Care Demonstration Project End of Year Care Template (EOYC)

OMB No. 0990-0299

Exp. XX/XX/XXXX

Adolescent Family Life Care Demonstration Project

End of Year Report

Grant Number (Example APH PA 2000):      

Applicant Organization:      

Title of Project:      

Project Period: (Example September 1, 2008 – August 31, 2009):      

Project Year (1-5):      

Project Director*:      

Title:       :      

Street Address:

Line 1:      

Line 2:      

City:       State (2 Characters):    9-Digit ZIP:      

E-mail:      

Telephone:       Fax:

Program Coordinator: (if different from Project Director):      

Title:            

E-mail:      

Telephone:       Fax:

A Resume or Curriculum Vitae must be mailed to OPHS Grants Management and to your OAPP project officer if this is a new project director.

Project Evaluator:      

Title:            

University/Organizational Affiliation:      

Street Address:

Line 1:      

Line 2:      

City:       State (2 Characters):    9-Digit ZIP:      

E-mail:      

Telephone:       Fax:     

A Resume or Curriculum Vitae must be mailed to your OAPP project officer if this is a new project evaluator.

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 0990-0299, expiration date XXXX. The time required to complete this information collection is estimated to average 65 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review 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 531-H; Washington D.C. 20201. Attention: PRA Reports Clearance Officer.

Adolescent Family Life Care Demonstration Project

End of Year Report

Please note: For more information regarding specific details of the Title XX legislation (i.e. core services, supplemental services, parental consent, etc. please refer to http://www.hhs.gov/opa/about/legislation/index.html).

I. Executive Summary (Abstract)

II. Detailed description of the demonstration model for the previous year.

A. Description of program/intervention for the care demonstration project including:

• Grantee organization (school, state agency, voluntary agency, etc.)

• Geographic area served (urban, rural, suburban).

• Setting(s) (i.e., clinic-based, school-based, home visit)

• Curricula and other educational materials used

• Target population (i.e., gender, age, race/ethnicity, fathers, family members, etc)

• Theoretical review - Brief review of the rationale for use of the project intervention based upon theory, previous practice, review of the literature and/or evaluation findings.

• Describe the demonstration model being implemented (brief description of the demonstration model should include intervention and comparison group breakdown and the services each receives). Include the target numbers for the project and the comparison group.

• Specific intervention strategies and activities (i.e., how services are provided to clients during pregnancy and after delivery with particular emphasis on achieving good health outcomes for mother and infant, how services enable adolescent parents to acquire good parenting and life skills). This needs to include sufficient detail so that someone not familiar with the program will have a reasonable understanding of what will be implemented. This section should include a description of the overall activities designed and the specific activities and intervention for the actual program year being reported on. Include actual numbers of clients served.

• Intensity of intervention(s): duration and frequency (e.g. one hour, once a week, for 12 weeks). Include target dosage for clients.

• Description, if applicable, of how the grantee uses AFL Care services to supplement existing adolescent health services in a school, hospital or other community setting.

• Description of case management and follow-up procedures, if applicable.

• Description of how the grantee provides, directly or by referral, each of the ten core services [see list in sec. 2006(a)(5)(A)] and any supplemental services as appropriate (include an appendix item for any new letters of agreement or new formal linkage agreements made with service providers (sec. 2006(a)(6)).

• Description of how the grantee, as appropriate, involves fathers, parents, guardians, and family members. Description of the process for obtaining parental consent (sec. 2006(a)(22)(A)). Description of how the grantee, as appropriate, incorporates voluntary associations, religious and charitable organizations and other groups in the private sector in the provision of Care services. (sec. 2006(a)(21)(A) and (13))

• Description of how the grantee incorporates the youth development (developmental assets) model into the project. Discuss specific assets being addressed in the project and program activities that are relevant.

B. Logic Model. Description and diagram of the project logic model. This should be created with the project director and evaluator during the early part of the first year and updated as necessary in subsequent project years. The Logic Model should cover each of the following points:

• Logic model is specific about program inputs and activities.

• Logic model depicts clear relationships between inputs, activities, and specific outcomes.

• A “theory of change” is embodied in the logic model.

• The logic model clearly delineates which intervention activities are hypothesized to be associated with which short-term outcomes, and which short-term outcomes are associated with which longer-term outcomes.

• The logic model includes discrete pathways (boxes and arrows) to depict the hypothesized relationships.

The narrative should describe the Logic Model with attention focused on the pathways.

