Personal Responsibility Education Program (PREP) Local Evaluation Support

Administration for Children and Families

Family and Youth Services Bureau

Adolescent Pregnancy Prevention Program

OMB Control #0970-0531

Personal Responsibility Education Innovative Strategies

(PREIS)

IMPLEMENTATION PLAN TEMPLATE

The PREIS implementation plan is designed to assist you with program implementation planning during Phase 1 of your grant. An implementation plan is a tool that provides detailed documentation of approaches and strategies that will be used for program implementation. This template can be used as a guide to help you map out or outline the key components of program implementation. Identifying each step in the process ensures your team and your partners have a clear understanding of what the program entails, and how it should be implemented. It can also be used to identify and think through potential challenges and proposed solutions before implementation begins.

• Who are the key partners involved in program implementation? Who are the key persons responsible for each program implementation component?

• What is the program that will be implemented?

• When and how often will the program be implemented?

• Where will program implementation take place?

• What are your anticipated challenges and needs for additional support?

All PREIS implementation plans should be finalized and approved by the end of Phase I. The first completed draft of your implementation plan is due to your Federal Project Officer two months before the end of your Phase I period. Please reserve approximately three to four hours to complete this template. During Phase II, your Federal Project Officer will work with you to document these changes using the table in Appendix A.

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 on PREP grantees’ implementation and evaluation plans in order to support their adolescent pregnancy prevention work. Public reporting burden for this collection of information is estimated to average 8 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. The OMB number and expiration date for this collection are OMB #: 0970-0531, 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 Jessica Johnson at [email protected].

Table of Contents

I. Grantee Contact Information 3

II. Program Overview 3

III. Program Content 4

IV. Project Components 5

V. Fidelity Monitoring 8

VI. Partnerships 10

VII. Implementation/Recruitment Site Plans 11

VIII. Service Referrals and Follow-Up 12

IX. Research & Evaluation 13

X: Participant Recruitment, Retention, & Tracking Strategies 14

XI: Staff Recruitment, Retention, & Training Plan 15

XII: Phase I Timeline 16

Appendix 17

Appendix A. 18

I. Grantee Contact Information

Grantee Name
Grantee Address
Primary Contact
Phone Number
E-mail

Evaluation Organization
Evaluation Lead
Phone Number
Email

II. Program Overview

Name of Project
Name of Curricula/Intervention
Target Population (e.g., race/ethnicity, sex, age/grade)
Location(s)/Geographic Region(s)
Setting(s)
Adulthood Preparation Subjects	Adolescent Development Healthy Relationships Healthy Life Skills Educational & Career Success Parent Child Communication Financial Literacy

III. Program Content

Describe the content of the intervention by either completing the chart below or attaching program content outlines. Be sure to identify where Adulthood Preparation Subjects are addressed. If you have more than one project component where key program content is delivered, please duplicate the chart.

	Title of Lesson/Session	Lesson/Session Objectives	Topics Covered

IV. Project Components

Complete the tables below to describe all the components of your PREIS project. For the purpose of this exercise, project components are defined as components that are implemented separately but when combined, comprise the whole project. This includes, but are not limited to, the core intervention and parts of the project that are implemented apart from the core intervention, such as community service, apps, and parent workshops.

Complete the tables that are applicable to your project. Two treatment tables are provided, one for group interventions and one for online/digital interventions. A control/comparison table is for provided for projects that plan to offer activities to the comparison group.

Row A: List each component that will be offered (including any group or individual sessions, case management, social media, service learning, other curricula or services).

Row B: For each component, describe the amount, duration, and intended dosage (e.g., Five 1-hour sessions over 3 weeks for a total of 15 hours of programming).

Row C: Briefly describe the content of each component.

Row D: Describe how the content will be delivered.

Row E: Describe the setting(s) in which the content will be delivered.

