COMET Data Collection Plan

Attachment 5:

COMET Data Collection Plan

COALITION STRUCTURE AND PROCESS SECTION

(Formerly part of ADMINISTRATION SECTION

and located at and of COMET)

Coalition Structure

Field Name

Data Type

Description

Keep (Keep, Delete, or New)

Rationale

Grantee Information

Numeric

Date Updated

Keep

Moved to first entry. Most of this section was located at the end of COMET under administration and some of the budget was previously located in the capacity section.

Text

Grantee Name

Keep

Text

Alternative Grantee Name

Delete

Do not need.

Numeric

Award Number

Keep

Numeric

Year of First Award

Keep

Is your coalition a SPF/SIG subrecipient?

New

Obtain data on related grants.

Is your coalition a STOP Act Grantee (pre-filled)?

New

Obtain data on related grants.

Prefilled

Status (Active)

Delete

All coalitions entering information are active.

Date

Date Coalition Was First Established (i.e., this can be prior to DFC funding)

Modify

To obtain more precise data about coalition history

Total number of members who are in your coalition?

Number of paid staff?

Number of volunteer staff?

New

Obtain overall staff numbers and those who are at least partially supported by DFC funds.

Text

Coalition Leader Contact Information

Keep

Text

Name

Keep

Text

Address

Keep

Text

City

Keep

Text

State

Keep

Numeric

Zip Code

Keep

Numeric

Phone

Keep

Numeric

Fax

Keep

Numeric

Extension

Keep

Text

 Email

Keep

 

Numeric

Month and Year coalition leader took position?

New

To obtain additional leadership information.

Yes/No

Did your coalition leader change during this report period?

New

To obtain additional leadership information.

Numeric

If yes, month and year coalition leader left position?

To obtain additional leadership information.

Staff Registration (Add Individual Members)

Users need to contact KIT solutions to modify staff list.

Delete

We will obtain information on numbers of participants by sector rather than having an individual list of names.

Check one or more

Geographic Setting Served

• Urban, Suburban, Rural

Keep

Catchment areas are very important for aligning data from other public use data files.

Check one or more

Community Setting Served

• Multiple School Districts

• Single School District

• Single School

• Multiple Schools,

• Native American/American Indian/Alaskan Native Reservation

• Neighborhood

• Multiple Neighborhoods

• City

• Multiple Cities

• Town

• Multiple Towns

• County

• Region or other subsection of a State

Modify

Added a few additional responses

Yes/No

Does your coalition serve a federally-recognized tribal area?

New

This information is necessary.

Yes/No

Is your coalition headed by a religious or faith-based organization?

New

This information is necessary.

Does your coalition have at least one representative of the Bureau of Indian Affairs, the Indian Health Service, or a Tribal Government Agency with expertise in the field of substance abuse?

New

This information is necessary.

Text

Please provide a brief summary of your coalition. This is your “Elevator Speech”. Include (a) a one-sentence description of your community and target population, (b) what are your primary goals?, (c) what activities do you focus on?, (d) what have you accomplished to date, & (e) what makes your coalition unique?

New

To obtain a concise summary of each coalition.

Enter numeric values (Add as many as apply)

Target Zip Codes

Keep

Numeric

Do you serve the entire zip code?

New

Increase collection of contextual information

Text

If no, please list the specific areas served

New

Now presented earlier in this section

Check one or more

Target Gender

Keep

Check one or more

Target Grade

Keep

Multiple grades should be more easily selected. Consider the use of check boxes.

Check all that apply

Substance of Issue in the Community

• Alcohol

• Tobacco

• Marijuana

• Prescription Drugs (Adderall, Oxycontin, Ritalin, Vicodin, Other)

Stimulants (Uppers)

• Methamphetamine

• Speed

• Other

Tranquilizers

• Barbiturates

• Benzodiazepines

• GHB (Liquid G) or GBH

• Ecstasy (MDMA)

• Other

Hallucinogens

• Ketamine (Super K, Special K)

• LSD (acid)

• Mushrooms

• Mescaline, Peyote,

Over-the-Counter (OTC) drugs

Inhalants

• Glue

• Nitrites

• Spray Paint

• Other

Steroids

Rohypnol

Other

Modify

We classified drug types into a smaller number of groups to reduce respondents’ burden. We referenced other drug surveys, such as PRIDE Surveys and ADAS.

Instruction: Users will click on the broad substance categories and the list of specific names will expand for users to click/check. Within broad substance categories, drugs will be listed alphabetically.

Rank the Top 5 Substances that your coalition is targeting. This is much better than a check all that apply approach, particularly for analysis.

