Mini Grant Second Quarterly Call

National Chlamydia Coalition

Mini-Grants

Second Quarterly Call

Second Quarterly Call September 22, 2010

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Agenda 2

Weaving Systems of Care

Center for Health TrainingWendy Nakatsukasa-Ono

May 1, 2010 – April 30, 2011Regions VIII, IX and X/National


The Center for Health Training and its partners are developing, testing and disseminating a toolkit to guide the standard delivery of STD care to American Indian and Alaska Native people.


Alaska Native Tribal Health Consortium Center for Health Training—Region IX Infertility

Prevention Project (NEW) IHS National STD Program Northwest Portland Area Indian Health Board JSI Research & Training Institute—Region VIII

Infertility Prevention Project Phoenix Indian Medical Center


Outcome Objectives Performance Measures Increase ANTHC and PIMCs capacity to provide CT screening and follow-up care, by December 31, 2010.

• Interviews of key administrators/clinicians to assess organizational intention to use of tool/protocol

• Baseline clinic capacity assessments to report on existence/status of current policy and protocol/standing orders vs. those developed for this project

Increase I/T/U Indian health programs’ awareness of the importance of CT screening by February 28, 2011.

• Follow-up clinic capacity assessments to measure increased awareness of importance of CT screening and intention to use /use of documents developed for this project

• Other post-project follow-up—online survey and/or limited individual follow-up?


Outcome Objectives Performance Measures Increase I/T/U Indian health programs’ capacity to provide CT screening and follow-up care by February 28, 2011.

• Other post-project follow-up—online survey and/or limited individual follow-up?


Process Objectives in Proposal Performance Measures in Proposal

Development of a protocol/decision tool. • Documentation of the development of sample policy, protocol/standing orders, flowchart and other documents

Dissemination of model protocol/tools to Indian health programs.

• Documentation of the dissemination of the tools

• Qualitative documentation by partners and quantitative documentation by ANTHC, NPAIHB and IHS National STD Program

Pilot-test the tools at ANTHC and PIMC. • Results of pilot-testing and modifications made to materials.


Clinic capacity assessments—baseline and follow-up

Sample policy Sample protocol and standing orders Sexual risk assessment EPT considerations Success stories

COMMUNITY APPROACH TO INCREASING CHLAMYDIA

SCREENING

Adagio HealthMaureen Utz

June 1, 2010 – May 31, 2011Pittsburgh, PA


Adagio Health, Inc., using GIS mapping to identify communities at high risk for chlamydia, is targeting residents of a low-income housing project with focus-group tested materials and chlamydia testing and treatment in alternative community settings.

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Community Approach to Increasing Chlamydia Screening

Outcome Objectives Performance Measures

To screen 45% (280 people) of the target group of Northview Heights residents during months four through ten of the project.

•Will track number of residents screened through the project testing site. •Will ask Northside Christian Health Center to provide information about changes observed in testing rates and in chlamydia awareness.

To establish a baseline and track number of positive chlamydia results within Northview Heights.

•Monthly PA DOH data on total number of individuals from Northview Heights with positive test results.

•Compare number of residents with positive results before and after project implementation, during same calendar months.

To measure positivity rates for Northview residents who seek screening through this project.

•Compare number screened versus number of positive results. (However, can’t compare positivity rates to prior year since screening data are not available).

To provide treatment for 100% of those who test positive for CT.

•Will track number of residents with positive results who are treated. •Through survey, will ask if they came in for testing and/or treatment due to partner referral.

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Process Objectives Performance Measures

Develop, test, and distribute messages. •Document number of focus group participants; document results of focus groups; document number of materials distributed and pattern of distribution.

•Through a short survey at testing site, will identify how they learned of the testing program and ask for feedback on materials.

Assess the acceptability of CT testing at a non-clinical, neighborhood site.

•Analyze demographic data for those who receive tests to measure testing rates by age and gender.

Partner with community groups to implement and evaluate the project.

•At end of project, will review interactions with community partners. Success will be measured by level of communication and cooperation during project implementation and evaluation. Analysis will be descriptive.

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• Questions for group discussion:• Does the outcome objective of testing

45% of target population seem feasible?

