Development of an Integrative Framework and Implications for Research
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Development of an Integrative Framework and Implications for Research document sample
Document Sample


Rhode Island College
School of Social Work
SW 642/643: INTEGRATIVE PROJECT I and II
Fall– Spring
COURSE DESCRIPTION
This two-semester project is designed to use research and policy analysis skills to address issues
and concerns arising from social work practice. Students will design and carry out empirically
based research/evaluation and advanced policy analysis in their primary practice area. Focus is on
conducting small scale projects that will have immediate applicability for the field. The projects
should focus on practical issues arising from one's field placement and should have the full
backing and involvement of agency administrators and staff. Examples of research activities that
might be carried out include clinical and program evaluations, consumer satisfaction surveys, key
informant interviews, and assessments of client needs. Projects will include an analysis of public
policy issues that goes beyond the descriptive in the student’s chosen area of inquiry. At the
conclusion of the year, students will submit a paper and do an oral presentation on the project.
COURSE OBJECTIVES
Students will:
1. Understand the ethical implications of research and policy activities;
2. Design, implement, collect and analyze data and examine policy related to a targeted
problem;
3. Gain experience in oral and written dissemination of research findings and policy
analysis;
4. Develop implications for practice and policy from their research project.
REQUIREMENTS
1. Design and carry out an empirical research/evaluation and policy analysis project that has
immediate practical use.
2. Complete all sections of the project paper, with references, by the following due dates
(see Project Outline for the content of each section):
Problem Statement and Reference List October
(including the project overview, policy analysis
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using the analytic model included here,
literature review, and conceptual framework)
Methods and Abstract November
Results March
Final draft April
(including the Discussion section and all
other components of the paper)
3. Students must obtain the signed approval of their field instructor, agency executive
director (or representative), and integrative project instructor before starting their data
collection and policy practice activities. The approval form is attached to this syllabus.
This approval is based on the following criteria:
a. submission of the Abstract, Problem Statement, Methodology and Reference List
b. compliance with the College's guidelines on the use of human participants in
research, including review by the College’s Institutional Review Board.
c. agreement between the student and his/her instructor about any changes needed in
the design of the project.
d. In order to receive a grade for the Fall semester, the approval form must be
completed by due date.
4. Incompletes must be negotiated with the course instructor prior to the completion of each
semester. Check with your individual instructor for dates by which this must be
completed.
5. The final approved copies of the paper must be submitted by due date for spring
graduation. Students are to submit two (2) copies of the paper on high quality white
paper (at least 24 lb.). Papers should be placed in a folder or a large envelope with no
staples or clips.
Integrative Project Seminar Schedule
Students will meet as a group every other week for discussion and supervision of project
activities. Class sessions will be used for a combination of group discussion and individual
tutorial. Individual meetings may be scheduled outside of class for additional as needed.
Fall Schedule
Session I Introductions and Overview of the Project Experience
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Students will discuss how advanced research and policy analysis skills are used to
inform quality social work practice. Emphasis will be placed on linking project
activities with students’ individual learning goals.
Session II Developing the Problem Statement and the Policy Analysis Statement
Students will discuss strategies for involving information users in the selection of
a research and policy analysis topic. Students will discuss procedures for
reviewing the literature and identifying relevant policy documents.
Session III Developing the Conceptual Framework for Research and the Policy Analysis
Statement
Students will discuss the development of research questions and hypotheses to
focus their research and the issues to be addressed in their policy analysis.
Session IV Developing Data Collection Instruments
Students will meet to work on the development of their data collection
instruments.
Session V Designing the Research Methods
Students will meet to discuss research design, sampling strategies, study
limitations, and procedures for protecting human participants.
Session VI Planning the Analysis of Data
Students will work on developing their plans for data analysis.
Session VII Plans for Data Collection
Students will finalize their plans for data collection and on-going project work.
Spring Schedule
Session I Data Collection and Policy Analysis
Students will discuss issues in collecting their data.
Session II Analyzing Data
Students will work on analysis of their data. The computer lab will be open and
available for student use
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Session III Organizing and Presenting Project Findings
Students will discuss guidelines for writing up the results of their work.
Sessions IV-VI Presentations of Integrative Projects
Students will present and discuss their projects.
Session VII Students will meet to review and evaluate the project experience.
