Form DSP-MRT Standard T DSP-MRT Standard T DSP-MRT Standard Tool

Throughout the progress report, grantee refers to the state/tribe/jurisdiction receiving the award from SAMHSA. Community refers to the grantee’s selected High-Need communities, and subrecipient indicates the grantee’s sub-awardees funded to lead the grant in the selected communities. Some grantees refer to their subrecipients as sub-grantees. Some grantees may not have a subrecipient responsible for leading the grant in each of the selected communities.

Grantee Information

Use this section to review and update your Grantee information as necessary.

Item	Response Options
Do you fund subrecipients for this grant?	Yes No
Do you use a sub-state model for this grant?	Yes No

Item	Response Options
Contact Information
Address	Free Text
City	Free Text
State/Territory	Free Text
Zip	Free Text
Project Director Name	Free Text
Project Director Email Address	Free Text
Project Director Phone Number	Numerical
Project Coordinator Name	Free Text
Project Coordinator Email Address	Free Text
Project Coordinator Phone Number	Numerical
Lead Evaluator Name	Free Text

Item	Response Options
Lead Evaluator Email Address	Free Text
Lead Evaluator Phone Number	Numerical
Epidemiological Lead Name	Free Text
Epidemiological Lead Email Address	Free Text
Epidemiological Lead Phone Number	Numerical

Sub-State Information

If you selected “yes” in the grantee information section to indicate you use a sub- state model for this grant, enter information on the sub-state(s) below. The term “Sub-State” refers to a regional, county-level, or other entity that serves as an intermediary between the Grantee and the Subrecipients.

Item	Response Options
In the SPARS data collection system, there will be an “Add” button to add each of your sub-states. Grantees will be able to click that button to add additional sub-states as needed.
Sub-State Name	Free text
Sub-State Type	Region County City Tribe/Tribal Organization Coalition Provider Agency Other
Specify Other Sub-State Type	Free text
Total Funding for Sub-State	Numerical
Briefly describe how Subrecipients are being funded?	Free text

Subrecipients

Enter information for the selected Subrecipient. Subrecipient indicates the grantee’s sub awardees funded to lead the grant in the selected communities. Some grantees refer to their subrecipients as sub-grantees or funded entities.

Item	Response Options
In the SPARS data collection system, there will be an “Add” button to add each of your subrecipients and/or selected high-need communities. Grantees will be able to click that button to add additional subrecipients and/or communities as needed.
Subrecipient Items
Subrecipient Name	Free text
Subrecipient Type	Behavioral health department (government entity) Behavioral health service organization City Coalition College/University Community-based health services organization Community-based recovery organization County Harm reduction agency Law enforcement agency Provider Agency/Organization Public health department (government entity) Region Syringe exchange program Tribe/Tribal Organization Other (specify)
Other Subrecipient Type, Specify	Free text
Subrecipient Street Address	Free text
Subrecipient City	Free text
Subrecipient State/Territory	All states and territories
Subrecipient ZIP Code	Numerical
Subrecipient Status	Selected but not yet active or funded Planning grant only: Not (yet) selected to implement all steps Active: Has begun implementation and/or funding De-activated: No longer funded
Has this Subrecipient been funded?	Yes No
Date Funded (If YES is selected)	Date Field
Funding End Date (If YES is selected)	Date Field
Amount awarded per year (If YES is selected)	Numerical

High-Need Communities

Selected High-Need Community: Through your Disparities Impact Statement (DIS) and your Needs Assessment (if applicable), every grantee is expected to identify one or more high-need/low-capacity community(ies). Use this section to add or update information about your selected high-need community(ies). For Single-Community grantees, if you identify your tribe or territory as your high-need community, please enter that here.

Item	Response Options
In the SPARS data collection system, there will be an “Add” button to add each of your selected high- need communities. Grantees will be able to click that button to add additional communities as needed.
High-Need Community Items
Selected High-Need Community Name	Free text
Selected High-Need Community Zip Code(s) (this is the community this subrecipient or you target for your program effort(s)	“Add” button and “USPS ZIP Code Look-up” link
ALTERNATIVE: If this subrecipient or you target an entire county (or counties), as the selected High-Need Community, indicate the county name(s) here.	Free text
Subrecipients Please select Subrecipients that are connected to this High Need Community.	Subrecipient 1 Subrecipient 2 Subrecipient 3 Etc.
Briefly describe how you are defining this community as a high- need community. This should summarize in 2-3 sentences what you reported in detail in your Disparity Impact Statement.	Free text
Start Date for High-Need Community	Date field

Needs Assessment

Assessment involves the systematic gathering and examination of data about alcohol and drug problems, related conditions, and consequences in the area of concern in your community(ies). Assessing the issues means pinpointing where the problems are in the community and the populations impacted. It also means examining the conditions within the community that put its populations at risk for the problems and identifying conditions that—now or in the future—could protect the population against the problems.

Needs Assessment

Use this section to upload and provide a brief description of your Needs Assessment document. Once you upload your Needs Assessment document, you will only update this section if you revise your Needs Assessment.

This document may not be required by your grant program; so please ask your project officer if you need to upload.

Item

Response Options

Upload Needs Assessment Document

“Browse” button

Provide a brief description of your Needs Assessment document and, if relevant, any changes made to your Needs Assessment document

between the previous version and this one.

Free text

Accomplishments and Barriers/Challenges

Use this section to enter information on any Accomplishments and/or Barriers/Challenges that you had this reporting period while performing activities related to your Needs Assessment. Please include actions you took to address any Barriers/Challenges.

After you save the Accomplishment or Barrier/Challenge, it will appear on the list. You can click "edit" to revise the record or you can add an additional record by clicking the "Add Accomplishments" or the "Add Barriers/Challenges" button.

