Evaluation of a Mentorship Program for Individuals With Autism Spectrum Disorder (ASD)
Phase: NA
Conditions: Autism Spectrum Disorder
Sponsor: University of Minnesota

PROTOCOL TITLE: Evaluation of a mentorship program for individuals with autism 
spectrum disorder (ASD) 
VERSION DATE: 7, 9.9.2020 
 
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Revised: January 29, 2017 
 
PROTOCOL TITLE: 
Evaluation of a mentorship program for individuals with autism spectrum 
disorder (ASD) 
PRINCIPAL INVESTIGATOR or FACULTY ADVISOR: 
Rebekah L. Hudock, PhD 
Pediatrics 
612-626-3538 
kale0040@umn.edu 
 
Lindsey Weiler, PhD 
Family Social Science 
612-301-9345 
lmweiler@umn.edu 
 
STUDENT INVESTIGATOR: 
Amy Gunty, MA 
Family Social Science 
612-460-1782 
gunty004@umn.edu 
VERSION NUMBER/DATE: 
Version 7, 9.9.2020 
 
 

PROTOCOL TITLE: Evaluation of a mentorship program for individuals with autism 
spectrum disorder (ASD) 
VERSION DATE: 7, 9.9.2020 
 
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Revised: January 29, 2017 
REVISION HISTORY 
 
Revision # 
Version Date 
Summary of Changes 
Consent Change? 
1 
08/08/2018 
Detail added to section 5 
yes 
2 
12/17/2018 
Additional detail in section 5, 
information about translation and 
interpretation 
yes 
3 
1/2/19 
Added information about 
incentives 
no 
4 
8/1/19 
Update to recruitment strategy, 
data collection location, study 
length, and number of participants. 
Correction of incentive information 
(correct on consent form). 
no 
5 
9/13/19 
Update to data collection, number 
of participants, study team, and 
consent forms 
yes 
6 
5/3/2020 
Update to data collection 
procedures, addition of secondary 
outcomes, and study team 
no 
7 
9/9/2020 
Extension of the study to include 
Phase 3 (virtual program trial), 
update to Phase 3 data collection 
procedures, addition of Phase 3 
consent, update to study team 
 
- All study activities for Phase 3 
will be done via telephone or on-
line (secondary to COVID-19 
pandemic) 
 
Yes (update to 
consent for Phase 
3) 
 
 
 
 

PROTOCOL TITLE: Evaluation of a mentorship program for individuals with autism 
spectrum disorder (ASD) 
VERSION DATE: 7, 9.9.2020 
 
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Table of Contents 
 
1.0 
Objectives ............................................................................................................... 6 
2.0 
Background ............................................................................................................. 6 
3.0 
Study Endpoints/Events/Outcomes ......................................................................... 6 
4.0 
Study Intervention(s)/Interaction(s) ........................................................................ 7 
5.0 
Procedures Involved................................................................................................ 7 
6.0 
Data Banking ........................................................................................................ 11 
7.0 
Sharing of Results with Participants ..................................................................... 12 
8.0 
Study Duration ...................................................................................................... 12 
9.0 
Study Population ................................................................................................... 13 
10.0 
Vulnerable Populations ......................................................................................... 14 
11.0 
Number of Participants ......................................................................................... 16 
12.0 
Recruitment Methods ............................................................................................ 16 
13.0 
Withdrawal of Participants ................................................................................... 18 
14.0 
Risks to Participants .............................................................................................. 18 
15.0 
Incomplete Disclosure or Deception ..................................................................... 19 
16.0 
Potential Benefits to Participants .......................................................................... 19 
17.0 
Data Management ................................................................................................. 20 
18.0 
Confidentiality ...................................................................................................... 20 
19.0 
Provisions to Monitor the Data to Ensure the Safety of Participants ................... 21 
20.0 
Provisions to Protect the Privacy Interests of Participants ................................... 21 
21.0 
Compensation for Research-Related Injury .......................................................... 22 
22.0 
Consent Process .................................................................................................... 22 
23.0 
Setting ................................................................................................................... 25 
24.0 
Multi-Site Research .............................................................................................. 27 
25.0 
Resources Available.............................................................................................. 27 
26.0 
References ............................................................................................................. 28 
 

PROTOCOL TITLE: Evaluation of a mentorship program for individuals with autism 
spectrum disorder (ASD) 
VERSION DATE: 7, 9.9.2020 
 
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ABBREVIATIONS/DEFINITIONS 
Include any abbreviations or definitions for key or technical terms you use in your 
protocol. 
• 
Autism Spectrum Disorder (ASD) 
• 
Autism Society of Minnesota (AuSM) 
• 
Minnesota Independence College and Community (MICC) 
• 
University of Minnesota (UMN) 
 
 

PROTOCOL TITLE: Evaluation of a mentorship program for individuals with autism 
spectrum disorder (ASD) 
VERSION DATE: 7, 9.9.2020 
 
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STUDY SUMMARY 
 
Study Title 
Evaluation of a mentorship program for individuals 
with autism spectrum disorder (ASD) 
Study Design 
Pre-, mid-, and post-program interviews, focus groups, 
and questionnaires 
Primary Objective 
Preliminary evaluation of a pilot mentoring program 
for individuals with ASD 
Secondary Objective(s) 
 
Primary Study Intervention 
or Interaction 
Participants will participate in interviews and focus 
groups and will complete questionnaires before, during 
and after participating in a pilot mentoring program. 
Study Population 
Adolescents and adults with ASD, parents of 
individuals with ASD, mentoring program staff 
Sample Size (number of 
participants) 
50-90 individuals  
Study Duration for 
Individual Participants 
Approximately 6-14 hours across 12-18 months 
For Phase 3 participants, an additional 6 hours over 9 
months 
 
 
 

PROTOCOL TITLE: Evaluation of a mentorship program for individuals with autism 
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VERSION DATE: 7, 9.9.2020 
 
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1.0 
Objectives  
1.1 Purpose: Describe the purpose, specific aims, or objectives. 
The purpose of this project is to evaluate the implementation of a pilot mentorship 
program for individuals with ASD implemented by a community group. Specific aims 
include conducting interviews and focus groups with and collecting survey information 
from individuals with ASD, family members, and mentorship program staff. Information 
from these interviews and questionnaires will be used to inform further development of 
the mentoring program for individuals with ASD.  
2.0 
Background 
2.1 Significance of Research Question/Purpose: Describe the relevant prior 
research and gaps in current knowledge for your research question. 
2.2 Preliminary Data: Describe any relevant preliminary data. 
No preliminary data currently exists 
2.3 Existing Literature: Provide the scientific or scholarly background for, 
rationale for, and significance of the research based on the existing 
literature and how will it add to existing knowledge. 
Relationships with caring, non-parental adults (i.e., mentors) are critical to healthy child 
development (DuBois et al., 2011). Mentoring programs can positively influence a range 
of outcomes for youth, including peer and parental relationships, academic achievement, 
self-concept, and prevention of problem behaviors, including substance use (DuBois et 
al., 2011; Rhodes, 2002; Rhodes & Roffman, 2002). Despite the importance of adult 
youth relationships, mentoring for children with autism spectrum disorder (ASD) has not 
been described or studied systematically. This is particularly problematic because 
children who lack quality support networks are vulnerable to behavioral health problems 
and limited social capital, both of which strongly affect educational achievement, 
economic success, and quality of life (Hale & Viner, 2012). The promise of youth 
mentoring for children with ASD is yet to be realized, but theoretical and empirical 
support for mentoring, in general, suggests such relationships may be a positive youth 
development intervention worth exploring. The cultural adaptation of evidence-based 
practices has emerged as a necessary strategy to adequately and appropriately meet the 
needs of specific populations (Castro, Barrera, & Holleran Steiker, 2010), and will 
provide a framework for translating and transforming mentoring best practices to fit the 
unique needs of children with ASD. Because no known research is available, the purpose 
of this study is to examine the feasibility, acceptability, and limited effectiveness of a 
pilot mentoring program, which matches children with ASD with adults with ASD in a 
one-to-one mentoring relationship. 
 
