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Brief: Substance use treatment

Prepared from Grant Precedent, 2026-10-23; data as of precedent 2026-10-21, measures 2026-10-22.

Measures funders require

Bureau of Justice Assistance (DOJ OJP), Adult Treatment Court, Veteran's Treatment Court, and Treatment Court Programs

Was there grant activity in the reporting period?

  • Code: Q1
  • Requirement: required
  • Definition: Grant activity is defined as any proposed activity in the Bureau of Justice Assistance (BJA)-approved grant application that is implemented or executed with BJA grant funds. A. Yes ____ B. No ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 1, https://bja.ojp.gov/funding/performance-measures/atc-statewide.pdf

Which one of the following type of areas best describes where your treatment court program is located?

  • Code: Q2
  • Requirement: required
  • Definition: Select only one area type. A. Urban (a large city with 50,000 or more people) ____ B. Suburban (territory outside of a large city with a population of 2,500 to 50,000 or more people) C. Rural (territory that encompasses all people or housing not included within an urban, suburban, or tribal area) ____ D. Tribal (territory that contains a concentration of people who identify with a federally recognized tribe) ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 1, https://bja.ojp.gov/funding/performance-measures/atc-statewide.pdf

Were BJA funds expended on treatment court staff trainings during the reporting period?

Enter the number of treatment court staff who successfully completed training during the reporting period. Staff are defined as, but not limited to, program managers, administrators, case managers, probation and parole officers, and clinicians. Do not count mentors, volunteers, or interns. Be consistent when reporting the type of staff across reporting periods. The number entered

  • Code: Q4
  • Requirement: required
  • Definition: should be greater than or equal to the number entered in question 5. If not, check for data entry errors. A. Number of treatment court staff who successfully completed training during the reporting period
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 1, https://bja.ojp.gov/funding/performance-measures/atc-statewide.pdf

Of the number listed in question 4, enter the number of treatment court staff who rated the training as satisfactory or better during the reporting period. Satisfaction may be measured based on a survey provided to participants. The number entered should be less than or equal to the number entered in question 4. If not, check for data entry errors.

  • Code: Q5
  • Requirement: required
  • Definition: A. Number of treatment court staff who rated training as satisfactory or better during the reporting period ____ Adult Discretionary Treatment Court Program—Statewide Performance Measures 2
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 1, https://bja.ojp.gov/funding/performance-measures/atc-statewide.pdf

Were BJA treatment court program funds expended on program evaluations during the reporting period?

Were BJA treatment court program funds expended on any management information system (MIS)-related activities during the reporting period?

  • Code: Q7
  • Requirement: required
  • Definition: A. Yes B. No C. If Yes, explain: REVISED DECEMBER 2014 The performance measure questions presented here are preliminary and may be subject to revision. This document is only to be used for planning and data collection purposes. Adult Discretionary Treatment Court Program—Statewide Performance Measures 3 In this module, you will identify the goals you hope to achieve with your funding. Once submitted, these goals cannot be changed without approval of your grant manager. Set S M A R T goals to clarify the scope of your priorities: • Specific • Measurable • Achievable • Relevant • Time-bound If you have multiple goals, provide updates on each on separately. Answer the following questions every semiannual reporting period (January and July of each year), based on your grant-funded activities.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 2, https://bja.ojp.gov/funding/performance-measures/atc-statewide.pdf

What were your accomplishments during this reporting period?

What goals were accomplished, as they relate to your grant application?

What problems/barriers did you encounter, if any, within the reporting period that prevented you from reaching your goals or milestones?

Is there any assistance that BJA can provide to address any problems/barriers identified in question 3?

Are you on track to complete your program fiscally and programmatically as outlined in your grant application?

What major activities are planned for the next 6 months?

Based on your knowledge of the criminal justice field, are there any innovative programs/accomplishments that you would like to share with BJA?

  • Code: Q7
  • Requirement: required
  • Definition: REVISED DECEMBER 2014 The performance measure questions presented here are preliminary and may be subject to revision. This document is only to be used for planning and data collection purposes.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 3, https://bja.ojp.gov/funding/performance-measures/atc-statewide.pdf

Was there grant activity in the reporting period?

  • Code: Q1
  • Requirement: required
  • Definition: Grant activity is defined as any proposed activity in the Bureau of Justice Assistance (BJA)-approved grant application that is implemented or executed with BJA program funds. B. No (If No, explain):
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 1, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Which one of the following type of areas best describes where your treatment court program is located?

  • Code: Q2
  • Requirement: required
  • Definition: Select only one area type. A. Urban (i.e., a large city with 50,000 or more people): B. Suburban (i.e., territory outside of a large city with a population of 2,500–50,000 or more people): C. Rural (i.e., territory that encompasses all people or housing not included within an urban, suburban, or tribal area): D. Tribal (i.e., territory that contains a concentration of people who identify with a federally recognized tribe):
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 1, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

What is the expected number of participants the treatment court program plans to serve with BJA program funds over the life of this award?

  • Code: Q3
  • Requirement: required
  • Definition: The value should correspond to what was reported in the grant application. A. Enter the expected number of participants:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 1, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Is this the last time the grantee is reporting in the Performance Measurement Tool (PMT) before closing out this award?

What type of treatment court is the grant serving?

  • Code: Q5
  • Requirement: required
  • Definition: A. Adult drug court: B. Hybrid Driving While Intoxicated (DWI)/drug court: C. Co-occurring court: D. Veterans treatment court: E. Tribal healing to wellness court: F. DWI court: G. Other: H. If Other, describe:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 1, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

What is the date that the treatment court first enrolled a participant after this BJA program funding was awarded?

  • Code: Q6
  • Requirement: required
  • Definition: The implementation date for questions 6 and 7 may be the same if the treatment court program did not exist before this BJA treatment court award. A. Enter date: ( / / )
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 2, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

What is the date that the treatment court first enrolled a participant?

  • Code: Q7
  • Requirement: required
  • Definition: If the treatment court was in existence before this BJA program funding, enter the date it first enrolled a participant. The intent of this question is to determine the amount of time since program implementation. A. Enter date: ( / / )
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 2, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Does your treatment court program have a formal policy for graduated sanctions and incentives that is documented in writing and implemented fairly and with certainty in response to participant behavior?

Does your treatment court program administer random and observed alcohol and substance use testing?

Does your treatment court program use evidence-based treatment services?

  • Code: Q10
  • Requirement: required
  • Definition: Evidence- based programs and practices are those demonstrated by the research literature to be effective at reducing substance use among court-involved individuals (a conclusion generally reached through one or more outcome evaluations). B. No: Amount of Services Added
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 2, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Were BJA program funds used to add inpatient treatment slots during the reporting period?

  • Code: Q11
  • Requirement: required
  • Definition: A treatment slot is a space or position used to determine the number of individuals who can be provided services based on available staff and program funds to deliver services. Inpatient services are services provided in a residential facility. B. No: C. If Yes, enter the number of inpatient treatment slots added during the reporting period as a result of this grant:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 2, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Were BJA program funds used to add outpatient treatment slots during the reporting period?

  • Code: Q12
  • Requirement: required
  • Definition: A treatment slot is a space or position used to determine the number of individuals who can be provided services based on available staff and program funds to deliver services. Outpatient services are not provided in a residential facility. B. No: C. If Yes, enter the number of outpatient treatment slots added during the reporting period as a result of this grant:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 3, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Were BJA program funds used to add staff who provide new case management or offender supervision services during the reporting period?

  • Code: Q13
  • Requirement: required
  • Definition: Only report new staff added during the reporting period in which they started offering services to the program (i.e., the reporting period in which they started work). B. No: C. If Yes, enter the number of case management or offender supervision staff added during the reporting period as a result of this grant: Amount of Services Delivered
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 3, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Were BJA program funds used to provide substance use treatment services to treatment court participants during the reporting period?

  • Code: Q14
  • Requirement: required
  • Definition: These services might include clinical assessment, residential, outpatient group, outpatient individual, intensive inpatient, outpatient detoxification, addiction receiving facility, substance use detoxification (residential), in-home counseling, and aftercare. B. No: C. If Yes, enter the number of new treatment court participants who received substance use treatment services during the reporting period:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 3, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Were BJA program funds used to provide inpatient substance use treatment services during the reporting period?

  • Code: Q15
  • Requirement: required
  • Definition: B. No: C. If Yes, enter the total number of days inpatient services were delivered during the reporting period: ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 3, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Were BJA program funds used to provide recovery support services to treatment court participants during the reporting period?

  • Code: Q16
  • Requirement: required
  • Definition: These services might include employment, housing, education, mental health, health services (such as medical and dental services), prosocial services (such as anger and stress management), faith-based services, family counseling, life skills training, mentoring, and other services. One participant may receive more than one category of services during the reporting period. For example, one person could receive a housing referral (housing services) and adult education classes in preparation of receiving a GED during the current reporting period. For this example, enter ‘1’ in housing services and ‘1’ in education services. B. No: C. If Yes, enter the total number of treatment court participants who received each of the following recovery support services for the first time during the reporting period. The intent of this question is to see what types of services each unique treatment court participant receives. Report only during the first quarter in which the participant receives services and not in subsequent reporting periods if services are received for more than one reporting period. i. Employment services: ii. Housing services: iii. Education services: iv. Mental health services: v. Health services (includes medical and/or dental services): vi. Trauma treatment: vii. Veteran services: viii. Prosocial services: ix. Other services: x. If Other, explain:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 4, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

What other program components are these BJA program funds supporting?

  • Code: Q17
  • Requirement: required
  • Definition: A. Offender supervision/case management: B. Equipment: C. Training: D. Evaluations: E. Management information system: F. Aftercare support: G. Enhancing risk/assessment screening: H. Performance measures standards: I. Other: J. If Other, explain: Medication-Assisted Treatment The following questions ask about any medication-assisted treatment (MAT) that participants may be receiving within your program during the reporting period. BJA supports the right of individuals to access appropriate MAT under the care and prescription of a physician. BJA recognizes that not all communities may access MAT due to lack of physicians who are able to prescribe and oversee clients using anti-alcohol and anti-opioid medications.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 4, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

If your treatment program includes MAT, which of the following medications are you utilizing, regardless of BJA funding?

  • Code: Q18
  • Requirement: required
  • Definition: Check all that apply. A. We do not provide MAT (Skip next question.): B. We do not have access to MAT (Skip next question.): C. Naltrexone (e.g., Vivitrol ® , depot naltrexone): D. Buprenorphine or Buprenorphine/Naloxone (e.g., Bup/NX, Suboxone ® ): E. Methadone:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 5, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Of the total participants enrolled in your program, how many were deemed eligible for MAT, and of those eligible, how many received MAT during the reporting period?

Enter the number of treatment court candidates who were screened during the reporting period. Treatment court candidates are those identified at the time of arrest or referred by criminal justice professionals (i.e., prosecutor, defense attorney, probation officer, judge, etc.) but who may not necessarily be deemed eligible for participation. A screening determines eligibility and

  • Code: Q20
  • Requirement: required
  • Definition: appropriateness for participation in a treatment court. A. Number of treatment court candidates who were screened during the reporting period:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 5, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Of those screened, enter the number of individuals who did not enroll in the treatment court during the reporting period.

Of those screened who did not enroll in the treatment court program, enter the number of such individuals based on the following categories. If an individual falls into multiple categories, select the category that best applies to them.

  • Code: Q22
  • Requirement: required
  • Definition: A. Participant refused entry: B. Prosecutor objection: C. Defense objection: D. Judicial objection: E. Out of jurisdiction F. Arrest, conviction, or incarceration on another charge: G. No drug problem: H. Exclusionary prior non-violent offense: I. Violent history: J. Mental health diagnosis that cannot be handled by the court: K. Insufficient risk (i.e., low risk): L. Ineligible for Veterans Affairs services: M. Accident involving injury: N. Candidate did not complete screening: O. Candidate waiting for program slot (will enroll in a subsequent quarter): P. Other: Q. If Other, explain:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 6, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Of those screened who did not enroll in the treatment court program, enter the number of such individuals based on the following demographic information. Enter the race, ethnicity, and sex of each individual determined to be ineligible for treatment court participation during the reporting period. Hispanics or Latinos should be counted in the race category that best

  • Code: Q23
  • Requirement: required
  • Definition: describes their racial identity, including White, Black or African American, Asian, American Indian or Alaska Native, Pacific Islander or Native Hawaiian, or multiracial. See census.gov for questions regarding classifying race and ethnicity. The number entered should be an unduplicated count, and the sum of each demographic group should equal the number of individuals who did not enter the treatment court program. If not, check the data for entry errors. A. Enter the ethnicity and sex of those screened who did not enroll in the treatment court program. Ethnicity and Sex A Hispanic or Latino B Non-Hispanic or Latino C Unknown B. Enter the race and sex of those screened who did not enroll in the treatment court program. Race and Sex A White B Black or African American C Asian D American Indian or Alaska Native E Pacific Islander or Native Hawaiian F Multiracial G Unknown H Other Risk Assessment
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 6, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Enter the number of newly admitted treatment court participants who were administered a risk and needs assessment during the reporting period. A risk and needs assessment is an instrument to help identify factors that may lead a participant to reoffend. It pinpoints needed services to minimize those risks. Only include those individuals who have been newly admitted to

  • Code: Q24
  • Requirement: required
  • Definition: the treatment court program during the reporting period. A. Number of newly admitted treatment court participants who were administered a risk and need assessment during the reporting period:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 7, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Name the risk assessment instrument that is used to assess risk and need.

Of those newly admitted participants who were administered a risk and needs assessment during the reporting period, enter the number of such individuals who were identified as having high criminogenic risks and use treatment needs.

  • Code: Q26
  • Requirement: required
  • Definition: A. Number of participants who were identified as having high criminogenic risk and use treatment needs: ___ Number of Treatment Court Participants Receiving Services
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 7, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Enter the total number of participants enrolled in the treatment court program at the end of the reporting period. Enrolled participants include new admissions and those admitted in a previous reporting period who continue to participate.

Has the treatment court program admitted new participants into the treatment court program during the reporting period?

Enter the number of newly admitted treatment court participants during the reporting period.

  • Code: Q29
  • Requirement: required
  • Definition: New participants are unique individuals who were not previously enrolled in the treatment court program in previous reporting periods. Individuals who exit the treatment court program without completion and are then readmitted or who have graduated and reentered may be counted twice. For the first reporting period that the program becomes operational, report all participants enrolled as new. A. Number of newly admitted treatment court participants during the reporting period:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 8, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Enter the race, ethnicity, and sex of each participant newly admitted to the treatment court program during the reporting period. For the first reporting period, include all participants enrolled in the treatment court program. Hispanics or Latinos should be counted in the race category that best describes their racial identity, including White, Black or African American, Asian,

  • Code: Q30
  • Requirement: required
  • Definition: American Indian or Alaska Native, Pacific Islander or Native Hawaiian, or multiracial. See census.gov for questions regarding classifying race and ethnicity. The number should be an unduplicated count, and the sum of each demographic group should equal the sum of the newly admitted participants in the program during the reporting period. If not, check for data entry errors. A. Enter the ethnicity and sex of newly admitted participants in the treatment court program. Ethnicity and Sex A Hispanic or Latino B Non-Hispanic or Latino C Unknown B. Enter the race and sex of newly admitted participants in the treatment court program. Race and Sex A White B Black or African American C Asian D American Indian or Alaska Native E Pacific Islander or Native Hawaiian F Multiracial G Unknown H Other Program Completion and Judicial Interaction
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 8, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Enter the number of treatment court participants who successfully completed all program requirements, excluding financial obligations, during the reporting period. The number entered should represent only those participants who successfully completed all the requirements of the treatment court program during the reporting period. Those being held because of financial

  • Code: Q31
  • Requirement: required
  • Definition: obligations (e.g., owing money to the court for their drug testing) should still be counted. A. Number of treatment court participants who successfully completed all program requirements during the reporting period:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 9, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Of those who completed all program requirements, from start to finish, indicate when these participants graduated from the program within the following time frames. The sum of all of these categories should be equal to the total number of successful completions in question 31. If not, check for data entry errors.

Enter the race, ethnicity, and sex of each participant who successfully completed all program requirements, excluding financial obligations, during the reporting period. Hispanics or Latinos should be counted in the race category that best describes their racial identity, including White, Black or African American, Asian, American Indian or Alaska Native, Pacific Islander or Native

  • Code: Q33
  • Requirement: required
  • Definition: Hawaiian, or multiracial. See census.gov for questions regarding classifying race and ethnicity. The number entered should be an unduplicated count, and the sum of each demographic group should be equal to the sum of the participants who successfully completed the program during the reporting period. If not, check for data entry errors. A. Enter the ethnicity and sex of participants who successfully completed the treatment court program. Ethnicity and Sex A Hispanic or Latino B Non-Hispanic or Latino C Unknown B. Enter the race and sex of participants who successfully completed the treatment court program. Race and Sex A White B Black or African American C Asian D American Indian or Alaska Native E Pacific Islander or Native Hawaiian F Multiracial G Unknown H Other
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 9, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Enter the number of individuals who exited the program unsuccessfully in the categories below. Participants should not fit in more than one category, so choose the option that best represents why these individuals did not complete the program.

  • Code: Q34
  • Requirement: required
  • Definition: Incompletes Measures Number Number of participants no longer in the program due to court or criminal A involvement (e.g., technical violation, arrest, conviction, revocation, reincarceration). Number of participants no longer in the program due to a lack of engagement B (e.g., no-shows and nonresponsive participants). C Number of participants no longer in the program due to absconding. Number of participants no longer in the program due to relocating or case D transfer. Number of participants no longer in the program due to death or serious illness. E Number of participants who did not complete the program for other reasons (specify). F
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 10, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Of those treatment court participants who exited the program unsuccessfully, indicate the number of these participants who left within the following time frames (from the start of the program to termination). The sum of these categories should be equal to the total number of incompletes in question 34. If not, check for data entry errors. Round up to the nearest month

  • Code: Q35
  • Requirement: required
  • Definition: category. A. 0 to 3 months: B. 4 to 6 months: C. 7 to 9 months: D. 10 to 12 months: E. 13 to 18 months: F. 19 or more months:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 11, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Enter the race, ethnicity, and sex of each participant who exited the program unsuccessfully during the reporting period. Hispanics or Latinos should be counted in the race category that best describes their racial identity, including White, Black or African American, Asian, American Indian or Alaska Native, Pacific Islander or Native Hawaiian, or multiracial. See census.gov for questions

  • Code: Q36
  • Requirement: required
  • Definition: regarding classifying race and ethnicity. The number entered should be an unduplicated count, and the sum of each demographic group should be equal to the sum of the participants in question 34. If not, check for data entry errors. A. Enter the ethnicity and sex of participants who exited the program unsuccessfully. Ethnicity and Sex A Hispanic or Latino B Non-Hispanic or Latino C Unknown B. Enter the race and sex of participants who exited the program unsuccessfully. Race and Sex A White B Black or African American C Asian D American Indian or Alaska Native E Pacific Islander or Native Hawaiian F Multiracial G Unknown H Other Alcohol and Substance Involvement
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 11, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Of those enrolled in the treatment court program for at least 90 days, enter the total number of participants tested for alcohol, non-prescribed medications, or illegal substances during the reporting period. This should represent the total number of treatment court participants who were tested for the presence of alcohol, non-prescribed medications, or

  • Code: Q37
  • Requirement: required
  • Definition: illegal substances. The number entered should be an unduplicated count only of participants enrolled in the program for at least 90 days who were tested for alcohol, non-prescribed medications, or illegal substances, and it should be equal to or greater than the number of participants who test positive. If not, check for data entry errors. A. Total number of participants tested for alcohol, non-prescribed medications, or illegal substance during the reporting period:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 12, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Of those enrolled in the treatment court program for at least 90 days, enter the number of participants who tested positive for the presence of alcohol, non-prescribed medications, or illegal substances during the reporting period. Alcohol and substance use information should be based on documented tests rather than self-reported information from program participants. Include

  • Code: Q38
  • Requirement: required
  • Definition: all participants who received services during the reporting period, regardless of whether they successfully completed the program, exited the program without completion, or are currently enrolled in the treatment court program. The number entered should be an unduplicated count only of participants enrolled in the program for at least 90 days who tested positive for alcohol, non- prescribed medications, or illegal substances, and it should be equal to or less than the total number of participants tested. If not, check for data entry errors. A. Total number of participants who tested positive for the presence of alcohol, non-prescribed medications, or illegal substances during the reporting period: The next set of questions is about court and criminal involvement for treatment court program participants. Note that individuals can be included in more than one category. For example, a treatment court participant could be arrested and have a conviction; thus, the individual should be counted in both categories. If an ex-offender has multiple arrests or convictions, only count that individual once. This section is to be completed at the close of the grant.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 12, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Since the start of this BJA program funding, enter the number of participants who:

  • Code: Q39
  • Requirement: required
  • Definition: A. Are still participating in the treatment court program? B. Have successfully completed the treatment court program? C. Exited the treatment court program unsuccessfully?
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 12, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

Since the start of the BJA award, enter the total number of participants who have had a criminal court and/or criminal involvement event. A participant can be counted in more than one category (i.e., an individual can have an arrest and a conviction). However, do not count the frequency of events (i.e., number of arrests and convictions). Pending charges that the individual

  • Code: Q40
  • Requirement: required
  • Definition: had before entering the program should not be counted. New charges that are dropped and/or not prosecuted should not be counted.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 13, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

How was the information obtained for those ex-offenders who were arrested on a new criminal charge?

  • Code: Q41
  • Requirement: required
  • Definition: Select the option that best describes how the information was obtained. A. The grantee has direct access to this information through its court information system. B. The grantee has a memorandum of understanding/agreement (MOU/A) or a data sharing agreement with a correctional agency that has access to this information. C. The grantee conducts public record jail/prison searches online. D. The grantee entered unofficial data (through word of mouth or from participants who reported the incident). E. The grantee does not have access to official justice information. F. Other, specify:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 13, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

How was the information obtained from those ex-offenders who were convicted of a new crime?

  • Code: Q42
  • Requirement: required
  • Definition: Select the option that best describes how the information was obtained. A. The grantee has direct access to this information through its court information system. B. The grantee has an MOU/A or a data sharing agreement with a correctional agency that has access to this information. C. The grantee conducts public record jail/prison searches online. D. The grantee entered unofficial data (through word of mouth or from participants who reported the incident). E. The grantee does not have access to official justice information. F. Other, specify: In this module, you will identify the goals you hope to achieve with your funding. Once submitted, these goals cannot be changed without approval of your grant manager. Set S-M-A-R-T goals to clarify the scope of your priorities: • Specific • Measurable • Achievable • Relevant • Time-bound If you have multiple goals, provide updates on each on separately. Answer the following questions every semiannual reporting period (i.e., January and July of each year), based on your grant-funded activities.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 13, https://bja.ojp.gov/funding/performance-measures/atc-enhancement.pdf

What were your accomplishments during this reporting period?

What goals were accomplished, as they relate to your grant application?

What problems/barriers did you encounter, if any, within the reporting period that prevented you from reaching your goals or milestones?

Is there any assistance that BJA can provide to address any problems/barriers identified in question 3?

Are you on track to complete your program fiscally and programmatically as outlined in your grant application?

What major activities are planned for the next 6 months?

Based on your knowledge of the criminal justice field, are there any innovative programs/accomplishments that you would like to share with BJA?

Was there grant activity during the reporting period?

  • Code: Q1
  • Requirement: required
  • Definition: Grant activity is defined as any proposed activity in the Bureau of Justice Assistance (BJA)-approved grant application that is implemented or executed with BJA program funds. A. Yes: B. No: (If No, explain.)
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 1, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Which one of the following types of areas best describes where your treatment court program is located?

  • Code: Q2
  • Requirement: required
  • Definition: Select only one area type. A. Urban (i.e., a large city with 50,000 or more people): B. Suburban (i.e., territory outside of a large city with a population of 2,500–50,000 or more people): C. Rural (i.e., territory that encompasses all people or housing not included within an urban, suburban, or tribal area): D. Tribal (i.e., territory that contains a concentration of people who identify with a federally recognized tribe):
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 1, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

What is the expected number of participants the treatment court program plans to serve with BJA program funds over the life of this award?

Is this the last time the grantee is reporting in the Performance Measurement Tool (PMT) before closing out this award?

What type of treatment court is the grant serving?

  • Code: Q5
  • Requirement: required
  • Definition: A. Adult drug court: B. Hybrid driving while intoxicated (DWI)/drug court: C. Co-occurring court: D. Veterans treatment court: E. Tribal healing to wellness court: F. DWI court: G. Other: H. If Other, describe:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 1, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

What is the date that the treatment court first enrolled a participant after this BJA program funding was awarded?

  • Code: Q6
  • Requirement: required
  • Definition: The implementation date for questions 6 and 7 may be the same if the treatment court program did not exist before this BJA treatment court award. A. Enter date: ( / / )
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 2, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

What is the date that the treatment court first enrolled a participant?

  • Code: Q7
  • Requirement: required
  • Definition: If the treatment court was in existence as a pilot program before this BJA program funding, enter the date it first enrolled a participant. The intent of this question is to determine the amount of time since program implementation. A. Enter date: ( / / )
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 2, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Does your treatment court program have a formal policy for graduated sanctions and incentives that is documented in writing and implemented fairly and with certainty in response to participant behavior?

Does your treatment court program administer random and observed alcohol and substance use testing?

Does your treatment court program use evidence-based treatment services?

  • Code: Q10
  • Requirement: required
  • Definition: Evidence- based programs and practices are those demonstrated by the research literature to be effective at reducing substance use among court-involved individuals (a conclusion generally reached through one or more outcome evaluations). A. Yes: B. No: Screening and Program Intake
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 2, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Enter the number of treatment court candidates who were screened during the reporting period. Treatment court candidates are those identified at the time of arrest or referred by criminal justice professionals (i.e., prosecutor, defense attorney, probation officer, judge, etc.) but who may not necessarily be deemed eligible for participation. A screening determines eligibility and

  • Code: Q11
  • Requirement: required
  • Definition: appropriateness for participation in a treatment court. A. Number of treatment court candidates who were screened during the reporting period:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 2, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Of those screened, enter the number of individuals who did not enroll in the treatment court during the reporting period.

Of those screened who did not enroll in the treatment court program, enter the number of such individuals based on the following categories. If an individual falls into multiple categories, select the category that best applies.

  • Code: Q13
  • Requirement: required
  • Definition: A. Participant refused entry: B. Prosecutor objection: C. Defense objection: D. Judicial objection: E. Out of jurisdiction: F. Arrest, conviction, or incarceration on another charge: G. No drug problem: H. Exclusionary prior non-violent offense: I. Violent history: J. Mental health diagnosis that cannot be handled by the court: K. Insufficient risk (i.e., low risk): L. Ineligible for Veterans Affairs services: M. Accident involving injury: N. Candidate did not complete screening: O. Candidate waiting for program slot (will enroll in a subsequent quarter): P. Other: Q. If Other, explain: R. The sum of all of these categories should be equal to the total number of individuals who did not enroll in question 12:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 3, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Of those screened who did not enroll in the treatment court program, enter the number of such individuals based on the following demographic information. Enter the race, ethnicity, and sex of each individual determined to be ineligible for treatment court participation during the reporting period. Hispanics or Latinos should be counted in the race category that best

  • Code: Q14
  • Requirement: required
  • Definition: describes their racial identity, including White, Black or African American, Asian, American Indian or Alaska Native, Pacific Islander or Native Hawaiian, or multiracial. See census.gov for questions regarding classifying race and ethnicity. The number entered should be an unduplicated count, and the sum of each demographic group should equal the number of individuals who did not enter the treatment court program. If not, check the data for entry errors. A. Enter the ethnicity and sex of those screened who did not enroll in the treatment court program. Ethnicity and Sex A Hispanic or Latino B Non-Hispanic or Latino C Unknown B. Enter the race and sex of those screened who did not enroll in the treatment court program. Race and Sex A White B Black or African American C Asian D American Indian or Alaska Native E Pacific Islander or Native Hawaiian F Multiracial G Unknown H Other Risk Assessment
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 3, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Please enter the number of newly admitted treatment court participants who were administered a risk and needs assessment during the reporting period. A risk and needs assessment is an instrument to help identify factors that may lead a participant to reoffend. It pinpoints needed services to minimize those risks. Only include those individuals who have been

  • Code: Q15
  • Requirement: required
  • Definition: newly admitted to the treatment court program during the reporting period. A. Number of newly admitted treatment court participants who were administered a risk and needs assessment during the reporting period:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 4, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Please name the risk assessment instrument that is used to assess risk and needs:

Of those newly admitted participants who were administered a risk and needs assessment during the reporting period, enter the number of such individuals who were identified as having high criminogenic risks and use treatment needs.

  • Code: Q17
  • Requirement: required
  • Definition: A. Number of participants who were identified as having high criminogenic risk and use treatment needs: Number of Treatment Court Participants Receiving Services
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 4, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Enter the total number of participants enrolled in the treatment court program at the end of the reporting period. Enrolled participants include new admissions and those admitted in a previous reporting period who continue to participate.

Has the treatment court program admitted new participants into the treatment court program during the reporting period?

Please enter the number of newly admitted treatment court participants during the reporting period. New participants are unique individuals who were not previously enrolled in the treatment court program in previous reporting periods. Individuals who exit the treatment court program without completion and are then readmitted or who have graduated and reentered may be

  • Code: Q20
  • Requirement: required
  • Definition: counted twice. For the first reporting period that the program becomes operational, report all participants enrolled as new. A. Number of newly admitted treatment court participants during the reporting period:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 5, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Please enter the race, ethnicity, and sex of each participant newly admitted to the treatment court program during the reporting period. For the first reporting period, include all participants enrolled in the treatment court program. Hispanics or Latinos should be counted in the race category that best describes their racial identity, including White, Black or

  • Code: Q21
  • Requirement: required
  • Definition: African American, Asian, American Indian or Alaska Native, Pacific Islander or Native Hawaiian, or multiracial. See census.gov for questions regarding classifying race and ethnicity. The number should be an unduplicated count, and the sum of each demographic group should equal the sum of the newly admitted participants in the program during the reporting period. If not, check for data entry errors. A. Please enter the ethnicity and sex of newly admitted participants in the treatment court program. Ethnicity and Sex A Hispanic or Latino B Non-Hispanic or Latino C Unknown B. Please enter the race and sex of newly admitted participants in the treatment court program. Race and Sex A White B Black or African American C Asian D American Indian or Alaska Native E Pacific Islander or Native Hawaiian F Multiracial G Unknown H Other
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 5, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Were BJA program funds used to provide substance use treatment services to treatment court participants during the reporting period?

  • Code: Q22
  • Requirement: required
  • Definition: These services might include clinical assessment, residential, outpatient group, outpatient individual, intensive inpatient, outpatient detoxification, addiction receiving facility, substance use detoxification (residential), in-home counseling, and aftercare. A. Yes: B. No: C. If Yes, enter the number of new treatment court participants who received substance use treatment services during the reporting period:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 6, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Were BJA program funds used to provide recovery support services to treatment court participants during the reporting period?

  • Code: Q23
  • Requirement: required
  • Definition: These services might include employment, housing, education, mental health, health services (such as medical and dental services), pro-social services (such as anger and stress management), faith-based services, family counseling, life skills training, mentoring, and other services. One participant may receive more than one category of services during the reporting period. For example, one person could receive a housing referral (housing services) and adult education classes in preparation of achieving a GED during the current reporting period. For this example, enter ‘1’ in housing services and ‘1’ in education services. A. Yes: B. No: C. If Yes, enter the total number of treatment court participants who received each of the following recovery support services for the first time during the reporting period. The intent of this question is to see what types of services each unique treatment court participant receives. Report only during the first quarter in which the participant receives services and not in subsequent reporting periods if services are received for more than one reporting period. i. Employment services: ii. Housing services: iii. Education services: iv. Mental health services: v. Health services (includes medical and/or dental services): vi. Trauma treatment: vii. Veteran services: viii. Pro-social services: ix. Other services: x. If Other, please explain:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 6, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

What other program components are these BJA program funds supporting?

  • Code: Q24
  • Requirement: required
  • Definition: A. Offender supervision/case management: B. Equipment: C. Training: D. Evaluations: E. Management information system (MIS): F. Aftercare support: G. Enhancing risk/assessment screening: H. Performance measures standards: I. Other: J. If Other, please explain: Medication-Assisted Treatment The following questions ask about any medication-assisted treatment (MAT) that participants may be receiving within your program during the reporting period. BJA supports the right of individuals to access appropriate MAT under the care and prescription of a physician. BJA recognizes that not all communities may access MAT due to lack of physicians who are able to prescribe and oversee clients using anti- alcohol and anti-opioid medications.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 6, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

If your treatment program includes medication-assisted treatment (MAT), which of the following medications are you utilizing, regardless of BJA funding?

  • Code: Q25
  • Requirement: required
  • Definition: Check all that apply. A. We do not provide MAT (Skip next question.): B. We do not have access to MAT (Skip next question.): C. Naltrexone (e.g., Vivitrol®, depot naltrexone): D. Buprenorphine or Buprenorphine-Naloxone (Bup/NX, Suboxone®): E. Methadone:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 7, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Of the total participants enrolled in your program, how many were deemed eligible for MAT, and of those eligible, how many received MAT during the reporting period?

Enter the number of treatment court participants who successfully completed all program requirements, excluding financial obligations, during the reporting period. The number entered should represent only those participants who successfully completed all the requirements of the treatment court program during the reporting period. Those being held because

  • Code: Q27
  • Requirement: required
  • Definition: of financial obligations (e.g., owing money to the court for their drug testing) should still be counted. A. Number of treatment court participants who successfully completed all program requirements during the reporting period:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 7, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Of those who completed all program requirements, from start to finish, indicate when these participants graduated from the program within the following time frames. The sum of all of these categories should be equal to the total number of successful completions in question 27.

  • Code: Q28
  • Requirement: required
  • Definition: If not, check for data entry errors. A. 0 to 6 months: B. 7 to 12 months: C. 13 to 18 months: D. 19 to 24 months: E. 25 months or more: ____ F. The sum of all of these categories should be equal to the total number of successful completions in question 25:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 7, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Please enter the race, ethnicity, and sex of each participant who successfully completed all program requirements, excluding financial obligations, during the reporting period.

  • Code: Q29
  • Requirement: required
  • Definition: Hispanics or Latinos should be counted in the race category that best describes their racial identity, including White, Black or African American, Asian, American Indian or Alaska Native, Pacific Islander or Native Hawaiian, or multiracial. See census.gov for questions regarding classifying race and ethnicity. The number entered should be an unduplicated count, and the sum of each demographic group should be equal to the sum of the participants who successfully completed the program during the reporting period. If not, check for data entry errors. A. Please enter the ethnicity and sex of participants who successfully completed the treatment court program. Ethnicity and Sex A Hispanic or Latino B Non-Hispanic or Latino C Unknown B. Please enter the race and sex of participants who successfully completed the treatment court program. Race and Sex A White B Black or African American C Asian D American Indian or Alaska Native E Pacific Islander or Native Hawaiian F Multiracial G Unknown H Other
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 8, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Please enter the number of individuals who exited the program unsuccessfully in the categories below. Participants should not fit in more than one category, so choose the option that best represents why these individuals did not complete the program.

  • Code: Q30
  • Requirement: required
  • Definition: Incompletes Measures Number Number of participants no longer in the program due to court or criminal A involvement (e.g., technical violation, arrest, conviction, revocation, reincarceration). Number of participants no longer in the program due to a lack of B engagement (e.g., no-shows and nonresponsive participants). C Number of participants no longer in the program due to absconding. Number of participants no longer in the program due to relocating or D case transfer. Number of participants no longer in the program due to death or E serious illness. Number of participants who did not complete the program for other reasons (specify): F
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 8, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Of those treatment court participants who exited the program unsuccessfully, indicate the number of these participants who left within the following time frames (from the start of the program to termination). The sum of these categories should be equal to the total number of incompletes in question 30. If not, check for data entry errors. Round up to the nearest month

Please enter the race, ethnicity, and sex of each participant who exited the program unsuccessfully during the reporting period. Hispanics or Latinos should be counted in the race category that best describes their racial identity, including White, Black or African American, Asian, American Indian or Alaska Native, Pacific Islander or Native Hawaiian, or multiracial. See census.gov

  • Code: Q32
  • Requirement: required
  • Definition: for questions regarding classifying race and ethnicity. The number entered should be an unduplicated count, and the sum of each demographic group should be equal to the sum of the participants in question 30. If not, check for data entry errors. A. Please enter the ethnicity and sex of participants who exited the program unsuccessfully. Ethnicity and Sex A Hispanic or Latino B Non-Hispanic or Latino C Unknown B. Please enter the race and sex of participants who exited the program unsuccessfully. Race and Sex A White B Black or African American C Asian D American Indian or Alaska Native E Pacific Islander or Native Hawaiian F Multiracial G Unknown H Other Alcohol and Substance Involvement
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 9, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Of those enrolled in the treatment court program for at least 90 days, enter the total number of participants tested for alcohol, non-prescribed medications, or illegal substances during the reporting period. This should represent the total number of treatment court participants who were tested for the presence of alcohol, non-prescribed medications, or

  • Code: Q33
  • Requirement: required
  • Definition: illegal substances. The number entered should be an unduplicated count only of participants enrolled in the program for at least 90 days who were tested for alcohol, non-prescribed medications, or illegal substances, and it should be equal to or greater than the number of participants who test positive. If not, check for data entry errors. A. Total number of participants tested for alcohol, non-prescribed medications, or illegal substance during the reporting period:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 10, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Of those enrolled in the treatment court program for at least 90 days, enter the number of participants who tested positive for the presence of alcohol, non-prescribed medications, or illegal substances during the reporting period. Alcohol and substance use information should be based on documented tests rather than self-reported information from program participants. Include

  • Code: Q34
  • Requirement: required
  • Definition: all participants who received services during the reporting period, regardless of whether they successfully completed the program, exited the program without completion, or are currently enrolled in the treatment court program. The number entered should be an unduplicated count only of participants enrolled in the program for at least 90 days who tested positive for alcohol, non- prescribed medications, or illegal substances, and it should be equal to or less than the total number of participants tested. If not, check for data entry errors. A. Total number of participants who tested positive for the presence of alcohol, non-prescribed medications, or illegal substances during the reporting period: The next set of questions is about court and criminal involvement for treatment court program participants. Note that individuals can be included in more than one category. For example, a treatment court participant could be arrested and have a conviction; thus, the individual should be counted in both categories. If an ex-offender has multiple arrests or convictions, only count that individual once. This section is to be completed at the close of the grant.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 10, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Since the start of this BJA program funding, enter the number of participants who:

  • Code: Q35
  • Requirement: required
  • Definition: A. Are still participating in the treatment court program: B. Have successfully completed the treatment court program: C. Exited the treatment court program unsuccessfully:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 11, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

Since the start of the BJA award, enter the total number of participants who have had a criminal court and/or criminal involvement event. A participant can be counted in more than one category (i.e., an individual can have an arrest and a conviction). However, do not count the frequency of events (i.e., number of arrests and convictions). Pending charges that the individual

  • Code: Q36
  • Requirement: required
  • Definition: had before entering the program should not be counted. New charges that are dropped and/or not prosecuted should not be counted.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 11, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

How was the information obtained for those ex-offenders who were arrested on a new criminal charge?

  • Code: Q37
  • Requirement: required
  • Definition: Select the option that best describes how the information was obtained. A. The grantee has direct access to this information through its court information system. B. The grantee has a memorandum of understanding/agreement (MOU/A) or a data sharing agreement with a correctional agency that has access to this information. C. The grantee conducts public record jail/prison searches online. D. The grantee entered unofficial data (through word of mouth or from participants who reported the incident). E. The grantee does not have access to official justice information. F. If Other, please specify:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 11, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

How was the information obtained from those ex-offenders who were convicted of a new crime?

  • Code: Q38
  • Requirement: required
  • Definition: Select the option that best describes how the information was obtained. A. The grantee has direct access to this information through a court information system. B. The grantee has a MOU/A or a data sharing agreement with a correctional agency that has access to this information. C. The grantee conducts public record jail/prison searches online. D. The grantee entered unofficial data (through word of mouth or from participants who reported the incident). E. The grantee does not have access to official justice information. F. If Other, please specify: In this module, you will identify the goals you hope to achieve with your funding. Once submitted, these goals cannot be changed without approval of your grant manager. Set S M A R T goals to clarify the scope of your priorities: • Specific • Measurable • Achievable • Relevant • Time-bound If you have multiple goals, provide updates on each on separately. Answer the following questions every semiannual reporting period (i.e., January and July of each year), based on your grant-funded activities.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 12, https://bja.ojp.gov/funding/performance-measures/atc-implementation.pdf

What were your accomplishments during this reporting period?

What goals were accomplished, as they relate to your grant application?

What problems/barriers did you encounter, if any, within the reporting period that prevented you from reaching your goals or milestones?

Is there any assistance that BJA can provide to address any problems/barriers identified in question 3?

Are you on track to complete your program fiscally and programmatically as outlined in your grant application?

What major activities are planned for the next 6 months?

Based on your knowledge of the criminal justice field, are there any innovative programs/accomplishments that you would like to share with BJA?

Bureau of Justice Assistance (DOJ OJP), Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP)

Is this the last reporting period for which the award will have data to report?

