Paper-based Survey

Attachment 7 (rev) State and Community Awardee Project Coordinator Project Director Needs Assessment.docx

Process Evaluation of "Teenage Pregnancy Prevention: Integrating Services, Programs, and Strategies through Community-Wide Initiatives"

Paper-based Survey

OMB: 0920-0952

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Form Approved

OMB No. 0920-0952

Exp. 12/31/2015

State and Community Awardee Project Director/Project Coordinator Needs Assessment

Public reporting burden of this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0952).

Staff Needs Assessment

The purpose of this assessment is to help your organization identify strengths and areas of potential growth regarding your ability to support the implementation of this project. This assessment is aligned with the key components of this project and requests information on your organizational background, partnerships, community mobilization, evidence-based programs, training and technical assistance for program implementation, contraceptive services for youth, educating stakeholders, and cultural competence and diversity.

Please respond to only those sections that apply to your project role. Please answer as honestly as possible. Results from this assessment will be used by CDC and the five funded National Organizations to develop a targeted training and technical assistance plan for your organization.

Thank you for your candor in completing this important assessment.

Section I. Individual Information

Please select your organization.

	Alabama Department of Public Health
	Adolescent Pregnancy Prevention Campaign of North Carolina
	Family Planning Council
	Fund for Public Health New York
	Georgia Campaign for Adolescent Pregnancy Prevention Campaign
	City of Hartford
	Massachusetts Alliance on Teen Pregnancy
	SC Campaign
	University of Texas Health Science Center at San Antonio

2. Which of the following describes your role/title? (select all that apply)

	Project Director
	Project Coordinator
	Clinical technical assistance provider
	Program technical assistance provider
	Youth leadership team coordinator
	Evaluator
	Other (please specify) ______________________________________________

3. For how many years have you held your position?

	< 2 years
	3-5 years
	> 5 years

4. For how many years have you worked in teen pregnancy prevention?

	< 2 years
	3-5 years
	> 5 years

5. For how many years has your organization worked to prevent teen pregnancy?

	< 2 years
	3-5 years
	> 5 years

6. How many hourly or salaried personnel in your organization work on this teen pregnancy prevention cooperative agreement?

Full time personnel
	1-3 full time individuals
	4-5 full time individuals
	5-7 full time individuals
	>7 full time individuals
Part time personnel
	1-3 part time individuals
	4-5 part time individuals
	5-7 part time individuals
	>7 part time individuals

7. How many external consultants do you use on this cooperative agreement?

	0 external consultants
	1 external consultants
	2 external consultants
	> 2 external consultants

8. What topic area(s) do the external consultant(s) cover?

	Topic area ___________________________________
	Topic area ___________________________________
	Topic area ___________________________________
	Topic area ___________________________________

9. Does your organization routinely do the following?

Skill set	Yes	No
Use logic models in planning the organization’s projects
Use adult learning theory or other applicable theory to enhance TA and training effectiveness
Monitor its program activities (e.g., who and how many you serve, quality assurance)
Evaluate program outcomes

Section II: Partnerships

Core Partner Leadership Team (CPLT)

10. How many times did your CPLT meet in the past year?

	1-2 times
	3-4 times
	5-6 times
	7-8 times
	9-10 times
	> 10 times

11. How many people serve on the CPLT?

	< 5 people
	5-10 people
	11-15 people
	16-20 people
	21-25 people
	> 25 people

12. Please indicate each group that is represented on the CPLT.

	Local school board
	Local department of health
	Funders
	Foundations
	Elected officials
	Teen pregnancy prevention program implementers (with MOU/MOA)
	Health service providers (with MOU/MOA)
	Teen pregnancy prevention program implementers (without MOU/MOA)
	Health service providers (without MOU/MOA)
	Other (please specify) __________________________________________

13. Does your CPLT include diversity in the following characteristics?

Skill set	Yes	No
Gender
Age
Race/ethnicity
Geographic location in the community
Type of organization (e.g., schools, governmental, community-based)
Other characteristic (please specify) ____________________________________

14. Please describe any current gaps in CPLT membership. Which members and roles you still would like to add to your group?

