PRT (Updated) Program Report Tool
Monitoring and Reporting System for Rape Prevention and Education (RPE) Program Awardees
Updated_Program Report Tool_OMB_No.0920-1130
Program Report Tool - Initial Population
OMB: 0920-1130
Instrument Program Report Tool
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Form Approved
OMB No. 0920-1130
Exp. Date: 08/31/2019
Public reporting burden of this collection of information is estimated to average 10 hours for the initial population of the tool and 3 hours for annual reporting 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 NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1130).
Rape Prevention and Education (RPE)
Program Report Tool
Before You Begin
The goals of the RPE cooperative agreement (14-1401) are to improve the ability of RPE-funded organizations to use the public health approach and effective prevention principles to implement and evaluate sexual violence prevention strategies. The Program Report Tool will capture key information to monitor progress toward the FOA goals. Sections of this tool relate to the steps in the public health approach, and questions are aligned with primary prevention principles. Information collected through this tool is intended to measure the extent to which FOA goals are met, and to provide RPE awardees with information they can use to plan, implement, and evaluate prevention strategies to prevent sexual violence.
Instructions: Please use this Program Report Tool to plan and report on your implementation of prevention strategies. For instructions on completing this tool, definitions, and additional information about the questions, please refer to the reporting guidance.
Submission: In addition to uploading it onto Grants Solutions for your Continuation Application, please submit an Excel version of your completed Tool with your Annual Performance Report to your Project Officer and [email protected]
Technical Tips: You may navigate this Tool by clicking on the navigation menu (shown below) located at the top of each spreadsheet or the tabs at the bottom of the window.
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Please enter information into the yellow fields. If you enter an invalid character in any field that is not open text, an error message box will pop up.
Which RPE awardee are you reporting on? Select from the drop down menu.* [Drop Down Menu]
RPE Awardee: [Drop Down Menu of list below] Reporting Year: February 1, 2018 - January 31, 2019
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Alabama
Hawaii
Massachusetts
New Mexico
South Dakota
District of Columbia
Alaska
Idaho
Michigan
New York
Tennessee
Guam
Arizona
Illinois
Minnesota
North Carolina
Texas
Mariana Islands
Arkansas
Indiana
Mississippi
North Dakota
Utah
Puerto Rico
California
Iowa
Missouri
Ohio
Vermont
US Virgin Islands
Colorado
Kansas
Montana
Oklahoma
Virginia
Connecticut
Kentucky
Nebraska
Oregon
Washington
Delaware
Louisiana
Nevada
Pennsylvania
West Virginia
Florida
Maine
New Hampshire
Rhode Island
Wisconsin
Georgia
Maryland
New Jersey
South Carolina
Wyoming
List the names of each of your implementing organizations. All organizations in your state or territory that implemented violence prevention strategies with RPE funding during this reporting period must be listed. This includes both direct awardees and sub-awardees of your state or territory’s RPE program and organizations that implement preventions strategies at the state and/or local level. Examples of implementing organizations include but are not limited to state sexual violence coalitions, sub-contractors of the state sexual violence coalition, local rape crisis centers, and the state health department. Collaborating or partnering organizations that do not receive RPE funding should not be reported. You may add as many implementing organizations as you need.* [Open Text Field]
Each implementing organization listed below needs to be reported on a corresponding implementing organization tab.
Once you enter the name of the implementing organization here, click the validate button to generate a tab for this implementing organization. The delete button may be used at any time to delete an implementing organization registered on the home page and its corresponding tab in the workbook.
Implementing Organization 1 [Open Text] [Button: Validate] [Button: Delete]
To add another row above, and subsequent tab on the sheet, for an implementing organization, click on this button at any time: [Button: Add Implementing Organization] [Dynamic spreadsheet that allows adding a new spreadsheet for additional implementing organization]
Questions and Support: If you have any content-related questions or need assistance, please contact your Project Officer. If you need technical support at any time, please send an email with a detailed description of your need to the following address: [email protected].
