The Billings Community Incentive Program is a multifaceted and comprehensive approach to reduce the risk of alcohol, tobacco, and other drug use among youth in the greater Billings area (N = 22,000). A coordinated community wide planning effort developed a proposal to address identified risk and protective factors through type 4 and 5 scientifically defensible principles, practices, and models. Programs include: Development of a Communities that Care Committee for long term prevention planning; Billings School District prevention curriculum revision; School health environment intervention; School-based peer health educators; Community after school academic enrichment program incorporating Second Step and Smart Moves; Big Brother and Sister mentoring program; Boys & Girls Club Smart Moves/Smart Leaders; Family Tree-Nurturing Program, Building Skills for Adulthood; InterMountain Planned Parenthood’s Friendly Peersausion; Safe and Drug Free School's Preparing for the Drug Free Years; Information dissemination and passage of a smoke-free air ordinance; and retail tobacco compliance checks. In addition to these programs, an extensive social marketing campaign will be administered through local media channels.
 

APPLICATION *

BUDGET WORKSHEET *

ABSTRACT *

TABLE OF CONTENTS *

PROPOSAL NARRATIVE *

COMMUNITY READINESS *

GOALS AND OBJECTIVES *

IDENTIFICATION OF SCIENTIFICALLY DEFENSIBLE PREVENTION PRACTICES *

Budget Narrative *

Evaluation Plan *

Proposal Attachments

Attachment A - Geographic Area

Attachment B - Time line of Major Milestones

Attachment C - Resumes

Attachment D - Collaboration Agreements

Attachment E - Fiscal Agent

Attachment F - Assurances, Certifications and Disclosures

Attachment G - Billings Healthy Communities Coalition Membership

Attachment H - Billings School District #2 Priorities and Recommendations for Prevention

PROPOSAL NARRATIVE
 
 

As the largest city in Montana, the Billings area is home to 125,770 residents (Montana Vital Statistics, 1997). School districts provide natural predetermined boundaries that divide the city and help define communities. The first year of the project will target students and adults within Billings School District #2 and expand to include surrounding school districts during year 2 and 3. The community to be served by the Billings Community Incentive Program (BCIP) includes children and adults that live within the boundaries of the following school districts in Billings Montana:

• District #2
• District #52 Independent

• District #26 Lockwood
• District #3 Blue Creek
• District # 17 Morin
• District #8 Elder Grove
• District #4 Canyon Creek
• District #23 Elysian

Billings' community readiness is demonstrated through the collaborative and coordinated efforts of numerous individuals and organizations. The initial planning for the Billings Community Incentive Program was conducted through the Billings Healthy Communities Coalition (BHCC). This coalition has an open door policy where no community member, agency or organization interested in health is excluded. The executive committee of the BHCC made every effort to involve any and all interested individual groups in the CIP planning process. The BHCC has provided the forum through which several key coalitions and organizations have come together to prepare this proposal.

Billings Healthy Communities Coalition

Established in 1994 with the vision to create a healthier community through collaborative, synergistic, outcome-based programming, the Billings Healthy Communities Coalition (BHCC) began discussing health-related issues within the community. It was determined that the mission of the Coalition was to maintain and strengthen a community network that shares information and identifies projects where collaboration can improve health outcome and health status.

As defined by the Coalition, a healthy community is one in which all residents have the opportunity to: access and receive high quality, affordable health care; exercise preventive health practices; breathe clean air; drink clean water; live in adequate housing; learn to the extent of their capacity; experience artistic stimuli; worship in the religion of their choosing; find rewarding recreational activities; work in a safe environment; and be safe from bodily harm.

The BHCC continues to meet on a monthly basis with broad ranging community representation. The meetings provide opportunities for information sharing and collaboration on various health issues. Representation comes from all corners of the community. A complete listing can be found in Attachment G.

The first year of the coalition was spent building relationships and adopting a definition of a healthy community. Having this foundation, the next step for the Coalition was to better understand community health needs as perceived by the community. To accomplish this, a Community Needs Assessment Task Force was created to facilitate data collection. Work began on the project by administering a mail survey to 35,000 households. The result was the publication of the Yellowstone County Community Needs Assessment during November 1994.

The BHCC has a history of determining community health needs, planning programs to target those needs, facilitating the implementing those programs, and evaluating. Utilizing the data collected by the community needs assessment, the Medication Assistance Program was established to help many community members fill their prescriptions.

The BHCC organizational structure includes an executive committee made up of the president, past president, delegate at large, vice president, state liaison, and secretary. The president and other members of the executive committee have generally served one-year terms. The BHCC has provided a forum through which all community agencies and citizens can come together to better the health of the community. No agency, organization, or persons has been excluded from participating.

Billings' Promise Alliance

The 1997 Presidents' Summit for America's Future provided a call to action for many communities through out the country. As a result, the Billings community, with the support of America's Promise - The Alliance for Youth, mobilized local social and economic capital to provide youth with the fundamental resources: caring adults, safe places and structured activities; a healthy start for a healthy future; marketable skills; and opportunities to give back through service to one's community.

