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Home My WebLink About20093154.tiffRESOLUTION RE: APPROVE COLORADO PREVENTION PARTNERS PURCHASE OF SERVICES AGREEMENT AND AUTHORIZE CHAIR TO SIGN - NORTH RANGE BEHAVIORAL HEALTH WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with a Colorado Prevention Partners Purchase of Services Agreement between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and North Range Behavioral Health, commencing September 30, 2009, and ending June 30, 2010, with further terms and conditions being as stated in said agreement, and WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Colorado Prevention Partners Purchase of Services Agreement between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Human Services, and North Range Behavioral Health be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said agreement. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 7th day of December, A.D., 2009. ATTEST: Weld County Clerk to the B BY:, yL4^ Dep1uy Cler i APPRO orney Date of signature: IL(jot1 L BOARD OF COUNTY COMMISSIONERS ELD COUNTCOLORADO / William F. Garcia, Chair Sea P. Conway acher, Pro-Tem 71/4/11C-ISEA-) a Kirkmeyer ) / L LAL David E. Long G CoCtolei6-) 2009-3154 , / / HR0080 I MEMORANDUM Aitta DATE: December 2, 2009 ' 1'�� TO: William F. Garcia, Chair, Board of County Commissioners �111eFROM: Judy A. Griego, Director, Human Services�y>sp'�Ytm11 COLORADO RE: Colorado Prevention Partners Purchase of Services Agreement between the Weld County Department of Human Services and North Range Behavioral Health Enclosed for Board approval is the Colorado Prevention Partners Purchase of Services Agreement between the Weld County Department of Human Services and North Range Behavioral Health. The original Colorado Prevention Partners Plan and Agreement with the State was discussed at the Board's July 14, 2009, Work Session. As background information, the Board entered into a FY 2007 Colorado Prevention Partners Contract with the Colorado Department of Human Services. Funding was awarded under a non-competitive "Colorado Prevention Partners" application, which was submitted on behalf of Weld County's Interagency Oversight Group (HB04-1451, "Collaborative Management of Multi -agency Services Provided to Children and Families), and at the request of the Governor's Office. The Department continues to act as the Fiscal Agent. North Range will act as the Program Administrator. Under this Agreement, the Juvenile Assessment Center (JAC), acting as the Interagency Oversight Group (IOG), provides oversight for the Project. 1. The purpose of the project is to reduce substance abuse in Weld County following evidence - based strategies using a multi -tiered approach. 2. The Contract provides for continued funding at an amount not to exceed $148,704.00 as outlined in a budget incorporated as part of the Agreement. Funding will pay for a Project Coordinator employed by North Range Behavioral Health, survey expenses, and related operating expenses. 3. The source of funding is through the Colorado Department of Human Services' Alcohol and Drug Abuse Division. 4. The period of the Agreement is September 30, 2009 through June 30, 2010. If you have questions, please give me a call at extension 6510. 2009-3154 Contract No: SFY09-10-CPP COLORADO PREVENTION PARTNERS PURCHASE OF SERVICES AGREEMENT BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND NORTH RANGE BEHAVIORAL HEALTH This Agreement, made and entered into the / ay of December 2009, by and between the Board of Weld County Commissioners, sitting as the Board of Human Services, on behalf of the Weld County Department of Human Services, hereinafter referred to as "Human Services," and North Range Behavioral Health, hereinafter referred to as "North Range Behavioral Health." WITNESSETH WHEREAS, required approval, clearance, and coordination have been accomplished from and with appropriate agencies; and WHEREAS, by and through Resolution #2008-1533, dated May 28, 2008, effective June 1, 2008, the Board of County Commissioners of Weld County combined into one department the functions of the Weld County Department of Social Services and the Weld County Department of Human Services, thereby authorizing the Weld County Department of Human Services as the department of Weld County government to receive funding for and to perform the duties of a county department of social services according to Colorado statutes and administrative regulations; and WHEREAS, the Weld County Juvenile Assessment Center (JAC), acting as the Interagency Oversight Group (IOG), formed under HB04-1451, provides a focus for a collaborative planning approach to the delivery of services to children and families that may lead to the provision of more appropriate and effective delivery of services in Weld County; and WHEREAS, Human Services, on behalf of the Weld County JAC and at the request of the State of Colorado Governor's Office, submitted in July 2006 a non -completive application under "Colorado Prevention Partners" grant, which had as its goal to increase community capacity to initiate implementation of a Strategic Prevention Framework project; and WHEREAS, the Colorado Department of Human Services, Alcohol and Drug Abuse Division continues to contract with and provide funding to Human Services since September 2006 to develop a community planning project entitled the "Colorado Prevention Program", designed to reduce substance abuse related problems; prevent onset and reduce progression of substance abuse, including childhood and underage drinking of alcohol; build prevention capacity and infrastructure at state and community levels; and develop a Strategic Prevention Framework model; and WHEREAS, the Weld County JAC, acting as the IOG, continues to accept the planning and guidance of the Colorado Prevention Program and has agreed to meet the guidelines and requirements set forth for the project by the Colorado Department of Human Services; and WHEREAS, Human Services, as the fiscal agent of the project, seeks services to develop the Colorado Prevention Program; and WHEREAS, the Weld County JAC, with the concurrence of Human Services, continues to select North Range Behavioral Health to provide services to develop the Colorado Prevention Program; and WHEREAS, North Range Behavioral Health, a Colorado non-profit corporation organized for the purpose of managing and coordinating high quality, cost efficient, integrated chemical dependency and related behavioral health care services, is willing to provide services to develop the Colorado Prevention Program and wishes to enter into an Agreement with Services to receive financial support for the project. Page 1 of 3 a7co9- .315'9 Contract No: SFY09-10-CPP NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows: 1. TERM: The term of the MOU and Agreement is September 30, 2009, and shall expire June 30, 2010, unless sooner terminated as provided herein, 2. SERVICES PROVIDED BY NORTH RANGE BEHAVIORAL HEALTH: North Range Behavioral Health shall be in compliance with Exhibit B, "Contract Between Colorado Department of Human Services and Weld County Department of Human Services, Routing No. I0-IHM-04554", which outlines the direct services to be provided by North Range Behavioral Health and the planning oversight requirements of the Weld County JAC, and which is attached hereto and incorporated herein by reference. 3. COMPENSATION TO NORTH RANGE BEHAVIORAL HEALTH: Human Services agrees to pay North Range Behavioral Health for services pursuant to this Agreement a sum of $148,704, according to the budget as follows: Personnel Project Director Fringe Benefits (28%) Eval Coordinator Total Personnel Travel Local Out of Area Total Travel $ 34,068 $ 9,539 $ 9,000 $ 52,607 $ 1,350 $ 1,420 $ 2,770 Operating PPB Stipends/Incentives $ 972 CPP Office/Phone $ 5,850 Copying/Printing $ 450 Office Supplies $ 225 Meeting Room Rental $ 300 Food/Meetings $ 1,800 Implementation $ 40,575 Indirect (20%) $ 9,000 Data Collection/HKCS $ 34,155 Total Operating $ 93,327 Grand Total $148,704 A. North Range Behavioral Health shall submit an itemized monthly bill according to proper invoices to Human Services for all costs incurred and services provided pursuant to Exhibit B of this Agreement in accordance with criteria established by Human Services. North Range Behavioral Health shall submit all itemized monthly billings to Human Services no later than the twenty-fifth (25) day of the month following the month the cost was incurred. B. Payments of costs incurred pursuant to this Agreement are expressly contingent upon the availability of the Alcohol and Drug Abuse Division - Colorado Prevention Partners Grant to Human Services. C. Human Services shall not be billed for, and reimbursement shall not be made for time involved in activities outside of those defined in Exhibit B. Work performed prior to the execution of this Contract shall not be reimbursed or considered part of this Agreement. Page 2 of 3 Contract No: SFY09-10-CPP D. Human Services may withhold any payment if North Range Behavioral Health has failed to comply with the Financial Management Requirements, program objectives, contractual terms, or reporting requirements. In the event of a forfeiture of reimbursements, North Range Behavioral Health may appeal such circumstance to the Director of Human Services. The decision of the Director of Human Services shall be final. 4. ASSURANCES: North Range Behavioral Health shall abide by all assurances as set forth in the Exhibit A, "Assurances," which is attached hereto and incorporated herein by reference. 5. CERTIFICATION: North Range Behavioral Health certifies that, at the time of entering into this Contract, it has currently in effect all necessary licenses, approvals, insurance, etc. required to properly provide the services and/or supplies covered by this contract. 6 TERMINATION: Either party may terminate this MOU or Agreement at any time by providing the other party with a 30 -day written notice thereof. Furthermore, this MOU or Agreement may be terminated at any time without notice upon a material breach of the terms of the MOU or Agreement. 7. TIME OF THE ESSENCE: Time is the essence in each and all of the provisions of this MOU and Agreement. 8. ENTIRE MOU AND AGREEMENT/MODIFICATIONS: This MOU including Exhibit B and this Agreement including Exhibit A and B constitutes the entire understanding between the parties with the respect to the promises and covenants made therein. No modification of the terms of this MOU or Agreement shall be valid unless made in writing and agreed to by all parties of the MOU and both parties of the Agreement. 9. NON -APPROPRIATION: No portion of this Agreement shall be deemed to create an obligation on the part of Human Services to expend funds not otherwise appropriated in each succeeding year. 10. WAIVER OF IMMUNITIES/THIRD PARTY LIABILITY: No portion of this Agreement shall be deemed to constitute a waiver of any immunities of Human Services or its officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care with respect to any persons other than Human Services and not a party of this Agreement. IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: WELD COUNTY CLERK TO THE BOARD By: puty Clerk APPROVED AS TO FORM: • 2 C'dunty Attorney WELD COUNTY DEPARTMENT OF HUMAN SJRV ES /,/tpy. I . ut By: Judy A. Gri Direct() RD OF COUNTY COJaMISSIONERS D COUNT CO William F. Garcia, Chair DEC 0 7 2009 NORTH RANGE BEHAVIORAL HEALTH BY w WayneMaxwell, Executive Director Page 3 of 3 ,7(rf $/J7 Contract No: SFY09-l0-CPP EXHIBIT A ASSURANCES 1. North Range Behavioral Health agrees it is an independent contractor and that its officers and employees do not become employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as the result of the execution of this Agreement. 2. Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be held liable for injuries or damages caused by any negligent acts or omissions of North Range Behavioral Health -contracted providers or its employees, volunteers, or agents while performing duties as described in this Agreement. North Range Behavioral Health shall indemnify, defend, and hold harmless Weld County, the Board of County Commissioners of Weld County, its employees, volunteers, and agents. North Range Behavioral Health shall provide adequate liability and worker's compensation insurance for all its employees, volunteers, and agents engaged in the performance of the Agreement upon request, North Range Behavioral Health shall provide Human Services with the acceptable evidence that such coverage is in effect. 3. No portion of this Contract shall be deemed to constitute a waiver of any immunities the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have treated a duty of care with respect to any persons not a party of this Agreement. 4. No portion of this Contract shall be deemed to create an obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise appropriated in each succeeding year. 5. If any section, subsections, paragraph, sentence, clause, or phrase of this Contract is for any reason held or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions. The parties hereto declare that they would have entered into this Contract and each and every section, subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional or invalid. 6. No officer, member or employee of Weld County and no member of their governing bodies shall have any pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof. 7. North Range Behavioral Health assures that they will comply with the Title VI of the Civil Rights Act of 1986 and that no person shall, on the grounds of race, creed, color, sex, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under this approved Contract. 8. North Range Behavioral Health assures that sufficient, auditable, and otherwise adequate records that will provide accurate, current, separate, and complete disclosure of the status of the funds received under the Contract are maintained for three (3) years or the completion and resolution of an audit. Such records shall be sufficient to allow authorized local, Federal, and State auditors, and representatives to audit and monitor North Range Behavioral Health. Page I of 4 Contract No: SFY09-10-CPP 9. All such records, documents, communications, and other materials shall be the property of Human Services and shall be maintained by North Range Behavioral Health, in a central location and custodian, in behalf of Human Services, for a period of four (4) years from the date of final payment under this Contract, or for such further period as may be necessary to resolve any matters which may be pending, or until an audit has been completed with the following qualifications: If an audit by or on behalf of the federal and/or state government has begun but is not completed at the end of the four (4) year period, or if audit findings have not been resolved after a four (4) year period, the materials shall be retained until the resolution of the audit finding. 10. North Range Behavioral Health assures that authorized local, federal, and state auditors and representatives shall, during business hours, have access to inspect any copy records, and shall be allowed to monitor and review through on -site visits, all contract activities, supported with funds under this Contract to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The results of the monitoring and evaluation activities shall be provided to the appropriate and interested parties. 1 1. This Contract shall be binding upon the parties hereto, their successors, heirs, legal representatives, and assigns. North Range Behavioral Health or Human Services may not assign any of its rights or obligations hereunder without the prior written consent of both parties. 12. North Range Behavioral Health certifies that federal appropriated funds have not been paid or will be paid, by or on behalf of North Range Behavioral Health, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any federal grant, the making of any federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative agreement. 13. North Range Behavioral Health assures that it will fully comply with all other applicable federal and state laws. North Range Behavioral Health understands that the source of funds to be used under this Contract is Colorado Works or Temporary Assistance for Needy Families funds. 14. North Range Behavioral Health assures and certifies that it and its principals: a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transaction by a federal department of agency. b. Have not, within a three-year period of preceding this Agreement, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public Page 2 of 4 Contract No: SFY09- I O-CPP transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph 11(b) of this certification; and d. Have not within a three-year period preceding this Contract, had one or more public transactions (federal, state, and local) terminated for cause or default. 15. The Appearance of Conflict of Interest applies to the relationship of a contractor with Human Services when the contractor also maintains a relationship with a third party and the two relationships are in opposition. In order to create the appearance of a conflict of interest, it is not necessary for the contractor to gain from knowledge of these opposing interests. It is only necessary that the contractor know that the two relationships are in opposition. During the term of the Contract, North Range Behavioral Health shall not enter any third party relationship that gives the appearance of creating a conflict of interest. Upon learning of an existing appearance of a conflict of interest situation, North Range Behavioral Health shall submit to Human Services, a full disclosure statement setting forth the details that create the appearance of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall constitute grounds for Human Services' termination, for cause, of its contract with North Range Behavioral Health. 16. North Range Behavioral Health shall protect the confidentiality of all applicant records and other materials that are maintained in accordance with this Contract. Except for purposes directly connected with the administration of Child Protection, no information about or obtained from any applicant/recipient in possession of North Range Behavioral Health shall be disclosed in a form identifiable with the applicant/recipient or a minor's parent or guardian unless in accordance with North Range Behavioral Health written policies governing access to, duplication and dissemination of, all such information. North Range Behavioral Health shall advise its employees, agents, and subcontractor, if any, that they are subject to these confidentiality requirements. North Range Behavioral Health shall provide its employees, agents, and subcontractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. 17. Proprietary information for the purposes of this Contract is information relating to a party's research, development, trade secrets, business affairs, internal operations and management procedures and those of its customers, clients or affiliates, but does not include information (I) lawfully obtained from third parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither party shall use or disclose directly or indirectly without prior written authorization any proprietary information concerning the other party obtained as a result of this Contract. Any proprietary information removed from the State's site by North Range Behavioral Health in the course of providing services under this Contract will be accorded at least the same precautions as are employed by North Range Behavioral Health for similar information in the course of its own business. Page 3 of 4 Contract No: SFY09-10-CPP 18. North Range Behavioral Health certifies it will abide by Colorado Revised Statue (C.R.S.) 26-6-104, requiring criminal background record checks for all employees, contractors, and sub -contractors. 19. North Range Behavioral Health certifies that it shall comply with the provisions of Colorado Revised Statutes (C.R.S.) 8-17.5-101, et seq. North Range Behavioral Health shall not knowingly employ or contract with an illegal alien to perform work under this Contract or enter into a contract with a subcontractor that fails to certify to North Range Behavioral Health that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this Contract. North Range Behavioral Health represents, warrants, and agrees that it (a) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (b) otherwise will comply with the requirements of C.R.S. 8-17.5- IO2(2)(b). North Range Behavioral Health shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of Labor and Employment. If North Range Behavioral Health fails to comply with any requirement of this provision or C.R.S. 8-17.5-101, et seq., Human Services may terminate this Contract for breach and North Range Behavioral Health shall be liable for actual and consequential damages to Human Services. Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if North Range Behavioral Health receives federal or state funds under this Contract, North Range Behavioral Health must confirm that any individual natural person eighteen (18) years of age or older is lawfully present in the United States pursuant to C.R.S. 24- 76.5-103(4) if such individual applies for public benefits provided under this Contract. If North Range Behavioral Health operates as a sole proprietor, it hereby swears or affirms under penalty of perjury that it (a) is a citizen of the United States or is otherwise lawfully present in the United States pursuant to federal law, (b) shall produce one of the forms of identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of identification required by C.R.S. 24-76.5-103 prior to the effective date of this Contract. Page 4 of 4 21139 OCT ! C Fi'I I: 08 10 IHM 04554 OPTION LETTER Exhibit F Date: September 3, 2009 State Fiscal Year: 2010 Option Letter No. _3_ SUBJECT: (Please indicate purpose by choosing one of the following) 5- Level of service change in conjunction with renewal for additional term In accordance with Paragraph 14 of Exhibit A of contract routing number 07 IHM 00161 between the State of Colorado, Department of Human Services, Alcohol and Drug Abuse Division and Weld County Social Services the State hereby exercises the option for an additional term of one year (September 30, 2009 through September 30, 2010) at an increase in the amount of services of $972.00 as specified in Paragraph 13 of Exhibit A, for a total amount for fiscal year 2010 of $148,704.00, in accordance with the revised CCP Budget 10, attached as Exhibit E amended. The amount of the current Fiscal Year contract value is increased/desceasecLli.y $148,704.00 to a new contract value of $807,903.00 ($193,695.00 for FY 07, $248,427.00 for FY 08, $217,077 for FY 09 and $148,704.00 for FY 10) to satisfy services/goods ordered under the contract for the current fiscal year 2010. The first sentence in Paragraph 13 of Exhibit A is hereby modified accordingly. The total contract value to include all previous amendments, option letters, etc. is $807,903.00. APPROVALS: State of Colorado: Bill Ritter Jr., Governor By: For the Executive Director Colorado Department of Human Services Date: ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER CRS 24-30-202 requires that the State Controller approve all state contracts. This contract is not valid until the State Controller, or such assistant as he may delegate, has signed it. The contractor is not authorized to begin performance until the contract is signed and dated below. If performance begins prior to the date below, the State of Colorado may not be obligated to pay for goods and/or services provided. State Controller David J. McDermott, CPA By: _ Date: VALRI GIMPLE Date Issued: February 10, 2003 CPP Budget Page - Fiscal Year 10 Exhibit E Amended PRdJEOCTO .y+„! a dRdJECY2'1.1" �` ::,:,.-, Weid,�:oViijyfDepapPiEfttgf Weld datin) Pre46111Po Division of Behaviora Health (DBH) CPP BUDGET PAGE 6/30/2010iafth.a .':g$ H3`rriasYi-Services&'N 9)30/209 Partners -TIME PERIOD 9/30/2009-6/30/2010 Category 8 Line Annual Time U Mos Hrs/ Week TOTAL BUDGET CPP FUND Other Source - Cash Other Source - Non Cash I In -Kind Personnel % 1 CPP Coordinator to fte.. ',. ' .. 9 ' :: 40 34,068 00 34,068 00 0.00 0.00 Fringe Benefits �2$% 9,539.00 9,539.00 0.00 0.00 2. Eval Liaison ,25fttaj$f29, i.“10 9,000.00 9,000.00 0.00 0.00 Fringe Benefits „. ':O/a 0.00 0.00 0.00 0.00 3. Admin Assistant : $/4 i&1?¢r «* 0.00 0.00 0.00 0.00 Fringe Benefits :: O% 0.00 0.00 0.00 0.00 4. Volunteer -in-kind 6,150.00 0.00 0.00 6,150.00 Total Personnel 58,757.00 52,607.00 0.00 6,150.00 Consultants 1. Youth Consultants 0.00 0.00 0.00 0.00 2. Subcontractor 0.00 0.00 0.00 0.00 3. Consultant/Coordinator OMNI 750.00 0.00 0.00 750.00 Total Consultant 750.00 0.00 0.001 750.00 Travel 1. Local 1,350.00 1,350.00 0.00 0.00 2. Out of Area 1,420.00 1,420.00 0.00 0.00 Total Travel 2,770.00 2,770.00 0.001 0.00 Operating 1. Training/Conference see above 0.00 0.00 0.00 0.00 2. Copying/Printing 450.00 450.00 0.00 0.00 3. MeetingRoom 9,750.00 300.00 0.00 9,450.00 4. Food 1,800.00 1,800.00 0.00 0.00 5. Indirect 9,000.00 9,000.00 0.00 0.00 6. Data Collection - HKCS 34,155.00 34,155.00 0.00 0.00 7.Office-rent/phone 5,850.00 5,850.00 0.00 0.00 8.lncentives/stipends 972.00 972.00 0.00 0.00 9.0ffice Supplies 225.00 225.00 0.00 0.00 Total Operating 62,202.00 52,752.00 0.00 9,450.00 Implementation 1. Goal 1 26,57500 26,575.00 0.00 0.00 2. Goal 2 8,200.00 8,200 00 0.00 0.00 3. Goal 3 5,800.00 5,800.00 0.00 0.00 Total Implementation 40,575.00 40,575.00 0.001 0.00 rand I otal I I I I I 165,054.00] 148,704.001 0.001 16,350.00 Page 1 of 1 Attachment A Colorado Prevention Partners Strategic Prevention Framework State Incentive Grant Guidelines for Continuation Process No -Cost Extension Application Packet 2009-2010 CONTRACTOR: Division of Behavioral Health (DBH) CPP BUDGET PAGE Services & North'Range:Behavior Health TIME PERIOD: 9/30/2009 - 6/30/2010 Weld Coun y Department of Human Weld CSUn y Preventi`onTafiri s, PROJECT TITLE: Category & Line Annual Time # Mos Hrs/ Week TOTAL BUDGET CPP FUND Other Source - Cash Other Source - Non -Cash f In -Kind Personnel 1. CPP Coordinator 1.0 fte - - 9 ..: - 40 34,068.00 34,068.00 0.00 0.00 Fringe Benefits ",28% 9,539.00 9,539.00 0.00 0.00 2. Eval Liaison .25 fte , 9 -10 9,000.00 9,000.00 0.00 0.00 Fringe Benefits 0% 0.00 0.00 0.00 0.00 3. Admin Assistant 0.00 0.00 0.00 0.00 Fringe Benefits .., - 0% 0.00 0.00 0.00 0.00 6,150.00 4. Volunteer - in -kind Total Personnel 52,607.00 52,607.00 0.00 6,150.00 Consultants 1. Youth Consultants 0.00 0.00 0.00 0.00 2 Subcontractor 0.00 0.00 0.00 0.00 3. Consultant/Coordinator OMNI 0.00 0.00 0.00 750.00 Total Consultant 0.00 0.00 0.00 750.00 Travel 1. Local 1,350.00 1,350.00 0.00 0.00 2 Out of Area 1,881.00 1,881.00 0.00 0.00 Total Travel 3,231.00 3,231.00 0.00 0.00 Operating 1. Training/Conference see above 0.00 0.00 0.00 0.00 2. Copying/Printing 450.00 450.00 0.00 0.00 3 Meeting Room 300.00 300.00 0.00 9,450.00 4. Food 1,800.00 1,800.00 0.00 0.00 5. Indirect 9,000.00 9,000.00 0.00 0.00 6.Data Collection - HKCS 7.Office-rentlphone 8. Incentives/stipends 9.Office Supplies 34,155.00 34,155.00 5,850.00 5,850.00 972.00 972.00 225 225 Total Operating 52,752.00 52,752.00 0.00 9,450.00 Implementation 1. Goal 1 26,575.00 26,575.00 0.0O 0.00 2. Goal 2 8,200.00 8,200.00 0.00 0.00 3. Goal 3 5,800.00 5,800.00 0.00 0.00 Total Implementation 40,575.00 40,575.001 0.001 0.00 rand lotal f I ( f f 149,1b5.00f 149,1bb.UUI U.U0I 16,359.110 Instructions: This is the budget format required for the next fiscal year. The budget should reflect and individually identify costs for both the fiscal agent and any subconstractors. Billings to DBH should be prepared referencing the line items in the budget. Your budget narrative must match the budget. cdhs cc:vIcdc Bc Vcrtrcc! a" ilrm.an Scrvrcec iuey4n LAU help leir';ile Guidelines for Colorado Prevention Partners Continuation Process September 30, 2009 —June 30, 2010 Use this page as a checklist to ensure inclusion of all required pages. Review 09-10 CPP Continuation Guidelines: Instructions and timeline Attachments ❑ Revise forms as needed (including HKCS Reporting Request Form) ❑ Sign and submit 2009-2010 Work Agreement (page 5) Complete Cover Page (Part 1) Review DBH and OMNI Prevention Program Directory Summary (Part 2) Complete CPP Program Narrative Report (Part 3) Submit a revised Work Plan using the sample format in the Attachment Section #4 page 8 (Part 4) Submit Steps 1 & 2 of your Sustainability Plan using the format in the Attachment Section #V page 9 (Part 5) Complete the Line Item Budget and Budget Narrative for 9 -months of 2009-2010 using the Excel budget sheet and following instructions in the Attachment Section #VIII page 33 (Part 6) Send one electronic copy of the application to Lou.Jenninas@state.co.us with a cc: to Melody.Durso@state.co.us no later than close of business Friday July 10, 2009 If you have electronic signature technology, send the signed cover page (Part 1) with your electronic copy If you do not have electronic signature technology, mail the signed cover page (Part 1) to the address below no later than close of business Friday, July 10, 2009. Extention was requested and approved for signed pages By mail or hand delivered: Community Prevention, Division of Behavioral Health 3824 W. Princeton Circle Denver, CO 80236-3111 Attention: Lou Jennings cc: Melody Durso cdbh Colorado Division of Behavioral Health Colorado Prevention Partners 2009-2010 No Cost Extension Application Packet 1. CPP Continuation Process Cover Page 2009-2010 1. Fiscal Agent Weld County Department of Human Services Address 315 North 11`h Avenue, Greeley, Co. 80631 Central Telephone 970 352-1551 Fiscal Contact Person Lennie Bottorff Fax 970 353-5215 Phone Number X6530 Email Address bottorll@co.weld.co.us Total Amount Requested (Must agree with budget forms) $ 149,165.00 2. Project Director r / Coordinator Maria "Nomie" Ketterling Agency Employed By North Range Behavioral Health Address 1260 H Street, Greeley, Co. 80631 Phone Number 970 313-1159 Email Address nomie.ketterling@northrange.org _ Name of CPP Project Weld County Prevention Partners 3. Approvals a. Official Authorized to Sign Contract William h. Garcia ,W 1(1 County Commissioner JuflyDirector '' J Billing Address Federal Tax ID Number P. O. Box A, Greeley, Co. 80632 tt84-6000813 Date 7/10 )ate Phone pr10- -IGl. Cyr. (DSK Phone h. Financial Officer for the Contractor Lennie Bottorff, Fiscal and Budget Manager 7h13101 Vo- z-bss��-r.i.3 Date Phone Colorado Prevention Partners 2009-20 I0 No Cost Extension Application Packet 2. DBH & OMNI Prevention Contract Directory Summary Review the Prevention Program Directory Summary on the DBH website at http://www.cdhs.state.co.us/adad/PDFs/PreventionDirectory08.pdf Section Seven (7) to confirm all information for your program is correct. If there are changes, submitthemtolou.ienninas@state.co.usandicollins@omni.org. 3. Narrative Report The 2009-2010 CPP No -Cost Extension Application is for 9 months of funding to continue implementation of strategic plans, collect an additional year of survey data, finalize sustainability plans and complete final reports. This is an opportunity to reflect on your progress in reaching your intended outcomes, challenges, leamings and to describe initiatives, approaches and/or programs for this final partial year of funding. For each of the following questions answer each question thoroughly A. Provide a brief description of the local data -driven process that supported the selection of CPP prevention strategies for your implementation plan. The Prevention Plan for WC CPP was developed from a process of utilizing community indicator data, youth survey results, resource assessments, focus groups, community readiness survey and coalition assessment. This plan set the goals and broad stroke strategies for WC CPP. The original plan was further refined moving into the implementation stage of engaging key stakeholders per strategy area in the selection process of the evidence -based program, policy and practice. At this time, further information was utilized to refine the "fit" and establish community readiness for implementation. The evidenced based Prevention Strategies implemented in the fiscal year 2008-2009 for WCPP. Were as follows: 1. Strengthening Families 10-14. Spring of 2008 brought about the revisit/re-strategize the original Prevention Plan for WC CPP when it originally called for the use of Project Northland (youth, parent and community strategies) in Greeley -Evans District 6 and it was established that there was not a readiness for this approach. From that community coalition process several best practice parenting programs were investigated. Strengthening Families 10-14 instructor was selected as the best fit. The SF 10-14 instructor from Iowa State University came to Greeley and trained 14 facilitators. 2. Social Norm campaign with ACTUALITY. WC CPP TEAM WINDSOR began meeting monthly in May 2007. The initial strategy was decided through the community assessment process mentioned earlier and as a strategy in Windsor with the goal of Colorado Prevention Partners 2009-2010 No Cost Extension Application Packet modifying social norms that accept/encourage underage drinking. The need and readiness of the Windsor High School for a social norming campaign came about through Team Meetings and presentations to school faculty and school board. The fall of 2008 a Core Group of adults were trained by ACTUALTIY on the science of social norming. January a focus group of high school youths were selected called the "STREET TEAM" and was also trained by ACTUALTITY. 3. Social Marketing. This subcommittee began meeting in spring 2008 and implementing the six steps decisional social marketing process with the guidance of OMNI staff. The messaging to middle school parents about prevention and expectations around alcohol/other drug use became the focus. The behavior was targeted for change focused on parents would begin communicating, with their children about their own expectations; thus "Let them know your limits" became the tagline. Two focus groups of parents with middle school aged youth, one in Greeley and one in Windsor helped to test and further refine the messaging that would be meaningful and the delivery systems that would be most effectives. 4. Prevention Education — Life Skills. Again, when the original plan was revisited in May 2008, an opening in the Greeley -Evans District 6 for a supplemental curriculum to the current health classes was established and a readiness to move forward. From the August 2008 Prevention Institute provided by WC CPP a large group of school faculty from three school districts reviewed a pre -researched list of supplemental health/prevention curriculums in a round robin format. Several of the finalists were further investigated particularly for School District 6, Greeley. Selected and accepted through the School Districts protocol is Life Skills for MS/HS. This curriculum will align with the current curriculum in the schools — the Glencoe Model. 5. Community Trials — mobilizing community thorough an organized retailers group of onsite and offsite liquor license holders and other interested parties; to effect retail access of alcohol to all ages of people. This group named "Responsible Alcohol Retailers of Weld County" (RAR of WC) was created in July 2008. The group wrote and accepted "RAR of WC" by- laws and a code of ethics. Members are concerned with preventing access of alcohol to underage drinkers and other drinking related problems. Members receive numerous benefits, networking, promotions, discounts and free beverage server training for their staff on a monthly basis if needed. 6. Functional Family Therapy — h1' 1 — intensive evidenced based therapy delivered to individual families. A defined number of slots are offered to School District 6 enrollment as an intervention to effect referred youth and their families before things become worse and lead to expulsion or youths dropping out of school, using substances, etc. This type of intervention was identified by the district as their greatest need. WC CPP supported these efforts addressing that need through the support of a successful strategy already established in Weld County and furthers that community -school partnership. B. Using the following data, provide a brief description of your progress reaching intended outcomes for this past year related to: a. Reduction of underage drinking b. Other identified outcomes I Colorado Prevention Partners 2009-2010 No Cost Extension Application Packet Progress towards outcomes reached in the past year: 1. Strengthening Families 10-14. Three sets of SF 10-14 classes were delivered in 2008- 2009. These classes were in Spanish and English and in the communities of Kersey and Greeley. OMNI's analysis of the pre/post test surveys of all three sets of classes demonstrated significant change toward more positive parenting behaviors, including parents ability to share rules and expectations about alcohol use and other sensitive topics. 2. Social Norm. Team Windsor has been implementing this strategy with fidelity, including gathering survey data on perceptions of youth in Windsor High School, engaging the youth and the school in the process, holding focus groups with youth and utilizing that data to develop the messaging. This social norm campaign in Windsor High School has taken on the name DEFY. Coming from the "street team" the message is about defying the expectations that everyone at Windsor High School abuses alcohol and drugs all the time. The youth that comprise the "street team" are committed to their own healthy choices and not using alcohol or drugs. In January 2009 a perception survey was given to the entire Windsor High School and here were the summarized results: "A discrepancy between students' self -report substance use and drinking and driving behavior and their perceptions of other students' substance use and drinking and driving behavior is evident in the data collected at Windsor High School (Figure 1). The discrepancy for the consumption of alcohol is such that almost two thirds of respondents reported that they had not used alcohol in the past 30 days, yet only 19% of respondents believed that other students at their school had not used alcohol in the past 30 days. The discrepancy between actual use and perceived use for other substances and behaviors is similarly divergent". Prepared by: Dawn Nannini, Ph.D., Research and Evaluation Specialist TEAM Fort Collins. 3. Social Marketing: The Greeley and Windsor Teams have followed a six -step decisional process for social marketing to develop the messaging and conducted focus groups to test and refine the messages. In addition, the coalition went through a renaming process, which resulted in only a slight revision: Weld County Prevention Partners. Launch date for the "Let them know your limits" social marketing campaign was set for June 151 with the release of the WC Prevention Partners website LIVE. Local HKCS community wide youth data, as well as state and national information are included in the messaging on the website www.wcpreventionpartners.org. In addition WCPP participated in its first community event in Johnstown. With a booth in the park with table top displays and full sized banners and a car in the parade with magnets and banner with our message, logo and tagline. This first phase is the development of the logo, tagline and various marketing materials including website, brochure, posters, stickers, tote bags, t -shirts and pens. Radio spots and print ads are being developed. ALL materials are in English and Spanish. 4. Prevention Education. As described previously, this evidence based curriculum was selected from a range of pre -researched programs by key stakeholders of the schools and determined to be a "fit" according to youth data, school readiness, and ability to implement in the schools. The Life Skills trainer from Minnesota trained 15 faculty from three different school districts in Weld County. Life Skills has a very strong prevention message and was well received by the participants. Each staff person received their own training manuals and student workbooks have been ordered for implementation into the Health classes at District 6, middle schools and high schools fall 2009. Colorado Prevention Partners 2009-2010 No Cost Extension Application Packet 5. Community Trials —Training and technical assistance on the model was received from Dr. Treno out of PIRE, Berkeley, California, as well as a Responsible Alcohol Retailers initiative from Larimer County consultant -Team Fort Collins. RAR of WC is in growth stage and increasing membership - and opportunities for members including TIPS training, a Blue Card/Red Card program offered free to member by the WC Sheriff's Office and recognition in local newspapers for compliance to local and state laws. Credibility and support is shown by the representation of State Liquor Enforcement and Local law enforcement including the Greeley Police Department, University of Northern Colorado Police Department and the WC Sheriff's Office. Recently the municipal judge has been supplied with a list of RAR of WC membership. 6. Functional Family Therapy — FFT — Eleven families were accepted into the FFT program with eight families reporting positive results from the North Range Behavior Health supervisor that deliver this evidence based therapy program. We are pleased to see that the school district has fully utilized the allotted slots for FFT through the CPP funds. The school district was careful with making referrals because it valued the program and results for the students. 7. HKCS highlights for Windsor schools. Reporting for 9°i graders in Windsor "during the past 30 days -have had 5 or more drinks of alcohol in a row" — binge drinking. 28% answered yes in 2007-08 compared to 17% in 2008-09. Other results for use in the past 30 days for 9a' graders were as follows: cigarettes 2007-2008 23% compared to 13% in 2008- 2009, alcohol 2007-2008 40% compared to 26% in 2008-2009, marijuana 2007-2008 23% compared to 11% 2008-2009. These positives indicators reflect well on implementation of strategies including school policy changes, the addition of a part time school counselor/student assistance staff, parent Substance Abuse Prevention Handbook and Prevention TIPS in the local newspaper and support for pro -social activities in Windsor schools by WCPP. 8. Windsor High School Policy and Practice. As a result of the parent-community/faculty meetings held in 2008 teachers and community alike wanted a policy change to alcohol violations by students with consequences that were meaningful and not damaging. Windsor High School administration and school board made changes in policy regarding how students were handled around violations and have now committed more FTE for student assistance staff. C. Describe how you have been or will be collecting output/outcome data related to your selected strategies as well as your plans for using that information locally. Future data collecting and plans for using the date: 1. Strengthening Families. This evidenced based curriculum is delivered the same every class by trained facilitators. Participants are tracked for each section as well as the content delivered to measure implementation and then the overall series ends with pre/post tests to collect outcome data. The analysis of the first sets of classes' survey results by OMNI have shown that there is change in parents behaviors that are not likely due to chance alone and youth attitudes have shown significant improvement. This information was shared with School District 6 and other agencies that may be interested in sustaining these powerful parenting classes. Colorado Prevention Partners 2009-2010 No Cost Extension Application Packet 2. Social Norm. This social norm campaign began with a "misperception survey of the entire Windsor High school. That data is being used to develop phase two of the social norm campaign to be rolled out fall 2009. Additionally, Windsor school administration was given the survey summary. It is scheduled to have a post perception survey completed in the spring 2010 for Windsor HS. The types and amounts of media materials along with timing will also be tracked. Following the model, changes in perceptions are said to lead to changes in behaviors. 3. Social Marketing. The birth of the WCPP website and subsequent construction underway at this time will include links to other coalitions and information for parents and youth. Numbers of "hits" or uses of the site will be gathered. Additionally, numbers of events attended, brochures distributed, other promotional items and educational information disseminated will be counted. A survey of parents will be conducted in approximately six months to gather data on effectiveness of the social marketing campaign. 4. Prevention Education — Life Skills an evidenced based curriculum will be provided by trained teachers. Built into the Life Skills classes are survey materials for youth completing the lessons- this data will be gathered and analyzed. In addition, implementation will be monitored checking on dosage and fidelity of implementation during the school year. 5. Community Trials — Responsible Alcohol Retailers of Weld County—RAR of WC - celebrates one year July 2009. The active involvement of businesses and community with RAR of WC suggests that a need is being filled as membership continues to increase. The major milestones achieved and the number of members will be tracked. In addition, the number of participants participating in beverage server training TIPS, will be tracked. 6, Functional Family Therapy —1-1-1 — this project will be under consideration for continuation in the future. It _ 1 works with individuals delivering intensive intervention. North Range Behavioral Health implements the FFT and gathers survey information on the outcomes as well as the number of families that participate. Families have become more successful with school retention, finding housing and resources in the community. D. For the strategies that you have been implementing for 6 months or longer, review your fidelity data (e.g. data collected through OMNI data collection forms) and describe what the data tell you about how well you are implementing those strategies. Strengthening Families 10-14 Classes. OMNI staff aggregated and analyzed three sets of classes delivered by trained SF10-14 facilitators. The Strengthening Families Program: For Parents and Youth 10-14 (SFP 10-14) is a parent, youth, and family skills -building curriculum designed to: -Prevent teen substance abuse and other behavior problems, -Strengthen parenting skills —Build family strengths The program is delivered with seven sessions for parents, youth, and families using realistic videos, role-playing, discussions, learning games, and family projects. Colorado Prevention Partners 2009-2010 No Cost Extension Application Packet Three cycles of SFP 10 — 14 have been conducted with families in Weld County with 21 parents and 31 youth completing the program between November 2008 and May 2009. Classes are available in English and Spanish. Table 1. Parent/Caregiver Survey Quantitative Results SFP 10 —14 Parent/Caregiver Survey Scores N=15 Total Total Difference Desired Score Score Direction Then Now of Change? 48.8 72.0 +23.2 Yes Significant? Yes The comparison between Then and Now scores is statistically significant, which indicates that the change in parenting behavior is not likely due to chance alone. The other strategies have process measures at this time of what has been achieved to date in alignment with the evidence -based model of social marketing, social norming and community trials. (see attachments for strategy summaries prepared by OMNI staff) E. Describe your 2008-2009 project successes. Visibility and awareness of this CPP prevention project in the community began to happen in earnest in October 2008. 1. The Weld County Substance Abuse Summit co -hosted by WCPP brought prevention to the forefront to the gathering as a whole and subsequently to the working action committees after the Substance Abuse Summit. 2. Team Windsor has had recognition in the local school district with their active commitment and involvement with Team Windsor. A WC PP PREVENTION TIP runs weekly since early 2008 in the local newspaper the Windsor Beacon and several articles have featured WCPP and various team members. 3. Community Prevention messages came forward with the cooperative work taking place with the Colorado Meth Project and the WC Sheriff's Office since January of 2009. Partnering with United Way of Weld County to drive inquires for help and information to 2-1-1 for listing of resources. And to provide the community an opportunity to expand an evidenced -based social marketing campaign that gives a positive and constructive message to parents on substance abuse and youth. 4. The Social Marketing campaign -"Let them know your limits" with "Education, Solutions, Hope" is a professional and user friendly body of materials that are currently rolling out to promote WCPP and educate our community. The campaign includes the new website, community booths/events /parades displaying marketing and prevention education and items being distributed. Large pull up banners with prevention messaging are on display at our local mental health center and family health center. A newly created parent brochure in English and Spanish will be distributed to various Weld County school districts and their families fall 2009. At the Greeley Colorado Prevention Partners 2009-2010 No Cost Extension Application Packet Stampede July 2009 the inside cover of the OFFICIAL event program was a large display with the "Let them know your limits" messaging to parents; 35,000 of these event programs were made. 5. WCPP has supported and/or sponsored several pro -social events and activities at our local colleges and school districts including; University of Northern Colorado football game tailgate parties, Aims Community College "back to school" days, a local girls basketball event program, a high school swim team and Journey a young women's conference held on the campus of UNC, Tailgate the Safety Way held in August at West High School grounds promotes underage drinking and driving prevention. We will also be there with our prevention education materials and table top displays. 6. Continued growth of the membership of the retailers group and the celebration of one year at the July annual meeting. Cooperation with the WC Sheriff's Office to offer a special "mystery shopper" project announced in a letter written by the WC Sheriff and sent out by WCPP to over 150 retailers adds credibility and visibility. 7. Strengthening Families 10-14 classes are popular and in demand with parents, organizations and school districts. Partnerships with two school districts, Centennial BOCES and the cities of Evans and Greeley have provided locations for classes. These classes taught in English and Spanish are showing significance change in parental and youth behaviors with the families where it has been implemented to date. 8. Relationships are of the MOST importance. This includes school districts administration and staff, community members and parents on Team Greeley and Windsor, and business owners that want the best for Weld County's families and youth. 9. Partnerships have been developed through the Sheriff's Office, the Greeley Police Department, State and local liquor enforcement, agencies, businesses and many organizations represented on the Teams Greeley and Windsor. 10. Colorado Department of Education - CDE funding encouraged school engagement and brought to Greeley a LIFE SKILLS trainer from Minnesota. Life Skills will be taught in District 6 schools — middle and high, fall 2009. Two other school districts had staff trained as well. This funding also supported the action committees from the Substance Abuse Summit and the promotion of Strengthening Families 10-14 classes to parents at a number of venues including schools, churches and parent/teacher conferences. 11. Youth involvement. Several youths have attended Team Windsor meetings and given important valuable feedback on social marketing messaging, website development and promotional material selection. Youth ARE the Street Team for social norming in Windsor High School. They run the weekly meetings, select messaging and materials working alongside the Core Team/adults/school staff. F. Describe your 2008-2009 project challenges/lessons learned. Biggest challenge: 1. HKCS is the key to assessment with many uses yet the collection of data through the HKCS has been a challenge in our largest school district where the policy remains that active parental permission is required for surveying. The results from active permission are less satisfactory (unusable results) than school districts that are requiring passive permission or informed intent. This is an issue that we are still working on solving. Grant writing, reporting and the analysis of outcomes require data to drive the planning and implementation of strategies and evaluating Colorado Prevention Partners 2009-2010 No Cost Extension Application Packet outcomes. The prevention policy board is stepping up to support us in raising the policy issue of active consent and for the school board to revisit this policy change. 2. Loss of coalition members (volunteers or professionals in the communities) as contacts and champions of WCPP. There are few members of the coalition that have been on board for three years or two years, but one year is more like it. 3. Balancing between the fiscal agent (Weld County) and the merger of two nonprofit organizations where WCPP and the Coordinator are housed. 4. WCPP takes a comprehensive approach to prevention and has a number of strategies in progress. Keeping all of these efforts going at once is challenging. Many lessons learned: 1.Everyone needs to benefit from their efforts or investments of time and/or money. 2.Relationships and networking are essential to success of coalitions. 3.Small communities want autonomy and control. 4.Direct service projects take lots of time and attention from WCPP staff. In the future a permanent location for SF 10-14 in an organization/agency or school would be ideal. 5.Funding to provide incentives, stipend, continuing education credits are necessary for school staff to participate and motivate volunteers. 6.Communities HAVE ANSWERS TO THEIR OWN PROBLEMS given enough support, guidance and resources. 7.Technical assistance and consultants for specialized projects is invaluable. Asking for help is a must. 8. Paid staffs are required to keep all the wheels turning smoothly. 9. Prevention pays but selling it is expensive! 10. Using professionals as noted in #7 & #8 is imperative for professional results. 11. Appreciation and recognition of volunteers is essential for retention. G. Describe the role of the CPP evaluation liaison in monitoring and reporting evaluation data. The WCPP Evaluation Liaison with the WCPP Coordinator completes required monitoring and reporting. Information is gathered and maintained through meeting or classroom agendas, attendance sheets, minutes and reports. Meeting minutes and agenda are shared with all Coalition members. The Evaluation Liaison attends most meetings to serve as the recorder. Information is shared with OMNI and through CLI regular reporting. H. Describe the involvement of the community coalition and other community members in contributing to the successes and use of needs assessment and evaluation data described above. Monthly WCPP Team meetings, RAR of WC meetings and social norming meetings are lead by community coalition volunteer members. On several occasions during this past year coalition members have been surveyed to determine their involvement the success or needs of the coalition and evaluation of the process of WCPP. Additionally, there is no social marketing material or message released without input from coalition members by email, phone, meetings, focus group, or survey. All and every decision made is by consensus of the coalition members. Responses from coalition members to a quality process surveys conducted/analyzed by OMNI showed high scores to Colorado Prevention Partners 2009-2010 No Cost Extension Application Packet questions, for example: The process is free of favoritism and I am treated with dignity by everyone involved in the process. Areas for improvement were keep policy change focused, keep moving forward, and provide some training. I. Other than TA from your RPC, describe any other priority technical assistance needed to carry out your work. WCPP has worked with consultant/experts: 1. To create, train, and launch a social marketing campaign and promotions. 2. To create, train and launch a social norm campaign 3. To train facilitators for Strengthening Families 10-14 4. To train coalition members in Community Trials 5. To train school faculty in Life Skills and prevention, in general. 6. To train beverage servers and bartenders in TIPS training. 7. Evaluation and data assistance from OMNI staff for example- survey and timeline analysis, assistance with an executive summary for HKCS, and SF 10-14 data collection analysis. 8. To train staff to manage the website. 9. Information technology provided by NRBH IT staff. In the future, WCPP will require the following in terms of technical assistance: I. Sustainability support working with the Sustainability committee 2. Evaluation assistance for evidence based strategies 3. HCKS support in administration and promotion 4. Grant writing support for new opportunities/additional funding 4. Work Plan Goal # 1. To modify social norms accepting/encouraging youth drinking and reduce social access to alcohol by middle school and high school aged population using a multilevel parent, school, and communitywide program designed to be alcohol specific. OBJECTIVE 1. — Team Greeley. Provide in school or community prevention education and ACTION ACTION STEPS TIMEFRAME RESPONSIBLE PARTIES 1. In school: Support, encourage and ensure the instruction of Life Skills curriculum to supplement the existing Health Curriculum in Greeley School District 6. Fa11 2009 -District 6 staff -WCPP Coordinator 2. In community: Provide prevention education materials to various venues and other organizations that work directly with parents and youth. Fall 2009- ongoing -WCPP Coordinator -Community coalition 3. In school/community: To provide Strengthening Fall 2009- -WCPP Coordinator Colorado Prevention Partners 2009-2010 No Cost Extension Application Packet Families 10-14, an evidenced based parenting curriculum in Spanish and English. spring 2010 -SF Site Coordinator -School personnel -BOCES personnel m campaign in Windsor High School. ACTION STEPS TIMEFRAME RESPONSIBLE PARTIES 1. In school: Continue into Phase 2 of ACTUALITY - a social norm project driven by a YOUTH street team, In the Windsor High School. Fall 2009- spring 2010 -ACTUALTIY staff -Windsor school staff — core team -Windsor student- street team -WCPP Staff 2. In community: Involve community when the campaign is ready for public awareness, Fall 2009 -Windsor school staff & youth -WCPP staff 4.In school: Evaluation through a post perception survey of Windsor High School students. Spring 2010 -ACTUALITY staff -Windsor school staff -Community coalition OBJECTIVE 3 — To provide a parental education brochure to parents of middle school age in Weld County. ACTION STEPS T TIMEFRAME RESPONSIBLE PARTIES 1. In schools: Support the distribution of a uniquely WCPP parent brochure in English and Spanish - created summer 2009, to be distributed to various school districts. Distribution will be assisted by WC Sheriff's Office Fall 2009 - ongoing -WCPP Staff -Sheriff's Office staff OBJECTIVE 4. - To implement a social marketing campaign in the community to focus on ACTION STEPS TIMEFRAME RESPONSIBLE PARTIES 1. In community: To manage a newly created website. Fall 2009- ongoing -WCPP Coordinator -Webmaster/marketing consultant 2. In community: To run print ads, billboards, radio spots and enhance marketing/promotional materials and peripherals. Fall 2009- ongoing -WCCPP staff -Marketing consultant -Community Coalition 3. Monitor and evaluate website and other social marketin efforts in Weld Count . Spring 2010 -WCPP staff -OMNI staff Colorado Prevention Partners 2009-2010 No Cost Extension Application Packet Goal # 2. To reduce access and availability of alcohol to middle school and high school youth by reducing retail and social access through increased enforcement of underage drinking laws/penalties. OBJECTIVE -1. Implement Community Trials interventions in Weld County -Community ___ ACTION STEPS TIMEFRAME RESPONSIBLE PARTIES 1. Community Mobilization. Continue regular meeting of RAR of WC group. The annual meeting being July of each year. October 2009- ongoing -WCPP Staff -RAR members -the owners and operators of alcohol retailers and law enforcement members of RAR of WC 2. Consult with Dr Treno or associate to review progress and modify if needed. October 2009 -WCPP Staff -RAR members OBJECTIVE 2- Implement Community Trials interventions — Responsible Beverage Server ACTION STEPS TIMEFRAME RESPONSIBLE PARTIES 1. Continue to offer monthly TIPS — beverage server training to RAR member staff, at no or reduced fees. Tall 2009 and ongoing -Trained TIP provider -RAR members -WCPP staff OBJECTIVE 3. — Implement Community Trials interventions- promotion and recognition of retailers. ACTION STEPS 1. Promotion/ recognition of members. Complete media/marketing of RAR of WC through the development of logo, website link to www.wcpreventionpartners.org , decals/window clings, radio spots, brochure and folder for RAR members. 2. Give recognition to retailers who are in compliance with state/local liquor laws. Working with law enforcement and the courts for recognition of RAR as a viable and credible group. TIMEFRAME RESPONSIBLE PARTIES Fall 2009 -RAR members -WCPP staff -Marketing professional Fall 2009 -RAR members -Law enforcement — local and state liquor enforcement -WCPP staff Goal # 3.To modify the social norms accepting/encouraging youth drinking and reduce social access of alcohol to youth through the strategy of keeping special events festive and safe in Windsor and Greeley. (Weld County) OBJECTIVE -1. 1 To educate/inform/disseminate prevention information to the community. Colorado Prevention Partners 2009-2010 No Cost Extension Application Packet ACTION STEPS TIMEFRAME RESPONSIBLE PARTIES 1. Social marketing campaign materials aimed at middle school parents will be on display in various venues in Weld County, including community events. "Let them know your limits" is directed to middle school parents to share and discuss expectations and consequences with their children. Fall 2009- ongoing -WCPP staff -Community coalition 2. Website includes a parent section and youth information section with prevention education and resources with a link to RAR of WC and United Way resources. Fall 2000- ongoing -WCPP staff 3. Advertise in the Greeley Stampede official program reaching with 35,000 copies. May 2010 -WCPP staff OBJECTIVE —2.1 To support and enhance prevention efforts at our local institutions of hi her education. ACTION STEPS 1. Support higher education at Aims Community College and University of Northern Colorado i.e. pro social activities on the college/university campus or support for MyLife Student Peer Education Council at Aims. TIMEFRAME - Fall 2009 RESPONSIBLE PARTIES - Aims Student Life staff -UNC DATE Staff -WCPP staff 5. Sustainability Plan Step One: Identify What to Sustain by the WC Prevention Partners In a joint meeting of the WCPP Teams Greeley and Windsor held on June 1, 2009 coalition members worked toward the continuation of these preventions efforts in Weld County. First, we identified what is currently happening with resources and implementation and then a preliminary discussion on what to sustain in the future. Resources (resources utilized to implement efforts and relative amounts utilized coordinator time; o SFP other staff (facilitators and site coordinators); o media consultants (marketer, graphic designer, Team Ft. Collins/Actuality); o volunteers; o partnerships (school, BOCES, law enforcement, retailers, coalition and policy board); o in -kind (facility, equipment, supplies, services, outreach); Colorado Prevention Partners 2009-2010 No Cost Extension Application Packet o operating costs (indirect); o local evaluation support ❑Coordinator • SFP staff Media staff OVolunteers ■ Partnerships Oln-kind 11Op Costs o Local oval Other Resources: o OMNI HKCS (contracted through WCPP and also additional support through state CPP) o OMNI CPP Evaluation Staff (additional support through state CPP) o OMNI RPS — Regional Prevention Consultant (ongoing support through DBH) Efforts (what is being implemented and relative amounts o media (social marketing and social norming); o prevention education and skills (SFP and Life Skills); o coalition building (SPF process of assessment (data + HKCS), planning, implementation, evaluation, etc...); o Community Trials (RAR, law enforcement of underage drinking with events, Tips training, etc...); o policy (at schools, at retailers); o school engagement; o FFT (intervention support); and o professional development; o alternative activities/pro-social (sponsorship of youth to attend conferences, etc...). OMedia e Prev Ed OCoalition Bldg oCmmly Trials ■ Policy OSchool Eng D Pro-Soc/AA ■ Prot Dev't Identification of Efforts/Strategies to Sustain in the Future: Colorado Prevention Partners 2009-2010 No Cost Extension Application Packet Participants of the June l' Sustainability meeting identified the following list of efforts to sustain, with the first two areas receiving the most support. o Media social marketing social norms campaign media campaign based on data collection o Coalition Building/Partnerships monthly meetings community -school partnerships coalition building and community mobilization- expanding to include other communities in the county o Community Trials —Responsible Alcohol Retailers of WC efforts o Data Collection — survey consistently o Increased policy emphasis o Strengthening Families o Functional Family Therapy Priorities of Sustainability in moving forward were identified as the following: o Diversified funding o Coordinator position o Solid infrastructure of the coalition shared group learning/networking o Community information on results and outcomes (strategic with funding opportunities) o Data and evaluation o Technical assistance — ongoing access and support (for EBP and otherwise) 0 All prevention WC Prevention Partners efforts are funded through this CPP SIF-SIG grant except for the in -kind contributions, discounts or partnerships with municipalities, school districts and individuals or businesses in the communities. Step 2: Case statement: Description of Weld County Prevention Partners Weld County Prevention Partners is an active community coalition situated largely in two communities in Weld County, a county with twenty three incorporated towns. Two teams —Team Greeley and Team Windsor are comprised of parents, youth, social service professionals representing various agencies of the 1451 Collaborative; the WCPP Prevention Policy Board, law enforcement, the faith community, schools- staff/administration and boards, counseling and substance abuse professionals, health system, media representatives and business people. Meetings occur in each community separately by teams and jointly several times a year to make decisions and celebrate accomplishments. WC Prevention Partners is being looked to as THE prevention hub in Weld County. WCPP offers prevention education and resources for the community regarding substance abuse information and awareness. The WCPP office is housed in the local community mental health center, North Range Behavioral Health. Efforts of all kinds are being connected through and with WC Prevention Colorado Prevention Partners 2009-2010 No Cost Extension Application Packet Partners including Substance Abuse Summit action committee — venue for meeting, support for meals and personnel. Education and resource booths and displays supported by WCPP are set up all over the county. With the inception of the WC Prevention Partners website information can be shared more effectively. Rational for sustaining WC Prevention Partners in the community. Information was obtained from the community coalition members and the Prevention Policy Board through a qualitative survey June 2009. Participants stated that the WCPP gives them; 1. The ability to impact issues through WCPP and to be involved in their own communities. • "The coalition has implemented strategies to prevent underage drinking of alcohol among young people in Windsor and Greeley, including the promotion of educational materials for parents in Windsor and marketing materials in Greeley, and the education of beverage servers through the TIPS program for RAR of WC members." • "As a parent in the community as well as a psychotherapist, I appreciate the dissemination of updated information that is specific to my community and the issue at hand. I have gained insight to the issue and an awareness of resources. I have also been given the opportunity to discuss issues with other concerned citizens." This is justification for the future of the website and the interactive abilities. • "The board provided a great framework auxiliary and community members to get involved and provide service in ways that are likely to have a positive impact on teen behavior." 2. Coalition and board members felt that through the WCPP they have increased their knowledge and awareness of issues and solutions among members. 3. Networking and support across efforts for resources, professional development and continuing education opportunities ad referrals to evidence based programs. "Biggest thing is how the individual efforts of each organization enhances and strengthens the efforts of the group as a whole, more so than each organization working independently". For the community as a whole the respondents stated that WC Prevention Partners provides a strategic and coordinated (streamlined effort) impact on prevention (and issue of underage drinking): • "The coalition provides an avenue for representatives from a variety of educational and organizational agencies to develop and implement evidence -based strategies that will reduce the use of alcohol by minors" • "A great plan to lower underage drinking. Awareness about underage drinking. Information about where to get help". • "Organized efforts to provide a positive marketing message that will help teens make better choices". • "A liaison between community resources/agencies, state resources/agencies and as a result I have seen information become more streamlines. Substance abuse prevention/intervention/treatment services seem to be less fragmented". And greater support to the community as a whole — awareness, resources, solutions: Colorado Prevention Partners 2009-20 I0 No Cost Extension Application Packet • "This coalition is extremely supportive of our community through the media, visibility at community and school functions, and the support they give to other community people". • "It provides information and other resources to community members who would not otherwise know of or know where to seek the information. It adds to the community's awareness at a time when so many are busy, almost too busy to address as an individual alone. It also brings to light a path that can be taken to change things such as social norms with the community. Also provided were ways to change social norms as well as support in doing so". • "Strong and positive message encouraging alcohol/drug prevention with real resources to be utilized by community members". At the June 1 st meeting we reviewed the next steps in the sustainability planning framework: o identify funding and resource strategies o conduct action planning o identify and elicit technical assistance and training required to strengthen sustainability efforts Sustainability Planning Committee: the next step is to form a subcommittee to continue working on the plan and members have been identified. This subcommittee will consist of current coalition members with additional new individuals interested in the sustainability of prevention in Weld County is scheduled to begin meeting by August 2009. WCPP has been included in two possible grants opportunities for 2009-2010: The Colorado Partnership for Success grant and the DFC-Mentoring grant with Denver Drug Strategies Office. In February 2009, the WCPP Coordinator along with the Executive Director of the 1451 Collaborative/the WCPP Prevention Policy Board attended the grant writing workshop for the DFC grant. It is the intention of these groups to pursue the DFC funding. Additionally, North Range Behavioral Health is supportive and discussing plans to support and sustain the projects/programs of WC Prevention Partners. Strengthening Families 10-14 is particularly of interest to NRBH as resource to its families/clients. Membership — the WCPP Coordinator is an alternate on the State steering committee - in the newly forming "Colorado Future" — the network of prevention coalitions in Colorado is sure to assist in networking and connections for sustaining efforts. Colorado Prevention Partners 2009-2010 No Cost Extension Application Packet 6. 2009-2010 Budget Based on your narrative reflections above and your revised work plan, include a current assessment of funding needs for the next nine months. PERSONNEL EXPENSES: Project Director and Evaluation Liaison - $52,607.00 Prorated for nine months Project Director —with 4% cost of living increase ($1747.00) = 45,424.00 = $3785.00 monthly x 9= $34,068.00. Fringe benefits are calculated at an additional 28% annually. $1060.00 monthly x 9 = $9539.00 Evaluation Liaison = $12,000.00 annually @. 25 FTE, no benefits. Hourly rate of $25.00/hour for 10 hours/week = $250 x 4= $1000.00/month for nine months = $9000.00 TRAVEL EXPENSES: $3,231.00 Out -of -area expenses: Conference - Meetings Denver Trips: Mileage for two trips to Denver @ 130 miles round trip x 2 trips =260 miles @ .50 per mile = $130; lodging for two rooms @ $100 per room = $200 per night x 1 night = $200 x 2 meetings = $400; meals per Diem ($49 per day Denver) x 2 people = $98 x 2 days = $196 x 2 meetings = $392 total= $922.00. Regional Prevention Summit Meeting and State Networking Meeting: One trip to Denver for 2 people @ 130 miles round trip @ .50 per mile = $65; lodging for 2 rooms @ $100 per room = $200 per night x 3 nights = $600; meals per diem ($49 per day) x 2 people = $98 x 3 days = $294 total = $959.00 TOTAL FOR Out of Area TRAVEL: $1881.00 In -area expenses: Local mileage: 300 miles per month x 12 months @ .50 cents = $1800.00 Out of county: included above Mileage rate has been adjusted down to $.50 per mile x 300 x 9 months = $1350.00 TOTAL FOR In Area TRAVEL $1350.00 prorated for nine months OPERATING EXPENSES: $52,752.00 Copying/printing: copy paper, ink, toner, $50.00/month x 9 = $450.00 Meeting Room Rental: $100/2 hour meeting x 3 = $300.00 Food for meetings: $100/meeting x 2 per month x 9 = $1800.00 Indirect - (utilities, bookkeeping staff, IT support, insurance) =$1000/month x 9 =$9,000.00 Data Collection costs: $34,155.00 HKCS-Healthy Kids Colorado Survey- survey materials - 4,000 students x $2.15= $8600.00 Additional costs for random sample process: $9000.00 Full Census for Windsor— 1770 x $2.15 = $3,655.00 Full Census for Greeley (70% parent participation) - 5600 x $2.15 = $12,040.00 Administration costs may include substitute teacher or admin assistant @ $45.00/hr x 4 hours x 2 = $360.00 Colorado Prevention Partners 2009-2010 No Cost Extension Application Packet Incentives for classrooms (students/staff) and pencils - $500.00 Incentives/stipends for coalition volunteers: $18/hour for attending 2 hour meetings/ gift cards trainings and assisting the project x 3 volunteers x a monthly meetings x prorated for 9 months = $972.00 Office rent/phone: $650/month x 9 = $5850.00 Office supplies: $25.00/month x 9= $225.00 IMPLEMENTATION EXPENSES: $40,575.00 Goal 1: To modify social norms accepting/encouraging youth drinking and reduce social access to alcohol by middle school and high school aged population using a multilevel parent, school, and communitywide program designed to be alcohol specific. Goal 1:1.1 Team Greeley- Life Skills curriculum program additional materials for District 6 = $1000.00 Goal 1: 1. 3 Team Greeley - Strengthening Families 10-14 = $15,900.00 Expand the offering of SF 10-14 classes to more school districts and communities. Three more classes in Weld County - $4500 x 3 = $13,500.00 SF 10-14 Site Coordinator for expanded program offering in Weld County —hourly rate of $20.00 approximately 120 hours = $2,400.00 Goal 1.2.1 Team Windsor — Support Phase Two of ACTUALITY — DEFY campaign in Windsor H.S. Peripherals = $2,000.00 (Post perception survey costs have been included in previous contract). Goal 1: 4.2 Team Greeley/Windsor - Social marketing/media campaign in Weld County. Second wave of Social Marketing campaign Fall 2009. To include outdoor advertising - billboards; $800.00 in Weld County $800 x 3 = $2400. + creating materials $1000.00 =$3400.00 Goal 1: 4.1 Website hosting contract= $375.00 and maintenance of website $250.00 per month for nine months = $2625.00 Adding a "Forum" to the WCPP website — online meeting place for open discussions or various topics. Cost for setup/program the interface and web layout, set up accounts and train WCPP staff on accessing the administrative panel = $1650.00 TOTAL = $4,275.00 TOTAL GOAL it 1: $26,575.00 Goal 2: To reduce access and availability of alcohol in middle school and high school youth by reducing retail and social access through increased enforcement of underage drinking laws/penalties. Goal 2: 1. ]Team Greeley - Retail Access - Community Mobilization RAR meeting expenses — refreshments, invitations, postage and incentives/host gifts =$1500.00 Goal 2: 2.1 - Retail Access - Beverage Server training = $4,050.00 - Colorado Prevention Panners 2009-2010 No Cost Extension Application Packet $150.00 x 9 sessions with trained instructor- $1350. Materials for RAR members taking the class — 9 classes x 15 x $20 = $2700.00 Goal 2: 3.2 Team Greeley - Retail Access - Incentives/recognition- promotions - $=$2,650.00 Professional marketing for Retail Access goals. Brochures, promotional items — t shirts, folders for membership materials developed with new logo and professional marketing appearance. $650.00 + creative design $500.00 + printing costs $1500.00 TOTAL GOAL #2: $8,200.00 Goal 3 —To modify the social norms accepting/encouraging youth drinking alcohol and reduce social access of alcohol to youth through the strategy of keeping special events festive and safe in Windsor and Greeley. (Weld County) Goal 3. 1. 1 — Professional marketing. Marketing campaign Fall 2009. To include outdoor advertising — billboards- including school brochures, print ads, etc. Noted above. $800.00 Goal 3. 1.3 — Advertising. Purchase advertising in the Greeley Stampede event program May 2010 — update design - $500. + $1500.00 $2,000.00 Goal 3. 2.1 Support for prevention-efforts/activities at institutions of higher education. - $3,000.00 TOTAL GOAL #3: $5,800.00 IN -KIND SUPPORT FOR WCPP PROJECTS AND EFFORTS: Monthly meeting in Windsor with 10-12 in attendance for 1.5 hours x $15.00 x 9 months = $2,025.00 Sustainability Committee — Task Force — Bi monthly meetings — 8-10 in attendance for 1.5 hours x $15.00 x 9 months = $2,025.00 Rooms and use of audio/visual equipment for three Strengthening Families 10-14 classes, City of Evans, City of Greeley and Greeley and Kersey school districts — three classes x 7 weeks each x $ 150.00 per class = $9,450.00 Volunteers from community and organizations to person booths and displays at various events and fairs/parades - two people x 4 hours x $15.00 x 4 events = $480.00 RAR of WC membership attending monthly meetings — 12-15 people x I hour x $15.00 x 9 months = $1,620.00 OMNI consultants — 15 hours x $50.00 - $750.00 Colorado Prevention Partners 2009-2010 No Cost Extension Application Packet SEE EXCEL BUDGET PAGE (separate attachment). Colorado Prevention Partners Strategic Prevention Framework State Incentive Grant Guidelines for Continuation Process No Cost Extension Year 2009 - 2010 Attachments TABLE OF CONTENTS Attachment I: ASSURANCES Attachment II: TERMS AND CONDITIONS Attachment III: WORK AGREEMENT CPP Strategic Prevention Framework Funds 2009-2010 Attachment IV: PLANNING TEMPLATE FORMAT with SAMPLE ITEMS 1 2 8 Attachment V: SUSTAINABILITY PLAN 9 Sustainability Plan Outline Step One Step Two Step Three Step Four Step Five 10 Il 15 16 18 19 Attachment VI: EVALUATION REQUIREMENTS 20 Attachment VII: PARTICIPATION AGREEMENTS/MOA 22 MOA Attachment A: Memorandum of Agreement (MOA) Template for Schools 23 MOA Attachment Al: Reporting Request Form: 2009-2010 CPP HKCS Survey Year 27 MOA Attachment A.2: Agreement and Work Plan Details 29 MOA Attachment A3: Healthy Kids Colorado Survey (HKCS): Administration and Data Sharing Protocol 30 MOA Attachment A.4: Example of Data Sharing Letter 32 Attachment VIII: BUDGET INSTRUCTIONS 2009-2010 SAMPLE BUDGET PAGE Attachment IX: LIST OF FREQUENTLY USED ACRONYMS Attachment X: GLOSSARY 33 38 40 41 Attachment I ASSURANCES (Signature is Optional) This itemization of Assurances is to be read, each assurance initialed, and the document signed by the autographic signature of the Applicant or an officer of the Applicant legally authorized to execute contractual obligations to indicate that the Applicant agrees to comply with the Assurances through the end of the grant period. An original of these pages must be included with your original hardcopy Response to this Continuation Application for Funding. ACCEPTANCE OF CPP APPLICATION TERMS AND CONDITIONS: An application submitted in response to this application is a binding offer. DBH assumes that by submitting an application the Applicant acknowledges all Terms and Conditions of the Application. APPLICATION CONTENT ACCEPTANCE: The contents of the response (including persons specified to implement the project) of the successful Applicant will become contractual obligations if acquisition action ensues. Failure of the successful Applicant to accept these obligations in a contract, purchase document, delivery order or similar acquisition instrument may result in cancellation of the award and such Applicant may be removed from future solicitations. INCURRING COSTS: The State of Colorado is not liable for any cost incurred by Applicants prior to issuance of a legally executed contract. No property interest of any nature must occur until a contract is awarded and signed by all concerned parties. PRIVACY, CONFIDENTIALITY: The Applicant will comply with all federal and state laws, regulations and rules related to the privacy and confidentiality of client information, records, etc., including compliance with both 42 CFR Part 2 and HIPAA, where applicable, throughout the duration of any resulting contract. (http://www.hipaa.samhsa.gov/privacyrule.htm) CHARITABLE CHOICE: Faith -based recipients have read, understand and will comply with Charitable Choice Provisions and Regulations found in 42 CFR Parts 54 and 54a. (http://www.access.apo.aov/nara/cfr/waisidx 03/42cfr54 03.html) Handwritten Signature by Authorized Officer of Fiscal Agency or Agent of Applicant Date Attachment H TERMS AND CONDITIONS (Signature is Optional) Colorado Prevention Partners and The Division of Behavioral Health, Community Prevention Services Section, require the following Terms and Conditions for any County or Tribal Community funded by this contract. The applicant's signature at the end of this section, returned with the Continuation Application, signifies that the applicant understands and agrees to the terms and conditions as well as agreements for participation. A. Terms and Conditions All activities supported by DBH/CPP funding including printed materials, notice of these materials or trainings on websites, etc., must acknowledge DBH, COLORADO DEPARTMENT OF HUMAN SERVICES, COLORADO PREVENTION PARTNERS and CSAP/SAMHSA as the funding sources, using the DBH, CDHS, CPP and SAMHSA logos when appropriate. All collections —data requirements, training materials, videos, books, files such as evaluation instrument files, and other library collections —purchased under a contract resulting from this application may be requested to be returned or given to another recipient at DBH's option, when the contract ends. Any equipment purchase over $1,000 must first be approved by DBH as part of the ongoing Continuation Application review. All equipment valued at $2,500 or over which is purchased under a contract resulting from this Continuation Application may be requested to be returned or given to another recipient at DBH's option, when the contract ends. All computer equipment and software used to implement any contract resulting from this Continuation Application must be compatible with DBH's requirements and must meet evaluation requirements. Funds can be budgeted for that purpose. Current minimum requirements IBM PC or compatible, Pentium class (II or III) CPU, VGA 800x600, 16mb Ram, 10mb free hard drive space, 56.6k modem, Windows 95 and up or NT 4.0 and up, Internet connection (regular phone line) with Microsoft Internet Explorer browser 5 and up. Web Browser The web browser supported by the CO Prevention System is Microsoft Internet Explorer (IE). Currently Mozilla Firefox, Netscape, AOL, MSN and other browsers are not supported. They may function, but not to design specifications. We recommend users have the latest version of IE installed on their computer along with the updates provided by Microsoft (which are released periodically). Any agency receiving a contract resulting from this Continuation Application must have an e-mail address. No Federal appropriated funds will be used for any activity that would be deemed as lobbying. Any agency receiving a contract resulting from this Continuation Application for Funding whose staff, subcontractors and volunteers have direct contact with children/youth or other vulnerable populations must have a background screening policy in keeping with CRS 27-1-110 that requires fingerprinting and a nationwide criminal check (including Colorado) for felonies, misdemeanors and outstanding warrants. This screening is permitted under CRS 24-72-305.3 (Part II, Overview). • No vehicles will be leased or purchased under any contracts funded by this Continuation Application for Funding. • Indirect rates are not to exceed 20%. The applicant must justify in the "budget narrative" section all costs that have been placed in both the "direct" and "indirect" categories. The process for arriving at the costs listed must be clearly described. Agreements for Participation By submitting this Continuation Application you are agreeing to: • Maintain staffing requirements, including, at a minimum, a 0.5 FTE Project Director/ Coordinator and a 0.25 FTE Local Evaluation Liaison to work with DBH, OMNI, and CPP. One individual can occupy both positions. • Maintain and enhance a Community Coalition and/or Prevention Policy Board and describe the roles and responsibilities of those groups. • Maintain the involvement of a Fiscal Agent (Unit of Local Government) to a) receive the funds from DBH and b) complete and submit monthly billings for reimbursement to DBH. If not yet submitted, provide a statement or statements of participation (MOU) that identify the key stakeholders who have agreed to participate in the CPP Project as of July 10, 2009and identify their roles and participation commitments. Continue to implement a youth involvement strategy for SPF Steps 1-5 of the CPP process. Continue to collaborate across funding streams, disciplines, age and cultural groups. Obtain a written Memoranda of Agreement (MOA) with required signatures from participating school districts. Obtain required consent forms, preferably passive, from all students that will participate in the next administration of the Healthy Kids Colorado Survey. Administer the Healthy Kids Colorado Survey in the fall of every grant year among all high schools and feeder middle schools in the target area, using either a census or sampling model based on population, for all 6th — 11th graders. In communities with Institutions of Higher Education, involve representatives from those institutions in planning, and if appropriate build funds into the budget to support higher education involvement. Conduct higher education CORE surveys in any higher education institutions that are included in the community strategic plan. Send CPP-funded staff to required meetings and trainings, including the following: • CPP Community Infrastructure Workgroup and Colorado Prevention Partners Advisory Council (CPPAC): The CPP Community Project Director/Coordinator and Local Evaluation Liaison must attend a minimum of two annual 2 -day Denver -based meetings. • State Workgroups: The Project Director is encouraged to participate in, or assign other staff, to other possible workgroups that advance the work of the statewide project (e.g., Underage Drinking Prevention & Reduction Workgroup, Evaluation Workgroup, etc.). • Substance Abuse Prevention Specialist Training (SAPST): All CPP staff must complete the SAPST within 6 months of contract start or hiring, whichever date comes first, unless the training was completed in the last 3-5 years. • Other Strategic Prevention Framework or Evaluation Trainings: CPP staff as designated must attend any other required trainings or meetings announced by Colorado Prevention Partners. Build funds from this contract into the budget for required trainings and professional development. For example, $75 per registrant (and an optional $90 for continuation education credits) for the four -day Substance Abuse Prevention Specialist Training (SAPST) plus lodging and per diem at the state rate (if applicable), and lodging and per diem costs at the state rate for two people to attend a two-day local or regional orientation and evaluation training. Fiscal agency tracks time and effort of project staff and tracks costs by programs and/or funding source. Handwritten Signature by Authorized Officer of Fiscal Agency or Agent of Applicant Date 4 Attachment III WORK AGREEMENT CPP Strategic Prevention Framework Funds 2009-2010 PLEASE RETURN A SIGNED COPY OF THIS WORK AGREEMENT WITH THE 2009-2010 CONTINUATIONAPPLICATION. (Note: changes for 2009-2010 are highlighted in bold) Timeline: September 30, 2009 to June 30, 2010 Goals and Objectives: Goal #1: Continue with SPF Steps 1-3 of Needs Assessment, Readiness Assessment, Capacity Development and Planning to Enhance and Improve the Strategic Prevention Framework (SPF) Plan. Objective 1.1: Between September 30, 2009 and May 31, 2010, continue SPF-SIG work on Steps One — Three (1.Conduct needs assessments; 2. Build state and local capacity; 3. Develop a comprehensive strategic plan) and as needed, submit any revisions to the Comprehensive Strategic Plan & budget to the CPP Management Team for approval. Activities: Revisit Needs Assessment • Revise, or update as needed, the indicators that are part of the Needs Assessment section in ASPIRE. • Revisit your data with subcommittee on the cause -consumption pattern -consequence model as needed to see what more can be learned about underage drinking and related issues in the community. • As needed, subcommittee identifies additional steps for the collection of local data and entry into ASPIRE. • Revise or update the resource assessment in ASPIRE. As needed, subcommittee reports additional findings from Step 1 activities to PPB/Coalition. • Continue to refine a plan of action for working with school officials to administer the Healthy Kids Colorado Survey in targeted schools. • Conduct final administration of Healthy Kids Colorado Survey in targeted schools. • Review results of the Healthy Kids Colorado Survey and share highlights with the PPB/Coalition. • Conduct higher education CORE surveys in any higher education institutions that are included in the community strategic plan. Only communities that have identified using the CORE survey in their strategic plan need to administer this survey. Data collected through the CORE survey should be used for needs assessment purposes. Continue to Enhance Local Capacity • Hold Coalition/PPB meetings to review any updated assessment findings and to refine capacity building goals and action steps. • Continue to build relationships with potential partners in sectors of the community that do not participate actively in prevention. • Continue to address sustainability, including final completion and implementation of a local sustainability plan. • Continue to address cultural responsiveness in all aspects of strategic plan implementation. For those communities that include higher education in their strategic plan, work with technical assistance provider, BACCHUS Network, to enhance community prevention efforts related to prevention in higher education. Comprehensive SPF Plan for Prevention • PPB/Coalition revisits or updates identified goals and action steps based on readiness and available community resources for addressing underage drinking. • PPB/Coalition revisits or updates identified goals and action steps based on underage drinking data and the gaps in prevention services. • Hold meetings with key stakeholders, other coalitions or community groups, and service providers to gather any additional feedback on findings, goals and action steps. • Evidence -based prevention programs, policies and practices are identified with the technical support of OMNI RPCs, based on the assessment of needs and existing resources. • Identified set of evidence -based prevention programs, policies and practices are examined for complementary and comprehensive design with fidelity and adaptation considerations to make strategies responsive to local culture, populations and assessment findings. • Strategic plan is updated or refined as needed, at a minimum annually with the Continuation Application, and any changes are reflected in a revised budget and work plan submitted to DBH that details the use of implementation funds for specific strategic plan approaches. Goal #2: Continue with SPF-SIG Step 4 and Implement Programs, Policies, and Practices. Objective 2.1: Between September 30, 2009 and May 30, 2010 Coalition and/or PPB will continue to implement evidence -based prevention programs, policies and practices based on the approved Strategic Plan developed during SPF Steps One -Three. Activities: • Staff are trained and appropriate protocol are developed to implement selected evidenced -based prevention programs, policies, and practices. The CPP project continues to implement selected evidenced -based prevention program, policy and practice approaches as reflected in Strategic Prevention Plan and Template with guidance from Community Coalition/Prevention Policy Board, Project Director/ Coordinator, Local Evaluation Liaison and OMNI RPCs. 6 Goal #3: Continue with SPF-SIG Step 5 Evaluation of the Strategic Prevention Framework project. Objective 3.1: Implementation of the Strategic Prevention Framework will be evaluated within identified community. Activities: PPB/Coalition notes are submitted to OMNI on a monthly basis. Local Evaluation Liaison and Project Coordinator work with OMNI Evaluation Liaison to coordinate completion of the CLI every 6 months. • Local Evaluation Liaison works with the OMNI Evaluation Liaison to coordinate evaluation activities such as site visits, stakeholder interviews and technical assistance when needed. • Continue using process and fidelity instruments and the Environmental Output Instrument on a monthly basis or as otherwise stated. Communities implementing programs such as Project Alert should continue administering the YPLAN instrument. These communities should contact their OMNI Evaluation Liaison for administration assistance. • Submit Implementation Spending Form, or other tools utilized to collect spending data, to OMNI Evaluation Liaisons on a monthly basis, or as otherwise stated. Complete the Quality Process Survey with Coalition/PPB members during a coalition/PPB meeting within the months of December, January, or February. Submit final data collection forms in Mid -April 2010. Goal #4: Prepare for CPP Strategic Prevention Framework Grant Close -down. Objective 4.1: By June 30, 2010 close down of the CPP Strategic Prevention Framework grant is completed and the sustainability plan for continuation of the project is implemented. Activities: Final narrative report is written between mid -April and June 2010. Final Sustainability Plan is completed in Mid April 2010. • Final narrative report is submitted by June 30, 2010. • Sustainability plan is fully implemented by June 30, 2010. • Final invoices are submitted by June 30, 2010. • Project is sustained through matches, integration with other community initiatives, other grants, local support. Handwritten Signature by Authorized Officer of Fiscal Agency or Agent of Applicant Date Attachment IV PLANNING TEMPLATE FORMAT with SAMPLE ITEMS GOAL 1 - Increase Awareness of The Degree of Underage Drinking in ABC County - Implement a community based media campaign .. _ _ . ACTION STEPS TIMEFRAME RESPONSIBLE PARTIES 1. Engage social marketing/media consultant to assist in development campaign to include tag line, overarching theme, website design and multi -media materials May - Sept '07 CPP Coordinator and Evaluation Liaison Task Group • Consultant 2. Utilize local data throughout campaign See above See above 3. Identify multiple venues and sectors for disseminating the media, including but not limited to: newspaper, internet, Rocky Mountain television, churches, schools, medical clinics, other private providers, Recreation Center, Liquor Stores See above See above 4. Create flexibility within the campaign to allow for cultural responsiveness and custom tailoring to specific target populations, age ranges and/or activities See above See above OBJECTIVE - Address s •ecific identified needs of 0-8 a ranee ACTION STEPS 1. Increase awareness of parents of young children about how their own use and behaviors can impact their child's development of perceptions and later behaviors TIMEFRAME • Develop Summer 07 • Implement Fall 07 RESPONSIBLE PARTIES CPP Task Group and coordinator in conjunction with early childhood educators and other invested •arties 2. Increase awareness for parents about the average a • e of first use and earl • revention ti • s See above See above - Address specific identified needs of 8-14 age grou ACTION STEPS TIMEFRAME RESPONSIBLE PARTIES I. Make community aware of critical shift in awareness and access to alcohol that occurs between 6th and 7th grade through sharing of local data • Develop Summer 07 Fall 07 • CPP Task Group • CPP Staff School Personnel Other youth service providers as appropriate 2. Provide parents of this age group with data driven information on age of first use and incorporate tips for addressing concerns "What to do if..." See above See above Attachment V SUSTAINABILITY PLAN Colorado Prevention Partners sustainability Template A sustainability plan connects the ongoing strategies of the coalition/policy board with the different resources required to support the strategic plan above and beyond SPF-SIG funding. The strength and feasibility of a sustainability plan is directly tied to the active expansion of partners working to support the community plan and strategies. It is essential that there is involvement from coalition/policy board members along with coalition staff to make, create and follow through with a sustainability plan. A sustainability plan, in essence, is an action plan and the development of this plan should include: Conducting a critical examination of the policy board or coalition's role and contributions as a collective body in leading the implementation of the strategic plan. • Examining the individual contributions of members and the coordinator in furthering the goal and objectives outlined in the strategic plan. • Assessing the progress achieved in the strategic plan compared with the original community vision. • Supporting ongoing communication with community residents and other stakeholders to promote the accomplishments of the strategies and plan beyond SPF-SIG funding • Evaluating the initial priorities based on community needs/opportunities to determine if modifications are required. The following pages include steps involved in creating a sustainability plan along with worksheets that will help you and your coalition/policy boards collect information to organize into the plan. Complete Parts 1 & 2 of the sustainability plan. Your RPC will assist you. Submit a copy as an attachment. A final plan will be due mid April 2010. Sustainability Plan Outline Step One: Identify What to Sustain i. Your coalition/policy board should begin by answering the following questions: I. What resources do we provide to the community? 2. What are the most critical resources that will be lost when SPF-SIG funding comes to an end? 3. How much of our strategy is linked solely to SPF-SIG funding? 4. Are we prepared to seek out other resource partners? 5. Are we prepared to put the time and energy needed into sustaining our efforts? 6. What are we really trying to sustain? ii. List of all elements identified (Coalition Sustainability Checklist Worksheet— to be completed by your coalition members) iii. Collect coalition/policy board member feedback (Qualitative Coalition/Policy Board Survey Worksheet — to be completed by your coalition members) iv. Create prioritized short-list of elements to be sustained II. Step Two: Case Statements (Describes the work of your coalition) i. Case Statements for elements to be sustained 1. Rationale a. Explain why your coalition is needed (what is the coalition's unique role in the community, show that your coalition is cost-effective — use the Qualitative Coalition/Policy Board Survey to inform the discussion of what the added value is of your coalition) b. Explain your prioritized short-list of elements to be sustained 2. Benefits/Harm of elements to be sustained a. Explain benefits to the coalition and its members and harm if benefits are lost/not achieved b. Explain how the coalition/policy board benefits the community and the harm if benefits are lost/not achieved 3. Involvement a. Describe who is involved and who will continue to be involved (i.e. staff, coalition/policy board members, volunteers, community stakeholders, etc.) III. Step Three: Funding and Resource Strategies i. Funding and Resources Strategy Worksheets for elements to be sustained 1. Description, Outcomes, Partners 2. Resources Required 3. Strategies IV. Step Four: Action Planning i. Action Planning Worksheet 1. Action Steps 2. Responsible Parties 3. Timeline V. Step Five: Identify Training and Technical Assistance Needs i. Types of training and technical assistance needed ii. Potential Sources of training and technical assistance 10 I. Step One: Identify What to Sustain i. Your coalition/policy board should begin by answering the following questions: 1. What resources do we provide to the community? 2. What are the most critical resources that will be lost when SPF-SIG funding comes to an end? 3. How much of our strategy is linked solely to SPF-SIG funding? 4. Are we prepared to seek out other resource partners? 5. Are we prepared to put the time and energy needed into sustaining our efforts? 6. What are we really trying to sustain? ii. List of all elements identified (Coalition Sustainability Checklist Worksheet— to be completed by your coalition members) Identify What Must Be Sustained olicy Board Sustainability Checklist Yes! i Limited 1 No! 1 1 Know I Criteria Element 1: Leaders take responsibility for their coalition's success ❑ ❑ ❑ ❑ 1 Coalition leaders have been identified ❑ O O ❑ O ❑ : , O ❑ O ❑ i Coalition leaders are clear about their roles and responsibilities . Coalition leaders actively fill their roles and responsibilities Training and recognition are provided to coalition leaders (and others) Element 2: Involve community leaders, partner organizations, and a variety of community members ❑ U O O ❑ I ❑ O ❑ O . O ❑j ❑ , New members are actively recruited O The coalition reaches out to community organizations on a regular basis ❑ New members are oriented and trained Champions have been identified and trained 0 HID ❑ Champions are used effectively Element 3: Diversified funding from the start O ❑ O ❑ ❑ I A long-term budget has been developed. O -I A long-term fundingplan has been develo d _ -- _ ❑ ❑ D ❑ 1 The fundingplan includes: ❑ ❑ ❑ ❑ ' O O - Local fund raising __-______._ -_Grant writing _ ❑ ❑ O O ' - Professional fund development activities O ; O O O D - Inclusion in organizational budg_ets - Fees for Services ( - Other - O O O Element 4: Solid Infrastructure _ ❑ O ❑ ❑ "Job descriptions" for all roles created by the coalition are written ❑ ❑ OT O O Members agree on the expectations for active membership O O O i Objectives and authority of each committee/workgroup are established ❑ ❑ ❑ I I O O ❑ ❑ ❑ ❑ I Meetings held regularly Agenda is used — distributed before the meeting ❑ D ❑ Meeting kept on track/minutes recorded O O O O E-mail lists, on-line groups, blo-gs keep information flowing ❑ D '❑ 1 O Contact madewith reporter/editor at your local piers ❑ ❑ O ❑ Meeting minutes, a endas and other information available 0 ❑ ❑ O Responsibility for fiscal accounting, 501(c)(3) status, insurance. is clear Element 5: A clear focus on the coalition's goals ' The coalition has clear statements of: ❑ ❑ ❑ ❑ - Vision Cl 0 ❑ O O 0 LI ❑ - Mission 4 - Specific goals and objectives - - - -- The Vision, Mission, goals and objectives are clearly communicated to: O D O - All coalition members O O 1 13 O I- Community leaders __.. 0 ❑ 0 ! ELL D Partner organizations _ ❑ i 0 O 1 - The community in which you are serving 12 Identify What Must Be Sustained Coalition/Policy Board Sustainability Checklist — page 2 Yes! Limited No! Don't Know Criteria Element 6: Addres problems the community cares about and demonstrate results O ❑ O D O'The j The community is informed about substance abuse problems and issues O O O coalition has a process in place to monitor community priorities O ❑ ❑ ❑ O The community is aware of what the coalition and its partners are doing ❑ I ❑ ❑ ❑ The coalition shares result / outcomes from the coalition and partners Element 7: Comprehensive Coalition Planning - Specific action plans developed for: O O D ! ❑ Availability of short-term funding and resources ❑_ U ❑ ❑ I ❑ Communications/marketing O O ❑ Evaluation and data collection ❑ O . ❑ D U ❑ D ; O I Training and technical assistance Fund raising -- - __ U ❑ U O U ❑ , U O Administration and Operations Program/strategy implementation Strategic planning process - ❑ O ❑ O Element 8: Ability to.adapt to changing community needs ❑ O ❑ O 4 The coalition collects information to identify changes in the community O D O ❑ i The coalition modifies strategies and procedures as needed O _ ❑_ ❑ ❑ ❑-- -The coalition actively seeks new partnerships O O ❑ I ❑ ! Training/coaching is provided to coalition members O ❑ ❑ The coalition seeks and receives technical assistance as needed What three items need to be addressed first? 3. What additional information is needed? Comments: 13 iii. Collect coalition/policy board member feedback (Qualitative Coalition/Policy Board Survey Worksheet — to be completed by your coalition members) Qualitative Coalition/Policy Board Survey 1. What do you get out of the coalition/policy board that enhances your organization/work in the community? 2. What do you believe the coalition/policy board provides to our community as a whole? 3. What do you give to the coalition/policy board that enhances coalition/board functioning and effectiveness? 4. What else would you like to see the coalition/policy board doing to support or enhance your organization and/or the community? II. Step Two: Case Statements (Describes the work of your coalition) Case Statements for elements to be sustained 1. Rationale a. Explain why your coalition is needed (what is the coalition's unique role in the community, show that your coalition is cost-effective — use the Qualitative Coalition/Policy Board Survey to inform the discussion of what the added value is of your coalition) b. Explain your prioritized short-list of elements to be sustained 2. Benefits/Harm of elements to be sustained a. Explain benefits to the coalition and its members and harm if benefits are lost/not achieved b. Explain how the coalition/policy board benefits the community and the harm if benefits are lost/not achieved 3. Involvement a. Describe who is involved and who will continue to be involved (i.e. staff, coalition/policy board members, volunteers, community stakeholders, etc.) I5 en u u L Ut U U L A J N CD U U H C; i I Funding and Resources Strategies Worksheet What strategies match the needs identified? Cl </: y d CL y U L C. What resources arc required? C L C U U Cr .�.. O U, r G What must be sustained? v C E C U N a - C. V J V C U C ^ = ^V r Q L CI 0. Funding and Resources Strategies Worksheet Example - s ' What strategies ma What must be sustained? What resources are required? identified? the needs Description Human Share What element(s) needs to be sustained? Personnel Asset Sharing Time In -Kind Contributions Desired Outcomes Skills Leveraging Shared Positions What are the desired outcomes that will be achieved? Experience Leadership Ask Action Steps Ideas Grants What actions need to be taken to achieve the Fundraisers outcomes? Social Individual Donors Connections United Way / Payroll Giving Partners Relationships Endowed Funds / Planned Giving What partners need to be involved? Agreements What partners will benefit? Social networks Charge Fee for Service Material Fine / Penalty Revenue to Prevention Supplies Line Item in Budget Office/Meeting Space City/County Prevention Budget Transportation Other CBO/NPO's Budget Technology Membership Dues Communication Acquiring Tax Revenues Money Earn Entrepreneur Activity Business Plan Partial Ownership of For -Profit Enterprises VI. Step Five: Identify Training and Technical Assistance Needs More details on this step will be distributed at a later date. Attachment VI EVALUATION REQUIREMENTS (Note: 2009-2010 changes are noted in bold) Overview Evaluation and monitoring is one of the five steps of the Strategic Prevention Framework. Colorado is utilizing CPP funding to develop and implement evaluation systems that can be used statewide. OMNI Institute will continue to work closely with CPP-funded communities to implement these evaluation systems so that information is available at the federal, state and local levels to monitor and refine Strategic Prevention Framework implementation and outcomes. Evaluation Expectations for 2009-2010 Counties receiving CPP continuation funds remain committed to the following requirements: Local Evaluation Liaison Identify a minimum .25 FTE Local Evaluation Liaison to coordinate with the OMNI evaluation team and to notify the OMNI evaluation team contact of any project changes. Training and Technical Assistance • Participate in CPP evaluation trainings and technical assistance forums (e.g., webinars, conference calls, etc.). • Utilize the assigned OMNI evaluation team contact to address evaluation questions such as submission of the semiannual cross -site Community Level Instrument (CLI) and monthly data collection forms. • Utilize the assigned OMNI evaluation team contact to address technical needs assessment questions, such as use of ASPIRE or Healthy Kids Colorado Survey data to update needs assessments annually. CPP Formative Evaluation • Participate in formative evaluation activities such as coalition and PPB note taking, (submitted to OMNI evaluation contact on a monthly or bimonthly basis), OMNI stakeholder, coordinator, and evaluation liaison interviews, and OMNI evaluation site visits. • Assist with coordination of at least one annual OMNI evaluation site visit (primarily observational to learn from your process) and supplemental stakeholder interviews. • Administer the Quality Process Survey with your coalition/PPB members during a coalition/PPB meeting in the month of December, January, or February. Healthy Kids Colorado Survey (HKCS) The Local Evaluation Liaison will oversee the administration of the school survey with OMNI evaluation TA and coordinate the ordering of needed survey supplies (including answer sheets forms) through online registration (http://omnisurvey.omni.org/ssc/survey/hkcsregistration.htm) and phone confirmation with OMNI. Online registration for survey administration is due a minimum of two weeks prior to the planned administration dates, in order to ensure adequate time for ordering and delivery of survey materials. 20 • Costs: $2.15 per person/survey • Survey administration: Administer the Healthy Kids Colorado Survey in the fall of every year among all high schools and feeder middle schools in the target area, using either a census or sampling model based on population, for all 6th — 11th graders. (Communities are welcome to include 12th graders, but this is not required as a part of the state evaluation.) Survey administration must be completed no later than December 15, 2009. • OMNI Institute must be consulted on the development and implementation of any student level or school level sampling procedures. Sampling strategies that do not meet OMNI's guidelines will make HKCS participation null and void for the school entities where the non-scientific sampling strategies were employed. • New MOAs need to be completed for HKCS administration in 2009-2010. A sample MOA document and instructions are located in Attachment VII. Submit completed MOAs, including all necessary signatures from participating school districts, 2 weeks prior to survey administration. Be mindful of confidentiality protections and sensitive to potential concerns of schools regarding public release of information. MOA Reporting Request Form: Please complete new Reporting Request Forms for 2009-2010. Please send in the form(s) with your continuation application. ASPIRE Continue the use of ASPIRE to review updated data indicators and enter custom -level indicators. CPP Data Collection Forms • Submit monthly process data collection forms. • Submit fidelity data collection forms on a semiannual basis, or as otherwise state. • Submit output data collection forms on a semiannual basis. • Utilize OMNI evaluation contact to ensure data quality. CLI (Community Level Instrument) Coordinate with the Project Coordinator, Local Evaluation Liaison and OMNI to complete the web -based Community Level Instrument for the national cross -site evaluation every 6 months, and any other supplemental evaluation instruments required. Higher Education CORE Surveys: Conduct higher education CORE surveys in any higher education institutions that are included in the community strategic plan. Only communities that have identified using the CORE survey in their strategic plan need to administer this survey. Data collected through the CORE survey should be used for needs assessment purposes. 21 Attachment VII PARTICIPATION AGREEMENTS/MOA Non -school Agency or Entity If you did not submit a participation document or documents (e.g., Memorandum of Understanding, letter of support or other) with your 2006-2007, 2007-2008 or 2008-2009 application that details the commitment of all participating non -school agencies or entities, including PPB representatives, submit that document or documents with this Continuation Application, or provide an updated document or documents to reflect new agency or entity representatives. School Participation Each participating school district must sign a Memorandum of Agreement. New MOAs need to be completed for HKCS administration in 2009-2010. A sample MOA document and instructions are located in Attachment A. Please utilize this sample MOA and contact your OMNI Evaluation Liaison with any questions about adaptation. Please submit completed MOAs, including all necessary signatures, no later than 2 weeks prior to survey administration. Be mindful of confidentiality protections and sensitive to potential concerns of school regarding public release of information. 22 MOA Attachment A: Memorandum of Agreement (MOA) Template for Schools CPP Strategic Prevention Framework Funds 2009-2010 Memorandum of Agreement Between Community Coalition/PPB And School District Name School District Name (Use additional blank if appropriate) School District Name (Use and add additional school district and potentially individual school name lines as appropriate) 1. Background In fiscal year 2004-05, the Colorado Prevention Partners (CPP) received funding from a State Incentive Grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), awarded to the Governor's Office to implement the Strategic Prevention Framework. The state underwent a preliminary needs assessment process to identify areas in Colorado that have elevated rates of underage drinking, substance abuse and related problems and that have proportionately fewer public resources allocated to address these issues. The Colorado Prevention Partnership Advisory Council (CPPAC) selected [County] and 13 other areas in Colorado to receive funding in fiscal year 2009-10. One purpose of these funds is to support collaboration between school systems and other organizations in the community to promote the prevention of underage drinking and other problems by supporting communities in building and enhancing local prevention infrastructure. Infrastructure includes prevention -focused coalitions, organizations and networks, professional workforce, and policy decision -making bodies. H. Purpose of the Agreement The CPP awarded funding to [County] to enhance school -community collaboration and the coordination of substance abuse -related prevention efforts for children, youth and adults. This MOA represents an agreement between the [Community Coalition/PPB] and the [School District(s)] to collaborate on the implementation of the Strategic Prevention 23 Framework in [Community]. Through this collaboration, [School District(s)] and [Coalition/PPB] will collaborate on their efforts to reduce substance abuse within [Community] and to build, enhance and sustain effective prevention strategies, policies, programs and practices, particularly as these relate to underage drinking. III Shared Concerns Both the [Community Coalition/PPB] and [School District(s)] recognize that enhancing the collaboration between [Community Coalition/PPB] and [School District(s)] represents an essential step in strengthening local prevention and reducing substance abuse, particularly underage drinking, in [Community]. We recognize that children and youth spend a significant amount of time working with school personnel on a daily basis, making school personnel and school systems a key part of prevention efforts. We also recognize that underage drinking and substance abuse impact school attendance, academic performance and other areas of students' lives that are important predictors of current and future health and well-being. Collectively, our work will strengthen schools and the broader community. IV. Substance of Agreement The [Coalition/PPB] will advise community needs assessment, mobilization, planning, implementation and evaluation activities funded through the CPP. School representatives have agreed to serve on the [Coalition]. A district official or designated representative also has agreed to serve on the [PPB or policy -making subcommittee of the Coalition]. Refer to Attachment A.1 for details about coalition and school plans to work together. In their roles on the [Coalition/PPB], school representatives will help support and guide the CPP Project Coordinator, Local Evaluation Liaison, and state evaluator (OMNI) in administering the Healthy Kids Colorado Survey (HKCS) as part of the local needs assessment and state evaluation. HKCS is supported by the Colorado Department of Education and Colorado's interagency Prevention Leadership Council. Refer to Attachment A.2 for survey administration and data sharing protocol. V. Confidentiality Protection The local PPB and participating schools must be in agreement that HKCS data can be used in the planning process. To protect the identity of individual respondents, a number of safeguards are put in place. These are as follows: a. PPBs/Coalitions and schools will not have access to raw data. b. Data will be presented in the aggregate with summaries of items and scales. c. Data will be disaggregated by gender and grade (giving the presence of certain conditions (see d.). No other sub -groups will be provided (i.e., by ethnic group). d. No data for gender or grade (e.g. 6th grade females) will be provided for any sub- group smaller than 6 students. e. OMNI will not release school or community -identified data to the general public for any purposes. There must be written agreement between the school(s) and Coalition/PPB in order for data to be used for any other than the purposes detailed in this document. If data are to be used for any other purposes (e.g. funding), refer to the example Data Sharing Letter, Attachment A.4. 21 VI. Things to Consider When Releasing Data Due to the sensitive nature of HKCS data, it is important to understand how the individuals or organizations that requested the data are intending to use the data. This will help to ensure that the data will not be used to skew an issue which can result in false assumptions and/or discrimination against a school, district, or community. Be careful in releasing data, as local media may choose to report on it without proper authorization. The school/district and/or the coalition/PPB are encouraged to work closely with the media to ensure that the data are portrayed in the most accurate and responsible way. VII. CPP Project Staff and Participating School District Representatives Contact Information [Project Coordinator name and contact information] [Local Evaluation Liaison name and contact information] [School representative names and contact information] VIII. Period of Agreement September 30, 2009 — June 30, 2010 IX. Acceptance and approval of authorizing officials The following signatures verify that the schools and community groups have discussed data dissemination, agreed to the above -mentioned administration procedures and confidentiality protections, and clarified at what level data release permissions have been granted. This MOA is tied to the position/title of the signee rather than to the individual person. In the event of staff turnover, the person holding that same title shall be responsible for upholding this agreement. All Community Level Reports will be sent to the CPP Coordinator to be shared with the Coalition/PPB. School and District Level Reports will be sent to individuals identified on the Reporting Request Form (Attachment A.I ). The CPP Coordinator agrees that information contained in the report(s) will be used only to support community planning and decision making. The CPP Coordinator is not allowed to use, distribute, or advertise the information contained the report(s) to any party or group outside of those named in this release without written agreement between the authorized school/district representative and the requester of the data report. There must be written agreement between the district/school(s) and the requester for data to be used for any other purposes than that detailed in this document. [See Attachment A.4 for an example of a written agreement.] [If superintendents and/or principals are releasing the district and/or individual school level reports to the CPP Coalition for planning purposes (with the same confidentiality agreements, as specified in Attachment A.3), this should be indicated here. In addition, they will be asked to sign the Reporting Request Form (Attachment A.I)). 25 School Superintendent Date CPP Project Coordinator Date [Name, Position of School Official (If applicable] Date [Name, Position of School Official (if applicable)] Date [Name, Position of School Official (if applicable)] Date 26 MOA Attachment A.1: Reporting Request Form 2009-2010 CPP HKCS Survey Year In addition to the CPP Community Healthy Kids Colorado Reports, OMNI also will create district and school level reports upon request. School Level Reports A school level report will present the data for an individual middle or high school that participated in the survey. The final school report will be submitted to the school principal. If signatures are provided and it is specified in the MOA, a copy of this report also can be provided to the CPP Project Coordinator. District Level Reports A district level report will provide survey results for all of the high schools and middle schools that participated in the Healthy Kids Colorado Survey for a given district. This report will be submitted to the superintendent of the district. If signatures are provided and it is specified in the MOA, a copy of this report also can be provided to the CPP Project Coordinator. In both cases, district level and school level data cannot be released to the public without a written release from school partners. Please complete the information below and return to your OMNI evaluation contact. Thank you! County Name: CPP Coordinator: Date Submitted: The following school level HKCS Reports are requested: School Name Principal Name Phone Number Email Address Signature (indicates agreement to release a copy to the CPP Project Coordinato_0 Note: A signature of the school principal named must be provided in the signature section of the MOA. 27 The following district level HKCS Reports are requested: School District Name Superintendent Name r Phone Number Email Address Signature (indicates agreement to release a copy to the CPP Project Coordinator)* Note: A signature of the superintendent named must be provided in the signature section of the MOA. 28 MOA Attachment A.2: Agreement and Work Plan Details Example CPP Project will • Notify school officials of Coalition/PPB meeting times, locations and related information on a regular basis. CPP Project Coordinator will serve as a liaison between community and school stakeholders. CPP Local Evaluation Liaison will work with OMNI to obtain survey supplies and to provide information about the school sample and survey administration timeline. Work with appointed school officials to coordinate the HKCS administration including mailing out passive/active consents to families, meeting with school personnel to review administration procedures, ensuring teachers are prepared to administer, and ensuring that completed surveys are boxed, inventoried and returned to OMNI in a timely manner. Pay for costs associated with the administration of HKCS. The Coalition/PPB review school/school district data for needs assessment, planning and evaluation purposes. Obtain technical support on interpreting school data from OMNI evaluation team contact. Obtain technical support on using school data for planning purposes from OMNI Regional Prevention Consultant (RPC). Appointed School District Officials will Appoint school official(s) to participate in Coalition/PPB meetings, strategic planning activities and project advisory/oversight responsibilities. School officials represent school perspective, serve as a resource on school issues and serve as a liaison between the CPP project and others involved in the school system. Work with the CPP Local Evaluation Liaison to provide needed information. Work with CPP Project Coordinator and Local Evaluation Liaison to provide information and support needed to coordinate the HKCS administration each fall in grades 6-11 of participating schools. Help prepare teachers for survey administration. Dedicate approximately 1 -hour classroom period to administer the HKCS. As members of the Coalition/PPB, participate in reviewing school/school district data for needs assessment, planning and evaluation purposes. Participate in Coalition/PPB meetings to discuss school survey results. Participate in Coalition/PPB meetings that use school and other sources of data to develop Community Strategic Prevention Plan. 29 MOA Attachment A.3: Healthy Kids Colorado Survey (HKCS) Administration and Data Sharing Protocol Administration Protocol and Agreements I. Surveys will be administered to participating high schools and feeder middle schools in the fall semester of each year, beginning fall 2007. 2. Surveys will be administered to students in grades 6-11 in participating school district(s), during one classroom period of approximately one hour. 3. OMNI Institute must be consulted on the development and implementation of any student level or school level sampling procedures. Sampling strategies that do not meet OMNI's guidelines will make HKCS participation null and void for the school entities where the non-scientific sampling strategies were employed. (Refer to sampling procedures in CPP General Guidelines, Evaluation Requirements, Section 4 last paragraph.) 4. School personnel and CPP project staff work together to implement HKCS administration guidelines, including the use, appropriate labeling and timely return of sealable envelopes for student answer sheets. II. Individual Protections and Agreements I. Parental Consent: If there is a district policy regarding parental consent, schools follow district policy. If there is not a district policy regarding parental consent, schools may choose to utilize either an active or passive parental consent process for students being requested to participate in the HKCS. "Active Consent" means that a parent must explicitly state on paper that his or her child may participate. If no record of this consent is obtained, a student may not participate in the survey. "Passive Consent" means that a parent must explicitly state on paper that his or her child cannot participate in the survey, otherwise it is assumed that the student can. Note that active consent procedures are more time consuming and are more difficult to manage as they require schools to track parent consent forms for all possible students. 2. Student Participation: Despite a parent's acknowledgement that his or her child may participate in the HKCS (through either passive or active consent processes), a child is always instructed before the survey administration that he or she may voluntarily choose not to participate in the entire survey or may choose not to answer any items for which he or she feels uncomfortable. 3. Survey Completion: Upon completion of a classroom survey administration, teachers are instructed to have all students insert their completed scan form (student answer sheets) into a sealable envelope. Once all the scan forms are in the envelope, it is to be sealed and assembled with other classroom envelopes. No teacher or school administrator is allowed to examine an individual student's survey responses. Students are instructed not to write their names anywhere on the answer sheet. 4. Survey Reporting: Raw data will not be released to school, community or state entities. 5. Aggregate raw data, using school and individual identifying numbers, may be provided to the federal cross -site evaluators. 30 Limited Use of Survey Data Agreements and Protections of School Survey Data State Evaluation. As a recipient of federal SPF-SIG dollars, Colorado is required to participate in the SPF-SIG national evaluation and to collect National Outcome Measures. The HKCS is one part of this evaluation. OMNI Institute will analyze HKCS for this purpose. Confidentiality protection: While these data will be analyzed at the school, district, and/or community level, these analyses will use confidential and unique identifying identification numbers. No data for individual schools, districts, or communities will be released to the public. A final report may be issued from DBH for the CPP project, but no HKCS data will be presented that specifically identifies participating schools or districts by name. 1. Local Planning. HKCS data is meant to be used to support planning and decision making at the local level. To do so requires that the local Coalition/PPB have access to the data for use in planning processes. An aggregated data report will be provided to agreed upon school entities and the CPP Project Coordinator simultaneously, unless an alternative agreement has been made between the Coalition/PPB and schools. The CPP Coalition/PPB is not permitted to use, distribute or advertise these data to any party or group outside of the Coalition/PPB structure unless there is written agreement between the Coalition/PPB and appropriate school officials. 2. Local Evaluation: Annual HKCS data also will be used for the PPB local evaluation effort. The data will be used to help the PPB reflect on any changes to targeted population groups, possible emerging trends, and to support changes to the local strategic plan. Confidentiality Protection: All conditions cited in Local Planning (above) apply for the Local Evaluation use of the data. 31 MOA Attachment A.4: Example of Data Sharing Letter April 12, 2009 To: Superintendent From: CPP Coordinator Re: Healthy Kids Colorado Survey Data Dear Superintendent, This letter serves to outline our agreement regarding the release and sharing of data from the Healthy Kids Colorado Survey (HKCS). We have appreciated the opportunity to partner with the School District to conduct the HKCS this past year. Because the work of the [Coalition/Organization[ is focused on the prevention of substance abuse and our goals and strategies are data -driven, the results from the HKCS will be invaluable to us in (e.g. seeking funding). The CPP and the School District agreements for releasing and sharing HKCS data with potential funders are outlined as follows: 1- Aggregate data at the district level only will be shared; 2- The content of data shared will be limited to HKCS survey results on Substance Use (Section IV., pp. 12- 46) and Risk and Protective Factors (Section IV., pp. 132-146); and 3- School specific HKCS reports will remain on file with the CPP Coordinator and the School District for reference purposes only. No school -level specific data will be released or shared. Our signatures below indicate acceptance of this agreement. CPP Coordinator Date Superintendent Date Attachment VIII BUDGET INSTRUCTIONS 2009-2010 (Changes are noted in bold) Based on your narrative reflections and your revised work plan, include a current assessment of funding needs for the next nine months. General Budget Instructions Please make sure that: 1. All requested funds are justified and directly relate to your Strategic Prevention Plan. 2. The line -item budget is submitted using the DBH budget page, which will be emailed to you as a separate Excel document. 3. A budget narrative is included and it: a. Details all costs by category b. Explains how the costs for each line item were calculated c. Explains all costs that have been placed in both the "direct" and "indirect" categories d. Describes the process for arriving at the costs listed Fiscal Guidelines — Allowable Costs Allowable costs include: 1. Staff time for: a. The minimum of a half-time Project Director/Coordinator (.5 FTE) b. The minimum of a quarter -time Local Evaluation Liaison (.25 FTE) c. A higher education representative (time allocation is flexible) d. Administrative support 2. Consultant expenses: Funds can be used for in -kind RPC services (see In -kind Services cost estimates) or for other paid consultation services. Coordinate with your Regional Prevention Consultant in budgeting these expenses. If any CPP staff are paid hourly, funds can be built into the consultant line to meet such staffing expectations 3. Travel expenses (mileage, lodging, per diem) to cover required out -of -area travel for the Project Director/Coordinator and Local Evaluation Liaison to attend: a. Two 2 -day annual Community Infrastructure Workgroup and CPPAC Advisory Council meetings per year in Denver b. A minimum of one regional CPP meeting c. Funds for any projected additional meetings, in -area or out -of -area, for training and other activities, for example to participate in state coalition network meetings d. Attendance at the SAPST training, if not yet accomplished e. Participation in regional sustainability TOT's 4. Operating: a. Training/conference expenses (two CPP Community Capacity meetings, Regional Evaluation trainings, SAPST training, coalition network meetings, TOTs, implementation training expenses) b. Copying, printing c. Meeting expenses (planning, food, facilitation services, meeting room rental costs) d. Postage 33 e. Data collection costs (HKCS surveys @ $2.15/student, etc.) f. Stipends/honoraria g. Telephone fees (cell phone/service is an acceptable operating expense) h. Other justifiable operating expenses i. Indirect costs for fiscal agent (20% maximum) 5. Implementation Expenses: Provide a detailed breakdown of 2009-2010 implementation costs (including training expenses) by each approach in your plan so that reimbursements can occur (see examples in budget instructions) 6. Equipment: Computer and printer costs if justifiable Note: Must meet DBH equipment/software requirements (see the section in the application regarding computer equipment and software in Terms and Conditions). 7. In -kind Services a. At an estimated value of $50 per hour for services, the Regional Prevention Services (RPS) Project provides support, technical assistance, and training in the 12 focus areas listed below. Build such services into the consultant line as "Other Sources/In-kind" • Coalition Building Sustainability Planning • Group Facilitation Needs Assessment • Logic Models and Use of Data • Resource Referral • Strategic Planning • Competence in Addressing the Cultures of Diverse Populations • Community Readiness Assessment • Substance Abuse Prevention Focused Programs, Practices, and Policies • The Colorado Prevention Partners (CPP) model or Strategic Prevention Framework (SPF) Follow-up to the Substance Abuse Prevention Specialist Training (SAPST) b. Other In -kind or Cash Services (from community) Please list any financial support, either cash or in -kind, that you receive to support the CPP project. These expenses are examples of sustainability progress. Examples include: • Meeting rooms (e.g. PPB member provides meeting room costs out of local LEAF grant) • Trainings • Staff time that is not included in the indirect budget • Volunteer time (valued at $19.51/hour by the Independent Sector) • Free or discounted event tickets • Gift certificates • Discounted rates on services or products (e.g. equipment, location space, training and materials) • Food and beverage for activities • Other agency support 34 • Supplies Municipal tax revenues c. Non -allowable costs in the budget include • Equipment over $2,500 per item • Car leasing Budget Narrative Instructions Personnel: Describe how the total amount requested was calculated, i.e., number of FTE @ $xx monthly salary. Fringe benefits at xx% of salary for xx months Example • $36,000 annual salary for Project Coordinator x .5 FTE = $18,000 or $1,500/month x 9 months - $13,500 • 20% fringe benefits x $1,500/month = $300/month x 9 months = $2,700 • $30,000 annual salary for Local Evaluation Liaison x .25 = $7,500 or $625/month x 9 months = $5,625 Consultant (If CPP staff will be paid an hourly wage, build their time into the Consultant line): The budget narrative must list each consultant, trainer and other contractor to be used, the cost for each, and a description of the activities they will perform. Coordinate with your Regional Prevention Consultant in budgeting these expenses. Use the attached in -kind chart to estimate the value of services you receive from your Regional Prevention Consultant. Example RPC facilitator for community meeting: $50/hour x 5 hours = $250 in -kind. Sustainability trainer Travel: Estimate the cost of local travel necessary to fulfill the scope of work. Out -of -area travel should include two 2 -day meetings for two people in Denver. Estimate 2 days per meeting plus a half -day of travel prior to and following each meeting. The budget narrative must list other in- state meetings and conferences, as well as the number of staff attending each and an estimate of associated costs. Follow these guidelines for calculating your travel expenses to Denver or other out -of -area trips. Depending on where you are, you may need to follow the policies of your county. Per diem for meals: Use state per diem rates, which can be found by going to: http://www.colorado.gov/dpa/dfp/sco/FiscalRules/I 0-01- 07/Max imum%20Allowab le%20Meal%20Per%20Di em.pdf Lodging: Use estimates based on the state rates listed for specific hotels/motels/lodges. This information can be found on http://www.colorado.gov/dpa/dcs.travel by clicking on "State Travel Management" and then on the "Lodging" link Mileage: Budget mileage anywhere between 50 cents per mile (current state rate) and 56 cents per mile (federal rate, which is acceptable for this grant if it is consistent with the reimbursing agency's reimbursement policies) Cost of Training: There will be no charge to attend the trainings. Travel Examples Out -of -area • Denver Trips: Mileage for three trips to Denver @ 150 miles round trip x 2 trips =450 miles @ .50 per mile = $225; lodging for two rooms @ $120 per room = $240 per night x I night = $240 x 2 meetings = $480; meals per diem ($49 per day Denver) x 2 people = $98 x 2 days = $196 x 2 meetings = $392. • Regional Prevention Meeting: one trip to x community for x people @ x miles, etc. (i.e., to Grand Junction for 3 people @ 200 miles round trip @ .50 per mile = $100; lodging for 3 rooms @ $65 per room = $195 per night x 3 nights = $585; meals per diem ($49 per day less $13 lunch = $36) x 3 people = $108 x 3 days = $324. In -area Local mileage: 250 miles per month x 9 months @ .50 cents = $1,125. Operating Expenses: The budget narrative must contain adequate information to show how the amount requested was calculated. Refer to the information listed above regarding allowable operating expenses. Example Copying/Printing: List specific amounts for operating costs per month e.g., Copying/printing (ink, paper), $50 x 9 months = $450 Implementation: Please break down your implementation expenses in detail, listing each approach in your implementation plan. Refer to the number/letter of each approach in your plan. Examples D.9 Goal 1: TIPS Trainings - $840 • Trainer's fee for 4 meetings @ $60 per meeting = $240 • Meeting expenses for 4 meetings @ $50 per meeting = $200 • Supplies and postage - $100 • Promotion, copying, printing - $300 D.10 Goal 2: Social Norms Process, Media Advocacy/Education Campaign - Develop social norms messages and community education materials and pay for their distribution - $5,850 • Training for coalition in evidence -based social norms model program - $2,500 • Printing of media messages (500 posters @ $50 per 100 posters = $250) • Billboard rental for media messages (4 per year) - $1,600 • Newspaper ads (1 ad per week in local newspaper for 5 weeks @ $300 per week - $1,500) D.I 1 Goal 3: Evidenced -based Curricula in Schools - $2,500 • Skill -based curricula [list name(s)] materials needed for 2009-2010 school year- $1,500 • New Mexico Media Literacy Curriculum - $500 • Project Action Supplemental Materials for Grades 7-10 - $1,000 • Classroom incentives/rewards-$1,000 D.12 Goal 4: Parent Education — $3,500 • Printing of Parent Guide, Talking with Your Kids About Underage Drinking - $2,000 • Positive Parenting Training from CSU Parent Resource Center/CFERT Training Services — state trainer in -kind (value of $2,000) • Funds to support co -facilitation by local trainer/facilitator - $500 Training manuals ($25 per person x 20 parents = $500) • Food and child care for parent trainings ($50 session x 10 sessions = $500) D. 13 Goal 5: Youth Engagement Youth Coalition Meetings - $1,380 • 12 @ $75 per meeting for room rental and refreshments = $900 • Stipends for 9 meetings ($40 per meeting = $360) • ATOD-free Alternative Youth Events to Support Positive Action Curricula (1-2 activities each month) - $ • 12 events @ $400 each = $4,800 • Stipends for event sponsors (12 events x 4 people x $20 = $960) D.14 Goal 6: DUI Task Force - $2,000 • Rack cards on laws and penalties for adults that provide alcohol to youth (cost includes production and displaying cards in 50 locations) - $1,000 Give aways/promotional items to support DUI enforcement messages - $1,000 Indirect: The budget for indirect costs may be up to 20% of the total budget. The Fiscal Agent may use 20% for its support of the project. Items that are not specifically service related fall into this category (e.g., utilities, rent, Executive Director's salary, bookkeeping staff, general liability insurance, etc.) Note: Some costs, like rent could fall into both indirect and direct. Only the area where the service is performed may be considered applicable for direct costs. For example, the Executive Director's space, the bookkeeper's work area, and other non -program related staff areas would fall into indirect. Rent costs would be figured at the percentage of time that a person is assigned to work within this contract. In the budget narrative section, please justify all costs that have been placed in both the direct and indirect categories. The process for arriving at the costs listed must be clearly described. Subcontracts: Please submit a budget and subcontract for each subcontractor. The budget for a subcontractor should follow the same format as that required for the Fiscal Agent. Ensure that the total of the subcontract budget(s) and the Fiscal Agent budget equals the requested amount for the 12 -month period. Attach the subcontract documents, subcontract budgets and narratives with your Continuation Application, or explain when those documents can be submitted to DBH. DBH must approve in advance, and in writing, any subcontract for services to be provided as part of the CPP project. DBH does not prescribe any specific contract format, but the prime contractor should assure that any subcontract holds the subcontractor responsible for every applicable duty required of the prime contractor. This is requested in order to clarify the role and duties of the subcontractor. Adding duties or requiring compliance of a subcontractor that is not clearly stated after the contract is signed cannot be done. Because contracts are legal documents, the prime contractor should assure the subcontract would be upheld in court. 37 SAMPLE BUDGET PAGE (DO NOT USE) *Use Excel Spreadsheet (An separate Excel document will be emailed to you.) A sample budget page is included below for viewing purposes only. Colorado Division of Behavioral Health (DBH) SAMPLE CPP BUDGET PAGE (do not use) Crt�NaTGT R a � ,� E PR© .$. Firs/ Week TIME PERIOD: 9/30/2009 - 6/30/2010 Category and Line Annual Time # Mos % Total Budget CPP Fund Other Source Cash Other Source Non -Cash / In -Kind Personnel I. CPP Coordinator �'urr `' - , 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Fringe Benefits 0%v 0.00 2. Evaluation Liaison 0.00 0.00 0.00 0.00 Fringe Benefits 0% 0.00 0.00 0.00 0.00 3. Admin Assistant ' 0.00 0.00 0.00 0.00 Fringe Benefits 0% 0.00 0.00 0.00 0.00 Total Personnel 0.00 0.001 0.00 0.00 Consultants I. Youth Consultants 0.00 0.00 0.00 0.00 2. Subcontractor 0.00 0.00 0.00 0.00 0.00 3. nsultant/Coord inato Consultant/Coordinato r 0.00 0.00 0.00 Total Consultant I 0.00 0.00 0.00 0.00 Travel 1. Local 0.00 0.00 0.00 0.00 2. Out of Area 0.00 0.00 0.00 0.00 38 Total Travel 0.001 0.00 0.00 0.00 Operating 1. Training/Conference 0.00 0.00 0.00 0.00 2. Copying/Printing 0.00 0.00 0.00 0.00 3. Meeting Room 0.00 0.00 0.00 0.00 4. Food 0.00 0.00 0.00 0.00 5. Indirect 0.00 0.00 0.00 0.00 Total Operating I III 0.00L 0.00 0.00 0.00 Category and Line Annual Time # Mos Itrs/ Week % Total Budget CPI' Fund Other Source Cash Other Source Non -Cash / In -Kind I plementation 1. Goal 1 0.00 0.00 0.00 0.00 2. Goal 2 0.00 0.00 0.00 0.00 3. Goal 3 1 0.00 0.00 0.00 0.00 Total Implementation 0.00 0.00 0.00 0.00 Grand Total ( 0.00 0.00 0.00 0.00 Instructions: This is the budget format required for the next fiscal year. The budget should reflect and individually identify costs for both the fiscal agent and any subcontractors. Billings to DBH should be prepared referencing the line items in the in the budget. Your budget narrative must match the budget. 39 Attachment IX LIST OF FREQUENTLY USED ACRONYMS ATOD Alcohol, Tobacco, & Other Drugs Substance abuse prevention focus. SPF-SIG Strategic Prevention Framework- State Incentive Grant The federal name for the federal grant that Colorado received to do a multi -county funded process and apply a specific 5 step planning process that it requires. CPP Colorado Prevention Partners What Colorado calls the multi -county funded process and the specific 5 step planning process that is required. PLC Prevention Leadership Council The name of the group that meets with all of the leaders of prevention efforts in the state. DBH Alcohol Drug Abuse Division The name of the state agency in Colorado which receives the federal block grant dollars for substance abuse prevention and treatment. CDPHE Colorado Department of Public Health & Environment The state agency for addressing public health and environment for all of Colorado. CDE Colorado Department of Education The state agency for addressing education in the state. CDOT Colorado Department of Transportation The state agency for addressing transportation in the state. RPCs Regional Prevention Services (project) Regional Prevention Consultants The name of the statewide project which provides prevention technical assistance and training and what the regional staff calls themselves. PPB Prevention Policy Boards What the required advisory boards are called which each CPP funded community must have. ASPIRE Assessment Prevention Indicators & Resources (Web -based system) Data assessment system to manage and report indicator and resource data. HKCS SEOW Healthy Kids Colorado Survey The integrated school youth survey which each CPP funded communit will have their schools use. State Epidemiological Outcomes Workgroup State group assembled to look at data sets. SWCAPT CSAP's Southwest Center for the Application of Prevention Technologies Provides technical assistance & training to the states in their prevention work. They cover multiple states in the Southwest part of the country. CSAP Center Substance Abuse Prevention National agency that leads policy on substance abuse prevention. Their website is a good resource for lots of information.: htt :// revention.samhsa. ov/ SAMHSA Substance Abuse & Mental Health Services Administration Federal agency that is the parent organization of CSAP. 40 Attachment X GLOSSARY *(Note: Changes from previous year are noted in italics) ASPIRE: (Assessment Prevention Indicators and Resources) ASPIRE is a web - based data system designed to store and manage indicator and resource data that can be queried to meet the user's needs. ASPIRE contains indicator data within numerous domains such as demographics, early childcare and education, community and civic involvement, mental health, and substance abuse and treatment. Capacity: Community Level Instrument (CLI): Community Coalition: The process by which a community develops the ability to build an effective and sustainable infrastructure. The community will have various types and levels of resources at its disposal to meet implementation demands. Web -based community level instrument for the national cross -site evaluation CPP communities are required to have a community -based coalition that will work in conjunction with or include policy makers as members that serve as a Prevention Policy Board (PPB) to plan, manage, and implement the CPP project. Because many of Colorado's communities already have one or more functioning coalitions, CPP communities have been encouraged to build on these existing groups as considered appropriate, particularly if the community has a coalition funded by a federal Drug Free Community Grant. CPP communities are expected to have developed their coalitions and to have obtained participation agreements (e.g., Memoranda of Understanding, letters of support, declaration of support). Updates are to be submitted with the Continuation Application Packet. However, the process of building a coalition is ongoing and will continue throughout the CPP project. Coalitions are defined as organized groups with multiple partners that have in place a process that includes a needs assessment; vision, mission, and goals; an action plan; and benchmarks for specific outcomes addressing reductions in alcohol, tobacco, or other drug use or related problems. Coalitions need not be separate legal entities or have non-profit status. Community Prevention Policy Board (PPB): CPP communities are required to continue efforts to engage key decision - makers from across disciplines to comprise a Prevention Policy Board that will work in conjunction with, or be part of, a Community Coalition to plan, mobilize and implement the project. Key decision -makers are defined as those individuals that hold policy -level positions in the county (e.g., school district superintendents, sheriffs, county commissioners, city officials and other governmental representatives, school board presidents, etc.) and that have the authority to institute changes in the local infrastructure. Contract Signer: Cultural Responsiveness: Evaluation: Evidence Based: Fiscal Agent: Formative Evaluation: Goal: Key Informant: CPP communities are expected to have progressed considerably in the development of their PPBs and to have obtained participation agreements (e.g., Memoranda of Understanding, letters of support, declaration of support). Updates are to be submitted with the Continuation Application Packet. However, the process of building a PPB is ongoing and will continue throughout the CPP project. The individual in the Fiscal Agency that is authorized to obligate the agency. An inclusive approach of inquiry and action to foster effective programs, policies, and practices that is respectful of cultural conditions within communities. The systematic collection of information about community needs, prevention strategies and program activities, participant characteristics and outcomes. To include those interventions that fall within one of the following three categories: • Included on a Federal List or Registries of evidence -based interventions; Reported with positive effects in peer reviewed journals; or • Documented effectiveness based on guidelines for evidence: An outside evaluator has written a comprehensive evaluation report, which includes: 1) A pre -post quantitative design using statistical analyses; and 2) A thorough literature review of the theoretical basis behind the approach; and 3) A comparison group (which could be comparable data such as national or state -level data); and 4) Positive findings. Person or persons responsible for financial matters; the agent must be a representative of a Unit of Local Government. Evaluative activities undertaken during the design and pre -testing of programs to guide the design process. Clearly stated, specific, measurable outcome(s) or change that can be reasonably expected at the conclusion of a methodically selected program. A community representative identified to participate in an evaluation or community readiness interview. Memorandum of Agreement (MOA): Memorandum of Understanding (MOU): Needs Assessment: No Cost Extension: Outcomes: Prevention Infrastructure: Stakeholder: Strategic Plan: Supplanting: Official and formalized contractual agreement with schools for their participation and administration of the I-IKCS. (See Appendix F). Participation agreements from community members involved with coalitions and/or PPB's to formalize relationships supporting the community initiative. The MOU may be a collectively signed document or individual letters of agreement. This is a type of evaluation that involves the systematic assessment of various targeted populations and prevention resources within the community and studies of current indicators to identify unique vulnerabilities and strengths that affect substance abuse in communities. A no -cost extension is an extension of the length of time needed to permit an orderly phase out of a project or to assure adequate completion of the originally approved project. The extent of change in targeted attitudes, values, behaviors or conditions between baseline measurement and subsequent points of measurement. Changes may be identified as immediate, intermediate, and long term. The policies, networks, coalitions, resources, professional staff and skills, programs and delivery system that serve as a foundation for prevention work within a community. An individual or an organization that has a vested interest and investment in a project or program (e.g., funder, program champion, community leader, etc.). A plan developed and used to guide the successful implementation of prevention programs, practices and policies. The strategic plan defines specific objectives and actions to be taken, in order to accomplish the proposed goals. According to OMB A-133, a compliance supplement used by auditors to determine federal grantee compliance with federal laws and regulations, federal funds should be used so as to supplement the level of Federal, State and local public funds that, in absence of such availability, would have been expended for programs and in no case to supplant such Federal, State and local public funds. The "supplement, not supplant" provision means that federal funds must be used only to provide additional services, staff, programs, or materials that could not be provided by the state of local agency in the absence of the federal funds. In other words, federal funds cannot be used to pay for things that would otherwise be paid for with state and/or local funds. Hello