Information & Consent Form for the Alcohol Change Course Screening

Please take the time to carefully read the following information. If any information is unclear, please email or phone 306-337-3331.

Purpose of the Screening: The purpose of the screening is to assess your present concerns and determine whether you are eligible for the Alcohol Change Course.

Overview of Online Therapy: The Alcohol Change Courses is designed to assist clients with alcohol misuse. The course discusses strategies for managing alcohol misuse. The course is short-term and typically requires clients to review the materials presented online on a weekly basis (~ 1 hour) as well as to practice skills that are taught in the course (1-2 hours). During some but not all Online Therapy courses, clients have brief contact with a therapist. The purpose of the therapist is to provide support and encouragement and assist with understanding materials. All clients who receive Online Therapy from us are also asked to complete questionnaires before, during and after participating in the courses in order to help us evaluate Online Therapy. These questionnaires typically take about 20-30 minutes.

Project Title: Evaluation of the Alcohol Change Course Enhanced: Improving Patient Narratives and Additional Resources

In this study, we are interested in evaluating the Alcohol Change Course Enhanced for use in Canada.

Format of the Screening

Pre-Online Screening: Once you consent to the screening, you will be asked some basic eligibility questions. For example, questions about residency and age. If you are not eligible for Online Therapy, the Online Screening will terminate and you will be given information about why you are not eligible. You can contact the Unit to discuss your eligibility further if you wish. This first part of the Online Screening will likely take 5 minutes.

Full Online Screening: If you meet basic eligibility for Online Therapy you will be asked to provide basic personal information such as name, address, telephone number, and email address before continuing. This information is necessary for Online Therapy Unit Staff to contact you to discuss the results of the Online Screening. In the Full Online Screening you will be presented with questions asking about your background, symptoms of anxiety, depression, alcohol misuse, other mental health concerns, health, relationships, occupation, and treatment history. We anticipate that this Online Screening will likely take 15-35 minutes to complete, depending on the responses you provide.

Telephone Screening: Following the Online Screening you will be asked to schedule a time for an Online Therapy Unit staff member to contact you by phone to discuss the results of the Online Screening with you and determine if you are eligible for one of the Online Therapy studies. We anticipate that this Telephone Screening will likely take 15-25 minutes to complete, depending on the nature of your concerns. Online Therapy Staff may ask you clarifying questions if more information is needed regarding your responses to the Online Screening. You may also use this time to ask any questions you may have. Please note: Online Therapy is not for everyone. Participation in the Online Screening does not guarantee participation in Online Therapy. There are also a limited number of therapists available to provide services. Even if you are eligible for Online Therapy, it may not be possible to offer you treatment, at this time.

Voluntary Participation & Ability to Withdraw:

Participation in the Online Screening is entirely voluntary. Should you choose not to participate, or if you wish to stop the screening at any time after starting and ask for your data to be excluded you may do so without any consequences to your present or future health care. However, once the data has been pooled for analysis after the screening has been completed, withdrawal of your data will no longer be possible. The information you have provided will be retained by researchers.

Limits of Confidentiality:

The responses you provide are confidential although there are certain limits to confidentiality that every participant must be aware of:

  • If you pose an immediate threat to your life, or another individual’s life, confidentiality may be broken in order to prevent harm.
  • If you disclose information suggesting that any child is at risk of abuse, the appropriate authorities will have to be notified.
  • If you become involved in a legal case, the judge has the right to subpoena any information relevant to the legal problem.
  • There are unique risks that may compromise your privacy that exist with any Internet-based service. A description of these risks follows:
    • Any computer connected to the Internet will store information about visited websites on the Internet in the browser’s history list and the browser’s cache. The responses to the questionnaires are only temporarily stored on your computer until you close down your browser window. In other words, after you complete and submit your responses, your computer will discard this information, although some of this information may remain in your browser’s cache. You may delete this information by clearing your history list and browser’s cache.
    • After you complete the Online Screening, the information you provide will be sent directly to the survey software website over a secure connection. The information will then be encrypted and securely stored in the database at which point it is only accessible by Online Therapy Unit staff.

Methods Used to Protect Your Information:

The Online Therapy staff has taken precautions to protect the security of your information. Both the University of Regina server and REDcap servers are protected with generally available security technologies, including firewalls and data encryption. In addition, information transmitted from your machine to the server is encrypted using secure socket layer technology (SSL).

In addition to these security precautions, it is important for all users of internet-delivered services to take additional security precautions when submitting sensitive information electronically to ensure the safety of their information.

