Expiration Date: XX/XX/XXXX
August 2022
THE PAPERWORK REDUCTION ACT OF 1995 This collection of information is voluntary and will be used to provide the Administration for Children and Families with information to help refine and guide program development in the area of adolescent pregnancy prevention. Public reporting burden for the collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, 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. The OMB number and expiration date for this collection are OMB #: XXXX-XXXX, Exp: XX/XX/XXXX. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Tiffany Waits at [email protected]. |
This first section asks questions about the SRAE grant organization you work for and the SRAE curricula your organization delivers.
RQ1: Curricula
ALL
A1. Which curricula are your sub-recipient providers delivering/have they delivered to youth this school year?
MARK ALL THAT APPLY
o Aspire 1
o Choosing the Best 2
o Game Plan 3
o Healthy Futures 4
o Heritage Keepers 5
o Living WELL Aware Adolescent Health Program 6
o Love Notes (Classic) 7
o Love Notes (SRA) 8
o Making a Difference 9
o Navigator 10
o Positive Potential 11
o Promoting Health Among Teens (Abstinence only) 12
o Promoting Health Among Teens (Comprehensive) 13
o Pure and Simple 14
o REAL Essentials 15
o Relationship Smarts Plus (Classic) 16
o Relationship Smarts Plus (SRA) 17
o Teen Outreach Program (TOP) 18
o Wise Guys 19
o Worth the Wait 20
o Your Future on the Line 21
o Other curricula (please name) 99
RQ3: Setting
PROGRAMMER: LOOP question filling each CURRICULUM for A1_1–A1_22 = YES
A2. In which of the following setting(s) do your sub-recipient providers deliver/have delivered [CURRICULUM] to youth in this school year?
MARK ALL THAT APPLY
Middle schools, during school 1
Middle schools, after school 2
High schools, during school 3
High schools, after school 4
Community-based organizations, outside of school time 5
Detention centers 6 Go to A2A
Foster care group homes 7 Go to A2A
Institutions for youth with emotional or behavioral health needs 8 Go to A2A
Faith-based institutions 9
Clinics/hospitals 10
Other settings (please describe) 99
RQ3: Setting
IF A2=6, 7, OR 8
A2a. ACF is interested in learning about implementation experiences in detention centers, foster care group homes, and institutional living settings for youth . We want to confirm that programming is delivered/has been delivered this school year in [FILL SELECTED 6,7,8 FROM A2], is that correct?
m Yes 1 Go to A2B
m No 0 Go to A3
RQ3: Setting
IF A2a=YES AND IF ANY 6,7, OR 8 IS SELECTED AT A2, ASK A2b. ELSE, GO TO A4.
A2b. IF A2= MORE THAN ONE SELECTED AT 6, 7, OR 8:] Which of these combinations of curriculum and setting serves the largest number of youth currently?
[IF A2= ONLY ONE 6, 7, OR 8 SELECTED AND A1= MORE THAN 1 SELECTED:] You reported that more than one curriculum was delivered to youth this school year. Thinking only about youth served in [FILL A2 RESPONSE= 6, 7, OR 8], which curriculum serves the largest number of youth?
You may also deliver programming in other settings, such as schools, but please answer only about your programming in [FILL SELECTED 6,7,8 FROM A2].
A2= MORE THAN ONE SELECTED AT 6, 7, OR 8, LIST CURRICULA Any A1= YES, REPEAT ANY
A1=Yes WITH EACH SETTING WHERE A2=6,7,8)
A2 = ONLY ONE 6, 7, OR 8 SELECTED AND A1- MORE THAN 1 SELECTED, LIST CURRICULA ANY A1= YES WITH A2 SELECTION ONLY 6, 7, OR 8).
[CURRICULUM] in [SETTING]
RQ3: Setting
EXCLUDE IF A2= 6, 7, OR 8.
IF MORE THAN 1 AT A1 SELECTED AND/OR MORE THAN 1 IN A2 SELECTED.
