RESEARCH DEPARTMENT OF CLINICAL, EDUCATIONAL AND
HEALTH PSYCHOLOGY
Evaluation of the NSPCC UK Minding the Baby Programme
Version 3
07/03/2014
Participants Statement:
I (participant’s name) …………………………………………...... agree that I have:
(please initial in the box below)
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1. Read the information sheet version 3 dated 07/03/2014 and the project has been explained to me verbally.
2. Had the opportunity to ask questions and discuss the study.
3. Received satisfactory answers to all my questions or have been advised of an individual to contact for answers to
important questions about the research.
4. I agree for myself and my baby to take part in the above study.
5. I understand that both my child’s and my participation will be taped/video recorded.
6. I am aware that the video material will be viewed and analysed only by those directly involved with the research.
7. I am aware that I am giving consent for the research team to access both mine and my baby’s medical
and social services reports for the duration of the research
records
8. I agree for my GP and the midwifery team to be informed about my involvement in the study.
9. I understand that in a situation where a serious risk to myself, my baby or the safety of others is disclosed, the
research team will need to inform other professionals.
10. I agree for the video material with my baby to be used for teaching professionals about baby development and
behaviour (optional).
I understand that I am free to withdraw from the study without penalty if I so wish and I consent to the processing of my personal
information for the purposes of this study only and that it will not be used for any other purpose. I understand that such information will be
treated as strictly confidential and handled in accordance with the provisions of the Data Protection Act 1998.
Signed:…………………………………Date:……………………..
Researchers Statement:
I …………………………………………… confirm that I have carefully explained the purpose of the study to the participant and
outlined any reasonably foreseeable risks or benefits (where applicable).
Signed:…………………………………Date:……………………..