instrument 3
SRAE performance reporting system data entry form
The 137 estimated grantees will report measures on participant demographics, behaviors, intentions, perceived effects, and program experiences; attendance, reach, and dosage; implementation challenges and needs for technical assistance; and structure, cost, and support for program implementation. The contractor (Public Strategies) and subcontractor (Mathematica) have developed this tool for grantees to use to collect data originating from subawardee providers and to organize all of the grantee-, provider-, and program-level performance measures data elements for submission into the SRAE Performance Measures Portal. The contractor is developing separate tools to support grantees in their submission of the data originating from the entry and exit surveys (Instruments #1 and #2). However, these tools are considered voluntary and to be used at the discretion of the grantees. Grantees may elect to use alternative means to collect the data that will be submitted. The only requirement will be that all grantees enter the required measures into the Portal systematically, and for that they will (1) use an online form that contains all of the items in this instrument and (2) upload data files containing the items in Instruments #1 and #2.
REPORT PERIOD |
[reporting period] |
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Grantee: |
Enter grantee name |
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SRAE Operational Status Related to COVID-19 |
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Did your SRAE program experience any interruptions of operations or services due to COVID-19? |
Y/N |
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If yes: |
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For how long did the program experience interruptions of operations or services due to COVID-19? |
Number of months:a ______ |
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Were your operations able to resume to full pre COVID-19 capacity? |
Y/N |
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If not, what is the percent capacity of operations at present? |
% |
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aThe SRAE Performance Measures Portal will include hover text to remind grantees about the reporting period (Sept. 2019 – Oct. 2020) when responding this question.
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Funding |
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Total amount of SRAE grant funding obligated (including any carryover funds) during [reporting period] |
$ |
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Percentage of total funding obligated for: |
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Percent of funding obligated |
Direct service provision (youth programming) |
% |
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Training, technical assistance, and monitoring conducted at the grantee level |
% |
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Evaluation and/or research |
% |
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Administrative purposes at the grantee level |
% |
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Grantee Staffing |
Count |
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Number of grantee staff involved in overseeing SRAE before COVID-19 occurred |
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Did the number of staff involved in overseeing SRAE decrease due to COVID-19? |
Y/N |
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If yes: how many staff were affected? |
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Number of grantee FTEs involved in overseeing SRAE before COVID-19 occurred |
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Did the number of FTEs involved in overseeing SRAE decrease due to COVID-19? |
Y/N |
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If yes: how many FTEs were affected? |
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Grantee Observation, Training and Technical Assistance |
Y/N |
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Grantee or its designee observed program delivery to monitor quality and fidelity to program models |
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Type of organization that conducted observations: |
Y/N |
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Type of Organization – Observations |
Grantee |
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Developer |
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Training or technical assistance partner |
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Evaluation partner |
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Program provider |
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Grantee or its designee provided technical assistance to support program implementation |
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Type of organization that provided technical assistance: |
Y/N |
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Type of Organization – TA |
Grantee |
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Developer |
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Training or technical assistance partner |
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Evaluation partner |
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Program provider |
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Grantee or its designee conducted training of facilitators who deliver the program (or of other staff who might train facilitators) |
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Type of organization that conducted program facilitator training: |
Y/N |
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Type of Organization – Training |
Grantee |
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Developer |
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Training or technical assistance partner |
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Evaluation partner |
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Program provider |
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Number of providers |
Count |
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Number of providers funded |
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Number of new providers |
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Target number of youth to be served by the grantee (in the original application or approved by your project officer) |
Count |
Target number of youth |
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Measures of Structure, Cost, and Support for Program Implementation
REPORT PERIOD |
[reporting period] |
Grantee: |
Enter grantee name |
Provider: |
Enter provider name |
Funding |
Amount |
SRAE annual award amount (for current grant year) |
$ |
Amount of non-SRAE funding received during current reporting year to support SRAE programming |
$ |
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Y/N |
Is provider new for the [reporting year]? |
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Did provider serve youth during the [reporting year]? |
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Facilitators |
Count |
Number of SRAE facilitators working for provider |
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Number of SRAE facilitators trained in delivering core curriculum |
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Number of SRAE facilitators observed once |
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Number of SRAE facilitators observed at least twice |
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Measures of Structure, Cost, and Support for Program Implementation
REPORT PERIOD |
[reporting period] |
Grantee: |
Enter grantee name |
Provider: |
Enter provider name |
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Use the scale at the right to indicate how the provider assessed the implementation challenges below. |
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Not a Problem |
Somewhat a problem |
A serious problem |
Implementation Challenges |
Recruiting youth |
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Keeping youth engaged |
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Getting youth to attend regularly |
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Recruiting qualified staff |
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Ensuring facilitators understand content |
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Covering program content |
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Staff turnover |
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Negative peer reactions |
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Youth behavioral problems |
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Natural disasters |
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Program facilities |
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Obtaining buy-in or support from key stakeholders |
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Parent support or engagement |
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Other |
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Use the scale at the right to indicate if the provider has expressed interest in receiving technical assistance for the implementation factors below. |
Not interested, already received |
Not Interested |
Somewhat Interested |
Very Interested |
Needs for Technical Assistance |
Recruiting youth |
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Keeping youth engaged in program sessions |
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Getting youth to attend regularly |
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Recruiting qualified staff |
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Training facilitators |
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Retaining staff |
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Minimizing negative peer reactions |
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Addressing youth behavioral issues |
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Obtaining buy-in or support from key stakeholders |
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Evaluation (e.g., how to select or manage an evaluator, data collection, data analysis, and report writing) |
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Parent support and engagement |
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Other |
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Measures of Structure, Cost, and Support for Program Implementation
REPORT PERIOD |
[reporting period] |
Grantee: |
Enter grantee name |
Provider: |
Enter provider name |
Program: |
Enter program name |
Program Delivery |
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Number of intended program delivery hours |
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Core curriculum |
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Indicate which SRAE topics are addressed by this core curriculum: |
Y / N |
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SRAE topics covered through core curriculum |
Teaching the benefits of: |
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Advantage of refraining from nonmarital sexual activity |
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Self-regulation |
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Goal setting |
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Success sequence for poverty prevention* |
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Healthy relationships |
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Resisting: |
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Sexual coercion |
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Dating violence |
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Other youth risk behaviors, such as alcohol, tobacco, and other drug use |
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Other program elements that address SRAE topics |
Are there any other program elements – such as supplemental curriculum, guest speakers, or other program activities that are not part of the core curriculum – that address SRAE topics? |
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Indicate which SRAE topics are addressed through supplemental program elements: |
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SRAE topics covered through supplemental program elements |
Teaching the benefits of: |
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Refraining from nonmarital sexual activity |
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Self-regulation |
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Goal setting |
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Success sequence for poverty prevention* |
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Healthy relationships |
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Resisting: |
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Sexual coercion |
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Dating violence |
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Other youth risk behaviors, such as alcohol, tobacco, and other drug use |
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*Success sequence for poverty prevention – The three steps that young adults should take to improve the likelihood of successful economic outcomes when reaching adulthood. The steps include, but are not limited to, graduating from high school, working a full time job, and waiting until age 21 or later to get married and have children (SRAE 2019 Funding Opportunity Announcement). |
Measures of Structure, Cost, and Support for Program Implementation
REPORT PERIOD |
[reporting period] |
Grantee: |
Enter grantee name |
Provider: |
Enter provider name |
Program: |
Enter program name |
Indicate which, if any, of the following youth groups are target populations for the provider’s program |
Y / N |
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Target Population |
Youth in high-need geographic areas |
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Youth in foster care |
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Homeless or runaway youth |
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Youth living with HIV/AIDS |
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Pregnant or parenting youth |
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Hispanic/Latino youth |
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African American youth |
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Native American youth |
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Youth in adjudication systems |
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Male youth |
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Out of school or dropout youth |
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Youth in residential treatment for mental health issues |
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Trafficked youth |
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Measures of Attendance, Reach, and Dosage
REPORT PERIOD |
[reporting period] |
Grantee: |
Enter grantee name |
Provider: |
Enter provider name |
Program: |
Enter program name |
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Enter the number of youth during the reporting period who: |
Enter Count |
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Reach |
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Total (unduplicated) |
Before COVID-19a |
Since COVID-19 |
Attended at least one program session |
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Number of middle school participants |
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Number of high school participants |
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Program Setting |
Attended a session in school during school |
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Attended a session in school after school |
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Attended a session in a community-based organization |
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Attended a session in a clinic |
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Attended a session in a foster care setting |
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Attended a session in a juvenile detention center |
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Attended a session in a residential mental health treatment facility |
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Attended a session onlineb |
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Attended a session in another setting |
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Attendance/Dosage |
Completed at least 75 percent of the scheduled program hours |
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aThe data submission portal will include hover text with the clarifying language, “Please think about the date stay-at-home orders were implemented or schools closed, etc.” bOnline includes any programming that is facilitated online rather than by an in-person facilitator, regardless of the physical setting where participants are located.
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Indicate whether more than 50 percent of youth attending the program were: |
Y / N |
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Majority population |
In foster care |
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Homeless or runaway |
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Pregnant or parenting |
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In adjudication systems |
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Enter the appropriate count below |
Enter Count |
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Parent Involvement |
Number of youth’s parents and other caring adults who attended at least one program session during the reporting period |
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Measures of Attendance, Reach, and Dosage
REPORT PERIOD |
[reporting period] |
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Grantee: |
Enter grantee name |
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Provider: |
Enter provider name |
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Program: |
Enter program name |
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Cohort |
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Enter a unique identifier for each cohort that received the program during this reporting period. |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
etc. |
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Did the cohort complete the program during the reporting period (Y/N)? |
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For those cohorts that completed the program during the reporting period, how many hours of programming, overall, were delivered? |
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Did SRAE programming end prematurely for the cohort due to COVID-19? (Y/N) |
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If programming for this cohort ended prematurely due to COVID-19, enter the number of intended program hours that was delivered to the cohort at the point implementation ended. |
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Did SRAE program implementation shift from in-person to online programming for the cohort due to COVID-19? (Y/N) |
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If programming for this cohort shifted to an online format, enter the percentage of participants who shifted to online SRAE programming. (If an exact percentage is not readily available, please enter your best estimate.) |
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File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | MATHEMATICA |
File Modified | 0000-00-00 |
File Created | 2021-01-11 |