  • Code: Q1
  • Requirement: required
  • Definition: For example, all funds have been expended and the award is in the process of closing out in the Justice Grants (JustGrants) system. A. Yes/No (If Yes, you must answer the questions in the Closeout section and the Goals and Objectives section. After completion, a final report will be created when closing out the Performance Measurement Tool [PMT] reporting requirements.)
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 1, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Was there grant activity during the reporting period?

  • Code: Q2
  • Requirement: required
  • Definition: There is grant activity when the grantee has obligated, expended, or drawn down grant funds to implement objectives proposed in the Bureau of Justice Assistance (BJA)-approved grant application. If Yes, the program becomes operational and should remain so until the grant closes out. If No, select all the reasons that apply for no grant activity during the reporting period and proceed to the Goals and Objectives section. A. Yes/No B. If No, select from the following responses: (Then skip to the Goals and Objectives section) Reason(s) for no grant activity during the reporting period Select all that apply In procurement ☐ Project or budget not approved by agency, county, city, or state ☐ governing agency Seeking subcontractors (request for proposal stage only) ☐ Waiting to hire project manager, additional staff, or coordinating staff ☐ Paying for the program using prior federal funds ☐ Administrative hold (e.g., court case pending) ☐ Still seeking budget approval from BJA ☐ Waiting for partners or collaborators to complete the application ☐ Other ☐ If Other, explain:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 1, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Indicate the amount of project funding you receive from each of the following sources. Only include funding related to the project outlined in your grant application. The amounts entered should reflect total project funding for the life of the Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP) (formerly COAP/COSSAP) award.

  • Code: Q3
  • Requirement: required
  • Definition: Funding Source Dollar Amount Percent A. COSSUP grant funding <autocalc> B. Other (Non-COSSUP) BJA grant funding <autocalc> C. Other DOJ grant funding <autocalc> D. CDC grant funding <autocalc> E. SAMHSA grant funding <autocalc> F. Other federal grant funding <autocalc> G. State funding <autocalc> H. Local funding <autocalc> I. Private funding <autocalc> J. In-kind support <autocalc> K. Other <autocalc> If Other, explain: Total <auto fill sum> <auto fill sum> Notes: BJA – Bureau of Justice Assistance CDC – Centers for Disease Control and Prevention DOJ – Department of Justice SAMSHA – Substance Abuse and Mental Health Services Administration This section’s purpose is to collect baseline information about COSSUP. All of these questions are required during the first reporting period and will carry forward into subsequent reporting periods. Your responses can be updated as needed.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 2, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Provide the name and contact information for the Project Director that your agency will be working with as part of this COSSUP. If there has been a change in the Project Director, please update. [Carry forward]

Has there been a change in your COSSUP Project Director during the reporting period?

Does your COSSUP include a researcher or a research partner? [Carry forward]

Provide the primary point of contact (POC) for the researcher/research partner that your agency will be working with as part of COSSUP. If there has been a change in the researcher/research partner POC, please update. [Carry forward]

Has there been a change in your COSSUP researcher/research partner or a significant change in the research team during the reporting period?

Do you have a webpage for your program? [Carry forward]

What geographic area is served by your grant activities? [Carry forward]

  • Code: Q10
  • Requirement: required
  • Definition: A. ____ A geographic area within a single city/county B. ____ A single city/county C. ____ Multiple geographic areas within a single state (e.g., multiple cities or counties) D. ____ The entire state E. ____ Multistate
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 3, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

How would you describe the geographic area served by your grant activities? [Carry forward]

  • Code: Q11
  • Requirement: required
  • Definition: A. ____ Urban (i.e., a large city with 50,000 or more people) B. ____ Suburban (i.e., a territory outside of a large city with a population of 2,500 to 50,000 people or more) C. ____ Rural (i.e., a territory that encompasses all people and housing not included within a suburban, urban, or tribal area) D. ____ Mixed (i.e., some combination of the above designations)
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 3, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Are any of your funds going to a tribal territory or community, and/or does the project serve a tribal community?

  • Code: Q12
  • Requirement: required
  • Definition: A tribal territory is one that contains a concentration of people who identify with a federally recognized tribe. [Carry forward] A. Yes/No B. If Yes, identify the tribal territory: ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 3, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

In which of the following ways were data analysis findings applied to your program during the reporting period?

  • Code: Q13
  • Requirement: required
  • Definition: Select all that apply. A. ____ Analysis was not conducted during this reporting period B. ____ Analysis was conducted this reporting period, but findings were not applied in any way C. ____ Informed our understanding of the problem of focus D. ____ Informed decisions to improve program implementation E. ____ Incorporated into program evaluation (e.g., outcome, process) F. ____ Presented as results/recommendations to the program leadership, staff, or workgroup G. ____ Communicated as results/recommendations to groups outside of the workgroup (e.g., local government, community organizations, media)
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 4, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Indicate the major obstacles the program faces when providing treatment and recovery support services in your area. Select all that apply. [Carry forward]

  • Code: Q14
  • Requirement: required
  • Definition: A. ____ We are not facing any major obstacles to providing services B. ____ Lack of public transportation C. ____ Limited availability of appropriate substance abuse treatment services D. ____ Limited availability of recovery support services E. ____ Limited public support for services and/or facilities F. ____ Limited hours of service G. ____ Limited client participation/commitment H. ____ Other, describe: ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 4, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

What obstacles, if any, did you encounter over the last reporting period that has had an impact on your project?

  • Code: Q15
  • Requirement: required
  • Definition: Select all that apply. A. ____ No obstacles or barriers (N/A) B. ____ Access to data C. ____ Level of referrals to our program D. ____ Collaboration/Coordination between partner agencies E. ____ Hiring project staff F. ____ Staff turnover G. ____ Retaining treatment providers H. ____ Competing agency priorities I. ____ Funding J. ____ Legal obstacles K. ____ Concerns about confidentiality L. ____ Differences in program implementation between partners M. ____ Technology challenges N. ____ Federal grant administration issues (e.g., unable to secure approval) O. ____ Training and Technical Assistance (TTA) provider issues P. ____ Other, describe: ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 4, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Indicate the extent to which you use the following strategies with regard to your problem of focus (e.g., identifying overdose survivors, increasing the use of diversion or alternatives to incarceration programs). Select N/A if the stated strategy is not relevant to your problem of focus.

  • Code: Q16
  • Requirement: required
  • Definition: Select Unavailable if the stated strategy is not available in your area of service. Strategy N/A elbaliavanU reveN yleraR semitemoS yltneuqerF 1 2 3 4 Screening to identify individuals at high risk for ☐ ☐ ☐ ☐ ☐ ☐ overdose Screening to identify individuals with substance ☐ ☐ ☐ ☐ ☐ ☐ abuse disorders Screening to identify crime victims ☐ ☐ ☐ ☐ ☐ ☐ Law enforcement diversion programs ☐ ☐ ☐ ☐ ☐ ☐ Prosecutor-led diversion programs ☐ ☐ ☐ ☐ ☐ ☐ Pretrial diversion programs ☐ ☐ ☐ ☐ ☐ ☐ Treatment courts (e.g., drug courts) ☐ ☐ ☐ ☐ ☐ ☐ Probation services designed to meet the needs of ☐ ☐ ☐ ☐ ☐ ☐ individuals with substance abuse disorders Jail- or prison-based substance abuse treatment ☐ ☐ ☐ ☐ ☐ ☐ programs Reentry programs ☐ ☐ ☐ ☐ ☐ ☐ Victim services programs ☐ ☐ ☐ ☐ ☐ ☐ Peer recovery services ☐ ☐ ☐ ☐ ☐ ☐ Treatment services in rural communities within our ☐ ☐ ☐ ☐ ☐ ☐ service area Naloxone distribution/deployment ☐ ☐ ☐ ☐ ☐ ☐ Medication-Assisted Treatment (MAT) ☐ ☐ ☐ ☐ ☐ ☐ Overdose prevention programs ☐ ☐ ☐ ☐ ☐ ☐ Public education campaigns ☐ ☐ ☐ ☐ ☐ ☐ Outreach to other professionals ☐ ☐ ☐ ☐ ☐ ☐ Hot spot analysis (e.g., identifying geographic areas with a cluster of individuals at high risk for ☐ ☐ ☐ ☐ ☐ ☐ substance abuse or overdose) Targeted educational interventions in hot spots ☐ ☐ ☐ ☐ ☐ ☐ Substance abuse prevention coalitions ☐ ☐ ☐ ☐ ☐ ☐
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 5, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

What kind of services are you delivering, or do you plan to deliver remotely?

  • Code: Q17
  • Requirement: required
  • Definition: Select N/A if your program does not, and will not, offer the particular service remotely. [Carry forward] Currently Plan to Service N/A Deliver Deliver Remotely Remotely Screening and assessment ☐ ☐ ☐ Group therapy ☐ ☐ ☐ Individual therapy ☐ ☐ ☐ Prescribing and monitoring medication ☐ ☐ ☐ Supervision check-ins ☐ ☐ ☐ Online curriculum ☐ ☐ ☐ Court check-ins ☐ ☐ ☐ Recovery support services ☐ ☐ ☐ Other ☐ ☐ ☐ If Other, explain:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 6, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Rate the following COSSUP workgroup partners based on this statement, “This partner was actively involved in COSSUP this reporting period.” Rate your partners on a scale of 1–5 as indicated below. If you have multiple partners in a category, rate them as a whole. If a partner fits in more than one category, rate them in the one category that fits the best for that partner. Do not rate

  • Code: Q18
  • Requirement: required
  • Definition: yourself. Select N/A if you do not have a COSSUP workgroup. This partner is actively involved in COSSUP: N/A ylgnortS eergasiD eergasiD eergA rehtieN eergasiD ron eergA eergA ylgnortS 1 2 3 4 5 County/City leadership ☐ ☐ ☐ ☐ ☐ ☐ Tribal leadership ☐ ☐ ☐ ☐ ☐ ☐ Federal law enforcement agencies ☐ ☐ ☐ ☐ ☐ ☐ State law enforcement agencies ☐ ☐ ☐ ☐ ☐ ☐ Local law enforcement agencies ☐ ☐ ☐ ☐ ☐ ☐ High-intensity drug trafficking areas ☐ ☐ ☐ ☐ ☐ ☐ Pretrial service organizations ☐ ☐ ☐ ☐ ☐ ☐ This partner is actively involved in COSSUP: N/A ylgnortS eergasiD eergasiD eergA rehtieN eergasiD ron eergA eergA ylgnortS 1 2 3 4 5 Prosecutor’s office ☐ ☐ ☐ ☐ ☐ ☐ Public defender’s office/defense attorney ☐ ☐ ☐ ☐ ☐ ☐ Courts ☐ ☐ ☐ ☐ ☐ ☐ Probation/Parole ☐ ☐ ☐ ☐ ☐ ☐ Jail/Corrections administrators ☐ ☐ ☐ ☐ ☐ ☐ Reentry services providers ☐ ☐ ☐ ☐ ☐ ☐ Health care providers/public health ☐ ☐ ☐ ☐ ☐ ☐ Mental health providers ☐ ☐ ☐ ☐ ☐ ☐ Substance abuse disorder treatment providers ☐ ☐ ☐ ☐ ☐ ☐ Child protective services ☐ ☐ ☐ ☐ ☐ ☐ Community-based service providers (e.g., housing, employment) ☐ ☐ ☐ ☐ ☐ ☐ Substance abuse prevention groups ☐ ☐ ☐ ☐ ☐ ☐ Recovery community representatives/peers ☐ ☐ ☐ ☐ ☐ ☐ Subject matter experts ☐ ☐ ☐ ☐ ☐ ☐ Foundations/Philanthropic organizations ☐ ☐ ☐ ☐ ☐ ☐ Researcher, evaluator, or statistical analysis centers ☐ ☐ ☐ ☐ ☐ ☐ Victim advocates ☐ ☐ ☐ ☐ ☐ ☐ Faith community ☐ ☐ ☐ ☐ ☐ ☐ Business community ☐ ☐ ☐ ☐ ☐ ☐ Neighborhood community groups ☐ ☐ ☐ ☐ ☐ ☐ Other ☐ ☐ ☐ ☐ ☐ ☐ If Other, explain:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 6, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Rate your level of agreement with the following statement.

  • Code: Q19
  • Requirement: required
  • Definition: The following stakeholders exhibit a high level of collaboration N/A with one another: ylgnortS eergasiD eergasiD eergA rehtieN eergasiD ron eergA eergA ylgnortS 1 2 3 4 5 Criminal courts and child welfare agencies ☐ ☐ ☐ ☐ ☐ ☐ Local and state law enforcement ☐ ☐ ☐ ☐ ☐ ☐ Local and federal law enforcement ☐ ☐ ☐ ☐ ☐ ☐ State and federal law enforcement ☐ ☐ ☐ ☐ ☐ ☐ Criminal justice agencies and substance abuse treatment ☐ ☐ ☐ ☐ ☐ ☐ providers Healthcare providers and substance abuse treatment providers ☐ ☐ ☐ ☐ ☐ ☐ Probation/parole and substance abuse treatment providers ☐ ☐ ☐ ☐ ☐ ☐ Victim services and local first responders (e.g., police, fire, and ☐ ☐ ☐ ☐ ☐ ☐ emergency medical services [EMS]) This section’s purpose is to measure training availability on COSSUP initiatives during reporting periods. This section also focuses on the frequency and quality of TTA provided by BJA-funded training assistance partners. The overall Office of Justice Programs performance measures related to this section are:  Percentage of grantees receiving technical assistance  Percentage of grantees providing training to staff
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 8, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Did the COSSUP provide or facilitate training to project workgroup members or other groups or organizations (e.g., first responders, victim services providers, and child protective services professionals) during the reporting period?

  • Code: Q20
  • Requirement: required
  • Definition: Your workgroup is defined as a larger group of stakeholders who have a vested interest in the project and may include any agencies involved in the planning or implementation of COSSUP. Also include training provided to first responders, victim services providers, and child protective services professionals. A. Yes/No (If No, skip to question 22) B. If Yes, how many trainings were completed during the reporting period: ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 8, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

For each of the trainings completed during the reporting period, indicate the number of individuals who attended the training and the length of the course in hours. Count each person only once per training topic, regardless of how many times he/she attended the training.

  • Code: Q21
  • Requirement: required
  • Definition: Number of Training Number of People Length of Training Name Training Provider Sessions Completed Trained Course [Open text] [Open text] [Open text] [Open text] [Open text] [Open text] [Open text] [Open text] [Open text]
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 9, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Did you/your agency/entire workgroup receive any technical assistance from a BJA-funded provider during the reporting period?

  • Code: Q22
  • Requirement: required
  • Definition: Technical assistance can be defined as using a partner for assistance implementing programs, strategic planning, curriculum development, data analysis, meetings, fostering relationships, trainings, research and information requests, and other technical areas that would supplement your COSSUP. A. Yes/No (If No, skip to question 24) B. If Yes, how many TTA providers did you work with during the reporting period: ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 9, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

For each technical assistance provider you interacted with during the reporting period, enter the following information. The number of entries should equal the number you entered in question 22B.

Were COSSUP grant funds used to develop a training course or curriculum?

  • Code: Q24
  • Requirement: required
  • Definition: A. Yes/No (If No, skip to next section) B. If Yes, materials/curricula should be submitted to BJA via the JustGrants system with your progress report.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 10, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

What type of training course/curriculum was developed?

  • Code: Q25
  • Requirement: required
  • Definition: A. ____ Certification training (i.e., training required to obtain a certification) B. ____ In service/annual training (i.e., training required to keep certification active or maintain proficiency) C. ____ Skill building (i.e., training that increases the skill or knowledge of employees in a particular area) D. ____ Leadership/Management (i.e., training for managers or administrators) E. ____ Conference F. ____ Other, describe: ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 10, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Describe the developed training course/curriculum. Include the targeted audience, primary sources used in the development of your curriculum, and a brief overview.

How many hours is the training course/curriculum designed to last?

  • Code: Q27
  • Requirement: required
  • Definition: A 1-day course is typically classified as an 8-hour course, and a week-long course is typically classified as a 40-hour course. A. ____ hours
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 10, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

What is the intended mode of delivery for your training course/curriculum?

  • Code: Q28
  • Requirement: required
  • Definition: Select all that apply. A. ____ Classroom based (e.g., in-person, face-to-face) B. ____ Web based (e.g., webinar) C. ____ Prerecorded (e.g., training videos) D. ____ Self-study (e.g., manuals, guidebooks, or other materials) E. ____ Other, describe: ____ If needed, repeat the above set of Training Development questions until all trainings or curricula developed are covered.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 10, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Did the COSSUP-funded program conduct any training, outreach, awareness, or prevention activities during the reporting period?

  • Code: Q29
  • Requirement: required
  • Definition: Community outreach and prevention could include activities like producing public service announcements, hosting an online or in-person presentation or meeting, providing training in the use of naloxone, etc. Do not include internal or external trainings. A. Yes/No (If No, skip to next section)
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 11, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Indicate the type of training, outreach, awareness, and prevention activities supported by COSSUP during the reporting period. Select one at a time and enter up to five per quarter.

  • Code: Q30
  • Requirement: required
  • Definition: A. ____ Train individuals on how to use naloxone B. ____ Implement a media campaign targeting the general public (Skip to next section) C. ____ Provide training and other professional development opportunities to increase the number of providers, including physicians, behavioral health providers, advanced practice nurses, pharmacists, and other health and social service professionals, who are able to identify and treat substance abuse disorder (SUD) and opioid use disorder (OUD) (Skip to questions 32—34) D. ____ Increase the number of providers who use a Prescription Drug Monitoring Program (Skip to questions 32—34) E. ____ Provide education to improve family members’ or caregivers’ understanding of evidence- based treatments and prevention strategies for SUD or OUD (Skip to questions 32—34) F. ____ Implement or expand community-based prevention programs that are evidence-based to prevent misuse of opioids, stimulants, and other substances (Skip to questions 32—34) G. ____ Implement or expand non-law-enforcement-led, school-based prevention programs that are evidence-based to prevent misuse of opioids, stimulants, and other substances (Skip to questions 32—34) H. ____ Identify and screen individuals who are at risk of SUD/OUD (Skip to question 35) I. ____ Implement or expand drug take-back programs (Skip to questions 36—37) J. ____ Implement or expand hepatitis or HIV testing for individuals with OUDs (Skip to question 38) K. ____ Implement or expand a syringe exchange program (Skip to question 38)
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 11, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

How many of the following types of individuals received training in the use of naloxone through COSSUP during the reporting period?

  • Code: Q31
  • Requirement: required
  • Definition: Only count individuals in the category that best describes their role. A. General public ____ B. Opioid or stimulant users ____ C. Family/Friends of opioid or stimulant users____ D. Law enforcement ____ E. EMS ____ F. Healthcare workers ____ G. Probation or parole workers ____ H. Social workers or outreach workers ____ I. Recovery coaches ____ J. Criminal justice/corrections staff ____ K. Treatment staff ____ L. Victim services providers ____ M. Youth serving organizations (e.g., schools, athletic leagues, or faith-based organizations) ____ N. Other, describe: ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 11, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Select the target audience for the training, outreach, awareness, or prevention activity.

  • Code: Q32
  • Requirement: required
  • Definition: Select all that apply. A. ____ General public B. ____ Law enforcement C. ____ EMS D. ____ Healthcare workers E. ____ Probation/Parole workers F. ____ Social workers or outreach workers G. ____ Recovery coaches H. ____ Criminal justice/corrections staff I. ____ Treatment staff J. ____ Family/Friends of opioid or stimulant users K. ____ Victim services providers L. ____ K-12 schools M. ____ Faith-based communities N. ____ Other youth-serving organizations (e.g., athletic leagues, faith-based organizations) O. ____ Other, describe: ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 12, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Describe the method of delivery for the training, outreach, awareness, or prevention activity. Select all that apply.

How many total people attended a training, outreach, awareness, or prevention activity during the reporting period?

How many individuals were screened during the reporting period?

During the reporting period, how many local, state, or national Take Back Day events did you coordinate/participate in with a law enforcement agency?

During the reporting period, how many pounds of controlled substances were received and disposed of in locations with receptacles where you have assisted with the coordination and installation?

  • Code: Q37
  • Requirement: required
  • Definition: Exclude any controlled substance already reported during Take Back Days (the previous question). A. Pounds of controlled substances received ____ B. Of those, pounds of controlled substances disposed of ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 12, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

How many individuals received services during the reporting period?

  • Code: Q38
  • Requirement: required
  • Definition: ____ If needed, repeat the above set of Outreach, Awareness, and Prevention Activities questions until all prevention or outreach activities are covered (up to five per quarter). The measures in this section are intended to describe the number of participants receiving services and types of services being provided.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 12, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Indicate if you used COSSUP funds to operate any of the following types of programs during the reporting period. Select only those programs that you are directly supporting with COSSUP funds. (Questions 40—46 required unless otherwise noted) If first responder/law enforcement diversion program is selected in question 39,

  • Code: Q39
  • Requirement: required
  • Definition: questions 42—46 are required A. ____ First responder/law enforcement diversion program (Questions 40—42 required; then skip to question 47) B. ____ Pretrial diversion program overseen by a pretrial supervision agency C. ____ Prosecutor diversion program overseen by a prosecutor’s office D. ____ Court-based diversion program E. ____ Family drug court program F. ____ Tribal healing-to-wellness court G. ____ Jail-based program focused on programming while inmates are in custody H. ____ Jail-based reentry program focused on preparing inmates to leave jail custody I. ____ Prison reentry program focused on preparing inmates to leave prison J. ____ Probation program (Skip to next section) K. ____ We are not using COSSUP funds to operate any of the above activities
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 13, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

How many individuals experienced a non-fatal overdose during the reporting period in your target area?

What entities refer/identify individuals to your program?

  • Code: Q41
  • Requirement: required
  • Definition: Select all that apply. [Carry forward] A. ____ Police officer/police employees B. ____ Sheriff’s department staff C. ____ Fire department employees D. ____ EMS staff E. ____ Prosecutor’s office F. ____ Defense attorney/public defender G. ____ Pretrial services H. ____ Courts I. ____ Probation J. ____ Parole K. ____ Jail/Prison staff L. ____ Reentry services providers M. ____ Substance abuse treatment providers N. ____ Child protective services O. ____ Court clinicians P. ____ School staff Q. ____ Self-referral R. ____ Hospital emergency department staff S. ____ Other health care providers T. ____ Friends and/or family U. ____ Victim services providers V. ____ N/A
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 13, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Who is the lead for the first responder diversion program?

  • Code: Q42
  • Requirement: required
  • Definition: If you have co-leads, select all that apply. [Carry forward] A. ____ Sheriff’s office B. ____ Police department C. ____ EMS D. ____ Fire department E. ____ Combined fire department/EMS F. ____ Community/Advocacy agency G. ____ Social service agency H. ____ Behavioral health agency I. ____ City, county, or state public health agency J. ____ Tribal agency K. ____ Other, describe: ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 14, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

How do individuals enter your first responder diversion program?

  • Code: Q43
  • Requirement: required
  • Definition: Select all that apply. [Carry forward] A. ____ An individual voluntarily initiates contact with a first responder agency for a treatment referral; if contact is initiated with a law enforcement agency, the individual makes the contact without fear of arrest. (Question 45 is required) B. ____ A first responder intentionally identifies or seeks an individual(s) to refer or engage with treatment and not for the purposes of criminal investigation. (Question 45 is required) C. ____ A first responder or program partner conducts outreach to engage an individual in linkage to treatment, specifically in response to an individual that has had a recent opioid overdose. (Question 45 is required) D. ____ A first responder provides treatment referral/engagement during routine activities (e.g., patrol, response to service call). Note: If law enforcement is the first responder, no charges are filed or arrests made. (Question 45 is required) E. ____ (Only applicable for law-enforcement-led diversion) The law enforcement first responder provides treatment referrals/engagement during routine activities (e.g., patrol), but the person is not booked into the justice system. Instead, the charges are held in abeyance or citations are issued that include a requirement for completion of treatment initiation or a treatment plan. (Question 46 is required) F. ____ Other, describe: ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 14, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Which individuals are identified for intervention in your program?

  • Code: Q44
  • Requirement: required
  • Definition: Select all that apply. [Carry forward] A. ____ N/A B. ____ Individuals that frequent known opioid or stimulant use or overdose hot spot locations such as drug markets or transient housing C. ____ Individuals who are high utilizers of health and/or justice resources D. ____ Individuals who are identified through state Prescription Drug Monitoring
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 15, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Are you using any of the following branded models?

  • Code: Q45
  • Requirement: required
  • Definition: Select all that apply. [Carry forward] A. ____ Angel/Police Assisted Addiction Recovery Initiative (PAARI) B. ____ Quick Response Team (QRT) C. ____ Law Enforcement Assisted Diversion (LEAD) D. ____ Civil citation E. ____ Safe station F. ____ Other, describe: ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 15, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

What recovery support services are COSSUP grant funds supporting in whole or in part?

  • Code: Q46
  • Requirement: required
  • Definition: Select all that apply. A. ____ The program is not providing recovery support with COSSUP funds (Skip to question 54) B. ____ Peer support or recovery coaching C. ____ Family counseling D. ____ Food and nutrition assistance E. ____ Housing support services F. ____ Employment assistance G. ____ Case management H. ____ Faith-based support I. ____ Vocational training J. ____ Education (e.g., GED support) K. ____ Family reunification services L. ____ Transportation assistance M. ____ Assistance with benefits applications N. ____ Tribal/Cultural healing O. ____ Other, describe: ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 15, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Through what mechanisms are referrals to recovery support services made?

  • Code: Q47
  • Requirement: required
  • Definition: Select all that apply. [Carry forward] A. ____ Individuals receive written information (e.g., card, flyer, brochure, or handout) about treatment and/or services resources B. ____ Individuals receive a written referral to a treatment and/or services provider by the program C. ____ Individuals receive a treatment and/or services appointment at a specific date and time by the program D. ____ Individuals receive a “warm handoff” via a personal introduction by the program to treatment/recovery/peer/case managers in real time for assessment and coordination of treatment planning E. ____ Other, describe: ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 15, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Enter the number of individuals receiving recovery support services through referrals to other agencies/community support groups or through your program. Count the number of individuals with an SUD/OUD. Family members referred to recovery support services should be counted in question 51. The cumulative total column will automatically display the count of all

  • Code: Q48
  • Requirement: required
  • Definition: individuals referred to and receiving recovery support services since your program began reporting data in the PMT. Number Cumulative Performance Measure of People Total During the reporting period, how many individuals were referred to recovery support services through your program or other A. <auto fill> agencies/community support groups? Report individuals only the first time they are referred. Of those, how many individuals received recovery support services? B. Do not include individuals who began receiving services in a previous <auto fill> reporting period. Of those individuals that were referred to or received recovery support services, how many were identified as crime victims? If your program C. is working with a victim services provider, provide additional <auto fill> information about these individuals in the Supporting Crime Victims and Child Welfare section.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 16, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

For those participants receiving recovery support services during the reporting period, how many are receiving services for:

For those participants who stopped receiving recovery support services during the reporting period, how many received services for:

How many friends/family members of program participants were referred to recovery support services during the reporting period?

Of those (from question 51), how many were identified as crime victims?

What substance abuse or co-occurring treatment services do you fund using your COSSUP funds?

  • Code: Q53
  • Requirement: required
  • Definition: Select all that apply. A. ____ The program is not providing substance abuse or co-occurring treatment services with COSSUP funds (Skip to next section) B. ____ Outpatient substance abuse treatment C. ____ Intensive outpatient substance abuse treatment D. ____ Residential substance abuse treatment E. ____ Partial Hospitalization Program (PHP) F. ____ Inpatient withdrawal management (detoxification) G. ____ MAT (Question 54 required) H. ____ Mental health assessment and/or treatment I. ____ Family therapy J. ____ Trauma treatment
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 17, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Which MAT medications are offered to individuals in the program?

Through what mechanisms are referrals to substance abuse or co-occurring treatment services made?

  • Code: Q55
  • Requirement: required
  • Definition: Select all that apply. [Carry forward] A. ____ Individuals receive written information (e.g., card, flyer, brochure, or handout) about treatment and/or services resources B. ____ Individuals receive a written referral to a treatment and/or services provider by the program C. ____ Individuals receive a treatment and/or services appointment at a specific date and time by the program D. ____ Individuals receive a “warm handoff” via a personal introduction by the program to treatment/recovery/peer/case managers in real time for assessment and coordination of treatment planning E. ____ Other, describe: ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 17, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Enter the number of individuals receiving substance abuse or co-occurring treatment services through referrals to other agencies or through your program. The cumulative total column will automatically display the count of all individuals referred to and receiving recovery support services since your program began reporting data in the PMT.

  • Code: Q56
  • Requirement: required
  • Definition: Number Cumulative Performance Measure of People Total During the reporting period, how many individuals were referred to substance abuse or co-occurring treatment services through your A. <auto fill> program or other agencies you referred them to? Report individuals only the first time they are referred. During the reporting period, how many individuals were assessed for B. substance abuse or co-occurring disorders? Report individuals only <auto fill> the first time they are assessed for services. Of those, how many individuals received substance abuse or co- C. occurring treatment services? Do not include individuals who began <auto fill> receiving services in a previous reporting period.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 18, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

On average, how long does it take for an individual to begin receiving substance abuse or co-occurring treatment services after receiving a referral?

For those participants receiving substance abuse or co-occurring treatment services during the reporting period, how many received services for:

For those participants who stopped receiving substance abuse or co-occurring treatment services during the reporting period, how many received services for:

Since the beginning of the program, how many subsequent overdose events did program participants experience (fatal or nonfatal) in the specified periods of time following their referral into the program?

  • Code: Q60
  • Requirement: required
  • Definition: Each overdose event should be counted as a separate incident. This measure should be updated each quarter, providing the total over the life of the grant. A. In the first 2 weeks: ____ events B. In the first month: ____ events C. In the first 3 months: ____ events D. In the first 6 months: ____ events
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 18, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Since the beginning of the program, how many individual participants experienced subsequent overdose events (fatal or nonfatal) in the specified period of time following their referral into the program?

  • Code: Q61
  • Requirement: required
  • Definition: Each person should be counted individually. This measure should be updated each quarter, providing the total over the life of the grant. A. In the first 2 weeks: ____ participants B. In the first month: ____ participants C. In the first 3 months: ____ participants D. In the first 6 months: ____ participants
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 19, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Indicate the number of program participants who had the specified number of contacts with their case manager during their first 30 days. A contact could include an in-person meeting, phone call, or series of electronic messages.

  • Code: Q62
  • Requirement: required
  • Definition: A. 0 contacts within 30 days: ____ participants B. 1—2 contacts within 30 days: ____ participants C. 3—4 contacts within 30 days: ____ participants D. 5 or more contacts within 30 days: ____ participants The measures in this section are intended to gather information about enhanced data collections and analysis efforts funded with COSSUP dollars.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 19, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Did your COSSUP use grant funds to develop or enhance data collection and analysis?

  • Code: Q63
  • Requirement: required
  • Definition: Select Yes if you used funds to support any type of data collection including Overdose Detection Mapping Application Program (ODMAP), overdose fatality review, expedited data collection from medical examiners/coroners, etc. A. Yes/No (If No, skip to next section)
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 19, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Indicate if you used COSSUP funds to operate any of the following types of data collection and analysis during the reporting period. Select only those programs that you are directly supporting with COSSUP funds. Select all that apply. [Carry forward]

  • Code: Q64
  • Requirement: required
  • Definition: A. ____ Implement or expand an overdose fatality review program B. ____ Conduct rapid assessment to quickly gather data in response to a question or crisis requiring timely intervention, such as a spike in overdoses C. ____ Conduct testing of drug paraphernalia such as syringes or glassine bags that are collected from syringe exchange programs or from public areas, where the syringe users are anonymous D. ____ Collaborate with medical examiners or coroners to expedite access to preliminary data on suspected overdose deaths prior to forensic toxicology data E. ____ Expedite toxicology analysis and utilize screening kits and new technology for potentially novel or counterfeit drugs F. ____ Administer voluntary and anonymous interviews and collect urine specimens from arrestees in a booking facility or jail on a monthly or quarterly basis to assess the dimension of the local substance abuse problem G. ____ Implement or expand the use of ODMAP H. ____ Implement systems to identify infants and children exposed to parental opioid use I. ____ Other, describe: ____ The measures in this section are intended to gather information about services provided to crime victims who have been impacted by the opioid epidemic and the reemergence of stimulant abuse (e.g., drug-endangered children, victims of child abuse or neglect, domestic violence, human trafficking, identify theft).
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 19, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Did your COSSUP use grant funds to develop partnerships with a victim services provider(s) to assist crime victims impacted by the opioid epidemic and the reemergence of stimulant abuse?

  • Code: Q65
  • Requirement: required
  • Definition: Select Yes if you received funds to support combination of victim services (through a victim services partnership) and general substance abuse treatment and recovery support services. A. Yes/No (If No, skip to next section) B. If Yes, describe how grant funds are being used (e.g., how are you working in partnership to support crime victims as well as ensure access to substance abuse treatment and support):
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 20, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Provide the name of the Victim Services Partner involved in your COSSUP. If there has been a change in the Victim Services Partner, please update. [Carry forward]

Has there been a change to your Victim Services Partner during the reporting period?

Enter the number of individuals assisted with a victim compensation application during the reporting period. Count the number of individuals who received assistance with completing a victim compensation application during the reporting period, even if they did not submit the application. Simply providing an individual with an application does not qualify as assistance.

How many individuals (including anonymous contacts) received services from victim services provider partner(s) during the reporting period?

  • Code: Q69
  • Requirement: required
  • Definition: Count all individuals who were identified as crime victims (e.g., drug endangered children, victims of child abuse or neglect, domestic violence, sexual assault, human trafficking, identity theft) served by the victim services partner(s) during the reporting period. This number should be an unduplicated count of people served during a single reporting period, regardless of the number of services they received or victimization types with which they presented. A. Total number of individuals provided services ____ B. Total number of individuals receiving services for the first time (i.e., new) Count individuals receiving services resulting from COSSUP that received services for the first time during the reporting period. This number should be an unduplicated count of identified new clients served during a single reporting period, regardless of the number of services they received or victimization types with which they presented. ____ C. Total number of anonymous contacts Anonymous contacts are those received by your organization through a hotline, online chat, or other service where the individuality of each contact cannot be established. If your organization did not have any anonymous contacts enter zero (0). ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 20, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Select the types of services provided by the victim services provider partner(s) during the reporting period. Select all that apply.

  • Code: Q70
  • Requirement: required
  • Definition: A. ____ Services were not provided by the victim services provider partner(s) (Skip to next section) B. ____ Information and referral C. ____ Personal advocacy/accompaniment D. ____ Emotional support or safety services E. ____ Shelter/Housing services F. ____ Criminal/Civil justice system assistance G. ____ Other services not listed, describe: ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 21, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Provide the number of individuals who received services by service type and number of times each service was provided during the reporting period. For each category (items B, C, D, E, and F) selected in question 70, enter the number of clients who received services from your agency during the reporting period. For each subcategory within a category (e.g., items A1, A2, A3, A4, etc.), enter the

  • Code: Q71
  • Requirement: required
  • Definition: number of times that service was provided during the reporting period. Zero (0) is a valid response. Because some clients may receive multiple services, the total number of times that services were provided within a category may be greater than the number of clients who received those services. A. Information and Referral The number of individuals who received services in this category: ____ Enter the number of times services were provided in each subcategory: A1. Information about the criminal justice process: ____ A2. Information about victim rights, how to obtain notifications, etc.: ____ A3. Referral to other victim services programs: ____ A4. Information about substance abuse treatment and support available to crime victims: ____ A5. Referral to other services, supports, and resources (e.g., legal, medical, faith-based organizations, mentoring programs, support groups, food and housing assistance, address- confidentiality programs): ____ A6. Referral to substance abuse treatment and support available to crime victims: ____ B. Personal Advocacy/Accompaniment The number of individuals who received services in this category: ____ Enter the number of times services were provided in each subcategory: B1. Victim advocacy/accompaniment to emergency medical care: ____ B2. Victim advocacy/accompaniment to medical forensic exam: ____ B3. Law enforcement interview advocacy/accompaniment: ____ B4. Individual advocacy (e.g., assistance in applying for public benefits, return of personal property or effects): ____ B5. Performance of medical or nonmedical forensic exam or interview, or medical evidence collection: ____ B6. Immigration assistance (e.g., special visas, continued presence application, other immigration relief): ____ B7. Intervention with employer, creditor, landlord, or academic institution: ____ B8. Child or dependent care assistance (includes coordination of services): ____ B9. Transportation assistance (includes coordination of services): ____ B10. Interpreter services: ____ C. Emotional Support or Safety Services The number of individuals who received services in this category: ____ Enter the number of times services were provided in each subcategory: C1. Crisis intervention (in-person, includes safety planning, etc.): ____ C2. Hotline/crisis line counseling: ____ C3. On-scene crisis response (e.g., responding to crime victims identified on overdose scenes, community crisis response): ____ C4. Individual counseling: ____ C5. Support groups (facilitated or peer): ____ C6. Other therapy (e.g., traditional, cultural, or alternative healing; art, writing, or play therapy): ____ C7. Emergency financial assistance (e.g., emergency loans and petty cash, payment for items such as food and/or clothing, changing windows and/or locks, taxis, prophylactic and nonprophylactic medications, durable medical equipment): ____ D. Shelter/Housing Services The number of individuals who received services in this category: ____ Enter the number of times services were provided in each subcategory: D1. Emergency shelter or safe house: ____ D2. Transitional housing: ____ D3. Relocation assistance (includes assistance with obtaining housing): ____ E. Criminal/Civil Justice System Assistance The number of individuals who received services in this category: ____ Enter the number of times services were provided in each subcategory: E1. Notification of criminal justice events (e.g., case status, arrest, court proceedings, case disposition, release): ____ E2. Victim impact statement assistance: ____ E3. Assistance with restitution (includes assistance in requesting and when collection efforts are not successful): ____ E4. Civil legal assistance in obtaining protection or restraining order: ____ E5. Civil legal assistance with family law issues (e.g., custody, visitation, support): ____ E6. Other emergency justice-related assistance: ____ E7. Immigration assistance (e.g., special visas, continued presence applications, other immigration relief): ____ E8. Prosecution interview advocacy/accompaniment (includes accompaniment with prosecuting attorney and with victim/witness): ____ E9. Law enforcement interview advocacy/accompaniment: ____ E10. Criminal advocacy/accompaniment: ____ E11. Other legal advice and/or counsel: ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 21, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Does your site plan to sustain program funding after BJA funds have been expended?

Indicate if you have applied for or received sustained funding from the following sources:

  • Code: Q73
  • Requirement: required
  • Definition: Have Applied Have Secured Funding Source N/A for Funding Funding Locality ☐ ☐ ☐ State ☐ ☐ ☐ Federal ☐ ☐ ☐ Private funding ☐ ☐ ☐ Other ☐ ☐ ☐ If Other, explain:
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 24, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Since the beginning of your program, has it demonstrated a measurable impact on the problem of focus?

  • Code: Q74
  • Requirement: required
  • Definition: When answering this question, consider your target population and/or implementation design and analysis findings to this point. If applicable, consult with the researcher/analyst when answering this question. A. Yes, positive impact B. Yes, negative impact C. No measurable impact (Skip to next section) D. Not yet measured (Skip to next section)
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 24, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Describe the impact your program has had, using specific data such as percentages and raw number increases or decreases, in reducing the incidence of opioid or stimulant overdoses, where possible. If your program was funded to enhance partnerships with victim services and child welfare, describe the impact the project had on identifying crime victims.

  • Code: Q75
  • Requirement: required
  • Definition: This section should be completed in January and July by all grantees that had any activity during the reporting period, or at the close of the grant, based on the previous or next 6 months.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 24, https://bja.ojp.gov/funding/performance-measures/cossup-questionnaire.pdf

Identify the goal(s) you hope to achieve with your funding. If you have multiple goals, report on each goal separately (one at a time) and repeat questions 1—4 for each goal.

What is the current status of this goal?

During the past 6 months, describe any progress you made or barriers you encountered related to this goal:

In the next 6 months, what major activities are planned for this goal?

Did you receive or do you desire any assistance from BJA or a BJA-funded technical assistance provider?

BJA likes to showcase grantees who are working on successful, innovative, and/or evidence-based programs. Do you have any noteworthy accomplishments, success stories, or program results from this reporting period that you would like to showcase?

Bureau of Justice Assistance (DOJ OJP), Residential Substance Abuse Treatment (RSAT) for State Prisoners Program

Is this the last reporting period for which the award will have data to report?

  • Code: Q1
  • Requirement: required
  • Definition: For example, were all funds expended and is the award in the process of closing out in the Grants Management System? A. Yes/No (If Yes, answer the semiannual narrative questions.)
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 1, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Was there grant activity during the reporting period?

  • Code: Q2
  • Requirement: required
  • Definition: There is grant activity when the grantee has obligated, expended, or drawn down grant funds to implement objectives proposed in the Bureau of Justice Assistance (BJA)-approved grant application. If you select Yes, the program becomes Operational and should remain so until the grant closes out? Reason(s) for no grant activity during the reporting period. Select all that apply In procurement ☐ Project or budget not approved by agency, county, city, or state governing agency ☐ Seeking subcontractors (Request for Proposal stage only) ☐ Waiting to hire project manager, additional staff, or coordinating staff ☐ Paying for the program using prior federal funds ☐ Administrative hold (e.g., court case pending) ☐ Still seeking budget approval from BJA ☐ Waiting for partners or collaborators to complete agreements ☐ Other ☐ If Other, please explain
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 1, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

What type of services do you provide to participants in your RSAT program?

