Attachment 5_P DFC Attachment 5_P DFC Progress Report Core Measures_2022

Drug Free Communities Support Program National Evaluation

Attachment 5_P DFC Progress Report Core Measures_2022_August.25docx

OMB: 3201-0012

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Attachment 5:

Revised Drug-Free Communities
Progress Report and Core Measures

Bi-Annual Progress Report
Mock-Up

October 2022

OMB Control Number: 3201-0012; Expiration Date: 1/31/2023

The public reporting burden for each Progress Report is estimated to be 24 hours (including core measures collection and reporting). 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.

COALITION INFORMATION
Sub-section: Grant Award Information
Award Number: (Note: this field will be auto-populated and cannot be changed without approval from your Government Project Officer) Grant Recipient Name: (Linked to AOR/Business official) name Recipient address: (Note: these fields will be auto-populated and cannot be changed without approval from your Government Project Officer) Coalition Name: (Note: this field will be auto-populated and cannot be changed without approval from your Government Project Officer) Coalition Address: (Note: this field will be auto-populated and cannot be changed without approval from your Government Project Officer) Year of First DFC Award: (Note: this field will be auto-populated and cannot be changed without approval from your Government Project Officer) What is the month and year the coalition was first established? MM/YYYY
Sub-section: Key Personnel Information
Authorized Organization Representative (AOR)/Business Official: Name, Email and phone (Note: these fields will be auto-populated and cannot be changed without approval from your Government Project Officer) Project Director/Principal Investigator Information: Name, email, and phone (Note: these fields will be auto-populated and cannot be changed without approval from your Government Project Officer) Project Coordinator Contact Information: Name, Email, phone: (Note: these field will be auto-populated and cannot be changed without approval from your Government Project Officer) Day/Month/Year (approximate day) Project Coordinator took current position: ____/_____/____ Did your project coordinator change during this reporting period? No Yes If yes, please provide the day/month/year (approximate day) your previous Project Coordinator left the position: ____/_____/__
What is the level of effort for your Project Director/Principal Investigator on this grant? _______% (0-100%) Is your PD/PI working with any other DFC coalitions? (if no, move to next item; if yes, ask information about the other grant, then ask again if working with other questions until says no) No Yes If yes, please provide the grant number and name of the other coalition and level of effort on each: Grant number: _________ Coalition Name: ____________________ Level of Effort: ______(0-100%) What is the level of effort for your Project Coordinator on this grant? _______% (0-100%) Is your project coordinator the coordinator for another DFC coalition? (if no, move to next item; if yes, ask information about the other grant, then ask again if working with other questions until says no) No Yes If yes, please provide the grant number and name of the other coalition and level of effort on each: Grant number: _________ Coalition Name: ____________________ Level of Effort: ______(0-100%)
Sub-section: Social Media
Please provide your coalition’s social media contact information for the following, if applicable: Twitter handle: ____________________ Instagram handle: _________________________ Facebook page/URL: ______________________ Coalition website (URL) ______________________
Sub-section: Other Grant Information
If your coalition is a SPF/SIG subrecipient, please enter your grant number. Our coalition is not a SPF/SIG subrecipient Our SPF/SIG subrecipient grant number is ____________ If your coalition is a STOP Act grant award recipient, please enter your grant number. Our coalition is not a STOP Act grant award recipient Our STOP Act grant number is ____________
Sub-section: High-Intensity Drug Trafficking Area (HIDTA)
Coalition Located in a HIDTA Region: (Note this field will be missing for first report and then will be prepopulated based on zip codes served. Any overlap between zip codes served with HIDTA will be considered as located in a HIDTA. If overlap, future reports will include which HIDTA(s) located in. If no overlap, No will be entered). HIDTA: Does your coalition actively work with a local High Intensity Drug Trafficking Areas (HIDTA) Program? No Yes If Yes, select from drop-down list to indicate which HIDTA working with If Yes, please describe your work with HIDTA: (OPEN TEXT BOX)

Sub-section: Elevator Speech
ELEVATOR SPEECH Please provide a brief summary of your coalition. This is your "Elevator Speech". Include a brief sentence on: (a) your community and population(s) of focus/primary goals, b) something that makes your coalition unique, c) the activities you are focusing on, d) key accomplishments to date and successes concerning goal achievement, e) key challenges to achieving goals, and. (Maximum of 2,000 characters with spaces)
Needs Assessment Needs Assessment refers to the decisions your coalition has made concerning the major community areas and populations you want to serve, the major problems upon which you want to focus, 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.
Sub-section: Settings
Geographic setting(s) served (check all that apply): Inner City Urban Suburban Rural Frontier	Community setting(s) served (check all that apply):
	City Multiple Cities Town Multiple Towns Neighborhood Multiple Neighborhoods		County Region or Other Subsection of a State Statewide Native American/American Indian/Alaskan Native Reservation Military Colleges & Universities
School Setting Served (select most applicable) Single School in a Single District Multiple Schools in a Single District Multiple Schools in Multiple Districts Not currently serving any schools/districts directly
Grade level(s) served (check all that apply):
Elementary school (K-5)		6^th grade 7^th grade 8^th grade		9^th grade 10^th grade 11^th grade 12^th grade
Sub-section: ZIP Codes Served/Congressional District
Please review the zip code(s) served by your coalition: (ZIP codes served must be entered in first Progress Report post award then information will be pre-populated by system). Please edit as appropriate. (Open text, must enter five-digit ZIP code(s) separated by commas)
Note: Please confirm congressional district(s) by entering your information here: https://www.house.gov/representatives/find-your-representative What is the congressional district associated with your coalition address? (Note: Coalition will select state and then two-digit district from drop down list). What is/are the congressional district(s) associated with the zip code(s) served by your coalition? (Note: Coalition will select state and then two-digit district from drop down list. Will enter as many as needed).

Sub-section: Diversity and Health Equity
The DFC NOFO defines health equity as: Striving for the highest possible standard of health for all people and giving special attention to the needs of those at greatest risk of poor health, based on social conditions.