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Fall 2009 Calendar For
INTEGRATIVE PROJECT OUTLINE
I. Abstract
The abstract is a statement of no more than 250 words which informs readers about the
purpose and design of the study and about the major findings and conclusions. The final
abstract should update the abstract submitted in the fall semester.
II. Problem Statement
Although “A” through “E” below must all be addressed in the Problem Statement section of
the project, you do not have to use the sub-headings we have listed here. It is important that
your Problem Statement section flows smoothly as a coherent whole with clear and logical
transitions from one idea to the next. Sub-headings, either those we have provided, or those
you choose, will help to provide those transitions.
A. Project overview - concise statement of the issue or problem you are studying
1. Describe the issue or problem clearly and discuss how it affects individuals and
society
2. Discuss factors that may be related to or may affect this issue or problem.
B. Importance of the issue and the study. Include a brief history of the issue, focusing on the
causal relationships surrounding it
1. Discuss the incidence and/or prevalence of this issue or problem
C. Policy analysis
1. Define a policy that is relevant to the problem or issue that you have introduced
2. Analyze the policy using the framework provided below
D. Literature review
1. Show what is known about the problem and the policy issues and what has already
been done to find solutions to the problem. This is the evidence-gathering part of the
Integrative project. Your task is to review a variety of published and unpublished
literature from journals, books, the web, and other sources.
2. Present the literature review so that it supports your description of the policy and
research issues to be studied, your research questions, and your methodology.
E. Conceptual framework
1. State the research hypotheses or research questions (whichever is applicable) that will
guide your study.
2. Operationally define the variables.
III. Methods
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A. Research design - description of the form of your study (e.g., exploratory, descriptive,
explanatory)
B. Sampling
1. Indicate the unit of analysis
2. Discuss the characteristics of the population from which the sample is drawn
3. Discuss how you obtained your sample
4. Indicate the sample size
5. Discuss the generalizability of the sample
C. Data Collection
1. Discuss the instruments you are using; indicate their origin, purpose, types of
questions, measuring scale, etc. . .
2. Indicate what is known about the reliability and validity of the instruments and of the
data collected
3. Describe specifically how you will be collecting data
D. Limitations of the study - threats to internal and external validity
E. Ethical issues raised by the research question, the sampling procedure, research design,
instrumentation, and/or dissemination of the findings
1. Discuss ethical issues raised in implementing the study
2. Discuss measures you will take to manage these ethical issues
3. Indicate decision of the Rhode Island College Committee on Human Participants in
Research regarding your project (if necessary) and attach a copy of an approved
Informed Consent Form (if necessary; see attached guidelines)
F. Data Analysis
1. Indicate the type of analysis you will use (e.g., quantitative analysis, qualitative
analysis)
2. Talk about statistical procedures - tests, rationale, significance levels, assumptions
about the data
IV. Results
V. Discussion
1. Talk about the results of your study, including how it refines, revises, and extends
existing knowledge
2. Present implications of your research for social work policy and practice. This would
include your evaluation of how policy might be changed as a result of your findings.
VI. References
VII. Appendices - copies of data collection instruments and other supportive documents.
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What is public policy?
The following material will help you with the policy analysis portion of your project:
Public policy includes a variety of federal, state and local government rules and interventions,
sanctioned by society and designed to meet human needs and to solve social problems. Public
policy reflects the knowledge, values, preferences, politics and economics of those who have
decision-making power as well as those who influence decision-makers.* Examples include:
Legislative policy: State and federal laws that are relevant to social work practice (e.g.
legislation in such areas as income assistance, child abuse and prevention, juvenile justice,
education, and health and mental health care).
Judicial policy: Court cases that address legal issues related to social work practice (e.g.
education, subsidized housing, domestic violence, or public welfare).
Administrative policy: The rules and regulations designed to guide the delivery of programs
administered by state and federal agencies (e.g. policies describing service delivery,
populations served, fees for service, and benefits of service)
For students needing a refresher, see Karger, H., & Stoesz D. (2006). Social policy and the
American welfare state (Chapter 1). In H. Karger, & D. Stoesz. American social welfare policy
(5th edition). Boston: Allyn & Bacon.
Analyzing Policy
Conducting a policy analysis requires that you gather data, ask questions, examine the policy’s
intent and actual result and then consider alternative solutions. For the Integrative Project paper,
you will take all of these steps.