3.0 
Study Endpoints/Events/Outcomes 
3.1 Primary Endpoint/Event/Outcome: Describe the primary study endpoint, 
event, or outcome you will be evaluating or observing. 

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VERSION DATE: 7, 9.9.2020 
 
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The evaluation will focus on identifying elements of the program that 
worked well as well as elements of the program that were difficult or did not 
work well. Initial outcomes for the limited exploration of the effectiveness 
of the program will include quality of life, self-concept, social skills, 
behavioral challenges, psychological well-being, academic achievement, 
communication, parent-child relationships, and pride in autistic identity.  
3.2 Secondary Endpoint(s)/Event(s)/Outcome(s): Describe any secondary study 
endpoints, events, or outcomes you will be evaluating or observing. 
Secondary data will also be collected regarding implementation of the 
program, including acceptability and feasibility of the intervention and 
experiences with the modality of the intervention.  
4.0 
Study Intervention(s)/Interaction(s) 
4.1 Description: Describe the study intervention(s) and/or interaction(s). 
Interventions may include staging scenarios or manipulating the 
environment to evaluate behavior. Interactions may include surveys, 
interviews, or focus groups. If the study does not involve intervention or 
interactions, describe any observations of public behavior. 
A community group, including the PIs, is overseeing the development and 
implementation of the mentorship program. The PIs serve on this committee 
to inform the group of best practice in evaluating such a program. UMN 
staff will attend training sessions and will continue to engage in steering 
committee meetings in order to oversee data collection and to educate the 
community group about participant protections and research procedures. As 
such, UMN staff will be focused specifically on evaluation of that program. 
UMN staff will engage participants, parents, and program staff in pre-, mid-, 
and post-program interviews, focus groups, and surveys. Furthermore, UMN 
staff will have access to program applications completed by participants and 
will receive weekly information from program staff regarding attendance 
and participant ratings of the weekly meetings. While program staff will be 
collecting application and weekly data, researchers will be overseeing the 
weekly data collection process. For Phase 3, all study activities will be 
conducted via telephone or other electronic means. 
5.0 
Procedures Involved 
5.1 Study Design: Describe and explain the study design. 
5.2 Study Procedures: Provide a description of all research procedures being 
performed and when they are performed, including procedures being 
performed to monitor participants for safety or to minimize risks. 
Describe: 
• 
Procedures to be performed for research purposes and, if relevant, 
which procedures would be performed regardless of whether the 

PROTOCOL TITLE: Evaluation of a mentorship program for individuals with autism 
spectrum disorder (ASD) 
VERSION DATE: 7, 9.9.2020 
 
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research was conducted, e.g., procedures performed for diagnostic or 
treatment purposes. 
• 
The data to be collected about participants and the source records 
that will be used to collect those data. (Attach all surveys, scripts, and 
participant-facing data collection forms in ETHOS.) 
5.3 Follow-Up: The data to be collected, including long-term follow-up data. 
The study will include evaluation activities to inform the further development of a 
mentorship program for individuals with ASD.   
 
The study will include distributing and collecting surveys from and conducting 
interviews and focus groups with mentorship program participants from Kennedy High 
School, Minnesota Independence College and Community (MICC), and the Autism 
Society of MN, along with parents of participants (where appropriate) and program staff. 
For Phase 3, all study activities will be conducted via telephone or electronic means. For 
Phase 3 only, data (naturalistic observations) will also be collected via video recordings 
of mentoring sessions via Zoom.  
 
Participants will include high school students with ASD, young adults with ASD, parents 
of individuals with ASD (note: for parents who speak Spanish, consent forms will be 
professionally translated and a professional interpreter will be present for each data 
collection meeting), and mentoring program staff (including staff from MICC, 
Bloomington Public Schools, and AMP-specific staff). The community group is 
responsible for the recruitment and selection of participants in the program. A member of 
the research team will assist with the recruitment process by contacting families who 
indicate to the community group that they are interested in learning more about the AMP 
program. This team member will call or email interested families who provide their 
contact information to answer questions about the program, screen for eligibility, and to 
connect them to the program coordinator for application materials if they would like to 
apply for the program.  
 
Individual interviews and focus groups will take place at AuSM headquarters, MICC, 
Kennedy High School, another Bloomington Public Schools building, or a local venue 
close to the participant’s home that can provide adequate privacy for study activities, 
whichever location is preferred by the participant. Surveys will be completed as a part of 
those data collection visits in which interviews are conducted. Interviews and select 
survey tools (NMRC Academic Achievement and School Engagement Scales, Future 
Orientation Scale, Loneliness Questionnaire, Rosenberg Self-Esteem Scale, Mentoring 
Relationship Quality Scale) will be administered via Qualtrics with permission from the 
developers and publishers. Online surveys will be completed by participants within their 
homes or at the location of their choice on personal electronic devices. Interviews and 
focus groups will be audio recorded and transcribed for analysis. Qualitative data (i.e., 
formative evaluation data) will be gathered and analyzed from the interviews and focus 
groups and will be used to inform the continued development of the mentorship program.  
 
 

PROTOCOL TITLE: Evaluation of a mentorship program for individuals with autism 
spectrum disorder (ASD) 
VERSION DATE: 7, 9.9.2020 
 
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Due to changes in the implementation of the mentoring program on the part of the 
community partners (who are responsible for the implementation), the length of the 
program will vary. A shorter program (Phase 1) will run from January until May 2019, 
during which we will evaluate acceptability and feasibility. A full pilot program (Phase 2) 
will then run for the next school year, from August 2019 to June 2020, during which we 
will continue to evaluate acceptability and feasibility while also collecting data to 
evaluate preliminary outcomes associated with the program. Due to changes in 
programming resulting from the COVID-19 pandemic, AMP is unable to be implemented 
in-person as intended; therefore, AMP will be implemented in a virtual format for the 
2020-2021 school year (Phase 3), and the program evaluation will be extended to 
evaluate the initial outcomes of a virtual AMP program. 
 
