Final Project- Interview with A Child/Adolescent and Parent(s)

Final Project for SW660: Interview Consent

Instructions

(1) Informing your Participant:

When an individual is approached to be interviewed, either with or without electronic recording, it is important that you explain to them very clearly who you are, what the project is about, why you are doing it, what risks it poses to them, who will benefit, and what will become of the materials. This makes for “informed consent,” meaning they truly understand what they are participating in. You can read the materials to them, and you may also give them the option of reading the description themselves by providing them a copy of the informed consent document.

(2) The Agreement to Interview Form

The Agreement to Interview form is a very good and appropriate way to insure that your participants understand what they are agreeing to. After you have read the project description to them, and explained clearly what the project is about, why you are doing it, and what will become of the interviews and other materials.

You may then, if you feel it’s appropriate, ask them to sign the Agreement to Interview form, and give them a copy. Attach this with your final project submission. Students are welcome to also obtain a copy for their own records.

Informed Consent:

SW 660: Practice with Children and Adolescents

Assignment Description:

Procedure and Risks:

For this assignment, the interview will not be recorded by electronic means. No personal identifiers be used during the interview, to ensure your anonymity. Please feel free to say as much or as little as you want. You can decide not to answer any question, or to stop the interview any time you want

There are no known risks associated with participation in this interview.

Benefits:

It is hoped that through my engagement with this assignment, that I will be able to continue to enhance my learning in the area of child and adolescent mental health.

Cost Compensation:

Participation in for interview will involve no costs or payments to you.

Confidentiality:

All information collected during this interview will be kept strictly confidential and is only to be use for educational purposes.

Interview Agreement Form

SW 660: Practice with Children and Adolescents

I, _____________________________________, agree to have my child/adolescent be interviewed for the Child & Adolescent mental health final project assignment which is being facilitated by ______________________ an MSW student of Saint Mary’s University of Minnesota.

I certify that I have been told of the confidentiality of information collected for this project and the anonymity of my child/adolescent’s participation; that I have been given satisfactory answers to my inquiries concerning this interview process; and that I have been advised that I am free to withdraw my consent and to discontinue my child/adolescent’s participation in the interview at any time without prejudice.

I agree to participate in one or more interviews for this project. I understand that such interviews and related materials will be kept completely anonymous, and its content is used for educational purposes only.

________________________________________ Date ________________________

Signature of child/adolescent interviewee

________________________________________ Date ________________________

Signature of parent/guardian

_______________________________________ Date ____________________________

Signature of SMUMN Social Work Student

If you cannot obtain satisfactory answers to your questions or have comments or complaints about your treatment during this interview, contact:

Dr. Mallory Knipe, DSW, LISW

Pronouns: She/Her/Hers

Interim Program Director & Associate Professor, Master of Social Work Program 

St. Mary’s University of Minnesota

Office: 612-728-5204

Email: [email protected]