C.. Describe challenges encountered while implementing program and proposed solutions.

D.. Describe any significant changes in the project since the continuation proposal, and how these changes affected implementation of the program and/or evaluation and the number of clients served.

E. Describe the unique features or accomplishments of the project in the previous year.

III. Grantee's financial sustainability plan and activities that support continuation of services at the termination of this Federal funding.

IV. Describe any grants management, program or evaluation issues not otherwise addressed in the report.

V. Evaluation

A. Research Objectives and Hypotheses: describe the outcome-based objectives, with a clear statement of results or benefits expected (or achieved). Objectives should be specific, measurable, achievable, realistic, and time-framed (S.M.A.R.T.).

Address each of the following points in your narrative

• The questions/hypotheses that the evaluation is addressing are clearly stated.

• The questions/hypotheses are closely tied to the SMART objectives.

• The evaluation goals and objectives are aligned with the activities that are being conducted. The outcomes are reasonable, given the level, type, and intensity of the intervention activities.

• The objectives are written in SMART (Specific, Measurable, Achievable, Realistic, Time-framed) terminology.

• The endpoints are behavioral, meaningful, and related to the program’s theory of change.

B. Process Evaluation: provide a description of the process or implementation evaluation plan. 

Please note that evaluations in their first year should focus on determining that the intervention is in place, that it is adequately and appropriately staffed, and that it is reaching its intended population.

1. Indicate if the process evaluation is in place and if it is ongoing.

Address each of the following points in your narrative

• A clear description of the aims of the process evaluation is provided, including a list of what is being assessed to evaluate implementation and fidelity of key program inputs and activities.

• SMART Process Objectives are stated for the key intervention activities.

• Process evaluation data are summarized and included in the report.

2. Describe the measures that are being used for the process evaluation.

Address each of the following points in your narrative

• The Process Evaluation measures and reports on the key intervention activities and objectives.

• The process measures provide sufficient detail to indicate whether implementation is occurring as expected.

• The measures have been used consistently across intervention conditions.

3. Measurement of dosage.

Address each of the following points in your narrative

• Address any inconsistencies between numbers or participants served by the project and those included in the analysis of program objectives and outcome evaluation.

• Exposure to intervention (e.g., number of sessions offered and attendance) for each component is included.

• Include target dosage for clients.

4. Describe any modifications in the program/evaluation.

Address each of the following points in your narrative

• A description of findings from the process evaluation that led to modifications in the program or the outcome evaluation is included.

• Based on the process evaluation data collected, any need for corrections or changes in the intervention’s implementation is described.

• The numbers served in the program match the numbers in the evaluation (i.e., address any inconsistencies between numbers or participants served by the project and those included in the analysis of program objectives and outcome evaluation).

C. Outcome Evaluation Research Design: provide a detailed statement, and possibly a diagram, of the research design. For example, “the evaluation is a quasi-experimental study which includes pretests, post-tests and six month follow-ups of students in the xy school and comparison group…”

1. Comparison Strategy: Describe who is being evaluated, from where they are recruited.

Address each of the following points in your narrative

• The study is characterized as an experimental (randomized) or a quasi-experimental (non-randomized) design. Evidence is given as to why this strategy makes sense in the context of the treatment program.

• The comparison group or groups are clearly specified.

• Members of the comparison group are similar to members of the treatment group.

• Threats to validity have been controlled or discussed.

• Other factors that could explain program effects have been discussed.

2. Sampling Strategy: describe, how many are in each group, and how is this determined, etc; the sample size and whether it is sufficient to ensure that any observed differences between groups are significant; the comparison group and how they are recruited/ sampled, or in the absence of a comparison group, comparison data or strategy.

Address each of the following points in your narrative

• A power analysis supports the sample size and indicates that it is sufficient to detect statistically significant differences in outcomes between treatment and control/comparison groups. If the sample size is not sufficient, this will need to be discussed.

• A description of client recruitment and retention method is included. The description of the method of selecting sample participants from the population is detailed and provides a reasonable basis for generalization of program effects to the broader population of people ‘like those’ in the study.

• If needed, a description is provided of steps to be taken by project staff to increase the likelihood of participation in the program. Reasons for recruitment rates below 70% - 80% are clearly explained.

2. Instrumentation: describe the data collection instruments (surveys, interviews, focus groups) used including information on reliability and validity of instruments and how intervention dosage is measured.  Include the instruments used for data collection in the report appendix the first time this report is submitted, and subsequently reference the data collection instruments as submitted in the out years’ reports.

