Project Title:  WKU IRB 21-0102 HRSA BHWET: Evaluation of Counselor Experiential Training and Interprofessional Development Program at Western Kentucky University

Investigator: Dr. Cheryl Pence, Department of Counseling and Student Affairs
      cheryl.wolf@wku.edu  |  (270) 745-4484
Co-Investigator:  Jenni Redifer, Department of Psychology
      Jenni.redifer@wku.edu  |  (270) 745-4081

Please read this consent document carefully before you decide to participate in this study.
You are being asked to participate in a project conducted through Western Kentucky University. The University requires that you give your signed agreement to participate in this project.

The investigator will explain to you in detail the purpose of the project, the procedures to be used, and the potential benefits and possible risks of participation. You may ask any questions you have to help you understand the project. A basic explanation of the project is written below. Please read this explanation and discuss with the researcher any questions you may have. If you then decide to participate in the project, please click continue to proceed to the electronic survey or evaluation. You may print or request a copy of this form to keep for your records.

Nature and Purpose of the Project:  This is an evaluation project to document the impact of a counseling training program. The purpose of the training program is to increase the number of qualified counselors that serve diverse and rural communities. In accordance with HRSA award requirements, the purposes of the evaluation are to: (a) determine the degree to which key objectives are implemented; (b) link the program design elements to outcomes and explain how and why aspects of the program work or do not work; (c) determine whether the program has effectively increased intern trainee competence and service in high need areas and whether effective interprofessional training opportunities have been offered; and (d) provide ongoing feedback for continuous program improvement and decision making. In addition, the evaluation will gauge participants’ perceptions of and reactions to the program. Identifying factors that facilitate and impede program implementation will guide program improvement.

Explanation of Procedures:  In the grant-related surveys and evaluations, you will be asked a series of questions related to the grant goals, counselor competence, skills, knowledge, etc. The results will be used for the grant program evaluation and reporting. They may also be used in published research to support the future training of mental health professionals.

Time required: Your completion of the individual grant-related surveys or evaluations may take approximately 15-20 minutes for each one that is relevant to your training or role.

Benefits and Risks:  There are no anticipated risks. Anticipated benefits include the opportunity to participate in the grant-funded trainings and receive free continuing education credits. Some eligible grant participants may also be eligible for a training or supervision stipend as well which is contingent on completing the federal and departmental grant requirements related to those stipends (provided in separate agreement).

Confidentiality:  The survey and evaluations may collect individual participant information to track the completion of academic and grant-related goals. However, collected data will remain password-protected on a secured drive and only shared with the project director, program evaluators, and relevant grant-related staff. Any results published as research will be aggregated and not include identifying participant information.

Refusal/Withdrawal:  Refusal to participate in this study will have no effect on any future services you may be entitled to from the University. Anyone who agrees to participate in this study is free to withdraw from the study at any time.

You understand also that it is not possible to identify all potential risks in an experimental procedure, and you believe that reasonable safeguards have been taken to minimize both the known and potential but unknown risks.

By clicking this button, you confirm that you have read the information provided above, freely decided to participate in this grant-funded program evaluation and research. You understand that you are not giving up any of your legal rights.

THE DATED APPROVAL ON THIS CONSENT FORM INDICATES THAT THIS PROJECT HAS BEEN REVIEWED AND APPROVED BY THE WESTERN KENTUCKY UNIVERSITY INSTITUTIONAL REVIEW BOARD
Robin Pyles, Human Protections Administrator
(270) 745-2129