The goal of the Billings' Promise is to encourage and support local actions by individuals, families, schools, community-based institutions and organization, faith communities, businesses and government to connect increasing numbers of youth in Billings to the five fundamental resources by the year 2000. In January 1997 the United Way contracted with the Prevention Resource Center to utilize the services of the Americorps Volunteer to heighten awareness and build relationships to create a prevention coalition. In April of 1997 the VISTA project combined efforts with the Promise to utilize the five resources as a focus and continue to build the Alliance. Since that time, a group of individuals who represented Billings at the Presidents' Summit have met on a monthly basis. This group is comprised of a steering committee that includes but is not limited to representatives from: city and county offices; the school district; police department; and juvenile justice. The alliance is comprise of the steering committee as well as promise makers such as local private and non-profit institutions, individuals, neighborhoods, organizations who are delivering promises youth. The effort is directed at mobilizing participation from all sectors of the community to make commitments to help strengthen the youth in Billings.

Whereas the five fundamental resources of the Billings' Promise effort are based on the risk and protective factor research, Billings' Promise steering committee members have agreed to partner through the establishment of the Billings Communities that Care Committee. This new committee will help to bring those interested in prevention together to establish a unified prevention approach for Billings during the next century.

The United Way of Yellowstone County

The mission of the United Way of Yellowstone County is to organize the capacity of people to care for one another by generating financial resources and mobilize community involvement and action to build a strong, healthy, more compassionate community. Founded on the principle that working together we can do more than we could ever do alone, the United Way is the keystone for the Billings Community Incentive Program. They have participated as leaders in the BHCC and the Billings' Promise Alliance. The United Way of Yellowstone County will be the fiscal agent that manages funding for this project.

Billings/Yellowstone County Tobacco Free Coalition

The Billings-Yellowstone County Tobacco Free Coalition is a collection of health promotion agencies, schools, and individuals interested in enhancing the health of its citizens. The coalition is funded by a grant from the Centers for Disease Control and Prevention, administered by the Montana Department of Public Health and Human Services. The mission of the Billings-Yellowstone County Tobacco Free Coalition is to decrease the negative impact of tobacco use on the health of our community by coordinating, implementing, and promoting community education, policies, and legislation that prevent tobacco use, protect the health of nonsmokers, provide resources for tobacco users to quit, and to promote tobacco-free lifestyles.

Recently, the coalition has been active in a number of initiatives that impact tobacco use in Yellowstone County, including researching and publishing a guide to smoke free restaurants and other public spaces, surveying public attitudes toward second hand smoke, and soliciting petitions and resolutions on environmental tobacco smoke. A summary of these efforts can be found on the coalition Website: http://OptimalHealthConcepts.com/tobacco. The current goal of the coalition is to promote and pass a city-wide ordinance on tobacco free public places.

Representatives of the coalition have been actively involved in the planning of the Billings Community Incentive Program proposal. The coalition will continue this involvement by participating in the Communities that Care Committee as well as in other initiatives outlined in this proposal.

Billings District #2 Prevention Task Force Report

In response to the many health and safety issues that are faced by the student population in District 2, administration is continually approached by prevention programs and well meaning citizens who are interested in offering health promotion programming within the district. The schools within the district offer an impressive number of prevention activities largely due to the fact there is a captive audience of 16,000 students. Unfortunately these requests can be burdensome and never ending. As a result and in light of the recent Montana Prevention Needs Assessment, District #2 administration and school board felt that this would be an opportune time reexamine the current health curriculum as well as reevaluate the prevention programming as a whole within the district. A task force of school and community members was created to examine the existing data and programs. The task force identified the following action items as recommendations for future prevention efforts.

• Action Item 1 - Establish a standing committee for District #2 prevention and promotion programs.
• Action Item 2 - Active utilization of safety resource officers to provide enforcement of laws regarding safety, school attendance, and drug use.
• Action Item 3 - Expand opportunities for parental and adult mentor involvement in all schools
• Action Item 4 - Increase opportunities for out of school alternatives including service learning.
• Action Item 5 - Adopt a comprehensive K-12 curriculum that meets or exceeds National and Montana State curricular standards.
• Action Item 6 - Move from an abstinence only curriculum to abstinence based sexuality education curriculum.
• Action Item 7 - Phase out the DARE program and substitute a comprehensive alcohol tobacco and drug prevention program with demonstrated effectiveness.
• Action Item 8 - Expand and integrate coordinated health education curriculum into the elementary grades.
• Action Item 9 - The school district must aggressively move to create a healthier culture in each of its schools.
• Action Item 10 - Offer faculty/staff worksite wellness programs at each school.
• Action Item 11 - All school food sales are consistent with good nutritional practices.
• Action Item 12 - Counseling and psychological services must be expanded to be more proactive in fostering sound supportive psychological services.
• Action Item 13 - Expand the services provided by school health services in district schools.

Faculty of the College of Education and Human Services at Montana State University — Billings have played an active role in each of the groups identified in this community readiness statement. Providing health promotion technical assistance and student workers to local prevention efforts, MSU-Billings has demonstrated its desire to participate in community prevention initiatives.

Collaborating closely with both the Billings Healthy Communities Coalition and local school districts, university personnel provide a unifying force and help ensure a research-based approach to prevention planning.