Item	Response Options
In the SPARS data collection system, there will be an “Add” button for this section. Grantees will be able to click that button to add additional accomplishments as needed.
Accomplishments
Accomplishment Name	Accomplishments Functioning of the State/Tribal/Jurisdiction Epidemiology Outcome Workgroup Monitoring community needs assessment activities Assessing Community assets and resources Assessment of community risk and protective factors/casual factors Identification of community gaps in services Assessment of community capacity Assessment of community readiness to act Assessment of the magnitude of substance use related problems (consumption/consequences) Identification of State/Tribe/Jurisdiction high need priorities Specification of baseline data Use of needs assessment data collected prior to award Use of the Epidemiological Outcomes Workgroup to enhance and supplement the current SEOW process Identification of target communities Assessment of State/Tribe/Jurisdiction capacity Identification of State/Tribe/Jurisdiction gaps in services Assessment of State/Tribe/Jurisdiction readiness to act Organizing ATOD indicators into a state/tribe profile Other Assessment Accomplishment (provide title in description box below)
Describe the Accomplishment	Free text

Item	Response Options
In the SPARS data collection system, there will be an “Add” button for this section. Grantees will be able to click that button to add additional barriers/challenges as needed.
Barriers/Challenges
Barrier/Challenge Name	Barrier/Challenges Major external community events like weather disasters Lack of collaboration between stakeholders (e.g., between agencies, between coalitions, between jurisdictions and funded community levels) State/Tribal/Jurisdictional contract or other delays getting subrecipient or high-need communities on board Low survey response rates Need for new data collection instruments Difficulty sampling target populations Lack of available data to address NOMs Lack of available data for specific age group populations (e.g. 18 to 25-year olds) Lack of available data to assess differences for racial/ethnic minorities LGTBQ, or other special populations Mismatch between level of disaggregation of available data (e.g., county) and communities being funded (e.g., towns within counties) Identification of State/Tribe/Jurisdiction gaps in services and capacity Lack of data analysis or evaluation expertise Limited staff capacity to conduct assessments Inadequate time for project staff and members to devote to the project Limited time to implement this Strategic Prevention Framework step Organizing ATOD indicators into a state/tribe profile Other Assessment Barrier (provide title in description box below)
Describe the Barrier/Challenge	Free text
Was technical assistance (TA) requested to help address this Barrier/Challenge?	Yes No
Date TA Requested (If YES is selected) NOTE: If you received TA for this issue, please report it on the Capacity > Training and Technical Assistance page.	Date field
In what other ways did you address this Barrier/Challenge?	Free text

Capacity

Capacity refers to the various types and levels of resources available to establish and maintain a community prevention system. This prevention system can identify and leverage resources that will support an effective strategy aimed at the priority problems and identified risk factors in the community at the appropriate population level. Capacity to carry out strategies depends not only upon the resources of the community organizations and their function as a cohesive problem-solving group, but also upon the readiness and ability of the larger community to commit its resources to addressing the identified problems.

Membership

Use this section to add any organizational and/or individual members to your Advisory Council, Epidemiological Outcome Workgroup (EOW; if required), or other Workgroup. To edit or mark previously added members as inactive, use the table headings to sort Members, then click the edit button for the Member you wish to edit. These members will carry over from one reporting period to the next, so only revise as new members join or old members become inactive.

Item	Response Options
In the SPARS data collection system, there will be an “Add” button for this section. Grantees will be able to click that button to add additional members as needed.
Date joined	Date field
Member type	Project Advisory Council EOW Evidence-Based Practices Workgroup Other (specify)
Specify Other Type	Free text
Member Name	Free text
Title	Free text
Organization	Free text

Item	Response Options
Sector:	Advocacy volunteers Affected family members Behavioral health department/division Business community Civic or volunteer organization Corrections Courts/judiciary Emergency medical system Faith-based organizations Healthcare professionals Law enforcement agency LGBTQ supportive organization Media (radio/TV stations, newspaper) Mental health professionals/ agencies Military/veteran organization Parent/family/caregiver groups Pharmacy Public health department Recovery community Research/evaluation School(s)/school districts State/Tribe/Jurisdiction agency Substance use disorder treatment Syringe exchange program Tribal government/tribal health board Youth groups/representatives Other (not listed)
Status	Active Inactive
Date Exited (If “Inactive” is selected for Status)	Date Field

Advisory Council and Other Workgroup Meetings

Use this section to report Advisory Council, Epidemiological Outcome Workgroup (EOW), or other Workgroup meetings that were conducted during this reporting period. If you had no Advisory Council, EOW, or other Workgroup meetings held during this reporting period related to your activities, please skip this section.

Shape5

Item	Response Options
In the SPARS data collection system, there will be an “Add” button for this section. Grantees will be able to click that button to add additional meetings as needed.
Meeting Date	Date field
Meeting Type	Project Advisory Council EOW Evidence-Based Practices Workgroup Other
Specify Other Meeting Type	Free text
Meeting Name/Topic	Free text

Grantee Funding Resources

Use this section to enter funding resources information for your grant. Unless the information changes from one reporting period to another, this information only needs to be entered once per fiscal year.

Which of the following funding sources did your organization receive during this fiscal year? Which of those sources did your organization use to fund priorities in high-need communities?

Data Item

Response Options

Source of funding

SAMHSA Partnerships for Success (PFS)
SAMHSA Strategic Prevention Framework for Prescription Drugs (SPF-Rx)
SAMHSA Medication-Assisted Treatment-Prescription Drug and Opioid Addiction (MAT-PDOA)
SAMHSA Minority HIV/AIDS Initiative (MAI)
SAMHSA State Targeted Response to the Opioid Crisis Grants (Opioid STR)
SAMHSA Grants to Prevent Prescription Drug/Opioid Overdose-Related Deaths (PDO)
CDC Prescription Drug Overdose: Prevention for States (PFS)
CDC Data-Driven Prevention Initiative (DDPI)
CDC Expanded Overdose Surveillance
BJA Harold Rogers Prescription Drug Monitoring Program (PDMP) Grant
Health Resources and Services Administration (HRSA) Rural Opioid Overdose Reversal (ROOR)
Drug Free Communities Grants
STOP Act Funding
Substance Abuse Prevention and Treatment Block Grant
Medicaid (Federal, State, and Local)
Other Federal Funds
State/Territory Funds (excluding State Medicaid)
Municipal Government Funds (excluding State Medicaid)
Local Funds (excluding State Medicaid)
Foundation/Non-Profit Organization Funding
Private/Corporate Entities
Individual Donations/Funding from Fundraising Events
Other (Please Specify)

Did the grantee use the funding stream for priorities in high-need communities?