1. Defining the problem or issue you want to address and constructing a review of the
literature about that problem and potential solutions are first steps in a policy analysis.
They provide the context for the policy discussion.
2. Select a policy that was intended to resolve or, in some way, deal with the problem you
have selected. Describe the policy in very specific terms, indicating any formal name,
title, and source.
a. Discuss its content and purpose.
b. Indicate theories that might underlie the policy
c. Provide some history of the policy and its implementation
d. Indicate who has responsibility for the policy
e. How has it been implemented?
3. Discuss the parameters of the policy – although not all these questions will fit, you can
use them as a guide for gathering information about the policy
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a. What were the original goals of the policy? What values underlie it? How do
those values fit with social work values?
b. Indicate the type of benefit people receive through the policy, e.g. cash, in-kind,
services, sanctions, social controls, or some combination
c. Discuss the nature of the policy. Is it intended to provide a long-term solution or
an emergency response? Is it intended to prevent, treat, or remediate the problem?
d. Who are the targets of the policy? Is the policy aimed at everyone (universal) or
are certain people/groups targeted (selective)? If selective, what are the criteria for
receiving services (e.g. income, age, geographic location, physical condition)?
e. How is eligibility determined under the policy?
f. Does everyone who fits the criteria receive benefits?
g. How is the policy funded? Is there sufficient funding to serve all those who might
need services? If those who are served must pay a fee for services, how are fees
determined?
h. What are the spatial determinants of the policy? Where do people receive
services? Are services the same across geographical locations?
i. Who monitors implementation of the policy? How are client/participant rights
protected?
4. Examine the outcomes of the policy – again not all questions will fit for your policy;
choose the questions that fit.
a. Was the policy implemented as expected? What differences exist and why?
b. Has implementing the policy affected the definition of the problem you presented
initially?
c. What do people actually receive as a benefit, as compared with the intent of the
policy? Can you find evidence of how people feel about the policy or resulting
program?
d. Are there sufficient services to meet needs?
e. Is everyone treated equally? Is everyone treated fairly? How are people from
vulnerable populations treated?
f. What are intended and unintended consequences of the policy? Are there
unexpected outcomes?
g. What are the advantages and disadvantages for clients/participants?
h. What are the social and economic costs and benefits of the policy?
i. Who is helped and who is hurt by the policy as implemented?
j. What is the impact for people receiving services? Is it what was anticipated?
k. What values are represented in the policy as implemented? Have ethical
dilemmas emerged in policy/program implementation?
Implications for Policy – The Discussion Section
In the Discussion section, students should return to the policy analysis and talk about pertinent
policy issues that may or could be affected by results of their study. These should be addressed
as implications for policy.
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Students whose projects have focused primarily on clinical or direct practice issues (e.g.,
evaluations of clinical interventions, assessments of treatment programs, client satisfaction
surveys) can include discussion of possible connections between their clinical/direct practice
findings and agency, administrative, or other policy statements/actions.
Examples include:
Legislative policy: Does the current policy need to be changed in light of your findings?
Should it receive further examination because of your findings? Are there federal or state
laws other than the policy you examined that are relevant to the clinical issue you studied
(e.g. the need for legislation to fund the delivery of mental health services for at-risk
populations that would rely on the intervention studied, the need to amend existing statutes
governing access to clinical services that would make use of the intervention)?
Judicial policy: Are there court cases that have addressed, or should address, legal issues
related to the use of the direct practice or other intervention (e.g., court-based controversy
concerning the use of aversive treatment techniques in programs for children with autism,
lawsuits challenging managed care companies’ limited payment for use of the intervention,
the use of court orders to mandate the use of treatment for at-risk clients)?
Administrative policy: What changes need to be made in the way that federal or state
agencies (mental health, human services, child welfare, corrections) design programs to
deliver services that would make use of the clinical intervention or strategy studied (e.g., the
ways in which public agencies might establish policies and programs to facilitate the delivery
of needed clinical services)?
Students whose studies focused on policy or administrative issues also should explicitly address
policy implications in the Discussion section. Speculate about policy matters that should be, or
are being addressed, in the courts, Congress and state legislatures, and public agencies.
Examples include:
Legislative policy: How can the existing policy you analyzed be improved? What new bills
should be introduced to enhance access to basic social services (e.g., affordable housing,
health care, education, vocational training)? In what ways do existing statutes need to be
amended?
