Promoting Community Conversations About Research to End Native Youth Suicide in Rural Alaska
Phase: NA
Conditions: Suicide
Sponsor: University of Michigan

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Promoting Community Conversations About Research to End 
Native Youth Suicide in Rural Alaska 
 
NCT03661255 
 
1/11/2023 
 
 
 

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Scientific Protocol and Data Management Plan 
PC CARES (Promoting Community Conversations About Research to End Suicide) is a community-level educational 
intervention aimed at increasing key community stakeholders’ understanding of current research in the field of suicide 
prevention and providing a structured time for them to discuss how they can use the research evidence in their own lives 
at work and at home.  PC CARES was piloted in 2015-2017 in Northwest Alaska with promising results.  Both the NWA 
pilot and this proposed implementation in Bering Straits are funded by the National Institute of Mental Health. 
We will implement PC CARES in at least 9 of the 16 communities in the Bering Straits region.  PC CARES implementation 
and data collection will take approximately 1 year in each village. We will select 6 villages to participate in the first year 
and 5 villages for each of the following 2 years.  Some villages may choose not to participate, and others may decide to 
participate in a later cohort. Both options are acceptable. 
 
Specific Aims: 
1. Specific Aim 1: Track the impact of PC CARES on participants' knowledge, attitudes and behavior, and identify 
key factors influencing these outcomes over time.  
2. Specific Aim 2: Document the community-level impact of PC CARES by tracking the number and type of 
interactions aimed at preventing youth suicide and promoting wellness in participating villages, and describe 
changes in the supportive social networks of young people before and after the intervention. 
 
Background: 
Youth suicide continues to disproportionately affect Indigenous communities, and has been difficult to detect early, 
prevent and reduce. In rural Indigenous communities, youth suicide is an extreme health disparity with Alaska Native (AN) 
suicide rates in remote villages up to 18 times higher than the rates of all American youth, ages 15-24 (124 vs 6.9 per 
100,000). AN youth who are showing signs of vulnerability but are not yet suicidal, are likely to interact with a variety of 
community workers such as village public safety officers, health aids, and school personnel. In 62% of all suicidal behavior 
in Northwest Alaska (NWA), AN youth display distress to their family and friends. A local survey (n=355) also revealed AN 
youth sought help from peers (54%), parents (40%), grandparents/Elders (21%), uncles/aunts and teachers (20%). These 
supporters, however, are not prepared to recognize suicide risk or reduce it before an acute event, when there are more 
options for culturally-responsive, social care (i.e. Elder mentoring, cultural activities) and risk reduction (i.e. removing guns 
from the home). Now, 75% of all suicide interventions in NWA are 'imminent risk' requiring safety protocols that forcibly 
remove distressed youth from their community (50+ air miles away) for hospital risk assessment, and return them 48 
hours later even less likely to seek help the next time. There is a clear need for 'upstream' suicide prevention before a 
crisis, which activates a youth's social network, reduces suicide risk and increases resources for wellness in rural AN 
communities. Representing a culmination of 20 years of community-based participatory suicide prevention research, 
Promoting Community Conversations About Research to End Suicide (PC CARES), does just that. It is built on the notion 
that community members are cultural and community experts, who are in the best position to create working solutions to 
their health problems, and recognizes that scientific knowledge can guide these efforts to strategic benefit. With strong 
tribal support and evidence of feasibility from the pilot study from 2014- 2017, the model has local facilitators host four 3-
hour learning circles, where family members, youth, and village providers learn about prevention science, and adapt and 
apply it to their local and cultural realities. Demonstrating potential for changing participants' knowledge and attitudes in 
rural Alaska, this trial will assess the transferability and preliminary effectiveness of PC CARES on individual and 
community levels.   

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Baseline Steps toward Prevention (STP) Survey:  
The Steps toward Prevention (STP) Survey will be administered at baseline (1-
2 months before PC CARES implementation) and three months post-
intervention. The questionnaire will be self-administered via a touch screen 
computer interface and will include 1) basic demographic questions, 2) 
questions about skills, knowledge, and attitudes toward taking preventive 
actions in their family and community, 3) questions about prevention actions 
they have done in the past 3 months, as well as permission to contact them 
again within a year to do a follow-up survey.  The computer interface will 
allow the respondent to answer questions privately and quickly with a touch 
screen, and press ‘enter’ so their answers are secured. The Steps toward 
Prevention Baseline Survey will be open to any village resident aged 15 or 
older.  Everyone filling out a 15-20 minute survey will receive $20. We will 
obtain informed consent from all participants on the touch screen computer 
interface before they proceed to the survey questions.  In each village, we 
expect to administer the Baseline STP Survey to 65-150 people. 
 
Recruitment for Steps Toward Prevention Survey: Our pilot 
research produced a roster of social ecological roles within the 
village (hereafter: 'network positions') that are relevant to 
suicide prevention. These positions are listed in boxes to the left. 
We will recruit all available people within the village institutions 
(targeted recruitment of individuals holding formal positions), 
youth (ages 15-24) (set up a table at the school to talk to 
students about our research), and others in the village interested 
in participating.  We expect that some of those who participate 
in the Baseline Survey will also participate in the PC CARES 
intervention and some will not. 
 
Beyond our initial baseline survey recruitment, we will use 
Respondent Driven Sampling (RDS) to recruit more widely 
throughout the community.  This means that to recruit 
community members, we will use a peer-referral system that 
tracks recruitment patterns via referral coupons. RDS involves 
giving participants 3 coupons that are redeemed for $5 if the 
person they recruited completes a survey (up to 3 people).  This 
means that each respondent can receive a stipend of $20 for 
completing the STP Baseline Survey, and an additional $15 for 
recruiting 3 other people to fill out a survey, for a total $35 per 
respondent.  The recruitment payment is intentionally set low 
enough to avoid encouraging coercion on the part of recruiters, 
yet its presence provides the recruiter with an incentive to choose among his/her associates those individuals with whom 
he/she has enough influence such that the receiver will participate in the study, and the recruiter can be assured of 
getting the recruitment fee.  
 
Since suicide risk is highest for Alaska Native young people, starting from age 15, it is important to understand the social 
dynamics, help-seeking and help-giving that occur for this age group. Our recruitment for young people to participate in 
the STP Baseline Survey will start by collaborating with the schools to determine the most effective, least intrusive means 
for recruiting students to participate. This could include setting up a table in the school lobby after school or during an 
event such as a basketball tournament to inform students about the STP Baseline Survey and to recruit them to 
Organizational network positions 
Village-level: 
   Tribe staff 
   Health workers (CHAPs) 
   Behavioral health workers 
   School personnel 
   Social Services workers 
   Religious leaders 
   City Government/Law Enforcement 
Region-level: 
   Norton Sound Doctors 
   CHAP supervisors 
   School District health counselors 
Network Positions: 
Informal/Community Supporters 
Elders (Ana and Taata) 
Parents  
Sibling (includes youth 15+) 
Close cousins and peer family (includes youth 15+) 
Adult family (includes close family friends) 
Other adults  
Friends (includes youth 15+) 
Formal/Organizational Supporters 
Youth Leaders (includes youth 15+) 
Tribal/Community leader 
CHAPs 
Behavioral Health Aid/TANF/Social Services 
Clinic staff 
Counselor/Regional Health Provider 
Teacher/school staff 
Pastor/Religious leader 
VPO/VPSO 
Kawerak staff 

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participate (see recruitment scripts). If interested, we will ask to speak with their parent (if under 18) and will go through 
an assent and consent process with both the young person and his or her parent.  
 
 
Training of Facilitators (ToF): 
Recruitment of Facilitators: We will recruit 2-4 people per village to be trained as PC CARES facilitators.  They will be 
adults (over 18), living and/or working in the participating, predominantly Alaska Native village.  Our Local Steering 
Committee and other community partners will help identify respected Elders as well as people who are in positions that 
related to community wellness (village-based counselors, youth leader sponsor, wellness worker, community health aides, 
and family workers) to be recruited as facilitators.  (see recruitment scripts). Once identified and they express interest, 
potential facilitators (particularly village-based counselors, youth workers, community health aids and family workers) will 
seek permission from their respective supervisors to be facilitators of PC CARES.  This permission is necessary since we 
assume that facilitators will be offering or preparing for Learning Circles during their regular workdays, if they are 
employed. This permission will allow us to move ahead with planning to support soon-to-be PC CARES facilitators in 
attending our weeklong Training of Facilitators (ToF), and for those who are interested, receiving 3 college credits in 
Human Services through the University of Alaska Fairbanks.   
 
We will obtain informed consent from ToF participants before any ToF-related data collection begins.  ToF participants 
have the option to participate in the ToF surveys and interviews or not, without repercussion.  Receiving college credit is 
not tied to whether facilitators fill out these surveys or participate in interviews. They can opt out of answering and still 
participate in the training and get college credit for their participation in implementing the Learning Circles.  We expect 
that most TOF participants will have already completed the Baseline PC CARES survey described above.  Any who consent, 
but have not already completed the baseline survey, will be given the option to complete the baseline survey at the 
beginning of the ToF.  All consenting participants will complete the Facilitator Post-Training Survey at the end of the ToF 
week. Additionally, consenting facilitators will be asked to participate in two 45 minute one-on-one interviews with a PC 
CARES research team member. These will be administered immediately after the training of facilitators and again after all 
learning circles have been facilitated.  Interviews will cover topics related to quality of their training, adequacy of 
facilitator support, and confidence in facilitating. 
 
Facilitators will need to reach a minimum level of proficiency before facilitating learning circles in their home 
communities. They will be told that they can opt out of having their data in the study, but that they need to reach a 
minimum level of proficiency before facilitating PC CARES. To ensure facilitators understand the content, a test of 
knowledge gains will focus on the content areas in ‘What We Know.’ Assessment, done at the end of the week-long ToF, 
will involve a content-focused group quiz. In our pilot study, this method was fun and acceptable to participants, and 
allowed trainers to clear up any remaining areas of confusion. When piloting this method at the end of our ToF in 
November 2015, 100% of our 36 participants answered 11 questions correctly, and the remaining 5 questions with mixed 
results (only about 70% or 25 people answering correctly), have been modified to be clearer to facilitators. Lastly, all ToF 
participants will demonstrate proficiency by facilitating one learning circle with a ToF trainer present. ToF trainers will 
assess facilitator fidelity using the tracking assessment.  
 