Does your coalition work to tailor at least some information/prevention efforts to the needs of youth/people from any of the following racial, ethnic, sexual, or other minority group groups? (NOTE: These should be youth/people actively engaged with the coalition and/or with whom coalition implements activities/services, not just community demographics. Not applicable should be selected ONLY when the given group is not present in your community.)

	Yes	No	Not Applicable
American Indian or Alaska Native
Asian/Asian-American
Black/African American
Hispanic/Latina/o/x
Native Hawaiian or Other Pacific Islander
White, Non-Hispanic
Lesbian, Gay, Bisexual, Transgender, Queer, Questioning Youth/People
Optional: Other (Please specify): _______________________________
Optional: Other (Please specify): _______________________________
Optional: Other (Please specify): _______________________________

Is the coalition working towards identifying and/or addressing diversity and/or health equity issues in your community?

Not applicable/No diversity and/or health equity issues identified
No/Not at all (Issue identified but not working to address)
Yes

If yes, to what extent Is the coalition working towards identifying and/or addressing health equity in each of the following?	Not applicable/ No health equity issues identified	Not at all (Issue identified but not working to address)	Slight Extent	Moderate Extent	Great Extent
Race/Ethnicity
Socioeconomic Status (financial, educational, social status)
Sexual Orientation /Gender Identity
Geographic (e.g., rural, urban)
Other equity issue, please describe ______________

How effective do you perceive your coalition’s efforts to address diversity and health equity have been in each of the following areas:	Not Applicable	Very Ineffective	Somewhat Ineffective	Somewhat Effective	Moderately Effective	Very Effective
Diversity in coalition leadership and sector representatives that are representative of the community
Diversity in participants in coalition activities representative of the community
Building Capacity with regard to addressing equity
Engaging in Assessment that informs coalition about equity challenges in the community
Planning with a focus on Equity
Implementation with a focus on Equity
Evaluation with a focus on Equity
Sustainability with a focus on Equity
Addressing Adverse Childhood Experiences
Overall
Other (Please describe) ______________
Please Describe any successes your coalition experienced related to addressing health equity during this reporting period. (Maximum of 2,000 characters with spaces)
Please Describe any challenges your coalition experienced related to addressing health equity during this reporting period. (Maximum of 2,000 characters with spaces)
Sub-section: Tribal Focus
Is your coalition located in or serving a federally recognized tribal area? Yes No 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? Yes No Do you actively involve American Indian/Alaska Native youth/people as part of coalition prevention efforts around: Needs assessment, capacity building, and planning; Yes No Implementation strategies: Yes No Data collection: Yes No
Briefly describe your work with American Indian or Alaska Native Youth/People, including any challenges you may have faced in serving these youth/people. If you are located within a federally-recognized tribal area but are not serving these youth/people, please explain why. (Maximum of 2,000 characters with spaces):

Sub-section: Substance Focus

Please select up to five (5) substances that your coalition is focusing on in your community:

Alcohol
Marijuana
Cocaine/Crack
Stimulants (uppers)
Tranquilizers
Hallucinogens

Over-the-counter (OTC) drugs
Inhalants
Steroids
Synthetic Drugs/Emerging Drugs
Prescription Drugs (Opioids)
Prescription Drugs (Non-Opioids)

Methamphetamine
Tobacco / Nicotine
Heroin / Fentanyl, Fentanyl analogs or other Synthetic Opioids

