Fns 885 Snap-ed Toolkit Intervention Scoring Tool

SNAP-Ed Toolkit Submission Form and Scoring Tool (FNS 885 and FNS 886) w/ Screenshots

Appendix 1.1 FNS 885 Final Draft 10-6-2021.rtf

Business for (130) and not for profit (16)

OMB: 0584-0639

Document [rtf]
Download: rtf | pdf


Print







Instructions



Shape2 Shape3 UNITED STATES DEPARTMENT OF AGRICULTURE

Food and Nutrition Service

SNAP-ED TOOLKIT INTERVENTION SCORING TOOL

OMB APPROVED NO. 0584-0639

Expiration Date: XX-XX-XXXX


  • Please enter your score next to each question in the "Score" column.

  • The Intervention Submission Tool Questions or Materials to Review are suggestions, please feel free to use all information provided about the intervention to determine a score for each question.

  • Please feel free to make comments for each question, these will only be shared with other reviewers if scores need to be aligned.

  • If an intervention is not chosen to be included in the SNAP-Ed Intervention Toolkit, intervention developers will be provided the reasons it was not included, and the additional information or actions to be taken for inclusion. This feedback will be de-identified.

  • Mandatory questions on the Intervention Submission Tool are indicated with an asterisk (*).

  • For more information about the RE-AIM Framework, please visit https://snapedtoolkit.org/training/online-training/



Review Question


Score

Intervention Submission Tool Questions or

Materials to Review

Maximum Possible

Points


Factors for High Score


Reviewer Comments

Reach

How many people are exposed or served and are they representative?

12



Did the intervention reach the intended target audience?


Shape19 Shape18 Shape17 Shape16 Shape15 Shape14 Shape13 Shape12 Shape11 Shape10 Shape9 Shape8 Shape7 Shape6

Questions 21*, 25*, & supporting documents


5

  • Total persons/institutions reached

  • High proportion of eligible persons/institutions reached

  • Persons/institutions reached are representative of target audience


Shape21

Is the intervention appropriate for the audience for which it was intended?



Shape35 Shape34 Shape33 Shape32 Shape31 Shape30 Shape29 Shape28 Shape27 Shape26 Shape25 Shape24 Shape23 Shape22

Questions 21*, 22*, 23*, supporting documents & intervention materials


7

  • Cultural needs and preferences were thoughtfully considered and integrated

  • Language level and availability (e.g. translation, format)

  • Resource commitment (time, space, capital, human resources)


Shape37 Reach Total:

Shape40 Shape39 Shape38




Effectiveness

What is the impact of your intervention on the intended outcomes?

35


Shape42 Was the target audience (or community partner) involved in the development of the intervention?



Shape56 Shape55 Shape54 Shape53 Shape52 Shape51 Shape50 Shape49 Shape48 Shape47 Shape46 Shape45 Shape44 Shape43

Questions 22*, 23*, 23a, & supporting documents


3


  • Depth and quality of involvement (true partnership versus consultation)

  • Demonstrated integration of target audience or

community partner feedback


Shape58 If applicable, does participant or partner feedback indicate acceptability of the intervention?


Shape72 Shape71 Shape70 Shape69 Shape68 Shape67 Shape66 Shape65 Shape64 Shape63 Shape62 Shape61 Shape60 Shape59

Questions 23*, 23a, & supporting documents


1


- Reports from participants, stakeholders, and partners indicating acceptability


Shape74 Do the intended outcomes indicate that objectives were appropriately addressed?


Shape88 Shape87 Shape86 Shape85 Shape84 Shape83 Shape82 Shape81 Shape80 Shape79 Shape78 Shape77 Shape76 Shape75

Questions 25*, 26, & supporting documents


10

  • Number of outcomes achieved

  • Extent of achievement (proportion of participants/ organizations reporting positive results, statistical significance, difference from baseline)

  • Who conducted the evaluation (external versus internal evaluators)


Form Approved OMB No. 0584-NEW | According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not 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 [0584-xxxx]. The time required to complete this information collection is estimated to average 6 hours 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.

Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: U.S. Department of Agriculture, Food and Nutrition Services, Office of Policy Support, 1320 Braddock Place Alexandria, VA 22314, ATTN: PRA (0584-xxxx*). Do not return the completed form to this address. Expiration date: XX/XX/XXXX



FORM FNS-885 Version 2 (04-21) Previous Editions Obsolete

SBU Electronic Form Version Designed in Adobe 11 Version


Review Question


Score

Intervention Submission Tool Questions or Materials to Review

Maximum Possible Points


Factors for High Score


Reviewer Comments

Shape90 Does the intervention address multiple levels of the SNAP-Ed Evaluation Framework (or multiple levels of the Socio-Ecological Model)?



