{"id":241,"date":"2020-07-20T10:48:45","date_gmt":"2020-07-20T14:48:45","guid":{"rendered":"https:\/\/research.ohioguidestone.org\/study\/?page_id=241"},"modified":"2020-07-31T04:10:22","modified_gmt":"2020-07-31T08:10:22","slug":"fathers-feelings-main-study-consent","status":"publish","type":"page","link":"https:\/\/research.ohioguidestone.org\/study\/fathers-feelings-main-study-consent\/","title":{"rendered":"Father&#8217;s Feelings Main Study Consent Form"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full wpforms-container-save-resume\" id=\"wpforms-245\"><form id=\"wpforms-form-245\" class=\"wpforms-validate wpforms-form\" data-formid=\"245\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/study\/wp-json\/wp\/v2\/pages\/241\" data-token=\"25233d6afe85872b8c5a7ce32422b496\" data-token-time=\"1776658308\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-245-field_11-container\" class=\"wpforms-field wpforms-field-html\" data-field-id=\"11\"><div id=\"wpforms-245-field_11\"><style>\r\nh6 {font-size: 1.2em;}\r\ntable {border: 1px solid #000; border-collapse: collapse;}\r\nth, td {border: none;}\r\nth {margin: 0 auto; text-align: center; font-weight: bold; color: #000;}\r\ntr {color: #000;}\r\n<\/style>\r\n\r\n<h4>Introduction<\/h4>  \r\n<p>You are being asked to participate in a research study at OhioGuidestone called <strong>\"Father's Feelings.\"<\/strong> The word \"you\" in this document refers to you as the possible participant or to your minor child if the person who will sign this consent form is the parent\/guardian of a possible participant under 18 years of age.<\/p>\r\n\r\n<p>You are being asked to participate in this study because you are:<\/p>\r\n<ul style=\"padding-left: 30px !important;\">\r\n<li>A male 14 years and older;<\/li>\r\n<li>A father of an unborn child (partner\/spouse still pregnant) OR a child between 0-12 months old;<\/li>\r\n<li>And have not been diagnosed or treated for any serious mental health illnesses.<\/li>\r\n<\/ul>\r\n\r\n<p>Your participation in this study is voluntary and is not required. If you or your family members get services, benefits or are in any programs at OhioGuidestone or with a participating location,  you will <span style=\"text-decoration: underline;\">not<\/span> be affected if you do or do not choose to participate.<\/p>\r\n\r\n<p>If you are a minor (under 18 years of age), your parent or legal guardian must sign this consent form. In addition, your \"assent\" (agreement) will be obtained by the researcher before you may participate in this study. You must sign the assent form. You and your parent\/guardian will be given a copy of the signed consent and assent forms to keep.<\/p>\r\n\r\n<p>Please read the information below and ask questions to better understand this research study.<\/p> \r\n\r\n<h4>Purpose of the Study<\/h4>\r\n<p>OhioGuidestone wants to create and study a short questionnaire (or survey) created for male fathers. The months before a baby is born is known as the prenatal period and the 12 months after the birth of a baby is known as the post-partum period. These two periods, prenatal and post-partum, are a part of what is known as the perinatal period.<\/p>\r\n\r\n<p>The perinatal period is sometimes a mixture of good and bad experiences, situations and feelings. Sometimes sadness or even depression can happen during the prenatal and or post-partum time for both mothers and fathers. We have created a special questionnaire that is made for male fathers\u2019 feelings during the perinatal period. There are other questionnaires that ask about feelings in the prenatal or post-partum time, but they were created for female mothers. We believe that men\u2019s feelings can be different, and different questions should be written differently, too. Sometimes these other questionnaires do not help men, their families and healthcare providers understand if dads need extra support.<\/p> \r\n\r\n<h4>Procedures<\/h4>\r\n<p>You may have learned about the research study after seeing a flyer or being told about the study. If you are interested in participating, study staff will contact you to schedule an appointment. The appointments are about \r\n to 1 1\/2 hours long (60-90 minutes). Study appointments will take place in your home, or a similar quiet and personal location (for example, a private room in a library near your home or work), or on the computer (using Zoom or Teams). You will need a device that has a camera, audio (speakers), and can connect to the internet. Research staff will help with connecting to the video conferencing platform. <\/p>   \r\n\r\n<p>If you agree to participate in the study you will sign an informed consent form (this document) and complete study appointments. Some participants will be in a part of the study that has more than one (1) session. You might participate in one (1) 60-minute session, or you might participate in up to five (5) 60-90 minutes sessions. Your study staff will explain what part you are in, why you are in that part, and remind you what study session(s) you will do. <\/p>  \r\n\r\n<h4>Each Study Visit<\/h4>\r\n<p>During each one-on-one appointment, you and a study staff member will fill out study paperwork and will have a conversation about your feelings around being a father. The conversation about your feelings is called an \u201cinterview\u201d but is more like a supportive conversation using questionnaires to better understand your feelings and experiences before your baby was born (called the pre-natal time) and your baby's first year between 0-12 months (called the post-partum time).