Data Collection Consent Form
SHIELD (Substance Use & Mental Health Intervention for Education, Learning and Diversion)
Participants & Caregivers
Siouxland Human Investment Partnership (SHIP) with Sky Ranch Behavioral Services (SRBS) will deliver Sky Ranch SHIELD, a culturally affirming evidence-based diversion initiative to divert 500 youth prior to arrest and booking in response to a crisis of tobacco and THC vaping with related substance use, mental health, and behavioral issues in the Sioux City Community School District (SCCSD) to reduce the number of youth with mental illness or COD involved in the juvenile justice system, increase resiliency skills, enhance school engagement, and improve well-being. Sky Ranch SHIELD will be delivered in partnership with SCCSD, Sioux City Police Department (SCPD), Iowa Juvenile Court Services (JCS) and the network of community-based providers.
Populations to Be Served: Sky Ranch SHIELD will prioritize and serve Woodbury County, Iowa located in the tristate (Iowa, Nebraska, South Dakota) region of the Sioux City Metropolitan Statistical Area (MSA), known as Siouxland. While this evidence-based early diversion initiative will be open to all youth ages 11 to 18 in grades 5 to 12, a priority focus will be on SCCSD, the largest District in the region with a student body of over 15,000, including youth disproportionately impacted by poverty, low academic performance, and identified barriers. Minority youth who have been disproportionately impacted by racial and equity barriers will also be prioritized to include the Indigenous, African American, Latino, and LGBTQIA+ youth. Youth will be referred and/or identified for Sky Ranch SHIELD by SCCSD, SCPD, and/or self-identified to receive early diversion with a goal of increasing resiliency and decreasing risk.
What SHIELD is about: SHIELD is a new early diversion initiative built upon a foundation of both current capacity and gaps in the service community for youth experiencing substance use and mental health challenges identified by youth and endorsed by SCCSD, Sioux City Police Department School Resource Officers (SROs) and Third Judicial District Juvenile Court Services (JCS) liaison officers in schools.
What we will ask you to do: We will conduct activities such as data collection, surveys, listening sessions, and offer opportunities for collection of information and feedback throughout your participation, as well as gain feedback about the impact of SHIELD.
Risks and benefits: There are possible risks. You may find some of the questions, activities, interventions about your experiences, history, trauma, development, substance use, mental health, related areas, and its effect on your youth and family to be sensitive. The benefit is that you and your family will receive access to an array of activities, services, and resources (outlined above). You will also be able to provide input on the benefits and how to improve these services.
Incentive: Your youth will earn an evaluation incentive gift card for completing evaluation activities at each interval (three) of participation in SHIELD.
Taking part is voluntary: Taking part in the data collection and evaluation is completely voluntary. If you decide not to take part or to skip some of the questions, it will not affect your current or future relationship with SHIELD. If you decide to take part, you are free to withdraw at any time.
Your answers will be confidential. The records of this project and evaluation will be kept private. In any sort of report or information we make public we will not include any information that will make it possible to identify you. Records will be kept in locked electronic systems and files; only the designated staff and evaluators will have access to the records.
If you have questions: Contact the Project Director. You will be given a copy of this form to keep for your records.