| 
				Organizational
				Context | 
				Mission | 
				Describe your
				organization’s mission. |  | 
		
			| 
				History | 
				Describe the history of
				your organization. | What
					led to the development of this organization?Who
					was part of the development team?How
					long has your organization been in existence?Describe
					the target population(s) your organization serves.
 | 
		
			| 
				Setting/
				infrastructure | 
				Describe your
				organization’s setting and infrastructure. | Where
					does your organization operate?What
					are the key programmatic areas of focus for your organization?Does
					your organization have a board of directors and/or medical
					advisory board?  If so, what is their role within your
					organization?How
					many people does your organization employ?Describe
					the staff expertise at your organization?What
					is the organizational structure?What is your
					organization’s operating budget?
 | 
		
			| 
				Role in organization | 
				How would you describe
				your role within your organization? |  | 
		
			| 
				
 
 
 
 
 
 
 Implementation
				of the YBCS Intervention 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 | 
				Intervention
				Overview, History and Rationale | 
				Describe the
				background/history of your organization’s YBCS
				intervention. 
				 |  | 
		
			| 
				Describe your
				organization’s YBCS intervention. | What
					are the key components of the YBCS intervention?Who
					is the target audience for the YBCS intervention?How
					have the key components of the YBCS intervention been tailored
					to meet the unique needs of the target audience?Was this YBCS
					intervention adapted from an already existing program or
					intervention?
 | 
		
			| 
				Describe your
				organization’s goals and objectives for the YBCS
				intervention. 
				 
 |  | 
		
			| 
				Describe the evidence base
				and/or factors that informed (e.g., behavioral/communication
				theory, scientific evidence, guidelines, formative research) the
				development of the YBCS intervention. |  | 
		
			| 
				Describe your role in the
				YBCS intervention. |  | 
		
			| 
				Intervention execution | 
				Describe how the YBCS
				intervention is implemented. | How
					often is each component of the YBCS intervention implemented?What
					is the duration of the YBCS intervention?Who
					is responsible for delivering key components of the YBCS
					intervention?How
					are YBCS intervention participants recruited?How
					has the delivery of the YBCS intervention been tailored to meet
					the unique needs of the target audience?How do you engage
					members of the target audience (e.g., YBCS, families/caregivers,
					health care providers) in the implementation of the YBCS
					intervention?
 | 
		
			| 
				What tools, guidelines
				and/or protocols are used to direct the implementation of the
				YBCS intervention? | What,
					if any, manuals have been created to support implementation of
					the YBCS intervention?Who
					created these guidelines?How are these used
					to implement the YBCS intervention?
 | 
		
			| 
				What
				trainings are offered to staff to implement the YBCS
				intervention?  
				 | How
					are trainings identified?Who
					delivers these trainings?What
					is the duration of each of these trainings?How
					often are trainings offered to staff?Are there external
					trainings that your organization has participated in to support
					implementation of the YBCS intervention?
 | 
		
			| 
				Implementation Fidelity | 
				To what extent has the
				YBCS intervention been implemented as planned? |  | 
		
			| 
				How does implementation of
				the YBCS intervention vary across sites? | Are there
					differences in the way that the YBCS intervention is delivered
					across sites (e.g., setting, geographic location, target
					population)?  If so, how is implementation different?
 | 
		
			| 
				Does your organization use
				any process improvement strategies to improve the delivery of the
				YBCS interventions? | 
				
 | 
		
			| 
				Resources | 
				How is the YBCS
				intervention funded? | 
				
 | 
		
			| 
				How
				does your organization use funding to implement the YBCS
				intervention? | 
				 
				 | 
		
			| 
				What other, if any,
				non-monetary resources have been provided to your organization to
				support the YBCS intervention? If so, please explain. | Have
					you received donated resources, such as materials and/or
					supplies, to help support implementation of the YBCS
					intervention? 
					Have
					people offered their time and/or expertise to help support
					implementation of the YBCS intervention? 
					Have you received
					any in-kind, paid media donations to promote and/or implement
					the YBCS intervention?
 | 
		
			| 
				Facilitators | 
				What factors, if any, have
				facilitated your organization’s implementation of the YBCS
				intervention? | What
					internal organizational factors (e.g., leadership, staff,
					resources, expertise) have helped your organization implement
					the YBCS intervention?What
					external factors (e.g., training, TA, partnerships) have helped
					your organization implement the YBCS intervention?
 | 
		