Address each of the following points in your narrative

• The outcome measures assess actual behavior change.

• The outcome measures map onto research objectives/hypotheses.

• A description of the measures’ validity and reliability is included.

• Scales as opposed to single items are used.

2. Data collection process and schedule.

Address each of the following points in your narrative

• The timing of the data collection is aligned with program activities.

• The data collection schedule is realistic and achievable.

• The data collection for the intervention and comparison group participants is similar. If there is a difference, there is a justification provided for the difference.

• Quality assurance procedures to improve data validity and reliability are described.

• A description of the data collectors and the training that they received is included.

• Challenges or logistical issues in administering data collection that could affect the interpretation of results are described.

2. Management Information System: describe what type of management information system is available and the entire data process, including how the survey is administered, who collects the data and enters them into the system, and who analyzes the data. State how the evaluator and program staff ensure confidentiality of the data.

Address each of the following points in your narrative

• Data confidentiality issues are discussed (e.g., how names of participants and their data are maintained).

6. Describe the follow-up assessment and longitudinal tracking of program participants during and after the intervention, if applicable.

7. Data analysis procedures.

Address each of the following points in your narrative

• Statistical methods used to assess the program’s impact are clearly described (e.g., type of design, statistics used).

• Analytic procedures are appropriate for the research design and data being collected.

• A description of the baseline comparability of groups is included, preferably in tabular form, with statistical comparisons.

• Subgroup analyses are described.

• Proposed methods for handling attrition bias are discussed. If longitudinal data were collected, these analyses are reported.

• Proposed methods for handling missing data are described. If there is missing data, these analyses are reported.

  8. Discuss the design limitations.

Address each of the following points in your narrative

• Identify the specific limitations of the overall design and of the actual implementation for the program year being reported on.

• A description of the threats to validity (e.g., selection bias, maturation, history, and cohort effects) is described along with explanations for change over time (e.g., secular trending).

9. Describe how the evaluation fits in with the program particularly how data is used for mid-course corrections and ongoing program improvements.

D. Results: describe the findings of the study using numbers, percentages, means and standard deviations, and results from other statistical analyses that are appropriate for the selected design.

1. Tables: provide tables or graphs showing demographics, proportion of participants receiving a given dosage/ intensity level, statistical analysis.

Address each of the following points in your narrative

• The report includes a table with the number of participants in the intervention group(s) and comparison group, as well as those recruited to the intervention, enrolled/completing baseline screening or pre-test, completing the intervention and/or the post-test, and completing follow-up surveys at subsequent follow-up intervals.

• The report addresses any inconsistencies between numbers or participants served by the project and those included in the analysis of program objectives and outcome evaluation.

2. Findings related to evaluation questions/ hypotheses and SMART objectives.

Address each of the following points in your narrative

• Findings are provided for each question and objective.

• Appropriate analyses are used to assess program effects and are adequately described in the narrative.

• Subgroup analyses that were performed are presented for primary outcomes.

2. Missing Data: Provide a discussion of missing data and strategies for overcoming data collection and follow-up challenges.

Address each of the following points in your narrative

• The report provides data on missing data at each round of data collection, and the results of analyses for handling for missing are included.

2. Attrition Analysis.

Address each of the following points in your narrative

• The report provides data on attrition at each round of data collection and the results of analyses for handling attrition bias are included.

E. Discussion

1. Interpretation of the results for each evaluation question, including relevant information from the process evaluation component.

2. Issues that affected the outcome evaluation and how they were addressed.

3. Problems encountered during the implementation and evaluation process and proposed solutions.

4. A statement of the extent to which the program reached or is approaching its objectives (that is, to what extent are both the process and outcome objectives being met).

5. Implications of findings

F. Recommendations from the evaluator based on the process and outcome evaluation results.

G. List of any professional presentations or publications from the AFL demonstration project. 

V. Appendices

A. Enclosure A: Numbers and types of program participants

B. Enclosure B: Data supporting the AFL Care Performance Measures

C. Enclosure C: Data regarding the AFL Efficiency Measure

D. Enclosure D: Process evaluation

Enclosure A – Care

Program Statistics

Special Note: Please count EVERY participant involved in your AFL program regardless of how long or the level of involvement in your program's activities. To the best of your ability, please provide unduplicated numbers of clients seen this year. The numbers of participants in the table for ethnicity should be the same as the numbers of participants in the table for race, for females and males respectively. *Please include in the category “adolescent parents” those who entered the project at the age of 18 or younger but are now over 18 due to being enrolled in the project for a follow-up period.