IMPLEMENTING ORGANIZATION #
Please answer questions 1 and 2 for each Implementing Organization in your State/Territory. You may use the dynamic ‘Add Implementing Organization’ button on the Home Page to include as many implementing organizations as you may need. Each implementing organization will appear as a separate tab.
[Navigational Menu of the Sections in this tab]
What is the name of the implementing organization?* [Locked Text based on entries on Home Page]
What is the implementing organization’s total annual RPE budget? Provide information in dollar amounts. [Open Numeric Field with two decimals]
$_____.___
Prevention Strategy #
Please complete the following questions for each prevention strategy this implementing organization is carrying out. A prevention strategy is a specific set of prevention activities intended to work together toward a desired goal or outcome. A prevention strategy may be a specific activity referenced as one of the seven permitted uses, curriculum, program, policy, or community effort.
Each distinct prevention strategy should be reported separately by name (i.e. prevention strategies should not be grouped together under generic categories). Other essential public health services like evaluation and surveillance that do not meet the definition of a prevention strategy should not be reported here. You may use the dynamic ‘Add Prevention Strategy’ button at the bottom of this tab to add as many prevention strategies as you need for this implementing organization.
Prevention Strategy Description
One of the effective prevention principles is that a prevention strategy should be based on the best available evidence (See CDC’s Understanding Evidence for more information about levels of evidence). At a minimum, prevention strategies should have an articulated theory base to address modifiable risk and protective factors related to sexual violence.
What is the prevention strategy you are implementing?* [Closed Options]
Bringing in the Bystander
Coaching Boys into Men
Fourth R
Green Dot
Safer Choices
Safe Dates
Second Step
Shifting-Boundaries
Other, please specify the name of the prevention strategy: _______________ [Open Text Field]
Describe the prevention strategy. Use the following questions as a guide: What are the goals and components of the prevention strategy (e.g., theory of change)? How do the goals and/or components of this strategy relate to primary prevention of sexual violence?* [Open Text Field]
Which of the following permitted uses/approaches from the RPE Cooperative Agreement (14-1401) does the implementation of this prevention strategy relate to? (Check all that apply).* [Check all that apply]
Educational seminars
Operation of hotlines
Training programs for professionals
Preparation of informational materials
Training programs for students and campus personnel designed to reduce the incidence of sexual assault at colleges and universities
Education to increase awareness about drugs and alcohol used to facilitate rape or sexual assault; and
Other efforts to increase awareness of the facts about or to help prevent sexual assault, including efforts to raise awareness in under-served communities and awareness among people with disabilities as defined in Section 3 of the Americans with Disabilities Act of 1990 (42 U.S.C. Section 12102)
Community Change Strategy [Choose one of the sub-group below]
Community mobilization
Coalition building
Policy education
Social norms change
Other, please specify: ________________ [Open Text Field]
Capacity Building, please specify: ________________ [Open Text Field]
Not Applicable, please specify: ________________ [Open Text Field]
Which of the following best describes the development of this prevention strategy?* [Closed Options]
Prevention strategy developed locally
Pre-packaged prevention strategy developed by another organization
Prevention strategy developed by combining pre-packaged components with locally developed components
Which strategy from the CDC’s STOP SV technical package best aligns with the focus of this prevention strategy? * [Closed Options]
Promote Social Norms that Protect Against Violence
Teach Skills to Prevent Sexual Violence
Provide Opportunities to Empower and Support Girls and Women
Create Protective Environments
Support Victims/Survivors to Lessen Harms
How many unique cycles of this prevention strategy have been implemented by your organization this reporting year?* [Open Numeric Field]
Sexual Violence Problem and Target Population
This section asks about the extent to which a public health approach was used in defining the sexual violence problem and identifying the target population or the entities that the prevention strategy is intended to affect and change (e.g. individual, organization, or communities).