• Suggestions for evaluating effectiveness of community partnerships?

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• Preliminary project results or research findings:

• Focus group results:• Participants believed residents

would be interested in community-based testing site

• Differing opinions about the best facility for a testing site

• For marketing efforts, stress that tests will be free, that CT is very common, often asymptomatic

•Too early to examine outcome or other process objectives

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• Evaluation tools:•Focus group guide•Survey administered at community-based testing site

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CATCh: Community-based Adolescent

Testing for Chlamydia

Maryland Department of Juvenile ServicesJennifer Maehr, MD

July 1, 2010 - June 31, 2011Baltimore, Maryland


Maryland Department of Juvenile Services is providing chlamydia and gonorrhea screening, treatment, and education through case management and somatic health staff for at least 500 Baltimore juvenile justice youth who are under community supervision.

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CATCh: Community-based Adolescent Testing for Chlamydia


To test at least 500 youth during the 12 month project

period.

Log book , CATCh Clinic form,

and on-line portal to document number of tests done.

To report on the prevalence of CT among youth in DERC and FIT, percent treated, number of referrals, and number of EPT prescriptions provided.

Use Log book, CATCh Clinic form, and on-line portal to report on percent of positive youth that are treated, number

of referrals, number of EPT

prescriptions provided.

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CATCh: Community-based Adolescent Testing for Chlamydia

Process Objectives Performance Measures To develop project tools/materials – log book, on-line portal for FIT, consent form, surveys, educational curriculum, and educational materials.

Results of youth satisfaction and staff survey - starting to collectDocument development of all materials - done

To train FIT and DERC staff on STIs and program protocol and procedures.

Completion of training session - done

To provide refresher training for staff and train on use of on-line portal.

# Staff trained

To train FIT and DERC staff to implement 3 risk reduction interventions (“Survive Outside”): a group video discussion, 1:1 counseling session, and the Making Proud Choices Curriculum.

# Staff trained - ETR training this month

To offer at least four educational sessions for youth.

# sessions done, results of youth satisfaction survey.

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CATCh: Questions for group discussion

• Access to free condom carrying cases?• Incentives to staff to screen/test• Treating partners on-site when partners are not in patient population for your setting

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CATCh: Preliminary Results July 1-Sept 15

Site &Client Sex

Potential Clients

Total Tests Done

+CT# (%)

+GC# (%)

# Treatedon-site

FIT unitFemale

212girls w/ visit to case manager

36by case

managers

8(22%)

1(3%)

7by RN or MD

DERCMale

103youth

enrolled

76by nurses

5(7%)

0(0%)

1by RN

Total 315 112 13(12%)

1(1%)

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CATCh: Preliminary project results FIT UnitJuly 1-September 15, 2010

# Clients with

Post-Test MD/RN On-Site Visit at

FIT

# Pregnancy Tests Done

On-Site

# Youth Administere

d EC On-Site

# Youth Given EC

as Advance Provision

# Youth Referred

for Additional Services

18(remaining

clients receive results by

phone)

8(all negative)

4 11 12

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CATCh: Preliminary Results July 1-Sept 15

FIT: CT rates are higher and GC rates are lower than for girls in DJS facilities

DERC: CT and GC rates are lower for boys in DERC than for boys in DJS facilities

Difficulty w/EPT & treating all positive boys at DERC before discharge from program

Condoms and condom cases are very popular; FIT girls could use additional family planning & STI testing on site

FIT girls rate program highly on survey

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CATCh: Evaluation Tools

• Staff survey form•Youth satisfaction survey•Log forms•Other: Referral Card

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Chlamydia Practice Improvement Project

(CPIP)

Michigan Department of Community Health (MDCH)Project Director: Amy PetersonProject Coordinator: Nancy DeisingGrant Cycle: 4-1-10 to 3-31-2011


You’re an Essential

Piece

Michigan Department of Community Health (State of Michigan) has partnered with Molina Healthcare, the largest Medicaid managed care provider in Michigan, to adapt an award-winning, culturally-specific awareness model to increase chlamydia screening among female plan members age 16-25 in southeastern Michigan, including the city of Detroit.


