Att 5 Com and Clinical Partners Prog Implem Partner Need

Form Approved

OMB No. 0920-xxxx

Exp. xx/xx/xxxx

State and Community Awardee

Program Implementation Partner Needs Assessment

Public reporting burden of this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-xxxx).

Program Implementation Partner Needs Assessment (PIPNA)

The purpose of this assessment is to help your organization identify current strengths, as well as areas of potential growth, related to the implementation of evidence-based programs to prevent teen pregnancy. This information will be used to help you adopt or strengthen evidence-based programs.

Name of Local Organization
Phone of Local Organization
Address of Local Organization
Name of CDC grantee organization
Name of person conducting assessment

Please complete the following information for each individual involved in completing this organizational assessment.

Name:					Length of time in organization:
Current position in your organization (select from the following options)
	Executive Director			Health/sexuality educator
	Program Director			Outreach Worker
	Assistant Director			Teacher/Coach
	Program staff member			Other (please describe):___________________________________

Name:					Length of time in organization:
Current position in your organization (select from the following options)
	Executive Director			Health/sexuality educator
	Program Director			Outreach Worker
	Assistant Director			Teacher/Coach
	Program staff member			Other (please describe):_____________________________________

Name:					Length of time in organization:
Current position in your organization (select from the following options)
	Executive Director			Health/sexuality educator
	Program Director			Outreach Worker
	Assistant Director			Teacher/Coach
	Program staff member			Other (please describe):_____________________________________

How was this assessment conducted (please select one):

	In-person interview
	Telephone interview
	Mail
	Web-based survey

PART I: Please provide some information about your organization.

1. Which statement best describes your organization? (Please select one)

	School		Community-Based Organization (CBO) focusing primarily on teen pregnancy
	School district		CBO where adolescent reproductive health is one of many programs
	Health department (non-clinical section)		Faith-based organization
	Planned Parenthood affiliate		Health care facility (hospital, clinic)
	Other (please describe): _________________________________________________________
Comment:

2. a. How long has your organization existed in years?

Years:

b. How long has your organization focused on teen pregnancy prevention (TPP)?

	<2 yrs
	2-5 yrs
	6-10 yrs
	>10 yrs
	TPP is a new focus for us
	TPP is not a focus for us

2. How many hourly or salaried personnel do you have in your organization? Schools, school districts, and health departments may skip this question.

Fulltime (≥ 35 hours)
Part-time

2. How many hourly or salaried personnel in your local organization work (or will work if this is a new focus) on teen pregnancy prevention (TPP) programming?

Full-time on TPP
Part-time on TPP

2. How many volunteer or in-kind individuals work (or will work if this is a new focus) on TPP programming?

Volunteer/In-kind

6. Does your organization have written job descriptions for the executive director (or equivalent) and other staff positions?

	Yes
	No
	Don’t Know

6. Does your organization have written personnel policies and procedures (e.g., a Human Resources Manual)?

	Yes
	No
	Don’t Know

8. Does your organization have someone on the staff or board who interviews candidates and obtains their references?

	Yes
	No
	Don’t Know

9. What is the current annual budget (approximate) of your organization? ____________________

10. Does your current budget cover all programming and administrative costs?

	Yes
	No
	Don’t Know

11. a. Which of the following fundraising strategies has your organization used during the past 12 months to support teen pregnancy prevention programs?

Strategy	Yes	No
A direct mail campaign
Fees for services
Cause-related marketing which collects a portion of sales on consumer items
Special events such as dinners, fund-raising events, etc.
Grant-writing
Other: Please describe___________________________________
Not applicable: We have not been involved in teen pregnancy prevention in the past 12 months.______­­­­­­­­

b. Please tell us about the funding sources for your organization during the past 12 months to support teen pregnancy prevention programs and indicate the percentage of total funding for TPP at your organization obtained from that source. Please select all that apply. Approximate values should sum up to 100%.

Funding Source		% of total funding
	Federal government
	State government
	Local government
	Corporate donors
	Individual/Private
	United Way
	Foundations (national, community, other)
	Other source (please describe):________________________________
	Not applicable: We have not been involved in teen pregnancy prevention during the past 12 months.

12. How would you rate your organization’s success in raising funds during the past 12 months for TPP programs?

	Excellent
	Good
	Fair
	Poor
	N/A we have not raised funds for this purpose

13. Does your organization have a clearly defined mission?

	Yes
	No
	Don’t Know

14. Does your organization have a written strategic plan to guide work and development over the next 3-5 years?

	Yes
	No, Skip to question 17
	Don’t Know

15. Is your current strategic plan realistic given the current resources of the organization?

	Yes
	No
	Don’t Know

16. Is there support from the board and staff of your organization for the strategic plan?

	Yes
	No
	Don’t Know

17. Does your organization have a board of directors?

	Yes
	No
	Don’t Know

PART II: Please provide some information about the TPP programs you currently provide or plan to provide.

