Form 1 SRAE Performance Reporting System Data Entry Form

INSTRUMENT 3

Sexual Risk Avoidance Education (SRAE)

performance reporting system data entry form

AUGUST 2021

The 192 estimated grantees will report measures on participant demographics, behaviors, intentions, perceived effects, and program experiences; attendance, reach, and dosage; implementation challenges and needs for technical assistance; and structure, cost, and support for program implementation. The contractor (Public Strategies) and subcontractor (Mathematica) have developed this tool for grantees to use to collect data originating from subrecipient providers and to organize all of the grantee-, provider-, and program-level performance measures data elements for submission into the SRAE Performance Measures Portal. The contractor developed separate tools to support grantees in their submission of the data originating from the entry and exit surveys (Instruments #1 and #2). However, these tools are considered voluntary and to be used at the discretion of the grantees. Grantees may elect to use alternative means to collect the data that will be submitted. The only requirement will be that all grantees enter the required measures into the Portal systematically, and for that they will (1) use an online form that contains all of the items in this instrument and (2) upload data files containing the items in Instruments #1 and #2.

THE PAPERWORK REDUCTION ACT OF 1995

Public reporting burden for this collection of information is estimated to average 16 hours 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.

Measures of Structure, Cost, and Support for Program Implementation

REPORT PERIOD		[reporting period]
Grantee:		Enter grantee name
SRAE Operational Status Related to COVID-19
Did the grantee experience any interruptions of SRAE administrative operations during the reporting period due to COVID-19?			Y/N
Did the grantee experience any interruptions of SRAE services to youth during the reporting period due to COVID-19?			Y/N
Funding
Total amount of SRAE grant funding obligated (including any carryover funds) during [reporting period]				$
Percentage of total funding obligated for:
Percent of funding obligated	Direct service provision (youth programming)			%
	Training, technical assistance, and monitoring conducted at the grantee level			%
	Evaluation and/or research			%
	Administrative purposes at the grantee level			%
Grantee Staffing				Count
Number of grantee staff involved in overseeing SRAE1				#
Number of grantee FTEs involved in overseeing SRAE				#

Grantee Observation, Training and Technical Assistance		Y/N
Grantee or its designee observed program delivery to monitor quality and fidelity to program models
Type of organization that conducted observations:		Y/N
Type of Organization – Observations	Grantee
	Developer
	Training or technical assistance partner
	Evaluation partner
	Program provider
Grantee or its designee provided technical assistance to support program implementation
Type of organization that provided technical assistance:		Y/N
Type of Organization – TA	Grantee
	Developer
	Training or technical assistance partner
	Evaluation partner
	Program provider
Grantee or its designee conducted training of facilitators who deliver the program (or of other staff who might train facilitators)
Type of organization that conducted program facilitator training:		Y/N
Type of Organization – Training	Grantee
	Developer
	Training or technical assistance partner
	Evaluation partner
	Program provider
Number of providers		Count
Number of providers funded
Number of new providers

Target number of youth to be served by the grantee (in the original application or approved by your project officer)	Count
Target number of youth

Measures of Structure, Cost, and Support for Program Implementation

REPORT PERIOD	[reporting period]
Grantee:	Enter grantee name
Provider:	Enter provider name

Provider Funding	Amount
SRAE annual award amount (for current grant year)	$
Amount of non-SRAE funding received during current reporting year to support SRAE programming	$
Provider Staff in SRAE Administration	Count
Number of provider staff involved in administering SRAE programs2
Number of provider FTEs involved in administering SRAE programs
Provider Status	Y/N
Is provider new for the [reporting year]?
Did provider serve youth during the [reporting year]?
Facilitators	Count
Number of SRAE facilitators working for provider
Facilitator Training and Observation	Count
Number of SRAE facilitators trained in delivering core curriculum
Number of SRAE facilitators observed exactly once
Number of SRAE facilitators observed at least twice

Measures of Structure, Cost, and Support for Program Implementation

REPORT PERIOD	[reporting period]
Grantee:	Enter grantee name
Provider:	Enter provider name

