TPP20 Tier 1 and Tier 2 Grantee Informational Form

Form Approved

OMB No. XXXX-XXXX

Exp. Date XX/XX/20XX

TPP Tiers 1 and 2: Grantee Pre-Interview Informational Form

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is XXXX-XXXX. The time required to complete this information collection is estimated to average 15 minutes per response, including the time, to review instructions, search existing data resources, gather the data needed, to review and complete the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

TPP Tiers 1 and 2: Grantee Pre-Interview Informational Form

Introduction & Confidentiality Information

Introduction

The Office of Population Affairs (OPA) partnered with Abt Associates and its partners, Decision Information Resources and Data Soapbox, to conduct an implementation evaluation of the Teen Pregnancy Prevention (TPP) FY2020/21 Tier 1 and Tier 2 grant programs. As part of the evaluation, Abt and DIR are asking all Tier 1 and Tier 2 grantees to complete a brief informational form to learn more about their TPP Programs prior to engaging in interviews.

The form should take about 15 minutes to complete. Please submit your completed form by [DATE].

The information you provide will only be seen by members of the evaluation team. Your responses will be used by the evaluation team to prepare for the upcoming interview. Your responses will also be used to populate a Grantee Profile that OPA will publish publicly. You will be given the opportunity to review the Grantee Profile for your organization before it is shared with OPA.

If you have any questions about the form, please contact Tanya de Sousa, Project Director for the evaluation, at Tanya_deSousa@abtassoc.com. If you have questions about the study overall, please contact OPA at Alexandra.Osberg@hhs.gov.

Opening Page

To access the form, enter the unique PIN that you received in the email with the link to this form and click submit. From there, you will be brought to the instruction screen.

Instructions

To navigate the form: On each page, you will see three buttons – Back, Next and Quit.

• The Next button advances you to the following question and saves previous responses.

• The Back button takes you back to the previous question, in case you need to review or change an answer.

• The Quit button will automatically save your responses and exit the form.

Please do not use the "Back" or "Forward" buttons on the top of your browser while in the survey, as this will prevent your responses from being saved.

You may return to the form at a later time to continue answering questions. Once you have completed the form, please click the ‘Submit’ button to submit your responses.

Background

(Ask questions 1-3 to all grantees):

1. What is the official name of your TPP Project:

__________________

2. What type of organization is [grantee name]? (Select one)

__ City/town government agency

__ County government agency

__ State government agency

__ Tribal government agency

__ Faith-based organization

__ Hospital, clinic, or other healthcare provider

__ Private non-profit agency/community-based organization

__ School district

__ University/college

__ Other (please specify) ______________

3. Has [grantee name] previously received TPP funding as a grantee or sub-awardee?

___Yes – as grantee

___ Yes – as sub-awardee

___No

(If 3=yes, then ask 3a):

3a. Please select the type of TPP funding previously received and the year awarded: (Select all that apply)

__ Tier 1 (2010-2015): Evidence-Based Programs (EBPs)

__ Tier 2 (2010-2015): Research and Demonstration

__ Tier 1a (2015-2020): Building Capacity to Implement EBPs

__ Tier 2a (2015-2020): Supporting Early Innovation to Prevent Teen Pregnancy

__ Tier 1b (2015-2020): Implementing EBPs to Scale

__ Tier 2b (2015-2020): Rigorously Evaluating New TPP Approaches

__ TPP18 (2018-2020): Phase I Testing New and Innovative TPP Strategies

__ TPP19 Tier 1 (2019-2020): Replicating Effective Programs to Prevent Teen Pregnancy

__ (If Tier 1 grantee, then include): TPP20 Tier 2 (2020-2023): TPP Innovation and Impact Networks

__ (If Tier 2 grantee, then include): TPP20 Tier 1 (2020-2023): Optimally Changing the Map for Teen Pregnancy Prevention

__ Other (please specify) ______________

(If Tier 1 grantee, ask questions 4-9):

4. What are your TPP project’s service area(s) as defined by geographic boundaries (e.g., the specific ZIP codes, school districts, cities, or counties, etc. served by the grant)?