	Local school board
	Local department of health
	Funders
	Foundations
	Elected officials
	Teen pregnancy prevention program implementers (with MOU/MOA)
	Health service providers (with MOU/MOA)
	Teen pregnancy prevention program implementers (without MOU/MOA)
	Health service providers (without MOU/MOA)
	Other (please specify) __________________________________________

15. Please describe any successes your organization has had in engaging key stakeholder groups in the CPLT.

Success (please specify) ______________________________________________________

16. Please describe any challenges your organization has had in engaging key stakeholder groups in the CPLT.

Challenge (please specify) ______________________________________________________

Community Action Team (CAT)

17. How many times did your CAT meet in the past year?

	1-2 times
	3-4 times
	5-6 times
	7-8 times
	9-10 times
	> 10 times

18. How many people serve on the CAT?

	< 5 people
	5-10 people
	11-15 people
	16-20 people
	21-25 people
	> 25 people

19. Please indicate each group that is represented on the CPLT.

	Public sector
	Nonprofit sector
	Business sector
	Health services (e.g., providers for adolescents)
	Education (e.g., school board, PTA, teachers)
	School and mental health services
	Minority health groups
	Juvenile justice
	Media members or those with media access
	Parents
	Youth from the Youth Leadership Team
	Religious leaders
	Researchers
	Civic leaders and public servants
	Neighbors
	Representatives from funding organizations
	Service organization members (e.g., Kiwanis, Rotary, sororities and fraternities)
	Other (please specify) _________________________________________________

20. Does your CAT include diversity in the following characteristics?

Skill set	Yes	No
Gender
Age
Race/ethnicity
Geographic location in the community
Type of organization (e.g., schools, governmental, community-based)
Other characteristic (please specify) ____________________________________

21. Please describe any current gaps in CAT membership. Which members and roles you still would like to add to your group?

	Public sector
	Nonprofit sector
	Business sector
	Health services (e.g., providers for adolescents)
	Education (e.g., school board, PTA, teachers)
	School and mental health services
	Minority health groups
	Juvenile justice
	Media members or those with media access
	Parents
	Youth from the Youth Leadership Team
	Religious leaders
	Researchers
	Civic leaders and public servants
	Neighbors
	Representatives from funding organizations
	Service organization members (e.g., Kiwanis, Rotary, sororities and fraternities)
	Other (please specify) _________________________________________________

22. Please describe any successes your organization has had in engaging key stakeholder groups in the CAT.

Success (please specify) ______________________________________________________

23. Please describe any challenges your organization has had in engaging key stakeholder groups in the CAT.

Challenge (please specify) ______________________________________________________

Youth Leadership Team (YLT)

24. How many times did your YLT meet in the past year?

	1-2 times
	3-4 times
	5-6 times
	7-8 times
	9-10 times
	> 10 times

25. How many people serve on the CAT?

	< 5 people
	5-10 people
	11-15 people
	16-20 people
	21-25 people
	> 25 people

26. Have you taken steps to assess whether the group represents the diversity of youth in your community?

	Yes (please describe) _________________________________________________________
	No

27. Please indicate which of the following groups of youth are represented on your YLT.

	Youth younger than 15
	Youth aged 15-17 years
	Youth aged 18-19 years
	Youth older than 19 years
	Out of school youth
	Youth in post-secondary institutions
	Other (please specify) _________________________________________________

28. Please describe any successes your organization has had in involving youth in the YLT.

Success (please specify) ______________________________________________________

29. Please describe any challenges your organization has had in involving key youth in the YLT.

Challenge (please specify) ______________________________________________________

Section III. Community Mobilization

30. Do you lead organizational efforts to work with community partners (e.g., core partner leadership team) in developing action plans and implementing community initiatives?

	Yes, please continue to question 31
	No, please skip to question 33, page 10

31. Please indicate whether you received training on certain topics related to leading/facilitating collaborative community wide efforts. Formal training refers to planned teaching of standard knowledge and/or skills related to specific capacities.

Skill set	Never	< 2 years	3-5 years	> 5 years
Conducting a comprehensive community needs and asset assessment in support of TPP
A theoretical justification for community mobilization in support of TPP
Developing a long-range community mobilization plan
Identifying and recruiting participants for a Core Partner Leadership Team
Identifying and recruiting participants for a Community Action Team
Identifying and recruiting participants for a Youth Leadership Team
Supporting community participants to develop TPP goals and identify strategies to address them
Preparing for possible opposition to TPP within communities
Identifying strategies for long-term sustainability of TPP activities within communities
Supporting community team members to evaluate their mobilization efforts