Judicial policy: Are there court cases that have addressed, or should address, the policy issues
(e.g., litigation involving racial bias and discrimination in the availability of educational
services for special needs students, involuntary commitment of people with mental illness to
psychiatric facilities, or the termination of parental rights)?
Administrative policy: What changes in administrative policy should officials in public
agencies consider in order to meet clients’ needs and enhance the delivery of social services
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(e.g., revising eligibility criteria, length-of-stay policies, termination-of-service protocols,
funding criteria for programs)?
Be sure that your discussion goes beyond superficial comments about policy. Explore relevant
policy matters in depth, drawing connections to the policy you analyzed in the Problem
Statement section of your paper.
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GUIDELINES FOR PROJECT PAPER
The following outline should be followed in preparing the final copy of your Integrative Project
paper:
Title Page
Acknowledgements (optional)
Abstract
Table of Contents
List of Tables
List of Figures
Problem Statement
Methods
Results
Discussion
References
Appendices
The Title Page, Abstract, Table of Contents, List of Tables, and List of Figures are to follow the
format provided in the sample pages (pp. 13-16). Two copies are to be submitted to your
integrative project instructor. The paper is to be printed using an inkjet or laser printer on good
quality white paper (24 lb. bright white), using at least 1 inch right, top, and bottom margins and
1.5 inch left margin. APA guidelines (5th edition) are to be used in literature citation and
headings. The final paper should be approximately 25-30 pages in length (excluding
attachments).
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(SAMPLE TITLE PAGE)
ENGAGING PARENTS OF JUVENILE SEX OFFENDERS
IN GROUP TREATMENT
by
Mary Smith
An Integrative Project
Submitted in Partial Fulfillment
of
The Requirements for a Master of Social Work Degree,
Rhode Island College School of Social Work
May 2010
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(SAMPLE)
KINSHIP CARE: WHAT ARE WE DOING NOW?
Abstract
In recent years, child welfare caseloads have expanded with limited resources. Increased
caseloads vary from state to state. The need to have kinship homes as an available resource is
growing. This exploratory study focused on the lack of clearly defined policies and practice
procedures guiding state and private child welfare agencies when placing children in kinship
homes. In November of 2006, 44 questionnaires were mailed to social workers from Casey
Family Services’ seven New England divisions. Thirty-two social workers responded to fourteen
questions regarding their number of cases, supportive services for children in kinship and non-
kinship homes, format, and whether the social workers thought Casey Family Services should
develop a more formalized effort of identifying kinship placements.
It was found that out of 252 cases reported, 206 involved children in non-kinship homes
compared to 19 in kinship homes. Thirty social workers responded to the statement “a more
intensified and formalized effort of identifying kinship placements should be a goal for Casey
Family Services”. Twenty-one strongly agreed and nine agreed. This study has implications for
practice and policy development. The findings support a need for clearer policies and exploration
into the equity of services delivered to children in kinship care.
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(SAMPLE)
Table of Contents
Page
Acknowledgements................................................................................ 2
Abstract..................................................................................................... 3
Problem Statement.................................................................................... 6
Methods..................................................................................................... 10
Results...................................................................................................... 15
Discussion.................................................................................................. 19
References................................................................................................ 22
Appendix A - Letter to Participants.................................................................... 24
Appendix B - Social Skills Questionnaire............................................................. 25
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(SAMPLE)
List of Tables
Page
Table I Pre-test & Post-test Results
from the Group Leaders....................................................................... 25
Table II Pre-test & Post-test Results
from the Teachers............................................................................... 26
Table III Pre-test & Post-test Results
from the Parents................................................................................. 27
Table IV Pre-test & Post-test Results
Regarding Satisfaction.......................................................................... 28
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The Committee on Human Participants in Research
Guidelines for Research Oversight
The Rhode Island College Institutional Review Board (IRB) is responsible for assuring
that research involving human participants is conducted according to federal guidelines issued by
the Department of Health and Human Services (45 CFR 46 – these guidelines can be found at
http://www.hhs.gov/ohrp//humansubjects/guidance/45cfr46.htm). If your project involves
“research” and “human subjects” as defined by 45 CFR 46, you must submit an application to the
CHPR for approval prior to the recruitment of participants and the collection of data. Human
subjects research for student research projects, theses, and dissertations always requires prior
CHPR approval. Data collected before approval is obtained cannot be used for research.