Measurable Objectives Performance Measures

•Increase the proportion of Molina Healthcare eligible female members age 16-24 who are screened for chlamydia in targeted southeast Michigan provider sites by 4 percentage points by June 30, 2011.

Baseline = 33.5% in 2009

•Percent of eligible members screened for chlamydia by target provider site


Piece


Process Objectives Performance Measures

•By July 31, 2010 conduct two patient focus groups •Focus group final report

•By September 30, 2010 develop patient education materials

•Compare findings and recommendations of focus group to brochure content

•By November 1, 2010 distribute patient education materials statewide

•Document distribution

•By November 1, 2011 conduct site visits with 20 provider sites

•Assess by post intervention survey

•By November 1, 2010 send targeted mailing with incentive

•Document distribution


Piece


Question for Group Discussion

• Do others have experiences/suggestions on how to assess cultural appropriateness for educational materials?


Piece


Preliminary Project Results or Research Findings

• Focus Group Report

• Patient Education

• On-site Provider Meetings (OPMs)

• Follow-up OPMs

• Provider Incentives


Piece


Evaluation Tools

• Focus Group Report

• Site Satisfactory Survey

• On-site Provider Meeting Pre-Visit Assessment

• Molina Healthcare claims database


Piece

PROMOTING CHLAMYDIA SCREENING IN A RURAL

AREA

Jackson County Health DepartmentKathy O’Laughlin, RN, MS

5/1/2010-4/30/2011Murphysboro, IL


Jackson County Health Department is implementing a provider outreach program to encourage routine chlamydia screening in private pediatric, internal medicine, and family practices, along with a peer mentor program to increase public awareness about chlamydia.

Promoting Chlamydia Screening in a Rural Area

Outcome Objectives Performance Measures By April 2011, increase the number of sexually active females (age 25 and younger) who are screened annually for CT by 5%.

•Collect data on number of screenings per year from providers, e.g. Terrier Care, Adolescent Health Center, SIU Student Health Center, Jackson County Health Department, Memorial Hospital of Carbondale. • Examine changes in the number of screenings done per year by each provider. Will approach other provider offices to determine if they can provide similar data. •Will contact all providers three months after workshops to assess whether they are routinely screening for Ct.


Process Objectives Performance Measures Conduct visits to at least 6 practices and educate at least 50 providers

•Document office visits and number of providers who attend workshops.

Provide materials to at least 100 providers. •Document distribution of materials. •Will also compare screening rates for those providers who received materials only versus providers who received workshops and materials.

Recruit and train 6-8 peer mentors, who will make at least 1000 educational contacts.

•Participant survey to assess learning outcomes. •Collect and analyze data on demographics of those who attend the educational programs. •SIU students will be referred to the Student Health Center for testing. Community participants will be referred to Terrier Care, Shawnee Health Care Carbondale or Jackson County Health Department for testing. Will collect data on numbers screened at each of these sites and compare them over time.

Identify changes in provider attitudes, knowledge and practices as a result of the project.

•Results of pre-and post-provider survey.

Questions for group discussion:

•What are the most valid indicators for “success” in this work—e.g. increased screening, increased awareness, decreased incidence?•How will increased screening impact rates of CT—in the short term, will we see increased incidence as more cases are identified; how long will it take before success is measured by decreasing incidence of chlamydia?



• Presented program to 85 providers• Mailing to 82 providers• No findings yet re: changes in

screening behaviors• Have identified 7 peer educators

(Diverse with respect to age, race and sexual orientation) and trainings are scheduled


• Evaluation tools: • For provider intervention, pre-

intervention screening tool is attached; post intervention tool is under development

• For peer education component, draft screening tool is attached; it will be revised to be able to use it with non-university groups


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PROMOTORAS DE SALUD

Planned Parenthood of Greater Washington and North IdahoAmy Claussen – VP of Education and Professional Training

March 2010 -Jan 2011Yakima, Washington


Planned Parenthood of Greater Washington and North Idaho is expanding its current Promotoras de Salud or “promoters of health” sexual health education program to focus on chlamydia-specific grassroots outreach within the Latino/a community in Yakima County.