  • Code: Q3
  • Requirement: required
  • Definition: Select the services that best reflect the program design. A. Jail-based treatment services. Jail is defined as any confinement facility of a federal, state, or local law enforcement agency whose primary use is to hold persons pending adjudication of criminal charges, persons committed to confinement after adjudication of criminal charges for sentences of 1 year or less, or persons adjudicated guilty who are awaiting transfer to a correctional facility B. Prison-based services. Prison is defined as any institution under federal or state jurisdiction whose primary use is for the confinement of individuals convicted of a serious crime, usually in excess of 1 year in length, or a felony C. Juvenile-based services (includes any program that provides services to juvenile) D. Aftercare services (including Department of Corrections (DOC) or DOC-operated community- based facilities) E. Program Characteristics
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 1, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Please enter the number of treatment staff who work directly with participants in the Residential Substance Abuse Treatment (RSAT) program since the beginning of grant funding. When answering ‘A’, please count all treatment staff regardless of funding source. Staff would be all treatment employees, including but not limited to program managers, case managers,

  • Code: Q4
  • Requirement: required
  • Definition: and clinicians. Do NOT count the number of mentors, volunteers, or interns. A. Number of treatment staff B. Of those reported in ‘A’, how many are paid for at least partially using BJA program funds, including matching funds?
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 2, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Please enter the amount of funds from all sources (in dollars) spent in your RSAT program during the reporting period for the following areas:

  • Code: Q5
  • Requirement: required
  • Definition: Non-BJA Funds Funds Spent during Quarter BJA Funds (All Other Sources) Personnel Fringe benefits Supplies/Equipment Contract/consultant fees Construction Indirect costs Other
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 2, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

During the reporting period, using BJA program funds including matching funds, did you pay for training for treatment staff to be cross trained in the jail/prison-based portion of the RSAT program?

Please enter the number of treatment staff members who were cross trained in the jail/prison-based portion of the RSAT program since the beginning of the program. This information should be based on the number of treatment staff who received training in the implementation of assessment instruments, motivational interviewing (MI) techniques, accountability

  • Code: Q7
  • Requirement: required
  • Definition: training, or addiction-related trainings, as well as the number of treatment staff who received officer training and other security training sessions. A. Number of treatment staff cross trained
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 2, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

During the reporting period, using BJA program funds including matching funds, did you pay for training for custody staff to be cross trained in the jail/prison-based portion of the RSAT program?

Please enter the number of custody staff members who were cross trained in the jail/prison-based portion of the RSAT program since the beginning of the program. This information should be based on the number of uniformed officers who received training in the implementation of assessment instruments, MI techniques, accountability training, or addiction-

  • Code: Q9
  • Requirement: required
  • Definition: related trainings, as well as the number of treatment staff who received officer training and other security training sessions. A. Number of custody staff cross trained The following questions pertain to individuals who are receiving services in your RSAT program. The following sections include the following: Risk Assessment and Treatment Planning, Number of Participants Receiving Services, Services Provided, Program Completion, Alcohol and Substance Involvement, and Court and Criminal Involvement. For these questions, please report the number of individuals that is equal to the proportion of the federal funds (plus matching funds) of your total annual budget for the RSAT program. For example, if the BJA RSAT grant (plus matching funds) accounts for 65 percent of the total annual budget, then please report on 65 percent of the program participants. When applying the percentage, please round to the nearest whole number. Similarly, if BJA RSAT funds (plus matching funds) are paying for a specific number of beds/treatment spaces within your facility, please report on those individuals who are occupying those beds/treatment spaces. Number of Participants Receiving Services
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 3, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Of those who entered the jail/prison-based portion of the RSAT program, please enter the number of jail/prison/juvenile-based participants for the following measures.

  • Code: Q10
  • Requirement: required
  • Definition: Measure Cumulative Total Total number of jail/prison-based participants enrolled as of the last day of the reporting period Number of NEW jail/prison-based participants admitted during the reporting period Risk Assessment and Treatment Planning
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 3, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Of those who entered the jail/prison-based portion of the RSAT program, please enter the number of jail/prison/juvenile-based participants for the following measures. Please only include those individuals who have been admitted to the RSAT program.

  • Code: Q11
  • Requirement: required
  • Definition: Measure Cumulative Total Number of jail/prison/juvenile-based participants administered a risk and needs assessment Number of jail/prison-based participants with high criminogenic risks/needs Number of jail/prison-based participants with an individualized treatment plan. Number should not exceed the number of new participants indicated in question 10
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 4, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Are risk assessment screening tool results used in determining who is admitted as a participant into the RSAT Program?

  • Code: Q12
  • Requirement: required
  • Definition: A risk and needs assessment is an instrument to help identify factors that may lead a participant to reoffend and services needed services to minimize those risks. The risk and needs assessment does not need to have been completed during the reporting period and could be completed by an outside entity. A. Yes/No
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 4, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Please name the risk assessment instrument(s) that is used to assess risk/need.

Please enter the number of jail/prison/juvenile-based participants who were provided services during the reporting period with BJA program funds, including matching funds, through the following treatment components:

Please enter the number of jail/prison/juvenile-based participants who were provided with transitional planning services with BJA program funds, including matching funds, since the beginning of grant funding. To provide transitional planning services, the RSAT program must work with clients to develop individualized post-release plans that address each client’s

  • Code: Q15
  • Requirement: required
  • Definition: needs in terms of housing, employment/financial support, and ongoing therapeutic needs. These include enrollment in Medicaid or subsidized insurance programs, where available. They also include prerelease engagement with the community correctional agency that will be providing post-release supervision of the client, where relevant. Note: Blanket referrals to community self-help programs do not constitute “transitional planning services.” Medication Assisted Treatment The following questions ask about any Medication Assisted Treatment (MAT) participants may be receiving within your program during the reporting period.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 5, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

If your treatment program includes MAT, which of the following medications are you utilizing?

  • Code: Q16
  • Requirement: required
  • Definition: Select all that apply. A. We do not provide MAT (Skip next question) B. We do not have access to MAT (Skip next question) C. Naltrexone (Vivitrol®, Depot naltrexone) D. Buprenorphine or Buprenorphine/Naloxone (Bup/NX) (Suboxone®,) E. Methadone
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 5, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Of the total participants enrolled in your program, how many were deemed eligible for MAT and of those eligible, how many received MAT during the reporting period?

  • Code: Q17
  • Requirement: required
  • Definition: A. Individuals eligible for MAT B. Individuals receiving at least one treatment Program Completion
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 5, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Please enter the number of participants who successfully completed all requirements of the jail/prison-based portion of your RSAT program during the reporting period. The number entered should represent only those participants who successfully completed all the requirements of the RSAT program during the reporting period.

Of those jail/prison/juvenile-based participants who successfully completed all program requirements, please enter the number who were released to the community during the reporting period.

  • Code: Q19
  • Requirement: required
  • Definition: A. Number of jail/prison/juvenile-based successful completers released to the community B. Of those reported in ‘A’, how many individuals were released under correctional supervision. C. Of the number of successful completers released to the community, how many individuals were referred to an aftercare program. Aftercare programs are defined in 42 U.S.C. 3796ff-1(c)
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 6, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Of those jail/prison/juvenile-based program completers released to the community, please enter the number with a continuity of care arrangement or reentry or transitional plan.

  • Code: Q20
  • Requirement: required
  • Definition: The number should be based on the number of participants with active treatment plans that continue in the community and on participants who receive referrals for services after their release into the community. A. Number of jail/prison/juvenile-based successful completers with confirmed continuity of care arrangements
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 6, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Please enter the number of individuals who did not complete and are no longer participants in the jail/prison/juvenile-based portion of the RSAT program during the reporting period. Former participants should not fit in more than one category, so please choose the option that best represents why these individuals did not complete the program.

  • Code: Q21
  • Requirement: required
  • Definition: Jail/Prison/Juvenile based Incompletes Measure Number Number of participants no longer in the program due to termination for a A new charge Number of participants no longer in the program due to release or transfer B to another correctional facility Number of participants no longer in the program due to death or serious C illness D Number of participants no longer in the program due to voluntary drop out Number of participants no longer in the program due to failure to meet E program requirements Number of participants no longer in the program due to violation of F institutional rules Number of participants who did not complete the program for other reasons G (Please specify) Please specify: Alcohol and Substance Involvement
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 6, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Please enter the number of jail/prison/juvenile-based participants who were administered an alcohol/drug test (e.g., urinalysis test) before admission into your RSAT program. As a requirement, grantees must agree to implement or continue to require urinalysis or other proven reliable forms of testing, including both periodic and random testing (1) of an individual before the

  • Code: Q22
  • Requirement: required
  • Definition: individual enters an RSAT program and during the period in which the individual participates in the treatment program; and (2) of an individual released from an RSAT program if the individual remains in the custody of the state. A. Number of jail/prison/juvenile-based participants tested before admission
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 7, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Of those enrolled in the jail/prison/juvenile-based portion of the RSAT program, please enter the total number of participants tested for alcohol or illegal substances during the reporting period. This should represent the total number of RSAT participants who were given drug tests. The number entered should be an unduplicated count only of participants who were tested for

  • Code: Q23
  • Requirement: required
  • Definition: alcohol or illegal substances, and it should be equal to or greater than the number of participants who tested positive. If not, please check for data entry error. A. Total number of jail/prison/juvenile-based participants tested for alcohol or illegal substances
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 7, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Of those enrolled in the jail/prison/juvenile-based portion of the RSAT program, please enter the number of participants who tested positive for the presence of alcohol or illegal substances during the reporting period. The number entered should be an unduplicated count only of participants who tested positive for alcohol or illegal substances, and it should be equal to or

  • Code: Q24
  • Requirement: required
  • Definition: less than the total number of participants tested. If not, please check for data entry error. Alcohol and substance use information should be based on documented tests rather than self-reported information from program participants. Include all participants who received services during the reporting period, regardless of whether they successfully completed the RSAT program, left without completing it, or are currently enrolled. A. Number of jail/prison/juvenile-based participants who tested positive for alcohol or illegal substances
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 7, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

During the reporting period, please enter the number of participants who were administered an alcohol/drug test (e.g., urinalysis test) within 30 days after successfully completing your residential drug treatment program and are still under supervision of the program.

  • Code: Q25
  • Requirement: required
  • Definition: A. Number of jail/prison/juvenile-based participants tested after program completion B. Of that number, how many tested positive for alcohol or illegal substances after program completion COURT AND CRIMINAL INVOLVEMENT: JAIL/PRISON BASED The next set of questions is about court and criminal involvement for offenders who have ever participated in the RSAT jail/prison-based program. This section is to be completed at the close of the grant.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 7, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Since the start of the BJA RSAT award, how many jail/prison/juvenile based participants:

  • Code: Q26
  • Requirement: required
  • Definition: A. Are still participating in the jail/prison/juvenile-based RSAT program? B. Have successfully completed the jail/prison-based RSAT program and released into the community? C. Did not complete the jail/prison-based RSAT program and released into the community? D. Were released into a mandated aftercare program. Aftercare programs are defined in 42 U.S.C. 3796ff-1(c) .
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 8, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Since the start of the RSAT BJA award, enter the total number of jail/prison/juvenile-based participants released into the community who successfully completed and unsuccessfully exited and were reincarcerated:

  • Code: Q27
  • Requirement: required
  • Definition: Court and Criminal Involvement Since the Start of the BJA Award for Individuals Who Received Aftercare Services Reincarcerated Reincarcerated based on a based on a Measure Revocation for a New Criminal Technical Charge Violation Participants released into the community (excluding mandated aftercare programs) who A. successfully completed the jail/prison based program Participants released into the community (excluding mandated aftercare programs) who B. participated but unsuccessfully exited the program The following questions pertain to individuals that are receiving services in your RSAT program. The following sections consist of the following: Risk Assessment and Treatment Planning, Number of Participants Receiving Services, Services Provided, Program Completion, Alcohol and Substance Involvement, and Court and Criminal Involvement. For these questions, please report the number of individuals that is equal to the proportion of the federal funds (plus matching funds) of your total annual budget for the RSAT program. For example, if the BJA RSAT grant (plus matching funds) accounts for 65% of the total annual budget, then please report on 65% of the program participants. When applying the percentage, please round to the nearest whole number. Similarly, if BJA RSAT funds (plus matching funds) are paying for a specific number of beds/treatment spaces within your facility, please report on those individuals that are occupying those beds/treatment spaces. Risk Assessment and Treatment Planning
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 8, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Of those who entered the aftercare portion of the RSAT, please enter the number of aftercare -based participants for the following measures.

  • Code: Q28
  • Requirement: required
  • Definition: Measure Cumulative Total Number of aftercare participants administered a risk and needs assessment. Number of aftercare participants with high criminogenic risks/needs Number of aftercare participants with an individualized treatment plan Number should not exceed the number of new participants indicated in question 23
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 9, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Are risk assessment screening tool results used in determining who is admitted as a participant into the RSAT aftercare program?

  • Code: Q29
  • Requirement: required
  • Definition: A risk and needs assessment is an instrument to help identify factors that may lead a participant to reoffend and services needed services to minimize those risks. The risk and needs assessment does not need to have been completed during the reporting period and it could be completed by an outside entity. A. Yes/No
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 9, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Please name the risk assessment instrument(s) that is used to assess risk/need.

Of those who entered the aftercare portion of the RSAT program, please enter the number of aftercare-based participants for the following measures.

  • Code: Q31
  • Requirement: required
  • Definition: Measure Cumulative Total Total number of aftercare participants enrolled as of the last day of the reporting period Number of NEW aftercare participants admitted during the reporting period Of those newly admitted aftercare participants released to the community, please enter the number with a continuity of care arrangement or reentry or transitional plan. The number should be based on the number of participants with treatment referrals for services after their release into the community Services Provided
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 10, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Please enter the number of aftercare participants who were provided services during the reporting period with BJA program funds, including matching funds, through the following treatment components:

If your treatment program includes MAT, which of the following medications are you utilizing?

  • Code: Q33
  • Requirement: required
  • Definition: Select all that apply. A. We do not provide MAT (Skip next question) B. We do not have access to MAT (Skip next question) C. Naltrexone (Vivitrol®, Depot naltrexone) D. Buprenorphine or Buprenorphine/Naloxone (Bup/NX) (Suboxone®,) E. Methadone
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 11, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Of the total participants enrolled in your program, how many were deemed eligible for MAT and of those eligible, how many received MAT during the reporting period?

  • Code: Q34
  • Requirement: required
  • Definition: A. Individuals eligible for MAT: B. Individuals receiving at least one MAT treatment: Program Completion
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 11, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Please enter the number of participants who successfully completed all requirements of the aftercare portion of your RSAT program during the reporting period. The number entered should represent only those participants who successfully completed all the requirements of the RSAT program during the reporting period.

Please enter the number of individuals who did not complete the aftercare portion of the RSAT program for the categories below. Participants should not fit in more than one category, so choose the option that best represents why these individuals did not complete the program.

  • Code: Q36
  • Requirement: required
  • Definition: Aftercare Incompletes Measure Number Number of participants no longer in the program due to failure to meet program A. requirements Number of participants no longer in the program due to court or criminal B. involvement (technical violation, arrest, conviction, revocation, reincarceration) C. Number of participants no longer in the program due to voluntary drop out D. Number of participants no longer in the program due to absconding E. Number of participants no longer in the program due to relocating or case transfer F. Number of participants no longer in the program due to death or serious illness Number of participants who did not complete the program for other reasons (please G. specify ) Please specify Alcohol and Substance Involvement
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 11, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Please enter the number of participants who were administered an alcohol/drug test before admission into your aftercare program. As a requirement, grantees must agree to implement or continue to require urinalysis or other proven reliable forms of testing, including both periodic and random testing (1) of an individual before the individual enters an RSAT program and during the

  • Code: Q37
  • Requirement: required
  • Definition: period in which the individual participates in the treatment program; and (2) of an individual released from an RSAT program if the individual remains in the custody of the state. A. Number of aftercare participants tested before admission into the program
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 12, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Of those enrolled in the aftercare portion of the RSAT program, please enter the total number of participants tested for alcohol or illegal substances during the reporting period.

  • Code: Q38
  • Requirement: required
  • Definition: This should represent the total number of RSAT participants who were given drug tests. The number entered should be an unduplicated count only of participants enrolled in the program who were tested for alcohol or illegal substances, and it should be equal to or greater than the number of participants who tested positive. If not, please check for data entry error. A. Total number of aftercare participants tested for alcohol or illegal substances
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 12, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Of those enrolled in the aftercare portion of the RSAT program, please enter the number of participants who tested positive for the presence of alcohol or illegal substances during the reporting period. The number entered should be an unduplicated count only of participants enrolled in the program who tested positive for alcohol or illegal substances, and it should be equal to or less

  • Code: Q39
  • Requirement: required
  • Definition: than the total number of participants tested. If not, please check for data entry error. Alcohol and substance use information should be based on documented tests rather than self-reported information from program participants. Include all participants who received services during the reporting period, regardless of whether they successfully completed the RSAT program, left the program without completing it, or are currently enrolled. A. Number of aftercare participants who tested positive for alcohol or illegal substances
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 12, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

During the reporting period, please enter the number of participants who were administered a drug test within 30 days after successfully completing your residential drug treatment program.

  • Code: Q40
  • Requirement: required
  • Definition: A. Number of aftercare participants tested after program completion B. Of that number, how many tested positive for alcohol or illegal substances following program completion? . COURT AND CRIMINAL INVOLVEMENT: AFTERCARE The next set of questions is about court and criminal involvement for ex-offenders who have ever participated in the RSAT Aftercare program. Note: Individuals can be included in more than one category. For example, an ex-offender could be arrested and have a conviction; the individual should therefore be counted in both categories. If an ex-offender has multiple arrests or convictions, only count that individual once. This section is to be completed at the close of the grant.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 12, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Since the start of the RSAT BJA award, how many aftercare participants:

  • Code: Q41
  • Requirement: required
  • Definition: A. Are still receiving aftercare services? B. Have successfully completed aftercare services? C. Did not complete aftercare services?
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 13, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Since the start of the RSAT BJA award, enter the total number of aftercare participants who have had a court and/or criminal involvement event. An ex-offender can be counted in more than one category (i.e., an individual can have an arrest and a conviction and then be reincarcerated).

  • Code: Q42
  • Requirement: required
  • Definition: However, do not count the frequency of events (i.e., number of arrests and convictions). Pending charges that the individual had prior to entering the program should not be counted. Court and Criminal Involvement Since the Start of the BJA Award for Individuals Who Received Aftercare Services Revocation of the Arrested on Conviction Reincarceration Terms of Measure a New for a New Based on a New Supervised Charge Charge Sentence Release Participants who are still A. participating in the program Ex-participants who successfully B. completed the program Ex-participants who C. unsuccessfully exit the program
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 13, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

How was the information obtained for those ex-offenders who were arrested on a new charge?

  • Code: Q43
  • Requirement: required
  • Definition: Select the best option that describes how the information was obtained. A. The grantee is a criminal justice agency such as the department of corrections, probation, or parole and has access to this information. B. The grantee has a Memorandum of Understanding (MOU), Memorandum of Agreement (MOA), or linkage agreement with a correctional agency that has access to this information. C. The grantee conducts public record jail/prison searches online. D. The grantee entered unofficial data (through word of mouth or from participants who reported the incident). E. The grantee does not have access to official justice information. F. Other (Please specify)
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 14, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

How was the information obtained for those ex-offenders who were convicted of a new crime?

  • Code: Q44
  • Requirement: required
  • Definition: Select the best option that describes how the information was obtained. A. The grantee is a criminal justice agency such as the department of corrections, probation, or parole and has access to this information. B. The grantee has a MOU, MOA, or linkage agreement with a correctional agency that has access to this information. C. The grantee conducts public record jail/prison searches online. D. The grantee entered unofficial data (through word of mouth or from participants who reported the incident). E. The grantee does not have access to official justice information. F. Other (Please specify)
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 14, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

How was the information obtained for ex-offenders who had a revocation of the terms of supervised release?

  • Code: Q45
  • Requirement: required
  • Definition: Select the best option that describes how the information was obtained. A. The grantee is a criminal justice agency such as the department of corrections, probation, or parole and has access to this information. B. The grantee has a MOU, MOA, or linkage agreement with a correctional agency that has access to this information. C. The grantee conducts public record jail/prison searches online. D. The grantee entered unofficial data (through word of mouth or from participants who reported the incident). E. The grantee does not have access to official justice information. F. Other (Please specify)
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 14, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

How was the information obtained for those ex-offenders who were reincarcerated based on a new sentence?

  • Code: Q46
  • Requirement: required
  • Definition: Select the best option that describes how the information was obtained. A. The grantee is a criminal justice agency such as the department of corrections, probation, or parole and has access to this information. B. The grantee has a MOU, MOA, or linkage agreement with a correctional agency that has access to this information. C. The grantee conducts public record jail/prison searches online. D. The grantee entered unofficial data (through word of mouth or from participants who reported the incident). E. The grantee does not have access to official justice information. F. Other (Please specify) Please answer the following questions every semiannual reporting period (January and July of each year), based on your grant-funded activities.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 15, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

What were your accomplishments during reporting period?

What goals were accomplished, as they relate to your grant application?

What problems/barriers did you encounter, if any, within the reporting period that prevented you from reaching your goals or milestones?

Is there any assistance that BJA can provide to address any problems/barriers identified in question #3?

  • Code: Q4
  • Requirement: required
  • Definition: (Please answer Yes or No. If No, please explain) A. Yes/No B. If Yes, please explain
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 15, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

Are you on track to fiscally and programmatically complete your program as outlined in your grant application?

  • Code: Q5
  • Requirement: required
  • Definition: (Please answer Yes or No. If No, please explain.) A. Yes/No B. If No, please explain
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, p. 15, https://bja.ojp.gov/funding/performance-measures/rsat.pdf

What major activities are planned for the next 6 months?

Based on your knowledge of the criminal justice field, are there any innovative programs/accomplishments that you would like to share with BJA?

Office of Juvenile Justice and Delinquency Prevention (DOJ OJP), Expanding Youth Access to Community-Based Treatment Program

How many unique individuals started the program during this reporting period?

  • Code: Q1
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refer to youth program participants. Program participant refers to an individual who started a program. Starting a program can be defined different ways in the context of your program. For example, starting a program can mean a formal agreement to participate in the program, or the first action an individual takes toward engaging with the program's services. Program refers to the specific set of activities that are carried out by the award recipient and supported by OJJDP award funds, in whole or in part. Reporting period is the specific timeframe covered by this report.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-community-based-treatment.pdf

How many unique individuals were discharged from the program during this reporting period?

  • Code: Q2
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refer to youth program participants. Program participant refers to an individual who started a program. Discharged means the program participant is no longer participating in services or receiving services directly or indirectly through your program. Program refers to the specific set of activities that are carried out by the award recipient and supported by OJJDP award funds, in whole or in part. Reporting period is the specific timeframe covered by this report.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-community-based-treatment.pdf

How many unique individuals were discharged from the program since the beginning of the award?

  • Code: Q3
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refer to youth program participants. Program participant refers to an individual who started a program. Discharged means the program participant is no longer participating in services or receiving services directly or indirectly through your program. Program refers to the specific set of activities that are carried out by the award recipient and supported by OJJDP award funds, in whole or in part. Beginning of the award refers to the Project Period Start Date for your award. You can find this date in your award documentation or in JustGrants.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-community-based-treatment.pdf

How many unique individuals were tested for substance use during this reporting period?

  • Code: Q4
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refer to youth program participants. Program participant refers to an individual who started a program. Tested for substance use means that a program official or another authorized individual administered a substance use test for the program participant. Reporting period is the specific timeframe covered by this report.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-community-based-treatment.pdf

How many unique individuals received assessments of their mental health during this reporting period?

  • Code: Q5
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refer to youth program participants. Program participant refers to an individual who started a program. Assessed for mental health means that a program official or another authorized individual conducted an evaluation to identify a youth’s emotional, behavioral, and developmental strengths and needs, using interviews, questionnaires, or observation to create a care plan or to assess a youth’s mental health functioning. Reporting period is the specific timeframe covered by this report.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-community-based-treatment.pdf

Did you adjust the program plan as described in your application’s proposal narrative. If yes, what adjustments did you make, and why?

Did you experience any challenges during this reporting period that impacted service delivery to program participants? If yes, how did you address the challenges or do the challenges remain unresolved?

Did you engage with OJJDP training and technical assistance providers this reporting period? If yes, did the providers adequately address your issue?

Of the unique individuals discharged during this reporting period, how many were discharged successfully?

  • Code: Q9
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refer to youth program participants. Program participant refers to an individual who started a program. Discharged means the program participant is no longer participating in services or receiving services directly or indirectly through your program. Reporting period is the specific timeframe covered by this report. Successful means the program participant met the program’s requirements, such as completing assessments, or prescribed treatment, or participating for an expected minimum duration.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-community-based-treatment.pdf

Of the unique individuals successfully discharged during this reporting period, how many demonstrated reduced substance use?

  • Code: Q10
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refer to youth program participants. Program participant refers to an individual who started a program. Successful means the program participant met the program’s requirements, such as completing assessments, or prescribed treatment, or participating for an expected minimum duration. Discharged means the program participant is no longer participating in services or receiving services directly or indirectly through your program. Reporting period is the specific timeframe covered by this report. Substance use refers to the use of selected substances, including alcohol, tobacco products, illicit drugs, inhalants, and other substances that can be consumed, inhaled, injected, or otherwise absorbed into the body with possible dependence and other detrimental effects.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-community-based-treatment.pdf

Of the unique individuals successfully discharged during this reporting period, how many experienced improved mental health?

  • Code: Q11
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refer to youth program participants. Program participant refers to an individual who started a program. Successful means the program participant met your program’s requirements, such as completing assessments or prescribed treatment or participating for an expected minimum duration. Discharged means the program participant is no longer participating in services or receiving services directly or indirectly through your program. Reporting period is the specific timeframe covered by this report. Improved mental health means the youth program participant is developing healthy emotional, psychological, and social skills; can manage stress; build strong relationships; and have the resilience to navigate challenges. These skills lead to better overall well-being, school success, and future potential, rather than just the absence of a disorder. It may also involve feeling connected, learning coping mechanisms, having access to supportive environments, and practicing self-care like good sleep and nutrition.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-community-based-treatment.pdf

Of the unique individuals discharged during this reporting period, how many were discharged unsuccessfully?

  • Code: Q12
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refer to youth program participants. Program participant refers to an individual who started a program. Discharged means the program participant is no longer participating in services or receiving services directly or indirectly through the program. Reporting period is the specific timeframe covered by this report. Unsuccessful discharges refer to individuals discharged for a reason other than successful, such as a discharge due to loss of contact, removal, or new petition. • Loss of contact means a youth in the program stops communicating with the program or fails to attend required appointments. • Removed means the program participant is no longer participating in the program for failing to follow program rules or treatment recommendations, such as consistently missing appointments, abusive behaviors, or lack of engagement. • Petition is a document filed in juvenile court alleging that a juvenile is a delinquent or a status offender and asking that the court assume jurisdiction over the juvenile or that an alleged delinquent be transferred to criminal court for prosecution as an adult.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-community-based-treatment.pdf

Of the unique individuals discharged during this reporting period, how many were discharged for another reason?

  • Code: Q13
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refer to youth program participants. Program participant refers to an individual who started a program. Discharged means the program participant is no longer participating in services or receiving services directly or indirectly through the program. Reporting period is the specific timeframe covered by this report. Other discharge statuses could include: • Transferred means the program participant moved to another level of care and/or provider. • Authorized departure means the youth left the program for circumstances beyond their control but were successful up to departure (i.e. moved out of area, conflict with another program or employment, etc.). • Withdrew means the exiting program participant stopped participating in the program. • Grant ended means the program participant was receiving services at grant award ending.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-community-based-treatment.pdf

Did you experience any challenges related to external factors beyond your control during the reporting period that impacted program outcomes? If yes, please describe the challenges.

Of the unique individuals discharged since the beginning of the award, how many were discharged successfully?

  • Code: Q15
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refer to youth program participants. Program participant refers to an individual who started a program. Discharged means the program participant is no longer participating in services or receiving services directly or indirectly through your program. Beginning of the award refers to the Project Period Start Date for your award. You can find this date in your award documentation or in JustGrants. Successful means the program participant met the program’s requirements, such as completing assessments or prescribed treatment or participating for an expected minimum duration.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-community-based-treatment.pdf

Of the unique individuals successfully discharged since the beginning of the award, how many experienced a new adjudication within 12 months of discharge?

  • Code: Q16
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refer to youth program participants. Program participant refers to an individual who started a program. Successful means the program participant met your program’s requirements, such as completing assessments or prescribed treatment or participating for an expected minimum duration. Discharged means the program participant is no longer participating in services or receiving services directly or indirectly through your program. Beginning of the award refers to the Project Period Start Date for your award. You can find this date in your award documentation or in JustGrants. New adjudication refers to the juvenile court process that determines if the juvenile committed the act for which he or she is charged. The term "adjudicated" indicates that the court concluded the juvenile committed the act. Project period end date is the end of the grant activity period. The project period end date can be found in your award documents or JustGrants.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-community-based-treatment.pdf

Of the unique individuals discharged since the beginning of the award, how many were discharged unsuccessfully?

  • Code: Q17
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refer to youth program participants. Program participant refers to an individual who started a program. Discharged means the program participant is no longer participating in services or receiving services directly or indirectly through your program. Beginning of the award refers to the Project Period Start Date for your award. You can find this date in your award documentation or in JustGrants. Unsuccessful discharges refer to individuals discharged for a reason other than successful, such as a discharge due to loss of contact, removal, or new petition. • Loss of contact means a youth in the program stops communicating with the program or fails to attend required appointments. • Removed means the program participant is no longer participating in the program for failing to follow program rules or treatment recommendations, such as consistently missing appointments, abusive behaviors, or lack of engagement. • Petition is a document filed in juvenile court alleging that a juvenile is a delinquent or a status offender and asking that the court assume jurisdiction over the juvenile or that an alleged delinquent be transferred to criminal court for prosecution as an adult.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-community-based-treatment.pdf

Of the individuals unsuccessfully discharged since the beginning of the award, how many experienced a new adjudication within 12 months of discharge?

  • Code: Q18
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refer to youth program participants. Program participant refers to an individual who started a program. Unsuccessful discharges refer to individuals discharged for a reason other than successful, such as a discharge due to loss of contact, removal, or a new petition. • Loss of contact means a youth in the program stops communicating with the program or fails to attend required appointments. • Removed means the program participant is no longer participating in the program for failing to follow program rules or treatment recommendations, such as consistently missing appointments, abusive behaviors, or lack of engagement. • Petition is a document filed in juvenile court alleging that a juvenile is a delinquent or a status offender and asking that the court assume jurisdiction over the juvenile or that an alleged delinquent be transferred to criminal court for prosecution as an adult. Discharged means the program participant is no longer participating in services or receiving services directly or indirectly through your program. Beginning of the award refers to the Project Period Start Date for your award. You can find this date in your award documentation or in JustGrants. New adjudication refers to the juvenile court process that determines if the juvenile committed the act for which he or she is charged. The term "adjudicated" indicates that the court concluded the juvenile committed the act. Project period end date is the end of the grant activity period. The project period end date can be found in your award documents or JustGrants.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-community-based-treatment.pdf

How would you describe progress toward this award's goals and objectives?

What services are supported, in whole or in part, by OJJDP’s grant funds? Select all that apply.

  • Code: Q1
  • Requirement: required
  • Definition: Answer options: o School-based programs o Family-based programs o Community engagement o Substance use disorder treatment o Mental health treatment o Medical services o Crisis response o Trauma-informed services o Case management o Mentoring o Support groups o Life skills o Referrals to community-based services o Wraparound services o Other, specify: ____ School-based programs involve classroom curricula to build skills such as refusal skills, social competence, or emotional regulation. Family-based programs include parent training, workshops, or home visits to strengthen family bonds and communication. Community engagement involves awareness campaigns or events with a specific outcome focus, such as reducing stigma or promoting healthy choices. Substance use disorder treatment usually offers individual, group, or family therapy sessions and typically focuses on understanding the nature of addiction, becoming drug-free, and preventing relapse. Mental health treatment refers to a range of therapeutic strategies used to address mental illnesses, mental health conditions, and behavioral health issues, including psychotherapy, medication, support groups, and lifestyle changes, often in a combination approach for a more effective recovery plan. Medical services provide healthcare access to youth, such as treatment for physical health or assistance with health coverage like Medicaid, and promote overall health and reduce the risk of returning to the juvenile justice system by addressing health-related barriers to successful community reintegration. Crisis response services are organized systems providing immediate, community-based help for mental health, substance use, or other critical situations, aiming to resolve crises effectively, prevent escalation, and divert people from the justice system by connecting them with appropriate care, often through call centers, mobile teams, and stabilization facilities. Trauma-informed services rely on understanding the physical, social, and emotional impact of trauma on the individual, as well as on the professionals who help them. This understanding guides practices and services that promote recovery and healing for people in the justice system who have been impacted by trauma. Case management is a comprehensive process of assessing needs, developing a plan, coordinating resources, and monitoring progress. Mentoring provides structured relationships where individuals guide and support the personal growth of others. These services facilitate skill transfer, career development, and the building of confidence by fostering supportive, trusted relationships through which mentors share knowledge and insights to help mentees reach their full potential. Support Groups are safe spaces where young people facing similar challenges—like mental health struggles or substance use—connect, share experiences, build coping skills, and find validation, fostering a sense of belonging and reducing isolation through shared understanding, often facilitated by trained adults or older peers. These groups can empower youth to develop self-esteem, communication, and problem-solving skills by learning from each other in a relatable, non-judgmental environment. Life skills services support youth in achieving and maintaining stability and avoiding future contact with the juvenile justice system. Examples include interventions that help young people learn about communication, relationships with other people, team-working, problem-solving, self-regulation, self-management, and other abilities that support personal and academic or workplace success. Referrals to community-based services are intended to assist youth (and/or their families) in obtaining community resources such as health care, mental health care, employability development and job training, and other social services. Wraparound services provide intensive, individualized, and community-based support for youth, creating a team around the youth and family to build on strengths and achieve goals. Typically, wraparound services are a family-driven process, involving a dedicated team (facilitator, clinician, family partner, etc.) and resources like therapy, case management, mentoring, and help accessing mental health and substance abuse treatment or counseling, all coordinated to create a holistic plan that respects the family's preferences.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-community-based-treatment.pdf

What is the target population of the program? Select all that apply.

  • Code: Q2
  • Requirement: required
  • Definition: Answer options: o Youth with substance use disorder (SUD) o Youth with mental health needs o Youth with substance use disorder (SUD) and co-occurring mental health and substance use disorder (MHSUD) needs o Other, specify: ____ The target population is the group for whom the program is primarily designed and whom the program envisions will participate in the program’s services. Youth refers to children and adolescents under the age of 18 who are/were involved in the juvenile justice system. Substance use disorder is a treatable, chronic medical illness characterized by a problematic pattern of using alcohol or drugs— including illegal substances and prescription medications. This leads to significant impairment, such as health issues, disability, or failing to meet major responsibilities at work, school, or home. Mental health needs are supports required for emotional, psychological, and social well-being, encompassing needs for coping with stress, managing conditions like anxiety or depression, building skills, fostering healthy relationships, accessing treatments, and addressing social factors that impact mental health such as poverty or discrimination. It's not only the absence of illness but also the ability to thrive, cope with life's challenges, and contribute to the community. These needs are diverse, ranging from basic needs for stability to specialized care.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-community-based-treatment.pdf

What is the lowest age of youth who will be served by the program?

What is the highest age of youth who will be served by the program?

How many unique individuals does the program plan to serve over the life of the award?

  • Code: Q5
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refer to youth program participants. Program participant refers to an individual who started a program. Served by the program refers to program participants, meaning that they started participating in your program or receiving services. Life of the award refers to the period from the start of the award to the closure of the award. This is typically three years.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-community-based-treatment.pdf

How many unique individuals started the program within a year prior to the beginning of this award?

What is the minimum length of participation for each program participant?

What is the frequency of participation expected for each program participant?

What tool or approach will the program use to assess outcomes for program participants?

  • Code: Q9
  • Requirement: required
  • Definition: Program participant refers to an individual who started a program. Outcomes refer to the specific, measurable benefits or changes in program participants that occur during or after their involvement in the program's activities. Examples include reduced substance use, increased stability, improved mental health, or increased prosocial behaviors.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-community-based-treatment.pdf

How is the information obtained for youth with a new adjudication? Select all that apply.

  • Code: Q10
  • Requirement: required
  • Definition: Answer options: o The grantee is a criminal justice agency such as the department of juvenile justice or probation and has access to this information. o The grantee has a memorandum of understanding (MOU), a memorandum of agreement (MOA), or a linkage agreement with an agency that has access to this information. o The grantee conducts public records searches online. o The grantee enters unofficial data (through word of mouth or from participants who reported the incident). o The grantee does not have access to official justice information. o Other, specify: ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-community-based-treatment.pdf

Office of Juvenile Justice and Delinquency Prevention (DOJ OJP), Family Treatment Court

How many unique families started the program during this reporting period?

  • Code: Q1
  • Requirement: required
  • Definition: Unique means unduplicated. Families should only be counted once. Unique families should not be counted in more than one reporting period. Families refers to any combination or grouping of parent and child (including pregnant mothers) who are participating in the program. Starting a program is defined in the context of your program. For example, starting a program can mean a formal agreement to participate in the program, or the first action an individual takes toward engaging with the program's services. Reporting period refers to the specific timeframe covered by this report.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

How many unique families were discharged from the program during this reporting period?

  • Code: Q2
  • Requirement: required
  • Definition: Unique means unduplicated. Families should only be counted once. Unique families should not be counted in more than one reporting period. Families refers to any combination or grouping of parent and child (including pregnant mothers) who are participating in the program. Discharged means the family is no longer participating in services or receiving services directly from or indirectly through your program. Reporting period refers to the specific timeframe covered by this report.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

How many unique families were discharged from the program since the beginning of the award? Enter the number of unique families who were discharged from the program since the beginning of the award. This is a cumulative number that includes counts from all reporting periods. Do not count a family in more than one reporting period.

  • Code: Q3
  • Requirement: required
  • Definition: Unique means unduplicated. Families should only be counted once. Unique families should not be counted in more than one reporting period. Families refers to any combination or grouping of parent and child (including pregnant mothers) participating in the program. Discharged means the family is no longer participating in services or receiving services directly from or indirectly through your program. Beginning of the award refers to the Project Period Start Date for your award. You can find this in your award documentation or in JustGrants.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

How many unique individuals were tested for substance use during this reporting period?

  • Code: Q4
  • Requirement: required
  • Definition: Unique means unduplicated. Families should only be counted once. Unique families should not be counted in more than one reporting period. Individuals refers to parents, and they should only be counted once. Unique individuals should not be counted in more than one reporting period. Tested for substance use means that a program official or another authorized individual applied a substance use test for the program participant. Substance use refers to the use of selected substances, including alcohol, tobacco products, illicit drugs, inhalants, and other substances that can be consumed, inhaled, injected, or otherwise absorbed into the body with possible dependence and other detrimental effects. Reporting period refers to the specific timeframe covered by this report.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

Of the unique families discharged during this reporting period, how many were discharged successfully?

  • Code: Q5
  • Requirement: required
  • Definition: Unique means unduplicated. Families should only be counted once. Unique families should not be counted in more than one reporting period. Families refers to any combination or grouping of parent and child (including pregnant mothers) who are participating in the program. Discharged means the family is no longer participating in services or receiving services directly from or indirectly through your program. Reporting period refers to the specific timeframe covered by this report. Successful means the family has met your program’s requirements, such as completing assessments or prescribed treatment or participating for an expected minimum duration.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

Of the unique families discharged during this reporting period, how many were discharged unsuccessfully?

  • Code: Q6
  • Requirement: required
  • Definition: Unique means unduplicated. Families should only be counted once. Unique families should not be counted in more than one reporting period. Families refers to any combination or grouping of parent and child (including pregnant mothers) who are participating in the program. Discharged means the family is no longer participating in services or receiving services directly from or indirectly through your program. Reporting period refers to the specific timeframe covered by this report. Unsuccessful discharge refers to families discharged for a reason other than successful, such as a discharge due to loss of contact or removal. • Loss of contact means a family in the program stops communicating with the program or fails to attend required appointments. • Removed means the exiting family is no longer participating in the program for failing to follow program rules or treatment recommendations, such as consistently missing appointments, abusive behaviors, or lack of engagement.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

Of the unique families discharged during this reporting period, how many were discharged for another reason?

  • Code: Q7
  • Requirement: required
  • Definition: Unique means unduplicated. Families should only be counted once. Unique families should not be counted in more than one reporting period. Families refers to any combination or grouping of parent and child (including pregnant mothers) who are participating in the program. Discharged means the family is no longer participating in services or receiving services directly from or indirectly through your program. Reporting period refers to the specific timeframe covered by this report. Other discharge status examples include: • Transferred means the exiting family moved to another level of care and/or provider. • Moved means the family moved out of the funded program service area and is no longer eligible to receive services. • Withdrew means the exiting family officially or unofficially stopped participating in the program. • Grant ended means the family was receiving services at grant award ending.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

Of the unique families discharged since the beginning of the award, how many were discharged successfully?

