C. Individual Consent for Participation in Research

Questionnaire (3)

Do you identify yourself as Irish-American? __________ American? __________

Other? __________________

Are you involved in any Irish –American organizations/agencies/causes? Yes__________ No__________ If yes which one(s):

Do you frequent foods/stores/entertainment that is considered from Irish culture? Yes______ No_____

Do tend to listen to Irish Music? Yes______________ No___________

Have you been or currently pursuing information regarding family history?

Yes____________ No__________________ . If yes what kind of information:

Have you travelled to Ireland? Yes: ______________ No: ________________ If yes did you visit in the North: _____________________ If yes what year(approximate) __________ Do you have close relatives still in Northern Ireland? Yes___________ No_______________ If yes, do you keep in contact with them?

Appendix C

Individual Consent for Participation in Research

INSTITUTE FOR CLINICAL SOCIAL WORK

I,______________________________________, acting for myself (or for my child _________________________________), agree to take part in the research entitled: Intergenerational Legacy of Political Turmoil (use a title that can be understood exactly by the participants).

This work will be carried out by Marie McKenna, LCSW(Principal Researcher) under the supervision of Joan DiLeonardi, Ph.D.(Dissertation Chair or Sponsoring Faculty)

This work is conducted under the auspices of the Institute for Clinical Social Work; 200 N. Michigan Ave., Suite 407; Chicago, IL 60601; (312) 726-8480).

Purpose

The purpose of this study is to explore the experiences of Irish-Americans with a

heritage from Northern Ireland. This study will explore if and how ethnopolitical turmoil of the past influences next generations. Consideration will be on personal/family world views, relationships, personal identity and beliefs. This is a research study for the purposes of completion of requirements for a Ph.D. Results of this study will be documented in dissertation report. This report will be in public domain and could be used by scholars as they pursue issues raised in this study.

PROCEDURES USED IN THE STUDY AND THE DURATION This study will require participants to complete one demographic questionnaire, meet for one interview (1-1 1/2 hr. duration). This study relies on personal reflection and sharing about growing up Irish-American. The interview will be digital-audio recorded in order for the researcher to consider the importance of the material presented. This study revolves around stories, personal, family, cultural. This is a study that keeps individual experiences intact rather than melding together to come to a general summary.

Benefits There are no direct benefits to participants in this study. This study may benefit society by increasing understanding of the effects of ethnopolitical turmoil on future generations. War is costly not only to those who are directly impacted but down the family system.

Costs

Describe any monetary costs to the participants (for travel, tests, etc.). If the costs are being covered by a sponsor or by the researcher, state that. If there are no costs associated with participation, state that explicitly.

Participants are asked to acquire their own transportation for interviews. There is no payment for time spent in interview.

Possible Risks and/or Side Effects

Though there are no inherent risks anticipated from this study it is recognized that reflection on personal material may raise a negative emotional response. During the interview participants will be reminded that they are not required to answer any question they do not want to answer, stop the interview at any time, and withdraw from the study. They will also be reminded that the researcher is a mandated reporter and when required by law confidentiality will be broken. No identifying information will be used when the results of the study are presented or published. At the completion of the interview information will be given as to signs to watch out for and resources to assist if needed. The researcher is available after the interview to speak with if there is a need to do so. Participants will also be given the names of (3) clinicians who are able/willing to meet for a consultation session.

Privacy and Confidentiality

Participants names will be known only to the researcher, Marie McKenna, LCSW. Data that is shared with transcriptionist and Faculty Sponsor will use code instead of names. All material collected is stored in a locked cabinet and a password protected computer. All materials will be disposed of at the end of 5 years after the study completion. Written materials will be shredded and digital/audio recordings will be erased.

Subject Assurances:

By signing this consent form, I agree to take part in this study. I have not given up any of my rights (my child’s rights) or released this institution from responsibility for carelessness.

I may cancel my consent and refuse to continue in this study (or take my child out of 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 (or my child) refuse to take part, or if I begin the study and then withdraw.

If I (or my child) have any questions about the research methods, I can contact Marie McKenna, LCSW(Principal Researcher) or Dr. Joan DiLeonardi(Dissertation Chair/Sponsoring Faculty), at this phone number (Marie McKenna: 708-446-7276 (day/evening),

If I have any questions about my rights – or my child’s rights – as a research subject, I may contact Theresa Vidalon Chair of Institutional Review Board; The Institute for Clinical Social Work at Robert Morris Center, 401 South State Street, Suite 822, Chicago, IL, 60605 at (773) 319-9587 or Theresa.vidalon@gmail.com.