<\/p>\r\n\r\n<p>Study staff are trained mental health professionals, so if you have strong or negative feelings during or after the study appointment, study staff will support you and help you deal with these thoughts or feelings. Study staff will also provide emergency contact numbers that you can call 24 hours a day, 7 days a week, if you need to talk to someone or need more help for your thoughts or feelings.<\/p>\r\n\r\n<p>At the end of your study appointment, study staff will let you know if your results suggest that you might be depressed, or showing other signs of needing mental healthcare. If this happens, it is very normal. The study staff will suggest that you make an appointment with a local mental health service provider and will give you information to learn more about father and family programs and organizations. <\/p>\r\n\r\n<p>After you complete your study appointments you will receive a follow-up call, text message, email messages, or letters will be sent two (2) weeks and one month after your study appointment if you need more help. We will keep in touch with you to share more programs and events for dads using phone calls, text messages, emails messages, or letters a few times per year (unless you tell us not to contact you).<\/p>\r\n\r\n<h4>Potential Risks<\/h4>\r\n<p>There are minor risks you may experience, such as thoughts or feelings that are upsetting to you. Study staff are trained mental health providers, so if this happens, they will support you and help you deal with these thoughts or feelings during your study appointment.<\/p>   \r\n\r\n<p>Study staff will also provide the name and contact information for local mental health services, programs or providers. If you express thoughts and feelings that you are depressed; or if your interview results suggest that you might be depressed study staff will help you make a follow-up appointment with a mental health service provider. Study staff will help if a mental health emergency happens, and will work with other medical emergency professionals. Even if your results do not suggest that you might be depressed, you will still be provided information if you want to reach out to schedule an appointment with a mental health service provider. Study staff will call you about 1 week, 2 weeks and 1 month after to see if you were able to make an appointment with a mental health service provider.<\/p>   \r\n\r\n<h4>Anticipated Benefits<\/h4>\r\n<p>You may or may not benefit from this study. Possible benefits may include:<\/p> \r\n<ul style=\"padding-left: 30px !important;\">\r\n<li>Learning more about your own feelings and thoughts<\/li>\r\n<li>Opportunity to be informed about more mental health supportive services<\/li>\r\n<li>Information specifically for fathers<\/li>\r\n<li>Free, short clinical interventions<\/li>\r\n<li>$25 gift card after participating in the study appointments<\/li>\r\n<li>Information learned from this research study may also benefit other men, fathers, children and families<\/li>\r\n<li>Better relationship between you and your baby<\/li>\r\n<li>Better relationship between you and your baby's mother (or other co-parent)<\/li>\r\n<li>Increased fun and play in your relationships with you and your baby<\/li>\r\n<li>Increased positive emotions and feelings in you and your baby<\/li>\r\n<li>Increased confidence as a father<\/li>\r\n<\/ul>\r\n\r\n<h4>Thank You Gift<\/h4> \r\n<p>You will receive a $25.00 gift card for your first study appointment. If you are in the part of the study that does five (5) study appointments, you will receive a second $25.00 gift card after participating in the fifth (5th) study appointment as a thank you gift.<\/p>\r\n\r\n<h4>Confidentiality<\/h4> \r\n<p>Your information will be kept confidential and only used for this research study. Only people working on this research study will have access to your study information. The only exception would be in the event of a referral to a mental health provider (with your permission we would share some information with the provider in this situation), and to let you know about other programs that you might want to know about at OhioGuidestone. We will collect your demographic information, but a unique number (access ID or study ID number) instead of your name or other identifying information will be used on study documents. If you submit study forms through our Research Portal, your IP address will be collected along with the form, for verification purposes only, and will be treated by study staff as identifying information. Your name or anything else that could identify you will not be included in reports, presentations or publications from this study. Your name and study information will not be in anyone else's records or paperwork. Your information will be kept in a locked file cabinet in a locked room at OhioGuidestone, or saved on secure and password protected computer files that can only be opened on password protected computers. All documentation with identifying information will be destroyed once the study has ended.