Form PFS Supplemental PFS Supplemental PFS Supplemental

Division of State Programs–Management Reporting Tool (DSP–MRT)

DSP–MRT Supplement for PFS Grants

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is XXXX–XXXX. Public reporting burden for this collection of information is estimated to average 3 hours per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 5600 Fishers Lane, Room 15E57A, Rockville, MD 20857.

Contents

Evidence-Based Practices, Policies, and Programs (EBPPPs) 1

Grantee-Level Evidence-Based Practices, Policies, and Programs (EBPPPs) 1

Subrecipient-Level Evidence-Based Practices, Policies, and Programs (EBPPPs) 2

Community Outcomes 3

Survey Data 4

Response Data 5

Administrative Data 6

Add/Edit Community-Level Outcome Data for Subrecipients 7

Response Data 8

Substitute Data Source Request 10

Substitute Data Source Request Detail 11

Additional Fields for Survey Data Sources Only 13

Notes 14

Note: This document is intended as a supplement to the Division of State Programs– Management Reporting Tool (DSP–MRT) for the Partnerships for Success (PFS) grant program. Please refer to the DSP–MRT document where applicable.

Evidence-Based Practices, Policies, and Programs (EBPPPs)

Use this section to report Evidence-Based Practices, Policies, and Programs (EBPPPs) and the numbers served and reached through your prevention interventions. EBPPPs are interventions that come from a federal registry, were reported as being effective for your target substance in a published scientific journal article, were based on a documented theory of change, or were deemed effective by a panel of experts.ⁱ A panel of experts may include qualified prevention researchers, local prevention practitioners, and key community leaders (such as law enforcement and education representatives, elders within indigenous

cultures).

NEW MEASURE: What are the Evidence-Based Practices, Policies, or Programs (EBPPs) you intend to
implement through this grant? Who is the intended audience? What is the non-duplicative number of
individuals you intend to serve each year of your grant?
Data Item		Response Options
Did you or your subrecipients actively deliver any Prevention Interventions that are evidence-based programs, policies, or practices (EBPPP)ii during the last fiscal year?		Yes No
If no, explain why?		Free text

Grantee-Level Evidence-Based Practices, Policies, and Programs (EBPPPs)

Data Item	Response Options
Status of Intervention	Active Inactive
Prevention Intervention Name	Drop-down menu with prevention intervention names
Was this EBPPP intervention actively implemented in this community prior to receiving funding for this grant?	Yes No
Target of the Intervention	Alcohol Prescription Drug Misuse Marijuana Opioids Other

Data Item	Response Options
Other (Please specify)	Free text
Number Servediii	Open-ended numerical response
Number Reachediv	Open-ended numerical response

REMINDER: After completing the required information, select “Add EBPPP” to add the entry to your list, then select “Save.” After you add the EBPPP, it will appear on the EBPPP main screen.

Subrecipient-Level Evidence-Based Practices, Policies, and Programs (EBPPPs)

Data Item	Response Options
Select Subrecipient	Drop-down menu with subrecipient names
Status of Intervention	Active Inactive
Prevention Intervention Name	Drop-down menu with prevention intervention names
Was this EBPPP intervention actively implemented in this community prior to receiving funding for this grant?	Yes No
Target of the Intervention	Alcohol Prescription Drug Misuse Marijuana Opioids Other
Other (Please specify)	Free text
Number Served	Free text
Number Reached	Free text

REMINDER: After completing the required information, select “Add EBPPP” to add the entry to your list, then select “Save.” After you add the EBPPP, it will appear on the EBPPP main screen.

Community Outcomes

Use this section to enter community outcome data for your subrecipients. Grantees that do not have subrecipients will also use this section to enter grantee-level outcome data. When you are ready to begin entering data for your subrecipients, select a subrecipient from the drop-down menu. Once you add records, you will be able to view previously added records for the selected subrecipient.

Community outcomes data include survey data and administrative data:

• Survey data is data collected from individuals, usually a sample of the population, by asking questions either in person, on paper, by phone, or online. Examples of survey data include the National Survey of Drug Use and Health (NSDUH), Youth Risk Behavior Survey (YRBS), and Behavioral Risk Factor Surveillance System (BRFSS).

• Administrative data refers to information collected primarily for administrative— not research—purposes. Government departments and other organizations often collect this type of data for the purposes of registration, transaction, and record keeping, and often the data include program outcome indicators. Examples of administrative data include educational records, client information from financial institutions, and hospital records of patient visits and health outcomes.