18. In what setting do you carry out (or plan to carry out if this is a new focus) your teTP programs? Please select all that apply.

	Schools
	After-school
	Foster care youth program
	Residential or group home
	Clinic-based facility
	Community Center or similar location
	Faith institution
	Other (please describe):
	Don’t know

19. What age group(s) do you intend to reach with your current (or future if this is a new focus) teen pregnancy prevention programs? Please select all that apply.

	10 years and younger
	11-12 years
	13-14 years
	15-17 years
	18-19 years
	20 years and older
	Parents of Teens/Preteens
	Don’t Know

20. Do you intend to select programming to use with a single racial/ethnic group? Please select all that apply.

	Black or African American
	American Indian or Alaska Native
	Native Hawaiian or Other Pacific Islander
	Asian
	White
	Hispanic or Latino
	Don’t know
	No, we do not plan to use a program for a single racial/ethnic group

21. a. Approximately how many young people participate in your teen pregnancy prevention programs each year? If you haven’t provided teen pregnancy prevention programs enter 0.

Enter number

b. If you do not currently offer teen pregnancy prevention programs, but plan to in the future, approximately how many young people do you aim to target in the next year?

Enter number

PART III: Please tell us about available data and planning activities.

22. Has your organization decided to use Getting To Outcomes (GTO) approach to planning, implementing, and evaluating evidence-based TPP programs?

	Yes
	No
	Don’t Know

23. Has your organization had formal training on Getting To Outcomes?

	Yes
	No
	Don’t Know

24. Have you received assistance and/or coaching in using Getting To Outcomes?

	Yes
	No
	Don’t Know

25. a. Which of the following data for the population that you serve do you now have access to? Please select all that apply.

	Teen birth rates by county
	Teen birth rates by age
	Teen birth rates by race/ethnicity
	Teen abortion rates
	Teen rates of STI/HIV
	A list of teen pregnancy prevention programs that currently exist in the community
	None of these

b. Did you consider data such as these when selecting target populations with whom to work?

	Yes
	No
	Don’t Know

26. a. In the past 12 months, have you conducted a needs assessment to gather information about the needs, assets and resources related to TPP in your community?

	Yes, continue to question 26b
	No, skip to question 27
	Don’t Know, skip to question 27

b. How did you conduct the needs assessment (check all that apply):

	Informal discussions with teens
	Focus groups
	Community survey
	Used existing Youth Risk Behavior Survey data
	Used recent needs assessment data from another group (please describe):_____________________
	Other (please describe):______________________________________________________________

27. a. Do you currently have a logic model for your TPP program?

	Yes, please continue to questions 27b-d
	No, please skip to question 28
	Don’t Know, please skip to question 28

b. Does the logic model indicate which teen pregnancy-related behaviors you are targeting
(e.g., age at first sex, contraceptive use)?

	Yes
	No
	Don’t Know

c. Does the logic model identify both risk and protective factors for each behavior
(i.e., what affects age at first sex or contraceptive use)?

	Yes
	No
	Don’t Know

d. Does the logic model include activities addressing these risk and protective factors?

	Yes
	No
	Don’t Know

28. a. Has your organization delivered a TPP program in the past 12 months?

	Yes, continue to question 28b
	No, skip to question 35

b. Thinking about the TPP program you delivered most recently, did you identify and think about various existing science-based programs before you chose your program?

	Yes
	No
	Don’t Know

29. Before the TPP program you delivered most recently, did you assess the program to determine if it fit with the needs and goals of your community?

	Yes
	No
	Don’t Know

30. Before the TPP program you delivered most recently, did you assess your internal capacity to deliver the program (e.g., number of staff, staff training, technical resources, and program budget)?

	Yes
	No
	Don’t Know

31. Thinking about the TPP program you delivered most recently, did you develop a written work plan for your program delivery?

	Yes
	No
	Don’t Know

32. a. During the past 12 months, did you evaluate the effectiveness of your teen pregnancy prevention program.

	Yes, continue to question 32b
	No, skip to question 34
	Don’t Know, please skip to question 34

b. Which of the following evaluation strategies did you use to assess the effectiveness of your program? Please select all that apply.

	Evaluation of the way each activity was implemented to see if it was delivered exactly as designed (with fidelity)
	Evaluation of youth participation to determine recruitment and retention by the intended target population.
	Outcome evaluation to measure the change in each targeted behavior
	Outcome evaluation to measure whether you are changing the risk or protective factors associated with said behaviors
	Don’t know
	Other (please specify):__________________________________________

33. a. Did you plan changes to the program based on the evaluation results?

	Yes, continue to question 33b
	No, please skip to question 34
	Don’t Know, please skip to question 34

b. Which of the following describes the changes made to the program? (Check all that apply)

	Selected a program that was a better fit (please specify):__________________________________
	Modified the existing curriculum using adaptation guidance
	Discontinued the current program
	Other (please specify): ___________________________________________________________

34. During the past 12 months, did you market your TPP programs to partners, funders, or others who might help you continue delivering or funding the programs in the future?

