Juvenile Mentoring Subgrantee Reporting Form

7/28/2019 Juvenile Mentoring Subgrantee Reporting Form

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OFFICE OF JUVENILE JUSTICE AND DELINQUENCY PREVENTION

JUVENILE MENTORING GRANT PROGRAM

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DCTAT SUBGRANTEE DATA COLLECTION FORM

Reporting Period: ________________________

This document is for your use to assist with gathering information that should be reported into the DCTAT tool.It is not necessary to submit this form to OJJDP. It is only for your information.

Award Information

Solicitation: (Prepopulated)Federal award number: (Prepopulated)

Award Period Start Date: (Prepopulated)(mm/dd/yyyy)

Award Period End Date: (Prepopulated)(mm/dd/yyyy)

1. Please enter the total amount of grant (Federal Funds Only): $*Any funds reported only represent an estimate of dollars allocated or used for activities covered by this grant award.

2. Was there grant activity during the reporting period? ___Yes ___ NoGrant activity is defined as proposed activities in the OJJDP-approved grant application that are implemented or executed with theOJJDP grant.

3. Please enter the Federal Congressional District(s) of where services are provided: ___________________Check boxes will appear in the system, where you will select your state/territory and Federal Congressional District(s).

Click http://www.house.gov, to use the zip code(s) of the area(s) served by the project to determine the Federal CongressionalDistrict(s).

4. Please enter the Project Title:

a. Please enter the Project Description:

5. Please enter the Implementing Organization Name:

6. Please select the implementing organization type:

___ Coalition

___ Juvenile Justice

___ Non-profit community-based organization

___ Other community-based organization

___ Other government agency

___ Police/other law enforcement

___ School/Other Education

___ Tribal Government

___ Unit of local government

7. Is this award used to implement evidence-based programs? ___Yes ___ No

8. If yes, select one source from which the program model was cited:

___ Blueprints for Violence Prevention___ CASEL (Collaborative for Academic, Social, &

Emotional learning)

___ Centers for Disease Control and Prevention

___ Community Guide to Helping Americas Youth

___ Department of Education Safe, Disciplined, &Drug-free Schools

___ Drug Strategies, Inc.

___ Making the Grade

___ Hamilton Fish Institute___ Institute for Medicine

___ NIDA Preventing Drug Abuse

___ National Institute of Justice What Works Report

___ OJJDP Model Programs Guide

___ Promising Practices Network

___ SAMSHA Model Programs

___ Surgeon Generals Youth Violence Report

___ Other (e.g., State model program resources)

9. If other, please specify:


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2

Target Population for this Subaward

Please check the appropriate boxes to indicate for this subaward:

1. The population actually served during the project period; and

2. The populations, if any, to which the program offers targeted services.

Targeted services include any services or approaches specifically designed to meet the needs of thepopulation (e.g., gender specific, culturally based, developmentally appropriate services).

Population1. Did you serve this

group during thereporting period?

2. Did this subgrantprovide targeted

services for any of thefollowing groups?

RACE/E

THNICITY

American Indian/Alaskan Native

Asian

Black/African American

Hispanic or Latino (of any race)

Native Hawaiian and Other Pacific IslanderOther Race

White/Caucasian

Youth population not directly served

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JUSTICE

At-Risk Population (no prior offense)

First Time Offenders

Repeat Offenders

Sex Offenders

Status Offenders

Violent Offenders


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GENDER

Male

Female


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AGE

0-10

11-18

Over 18


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GEO

Rural

Suburban

TribalUrban


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OTHER Mental Health

Substance Abuse

Truant/Dropout

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Bold indicates mandatory indicators.

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Performance Measures

Output Measure Definition Data Grantee Provides Record Data Here

1 Number and percent of

youth with whom anevidence-based practice wasused

The number and percent of youth with whom an

evidence-based practice was used. Evidence-based practice models include program modelsthat have been shown, through rigorousevaluation and replication, to be effective atpreventing or reducing juvenile delinquency orrelated risk factors, such as substance abuse.Model programs can come from many validsources (e.g., Blueprints, OJJDPs ModelPrograms Guide, SAMHSAs Model Programs,state model program resources, etc.)

A. The number of youth served using an

evidence-based model or programB. The number of youth servedC. Percent (A/B)

2 Increase in number ofprogram mentors recruited

The number of new mentors recruited during thereporting period. Recruited mentors are thosewho have completed requirements to be ready fortraining.

Program records are the preferred data source.

A. The increase in number of program mentorsrecruited (ready for training) during thereporting period

3 Number and percent ofprogram mentorssuccessfully completingtraining

The number and percent of program mentorssuccessfully completing training during thereporting period.


A.Number of program mentors successfullycompleting training during the reporting period

B.Total number of program mentors who begantraining during the reporting period

C.Percent (A/B)

4 Number and percent oftrained program mentorswith increased knowledge ofthe program area

The number of trained program mentorsdemonstrating increased knowledge of theprogram during the reporting period.


