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School Based Substance Abuse Services - Year 2

Grantee Information

*1. Supervisory Union/School District


j AddisonNorthwest
k
l
m
n
j AddisonRutland
k
l
m
n
j Barre
k
l
m
n

j Burlington
k
l
m
n

j EssexCaledonia
k
l
m
n
j FranklinCentral
k
l
m
n

j FranklinNortheast
k
l
m
n
j FranklinWest
k
l
m
n
j GrandIsle
k
l
m
n

j LamoilleSouth
k
l
m
n

j OrangeWindsor
k
l
m
n
j SouthwestVT
k
l
m
n

j SpringfieldSD
k
l
m
n

j WashingtonSouth
k
l
m
n
j WindhamCentral
k
l
m
n

j WindhamNortheast
k
l
m
n

j WindhamSoutheast
k
l
m
n

j WindhamSouthwest
k
l
m
n
j WindsorNorthwest
k
l
m
n

j TwoRiversRutlandWindsor
k
l
m
n

j TwoRiversWindsorSouthwest
k
l
m
n

*2. Please enter the name of school

*3. Reporting Period


j FirstPeriod(AugustNovember)
k
l
m
n
j SecondPeriod(DecFeb)
k
l
m
n

j FinalPeriod(MarchJune)
k
l
m
n

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School Based Substance Abuse Services - Year 2

*4. Please enter your name (person entering the data for this school)

Screening and Referral

*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

Screening and Referral

*6. Please indicate why you did not provide screening and referral at this school during

this reporting period

j Thisschoolisanelementaryschool
k
l
m
n
j Positionisvacant
k
l
m
n

j Other(pleasespecify)
k
l
m
n

Screening and Referral

*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?

*9. Screening and Referral


Numberofstudentsscreened(usingCRAFFTorGAINSS)thisreportingperiodatthisschool
Numberofstudentswhoscreenedpositiveforpossiblesubstanceusedisorderthisreportingperiodatthisschool.
Ofthosestudentswhoscreenedpositive,thenumberofstudentswhowerereferredtoasubstanceabuseassessmentthisreporting
periodatthisschool
Ofthosestudentsreferredtoasubstanceabuseassessmentthisreportingperiod,howmanyconnectedwithrecommendedservices
(asconfirmedbystudentreport,parentreport,orreleaseofinformationwithserviceprovider)?
Numberofstudentswhoscreenedpositiveforpossiblementaldisordersthisreportingperiodatthisschool
Ofthosewhoscreenedpositive,thenumberofstudentswhowerereferredtoamentalhealthassessmentthisreportingperiodat
thisschool
Ofthosestudentsreferredtoamentalhealthassessmentthisreportingperiod,howmanyconnectedwithrecommendedservices(as
confirmedbystudentreport,parentreportorreleaseofinformationwithserviceprovider)?

Page 2

School Based Substance Abuse Services - Year 2

*10. Please indicate which key tasks related to Screening and Referral were completed

this reporting period for this school.


c AttendedScreeningTooltraining
d
e
f
g
c Developedprotocolforscreening
d
e
f
g

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

Screening and Referral

*12. Have staff at this school received any training or technical assistance related to

screening and referral during this reporting period?

j Yes
k
l
m
n
j No
k
l
m
n

Screening and Referral

Page 3

School Based Substance Abuse Services - Year 2

*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
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)

Screening and Referral

14. Technical Assistance needs for this activity, if any


5
6

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

Support Coordinated School Health Inititatives

*17. What is the name of the person responsible for supporting Coordinated School

Health Initiatives at this school?

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School Based Substance Abuse Services - Year 2

*18. What is the job title for the person who is responsible for supporting Coordinated

School Health Initiatives at this school?

*19. Coordinated School Health Initiatives


Numberofmeetingsheldthisreportingperiodforthisschool

*20. Please indicate which key tasks related to Coordinated School Health were

completed this reporting period for this school.