Sub-section: Risks and Protective 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. 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.
RISK FACTORS (36)	To what extent is this a risk factor in your community? No/Low Moderate High	Is your coalition engaged in efforts to address this factor in your community? Yes No	PROTECTIVE FACTORS (35)	To what extent Is this a protective factor in your community? No/Low Moderate High	Is your coalition engaged in efforts to establish/ strengthen this factor in your community? Yes No
Community Factors (12)			Community Factors (12)
Low rates of youth connection to the community; little sense that youth have a voice in the community/active in community organizations			High rates of youth connection to the community; youth have a voice in the community are actively engaged with community organizations
Few community activities for young people			Plentiful community activities for young people
Inadequate laws/ordinances related to substance use/access			Laws, regulations, and policies in place related to substance use/access
Inadequate enforcement of laws/ordinances related to substance use			Adequate law enforcement presence sufficient to enforce laws/ordinances related to substance use.
Perceived Community norms favorable toward substance use; Advertising promoting substance use highly visible in the community			Prevention Advertising and other promotion of information related to preventing/ reducing substance use highly visible in the community
Weak community organization (e.g., High rates of violence/crime, little access to safe, stable housing)			Strong community organization (e.g., low rates of crime/violence, high access to safe, stable housing)
Easy Availability of substances (drugs, tobacco, alcohol) that can be misused and/or high visibility of drug dealing			Low availability of substances (drugs, tobacco, alcohol) that can be misused; low visibility of drug dealing
High rates of poverty and limited access to educational/economic opportunities; High unemployment and/or underemployment;			High rates of economic stability and access to educational/economic opportunities
Community organizations have limited emphasis on cultural awareness, sensitivity, and inclusiveness and promoting equity			Community organizations have a strong emphasis on cultural awareness, sensitivity, and inclusiveness and promoting equity
Community supports are generally unavailable or are inequitably available (e.g., only available in certain neighborhoods or to those with economic resources)			Community supports are generally available and are equitably available (e.g., available to range of families in the community)
Lack of local treatment services for substance use and/or poor access to mental health services generally in the community			Sufficient access to mental health and treatment/recovery services in the community
Available treatment/recovery services for substance use insufficient to meet needs in timely manner			Treatment/recovery services for substance use are sufficient to meet demand in a timely manner
School, Faith, & Peer Factors (10)			School, Faith, & Peer Factors (10)
Low school connectedness: Youth do not feel a sense of connectedness to schools/teachers; Youth unlikely to have adults who are mentors/someone to confide in at school			High school connectedness: Youth feel a sense of connection to schools/teachers; Youth have adults who are mentors/someone they can confide in at school
Low commitment to attend/stay in school; High rates of truancy and/or extended time missing school or dropping out of school			High commitment to staying in school and attending school
High rates of youth struggling in school; Academic failure			High rates of youth academic success
Low access to safe, high-quality schools across the lifespan			High/Broad access to safe, high-quality schools across the lifespan
Few youth feel connected to a faith-based community or see the faith-based community as the source of a positive adult			Most youth feel connected to a faith-based community or see the faith-based community as the source of a positive adult
Poor access to a range of faith-based services in the community			Broad access to a range of faith-based services in the community
High rates of youth perceiving peer acceptability (or lack of disapproval) of substance use			Low rates of youth perceiving peer acceptability (or lack of disapproval) of substance use
Poor access to adult or peer-to-peer mentoring for youth in need of a mentor; youth have poor access to someone to turn to when help is needed in schools or peer group.			High/easy access to adult or peer-to-peer mentoring for youth in need of a mentor or someone to provide help/advise
Youth have easy access to peers who engage in negative, unhealthy, or delinquent behavior;			Youth have easy access to/strong friendships with peers who engage in positive and healthy behaviors;
High rates of bullying schools/peer group.			Low rates of bullying schools/peer group.
Family/Parent/Caregiver Factors (5)			Family/Parent/Caregiver Factors (5)
Low Family Connectedness: youth do not feel connected to their families/parents/caregivers do not perceive family as a source of support			Family connectedness (youth feel connected to families/caregivers – feel can talk to them about range of feelings/issues)
Family trauma/stress (e.g., parental/sibling substance use, domestic violence, death of family member)			Families/Parents/Caregivers engage in prosocial behaviors and maintain healthy stable relationships.
Perceived parental acceptability (or lack of disapproval) of unhealthy behaviors, including substance use			Families/Parents/Caregivers encourage youth to engage in healthy behaviors including avoiding substance use
Family/Parental/Guardian attitudes favorable to antisocial behavior			High engagement by families/parents/caregivers in monitoring and supervision of youth
Families/parents/caregivers lack ability/confidence to speak to their children about substance use			Families/parents/caregivers feel able/confident to speak to youth about healthy behaviors including avoiding substance use
Individual Factors (7)			Individual Factors (6)
High rates of youth who have experienced two or more risk factors/stressors (e.g., abuse, homelessness, school failure)			Few youth who have experienced two or more risk factors/stressors
Early initiation of negative or unhealthy behavior, including substance use			Delayed or no initiation of negative or unhealthy behavior, including substance use
Individual youth have favorable attitudes towards substance use/misuse			Youth have good life skills such as good decision-making and problem-solving skills.
Youth only follow rules around substance use when appropriately supervised; Breaks rules related to substance use across settings (school, home, other settings)			Youth generally follow and appreciate rules related to substance use at home, in school and other settings even without supervision
Youth has few if any appropriate, prosocial, healthy activities or interest.			Youth seek out and engages in available positive, healthy, or prosocial behaviors
Youth as little/no interest in education and work and has poor school and work habits that may contribute to failure.			Youth value education and work and engages in habits to succeed in these settings.
Youth experiences death of peer/classmate/lose friend
Please report any additional details about your risk factors including identifying any that were not captured above. How have you aligned implementation of your action plan with addressing local risk factors? (Maximum of 2,000 characters with spaces):
Please report any additional details about your protective factors including identifying any that were not captured above. How have you aligned implementation of your action plan with establishing or building on local protective factors? (Maximum of 2,000 characters with spaces):
Do you have any additional information about activities your coalition has engaged in to address underlying factors that may contribute to youth substance use, specifically adverse childhood experiences or mental health? No Yes If Yes, the following open-text question will be available.
Please describe any key activities your coalition has engaged in around these underlying factors. Provide as much detail as possible about the activity: What was the activity (clear description, including context if part of other activities)? Who (DFC staff/community members/sectors) was involved in planning and carrying out the activity? Who was the audience(s) for the activity? When did activity occur (including how often if more than once)? Please share any evidence that the strategy has been effective/successful to date based on the goals of the activity. Identify any challenges your coalition needed to address or is still facing that had/would need to be addressed in order for similar activities to be effective in other communities.
Sub-section: Assessment Activities Assessment - The systematic gathering and analysis of data to identify current assets, problems, and related conditions that require intervention.
Please select up to three (3) assessment activities that were the main focus of your coalition’s efforts during the last reporting period: Preparing to assess needs and capacity (e.g., identifying coalition goals) Assessing action plan in order to design/select strategies/activities Collecting data for needs assessment purposes Collecting data for resource assessment purposes Analyzing and reporting assessment data Completing a SWOT (strengths, weaknesses, opportunities, and threats) analysis Developing a framework/logic model for change Using assessment data (e.g., revising a logic model) Other (please specify): _____________________
Please report any notable accomplishments related to assessment activities achieved during this reporting period (Maximum of 2,000 characters with spaces):
Please report any additional details, including barriers or challenges, about your assessment activities that were not captured above (Maximum of 2,000 characters with spaces):

	BUILDING CAPACITY SECTION Capacity refers to the types (such as skills or technology) and levels (such as individual or organizational) of resources that a coalition has at its disposal to meet its aims.
	Sub-section: Coalition Meetings, Staffing, and Leadership
	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. Unpaid staff should only be included if they are attending as a sector member): (Note: This number should reflect the number of attendees at full coalition meetings, on average. Do not include paid staff and only include unpaid staff 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.): Increasing Decreasing Staying the same
	Number of paid staff: _________ (Note: Number of staff with salaries funded partially or fully through the DFC grant.) Number of unpaid staff: ________ (Note: Number of unpaid staff that contribute significantly to coalition work.)
	Please select the sector that serves as the lead or head agency for your coalition. (Note: Select one from list of sectors or select “lead is shared across agencies”. If select “Lead is shared across agencies”, please describe: ____________________________)		Please select each sector that serves as a key partner agency for your coalition. (Note: Select all that apply. Key partners play a central role in the work of the coalition. This can include work at any step in the Strategic Prevention Framework (e.g., assessment, action plan development, planning and implementation of activities))
	Sub-section: Capacity Building Activities
Please select up to six (6) capacity building activities that were the main focus of your coalition’s efforts during the last reporting period. Focus activities are those that you would be able to describe in detail your efforts.
Gathering community input (e.g., holding hearings on drug problems) Recruitment (e.g., increasing coalition membership and participation) Training to build capacity among coalition members (e.g., DFC goals, leadership skills, health equity) Building shared vision/consensus (e.g., attaining an agreement among coalition members regarding goals, planned initiatives, etc.) Increasing fiscal resources (e.g., attaining funding for substance use prevention initiatives) Strengthening strategies (e.g., planning/executing substance use/misuse prevention initiatives) Outreach (e.g., engaging key partners in substance use prevention initiatives)		Engaging the general community in substance use prevention initiatives Improving information resources (e.g., engaging in research or evaluation activities) Strengthening data connections across coalition sectors Working with other coalitions in your region/state around identifying/addressing risk and protective factors Established one or more work groups or subgroups (e.g., task force, committee, subcommittee) specifically focused on opioids/methamphetamine. Invited new community members/sectors to join the coalition based on expertise relevant to addressing opioids/methamphetamine Key coalition staff engaged with work groups (e.g., task force, committee, subcommittee) organized by others in the community to address opioids/methamphetamine Other (please specify): _____________________