Program Budget

Numeric

Have you experienced any changes in your program budget or funding sources during tis reporting period?

Modify

Just moved this section up from capacity.

Numeric

What is your Coalition's total annual operating Budget?

Keep

Please specify the period that this budget covers: From XXXX To XXXX

New

For verification purposes

Numeric

Please indicate the dollar amount of your total budget for sources that support your coalition and its strategies

Keep

For reporting requirements.

Numeric

DFC Grant

Keep

Numeric

STOP Act Grant

Keep

Numeric

SPF-SIG Funding

Keep

Numeric

Other drug abuse prevention grants

Keep

Numeric

Fundraising/private donations

Keep

Numeric

Other federal government funding

Keep

Numeric

Other state government funding

Keep

Numeric

Other local government funding

Keep

Numeric

Foundations/non-profit organizations

Keep

Numeric

Private/Corporate entities

Keep

Numeric

Individual donations/Funding from fundraising events

Keep

Numeric

In-Kind contributions

Keep

Numeric

Other (please list)

Keep

Choose One

In the next 12 months do you expect your coalition's funding level to

• Increase

• Decrease

Stay about the Same

Keep

MEMBER CAPACITY SECTION

Capacity refers to the types (such as skills or technology) and levels (such as individual or organizational) of resources

that a coalition has at its disposal to meet its aims.

Coalition Membership

Choose One

Member Type

• Individual

• Organization

Delete

Entering each coalition member poses too much burden on respondents (see new proposed items below).

• Project officers need to know if coalitions are compliant with DFC regulations by including members from all 12 sectors.

• We propose that coalitions report the number of active members from the twelve sectors and then rate an average degree of involvement by each sector.

• This will provide us with quick numbers for quantity of representatives by sector and quality of involvement/participation.

Text (2,000 Character Limit)

Member Name, Either Organizational or Individual

Delete

Choose One

12 Required Sector Representatives:

• Parent

• Youth

• Business community

• Civic and volunteer group

• Healthcare professionals

• Law Enforcement agency

• Media

• Religious or fraternal organization

• School

• State, local, and/or tribal governmental agency

• Youth-serving organization

• Other organization involved in reducing substance abuse

Delete

Coalition Membership

Choose One

Membership Status (defined as attending one meeting in the past year)

• Active

• Inactive

Delete

Numeric

Total Number of Current Representatives

Delete

Numeric

Number of Representatives Active in Coalition Meetings, Activities, and Tasks

Delete

Numeric

Number of coalition meetings held during this period

New

Good context information; low burden.

Choose One

Is collaboration among members of your coalition

• Increasing

• Decreasing

• Staying the same

Keep

Numeric

Average attendance at coalition meetings (not including paid staff):

New

Good context information; low burden.

Numeric & Likert

How many coalition members represent this sector? (*Note: if a member represents more than one sector please only count them once, under that sector that represents him/her best).

How many of these coalition members are “active” (I.e., have attended at least one meeting in the past six months)?

What is the average level of involvement for each of the sectors (5=Very High to 1=Low; 0= Not Applicable)?

	# of Active members	Level of Involvement
Parent
Youth
Business community
Civic and volunteer group
Healthcare professionals
Law Enforcement agency
Media
Religious or fraternal organization
School
State, local, and/or tribal governmental agency
Youth-serving organization DFC paid staff member
Other:___

New

Numeric

Please rank up to three capacity building activities (in rank order of importance e.g., 1,2,3) that were major foci of your coalition’s efforts during the last reporting period. If you worked on more than three, please check those additional activities and events:

• Holding hearings on drug problems

• Increasing coalition membership and participation

• Building leadership capacity among coalition members

• Attaining an agreement among coalition members regarding goals, planned initiative, etc.

• Attaining funding for substance abuse prevention initiatives

• Planning/executing substance abuse initiatives

• Engaging key stakeholders (e.g., school personnel) in substance abuse prevention initiatives

• Engaging the general community in substance abuse prevention initiatives

• Developing/Executing a media plan to draw attention to new drug threats

• Engaging in research and evaluation activities

• Other:____

Modify

This section has been slightly modified to focus on the primary capacity building activities.