After training, continuing virtual support will be offered to cohorts of facilitators monthly in teleconferences where they 
can check in with each other, hear about the progress each team is making and offer suggestions for addressing problems 
or issues as they come up. 
 
RHS Cohort facilitators 
A cohort of students in the Rural Human Services Certificate Program at University of Alaska-Fairbanks, Kuskokwim 
campus will fulfill their practicum requirement by facilitating PC CARES Learning Circles in their home communities.   
Students who consent to participate in the study will complete 3 surveys (Pre-Training, Post-Training, and 6 month Follow 
Up) with questions that have already been approved by IRB.  In addition, we will ask for consent to take field notes during 
the Facilitator Training and during the monthly Facilitator support calls.  These field notes will focus on what kinds of 

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questions are raised by trainees, what challenges and success they have as facilitators, and other information related to 
the experience of being a facilitator. 
 
 
Surveys for Learning Circle Participants: 
The PC CARES Learning Circles, in keeping with tribal partners' preferences, will be open to all residents aged 15+, and will 
take place in public spaces in each village (e.g. tribal building, school, city building). Exclusion criteria includes persons 
under the age of 15 because the curriculum requires some level of maturity to understand and make use of the 
information discussed.  
 
Recruitment of Learning Circle Participants:  Trained facilitators will recruit PC CARES participants in the villages they live 
in or serve. This will likely include word-of-mouth recruitment in the schools, churches, tribal offices, public safety offices, 
and city buildings and CB radio announcements, flyers, and Facebook events. At schools, tribal offices, health clinics, 
facilitators will do targeted recruitment of key employees in those organizations (teachers, principals, tribal leaders, 
health aids).  They may also ask for permission to hang a flyer in that organization’s building. Participation in PC CARES 
will be voluntary but will seek to have a variety of youth and adults. We will target people in the formal and informal 
network positions mentioned above.  
 
 If a community member attends a PC CARES Learning Circle, but did not complete the demographic and baseline survey, 
they will be given the opportunity give informed consent, and if they consent, will be given a paper copy of the survey and 
asked to complete it.  
 
After each Learning Circle, all participants will be asked to complete (on paper) a survey that includes questions about 
their skills, knowledge and attitudes toward taking preventive action (from baseline survey), plus questions about 
satisfaction and about intention to use what was learned in the session.  Each time they are asked to complete a survey, 
participants will be given the option of not filling them out without recourse. Whenever participants are asked to fill out a 
paper survey, they will be given a blank envelope. In order to maintain privacy and confidentiality, when they complete 
their survey, they can seal it in the envelope before returning their survey to the facilitator. The facilitator will send all 
surveys in their sealed envelopes to the research team. Each PC CARES participant will receive a $20 incentive for 
purchases from the village store or the grocery store in Nome (which will box and send purchases to villages) for 
completing the 15-20 minute survey.  
 
Audio Recording: 
The PC CARES Learning Circles in the villages will be recorded if all the participants give permission for this to be done. The 
recordings will be transcribed into written scripts and all identifying information for participants will be removed from the 
word processing files. The session transcripts will be reviewed to analyze the themes that arise from discussion among LC 
participants, for curriculum fidelity, and to continuously improve the curriculum as each village cohort implements PC 
CARES. 
In order to obtain assent to be recorded, local facilitators will read a script:  
“We will be audio-recording this session in order to track how PC CARES works and to make it better and better. 
We will not be connecting the recording to anyone’s name. Instead, we will listen to see how useful and understandable 
the curriculum is. We want to hear how PC CARES works in villages and to see if there are any changes that need to be 
made in the format and content. Your name will not be connected to the voice recordings. At the end of the research study, 
all voice recordings will be destroyed. Can you give a ‘thumbs up’ if it is okay with you if we record. Give a ‘thumbs down’ if 
that is not OK with you. We will only record if everyone agrees.” 
If thumbs up and participants agree to audio recording: “If at any time during the session, you change your mind, 
please just ask us and we will stop recording or will destroy the recording if you are uncomfortable with what you said.” 
If participants agree, an audio recorder is set up and the session is recorded and saved on a thumb drive. The 
thumb drive is sent to UMass in a self-addressed, stamped envelope along with the paper surveys after the learning circle 
is finished. If there is 1 'thumbs down' indicating that a participant does not wish to be recorded, we will not record the 

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session. The transcripts for these sessions do not have names associated with recorded narratives nor do transcripts have 
a list of attendees. Attendance records for each learning circle are kept separately.  
Because there is limited internet access in the village where Learning Circles will occur, transferring data 
electronically is not a viable option. All data will be sent to the research team via USPS in Self Addressed Stamped 
envelopes that we provide. 
 
Each participating facilitator will receive a $50 incentive for collecting this data (attendance, surveys, audio recordings of 
Learning Circles) and sending it to UMass. Once the packet of data is received, the project coordinator will send an 
electronic Amazon gift card to participating facilitators in appreciation of their time.  
 
Steps toward Prevention 3-Month Follow-Up Survey: 
Approximately 3 months after the final PC CARES Learning Circle, we will again use the touch screen computer interfaces 
to collect follow-up data. This survey will be identical to the baseline survey.  Again, the Steps toward Prevention 3-Month 
Follow-Up Survey will be open to all community members aged 15 +, and we will target recruitment to 1) those who 
completed the Steps toward Prevention Baseline Survey, 2) those who attended at least 1 PC CARES Learning Circle, and 
3) those who inhabit specified formal and informal prevention related roles in the community whether or not they 
participated in PC CARES.  Again, we will use Respondent Driven Sampling to recruit throughout the community with each 
participant receiving $20 for completing the Steps toward Prevention 3-Month Follow-Up Survey, and up to $15 for 
recruiting others to participate.  Again, we expect 65-150 participants per village. 
 
PC CARES at School: For the 2021-2022 school year, we will expand our research to include Nome Public Schools, in 
addition to the Bering Straits school District, and Northwest Arctic Borough School District. 
During COVID, in addition to holding Learning Circles, we will offer inservice trainings for Bering Strait School District staff 
on what they can do (and the school as a whole can do) to prevent suicide among their students.  Trainings include an all 
staff ‘one time’ training, and afterward, interested staff and community members will be invited to participate in on-going 
learning circles hosted by PC CARES curriculum trainers aimed at developing a suicide prevention and postvention plan for 
their school and/or district. School staff who are at least 18 years old, and who participate in any level of training will have 
the option to participate in 3 online surveys to assess their changes in attitudes, behavior, knowledge related to suicide 
prevention: 1) before any trainings are offered, 2) soon after the inservice, and 3) at the end of the school year.  The link 
to participate in the survey will be provided to school staff, volunteers, and key service system personnel via email at the 
timepoints described below.  Participants will receive a $20 Amazon.com gift card for the Baseline and $40 for the 
FollowUp survey, for a possible total of $60. 
 
Baseline survey: Participants in the PC CARES at School training will fill out a registration form for the training.  The 
registration form will include a brief description of the research (using recruitment script attached) and participants can 
opt in  (or opt out) to participate in the research.  They can choose to attend the training, but not be research 
participants/subjects.  The school and district will not be informed as to which staff choose to participate in the research.  
If they opt in, they will click on a link that gives them the consent form.  If they click their consent, they will be brought to 
the PC CARES at School Baseline Survey.  This survey largely mirrors the Steps Toward Prevention survey, with a few 
added questions that pertain the to school context.  If participants answer ‘yes’ to some questions, they get a follow up 
questions of ‘with whom?’.  For PC CARES at School, we will  add some answer choices to the previously approved list that 
include Teacher, Administrator, Coach, Administrative Assistant/Front Desk, Classroom Aide, Other school staff (including 
janitor/cafeteria worker), Student, Parent of student. 
 
After the training, all staff who opted into the research will be sent a link to a PC CARES at School Satisfaction survey.  This 
survey consists only of previously approved questions from the previously approved Learning Circle survey, with very 

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slight changes to indicate that the questions pertain to the in-service training.  The Follow Up survey will include a 
question in which we will ask survey participants to identify which people who attended PC CARES Learning Circles they 
are close to.  We will list the names of all PC CARES Learning Circle attendees in their region (40-50 names), and ask 
survey participants to identify if they are close to any of the people listed.  (Learning Circle Attendees attend the Learning 
Circles publicly and there is no expectation that their attendance be kept private.  People can be Learning Circle Attendees 
without being research participants.  We will not list the names of the research participants (confidential), but the names 
of the Learning Circle attendees (public). 
Follow up survey: Approximately 6 months after the training, all staff who opted in to the research by participating in the 
Baseline survey will be sent a follow up survey.  This survey will be identical to the Baseline survey, but with a few added 
questions. 
We will continue to hold Learning Circles with school staff (and other local professionals) and as in our original PC CARES 
project, we will ask participants to complete a Learning circle survey after each Learning Circle they attend. We have 
added a Learning Circle to the curriculum, so there are now 6 learning Circles.   Participants will receive a $10 giftcard for 
each Learning Circle survey they submit. 
 
Recording for PC CARES at School: During each Learning Circle via Zoom, we start with approximately 45 minutes of 
researchers presenting information.  This portion will be recorded, and shared back with participants who may want to re-
review the material or who missed a session. 
 
Notes during LC discussions for PC CARES at School: Participants will contribute their thoughts during 45 minute ‘breakout 
sessions.’  These breakout sessions will not be recorded.  However, we will take notes (with no identifiers) on what is 
being discussed and shared in the ‘breakout sessions.’  At the first Learning Circle, we will conduct an anonymous poll 
(through Zoom) asking participants whether we can use the notes from their breakout sessions in our research.  By 
default Zoom hides the results from participants. If we have 1 person who responds to the poll stating that they do not 
want to be included in notes used for research, then we will exclude the notes from their breakout session from analysis.  
We will use the following script to ask permission from attendees: 
 
We will be taking notes and responding to prompts in google documents and the chat during this session to facilitate our 
learning. Our team may want save these notes and comments for later use to track how PC CARES works and to make it 
better. We will not be connecting the notes to anyone’s name or school. Instead, we will listen to see how useful the 
curriculum is, to see if there are any changes that need to be made to the format, and to describe what 
people talk about and learn in each class. At the end of the research study, all 
notes will be destroyed. We’ll use a zoom poll to ask you if you agree 
to have these notes saved for our use. We will only 
use them if everyone in your breakout group agrees. If at any time during the session 
you change your mind, please just ask and we will destroy 
any notes if you are uncomfortable with what you said. 
 