(If you selected any of the sources of funding above, please indicate if your organization used the source to fund priorities in high-need communities.)

Training and Technical Assistance (TA)

Use this section to record any Training and TA provided to the grantee or subrecipients and communities to build capacity. This includes training and TA provided by grantees or by other contractors and consultants.

Training refers to the delivery of structured events focused on topics such as data collection protocols and systems, building community partnerships, or implementing media campaigns.

Technical Assistance refers to substantial services provided by professional prevention staff to give technical guidance to grantees and individuals to effectively implement their grant.

Training and TA should be counted as one unit per issue. It does not include simple clarifying assistance (e.g., sending someone to a web site).

Grantee refers to the state, tribe, or jurisdiction receiving the award from SAMHSA. Community refers to the grantee’s selected High-Need Communities, and Subrecipient indicates the grantee’s sub-awardees funded to lead the grant in the selected communities.

Item	Response Options
In the SPARS data collection system, there will be “Add” buttons for both T/TTA received by the Grantee AND T/TTA provided to Subrecipients or Communities. Grantees will be able to click these buttons to add T/TA as needed.
Status	Has Received Closed
Subrecipients	Subrecipient 1 Subrecipient 2 Subrecipient 3
Date Began Receiving this Training or TA	Date field
Name of Training/TA	Free text

Item	Response Options
Training/TA Topic	Behavioral Health Disparities PTTC Information Collaboration Community Data Collection Community Development Cultural Competence/Diversity Data Entry Developing Prevention Systems Development of Overdose Prevention System Environmental Strategies Grant Writing/ Funding/ Resource Development Grantee Data Collection Identifying /Selecting/ Implementing Evidence- Based Programs Information Technology Infrastructure Development Marketing/Communications National Outcomes Measures (NOMS) Needs Assessment Organization Development Overdose Outcome Measures Overdose Prevention in Specific Settings (e.g., shelter, correction facility) Prevention Fundamentals Prevention in Specific Settings (e.g., workplace, correctional facilities) Readiness Assessment Risk and Protective Factors SAMHSA's Strategic Prevention Framework (SPF) State/Territory Data Collection Strategic Planning Substance Use Sustainability Utilizing Epidemiological Data Violence Prevention Youth Involvement Other
Brief Description of the Need for the Training/TA	Free text
Source of Assistance	CSAP PTTC My Project Officer Other Grantee This Grantee SPARS Other
Specify Other Source of Assistance	Free text

Item	Response Options
Delivery Mechanism	Face to Face Video Conference Telephone Conference Web Conference Moderated Distance Learning Course Self-Paced Distance Learned Course/Tool Other
Was this training or TA timely?	Yes No
Was this training or TA effective?	Yes No
Explain why you believe the training or TA was not timely or effective ( If “No” is selected for either Timely or Effective fields)	Free text
Provide any additional description of this training/TA experience here	Free text

Accomplishments and Barriers/Challenges

Use this section to enter information on any Accomplishments and/or Barriers/Challenges that you experienced while performing activities related to capacity building, such as building your advisory council or workgroups, leveraging resources, and training staff or subrecipients and communities. Each Accomplishment or Barrier will be listed in a table. Use the table heading links to sort Accomplishments/Barriers/Challenges by column. Click on the Name that you've assigned to each Accomplishment or Barrier to edit that record. You will also report on actions taken to resolve Barriers/Challenges related to Capacity during this reporting period.

Only update this section if you conducted Capacity-related activities or faced new Capacity-related Barriers/Challenges during this reporting period.

Item	Response Options
In the SPARS data collection system, there will be an “Add” button for this section. Grantees will be able to click that button to add additional accomplishments as needed.
Accomplishments
Accomplishment Name		Accomplishments Engagement of State/Tribe/Jurisdiction level stakeholders Convening leaders and stakeholders Engagement of leadership from high needs/disparity communities Developing relationships among stakeholders Building coalitions Training and technical assistance to enhance the capacity of State/ Tribe/Jurisdiction stakeholders Organizing agency networks Leveraging funding and other resources Description of necessary infrastructure development Engaging stakeholders to help sustain outcomes Contributing to decisions to allocate resources Coordination with Advisory Board/Council Developing a set of Alcohol Tobacco or Other Drug intervening variables, consequences, and consumption indicators Tracking substance use and consequences indicators over time Using data to monitor changes in Alcohol Tobacco or Other Drug intervening variables, consequences, and consumption indicators Training and technical assistance to enhance the capacity of community stakeholders, coalitions, partner organizations, and service providers Planning for sustaining the infrastructure Other infrastructure development Other Capacity Accomplishment (provide title in description box below)
Describe the Accomplishment		Free text

Item	Response Options
In the SPARS data collection system, there will be an “Add” button for this section. Grantees will be able to click that button to add additional barriers/challenges as needed.
Barriers/Challenges
Barrier/Challenge Name		Barrier/Challenges Major external community events like weather disasters Lack of collaboration between stakeholders (e.g., between agencies, between coalitions, between jurisdictions and funded community levels) Differing perspectives between the project and jurisdiction- level administrators (e.g., Single State Authority, Governor's Office, tribal entity, etc.) No leadership or political commitment to the issue State/Tribal/Jurisdictional contract or other delays getting sub- recipient communities on board Inadequate pool of qualified people for identifying members (State Advisory Council, Epidemiological Outcomes Workgroup, Evidence Based Practices Workgroup) Difficulties getting buy-in from partnering agencies Difficulty balancing efficiency vs. inclusiveness of project members Insufficient/inadequate training/technical assistance provided directly by the project or partnering entity at the state/tribe/jurisdiction level Insufficient/inadequate technical assistance provided directly by the project or partnering entity at the funded community level Funding challenges (e.g. state budget cuts; delayed receipt of program funds) No coordination of funds No capacity for leveraging of funds or in-kind donations No capacity for monitoring objectives and goals Under-developed prevention infrastructure Limited incorporation of cultural competencies Inadequate funds to thoroughly implement Strategic Prevention Framework model Staffing challenges (e.g., delays in hiring, delays in training, turnover) Inadequate time for project staff and members to devote to the project Limited time to implement the Strategic Prevention Framework step Other Capacity Barrier (provide title in description box below)
Describe the Barrier/Challenge		Free text
Was technical assistance (TA) requested to help address this Barrier/Challenge?		Yes No

Item

Response Options

Date TA Requested (If YES is selected)

NOTE: If you received TA for this issue, please report it on the Capacity > Training and

Technical Assistance page.

