Beruflich Dokumente
Kultur Dokumente
Grantee Information
j Burlington
k
l
m
n
j EssexCaledonia
k
l
m
n
j FranklinCentral
k
l
m
n
j FranklinNortheast
k
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m
n
j FranklinWest
k
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m
n
j GrandIsle
k
l
m
n
j LamoilleSouth
k
l
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n
j OrangeWindsor
k
l
m
n
j SouthwestVT
k
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m
n
j SpringfieldSD
k
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m
n
j WashingtonSouth
k
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n
j WindhamCentral
k
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m
n
j WindhamNortheast
k
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m
n
j WindhamSoutheast
k
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n
j WindhamSouthwest
k
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n
j WindsorNorthwest
k
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n
j TwoRiversRutlandWindsor
k
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n
j TwoRiversWindsorSouthwest
k
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n
j FinalPeriod(MarchJune)
k
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m
n
Page 1
*4. Please enter your name (person entering the data for this school)
*5. Did you provide screening and referral at this school this reporting period?
j Yes
k
l
m
n
j No
k
l
m
n
*6. Please indicate why you did not provide screening and referral at this school during
j Thisschoolisanelementaryschool
k
l
m
n
j Positionisvacant
k
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m
n
j Other(pleasespecify)
k
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m
n
*7. What is the name of the person providing screening and referral at this school?
*8. What is the job title for the person who provides screening and referral at this school?
Page 2
*10. Please indicate which key tasks related to Screening and Referral were completed
c Distributedprotocolforscreeningtoallschoolstaff
d
e
f
g
c Developedprotocolforreferraltotreatmentservicesinconsultationwithcommunitysubstanceabuseandmentalhealthtreatment
d
e
f
g
providers
c Distributedprotocolforreferraltoallschoolstaffandtreatmentproviders
d
e
f
g
c Deliveredscreeningandtimelyreferraltosubstanceabuseandmentalhealthservices
d
e
f
g
c Assessedimpact
d
e
f
g
c Other
d
e
f
g
Other(pleasespecify)
*11. Briefly describe progress on this activity for this reporting period.
5
6
*12. Have staff at this school received any training or technical assistance related to
j Yes
k
l
m
n
j No
k
l
m
n
Page 3
*13. Who provided the training or TA that you received and how useful was it? (check
one box to the right of only those sources you received training or TA from this reporting
period)
Notatalluseful
Notveryuseful
Somewhatuseful
Veryuseful
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHSchoolLiaison
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHADAPStaff(other
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Stateevaluator
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHsponsoredtraining
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
AOEsponsoredtraining
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Trainerwithexpertise
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Other
j
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l
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n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHADAPPrevention
Consultant
thanPrevention
Consultant)
Other(pleasespecify)
15. Success related to Screening and Referral this reporting period at this school?
5
6
16. What lessons have you learned from implementation of Screening and Referral during
this reporting period?
5
6
*17. What is the name of the person responsible for supporting Coordinated School
Page 4
*18. What is the job title for the person who is responsible for supporting Coordinated
*20. Please indicate which key tasks related to Coordinated School Health were
c DevelopedplantodiscussSchoolHealthinitiativesandaddressareasneedingimprovement
d
e
f
g
c MettodiscussCoordinatedSchoolHealthInitiatives
d
e
f
g
c Assessedimpact
d
e
f
g
c Other
d
e
f
g
Other(pleasespecify)
*21. Briefly describe progress on this activity for this reporting period.
5
6
*22. Have staff at this school received any training or technical assistance for
j Yes
k
l
m
n
j No
k
l
m
n
Page 5
*23. Who provided the training or TA that you received and how useful was it? (check
one box to the right of only those sources you received training or TA from this reporting
period)
Notatalluseful
Notveryuseful
Somewhatuseful
Veryuseful
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHSchoolLiaison
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHADAPStaff(other
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Stateevaluator
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHsponsoredtraining
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
AOEsponsoredtraining
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Trainerwithexpertise
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Other
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHADAPPrevention
Consultant
thanPrevention
Consultant)
Other(pleasespecify)
25. Successes related to supporting School Health initiatives this reporting period at this
school?
