Attachment 4:
Proposed Changes to Drug-Free Communities Progress Report and Core Measures
Bi-Annual
Progress Report
Mock Up
OMB
Control Number: 3201-0012; Expiration Date: 1/31/2019
The public reporting burden for each Progress Report is estimated to be 5 hours. To help ensure minimum reporting burden on grant award recipients, ongoing technical assistance is available from [email protected] to address problems or issues in real-time. Send comments regarding the accuracy of this burden estimate and any suggestions for reducing the burden to: U.S. Office of Personnel Management, Federal Investigative Services, Attn: OMB Number (3201-0012), 1900 E Street NW, Washington, DC 20415-7900. You are not required to respond to this collection of information unless a valid OMB control number is displayed."
Summary of Proposed Changes to the
Drug-Free Communities Progress Report
Summary of proposed changes:
Modified wording of various items to clarify language, align with CADCA or other entities’ preferred language, or split items to differentiate between previously combined responses (e.g., Prescription vs. Non-prescription opioids, risks and protective factors)
Added new items:
to identify coalitions working with HIDTA and/or receiving CARA-ALDC grants
to allow ONDCP to connect with coalitions on social media outlets
to capture congressional districts served by the coalition
to give coalitions the opportunity to provide more information about work with specific populations (i.e., youth coalitions; American Indians or Alaska Natives)
to identify lead and key partner sectors
to capture more information or likely common responses based on previously submitted open-ended responses or other lessons learned from field
to provide additional data if available or applicable:
Specific efforts to educate and inform regarding policy changes accomplished by coalition activities/efforts
Specific accomplishments and challenges related to each of the seven strategies
Types of funding received
Additional sectors represented in the coalition to provide more information on how coalitions are building capacity building
Core Measures for Heroin and Methamphetamines, if available
Strategies engaged in by coalitions if addressing Local Drug Crisis (e.g., opioids, CARA-ALDC), if applicable. This also includes addressing vaping based on feedback from DFC coalitions.
Split open ended text items to differentiate clearly between accomplishments and challenges in coalition activities
Deleted items that:
are now automatically populated (e.g., coalition name, zip codes served) or calculated (budget total) in DFC Me system
did not bring additional information in previous data submissions (e.g., other substances targeted)
were often difficult for coalitions to provide (e.g., Core Measures by gender)
COALITION STRUCTURE AND PROCESSES SECTION |
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Coalition Information |
Proposed Changes |
Grant Award Recipient Name: _______________________ Award Number: ____________________ Coalition Name: _______________________ Year of First DFC Award: _______ (Note: these fields will be auto-populated) Month and year the coalition was first established: ___/___
If your coalition is a SPF/SIG subrecipient, please enter your grant number.
If your coalition is a STOP Act grant award recipient, please enter your grant number.
Does your coalition actively work with a local High Intensity Drug Trafficking Areas (HIDTA) Program?
Has your coalition been awarded the Community-based Coalition Enhancement Grant to Address Local Drug Crises (CARA-ALDC) grant from ONDCP to combat opioid use? If your coalitions is a CARA recipient, please enter your grant number.
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Project Coordinator Contact Information: Name: (Note: this field will be auto-populated and cannot be changed without approval from your SAMHSA Project Officer) Title: (Note: this field will be auto-populated and cannot be changed without approval from your SAMHSA Project Officer) Address: (Note: this field will be auto-populated and cannot be changed without approval from your SAMHSA Project Officer) Phone: (Note: this field will be auto-populated and cannot be changed without approval from your SAMHSA Project Officer) Email: (Note: this field will be auto-populated and cannot be changed without approval from your SAMHSA Project Officer) Month and year Project Coordinator took current position: ____/_____ Did your project coordinator change during this reporting period?
If yes, please provide the month and year your previous Project Coordinator left the position: ____/_____ |
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Please provide your coalition’s social media contact information for the following, if applicable: Twitter handle: ____________________ Facebook page/URL: ______________________ Instagram handle: _________________________ |
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Is your coalition headed by a religious or faith-based organization?
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Please provide a brief summary of your coalition. This is your "Elevator Speech". Consider including a brief sentence on: (a) your community and target population, (b) your primary goals, (c) the activities you are focusing on, (d) accomplishments to date, (e) successes concerning goal achievement, f) challenges in goal achievement, and g) things that make your coalition unique (2,000 character max). |
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Needs Assessment Needs Assessment refers to the decisions your coalition has made concerning the major problems upon which you want to focus, the major community areas and populations you want to serve, and the reasons that these priorities were established. In addition, needs assessment refers to the ways you have collected data, or assessed the community’s concern to establish these priorities. |
Proposed Changes |
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Geographic setting(s) served (check all that apply):
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Community setting(s) served (check all that apply): |
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Is your coalition located in or serve a federally-recognized tribal area?
Do you target information/prevention efforts specifically to American Indians or Alaska Natives?
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Does your coalition have at least one (1) representative from the Bureau of Indian Affairs, the Indian Health Service, or a Tribal Government Agency with expertise in the field of substance use prevention?
Briefly describe your work with the American Indian or Alaska Native population, including any challenges you may have faced in serving this population. If you are located within a federally-recognized tribal area but are not serving this population, please explain why. |
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Do you target at least some information/prevention efforts to a specific minority group or minority groups?
If yes, please specify (check all that apply):
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Grade level(s) served (check all that apply): |
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No Change |
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Please select up to five (5) substances that your coalition is targeting in your community: |
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Target Zip Codes Note: You may either enter each zip code individually OR upload an Excel file of zip codes served. You DO NOT need to submit the file AND enter each zip code individually. In order to enter the zip codes as a file, you MUST use the provided Excel file template. |
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Zip Code Served |
Do you serve the entire zip code? (Dropdown: Yes/No) |
If no, please list the specific areas served (e.g., names of neighborhoods, school districts, etc.) |
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Please review the zip code(s) served by your coalition: (information will be pre-populated by system)
Is/are the zip code(s) listed above correct?
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Note: please look up congressional district by entering your information here: https://www.house.gov/representatives/find-your-representative What is the congressional district associated with the address/zip code(s) in which your coalition is located?
What is/are the congressional district associated with the address/zip code(s) served by your coalition?
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Coalition Budget |
Proposed Changes |
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Please specify the period that this budget covers: From: mm/dd/yyyy To: mm/dd/yyyy (Note: Typically one fiscal year, but may represent only part of the year (e.g., if new funding added). May be longer than one year if grant award recipient received an extension.) |
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What is your coalition’s total annual operating budget? ______________ |
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What dollar amount of
your total operating budget comes from each of the following
funding sources? |
Dollar Amount (Note: Be sure the amount the system calculates as your total budget reflects your actual current total annual operating budget.) |
Percentage (Note: The system will automatically calculate percentages.) |
Minor Change to Note |
DFC grant |
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No Change |
STOP Act grant |
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No Change |
SPF-SIG funding |
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No Change |
CARA-ALDC |
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Other federal government funding |
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No Change |
Other state government funding |
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No Change |
Other local government funding |
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No Change |
Foundation/Non-profit organizations |
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No Change |
Private/Corporate entities |
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No Change |
Individual donations/Funding from fundraising events |
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No Change |
In-Kind contributions |
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No Change |
Other (if applicable, please specify up to one other funding source) _____________________ |
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No Change |
TOTAL Annual Budget |
Note: The system will automatically calculate this number based on what the grant award recipient enters above. |
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In the next 12 months do you expect your coalition's funding level to:
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No Change |
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Please provide any information relevant to understanding your expectations regarding your coalition's funding level. Please note funding uncertainties, opportunities, or other information relevant for understanding your coalition's future funding (2,000 character max).