	Treatment: Group Intervention
	Component 1	Component 2	Component 3
A: Component (e.g., Classroom lessons, supplemental app, supplemental parent workshops, community service)	Ex: Classroom Lessons	Ex: Parent/Guardian Workshops	Ex: Case Management
B: Amount, duration, intended dosage (e.g., 5 sessions over 3 weeks for a total of 15 hours of programming)
C: Content (e.g., Lessons on healthy relationships, contraceptive use, HIV/STIs, decision making, and setting educational goals)
D: Method of Delivery (e.g., In-person, virtual )
E. Setting(s) (e.g., community centers, clinics, schools)

	Treatment: Online/Digital Intervention
	Component 1	Component 2	Component 3
A: Component (e.g., Online lesson, website interaction or text-based component, app)
B: Amount, duration, intended dosage (e.g., 5 sessions over 3 weeks for a total of 15 hours of programming)
C: Content (e.g., Lessons on healthy relationships, contraceptive use, HIV/STI, decision making, and setting educational goals)
D: Method of Tracking Dosage & Completion (e.g., Time stamp of lesson duration, submission buttons, completion of interactive activities such as polls, quizzes, option selections)
E. Setting(s) (e.g., implementation or recruitment setting or such as group homes or schools)

	Control/Comparison
	Component 1	Component 2	Component 3
A: Component (e.g., Classroom lessons, supplemental app, supplemental parent workshops, community service)
B: Amount, duration, intended dosage (e.g., 5 sessions over 3 weeks for a total of 15 hours of programming)
C: Content (e.g., Lessons on healthy relationships, contraceptive use, HIV/STI , decision making, and setting educational goals)
D: Method of Delivery (e.g., In-person, virtual)
E. Setting(s) (e.g., community centers, clinics, schools)

V. Fidelity Monitoring

Please describe how you will monitor fidelity for the treatment group activities and, if applicable, the control/comparison group activities. FYSB strongly recommends either formal or informal observations for a minimum of 10% of sessions for each implementation cycle. In the beginning of the study implementation phase, Phase II, PREIS grantees will be expected to conduct either informal, formal, or a combination of both on a more frequent basis than 10% of sessions. The exact frequency of fidelity monitoring observations should be determined with your Federal Project Officer.

Program Implementation Indicators	Brief Description	Person(s) Responsible
Fidelity Monitoring Tools (e.g., checklists, observation forms)
Fidelity Monitoring Observations, including type (formal, informal, or both) and frequency
Strategies for addressing lack of fidelity

Anticipated Challenges & Proposed Solutions

What challenges do you foresee? What are your proposed solutions for addressing these challenges? In what areas do you anticipate needing additional support and/or TA?

Challenge #1:

Proposed Solution(s):

Challenge #2:

Proposed Solution(s):

Need for Additional Support/TA:

VI. Partnerships

Describe how partnerships will be maintained and managed throughout the project.

Please provide information for partners across the project, including implementation/recruitment sites and partners providing training and support services. Partners are defined as those organizations that have a third party agreement with the grantee organization to provide services and/or support.

	Name of Partner	Types of Services Partner Provides	Type of 3rd Party Agreement (Letter of Agreement, MOU)

Anticipated Challenges & Proposed Solutions

What challenges do you foresee? What are your proposed solutions for addressing these challenges? In what areas do you anticipate needing additional support and/or TA?

Challenge #1:

Proposed Solution(s):

Challenge #2:

Proposed Solution(s):

VII. Implementation/Recruitment Site Plans

Describe the approach and strategies you will use to recruit implementation and/or recruitment sites.

Complete the table below to provide additional details on the plans for your implementation/recruitment sites. If the plan varies by site or groups of sites, please duplicate the table and complete one for each variation.

Implementation/Recruitment Site(s):
Site Location(s)(e.g., Johnson City, Whitehall County)
Type of Site	Intervention Control/Comparison Both If both, please describe the extent to which the intervention and control/comparison participants will remain separate during implementation?
Anticipated Total Number of Groups/Cohorts (e.g., 4 cohorts)
Number of Participants per Group/Cohort (e.g., 25 youth per cohort)
Meeting Location (if applicable) (e.g., classroom, gym, community room)
Dates/Times of Sessions (if applicable) (e.g., Mondays and Wednesdays 3-4pm)

VIII. Service Referrals and Follow-Up

Use the table below to describe the strategies you plan to use to identity and refer youth to services and to follow-up to ensure the youth are connected to a service provider.

