Form HM PPR

PERFORMANCE PROGRESS REPORT

Office of Family Assistance

Healthy Marriage and Responsible Fatherhood Grant Program

REPORT TEMPLATE FOR HEALTHY MARRIAGE PROGRAMS

OMB Control No.: 0970-0XXX

Expiration Date: XX/XX/XXXX

Information from the semi-annual Administration for Children and Families (ACF) performance progress report (PPR) will be used by the Office of Family Assistance (OFA) to meet grants management requirements and by grantees themselves to self-monitor progress and challenges (continuous quality improvement (CQI)). Semi-annual progress reports are due within 30 days of the end of each 6-month reporting period, which are:

• Reporting Period 1: September 30 – March 31; Report Due: April 30

• Reporting Period 2: September 30 – September 29; Report Due: October 30

The PPR consists of the following four parts, with both qualitative and quantitative descriptions of program performance:

Part 1: ACF-OGM-SF-PPR Cover Page

Found at: https://www.acf.hhs.gov/sites/default/files/assets/acf_ogm_ppr_new_exp_date_113022.pdf.

Part 2: Appendix B – Qualitative (narrative) description of program indicators:

B-01 Performance Narrative

B-02 Major Activities and Accomplishments

B-03 Problems

B-04 Significant Findings and Events

B-05 Dissemination Activities

B-06 Other Activities

B-07 Activities Planned for the Next Reporting Period

B-08 Selected Participant Outcomes

Part 3: Appendix C – Quantitative (numeric) performance measures:

C-01 Recruitment

C-02 Applicant Characteristics

C-03 Program Enrollment

C-04 Program Participation

C-05 Quality Assurance and Monitoring (Continuous Quality Improvement)

C-06 Referrals

C-07 Implementation Challenges

C-08 Marketing

C-09 Participant Outcomes

9.1 Adults

9.2 Youth

Part 4: Federal Financial Report (FFR) SF-425

Found at: http://apply07.grants.gov/apply/forms/sample/SF425-V1.0.pdf.

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: The purpose of this information collection is to support program performance monitoring and program improvement activities for Healthy Marriage and Responsible Fatherhood programs. Public reporting burden for this collection of information is estimated to average 3 hours per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. The answers you give will be kept private. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0XXX and the expiration date is XX/XX/XXXX. If you have any comments on this collection of information, please contact Dr. Mathew Stange at nform2helpdesk@mathematica-mpr.com.

Please address each reporting area. Once you complete the PPR packet, upload it, along with the ACF-OGM-SF-PPR Cover Page, as a Grant Note in GrantSolutions. Please contact your OFA Federal Program Specialist for additional guidance.

Part 1: ACF-OGM-SF-PPR Cover Page

Part 2: Appendix B – PROGRAM INDICATORS

B-01 PERFORMANCE NARRATIVE

Please provide details on the following questions about your program and services.

1. Target population

Please provide a detailed description of your target population.

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2. Program services

Please provide a detailed description of the following:

• Program components, including workshops and case management.

• Curriculum, including name, length, and format.

• Type, frequency, and purpose of individual-level contacts with participants.

• Program supports, such as gas cards or bus tokens to get to workshops.

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3. Job and Career Advancement

Please provide a detailed description of the following:

• Describe the employment services offered to participants in need of employment.

• Provide a list of employment partners (including those that provide subsidized and unsubsidized jobs) and their roles and responsibilities. Also, indicate whether each partner has a memorandum of understanding (MOU) with the grantee.

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4. Programs with Subsidized Employment Elements

If employment subsidies are provided, please provide detailed descriptions to the following:

• Policies, procedures, and requirements for placing participants in subsidized employment.

• The process used by employment specialists to identify and create employment opportunities.

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5. Staffing

Please provide a list of program key staff with roles and responsibilities.

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6. Organizational/Program Partners

Please provide a list of program partners (specify those with MOUs) and their roles and responsibilities for program implementation.

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7. Other

Please provide any other details on performance that you think are relevant for this reporting period.

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B-02 MAJOR ACTIVITIES & ACCOMPLISHMENTS

Describe major programmatic and operational activities and accomplishments during this reporting period in the topical areas shown below.

1. Recruitment methods and strategies

Please provide a detailed description of your recruitment strategies and approaches, including any changes, during this reporting period.

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2. Recruitment performance measures

Please review the performance measures in section C-01 of the PPR. Is there anything else you would like to share about the recruitment methods?

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3. Program intake and applicant characteristics

Please describe your program’s intake and enrollment process.

