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1. This informed consent form was approved by the Rutgers University Institutional Review Board for the Protection of Human Subjects on Oct. 31 2014; Currently, there is no expiration on the approval of this form.
INFORMED CONSENT TO PARTICIPATE IN AN ONLINE SURVEY
You are invited to participate in a pilot study that is being conducted by Laura Heimlich, who is a doctoral candidate in The Graduate School of Applied and Professional Psychology at Rutgers University. The purpose of this pilot study is to determine 1) professional teacher and behavioral consultant perceptions and practices regarding the integration of digital media technology into classroom-based instruction, and 2) to elicit expert feedback with regards to the length of time required to complete the survey items, the content and format of the survey and the potential utility of the Common Core Digital Media Website (CCDMI) as a resource for professional educators and behavioral consultants.
Approximately five (5) subjects will participate in the study and each individual's participation will last approximately thirty (30) minutes.
Participation in this study will involve the following: providing online informed consent, responding to online survey and feedback items, viewing a website and completing further survey and feedback items regarding the website and employment demographic information.
This research is confidential. Confidential means that the research records will include some information about you and this information will be stored in such a manner as to protect your privacy. Some of the information collected about you includes your professional email address and employment demographics. Your responses to survey items will be completely confidential. We will NOT know your IP address when you respond to the online survey. Your name and email address will not be stored with data from your survey. The researchers will not be able to link your professional email address with to your individual survey responses and the results. Instead, you will be assigned a computer generated participant number. This number will be kept securely by the research team only until study completion. Once this research project is complete, your professional email address will be shredded and no link between the survey data and identity will exist. The survey software that you will be using includes a Secure Socket Layer (SSL). SSL is a cryptographic protocol that provides communication security over the internet. SSL provides a reasonable guarantee that one is communicating with precisely the web site that one intended to communicate with (as opposed to an impostor) as well as ensuring that the content of communications between the user and site cannot be read or forged by any third party.
The research team and the Institutional Review Board at Rutgers University are the only parties that will be allowed to see the data, except as may be required by law. If a report of this study is published, or the results are presented at a professional conference, only group results will be stated. All study data will be kept for a minimum of three years.
There are no foreseeable risks to participation except the remote possibility that your professional email address would be inadvertently disclosed. However, the principal investigator has put in place adequate protections for your privacy in that all information provided will be kept confidential by using a randomly generated code in place of your email address. If you feel uncomfortable with a survey item you can skip that item or withdraw from the study all together by using the "exit survey" option. If you decide to quit at any time before you have finished the survey, your answers will NOT be recorded.
There are potential benefits from your participation in this study. You will be provided with hyperlinked access to the Common Core Digital Media Index (CCDMI), a resource that has been designed for the purpose of providing teachers and behavioral consultants with user-friendly access to digital media resources that are indexed according to Common Core State Standards. These resources may be used for the purpose of supporting Common Core instruction in general and special education classrooms.
Participation in this pilot study is voluntary. You may choose not to participate, and you may withdraw at any time during the study procedures without any penalty to you. In addition, you may choose not to answer any questions with which you are not comfortable.
If you have any questions about the study or study procedures, you may contact myself at [email protected] or (732)445-5384.
You may also contact my faculty advisor, Dr. Michael Petronko, at:
The Graduate School of Applied and Professional Psychology
Rutgers, The State University of New Jersey
797 Hoes Lane West
Piscataway, NJ 08854
(732)445-2181
[email protected]
If you have any questions regarding your rights as a research subject, you may contact the IRB administrator at Rutgers University at:
Rutgers University, The State University of New Jersey
Institutional Review Board for the Protection of Human Subjects
Office of Research and Regulatory Affairs
3 Rutgers Plaza
New Brunswick, New Jersey 08901-8559
Telephone: (848)932-0150
Email: [email protected]
Additionally, if you are interested, you can be provided with the results of this study. If you would like to receive the results of this study, please email your request to [email protected].
You may print a copy of this consent page for your records.
By beginning the survey, you acknowledge that you have read this information and agree to participate in this pilot study, with the knowledge that you are free to withdraw your participation at any time without penalty.
Please click the "I Agree" box and then "Continue" if you agree to participate in this pilot study.
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| Are the terms that you just read in Question #3 clearly defined? If not, please provide specific feedback. | | | | Do you have any further feedback regarding Question #3? | | |
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| 5. How often are EACH OF the following goals identified by educators as the reason for referral for school-based behavioral consultation?
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| Is Question #5 clearly stated (including response choices)? If not, please provide specific feedback. | | | | Is the rating scale format easy to complete? If not, please provide specific feedback. | | | | Do you have any further feedback regarding Question #5? | | |
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| 7. Please rate how important you feel that it is to assess EACH OF the following factors when developing classroom-based positive behavior supports.
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| Is Question #7 clearly stated (including response choices)? If not, please provide specific feedback. | | | | Is the rating scale format easy to complete? If not, please provide specific feedback. | | | | Do you have any further feedback regarding Question #7? | | |
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9. What factors MOST OFTEN interfere with fidelity of implementation of the positive behavior support strategies that you recommend to consultees during school-based behavioral consultation?