Optimal Health Concepts

Optimal Health Concepts is a thirteen year old private health promotion consulting firm that has operated in the Billings area for the past four years. Working on both a national and local level, this company provides services to businesses, educational institutions and individuals. Recent consulting projects have included school health planning assessments, health care market research, corporate and school worksite health promotion, and interactive multimedia production. As volunteer members of the Billings Healthy Communities Coalition, the principals of this company have been able to provide important insights to effective prevention planning. Under contract to this grant, Optimal Health Concepts will develop the social marketing campaign and oversee all evaluation efforts.

STATEMENT OF NEED
 

The Billings CIP will target youth within the boundaries of the 8 Billings School Districts (see above). The need to target youth within Billings is based on information obtained from several data sources. The 1999 Youth Risk Behavior Survey revealed that for the 345 high school students in school district #2:

• 45% admitted to riding in a car driven by someone who had been drinking alcohol.
• 25% had driven a car or other vehicle during the past 30 days while they had been drinking alcohol.
• 67% had tried smoking cigarettes.
• 32% reported smoking more than one cigarette a day.
• 67% reported having at least one drink of alcohol within the past 30 days.
• 63% had tried marijuana.
• 17% had used marijuana over 100 times during their lifetime.

• 20% had smoked at least one cigarette within the past 30 days.
• 27% had at least one drink of alcohol within the past 30 days.
• 26% had tried marijuana at least once during their lifetime.
• 15% had smoked marijuana at least once within the past 30 days.
• 20% had used an inhalant to get high sometime during their life.

• Billings High School students were over 10% higher risk on having attitudes favorable to alcohol, tobacco, and other drug (ATOD) use as compared to the State average.
• Billings High School students were over 10% higher risk on having friends who use ATOD as compared to the State average.
• Billings High School students were over 5% higher risk on perceived availability of ATOD and guns as compared to the State average.
• Billings Elementary School were over 5% higher risk on transition and mobility as compared to the State average.

• Billings High School students were over 5% lower on rewards for prosocial involvement as compared to the State average.

During 1994, numerous agencies within Billings participated in the Yellowstone County Need Assessment. The need for parent education was listed as one of the top three major concerns. Additionally, 409 adults were surveyed during 1998 using funding from Montana Board of Crime Control. Regarding the major gaps in youth risk behavior, parent involvement (45.3%) was by far the most common answer.

A survey recently conducted for the Billings Gazette revealed that community resident have a high level of awareness and concern about he risk of tobacco, alcohol and drug use within the community. The survey participants noted their greatest concern was for youth at risk for substance abuse.

Given these data, Billings has some unique challenges in addressing alcohol, tobacco and other drug use. To meet these challenges, Billings has many existing programs that provide the area with a rich assortment of prevention activities. A few of these programs include Billings' Promise, Big Brother and Sisters, the Boys & Girls Club, Community After School Activities Inc., and Second Step through the Family Tree Center. Beyond these few programs, students from Montana State University - Billings began a process of asset mapping for Billings in an effort to identify additional community resources.

Despite the numerous program efforts currently underway in Billings, more needs to be done to support existing programs and provide a structure for a coordinated, unified prevention effort. The BCIP will provide the vehicle to accomplish this task.

To address the needs of diverse groups, the BCIP will target all youth through a variety of program offerings. Some approaches target all area youth (i.e., school curriculum, social marketing, etc.) while other approaches will target high-risk youth (i.e., PEERsuasion, mentoring, etc.).

A number of community data sources will be used to help track the impact and outcome of the BCIP. These data sources include the Youth Risk Factor Behavior Survey, Montana Prevention Needs Assessment, and the Community Indicators Report. Billings School District #2 has participated and will continue to participate in the Youth Risk Factor Behavior Survey and the Montana Prevention Needs Assessment.

The Community Indictors Report was first prepared in 1998. The key elements of this report were selected by a group of community experts and coincide with the categories found in the Community Needs Assessment. The Report provides a snapshot of current community conditions and trends based on quantitative data gathered from a variety of sources. This report provides valuable local information that allows the community to focus prevention efforts. Social indicators for Yellowstone County that relate to risk and protective factors will be tracked through this annual report.

Additional data sources will be used to follow the broader success of the prevention efforts. These sources include the Yellowstone County Health Profile and the Billings Community Resource Information System (CRIS).
 
 

• Increase the capacity for developing meaningful partnerships to facilitate future prevention planning within the community of Billings.

• Establish a community wide prevention committee (i.e., Billings Communities that Care Committee) by November 1999.

• Participants will be encouraged to participate during the September and October 1999 meetings of the Billings Healthy Communities Coalition.
• Collaboration will begin with the Department of Addictive and Mental Disorders Division during September 1999 to facilitate the implementation of the Communities That Care model.

• Establish a coordinated school/community prevention committee by November 1999.

• Increase protective factors by helping youth establish ongoing relationships with caring adults through the expansion of additional mentoring programs.

• Increase the number of mentoring relationships to 200 through Big Brothers and Sisters by July 2000.
• Work to implement the High School Bigs Program in every high school in Billings by July 2000. (40 matches)
• Implement 4 Site-based mentoring programs (one sport, one business, and two schools) by July 2000. (16 matches)
• Implement one additional Core alternative mentoring program by July 2000. (8 matches)
• Increase the number of mentor relationships to 150 through Building Skills For Adulthood Program by July 2000.
• Disseminate printed informational/educational materials regarding the Building Skills For Adulthood Program
• Develop and disseminate a minimum of 3 interviews with local media by July 2000.
• Establish relationships with Montana State University - Billing and Rocky Mountain College to help students earn credits for mentoring by November 1999.
• Conduct campus recruitment at Montana State University - Billing and Rocky Mountain College during September 1999.
• Offer one Mentoring 101 (collaborate effort with United Way and Big Bothers and Sisters) per quarter to increase understanding of mentoring.