Blank

4. Applicant characteristics performance measures

Please review the performance measures in section C-02 of the PPR. Please provide additional information describing/explaining the characteristics of program applicants this reporting period.

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5. Program enrollment

Please describe your program’s progress toward meeting enrollment targets.

In the space provided below, please describe:

• The degree to which you are enrolling your intended target population.

• If you are not meeting your enrollment targets, the challenges you are experiencing and plans to address them.

• If you are exceeding your target, what you think is contributing to your success—including both program-related and contextual (i.e., non-program-related) factors.

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6. Screening for intimate partner violence or teen dating violence

Please describe whether and how applicants are screened for intimate partner violence or teen dating violence.

Blank

7. Process for handling disclosures of intimate partner violence or teen dating violence

Please indicate whether the grantee has a written plan to respond to possible disclosures of intimate partner violence or teen dating violence. If yes, please provide a copy with the report.

Blank

8. Program enrollment performance measures

Please review the performance measures in section C-03 of the PPR. Please provide additional information describing/explaining program enrollment and intimate partner violence or teen dating violence screening this reporting period.

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9. Program participation

In the space provided below, please describe:

Enrollment:

• Strategies planned or being implemented to engage program enrollees in services within two weeks of program enrollment.

• Reasons why program initiation is lower than expected or desired, if relevant. Consider program-related factors (e.g., workshop schedule) as well as non-program-related (contextual) factors (e.g., client barriers to participation). Describe your current or planned efforts to increase program initiation.

• Reasons why program initiation is higher than expected, if relevant. Consider program-related and non-program-related (contextual) factors. Identify any promising practices you think may be contributing to your success in getting enrollees to begin services.

Retention:

• Strategies planned or being implemented to ensure program enrollees complete the workshops in which they have enrolled, and that they receive as many individual service contacts as necessary.

• Reasons why program retention is lower than expected or desired, if relevant. Consider program-related factors as well as non-program-related (contextual) factors. Describe your current or planned efforts to increase program retention.

• Reasons why program retention is higher than expected, if relevant. Consider program-related and non-program-related (contextual) factors. Identify any promising practices you think may be contributing to your success in getting participants to regularly attend and complete program services.

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10. Program participation performance measures

Please review the performance measures in section C-04 of the PPR. Please provide additional information describing/explaining program participation this reporting period.

Blank

11. Quality assurance and monitoring (continuous quality improvement)

Please provide a detailed description of your plans for program quality assurance and monitoring, including training and supervision. Please provide a detailed description of your CQI plan and its implementation.

Blank

12. Quality assurance and monitoring (continuous quality improvement) performance measures

Please review the performance measures in section C-05 of the PPR. Please provide additional information describing/explaining your activities this reporting period to ensure program quality.

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13. Staff Training

In the space provided below, please describe any trainings that staff received.

Blank

14. Referrals

In the space provided below, please provide a detailed description of your process for follow-up with participants referred for services.

Blank

15. Referral performance measures

Please review the performance measures in section C-06 of the PPR. Please provide additional information describing/explaining referrals this reporting period.

Blank

16. Local program evaluation (if applicable)

Please describe activities and accomplishments pertaining to the design and execution of your local program evaluation.

Blank

17. Other

Please describe other activities and accomplishments during the reporting period.

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B-03 PROBLEMS

Describe challenges encountered implementing your program during this reporting period. Describe any current or expected deviations or departures from the original project plan, including actual/anticipated slippage in task completion dates, and special problems encountered or expected. Use this section to advise your Federal Program Specialist and Grants Management Specialist of assistance needs.

1. Implementation challenges performance measures

Please review the performance measures in section C-07 of the PPR. For any challenge categorized as “somewhat of a problem” or “a serious problem,” please describe the nature of the problem and any proposed solutions.

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2. Staff turnover

Please describe any positions that are currently vacant and your plan to fill each vacancy.

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3. Technical assistance needs

Describe any guidance or technical assistance you would like to help address current or anticipated challenges.

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B-04 SIGNIFICANT FINDINGS & EVENTS In the table provided below, please list and briefly describe any significant findings and events that occurred this reporting period. Topics may include innovative strategies or promising practices in areas such as: Program staffing Marketing, outreach, and recruitment strategies Achieving enrollment targets How to get enrollees to attend their first service How to retain participants in program services and ensure they complete all workshop sessions Service delivery structure and sequencing Workshop format(s) Quality assurance and monitoring of program operations (continuous quality improvement) Ensuring staff enter service delivery data accurately, in a timely fashion, and in a manner that protects privacy Designing or executing your local program evaluation When possible, please use data to substantiate your findings.
Finding or Event	Description
Blank	Blank
Blank	Blank
Blank	Blank
Blank	Blank

B-05 DISSEMINATION ACTIVITIES

In the space provided below, please describe your program’s marketing and dissemination activities. Additionally, please itemize your efforts and include copies of any newspaper, newsletter, magazine articles, or other published materials relevant to your project’s activities, or used for marketing purposes.

