2016-2017 EHDI Annual Report Instructions and Template

Due Date: July 25, 2017

Revised May 2017

The EHDI Annual Report is designed for grantees to report on their project activities and evaluation outcomes for the reporting period of July 1, 2016 to June 30, 2017. Please complete this report and send it as a single Word document . Be sure to include the attachments specified at the end of the reporting template. This document must be submitted on July 25, 2017.

What is the goal of this template?

The goal of this reporting template is for grantees to create succinct comprehensive summaries of their project activities and evaluation results to share with a wide range of audiences (e.g.,program staff and participants, community stakeholders, legislators, Minnesota Department of Health). We are asking grantees to synthesize key information about their approach, activities, outcomes, and lessons learned.

The EHDI Annual Report serves to benefit EHDI grantees,the Center for Health Equity at Minnesota Department of Health (MDH), as well as populations of color and American Indians living in Minnesota.

  • Grantees can use information in the report in a variety of ways, such as creating a 1-page summary of the grant to share with community members, submitting as an abstract for a presentation, writing a newsletter article, posting on a webpage, or using in future grant applications.
  • The Center for Health Equity will summarize components of the report for legislative reports and to share with other programs within MDH.

What information is available to help fill out this report?

Grantees can refer to documents they have already completed to write the report including:

1)EHDI grantapplication

2)Logic Model

3)Evaluation Plan

4)Previous EHDI reports

5)Other documents and publications you have prepared about this grant

Questions about how to complete this report?

If you have questions on how to complete this report, please contact your Evaluation Support Coach. Grantees may also contact Mia Robillos at .

____[INSERT GRANTEE ORGANIZATION NAME HERE)____

2016-2017 EHDI Annual Report

Eliminating Health Disparities Initiative

Due Date: July 25, 2017

**Include evaluation findings for 2016-2017 grant year only**

1.Grantee Information

Project Name:
Lead Agency:
Contact Name for Report:
Contact Email:
Contact Phone:
Lead Agency Address:
Priority Health Area(s) Funded: / Mark all that apply / Priority Health Area
Breast and Cervical Cancer Screening
Diabetes
Heart Disease and Stroke
HIV/AIDS and Sexually-Transmitted Diseases
Immunizations for Adults and Children
Infant Mortality
Teen Pregnancy
Unintentional Injury and Violence
EHDI Target Population(s) Served by your EHDI Project:
Mark the appropriate box(es) / African/African American / American Indian / Asian/Pacific Islander / Hispanic/ Latino
Geographic Area Served: Describe the service area(s) and who was served.(Limit to 100 words)

2.Lead Organization, Project Partners and Advisory Group

a. Write the names of the lead organization and project partners, specify the type of organization (e.g., clinic or hospital, school, church, business, social service organization, advocacy organization, etc.), and describe their role in the project. Add rows as needed.
Name / Type of Organization / Role in Project(1-2 sentences per organization)
Lead Organization:
Partners:
1)
2)
3)
4)
5)
6)
7)
b. If you formed an advisory group for your project, briefly describe the composition of the group and its role in the project.(Limit to 150 words)

3.Community Feedback on Activities

a. How did you collect community feedback? (Limit to 100 words)
b. What kind of feedback did you receive? (Limit to 100 words)
c. How did you use this feedback to guide project activities? (Limit to 100 words)

4. Project Rationale: What problem are you addressing? (Limit to 150-200 words per health area)

State the priority health areayour EHDI project is addressing. How did you identify this health need in your community? What is the extent of the disparity in the health area? How will your project contribute to reducing the disparity?Please answer these questions for each priority health area addressed.

5. Updated Project Description (Limit to 250 words)

Provide an updated brief but comprehensive overview of your project (e.g., goal, mission, vision). You may include images such as diagrams of your project activities, processes, or theory or change. Large diagrams should go under Part 17E. Other Attachments.

6. Programmatic Highlights (Limit to 250 words)

What were your key programmatic (non-evaluation) accomplishments during the one-year grant period? Provide 3-7 bulletpoints briefly summarizing project activity highlights; for example, highlights in your recruitment, collaboration, curriculum development, outreach, or education. Evaluation highlights belong under Part 7C.

7. Evaluation Outcomes

Describe the outcomes of your evaluation. This section has three parts:

Part A. Work Plan Update

Part B. Summary of Numbers of People Reached

Part C. Summary of Key Evaluation Outcomes

Part A. Work Plan Update
Complete the work plan template provided at the end of this document and attach it to this report. In the last column (Achieved Outcomes), indicate the progress you have made oneach of the activities in your approved 2016-2017 work plan.
Part B. Numbers of People Reached from July 1, 2016 to June 30, 2017.
i. Direct Contact
Provide the number of direct contacts made in each priority health area with individuals from EHDI’s target populations. A direct contact includesindividual contact (e.g., counseling, clinical services, screenings, private tutoring) or group contact (e.g., classes, workshops, and support groups). There may be duplicate numbers; for example, if a person participated in both individual counseling and a class.
If your programdirectly served individuals who are not part of your prespecified EHDI target population, please indicate it with an asterisk (*) next to the number. For example, if your Teen Pregnancy program targets African Americans but also served 10 Hmong in FY 2016-2017, then write “10*” under the Asian/Pacific Islander column corresponding to Teen Pregnancy. For more detailed instructions, please refer to the EHDI Tip Sheet: Guide to the Annual Report.
Priority Health Area / EHDI Target Populations
African/ African American / American Indian / Asian/Pacific Islander / Hispanic/ Latino
Breast Cervical Cancer Screening
Diabetes
Heart Disease and Stroke
HIV/AIDS and Sexually-Transmitted Diseases
Immunizations for Adults and Children
Infant Mortality
Teen Pregnancy
Unintentional Injury and Violence
Community Primary Prevention
TOTAL
Please describe the type of direct contactwith the individuals you reached. (Limit to 100 words)
For example, do the numbers refer to individuals who attended classes, received counseling, were screened, or were immunized?
Write down any comments or clarifications about the numbers you provided above or that do not fit under any of the four EHDI target populations.
ii. Indirect Contact from July 1, 2015 to June 30, 2016
Provide the number of indirect contacts made in each priority health area with individuals from EHDI’s target populations, if applicable. An indirect contact is minimal or fleeting contact, and may occur when your project conducts outreach at large events. For example, an estimate of the number of individuals to whom you distributed pamphlets at a health fair or who received reminder letters for breast and cervical cancer screening. Provide your best estimate.
As in part (i), if your program indirectly served individuals who are not part of your prespecified EHDI target population, please indicate this with an asterisk (*) next to the number. For more detailed instructions, please refer to the EHDI Tip Sheet: Guide to the Annual Report.
Priority Health Area / EHDI Target Populations
African/ African American / American Indian / Asian/Pacific Islander / Hispanic/ Latino
Breast Cervical Cancer Screening
Diabetes
Heart Disease and Stroke
HIV/AIDS and Sexually-Transmitted Diseases
Immunizations for Adults and Children
Infant Mortality
Teen Pregnancy
Unintentional Injury and Violence
Community Primary Prevention
TOTAL
Please describe the type of indirect contact with the individuals you reached. (Limit to 100 words)
For example, do the numbers refer to individuals to whom you handed out flyers or pamphlets at a health fair, who called to ask about your program, who attended a church meeting where you presented information about your program, or those on your project mailing or email distribution list?
Write down any comments or clarifications about the numbers you provided above or that do not fit under any of the four EHDI target populations.
Part C. Key Evaluation Findings (Limit to 1,000 words)
Summarize key evaluation findings including outputs, outcomes, or impacts. Refer to your evaluation plan whencompleting this section. This section is meant to provide a brief but comprehensive summary of your results. If you want to include more details, or any tables or charts, please include them in Section 17E. Other Attachments. You may use bullets to highlight your key evaluation findings. Report evaluation findings for each priority health area on which your project is focused.
Key Outputs (e.g., number of participants, number of graduates, number of classes, number of screenings, number of immunization clinics):
Key Outcomes or Impacts (changes in behavior, changes in health condition or status, changes in policies or systems):

8. Evidence-Based, Promising, and Culturally Responsive Practices

In the 2015 EHDI Request for Proposals (RFP), grantees were encouraged to use evidence-based or promising practices and culturally specific approaches in their grant activities. Please refer to the 2015EHDI RFP Menu of Activities in Appendices C-J. The RFP is available on the CHE Funding Opportunities page.

In Part 8a, list and describe any evidence-based or promising practices or culturally relevant/specific approaches used(see definitions below). Then, provide documentation bydoing one of the following:

  • If your evidence-based or promising practice is listed in the 2015 EHDI RFP Menu of Activities, simply write “2015 EHDI RFP” after your description in the second column.
  • If it is not in the 2015 RFP, include a link to a web page or article discussing the practice as evidence-based or promising.
  • If the model was developed by your organization or program, write “Own.”
  • If it was developed by another organization or program and there is no documentation, indicate the name of the organization or program that developed it.

In Part 8b, if you adapted a model or practice to be culturally specific and/or to meet the needs of your project, please describe how and why you adapted it.

Definitions:

Evidence Based (EB) / Interventions that have demonstrated effectiveness based on the principles of scientific evidence, including systematic uses of data and information systems, and appropriate use of behavioral science theory in order to explicitly demonstrate effectiveness.
Promising Practice (PP) / Interventions that have demonstrated effectiveness based on local practices and/or cultural experiences, for example, non-experimental data or the experience of practitioners.
Culturally Responsive Practices (CR) / Interventions that are adapted to meet the unique cultural needs of different communities but might not yet been demonstrated to be evidence-based or promising.
Target Group / A/AA = African/African American; AI = American Indian; API = Asian/Pacific Islander; H = Hispanic/Latino
a. Please list and describe any evidence-based or promising practices or culturally relevant models or approaches used, and document the source. EB and PP activities can also be CR. Add rows as needed.
Practice or Model Used / Descriptionand documented source of evidence-based, promising practice, or culturally responsive practices. / Type
(EB or PP and /or CR) / Target Group
(A/AA, AI, API, H) / Setting
(Clinic, Community, or please specify)
EXAMPLE
Celebration Of Change / A culturally enriched and evidence-informed curriculum programfor African American girls ages 9-12 created by the Annex Teen clinic with community input. The program is designed to strengthen communication and knowledge of puberty and sexuality among mothers/adult women and girls ages 9-12.
Source: Developed by Annex Teen Clinic / CR / AA/A / Schools, Churches, Community (faith-based orgs)
b. Which of the models or practices listed above did you adapt to be culturally specific and/or to meet the needs of your project (if applicable)? Describe how you adapted it and why adapting it is important for working with your community.

