Quarterly Impact Report

Organization Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name of Representative Completing Report

First NameLast Name

Title

Phone Number

Please enter a valid phone number.

Please indicate which approved strategy or strategies you used opioid settlement funding for during this reporting quarter:*

Current stage of implementation for the approved strategy:

Please provide a brief progress report for each strategy that you selected describing the progress made by your organization.

Please share any success stories from a person or persons who have benefited from your implemented strategies.

STRATEGY-SPECIFIC PROCESS MEASURES Process measures answer the question, “How much did you do?”. Please quantify the process measures relevant to your implementation of this strategy. Indicate whether the count represents efforts supported only by opioid settlement funds or efforts supported by multiple funding sources including opioid settlement funds. Process measures should reflect numbers from the current reporting period (fiscal year).

	Count	How were efforts supported?	Notes
# of staff hired to lead Collaborative Strategic Planning efforts related to the Opioid Settlements
# of meetings facilitated to support Collaborative Strategic Planning efforts related to the Opioid Settlements
# of collaborative strategic plans produced, in which all of the activities below were completed

During the collaborative strategic planning process, were…

	(Y/N)	How Were Efforts Supported?	Notes
A. Diverse stakeholders engaged?
B. Facilitator designated?
C. Related planning efforts built upon?
D. Shared vision agreed upon?
E. Key indicator(s) identified?
F. Root causes explored and identified?
G. Potential strategies identified and evaluated?
H. Gaps in existing efforts identified?
I. Strategies prioritized?
J. Goals, measures, and evaluation plan identified
K. Alignment of strategies considered?
L. Organizations identified?
M. Budgets and timelines developed?
N. Recommendations offered?

STRATEGY-SPECIFIC PROCESS MEASURES Process measures answer the question, “How much did you do?”. Please quantify the process measures relevant to your implementation of this strategy. Indicate whether the count represents efforts supported only by opioid settlement funds or efforts supported by multiple funding sources including opioid settlement funds. Process measures should reflect numbers from the current reporting period (fiscal year).

	Count	How Were Efforts Supported?	Notes
# of naloxone kits distributed
# of OTPs that dispense methadone, buprenorphine, and naltrexone
# of OTPs that dispense only methadone
# of OTP-based medical providers who prescribe methadone for OUD patients
# of referrals to opioid treatment programs
# of unique patients with OUD served at OTP
# of referrals to OBOT
# of referrals to FQHC MAT services
# of unique patients with OUD served at FQHC
# of referrals to in-patient MAT services
# of unique hospital in-patients with OUD served with MAT
# of referrals from emergency department to community providers
# of patients who are justice-involved that are referred to any MAT program

Demographics - Of the # of unique patients who have OUD, served in the count above, how many people identified as:

	Count	Notes
American Indian/Alaska Native Non-Hispanic
Asian Non-Hispanic
Black Non-Hispanic
Native Hawaiian or Other Pacific Islander Non-Hispanic
White Non-Hispanic
Hispanic
Some Other Race or Multiple Races
Unknown

Quality measures answer the question, “How well did you do it?”. Please quantify the quality measures relevant to your implementation of this strategy. Quality measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of referrals to opioid treatment programs that resulted in 1st appointment attended
# of referrals to opioid treatment programs
# of referrals to OBOT services that resulted in 1st appointment attended at office-based clinic
# of referrals to OBOT services at office-based clinic
# of referrals to OBOT services that resulted in 1st appointment attended at FQHC
# of referrals to OBOT services at FQHC
# of referrals to OBOT services that resulted in 1st appointment attended at LHD
# of referrals to OBOT services at LHD
# of referrals to EMS-based MAT programs that resulted in 1st appointment for treatment attended
# of referrals to EMS-based MAT programs
# of referrals to SSP-based MAT services that resulted in 1st appointment for treatment attended
# of referrals to SSP-based MAT services
# of patients who are justice-involved that are referred to any MAT program that resulted in 1st appointment for treatment attended
# of patients who are justice-involved that are referred to any MAT program
# of unique patients who have OUD, served, who report they are satisfied with services
# of unique patients who have OUD, served

Outcome measures answer the question, “Is anyone better off?”. Outcome measures can be at the program- or population-level. Please quantify the outcome measures relevant to your implementation of this strategy. Outcome measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of unique patients with OUD who were connected to treatment and have adhered to treatment at 6 months
# of unique patients who have OUD who were connected to treatment (i.e. attended their first appointment)
# of patients who have OUD served who report getting the social and emotional support they need
# of unique patients who have OUD, served
# of community overdose reversals using naloxone

	Are you expecting to change this measure as a result of implementing this strategy?	Notes
% of residents receiving dispensed buprenorphine prescriptions
Treatment services rate per 100,000 residents, representing # of uninsured people and Medicaid beneficiaries who received treatment for OUD
Overdose death rate per 100,000 residents
Overdose emergency department visits per 100,000 residents

STRATEGY-SPECIFIC PROCESS MEASURES Process measures answer the question, “How much did you do?”. Please quantify the process measures relevant to your implementation of this strategy. Indicate whether the count represents efforts supported only by opioid settlement funds or efforts supported by multiple funding sources including opioid settlement funds. Process measures should reflect numbers from the current reporting period (fiscal year).

