Title V / Maternal and Child Health (MCH) subgrant – FY 2015

Report on Work Plan

☐1st Quarter / ☐2nd Quarter / ☐3rd Quarter / ☐4th Quarter
10/01/14 -12/31/14 / 01/01/15 – 03/31/15 / 04/01/15 – 06/30/15 / 07/01/15 – 09/30/15
Subrecipient:
Street Address:
City, State, Zip:
Primary Contact:
Phone:
Email:

See instructions.

See measurement of performance.

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Use the space below for more general narrative about the Work Plan. For example, share success stories, unanticipated challenges, and/or to describe any change in the Work Plan based on your formative evaluation.

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Goal 1
Outcome 1
Objective 1
Activities:
1.1
1.2
1.3
Performance Measures: In the first row, state the measure for each: a) quantity; b) quality; c) result. Report on the measure in the row immediately below it.
a)
b)
c)

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INSTRUCTIONS: A fillable form is intended to simply the report process. If you have problems using the form, you may type the report in your own document using the same format.

Click on the box to insert an ‘x’ next to the relevant Quarter. Enter information in the shaded areas of the fillable form; it will expand as text is entered. Enter demographic information. Double click at the bottom of the page to toggle to the footer. Enter Subrecipient name and reporting period (e.g. FY 2013 - 1st Quarter). Double click to return to the document.

Report on the Work Plan using these steps: Step 1. Copy / paste or type the Goal, Outcome(s) and Objectives for each goal from your DHHS-approved Work Plan. Helpful hint: Click inside the shaded area and begin typing, or copy/paste from your Work Plan. Step 2. Create additional table(s) for each goal and outcome. A goal may have more than one outcome and typically has multiple objectives. Helpful hint: Rest the cursor on the table until the table move handle appears. Copy the entire table, or only parts of the table. Paste into the shaded areas. Check that the Goal, Outcome, and Objectives are numbered correctly. Step 3. Use a separate report for each quarter. Do not add text to previous reports for a cumulative report as this practice unnecessarily creates lengthy reports. Helpful hint: Duplicate the MS Word file for each of the four reporting periods. Determine if, for your specific Work Plan, it is more efficient to duplicate before, or after, the next step. Step 4. Using the numbering system in the approved Work Plan (1.1, 1.2, 1.3; 2.1, 2.2; 3.1, 3.2, etc)., report on each planned activity, including as relevant ‘not applicable this quarter’ . Be sure to adjust activities, if needed, based on your formative evaluation. Step 5. Report on performance measures when appropriate to do so. Because the performance measures assess different aspects of an objective, they will not necessarily be measured at the same time or with the same data/methods. Measures of quantity may be reportable for 1st or 2nd Quarters, measures of quality for 2nd or 3rd Quarters, and measures of results for 3rd or 4th Quarters. Helpful hint: If your performance measures were incorrectly stated as activities in the Work Plan, it’s not too late to modify the measures to more accurately identify an expected level of achievement towards the objective. Step 6. Submit the report electronically to , or mail to Rayma Delaney, Lifespan Health Services, Nebraska Department of Health and Human Services, 301 Centennial Mall South, PO Box 95026, Lincoln, NE 68509-5026.

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The measurement of performance is meant to improve program delivery and effectiveness. The objectives in your Work Plan must be monitored and measured for progress towards the outcome(s) and goal. This is done through performance measures. Each objective should have three corresponding performance measures that address 1) quantity, 2) quality, and 3) result. It may be necessary to set baselines of current performance and targets for improvement based on new activities.

Be careful when developing performance measures. Measures are not statements of activity, rather a statement how a culmination of Work Plan activities can simply be identified as having reached an expected level of achievement. Correct performance measures are dependent on the goal, outcomes(s), and objectives as well as the resources that can be committed to achieving the desired results. Below is a brief description of the three types of measures:

a.  Measures of Quantity: This is a measurement of effort and is the most common type of data collected by a program or project. This answers questions about what is being produced and how much was provided. Examples are the number served and demographics, or the number of activities.

b.  Measures of Quality: This is a measurement of effort that answers questions about how well the program/activity did in meeting an objective. Examples of measures of quality are motivation, satisfaction, knowledge, and awareness of participants or the target population as well as the accuracy, accessibility, and timeliness of the intervention/activity.

c.  Measures of Result: This is a measurement of effect that answers questions about how well your effort worked for those you are targeting and whether the expected change occurred. Some examples are the number and percent who perform as expected (now and across time) or number and percent reporting a change in behavior.

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Instructions - Title V / MCH Subgrant - Report on Work Plan