• Clearly link goals and objectives to the problem or issue the practice is addressing
• Indicate what the practice intends to accomplish
  

• What are the specific tasks taken that achieve each goal and objective of the practice?
• What is the timeframe for carrying out these tasks?
  

• What is the public health issue the practice addresses?
• What process was used to determine the public health issue’s relevancy to the community?
• How does the practice address the issue?
  

Check off only one box below and answer each of the questions under that box in the field below. DO NOT EXCEED 300 WORDS.

Check here if the program/project is new to the field of public health and answer the following questions:
• What process was used to determine that the practice is new to the field of public health?
• How does this practice differ from other approaches used to address the public health issue?

Check here if the program/project is an inventive use of an existing tool or practice and answer the following questions:
• What process was used to determine that the practice is an inventive use of an existing tool or practice?
• How does this practice differ from other approaches used to address the public health issue? If you used a tool to implement your program (e.g. PACE EH, MAPP, Assessment Protocol for Excellence in Public Health (APEX PH), Planned Approach to Community Heath (PATCH), etc), how was your approach to implementing the tool unique?
• If this practice is similar to an existing model practice in NACCHO’s Model Practice Database (www.naccho.org), how does your practice differ?

• What is the local public health agency’s role in this practice?
• What is the role of stakeholders/partners in the planning and implementation of the practice?
• What does the local public health agency do to foster collaboration with community stakeholders? Describe the relationship and how it furthers the practice’s goals.

Sustainability is determined by the availability of adequate resources. In addition, the practice should be designed so that stakeholders are invested in the maintenance of the program and to ensure it is sustained after initial development. (NACCHO acknowledges the fiscal crises and budget cuts that may limit the feasibility of a program’s continuation.) Answer each of the following questions. DO NOT EXCEED 300 WORDS.

• Is there sufficient stakeholder commitment to perpetuate the practice? Describe how this commitment is ensured.
• Describe plans to sustain the practice over time and leverage resources.

Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice’s efforts. Results may be long-term, such as an improvement in health-status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (such as focus group results, in-depth interviews, or anecdotal evidence).

Fill out the grid on the following page. If you have more than one goal, list your TOP goal. If you have more than three objectives, list your TOP three objectives. For each objective, provide information about the following:

• Performance measures: List your expectations (e.g. number of meetings held by a specific date, number of partners contacted by a specific date)
• Data collection: List what data were collected, who collected them, and how
• Logistics: List when and how often the data were collected
• Feedback: List who received the data results, what lessons were learned, and what modifications, if any, were made to the practice as a result of the data findings
• Outcome: State the outcome of the objective and check whether the outcome was unintended, short term, intermediate term, or long term. If you have additional information, put it in the box below.