	Count	How were efforts supported?	Notes
# of unique participants, who use opioids and/or have OUD, served
# of total contacts with all participants of the program
# of participants who use opioids and/or have OUD, referred to addiction treatment
# of participants who use opioids and/or have OUD, referred to recovery supports (e.g., employment services, housing services, etc.)
# of participants who use opioids and/or have OUD, referred to harm reduction services (e.g., syringe and supply access, overdose prevention education, disease prevention, etc.)
# of participants who use opioids and/or have OUD, referred to primary healthcare
# of participants who use opioids and/or have OUD, referred to other services
# of peer support specialists/care navigators
# of naloxone kits distributed

DEMOGRAPHICS: Provide the following information on race and ethnicity for the # of unique participants, who use opioids and/or have OUD, served during the current reporting period (fiscal year).

	Count	Notes
American Indian/Alaska Native Non-Hispanic
Asian Non-Hispanic
Black Non-Hispanic
Native Hawaiian or Other Pacific Islander Non-Hispanic
White Non-Hispanic
Hispanic
Some Other Race or Multiple Races
Unknown

Quality measures answer the question, “How well did you do it?”. Please quantify the quality measures relevant to your implementation of this strategy. Quality measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of unique participants, who use opioids and/or have OUD, served, who report they are satisfied with services
# of unique participants, who use opioids and/or have OUD, served
# of referrals to addiction treatment, recovery supports, harm reduction services, primary healthcare, and other services that result in linkage to supports/services
# of referrals to addiction treatment, recovery supports, harm reduction services, primary healthcare, and other services
# of staff with lived experience with OUD
# of staff
# of unique participants, who use opioids and/or have OUD, served who received naloxone kit
# of unique participants, who use opioids and/or have OUD, served

Outcome measures answer the question, “Is anyone better off?”. Outcome measures can be at the program- or population-level. Please quantify the outcome measures relevant to your implementation of this strategy. Outcome measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of unique patients with OUD who were connected to treatment and have adhered to treatment at 6 months
# of unique patients who have OUD who were connected to treatment (i.e. attended their first appointment)
# of patients who have OUD served who report getting the social and emotional support they need
# of unique patients who have OUD, served
# of community overdose reversals using naloxone

	Are you expecting to change this measure as a result of implementing this strategy?	Notes
% of residents receiving dispensed buprenorphine prescriptions
Treatment services rate per 100,000 residents, representing # of uninsured people and Medicaid beneficiaries who received treatment for OUD
Overdose death rate per 100,000 residents
Overdose emergency department visits per 100,000 residents

STRATEGY-SPECIFIC PROCESS MEASURES Process measures answer the question, “How much did you do?”. Please quantify the process measures relevant to your implementation of this strategy. Indicate whether the count represents efforts supported only by opioid settlement funds or efforts supported by multiple funding sources including opioid settlement funds. Process measures should reflect numbers from the current reporting period (fiscal year).

	Count	How Were Efforts Supported?	Notes
# of unique participants who have OUD, served
# of people with OUD who received assistance with rent
# of people with OUD who received assistance with application fees
# of people with OUD who received assistance with deposits
# of people with OUD who received assistance with utilities
# of programs where access is not contingent on sobriety, min. income requirements, lack of a criminal record, completion of treatment, participation in services, or other unnecessary conditions
# of programs with services which are informed by a harm-reduction philosophy that recognizes that drug and alcohol use and addiction are a part of some tenants’ lives
# of programs where substance use in and of itself, without other lease violations, is not considered a reason for eviction
# of programs in contact with the HUD-funded Continuum of Care (CoC) or Balance of State Continuum of Care (BoS CoC) for your area
# of naloxone kits distributed

DEMOGRAPHICS: Provide the following information on race and ethnicity for the # of unique participants, who use opioids and/or have OUD, served during the current reporting period (fiscal year).