Date

In what other ways did you

address this Barrier/Challenge?

Free text

Planning

Planning involves following logical sequential steps designed to produce specific results. The desired results (Outcomes) are based upon data obtained from a formal assessment of needs and resources. Thus, the plan outlines what will be done over time to create the desired change.

Strategic Plan

Use this section to upload and provide a brief description of your strategic plan. Note that this section is for uploading grantee-level, rather than community- or subrecipient-level documents. So do not load community- or subrecipient-level plans here. Once you upload the strategic plan, only update this section if you revised the plan.

This document may not be required by your grant program; so please ask your project officer if you need to upload.

Item

Response Options

Upload State-, Tribe-, or Territory-wide Strategic Plan

Browse

Describe the document or any changes made to your strategic plan between the previous version and this one. If a plan was not available or not uploaded, describe the plan or guidelines you are

using.

Free text

Accomplishments and Barriers/Challenges

Use this section to enter information on any Accomplishments and/or Barriers/Challenges that you experienced while performing activities related to Planning. Each Accomplishment or Barrier/Challenge will be listed in the table. Use the table heading links to sort Accomplishments/Barriers/Challenges by column.

Click on the Name that you've assigned to each Accomplishment or Barrier to edit

that record. You will also report on actions taken to resolve Barriers/Challenges related to Planning during this reporting period.

Only update this section if you conducted Planning-related activities or faced new Planning-related Barriers/Challenges during this reporting period, for example if you revised your strategic plan.

Item	Response Options
In the SPARS data collection system, there will be an “Add” button for this section. Grantees will be able to click that button to add additional accomplishments as needed.
Accomplishments
Accomplishment Name	Accomplishments Use of statewide needs assessment in the development of the strategic plan Discussion on adjustments based on on-going needs assessment activities Identification of the State/Tribe/Jurisdiction level priorities Articulation of a vision for prevention activities Identification of key milestones and outcomes Identification/coordination/allocation of resources Identification of other sources of funding for the plan Identification of appropriate funding mechanism(s) Establishment of key policies Involvement of public and private service systems in planning Planning for sustaining the infrastructure Other Planning Accomplishment (provide title in description box below)
Describe the Accomplishment	Free text

Item	Response Options
In the SPARS data collection system, there will be an “Add” button for this section. Grantees will be able to click that button to add additional barriers/challenges as needed.
Barriers/Challenges
Barrier/Challenge Name	Barrier/Challenges Major external community events like weather disasters Lack of collaboration between stakeholders (e.g., between agencies, between coalitions, between jurisdictions and funded community levels) Differing perspectives between the project and jurisdiction-level administrators (e.g., Single State Authority, Governor's Office, tribal entity, etc.) No leadership or political commitment to substance use prevention Resistance to adopting Strategic Prevention Framework model Difficulty convening members Difficulty balancing efficiency vs. inclusiveness of project members Disagreement among stakeholders regarding the project's priorities or strategies Disagreement among stakeholders about resource allocation procedures (i.e., alignment) Lack of stakeholder support for the program plan State/Tribal/Jurisdictional contract or other delays getting communities on board Challenges finding other sources of funding for the plan Challenges planning for sustaining the infrastructure Inadequate time for project staff and members to devote to the project Limited time to implement this Strategic Prevention Framework step Other Planning Barrier (provide title in description box below)
Describe the Barrier/Challenge	Free text
Was technical assistance (TA) requested to help address this Barrier/Challenge?	Yes No
Date TA Requested (If YES is selected) NOTE: If you received TA for this issue, please report it on the Capacity > Training and Technical Assistance page.	Date
In what other ways did you address this Barrier/Challenge?	Free text

Behavioral Health Disparities

SAMHSA defines behavioral health as mental/emotional well-being and/or actions that affect wellness. The phrase “behavioral health” is also used to describe service systems that encompass prevention and promotion of emotional health; prevention of mental and substance use disorders, substance use, and related problems; treatments and services for mental and substance use disorders; and recovery support (for more information see: https://www.samhsa.gov/data/national- behavioral-health-quality-framework).

Healthy People 2030 prioritizes eliminating health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion.

In this section, we would like you to describe the efforts and activities that your state, tribe, or jurisdiction has undertaken in the project to address Behavioral Health Disparities related to substance use disorders risks, prevalence, and outcomes.

Disparities Impact Statement (DIS)

Use this section to upload your Disparities Impact Statement (DIS). After you upload the DIS and it is accepted by your project officer, you will only update this section if there are newly identified disparate and population(s) or if you are revising plans to improve the quality of programming to address the needs (access, use/reach, outcomes) of the disparate population. If you do not have an approved DIS, please continue to work with your project officer to finalize it as soon as possible. You

should not enter any additional information in the Behavioral Health Disparities module until it is approved.

Item	Response Options
Upload Disparities Impact Statement	“Browse” button
Document Description	Free text

Population(s) Experiencing the Disparity

Although the term disparities is often interpreted to mean racial or ethnic disparities, many dimensions of disparity exist in the United States, particularly in health. If a health outcome is seen to a greater or lesser extent between populations, there is disparity.” We are asking grantees to specify the population(s) experiencing the disparity within the context of your High-Need Community(ies) and subrecipients.