Sub-section: Sector Members & Involvement
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 for this sector? (Note: Very High Involvement might be associated with agreeing to lead an initiative, agreeing to implement or help implement an evidence-based strategy, etc.)	Compared to the prior year, has involvement by this sector generally increased, decreased, or stayed the same?
Sectors			Very High High Medium Low Very Low	Increased Stay about the same Decreased Not applicable (did not have award in prior year)
Parents
Youth
Business Community
Civic/Volunteer Groups
Healthcare Professionals
Law Enforcement Agency
Media
Religious/Fraternal Organizations
Schools
State, Local, and/or Tribal Government Agencies with Expertise in Substance Abuse
Youth-Serving organizations
Other Organization with Expertise in Substance Abuse (please specify the organization) ___________________
Describe any changes in membership. Are there sectors where you are working to increase membership and/or involvement of the sector? Sectors where membership has decreased and how that has impacted (positively or negatively) your coalition? What is being done to increase membership in any sectors not represented or with no active members? (Maximum of 2,000 characters with spaces)

Sub-section: 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.)

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.)

Is this person a Sector Representative with whom you have a Coalition Involvement Agreement (CIA)?

Status

(Note: Select from drop down menu if individual/ organization is an active or inactive member of the coalition.)

Sub-section: Youth Coalitions

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.)

Yes
Not currently, but the coalition is working to host a youth coalition within the next six months.
No and no plans to host a youth coalition within the next six months.

If yes, how often did the youth coalition meet over the last six months?

Every 1-2 weeks
Once a month
Once every two months
One to two times in the past six months

What is the average level of involvement of the youth coalition in planning prevention activities with youth?

Very High
High
Medium
Low
Very Low

Does at least one member of the youth coalition serve on the coalition’s board, steering committee, leadership team (i.e., the group that provides overall leadership to the coalition)?

Not Applicable, our coalition does not have a board, steering committee, leadership team (i.e., the group that provides overall leadership to the coalition)?
No, there are no youth coalition members who attend these meetings.
Yes, and the youth coalition member attends these meetings but does not have a vote or say in coalition decisions
Yes, and the youth coalition member not only attends but has a vote or say in coalition decisions made during the meeting.

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):

If the coalition does NOT host a youth coalition, briefly describe why that is and/or describe how you work to engage youth in other ways. Also, please describe any change in youth coalition/youth coalition status over time. (Maximum of 2,000 characters with spaces):

Sub-section: New Partnerships, Building Capacity Accomplishments and Challenges

Please share any information about any additional or unique sector members that your coalition has brought into the coalition since your last progress report (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)

Please report any notable accomplishments related to capacity building activities achieved during this reporting period (Maximum of 2,000 character with spaces):

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 character with spaces):

PLANNING SECTION

Planning is a process of developing a logical sequence of steps that lead from individual actions
to community-level drug outcomes and achievement of the coalition’s vision for a healthier community.

Sub-section: 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.

Has your coalition created or made any modifications to your sustainability plan during this reporting period? (Reminder: Coalitions must provide a sustainability plan in Year 3 and Year 7.)

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: _______________________________

If yes, this plan must be provided to your project officer or uploaded in GrantSolutions. Have you provided as required?

Please report any notable accomplishments related to coalition planning activities achieved during this reporting period (Maximum of 2,000 characters with spaces):

Please report any additional details, including barriers or challenges, about your coalition planning activities that were not captured above (Maximum of 2,000 characters with spaces):

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 recipients will be asked to describe the types of activities engaged in during the reporting period.
Sub-section: Innovation During this Reporting Period . . .
Implementation Strategies (Note: These categories apply to both capacity building in the community (supporting programs to do these things) as well as implementation of activities designed to prevent/reduce youth substance use.)	Were any activities implemented in this strategy type? (Yes/No) If no, move to next strategy type)	Were any of the activities implemented in this strategy type innovative? (NOTE: Innovation may be creative or outside-the-box solutions coalitions implemented or may be modifications to existing evidence-based practices [e.g. to be culturally relevant)	If yes, please describe innovative activities implemented during this reporting period.
Providing Information (e.g., community education, increasing knowledge, raising awareness)
Enhancing Skills (e.g., building skills and competencies)
Providing Support (e.g., increasing involvement in drug-free/healthy alternative activities)
Enhancing Access/Reducing Barriers (e.g., improving access, availability, and use of systems and services)
Changing Consequences (e.g., incentives/disincentives, increasing attention to enforcement and compliance)
Physical Design (e.g., improving environmental and structural signs and areas to support the initiative)
Educating/Informing about Modifying/Changing Policies or Laws (e.g., changing institutional or government policies)

