Survey -Word version

Form Approved

OMB No. 0920-0952

Exp. 12/31/2015

State and Community Awardee Staff 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).

Staff Needs Assessment

The purpose of this assessment is to help your organization identify strengths and areas of potential growth regarding your ability to support the implementation of this project. This assessment is aligned with the key components of this project and requests information on your organizational background, partnerships, community mobilization, evidence-based programs, training and technical assistance for program implementation, contraceptive services for youth, educating stakeholders, and cultural competence and diversity.

Please respond to only those sections that apply to your project role. Please answer as honestly as possible. Results from this assessment will be used by CDC and the five funded National Organizations to develop a targeted training and technical assistance plan for your organization.

Thank you for your candor in completing this important assessment.

Section I. Individual Information

1. Please select your organization.

	Alabama Department of Public Health
	Adolescent Pregnancy Prevention Campaign of North Carolina
	Family Planning Council
	Fund for Public Health New York
	Georgia Campaign for Adolescent Pregnancy Prevention Campaign
	City of Hartford
	Massachusetts Alliance on Teen Pregnancy
	SC Campaign
	University of Texas Health Science Center at San Antonio

2. Which of the following describes your role/title? (select all that apply)

	Clinical technical assistance provider
	Program technical assistance provider
	Youth leadership team coordinator
	Evaluator
	Other (please specify) ______________________________________________

3. For how many years have you held your position?

	< 2 years
	3-5 years
	> 5 years

4. For how many years have you worked in teen pregnancy prevention?

	< 2 years
	3-5 years
	> 5 years

Section II. Community Mobilization

5. Do you lead organizational efforts to work with community partners (e.g., core partner leadership team) in developing action plans and implementing community-wide initiatives?

	Yes, please continue to question 6
	No, please skip to question 8, page 4

6. Please indicate whether you have received formal training and the time frame in which the formal training on leading/facilitating collaborative community-wide efforts was received. Formal training refers to planned teaching of standard knowledge and/or skills related to specific capacities.

Skill set	Never	< 2 years	3-5 years	> 5 years
Conducting a comprehensive community needs and asset assessment in support of TPP
A theoretical justification for community mobilization in support of TPP
Developing a long-range community mobilization plan
Identifying and recruiting participants for a Core Partner Leadership Team
Identifying and recruiting participants for a Community Action Team
Identifying and recruiting participants for a Youth Leadership Team
Supporting community participants to develop TPP goals and identify strategies to address them
Preparing for possible opposition to TPP within communities
Identifying strategies for long-term sustainability of TPP activities within communities
Supporting community team members to evaluate their mobilization efforts

7. How confident are you in your ability to lead a community group through the following activities?

Skill set	Not at all Confident 1	2	Somewhat Confident 3	4	Extremely Confident 5
Conducting a comprehensive community needs and asset assessment in support of TPP
A theoretical justification for community mobilization in support of TPP
Developing a long-range community mobilization plan
Identifying and recruiting participants for a Core Partner Leadership Team
Identifying and recruiting participants for a Community Action Team
Identifying and recruiting participants for a Youth Leadership Team
Supporting community participants to develop TPP goals and identify strategies to address them
Preparing for possible opposition to TPP within communities
Identifying strategies for long-term sustainability of TPP activities within communities
Supporting community team members to evaluate their mobilization efforts

Section III. Community Mobilization

8. Do you lead organizational efforts to facilitate one or more of the 3 partnership groups (i.e., Core Partner Leadership Team, Community Action Team, or Youth Leadership Team)?

	Yes, please continue to question 9
	No, please skip to question 11, page 5

9. With which of the three groups you are involved as a facilitator/group leader? (please select all that apply)

	Core partner leadership team
	Community action team
	Youth leadership team

10. How confident are you in your ability to do the following activities?

Skill set	Not at all Confident 1	2	Somewhat Confident 3	4	Extremely Confident 5
Facilitate the goal setting process within your project team to achieve community mobilization in support of TPP
Work within your project team to identify, recruit and retain the best “mix” of persons for your community teams
Work within your project team to help community teams establish their legitimacy as spokespersons for TPP within their communities
Work within your project team to help community teams rally support for TPP within their communities
Work within your project team to evaluate the functioning of the community teams to achieve their goals

Section IV. Contraceptive Services for Youth

11. Do you lead organizational efforts to provide training and technical assistance to clinic partners as part of the Teen Pregnancy Prevention project?

	Yes, please continue to question 12
	No, please skip to question 14, page 7

12. Please indicate whether you have received formal training and the time frame in which the formal training on certain topics related to reproductive health services was received. Formal training refers to planned teaching of standard knowledge and/or skills related to specific capacities.

Skill set	Never	< 2 years	3-5 years	> 5 years
The use of the Quick Start Method for dispensing hormonal contraception to adolescents
The use of the Quick Start Methods for dispensing IUDs
Pap smear guidelines for adolescents
Healthcare delivery system budgeting
Business planning including maximizing coding, billing, and reimbursement strategies
Coding confidentiality in billing for adolescent reproductive health services
Work flow processes for patient visits
Health care delivery systems productivity standards
Appointment scheduling practices
Contraceptive methods for adolescents
Performance improvement or quality improvement methodologies
Performance measurement
Strategies for supporting time-alone between a provider and an adolescent client
Strategies for supporting confidentiality in the delivery of contraceptive and reproductive services for adolescents
Addressing social determinants of health in the clinical setting
Male sexual and reproductive health services

13. How knowledgeable are you about each of the following?

Skill set	Not at all 1	2	Somewhat 3	4	Extremely 5
Intrauterine devices (IUDs)
Efficacy
Costs
Side effects
Dispensing procedures
Contraceptive implant (Implanon)
Efficacy
Costs
Side effects
Dispensing procedures
Injectable contraception (Depo-provera)
Efficacy
Costs
Side effects
Dispensing procedures
Birth control pills
Efficacy
Costs
Side effects
Dispensing procedures
Emergency contraception
Efficacy
Costs
Side effects
Dispensing procedures
Male condoms
Efficacy
Costs
Side effects
Dispensing procedures
Female condoms
Efficacy
Costs
Side effects
Dispensing procedures
Other methods (please list) ______________________
Efficacy
Costs
Side effects
Dispensing procedures

Section V. Educating Stakeholders

14. Do you lead/co-lead organizational efforts to educate stakeholders in your community?

	Yes, please continue to question 15
	No, please skip to question 18, page 8

15. How knowledgeable are you about each of the following?

Skill set	Not at all 1	2	Somewhat 3	4	Extremely 5
How to identify important stakeholders in your community
How to determine your target audiences for stakeholder education
How to determine goals and objectives and an action plan for stakeholder education using data from your community needs assessment
Methods for raising awareness of your community-wide initiative
How to educate on statistics and trends in teen pregnancy, by age and race/ethnicity and for special populations
Methods for educating on evidence-based and/or evidence-informed strategies to reduce teen pregnancy and data on needs and resources in target communities
Methods for crisis communication and managing controversy

16. How confident are you in your ability to conduct the following activities?

Skill set	Not at all Confident 1	2	Somewhat Confident 3	4	Extremely Confident 5
Identify important stakeholders in your community
Determine your target audiences for stakeholder education
Determine goals and objectives and an action plan for stakeholder education using data from your community needs assessment
Raise awareness of your community-wide initiative
Educate on evidence-based and/or evidence-informed strategies to reduce teen pregnancy and data on needs and resources in target communities
Manage controversy through communication techniques/strategies

17. What resources or tools would increase your capacity to work with stakeholders in your community?

	Specific talking points
	Additional training
	Resources and fact sheets
	Individual technical assistance
	Other (please specify) ______________________________________________________

SECTION VI – Working with Diverse Communities – Project Lead/Co-lead

18. Do you lead/co-lead organizational efforts for working with diverse communities?

	Yes, please continue to question 19
	No, please skip to question 21, page 9

19. How knowledgeable are you regarding each of the following topics?

Skill set	Not at all 1	2	Somewhat 3	4	Extremely 5
Health equity
Health disparities
Social determinants of health
Frameworks for examining and addressing social determinants of health
Cultural competency
Strategies for engaging marginalized youth (i.e. foster care, homeless, GLBTQ) in teen pregnancy prevention efforts

20. How confident do you feel about providing technical assistance or training to individuals in your community?

Skill set	Not at all Confident 1	2	Somewhat Confident 3	4	Extremely Confident 5
Increase awareness around the impact of social determinants of teen pregnancy with community partners
Actively engage informal community leaders and other influential community stakeholders (i.e. business leaders) around the significance of addressing social determinants of teen pregnancy
Assess attitudes and beliefs around social determinants among different audiences
Facilitate a process to identify key social determinants of teen pregnancy with community partners
Identify feasible strategies to address key social determinants of teen pregnancy
Enhance levels of cultural competence for clinical providers and program facilitators
Utilize community-based participatory approaches to evaluation
Assess and evaluate progress on strategies to address social determinants of teen pregnancy.

Section VII. Evidence-Based Programs - Training and Technical Assistance for Implementation

21. Do you provide training and technical assistance to support program implementation as part of the Teen Pregnancy Prevention project?

	Yes, please continue to question 26
	No, please skip to question 30, page 15

22. Please indicate whether you have received formal training and the time frame in which the formal training on certain topics related to evidence-based approaches to planning, selection, implementation, and evaluation of evidence-based programs and practices was received. Formal training refers to planned teaching of standard knowledge and/or skills related to specific capacities.