Anonymous Zoom poll will then ask: 
 
Do you feel comfortable with the notes from your breakout group being used as part of our research? 
 
 
 

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PC CARES at School Focus Groups: At the end of each cohort of PC CARES at School Learning Circles, we will invite 
research participants from the Learning Circles to participate in a Focus Group.  Each focus group will be audio recorded, 
will take about 1 hour and will have approximately 8 participants.  Audio recordings will be transcribed (redacting any 
personal or community identifiers).  After transcription is complete, the audio recording with be destroyed.  Each 
participant will earn a $50 Amazon.com gift card.  Focus group questions will center around the experiences of 
participants in PC CARES at School.  There will be a total of 6 focus groups: 
1. In Bering Straits in Spring 2021 
2. In Northwest Alaska in Spring 2021 
3. In Bering Straits in Spring 2022 
4. In Northwest Alaska in Spring 2022 
PC CARES at Home: 
Also due to COVID-related restrictions, we will send PC CARES Care packages to approximately 100 community members 
who ‘opt in’ to receive them.  Care packages will contain brief information about what research shows community 
members can do to prevent suicide and promote wellness in their community.  It will also contain small gifts that 
community members can use in their wellness promotion/suicide prevention, such as Uno cards they can use to spend 
time with young people, an emotion wheel they can use with young people to understand their emotions, and YouMatter 
cards that have affirming messages that they can share with others in their community.  Approximately 8 Care packages 
will be sent over the course of a year and each will have different items and different information.  Each care package will 
contain a survey with a self-addressed stamped envelope.  Participants who return the survey to researchers will be 
entered into a raffle to win a prize worth approximately $50.  After each care package is sent, we will also randomly select 
5 Care package recipients to be invited to participate in a brief interview to collect additional data about how they are 
using the Care package information and items and to help us make the Care packages more useful to them over time.  
Interview participants will receive a $20 gift card as an incentive to participate. 
 
 
 
Data Management: 
Once data is received by University of Massachusetts personnel, all paper copies of surveys and all thumb drives 
containing audio recordings of LCs and facilitator interviews will be stored in a locked file cabinet in a locked office after 
data is entered.  All electronic data will be stored on a secure, encrypted, password-protected, University-run server.  The 
PI and key personnel will have access to all project data. LSC members will have access to de-identified and summarized 
project data. Names and proper nouns, like place names, on any transcripts made available to LSC members will be coded 
to protect the confidentiality of participants.  
 
All academic partners will have an up-to-date Collaborative Institutional Training Initiative (CITI) certification to ensure 
that all researchers adhere to ethical standards and follow all informed consent and confidentiality protocols as spelled 
out in our AAIRB application and in accompanying informed consent forms. 
 
The social network data collected (data about prevention actions survey participants have taken) will be maintained by 
Co-PI Dombrowski and stored in encrypted, password protected, electronic form at his offices at UNL. Because these data 
contain information from a small population, and thus the identity of project participants may be discernible from the 
data despite de-identification, the network data will not be made publicly available at any time. Requests to the PI/co-PI 
for relevant analysis from participating tribal partners will be honored in perpetuity, to ensure the highest level of access 
and collaboration without risk of public disclosure of participant identity or the data he/she supplied. 
 
We are strongly committed to ensuring the safety of participants and the integrity of the study and will therefore convene 
a Research Advisory Board (RAB). The RAB will have four members (one who is an Alaska Native academic) who have 
combined expertise that includes clinical trials, research with Alaska Natives in Alaska and community-based research. The 
RAB oversees the scientific and ethical integrity of the research study. Members review protocols, ensure safety and aid in 

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dissemination activities. Quarterly meetings enable RAB members to guide all aspects of the research from the 
development of protocols, organization of data and data collection, analysis and dissemination. RAB member participation 
in the pilot work for this research was invaluable. 
 
PC CARES at School: 
All surveys for PC CARES at School will be completed on line in REDCap which is a secure, encrypted online survey tool.  
Data will be kept separately from identifying information.  Data will be collected electronically.  Participants will be 
asked to assign themselves an ID.  Only the ID will be tied to the survey data.  Spreadsheet that links the names to IDs 
will be stored separately and only available the research coordinator and the PI. 
 
 
 
Data Analysis: 
Using a multi-level growth model for participant outcomes, we will generate reliable estimates of changes in participants’ 
knowledge, attitudes and behaviors before, over our 4-6-month intervention and follow-up: 7 occasions of measurement 
(Baseline STP survey, 5 Learning Circle surveys completed after each learning circle and a Follow-Up STP survey). We will 
model variability in these changes over time, and identify key factors affecting these outcomes within the three domains 
identified through our pilot study: a) cross-sector participation on a community level; b) individual dosage, and c) 
participant social role: informal or formal.  In addition, we will record the effectiveness of our intervention at the network 
and community level by performing pre- and post-intervention Steps Toward Prevention surveys documenting the level 
and type of institutional/role interactions that take place across those institutions and the social positions best able to 
meet the needs of young people at risk for suicide. Pre-post intervention STP surveys and variation in initial rollout timing 
will create a natural stepped wedge design. To assess intervention outcomes we will collect bipartite (individual and 
institution/social role) interaction data in each participating community. This method builds on research previously 
undertaken by the research team in NWA in 2015-17 and Inuit communities in Arctic Canada in 2010-11, and will focus on 
levels of cross-sector collaboration (including informal supports) and youth support networks within each community. 
Rigorous network statistical analyses will focus on variation across participating communities, and before/after the 
community-level intervention. Structural clustering of 12 family and community level network roles and key organizations 
will be derived via the 1) transformation of bipartite graphs of individuals and organizations/roles in single-mode, sector-
level social networks with interaction weighted links, 2) use of Generalized Ward’s criterion to discover meaningful 
clusters of structured interaction, and 3) block modeling of these clusters (using standard density criterion) to create 
models of organizational structure. Analysis of the pre- and post-PC CARES structures will allow us to capture changes in 
suicide prevention and supportive practices within and between these network roles/organizations before and after each 
cohort wave of 3 villages, and across all the intervention villages. 
Facilitator Interviews and Surveys. We will perform exploratory and descriptive qualitative analysis designed to yield 
information about specific contexts, characteristics, and processes of the PC CARES project from the facilitators’ 
perspectives. For example, while the quantitative measures of this study track the number and type of interactions among 
different community sectors, this analysis will use facilitator interviews and surveys to explore in more depth why some 
sectors participated and/or reached across community sectors (e.g. history of organizational collaboration and the 
context of village relationships) while others did not. Before and after timing of both interview and survey data collection 
is designed to capture changes in facilitator perspectives as they gain experience with implementation of the PC CARES 
Learning Circle curriculum.  
‘PC CARES at School’: Baseline and Follow up surveys will be analyzed for change over time using Wilcoxon or t-test. 
Outcomes measured over time will be compared for change using hierarchical linear modelling.  Satisfaction surveys will 
be analyzed by mean scores for individual items and for constructs, as well as frequencies for individual items. 
 
Local Steering Committee Members (LSC): 

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The LSC members will be local tribal administrators, leaders and young people interested in strengthening local 
communities' safety net to increase health and prevent suicide. Most of the members of this group have been involved in 
research for many years through the pilot research and through their participation in the Northwest Alaska Wellness 
Initiative. LSC members will not have access to project data, except in collated, region-level summaries. Names and 
proper nouns, like place names, on any de-identified and summarized project data made available to LSC members will be 
coded to protect the confidentiality of participants. 
 
 
 
 
Informed Consent Forms to follow: 
1. Baseline, Post- and Follow-Up Steps Toward Prevention Survey Consent Form 
2. Post Learning Circle Survey Consent Form 
3. Participant Focus Group Consent Form 
4. Care Package survey consent form 
5. Care package interview consent form 
6. Facilitator survey consent form 
7. Field notes consent form 
 
 

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1. Baseline, Post- and Follow-Up Steps Toward Prevention Survey Consent Form 
 
UNIVERSITY OF MICHIGAN 
CONSENT TO BE PART OF A RESEARCH STUDY  
 
KEY INFORMATION ABOUT THE RESEARCHERS AND THIS STUDY   
Study title: Promoting Community Conversations About Research to End Suicide (PC CARES at 
School) 
Principal Investigator: Lisa Wexler, PhD, University of Michigan in collaboration with Kawerak and Norton 
Sound Health Corporation  
Study Sponsor: National Institutes of Health 
 
You are invited to take part in a research study.  This form contains information that will help you decide 
whether to join the study.  
 
Introduction:  Thank you for showing interest in joining our research project aimed at implementing, assessing 
and improving the PC CARES at School curriculum which aims to increase wellness and suicide prevention in 
Native Alaskan communities.  We will ask you to complete a survey before the training begins, at the end of 
the training, and again approximately 6 months after the training. Your participation in our 3 surveys will take 
approximately 20 minutes each.  There is a small risk that the survey questions may remind you of a difficult 
event or will point out something you are not currently doing for prevention.  The benefit of participating is that 
you will help us understand where PC CARES at School is successful in improving wellness and prevention 
behaviors.  Please ask any questions you have about the project or your participation in it.  Participating in this 
research project is totally voluntary an up to you. Even after starting, you can choose to quit at any time and 
that will be okay.   
This consent form is set up to describe the project and your part in it a little at a time. Take as much time as 
you need to read through this form. 
PURPOSE OF THIS STUDY 
We want to learn how we can make PC CARES at School better. Just to remind you, PC CARES stands for 
Promoting Community Conversations About Research to End Suicide. This study will help us evaluate how 
well PC CARES at School works, and to make the model better. Ultimately, we hope that successful 
implementation of PC CARES at School will increase wellness and prevention in your community. 
WHO CAN PARTICIPATE IN THE STUDY 
Who can take part in this study? Anyone aged 18 +  who attends the PC CARES at School training can 
participate in this study. 
 