• Reduce adolescent tobacco use among Billings youth.

• Establish monthly tobacco vendor compliance checks by November 1999.
• Implement peer led tobacco cessation programs by August 2000.
• Pass a city wide smoke free ordinance for Billings by July 2000.

• Increase protective factors and reduce risk factors among families in Billings through the expansion of parenting effectiveness programs.

• Expand the Family Tree Center Nurturing Program to two additional offerings by March 2000.

• Train 6 additional Nurturing Program facilitators in both October 1999 and February 2000.
• Schedule and market two additional Nurturing Program sessions by November 1999.
• Provide intake services and preassessment to families enrolled in the program prior to participation.

• Provide two additional sessions by March 2000; one will focus on parents of preschoolers/toddlers and one will focus on parents of 5-12 year olds. (20-24 families)

• Continue to imbed Nurturing Program in a comprehensive family support program (respite child care, ongoing support groups, home visiting services, resource library).
• Provide information to local media regarding parenting classes and ongoing family support programs and disseminate primary prevention information for parents by November 1999.

• Offer additional parent education opportunities through the Second Step Family Guide Prevention Program by May 2000.
• Train 15 additional Family Guide facilitators by November 1, 1999.
• Purchase additional Second Step and Family Guide Kits (2 each Grade Level).
• Train Community After School Activities staff, Child Care Association members, teachers new to School District #2 and Lockwood School District in Second Step curriculum by February 2000.
• Provide Booster Training to teachers in School District #2 and Lockwood (two booster training scheduled for South Central Montana Teacher's Conference in October 1999) by March 2000.
• Provide four additional 5-week Family Guide to Second Step parent education classes by May 2000 at a variety of locations (schools, child care/preschool facilities, churches, The Family Tree Center, i.e.) (potentially, 100 families)
• Offer Preparing for the Drug Free Years at Family Tree and through the Billings Safe and Drug Free Schools program by June 2000.
• Purchase curriculum, parent activity books and facilitator training by January 2000.
• Train additional facilitators (facilitators trained in the program will train volunteers who want to facilitate the classes) by February 2000.
• Schedule and market classes in cooperation with School District #2 by February 2000.
• Implement volunteer facilitated classes (five two hour sessions each) by May 2000.
• Develop two day workshop for parents based on curriculum by March 2000.

• Reduce the use of alcohol, tobacco, and other drugs by developing new opportunities for after school and out of school programs.

• Boys & Girls Club of Billings and Yellowstone County will implement SMART Moves by August 2000 and SMART Leaders by August 2002.
• Participate in SMART Moves/SMART Leaders training by April 2000.
• Hire 2 additional staff members to implement SMART Moves/SMART Leaders by November, 1999.
• The CASA will implement 2 additional intermediate programs by January 2002.
• Increase to 100 new 4, 5, 6 graders in intermediate programs by January 2002.
• Provide all participants with exposure to the five fundamental resources of the Billings' Promise by July 2000.
• Train entire staff in Second Step and additional drug prevention programming by July 2000.
• Collaborate with Boys & Girls Club of Billings and Yellowstone County in delivering the SMART Moves program to CASA participant by August 2000.

• Reduce the use of alcohol, tobacco and other drug by adopting and implementing a comprehensive school prevention curriculum in grades K-12 of the Billings School District #2.

• Purchase Level 4 or 5 prevention curricula and materials for grades K-12.
• Train faculty in the implementation of Level 4 or 5 classroom curriculum.
• Implement curriculum assessment software in School District #2 by June 1, 2000.

• Reduce the risk factors for alcohol, tobacco and other drug use by implementing Project HELP (Health Education Leading Peers) programs in high schools.

• Research and develop peer educator resource and referral manual by May 2000.
• Recruitment of peer education leaders by May 2000.
• Train peer education leaders by September 2000.

• Increase protective factors by implementing a school health conference based on the Seaside Model.

• Conduct school health conference for School District #2 and Lockwood faculty, administration and staff by August 31, 2000.
• Conduct additional school health conferences for remaining school districts in Billings by August 31, 2002.

• Evaluate and develop recommendations for Billings School District counseling and psychological services geared to prevention, early detection, and treatment referral.

• Launch social marketing and counter advertising media campaign.

• Participate in social norm marketing training activities by January 1, 2000.
• Implement social norm marketing and counter advertising campaign by January 1, 2000.
• Meet with the Billings Broadcasters Association to implement local prevention media campaign by January 1, 2000.
• Conducted three focus groups and pilot test to develop market messages by June 1, 2000.
• Develop locally produced public service announcements by June 1, 2000.

