Awardee Training and Technical Assistance Tool

Performance Monitoring of “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Youth from Vulnerable Populations

Att 12 Awardee Training and TA Tool.xls

Awardee Training and Techmnical Assistance Tool

OMB: 0920-1156

Document [xlsx]
Download: xlsx | pdf

Overview

Sheet1
GRANTEE DATA
Answer Categories
INSTRUCTIONS


Sheet 1: Sheet1

Form Approved ( In Progress)
OMB No.
Exp. 12/31/2020


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).





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).

Sheet 2: GRANTEE DATA









Form Approved








OMB No. 0920-xxxx








Exp. Date xx/xx/xxxx
DATE ID TA PROVIDER HEALTH CENTER/YOUTH SERVING SYSTEM RECEIVING TA MODE OF TA TIME GIVING TA NUMBER OF PARTICIPANTS TYPE OF TA or TRNG
04/05/16 100 Grantee 1 10001 Single Site TA, in-person 45 minutes 5 CL-Accessibility: Outreach to youth for use of clinical services


















































































































































































































































































































Public reporting of this collection of information is estimated to average 2 hours per response, including the time for reviewing instructions and completing and reviewing the collection of information. An agency many not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current 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 NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (XXXX-XXXX)

Sheet 3: Answer Categories

DATE TA PROVIDER HEALTH CENTER/YOUTH SERVING SYSTEM RECEIVING TA MODE OF TA CONTACT TIME GIVING TA NUMBER OF PARTICIPANTS TYPE OF TA or TRNG






CL-Accessibility: General
mm/dd/yy Grantee 1 Health Center 1 Single Site TA, in-person < 15 minutes
CL-Accessibility: Low or no cost services

Grantee 2 Health Center 2 Single Site TA, by phone 15 minutes
CL-Accessibility: Flexible


Health Center 3 Single Site Training, in-person 30 minutes
CL-Accessibility: Follow-up with youth post-contraception visit


Youth Serving Organization 1 Single Site Training, by phone 45 minutes
CL-Accessibility: Transportatio-related strategies (e.g. vouchers, signs on public transportation system)


Youth Serving Organization 2 Multi-Site TA, in-person 1 hour
CL-Accessibility: Outreach to youth for use of clinical services


Youth Serving Organization 3 Multi-Site TA, by phone 1 hour, 15 min
CL-Equity: Cultural competence



Multi-Site Training, in-person 1 hour, 30 min
CL-Equity: Culturally appropriate materials



Multi-Site Training, by phone 1 hour, 45 min
CL-Equity: Staffing strategies to match client demographics



Multi-Site Training, by webcast 2 hours
CL-Client-Centered: Confidential Services/State laws



Email TA 3 hours
CL-Client-Centered: Communication and healthy relationships




4 hours
CL-Client-Centered: Youth advisory groups




5 hours
CL-Client-Centered: Programs and support for youth




6 hours
CL-Client-Centered: Engaging youth in clincal efforts




7 hours
CL-Client-Centered: Healthy relationships materials and programs




8 hours
CL-Client-Centered: Staff Task Analysis/Scheduling to alow extra time and time alone for adolescents






CL – Effective: Evidence-based guidelines/QFP: Tiered, client-centered Contraceptive counseling






CL – Effective: Evidence-based guidelines/QFP: Direct support for LARC provision






CL – Effective: Evidence-based guidelines/QFP: Preconception






CL – Effective: Evidence-based guidelines/QFP: STD prevention






CL – Effective: Evidence-based guidelines/QFP: QFP, SPRC-related aspects






CL – Effective: Evidence-based guidelines/QFP: Provision of comprehensive information and services






CL – Effective: Evidence-based guidelines/QFP: Sexual health history/assessment






CL – Effective: Evidence-based guidelines/QFP: Evidence-based teen pregnancy/STD/HIV prevention programs






CL – Effective: Evidence-based guidelines/QFP: Referral to programs such as home visiting