How many people are expected to take part in this study? We expect to have between 100 and 200 people 
participate in this research. 
INFORMATION ABOUT STUDY PARTICIPATION 
What will happen to me in this study? If you participate in the training, we will give you the knowledge and 
skills you need to support students in a way that reduces suicide risk.  By attending the training, you can also 
earn CEUs. 
You can choose to just attend the training, or you can choose to attend the training AND also be a participant 
in our research about PC CARES at School.  If you choose to participate in the study, we will ask you to do 3 
surveys: 1) before this training begins, 2) at the end of this training, and 3) a final survey about 6 months after 
the training. 
How much of my time will be needed to take part in this study? Each survey will take about 20 minutes to 
fill out.   The entire study will be completed in 2021. 
INFORMATION ABOUT STUDY RISKS AND BENEFITS 
What risks will I face by taking part in the study?  What will the researchers do to protect me against 
these risks? It is possible that answering the questions may remind you of a difficult event or may point out 
something that you are not doing for prevention. If this happens, you can skip any questions or stop filling out 
the survey, no problem. 
 

12 
 
How could I benefit if I take part in this study?  How could others benefit?  By attending the training, you 
will gain skills in how to increase wellness and reduce suicide risk in your community.  You can also earn 
CEUs for attending.  If you also participate in the study, you will help us make PC CARES at School better by 
tracking what you and other school community members learn and do before and after participating in PC 
CARES at School training. 
ENDING THE STUDY 
If I want to stop participating in the study, what should I do? You are free to leave the study at any time.  If 
you leave the study before it is finished, there will be no penalty to you. If you decide to leave the study before 
it is finished, please tell one of the persons listed in the “Contact Information” section below. If you choose to 
tell the researchers why you are leaving the study, your reasons may be kept as part of the study record. The 
researchers will keep the information collected about you for the research unless you ask us to delete it from 
our records. If the researchers have already used your information in a research analysis it will not be possible 
to remove your information. 
PROTECTING AND SHARING RESEARCH INFORMATION  
How will the researchers protect my information? Surveys will all be conducted using a secure, 
encrypted online survey platform.  We will ask you to assign yourself an ID.  All of your answers will be 
tied to that ID and no longer be tied to your name.  All results that are made public will be summary 
results, they will not report anything that would identify a person. Summary results will be shared with 
Tribal leadership and may appear in scientific literature.   Whether or not you choose to participate will 
not be shared with your employer or anyone else.   
 
Who will have access to my research records?  Only Dr. Wexler and her direct research staff will have 
access to you records. 
 
What will happen to the information collected in this study? Your answers will be private and will not be 
connected with your name, just an ID number so we can see what people learn over time. We will not share 
your answers with your supervisor, employer, or anyone else. All results that are made public will be summary 
results, they will not report anything that would identify any particular person. Summary results will be shared 
with Tribal leadership and may appear in scientific literature. 
 
Will my information be used for future research or shared with others? We may use or share your 
research information for future research studies. If we share your information with other researchers it will be 
de-identified, which means that it will not contain your name or other information that can directly identify you. 
This research may be similar to this study or completely different. We will not ask for your additional informed 
consent for these studies.  
 
Special Requirements  A description of this clinical trial will be available on www.ClinicalTrials.gov, as 
required by the National Institutes of Health (NIH). This website will not include information that can identify 
you. At most, the website will include a summary of the results. You can search this website at any time.  
 
To protect your privacy, this research holds a Certificate of Confidentiality from the National Institutes of 
Health. This means that we cannot be forced to disclose any research information that may identify you, even 
by a court subpoena, in any federal, state, or local civil, criminal, administrative, legislative, or other 
proceedings. For additional information about the CoC please contact the Principal Investigator. 
CONTACT INFORMATION 
Who can I contact about this study? 
Please contact the researchers listed below to: 
• 
Obtain more information about the study 
• 
Ask a question about the study procedures 
• 
Report an illness, injury, or other problem (you may also need to tell your regular doctors) 
• 
Leave the study before it is finished 
• 
Express a concern about the study 
 
Principal Investigator: Dr. Lisa Wexler 

13 
 
Email:lwexler@umich.edu 
Phone: (413) 824-1190 
 
If you have questions about your rights as a research participant, or wish to obtain information, ask 
questions or discuss any concerns about this study with someone other than the researcher(s), please 
contact the following: 
University of Michigan  
Health Sciences and Behavioral Sciences Institutional Review Board (IRB-HSBS) 
2800 Plymouth Road 
Building 520, Room 1169Ann Arbor, MI 48109-2800 
Telephone: 734-936-0933 or toll free (866) 936-0933  
Fax: 734-936-1852 
E-mail: irbhsbs@umich.edu  
 
Or  
 
Alaska Area IRB: 907-729-3924 (collect calls accepted) akaalaskaareaIRB@anthc.org  
Norton Sound RERB: (907) 443-3304 /  research@nshcorp.org 
YOUR CONSENT  
Consent/Assent to Participate in the Research Study 
By signing this document, you are agreeing to be in this study. Make sure you understand what the study is 
about before you sign. I/We will give you a copy of this document for your records and I/we will keep a copy 
with the study records.  If you have any questions about the study after you sign this document, you can 
contact the study team using the information provided above. 
 
I understand what the study is about and my questions so far have been answered. I agree to take part in this 
study.  
 
Print Legal Name: _____________________________________________________ 
 
Signature: ___________________________________________________________ 
 
Email address:_____________________________________________________________ 
 
Date of Signature (mm/dd/yy): ___________________________________________ 
 
 
 
 
 
 
 

14 
 
2. Post-Learning Circle Survey 
 
UNIVERSITY OF MICHIGAN 
CONSENT TO BE PART OF A RESEARCH STUDY  
 
KEY INFORMATION ABOUT THE RESEARCHERS AND THIS STUDY   
Study title: Promoting Community Conversations About Research to End Suicide 
Principal Investigator: Lisa Wexler, PhD, University of Michigan in collaboration with Kawerak and Norton 
Sound Health Corporation  
Study Sponsor: National Institutes of Health 
 
You are invited to take part in a research study.  This form contains information that will help you decide 
whether to join the study.  
 
Introduction:  Thank you for coming today and participating in this PC CARES session. As part of our 
research and to help us know what you learn in the session and to evaluate PC CARES, we invite you to fill out 
a short survey (approximately 20 minutes) that asks you about your knowledge, beliefs, skills, relationships 
and suicide prevention actions. Participating in this research study is totally voluntary and up to you. Even after 
starting the survey, you can quit at any time and that will be okay.  There is a small risk that the survey 
questions may ask about something you don’t feel confident about, and the benefit of participating is that you 
will help us understand where PC CARES is successful in improving wellness and prevention behaviors in your 
school and community. 
PURPOSE OF THIS STUDY 
We are trying to learn what works about our approach, and how to make PC CARES better. We hope you will 
learn information and useful skills to help you reach out to young people in your lives, to share ideas about 
prevention, and to get help and support if are worried about someone. By filling out these surveys, you will help 
us track what you learned through these sessions, and your feedback will help us improve PC CARES. 
WHO CAN PARTICIPATE IN THE STUDY 
Who can take part in this study? Anyone aged 18 or older who attended this PC CARES session. 
 
How many people are expected to take part in this study? We expect to have up to 100 people across the 
Bering Strait region and Northwest Alaska to participate in this research. 
INFORMATION ABOUT STUDY PARTICIPATION 
What will happen to me in this study? You will be asked to complete a short survey now, and at the end of 
each future PC CARES session you attend for a total of 5, if you attend all of the sessions.  We also ask if you 
will let us contact you for a short follow-up survey in the spring. 
How much of my time will be needed to take part in this study? Each survey will take about 20 minutes to 
fill out.   The entire study will be completed in 2022. 
 INFORMATION ABOUT STUDY RISKS AND BENEFITS 
What risks will I face by taking part in the study?  What will the researchers do to protect me against 
these risks? It is possible that completing the survey may point out something you may not be confident about 
or something that you have not yet done, which may not feel good. We only ask you questions about what you 
know and do for prevention. We do not ask about risk. 
 
How could I benefit if I take part in this study?  How could others benefit?  The PC CARES sessions will 
help us track what you learned and how (or if) it was helpful and whether you used what you learned. This 
information will help us improve PC CARES for your community and others like it. 
ENDING THE STUDY 
If I want to stop participating in the study, what should I do? You are free to leave the study at any time.  If 
you leave the study before it is finished, there will be no penalty to you. If you decide to leave the study before 

15 
 
it is finished, please tell one of the persons listed the “Contact Information” section below. If you choose to tell 
the researchers why you are leaving the study, your reasons may be kept as part of the study record. The 
researchers will keep the information collected about you for the research unless you ask us to delete it from 
our records. If the researchers have already used your information in a research analysis it will not be possible 
to remove your information. 
FINANCIAL CONSIDERATIONS  
 Will I be paid?  You will receive a $10 Amazon.com gift card for each survey that you complete.  If you attend 
all 6 PC CARES sessions and fill out a survey after each one, you will receive $60. 
PROTECTING AND SHARING RESEARCH INFORMATION  
 How will the researchers protect my information? At the beginning of this survey, you will be asked 
to enter a participant ID.  All of your answers will be tied to that ID, not to your name.  All results that 
are made public will be summary results, they will not report anything that would identify a person. 
Summary results will be shared with Tribal leadership and may appear in scientific literature. 
 
Who will have access to my research records?  Only Dr. Wexler and her direct research staff will have 
access to you records. 
 
What will happen to the information collected in this study? Your answers will be private and will not be 
associated with your name, just a research identification number. We will use this number to look at what you 
learned over time. Your name will not be linked to your survey and will not be shared with anyone.   
 
Will my information be used for future research or shared with others? We may use or share your 
research information for future research studies. If we share your information with other researchers it will be 
de-identified, which means that it will not contain your name or other information that can directly identify you. 
This research may be similar to this study or completely different. We will not ask for your additional informed 
consent for these studies.  
 
