Reach and Demographics

OMB# 0990-0438

Expiration Date: xx/xx/xxxx

TPP Performance Measures for

FY2020: Reach and Demographics

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0XXX. The time required to complete this information collection is estimated to average 3 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

Questions at Section (Program or Intervention) Level: Reach and Demographics

These items are for Tier 1s and Tier 2 Phase IIs.

For each section (group or class receiving the Teen Pregnancy Prevention (TPP) program proven effective (Tier 1) /promising intervention (Tier 2) together), grantees report the following.

Name of the TPP Program (Tier 1) or Intervention (Tier 2) being delivered:

Tier 1 grantees would report the name of the effective program (i.e. program proven effective).

Tier 2 phase II grantees would report the TPP intervention that is being rigorously evaluated, and would only report performance data for the participants in the intervention (treatment) arm of the rigorous study.

State/Territory where implemented:

Setting of Implementation: select one or more of the following that best describes where the majority of sessions in the section took place

In-school (Programs that take place primarily or exclusively during a school day on a school campus. This category may include public or private schools, traditional or alternative schools, of any grade level).

Clinic-based

Faith-based

Runaway and homeless youth (such as drop in shelter/centers, other)

Out-of-home (such as the child welfare system/foster care, group homes, residential centers. Juvenile justice should be counted separately below)

Juvenile justice (such as detention centers, residential centers –serving uniquely juvenile justice youth, camps)

other out-of-school time/community(programs that primarily take place outside of school hours, and may be located within a community organization not listed above or on a school campus before or after the school day)

Technology-based (includes programs that do not take place in a physical location, such as virtual programs, text messaging, apps, internet-based programs, etc.)

Urbanicity of Implementation Site: urban, rural, suburban

Reach and Demographics of TPP Participants

For each section (class or group) of TPP effective programs or promising interventions implemented with youth, how many youth participated in your program for at least one activity in the reporting period? Report total numbers per section and numbers by each demographic category below:

Gender – Male, Female, Transgender, Does not identify, Not reported

Age – 10 or younger, 11, 12, 13, 14, 15, 16, 17, 18, 19, >19, Not reported

Grade – 6 or less, 7, 8, 9, 10, 11, 12, GED program, Technical/vocational training/college, Ungraded, Not currently in school, Not reported

Ethnicity – Hispanic or Latinx, Not Hispanic or Latinx, Not reported

Race – American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, White, More than one race, Not reported

Total

For each section (class or group) of the effective program (Tier 1)/promising intervention (Tier 2) implemented with non-youth participants, how many non-youth participants attended at least one activity of your effective program (Tier 1)/promising intervention (Tier 2) in the reporting period? Indicate the unduplicated total number in each category.

Caregivers (such as parents, legal guardians, siblings, extended family; foster parents; “chosen” family members of adolescents): _____

[Note: this count should only include caregivers who are the target population or end-users of a TPP effective program (Tier 1) or a promising intervention to be rigorously tested (Tier 2). Caregivers who are engaged in other aspects of the grant project should be included elsewhere in the stakeholder engagement item.)

Youth-serving professionals (such as social workers, health care providers, teachers, juvenile justice staff, court staff): ____________

[Note: this count should only include youth-serving professionals for whom a TPP effective program (Tier 1) or promising intervention to be rigorously tested (Tier 2) are the target population. Professionals who are trained to provide services to youth should be included in the partners item. Professionals who are involved in the systems approaches should be included within the stakeholder engagement item]

For each section (class or group) of the TPP effective program/promising intervention implemented, how many non-youth participants attended at least l supplemental activity (that is, an activity other than the effective program/promising intervention) during the reporting period? Indicate the unduplicated total number in each category.

Caregivers (parents or legal guardians of adolescents): _____

[Note: this count should only include caregivers who attend supplemental activities associated with an effective program/promising intervention such as parent rallies, parent information sessions, or other supplemental activities. Caregivers who are engaged in other aspects of the grant project should be included elsewhere in the systems engagement item.). Caregivers who participate as the target population of the effective program/promising intervention should be counted in the previous item.

Youth-serving professionals (social workers, health care providers, teachers, juvenile justice staff, court staff): ____________

[Note: this count should only include any youth-serving professionals who may receive supplemental activities. The youth-serving professionals served by a TPP effective program (Tier 1) or promising intervention to be rigorously tested (Tier 2 should be counted elsewhere). Professionals who are trained to provide services to youth should be included in the training item. Professionals who are involved in the systems approaches should be included within the stakeholder engagement item]