Grantees may describe the population(s) experiencing the disparity using a broad demographic or cultural category - or “subpopulation”. The DIS asks you to use publicly available data to identify subpopulations within your High-Need Communities. You may quantify subpopulations more specifically as a “disparate population” using data and a designated comparison group. For example, you may identify the subpopulations by “race” and the disparate population as “Black or African American”. However, just because you can separate out a subpopulation (e.g., age separated out by age ranges), does not mean you should identify it as disparate. You should only consider a population “disparate” if you identify a specific race, ethnicity, sex, or LGBTQ identity using a data-driven justification.

Use the "Add a Population(s) Experiencing Disparity Record" button to create a new record. You will first identify your disparate and other subpopulations and then estimate how many individuals from those populations you plan to directly reach/indirectly serve per year. When this information is finalized, click the

"Complete Plan" link (note: if you are still in the planning stage, you should not click the "Complete Plan" link. You should submit what you have as a draft).

After you complete your plan, you will report the number of individuals your high- need community(ies) actually reached/served each reporting period.

Item

Response Options

In the SPARS data collection system, there will be an “Add a Population(s) Experiencing Disparity Record” button for this section. Grantees will be able to click that button to add

additional records as needed.

Select High-Need Community(ies)

If all High-Need Communities focus on the same disparate and subpopulations, select "All High-Need Communities". If not, select "Specific High-Need Community" and choose the High-Need Community(ies) you wish to report on. You should only select more than one community under “Specific High-Need Community(ies) if the communities focus on the same disparate and subpopulations. If they

don’t focus on the same disparate and subpopulations, please add an additional record.

All High-Need Communities
Specific High-Need Community(ies)

Note: This version of the question appears for planning stage

From the subpopulations below, please select the disparate population(s) on which this high-need community(ies) is focusing its efforts.

For each selected disparate population, provide estimates for how many individuals the High-Need Community(ies) plans to directly serve and indirectly reach with its efforts per year.

Race

African American/Black
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
White
Two or more races

Ethnicity

Hispanic or Latino
Not Hispanic or Latino

Sex

Male
Female

LGBTQ

Lesbian, Gay, Bisexual, Transgender, Questioning, or Two-Spirit

Item

Response Options

Note: This version of the question appears after the plan is complete and grantees are reporting actual values

For each selected disparate population, provide estimates for the actual number of individuals the High-Need Community(ies) directly served and indirectly reached for this reporting period

Race

African American/Black
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
White
Two or more races

Ethnicity

Hispanic or Latino
Not Hispanic or Latino

Sex

Male
Female

LGBTQ

Lesbian, Gay, Bisexual, Transgender, Questioning, or Two-Spirit

Describe why this high-need community(ies) has not yet identified (or finalized the identification of) a disparate population, when it intends to do so, and how soon implementation will begin.

You only need to respond to this item if your selection

of the disparate population is in progress. If your selection is complete, enter “n/a”

Free text

Note: This version of the question appears for planning stage, but will only appear if the “Show Additional Populations” box is checked

From the options below, please select any additional subpopulation(s) on which this high-need community is focusing their efforts.

For each subpopulation below provide estimates for how many individuals you expect this high-need community to directly serve and indirectly reach with their efforts per year.

Age

12-17 years old
18-24 years old
25-34 years old
35-44 years old
45-54 years old
55-64 years old
65+ years old

Residence

Urban
City
Town
Suburb
Rural
Frontier

Socioeconomic status

High
Middle
Low

Other

Shape11

Service members, veterans, and their families
Persons with disabilities
Persons with mental illness
Other (specify)

Item

Response Options

Note: This version of the question appears after the plan is complete and grantees are reporting actual values

For each selected subpopulation, provide estimates for the actual number of individuals the High-Need Community(ies) directly served and indirectly reached for this reporting period

Age

12-17 years old
18-24 years old
25-34 years old
35-44 years old
45-54 years old
55-64 years old
65+ years old

Residence

Shape12

Urban
City
Town
Suburb
Rural
Frontier

Socioeconomic status

High
Middle
Low

Other

Service members, veterans, and their families
Persons with disabilities
Persons with mental illness
Other (specify)

Describe how and why the population(s) experiencing the disparity has changed.

(This question appears if you indicate you need to edit your plan.)

Free text

Focus and Data Gaps

The following section ensures that your high-need communities focus on the subpopulation(s) experiencing the disparities and asks about any data gaps related to the disparate and subpopulation(s) that you identified.

Item	Response Options
What steps did you take to ensure that your high-need communities are focusing on the identified disparate and subpopulation(s)?	Free text
Describe any data gaps you identified related to the disparate or subpopulation(s). Please be specific. If no data gaps currently exist, please enter “n/a” for not applicable.	Free text

Item	Response Options
For any data gaps described above, please explain how you are addressing the gaps. If you had none, please enter “n/a” for not applicable.	Free text

Access to Prevention Efforts

Increasing access to prevention efforts is an important part of reducing behavioral health disparities. Use this section to enter information about technical assistance and/or guidance you provided to your high-need communities to increase access to prevention efforts for their identified disparate and subpopulations. Be sure to consider this as it relates to implementation of policies, practices, and/or programs to address behavioral health disparities.

Item

Response Options

Briefly describe the specific strategies implemented to address behavioral health disparities in your high-need community(ies). Include any information on how you, as the

grantee, are supporting its/their progress.

Free text

If you used a planning model, please briefly describe the model you are using and how you are ensuring your high-need community(ies) integrated it into its/their approach to addressing behavioral health disparities. If you did not use a planning model, enter “n/a” for not applicable.

Note: you will report general updates in the Implementation section, anything reported here should be specific to behavioral health disparities.

Free text

Item	Response Options
From the list, please select the strategies you developed and implemented to ensure that your high-need communities understand and are using the National CLAS Standards.	Increased participation of disparate and subpopulations on advisory boards and workgroups Developed strategic partnerships and collaborations with the goal of preventing behavioral health disparities among disparate and subpopulations Increased capacity and readiness of high- need communities to prevent behavioral health disparities among identified disparate and subpopulations Implemented diverse cultural health beliefs and practices Used preferred languages Addressed health literacy and other communication needs of all disparate and subpopulations Other (Specify)
How are communities documenting and monitoring use of National CLAS Standards?	Free text

Use and Reach of Prevention Efforts

Ensuring that the prevention efforts reach the populations experiencing the behavioral health disparity and that they in turn use them is another important factor. Use this section to enter information about steps you are taking to monitor implementation at the community level to address behavioral health disparities.

