FormChildren and Youth Services

Research Application Unique identifier:Effective

from:

P19/0001641/07/2019

This form relates to CYS procedure: Research Application and Approval

Application Information for ResearchersResearchers are requested to complete this form (and provide supporting documentation, as required). The information provided will become the basis for consideration of your research proposal and assist Children and Youth Services (CYS), Department of Communities Tasmania to decide whether to give permission for research to be conducted.Please note: Clear and concise information will facilitate timely consideration of your proposal.

Research ProjectTitle of research proposal Brief project description (max 50 words)

Applicant DetailsName of Chief Investigator/ApplicantContact detailsPositionPostal AddressTelephone number/sEmail addressOrganisationCourse/school (if applicable)In what capacity is the research being undertaken?

☐ Academic ☐ Student*☐ Independent*Is the study contributing towards an academic qualification? If so, please specify

Name and contact details of research supervisorPositionOrganisationPostal AddressTelephone number/sEmail addressCollaborating organisations (if applicable)Sponsoring organisations (if applicable)Is the proposal an application for a grant from another organisation?

☐ No☐ Yes Name of organisation, grant program and amount

Ethics ApprovalIs ethics approval required for this proposal?

☐ YesAttach letter of approval from an appropriate Human Research Ethics Committee (HREC), along with the HREC approved version of the researcher’s application for ethical clearance, along with all HREC approved research instruments to be used in the proposed research such as survey questionnaires, interview schedules, participant information materials and informed consent forms.

☐ NoProvide details as to why it is exempt

Tasmanian Working with Vulnerable People Registration No.

Proposed Research PlanGeneral outline of research methods to be used for collecting informationSchedule of activities, including time-line for completion of entire programRegion/s where research will be conductedOutline plans for disseminating results of the research projectProposed date the research report will be provided to CYS

CYS InvolvementWhat people and/or resources associated with CYS will the research require access to?

☐ CYS Clients (children and young people)Client groupNo. of clients to be involvedGender breakdownSpecific age/age groupsApproximate date/s, length of time and frequency of contact requiredNature of contact(face to face interview, psychological testing, etc)Other details

☐ Parents/guardians/carers of CYS clientsCYS client groupNo. of parents/guardians/carers to be involvedApproximate date/s, length of time and frequency of contact required

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Nature of contact(face to face interview, etc)Other details

☐ CYS StaffCYS staff unitNo. of staff to be involvedLength of time and frequency of contact requiredNature of contact(face to face interview, etc)Other details

☐ CYS DataIs CYS Data required for the research project?

☐ YesCompletion of the ‘Application for Data Release’ form (see attachment 1) is required for applications to obtain CYS data.

☐ No

☐ OtherSpecify details

Strategic RelevanceList the human service area/s to which this research relates

☐ Child Safety ☐ Adoption and Permanency ☐ Out of Home Care☐ Community Youth Justice ☐ Ashley Youth Detention Centre☐ Family Violence

Describe how the research aligns with relevant National/State policy agendas (plans, frameworks, agreements)Describe the expected outcomes of the research and potential benefit to the Department and/or its stakeholders and clients

Research Support Requests☐ Request for Funding Support from CYS

Total amountTime period From (date): To (date):Payment schedule

☐ Request for Staff in kind support from CYSCYS staff unitProposed roleNo. and time required

☐ Request for other in-kind support from CYSProvide details

Have you had any contact with any CYS staff to discuss your proposal or supports required? If yes, please provide details

☐ Yes

☐ No

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Is this research being supported/resourced by other organisations? If yes, please provide details of support including any funding and which organisation/s (and attachments where applicable).

☐ Yes

☐ No

Checklist of Attachments (please complete)☐ Relevant Research and Ethics Committee Approval received and evidence provided

☐ Copy of researcher’s Tasmanian Working with Vulnerable People Card

☐ Copies of letters of support

☐ Declaration signed and dated by all investigators

☐ Other (eg Project proposals, evidence of funding etc)

DeclarationI/we agree to abide by the conditions set out in the Guidelines for Conducting Research in Children and Youth Services.