Ongoing Community Organization for System Wide Substance Abuse Prevention

The Billings community has demonstrated a commitment to systematically address important health issues through the Billings Healthy Community Coalition (BHCC). In a city the size of Billings with its variety of health care providers and prevention resources this is no small task. As a result of the Billings Community Incentive Program, a community wide prevention committee (i.e., Billings Communities that Care Committee) will receive State sponsored Communities that Care training on September 27, 1999. This committee will report to the BHCC and their efforts will effectively bring together various segments of the community to address substance abuse prevention.

The Communities That Care model has been identified as a best practice model for its ability to mobilizing communities to address adolescent problem behaviors (Arthur et al., 1994). Communities That Care incorporates the following critical components:

• Involves a broad spectrum of individuals, groups and organizations who represent the diversity of the community.
• Builds support for risk and protective factor-focused prevention from key leaders as well as grassroots community members.
• Promotes widespread communication and collaboration across all domains and disciplines.
• Provides opportunities, skills and recognition to foster bonding to the community.
• Utilizes a data-driven assessment process that empowers community members to collect data on risk protection and resources.
• Promotes a long-term community commitment to achieving a shared healthy vision for the future.

Active social learning techniques (i.e., modeling, role playing, and discussion, with student peer leaders assisting teachers) are used in the school program, along with homework assignments designed to involve family members. The parental program involves a parent-principal committee that meets to review school drug policy, and parent-child communications training. A consistent message supporting a non-drug use norm is delivered via the other three components: mass media coverage and programming, community organization, and the local health policy change component. All components involve regular meetings of respective deliverers (e.g., community leaders for organization)

To review and refine programs.

Evaluations of the MPP have demonstrated for program youth, compared to control youth: reductions of up to 40 percent in daily smoking; similar reduction in marijuana use, and smaller reductions in alcohol use maintained through grade 12; effects on daily smoking, heavy marijuana use, and some hard drug use have been shown through early adulthood (age 23); and increased parent-child communications about drug use. Further, these evaluations have demonstrated that the MPP facilitated development of prevention programs, activities, and services among community leaders (Pentz, M.A., Mihalic, S.F., & Grotpeter, J.K. 1998).

As prevention professionals, the Billings Communities that Care Committee understands that there is no magic bullet to successful programming and we are committed to adopting successful practices in our community in a comprehensive manner. This will be accomplished by using multiple prevention strategies, delivered through multiple domains, targeting substance abuse and related problem behaviors (e.g., school prevention curriculum, mentoring programs, peer led interventions, social marketing and media counter advertising). Within the first year of funding for this project the overall goal is to enhance identified youth protective factors while reducing risk factors. In an analysis of current programs and a comparison to identified needs, we are attempting to institute new programs and strengthen existing programs where needed. In the course of the next three years it is likely that we will identify additional areas in need of development and future-funding requests will reflect continued assessment and planning.

Prevention efforts will entail school-based initiatives; community program initiatives and mass media utilization as described below.

School-Based Initiatives

Billings School District 2 Prevention Programs

In response to the results of the 1997 Youth Risk Behavior Survey, ongoing curricular planning, and continual requests from various community groups to institute prevention programs, the School Board of the Billings School District convened a Prevention Task Force to examine existing programs and make recommendations for future planning. Prevention Task Force membership included school faculty and administrators, community health and human service professionals, representatives of the faith community, Billings police and parents. The group met over the course of five months reviewing school based prevention programs and produced a final report that was accepted by the School Board on June 7, 1999.

The report, which is included as Attachment H, highlights recommendations for substance abuse, teen pregnancy, academic failure, chronic and communicable disease, violence and unintentional injury prevention. Each of the above areas represents complex issues with numerous underlying causes. Much of the prevention research can be summarized by a statement from one expert who said, "For every complex problem there is a simple solution, and it is wrong". Prevention experts generally agree that a host of risk factors and protective factors must be addressed if prevention programs are to have a significant impact. School based prevention programs must be broad based and system wide. Ultimately they must reflect a cultural change that places children's’ health and wellbeing first.

The report noted that the Billings Schools’ prevention programs consist of a collection of fragmented and sometimes ineffective approaches. When effective research based programs were utilized, they were often only available to certain students in specific schools. To more effectively address the above priority areas, the Billings District 2 Prevention Task Force recommended adopting a model promoted by the Centers for Disease Control and Prevention (CDC) and numerous other health professional groups: the Comprehensive School Health Program (CSHP).

The purpose of a CSHP model is that it functions by saturating the school with consistent health messages in an attempt to change the culture and climate of a school or school system. The Comprehensive School Health Program utilizes: Multiple disciplines, to employ; multiple health promotion interventions (Policy Mandates, Environmental Change/Facility Modification, Direct Intervention, Social Support, Role Modeling, Media, and Curriculum); which are provided through multiple channels, (School, Community, Home, and Media); by multiple agents (Parents, Professionals, and Peers); assuring multiple consistent messages. The Comprehensive School Health Program (CSHP) consists of the following eight areas:

• Family, Business & Community Involvement
• Healthy School Environment

• Health Services
• School Food Services
• Comprehensive Health Instruction
• Physical Education
• Guidance, Psychological, & Social Services
• Staff Health and Wellness Promotion

The first recommendation of the school board prevention task force was the establishment of a standing committee on prevention programs to report to the superintendent of schools. This recommendation was approved and the committee will begin its work this fall. The committee with membership from both the school district and the community at large will be responsible for the review of existing and proposed prevention programs including curriculum. Working in collaboration with the Communities that Care Committee, this group will work to ensure that best practices (i.e., level 4 and 5) are employed where ever feasible in the School District’s long term planning. This group will also focus on consistent assessment and evaluation (YRBS & Montana Prevention Needs Assessment) of Billings youth to determine both prevention needs and to evaluate the effectiveness of prevention programming.

