A. Individual Consent for Participation in Research

Appendix A

Consent Form

Institute for Clinical Social Work

Research Information and Consent for Participation in Social Behavioral Research

“How Parents Experience Their Child’s Launch: The impact of prior parental death”

I, ________________________________, acting for myself, agree to take part in the research entitled: “How Parents Experience Their Child’s Launch : The impact of prior parental death”

This work will be carried out by Paige LaCava, under the supervision of Sponsoring Faculty, Dr. Karen Bloomberg.

This work is sponsored by and conducted under the auspices of the Institute for Clinical Social Work; At Robert Morris Center, 401 South State Street; Suite 822, Chicago, IL 60605; (312) 935-4232.

Purpose: The purpose of this study is to explore the experiences of parents, presently aged 36-60 years old, who have children in the process of launching (aged 18-24 years old).

You will be asked to reflect on your current parent-child relationship, as well as how you feel that the loss of your parent during your own launch, impacts the present process. The purpose of this inquiry is to broaden understanding in the field of psychology about how parents experience the process of a child’s launch, from an emotional and reflective perspective. The inquiry will encompass the participants reflection on the earlier loss of their parent during their own launch.

This information may be useful to the fields of clinical social work, counseling and psychology for expanding our understanding of the parent-child dynamics in launching, with the benefit of extending clinical insight when treating patients undergoing complications of “launch”.

Procedures used in the study and the duration: This study will take place in the course of three 60-minute interviews, conducted in a neutral, private office space, to be determined or Skype. You will be given a gift card worth $25 for your time.

Benefits: There are no direct benefits to you for participation in this study. Payment is not considered a benefit. By participating in this research, you may discover personal information that enriches your own self-understanding. In addition, time and information shared may contribute to expanding knowledge in the field of clinical social work, psychology and psychotherapy practice, and to improving the general society. Costs: Involvement in this study will not require any costs or expenditures.

Possible Risks and/or Side Effects: Potential risks may include the possibility of negative emotional responses to exposure and exploration of sensitive subjects, (although everyone is different, therefore risk level cannot be predicted.) During the interview, you are free to stop at any time, should discomfort or distress arise. Measures will be taken to protect your confidentiality. The interviewer is a trained professional, sensitive to the emotional state of the participant. All participants in the interview portion of the study will be invited to return for an additional evaluation/process visit, not for research purposes. If further support is deemed necessary, referrals will be made upon request.

Privacy and Confidentiality: The only people who will know that you are a research subject are members of the research team. No information about you, or provided by you during the research, will be disclosed to others without your written permission, except: - if necessary to protect your rights or welfare (for example, if you are injured and need emergency care or when the ICSW Institutional Review Board monitors the research or consent process); or - if required by law, for example, if you indicate plans to harm yourself or others.

When the results of the research are published or discussed in conferences, no information will be included that would reveal your identity. Any information that is obtained in connection with this study and that can be identified with you will remain confidential and will be disclosed only with your permission or as required by law. Only I, as the researcher, and the transcription company I use to transcribe the study interviews will have access to the interview transcripts and computer data files. The transcription company will sign a confidentiality agreement that contracts them to destroy all data after the transcription has been sent to the researcher. In order to protect your confidentiality, I will not write your name on the interviews. Instead I will assign you a pseudonym. I will store the interview transcripts in a locked file cabinet separate from any papers that have your name on them. The list connecting your name and pseudonym will be kept in a password protected computer file. This file will be destroyed once data collection is complete. All interview transcripts will be destroyed five years after the results of the study are published.

Subject Assurances: By signing this consent form, I agree to take part in this study. I have not given up any of my rights or released this institution from responsibility for carelessness.

I may cancel my consent and refuse to continue in this study at any time without penalty or loss of benefits. My relationship with the staff of the ICSW will not be affected in any way, now or in the future, if I refuse to take part, or if I begin the study and then withdraw.

If I have any questions about the research methods, I can contact Paige LaCava at placava@icsw.edu or Dr. Karen Bloomberg, Sponsoring Faculty, at (312) 565-1349.

Signatures: I have read this consent form and I agree to take part in this study as it is explained in this consent form. _________________________________ _____________ Signature of Participant Date

I certify that I have explained the research to _____________________ (Name of subject) and believe that they understand and that they have agreed to participate freely. I agree to answer any additional questions when they arise during the research or afterward.

________________________________ ______________ Signature of Researcher Date