To protect your privacy, this research holds a Certificate of Confidentiality from the National Institutes of 
Health. This means that we cannot be forced to disclose any research information that may identify you, even 
by a court subpoena, in any federal, state, or local civil, criminal, administrative, legislative, or other 
proceedings. For additional information about the CoC please contact the Principal Investigator. 
 
CONTACT INFORMATION 
Who can I contact about this study? 
Please contact the researchers listed below to: 
• 
Obtain more information about the study 
• 
Ask a question about the study procedures 
• 
Report an illness, injury, or other problem (you may also need to tell your regular doctors) 
• 
Leave the study before it is finished 
• 
Express a concern about the study 
 
Principal Investigator: Dr. Lisa Wexler 
Email:lwexler@umich.edu 
Phone: (413) 824-1190 
 
If you have questions about your rights as a research participant, or wish to obtain information, ask 
questions or discuss any concerns about this study with someone other than the researcher(s), please 
contact the following: 
University of Michigan  
Health Sciences and Behavioral Sciences Institutional Review Board (IRB-HSBS) 
2800 Plymouth Road 

16 
 
Building 520, Room 1169Ann Arbor, MI 48109-2800 
Telephone: 734-936-0933 or toll free (866) 936-0933  
Fax: 734-936-1852 
E-mail: irbhsbs@umich.edu  
 
Or  
 
Alaska Area IRB: 907-729-3924 (collect calls accepted) akaalaskaareaIRB@anthc.org  
Norton Sound RERB: (907) 443-3304 /  research@nshcorp.org 
YOUR CONSENT  
BY FILLING OUT THE ATTACHED SURVEY, YOU AGREE TO PARTICIPATE IN THE EVALUATION OF 
PC CARES.   
 
 
 
 
 

17 
 
3. Participant Focus Group 
 
UNIVERSITY OF MICHIGAN 
CONSENT TO BE PART OF A RESEARCH STUDY  
PC CARES at School Focus Groups 
 
KEY INFORMATION ABOUT THE RESEARCHERS AND THIS STUDY   
Study title: Promoting Community Conversations About Research to End Suicide (PC CARES) 
Principal Investigator: Lisa Wexler, PhD, University of Michigan in collaboration with Kawerak and Norton 
Sound Health Corp., Maniilaq, Bering Straits School District, and Northwest Arctic Borough School District  
Study Sponsor: National Institutes of Health 
 
This form can be read to you if you ask. 
You are invited to take part in a research study.  This is a consent form for a focus group about your 
experience with PC CARES at School. It will give you information about the focus groups so you can make an 
informed decision about whether you want to participate.  If you have questions please ask us. Take as much 
time as you need to decide. If you choose to be in the study, you will need to sign this form. 
 
Key Information 
1. We are inviting you to take part in a focus group for this research study, and are asking for your 
consent to join.  It is completely up to you to decide if you want to take part in a focus group.   
2. The purpose of the PC CARES at School Focus Groups is to learn more about specific 
contexts, characteristics, and processes of the PC CARES project that encourage community 
changes to reduce suicide risk. Each focus group will take about 1 hour and will be conducted 
through Zoom or via phone.  A facilitator will ask questions about your experience with PC 
CARES at School and how you  have used the information you learned. 
3. Risks for taking part are minimal.  Focus Group discussion may remind you of a difficult 
experience, or you may feel uncomfortable if we discuss suicide prevention actions that you 
haven’t yet taken. 
4. The benefit of joining is that you will help us understand how to make the PC CARES program better 
overall in promoting community changes to reduce suicide risk.  
 
PURPOSE OF THIS STUDY 
Why are we doing this? We want to learn more about specific contexts, characteristics, and processes of the 
PC CARES project that encourage community changes to reduce suicide risk. Part of this is understanding 
what helps you take actions related to wellness and suicide prevention.  
WHO CAN PARTICIPATE IN THE STUDY 
Who can be in this study?  Anyone who attended the PC CARES at School sessions can participate in these 
focus groups. 
How many people are expected to take part in this study? We expect to conduct a total of 4 focus groups, 
each with about 8 people, for a total of about 32 focus group participants. 
INFORMATION ABOUT STUDY PARTICIPATION 
What will happen to me in this study?  
If you choose to participate in the focus groups, we will set up a Zoom call in which you can join by 
videoconferencing or by phone.  We will audio record the focus group for transcription later on, so we can 
remember what was said.  Examples of questions we might ask are: 
What was it like to participate in the PC CARES course? 
What information from our course do you expect will be easy for you to do? 
What do you hope to see happen in your community as a result of this class? 
What has already happened in your community as a result of taking this class? 
 

18 
 
Incentives: Each focus group participant will receive a $50 Amazon.com gift card in appreciation for your time. 
How much of my time will be needed to take part in this study? The focus group is expected to last about 
1 hour.   The entire study will be completed in 2022. 
 
Who is funding this study?  This research project is funded by the National Institute of Mental Health. 
INFORMATION ABOUT STUDY RISKS AND BENEFITS 
What risks will I face by taking part in the study?  What will the researchers do to protect me against 
these risks? We believe there are no known risks to participating, but it is possible that answering the 
questions may remind you of a difficult event or may point out something that you are not doing for prevention.  
If this happens, you can take a break or leave the focus group and it will be okay. 
 
How could I benefit if I take part in this study?  How could others benefit?  The benefit of participating is 
that you will help us understand how to make the PC CARES program better at promoting community-wide 
increase in actions that promote wellness and decrease suicide risk. 
ENDING THE STUDY 
If I want to stop participating in the study, what should I do? You are free to leave the focus group at any 
time without any penalty to you.  Whatever you share in the focus group before you decide to leave will remain 
as part of the researcher’s data.  Because the researchers will not keep track of who makes each comment in 
the focus group, it will not be possible for researchers to take out your comments after the focus group. 
PROTECTING AND SHARING RESEARCH INFORMATION  
How will the researchers protect my information? Researchers will not keep track of who in the 
focus group makes which comments; therefore, no identifying information will be kept in the audio 
recording or transcript of the focus group.  We will not share any information from your focus groups 
with your supervisor, or anyone else. Transcripts and notes from focus groups will be recorded with all 
identifying information (for example: names of people, tribes, or villages), redacted.  Once transcripts 
are completed, all audio recordings will be destroyed.   We will ask all focus group members to protect 
the privacy of other focus group members by not sharing with others what they hear in the focus group.  
Researchers cannot guarantee that your fellow focus group members will keep your comments private. 
 
All results that are made public will be summary results, they will not report anything that would identify 
a person. Summary results will be shared with Tribal leadership and may appear in scientific literature. 
 
Who will have access to my research records?  Only Dr. Wexler and her direct research staff will  have 
access to you records. 
 
Will my information be used for future research or shared with others? We may use or share your 
research information for future research studies. If we share your information with other researchers it will not 
contain your name or other information that can directly identify you. This research may be similar to this study 
or completely different. We will not ask for your additional informed consent for these studies.  
 
Special Requirements  A description of this clinical trial will be available on www.ClinicalTrials.gov, as 
required by the National Institutes of Health (NIH). This website will not include information that can identify 
you. At most, the website will include a summary of the results. You can search this website at any time.  
 
To protect your privacy, this research holds a Certificate of Confidentiality from the National Institutes of 
Health. This means that we cannot be forced to disclose any research information that may identify you, even 
by a court subpoena, in any federal, state, or local civil, criminal, administrative, legislative, or other 
proceedings. For additional information about the CoC please contact the Principal Investigator. 
 

19 
 
Data Storage: Your focus group data will be stored at the University of Michigan.  Electronic files will 
be kept on a secure encrypted server that is accessed only with a password.  We plan to keep your 
answers for as long as they are useful to the study, then the information will be destroyed. 
 
You have a choice.  Remember it’s up to you if you want to participate in PC CARES focus groups, and even 
after we start you can choose to stop at any time and that will be okay.   
 
CONTACT INFORMATION 
Who can I contact about this study? 
Please contact the researchers listed below to: 
• 
Obtain more information about the study 
• 
Ask a question about the study procedures 
• 
Report an illness, injury, or other problem (you may also need to tell your regular doctors) 
• 
Leave the study before it is finished 
• 
Express a concern about the study 
 
Principal Investigator: Dr. Lisa Wexler 
Email:lwexler@umich.edu 
Phone: (413) 824-1190 
 
If you have questions about your rights as a research participant, or wish to obtain information, ask 
questions or discuss any concerns about this study with someone other than the researcher(s), please 
contact the following: 
University of Michigan  
Health Sciences and Behavioral Sciences Institutional Review Board (IRB-HSBS) 
2800 Plymouth Road 
Building 520, Room 1169Ann Arbor, MI 48109-2800 
Telephone: 734-936-0933 or toll free (866) 936-0933  
Fax: 734-936-1852 
E-mail: irbhsbs@umich.edu  
 
Or  
 
Alaska Area IRB: 907-729-3924 (collect calls accepted) akaalaskaareaIRB@anthc.org  
Norton Sound RERB: (907) 443-3304 /  research@nshcorp.org 
YOUR CONSENT  
Consent to Participate in the Research Study 
By signing this document, you are agreeing to be in this study. Make sure you understand what the study is 
about before you sign. I/We will give you a copy of this document for your records and I/we will keep a copy 
with the study records.  If you have any questions about the study after you sign this document, you can 
contact the study team using the information provided above. 
 
I understand what the study is about and my questions so far have been answered. I agree to take part in this 
study.  
 
