Informed Consent Form for Adult Participants (Ages 18 and Older)
Community Action Health Network (CHAN) You are invited to participate in the evaluation of the services provided by Community Action Health Network (CHAN) funded by the California Child/Youth Behavioral Health Initiative (CYBHI) Scaling Evidence-Based and Community-Defined Practices (EBPs/CDEPS) Grant. The services funded under this grant may include various clinical and non-clinical activities aimed at improving your well-being. Purpose of the Evaluation: The purpose of this evaluation is to understand the overall impact of the services and activities provided under the CYBHI Scaling EBPs/CDEPs Grant on well-being among children, youth, and families. This information will be used to improve the program and inform future policies and practices. Please note that the data collected will be used solely for program evaluation and not for research intended for publication in peer-reviewed journals.
What Will Happen During the Evaluation: If you agree to participate, you will be asked to complete surveys at the beginning and end of the program. These surveys will ask about your general well-being, mental health, daily functioning, and social connections and that of your child. The surveys will take approximately 10 minutes to complete.
Confidentiality: All information you provide will be kept confidential. Your responses will be stored securely, and only the evaluation team will have access to them. Your data will be de-identified, meaning your name or personal information will not be connected to your responses in any reports. All findings will be reported as group data, with no reference to individual participant responses.
Voluntary Participation: Your participation in this evaluation is entirely voluntary. You have the right to choose not to participate or to withdraw from the evaluation at any time without any penalty or loss of benefits. Your decision will not affect the services you receive in any way.
By participating in this evaluation, you may contribute to the improvement of services provided under CYBHI. Your feedback will help us understand the needs and experiences of participants like you and enhance the quality of behavioral health services.
There are minimal risks associated with this evaluation. You may feel uncomfortable answering some questions about your experiences or feelings. You are free to skip any questions that you do not wish to answer. Your privacy will be protected, and all responses will be kept secure in locked files or encrypted electronic files.