Shape104 Shape103 Shape102 Shape101 Shape100 Shape99 Shape98 Shape97 Shape96 Shape95 Shape94 Shape93 Shape92 Shape91

Questions 27*,30*, 31*, supporting documents & intervention materials



5


  • Type of intervention

  • Intervention setting(s)

  • Outcomes and the extent to which they occurred


Shape106

Does the supporting documentation indicate that the intervention is evidence-based at a level that is appropriate for the intervention's stage of development (Research-tested, Practice-tested, Emerging)?




Shape120 Shape119 Shape118 Shape117 Shape116 Shape115 Shape114 Shape113 Shape112 Shape111 Shape110 Shape109 Shape108 Shape107



Questions 15*, 16*, 27*, supporting documents, & intervention materials




8

  • Evaluation methods used

  • Evaluation type for lifespan of intervention

  • Quality of the supporting materials and conclusions as appropriate for a low-income audience


Shape122 Does the evidence provided support that the intervention would be effective if adopted by other SNAP-Ed agencies? Is it reasonable to expect that this intervention will be effective in the field?



Shape135 Shape134 Shape133 Shape132 Shape131 Shape130 Shape129 Shape128 Shape127 Shape126 Shape125 Shape124 Shape123

Questions 15*, 16*, 27*, supporting documents, intervention materials, & possible outside research by reviewer




6

  • Theory of behavior change

  • Extent to which behavior change theory is addressed through intervention methods

  • Extent to which intervention has been implemented and evaluated by other SNAP-Ed agencies

-


Shape137 Are process evaluation materials provided?


Shape151 Shape150 Shape149 Shape148 Shape147 Shape146 Shape145 Shape144 Shape143 Shape142 Shape141 Shape140 Shape139 Shape138

Questions 28*, 28a, 28b, & intervention materials


2


- Yes/No


Effectiveness Total:




Shape152

Adoption

How many settings/sectors are involved and are they representative?

14


Shape154

Has the intervention previously been been used with a low-income audience?implemented with people eligible for SNAP-Ed (on limited incomes or earning low wages)?



Shape168 Shape167 Shape166 Shape165 Shape164 Shape163 Shape162 Shape161 Shape160 Shape159 Shape158 Shape157 Shape156 Shape155



Question 332*



1



- Yes/No



Review Question


Score

Intervention Submission Tool Questions or Materials to Review

Maximum Possible Points


Factors for High Score


Reviewer Comments

Shape170 How appropriate is the intervention for the setting for which it was intended?


Shape183 Shape182 Shape181 Shape180 Shape179 Shape178 Shape177 Shape176 Shape175 Shape174 Shape173 Shape172 Shape171

Questions 29*, 30*, supporting documents, & intervention materials


5


  • Resources needed for adoption (materials, staff, time, space)

  • Ability of setting to reach SNAP-Ed target audience

  • Availability of setting in communities of need


Shape185


Did most of the sites/settings/ partners engaged complete the intervention?




Shape199 Shape198 Shape197 Shape196 Shape195 Shape194 Shape193 Shape192 Shape191 Shape190 Shape189 Shape188 Shape187 Shape186



Questions 30*, 31*, & supporting documents




2

  • Number of sites/settings/partners approached that

  • completed all components of the intervention

  • Sites/settings/partners who expressed desire to continue but were unable to complete due to reasons beyond the scope of the intervention (such as closure of business)


Shape201

Does the intervention collaboratively engage partners who can affect change in multiple levels of the SNAP-Ed Evaluation Framework (or multiple levels of the Socio-Ecological Model)?




Shape215 Shape214 Shape213 Shape212 Shape211 Shape210 Shape209 Shape208 Shape207 Shape206 Shape205 Shape204 Shape203 Shape202

Questions 30*, 31*, 32*, supporting documents, implementation materials, & possible outside research by reviewer




6



  • Mix of partners across the sectors of influence

  • Ability of setting to reach SNAP-Ed target audience

  • Availability of setting in communities of need


Shape217 Adoption Total:


Shape219 Shape218




Implementation

Were the required activities of your intervention successfully implemented?

20


Shape221 Are training materials available for staff, partners, and/or volunteers?


Shape234 Shape232 Shape231 Shape230 Shape229 Shape227 Shape224 Shape222


Questions 36*, 36a, & intervention materials


2


- Yes/No




Are implementation directions and materials clear and easy to follow?



Shape250 Shape248 Shape247 Shape246 Shape245 Shape243 Shape240 Shape238




Intervention materials




5

  • Language level

  • Logical flow of implementation steps

  • Materials are provided to support successful implementation with fidelity

  • Materials are appropriate for knowledge and experience level of intended user (for example, materials for lay persons avoid technical jargon)


Are the intervention's main components (critical features) reasonably feasible to replicate with fidelity?



Shape266 Shape264 Shape263 Shape262 Shape261 Shape259 Shape256 Shape254


Questions 35*,36*, 36a, 37*, & intervention materials



8

  • Resources needed for implementation (including cost)

  • Availability and feasibility of methods for ensuring intervention fidelity

  • Ability of organizations with limited resources to implement the intervention



Are the methods described to ensure program fidelity appropriate for the interventions?



Shape281 Shape279 Shape278 Shape277 Shape275 Shape272 Shape270


Questions 35*, 36*, 36a, 37* & intervention materials


5

  • Data collection methods

  • Resources needed to ensure intervention is completed with fidelity (such as staff time for observations or physical materials)


Implementation Total:




Review Question


Score

Intervention Submission Tool Questions or Materials to Review

Maximum Possible Points


Factors for High Score


Reviewer Comments

Maintenance

What are the long-term effects of your intervention? Is the intervention sustainable?

18



Any evidence of maintenance of outcomes? (After 6 months for individuals)


Shape302 Shape300 Shape299 Shape298 Shape297 Shape295 Shape292 Shape290


Questions 25*, 26 & supporting documents



2

  • Feasibility of maintaining outcomes

  • Are maintenance outcomes expected at this point in the lifespan of the intervention (esp. if emerging)


Are resources or materials reusable or available to participants/partners at no/low cost on an ongoing basis to facilitate outcome maintenance?


Shape317 Shape315 Shape314 Shape313 Shape311 Shape308 Shape306

Questions 10*, 11, 25*, 40*, 43

& intervention materials



3

  • Feasibility of maintaining outcomes

  • Comparison of outcome maintenance to similar interventions

  • Are maintenance outcomes expected at this point in the lifespan of the intervention (esp. if emerging)


Are the core components of the

intervention clearly described and realistic for the audience and setting for which it is intended?

Can components of the intervention be adapted to be used in settings or communities other than those explicitly described in the submission criteria?




Shape332 Shape330 Shape329 Shape328 Shape326 Shape323 Shape321



Questions 35*, 40*, 41, 42,

supporting documents & intervention materials





5




  • Resources needed for implementation (including cost)

  • Appropriateness of the intervention for multiple audiences/settings


Has the intervention been adopted by partners/in settings not directly supported by SNAP-Ed?


Shape348 Shape346 Shape345 Shape344 Shape343 Shape341 Shape338 Shape336


Question 39*


1


- Yes/No


Are sustainability concerns reasonable and able to be addressed through routine operation, including expressed or expected partnerships or diversified funding mechanisms? Consider both expressed and

intuited concerns.




Shape364 Shape362 Shape361 Shape360 Shape359 Shape357 Shape354 Shape352



Questions 40*, 43 supporting documents & intervention materials




7


  • Number and extent of sustainability concerns

  • Total resources needed for intervention adoption, implementation, and maintenance

  • Diversity of potential partners or funding streams

  • Number of potential partners or funding streams


Maintenance Total:






BONUS: Does the intervention reach an underrepresented audience in the toolkit?




Shape382 Shape380 Shape379 Shape378 Shape377 Shape375 Shape372 Shape370


Questions 19*, 20* supporting documents & intervention materials




5

Less than 30% of interventions currently represented in the Toolkit address this population:

  • Middle School

  • High School

  • Pregnant/Breastfeeding Women

  • Homeless/Food Pantry Clients

  • African Americans

  • Asian Americans/Pacific Islanders

  • Native Americans/Alaskan Natives






- Language other than English or Spanish




Review Question


Score

Intervention Submission Tool Questions or Materials to Review

Maximum Possible Points


Factors for High Score


Reviewer Comments



BONUS: Does the intervention reach an underrepresented setting in the toolkit?





Questions 29* & 32*




5

Less than 30% of interventions currently represented in the Toolkit address this setting:

  • Community Gardens

  • Farmers Markets

  • School Gardens

  • Faith-based community

  • Food pantries

  • Health Care

  • Indian Tribal Organizations

  • Food Retail

  • USDA Program Sites

  • Worksites







BONUS: Does the intervention use an approach/strategy that is currently underutilized in the toolkit?




Shape397 Shape395 Shape394 Shape393 Shape391 Shape388 Shape386




Question 14*




5

Less than 30% of interventions currently represented in the Toolkit address this implementation strategy:


- Social marketing


**Consider if this intervention is appropriate for the target audience and settings, would reach the SNAP- Ed target audience, and if it is feasible for organizations to adopt and implement


BONUS: How would you rate the overall quality of the intervention responses and materials?



5

  • Responses that are comprehensive and use specific, concise language

  • Materials that provide relevant supporting information and are clearly referenced





Bonus Total:

Shape404 Shape403 Shape402 Shape401


Total Score (No Bonus):


Shape409

Shape408

If no to above, please describe your reasoning for exclusion from the Toolkit:

If no to above, please describe what additional information or actions would be needed to recommend this intervention for inclusion in the Toolkit:

If yes to above, please describe your reasoning for inclusion in the Toolkit:


File Typetext/rtf
File TitleFNS-885
SubjectSNAP-Ed Toolkit Intervention Scoring Tool
AuthorProctor, Jakira - FNS
File Modified2021-10-06
File Created2021-09-20

© 2024 OMB.report | Privacy Policy