Program Implementation Indicators	Brief Description	Person(s) Responsible
Referral Strategies
Follow-Up Strategies

IX. Research & Evaluation

The purpose of this section is to provide a brief overview of the research and evaluation design. PREIS grantees will outline the evaluation plan in further detail in a separate Impact Evaluation Plan template.

Impact Evaluation

Type of Design	Randomized Controlled Trial Quasi-experimental Design
Unit of Randomization (e.g., individuals, schools, classes)
Data Collection Time Points*

*The time points should be the same for both intervention and control group.

Annual Number of Participants (excluding pilot testing)

	# of Intervention Participants	# of Control Participants
Year 1
Year 2
Year 3
Year 4
Year 5*
Total

* In order to complete this project within the 5-year grant period, PREIS grantees must complete all study data collection by March 2026.

Primary Research Questions

Please ensure the research questions and outcomes align with the program content.

Research Questions	Outcomes
1.
2.
3.

Secondary Research Questions

Research Questions	Outcomes
1.
2.
3.

X: Participant Recruitment, Retention, & Tracking Strategies

Provide information on the number of participants you expect to recruit, enroll, and retain in the study.

Participant Recruitment Target (e.g., 1000):

Participant Enrollment Target (e.g., 750):

Participant Retention Target (e.g., 85%):

Complete the table below to describe the materials and strategies that will be used for participant recruitment, retention, and tracking. If the approach to recruitment, retention, or tracking differs by site or groups of sites, please duplicate the table and complete one for each approach.

	Brief Description	Person(s) Responsible
Recruitment Materials
Recruitment Strategies
Retention Strategies
Tracking Strategies

Anticipated Challenges & Proposed Solutions

What challenges do you foresee? What are your proposed solutions for addressing these challenges? In what areas do you anticipate needing additional support and/or TA?

Challenge #1:

Proposed Solution(s):

Challenge #2:

Proposed Solution(s):

Need for Additional Support/TA:

XI: Staff Recruitment, Retention, & Training Plan

Provide a staffing chart that lists all project staff names, position titles, and effort (FTE), including vacant positions.

Use the table below to describe staff recruitment, retention, and training plans.

	Brief Description	Person(s) Responsible
Staff Recruitment Strategies
Staff Retention Strategies
Staff Training in Curricula Model(s) (including follow-up trainings)
Staff Training on Other Topics

Anticipated Challenges & Proposed Solutions

What challenges do you foresee? What are your proposed solutions for addressing these challenges? In what areas do you anticipate needing additional support and/or TA?

Challenge #1:

Proposed Solution(s):

Challenge #2:

Proposed Solution(s):

Need for Additional Support/TA:

XII: Phase I Timeline

All Phase I activities should be completed in the first 12 to 18 months of award. Please use the most appropriate template below to complete a timeline to show Phase I activities. Shade the blocks to indicate the start and end dates for each activity.

12 Month Template

Task

Oct

Nov

Dec

Jan

Feb

Mar

April

May

June

July

Aug

Sept

Ex. Hire & Onboard Staff

Ex. Curricula Training

18 Month Template

Task

Oct

Nov

Dec

Jan

Feb

Mar

April

May

June

July

Aug

Sept

Oct

Nov

Dec

Jan

Feb

Mar

Appendix

Appendix A.

Modifications to the Implementation Plan

During Phase II, PREIS Federal Project Officers will use this chart to document changes to program implementation that occur. Modifications to program implementation includes deviations from the approach in the approved implementation plan. Modifications may include, but are not limited to, minor changes to program/curricula materials, method of delivery, the program delivery schedule, the setting, staffing structure, or the services provided.

	Brief Description	Rationale for Adaptation	Permission from Author/Developer? (Yes/No/Not Applicable)	Date of Adaptation (Month/Year)
Modification #1
Modification #2
Modification #3
Modification #4
Modification #5
Modification #6
Modification #7
Modification #8
Modification #9
Modification #10

1