For Phase 3, all efforts described here will be conducted electronically so as to facilitate 
appropriate no-person-contact measures that are indicated vis-à-vis current COVID-19 
pandemic. Participants will be encouraged to situate themselves in a context where their 
privacy is ensured / facilitated (e.g., a private room in their apartment or house with the 
door shut). Researchers will do the same, and communicate as such during consent 
processes and before study activities begin. To better describe participants, Phase 3 
participants will complete a brief assessment of cognitive skills, language skills, and 
symptoms related to autism. To better understand the content of mentoring sessions and 
the quality of mentoring interactions and relationships, virtual mentoring sessions will 
also be video recorded via videoconferencing applications (e.g., Zoom) and analyzed at a 
later date by the research team for naturalistic observation of the sessions. The consent 
form will be updated to reflect the addition of Phase 3 and changes in data collection 
procedures. Consent will be obtained electronically for participants participating in Phase 
3. 
 
 
In sum, researchers will use the following data in the evaluation of the pilot program: 
• 
Pre-program 
o Information from applications to the program 
o Brief baseline skills assessment (Phase 3) 
 
Ravens Progressive Matrices (mentees, mentors) 
 
Peabody Picture Vocabulary Test- 5th Edition (PPVT-5) (mentees, 
mentors) 
 
Social Responsiveness Scale – 2nd Edition (SRS-2) (mentors, 
parents) 
o Interviews/Online Surveys (30-60 minutes) 
 
Open-ended and Likert-scale questions about demographics 
(gender, race, ethnicity, household income, diagnosis, education 
level), quality of life, autistic identity, personal goals, social 
activities and relationships, independent living skills, social and 
emotional well-being, experience with the mentorship program, 
and impact of COVID-19 (COVID-related questions only in Phase 
3). 
o Questionnaires (60-90 minutes) 

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VERSION DATE: 7, 9.9.2020 
 
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 
Achenbach scales (Phases 1 &2) 
 
Child Behavior Checklist (CBC; parent-report, mentees) 
 
Youth Self-Report (YSR; mentees) 
 
Adult Self-Report (ASR; mentors)  
 
Social Skills Improvement System (SSIS; parent report and 
student-report, mentors and mentees) (Phases 1-3) 
 
Piers-Harris Self-Concept Scale-(Phase 1)/Rosenberg Self-Esteem 
Scale-full pilot (Phases 2 &3) (mentors and mentees) 
 
Mentoring Relationship Quality Scales (Phases 1-3) 
 
Child Communication Checklist – 2nd Edition (CCC-2, parents) – 
(Phases 2 &3) 
 
Stress Index for Parents of Adolescents (SIPA, parents) – (Phase 2) 
 
NMRC Academic Performance & School Engagement – (Phases 
2&3) 
 
Future Orientation Scale (mentors and mentees) (Phase 3) 
 
Loneliness Questionnaire (mentors and mentees) (Phase 3) 
 
Beck Depression Inventory – 2nd Edition (BDI-2) (mentors and 
mentees) (Phase 3) 
 
Beck Anxiety Inventory (BAI) (mentors and mentees) (Phase 3) 
• 
Beginning of Program (90 minutes) – (Phase 1 only) 
o Focus groups regarding goals and program implementation (goals for the 
program, what is working and what is not working) 
• 
Weekly (5 minutes) 
o Exit slip including information about how that week’s particular meeting 
went, from: 
 
mentors 
 
mentees 
 
staff members 
o Video recordings of virtual mentoring sessions 
• 
Mid-program (60-90 minutes) 
o Interviews/Online Surveys (modified version of pre- and post-
interviews/surveys) 
 
Mentoring Relationship Quality Scale 
 
NMRC Academic Performance & School Engagement Scales – 
(Phases 2&3) 
• 
Post program 
o Interviews/Online Surveys (30-60 minutes) 
o Questionnaires (60-90 minutes) 
 
Achenbach scales (Phases 1&2) 
 
Child Behavior Checklist (CBC; parent-report, mentees) 
 
Youth Self-Report (YSR; mentees) 
 
Adult Self-Report (ASR; mentors)  
 
Social Skills Improvement System (SSIS; parent report and 
student-report, mentors and mentees) (Phases 1-3) 
 
Piers-Harris Self-Concept Scale- (Phase 1)/Rosenberg Self-Esteem 
Scale-full pilot (mentors and mentees) (Phases 2&3) 

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spectrum disorder (ASD) 
VERSION DATE: 7, 9.9.2020 
 
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 
Mentoring Relationship Quality Scale (Phases 1-3) 
 
Child Communication Checklist – 2nd Edition (CCC-2, parents) – 
(Phases 2&3) 
 
Stress Index for Parents of Adolescents (SIPA, parents) – (Phase 2) 
 
NMRC Academic Performance & School Engagement Scales – 
(Phases 2&3) 
 
Future Orientation Scale (mentors and mentees) (Phase 3) 
 
Loneliness Questionnaire (mentors and mentees) (Phase 3) 
 
Beck Depression Inventory – 2nd Edition (BDI-2) (mentors and 
mentees) (Phase 3) 
 
Beck Anxiety Inventory (BAI) (mentors and mentees) (Phase 3) 
 
Project-developed questionnaire regarding implementation of the 
program (AMP founder and program manager) – (Phases 2&3) 
 
Project-developed questionnaire regarding implementation of the 
program within a school setting (AMP educational staff from 
MICC and Bloomington Public Schools) – (Phases 2&3) 
 
Project-developed questionnaire regarding planning, acceptability, 
and feasibility of the program (AMP steering committee, AMP 
staff) – (Phases 2&3) 
o Focus Groups (mentees, mentors, parents) (Phases 1&3) 
 
Incentives. Participants will receive the following incentives: 
• Phase 1 (December 2018 through June 2019): $10 for each completed data 
collection activity (i.e., pre-program, post-program) 
• Phase 2 (August 2019 through June 2020): 
• Baseline data: $10 
• Mid-program interviews: $20 
• Post-program data: $25 
• Phase 3 (September 2020-June 2021) 
• Baseline assessment: $20 
• Pre-intervention data collection: $50 
• Mid-program data collection: $30 
• Post-program data collection: $50 
• Post-program focus group: $50 
 
6.0 
Data Banking 
If this study does not involve data banking for future use, type “N/A” and delete 
the sub-headings below. Otherwise, complete all items below. 
6.1 Storage and Access: If data will be banked for future use, describe where 
the data will be stored, how long they will be stored, how the data will be 
accessed, and who will have access to the data.  
Data from this pilot study will be stored within a secure Box account sponsored by UMN. 
The PIs will manage this database and will provide access to the data to identified key 
study personnel who will be responsible for managing and analyzing study data. Data 

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VERSION DATE: 7, 9.9.2020 
 
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will not be accessible to individuals outside of the research team. Data will be stored for 
up to 7 years in order to inform future studies expanding on this work and to be used for 
preparation of publications.  
6.2 Data: List all of the data elements to be collected and banked for future use. 
Data will be collected regarding interviews, interview responses, focus group discussions, 
questionnaire/survey responses, educational information (school, grade, classroom, 
special education services), video recordings of mentoring sessions, brief assessment of 
cognitive/language functioning and ASD symptoms, clinical and/or educational 
evaluations to include diagnoses and classifications, and participant demographic 
information (age, gender, race, ethnicity, city of residence, household income, 
employment status, educational status) via self- and/or parent-report. Data collected 
include information mentioned above (protocols included in appendices). 
 
