Washington Drug and Alcohol Commission, Inc

WASHINGTON DRUG AND ALCOHOL COMMISSION, INC

PROBLEM GAMBLING OUTREACH MINI -GRANT PROPOSAL

1. Purpose

The mini-grant program is intended to facilitate a means by which individuals and agencies can educate their local community on issues related to problem and compulsive gambling. The primary objectives are to establish and enhance collaborative relationships and increase awareness and knowledge in the area of problem and compulsive gambling; work collaboratively on system-wide efforts to increase referral and engagement into treatment for problem gambling; and implement activities directed toward changing individual and community norms regarding problem gambling behaviors.

1. Eligibility Requirements

Eligible applicants are Pennsylvania organizations or individuals with a Federal Tax ID number. Individual applicants may utilize their social security number if they are a private provider. All grant applicants must include a copy of their most recent "Request for Taxpayer Identification Number and Certification W-9 Form" with their application.

1. Application Timeline

Completed applications are to be accepted on an ongoing basis throughout the fiscal year (July 1-June 30). An applicant can apply for one or more grants per fiscal year up to a total of $5000. All grant activities must be completed prior to the end of the fiscal year (June 30, 2013)in which the grant was awarded.

D. Award Determination

All mini-grant awards are contingent on the availability of funds. Applications are to be processed on a first come first serve basis.

1. Invoices

Include the list of proposed payable items with the individual item costs on program letterhead and submit to the Single County Authority(SCA), Washington Drug and Alcohol Commission, Inc, 90 West Chestnut Street, Suite 310T, Washington, PA15301, as soon as the proposed activity or service has been completed or email to Tammy Taylor . Any questions can also be directed to Tammy Taylor at (724) 223-1181 x126. The SCA will only reimburse for actual approved costs incurred.

1. For rental of facilities (fire halls, churches, etc.) provide either a receipt or copy of a cancelled check.

Ineligible Costs

The following costs are not eligible for reimbursement under the mini-grant program:

1. New construction or capital expenses

2. Staffing for existing services

3. Direct cash payment to recipients of services

4. Alcohol served at any type of event or activity

5. Reimbursement of any treatment services

6. Reimbursement of current employer/employee for time spent on this project

7. Office equipment

8. Purchase of giveaway items such as gift cards, gift baskets, gift surprises,

etc.

9. Advertising for individual Problem Gambling Treatment Providers

1. Final Report

A detailed final report and finalinvoicemust be submitted to the SCA (Washington Drug and Alcohol Commission)within 30 days of the event. The final report must include a summary of the funded activities including an assessment of the impact.Please include a measurement related to how your presentation(s) has reached the public, such as the number of persons who attended your event, how many pamphlets (handouts, booklets, etc) were distributed, how the audience responded to the speaker/presenter, etc. Failure to submit a final report along with the final invoice could make the applicant ineligible for future mini-grant funding. If a final report is not submitted, the SCA will withhold payment of invoices. The SCA shall submit copies of all mini-grant final reports to BDAP within 60 days of the event.

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PROBLEM GAMBLING OUTREACH MINI-GRANT APPLICATION

Section A: Individual/Organization Information

1. Name of Individual/Organization:

1. Address of Individual/Organization:

StreetCityStateZip CodeCounty

1. Telephone Number (include area code):

1. Fax Number (include area code):

1. Email Address:

1. Contact Person: Title of Contact Person:

1. Federal Tax ID #:

1. CVMU Vendor #:

1. Type of organization: (Check all that apply)

Community groups/coalitionsCommunity Health Centers

CountyGovernmentEducation-Schools, Colleges, University,

BusinessFaith-Based Group

For-Profit GroupNon-profit Group

Social/human service agencies

1. Type of event, product, activity, or materials are you requesting the Department of health sponsor and fund as part of the mini-grant program e (Check all that apply) as part of the mini-grant program:

Educational ResourcesOutreach EventPhoto Exhibit

Information Dissemination Speaking EngagementTraining Event

Other: Specify______

1. Write a concise paragraph of the individual/organization’s current mission.

(This section is to introduce the individual/organization to the review panel.)