A3. Considering all the curricula that are delivered by your sub-recipients and the settings those curricula are delivered in, select the combination of curriculum and setting that served the largest number of youth this school year.
SELECT ONE ONLY FROM THE LIST BELOW
LIST CURRICULA Any A1 SELECTED, REPEAT ANY A1 SELECTED WITH EACH SETTING WHERE A2 SELECTED)
[CURRICULUM] in [SETTING]
PROGRAMMER BOX
SET FILLS FOR “CURRICULUM” AND “SETTING” AT ALL FOLLOWING ITEMS SUCH THAT:
FOR ALL CASES WITH RESPONSE AT A2B:
-FILL “CURRICULUM” WITH SELECTION OF A1 RESPONSE AT A2B.
-FILL “SETTING” WITH SELECTION OF A2= 6, 7, OR 8 RESPONSE AT A2B OR IF A2= ONLY ONE SELECTION AT 6, 7, OR 8, FILL “SETTING” WITH THAT RESPONSE.
FOR ALL CASES WITH RESPONSE AT A3
-FILL “CURRICULUM” WITH SELECTION OF A1 RESPONSE AT A3
-FILL “SETTING” WITH SELECTION OF A2 RESPONSE AT A3
RQ3: Setting
IF A3 [SETTING] ≠ middle schools, during school; middle schools, after school; high schools, during school; or high schools, after school
FILL [CURRICULUM] AND [SETTING]
A4. What is the age range of the youth where [CURRICULUM] in [SETTING] has been delivered this school year?
MARK ALL THAT APPLY
o 10-13 1
o 14–15 2
o 16 and older 3
The next questions ask about any modifications you may have made to the curricula topics.
RQ1: Modifications
B1. Thinking back to your plans at the start of your [first] SRAE grant, have you made any of the following changes from what you had originally planned?
|
No changes have been made |
Yes, changes made only in response to the COVID-19 pandemic |
Yes, changes made for other reasons (not in response to the COVID-19 pandemic) |
a. Target population |
1 m |
2 m |
3 m |
b. Total program dosage |
1 m |
2 m |
3 m |
c. Setting |
1 m |
2 m |
3 m |
d. Facilitators (such as changing from a school-teacher to a facilitator from an outside organization) |
1 m |
2 m |
3 m |
e. Content (for example, content presented in a different way, more or less information provided on a topic, more or fewer participatory activities conducted) |
1 m |
2 m |
3 m |
f. Other changes (please describe) |
1 m |
2 m |
3 m |
|
|
|
|
g. Other changes (please describe) |
1 m |
2 m |
3 m |
|
|
|
|
h. Other changes (please describe) |
1 m |
2 m |
3 m |
|
|
|
|
RQ1: Modifications
If B1_a (target population) = 3
B2. What changes were made to the target population?
MARK ALL THAT APPLY
o Changed to or added a younger population 1
o Changed to or added an older population 2
o Changed to or added youth in out-of-home care 3
o Changed to or added youth with other special needs (please describe) 4
o Other (please describe) 99
RQ1: Modifications
If B1_b (dosage)= 3
B3. What changes were made to the dosage?
MARK ALL THAT APPLY
o Increased dosage 1
o Decreased dosage 2
o Other (please describe) 99
RQ1: Modifications
If B1_c (setting)= 3
B4. What changes were made to the setting?
MARK ALL THAT APPLY
o More school sites 1
o More out-of-school sites 2
o Other (please describe) 99
RQ1: Modifications
If B1_d (facilitators)= 3
B5. What changes were made to the types of facilitators?
MARK ALL THAT APPLY
o Changed to or added to using health educators or outside facilitators 1
o Changed to or added using schoolteachers 2
o Changed to or added using peer facilitators 3
o Other (please describe) 99
RQ1: Changes made to curricular content and why (not COVID related)
If B1_e (content)= 3
B6. In what ways did the content change?