  • Code: Q8
  • Requirement: required
  • Definition: Unique means unduplicated. Families should only be counted once. Unique families should not be counted in more than one reporting period. Families refers to any combination or grouping of parent and child (including pregnant mothers) participating in the program. Discharged means the family is no longer participating in services or receiving services directly from or indirectly through your program. Beginning of the award refers to the Project Period Start Date for your award. You can find this in your award documentation or in JustGrants. Successful means the family has met all program requirements, such as completing assessments or prescribed treatment or participating for an expected minimum duration in services.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

Of the unique families discharged since the beginning of the award, how many were discharged unsuccessfully?

  • Code: Q9
  • Requirement: required
  • Definition: Unique means unduplicated. Families should only be counted once. Unique families should not be counted in more than one reporting period. Families refers to any combination or grouping of parent and child (including pregnant mothers) participating in the program. Discharged means the family is no longer participating in services or receiving services directly from or indirectly through your program. Beginning of the award refers to the Project Period Start Date for your award. You can find this in your award documentation or in JustGrants. Unsuccessful discharge refers to families discharged for a reason other than successful, such as a discharge due to loss of contact or removal. • Loss of contact means a family in the program stops communicating with the program or fails to attend required appointments. • Removed means the exiting family is no longer participating in the program for failing to follow program rules or treatment recommendations, such as consistently missing appointments, abusive behaviors, or lack of engagement.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

Of the unique individuals successfully discharged during this reporting period, how many demonstrated reduced substance use?

  • Code: Q10
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to a parent. Unique individuals should only be counted once and should not be counted in more than one reporting period. Successful means the program participant has met all program requirements, such as completing assessments or prescribed treatment or participating for an expected minimum duration in services. Discharged means the individual is no longer participating in services or receiving services directly from or indirectly through your program. Reporting period refers to the specific timeframe covered by this report. Substance use refers to the use of selected substances, including alcohol, tobacco products, illicit drugs, inhalants, and other substances that can be consumed, inhaled, injected, or otherwise absorbed into the body with possible dependence and other detrimental effects.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

Of the unique individuals unsuccessfully discharged during this reporting period, how many demonstrated reduced substance use?

  • Code: Q11
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to a parent. Unique individuals should only be counted once and should not be counted in more than one reporting period. Unsuccessful discharge refers to individuals discharged for a reason other than successful, such as a discharge due to loss of contact or removal. • Loss of contact means an individual in the program stops communicating with the program or fails to attend required appointments. • Removed means the exiting individual is no longer participating in the program for failing to follow program rules or treatment recommendations, such as consistently missing appointments, abusive behaviors, or lack of engagement. Discharged means the individual is no longer participating in services or receiving services directly from or indirectly through your program. Reporting period refers to the specific timeframe covered by this report. Substance use refers to the use of selected substances, including alcohol, tobacco products, illicit drugs, inhalants, and other substances that can be consumed, inhaled, injected, or otherwise absorbed into the body with possible dependence and other detrimental effects.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

Of the unique families successfully discharged during this reporting period, how many children demonstrated satisfactory well being?

  • Code: Q12
  • Requirement: required
  • Definition: Unique means unduplicated. Families should only be counted once. Unique families should not be counted in more than one reporting period. Families refers to any combination or grouping of parent and child (including pregnant mothers) who are participating in the program. Successful means the family has met all program requirements, such as completing assessments or prescribed treatment or participating for an expected minimum duration in services. Discharged means the family is no longer participating in services or receiving services directly from or indirectly through your program. Reporting period refers to the specific timeframe covered by this report. Satisfactory means acceptable for the particular child and absent any identifiable or reportable problems or concerns assessed by program staff. Well-being refers to the child’s overall physical, emotional, and behavioral health. This can be self-reported and/or observed by program staff via an assessment.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

Of the unique families discharged during this reporting period, how many demonstrated placement stability for their children?

  • Code: Q13
  • Requirement: required
  • Definition: Unique means unduplicated. Families should only be counted once. Unique families should not be counted in more than one reporting period. Families refers to any combination or grouping of parent and child (including pregnant mothers) who are participating in the program. Discharged means the family is no longer participating in services or receiving services directly from or indirectly through your program. Reporting period refers to the specific timeframe covered by this report. Placement stability refers to minimizing the number of moves a child makes from their primary home or foster home during program participation. Stability would be no more than one change in placement during program participation.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

Of the unique families successfully discharged since the beginning of the award, how many experienced new child welfare system involvement within 12 months of discharge?

  • Code: Q14
  • Requirement: required
  • Definition: Unique means unduplicated. Families should only be counted once. Unique families should not be counted in more than one reporting period. Families refers to any combination or grouping of parent and child (including pregnant mothers) who are participating in the program. Successful means the family has met all program requirements, such as completing assessments or prescribed treatment or participating for an expected minimum duration in services. Discharged means the family is no longer participating in services or receiving services directly from or indirectly through your program. Beginning of the award refers to the Project Period Start Date for your award. You can find this in your award documentation or in JustGrants. Award Closeout is when the federal awarding agency determines that the grantee and the federal awarding agency have completed all applicable administrative actions.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

Of the unique families unsuccessfully discharged since the beginning of the award, how many experienced new child welfare system involvement within 12 months of discharge?

  • Code: Q15
  • Requirement: required
  • Definition: Unique means unduplicated. Families should only be counted once. Unique families should not be counted in more than one reporting period. Families refers to any combination or grouping of parent and child (including pregnant mothers) who are participating in the program. Unsuccessful discharge refers to families discharged for a reason other than successful, such as a discharge due to loss of contact or removal. • Loss of contact means a family in the program stops communicating with the program or fails to attend required appointments. • Removed means the exiting family is no longer participating in the program for failing to follow program rules or treatment recommendations, such as consistently missing appointments, abusive behaviors, or lack of engagement. Discharged means the family is no longer participating in services or receiving services directly from or indirectly through your program. Beginning of the award refers to the Project Period Start Date for your award. You can find this in your award documentation or in JustGrants. Award Closeout is when the federal awarding agency determines that the grantee and the federal awarding agency have completed all applicable administrative actions.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

Did you adjust the program plan as described in your application’s proposal narrative? If yes, what adjustments did you make, and why?

Did you experience any challenges during this reporting period that impacted service delivery to program participants? If yes, how did you address the challenges, or do the challenges remain unresolved?

  • Code: Q17
  • Requirement: required
  • Definition: Reporting period refers to the specific timeframe covered by this report. Program participant refers to an individual who started a program. Individuals refers to parents and should only be counted once. Unique individuals should not be counted in more than one reporting period.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

Did you engage with OJJDP training and technical assistance providers this reporting period? If yes, did the providers adequately address your issue?

Did you experience any challenges related to external factors beyond your control during the reporting period that impacted program outcomes? If yes, please describe the challenges.

How would you describe progress made toward this award’s goals and objectives? Select all that apply.

What services are supported, in whole or in part, by OJJDP’s grant funds? Select all that apply.

  • Code: Q1
  • Requirement: required
  • Definition: Answer options: o Substance Use Disorder Treatment o Recovery Support Services: • Substance Use Disorder Treatment Aftercare • Employment Services • Education Services • Housing Assistance • Mental Health Treatment • Health Services (including medical and/or dental services) • Trauma Treatment o Case Management o Family Counseling o Children’s Mental Health Services o Other services, specify: ____ Substance Use Disorder Treatment usually offers individual, group, or family therapy sessions and typically focuses on understanding the nature of addiction, becoming drug-free, and preventing relapse. Recovery support services include a wide variety of non-clinical services designed to assist individuals in their recovery from substance use disorders and mental health issues. Employment services provide essential job-related support for individuals participating in the program. Services might include skills training in areas like basic education, career readiness, and specific trades; job search assistance, such as resume building and interview coaching; and job placement services to connect individuals with employers. Programs might also offer vocational training, apprenticeships, on-the-job training, and career planning. Education services provide academic and vocational training to further any educational interests related to promoting family stability and support. Housing assistance includes services such as transitional housing; help with security deposits and move-in costs; rental assistance; and case management to find stable, affordable accommodations. These services help parents transition into the community, providing a stable foundation to prevent homelessness and support successful reintegration. Mental health treatment refers to a range of therapeutic strategies used to address mental illnesses, mental health conditions, and behavioral health issues, including psychotherapy, medication, support groups, and lifestyle changes, often in a combination approach for a more effective recovery plan. Health services provide healthcare access to families participating in the program, such as treatment for physical health or assistance with health coverage like Medicaid and promote overall health. This can include medical or dental care. Trauma treatment involves a mental health treatment approach that recognizes the symptoms and root causes of trauma and provides a safe, supportive environment. These approaches can include a range of therapy types including, but not limited to, Trauma-Focused Cognitive Behavioral Therapy, Cognitive Behavioral Intervention for Trauma in Schools, Reprocessing, and Cognitive Processing Therapy. Case management is a comprehensive process that assesses needs, develops a plan, coordinates resources, and monitors progress. Family Counseling refers to a range of therapeutic strategies used to address family dynamics, issues, and concerns, with the goal of promoting improved parent/child relationships. Children’s mental health services refers to a range of therapeutic strategies used to address mental, emotional, and behavioral health issues including psychotherapy, medication, support groups, and lifestyle changes.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

What is the target population of the program? Select all that apply.

  • Code: Q2
  • Requirement: required
  • Definition: Answer options: o Parents o Males o Females o Low Risk Youth o Medium Risk Youth o High Risk Youth o Other, specify: ____ Target population is the group(s) of people for whom the program is primarily designed and who the program envisions will engage in the program’s services. Low risk youth refers to a young person unlikely to reoffend in the near future. Typically supported by strong community or family bonds, positive peer groups, and a lack of previous offenses. Medium risk youth refers to a young person showing some risk factors for delinquency such as truancy, inconsistent home life, or association with delinquent peers. These factors moderately increase the probability of offenses in the near future. High risk youth refers to a young person more likely to reoffend in the near future due to an accumulation of risk factors. These may include early onset of aggressive behavior, severe family conflict, gang involvement, or shared characteristics with populations that have historically reoffended at higher rates.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

How many unique families does the program expect to serve over the life of the grant?

  • Code: Q3
  • Requirement: required
  • Definition: Unique means unduplicated. Families should only be counted once. Unique families should not be counted in more than one reporting period. Families refers to any combination or grouping of parent and child (including pregnant mothers) who are participating in the program. Life of the grant refers to the period from the start of the award to the closure of the award. For OJJDP awards, this is typically three years.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

What is the minimum duration of participation expected for each program participant?

  • Code: Q4
  • Requirement: required
  • Definition: Duration means typical length of time needed to complete the program. Program participant refers to an individual who started a program. Individuals refers to parents and should only be counted once. Unique individuals should not be counted in more than one reporting period.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

What is the frequency of participation for each individual?

What tool or approach will be used to assess participant outcomes after receiving the program’s services?

  • Code: Q6
  • Requirement: required
  • Definition: Program participant refers to an individual who started a program. Individuals refers to parents and should only be counted once. Unique individuals should not be counted in more than one reporting period. Outcomes refer to the specific, measurable benefits or changes in program participants that occur during or after their involvement in the program's activities. Examples include reduced substance use, increased stability, improved mental health, and increased prosocial behaviors.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

How will the program track outcomes for families with new child welfare system involvement? Select all that apply.

  • Code: Q7
  • Requirement: required
  • Definition: Answer options: o The grantee is a child welfare agency such as the department of social services and has access to this information. o The grantee has a memorandum of understanding (MOU), a memorandum of agreement (MOA), or a linkage agreement with an agency that has access to this information. o The grantee conducts public records searches online. o The grantee enters unofficial data (through word of mouth or self-reporting from participants). o The grantee does not have access to official justice information. o Other, specify: ____
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-family-treatment-court.pdf

Office of Juvenile Justice and Delinquency Prevention (DOJ OJP), Juvenile Drug Treatment Court Program

How many unique individuals started the program during this reporting period?

  • Code: Q1
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refer to youth. Program participant refers to an individual who started a program. Starting a program can be defined different ways in the context of your program. For example, starting a program can mean a formal agreement to participate in the program, or the first action an individual takes toward engaging with the program's services. Reporting period varies by grant but typically includes the six-month period ending June 30 or December 31.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-juvenile-drug-treatment-court.pdf

How many unique individuals were tested for substance during this reporting period?

  • Code: Q2
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth program participants. Program participant refers to an individual who started a program. Tested for substance use means that a program official or another authorized individual applied a substance use test for the program participant. Reporting period varies by grant but typically includes the six-month period ending June 30 or December 31.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-juvenile-drug-treatment-court.pdf

How many unique individuals were discharged from the program during this reporting period?

  • Code: Q3
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once during a reporting period. Also, unique individuals should not be counted in more than one reporting period. Individuals refer to youth program participants. Program participant refers to an individual who started a program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Reporting period varies by grant but typically includes the six-month period ending June 30 or December 31.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-juvenile-drug-treatment-court.pdf

Of the unique individuals discharged during this reporting period, how many were discharged successfully?

  • Code: Q4
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth program participants. Program participant refers to an individual who started a program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Successful means the program participant has met your program’s requirements, such as completing assessments or prescribed treatment or participating for an expected minimum duration. Reporting period varies by grant but typically includes the six-month period ending June 30 or December 31.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-juvenile-drug-treatment-court.pdf

Of the unique individuals successfully discharged during this reporting period, how many demonstrated reduced substance use by program exit?

  • Code: Q5
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth program participants. Program participant refers to an individual who started a program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Successful means the program participant has met all program requirements, such as completing assessments or prescribed treatment or participated for an expected minimum duration in services. Substance use refers to the use of selected substances, including alcohol, tobacco products, illicit drugs, inhalants, and other substances that can be consumed, inhaled, injected, or otherwise absorbed into the body with possible dependence and other detrimental effects. Reporting period varies by grant but typically includes the six-month period ending June 30 or December 31.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-juvenile-drug-treatment-court.pdf

Of the unique individuals discharged during this reporting period, how many were discharged unsuccessfully?

  • Code: Q6
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth program participants. Program participant refers to an individual who started a program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Unsuccessful discharges refer to individuals discharged for a reason other than successful, such as a discharge due to loss of contact, removal, or new petition • Loss of contact means a youth in the program stops communicating with the program or fails to attend required appointments. • Removed means the exiting program participant is no longer participating in the program for failing to follow program rules or treatment recommendations, such as consistently missing appointments, abusive behaviors, or lack of engagement. • Petition is a document filed in juvenile court alleging that a juvenile is a delinquent or a status offender and asking that the court assume jurisdiction over the juvenile or that an alleged delinquent be transferred to criminal court for prosecution as an adult. Reporting period varies by grant but typically includes the six-month period ending June 30 or December 31.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-juvenile-drug-treatment-court.pdf

Of the unique individuals unsuccessfully discharged during this reporting period, how many demonstrated reduced substance use by program exit?

  • Code: Q7
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth program participants. Program participant refers to an individual who started a program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Unsuccessful discharges refer to individuals discharged for a reason other than successful, such as a discharge due to loss of contact, removal, or new petition. • Loss of contact means a youth in the program stops communicating with the program or fails to attend required appointments. • Removed means the exiting program participant is no longer participating in the program for failing to follow program rules or treatment recommendations, such as consistently missing appointments, abusive behaviors, or lack of engagement. • Petition is a document filed in juvenile court alleging that a juvenile is a delinquent or a status offender and asking that the court assume jurisdiction over the juvenile or that an alleged delinquent be transferred to criminal court for prosecution as an adult. Substance use refers to the use of selected substances, including alcohol, tobacco products, illicit drugs, inhalants, and other substances that can be consumed, inhaled, injected, or otherwise absorbed into the body with possible dependence and other detrimental effects. Reporting period varies by grant but typically includes the six-month period ending June 30 or December 31.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-juvenile-drug-treatment-court.pdf

Of the unique individuals discharged during this reporting period, how many were discharged for another reason?

  • Code: Q8
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth program participants. Program participant refers to an individual who started a program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Other discharge statuses examples include: • Transferred means exiting program participant moved to another level of care and/or provider. • Moved out of the funded program service area and no longer eligible to receive services. • Withdrew means the exiting program participant officially or unofficially stopped participating in the program. • Grant ended means the program participant was receiving services at grant award ending. Reporting period varies by grant but typically includes the six-month period ending June 30 or December 31.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-juvenile-drug-treatment-court.pdf

How many unique individuals were discharged from the program since the beginning of the award? Enter the number of unique youth who were discharged from the program since the beginning of the award. This is a cumulative number that includes counts from all reporting periods. Do not count an individual in more than one reporting period.

  • Code: Q9
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth program participants. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Beginning of the award refers to the Project Period Start Date for your award. You can find this in your award documentation or in JustGrants.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-juvenile-drug-treatment-court.pdf

Of the unique individuals discharged since the beginning of the award, how many were discharged successfully?

  • Code: Q10
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth program participants. Program participant refers to an individual who started a program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Successful means the program participant has met all program requirements, such as completing assessments or prescribed treatment or participated for an expected minimum duration in services. Beginning of the award refers to the Project Period Start Date for your award. You can find this in your award documentation or in JustGrants.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-juvenile-drug-treatment-court.pdf

Of the unique individuals successfully discharged since the beginning of the award, how many experienced a new adjudication within 12 months of discharge?

  • Code: Q11
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth program participants. Program participant refers to an individual who started a program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Successful means the program participant has met all program requirements, such as completing assessments or prescribed treatment or participated for an expected minimum duration in services. Beginning of the award refers to the Project Period Start Date for your award. You can find this in your award documentation or in JustGrants. Award Closeout is the end of the grant process by which the federal awarding agency determines that the grantee and the federal awarding agency have completed all applicable administrative actions.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-juvenile-drug-treatment-court.pdf

Of the unique individuals discharged since the beginning of the award, how many were discharged unsuccessfully?

  • Code: Q12
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth program participants. Program participant refers to an individual who started a program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Unsuccessful discharges refer to individuals discharged for a reason other than successful, such as a discharge due to loss of contact, removal, or new petition. • Loss of contact means a youth in the program stops communicating with the program or fails to attend required appointments. • Removed means the exiting program participant is no longer participating in the program for failing to follow program rules or treatment recommendations, such as consistently missing appointments, abusive behaviors, or lack of engagement. • Petition is a document filed in juvenile court alleging that a juvenile is a delinquent or a status offender and asking that the court assume jurisdiction over the juvenile or that an alleged delinquent be transferred to criminal court for prosecution as an adult. Beginning of the award refers to the Project Period Start Date for your award. You can find this in your award documentation or in JustGrants.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-juvenile-drug-treatment-court.pdf

Of the individuals unsuccessfully discharged since the beginning of the award, how many experienced a new adjudication within 12 months of discharge?

  • Code: Q13
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth program participants. Program participant refers to an individual who started a program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Unsuccessful discharges refer to individuals discharged for a reason other than successful, such as a discharge due to loss of contact, removal, or new petition. • Loss of contact means a youth in the program stops communicating with the program or fails to attend required appointments. • Removed means the exiting program participant is no longer participating in the program for failing to follow program rules or treatment recommendations, such as consistently missing appointments, abusive behaviors, or lack of engagement. • Petition is a document filed in juvenile court alleging that a juvenile is a delinquent or a status offender and asking that the court assume jurisdiction over the juvenile or that an alleged delinquent be transferred to criminal court for prosecution as an adult. Beginning of the award refers to the Project Period Start Date for your award. You can find this in your award documentation or in JustGrants. Award Closeout is the end of the grant process by which the federal awarding agency determines that the grantee and the federal awarding agency have completed all applicable administrative actions.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-juvenile-drug-treatment-court.pdf

Did you adjust the program plan as described in your application’s proposal narrative? If yes, what adjustments did you make, and why?

Did you experience any challenges during this reporting period that impacted service delivery to program participants? If yes, how did you address the challenges, or do the challenges remain unresolved?

Did you engage with OJJDP training and technical assistance providers this reporting period? If yes, did the providers adequately address your issue?

Did you experience any challenges related to external factors beyond your control during the reporting period that impacted program outcomes? If yes, please describe the challenges.

How would you describe the progress toward your program goals and objectives? PROGRAM QUESTIONS

What services are supported in whole or in part by OJJDP’s grant funds? Select all that apply. Substance Use Disorder Treatment.

  • Code: Q1
  • Requirement: required
  • Definition: Answer options: o Recovery Support Services: o • Substance Use Disorder Treatment Aftercare. • Employment Services. • Education Services. • Housing Assistance. • Mental Health Treatment. • Medical Services. • Trauma Treatment. Mentoring. o Family Engagement. o Other, specify ____ o Substance Use Disorder Treatment usually offer individual, group or family therapy sessions and typically focus on understanding the nature of addiction, becoming drug-free and preventing relapse. Recovery Support Services include a wide variety of non-clinical services designed to assist individuals in their recovery from substance use disorders and mental health issues. Substance Use Disorder Treatment Aftercare usually offer individual, group or family therapy sessions and typically focus on understanding the nature of addiction, becoming drug-free and preventing relapse. Employment services provide essential job-related support to justice- involved youth to help them successfully transition back to the community and find stable employment. Services might include skills training in areas like basic education, career readiness, and specific trades; job search assistance such as resume building and interview coaching; and job placement services to connect youth with employers. Programs also might offer vocational training, apprenticeships, on-the-job training, and career planning. Education services provide academic and vocational training to prepare youth for a successful return to the community, aiming to reduce recidivism by fostering practical skills and facilitating access to post- confinement opportunities. Housing assistance includes services such as transitional housing, help with security deposits and move-in costs, rental assistance, and case management to find stable, affordable accommodations. These services help young people transition into the community, providing a stable foundation to prevent homelessness and support successful reintegration. Mental health treatment refers to a range of therapeutic strategies used to address mental illnesses, mental health conditions, and behavioral health issues, including psychotherapy, medication, support groups, and lifestyle changes, often in a combination approach for a more effective recovery plan. Medical services provide healthcare access to youth, such as treatment for physical health or assistance with health coverage like Medicaid, and promote overall health and reduce the risk of returning to the juvenile justice system by addressing health-related barriers to successful community reintegration. This can include medical or dental care. Trauma treatment involves a mental health treatment approach that recognizes the symptoms and root causes of trauma and provide a safe, supportive environment. These approaches can include range of types of therapy including, but not limited to, Trauma-Focused Cognitive Behavioral Therapy, Cognitive Behavioral Intervention for Trauma in Schools, and Reprocessing, and Cognitive Processing Therapy. Mentoring provides structured relationships where individuals guide and support the personal growth of others. This can also include “Peer Support”. Family Engagement refers to actively engaging participation of families in treatment efforts of the youth target population.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-juvenile-drug-treatment-court.pdf

What is the target population of your program? Select all that apply. Males.

  • Code: Q2
  • Requirement: required
  • Definition: Answer options: o Females. o High Risk. o Medium Risk. o Low Risk. o Other, specify ____ o Target population is the group(s) of people for whom the program is primarily designed and who the program envisions will engage in the program’s services. High Risk means youth experiencing multiple risk factors and have a greater likelihood of committing a crime or reoffending in the near future if they do not receive appropriate services and supervision. Medium Risk is neither low nor high risk. It’s unclear if they require the same services as high-risk youth, but they may need more attention than low risk youth. Low Risk means youth with few risk factors and are unlikely to reoffend or engage in delinquent behavior in the near future.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-juvenile-drug-treatment-court.pdf

What is the lowest age of youth who will be served by your program?

What is the highest age of youth who will be served by your program?

How many unique individuals do you plan to provide services to over the life of the award?

  • Code: Q5
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth program participants. Life of the award refers to the period from the start of the award to the closure of the award. For OJJDP awards, this is typically three years.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-juvenile-drug-treatment-court.pdf

What is the expected duration of your program for each program participant?

How frequently do you expect program participants to engage with your program? Daily.

What assessment tool or approach will you use to measure outcomes?

  • Code: Q8
  • Requirement: required
  • Definition: Program participant refers to an individual who started a program. Outcomes refer to the specific, measurable benefits or changes in program participants that occur during or after their involvement in the program's activities. Examples include reduced substance use, increased stability, improved mental health, increased prosocial behaviors.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-juvenile-drug-treatment-court.pdf

How is the information obtained for youth with a new adjudication? Select all that apply. The grantee is a criminal justice agency such as the o department of juvenile justice or probation and has access to this information. The grantee has a memorandum of understanding (MOU), o a memorandum of agreement (MOA), or a linkage agreement with an agency that has access to this information. The grantee conducts public records searches online.

Office of Juvenile Justice and Delinquency Prevention (DOJ OJP), Opioid Affected Youth Initiative Program

How many unique individuals started the program during this reporting period?

  • Code: Q1
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth or their family members who participate in the program. Starting a program can be defined differently in the context of your program. For example, starting a program can mean a formal agreement to participate in the program, or the first action an individual takes toward engaging with the program's services. Program refers to the specific set of activities that are carried out by the award recipient and supported by OJJDP award funds, in whole or in part. Reporting period refers to the specific timeframe covered by this report.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-opioid-affected-youth-initiative.pdf

How many unique individuals were discharged from the program during this reporting period?

  • Code: Q2
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth or their family members who participate in the program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through the program. Program refers to the specific set of activities that are carried out by the award recipient and supported by OJJDP award funds, in whole or in part. Reporting period refers to the specific timeframe covered by this report.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-opioid-affected-youth-initiative.pdf

How many unique individuals were discharged from the program since the beginning of the award?

  • Code: Q3
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth or their family members who participate in the program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Program refers to the specific set of activities that are carried out by the award recipient and supported by OJJDP award funds, in whole or in part. Beginning of the award refers to the Project Period Start Date for your award. You can find this in your award documentation or in JustGrants.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-opioid-affected-youth-initiative.pdf

How many unique individuals were tested for substance use during this reporting period?

  • Code: Q4
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth or their family members who participate in the program. Tested for substance use means that a program official or another authorized individual applied a substance use test for the program participant. Reporting period refers to the specific timeframe covered by this report.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-opioid-affected-youth-initiative.pdf

Did you adjust the program pla n a s describe d in yo ur applicatio n’s propo sa l nar rativ e? If yes, wha t a djus tment s did you m ake, and why? Yes:

Did you experience any challenges during this reporting period that impacted service delivery to program participants? If yes, how did you address the challenges or do the challenges remain unresolved? Yes:

Did you engage with OJJDP training and technical assistance providers this reporting period? If yes, did the providers adequately address your issue? Yes:

Of the unique individuals discharged during this reporting period, how many were discharged successfully?

  • Code: Q8
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth or their family members who participate in the program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Successful means the program participant has met your program’s requirements, such as completing assessments or prescribed treatment, or participating for an expected minimum duration. Reporting period refers to the specific timeframe covered by this report.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-opioid-affected-youth-initiative.pdf

Of the unique individuals discharged during this reporting period, how many were discharged unsuccessfully?

  • Code: Q9
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth or their family members who participate in the program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Unsuccessful discharges refers to individuals discharged for a reason other than successful program completion, such as a discharge due to loss of contact, removal, new petition, or new charge. • Loss of contact means a youth in the program stops communicating with the program or fails to attend required appointments. • Removed means the exiting program participant is no longer participating in the program for failing to follow program rules or treatment recommendations, such as consistently missing appointments, abusive behaviors, or lack of engagement. • Petition is a document filed in juvenile court alleging that a juvenile is a delinquent or a status offender and asking that the court assume jurisdiction over the juvenile, or that an alleged delinquent be transferred to criminal court for prosecution as an adult. • Charge refers to a new criminal charge filed in criminal court stating that a law enforcement agency or prosecutor has formally accused an individual of violating a criminal statute, initiating a legal process that could result in conviction, fines, or incarceration. Reporting period refers to the specific timeframe covered by this report
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-opioid-affected-youth-initiative.pdf

Of the unique individuals discharged during this reporting period, how many were discharged for another reason?

  • Code: Q10
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth or their family members who participate in the program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Other discharge statuses could include transferred, authorized departure, or withdrawal: • Transferred means the exiting program participant moved from one service or program, or from one provider, location, or system, to another. • Authorized departure means the youth left the program for circumstances beyond their control but were successful up to departure (i.e. moved out of area, conflict with another program, employment, etc.). • Withdrew means the exiting program participant officially or unofficially stopped participating in the program; this is an authorized departure. Reporting period refers to the specific timeframe covered by this report.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-opioid-affected-youth-initiative.pdf

Of the unique individuals discharged since the beginning of the award, how many were discharged successfully?

  • Code: Q11
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth or their family members who participate in the program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Successful means the program participant met your program’s requirements, such as completing assessments or prescribed treatment, or participating for an expected minimum duration. Beginning of the award refers to the Project Period Start Date for your award. You can find this in your award documentation or in JustGrants.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-opioid-affected-youth-initiative.pdf

Of the unique individuals discharged since the beginning of the award, how many were discharged unsuccessfully?

  • Code: Q12
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth or their family members who participate in the program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Unsuccessful discharges refers to individuals discharged for a reason other than successful program completion, such as a discharge due to loss of contact, removal, new petition, or new charge. • Loss of contact means a youth in the program stops communicating with the program or fails to attend required appointments. • Removed means the exiting program participant is no longer participating in the program for failing to follow program rules or treatment recommendations, such as consistently missing appointments, abusive behaviors, or lack of engagement. • Petition is a document filed in juvenile court alleging that a juvenile is a delinquent or a status offender and asking that the court assume jurisdiction over the juvenile, or that an alleged delinquent be transferred to criminal court for prosecution as an adult. • Charge refers to a new criminal charge stating that a law enforcement agency or prosecutor has formally accused an individual of violating a criminal statute, initiating a legal process that could result in conviction, fines, or incarceration. Beginning of the award refers to the Project Period Start Date for your award. You can find this in your award documentation or in JustGrants.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-opioid-affected-youth-initiative.pdf

Of the unique individuals successfully discharged this reporting period, how many demonstrated satisfactory well-being at program exit?

  • Code: Q13
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth or their family members who participate in the program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Well-being refers to the individual’s overall physical and behavioral health. Reporting period refers to the specific timeframe covered by this report.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-opioid-affected-youth-initiative.pdf

Of the unique individuals successfully discharged during this reporting period, how many demonstrated reduced substance use at program exit?

  • Code: Q14
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth or their family members who participate in the program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Successful means the program participant met your program’s requirements, such as completing assessments or prescribed treatment, or participating for an expected minimum duration. Substance use refers to the use of selected substances, including alcohol, tobacco products, illicit drugs, inhalants, and other substances that can be consumed, inhaled, injected, or otherwise absorbed into the body, possibly resulting in dependence and other detrimental effects.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-opioid-affected-youth-initiative.pdf

During the reporting period, did you experience any challenges related to external factors beyond your control that impacted program outcomes? If yes, please describe the challenges. Yes:

How would you describe progress made toward this award's goals and objectives? Not started

Of the unique individuals successfully discharged since the beginning of the award, how many experienced a new adjudication or conviction within 12 months of discharge?

  • Code: Q17
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth or their family members who participated in the program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Successful means the program participant met your program’s requirements, such as completing assessments or prescribed treatment, or participating for an expected minimum duration. Adjudication refers to the juvenile court process that determines if a juvenile committed the act for which he or she is charged. The term "adjudicated" indicates that the court concluded the juvenile committed the act. Conviction refers to the court process that determines if the individual committed the act for which he or she is charged. The term "convicted" indicates that the court concluded the individual committed the act. Beginning of the award refers to the Project Period Start Date for your award. You can find this in your award documentation or in JustGrants. Project period end date is the end of the grant activity period. The project period end date can be found in your award documents or JustGrants.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-opioid-affected-youth-initiative.pdf

Of the unique individuals unsuccessfully discharged since the beginning of the award, how many experienced a new adjudication or conviction within 12 months of discharge?

  • Code: Q18
  • Requirement: required
  • Definition: Answer options: o Opioid and other substance use treatment services o Opioid and other substance testing o Opioid and other substance use recovery services o Caregiver engagement o Family support services o Family reunification services o Youth mental healthcare o Youth development programs o Community coordination o Other, specify: ____ o Unique means unduplicated. Individuals should only be counted once. Unique individuals should not be counted in more than one reporting period. Individuals refers to youth or their family members who participated in the program. Discharged means the program participant is no longer participating in services or receiving services directly from or indirectly through your program. Unsuccessful discharges refers to individuals discharged for a reason other than successful program completion, such as a discharge due to loss of contact, removal, new petition, or new charge. • Loss of contact means a youth in the program stops communicating with the program or fails to attend required appointments. • Removed means the exiting program participant is no longer participating in the program for failing to follow program rules or treatment recommendations, such as consistently missing appointments, abusive behaviors, or lack of engagement. • Petition is a document filed in juvenile court alleging that a juvenile is a delinquent or a status offender and asking that the court assume jurisdiction over the juvenile, or that an alleged delinquent be transferred to criminal court for prosecution as an adult. • Charge refers to a new criminal charge stating that a law enforcement agency or prosecutor has formally accused an individual of violating a criminal statute, initiating a legal process that could result in conviction, fines, or incarceration. Adjudication refers to the juvenile court process that determines if a juvenile committed the act for which he or she is charged. The term "adjudicated" indicates that the court concluded the juvenile committed the act. Conviction refers to the court process that determines if the individual committed the act for which he or she is charged. The term "convicted" indicates that the court concluded the individual committed the act. Beginning of the award refers to the Project Period Start Date for your award. You can find this in your award documentation or in JustGrants. Project period end date is the end of the grant activity period. The project period end date can be found in your award documents or JustGrants. DEFINITIONS Opioid or other substance use prevention education teaches individuals the skills and knowledge to avoid substance use, misuse, and addiction by focusing on the risks of substance use, building positive life skills, and promoting healthy choices. It utilizes comprehensive, often interactive, and evidence-based programs that go beyond simple information delivery, including skill-building in areas like decision-making and stress management. Opioid or other substance use treatment services usually offer individual, group, or family therapy sessions and typically focus on understanding the nature of addiction, becoming drug-free, and preventing relapse. Opioid and other substance use testing looks for the presence or absence of specific drugs in a biological sample, such as urine. As a tool in substance use treatment programs, drug testing can monitor a program participant’s progress and inform their treatment. Opioid or other substance recovery services include wrap-around services, such as care coordination, mentoring, coaching, educational support, job readiness and training, public transportation, and other services to support and sustain recovery. Caregiver engagement refers to programs and strategies designed to build partnerships with and provide support to family and unpaid caregivers, integrating them as active partners in the care of youth or family members. These services aim to address caregivers' unique needs, offer practical and emotional support, provide education and resources, and improve communication between caregivers, recipients of care or services, and providers with the aim of enhancing overall care or service outcomes. Family support services are community-based resources that assist families in promoting their members' well-being and stability. Examples include counseling, peer mentoring, navigation of social services, respite care, and support for families in caring for a child with a developmental or behavioral challenge. Family reunification services provide support to children separated from their families and to the families themselves, aiming to safely and appropriately reunite them by addressing the circumstances of the separation and strengthening family bonds. These services might include resources like counseling, case management, housing assistance, education, or legal services. Youth mental healthcare refers to a range of therapeutic strategies used to address mental illnesses, mental health conditions, and behavioral health issues, including psychotherapy, medication, support groups, and lifestyle changes. These approaches are often combined to create a more effective recovery plan. Youth development programs are structured initiatives that support the positive growth of young people by building their social, emotional, and cognitive competencies. Rather than focusing solely on preventing risky behaviors, these programs focus on nurturing individual strengths and potential to prepare youth for adulthood. Common examples include after-school programs, mentoring, sports leagues, and educational workshops, which foster skills like leadership, communication, resilience, and community involvement Community coordination is a collaborative process where groups in the community work together to identify community needs, share resources, and implement solutions to improve overall community well-being.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-opioid-affected-youth-initiative.pdf

What is the target population of the program? Select all that apply. Youth

  • Code: Q2
  • Requirement: required
  • Definition: Answer options: o Family members o Other, specify: ____ o The target population is the group(s) for whom the program is primarily designed, whom the program envisions will participate in the program’s services. Family members can include siblings, parents, and extended family members such as grandparents, aunts, uncles, and cousins, or individuals identified by youth as family members.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-opioid-affected-youth-initiative.pdf

How many individuals does the program plan to serve over the life of the award?

  • Code: Q3
  • Requirement: required
  • Definition: Unique means unduplicated. Individuals should only be counted once during a six-month reporting period, regardless of the number of matches they may have been involved in. Individuals refers to youth or their family members who participated in the program. Life of the award refers to the period from the start of the award to the closure of the award. For OJJDP awards, this is typically 3 years.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-opioid-affected-youth-initiative.pdf

What is the minimum length of participation for each program participant?

What is the frequency of participation expected for each program participant? Daily

What tool or approach will the program use to assess outcomes for program participants?

