Practitioner Consent Form

Consent Form
There was an error on your page. Please correct any required fields and submit again. Go to the first error
Dear Practitioners,

We are conducting a study aimed at evaluating juvenile experiences with sex offender registration and notification with Johns Hopkins Bloomberg School of Public Health and would like to invite you to join us. The online survey will take about 10 minutes to complete (range of 5 to 20 minutes) and your participation is entirely voluntary.

If you consent to participate, you will be asked to complete a brief online survey that will ask you general questions about any current clients under the age of 18 that you are working with in an outpatient setting for sexually inappropriate behaviors. The questions will not ask you to reveal the identity of any such clients. Questions are focused on uncovering general information about the impact of sex offender registration and notification laws on juvenile clients through the eyes of their mental health practitioner. Even if none of your clients are subjected to registration or notification policies, your participation in this study is still important. An additional set of questions will ask about the state in which you practice, what type of practice you work in, and your treatment approach.

Your participation in this study is entirely voluntary and all of your survey responses will remain strictly confidential. You may feel free to skip any questions you are not comfortable answering and you may stop the survey at any time. At the end of the survey, you will be asked if you would be willing to refer any of your current clients and their parents or legal guardians to the youth and caregiver survey components of our study. Referring clients into the youth and caregiver portion of our study is voluntary and does not impact your decision to participate in the online practitioner survey. If you indicate that you are willing to refer potential study participants, you will be directed to a separate online site to provide contact information. Once we receive your contact information, which cannot be linked to your survey responses, we will follow up with details about referral procedures. Your name and contact information, as well as your consent form to participate in the online practitioner survey will be kept in a password-protected file, completely separate from your survey responses. Your name and personal information will not be disclosed in any publicly disseminated results or research findings. Details about the referral process and the youth and caregiver portion of the survey will be provided, should you express interest in this portion of the study.

Although there is no immediate benefit or payment participating in this study, we hope that the information we obtain will help improve legislation that addresses youth sexual offending.

If you have any questions or concerns about the practitioner survey, you may contact Amanda Ruzicka, the Project Coordinator by telephone at 717-269-9886 or by email at aruzicka@jhsph.edu. You may also contact the Johns Hopkins Bloomberg School of Public Health Institutional Review Board, which approved this study with any problems or concerns by mail at 615 N. Wolfe Street, Suite E1100 Baltimore, MD 21205 or by phone at 410-502-0584 or toll free at 1-888-262-3242.

Thank you for your help and cooperation.

Sincerely,



Elizabeth Letourneau, Ph.D.
Associate Professor
Department of Mental Health
Johns Hopkins Bloomberg School of Public Health
Please enter your first name, last name and the date below and select 'yes' to consent to participate in the practitioner survey, or 'no' to remove your name from the study's contact list.
Please enter your first name, last name, and the date. *This question is required.
Do you consent to participate in the practitioner survey? *This question is required.