MARK ALL THAT APPLY
o Presented content in different way 1
o Included more information on specific topic 2
o Included less information on specific topic 3
o Included more participatory activities for youth (on a specific topic) 4
o Included fewer participatory activities for youth (on a specific topic) 5
o Other (please describe) 99
RQ1: Changes made to curricular content and why (not COVID related)
If B1_e (content)= 3
B6a. What specific changes were made to the curricular content?
|
SELECT ALL THAT APPLY |
a. Updated and/or customized statistics and other reproductive health information |
1 □ |
b. Customized role play scenarios (e.g., using wording more reflective of the youth culture) |
2 □ |
c. Made activities more interactive, appealing to different learning styles |
3 □ |
d. Tailored aspects of instructional approaches or activities to youth culture, developmental stage, gender, sexual orientation |
4 □ |
e. Changed the order of sessions or sequence of activities |
5 □ |
f. Added activities to reinforce learning |
6 □ |
g. Added activities to address additional risk and protective factors |
7 □ |
h. Modified condom lessons |
8 □ |
i. Replaced or supplemented videos with other videos |
9 □ |
j. Replaced or supplemented activities with videos |
10 □ |
k. Other (please describe) |
99 □ |
|
|
RQ1: Modifications
If B1_e (content)= 3
B6b. What were the reasons you made changes to the curricular content?
MARK ALL THAT APPLY
o To be medically accurate 1
o To be age appropriate 2
o To be culturally relevant 3
o To be linguistically appropriate 4
o To tailor to the target population 5
o Other (please describe) 99
RQ1: Modifications
If B1_e (content)= 3
B6c. Which of the following were influential in the content change?
MARK ALL THAT APPLY
o Input from youth 1
o Staff at setting 2
o Parents 3
o Broader community 4
o Facilitators 5
o State policy 6
o Local policy 7
o Input from sub-recipients 8
o Guidance from FYSB 9
o FYSB medical accuracy review 10
o Other (please describe) 99
RQ1: Changes made to curricular content and why (not COVID related)
If B1_e (content)= 3
B7. Next, please provide information about the changes made to specific topics under each A-F content area.
First, tell us which topics you have changed.
Next, for each topic where content was changed, indicate if that change was due to a medical accuracy review.
|
CHANGED TOPIC |
CHANGE DUE TO MEDICAL ACCURACY REVIEWS |
|||
|
SELECT ONE RESPONSE PER ROW |
SELECT ONE RESPONSE PER ROW |
|||
|
Yes, changed this topic |
No, did not change this topic |
Yes |
No |
I don’t know |
Life skill building to support future goals and well-being |
|
|
|
|
|
a. Personal responsibility |
1 m |
0 m |
1 m |
0 m |
d m |
b. Self-worth |
1 m |
0 m |
1 m |
0 m |
d m |
c. Goal setting and future planning |
1 m |
0 m |
1 m |
0 m |
d m |
d. Decision making |
1 m |
0 m |
1 m |
0 m |
d m |
e. Self-regulation |
1 m |
0 m |
1 m |
0 m |
d m |
Advantages of refraining from nonmarital sexual activity to improve future outcomes, enhance overall health, and avoid poverty |
|
|
|
|
|
f. Optimal or overall health (defined as a dynamic balance of physical, emotional, social, spiritual, and intellectual health.) |
1 m |
0 m |
1 m |
0 m |
d m |
g. Physical health |
1 m |
0 m |
1 m |
0 m |
d m |
h. Sexual health |
1 m |
0 m |
1 m |
0 m |
d m |
i. Social and emotional health |
1 m |
0 m |
1 m |
0 m |
d m |
Healthy relationships as the foundation for healthy marriage and family formation |
|
|
|
|
|
j. Benefits of a healthy marriage |
1 m |
0 m |
1 m |
0 m |
d m |
k. Trusted relationships with parents/adults |
1 m |
0 m |
1 m |
0 m |
d m |
l. Healthy peer friendships |
1 m |
0 m |
1 m |
0 m |
d m |
m. Healthy romantic relationships |
1 m |
0 m |
1 m |
0 m |
d m |
n. Community connections |
1 m |
0 m |
1 m |
0 m |
d m |
Avoidance of negative risk behaviors, such as drug and alcohol use |
|
|
|
|
|
o. Peer norms and behaviors |
1 m |
0 m |
1 m |
0 m |
d m |
p. Drug and alcohol use |
1 m |
0 m |
1 m |
0 m |
d m |
q. Media use and influence |
1 m |
0 m |
1 m |
0 m |
d m |
Prevention of and support related to sexual coercion and dating violence |
|
|
|
|
|
r. Sexual consent |
1 m |
0 m |
1 m |
0 m |
d m |
s. Sexual coercion and dating violence |
1 m |
0 m |
1 m |
0 m |
d m |
The next questions ask about any partners you may be working with specifically on work conducted under the current SRAE grant. Please consider any partners that play an important role in helping your organization with the SRAE program.