The IRB is concerned with the protection of research participants. Protection involves the
following:
1. Minimizing risks and harm to participants
2. Assuring that risks are reasonable relative to benefits of the research
3. Selection of participants is equitable, including examination of inclusion/exclusion
criteria and strategies for assuring that gender, age, race, ethnicity and other differences
are considered
4. Informed consent is obtained in ways that ensure the participant understands the consent,
is aware that research participation is voluntary, and there is no threat of coercion or
undue influence
5. Informed consent is documented
6. Privacy and confidentiality are maintained, including assurances that HIPAA
requirements are met
7. Research participants in vulnerable populations receive additional safeguards; these
include children, students of any age, people who are disabled in any way, people who are
poor, and prisoners
All research protocols involving human participants should be submitted to the CHPR or
its designee sub-committees. The sub-committee at the School of Social Work can determine if
the protocol must be forwarded to the IRB. Determination can be made on the following bases:
1. The research is conducted with adults, involving non-sensitive issues and questions. No
vulnerable population is involved. Confidentiality is not in question. The data to be
collected also may be secondary data. Such research is considered exempt and does not
have to come to the full Committee. Student researchers and faculty mentors should use
informed consent guidelines.
2. The research is conducted with adults involving non-sensitive issues and no vulnerable
population is involved. However, there are questions about confidentiality or privacy. Or
there are concerns about risks or sample selection. The research protocol and required
materials should be forwarded to the Committee as a whole and would probably be
eligible for expedited review (approximately a 10-day turnaround). Electronic submission
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is preferred.
3. The research is conducted with a vulnerable population (see #7 above) or there are
sensitive issues within the research (discussions of intimate partner violence, sexuality,
substance abuse, mental illness, etc. . .). The research protocol and required materials
should be forwarded to the IRB as a whole and full review of the IRB is necessary.
Electronic submission is preferred. Full review requires submission of materials to be
reviewed by the first of the month in which a review will occur.
Students and faculty mentors may contact the chair of the IRB to obtain more detailed
information or to seek answers to specific questions regarding a research protocol. You may also
contact Kevin Middleton, staff to the Committee at kmiddleton@ric.edu or 8778.
The following page contains a model informed consent form. Students should feel free to
use this form and adapt it to the needs of their participant population. You are cautioned
however, that all sections of the consent that are relevant to your research must be included in the
consent form you use. For example, you may not have any alternatives to participation, so you
may leave that out or you may state that there is no alternative method of participation; you may
not be compensating participants, so you should say there is no compensation. You may adapt
language to the reading level of your participants.
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Model Informed Consent Form - (at least) 12-point font
The document below is a model for an adult consent form. It is written at a 12th
grade level and the words would need to be altered for some potential participants. If you
are intending to obtain consent from youth aged 8 – 17, you should use a written and
signed child assent form in addition to obtaining parental permission in a form such as this
one. When drafting a written assent form, researchers have two options for obtaining
consent. They may find it helpful to create a simplified version of this adult consent, called
a youth assent, to be given to and signed by the youth. The parent then reviews and signs a
document such as this. Or this document in simpler wording can be used as both assent for
the youth and consent for the parent.
INFORMED CONSENT DOCUMENT
Rhode Island College
[insert title of study]
You [and/or your child] are being asked to participate in a study about [insert general statement
about study]. You were selected as a possible participant because [explain how subject was
identified]. Please read this form and ask any questions that you may have before deciding
whether or not to be in the research.
Researchers at Rhode Island College are conducting this study.
Background Information
The purpose of this research is [explain research question and purpose in lay language].
If the investigators have a financial interest in the research or its outcomes, please add to this
section the following: Please note that the responsible investigator and/or other members of the
research team have a significant financial interest in [choose one: the sponsor of this research
OR the product/service being investigated in this study].