Item	Response Options
How do you monitor the efforts related to addressing behavioral health disparities at the community level?	Free text
What are your data collection processes related to behavioral health disparities data?	Free text
How are you determining the accuracy of numbers directly served and numbers indirectly reached for each high-need community?	Free text
How are you helping communities use their data to address the identified behavioral health disparities?	Free text

Outcomes of Prevention Efforts

The goal is for prevention efforts to produce positive outcomes for those experiencing disparities. Use this section to enter additional information on how you will assess the behavioral health disparities outcomes at the community level.

Item	Response Options
How are you monitoring outcomes related to disparate subpopulations at the community level?	Free text
Describe how you use outcome data related to disparate subpopulations to evaluate processes and/or make programmatic adjustments to address your identified priorities and issues.	Free text
Describe other ways that you use programmatic data to demonstrate the impact of your efforts on reducing behavioral health disparities.	Free text

Accomplishments and Barriers/Challenges

Use this section to enter information on any Accomplishments and/or Barriers/Challenges that you experienced while performing activities related to Behavioral Health Disparities. Each Accomplishment or Barrier will be listed in the table. Use the table heading links to sort Accomplishments/Barriers/Challenges by column. Click on the Name that you've assigned to each Accomplishment or Barrier to edit that record. You will also report on actions taken to resolve Barriers/Challenges related to Behavioral Health Disparities during this reporting period.

Only update this section if you conducted Behavioral Health Disparities-related activities or faced new Behavioral Health Disparities-related Barriers/Challenges during this reporting period.

Item

Response Options

In the SPARS data collection system, there will be an “Add” button for this section. Grantees will be able to click that button to add additional accomplishments as needed.

Accomplishments

Item

Response Options

Accomplishment Name

Accomplishments

ASSESSMENT: Defined disparate population(s) (race, ethnicity, sex, LGBTQ)
ASSESSMENT: Defined additional high-need subpopulations (age, residential area, SES, other)
ASSESSMENT: Identified specific behavioral health disparities faced by your disparate or high-need sub-population(s)
ASSESSMENT: Obtained data specific to your disparate or high-need sub-population(s)
PLANNING: Considered behavioral health disparities in the planning process (e.g. in prioritization, community selection, or intervention selection)
ALL: Ensured the involvement of population(s) experiencing substance use-related behavioral health disparities in assessment, capacity building, planning, implementation, evaluation, or dissemination efforts
ALL: Integrated National Standards for Culturally and Linguistically Appropriate Services (CLAS) into grant program activities
CAPACITY: Developed coalitions or strategic partnerships with other agencies or key stakeholders to address substance use-related behavioral health disparities in your state, tribe, or jurisdiction
CAPACITY: Provided training to increase the capacity of prevention workforce and relevant agencies or organizations to address substance use-related behavioral health disparities in your state, tribe, or jurisdiction.
CAPACITY: Delivered training to increase subrecipient community capacity related to behavioral health disparities
IMPLEMENTATION: Ensured that implemented interventions were specific to behavioral health disparities of disparate and high-need subpopulation(s)
IMPLEMENTATION: Helped adapt interventions to make them apply to specific health disparities of disparate and high-need subpopulation(s)
IMPLEMENTATION: Increased availability of substance use prevention services to disparate population(s) (race, ethnicity, sex, LGBTQ)
IMPLEMENTATION: Increased availability of substance use prevention services to high-need subpopulation(s) (age, residential area, SES, other)
IMPLEMENTATION: Increased access to substance use prevention services to disparate population(s) (race, ethnicity, SES, other)
IMPLEMENTATION: Increased access to substance use prevention services to high-need subpopulation(s) (age, residential area, SES, other)
EVALUATION: Assessed changes in outcomes by populations that face behavioral health disparities related to substance use.
EVALUATION: Assessed changes in the number of individuals in the disparate population served or reached. (race, ethnicity, sex, LGBTQ)
EVALUATION: Assessed changes in the number of individuals in the high-need subpopulation served or reached. (age, residential area, SES, other)
SUSTAINABILITY: Developed a plan to ensure that the progress made in addressing substance use-related behavioral health disparities is sustained beyond the grant program initiative
Other Behavioral Health Disparities Accomplishment (provide title in description box below)

Describe the Accomplishment

Free text

Item	Response Options
In the SPARS data collection system, there will be an “Add” button for this section. Grantees will be able to click that button to add additional barriers/challenges as needed.
Barriers/Challenges
Barrier/ Challenge Name	Barrier/Challenges ASSESSMENT: Difficulty defining the disparate population(s) (race, ethnicity, sex, LGBTQ) ASSESSMENT: Difficulty obtaining data on needs or outcomes for disparate population(s) (race, ethnicity, sex, LGBTQ) ASSESSMENT: Difficulty obtaining data on needs or outcomes for high-need subpopulations (age, residential area, SES, other) ALL: Difficulty engaging the population(s) experiencing substance use-related behavioral health disparities in assessment, capacity building, planning, implementation, evaluation, or dissemination efforts ALL: Problems understanding or applying National Standards for Culturally and Linguistically Appropriate Services (CLAS) to grant program activities CAPACITY: Difficulty developing coalitions or strategic partnerships with other agencies or key stakeholders to address substance use-related behavioral health disparities in your state, tribe, or jurisdiction CAPACITY: Low capacity among subrecipients to address behavioral health disparities issues CAPACITY: Difficulty finding or providing appropriate training for communities to address behavioral health disparities IMPLEMENTATION: Lack of interventions specific to the disparate population(s) (race, ethnicity, sex, LGBTQ) IMPLEMENTATION: Lack of interventions specific to the high-need subpopulation(s) (age, residential area, SES, other) IMPLEMENTATION: Inability to adapt interventions to make them applicable to specific behavioral health disparities of disparate and high-need subpopulation(s) EVALUATION: Lack of data to assess changes in outcomes by populations that face behavioral health disparities related to substance use. EVALUATION: Lack of data to assess changes in the number of individuals in the disparate population served or reached. (race, ethnicity, sex, LGBTQ) EVALUATION: Lack of data to assess changes in the number of individuals in the high-need subpopulation served or reached. (age, residential area, SES, other) Other Behavioral Health Disparities Barrier (provide title in description box below)
Describe the Barrier/Challenge	Free text
Was technical assistance (TA) requested to help address this Barrier/Challenge?	Yes No

Item

Response Options

Date TA Requested (If YES is selected)

NOTE: If you received TA for this issue, please report it on the Capacity > Training and

Technical Assistance page.