______________

5. Does your TPP project have a specific focus population(s) in the designated service area(s)?

___Yes

___No

(If 5=yes, then ask 5a and 5b):

5a. Please describe the focus population(s) (e.g., demographic characteristics, ages, special populations, and/or participant types):

_____________

5b. Does the TPP project only serve the focus population(s)?

___Yes

___No

6. What role does [grantee name] have in the TPP project? (Select all that apply)

___Fiscal agent (disburses funds to partners/sub-awardees who provide the programming)

___Identifying evidence-based interventions (EBIs)

___Other program design

___Provide EBIs directly to youth

___Provide other services directly to youth (Specify:_____________)

___Collect and report performance measures

___Conduct fidelity monitoring

___Provide training and technical assistance or capacity-building

___Other: Specify:______________

Services

7. In the table below, please select the evidence-based interventions (EBIs) that are being implemented by the TPP project and the setting(s) in which they are being implemented.

EBI Name	Setting 1	Setting 2	Setting 3	Setting 4	Setting 4

8. What supportive services (in addition to EBIs) does the TPP project provide directly? Please limit your answers to those services that are directly supported by TPP grant funds. (Select all that apply)

___Reproductive healthcare

___Primary healthcare

___Case management

___Educational services

___Food and nutrition (SNAP, WIC, other)

___Health insurance (Medicaid, CHIP)

___Housing support

___Income security (TANF, etc.)

___Job training/work-readiness

___Mental health

___Substance use services

___Violence prevention services

___Other: Specify__________

9. To which supportive services (in addition to EBIs) does the TPP project provide referrals? Please include in your response services that your organization may provide that are not directly supported by TPP grant funds. (Select all that apply)

___Reproductive healthcare

___Primary healthcare

___Case management

___Educational services

___Food and nutrition (SNAP, WIC, other)

___Health insurance (Medicaid, CHIP)

___Housing support

___Income security (TANF, etc.)

___Job training/work-readiness

___Mental health

___Substance use services

___Violence prevention services

___Other: Specify__________

(If Tier 2 grantee, ask questions 10-11):

10. Does your TPP project have a specific focus population within your selected priority area? (Select all that apply)

___Yes

___No

(If 10=yes, then ask 10a):

10a. Please describe the focus population(s):

_____________

11. As the lead organization, what is your role in implementing the TPP project? (Select all that apply)

___Fiscal agent (disburses funds to partners/sub-awardees who provide programming)

___Establish and support partnership network only

___Explore interventions

___Develop new interventions

___Test interventions

___Refine interventions

___Evaluate interventions

___Disseminate interventions

___Other (Specify:______________)

Partnerships

(If Tier 2 grantee, ask question 12):

12. How many partners are involved in the TPP project?

___________

(Ask questions 13-15 for all grantees):

13. How many formal partners are involved in the TPP project? By formal partners we mean the organization has an MOU or letter of commitment with your organization or received a portion of the grant funding in order to complete some aspect(s) of the TPP project.

_____

14. Among these formal partners, how many did your organization have a pre-existing relationship with prior to (If Tier 1 grantee): applying for FY2020 TPP project funding (If Tier 2 grantee): joining the network?

_____

15. What types of organizations are your formal partners? (Select all that apply)

___City/town government agency

___County government agency

___State government agency

___Tribal government agency

___Elementary or secondary education (public or private)

___Faith-based organization

___Health care service provider (e.g., clinics, hospital, public health, private healthcare providers)

___Private non-profit agency/Community-based organization

___Private for-profit company/consultant

___University/college

___Other (Specify): ______________

(If Tier 1 grantee, ask question 16):