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

Coordinated School Health initiatives during this reporting period?

j Yes
k
l
m
n
j No
k
l
m
n

Support Coordinated School Health Inititatives

Page 5

School Based Substance Abuse Services - Year 2

*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)

Support Coordinated School Health Initiatives

24. Technical Assistance needs for this activity, if any


5
6

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

Support EvidenceBased Curriculum

Page 6

School Based Substance Abuse Services - Year 2

*27. Does your implementation plan for this school include "Supporting an Evidence

Based Substance Abuse Curriculum"?

j Yes
k
l
m
n
j No
k
l
m
n

Support EvidenceBased Curriculum

*28. Did you implement an evidencebased substance abuse curriculum this reporting

period at this school?

j Yes
k
l
m
n
j No
k
l
m
n

Support EvidenceBased Curriculum

*29. Please indicate why you did not implement the evidencebased substance abuse

curriculum at this school this reporting period.


5
6

Support EvidenceBased Curriculum

*30. What is the name of the person who teaches the evidencebased substance abuse

curriculum at this school?

*31. What is the job title for the person who teaches the evidencebased substance

abuse curriculum at this school.

Page 7

School Based Substance Abuse Services - Year 2

*32. Which evidencebased substance abuse school curriculum did you implement this

reporting period at this school?


c LIfeSkillsTraining
d
e
f
g
c MichiganModel
d
e
f
g
c ProjectAlert
d
e
f
g

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)

Support EvidenceBased Curriculum

*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

School Based Substance Abuse Services - Year 2

*34. Does the number of students reported in each grade above represent all students in

those grades, or a subset of students?


j Allstudentsingrade(s)
k
l
m
n
j Other
k
l
m
n

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

37. Evaluation Results (process and outcome results as available)


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

Support EvidenceBased Curriculum

Page 9

School Based Substance Abuse Services - Year 2

*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)

Support EvidenceBased Curriculum

40. Technical Assistance needs for this activity, if any


5
6

41. Successes related to implementing EvidenceBased Substance Abuse Curriculum this


reporting period at this school?
5
6

42. What lessons have you learned from implementing EvidenceBased Substance Abuse
Curriculum this reporting period at this school?
5
6

Organize Youth Empowerment Group

Page 10

School Based Substance Abuse Services - Year 2

*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

Organize Youth Empowerment Group

*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

Organize Youth Empowerment Group

*45. Please explain why you did not organize a youth empowerment group at this school

this reporting period?

5
6

Organize Youth Empowerment Group

*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

during this school year.

5
6

Page 11

School Based Substance Abuse Services - Year 2

*50. Please indicate which key tasks related to Organizing Youth Empowerment Groups

were completed this reporting period for this school.


c Identifiedadultadvisor
d
e
f
g
c Recruitedstudents
d
e
f
g

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

Empowerment Groups during this reporting period?

j Yes
k
l
m
n
j No
k
l
m
n

Organize Youth Empowerment Group

Page 12

School Based Substance Abuse Services - Year 2

*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)

Organize Youth Empowerment Group

54. Technical Assistance needs for this activity, if any


5
6

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

Deliver Parent Information or Education Programs

Page 13

School Based Substance Abuse Services - Year 2

*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

Deliver Parent Education Program

*58. Did you implement an evidencebased parent education program this reporting

period at this school?

j Yes
k
l
m
n
j No
k
l
m
n

Deliver Parent Education Program

*59. Please indicate why did not implement an evidencebased parent education program

at this school this reporting period.

5
6

Deliver Parent Education Program

*60. What is the name of the person who delivers the evidencebased parent education

program at this school?

