0920-1156 Change Request Justification

Change Request

March 3, 2017

Information Collection Request: “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Youth from Vulnerable Populations”

(OMB no. 0920-1156, exp. date 1/31/2020)

Background and Justification

CDC is currently approved to collect information needed to evaluate the impact of making organizational changes to improve a program’s ability to deliver adolescent reproductive health care for teens from vulnerable populations. Three organizations under the cooperative agreement “Working with Publicly Funded Health Centers to Reduce Teen Pregnancy among Vulnerable Populations” have been funded to 1) work with health centers to enhance implementation of best practices in adolescent reproductive health care and 2) work with youth-serving organizations (YSOs) to develop systematic approaches to referring youth at risk for a teen pregnancy to reproductive health care. Information collected through this program evaluation will be used to monitor awardee performance and determine training and technical assistance needs to address any performance issues. The three awardee organizations will plan, coordinate, and lead the efforts in collaboration with approximately 25 health centers and 35 YSOs, in total, to make organizational changes. Reflecting expected changes in policies, staff practices, and youth health care seeking and teen pregnancy prevention behaviors, awardees will conduct assessments of health center and YSO partners’ organizations, staff members at the partner organizations, and youth served by the health center partner organizations. Most assessments will be conducted annually throughout the five year projects.

CDC obtained the current approval in January 2017. Since submitting the 30 day notice and accompanying materials in June 2016, CDC identified funds that allowed us to support development of an online data collection system intended to make responding simpler by utilizing automatic skip patterns while also simplifying data submission. In the process of developing the online data collection system, we noted places in the currently approved measures that would need slight modifications (e.g., small changes to directions, changing from a table to a question format) in order to function correctly in the online measures. We also noted places where the measures could be made clearer. As a result, CDC is now requesting approval of these minor changes to the previously approved versions of the measures that were created in word. There is no change in burden associated with these changes.

We have listed all of the changes below. Changes to the paper forms are listed first, followed by a listing of the online forms that have been added. The paper versions Attachments 4-8, 10 and 13 have been revised as outlined below. The paper version of Attachments 9 and 11 had no changes. Attachment 12 is an Excel file and remains unchanged.

Changes to Previously Approved Paper Measures Completed in Word

Attachment 4: Health Center Organizational Assessment

Part 1: Health Center

12. Added ‘the’ for consistency with previous item.

17. Corrected skip pattern so that saying ‘no’ takes respondent to item 20 rather than 19.

Part 2: Practice Setting

5b. Changed wording of directions or column header to make the language consistent from the directions to the column headers.

11. Added a choice of ‘0’ to allow for that possibility.

15. Added definition of Tier 2 and Tier 3 contraceptive methods to increase ease of answering item.

17. Changed the order of responses to ‘None, some, all’ for consistency with ordering of responses found in the rest of the measure.

Attachment 5: Health Center Provider Survey

Instructions: Removed “and your completed assessment will be stored on a secure, password protected server” because it does not belong in the paper version of the survey.

2. Changed awkward question phrasing from ‘Approximately what percent of your female patients, ages 15-19, do you provide sexual and reproductive health services?’ to ‘Approximately what percent of your female patients, ages 15-19, receive sexual and reproductive health services from you?’.

4-6. Changed order of items 4 through 6 so that questions about contraceptive implants come first. Medical providers are more likely to provide implants than IUD’s to adolescent patients and are more likely to see the implant questions as important when describing care that they provide their patients.

5. Used the term intrauterine device before using IUD to clarify meaning of IUD. Changed the wording of one response from ‘I do not have nulliparous adolescents as patients” to ‘I rarely have nulliparous adolescents as patients’ to allow for the possibility that a provider does not provide IUDs to nulliparous adolescents because they rarely (as opposed to never) have such patients.

9. Corrected the verb tense from ‘develop’ to ‘developed’ in fourth row of Table 9.

10. This item was previously one in which the respondent checked a box if the statement was true. For skip patterns to work correctly in the online version of the measure, there needed to be a ‘yes’ box which takes the respondent to the last 2 items of the measure and a ‘no’ box which takes them to the end of the survey. We made the same changes to the paper version for consistency with the online version.

11 and 12. Added text in italics ‘Time alone without a parent present’ to clarify what was meant by ‘time alone’ with a member of the clinical team.

Attachment 6: Health Center Youth Survey

Instructions: Changed ‘your experience’ to ‘things that happened’ to simplify the language in a survey that will be completed by 15-19 year olds.

