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Example of Meeting Minutes

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Example of Meeting Minutes document sample

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									Example                                                             Grantee:             GRANT COUNTY
Instructions: Complete this document on a monthly basis and email to DMHA (North~ Marcia French marcia.french@fssa.in.gov, South~ Kim Manlove kim.manlove@fssa.in.gov) and IPRC (Mari Kermit-
Canfield mkermitc@indiana.edu) by the 10th of each month.
CSAP Expectation      Outcome               Goal/Objective          Action Step          Progress                   Tangible                 Completion Completion Target        Person
                                                                                                                                             Rating %    Date         Date       Responsible
Assess levels of
local substance
abuse-related
problems using
state and local
epidemiology data to
determine:
Magnitude of            Complete Local Epi-   Provide data and       Complete Surveys and Collected community            Community readiness       50%   In Progress 30-Nov-07 Jane Doe
substance abuse and profile                   evidence to            Analysis of community readiness survey data and     survey results (tables)
related mental health                         community on what                            scheduled to complete the
disorders in the state,                       areas and populations                        community alcohol
and locations of                              policies/programs will                       assessment 9-15
where the problems                            be focused on          Identify data sources Identified 2 state and 1      NSDUH, IPRC School        25%   In Progress             Jane Doe
are most severe                                                      and gather pertinent  local sources of data         Survey, UCR local data
                                                                     data from community




Level of risk and                                                   Pull data from State    Identified state and county State prevalence = 4%;   25%     In Progress             LEOW
protective factors                                                  Epi-profile and         lifetime cocaine prevalence County prevalence = 5.5%
associated with                                                     aggragate community     rate among 18-25 year
substance abuse and                                                 data                    olds, but no risk/protective
related mental health                                                                       factors data yet
disorders


Community assets                                                    Write, following format In data collection phase,    None                      0%    NA                      LEOW and
and resources (gaps                                                 of state epi-report, a  thus no sections of report                                                           Jane Doe
in services and                                                     local epi-profile       written
capacity; readiness to
act)
CSAP Expectation          Outcome                 Goal/Objective          Action Step             Progress                     Tangible                    Completion   Completion Target      Person
                                                                                                                                                           Rating %     Date       Date        Responsible
Engage
stakeholders to
sustain prevention
activities:
Convene leaders and Hiring of key staff   Establish staff to            Identify & hire           Hired Billy Madison,       Signed contracts              100%         1-Aug-07    8-Aug-07   John Doe
stakeholders and/or members (inclusive of implement SPF                 Program Director,         Program Director and Mark
build coalitions    fiscal manager)       project                       Administrative            McGuire, Admin Asst and
                                                                        Assistant, and            Riley Bell, Fiscal Manager
                                                                        Fiscal Manger
                          Establish LAC &         Establish Councils to • Identify and appoint    Chairs selected, 2 LAC and   Letters of invitation and   25%          In Progress 30-Sep-07 Billy Madison
                          LEOW and local by-      support staff in      Chairs for LAC &          4 LEOW members invited,      response, membership
                          laws for coalition      implementing SPF      LEOW                      2 meetings scheduled, 1      roster, meeting schedule,
                                                  project               • Identify & invite       meeting held August 19th,    meeting minutes
                                                                        members                   by-laws not yet started
                                                                        • Set up meeting
                                                                        schedules and times
                                                                        • Write by-laws for
                                                                        council
                          Identify and Organize Identify Workgroups       • Evaluation            Chairs selected, members - Letters of invitation and     50%          In Progress 30-Sep-07 Billy Madison
                          Workgroup, chairs     to assist in the work     • Cultural Competence   2 evaluation 3 cultural       response
                          and members           of the SPF project        • Training and          competence, 1
                                                                          Outreach                training/outreach, 4 youth, 2
                                                                          • Youth/Young Adult     program/policy
                                                                          • Program/Policy

Train community           Develop:                Provide                 Provide Local SPF       Chart completed; draft       Organizational chart,       75%                      15-Oct-07 Mark
stakeholders,             Mission/Vision/Goals    organizational set-up   organizational chart    vision, mission, goals       vision/mission/goals with                                      McGuire
coalitions, and service   and timeline for each   to implement the SPF    with                    completed and waiting for    tasks and timelines
providers                 council/workgroup       project                 vision/mission/goals    workgroup input; tasks
                                                                          for                     outlined and timelines set
Organize agency
                                                                          each workgroup with
networks, leverage
                                                                          tasks and timelines
resources
CSAP Expectation         Outcome                Goal/Objective           Action Step               Progress                   Tangible           Completion   Completion Target     Person
                                                                                                                                                 Rating %     Date       Date       Responsible
Develop a strategic
plan that:

Articulates a vision for Complete logic model   Establish data-driven    Develop from the state Use patterns and              logic model        25%          In Progress 15-Jan-08 Evaluation
the prevention                                  decision making          epi-profile a logic    consequences completed                                                              Workgroup
activities and                                  process to determine     model with identifiers only
strategies for                                  population and area      from the local and
organizing and                                  of foci for              state epi reports and
implementing                                    implementation phase     data
prevention efforts                              of project
based on                 Identify principles/   Determine from logic     Review programs/          Incomplete - not enough     none              0%           NA          15-Feb-08 Program/Poli
documented needs         practices/ policy/     model and indicators     policies/ practices/      data collected to determine                                                      cy
                         program                from epi-report a        principles that address   specific population or                                                           Workgroup
                                                program/policy that is   the priority and the      intervention necessary
                                                evidence based and       specific identified
                                                will address the         population to focus on
                                                needs of your            for prevention
                                                community’s priority     implementation phase
                                                                         (NREPP, Central
                                                                         CAPT reviews,
                                                                         community literature
                                                                         reviews and
                                                                         knowledge)


Builds on identified     Develop and submit     Provide a working        Following the format of Draft of capacity and        Draft of section   25%          In Progress 15-Apr-08 LAC and Billy
resources/strengths      Strategic Plan         plan for the             the State Strategic     infrastructure section                                                             Madison
                                                implementation phase     Plan and guidance       completed
Sets measurable                                 of the project           document, write a
objectives                                                               comprehensive
                                                                         strategic plan
Specifies
performance
measures and
baseline data against
which progress will be
monitored
Describes
mechanisms for
making adjustments
using needs
assessment and
monitoring
information
Describes a long-term
strategy to sustain
policies, programs
and practices
CSAP Expectation         Outcome                   Goal/Objective           Action Step              Progress                       Tangible                   Completion   Completion Target      Person
                                                                                                                                                               Rating %     Date       Date        Responsible
Conduct on-going
monitoring and
oversight of SPF SIG
activites to:

Identify successes       Retain 80% of original Sustain LAC and             Identify alternates from Alternates identified for 25   Membership rosters          85%         In Progress 15-Nov-08 Billy Madison
                         partner representation workgroup                   each organization to     of 30 members                  identifying agency, sector
                                                membership over the         serve in the case of                                    (e.g, medical, education,
                                                course of the grant         absence, illness, etc.                                  law enforcement) and
                                                                                                                                    alternate with contact info



                         Increase average          Improve cultural         Administer cultural      Cultural competency            Completed continuum        50%          In Progress 30-Jun-08 Peyton
                         level of cultural         compentcy of LAC         compentency              continuum administered to      sheets, average                                               Manning
                         competency of LAC         and workgroups           continuum to the LAC     LAC and workgroup              competency score of 3.4
                         and workgroups in                                  and workgroups twice     members at initial meeting
                         year 1                                             per year


Encourage needed         Monitor collaborating     Maintain a high level    Identify areas needing   Administered satisfaction    Completed satisfaction       15% (one of In Progress 30-Jun-08 Billy Madison
improvement              partner satisfaction      of satisfaction of SPF   improvement (<Good)      survey after LAC meeting     survey, data file,           seven
                         upon conclusion of        activities among         by 50% or more of        on 11-5-07; 65% of those     frequencies table            groups to be
                         each LAC and              collaborating partners   membership and           surveyed thought the length                               surveyed)
                         workgroup meeting                                  employ improvement       of the meeting was <Good;
                         via administration of a                            strategies               Next meeting will be held at
                         satisfaction survey                                                         1 hour max.

Promote sustainability Obtain training in the      Improve capacity of     Attend IPRC/DMHA          Attended IPRC needs       Training agenda                 20%          In Progress 30-Jun-08 Billy
                       areas of evaluation,        collaborating partners sponsored trainings        assessment and evaluation                                                                    Madison,
                       needs assessment,           to conduct evaluation,                            training September 24-25                                                                     workgroup
                       capacity building, and      asses need, build                                                                                                                              chairs
                       strategic planning          coalition capacity, and
                                                   prepare a strategic
                                                   plan

                         Increase confidence                                Administer self-         Administered self-efficacy     Completed survey, data     50%          In Progress 30-Jun-08 Workgroup
                         of collaborating                                   efficacy survey twice    survey to LAC and              file, frequencies table,                                      chairs
                         members to perform                                 per year                 workgroups at initial          meeting schedule
                         tasks (evaluation,                                                          meetings
                         needs assessment,
                         etc) by 10% (those
                         indicating very and
                         somewhat confident)
Supervise the delivery   Establish procedure       Provide Year 1           Complete Community Completed 22 relevant                CLI WORD document          20%          In Progress 30-Jan-08 Billy
of required              for completion of         process evaluation       Level Instrument (CLI) items                                                                                          Madison,
performance data to      process evaluation        data to IPRC and         part 1 items on a                                                                                                     Riley Bell
SAMHSA                   documentation             state-level evaluators   monthly basis
             Sep-07                                                 Grantee:             COUNTY
Instructions: Complete this document on a monthly basis and email to DMHA (North~ Marcia French marcia.french@fssa.in.gov, South~ Kim Manlove kim.manlove@fssa.in.gov) and IPRC (Mari Kermit-
Canfield mkermitc@indiana.edu) by the 10th of each month.
CSAP Expectation      Outcome               Goal/Objective          Action Step          Progress                   Tangible                 Completion Completion Target        Person
                                                                                                                                             Rating %    Date         Date       Responsible
Assess levels of
local substance
abuse-related
problems using
state and local
epidemiology data to
determine:
Magnitude of            Complete Local Epi-   Provide data and       Complete Surveys and
substance abuse and profile                   evidence to            Analysis of community
related mental health                         community on what
disorders in the state,                       areas and populations
and locations of                              policies/programs will
where the problems                            be focused on          Identify data sources
are most severe                                                      and gather pertinent
                                                                     data from community




Level of risk and                                                   Pull data from State
protective factors                                                  Epi-profile and
associated with                                                     aggragate community
substance abuse and                                                 data
related mental health
disorders


Community assets                                                    Write, following format
and resources (gaps                                                 of state epi-report, a
in services and                                                     local epi-profile
capacity; readiness to
act)
CSAP Expectation          Outcome                 Goal/Objective          Action Step             Progress   Tangible   Completion   Completion Target   Person
                                                                                                                        Rating %     Date       Date     Responsible
Engage
stakeholders to
sustain prevention
activities:
Convene leaders and Hiring of key staff   Establish staff to            Identify & hire
stakeholders and/or members (inclusive of implement SPF                 Program Director,
build coalitions    fiscal manager)       project                       Administrative
                                                                        Assistant, and
                                                                        Fiscal Manger
                          Establish LAC &         Establish Councils to • Identify and appoint
                          LEOW and local by-      support staff in      Chairs for LAC &
                          laws for coalition      implementing SPF      LEOW
                                                  project               • Identify & invite
                                                                        members
                                                                        • Set up meeting
                                                                        schedules and times
                                                                        • Write by-laws for
                                                                        council
                          Identify and Organize Identify Workgroups       • Evaluation
                          Workgroup, chairs     to assist in the work     • Cultural Competence
                          and members           of the SPF project        • Training and
                                                                          Outreach
                                                                          • Youth/Young Adult
                                                                          • Program/Policy

Train community           Develop:                Provide                 Provide Local SPF
stakeholders,             Mission/Vision/Goals    organizational set-up   organizational chart
coalitions, and service   and timeline for each   to implement the SPF    with
providers                 council/workgroup       project                 vision/mission/goals
                                                                          for
Organize agency
                                                                          each workgroup with
networks, leverage
                                                                          tasks and timelines
resources
CSAP Expectation         Outcome                Goal/Objective           Action Step               Progress   Tangible   Completion   Completion Target   Person
                                                                                                                         Rating %     Date       Date     Responsible
Develop a strategic
plan that:

Articulates a vision for Complete logic model   Establish data-driven    Develop from the state
the prevention                                  decision making          epi-profile a logic
activities and                                  process to determine     model with identifiers
strategies for                                  population and area      from the local and
organizing and                                  of foci for              state epi reports and
implementing                                    implementation phase     data
prevention efforts                              of project
based on                 Identify principles/   Determine from logic     Review programs/
documented needs         practices/ policy/     model and indicators     policies/ practices/
                         program                from epi-report a        principles that address
                                                program/policy that is   the priority and the
                                                evidence based and       specific identified
                                                will address the         population to focus on
                                                needs of your            for prevention
                                                community’s priority     implementation phase
                                                                         (NREPP, Central
                                                                         CAPT reviews,
                                                                         community literature
                                                                         reviews and
                                                                         knowledge)


Builds on identified     Develop and submit     Provide a working        Following the format of
resources/strengths      Strategic Plan         plan for the             the State Strategic
                                                implementation phase     Plan and guidance
Sets measurable                                 of the project           document, write a
objectives                                                               comprehensive
                                                                         strategic plan
Specifies
performance
measures and
baseline data against
which progress will be
monitored
Describes
mechanisms for
making adjustments
using needs
assessment and
monitoring
information
Describes a long-term
strategy to sustain
policies, programs
and practices
CSAP Expectation         Outcome                   Goal/Objective            Action Step              Progress   Tangible   Completion   Completion Target   Person
                                                                                                                            Rating %     Date       Date     Responsible
Conduct on-going
monitoring and
oversight of SPF SIG
activites to:

Identify successes       Objectives - smaller      Goals should be
                         outcomes, the sum of      worded in terms of
                         which make are            new skills,
                         expected to result in     knowledge, or
                         project Goals.            attitudes for
                                                   stakeholders or as
                                                   changes in conditions
                                                   bearing on the
                                                   project, rather than as
                                                   activities

Encourage needed         Monitor collaborating     Maintain a high level     Identify areas needing
improvement              partner satisfaction      of satisfaction of SPF    improvement (<Good)
                         upon conclusion of        activities among          by 50% or more of
                         each LAC and              collaborating partners    membership and
                         workgroup meeting                                   employ improvement
                         via administration of a                             strategies
                         satisfaction survey

Promote sustainability Obtain training in the      Improve capacity of     Attend IPRC/DMHA
                       areas of evaluation,        collaborating partners sponsored trainings
                       needs assessment,           to conduct evaluation,
                       capacity building, and      asses need, build
                       strategic planning          coalition capacity, and
                                                   prepare a strategic
                                                   plan

                         Increase confidence                                 Administer self-
                         of collaborating                                    efficacy survey twice
                         members to perform                                  per year
                         tasks (evaluation,
                         needs assessment,
                         etc) by 10% (those
                         indicating very and
                         somewhat confident)
Supervise the delivery   Establish procedure       Provide Year 1            Complete Community
of required              for completion of         process evaluation        Level Instrument (CLI)
performance data to      process evaluation        data to IPRC and          part 1 items on a
SAMHSA                   documentation             state-level evaluators    monthly basis
              Oct-07                                                Grantee:             COUNTY
Instructions: Complete this document on a monthly basis and email to DMHA (North~ Marcia French marcia.french@fssa.in.gov, South~ Kim Manlove kim.manlove@fssa.in.gov) and IPRC (Mari Kermit-
Canfield mkermitc@indiana.edu) by the 10th of each month.
CSAP Expectation      Outcome               Goal/Objective          Action Step          Progress                   Tangible                 Completion Completion Target        Person
                                                                                                                                             Rating %    Date         Date       Responsible
Assess levels of
local substance
abuse-related
problems using
state and local
epidemiology data to
determine:
Magnitude of            Complete Local Epi-   Provide data and       Complete Surveys and
substance abuse and profile                   evidence to            Analysis of community
related mental health                         community on what
disorders in the state,                       areas and populations
and locations of                              policies/programs will
where the problems                            be focused on          Identify data sources
are most severe                                                      and gather pertinent
                                                                     data from community




Level of risk and                                                   Pull data from State
protective factors                                                  Epi-profile and
associated with                                                     aggragate community
substance abuse and                                                 data
related mental health
disorders


Community assets                                                    Write, following format
and resources (gaps                                                 of state epi-report, a
in services and                                                     local epi-profile
capacity; readiness to
act)
CSAP Expectation          Outcome                 Goal/Objective          Action Step             Progress   Tangible   Completion   Completion Target   Person
                                                                                                                        Rating %     Date       Date     Responsible
Engage
stakeholders to
sustain prevention
activities:
Convene leaders and Hiring of key staff   Establish staff to            Identify & hire
stakeholders and/or members (inclusive of implement SPF                 Program Director,
build coalitions    fiscal manager)       project                       Administrative
                                                                        Assistant, and
                                                                        Fiscal Manger
                          Establish LAC &         Establish Councils to • Identify and appoint
                          LEOW and local by-      support staff in      Chairs for LAC &
                          laws for coalition      implementing SPF      LEOW
                                                  project               • Identify & invite
                                                                        members
                                                                        • Set up meeting
                                                                        schedules and times
                                                                        • Write by-laws for
                                                                        council
                          Identify and Organize Identify Workgroups       • Evaluation
                          Workgroup, chairs     to assist in the work     • Cultural Competence
                          and members           of the SPF project        • Training and
                                                                          Outreach
                                                                          • Youth/Young Adult
                                                                          • Program/Policy

Train community           Develop:                Provide                 Provide Local SPF
stakeholders,             Mission/Vision/Goals    organizational set-up   organizational chart
coalitions, and service   and timeline for each   to implement the SPF    with
providers                 council/workgroup       project                 vision/mission/goals
                                                                          for
Organize agency
                                                                          each workgroup with
networks, leverage
                                                                          tasks and timelines
resources
CSAP Expectation         Outcome                Goal/Objective           Action Step               Progress   Tangible   Completion   Completion Target   Person
                                                                                                                         Rating %     Date       Date     Responsible
Develop a strategic
plan that:

Articulates a vision for Complete logic model   Establish data-driven    Develop from the state
the prevention                                  decision making          epi-profile a logic
activities and                                  process to determine     model with identifiers
strategies for                                  population and area      from the local and
organizing and                                  of foci for              state epi reports and
implementing                                    implementation phase     data
prevention efforts                              of project
based on                 Identify principles/   Determine from logic     Review programs/
documented needs         practices/ policy/     model and indicators     policies/ practices/
                         program                from epi-report a        principles that address
                                                program/policy that is   the priority and the
                                                evidence based and       specific identified
                                                will address the         population to focus on
                                                needs of your            for prevention
                                                community’s priority     implementation phase
                                                                         (NREPP, Central
                                                                         CAPT reviews,
                                                                         community literature
                                                                         reviews and
                                                                         knowledge)


Builds on identified     Develop and submit     Provide a working        Following the format of
resources/strengths      Strategic Plan         plan for the             the State Strategic
                                                implementation phase     Plan and guidance
Sets measurable                                 of the project           document, write a
objectives                                                               comprehensive
                                                                         strategic plan
Specifies
performance
measures and
baseline data against
which progress will be
monitored
Describes
mechanisms for
making adjustments
using needs
assessment and
monitoring
information
Describes a long-term
strategy to sustain
policies, programs
and practices
CSAP Expectation         Outcome                   Goal/Objective            Action Step              Progress   Tangible   Completion   Completion Target   Person
                                                                                                                            Rating %     Date       Date     Responsible
Conduct on-going
monitoring and
oversight of SPF SIG
activites to:

Identify successes       Objectives - smaller      Goals should be
                         outcomes, the sum of      worded in terms of
                         which make are            new skills,
                         expected to result in     knowledge, or
                         project Goals.            attitudes for
                                                   stakeholders or as
                                                   changes in conditions
                                                   bearing on the
                                                   project, rather than as
                                                   activities
Encourage needed         Monitor collaborating     Maintain a high level     Identify areas needing
improvement              partner satisfaction      of satisfaction of SPF    improvement (<Good)
                         upon conclusion of        activities among          by 50% or more of
                         each LAC and              collaborating partners    membership and
                         workgroup meeting                                   employ improvement
                         via administration of a                             strategies
                         satisfaction survey

Promote sustainability Obtain training in the      Improve capacity of     Attend IPRC/DMHA
                       areas of evaluation,        collaborating partners sponsored trainings
                       needs assessment,           to conduct evaluation,
                       capacity building, and      asses need, build
                       strategic planning          coalition capacity, and
                                                   prepare a strategic
                                                   plan

                         Increase confidence                                 Administer self-
                         of collaborating                                    efficacy survey twice
                         members to perform                                  per year
                         tasks (evaluation,
                         needs assessment,
                         etc) by 10% (those
                         indicating very and
                         somewhat confident)
Supervise the delivery   Establish procedure       Provide Year 1            Complete Community
of required              for completion of         process evaluation        Level Instrument (CLI)
performance data to      process evaluation        data to IPRC and          part 1 items on a
SAMHSA                   documentation             state-level evaluators    monthly basis
             Nov-07                                                 Grantee:             COUNTY
Instructions: Complete this document on a monthly basis and email to DMHA (North~ Marcia French marcia.french@fssa.in.gov, South~ Kim Manlove kim.manlove@fssa.in.gov) and IPRC (Mari Kermit-
Canfield mkermitc@indiana.edu) by the 10th of each month.
CSAP Expectation      Outcome               Goal/Objective          Action Step          Progress                   Tangible                 Completion Completion Target        Person
                                                                                                                                             Rating %    Date         Date       Responsible
Assess levels of
local substance
abuse-related
problems using
state and local
epidemiology data to
determine:
Magnitude of            Complete Local Epi-   Provide data and       Complete Surveys and
substance abuse and profile                   evidence to            Analysis of community
related mental health                         community on what
disorders in the state,                       areas and populations
and locations of                              policies/programs will
where the problems                            be focused on          Identify data sources
are most severe                                                      and gather pertinent
                                                                     data from community




Level of risk and                                                   Pull data from State
protective factors                                                  Epi-profile and
associated with                                                     aggragate community
substance abuse and                                                 data
related mental health
disorders


Community assets                                                    Write, following format
and resources (gaps                                                 of state epi-report, a
in services and                                                     local epi-profile
capacity; readiness to
act)
CSAP Expectation          Outcome                 Goal/Objective          Action Step             Progress   Tangible   Completion   Completion Target   Person
                                                                                                                        Rating %     Date       Date     Responsible
Engage
stakeholders to
sustain prevention
activities:
Convene leaders and Hiring of key staff   Establish staff to            Identify & hire
stakeholders and/or members (inclusive of implement SPF                 Program Director,
build coalitions    fiscal manager)       project                       Administrative
                                                                        Assistant, and
                                                                        Fiscal Manger
                          Establish LAC &         Establish Councils to • Identify and appoint
                          LEOW and local by-      support staff in      Chairs for LAC &
                          laws for coalition      implementing SPF      LEOW
                                                  project               • Identify & invite
                                                                        members
                                                                        • Set up meeting
                                                                        schedules and times
                                                                        • Write by-laws for
                                                                        council
                          Identify and Organize Identify Workgroups       • Evaluation
                          Workgroup, chairs     to assist in the work     • Cultural Competence
                          and members           of the SPF project        • Training and
                                                                          Outreach
                                                                          • Youth/Young Adult
                                                                          • Program/Policy

Train community           Develop:                Provide                 Provide Local SPF
stakeholders,             Mission/Vision/Goals    organizational set-up   organizational chart
coalitions, and service   and timeline for each   to implement the SPF    with
providers                 council/workgroup       project                 vision/mission/goals
                                                                          for
Organize agency
                                                                          each workgroup with
networks, leverage
                                                                          tasks and timelines
resources
CSAP Expectation         Outcome                Goal/Objective           Action Step               Progress   Tangible   Completion   Completion Target   Person
                                                                                                                         Rating %     Date       Date     Responsible
Develop a strategic
plan that:

Articulates a vision for Complete logic model   Establish data-driven    Develop from the state
the prevention                                  decision making          epi-profile a logic
activities and                                  process to determine     model with identifiers
strategies for                                  population and area      from the local and
organizing and                                  of foci for              state epi reports and
implementing                                    implementation phase     data
prevention efforts                              of project
based on                 Identify principles/   Determine from logic     Review programs/
documented needs         practices/ policy/     model and indicators     policies/ practices/
                         program                from epi-report a        principles that address
                                                program/policy that is   the priority and the
                                                evidence based and       specific identified
                                                will address the         population to focus on
                                                needs of your            for prevention
                                                community’s priority     implementation phase
                                                                         (NREPP, Central
                                                                         CAPT reviews,
                                                                         community literature
                                                                         reviews and
                                                                         knowledge)


Builds on identified     Develop and submit     Provide a working        Following the format of
resources/strengths      Strategic Plan         plan for the             the State Strategic
                                                implementation phase     Plan and guidance
Sets measurable                                 of the project           document, write a
objectives                                                               comprehensive
                                                                         strategic plan
Specifies
performance
measures and
baseline data against
which progress will be
monitored
Describes
mechanisms for
making adjustments
using needs
assessment and
monitoring
information
Describes a long-term
strategy to sustain
policies, programs
and practices
CSAP Expectation         Outcome                   Goal/Objective            Action Step              Progress   Tangible   Completion   Completion Target   Person
                                                                                                                            Rating %     Date       Date     Responsible
Conduct on-going
monitoring and
oversight of SPF SIG
activites to:

Identify successes       Objectives - smaller      Goals should be
                         outcomes, the sum of      worded in terms of
                         which make are            new skills,
                         expected to result in     knowledge, or
                         project Goals.            attitudes for
                                                   stakeholders or as
                                                   changes in conditions
                                                   bearing on the
                                                   project, rather than as
                                                   activities


Encourage needed         Monitor collaborating     Maintain a high level     Identify areas needing
improvement              partner satisfaction      of satisfaction of SPF    improvement (<Good)
                         upon conclusion of        activities among          by 50% or more of
                         each LAC and              collaborating partners    membership and
                         workgroup meeting                                   employ improvement
                         via administration of a                             strategies
                         satisfaction survey

Promote sustainability Obtain training in the      Improve capacity of     Attend IPRC/DMHA
                       areas of evaluation,        collaborating partners sponsored trainings
                       needs assessment,           to conduct evaluation,
                       capacity building, and      asses need, build
                       strategic planning          coalition capacity, and
                                                   prepare a strategic
                                                   plan

                         Increase confidence                                 Administer self-
                         of collaborating                                    efficacy survey twice
                         members to perform                                  per year
                         tasks (evaluation,
                         needs assessment,
                         etc) by 10% (those
                         indicating very and
                         somewhat confident)
Supervise the delivery   Establish procedure       Provide Year 1            Complete Community
of required              for completion of         process evaluation        Level Instrument (CLI)
performance data to      process evaluation        data to IPRC and          part 1 items on a
SAMHSA                   documentation             state-level evaluators    monthly basis
             Dec-07                                                 Grantee:             COUNTY
Instructions: Complete this document on a monthly basis and email to DMHA (North~ Marcia French marcia.french@fssa.in.gov, South~ Kim Manlove kim.manlove@fssa.in.gov) and IPRC (Mari Kermit-
Canfield mkermitc@indiana.edu) by the 10th of each month.
CSAP Expectation      Outcome               Goal/Objective          Action Step          Progress                   Tangible                 Completion Completion Target        Person
                                                                                                                                             Rating %    Date         Date       Responsible
Assess levels of
local substance
abuse-related
problems using
state and local
epidemiology data to
determine:
Magnitude of            Complete Local Epi-   Provide data and       Complete Surveys and
substance abuse and profile                   evidence to            Analysis of community
related mental health                         community on what
disorders in the state,                       areas and populations
and locations of                              policies/programs will
where the problems                            be focused on          Identify data sources
are most severe                                                      and gather pertinent
                                                                     data from community




Level of risk and                                                   Pull data from State
protective factors                                                  Epi-profile and
associated with                                                     aggragate community
substance abuse and                                                 data
related mental health
disorders


Community assets                                                    Write, following format
and resources (gaps                                                 of state epi-report, a
in services and                                                     local epi-profile
capacity; readiness to
act)
CSAP Expectation          Outcome                 Goal/Objective          Action Step             Progress   Tangible   Completion   Completion Target   Person
                                                                                                                        Rating %     Date       Date     Responsible
Engage
stakeholders to
sustain prevention
activities:
Convene leaders and Hiring of key staff   Establish staff to            Identify & hire
stakeholders and/or members (inclusive of implement SPF                 Program Director,
build coalitions    fiscal manager)       project                       Administrative
                                                                        Assistant, and
                                                                        Fiscal Manger
                          Establish LAC &         Establish Councils to • Identify and appoint
                          LEOW and local by-      support staff in      Chairs for LAC &
                          laws for coalition      implementing SPF      LEOW
                                                  project               • Identify & invite
                                                                        members
                                                                        • Set up meeting
                                                                        schedules and times
                                                                        • Write by-laws for
                                                                        council
                          Identify and Organize Identify Workgroups       • Evaluation
                          Workgroup, chairs     to assist in the work     • Cultural Competence
                          and members           of the SPF project        • Training and
                                                                          Outreach
                                                                          • Youth/Young Adult
                                                                          • Program/Policy

Train community           Develop:                Provide                 Provide Local SPF
stakeholders,             Mission/Vision/Goals    organizational set-up   organizational chart
coalitions, and service   and timeline for each   to implement the SPF    with
providers                 council/workgroup       project                 vision/mission/goals
                                                                          for
Organize agency
                                                                          each workgroup with
networks, leverage
                                                                          tasks and timelines
resources
CSAP Expectation         Outcome                Goal/Objective           Action Step               Progress   Tangible   Completion   Completion Target   Person
                                                                                                                         Rating %     Date       Date     Responsible
Develop a strategic
plan that:

Articulates a vision for Complete logic model   Establish data-driven    Develop from the state
the prevention                                  decision making          epi-profile a logic
activities and                                  process to determine     model with identifiers
strategies for                                  population and area      from the local and
organizing and                                  of foci for              state epi reports and
implementing                                    implementation phase     data
prevention efforts                              of project
based on                 Identify principles/   Determine from logic     Review programs/
documented needs         practices/ policy/     model and indicators     policies/ practices/
                         program                from epi-report a        principles that address
                                                program/policy that is   the priority and the
                                                evidence based and       specific identified
                                                will address the         population to focus on
                                                needs of your            for prevention
                                                community’s priority     implementation phase
                                                                         (NREPP, Central
                                                                         CAPT reviews,
                                                                         community literature
                                                                         reviews and
                                                                         knowledge)


Builds on identified     Develop and submit     Provide a working        Following the format of
resources/strengths      Strategic Plan         plan for the             the State Strategic
                                                implementation phase     Plan and guidance
Sets measurable                                 of the project           document, write a
objectives                                                               comprehensive
                                                                         strategic plan
Specifies
performance
measures and
baseline data against
which progress will be
monitored
Describes
mechanisms for
making adjustments
using needs
assessment and
monitoring
information
Describes a long-term
strategy to sustain
policies, programs
and practices
CSAP Expectation         Outcome                   Goal/Objective            Action Step              Progress   Tangible   Completion   Completion Target   Person
                                                                                                                            Rating %     Date       Date     Responsible
Conduct on-going
monitoring and
oversight of SPF SIG
activites to:

Identify successes       Objectives - smaller      Goals should be
                         outcomes, the sum of      worded in terms of
                         which make are            new skills,
                         expected to result in     knowledge, or
                         project Goals.            attitudes for
                                                   stakeholders or as
                                                   changes in conditions
                                                   bearing on the
                                                   project, rather than as
                                                   activities

Encourage needed         Monitor collaborating     Maintain a high level     Identify areas needing
improvement              partner satisfaction      of satisfaction of SPF    improvement (<Good)
                         upon conclusion of        activities among          by 50% or more of
                         each LAC and              collaborating partners    membership and
                         workgroup meeting                                   employ improvement
                         via administration of a                             strategies
                         satisfaction survey

Promote sustainability Obtain training in the      Improve capacity of     Attend IPRC/DMHA
                       areas of evaluation,        collaborating partners sponsored trainings
                       needs assessment,           to conduct evaluation,
                       capacity building, and      asses need, build
                       strategic planning          coalition capacity, and
                                                   prepare a strategic
                                                   plan

                         Increase confidence                                 Administer self-
                         of collaborating                                    efficacy survey twice
                         members to perform                                  per year
                         tasks (evaluation,
                         needs assessment,
                         etc) by 10% (those
                         indicating very and
                         somewhat confident)
Supervise the delivery   Establish procedure       Provide Year 1            Complete Community
of required              for completion of         process evaluation        Level Instrument (CLI)
performance data to      process evaluation        data to IPRC and          part 1 items on a
SAMHSA                   documentation             state-level evaluators    monthly basis
             Jan-07                                                 Grantee:             COUNTY
Instructions: Complete this document on a monthly basis and email to DMHA (North~ Marcia French marcia.french@fssa.in.gov, South~ Kim Manlove kim.manlove@fssa.in.gov) and IPRC (Mari Kermit-
Canfield mkermitc@indiana.edu) by the 10th of each month.
CSAP Expectation      Outcome               Goal/Objective          Action Step          Progress                   Tangible                 Completion Completion Target        Person
                                                                                                                                             Rating %    Date         Date       Responsible
Assess levels of
local substance
abuse-related
problems using
state and local
epidemiology data to
determine:
Magnitude of            Complete Local Epi-   Provide data and       Complete Surveys and
substance abuse and profile                   evidence to            Analysis of community
related mental health                         community on what
disorders in the state,                       areas and populations
and locations of                              policies/programs will
where the problems                            be focused on          Identify data sources
are most severe                                                      and gather pertinent
                                                                     data from community




Level of risk and                                                   Pull data from State
protective factors                                                  Epi-profile and
associated with                                                     aggragate community
substance abuse and                                                 data
related mental health
disorders


Community assets                                                    Write, following format
and resources (gaps                                                 of state epi-report, a
in services and                                                     local epi-profile
capacity; readiness to
act)
CSAP Expectation          Outcome                 Goal/Objective          Action Step             Progress   Tangible   Completion   Completion Target   Person
                                                                                                                        Rating %     Date       Date     Responsible
Engage
stakeholders to
sustain prevention
activities:
Convene leaders and Hiring of key staff   Establish staff to            Identify & hire
stakeholders and/or members (inclusive of implement SPF                 Program Director,
build coalitions    fiscal manager)       project                       Administrative
                                                                        Assistant, and
                                                                        Fiscal Manger
                          Establish LAC &         Establish Councils to • Identify and appoint
                          LEOW and local by-      support staff in      Chairs for LAC &
                          laws for coalition      implementing SPF      LEOW
                                                  project               • Identify & invite
                                                                        members
                                                                        • Set up meeting
                                                                        schedules and times
                                                                        • Write by-laws for
                                                                        council
                          Identify and Organize Identify Workgroups       • Evaluation
                          Workgroup, chairs     to assist in the work     • Cultural Competence
                          and members           of the SPF project        • Training and
                                                                          Outreach
                                                                          • Youth/Young Adult
                                                                          • Program/Policy

Train community           Develop:                Provide                 Provide Local SPF
stakeholders,             Mission/Vision/Goals    organizational set-up   organizational chart
coalitions, and service   and timeline for each   to implement the SPF    with
providers                 council/workgroup       project                 vision/mission/goals
                                                                          for
Organize agency
                                                                          each workgroup with
networks, leverage
                                                                          tasks and timelines
resources
CSAP Expectation         Outcome                Goal/Objective           Action Step               Progress   Tangible   Completion   Completion Target   Person
                                                                                                                         Rating %     Date       Date     Responsible
Develop a strategic
plan that:

Articulates a vision for Complete logic model   Establish data-driven    Develop from the state
the prevention                                  decision making          epi-profile a logic
activities and                                  process to determine     model with identifiers
strategies for                                  population and area      from the local and
organizing and                                  of foci for              state epi reports and
implementing                                    implementation phase     data
prevention efforts                              of project
based on                 Identify principles/   Determine from logic     Review programs/
documented needs         practices/ policy/     model and indicators     policies/ practices/
                         program                from epi-report a        principles that address
                                                program/policy that is   the priority and the
                                                evidence based and       specific identified
                                                will address the         population to focus on
                                                needs of your            for prevention
                                                community’s priority     implementation phase
                                                                         (NREPP, Central
                                                                         CAPT reviews,
                                                                         community literature
                                                                         reviews and
                                                                         knowledge)


Builds on identified     Develop and submit     Provide a working        Following the format of
resources/strengths      Strategic Plan         plan for the             the State Strategic
                                                implementation phase     Plan and guidance
Sets measurable                                 of the project           document, write a
objectives                                                               comprehensive
                                                                         strategic plan
Specifies
performance
measures and
baseline data against
which progress will be
monitored
Describes
mechanisms for
making adjustments
using needs
assessment and
monitoring
information
Describes a long-term
strategy to sustain
policies, programs
and practices
CSAP Expectation         Outcome                   Goal/Objective            Action Step              Progress   Tangible   Completion   Completion Target   Person
                                                                                                                            Rating %     Date       Date     Responsible
Conduct on-going
monitoring and
oversight of SPF SIG
activites to:

Identify successes       Objectives - smaller      Goals should be
                         outcomes, the sum of      worded in terms of
                         which make are            new skills,
                         expected to result in     knowledge, or
                         project Goals.            attitudes for
                                                   stakeholders or as
                                                   changes in conditions
                                                   bearing on the
                                                   project, rather than as
                                                   activities

Encourage needed         Monitor collaborating     Maintain a high level     Identify areas needing
improvement              partner satisfaction      of satisfaction of SPF    improvement (<Good)
                         upon conclusion of        activities among          by 50% or more of
                         each LAC and              collaborating partners    membership and
                         workgroup meeting                                   employ improvement
                         via administration of a                             strategies
                         satisfaction survey

Promote sustainability Obtain training in the      Improve capacity of     Attend IPRC/DMHA
                       areas of evaluation,        collaborating partners sponsored trainings
                       needs assessment,           to conduct evaluation,
                       capacity building, and      asses need, build
                       strategic planning          coalition capacity, and
                                                   prepare a strategic
                                                   plan

                         Increase confidence                                 Administer self-
                         of collaborating                                    efficacy survey twice
                         members to perform                                  per year
                         tasks (evaluation,
                         needs assessment,
                         etc) by 10% (those
                         indicating very and
                         somewhat confident)
Supervise the delivery   Establish procedure       Provide Year 1            Complete Community
of required              for completion of         process evaluation        Level Instrument (CLI)
performance data to      process evaluation        data to IPRC and          part 1 items on a
SAMHSA                   documentation             state-level evaluators    monthly basis
             Feb-07                                                 Grantee:             COUNTY
Instructions: Complete this document on a monthly basis and email to DMHA (North~ Marcia French marcia.french@fssa.in.gov, South~ Kim Manlove kim.manlove@fssa.in.gov) and IPRC (Mari Kermit-
Canfield mkermitc@indiana.edu) by the 10th of each month.
CSAP Expectation      Outcome               Goal/Objective          Action Step          Progress                   Tangible                 Completion Completion Target        Person
                                                                                                                                             Rating %    Date         Date       Responsible
Assess levels of
local substance
abuse-related
problems using
state and local
epidemiology data to
determine:
Magnitude of            Complete Local Epi-   Provide data and       Complete Surveys and
substance abuse and profile                   evidence to            Analysis of community
related mental health                         community on what
disorders in the state,                       areas and populations
and locations of                              policies/programs will
where the problems                            be focused on          Identify data sources
are most severe                                                      and gather pertinent
                                                                     data from community




Level of risk and                                                   Pull data from State
protective factors                                                  Epi-profile and
associated with                                                     aggragate community
substance abuse and                                                 data
related mental health
disorders


Community assets                                                    Write, following format
and resources (gaps                                                 of state epi-report, a
in services and                                                     local epi-profile
capacity; readiness to
act)
CSAP Expectation          Outcome                 Goal/Objective          Action Step             Progress   Tangible   Completion   Completion Target   Person
                                                                                                                        Rating %     Date       Date     Responsible
Engage
stakeholders to
sustain prevention
activities:
Convene leaders and Hiring of key staff   Establish staff to            Identify & hire
stakeholders and/or members (inclusive of implement SPF                 Program Director,
build coalitions    fiscal manager)       project                       Administrative
                                                                        Assistant, and
                                                                        Fiscal Manger
                          Establish LAC &         Establish Councils to • Identify and appoint
                          LEOW and local by-      support staff in      Chairs for LAC &
                          laws for coalition      implementing SPF      LEOW
                                                  project               • Identify & invite
                                                                        members
                                                                        • Set up meeting
                                                                        schedules and times
                                                                        • Write by-laws for
                                                                        council
                          Identify and Organize Identify Workgroups       • Evaluation
                          Workgroup, chairs     to assist in the work     • Cultural Competence
                          and members           of the SPF project        • Training and
                                                                          Outreach
                                                                          • Youth/Young Adult
                                                                          • Program/Policy

Train community           Develop:                Provide                 Provide Local SPF
stakeholders,             Mission/Vision/Goals    organizational set-up   organizational chart
coalitions, and service   and timeline for each   to implement the SPF    with
providers                 council/workgroup       project                 vision/mission/goals
                                                                          for
Organize agency
                                                                          each workgroup with
networks, leverage
                                                                          tasks and timelines
resources
CSAP Expectation         Outcome                Goal/Objective           Action Step               Progress   Tangible   Completion   Completion Target   Person
                                                                                                                         Rating %     Date       Date     Responsible
Develop a strategic
plan that:

Articulates a vision for Complete logic model   Establish data-driven    Develop from the state
the prevention                                  decision making          epi-profile a logic
activities and                                  process to determine     model with identifiers
strategies for                                  population and area      from the local and
organizing and                                  of foci for              state epi reports and
implementing                                    implementation phase     data
prevention efforts                              of project
based on                 Identify principles/   Determine from logic     Review programs/
documented needs         practices/ policy/     model and indicators     policies/ practices/
                         program                from epi-report a        principles that address
                                                program/policy that is   the priority and the
                                                evidence based and       specific identified
                                                will address the         population to focus on
                                                needs of your            for prevention
                                                community’s priority     implementation phase
                                                                         (NREPP, Central
                                                                         CAPT reviews,
                                                                         community literature
                                                                         reviews and
                                                                         knowledge)


Builds on identified     Develop and submit     Provide a working        Following the format of
resources/strengths      Strategic Plan         plan for the             the State Strategic
                                                implementation phase     Plan and guidance
Sets measurable                                 of the project           document, write a
objectives                                                               comprehensive
                                                                         strategic plan
Specifies
performance
measures and
baseline data against
which progress will be
monitored
Describes
mechanisms for
making adjustments
using needs
assessment and
monitoring
information
Describes a long-term
strategy to sustain
policies, programs
and practices
CSAP Expectation         Outcome                   Goal/Objective            Action Step              Progress   Tangible   Completion   Completion Target   Person
                                                                                                                            Rating %     Date       Date     Responsible
Conduct on-going
monitoring and
oversight of SPF SIG
activites to:

Identify successes       Objectives - smaller      Goals should be
                         outcomes, the sum of      worded in terms of
                         which make are            new skills,
                         expected to result in     knowledge, or
                         project Goals.            attitudes for
                                                   stakeholders or as
                                                   changes in conditions
                                                   bearing on the
                                                   project, rather than as
                                                   activities

Encourage needed         Monitor collaborating     Maintain a high level     Identify areas needing
improvement              partner satisfaction      of satisfaction of SPF    improvement (<Good)
                         upon conclusion of        activities among          by 50% or more of
                         each LAC and              collaborating partners    membership and
                         workgroup meeting                                   employ improvement
                         via administration of a                             strategies
                         satisfaction survey

Promote sustainability Obtain training in the      Improve capacity of     Attend IPRC/DMHA
                       areas of evaluation,        collaborating partners sponsored trainings
                       needs assessment,           to conduct evaluation,
                       capacity building, and      asses need, build
                       strategic planning          coalition capacity, and
                                                   prepare a strategic
                                                   plan

                         Increase confidence                                 Administer self-
                         of collaborating                                    efficacy survey twice
                         members to perform                                  per year
                         tasks (evaluation,
                         needs assessment,
                         etc) by 10% (those
                         indicating very and
                         somewhat confident)
Supervise the delivery   Establish procedure       Provide Year 1            Complete Community
of required              for completion of         process evaluation        Level Instrument (CLI)
performance data to      process evaluation        data to IPRC and          part 1 items on a
SAMHSA                   documentation             state-level evaluators    monthly basis
             Mar-07                                                 Grantee:             COUNTY
Instructions: Complete this document on a monthly basis and email to DMHA (North~ Marcia French marcia.french@fssa.in.gov, South~ Kim Manlove kim.manlove@fssa.in.gov) and IPRC (Mari Kermit-
Canfield mkermitc@indiana.edu) by the 10th of each month.
CSAP Expectation      Outcome               Goal/Objective          Action Step          Progress                   Tangible                 Completion Completion Target        Person
                                                                                                                                             Rating %    Date         Date       Responsible
Assess levels of
local substance
abuse-related
problems using
state and local
epidemiology data to
determine:
Magnitude of            Complete Local Epi-   Provide data and       Complete Surveys and
substance abuse and profile                   evidence to            Analysis of community
related mental health                         community on what
disorders in the state,                       areas and populations
and locations of                              policies/programs will
where the problems                            be focused on          Identify data sources
are most severe                                                      and gather pertinent
                                                                     data from community




Level of risk and                                                   Pull data from State
protective factors                                                  Epi-profile and
associated with                                                     aggragate community
substance abuse and                                                 data
related mental health
disorders


Community assets                                                    Write, following format
and resources (gaps                                                 of state epi-report, a
in services and                                                     local epi-profile
capacity; readiness to
act)
CSAP Expectation          Outcome                 Goal/Objective          Action Step             Progress   Tangible   Completion   Completion Target   Person
                                                                                                                        Rating %     Date       Date     Responsible
Engage
stakeholders to
sustain prevention
activities:
Convene leaders and Hiring of key staff   Establish staff to            Identify & hire
stakeholders and/or members (inclusive of implement SPF                 Program Director,
build coalitions    fiscal manager)       project                       Administrative
                                                                        Assistant, and
                                                                        Fiscal Manger
                          Establish LAC &         Establish Councils to • Identify and appoint
                          LEOW and local by-      support staff in      Chairs for LAC &
                          laws for coalition      implementing SPF      LEOW
                                                  project               • Identify & invite
                                                                        members
                                                                        • Set up meeting
                                                                        schedules and times
                                                                        • Write by-laws for
                                                                        council
                          Identify and Organize Identify Workgroups       • Evaluation
                          Workgroup, chairs     to assist in the work     • Cultural Competence
                          and members           of the SPF project        • Training and
                                                                          Outreach
                                                                          • Youth/Young Adult
                                                                          • Program/Policy

Train community           Develop:                Provide                 Provide Local SPF
stakeholders,             Mission/Vision/Goals    organizational set-up   organizational chart
coalitions, and service   and timeline for each   to implement the SPF    with
providers                 council/workgroup       project                 vision/mission/goals
                                                                          for
Organize agency
                                                                          each workgroup with
networks, leverage
                                                                          tasks and timelines
resources
CSAP Expectation         Outcome                Goal/Objective           Action Step               Progress   Tangible   Completion   Completion Target   Person
                                                                                                                         Rating %     Date       Date     Responsible
Develop a strategic
plan that:

Articulates a vision for Complete logic model   Establish data-driven    Develop from the state
the prevention                                  decision making          epi-profile a logic
activities and                                  process to determine     model with identifiers
strategies for                                  population and area      from the local and
organizing and                                  of foci for              state epi reports and
implementing                                    implementation phase     data
prevention efforts                              of project
based on                 Identify principles/   Determine from logic     Review programs/
documented needs         practices/ policy/     model and indicators     policies/ practices/
                         program                from epi-report a        principles that address
                                                program/policy that is   the priority and the
                                                evidence based and       specific identified
                                                will address the         population to focus on
                                                needs of your            for prevention
                                                community’s priority     implementation phase
                                                                         (NREPP, Central
                                                                         CAPT reviews,
                                                                         community literature
                                                                         reviews and
                                                                         knowledge)


Builds on identified     Develop and submit     Provide a working        Following the format of
resources/strengths      Strategic Plan         plan for the             the State Strategic
                                                implementation phase     Plan and guidance
Sets measurable                                 of the project           document, write a
objectives                                                               comprehensive
                                                                         strategic plan
Specifies
performance
measures and
baseline data against
which progress will be
monitored
Describes
mechanisms for
making adjustments
using needs
assessment and
monitoring
information
Describes a long-term
strategy to sustain
policies, programs
and practices
CSAP Expectation         Outcome                   Goal/Objective            Action Step              Progress   Tangible   Completion   Completion Target   Person
                                                                                                                            Rating %     Date       Date     Responsible
Conduct on-going
monitoring and
oversight of SPF SIG
activites to:

Identify successes       Objectives - smaller      Goals should be
                         outcomes, the sum of      worded in terms of
                         which make are            new skills,
                         expected to result in     knowledge, or
                         project Goals.            attitudes for
                                                   stakeholders or as
                                                   changes in conditions
                                                   bearing on the
                                                   project, rather than as
                                                   activities
Encourage needed         Monitor collaborating     Maintain a high level     Identify areas needing
improvement              partner satisfaction      of satisfaction of SPF    improvement (<Good)
                         upon conclusion of        activities among          by 50% or more of
                         each LAC and              collaborating partners    membership and
                         workgroup meeting                                   employ improvement
                         via administration of a                             strategies
                         satisfaction survey

Promote sustainability Obtain training in the      Improve capacity of     Attend IPRC/DMHA
                       areas of evaluation,        collaborating partners sponsored trainings
                       needs assessment,           to conduct evaluation,
                       capacity building, and      asses need, build
                       strategic planning          coalition capacity, and
                                                   prepare a strategic
                                                   plan

                         Increase confidence                                 Administer self-
                         of collaborating                                    efficacy survey twice
                         members to perform                                  per year
                         tasks (evaluation,
                         needs assessment,
                         etc) by 10% (those
                         indicating very and
                         somewhat confident)
Supervise the delivery   Establish procedure       Provide Year 1            Complete Community
of required              for completion of         process evaluation        Level Instrument (CLI)
performance data to      process evaluation        data to IPRC and          part 1 items on a
SAMHSA                   documentation             state-level evaluators    monthly basis
              Apr-07                                                Grantee:             COUNTY
Instructions: Complete this document on a monthly basis and email to DMHA (North~ Marcia French marcia.french@fssa.in.gov, South~ Kim Manlove kim.manlove@fssa.in.gov) and IPRC (Mari Kermit-
Canfield mkermitc@indiana.edu) by the 10th of each month.
CSAP Expectation      Outcome               Goal/Objective          Action Step          Progress                   Tangible                 Completion Completion Target        Person
                                                                                                                                             Rating %    Date         Date       Responsible
Assess levels of
local substance
abuse-related
problems using
state and local
epidemiology data to
determine:
Magnitude of            Complete Local Epi-   Provide data and       Complete Surveys and
substance abuse and profile                   evidence to            Analysis of community
related mental health                         community on what
disorders in the state,                       areas and populations
and locations of                              policies/programs will
where the problems                            be focused on          Identify data sources
are most severe                                                      and gather pertinent
                                                                     data from community




Level of risk and                                                   Pull data from State
protective factors                                                  Epi-profile and
associated with                                                     aggragate community
substance abuse and                                                 data
related mental health
disorders


Community assets                                                    Write, following format
and resources (gaps                                                 of state epi-report, a
in services and                                                     local epi-profile
capacity; readiness to
act)
CSAP Expectation          Outcome                 Goal/Objective          Action Step             Progress   Tangible   Completion   Completion Target   Person
                                                                                                                        Rating %     Date       Date     Responsible
Engage
stakeholders to
sustain prevention
activities:
Convene leaders and Hiring of key staff   Establish staff to            Identify & hire
stakeholders and/or members (inclusive of implement SPF                 Program Director,
build coalitions    fiscal manager)       project                       Administrative
                                                                        Assistant, and
                                                                        Fiscal Manger
                          Establish LAC &         Establish Councils to • Identify and appoint
                          LEOW and local by-      support staff in      Chairs for LAC &
                          laws for coalition      implementing SPF      LEOW
                                                  project               • Identify & invite
                                                                        members
                                                                        • Set up meeting
                                                                        schedules and times
                                                                        • Write by-laws for
                                                                        council
                          Identify and Organize Identify Workgroups       • Evaluation
                          Workgroup, chairs     to assist in the work     • Cultural Competence
                          and members           of the SPF project        • Training and
                                                                          Outreach
                                                                          • Youth/Young Adult
                                                                          • Program/Policy

Train community           Develop:                Provide                 Provide Local SPF
stakeholders,             Mission/Vision/Goals    organizational set-up   organizational chart
coalitions, and service   and timeline for each   to implement the SPF    with
providers                 council/workgroup       project                 vision/mission/goals
                                                                          for
Organize agency
                                                                          each workgroup with
networks, leverage
                                                                          tasks and timelines
resources
CSAP Expectation         Outcome                Goal/Objective           Action Step               Progress   Tangible   Completion   Completion Target   Person
                                                                                                                         Rating %     Date       Date     Responsible
Develop a strategic
plan that:

Articulates a vision for Complete logic model   Establish data-driven    Develop from the state
the prevention                                  decision making          epi-profile a logic
activities and                                  process to determine     model with identifiers
strategies for                                  population and area      from the local and
organizing and                                  of foci for              state epi reports and
implementing                                    implementation phase     data
prevention efforts                              of project
based on                 Identify principles/   Determine from logic     Review programs/
documented needs         practices/ policy/     model and indicators     policies/ practices/
                         program                from epi-report a        principles that address
                                                program/policy that is   the priority and the
                                                evidence based and       specific identified
                                                will address the         population to focus on
                                                needs of your            for prevention
                                                community’s priority     implementation phase
                                                                         (NREPP, Central
                                                                         CAPT reviews,
                                                                         community literature
                                                                         reviews and
                                                                         knowledge)


Builds on identified     Develop and submit     Provide a working        Following the format of
resources/strengths      Strategic Plan         plan for the             the State Strategic
                                                implementation phase     Plan and guidance
Sets measurable                                 of the project           document, write a
objectives                                                               comprehensive
                                                                         strategic plan
Specifies
performance
measures and
baseline data against
which progress will be
monitored
Describes
mechanisms for
making adjustments
using needs
assessment and
monitoring
information
Describes a long-term
strategy to sustain
policies, programs
and practices
CSAP Expectation         Outcome                   Goal/Objective            Action Step              Progress   Tangible   Completion   Completion Target   Person
                                                                                                                            Rating %     Date       Date     Responsible
Conduct on-going
monitoring and
oversight of SPF SIG
activites to:

Identify successes       Objectives - smaller      Goals should be
                         outcomes, the sum of      worded in terms of
                         which make are            new skills,
                         expected to result in     knowledge, or
                         project Goals.            attitudes for
                                                   stakeholders or as
                                                   changes in conditions
                                                   bearing on the
                                                   project, rather than as
                                                   activities
Encourage needed         Monitor collaborating     Maintain a high level     Identify areas needing
improvement              partner satisfaction      of satisfaction of SPF    improvement (<Good)
                         upon conclusion of        activities among          by 50% or more of
                         each LAC and              collaborating partners    membership and
                         workgroup meeting                                   employ improvement
                         via administration of a                             strategies
                         satisfaction survey

Promote sustainability Obtain training in the      Improve capacity of     Attend IPRC/DMHA
                       areas of evaluation,        collaborating partners sponsored trainings
                       needs assessment,           to conduct evaluation,
                       capacity building, and      asses need, build
                       strategic planning          coalition capacity, and
                                                   prepare a strategic
                                                   plan

                         Increase confidence                                 Administer self-
                         of collaborating                                    efficacy survey twice
                         members to perform                                  per year
                         tasks (evaluation,
                         needs assessment,
                         etc) by 10% (those
                         indicating very and
                         somewhat confident)
Supervise the delivery   Establish procedure       Provide Year 1            Complete Community
of required              for completion of         process evaluation        Level Instrument (CLI)
performance data to      process evaluation        data to IPRC and          part 1 items on a
SAMHSA                   documentation             state-level evaluators    monthly basis
            May-07                                                  Grantee:             COUNTY
Instructions: Complete this document on a monthly basis and email to DMHA (North~ Marcia French marcia.french@fssa.in.gov, South~ Kim Manlove kim.manlove@fssa.in.gov) and IPRC (Mari Kermit-
Canfield mkermitc@indiana.edu) by the 10th of each month.
CSAP Expectation      Outcome               Goal/Objective          Action Step          Progress                   Tangible                 Completion Completion Target        Person
                                                                                                                                             Rating %    Date         Date       Responsible
Assess levels of
local substance
abuse-related
problems using
state and local
epidemiology data to
determine:
Magnitude of            Complete Local Epi-   Provide data and       Complete Surveys and
substance abuse and profile                   evidence to            Analysis of community
related mental health                         community on what
disorders in the state,                       areas and populations
and locations of                              policies/programs will
where the problems                            be focused on          Identify data sources
are most severe                                                      and gather pertinent
                                                                     data from community




Level of risk and                                                   Pull data from State
protective factors                                                  Epi-profile and
associated with                                                     aggragate community
substance abuse and                                                 data
related mental health
disorders


Community assets                                                    Write, following format
and resources (gaps                                                 of state epi-report, a
in services and                                                     local epi-profile
capacity; readiness to
act)
CSAP Expectation          Outcome                 Goal/Objective          Action Step             Progress   Tangible   Completion   Completion Target   Person
                                                                                                                        Rating %     Date       Date     Responsible
Engage
stakeholders to
sustain prevention
activities:
Convene leaders and Hiring of key staff   Establish staff to            Identify & hire
stakeholders and/or members (inclusive of implement SPF                 Program Director,
build coalitions    fiscal manager)       project                       Administrative
                                                                        Assistant, and
                                                                        Fiscal Manger
                          Establish LAC &         Establish Councils to • Identify and appoint
                          LEOW and local by-      support staff in      Chairs for LAC &
                          laws for coalition      implementing SPF      LEOW
                                                  project               • Identify & invite
                                                                        members
                                                                        • Set up meeting
                                                                        schedules and times
                                                                        • Write by-laws for
                                                                        council
                          Identify and Organize Identify Workgroups       • Evaluation
                          Workgroup, chairs     to assist in the work     • Cultural Competence
                          and members           of the SPF project        • Training and
                                                                          Outreach
                                                                          • Youth/Young Adult
                                                                          • Program/Policy

Train community           Develop:                Provide                 Provide Local SPF
stakeholders,             Mission/Vision/Goals    organizational set-up   organizational chart
coalitions, and service   and timeline for each   to implement the SPF    with
providers                 council/workgroup       project                 vision/mission/goals
                                                                          for
Organize agency
                                                                          each workgroup with
networks, leverage
                                                                          tasks and timelines
resources
CSAP Expectation         Outcome                Goal/Objective           Action Step               Progress   Tangible   Completion   Completion Target   Person
                                                                                                                         Rating %     Date       Date     Responsible
Develop a strategic
plan that:

Articulates a vision for Complete logic model   Establish data-driven    Develop from the state
the prevention                                  decision making          epi-profile a logic
activities and                                  process to determine     model with identifiers
strategies for                                  population and area      from the local and
organizing and                                  of foci for              state epi reports and
implementing                                    implementation phase     data
prevention efforts                              of project
based on                 Identify principles/   Determine from logic     Review programs/
documented needs         practices/ policy/     model and indicators     policies/ practices/
                         program                from epi-report a        principles that address
                                                program/policy that is   the priority and the
                                                evidence based and       specific identified
                                                will address the         population to focus on
                                                needs of your            for prevention
                                                community’s priority     implementation phase
                                                                         (NREPP, Central
                                                                         CAPT reviews,
                                                                         community literature
                                                                         reviews and
                                                                         knowledge)