5
6
26. What lessons have you learned from supporting School Health Initiatives this reporting
period at this school?
5
6
Page 6
*27. Does your implementation plan for this school include "Supporting an Evidence
j Yes
k
l
m
n
j No
k
l
m
n
*28. Did you implement an evidencebased substance abuse curriculum this reporting
j Yes
k
l
m
n
j No
k
l
m
n
*29. Please indicate why you did not implement the evidencebased substance abuse
*30. What is the name of the person who teaches the evidencebased substance abuse
*31. What is the job title for the person who teaches the evidencebased substance
Page 7
*32. Which evidencebased substance abuse school curriculum did you implement this
c KnowYourBody
d
e
f
g
c ProtectingYou/ProtectingMe
d
e
f
g
c GoodBehaviorGame
d
e
f
g
c Other
d
e
f
g
Other(pleasespecify)
*33. Please indicate the number of students in each grade that participated this reporting
period
Kindergarten
1stgrade
2ndgrade
3rdgrade
4thgrade
5thgrade
6thgrade
7thgrade
8thgrade
9thgrade
10thgrade
11thgrade
12thgrade
Page 8
*34. Does the number of students reported in each grade above represent all students in
Other(pleaseexplain)
*35. Please indicate which key tasks related to implementing EvidenceBased Substance
Abuse Curriculum were completed this reporting period for this school.
c Staffaretrainedtoimplementcurriculum
d
e
f
g
c Implementedallofthesessionsindicatedinthecurriculumfortherequiredduration(ifdeviatedfromcurriculum,pleasedescribehow
d
e
f
g
andwhyin"Other"commentbox)
c Assessedimpact
d
e
f
g
c Other
d
e
f
g
Other(pleasespecify)
*36. Briefly describe progress on this activity for this reporting period.
5
6
*38. Have staff from this school received any training or technical assistance for
Evidence Based Substance Abuse Prevention Curricula during this reporting period?
j Yes
k
l
m
n
j No
k
l
m
n
Page 9
*39. Who provided the training or TA that you received and how useful was it? (check
one box to the right of only those sources you received training or TA from this reporting
period)
Notatalluseful
Notveryuseful
Somewhatuseful
Veryuseful
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHSchoolLiaison
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHADAPStaff(other
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Stateevaluator
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHsponsoredtraining
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
AOEsponsoredtraining
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Trainerwithexpertise
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Other
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHADAPPrevention
Consultant
thanPrevention
Consultant)
Other(pleasespecify)
42. What lessons have you learned from implementing EvidenceBased Substance Abuse
Curriculum this reporting period at this school?
5
6
Page 10
*43. Does your implementation plan for this school include "Organizing Youth
Empowerment Groups"?
j Yes
k
l
m
n
j No
k
l
m
n
*44. Did you implement a youth empowerment group this reporting period at this school?
j Yes
k
l
m
n
j No
k
l
m
n
*45. Please explain why you did not organize a youth empowerment group at this school
5
6
*46. What is the name of the person who organizes your youth empowerment group at
this school?
*47. How many students participated in a youth empowerment group this reporting
period?
*48. How many meetings were held during this period at this school?
*49. Please describe the types of youth empowerment groups that have been meeting
5
6
Page 11
*50. Please indicate which key tasks related to Organizing Youth Empowerment Groups
c Identifiedgoalsofgroupandassociatedactivities
d
e
f
g
c Setmeetingschedule
d
e
f
g
c Metregularlyasdesignatedbyschedule
d
e
f
g
c Assessedimpact
d
e
f
g
c Other
d
e
f
g
Other(pleasespecify)
*51. Briefly describe progress on this activity for this reporting period.