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No Change |
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Please share any additional information about the relevant types of “other” federal, state, and local funding your coalition has received.
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MEMBER CAPACITY SECTION Capacity
refers to the types (such as skills or technology) and levels
(such as individual or |
Proposed Changes |
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Membership |
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Number of formal coalition meetings held during this period (This is the number of meetings that involve the full coalition plus the number of additional meetings that involve conducting important coalition business, e.g., subcommittee meetings.): __________ Average
attendance at coalition meetings (not including paid staff.
Volunteer staff should only be included if they are attending as a
sector member): |
Is collaboration among members of your coalition (Note: Think about the level of participation in coalition decisions, joint activities, and other collaborative interactions in your prior reporting period relative to now.):
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No Change |
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Total number of members participating in your coalition:____________ (Note: This number should include all members plus all staff (paid and volunteer).) Number of paid staff: _________ (Note: Number of staff with salaries funded partially or fully through the DFC grant.) Number
of (Note: Number of unpaid staff that contribute significantly to coalition work.) |
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Does your coalition host a youth coalition that meets separately? (Note: A youth coalition is a group of youth who work together to plan and implement activities related to the mission of the full coalition. An adult coalition member serves as a mentor or leader, but the youth have key leadership roles. The youth coalition is integral to the full coalition, but generally meets independently.)
If yes, how often did the youth coalition meet over the last six months?
What is the average level of involvement of the youth coalition in planning prevention activities with youth?
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If the coalition hosts a youth coalition, briefly describe the youth coalition’s work over the past six months. How/to what extent has the youth coalition helped to meet your coalition goals and to engage youth in the coalition? (Maximum of 2,000 characters with spaces):
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Sectors |
How many coalition members represent this sector? (Note: A person can be counted as representing the sector if they provide any support to the coalition. They do not need to have been active in the past six months, but they do need to be available to the coalition if needed. Do not count everyone working for a partner organization if they are not directly involved in coalition activities. If an individual member represents more than one sector (e.g., police officer who is also a parent), choose the sector they represent in an official capacity) |
How many of these coalition members are “active”? (Note: Members should only be counted as active if they have attended a meeting, participated in planning/ implementing a coalition event, or provided some type of support to the coalition in the past six months.) |
What is the average level
of involvement |
No Change |
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Very High |
High |
Medium |
Low |
Very Low |
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Parents |
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No Change |
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Youth |
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No Change |
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Business Community |
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No Change |
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Civic/Volunteer Groups |
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No Change |
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Healthcare Professionals |
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No Change |
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Law Enforcement Agency |
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No Change |
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Media |
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No Change |
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Religious/Fraternal Organizations |
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No Change |
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Schools |
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No Change |
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State, Local, and/or Tribal Government Agencies with Expertise in Substance Abuse |
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No Change |
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Youth-Serving organizations |
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No Change |
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Other Organization with Expertise in Substance Abuse (please specify the organization) ___________________ |
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What is being done to increase membership generally? Specifically, what is being done to increase membership in the sectors not represented or with no active members? (Maximum of 2,000 characters with spaces)
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Please share any information about any additional or unusual sector members that your coalitions has brought into the coalition over the last six months (e.g., youth coalition members, realtors, athletic coaches, waste management). These members should be included in the count above. Here you can share any relevant information about who the coalition is working with, how that came about, and how that has increased capacity. (Maximum of 2,000 characters with spaces) |
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Member Roster (Note: Please enter a roster of all individuals and organizations involved in your coalition. You may either enter each member individually below OR you may upload a member roster file. You DO NOT need to submit the file AND enter each member individually. In order to enter the roster as a file, you MUST use the provided Excel file template.) |
Proposed Changes |
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First Name (Note: If entering an organization enter organization name in last name and leave first name blank.) |
Last Name (Note: If entering an organization enter organization name in last name and leave first name blank.) |
Type (Note: You will select either individual or organization from drop down list.) |
Sector (Note: Select from drop down: list of sectors. If you select “other” you will be asked to specify.) |
Status (Note: Select from drop down menu if individual/organization is an active or inactive member of the coalition.) |
No Change |
Note: You will be able to enter as many members as needed. |
No Change |
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Capacity Building Activities Capacity building activities include any efforts explicitly designed to improve the ability of the coalition to successfully assess needs, plan, make decisions, implement effective activities, evaluate, improve, and sustain coalition functioning. |
Proposed Changes |
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Please select up to three (3) capacity building activities that were the main focus of your coalition’s efforts during the last reporting period: |
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Please report any notable accomplishments related to capacity building activities achieved during this reporting period. (Maximum of 2,000 characters with spaces):
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Please report any additional details, including barriers or challenges, about your capacity building activities that were not captured above, but are relevant to understanding your coalition’s activities/outcomes. (Maximum of 2,000 characters with spaces):
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COALITION PROCESSES SECTION |
Proposed Changes |
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Risks and Protective Factors |
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Risk Factors Risk factors are characteristics of community, individuals, families, schools or other circumstances that increase the likelihood or difficulty of mitigating substance use and its associated harms. Prevention activities often focus on reducing risk factors that are perceived to be particularly important in a community. |
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Select the major risk factors that your coalition is targeting. (Note: Select all that apply.) |
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Community Factors
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No Change |
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No Change |
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Individual Factors
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No Change |
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Family Factors
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No Change |
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No Change |
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School Factors
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No Change |
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No Change |
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Other (please specify)
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No Change |
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Protective Factors Protective factors are characteristics of a community, individuals, families, schools or other circumstances that decrease the likelihood of substance use and its associated harms. Prevention activities often focus on strengthening protective factors that are perceived to be particularly important in a community. |
No Change |
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Select the major protective factors that your coalition is targeting. (Note: Select all that apply.) |
No Change |
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Community Factors
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No Change |
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No Change |
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No Change |
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No Change |
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Family Factors
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No Change |
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No Change |
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No Change |
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No Change |
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Individual Factors
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No Change |
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No Change |
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School Factors
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No Change |
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No Change |
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No Change |
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Other (please specify) Coalition can enter free-form text |
No Change |
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Please report any additional details about your risk factors that were not captured above (Maximum of 2,000 character with spaces):
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Please report any additional details about your protective factors that were not captured above (Maximum of 2,000 character with spaces):
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Assessment Activities Assessment - The systematic gathering and analysis of data to identify current assets, problems, and related conditions that require intervention. |
Proposed Changes |
Please select up to three (3) assessment activities that were the main focus of your coalition’s efforts during the last reporting period:
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Please report any notable accomplishments related to assessment activities achieved during this reporting period (Maximum of 2,000 character with spaces):
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No Change |
Please report any additional details, including barriers or challenges, about your assessment activities that were not captured above (Maximum of 2,000 character with spaces):
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No Change |
PLANNING SECTION Planning
is a process of developing a logical sequence of steps that lead
from individual actions |
Proposed Changes |
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Planning Activities Note: Coalitions will be prompted to upload their strategic plan, logic model, and action plans. Anytime you change any of these documents, a new file should be uploaded. |
No Change |
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Has your coalition made any modifications to your sustainability plan during this reporting period?