	Count	Notes
American Indian/Alaska Native Non-Hispanic
Asian Non-Hispanic
Black Non-Hispanic
Native Hawaiian or Other Pacific Islander Non-Hispanic
White Non-Hispanic
Hispanic
Some Other Race or Multiple Races
Unknown

Quality measures answer the question, “How well did you do it?”. Please quantify the quality measures relevant to your implementation of this strategy. Quality measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of people with OUD who received assistance with rent
# of people with OUD who requested assistance with rent
# of people with OUD who received assistance with application fees
# of people with OUD who requested assistance with application fees
# of people with OUD who received assistance with deposits
# of people with OUD who requested assistance with deposits
# of people with OUD who received assistance with utilities
# of people with OUD who requested assistance with utilities
# of participants with OUD who have achieved their individual plans/treatment goals
# of participants with OUD who have individual plans/treatment goals
# of unique participants who have OUD, served, who needed crisis services/hospitalization
# of unique participants who have OUD, served
Average # of days from initial referral to primary engagement
# of unique patients who have OUD, served, who report they are satisfied with services
# of unique participants who have OUD, served

Outcome measures answer the question, “Is anyone better off?”. Outcome measures can be at the program- or population-level. Please quantify the outcome measures relevant to your implementation of this strategy. Outcome measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of Housing First or related programs available to connect people who use drugs to housing services
# of unique participants who have OUD, served who retain permanent housing at 6 months
# of unique participants who have OUD, served
# of unique participants who have OUD, served who retain permanent housing at one year
# of unique participants who have OUD, served
# of participants who have OUD, served who report getting the social and emotional support they need
# of unique participants who have OUD, served
# of community overdose reversals using naloxone

STRATEGY-SPECIFIC PROCESS MEASURES Process measures answer the question, “How much did you do?”. Please quantify the process measures relevant to your implementation of this strategy. Indicate whether the count represents efforts supported only by opioid settlement funds or efforts supported by multiple funding sources including opioid settlement funds. Process measures should reflect numbers from the current reporting period (fiscal year).

	Count	How Were Efforts Supported?	Notes
# of unique participants who have OUD, served
# of job training sessions offered
# of job skill building trainings offered
# of people assisted with job placement
# of interview coaching session offered
# of resume review sessions offered
# of participants who received professional attire
# of participants in community college courses
# of requests for transportation assistance fulfilled
# of transportation vouchers distributed
# of naloxone kits distributed

DEMOGRAPHICS: Provide the following information on race and ethnicity for the # of unique participants, who use opioids and/or have OUD, served during the current reporting period (fiscal year).

	Count	Notes
American Indian/Alaska Native Non-Hispanic
Asian Non-Hispanic
Black Non-Hispanic
Native Hawaiian or Other Pacific Islander Non-Hispanic
White Non-Hispanic
Hispanic
Some Other Race or Multiple Races
Unknown

Quality measures answer the question, “How well did you do it?”. Please quantify the quality measures relevant to your implementation of this strategy. Quality measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of unique participants who have OUD, served, who report they are satisfied with services
# of unique participants who have OUD, served
# of unique participants who have OUD, who attended job training and showed improvement from pre-test to post-test
# of unique participants who have OUD, who attended job training
# of unique participants who have OUD, who attended job training and then sought job placement services
# of unique participants who have OUD, who attended job training
# of unique participants who have OUD, who attended interview coaching session and improved their interviewing skills
# of unique participants who have OUD, who attended interview coaching session
# of unique participants who have OUD, who attended resume review session and improved their resumes
# of unique participants who have OUD, who attended resume review session
# of unique participants who have OUD, served who say they have the professional attire needed
# of unique participants who have OUD, served
# of participants in community college courses, who completed their course(s)
# of participants in community college courses
# of requests for transportation assistance fulfilled
# of requests for transportation assistance
# of transportation vouchers used
# of transportation vouchers distributed

Outcome measures answer the question, “Is anyone better off?”. Outcome measures can be at the program- or population-level. Please quantify the outcome measures relevant to your implementation of this strategy. Outcome measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of people assisted with job placement who are employed 6 months after placement
# of people assisted with job placement
# of participants who have OUD, served who report getting the social and emotional support they need
# of unique participants, who have OUD, served
# of community overdose reversals using naloxone

STRATEGY-SPECIFIC PROCESS MEASURES Process measures answer the question, “How much did you do?”. Please quantify the process measures relevant to your implementation of this strategy. Indicate whether the count represents efforts supported only by opioid settlement funds or efforts supported by multiple funding sources including opioid settlement funds. Process measures should reflect numbers from the current reporting period (fiscal year).