What types of capacity building will the program provide over the life of the award? Select all that apply. Community capacity building

  • Code: Q7
  • Requirement: required
  • Definition: Answer options: o Organizational capacity building o Individual capacity building o Other, specify: ____ o Community capacity building involves identifying and/or implementing strategies that can galvanize the community toward greater capacity to address the impacts of opioids and other substance use. Examples include: • Coalition building, network development, stakeholder engagement, and partnership management. • Collaborating with other organizations to improve services, create efficiencies, and eliminate duplication. • Delivery and sharing of tools, resources, and training developed by technical assistance providers and subject matter experts. • Expansion of best practices and leveraging successful models and strategies. Organizational capacity building is the strategic, ongoing process of strengthening organizational systems, structures, skills, and resources to improve performance, sustainability, and ability to achieve the organizational mission. Examples include: • Enhancing staff knowledge, skills, and leadership capabilities. • Upgrading technology, software, and internal processes. • Refining organizational goals, governance, and business models. • Securing financial, technical, and material resources to ensure long-term viability. Individual capacity building refers to strengthening the skills, resources, and abilities of staff of local organizations, thereby furthering their capacity to contribute to the development of their organizations and addressing opioid and substance use. Examples include training, mentorship, and skills development of staff or organizational leaders to improve program and service provision. Life of the award refers to the period from the start of the award to the closure of the award. For OJJDP awards, this is typically 3 years.
  • Target rule: No target rule stated
  • Source: DOJ Office of Justice Programs, solicitation performance measures, https://ojjdp.ojp.gov/funding/performance-measures/pmqd/performance-measures-opioid-affected-youth-initiative.pdf

Substance Abuse and Mental Health Services Administration (SAMHSA), SAMHSA First Responders – Comprehensive Addiction and Recovery Act (FR-CARA)

Estimated number of naloxone kits to be purchased:

Estimated number of naloxone kits to be distributed:1

Estimated number of naloxone kits to be distributed to…

  • Code: ATR-3
  • Requirement: required
  • Definition: a. Professional first responders: b. Other key community sector members: c. Nontraditional community sector members:
  • Instrument: CORT
  • Reporting frequency: annual
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 4, https://www.samhsa.gov/sites/default/files/gpra-cort-fr-cara.pdf

Estimated number of professional first responders to be equipped with naloxone kits:

Estimated number of other key community sector members to be equipped with naloxone kits:

Estimated number of nontraditional community sector members to be equipped with naloxone kits: Naloxone training

Estimated number of professional first responders to be trained on…

  • Code: ATR-7
  • Requirement: required
  • Definition: a. Naloxone administration: b. Safety around fentanyl, carfentanil and other dangerous and illicit drugs: c. Establishing policies and procedures for the implementation of evidence-based trauma-informed care practices:
  • Instrument: CORT
  • Reporting frequency: annual
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-cort-fr-cara.pdf

Estimated number of other key community sector members to be trained on…

  • Code: ATR-8
  • Requirement: required
  • Definition: a. Naloxone administration: b. Safety around fentanyl, carfentanil and other dangerous and illicit drugs: c. Establishing policies and procedures for the implementation of evidence-based trauma-informed care practices:
  • Instrument: CORT
  • Reporting frequency: annual
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-cort-fr-cara.pdf

Estimated number of nontraditional community sector members to be trained on…

  • Code: ATR-9
  • Requirement: required
  • Definition: a. Naloxone administration: b. Safety around fentanyl, carfentanil and other dangerous and illicit drugs: c. Establishing policies and procedures for the implementation of evidence-based trauma-informed care practices:
  • Instrument: CORT
  • Reporting frequency: annual
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-cort-fr-cara.pdf

Total number of naloxone kits purchased: ____

Total number of naloxone kits distributed:2

  • Code: QPR-2
  • Requirement: required
  • Definition: a. Number of naloxone kits distributed to professional first responders: b. Number of naloxone kits distributed to other key community sector members: c. Number of naloxone kits distributed to nontraditional community sector members: d. Number of naloxone kits distributed to other community members:
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 6, https://www.samhsa.gov/sites/default/files/gpra-cort-fr-cara.pdf

Number of professional first responders equipped with naloxone kits:

Number of other key community sector members equipped with naloxone kits:

Number of nontraditional community sector members equipped with naloxone kits:

Number of other community members equipped with naloxone kits following an opioid- related overdose event: Naloxone Training

Number of professional first responders trained on…

  • Code: QPR-7
  • Requirement: required
  • Definition: a. Naloxone administration: b. Safety around fentanyl, carfentanil and other dangerous and illicit drugs: c. Establishing policies and procedures for the implementation of evidence-based trauma-informed care practices:
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 7, https://www.samhsa.gov/sites/default/files/gpra-cort-fr-cara.pdf

Number of other key community sector members trained on…

  • Code: QPR-8
  • Requirement: required
  • Definition: a. Naloxone administration: b. Safety around fentanyl, carfentanil and other dangerous and illicit drugs: c. Establishing policies and procedures for the implementation of evidence-based trauma-informed care practices:
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 7, https://www.samhsa.gov/sites/default/files/gpra-cort-fr-cara.pdf

Number of nontraditional community sector members trained on…

  • Code: QPR-9
  • Requirement: required
  • Definition: a. Naloxone administration: b. Safety around fentanyl, carfentanil and other dangerous and illicit drugs: c. Establishing policies and procedures for the implementation of evidence-based trauma-informed care practices: Immediate outcomes following known or suspected opioid overdose events
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 7, https://www.samhsa.gov/sites/default/files/gpra-cort-fr-cara.pdf

Total number of known or suspected opioid overdose events: Events involving naloxone administration by professional first responders

  • Code: QPR-10
  • Requirement: required
  • Definition: a. Number of events where naloxone was administered by professional first responders by outcome (1) Opioid overdose reversal: (2) Death: (3) Not an opioid overdose: (4) Unknown: [If II.B.10.a(4) = 0, then skip to II.B.10.b] (4a) Please explain why outcomes are unknown: b. Total number of naloxone doses administered by professional first responders: ____ Events involving naloxone administration by other key community sector members c. Number of events where naloxone was administered by other key community sector members by outcome (1) Opioid overdose reversal: (2) Death: (3) Not an opioid overdose: (4) Unknown: [If II.B.10.c(4) = 0, then skip to II.B.10.d] (4a) Please explain why outcomes are unknown: d. Total number of naloxone doses administered by other key community sector members: ____ Events involving naloxone administration by nontraditional community sector members e. Number of events where naloxone was administered by nontraditional community sector members by outcome (5) Opioid overdose reversal: (6) Death: (7) Not an opioid overdose: (8) Unknown: [If II.B.10.e(4) = 0, then skip to II.B.10.f] (4a) Please explain why outcomes are unknown: f. Total number of naloxone doses administered by nontraditional key community sector members: ____ Information on and linkages to additional services
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 8, https://www.samhsa.gov/sites/default/files/gpra-cort-fr-cara.pdf

Number of opioid overdose survivors who…

  • Code: QPR-11
  • Requirement: required
  • Definition: a. Received information about treatment services: b. Received information about recovery support services: c. Were linked to services:
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 9, https://www.samhsa.gov/sites/default/files/gpra-cort-fr-cara.pdf

Number of opioid overdose family members who…

  • Code: QPR-12
  • Requirement: required
  • Definition: a. Received information about treatment services: b. Received information about recovery support services: c. Were linked to services: Responses to service requests
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 9, https://www.samhsa.gov/sites/default/files/gpra-cort-fr-cara.pdf

Total number of responses to service requests: ____

  • Code: QPR-13
  • Requirement: required
  • Definition: a. Number of responses provided by grantee organization: b. Number of responses provided by other entities:
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 9, https://www.samhsa.gov/sites/default/files/gpra-cort-fr-cara.pdf

Substance Abuse and Mental Health Services Administration (SAMHSA), SAMHSA Grants to Prevent Prescription Drug/Opioid Overdose-Related Deaths (PDO)

Percent of total award budgeted for naloxone product purchases: %

Amount budgeted for purchase of naloxone products by type

Estimated number of naloxone kits to be distributed to high need communities:1

Estimated number of naloxone kits to be distributed to…

  • Code: ATR-4
  • Requirement: required
  • Definition: a. Professional first responders: b. Other key community sector members: c. Nontraditional community sector members: d. Other community members: Education/training
  • Instrument: CORT
  • Reporting frequency: annual
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-cort-pdo.pdf

Estimated number of trainings to be conducted on opioid overdose death prevention strategies: ____

Estimated number of individuals to be trained on opioid overdose death prevention strategies by participant type

  • Code: ATR-6
  • Requirement: required
  • Definition: a. Professional first responders: b. Other key community sector members: c. Nontraditional community sector members: d. Other community members:
  • Instrument: CORT
  • Reporting frequency: annual
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-cort-pdo.pdf

Estimated number of individuals to be trained on use of naloxone by participant type2

  • Code: ATR-7
  • Requirement: required
  • Definition: a. Professional first responders: b. Other key community sector members: c. Nontraditional community sector members: d. Other community members:
  • Instrument: CORT
  • Reporting frequency: annual
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-cort-pdo.pdf

Estimated number of medical professionals to be trained on risks of overprescribing:

Percent of total grant funds spent on naloxone product purchases: %

Amount of award funds spent on naloxone product purchases by type

  • Code: QPR-2
  • Requirement: required
  • Definition: a. Injectable: $ b. Auto-injector: $ c. Intranasal spray: $
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 6, https://www.samhsa.gov/sites/default/files/gpra-cort-pdo.pdf

Total number of naloxone kits distributed to high need communities using PDO grant-funded resources:3

  • Code: QPR-3
  • Requirement: required
  • Definition: a. Number of PDO grant-purchased naloxone kits distributed: ____ b. Number of non-PDO grant-purchased naloxone kits distributed: ____
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 6, https://www.samhsa.gov/sites/default/files/gpra-cort-pdo.pdf

Number of naloxone kits distributed to…

  • Code: QPR-4
  • Requirement: required
  • Definition: a. Professional first responders: b. Other key community sector members: c. Nontraditional community sector members: d. Other community members: Education/training
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 7, https://www.samhsa.gov/sites/default/files/gpra-cort-pdo.pdf

Total number of trainings conducted on opioid overdose death prevention strategies:

Number of individuals trained on opioid overdose death prevention strategies by participant type

  • Code: QPR-6
  • Requirement: required
  • Definition: a. Professional first responders: b. Other key community sector members: c. Nontraditional community sector members: d. Other community members:
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 7, https://www.samhsa.gov/sites/default/files/gpra-cort-pdo.pdf

Number of individuals trained on use of naloxone by participant type4

  • Code: QPR-7
  • Requirement: required
  • Definition: a. Professional first responders: b. Other key community sector members: c. Nontraditional community sector members: d. Other community members:
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 7, https://www.samhsa.gov/sites/default/files/gpra-cort-pdo.pdf

Number of medical professionals trained on risks of overprescribing:

Total number of known or suspected opioid overdose events:

Number of naloxone administration events by participant type

  • Code: QPR-10
  • Requirement: required
  • Definition: a. Professional first responders: b. Other key community sector members: c. Nontraditional community sector members: d. Other community members:
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 8, https://www.samhsa.gov/sites/default/files/gpra-cort-pdo.pdf

Number of naloxone doses administered:

Number of naloxone administration events by location

  • Code: QPR-12
  • Requirement: required
  • Definition: a. At a private residence: b. In a public outdoor location (e.g., street, park), car, camp, or shelter: c. At an indoor public place/business (including hotel/motel): d. Unknown: e. Other (please specify):
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 8, https://www.samhsa.gov/sites/default/files/gpra-cort-pdo.pdf

Number of events where naloxone was administered by professional first responders by outcome

  • Code: QPR-13
  • Requirement: required
  • Definition: a. Opioid overdose reversal: b. Death: c. Not an opioid overdose: d. Unknown: [If II.B.13.d = 0, then skip to II.B14] d.1. Please explain why outcomes are unknown:
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 8, https://www.samhsa.gov/sites/default/files/gpra-cort-pdo.pdf

Number of events where naloxone was administered by other key community sector members by outcome

  • Code: QPR-14
  • Requirement: required
  • Definition: a. Opioid overdose reversal: b. Death: c. Not an opioid overdose: d. Unknown: [If II.B.14.d = 0, then skip to II.B15] d.1. Please explain why outcomes are unknown: Information, referrals and linkages following naloxone administration
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 8, https://www.samhsa.gov/sites/default/files/gpra-cort-pdo.pdf

Number of referrals for naloxone-related information and resources:

Number of referrals to substance use disorder treatment services:

Number of individuals linked to treatment or recovery support services following successful overdose reversal administration:

Substance Abuse and Mental Health Services Administration (SAMHSA), SAMHSA Improving Access to Overdose Treatment (ODTA)

Estimated number of individuals expected to complete Training of Trainers (ToT) primary training: [If I.B.1 = 0, then skip to I.B.4]

Estimated number of individuals expected to complete ToT primary training by participant type

  • Code: ATR-2
  • Requirement: required
  • Definition: a. Prescribing health care providers (1) Physicians: (2) Physician assistants: (3) Nurse practitioners: (4) Dentists: b. Pharmacists: c. Non-prescribing service providers: d. Other individuals: [If I.B.2.d = 0 , then skip to I.B.4]
  • Instrument: CORT
  • Reporting frequency: annual
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 4, https://www.samhsa.gov/sites/default/files/gpra-cort-odta.pdf

Estimated number of other individuals expected to complete the ToT primary training by specified type

  • Code: ATR-3
  • Requirement: required
  • Definition: a. (Specified other type 1): b. (Specified other type 2): x. (Specified other type x):
  • Instrument: CORT
  • Reporting frequency: annual
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-cort-odta.pdf

Estimated number of individuals expected to complete ToT secondary training:

Estimated number of individuals expected to complete ToT secondary training by participant type

  • Code: ATR-5
  • Requirement: required
  • Definition: a. Prescribing health care providers (1) Physicians: (2) Physician assistants: (3) Nurse practitioners: (4) Dentists: b. Pharmacists: c. Non-prescribing service providers: d. Other individuals: [If I.B.5.d = 0 , then skip to I.B.7]
  • Instrument: CORT
  • Reporting frequency: annual
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-cort-odta.pdf

Estimated number of other individuals expected to complete ToT secondary training by specified type

  • Code: ATR-6
  • Requirement: required
  • Definition: a. (Specified other type 1): b. (Specified other type 2): xc.. (Specified other type x):
  • Instrument: CORT
  • Reporting frequency: annual
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-cort-odta.pdf

Estimated number of service providers to be trained on prescribing naloxone by service provider type

  • Code: ATR-7
  • Requirement: required
  • Definition: a. Physicians: b. Physician assistants: c. Nurse practitioners: d. Pharmacists: e. Dentists: f. Other service providers:
  • Instrument: CORT
  • Reporting frequency: annual
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 6, https://www.samhsa.gov/sites/default/files/gpra-cort-odta.pdf

Estimated number of other service providers to be trained on prescribing naloxone by specified type

  • Code: ATR-8
  • Requirement: required
  • Definition: a. (Specified other type 1): b. (Specified other type 2): xc.. (Specified other type x): Projected naloxone-related spending and distribution For reporting purposes, “naloxone” refers to naloxone or other FDA-approved opioid overdose-reversing medication or device.
  • Instrument: CORT
  • Reporting frequency: annual
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 6, https://www.samhsa.gov/sites/default/files/gpra-cort-odta.pdf

Estimated amount of award funds to be spent on naloxone purchases by type

Estimated amount of award funds to be spent on…

Estimated number of naloxone kits to be distributed:1

Number of trainings conducted by ToT type

  • Code: QPR-1
  • Requirement: required
  • Definition: a. Primary trainings: b. Secondary trainings: c. Tertiary trainings: [If II.B.1.a = 0 and II.B.1.b ≠ 0, then skip to II.B.5] [If II.B.1.a = 0 and II.B.1.b = 0, then skip to II.B.7]
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 7, https://www.samhsa.gov/sites/default/files/gpra-cort-odta.pdf

Number of individuals who completed ToT primary trainings:

Number of individuals who completed ToT primary trainings by participant type

  • Code: QPR-3
  • Requirement: required
  • Definition: a. Prescribing health care providers (1) Physicians: (2) Physician assistants: (3) Nurse practitioners: (4) Dentists: b. Pharmacists: c. Non-prescribing service providers: d. [Other type 1 specified in ATR]: e. [Other type 2 specified in ATR]: x. [Other type X specified in ATR]: y. Other individuals: [If II.B.3.y = 0 and II.B.1.b ≠ 0, then skip to II.B.5] [If II.B.3.y = 0 and II.B.1.b = 0, then skip to II.B.7]
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 7, https://www.samhsa.gov/sites/default/files/gpra-cort-odta.pdf

Number of other individuals who completed ToT primary trainings by specified type

  • Code: QPR-4
  • Requirement: required
  • Definition: a. (Specify other type 1): b. (Specify other type 2): x. (Specify other type X): [If II.B.1.a ≠ 0 and II.B.1.b = 0, then skip to II.B.7]
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 8, https://www.samhsa.gov/sites/default/files/gpra-cort-odta.pdf

Number of individuals who completed ToT secondary trainings by participant type

  • Code: QPR-5
  • Requirement: required
  • Definition: a. Prescribing health care providers (1) Physicians: (2) Physician assistants: (3) Nurse practitioners: (4) Dentists: b. Pharmacists: c. Non-prescribing service providers: d. [Other type 1 specified in ATR]: e. [Other type 2 specified in ATR]: x. [Other type X specified in ATR]: y. Other individuals: [If II.B.5.y = 0, then skip to II.B.7]
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 8, https://www.samhsa.gov/sites/default/files/gpra-cort-odta.pdf

Number of individuals who completed ToT secondary trainings by specified type

  • Code: QPR-6
  • Requirement: required
  • Definition: a. (Specify other type 1): b. (Specify other type 2): cx.. (Specify other type X):
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 9, https://www.samhsa.gov/sites/default/files/gpra-cort-odta.pdf

Number of service providers trained on prescribing naloxone by service provider type

  • Code: QPR-7
  • Requirement: required
  • Definition: a. Prescribing health care providers (1) Physicians: (2) Physician assistants: (3) Nurse practitioners: (4) Dentists: b. Pharmacists: c. [Other type 1 specified in ATR]: d. [Other type 2 specified in ATR]: x. [Other type X specified in ATR]: y. Other service providers: [If II.B.7.y = 0, then skip to II.B.9]
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 9, https://www.samhsa.gov/sites/default/files/gpra-cort-odta.pdf

Number of other service providers trained on prescribing naloxone by specified type

  • Code: QPR-8
  • Requirement: required
  • Definition: a. (Specify other type 1): b. (Specify other type 2): x. (Specify other type x): Naloxone-related spending and distribution For reporting purposes, “naloxone” refers to naloxone or other FDA-approved opioid overdose-reversing medication or device.
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 9, https://www.samhsa.gov/sites/default/files/gpra-cort-odta.pdf

Amount of award funds spent on naloxone purchases by type

Amount of award funds spent on…

Total number of naloxone kits distributed using ODTA grant-funded resources:2____

  • Code: QPR-11
  • Requirement: required
  • Definition: a. Number of ODTA grant-purchased naloxone kits distributed: b. Number of non-ODTA grant-purchased naloxone kits distributed:
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 10, https://www.samhsa.gov/sites/default/files/gpra-cort-odta.pdf

Number of events where naloxone was administered by ToT-trained individuals by outcome

  • Code: QPR-12
  • Requirement: required
  • Definition: a. Opioid overdose reversal: b. Death: c. Not an opioid overdose: d. Unknown: [If II.B.12.d = 0, then skip to II.B.13] d.1. Please explain why outcomes are unknown:____
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 10, https://www.samhsa.gov/sites/default/files/gpra-cort-odta.pdf

Number of patients linked to treatment services following opioid overdose reversal by service type

  • Code: QPR-13
  • Requirement: required
  • Definition: a. Medication for opioid use disorder (MOUD): b. Counseling: c. Behavioral therapies: d. Recovery support services: e. Other types of treatment services:
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 11, https://www.samhsa.gov/sites/default/files/gpra-cort-odta.pdf

Number of patients who initiated treatment services following an opioid overdose reversal by service type

  • Code: QPR-14
  • Requirement: required
  • Definition: a. Medication for opioid use disorder (MOUD): b. Counseling: c. Behavioral therapies: d. Recovery support services: e. Other types of treatment services:
  • Instrument: CORT
  • Reporting frequency: quarterly
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 11, https://www.samhsa.gov/sites/default/files/gpra-cort-odta.pdf

Substance Abuse and Mental Health Services Administration (SAMHSA), SAMHSA discretionary grants: SUPRT-A Administrative Report

[AT BASELINE] What is the client’s month and year of birth (MM/YYYY)? | | | / | | | | |

What is the date of the assessment (MM/DD/YYYY)? | | | / | | | / | | | | | MONTH DAY YEAR

Which assessment type?

  • Code: A3
  • Requirement: required
  • Definition: Answer categories: Baseline | Reassessment (for clients in care at 3 or 6 months) | Annual (for clients in care for more than 12 months) | Record closeout
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 3, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

[AT BASELINE ASSESSMENT ONLY] When did the client first receive services under this grant (MM/YYYY)? | | | / | | | | |

[AT REASSESSMENT OR ANNUAL OR CLOSEOUT] When did the client most recently receive services under this grant (MM/YYYY)? | | | / | | | | |

[AT RECORD CLOSEOUT] Why are you closing out this client’s record?

  • Code: A6
  • Requirement: required
  • Definition: Answer categories: Completed the program | No contact | Withdrew from/Refused treatment | Referred out | Transferred to a different grant program | Incarceration | Moved | Death | Other
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 3, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

[IF QUESTION A6 IS DEATH] What is the cause of death?

What insurance does the client or guarantor have?

  • Code: B1
  • Requirement: required
  • Definition: Answer categories: SELECT ALL THAT APPLY | Medicare | Medicaid | Private Insurance or Employer Provided | TRICARE, CHAMPUS, CHAMPVA or other veteran or military health care | Indian Health Service Tribal Health Care | An assistance program [for example, a medication assistance program] | Any other type of health insurance or health coverage plan | None | Not documented in records or not documented in records using this standard
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

In the past 30 days, was the client admitted to a hospital?

  • Code: B2
  • Requirement: required
  • Definition: Answer categories: Yes – Behavioral health reasons, for example mental health or substance use disorder | Yes – other health reasons, for example injury or illness | No | Not documented in records or not documented in records using this standard
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

In the past 30 days, did the client visit an emergency department?

  • Code: B3
  • Requirement: required
  • Definition: Answer categories: Yes – Behavioral health reasons, for example mental health or substance use disorder | Yes – other health reasons, for example injury or illness | No | Not documented in records or not documented in records using this standard
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

In the past 30 days, did the client experience a behavioral health crisis or request crisis response, for example from 988 or 911?

[IF QUESTION B4 IS YES] What is the primary crisis issue?

  • Code: B4a
  • Requirement: required
  • Definition: Answer categories: Suicide risk | Other risk of harm to self or others (e.g. NSSI, homicidal thoughts) | Mental health | Substance use other than overdose | Overdose | Other | Not documented in records or not documented in records using this standard
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

In the past 30 days, did the client spend one or more nights at a residential behavioral health treatment facility, for example crisis stabilization or residential substance use disorder treatment facility, including for withdrawal management?

[CLIENTS 11 YEARS OR OLDER ONLY] In the past 90 days, was the client arrested, taken into custody, or detained?

  • Code: B6
  • Requirement: required
  • Definition: Answer categories: Yes | No | Not applicable | Not documented in records or not documented in records using this standard
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 6, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

[CLIENTS 11 YEARS OR OLDER ONLY] In the past 90 days, did the client spend one or more nights in jail or a correctional facility?

  • Code: B7
  • Requirement: required
  • Definition: Answer categories: Yes | No | Not applicable | Not documented in records or not documented in records using this standard
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 6, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

[CLIENTS 11 YEARS OR OLDER ONLY] In the past 90 days, has the client been on probation, parole, or intensive pretrial supervision for one or more days?

  • Code: B8
  • Requirement: required
  • Definition: Answer categories: Yes | No | Not applicable | Not documented in records or not documented in records using this standard
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 6, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

Within the past 30 days, was the client screened or assessed by your program for risk of suicidality?

  • Code: C1
  • Requirement: required
  • Definition: Answer categories: Yes – Screening result was negative (no or low risk) | Yes – Screening result was positive (at risk) | No, not screened or assessed | Not documented in records or not documented in records using this standard
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 7, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

Within the past 30 days, was the client screened or assessed by your program for substance use?

  • Code: C2
  • Requirement: required
  • Definition: Answer categories: Yes – Screening result was negative (no or low risk for substance use disorder (SUD)) | Yes – Screening result was positive (at risk for SUD) | No, not screened or assessed | Not documented in records or not documented in records using this standard
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 7, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

[IF QUESTION C2 IS “YES”] During the screening and assessment process, what was the reported use for the following substances? Recent use Past use (within the past (greater than Not Substance 30 days) 30 days) Never used documented a. Alcohol ...

  • Code: C3
  • Requirement: required
  • Definition: Item text continues:     b. Opioids ...     c. Cannabis ...     d. Sedative, hypnotic, or anxiolytics ...     e. Cocaine ...     f. Methamphetamine ...     g. Other stimulants ...     h. Hallucinogens or psychedelics ...     i. Inhalants ...     j. Other psychoactive substances ...     k. Tobacco or nicotine ...    
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 7, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

Within the past 30 days, was the client screened or assessed by your program for the following disorders? (Please select one per disorder) Not Screened / documented in Disorder assessed Not screened Not applicable records a. Depression, depressive disorders ...     b.

  • Code: C4
  • Requirement: required
  • Definition: Item text continues: Anxiety disorders ...     c. Bipolar disorders ...     d. Psychosis, psychotic disorders ...     e. Trauma disorders, including PTSD ...     f. [IF CLIENT < 18 YEARS] Answer categories: Developmental, neurologic disorders ... | g. [IF CLIENT < 18 YEARS] | Behavioral and emotional...
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 8, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

Substance use disorder diagnosis (record up to 3) Enter ICD-10-CM/DSM-5 code F10-F19- or indicate no diagnosis | | | | | Enter ICD-10-CM/DSM-5 code F10-F19- or indicate no diagnosis | | | | | Enter ICD-10-CM/DSM-5 code F10-F19- or indicate no diagnosis | | | | |

Mental health diagnosis (record up to 3) Enter ICD-10-CM/DSM-5 code F20-F99- or indicate no diagnosis | | | | | Enter ICD-10-CM/DSM-5 code F20-F99- or indicate no diagnosis | | | | | Enter ICD-10-CM/DSM-5 code F20-F99- or indicate no diagnosis | | | | |

Other factors influencing health status (record up to 3) Enter ICD-10-CM/DSM-5 code Z55-Z65 or Z69-Z76- or indicate no diagnosis | | | | | Enter ICD-10-CM/DSM-5 code Z55-Z65 or Z69-Z76- or indicate no diagnosis | | | | | Enter ICD-10-CM/DSM-5 code Z55-Z65 or Z69-Z76- or indicate no diagnosis | | |

  • Code: D3
  • Requirement: required
  • Definition: Item text continues: | | Answer categories: No diagnosis | OTHER HEALTH STATUS QUESTIONS | Please indicate additional health status information as applicable and as documented in a clinical record.
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 9, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

Is the client currently pregnant?

  • Code: D4
  • Requirement: required
  • Definition: Answer categories: Yes | No | Not applicable | Not documented in records or not documented in records using this standard
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 9, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

[CLINICAL HIGH RISK PSYCHOSIS CLIENTS ONLY] [AT REASSESSMENT OR ANNUAL] Has the client experienced an episode of psychosis since their last assessment?

[SUBSTANCE USE DISORDER TREATMENT CLIENTS ONLY] In the previous 30 days, did the client experience an overdose or take too much of a substance that resulted in needing supervision or medical attention?

  • Code: D6
  • Requirement: required
  • Definition: Answer categories: Yes | No | Not applicable | Not documented in records or not documented in records using this standard
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 10, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

[IF QUESTION D6 IS YES] After taking too much of a substance or overdosing, what intervention(s) did the client receive?

  • Code: D6a
  • Requirement: required
  • Definition: Answer categories: SELECT ALL THAT APPLY | Naloxone (Narcan) or other opioid overdose reversal medication | Care in an emergency department | Care from a primary care provider | Admission to a hospital | Supervision by someone else | Other | Not applicable | Not documented in records or not documented in records using this standard
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 10, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

[MAI PROGRAM CLIENTS ONLY] Has the client ever tested positive for HIV?

  • Code: D7
  • Requirement: required
  • Definition: Answer categories: Yes, HIV-positive | No, HIV-negative | Not documented in records or not documented in records using this standard
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 10, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

[IF QUESTION D7 IS YES, HIV-INFECTED] Is the client currently on ART?

  • Code: D7a
  • Requirement: required
  • Definition: Answer categories: Yes, currently taking ART | No, not currently taking ART | Not documented in records or not documented in records using this standard
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 10, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

[IF QUESTION D7 IS NO, HIV-NEGATIVE] Is the client currently taking HIV PrEP?

  • Code: D7b
  • Requirement: required
  • Definition: Answer categories: Yes, currently on PrEP | No, not currently on PrEP | Not documented in records or not documented in records using this standard
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 10, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

Has the client ever tested positive for Hepatitis C?

  • Code: D8
  • Requirement: required
  • Definition: Answer categories: Yes, active or previous Hepatitis C infection | No, never had Hepatitis C | Not documented in records or not documented in records using this standard
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 10, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

[IF QUESTION D8 IS YES, ACTIVE OR PREVIOUS HEPATITIS C INFECTION] Is the client currently taking viral Hepatitis C treatment?

  • Code: D8a
  • Requirement: required
  • Definition: Answer categories: Yes, currently taking viral Hepatitis C treatment | No, took treatment and cured | No, Hepatitis C infection naturally cleared without need for treatment | No, not currently taking treatment | Not documented in records or not documented in records using this standard
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 11, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

Since the previous administrative assessment, did the project provide or refer the client for one or more behavioral health services?

If yes, please indicate which: Not No – not documented Yes – Referred for provided or in records / provided service referred unknown a. Case or care management or coordination ...     b. Person- or family-centered treatment planning ...     c.

  • Code: E1a
  • Requirement: required
  • Definition: Item text continues: Substance use psychoeducation ...     d. Mental health psychoeducation ...     e. Mental health therapy ...     f. Co-occurring therapy (substance use & mental health)     g. Group counseling ...     h. Individual counseling ...     i. Family counseling ...     j. Psychiatric rehabilitation services ...     k. Prescription medication for mental health disorder ...     l. Medication for substance use disorder...     m. Intensive day treatment ...     n. Withdrawal management (whether in hospital, Answer categories: residential, or ambulatory) ... | o. After care planning and referrals ...     | p. Co-occurring disorders (including developmental or | neurologic) ...
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 12, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

[IF E1a_l = MEDICATION FOR SUBSTANCE USE DISORDER IS YES – PROVIDED] Indicate medication received Not documented in No – not records / Yes – received received unknown a. Naltrexone ...    b.

  • Code: E2
  • Requirement: required
  • Definition: Item text continues: Extended-release Naltrexone ...    c. Disulfiram ...    d. Acamprosate ...    e. Methadone ...    f. Buprenorphine ...    g. Nicotine cessation therapy (e.g. Nicotine patch, gum, lozenge) ..    h. Bupropion ...    i. Varenicline ...    j. Other ...    CRISIS SERVICES
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 13, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

Since the previous administrative assessment, did the project provide or refer the client for one or more crisis services?

If yes, please indicate which: Not No – not documented in Referred for provided or records / Yes – provided service referred unknown a. Crisis response planning ...     b. Crisis response ...     c.

  • Code: E3a
  • Requirement: required
  • Definition: Item text continues: Crisis stabilization ...     d. Crisis follow-up ...     RECOVERY AND SUPPORT SERVICES
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 13, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

Since the previous administrative assessment, did the project provide or refer the client for one or more recovery support services?

If yes, please indicate which: No – not Not documented Referred for provided or in records / Yes – provided service referred unknown a. Employment support...     b. Family support services, including family peer

  • Code: E4a
  • Requirement: required
  • Definition: Answer categories: support ... | c. Childcare ...     | d. Transportation ...     | e. Education support...     | f. Housing support ...     | g. Recovery housing ...     | h. Spiritual, ceremonial, and/or traditional | activities ... | i. Mutual support groups ...     | j. Peer support specialist services, coaching or | mentoring ... | k. Respite care ...     | l. Therapeutic foster care ...     | INTEGRATED SERVICES
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 14, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

Since the previous administrative assessment, did the project provide or refer the client for one or more integrated services?

If yes, please indicate which: Not No – not documented in Referred for provided or records / Yes – provided service referred unknown a. Primary health care ...     b. Maternal health care or OB/GYN ...     c.

  • Code: E5a
  • Requirement: required
  • Definition: Item text continues: HIV testing ...     d. Viral hepatitis testing ...     e. HIV treatment ...     f. HIV pre-exposure prophylaxis (PrEP) ...     g. Viral hepatitis treatment ...     h. Other STI testing or treatment ...     i. Dental care ...    
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 15, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

What is the client’s race or ethnicity? Select all that apply and enter additional details in the spaces below.

  • Code: F1
  • Requirement: required
  • Definition: Answer categories: White – Provide details below. | German | Irish | English | Italian | Polish | French | Enter, for example, Scottish, Norwegian, Dutch, etc. ____ | Hispanic or Latino – Provide details below. | Mexican or Mexican American | Puerto Rican | Cuban | Salvadoran | Dominican | Colombian | Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc. ____ | Black or African American – Provide details below. | African American | Jamaican | Haitian | Nigerian | Ethiopian | Somali | Enter, for example, Ghanaian, South African, Barbadian, etc. ____ | Asian – Provide details below. | Chinese | Filipino | Asian Indian | Vietnamese | Korean | Japanese | Enter, for example, Pakistani, Cambodian, Hmong, etc. ____ | American Indian or Alaska Native – Provide details below. | Specify, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow | Inupiat Traditional Government, Tlingit, etc. ____ | Middle Eastern or North African – Provide details below. | Lebanese | Iranian | Egyptian | Syrian | Moroccan | Israeli | Enter, for example, Algerian, Iraqi, Kurdish, etc. ____ | Native Hawaiian or Pacific Islander – Provide details below. | Native Hawaiian | Samoan | Chamorro | Tongan | Fijian | Marshallese | Enter, for example, Palauan, Tahitian, Chuukese, etc. ____ | Race/ethnicity not captured in grantee records using detailed OMB categories. | Client/caregiver declined to provide race/ethnicity.
  • Instrument: SUPRT-A
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 16, https://www.samhsa.gov/sites/default/files/gpra-suprt-a-tool.pdf

What is the individual’s sex?

Substance Abuse and Mental Health Services Administration (SAMHSA), SAMHSA discretionary grants: SUPRT-C client/caregiver form

Please choose the option that best applies to you right now:

  • Code: A1
  • Requirement: required
  • Definition: Answer categories: I consider myself to be in recovery from substance use issues | I consider myself to be in recovery from mental health issues | I consider myself to be in recovery from substance use and mental health issues | I do not consider myself to be in recovery for substance use or mental health issues | I prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: annual
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 3, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-annual-tool.pdf

As of right now, please select whether you strongly agree, agree, somewhat agree, somewhat disagree, disagree, or strongly disagree with each statement in the table below. Strongly Somewhat Somewhat Strongly Prefer not Agree Agree Agree Disagree Disagree Disagree to answer a.

  • Code: A2
  • Requirement: required
  • Definition: Item text continues: I am physically fine most days. ...        b. My mental health is fine most Answer categories: days. ... | c. My substance use does not | cause problems in my life. ... | d. I have stable housing. ...        | e. I have a steady job or am | involved in things like school,        | training, or volunteering. ... | f. My life has purpose and | meaning. ... | g. I have enough money to meet | my needs. ... | h. I am proud of the community I | live in and feel a part of it. ... | i. I am supported by the people | around me. ... | j. The future appears bright to me.        | k. I am in control of my life. ...        | l. I bounce back quickly after hard | times. ...
  • Instrument: SUPRT-C
  • Reporting frequency: annual
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 3, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-annual-tool.pdf

On a scale of 0 to 100, if 0 represents no quality of life and 100 is perfect quality of life, how would you rate your quality of life? | | | |

As a result of the services you received, which goals did you make progress on?

  • Code: A4
  • Requirement: required
  • Definition: Answer categories: CHECK ALL THAT APPLY | Improve the symptoms that led me to services (for example distress, anxiety) | Reduce my drug and/or alcohol use | Gain access to medical services I need | Enroll in or finish education (for example GED, degree, vocational training) | Get or maintain a job | Live in stable housing | Be a better parent or caregiver | Improve my friendships and relationships | Comply with court order or avoid contact with the police and/or justice system | Other goal - Please describe: ____ | Prefer not to answer | Thank you for completing this annual assessment form. | Public reporting burden for this collection of information is estimated to average 7 minutes per response. Send | comments regarding this burden estimate, or any other aspect of this collection of information, to the Substance | Abuse and Mental Health Services Administration (SAMHSA) Reports Clearance Officer, Room 15E57B, 5600 | Fishers Lane, Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to | respond to, a collection of information unless it displays a currently valid Office of Management and Budget | (OMB) control number. The control number for this project is 0930-0400. | [OFFICE USE ONLY] RECORD MANAGEMENT – ADULT / CLIENT / ANNUAL | CLIENT ID | | | | | | | | | | | | | SITE ID | | | | | | | | | | | | GRANT ID | | | | | | | | | | 1. Was this assessment conducted with the client/caregiver? | Yes – Client | Yes – Caregiver/Proxy | No | 1a. [IF QUESTION 1 IS YES] When? | | | | / | | | / | | | | | MM / DD / YYYY | 1b. [IF QUESTION 1 IS NO] Why not? Choose the primary reason. | Client/Caregiver was unable to provide consent | Client was not reached for assessment | Client no longer in care
  • Instrument: SUPRT-C
  • Reporting frequency: annual
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 4, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-annual-tool.pdf

What is your race or ethnicity? Select all that apply and enter additional details in the spaces below. Note, you may report more than one group.

  • Code: A1
  • Requirement: required
  • Definition: Answer categories: White – Provide details below. | German | Irish | English | Italian | Polish | French | Enter, for example, Scottish, Norwegian, Dutch, etc. ____ | Hispanic or Latino – Provide details below. | Mexican or Mexican American | Puerto Rican | Cuban | Salvadoran | Dominican | Colombian | Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc. ____ | Black or African American – Provide details below. | African American | Jamaican | Haitian | Nigerian | Ethiopian | Somali | Enter, for example, Ghanaian, South African, Barbadian, etc. ____ | Asian – Provide details below. | Chinese | Filipino | Asian Indian | Vietnamese | Korean | Japanese | Enter, for example, Pakistani, Cambodian, Hmong, etc. ____ | American Indian or Alaska Native – Provide details below. | Specify, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow | Inupiat Traditional Government, Tlingit, etc. ____ | Middle Eastern or North African – Provide details below. | Lebanese | Iranian | Egyptian | Syrian | Moroccan | Israeli | Enter, for example, Algerian, Iraqi, Kurdish, etc. ____ | Native Hawaiian or Pacific Islander – Provide details below. | Native Hawaiian | Samoan | Chamorro | Tongan | Fijian | Marshallese | Enter, for example, Palauan, Tahitian, Chuukese etc. ____
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 3, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-baseline-tool.pdf

What is your sex?

Do you speak a language other than English at home? (If no, please skip to question A4.)

For persons speaking a language other than English (answering yes to the question above): What is this language(s)?

  • Code: A3a
  • Requirement: required
  • Definition: Answer categories: CHECK ALL THAT APPLY | American Sign Language (ASL) | Arabic | Chinese | French | Portuguese | Spanish | Other Language – specify: ____ | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 4, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-baseline-tool.pdf

Have you ever served in the Armed Forces, the Reserves, the National Guard or other Uniformed Services?

Please respond to the following questions about your physical health. Prefer not Yes No to answer a. Are you deaf or do you have serious difficulty hearing? ...    b. Are you blind or do you have serious difficulty seeing, even when wearing

  • Code: A5
  • Requirement: required
  • Definition: Answer categories: glasses? ... | c. Because of a physical, mental, or emotional condition, do you have serious | difficulty concentrating, remembering, or making decisions? ... | d. Do you have serious difficulty walking or climbing stairs? ...    | e. Do you have difficulty dressing or bathing? ...    | f. Because of a physical, mental, or emotional condition, do you have | difficulty doing errands alone such as visiting a doctor’s office or shopping?
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-baseline-tool.pdf

How hard is it for you to pay for the very basics like food, housing, medical care, and heating?

What is your living situation today?

  • Code: B2
  • Requirement: required
  • Definition: Answer categories: I have a steady place to live | I have a place to live today but I am worried about losing it in the future | I do not have a steady place to live (I am temporarily staying with others, in a hotel, in a shelter, living | outside on the street, on a beach, in a car, abandoned building, bus or train station, or in a park) | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 6, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-baseline-tool.pdf

Which of the following best describes your current living situation?

  • Code: B3
  • Requirement: required
  • Definition: Answer categories: House or apartment | Your partner’s place | A friend or relative’s and paying rent | A friend or relative’s and not paying rent | Permanent housing program | Transitional housing program | Domestic violence shelter | Emergency shelter | Voucher hotel or motel | Hotel or motel you pay for | Residential drug or alcohol program | Jail or prison | Car or other vehicle | Abandoned building | Anywhere outside | Somewhere else [where]: ____ | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 6, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-baseline-tool.pdf

Are you currently employed?

  • Code: B4
  • Requirement: required
  • Definition: Answer categories: Employed, full time or part time (includes temporary, seasonal, hours change each week) | Not employed, seeking employment | Not employed, not seeking employment (includes if you are in school and not seeking a job, retired, | not looking for work because of a disability, a homemaker, etc.) | Other – specify: ____ | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 6, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-baseline-tool.pdf

What is the highest level of education you have finished?

  • Code: B5
  • Requirement: required
  • Definition: Answer categories: Less than high school diploma | High school degree or GED | Some vocational, technical, college, or university credit(s) | Associate's degree or technical/vocational certificate | 4-year degree or higher | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 7, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-baseline-tool.pdf

In the last 3 months, have you attended school/college, homeschool, or vocational training regularly?

In the last 3 months, has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?

  • Code: B7
  • Requirement: required
  • Definition: Answer categories: CHECK ALL THAT APPLY | Yes, it has kept me from medical appointments or from getting my medications | Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need | No | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 7, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-baseline-tool.pdf

Please choose the option that best applies to you right now:

  • Code: C1
  • Requirement: required
  • Definition: Answer categories: I consider myself to be in recovery from substance use issues | I consider myself to be in recovery from mental health issues | I consider myself to be in recovery from substance use and mental health issues | I do not consider myself to be in recovery for substance use or mental health issues | I prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 8, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-baseline-tool.pdf

As of right now, please select whether you strongly agree, agree, somewhat agree, somewhat disagree, disagree, or strongly disagree with each statement in the table below. Strongly Somewhat Somewhat Strongly Prefer not Agree Agree Agree Disagree Disagree Disagree to answer a.

  • Code: C2
  • Requirement: required
  • Definition: Item text continues: I am physically fine most days. ...        b. My mental health is fine most Answer categories: days. ... | c. My substance use does not | cause problems in my life. ... | d. I have stable housing. ...        | e. I have a steady job or am | involved in things like school,        | training, or volunteering. ... | f. My life has purpose and | meaning. ... | g. I have enough money to meet | my needs. ... | h. I am proud of the community I | live in and feel a part of it. ... | i. I am supported by the people | around me. ... | j. The future appears bright to me.        | k. I am in control of my life. ...        | l. I bounce back quickly after hard | times. ...
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 8, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-baseline-tool.pdf

On a scale of 0 to 100, if 0 represents no quality of life and 100 is perfect quality of life, how would you rate your quality of life? | | | |

Which goals do you have for participating in this program?

  • Code: C4
  • Requirement: required
  • Definition: Answer categories: CHECK ALL THAT APPLY | Improve the symptoms that led me to services (for example distress, anxiety) | Reduce my drug and/or alcohol use | Gain access to medical services I need | Enroll in or finish education (for example GED, degree, vocational training) | Get or maintain a job | Live in stable housing | Be a better parent or caregiver | Improve my friendships and relationships | Comply with court order or avoid contact with the police and/or justice system | Other goal - please describe: ____ | Prefer not to answer | Thank you for completing this baseline form. | Public reporting burden for this collection of information is estimated to average 15 minutes per response. Send | comments regarding this burden estimate, or any other aspect of this collection of information, to the Substance | Abuse and Mental Health Services Administration (SAMHSA) Reports Clearance Officer, Room 15E57B, 5600 | Fishers Lane, Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to | respond to, a collection of information unless it displays a currently valid Office of Management and Budget | (OMB) control number. The control number for this project is 0930-0400. | [OFFICE USE ONLY] RECORD MANAGEMENT – ADULT / CLIENT / BASELINE | CLIENT ID | | | | | | | | | | | | | SITE ID | | | | | | | | | | | | GRANT ID | | | | | | | | | | 1. Was this assessment conducted with the client/caregiver? | Yes – Client | Yes – Caregiver/Proxy | No | 1a. [IF QUESTION 1 IS YES] When? | | | | / | | | / | | | | | MM / DD / YYYY | 1b. [IF QUESTION 1 IS NO] Why not? Choose the primary reason. | Client/Caregiver was unable to provide consent | Client was not reached for assessment | Client no longer in care
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 9, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-baseline-tool.pdf

How hard is it for you to pay for the very basics like food, housing, medical care, and heating?

