As a grantee, you are required to submit reports according to the schedule specified in your grant. Find your program's reporting forms and guidance documents below.
|Agency of Administration|
|Human Subjects||Institutional review Board|
|Tobacco||Tobacco - Resources, Trainings, Webinars, Policies, Toolkits|
|Wording for Event Attendee Evaluations|
|Data Collection Tool|
|CHL Quarterly Reporting and Evaluation Summary Form|
With the enactment of Act 86 effective July 1, 2018, ADAP is sharing some examples of grantee-developed marijuana information for communities. These examples are not vetted nor necessarily endorsed by the Department of Health.
- Act 86 Marijuana Flowchart - Partners for Prevention
- Act 86 What You Need to Know - Mt. Ascutney Prevention Partnership
- What Does Marijuana Legalization Look Like in Vermont - Mt. Ascutney Prevention Partnership & Burlington Partnership for a Healthy Community
- Marijuana Policy Sample Lease Addendum - St. Johnsbury Regional Prevention Partnerships Grantee
- Current PrEvents: What Marijuana Legalization Means for You, Times Argus - Central Vermont New Directions Coalition
What are NOMs?
The National Outcome Measures are the federal Substance Abuse and Mental Health Services Administration's approach to performance measures. States are required to report on National Outcome Measures for both prevention and treatment programs as part of their block grant requirements. National Outcome Measures are broken down into sub-categories called “domains”. For Prevention National Outcome Measures, each state is only being asked to collect data in 3 of the 8 domains. The other five domains are being pre-populated by existing data sources.
What are the National Outcome Measures Domains?
- Domain 1: Reduced Morbidity – Abstinence from Drug or Alcohol Use
- Domain 2: Employment/Education
- Domain 3: Crime and Criminal justice
- Domain 4: Social Connectedness
- Domain 5: Access/Capacity*
- Domain 6: Retention
- Domain 7: Cost Effectiveness*
- Domain 8: Use of Evidence-based Practices and Strategies*
* Vermont is collecting data from prevention grantees to report on the three domains in bold.
What domains are Alcohol and Drug Abuse Programs Prevention Grantees required to provide?
Alcohol & Drug Abuse Programs grantees will need to provide detailed data for the "Access/Capacity" domain and budget data for the "Cost Effectiveness" domain. Alcohol & Drug Abuse Programs will submit the information for the "Evidence-based Practice" domain based on grantee information from the original applications for funding.
How will grantees provide this information?
Alcohol & Drug Abuse Programs grantees will collect the data throughout their grant period and submit it as part of their regular reporting activities for the grant. Special forms have been designed for grantees to use to report this data to Alcohol & Drug Abuse Programs. Additional forms have been provided by Alcohol & Drug Abuse Programs to assist grantees in collecting the data.
What data is collected for the Access/Capacity domain?
This domain captures information about the number of people served by race, ethnicity, age and gender:
- Individual-based programs and population-based programs: total number served by age, gender, race and ethnicity.
- Institute of Medicine category delineated for each grant-funded program. These are: universal-indirect, universal-direct, indicated and selected.
|NOMs Data Collection Form|
|Supplemental Budget Form|
Regional Prevention Partnership County Profiles available on the Data & Reports page.
|2020 Media Guidance|
|2020 Grantee Media Guidance|
|FY20 RPP Strategy Proposal Process|
|SurveyGizmo Strategy Proposal Form (Due no later than 12/31/2019)|
|Strategy Proposal Questions & Resources List|
|Submission Scoring Rubric|
|Example Completed Submission|
|Treatment Provider Quarterly Report Templates (FY19)|
|Brattleboro Retreat Hub||NKHS|
|Brattleboro Retreat Starting Now|
|Clara Martin Center||RRMC Hub|
|Howard Center Hub||Valley Vista|
|Howard Center Non Hub||WCYSB|
Information for opioid treatment programs, sometimes known as “hubs.”
|Hub Census Report|
|OLD FORM - Hub Census Form|
|Medication Assisted Treatment - Screening Form|
|Third Party Payer Status|
|Uninsured Buprenorphine Client Report|
|Buprenorphine Billing Codes for Hubs|
|Drug Toxicology Screening Protocol|
|Standards for Recovery Services|