Print Legal Name: _____________________________________________________ 
 
Signature: ___________________________________________________________ 
 
Date of Signature (mm/dd/yy): ___________________________________________ 

2 0  
 
5.5.  C ar e P ack a g e s urv ey c o ns e nt
C ar e P ack a g e s urv ey c o ns e nt  f or m
f or m 
 
If y o u wi s h t o c o m pl et e t hi s s ur v e y,  y o u c a n eit h er  fill it o ut a n d m ail it b a c k t o 
u s i n  t h e e n v el o p e  pr o vi d e d  O R  t a k e t h e s ur v e y o nli n e  b y  f oll o wi n g t hi s li n k:  
[ LI N K] Or , u s e  y o ur  s m art p h o n e  c a m er a  t o s c a n  t hi s c o d e  à  
 
U NI V E R SI T Y  O F  MI C HI G A N   
C O N S E N T  T O  B E  P A R T  O F  A  R E S E A R C H  S T U D Y  
K E Y  I N F O R M A TI O N A B O U T  T H E  R E S E A R C H E R S  A N D  T HI S  S T U D Y  
St u d y titl e: Pr o m oti n g C o m m u nit y C o n v er s ati o n s A b o ut R e s e ar c h t o E n d S ui ci d e ( P C C A R E S at 
H o m e)  Pri n ci p al I n v e sti g at or: Li s a W e xl er, P h D, U ni v er sit y of Mi c hi g a n i n c oll a b or ati o n wit h 
K a w er a k I n c., N ort o n S o u n d  H e alt h  C or p or ati o n  &  M a niil a q  A s s o ci ati o n  
St u d y  S p o n s or:  N ati o n al  I n stit ut e s of  H e alt h  
T h a n k  y o u  f or y o ur  i nt er e st i n j oi ni n g o ur  r e s e ar c h pr oj e ct  ai m e d  at  i m pr o vi n g P C  C A R E S  P a c k a g e s  w hi c h  
ai m  t o i n cr e a s e w ell n e s s a n d pr e v e nt s ui ci d e.  W e’ d l o v e t o fi n d o ut w h at y o u t hi n k a b o ut t hi s C ar e P a c k a g e.  If 
y o u c o m pl et e t hi s s ur v e y  a n d  s e n d it  b a c k  t o u s  wit h y o ur  n a m e,  y o u  will  b e e nt er e d  i nt o a r affl e  t o wi n  a 
$ 5 0 A m a z o n. c o m gift  c ar d.  
St u d y P ur p o s e : T hi s st u d y will h el p u s e v al u at e h o w w ell P C C A R E S P a c k a g e s w or k, s o w e c a n m a k e 
it b ett er i n a n  eff ort  t o s u p p ort  w ell n e s s  a n d pr e v e nti o n i n  y o ur  c o m m u nit y.  
 
W h o C a n P arti ci p at e ?  A n y o n e a g e d 1 8 + w h o r e c ei v e s P C C A R E S at H o m e C ar e P a c k a g e s c a n p arti ci p at e 
i n t hi s st u d y. W e  e x p e ct  t o h a v e a p pr o xi m at el y 1 0 0 p e o pl e  p arti ci p at e i n t hi s r e s e ar c h  o v er  t h e c o ur s e of  t h e 
n e xt  f e w y e ar s. 
 
St u d y P arti ci p ati o n:  T h e s ur v e y will a s k a b o ut t h e P C C A R E S P a c k a g e y o u r e c ei v e d a n d will t a k e l e s s 
t h a n 1 0 mi n ut e s. T h e  e ntir e  st u d y  will b e c o m pl et e d i n 2 0 2 3.  
 
I nf or m ati o n a b o ut St u d y Ri s k s a n d B e n efit s: T h er e i s v er y f e w (if a n y) ri s k s i n p arti ci p ati n g i n t hi s s ur v e y.  
T h er e i s a  s m all  ri s k t h at t h e i nt er vi e w will bri n g u p  h ar d f e eli n g s  a b o ut  t hi n g s y o u m a y  n ot  h a v e d o n e  t o 
i n cr e a s e w ell n e s s. 
T h e  b e n efit  of  p arti ci p ati n g  i s t h at y o u will h el p  u s  u n d er st a n d  h o w P C  C A R E S  P a c k a g e s  ar e h el pf ul  t o y o u.  
 
E n di n g  t h e st u d y: Y o u ar e fr e e  t o st o p  t h e s ur v e y  at  a n y  ti m e: n o pr o bl e m.  J u st  d o n’t  s e n d i n t hi s  s ur v e y.  
 
Pr ot e cti n g a n d S h ari n g R e s e ar c h i nf or m ati o n:  Y o ur i nf or m ati o n will b e pri v at e. All p a p er s ur v e y s 
will b e st or e d  i n a l o c k e d fil e  c a bi n et  a n d all  el e ctr o ni c  r e c or d s will  b e st or e d  o n  s e c ur e p a s s w or d -
pr ot e ct e d  s er v er s.  O nl y  Dr.  
W e xl er a n d h er dir e ct r e s e ar c h st aff will h a v e a c c e s s t o y o ur r e c or d s. Y o ur d at a will n ot b e s h ar e d 
wit h ot h er  r e s e ar c her s or u s e d f or a n y f ut ur e r e s e ar c h st u di e s.  All r e s ult s t h at ar e m a d e p u bli c will 
b e s u m m ar y r e s ult s.  All  i nf or m ati o n will b e d e-i d e ntifi e d, w hi c h m e a n s t h at it will n ot c o nt ai n y o ur 
n a m e or ot h er i nf or m ati o n t h at c a n  dir e ctl y i d e ntif y  y o u.  S u m m ar y r e s ult s will  b e  s h ar e d  wit h  Tri b al  
l e a d er s hi p a n d  m a y  a p p e ar  i n s ci e ntifi c  lit er at ur e. 
 
S p e ci al R e q uir e m e nt s:  T o pr ot e ct y o ur pri v a c y, t hi s r e s e ar c h h ol d s a C ertifi c at e of C o nfi d e nti alit y ( C o C) 
fr o m t h e N ati o n al  I n stit ut e s of  H e alt h.  T hi s  m e a n s  t h at w e c a n n ot  b e f or c e d  t o di s cl o s e a n y  r e s e ar c h 
i nf or m ati o n t h at m a y  i d e ntif y y o u, e v e n b y a c o urt s u b p o e n a, i n a n y f e d er al, st at e, or l o c al ci vil, cri mi n al, 
a d mi ni str ati v e, l e gi sl ati v e, or ot h er  pr o c e e di n g s.  F or  a d diti o n al i nf or m ati o n a b o ut  t h e C o C pl e a s e c o nt a ct  t h e 
Pri n ci p al  I n v e sti g at or. 
 
C o nt a ct I nf or m ati o n:  T o ( 1) g et m or e i nf or m ati o n a b o ut t h e st u d y, ( 2) a s k a b o ut t h e st u d y pr o c e d ur e s, ( 3) 
r e p ort a n ill n e s s, i nj ur y, or ot h er pr o bl e m, ( 4) L e a v e t h e st u d y b ef or e it i s fi ni s h e d or ( 5) e x pr e s s a c o n c er n 
a b o ut t h e st u d y, pl e a s e  c o nt a ct  Pri n ci p al  I n v e sti g at or, Li s a W e xl er at  l w e xl er @ u mi c h. e d u or  ( 4 1 3) 8 2 4 -
1 1 9 0  
 
Q R C O D E  

21 
 
If you have questions about your rights as a research participant, or wish to obtain information, or discuss 
any concerns about this study with someone other than the researcher(s), please contact the following: 
University of Michigan 
Health Sciences and Behavioral Sciences Institutional Review Board 
(IRB-HSBS) 2800 Plymouth Road 
Building 520, Room 1169 Ann Arbor, MI 48109-2800 
Telephone: 734-936-0933 or toll free 
(866) 936-0933 Fax: 734-936-1852 E-
mail: irbhsbs@umich.edu 
Or 
Alaska Area IRB: 907-729-3924 (collect calls accepted) 
akaalaskaareaIRB@anthc.org Norton Sound RERB: (907) 443-3304 /  
research@nshcorp.org 
Dr. Klejka at YKHC Human Subjects Committee (907) 543-6028 
 
 

22 
 
 
6. Care package interview consent form 
 
UNIVERSITY OF MICHIGAN 
CONSENT TO BE PART OF A RESEARCH STUDY  
 
KEY INFORMATION ABOUT THE RESEARCHERS AND THIS STUDY   
Study title: Promoting Community Conversations About Research to End Suicide (PC CARES at Home) 
Principal Investigator: Lisa Wexler, PhD, University of Michigan in collaboration with Kawerak and Norton 
Sound Health Corporation, Maniilaq 
Study Sponsor: National Institutes of Health 
Recruitment Script: My name is [name] and I’m calling to ask you a few questions about the PC CARES Care 
Package you received.   We’d like to know what you thought about the Care Package and how you used it.  
You will receive a $20 Amazon.com gift card for participating.  Do you have a few minutes to review our 
consent form and to answer a few questions?  Or can we schedule a different time that is more convenient for 
you? 
[If Yes, the proceed to the consent form] 
 
Introduction:  Thank you for your interest in joining our research project aimed at improving PC CARES 
Packages which aim to increase wellness and prevent suicide.  You recently received a care package with 
items including [name items included in care package].  We are calling a few people who received these to find 
out what they think about them. If you agree to talk with me today, the interview will take less than 15 minutes, 
and your answers will help us understand how people use the care packages and how we can make them 
better. We will send also you a $20 Amazon.com gift card. 
Where should we send the Amazon.com Gift Card? (email address, text, mailing address):  
 
________________________________________________________________________________ 
I am going to go over a few things about the study before we begin. 
PURPOSE OF THIS STUDY 
This study will help us evaluate how well PC CARES Packages work, so we can make it better in an effort to 
support wellness and prevention in your community. 
WHO CAN PARTICIPATE IN THE STUDY 
Anyone aged 18 +  who receives PC CARES at Home Care Packages can participate in this study.  We expect 
to have approximately 100 people participate in this research over the course of the next few years. 
INFORMATION ABOUT STUDY PARTICIPATION 
The interview will ask about the PC CARES Package you received, and will take less than 15 minutes.  
The entire study will be completed in 2023. 

