research if I would like them.
I understand that my participation is strictly voluntary. My decision regarding my participation will not affect my current or future relationship with the Illinois School of Professional Psychology and my referring doctors. If I decide to participate, I am free to refuse to answer any of the questions that may make me uncomfortable. I, as the participant of this study, can withdraw at any time without my relations with the University, job, benefits, etc., being affected. I can contact Denise Romanow, Dromano2@stu.argosy.edu or Dr. John Tirado, jtirado@argosy.edu with any questions about this study.