Skill set	Never	< 2 years	3-5 years	> 5 years
Understanding the benefits of using evidence-based approaches such as the Getting To Outcomes (GTO) approach to prevent teen pregnancy
Knowing which evidence-based programs and/or practices have reduced sexual behaviors leading to teen pregnancy, STI, and/or HIV
Using logic models to plan general organizational activities
Using logic models that link risk and protective factors to intervention activities for the purpose of selecting an appropriate TPP program/curriculum or practice.
Knowing how to plan and conduct effective trainings on evidence-based or evidence-informed programs to others
Knowing how to assess an evidence-based program for fit with one's priority population and community
Knowing how to conduct process evaluation
Knowing how to conduct outcome evaluation

23. We are interested in the amount of experience you have providing technical assistance and training on the topics listed in question 26. Experience providing training and TA refers to working with one or more client organizations on a particular topic. Please indicate if you have at least 6 months of experience providing technical assistance and training on the following.

Skill set	Yes	No
The benefits of using evidence-based approaches such as the GTO approach to prevent teen pregnancy
Which programs, practices, or policies related to promoting adolescent sexual health have evidence of effectiveness
Using logic models to plan general organizational activities
Using logic models that link risk and protective factors to intervention activities for the purpose of selecting an appropriate TPP program/curriculum or practice.
How to plan and conduct effective trainings on evidence-based or evidence-informed programs to others
How to assess an evidence-based program for fit with one's priority population and community
How to conduct process evaluation
How to conduct outcome evaluation

24. How knowledgeable are you regarding each of the following teen pregnancy prevention activities?

Skill set	Not at all 1	2	Somewhat 3	4	Extremely 5
Develop program goals for a teen pregnancy prevention activity or program
Assess how well program activities fit within other existing program activities offered to the same target population
Define a target population for teen pregnancy prevention program(s) or practices
Measure participant satisfaction with a prevention program or practice
Evaluate an activity to ensure that it is meeting goals and objectives, including completing analysis and interpretation of data
Identify those who will be responsible for each program delivery task
Specify the amount of change to expect in program objectives
Assess community strengths in programming by examining existing resources such as existing programs and availability of volunteers
Determine if an existing program or practice is suited to a community program’s goals and objectives
Develop program objectives that are linked to program goals
Examine how a prevention program fits with the philosophy of a community organization
Measure how well program implementation followed the original program design (i.e., fidelity) for each program activity
Ensure that all new program activities are linked to specific goals and objectives
Determine if any evidence-based programs are applicable to a target/priority population(s)
Specify by when one should expect the change in their objectives to occur
Assess the causes and underlying risk factors for teen pregnancy in a community
Assess the adequacy of resources to implement a (new) program (e.g., staff, 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 successful programs or activities (i.e., determine future funding sources, staffing)
Use evaluation results to improve delivery of a teen pregnancy prevention program or practice the next time it is offered
Adapt an evidence-based teen pregnancy prevention program while maintaining the integrity of the program

25. How confident would you be providing training or technical assistance in the following areas to support other organizations as part of the TPP project?

Skill set	Not at all Confident 1	2	Somewhat Confident 3	4	Extremely Confident 5
Develop program goals for a teen pregnancy prevention activity or program
Assess how well program activities fit within other existing program activities offered to the same target population
Define a target population for teen pregnancy prevention program(s) or practices
Measure participant satisfaction with a prevention program or practice
Evaluate an activity to ensure that it is meeting goals and objectives, including completing analysis and interpretation of data
Identify those who will be responsible for each program delivery task
Specify the amount of change to expect in program objectives
Assess community strengths in programming by examining existing resources such as existing programs and availability of volunteers
Determine if an existing program or practice is suited to a community program’s goals and objectives
Develop objectives that are linked to goals
Examine how a prevention program fits with the philosophy of a community organization
Measure how well program implementation followed the original program design (i.e., fidelity) for each program activity
Ensure that all new program activities are linked to specific goals and objectives
Determine if any evidence-based programs are applicable to a target/priority population(s)
Specify by when one should expect the change in their objectives to occur
Assess the causes and underlying risk factors for teen pregnancy in a community
Assess the adequacy of resources to implement a (new) program (e.g., staff, 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 successful programs or activities (i.e., determine future funding sources, staffing)
Use evaluation results to improve delivery of a teen pregnancy prevention program or practice the next time it is offered
Adapt an evidence-based teen pregnancy prevention program while maintaining the integrity of the program
Document adaptations made to evidence-based programs to reflect and respond to the youth and community context.
Train program facilitators to develop their understanding around cultural and gender difference with respect to adolescent sexual risk behavior, teen pregnancy and implications of this on engagement and program implementation.

Section VIII. Organizational Technical Assistance Needs

CDC and the funded national organizations will use the following information to plan future TA and training.

26. Please list topics, in order of priority, on which you would most like to receive technical assistance and training through this project over the next year.

Skill set

29