There are various things that you can do to protect your information:

  1. Use your home computer instead of a computer in a shared space, such as a library or office.
  2. When you leave your computer, or are done working with the web application ensure you have exited the Online Screening.
  3. Since your Internet browser stores information in its memory, or disk cache, you can clean the cache after you use the computer. Certain browsers have "Privacy" modes that can be enabled. Once in this mode, the user's interactions are not saved to browser history and no data is stored in browser cache. Once the browser is closed or this mode is exited, there are no browser records of any of the interactions that occurred while in the "Privacy" mode. Firefox has this feature, and is, therefore, highly recommended when completing the Online Screening. Browsers that do not have this mode, or users that do not use this feature, must manually purge their browser history and cache to prevent others from seeing their web interactions.
  4. Enable either the firewall software that came with your operating system (e.g. Windows firewall), or install a reputable 3rd party software, such as ZoneAlarm. Firewalls protect your computer and information from network attacks and threats.
  5. Use anti-virus software to both prevent and recover from virus programs. While most anti-virus software is for purchase, there are free software options available to download. However, one must still be cautious in order to avoid downloading and installing malicious software that appears to be legitimate.
  6. Malware-detection software (such as Spybot: Search and Destroy, Microsoft Security Essentials) can be used to scan your computer for software and files that may be leaking your personal information to 3rd parties.

Use of Information Collected through the Screening:

Information gathered through the screening will be used for three purposes:

  1. To determine eligibility for Online Therapy:
    • If during the telephone discussion it is determined that you do not meet criteria for Online Therapy, Online Therapy Staff will attempt to provide you with other treatment options available to you in your community.
  2. To better assist with the treatment you receive with the Online Therapy Unit.
    • If during the telephone discussion it is determined that Online Therapy would be appropriate for you, your screening will become part of your Online Therapy Unit file. If you have been assigned a therapist this file will be provided to the therapist who is assigned to work with you.
  3. To be used in de-identified form (identifying information removed) by researchers to evaluate the Online Screening and Online Therapy Courses and to help guide the development of future screening tools, courses and advance ICBT as a whole. Any publications stemming from the evaluation of this information will examine all respondents as a whole and you will not be personally identified.

Storage of Online Screening Information:

  1. Your responses to the online screening will be collected by REDcap and then stored on their secure server housed at the Saskatchewan Health Authority until we retrieve this information. This server is located in Canada and information on that server is covered by the Canadian Privacy Act.
  2. In the event you take part in a treatment study, your responses from the online screening will be retrieved from REDcap by Online Therapy Unit clinical staff and will be stored on the Online Therapy Unit secure server at the University of Regina with your course data as your clinical file. This clinical file is similar to the file your doctor would keep for you. This file will be kept for 10 years consistant with clinical practice standards. After this time, the clinical file will be destroyed using industry standards for the destruction ofof personal data.
  3. The de-identified research data will be retained by the research team for 25 years after publication. You can withdraw your data from the research database up until you complete treatment. After this time, data may have been pooled and used in publications and therefore it may not be possible to withdraw your data.

Research Data Sharing and Open Science

Open Science is a movement to make scientic research accessible to all levels of society through collaborative networks. In the spirit of open science, de-identified data from this study may be shared with authorized researchers and the research community at large to advance science and health. If you decide to be part of this study, any information that is collected that can identify you will be removed or changed before files are shared with other researchers or results are made public. Any data that is transmitted to researchers outside of Saskatchewan will be subject to the privacy legistlation and ethical requirments of that researcher's juristiction however, every effort will be made by the principal investigator to ensure your privacy will be respected. Please note that the Open Science initiative does not charge a fee to access data from other researcher's studies, as the philosophy behind Open Science is to share data with researchers and encourage collaboration. The researchers of the study will not have monetary benefits by sharing data with other scientists.

Ethics Approval:

Project Title: Evaluation of the Alcohol Change Course Enhanced: Improving Patient Narratives and Additional Resources

The research project has been approved on ethical grounds by the Research Ethics Board (REB) of the University of Regina and has operational approval with the Saskatchewan Health Authority. Any questions regarding your rights as a participant may be addressed to through:

The University of Regina Ethics Board at 306-585-4775 or email:

Out of town participants may call collect.

Online Therapy Unit for Service, Education, and Research

Department of Psychology

University of Regina

Regina, SK S4S 0A2

Ph: 306-585-4203

Technical Questions: If you have any technical difficulty with the screening, contact the Online Therapy Unit Operations Director at 306-337-3331. You can also email us at

Version 2.2
Approval Date: September 8, 2022

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