Stage 1: Assess
|
1
|
Have you identified a specific population
(or populations) with demonstrated need, risk or disparities upon which to
focus your program?
|
|
2
|
Have you
identified the key determinants that contribute to risk or disparities among
this population(s)?
|
|
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?
|
|
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?
|
|
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?
|
|
Stage 2: Select
|
1
|
Have you engaged key
stakeholders in the program selection and adaptation process?
|
|
2
|
Have you
selected a program based on established criteria (e.g., medical accuracy,
population needs, stakeholder interest, organizational capacity and
policies)?
|
|
3
|
Are you
proficient at using ETR’s adaptation guidelines to make any necessary program
adaptations?
|
|
4
|
Have you made
all necessary program adaptations to optimize the program for your
population?
|
|
5
|
Have you
piloted your program with your population(s) and made all necessary
revisions?
|
|
Stage 3: Develop
|
1
|
Do you have a written policy
and/or plan that details the implementation of your program?
|
|
2
|
Do you have a
written policy and/or plan that details the provision of professional
development for program implementers?
|
|
3
|
Have you
developed a plan to evaluate the implementation and impact of your program?
|
|
4
|
Have you
developed a plan to sustain the implementation of your program?
|
|
5
|
Do you have a
plan to communicate program progress and successes to your key stakeholders?
|
|
Stage 4: Implement
|
1
|
Are you implementing the
selected program with fidelity (including appropriate planned adaptations)?
|
|
2
|
Are you
collecting evaluation data, using data for continuous quality improvement,
and communicating evaluation findings to key stakeholders?
|
|
3
|
Are you
equipped to address implementation challenges?
|
|
4
|
Do you provide
and evaluate training and professional development for program implementers?
|
|
5
|
Are you
successfully implementing your sustainability plan?
|
|
Stage 5 Thrive
|
1
|
Are program implementers and key
stakeholders motivated, engaged and effectively supporting your program?
|
|
2
|
Does your
program have an ongoing, positive impact that is shared widely with others?
|
|
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?
|
|
4
|
Do you review
and revise your sustainability plan annually?
|
|
5
|
Have you scaled
up your program to reach a broad audience?
|
|