	Use the scale at the right to indicate how the provider assessed the implementation challenges below.		Not a Problem	Somewhat a problem	A serious problem
Implementation Challenges	Recruiting youth
	Keeping youth engaged
	Getting youth to attend regularly
	Recruiting qualified staff
	Ensuring facilitators understand content
	Covering program content
	Staff turnover
	Negative peer reactions
	Youth behavioral problems
	Natural disasters
	Program facilities
	Obtaining buy-in or support from key stakeholders
	Parent support or engagement
	Other
	Use the scale at the right to indicate if the provider has expressed interest in receiving technical assistance for the implementation factors below.	Not Interested, Because Already Received	Not Interested	Somewhat Interested	Very Interested
Needs for Technical Assistance	Recruiting youth
	Keeping youth engaged in program sessions
	Getting youth to attend regularly
	Recruiting qualified staff
	Training facilitators
	Retaining staff
	Minimizing negative peer reactions
	Addressing youth behavioral issues
	Obtaining buy-in or support from key stakeholders
	Evaluation (e.g., how to select or manage an evaluator, data collection, data analysis, and report writing)
	Parent support and engagement
	Other

Measures of Structure, Cost, and Support for Program Implementation

REPORT PERIOD	[reporting period]
Grantee:	Enter grantee name
Provider:	Enter provider name
Program:	Enter program name

Program Delivery
Number of intended program delivery hours
Core curriculum
Indicate which SRAE topics3 are addressed by this core curriculum:			Y/N
SRAE topics covered through core curriculum	Teaching the benefits of:
	Advantage of refraining from nonmarital sexual activity (B)
	Self-regulation (A)
	Goal setting (A)
	Success sequence for poverty prevention4 (C)
	Healthy relationships (D)
	Resisting:
	Sexual coercion (F)
	Dating violence (F)
	Other youth risk behaviors, such as alcohol, tobacco, and other drug use (E)
Other program elements that address SRAE topics	Are there any other program elements – such as supplemental curriculum, guest speakers, or other program activities that are not part of the core curriculum – that address SRAE topics?		Y/N

Measures of Structure, Cost, and Support for Program Implementation

REPORT PERIOD	[reporting period]
Grantee:	Enter grantee name
Provider:	Enter provider name
Program:	Enter program name

Indicate which SRAE topics3 are addressed through supplemental program elements:			Y/N
SRAE topics covered through supplemental program elements		Teaching the benefits of:
		Refraining from nonmarital sexual activity (B)
		Self-regulation (A)
		Goal setting (A)
		Success sequence for poverty prevention4 (C)
		Healthy relationships (D)
		Resisting:
		Sexual coercion (F)
		Dating violence (F)
		Other youth risk behaviors, such as alcohol, tobacco, and other drug use (E)
Indicate which, if any, of the following youth groups are target populations for the provider’s program			Y/N
Target Population	Youth in high-need geographic areas
	Youth in foster care
	Homeless or runaway youth
	Youth living with HIV/AIDS
	Pregnant or parenting youth
	Hispanic/Latino youth
	African American youth
	Native American youth
	LGBTQ youth
	Youth in adjudication systems
	Male youth
	Out of school or dropout youth
	Youth in residential treatment for mental health issues
	Trafficked youth

Measures of Attendance, Reach, and Dosage

REPORT PERIOD	[reporting period]
Grantee:	Enter grantee name
Provider:	Enter provider name
Program:	Enter program name

	Enter the number of youth during the reporting period who:	Enter Count
Reach	Attended at least one program session
	Number of middle school age participants
	Number of high school age or older participants
Program Setting	Attended a session in school during school
	Attended a session in school after school
	Attended a session in a community-based organization
	Attended a session in a clinic
	Attended a session in a foster care setting
	Attended a session in a juvenile detention center
	Attended a session in a residential mental health treatment facility
	Attended a virtual sessiona
	Attended a session in another setting
Attendance/Dosage	Completed at least 75 percent of the scheduled program hours
aVirtual includes any programming that is facilitated virtually rather than by an in-person facilitator, regardless of the physical setting where participants are located.
	Indicate whether more than 50 percent of youth attending the program were:	Y / N
Majority population	In foster care
	Homeless or runaway
	Pregnant or parenting
	In adjudication systems
	LGBTQ youth
	Enter the appropriate count below	Enter Count
Parent Involvement	Number of youth’s parents and other caring adults who attended at least one program session during the reporting period

Measures of Attendance, Reach, and Dosage

REPORT PERIOD					[reporting period]
Grantee:					Enter grantee name
Provider:					Enter provider name
Program:					Enter program name
	Cohort5
Enter a unique identifier for each cohort that ended the program during this reporting period.	1	2	3	4		5	6	7	8	9	etc.
How many hours of programming, overall, were delivered to the cohort?

