Nuclear Descendants - Adaption to Trauma Logo

  • Nuclear Descendants - Adaption to Trauma

    • Consent 

    • Informed Consent Form

      Intergenerational Legacies of Nuclear Radiation/Fallout Exposure: An International Comparative Study Informed Consent Form TITLE:​ Intergenerational Legacies of Nuclear Radiation/Fallout Exposure: An International Comparative Study PROTOCOL NO.:​ None​IRB Protocol #20221552 SPONSOR:​ Ferkauf Graduate School of Psychology at Yeshiva University PRINCIPAL INVESTIGATOR: Yael Danieli, PhD​Founder and Executive Director, International Center for MultiGenerational Legacies of Trauma​345 East 80th Street (Apt. 31-J)​New York, NY 10075 STUDY-RELATED PHONE NUMBER(S): +1-​212-737-8524 (24 hours) The principal investigator of this study is Dr. Yael Danieli, Founder and CEO of the International Center for the Study, Prevention and Treatment of MultiGenerational Legacies of Trauma. The purpose of this research study: Is to explore adaptational patterns in families of parent(s) exposed to nuclear radiation/fallout to better understand how their children's lives are affected. What will be done: You will be asked to complete a three-part questionnaire about (1) interactions in your family (both parents), (2) your own responses to them, and (3) your family history and demographics. Survey Duration: The full survey will take approximately 90 minutes to complete.Participation is voluntary.  You may refuse to participate or discontinue participation at any time without penalty or loss of benefits to which you are otherwise entitled.   Benefits of this Study: While it might not benefit you directly, it should contribute to knowledge about family adaptation to trauma.Alternative of this study: Your alternative is not to participate in the study. Confidentiality: The information will not be shared with anyone outside the research team or in any way that personally identifies you.  Your information will be shared with WCG IRB.  It is for the sole purpose of understanding family adaptation to trauma via the use of this three-part questionnaire. According to data protection laws, each use we make of personal information must have a “legal basis”. The relevant legal bases are set out in the General Data Protection Regulation (EU Regulation 2016/679) and in current UK data protection legislation.We may publish the results of this research. However, we will keep your name and other identifying information confidential. We protect your information from disclosure to others to the extent required by law. We cannot promise complete secrecy. Risks or discomforts: Some of the questions are personal and they may cause you to experience some distress upon remembering unpleasant things.  You can stop at any time. If you experience significant distress, please contact Dr. Danieli (contact information below), your local trusted support, or your national helpline. There is the risk of a loss of confidentiality, but there are procedures in place to minimize this risk. How the findings will be used: To help understand family adaptation to trauma in general and to nuclear radiation/fallout exposure, in particular. You will not be paid for being in this study. There is no cost for you in the study. Contact Information: For any complaints, concerns or questions about this study or to opt-out at any time, please, contact Dr. Yael Danieli at +1-212-737-8524 (24 hours) or at yaeld@aol.com. This research is being overseen by WCG IRB. An IRB is a group of people who perform independent review of research studies. You may talk to them at 855-818-2289 or researchquestions@wcgirb.com if:o You have questions, concerns, or complaints that are not being answered by the research team.o You are not getting answers from the research team.o You cannot reach the research team.o You want to talk to someone else about the research.o You have questions about your rights as a research subject. CONSENTI have read and understand the information provided above. All my questions about the study and my part in it have been answered. I freely consent to participate in this research study. By signing this form, I have not given up any of my legal rights. By signing below, I acknowledge:⎯ My participation in this study is voluntary⎯ I am 18 years of age or older⎯ I am aware that I may choose to terminate my participation at any time for any reason
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    • Section 1 - About You 
    • Section 2- Your Family of Origin 

    • The statements below describe ways of life in some families. You will be asked to state how much you agree or disagree with the statements as they apply to your family of origin. To indicate your level of agreement, please click the button next to your chosen response. First answer the question as it applies to your father, then as it applies to your mother.

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    • Section 3 - The statements below describe you and your way of life.  

    • You will be asked to state how much you agree or disagree with the statements as they apply to you. To indicate your level of agreement, please click the button next to your chosen response.

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    • Section 4 - Four Generation Family History and Demographics 

    • The following questions are about your family’s history, characteristics, and circumstances. Please answer all questions to the best of your ability.

    • Your Mother

    • Your Father

    • Your siblings

    • Your mother's mother (maternal grandmother)

    • Your mother's father (maternal grandfather)

    • Your father's mother (paternal grandmother)

    • Your father's father (paternal grandfather)

    • Your aunts and uncles

    • The next questions are about experiences your Mother had during and after the nuclear radiation/fallout exposure.

    • The next questions are about experiences your Father had during the nuclear radiation/fallout exposure.

    • Other Family Information 

    • Parents' marriage

    • Parents' Ethnicity/Religion/Faith/Spirituality

    • Parents' Education/Occupation/Socioeconomic Status

    • Generational Linkages

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    • Information about yourself

    • Ethnicity/Religion/Faith/Spirituality

    • Your Education/Occupation/Socioeconomic Status

    • Should be Empty: