APPLETREE Annual Performance Report (APR)

Attachment 4e. APPLETREE Annual Performance Report (APR) Template

Form Approved

OMB No. 0923-0057

Exp. Date 07/31/2019

RFA-TS20-2001 ATSDR’s Partnership to Promote Local Efforts to Reduce Environmental Exposure (APPLETREE) Annual Performance Report (APR)

Name of Jurisdiction/Agency Submitting Plan: Click to enter text

Point of Contact for Correspondence: Click to enter text

Email: Click to enter text

Phone: Click to enter text

ATSDR estimates the average public reporting burden for this collection of information as 2 hours per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information 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 Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0923-0057).

Executive Summary

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Performance Measures

Performance Measures:

Table 1. Process Performance Measures

Performance Measure	Component/ Strategy	Quantitative and/or Qualitative Results	Target, if applicable
Proportion of activities completed from work plan	1/A	Click to enter text	80% (standard)
Proportion of site-specific assessments completed from work plan	1/A	Click to enter text	Click to enter text
Number of internal and/or external capacity building opportunities engaged to expedite release of assessments and educational products	1/A	Click to enter text	Click to enter text
Assessment that defines the childcare landscape and identifies needs*	1/B	See CSPECE Reporting Supplement	N/A
Number of partnerships identified to help prevent exposure*	1/B	See CSPECE Reporting Supplement	Click to enter text
Choose Safe Places for Early Care and Education Pilot Plan*	1/B	See CSPECE Reporting Supplement	N/A
Number of MOUs and/or letters of intent from partners demonstrating long-term commitment to program**	1/B	See CSPECE Reporting Supplement	Click to enter text
Completion of sustainability plan**	1/B	See CSPECE Reporting Supplement	N/A
Identification of key implementation barriers, facilitators, and lessons learned	2	Click to enter text	N/A

Table 2. Outcome Performance Measures

Performance Measure	Component/ Strategy	Quantitative and/or Qualitative Results	Target, if applicable
Number of health education and/or community involvement activities completed to disseminate information to partners, stakeholders, and community members.	1/A	Click to enter text	Click to enter text
Number (and percentage) of public health recommendations made by recipients that are accepted by stakeholders	1/A	Click to enter text	Click to enter text
Number (and percentage) of public health recommendations made by recipients that are adopted (implemented) by stakeholders within performance period	1/A	Click to enter text	Click to enter text
Number (and percentage) of sites with decreased or eliminated exposures based on recommendations that are adopted (implemented) by stakeholders	1/A	Click to enter text	Click to enter text
Number of partners indicating commitment to help prevent exposures in ECEs*	1/B	See CSPECE Reporting Supplement	Click to enter text
Identified barriers, facilitators, and lessons learned from pilot process*	1/B	See CSPECE Reporting Supplement	N/A
Execution of enhanced/expanded program**	1/B	See CSPECE Reporting Supplement	N/A
Number of infrastructure enhancements implemented**	1/B	See CSPECE Reporting Supplement	Click to enter text
Number (and percentage) of ECEs referred to program that make changes because of identified issues***	1/B	See CSPECE Reporting Supplement	Click to enter text
Number of policy, systems, and/or environment changes to support prevented exposures***	1/B	See CSPECE Reporting Supplement	Click to enter text
Description of effective practices, policies, and processes for preventing exposures***	1/B	See CSPECE Reporting Supplement	N/A

*Intended only for previously NOT funded under TS17-1701; those previously funded may delete

**Intended only for previously funded under TS17-1701; those NOT previously funded may delete

***Intended for both previously funded and not funded under TS17-1701

Table 3. State-Specific Performance Measures

Performance Measure	Component/ Strategy	Quantitative and/or Qualitative Results	Target, if applicable
Click to enter text	Click to enter text		Click to enter text
Add additional rows as necessary

Evaluation

Table 4. Evaluation Design and Data Collection:

Component: Click here to enter text

Strategy: Click here to enter text

Activity (What activity is in the logic model?): Click here to enter text

Describe the activity in less than 200 words: Click here to enter text

Evaluation Question What do we want to know?	Indicator How can we measure the answer?	Data Source(s) Where do we get the data?	Data Collection & Analysis Methods How do we get the data?
Question: Click to enter text Select one: ☐Process question ☐Outcome question	Click to enter text	Click to enter text	Select at least one: ☐Data already exist ☐Collecting new data If collecting new data: ☐Survey ☐Interview or focus group ☐Observation ☐Other_____________ When will data be collected: ☐At one point in time (cross-sectional) ☐Baseline/follow-up format ☐Retrospective post ☐Pre/mid/post ☐Other, specify:______ How are you analyzing data:
Add additional rows as necessary

• Description of results for reporting period considered significant: Click to enter text

• Changes to Evaluation Plan: Click to enter text

• Barriers during reporting period: Click to enter text

• Facilitators during reporting period: Click to enter text

• Conclusions: Click to enter text

*Copy Table 4 and bullets for to report out on each component/strategy as necessary.

Successes

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Work Plan

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Challenges

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CDC Program Support to Awardee

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