6.3 Release/Sharing: Describe the procedures to release data, including: the 
process to request a release, approvals required for release, who can obtain 
data, and the data elements to be provided. 
Data will not be released to individuals other than those identified by the PIs as key 
personnel who are responsible for managing or analyzing the data. The PI will grant 
access to the secure Box database on an individual basis after assessing the need for an 
individual’s access. Otherwise, the PIs will be responsible for sharing relevant 
information with the advisory team who will develop the mentoring program. Upon 
request from the community partners, the research team may also produce summaries of 
study results to be shared with community stakeholders.  
 
7.0 
Sharing of Results with Participants 
7.1 Describe whether results (study results or individual participant results, 
such as survey results) will be shared with participants or others (e.g., 
participants’ parent or school administrators) and, if so, describe how the 
results will be shared. 
Please see the Investigator Manual (HRP-103) for additional information 
about language that should be included in the consent form related to 
sharing of results. 
Results of the interviews and questionnaires will not be shared directly with participants; 
however, results will be shared with the community group in order to inform the further 
development of the mentoring program. Upon request from the community partners, the 
research team may also produce summaries of study results to be shared with community 
stakeholders, which may be accessible to study participants. 
 
8.0 
Study Duration 
8.1 Describe: 

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VERSION DATE: 7, 9.9.2020 
 
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• 
The duration anticipated for an individual participant’s participation 
in the study. 
• 
The duration anticipated to enroll all study participants. 
• 
The duration anticipated to complete all study procedures and data 
analysis. 
The study is anticipated to last approximately 12-18 months, depending 
upon whether participants participate in Phases 1 and 2 of the program, or 
only Phase 2 of the program. Participants who wish to participate in Phase 3 
of the study will participate for an additional 9 months. Researchers will 
conduct interviews and focus groups and collect questionnaires at the 
beginning and end of the pilot year of the mentoring program (August-
September 2018 and May-June 2019 for Phase 1; in September/October 
2019, January/February 2020, and May/June 202 for Phase 2; in October 
2020, January 2021, and May/June 2021 for Phase 3) to gather data to be 
used for formative evaluation of the program. Data analysis will occur in the 
months following the completion of the program each year. The community 
group developing and implementing the mentorship program is primarily 
responsible for the recruitment of participants and decisions regarding the 
inclusion of participants. We will approach participants during the 
mentorship program time itself and/or via email or phone call at the 
beginning of the school year to facilitate evaluation activities. Depending 
upon which years of the study participants choose to participate in, 
participation is expected to take approximately 6 hours of the participant’s 
time over the course of 12 months, or 14 hours over the course of 18 
months. Phase 3 will require approximately 6 hours of the participants’ time 
over 9 months.  
Following the completion of interviews and questionnaires, the research 
team will meet to analyze the data, share results with the advisory team, and 
make recommendations regarding further development of the mentoring 
program.  
9.0 
Study Population 
9.1 Inclusion Criteria: Describe the criteria that define who will be included in 
your final study sample. 
Please reference Section: Vulnerable Populations. Please note that you may 
not include vulnerable populations as participants in your research unless 
you indicate this in your inclusion criteria. 
The mentoring program will include high school students with ASD (ages 14-21) and 
young adults with ASD (ages 18-35). Evaluation data will also be collected from parents 
of participants (where appropriate), professionals who work with individuals with ASD 
who are involved in the implementation of the pilot mentoring program (special 
educators and school administrator, MICC staff), and community members overseeing 
the development and implementation of the mentoring program. Inclusion criteria will be 
that individuals are participants, participants’ parents, or staff in the mentoring program. 

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Participants must have fluent language and will speak and understand English and/or 
Spanish fluently. Participants must be able to commit to providing evaluation data. 
Participants will not have an intellectual disability (IQ under 70) as documented in the 
baseline assessment or in the clinical or educational evaluation provided at the beginning 
of the program. Participants will have a diagnosis/classification of ASD as documented 
via medical/psychological documentation or educational records.  
9.2 Exclusion Criteria: Describe the criteria that define who will be excluded in 
your final study sample. 
Participants will be excluded from the interviews and questionnaires if they are not 
participants in the mentoring program, parents of participants in the mentoring program, 
or mentoring program staff. They will also be excluded if they do not have fluent 
language, and if they do not speak and understand English and/or Spanish. Participants 
will be excluded if they have an intellectual disability (IQ under 70; note that this is also 
exclusion criteria for participation in the mentoring program at this time) and if they do 
not have a diagnosis/classification of ASD. Participants who are unable to commit to the 
time needed for the interview and questionnaires will not be included. 
9.3 Screening: Describe how individuals will be screened or assessed for 
eligibility. 
Participants will be personally invited by community group staff at the mentoring 
program. A brief speech sample will be taken at the beginning of the interview. 
Participants will also be asked to provide documentation of their ASD diagnosis and IQ 
either via medical/psychological records or educational evaluation/records.  
 
10.0 Vulnerable Populations 
10.1 Vulnerable Populations: Identify which of the following populations will be 
involved in this study. (You may not include members of the populations 
below as participants in your research unless you indicate this in your 
inclusion criteria above.) 
x Children 
☐ Pregnant women/Fetuses/Neonates 
☐ Prisoners 
☒ Adults lacking capacity to consent and/or adults with diminished capacity 
to consent, including, but not limited to, those with acute medical 
conditions, psychiatric disorders, neurologic disorders, developmental 
disorders, and behavioral disorders 
☒ Non-English speakers 
☐ Those unable to read (illiterate) 
☐ Employees of the researcher 
☐ Students of the researcher 
☐ None of the above 
10.2 Adults lacking capacity to consent and/or adults with diminished capacity to 
consent: 

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VERSION DATE: 7, 9.9.2020 
 
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• 
If the research involves cognitively impaired adults, or adults with 
fluctuating, diminished, or lacking capacity to consent, review 
“CHECKLIST: Cognitively Impaired Adults (HRP-417)” to ensure 
that you have provided sufficient information.  
• 
Provide justification for the inclusion of this population and describe 
the importance of the knowledge to be gained. 
• 
Explain how including this population represents the least degree of 
impairment compatible with the aims of this study. 
• 
Specify how risks are minimized and/or whether the risks or 
discomforts are greater for this population. 
Participants will not have intellectual/cognitive disability; therefore, 
they are assumed to have the capacity to consent/assent. However, 
individuals with ASD may have some difficulty processing 
information and tend to have higher rates of anxiety, which may make 
the consent process stressful for some participants. Therefore, we will 
administer the UBACC to all adults with ASD consenting to 
participate in this study to ensure that they fully understand their 
participation and the purpose of the study. Minors and individuals who 
have a legal guardian will also have their parent/legal guardian 
consent. This program is being specifically designed for individuals 
with ASD; therefore, they must be included in the study.  Risks will be 
minimized by reviewing consent and study materials on more than one 
occasion and by providing visual supports to assist in understanding 
the information. Adults with ASD are welcome to have their 
parents/teachers present during the consent process if they wish. 
While all mentors and mentees in the program will be fluent in 
English, some parents of mentees may speak Spanish. Consent forms 
have been translated into Spanish, and when possible Spanish versions 
of questionnaires will be provided. A Spanish-speaking interpreter will 
be present for all portions of the study that parents participate in. 
Because we are evaluating a community-based program, it is 
necessary to provide access to the program for a representative sample 
of the population.  
  