5
6
*52. Have staff at this school received any training or technical assistance for Youth
j Yes
k
l
m
n
j No
k
l
m
n
Page 12
*53. Who provided the training or TA that you received and how useful was it? (check
one box to the right of only those sources you received training or TA from this reporting
period)
Notatalluseful
Notveryuseful
Somewhatuseful
Veryuseful
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHSchoolLiaison
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHADAPStaff(other
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Stateevaluator
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHsponsoredtraining
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
AOEsponsoredtraining
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Trainerwithexpertise
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Other
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHADAPPrevention
Consultant
thanPrevention
Consultant)
Other(pleasespecify)
55. Successes related to organizing Youth Empowerment Groups this reporting period at
this school?
5
6
56. What lessons have you learned from implementation of Youth Empowerment Groups
this reporting period at this school?
5
6
Page 13
*57. Does your implementation plan for this school include an "EvidenceBased Parent
Education Program"?
j Yes
k
l
m
n
j No
k
l
m
n
*58. Did you implement an evidencebased parent education program this reporting
j Yes
k
l
m
n
j No
k
l
m
n
*59. Please indicate why did not implement an evidencebased parent education program
5
6
*60. What is the name of the person who delivers the evidencebased parent education
c CreatingLastingFamilyConnections
d
e
f
g
c StrengtheningFamilies
d
e
f
g
c Other
d
e
f
g
Other(pleasespecify)
Page 14
*62. How many parents participated this reporting period at this school?
Numberofparents
*63. How many sessions did you implement this reporting period at this school?
Numberofsessions
*64. Please indicate which key tasks related to implementing an EvidenceBased Parent
c Implementedprogramwithfidelity(i.e,coveredallofthemajortopicsindicatedintheprogramplanandfortherecommendedtime.If
d
e
f
g
deviated,pleasedescribehowandwhybelowinthe"Other"commentbox)
c Assessedimpact
d
e
f
g
c Other
d
e
f
g
Other(pleasespecify)
*65. Briefly describe progress on this activity for this reporting period.
5
6
*67. Have staff at this school received any training or technical assistance for Evidence
j Yes
k
l
m
n
j No
k
l
m
n
Page 15
*68. Who provided the training or TA that you received and how useful was it? (check
one box to the right of only those sources you received training or TA from this reporting
period)
Notatalluseful
Notveryuseful
Somewhatuseful
Veryuseful
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHSchoolLiaison
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHADAPStaff(other
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Stateevaluator
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHsponsoredtraining
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
AOEsponsoredtraining
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Trainerwithexpertise
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Other
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHADAPPrevention
Consultant
thanPrevention
Consultant)
Other(pleasespecify)
71. What lessons have you learned from implementing an EvidenceBased Parent
Program this reporting period at this school?
5
6
Page 16
*72. Does your implementation plan for this school include "Deliver Parent Information"?
j Yes
k
l
m
n
j No
k
l
m
n
*73. Did you provide parent information this reporting period at this school?
j Yes
k
l
m
n
j No
k
l
m
n
*74. Please indicate why you did not provide parent information at this school this
reporting period.
5
6
*75. What type of parent information did you deliver during this reporting period?
c ParentDialogueNight
d
e
f
g
c ParentUpinformation
d
e
f
g
c Other
d
e
f
g
Other(pleasedescribe)
*76. How many parents were reached with parent information during this reporting
period?
Numberofparents
Page 17
*77. Please indicate which key tasks associated with delivering Parent Information were
Other(pleasespecify)
*78. Briefly describe progress on this activity for this reporting period.
5
6
*79. Have staff at this school received any training or technical assistance for delivery of
j Yes
k
l
m
n
j No
k
l
m
n
*80. Who provided the training or TA that you received and how useful was it? (check
one box to the right of only those sources you received training or TA from this reporting
period)
Notatalluseful
Notveryuseful
Somewhatuseful
Veryuseful
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHSchoolLiaison
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHADAPStaff(other
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Stateevaluator
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHsponsoredtraining
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
AOEsponsoredtraining
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Trainerwithexpertise
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Other
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHADAPPrevention
Consultant
thanPrevention
Consultant)
Other(pleasespecify)
Page 18
82. Successes related to delivering Parent Information this reporting period at this school?
5
6
83. What lessons have you learned from delivering Parent Information this reporting
period at this school?