A. Number of trained program mentorsdemonstrating increased knowledge of theprogram during the reporting period

B. Number of trained program mentors (Auto fillfrom 3A)

C. Percent (A/B)

5 Mentor Retention The number of program mentors retained by theprogram within the reporting period.


A. Number of mentors who have left the programduring the reporting period

B. The total number of mentors in the programduring the reporting period

C. (B A)/B = Mentor Retention Rate

6 Increase in youth enrolledsince the beginning of thegrant program

Increase in the number of youth enrolled (beingmentored) since the beginning of the grantprogram.

A. Number of youth enrolled at the beginning ofthe reporting period

B. Number of NEW youth added during thereporting period


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# Outcome Measure Definition Data Grantee Provides Record Data Here

1 Percent of mentoringprograms with activepartners

The percent of mentoring programs with activepartners representing the following types ofgroups: non-profit service organizations and / orfaith based organizations; private industry;secondary education provider; and post-secondary

education provider or vocational training provider;other active partners.

A. Number of mentoring programs with activepartners

B. Number of mentoring programsC. Percent (A/B)

2 Number and percent ofprogram youth completingprogram requirements(short term)

The number and percent of program youth whohave successfully fulfilled all program obligationsand requirements. This does not include youth whoare still in ongoing programs. Program obligationswill vary by program, but should be a predefinedlist of requirements or obligations that clients mustmeet before program completion.

The total number of youth (the B value) includesthose youth who have exited successfully andunsuccessfully.


A. Number of program youth who exited theprogram having completed programrequirements

B. Total number of youth who exited theprogram during the reporting period (bothsuccessfully and unsuccessfully)

C. Percent (A/B)

Select at least one of the following from 3A through 3I depending onthe primary focus of the program.

3A Antisocial behavior(short term)

The number and percent of youth who haveexhibited a decrease in antisocial behavior duringthe reporting period.

Anti-social behavior is a pervasive pattern ofbehavior that displays disregard for and violation ofthe rights of others, societal mores, or the law(such as deceitfulness, irritability, consistentirresponsibility, lack of remorse, failure to conformto social norms).

Self-report or staff ratings are the most likely datasources.

A. Number of program youth served during thereporting period with the noted behavioralchange

B. Total number of youth receiving services fortarget behavior during the reporting period

C. Percent (A/B)

3A Antisocial behavior(long term)

The number and percent of program youth whoexhibited a desired change in antisocial behavior612 months after exiting the program.

Antisocial behavior is a pervasive pattern ofbehavior that displays disregard for and violation ofthe rights of others, societal mores, or the law(such as deceitfulness, irritability, fighting,disruptive behavior, consistent irresponsibility, lackof remorse, or failure to conform to social norms).


A. Total number of youth who exited theprogram 6-12 months ago who had thenoted behavioral change

B. Total number of youth who received servicesfor the target behavior and who exited theprogram 612 months ago

C. Percent (A/B)


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3D Gang resistance/involvement

(short term)

The number and percent of program youth who

have exhibited a desired change in gangresistance behavior during the reporting period.

Self-reported or staff ratings are the most likelydata sources.

A. Number of program youth served during the

reporting period with the noted behavioralchangeB. Total number of youth receiving services for

target behavior during the reporting periodC. Percent (A/B)

3D Gang resistance/involvement(long term)

The number and percent of program youth whoexhibited a desired change in gang resistancebehavior 612 months after exiting the program.



B. Total number of youth who receivedservices for the target behavior andwho exited the program 612 monthsago

C. Percent (A/B)

3E Substance use (short term) The number and percent of program youth whohave exhibited a decrease in substance use duringthe reporting period.

Self-report or staff ratings are most likely datasources.



C. Percent (A/B)


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3E Substance use(long term) The number and percent of program youth whoexhibited a decrease in substance use 612months after exiting the program.

Self-report, staff rating, or urinalysis are most likely

data sources.


B. Total number of youth who receivedservices for the target behavior and who

exited the program 612 months agoC. Percent (A/B)

3F School attendance(short term)

The number of program youth who have exhibitedan increase in school attendance during thereporting period.




C. Percent (A/B)

3F School attendance(long term)

The number and percent of program youth whoexhibited a desired change in school attendance612 months after exiting the program.

Self-report or official records are the most likely

data sources.

A. Total number of youth who exited theprogram 6-12 months ago who had thenoted behavioral change.

B. Total number of youth who receivedservices for the target behavior and who

exited the program 612 months agoC. Percent (A/B)

3H GPA (short term) The number and percent of program youth whoexhibited an increase in GPA during the reportingperiod.




C. Percent (A/B)

3H GPA(long term) The number and percent of program youth whoexhibited a desired change in GPA 612 monthsafter exiting the program.

Self-report or official records are the most likelydata sources.

A. Total number of youth who exited theprogram 612 months ago who had thenoted behavioral change

B. Total number of youth who receivedservices for the target behavior and whoexited the program 612 months ago

C. Percent (A/B)


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3I

4 Number and percent ofprogram youth whoOFFEND (short term)

Updated 11/04/2011

The number and percent of participating programyouth who were arrested or seen at a juvenile courtfor a delinquent offense during the reportingperiod. Appropriate for any youth-serving program.Official records (police, juvenile court) are thepreferred data source.