B8. Since the beginning of your grant, have you partnered with other entities for help with any of the following?
If you do not have any partners, check this box to go to the next question.
SELECT ONE PER ROW
|
YES |
NO |
Curricula and training |
|
|
a. Curricula development |
1 m |
0 m |
b. Training staff on curricula |
1 m |
0 m |
c. Other staff professional development (not including training on the curricula) |
1 m |
0 m |
Technology |
|
|
d. Technological support/platforms |
1 m |
0 m |
e. Training on technology |
1 m |
0 m |
Program delivery |
|
|
f. Providing staff for program implementation |
1 m |
0 m |
g. Providing space for the programming |
1 m |
0 m |
Evaluation and monitoring |
|
|
h. Collecting data |
1 m |
0 m |
i. Managing and analyzing data |
1 m |
0 m |
j. Quality of program implementation and monitoring fidelity to the model |
1 m |
0 m |
Partnered for any other reasons |
|
|
k. Other (please describe) |
1 m |
0 m |
|
|
|
B9. Which of the following have occurred during the current SRAE grant period with regard to your partnerships?
During the current grant period…
|
SELECT ONE PER ROW |
||
|
YES |
NO |
DOES NOT APPLY |
a. We have added partners |
1 m |
0 m |
NA m |
b. We have had partners become inactive |
1 m |
0 m |
NA m |
c. We have renegotiated the terms of formal agreements with partners |
1 m |
0 m |
NA m |
d. We have resolved significant challenges with partners |
1 m |
0 m |
NA m |
The next questions ask about referrals your organization makes for youth you serve under the current SRAE grant.
B10. Indicate whether your organization has made any referrals for youth for any of the following reasons. For any type of referral made, please indicate the total number of youth referred for that reason in the 2022 fiscal year.
|
SELECT ONE PER ROW |
(IF
YES) |
|
|
YES |
NO |
|
a. Academic tutoring |
1 m |
0 m |
|
b. Special education services |
1 m |
0 m |
|
c. Counseling services |
1 m |
0 m |
|
d. Food or personal care (e.g., clothing, hygiene products, etc.) assistance |
1 m |
0 m |
|
e. Family services/social services |
1 m |
0 m |
|
f. Other referrals (please describe and then enter total youth referred) |
1 m |
0 m |
|
|
|
|
|
RQ1: Modifications
B11. How much flexibility do your sub-recipient providers have to propose program changes that go beyond the ones you made so they can meet local needs?
m No flexibility to propose program changes 1
m Some flexibility to propose program changes 2
m A lot of flexibility to propose program changes 3
RQ2: Interpretation and understanding of A-F topics
C1. Thinking back to the start of your [first] SRAE grant, and comparing that to now, has your program changed how it covers and emphasizes each of the A–F topics overall? Please note that these criteria are only requirements for Title V grantees.