______

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Section B: Basic Information

(Note: There may be questions that are not applicable.)

1. Audience

Who is the target audience? Please explain who you are trying target to reach with this outreach event, product, or activity? Include the rationale for your selection, including whether the activities are designed to address any population health disparities such as race/ethnic target groups, low socioeconomic groups and/or specific populations groups such as teens, seniors, etc.

How many people will the event or activity be able to accommodate and/ or the number of individuals participating to be impacted to the application?

1. Cost

See budget sheet to show actual costs of items. Include documentation of each line item on the proposed budget. If you are having multiple events submit a separate budget for each event.

1. Will participants be charged to attend any part of this event or activity?

YesNo

If yes please specify:

b.Will there be any co-sponsors?YesNo

If yes specify who will be co-sponsoring:

c.Will the co-sponsors be funding any portion of the event or activity?

YesNo

If so, what will their contribution?

3. Media

a.Will this event or activity be promoted? YesNo

If yes please specify exactly how it will be promoted:

b.Will there be media coverage at the event or activity? YesNo

If yes please specify exactly what media coverage:

4. Format of Event

a. When and where will this event or activity be held:

Date:

Time:

Location:

Is the facility Americans with Disabilities Act (ADA) Accessible? YesNo

Note: We cannot fund events in facilities that are not ADA accessible.

b. Is this an all day event or activity:YesNo

c. If there is a registration process for this event or activity, who will handle the registration process?

1. What will the registration entail? please explain:

e. Will material, supplies, goodie bags, etc be handed out to participants.

YesNo

If yes, where is this material coming from and who is paying for it?

f. Will individuals be able to earn educational credits for attending?

YesNo

Which ones are available? (Check all that apply)

Act 48 Credits AMA CreditsCEU’s

Credits for ClergyContinuing Medical CreditsNCPG CreditsPCB credits Social Work Credits Other:Specify______

g. Will there be vendors at this event or activity?YesNo

If yes will they be charged a fee to participate? YesNo

h.What type of vendors will be at this event or activity?

i.Will there be multiple speakers:YesNo

If yes what will the format be if there are multiple speakers:

If you are requesting an Honorarium for a speaker and/or a trainer fee, please include the name and credentials of the speakers and/or trainers.

If you are requesting an Honorarium for a speaker and/or a trainer fee, please include a justification for the dollar amount you are requesting per speaker and/or trainer.

5. Information Dissemination

(Note: If your mini-grant involves printing materials this section must be completed.) (Check all that apply)

What is to be printed? (Check all that apply) BillboardBrochures/ Pamphlets

Bulletin insertsPostersNewsletters

Other: ______

Please note: The SCA (Washington Drug and Alcohol Commission) shall review and pre-approve all final materials that are going to be printed and distributed to the public. A draft of all proposed printed materials or broadcast media (Public Service Announcements, etc.) must be enclosed with your application. All materials mentioned above must include the Pennsylvania Department of Health’s Problem Gambling Hotline number (877-565-2112)and website

Do any of the materials have copyright issues? Yes NoNot Sure

Note: We cannot fund copyrighted materials.

6. Educational Resources

Are you planning on purchasing educational resources:YesNo

Type of resources: (Check all that apply)

BooksBrochures/Pamphlets Cassette Tapes /DVDs/VHS Videos

Computer Software ProgramsCurriculumPosters

Provide a list below of the titles of all proposed educational materials/resources that you wish to purchase:

List and describe in detail each activity, purchase, education, effort, training, etc that is not addressed elsewhere in the application.

If additional information is required the SCA will contact you for further information.

As a contractor of the SCA, there is the expectation that you as the contractor understand that the SCA is neutral on the issue of gambling.

