Provincial Wellness Consent form
Project Title: Provincial Wellness Project
Principal Investigator: Dr. Scott McLean
Faculty of Arts and Project Lead
403-401-4215 | firstname.lastname@example.org
Co-Investigators: Dr. D. Scharie Tavcer
Faculty of Arts
403-440-6383 | email@example.com
Dr. Patricia Kostouros
Faculty of Health, Community & Education
403-440-6440 | firstname.lastname@example.org
Sponsor: Department of Justice Canada – Victims Fund
Please note this consent form serves to provide an overview of what the research project in question is about and what your participation would entail; it is only one part of the consent process. For further information, please ask. Read this consent carefully and be sure to understand any accompanying information. You will receive a copy of this form.
Heese (2002) provided an understanding of secondary traumatic stress (STS) as when an individual (Program Managers, staff, and volunteers) has knowledge of trauma and experiences it similarly to how the victim would experience it, even though the staff or volunteer was not directly victimized. Such trauma can seriously impact Program Managers, staff and volunteers’ personal and professional wellbeing as it has potential short and long-term consequences. In addition, the consequences can lead to symptoms similar to PostTraumatic Stress Disorder (PTSD).
A basic demographic survey will be collected in addition to the Professional Quality of Life (ProQOL) questionnaire and the Provincial Wellness Project (PWP) survey. These will be administered on three (3) occasions. Responses to the surveys will be compared and analyzed. Results of the general characteristics of secondary traumatic stress will be examined as a group without individual identification.
What Would My Involvement Include?
- You will be asked to reflect and report on your experiences as personnel (Program Manager, staff, and volunteers) within the police-based victim assistance unit.
- You will complete the Demographic survey that provides information such as gender, age, marital status, years of service, and role within victim services.
- You will complete the ProQOL questionnaire that asks about your satisfaction and fatigue characteristics in context with your role with victim assistance.
- You will complete the PWP survey that will reflect your individual and collective experiences at victim services.
- Your time to complete the surveys will be approximately 30-45 minutes.
You will be able to access the surveys on-line via the Victim Services of Alberta webpage https://victimservicesalberta.com/provincial-wellness-project/. You will receive a User ID that will be used for participation in the research project that will be entered in the Survey Monkey.
You will have digital access to the surveys at three different points in time over the next two years:
- Directly after you have completed the Provincial Resiliency Training,
- One year after you participated in the Provincial Resiliency Training, and
- At the conclusion of the Wellness Provincial Project (December 2017).
What Sort of Personal Information Would Be Collected and How?
There are two types of information that will be collected from you. The first will be demographic information which includes gender, age, marital status, educational level, ethnic background, years of service, areas or service and primary area of focus. The second type of information, based on your experiences within the victim assistance unit, will be your responses to the ProQOL questionnaire and PWP survey. All of the data will be collected on-line (digital) through SurveyMonkey. Your responses will be anonymous.
Please note the following:
The online survey is being administered by SurveyMonkey©, an American software company. As such, your responses are subject to U.S. laws, including the USA Patriot Act. The risks associated with participation are minimal, however, and similar to those associated with many email programs, such as Hotmail© and social utilities spaces, such as Facebook© and MySpace©.
The data that you complete is collected and stored digitally, and will be accessed by the research team (principal investigator, co-investigators, and research assistants) for the purpose of inputting, reviewing and analyzing this data. All digital data will be password protected on the researcher’s computer. All digital records of your participation will be deleted six months after the conclusion of the Provincial Wellness Project or June 01st, 2018.
What Are the Risks and Benefits Involved in My Participation?
Participation in this study is considered minimal risk. You may encounter some levels of emotional discomfort when reviewing, reliving and reporting any traumatic experience within the questionnaires. Support for emotional stress will be seeking services from the Primary Investigator, Program Manager, other psychological services, and using your own support system. Additionally, the Distress Centre’s 24hour phone number (403 266.4357 – Calgary; 780 482.4357 – Edmonton; and 1.800.232.7288 – Vermillion) is available free of charge to anyone across Alberta.
Another mechanism to minimize risk will be that all participants will be engaged in the Resiliency Training (with your team and Program Manager) and ongoing participation in the regular components of the Provincial Wellness Project.
You might see the opportunity to participate in the research as beneficial. By participating you have the opportunity to contribute to and inform our understanding of police-based victim services and its impact on compassion satisfaction and secondary trauma. You will also have the opportunity to reflect on and share your experiences. Finally, knowing that this information has the potential to benefit other victim service personnel may be a consideration for you of participation in this study.
Voluntary Participation and Withdrawal of Consent:
You are under no obligation to participate in this research study. You are free to withdraw and choose not to participate without negative consequence or prejudice. You will not suffer any disadvantages.
Should you choose to withdraw from the research study, after initially agreeing to participate, send the Victim Service IT Contractor, Mr. Eddie Wong and email indicating so: email@example.com
No explanation will be needed to withdraw. Once Mr. Wong receives your email, he will retrieve and destroy your data. However, once data analysis begins (initial analysis projected to take place by December 2016), it will not be possible to retrieve and destroy your data. But it will remain possible to withdraw from the study and any future data collection.
If you are a current or graduated student from Mount Royal University (MRU) employed and/or volunteering at any of these victim assistance units, please know that this research project is not connected to any course or program at MRU.
What Will Happen to the Results of this Research Project?
You will be made aware of the study results once it is entirely completed. A final report will be compiled and you will have an opportunity to receive a copy of an executive summary of this report. Additionally, a summary of the results will be posted on the Provincial Victim Services website: https://victimservicesalberta.com/provincial-wellness-project/. The primary and co-investigators are intending to report the results in a peer-reviewed (scholarly) journal as well as presenting the study at various conferences in Alberta, Canada, and on an International basis.
It should be noted that the information collected will have no identification to you directly or indirectly as the results will be grouped collectively. If you have any questions about the results of the research, you can contact Dr. Scott McLean at firstname.lastname@example.org.
Who Should I Call if I Have Concerns Regarding Ethical Issues Related to this Research Project?
The Human Research Ethics Board of Mount Royal University has approved this research study. If you have any questions concerning your rights as a possible participate in this research, please contact the Research Ethics Office, at Mount Royal University, via phone 403 440-8470 or email: email@example.com.
The research team appreciates your time and consideration in being a participant in this research, however there is no compensation for your participation in this research study.
Signature (written consent):
Your signature on this forms indicates that you:
- Are voluntarily consenting to participate in this research project,
- Understand to your satisfaction the information regarding your participation in the research project and your agreement to participate.
- Have not yet commenced participation in the research project – your participation will only begin once you have provided your consent, and
- Have been given adequate time and opportunity to:
- Consider the information provided
- Pose and questions you may have, and
- Discuss and consider whether you will participate.
If you have any questions, please contact the Principal Investigator, Dr. Scott McLean (Faculty of Arts) via phone at 403 401-4215 or email: firstname.lastname@example.org
Principal Investigator: Dr. Scott McLean
Signature and Date: May 01st, 2016