32. How confident are you in your ability to lead a community group through the following activities?

Skill set	Not at all Confident 1	2	Somewhat Confident 3	4	Extremely Confident 5
Conducting a comprehensive community needs and asset assessment in support of TPP
A theoretical justification for community mobilization in support of TPP
Developing a long-range community mobilization plan
Identifying and recruiting participants for a Core Partner Leadership Team
Identifying and recruiting participants for a Community Action Team
Identifying and recruiting participants for a Youth Leadership Team
Supporting community participants to develop TPP goals and identify strategies to address them
Preparing for possible opposition to TPP within communities
Identifying strategies for long-term sustainability of TPP activities within communities
Supporting community team members to evaluate their mobilization efforts

33. Do you lead organizational efforts to facilitate one or more of the 3 partnership groups (i.e., Core Partner Leadership Team, Community Action Team, or Youth Leadership Team)?

	Yes, please continue to question 34
	No, please skip to question 37, page 11

34. With which of the three groups you are involved as a facilitator/group leader? (please select all that apply)

	Core partner leadership team
	Community action team
	Youth leadership team

35. How confident are you in your ability to do the following activities?

Skill set	Not at all Confident 1	2	Somewhat Confident 3	4	Extremely Confident 5
Facilitate the goal setting process within your project team to achieve community mobilization in support of TPP
Work within your project team to identify, recruit and retain the best “mix” of persons for your community teams
Work within your project team to help community teams establish their legitimacy as spokespersons for TPP within their communities
Work within your project team to help community teams rally support for TPP within their communities
Work within your project team to evaluate the functioning of the community teams to achieve their goals

Section IV. Contraceptive Services for Youth

36. Has your organization completed an assessment that has served to identify and describe the components of the health care delivery system in your target community?

	Yes Methods used to complete assessment _____________________________________ Assessment start/end date _______________________________________________
	No
	Planned Methods to complete assessment _________________________________________ Anticipated start/end date _______________________________________________
	In process Methods used to complete assessment _____________________________________ Anticipated start/end date _______________________________________________

37. Does your Core Partner Leadership team (CPLT) or Community Action Team (CAT) include professionals from the community with expertise in the following areas?

Group	Yes	No
Adolescent Contraceptive and Reproductive Health
Health Care Reform
Health Care Financing

38. Please indicate which of the following health care delivery settings you have an MOU with.

Setting	Yes, with MOU	Yes, without MOU	No
Family Medicine Practice
Adolescent Health Practice
Private Ob/Gyn Practice
Public funded family planning clinics
Hospital-based Health Centers
Mobile Health Units
Health Department Clinics
Community Health Centers
School Based Health Centers
School Linked Health Centers
Other (please specify) ____________________________________

39. Please indicate whether your organization has an established referral network to link youth to reproductive health services. Referral refers to any mechanism or medium that directs clients to care. Referral sources may include friends, family members, Internet sources, schools, as well as linkage partner organizations/agencies/institutions.

	Yes we have an established network
	Yes, we developed a network for this initiative
	No
	Other (please specify) _______________________________________________

40. Please indicate which of the following steps you took to develop this referral network. Please select all that apply.

	Identified reproductive health service providers/clinics in the community
	Assessed the capacity and quality of reproductive health service providers/clinics
	Contacted those reproductive health service providers/clinics identified as appropriate for meeting program goals/objectives
	Developed agreements with these reproductive health service providers/clinics on processes for referring youth to services
	Other (please specify) ____________________________________________________________

41. Does your community-wide initiative have a resource for youth that describes available reproductive health services in your target community? Please select all that apply.

	Yes, a website
	Yes, a pamphlet
	Yes, a call center
	Yes, other (please specify) _______________________________________
	Planned
	In process of developing

42. Does your organization have a referral network in place to help direct providers of adolescent services in your community to providers of reproductive health services?

	Yes
	No, please skip to question 46
	Planned
	In process

43. Please indicate which of the following steps you took to develop your referral network. Please select all that apply.

	Identified youth-serving organizations/centers in community
	Assessed the capacity and quality of youth-serving organizations/centers
	Contacted those organizations/centers identified as appropriate for meeting program goals/objectives
	Developed agreements with these organizations/centers on processes for referring youth to services
	Developed agreements with these organizations/centers on how to track referrals made and referrals resulting in receipt of care
	Other, please specify ___________________________________________________

44. Please indicate which of the following groups you involved in the development of your referral network.

	Community Partner Team
	Community Advisory Team
	Youth Leaders Team
	Other, please specify ___________________________________________________

45. Please select the institutions that you have partnered with to build a sustainable source of support for clinical partners in your community. Please select all that apply.

