"Consent Form for Offender Participation in the Pttcq Implementation and Impact Study" - Quebec, Canada

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PROGRAMME   DE   TRAITEMENT   DE   LA   TOXICOMANIE   DE   LA   COUR   DU   QUÉBEC    (PTTCQ)  
C
PTTCQ
ONSENT FORM FOR OFFENDER PARTICIPATION IN THE
IMPLEMENTATION AND
IMPACT STUDY
Information prior to consent
The implementation of the Court of Québec addict ion treatment program
(programme de traitement de la toxicomanie de la Cour du Québec or PTTCQ) in
Montréal is being scientifically assessed by researchers from the Québec
research and intervention group on psychoactive substances (Recherche et
intervention sur les substances psychoactives – Québec, or RISQ).
We would like you to participate in the study. The data collected will be used to
establish your profile and monitor your progress through the court system during
your participation in the treatment program. This information will help improve the
PTTCQ. It will remain confidential and only members of the research team will
have access to it
.
You are free to withdraw from the study at any time by giving verbal notice; this
will have no negative impact on you and you will not have to justify your decision.
Consent by participant
For the purposes of the PTTCQ implementation and impact st udy,
 I authorize the research team to collect and use information from my file,
kept by the addiction treatment resource.
Yes      No   
 I agree to t ake part in an interview lasting 60 to 90 minutes with a research
Yes      No   
professional.
Name of offender: ________________________ Date:__________________
File number or numbers:________________________________________
 
 
PROGRAMME   DE   TRAITEMENT   DE   LA   TOXICOMANIE   DE   LA   COUR   DU   QUÉBEC    (PTTCQ)  
C
PTTCQ
ONSENT FORM FOR OFFENDER PARTICIPATION IN THE
IMPLEMENTATION AND
IMPACT STUDY
Information prior to consent
The implementation of the Court of Québec addict ion treatment program
(programme de traitement de la toxicomanie de la Cour du Québec or PTTCQ) in
Montréal is being scientifically assessed by researchers from the Québec
research and intervention group on psychoactive substances (Recherche et
intervention sur les substances psychoactives – Québec, or RISQ).
We would like you to participate in the study. The data collected will be used to
establish your profile and monitor your progress through the court system during
your participation in the treatment program. This information will help improve the
PTTCQ. It will remain confidential and only members of the research team will
have access to it
.
You are free to withdraw from the study at any time by giving verbal notice; this
will have no negative impact on you and you will not have to justify your decision.
Consent by participant
For the purposes of the PTTCQ implementation and impact st udy,
 I authorize the research team to collect and use information from my file,
kept by the addiction treatment resource.
Yes      No   
 I agree to t ake part in an interview lasting 60 to 90 minutes with a research
Yes      No   
professional.
Name of offender: ________________________ Date:__________________
File number or numbers:________________________________________