I/we, the undersigned declare that the information supplied is true and accurate to the best of my/our knowledge.

I/we understand that upon completion of the above research (and/or following the first twelve months of the project), a report is to be submitted to Children and Youth Services, and feedback is to be provided to the research participants.

Name of Applicant/s: ………………………………………………………………………………………………………..

Signature of Applicant/s: ………………………………………………………………………………………………………..

Date: ………………………………………………………………………………………………………..

SubmissionPlease submit this application form and all attachments to the Chair, Research Evaluation Committee at cys.psld.support@communities.tas.gov.au

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Section below to be completed by Research Evaluation Committee

Research Evaluation Committee ApprovalREC assessment: ☐ Recommended ☐ Not RecommendedREC Comments (If applicable):

REC Chair Signature: Date ____/____/____

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REC Chair Name: WHAT NEXT? REC table the recommendation and research application at WEM.

Attachment 1

Application for Data ReleasePerformance and EvaluationChildren and Youth ServicesDepartment of Communities Tasmania

Request details

Short title

Date of applicationDate data required1

Data specificationsData items(e.g. sex, age, placement type etc.)

Year(s)

Year format (calendar or financial)

Reporting format(e.g. aggregate by Indigenous status)

Intended usePurpose for which information will be used and intended audience

Name of report or presentation

Intended release or presentation date

Requestor contact for correspondencePrincipal Investigator or Project Manager nameOrganisation, Institution or Business2

Contact name

Postal Address

Email

PhoneList any other personnel who will have direct access to the supplied data (insert additional rows as necessary)

Name Organisation, Institution or Business Role in project

1 While every effort will be made to meet this date, this may not be possible2 Please include division, unit branch and business unit were applicable

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When requesting data from the Department of Communities Tasmania please consider the following steps:

1. Identify the information required. 2. Clearly state the purpose for which the information will be used. 3. Fill out the attached application and forward to:

Performance and Evaluation Children and Youth Services Department of Communities TasmaniaGPO Box 65 Hobart, Tasmania 7001

4. The Department will be in contact to discuss the application and/or negotiate conditions for the release of the data.

You should also note that: If the data required by your organisation is not in a form readily collected and

reported by the Department there may be delays in providing the necessary information. Please keep this in mind when planning for critical supply dates;

The Department may set other conditions on the use and disclosure of the information; and

There is no guarantee that your request will be approved. If you have any complaints about your application or the way in which it was processed, or would like to request a review of the decision please contact Performance and Evaluation on the above details.

In most cases data will only be supplied if the following conditions are met: i. The information to which access is sought will be used solely for the

purpose of undertaking the project/activity outlined;ii. The information is not linked with any other data set3;iii. Any publication or presentation that uses the data requested will correctly

attribute the origin of the data; andiv. Adequate opportunity for review and comment will be provided before the

release of any publication or presentation that uses the requested data, or information derived from that data.

3 Please note that requests for identified or linked data, or requests to link data, should be accompanied by a detailed explanation of why it is necessary and what steps will be taken to ensure confidentiality and information protection in accordance with the Personal Information Protection Act 2004

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Agreed conditions of release (please select applicable conditions and provide details as necessary)

1. Data Linkage

The following physical data linkage conditions have been agreed:☐ The released data will not be linked with data from other sources (go

to part 2);OR☐ The data will be linked to/matched with data from the following

sources only:

☐The data linkage will be undertaken under the supervision of the Accountable Person using the separation principle to maintain the confidentiality of the subjects;

OR☐ The accredited linking authority to undertake the data linkage is:

2. Data Security

The following physical access controls have been agreed:☐ Data will only be accessed in a specific IT facility;OR☐ List any agreed specific physical access controls

(e.g. Data will not be stored on portable hardware):

Specify the method of data transfer including details of how the data will be protected during transit if applicable:

The following electronic access controls have been agreed(e.g. Data will not be stored on portable hardware):

1. Data Disposal

The following methods of disposal of data have been agreed:

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Before the requested data can be released, the Requestor must agree with the following undertaking:

I, ..............................................................................................................(full name and position of Requestor)

In the ......................................................................................................