23 
 
INFORMATION ABOUT STUDY RISKS AND BENEFITS 
There is very few (if any) risks in participating in this interview.  There is a small risk that the interview will bring 
up hard feelings about things you may not have done to increase wellness. 
The benefit of participating is that you will help us understand how PC CARES Packages are helpful to you.   
ENDING THE STUDY 
You are free to stop the interview at any time: no problem.  We will keep the information you gave up until then 
unless you ask us not to. If you prefer, just ask us to delete it from our records. If you decide a month after the 
interview, it is unlikely we will be able to remove your information from the research because it will be put with 
others’ information and analyzed. 
PROTECTING AND SHARING RESEARCH INFORMATION  
Your information will be private. Instead of using your name, the information you give is assigned an ID.  
Your answers will saved on a secure, encrypted, password protected server.   
Only Dr. Wexler and her direct research staff will have access to your records. 
All results that are made public will be summary results, they will not report anything that would identify any 
particular person. All information will be de-identified, which means that it will not contain your name or other 
information that can directly identify you. Summary results will be shared with Tribal leadership and may 
appear in scientific literature. 
Because the research is supported by the National Institute of Mental Health, a description of this clinical trial 
will be available on www.ClinicalTrials.gov, as required by the National Institutes of Health (NIH). This website 
will not include information that can identify you. At most, the website will include a summary of the results. 
You can search this website at any time.  
To protect your privacy, this research holds a Certificate of Confidentiality from the National Institutes of 
Health. This means that we cannot be forced to disclose any research information that may identify you, even 
by a court subpoena, in any federal, state, or local civil, criminal, administrative, legislative, or other 
proceedings. For additional information about the CoC please contact the Principal Investigator. 
Again: You don’t have to participate if you don’t want to.  Even after we start, you can choose to quit at any 
time and that will be okay.  Your answers are confidential: we hope you will be honest and tell us what you 
think so we can make the PC CARES Packages better. After we finish, we plan to keep your answers for as 
long as they are useful to the study, and then we will destroy them. 
Contacts: Along with your gift card, we will send you a copy of all of the information I’ve just shared with you.  
It will also include the names, phone numbers and email addresses of several people that you can call if you 
have any questions or concerns.  If you’d like, I can read those names and their phone numbers and email 
addresses to you now, or you can just wait and receive them in a few days with your Gift Card. 
Would you like me to read them to you now or would you like them to receive them in a few days with your Gift 
Card? 
[If participant would like you to read them the contact info, please see the bottom of this document for 
appropriate information to read to them] 
Do you have any questions are is there anything you’d like me to explain more clearly? 
 
 

24 
 
YOUR CONSENT  
AGREEMENT TO PARTICIPATE: 
 
Do you agree to participate in this research study?  
 
___ YES 
 
 
 
 
 
___ NO 
 
Interviewer signature ___________________________________ 
 
Date__________ 
 
---------------------------------------------------------------------------------------------------------------------------- 
To be read if the participant does not want this information sent with gift card 
 
CONTACT INFORMATION 
Please contact the researchers listed below to: 
• 
Obtain more information about the study or ask a question about the study procedures 
• 
Report an illness, injury, or other problem (you may also need to tell your regular doctors) 
• 
Leave the study before it is finished or express a concern about the study 
 
Principal Investigator: Dr. Lisa Wexler 
Email:  lwexler@umich.edu            Phone: (413) 824-1190 
 
If you have questions about your rights as a research participant, or wish to obtain information, ask 
questions or discuss any concerns about this study with someone other than the researcher(s), please 
contact the following: 
University of Michigan  
Health Sciences and Behavioral Sciences Institutional Review Board (IRB-HSBS) 
2800 Plymouth Road 
Building 520, Room 1169Ann Arbor, MI 48109-2800 
Telephone: 734-936-0933 or toll free (866) 936-0933  
Fax: 734-936-1852 
E-mail: irbhsbs@umich.edu  
Or  
Alaska Area IRB: 907-729-3924 (collect calls accepted) akaalaskaareaIRB@anthc.org  
Norton Sound RERB: (907) 443-3304 /  research@nshcorp.org 
 

25 
 
7. Facilitator survey consent form 
 
UNIVERSITY OF MICHIGAN 
CONSENT TO BE PART OF A RESEARCH STUDY  
KEY INFORMATION ABOUT THE RESEARCHERS AND THIS STUDY   
Study title: Promoting Community Conversations About Research to End Suicide 
Principal Investigator: Lisa Wexler, PhD, University of Michigan in collaboration with Yukon Kuskokwim 
Health Corporation 
Study Sponsor: National Institutes of Health 
You are invited to take part in a research study.  This form contains information that will help you decide 
whether to join the study.  
Things you should know: 
• 
The purpose of the study is to better understand the experiences of PC CARES facilitators in 
implementing PC CARES 
• 
If you choose to participate, you will be asked to complete 3 surveys.  1) Before the Facilitator training, 
2) At the end of the Facilitator training, 3) during Spring 2023.  Each survey will take 25 minutes or less.  
• 
Risks or discomforts from this research include the possibility that answering the questions may remind 
you of a difficult event or may point out something that you are not doing for prevention. If this happens, 
you can skip any questions or stop filling out the survey, no problem. 
• 
There are no direct benefits to you for participating, but your participation will help us build increased 
supports for future PC CARES facilitators. 
 
Participating in this research project is totally voluntary an up to you. Even after starting, you can 
choose to quit at any time and that will be okay.  Please take time to read this entire form and ask 
questions before deciding whether to take part in this research project. 
PURPOSE OF THIS STUDY 
We want to learn how we can make PC CARES better by understanding more about the experiences of PC 
CARES facilitators. Just to remind you, PC CARES stands for Promoting Community Conversations About 
Research to End Suicide. As a PC CARES facilitator, you will work with your community members to prepare 
and support them to reach out to young people in their lives before a crisis. This study will help us understand 
what parts of PC CARES are challenging for facilitators and how we can build additional supports for future PC 
CARES facilitators.  Ultimately, we hope that successful implementation of PC CARES will increase wellness 
and prevention in your community. 
WHO CAN PARTICIPATE IN THE STUDY 
Who can take part in this study? Anyone who attends the PC CARES Training of Facilitators can participate 
in this study. 
 
How many people are expected to take part in this study? We expect to have approximately 20 people  
participate in this aspect of the research.  The full research projects includes about 1600 people. 
INFORMATION ABOUT STUDY PARTICIPATION 

26 
 
What will happen to me in this study? If you become a facilitator, we will give you the knowledge and skills 
you need during this week-long training to host PC CARES learning circles in your home community.  After the 
week-long training, we also ask you to attend monthly teleconferences with the other facilitators here, and to 
hold 5 learning circles in your home community. 
You can choose to just be a facilitator and complete the tasks mentioned above, or you can choose to be a 
facilitator AND also be a participant in our research about PC CARES.  If you choose to participate in the 
study, we will ask you to do a number of surveys: 1) before this training begins, 2) at the end of this training, 
and 3) a final survey about 3 months after you’ve finished the 5 PC CARES learning circles in your village. 
How much of my time will be needed to take part in this study? Each survey will take about 25 minutes to 
fill out.   The entire study will be completed in 2023. 
INFORMATION ABOUT STUDY RISKS AND BENEFITS 
What risks will I face by taking part in the study?  What will the researchers do to protect me against 
these risks? It is possible that answering the questions may remind you of a difficult event or may point out 
something that you are not doing for prevention. If this happens, you can skip any questions or stop filling out 
the survey, no problem. Because this study collects information about you,the primary risk of this research is a 
loss of confidentiality. See the section on ‘Protecting and Sharing Research Information’ below in this 
document for more information on how the study team will protect your confidentiality and privacy. 
How could I benefit if I take part in this study?  How could others benefit?  You may not receive any 
personal benefits from being in this study. However, others may benefit from the knowledge gained from this 
study. By becoming a facilitator, you will gain skills in how to increase wellness in your community.  If you also 
participate in the study, you will help us make PC CARES better by understanding more about the experiences 
of facilitating PC CARES Learning Circles. 
ENDING THE STUDY 
If I want to stop participating in the study, what should I do? You are free to leave the study at any time.  If 
you leave the study before it is finished, there will be no penalty to you. If you decide to leave the study before 
it is finished, please tell one of the persons listed in the “Contact Information” section below. If you choose to 
tell the researchers why you are leaving the study, your reasons may be kept as part of the study record. The 
researchers will keep the information collected about you for the research unless you ask us to delete it from 
our records. If the researchers have already used your information in a research analysis it will not be possible 
to remove your information. 
FINANCIAL INFORMATION 
7.1 Will I be paid or given anything for taking part in this study? You will receive a $20 Amazon.com 
giftcard for completing the first survey, a $10 Amazon.com giftcard for completing the second survey, and a 
$40 Amazon.com gift card for completing the 3rd survey. 
PROTECTING AND SHARING RESEARCH INFORMATION  
How will the researchers protect my information? Once we enter your data into a computer 
database, we’ll assign you a Participant ID.  All of your answers will be tied to that ID and no longer be 
tied to your name.  All results that are made public will be summary results, they will not report anything 
that would identify a person. Summary results will be shared with Tribal leadership and may appear in 
scientific literature. 
Who will have access to my research records?  Only Dr. Wexler and her direct research staff will  have 
access to you records. 

27 
 
What will happen to the information collected in this study? Your answers will be private and will not be 
connected with your name, just an ID number so we can see what people learn over time. We will not share 
your answers with your supervisor, UAF instructor, or anyone else. All results that are made public will be 
summary results, they will not report anything that would identify any particular person. Summary results will be 
shared with Tribal leadership and may appear in scientific literature. 
Will my information be used for future research or shared with others? We may use or share your 
research information for future research studies. If we share your information with other researchers it will be 
de-identified, which means that it will not contain your name or other information that can directly identify you. 
This research may be similar to this study or completely different. We will not ask for your additional informed 
consent for these studies.  
Special Requirements  A description of this clinical trial will be available on www.ClinicalTrials.gov, as 
required by the National Institutes of Health (NIH). This website will not include information that can identify 
you. At most, the website will include a summary of the results. You can search this website at any time.  
To protect your privacy, this research holds a Certificate of Confidentiality from the National Institutes of 
Health. This means that we cannot be forced to disclose any research information that may identify you, even 
by a court subpoena, in any federal, state, or local civil, criminal, administrative, legislative, or other 
proceedings. For additional information about the CoC please contact the Principal Investigator. 
CONTACT INFORMATION 
Who can I contact about this study? 
Please contact the researchers listed below to: 
• 
Obtain more information about the study 
• 
Ask a question about the study procedures 
• 
Report an illness, injury, or other problem (you may also need to tell your regular doctors) 
• 
Leave the study before it is finished 
• 
Express a concern about the study 
 
Principal Investigator: Dr. Lisa Wexler 
Email:lwexler@umich.edu 
Phone: (413) 824-1190 
If you have questions about your rights as a research participant, or wish to obtain information, ask 
questions or discuss any concerns about this study with someone other than the researcher(s), please 
contact the following: 
University of Michigan  
Health Sciences and Behavioral Sciences Institutional Review Board (IRB-HSBS) 
2800 Plymouth Road 
Building 520, Room 1169Ann Arbor, MI 48109-2800 
Telephone: 734-936-0933 or toll free (866) 936-0933  
Fax: 734-936-1852 
E-mail: irbhsbs@umich.edu  
 
You can also contact the University of Michigan Compliance Hotline at 1-866-990-0111.  

