(Re)Claim and Connect Weekend Program - Screening Questionnaire |
Dear Participants,
Thank you for your interest in taking part in (Re)Claim and Connect. (Re)Claim and Connect is a group designed to foster belonging through reflecting and sharing stories related to your Asian Canadian identity. It is part of a pilot study that aims to address anti-Asian racism by connecting through stories. The study is conducted by Dr. Fred Chou and colleagues at the University of Victoria.
The group will be online with two facilitators (counsellor(s) and/or psychologist(s)) and a maximum of 5 participants. There will be one 1.5-hour pre-session meeting and the program will run over a weekend (Saturday and Sunday from 9 am to 5 pm). During the program you will be invited to share your pre-written story about themes related to your Asian Canadian identity. There will be a pre- and post- measure to determine the impacts of the group, a demographic questionnaire and an evaluation survey after completing the group.
As with all programs there are both benefits and possible risks. These risks may include:
Thank you for your interest in taking part in (Re)Claim and Connect. (Re)Claim and Connect is a group designed to foster belonging through reflecting and sharing stories related to your Asian Canadian identity. It is part of a pilot study that aims to address anti-Asian racism by connecting through stories. The study is conducted by Dr. Fred Chou and colleagues at the University of Victoria.
The group will be online with two facilitators (counsellor(s) and/or psychologist(s)) and a maximum of 5 participants. There will be one 1.5-hour pre-session meeting and the program will run over a weekend (Saturday and Sunday from 9 am to 5 pm). During the program you will be invited to share your pre-written story about themes related to your Asian Canadian identity. There will be a pre- and post- measure to determine the impacts of the group, a demographic questionnaire and an evaluation survey after completing the group.
As with all programs there are both benefits and possible risks. These risks may include:
- Experiencing emotional discomfort;
- Emotional vulnerability in sharing your story in a group setting; and
- Possibly knowing someone in the group that may impact how you are perceived.
Meanwhile. benefits for partaking in this program may include:
- Strengthening your connection to yourself, your family, and/or your community by sharing your personal experiences and hearing stories of other Asian Canadians;
- Gaining a sense of appreciation for your own life experiences, as well as others’; and
- Opportunity to improve the program that may be beneficial for other Asian Canadians.
You will be asked a few screening questions in the next page. If you meet the minimum criteria for the group, you will be contacted by one of the facilitators for an intake interview. During the intake interview, you will be asked questions about whether you can attend the full program and if you fit the program criteria, as well as personal questions about your heritage, current social and professional supports, and goals for taking part in the group. Your intake information will be kept as clinical records and maintained by the respective facilitators of your program. They will follow the standards for record keeping for Registered Clinical Counsellors or Psychologists in BC and only the facilitators will have access to these records.
If you are ineligible for the study, you will be provided with referral resources that are more suited to your concern and your intake information related to the research project will be disposed of. If you have any questions before the screening interview, please contact Dr. Fred Chou at fchou@uvic.ca.
Sincerely,
Dr. Fred Chou, R.Psych.
Assistant Professor, Counselling Psychology
University of Victoria
If you are ineligible for the study, you will be provided with referral resources that are more suited to your concern and your intake information related to the research project will be disposed of. If you have any questions before the screening interview, please contact Dr. Fred Chou at fchou@uvic.ca.
Sincerely,
Dr. Fred Chou, R.Psych.
Assistant Professor, Counselling Psychology
University of Victoria