Builds on identified     Develop and submit     Provide a working        Following the format of
resources/strengths      Strategic Plan         plan for the             the State Strategic
                                                implementation phase     Plan and guidance
Sets measurable                                 of the project           document, write a
objectives                                                               comprehensive
                                                                         strategic plan
Specifies
performance
measures and
baseline data against
which progress will be
monitored
Describes
mechanisms for
making adjustments
using needs
assessment and
monitoring
information
Describes a long-term
strategy to sustain
policies, programs
and practices
CSAP Expectation         Outcome                   Goal/Objective            Action Step              Progress   Tangible   Completion   Completion Target   Person
                                                                                                                            Rating %     Date       Date     Responsible
Conduct on-going
monitoring and
oversight of SPF SIG
activites to:

Identify successes       Objectives - smaller      Goals should be
                         outcomes, the sum of      worded in terms of
                         which make are            new skills,
                         expected to result in     knowledge, or
                         project Goals.            attitudes for
                                                   stakeholders or as
                                                   changes in conditions
                                                   bearing on the
                                                   project, rather than as
                                                   activities
Encourage needed         Monitor collaborating     Maintain a high level     Identify areas needing
improvement              partner satisfaction      of satisfaction of SPF    improvement (<Good)
                         upon conclusion of        activities among          by 50% or more of
                         each LAC and              collaborating partners    membership and
                         workgroup meeting                                   employ improvement
                         via administration of a                             strategies
                         satisfaction survey

Promote sustainability Obtain training in the      Improve capacity of     Attend IPRC/DMHA
                       areas of evaluation,        collaborating partners sponsored trainings
                       needs assessment,           to conduct evaluation,
                       capacity building, and      asses need, build
                       strategic planning          coalition capacity, and
                                                   prepare a strategic
                                                   plan

                         Increase confidence                                 Administer self-
                         of collaborating                                    efficacy survey twice
                         members to perform                                  per year
                         tasks (evaluation,
                         needs assessment,
                         etc) by 10% (those
                         indicating very and
                         somewhat confident)
Supervise the delivery   Establish procedure       Provide Year 1            Complete Community
of required              for completion of         process evaluation        Level Instrument (CLI)
performance data to      process evaluation        data to IPRC and          part 1 items on a
SAMHSA                   documentation             state-level evaluators    monthly basis
             Jun-07                                                 Grantee:             COUNTY
Instructions: Complete this document on a monthly basis and email to DMHA (North~ Marcia French marcia.french@fssa.in.gov, South~ Kim Manlove kim.manlove@fssa.in.gov) and IPRC (Mari Kermit-
Canfield mkermitc@indiana.edu) by the 10th of each month.
CSAP Expectation      Outcome               Goal/Objective          Action Step          Progress                   Tangible                 Completion Completion Target        Person
                                                                                                                                             Rating %    Date         Date       Responsible
Assess levels of
local substance
abuse-related
problems using
state and local
epidemiology data to
determine:
Magnitude of            Complete Local Epi-   Provide data and       Complete Surveys and
substance abuse and profile                   evidence to            Analysis of community
related mental health                         community on what
disorders in the state,                       areas and populations
and locations of                              policies/programs will
where the problems                            be focused on          Identify data sources
are most severe                                                      and gather pertinent
                                                                     data from community




Level of risk and                                                   Pull data from State
protective factors                                                  Epi-profile and
associated with                                                     aggragate community
substance abuse and                                                 data
related mental health
disorders


Community assets                                                    Write, following format
and resources (gaps                                                 of state epi-report, a
in services and                                                     local epi-profile
capacity; readiness to
act)
CSAP Expectation          Outcome                 Goal/Objective          Action Step             Progress   Tangible   Completion   Completion Target   Person
                                                                                                                        Rating %     Date       Date     Responsible
Engage
stakeholders to
sustain prevention
activities:
Convene leaders and Hiring of key staff   Establish staff to            Identify & hire
stakeholders and/or members (inclusive of implement SPF                 Program Director,
build coalitions    fiscal manager)       project                       Administrative
                                                                        Assistant, and
                                                                        Fiscal Manger
                          Establish LAC &         Establish Councils to • Identify and appoint
                          LEOW and local by-      support staff in      Chairs for LAC &
                          laws for coalition      implementing SPF      LEOW
                                                  project               • Identify & invite
                                                                        members
                                                                        • Set up meeting
                                                                        schedules and times
                                                                        • Write by-laws for
                                                                        council
                          Identify and Organize Identify Workgroups       • Evaluation
                          Workgroup, chairs     to assist in the work     • Cultural Competence
                          and members           of the SPF project        • Training and
                                                                          Outreach
                                                                          • Youth/Young Adult
                                                                          • Program/Policy

Train community           Develop:                Provide                 Provide Local SPF
stakeholders,             Mission/Vision/Goals    organizational set-up   organizational chart
coalitions, and service   and timeline for each   to implement the SPF    with
providers                 council/workgroup       project                 vision/mission/goals
                                                                          for
Organize agency
                                                                          each workgroup with
networks, leverage
                                                                          tasks and timelines
resources
CSAP Expectation         Outcome                Goal/Objective           Action Step               Progress   Tangible   Completion   Completion Target   Person
                                                                                                                         Rating %     Date       Date     Responsible
Develop a strategic
plan that:

Articulates a vision for Complete logic model   Establish data-driven    Develop from the state
the prevention                                  decision making          epi-profile a logic
activities and                                  process to determine     model with identifiers
strategies for                                  population and area      from the local and
organizing and                                  of foci for              state epi reports and
implementing                                    implementation phase     data
prevention efforts                              of project
based on                 Identify principles/   Determine from logic     Review programs/
documented needs         practices/ policy/     model and indicators     policies/ practices/
                         program                from epi-report a        principles that address
                                                program/policy that is   the priority and the
                                                evidence based and       specific identified
                                                will address the         population to focus on
                                                needs of your            for prevention
                                                community’s priority     implementation phase
                                                                         (NREPP, Central
                                                                         CAPT reviews,
                                                                         community literature
                                                                         reviews and
                                                                         knowledge)


Builds on identified     Develop and submit     Provide a working        Following the format of
resources/strengths      Strategic Plan         plan for the             the State Strategic
                                                implementation phase     Plan and guidance
Sets measurable                                 of the project           document, write a
objectives                                                               comprehensive
                                                                         strategic plan
Specifies
performance
measures and
baseline data against
which progress will be
monitored
Describes
mechanisms for
making adjustments
using needs
assessment and
monitoring
information
Describes a long-term
strategy to sustain
policies, programs
and practices
CSAP Expectation         Outcome                   Goal/Objective            Action Step              Progress   Tangible   Completion   Completion Target   Person
                                                                                                                            Rating %     Date       Date     Responsible
Conduct on-going
monitoring and
oversight of SPF SIG
activites to:

Identify successes       Objectives - smaller      Goals should be
                         outcomes, the sum of      worded in terms of
                         which make are            new skills,
                         expected to result in     knowledge, or
                         project Goals.            attitudes for
                                                   stakeholders or as
                                                   changes in conditions
                                                   bearing on the
                                                   project, rather than as
                                                   activities
Encourage needed         Monitor collaborating     Maintain a high level     Identify areas needing
improvement              partner satisfaction      of satisfaction of SPF    improvement (<Good)
                         upon conclusion of        activities among          by 50% or more of
                         each LAC and              collaborating partners    membership and
                         workgroup meeting                                   employ improvement
                         via administration of a                             strategies
                         satisfaction survey

Promote sustainability Obtain training in the      Improve capacity of     Attend IPRC/DMHA
                       areas of evaluation,        collaborating partners sponsored trainings
                       needs assessment,           to conduct evaluation,
                       capacity building, and      asses need, build
                       strategic planning          coalition capacity, and
                                                   prepare a strategic
                                                   plan

                         Increase confidence                                 Administer self-
                         of collaborating                                    efficacy survey twice
                         members to perform                                  per year
                         tasks (evaluation,
                         needs assessment,
                         etc) by 10% (those
                         indicating very and
                         somewhat confident)
Supervise the delivery   Establish procedure       Provide Year 1            Complete Community
of required              for completion of         process evaluation        Level Instrument (CLI)
performance data to      process evaluation        data to IPRC and          part 1 items on a
SAMHSA                   documentation             state-level evaluators    monthly basis
              Jul-07                                                Grantee:             COUNTY
Instructions: Complete this document on a monthly basis and email to DMHA (North~ Marcia French marcia.french@fssa.in.gov, South~ Kim Manlove kim.manlove@fssa.in.gov) and IPRC (Mari Kermit-
Canfield mkermitc@indiana.edu) by the 10th of each month.
CSAP Expectation      Outcome               Goal/Objective          Action Step          Progress                   Tangible                 Completion Completion Target        Person
                                                                                                                                             Rating %    Date         Date       Responsible
Assess levels of
local substance
abuse-related
problems using
state and local
epidemiology data to
determine:
Magnitude of            Complete Local Epi-   Provide data and       Complete Surveys and
substance abuse and profile                   evidence to            Analysis of community
related mental health                         community on what
disorders in the state,                       areas and populations
and locations of                              policies/programs will
where the problems                            be focused on          Identify data sources
are most severe                                                      and gather pertinent
                                                                     data from community




Level of risk and                                                   Pull data from State
protective factors                                                  Epi-profile and
associated with                                                     aggragate community
substance abuse and                                                 data
related mental health
disorders


Community assets                                                    Write, following format
and resources (gaps                                                 of state epi-report, a
in services and                                                     local epi-profile
capacity; readiness to
act)
CSAP Expectation          Outcome                 Goal/Objective          Action Step             Progress   Tangible   Completion   Completion Target   Person
                                                                                                                        Rating %     Date       Date     Responsible
Engage
stakeholders to
sustain prevention
activities:
Convene leaders and Hiring of key staff   Establish staff to            Identify & hire
stakeholders and/or members (inclusive of implement SPF                 Program Director,
build coalitions    fiscal manager)       project                       Administrative
                                                                        Assistant, and
                                                                        Fiscal Manger
                          Establish LAC &         Establish Councils to • Identify and appoint
                          LEOW and local by-      support staff in      Chairs for LAC &
                          laws for coalition      implementing SPF      LEOW
                                                  project               • Identify & invite
                                                                        members
                                                                        • Set up meeting
                                                                        schedules and times
                                                                        • Write by-laws for
                                                                        council
                          Identify and Organize Identify Workgroups       • Evaluation
                          Workgroup, chairs     to assist in the work     • Cultural Competence
                          and members           of the SPF project        • Training and
                                                                          Outreach
                                                                          • Youth/Young Adult
                                                                          • Program/Policy