If yes, please describe: _______________________________ |
Has your coalition made any modifications to your Logic Model(s) during this reporting period?
If yes, please describe: ____________________________ |
Has your coalition developed a new 12-month action plan during this reporting period?
If yes, please describe: _______________________________ |
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Please report any notable accomplishments related to planning activities achieved during this reporting period (Maximum of 2,000 characters with spaces):
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No Change |
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Please report any additional details, including barriers or challenges, about your planning activities that were not captured above (Maximum of 2,000 characters with spaces): |
No Change |
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Summary of Effort: Coalition Processes |
No Change |
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Approximately what percent of overall coalition effort went into each of the following processes? (Note: Total is automatically calculated by the system and must sum to 100%) ___% Assessment ___% Capacity ___% Planning ___% Implementation ___% Evaluation |
No Change |
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Approximately what percent of overall coalition resources went into each of the following processes? (Note: Total must sum to 100%) ___% Assessment ___% Capacity ___% Planning ___% Implementation ___% Evaluation |
No Change |
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IMPLEMENTATION SECTION Implementation puts into motion the activities identified in the planning process. In this section, grant award recipients will first rank their level of effort related to each of the seven strategies. Then, for each strategy, grant award recipient will be asked to describe the types of activities engaged in during the reporting period. |
Proposed Changes |
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Implementation Strategies During this Reporting Period . . . |
Minor Change: Note that grantee changed to grant award recipient throughout |
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Implementation Strategies
(Note: These categories apply to both capacity building in the community (supporting programs to do these things) as well as direct actions.) |
Rank the implementation strategies by the amount of your coalition's paid staff labor effort that was spent on each: |
Rank the implementation strategies by the amount of your coalition members’ labor effort that was spent on each: |
Rank the implementation strategies by the amount of your coalition's budget that was spent on each: |
No Change |
Providing Information (e.g., community education, increasing knowledge, raising awareness) |
Drop down of ranks (1=Most Effort to 7=Least Effort), plus an Option for Not Applicable (no effort expended) |
Drop down of ranks (1=Most Effort to 7=Least Effort), plus an Option for Not Applicable (no effort expended) |
Drop down of ranks (1=Most Budget to 7=Least Budget), plus an Option for Not Applicable (no money expended) |
No Change |
Enhancing Skills (e.g., building skills and competencies) |
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No Change |
Providing Support (e.g., increasing involvement in drug-free/healthy alternative activities) |
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No Change |
Enhancing Access/Reducing Barriers (e.g., improving access, availability, and use of systems and services) |
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No Change |
Changing Consequences (e.g., incentives/disincentives, increasing attention to enforcement and compliance) |
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No Change |
Physical Design (e.g., improving environmental and structural signs and areas to support the initiative) |
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No Change |
Educating/Informing about Modifying/Changing Policies (e.g., changing institutional or government policies) |
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Strategy Activity Details: Providing Information |
Proposed Changes |
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Activities focused on Providing Information |
Did your coalition work on this activity during this reporting period? (if coalition selects ‘yes’ they are shown the other items) |
Did your coalition use STOP Act funds to support the following new or enhanced activities? |
Number of completed activities this period |
Target Substance(s) Select all that apply: Alcohol, Tobacco, Marijuana, Prescription Drugs (Opioids), Prescription Drugs (Non-Opioids), Heroin, Other Substance, No Substance Specified |
How many people did this activity reach? |
Sector(s) contributing to this activity Select all that apply: list of sectors, includes options for Paid/Unpaid Staff/ Accomplishment |
In your opinion, how successful was this effort? Drop down: (1) very successful; (2) moderately successful; (3) not successful |
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Adults |
Youth |
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No Change |
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Media campaigns: Television/radio/print/billboards/bus or other posters |
Yes No |
Yes No |
Number of independent spots/ads aired or placed during this reporting period. |
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Not applicable for this activity |
Not applicable for this activity |
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No Change |
Media coverage : TV/radio/newspaper stories |
Yes No |
Yes No |
Number of media stories appearing this reporting period. |
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Not applicable for this activity |
Not applicable for this activity |
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No Change |
Informational materials prepared/produced |
Yes No |
Yes No |
Number of press releases, brochures, flyers, posters, audiovisual products prepared/produced during this reporting period. |
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Not applicable for this activity |
Not applicable for this activity |
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No Change |
Informational materials disseminated |
Yes No |
Yes No |
Number of brochures, flyers, posters, audio visual products distributed during this reporting period. |
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No Change |
Social networking (Facebook, Twitter, etc.) |
Yes No |
Yes No |
Number of posts on social media sites during reporting period. |
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Adult Facebook Friends, Twitter Followers, etc. |
Youth Facebook Friends, Twitter Followers, etc. |
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No Change |
Information on Coalition website |
Yes No |
Yes No |
Number of new materials posted during this reporting period. |
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Number of web hits. |
Not applicable for this activity |
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Direct, face-to-face information sessions |
Yes No |
Yes No |
Number of educational presentations, workshops, seminars, town hall meetings held during this reporting period. Only include sessions to provide general information. Training sessions will be covered in the next strategy. |
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Number of adults in audience |
Number of youth in audience |
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No Change |
Special events (e.g., fairs, community celebrations) |
Yes No |
Yes No |
Number of events that your coalition participated in during this reporting period. These events could be either run by your coalition or your coalition could participate in them. |
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Approximate adult attendance at events |
Approximate youth attendance at events |
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No Change |
Other (please specify): (NOTE: Able to add up to three “other” activity rows) |
