LONG ISLAND UNIVERSITY
INSTITUTIONAL REVIEW BOARD (IRB)
RESEARCH PARTICIPANT INFORMED CONSENT FORM
Study Title: Clinical Decision Making for Traumatic Brain Injury (TBI) Adolescents: A Simulation Study
You are invited to participate in a study of clinical decision making for students with potential traumatic brain injuries. This is a research study being conducted by a student, Geneva Toledo, through the Department of Communication Sciences and Disorders at Long Island University - Brooklyn. The online survey takes approximately 15-20 minutes to complete and will consist of simulated case studies followed by clinical recommendations. Participation in this study is voluntary. Even if you decide to join now, you can change your mind later.
Faculty Investigator: Reem Khamis, Ph.D., CCC-SLP, Reem.khamis@liu.edu, Professor & Academic Program Director of Communication Sciences & Disorders Department, LIU Brooklyn, 1 University Plaza, Brooklyn, NY United States
Faculty Investigator: Miriam Baigorri, Ph.D., CCC-SLP, miriam.baigorri@liu.edu, Associate Professor of Communication Sciences & Disorders Department, LIU Brooklyn, 1 University Plaza, Brooklyn, NY United States
Faculty Investigator: Mayya Teytel-Cocozza, M.S., CCC-SLP, mayya.teytelcocozza@liu.edu, Clinical Supervisor and Adjunct Professor of Communication Sciences & Disorders Department, LIU Brooklyn, 1 University Plaza, Brooklyn, NY United States
Student Investigator: Geneva Toledo, Geneva.toledo@my.liu.edu, Communication Sciences & Disorders Department, LIU Brooklyn, 1 University Plaza, Brooklyn, NY United States
1. Why is this research being done?
This research is being done to study clinical decision making for students with potential traumatic brain injuries (TBI) who may be exhibiting disruptive behaviors in class and/or attention deficits.
People who are currently employed as a Speech Language Pathologist in New York may join.
2. What will happen if you join this study?
If you agree to be in this study, we will ask you to do the following things:
Complete an online survey on the Campus Labs platform run by Long Island University that includes:
o Your demographics
o Brief education/employment background
o Read 8 simulated student referrals and answer 5 questions on a 4-point Likert scale and an optional open-ended question regarding your clinical recommendations for each case study
How long will you be in the study?
Participation in the study will take approximately 15-20 minutes.
4. What are the risks or discomforts of the study?
There are no foreseeable risks involved in participating in the study that we know of.
You may get tired or bored when we are asking you questions or you are completing questionnaires. You do not have to answer any question you do not want to answer.
Although your IP Address will not be stored in the survey results, there is always the possibility of tampering from an outside source when using the Internet for collecting information. While the confidentiality of your responses will be protected once the data is downloaded from the Internet, there is always the possibility of hacking or other security breaches that could threaten the confidentiality of your responses.
5. Are there benefits to being in the study?
This study may benefit society if the results lead to a better understanding of clinical decision making in schools and the role of speech-language pathologists in schools.
6. What are your options if you do not want to be in the study?
Your participation in this study is entirely voluntary. You choose whether to participate.
If you decide not to participate, there are no penalties, and you will not lose any benefits to which you would otherwise be entitled.
7. Will it cost you anything to be in this study?
No, it will not cost you anything to be in this study.
8. Will you be paid if you join this study?
You will not receive direct payment for participating in this study. However, you will have the opportunity to enter a raffle when completing this consent form. Three participants will be randomly selected to each receive a $25 gift card. If you choose to enter the raffle, you may provide your email address at the end of this form. If selected, the gift card will be sent to you via email.
9. Can you leave the study early?
You can agree to be in the study now and change your mind later, without any penalty or loss of benefits.
10. How will the confidentiality of your biospecimens and/or data be protected?
Any study records that identify you will be kept confidential to the extent possible by law. The records from your participation may be reviewed by people responsible for making sure that research is done properly, including members of the Long Island University Institutional Review Board and officials from government agencies such as the National Institutes of Health and the Office for Human Research Protections. (All of these people are required to keep your identity confidential.) Otherwise, records that identify you will be available only to people working on the study, unless you give permission for other people to see the records.
11. What is the Institutional Review Board (IRB) and how does it protect you?
This study has been reviewed by an Institutional Review Board (IRB), a group of people that reviews human research studies. The IRB can help you if you have questions about your rights as a research participant or if you have other questions, concerns or complaints about this research study. You may contact the IRB at osp@liu.edu.
What should you do if you have questions about the study?
Contact the student investigator (Geneva Toledo at geneva.toledo@my.liu.edu or the faculty investigator Reem Khamis at reem.khamis@liu.edu. If you wish, you may contact the principal investigator by letter. The address is on page one of this consent form. If you cannot reach the investigators or wish to talk to someone else, contact the IRB office at osp@liu.edu.
You can ask questions about this research study now or at any time during the study.
If you have questions about your rights as a research participant or feel that you have not been treated fairly, please call the Institutional Review Board at Long Island University at osp@liu.edu.
12. What does your agreement on this consent form mean?
By marking the “Agree to Participate” box below, you are indicating that you have fully read the above text and have had the opportunity to print the consent form (or ask for a printed copy) and ask questions about the purposes and procedures of this study. If you choose not to participate, please choose the “Decline to Participate” box below.