Marketing performance measures

Please review the performance measures in section C-08 of the PPR. Please provide additional information describing/explaining dissemination activities this reporting period.

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B-06 OTHER ACTIVITIES

In the space provided below, please describe other activities that are a part of your program. Please indicate whether the program activity is supported by the OFA grant, another funding source, or provided in-kind through another source (if applicable, please name the source).

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B-07 ACTIVITIES PLANNED FOR NEXT REPORTING PERIOD In the table provided below, please list the key activities you plan to engage in over the next 6 months, and a general timeline for completion. Activities may be related to: Staffing Marketing, outreach, and recruitment Program enrollment Engaging participants in their first program service Retaining participants in program services Service delivery Quality assurance and monitoring program operations (continuous quality improvement) Data collection and data entry Program evaluation
Planned Activity	Timeline
Blank	Blank
Blank	Blank
Blank	Blank
Blank	Blank

B-08 SELECTED PARTICIPANT OUTCOMES

Please review the performance measures in section C-09 of the PPR. Please provide additional information describing/explaining program participants’ outcomes from this reporting period.

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Part 3: Appendix C – PERFORMANCE MEASURES

C-01 RECRUITMENT

1. Recruitment methods used during the reporting period	Blank
Phone, mail, or email outreach	Blank
Social media (such as Facebook, blogs, or Instagram)
Street outreach (recruiting people in person in their neighborhoods or places they frequent)	Blank
Referrals from inside your organization
Referrals from external organizations	Blank
On-site recruitment at external agencies or events	Blank
Other	Blank

2. Agencies and organizations that provided referrals during the reporting period	Blank
Hospitals, maternity clinics, or doctors’ offices	Blank
Schools	Blank
Places of worship or faith-based community centers	Blank
Child support agencies (voluntary enrollment)	Blank
Child support agencies (court ordered to enroll in a program like this)	Blank
Employment assistance centers or one-stops	Blank
Temporary Assistance for Needy Families (TANF) offices	Blank
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) agencies	Blank
Head Start	Blank
Healthy Start	Blank
Child protective services (voluntary enrollment)
Child protective services (court ordered to enroll in a program like this)
Other child welfare agencies (voluntary enrollment)	Blank
Other child welfare agencies (court ordered to enroll in a program like this)	Blank
Probation and parole	Blank
Correctional facilities
External organizations	Blank
Self-referrals	Blank
Other	Blank

3. FTE staff dedicated to recruitment during the reporting period	Number of staff
<1 FTE	Blank
1 to 1.9 FTE	Blank
2 to 2.9 FTE	Blank
3 to 3.9 FTE	Blank
4 to 4.9 FTE	Blank
5 or more FTE	Blank

4. Program applicants (during the reporting period) who reported hearing about the program through each source	Percent of applicantsa
My school offered the program or class	Blank
Newspaper ad, billboards, or a flyer	Blank
Radio ad, TV commercial, or news story	Blank
Internet ad or social media such as Facebook, Twitter	Blank
Government agency, such as the Office of Child Support Enforcement, TANF, WIC, Child Welfare (CPS), parole/probation office, other agency	Blank
Community organization, such as a school, hospital, maternity clinic, doctor’s office, place of worship, Head Start, or Healthy Start center	Blank
Program offered in prison or criminal justice facility
Program staff in the community or at a community event, such as a street fair	Blank
Word of mouth (friends, family, acquaintances)
Other	Blank

5. Primary reason applicant chose to enroll in the program	Percent of applicants
To learn about being a better parent	Blank
To learn how to improve my personal relationships, such as with my partner or co-parent	Blank
To find a job or a better job	Blank
To meet a school requirement
Friends were coming	Blank
Spouse/partner asked them to come	Blank
Parole/probation officer told them to enroll in a program like this	Blank
A court ordered them to enroll in a program like this	Blank
None of the above	Blank

^aApplicants may provide multiple responses, so total may exceed 100 percent.