Who is, or what entities are, the primary target population of the prevention strategy? (Check all that apply)* [Check all that apply field with an open text field for “Other”]
Individuals |
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Communities |
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What are the characteristics of the primary target population selected above? (Check all that apply)* [Check all that apply field with an open text field for “Other”]
Gender |
Race |
Age |
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Sexual Identity |
Other Characteristics |
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Ethnicity |
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Briefly provide any additional information about the selected target population for this prevention strategy or elaborate on the above as needed. [Open Text Field]
What information or data, and from what sources, did you use to identify and select the target population for this prevention strategy? (Check all that apply).* [Check all that apply field with open text fields]
Needs assessment
Evaluation/Evaluation report
In-depth interviews
Surveys
Focus groups
Police reports
Medical examiner files
Vital records
Hospital charts
Registries
Population-based surveys
Other, please specify: _____________ [Open Text Field]
Other, please specify: _____________ [Open Text Field]
Other, please specify: _____________ [Open Text Field]
In a few sentences describe the needs and sexual violence problem(s) of the selected target population. Use the following questions as a guide: What is the sexual violence problem that needs to be prevented among the target population? What factors protect the target population or put them at risk for experiencing or perpetrating sexual violence?* [Open Text Field]
Prevention Strategy Selection
This section asks about the extent to which a public health approach was used in selecting the prevention strategy and the extent to which the prevention strategy is a good fit for the defined sexual violence problem and target population.
Which of the following risk factors does this strategy directly address for your target population? (Check all that apply)* [Check all that apply field with an open text field for “Other”]
Individual |
Relationship |
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Community |
Societal |
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Which of the following protective factors does this strategy directly address for your target population? (Check all that apply)* [Check all that apply field with an open text field for “Other”]
Individual |
Relationship |
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Community |
Societal |
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In a few sentences describe the rationale for selecting this prevention strategy to implement for the selected population. Use the following questions as a guide: To what extent does the prevention strategy align with the needs and defined sexual violence problem in the selected target population described above? To what extent does the prevention strategy address the identified risk and protective factors in the target population? * [Open Text Field]
What sources of information or data informed your selection of the prevention strategy and helped determine that it may be effective in changing sexual violence-related outcomes and/or addressing identified risk and protective factors in the selected target population? (Check all that apply).* [Check all that apply field with an open text field for “Other”]
Needs assessment
Capacity or assets assessment
Environmental scan
Strategy theory or Logic model
Evaluation report
Literature review
Other, please specify: __________________ [Open Text Field]
Other, please specify: __________________ [Open Text Field]
Other, please specify: __________________ [Open Text Field]
At what level of the Social Ecological Model do you expect change to occur? (Check all that apply)* [Check all that apply field with an open text field for “Other”]
Individual
Relationship
Community
Societal
Other: Capacity Building
Other, please specify: [Open Text Field]
Reach Target population
This section asks about how much of the target population defined above were actually reached and affected.
To what extent does the prevention strategy reach or affect change in the selected target population?* Use the table below to report the total number of individuals, organizations, and/or communities reached with this prevention strategy by this implementing organization across implementation sites. (Reach Impact = Potential or Intended / Actual number of individuals, organizations, or communities affected by or who received the prevention strategy).
In most cases reach should be reported using only one unit of analysis (individual, organizational, or community). The number of individuals reached is likely to be the appropriate unit of analysis for most prevention strategies (e.g. prevention strategies that most immediately target individual knowledge, attitude and behavior change). For prevention strategies that directly aim to change organizational or community-wide policies, environments, or other structures, the organizational or community unit of analysis may be appropriate. Reach can be reported using more than one unit of analysis only if the prevention strategy is a multi-component strategy with multiple targets of change (e.g. prevention strategy that aims to change both individuals with educational curriculum and organizations with policy change efforts). Please consult the RPE Monitoring and Reporting System Guidance for further instructions and examples on how to report reach.
