16 Feb For this assignment, you will now use the information and findings from your community needs assessment to complete the second p

Benchmark – Program Implementation Plan

Part 1 – Description of Program and Logic Model

Describe an evidence-based intervention based on your completed needs assessment. Your intervention should be population-based and informed by your chosen theory and SMART goals and objectives. Population-based interventions can be directed at the entire population within a community, the systems that affect the health of those populations, and/or the individuals and families within those populations known to be at risk. Use the Logic Model to design your proposed intervention.

1. Description of the Intervention

0. Describe the population-based, evidence-based program/intervention.

0. Discuss how the intervention will support improving the health issue for the target population.

1. Goal and Objectives

1. Goal:

1. Process Objectives (the activities to be completed in a specific time period):

1. Outcome Objectives (changes in knowledge, attitudes, behaviors, policy, environment systems, etc.):

1. Complete the Logic Model. Design your intervention using the template on the following page:

Inputs

Long-Term Outcomes

Intermediate Outcomes

Short-Term Outcomes

Outputs

Activities

Legend

Inputs: What resources do you need to make this happen? (e.g., staff, space, funding)

Activities: What are you going to do? (e.g., educate and establish partnerships)

Outputs: What will happen because of your activities? (e.g., 100 people trained)

Short-Term Outcomes: Immediate changes you expect to occur (e.g., changes in knowledge)

Intermediate Outcomes: (e.g., changes in behavior)

Long-Term Outcomes: How will this program help in the future (e.g., obesity prevention)?

Target Population (as identified by needs assessment):

Health issue affecting target population:

Theory or model used to inform an intervention:

Logic Model

Part 2 – Implementation Timeline and Action Plan

Develop a program timeline and action plan using a Gantt chart, depicting the key tasks, activities and people involved in the first 12 months (1 year) of implementing your program and the projected timeframe for completion of each task. Use the objectives you defined in Part 1.

Example :

Objective: By the end of the school year, district health educators will have delivered lessons on tobacco refusal skills to 90% of youth participants in the middle school tobacco prevention curriculum.

Timeline for Tasks/Activities

Task/Activity

Personnel Responsible

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Train volunteers on curricula

Program coordinator

X

X

Deliver education classes

Volunteers

X

X

X

1. Complete the table below for your intervention (add rows, as needed):

Objective 1:

Timeline for Tasks/Activities

Task/Activity

Personnel Responsible

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Objective 1:

Timeline for Tasks/Activities

Task/Activity

Personnel Responsible

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Objective 1:

Timeline for Tasks/Activities

Task/Activity

Personnel Responsible

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Objective 1:

Timeline for Tasks/Activities

Task/Activity

Personnel Responsible

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Objective 1:

Timeline for Tasks/Activities

Task/Activity

Personnel Responsible

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Part 3 – Budget and Budget Justification

Review the "Program Budget Resource" to complete your budget and justification. Identify a potential source of funding for your project. Add or remove rows from the tables below, as needed, to complete your budget.

Source of Funding:

1. Personnel

Staff Position	Yearly Salary	% of Time	Fringe Benefits (as % or additional cost)	Total Amount (Do not add fringe benefits twice.)
Total

1. Travel

Item	Description of Travel Event Expenses	Amount
Item 1
Item 2
Item 3
Total

1. Equipment

Equipment Item	Description	Amount	Total
Total

1. Supplies

Supply Item	Description	Amount	Total
Total

1. Consultant

Consultant/ Organizational Affiliation	Services to Be Rendered and Relevance to Service Project	Number of Days	Expected Rate of Compensation
Total			Total

1. Other

Item	Description	Amount or Amount/Month	Total
Total		Total

1. Total Direct Costs

Budget Item	Total Amount
Personnel
Fringe
Travel
Equipment
Supplies
Contractual
Consultant
Other
Total

1. Budget Proposal and Justification

Write a 250-500 word justification for your budget. The justification summarizes the resources needed and why. Provide relevant rationale and evidence to support your summary.