C-02 Applicant Characteristics

1. Demographic characteristics	Percent of applicants
1. Gender	Blank
Female
Male
Transgender
None of these
2. Age	Blank
13 – 15 years
16 – 17 years
18 – 20 years	Blank
21 – 24 years	Blank
25 – 34 years	Blank
35 – 44 years	Blank
45 – 54 years	Blank
55 years or older	Blank
	Blank
3. Grade	Blank
Less than 9th grade	Blank
9th grade	Blank
10th grade	Blank
11th grade	Blank
12th grade	Blank
Working toward a GED
College	Blank
Vocational/technical training or other post-high school education
4. Racea	Blank
American Indian or Alaska Native	Blank
Asian	Blank
Black or African American	Blank
Native Hawaiian or other Pacific Islander	Blank
White	Blank
Other	Blank
5. Ethnicity	Blank
Hispanic or Latino
Not Hispanic or Latino

6. Primary language	Blank
English
Spanish
English and Spanish equally
Other

^aApplicants may provide multiple responses, so total may exceed 100 percent.

2. Financial well-being	Percent of applicants
1. Educational attainment	Blank
No degree or diploma earned	Blank
General Educational Development (GED)	Blank
High school diploma	Blank
Vocational/technical certification	Blank
Some college, but no degree
Associate’s degree
Bachelor’s degree
Master’s degree or advanced degree
2. Employment statusa	Blank
Full-time employed (usually work 35 or more hours a week)	Blank
Part-time employed (usually work 1-34 hours a week)	Blank
Employed but number of hours change from week to week	Blank
Temporary, occasional, or seasonal employment, or odd jobs for pay	Blank
Stay at home parent or homemaker
Not currently employed	Blank
Actively looking for work (among those not currently employed and stay at home parents only)	Blank
3. Receipt of assistance in the past month by anyone in the household	Blank
Temporary Assistance for Needy Families (TANF)	Blank
Supplemental Security Income (SSI)	Blank
Social Security Disability Insurance (SSDI)	Blank
Supplemental Nutrition Assistance Program (SNAP)/Food stamps	Blank
Women, Infants, and Children (WIC)	Blank
Unemployment insurance	Blank
Housing choice voucher (sometimes called Section 8)	Blank
Cash assistance	Blank
Child support	Blank
4. Earnings in past 30 days
No earnings in the past 30 days
$1 – $499
$500 – $1,000
$1,001 – $2,000
$2,001 – $3,000
$3,001 – $4,000
$4,001 – $5,000
More than $5,000

^aApplicants may provide multiple responses, so total may exceed 100 percent.

3. Family status	Percent of applicants
1. Marital status	Blank
Married	Blank
Engaged	Blank
Separated	Blank
Divorced	Blank
Widowed	Blank
Never married/single	Blank
2. Non-marital partner status	Blank
No current partner (unpartnered or single)	Blank
Romantically involved or in a committed relationship with someone on a steady basis	Blank
Involved in an on-again and off-again relationship	Blank
3. Living with partner	Blank
All of the time	Blank
Most of the time	Blank
Some of the time	Blank
None of the time	Blank
4. Applicant or partner is pregnant	Blank
5. Average number of biological and adopted children younger than 24 years old (not including current pregnancies)	Blank
6. Average number of biological and adopted children who are 24 or younger who live with applicants all or most of the time	Blank
7. Average number of non-biological and non-adopted children who are 24 or younger and who live with applicants all or most of the time
8. Actively engaged in raising a child or youth up to age 24 who is the child of a partner or relative, but not the biological or legally adopted child the applicant
9. Foster care status (among applicants under 21 only)	Blank
Never been in foster care	Blank
Left foster care over 6 months ago	Blank
Recently (in the past 6 months) left foster care	Blank
Currently in foster care	Blank
Not sure

Characteristics of Adult Couple and Individual Clients at Beginning of Program

4. Relationships/Marriage

Outcome	Average score	Range	Number of respondents
Attitudes about marriage	Blank	Blank	Blank
Believes that it is better for children if their parents are married	Blank	1 (strongly agree) to 4 (strongly disagree)	Blank
Believes that living together is just the same as being married	Blank	1 (strongly agree) to 4 (strongly disagree)	Blank
Conflict management (only those with a partner)	Blank	Blank	Blank
Negative conflict management skills (5-item scale) My partner/spouse was rude or mean to me when we disagree My partner/spouse seemed to view my words or actions more negatively than I meant them to be Our arguments became very heated Small issues suddenly became big arguments My partner/spouse or I stayed mad at one another after an argument	Blank	5 (never) – 20 (often)	Blank
Satisfaction with how conflict with partner is handled	Blank	1 (very satisfied) to 3 (not at all satisfied)	Blank