9. Policy, Systems, and Environmental (PSE) Changes

The 2015EHDI RFP listed activities under each priority health area, some of which were labeled as PSE to indicate an activity that would lead to a policy, systems, or environmental change. In this section, list any policy, systems, or environmental change activity on which your project is working;indicate if this will lead to a policy (P), systems (S) or environmental (E) change (see definitions below);describe the change; and, indicate the status of progress on the P, S, or E change. The status would be NS if you have not started work on the change, IP if it is in progress, or C if it is complete.

Definitions for Type of Change
Policy Intervention (P) / Includes implementation of laws, rules, ordinances, mandates, or resolutions in order to influence population behavior. An example is a policy that all clinic staff complete training on the developmental and health needs of culturally-diverse adolescents, or a city passing an ordinance that requires rental units to undergo annual safety checks.
Systems Intervention (S) / Includes changes in processes or proceduresthat impact all elements of an organization, institution, or system such that people or departments within that organization, institution or system change the way they operate or “do their work.” Examples include creating a baby-friendly or teen-friendly clinic, a clinic converting to an electronic records system, or a joint-use agreement between a school district and park board to allow use of each other’s facilities.
Environmental Intervention (E) / Includes physical or material changes to the economic, social, or physical environment to benefit entire populations. Examples are incorporating sidewalks, walking paths, and recreational areas into community development design, providing health insurance discounts to employees who visit the gym regularly, and replacing sodas with bottled water in school vending machines.
Codes for Implementation Status
NS = Not Started IP = In Progress C = Completed
Describe the Policy, Systems or Environmental Change (Add rows as needed) / Type (P,S,E) / Progress
(NS,IP,C)
Describe successes in implementing PSE changes.
Describe any barriers and challenges to implementing PSE changes and how you addressed or propose to address them.

10. Photograph – OPTIONAL

Please include a photograph from your project that can be featured on the EHDI web page. Please make sure the people in the photo have signed a photo release. You may use your own photo release form or the form at the end of this template. Please insert your photo into this report and also submit the image file (e.g., TIF, JPEG, PNG, GIF) and photo releases as attachments to this report.

Caption for Photograph:
Photograph:

11. Story (Limit to 250 words)

Tell a story that illustrates the impact of your project on an individual, agency or system. This story should highlight one or more of your strategies or activities. Your story must include the following elements (not necessarily in this order):

  • The strategy or activity you are highlighting
  • Who and how many people it has impacted
  • What has changed due to your efforts and how this will/has made a difference
  • What partners you worked with

Title for Story:
Story:

12. Lessons Learned

Describeup tothreeimportant lessons you have learned in the implementation of your project that you could impart to others.

13. Recommendations for Center for Health Equity (CHE)/EHDI and MDH

In terms of addressing racial and ethnic health disparities for Minnesota’s population of color and American Indians, what suggestions or recommendations do you have for CHE/EHDI and MDH on how to improve the EHDI program?

14. Cost Savings

Did your project activities have direct or indirect economic impact on health care costs for the state of Minnesota? Tell us how you see your program contributing towards cost savings. If you cite specific statistics, please include references or web links to the source. Please see Tip Sheet on Cost Savings available on the EHDI Grantee Portal for examples and resources.

15. Sustainability

Describe how you plan to sustain your program. Include information on whether you have been able to leverage EHDI funds to sustain your program beyond the EHDI grant.

16. Grantee Logo

Insert Grantee Logo HERE- Please also submit it as an attachment to the report.

17. Attachments

Please submit these additional attachments with your report
A. Copy of 2016-2017Work Plan Update with updates
B. Program photo(s)
C. Signed Photo Release Form(s)
D. Grantee logo
E. Additional information or reports you would like to include

18. Other information for grantee use

If you decided to use portions of this report to create a short summary of your project for your own use, we include here a copy of the MDH Center for Health Equity logo and the Disclosure Statement that must be included. If you do create such a document, please submit a copy with your report.

This activity is made possible by a grant from the Eliminating Health Disparities Initiative (EHDI) of the Minnesota Department of Health’s Center for Health Equity, through an appropriation from the Minnesota State Legislature.

Photograph and Video Release Form

Date______

I, ______,

(Name – Please Print)

do hereby grant permission to the Minnesota Department of Health (MDH) to videotape or photograph me, and to use the images thus obtained a part or in connection with the production of MDH publications and audio-visual presentations. I understand that these materials will be used for the purpose of informing and educating the public about MDH programs and activities. I further understand that these photographic or video images may be distributed or displayed to members of the general public in connection with MDH informational programs and activities.