Review and agree to consent
You are being asked to take part in a study to see if parents will use a free online site to check their child’s development. It is also looking at how use of the site can help parents learn about a child’s development and connect to local resources.
This site is open to all parents of children ages 1 month up to 72 months. If you decide to participate you will complete one or two questionnaires about your child’s development. You will also be asked a few questions about your child and family background. It will take about 10-30 minutes to complete. You can quit at any time.
Before you agree, please read this form. Please ask any questions you may have.
No personal names or addresses are needed or collected. Researchers follow rules to make sure records and websites are secure and password protected. No names are asked or used in any type of report we write. Research records will be destroyed within 3 years. Only the researchers have access to the data. Sometimes funders, regulators and University staff who review research may have to look at the research records.
If you choose to enter or send an email address, it will only be used to respond to your requests. It is not stored with the online data. There are no expected risks.
You will be able to see and download your completed questionnaire(s) and results at the end of the session. You can download play activities from links at the end of the session too. You can also choose to have results sent to your email. If you have concerns at any time, you can contact one of the researchers by email or phone.
This study will provide benefits for participants and for humanity in general. Access to a free online way for parents to check their child’s development may improve the quality of life for some children. Results of the screening can help parents take steps to contact early intervention or community services for timely support of a child’s early development.
If you have any questions about the research, contact Jane Squires* at (541) 346.2634. You may also reach us at the Early Intervention Program, University of Oregon, 5253 University of Oregon, Eugene OR 97403-5253. If you have any questions about your rights as a research subject, please contact Research Compliance Services at the University of Oregon at 541.346.2510. Thank you for your help.
Statement of Consent : I have read (or have had read to me) this consent form. I have been encouraged to ask questions. I have received answers to my questions. I give my consent to take part in this study.
Participation is voluntary and there is no penalty if you decide to withdraw. You may withdraw your consent at any time.
When you click Submit and Continue you give your consent to participate.
Jane Squires, Ph.D.
Oregon Screening Project
*The principal investigator, Dr. Squires, is one of the authors of the ASQ, and the assessment is commercially available and published through Brookes Publishing Company, Inc.