5
6
*84. Does your implementation plan for this school include "Deliver ATOD Teacher and
Staff Training"?
j Yes
k
l
m
n
j No
k
l
m
n
*85. Did you provide ATOD staff training at this school this reporting period?
j Yes
k
l
m
n
j No
k
l
m
n
*86. Please indicate why you did not deliver ATOD teacher and staff training at this
5
6
Page 19
*87. Who is responsible for providing ATOD staff training at this school?
*88. How many teachers and other staff were trained during this reporting period?
*89. Please indicate which key tasks associated with delivering ATOD training were
c AssessedstaffATODtrainingneeds
d
e
f
g
c Developedplanfordeliveringtraining
d
e
f
g
c Deliveredappropriatetraining
d
e
f
g
c Assessedimpact
d
e
f
g
c Other
d
e
f
g
Other(pleasespecify)
*90. Briefly describe ATOD training provided to teachers and staff during this reporting
period.
5
6
*91. Have staff at this school received any training or technical assistance for this activity
j Yes
k
l
m
n
j No
k
l
m
n
Page 20
*92. Who provided the training or TA that you received and how useful was it? (check
one box to the right of only those sources you received training or TA from this reporting
period)
Notatalluseful
Notveryuseful
Somewhatuseful
Veryuseful
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHSchoolLiaison
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHADAPStaff(other
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Stateevaluator
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHsponsoredtraining
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
AOEsponsoredtraining
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Trainerwithexpertise
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Other
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHADAPPrevention
Consultant
thanPrevention
Consultant)
Other(pleasespecify)
94. Successes related to delivering ATOD teacher and other staff training this reporting
period at this school?
5
6
95. What lessons have you learned from delivering ATOD teacher and other staff training
this reporting period at this school?
5
6
Page 21
*96. Does your implementation plan for this school include "Deliver Educational Support
Groups"?
j Yes
k
l
m
n
j No
k
l
m
n
*97. Did you implement an educational support group this reporting period?
j Yes
k
l
m
n
j No
k
l
m
n
*98. Please explain why you did not implement an educational support group at this
5
6
*99. Who is responsible for implementing educational support groups at this school?
*100. How many different types of educational support groups were implemented this
reporting period?
j 1
k
l
m
n
j 2
k
l
m
n
j 3
k
l
m
n
j 4ormore
k
l
m
n
*101. What educational support groups did you implement this reporting period? Please
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*102. How many group sessions were held this reporting period?
Numberofgroupsessions
*103. How many unique students participated in educational support groups conducted
*104. Please indicate which key tasks associated with implementing Educational Support
c Identifiedgoalsofgroup(s)
d
e
f
g
c Assessedimpact
d
e
f
g
c Other
d
e
f
g
Other(pleasespecify)
*105. Briefly describe progress on this activity for this reporting period.
5
6
*106. Have staff at this school received any training or technical assistance for the
j Yes
k
l
m
n
j No
k
l
m
n
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*107. Who provided the training or TA that you received and how useful was it? (check
one box to the right of only those sources you received training or TA from this reporting
period)
Notatalluseful
Notveryuseful
Somewhatuseful
Veryuseful
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHSchoolLiaison
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHADAPStaff(other
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Stateevaluator
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHsponsoredtraining
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
AOEsponsoredtraining
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Trainerwithexpertise
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Other
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
VDHADAPPrevention
Consultant
thanPrevention
Consultant)
Other(pleasespecify)
109. Successes related to implementing Educational Support Groups this reporting period
at this school?
5
6
110. What lessons have you learned related to implementing Educational Support Groups
this reporting period at this school?
5
6
Program Highlight
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112. Would you like to enter another school's data within your supervisory union?
j Yes
k
l
m
n
j No,I'mfinishedenteringthedataformySU/SD.
k
l
m
n
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