Unit of Analysis |
Target Population Description |
Potential Reach |
Actual Reach |
Reach Impact |
Individual |
[Open Text Field]
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[Open Numeric Field] |
[Open Numeric Field] |
{auto calculation} |
Organizational |
[Open Text Field]
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[Open Numeric Field] |
[Open Numeric Field]
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{auto calculation} |
Community |
[Open Text Field]
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[Open Numeric Field] |
[Open Numeric Field]
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{auto calculation} |
Briefly provide any additional information or elaborate on the above as needed. [Open Text Field]
Information Collection and Evaluation
This section asks about information collection or evaluation activities and use of collected information.
How much funding is allocated for the implementation of this prevention strategy? Provide information in dollar amounts. [Open Numeric Field with two decimals]
$_____.___
Is funding allocated for the evaluation of this prevention strategy?* [Closed Options]
Yes, funds are allocated for evaluation for each prevention strategy. [Answer Q22a]
No, funds are only allocated for evaluation at the implementing organization level. [Skip to Q22b]
No, funds are not allocated at all for evaluation. [Skip to Q23]
Not applicable, evaluation is only being implemented at the state. [Skip to Q23]
How much funding is allocated for the evaluation of this prevention strategy? Provide information in dollar amounts. [Open Numeric Field with two decimals]
$_____.___
How much funding is allocated for evaluation at the implementing organization level? Provide information in dollar amounts. [Open Numeric Field with two decimals]
$_____.___
Do you collect data/information on the implementation of this prevention strategy?* [Closed Options]
Yes [Answer Q23a and Q23b]
No [Skip to Q24]
What types of information does your organization collect about the implementation of this prevention strategy? [Check all that apply field with open text fields for Other]
Recruitment
Attendance
Participant satisfaction and/or engagement
Number of sessions/events/services etc. delivered or provided
Fidelity
Adaptation
Implementation barriers and facilitators
Contextual information
Other, please specify: __________________ [Open Text Field]
Other, please specify: __________________ [Open Text Field]
Other, please specify: __________________ [Open Text Field]
What data sources does your organization use to measure implementation? (Check all that apply). [Check all that apply field with an open text field for Other]
Capacity or assets assessment
Environmental scan
Strategy theory or Logic model
Evaluation report
Literature review
Administrative records
Observations
Tracking logs
Surveys
Focus groups
In-depth interviews
Other, please specify: __________________ [Open Text Field]
Other, please specify: __________________ [Open Text Field]
Other, please specify: __________________ [Open Text Field]
Do you collect information or data on the outcomes of the prevention strategy?* [Closed Options]
Yes [Answer Q24a and Q24b]
No [Skip to Q25]
24a. What types of data or information do you collect about the outcomes of the prevention strategy? (Check all that apply). [Check all that apply field with open text fields for Other]
Risk/protective factors
Rates of victimization
Rates of perpetration
Knowledge/skills
Behaviors/attitudes
Social norms
Change in policy or practice
Environmental change
Other, please specify: _____________ [Open Text Field]
Other, please specify: _____________ [Open Text Field]
Other, please specify: _____________ [Open Text Field]
24b. What data sources do your organization use to measure those outcomes? (Check all that apply). [Check all that apply field with open text fields for Other]
Needs assessment
Evaluation/Evaluation report
In-depth interviews
Surveys
Focus groups
Police reports
Medical examiner files
Vital records
Hospital charts
Registries
Population-based surveys
Other, please specify: _____________ [Open Text Field]
Other, please specify: _____________ [Open Text Field]
Other, please specify: _____________ [Open Text Field]
Do you use information or data that you collect for program improvement?* [Closed Options]
Yes
No
26. In a few sentences describe how you use the information or data you collect. If relevant, mention how you disseminate or share the information or data you collect and with whom. [Open Text Field]
[Button: Add Prevention Strategy] [Dynamic button to repeat Questions 4 to 26]
Program Report Tool Word Version
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Pari Chowdhary |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |
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