The number of youth tracked should reflect thenumber of program youth that are followed or

monitored for arrests or offenses. Ideally thisnumber should be all youth served by the programduring this reporting period.

A youth may be committed to a juvenile facilityanytime that he/she is held overnight.

Certain jurisdictions refer to adjudications assentences.

Example: If I am tracking 50 program youth then,A would be 50. Of these 50 program youth that Iam tracking, if 25 of them were arrested or had adelinquent offense during the reporting period,then B would be 25. This logic should follow for

C values. The percent of youth offendingmeasured short-term will be auto calculated in D.

A. Number of program youth tracked during thereporting period

B. Of A, the number of program youth who hadan arrest or delinquent offense during the

reporting period

C. Number of program youth who werecommitted to a juvenile facility during the

reporting period

D. Number of program youth who weresentenced to adult prison during the

reporting period

E. Percent OFFENDING (B/A)


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5 Number and percent ofprogram youth whoOFFEND (long term)

Updated 11/04/2011

The number and percent of participating program

youth who were arrested or seen at a juvenile court

for a delinquent offense during the reporting

period. Appropriate for any youth-serving program.

Official records (police, juvenile court) are the

preferred data source.

The number of youth tracked should reflect the

number of program youth that are followed or

monitored for arrests or offenses 6-12 months after

exiting the program.

A youth may be committed to a juvenile facility

anytime that he/she is held overnight.

Certain jurisdictions refer to adjudications as

sentences.

Example: A grantee may have several youth who

exited the program 6-12 months ago, however,they are tracking only 100 of them, therefore, andthe A value will be 100. Ofthese 100 programyouth that exited the program 6-12 months ago.65 had an arrest or delinquent offense during thereporting period, therefore the B value should berecorded as 65. This logic should follow for Cvalues. The percent of youth offending measuredlong-term will be auto calculated in D.

A. Total number of program youth who exitedthe program 6-12 months ago that you aretracking

B. Of A, the number of program youth who hadan arrest or delinquent offense during the

reporting periodC. Number of program youth who were

committed to a juvenile facility during thereporting period

D. Number of program youth who weresentenced to adult prison during thereporting period

E. Percent OFFENDING (B/A)

6 Number and percent ofprogram youth whoRE-OFFEND(short term)

Updated 11/04/2011

The number and percent of participating program

youth who were arrested or seen at a juvenile court

for a new delinquent offense during the reporting

period. Appropriate for any youth-serving program.

Official records (police, juvenile court) are the

preferred data source.



monitored for new arrests or offenses. Ideally this

number should be all youth served by the program

during this reporting period.

Certain jurisdictions refer to adjudications as

sentences.

Example: If I am tracking 50 program youth then

the A value would be 50. Of these 50 program

youth that I am tracking, if 25 of them had a new

arrest or had a new delinquent offense during the

reporting period, then B would be 25. This logic

should follow for C, D, and E values. The

percent of youth re-offending measured short-term

will be auto calculated in F.

A. Number of program youth tracked during thereporting period

B. Of A, number of program youth who had anew arrest or new delinquent offense duringthe reporting period

C. Number of program youth who wererecommitted to a juvenile facility during thereporting period

D. Number of program youth who weresentenced to adult prison during thereporting period

E. Number of youth who received anothersentence during the reporting period

F. Percent RECIDIVISM (B/A)


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10 Number or percentage of

youth who are

RE-VICTIMIZED (short term)

Updated 11/04/2011

The re-victimization measure counts the number of

youth who experienced subsequent victimization.

Victimization can be physical or psychological; it

also includes harm or adverse effects to youths

property.



monitored for re-victimization. Ideally this number

should be all youth served by the program during

the reporting period.

Example: If I am tracking 50 program youth, then,

the B value would be 50. Of these 50 program

youth that I am tracking, if 25 of them were re-

victimized during the reporting period, then B

would be 25. The percent of youth who are re-

victimized measured short-term will be auto

calculated in C based on A and B values.

A. Number of program youth tracked during thereporting period for re-victimization

B. Of A, the number of program youth whowere re-victimized

C. Percent RE-VICTIMIZED (B/A)

11 Number or percentage of

youth who are

RE-VICTIMIZED (long term)

Updated 11/04/2011

The re-victimization measure counts the number of

youth who experienced subsequent victimization.

Victimization can be physical or psychological; it

also includes harm or adverse effects to youths

property.



monitored for re-victimization 6-12 months after

exiting the program.

Example: If I am tracking 50 program youth, then,

the B value would be 50. Of these 50 program

youth that I am tracking, if 25 of them were re-victimized during the reporting period, then B

would be 25. The percent of youth who are re-

victimized measured long-term will be auto

calculated in C based on A and B values.

A. Number of program youth who exited theprogram 6-12 months ago that you are

tracking for re-victimization

B. Of A, the number of program youth whowere re-victimized during the reporting

period

C. Percent RE-VICTIMIZED (B/A)

Juvenile Mentoring Subgrantee Reporting Form

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