			| 
				Barriers | 
				What factors, if any, have
				challenged your organization’s implementation of the YBCS
				intervention? | What
					internal organizational factors (e.g., leadership staff,
					resources, expertise) have challenged your organization’s
					implementation of the YBCS intervention?What
					external factors (e.g., training, TA, partnerships) have
					challenged your organization’s implementation of the YBCS
					intervention?
 | 
		
			| 
				What
				strategies has your organization used to overcome barriers
				related to implementation of the YBCS intervention? | 
				
 | 
		
			| 
				
 
 
 
 
 
 
 
 
 Evaluation 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 | 
				Knowledge | 
				Describe your
				understanding of program monitoring and/or evaluation.
				
				 
 | Have
					you participated in any past evaluation efforts?  If so, please
					describe.Do you have
					experience creating program logic models?
 | 
		
			| 
				
 
 
 
 
 
 
 
 
 Measurement 
 
 
 
 
 
 
 
 
 
 
 
 
 
 | 
				For what the YBCS
				intervention is trying to accomplish, how would you define
				success? 
				 |  | 
		
			| 
				How is success measured or
				documented? 
				 | Do
					you have baseline data? Do you intend to collect follow-up data?
					At what time?Do
					you collect data at specified points over time (time
					series)? What
					length of time?Do
					you follow a sample of participants over time (cohort
					study)? What
					length of time?Do
					you have a comparison group?What does the
					evaluation activity tell you about the success of the YBCS
					intervention?
 | 
		
			| 
				Describe how your
				organization defines and assesses reach for the YBCS
				intervention. | 
				
 | 
		
			| 
				Describe how your
				organization measures the implementation of the YBCS
				intervention. | What
					data do you collect?Who
					is responsible for measuring/monitoring implementation?Are
					other staff members involved in data collection? How so?Are
					there plans to expand or change how your organization monitors
					implementation of the YBCS intervention?  If so, please explain?
 | 
		
			| 
				What are the available
				data sources used to support program monitoring and evaluation
				for the YBCS intervention? 
				 
 | What
					data collection tools or instruments does your organization use
					in relation to the YBCS intervention? (Request to see or obtain
					copies of data, data collection tools, or evaluation reports.)Describe the data
					collection methods used to collect evaluation data for the YBCS
					intervention.
 | 
		
			| 
				How does your organization
				analyze data from the YBCS evaluation in order to collect program
				monitoring and evaluation? | What
					analytic techniques does your organization use to conduct
					program monitoring and evaluation for the YBCS intervention? 
					Who within your
					organization, who is responsible for conducting analysis for the
					YBCS intervention?
 | 
		
			| 
				How does your organization
				use evaluation findings to inform implementation of the YBCS
				intervention? | 
				
 | 
		
			| 
				Describe how your
				organization shares evaluation findings from the YBCS
				intervention. 
				 |  | 
		
			| 
				Facilitators | 
				What, if any, facilitators
				have helped your organization conduct program monitoring and
				evaluating for the YBCS intervention? | 
				
 
 | 
		
			| 
				Barriers | 
				What, if any, barriers has
				your organization encountered in evaluating the YBCS
				intervention? | 
				
 | 
		
			| 
				What
				strategies has your organization used to overcome barriers
				related to program monitoring and evaluation of the YBCS
				intervention? | 
				
 | 
		
			| 
				
 
 Partnerships 
 
 
 
 
 
 
 | 
				Development
				and Engagement 
 | 
				Describe
				the process your organization has used to identify and develop
				partnerships. |  | 
		
			| 
				Describe
				how new partnerships have been formed to support the
				implementation of the YBCS intervention. |  | 
		
			| 
				Describe
				how you have worked to maintain existing partnerships to support
				the implementation of the YBCS intervention. | Why
					were these partners identified (e.g., access to target
					population, resources, expertise)?How
					did you continue your engagement with these organizations?
 | 
		
			| 
				Contribution
				to the intervention 
 | 
				Describe
				how partners participate in the planning or implementation of the
				YBCS intervention. | How
					does your organization interact with partners?How
					does your organization communicate with partners?How
					often does your organization communicate with
					partners?How
					long has your organization worked partners?
					
					
 | 
		
			| 
				What partnerships have
				been the most beneficial for your organization in the
				implementation of the YBCS intervention? |  | 
		
			| 
				What additional
				partnerships would [insert Nonfunded Organization name] benefit
				from to support the implementation of the YBCS intervention? | 
				
 | 
		
			| 
				Capacity
				and Sustainability | 
				Capacity
				to implement intervention | 
				Describe
				your organization’s capacity to implement the YBCS
				intervention and how capacity has changed over time. | 
				
 | 
		
			| 
				Capacity
				to evaluate | 
				Describe your
				organization's capacity to plan and implement program monitoring
				and evaluation activities, such as creating data collection
				tools, collecting data, conducing analysis, and reporting. 
 | Describe
					program staff members who have the expertise/experience to
					collect and/or analyze data.What
					additional outside resources does your organization rely on to
					help with evaluation (e.g., does your organization use an
					external evaluator)?
 
					Describe
					the resources your organization reserves to support data
					collection (e.g., time, materials, technology) to support
					program monitoring and/or evaluation?What
					other resources does your organization designate for program
					evaluation/monitoring (e.g., staff, time, technology,
					materials)? | 
		
			| 
				Sustainability
				of intervention | 
				Describe
				the sustainability of the YBCS intervention and how
				sustainability has changed over time. |  | 
		
			| 
				Perceptions | 
				Awareness | 
				How has the YBCS
				intervention affected awareness for the existence of support
				services and/or educational resources among the target audience? | In
					your opinion, what aspect of the YBCS intervention has been the
					most effective in increasing awareness for support
					services and/or educational resources?
					
					In
					your opinion, what communication strategies were the most
					effective in promoting and increasing awareness for the YBCS
					intervention?Does your
					organization have data to support the effectiveness of this?  If
					so, explain how this data is used. (Request to see or obtain
					copies of data, data collection tools, or reports pertaining to
					how a program has assessed awareness.)
 | 
		
			| 
				Access | 
				How has the YBCS
				intervention affected access to support services and/or
				educational resources for the target audience? | In
					your opinion, what aspect of the YBCS intervention has been the
					most effective in increasing access to support
					services and/or educational resources?
					
					Does your
					organization have data to support the effectiveness of this?  If
					so, explain how this data is used. (Request to see or obtain
					copies of data, data collection tools, or reports pertaining to
					how a program has assessed access.)
 | 
		
			| 
				Utilization | 
				How has the YBCS
				intervention affected utilization of support services and/or
				educational resources by the target audience? | In
					your opinion, what aspect of the YBCS intervention has been the
					most effective in increasing utilization of support
					services and/or educational resources?
					
					Does your
					organization have data to support the effectiveness of this?  If
					so, explain how this data is used. (Request to see or obtain
					copies of data, data collection tools, or reports pertaining to
					how a program has assessed utilization.)
 | 
		
			| 
				YBCS
				knowledge, attitudes, and beliefs (KAB) | 
				What knowledge, attitudes,
				and beliefs does the YBCS intervention aim to affect? How has the
				YBCS intervention impacted those specific knowledge, attitudes,
				and/or beliefs among the target population? (Examples of KAB
				targets include: strategies for reducing
				the risk of recurrence and the development of new malignancies,
				chronic disease onset, and improving overall health and quality
				of life). | In
					your opinion, what aspect of the YBCS intervention has been the
					most effective in KAB among the target population?
					
					Does your
					organization have data to support the effectiveness of this?  If
					so, explain how this data is used. (Request to see or obtain
					copies of data, data collection tools, or reports pertaining to
					how a program has assessed KAB among target audience(s).)
 | 
		
			| 
				Value of the YBCS intervention | 
				What has been the value of
				the YBCS intervention? | In
					your opinion, how did the YBCS intervention impact the target
					audience?In your opinion,
					how did the YBCS intervention contribute to the evidence base
					for promising strategies to reach YCBS, YBCS caregivers, and/or
					YBCS health care providers?
 | 
		
			| 
				Lessons learned | 
				What have been some key
				lessons learned from your organization’s experience with
				the YBCS intervention? |  | 
		
			| 
				Recommendations | 
				What ideas do you have for
				improving your organization’s YBCS intervention? | 
				
 |