Measures Related to Collection of Participant Entry Surveys

REPORT PERIOD	[reporting period]
Grantee:	Enter grantee name
Provider:	Enter provider name
Program:	Enter program name

	Enter Count			Enter Count
Total Entry Surveys Completed (Middle School):			Total Entry Surveys Completed (High School or Older):

Did the program receive an approval from their Federal Project Officer to delay their survey data collection start date?	Y/N
Did the program receive an approved waiver letter from their Federal Project Officer for any entry survey items?	Y/N
At any point during the reporting period [DATES], was the program unable to collect entry survey data due to COVID-19?	Y/N
What mode(s) of data collection did the program use for participant entry surveys during the reporting period? MARK YES OR NO FOR EACH
In-person paper-and-pencil survey	Y/N
Online, web-based survey	Y/N
Telephone survey	Y/N
Mail survey	Y/N
Other (specify:___________)	Y/N

Measures Related to Collection of Participant Exit Surveys

REPORT PERIOD							[reporting period]
Grantee:							Enter grantee name
Provider:							Enter provider name
Program:							Enter program name
			Enter Count					Enter Count
Total Exit Surveys Completed (Middle school):					Total Exit Surveys Completed (High school and older):

Did the program receive an approval from their Federal Project Officer to delay the survey data collection start date?	Y/N
Did the program receive an approved waiver letter from their Federal Project Officer for any exit survey items?	Y/N
At any point during the reporting period [DATES], was the program unable to collect exit survey data due to COVID-19?	Y/N
What mode(s) of data collection did the program use for participant exit surveys during the reporting period? MARK YES OR NO FOR EACH
In-person paper-and-pencil survey	Y/N
Online, web-based survey	Y/N
Telephone survey	Y/N
Mail survey	Y/N
Other (specify:___________ )	Y/N

1 The Portal will include the following hover-over text: “This measure should include grantee staff, such as SRAE program directors and program coordinators, who were directly responsible for administering, managing, and overseeing the SRAE program. Do not include grantee staff who provide programming directly to youth but do not oversee SRAE in this measure. Those staff should be counted in the measure of facilitators on the program provider data page. If staff play both roles, they should be included in both measures.”

2 The Portal will include the following hover-over text: “This measure should include provider staff, such as SRAE program directors and program coordinators, who were directly responsible for administering, managing, and overseeing the SRAE program for the provider. Do not include staff who provide programming directly to youth in this measure. Those staff should be counted in the measure of facilitators later in this section. If staff play both roles, they should be included in both measures.”

3 The letter in parentheses after each of these measures indicates which of the A-F topics in the Title V, Section 510 legislation it aligns with:

1. The holistic individual and societal benefits associated with personal responsibility, self-regulation, goal setting, healthy decision-making, and a focus on the future.

2. The advantage of refraining from non-marital sexual activity in order to improve the future prospects, and physical and emotional health of youth.

3. The increased likelihood of avoiding poverty when youth attain self-sufficiency and emotional maturity before engaging in sexual activity.

4. The foundational components of healthy relationships and their impact on the formation of healthy marriages and safe and stable families.

5. How other youth risk behaviors, such as drug and alcohol usage, increase the risk for teen sex.

6. 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.

4 Success sequence for poverty prevention – The three steps that young adults should take to improve the likelihood of successful economic outcomes when reaching adulthood. The steps include, but are not limited to, graduating from high school, working a full time job, and waiting until age 21 or later to get married and have children (SRAE 2019 Funding Opportunity Announcement).

5 The Portal will include the following hover-over text: “A cohort, in this context, represents a group of youth that all jointly receive a defined SRAE program, which could include a specific curriculum and any additional hours of programming added to meet all requirements for the SRAE program. If a provider is delivering a SRAE program to multiple groups of youth simultaneously, but these groups meet separately, each group of youth should be considered a separate cohort. A cohort could consist of an individual, if programming is delivered one-on-one.”