WORK PLAN MEASURE TEMPLATE CDC-RFA-DD17-1701.xlsx

Sheet1 Documentation and Use of Follow-up Diagnostic and Intervention Services Data through the Maintenance and Enhancement of the Early Hearing Detection and Intervention Information System (EHDI-IS)

CDC-RFA-DD17-1701

Work Plan and Measures of Success Template

VERSION 1

[Insert Applicant Name]

(Select Application Category) 1

Year 1: 7/1/2017 – 6/30/2018

Instructions:

Applicants may use the Template to document their detailed work plan for Year 1 of the award and provide a general summary of work plan activities for Years 2-3 in narrative form. Applicants are not required to use this work plan template, but any plan submitted must include all of the elements in the template.

The applicant’s work plan for the Core and Optional Expanded Activities should include work in all 5 strategy areas (Surveillance; Training and Support; Partnerships; Strategic Communication & Dissemination, and Evaluation) and report on all performance measures contained in the Core Table in the FOA. The Template is pre-populated with the 5 strategies and the performance measures that align with each.

Applicants must address each strategy area during at least one year of the project and should insert “N/A” for any strategies they do not intend to implement in a given year.

Note on printing to PDF: In Microsoft Office 2013, select "File", "Export", "Create PDF/XPS Document" and press the button "Create PDF/XPS." Once the Publish dialog box appears, press the "Options..." button, and select the option to publish the "Entire Workbook." When you close the Options dialog, you will be prompted for a location to save the file. Please save the file as "state name_workplan.pdf". Microsoft Office 2007 and 2010 have similar capabilities. If you do not have access to these programs, you can select from a variety of free or paid programs that allow you to create PDF documents.

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Numerator= Total Screened

Numerator= Total Screened before 1 month of age

LFU/LTD for diagnosis (National overall 32.1%) Numerator = (# Unable to Contact) + (# Number Unresponsive) + (# Unknown)

Percentage diagnostic assessment overall (National overall 59.0%) Numerator = Total w/ completed diagnostic assessment (No Hearing Loss + Hearing Loss)

Numerator = Total w/ Completed diagnostic assessment before 3 Months of Age

Improved documentation of intervention enrollment status, for those infants with identified hearing loss Early Intervention Services LFU/LTD for Early Intervention (National overall 25.8%) Numerator = (# Unresponsive) + (# Unknown)

Numerator=Total enrolled in EI (Part C & non-Part C)

Numerator = Total enrolled in EI (before 6 months, Part C & non-Part C)

Increased collaboration between internal and external partners about sustained tracking and surveillance activities. Number of signed MOU/MOA; New relationship, policy, event situation etc. with potential for expanding EHDI capacity in collecting diagnostic data. Description - Enter text

Increased reporting frequencies by providers of all diagnoses (i.e., permanent hearing loss and no hearing loss) to the EHDI program. Document the percentage of audiologists reporting all diagnoses. Baseline (%) Target (%)

Improved program planning, policy development, and decision making to support tracking and surveillance activities Description of actions taken during the reporting period to improve program planning, policy development, and decision making to support tracking and surveillance activities Description - Enter text

http://www.cdc.gov/ncbddd/hearingloss/ehdi-is-functional-standards-.htmlmailto:ehdico-op@cdc.gov Sheet2