The research team participates in and regularly consults with an 
advisory board who will be responsible for developing and 
implementing the mentoring program. The advisory board consists of 
individuals with ASD, parents of children/young adults with ASD, and 
individuals who specialize in working with individuals with ASD. Our 
research team has expertise in working with and creating materials and 
programming specifically for this population and will work to identify 
and minimize risks and discomfort to the participants.  

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10.3 Additional Safeguards: If the research involves individuals Checked in 
Section 10.1 above, provide justification for their inclusion and describe 
additional safeguards included to protect their rights and welfare. 
• 
If the research involves pregnant women, review “CHECKLIST: 
Pregnant Women (HRP-412)” to ensure that you have provided 
sufficient information. 
• 
If the research involves neonates of uncertain viability or non-viable 
neonates, review “CHECKLIST: Non-Viable Neonates (HRP-413)” or 
“CHECKLIST: Neonates of Uncertain Viability (HRP-414)” to ensure 
that you have provided sufficient information. 
• 
If the research involves prisoners, review “CHECKLIST: Prisoners 
(HRP-415)” to ensure that you have provided sufficient information. 
• 
If the research involves persons who have not attained the legal age 
for consent to treatments or procedures involves in the research, 
review “CHECKLIST: Children (HRP-416)” to ensure that you have 
provided sufficient information. 
See section 10.2 
11.0 Number of Participants 
11.1 Number of Participants to be Consented: State the approximate number of 
participants you plan to enroll. Give the lowest number that will allow data 
analysis and the maximum that might agree to participate. If the research 
involves secondary analysis of existing data, give the estimated number of 
records that will be used.  
We anticipate enrolling 50-90 participants for evaluation of the mentoring 
program. This includes 10-25 mentors, 10-25 mentees, up to 30 parents of 
participants, and up to 10 mentoring program staff. 
12.0 Recruitment Methods 
12.1 Recruitment Process: Describe when, where, and how potential participants 
will be recruited. 
The community group implementing the program is primarily responsible 
for the recruitment and selection of participants in the pilot mentoring 
program. A member of the research team will assist with the recruitment 
process by contacting families who indicate to the community group that 
they are interested in learning more about the AMP program. This team 
member will call or email interested potential participants who provide their 
contact information to answer questions about the program, screen for 
eligibility, and to connect them to the program coordinator for application 
materials if they would like to apply for the program.   
12.2 Source of Participants: Describe the source of potential participants, e.g., 
Research Experience Program. 

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The community group developing and implementing the pilot program is 
responsible for the identification of program participants, and they are also 
responsible for final decisions regarding inclusion or exclusion of those 
potential participants. This group is hand-selecting participants for the 
program. Given the pilot nature of the mentoring program, the community 
group will communicate to potential participants that formative evaluation is 
an important part of the pilot program.   
12.3 Identification of Potential Participants: Describe the methods that will be 
used to identify potential participants. Describe whether participants will 
self-identify in response to posters, mailings, emails, etc., or whether they 
will be recruited based on information contained in private/protected 
records (e.g., medical records, student records; note that this also includes 
participants who will be recruited from the PI’s or Co-PI’s patient or 
student population.) 
• 
For information contained in private/protected records, explain how 
the researcher has legitimate access to these records. 
• 
Identify who will make initial contact with potential participants. 
• 
Identify whether the private/protected records will include MEDICAL 
records and the mechanism the PI will use to confirm that patients 
have agreed to release their PHI contained in their medical records 
for research purposes; for example, a particular patient has 
documented consent to research on their treatment, intake, or hospital 
admitting form. (MN Statute 144.334 Subd. 3; Access to Medical 
Records for Research), e.g., Academic Health Center Information 
Exchange (AHC-IE). 
The community group will send letters and emails advertising the program. 
Their recruitment materials will allow for potential participants to indicate 
whether they are interested and would like to learn more about AMP. 
Potential participants who indicate interest and provide their contact 
information will then be contacted by a member of the research team to 
screen for eligibility, answer questions about the program, and refer to the 
AMP program coordinator if they are interested in applying.  See 12.2 for 
additional information. 
12.4 Recruitment Materials: Describe materials that will be used to recruit 
participants. (Attach copies of these materials in ETHOS. For 
advertisements, attach the final copy of printed advertisements. When 
advertisements are recorded for broadcast, attach the final audio/video 
recording in ETHOS. You may instead submit the wording or script for any 
recorded advertisements in ETHOS prior to recording them. This will 
preclude re-recording because of inappropriate wording, provided the IRB 
reviews the final audio/video recording after approving the initial wording 
or script. You would likely include any recording with a modification in 
ETHOS.) 

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The community group implementing the pilot program is responsible for the 
recruitment and selection of participants in the program. 
12.5 Payment: Describe the amount, timing, and type of any payments to 
participants. 
• 
Indicate whether gifts, payments, compensation, reimbursement, 
services without charge, or extra credit will be provided to the 
participants for participating in the research. 
• 
Describe the type of compensation and the maximum value 
participants may receive during the course of participation. 
• 
Describe when compensation will be provided, including a schedule, 
and whether payments will be prorated for multiple visits/sessions. 
• 
Describe who will receive payments, if not the participants themselves. 
• 
Describe whether Research Experience Points will be awarded. 
Incentives. Participants will receive the following incentives: 
• Phase 1 (December 2018 through June 2019): $10 for each completed 
data collection activity (i.e., pre-program, post-program) 
• Phase 2 (August 2019 through June 2020): 
• Baseline data: $10 
• Mid-program interviews: $20 
• Post-program data: $25 
• Phase 3 (September 2020-June 2021) 
o Baseline assessment: $20 
o Pre-intervention data collection: $50 
o Mid-program data collection: $30 
o Post-program data collection: $50 
o Post-program focus group: $50 
 
13.0 Withdrawal of Participants 
13.1 Withdrawal Circumstances: Describe anticipated circumstances under 
which participants will be withdrawn from the research without their 
consent. 
13.2 Withdrawal Procedures: Describe procedures that will be followed when 
participants withdraw from procedures with continued data collection (e.g., 
participants withdraw, but you wish to continue collecting data from a 
private/protected record). 
13.3 Termination Procedures: Describe any procedures for orderly termination 
and describe whether data will be used after termination. 
Any participants who withdraw from the program will be offered a voluntary final 
interview at the time of their withdrawal.  
 
