2015 GOT OUTCOMES! Coalition of Excellence Awards Data/Interventions Templates INSTRUCTIONS (Please read carefully): You should have already completed one “Big Picture Overview” template for EACH substance use/abuse problem you are highlighting in your Phase I application before working on this template. Your “Big Picture” Overview template(s) serve as a cover page for the information that will follow in these “Data/Interventions” template slides. You will need to complete one “Data/Interventions” slide for each local condition you include on your “Big Picture Overview”. Each slide will demonstrate that your coalition comprehensively addressed each local condition in a unique and tailored way through strategies/interventions. Applicants that are highlighting only ONE substance use/abuse problem will only need to complete one “Big Picture Overview” template slide and the following FOUR “Data/Interventions” template slides that correspond to each of the four local conditions they provide. If your coalition is highlighting work in more than one substance use/abuse issue, you will need to modify accordingly. First, transfer the problem statements from your “Big Picture Overview” template(s) to this “Data/Interventions” template. Than, for each of the problem(s) root causes and local conditions, provide at least two specific pieces of baseline assessment data to support your statements. The baseline data are the specific numbers that drove your coalition to plan the strategies/interventions that were implemented (on the right column). Be sure to include the year the data were collected and the name of the data source. The data you include for each data source should link directly back to the outcomes (improvements in your baseline data) that you present in your PowerPoint presentation. Finally, provide a comprehensive and complementary list of interventions that your coalition has already implemented to address each unique local condition in the “Strategies/Interventions” box. These are the interventions you feel have most greatly contributed to the successes you see today in that particular local condition (short-term outcomes) as well as your intermediate and long-term outcomes (Coalition in Focus, Coalition of the Year). Provide a brief description of each intervention you list (enough for the reviewer to understand what you did), and align them as best as you can with the appropriate “seven behavior change strategy” (See page 7 for reference) An example is provided on page 9 of the application

2015 GOT OUTCOMES! Coalition of Excellence Awards Data/Interventions Templates Strategies/Interventions: 1.Provide Information: (Insert intervention names and descriptions) 2. Enhance Skills (Insert intervention names and descriptions) 3. Provide Support: (Insert intervention names and descriptions) 4. Enhance access/reduce barriers: (Insert intervention names and descriptions) 5. Change consequences: (Insert intervention names and descriptions) 6. Change physical design: (Insert intervention names and descriptions) 7. Modify/change policies: (Insert intervention names and descriptions) Strategies/Interventions: 1.Provide Information: (Insert intervention names and descriptions) 2. Enhance Skills (Insert intervention names and descriptions) 3. Provide Support: (Insert intervention names and descriptions) 4. Enhance access/reduce barriers: (Insert intervention names and descriptions) 5. Change consequences: (Insert intervention names and descriptions) 6. Change physical design: (Insert intervention names and descriptions) 7. Modify/change policies: (Insert intervention names and descriptions) Local Condition #1: (Insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source) Root Cause #1 “But why?” (insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source) Problem #1 (Insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source)

2015 GOT OUTCOMES! Coalition of Excellence Awards Data/Interventions Templates Strategies/Interventions: 1.Provide Information: (Insert interventions) 2. Enhance Skills (Insert interventions) 3. Provide Support: (Insert interventions) 4. Enhance access/reduce barriers: (Insert interventions) 5. Change consequences: (Insert interventions) 6. Change physical design: (Insert interventions) 7. Modify/change policies: (Insert interventions) Strategies/Interventions: 1.Provide Information: (Insert interventions) 2. Enhance Skills (Insert interventions) 3. Provide Support: (Insert interventions) 4. Enhance access/reduce barriers: (Insert interventions) 5. Change consequences: (Insert interventions) 6. Change physical design: (Insert interventions) 7. Modify/change policies: (Insert interventions) Local Condition #2: (Insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source) Root Cause #1 “But why?” (insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source) Problem #1 (Insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source)

2015 GOT OUTCOMES! Coalition of Excellence Awards Data/Interventions Templates Strategies/Interventions: 1.Provide Information: (Insert interventions) 2. Enhance Skills (Insert interventions) 3. Provide Support: (Insert interventions) 4. Enhance access/reduce barriers: (Insert interventions) 5. Change consequences: (Insert interventions) 6. Change physical design: (Insert interventions) 7. Modify/change policies: (Insert interventions) Strategies/Interventions: 1.Provide Information: (Insert interventions) 2. Enhance Skills (Insert interventions) 3. Provide Support: (Insert interventions) 4. Enhance access/reduce barriers: (Insert interventions) 5. Change consequences: (Insert interventions) 6. Change physical design: (Insert interventions) 7. Modify/change policies: (Insert interventions) Local Condition #1: (Insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source) Root Cause #2 “But why?” (insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source) Problem #1 (Insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source)

2015 GOT OUTCOMES! Coalition of Excellence Awards Data/Interventions Templates Strategies/Interventions: 1.Provide Information: (Insert interventions) 2. Enhance Skills (Insert interventions) 3. Provide Support: (Insert interventions) 4. Enhance access/reduce barriers: (Insert interventions) 5. Change consequences: (Insert interventions) 6. Change physical design: (Insert interventions) 7. Modify/change policies: (Insert interventions) Strategies/Interventions: 1.Provide Information: (Insert interventions) 2. Enhance Skills (Insert interventions) 3. Provide Support: (Insert interventions) 4. Enhance access/reduce barriers: (Insert interventions) 5. Change consequences: (Insert interventions) 6. Change physical design: (Insert interventions) 7. Modify/change policies: (Insert interventions) Local Condition #2: (Insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source) Root Cause #2 “But why?” (insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source) Problem #1 (Insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source)