Ranking Top 3

COALITION PROCESS SECTION
ASSESSMENT Assessment – The systematic gathering and analysis of data to identify current assets, problems, and related conditions that require intervention.
Field Name	Data Type	Description	Keep (Keep, Delete, Modify, or New)	Rationale
Risk and Protective Factors (Users can add as many factors they choose to)			Delete	All coalitions are using the SPF framework.
	Check one	Type of risk and protective factors Risk Protective	Delete	Respondent burden is heavy. The historical DFC data shows that most coalitions have provided information; however, their data may not be complete. There is no way of knowing what really existed if the coalitions did not enter full information. Also judgment required here is highly subjective. See new proposed items below. Simplified Risk/Protective Factors and Order Them By Domain. Note: the factors were based on Hawkins & Catalano’s classification system.
	Check one	Factor to Target (For RISK factors): Community - Availability of substances that can be abused Community - Perceived acceptability (or disapproval) of substance abuse Community - Poverty Community - Transitions and mobility Community - Racism and discrimination Community - Poor family management Community - High family conflict Family - Family trauma/stress Family - Mobility of family Family - Abuse and neglect Family - Family history of antisocial behavior Family - Parental attitudes favorable to antisocial behavior	Delete
		Factor to Target (For Protective Factors): Community - Laws and policies Community - Level of community organization (e.g., less crime, less visible drug dealing) Community - Advertising and other promotion of ATOD Community - Enforcement of laws and regulations Family - Family economic resources Family - Acculturation Family - Parental monitoring and supervision Family - Family bonding Family - Opportunities for pro-social community involvement Family - Rewards for pro-social community involvement Family - Opportunities for pro-social family involvement Family - Rewards for pro-social family involvement Family - Family history of successful socialization	Delete
	Text (no limit)	Description	Delete
	Check one	Trend is (Improving, Staying the Same, Worsening, No Trend Data)	Modify and combine with the new item below.	Integrate this with the new item below. Add“No trend data” as at response (to avoid users to make a guess that is not based on trend data).
	Numeric	What are the TOP FIVE major risk factors that your coalition is targeting? Dropdowns include Community - Availability of substances that can be abused Community - Perceived acceptability (or disapproval) of substance abuse Community - Poverty Community - Transitions and mobility Community - Racism and discrimination Community - Poor family management Community - High family conflict Family - Family trauma/stress Family - Mobility of family Family - Abuse and neglect Family - Family history of antisocial behavior Family - Parental attitudes favorable to antisocial behavior Individual - Alienation and rebelliousness Individual - Friends who engage in the problem behavior Individual - Favorable attitudes towards the problem behavior Individual - Early initiation of the problem behavior School - Early and persistent antisocial behavior School - Academic failure beginning in elementary school School - Low commitment to school For each of the risk factors, is trend data during this reporting period: (3) improving, (2) staying the same, (1) getting worse, (0)vno trend data/not applicable	New and modify	This style of question will reduce respondents’ burden. It also allows users to identify priority items. We added family and individual factors to be more comprehensive than the original set of factors. Individual- and school-level factors (identified by Hawkins & Catalano) are now added.
	Numeric	What are the TOP FIVE major risk factors that your coalition is targeting? Dropdowns include: Community - Laws and policies Community - Level of community organization (e.g., less crime, less visible drug dealing) Community - Advertising and other promotion of ATOD Community - Enforcement of laws and regulations Family - Family economic resources Family - Acculturation Family - Parental monitoring and supervision Family - Family bonding Family - Opportunities for pro-social community involvement Family - Rewards for pro-social community involvement Family - Opportunities for pro-social family involvement Family - Rewards for pro-social family involvement Family - Family history of successful socialization Individual - Meaningful opportunities to contribute to the peer group Individual - Skills to successfully take advantage of those opportunities Individual - Recognition/acknowledgement of efforts School - Meaningful opportunities to contribute to the school community School - Skills to successfully take advantage of those opportunities School - Recognition/ acknowledgement of efforts For each of the risk factors, is trend data during this reporting period: (3) improving, (2) staying the same, (1) getting worse, (0) no trend data/not applicable	New and modify
	Numeric	Please rank up to three assessment activities that were the primary focus of your coalition’s efforts during the last reporting period: Planning and preparing for assessment activities Identifying coalition goals Identifying community resources Collecting NEW data for assessment purposes Collecting/analyzing pre-existing data for assessment purposes Completing a SWOT (strengths, weaknesses, opportunities, and threats) analysis Developing/revising a framework/logic model for change Other (specify):___	New	Based on analysis of prior text fields. Rank Top 3
	Text	Please report any notable accomplishments related to assessment achieved during this reporting period:____	New	AT kick-off, DFC grantees noted they wanted space to document other types of accomplishments, challenges, and activities that did not fall under explicit questions.
	Text	Please report any additional details about your assessment activities that were not captured above:___	New
Assessment Activity	Text	Activity Name	Delete	Too much burden on respondents.
	Date	Date started	Delete	Too much burden on respondents.
	Date	Date completed	Delete	Too much burden on respondents. We want to ask grantees about the degree or intensity level of DFC efforts on specific assessment activities. Dropdowns with "groupings" and have them rate how often they engaged in these activities using a Likert scale. Based on qualitative analysis of randomly selected pre-existing data, dropdown categories were created.
	Check one	Activity Status Active Inactive Planned Completed Discontinued	Delete
	Text (1,000 character limit)	Description of activity	Delete
Assessment Progress	Text (200 Character Limit)	Progress Name	Delete	Too much burden on respondents. No substantive purpose for the evaluation.
	Choose reporting period	Reporting Period Identified (2005S1, etc).	Delete	Too much burden on respondents. No substantive purpose for the evaluation. The current system lets users choose relevant reporting periods for which data are entered. The availability of this option could be confusing as respondents reach this page mostly to enter information for a current period. To avoid confusion, users should not be given an option to revisit the data entered in the earlier reporting periods. Dropdowns with "groupings" and have them rate the ‘degree to which each item was a (1) Significant Challenge to (5) Significant Accomplishment. Based on qualitative analysis of randomly selected pre-existing data, dropdown categories were created and are listed in another appendix. This will provide much more useful information for the evaluation of DFC.
	Choose one	Type Accomplishment Challenge/Barrier	Delete
	Text (3,000 Character Limit)	Description of Progress	Delete