14.0 Risks to Participants 

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For each risk or set of risks below, include the procedures to be performed to 
lessen the probability, magnitude, duration, or reversibility of those risks. 
14.1 Foreseeable Risks: List the reasonably foreseeable risks, discomforts, 
hazards, or inconveniences related to participants’ participation in the 
research. Include, as may be useful for the IRB’s consideration, a 
description of the probability, magnitude, duration, and reversibility of the 
risks. Depending on the type of research, this description may or may not 
include statistical information. Categories such as common, rare, etc., may 
be acceptable. Consider physical, psychological, social, legal, and 
economic risks. 
14.2 Reproduction Risks: If applicable, indicate which procedures may have 
risks to an embryo or fetus should the participants or participants’ partners 
be or become pregnant. (Note that if reproductive risks are a factor, then 
you are likely conducting procedures that would require use of “MEDICAL 
PROTOCOL TEMPLATE (HRP-590).” Please review the instruction at the 
beginning of this protocol template.) 
14.3 Risks to Others: If applicable, describe risks to others who are not 
participants. 
There are minimal risks involved in participating in study activities. Potential risks may 
include discomfort resulting from social situations and discussing potentially upsetting 
topics (e.g., difficulties with friendships).  
 
15.0 Incomplete Disclosure or Deception 
15.1 Incomplete Disclosure or Deception: If the research will use incomplete 
disclosure or deception, please provide a rationale. Please also provide a 
description and documentation of the debriefing process, if appropriate, 
that will be used to make participants aware of the incomplete disclosure or 
deception and their right to withdraw any record of their participation. 
N/A 
16.0 Potential Benefits to Participants 
16.1 Potential Benefits: Describe the potential benefits that individual 
participants may experience from taking part in the research. Include, as 
may be useful for the IRB’s consideration, the probability, magnitude, and 
duration of the potential benefits. 
Indicate if there is no direct benefit to individual participants. Do not 
include benefits to society or others. 
There are no direct benefits to participating in this evaluation, though there are potential 
benefits to participating in the mentoring program itself. Potential benefits of the study 
include contributing to the development of programming that can benefit families with 
ASD. 
 

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17.0 Data Management 
17.1 Data Analysis Plan: Describe the data analysis plan, including any 
statistical procedures. 
17.2 Power Analysis: Provide a power analysis, if applicable. 
17.3 Data Integrity: Describe any procedures that will be used for quality control 
of collected data. 
Data from the focus groups will be analyzed qualitatively by identifying themes in the 
information provided by participants. Demographic data will also be summarized to 
provide a description of participants who provided input into the development of the 
mentoring program. Descriptive statistics and visual analyses will be provided for data 
from interviews and questionnaires. Video recordings of mentoring sessions in Phase 3 
will be analyzed qualitatively to identify core components of mentoring sessions and to 
describe the quality of interactions between mentors/mentees.  
 
18.0 Confidentiality 
18.1 Data Security: Describe the steps that will be taken to secure the data (e.g., 
training, authorization of access, password protection, encryption, physical 
controls, certificates of confidentiality, and separation of identifiers and 
data) for storage, use, and transmission of data. Include also whether a 
copy of the consent form or other research study information will be 
placed in the participants’ medical, employment, or educational records, 
and why that is appropriate (if so, this information must be included in the 
confidentiality section of the consent form). 
Data from this study will be stored within a secure Box account sponsored 
by UMN. Participants will be assigned a study ID and participant data will 
be de-identified within the database. The PIs will manage this database and 
will provide access to the data to key study personnel who will assist in 
managing and analyzing study data. Consent forms, assessment protocols, 
and verification of diagnosis and IQ will be kept within a locked file cabinet 
and a locked office. No study data or information will be placed within 
medical, employment, or educational records. Data will not be accessible to 
individuals outside of the research team. Data will be stored for up to 7 
years in order to inform future studies expanding on this work and to be 
used for preparation of publications. For online study activities, participants 
will be encouraged to situate themselves in a context where their privacy is 
ensured / facilitated (e.g., a private room in their apartment or house with 
the door shut). Researchers will do the same, and communicate as such prior 
to study activities. When using videoconferencing platforms, security 
measures will be used including: using University-sponsored Zoom 
accounts, emailing access links directly to the participant, requiring 
passwords to enter meetings, enabling waiting room, disabling video 
recording by participants who are not the host, and locking the meeting once 
in progress.    

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19.0 Provisions to Monitor the Data to Ensure the Safety of 
Participants 
This section is required when research involves more than Minimal Risk to 
participants. If you believe that the study is not greater than Minimal Risk, type 
“N/A” and delete the sub-headings below. Otherwise, complete all items below. 
The IRB ultimately determines the risk level of the study. 
N/A 
This study involves minimal risk to participants; however, participants will be 
asked to report on their emotional functioning, including symptoms of anxiety and 
depression. If a participant endorses suicidality, research team members will 
contact Dr. Hudock or Dr. Weiler (both licensed mental health providers) 
immediately to conduct a risk assessment. Appropriate mental health referrals 
(including the local suicide hotline and crisis management numbers: 
https://www.hennepin.us/residents/emergencies/mental-health-emergencies) will 
be made at that time if needed. The consent form also alerts participants to the 
fact that confidentiality will be broken if it is determined that a participant is at 
risk to themselves or others at any time during the study. If needed, 
parents/guardians and any other necessary authorities will be notified and 
appropriate referrals will be made.  
20.0 Provisions to Protect the Privacy Interests of Participants 
20.1 Protecting Privacy: Describe the steps that will be taken to protect 
participants’ privacy interest. “Privacy interest” refers to a person’s desire 
to place limits on with whom they interact or to whom they provide personal 
or sensitive information. 
Describe any privacy concerns and what steps you will take to make the 
participants feel more comfortable with the research situation in terms of 
the questions being asked and the procedures being performed. 
“Comfortable” does not refer to physical discomfort only, but to the sense 
of intrusiveness a participant might experience in response to questions, 
procedures, or interactions with researchers or in certain settings. 
20.2 Access to Participants: Explain why the research team is permitted to access 
medical records, student records, or any other sources of private 
information about the participants. (Note that you were asked a similar 
question above about access to information about potential participants. 
This item refers to information about participants who have consented to 
participate and about whom you are collecting research data.) 
Interviews, surveys, and focus groups will be held in spaces that are closed to the general 
public, or that provide reasonable privacy (i.e., conversations and interviews cannot be 
overheard by others in the space) for conducting study activities. For online study 
activities, participants will be encouraged to situate themselves in a context where their 
privacy is ensured / facilitated (e.g., a private room in their apartment or house with the 
door shut). Researchers will do the same, and communicate as such prior to study 

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activities. When using videoconferencing platforms, security measures will be used 
including: using University-sponsored Zoom accounts, emailing access links directly to 
the participant, requiring passwords to enter meetings, enabling waiting room, disabling 
video recording by participants who are not the host, and locking the meeting once in 
progress. Confidentiality of participant responses will be discussed at the beginning of 
the interviews and focus groups and also included within the consent form.  
 
