2.1.6 *Target Ethnicity Hispanic or Latino Not Hispanic or Latino Select your project’s target ethnicity. Select all that apply. 2.1.7 *Target Sexual Orientation Straight or Heterosexual Bisexual Gay or Lesbian Unsure Select your project’s target sexual orientation. Select all that apply. 2.1.8 *Target Age Group 12–15 16–17 18–20 21–24 25–29 30–39 40–49 50–59 60–69 70+ Select your project’s target age group. Select all that apply.
3.1.16 *Date Joined Date (mm/dd/yyyy) Enter the date the collaborator organization joined with your organization. 3.1.17 *Collaborator Type Government Nongovernment Select the collaborator type. 3.1.18 *Government Type Federal State Local If the collaborator type is Government, select whether the collaborator is federal, state, or local government. 3.1.19 *Organization Scope National Statewide If the collaborator type is Nongovernment, select whether the organization’s scope is national, statewide, or local. 3.1.20 *Status Active Inactive Select whether the collaborator is active or inactive. Active: The collaborator is currently working with your organization. If a collaborator organization is currently attending project meetings, mark the organization as active. Inactive: The collaborator no longer works with your organization. 3.1.21 Date Exited Date (mm/dd/yyyy) If a collaborator is inactive, indicate the date when the organization became inactive. 3.2 Project Advisory Council Meetings In this section, record information about meetings held by Project Advisory Council members. Select “Add Meeting” to open this section. ID Data Item Response Options Guidance and Related Definitions 3.2.1 *Meeting Date Date (mm/dd/yyyy) Enter the date when you held the meeting. 3.2.2 *Meeting Name/Topic text a brief description of the meeting based on the meeting content or topic.
3.3.5 *Delivery Mechanism Distance learning Technical assistance by telephone On-site/in-person technical assistance Technical assistance by e-mail In-person class Conference or workshop Teleconference or telephone-based training Written materials Select the option that best describes how the contractor delivered the T/TA or how you like to receive the T/TA. Select one option from the drop down menu. 3.3.6 *Source of Assistance CAPT CSAP Project Officer PEP-C SAMHSA Behavioral Health HIV Technical Assistance Center (AHP) State Prevention Organization Other (Specify) Use the drop down menu to select the option that best describes who provided the T/TA or who you would like to provide the T/TA. If you select “Other,” specify who provided or will provide the T/TA. 3.3.7 *Was the Training/TA provided in a timely and effective manner? Yes No (please explain) Indicate whether you think that you received the T/TA in a timely and effective manner. If you select “No,” provide a brief explanation. 3.3.8 *Description Open-ended text a brief description of the T/TA that you received or are requesting. 3.4 Accomplishments and Barriers Complete this section separately for each accomplishment or barrier related to capacity planning and building. Select “Add Accomplishments/Barriers” to open this section.
4.3.4 Past 30-day substance use (participant level) Alcohol use Binge drinking Marijuana use Injectable drug use Nonmedical use of prescription drugs Illicit drug use other than marijuana, injectables, and prescription drug misuse If you select this outcome category, indicate the outcome measures your program will use to assess success. Select all that apply. 4.3.5 Consequences of substance abuse (participant level) Driving the influence of alcohol or drugs Victim of unwanted sex while under the influence of alcohol or drugs Emotional problems due to substance use Stress due to substance abuse If you select this outcome category, indicate the outcome measures your program will use to assess success. Select all that apply. 4.3.6 Substance abuse related community-level outcomes Prevalence of alcohol use Prevalence of binge drinking Prevalence of marijuana use Prevalence of injectable drug use Percent who perceive risk of harm from binge drinking Percent who perceive risk of harm from marijuana use Percent who perceive risk of harm from substances other than alcohol and marijuana Percent who disapprove of binge drinking Percent who think their peers would disapprove of their binge drinking Percent who believe that most of their peers binge drink Alcohol/drug related traffic crashes or fatalities Other (Specify) If you select this outcome category, indicate the outcome measures your program will use to assess success. If you select “Other,” enter a brief description of the outcome measure. Select all that apply.