28 
 
You can also contact Dr. Joseph Klejka from the Yukon-Kuskokwim Health Corporation at 907-543-6024 email 
him at joe_klejka@ykhc.org if you have questions regarding your rights as a research participant. 
The UAF Institutional Review Board (IRB) is a group that looks at research projects involving people. This review 
is done to protect people like you who are part of research. If you have questions or concerns about your  rights 
as a research participant, you can contact the UAF Office of Research Integrity at 474-7800 (Fairbanks area) 
or 1-866-876-7800 (toll-free outside the Fairbanks area) or uaf-irb@alaska.edu. 
 
YOUR CONSENT  
Consent/Assent to Participate in the Research Study 
By signing this document, you are agreeing to be in this study. Make sure you understand what the study is 
about before you sign. I/We will give you a copy of this document for your records and I/we will keep a copy 
with the study records.  If you have any questions about the study after you sign this document, you can 
contact the study team using the information provided above. 
I understand what the study is about and my questions so far have been answered. I agree to take part in this 
study.  
 
Print Legal Name: _____________________________________________________ 
 
Signature: ___________________________________________________________ 
 
Date of Signature (mm/dd/yy): ___________________________________________ 
 
 
 

29 
 
 
8. Field notes consent form 
 
UNIVERSITY OF MICHIGAN 
CONSENT TO BE PART OF A RESEARCH STUDY  
 
1.  KEY INFORMATION ABOUT THE RESEARCHERS AND THIS STUDY   
Study title: Promoting Community Conversations About Research to End Suicide 
Principal Investigator: Lisa Wexler, PhD, University of Michigan in collaboration with Yukon Kuskokwim 
Health Corporation 
Study Sponsor: National Institutes of Health 
 
You are invited to take part in a research study.  This form contains information that will help you decide 
whether to join the study.  
 
Things you should know: 
• 
The purpose of the study is to better understand the experiences of PC CARES facilitators in 
implementing PC CARES 
• 
If you choose to participate, you will be asked to sign this consent form to allow us to take notes during 
the Training of Facilitators and the monthly support calls.  Then you can participate in conversations 
normally. 
• 
Risks or discomforts from this research include the possibility that you may say something that you later 
regret.  If this happens, you can contact the researchers to ask them to remove the remark from the 
notes. 
• 
There are no direct benefits to you for participating, but your participation will help us build increased 
supports for future PC CARES facilitators. 
 
Taking part in this research project is voluntary. You do not have to participate and you can stop at any time. 
Please take time to read this entire form and ask questions before deciding whether to take part in this 
research project. 
2. PURPOSE OF THIS STUDY 
We want to learn how we can make PC CARES better by understanding more about the experiences of PC 
CARES facilitators. Just to remind you, PC CARES stands for Promoting Community Conversations About 
Research to End Suicide. As a PC CARES facilitator, you will work with your community members to prepare 
and support them to reach out to young people in their lives before a crisis. This study will help us understand 
what parts of PC CARES are challenging for facilitators and how we can build additional supports for future PC 
CARES facilitators.  Ultimately, we hope that successful implementation of PC CARES will increase wellness 
and prevention in your community. 
3. WHO CAN PARTICIPATE IN THE STUDY 
Who can take part in this study? Anyone who attends the PC CARES Training of Facilitators can participate 
in this study. 
 
How many people are expected to take part in this study? We expect to have approximately 20 people  
participate in this aspect of the research.  The full research projects includes about 1600 people. 
4.  INFORMATION ABOUT STUDY PARTICIPATION 
4.1 What will happen to me in this study? 
If you choose to participate in this study, you will participate in conversations during the Training of Facilitators 
and during the monthly support calls normally.  You don’t need to do anything special.  We will take notes 
about your experiences, concerns, challenges, successes, questions, but will not write your name. 

30 
 
 
4.3 If I decide not to take part in this study, what other options do I have?  
If you choose not to participate in this portion of the study, that is fine.  We will still take notes on what others in 
the class say, but we will not take notes on any of your comments. 
 
5.  INFORMATION ABOUT STUDY RISKS AND BENEFITS 
5.1 What risks will I face by taking part in the study?  What will the researchers do to protect me 
against these risks?  It is possible that you will say something during the Facilitator Training or during the 
monthly support calls that you later reconsider or regret.  If that happens, you can contact the researchers to 
ask us to remove that comment from our notes. 
 
Breach of confidentiality is a potential risk in all research.  We avoid this risk by not writing down anyone’s 
name or identifying information in our notes. 
 
5.2 How could I benefit if I take part in this study?  How could others benefit?  You may not receive any 
personal benefits from being in this study. However, others may benefit from the knowledge gained from this 
study. By becoming a facilitator, you will gain skills in how to increase wellness in your community.  If you also 
participate in the study, you will help us make PC CARES better by understanding more about the experiences 
of facilitating PC CARES Learning Circles. 
6.  ENDING THE STUDY 
6.1 If I want to stop participating in the study, what should I do? You are free to leave the study at any 
time.  If you leave the study before it is finished, there will be no penalty to you. If you decide to leave the study 
before it is finished, please tell one of the persons listed in the “Contact Information” section below. If you 
choose to tell the researchers why you are leaving the study, your reasons may be kept as part of the study 
record. The researchers will keep the information collected about you for the research unless you ask us to 
delete it from our records. If the researchers have already used your information in a research analysis it will 
not be possible to remove your information. 
7.  FINANCIAL INFORMATION 
7.1 Will I be paid or given anything for taking part in this study? There is no compensation for this portion 
of the research study.   
8. PROTECTING AND SHARING RESEARCH INFORMATION  
8.1 How will the researchers protect my information Once we enter your data into a computer database, 
we’ll assign you a Participant ID.  All of your answers will be tied to that ID and no longer be tied to your name.  
All results that are made public will be summary results, they will not report anything that would identify a 
person. Summary results will be shared with Tribal leadership and may appear in scientific literature. 
 
8.2 Who will have access to my research records? 
Only Dr. Wexler and her direct research staff will  have access to you records. 
 
8.3 What will happen to the information collected in this study? 
Your answers will be private and will not be connected with your name, just an ID number so we can see what 
people learn over time. We will not share your answers with your supervisor, UAF instructor, or anyone else. 
All results that are made public will be summary results, they will not report anything that would identify any 
particular person. Summary results will be shared with Tribal leadership and may appear in scientific literature. 
 
8.4 Will my information be used for future research or shared with others? 
We may use or share your research information for future research studies. If we share your information with 
other researchers it will be de-identified, which means that it will not contain your name or other information 
that can directly identify you. This research may be similar to this study or completely different. We will not ask 
for your additional informed consent for these studies. 

31 
 
 
8.4.1 Special Requirements A description of this clinical trial will be available on www.ClinicalTrials.gov, as 
required by the National Institutes of Health (NIH). This website will not include information that can identify 
you. At most, the website will include a summary of the results. You can search this website at any time.  
 
This trial will be registered and may report results on www.clinicaltrials.gov. This site will not include 
information that can identify you. At most, the website will include a summary of the results. You can search 
this website at any time. 
 
9. CONTACT INFORMATION 
Who can I contact about this study? 
Please contact the researchers listed below to: 
• 
Obtain more information about the study 
• 
Ask a question about the study procedures 
• 
Report an illness, injury, or other problem (you may also need to tell your regular doctors) 
• 
Leave the study before it is finished 
• 
Express a concern about the study 
 
Principal Investigator: Dr. Lisa Wexler 
Email:lwexler@umich.edu 
Phone: (413) 824-1190 
 
If you have questions about your rights as a research participant, or wish to obtain information, ask 
questions or discuss any concerns about this study with someone other than the researcher(s), please 
contact the following: 
University of Michigan  
Health Sciences and Behavioral Sciences Institutional Review Board (IRB-HSBS) 
2800 Plymouth Road 
Building 520, Room 1169Ann Arbor, MI 48109-2800 
Telephone: 734-936-0933 or toll free (866) 936-0933 For International Studies, include the appropriate 
calling codes. 
Fax: 734-936-1852 
E-mail: irbhsbs@umich.edu  
 
 
You can also contact the University of Michigan Compliance Hotline at 1-866-990-0111.  
 
You can also contact Dr. Joseph Klejka from the Yukon-Kuskokwim Health Corporation at 907-543-6024 email 
him at joe_klejka@ykhc.org if you have questions regarding your rights as a research participant. 
 
The UAF Institutional Review Board (IRB) is a group that looks at research projects involving people. This review 
is done to protect people like you who are part of research. If you have questions or concerns about your  rights 
as a research participant, you can contact the UAF Office of Research Integrity at 474-7800 (Fairbanks area) 
or 1-866-876-7800 (toll-free outside the Fairbanks area) or uaf-irb@alaska.edu. 
 
10. YOUR CONSENT  
Consent/Assent to Participate in the Research Study 
By signing this document, you are agreeing to be in this study. Make sure you understand what the study is 
about before you sign. I/We will give you a copy of this document for your records and I/we will keep a copy 

32 
 
with the study records.  If you have any questions about the study after you sign this document, you can 
contact the study team using the information in Section 9 provided above. 
 
I understand what the study is about and my questions so far have been answered. I agree to take part in this 
study.  
 
Print Legal Name: _____________________________________________________ 
 
Signature: ___________________________________________________________ 
 
Date of Signature (mm/dd/yy): ___________________________________________