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Consent Form Questionnaire

613 Shared Subjects

N/A
Clinical Assessments
Questionnaire
12/30/2014
cfq01
05/29/2018
View Change History
01
Query Element Name Data Type Size Required Description Value Range Notes Aliases
subjectkey GUID Required The NDAR Global Unique Identifier (GUID) for research subject NDAR* guidasd
src_subject_id String 20 Required Subject ID how it's defined in lab/project patid
interview_date Date Required Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY icfdtm, rutgicf
interview_age Integer Required Age in months at the time of the interview/test/sampling/imaging. 0 :: 1260 Age is rounded to chronological month. If the research participant is 15-days-old at time of interview, the appropriate value would be 0 months. If the participant is 16-days-old, the value would be 1 month.
sex String 20 Required Sex of subject at birth M;F; O; NR M = Male; F = Female; O=Other; NR = Not reported gender
Query asstyp Integer Recommended Assessment type 1::20 1=TADS GATE A; 2=TADS GATE B; 3 = TADS Gate C; 4 = TADS Week 6; 5 = TADS Week 12; 6 = TADS Week 18; 7 = TADS Week 24; 8 = TADS Week 30; 9 = TADS Week 36; 10 = TADS F/U Mo 3; 11 = TADS F/U Mo 6; 12 = TADS F/U Mo 9; 13 = TADS F/U Mo 12; 14 = SOFTAD month 6; 15 = SOFTAD month 12; 16 = SOFTAD month 18; 17 = SOFTAD month 24; 18 = SOFTAD month 30; 19 = SOFTAD month 36; 20 = SOFTAD month 42
Query stage Integer Recommended Study stage
0::5; 51::53; 67; -888; -999
0 = Pre-Randomization (TADS) 1 = Stage 1 (TADS) 2 = Stage 2 (TADS) 3 = Stage 3 (TADS) 4 = Stage 4 (TADS) 5 = Stage 5 (SOFTAD); 51=Treatmentas Usual; 52=Screening Alone; 53=Intervention; 67=Unknown; -888=Not Applicable; -999=Missing;
Query bsit0 Float Recommended Weeks from Time 0/baseline to assessment cfqt0
Query relationship Integer Recommended Relationship of respondent to individual
1::94;-999
1 = Biological mom; 2 = Biological dad; 3 = Grandparent; 4 = Special education (sped) teacher; 5 = General education teacher; 6 = Occupational therapist; 7 = Speech and language therapist; 8 = Behavioral therapist; 9 = Paraprofessional; 10 = Aide; 11 = Principal; 12 = Administrator; 14 = Content teacher; 15 = Parent center director; 16 = Self; 17=Adoptive mother; 18=Adoptive father; 19=Foster mother; 20 = Foster father; 21=Grandmother; 22=Grandfather; 23=Step-mother; 24 = Step-father; 25=Aunt; 26=Uncle; 28=Both parents;31= Grandmother from mother side; 32= Grandfather from mother side; 33= Grandmother from father side; 34= Grandfather from father side; 36= Brother; 37= Sister; 38= Cousin; 39= female caregiver; 40=male caregiver; 41=Female child; 42=Male child; 43=Spouse/Mate; 44=Friend; 45=Parent; 46=Significant other; 47=Sibling; 48=Son/Daughter; 49=Son-in-law/Daughter-in law; 50=Other Relative; 51=Paid caregiver; 52=Friends; 53=Roommate; 54=Supervisor; 55=mother's boyfriend; 56=other parental figure; 57=Summary; 58=counselor ; 59 = other female relative; 60 = other male relative; 61 = non-relative ; 62=Maternal Aunt; 63=Maternal Uncle; 64=Maternal Cousin; 65 = Paternal Aunt; 66=Paternal Uncle; 67=Paternal Cousin ; 68=Biological/Adoptive Mother and Grandmother; 69=Biological/Adoptive Mother and Stepmother and Grandmother; 70=Biological/Adoptive Mother and Grandmother and Foster Father; 71=Biological/Adoptive Mother and Stepmother and Foster Mother; 72=Biological/Adoptive Mother and Foster Mother; 73=Biological/Adoptive Mother and Biological/Adoptive Father; 74=Biological/Adoptive Mother and Stepmother and Biological/Adoptive Father; 75=Biological/Adoptive Mother and Other; 76=Biological/Adoptive Mother and Stepmother and Stepfather; 77=Biological/Adoptive Mother and Stepfather; 78=Biological/Adoptive Mother and Grandfather; 79=Biological/Adoptive Mother and Stepmother and Foster Father; 80=Biological/Adoptive Mother and Stepmother; 81=Guardian, female; 82=Other female; 83=Guardian, male; 84=Other male; 85=Other/Grandparent/Nanny; 86 = Mother, Father, Guardian; 87 = Daughter, son, grandchild; 88 = Professional (e.g., social worker, nurse, therapist, psychiatrist, or group home staff); -999=Missing; 89 = Biological parent; 90=Other; 91 = Stepparent; 92 = Adoptive parent; 93 = Foster parent; 94 = Co-worker cfqinf
Query cprs_g Integer Recommended Relationship of person completing questionnaire (parent/guardian informant) - collapsing categories 1::4 1 = Adolescent; 2 = Mother figure; 3 = Father figure; 4= Other cfqinfg
Query cfq1 Integer Recommended Question 1: The best way to describe this program is as: 1::3 1 = Education to make families and teenagers aware of emotional problems 2 = A research study 3 = A program for delivering free care
Query cfq2 Integer Recommended Question 2: To participate in this program, teenagers must: 1::3 1 = Have learning problems 2 = Be suffering from attention deficit hyperactivity disorder 3 = Be suffering from depression