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No Change |
Indicate the average level of contribution that coalition paid/unpaid staff made to activities involving Providing Information: Completely responsible for most activities Typically takes lead with help from coalition members Typically does not take lead, but helps coalition members Minimally involved: coalition members take on most responsibilities |
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Please provide a brief overview of any notable accomplishments related to Providing Information activities that you achieved during this reporting period (Maximum of 2,000 character with spaces):
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Please provide a brief overview of any challenges related to Providing Information activities that you experienced during this reporting period (Maximum of 2,000 character with spaces):
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Strategy Activity Details: Enhancing Skills |
Proposed Changes |
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Activities focused on Enhancing Skills |
Did your coalition work on this activity during this reporting period? |
Did your coalition use STOP Act funds to support the following new or enhanced activities? |
Number of completed activities this period |
Target Substance(s) Select all that apply: Alcohol, Tobacco, Marijuana, Prescription Drugs (Opioids), Prescription Drugs (Non-Opioids), Heroin, Other Substance, No Substance Specified |
How many people did this activity reach? (Do not double count participants if attended more than one session) |
Sector(s) contributing to this activity Select all that apply: list of sectors, includes option for N/A: Paid/Unpaid Staff Accomplishment |
In your opinion, how successful was this effort? Drop down: (1) very successful; (2) moderately successful; (3) not successful |
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Adults |
Youth |
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No Change |
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Youth Education and Training Programs |
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Number of sessions delivered of programs focusing on information/skills for youth. |
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Not applicable for this activity |
Number of youth receiving training (do not double count if youth attended more than one session) |
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No Change |
Parent Education and Training Programs |
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Number of training sessions on drug awareness, prevention strategies, or parenting skills specifically for parents. |
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Number of Parents trained (do not double count if parent attended more than one session) |
Not applicable for this activity |
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No Change |
Teacher/Youth Worker Education and Training Programs |
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Number of training sessions on drug awareness and prevention strategies specifically for teachers/youth workers. |
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Number of teachers/youth workers trained (do not double count if participant attended more than one session) |
Not applicable for this activity |
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No Change |
Community Member Education and Training Programs |
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Number of training sessions on drug awareness, prevention strategies, or cultural competence for community members, including law enforcement, media, and landlords. |
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Number of community members trained (do not double count if community member attended more than one session)
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Not applicable for this activity |
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No Change |
Business Training (e.g., responsible beverage service/vendor training [voluntary or mandatory]) |
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Number of training sessions delivered on server compliance, training on youth marketed alcohol products, tobacco sales, etc. |
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Number of people trained (do not double count if participant attended more than one session) |
Not applicable for this activity |
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No Change |
Other (please specify): (NOTE: Able to add up to three “other” activity rows) |
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No Change |
Indicate the average level of contribution that coalition paid/ unpaid staff made to activities involving Enhancing Skills: Completely responsible for most activities Typically takes lead with help from coalition members Typically does not take lead, but helps coalition members Minimally involved; coalition members take on most responsibilities
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Please provide a brief overview of any notable accomplishments related to Enhancing Skills activities that you achieved during this reporting period (Maximum of 2,000 character with spaces):
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Please provide a brief overview of any challenges related to Enhancing Skills activities that you experienced during this reporting period (Maximum of 2,000 character with spaces):
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Strategy Activity Details: Providing Support |
Proposed Changes |
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Activities focused on Providing Support |
Did your coalition work on this activity during this reporting period?
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Did your coalition use STOP Act funds to support the following new or enhanced activities? |
Number of completed activities this period |
Target Substance(s) Select all that apply: Alcohol, Tobacco, Marijuana, Prescription Drugs (Opioids), Prescription Drugs (Non-Opioids), Heroin, Other Substance, No Substance Specified |
How many people did this activity reach? |
Sector(s) contributing to this activity Select all that apply: list of sectors, includes option for N/A: Paid Staff/Volunteer Accomplishment |
In your opinion, how successful was this effort? Drop down: (1) very successful; (2) moderately successful; (3) not successful |
|
|
Adults |
Youth |
||||||||
Alternative/drug-free social events |
|
|
Number of drug-free parties, other events supported by coalition |
|
Number of adult attendees not part of coalition |
Number of youth attendees |
|
|
No Change |
Youth organizations/drop-in centers |
|
|
Number of clubs (after-school or other) and centers supported by your coalition. "Support" can be in the form of financial, labor, or in-kind assistance. |
|
Number of adults belonging to clubs or centers |
Number of youth belonging to clubs or centers |
|
|
No Change |
Organized youth recreation programs (e.g., athletics, arts, outdoor activities) |
|
|
Number of programs supported by coalition |
|
Number of adults this activity reached |
Number of program participants |
|
|
No Change |
Youth/family community involvement (e.g., school or neighborhood cleanup) |
|
|
Number of community involvement events held |
|
Number of adults this activity reached |
Number of youth this activity reached |
|
|
No Change |
Youth/family support groups |
|
|
Number of groups (e.g., leadership groups, mentoring programs, youth employment programs) |
|
|
Number of youth participants, including number of peer mentors (do not double count if attended multiple groups or sessions) |
|
|
No Change |
Other (please specify): (NOTE: Able to add up to three “other” activity rows) |
|
|
|
|
|
|
|
|
No Change |
Indicate the average level of contribution that coalition paid/ unpaid staff made to activities involving Providing Support: Completely responsible for most activities Typically takes the lead with help from coalition members Typically does not take lead, but helps coalition members Minimally involved; coalition members take on most responsibilities