Sub-section: Strategy Activity Details: Providing Information
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)	Number of completed activities this period	Substance(s) Focused On 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: Coalition Leadership/Key Personnel)	In your opinion, how successful was the activity (activities) in this effort? Drop down: (1) very successful; (2) moderately successful; (3) not successful	Progress made towards action plan goals with this activity m New activity implemented with progress made during the reporting period m Continuing activity, no progress made since the last reporting period m Continuing activity, progress made since last reporting period m Activity deleted/removed from action plan or replaced with a new activity in action plan m Activity completed (no plan to implement in the future)	Linking to Action Plan Describe where in your action plan can the activity be found ((i.e., Goal 1, Objective 2, Strategy Name, Activity 1; enter as many as applicable)
Activities focused on Providing Information		Number of completed activities this period		Adults	Youth
Media campaigns: Television/radio/print/billboards/bus or other posters	m Yes m No	Number of independent spots/ads aired or placed during this reporting period.		Not applicable for this activity	Not applicable for this activity
Media coverage: TV/radio/newspaper stories	m Yes m No	Number of media stories appearing this reporting period.		Not applicable for this activity	Not applicable for this activity
Informational materials prepared/produced (e.g., information about marijuana; information about opioids, fentanyl, and methamphetamine; information on sharing/ storage of prescription drugs; treatment referrals)	m Yes m No	Number of press releases, brochures, flyers, posters, audiovisual products prepared/produced during this reporting period.		Not applicable for this activity	Not applicable for this activity
Informational materials disseminated	m Yes m No	Number of brochures, flyers, posters, audio visual products distributed during this reporting period.
Social networking (Facebook, Twitter, etc.)	m Yes m No	Number of posts on social media sites during reporting period.		Total number of follows: Facebook Friends, Twitter Followers, etc.	Not applicable for this activity
New Information on Coalition website	m Yes m No	Number of new materials posted during this reporting period.		Number of web hits.	Not applicable for this activity
Direct, face-to-face information sessions	m Yes m 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.		Number of adults in audience	Number of youth in audience
Conduct or promote special programs and/or special events (e.g., prescribing guidelines, PDMP, drop boxes/take back events, fairs, town halls, community celebrations)	m Yes m 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.		Approximate adult attendance at events	Approximate youth attendance at events
Other (please specify): (NOTE: Able to add up to three “other” activity rows)
Please provide a brief overview of any notable accomplishments related to Providing Information activities that you achieved during this reporting period. Describe how implementation has contributed to progress on coalition action plan goals. (Maximum of 3,000 characters with spaces):
Please provide a brief overview of any challenges related to Providing Information activities that you experienced during this reporting period. (Maximum of 2,000 characters with spaces):

Sub-section: Strategy Activity Details: Enhancing Skills
Activities focused on Enhancing Skills	Did your coalition work on this activity during this reporting period?	Number of completed activities this period	Substance(s) Focused On Select all that apply:	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: Coalition Leadership/Key Personnel)	In your opinion, how successful was the activity (activities) in this effort? Drop down: (1) very successful; (2) moderately successful; (3) not successful	Progress made towards action plan goals with this activity	Linking to Action Plan Describe where in your action plan can the activity be found.
Activities focused on Enhancing Skills		Number of completed activities this period	Substance(s) Focused On Select all that apply:	Adults	Youth
Education and training specifically to reduce stigma associated with substance use/substance use disorder	Yes No
Implementation/ Supported Implementation of an Evidence-Based Curriculum in School Setting	Yes No	Number of sessions delivered of programs focusing on information/skills for youth.		Not applicable for this activity	Number of youth receiving curriculum
Trainings specifically on identifying signs of potential drug use and/or risks associated with drug use (e.g., risks of adolescent marijuana use; opioid risks/signs of use for various community members; signs of methamphetamine use/sales)	Yes No			Number of adults trained	Number of youth trained
Youth Education and Training Programs	Yes No	Number of sessions delivered of programs focusing on information/skills for youth.		Not applicable for this activity	Number of youth receiving training (do not double count if youth attended more than one session)
Parent Education and Training Programs	Yes No	Number of training sessions on drug awareness, prevention strategies, or parenting skills specifically for parents.		Number of Parents trained (do not double count if parent attended more than one session)	Not applicable for this activity
Teacher/Youth Worker Education and Training Programs	Yes No	Number of training sessions on drug awareness and prevention strategies specifically for teachers/youth workers.		Number of teachers/youth workers trained (do not double count if participant attended more than one session)	Not applicable for this activity
Community Member Education and Training Programs	Yes No	Number of training sessions on drug awareness, prevention strategies, or cultural competence for community members, including law enforcement, media, and landlords.		Number of community members trained (do not double count if community member attended more than one session)	Not applicable for this activity
Sector-Based Training (e.g., responsible beverage service/vendor training prescription drug monitoring trainings, prescriber education & training; training on use and how/where to access naloxone and/or fentanyl test strips])	Yes No	Number of training sessions delivered on server compliance, training on youth marketed alcohol products, tobacco sales, etc.		Number of people trained (do not double count if participant attended more than one session)	Not applicable for this activity
Other (please specify): (NOTE: Able to add up to three “other” activity rows)	Yes No
Please provide a brief overview of any notable accomplishments related to Enhancing Skills activities that you achieved during this reporting period. Describe how implementation has contributed to progress on coalition action plan goals. (Maximum of 3,000 characters with spaces):
Please provide a brief overview of any challenges related to Enhancing Skills activities that you experienced during this reporting period (Maximum of 2,000 characters with spaces):

Sub-section: Strategy Activity Details: Providing Support

Activities focused on Providing Support

Did your coalition work on this activity during this reporting period?

Number of completed activities this period

Substance(s) Focused On

Select all that apply:

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: Coalition Leadership/Key Personnel)

In your opinion, how successful was the activity (activities) in this effort?

Drop down: (1) very successful; (2) moderately successful; (3) not successful

Progress made towards action plan goals with this activity

Linking to Action Plan

Describe where in your action plan can the activity be found.

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

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

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

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

Youth/family support groups (e.g., for those who have relationships with individuals who use/misuse substances and recovery groups/events)

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)

Other (please specify): (NOTE: Able to add up to three “other” activity rows)

Please provide a brief overview of any notable accomplishments related to Providing Support activities that you achieved during this reporting period. Describe how implementation has contributed to progress on coalition action plan goals. (Maximum of 3,000 characters 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 characters with spaces):

Sub-section: Changing Access/Barriers

Activities focused on Changing Access/Barriers

Did your coalition work on this activity during this reporting period?

