| 
				Organizational
				Context | 
				Role
				in organization | 
				How
				would you describe your role within your organization? |  | 
		
			| 
				Implementation
				of the Cooperative Agreement (CA) | 
				Core Components of the
				DP11-1111 Cooperative Agreement | 
				Describe
				your participation in the DP11-1111 cooperative agreement (CA). |  | 
		
			| 
				Facilitators | 
				What
				factors, if any, have facilitated your organization’s
				participation in the
				CA?
 
 
 | What
					internal organizational factors (e.g., staff, resources,
					expertise) have helped your organization participate in the CA?What
					external factors (e.g., training, TA, partnerships) have helped
					your organization participate in the CA?
 | 
		
			| 
				Barriers | 
				What
				factors, if any, have challenged your organization’s
				participation in the
				CA? | What
					internal organizational factors (e.g., staff, resources,
					expertise) have challenged your organization’s
					participation in the CA?What
					external factors (e.g., training, TA, partnerships) have
					challenged your organization’s participation in the CA?
 | 
		
			| 
				What
				strategies has your organization used to overcome
				barriers/challenges related to the CA? | 
				
 | 
		
			| 
				Implementation
				of the YBCS Intervention | 
				Intervention Overview,
				History and Rationale | 
				Describe
				your organization’s YBCS intervention that is funded
				through the CA. | 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?
 | 
		
			| 
				Describe
				your organization’s goals and objectives for 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
				communication strategies is your organization using to promote or
				implement the YBCS intervention? | How
					is mass media (e.g., radio, newspaper, Internet) being utilized
					to deliver or promote YBCS intervention components?How
					is small media (e.g., newsletter, email, brochures) being
					utilized to deliver or promote YBCS intervention components?How
					is social media (e.g., Facebook, Twitter) being utilized to
					deliver or promote YBCS intervention components?How
					is earned media (e.g., free or donated media) being utilized to
					deliver or promote YBCS intervention components?
 | 
		
			| 
				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? | 
				
 | 
		
			| 
				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 have 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? 
				 |  | 
		
			| 
				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 | 
				How
				has your organization’s involvement in the CA helped you to
				develop and maintain partnerships? | Have
					you collaborated with other grantees as a part of the CA?Has
					access to other programs serving YBCS helped your organization
					develop new partnerships? If so, please explain.
 | 
		
			| 
				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 Grantee Organization name]
				benefit from to support the implementation of the YBCS
				intervention? | 
				
 | 
		
			| 
				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? | 
				
 |