If you are providing data to meet requirements for a specific PFS Required Outcome Measure, and your data source does not match the PFS Required Outcome exactly (survey item wording/response options or administrative data measure calculation) nor does the data source match the list of acceptable PFS Required Outcome Measure substitutes, you must receive approval from your Project Officer for the substitute data source. Use the Substitute Data Source Request Page to submit a request for review and approval.

Survey Data

Survey data is data collected from individuals by asking questions either in person, on paper, by phone, or online. Examples of survey data include the NSDUH, YRBS, and BRFSS.

To enter Survey Data, select “Add Data Source,” enter the name of the survey, and select “Save.”

Fields that Appear if "Survey data" Is Selected in the Data Source Type Field
Data Item	Response Options
Data Source Name	Free text
Specified Substance	Alcohol Prescription drugs Other
Other (If “Other” is selected for Specified Substance)	Free text
PFS Required Outcome Measure	Alcohol Outcome Measure Response Options 30-day use Binge drinking Perception of parental or peer disapproval/attitude Perceived risk/harm of use Substance-related car crashes and injuries Substance-related crime Family communication Substance-related emergency room visits Other Prescription Drug Outcome Measure Response Options 30-day use Past 12-month use Perception of parental or peer disapproval/attitude Perceived risk/harm of use Substance-related car crashes and injuries Substance-related crime Family communication Substance-related emergency room visits Other

Fields that Appear if "Survey data" Is Selected in the Data Source Type Field
Data Item	Response Options
	Other Substance Outcome Measure Response Options 30-day use Perception of parental or peer disapproval/attitude Perceived risk/harm of use Substance-related car crashes and injuries Substance-related crime Family communication Substance-related emergency room visits Other
Other Outcome Measure	Free text
Are you reporting an exact PFS Required Outcome, an approved substitute PFS Required Outcome, or neither?	Exact PFS Required Outcome Measure Approved substitute PFS Required Outcome Measure Not a PFS Required Outcome Measure or approved substitute
Survey Item	Free text
Response Option	Free text
Reported Outcome Description	Free text

• Click on “Add Follow-up Data” to add follow-up data for a previously entered baseline record.

• To edit existing records, click “Edit” next to the Survey Item name.

• To enter Subrecipient Survey Response Data, select “Add Subrecipient Response Data.”

• If you are entering survey data at the grantee level, select “Add Baseline Response Data.”

Response Data

Data Item	Response Options
Subrecipient [Item only appears if applicable]	Drop-down menu with subrecipient names
Data Collection Date	Date Field
Population Parameters	Age range Grades
Age Range Minimum (If “Enter age range” is selected for Population Parameters)	Numerical
Age Range Maximum (If “Enter age range” is selected for Population Parameters)	Numerical

Data Item	Response Options
Grades (If “Enter grade[s]” is selected for Population Parameters) (Check all that apply)	□ K □ 1 □ 2 □ 3 □ 4 □ 5 □ 6 □ 7 □ 8 □ 9 □ 10 □ 11 □ 12 □ College
Other Sample Descriptors	Free text
Description of Sampling Design	Census Convenience sample Random sample Stratified random sample
Multiple Year Pooled Estimate	Yes No
Multiple Year Estimate Description: (If “Yes” is selected)	Free text
Value Type	Mean Percentage Other
Other (Please specify)	Free text
Calculated Value	Numerical
Standard Error	Numerical
Standard Deviation	Numerical
Survey Item Valid N	Numerical
Comments	Free text

Administrative Data

Administrative data is data collected for the purposes of registration, transaction, and record keeping, but often also includes indicators of program outcomes. Examples of

administrative data include educational records, client information from financial institutions, and hospital records of patient visits and health outcomes.

To enter Administrative Data, select “Add Data Source,” enter the name of the new data source, and select “Save.”