Count of Pregnant and Parenting Adolescent Women in the AFL Project:*

Ethnicity	14 years and under	15-17 years	18-19 years	20 Years and Older	Total
Hispanic or Latino
Not Hispanic or Latino
Unknown/unreported
Total

Race	14 years and under	15-17 years	18-19 years	20 Years and Older	Total
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
More than one race
Unknown/unreported
Total

Count of Adolescent Fathers and Male Partners in the AFL Project*

Ethnicity	14 years and under	15-17 years	18-19 years	20 Years and Older	Total
Hispanic or Latino
Not Hispanic or Latino
Unknown/unreported
Total

Race	14 years and under	15-17 years	18-19 years	20 Years and Older	Total
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
More than one race
Unknown/unreported
Total

Count of Other Clients Served:

	Infants and Children	Siblings	Parents/ Grandparents	Other Care Services Recipients (describe below)	Total
Total

Enclosure B – Care

Performance Measures for AFL Care Projects

All grantees should complete Performance Measures 1-3 using the AFL Care Core Follow-Up Instrument. A separate Enclosure B should be completed for clients at 12 and 24 month follow-up data points. Please only report on clients in the intervention group for the performance measures. If there are 2 intervention groups, report on all clients in intervention groups based on follow-up data point.

CARE LONG TERM MEASURE # 1: Maintain the incidence of clients in AFL Care demonstration projects who do not have a repeat pregnancy

Number of respondents who answered “yes” to Care Core Follow-up Question 33: “Have you been pregnant since that pregnancy ended?” (This question is for pregnant baseline.) _____

Number of respondents completing Follow-Up Question 33. _____

AND

Number of respondents who answered “yes” to Care Core Follow-up Question 34: “Have you been pregnant since that pregnancy?” (This question is for parenting teens at baseline.) _____

Number of respondents completing Follow-Up Question 34. _____

CARE LONG TERM MEASURE #2: Increase infant immunization among clients in AFL Care demonstration projects.

Number of respondents with infants aged 3 months or older who answered “yes” to all 6 vaccinations listed in Care Core Follow-up Question 22 “Has this child had any of the following vaccinations/shots?” ______

Number of respondents with infants aged 3 months or older completing Follow-up Question 22. ______

CARE LONG TERM MEASURE #3: Increase the educational attainment of clients in AFL Care demonstration projects.

Number of respondents who answered “in school or GED program” or “graduated from high school or completed GED” to Care Core Follow-up Question 37: “What is your current school status?” _____

Number of respondents to Follow-up Question 37 _____

This Enclosure B is for data collected at 12 months _____ or 24 months _____.

Enclosure C – Care

Efficiency Measure for AFL Care Projects

All projects reporting for years 2-5 should complete the efficiency measure. Please review the instructions carefully prior to completing the efficiency measure.

EFFICIENCY MEASURE: Sustain the cost to encounter ratio in Title XX Care Demonstration Projects.

Numerator

Program costs: Financial Status Report Line 10D: (Net outlays) minus Evaluation costs allotted in the budget (Total program costs should include Federal and non-Federal monies)

______

Denominator

Individual Client Service Hours delivered this year _____

Group/ Family Client Service Hours delivered this year _____

Total Client Service Hours delivered this year _____

Enclosure D – Care

Process Evaluation Data Collection Form

A. INTERVENTION SETTING AND POPULATION

The following questions are about your AFL demonstration project and target population characteristics. If your demonstration project evaluation involves a treatment group and a comparison group, these questions are about your treatment group.

A1. How many treatment groups does your project have?

Mark one response

₁ One

₂ More than onePlease complete a separate Enclosure D for each treatment group

A2. Which of the following best describes where your AFL project activities are primarily delivered?

Mark one response

₁ Faith-based organization(s)

₂ Health clinic(s)

₃ Hospital(s)

₄ Other community-based organization(s)

(a. Describe:

     

)

₅ Participants’ homes

₆ School(s)

7 Other (a. Describe:

     

)

A3. How are adolescents selected to participate in your project?

Mark all that apply

₁ Self-referral

₂ Referral by school

₃ Referral by doctor/clinic

4 Other (a. Describe:

     

)

A4. Please indicate what percentages of adolescents selected to participate in your project at intake are:

     ₁ % pregnant, in the first trimester

     ₂ % pregnant, in the second trimester

     ₃ % pregnant, in the third trimester

     ₄ % parenting, with an infant under 3 months

     ₅ % parenting, with an infant from 3 to 6 months

     ₆ % parenting, with a child 6 months or older

(Percentages should total 100%.)