Number of completed activities this period

Substance(s) Focused On

Select all that apply:

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: Coalition Leadership/Key Personnel)

In your opinion, how successful was the activity (activities) in this effort?

Drop down: (1) very successful; (2) moderately successful; (3) not successful

Progress made towards action plan goals with this activity

Linking to Action Plan

Describe where in your action plan can the activity be found.

Adults

Youth

Increased Access to Substance Use Services (e.g., court mandated services; assessment and referral, recovery services; make available or increase availability of substance use screening programs [e.g., SBIRT]; judicial alternatives for individuals with a substance use disorder who are convicted of a crime (e.g., drug court, teen court)

Number of adults served, referred to treatment, involved in EAPs

Number of youth served, referred to treatment, involved in SAPs

Reducing Home and Social Access (e.g., prescription drug disposal/storage; alcohol storage; make available or increase availability of local prescription drug take-back events; make available or increase availability of local prescription drug take-back boxes)

Number of adults participating

Number of youth participating

Improve supports for service use (e.g., child care, transportation; make available or increase availability of transportation to support prevention, treatment, or recovery services [e.g., medication assisted treatment, counseling, drug court])

Number of adults activity reached

Number of youth activity reached

Improve access to prevention, treatment and recovery services through culturally sensitive outreach (e.g., multilingual materials/ speakers; culturally responsive messaging)

Number of adults reached (this may be double-counted with entries for Providing Information)

Number of youth reached (this may be double-counted with entries for Providing Information)

Improving access to overdose prevention materials (e.g. support partner in distribution of naloxone and/or fentanyl test strips) (Note this item will be optional)

Not applicable

Other (please specify): (NOTE: Able to add up to three “other” activity rows)

Please provide a brief overview of any notable accomplishments related to Changing Access/Barriers activities that you achieved during this reporting period. Describe how implementation has contributed to progress on coalition action plan goals. (Maximum of 3,000 characters with spaces):

Please provide a brief overview of any challenges related to Changing Access/Barriers activities that you experienced during this reporting period. (Maximum of 2,000 characters with spaces):

Sub-section: Changing Consequences

Activities focused on Changing Consequences

Did your coalition work on this activity during this reporting period?

Number of completed activities this period

Substance(s) Focused On

Select all that apply:

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: Coalition Leadership/Key Personnel)

In your opinion, how successful was the activity (activities) in this effort?

Drop down: (1) very successful; (2) moderately successful; (3) not successful

Progress made towards action plan goals with this activity

Linking to Action Plan

Describe where in your action plan can the activity be found.

Adults

Youth

Strengthening Enforcement (e.g., supporting DUI checkpoints, shoulder tap programs, open container laws; drug task forces to reduce access to opioids/methamphetamine in community)

Not applicable for this activity

Strengthening Surveillance (e.g., monitoring “hot spots,” party patrols; identify and/or increase monitoring of opioid/methamphetamine use “hot spots”

Not applicable for this activity

Recognition programs (e.g., programs for merchants who pass compliance checks, recognizing drug-free youth; physicians exercising responsible prescribing practices; individuals in recovery)

Number of businesses receiving recognition for compliance

Publicize Non-Compliance (e.g., highlighting businesses not compliant with local ordinances)

Number of businesses highlighted for non-compliance

Other (please specify): (NOTE: Able to add up to three “other” activity rows)

Please provide a brief overview of any notable accomplishments related to Changing Consequences activities that you achieved during this reporting period. Describe how implementation has contributed to progress on coalition action plan goals. (Maximum of 3,000 characters 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 characters with spaces):

Sub-section: Physical Design

Activities focused on Physical Design

Did your coalition work on this activity during this reporting period?

Number of completed activities this period

Substance(s) Focused On

Select all that apply:

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: Coalition Leadership/Key Personnel)

In your opinion, how successful was the activity (activities) in this effort?

Drop down: (1) very successful; (2) moderately successful; (3) not successful

Progress made towards action plan goals with this activity

Linking to Action Plan

Describe where in your action plan can the activity be found.

Adults

Youth

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.

Cleanup and Beautification (e.g., Improve parks and other physical landscapes, neighborhood clean-ups; clean needles and other waste related to substance use from parks and neighborhoods)

Number of cleanup / beautification events held this period (e.g., neighborhood cleanup days)

Improve visibility/ease of surveillance in public places and substance use hotspots (e.g., work with partner to provide improved lighting, surveillance cameras, improved lines of sight)

Number of areas (public places/hot spots) in which surveillance/visibility was improved this period.

Promote improved signage/advertising/practices by suppliers (e.g., Decrease signage or advertising, change product locations; post no smoking/no vaping signage)

Number of suppliers making changes in signage/advertising/displays this period.

Increase safe storage solutions in homes or schools (e.g., lock boxes, drug deactivation kits))

Identify problem establishments for closure (e.g., close drug houses)

Number of problem establishments closed/modified practices

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)

Please provide a brief overview of any notable accomplishments related to Physical Design activities that you achieved during this reporting period. Describe how implementation has contributed to progress on coalition action plan goals. (Maximum of 3,000 characters 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 characters with spaces):