Add/Edit Community-Level Outcome Data for Subrecipients

Data Item	Response Options
Data Source Name	Free text
Specified Substance	Alcohol Prescription drugs Other
Other Substance (If “Other” is selected)	Free text
PFS Required Outcome Measure	Alcohol Outcome Measure Response Options 30-day use Binge drinking Perception of parental or peer disapproval/attitude Perceived risk/harm of use Substance-related car crashes and injuries Substance-related crime Family communication Substance-related emergency room visits Other Prescription Drug Outcome Measure Response Options 30-day use 12-month use Perception of parental or peer disapproval/attitude Perceived risk/harm of use Substance-related car crashes and injuries Substance-related crime Family communication Substance-related emergency room visits Other

Data Item	Response Options
	Other Substance Outcome Measure Response Options 30-day use Perception of parental or peer disapproval/attitude Perceived risk/harm of use Substance-related car crashes and injuries Substance-related crime Family communication Substance-related emergency room visits Other
Other Outcome Measure	Free text
Are you reporting an exact PFS Required Outcome, an approved substitute PFS Required Outcome, or neither?	Exact PFS Required Outcome Measure Approved substitute PFS Required Outcome Measure Not a PFS Required Outcome Measure or approved substitute
Reported Outcome/Measure Calculation Description	Free text

• Click on “Add Follow-up Data” to add follow-up data for a previously entered baseline record.

• To edit existing records, click “Edit.”

• To enter Subrecipient Administrative Response Data, select “Add Subrecipient Response Data.”

• If you are entering administrative data at the grantee level, select “Add Baseline Response Data.”

Response Data

Fields that Appear if "Administrative data" Is Selected in the Data Source Type Field
Data Item	Response Options
Select Subrecipient* [Item only appears if applicable]	Drop-down menu with subrecipient names
Data Source Time Frame Begin Date	Date field
Data Source Time Frame End Date	Date field
Population Parameters	Age range Grade(s)
Age Range Minimum (If “Enter age range” is selected for Population Parameters)	Numerical
Age Range Maximum (If “Enter age range” is selected for Population Parameters)	Numerical

Fields that Appear if "Administrative data" Is Selected in the Data Source Type Field
Data Item	Response Options
Grades (If “Enter grade[s]” is selected for Population Parameters) (Check all that apply)	□ K □ 1 □ 2 □ 3 □ 4 □ 5 □ 6 □ 7 □ 8 □ 9 □ 10 □ 11 □ 12 □ College
Other Sample Descriptors	Free text
Number of Events	Numerical
Denominator Definition	Free text
Denominator Value	Numerical
Value Type	□ Percentage □ Rate per 1,000 □ Rate per 10,000 □ Rate per 100,000 □ Other
Other Value Type* (If “Other” is selected)	Free text
Calculated Value	Numerical
Comments	Free text

Substitute Data Source Request

Use this section to obtain approval from your State Project Officer for the use of substitute outcome measures in place of PFS Required Outcome Measures.

Note that SAMHSA only requires grantees to submit a substitute data request for measures that they are using to meet the annual exact/substitute measure requirement (one annual measure for alcohol and one for prescription drugs for each community). You do not need to submit a substitute data request for any of the other/additional measures you plan to submit.

To begin the substitute measure approval process:

First, decide whether SAMHSA is likely to approve your proposed substitute. To review the PFS Required Outcome Measures, review appendix A, table A.2 in the Division of State Programs–Management Reporting Tool (DSP–MRT) Question-by-Question Instruction Guide for Strategic Prevention Framework–Partnerships for Success (SPF–PFS) Grantees. For a comparison between PFS Required Outcome Measure survey items and items from commonly used surveys, see table A.3.

Note: If table A.3 lists an item as an acceptable PFS Required Outcome Measure substitute, you will not need to submit a substitute data request for the measure. If an item is not an acceptable PFS Required Outcome Measure, SPARS will not accept that item as a substitute data source.

To submit a Substitute Data Request through SPARS, go to your SPARS Dashboard and select the plus sign (+) next to Substitute Data Request in the Work Plans section, then select “View” to open the section.

Substitute Data Source Request Detail

To submit a Substitute Data Request for Survey Data, select the arrow next to Survey Data and then select “Add Data Source.” To submit a request for Administrative Data, select the arrow next to Administrative Data and then select “Add Data Source.”

