CLI-R Guide to Required Responses

Iowa Partnerships for Success (IPFS) Counties

CLI-R – Guide to Required Responses

Reporting Period: 4/1/2017 to 9/30/2017

or 10/1/2016 to 9/30/2017 (only if the question specifies past Federal Fiscal Year)

Due Date for MRT Entry: November 17, 2017

Instructions: The following questions will require all IPFS funded counties to answer with a specific response or from a specific set of responses. Please use this guide as you complete the CLI-R (Community Level Instrument- Revised) for the reporting period indicated above. This guide does not cover all responses, only those where responses will be relatively standard across all counties. You will still need to answer other required questions on the CLI-R even if they are not included in this guide (e.g. questions specific to your site or asking for your opinions).

You will complete and submit the CLI-R in the PEP-C MRT system (Program Evaluation for Prevention- Management Reporting Tool) at If you are unable to access the system or need assistance logging-in, please contact Cheryl Yates (), IPFS State Evaluator.

The Web browsers supported by the PEP-C MRT are Microsoft Internet Explorer (IE) versions 7-10, Chrome, and Firefox. Safari and other browsers may not be supported. They may function but not to design specifications.

After logging into the PEP-C MRT system, you will find the CLI-R Instrument in the “Cross-Site Instruments” tab on the far right of the home screen. Click on the “Community Level Instrument-Revised” button. You will then choose the respective reporting period. All the sections and sub-forms you are required to complete are included in just the one CLI-R (the instrument no longer has two parts,if you are familiar with the SPF SIG). See the following pages for specific directions on how to answer some of the questions. Please contact if you have any questions about the CLI-R or experience technical difficulties. She will contact the PEP-C Technical Assistance, if necessary.

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Section 1: Administrative Survey

This section asks you questions related to your organization type, funding, and cultural competence and health disparities.

7)Which of the following health disparities-related activities did your sub-recipient organization conduct during the past 6 months?

Select any service(s) provided on health care disparities during the past six months.

Section 2: Strategic Prevention Framework

This section contains questions regarding each of the five steps in the SPF process. The five steps include 1) needs and resources assessments, 2) capacity building, 3) strategic plan development, 4) prevention intervention implementation, and 5) monitoring and evaluation.

8)Has your organization completed an assessment of community needs and resources during the past federal fiscal year?

Select “Yes”

9)Indicate the types of community needs and resources that were assessed during the past federal fiscal year.

Select all that apply in the last federal fiscal year. At minimum you should select the following:

“Prevention resources (e.g. trained implementers)

“Partnerships with relevant organizations in the community”

14)For each of the types of data, indicate whether or not you used the data in conducting your community needs and resources assessment and whether or not it was provided to you by the SEOW (State Epidemiological Workgroup). This would also include data that the SEOW showed you how to access or use.

Q14 will auto-complete based on your responses on the last CLI-R. Letters a, b, e, f, g, h, and i: Select the response indicated by an “x” below. All others: choose one of the responses indicated by an * (asterisk) below, as appropriate based on the data sources used in your county’s County Assessment Workbook. The response in the first column below is not a valid answer, and should not be used as a response on any of the letters.

Yes, the data were used and provided by the SEOW / Yes, the data were used but not provided by the SEOW / No, we did not use the data
a. Student school survey data / X
b. School achievement data / X
c. Community surveys / * / *
d. Social norms data / * / *
e. Census data / X
f. Public health statistics (e.g. rates of mortality due to drug overdose) / X
g. Law enforcement data (e.g. drug arrests or drug trafficking) / X
h. Justice data (e.g. outcomes of criminal cases) / X
i. Public safety data (e.g. number of automobile accidents caused by drinking and driving) / X
j. Emergency room data related to underage drinking or prescription drug misuse / * / *
k. Prescription drug monitoring system data / * / *
l. Poison call center data related to alcohol or prescription drug use / * / *
m. Interviews or focus groups / * / *
n. Public meetings or forums (e.g. town hall meetings) / * / *
o. Other (describe) / * / *

Q15 thru Q19 should auto-complete based on previous responses.

21) Have you conducted activities that produced gains in your organizational resources related to PFS during the past year?

Please note that this question specifically asks ONLYabout PFS-related activities.

Answer as appropriate. If “no,” the question will skip Q22.

22) Indicate the activity or activities you conducted during the past federal fiscal year that produced gains in your organizational resources related to PFS.

Please note that this question specifically asks ONLYabout PFS-related activities.

Answer as appropriate.

23) Select the area(s) in which you needed, requested, and/or received SPF-PFS-related guidance or training and technical assistance (T/TA) during the past federal fiscal year.

Note: This question refers to only the training(s) provided by IDPH. Answer as indicated below for c, d, f, g, m, and n. All others, answer as appropriate in your county if T/TA was needed or requested.