<\/p>  \r\n\r\n<p>If your study results suggest that you might be depressed, you will receive information for a local mental health provider, and a referral form to take with you to your appointment. This referral form will show that you were a participant in this study and completed surveys to see if you might be depressed. The form will include the scores from the study questionnaires you completed, your contact information, and current medications. It also is possible that the referral may include any responses you gave to study questions. Observations and notes from study staff would be included, too. These would be shared only with the mental health provider, since they might be relevant to any mental health care you might receive. A referral to a mental health provider cannot happen without your permission.<\/p>\r\n\r\n<h4>Voluntary Participation and Withdrawal<\/h4>\r\n<p><span style=\"text-decoration: underline;\">Your participation in this study is completely voluntary<\/span>. If you choose not to participate, it will <span style=\"text-decoration: underline;\">not<\/span> affect your relationship with OhioGuidestone or any other organization, program or service. You will still have the right to services that you are eligible for at OhioGuidestone or any other organization, program or service. You will not be treated differently if you decide not to participate.<\/p>   \r\n<p>If you decide to participate, you are free to withdraw your consent and stop at any time. You will not be treated any differently if you decide to withdraw from the study. If you withdraw from the study, your services or relationship with OhioGuidestone or any other organization, program or service will still continue.<\/p>   \r\n\r\n<p>If you do participate in this study, your access to current and future services and client rights will not be changed or different. There is no cost to participate in this research study.<\/p>   \r\n\r\n<h4>Contacts and Questions<\/h4>\r\n<p>If you have any questions about this study, you can contact the study leader: <br\/ > <a href=\"tel:4402608865\">440.260.8865<\/a>.<\/p> \r\n\r\n<p>If you have any questions about <a href=\"https:\/\/ohioguidestone.org\" target=\"_blank\" rel=\"noopener noreferrer\">OhioGuidestone<\/a>\u2019s services, including client rights, you can contact the agency\u2019s Client Advocate at <a href=\"tel:4402608308\">440.260.8308<\/a>.<\/p>   \r\n\r\n<p>You may also ask the staff explaining this paper to you any questions that you have now, or during any part of the research study.<\/p>    \r\n \r\n<h4>Signature of Research Subject or Parent\/Guardian<\/h4>\r\n<p>Informed consent to participate in research is very important. By signing below you agree:<\/p> \r\n<ul style=\"padding-left: 30px !important;\">\r\n<li>That you have read the information about this research study;<\/li>\r\n<li>You have been given the chance to answer questions and they have been answered;<\/li>\r\n<li>You or your minor child volunteer to participate in the study and understand that you or your minor child can withdraw from the study at any time.<\/li>\r\n<\/ul>\r\n<p>A copy of this consent form will be provided to you.<\/p><\/div><\/div><div id=\"wpforms-245-field_14-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"14\"><label class=\"wpforms-field-label\">Electronic Agreement <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-245-field_14\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-245-field_14_1\" name=\"wpforms[fields][14][]\" value=\"By checking this box, I agree to use electronic records and electronic signatures.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-245-field_14_1\">By checking this box, I agree to use electronic records and electronic signatures.