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SPF SIG Collaboration Agreement

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SPF SIG Collaboration Agreement Powered By Docstoc
					           Iowa Strategic Prevention Framework State Incentive Grant
                            Collaboration Agreement




The following information provides guidance for Comprehensive Substance Abuse Prevention
contractors on collaboration efforts before beginning the Strategic Prevention Framework
process. Each funded Comprehensive Substance Abuse Prevention agency in the 23 identified
counties of highest need is required to complete the following document and return to Julie
Hibben, SPF SIG Project Director via e-mail at julie.hibben@idph.iowa.gov by May 6, 2011.

Key Project Staff
At least one FTE must be hired as the SPF SIG Project Coordinator to lead the project and
complete project requirements in each SPF SIG funded county. One staff member cannot be
hired to serve more than one SPF SIG county. Each county will collectively decide which
organization will hire and supervise this staff member as well as the office location where this
staff is to be housed. Once this key staff member is hired, their contact information needs to be
submitted to the SPF SIG Project Director. Additionally, one staff member from the
Comprehensive Substance Abuse Prevention agency needs to serve as the SPF SIG Liaison until
the Coordinator is hired or if the hired Coordinator is managed by another organization.

At least one FTE will need to be hired to lead the completion of project work. This person can
be hired by the prevention agency, Drug Free Community Program grantee or other substance
abuse prevention coalition. Fill out the following information about the key project staff:

   1. Name of Current SPF SIG Liaison at Comprehensive Agency:

       Phone Number:

       E-mail Address:

   2. Will SPF SIG staff be hired internally or through a subcontract?

   3. Where will the SPF SIG staff member(s) be housed?

   4. Who will the newly hired SPF SIG staff member(s) report to?



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Stakeholders Meeting
The Comprehensive Substance Abuse Prevention agency is required to meet with the following
stakeholders before this completed document is due to IDPH. Agencies can choose to hold one
large meeting or multiple meetings but the following sectors need to be included:

      Drug Free Communities Support                       Youth
       Program grantee (if applicable)                     County and city officials (Board of
      Other substance abuse prevention                     Supervisors)
       coalitions                                          Other substance abuse prevention
      Public health                                        grantees (EUDL, STOP Act, etc.)
      Law enforcement                                     Substance abuse treatment provider
      School districts                                     if the funded prevention agency does
      Juvenile court/corrections                           not provide treatment services

During the meeting(s), agencies will provide an overview of SPF SIG project, discuss SPF SIG
priorities, how this project fits with the county priorities and SPF SIG funding. Each stakeholder
should then be invited to participate in the SPF SIG project. If the invited stakeholder agrees to
participate, ask what role they will have in the project. A variety of SPF SIG PowerPoint
presentations, handouts, and other information can be located on the Iowa SPF SIG Workstation
website at www.iowaspfsig.org. Agencies need to inform the SPF SIG Project Director via e-
mail of meeting date(s), time(s) and location(s) at least one week before the meeting(s) occurs.
IDPH SPF SIG Project Team members may attend the meetings or participate in the meetings
via conference call.

After the meeting(s) occurs, answer the following questions:

   1. List the names of stakeholders included in the SPF SIG meeting(s). Describe the different
      organization roles in the project. How will these various organizations work together?
      Who will receive funding?

   2. Describe how the SPF SIG funding will provide a countywide collaboration.

   3. Is there a Drug Free Communities Support Program grantee in the funded county? If so,
      how will that grantee be funded and involved in the SPF SIG project?

   4. What are the county priorities from the 2011 Community Health Needs Assessment &
      Health Improvement Planning (CHNA-HIP)? To learn more about this report, go to
      www.idph.state.ia.us/chnahip/default.asp.




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   5. Include a description of work being completed on underage drinking and binge drinking
      in the county.

   6. List the active youth groups related to the CHNA-HIP priorities and discuss how these
      youth will assist with the SPF SIG project.

   7. What are the goals of the Comprehensive Substance Abuse Prevention Action Plan?

Description of Coalition(s) Involved
Each SPF SIG funded county is required to involve at least one substance abuse prevention
coalition. This involvement can include creating a subcommittee of an established countywide
coalition to focus on the SPF SIG project. Due to the challenges of the SPF process, no new
coalitions will be created for this SPF SIG project. If no countywide coalition exists, a
Collaboration Council can be created to guide the project. If the county identified as highest
need has a funded DFC grantee, IDPH requires that these grantees be given the opportunity for
involvement in the SPF SIG project and receive SPF SIG funding. Additional information about
coalition involvement and ideas for DFC involvement are included in the Iowa SPF SIG
Expectations document.