Procedures
If you agree to be a participant in this research, we will ask you to do the following things:
[describe the procedures to be followed (including audio/video taping); indicate expected
frequency and duration of the subject’s participation; identify any procedures that are
experimental]
Risks and Benefits to Being in the Study
This research has the following risks: First, [explain first risk, including the likelihood of the
risk. Risks could be physical, psychological, emotional, etc. . .]. Second, [explain second risk,
including the likelihood of the risk]. Third, …
[if there are no foreseeable risks, state as such]
[If there are significant physical or psychological risks to participation, the subjects should be
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told under what conditions the researcher will terminate the study]
The benefits of participation are [explain benefits of participation that will be gained by the
participants and/or others (Note: monetary compensation is not considered a benefit)]
[if there are no benefits, state as such]
Alternatives to Participation as Described
[provide information about alternatives to the procedures you have described or remove this
section if there are no alternatives]
Compensation
You will receive the following payment/reimbursement: [explain amount of payment or other
reimbursement information (e.g., class credits, tokens, etc.), as well as when payment and/or
reimbursement will occur]
Confidentiality
The records of this research will be kept private. In any sort of report we might publish or
presentation we might make, we will not include any information that will make it possible to
identify a participant. Research records will be kept in a locked file at/in [state where records
will be kept], and access will be limited to the researchers. If there is a review or audit of the
research, access will be granted to the Institutional Review Board (IRB), regulatory agencies, and
[add only if applicable] sponsors and funding agencies. The records and data from this study will
be maintained until [state how long you will keep the original and any identifiable data. This
should be at least three years following completion of the research.]. After that all records will
be destroyed. [if tape or video recordings are made, explain who will have access to them, and
when they will be erased/destroyed]
Voluntary Nature of the Study
Your participation is voluntary. If you choose not to participate, it will not affect your current or
future relations with the College [or with other cooperating institutions (insert names)]. There is
no penalty or loss of benefits for not participating or for discontinuing your participation.
[explain any consequences (e.g., adjusted monetary benefits or loss of course credit) due to early
withdrawal. Explain how such withdrawal will be pro-rated (e.g., half of the money or extra
credit if discontinue participation half-way through)]
You will be provided with any significant new findings that develop during the course of the
research that may make you decide that you want to stop participating. [This statement is part of
our template, but if it does not or cannot apply to your study, please delete it or justify how you
plan to share findings to participants.]
Contacts and Questions
The researchers conducting this study are [Responsible Investigator-faculty or student] and [Co-
Investigator(s)-faculty mentor, other faculty, staff, and students]. You may ask any questions
you have now. If you have any questions later, you may contact them at [contact information].
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If the researchers cannot be reached, or if you would like to talk to someone other than the
researcher(s) about; (1) concerns regarding this study, (2) research participant rights, (3)
research-related injuries, or (4) other human subjects issues, please contact Kevin Middleton,
Rhode Island College IRB at (401) 456-8228 or write: Kevin Middleton, c/o Rhode Island
College IRB at Office of Research and Grants Administration, Roberts Hall, 600 Mount Pleasant
Avenue, Providence, RI 02908.
You will be given a copy of this form for your records.
Statement of Consent
I have read the above information. I have received answers to the questions I have asked. I
consent to participate in this research. I am at least 18 years of age.
This consent is null and void after one year from approval of the protocol. [you also may specify
a date approximately one year away, after which the consent is nullified]
[Note to Researcher: If this form is used as a parental permission and assent form (usually
appropriate for teenage subjects), please omit “I am at least 18 year of age.” If you are using
audio or video tapes, add to the signature section the following “I consent to audiotaping” and
“I do not consent to audiotaping” with space for participant to indicate a preference. Use the
same sentences but substitute “videotaping” for the other choice.]
Print Name of Participant:
Signature of Participant: Date:
Signature of Parent or Guardian [omit if not applicable]: Date:
Signature of Person Obtaining Consent [omit if not applicable]: Date: _____________
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Rhode Island College
Master of Social Work Program
INTEGRATIVE PROJECT APPROVAL FORM
All projects are to be approved before data collection and analysis activities begin. The approval
of the project is to be based on a review of the first sections of the project paper - the Problem
Statement and Methodology. Once these two sections have been approved, this form should be
completed by the instructor in consultation with the student. In order for the student to receive a
grade for the fall semester, the form and the Project Abstract must be completed by December
11, 2009.
Name(s): ___________________________________________________
Project Title: _____________________________________________
Conditions of approval: ____________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Abstract attached: _____________________
The project has been reviewed for compliance with the Rhode Island College Institutional
Review Board: ____________________
___________________________________ _______________ Date
Student's Signature
___________________________________ _______________ Date
Instructor's Signature
___________________________________ _______________ Date
Field Instructor’s Signature
___________________________________ ________________ Date
Agency Director’s Signature (or representative)
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