<\/label><\/li><\/ul><\/div><div id=\"wpforms-245-field_0-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-first\" data-field-id=\"0\"><label class=\"wpforms-field-label\">Name of Participant <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-245-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" required><label for=\"wpforms-245-field_0\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-245-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" required><label for=\"wpforms-245-field_0-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-245-field_15-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half\" data-field-id=\"15\"><label class=\"wpforms-field-label\">Name of Parent\/Guardian<\/label><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-245-field_15\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][15][first]\" ><label for=\"wpforms-245-field_15\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-245-field_15-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][15][last]\" ><label for=\"wpforms-245-field_15-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-245-field_4-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half wpforms-first\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-245-field_4\">Date <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-245-field_4\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-large\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][4][date]\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-245-field_9-container\" class=\"wpforms-field wpforms-field-email wpforms-one-half\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-245-field_9\">Email Address<\/label><input type=\"email\" id=\"wpforms-245-field_9\" class=\"wpforms-field-large\" name=\"wpforms[fields][9]\" spellcheck=\"false\" ><div class=\"wpforms-field-description\">If entered, we will email a copy of this Consent to the supplied email address <\/div><\/div><div id=\"wpforms-245-field_10-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"10\"><label class=\"wpforms-field-label\">How was this form completed? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-245-field_10\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-245-field_10_1\" name=\"wpforms[fields][10]\" value=\"In-Person\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-245-field_10_1\">In-Person<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-245-field_10_2\" name=\"wpforms[fields][10]\" value=\"By Phone\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-245-field_10_2\">By Phone<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-245-field_10_3\" name=\"wpforms[fields][10]\" value=\"Online\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-245-field_10_3\">Online<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-245-field_10_4\" name=\"wpforms[fields][10]\" value=\"Mail-In\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-245-field_10_4\">Mail-In<\/label><\/li><\/ul><\/div><div id=\"wpforms-245-field_13-container\" class=\"wpforms-field wpforms-field-checkbox wpforms-one-half wpforms-first wpforms-list-inline\" data-field-id=\"13\"><label class=\"wpforms-field-label\">Acknowledgement <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-245-field_13\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-245-field_13_1\" name=\"wpforms[fields][13][]\" value=\"I have received education about this research study and reviewed this document with a member of the Research Team.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-245-field_13_1\">I have received education about this research study and reviewed this document with a member of the Research Team.<\/label><\/li><\/ul><\/div><div id=\"wpforms-245-field_12-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-245-field_12\">Date of Informed Consent Education Session <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-245-field_12\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-large\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][12][date]\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-245-field_3-container\" class=\"wpforms-field wpforms-field-signature\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-245-field_3\">Signature of Participant or Parent\/Guardian <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-245-field_3\" class=\"wpforms-signature-input wpforms-screen-reader-element wpforms-field-required\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][3]\" autocomplete=\"off\" inputmode=\"none\" required><div class=\"wpforms-signature-wrap wpforms-field-row wpforms-field-large\"><canvas class=\"wpforms-signature-canvas\" id=\"wpforms-245-field_3-signature\" data-color=\"#000000\"><\/canvas><div class=\"wpforms-signature-clear\" title=\"Clear Signature\" tabindex=\"0\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"1em\" 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-->\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"class_list":["post-241","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/pages\/241","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/comments?post=241"}],"version-history":[{"count":10,"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/pages\/241\/revisions"}],"predecessor-version":[{"id":458,"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/pages\/241\/revisions\/458"}],"wp:attachment":[{"href":"https:\/\/research.ohioguidestone.org\/study\/wp-json\/wp\/v2\/media?parent=241"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}