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Service Registration

Plain Language Statement and Consent

Why are we doing this project?

Research tells us that set gender roles can lead to gender inequality – one of the key factors leading to men’s violence against women. Challenging gender stereotypes can help children to build respectful and equal relationships, express emotions in a healthy way and promotes gender equity.

Free to Be Me (F2BM) is an online program that aims to support early childhood services and educators to create environments where children can be free to be whoever they are, without the restriction of gender stereotypes.

Data Collection

We are seeking your consent to collect and use the information you provide in the F2BM online program (including future use), to evaluate the impact of the program. Evaluation is an opportunity for us to learn how well this program supports early childhood services to provide an environment that promotes gender equity and challenges gender stereotypes.

The information we plan to collect and use for the evaluation include:

  1. Registration details:
    • Name of your service
    • Address of your service
    • Primary contact name
    • Role title
    • Email
    • Phone number
  2. Completed surveys:
    • These surveys will help us assess the success of the program.
  3. Completed Assessment Tools and Quality Improvement Plans:
    • These tools will help us understand if the program has led to positive changes in your service’s practices
  4. Uploaded materials (such as policies):
    • These materials will help us assess the resources you’ve used to support staff to create an environment that promotes gender equity.
  5. YouTube and website analytics:
    • This data will include information about clicks, such as page views, data entry, document upload or download, and hyperlinks. It will help us understand how participants interact with our online portal.

Future use of the data, specifically aggregated data from completed surveys, assessment tools and quality improvement plans and YouTube and website analytics, may include:

  • publishing to add to the gender equity and health promotion evidence base
  • Analysing the pre and post survey results to learn about changes in different groups over time
  • Sharing in our organisational annual report and other prevention publications
  • Sharing with agencies that are measuring collective impact, for example Women’s Health East, Department of Health.

Privacy and confidentiality

Access Health and Community is dedicated to protecting your privacy. We will collect, store and manage the information you provide for program evaluation only, in line with the Privacy Act.

Data Storage and security

Your information will be stored within the password-protected online platform. This information may be accessed and downloaded from a password-protected administration site by permitted persons only. Any data downloaded for evaluation purposes will be stored securely on the AccessHC workplace system only. Data collected for this program will be stored for at least seven years, after which it will be securely destroyed.

Data Sharing

De-identified data may be shared with permitted staff at AccessHC (and partner organisations healthAbility (hA) and Link Health and Community (LinkHC) for program evaluation purposes. A summary of the evaluation may be provided to you upon request.

Publication

Information collected for this program, including a de-identified summary of survey responses, assessment tool information, and quality improvement plans, may be published to add to the gender equity and health promotion evidence base. All information will be deidentified in any published material to ensure your privacy is protected. No ‘uploaded materials’ (e.g. policy) will be published without additional written consent of the individual service.
At the stage we de-identify the data, we will decide if it aligns with best practices that warrant sharing. If deemed suitable, we will seek your written consent. After this, your materials will be de-identified before sharing (we will keep a code to connect the de-identified policy with your service).

Access to information

You have the right to access your own information upon request – you can reach out directly to the Privacy Officer at privacy@accesshc.org.au.

What happens when you choose not to provide information?

Taking part in this program is voluntary. If you choose not to provide some or all the information in the program, it will not impact your involvement in the program. You may withdraw at any point, without impacting any other services or partnership with AccessHC, hA or LinkHC. Note that once your service has completed the program and evaluation data is de-identified, your data cannot be withdrawn.

Consent

By continuing to take part in the program, you acknowledge that you have read and understood this plain language statement and consent form.

You will not be paid by AccessHC to participate in or complete the program, including the evaluation.

I have read and understood the plain language statement and consent form and I agree to AccessHC collecting my data.
By not agreeing, you have stated you do not consent to AccessHC collecting your data. The F2BM program involves entering information into the online portal and therefore you will not be eligible to register for the program.
Please enter valid data.

Data will be collated to evaluate the impact of this program. Evaluation is important as it will contribute to the gender equity and health promotion research base. It will support continuous improvement of the program and inform future decision making to ensure the program is benefitting our community. By providing your consent, you agree to allow AccessHC to use your data to evaluate the impact of this program.

If you choose not to participate in the evaluation, it will not impact your involvement in the program.

*
I agree for AccessHC to use my data to undertake an evaluation of this program as outlined in the plain language statement above
YesNo
Please select one option.
Please enter valid data.

Participation of staff

By agreeing to invite your staff to participate in F2BM, you also agree that they have the ability to choose to participate or not to participate in the program or the evaluation, and that it will not negatively affect their employment status, role or relationships within the workplace.

I agree to support my staff to participate or not participate without any negative consequences.
Please check atleast one option.
Please enter valid data.