|
SELECT ONE RESPONSE PER ROW |
|||||
|
Covered this with less emphasis at the start of the grant compared to now |
Covered this with about the same emphasis at the start of the grant compared to now |
Covered this with a stronger emphasis at the start of the grant compared to now |
Not covered at the start of the grant and not covered now/Not applicable |
I don’t know |
|
a. The holistic and individual societal benefits associated with personal responsibility, self-regulation, goal setting, healthy decision making, and a focus on the future |
1 m |
2 m |
3 m |
4 m |
d m |
|
b. The advantage of refraining from nonmarital sexual activity in order to improve the future prospects and physical and emotional health of youth |
1 m |
2 m |
3 m |
4 m |
d m |
|
c. The increased likelihood of avoiding poverty when you attain self-sufficiency and emotional maturity before engaging in sexual activity |
1 m |
2 m |
3 m |
4 m |
d m |
|
d. The foundational components of healthy relationships and their impact on the formation of healthy marriages and safe and stable families |
1 m |
2 m |
3 m |
4 m |
d m |
|
e. How other youth risk behaviors, such as drug and alcohol usage, increase the risk for teen sex |
1 m |
2 m |
3 m |
4 m |
d m |
|
f. How to resist and avoid, and receive help regarding, sexual coercion and dating violence, recognizing that even with consent teen sex remains a youth risk behavior |
1 m |
2 m |
3 m |
4 m |
d m |
|
RQ2: Interpretation and understanding of A-F topics
C2. You indicated you covered [LOOP: FILL C2-a-f IF=1 OR 3] with [less emphasis at the start of the grant compared to now/stronger emphasis at the start of the grant compared to now]. Why did the emphasis on that topic change?
MARK ALL THAT APPLY
o Our interpretation of the A-F topics changed 1
o Feedback from FYSB 2
o Feedback from the community 3
o Changes to needs in the community 4
o Conversations with other SRAE grantees or providers 5
o Curriculum developer 6
o Other reason (please describe) 99
RQ2: Interpretation and understanding of A-F topics
C3. Thinking back to the start of your [first] SRAE grant to now, how much has your interpretation of the A–F topics changed over time?
|
SELECT ONE RESPONSE PER ROW |
||||
|
Our interpretation has not changed at all |
Our interpretation has changed a little |
Our interpretation has changed a lot |
Not included in the program/not applicable |
I don’t know |
a. The holistic and individual societal benefits associated with personal responsibility, self-regulation, goal setting, healthy decision making, and a focus on the future |
1 m |
2 m |
3 m |
4 m |
d m |
b. The advantage of refraining from nonmarital sexual activity in order to improve the future prospects and physical and emotional health of youth |
1 m |
2 m |
3 m |
4 m |
d m |
c. The increased likelihood of avoiding poverty when you attain self-sufficiency and emotional maturity before engaging in sexual activity |
1 m |
2 m |
3 m |
4m |
d m |
d. The foundational components of healthy relationships and their impact on the formation of healthy marriages and safe and stable families |
1 m |
2 m |
3 m |
4 m |
d m |
e. How other youth risk behaviors, such as drug and alcohol usage, increase the risk for teen sex |
1 m |
2 m |
3 m |
4 m |
d m |
f. How to resist and avoid, and receive help regarding, sexual coercion and dating violence, recognizing that even with consent teen sex remains a youth risk behavior |
1 m |
2 m |
3 m |
4 m |
RQ2: Interpretation and understanding of A-F topics
IF ANY AT C3 = 2 or 3
C3a. You indicated there were some changes in how you interpreted the A–F topics. What is the reason for those changes?