*61. Which evidencebased parent education program did you implement?


c LifeSkillsTraining,ParentComponent
d
e
f
g
c GuidingGoodChoices
d
e
f
g

c CreatingLastingFamilyConnections
d
e
f
g
c StrengtheningFamilies
d
e
f
g
c Other
d
e
f
g

Other(pleasespecify)

Deliver Parent Education Program

Page 14

School Based Substance Abuse Services - Year 2

*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

Education Program were completed this reporting period at this school.


c Trainedstafftoimplementprogram
d
e
f
g

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

66. Evaluation Results (process and outcome results as available)


5
6

*67. Have staff at this school received any training or technical assistance for Evidence

Based Parent Education during this reporting period?

j Yes
k
l
m
n
j No
k
l
m
n

Deliver Parent Education Program

Page 15

School Based Substance Abuse Services - Year 2

*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)

Deliver Parent Education Program

69. Technical Assistance needs for this activity, if any


5
6

70. Successes related to implementing an EvidenceBased Parent Program this reporting


period at this school?
5
6

71. What lessons have you learned from implementing an EvidenceBased Parent
Program this reporting period at this school?
5
6

Deliver Parent Information

Page 16

School Based Substance Abuse Services - Year 2

*72. Does your implementation plan for this school include "Deliver Parent Information"?

j Yes
k
l
m
n
j No
k
l
m
n

Deliver Parent Information

*73. Did you provide parent information this reporting period at this school?

j Yes
k
l
m
n
j No
k
l
m
n

Deliver Parent Information

*74. Please indicate why you did not provide parent information at this school this

reporting period.

5
6

Deliver Parent Information

*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

School Based Substance Abuse Services - Year 2

*77. Please indicate which key tasks associated with delivering Parent Information were

completed this reporting period.


c Identifiedparentinformationneeds
d
e
f
g
c Identifieddeliverymethod
d
e
f
g
c Deliveredinformation
d
e
f
g
c Assessedimpact
d
e
f
g
c Other
d
e
f
g

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

Parent Information during this reporting period?

j Yes
k
l
m
n
j No
k
l
m
n

Deliver Parent Information

*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

School Based Substance Abuse Services - Year 2


Deliver Parent Information

81. Technical Assistance needs for this activity, if any


5
6

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

Deliver ATOD Teacher and Staff Training

*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

Deliver ATOD Teacher and Staff Training

*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

Deliver ATOD Teacher and Staff Training

*86. Please indicate why you did not deliver ATOD teacher and staff training at this

school this reporting period.

5
6

Deliver ATOD Teacher and Staff Training

Page 19

School Based Substance Abuse Services - Year 2

*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

completed this period.

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

during this reporting period

j Yes
k
l
m
n
j No
k
l
m
n

Deliver ATOD Teacher and Staff Training

Page 20

School Based Substance Abuse Services - Year 2

*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)

Deliver ATOD Teacher and Staff Training

93. Technical Assistance needs for this activity, if any


5
6

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

Deliver Educational Support Groups

Page 21

School Based Substance Abuse Services - Year 2

*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

Deliver Educational Support Groups

*97. Did you implement an educational support group this reporting period?

j Yes
k
l
m
n
j No
k
l
m
n

Deliver Educational Support Groups

*98. Please explain why you did not implement an educational support group at this

school this reporting period.

5
6

Deliver Educational Support Groups

*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

name the curriculum or briefly describe the group model.


5
6

Deliver Educational Support Groups

Page 22

School Based Substance Abuse Services - Year 2

*102. How many group sessions were held this reporting period?
Numberofgroupsessions

*103. How many unique students participated in educational support groups conducted

this reporting period?

*104. Please indicate which key tasks associated with implementing Educational Support

Groups were completed this reporting period


c IdentifiedEducationalSupportGroups
d
e
f
g
c Identifiedadultlead
d
e
f
g

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

delivery of Educational Support Groups during this reporting period?

j Yes
k
l
m
n
j No
k
l
m
n

Deliver Educational Support Groups

Page 23

School Based Substance Abuse Services - Year 2

*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)

Deliver Educational Support Groups

108. Technical Assistance needs for this activity, if any


5
6

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

Page 24

School Based Substance Abuse Services - Year 2


111. Please share a highlight or success story about any of the progress on funded
activities at this school from this reporting period. (Narrative may be quoted in a legislative
Report)
5
6

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

Page 25

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