Comprehensive School Improvement Intervention: Healthy School Environment

The Prevention Task Force of the Billings School District has identified the overall climate of Billings schools as an area in need of significant improvement. An analysis of the Montana Prevention Needs Assessment reinforced observations of Task Force members. As a component of the Comprehensive School Health Model this area is directly related to a number of community, school and peer/individual protective and risk factors identified in Billings. Changing the culture and climate of the schools will have a direct impact on increasing awards for pro-social involvement, while decreasing the risk factors of: laws and norms favorable to ATOD use, low commitment to school, early initiation of problem behavior, attitudes favorable to ATOD use, perceived risk of ATOD use, antisocial behavior, interaction with antisocial peers and rewards for antisocial involvement.

Based upon type 4 and 5 principles and practices included in the Child Development Project (CASP Grant #2647), Multi-Model School-Based Prevention Demonstration, Norms for Behavior (CASP Grant #2630), Seattle Social Development Program (National Institute on Drug Abuse, 1997) and Rule Setting in School and Organizational Change in Schools Using the Program Development Evaluation (PDE) Method (Gottfredson, 1986), funding from the CIP will assist the school district in facilitating and sustaining necessary changes. The aforementioned programs have utilized similar methods to empower schoolteachers and administrators to systematically improve the instructional climate, change classroom management, establish behavioral norms and increase student participation and school bonding.

As stated in Preventing Crime: What Works, What Doesn’t and What’s Promising, Office of Justice Programs' Research Report, "programs aimed at setting norms or expectations for behavior, either by establishing and enforcing rules or by communicating and reinforcing norms in other ways, have been demonstrated in several studies of reasonable methodological rigor to reduce alcohol and marijuana use and to reduce delinquency. Note, however that schools where rules were manipulated also used school teams to plan and implement the programs, so it is not possible to separate the specific effects of school rules and discipline strategies from the more general effects of encouraging teams of school personnel to solve their schools' problems." (p. 16).

Using the Seaside model (Davis & Fetro, 1986) of health promotion in schools, teams of teachers, administrators, and support staff will attend a week long school health conference each Summer at the Montana State University-Billings Campus. During the week teams will be given information on risk and protective factors for their area schools as well as detailed descriptions of effective practices in school improvement related to ATOD prevention. Teams will receive training on the successful implementation of measurable school objectives and be given the task of formulating an action plan for the improvement of their school during the next school year. Teams will be required to measure and report their progress by end of the calendar year and once again at the conclusion of the school year in a final report to the prevention committee of the school district.

Changes resulting from the planning activity will include efforts to increase clarity of rules and consistency of rule enforcement and activities to increase students’ success experiences and feelings of belonging. This strategy focuses on school-wide efforts to redefine norms for behavior and signal appropriate behavior through the use of rules. These activities target the entire population in each school. An evaluation of a similar process in the Program Development Evaluation (PDE) method (Gottfredson, 1986), demonstrated that students in the schools using PDE reported significantly less delinquent behavior and drug use, had fewer suspensions, and fewer school punishments, and less rebellious behavior after the first year of the program.

Organizing the school health conference in conjunction with Montana State University-Billings will allow organizers to offer incentives in the way of graduate credit scholarships for all school personnel that attend. This model will allow all 34 schools in this district to begin implementing consistent system wide changes while allowing local decision making and ownership of action plans at each school. Operating each summer of the grant period this conference will expand to allow rural elementary and middle schools (N = 6) that feed into the Billings School System to also attend.

Billings School District 2 K-12 Prevention Curriculum

The Billings School District Prevention Task Force has identified curricular revision as a critical area for effective prevention in the Billings schools. Funds acquired through this grant will allow School District 2 to improve prevention programming in grades K-12 by implementing curricula demonstrated to be effective in reducing substance use and abuse. Beginning in the Fall 1999 academic year the school/community prevention committee will review and choose from curricular packages have been identified as level 4 and 5 best practice models (e.g., Growing Healthy, Life Skills Training, and Teenage Health Teaching Modules).

A number of these curricula have demonstrated impressive effects in reducing alcohol, tobacco, and other drugs. Life Skills Training is a case in point. The Life Skills training program has been extensively studied over the past 16 years. Results indicate that this prevention approach can produce 59- to 75-percent lower levels (relative to controls) of tobacco, alcohol, and marijuana use. Long-term follow-up data from a randomized field trial involving nearly 6,000 students from 56 schools found significantly lower smoking, alcohol, and marijuana use 6 years after the initial baseline assessment. The prevalence of cigarette smoking, alcohol use, and marijuana use for the students who received the Life Skills Training program was 44 percent lower than for control students, and the regular (weekly) use of multiple drugs was 66 percent lower (Preventing Drug Use Among Children and Adolescents: A Research-Based Guide, National Institute on Drug Abuse, 1997, page 22.)