MARK ALL THAT APPLY
o Direct guidance from project officer 1
o General guidance from FYSB 2
o Program technical assistance webinar 3
o Program technical assistance resource document 4
o Individual technical assistance from a contractor 5
o Conversations with other SRAE grantees or providers 6
o Curriculum developer 7
o Other outside consultants (please describe) 8
o Other resources (please describe)
RQ2: Interpretation and understanding of A-F topics
IF ANY AT C3 = 2 or 3
C3b. Did any of the following change due to changes in your interpretation of the A-F topics?
MARK ALL THAT APPLY
o Target population 1
o Total program dosage 2
o Curriculum 3
o Setting 4
o Type of facilitator 5
RQ2: Interpretation and understanding of A-F topics
C4. Thinking about the time period from the start of your [first] SRAE grant to now, how useful have the following resources been for interpreting, understanding, or addressing the A–F topics?
First, tell us whether you have used each of the following resources.
Next, for each resource used, report the usefulness of that resource.
|
USED RESOURCE |
USEFULNESS OF RESOUCE |
||||
|
SELECT ONE RESPONSE PER ROW |
MARK ALL THAT APPLY |
||||
|
Yes, used this resource |
No, did not use this resource |
Not at all useful |
Not that useful |
Somewhat useful |
Very useful |
a. Direct guidance from your project officer |
1 m |
0 m |
1 o |
2 o |
3 o |
4 o |
b. General guidance from FYSB |
1 m |
0 m |
1 o |
2 o |
3 o |
4 o |
c. Program technical assistance webinar |
1 m |
0 m |
1 o |
2 o |
3 o |
4 o |
d. Program technical assistance resource document |
1 m |
0 m |
1 o |
2 o |
3 o |
4 o |
e. Individual technical assistance from a contractor |
1 m |
0 m |
1 o |
2 o |
3 o |
4 o |
f. Conversations with other SRAE grantees or providers |
1 m |
0 m |
1 o |
2 o |
3 o |
4 o |
g. Curriculum developer |
1 m |
0 m |
1 o |
2 o |
3 o |
4 o |
h. Other outside consultants (please describe) |
1 m |
0 m |
1 o |
2 o |
3 o |
4 o |
|
|
|
|
|
|
|
i. Other resources (please describe) |
1 m |
0 m |
1 o |
2 o |
3 o |
4 o |
|
|
|
|
|
|
|
The questions in this section are about your experiences with the community and the setting in regard to their reactions to the SRAE program curriculum content.
RQ1: Receptivity of schools and communities to curricular content
D1. In your opinion, how supportive or unsupportive are parents and guardians of the SRAE curriculum youth receive?
m Very supportive 1
m Somewhat supportive 2
m Neither supportive or unsupportive 3
m Somewhat unsupportive 4
m Very unsupportive 5
m I don’t know/unsure d
RQ1: Receptivity of schools and communities to curricular content
D2. In your opinion, how supportive or unsupportive are staff at your organization (at the grantee level) of the SRAE curriculum youth receive?
m Very supportive 1
m Somewhat supportive 2
m Neither supportive or unsupportive 3
m Somewhat unsupportive 4
m Very unsupportive 5
RQ1: Receptivity of schools and communities to curricular content
D3. In your opinion, how supportive or unsupportive is the broader community of the SRAE curriculum youth receive?
m Very supportive 1
m Somewhat supportive 2
m Neither supportive or unsupportive 3
m Somewhat unsupportive 4
m Very unsupportive 5
m I don’t know/unsure d
[STATE GRANTEES ONLY] The final questions focus on your organization’s use of data under the current SRAE grant.
D4. [STATE GRANTEES ONLY] Thinking about the system you use to submit performance measures data to FYSB, is that data system centralized within your state office?
A centralized system means that all data are entered into a main, shared system by providers.
m Yes 1
m No 0
D5. [STATE GRANTEES ONLY] Are your subcontractors required to submit data other than performance measures?
m Yes 1
m No 0
Thank you for participating in this important survey!
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | Mathematica Proposal |
Subject | proposal |
Author | SRAENE |
File Modified | 0000-00-00 |
File Created | 2022-09-08 |