CAPACITY - MOVED TO EARLIER SECTION OF COMET
Field Name	Data Type	Description	Keep (Keep, Delete, or New)	Rationale
Coalition Membership	Choose One	Member Type Individual Organization	Delete	Entering each coalition member poses too much burden on respondents (see new proposed items below). Project officers need to know if coalitions are compliant with DFC regulations by including members from all 12 sectors. We propose that coalitions report the number of active members from the twelve sectors and then rate an average degree of involvement by each sector. This will provide us with quick numbers for quantity of representatives by sector and quality of involvement/ participation.
	Text (2,000 Character Limit)	Member Name, Either Organizational or Individual	Delete
	Choose One	12 Required Sector Representatives: Parent Youth Business community Civic and volunteer group Healthcare professionals Law Enforcement agency Media Religious or fraternal organization School State, local, and/or tribal governmental agency Youth-serving organization Other organization involved in reducing substance abuse	Delete
	Choose One	Membership Status (defined as attending one meeting in the past year) Active Inactive	Delete
	Numeric	Total Number of Current Representatives	Delete
	Numeric	Number of Representatives Active in Coalition Meetings, Activities, and Tasks	Delete
				MOVED -

PLANNING SECTION Planning is a process of developing a logical sequence of steps that lead from individual actions to community-level drug outcomes and achievement of the coalition’s vision for a healthier community.
Field Name	Data Type	Description	Keep (Keep, Delete, or New)	Rationale
	Yes/No	Prompt coalition to upload their strategic plan and logic model (if there are changes), and current action plan.	Keep
	Yes/No	Has your coalition made any modifications to your strategic plan during this reporting period Yes No If yes, please describe:___	Modify
	Yes/No	Has your coalition made any modifications to your logic model during this reporting period Yes No If yes, please describe:___	Modify
	Yes/No	Has your coalition developed a new action plan during this reporting period? Yes No	Keep
	Text	Please report any notable accomplishments related to planning achieved during this reporting period:__	New
	Text	Please report any additional details about your planning activities that were not captured above:___	New
	Numeric (%)	Approximately what percent of overall coalition effort went into the following strategies (the total should add up to 100%) % Assessment % Capacity % Planning % Implementation % Evaluation	Modify
	Numeric (%)	Approximately what percent of overall coalition resources went into the following strategies (the total should add up to 100%) % Assessment % Capacity % Planning % Implementation % Evaluation	Modify
Goals and Objectives	Choose one	Goal Reduce substance abuse among youths and adults Establish and strengthen collaboration	Delete	Too much burden on respondents. There are two goals “Reduce substance abuse among youths and adults” and “Establish and strengthen collaboration” are specific to DFC requirements. The current data include objectives as free text information. Based on the historical data, we created dropdowns of objectives that are both frequently reported and important in light of the goals of the DFC coalitions. Objectives are currently linked to goals and strategies are linked to objectives. Risk/Protective factors are also linked to objectives. Objective is linked to core outcome measure variable. Linked to grade. Linked to gender. Linked to date. “De-link” this association given feedback on COMET – focus group and social media website indicated this not only caused substantial confusion but repetition and duplication of data entry (e.g., one strategy could be linked to multiple objectives).
	Text (200 Character Limit)	Objective Name	Delete
	Check all that apply	Strategies to Achieve Objective Providing information (e.g., community education, increasing knowledge, raising awareness) Enhancing skills (e.g., building skills and competencies) Providing support (e.g., increasing involvement in drug-free/healthy alternative activities) Enhancing access/reducing barriers (e.g., improving access, availability, and use of systems and service Changing consequences (e.g., incentives/disincentives, increasing attention to enforcement and compliance) Physical design (e.g., environmental and structural) Modifying/changing policies (e.g., changing institutional or government policies)	Delete
	Date	Date Objective Established	Delete
	Check all that apply	Link Objective to Targeted Risk Factor (Risk factors are selected earlier by respondent in the assessment section) For example: Family – Parental substance abuse Community – Cultural norms etc.	Delete
	Check all that apply	Link Objective to Targeted Protective Factor (Risk factors are selected earlier by respondent in the assessment section) For example: Community – Community attachment Community – Enforcement of laws and regulations	Delete
	Check all that apply	Link Objective to DFC Core Outcome Measure Average Age of Onset Past 30-day Use Perception of Parental Disapproval Perception of Risk or Harm	Delete
	Check all that apply	Targeted Substance Alcohol Tobacco Marijuana Amphetamines Barbiturates Cocaine (including crack) Crystal Methamphetamine MDMA (Ecstasy) GHB (liquid G) Hallucinogens (other than LSD) Heroin Hydrocodone Inhalants (including amylnitrite, cleaning fluid, gasoline, paint, and glue) Ketamine (super K) LSD Non-medical use of other prescription drugs (other than Hydrocodone, Oxycodone, Barbiturates, Amphetamines) Methamphetamine (including Ice) Narcotics other than heroin Nitrites Other Over-the-counter drugs Oxycodone PCPRohypnol (date rape drug) Steroids Tranquilizers	Delete