Data Item	Response Options
Label of the PFS Required Outcome Measure(s) indicator for which grantee is requesting a substituted proxy measure (e.g., 30-day use of alcohol)	Survey Data Response Options 30-day alcohol use 30-day prescription drug misuse Past-year prescription drug misuse Binge drinking Perception of parental or peer disapproval/attitude Perceived risk/harm of use Family communication around drug use Other Administrative Data Response Options School attendance and enrollment Alcohol- and/or drug-related car crashes and injuries Alcohol- and drug-related crime Alcohol- and prescription drug-related emergency room visits
Data source name	Free text
Exact wording of the proxy item and response options the grantee is requesting to substitute for the PFS Required Outcome Measure	Free text
Exact wording of the outcome that will be reported to SAMHSA/CSAP	Free text
Formulae for calculating or deriving the prevalence estimate (reported outcomes)	Free text
Summarize how the collection and reporting of community-level PFS Required Outcome Measure was written in your approved PFS Strategic Plan, if applicable	Free text
Does the requested substitution differ from what was written in your approved PFS Strategic Plan?	Yes No
If yes, why? (If “Yes” is selected)	Free text
Reason for the substitution request	Free text
Agency/organization responsible for data collection	Free text

Fields that Appear if "Survey data" Is Selected in the Data Source Type Field
Data Item	Response Options
Were there validity and reliability tests of the survey items constituting the substitute measure?	Yes No
Description of the reliability/validity study(ies): (If “Yes” is chosen)	Free text
Are there any published validity/reliability studies for this instrument?	Yes No
Bibliographic Information: (If “Yes” is chosen)	Free text
Substitute Data Source Request Supporting Document	Upload feature
For each data file, describe the contents of the data record(s) field that will be displayed.	Free text

• Select “Save” to add your data source. Your outcome measure will then appear in the list of data sources.

• If you are entering community outcomes at the subrecipient level, select “Add Subrecipient Response Data” to complete data entry to the substitute data request.

• If you are entering community outcome data at the grantee level, select “Add Baseline Response Data.”

Data Item	Response Options
In the MRT, grantees will select their subrecipients from a prepopulated list to access the following required items for submitting a substitute data source request.
Subrecipient* [item only appears if applicable.]	Drop-down menu
Do the data approximate the community (e.g., county, city, town, school) where SPF–PFS interventions are delivered?	Yes No
If no, indicate how they differ (If “No” is selected)	Free text
Most recent month and year for which data are available?	Date field
Is there a data point collected at least 6 months prior to the implementation of SPF–PFS interventions in the community? (i.e., a baseline prevalence estimate)	Yes No
Is the data collection repeated every year?	Yes No
Frequency of data collection (If “No” is selected)	Free text
Are trend data available?	Yes No
Start year of trend data (If “Yes” is selected)	Date field

Additional Fields for Survey Data Sources Only

Data Item	Response Options
Fields that Appear if "Survey data" Is Selected in the Data Source Type Field in the Previous Section
Date of Data Collection	Date field
Sample Size	Numerical
Sampling Ratio	Free text
What type of sampling strategy was used to select respondents?	Census Convenience sample Random sample Stratified random sample
If “Random sample” or “Stratified random sample” is selected:
Stratified Sampling – Identify each stratum	Free text
Cluster Sampling – Identify the clustering unit	Free text

Data Item	Response Options
Multistage design – Identify the unit sampled at each stage	Free text
Potential sources of bias in the sample design	Free text
Method of Administration	Mail-in Telephone Face-to-Face Self-administered: school-based Self-administered: survey site other than school Other
Other Method (Specify) (If “Other” is selected)	Free text
Was this a computer-assisted interview?	Yes No
What was the survey response rate?	Free text

Once your Substitute Data Request data entry is complete, return to your Dashboard in SPARS, select the gear icon under “Actions” next to Substitute Data Request, and select “Submit to Project Officer.” Enter your information in the submission form that appears and select “Submit.”

Notes

ⁱ Panel of Experts: Panel of Experts may include qualified prevention researchers, local prevention practitioners, and key community leaders (e.g., law enforcement and education representatives, elders within indigenous cultures).

ⁱⁱ Evidence-Based Practices, Policies, and Programs: EBPPPs are interventions that come from a federal registry, were reported

as effective for your target substance in a published scientific journal article, were based on a documented theory of change, or were deemed effective by a panel of experts.

ⁱⁱⁱ Number Served: Refers to individual-based prevention strategies or services directly delivered to individuals, either on a one- on-one basis or in a group format. Typically, the service provider and the participant are at the same location during the service encounter. Since providers have direct interaction with these individuals, they are able to keep accurate counts and in many cases, to collect data about the characteristics and outcomes of these participants through attendance lists and pre-post surveys. Examples include training sessions and educational classes.

^iv Number Reached: Refers to population-based prevention strategies aimed at impacting an entire population. Since there is no direct interaction with the populations affected by the services, counts of people reached are typically estimates obtained from sources such as the census (the population of the targeted community) or media outlets (estimated readership or audience size).