Mending the Split: Mandatory Psychological Evaluations for Children of Divorce

Your child has been invited to join a research study to look at the mental health of children who’ve
experienced family disruption. Please take whatever time you need to discuss the study with your family
and friends, or anyone else you wish to. The decision to let you child join, or not to join, is up to you.

In this research study, I’ll be collecting a series of interviews from adults and teens who’ve experienced
family disruption as a child and publishing them in a memoir to raise awareness for mental health
treatment.

The purpose of this publication is to evaluate the need for court-mandated psychological evaluations for
each minor child involved in a divorce proceeding in family courts. My goal when publishing these
interviews is not to cast shame on parents who have chosen divorce or who have experienced family
disruption. The purpose of this publication is to instead demonstrate the potential for early mental health
intervention to mitigate long-term emotional impairment and mental illness.

WHAT IS INVOLVED IN THE STUDY?

Your child will be asked to answer a series of questions concerning childhood, family conflict, their
interpretation of said conflict, and other questions that surround the topic of mental health. This may take
up to an hour.

Your child can stop participating at any time. If your child stops he/she will not lose any benefits.

BENEFITS TO TAKING PART IN THE STUDY?

You and your child will have successfully contributed to the fight for mental health awareness and
intervention. Additionally, you will have helped an amateur researcher make her first mark on the field!
(Hint: That researcher is me. And I’m extremely grateful for your time and effort!!!)

CONFIDENTIALITY

Your child’s name will not be used when data from this study are published. Every effort will be made to
keep research records and other personal information confidential.

We will take the following steps to keep information confidential, and to protect it from unauthorized
disclosure, tampering, or damage: every subject age 17 or under in the study will be given a pseudonym
in place of their birth-given name, and any additional details wished to be concealed must be noted where
appropriate on this document.

CONTACTS FOR QUESTIONS OR PROBLEMS?

Call me at (252)-621-3082 or email me at apg7856@gmail.com if you have questions about the study,
any problems, if your child experiences any unexpected physical or psychological discomforts, any
injuries, or think that something unusual or unexpected is happening.

Permission for a Child to Participate in Research

As parent or legal guardian, I authorize _________________________________ (child’s name) to
become a participant in the research study described in this form.

Child’s Date of Birth

Parent or Legal Guardian’s Signature Date

___________________________________________________

Upon signing, the parent or legal guardian will receive a copy of this form, and the original will be held in
the subject’s research record.