|
|
||||||||
Please provide a brief overview of any notable accomplishments related to Providing Support activities that you achieved during this reporting period (Maximum of 2,000 character with spaces):
|
|
||||||||
Please provide a brief overview of any challenges related to Providing Support activities that you experienced during this reporting period (Maximum of 2,000 character with spaces):
|
|
||||||||
Strategy Activity Details: Enhancing Access/Reducing Barriers |
Proposed Changes |
|||||||
Activities focused on Enhancing Access/Reducing Barriers |
Did your coalition work on this activity during this reporting period? |
Did your coalition use STOP Act funds to support the following new or enhanced activities? |
Target Substance(s) Select all that apply: Alcohol, Tobacco, Marijuana, Prescription Drugs (Opioids), Prescription Drugs (Non-Opioids), Heroin, Other Substance, No Substance Specified |
How many people did this activity reach? |
Sector(s) contributing to this activity Select all that apply: list of sectors, includes option for N/A: Paid Staff/ Volunteer Accomplishment |
In your opinion, how successful was this effort? Drop down: (1) very successful; (2) moderately successful; (3) not successful |
|
|
Adults |
Youth |
|||||||
Increased Access to Substance Use Services (e.g., court mandated services, assessment and referral, EAPs, SAPs) |
|
|
|
Number of adults served, referred to treatment, involved in EAPs |
Number of youth served, referred to treatment, involved in SAPs |
|
|
No Change |
Reducing Home and Social Access (e.g., prescription drug disposal) |
|
|
|
Number of adults participating |
Number of youth participating |
|
|
No Change |
Improve supports for service use (e.g., transportation, child care) |
|
|
|
Number of adults activity reached |
Number of youth activity reached |
|
|
No Change |
Improve access through culturally sensitive outreach (e.g., multilingual materials) |
|
|
|
Number of adults targeted (this may be double-counted with entries for Providing Information) |
Number of youth targeted (this may be double-counted with entries for Providing Information) |
|
|
No Change |
Other (please specify): (NOTE: Able to add up to three “other” activity rows) |
|
|
|
|
|
|
|
No Change |
Indicate the average level of contribution that coalition paid/ unpaid staff made to activities involving Enhancing Access/Reducing Barriers: Completely responsible for most activities Typically takes lead with help from coalition members Typically does not take lead, but helps coalition members Minimally involved; coalition members take on most responsibilities |
|
|||||||
Please provide a brief overview of any notable accomplishments related to Enhancing Access/Reducing Barriers activities that you achieved during this reporting period (Maximum of 2,000 character with spaces):
|
|
|||||||
Please provide a brief overview of any challenges related to Enhancing Access/Reducing Barriers activities that you experienced during this reporting period (Maximum of 2,000 character with spaces):
|
|
|||||||
Strategy Activity Details: Changing Consequences |
Proposed Changes |
||||||
Activities focused on Changing Consequences |
Did your coalition work on this activity during this reporting period? |
Did your coalition use STOP Act funds to support the following new or enhanced activities? |
Target Substance(s) Select all that apply: Alcohol, Tobacco, Marijuana, Prescription Drugs (Opioids), Prescription Drugs (Non-Opioids), Heroin, Other Substance, No Substance Specified |
How many businesses did each activity reach? |
Sector(s) contributing to this activity Select all that apply: list of sectors, includes option for N/A: Paid Staff/Volunteer Accomplishment |
In your opinion, how successful was this effort? Drop down: (1) very successful; (2) moderately successful; (3) not successful |
|
Strengthening Enforcement (e.g., supporting DUI checkpoints, shoulder tap programs, open container laws) |
|
|
|
Not applicable for this activity |
|
|
No Change |
Strengthening Surveillance (e.g., monitoring “hot spots,” party patrols) |
|
|
|
Not applicable for this activity |
|
|
No Change |
Recognition programs (e.g., programs for merchants who pass compliance checks, drug-free youth) |
|
|
|
Number of businesses receiving recognition for compliance |
|
|
No Change |
Publicize Non-Compliance (e.g., advertisements highlighting businesses not compliant with local ordinances) |
|
|
|
Number of businesses highlighted for non-compliance |
|
|
No Change |
Other (please specify): (NOTE: Able to add up to three “other” activity rows) |
|
|
|
|
|
|
No Change |
Indicate the average level of contribution that coalition paid/ unpaid staff made to activities involving changing consequences: Completely responsible for most activities Typically takes lead with help from coalition members Typically does not take lead, but helps coalition members Minimally involved: coalition members take on most responsibilities |
|
||||||
Please provide a brief overview of any notable accomplishments related to Changing Consequences activities that you achieved during this reporting period (Maximum of 2,000 character with spaces):
|
|
||||||
Please provide a brief overview of any challenges related to Changing Consequences activities that you experienced during this reporting period (Maximum of 2,000 character with spaces):
|
|
||||||
Strategy Activity Detail: Physical Design |
Proposed Changes |
||||||
Activities focused on Physical Design |
Did your coalition work on this activity during this reporting period? |
Did your coalition use STOP Act funds to support the following? |
Number of completed activities this period |
Target Substance(s) Select all that apply: Alcohol, Tobacco, Marijuana, Prescription Drugs (Opioids), Prescription Drugs (Non-Opioids), Heroin, Other Substance, No Substance Specified |
Sector(s) contributing to this activity Select all that apply: list of sectors, includes option for N/A: Paid Staff/Volunteer Accomplishment |
In your opinion, how successful was this effort? Drop
down: (1) very successful; |
|
Identify Physical Design Problems (e.g., environmental scans, neighborhood meetings, windshield surveys) |
|
|
Number of physical design problems (e.g., hot spots, clean up areas, outlet clusters) identified this period. |
|
|
|
No Change |
Cleanup and Beautification (e.g., Improve parks and other physical landscapes, neighborhood clean-ups) |
|
|
Number of cleanup / beautification events held this period (e.g., neighborhood cleanup days) |
|
|
|
No Change |
Improve visibility/ease of surveillance in public places and substance use hotspots (e.g., improved lighting, surveillance cameras, improved lines of sight) |
|
|
Number of areas (public places/hot spots) in which surveillance/visibility was improved this period. |
|
|
|
No Change |
Promote improved signage/advertising/practices by suppliers (e.g., Decrease signage or advertising , change product locations) |
|
|
Number of suppliers making changes in signage/advertising/displays this period. |
|
|
|
No Change |
Identify problem establishments for closure (e.g., close drug houses) |
|
|
Number of problem establishments closed/modified practices |
|
|
|
No Change |
Encourage business/supplier designation of “no alcohol,” “no tobacco,” or “no marijuana” zones |
|
|
Number of businesses that made changes |
|
|
|
|
Other (please specify): (NOTE: Able to add up to three “other” activity rows) |
|
|
|
|
|
|
No Change |
Indicate the average level of contribution that coalition paid/ unpaid staff made to activities involving Physical Design: Completely responsible for most activities Typically takes lead with help from coalition members Typically does not take lead, but helps coalition members Minimally involved: coalition members take on most responsibilities
|
|
||||||
Please provide a brief overview of any notable accomplishments related to Physical Design activities that you achieved during this reporting period (Maximum of 2,000 character with spaces):
|
|
||||||
Please provide a brief overview of any challenges related to Physical Design activities that you experienced during this reporting period (Maximum of 2,000 character with spaces):