	American Academy of Pediatrics
	American Academy of Pediatrics Section on Adolescent Health
	American Academy of Family Physicians
	Society for Adolescent Health and Medicine
	American Congress of Obstetricians and Gynecologists
	Federally Qualified Health Center Health Disparities Collaborative
	State Office of Minority Health Initiatives
	Public Health Associations
	Practice-based Research Networks

46. Has your organization identified any of the following groups of youth?

Group	Yes	No	Planned	In progress
Foster youth
Youth relying primarily on ER for care
Youth enrolled in Medicaid but who have not received preventative care
Uninsured youth
Undocumented immigrant youth
Youth not enrolled in school
Youth participating in EBIs
Non-English speaking youth
Other (please specify) ________________________________

47. Have you identified organizations that serve the above groups of youth?

	Yes
	No
	Planned
	In process

48. Have you supported the development of Linkage Agreements between the youth serving organizations and reproductive health providers? Linkage refers to a formal partnership between community organizations, agencies, or other institutions (which may include but are not limited to health centers, schools, and churches). The partnership is formalized through a written agreement (e.g., a MOU) that clearly defines how partners will share resources and services related to teen pregnancy prevention.

	Yes
	No
	Planned
	In process

49. Have you completed an assessment of attitudes and beliefs related to youth access to contraceptive and reproductive health care without parental consent for the following community members?

Group	Yes	No	Planned	In progress
Parents/Caregivers
Youth
Health care providers
School nurses
Teachers
School administrators
Local government officials
Other (please specify) ________________________________

50. Have you completed an assessment of attitudes and beliefs about youth and utilization of highly reliable contraception (IUD and Implants) among the following community members?

Group	Yes	No	Planned	In progress
Parents/Caregivers
Youth
Health care providers
School nurses
Teachers
School administrators
Local government officials
Other (please specify) ________________________________

51. Please indicate whether or not your organization has provided technical assistance or training in the past 2 years to health center partners on utilizing the following performance improvement tools and methods.

Group	Yes	No	Planned	In progress
Conducting Clinical Provider Practice Assessment
Analyzing and Sharing Provider Practice Assessment Results with Health Center
Conducting a Work Flow Analysis (ie: Process Mapping, Mapping Steps in Visit)
Examining Capacity of Health Center to Serve Clients (ie: examine current number of clients served compared to staff FTE’s)
Examining and Re-aligning Staff Roles/Responsibilities to Increase Access to Contraceptive and Reproductive Health Care (ie: Task Shifting, scope of practice)
Examining Patient Appointment Scheduling Practices (ie: Appointment No Show Rates, Appointment Types, Appointment Framework)
Conducting a Health Center Walk Through
Using the IHI Model for Improvement to define and establish a performance improvement project
Using the Plan Do Study Act (PDSA) method to test small changes to improve health center performance
Developing a Work Plan (CQI Plan) to Improve Access to Contraceptive and Reproductive Health Care for Adolescents Using Information from the Clinical Provider Assessment
Establishing a set of performance measures related to the health center improvement plan and data systems and tools to support collection and analysis of relevant data
Facilitating and supporting the collection and analysis of performance measurement data
Facilitating the development of a health center improvement team
Facilitating and supporting health center improvement team meetings
Designing and running a collaborative among health center partners
Examining health center billing and reimbursement practices to support efforts to ensure fiscal sustainability of health center operations and maximize third party revenue opportunities
Other (please specify) ________________________________

Section VI. Contraceptive Services for Youth

52. Do you lead organizational efforts to provide training and technical assistance to clinic partners as part of the Teen Pregnancy Prevention project?

	Yes, please continue to question 54
	No, please skip to question 54, page 18

53. Please indicate whether you have received formal training and the time frame in which the formal training on certain topics related to reproductive health services was received. Formal training refers to planned teaching of standard knowledge and/or skills related to specific capacities.

Skill set	Never	< 2 years	3-5 years	> 5 years
The use of the Quick Start Method for dispensing hormonal contraception to adolescents
The use of the Quick Start Methods for dispensing IUDs
Pap smear guidelines for adolescents
Healthcare delivery system budgeting
Business planning including maximizing coding, billing, and reimbursement strategies
Coding confidentiality in billing for adolescent reproductive health services
Work flow processes for patient visits
Health care delivery systems productivity standards
Appointment scheduling practices
Contraceptive methods for adolescents
Performance improvement or quality improvement methodologies
Performance measurement
Strategies for supporting time-alone between a provider and an adolescent client
Strategies for supporting confidentiality in the delivery of contraceptive and reproductive services for adolescents
Addressing social determinants of health in the clinical setting
Male sexual and reproductive health services

54. How knowledgeable are you about each of the following?

Skill set	Not at all 1	2	Somewhat 3	4	Extremely 5
Intrauterine devices (IUDs)
Efficacy
Costs
Side effects
Dispensing procedures
Contraceptive implant (Implanon)
Efficacy
Costs
Side effects
Dispensing procedures
Injectable contraception (Depo-provera)
Efficacy
Costs
Side effects
Dispensing procedures
Birth control pills
Efficacy
Costs
Side effects
Dispensing procedures
Emergency contraception
Efficacy
Costs
Side effects
Dispensing procedures
Male condoms
Efficacy
Costs
Side effects
Dispensing procedures
Female condoms
Efficacy
Costs
Side effects
Dispensing procedures
Other methods (please list) ______________________
Efficacy
Costs
Side effects
Dispensing procedures

SECTION V -Educating Stakeholders

55. Has your organization conducted an assessment of knowledge regarding evidence-based teen pregnancy prevention strategies for any of the following stakeholder groups?

	Group
	Adolescents
	Parents
	Local youth serving coalitions or task forces
	Local organizations that directly serve youth
	Local organizations that serve underserved or at-risk youth (e.g., juvenile justice, juvenile court, welfare agency)
	Postsecondary educators/leadership (e.g., community colleges, colleges)
	K12 school educators/leadership
	Local school board
	Health care providers/clinics
	Local/County Health Department
	Funders, such as community foundations
	Members of the media
	Faith-based leaders
	Community organizations such as voluntary civic organizations
	Members of the business community
	Policymakers at the local level
	Mayor
	Regional youth serving organizations
	State youth serving organizations
	Title XX directors
	Title X directors
	Title V directors
	State Education Agency
	State Health Department
	State Human Service Agency
	State Medicaid directors/officials
	Legislators at the state or local level
	Other policymakers in state or local government
	Governor
	Other (please specify) _________________________________

	Confidence Level
	1 - Very confident
	2 -
	3 - Somewhat confident
	4 -
	5- Not at all confident

SECTION V. Educating Stakeholders

62. Do you lead/co-lead organizational efforts to educate stakeholders in your community?

	Yes, please continue to question 64
	No, please skip to question 67, page 23

63. How knowledgeable are you about each of the following?

Skill set	Not at all 1	2	Somewhat 3	4	Extremely 5
How to identify important stakeholders in your community
How to determine your target audiences for stakeholder education
How to determine goals and objectives and an action plan for stakeholder education using data from your community needs assessment
Methods for raising awareness of your community-wide initiative
How to educate on statistics and trends in teen pregnancy, by age and race/ethnicity and for special populations
Methods for educating on evidence-based and/or evidence-informed strategies to reduce teen pregnancy and data on needs and resources in target communities
Methods for crisis communication and managing controversy

64. How confident are you in your ability to conduct the following activities?

Skill set	Not at all Confident 1	2	Somewhat Confident 3	4	Extremely Confident 5
Identify important stakeholders in your community
Determine your target audiences for stakeholder education
Determine goals and objectives and an action plan for stakeholder education using data from your community needs assessment
Raise awareness of your community-wide initiative
Educate on evidence-based and/or evidence-informed strategies to reduce teen pregnancy and data on needs and resources in target communities
Manage controversy through communication techniques/strategies

65. What resources or tools would increase your capacity to work with stakeholders in your community?

	Specific talking points
	Additional training
	Resources and fact sheets
	Individual technical assistance
	Other (please specify) ______________________________________________________

SECTION VI. Working with Diverse Communities

66. Please indicate how often your organization does the following activities.

Skill set	Never 1	2	Sometimes 3	4	Often 5
Technical assistance and training activities are routinely and systematically reviewed to enhance delivery the culturally competent practices and strategies
Input from community members reflective of cultural composition is actively sought and utilized when assessing need for technical assistance and consultation.
Efforts are made to involve consultants who have knowledge of and experience with the cultural groups receiving technical assistance or consultation.
Representatives of diverse cultures are actively sought to participate in the planning and implementation of training activities.
Representatives of the diverse cultures are actively sought to participate in the planning of outreach activities. Training curriculum, materials, and activities are systematically evaluated to determine if they achieve cultural competence.
Learning opportunities to enhance staff understanding of diverse cultures of community youth (i.e. attitudes toward disability, LGBTQ youth, cultural beliefs and values, and health, spiritual, and religious practices) are provided.

67. Please indicate the extent to which the following are consistent with your current project’s practices.

Skill set	Not at all 1	2	Somewhat 3	4	Great Extent 5
Representatives of ethnic communities actively incorporate their knowledge and experience in organizational planning
Supports involvement with and/or utilization of the resources of regional and/or national forums that promote cultural competence.
Personnel recruitment, hiring, and retention practices reflect the goal to achieve ethnic diversity and cultural competence.
Resources are in place to support initial and ongoing training for personnel to develop cultural competence.
Fiscal resources are available to support translation and interpretation services.

68. Do you lead/co-lead organizational efforts for working with diverse communities?

	Yes, please continue to question 70
	No, please skip to question 72, page 25

69. How knowledgeable are you regarding each of the following topics?

Topic	Not at all 1	2	Somewhat 3	4	Extremely 5
Health equity
Health disparities
Social determinants of health
Frameworks for examining and addressing social determinants of health
Cultural competency
Strategies for engaging marginalized youth (i.e. foster care, homeless, GLBTQ) in teen pregnancy prevention efforts
Strategies for engaging non-traditional partners (i.e. business leaders, social service agencies) in teen pregnancy prevention efforts

70. How confident do you feel about providing technical assistance or training to individuals in your community around the following areas?

Skill set	Not at all Confident 1	2	Somewhat Confident 3	4	Extremely Confident 5
Increase awareness around the impact of social determinants of teen pregnancy with community partners
Actively engage informal community leaders and other influential community stakeholders (i.e. business leaders) around the significance of addressing social determinants of teen pregnancy
Assess attitudes and beliefs around social determinants among different audiences
Facilitate a process to identify key social determinants of teen pregnancy with community partners
Identify feasible strategies to address key social determinants of teen pregnancy
Enhance levels of cultural competence for clinical providers and program facilitators
Utilize community-based participatory approaches to evaluation
Assess and evaluate progress on strategies to address social determinants of teen pregnancy.

Section VII. Evidence-based Programs

71. On which evidence-based programs...

Program	Are staff members from your organization currently trained?	Are staff members from your organization able to provide a Training of Trainers (TOT)?	Are staff members from your organization able to provide a Training of Educators (TOE)?
Aban Aya Youth Project
Adult Identity Mentoring (Project AIM)
All4You!
Assisting in Rehabilitating Kids (ARK)
Be Proud! Be Responsible!
Be Proud! Be Responsible! Be Protective!
Becoming a Responsible Teen (BART)
Children's Aid Society (CAS)
Carrerra Programs
Cuidate!
Draw the LIne/Respect the Line
FOCUS
Heritage Keepers
Abstinence Education
Horizons
It's Your Game: Keep it Real
Making a Difference

72. On which evidence-based programs...

Program	Are staff members from your organization currently trained?	Are staff members from your organization able to provide a Training of Trainers (TOT)?	Are staff members from your organization able to provide a Training of Educators (TOE)?
Making Proud Choices!
Project TALC
Promoting Health Among Teens! Abstinence Only Intervention
Promoting Health Among Teens! Comprehensive Abstinence and Safer Sex Intervention
Raising Healthy Children
Reducing the Risk
Respeto/Proteger
Rikers Health Advocacy Program (RHAP)
Safer Choices
Safer Sex
SiHLE
Sexual Health and Adolescent Risk Prevention(SHARP)
Sisters Saving Sisters
Teen Health Project
Teen Outreach Program
What Could You Do?
Making Proud Choices!

73. Are there other agency(s) in your state/territory/region that are able to provide a TOT/TOF on particular EBP(s)? If so, please specify the name of the agency(s), which type of training they can provide (TOT and/or TOF), and on which EBP(s). If there is a specific person to contact, please provide their name and contact information as well.

Name of Agency
State which type of training it is able to provide (TOT or TOF)
Which EBP?

Name of Agency
State which type of training it is able to provide (TOT or TOF)
Which EBP?

Name of Agency
State which type of training it is able to provide (TOT or TOF)
Which EBP?

74. On which other programs (outside of the HHS 28 approved programs) are your staff trained?

	Circle of Life		Safe Dates
	Flash		STAND
	Live it (Native American Youth)		Street Smart
	Health & Responsible Relationships – Michigan Model		Tailoring Family Planning Services to the Special Needs of Adolescents
	Native STAND		Teen Talk
	Parents Matter		The Fourth R (Relationships) – Alaska Perspectives (adapted version of the original Fourth R curriculum from Canada)
	Power Through Choices		Wise Guys
	Real Talk/Sex Ed For Parents		Wait Training
	Relationship Smarts		Other (please specify)

75. Are you or any key partners planning an upcoming training that could potentially be open to other grantees or grantee partners? If so, please provide the name of the curriculum or training topic, as well as the date, time, location, organization, and contact information for the training.

Training Topic/Program Name
Date/Time
Location
Organization conducting training
Contact information for training

76. The federal collaborative is evaluating the feasibility of creating a document or tool in which TPP grantees could search for organizations capable of providing training on a particular EBP, either by location or by EBP. We are interested in how useful your organization might find such a tool. Please provide any comments you have regarding this potential tool (for example, preferred type of tool, important features or information, concerns, etc).

Comment
Comment
Comment

77. Do you have suggestions as to how one or more of the Federal agencies funding teen pregnancy prevention programs (OAH, ACF, CDC, etc) could help your organization with these training needs? If so, please briefly describe your suggestion below.

Suggestion
Suggestion
Suggestion

78. Do you provide training and technical assistance to support program implementation as part of the Teen Pregnancy Prevention project?

	Yes, please continue to question 79
	No, please skip to question 83, page 31

79. Please indicate whether you have received formal training and the time frame in which the formal training on certain topics related to evidence-based approaches to planning, selection, implementation, and evaluation of evidence-based programs and practices was received. Formal training refers to planned teaching of standard knowledge and/or skills related to specific capacities.

Skill set	Never	< 2 years	3-5 years	> 5 years
Understanding the benefits of using evidence-based approaches such as the Getting To Outcomes (GTO) approach to prevent teen pregnancy
Knowing which evidence-based programs and/or practices have reduced sexual behaviors leading to teen pregnancy, STI, and/or HIV
Using logic models to plan general organizational activities
Using logic models that link risk and protective factors to intervention activities for the purpose of selecting an appropriate TPP program/curriculum or practice.
Knowing how to plan and conduct effective trainings on evidence-based or evidence-informed programs to others
Knowing how to assess an evidence-based program for fit with one's priority population and community
Knowing how to conduct process evaluation
Knowing how to conduct outcome evaluation

80. We are interested in the amount of experience you have providing technical assistance and training on the topics listed in question 77. Experience providing training and TA refers to working with one or more client organizations on a particular topic. Please indicate if you have at least 6 months of experience providing technical assistance and training on the following.

Skill set	Yes	No
The benefits of using evidence-based approaches such as the GTO approach to prevent teen pregnancy
Which programs, practices, or policies related to promoting adolescent sexual health have evidence of effectiveness
Using logic models to plan general organizational activities
Using logic models that link risk and protective factors to intervention activities for the purpose of selecting an appropriate TPP program/curriculum or practice.
How to plan and conduct effective trainings on evidence-based or evidence-informed programs to others
How to assess an evidence-based program for fit with one's priority population and community
How to conduct process evaluation
How to conduct outcome evaluation

81. How knowledgeable are you regarding each of the following teen pregnancy prevention activities?

Skill set	Not at all 1	2	Somewhat 3	4	Extremely 5
Develop program goals for a teen pregnancy prevention activity or program
Assess how well program activities fit within other existing program activities offered to the same target population
Define a target population for teen pregnancy prevention program(s) or practices
Measure participant satisfaction with a prevention program or practice
Evaluate an activity to ensure that it is meeting goals and objectives, including completing analysis and interpretation of data
Identify those who will be responsible for each program delivery task
Specify the amount of change to expect in program objectives
Assess community strengths in programming by examining existing resources such as existing programs and availability of volunteers
Determine if an existing program or practice is suited to a community program’s goals and objectives
Develop program objectives that are linked to program goals
Examine how a prevention program fits with the philosophy of a community organization
Measure how well program implementation followed the original program design (i.e., fidelity) for each program activity
Ensure that all new program activities are linked to specific goals and objectives
Determine if any evidence-based programs are applicable to a target/priority population(s)
Specify by when one should expect the change in their objectives to occur
Assess the causes and underlying risk factors for teen pregnancy in a community
Assess the adequacy of resources to implement a (new) program (e.g., staff, technical resources, funding)
Create timelines for completing all program tasks
Develop a budget that outlines the funding required for each program activity
Develop a plan to sustain successful programs or activities (i.e., determine future funding sources, staffing)
Use evaluation results to improve delivery of a teen pregnancy prevention program or practice the next time it is offered
Adapt an evidence-based teen pregnancy prevention program while maintaining the integrity of the program