	Count	How Were Efforts Supported?	Notes
# of Youth Mental Health First-Aid training programs held
# of unique participants trained in Youth Mental Health First-Aid
# of trainers who provide Youth Mental Health First-Aid programs
# of peer-based training programs held
# of unique participants trained in peer-based program
# of trainers who provide peer-based programs
# of other early intervention training programs held
# of unique participants trained in other early intervention programs
# of trainers who provide other early intervention programs

DEMOGRAPHICS: Provide the following information on race and ethnicity for the # of unique participants, who use opioids and/or have OUD, served during the current reporting period (fiscal year).

	Count	Notes
American Indian/Alaska Native Non-Hispanic
Asian Non-Hispanic
Black Non-Hispanic
Native Hawaiian or Other Pacific Islander Non-Hispanic
White Non-Hispanic
Hispanic
Some Other Race or Multiple Races
Unknown

Quality measures answer the question, “How well did you do it?”. Please quantify the quality measures relevant to your implementation of this strategy. Quality measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of unique participants trained, who are satisfied w/ training
# of unique participants trained
# of unique participants trained, who feel more confident in supporting children and adolescents who may be struggling
# of unique participants trained
# of unique participants trained, who improved skills in supporting children and adolescents who may be struggling
# of unique participants trained
# of unique participants trained, who improved knowledge in supporting children and adolescents who may be struggling
# of unique participants trained

Outcome measures answer the question, “Is anyone better off?”. Outcome measures can be at the program- or population-level. Please quantify the outcome measures relevant to your implementation of this strategy. Outcome measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of unique participants trained, who report using skills/knowledge gained in training
# of unique participants trained
# of unique participants trained, who report getting the social and emotional support they need
# of unique participants trained
% of short-term suspensions
# of community overdose reversals using naloxone

STRATEGY-SPECIFIC PROCESS MEASURES Process measures answer the question, “How much did you do?”. Please quantify the process measures relevant to your implementation of this strategy. Indicate whether the count represents efforts supported only by opioid settlement funds or efforts supported by multiple funding sources including opioid settlement funds. Process measures should reflect numbers from the current reporting period (fiscal year).

	Count	How Were Efforts Supported?	Notes
# of unique participants, who use opioids and/or have OUD, served
# of intramuscular naloxone kits distributed
# of intranasal naloxone kits distributed
# of trainings on harm reduction (e.g., overdose prevention, safer use practice, disease prevention) provided
# of people trained in harm reduction
# of naloxone trainings
# of people trained on naloxone

DEMOGRAPHICS: Provide the following information on race and ethnicity for the # of unique participants, who use opioids and/or have OUD, served during the current reporting period (fiscal year).

	Count	Notes
American Indian/Alaska Native Non-Hispanic
Asian Non-Hispanic
Black Non-Hispanic
Native Hawaiian or Other Pacific Islander Non-Hispanic
White Non-Hispanic
Hispanic
Some Other Race or Multiple Races
Unknown

Quality measures answer the question, “How well did you do it?”. Please quantify the quality measures relevant to your implementation of this strategy. Quality measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of unique participants, who use opioids and/or have OUD, served, who report they are satisfied with services
# of unique participants, who use opioids and/or have OUD, served
# of naloxone distributed to individuals
# of naloxone kits distributed
# of naloxone distributed to EMS
# of naloxone kits distributed
# of naloxone distributed to hospital ED
# of naloxone kits distributed
# of naloxone distributed to community based organizations
# of naloxone kits distributed
# of naloxone distributed to firefighters
# of naloxone kits distributed
# of naloxone distributed to police
# of naloxone kits distributed
# of those trained on naloxone, who report they know how to respond to an opioid overdose and administer naloxone
# of people trained on naloxone
# of months in past year that program had to ration naloxone

Outcome measures answer the question, “Is anyone better off?”. Outcome measures can be at the program- or population-level. Please quantify the outcome measures relevant to your implementation of this strategy. Outcome measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of community overdose reversals using naloxone
# of patients who were visited by EMS more than once because of overdose
# of patients who were admitted to the ED more than once because of overdose
# of patients who have OUD, served who report getting the social and emotional support they need
# of unique participants, who use opioids and/or have OUD, served

STRATEGY-SPECIFIC PROCESS MEASURES Process measures answer the question, “How much did you do?”. Please quantify the process measures relevant to your implementation of this strategy. Indicate whether the count represents efforts supported only by opioid settlement funds or efforts supported by multiple funding sources including opioid settlement funds. Process measures should reflect numbers from the current reporting period (fiscal year).