2. Made minor modifications to response choices. Reduced response choices by removing ‘other family member’ and ‘other adult’ and replacing with a single item ‘other.’ Simplified response of ‘not sure/been coming here for years’ to ‘not sure.’ Added a space for respondents to indicate the name of their school or the name of the website through which they learned about the health center in order to help grantees learn more about which possible referral sources were leading to health center visits by youth.

3. Changed response choice of ‘seeking birth control’ to ‘needed birth control’ in order to simplify language. Added ‘sports physical’ as a response given that it is a common reason for teens to see a doctor.

18. Added the phrase ‘at the same time’ to clarify the meaning of the question about dual use of condoms and hormonal contraception.

20. Added a question about respondent’s gender so that male respondents could skip items 21-26 which ask about contraception.

22. Added ‘Skyla’ as an example of another brand name of a commonly used IUD.

Attachment 7: Quarterly Health Center Performance Measure Reporting Tool

Table 3a. Cut table in which respondent is asked to calculate percentages from data reported elsewhere in the measure. To reduce respondent burden, CDC staff will calculate these percentages and provide to the grantee in quality improvement reports.

Table 4. In order to improve clarity of directions, the following change was made: Please reflect on how confident your team is that the data reported for each of the items listed below accurately represents the extent of the extent to which the data reflects your team’s understanding of the sexual and reproductive health services being provided in your practice setting.

Table 4. Several words were capitalized unnecessarily; changed to lower case.

Attachment 8: Annual Health Center Performance Measure Reporting Tool

Formatting Change. Items from Table 1 specifying the number of teen clients served by race/ethnicity were removed and put in a new table (Table 5). Similarly items from Table 3 specifying the number of clients receiving each type of contraception by race/ethnicity were removed and put in a new table (Table 6). This change was made so that Tables 1 through 4 of the Annual Health Center Performance Measure Reporting Tool (completed at the end of the fourth quarter) would be the same as the first four tables of the Quarterly Health Center Performance Measure Reporting Tool (completed at the end of the first, second, and third quarters). We are requesting to make this change based on feedback that it would be easier for the grantees to complete the Annual measure if most of the measure was exactly the same as the Quarterly measure with additional items added to the end.

These changes reflect only a change in format made to increase the ease with which respondents could complete the measure. All of the same questions from the approved version remain in the re-formatted version and no additional items have been added. The directions at the beginning of the measure were edited to reflect the formatting changes.

7a and 7b. These tables were initially prefaced with a checkbox that allowed respondents to skip the items if they only provided sexual and reproductive health care. However, for skip patterns to work correctly in the online version of the measure, there needed to be a ‘yes’ box which takes the respondent to the associated table and a ‘no’ box which skips them to the next item or the end of the survey. We made the same changes to the paper version for consistency with the online version.

Attachment 10: YSO Staff Survey

Instructions: A statement thanking the participant for completing the survey was removed. Participants are already thanked at the end of the survey and thanking them at the start presupposes that they will complete the survey. Removed “and your completed assessment will be stored on a secure, password protected server” because it does not belong in the paper version of the survey.

Table 2, Item 2.a. ‘Job opportunities’ was added as an example of other possible referral types in order to better illustrate what is meant by the item.

Table 3, Item 3.3. The example “is at risk for unwanted pregnancy or STI” was expanded to say “is at risk for unwanted pregnancy or STI as a result of being sexually active and not using contraception/condoms” to more clearly indicate the types of behaviors screened to determine if a youth is in need of health services.

Attachment 13: Awardee Performance Measure Reporting Tool

3. To clarify the meaning of the item, respondents will be asked to indicate ‘the total number of targeted practice settings across all health center(s)’ rather than ‘within each health center.’

Online Data Collection

We are also requesting approval of the online data collection. Screen shots of each measure are included as appendices. These changes are expected to slightly reduce burden though it does not change our overall burden estimates.

Attachment 4a: Health Center Organizational Assessment Online Version

Attachment 5a: Health Center Provider Survey Online Version

Attachment 6a: Health Center Youth Survey Online Version

Attachment 7a: Quarterly Health Center Performance Measure Reporting Tool Online Version

Attachment 8a: Annual Health Center Performance Measure Reporting Tool Online Version

Attachment 9a: YSO Organizational Assessment Online Version

Attachment 10a: YSO Staff Survey Online Version

Attachment 11a: YSO Performance Measure Reporting Tool Online Version

Attachment 13a: Awardee Performance Measure Reporting Tool Online Version

OMB approval is requested, effective immediately.

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