Component 1 Reporting Template

P S18-1807 Component 2 Reporting Template

Site Name: Click or tap here to enter text. Grant #: PS00xxxx

Timeframe: ☐ August 1, 20xx – January 31, 20xx ☐ February 1, 20xx – July 31, 20xx

DASH Program Consultant:

Activities by Strategy	Components Requested
Sexual Health Education (SHE)	Achievement of Requirement	Comment and/ or Summarize Requirement Progress	Level of Implementation (Check all that apply)	Number of Students Reached
Required SHE1. Identify and approve a list of instructional competencies to be demonstrated by those teaching skills-based health and sexual health education in middle and school high.	☐ Completed ☐ In Progress ☐ Not started	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	N/A
Required SHE2. Provide necessary training at LEA once per year, to ensure school health and sexual health education teachers have content knowledge, comfort, and instructional competencies to effectively implement approved school health and sexual health education instructional programs.	☐ Completed ☐ In Progress ☐ Not started	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	N/A
Required SHE3. Establish, adopt, and implement a skills-based health education course requirement which includes sexual health education content for all students attending middle and high schools in the district/consortium.	☐ Completed ☐ In Progress ☐ Not started	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	# of Middle School students reached: # of High School students reached:
Required SHE4. Develop and approve a health education scope and sequence that delineates sexual health education learning outcomes for all students in middle and high schools in the district.	☐ Completed ☐ In Progress ☐ Not started	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	N/A
Required SHE5. Develop, revise, or select a sexual health education instructional program consistent with the approved scope and sequence (see SHE4 above), and inclusive of instructional lessons, student learning activities, resources, and student assessment.	☐ Completed ☐ In Progress ☐ Not started	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	N/A
Required SHE6. Develop, update, and foster use of teaching tools and resources (e.g., lesson pacing guide, specific lesson plans) for teachers to continuously improve delivery of the identified sexual health education instructional program.	☐ Completed ☐ In Progress ☐ Not started	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	N/A
Required SHE7. Establish and maintain a School Health Advisory Council (SHAC) that regularly provides district-level advice and guidance to improve health and sexual health education programs for students and health and sexual health education instruction for staff.	☐ Completed ☐ In Progress ☐ Not started	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	N/A
Required SHE8. Integrate strategies to actively engage parents in sexual health education instructional programs.	☐ Completed ☐ In Progress ☐ Not started	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	N/A
Additional SHE9. Develop and implement a technical assistance plan that incorporates teacher observation, coaching, peer mentoring, and other methods to improve an individual teacher’s sexual health education instruction in a select number of schools annually.	☐ Completed ☐ In Progress ☐ Not started ☐ Not applicable	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	N/A
Additional SHE10. Develop, revise, or select health education instructional programs for students in elementary grades that align with the priorities for health and sexual health education established in the health education scope and sequence.	☐ Completed ☐ In Progress ☐ Not started ☐ Not applicable	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	# of Elementary School students reached
Additional SHE11. Incorporate specific changes to existing instructional programs to better meet needs of lesbian, gay, bisexual, and transgender youth.	☐ Completed ☐ In Progress ☐ Not started ☐ Not applicable	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	N/A
Additional SHE12. Strengthen student assessment instruments to more accurately assess student mastery of health education knowledge and skills.	☐ Completed ☐ In Progress ☐ Not started ☐ Not applicable	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	N/A
District Optional SHE: site-specific activity	☐ Completed ☐ In Progress ☐ Not started ☐ Not applicable	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	# of Middle School students reached: # of High School students reached:

Activities by Strategy	Components Requested
Sexual Health Services (SHS)	Achievement of Requirement	Comment and/ or Summarize Requirement Progress	Level of Implementation (Check all that apply)	Number Students Reached
Required SHS1. Provide training and professional development (PD) to staff to support SHS activities annually.	☐ Completed ☐ In Progress ☐ Not started	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	N/A
Required SHS2. Assess district and priority school capacity to implement activities to increase student access to SHS, in collaboration and coordination with the Component 3B recipient.	☐ Completed ☐ In Progress ☐ Not started	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	N/A
Required SHS3. Incorporate skill-based instruction to students on accessing SHS into SHE annually.	☐ Completed ☐ In Progress ☐ Not started	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	# of Middle School students reached: # of High School students reached:
Required SHS4. [check one] ☐ Establish or improve use of a referral system to link sexually active students to community providers for SHS by using the referral system toolkit to implement the 7 core components of a referral system. OR ☐ Improve student use and quality of SHS provided by School-Based Health Centers (SBHCs).	☐ Completed ☐ In Progress ☐ Not started	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	# of Middle School students reached: # of High School students reached:
Required SHS5. Implement school-wide, student-planned marketing campaigns that promote recommended health services for teens and selected school SHS programs.	☐ Completed ☐ In Progress ☐ Not started	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	# of Middle School students reached: # of High School students reached:
Additional SHS6. Conduct school-based STD screening (SBSS) events.	☐ Completed ☐ In Progress ☐ Not started ☐ Not applicable	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	# of Middle School students reached: # of High School students reached:
Additional SHS7. Implement or improve a condom availability program (CAP).	☐ Completed ☐ In Progress ☐ Not started ☐ Not applicable	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	# of Middle School students reached: # of High School students reached:
Additional SHS8. Disseminate SHS-related materials for parents.	☐ Completed ☐ In Progress ☐ Not started ☐ Not applicable	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	N/A
District Optional SHS: site-specific activity	☐ Completed ☐ In Progress ☐ Not started ☐ Not applicable	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	# of Middle School students reached: # of High School students reached:

Activities by Strategy	Components Requested
Safe and Supportive Environments (SSE)	Achievement of Requirement	Comment and/ or Summarize Requirement Progress	Level of Implementation (Check all that apply)	Number of Students Reached
Required SSE1. Provide professional development to teachers on classroom management annually.	☐ Completed ☐ In Progress ☐ Not started	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	N/A
Required SSE2. Provide professional development to all school staff on supporting lesbian, gay, bisexual, and transgender (LGBT) youth annually.	☐ Completed ☐ In Progress ☐ Not started	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	N/A
Required SSE3. Implement mentoring, service learning, and/or other positive youth development programs for students and/or connect students to such community-based programs.	☐ Completed ☐ In Progress ☐ Not started	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	# of Middle School students reached: # of High School students reached:
Required SSE4. Establish or enhance student-led clubs that support LGBT youth (often known as Gay-Straight Alliances or Genders and Sexualities Alliances).	☐ Completed ☐ In Progress ☐ Not started	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	# of Middle School students reached: # of High School students reached:
Required SSE5. Disseminate resources to parents/caregivers on parental monitoring and parent-adolescent communication (generally and specifically about sex).	☐ Completed ☐ In Progress ☐ Not started	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	N/A
Additional SSE6. Disseminate resources specifically relevant to parents of LGBT students	☐ Completed ☐ In Progress ☐ Not started ☐ Not applicable	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	N/A
Additional SSE7. Implement and/or connect parents to skill-building parenting programs	☐ Completed ☐ In Progress ☐ Not started ☐ Not applicable	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	N/A
District Optional SSE. site-specific activity	☐ Completed ☐ In Progress ☐ Not started ☐ Not applicable	Click or tap here to enter text.	☐ District-level ☐ Priority Schools ☐ Diffusion schools	# of Middle School students reached: # of High School students reached:

Evaluation Activities: Please share any evaluation efforts and updates (i.e., reports, 1-pager, infographics, conference abstracts, developing systems to capture referrals, technical assistance, etc.) developed during the reporting period:

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Successes: Please describe any additional successes (e.g., identified through evaluation results or lessons learned).

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Challenges: Please describe any challenges that might affect your ability to achieve annual and project-period outcomes, conduct performance measures, or complete the activities in the work plan. Also please describe any additional challenges (e.g., identified through evaluation results or lessons learned).

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CDC Program Support to Awardees: Please describe how CDC could help you overcome challenges to achieving annual and project-period outcomes, and performance measures, and completing activities outlined in the work plan.

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CDC/DASH 1807 Reporting 4