	Count	How Were Efforts Supported?	Notes
# of unique participants, who use opioids and/or have OUD, served
# of established agency-level network partners
# of referrals to PORT following an overdose reversal
# of people who experience an overdose who agree to talk with a PORT member
# of total contacts with all participants who use opioids and/or have OUD
# of participants who use opioids and/or have OUD referred to addiction treatment
# of participants who use opioids and/or have OUD referred to recovery supports (e.g., employment services, housing services, etc.)
# of participants who use opioids and/or have OUD referred to harm reduction services (e.g., syringe and supply access, overdose prevention education, disease prevention, etc.)
# of participants who use opioids and/or have OUD referred to primary healthcare
# of participants who use opioids and/or have OUD referred to other services
# of naloxone kits distributed

DEMOGRAPHICS: Provide the following information on race and ethnicity for the # of unique participants, who use opioids and/or have OUD, served during the current reporting period (fiscal year).

	Count	Notes
American Indian/Alaska Native Non-Hispanic
Asian Non-Hispanic
Black Non-Hispanic
Native Hawaiian or Other Pacific Islander Non-Hispanic
White Non-Hispanic
Hispanic
Some Other Race or Multiple Races
Unknown

Quality measures answer the question, “How well did you do it?”. Please quantify the quality measures relevant to your implementation of this strategy. Quality measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of unique participants, who use opioids and/or have OUD, served, who report they are satisfied with services
# of unique participants, who use opioids and/or have OUD, served
# of EMS calls for opioid overdose
# of EMS calls

Outcome measures answer the question, “Is anyone better off?”. Outcome measures can be at the program- or population-level. Please quantify the outcome measures relevant to your implementation of this strategy. Outcome measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of unique participants with OUD who were connected to treatment and have adhered to treatment
# of unique participants who have OUD who were connected to treatment (i.e. attended their first appointment)
# of unique participants with OUD served who were connected to employment services and obtained employment
# of participants who use opioids and/or have OUD, referred to recovery supports (e.g., employment services, housing services, etc.)
# of unique participants with OUD served who were connected to housing services and retained housing
# of participants who use opioids and/or have OUD, referred to recovery supports (e.g., employment services, housing services, etc.)
# of unique participants with OUD served who were connected to harm reduction services and remained engaged with harm reduction services
# of participants who use opioids and/or have OUD, referred to harm reduction services
# of unique participants with OUD served who were connected to primary healthcare services and who kept using services
# of participants who use opioids and/or have OUD, referred to primary healthcare
# of unique participants with OUD served who were referred to other services and who kept using services
# of participants who use opioids and/or have OUD, referred to other services
# of participants who use opioids and/or have OUD, served who report getting the social and emotional support they need
# of participants who use opioids and/or have OUD, served
# of community overdose reversals using naloxone

STRATEGY-SPECIFIC PROCESS MEASURES Process measures answer the question, “How much did you do?”. Please quantify the process measures relevant to your implementation of this strategy. Indicate whether the count represents efforts supported only by opioid settlement funds or efforts supported by multiple funding sources including opioid settlement funds. Process measures should reflect numbers from the current reporting period (fiscal year).

	Count	How Were Efforts Supported?	Notes
# of unique participants, who use opioids and/or have OUD, served
# of total contacts the program had with all participants
# of syringes distributed
# of types of supplies distributed (not count of individual items)
# of trainings on harm reduction (e.g., overdose prevention, safer use practice, disease prevention) provided to participants
# of participants trained on harm reduction (e.g., overdose prevention, safer use practice, disease prevention)
# of participants referred to Treatment Services for OUD
# of participants referred to Mental Health Services
# of participants referred to Primary Care Services
# of participants referred to Employment Resources
# of participants referred to Housing Resources
# of naloxone kits distributed

DEMOGRAPHICS: Provide the following information on race and ethnicity for the # of unique participants, who use opioids and/or have OUD, served during the current reporting period (fiscal year).

	Count	Notes
American Indian/Alaska Native Non-Hispanic
Asian Non-Hispanic
Black Non-Hispanic
Native Hawaiian or Other Pacific Islander Non-Hispanic
White Non-Hispanic
Hispanic
Some Other Race or Multiple Races
Unknown

Quality measures answer the question, “How well did you do it?”. Please quantify the quality measures relevant to your implementation of this strategy. Quality measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of unique participants, who use opioids and/or have OUD, served, who report they are satisfied with services
# of unique participants, who use opioids and/or have OUD, served who report they have enough sterile syringes to cover every injection between SSP visits
# of unique participants, who use opioids and/or have OUD, served
# of participants trained who increased their knowledge of harm reduction practices
# of participants trained on harm reduction (e.g., overdose prevention, safer use practice, disease prevention)