.................................................................................................................(name of department or organisation)

HEREBY ACKNOWLEDGE and AGREE TO the following conditions of release:Privacy and confidentiality1. The Personal Information Protection Principles in the Personal Information Protection Act,

2004 will be adhered to at all times. All personnel who will have access to the data are aware of their obligations to: Not attempt re-identification of the data. Take caution in relation to data items that pose a high risk of identification because they

may be used to identify particular individuals and health services. 2. Only those personnel specifically listed in the request will have access to the data. If

personnel changes require data to be accessed by additional staff, approval will be sought from the Data Custodian in writing.

3. The data will only be used for the purpose specified in the Statement of Intent. Research will be restricted to only the research project described in the approved data request and for which appropriate HREC approval was obtained. Should data be required for an additional purpose, a new data access request will be submitted.

4. The data will not be used as a basis for any legal, administrative or other actions that could directly affect any particular person or organisation as a result of their identification in the data released.

5. The data will not be disclosed to any person, organisation or other third party not specified in the application.

6. Publications will contain only aggregated statistical information that does not identify a person, an establishment or a business unit. The minimum number of individuals contributing to an aggregate statistic is five (5).

7. Any tables, graphs, or commentary derived from the use of the data will also protect the identity of individuals. Note that in this context ‘an individual’ includes patients and clients of the Department, employees or contractors providing service to clients of the Department, treating clinicians, and any third party involved in the care or treatment of a patient or client.

Data Linkage8. Any and all agreements listed under part 1 of the section "Agreed conditions of release”

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Data Security9. Physical access to the data will be restricted to those nominated in the application. This

means preventing unauthorised access to the data location such as to computer terminals and storing any removable media in locked storage when it is not in use.

10.Electronic safeguards are in place to prevent unauthorised or accidental access, modification, loss, damage, copying or usage, anti-virus software is in place and up-to-date and all available software security patches have been installed.

11.Any and all agreements listed under part 2 of the section "Agreed conditions of release”

Intellectual Property and Agreement to Publish depends on review 12.The Department of Communities Tasmania retains ownership of the released data and the

Intellectual Property (IP) contained within it.13.Written approval will be obtained from the Data Custodian for all publications arising from

these data. 14.Copies of all draft publications that use the data must be provided to the Data Custodian

before the intended publication date and with sufficient time for review.15.Agreement to publish depends on review outcomes. The Department may prohibit

publication of reports, analysis or interpretation of the data if doing so would compromise the privacy or confidentiality of the subjects or otherwise cause harm to an individual(s).

16.Regardless of the effort expended by Requestor, the Department retains the right to refuse permission for publication if the analysis and interpretation misrepresent the data supplied.

17.The metadata and the source of the data may be disclosed to others but requests to view or use the actual dataset must be applied for as new requests.

18.Any and all agreements listed under part 3 of the section "Agreed conditions of release”

Copyright and Licencing19.These data are made available under a Creative Commons licence - Creative Commons

Attribution-Non Commercial 3.0 Australia - https://creativecommons.org/licenses/by-nc/3.0/au/

Disposal20.All data provided, including any duplicate copies, or other copies created through

manipulation of the original data, will be returned to the Department of Communities Tasmania and/or deleted, physically destroyed or rendered irrecoverable when they are no longer required or at the times specified in the notification of approval.

21.The Department will be notified when disposal of the data is complete.22.Any and all agreements listed under part 4 of the section "Agreed conditions of release”

ApprovalsThis document must be approved by the Manager, Performance and Evaluation. Once signed, Performance and Evaluation are to seek approval from the Deputy Secretary, Department of Communities Tasmania before data may be released to the requestor.

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