5. Parenting

Outcome	Average score	Range	Number of respondents
Nurturing parentinga	Blank	Blank	Blank
Tries to comfort child when he/she is upset	Blank	1 (never) to 4 (often)	Blank
Spends time with child doing what he/she likes to do	Blank	1 (never) to 4 (often)	Blank
Disciplinea	Blank	Blank	Blank
Hits, spanks, grabs, or uses physical punishment	Blank	1 (yes) 0 (no)
Yells, shouts, or screams at child when he/she is mad at him/her	Blank	1 (yes) 0 (no)
Talks about what child did wrong	Blank	1 (yes) 0 (no)	Blank
Co-parenting	Blank	Blank	Blank
Works well with co-parent in parenting child	Blank	1 (strongly agree) to 4 (strongly disagree)	Blank

^a Responses averaged across respondent’s youngest and oldest children, if applicable.

6. Job and career advancement

Outcome	Average score	Range	Number of respondents
Willing to work	Blank	Blank	Blank
I would like to learn new job skills	Blank	1 (strongly agree) to 4 (strongly disagree)	Blank
I feel confident in my ability to conduct an effective job search for a job I want	Blank	1 (strongly agree) to 4 (strongly disagree)	Blank

Characteristics of Youth Clients at Beginning of Program

7. Marriage and relationship attitudes

Outcome	Average score	Range	Number of respondents
Marriage beliefs	Blank	Blank	Blank
It is okay to live with a boyfriend/girlfriend without being married	Blank	1 (strongly agree) to 4 (strongly disagree)	Blank
It is okay to have kids without being married	Blank	1 (strongly agree) to 4 (strongly disagree)	Blank
Attitudes about intimate partner violence/teen dating violence	Blank	Blank	Blank
Believes that sometimes physical violence, such as hitting or pushing, is the only way to express feelings	Blank3	1 (strongly disagree) to 4 (strongly agree)	Blank
Believes that it’s okay to stay in a relationship even if afraid of boyfriend/girlfriend	Blank	1 (strongly disagree) to 4 (strongly agree)	Blank

8. Attitudes about sex

Outcome	Average score	Range	Number of respondents
Believes that two people in love do not need to use condoms or birth control	Blank	1 (strongly disagree) to 4 (strongly agree)	Blank
Would find it hard to say “no” if boyfriend/girlfriend pressured for sex	Blank	1 (strongly disagree) to 4 (strongly agree)	Blank

9. Relationship skills

Outcome	Average score	Range	Number of respondents
I have the skills needed for a lasting, stable romantic relationship	Blank	1 (none of the time) to 5 (all of the time)	Blank
I am able to recognize the warning signs of a bad relationship	Blank	1 (none of the time) to 5 (all of the time)	Blank

10. Parenting

Outcome	Average score	Range	Number of respondents
Discipline (if live with child)	Blank	Blank	Blank
Talks about what child did wrong	Blank	1 (yes) 0 (no)	Blank
Hits, spanks, grabs, or uses physical punishment	Blank	1 (yes) 0 (no)	Blank
Yells, shouts, or screams at child because mad at him/her	Blank	1 (yes) 0 (no)	Blank
Frequency saw child in past month (if do not live with child)	Blank	Blank	Blank
Every day or almost every day (%)	Blank	0–100	Blank
One to three times a week (%)	Blank	0–100	Blank
One to three times a month (%)	Blank	0–100	Blank
Did not see child in past month (%)	Blank	0–100	Blank

C-03 Program Enrollment

1. Screening for intimate partner violence or teen dating violence

Blank	Applicants screened for intimate partner violence or teen dating violence
Blank	#	%
Number and proportion of applicants screened for intimate partner violence or teen dating violence	Blank	Blank

2. Enrollment targets and actual enrollment

Blank	Number of adult couplesa	Number of adult individuals	Number of youth
Enrollment target for the grant year	Blank	Blank	Blank
Enrolled since the beginning of grant year through the end of reporting period	Blank	Blank	Blank
% of grant-year target met to date	Blank	Blank	Blank

^aThe number of adult couples is the number of couple units.

C-04 PARTICIPATION

1. Initial participation

Blank	Adult couples		Adult individuals		Youth
Blank	#	%	#	%	#	%
Participated in their first program service (workshop or individual service contact) during the time period shown
Within 1 week of program enrollment
Between 2 and 4 weeks of program enrollment
Between 1 and 2 months of program enrollment
More than 2 months since program enrollment
Not yet participated in a service
Participated in their first workshop session series occurrence during the time period shown
Within 1 week of program enrollment
Between 2 and 4 weeks of program enrollment
Between 1 and 2 months of program enrollment
More than 2 months since program enrollment
Not yet participated in a workshop session series occurrence

2.a Attendance at workshops

nFORM generates a table that reports on participation for each workshop offered by the grantee. The primary population served, workshop name, workshop activities, workshop elements, and workshop type automatically fill from what grantees enter in nFORM.