Public disclosure

We would like to recognise (name) your service as taking part in the Free to Be Me program. This is to encourage services to reach out and share your learnings and experiences. If you agree, the name of your service will be added to the Free to Be Me website, visible to the public and other participating services in your area. Information collected as part of this program will not be connected to your service name so your privacy will still be protected.

*
Are you happy to be publicly recognised (named) as a service taking part in this program?
YesNo
Please select one option.
Please enter valid data.

Use of Logo

We are seeking permission to use your service’s logo. Your logo will be added to promotional material for your internal and external use only, such as a promotional poster, parent and carer information. Your logo will not be used for any other purposes.

*
I give permission for Access Health and Community to include my logo for promotional purposes.
YesNo
Please select one option.
Please enter valid data.
Upload your logo here:
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Invalid file selected.
Invalid file selected.

Content Warning: The program and evaluation covers the reference to family violence. Thinking about family violence when completing the program and evaluation may be upsetting. If you need support during or after the evaluation, you can speak to your service’s Employee Assistance Program or contact 1800Respect on 1800 737 732.

Further information and contact details:

If you have any questions, complaints and concerns, or need more information, please contact us at:

Research and Program Team – freetobeme@accesshc.org.au

Access Health and Community Privacy Officer – privacy@accesshc.org.au

This evaluation has been reviewed by the Department of Health and Department of Families, Fairness and Housing Human Research Ethics Committee (Submission ID: 103027).

If you have a complaint or concern about the conduct of the project, you may contact the Research Ethics office administrator on 0498 956 722 or research.ethics@health.vic.gov.au

Registration Details

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Name of Service
Centre Name cannot be Empty
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Address of Service

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Street Address
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*
Suburb
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*
Postal Code
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Name of Service Contact

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First Name
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*
Last Name
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*
Role Title of Service Contact :
Role can not be left blank.
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*
Email Address
Email Address can not be left blank.
Please enter valid email address.
Please enter valid email address.
This email is already registered, please choose another one.
*
Phone Number :
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Please enter valid Australian Phone Number format
Please enter valid Australian Phone Number format
*
Password
Password can not be left blank.
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Please enter at least 6 characters.
    Strength: Very Weak
    *
    Confirm Password
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    *
    Which LGA Is your early childhood service located in ?
    Select OptionAlpine Shire CouncilArarat Rural City CouncilBallarat City CouncilBanyule City CouncilBass Coast Shire CouncilBaw Baw Shire CouncilBayside City CouncilBenalla Rural City CouncilBoroondara City CouncilBorough of Queenscliffe CouncilBrimbank City CouncilBuloke Shire CouncilGreater Bendigo City CouncilCampaspe Shire CouncilCardinia Shire CouncilCasey City CouncilCentral Goldfields Shire CouncilColac Otway Shire CouncilCorangamite Shire CouncilDarebin City CouncilGreater Dandenong City CouncilEast Gippsland Shire CouncilFrankston City CouncilGannawarra Shire CouncilGlen Eira City CouncilGlenelg Shire CouncilGolden Plains Shire CouncilGreater Geelong City CouncilGreater Shepparton City CouncilHepburn Shire CouncilHindmarsh Shire CouncilHobsons Bay City CouncilHorsham Rural City CouncilHume City CouncilIndigo Shire CouncilKingston City CouncilKnox City CouncilLatrobe City CouncilLoddon Shire CouncilMacedon Ranges Shire CouncilManningham City CouncilMansfield Shire CouncilMaribyrnong City CouncilMaroondah City CouncilMelbourne City CouncilMelton City CouncilMerri-bek City CouncilMildura Rural City CouncilMitchell Shire CouncilMoira Shire CouncilMonash City CouncilMoonee Valley City CouncilMoorabool Shire CouncilMornington Peninsula Shire CouncilMount Alexander Shire CouncilMoyne Shire CouncilMurrindindi Shire CouncilNillumbik Shire CouncilNorthern Grampians Shire CouncilPort Phillip City CouncilPyrenees Shire CouncilSouth Gippsland Shire CouncilSouthern Grampians Shire CouncilStonnington City CouncilStrathbogie Shire CouncilSurf Coast Shire CouncilSwan Hill Rural City CouncilTowong Shire CouncilWangaratta Rural City CouncilWarrnambool City CouncilWellington Shire CouncilWest Wimmera Shire CouncilWhitehorse City CouncilWhittlesea City CouncilWodonga City CouncilWyndham City CouncilYarra City CouncilYarra Ranges Shire CouncilYarriambiack Shire Council
    Please select atleast one option.
    Please enter valid data.

    *
    Please specify what type of early childhood service you provide ?
    KindergartenLong Day CareOccassional CareFamily Day CareOther
    Please check atleast one option.
    Please enter valid data.
    *
    How did you hear about this program ?
    Health Promotion PractitionerHealth ServiceSocial MediaRadio/TV/NewspaperLocal GovernmentOther Early Childhood ServicesWebsiteParentsOther
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    Please enter valid data.
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