| 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 |
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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 |
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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 |
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CL-Accessibility: Outreach to youth for use of clinical services |
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Youth Serving Organization 3 |
Multi-Site TA, by phone |
1 hour, 15 min |
|
CL-Equity: Cultural competence |
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Multi-Site Training, in-person |
1 hour, 30 min |
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CL-Equity: Culturally appropriate materials |
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Multi-Site Training, by phone |
1 hour, 45 min |
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CL-Equity: Staffing strategies to match client demographics |
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Multi-Site Training, by webcast |
2 hours |
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CL-Client-Centered: Confidential Services/State laws |
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Email TA |
3 hours |
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CL-Client-Centered: Communication and healthy relationships |
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4 hours |
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CL-Client-Centered: Youth advisory groups |
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5 hours |
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CL-Client-Centered: Programs and support for youth |
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6 hours |
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CL-Client-Centered: Engaging youth in clincal efforts |
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7 hours |
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CL-Client-Centered: Healthy relationships materials and programs |
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8 hours |
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CL-Client-Centered: Staff Task Analysis/Scheduling to alow extra time and time alone for adolescents |
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CL – Effective: Evidence-based guidelines/QFP: Tiered, client-centered Contraceptive counseling |
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CL – Effective: Evidence-based guidelines/QFP: Direct support for LARC provision |
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CL – Effective: Evidence-based guidelines/QFP: Preconception |
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CL – Effective: Evidence-based guidelines/QFP: STD prevention |
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CL – Effective: Evidence-based guidelines/QFP: QFP, SPRC-related aspects |
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CL – Effective: Evidence-based guidelines/QFP: Provision of comprehensive information and services |
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CL – Effective: Evidence-based guidelines/QFP: Sexual health history/assessment |
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CL – Effective: Evidence-based guidelines/QFP: Evidence-based teen pregnancy/STD/HIV prevention programs |
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CL – Effective: Evidence-based guidelines/QFP: Referral to programs such as home visiting |
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CL – Safe: Clinical Skill Development: LARC insertion and removal |
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CL – Safe: Clinical Skill Development: Eligibility Criteria for LARC insertion |
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CL – General Infrastructure: Leadership support |
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CL – General Infrastructure: Team-based contraceptive care model |
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CL – General Infrastructure: Operational flow/space (e.g. private room for contraceptive counseling, teen-friendly waiting room) |
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CL – General Infrastructure: Policies and procedures |
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YSO – Teen Pregnancy Prevention Efforts – General: Policy modification/development |
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YSO – Teen Pregnancy Prevention Efforts – General: Staff task analysis and training |
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YSO – Teen Pregnancy Prevention Efforts – General: Standard Operating Procedures Modification |
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YSO – Sexual Health of youth: Sexual health assessments |
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YSO – Sexual Health of youth: General sexual health |
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YSO – Sexual Health of youth: Cultural Competency |
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YSO – Sexual Health of youth: Adolescent Development |
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YSO – Sexual Health of youth: State confidentiality laws |
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YSO – Evidence-based interventions: Director implementer support |
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YSO – Evidence-based interventions: Program training and support |
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YSO – Evidence-based interventions: Using Getting to Outcomes |
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Partnerships: Collaboration and coordination |
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Partnerships: Leadership |
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Partnerships: Engagement and planning |
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Partnerships: Development |
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Referrals and Linkages: Linkages |
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Referrals and Linkages: Referrals to reproductive health services |
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Referrals and Linkages: Referrals for pregnant and parenting teens |
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Referrals and Linkages: Referrals for other health services |
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Referrals and Linkages: Tracking/Monitoring System Development |
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Health communications and Outreach: Print Communication collateral design |
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Health communications and Outreach: Campaign support |
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Health communications and Outreach: Enhanced outreach to community organizations |
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Health communications and Outreach: Patient education materials |
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Health communications and Outreach: Parent education materials |
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Health communications and Outreach: Social marketing (including social media) |
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Evaluation: Data collection |
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Evaluation: Data Anaylysis |
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Evaluation: Monitoring and Reporting |
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Continuous Quality Improvement (CQI): CQI Team Development |
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Continuous Quality Improvement (CQI): Plan for data-informed decision-making |
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Continuous Quality Improvement (CQI): Process of developing measures of success |
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Continuous Quality Improvement (CQI): Potential change strategies for producing |
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Continuous Quality Improvement (CQI): Improvement and continuous monitoring |
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GEN – Tracking Software: Data Entry |
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GEN – Tracking Software: Software Updates |
| 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 |
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| TA PROVIDER |
| Select the organization that provided the Training or Technical Assistance (TTA) |
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| 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 |
|
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| TYPE OF TA or TRNG |
| Select the menu item that best represents the content of the TA/training provided. |