Form 1 Partners Process Evaluation Form

OMB No.: XXXX – XXXX

Expiration Date: XX/XXXX

Evaluation of OWH-Girls At-Risk for HIV/Juvenile Delinquency Programs

Partners: Process Evaluation Questionnaire

Introduction: The Office on Women’s Health (OWH), Department of Health and Human Services has engaged GEARS, Inc. to conduct an evaluation of its HIV prevention program for girls at-risk for HIV/juvenile delinquency. You are being asked to participate in this interview because you are a staff member of a program that has received a grant from OWH to provide intervention services to girls who are at-risk for HIV and juvenile delinquency. The interview will last approximately 45 minutes. It will include questions about your experiences with program implementation of your OWH funded HIV/AIDS and juvenile delinquency prevention program. The information we gather from you may help to improve our understanding of the issues, which confront HIV/AIDS primary prevention programs for girls who are at-risk for juvenile delinquency. All information that you provide to GEARS staff is for evaluation purposes only. It will be kept private to the extent permitted by the law.

According to the Paperwork Reduction Act of 1995, no persons are 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 0990-XXXX. The time required to complete this information collection is estimated to average 45 minutes per response including the time to review instructions, search existing data resources, the gather data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to:

U.S. Department of Health & Human Services
OS/OIRM/PRA
200 Independence Ave., S.W., Suite 531-H
Washington D.C. 20201

Attention: PRA Reports Clearance Officer.

Interview date
Name of implementing agency
Name of interviewee
Program title
Interviewee’s telephone number
Interviewee’s mailing address
Interviewee’s email address
Name if interviewer
Interview starting time
Interview ending time
Length of interview

Interviewer Instructions:

Please ask the following questions of the respondent.  Probes are provided to ensure that the type of information needed is collected from all respondents.  If the respondent does not provide the content pertaining to probes in her or his original response, please ask the probe.  Probe questions are not optional.  They represent information that is required for the process evaluation.

1. What is your organization mission?

Probe:

• When were your organization founded?

2. What are your organization’s main services?

Probe:

• How long has your organization been providing HIV prevention services?

• How long has your organization been providing juvenile delinquency services?

• Who is the primary beneficiary of the services your organization provides?

3. What do you think is the purpose of the OWH HIV/JD prevention program that you

work with?

Probes:

• How was the purpose of the OWH JD/HIV prevention program communicated to you?

• How were participants selected for the program?

• How are program participants identified and recruited into the program?

4. What is your role in the partnership?

Probes:

• Who was responsible for defining your role in the partnership?

• How did you initially envision your role in the partnership?

• What technical capacity or expertise was required for participation in the partnership?

• What work background or expertise do you bring to the partnership?

4. How were you approached to engage in the partnership?

Probes:

• What was your perception of the program?

• What did you think of the goals and expected outcomes of the partnership?

• How were your partner responsibilities communicated?

• Have you partnered with the program before?

4. What are the benefits of this partnership?

Probes:

• What are the benefits of this partnership for girls?

• What are the benefits of this partnership for the community?

• What are the benefits of this partnership for you?

• What are the benefits of this partnership for your organization?

4. Are key personnel in place to support this partnership?

Probe:

• If not, what is missing? (What positions are unfilled?)

4. What do you see as the most important components of the JIV/JD partnership (By program components we are referring to the different aspects of your program such as outreach, recruitment, prevention education, referral, etc).

Probes:

• What do you see as the most important component of the HIV/JD partnership for OWH?

• What do you see as the most important component of the HIV/JD partnership for the participants?

• What do you see as the most important component of the HIV/JD partnership for the community organizations?

4. What factors help the partnership or the collaboration with the HIV/JD program

work successfully?

10. What factors hinder or challenge the partnership or the collaboration with the

HIV/JD program from working successfully?

Probes:

• Were their specific management challenges that affected the

implementation of the partnership?

11. How were the challenges of partnership implementation resolved?

Probes:

• How were the challenges of the partnership implementation resolved with the program participants?

• How were the challenges of the partnership implementation resolved with the program staff?

• How were the challenges of the partnership implementation resolved with OWH?

11. Were these efforts successful?

13. What do you think are key factors for a successful partnership?

Is there anything that you would like to see changed in the partnership

process? If so, please describe what you would like to see changed.

Probes:

• Is there anything that you would like to see changed in the way in which your partnership is developed?

• Is there anything that you would like to see changed in the way in which your partnership is managed?

Comments:

Are there any additional comments that you would like to share about the partnership?

Thank you for participating in this interview.

Developed by GEARS, Inc. Page 5 of 5