16. What role do the formal partners have in the TPP project? (Select all that apply)

___ Deliver evidence-based interventions (EBIs) to youth

___ Provide youth referrals to EBIs

___ Provide program setting or access to youth

___ Provide support for evaluation/performance measures

___ Provide training on EBIs to providers

___ Provide other training or capacity building services (specify: ________)

___ Provide youth-friendly health care services

___ Provide youth with other services (Specify: ____________)

___ Participate in or lead a community or youth advisory group related to the project

___ Provide or support dissemination and public messaging (e.g., for recruitment or program awareness)

___ Intermediary (disperses funds to organizations who provide the EBI programming)

___ Other (Specify):_____________________________________

(If Tier 2 grantee, ask questions 17-20):

17. What role does your organization have in coordinating and supporting the network? (Select all that apply)

___Provide personalized coaching to network partners

___Provide expert-led workshops

___Provide/facilitate peer-to-peer learning

___Facilitate small team workgroups

___Provide technical assistance to network partners

___Other (please specify): ______________

18. What role(s) do formal partners have in coordinating and supporting the network? (Select all that apply)

___Provide personalized coaching to network partners

___Provide expert-led workshops

___Provide/facilitate peer-to-peer learning

___Facilitate small team workgroups

___Provide technical assistance to network partners

___Other (Specify): ______________

19. Are informal partners involved in coordinating or supporting the network? By informal partners we mean those organizations or parties that do not have an MOU with your organization or did not receive a portion of the grant funds.

___Yes

___No

(If 19=yes, then ask 19a):

19a. Please briefly describe how informal partners are involved in coordinating or supporting the network:

_____________

20. What roles do your formal and informal partners have in implementing the TPP project? (Select all that apply)

___Explore interventions

___Develop new interventions

___Test interventions

___Refine interventions

___Evaluate interventions

___Disseminate interventions

___Other (Specify:______________)

Interventions

(If Tier 2 grantee, ask questions 21-24):

21. How many innovations (interventions) have been developed by the TPP project?

_____

22. Please list the innovations and their current stage of development.

_____(open text field) _____(drop down list of stages of development)

23. How many innovations have entered the dissemination phase?

_____

24. Please briefly describe how the TPP project is disseminating new innovations to make them easily accessible and available to others.

_________________

Community Engagement

(If Tier 1 grantee, ask questions 25-28):

25. How did the TPP project engage youth to support planning and implementation of the TPP project? (Select all that apply)

___ Engaged existing youth-led advisory groups or coalitions

___ Created a new youth-led advisory group or coalition

___ Engaged existing adult-led community advisory groups or coalitions

___ Created new adult-led community advisory group or coalition

___ Held public listening sessions or open meetings

___ Had ad-hoc engagements

___ Held focus groups

___ Surveys

___ Used a community needs assessment

___ Used social media and web-communications

___ Other: Specify ____________________

26. How did the TPP project engage parents or caregivers to support planning and implementation of the TPP project? (Select all that apply)

___ Engaged existing advisory groups or coalitions

___ Created a new advisory group or coalition

___ Held public listening sessions or open meetings

___ Had ad-hoc engagements

___ Held focus groups

___ Surveys

___ Used a community needs assessment

___ Used social media and web-communications

___ Other: Specify ____________________

27. How did the TPP project engage other community members to support planning and implementation of the TPP project? (Select all that apply)

___ Engaged existing community advisory groups or coalitions

___ Created new community advisory group or coalition

___ Held public listening sessions or open meetings

___ Had ad-hoc engagements

___ Held focus groups

___ Surveys

___ Used a community needs assessment

___ Used social media and web-communications

___ Other: Specify ____________________

28. What types of platforms did the TPP project use for community outreach and communication to recruit participants or educate parents, caregivers, and other community members?

___ Blog posts

___ Flyers/brochures

___ Health fairs or other public events

___ Local media (e.g., radio, television, newspapers)

___ Newsletters

___ Public presentations

___ Publications

___ Social media

___ Websites

___ Other: Specify_____________

(Ask question 29 to all grantees):

29. Is there anything else you would like to share with the evaluation team or any clarifications you would like to provide to your answers above? (Optional)

_____________________________________________