Example of nFORM-Generated Table on Participation:

Primary Population Served: Workshop Name: Workshop Activities: Workshop Elements: Workshop Type:	Adult couples
	#	%
Workshop Retention
Did not attend any workshop session series hours
Attended 1 to 24% of all workshop session series hours
Attended 25 to 49% of all workshop session series hours
Attended 50 to 74% of all workshop session series hours
Attended 75 to 89% of all workshop session series hours
Attended 90 to 99% of all workshop session series hours
Attended 100% or more of all workshop session series hours

2.b Primary Workshop Participation

Table 1: Participation in primary workshop hours through end of reporting period	Adult couples
	Target hours	Average hours	Average %
Participation in primary workshop hours—Clients enrolled in grant year

Table 2: Participation in primary workshop(s)—Clients enrolled in grant year	Adult couples
	Annual target	Actual to date	%
Number of clients enrolled
Attended at least one primary workshop
Attended at least 50% of primary workshop hours
Attended at least 90% of primary workshop hours
Attended at least 100% of primary workshop hours

3. Participation in individual service contacts

Blank	Adult couples		Adult individuals		Youth
Number of individual service contacts participants received during the reporting period	#	%	#	%	#	%
No individual service contacts
One to four individual service contacts
Five to eight individual service contacts
More than eight individual service contacts
Average number of individual service contacts

C-05 Quality Assurance and Monitoring (continuous quality improvement)

1. Staff training

In the reporting period, did the following staff receive their initial training on the program curriculum(a)?	Yes	No	Do not have this position on staff
a. Facilitators
b. Case managers
c. Employment specialists
d. Supervisors
e. Program managers
f. Other program staff

In the reporting period, did the following staff receive follow-up or refresher training on the program curriculum(a)?	Yes	No	Do not have this position on staff
a. Facilitators
b. Case managers
c. Employment specialists
d. Supervisors
e. Program managers
f. Other program staff

In the reporting period, did the following staff receive training other than on the program curriculum(a)?	Yes	No	Do not have this position on staff
a. Facilitators
b. Case managers
c. Employment specialists
d. Supervisors
e. Program managers
f. Other program staff

2. Frequency of direct observation

Were the following staff observed by a supervisor or another experienced facilitator in the reporting period?	Yes	No
a. Facilitators hired in the reporting period
b. Experienced facilitators

3. Staff supervision

In the reporting period, on average, how often did the following staff meet with their supervisors one-on-one?	At least weekly	Biweekly	Monthly	Once	Not in reporting period	Do not have this position on staff
a. Facilitators
b. Case managers
c. Employment specialist
d. Supervisors
e. Program managers
f. Other program staff

4. Staff meetings

In the reporting period, how often were staff meetings held (such as discussions about CQI and team-building meetings) that included the following staff?	At least weekly	Biweekly	Monthly	Once	Not in reporting period	Do not have this position on staff
a. Facilitators
b. Case managers
c. Employment specialists
d. Supervisors
e. Program managers
f. Other program staff

5. Caseloads

Blank	Average
Average number of participants assigned to each case manager

C-06 REFERRALS

Blank	Adult couples		Adult individuals		Youth
Blank	#	%	#	%	#	%
Number of referrals participants received during reporting period
No referrals
One to four referrals
Five to eight referrals
More than eight referrals
Average number of referrals
Number of participants who followed-up on referrals (of those who received at least one referral)
Did not follow-up on any referrals
Followed-up 1 to 50% of referrals received
Followed-up on 51% or more of referrals received
Unknown

C-07 Implementation Challenges

1. Common implementation challenges

	Not a problem	Somewhat of a problem	A serious problem
a. Obtaining referrals from external organizations
b. Recruiting participants
c. Enrolling the intended target population
d. Getting enrollees to start participating in services
e. Getting enrollees to attend regularly
f. Keeping participants engaged during sessions
g. Getting enrollees to complete the program
h. Recruiting qualified staff
i. Maintaining staff performance
j. Ensuring facilitators understand content
k. Covering all program content in the time allotted
l. Implementing curriculum with fidelity
m. Having adequate program facilities
n. Cooperation of recruitment and referral sources
o. Working with service delivery partners
p. Experiencing extreme weather or natural disasters
q. Getting participants to complete pre-test or post-test
r. Retaining staff
s. Filling open staff positions
t. Providing comprehensive case management services
u. Providing grant-funded participation supports
v. Entering and reporting data