Please drag and rank the following in order of factors (1st to 7th) that MOST often interfere with fidelity: |
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| | Administrator buy-in Teacher buy-in Student buy-in Items/activities identified as rewards do not have a robust or consistent reinforcing effect on desired behavior Intermittent reinforcement of problem behavior Inconsistent reinforcement of desired behavior Classroom demands are absent of factors that are inherently reinforcing of desired student behavior
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| Is Question #9 clearly stated (including response choices)? If not, please provide specific feedback. | | | | Is the rank ordering response format easy to complete? If not, please provide specific feedback. | | | | Do you have any further feedback regarding Question #9? | | |
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| 11. How potentially useful do you feel the integration of digital media technology into Common Core instruction to be as an antecedent intervention to support EACH OF the following student factors:
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| Is Question #11 clearly stated (including response choices)? If not, please provide specific feedback. | | | | Is the rating scale format easy to complete? If not, please provide specific feedback. | | | | Do you have any further feedback regarding Question #11? | | |
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| 13. How potentially useful do you feel digital media technology to be in the preparation of differentiated Common Core lesson plans developed by teachers? |
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| Is Question #13 clearly stated? If not, please provide specific feedback. | | | | Do you have any further feedback regarding Question #13? | | |
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| 15. Please drag and rank the following in order(1st to 7th) of the most important characteristics that make digital media technology potentially useful in differentiating Common Core content. |
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| | Content presentation can be differentiated (word-by-word/line-by-line read-aloud, text/background color) Student interest and preference can be incorporated into lesson design Content can be broken down into manageable components Teacher can select content and types of activities through which learning objectives are presented (video, audio recording, games) Highly interactive learning Technology-mediated instruction supports the development of students' digital literacy skills Content can be delivered at different paces and/or repetitively
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| Is Question #15 clearly stated (including response choices)? If not, please provide specific feedback. | | | | Is the rank ordering response format easy to complete? If not, please provide specific feedback. | | | | Do you have any further feedback regarding question #15? | | |
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| 17. Would you find it valuable to be able to offer teachers support regarding the integration of digital media technology into Common Core instruction as an antecedent behavioral and academic support strategy? |
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| Is Question #17 clearly stated (including response choices)? If not, please provide specific feedback. | | | | Do you have any further feedback regarding question #17? | | |
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| Did Question #19 clearly communicate to view CCDMI the website before continuing the survey? If not, please provide specific feedback. | | | | Did Question #19 clearly communicate to please not only view, but to also navigate the CCDMI website for about 5 minutes? If not, please provide specific feedback. | | | | Did the link to the CCDMI website work? | | |
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| Did you view and navigate the CCDMI website for about 5 minutes? If not, please go back and do so. If you did, please type "yes" in the box below. Thank you for viewing the CCDMI website! | | | | Was the CCDMI website easy to navigate? If not, please provide specific feedback. | | | | Did all of the links that you chose on the CCDMI website work? | | | | Do you have any further feedback regarding viewing and navigating the CCDMI website? | | |
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| 22. Do you feel that the CCDMI is a useful resource to identify digital media technology to integrate into teacher developed Common Core Lesson plans? |
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| Is Question #22 clearly stated? If not, please provide specific feedback. | | | | Do you have any further feedback regarding Question #22? | | |
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| 24. How likely are you to reference the CCDMI during consultation with classroom teachers for the purpose of identifying digital media technology to integrate into Common Core lesson plans? |
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| Is Question #24 clearly stated (including response choices)? If not, please provide specific feedback. | | | | Do you have any further feedback regarding Question #24? | | |
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| 26. Do you feel that the CCDMI is a useful resource to identify digital media technology for the purpose of differentiating instruction? |
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| Is Question #26 clearly stated? If not, please provide specific feedback. | | | | Do you have any further feedback regarding Question #26? | | |
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| 28. How likely are you to reference the CCDMI during consultation with classroom teachers for the purpose of identifying digital media technology to differentiate instruction? |
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| Is Question #28 clearly stated (including response choices)? If not, please provide specific feedback. | | | | Do you have any further feedback regarding Question #28? | | |
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| 30. How likely are you to recommend the CCDMI to other colleagues? |
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| Is Question #30 clearly stated (including responses)? If not, please provide specific feedback. | | | | Do you have any further feedback regarding Question #30? | | |
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| 32. How often do you use each of the following?
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| Is Question #32 clearly stated (including response choices)? If not, please provide specific feedback. | | | | Do you have any further feedback regarding Question #32? | | |
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34. THANK YOU FOR YOUR TIME TODAY!
To finish, please answer the following brief demographic questions |
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| 35. To what grade levels do you provide behavioral consultation services? | | | | Do you provide behavioral consultation services to general education, special education or both? | | | | To what special education placements to you provide behavioral consultation services (self-contained, in class support, etc.) | | | | How many years have you been providing behavioral consultation in schools? | | |
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| Is Question #35 clearly stated? If not, please provide specific feedback. | | | | Is the open-ended format easy to complete? If not, please provide specific feedback. | | | | Do you have any further feedback regarding Question #35? | | |
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| Do you have any further feedback regarding the format, content or other aspects of this survey? | | | | Not including the feedback questions, do you feel that the time to take this survey is too long, too short, or just right? | | |
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| Do you have any further feedback regarding the format or content of the CCDMI website? | | | | Do you have any further feedback regarding the purpose or utility of the CCDMI website? | | |
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