Outcome measures answer the question, “Is anyone better off?”. Outcome measures can be at the program- or population-level. Please quantify the outcome measures relevant to your implementation of this strategy. Outcome measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of participants engaged with SSP services at 6 months
# of unique participants, who use opioids and/or have OUD, served
# of unique participants with OUD who were connected to treatment and have adhered to treatment
# of unique participants who have OUD who were connected to treatment (i.e. attended their first appointment)
# of participants using mental health services at 6 months
# of unique participants, who use opioids and/or have OUD, served
# of participants with OUD using primary healthcare services at 6 months
# of unique participants, who use opioids and/or have OUD, served
# of participants who have obtained employment at 6 months, through engagement with recovery support services
# of unique participants, who use opioids and/or have OUD, served
# of participants who retain housing at 6 months, through engagement with recovery support services
# of unique participants, who use opioids and/or have OUD, served
# of participants who report getting the social and emotional support they need
# of unique participants, who use opioids and/or have OUD, served
# of community overdose reversals using naloxone

STRATEGY-SPECIFIC PROCESS MEASURES Process measures answer the question, “How much did you do?”. Please quantify the process measures relevant to your implementation of this strategy. Indicate whether the count represents efforts supported only by opioid settlement funds or efforts supported by multiple funding sources including opioid settlement funds. Process measures should reflect numbers from the current reporting period (fiscal year).

	Count	How Were Efforts Supported?	Notes
# of 911 calls with primary concern related to substance use
# of dispositions where person was transported to services by law enforcement
# of dispositions where person was stabilized in community
# of arrest diversion referrals to pre-arrest diversion programs by law enforcement
# of social referrals to pre-arrest diversion programs by law enforcement
# of intakes for pre-arrest diversion programs completed
# of unique participants enrolled in pre-arrest diversion programs
# of full-time pre-arrest diversion program staff
# of participants on staff caseload (average)
# of contacts with pre-arrest diversion program participants
# of people arrested who are screened for OUD
# of referrals to post-arrest diversion programs by jail/correctional staff
# of intakes for post-arrest diversion programs completed
# of unique participants enrolled in post-arrest diversion programs
# of dedicated post-arrest diversion program staff
# of contacts with post-arrest diversion program participants
# of people at intake with no fixed address or address is shelter
# of referrals to pre-trial service programs by court staff
# of intakes for pre-trial service programs completed
# of unique participants enrolled in pre-trial service programs
# of contacts with pre-trial service program participants
# of initial hearings annually for people identified as having opioid use disorder
# of participants who use opioids and/or have OUD, referred to addiction treatment
# of participants who use opioids and/or have OUD, referred to recovery supports (e.g., employment services, housing services, etc.)
# of participants who use opioids and/or have OUD, referred to harm reduction services (e.g., syringe and supply access, overdose prevention education, disease prevention, etc.)
# of participants who use opioids and/or have OUD, referred to primary healthcare
# of participants who use opioids and/or have OUD, referred to other services
# of participants who use opioids and/or have OUD, provided addiction treatment
# of participants who use opioids and/or have OUD, provided with recovery support services (e.g., employment services, housing services, etc.)
# of participants who use opioids and/or have OUD, provided with harm reduction services
# of participants who use opioids and/or have OUD, provided with primary healthcare services
# of participants who use opioids and/or have OUD, provided with other services
# of naloxone kits provided

DEMOGRAPHICS: Provide the following information on race and ethnicity for the # of unique participants, who use opioids and/or have OUD, served during the current reporting period (fiscal year).

	Count	Notes
American Indian/Alaska Native Non-Hispanic
Asian Non-Hispanic
Black Non-Hispanic
Native Hawaiian or Other Pacific Islander Non-Hispanic
White Non-Hispanic
Hispanic
Some Other Race or Multiple Races
Unknown

Quality measures answer the question, “How well did you do it?”. Please quantify the quality measures relevant to your implementation of this strategy. Quality measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of unique participants, who use opioids and/or have OUD, served, who report they are satisfied with services
# of unique participants, who use opioids and/or have OUD, served
# of 911 calls with primary concern related to substance use
# of 911 calls
# of people arrested who screen positive for OUD
# of people arrested who are screened for OUD
# of law enforcement officers who have referred to diversion program
# of law enforcement officers
# of unique participants, who use opioids and/or have OUD, served, who are connected to services
# of unique participants, who use opioids and/or have OUD, served
# of unique participants, who use opioids and/or have OUD, served, who have been provided with services
# of unique participants, who use opioids and/or have OUD, served