IMPLEMENTATION SECTION Implementation puts into motion the activities identified in the planning process.
Field Name	Data Type	Description	Keep (Keep, Delete, or New)	Rationale
Implementation Activity	Already filled	Goal	Delete	Too much burden for respondents.
	Already filled	Objective	Delete
	Choose one	Strategy (Identified earlier by respondent)	Delete
	Choose one	Activity Type. The choice depends on specific strategies taken. For example: Media campaigns Information Dissemination, Direct, face to face communication, etc.	Delete
	Text (no limit)	Brief Description of Activity	Delete
	Date	Date Started	Delete
	Date	Date Completed	Delete
	Choose one	Activity Status (Active, etc.)	Delete
	Choose one	Activity Leader (Names of Coalition Staff)	Delete
	Choose one	Scope/Reach of Activity (25% increment of target community)	Delete
Implementation Progress	Add Accomplishment or Challenge/Barrier
	Already filled	Goal	Delete
	Already filled	Objective	Delete
	Text (200 Character Limit)	Progress Name	Delete
	Choose one	Reporting Period Identified	Delete	If users need to enter historical information, they should enter the survey interface that is specific to reporting periods.
		Type Accomplishment Challenge/Barrier	Delete
	Text (3,000 Character Limit)	Description	Delete
	Numeric (percentages)	Service Mix During this reporting period… Rows include: Providing Information (e.g., community education, increasing knowledge, raising awareness) Enhancing Skills (e.g., building skills and competencies) Providing Support (e.g., increasing involvement in drug-free/healthy alternative activities) Modifying/Changing Policies (e.g., changing institutional or government policies) Changing Consequences (e.g., incentives/disincentives, increasing attention to enforcement and compliance) Enhancing Access/Reducing Barriers (e.g., improving access, availability, and use of systems and service) Physical Design (e.g., improving environmental and structural signs and areas to support the initiative) Columns include: “Rank the following implementation activities by the amount of your coalition’s …” Paid staff labor effort that was spent on each? Coalition members’ labor effort that was spent on each? Budget that was spent on each?	New	Streamlined method to capture strategy and service mix. In particular, percent effort by coalition along the 7 DFC strategies.
	Numeric, Categorical (dropdowns), Likert	Activities focused on providing information Rows include: Media campaigns: Television/Radio Media campaigns: Billboards Media campaigns: Print (4) Social networking (Facebook, Twitter, etc.) (5) Information on DFC Coalition Web site (6) Direct, face-to-face information sessions (7) Special events to heighten awareness (e.g., fairs, community celebrations) (8) Other:___ (9) Other:___ (10) Other:___ Columns include: Did your coalition use STOPACT funds to do the following? (VISIBLE ONLY TO STOP ACT GRANTEES) Number of completed activities this period (hover over cells for more information) Target substance (dropdowns) How many people did each activity reach a. Adults b. Youth (5) Primary sector responsible (dropdowns) In your opinion, how successful was this effort in preventing ATOD use (1) very successful, (2) moderately successful, (3) not successful	New	Streamlined (including for STOP ACT Grantees) approach in quantifying dosage of intervention and prevention activities.
	Numeric, Categorical (dropdowns), Likert	Activities focused on enhancing skills Rows include: Student Educational and Training Programs Student Train-the-Trainers Parent Education and Training Programs Teacher Education and Training Programs Community Member Education and Training Programs Responsible beverage service / vendor training (voluntary or mandatory) Other:___ Other:___ Other:___ Columns include: Did your coalition use STOPACT funds to do the following? (VISIBLE ONLY TO STOP ACT GRANTEES) Number of completed activities this period (hover over cells for more information) Target substance (dropdowns) How many people did each activity reach a. Adults b. Youth (5) Primary sector responsible (dropdowns) (6) In your opinion, how successful was this effort in preventing ATOD use (1) very successful, (2) moderately successful, (3) not successful	New	Capturing the activity mix (dosage) within the overarching DFC strategy. Some rows will be blacked out if they don’t apply (e.g., Student educational and training programs will be shaded for adults since this is N/A for them).
	Numeric, Categorical (dropdowns), Likert	Activities focused on providing support Rows include: Drug-free events Youth drop-in centers of clubs Youth athletic leagues Youth alternative activities (e.g., rock climbing, ropes courses, etc.) Youth support groups Parent support groups Other:___ Other:___ Other:___ Columns include: Did your coalition use STOPACT funds to do the following? (VISIBLE ONLY TO STOP ACT GRANTEES) Number of completed activities this period (hover over cells for more information) Target substance (dropdowns) How many people did each activity reach a. Adults b. Youth (5) Primary sector responsible (dropdowns) (6) In your opinion, how successful was this effort in preventing ATOD use (1) very successful, (2) moderately successful, (3) not successful	New	Capturing the activity mix (dosage) within the overarching DFC strategy. Some rows will be blacked out if they don’t apply (e.g., Youth athletic leagues will be shaded for adults since this is N/A for them).