Promotoras de Salud

Outcome Objectives Performance Measures 100 individuals are tested for CT due to Promotora referral.

• Using promotional coupon to track the number of new CT clients in lieu of running FP 2000 reports.

Process Objectives Performance Measures Distribute information to 500 Spanish-speaking venues.

• Tools will be used to assess distribution and reach of materials

• Inventory conducted to measure the number of information units distributed.

Promotoras de Salud

Process Objectives (continued) Performance Measures (continued)Hold 400 conversations with members of the community

• A tool will be created to assess number of contacts and audience demographics.

• Qualitative descriptions of conversations and script will be produced.

Develop a referral tracking system that is implemented in the health center.

• Using promotional coupon to track the number of new CT clients in lieu of running FP 2000 reports.

Secure five earned media spots to promote the campaign.

• Tally number of earned media spots and assess content of coverage.

Promotoras de Salud


• The CT screening coupon has not been very successful – are there ways to track education and outreach initiatives that don’t require community members to bring something back?

Promotoras de Salud

• Preliminary project results or research findings: Promotoras have distributed information to 500 individuals in numerous ways: door to door, at 2 health fairs and house parties. The community canvassing portion of the project increased promotora membership. An open house invitation was included in the informational gift, which drew 20 new promtora applicants.Qualitative impact was substantial via face-to-face conversations regarding CT and its effects on the future family – however, the intervention has not yet motivated many in the community to seek testing. Two conference presentations – resulting in statewide collaborations for future promotora program development. Two “en comunidad” spots that resulted in several calls for more information re: the promotora program upon which we were able to educate about the CT project.

MINNESOTA CHLAMYDIA PARTNERSHIP AND

SUMMIT

Minnesota Department of HealthCandy Hadsall, RN, MA

March 1, 2010 – March 1, 2011State of Minnesota


Minnesota Department of Health, based on an effective model for coalition-building, has organized the first statewide Minnesota Chlamydia Partnership to encourage a wide range of organizations to offer chlamydia screening and treatment.

Minnesota Chlamydia Partnership

Outcome Objectives Performance Measures A statewide Minnesota Chlamydia Partnership (MCP) will be created.

•Document and define the membership in the MCP, creation of a Steering Committee, and activities of the Partnership.•Analyze representation from different organizations and geographic regions. •Describe process for establishing/managing steering committee and workgroups.

A Minnesota Chlamydia Strategy will be created.

•Document the creation and adoption of the statewide strategy. The timeline has been modified to allow more development by the workgroups and for approval from the Commissioner of Health. •Document the launch of the strategy immediately after Commissioner’s approval; hopefully in April 2011.


Process Objectives Performance Measures At least 100 people will attend the Minnesota Chlamydia Summit.

Document the attendance at the Summit, including satellite locations, and determine the organizational affiliation of participants. Document media coverage of the Summit and chlamydia.

60% of participants will agree that the Summit educated them about CT and 50% agree to take action to reduce CT in their communities.

Results of the Summit survey completed by participants. The survey assessed primary reason for attending, whether their primary objective was fulfilled, if they volunteered to participate in the MCP, and if they were inspired to take action.

At least 20 Summit participants will commit to participating in the Minnesota Chlamydia Partnership workgroups, which will meet at least three times in the next six months.

Document number of Summit participants who agreed to participate in the workgroups and assess their ongoing level of involvement.

Preliminary project results or research findings: • MCP: created in March 2010, Steering committee established with 20 members and planned/led the Summit, will lead workgroups.

•Minnesota Chlamydia Strategy: workgroups drafting strategy, MDH staff creating outline and format, 33 meetings have been held since January. Steering committee actively involved.

•Summit: Overall attendance was 275, which greatly exceeds original objective of 100 in attendance. 144 in St. Paul, and 131 in nine satellite locations. 16% were youth. Represented wide range of organizations, with most from non-profits, local or city public health department, public health clinic, or private clinic.


Preliminary project results or research findings (cont.): •Participant evaluation of Summit: 88% said their primary objective for attending the meeting was fulfilled. 33% said they volunteered to be part of MCP. 100% want to stay informed.