CL – Safe: Clinical Skill Development: LARC insertion and removal






CL – Safe: Clinical Skill Development: Eligibility Criteria for LARC insertion






CL – General Infrastructure: Leadership support






CL – General Infrastructure: Team-based contraceptive care model






CL – General Infrastructure: Operational flow/space (e.g. private room for contraceptive counseling, teen-friendly waiting room)






CL – General Infrastructure: Policies and procedures






YSO – Teen Pregnancy Prevention Efforts – General: Policy modification/development






YSO – Teen Pregnancy Prevention Efforts – General: Staff task analysis and training






YSO – Teen Pregnancy Prevention Efforts – General: Standard Operating Procedures Modification






YSO – Sexual Health of youth: Sexual health assessments






YSO – Sexual Health of youth: General sexual health






YSO – Sexual Health of youth: Cultural Competency






YSO – Sexual Health of youth: Adolescent Development






YSO – Sexual Health of youth: State confidentiality laws






YSO – Evidence-based interventions: Director implementer support






YSO – Evidence-based interventions: Program training and support






YSO – Evidence-based interventions: Using Getting to Outcomes






Partnerships: Collaboration and coordination






Partnerships: Leadership






Partnerships: Engagement and planning






Partnerships: Development






Referrals and Linkages: Linkages






Referrals and Linkages: Referrals to reproductive health services






Referrals and Linkages: Referrals for pregnant and parenting teens






Referrals and Linkages: Referrals for other health services






Referrals and Linkages: Tracking/Monitoring System Development






Health communications and Outreach: Print Communication collateral design






Health communications and Outreach: Campaign support






Health communications and Outreach: Enhanced outreach to community organizations






Health communications and Outreach: Patient education materials






Health communications and Outreach: Parent education materials






Health communications and Outreach: Social marketing (including social media)






Evaluation: Data collection






Evaluation: Data Anaylysis






Evaluation: Monitoring and Reporting






Continuous Quality Improvement (CQI): CQI Team Development






Continuous Quality Improvement (CQI): Plan for data-informed decision-making






Continuous Quality Improvement (CQI): Process of developing measures of success






Continuous Quality Improvement (CQI): Potential change strategies for producing






Continuous Quality Improvement (CQI): Improvement and continuous monitoring






GEN – Tracking Software: Data Entry






GEN – Tracking Software: Software Updates

Sheet 4: INSTRUCTIONS

DATE
Enter date TA was provided using 2 digits for month, day and year, e.g., 01/01/16

ID
Enter the CDC ID of the TA Provider

TA PROVIDER
Select the organization that provided the Training or Technical Assistance (TTA)

HEALTH CENTER/YOUTH SERVING SYSTEM RECEIVING TA
Enter the CDC ID for the health center/youth serving system this TTA

MODE OF TA
Select the item in the drop down menu that most closely corresponds to the way the TA/training was provided. "TA" refers to technical assistance provided in response to a specific need of the recipient. "Training" refers to a formal or standard knowledge and/or skills building session your organization provides on a specific capacity issue (e.g., a training on logic models). If the TA or training was provided to a single organization, select the appropriate "single site" option, according to whether the service was provided in person or by phone. If the TA or training was provided to more than one recipient organization at a time, select the appropriate "Multi-Site" option, according to whether the service was provided in person, by phone, or by webcast. IF MULTIPLE ORGANIZATIONS ATTENDED A TRAINING, ENTER EACH ORGANIZATION INDIVIDUALLY. "Email TA" - please ONLY include this if the email took a substantial amount of time to prepare, it contained significant TA substance, etc.

TIME GIVING TA
Select the menu option that most closely equals the time spent on the specific TA activity. Please round to the nearest quarter hour, or the nearest hour if more than 2 hours were spent.

NUMBER OF PARTICIPANTS
Enter the number of participants TA or TRNG was provided during this session


TYPE OF TA or TRNG
Select the menu item that best represents the content of the TA/training provided.
File Typeapplication/vnd.ms-excel
Authorckl9
Last Modified ByPazol, Karen (CDC/ONDIEH/NCCDPHP)
File Modified2016-04-07
File Created2007-01-17

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