	Numeric, Categorical (dropdowns), Likert	Activities focused on modifying/changing policies Rows include: Efforts to increase tax on alcohol or tobacco Laws/policies targeting minors in possession Laws targeting underage drinking and driving Laws targeting parents Laws targeting suppliers: Alcohol and cigarette advertising restrictions in public places Laws targeting suppliers: Responsible beverage service Laws targeting suppliers: Limitations and restrictions of location and density of alcohol outlets Laws targeting suppliers: Restrictions on methamphetamine pre-cursosr access Other:___ Other:___ Other:___ Columns include: Did your coalition use STOPACT funds to do the following? (VISIBLE ONLY TO STOP ACT GRANTEES) Number of completed activities this period (hover over cells for more information) Target substance (dropdowns) How many people did each activity reach a. Adults b. Youth (5) Primary sector responsible (dropdowns) (6) In your opinion, how successful was this effort in preventing ATOD use (1) very successful, (2) moderately successful, (3) not successful	New	Capturing the activity mix (dosage) within the overarching DFC strategy.
	Numeric, Categorical (dropdowns), Likert	Activities focused on changing consequences Rows include: Recognition program for merchants who pass compliance checks Recognize youth for staying ATOD free Increased enforcement of impaired-driving laws (e.g., sobriety checkpoihnts) Increase surveillance of areas known for illegal drug sales Party patrols “Shoulder-tap” enforcement program Compliance checks for alcohol or tobacco sales to minors Other:___ Other:___ Other:___ Columns include: Did your coalition use STOPACT funds to do the following? (VISIBLE ONLY TO STOP ACT GRANTEES) Number of completed activities this period (hover over cells for more information) Target substance (dropdowns) How many people did each activity reach a. Adults b. Youth (5) Primary sector responsible (dropdowns) (6) In your opinion, how successful was this effort in preventing ATOD use (1) very successful, (2) moderately successful, (3) not successful	New	Capturing the activity mix (dosage) within the overarching DFC strategy. Some rows will be blacked out if they don’t apply (e.g., Recognize youth for staying ATOD free will be shaded for adults since this is N/A for them).
	Numeric, Categorical (dropdowns), Likert	Activities focused on enhancing access/reducing barriers Rows include: Provide referral to treatment services Create culturally appropriate media and materials Provide alcohol merchant education in language other than English Improve access to employee assistance programs Other:___ Other:___ Other:___ Columns include: Did your coalition use STOPACT funds to do the following? (VISIBLE ONLY TO STOP ACT GRANTEES) Number of completed activities this period (hover over cells for more information) Target substance (dropdowns) How many people did each activity reach a. Adults b. Youth (5) Primary sector responsible (dropdowns) (6) In your opinion, how successful was this effort in preventing ATOD use (1) very successful, (2) moderately successful, (3) not successful	New	Capturing the activity mix (dosage) within the overarching DFC strategy. Some rows will be blacked out if they don’t apply (e.g., improve access to employee assistance programs will be shaded for youth since this is N/A for them).
	Numeric, Categorical (dropdowns), Likert	Activities focused on physical design Rows include: Conduct environmental scans Improve parks and other physical landscapes Decrease signage/advertising Improve lighting Close drug houses Reduce the density of alcohol outlets Designation of “no alcohol” or “no tobacco” zones Install surveillance cameras in drug hot spots and alcohol outlets Other:___ Other:___ Other:___ Columns include: Did your coalition use STOPACT funds to do the following? (VISIBLE ONLY TO STOP ACT GRANTEES) Number of completed activities this period (hover over cells for more information) Target substance (dropdowns) How many people did each activity reach a. Adults b. Youth (5) Primary sector responsible (dropdowns) (6) In your opinion, how successful was this effort in preventing ATOD use (1) very successful, (2) moderately successful, (3) not successful	New	Capturing the activity mix (dosage) within the overarching DFC strategy.
		Please report any notable accomplishments related to implementation achieved during this reporting period:___	New	Space for grantees to document issues, activities, challenges, and accomplishments not asked about in standardized protocol.
		Please report any additional details about your implementation activities that were not captured above:___	New

