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NEW Partnership for Children and Families

Secondary Traumatic Stress and the Child Welfare Professional in Northeast Wisconsin
Informed Consent

This informed consent is for participating in a research study that will examine the impact of secondary traumatic stress and burnout on child welfare professionals and others in your agency. A printable copy is available by clicking on the following link: Printable Informed Consent Form

Research Introduction:
You are being invited to participate in a study that will examine the impact of secondary traumatic stress and burnout on child welfare professionals and others in your agency. This study will utilize The Professional Quality of Life Scale: Compassion Satisfaction, Burnout and Compassion Fatigue/Secondary Trauma scales.

Research Purpose(s):
The intent of this research is to collect data and examine the impact of secondary traumatic stress and burnout in child welfare professionals and others in your agency and in Northeast Wisconsin. The Professional Quality of Life Scale will be administered and the results compiled. It is our intent to utilize the results of the study to develop a collaborative plan to address secondary traumatic stress and/or burnout in your agency. In addition, it is our intent to have study outcomes benefit child welfare professionals and others in your agency, in Northeastern Wisconsin and perhaps, nationally.

Data Collection:
Information obtained from subjects will be securely stored electronically at NEW Partnership, utilizing multiple password protection mechanisms. Individual’s information or scores will not be provided to anyone other than the individual – agency personnel will not have access to individual scores. Information may be compiled by agency unit (based on the county administrators’ request) or compiled by the entire agency. The unit groupings for data collection may change, based on the organization of each county agency. If a particular unit has less than 3 workers, data from more than one unit will be combined. If a county agency has a limited number of total workers total (as is the case in many small rural agencies), the data will be compiled “by agency”.

NEW Partnership will provide your individual score from the Professional Quality of Life Scale. Therefore, you will be asked for your name and e-mail address in order to provide your individual score. Identifying information will only be used to provide individual scores and once the scores are provided, all identifying information will be removed. In an effort to safeguard the identity of subjects, once a participant’s individual scores is provided, individual data will no longer be directly linked to you and at this point you will not be able to withdraw from the study. Individuals can choose not to complete the survey at any point during the survey.

Information compiled will be shared with the particular agency involved in the study and may be published for the agency’s exclusive use. As additional agencies take part in this study, information from additional agencies may be compiled in aggregate form. Information compiled by agency will not be shared, except with that particular agency or after compilation with other agencies in the study.

Individual data will be maintained without any identifying information. Compiled data will be maintained.

Voluntary Participation:
You cannot be required to participate in this research. If you decide to complete the Professional Quality of Life Scale, it will be done on a strictly voluntary basis. Any future involvement in the NEW Partnership at the University of Wisconsin-Green Bay does not depend on your participation in this research.

Assurance of Confidentiality:
If you complete the Professional Quality of Life Scale, you will be asked for your name and e-mail address in order to provide individualized results. After the results are provided, all identifying information will be deleted and will not be connected to the data. Access to all study data will be limited; research records will be stored in a secure computer program with multiple password protection mechanisms and kept for a period of three years; and consent forms with your name will not be kept with other research records. Information collected throughout the course of this research project may be disseminated; however, your name will never be associated with data you provide. Any demographic information collected by multiple counties, will be presented in the aggregate.

Various limits to confidentiality exist which includes the sharing of information upon request with the Institutional Review Board for the Protection of Human Subjects and the Chancellor at the University of Wisconsin-Green Bay, and supervisory personnel of this same institution. Information will also be shared in the event that a court subpoena is presented to the researcher.

Benefits and Risks:
There are no anticipated risks in participating in this study. In addition, there are no known benefits for participating in this research, you will not be compensated in any way, nor should it cost you any money.

Providing Consent/Not Consenting:
I have read the information on this consent form and had the opportunity to discuss and clarify any questions with the researcher. I understand the content of this consent form and I realize that I can only participate if I am at least 18 years old. I realize that my consent to participate or a decision not to participate will not impact any established or future relationships with the researchers or the host institution. Should I wish to have a copy of this form, I realize that a copy of this e-mail and the attachment can be printed for my records.

Questions about consent or other aspects of this study may be directed to any one of the researchers below:

Tammy Snortum, Training Manager
NEW Partnership for Children and Families
2420 Nicolet Drive
Green Bay, Wisconsin 54311-7001
(920) 465-2724 (or) snortumt@uwgb.edu
Stephanie Reilly, Director
NEW Partnership for Children and Families
University of Wisconsin - Green Bay
2420 Nicolet Drive Green Bay, Wisconsin 54311-7001
(920) 465-2866 (or) reillys@uwgb.edu

Samantha Surowiec, Information Processing Specialist
NEW Partnership for Children and Families
2420 Nicolet Drive
Green Bay, Wisconsin 54311-7001
(920) 465-2363 (or) surowies@uwgb.edu

Please click on the circle if you wish to participate:

Please complete the information below
Participant -
type your name:
Date:
Email:
If you would like a copy your individualized results, click in the box to the right:

I do not wish to particpate button

Researcher - type or sign:_________________________ Date:______________________
(Will be completed by the researcher after this form is sent)

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URL: http://www.uwgb.edu/newpart/
University of Wisconsin - Green Bay
NEW Partnership for Children and Families
Rose Hall 310
2420 Nicolet Dr.
Green Bay Wisconsin 54311
920-465-2724

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Last Updated: April 20, 2009