Date

In what other ways did you

address this Barrier/Challenge?

Free text

Implementation

Implementation is the point at which you or your subrecipient communities conduct your intervention activities.

Accomplishments and Barriers/Challenges

Use this section to enter information on any Accomplishments and/or Barriers/Challenges that you or your subrecipients experienced while performing activities related to Implementation. Each Accomplishment or Barrier will be listed in a table. Use the table heading links to sort Accomplishments/Barriers/Challenges by column. Click on the Name that you've assigned to each Accomplishment or Barrier to edit that record. You will also report on actions taken to resolve Barriers/Challenges related to Implementation during this reporting period.

Only update this section if you or your subrecipients conducted Implementation- related activities or faced new Implementation-related Barriers/Challenges during this reporting period, for example if you funded subrecipients or if your subrecipient communities began implementing interventions.

Item	Response Options
In the SPARS data collection system, there will be an “Add” button for this section. Grantees will be able to click that button to add additional accomplishments as needed.
Accomplishments
Accomplishment Name	Accomplishments Leadership or political commitment to the issue among stakeholders Developed effective stakeholder partnerships (e.g., between state agencies, and community and partner organizations) Monitoring the development and implementation of community- level strategic plans Developing a process for selection of evidence-based policies, programs, and practices Obtaining evidence that selected interventions are proven effective in research settings and communities Selection of evidence-based interventions (policies, programs, practices) Adapting interventions to ensure cultural competence while preserving core program elements Grantee-level interventions being implemented Specific community-level interventions being implemented Developed efficient systems for distributing tangible resources (e.g., naloxone kits) Successfully recruited appropriate intervention attendees Implemented policies within organizations to facilitate interventions Monitoring the implementation of interventions Ensured interventions implemented with consistency and fidelity Other Implementation Accomplishment (provide title in description box below)
Describe the Accomplishment	Free text

Item	Response Options
In the SPARS data collection system, there will be an “Add” button for this section. Grantees will be able to click that button to add additional barriers/challenges as needed.
Barriers/Challenges
Barrier/Challenge Name	Barrier/Challenges Major external community events like weather disasters Lack of collaboration between stakeholders (e.g., between agencies, between coalitions, between jurisdictions and funded community levels) Limited stakeholder support for the program plan No leadership or political commitment to the issue State/Tribal/Jurisdictional contract or other delays getting sub- recipient communities on board Inadequate funds to thoroughly implement SPF model Inadequate knowledge of evidence-based programs, policies, and practices that are relevant for our goals Limited evidence-based programs, policies, and practices that are relevant for our goals Need to adapt evidence-based programs, policies, and practices for our local culture and context Lack of information on how to incorporate cultural competencies Logistical barriers to purchasing/distributing tangible resources (e.g., naloxone kits) Logistical barriers to providing interventions (e.g. lack of space) Interventions not well attended by desired audience Difficulties getting schools, law enforcement, medical facilities, or other organizations on board for implementation Staffing challenges (e.g., hiring delays, lack of adequate skills, turnover) Inadequate time for project staff and members to devote to the project Limited time to implement this Strategic Prevention Framework step Other Implementation Barrier (provide title in description box below)
Describe the Barrier/Challenge	Free text
Was technical assistance (TA) requested to help address this Barrier/Challenge?	Yes No
Date TA Requested (If YES is selected) NOTE: If you received TA for this issue, please report it on the Capacity > Training and Technical Assistance page.	Date
In what other ways did you address this Barrier/Challenge?	Free text

Subrecipient Progress

Item	Response Options
Select Subrecipient	Subrecipient 1 Subrecipient 2 Etc.
Briefly describe where this Subrecipient is in the process and their accomplishments to date	Free text

Promising Approaches and Innovations

Use this section to enter information on any promising approaches or innovations demonstrated during your implementation of the grant.

Only update this section if you implemented new promising approaches or innovations during this reporting period.

Item	Response Options
In the SPARS data collection system, there will be an “Add” button for this section. Grantees will be able to click that button to add additional approaches or innovations as needed.
Select Subrecipient (This question will only be visible if you entered subrecipients in the administration section. If not, it is assumed the approach or innovation being reported is at the grantee level)	Subrecipient 1 Subrecipient 2 Etc.
Promising Approach or Innovation Name	Free text
Briefly describe the promising approach or innovation implemented	Free text

Evaluation

The Evaluation Step is comprised of conducting, analyzing, reporting on and using the results of outcome evaluation. Outcome evaluation involves collecting and analyzing information about whether the intended Goals and Objectives were achieved. Evaluation results identify areas where modifications to prevention strategies may be needed, and can be used to help plan for sustaining the prevention effort as well as future endeavors.

Evaluation Plan Upload

Upload and provide a brief description of your document. Use the Browse button to select a file from your computer, use the upload button to add your document, enter a description, then click the Save button. If your document has not changed since your previous upload, then you do not need to upload a new document.

Item	Response Options
Upload Evaluation Plan	Browse button
Description	Free text

Evaluation Report

Item	Response Options
Upload Final Evaluation Report	Browse button
Description	Free text

Accomplishments and Barriers/Challenges

Use this section to enter information on any Accomplishments and/or Barriers/Challenges that you experienced while performing activities related to Evaluation. Each Accomplishment or Barrier will be listed in a table. Use the table heading links to sort Accomplishments/Barriers/Challenges by column. Click on the Name that you've assigned to each Accomplishment or Barrier to edit that record.

You will also report on actions taken to resolve Barriers/Challenges related to Evaluation during this reporting period.

Only update this section if you or your subrecipients conducted Evaluation-related activities or faced new Evaluation-related Barriers/Challenges during this reporting period.

Item	Response Options
In the SPARS data collection system, there will be an “Add” button for this section. Grantees will be able to click that button to add additional accomplishments as needed.
Accomplishments
Accomplishment Name		Accomplishments Monitor and evaluate all program activities Development and implementation of community-level evaluation Assess program effectiveness Ensure service delivery quality Encourage needed improvement Promote sustainability of outcomes Identify successes Other Evaluation Accomplishment (provide title in description box below)
Describe the Accomplishment		Free text

Item	Response Options
In the SPARS data collection system, there will be an “Add” button for this section. Grantees will be able to click that button to add additional barriers/challenges as needed.
Barriers/Challenges
Barrier/Challenge Name		Barrier/Challenges Major external community events like weather disasters Lack of collaboration between stakeholders (e.g., between agencies, between coalitions, between jurisdictions and funded community levels) State/Tribal/Jurisdictional contract or other delays getting sub-recipient communities on board Lack of cooperation/follow-through by communities/subrecipients/partners in collecting data Challenges in development and implementation of community-level evaluation Under-development of existing data or performance monitoring infrastructure Lack of available data to assess differences for racial/ethnic minorities LGTBQ, or other special populations Lack of available data to meet national cross-site evaluation or monitoring requirements Mismatch between level available data (e.g., county) and communities being funded (e.g., towns within counties) Other data or data collection challenges No capacity for monitoring objectives and goals Challenges assessing program effectiveness Challenges identifying successes Lack of data analysis or evaluation expertise Delays in hiring evaluator Inadequate time for project staff and members to devote to the project Limited time to implement this Strategic Prevention Framework step Other Evaluation Barrier (provide title in description box below)
Describe the Barrier/Challenge		Free text
Was technical assistance (TA) requested to help address this Barrier/Challenge?		Yes No
Date TA Requested (If YES is selected) NOTE: If you received TA for this issue, please report it on the Capacity > Training and Technical Assistance page.		Date
In what other ways did you address this Barrier/Challenge?		Free text

Sustainability

Sustainability is the process of ensuring an adaptive and effective system that achieves and maintains long-term results. Sustainability efforts may include the institutionalization of policies and practices, the acquisition of stable funding for training and prevention efforts, continued workforce development, and other efforts.

Accomplishments and Barriers/Challenges

Use this section to enter information on any Accomplishments and/or Barriers/Challenges that you experienced while performing activities related to Sustainability. Each Accomplishment or Barrier will be listed in a table. Use the table heading links to sort Accomplishments/Barriers/Challenges by column. Click on the Name that you've assigned to each Accomplishment or Barrier to edit that record.

You will also report on actions taken to resolve Barriers/Challenges related to Sustainability during this reporting period.

Only update this section if you conducted Sustainability-related activities or faced new Sustainability-related Barriers/Challenges during this reporting period.

Item	Response Options
In the SPARS data collection system, there will be an “Add” button for this section. Grantees will be able to click that button to add additional accomplishments as needed.
Accomplishments
Accomplishment Name	Accomplishments Establishment of key ongoing policies Planning for sustaining the infrastructure Leveraging funding and other resources to ensure sustainability of efforts Training grantee-level stakeholders and administrators on the importance of program activities Other Sustainability Accomplishment (provide title in description box below)
Describe the Accomplishment	Free text

Item	Response Options
In the SPARS data collection system, there will be an “Add” button for this section. Grantees will be able to click that button to add additional barriers/challenges as needed.
Barriers/Challenges
Barrier/Challenge Name	Barrier/Challenges No leadership or political commitment to sustaining program activities No coordination of funds to ensure sustainability of program activities No capacity for leveraging of funds or in-kind donations to ensure sustainability of activities No planning for sustaining the infrastructure Under-developed data infrastructure to demonstrate outcomes in support of sustaining activities Other Sustainability Barrier (provide title in description box below)
Describe the Barrier/Challenge	Free text
Was technical assistance (TA) requested to help address this Barrier/Challenge?	Yes No
Date TA Requested (If YES is selected) NOTE: If you received TA for this issue, please report it on the Capacity > Training and Technical Assistance page.	Date
In what other ways did you address this Barrier/Challenge?	Free text

Shape3

DSP-Management Reporting Tool print version— 2

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	Division of State Programs-Management Reporting Tool (DSP-MRT) Common Monitoring Tool
Subject	The Division of State Programs-Management Reporting Tool (DSP-MRT), to be used for all Center for Substance Abuse Prevention (CS
Author	Substance Abuse and Mental Health Services Administration, Cente
File Modified	0000-00-00
File Created	2021-10-17

Form DSP-MRT Standard T DSP-MRT Standard T DSP-MRT Standard Tool

Division of State Programs—Management Reporting Tool (DSP-MRT)

DSP-MRT Attachment _1 Revised 4-23-21

DSP-MRT Standard Tool

OMB: 0930-0354

OMB No: XXXX-XXXX

Expiration Date: XX/XX/XXXX

Administration

Grantee Information

Sub-State Information

Subrecipients

High-Need Communities

Needs Assessment

Needs Assessment

Accomplishments and Barriers/Challenges

Capacity

Membership

Advisory Council and Other Workgroup Meetings

Grantee Funding Resources

Training and Technical Assistance (TA)

Accomplishments and Barriers/Challenges

Planning

Strategic Plan

Accomplishments and Barriers/Challenges

Behavioral Health Disparities

Disparities Impact Statement (DIS)

Population(s) Experiencing the Disparity

Focus and Data Gaps

Access to Prevention Efforts

Use and Reach of Prevention Efforts

Outcomes of Prevention Efforts

Accomplishments and Barriers/Challenges

Implementation

Accomplishments and Barriers/Challenges

Subrecipient Progress

Promising Approaches and Innovations

Evaluation

Evaluation Plan Upload

Evaluation Report

Other Document Upload

Accomplishments and Barriers/Challenges

Sustainability

Accomplishments and Barriers/Challenges