Budget Sheet for Event / Cost of Item
Location
Facility Cost
Food/Meals (snacks for breaks, lunch for trainings, etc)
Other: (Specify)
Total Cost for Location / 0
Speaker
Speaker's Honorarium
Speaker's hotel cost *
Speaker's travel cost *
Speaker's- food *
Total Cost for Speaker / 0
Training
Trainer's cost to train
Trainer's hotel cost *
Trainer's travel cost *
Trainer's- food *
Total Cost for Training / 0
Educational Resources
Books
Brochures/Pamphlets
DVD's/ VHS Videos/ Cassette Tapes
Computer Software
Curriculum
Posters
Other: (Specify)
Total Cost for Educational Resources / 0
Advertising and Media
Mailing- Postage
Production of Pubic Service Announcements
Cost of Radio Spots for PSA
Cost of TV Spots for PSA
Web page advertising
Newspaper advertising
Total Cost for Advertising and Media / 0
Printing of Materials
Billboards
Booklets/ Brochures/ Pamphlets
Bulletin Inserts
Manuals
Newsletters
Printing Costs
Posters
Other: (Specify)
Total Cost for Printing of Materials / 0
Promotional Items with Problem Gambling Messages
Coffee Mugs/ Cups
Lanyards
Magnets
Paper tablets
Pencils/ Pens
Pens
Poker chip with helpline number on it
Post it notes
Rulers
Stress balls
Other: (Specify)
Total Cost for Promotional Items with Problem Gambling Message / 0
Anything not listed above please list all below
Grand Total Cost of Event of What We Were Paying / 0
* Travel and subsistence shall be reimbursed in accordance with the
requirements of the SCA.

**The following pages are examples of gambling strategies and programs that can be used for a mini-grant, these are only examples and do not have to be used for your program. **

GAMBLING STRATEGIES

Gambling Alternative Activities

These activities promote gambling alternatives in the community and school districts. These activities provide various school/community gambling-free recreational and/or social opportunities. This includes recognition events. Functions intended to prevent gambling/problem gambling by involving youth and adults in providing a variety of community services. Examples: Community cleanup activities, Events to repair or rebuild neighborhoods, fundraising for charitable causes, Support to the elderly, handicapped, ill, etc.

Gambling Community Events

A wide array of services and methods for dissemination of information intended to educate individuals, schools, families, and communities about specific gambling and health related risks, risk reduction activities, and other activities to promote positive and healthy lifestyles. Examples: School health fair, Health fairs at shopping malls, Church fairs or carnivals, Public health or health education fairs.

Gambling Community Prevention Partnerships

Community Prevention Partnerships are designed to engage partners from various sectors of the community in the planning, implementation, and evaluation of prevention activities. Examples: Coalitions, Advisory Councils. Note: This also includes providing Technical Assistance (TA) to school districts related to the planning, implementation, and evaluation of prevention activities.

Gambling Education Services

Gambling and problem gambling prevention education. Used to raise awareness of the harmful effects of gambling, through speaking engagements and basic gambling recurring education.

Gambling Environmental Prevention Strategies

These strategies focus on gambling/problem gambling environmental activities.

Gambling Information Dissemination

These activities complement all other prevention services, activities, strategies and programs by disseminating information in printed, audio-visual format, etc. It includes, but is not limited to, distribution of pamphlets, handouts, newsletters, videos, books, PSAs and media campaigns. Incentives such as pens or pencils.

Gambling Intervention Strategies

These strategies refer to activities intended to provide a risk screening, assessment, and referral to prevention service populations for placement in prevention or other appropriate services.

Gambling Materials Development

The creation of original documents and other educational pieces for use in information dissemination
activities related to gambling and its effects on individuals, schools, families, and communities.
Services under this category include audiovisual materials, printed materials, curricula, newsletters,
public service announcements, and resource directories.

Gambling Prevention Marketing and/or Development

These strategies include all aspects of program planning, development and implementation. It also includes the marketing of State Approved Effective Programs and Evidenced Based Programs.