|
|
||||||
Strategy Activity Detail: Educating/Informing about Modifying/Changing Policies |
Proposed Changes |
|
|||||||||
Activities focused on Educating/Informing about Modifying/Changing Policies |
Did your coalition work on this activity during this reporting period? |
Did your coalition use STOP Act funds to support the following new or enhanced activities? |
Number of policies or laws your coalition was active in informing or educating this reporting period |
Number of Policies or Laws Passed/Modified During This Period |
Target Substance(s) Select all that apply: Alcohol, Tobacco, Marijuana, Prescription Drugs (Opioids), Prescription Drugs (Non-Opioids), Heroin, Other Substance, No Substance Specified |
Sector(s) contributing to this activity Select all that apply: list of sectors, includes option for N/A: Paid Staff/ Volunteer Accomplishment |
In your opinion, how successful was this effort? Drop down: (1) very successful; (2) moderately successful; (3) not successful |
|
|
|
|
Cost: Laws/public policies concerning cost (e.g., alcohol, tobacco, or marijuana tax, fees) |
|
|
Number of laws or policies concerning cost incentives you actively informed or helped educate during this reporting period |
Number of laws passed or modified this period concerning cost incentives |
|
|
|
|
|
|
|
Underage Use: Laws/public policies targeting use, possession, or behavior under the influence for minors |
|
|
Number of laws or public policies you actively informed or helped educate concerning underage use, possession, or behavior under the influence (e.g., underage consumption, false identification laws, blood alcohol concentration, graduated driver’s licenses, loss of driving privileges for alcohol violations by minors) |
Number of laws passed or modified this period concerning underage use, possession, or behavior under the influence (e.g., underage consumption, false identification laws, blood alcohol concentration, graduated driver’s licenses, loss of driving privileges for alcohol violations by minors) |
|
|
|
No Change |
|
|
|
School: Policies promoting drug-free schools |
|
|
Number of laws or policies concerning drug-free schools you actively informed or helped educate this period. Do not include policies focused on underage use/possession that were covered above. |
Number of laws or policies concerning drug-free schools passed or modified during this period. Do not include policies focused on underage use/possession that were covered above |
|
|
|
No Change |
|
|
|
Treatment/Prevention: Laws/public policies promoting treatment or prevention alternatives (e.g., diversion treatment programs for underage substance use offenders) |
|
|
Number of laws or public policies concerning availability and sentencing alternatives to increase treatment/prevention you actively informed or helped educate this period. |
Number of laws/policies passed or modified this period concerning availability and sentencing alternatives to increase treatment/prevention |
|
|
|
No Change |
|
|
|
Workplace: Policies promoting drug-free workplaces |
|
|
Number of laws or policies concerning drug-free workplaces you actively informed or helped educate this period. Do not include policies mandating treatment. |
Number of laws or policies concerning drug-free workplaces passed or modified during this period. Do not include policies mandating treatment. |
|
|
|
No Change |
|
|
|
Citizen enabling/Liability: Laws/public policies concerning adult (including parent) social enabling or liability (e.g., social host ordinances) |
|
|
Number of laws or public policies concerning adult/parent social enabling or liability you actively informed or helped educate this period. |
Number of laws passed or modified this period concerning adult/parent social enabling/liability. |
|
|
|
No Change |
|
|
|
Supplier Promotion/Liability: Laws/public policies concerning supplier advertising, promotion, liability, (e.g., server liability, product placement, happy hours, drink specials, mandatory compliance checks, responsible beverage service) |
|
|
Number of laws or public policies concerning supplier advertising, promotion, or liability you actively informed or helped educate this period. |
Number of laws passed or modified this period concerning supplier advertising, promotion, or liability. |
|
|
|
No Change |
|
|
|
Outlet Location/Density: Laws/public policies concerning limitation and restrictions of location and density of alcohol or marijuana outlets |
|
|
Number of laws or zoning ordinances concerning density/location of alcohol outlets you actively informed or helped educate this reporting period. |
Number of laws/zoning ordinances passed this period concerning the density of alcohol outlets. |
|
|
|
|
|
|
|
Sales Restrictions: Laws/public policies concerning restrictions on product sales (e.g., methamphetamine pre-cursor access, alcohol at gas stations) |
|
|
Number of laws or public policies concerning restrictions on product sales you actively informed or helped educate this period. |
Number of laws/public policies passed or modified this period concerning restrictions on product sales. |
|
|
|
No Change |
|
||
Other (please specify): (NOTE: Able to add up to three “other” activity rows) |
|
|
|
|
|
|
|
No Change |
|
||
Indicate the average level of contribution that coalition paid/unpaid staff made to activities involving Educating/Informing About Modifying/Changing Policies: Completely responsible for most activities Typically takes lead with help from coalition members Typically does not take lead, but helps coalition members Minimally involved: coalition members take on most responsibilities |
|
|
|||||||||
Please provide a brief overview of any notable accomplishments related to Educating/Informing About Modifying/Changing Policies activities that you achieved during this reporting period (Maximum of 2,000 character with spaces):
|
|
|
|||||||||
Please provide a brief overview of any challenges related to Educating/Informing About Modifying/Changing Policies activities that you experienced during this reporting period (Maximum of 2,000 characters with spaces):
|
|
|
|||||||||
Implementation Summary |
Proposed Changes |
||||||||||||
In the last six months, did you coalition successfully modify/change any policies/laws? Yes No |
No change |
||||||||||||
If yes, briefly describe each policy/law successfully modified/changed, indicate the month and year the work to successfully modify/change the policy was completed, select the substance(s) targeted by the policy, and briefly describe the modifications/changes to the policy/law.
|
|
||||||||||||
Please report your top notable accomplishments related to implementation activities achieved during this reporting period (Maximum of 2,000 character with spaces):
|
No Change |
||||||||||||
Please report any additional details, including barriers or challenges, about your implementation activities that were not captured above (Maximum of 2,000 character with spaces):
|
No Change |
Coalition Evaluation Effort |
Proposed Changes |
Approximately what percent of your coalition’s evaluation effort and resources went into the following activities? (Note: Total must add to 100%): |
No Change |
___% Data collection ___% Data analysis ___% Identifying recommendations for improvement ___% Presenting evaluation findings ___% Other ( please specify ): _____________________ |
COMMUNITY AND POPULATION-LEVEL OUTCOMES Evaluation measures the quality and outcomes of coalition work Evaluation enables the improvement of interventions and coalition practices |
Proposed Changes |
|||||||||