COMMUNITY AND POPULATION-LEVEL OUTCOMES Evaluation measures the quality and outcomes of coalition work. Evaluation enables the improvement of interventions and coalition practices.
Field Name	Data Type	Description	Keep (Keep, Delete, or New)	Rationale
DFC Core Outcome Measures	Choose one	Outcome Category this Data Applies to: Past 30-Day Use Perception of Parental and Peer Disapproval Perception of Harm/Risk <Other outcomes specific to a coalition> Fill in table by grade and gender, list sample size	Keep and modify	Changes have been made to core measures based upon discussion among all key stakeholders. First and foremost, prescription drugs have been added as a core measure. Additionally, age of onset has been removed. Other changes include: perception of parental disapproval remains and a peer disapproval has been added; perception of risk has been modified to address binge drinking.
	Numerical (%)	What percent of your coalition’s effort went into the following activities? % Data collection % Data Analysis % Identifying recommendations for improvement % Presentation of findings % Other	New
	Numerical (%)	What percent of your coalition’s resources went into the following activities? % Data collection % Data analysis % Identifying recommendations for improvement % Presentation evaluation findings % Other:___	New
	Choose one (Month and Year)	Compared to the Target Area (Locust Point), the Geographical Area covered by this data is Large Smaller Same	Keep
	Choose one	Source for this Data	Keep
	Choose one (Month and Year)	Month and Year data was collected	Keep
	Yes/No	Do you think that the data are representative of your target population?	New
	Yes/No	Do your data represent the same grades and same schools that were surveyed in your last report?	New
	Numeric	Enter Data by Grade	Keep and modify
	Numeric	Enter Data by Gender	Keep
	Yes/No	Did your data collection employ honesty checks?	New	To obtain an assessment of validity of data.
	Yes/No and Text	Do you have any concerns about the quality of your data? Please describe___	New	To obtain an assessment of validity of data.
	New	Please report any notable accomplishments related to evaluation achieved during this reporting period.
	New	Please report any additional details about your evaluation activities that were not captured above.
Long-Term Health Outcomes	Text	Outcome Category (School Drop Out, etc.)	Delete	Since this is part of the Logic Model, we should keep or find a better/easier way for them to report anything they may have.
	Date	Date Collected	Delete
	Choose one	Did you coalition use this data for program planning purposes? Yes No	Delete
	Text (1,000 Character Limit)	Description	Delete
Evaluation Activity	Text	Activity Name	Delete	Too much burden to enter multiple entries. See proposed new items below.
	Choose one	Type Data collection Evaluation Presentation of findings Recommendations for improvements	Delete
	Date	Date Started	Delete
	Date	Date Completed	Delete
	Choose one	Activity Status (Active, Inactive, etc.)	Delete
	Choose one	Activity Leader (A list of names)	Delete
	Text (200 Character Limit)	Progress Name	Delete
	Choose one	Reporting Period Identified	Delete
	Choose one	Type Accomplishment Challenge/Barrier	Delete
	Text (3000 Characters Limit)	Description	Delete
	Likert	CHALLENGES To what extent has your coalition experienced challenges in the following area? Increasing coalition membership and participation Building leadership capacity among coalition members Attaining an agreement among coalition members regarding goals, planned initiatives, etc. Developing/revising a framework/logic model of change Completing a SWOT (strengths, weaknesses, opportunities, and threats) analysis Collecting/analyzing dta for assessment pruposes Recruiting/engaging target populations (e.g., students) in substance abuse prevention initiatives Engaging key stakeholders (e.g., school personnel) in substance abuse prevention initiatives Engaging the general community in substance abuse prevention initiatives Planning/executing substance abuse prevention initiatives Developing/executing a media plan to draw attention to new drug threats Attaining funding for substance abuse prevention initiatives Collecting analyizing data for evaluation pruposes Other:__ Other: Other:___	New	Dropdowns with "groupings" and have them rate the ‘degree to which each item was a (4) Significant Challenge to (1) No Challenge (include a not applicable category).. This will provide much more useful information for the evaluation of DFC.