21.0 Compensation for Research-Related Injury 
21.1 Compensation for Research-Related Injury: If the research involves greater 
than Minimal Risk to participants, describe the available compensation in 
the event of research-related injury. N/A 
21.2 Contract Language: Provide a copy of the contract language, if any, 
relevant to compensation for research-related injury. N/A 
22.0 Consent Process 
Note: You must follow “SOP: Informed Consent Process for Research (HRP-
090)” and “SOP: Written Documentation of Consent (HRP-091).” 
22.1 Consent Process (when consent will be obtained): Describe the consent 
process, including: 
• 
Where the consent process will take place. 
• 
Any waiting period available between informing the prospective 
participants and obtaining the consent. 
• 
Any process to ensure ongoing consent. 
• 
If you will document consent in writing, submit a consent document in 
ETHOS. If you will obtain consent, but not document consent in 
writing, submit a consent script in ETHOS. Review “CHECKLIST: 
Waiver of Written Documentation of Consent (HRP-411)” to ensure 
that you have provided sufficient information. 
For Phases 1 and 2, participants will be e-mailed a copy of the consent form for review 
upon their acceptance into the program and their expressed interest in participating in the 
evaluation of the pilot program. Consent will then take place at the site of interview 
(AuSM, MICC, or Kennedy High School, other venue agreed upon by the research team 
and family). Consent will be obtained by a research team member familiar with obtaining 
consent who will review the consent form and study procedures with individual families. 
Families will have an opportunity to ask questions about the study and consent process 
prior to the beginning of the interviews. For Phase 3, updated consent will be obtained 
electronically via REDCap; signed consent form returned via email by participant; or 
photo of signed consent form sent directly to the researcher from the participant.  
22.2 Waiver or Alteration of Consent Process (when consent will not be 
obtained, required information will not be disclosed, or the research 
involves deception): If you are not requesting a consent alteration or 
waiver, type “N/A” and delete the bullets below. Otherwise, complete all 
items below: N/A 

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22.3 Non-English Speaking Participants: Indicate what language(s) other than 
English is/are understood by prospective participants or their 
representatives. 
• 
As identified in Section 10.1, if participants who do not speak English 
will be enrolled, describe the process to ensure that the oral or written 
information provided to those participants will be in their own 
language. Indicate the language that will be used by those obtaining 
consent. 
• 
If you will be using a translator during recruitment, consent, data 
collection, or data analysis, specify how you will identify an 
appropriate translator and what the provisions will be for protecting 
the confidentiality of participants. 
• 
Translated short forms are available on the UMN IRB website: 
https://www.research.umn.edu/irb/guidance/short-forms.html. 
Spanish-speaking families may also enroll in this study. Consent forms 
will be translated into Spanish for families who do not speak English. 
A Spanish-speaking interpreter will be present throughout data 
collection activities for Spanish-speaking families and will assist in 
interpreting interviews and surveys.   
A professional Spanish-speaking interpreter will be provided by 
Bloomington Public Schools in order to assist with consent and data 
collection for Spanish-speaking families. This interpreter will meet 
with the research team to review study procedures, including the 
importance of protecting the confidentiality of participant information 
and responses.  
22.4 Participants Who Are Not Yet Adults (infants, children, teenagers under 18 
years of age): 
• 
Describe the criteria that will be used to determine whether a 
prospective participant has not attained the legal age for consent to 
treatments or procedures involved in the research under the 
applicable law of the jurisdiction in which the research will be 
conducted. (E.g., in Minnesota, individuals under the age of 18 years.) 
o 
For research conducted in Minnesota, review “SOP: Legally 
Authorized Representatives, Children, and Guardians (HRP-
013)” to be aware of which individuals in the state meet the 
definition of “children.” 
o 
For research conducted outside of Minnesota, provide 
information that describes which persons have not attained the 
legal age for consent to treatments or procedures involved the 
research, under the applicable law of the jurisdiction in which 
research will be conducted. One method of obtaining this 
information is to have a legal counsel or authority review your 
protocol along with the definition of “children” in “SOP: 

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Legally Authorized Representatives, Children, and Guardians 
(HRP-013).” 
• 
Describe whether parental permission will be obtained from: 
o 
Both parents, unless one parent is deceased, unknown, 
incompetent, or not reasonably available, or when only one 
parent has legal responsibility for the care and custody of the 
child. 
o 
One parent, even if the other parent is alive, known, competent, 
reasonably available, and shares legal responsibility for the care 
and custody of the child. 
• 
Describe whether permission will be obtained from individuals other 
than parents, and if so, who will be allowed to provide permission. 
Describe the process used to determine these individuals’ authority to 
consent to each child’s general medical care. 
• 
Indicate whether assent will be obtained from all, some, or none of the 
children. If assent will be obtained from some children, indicate which 
children will be required to assent. 
• 
When assent of children is obtained describe whether and how it will 
be documented. 
Individuals 18 and over will sign their own consent. Adults with a 
legal guardian will also have their legal guardian/parent sign the 
consent form. Individuals under 18 will sign an assent form and one 
parent will sign the consent form.  
22.5 Cognitively Impaired Adults, or adults with fluctuating or diminished 
capacity to consent: 
• 
Describe the process to determine whether an individual is capable of 
consent. Review “POLICY: Capacity to Consent (HRP-110)” and 
“POLICY: Research Involving Adults Under Court Jurisdiction (HRP-
111)” for additional information. Reference “CHECKLIST: 
Cognitively Impaired Adults (HRP-417).” 
• 
Confirm use of one of the approved validated instruments to assess 
capacity to consent appropriate for the level of risk associated with 
the research (i.e., the MacArthur Competence Assessment Tool for 
Clinical Research for greater than Minimal Risk research or the 
UCSD Brief Assessment of Capacity to Consent for Minimal Risk 
research). If you will not be using one of these tools, describe the 
alternative validated tool(s) you propose to use instead. If available in 
electronic format, submit the alternative tool(s) for review by the IRB 
in ETHOS. 
• 
Document plans, if any, to avoid seeking consent during periods of 
greater than normal impairment. 
While participants may have a diagnosis of ASD, they will not have intellectual disability 
and will be able to participate in the consent process. For individuals who have difficulty 

