The fields with the red border are required.

Stage 1: Assess
1  Have you identified a specific population (or populations) with demonstrated need, risk or disparities upon which to focus your program?  
Yes
No
Don't Know
2 Have you identified the key determinants that contribute to risk or disparities among this population(s)?
Yes
No
Don't Know
3 Are you aware of the state, local and/or organizational policies that may influence the implementation and sustainability of a program with this population?
Yes
No
Don't Know
4 Do you have the organizational capacity (e.g., supportive leadership, adequate staff, skills, resources) needed to implement and sustain a program with this population?
Yes
No
Don't Know
5 Do you have established partnerships with the key stakeholders (e.g., partnering agencies, educators, elected officials, parents, youth) needed to implement and sustain a program with this population?
Yes
No
Don't Know
Stage 2: Select
1 Have you engaged key stakeholders in the program selection and adaptation process?
Yes
No
Don't Know
2 Have you selected a program based on established criteria (e.g., medical accuracy, population needs, stakeholder interest, organizational capacity and policies)?
Yes
No
Don't Know
3 Are you proficient at using ETR’s adaptation guidelines to make any necessary program adaptations?
Yes
No
Don't Know
4 Have you made all necessary program adaptations to optimize the program for your population?
Yes
No
Don't Know
5 Have you piloted your program with your population(s) and made all necessary revisions?
Yes
No
Don't Know
Stage 3: Develop
1 Do you have a written policy and/or plan that details the implementation of your program?
Yes
No
Don't Know
2 Do you have a written policy and/or plan that details the provision of professional development for program implementers?
Yes
No
Don't Know
3 Have you developed a plan to evaluate the implementation and impact of your program?
Yes
No
Don't Know
4 Have you developed a plan to sustain the implementation of your program?
Yes
No
Don't Know
5 Do you have a plan to communicate program progress and successes to your key stakeholders?
Yes
No
Don't Know
Stage 4: Implement
1 Are you implementing the selected program with fidelity (including appropriate planned adaptations)?
Yes
No
Don't Know
2 Are you collecting evaluation data, using data for continuous quality improvement, and communicating evaluation findings to key stakeholders?
Yes
No
Don't Know
3 Are you equipped to address implementation challenges?
Yes
No
Don't Know
4 Do you provide and evaluate training and professional development for program implementers?
Yes
No
Don't Know
5 Are you successfully implementing your sustainability plan?
Yes
No
Don't Know
Stage 5 Thrive
1 Are program implementers and key stakeholders motivated, engaged and effectively supporting your program?
Yes
No
Don't Know
2 Does your program have an ongoing, positive impact that is shared widely with others?
Yes
No
Don't Know
3 Do you continuously assess and adapt to changes in your population, organization and environment that may influence the success of your intervention or program?
Yes
No
Don't Know
4 Do you review and revise your sustainability plan annually?
Yes
No
Don't Know
5 Have you scaled up your program to reach a broad audience?
Yes
No
Don't Know
Overall Score & General Recommendations
Overal Score:  T/TA Package Recommendation: 
average score   # stages with score of 5 # stages w/score of 2 or below
Explanation of Score
1 Great job! You have some strong systems in place to help sustain and implement your program.  Below are some great free resources you might find helpful. Then learn more about ways that ETR can make your program even stronger. 
  We recommend: Training & TA Package I
2 You are on your way to building an impactful and sustainable program. Check out the free resources below for some additional help. Then learn more about ways that ETR can support you in building your capacity for program success.
  We recommend: Training & TA Package II
3 You are building your capacity in a number of stages. Check out the free resources below to get you  started. Then learn more about ways that ETR can assist you in building your capacity for program success. 
  We recommend: Training & TA Package II
Stage Specific Resources
Stage Your Score Resources to get your started How ETR can assist
Assess More resources are available on the ASSESS page Technical Assistance
Topics include:
Assess the target population
Conduct environmental scan
Identify/analyze relevant data
Engage stakeholders

Customized Trainings
NASBE State School Policy Database
Conducting a Root Cause Analysis
External Assessment 
Best Practices: Focus Groups
Best Practices: Surveys
Organizational Assessment
WISE Toolkit: Planning &'>WISE Toolkit: Planning & Environmental Scan
Select More resources are available on the SELECT page Technical Assistance
Topics include:
Complimentary ETR EBP selection consultation
Adaptation Support

Customized Trainings
EBP Selection Tool
EBP Comparison Chart
Adaptation Guidelines
Characteristics of Effective Programs
Develop More resources are available on the DEVELOP page Training
Organizational Development
TOEs for EBPs
Enhancement Trainings
TOTs

Customized Trainings

Technical Assistance
Topics include:
Implementation Monitoring Plan Evaluation
Adaptation Support
Organizational development
FoSE Sex Education Teacher Standards 
Tip sheet: Factors that Impact Sustainability
Policy Development Tool
Data Collection Planning
Evaluation Communication Plan 
Implement More resources are available on the IMPLEMENT page Training
Adaptation Boosters
EBP Boosters
New Staff Training 

Customized trainings

Technical Assistance
Topics include:
Relationship Maintenance
Evaluation/Data manage
Adaptation Support Documents
Fidelity Logs
Thrive More resources are available on the THRIVE page Training
Communicating Evaluation Results

Customized trainings

Technical Assistance
Topics include:
Adaptation & Program Development
Dissemination & Packaging Services
National Mentoring Center Sustainability Planning
Program Dissemination Webinar (FYSB)
Dissemination Planning Tool
Sustainability Transition Tool