DATA COLLECTION FORM FOR DETAIL SHEET #33

Building Toward MCH Program Sustainability

Use the scale below to rate the degree to which your program has taken the following actions to promote sustainability of your program or initiative. Since these actions and their outcomes are necessarily progressive over the funding period, the ratings are expected to begin lower and progress over the grant period.

Please use the space provided for notes to clarify reasons for score.

0 1 2 3 Element
        1. A written sustainability plan is in place within two years of the MCHB grant award, with goals, objectives, action steps, and timelines to monitor plan progress.
        2. Staff and leaders in the organization engage and build partnerships with consumers, and other key stakeholders in the community, in the early project planning, and in sustainability planning and implementation processes.
        3.There is support for the MCHB-funded program or initiative within the parent agency or organization, including from individuals with planning and decision making authority.
        4. There is an advisory group or a formal board that includes family, community and state partners, and other stakeholders who can leverage resources or otherwise help to sustain the successful aspects of the program or initiative.
        5. The program’s successes and identification of needs are communicated within and outside the organization among partners and the public, using various internal communication, outreach and marketing strategies.
        6. The grantee identified, actively sought, and obtained other funding sources and in-kind resources to sustain the entire MCHB-funded program or initiative.
        7. Policies and procedures developed for the successful aspects of the program or initiative are incorporated into the parent or another organization’s system of programs and services.
        8. The responsibilities for carrying out key successful aspects of the program or initiative have begun to be transferred to permanent staff positions in other ongoing programs or organizations.
        9. The grantee has secured financial or in-kind support from within the parent organization or external organizations to sustain the successful aspects of the MCHB-funded program or initiative.

0=Not Met
1=Partially Met
2=Mostly Met
3=Completely Met
Total the numbers in the boxes (possible 0-27 score) _________

NOTES/COMMENTS: