Detailed Information on the
Family Planning Assessment

Proceeding with an independent evaluation of sufficient quality and scope. Monitoring the progress and providing the advisory committee with updated and clarifying information as needed. Action will be achieved by Fall '09.

OFP will develop ambitious baselines and targets as well as timeframes for all long-term measures that link to program mission and purpose.

OFP will develop ambitious baselines and targets for all annual measures.

Planning for an independent evaluation of sufficient quality and scope, conducted at the Federal level, that will demonstrate the overall impact of the program. Action will be achieved by Spring '07.

Proceeding with an independent evaluation of sufficient quality and scope. Monitoring the completion of contract negotiations between Department entities, the Program and the Independent Contractor. Action will be achieved by Fall '07.

Measure: Reduce invasive cervical cancer among women attending Title X family planning clinics by providing Pap tests.

Explanation:Baselines will be established and targets determined after receipt of 2005 Family Planning Annual Report Data (April 2006).

Measure: Reduce infertility among women attending Title X family planning clinics by identifying Chlamydia infection through screening of females ages 15-24.

Explanation:Baselines will be established and targets determined after receipt of 2005 Family Planning Annual Report Data (April 2006).

Measure: Maintain the actual cost per Title X family planning client below the medical care inflation rate.

Explanation:Performance will be reported upon receipt of 2005 Family Planning Annual Report Data (April 2006).

Measure: Increase the number of unintended pregnancies averted by providing Title X Family Planning Services, with priority for services to low income individuals.

Explanation:Performance on measure will be reported based on 2008 Family Planning Annual Report Data. Annual progress toward meeting long-term target will be reported based on 2005 Family Planning Annual Report Data (April 2006).

Is the program purpose clear?

Explanation: The purpose and mission of the Family Planning program is to provide individuals the medical, educational and social services necessary to 1) exercise personal choice in determining the number and spacing of their children and 2) ensure their reproductive health and well-being (through prevention of STDs, HIV and routine cancer screenings), with a priority given to low-income persons. By increasing utilization of family planning services within underserved populations, and by providing preventative health care that prevents the acquisition and spread of STDs and HIV, the program seeks to improve the health of individuals who would otherwise not have access to family planning and related preventative health services.

Evidence: Evidence for this answer can be found in the following documents: ?? Family Planning Services and Population Research Act of 1970 (Public Law 91-572) ?? Title X of the Public Health Service Act (42 USC 300 et. seq.) ?? Regulations: [42CFR Part 59, Subpart A] ?? Family Planning FY 2006 Performance Plan ?? Program Guidelines for Project Grants for Family Planning Services (Mission statement, p.2, 2nd paragraph) ?? OPA Website, OFP homepage: opa.osophs.dhhs.gov

Does the program address a specific and existing problem, interest, or need?

Explanation: According to the U.S. Census Bureau, of the approximately 45 million people who are currently without health insurance, approximately 50% (26.4 million) are within the reproductive ages of 18-44. Subsequently, millions of Americans do not have regular access to preventative health services and education necessary to make informed decisions about their reproductive health. Almost 50% of pregnancies in the U.S. are unintended and 40% of women who are not seeking pregnancy and not using a method of contraception account for 53% of unintended pregnancies. Each year, publicly-subsidized family planning services help women avoid an estimated 1.3 million unintended pregnancies.

Evidence: Evidence for this answer can be found in the following documents: 1) Family Planning FY 2006 Performance Plan (GPRA) (Performance Goal1 and p. 8, Goal I.C. Frost, J., Frohwirth, L., & Purcell, A. 2) "The Availability and Use of Publicly Funded Family Planning Clinics: U.S. Trends, 1994-2001" (Perspectives on Sexual and Reproductive Health, 2004. 36(5), 206-216) 3) Henshaw, S. "Unintended Pregnancy in the United States" (Family Planning Perspectives, 1998. 30(1), 24-29;46) 4) "Contraceptive Needs and Services, 2001-2002" (The Alan Guttmacher Institute, 2004) 5) Issues in Brief, 2004 Series, No. 3, "Preventing Unintended Pregnancy in the United States.

Is the program designed so that it is not redundant or duplicative of any other Federal, state, local or private effort?

Explanation: Title X is the sole federal program dedicated to the provision of family planning services for those who do not qualify for Medicaid and who are otherwise unable to afford adequate health insurance. Title X supported clinics play a vital role in providing services to individuals who are poor but not covered by Medicaid because they 1) are not poor enough to qualify, 2) do not have a child or 3) they do not have a private physician who is willing to accept Medicaid clients. While private and non-profit organizations, as well as other Federal programs, such as Community Health Centers (CHC), provide varying levels of family planning services, none of them were designed to provide the breadth and quality of reproductive health care as that which is provided by the Family Planning program. The Family Planning program is unique in its both its purpose and ability to enable uninsured (and underinsured) individuals to make informed reproductive choices and remain in good health so that they experience successful outcomes in future pregnancies.

Evidence: Evidence for this answer can be found in the following documents: ?? Issues in Brief - Community Health Centers and Family Planning ?? Frost, J., Frohwirth, L., & Purcell, A. "The Availability and Use of Publicly Funded Family Planning Clinics: U.S. Trends, 1994-2001" (Perspectives on Sexual and Reproductive Health, Vol. 36, Number 5, Sept./Oct. 2004, 206-216) ?? Frost, J. "Public or Private Providers? U.S. Women's Use of Reproductive Health Services (Family Planning Perspectives, 2001. 33(1):4-12) ?? Use of Contraception and Use of Family Planning Services in the United States: 1982-2002. Advance Data No. 350 (2004)

Is the program design free of major flaws that would limit the program's effectiveness or efficiency?

Explanation: The Title X Family Planning program is intended to provide accessible, high-quality, and community-based family planning services to all who want and need them- with priority given to low-income persons who would otherwise not have access to such care. The program accomplishes this by awarding grants and/or contracts, on a competitive basis, to public or not-for-profit community-based providers who possess a good understanding of their communities' needs. Because the purpose of the program is to provide direct health services to an underserved population, issuing grants or contracts to local clinics to provide these services is the most efficient way to achieve the program's intended purpose. Title X funds also represent only approximately 25% of their grantees' revenues. This ensures that these clinics receive buy in from other State and local organizations that have an interest in providing family planning services to low-income communities.

Evidence: Evidence for this answer can be found in the following documents: ?? Program Guidelines for Project Grants for Family Planning Services ?? Federal Register Announcements - FY05 Services, FY05 General Training, FY 05 Service Delivery Improvement Research ?? OPA Clearinghouse Publications List ?? FY 2005 Regional MOU and Work Plan Guidance ?? Frost, J., Frohwirth, L., & Purcell, A. "The Availability and Use of Publicly Funded Family Planning Clinics: U.S. Trends, 1994-2001" (Perspectives on Sexual and Reproductive Health, Vol. 36, Number 5, Sept./Oct. 2004, 206-216)

Is the program design effectively targeted so that resources will address the program's purpose directly and will reach intended beneficiaries?

Explanation: The Family Planning program is designed in a manner that ensures resources are being used directly and effectively to meet the program's purpose. As the program was developed to provide family planning services to all who need and want them, with priority given to low-income individuals, the program's services are provided at no cost to individuals at or below 100% of the Federal Poverty Level (FPL). For those just above the FPL, the program utilizes a sliding fee scale for those individuals between 101% and 250% of the FPL. According to the 2003 Family Planning Annual Report (FPAR), over two-thirds (67%) of clients served in Title X clinics were at or below 100% of the FPL, and 90% were below 200% of the FPL, indicating that the program's family planning services are being provided to it's priority populations.

Evidence: Evidence for this answer can be found in the following documents: ?? 2003 FPAR - Table A-5 ?? Program Review Tool ?? FY 2005 Regional MOU ?? Title X Statute ?? Title X Regulations ?? Program Guidelines for Family Planning Services (2001) ?? FY 2005 Family Planning Services Announcement 90% Appropriations Language

Does the program have a limited number of specific long-term performance measures that focus on outcomes and meaningfully reflect the purpose of the program?

Explanation: The Office of Population Affairs' (OPA) Office of Family Planning has developed three long-term measures that directly reflect the core purpose of the program and reflect the program's progress in achieving meaningful health outcomes. These long-term measures are linked to Healthy People 2010 and are responsive to both HRSA's long-term plan and the HHS Strategic Goals and Objectives as reflected in the FY 2006 HRSA budget/performance integration plan.

Evidence: The program's long-term measures are as follows: 1) Increase the number of unintended pregnancies averted by providing Title X Family Planning services, with priority for services to low-income individuals 2) Reduce infertility among women attending Title X Family Planning clinics by identifying Chlamydia infection through screening of females ages 15-24. 3) Reduce invasive cervical cancer among women attending Title X Family Planning clinics by providing Pap tests.

Does the program have ambitious targets and timeframes for its long-term measures?

Explanation: The program has a clear baseline and specific quantified targets for one of its long-term measures (averting unintended pregnancies by ensuring access to a broad range of family planning services and methods), and is presently developing baselines and targets for its other two long-term measures. Because the baselines and targets for these two measures will not be available until Spring 2006, and therefore not available for inclusion in the FY 2007 Budget, this question must be answered "no".

Evidence: Evidence for this answer can be found in the following documents: ?? FPAR 2003 ?? Proposed long-term objectives for Title X ?? Title X budget and performance plan for FY 2006 ?? Appropriations language Title X FY 2005 ?? Issues in Brief, 2004 Series, No. 3, "Preventing Unintended Pregnancy in the United States"

Does the program have a limited number of specific annual performance measures that can demonstrate progress toward achieving the program's long-term goals?

Explanation: In order to measure their progress annually in achieving their long-term goals, the Family Planning program will simply break down its long-term measures into annual targets. Therefore their annual measures will look identical to their long-term measures (sited in the evidence section of question 3.1), with the exception that each measure will have annual targets. The program already has yearly targets in place for its "unintended pregnancies averted" measure, and are in the process of developing baselines and annual targets for its other two measures.

Evidence: Evidence for this answer can be found in the following documents: ?? FPAR 2003 ?? Title X budget and performance plan for FY 2006 ?? HRSA and HHS Strategic Goals and Objectives ?? Revised FPAR forms and instructions ?? AGI Estimates of the number of unintended pregnancies averted among all women and women under age 20 attending Title X family planning clinics 2000-2003

Does the program have baselines and ambitious targets for its annual measures?

Explanation: The program does have a baseline and ambitious targets for one of the above annual measures (increasing the number of unintended pregancies averted) and is presently developing baselines and targets for its other two annual measures. Because the baselines and annual targets for these two measures will not be available until Spring 2006, and therefore not available for inclusion in the FY 2007 Budget, this question must be answered "no".

Evidence: Evidence for this answer can be found in the following documents: ?? Title X statute and regulations ?? FPAR 2003 (trend table) ?? Title X budget and performance plan for FY 2006

Do all partners (including grantees, sub-grantees, contractors, cost-sharing partners, and other government partners) commit to and work toward the annual and/or long-term goals of the program?

Explanation: All of the program's partners are committed to and work toward the annual and long-term goals of the program. The memorandum of understanding (MOU) with the Regional Offices is a written commitment to the stated annual program goals and priorities. The program priorities define the context for program activities that contribute to achieving long- and short-term goals, and define program requirements for grantees. Grantees commit to and report on achievement toward annual program goals in the annual continuation grant applications and on the FPAR. Grantees are required to use a competitive process to distribute funds to sub-recipients that is consistent with Title X requirements, and commit to monitor sub-recipients and hold them accountable for performance

Evidence: Evidence for this answer can be found in the following documents: ?? Federal Register Notices - Availability of Funds for Family Planning Services Projects, 2003, 2004, 2005 ?? Family Planning Program Priorities, Legislative Mandates, and Key Issues ?? Title X statute and regulations ?? Competing Application Guidance for Title X Services Grants ?? Review Criteria for Title X objective review of Title X services project applications ?? Application kit contents

Are independent evaluations of sufficient scope and quality conducted on a regular basis or as needed to support program improvements and evaluate effectiveness and relevance to the problem, interest, or need?

Explanation: Independent evaluations of sufficient scope and have not been conducted on a regular basis. While several independent evaluations have been conducted recently (and over the course of the program), all were narrow in scope and did not attempt to assess the overall impact of the program.

Evidence:

Are Budget requests explicitly tied to accomplishment of the annual and long-term performance goals, and are the resource needs presented in a complete and transparent manner in the program's budget?

Explanation: The program does not make clear the impact of its budget on its expected performance nor does it provide evidence as to how its requested resources/funding enable it to achieve its annual and long-term goals.

Evidence: FY 2006 Family Planning program Congressional Justification

Has the program taken meaningful steps to correct its strategic planning deficiencies?

Explanation: The program is in the process of contracting with an the Research Triangle Institute, a non-profit research firm that has done work for the CDC, USAID and EPA, to evaluate in a comprehensive manner the effectiveness and overall impact of the program.

Evidence: The evaluation of the Family Planning program is being conducted by the Research Traingle Institute (RTI) to assess the effects the effects of current administrative processes, financial requirements and/or constraints, staff adequacy, and organizational behavior on the quality, effectiveness and efficiency of Title X services.

Does the agency regularly collect timely and credible performance information, including information from key program partners, and use it to manage the program and improve performance?

Explanation: The program regularly collects high-quality performance data from its grantees related to the program's goals and objectives, which is then used to determine whether the grantees are effectively meeting the needs of their client population. This data is also used to determine if additional services or attention are required in specific areas of the program. These annual performance plans and are reviewed and evaluated each year by program staff. Who then respond by creating new performance objectives or are given assistance to meet unmet performance objectives

Evidence: The program collects data from family planning service grantees annually through the Family Planning Annual Report (FPAR). Every three (3) years a comprehensive program review is conducted of each grantee that includes a review of administrative, fiscal, clinical and educational/outreach components of the grantee organization. This review assesses grantee compliance with Title X and other applicable Federal Regulations and identifies areas where grantees need technical assistance. In addition, each grantee that receives a total of $500,000 or more in federal funding is required to submit an annual A-133 audit to the Federal Audit Clearinghouse Bureau of the Census in Jeffersonville, Indiana. Any audit findings are followed up by the OPHS Office of Grants Management (OGM) for resolution

Are Federal managers and program partners (including grantees, sub-grantees, contractors, cost-sharing partners, and other government partners) held accountable for cost, schedule and performance results?

Explanation: The federeal managers of the family Planning program are held accountable for operations and performance results of the program through their annual performance plans. These performance plans include criteria that measure the performance of each manager with reference to the completion and quality of essential duties, responsibilities, program monitoring tasks and other position-specific functions, including project oversight of program partners. In addition, Project officers are held accountable for monitoring the Program's grantees and contracts. Program partners (grantees) complete annual continuing applications for every up-coming funding year. Continued funding is dependent on the level of progress toward meeting goals, objectives and deliverables for the past project year and for inclusion of specific, measurable, achievable, realistic and time-framed (SMART) objectives for the up-coming project year.

Evidence: The Performance plans for managers and staff are re-assessed annually. They are based on a three-tiered performance scale. This system was implemented in FY 2004 and results have not yet been evaluated. Additional evidence can be found in the: 1) Federal Register Notice for a sample grant 2) Sample Staff Annual Performance Plan 3) FY 2005 MOU and Work Plan Guidance

Are funds (Federal and partners') obligated in a timely manner and spent for the intended purpose?

Explanation: Program funds are obligated consistently with the overall program plan as quarterly spending plans are developed by the Program at the beginning of each fiscal year. Year end obligations have historically reflected a lapsed balance of less than 1 percent of the appropriation. The Program distributes funding to the regional offices no more than 60 days after receiving the Program's appropriation. In the instance when the Federal government is operating under a continuing resolution (CR) and the budget start date for a specific grantee falls within the time of the CR, the grantee is provided with funding based on half of the previous year's base funding. The remaining portion is distributed once the Federal budget has been signed and the full appropriation has been received by the Program. All Program partners (grantees and contractors) are required to complete an annual FSR 90 following the close of their budget period.

Evidence: Evidence for this answer can be found in the following documents: ?? Sample Notice of Grant Award ?? Sample Financial Status Report - Long and Short Form ?? Budget Distribution Report ?? Title X Statute and Regulations

Does the program have procedures (e.g. competitive sourcing/cost comparisons, IT improvements, appropriate incentives) to measure and achieve efficiencies and cost effectiveness in program execution?

Explanation: The program has taken (and is in the process of taking) several steps that will allow it to both measure and achieve efficiencies and cost effectiveness in program execution. 1) The program outsources performance-based contracts for technical assistance, objective review committees, FPAR compilation and meeting logistics, in which compensation is based on the delivery of services or products depending on the scope of work. 2) The program also has a new efficiency measure with baseline and targets.

Evidence: The Program is able to measure and set targets for the average cost per client using the FPAR data and comparing the annual rate of growth of actual expenditures to the baseline amount forecasted using the Consumer Price Index (CPI) for medical care prices. This monitoring will use 1999 data as the baseline figure. This monitoring will use 1999 data as the baseline figure. The baseline figure will be reexamined at five (5) year intervals (e.g. baseline year 1999 - target year 2004, baseline year 2000 - target year 2005, etc.).

Does the program collaborate and coordinate effectively with related programs?

Explanation: The program collaborates with several other related government programs and agencies which enables the program to maximize its resources and improve its capacity to achieve its goals. The agencies with which the Family Planning program collaborates are CDC, HRSA, ACF, Ryan White HIV/AIDS program and CMS.

Evidence: The Family Planning program works with CDC on the prevention and treatment of STDs, and promotion of reproductive health through HIV testing and prevention. Coordination with HRSA's 340B program aids in decreasing the cost of pharmaceuticals for the FP program's grantees. The program also collaborates with the Admin. for Children and Families' (ACF) Infant Adoption Awareness Training Program (IAATP) to assist Title X grantees with providing accurate information about adoption.

Does the program use strong financial management practices?

Explanation: The Office of the Inspector General audit of the financial statement audit for the Department of Health and Human Services in FY 2004 reflected an unqualified or "clean" audit for the Department, the sixth clean consecutive opinion for the departmental financial statement audit. The audit does not cite any material internal control weaknesses specific to the Program. None of the agency-wide material weaknesses identified in the report has a direct relation to the Family Planning Program. The Program also completed the Improper Payment Improvement Act risk assessment. The Program used the GAO Internal Control Management and Evaluation Tool to evaluate the control environment. The Program determined the risk of improper payments to be low. Spending plans guide the timely obligation of funds to Program grantees. Financial management of all OPHS office budgets reside in the Office of the Assistant Secretary for Health.

Evidence: Evidence for this answer can be found in the following documents: ?? Department-wide Independent Auditor's Report on Financial Statements and Management Response ?? Improper Payment Risk Assessment ?? Federal Manager's Financial Integrity Act (FMFIA) Report

Has the program taken meaningful steps to address its management deficiencies?

Explanation: There are no management deficiencies for the program to correct.

Evidence:  

Are grants awarded based on a clear competitive process that includes a qualified assessment of merit?

Explanation: All grants awarded by the Family Planning program are awarded on a competitive basis. In addition, each application is reviewed by an Objective Review Committee (ORC) made up of an independent and diverse group familiar with family planning and the specific subject area. Prior to the review of each application, the members of the ORC are required to complete a conflict of interest form. The applications, including the proposed project and budget plans, are individually reviewed and scored by the ORC based on the established evaluation criteria which are published in the Federal Register announcement.

Evidence: Evidence for this explanation can be found in the following documents: ?? ASAM Review and Corrective Action Plan ?? Sample RFA ?? ORC documents ?? Application Checklist ?? Continuing Application Guidance ?? Conflict of Interest Form

Does the program have oversight practices that provide sufficient knowledge of grantee activities?

Explanation: The Program, decentralized with family planning program staff in each of the 10 Public Health Service (PHS) regions conduct annual site visits in addition to comprehensive program reviews of administrative, fiscal, clinical and educational components once every three years. These site visit and program review reports are submitted to the Program's Central Office upon completion. Additionally, the grantees are required to complete an annual continuing application for each budget year of their approved project period. Financial Status Reports (FSRs) are required of each program grantee within 90 days following the end of the budget period. Future funding within their project period is contingent on successful completion of a continuation application which includes progress on the past project year, future performance goals and objectives and supporting evidence on challenges, and proposed solutions for actual and possible challenges.

Evidence: Evidence for this answer can be found in the following documents: 1) FY 2005 MOU and Work Plan Guidance 2) Non-competing and continuing application guidance (progress report formats) 3) Program Review Tool

Does the program collect grantee performance data on an annual basis and make it available to the public in a transparent and meaningful manner?

Explanation: The Program grantees provide data annually to OFP in the form of the FPAR. The Program uses the data in conjunction with other publicly available reports to determine the patterns and trends regarding program funding, service availability, use, access, quality and other measures that assess the performance of the Program. The FPAR forms and instructions as well as the most recent final report are posted on the OPA web page. The Program's annual performance plan is also posted on the OPA web page. Continuing grant applications which are required annually also include performance information which details the progress toward stated performance goals and objectives. The Program also makes available evaluation reports from specific studies regarding the performance of the Program and its partners.

Evidence: Evidence for this answer can be found in the following documents: ?? FPAR reports ?? Continuing application guidance ?? Program's website: http://opa.osophs.dhhs.gov/titlex/ofp.html

Has the program demonstrated adequate progress in achieving its long-term performance goals?

Explanation: While the program has developed three new long-term goals, it is only able to demonstrate progress towards one of those goals (number of unintended pregnancies averted), as there exists no historical data available for the other two measures (reducing infertility among women attending Title X Family Planning clinics by identifying Chlamydia infection through screening of females ages 15-24 and reducing invasive cervical cancer among women attending Title X Family Planning clinics by providing Pap tests).

Evidence: Evidence for this answer can be found in the following documents: ?? Family Planning Annual Report: 2003 Summary ?? Title X Funding History. http://opa.osophs.dhhs.gov/titlex/ofp-funding-history.html ?? Systematic Evidence Review Number 3: Screening for Chlamydia Infection, Agency for Healthcare Research and Quality, U.S. Preventive Services Taskforce

Does the program (including program partners) achieve its annual performance goals?

Explanation: The program's annual measures are the same as its long-term measures- except with targets set annually, and hence the program is only able to demonstrate annual performance in regards to one of its three annual goals. The measure for which the program does have long-term historical data clearly demonstrates that the program has annually exceeded its targets for the number of unintended pregnancies averted through the provision of Title X Family Planning Services.

Evidence: Evidence for this answer can be found in the following documents: ?? Family Planning Annual Report: 2005 Instructions and Forms ?? Family Planning Annual Report: 2003 Summary ?? GPRA measures ?? Cervical Cancer (PDQ??): Screening, National Cancer Institute, www.nci.nih.gov/cancertopics/pdq/screening/cervical/HealthProfessional/page1

Does the program demonstrate improved efficiencies or cost effectiveness in achieving program goals each year?

Explanation: Over the past several years the Family Planning program has continued to demonstrat both increasing efficiencies and cost effectiveness. The title X service sites have seen more users per site while requiring less revenue per user. Between 1998 and 2002, the total adjusted revenue per user in Title X projects decreased 5%. During this same time period, the average number of users per service site, across all regions, increased 11%. The continuing efficiency and cost effectiveness of Title X programs is demonstrated through ongoing success in meeting the need for publicly funded family planning services in the United States. In 2001, Title X clinics met 28% of the national need for publicly funded family planning services, an 11% increase from 1994. In states employing income-based Medicaid waivers for family planning, the increasing success of Title X clinics was even greater, with a 33% increase in met need from 1994 to 2001.

Evidence: Evidence for this answer can be found in the following documents: ?? Total adjusted revenue per user in Title X projects decreased 5% from $55.04 per user in 1998 to $52.47 per user in 2002. Adjusted Title X revenue per user decreased 1% from $13.62 per user in 1998 to $13.51 per user in 2001. - AGI FPAR summaries, 1998 to 2002 (see RTI report p. 25) ?? AGI FPAR summaries, 1998 to 200,(see RTI report p 49) ?? Frost JJ, Frohwirth L and Purcell A (2004). The availability and use of publicly funded family planning clinics: U.S. trends, 1994-2001. Perspectives on Sexual and Reproductive Health, 36 (5).

Does the performance of this program compare favorably to other programs, including government, private, etc., with similar purpose and goals?

Explanation: The program Title X program services compare favorably with other publicly funded family planning services in regards to the types and quality of care the program provides (see evidence column to the right). However, because there have been no independent studies that have evaluated the overall impact of the program, it is difficult at this time to compare the overall effectiveness of Title X clinics relative to other public, private or non-profit groups.

Evidence: In the provision of contraceptive services, the mean number of contraceptive methods offered in Title X funded agencies is significantly higher than the number offered by agencies receiving no Title X funds. In addition, a significantly higher proportion of Title X-funded agencies (90%) provide oral contraceptives on-site, compared to agencies receiving no Title X funding. Woman utilizating Title X services as their primary source of health care also have significantly higher odds of receiving contraceptive services and/or STD related care than women utilizing private physicians or HMOs.

Do independent evaluations of sufficient scope and quality indicate that the program is effective and achieving results?

Explanation: While there has not been an independent evaluation of sufficient quality and scope conducted at the federal level that demonstrates the overall impact of the program, there have been several studies conducted by independent contractors that have focused on varying aspects of the program. These studies have demonstrated that the program has been implementing aspects of the program that play a key role in the enabling the program to achieve its primary goals and objectives.

Evidence: An April 2005 Report issued by the Office of the Inspector General that the FP program had informed, and periodically reminded, Title X greantees of their responsibilities regarding State requirements for reporting and notification of child abuse, molestation, sexual abuse, rape and incest. A 2004 evaluation conducted by the Assistant Secretary for Administration and Management (ASAM) rewarded the Family Planning Services grant review protocol the Best Program for grant monitoring. Recently, the program contracted with the Research Triangle Institute, Inc. to conduct an assessment of Title X program evaluation needs.