First Steps Climate Pilot (Focus Group)

First Steps Climate Pilot - Consent Form part 1

Consent Form (part 1)

Consent Form: PILOT (Parents / Care Givers)

Research Project Title: First Steps for a Healthy Climate: Exploring grassroots/parent-led community resiliency, civic empowerment and location-based education for climate change
Ethics Application Number: #30000887

Who is conducting this study?
Researcher/Educator: Laurel Hart, Faculty of Education, Simon Fraser University
604-441-0147, laurel_hart@sfu.ca (or) laurelhart@gmail.com
Co-Investigator: Lynn Fels, Simon Fraser University, lynn_fels@sfu.ca

Who is funding this study? Funding for this program comes from the City of Vancouver’s Greenest City Grant, a Mitacs accelerate grant, registration fees, and in-kind support (partnership & permission) from the West Side Family Place and Five Family Place Partnership.

Invitation & study purpose: Why are we doing this study?
You are invited to participate in the First Steps to a Healthy Climate pilot session (First Steps), as a parent or caregiver with a child age 5 or younger. We want to understand the needs of families and to develop resources to assist families in adapting to a changing world and climate, through the development of the First Steps program.

Study Procedures – What happens to you in the study? How is data collected?
If you take part in this research program and family/educational program, you will register through the Family Place and sign the consent form (either during registration or at the start of our first session.) Family Places will gather your basic information for registration in the program and to share with the researcher/educator.

This “one-of” pilot session will last 60-90 minutes. In this session, we will brainstorm and explore topics of interest for the First Steps to a Healthy Climate program, and determine resources to be developed. While parents discuss, children will engage in eco-friendly activities.

[Recordings] The teacher/researcher will audio record this session and take notes, in order to review it afterwards. Audio recordings will be destroyed once transcribed (typed up).
[Social Media] Resources will be developed from this session, and will be shared through social media sites (e.g., those of Family Places, First Steps to a Healthy Climate), and websites.
[Video and photographs] Activities will be photographed and video documented (as parental consent allows), in order to create resources and share about the program. A separate photo release will be provided. You do not have to agree to your or your child’s image being shared in order to participate in this pilot session. See information sheet for details.
The teacher/researcher will keep data collected as part of the First Steps program on her password-protected personal computer for up to 7 years.

In-Person Activities / Covid-19.
Full vaccination is required for all participating adults; we will abide by the latest provincial health guidelines in relation to the COVID19 pandemic. You may need to wear a mask.
(If you prefer to participatew online-only, contact Laurel.)

Is there any way being in this study could be bad for you? (Risks)
We do not think there is anything in this study that could harm you. Climate change can be stressful, but it is a part of our lives. We aim to create a hopeful and helpful space. Should you require extra support, Family Place staff are trained support workers who can meet with you.

What are the benefits of participating? (Benefits)
You may find it beneficial to be part of a community of caregivers exploring tools, skills, and information for adapting to a changing world. This program seeks to empower, support, and generate resources around climate-friendly behaviours for families. Educators, other parents, and our earth will also likely benefit from the knowledge/resources this program will create.

Payment / Fees.
There is no fee for participating in this pilot. Financial compensation will not be provided for commercialization activities the researcher undertakes with the data (like publishing a book).

Confidentiality – How will your identity be protected and your privacy maintained?
Full confidentiality cannot be maintained in a group setting. While we encourage participants not to discuss personal details shared, with people outside the group, we cannot control what participants do. Any data you provide may be transmitted and stored in countries outside of Canada, as well as in Canada. It is important to remember that privacy laws vary in different countries and may not be the same as in Canada.

What if I decide to withdraw my consent to participate? What if I want to change my privacy?
At any point, you may withdraw yourself and your child from this study, without giving reasons, and with no effects on any other services you may be entitled to receive. You can withdrawal up to 10 days after the session, by contacting Laurel Hart. You can also request a change to how you are identified (by a pseudonym, your real name, or “a parent”).

Study results.
Resources developed will be available on the program website: www.firststepsclimate.com and on our social media platforms. Findings will be published in academic journals and presented in conferences. An annual newsletter will be sent to you and research partners via email. You will not be identified in any research outputs unless you have expressly consented to this. The researcher/educator may commercialize findings in the future, for example, by publishing a book or resource guide for parents/educators.

Please see the information sheet for additional details about the research, consent, publication, data retention & security, limitations to withdrawal of data and other details.

Who can you contact for information about the study?
Laurel Hart, 604-441-0147, laurelh@sfu.ca (or) laurelhart@gmail.com.
Who can you contact if you have complaints or concerns about the study?
If you have any concerns about your rights as a research participant and/or your experiences while participating in this study, please contact the SFU Office of Research Ethics at dore@sfu.ca or 778-782-6618.

Identification of caregiver and child(ren)
Due to the small group size, and the local nature of the program, it is impossible to ensure anonymity. Even if a pseudonym is used, you may still be identifiable.

Question Title

* 1. Parent / caregiver, please select whether you would like to be identified by:

Real name

A pseudonym

No name (e.g. a parent)

Question Title

* 2. If you selected your real name or a pseudonym, please write how you would like to be referred to.
(Note: If you selected pseudonym, you may leave this blank and a pseudonym will be selected for you.)

Question Title

* 3. Child(ren). Please select whether you want your child(ren) to be identified by their:

Real Name

A Pseudonym

No Name

Question Title

* 4. If you selected your child(ren)’s real name(s) or pseudonym, please write how you would like your child to be referred to (e.g. first name? a nickname?)
(Note: If you selected pseudonym, you may leave this blank, and a pseudonym will be selected for your child.)

Question Title

* 5. Future contact.
Do you grant the teacher/researcher permission to contact you after the pilot study, for follow-up purposes (such as a reunion) or to participate in other studies?
(Note: You are under no obligation to participate in the future if you select yes.)

Yes, you may contact me in the future.

No, you may not contact me in the future.

PARTICIPANT CONSENT AND SIGNATURE PAGE
Taking part in this study is entirely up to you. You have the right to refuse to participate in this study. If you decide to take part with your child, you may choose to pull out of the study at any time without giving a reason and without any negative impact on your access to further services from Family Places, day care, or engagement with other community groups and organizations.

Your signature below indicates that you have received a copy of this consent form for your own records.
Your signature indicates that you consent to participate in this study,
Your signature indicates that you consent to your child participating in this study.
You do not waive any of your legal rights by participating in this study.

Question Title

* 6. Upload Signature

Please upload an image of your signature (you can write on a paper and take a photo.) If you prefer, you can leave this blank, and you will be asked to sign the signature page on the first day.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 7. Date (yyyy/mm/dd)

Question Title

* 8. Printed Name of the Participant (& Parent or Guardian) signing above

Version 5, 2022-04-19
IT27937

Question Title

* 9. Email address
(You will be sent an email to confirm registration within 1-2 days, and a Zoom link prior to the session. Please add firststepsclimate@gmail.com to your contact list, or check your SPAM if you do not receive a message in 1-2 days.)

First Steps Climate Pilot (Focus Group)

First Steps Climate Pilot - Consent Form part 1

Question Title

* 1. Parent / caregiver, please select whether you would like to be identified by:

Question Title

* 2. If you selected your real name or a pseudonym, please write how you would like to be referred to.(Note: If you selected pseudonym, you may leave this blank and a pseudonym will be selected for you.)

Question Title

* 3. Child(ren). Please select whether you want your child(ren) to be identified by their:

Question Title

* 4. If you selected your child(ren)’s real name(s) or pseudonym, please write how you would like your child to be referred to (e.g. first name? a nickname?) (Note: If you selected pseudonym, you may leave this blank, and a pseudonym will be selected for your child.)

Question Title

* 5. Future contact.Do you grant the teacher/researcher permission to contact you after the pilot study, for follow-up purposes (such as a reunion) or to participate in other studies? (Note: You are under no obligation to participate in the future if you select yes.)

Question Title

* 6. Upload Signature

Question Title

* 7. Date (yyyy/mm/dd)

Question Title

* 8. Printed Name of the Participant (& Parent or Guardian) signing above

Question Title

* 9. Email address(You will be sent an email to confirm registration within 1-2 days, and a Zoom link prior to the session. Please add firststepsclimate@gmail.com to your contact list, or check your SPAM if you do not receive a message in 1-2 days.)

Question Title

* 10. Do you have any other questions or comments?

* 2. If you selected your real name or a pseudonym, please write how you would like to be referred to.
(Note: If you selected pseudonym, you may leave this blank and a pseudonym will be selected for you.)

* 4. If you selected your child(ren)’s real name(s) or pseudonym, please write how you would like your child to be referred to (e.g. first name? a nickname?)
(Note: If you selected pseudonym, you may leave this blank, and a pseudonym will be selected for your child.)

* 5. Future contact.
Do you grant the teacher/researcher permission to contact you after the pilot study, for follow-up purposes (such as a reunion) or to participate in other studies?
(Note: You are under no obligation to participate in the future if you select yes.)

* 9. Email address
(You will be sent an email to confirm registration within 1-2 days, and a Zoom link prior to the session. Please add firststepsclimate@gmail.com to your contact list, or check your SPAM if you do not receive a message in 1-2 days.)