Core Measures Core Measures will be reported in a separate section of the DFC Me system. To create a new core measures report, select the Core Measures tab under Reporting. Once you’ve completed entering your core measures data into a report, click Mark as Ready for Submission. Then, in the Progress Report Community & Population Level Outcomes Section, click the box next to the name of your core measures report to attach the measures to the progress report. You must submit the survey used to collect the data that you are submitting in order to be able to submit core measure data. You will receive a survey review guide from the DFC National Evaluation team once their review of your survey is complete. Be sure to leave adequate time prior to core measure data submission to complete this step in the process. Surveys can be submitted at any time. Your survey review guide provides you with information on what data the grant award recipient is expected to submit (which core measures have been approved for which substances) as well as guidance on how to calculate percentage use. For substances labeled as Optional, data may be submitted if available but are not required. |
See notes on p. 52 and clean copy of mockup. |
|||||||||
Survey (dropdown of coalition’s approved surveys) |
No Change |
|||||||||
For which grade levels are you reporting data? Select all grade levels that you will report data for. Please note that if you are unable to separate your data by grade level, please select “All Middle School (aggregate data)” and/or “All High School (aggregate data)” to report combined core measures data for middle and high school students. |
No Change |
|||||||||
Month and Year Data Were Collected: __/__ |
No Change |
|||||||||
Past 30-Day Use Please report the percentage of students who reported any use in the past 30-days, including only reporting use on one day |
No Change |
|||||||||
Grade |
Measure |
Alcohol |
Marijuana |
Tobacco |
Prescription Drugs |
(Optional) Heroin |
(Optional) Methamphetamines |
see note on p. 52 for details on new optional items |
||
6 |
30-day Use % |
|
|
|
|
|
|
No Change |
||
Sample Size |
|
|
|
|
|
|
No Change |
|||
7 |
30-day Use % |
|
|
|
|
|
|
No Change |
||
Sample Size |
|
|
|
|
|
|
No Change |
|||
8 |
30-day Use % |
|
|
|
|
|
|
No Change |
||
Sample Size |
|
|
|
|
|
|
No Change |
|||
9 |
30-day Use % |
|
|
|
|
|
|
No Change |
||
Sample Size |
|
|
|
|
|
|
No Change |
|||
10 |
30-day Use % |
|
|
|
|
|
|
No Change |
||
Sample Size |
|
|
|
|
|
|
No Change |
|||
11 |
30-Day Use % |
|
|
|
|
|
|
No Change |
||
Sample Size |
|
|
|
|
|
|
No Change |
|||
12 |
30-Day Use % |
|
|
|
|
|
|
No Change |
||
Sample Size |
|
|
|
|
|
|
No Change |
|||
Middle School |
30-Day Use % |
|
|
|
|
|
|
No Change |
||
Sample Size |
|
|
|
|
|
|
No Change |
|||
High School |
30-Day Use % |
|
|
|
|
|
|
No Change |
||
Sample Size |
|
|
|
|
|
|
No Change |
|||
|
|
|
|
|
|
|
||||
|
|
|
|
|
|
|||||
|
|
|
|
|
||||||
|
|
|
|
|
|
|||||
|
|
|
|
|
||||||
Perception of Risk Please report the percentage of students who reported moderate and great risk responses for each substance |
No Change |
|||||||||
Grade |
Measure |
Alcohol |
Marijuana |
Tobacco |
Prescription Drugs |
(Optional) Heroin |
(Optional) Methamphetamines |
see note on p. 52 for details on new optional items |
||
6 |
Perception of Risk % |
|
|
|
|
|
|
No Change |
||
Sample Size |
|
|
|
|
|
|
No Change |
|||
7 |
Perception of Risk % |
|
|
|
|
|
|
No Change |
||
Sample Size |
|
|
|
|
|
|
No Change |
|||
8 |
Perception of Risk % |
|
|
|
|
|
|
No Change |
||
Sample Size |
|
|
|
|
|
|
No Change |
|||
9 |
Perception of Risk % |
|
|
|
|
|
|
No Change |
||
Sample Size |
|
|
|
|
|
|
No Change |
|||
10 |
Perception of Risk % |
|
|
|
|
|
|
No Change |
||
Sample Size |
|
|
|
|
|
|
No Change |
|||
11 |
Perception of Risk % |
|
|
|
|
|
|
No Change |
||
Sample Size |
|
|
|
|
|
|
No Change |
|||
12 |
Perception of Risk % |
|
|
|
|
|
|
No Change |
||
Sample Size |
|
|
|
|
|
|
No Change |
|||
Middle School |
Perception of Risk % |
|
|
|
|
|
|
No Change |
||
Sample Size |
|
|
|
|
|
|
No Change |
|||
High School |
Perception of Risk % |
|
|
|
|
|
|
No Change |
||
Sample Size |
|
|
|
|
|
|
No Change |
|||
|
|
|
|
|
|
|
||||
|
|
|
|
|
|
|||||
|
|
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|
|
||||||
|
|
|
|
|
|
|||||
|
|
|
|
|
||||||
Perception of Peer Disapproval Please report the percentage of students who reported wrong and very wrong responses for each substance |
No Change |
|||||||
Grade |
Measure |
Alcohol |
Marijuana |
Tobacco |
Prescription Drugs |
(Optional) Heroin |
(Optional) Methamphetamines |
see note on p. 52 for details on new optional items |
6 |
Perception of Peer Disapproval % |
|
|
|
|
|
|
No Change |
Sample Size |
|
|
|
|
|
|
No Change |
|
7 |
Perception of Peer Disapproval % |
|
|
|
|
|
|
No Change |
Sample Size |
|
|
|
|
|
|
No Change |
|
8 |
Perception of Peer Disapproval % |
|
|
|
|
|
|
No Change |
Sample Size |
|
|
|
|
|
|
No Change |
|
9 |
Perception of Peer Disapproval % |
|
|
|
|
|
|
No Change |
Sample Size |
|
|
|
|
|
|
No Change |
|
10 |
Perception of Peer Disapproval % |
|
|
|
|
|
|
No Change |
Sample Size |
|
|
|
|
|
|
No Change |
|
11 |
Perception of Peer Disapproval % |
|
|
|
|
|
|
No Change |
Sample Size |
|
|
|
|
|
|
No Change |
|
12 |
Perception of Peer Disapproval % |
|
|
|
|
|
|
No Change |
Sample Size |
|
|
|
|
|
|
No Change |
|
Middle School |
Perception of Peer Disapproval % |
|
|
|
|
|
|
No Change |
Sample Size |
|
|
|
|
|
|
No Change |
|
High School |
Perception of Peer Disapproval % |
|
|
|
|
|
|
No Change |
Sample Size |
|
|
|
|
|
|
No Change |
|
|
|
|
|
|
|
|
||
|
|
|
|
|
|
|||
|
|
|
|
|
||||
|
|
|
|
|
|
|||
|
|
|
|
|
||||
Perception of Parental Disapproval Please report the percentage of students who reported wrong and very wrong responses for each substance |
No Change |
|||||||
Grade |
Measure |
Alcohol |
Marijuana |
Tobacco |
Prescription Drugs |
(Optional) Heroin |
(Optional) Methamphetamines |
see note on p. 52 for details on new optional items |
6 |
Perception of Parental Disapproval % |
|
|
|
|
|
|
No Change |
Sample Size |
|
|
|
|
|
|
No Change |
|
7 |
Perception of Parental Disapproval % |
|
|
|
|
|
|
No Change |
Sample Size |
|
|
|
|
|
|
No Change |
|
8 |
Perception of Parental Disapproval % |
|
|
|
|
|
|
No Change |
Sample Size |
|
|
|
|
|
|
No Change |
|
9 |
Perception of Parental Disapproval % |
|
|
|
|
|
|
No Change |
Sample Size |
|
|
|
|
|
|
No Change |
|
10 |
Perception of Parental Disapproval % |
|
|
|
|
|
|
No Change |
Sample Size |
|
|
|
|
|
|
No Change |
|
11 |
Perception of Parental Disapproval % |
|
|
|
|
|
|
No Change |
Sample Size |
|
|
|
|
|
|
No Change |
|
12 |
Perception of Parental Disapproval % |
|
|
|
|
|
|
No Change |
Sample Size |
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No Change |
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Middle School |
Perception of Parental Disapproval % |
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No Change |
Sample Size |
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No Change |
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High School |
Perception of Parental Disapproval % |
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No Change |
Sample Size |
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No Change |
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STOP ACT Core Measure: Attitude Toward Peer Use of Alcohol Please report the percentage of students who reported moderate and great risk response options for alcohol |
Proposed Changes |
||
Grade |
Measure |
Alcohol |
No Change |
6 |
Attitude Toward Peer Use of Alcohol % |
|
No Change |
Sample Size |
|
No Change |
|
7 |
Attitude Toward Peer Use of Alcohol % |
|
No Change |
Sample Size |
|
No Change |
|
8 |
Attitude Toward Peer Use of Alcohol % |
|
No Change |
Sample Size |
|
No Change |
|
9 |
Attitude Toward Peer Use of Alcohol % |
|
No Change |
Sample Size |
|
No Change |
|
10 |
Attitude Toward Peer Use of Alcohol % |
|
No Change |
Sample Size |
|
No Change |
|
11 |
Attitude Toward Peer Use of Alcohol % |
|
No Change |
Sample Size |
|
No Change |
|
12 |
Attitude Toward Peer Use of Alcohol % |
|
No Change |
Sample Size |
|
No Change |
|
Middle School |
Attitude Toward Peer Use of Alcohol % |
|
No Change |
Sample Size |
|
No Change |
|
High School |
Attitude Toward Peer Use of Alcohol % |
|
No Change |
Sample Size |
|
No Change |
|
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STOP ACT Core Measure: Perception of Risk (Regular Alcohol Use) Please report the percentage of students who reported somewhat and strongly disapprove response options for alcohol |
No Change |
||
Grade |
