INSTRUCTIONS Please read carefully You should have already

INSTRUCTIONS (Please read carefully): You should have already completed one “Big Picture Overview” template for the 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. To complete, first, transfer the problem statement from your “Big Picture Overview” template to this “Data/Interventions” template. Then, for the problem, 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 (in 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 Power. Point 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. 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”. An example is provided in the Applicant Reference Document. 2016 GOT OUTCOMES! Coalition of Excellence Awards Data/Interventions Templates

Strategies/Interventions: 1. Provide Information: • (Insert intervention names and descriptions) Problem (Insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source) 2. Enhance Skills • (Insert intervention names and descriptions) Root Cause #1 “But why? ” (insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source) Local Condition #1: (Insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source) 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) 2016 GOT OUTCOMES! Coalition of Excellence Awards Data/Interventions Templates

Strategies/Interventions: 1. Provide Information: • (Insert interventions) 2. Enhance Skills • (Insert interventions) Problem (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) Local Condition #1: (Insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source) 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) 2016 GOT OUTCOMES! Coalition of Excellence Awards Data/Interventions Templates

Strategies/Interventions: 1. Provide Information: • (Insert interventions) 2. Enhance Skills • (Insert interventions) Problem (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) Local Condition #2: (Insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source) 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) 2016 GOT OUTCOMES! Coalition of Excellence Awards Data/Interventions Templates

Strategies/Interventions: 1. Provide Information: • (Insert interventions) 2. Enhance Skills • (Insert interventions) Problem (Insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source) Root Cause #3 “But why? ” (insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source) Local Condition #1: (Insert statement) Data 1: (baseline year, source) Data 2: (baseline year, source) 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) 2016 GOT OUTCOMES! Coalition of Excellence Awards Data/Interventions Templates