4.3.7 HIV knowledge, beliefs, and attitudes (participant level) Perceived risk of sharing non-sanitized needles questionnaire only) Perception of risk of harm from unprotected sex Perceived risk of harm from risky sexual behavior (adult questionnaire only) Disapproval of peers engaging in unprotected sex Perceived peer disapproval of unprotected sex Belief that most peers engage in unprotected sex Intention to engage in risky sexual behaviors (next 3 months) If you select this outcome category, indicate the outcome measures your program will use to assess success. Select all that apply. 4.3.8 Risky sexual behaviors (participant level) Sex under the influence of drugs or alcohol Unprotected sex Number of sexual partners Exchanging sex for drugs, money, or shelter If you select this outcome category, indicate the outcome measures your program will use to assess success. Select all that apply. 4.3.9 Other HIV or viral hepatitis risk/protective factors (participant level) Sexual self-efficacy Social support for sexual issues (adult questionnaire only) Family cohesion of relationship abuse (adult questionnaire only) Identification with ethnic group (youth questionnaire only) Homelessness Mental health status If you select this outcome category, indicate the outcome measures your program will use to assess success. Select all that
4.4.8 Evidence-based Justification Inclusion in a Federal List or Registry of evidence-based interventions Being reported (with positive effects) in a peer reviewed journal Documentation of effectiveness on all three of the following criteria: 1) based on solid theory validated by research; 2) supported by a body of knowledge generated from similar interventions; 3) consensus among informed experts of effectiveness based on theory, research, practice, and experience If you select “Yes” for the question “Is this direct-service intervention evidence-based?” provide justification for the intervention being evidence-based. Select all that apply. 4.4.9 Do you plan to adapt this intervention from the original? Yes No If you select “Yes” for “Is this direct-service intervention evidence-based?,” use the drop down menu to indicate whether you plan to adapt the direct-service intervention. 4.4.10 Description of Adaptation Open-ended text If you select “Yes” for “Do you plan to this intervention from the original?,” enter a description of how you plan to adapt the intervention. Example: We plan to offer only group counseling sessions and no individual counseling sessions at this time due to staffing limitations. 4.4.11 *Status Active Inactive Use the drop down menu to indicate whether the intervention is currently active or inactive. service service service
4.7.3 *How many people do you expect will receive a VH test using CSAP/MAI grant funds? Open-ended numerical response Provide an estimate for the number of people you anticipate will receive a VH test through CSAP/MAI grant funds throughout the life of your grant. 4.8 Viral Hepatitis (VH) Vaccination Planning Note: This section is for HIV CBI grantees only. Select “Edit this Record” to open this section. This section is not required. ID Data Item Response Options Guidance and Related Definitions 4.8.1 How does your organization plan to provide VH vaccination services? VH vaccinations will be provided by the grantee organization VH vaccinations will be available through referral to an outside organization Select all response options that apply. 4.8.2 Please describe how VH vaccinations will be conducted and where. Open-ended text Provide a description of how and where you will conduct VH vaccinations (e.g., off-site, local health department, subcontract, hospital). 4.8.3 How many people do you expect will receive a VH vaccination CSAP/MAI grant funds? numerical response Provide an estimate for the number of people you anticipate will receive a VH vaccination through CSAP/MAI grant funds throughout the life of your grant.
4.9.6 Environmental Strategy Purpose Limit access to substances Change culture and context within which decisions about substance use or sexual behaviors are made Change physical design of the environment (e.g., improve lighting, add emergency phones) Reduce negative consequences associated with substance use or risky sexual behaviors Enhance access or reduce barriers to prevention and healthcare resources Increase access to condoms or other forms of protection Change social Reduce glamorization of substance abuse Increase pricing of alcohol Increase penalties or sanctions Capacity/coalition building Educate for policy change Increased access to viral hepatitis vaccine Other (Specify) If you selected “Environmental Strategy” as the Indirect Service Type (item 4.9.3), indicate the purpose. Select all that apply. If you select “Other,” enter a description of the purpose.
5.2 Numbers Reached Select “Edit this Record” to open this section. ID Data Item Response Options Guidance and Related Definitions 5.2.1 *Date Entered Date (mm/dd/yyyy) Enter the date when you input the data. 5.2.2 *So far this reporting period, how many people did you reach through indirect services? Open-ended numerical response Enter the total number of people reached so far this reporting period through indirect-service interventions.
5.4.4 *Were all direct services/topics/ sessions from the planned intervention covered? Yes No Select whether you covered all direct services/topics/sessions from the planned intervention. 5.4.5 *How did the direct services/topics/ sessions differ from what was planned? Open-ended text Only complete this question if you selected “No” for the question “Were all direct services/topics/sessions from the planned intervention covered?” (item 5.4.4). If you selected “No,” indicate how the direct services/topics/sessions differed from what you planned. Example: We planned to offer four group sessions and up offering five sessions in order to continue discussion and address topics not covered in the first four sessions. 5.4.6 *What are the reasons the intervention differed from planned? Open-ended text Only complete this question if you selected “No” for the question “Were all direct services/topics/sessions from the planned intervention covered?” (item 5.4.4). If you selected “No,” explain why the intervention differed from what you planned. Example: The topics in the four initial sessions led to discussions and we were not able to cover all of the planned topics, so we added a fifth session. 5.4.7 *Retention Activities Open-ended text Enter a description of your retention activities. Example: In the first group session, we emphasized the importance of attending all sessions. Participants who attended all four initial sessions received a $10 gift card to a local restaurant.
5.8 Viral Hepatitis (VH) Vaccination Implementation Note: This section is for HIV CBI grantees only and is not required. Select “Edit this Record” to open this section. ID Data Item Response Options Guidance and Related Definitions 5.8.1 Date Entered Date (mm/dd/yyyy) Enter the date when you input the data. 5.8.2 In this reporting period, how many people received a VH vaccination (e.g., Twinrix) using CSAP/MAI funds? Open-ended numerical response Enter the total number of people who received a VH vaccination using CSAP/MAI funds this reporting period.