Outcome measures answer the question, “Is anyone better off?”. Outcome measures can be at the program- or population-level. Please quantify the outcome measures relevant to your implementation of this strategy. Outcome measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of referrals that resulted in enrollment in diversion program
# of referrals to diversion programs
# of unique participants with OUD who were connected to treatment and have adhered to treatment
# of unique participants who have OUD who were connected to treatment (i.e. attended their first appointment)
# of participants who have obtained employment at 6 months
# of participants who use opioids and/or have OUD, referred to recovery supports (e.g., employment services, housing services, etc.)
# of participants who retain housing at 6 months
# of participants who use opioids and/or have OUD, referred to recovery supports (e.g., employment services, housing services, etc.)
# of unique participants with OUD served who were referred to harm reduction services and remained engaged with harm reduction services
# of participants who use opioids and/or have OUD, referred to harm reduction services (e.g., syringe and supply access, overdose prevention education, disease prevention, etc.)
# of participants with OUD using primary healthcare services at 6 months
# of participants who use opioids and/or have OUD, referred to primary healthcare
# of participants with OUD using other services at 6 months
# of participants who use opioids and/or have OUD, referred to other services
# of community overdose reversals using naloxone

STRATEGY-SPECIFIC PROCESS MEASURES Process measures answer the question, “How much did you do?”. Please quantify the process measures relevant to your implementation of this strategy. Indicate whether the count represents efforts supported only by opioid settlement funds or efforts supported by multiple funding sources including opioid settlement funds. Process measures should reflect numbers from the current reporting period (fiscal year).

	Count	How Were Efforts Supported?	Notes
# of people who are incarcerated screened as having OUD
# of people who are incarcerated who receive methadone for OUD
# of people who are incarcerated who receive buprenorphine for OUD
# of people who are incarcerated who receive naltrexone for OUD
# of group classes, for people who are incarcerated, held on overdose prevention
# of people who are incarcerated that attended group classes on overdose prevention
# of group classes, for staff, held on overdose prevention
# of staff that attended group classes on overdose prevention
# of naloxone kits distributed to people who were incarcerated upon release
# of opioid overdose reversals using naloxone within the jail or prison
# of deaths due to overdose within the jail or prison
# of referrals made for continued MAT support upon release

DEMOGRAPHICS: Provide the following information on race and ethnicity for the # of unique participants, who use opioids and/or have OUD, served during the current reporting period (fiscal year).

	Count	Notes
American Indian/Alaska Native Non-Hispanic
Asian Non-Hispanic
Black Non-Hispanic
Native Hawaiian or Other Pacific Islander Non-Hispanic
White Non-Hispanic
Hispanic
Some Other Race or Multiple Races
Unknown

Quality measures answer the question, “How well did you do it?”. Please quantify the quality measures relevant to your implementation of this strategy. Quality measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of people who are incarcerated who receive medication for OUD, who report they are satisfied with services"
# of people who are incarcerated who receive medication for OUD"
# of people who are incarcerated that are screened for OUD
# of people incarcerated
# of people who increase knowledge about overdose prevention after attending group classes
# of people who attended group classes on overdose prevention
# of referrals made for continued MAT support upon release, that resulted in first appointment
# of referrals made for continued MAT support upon release
# of people released from jail, who receive a naloxone kit upon release
# of people released from jail

Outcome measures answer the question, “Is anyone better off?”. Outcome measures can be at the program- or population-level. Please quantify the outcome measures relevant to your implementation of this strategy. Outcome measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of people who are incarcerated and screen positive as having OUD and then receive methadone in jail
# of people who are incarcerated and screen positive as having OUD
# of people who are incarcerated and screen positive as having OUD and then receive buprenorphine in jail
# of people who are incarcerated and screen positive as having OUD
# of people who are incarcerated and screen positive as having OUD and then naltrexone in jail
# of people who are incarcerated and screen positive as having OUD
# of people who are incarcerated and screen positive as having OUD who started MAT in jail
# of people who are incarcerated and screen positive as having OUD
# of participants who are incarcerated and were on MAT before entering jail, who continued MAT in jail
# of participants who are incarcerated and were on MAT before entering jail
# of deaths due to overdose within the jail
# of deaths within the jail
# of people who are incarcerated screened as having OUD, who report getting the social and emotional support they need
# of people who are incarcerated screened as having OUD

STRATEGY-SPECIFIC PROCESS MEASURES Process measures answer the question, “How much did you do?”. Please quantify the process measures relevant to your implementation of this strategy. Indicate whether the count represents efforts supported only by opioid settlement funds or efforts supported by multiple funding sources including opioid settlement funds. Process measures should reflect numbers from the current reporting period (fiscal year).