Needed T/TA in this area / Requested T/TA in this area / Received T/TA in this area / Number of hours T/TA received in the past year
a. Needs and resource assessment
b. Strategic plan development
c. Staff, task force, or coalition member training / X / Answer as appropriate for your county
d. Building relationships / X / 1
e. Intervention selection
f. Participant recruitment / X / 2
g. Intervention implementation / X / 5
h. Intervention adaptation
i. Cultural competence
j. Health disparities
k. Evaluation / X / 1
l. Sustainability / X / 3
m. Other (describe) - Communication / X / 2
n. Other (describe) – Coalition Resources / X / 1
o. Other (describe)

24) Have you identified key stakeholders, partners, and partner organizations to participate in your SPF-PFS planning and prevention intervention activities?

Select “Yes” (and then answer Q25)

28) During the past federal fiscal year, how have you worked to ensure that prevention intervention activities and outcomes continue after SPF-PFS funding has ended?

Select all that apply during the last federal fiscal year. At minimum, you should select at least one of the following:

“Leveraged, redirected, or realigned other funding sources or in-kind resources”

“Worked to ensure that prevention intervention activities are incorporated into the missions/goals and activities of other organizations”

“Worked to gain formal adoption of prevention intervention activities into other organizations’ practices”

“Worked to implement local level laws, policies, or regulations to guarantee the continuation of prevention intervention activities or outcomes”

“Worked on developing a partnership structure that will continue to function beyond the end of the PFS grant period”

“Other______”

30) Did you complete or substantially revise your completed SPF-PFS strategic plan during the past federal fiscal year?

Select “Yes” – only if there was a strategy change during the last federal fiscal year

Select “No, your PFS strategic plan was completed earlier, and you have not revised it” – if no strategy changes occurred (skips Q31)

31) Has your strategic plan been reviewed and approved by the agency responsible for the SPF-PFS initiative in your state?

Select “No”

32) Did you or your community partners deliver any PFS-related prevention interventions during the past 6 months?

Select “Yes”

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33) Name all the prevention interventions you or your community partners delivered during this reporting period as part of your PFS efforts.

Q33will auto-complete based on your responses on the last CLI-R.

Woodbury, Jackson, and Allamakee will change the Status (Column h) of Enforcement of Administrative Penalties Strategy to “discontinued.” Then, please fill in the date this strategy was discontinued.

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34) Describe the types of funding for substance abuse prevention you received in the past federal fiscal year.

Please respond as shown in the table below for letters a and e.

Source of funding/resources / Total dollar amount that went to prevention / Is any part of funding used for PFS? / Amount of funding used for PFS ($)
34a) SPF-PFS / Total amount that your county receives for PFS / “Yes” / Total amount of PFS funding
34b) DFC grant
34c) STOP Act
34d) HIV/AIDS Initiative
34e) Substance Abuse Prevention and TX Block Grant / If your agency has the Comprehensive SA Prevention Grant / No / $0
34f) Medicaid
34g) Other Federal funds
34h) Other State funds
34i) Other local funds
34j) Foundations/non- profit
34k) Corporate/business
34l) Individuals/fundraiser
34m) Other

For each intervention listed in Q.33, you will answer questions35-41. All of the questions in this section, except for Q40 and Q41a, should auto-complete based on your responses from last time.

35a) What specific consumption pattern(s) and/or consequence(s) is the prevention intervention intended to target?

Please choose all that apply to the IPFS priority/consequences the strategy is listed under in the Logic Model.

35b) What specific intervening variable(s) is the prevention intervention intended to target?

Please choose all that apply to the strategy’s intervening variables listed in the Logic Model.

35c) Which factors did you consider when choosing this prevention intervention?

Select the following responses:

“It matched your target intervening variable(s)”

“It addressed your specific target population(s)”

“The intervention was recommended by your State, tribal entity, or jurisdiction”

36a) Is this an evidence-based program, policy, or practice?

Answer “yes”

36b) How do you know this is an evidence-based program, policy, or practice?

Select the following response:

“Appeared on a list of recommended programs”

37) Which of the following best describes the implementation history of this prevention intervention in your community?

Select the following response:

“Not implemented in the community before PFS funding”

38) Does this prevention intervention include a curriculum or manual?

Answer “yes”

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39a) Location of (prevention intervention service type)

Environmental strategies:

If the strategy’s reach is county-wide, provide only the name of the county.
If the strategy is being implemented in certain communities within the county, each community should be listed on a separate line.

Individual strategies:

Each school, district, or organization (whichever applies)that will participate in the individual program should be listed on a separate line.

IDPH Media campaign:

Please provide only the name of the county.

39e) Other geographic descriptor of (prevention intervention service type)

Leave blank.

39f) Target population of (prevention intervention service type)

If the Location of the strategy reported in Q39a is county or community, please indicate the age group(s) of the youth being targeted for the strategy (e.g. 12-20 year olds or 13-16 year olds, etc.)

If the Location of the strategy reported in Q39a is school, district, or organization, indicate the age group(s)or the grade level(s) of youth who will participate as appropriate for each location.

39g) Estimated target population number within the area described

If the Location reported is county (strategy is county-wide), you may use the 2015 CountyTarget Population Table below. Several age groups are provided, so please report the relevant age group your specific strategy is targeting.