2. Staff hiring and turnover

	Full time staff	Part time staff
Number of staff funded by the grant during the reporting period
Number of staff funded by the grant who left during the reporting period
Number of staff funded by the grant who started during the reporting period

C-08 Marketing

1. Advertising purchased, donated, or conducted during the reporting period	Blank
Newspaper ads or publicity	Blank
TV spots	Blank
Billboards, including those on public transportation or bus stop (that is, bench ads)	Blank
Radio ad or announcements	Blank
Internet ads	Blank
Social marketing (such as Facebook or Twitter)	Blank
Flyers	Blank
Presentations to external organizations	Blank
Word-of-mouth campaign/outreach by program graduates	Blank
Other	Blank

C-09 Participant Outcomes

1. Characteristics of Adult Couple and Individual Clients at Program Exit

A. Relationships/Marriage

Outcome	Average posttest score	Range	Number of respondents
Attitudes about marriage	Blank	Blank	Blank
Believes that it is better for children if their parents are married	Blank	1 (strongly agree) to 4 (strongly disagree)	Blank
Believes that living together is just the same as being married	Blank	1 (strongly agree) to 4 (strongly disagree)	Blank
Relationship status (%)	Blank	Blank	Blank
Married	Blank	0 – 100	Blank
Engaged	Blank	0 – 100	Blank
Separated	Blank	0 – 100	Blank
Divorced	Blank	0 – 100	Blank
Widowed	Blank	0 – 100	Blank
Never married	Blank	0 – 100	Blank
Conflict management (only those with a partner)	Blank	Blank	Blank
Negative conflict management skills (5-item scale) My partner/spouse was rude or mean to me when we disagree My partner/spouse seemed to view my words or actions more negatively than I meant them to be Our arguments became very heated Small issues suddenly became big arguments My partner/spouse or I stayed mad at one another after an argument	Blank	5 (never) – 20 (often)	Blank

Outcome	Average posttest score	Range	Number of respondents
Positive conflict management skills (7-item scale) My partner/spouse and I were good at working out our differences I felt respected even when my partner/spouse and I disagree When my partner/spouse and I had a serious disagreement, we worked on it together to find a resolution When my partner/spouse had a serious disagreement, we discussed our disagreements respectfully During arguments, my partner/spouse and I were good at taking breaks when we needed them When my partner/spouse and I argued, past hurts got brought up again (reverse coded) My partner/spouse understands that there are times when I do not feel like talking and times when he/she does	Blank	7 (never) – 28 (often)	Blank
Satisfaction with how conflict with partner is handled	Blank	1 (very satisfied) to 3 (not at all satisfied)	Blank
Commitment to marriage (only those who are married)	Blank	Blank	Blank
View marriage as lifelong	Blank	1 (strongly agree) to 4 (strongly disagree)	Blank

B. Parenting

Outcome	Average posttest score	Range	Number of respondents
Nurturing parentinga	Blank	Blank	Blank
Happy being with child	Blank	1 (never) to 4 (often)	Blank
Feels very close to child	Blank	1 (never) to 4 (often)	Blank
Tries to comfort child when she/he is upset	Blank	1 (never) to 4 (often)	Blank
Spends time with child doing what he/she likes to do	Blank	1 (never) to 4 (often)	Blank
Disciplinea	Blank	Blank	Blank
Hits, spanks, grabs, or uses physical punishment	Blank	1 (yes) 0 (no)	Blank
Yells, shouts, or screams at child when he/she is mad at him/her	Blank	1 (yes) 0 (no)	Blank
Talks about what child did wrong	Blank	1 (yes) 0 (no)	Blank
Helpfulness of program for parenting	Blank	Blank
Overall, how helpful the program was for parenting	Blank	1 (not at all) to 5 (extremely helpful)
		Not addressed by program
Co-parenting	Blank	Blank	Blank
Works well with co-parent in parenting child	Blank	1 (strongly agree) to 4 (strongly disagree)	Blank
Helpfulness of program for co-parenting	Blank	Blank	Blank
Overall how helpful the program was for co-parenting	Blank	1 (not at all) to 5 (extremely helpful)	Blank
		Not addressed by program

^a Responses averaged across respondent’s youngest and oldest children, if applicable.