Sub-section: Educating/Informing About Modifying/Changing Policies or Laws
Activities focused on Physical Design	Did your coalition work on this activity during this reporting period?	Number of Policies or Laws your coalition was active in Educating/Informing about Modifying/Changing during this reporting period	Number of Policies or Laws Educated or Informed about that were Passed/Modified During This Period	Substance(s) Focused On Select all that apply	Sector(s) contributing to this activity Select all that apply: list of sectors, includes option for N/A: Coalition Leadership/Key Personnel)	In your opinion, how successful was the activity (activities) in this effort? Drop down: (1) very successful; (2) moderately successful; (3) not successful	Progress made towards action plan goals with this activity	Linking to Action Plan Describe where in your action plan can the activity be found.
Cost: Laws/public policies concerning cost (e.g., alcohol, tobacco, or marijuana tax, fees)	Yes No	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 focusing on use, possession, or behavior under the influence for minors	Yes No	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)
School: Policies promoting drug-free schools	Yes No	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
Treatment/Prevention: Laws/public policies promoting treatment or prevention alternatives (e.g., diversion treatment programs for underage substance use)	Yes No	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
Workplace: Policies promoting drug-free workplaces	Yes No	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.
Citizen enabling/Liability: Laws/public policies concerning adult (including parent) social enabling or liability such as social host ordinances; policies regarding Narcan/naloxone administration; Good Samaritan Laws	Yes No	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.
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; Prescription Drug Monitoring Programs)	Yes No	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.
Outlet Location/Density: Laws/public policies concerning limitation and restrictions of location and density of alcohol or marijuana outlets	Yes No	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., alcohol at gas stations)	Yes No	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.
Other (please specify): (NOTE: Able to add up to three “other” activity rows)	Yes No
Please provide a brief overview of any notable accomplishments related to Educating/Informing About Modifying/Changing Policies or Laws activities that you achieved during this reporting period. Describe how implementation has contributed to progress on coalition action plan goals. (Maximum of 3,000 characters with spaces):
Please provide a brief overview of any challenges related to Educating/Informing About Modifying/Changing Policies or Laws activities that you experienced during this reporting period (Maximum of 2,000 characters with spaces):

Sub-section: Implementation Summary

In the last six months, did your coalition successfully educate or inform about any policies/laws that were modified/changed?

m Yes

m No

If yes, briefly describe each policy/law successfully modified/changed and how your coalition educated or informed about it, indicate the month and year the work to successfully modify/change the policy was completed, select the substance(s) affected by the policy, and briefly describe the modifications/changes to the policy/law.

Policy 1: (please describe)

Month/Year

Substance(s) affected

Drop down: Select all that apply: Alcohol, Tobacco, Marijuana, Prescription Drugs (Opioids), Prescription Drugs (Non-Opioids), Heroin, Other Substance, No Substance Specified; Grant award recipients may select multiple substances

Policy 2:

(please describe)

Month/Year

Substance(s) affected

Policy 3:

(please describe)

Month/Year

Substance(s) affected

Drop down: Alcohol, Select all that apply: Alcohol, Tobacco, Marijuana, Prescription Drugs (Opioids), Prescription Drugs (Non-Opioids), Heroin, Other Substance, No Substance Specified; Grant award recipients may select multiple substances

Please report your top notable accomplishments related to implementation activities achieved during this reporting period (Maximum of 2,000 characters with spaces):

Please report any barriers or challenges related to implementation of activities that were not captured above (Maximum of 2,000 characters with spaces):

Sub-section: Coalition Local Evaluation Effort
Did your coalition locally evaluate any of your activities? No Yes
If yes, did your coalition engage in any of the following with regard to this local evaluation of implementation activities?	Yes	No
Level or Fidelity of Implementation	m	m
Identified areas for improving implementation	m	m
Perceptions of satisfaction/engagement of participants in the activity	m	m
Perceptions of dissatisfaction/lack of engagement of participants in the activity	m	m
Pre-test and Post-test Knowledge/Skills assessments	m	m
Link between implementation and core measures outcomes	m	m
Link between implementation and outcomes other than knowledge or core outcomes?	m	m
Analyzed local core measures data (e.g., change over time, subgroup differences)	m	m
Presented evaluation findings to your coalition?	m	m
Presented evaluation findings to your community?	m	m
Please summarize what you learned from your evaluation and how the coalition used the information?

EMERGING DRUG THREATS/ISSUES

Sub-section: Addressing Opioids/Methamphetamine

Has your coalition engaged in any activities to address opioids (e.g., prescription opioids, heroin, fentanyl, fentanyl analogs or other synthetic opioids)/methamphetamine (Emerging Drug Threats) in the community?

Yes (If yes, the following items will be made available).
No

If yes, indicate (yes/no) if your work focuses on each of the following substances specifically	Yes	No
Methamphetamine	m	m
Prescription opioids	m	m
Prescription non-opioids	m	m
Heroin	m	m
Fentanyl, fentanyl analogs or other synthetic opioids	m	m
Please describe any key activities your coalition has engaged in around building capacity to address opioids/methamphetamine. How successful have these activities been? Any challenges to overcome in building capacity to address opioids/methamphetamine?
Please describe any key implementation activities your coalition has engaged in around the issue of addressing opioids/ methamphetamine in your area. Key activities may be any strategy type from Providing Information to build community awareness to Educating/Information about Changing/Modifying Policies/Laws, with environmental strategies of particular interest. Provide as much detail as possible about the activity and be clear on how effective the activities were based on coalition goals for the activity (link to your Action Plan): What was the activity (clear description, including context if part of other activities) Who (staff/community members/sectors) was involved in planning and carrying out the activity Who was the audience(s) for the activity When did activity occur (including how often if more than once), How the activity impacted the community (e.g., any opioid/methamphetamine outcomes associated with the activity).
Identify any challenges that occurred during implementation. Include any recommendations to address/overcome challenges in order for the activity to be effective or for similar activities to be effective in other communities.

Sub-section: Vaping

Has your coalition engaged in any activities to address vaping (e.g., e-cigarettes) in the community?

Yes (If yes, the following items will be made available).
No

Indicate (yes/no) if your work focuses on each of the following substances with regard to vaping specifically:

	Yes	No
Nicotine	m	m
Marijuana	m	m
Other (Please describe ___________)	m	m

Please describe any key activities your coalition has engaged in around the issue of addressing vaping in your area. Activities may be key at any step in the process from capacity building and building community awareness to preventing or reducing vaping use. Provide as much detail as possible about the activity:

What was the activity (clear description, including context if part of other activities)
Who (DFC staff/community members/sectors) was involved in planning and carrying out the activity
Who was the audience(s) for the activity
When did activity occur (including how often if more than once),
How the activity impacted the community (e.g., any vaping outcomes associated with the activity).

Be clear on how successful/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.