What is your living situation today?

  • Code: A2
  • Requirement: required
  • Definition: Answer categories: I have a steady place to live | I have a place to live today but I am worried about losing it in the future | I do not have a steady place to live (I am temporarily staying with others, in a hotel, in a shelter, living | outside on the street, on a beach, in a car, abandoned building, bus or train station, or in a park) | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: reassessment
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 3, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-reassessment-tool.pdf

Which of the following best describes your current living situation?

  • Code: A3
  • Requirement: required
  • Definition: Answer categories: House or apartment | Your partner’s place | A friend or relative’s and paying rent | A friend or relative’s and not paying rent | Permanent housing program | Transitional housing program | Domestic violence shelter | Emergency shelter | Voucher hotel or motel | Hotel or motel you pay for | Residential drug or alcohol program | Jail or prison | Car or other vehicle | Abandoned building | Anywhere outside | Somewhere else [where]: ____ | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: reassessment
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 3, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-reassessment-tool.pdf

Are you currently employed?

  • Code: A4
  • Requirement: required
  • Definition: Answer categories: Employed, full time or part time (includes temporary, seasonal, hours change each week) | Not employed, seeking employment | Not employed, not seeking employment (includes in school not seeking, retired, due to disability, | homemaker, etc.) | Other – specify: ____ | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: reassessment
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 3, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-reassessment-tool.pdf

What is the highest level of education you have finished?

  • Code: A5
  • Requirement: required
  • Definition: Answer categories: Less than high school diploma | High school degree or GED | Some vocational, technical, college, or university credit(s) | Associate's degree or technical/vocational Certificate | 4-year degree or higher | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: reassessment
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 4, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-reassessment-tool.pdf

In the last 3 months, have you attended school/college, homeschool, or vocational training regularly?

In the last 3 months, has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?

  • Code: A7
  • Requirement: required
  • Definition: Answer categories: CHECK ALL THAT APPLY | Yes, it has kept me from medical appointments or from getting my medications. | Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need. | No | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: reassessment
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 4, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-reassessment-tool.pdf

Please choose the option that best applies to you right now:

  • Code: B1
  • Requirement: required
  • Definition: Answer categories: I consider myself to be in recovery from substance use issues | I consider myself to be in recovery from mental health issues | I consider myself to be in recovery from substance use and mental health issues | I do not consider myself to be in recovery for substance use or mental health issues | I prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: reassessment
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-reassessment-tool.pdf

As of right now, please select whether you strongly agree, agree, somewhat agree, somewhat disagree, disagree, or strongly disagree with each statement in the table below. Strongly Somewhat Somewhat Strongly Prefer not Agree Agree Agree Disagree Disagree Disagree to answer a.

  • Code: B2
  • Requirement: required
  • Definition: Item text continues: I am physically fine most days. ...        b. My mental health is fine most Answer categories: days. ... | c. My substance use does not | cause problems in my life. ... | d. I have stable housing. ...        | e. I have a steady job or am | involved in things like school,        | training, or volunteering. ... | f. My life has purpose and | meaning. ... | g. I have enough money to meet | my needs. ... | h. I am proud of the community I | live in and feel a part of it. ... | i. I am supported by the people | around me. ... | j. The future appears bright to me.        | k. I am in control of my life. ...        | l. I bounce back quickly after hard | times. ...
  • Instrument: SUPRT-C
  • Reporting frequency: reassessment
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-reassessment-tool.pdf

On a scale of 0 to 100, if 0 represents no quality of life and 100 is perfect quality of life, how would you rate your quality of life? | | | |

As a result of the services you received, which goals did you make progress on?

  • Code: B4
  • Requirement: required
  • Definition: Answer categories: CHECK ALL THAT APPLY | Improve the symptoms that led me to services (for example distress, anxiety) | Reduce my drug and/or alcohol use | Gain access to medical services I need | Enroll in or finish education (for example GED, degree, vocational training) | Get or maintain a job | Live in stable housing | Be a better parent or caregiver | Improve my friendships and relationships | Comply with court order or avoid contact with the police and/or justice system | Other goal - Please describe: ____ | Prefer not to answer | Thank you for completing this reassessment form. | Public reporting burden for this collection of information is estimated to average 10 minutes per response. Send | comments regarding this burden estimate, or any other aspect of this collection of information, to the Substance | Abuse and Mental Health Services Administration (SAMHSA) Reports Clearance Officer, Room 15E57B, 5600 | Fishers Lane, Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to | respond to, a collection of information unless it displays a currently valid Office of Management and Budget | (OMB) control number. The control number for this project is 0930-0400. | [OFFICE USE ONLY] RECORD MANAGEMENT – ADULT / CLIENT / REASSESSMENT | CLIENT ID | | | | | | | | | | | | | SITE ID | | | | | | | | | | | | GRANT ID | | | | | | | | | | 1. Was this assessment conducted with the client/caregiver? | Yes – Client | Yes – Caregiver/Proxy | No | 1a. [IF QUESTION 1 IS YES] When? | | | | / | | | / | | | | | MM / DD / YYYY | 1b. [IF QUESTION 1 IS NO] Why not? Choose the primary reason. | Client/Caregiver was unable to provide consent | Client was not reached for assessment | Client no longer in care
  • Instrument: SUPRT-C
  • Reporting frequency: reassessment
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 6, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-adult-reassessment-tool.pdf

What is your child’s race or ethnicity? Select all that apply and enter additional details in the spaces below. Note, you may report more than one group.

  • Code: A1
  • Requirement: required
  • Definition: Answer categories: White – Provide details below. | German | Irish | English | Italian | Polish | French | Enter, for example, Scottish, Norwegian, Dutch, etc. ____ | Hispanic or Latino – Provide details below. | Mexican or Mexican American | Puerto Rican | Cuban | Salvadoran | Dominican | Colombian | Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc. ____ | Black or African American – Provide details below. | African American | Jamaican | Haitian | Nigerian | Ethiopian | Somali | Enter, for example, Ghanaian, South African, Barbadian, etc. ____ | Asian – Provide details below. | Chinese | Filipino | Asian Indian | Vietnamese | Korean | Japanese | Enter, for example, Pakistani, Cambodian, Hmong, etc. ____ | American Indian or Alaska Native – Provide details below. | Specify, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow | Inupiat Traditional Government, Tlingit, etc. ____ | Middle Eastern or North African – Provide details below. | Lebanese | Iranian | Egyptian | Syrian | Moroccan | Israeli | Enter, for example, Algerian, Iraqi, Kurdish, etc. ____ | Native Hawaiian or Pacific Islander – Provide details below. | Native Hawaiian | Samoan | Chamorro | Tongan | Fijian | Marshallese | Enter, for example, Palauan, Tahitian, Chuukese etc. ____
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 3, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-child-caregiver-baseline-tool.pdf

What is your child’s sex?

Does your child speak a language other than English at home? (If no, please skip to question A4.)

For persons speaking a language other than English (answering yes to the question above): What is this language(s)?

Please respond to the following questions about your child’s physical health. Prefer not Yes No to answer a. Is your child deaf or does your child have serious difficulty hearing? ...    b. Is your child blind or does your child have serious difficulty seeing, even

  • Code: A4
  • Requirement: required
  • Definition: Answer categories: when wearing glasses? ... | c. Because of a physical, mental, or emotional condition, does your child | have serious difficulty concentrating, remembering, or making decisions? | d. Does your child have serious difficulty walking or climbing stairs? ...    | e. Does your child have difficulty dressing or bathing? ...    | f. Because of a physical, mental, or emotional condition, does your child | have difficulty doing errands alone such as visiting a doctor’s office or    | shopping? ...
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-child-caregiver-baseline-tool.pdf

How hard is it for you to pay for the very basics like food, housing, medical care, and heating for your child?

What is your child’s living situation today?

  • Code: B2
  • Requirement: required
  • Definition: Answer categories: My child has a steady place to live | My child has a place to live today but I am worried they may lose it in the future | My child does not have a steady place to live (My child is temporarily staying with others, in a hotel, in | a shelter, living outside on the street, on a beach, in a car, abandoned building, bus or train station, or | in a park) | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 6, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-child-caregiver-baseline-tool.pdf

Which of the following best describes your child’s current living situation?

  • Code: B3
  • Requirement: required
  • Definition: Answer categories: Your house or apartment | Your partner’s place | A friend or relative’s and paying rent | A friend or relative’s and not paying rent | Permanent housing program | Transitional housing program | Domestic violence shelter | Emergency shelter | Voucher hotel or motel | Hotel or motel you pay for | Residential drug or alcohol program | Jail or prison | Car or other vehicle | Abandoned building | Anywhere outside | Somewhere else [where]: ____ | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 6, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-child-caregiver-baseline-tool.pdf

What is the highest level of education your child has finished?

In the last 3 months, has your child attended school/college, homeschool, or vocational training regularly?

  • Code: B5
  • Requirement: required
  • Definition: Answer categories: Enrolled, attending regularly | Enrolled, not attending regularly | Not enrolled | Prefer not to answer | Thank you for completing this baseline form. | Public reporting burden for this collection of information is estimated to average 10 minutes per response at | baseline. Send comments regarding this burden estimate, or any other aspect of this collection of information, to | the Substance Abuse and Mental Health Services Administration (SAMHSA) Reports Clearance Officer, Room | 15E57B, 5600 Fishers Lane, Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not | required to respond to, a collection of information unless it displays a currently valid Office of Management and | Budget (OMB) control number. The control number for this project is 0930-0400. | [OFFICE USE ONLY] RECORD MANAGEMENT – CHILD / CAREGIVER / BASELINE | CLIENT ID | | | | | | | | | | | | | SITE ID | | | | | | | | | | | | GRANT ID | | | | | | | | | | 1. Was this assessment conducted with the client/caregiver? | Yes – Client | Yes – Caregiver/Proxy | No | 1a. [IF QUESTION 1 IS YES] When? | | | | / | | | / | | | | | MM / DD / YYYY | 1b. [IF QUESTION 1 IS NO] Why not? Choose the primary reason. | Client/Caregiver was unable to provide consent | Client was not reached for assessment | Client no longer in care
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 7, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-child-caregiver-baseline-tool.pdf

How hard is it for you to pay for the very basics like food, housing, medical care, and heating for your child?

What is your child’s living situation today?

  • Code: A2
  • Requirement: required
  • Definition: Answer categories: My child has a steady place to live | My child has a place to live today but I am worried they may lose it in the future | My child does not have a steady place to live (My child is temporarily staying with others, in a hotel, in | a shelter, living outside on the street, on a beach, in a car, abandoned building, bus or train station, or | in a park) | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: reassessment
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 3, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-child-caregiver-reassessment-tool.pdf

Which of the following best describes your child’s current living situation?

  • Code: A3
  • Requirement: required
  • Definition: Answer categories: Your house or apartment | Your partner’s place | A friend or relative’s and paying rent | A friend or relative’s and not paying rent | Permanent housing program | Transitional housing program | Domestic violence shelter | Emergency shelter | Voucher hotel or motel | Hotel or motel you pay for | Residential drug or alcohol program | Jail or prison | Car or other vehicle | Abandoned building | Anywhere outside | Somewhere else [where]: ____ | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: reassessment
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 3, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-child-caregiver-reassessment-tool.pdf

What is the highest level of education your child has finished?

In the last 3 months, has your child attended school/college, homeschool, or vocational training regularly?

  • Code: A5
  • Requirement: required
  • Definition: Answer categories: Enrolled, attending regularly | Enrolled, not attending regularly | Not enrolled | Prefer not to answer | Thank you for completing this reassessment form. | Public reporting burden for this collection of information is estimated to average 5 minutes per response. Send | comments regarding this burden estimate, or any other aspect of this collection of information, to the Substance | Abuse and Mental Health Services Administration (SAMHSA) Reports Clearance Officer, Room 15E57B, 5600 | Fishers Lane, Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to | respond to, a collection of information unless it displays a currently valid Office of Management and Budget | (OMB) control number. The control number for this project is 0930-0400. | [OFFICE USE ONLY] RECORD MANAGEMENT – CHILD / CAREGIVER / BASELINE | CLIENT ID | | | | | | | | | | | | | SITE ID | | | | | | | | | | | | GRANT ID | | | | | | | | | | 1. Was this assessment conducted with the client/caregiver? | Yes – Client | Yes – Caregiver/Proxy | No | 1a. [IF QUESTION 1 IS YES] When? | | | | / | | | / | | | | | MM / DD / YYYY | 1b. [IF QUESTION 1 IS NO] Why not? Choose the primary reason. | Client/Caregiver was unable to provide consent | Client was not reached for assessment | Client no longer in care
  • Instrument: SUPRT-C
  • Reporting frequency: reassessment
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 4, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-child-caregiver-reassessment-tool.pdf

What is your child’s race or ethnicity? Select all that apply and enter additional details in the spaces below. Note, you may report more than one group.

  • Code: A1
  • Requirement: required
  • Definition: Answer categories: White – Provide details below. | German | Irish | English | Italian | Polish | French | Enter, for example, Scottish, Norwegian, Dutch, etc. ____ | Hispanic or Latino – Provide details below. | Mexican or Mexican American | Puerto Rican | Cuban | Salvadoran | Dominican | Colombian | Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc. ____ | Black or African American – Provide details below. | African American | Jamaican | Haitian | Nigerian | Ethiopian | Somali | Enter, for example, Ghanaian, South African, Barbadian, etc. ____ | Asian – Provide details below. | Chinese | Filipino | Asian Indian | Vietnamese | Korean | Japanese | Enter, for example, Pakistani, Cambodian, Hmong, etc. ____ | American Indian or Alaska Native | Specify, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow | Inupiat Traditional Government, Tlingit, etc. ____ | Middle Eastern or North African – Provide details below. | Lebanese | Iranian | Egyptian | Syrian | Moroccan | Israeli | Enter, for example, Algerian, Iraqi, Kurdish, etc. ____ | Native Hawaiian or Pacific Islander – Provide details below. | Native Hawaiian | Samoan | Chamorro | Tongan | Fijian | Marshallese | Enter, for example, Palauan, Tahitian, Chuukese etc. ____
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 3, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-young-child-caregiver-baseline-tool.pdf

What is your child’s sex?

Please respond to the following questions about your child’s physical health. Prefer not Yes No to answer a. Is your child deaf or does your child have serious difficulty hearing? ...    b. Is your child blind or does your child have serious difficulty seeing, even

How hard is it for you to pay for the very basics like food, housing, medical care, and heating for your child?

What is your child’s living situation today?

  • Code: B2
  • Requirement: required
  • Definition: Answer categories: My child has a steady place to live | My child has a place to live today but I am worried they may lose it in the future | My child does not have a steady place to live (My child is temporarily staying with others, in a hotel, in | a shelter, living outside on the street, on a beach, in a car, abandoned building, bus or train station, or | in a park) | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-young-child-caregiver-baseline-tool.pdf

Which of the following best describes your child’s current living situation?

  • Code: B3
  • Requirement: required
  • Definition: Answer categories: Your house or apartment | Your partner’s place | A friend or relative’s and paying rent | A friend or relative’s and not paying rent | Permanent housing program | Transitional housing program | Domestic violence shelter | Emergency shelter | Voucher hotel or motel | Hotel or motel you pay for | Residential drug or alcohol program | Jail or prison | Car or other vehicle | Abandoned building | Anywhere outside | Somewhere else [where]: ____ | Prefer not to answer | Thank you for completing this baseline form. | Public reporting burden for this collection of information is estimated to average 6 minutes per response. Send | comments regarding this burden estimate, or any other aspect of this collection of information, to the Substance | Abuse and Mental Health Services Administration (SAMHSA) Reports Clearance Officer, Room 15E57B, 5600 | Fishers Lane, Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to | respond to, a collection of information unless it displays a currently valid Office of Management and Budget | (OMB) control number. The control number for this project is 0930-0400. | [OFFICE USE ONLY] RECORD MANAGEMENT – YOUNG CHILD / CAREGIVER / | BASELINE | CLIENT ID | | | | | | | | | | | | | SITE ID | | | | | | | | | | | | GRANT ID | | | | | | | | | | 1. Was this assessment conducted with the client/caregiver? | Yes – Client | Yes – Caregiver/Proxy | No | 1a. [IF QUESTION 1 IS YES] When? | | | | / | | | / | | | | | MM / DD / YYYY | 1b. [IF QUESTION 1 IS NO] Why not? Choose the primary reason. | Client/Caregiver was unable to provide consent | Client was not reached for assessment | Client no longer in care
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-young-child-caregiver-baseline-tool.pdf

How hard is it for you to pay for the very basics like food, housing, medical care, and heating for your child?

What is your child’s living situation today?

  • Code: A2
  • Requirement: required
  • Definition: Answer categories: My child has a steady place to live | My child has a place to live today but I am worried they may lose it in the future | My child does not have a steady place to live (My child is temporarily staying with others, in a hotel, in | a shelter, living outside on the street, on a beach, in a car, abandoned building, bus or train station, or | in a park) | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: reassessment
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 3, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-young-child-caregiver-reassessment-tool.pdf

Which of the following best describes your child’s current living situation?

  • Code: A3
  • Requirement: required
  • Definition: Answer categories: Your house or apartment | Your partner’s place | A friend or relative’s and paying rent | A friend or relative’s and not paying rent | Permanent housing program | Transitional housing program | Domestic violence shelter | Emergency shelter | Voucher hotel or motel | Hotel or motel you pay for | Residential drug or alcohol program | Jail or prison | Car or other vehicle | Abandoned building | Anywhere outside | Somewhere else [where]: ____ | Prefer not to answer | Thank you for completing this reassessment form. | Public reporting burden for this collection of information is estimated to average 3 minutes per response. Send | comments regarding this burden estimate, or any other aspect of this collection of information, to the Substance | Abuse and Mental Health Services Administration (SAMHSA) Reports Clearance Officer, Room 15E57B, 5600 | Fishers Lane, Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to | respond to, a collection of information unless it displays a currently valid Office of Management and Budget | (OMB) control number. The control number for this project is 0930-0400. | [OFFICE USE ONLY] RECORD MANAGEMENT – YOUNG CHILD / CAREGIVER / | REASSESSMENT | CLIENT ID | | | | | | | | | | | | | SITE ID | | | | | | | | | | | | GRANT ID | | | | | | | | | | 1. Was this assessment conducted with the client/caregiver? | Yes – Client | Yes – Caregiver/Proxy | No | 1a. [IF QUESTION 1 IS YES] When? | | | | / | | | / | | | | | MM / DD / YYYY | 1b. [IF QUESTION 1 IS NO] Why not? Choose the primary reason. | Client/Caregiver was unable to provide consent | Client was not reached for assessment | Client no longer in care
  • Instrument: SUPRT-C
  • Reporting frequency: reassessment
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 3, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-young-child-caregiver-reassessment-tool.pdf

What is your race or ethnicity? Select all that apply and enter additional details in the spaces below. Note, you may report more than one group.

  • Code: A1
  • Requirement: required
  • Definition: Answer categories: White – Provide details below. | German | Irish | English | Italian | Polish | French | Enter, for example, Scottish, Norwegian, Dutch, etc. ____ | Hispanic or Latino – Provide details below. | Mexican or Mexican American | Puerto Rican | Cuban | Salvadoran | Dominican | Colombian | Enter, for example, Guatemalan, Spaniard, Ecuadorian, etc. ____ | Black or African American – Provide details below. | African American | Jamaican | Haitian | Nigerian | Ethiopian | Somali | Enter, for example, Ghanaian, South African, Barbadian, etc. ____ | Asian – Provide details below. | Chinese | Filipino | Asian Indian | Vietnamese | Korean | Japanese | Enter, for example, Pakistani, Cambodian, Hmong, etc. ____ | American Indian or Alaska Native – Provide details below. | Specify, for example, Navajo Nation, Blackfeet Tribe, Mayan, Aztec, Native Village of Barrow | Inupiat Traditional Government, Tlingit, etc. ____ | Middle Eastern or North African – Provide details below. | Lebanese | Iranian | Egyptian | Syrian | Moroccan | Israeli | Enter, for example, Algerian, Iraqi, Kurdish, etc. ____ | Native Hawaiian or Pacific Islander – Provide details below. | Native Hawaiian | Samoan | Chamorro | Tongan | Fijian | Marshallese | Enter, for example, Palauan, Tahitian, Chuukese etc. ____
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 3, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-youth-baseline-tool.pdf

What is your sex?

Do you speak a language other than English at home? (If no, please skip to question A4.)

For persons speaking a language other than English (answering yes to the question above): What is this language(s)?

  • Code: A3a
  • Requirement: required
  • Definition: Answer categories: CHECK ALL THAT APPLY | American Sign Language (ASL) | Arabic | Chinese | French | Portuguese | Spanish | Other Language – specify: ____ | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 4, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-youth-baseline-tool.pdf

Please respond to the following questions about your physical health. Prefer not to Yes No answer a. Are you deaf or do you have serious difficulty hearing? ...    b. Are you blind or do you have serious difficulty seeing, even when    wearing glasses?

  • Code: A4
  • Requirement: required
  • Definition: Item text continues: ... c. Because of a physical, mental, or emotional condition, do you have Answer categories: serious difficulty concentrating, remembering, or making decisions? | d. Do you have serious difficulty walking or climbing stairs? ...    | e. Do you have difficulty dressing or bathing? ...    | f. Because of a physical, mental, or emotional condition, do you have | difficulty doing errands alone such as visiting a doctor’s office or    | shopping? ...
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-youth-baseline-tool.pdf

What is your living situation today?

  • Code: B1
  • Requirement: required
  • Definition: Answer categories: I have a steady place to live | I have a place to live today but I am worried about losing it in the future | I do not have a steady place to live (I am temporarily staying with others, in a hotel, in a shelter, living | outside on the street, on a beach, in a car, abandoned building, bus or train station, or in a park) | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 6, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-youth-baseline-tool.pdf

Which of the following best describes your current living situation?

  • Code: B2
  • Requirement: required
  • Definition: Answer categories: My parent/guardian’s house or apartment | Your partner’s place | A friend or relative’s and paying rent | A friend or relative’s and not paying rent | Permanent housing program | Transitional housing program | Domestic violence shelter | Emergency shelter | Voucher hotel or motel | Hotel or motel you pay for | Residential drug or alcohol program | Jail or prison | Car or other vehicle | Abandoned building | Anywhere outside | Somewhere else [where]: ____ | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 6, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-youth-baseline-tool.pdf

What is the highest level of education you have finished?

  • Code: B3
  • Requirement: required
  • Definition: Answer categories: Preschool – Kindergarten | Grade 1 – Grade 5 | Grade 6 – Grade 8 | Grade 9 – 12 | High school degree or GED | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 6, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-youth-baseline-tool.pdf

In the last 3 months, have you attended school/college, homeschool, or vocational training regularly?

  • Code: B4
  • Requirement: required
  • Definition: Answer categories: Enrolled, attending regularly | Enrolled, not attending regularly | Not enrolled | Prefer not to answer | Thank you for completing this baseline form. | Public reporting burden for this collection of information is estimated to average 10 minutes per response. Send | comments regarding this burden estimate, or any other aspect of this collection of information, to the Substance | Abuse and Mental Health Services Administration (SAMHSA) Reports Clearance Officer, Room 15E57B, 5600 | Fishers Lane, Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to | respond to, a collection of information unless it displays a currently valid Office of Management and Budget | (OMB) control number. The control number for this project is 0930-0400. | [OFFICE USE ONLY] RECORD MANAGEMENT – YOUTH / CLIENT / BASELINE | CLIENT ID | | | | | | | | | | | | | SITE ID | | | | | | | | | | | | GRANT ID | | | | | | | | | | 1. Was this assessment conducted with the client/caregiver? | Yes – Client | Yes – Caregiver/Proxy | No | 1a. [IF QUESTION 1 IS YES] When? | | | | / | | | / | | | | | MM / DD / YYYY | 1b. [IF QUESTION 1 IS NO] Why not? Choose the primary reason. | Client/Caregiver was unable to provide consent | Client was not reached for assessment | Client no longer in care
  • Instrument: SUPRT-C
  • Reporting frequency: baseline
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 6, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-youth-baseline-tool.pdf

What is your living situation today?

  • Code: A1
  • Requirement: required
  • Definition: Answer categories: I have a steady place to live | I have a place to live today but I am worried about losing it in the future | I do not have a steady place to live (I am temporarily staying with others, in a hotel, in a shelter, living | outside on the street, on a beach, in a car, abandoned building, bus or train station, or in a park) | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: reassessment
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 3, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-youth-reassessment-tool.pdf

Which of the following best describes your current living situation?

  • Code: A2
  • Requirement: required
  • Definition: Answer categories: My parent/guardian's house or apartment | Your partner’s place | A friend or relative’s and paying rent | A friend or relative’s and not paying rent | Permanent housing program | Transitional housing program | Domestic violence shelter | Emergency shelter | Voucher hotel or motel | Hotel or motel you pay for | Residential drug or alcohol program | Jail or prison | Car or other vehicle | Abandoned building | Anywhere outside | Somewhere else [where]: ____ | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: reassessment
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 3, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-youth-reassessment-tool.pdf

What is the highest level of education you have finished?

  • Code: A3
  • Requirement: required
  • Definition: Answer categories: Preschool – Kindergarten | Grade 1 – Grade 5 | Grade 6 – Grade 8 | Grade 9 - 12 | High school degree or GED | Prefer not to answer
  • Instrument: SUPRT-C
  • Reporting frequency: reassessment
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 3, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-youth-reassessment-tool.pdf

In the last 3 months, have you attended school/college, homeschool, or vocational training regularly?

  • Code: A4
  • Requirement: required
  • Definition: Answer categories: Enrolled, attending regularly | Enrolled, not attending regularly | Not enrolled | Prefer not to answer | Thank you for completing this reassessment form. | Public reporting burden for this collection of information is estimated to average 5 minutes per response. Send | comments regarding this burden estimate, or any other aspect of this collection of information, to the Substance | Abuse and Mental Health Services Administration (SAMHSA) Reports Clearance Officer, Room 15E57B, 5600 | Fishers Lane, Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to | respond to, a collection of information unless it displays a currently valid Office of Management and Budget | (OMB) control number. The control number for this project is 0930-0400. | [OFFICE USE ONLY] RECORD MANAGEMENT – YOUTH / CLIENT / REASSESSMENT | CLIENT ID | | | | | | | | | | | | | SITE ID | | | | | | | | | | | | GRANT ID | | | | | | | | | | 1. Was this assessment conducted with the client/caregiver? | Yes – Client | Yes – Caregiver/Proxy | No | 1a. [IF QUESTION 1 IS YES] When? | | | | / | | | / | | | | | MM / DD / YYYY | 1b. [IF QUESTION 1 IS NO] Why not? Choose the primary reason. | Client/Caregiver was unable to provide consent | Client was not reached for assessment | Client no longer in care
  • Instrument: SUPRT-C
  • Reporting frequency: reassessment
  • Target rule: No target rule stated
  • Source: SAMHSA SUPRT data collection tools, p. 3, https://www.samhsa.gov/sites/default/files/gpra-suprt-c-youth-reassessment-tool.pdf

Substance Abuse and Mental Health Services Administration (SAMHSA), SAMHSA discretionary grants: SUPRT-P Project tool

Total Number of Individuals Served

  • Code: TS1
  • Requirement: required
  • Definition: For annual targets, enter the total number of individuals your grant plans to serve through one or more grant services during the federal fiscal year specified. For quarterly reporting, enter the total number of unduplicated new individuals served with one or more grant services during the quarter. Total of new individuals served
  • Instrument: SUPRT-P
  • Reporting frequency: annual targets; quarterly results
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 4, https://www.samhsa.gov/sites/default/files/spars-suprt-p-tool.pdf

Total Served by Sex

  • Code: TS2
  • Requirement: required
  • Definition: Enter the number of new individuals served by sex. Each individual may be reported only under one sex. a. Female b. Male
  • Instrument: SUPRT-P
  • Reporting frequency: annual targets; quarterly results
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 4, https://www.samhsa.gov/sites/default/files/spars-suprt-p-tool.pdf

Total Served by Age Group

  • Code: TS3
  • Requirement: required
  • Definition: Enter the number of new individuals served for each of the following age groups. Each individual may be reported only under one age group. a. 0-9 years b. 10-17 years c. 18-20 years d. 21-24 years e. 25-44 years f. 45-64 years g. 65+ years h. Age not available
  • Instrument: SUPRT-P
  • Reporting frequency: annual targets; quarterly results
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 4, https://www.samhsa.gov/sites/default/files/spars-suprt-p-tool.pdf

Total Served by Military Status

  • Code: TS4
  • Requirement: required
  • Definition: Enter the number of new individuals served by military status. Each individual may be reported only under one military status group. a. Veteran b. Active Duty c. Reserve Status d. Military status not available
  • Instrument: SUPRT-P
  • Reporting frequency: annual targets; quarterly results
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/spars-suprt-p-tool.pdf

Number of mental health awareness and promotion messaging impressions

Number of substance use prevention messaging impressions

Number of 988 awareness messaging impressions Outreach (O) Outreach (O) indicators track one-on-one contact with individuals outside of the clinical

  • Code: AW3
  • Requirement: required
  • Definition: setting to encourage care seeking, improve access to care, linkages to care, and retention in care. Outreach Result For annual targets, enter the total number of connections your grant plans to contact through outreach during the federal fiscal year specified. For quarterly reporting, enter the total number of connections your grant contacted through outreach during the quarter.
  • Instrument: SUPRT-P
  • Reporting frequency: annual targets; quarterly results
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 5, https://www.samhsa.gov/sites/default/files/spars-suprt-p-tool.pdf

Number of connections made through program outreach

Number of connections made through program outreach in geographically isolated areas

Number of connections made through program outreach in under- resourced communities

Number of new individuals vaccinated for hepatitis A (HAV)

Number of new individuals vaccinated for hepatitis B (HBV)

Number of opioid overdose reversal medication (OORM) kits purchased

Number of opioid overdose reversal medication (OORM) kits distributed

Number of prevention devices distributed

Number of medication lock boxes distributed

Number of sharps containers distributed

Number of medication disposal kits distributed Prevention Activities

Number of safe sex kits including condoms distributed

Number of wound management kits distributed

Number of gun locks distributed

Number of drug checking technologies distributed Prevention Education - Encounters (PE) indicators track components of universal prevention strategies delivered to individuals through one-on-one brief interactions or

  • Code: PA12
  • Requirement: required
  • Definition: group setting activities. Prevention Education - Encounters Result For annual targets, enter the total number of education encounters your grant plans to provide with prevention education, or promotion during the federal fiscal year specified. For quarterly reporting, enter the total number of education encounters your grant provided with prevention education or promotion during the quarter.
  • Instrument: SUPRT-P
  • Reporting frequency: annual targets; quarterly results
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 7, https://www.samhsa.gov/sites/default/files/spars-suprt-p-tool.pdf

Number of mental health promotion education encounters

Number of substance use education encounters

Number of substance use treatment education encounters

Number of substance use prevention education encounters

Number of substance use recovery education encounters

Number of prevention of suicide education encounters

Number of prevention of viral hepatitis, HIV, or other communicable diseases education encounters

Number of prevention of hepatitis B (HBV) education encounters

Number of prevention of hepatitis C (HBC) education encounters

Number of prevention of HIV education encounters

Number of pre-exposure prophylaxis for HIV (PrEP) education encounters

Number of post-exposure prophylaxis for HIV (PEP) education encounters

Number of prevention of bacterial sexually transmitted infections (STIs) education encounters Prevention Education - Individuals (PEI) indicators track components of universal

  • Code: PE13
  • Requirement: required
  • Definition: prevention strategies delivered to individuals through one-on-one brief interactions or group setting activities. Prevention Education - Encounters Result For annual targets, enter the total number of new individuals your grant plans to reach with prevention education, or promotion through outreach during the federal fiscal year specified. For quarterly reporting, enter the total number of new individuals your grant reached with prevention education or promotion during the quarter.
  • Instrument: SUPRT-P
  • Reporting frequency: annual targets; quarterly results
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 7, https://www.samhsa.gov/sites/default/files/spars-suprt-p-tool.pdf

Number of new individuals educated on mental health promotion

Number of new individuals educated on substance use

Number of new individuals educated on substance use treatment

Number of new individuals educated on substance use prevention

Number of new individuals educated on substance use recovery

Number of new individuals educated on prevention of suicide

Number of new individuals educated on prevention of viral hepatitis, HIV, or other communicable diseases

Number of new individuals educated on prevention of hepatitis B (HBV)

Number of new individuals educated on prevention of hepatitis C (HBC)

Number of new individuals educated on prevention of HIV

Number of new individuals educated on pre-exposure prophylaxis for HIV (PrEP)

Number of new individuals educated on post-exposure prophylaxis for HIV (PEP)

Number of new individuals educated on prevention of bacterial sexually transmitted infections (STIs)

Number of mental health screening encounters

Number of trauma experience screening encounters

Number of substance use screening encounters

Number of positive substance use screening encounters

Number of positive substance use screening encounters where services were declined

Number of suicide risk screening encounters

Number of positive suicide risk screening encounters

Number of screening encounters for risk factors associated with viral hepatitis, HIV, bacterial STIs, and tuberculosis

Number of screening encounters for risk of HIV

Number of screening encounters for risk of hepatitis B (HBV)

Number of screening encounters for risk of hepatitis C (HCV)

Number of screening encounters for risk of bacterial sexually transmitted infections (STIs)

Number of screening encounters for risk of tuberculosis (TB)

Number of supportive services needs screening encounters

Number of educational/vocational needs screening encounters

Number of employment needs screening encounters

Number of family support needs screening encounters

Number of childcare needs screening encounters Screening Encounter

Number of transportation needs screening encounters

Number of housing stability screening encounters

Number of screening encounters positive for experiencing homelessness

Number of recovery housing needs screening encounters

Number of peer support needs screening encounters

Number of food insecurity screening encounters

Number of other health conditions screening encounters Screening - Individual

  • Code: SE25
  • Requirement: required
  • Definition: For annual targets, enter the total number of individuals your grant plans to screen during the federal fiscal year specified. Do not enter targets for the number of individuals expected to have a positive screen. For quarterly reporting, enter the total number of individuals your grant screened during the quarter.
  • Instrument: SUPRT-P
  • Reporting frequency: annual targets; quarterly results
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 10, https://www.samhsa.gov/sites/default/files/spars-suprt-p-tool.pdf

Number of new individuals screened for mental health

Number of new individuals screened for substance use

Number of new individuals who screened positive for substance use

Number of new individuals who screened positive for substance use but declined services

Number of new individuals screened for suicide risk

Number of new individuals who screened positive for suicide risk

Number of new individuals screened for risk factors associated with viral hepatitis, HIV, bacterial STIs, and tuberculosis

Number of new individuals who screened at risk for HIV

Number of new individuals who screened at risk for hepatitis B (HBV)

Number of new individuals who screened at risk for hepatitis C (HCV)

Number of new individuals who screened at risk for bacterial sexually transmitted infections (STIs)

Number of new individuals who screened at risk for tuberculosis (TB) Screening - Individual

Number of new individuals screened for need for supportive services

Number of new individuals screened for educational/vocational needs

Number of new individuals screened for employment needs

Number of new individuals screened for family support needs

Number of new individuals screened for childcare needs

Number of new individuals screened for transportation needs

Number of new individuals screened for housing stability

Number of new individuals screened positive for homelessness

Number of new individuals screened for recovery housing needs

Number of new individuals screened for peer support needs

Number of new individuals screened for food insecurity

Number of new individuals screened for other health conditions Assessment and Testing

  • Code: SI24
  • Requirement: required
  • Definition: For annual targets, enter the total number of individuals your grant plans to test during the federal fiscal year specified. Do not enter targets for the number of individuals expected to have a positive test result or a diagnosis. For quarterly reporting, enter the total number of new individuals your grant assessed or tested during the quarter.
  • Instrument: SUPRT-P
  • Reporting frequency: annual targets; quarterly results
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 11, https://www.samhsa.gov/sites/default/files/spars-suprt-p-tool.pdf

Number of new individuals assessed for a serious mental illness (SMI) or a

Number of new individuals diagnosed with a SMI

Number of new individuals diagnosed with a SED

Number of new individuals assessed for a substance use disorder (SUD)

Number of new individuals diagnosed with an SUD

Number of new individuals tested for HIV

Number of new individuals who tested positive for HIV

Number of new individuals reached with a known HIV-positive status but not currently receiving treatment Assessment and Testing

Number of new individuals tested for hepatitis B (HBV)

Number of new individuals who tested positive for HBV

Number of new individuals reached with a known HBV-positive status but not currently receiving treatment

Number of new individuals tested for hepatitis C (HCV)

Number of new individuals who tested positive for HCV

Number of new individuals reached with a known HCV-positive status but not currently receiving treatment

Number of new individuals tested for bacterial sexually transmitted infections (STIs)

Number of new individuals who tested positive for gonorrhea

Number of new individuals who tested positive for chlamydia

Number of new individuals who tested positive for syphilis

Number of new individuals who tested for tuberculosis (TB)

Number of new individuals who tested positive for tuberculosis (TB) Referral (R) Referral indicators track efforts to refer the individuals identified with behavioral health

  • Code: AT20
  • Requirement: required
  • Definition: and related health or support needs. Referral Result For annual targets, enter the total number of referrals your grant plans to provide during the federal fiscal year specified. For quarterly reporting, enter the total number of referrals your grant provided during the quarter.
  • Instrument: SUPRT-P
  • Reporting frequency: annual targets; quarterly results
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 12, https://www.samhsa.gov/sites/default/files/spars-suprt-p-tool.pdf

Number of referrals provided to mental health services

Number of referrals provided to substance use services

Number of referrals provided to treatment after a positive screening for substance use

Number of referrals provided to treatment after an overdose reversal

Number of referrals provided to crisis services

Number of referrals provided to co-occurring treatment services Referral - Encounter

  • Code: R6
  • Requirement: required
  • Definition: For annual targets, enter the total number of referral encounters your grant plans to provide during the federal fiscal year specified. For quarterly reporting, enter the total number of referral encounters your grant provided during the quarter.
  • Instrument: SUPRT-P
  • Reporting frequency: annual targets; quarterly results
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 13, https://www.samhsa.gov/sites/default/files/spars-suprt-p-tool.pdf

Number of mental health service referral encounters

Number of traumatic stress referral encounters

Number of suicide prevention referral encounters

Number of substance use service referral encounters

Number of substance use service referral encounters after a positive screening for substance use

Number of substance use service referral encounters after an overdose reversal

Number of crisis service referral encounters

Number of co-occurring treatment service referral encounters Referral - Individual

  • Code: RE8
  • Requirement: required
  • Definition: For annual targets, enter the total number of new individuals your grant plans to refer during the federal fiscal year specified. For quarterly reporting, enter the total number of new individuals your grant referred during the quarter.
  • Instrument: SUPRT-P
  • Reporting frequency: annual targets; quarterly results
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 13, https://www.samhsa.gov/sites/default/files/spars-suprt-p-tool.pdf

Number of new individuals referred to mental health services

Number of new individuals referred to substance use services

Number of new individuals referred to treatment after a positive screening for substance use

Number of new individuals referred to treatment after an overdose reversal

Number of new individuals referred to crisis services

Number of new individuals referred to co-occurring treatment services

Number of new individuals linked to mental health services

Number of new individuals linked to substance use services

Number of new individuals linked to substance use treatment after an overdose reversal

Number of new individuals linked to care for viral hepatitis, HIV, or other communicable disease

Number of new individuals linked to HIV pre-exposure prophylaxis (PrEP)

Number of new individuals linked to HIV post-exposure prophylaxis (PEP)

Number of new individuals linked to HIV treatment

Number of new individuals linked to hepatitis B (HBV) treatment

Number of new individuals linked to hepatitis C (HCV) treatment Access and Linkage to Care or Treatment

  • Code: AC9
  • Requirement: required
  • Definition: AC 10. Number of new individuals linked to gonorrhea treatment
  • Instrument: SUPRT-P
  • Reporting frequency: annual targets; quarterly results
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 14, https://www.samhsa.gov/sites/default/files/spars-suprt-p-tool.pdf

Number of new individuals linked to chlamydia treatment

Number of new individuals linked to syphilis treatment

Number of new individuals linked to tuberculosis (TB) treatment

Number of new individuals linked to recovery and resilience support AC 15. Number of new individuals linked to educational or vocational support services

Number of new individuals linked to employment support services

Number of new individuals linked to family support services

Number of new individuals linked to childcare services

Number of new individuals linked to transportation services AC 20. Number of new individuals linked to housing support services

Number of new individuals linked to recovery housing services

Number of new individuals linked to peer coaching and mentoring

Number of new individuals linked to specialized population services

Number of new individuals linked to peer group/mutual support groups AC 25. Number of new individuals linked to respite care

Number of new individuals linked to therapeutic foster care

Number of new individuals linked to individualized advocacy or consultation

Number of new individuals linked to family unification services

Number of new individuals linked to other recovery support services AC 30. Number of new individuals linked to services for other health conditions

Number of brief intervention encounters for mental health

Number of brief intervention encounters for substance use

Number of brief treatment encounters for substance use

Number of brief intervention encounters for suicide prevention

Number of opioid overdose reversal medication (OORM) administration events Services