	Count	How Were Efforts Supported?	Notes
# of unique participants who use opioids and/or have OUD, enrolled
# of written transition case plans developed prior to release
# of written transition case plans updated during participation
# of case management meetings attended by participants
# of OUD treatment sessions attended by participants
# of reentry navigators/peer support specialists on staff
# of participants provided with harm reduction education
# of participants who use opioids and/or have OUD, referred to addiction treatment
# of participants who use opioids and/or have OUD, referred to recovery supports (e.g., employment services, housing services, etc.)
# of participants who use opioids and/or have OUD, referred to harm reduction services (e.g., syringe and supply access, overdose prevention education, disease prevention, etc.)
# of participants who use opioids and/or have OUD, referred to primary healthcare
# of participants who use opioids and/or have OUD, referred to other services
# of participants who use opioids and/or have OUD, provided addiction treatment
# of participants who use opioids and/or have OUD, provided with recovery support services (e.g., employment services, housing services, etc.)
# of participants who use opioids and/or have OUD, provided with harm reduction services
# of participants who use opioids and/or have OUD, provided with primary healthcare services
# of participants who use opioids and/or have OUD, provided with other services
# of naloxone kits distributed

DEMOGRAPHICS: Provide the following information on race and ethnicity for the # of unique participants, who use opioids and/or have OUD, served during the current reporting period (fiscal year).

	Count	Notes
American Indian/Alaska Native Non-Hispanic
Asian Non-Hispanic
Black Non-Hispanic
Native Hawaiian or Other Pacific Islander Non-Hispanic
White Non-Hispanic
Hispanic
Some Other Race or Multiple Races
Unknown

Quality measures answer the question, “How well did you do it?”. Please quantify the quality measures relevant to your implementation of this strategy. Quality measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of unique participants who use opioids and/or have OUD, enrolled, who report they are satisfied with services
# of unique participants who use opioids and/or have OUD, enrolled
# of unique participants who use opioids and/or have OUD, enrolled who have an updated transition case plan
# of unique participants who use opioids and/or have OUD, enrolled
# of case management meetings attended by participants
# of case management meetings offered
# of OUD treatment sessions attended by participants
# of OUD treatment sessions offered
# of naloxone kits distributed
# of unique participants who use opioids and/or have OUD, enrolled

Outcome measures answer the question, “Is anyone better off?”. Outcome measures can be at the program- or population-level. Please quantify the outcome measures relevant to your implementation of this strategy. Outcome measures should reflect numbers from the current reporting period (fiscal year).

	Count	Notes
# of unique participants who use opioids and/or have OUD, enrolled, who experience an arrest (i.e., arrest for misdemeanor and/or low-level felony) within 6 months of completing program
# of unique participants who use opioids and/or have OUD, enrolled
# of unique participants with OUD who were connected to treatment and have adhered to treatment
# of unique participants who have OUD who were connected to treatment (i.e. attended their first appointment)
# of participants who use opioids and/or have OUD, who were referred to employment services and obtained employment
# of participants who use opioids and/or have OUD, referred to recovery supports (e.g., employment services, housing services, etc.)
# of participants who use opioids and/or have OUD, who were referred to housing services and retained housing
# of participants who use opioids and/or have OUD, referred to recovery supports (e.g., employment services, housing services, etc.)
# of participants who use opioids and/or have OUD, referred to harm reduction services who remained engaged with harm reduction services
# of participants who use opioids and/or have OUD, referred to harm reduction services (e.g., syringe and supply access, overdose prevention education, disease prevention, etc.)
# of unique participants with OUD served who were referred to primary healthcare services and who kept using services
# of participants who use opioids and/or have OUD, referred to primary healthcare
# of unique participants who use opioids and/or have OUD enrolled, who report they are satisfied with services
# of unique participants who use opioids and/or have OUD, enrolled
# of community overdose reversals using naloxone

Provide the amount of funding used for each strategy and be specific in what it was used for.*

	Strategy	Amount Spent	Details
1
2
3
4
5
6
7
8
9
10

ALL receipts for expenditures are required to be turned in. These can be uploaded below.

Use the space below to list any additional expenditures or relevant information not captured in the table above.

Please provide any other updates, questions, concerns you might have regarding your project.

Quarterly Impact Report

Organization Information

Impact Report

Outputs and Outcomes - Collaborative Strategic Planning

Outputs and Outcomes - Evidence Based Treatment

Outputs and Outcomes - Recovery

Outputs and Outcomes - Housing

Outputs and Outcomes - Employment

Outputs and Outcomes - Early Intervention

Outputs and Outcomes - Naloxone

Outputs and Outcomes - Post Overdose Response Team

Outputs and Outcomes - Syringe Services

Outputs and Outcomes - CJ Diversion

Outputs and Outcomes - Treatment - Jails

Outputs and Outcomes - Reentry

Financial Report

Feedback/Concerns/Comments