C. Job and career advancement

Outcome	Average posttest score	Range	Number of respondents
Willing to work	Blank	Blank	Blank
I would like to learn new job skills	Blank	1 (strongly agree) to 4 (strongly disagree)	Blank
I feel confident in my ability to conduct an effective job search for a job I want	Blank	1 (strongly agree) to 4 (strongly disagree)	Blank
Current employment status (%)	Blank	Blank	Blank
Full-time employment (usually work 35 hours or more a week)	Blank	0–100	Blank
Part-time employment (usually work 1 – 34 hours a week)	Blank	0–100	Blank
Employed, but hours vary	Blank	0–100	Blank
Temporary, occasional, or seasonal employment, or odd jobs for pay	Blank	0–100	Blank
Stay-at-home parent or homemaker
Not currently employed	Blank	0–100	Blank
Actively looking for work	Blank	0–100	Blank
In school, working toward GED, or in college or other post-high school education	Blank	0–100	Blank
Employment stability	Blank	Blank	Blank
Length of time in current job	Blank	To be determined	Blank
Perceived improvements in money management	Blank	Blank	Blank
Overall, how helpful the program was for financial well-being	Blank	1 (not at all) to 5 extremely helpful)	Blank
		Not addressed by program

D. Program perceptions

Outcome	Average posttest score	Range	Number of respondents
Overall, how helpful the program was	Blank	1 (not at all) to 5 (extremely helpful)	Blank

2. Characteristics of Youth Clients at Program Exit

A. Marriage and relationship attitudes

Outcome	Average posttest score	Range	Number of respondents
Marriage beliefs	Blank	Blank	Blank
It is okay to live with a boyfriend/girlfriend without being married	Blank	1 (strongly agree) to 4 (strongly disagree)	Blank
It is okay to have kids without being married	Blank	1 (strongly agree) to 4 (strongly disagree)	Blank
Expectations	Blank	Blank	Blank
Expect to have a healthy marriage with one person for life	Blank	1 (almost no chance) to 5 (almost certain chance)	Blank
Expect to live with boyfriend/girlfriend without being married	Blank	1 (almost no chance) to 5 (almost certain chance)	Blank
Expect to have a child without being married	Blank	1 (almost no chance) to 5 (almost certain chance)	Blank
Attitudes about intimate partner violence	Blank	Blank	Blank
Believes that sometimes violence is the only way to express feelings	Blank	1 (strongly disagree) to 4 (strongly agree)	Blank
Believes that it’s okay to stay in a relationship even if afraid of partner	Blank	1 (strongly disagree) to 4 (strongly agree)	Blank
Ended unhealthy relationship	Blank	Blank	Blank
Ended an emotionally unhealthy or abusive relationship since completing the program (%)	Blank	0 – 100	Blank
Ended a physically unhealthy or abusive relationship since completing program (%)	Blank	0 – 100	Blank

B. Attitudes about sex

Outcome	Average posttest score	Range	Number of respondents
Believes that two people in love do not need to use condoms or birth control	Blank	1 (strongly disagree) to 4 (strongly agree)	Blank
Would find it hard to say “no” if boyfriend/girlfriend pressured for sex	Blank	1 (strongly disagree) to 4 (strongly agree)	Blank

C. Relationship skills

Outcome	Average posttest score	Range	Number of respondents
I have the skills needed for a lasting, stable romantic relationship	Blank	1 (none of the time) to 5 (all of the time)	Blank
I am able to recognize the warning signs of a bad relationship	Blank	1 (none of the time) to 5 (all of the time)	Blank

D. Parenting

Outcome	Average posttest score	Range	Number of respondents
Nurturing parenting (if live with child)	Blank	Blank	Blank
Happy being with child	Blank	1 (never) to 4 (often)	Blank
Feels very close to child	Blank	1 (never) to 4 (often)	Blank
Tries to comfort child when she/he is upset	Blank	1 (never) to 4 (often)	Blank
Spends time with child doing what he/she likes to do	Blank	1 (never) to 4 (often)	Blank
Discipline (if live with child)	Blank	Blank	Blank
Talks about what child did wrong	Blank	1 (yes) 0 (no)	Blank
Hits, spanks, grabs, or uses physical punishment	Blank	1 (yes) 0 (no)	Blank
Yells, shouts, or screams at child because mad at him/her	Blank	1 (yes) 0 (no)	Blank
Frequency saw child in past month (if do not live with child)	Blank	Blank	Blank
Every day or almost every day (%)	Blank	0–100	Blank
One to three times a week (%)	Blank	0–100	Blank
One to three times a month (%)	Blank	0–100	Blank
Did not see child in past month (%)	Blank	0–100	Blank

E. Program perceptions

Outcome	Average posttest score	Range	Number of respondents
Overall, how helpful the program was	Blank	1 (not at all) to 5 (extremely helpful)	Blank

Part 4: Federal Financial Report

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