Effective teacher training and access to quality teaching materials is essential to curriculum implementation. Curricular materials and teacher training for all Billings schools and Lockwood schools (N = 33) will begin in the first year of this grant project. In subsequent years, training and curriculum materials will be provided for new teachers and independent schools (N = 6) that feed into the Billings School System. Training and graduate credits will be provided through Montana State University - Billings as part of the implementation plan.

As the curriculum is being implemented a computerized evaluation process will also be developed. Consistent with other curricular areas in the Billings School District (e.g., Math, Language Arts, and Science) a computerized student assessment program will track and evaluate student learning. When utilized by classroom teachers this system will allow consistent analysis of student skills that are related to curricular objectives, thus providing feedback to district administrators and parents of district, school and individual student progress. Parental notification and involvement is a recognized principle of successful prevention programming. Data generated by this system will become part of the evaluation process for this grant cycle.

Project HELP (Health Education Leading Peers)

A common principle of many type 4 and 5 prevention models is the use of peer led interventions (The Residential Student Assistance Program, Smart Leaders, Peer Support Retreats, Project Success, Project PATHE, Perth Amboy Community Partnership for Youth, Growing Up Well, and Project Northland). Educational prevention approaches that include peer-led components are more effective than programs that do not include these kinds of components (Errecart et. al., 1991, Tobler, 1986,1992). The peer education program planned for the Billings School District will supplement the formal educational process of the prevention curriculum. Peer educators will be used to target the Billings high school’s risk factors of early initiation of problem behavior, attitudes favorable to ATOD use, perceived risk of ATOD use, friends’ ATOD use, antisocial behavior, interaction with antisocial peers, and the protective factors of rewards for pro-social involvement and social skills.

During the first year of this program a peer educator resource and referral manual will be developed by health education/promotion college students (N = 6) working under the direction of Montana State University - Billings. In spring of 2000, students (Juniors and Sophomores) nominated by high school teachers at each of the three high schools will be asked to apply to become peer health educators working in Project HELP (Health Education Learning Partners). An application and interview process will used to select 25 students from each high school that are representative of the student body. These 75 students will attend a summer training institute at Montana State University-Billings.

Peer educators usually require extensive prior instruction to prepare them to present before or engage their peers. While at the Summer Institute students will receive extensive training in teenage health concerns with considerable attention to ATOD issues. Students will tour residential and outpatient drug treatment facilities, and be given presentations by area health professionals and law enforcement officers. Each peer educator will also undergo training in tobacco cessation methods, conflict resolution, stress management, theatrical skills, health education strategies, and general counseling methods.

Beginning in the fall of 2000, representatives from the peer groups of each high school will serve on the School/Community Prevention Committee, the Billings Healthy Community Coalition and the Billings/Yellowstone County Tobacco Free Coalition. As members of these planning groups, students will provide valuable insights to prevention planning.

Working with the Billings/Yellowstone County Tobacco Free Coalition, peer educators will also fulfill a valuable community service as they take part in monthly retail tobacco compliance checks in the greater Billings community. Accompanied by volunteer adults and college student supervisors, students will attempt to purchase tobacco products at various locations in the city of Billings. Retailers who sell tobacco products to underage individuals will be reported to authorities and will be required to pay a fine. This will subsequently reduce the availability of tobacco products to underage youth.

Peer health educators will also be involved in the task of developing selected social marketing media messages for television, radio and printed media. Members of the Billings Broadcasters Association, the Billings Gazette, and the Billings Advertising Federation have agreed to assist in this process providing training, technical assistance and funding. As part of the social marketing plan, peer health educators will be featured in radio, TV and print media to bring greater visibility to the local campaign.

During the school year college student supervisors/mentors will work with students to develop a marketing plan for the services that they provide to students and the community. At the beginning of the fall 2000 school year, each high school student will receive an informational pamphlet describing Project HELP and the services that are available through the peer educators. Under the direction of college students, peer educators at each school will develop a schedule to offer health advice on a drop in basis. Monthly tobacco cessation classes will be offered for students that want help in quitting, or for information on helping friends and family members to quit. Weekly outreach, informational programs, and drug free school activities will planned throughout the school year.

Peer health educators will also be utilized to offer cross-generational drug education programming to middle and elementary school students as part of the formal curriculum. Students will also be utilized to bring drug free messages to students taking part in Community After School Activities (CASA). This and other forms of community service will become an established requirement for students trained as peer health educators.

School Counseling Improvement Program

The Billings School District Prevention Task Force has identified counseling and psychological services as a school component that is in need of improvement. The new School/Community Prevention Committee will examine the role of counseling services in the schools as they pertain to early identification and referral of students with emotional and substance abuse problems. An evaluation of existing programs and recommendations with action steps will be made at the conclusion of the 99/00 academic year.

Community Program Initiatives

Community After School Activities, Inc.

Community After School Activities, Inc. (CASA) provides academic enrichment options and a safe place for elementary school children after school hours. Established in 1991, CASA programs are serving a growing number of children in the Billings area and CASA currently operates 5 sites with its 6^th site, a school-based program, opening this Fall at Sandstone Elementary. The Sandstone program incorporates the concept of a school-based community learning center by utilizing a comprehensive, collaborative approach of school, not-for-profits, private child care centers, and community educational and recreational entities working collectively to provide opportunities for intermediate age children in the after school hours.