	Likert	Training and Technical Assistance (T/TA) To what extent would your coalition benefit from T/TA in each of these areas? (A great deal; Some; A little; Not at all) Coalition and partnership development Coalition and partnership maintenance Community needs and resource assessment Goal and outcome development and assessment Effective problem solving within a group setting Develop a framework or model of change Leadership development Cultural competency Organizational management Strategic planning Developing a substance abuse prevention initiatives Advocacy and policy development Grant writing Program evaluation Program/initiative sustainability Other:___		Just moving to a different place in the on-line data system. It used to be in capacity but now makes more sense to locate here.
	Check all that apply	What is your preferred method(s) for receiving training and technical assistance (T/TA)? Distance learning/web-based T/TA T/TA by telephone/teleconference In-person class, conference, or workshop (not targeted to your community) In-person class, conference, or workshop (targeted to your community) Written materials On-site/In-person T/TA T/TA by telephone T/TA by e-mail	Keep
	Yes/No & Text	Did your coalition provide any training or technical assistance to other community groups or organizations? Yes/No If yes, please describe:___
	Circle All that Apply and fill out Date	For any training or TA needs, please fill out this information. Please identify the type of technical assistance or training needed from the list below and identify the date by which it is needed: Coalition and partnership development Coalition and partnership maintenance Community needs and resource assessment Goal and outcome development and assessment Effective problem solving within a group setting Develop a framework or model of change Leadership development Cultural competency Organizational management Strategic planning Developing substance abuse prevention initiatives Advocacy and policy development Grant writing Program evaluation Program/Initiative sustainability Other (please specify)	Keep
	Text	Please describe the technical assistance or training needed.	Keep
	Circle All That Apply	Please identify the delivery mode: Distance learning/web-based T/TA T/TA by telephone/teleconference In-person class, conference, or workshop (not targeted to your community) In-person cl;ass, conference, or workshop (targeted to your community) Written materials On-site/In-person T/TA T/TA by telephone T/TA by e-mail	Keep
	Circle One	Please identify the status of the desired technical assistance or training needed. Needed Received Closed	Keep
	Circle All That Apply and insert Date	For any training or TA that has been received, please fill out this information… If received, please identify the type of technical assistance or training received from the list below and identify the date by which it is received: Coalition and partnership development Coalition and partnership maintenance Community needs and resource assessment Goal and outcome development and assessment Effective problem solving within a group setting Develop a framework or model of change Leadership development Cultural competency Organizational management Strategic planning Developing substance abuse prevention initiatives Advocacy and policy development Grant writing Program evaluation Program/Initiative sustainability Other (please specify)	keep
	Text	Please describe the technical assistance or training received?	Keep
	Circle One	Please identify the delivery mode received: Distance learning/web-based T/TA T/TA by telephone/teleconference In-person class, conference, or workshop (not targeted to your community) In-person class, conference, or workshop (targeted to your community) Written materials On-site/In-person T/TA T/TA by telephone T/TA by e-mail	Keep
	Circle All That Apply	Please identify the source of receive technical assistance or training needed CADCA’s National Coalition Institute DFC Project Officer (SAMHSA) State Agency Local Agency (e.g., peer coalitions, local United Way) My coalition	Keep
	Likert	How satisfied were you with the assistance you received? Very satisfied Satisfied Neutral Dissatisfied Very dissatisfied	Keep
	Text	Optional: Please explain how assistance can be improved.	Keep

2