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Pikes Peak Region 16 · Subrecipient reporting

Quarterly reporting submission

Subrecipients are responsible for ensuring each quarterly report is complete, accurate, and reflects activities conducted during the reporting period. Base all reported data on actual program records and documentation.

Every reporting field must contain a numeric value or “N/A.” Do not leave fields blank.

Prevention Program Participant Survey

Evidence-Based Treatment and Intervention Participant Survey

Increase Recovery Supports Participant Survey

Report Submission

Submission of quarterly and annual reporting as required by the grant agreement

"*" indicates required fields

Report Submitter Information

First Last Title held (Position)

Name of Organization*

Email*

What Year was your Organization funded?*

Which cycle was your Organization funded in?*

Spring funding cycle Application window: January 1 through March 1 Fall funding cycle Application window: July 1 through September 1

Total Awarded Amount*

Total Amount Remaining*

Total Award Amount – Total Amount Spent to date

Reporting Year*

Reporting Period*

Program Overview

Project Status*

County or Counties Served

Achievements this period*

Provide concise but meaningful descriptions of: Major accomplishments, Program activities completed, notable outcomes, Significant partnerships or community collaborations

Challenges (if applicable)

If applicable, please provide any challenged your organization faced this period

Success story (if applicable)

If applicable, please provide a success story

Performance Metrics Reporting

Subrecipients are responsible for ensuring that all quarterly reporting is complete, accurate, and reflective of activities conducted during the reporting period. Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program or funded service, or when no individuals were served within a specific reporting category during the reporting period. Do not leave any fields blank, as blank responses make it impossible to determine whether the metric was overlooked, was not applicable, or simply had no reportable activity. All reported data should be based on actual program records and documentation.

Strategic Pillar*

Please select the appropriate Strategic Pillar in which you applied under.

Focus Age

Select the most appropriate age range your program focuses on

5-9 Year Old

10-14 Year Old

15-19 Year Old

20-24 Year Old

25-29 Year Old

30+ Year Old

Prevent and Reduce Youth Substance Misuse

Total # of unduplicated youths who participated in prevention programming*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Total # of youth showing reduced intention or favorable attitude toward vaping / nicotine use*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Total # of youths who participated in after-school activities*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Average attendance rate across prevention sessions*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Total # of unduplicated parents / caregivers completing prevention education*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Total # of parents who received prescription storage & monitoring education*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Expand Access to Evidence-Based Treatment and Intervention

Total # of unduplicated individuals receiving evidence-based treatment services*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Total # of unduplicated individuals who remain actively engaged in treatment for at least six months after enrollment*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Total # of individuals who completed treatment*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Average # of days from referral to first treatment service*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Total # of eligible overdose cases or high-risk individuals receiving follow-up contact within 72 hours*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Number of active treatment slots / beds with wraparound services in effect at the end of the Reporting period*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Increase Recovery Supports

Total # of unduplicated individuals receiving recovery support services*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Total # of individuals who remained in recovery for 12 months*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Total # of individuals who accessed sober living supports*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Total # of unduplicated individuals with stable housing status*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Total # of participants employed, in education, or in job training*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Total # of participants successfully linked to at least one recovery support resource within 30 days of enrollment*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Total # of participants still engaged in recovery support services 90 days after enrollment*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Total # of unduplicated family members receiving family recovery support services*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Total # of unduplicated individuals who establish ongoing access to primary medical care and dental care services*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Increase Data Collection & System Coordination

# of data gaps identified*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

# of multiuse data collections identified*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

# of evaluation capacities identified*

Every reporting field should contain either a numeric value or “N/A.” Use “N/A” when a performance metric does not apply to your program

Additional Metrics

Additional metrics to report on*

Please provide any additional metrics you would like to report on.

Expenditures

In accordance with the grant agreement, organizations must maintain sufficient documentation to substantiate all expenditures made with Pikes Peak Region 16 Opioid Abatement Council Grant funds.

Expense Details*

Line Item details for expenditures. Use the + icon on the right to create additional lines

Date

Expenditure Description

Amount spent this quarter

Notes

Supporting Documents

Upload supporting documentation for the quarterly report submitted above. Documentation should clearly substantiate and align with the reported expenditures, activities, or performance metrics.

Supporting Documents*

Drop files here or

Max. file size: 8 MB, Max. files: 6.