Query cfq3 Integer Recommended Question 3: I understand that the main goal for doctors in this program is: 1::3 1 = To find out which type of treatment works best for teenagers with depression 2 = To give free care to teenagers with depression 3 = To offer a new treatment that is available only in research studies
Query cfq4 Integer Recommended Question 4: Possible treatments in this program include: 1::3 1 = A medication called fluoxetine and a type of psychotherapy called cognitive- behavioral therapy 2 = A medication called imipramine and skill training for parents 3 = A medication called paroxetine and a type of psychotherapy called interpersonal therapy
Query cfq5 Integer Recommended Question 5: Before starting the program: 1::3 1 = I was given little or no information about the program 2 = The doctor(s) told me about the program and answered my questions 3 = The study doctor(s) didn't say much so I found the information elsewhere
Query cfq6 Integer Recommended Question 6: Before starting the program: 1::3 1 = I wasn't asked if I would agree to participate 2 = I verbally agreed to participate 3 = I signed a consent form agreeing to participate
Query cfq7 Integer Recommended Question 7: During the first 12 weeks of this program: 1::3 1 = All teens who take pills are given �active� medication 2 = Some teens are given a �real� medication and other teens are given an �inactive� medication 3 = All teens are given �inactive� medication for 1 month before they can receive �real� medication
Query cfq8 Integer Recommended Question 8: When I agreed to participate in this program, the chance of being assigned to inactive medication for the first 12 weeks was: 1::4 1 = 0%; 2 = 25%; 3 = 75%; 4 = 100%
Query cfq9 Integer Recommended Question 9: Before starting this program: 1::3 1 = I was told that there were benefits but not risks to participating 2 = I was told that there were benefits and risks to participating 3 = I was not told of benefits or risks to participating
Query cfq10 Integer Recommended Question 10: At the time I agreed to participate in this program: 1::3 1 = I was told of other treatments that could be used for depression 2 = I was told that no other treatments for depression were available 3 = I was told that treatments offered in this program were available only in research studies
Query cfq11 Integer Recommended Question 11: After I gave my permission to participate in this program: 1::3 1 = I couldn't quit even if I wanted to 2 = I had the right to stop participating at any time, even if the study was not finished 3 = I could quit the program but only if the doctors said OK
Query cfq12 Integer Recommended Question 12: The choice of study treatment was decided: 1::3 1 = Randomly 2 = I got to choose which treatment I wanted 3 = The doctors chose the treatment based on what was best for each teen
Query cfq13 Integer Recommended Question 13: The single most important reason for participating in this program is that we: 1::6 1 = Wanted to contribute to advancing scientific knowledge 2 = Needed free care that we could not afford otherwise 3 = Liked the payments that study offered for filling out the study forms 4 = Were curious about what a program like this was about 5 = Wanted the best possible care 6 = Other
Query cfq14 Integer Recommended Question 14: Before this program started, we (the teen and family): 1::3 1 = Agreed from the beginning about participating 2 = Sort of agreed about participating 3 = Disagreed about participating
version_form String 121 Recommended Form used/assessment name icfversn, rutgvrs
Query ptcon Integer Recommended Patient consented
0;1
0=No; 1=Yes rutref
Query daysrz Integer Recommended days since randomization
Query visnum Float Recommended Numeric Visit Number -1.5 = Pre-Screening; -1 = Screening; 0 = Baseline; ## = Visit ## (from 1 to 10); Whole numbers = standard monthly visits; #.001 - #.009 = Unscheduled; #.1 = End of Phase 1; #.2 = End of Phase 2; #.3 = End of Phase 3; #.4 = End of Open Choice Phase; #.5 = End of Study; #.6 = Genetic Analysis; 1000=all visits
Query site String 101 Recommended Site Study Site
Query rcpentry Integer Recommended consent days since randomization
time_assess String 20 Recommended Time of day the assessment was taken. Hour:minutes
Query visit String 60 Recommended Visit name
Data Structure

This page displays the data structure defined for the measure identified in the title and structure short name. The table below displays a list of data elements in this structure (also called variables) and the following information:

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  • Data Type: Which type of data this element is, e.g. String, Float, File location.
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  • Description: A basic description
  • Value Range: Which values can appear validly in this element (case sensitive for strings)
  • Notes: Expanded description or notes on coding of values
  • Aliases: A list of currently supported Aliases (alternate element names)
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