2015 County Target Population Table

County / # 12-20 year olds / # 13-16 year olds / # 18-20 year olds / # 12-17 year olds
Allamakee / 1426 / 647 / 456 / 970
Appanoose / 1267 / 578 / 399 / 868
Audubon / 609 / 272 / 202 / 407
Chickasaw / 1370 / 624 / 434 / 936
Clayton / 1885 / 860 / 595 / 1290
Delaware / 2040 / 927 / 649 / 1391
Emmet / 1148 / 504 / 391 / 757
Jackson / 2203 / 998 / 707 / 1496
Sac / 1083 / 495 / 341 / 742
Van Buren / 790 / 365 / 243 / 547
Webster / 4766 / 2032 / 1718 / 3047
Woodbury / 13207 / 5874 / 4396 / 8810

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If the Location reported is community(ies) (strategy is only implemented in certain communities), you will need to go to the following Census website and lookup each community(ies)for youth population numbers. The age categories provided on the Census website may not match your strategy’s target population, so you will need to calculate an estimate for the specific age group(s)targeted in the community.

Please contact the evaluator for help calculating an estimate.

If the Location reported is school(s) or district(s) (strategy is implemented in certain schools or districts), you can findenrollment information from the Iowa Department of Education website, and then calculate an estimate for your specific grade level(s)/age(s), whichever is relevant.

Please contact the evaluator for help calculating an estimate.

If the Location reported is organization(s) (strategy is implemented in certain organizations), you may be able to contact the organization(s) or look at their website to find estimates on the number of youth in targetpopulation they are providing services to.

41a) Did your organization leverage funding or resources to support implementation of this prevention intervention service type?

Answer as appropriate for your county, if “no” the question will skip Q41b(Q41b will auto-fill based on your response last time)

42) Approximately what percentage of total funding for this prevention intervention service type comes from SPF-PFS funds?

Answer 100%

After answering Q.42, you will need to answerthree sub-formsassociated withthe strategies in your county: Prevention Education (Individual Strategies), Environmental Strategies, and Information Dissemination (Media Campaign).

PREVENTION EDUCATION SUB-FORM (Individual Strategies)

Q.62-64 in this section should auto-complete based on your answers last time.

62) When did you first start serving participants with this Prevention Education intervention for PFS initiative?

Q62 will auto-fill. Please report the date your county’s strategic plan was approved (provided below):

6/1/16 for Chickasaw, Van Buren, and Webster

6/3/16 for Delaware

6/21/16 for Allamakee, Jackson, and Sac

6/28/16 for Emmet and Woodbury

7/12/16 for Appanoose

7/14/16 for Audubon

8/1/16 for Clayton

67. Location(s) where the prevention education intervention took place.

This should match the location(s) for the individual strategy reported in Q39a. Each location (school or organization) should be reported on a separate line.

69a) How many total participants were served by this prevention education intervention during past 6 months?

Please report how many youth actually participated in the individual strategy curriculum in the past 6 months. This number should be equal to or less than the target population number reported in Q39g for the individual strategy.

69b) Of those served by the prevention education intervention during the past 6 months, how many were new participants?

Please respond as appropriate. New participants are participants who have not received of participated in the prevention intervention before and were therefore not counted in the first 6 months of the year.

70 thru 77) Questions 70 thru 77 ask for demographic information about the youth who participated in the individual strategy curriculum in the past 6 months.

The numbers for each category in the questionshould total the number of youth reported on Q69b (for new participants in the past 6 months ONLY).

Provide the numbers (or estimates) for each sex, age, race/ethnicity, language, disability, and family military status categories provided on the CLI-R for ONLY the new participants in the past 6 months. If the number is unknown for a category and you are unable to provide estimates, particularly for the disability or family military of youth participants, please report the total number of participants in the “unknown” category.

ENVIRONMENTAL STRATEGIES SUB-FORM (Environmental Strategies)

Q.112, Q.114, Q.115a, Q.116, and Q.117 in this section should auto-complete based on your answers last time.

112) When did you first start conducting the environmental strategy for your PFS initiative?

Q112 will auto-fill. Please report the date your county’s strategic plan was approved (provided below):

6/1/16 for Chickasaw, Van Buren, and Webster

6/3/16 for Delaware

6/21/16 for Allamakee, Jackson, and Sac

6/28/16 for Emmet and Woodbury

7/12/16 for Appanoose

7/14/16 for Audubon

8/1/16 for Clayton

128b. How many compliance checks were conducted during the past 6 months?

Please report the specific number of compliance checks instead of rounds.

129a. For this particular environmental strategy, did you establish sobriety checkpoints during the past 6 months?

Answer as appropriate. Please note that this question refers to “safety” checkpoints.

129b. How many separate sobriety checkpoints were established during the past 6 months?

Please provide the specific number of safety checkpoints instead of rounds.

133a) Estimate the total number of individuals who were reached or affected by your environmental strategy during the past 6 months.

This answer should be the same as the number of youth in the target population reported in Q39g for the environmental strategy.

2015 County Target Population Table

133b) Of those who received or were reached or affected by your environmental strategy in the past 6 months, how many were new during the second half of the federal fiscal year?