82. How confident would you be providing training or technical assistance in the following areas to support other organizations as part of the TPP project?

Skill set	Not at all Confident 1	2	Somewhat Confident 3	4	Extremely Confident 5
Develop program goals for a teen pregnancy prevention activity or program
Assess how well program activities fit within other existing program activities offered to the same target population
Define a target population for teen pregnancy prevention program(s) or practices
Measure participant satisfaction with a prevention program or practice
Evaluate an activity to ensure that it is meeting goals and objectives, including completing analysis and interpretation of data
Identify those who will be responsible for each program delivery task
Specify the amount of change to expect in program objectives
Assess community strengths in programming by examining existing resources such as existing programs and availability of volunteers
Determine if an existing program or practice is suited to a community program’s goals and objectives
Develop objectives that are linked to goals
Examine how a prevention program fits with the philosophy of a community organization
Measure how well program implementation followed the original program design (i.e., fidelity) for each program activity
Ensure that all new program activities are linked to specific goals and objectives
Determine if any evidence-based programs are applicable to a target/priority population(s)
Specify by when one should expect the change in their objectives to occur
Assess the causes and underlying risk factors for teen pregnancy in a community
Assess the adequacy of resources to implement a (new) program (e.g., staff, technical resources, funding)
Create timelines for completing all program tasks
Develop a budget that outlines the funding required for each program activity
Develop a plan to sustain successful programs or activities (i.e., determine future funding sources, staffing)
Use evaluation results to improve delivery of a teen pregnancy prevention program or practice the next time it is offered
Adapt an evidence-based teen pregnancy prevention program while maintaining the integrity of the program
Document adaptations made to evidence-based programs to reflect and respond to the youth and community context.
Train program facilitators to develop their understanding around cultural and gender difference with respect to adolescent sexual risk behavior, teen pregnancy and implications of this on engagement and program implementation.

Section VIII. Organizational Technical Assistance Needs

CDC and the funded national organizations will use the following information to plan future TA and training.

83. Please list topics, in order of priority, on which you would most like to receive technical assistance and training through this project over the next year.

Skill set

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	Group
	Contact with local media
	Issued press releases
	Distributed fact sheets, reports, or journal articles on TPP
	Offered an electronic newsletter with information on TPP
	Regularly published a printed newsletter that highlights TPP
	Held an annual conference that included TPP
	Held meetings, roundtables, or symposia related to TPP
	Used social media (e.g., Twitter, Facebook)
	Held briefings on your program
	Hosted a site visit
	Provided latest scientific information
	Reported on a community needs assessment
	Responded to questions and requests for information
	Testified (if invited to a hearing)
	Told a story about how your program impacted a member of the community
	Given an award
	Other (please specify) ________________________________________

Group	Yes, formal assessment	Yes, informal assessment	No
Adolescents
Parents
Local youth serving coalitions or task forces
Local organizations that directly serve youth
Local organizations that serve underserved or at-risk youth (e.g., juvenile justice, juvenile court, welfare agency)
Postsecondary educators/leadership (e.g., community colleges, colleges)
K12 school educators/leadership
Local school board
Health care providers/clinics
Local/County Health Department
Funders, such as community foundations
Members of the media
Faith-based leaders
Community organizations such as voluntary civic organizations
Members of the business community
Policymakers at the local level
Mayor
Regional youth serving organizations
State youth serving organizations
Title XX directors
Title X directors
Title V directors
State Education Agency
State Health Department
State Human Service Agency
State Medicaid directors/officials
Legislators at the state or local level
Other policymakers in state or local government
Governor
Other (please specify) _________________________________

	Yes (please specify) _______________________________________
	No