Train community           Develop:                Provide                 Provide Local SPF
stakeholders,             Mission/Vision/Goals    organizational set-up   organizational chart
coalitions, and service   and timeline for each   to implement the SPF    with
providers                 council/workgroup       project                 vision/mission/goals
                                                                          for
Organize agency
                                                                          each workgroup with
networks, leverage
                                                                          tasks and timelines
resources
CSAP Expectation         Outcome                Goal/Objective           Action Step               Progress   Tangible   Completion   Completion Target   Person
                                                                                                                         Rating %     Date       Date     Responsible
Develop a strategic
plan that:

Articulates a vision for Complete logic model   Establish data-driven    Develop from the state
the prevention                                  decision making          epi-profile a logic
activities and                                  process to determine     model with identifiers
strategies for                                  population and area      from the local and
organizing and                                  of foci for              state epi reports and
implementing                                    implementation phase     data
prevention efforts                              of project
based on                 Identify principles/   Determine from logic     Review programs/
documented needs         practices/ policy/     model and indicators     policies/ practices/
                         program                from epi-report a        principles that address
                                                program/policy that is   the priority and the
                                                evidence based and       specific identified
                                                will address the         population to focus on
                                                needs of your            for prevention
                                                community’s priority     implementation phase
                                                                         (NREPP, Central
                                                                         CAPT reviews,
                                                                         community literature
                                                                         reviews and
                                                                         knowledge)


Builds on identified     Develop and submit     Provide a working        Following the format of
resources/strengths      Strategic Plan         plan for the             the State Strategic
                                                implementation phase     Plan and guidance
Sets measurable                                 of the project           document, write a
objectives                                                               comprehensive
                                                                         strategic plan
Specifies
performance
measures and
baseline data against
which progress will be
monitored
Describes
mechanisms for
making adjustments
using needs
assessment and
monitoring
information
Describes a long-term
strategy to sustain
policies, programs
and practices
CSAP Expectation         Outcome                   Goal/Objective            Action Step              Progress   Tangible   Completion   Completion Target   Person
                                                                                                                            Rating %     Date       Date     Responsible
Conduct on-going
monitoring and
oversight of SPF SIG
activites to:

Identify successes       Objectives - smaller      Goals should be
                         outcomes, the sum of      worded in terms of
                         which make are            new skills,
                         expected to result in     knowledge, or
                         project Goals.            attitudes for
                                                   stakeholders or as
                                                   changes in conditions
                                                   bearing on the
                                                   project, rather than as
                                                   activities
Encourage needed         Monitor collaborating     Maintain a high level     Identify areas needing
improvement              partner satisfaction      of satisfaction of SPF    improvement (<Good)
                         upon conclusion of        activities among          by 50% or more of
                         each LAC and              collaborating partners    membership and
                         workgroup meeting                                   employ improvement
                         via administration of a                             strategies
                         satisfaction survey

Promote sustainability Obtain training in the      Improve capacity of     Attend IPRC/DMHA
                       areas of evaluation,        collaborating partners sponsored trainings
                       needs assessment,           to conduct evaluation,
                       capacity building, and      asses need, build
                       strategic planning          coalition capacity, and
                                                   prepare a strategic
                                                   plan

                         Increase confidence                                 Administer self-
                         of collaborating                                    efficacy survey twice
                         members to perform                                  per year
                         tasks (evaluation,
                         needs assessment,
                         etc) by 10% (those
                         indicating very and
                         somewhat confident)
Supervise the delivery   Establish procedure       Provide Year 1            Complete Community
of required              for completion of         process evaluation        Level Instrument (CLI)
performance data to      process evaluation        data to IPRC and          part 1 items on a
SAMHSA                   documentation             state-level evaluators    monthly basis
             Aug-07                                                 Grantee:             COUNTY
Instructions: Complete this document on a monthly basis and email to DMHA (North~ Marcia French marcia.french@fssa.in.gov, South~ Kim Manlove kim.manlove@fssa.in.gov) and IPRC (Mari Kermit-
Canfield mkermitc@indiana.edu) by the 10th of each month.
CSAP Expectation      Outcome               Goal/Objective          Action Step          Progress                   Tangible                 Completion Completion Target        Person
                                                                                                                                             Rating %    Date         Date       Responsible
Assess levels of
local substance
abuse-related
problems using
state and local
epidemiology data to
determine:
Magnitude of            Complete Local Epi-   Provide data and       Complete Surveys and
substance abuse and profile                   evidence to            Analysis of community
related mental health                         community on what
disorders in the state,                       areas and populations
and locations of                              policies/programs will
where the problems                            be focused on          Identify data sources
are most severe                                                      and gather pertinent
                                                                     data from community




Level of risk and                                                   Pull data from State
protective factors                                                  Epi-profile and
associated with                                                     aggragate community
substance abuse and                                                 data
related mental health
disorders


Community assets                                                    Write, following format
and resources (gaps                                                 of state epi-report, a
in services and                                                     local epi-profile
capacity; readiness to
act)
CSAP Expectation          Outcome                 Goal/Objective          Action Step             Progress   Tangible   Completion   Completion Target   Person
                                                                                                                        Rating %     Date       Date     Responsible
Engage
stakeholders to
sustain prevention
activities:
Convene leaders and Hiring of key staff   Establish staff to            Identify & hire
stakeholders and/or members (inclusive of implement SPF                 Program Director,
build coalitions    fiscal manager)       project                       Administrative
                                                                        Assistant, and
                                                                        Fiscal Manger
                          Establish LAC &         Establish Councils to • Identify and appoint
                          LEOW and local by-      support staff in      Chairs for LAC &
                          laws for coalition      implementing SPF      LEOW
                                                  project               • Identify & invite
                                                                        members
                                                                        • Set up meeting
                                                                        schedules and times
                                                                        • Write by-laws for
                                                                        council
                          Identify and Organize Identify Workgroups       • Evaluation
                          Workgroup, chairs     to assist in the work     • Cultural Competence
                          and members           of the SPF project        • Training and
                                                                          Outreach
                                                                          • Youth/Young Adult
                                                                          • Program/Policy

Train community           Develop:                Provide                 Provide Local SPF
stakeholders,             Mission/Vision/Goals    organizational set-up   organizational chart
coalitions, and service   and timeline for each   to implement the SPF    with
providers                 council/workgroup       project                 vision/mission/goals
                                                                          for
Organize agency
                                                                          each workgroup with
networks, leverage
                                                                          tasks and timelines
resources
CSAP Expectation         Outcome                Goal/Objective           Action Step               Progress   Tangible   Completion   Completion Target   Person
                                                                                                                         Rating %     Date       Date     Responsible
Develop a strategic
plan that:

Articulates a vision for Complete logic model   Establish data-driven    Develop from the state
the prevention                                  decision making          epi-profile a logic
activities and                                  process to determine     model with identifiers
strategies for                                  population and area      from the local and
organizing and                                  of foci for              state epi reports and
implementing                                    implementation phase     data
prevention efforts                              of project
based on                 Identify principles/   Determine from logic     Review programs/
documented needs         practices/ policy/     model and indicators     policies/ practices/
                         program                from epi-report a        principles that address
                                                program/policy that is   the priority and the
                                                evidence based and       specific identified
                                                will address the         population to focus on
                                                needs of your            for prevention
                                                community’s priority     implementation phase
                                                                         (NREPP, Central
                                                                         CAPT reviews,
                                                                         community literature
                                                                         reviews and
                                                                         knowledge)


Builds on identified     Develop and submit     Provide a working        Following the format of
resources/strengths      Strategic Plan         plan for the             the State Strategic
                                                implementation phase     Plan and guidance
Sets measurable                                 of the project           document, write a
objectives                                                               comprehensive
                                                                         strategic plan
Specifies
performance
measures and
baseline data against
which progress will be
monitored
Describes
mechanisms for
making adjustments
using needs
assessment and
monitoring
information
Describes a long-term
strategy to sustain
policies, programs
and practices
CSAP Expectation         Outcome                 Goal/Objective           Action Step              Progress   Tangible   Completion   Completion Target   Person
                                                                                                                         Rating %     Date       Date     Responsible
Conduct on-going
monitoring and
oversight of SPF SIG
activites to:

Identify successes       Objectives - smaller    Goals should be
                         outcomes, the sum of    worded in terms of
                         which make are          new skills,
                         expected to result in   knowledge, or
                         project Goals.          attitudes for
                                                 stakeholders or as
                                                 changes in conditions
                                                 bearing on the
Encourage needed         Monitor collaborating Maintain a high level      Identify areas needing
improvement              partner satisfaction    of satisfaction of SPF   improvement (<Good)
                         upon conclusion of      activities among         by 50% or more of
                         each LAC and            collaborating partners   membership and
                         workgroup meeting                                employ improvement
                         via administration of a                          strategies
                         satisfaction survey

Promote sustainability Obtain training in the    Improve capacity of     Attend IPRC/DMHA
                       areas of evaluation,      collaborating partners sponsored trainings
                       needs assessment,         to conduct evaluation,
                       capacity building, and    asses need, build
                       strategic planning        coalition capacity, and
                                                 prepare a strategic
                                                 plan

                         Increase confidence                              Administer self-
                         of collaborating                                 efficacy survey twice
                         members to perform                               per year
                         tasks (evaluation,
                         needs assessment,
                         etc) by 10% (those
                         indicating very and
                         somewhat confident)
Supervise the delivery   Establish procedure     Provide Year 1           Complete Community
of required              for completion of       process evaluation       Level Instrument (CLI)
performance data to      process evaluation      data to IPRC and         part 1 items on a
SAMHSA                   documentation           state-level evaluators   monthly basis

								
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