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Consent and Assent Forms 3 12-File1-V6 Consent Form

Consent and Assent Forms 3 12-File1-V6 Consent Form

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Published by mlaverty1
Consent form to participate in a virtual focus group research study regarding the efficacy of methods to develop expressive language in children with autism.
Consent form to participate in a virtual focus group research study regarding the efficacy of methods to develop expressive language in children with autism.

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Categories:Types, Research, Science
Published by: mlaverty1 on Mar 12, 2011
Copyright:Attribution Non-commercial


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 Consent Form for Participation in the Research Study Entitled :
A Survey of Method Efficacy in Developing Expressive Language in Children With Autism SpectrumDisorder 
Funding Source: None.IRB protocol #:Principal investigator Co-investigatoMichael J. Laverty MBA Charles Mosley Ph.D.1114 Hagen Dr., 2309 Wimbledon DriveTrinity, Fl 34655 Las Vegas, Nevada 89107727-376-0829 702-232-0030For questions/concerns about your research rights, contact:Human Research Oversight Board (Institutional Review Board or IRB)Nova Southeastern University(954) 262-5369/Toll Free: 866-499-0790IRB@nsu.nova.eduSite InformationPasco County School Board7227 Land O’ Lakes Blvd.Land O’Lakes, Fl 34638
What is the study about?
The purpose of the study is to evaluate method efficacy in developing expressivelanguage in children with autism spectrum disorder .The proposed study will examinemethod efficacy of joint attention, imitation, and play interventions, according to theviews of participant speech pathologists.
Why are you asking me?
You are being asked to participate in this focus group study as an individual who worksin the field of speech pathology.
Initials: _______ Date: ________ Page 1 of 3
What will I be doing if I agree to be in the study?
You will complete a self administered questionnaire to provide the researcher withpreliminary knowledge in regard to your use of the examined methods. The self administered survey, which will take 20- 30 minutes to complete, will be deliveredvirtually throughwww.surveymonkey.com. You will then attend and participate in afocus group to learn of the latest research in regards to deployment of theseinterventions. You will be asked to complete a
Perspective Survey 
prior to andimmediately following the conduct of the focus group event . You will then be askedquestions in regards to your views of the methods. The focus group is expected to last1.5 hours.
Is there any audio or video recording?
This research project will include audio recording of the focus group event. This audioand video recording will be available to be heard by the researcher, the IRB, Dr. CharlesMosley and participants in the virtual focus group. The recording will not be transcribed.The recording will be kept securely at the home of the researcher at the address notedabove. The recording will be kept for 36 months and destroyed after that time viadeletion from the computer of the researcher. Because your voice will be potentiallyidentifiable by anyone who the recording, your confidentiality for things you say or do)on the recording cannot be guaranteed although the researcher will try to limit access tothe tape as described in this paragraph.
What are the dangers to me?
There may be a risk for loss of confidentiality with this study.If you have any questions about the research, your research rights, or have a research-related injury, please contact Michael J. Laverty or Dr. Charles Mosley at the contactnumbers listed above. You may also contact the IRB at the numbers indicated abovewith questions as to your research rights.
Are there any benefits for taking part in this research study?
There are no direct benefits.
Will I get paid for being in the study? Will it cost me anything?
There are no costs to you or payments made for participating in this study.
How will you keep my information private?
All information procured will be kept in a secure location at the home address of theprimary researcher and will be maintained for a minimum of 36 months from theconclusion of the study.
Initials: _______ Date: _______

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