A5. Does your project also serve any of the following?

Mark all that apply

₁ Adolescent fathers

₂ Parents of pregnant or parenting adolescents

₃ Other family members of pregnant or parenting adolescents

(a. Describe:

     

)

₄ This project only serves pregnant and/or parenting adolescent girls

A6. Which of the following best describes your project’s approach towards pregnant and/or parenting adolescents?

Mark one response

₁ Generally available to all adolescents in need of services in a school, community, or clinic  If your project is generally available to all adolescents in need of services,
skip to Section B

₂ Targeted at specific adolescents

A7. Which adolescents are targeted?

Mark all that apply

₁ Adolescents who have dropped out or are at risk for dropping out of school

₂ Homeless adolescents

₃ Immigrant adolescents

4 Other (a. Describe:

     

)

B. PROJECT CONTENT AND DELIVERY

The following questions are about your AFL demonstration project components and activities. If your demonstration project evaluation involves a treatment group and a comparison group, these questions are about your treatment group. Unless directed otherwise, think about all of the project activities that benefit adolescents in the treatment group in your AFL demonstration project.

B1. Which of the following would you identify as the primary goal(s) of your AFL demonstration project?

Mark all that apply

₁ Improve immunization compliance

₂ Improve parenting skills

₃ Improve performance in school (i.e., grades)

₄ Improve social support systems for adolescent parents

₅ Prevent sexually transmitted infections (STIs)

₆ Prevent repeat pregnancy

₇ Prevent school dropout

8 Other (a. Describe:

     

)

B2. Does your project implement any of the following activities to recruit adolescents?

Mark all that apply
1 Implement activities at times convenient for adolescents
2 Invite adolescents to attend the project
3 Partner with prenatal care clinic(s)
4 Pass out flyers about the project
5 Provide infant or child care during project activities
6 Provide food for participants during activities
7 Provide other incentives (e.g., gift certificates)
8 Provide a telephone number adolescents could call
9 Other (a. Describe:	     	)

B3. Which of the following best describes your project activities?

Mark one response

₁ Project activities are one-on-one with staff and participants If your project activities

are one-on-one with staff and participants, skip to item B5

₂ Project activities occur with groups of participants

₃ This project includes both group and one-on-one activities

B4. What is the average number of participants and staff per group in the project?

a.       participants per b.       staff

B5. Are messages about sexual behavior tailored in any of the following ways?

Mark all that apply

₁ Yes—To the age of the adolescents

₂ Yes—To the sexual experience of the adolescents

₃ Yes—To the gender of the adolescents

₄ Yes—To the culture of the adolescents

5 Yes—Other (a. Describe:

     

)

₉₈ No—Standardized messages are provided to all adolescents

B6. Which of the following family planning-related activities to reduce repeat pregnancy does your project employ?

Mark all that apply

₁ Counseling about contraceptive options

₂ Information about how different family planning options work

₃ Provision of condoms

₄ Role play discussing family planning with partners

5 Other (a. Describe:

     

)

₉₈ None of the above

B7. To improve compliance with recommended infant immunization schedules, does your project do any of the following?

Mark all that apply

₁ Conduct community-wide education campaigns (e.g., mail, radio, newspaper, TV, posters)

₂ Conduct home visits including education, assessment of need, referral, and/or provision of vaccinations

₃ Educate participants to address health concerns regarding vaccinations

₄ Educate participants to address other barriers to vaccinations

₅ Educate participants about vaccination services available

₆ Provide vaccination records to participants or their families

₇ Reduce out-of-pocket costs for vaccinations

₈ Refer participants to the Women, Infants, and Children (WIC) program

₉ Remind participants about immunization schedule

10 Other (a. Describe:

     

)

₉₈ None of the above

B8. To improve educational attainment, does your project provide any of the following?

Mark all that apply

₁ Behavioral modeling

₂ Cognitive-behavioral methods

₃ Community service activities

₄ Counseling

₅ Mentoring

₆ Self-control instruction

₇ Social competency development

₈ Tutoring

9 Other (a. Describe:

     

)

₉₈ None of the above

B9. Does your AFL demonstration project provide home visiting services for pregnant and/or parenting adolescents?

₁ Yes

₀ No  If your AFL demonstration project does not provide home visiting services for pregnant and/or parenting adolescents, skip to item B12 on page 17

Remember, if your demonstration project evaluation involves a treatment group and a comparison group, the following questions refer to your treatment group.

B10. Which of the following best describes the individuals who conduct home visits?

Mark all that apply

₁ Nurses

₂ Social workers

₃ Trained community members

₄ Trained peer educators

5 Other (a. Describe:

     

)

B11. How frequently are home visits conducted?

Mark one response

₅ Weekly or more often

₄ Every 2 weeks

₃ Monthly

₂ Once every 2 or 3 months

1 Less frequently (a. Specify:

     

)

B12. Does your AFL demonstration project provide mentoring for adolescents?

₁ Yes

₀ No  If your AFL demonstration project does not provide mentoring for adolescents, skip to item B19 on page 18

B13 Are mentoring activities one-on-one?

Mark one response

₁ Yes

0 No (a. Describe: ______________________________________________)

B14. Where do mentors and mentees typically meet?

Mark all that apply

₁ In person at a school

₂ In person at a community center or other community location

₃ In person at the mentee’s home

₄ By telephone

5 Other (a. Describe:

     

)

B15. Which of the following best describes when training for mentors occurs?

Mark one response

₀ There is no specific training for mentors

₁ Before the mentor and mentee are matched

₂ After the mentor and mentee are matched

₃ Both before and after the mentor and mentee are matched

B16. Which of the following best describes mentors’ employment status?

Mark one response

₁ Mentors are paid staff

₂ Mentors are volunteers

3 Other (a. Describe:

     

)

B17. Which of the following best describes the way mentors are assigned to mentees?

Mark one response

₁ Mentors are assigned to mentees based on specific criteria (such as gender,

race, mutual interests, etc.)

₂ Mentors are matched to mentees based on availability

3 Other (a. Describe:

     

)

B18. Which of the following are true for your project?

Mark all that apply

₁ Mentor-mentee relationship is monitored by an AFL project staff person

₂ Mentoring is provided by adult mentors

₃ Mentoring is provided by peer mentors

₄ Prospective mentors are screened (e.g., a background check or an interview)

₅ The mentoring component seeks support from the parent or guardian of the

mentee

₆ There are clear expectations for frequency of mentor/mentee contact

₇ There are clear expectations for the length of the mentor/mentee relationship

₈ There are structured activities for mentors and mentees

B19. Does your AFL demonstration project provide case management services for pregnant and/or parenting adolescents?

₁ Yes

₀ No  If your AFL demonstration project does not provide case management services for pregnant and/or parenting adolescents, skip to item B23 on page 19

Remember, if your demonstration project evaluation involves a treatment group and a comparison group, the following questions refer to your treatment group.

B20. What is the average caseload of a case manager at your demonstration project?

Mark one response

₁ Less than 10 participants (Specify :_________participants)

₂ 10 to 19 participants

₃ 20 to 29 participants

₄ 30 to 39 participants

₅ 40 participants or more (Specify :_________participants)

B21. How often do case managers meet with adolescents?

Mark one response

₇ Daily

₆ Several times a week

₅ Once a week

₄ Once every two weeks

₃ Once a month

2 Less than once a month (a. Specify:

     

)

₁ One time only

B22. Which of the following are provided as part of the case management component of your demonstration project?

Mark all that apply
1 Advocacy for adolescents who encounter barriers to services
2 Coordination with adolescents’ classroom teachers
3 Coordination with adolescents’ health care providers
4 Crisis intervention
5 Health assessment
6 Home visits
7 Individual counseling
8 Nutritional assessment
9 Psychosocial assessment
10 Parenting skills training
11 Referrals to other services
12 Service planning
13 Tutoring
14 Vocational or educational assessment
15 Other (a. Describe:	     

B23. Does your AFL demonstration project conduct activities at school during school hours?

₁ Yes

₀ No  If your AFL demonstration project does not conduct activities at school during

school hours, skip to item B26 on page 20

Remember, if your demonstration project evaluation involves a treatment group and a comparison group, the following questions refer to your treatment group.

B24. How often do adolescents participate in school-based activities?

Mark one response

₇ Daily

₆ Several times a week

₅ Once a week

₄ Once every two weeks

₃ Once a month

2 Less than once a month (a. Specify:

     

)

₁ One time only

B25. Which of these activities does your project conduct as part of the school-based component? School-based activities are activities that are conducted at school during school hours.