•Media Coverage: In advance of the Summit and during the meeting, comprehensive stories appeared in radio (Minnesota Public Radio), newspapers, and tv.

•Volunteers: At least 50 individuals have volunteered to serve on a workgroup and help create the strategy.

•Membership in the MCP: We consider everyone who attended the Summit to be part of the MCP, along with others who have signed up on the MCP website.


• Evaluation tools:•Summit evaluation survey


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Illinois SBHC Screening during Sports Physicals

Uplift School Health Center Children’s Memorial Hospital

Cynthia Mears DO FAAP5/10 to 5/11Chicago, IL


Children’s Memorial Hospital, Uplift School Based Health Center is adding free Chlamydia and gonorrhea screening to student athletes’ pre-participation sports physicals provided at five school-based health centers in the Chicago and rural Illinois areas.

SBHC Screening during Sports Physicals


Increase the rate of student participation in CT screening by offering it at the time of sports physicals.

Using lab results, will measure rate of student participation in screening during sports physicals.Will compare rates of screening to same time period in prior year(s).

To measure the prevalence of Chlamydia and gonorrhea in the adolescents presenting to school- based health centers for sports pre- participation exams.

Results of lab tests.


Process Objectives Performance Measures To evaluate the process: the feasibility, effectiveness, cost, and logistics of this novel intervention and comparison.

Cost: The state lab will be able to provide us with total numbers of tests and cost of treatment. Effectiveness: We will be able to look at numbers of students reached and compare to numbers from the same time period in a previous year.Comparison: We can show if our total testing numbers increased by focusing on this additional sub group.Feasibility/Logistics: We will track the numbers of students that we have reached as well as the numbers of students who declined participation. Each site will tabulate this information via clinical fusion. Uplift will consolidate all information. We also hope to obtain feedback from the sites on how feasible it was to add this into their sports physical routine.

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Process Objectives Performance Measures To develop a protocol at these five sites that could be instituted statewide in school-based health centers, if effective.

If the current protocol demonstrates an increase in screening and STD treatment as compared to not instituting the protocol, then we hope to disseminate the benefits of this program for others to apply to their sites.

Results will be disseminated by Dr. Mears at the 6 regional SBHC meetings and the National Assembly of Meetings and regional/state NAPNAP meetings.

Interview state and national organizations to determine past numbers in attendance to help estimate possible numbers reached and report on actual attendance.




• Any suggestions from the group as to how to accurately reflect any changes in screening numbers from the year prior to the program to present day?



• Low participation numbers in the first quarter have not given us solid data with which to work. A recent increase in the number of sports physicals being performed will add valuable information.

• From testing performed thus far, it appears that the sports PE testing accounts for 9 percent of our overall testing for this time period.

• In both groups, Hispanics have had no positive tests for gonorrhea or Chlamydia.

• There also appears to be a lower incidence of Chlamydia in the sports group as compared to the general testing, but with such small numbers, it may be too soon to tell.

• It appears there were better overall testing numbers from this time last year as compared to this year, but this data will not reflect sites that were screening for STI during sports physicals last year (Uplift pilot).

• There also appears to be a lower percentage of positives for Chlamydia this year but a higher percentage of positives for gonorrhea.


Evaluation tools: •State data from last year cannot be reviewed for STI testing done during sports physicals. •We need to ask each site to obtain preliminary data from Clinical Fusion. A template has been made to record these data.

ENHANCED CHLAMYDIA SCREENING IN THE MEDICAL HOME

American Academy of Pediatrics New York State Chapter 1

Gale R Burstein, MD, MPH, FAAPMarch 2010 – February 2011

Western New York State


University at Buffalo, State University of NY: Three pediatric offices, located in western New York State, are pilot-testing an intervention designed to enhance the delivery of comprehensive and confidential adolescent preventive care, including sexual health services.

Enhanced Chlamydia Screening in the Medical Home


Increase the number of providers who routinely take a confidential medical history.

•Pre and post-intervention data will be collected. Conduct survey of participating providers. •Number of completed confidential adolescent screening questionnaires.

Increase the number of providers who regularly screen sexually active female teens for chlamydia.

•Pre and post-intervention data will be collected.•Number of chlamydia tests ordered on sexually active adolescent female patients.•Data will be generated from the health risk assessments/provider action forms.

An improved understanding of the barriers to providing universal CT screening for commercially-insured adolescents.

In our data collection instrument, we ask why a CT test was not sent on sexually active teens and asking providers why they are not screening consistently. We will also do a survey and/or post-intervention focus group with providers.


Process Objectives Performance Measures To provide information about minors’ rights to consent for certain health services to providers and medical office staff.

Numbers of providers and office staff reached with information on minors’ rights to consent for confidential health care services.

To provide information and tools to assist providers to improve their adolescent risk assessment.

Number of providers reached with tools to improve adolescent health risk assessment.

To distribute tools and information to medical offices to assist them in developing adolescent medical homes.

Number of offices where materials were distributed.

To educate providers on their chlamydia screening practices for their adolescent patients.

Number of office visits where chlamydia screening outcomes data were presented.

To assist providers to enhance their web sites’ adolescent health information quality and accessibility for their patients (as part of the medical home).

Number of offices that added adolescent health information to their web sites.

• Questions for group discussion:• Not sure how to document offices’ chlamydia screening practices before they were given the tools to measure the effectiveness of receiving the tools without training.

•Offices are not completing the section to explain why a chlamydia test was not sent. Not sure what to do.

•One office refused to send any chlamydia tests. After the training intervention and a partner meeting they have decided to start. They are now working on a protocol but this may not be implemented before the end of the data collection. How do I document improved care?



•BEFORE TRAINING


Question N = 84 Male FemaleI have provided info on Sexual Health 26.3% 8.7%Counseled about contraception 40% 30.4%Ordered HIV test 0% 0%Ordered Chlamydia test 0% 0%

Mid-sized suburban/rural peds practice

Question N = 58 Male FemaleI have provided info on Sexual Health 66.7% 94.3%Counseled about contraception 100% 97.2%Ordered HIV test 0% 0%Ordered Chlamydia test 0% 41.7%

Large suburban/rural peds practice

Question N=54 Male FemaleI have provided info on Sexual Health 100% 89.9%Counseled about contraception 100% 77.8Ordered HIV test 33.3% 0%Ordered Chlamydia test 83.3% 55.6%

Small urban/rural peds practice

• Evaluation tools:•Health risk questionnaire provider area•Focus groups•Surveys?


ODU CHLAMYDIA PROJECT

Old Dominion UniversityJenny Foss & Kim Cholewinski

6/1/10 - 5/31/11Norfolk, Virginia


Old Dominion University Research Foundation, through Old Dominion University’s Student Health Service, is implementing a multi-faceted project to increase chlamydia awareness, screening and treatment at ODU and in the surrounding Tidewater region of Virginia.

ODU Chlamydia Project

Outcome Objectives Performance Measures Screening for CT will increase by 20% among ODU students.

•Direct access chlamydia testing will be tracked (number of tests and positivity rate).

•Direct Access testing will be tracked separately from our “normal” appointment-based testing to determine whether or not direct access testing made an impact on screening rate.

25% of non-ODU partners will be tested/treated at Norfolk Public Health Department.

•Quarterly, the Public Health Department will report number of referral cards collected, which will be compared with number issued by ODU.

•Cards will be offered for both ODU students and non-students but only students using the health department will be tracked --- some may be ODU students, but we will be unaware of that.


Process Objectives in Proposal Performance Measures in Proposal

Number of calls to CT hotline will increase by 40%.

•Quarterly reports of the number of calls compared to pre-project implementation call level.

50% of ODU students will recognize at least one CT poster.

•Survey of 100 students will be administered to assess recognition.

By October 2010 the Tidewater Chlamydia Coalition will be created.

•Assess activities of subcommittees through subcommittee reporting sheets.

75% of students receiving health education/sexual health programming will complete a survey acknowledging understanding of Chlamydia and need for screening.

•General health education evaluation used at the end of programming.



~We started our project 9/1/10 and do not have any results as of yet.


• Evaluation tools:•Surveys, reporting forms (subcommittee)

Health & Medicine

Mini Grant Second Quarterly Call