  • Code: BI5
  • Requirement: required
  • Definition: For annual targets, enter the total number of individuals your grant plans to serve during the federal fiscal year specified. For quarterly reporting, enter the total number of new individuals your grant served during the quarter.
  • Instrument: SUPRT-P
  • Reporting frequency: annual targets; quarterly results
  • Target rule: Applicant proposes the target
  • Source: SAMHSA SUPRT data collection tools, p. 16, https://www.samhsa.gov/sites/default/files/spars-suprt-p-tool.pdf

Number of new individuals who received mental health services

Number of new individuals who received therapy or counseling

Number of new individuals who received group counseling

Number of new individuals who received family counseling

Number of new individuals who received psychiatric rehabilitation services

Number of new individuals who received intensive day treatment

Number of new individuals who received substance use treatment services

Number of new individuals who received inpatient hospitalization treatment

Number of new individuals who received residential/rehabilitation

Number of new individuals who received outpatient treatment

Number of new individuals who received withdrawal management Services

Number of new individuals who received after care

Number of new individuals who received medications for substance use

Number of new individuals who received medications for opioid use disorder (MOUD) by mobile medication units

Number of new individuals who received medications for alcohol use disorder (MAUD) by mobile medication units

Number of new individuals who received suicide-specific services

Number of new individuals who received viral hepatitis, HIV, or other communicable disease services

Number of new individuals who received HIV PrEP

Number of new individuals who received HIV PEP

Number of new individuals who received treatment for HIV

Number of new individuals who received treatment for hepatitis B (HBV)

Number of new individuals who received direct acting antiviral-based treatment

Number of new individuals who received treatment for gonorrhea

Number of new individuals who received treatment for chlamydia

Number of new individuals who received treatment for syphilis

Number of new individuals who received treatment for tuberculosis (TB)

Number of new individuals who received support services that assist with recovery and resilience

Number of new individuals who received educational or vocational support services

Number of new individuals who received employment support services

Number of new individuals who received family support services

Number of new individuals who received childcare services

Number of new individuals who received transportation services

Number of new individuals who received housing support services Services

Number of new individuals who received recovery housing services

Number of new individuals who received peer coaching and mentoring

Number of new individuals who received specialized population services

Number of new individuals who participated in peer group/mutual support groups

Number of new individuals who received respite care

Number of new individuals who received therapeutic foster care

Number of new individuals who received individualized advocacy or consultation

Number of new individuals who received family unification services

Number of new individuals who received other recovery support services

Number of new individuals who received services for other health conditions

Number of new individuals who received primary health care services

Number of new individuals who received maternal health care services

Number of new individuals who received dental care services

Number of new individuals who received other health care services

Number of new individuals who received case management services

Number of new individuals who received care coordination

Number of new individuals who received treatment planning

Number of contacts who received mental health services

Number of contacts who received therapy or counseling

Number of contacts who received group counseling

Number of contacts who received family counseling

Number of contacts who received psychiatric rehabilitation services

Number of contacts who received intensive day treatment

Number of contacts who received behavioral health crisis services

Number of contacts who received mobile crisis response

Number of contacts who received crisis stabilization

Number of contacts who received crisis residential care

Number of contacts who received crisis follow-up care

Number of contacts who received crisis follow-up contacts (phone, chat, text, or other)

Number of contacts linked to behavioral health crisis services

Number of contacts linked to care for suicide risk

Number of contacts linked with 911/emergency services

Number of mental health intervention training participants

Number of mental health intervention training participants who were behavioral health professionals

Number of trauma informed care training participants

Number of trauma informed care training participants who were behavioral health professionals

Number of suicide prevention and/or behavioral health crisis response training participants

Number of suicide prevention and/or behavioral health crisis response training participants who were professional first responders

Number of suicide prevention and/or behavioral health crisis response training participants who were behavioral health professionals

Number of suicide prevention and/or behavioral health crisis response training participants who were medical health professionals

Number of substance use treatment training participants

Number of alcohol use disorder (AUD) training participants

Number of opioid use disorder (OUD) training participants

Number of opioid use disorder (OUD) training participants who were professional first responders

Number of opioid use disorder (OUD) training participants who were behavioral health professionals

Number of opioid use disorder (OUD) training participants who were medical health professionals

Number of opioid overdose response training participants Training and Workforce Development

Number of opioid overdose response training participants who were professional first responders

Number of opioid overdose response training participants who were other key community sector members

Number of opioid overdose response training participants who were school personnel trained

Number of opioid overdose response training participants who were behavioral health professionals

Number of opioid overdose response training participants who were non- traditional community sector members

Number of opioid overdose response training participants who were other community members

Number of opioid overdose response training participants who were family members of someone who experienced an opioid overdose

Number of opioid overdose response training participants who were individuals with lived experience

Number of opioid overdose reversal medication (OORM) administration training participants

Number of screening and identification of opioid use disorder (OUD) training participants

Number of medication administration for opioid use disorder (MOUD) training participants

Number of non-opioid therapies training participants

Number of peer support training participants who were individuals with lived experience

Number of co-occurring mental health and substance use disorder intervention training participants

Number of co-occurring mental health and substance use disorder intervention training participants who were professional first responders

Number of viral hepatitis, HIV, or other communicable diseases participants

Number of viral hepatitis, HIV, or other communicable diseases training participants who were behavioral health professionals

Number of opioid overdose reversals

Number of individuals who attempted suicide

Number of individuals who died by suicide

Number of families that successfully reunited with children in kinship or foster care arrangements through support services that assist with recovery

Number of new individuals who completed their course of treatment for hepatitis

Number of new individuals who achieved a hepatitis C (HCV) cure (SVR4 or later)

Number of new emergency department (ED) patients

Number of new ED patients treated for pain

Number of new ED patients treated with opioids for pain

Number of new ED patients who received non-opioid therapies for pain

Number of new emergency department (ED) patients who received an opioid prescription after receiving alternative therapies

Number of new emergency department (ED) patients presenting with pain

Number of ED patients with OUD to whom MOUD was provided in the ED

Number of new patients with OUD who were referred to outpatient MOUD services

[Q4 ONLY] Number of work group/advisory group/council members

[Q4 ONLY] Number of work group/advisory group/council members who have lived behavioral health experience

Number of new individuals with lived experience who provide behavioral health or recovery support services, including peer support or individual advocacy

Number of new individuals with lived experience who completed peer support certification

Number of new organizations that entered partnerships or collaboration with your grant

Number of new organizations that entered into formal written agreements Quarterly Narrative: Progress Report Overview

What you can collect, and how

Tier 1 is collected today from your own records. Tier 2 needs one free instrument. Tier 3 needs a partner under a data agreement. A measure that matches no rule has no tier.

Tier 1: Collect today from your own records

Enter the number of treatment court staff who successfully completed training during the reporting period. Staff are defined as, but not limited to, program managers, administrators, case managers, probation and parole officers, and clinicians. Do not count mentors, volunteers, or interns. Be consistent when reporting the type of staff across reporting periods. The number entered

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the number listed in question 4, enter the number of treatment court staff who rated the training as satisfactory or better during the reporting period. Satisfaction may be measured based on a survey provided to participants. The number entered should be less than or equal to the number entered in question 4. If not, check for data entry errors.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the total participants enrolled in your program, how many were deemed eligible for MAT, and of those eligible, how many received MAT during the reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Enter the number of treatment court candidates who were screened during the reporting period. Treatment court candidates are those identified at the time of arrest or referred by criminal justice professionals (i.e., prosecutor, defense attorney, probation officer, judge, etc.) but who may not necessarily be deemed eligible for participation. A screening determines eligibility and

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those screened, enter the number of individuals who did not enroll in the treatment court during the reporting period.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those screened who did not enroll in the treatment court program, enter the number of such individuals based on the following categories. If an individual falls into multiple categories, select the category that best applies to them.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those screened who did not enroll in the treatment court program, enter the number of such individuals based on the following demographic information. Enter the race, ethnicity, and sex of each individual determined to be ineligible for treatment court participation during the reporting period. Hispanics or Latinos should be counted in the race category that best

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Enter the number of newly admitted treatment court participants who were administered a risk and needs assessment during the reporting period. A risk and needs assessment is an instrument to help identify factors that may lead a participant to reoffend. It pinpoints needed services to minimize those risks. Only include those individuals who have been newly admitted to

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those newly admitted participants who were administered a risk and needs assessment during the reporting period, enter the number of such individuals who were identified as having high criminogenic risks and use treatment needs.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Enter the total number of participants enrolled in the treatment court program at the end of the reporting period. Enrolled participants include new admissions and those admitted in a previous reporting period who continue to participate.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Enter the number of newly admitted treatment court participants during the reporting period.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Enter the race, ethnicity, and sex of each participant newly admitted to the treatment court program during the reporting period. For the first reporting period, include all participants enrolled in the treatment court program. Hispanics or Latinos should be counted in the race category that best describes their racial identity, including White, Black or African American, Asian,

  • Collect today from your own records. A count of people served, held in the organization’s own records.

Enter the number of treatment court participants who successfully completed all program requirements, excluding financial obligations, during the reporting period. The number entered should represent only those participants who successfully completed all the requirements of the treatment court program during the reporting period. Those being held because of financial

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Enter the number of individuals who exited the program unsuccessfully in the categories below. Participants should not fit in more than one category, so choose the option that best represents why these individuals did not complete the program.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those treatment court participants who exited the program unsuccessfully, indicate the number of these participants who left within the following time frames (from the start of the program to termination). The sum of these categories should be equal to the total number of incompletes in question 34. If not, check for data entry errors. Round up to the nearest month

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those enrolled in the treatment court program for at least 90 days, enter the total number of participants tested for alcohol, non-prescribed medications, or illegal substances during the reporting period. This should represent the total number of treatment court participants who were tested for the presence of alcohol, non-prescribed medications, or

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those enrolled in the treatment court program for at least 90 days, enter the number of participants who tested positive for the presence of alcohol, non-prescribed medications, or illegal substances during the reporting period. Alcohol and substance use information should be based on documented tests rather than self-reported information from program participants. Include

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Since the start of this BJA program funding, enter the number of participants who:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Since the start of the BJA award, enter the total number of participants who have had a criminal court and/or criminal involvement event. A participant can be counted in more than one category (i.e., an individual can have an arrest and a conviction). However, do not count the frequency of events (i.e., number of arrests and convictions). Pending charges that the individual

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Enter the number of treatment court candidates who were screened during the reporting period. Treatment court candidates are those identified at the time of arrest or referred by criminal justice professionals (i.e., prosecutor, defense attorney, probation officer, judge, etc.) but who may not necessarily be deemed eligible for participation. A screening determines eligibility and

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those screened, enter the number of individuals who did not enroll in the treatment court during the reporting period.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those screened who did not enroll in the treatment court program, enter the number of such individuals based on the following categories. If an individual falls into multiple categories, select the category that best applies.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those screened who did not enroll in the treatment court program, enter the number of such individuals based on the following demographic information. Enter the race, ethnicity, and sex of each individual determined to be ineligible for treatment court participation during the reporting period. Hispanics or Latinos should be counted in the race category that best

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Please enter the number of newly admitted treatment court participants who were administered a risk and needs assessment during the reporting period. A risk and needs assessment is an instrument to help identify factors that may lead a participant to reoffend. It pinpoints needed services to minimize those risks. Only include those individuals who have been

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those newly admitted participants who were administered a risk and needs assessment during the reporting period, enter the number of such individuals who were identified as having high criminogenic risks and use treatment needs.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Enter the total number of participants enrolled in the treatment court program at the end of the reporting period. Enrolled participants include new admissions and those admitted in a previous reporting period who continue to participate.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Please enter the number of newly admitted treatment court participants during the reporting period. New participants are unique individuals who were not previously enrolled in the treatment court program in previous reporting periods. Individuals who exit the treatment court program without completion and are then readmitted or who have graduated and reentered may be

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Please enter the race, ethnicity, and sex of each participant newly admitted to the treatment court program during the reporting period. For the first reporting period, include all participants enrolled in the treatment court program. Hispanics or Latinos should be counted in the race category that best describes their racial identity, including White, Black or

  • Collect today from your own records. A count of people served, held in the organization’s own records.

Of the total participants enrolled in your program, how many were deemed eligible for MAT, and of those eligible, how many received MAT during the reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Enter the number of treatment court participants who successfully completed all program requirements, excluding financial obligations, during the reporting period. The number entered should represent only those participants who successfully completed all the requirements of the treatment court program during the reporting period. Those being held because

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Please enter the number of individuals who exited the program unsuccessfully in the categories below. Participants should not fit in more than one category, so choose the option that best represents why these individuals did not complete the program.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those treatment court participants who exited the program unsuccessfully, indicate the number of these participants who left within the following time frames (from the start of the program to termination). The sum of these categories should be equal to the total number of incompletes in question 30. If not, check for data entry errors. Round up to the nearest month

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those enrolled in the treatment court program for at least 90 days, enter the total number of participants tested for alcohol, non-prescribed medications, or illegal substances during the reporting period. This should represent the total number of treatment court participants who were tested for the presence of alcohol, non-prescribed medications, or

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those enrolled in the treatment court program for at least 90 days, enter the number of participants who tested positive for the presence of alcohol, non-prescribed medications, or illegal substances during the reporting period. Alcohol and substance use information should be based on documented tests rather than self-reported information from program participants. Include

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Since the start of this BJA program funding, enter the number of participants who:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Since the start of the BJA award, enter the total number of participants who have had a criminal court and/or criminal involvement event. A participant can be counted in more than one category (i.e., an individual can have an arrest and a conviction). However, do not count the frequency of events (i.e., number of arrests and convictions). Pending charges that the individual

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

For each of the trainings completed during the reporting period, indicate the number of individuals who attended the training and the length of the course in hours. Count each person only once per training topic, regardless of how many times he/she attended the training.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many hours is the training course/curriculum designed to last?

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How many of the following types of individuals received training in the use of naloxone through COSSUP during the reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many total people attended a training, outreach, awareness, or prevention activity during the reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many individuals were screened during the reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

During the reporting period, how many local, state, or national Take Back Day events did you coordinate/participate in with a law enforcement agency?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

During the reporting period, how many pounds of controlled substances were received and disposed of in locations with receptacles where you have assisted with the coordination and installation?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many individuals received services during the reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many individuals experienced a non-fatal overdose during the reporting period in your target area?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Through what mechanisms are referrals to recovery support services made?

  • Collect today from your own records. An output the funder classes as a count of activity.

Enter the number of individuals receiving recovery support services through referrals to other agencies/community support groups or through your program. Count the number of individuals with an SUD/OUD. Family members referred to recovery support services should be counted in question 51. The cumulative total column will automatically display the count of all

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

For those participants receiving recovery support services during the reporting period, how many are receiving services for:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

For those participants who stopped receiving recovery support services during the reporting period, how many received services for:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many friends/family members of program participants were referred to recovery support services during the reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those (from question 51), how many were identified as crime victims?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Through what mechanisms are referrals to substance abuse or co-occurring treatment services made?

  • Collect today from your own records. An output the funder classes as a count of activity.

Enter the number of individuals receiving substance abuse or co-occurring treatment services through referrals to other agencies or through your program. The cumulative total column will automatically display the count of all individuals referred to and receiving recovery support services since your program began reporting data in the PMT.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

On average, how long does it take for an individual to begin receiving substance abuse or co-occurring treatment services after receiving a referral?

  • Collect today from your own records. An output the funder classes as a count of activity.

For those participants receiving substance abuse or co-occurring treatment services during the reporting period, how many received services for:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

For those participants who stopped receiving substance abuse or co-occurring treatment services during the reporting period, how many received services for:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Since the beginning of the program, how many subsequent overdose events did program participants experience (fatal or nonfatal) in the specified periods of time following their referral into the program?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Since the beginning of the program, how many individual participants experienced subsequent overdose events (fatal or nonfatal) in the specified period of time following their referral into the program?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Indicate the number of program participants who had the specified number of contacts with their case manager during their first 30 days. A contact could include an in-person meeting, phone call, or series of electronic messages.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Enter the number of individuals assisted with a victim compensation application during the reporting period. Count the number of individuals who received assistance with completing a victim compensation application during the reporting period, even if they did not submit the application. Simply providing an individual with an application does not qualify as assistance.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many individuals (including anonymous contacts) received services from victim services provider partner(s) during the reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Provide the number of individuals who received services by service type and number of times each service was provided during the reporting period. For each category (items B, C, D, E, and F) selected in question 70, enter the number of clients who received services from your agency during the reporting period. For each subcategory within a category (e.g., items A1, A2, A3, A4, etc.), enter the

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Please enter the number of treatment staff who work directly with participants in the Residential Substance Abuse Treatment (RSAT) program since the beginning of grant funding. When answering ‘A’, please count all treatment staff regardless of funding source. Staff would be all treatment employees, including but not limited to program managers, case managers,

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Please enter the number of treatment staff members who were cross trained in the jail/prison-based portion of the RSAT program since the beginning of the program. This information should be based on the number of treatment staff who received training in the implementation of assessment instruments, motivational interviewing (MI) techniques, accountability

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Please enter the number of custody staff members who were cross trained in the jail/prison-based portion of the RSAT program since the beginning of the program. This information should be based on the number of uniformed officers who received training in the implementation of assessment instruments, MI techniques, accountability training, or addiction-

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those who entered the jail/prison-based portion of the RSAT program, please enter the number of jail/prison/juvenile-based participants for the following measures.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those who entered the jail/prison-based portion of the RSAT program, please enter the number of jail/prison/juvenile-based participants for the following measures. Please only include those individuals who have been admitted to the RSAT program.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Please enter the number of jail/prison/juvenile-based participants who were provided services during the reporting period with BJA program funds, including matching funds, through the following treatment components:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Please enter the number of jail/prison/juvenile-based participants who were provided with transitional planning services with BJA program funds, including matching funds, since the beginning of grant funding. To provide transitional planning services, the RSAT program must work with clients to develop individualized post-release plans that address each client’s

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the total participants enrolled in your program, how many were deemed eligible for MAT and of those eligible, how many received MAT during the reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Please enter the number of participants who successfully completed all requirements of the jail/prison-based portion of your RSAT program during the reporting period. The number entered should represent only those participants who successfully completed all the requirements of the RSAT program during the reporting period.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those jail/prison/juvenile-based participants who successfully completed all program requirements, please enter the number who were released to the community during the reporting period.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those jail/prison/juvenile-based program completers released to the community, please enter the number with a continuity of care arrangement or reentry or transitional plan.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Please enter the number of individuals who did not complete and are no longer participants in the jail/prison/juvenile-based portion of the RSAT program during the reporting period. Former participants should not fit in more than one category, so please choose the option that best represents why these individuals did not complete the program.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Please enter the number of jail/prison/juvenile-based participants who were administered an alcohol/drug test (e.g., urinalysis test) before admission into your RSAT program. As a requirement, grantees must agree to implement or continue to require urinalysis or other proven reliable forms of testing, including both periodic and random testing (1) of an individual before the

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those enrolled in the jail/prison/juvenile-based portion of the RSAT program, please enter the total number of participants tested for alcohol or illegal substances during the reporting period. This should represent the total number of RSAT participants who were given drug tests. The number entered should be an unduplicated count only of participants who were tested for

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those enrolled in the jail/prison/juvenile-based portion of the RSAT program, please enter the number of participants who tested positive for the presence of alcohol or illegal substances during the reporting period. The number entered should be an unduplicated count only of participants who tested positive for alcohol or illegal substances, and it should be equal to or

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

During the reporting period, please enter the number of participants who were administered an alcohol/drug test (e.g., urinalysis test) within 30 days after successfully completing your residential drug treatment program and are still under supervision of the program.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Since the start of the BJA RSAT award, how many jail/prison/juvenile based participants:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those who entered the aftercare portion of the RSAT, please enter the number of aftercare -based participants for the following measures.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those who entered the aftercare portion of the RSAT program, please enter the number of aftercare-based participants for the following measures.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Please enter the number of aftercare participants who were provided services during the reporting period with BJA program funds, including matching funds, through the following treatment components:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the total participants enrolled in your program, how many were deemed eligible for MAT and of those eligible, how many received MAT during the reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Please enter the number of participants who successfully completed all requirements of the aftercare portion of your RSAT program during the reporting period. The number entered should represent only those participants who successfully completed all the requirements of the RSAT program during the reporting period.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Please enter the number of individuals who did not complete the aftercare portion of the RSAT program for the categories below. Participants should not fit in more than one category, so choose the option that best represents why these individuals did not complete the program.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Please enter the number of participants who were administered an alcohol/drug test before admission into your aftercare program. As a requirement, grantees must agree to implement or continue to require urinalysis or other proven reliable forms of testing, including both periodic and random testing (1) of an individual before the individual enters an RSAT program and during the

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those enrolled in the aftercare portion of the RSAT program, please enter the total number of participants tested for alcohol or illegal substances during the reporting period.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of those enrolled in the aftercare portion of the RSAT program, please enter the number of participants who tested positive for the presence of alcohol or illegal substances during the reporting period. The number entered should be an unduplicated count only of participants enrolled in the program who tested positive for alcohol or illegal substances, and it should be equal to or less

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

During the reporting period, please enter the number of participants who were administered a drug test within 30 days after successfully completing your residential drug treatment program.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Since the start of the RSAT BJA award, how many aftercare participants:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Since the start of the RSAT BJA award, enter the total number of aftercare participants who have had a court and/or criminal involvement event. An ex-offender can be counted in more than one category (i.e., an individual can have an arrest and a conviction and then be reincarcerated).

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many unique individuals started the program during this reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many unique individuals were discharged from the program during this reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many unique individuals were discharged from the program since the beginning of the award?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many unique individuals were tested for substance use during this reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many unique individuals received assessments of their mental health during this reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique individuals discharged during this reporting period, how many were discharged successfully?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique individuals discharged during this reporting period, how many were discharged unsuccessfully?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique individuals discharged during this reporting period, how many were discharged for another reason?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique individuals discharged since the beginning of the award, how many were discharged successfully?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique individuals discharged since the beginning of the award, how many were discharged unsuccessfully?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many unique individuals started the program within a year prior to the beginning of this award?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many unique families started the program during this reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many unique families were discharged from the program during this reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many unique families were discharged from the program since the beginning of the award? Enter the number of unique families who were discharged from the program since the beginning of the award. This is a cumulative number that includes counts from all reporting periods. Do not count a family in more than one reporting period.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many unique individuals were tested for substance use during this reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique families discharged during this reporting period, how many were discharged successfully?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique families discharged during this reporting period, how many were discharged unsuccessfully?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique families discharged during this reporting period, how many were discharged for another reason?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique families discharged since the beginning of the award, how many were discharged successfully?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique families discharged since the beginning of the award, how many were discharged unsuccessfully?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique families successfully discharged during this reporting period, how many children demonstrated satisfactory well being?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique families discharged during this reporting period, how many demonstrated placement stability for their children?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique families successfully discharged since the beginning of the award, how many experienced new child welfare system involvement within 12 months of discharge?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique families unsuccessfully discharged since the beginning of the award, how many experienced new child welfare system involvement within 12 months of discharge?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many unique individuals started the program during this reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many unique individuals were tested for substance during this reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many unique individuals were discharged from the program during this reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique individuals discharged during this reporting period, how many were discharged successfully?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique individuals discharged during this reporting period, how many were discharged unsuccessfully?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique individuals discharged during this reporting period, how many were discharged for another reason?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many unique individuals were discharged from the program since the beginning of the award? Enter the number of unique youth who were discharged from the program since the beginning of the award. This is a cumulative number that includes counts from all reporting periods. Do not count an individual in more than one reporting period.

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique individuals discharged since the beginning of the award, how many were discharged successfully?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique individuals discharged since the beginning of the award, how many were discharged unsuccessfully?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many unique individuals started the program during this reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many unique individuals were discharged from the program during this reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many unique individuals were discharged from the program since the beginning of the award?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

How many unique individuals were tested for substance use during this reporting period?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique individuals discharged during this reporting period, how many were discharged successfully?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique individuals discharged during this reporting period, how many were discharged unsuccessfully?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique individuals discharged during this reporting period, how many were discharged for another reason?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique individuals discharged since the beginning of the award, how many were discharged successfully?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique individuals discharged since the beginning of the award, how many were discharged unsuccessfully?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Of the unique individuals successfully discharged this reporting period, how many demonstrated satisfactory well-being at program exit?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Estimated number of naloxone kits to be purchased:

  • Collect today from your own records. An output the funder classes as a count of activity.

Estimated number of naloxone kits to be distributed:1

  • Collect today from your own records. An output the funder classes as a count of activity.

Estimated number of naloxone kits to be distributed to…

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Estimated number of professional first responders to be equipped with naloxone kits:

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Estimated number of other key community sector members to be equipped with naloxone kits:

  • Collect today from your own records. An output the funder classes as a count of activity.

Estimated number of nontraditional community sector members to be equipped with naloxone kits: Naloxone training

  • Collect today from your own records. An output the funder classes as a count of activity.

Estimated number of professional first responders to be trained on…

  • Collect today from your own records. An output the funder classes as a count of activity.

Estimated number of other key community sector members to be trained on…

  • Collect today from your own records. An output the funder classes as a count of activity.

Estimated number of nontraditional community sector members to be trained on…

  • Collect today from your own records. An output the funder classes as a count of activity.

Total number of naloxone kits purchased: ____

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Total number of naloxone kits distributed:2

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of professional first responders equipped with naloxone kits:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of other key community sector members equipped with naloxone kits:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of nontraditional community sector members equipped with naloxone kits:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of other community members equipped with naloxone kits following an opioid- related overdose event: Naloxone Training

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of professional first responders trained on…

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of other key community sector members trained on…

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of nontraditional community sector members trained on…

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Total number of known or suspected opioid overdose events: Events involving naloxone administration by professional first responders

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of opioid overdose survivors who…

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of opioid overdose family members who…

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Total number of responses to service requests: ____

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Percent of total award budgeted for naloxone product purchases: %

  • Collect today from your own records. An output the funder classes as a count of activity.

Amount budgeted for purchase of naloxone products by type

  • Collect today from your own records. An output the funder classes as a count of activity.

Estimated number of naloxone kits to be distributed to high need communities:1

  • Collect today from your own records. An output the funder classes as a count of activity.

Estimated number of naloxone kits to be distributed to…

  • Collect today from your own records. An output the funder classes as a count of activity.

Estimated number of trainings to be conducted on opioid overdose death prevention strategies: ____

  • Collect today from your own records. An output the funder classes as a count of activity.

Estimated number of individuals to be trained on opioid overdose death prevention strategies by participant type

  • Collect today from your own records. An output the funder classes as a count of activity.

Estimated number of individuals to be trained on use of naloxone by participant type2

  • Collect today from your own records. An output the funder classes as a count of activity.

Estimated number of medical professionals to be trained on risks of overprescribing:

  • Collect today from your own records. An output the funder classes as a count of activity.

Percent of total grant funds spent on naloxone product purchases: %

  • Collect today from your own records. An output the funder classes as a count of activity.

Amount of award funds spent on naloxone product purchases by type

  • Collect today from your own records. An output the funder classes as a count of activity.

Total number of naloxone kits distributed to high need communities using PDO grant-funded resources:3

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of naloxone kits distributed to…

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Total number of trainings conducted on opioid overdose death prevention strategies:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of individuals trained on opioid overdose death prevention strategies by participant type

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of individuals trained on use of naloxone by participant type4

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of medical professionals trained on risks of overprescribing:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Total number of known or suspected opioid overdose events:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of naloxone administration events by participant type

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of naloxone doses administered:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of naloxone administration events by location

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of events where naloxone was administered by professional first responders by outcome

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of events where naloxone was administered by other key community sector members by outcome

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of referrals for naloxone-related information and resources:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of referrals to substance use disorder treatment services:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of individuals linked to treatment or recovery support services following successful overdose reversal administration:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Estimated number of service providers to be trained on prescribing naloxone by service provider type

  • Collect today from your own records. An output the funder classes as a count of activity.

Estimated number of other service providers to be trained on prescribing naloxone by specified type

  • Collect today from your own records. An output the funder classes as a count of activity.

Estimated amount of award funds to be spent on naloxone purchases by type

  • Collect today from your own records. An output the funder classes as a count of activity.

Estimated amount of award funds to be spent on…

  • Collect today from your own records. An output the funder classes as a count of activity.

Estimated number of naloxone kits to be distributed:1

  • Collect today from your own records. An output the funder classes as a count of activity.

Number of trainings conducted by ToT type

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of individuals who completed ToT primary trainings:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of individuals who completed ToT primary trainings by participant type

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of other individuals who completed ToT primary trainings by specified type

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of individuals who completed ToT secondary trainings by participant type

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of individuals who completed ToT secondary trainings by specified type

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of service providers trained on prescribing naloxone by service provider type

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of other service providers trained on prescribing naloxone by specified type

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Amount of award funds spent on naloxone purchases by type

  • Collect today from your own records. An output the funder classes as a count of activity.

Amount of award funds spent on…

  • Collect today from your own records. An output the funder classes as a count of activity.

Total number of naloxone kits distributed using ODTA grant-funded resources:2____

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of events where naloxone was administered by ToT-trained individuals by outcome

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of patients linked to treatment services following opioid overdose reversal by service type

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of patients who initiated treatment services following an opioid overdose reversal by service type

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Total Number of Individuals Served

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Total Served by Sex

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Total Served by Age Group

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Total Served by Military Status

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Number of mental health awareness and promotion messaging impressions

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of substance use prevention messaging impressions

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of 988 awareness messaging impressions Outreach (O) Outreach (O) indicators track one-on-one contact with individuals outside of the clinical

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of connections made through program outreach

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of connections made through program outreach in geographically isolated areas

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of connections made through program outreach in under- resourced communities

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals vaccinated for hepatitis A (HAV)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals vaccinated for hepatitis B (HBV)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of opioid overdose reversal medication (OORM) kits purchased

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of opioid overdose reversal medication (OORM) kits distributed

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of prevention devices distributed

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of medication lock boxes distributed

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of sharps containers distributed

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of medication disposal kits distributed Prevention Activities

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of safe sex kits including condoms distributed

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of wound management kits distributed

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of gun locks distributed

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of drug checking technologies distributed Prevention Education - Encounters (PE) indicators track components of universal prevention strategies delivered to individuals through one-on-one brief interactions or

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of mental health promotion education encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of substance use education encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of substance use treatment education encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of substance use prevention education encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of substance use recovery education encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of prevention of suicide education encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of prevention of viral hepatitis, HIV, or other communicable diseases education encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of prevention of hepatitis B (HBV) education encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of prevention of hepatitis C (HBC) education encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of prevention of HIV education encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of pre-exposure prophylaxis for HIV (PrEP) education encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of post-exposure prophylaxis for HIV (PEP) education encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of prevention of bacterial sexually transmitted infections (STIs) education encounters Prevention Education - Individuals (PEI) indicators track components of universal

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals educated on mental health promotion

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals educated on substance use

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals educated on substance use treatment

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals educated on substance use prevention

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals educated on substance use recovery

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals educated on prevention of suicide

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals educated on prevention of viral hepatitis, HIV, or other communicable diseases

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals educated on prevention of hepatitis B (HBV)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals educated on prevention of hepatitis C (HBC)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals educated on prevention of HIV

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals educated on pre-exposure prophylaxis for HIV (PrEP)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals educated on post-exposure prophylaxis for HIV (PEP)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals educated on prevention of bacterial sexually transmitted infections (STIs)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of mental health screening encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of trauma experience screening encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of substance use screening encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of positive substance use screening encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of positive substance use screening encounters where services were declined

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of suicide risk screening encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of positive suicide risk screening encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of screening encounters for risk factors associated with viral hepatitis, HIV, bacterial STIs, and tuberculosis

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of screening encounters for risk of HIV

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of screening encounters for risk of hepatitis B (HBV)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of screening encounters for risk of hepatitis C (HCV)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of screening encounters for risk of bacterial sexually transmitted infections (STIs)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of screening encounters for risk of tuberculosis (TB)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of supportive services needs screening encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of educational/vocational needs screening encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of employment needs screening encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of family support needs screening encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of childcare needs screening encounters Screening Encounter

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of transportation needs screening encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of housing stability screening encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.
  • No cleared, validated, free outcome instrument exists for housing stability. The funder's own item (SAMHSA SUPRT-C client form, item A2d), an HMIS exit destination, or a partner record is the substitute.

Number of screening encounters positive for experiencing homelessness

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of recovery housing needs screening encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of peer support needs screening encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of food insecurity screening encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of other health conditions screening encounters Screening - Individual

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals screened for mental health

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals screened for substance use

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who screened positive for substance use

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who screened positive for substance use but declined services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals screened for suicide risk

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who screened positive for suicide risk

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals screened for risk factors associated with viral hepatitis, HIV, bacterial STIs, and tuberculosis

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who screened at risk for HIV

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who screened at risk for hepatitis B (HBV)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who screened at risk for hepatitis C (HCV)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who screened at risk for bacterial sexually transmitted infections (STIs)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who screened at risk for tuberculosis (TB) Screening - Individual

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals screened for need for supportive services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals screened for educational/vocational needs

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals screened for employment needs

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals screened for family support needs

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals screened for childcare needs

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals screened for transportation needs

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals screened for housing stability

  • Collect today from your own records. A count of services or people, held in the organization’s own records.
  • No cleared, validated, free outcome instrument exists for housing stability. The funder's own item (SAMHSA SUPRT-C client form, item A2d), an HMIS exit destination, or a partner record is the substitute.

Number of new individuals screened positive for homelessness

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals screened for recovery housing needs

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals screened for peer support needs

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals screened for food insecurity

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals screened for other health conditions Assessment and Testing

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals assessed for a serious mental illness (SMI) or a

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals diagnosed with a SMI

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals diagnosed with a SED

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals assessed for a substance use disorder (SUD)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals diagnosed with an SUD

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals tested for HIV

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who tested positive for HIV

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals reached with a known HIV-positive status but not currently receiving treatment Assessment and Testing

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals tested for hepatitis B (HBV)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who tested positive for HBV

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals reached with a known HBV-positive status but not currently receiving treatment

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals tested for hepatitis C (HCV)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who tested positive for HCV

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals reached with a known HCV-positive status but not currently receiving treatment

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals tested for bacterial sexually transmitted infections (STIs)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who tested positive for gonorrhea

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who tested positive for chlamydia

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who tested positive for syphilis

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who tested for tuberculosis (TB)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who tested positive for tuberculosis (TB) Referral (R) Referral indicators track efforts to refer the individuals identified with behavioral health

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of referrals provided to mental health services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of referrals provided to substance use services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of referrals provided to treatment after a positive screening for substance use

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of referrals provided to treatment after an overdose reversal

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of referrals provided to crisis services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of referrals provided to co-occurring treatment services Referral - Encounter

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of mental health service referral encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of traumatic stress referral encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of suicide prevention referral encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of substance use service referral encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of substance use service referral encounters after a positive screening for substance use

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of substance use service referral encounters after an overdose reversal

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of crisis service referral encounters

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of co-occurring treatment service referral encounters Referral - Individual

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals referred to mental health services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals referred to substance use services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals referred to treatment after a positive screening for substance use

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals referred to treatment after an overdose reversal

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals referred to crisis services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals referred to co-occurring treatment services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals linked to mental health services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals linked to substance use services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals linked to substance use treatment after an overdose reversal

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals linked to care for viral hepatitis, HIV, or other communicable disease

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals linked to HIV pre-exposure prophylaxis (PrEP)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals linked to HIV post-exposure prophylaxis (PEP)

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals linked to HIV treatment

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals linked to hepatitis B (HBV) treatment

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals linked to hepatitis C (HCV) treatment Access and Linkage to Care or Treatment

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals linked to chlamydia treatment

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals linked to syphilis treatment

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals linked to tuberculosis (TB) treatment

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals linked to recovery and resilience support AC 15. Number of new individuals linked to educational or vocational support services

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Number of new individuals linked to employment support services

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Number of new individuals linked to family support services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals linked to childcare services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals linked to transportation services AC 20. Number of new individuals linked to housing support services

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Number of new individuals linked to recovery housing services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals linked to peer coaching and mentoring

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals linked to specialized population services

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Number of new individuals linked to peer group/mutual support groups AC 25. Number of new individuals linked to respite care

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Number of new individuals linked to therapeutic foster care

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Number of new individuals linked to individualized advocacy or consultation

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Number of new individuals linked to family unification services

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Number of new individuals linked to other recovery support services AC 30. Number of new individuals linked to services for other health conditions

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Number of brief intervention encounters for mental health

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Number of brief intervention encounters for substance use

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Number of brief treatment encounters for substance use

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Number of brief intervention encounters for suicide prevention

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Number of opioid overdose reversal medication (OORM) administration events Services

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Number of new individuals who received mental health services

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Number of new individuals who received therapy or counseling

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Number of new individuals who received group counseling

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Number of new individuals who received family counseling

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Number of new individuals who received psychiatric rehabilitation services

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Number of new individuals who received intensive day treatment

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Number of new individuals who received substance use treatment services

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Number of new individuals who received inpatient hospitalization treatment

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Number of new individuals who received residential/rehabilitation

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Number of new individuals who received outpatient treatment

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Number of new individuals who received withdrawal management Services

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Number of new individuals who received after care

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Number of new individuals who received medications for substance use

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Number of new individuals who received medications for opioid use disorder (MOUD) by mobile medication units

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Number of new individuals who received medications for alcohol use disorder (MAUD) by mobile medication units

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Number of new individuals who received suicide-specific services

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Number of new individuals who received viral hepatitis, HIV, or other communicable disease services

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Number of new individuals who received HIV PrEP

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Number of new individuals who received HIV PEP

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Number of new individuals who received treatment for HIV

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Number of new individuals who received treatment for hepatitis B (HBV)

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Number of new individuals who received direct acting antiviral-based treatment

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Number of new individuals who received treatment for gonorrhea

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Number of new individuals who received treatment for chlamydia

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Number of new individuals who received treatment for syphilis

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Number of new individuals who received treatment for tuberculosis (TB)

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Number of new individuals who received support services that assist with recovery and resilience

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Number of new individuals who received educational or vocational support services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who received employment support services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who received family support services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who received childcare services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who received transportation services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who received housing support services Services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who received recovery housing services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who received peer coaching and mentoring

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who received specialized population services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who participated in peer group/mutual support groups

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Number of new individuals who received respite care

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who received therapeutic foster care

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who received individualized advocacy or consultation

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who received family unification services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who received other recovery support services

  • Collect today from your own records. A count of services or people, held in the organization’s own records.

