0920-n/a OD2A-LOCAL Evaluation and Performance Measuring Plan Tem

Evaluation & Performance Measurement Plan Template

Form Approved 

OMB NO: 0920-1283 

Exp. Date: XXX

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Instructions: Please use this template to outline your approach to meeting the following evaluation requirements: evaluation of required prevention activities, performance measurement reporting, targeted evaluation project focused on navigation activities, evaluation translational product, community needs assessment, evaluation community of practice, and cross-site evaluation. This template will be updated 6 months post-award and should not exceed 20 pages. For more guidance, please refer to the Evaluation and Performance Measurement section of the Notice of Funding Opportunity (NOFO).

Definition of key terms used in this template:

Evaluation Question: Evaluation questions can be either process or outcome focused. Evaluation questions describe exactly what you are evaluating. Example evaluation questions are provided for the “enhance PDMP” activity: (1) To what extent were barriers to PDMP registration removed? (2) To what extent were healthcare professionals accessing the PDMP? (3) To what extent were PDMP registration and use percentages changed?

Outcome: Describe general benefits related to changes in behavior, skills, knowledge, attitudes, values, condition, status or other attributes. Outcomes can be short-term, intermediate, and long-term and should align with logic model outlines. An outcome example is improved PDMP registration.

Indicator: Measures achievement and are considered operationalized outcomes; specify how the outcome will be measured. An indicator example for the outcome “improved PDMP registration” is percent of prescribers registered with PDMP. Indicators are closely tied to the outcomes that are in the logic model/NOFO and should be responsive to evaluation questions.

Data Collection Method: In this column of the template, describe how the data will be collected. For example, survey, key informant interview, document review, etcetera.

Data Source: List the source of your data. For example, if it is your PDMP, then list the name of your PDMP. If another existing data system is being used for health outcomes, list the name of that system. If you are collecting new data, then describe who you are interviewing, surveying, etc. For example, healthcare providers, people with lived experience, etc.

Timeline: Describe the frequency of data collection, data analysis, and dissemination. For example, monthly, quarterly, annually, etcetera.

Insert Name of Applicant

Overall Evaluation Approach
Describe how health equity will be integrated throughout your evaluation efforts:
Describe the approach to considering the needs of priority populations and people with lived experience during program/evaluation planning and development:
Describe how the evaluation will measure the impact of tailored activities to groups disproportionately affected by overdose:
Describe how evaluation data will be used and disseminated to various partners, collaborators, and affected groups (Dissemination methods should vary depending on the audience):
Evaluation of all required prevention activities
Utilize Navigators for Linkage Navigators can include peer navigators, certified peer recovery specialists, peer support specialists, case managers, patient navigators, community health workers, persons with lived experience, and other individuals who link PWUD to care and harm reduction resources. These are individuals familiar with the local public health landscape and who work directly with individuals with OUD and/or StUD to ensure they have the tools to address barriers to seeking care and who support people accessing treatment and supporting their retention (and reengagement if necessary) in SUD treatment and care, as well as support access to other services, such as harm reduction and social supports. CDC defines linkage using navigators as: 1) linkage to evidence-based treatment for substance use disorders- to include MOUD and other treatment (e.g., cognitive behavioral therapy [CBT], contingency management) and 2) linkage to harm reduction services.
Describe the type of evaluation to be conducted (i.e., process, outcome, or both):
Describe the *timeline of evaluation efforts and how findings will be used to ensure program improvement:
*Key Evaluation Questions	*Indicators	*Outcomes	*Data Collection Methods	*Data Sources
1.
2.
3. (Add additional rows as needed)
Additional Context (Note any additional descriptions that would be helpful to understand the planned evaluation of this activity):
*Denotes terms that are defined on page 1 of this template
Overdose Education and Naloxone Distribution
Describe the type of evaluation to be conducted (i.e., process, outcome, or both):
Describe the timeline of evaluation efforts and how findings will be used to ensure program improvement:
Key Evaluation Questions	Indicators	Outcomes	Data Collection Methods	Data Sources
1.
2.
3. (Add additional rows as needed)
Additional Context (Note any additional descriptions that would be helpful to understand the planned evaluation of this activity):
Guideline-concordant care for prescribing
Describe the type of evaluation to be conducted (i.e., process, outcome, or both):
Describe the timeline of evaluation efforts and how findings will be used to ensure program improvement:
Key Evaluation Questions	Indicators	Outcomes	Data Collection Methods	Data Sources
1.
2.
3. (Add additional rows as needed)
Additional Context (Note any additional descriptions that would be helpful to understand the planned evaluation of this activity):
Performance Measures
List potential Performance measures related to NOFO logic model short-term and intermediate-term outcomes: Reminder: The logic model is embedded in the approach and outcomes section of the NOFO.
Describe how you will collect the performance measures and the frequency of data collection:
Describe how quality of performance data will be assured:
Describe how key program partners will participate in the evaluation and performance measurement planning processes:
Describe barriers to obtaining and calculating proposed measures:
Outline additional comments or questions you have about the proposed measures:
Targeted Evaluation Project (TEP)
Describe your overall approach to the TEP including potential key evaluation questions, indicators, data collection methods, and data sources: Please note: The TEP should be a more in-depth evaluation of your navigation activities for linkage to care and harm reduction services. Please refer to Appendix 10 of the NOFO for more details.
Describe the annual timeline of key steps for conducting the TEP (e.g., Year 1 planning and development, Year 2 Conduct evaluation activities) and how findings will be used to ensure program improvement:
Evaluation Translational Product Translational products can include but are not limited to detailed reports, training or technical assistance resources, case studies, or peer-reviewed publications.
Describe how you will identify which evaluated prevention activity will result in a translational product:
Describe the potential dissemination channels and intended audiences of the product:
Community Needs Assessment Recipients will be required to conduct a needs assessment focused on addressing health equity and the needs of priority populations and people with lived experience within the first 6 months of the new NOFO. For recipients who have already conducted a recent comprehensive needs assessment within the last 2 years, a 3- to 5-page summary of results should be submitted with applications, and additional gaps can be discussed with CDC, if any. Once CDC reviews the assessment, and if it determines that it does not meet the requirements, CDC will work with funded recipients to revise their workplan to include an activity around the assessment. See Appendix 9 of the NOFO for a description of community assessment requirements.
Describe your approach to conducting a community needs assessment and how priority populations will be included:
Describe the potential dissemination channels and intended audiences of the needs assessment:
Evaluation Community of Practice (CoP)
To promote sharing between jurisdictions and between CDC and funded recipients, recipients will participate in a community of practice (CoP), specifically focused on evaluating their overdose prevention activities. The CoP will meet quarterly beginning the first year of the cooperative agreement. Describe how you will participate in and contribute to the evaluation CoP:
Cross-site Evaluation
Recipients will be expected to participate in a CDC-sponsored cross-site evaluation by sharing data already collected and/or participating in new data collection activities. Recipients will be expected to share data collected via a cross-site evaluation with CDC and/or its designee (e.g., contractor). Please enter the name of your jurisdiction below to acknowledge your participation, if awarded: (Name of Applicant) agrees to participate in the cross-site evaluation during the period of performance as described here and in the NOFO.