Awardee Training and Technical Assistance Tool

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Overview

Sheet1
GRANTEE DATA
Answer Categories
INSTRUCTIONS

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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).

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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)

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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

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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.