Number of new individuals who received services for other health conditions

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Number of new individuals who received primary health care services

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Number of new individuals who received maternal health care services

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Number of new individuals who received dental care services

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Number of new individuals who received other health care services

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Number of new individuals who received case management services

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Number of new individuals who received care coordination

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Number of new individuals who received treatment planning

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Number of contacts who received mental health services

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Number of contacts who received therapy or counseling

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Number of contacts who received group counseling

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Number of contacts who received family counseling

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Number of contacts who received psychiatric rehabilitation services

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Number of contacts who received intensive day treatment

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Number of contacts who received behavioral health crisis services

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Number of contacts who received mobile crisis response

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Number of contacts who received crisis stabilization

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Number of contacts who received crisis residential care

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Number of contacts who received crisis follow-up care

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Number of contacts who received crisis follow-up contacts (phone, chat, text, or other)

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Number of contacts linked to behavioral health crisis services

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Number of contacts linked to care for suicide risk

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Number of contacts linked with 911/emergency services

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Number of mental health intervention training participants

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Number of mental health intervention training participants who were behavioral health professionals

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Number of trauma informed care training participants

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Number of trauma informed care training participants who were behavioral health professionals

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Number of suicide prevention and/or behavioral health crisis response training participants

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Number of suicide prevention and/or behavioral health crisis response training participants who were professional first responders

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Number of suicide prevention and/or behavioral health crisis response training participants who were behavioral health professionals

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Number of suicide prevention and/or behavioral health crisis response training participants who were medical health professionals

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Number of substance use treatment training participants

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Number of alcohol use disorder (AUD) training participants

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Number of opioid use disorder (OUD) training participants

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Number of opioid use disorder (OUD) training participants who were professional first responders

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Number of opioid use disorder (OUD) training participants who were behavioral health professionals

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Number of opioid use disorder (OUD) training participants who were medical health professionals

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Number of opioid overdose response training participants Training and Workforce Development

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Number of opioid overdose response training participants who were professional first responders

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Number of opioid overdose response training participants who were other key community sector members

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Number of opioid overdose response training participants who were school personnel trained

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Number of opioid overdose response training participants who were behavioral health professionals

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Number of opioid overdose response training participants who were non- traditional community sector members

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Number of opioid overdose response training participants who were other community members

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Number of opioid overdose response training participants who were family members of someone who experienced an opioid overdose

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Number of opioid overdose response training participants who were individuals with lived experience

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Number of opioid overdose reversal medication (OORM) administration training participants

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Number of screening and identification of opioid use disorder (OUD) training participants

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Number of medication administration for opioid use disorder (MOUD) training participants

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Number of non-opioid therapies training participants

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Number of peer support training participants who were individuals with lived experience

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Number of co-occurring mental health and substance use disorder intervention training participants

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Number of co-occurring mental health and substance use disorder intervention training participants who were professional first responders

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Number of viral hepatitis, HIV, or other communicable diseases participants

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Number of viral hepatitis, HIV, or other communicable diseases training participants who were behavioral health professionals

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Number of opioid overdose reversals

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Number of individuals who attempted suicide

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Number of individuals who died by suicide

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Number of families that successfully reunited with children in kinship or foster care arrangements through support services that assist with recovery

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Number of new individuals who completed their course of treatment for hepatitis

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Number of new individuals who achieved a hepatitis C (HCV) cure (SVR4 or later)

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Number of new ED patients treated for pain

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Number of new ED patients treated with opioids for pain

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Number of new ED patients who received non-opioid therapies for pain

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Number of ED patients with OUD to whom MOUD was provided in the ED

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Number of new patients with OUD who were referred to outpatient MOUD services

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[Q4 ONLY] Number of work group/advisory group/council members

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[Q4 ONLY] Number of work group/advisory group/council members who have lived behavioral health experience

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Number of new individuals with lived experience who provide behavioral health or recovery support services, including peer support or individual advocacy

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Number of new individuals with lived experience who completed peer support certification

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Number of new organizations that entered partnerships or collaboration with your grant

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Number of new organizations that entered into formal written agreements Quarterly Narrative: Progress Report Overview

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Tier 1 + 3: Collect today from your own records; and Needs a partner under an agreement

Since the start of the RSAT BJA award, enter the total number of jail/prison/juvenile-based participants released into the community who successfully completed and unsuccessfully exited and were reincarcerated:

  • Collect today from your own records. A count of services or people, held in the organization’s own records.
  • You count your own participants; the court or corrections record confirms the outcome.
  • Partner route: PA: reincarceration and other corrections outcomes, held by Pennsylvania Department of Corrections. Lag: Event and update lag and approval SLA NR. Request: https://www.pa.gov/services/cor/submit-a-research-proposal
  • Partner route: MA: new criminal cases and dispositions, and defined recidivism measures, held by Department of Criminal Justice Information Services, CORI repository. Lag: Event-to-record and update lag NR. Research approvals are renewable, generally for one year. Request: https://www.mass.gov/how-to/request-research-access-to-criminal-record-data

Of the unique individuals successfully discharged since the beginning of the award, how many experienced a new adjudication within 12 months of discharge?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.
  • You count your own participants; the court or corrections record confirms the outcome.
  • Partner route: PA: reincarceration and other corrections outcomes, held by Pennsylvania Department of Corrections. Lag: Event and update lag and approval SLA NR. Request: https://www.pa.gov/services/cor/submit-a-research-proposal
  • Partner route: MA: new criminal cases and dispositions, and defined recidivism measures, held by Department of Criminal Justice Information Services, CORI repository. Lag: Event-to-record and update lag NR. Research approvals are renewable, generally for one year. Request: https://www.mass.gov/how-to/request-research-access-to-criminal-record-data

Of the individuals unsuccessfully discharged since the beginning of the award, how many experienced a new adjudication within 12 months of discharge?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.
  • You count your own participants; the court or corrections record confirms the outcome.
  • Partner route: PA: reincarceration and other corrections outcomes, held by Pennsylvania Department of Corrections. Lag: Event and update lag and approval SLA NR. Request: https://www.pa.gov/services/cor/submit-a-research-proposal
  • Partner route: MA: new criminal cases and dispositions, and defined recidivism measures, held by Department of Criminal Justice Information Services, CORI repository. Lag: Event-to-record and update lag NR. Research approvals are renewable, generally for one year. Request: https://www.mass.gov/how-to/request-research-access-to-criminal-record-data

Of the unique individuals successfully discharged since the beginning of the award, how many experienced a new adjudication within 12 months of discharge?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.
  • You count your own participants; the court or corrections record confirms the outcome.
  • Partner route: PA: reincarceration and other corrections outcomes, held by Pennsylvania Department of Corrections. Lag: Event and update lag and approval SLA NR. Request: https://www.pa.gov/services/cor/submit-a-research-proposal
  • Partner route: MA: new criminal cases and dispositions, and defined recidivism measures, held by Department of Criminal Justice Information Services, CORI repository. Lag: Event-to-record and update lag NR. Research approvals are renewable, generally for one year. Request: https://www.mass.gov/how-to/request-research-access-to-criminal-record-data

Of the individuals unsuccessfully discharged since the beginning of the award, how many experienced a new adjudication within 12 months of discharge?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.
  • You count your own participants; the court or corrections record confirms the outcome.
  • Partner route: PA: reincarceration and other corrections outcomes, held by Pennsylvania Department of Corrections. Lag: Event and update lag and approval SLA NR. Request: https://www.pa.gov/services/cor/submit-a-research-proposal
  • Partner route: MA: new criminal cases and dispositions, and defined recidivism measures, held by Department of Criminal Justice Information Services, CORI repository. Lag: Event-to-record and update lag NR. Research approvals are renewable, generally for one year. Request: https://www.mass.gov/how-to/request-research-access-to-criminal-record-data

Of the unique individuals successfully discharged since the beginning of the award, how many experienced a new adjudication or conviction within 12 months of discharge?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.
  • You count your own participants; the court or corrections record confirms the outcome.
  • Partner route: PA: reincarceration and other corrections outcomes, held by Pennsylvania Department of Corrections. Lag: Event and update lag and approval SLA NR. Request: https://www.pa.gov/services/cor/submit-a-research-proposal
  • Partner route: MA: new criminal cases and dispositions, and defined recidivism measures, held by Department of Criminal Justice Information Services, CORI repository. Lag: Event-to-record and update lag NR. Research approvals are renewable, generally for one year. Request: https://www.mass.gov/how-to/request-research-access-to-criminal-record-data

Of the unique individuals unsuccessfully discharged since the beginning of the award, how many experienced a new adjudication or conviction within 12 months of discharge?

  • Collect today from your own records. A count of services or people, held in the organization’s own records.
  • You count your own participants; the court or corrections record confirms the outcome.
  • Partner route: PA: reincarceration and other corrections outcomes, held by Pennsylvania Department of Corrections. Lag: Event and update lag and approval SLA NR. Request: https://www.pa.gov/services/cor/submit-a-research-proposal
  • Partner route: MA: new criminal cases and dispositions, and defined recidivism measures, held by Department of Criminal Justice Information Services, CORI repository. Lag: Event-to-record and update lag NR. Research approvals are renewable, generally for one year. Request: https://www.mass.gov/how-to/request-research-access-to-criminal-record-data

Number of new emergency department (ED) patients

Number of new emergency department (ED) patients who received an opioid prescription after receiving alternative therapies

Number of new emergency department (ED) patients presenting with pain

Tier 2: Add one free instrument

Of the unique individuals successfully discharged during this reporting period, how many demonstrated reduced substance use?

Of the unique individuals successfully discharged during this reporting period, how many experienced improved mental health?

Of the unique individuals successfully discharged during this reporting period, how many demonstrated reduced substance use?

Of the unique individuals unsuccessfully discharged during this reporting period, how many demonstrated reduced substance use?

Of the unique individuals successfully discharged during this reporting period, how many demonstrated reduced substance use by program exit?

Of the unique individuals unsuccessfully discharged during this reporting period, how many demonstrated reduced substance use by program exit?

Of the unique individuals successfully discharged during this reporting period, how many demonstrated reduced substance use at program exit?

On a scale of 0 to 100, if 0 represents no quality of life and 100 is perfect quality of life, how would you rate your quality of life? | | | |

On a scale of 0 to 100, if 0 represents no quality of life and 100 is perfect quality of life, how would you rate your quality of life? | | | |

On a scale of 0 to 100, if 0 represents no quality of life and 100 is perfect quality of life, how would you rate your quality of life? | | | |

Implementation question, answered from program records

Was there grant activity in the reporting period?

Are you on track to complete your program fiscally and programmatically as outlined in your grant application?

Was there grant activity in the reporting period?

Is this the last time the grantee is reporting in the Performance Measurement Tool (PMT) before closing out this award?

Does your treatment court program have a formal policy for graduated sanctions and incentives that is documented in writing and implemented fairly and with certainty in response to participant behavior?

Does your treatment court program administer random and observed alcohol and substance use testing?

Does your treatment court program use evidence-based treatment services?

Has the treatment court program admitted new participants into the treatment court program during the reporting period?

Are you on track to complete your program fiscally and programmatically as outlined in your grant application?

Was there grant activity during the reporting period?

Is this the last time the grantee is reporting in the Performance Measurement Tool (PMT) before closing out this award?

Does your treatment court program have a formal policy for graduated sanctions and incentives that is documented in writing and implemented fairly and with certainty in response to participant behavior?

Does your treatment court program administer random and observed alcohol and substance use testing?

Does your treatment court program use evidence-based treatment services?

Has the treatment court program admitted new participants into the treatment court program during the reporting period?

Are you on track to complete your program fiscally and programmatically as outlined in your grant application?

Is this the last reporting period for which the award will have data to report?

Was there grant activity during the reporting period?

Has there been a change in your COSSUP Project Director during the reporting period?

Does your COSSUP include a researcher or a research partner? [Carry forward]

Has there been a change in your COSSUP researcher/research partner or a significant change in the research team during the reporting period?

Do you have a webpage for your program? [Carry forward]

Are any of your funds going to a tribal territory or community, and/or does the project serve a tribal community?

Did you/your agency/entire workgroup receive any technical assistance from a BJA-funded provider during the reporting period?

Were COSSUP grant funds used to develop a training course or curriculum?

Did the COSSUP-funded program conduct any training, outreach, awareness, or prevention activities during the reporting period?

Are you using any of the following branded models?

Did your COSSUP use grant funds to develop or enhance data collection and analysis?

Did your COSSUP use grant funds to develop partnerships with a victim services provider(s) to assist crime victims impacted by the opioid epidemic and the reemergence of stimulant abuse?

Has there been a change to your Victim Services Partner during the reporting period?

Since the beginning of your program, has it demonstrated a measurable impact on the problem of focus?

Did you receive or do you desire any assistance from BJA or a BJA-funded technical assistance provider?

Is this the last reporting period for which the award will have data to report?

Was there grant activity during the reporting period?

Are risk assessment screening tool results used in determining who is admitted as a participant into the RSAT Program?

Are risk assessment screening tool results used in determining who is admitted as a participant into the RSAT aftercare program?

Are you on track to fiscally and programmatically complete your program as outlined in your grant application?

Did you adjust the program plan as described in your application’s proposal narrative. If yes, what adjustments did you make, and why?

Did you experience any challenges during this reporting period that impacted service delivery to program participants? If yes, how did you address the challenges or do the challenges remain unresolved?

Did you engage with OJJDP training and technical assistance providers this reporting period? If yes, did the providers adequately address your issue?

Did you experience any challenges related to external factors beyond your control during the reporting period that impacted program outcomes? If yes, please describe the challenges.

Did you adjust the program plan as described in your application’s proposal narrative? If yes, what adjustments did you make, and why?

Did you experience any challenges during this reporting period that impacted service delivery to program participants? If yes, how did you address the challenges, or do the challenges remain unresolved?

Did you engage with OJJDP training and technical assistance providers this reporting period? If yes, did the providers adequately address your issue?

Did you experience any challenges related to external factors beyond your control during the reporting period that impacted program outcomes? If yes, please describe the challenges.

Did you adjust the program plan as described in your application’s proposal narrative? If yes, what adjustments did you make, and why?

Did you experience any challenges during this reporting period that impacted service delivery to program participants? If yes, how did you address the challenges, or do the challenges remain unresolved?

Did you engage with OJJDP training and technical assistance providers this reporting period? If yes, did the providers adequately address your issue?

Did you experience any challenges related to external factors beyond your control during the reporting period that impacted program outcomes? If yes, please describe the challenges.

Did you adjust the program pla n a s describe d in yo ur applicatio n’s propo sa l nar rativ e? If yes, wha t a djus tment s did you m ake, and why? Yes:

Did you experience any challenges during this reporting period that impacted service delivery to program participants? If yes, how did you address the challenges or do the challenges remain unresolved? Yes:

Did you engage with OJJDP training and technical assistance providers this reporting period? If yes, did the providers adequately address your issue? Yes:

During the reporting period, did you experience any challenges related to external factors beyond your control that impacted program outcomes? If yes, please describe the challenges. Yes:

Within the past 30 days, was the client screened or assessed by your program for risk of suicidality?

Within the past 30 days, was the client screened or assessed by your program for substance use?

Within the past 30 days, was the client screened or assessed by your program for the following disorders? (Please select one per disorder) Not Screened / documented in Disorder assessed Not screened Not applicable records a. Depression, depressive disorders ...     b.

Has the client ever tested positive for Hepatitis C?

Since the previous administrative assessment, did the project provide or refer the client for one or more behavioral health services?

Since the previous administrative assessment, did the project provide or refer the client for one or more crisis services?

Since the previous administrative assessment, did the project provide or refer the client for one or more recovery support services?

Since the previous administrative assessment, did the project provide or refer the client for one or more integrated services?

Do you speak a language other than English at home? (If no, please skip to question A4.)

Have you ever served in the Armed Forces, the Reserves, the National Guard or other Uniformed Services?

Are you currently employed?

In the last 3 months, have you attended school/college, homeschool, or vocational training regularly?

In the last 3 months, has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?

Are you currently employed?

In the last 3 months, have you attended school/college, homeschool, or vocational training regularly?

In the last 3 months, has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?

Does your child speak a language other than English at home? (If no, please skip to question A4.)

In the last 3 months, has your child attended school/college, homeschool, or vocational training regularly?

In the last 3 months, has your child attended school/college, homeschool, or vocational training regularly?

Do you speak a language other than English at home? (If no, please skip to question A4.)

In the last 3 months, have you attended school/college, homeschool, or vocational training regularly?

In the last 3 months, have you attended school/college, homeschool, or vocational training regularly?

Narrative response

Which one of the following type of areas best describes where your treatment court program is located?

What were your accomplishments during this reporting period?

What goals were accomplished, as they relate to your grant application?

What problems/barriers did you encounter, if any, within the reporting period that prevented you from reaching your goals or milestones?

What major activities are planned for the next 6 months?

Based on your knowledge of the criminal justice field, are there any innovative programs/accomplishments that you would like to share with BJA?

Which one of the following type of areas best describes where your treatment court program is located?

What type of treatment court is the grant serving?

What is the date that the treatment court first enrolled a participant after this BJA program funding was awarded?

What is the date that the treatment court first enrolled a participant?

What other program components are these BJA program funds supporting?

If your treatment program includes MAT, which of the following medications are you utilizing, regardless of BJA funding?

Name the risk assessment instrument that is used to assess risk and need.

How was the information obtained for those ex-offenders who were arrested on a new criminal charge?

How was the information obtained from those ex-offenders who were convicted of a new crime?

What were your accomplishments during this reporting period?

What goals were accomplished, as they relate to your grant application?

What problems/barriers did you encounter, if any, within the reporting period that prevented you from reaching your goals or milestones?

What major activities are planned for the next 6 months?

Based on your knowledge of the criminal justice field, are there any innovative programs/accomplishments that you would like to share with BJA?

Which one of the following types of areas best describes where your treatment court program is located?

What type of treatment court is the grant serving?

What is the date that the treatment court first enrolled a participant after this BJA program funding was awarded?

What is the date that the treatment court first enrolled a participant?

Please name the risk assessment instrument that is used to assess risk and needs:

What other program components are these BJA program funds supporting?

If your treatment program includes medication-assisted treatment (MAT), which of the following medications are you utilizing, regardless of BJA funding?

How was the information obtained for those ex-offenders who were arrested on a new criminal charge?

How was the information obtained from those ex-offenders who were convicted of a new crime?

What were your accomplishments during this reporting period?

What goals were accomplished, as they relate to your grant application?

What problems/barriers did you encounter, if any, within the reporting period that prevented you from reaching your goals or milestones?

What major activities are planned for the next 6 months?

Based on your knowledge of the criminal justice field, are there any innovative programs/accomplishments that you would like to share with BJA?

Indicate the amount of project funding you receive from each of the following sources. Only include funding related to the project outlined in your grant application. The amounts entered should reflect total project funding for the life of the Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP) (formerly COAP/COSSAP) award.

Provide the name and contact information for the Project Director that your agency will be working with as part of this COSSUP. If there has been a change in the Project Director, please update. [Carry forward]

What geographic area is served by your grant activities? [Carry forward]

How would you describe the geographic area served by your grant activities? [Carry forward]

In which of the following ways were data analysis findings applied to your program during the reporting period?

Indicate the major obstacles the program faces when providing treatment and recovery support services in your area. Select all that apply. [Carry forward]

What obstacles, if any, did you encounter over the last reporting period that has had an impact on your project?

Indicate the extent to which you use the following strategies with regard to your problem of focus (e.g., identifying overdose survivors, increasing the use of diversion or alternatives to incarceration programs). Select N/A if the stated strategy is not relevant to your problem of focus.

  • No cleared, validated, free outcome instrument exists for victim safety. HARK is a screen for identifying partner violence, not a measure of change, and the other candidates need permission that was not confirmed. The funder's own item or a partner record is the substitute.

What kind of services are you delivering, or do you plan to deliver remotely?

For each technical assistance provider you interacted with during the reporting period, enter the following information. The number of entries should equal the number you entered in question 22B.

What type of training course/curriculum was developed?

Describe the developed training course/curriculum. Include the targeted audience, primary sources used in the development of your curriculum, and a brief overview.

What is the intended mode of delivery for your training course/curriculum?

Indicate the type of training, outreach, awareness, and prevention activities supported by COSSUP during the reporting period. Select one at a time and enter up to five per quarter.

Select the target audience for the training, outreach, awareness, or prevention activity.

Describe the method of delivery for the training, outreach, awareness, or prevention activity. Select all that apply.

Indicate if you used COSSUP funds to operate any of the following types of programs during the reporting period. Select only those programs that you are directly supporting with COSSUP funds. (Questions 40—46 required unless otherwise noted) If first responder/law enforcement diversion program is selected in question 39,

What entities refer/identify individuals to your program?

Who is the lead for the first responder diversion program?

How do individuals enter your first responder diversion program?

Which individuals are identified for intervention in your program?

What recovery support services are COSSUP grant funds supporting in whole or in part?

What substance abuse or co-occurring treatment services do you fund using your COSSUP funds?

Which MAT medications are offered to individuals in the program?

Indicate if you used COSSUP funds to operate any of the following types of data collection and analysis during the reporting period. Select only those programs that you are directly supporting with COSSUP funds. Select all that apply. [Carry forward]

Provide the name of the Victim Services Partner involved in your COSSUP. If there has been a change in the Victim Services Partner, please update. [Carry forward]

  • No cleared, validated, free outcome instrument exists for victim safety. HARK is a screen for identifying partner violence, not a measure of change, and the other candidates need permission that was not confirmed. The funder's own item or a partner record is the substitute.

Select the types of services provided by the victim services provider partner(s) during the reporting period. Select all that apply.

Indicate if you have applied for or received sustained funding from the following sources:

Describe the impact your program has had, using specific data such as percentages and raw number increases or decreases, in reducing the incidence of opioid or stimulant overdoses, where possible. If your program was funded to enhance partnerships with victim services and child welfare, describe the impact the project had on identifying crime victims.

  • No cleared, validated, free outcome instrument exists for victim safety. HARK is a screen for identifying partner violence, not a measure of change, and the other candidates need permission that was not confirmed. The funder's own item or a partner record is the substitute.

Identify the goal(s) you hope to achieve with your funding. If you have multiple goals, report on each goal separately (one at a time) and repeat questions 1—4 for each goal.

What is the current status of this goal?

During the past 6 months, describe any progress you made or barriers you encountered related to this goal:

In the next 6 months, what major activities are planned for this goal?

What type of services do you provide to participants in your RSAT program?

Please name the risk assessment instrument(s) that is used to assess risk/need.

If your treatment program includes MAT, which of the following medications are you utilizing?

Please name the risk assessment instrument(s) that is used to assess risk/need.

If your treatment program includes MAT, which of the following medications are you utilizing?

How was the information obtained for those ex-offenders who were arrested on a new charge?

How was the information obtained for those ex-offenders who were convicted of a new crime?

How was the information obtained for ex-offenders who had a revocation of the terms of supervised release?

How was the information obtained for those ex-offenders who were reincarcerated based on a new sentence?

What were your accomplishments during reporting period?

What goals were accomplished, as they relate to your grant application?

What problems/barriers did you encounter, if any, within the reporting period that prevented you from reaching your goals or milestones?

What major activities are planned for the next 6 months?

Based on your knowledge of the criminal justice field, are there any innovative programs/accomplishments that you would like to share with BJA?

How would you describe progress toward this award's goals and objectives?

What services are supported, in whole or in part, by OJJDP’s grant funds? Select all that apply.

What is the target population of the program? Select all that apply.

What is the lowest age of youth who will be served by the program?

What is the highest age of youth who will be served by the program?

What is the minimum length of participation for each program participant?

What is the frequency of participation expected for each program participant?

What tool or approach will the program use to assess outcomes for program participants?

How is the information obtained for youth with a new adjudication? Select all that apply.

How would you describe progress made toward this award’s goals and objectives? Select all that apply.

What services are supported, in whole or in part, by OJJDP’s grant funds? Select all that apply.

What is the target population of the program? Select all that apply.

What is the minimum duration of participation expected for each program participant?

What is the frequency of participation for each individual?

What tool or approach will be used to assess participant outcomes after receiving the program’s services?

How will the program track outcomes for families with new child welfare system involvement? Select all that apply.

How would you describe the progress toward your program goals and objectives? PROGRAM QUESTIONS

What services are supported in whole or in part by OJJDP’s grant funds? Select all that apply. Substance Use Disorder Treatment.

What is the target population of your program? Select all that apply. Males.

What is the lowest age of youth who will be served by your program?

What is the highest age of youth who will be served by your program?

What is the expected duration of your program for each program participant?

How frequently do you expect program participants to engage with your program? Daily.

What assessment tool or approach will you use to measure outcomes?

How is the information obtained for youth with a new adjudication? Select all that apply. The grantee is a criminal justice agency such as the o department of juvenile justice or probation and has access to this information. The grantee has a memorandum of understanding (MOU), o a memorandum of agreement (MOA), or a linkage agreement with an agency that has access to this information. The grantee conducts public records searches online.

How would you describe progress made toward this award's goals and objectives? Not started

What is the target population of the program? Select all that apply. Youth

What is the minimum length of participation for each program participant?

What is the frequency of participation expected for each program participant? Daily

What tool or approach will the program use to assess outcomes for program participants?

What types of capacity building will the program provide over the life of the award? Select all that apply. Community capacity building

What is the date of the assessment (MM/DD/YYYY)? | | | / | | | / | | | | | MONTH DAY YEAR

Which assessment type?

What insurance does the client or guarantor have?

If yes, please indicate which: Not No – not documented Yes – Referred for provided or in records / provided service referred unknown a. Case or care management or coordination ...     b. Person- or family-centered treatment planning ...     c.

If yes, please indicate which: Not No – not documented in Referred for provided or records / Yes – provided service referred unknown a. Crisis response planning ...     b. Crisis response ...     c.

If yes, please indicate which: No – not Not documented Referred for provided or in records / Yes – provided service referred unknown a. Employment support...     b. Family support services, including family peer

If yes, please indicate which: Not No – not documented in Referred for provided or records / Yes – provided service referred unknown a. Primary health care ...     b. Maternal health care or OB/GYN ...     c.

What is the client’s race or ethnicity? Select all that apply and enter additional details in the spaces below.

What is the individual’s sex?

Please choose the option that best applies to you right now:

As of right now, please select whether you strongly agree, agree, somewhat agree, somewhat disagree, disagree, or strongly disagree with each statement in the table below. Strongly Somewhat Somewhat Strongly Prefer not Agree Agree Agree Disagree Disagree Disagree to answer a.

As a result of the services you received, which goals did you make progress on?

What is your race or ethnicity? Select all that apply and enter additional details in the spaces below. Note, you may report more than one group.

What is your sex?

What is your living situation today?

Which of the following best describes your current living situation?

What is the highest level of education you have finished?

Please choose the option that best applies to you right now:

As of right now, please select whether you strongly agree, agree, somewhat agree, somewhat disagree, disagree, or strongly disagree with each statement in the table below. Strongly Somewhat Somewhat Strongly Prefer not Agree Agree Agree Disagree Disagree Disagree to answer a.

Which goals do you have for participating in this program?

What is your living situation today?

Which of the following best describes your current living situation?

What is the highest level of education you have finished?

Please choose the option that best applies to you right now:

As of right now, please select whether you strongly agree, agree, somewhat agree, somewhat disagree, disagree, or strongly disagree with each statement in the table below. Strongly Somewhat Somewhat Strongly Prefer not Agree Agree Agree Disagree Disagree Disagree to answer a.

As a result of the services you received, which goals did you make progress on?

What is your child’s race or ethnicity? Select all that apply and enter additional details in the spaces below. Note, you may report more than one group.

What is your child’s sex?

What is your child’s living situation today?

Which of the following best describes your child’s current living situation?

What is the highest level of education your child has finished?

What is your child’s living situation today?

Which of the following best describes your child’s current living situation?

What is the highest level of education your child has finished?

What is your child’s race or ethnicity? Select all that apply and enter additional details in the spaces below. Note, you may report more than one group.

What is your child’s sex?

What is your child’s living situation today?

Which of the following best describes your child’s current living situation?

What is your child’s living situation today?

Which of the following best describes your child’s current living situation?

What is your race or ethnicity? Select all that apply and enter additional details in the spaces below. Note, you may report more than one group.

What is your sex?

What is your living situation today?

Which of the following best describes your current living situation?

What is the highest level of education you have finished?

What is your living situation today?

Which of the following best describes your current living situation?

What is the highest level of education you have finished?

Planning figure, no collection needed

What is the expected number of participants the treatment court program plans to serve with BJA program funds over the life of this award?

What is the expected number of participants the treatment court program plans to serve with BJA program funds over the life of this award?

Provide the primary point of contact (POC) for the researcher/research partner that your agency will be working with as part of COSSUP. If there has been a change in the researcher/research partner POC, please update. [Carry forward]

Does your site plan to sustain program funding after BJA funds have been expended?

How many unique individuals does the program plan to serve over the life of the award?

How many unique families does the program expect to serve over the life of the grant?

How many unique individuals do you plan to provide services to over the life of the award?

How many individuals does the program plan to serve over the life of the award?

Estimated number of individuals expected to complete Training of Trainers (ToT) primary training: [If I.B.1 = 0, then skip to I.B.4]

Estimated number of individuals expected to complete ToT primary training by participant type

Estimated number of other individuals expected to complete the ToT primary training by specified type

Estimated number of individuals expected to complete ToT secondary training:

Estimated number of individuals expected to complete ToT secondary training by participant type

Estimated number of other individuals expected to complete ToT secondary training by specified type

Tier not determined

Were BJA funds expended on treatment court staff trainings during the reporting period?

Were BJA treatment court program funds expended on program evaluations during the reporting period?

Were BJA treatment court program funds expended on any management information system (MIS)-related activities during the reporting period?

Is there any assistance that BJA can provide to address any problems/barriers identified in question 3?

Were BJA program funds used to add inpatient treatment slots during the reporting period?

Were BJA program funds used to add outpatient treatment slots during the reporting period?

Were BJA program funds used to add staff who provide new case management or offender supervision services during the reporting period?

Were BJA program funds used to provide substance use treatment services to treatment court participants during the reporting period?

Were BJA program funds used to provide inpatient substance use treatment services during the reporting period?

Were BJA program funds used to provide recovery support services to treatment court participants during the reporting period?

Of those who completed all program requirements, from start to finish, indicate when these participants graduated from the program within the following time frames. The sum of all of these categories should be equal to the total number of successful completions in question 31. If not, check for data entry errors.

Enter the race, ethnicity, and sex of each participant who successfully completed all program requirements, excluding financial obligations, during the reporting period. Hispanics or Latinos should be counted in the race category that best describes their racial identity, including White, Black or African American, Asian, American Indian or Alaska Native, Pacific Islander or Native

Enter the race, ethnicity, and sex of each participant who exited the program unsuccessfully during the reporting period. Hispanics or Latinos should be counted in the race category that best describes their racial identity, including White, Black or African American, Asian, American Indian or Alaska Native, Pacific Islander or Native Hawaiian, or multiracial. See census.gov for questions

Is there any assistance that BJA can provide to address any problems/barriers identified in question 3?

Were BJA program funds used to provide substance use treatment services to treatment court participants during the reporting period?

Were BJA program funds used to provide recovery support services to treatment court participants during the reporting period?

Of those who completed all program requirements, from start to finish, indicate when these participants graduated from the program within the following time frames. The sum of all of these categories should be equal to the total number of successful completions in question 27.

Please enter the race, ethnicity, and sex of each participant who successfully completed all program requirements, excluding financial obligations, during the reporting period.

Please enter the race, ethnicity, and sex of each participant who exited the program unsuccessfully during the reporting period. Hispanics or Latinos should be counted in the race category that best describes their racial identity, including White, Black or African American, Asian, American Indian or Alaska Native, Pacific Islander or Native Hawaiian, or multiracial. See census.gov

Is there any assistance that BJA can provide to address any problems/barriers identified in question 3?

Rate the following COSSUP workgroup partners based on this statement, “This partner was actively involved in COSSUP this reporting period.” Rate your partners on a scale of 1–5 as indicated below. If you have multiple partners in a category, rate them as a whole. If a partner fits in more than one category, rate them in the one category that fits the best for that partner. Do not rate

Rate your level of agreement with the following statement.

Did the COSSUP provide or facilitate training to project workgroup members or other groups or organizations (e.g., first responders, victim services providers, and child protective services professionals) during the reporting period?

BJA likes to showcase grantees who are working on successful, innovative, and/or evidence-based programs. Do you have any noteworthy accomplishments, success stories, or program results from this reporting period that you would like to showcase?

Please enter the amount of funds from all sources (in dollars) spent in your RSAT program during the reporting period for the following areas:

During the reporting period, using BJA program funds including matching funds, did you pay for training for treatment staff to be cross trained in the jail/prison-based portion of the RSAT program?

During the reporting period, using BJA program funds including matching funds, did you pay for training for custody staff to be cross trained in the jail/prison-based portion of the RSAT program?

Is there any assistance that BJA can provide to address any problems/barriers identified in question #3?

[AT BASELINE] What is the client’s month and year of birth (MM/YYYY)? | | | / | | | | |

[AT BASELINE ASSESSMENT ONLY] When did the client first receive services under this grant (MM/YYYY)? | | | / | | | | |

[AT REASSESSMENT OR ANNUAL OR CLOSEOUT] When did the client most recently receive services under this grant (MM/YYYY)? | | | / | | | | |

[AT RECORD CLOSEOUT] Why are you closing out this client’s record?

[IF QUESTION A6 IS DEATH] What is the cause of death?

In the past 30 days, was the client admitted to a hospital?

In the past 30 days, did the client visit an emergency department?

In the past 30 days, did the client experience a behavioral health crisis or request crisis response, for example from 988 or 911?

[IF QUESTION B4 IS YES] What is the primary crisis issue?

In the past 30 days, did the client spend one or more nights at a residential behavioral health treatment facility, for example crisis stabilization or residential substance use disorder treatment facility, including for withdrawal management?

[CLIENTS 11 YEARS OR OLDER ONLY] In the past 90 days, was the client arrested, taken into custody, or detained?

[CLIENTS 11 YEARS OR OLDER ONLY] In the past 90 days, did the client spend one or more nights in jail or a correctional facility?

[CLIENTS 11 YEARS OR OLDER ONLY] In the past 90 days, has the client been on probation, parole, or intensive pretrial supervision for one or more days?

[IF QUESTION C2 IS “YES”] During the screening and assessment process, what was the reported use for the following substances? Recent use Past use (within the past (greater than Not Substance 30 days) 30 days) Never used documented a. Alcohol ...

Substance use disorder diagnosis (record up to 3) Enter ICD-10-CM/DSM-5 code F10-F19- or indicate no diagnosis | | | | | Enter ICD-10-CM/DSM-5 code F10-F19- or indicate no diagnosis | | | | | Enter ICD-10-CM/DSM-5 code F10-F19- or indicate no diagnosis | | | | |

Mental health diagnosis (record up to 3) Enter ICD-10-CM/DSM-5 code F20-F99- or indicate no diagnosis | | | | | Enter ICD-10-CM/DSM-5 code F20-F99- or indicate no diagnosis | | | | | Enter ICD-10-CM/DSM-5 code F20-F99- or indicate no diagnosis | | | | |

Other factors influencing health status (record up to 3) Enter ICD-10-CM/DSM-5 code Z55-Z65 or Z69-Z76- or indicate no diagnosis | | | | | Enter ICD-10-CM/DSM-5 code Z55-Z65 or Z69-Z76- or indicate no diagnosis | | | | | Enter ICD-10-CM/DSM-5 code Z55-Z65 or Z69-Z76- or indicate no diagnosis | | |

Is the client currently pregnant?

[CLINICAL HIGH RISK PSYCHOSIS CLIENTS ONLY] [AT REASSESSMENT OR ANNUAL] Has the client experienced an episode of psychosis since their last assessment?

[SUBSTANCE USE DISORDER TREATMENT CLIENTS ONLY] In the previous 30 days, did the client experience an overdose or take too much of a substance that resulted in needing supervision or medical attention?

[IF QUESTION D6 IS YES] After taking too much of a substance or overdosing, what intervention(s) did the client receive?

[MAI PROGRAM CLIENTS ONLY] Has the client ever tested positive for HIV?

[IF QUESTION D7 IS YES, HIV-INFECTED] Is the client currently on ART?

[IF QUESTION D7 IS NO, HIV-NEGATIVE] Is the client currently taking HIV PrEP?

[IF QUESTION D8 IS YES, ACTIVE OR PREVIOUS HEPATITIS C INFECTION] Is the client currently taking viral Hepatitis C treatment?

[IF E1a_l = MEDICATION FOR SUBSTANCE USE DISORDER IS YES – PROVIDED] Indicate medication received Not documented in No – not records / Yes – received received unknown a. Naltrexone ...    b.

For persons speaking a language other than English (answering yes to the question above): What is this language(s)?

Please respond to the following questions about your physical health. Prefer not Yes No to answer a. Are you deaf or do you have serious difficulty hearing? ...    b. Are you blind or do you have serious difficulty seeing, even when wearing

How hard is it for you to pay for the very basics like food, housing, medical care, and heating?

How hard is it for you to pay for the very basics like food, housing, medical care, and heating?

For persons speaking a language other than English (answering yes to the question above): What is this language(s)?

Please respond to the following questions about your child’s physical health. Prefer not Yes No to answer a. Is your child deaf or does your child have serious difficulty hearing? ...    b. Is your child blind or does your child have serious difficulty seeing, even

How hard is it for you to pay for the very basics like food, housing, medical care, and heating for your child?

How hard is it for you to pay for the very basics like food, housing, medical care, and heating for your child?

Please respond to the following questions about your child’s physical health. Prefer not Yes No to answer a. Is your child deaf or does your child have serious difficulty hearing? ...    b. Is your child blind or does your child have serious difficulty seeing, even

How hard is it for you to pay for the very basics like food, housing, medical care, and heating for your child?

How hard is it for you to pay for the very basics like food, housing, medical care, and heating for your child?

For persons speaking a language other than English (answering yes to the question above): What is this language(s)?

Please respond to the following questions about your physical health. Prefer not to Yes No answer a. Are you deaf or do you have serious difficulty hearing? ...    b. Are you blind or do you have serious difficulty seeing, even when    wearing glasses?

What grantees achieved

Program-level figures, not individual grantees: Addiction Treatment and Related Services reported 223 results against targets over 12 periods; the median result was 100% of target (middle half 93% to 108%), and 61% met or exceeded the target. Source: Illinois Comptroller Public Accountability Reports, https://par.illinoiscomptroller.gov/index.cfm?AgencyNo=601&FiscalYear=2022&ProgramAreaGroupID=3&ProgramID=1&UniqueProgramID=6011.

Program-level figures, not individual grantees: Substance Use Prevention and Recovery - Addiction Treatment and Related Services reported 106 results against targets over 7 periods; the median result was 96% of target (middle half 63% to 100%), and 33% met or exceeded the target. Source: Illinois Comptroller Public Accountability Reports, https://par.illinoiscomptroller.gov/index.cfm?AgencyNo=601&FiscalYear=2022&ProgramAreaGroupID=3&ProgramID=1&UniqueProgramID=6011.

Program-level figures, not individual grantees: Alcoholism and Substance Abuse - Addiction Treatment and Related Services reported 70 results against targets over 5 periods; the median result was 100% of target (middle half 90% to 100%), and 53% met or exceeded the target. Source: Illinois Comptroller Public Accountability Reports, https://par.illinoiscomptroller.gov/index.cfm?AgencyNo=601&FiscalYear=2022&ProgramAreaGroupID=3&ProgramID=1&UniqueProgramID=6011.

Program-level figures, not individual grantees: Substance Abuse Drug Courts reported 15 results against targets over 2 periods; the median result was 103% of target (middle half 100% to 105%), and 87% met or exceeded the target. Source: OMB PART assessments (ExpectMore.gov archive), https://obamawhitehouse.archives.gov/sites/default/files/omb/assets/omb/expectmore/detail/10002335.2004.html.

Program-level figures, not individual grantees: Substance Abuse Treatment Programs of Regional and National Significance reported 13 results against targets over 6 periods; the median result was 101% of target (middle half 99% to 104%), and 69% met or exceeded the target. Source: OMB PART assessments (ExpectMore.gov archive), https://obamawhitehouse.archives.gov/sites/default/files/omb/assets/omb/expectmore/detail/10002335.2004.html.

Program-level figures, not individual grantees: Access to Recovery reported 12 results against targets over 2 periods; the median result was 102% of target (middle half 97% to 117%), and 75% met or exceeded the target. Source: OMB PART assessments (ExpectMore.gov archive), https://obamawhitehouse.archives.gov/sites/default/files/omb/assets/omb/expectmore/detail/10002335.2004.html.

Program-level figures, not individual grantees: Drug Courts reported 11 results against targets over 3 periods; the median result was 91% of target (middle half 74% to 161%), and 36% met or exceeded the target. Source: OMB PART assessments (ExpectMore.gov archive), https://obamawhitehouse.archives.gov/sites/default/files/omb/assets/omb/expectmore/detail/10002335.2004.html.

Program-level figures, not individual grantees: Substance Abuse Prevention and Treatment Block Grant reported 9 results against targets over 8 periods; the median result was 98% of target (middle half 97% to 106%), and 44% met or exceeded the target. Source: OMB PART assessments (ExpectMore.gov archive), https://obamawhitehouse.archives.gov/sites/default/files/omb/assets/omb/expectmore/detail/10002335.2004.html.

Program-level figures, not individual grantees: Residential Substance Abuse Treatment reported 8 results against targets over 6 periods; the median result was 152% of target (middle half 85% to 277%), and 63% met or exceeded the target. Source: OMB PART assessments (ExpectMore.gov archive), https://obamawhitehouse.archives.gov/sites/default/files/omb/assets/omb/expectmore/detail/10002335.2004.html.

Target-setting language with precedent

Each item comes from one funder, one program or one department; none is a government-wide rule.

Showing clauses from HHS.

What reviewers penalize

These ten weaknesses recur in 17 published reviewer critiques, mostly U.S. Department of Education and NIH. The count is the number of critiques that name it, not a rate, and a reviewer comment is a judgment.

Protocol skeleton

Draft text, edit before use

Measures: Was there grant activity in the reporting period?; Which one of the following type of areas best describes where your treatment court program is located?; Were BJA funds expended on treatment court staff trainings during the reporting period?; Enter the number of treatment court staff who successfully completed training during the reporting period. Staff are defined as, but not limited to, program managers, administrators, case managers, probation and parole officers, and clinicians. Do not count mentors, volunteers, or interns. Be consistent when reporting the type of staff across reporting periods. The number entered; Of the number listed in question 4, enter the number of treatment court staff who rated the training as satisfactory or better during the reporting period. Satisfaction may be measured based on a survey provided to participants. The number entered should be less than or equal to the number entered in question 4. If not, check for data entry errors.; Were BJA treatment court program funds expended on program evaluations during the reporting period?; Were BJA treatment court program funds expended on any management information system (MIS)-related activities during the reporting period?; What were your accomplishments during this reporting period?; What goals were accomplished, as they relate to your grant application?; What problems/barriers did you encounter, if any, within the reporting period that prevented you from reaching your goals or milestones?; Is there any assistance that BJA can provide to address any problems/barriers identified in question 3?; Are you on track to complete your program fiscally and programmatically as outlined in your grant application?; and 682 more listed above. Baseline: ____ months from award, using CORT; SUPRT-A; SUPRT-C; SUPRT-P. Targets: set from the observed baseline at month ____, or committed now as a change of ____ percentage points from baseline.

Missing-data plan (how dropout and missing observations will be handled): ____

Comparison group or baseline (what you compare against and how the groups started): ____

Fallback if recruitment, data access or the first analysis falls short: ____

Fidelity threshold (what counts as full implementation, and how it is measured): ____

Instrument named, with its validity evidence and its rights (license) status: ____

Numeric target for each measure (a number, not a direction): ____

Analysis for each outcome (method, comparison, adjustment): ____

Data protection and data management (who holds identifiable data, where, for how long): ____

Feedback schedule (who reviews the data, how often, and what changes as a result): ____

Evaluator role and independence (who evaluates and how they are separate from delivery): ____

The text is copied or summarized from public documents. It is not legal advice.