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with processing information, attention, or executive functioning, the research team will 
read the consent aloud and allow for extra opportunity for the individual to ask questions.  
22.6 Adults Unable to Consent: 
• 
Permission: List the individuals from whom permission will be 
obtained in order of priority (e.g., durable power of attorney for 
health care, court appointed guardian for health care decisions, 
spouse, and adult child.) 
o 
For research conducted in Minnesota, review “SOP: Legally 
Authorized Representatives, Children, and Guardians (HRP-
013)” to be aware of which individuals in the state meet the 
definition of “legally authorized representative.” Additionally, 
be aware of special restrictions regarding recruiting or enrolling 
persons under a stay of commitment. 
o 
For research conducted outside of Minnesota, provide 
information that describes which individuals are authorized 
under applicable law to consent on behalf of a prospective 
participant to their participation in the procedure(s) involved in 
this research. One method of obtaining this information is to 
have a legal counsel or authority review your protocol along 
with the definition of “legally authorized representative” in 
“SOP: Legally Authorized Representatives, Children, and 
Guardians (HRP-013).” 
• 
Assent: Describe the process for assent of the participants. Indicate 
whether: 
o 
Assent will be required of all, some, or none of the participants. 
If some, indicate which participants will be required to assent 
and which will not. 
o 
If assent will not be obtained from some or all participants, an 
explanation of why not. 
o 
Describe whether assent of the participants will be documented 
and the process to document assent. 
Adults with ASD will not have intellectual disabilities and will sign their own consent. 
Individuals under 18 will sign assent forms and their parent/legal guardian will sign 
consent. For individuals with a legal guardian, the participant and their legal guardian 
will sign consent.  
 
23.0 Setting 
23.1 International Research: If the research will take place in more than one 
international location, include information below for each location. 
• 
N/A 
23.2 Community Based Participatory Research: If the research will be based in 
or in partnership with more than one community, include information below 
for each community. 

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• 
Describe how community partners will participate in various stages of 
the research. 
• 
Describe the plan for educating community partners about human 
research protections. 
• 
Describe the agreement with the community partner organization. If 
appropriate, provide a letter, memorandum of understanding, or 
contract in the “Supporting Documents” section in ETHOS. 
This project is highly collaborative. The PIs and research team are 
working closely with staff and individuals with ASD who from MICC, 
AuSM, and Kennedy High School to plan and implement the 
evaluation of the pilot mentoring program. The PIs participate on an 
advisory board with parents, professionals, community members, 
mentoring experts, and self-advocates with ASD who are have 
developed and are implementing the mentoring program for 
individuals with ASD in the community. The PIs are responsible for 
educating the advisory board and community partners about human 
research protections and research and data collection and management 
procedures. While community partners will participate in facilitating 
portions of the study, the PIs will remain involved in each step of the 
research. The research team will remain involved with this advisory 
board and community partners throughout this evaluation and the 
eventual development and implementation of the program.  
23.3 Research Sites: Describe the sites or locations where your research team 
will conduct the research. 
• 
Identify where your research team will identify and recruit potential 
participants. 
• 
Identify where research procedures will be performed. 
• 
Describe the composition and involvement of any community advisory 
board, school board, school principals or teachers, etc. 
• 
For research conducted outside of your organization and its affiliates, 
describe: 
o 
Site-specific regulations or customs affecting the research. 
o 
Local scientific and ethical review structure. 
The community group implementing the mentoring program is directly 
responsible for recruitment and selection of participants. Interviews, 
surveys, and focus groups will be held in spaces that are closed to the 
general public, or that provide reasonable privacy (i.e., conversations and 
interviews cannot be overheard by others in the space) for conducting 
study activities. Due to current COVID-19 pandemic, all study activities 
will occur via the videoconferencing platform Zoom using a University-
sponsored account and appropriate security settings. Qualtrics surveys will 
be completed by participants on their personal devices. Participants may 
complete data collection via telephone if they prefer this method to Zoom 

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and/or Qualtrics. Data storage and analysis will take place at UMN within 
the PIs’ respective departments and office/research spaces.   
The evaluation development is being overseen by a board of researchers 
and community members, comprised of individuals from UMN, MICC, 
AuSM, and The Mentoring Partnership of MN. Individuals on the board 
include UMN ASD clinicians and researchers, mentorship specialists, 
MICC students and staff, self-advocates, and parents of individuals with 
ASD. This advisory board meets twice per month at AuSM.  
24.0 Multi-Site Research 
If this is not a multi-site study where you are the lead investigator, type “N/A” 
and delete the sub-headings below. Otherwise, complete all items below.  
N/A 
25.0 Resources Available 
25.1 Resources Available: Describe other resources available to conduct the 
research. For example, as appropriate: 
• 
If the study is being conducted by a student investigator, include a 
description of how the faculty advisor will support the student. 
• 
Justify the feasibility of recruiting the required number of suitable 
participants with the agreed upon recruitment period. For example, to 
how many potential participants do you have access? What 
percentage of those potential participants do you need to recruit? 
• 
Describe the time that you will devote to conducting and completing 
the research. 
• 
Describe your facilities. 
• 
Describe the availability of medical or psychological resources that 
participants might need as a result of an anticipated or unanticipated 
consequences of the research. 
• 
Describe your process to ensure that all persons assisting with the 
research are adequately informed about the protocol, the research 
procedures, and their duties and functions. 
Since participants in the program will be selected by the community 
group implementing the mentoring program, researchers will utilize 
this participant pool. 
The duration of the study is expected to last approximately 12-18 
months. Interviews, surveys, and focus groups will be held in spaces 
that are closed to the general public, or that provide reasonable privacy 
(i.e., conversations and interviews cannot be overheard by others in 
the space) for conducting study activities.  
The PIs have expertise in social science, neuroscience, psychology, 
and educational psychology. Several research team members are 
teachers, counselors, and psychologists who can assist in providing 

PROTOCOL TITLE: Evaluation of a mentorship program for individuals with autism 
spectrum disorder (ASD) 
VERSION DATE: 7, 9.9.2020 
 
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Revised: January 29, 2017 
mental health supports as needed, including making appropriate 
referrals if needed. The research team meets approximately every 2 
weeks to discuss the project, protocol, and necessary training. The PIs 
participate on the advisory board and keep the group informed on 
research policies and procedures. The team is also in frequent contact 
via e-mail and a private Slack page.  
26.0 References 
Include references to any scholarly articles or other materials used to discuss the 
background for the study or to justify any proposed procedures. 
Castro, F. G., Barrera Jr, M., & Holleran Steiker, L. K. (2010). Issues and challenges in 
the design of culturally adapted evidence-based interventions. Annual Review of Clinical 
Psychology, 6, 213-239. 
DuBois, D. L., Portillo, N., Rhodes, J. E., Silverthorn, N., & Valentine, J. C. (2011). How 
effective are mentoring programs for youth? A systematic assessment of the 
evidence. Psychological Science in the Public Interest,12(2), 57-91. 
Hale, D. R. & Viner, R. M. (2012). Policy responses to multiple risk behaviors in 
adolescents. Journal of Public Health, 34(suppl 1), i11-i19. doi: 10.1093/pubmed/fdr112 
Rhodes, J. E. (2002). Stand by me: Risks and rewards in youth mentoring. Cambridge, 
MA: Harvard University Press. 
Rhodes, J.E. & Roffman, J. G. (2002). Nonparental adults as asset builders in the lives of 
youth. In R. J. Lerner & P. Benson (Eds.) Developmental assets and asset-building 
communities. Implications for research, policy, and practice. New York: NY: Kluwer 
Academic Publishers.