	Yes
	No
	Don’t Know

35. How familiar are you with Getting to Outcomes (GTO)?

	Not at all
	Somewhat
	Very

36. Have your been trained on the iGTO web-based system for teen pregnancy prevention?

	Yes
	No
	Don’t Know

37. Have you used the iGTO web-based system to complete any of the above activities?

	Yes
	No
	Don’t Know

38. How much do you and your team agree or disagree with each of the following statements [by team, we mean those who will work with you to provide TPP programs]?

Skill set	Strongly Agree 1	2	3	Neutral 4	5	6	Strongly Disagree 7
Goals and objectives are primarily for funders and grant applications
Our programs would be improved by modifying them based on evaluation data
The extra time and costs required to implement scientifically proven programs greatly outweigh the benefits
Program staff often know whether a program is working well without having to do a formal evaluation
Implementing a program that is mismatched with the values of the local community will lead to poor implementation and outcomes
Time spent writing out all the activities of a program on a timeline could be better spent on implementation
We could better achieve our mission by devoting resources to regularly gathering information about the teen pregnancy prevention needs of the community
Funding is available for a teen pregnancy prevention program that produces positive results.
Changing programs based on evaluation data will likely cause problems
When implementing new programs we would benefit from only choosing ones that are scientifically proven
Given all the time constraints on staff, formal evaluations of programs are not critical to do
It is likely that a successful teen pregnancy prevention program will continue to receive funding with little effort
Programs should be changed over time if evaluation data says so
Resources (e.g., staff time, funds) devoted to data collection to understand the teen pregnancy prevention needs of our community could be better spent elsewhere
Staff should only implement program activities that can be linked to our goals and objectives
Using measurable objectives in the planning process is a step that must be taken in order to demonstrate our success
Before implementing programs, it is important to critically assess whether we have adequate resources/ capacity to implement the program (e.g., number of staff, staff training, technical resources, program budget)

39. Imagine that your team is thinking about implementing a new program in your community. For the tasks listed below, please rate each item on a scale of 1 to 5 based on how much assistance you think that you and your team would need in order to complete each task. A rating of 1 indicates the need for a great deal of assistance, while a rating of 5 indicates the ability to complete the task without any assistance.

Task	A great deal of assistance needed 1	2	Some assistance needed 3	4	No assistance needed 5
Develop program goals for your new activity
Assess how well your new program activity will fit within other existing program activities offered to the same target population
Define a target population for your new activity
Measure participant satisfaction
Evaluate the activity to ensure that it is meeting goals and objectives by analyzing and interpreting data
Identify those who will be responsible for each task
Specify the amount of change expected in your objectives
Assess community strengths in programming by examining existing resources such as existing programs and availability of volunteers
Determine if an existing evidence-based program would meet your goals and objectives
Examine how the new program will fit with the values of your organization
For each program activity, measure how well the implementation followed the original program design (i.e., fidelity)
Ensure that all new program activities are linked to the goals and objectives by using a logic model
Determine if any evidence-based programs are applicable to your target population
Assess the causes and underlying risk factors for teen pregnancy in your community
Assess whether there are adequate resources to implement the new program (e.g., number of staff, staff training, technical resources, funding)
Create timelines for completing all program tasks
Develop a budget that outlines the funding required for each program activity
Develop a plan to sustain the program if it is successful (i.e., determine future funding sources)
Use results from an evaluation to improve program delivery the next time it is offered

40. Listed below are the same tasks from question 26. Place a check by those tasks for which your team would like technical assistance or training in the next 12 months.

	Task
	Develop program goals for your new activity
	Assess how well your new program activity will fit within other existing program activities offered to the same target population
	Define a target population for your new activity
	Measure participant satisfaction
	Evaluate the activity to ensure that it is meeting goals and objectives by analyzing and interpreting data
	Identify those who will be responsible for each task
	Specify the amount of change expected in your objectives
	Assess community strengths in programming by examining existing resources such as existing programs and availability of volunteers
	Determine if an existing science-based program would meet your goals and objectives
	Examine how the new program will fit with the values of your organization
	For each program activity, measure how well the implementation followed the original program design (i.e., fidelity)
	Ensure that all new program activities are linked to the goals and objectives by using a logic model
	Determine if any science-based programs are applicable to your target population
	Assess the causes and underlying risk factors for teen pregnancy in your community
	Assess whether there are adequate resources to implement the new program (e.g., number of staff, staff training, technical resources, funding)
	Create timelines for completing all program tasks
	Develop a budget that outlines the funding required for each program activity
	Develop a plan to sustain the program if it is successful (i.e., determine future funding sources)
	Use results from an evaluation to improve program delivery the next time it is offered
	Use iGTO to support program selection and implementation
	No TA requested on any of these topics.

THANK YOU!

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