Measure |
Regular Alcohol Use |
No Change |
6 |
Perception of Risk (Regular Alcohol Use) % |
|
No Change |
Sample Size |
|
No Change |
|
7 |
Perception of Risk (Regular Alcohol Use) % |
|
No Change |
Sample Size |
|
No Change |
|
8 |
Perception of Risk (Regular Alcohol Use) % |
|
No Change |
Sample Size |
|
No Change |
|
9 |
Perception of Risk (Regular Alcohol Use) % |
|
No Change |
Sample Size |
|
No Change |
|
10 |
Perception of Risk (Regular Alcohol Use) % |
|
No Change |
Sample Size |
|
No Change |
|
11 |
Perception of Risk (Regular Alcohol Use) % |
|
No Change |
Sample Size |
|
No Change |
|
12 |
Perception of Risk (Regular Alcohol Use) % |
|
No Change |
Sample Size |
|
No Change |
|
Middle School |
Perception of Risk (Regular Alcohol Use) % |
|
No Change |
Sample Size |
|
No Change |
|
High School |
Perception of Risk (Regular Alcohol Use) % |
|
No Change |
Sample Size |
|
No Change |
|
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Addition of optional Core Measures for new core measure substances of Heroin and Methamphetamine (will add columns and collect in same manner as for four core substances):
Coalitions will not be required to report this information but may submit it if available. Note that wording below will be added to the survey review guide and is used in YRBS 2017. (Centers for Disease Control, YRBSS Questionnaire Content: 1991-2019, https://www.cdc.gov/healthyyouth/data/yrbs/pdf/2019/YRBS_questionnaire_content_1991-2019.pdf )
Proposed optional Heroin items:
During the past 30 days have you used heroin (also called smack, junk, China White)? (yes, no)
How wrong do your parents feel it would be for you to use heroin (also called smack, junk, China White)? (Not at all wrong, a little bit wrong, wrong, very wrong) (also called smack, junk, China White)
How wrong do your friends feel it would be for you to use heroin (also called smack, junk, China White)? (Not at all wrong, a little bit wrong, wrong, very wrong)
How much do you think people risk harming themselves physically or in other ways if they use heroin? (no risk, slight risk, moderate risk, great risk)
Proposed optional Methamphetamine items:
During the past 30 days have you used methamphetamine (also called speed, crystal, crank, ice)? (yes, no)
How wrong do your parents feel it would be for you to use methamphetamine (also called speed, crystal, crank, ice)? (Not at all wrong, a little bit wrong, wrong, very wrong)
How wrong do your friends feel it would be for you to use methamphetamine (also called speed, crystal, crank, ice)? (Not at all wrong, a little bit wrong, wrong, very wrong)
How much do you think people risk harming themselves physically or in other ways if they use methamphetamine (also called speed, crystal, crank, ice)? (no risk, slight risk, moderate risk, great risk)
Outcomes Summary Note: You are only required to complete these four fields if you will be submitting Core Measures with this Progress Report. |
Proposed Changes |
Compared to target area, the geographical area covered by these data is:
|
No Change |
Does your data represent your target population?
If no, please explain: _______________________________ |
No Change |
Does your data represent the same grades and same schools that were surveyed in your last report?
If no, please explain: _______________________________ |
No Change |
Do you have any concerns about the quality of your data? Please explain.
If yes, please explain:_______________________________ |
No Change |
Please report any notable accomplishments related to evaluation achieved during this reporting period (Maximum of 2,000 characters with spaces):
|
No Change |
Please report any additional details, including barriers or challenges, about your evaluation activities that were not captured above (Maximum of 2,000 characters with spaces):
|
No Change |
CHALLENGES AND Coalition Development Support |
Proposed Changes Minor Change: (Note: CADCA now refers to Technical Assistance as Coalition Development Support so aligned here) |
|||||
Challenges |
No Change |
|||||
To what extent has your coalition experienced challenges in the following area? |
Significant Challenge (Please select up to three (3) that are the primary challenges experienced by your coalition) |
Some Challenge |
A Little Challenge |
No Challenge |
Not Applicable |
|
Increasing coalition membership and participation |
|
|
|
|
|
No Change |
Building leadership capacity among coalition members |
|
|
|
|
|
No Change |
Attaining an agreement among coalition members regarding goals, planned initiatives, etc. |
|
|
|
|
|
No Change |
Developing/revising a framework/logic model of change |
|
|
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|
|
No Change |
Completing a SWOT (strengths, weaknesses, opportunities, and threats) analysis |
|
|
|
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|
No Change |
Collecting/analyzing data for assessment purposes |
|
|
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|
|
|
Recruiting/engaging target populations (e.g., students) in substance use prevention initiatives |
|
|
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|
No Change |
Engaging key stakeholders (e.g., school personnel, parents) in substance use prevention initiatives |
|
|
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|
|
Engaging the general community in substance use prevention initiatives |
|
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|
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Planning/executing substance use prevention initiatives |
|
|
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|
|
Developing/executing a media plan to draw attention to new drug threats |
|
|
|
|
|
No Change |
Attaining funding for substance use prevention initiatives |
|
|
|
|
|
|
Collecting/analyzing data for evaluation purposes |
|
|
|
|
|
No Change |
Other (please specify): __________________________ |
|
|
|
|
|
No Change |
Other (please specify): __________________________ |
|
|
|
|
|
No Change |
Other (please specify): __________________________ |
|
|
|
|
|
No Change |
Coalition Development Support: Survey of Needs |
Proposed Changes |
||||
Areas |
To what extent would your coalition benefit from training and Coalition Development support in each of these areas during the next 6 months |
|
|||
A Great Deal (Top 3 Need) |
Some (Beyond Top 3 Need) |
A Little (Anticipated Need once others are addressed) |
Not at All |
||
Coalition and partnership development |
|
|
|
|
No Change |
Coalition and partnership maintenance |
|
|
|
|
No Change |
Community needs and resource assessment |
|
|
|
|
No Change |
Goal and outcome development and assessment |
|
|
|
|
No Change |
Effective problem solving within a group setting |
|
|
|
|
No Change |
Develop a logic model for
each prioritized substance
|
|
|
|
|
|
Leadership development |
|
|
|
|
No Change |
Cultural competency |
|
|
|
|
No Change |
Organizational management |
|
|
|
|
No Change |
Strategic/action planning |
|
|
|
|
|
Developing substance use prevention initiatives |
|
|
|
|
|
Advocacy and policy development |
|
|
|
|
No Change |
Grant writing |
|
|
|
|
No Change |
Program evaluation |
|
|
|
|
No Change |
Program/Initiative sustainability |
|
|
|
|
No Change |
Other (please specify): __________________________ |
|
|
|
|
No Change |
Did your coalition provide any training or technical assistance to other community groups or organizations?
If yes, please describe: |
No Change |
||||
Local Drug Crisis |
Proposed Changes |
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Be clear on how effective the activities were based on coalition goals for the activity. Identify any challenges that had/would need to be addressed in order for similar activities to be effective in other communities. |
|
VAPING
|
|
||||||||||||
Be clear on how effective the activities were based on coalition goals for the activity. Identify any challenges that had/would need to be addressed in order for similar activities to be effective in other communities. |
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | ASSESSMENT SECTION |
| Author | ICF |
| File Modified | 0000-00-00 |
| File Created | 2021-01-15 |