Mark all that apply
1 Case management at school
2 Child care at school
3 Coordination of services with adolescents’ teachers
4 Education or vocational planning at school
5 Group instruction for adolescents at school
6 In-service education with school faculty and staff about project services
7 Mental health counseling at school
8 Mentoring at school
9 Nutritional counseling at school
10 One-on-one instruction at school
11 Parenting skills instruction/curriculum at school
12 Prenatal care at the school
13 Supervised parenting skills practice at the school
14 Tracking absent days
15 Tutoring
16 Well-baby care at the school
17 Other (a. Describe:	     	)

B26. Is your project based on specific behavioral theory or theories?

1 Yes (a. Which one[s]?

     

)

₀ No

B27. Does your project use any evidence-based curricula, programs, or strategies? (Evidence-based curricula, programs, or strategies have been proven to be effective through evaluation.)

1 Yes  (a. Which one[s]?

     

)

₀ No  If your project does not use any evidence-based curricula, programs, or strategies skip to item B29

₉₇ Not sure  If you are not sure whether your project uses any evidence-based curricula, programs, or strategies, skip to item B29

B28. We’d like to learn more about your evidence-based curriculum, program, or strategy. Can you provide a Web site, article(s), publisher, or other source of information we could use to read more about the curriculum and evidence of its effectiveness?

     

     

B29. We want to learn about what makes your project a demonstration project or an innovation. Does your project:

Mark all that apply

₁ Adapt or make changes to an evidence-based curriculum

₂ Deliver an existing project to a previously underserved population

₃ Add or change one or more project components to modify an existing project

₄ Employ a new approach

₅ Do something else innovative

₉₈ None of the above If none of the above applies to your project, skip to item B31 on page 22

B30. Please explain your answer to Question B29.

     

     

     

B31. Please indicate whether you provide the following services directly at your organization or by referral to a partner or other agency.

Mark one response for each item:	Only provided directly	Only provided by referral	Both provided directly and by referral	Service not provided
a. Adoption counseling	1	2	3	98
b. Counseling for family planning	1	2	3	98
c. Education about the responsibilities of sexuality and parenting	1	2	3	98
d. Educational and vocational services	1	2	3	98
e. Educational materials to support the role of parents as providers of sex education	1	2	3	98
f. Educational resources about self-discipline and responsibility in human sexuality are provided to:
1. Parents	1	2	3	98
2. Schools	1	2	3	98
3. Health providers	1	2	3	98
4. Youth agencies	1	2	3	98
g. Information about adoption	1	2	3	98
h. Maternity counseling	1	2	3	98
i. Mental health services	1	2	3	98
j. Nutrition information and counseling	1	2	3	98
k. Pediatric care	1	2	3	98
l. Postnatal care	1	2	3	98
m. Pregnancy testing	1	2	3	98
n. Prenatal care	1	2	3	98
o. Provision of family planning services	1	2	3	98
p. Screening and treatment of STIs	1	2	3	98

C. INTERVENTION EXPOSURE

The following questions are about participant exposure to your project and the amount of time participants receive project activities. If your demonstration project evaluation involves a treatment group and a comparison group, these questions are about your treatment group.

C1. On average, how many hours does each participant receive project activities?

Mark one response

1 6 hours or less (a. Specify:

     

hours)

₂ 7–13 hours

₃ 14–20 hours

₄ 21–30 hours

₅ 31–50 hours

₆ 51–75 hours

₇ 76–100 hours

8 More than 100 hours (a. Specify:

     

hours)

C2. How often do participants receive project activities?

Mark one response

₇ Daily

₆ Several times a week

₅ Once a week

₄ Once every two weeks

₃ Once a month

2 Less than once a month (a. Specify:

     

)

₁ One time only

C3. Over what period of time does each participant receive project activities?

Mark one response

₁ Less than 6 months

₂ 6 to 12 months

₃ 13 to 18 months

₄ 19 to 24 months

5 More than 24 months (a. Specify:

     

months)

C4. Generally, what proportion of participants enrolled in the project completes the intervention in its entirety?

Mark one response

₄ All

₃ Many

₂ About half

₁ Some

₀ None

D. ORGANIZATIONAL CONTEXT

D1. For how many years has this project been in place? If this project was in place prior to the current AFL funding, please be sure to count those years. If this project has been adapted from a past project within your organization but still has similar goals, please be sure to count those years.

     

year(s)

D2. Which of the following best describes how permanent this project is within your organization?