Answer the following questions about the coalition involved in the project. If more than one
substance abuse prevention coalition is involved, copy and paste the set of questions and start a
new section for each coalition.

   1. Name of coalition

   2. Name of Coalition Coordinator:
      Coordinator Phone Number:
      Coordinator E-mail Address:

   3. Description of coalition

   4. Structure of coalition

   5. Sectors involved in the coalition

   6. Describe the funding streams the coalition receives.

   7. Is the coalition SAFE or Community of Promise certified?

   8. Include coalition mission statement.


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   9. List the goals of the coalition.

   10. Discuss current coalition projects.

   11. List the subcommittees of the coalition and include a description of each.

   12. Explain how the SPF SIG project will fit into the coalition structure.

   13. Do the coalition members match the cultural make up of the county? If not, how will
       these groups be represented?

Agreement of Collaboration
In order to show agreement with the above plan, a Memorandum of Understanding (MOU) is to
be developed. The Comprehensive Substance Abuse Prevention Agency Director, the Drug Free
Communities Support Program Coordinator (if applicable), the involved substance abuse
prevention coalition coordinator and the county public health administrator are required to sign
this document to show that they agree with the proposed collaboration. If SPF SIG counties do
not have agreement from these required stakeholders, funding may not be distributed to the
Comprehensive Substance Abuse Prevention agency and the next eligible county of highest need
could be contacted to participate. An updated MOU needs to be submitted to IDPH each Fiscal
Year of the project. A sample MOU can be found on the following page.




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                                        [Applicant Letterhead]


                         Sample Memorandum of Understanding

WHEREAS, [Comprehensive Substance Abuse Prevention Agency], [Partner 1], [Partner 2] and
[Partner 3] have come together to collaborate for the Strategic Prevention Framework State
Incentive Grant; and

WHEREAS, the partners listed below have agreed to enter into a collaborative agreement in which
[Comprehensive Substance Abuse Prevention Agency] will be the funded agency and the other
agencies will be partners in this collaboration; and

WHEREAS, the partners herein desire to enter into a Memorandum of Understanding setting forth the
services to be provided by the collaborative; and

WHEREAS, the Collaboration Agreement prepared and approved by the county through its partners is to
be submitted to the Iowa Department of Public Health on or before May 6, 2011.

I) Description of Partner Agencies

For each member of the collaborative, provide some background on the agency or organization and its
work regarding substance abuse prevention, specifically focusing on preventing binge drinking and
underage alcohol use.

II) History of Collaboration

      Provide a brief history of the collaborative relationship between the partners, including when and
       under what circumstances the relationship began.
      Describe the critical and long-range goals of the collaboration.

III) Roles and Responsibilities
NOW, THEREFORE, it is hereby agreed by and between the partners as follows:

      Clearly state the roles and responsibilities each organization or agency will assume to ensure the
       success of the project.
      Specify how often the collaborators will meet.
      Describe the resources each partner will contribute to the project either through time, in-kind
       contribution or with the use of grant funds, e.g. office space, project staff, training.
      Demonstrate a commitment on the part of all partners to work together to achieve stated project
       goals and to sustain the outcomes to the best of their abilities once grant funds are no longer
       available.

1) [Applicant X] will provide [specify type of program/assistance/service] including:

2) [Partner 1] will provide [specify type of program/assistance/service] including:

3) [Partner 2] will provide [specify type of program/assistance/service] including:

4) [Partner 3] will provide [specify type of program/assistance/service] including:

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4) [Applicant X] and [Partner 1] will collaborate in the following manner:

5) [Applicant X] and [Partner 2] will collaborate in the following manner:

6) [Applicant X] and [Partner 3] will collaborate in the following manner:

V) Timeline

Responsibilities under this Memorandum of Understanding would coincide with the grant period,
anticipated to be April 1, 2011 through June 30, 2011.

VI) Commitment to Partnership

1) The partners agree to collaborate and provide [specify type of service through the collaboration] as
    listed in the attached Collaboration Agreement.

2) We, the undersigned have read and agree with this MOU. Further, we have reviewed the proposed
    Collaboration Agreement and approve it.

  By ____________________                                 By________________________
  Comprehensive Substance Abuse Prevention                Drug Free Communities Support
  Agency Director                                         Program Coordinator (if applicable)

  Date __________________                                 Date _______________________


  By________________________                               By________________________
  County Public Health Administrator                       *Substance Abuse Prevention Coalition
                                                           Coordinator

  Date _______________________                             Date _______________________


  *Include a signature from each coalition coordinator if more than one coalition is participating
  in the project.




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