Sub-section: Other Emerging Threats

Is your coalition working to address other emerging drug threats locally? (Note: Other than core substances, opioids, methamphetamine, vaping)

Please describe the emerging threat including what substance it is related to? Describe what your coalition is doing to address this emerging threat in your community and any successes/challenges to date.

COMMUNITY AND POPULATION-LEVEL OUTCOMES SECTION

SUB-SECTION: DATA MANAGEMENT PLAN

Have you previously submitted a data management plan?

No (If no, immediately sent to the first item to determine if need a data management plan.
Yes

If Yes, do you need to update your data management plan?

No (If no, coalition is done with data management plan.
Yes (If yes, immediately sent to the first item to determine if need a data management plan.)

Do you collect more data than the DFC Core Measures that are reported to ICF?

Yes
No (if no, you do not need a data management plan, no other questions asked)

If yes, are you collecting or generating NEW public health data? Generating refers to linking data sources to create a new dataset (This includes if coalition members/volunteers collect the data at the request of DFC-funded staff)

Yes
No (if no, you do not need a data management plan, no other questions asked)

If yes, what funds are used to collect or generate this data?

DFC funds are used. This includes for any part of the process, including the involvement of staff paid with DFC funds. (Data Management Plan Required)
Matching funds are used. This includes for any part of the process, including the involvement of staff paid with Matching funds. (Data Management Plan Required)
Both DFC & matching funds are used. This includes for any part of the process, including the involvement of staff paid from either of these funds. (Data Management Plan Required)
No DFC or matching funds are used to collect or generate this data. (if no, you do not need a data management plan, no other questions asked)

If Yes, a data management plan is required, please answer the following questions:

Element 1: Description of Data: (open-text, no character limit)

What data are being collected? (Data elements [i.e., variables or indicators that are collected], Anticipated time frame and frequency of data collection)

How are data being collected? (e.g., interviews, focus groups, surveys, surveillance data)
- Where are they maintained and who is responsible?
Do data to be collected include personally identifiable information (PII)?
- PII is information that can be used to determine a person’s identity, either alone or when combined with other info that is or can be linked to a specific person
- Examples of PII: name, date of birth, street address, email address, social security number, telephone number, images, other identifying numbers, etc.

Element 2: Description of Data (Maximum of 2,000 characters with spaces)

Please describe procedures to ensure data quality

Element 3: Data Sharing

Will the data be shared?

Yes, with the general public
Yes, with coalition partners
Yes, with both the general public and coalition partners.
No

If no to data sharing, please provide a justification:

Data cannot be shared without compromising participants’ privacy
Data shared with DFC/CARA recipient under a data use agreement (third party data)

Explain that the recipient does not retain ownership ____________
Provide point of contact for the data _________________

Value of data is specific to the program

If yes to data sharing, please describe who will share the data, what will be shared, and when the data will be shared. Then provide information requested for Elements 4 and 5. (Maximum of 2,000 characters with spaces)

Element 4: Data Use Standards (unlimited characters)

If you plan to share data, please describe where and how data will be stored

Element 5: Data Preservation (unlimited characters)

If you plan to share data, please indicate the following:

How long the data will be stored/maintained:
How will people be able to access the data (e.g. email request, posted on public website)?
Who will serve as the point of contact:

Sub-section: Core Measures

Core Measures will be reported in a separate section of the DFC & CARA 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. Core measure recommended wording is provided at the end of this document.

Select Survey (dropdown of coalition’s approved surveys)

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.

Day/Month/Year (approximate day finished collecting) Data Were Collected: __/__/_____

Core Measure: 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

Grade

Measure

Alcohol

Marijuana

Tobacco

Prescription Drugs

(Optional)

Heroin

(Optional)

Methamphetamine

30-day Use %

Sample Size

30-day Use %

Sample Size

30-day Use %

Sample Size

30-day Use %

Sample Size

30-day Use %

Sample Size

30-Day Use %

Sample Size

30-Day Use %

Sample Size

Middle School

30-Day Use %

Sample Size

High School

30-Day Use %

Sample Size

Optional Core Measure: Past Year (12-Month) Use

Please report the percentage of students who reported any use in the past year, including only reporting use on one day

Grade

Measure

(Optional) Heroin

(Optional) Methamphetamine

Past Year Use %

Sample Size

Past Year Use %

Sample Size

Past Year Use %

Sample Size

Past Year Use %

Sample Size

Past Year Use %

Sample Size

Past Year Use %

Sample Size

Past Year Use %

Sample Size

Middle School

Past Year Use %

Sample Size

High School

Past Year Use %

Sample Size

Core Measure: Perception of Risk

Please report the percentage of students who reported moderate and great risk responses for each substance

Grade

Measure

Alcohol

Marijuana

Tobacco

Prescription Drugs

(Optional)

Heroin

(Optional)

Methamphetamine

Perception of Risk %

Sample Size

Perception of Risk %

Sample Size

Perception of Risk %

Sample Size

Perception of Risk %

Sample Size

Perception of Risk %

Sample Size

Perception of Risk %

Sample Size

Perception of Risk %

Sample Size

Middle School

Perception of Risk %

Sample Size

High School

Perception of Risk %

Sample Size

Core Measure: Perception of Peer Disapproval

Please report the percentage of students who reported wrong and very wrong responses for each substance

Grade

Measure

Alcohol

Marijuana

Tobacco

Prescription Drugs

(Optional)

Heroin

(Optional)

Methamphetamine

Perception of Peer Disapproval %

Sample Size

Perception of Peer Disapproval %

Sample Size

Perception of Peer Disapproval %

Sample Size

Perception of Peer Disapproval %

Sample Size

Perception of Peer Disapproval %

Sample Size

Perception of Peer Disapproval %

Sample Size

Perception of Peer Disapproval %

Sample Size

Middle School

Perception of Peer Disapproval %

Sample Size

High School

Perception of Peer Disapproval %

Sample Size

Core Measure: Perception of Parental/Guardian/Caregiver Disapproval

Please report the percentage of students who reported wrong and very wrong responses for each substance

Grade

Measure

Alcohol

Marijuana

Tobacco

Prescription Drugs

(Optional)

Heroin

(Optional)

Methamphetamine