Mark one response

₁ Not at all permanent

₂ Somewhat permanent

₃ Permanent

D3. Which of the following is true for your AFL demonstration project?

Mark all that apply

₁ The project’s goals and objectives have been put into writing

₂ Plans and procedures used for implementing this project have been put into writing

₃ A schedule (e.g., timetable, plan of action) used for implementing project activities has been put into writing

₄ Strategies for implementing this project have been adapted to fit local circumstances

₅ Formalized job descriptions have been written for staff involved with this project

₆ Permanent staff have been assigned to implement this project

₇ An administrative-level individual within your organization has been actively involved in advocating for this project’s continuation

₈ Staff in your organization other than those actually implementing this project actively contribute to the project’s operations

D4. Have you involved any of the following external stakeholders in your AFL demonstration project?

Mark all that apply
1 Community organizations
2 Faith community
3 Local government (e.g., town or city government)
4 Private, non-profit social service provider (e.g., family services, drug treatment center)
5 School district(s)
6 Other (a. Describe:	_________________________________     	)

E. PROJECT STAFF

E1. How many different individuals at your organization are paid (either part-time or full-time) to work on the AFL demonstration project?

     

staff persons

E2. What is the total number of full-time equivalent paid staff (FTEs) who work on your AFL demonstration project? For example, if two paid staff each work at 50% time on AFL demonstration project activities, they would equal 1 FTE.

     

FTEs

E3. How many volunteers work on the AFL demonstration project?

     

volunteers

The next questions ask about individuals who deliver AFL demonstration project activities to participants.

E4. Please indicate how many individuals in each of the following age ranges deliver project activities?

     ₁ Younger than 18 years old

     ₂ 19–25 years old

     ₃ 26–35 years old

     ₄ 36–45 years old

     ₅ 46–55 years old

     ₆ 56–65 years old

     ₇ Older than 65 years old

E5. Are the individuals delivering AFL project activities. . .

Mark one response

₁ All female

₂ Mostly female

₃ Evenly split male and female

₄ Mostly male

₅ All male

E6. Please indicate how many individuals who completed each of the following levels of education deliver AFL project activities?

     ₁ Some high school

     ₂ High school diploma or GED

     ₃ Some college, but no degree

     ₄ 2-year college degree

     ₅ Bachelor’s degree

     ₆ Master’s degree or higher

E7. Which of the following best describes the educational background or experience (prior to working on the AFL demonstration project) of the individuals delivering project activities to AFL demonstration project participants?

Mark all that apply

₁ Adolescent medicine

₂ Adolescent reproductive health

₃ Case management

₄ Counseling

₅ Education (e.g., school teacher)

₆ Health education

₇ Nursing

₈ Nutrition

₉ Public health

₁₀ Pediatric medicine

₁₁ Sex education or HIV education

₁₂ Social work

₁₃ Other (a. Describe: )

E8. On average, how long have individuals delivering project activities worked with pregnant and parenting adolescents, not including their time with this AFL demonstration project?

Mark one response

₁ Not at all – the average individual delivering project activities has never worked with pregnant or parenting adolescents beyond their work on this AFL demonstration project

₂ Less than 6 months

₃ 6 months or more but less than 1 year

₄ 1 to 3 years

₅ 4 to 6 years

₆ 7 or more years (a. How many? _______years)

E9. Are there individuals delivering project activities who are Hispanic or Latino?

₁ Yes

₀ No

E10. Mark the box or boxes below that describe the race of individuals delivering project activities.

Mark all that apply

₁ White

₂ Black or African American

₃ Asian

₄ Native Hawaiian or Other Pacific Islander

₅ American Indian or Alaska Native

6 Other (a. Describe:

     

)

E11. What proportion of individuals delivering project activities receive training to do this (other than training provided by OAPP)?

Mark one response

₄ All

₃ Many

₂ About half

₁ Some

₀ None  If none of the individuals delivering project activities receive training, skip to item E13

E12 Of those who receive training, how much training do they receive (other than training provided by OAPP)?

Mark one response

1 7 hours or less (a. How many?

     

hours)

₂ 8 to 15 hours

₃ 16 to 23 hours

₄ 24 to 31 hours

₅ 32 to 39 hours

₅ 40 to 47 hours

6 48 hours or more (a. How many?

     

hours)

E13. On average, how long have individuals delivering project activities served in their current roles?

Mark one response

₁ 1 year or less

₂ 2 years

₃ 3 years

₄ 4 years

5 5 years or more (a. How many?

     

years)

10