NGO Sexual Health Services Measures

Form Approved

OMB No: 0920-XXXX

Exp. Date: XX/XX/XXXX

“Promoting Adolescent Health through School-Based HIV/STD Prevention”

Att. 3a

NGO SHS Items

Public reporting burden of this collection of information is estimated to average 30 minutes 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. 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. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-New)

DRAFT NGO Measures – SHS SEA

Measures	Data Reporting System	Questions for Collection of Measures
SHS Process Measure 1: % of funded SEAs that received assistance on SHS	PERS	In the past six months, how often did you interact with [FUNDED SEA NAME] to provide assistance (e.g., capacity building assistance, professional development events, technical assistance, guidance or resource materials, and referrals to other agencies or organizations) on SHS? _____ Not at all _____ A few times _____ About once a month _____ Two to three times a month _____ One or more times per week On what SHS topics did you provide assistance to [FUNDED SEA NAME]? (Check all that apply) Establish new or strengthen existing organizational partnerships, whether formal or informal, between districts or schools and youth-friendly sexual health service providers Assess sexual health service providers for youth-friendliness of clinical services Develop or revise a written sexual health service referral procedure Implement a written sexual health service referral procedure Assess students for sexual health service needs Create a list of youth-friendly sexual health service providers Develop or revise a procedure for maintaining student confidentiality throughout the referral process Implement a procedure for maintaining student confidentiality throughout the referral process Expand onsite youth-friendly sexual health services Obtain third-party reimbursement for the provision of school-based health services Implement strategies to ensure awareness among students of sexual health service providers and referral services Implement strategies to engage youth in the design, delivery and MEA of sexual health services Assess sexual health services policies Monitor the implementation of sexual health services policies Manage controversy around sexual health services Build staff competencies and techniques to improve the delivery of sexual health services

DRAFT NGO Measures – SHS LEA

Measures	Data Reporting System	Questions for Collection of Measures
SHS Process Measure 1: % of funded LEAs that received assistance on SHS	PERS	In the past six months, how often did you interact with [FUNDED LEA NAME] to provide assistance (e.g., capacity building assistance, professional development events, technical assistance, guidance or resource materials, and referrals to other agencies or organizations) on SHS? _____ Not at all _____ A few times _____ About once a month _____ Two to three times a month _____ One or more times per week On what SHS topics did you provide assistance to [FUNDED LEA NAME]? (Check all that apply) Establish new or strengthen existing organizational partnerships, whether formal or informal, between districts or schools and youth-friendly sexual health service providers Assess sexual health service providers for youth-friendliness of clinical services Develop or revise a written sexual health service referral procedure Implement a written sexual health service referral procedure Assess students for sexual health service needs Create a list of youth-friendly sexual health service providers Develop or revise a procedure for maintaining student confidentiality throughout the referral process Implement a procedure for maintaining student confidentiality throughout the referral process Expand onsite youth-friendly sexual health services Obtain third-party reimbursement for the provision of school-based health services Implement strategies to ensure awareness among students of sexual health service providers and referral services Implement strategies to engage youth in the design, delivery and evaluation of sexual health services Assess sexual health services policies Monitor the implementation of sexual health services policies Manage controversy around sexual health services Build staff competencies and techniques to improve the delivery of sexual health services