Sample Consent

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UNIVERSITY OF MASSACHUSETTS LOWELL

Institutional Review Board

Informed Consent Form

Date Prepared: March 18, 2005

Project Title: Other Children in the Family

Principal Investigator: Doreen Arcus, Ph.D.

Co-Researcher(s): Meghan McCarthy

APPROVED FOR USE BY THE UNIVERSITY OF MASSACHUSETTS LOWELL INSTITUTIONAL REVIEW BOARD.

Signature of IRB Administrator Date of Approval

This Informed Consent Form is valid for a period not to exceed one year from the Date of Approval appearing above.

Purpose

You are invited to participate in a research study that involves exploring the experiences of individuals who grew up in families with more than one child, either by birth or by providing foster care. We are interested in what you recall of your relationships with these other children and any perceived impacts they had on you.

Procedure and Duration

You are being asked to participate in a three-part study. The first is participation in a focus group involving 3-5 participants with similar family structures. A group facilitator will pose questions for discussion about your experiences with siblings and/or foster siblings. You will be free to respond, or not respond, as you are comfortable. During the discussion, a research assistant will keep notes and the discussion will be audiotaped so that accuracy can be checked afterwards; the tapes will then be destroyed. This should take about one hour.

Second, after the focus group has completed its discussion, you will be asked to complete three short standard questionnaires that ask about: (a) your childhood personality, (b) stresses or traumas that may be associated with your siblings, and (c) general demographic information (age, size of family, etc.). This should take 15-20 minutes.

Finally, we will ask you to rate the extent to which you agree or disagree with comments that are made across all of the focus groups that we will be conducting. This questionnaire will be mailed to you within 6 weeks after you have met in your focus group and we will include a stamped, self-addressed envelope for its return; alternatively you may choose to use the online version of this questionnaire. This should take no more than 30 minutes; total time in the study should not exceed two hours.

Risks and Discomfort

There are no foreseen risks to your participation. If you are uncomfortable with any of the questions asked, you do not need to answer them. If you are made uncomfortable by any aspect of your participation, please contact Dr. Arcus at the number on the on the reverse side of this form at any time.

Incentives/Compensation

When you complete your participation, we will mail you two movie tickets as a token of our thanks.

Benefits

There are no foreseen benefits to your participation other than the knowledge that you will be contributing to our knowledge of families and individual development.

Project Title: Other Children in the Family Page 2 of 2

Refusal or Withdrawal of Participation

Participation in this study is completely voluntary. Whether you choose to participate or not to participate will not affect you or your relationships with the researcher, the university, or any other agency. You may discontinue your participation in this research program at any time without penalty or costs of any nature, character and kind.

Privacy and Confidentiality

Because this study involves conversation with other individuals whose behavior cannot be regulated after they leave the session, we cannot assure total confidentiality in what you elect to say in the focus group. You will be identified by first name only. We will ask all participants to respect everyone’s privacy, but have no way to ensure it. No one will be forced or coerced to answer any questions or participate in discussion at any point, so if you are not comfortable sharing any particular information, you should feel free not to do so. Your name will not be on any of the forms you complete for this study; they will contain only an identification number. A single page will contain both the number and your name/contact information, and it will be kept in a locked file cabinet.

Although we are taping the focus groups, the tapes are only to help us to transcribe comments and not to link individuals to the things they said. They will be reviewed only by research assistants connected with this project and not shown under any other circumstances. As soon as the comments have been written down, the tape will be destroyed.

Additional Information

If you do not understand any portion of what you are being asked to do or the contents of this form, the Researchers are available to provide a complete explanation. If you have any questions about anything related to this research, please feel free to ask them at any time even after the study has been completed. Both Meghan McCarthy and Dr. Doreen Arcus can be reached at the following address and phone:

Department of Psychology Office: 978-934-4172

University of Massachusetts Lowell Lab: 978-934-4377

870 Broadway; Lowell, MA 01854

Doreen Arcus, Ph.D., Principal Investigator Date Signed

Meghan McCarthy, Co-Researcher Date Signed

By signing below I agree that I understand the foreseeable risks and/or discomfort that have been described in this document. I have read the statements contained herein, have had the opportunity to fully discuss my concerns and questions, and fully understand the nature and character of my involvement in this research program as a participant and the attendant risks and consequences.

Research Participant Date

A COPY OF THIS INFORMED CONSENT FORM IS TO BE GIVEN TO THE RESEARCH STUDY PARTICIPANT WHO HAS SIGNED THIS FORM, AND THE ORIGINAL SHOULD BE RETAINED BY THE RESEARCHER.