Gambling Professional Development

Professional Development includes providing in-service training to specific agency staff. Examples: teachers, counselors, administrators, children and youth case workers, prevention specialists and others on problem Gambling issues and concerns

Gambling Social Norms Marketing Campaign

The "Social Norms Model" has emerged as a science-based environmental approach that focuses on the influence of perceived peer norms and has provided notable success in many initiatives including higher education, secondary schools, and community settings. Based on more than two decades of research with tens of thousands of middle school, high school, and college students as well as studies of other young adults and parents in community settings it is known that the harmful misperceptions of peer norms that are pervasive in schools and communities. Research clearly shows the importance of harnessing the positive power of peers through the promotion of accurate social norms. This strategy includes counter-advertising, social norms marketing, and other structured environmental strategies or services that target social norms change.

Gambling Strategic Planning

Program is used to assess community needs, assess existing services, set priorities, and allocate resources. Activities can include needs assessments, organization plans, goal and objective development.

Gambling Telephone/E-mail Information Resource/Referral Programs

Telephone and E-mail services intended to provide information about gambling issues and services. Examples: Toll free telephone number services, Information and referral lines, Hotlines, Crisis lines, E-mail requests or online requests.

Gambling Training of Trainers

Provide train the trainer programs to schools, faith based groups, and community partners on gambling State Approved Effective Programs and Evidence-Based prevention programs. Allowing the partners to implement the State Approved Effective Program or Evidence-Based Program

PROGRAMS

The programs listed in this section may not have formal evaluations or research backgrounds, yet are included as they have either been reviewed and endorsed by a government jurisdiction and/or are widely cited gambling prevention programs. It is not mandated that SCAs provide these specific programs. These are included to assist the SCA in developing/implementing problem gambling prevention programs in an expedient manner. Programs utilized under this funding initiative should be theoretically similar to the core curriculum listed below so as to provide effective and efficient programs for public education, awareness and training regarding compulsive and problem gambling and the treatment and prevention of compulsive and problem gambling. Programs provided should be looking at how efforts will assist in reducing the incidence, prevalence, and problematic consequences of problem gambling for the gambler and gambler's family.

ADOLESCENT COMPULSIVE GAMBLING PREVENTION PROGRAM:

WANNA BET?

Source: North American Training Institute, a division of the Minnesota Council on

Compulsive Gambling, Inc.

Program description and format: “The North American Training Institute has designed and field-tested this interdisciplinary curriculum to discourage underage gambling through improved critical thinking and problem solving” (North American Training Institute website, Curriculum includes an educator's guide, an 11-minute video, “Andy's Story”, a Wanna Bet? Resource Guide, overhead transparencies, plus a bibliography and resource list. This easy-to-use curriculum also includes a Gambling Fact Sheet, a Brief History of Gambling, and a Parent Letter, all of which are copy ready. Wanna Bet? Magazine is an interactive online publication designed by teens for teens.

Risk factor(s) assumed to be addressed:

Early initiation of gambling behavior

Community laws and norms favorable toward gambling

Lack of parental knowledge

Lack of parental objection

Protective factor(s) assumed to be addressed:

Skills

Healthy beliefs and clear standards

Parental monitoring

CSAP strategies:

Education

Type of IOM approach:

Universal

Populations appropriate for this promising program:

5th-8th grade students

Availability / More information:

A copy of the program is available from the Oregon Prevention and Treatment Resource Clearinghouse. For more information or availability of the curricula, visit the North American Training Institute website,

ALL BETS OFF

Source: Missouri Alliance to Curb Problem Gambling (Alliance) and the Second Chance

Foundation (Jefferson City, MO).

Program description and format: This one-hour “informative interactive workshop” addresses the intertwined nature of addictions and how similar the risk factors, symptoms and consequences are across the spectrum of addictive behaviors. All Bets Off addresses gambling as a potential addiction, presents facts about addictions, and seeks to raise awareness of some of the resources available for individuals with an addiction in their family.

Program Objectives:

To educate youth about the dangers and risk factors of addictions, including gambling