After-school programs have met with success around the country as model programs have been implemented. The assumption is that communities fare better when children are kept busy in meaningful activities. For example, such programs have proven to reduce the juvenile crime rate, the likelihood that youth will use tobacco, and have increased the self-confidence and academic performance of youth (U.S. Department of Education, 1998). Despite these initial findings, prevention professionals remain skeptical that alternative activities like after-school programs are truly effective. Alternative activities such as organized sports and elaborate field trips are viewed as "hooks" that attract youth to community-based prevention programs. "The implication is that other activities, such as skills training, are more essential components of prevention programming" (Center for Substance Abuse Prevention, 1996, pg. 27-28).

Understanding the importance of prevention activities and the necessity to implement skills building activities into their programming, CASA has developed a collaborative relationship with The Family Tree Center, 4/H, Junior Achievement, Boys & Girls Club, and Billings City Parks and Recreation. Through these collaborative relationships, youth in the intermediate CASA programs will be able to receive enriching educational activities from trained professional educators that include exposure to the Second Step curriculum and SMART Moves. In addition, youth have the opportunities to spend time with caring adults and to participate in such hands on activities as science experiments, computers, games, outdoor activities, imaginary play centers, guest presenters, art activities, and other health and nutrition programs.

During 1997-1998, 294 children were served through CASA. The implementation of 2 additional sites will allow the program to serve 100 more children. Funding is requested for the program so that 2 additional after-school sites targeting 4^th -6^th grades might be implemented by the year 2002. Funding will initially be used to help support the development of the new Sandstone Elementary School CASA program. During year 2 and 3, an additional school-based CASA project will be implemented using CIP funds. Site operation beyond the funding cycle will be continued through a fee for service basis.
 
 
 
 
 

Risk Factor(s) addressed:	Community laws and norms favorable toward drug use Early initiation of problem behavior
Protective Factor(s) addressed:	Opportunities Skills and recognition
CSAP Strategy:	Education Information Dissemination  Alternatives

Boys and Girls Club: SMART Moves/SMART Leaders

"The Boys & Girls Clubs SMART Moves is one of the very few programs in the country that offer excellent prevention teaching combined with challenging supervised activities. The program is a real catalyst for change for very high-risk children, their families, and their communities. Expanding SMART Moves should be a top priority for our nation's efforts to combat substance abuse."

For 29 years, Boys & Girls Club of Billings & Yellowstone County has been in the forefront of youth development, working with young people from disadvantaged economic, social, and family circumstances. The Boys & Girls Club of Billings & Yellowstone County has actively sought to enrich the lives of girls and boys whom other youth agencies have had difficulty in reaching. In a world that has never seemed more threatening and devoid of promise for a disproportionate number of America's children, the Boys & Girls Club of Billings & Yellowstone County provides a tangible measure of hope. The Club offers young people what they need and want most - adults who respect and listen to them; a safe environment where they can have fun and be themselves; and interesting, constructive activities that channel youthful energy into challenging pursuits.

Today, over 2000 boys and girls at risk and in need are taking advantage of the programs, activities, and services provided by the Boys & Girls Club of Billings & Yellowstone County. They benefit from trained, caring, professional staff and volunteers who help young people take control of their lives, envision productive futures, and reach their goals. The SMART Moves program will contribute significantly to the positive, overall development of Club members.

Responding to the urgent need for an effective prevention program, Boys & Girls Clubs of America developed and field-tested a comprehensive program to help young people develop skills to resist alcohol and other drug use, and premature sexual activity. The results were outstanding. Called SMART Moves, the program is based on two rigorously tested curricula: Life Skills Training (Gilbert Botvin, Ph.D., Cornell University) and Project SMART (William Hansen, Ph.D., University of Southern California). Additional results have also shown that various components of the SMART Moves program have reduced overall drug use, marijuana-related behavior, cigarette-related behavior, alcohol-related behavior, and ATOD drug use knowledge(Center for Substance Abuse Prevention, unpublished document).

SMART Moves recognizes that in addition to resistance training and the development of social skills, self-esteem is a very important factor in regulating basic human drives and attitudes.

When children are made to feel that they matter, that they have a unique contribution to make, and when they are helped to understand their feelings, they are less likely to endanger their

own health or that of others by indulging in behaviors that put them at risk.

SMART Moves also recognizes that in order for youth to learn and apply prevention principles, prevention programs must include parents and members of the community. SMART Moves uses a team approach to implement the program. The prevention team consists of Club staff, community representatives, parents and older teens.

The objective of the SMART Moves program is to prevent or delay the onset of alcohol and other drug use, and sexual involvement by young people. This is accomplished by:

1. Increasing participants' knowledge about alcohol and other drugs and sexuality.
2. Increasing communication among staff members, parents, guardians, and Club members regarding alcohol and other drugs and adolescent sexual involvement.
3. Helping pre-teens identify and resist peer and media pressures to use alcohol and other drugs, and understand the physical and social changes taking place in their lives.
4. Helping teens develop and improve skills around making decisions, resisting social and peer pressures, and coping with the stress of growing up.
5. The SMART Moves curriculum is comprised of the following components:

• Be SMART: An in-service training that provides staff and volunteers with an overview of the program, and suggests ways to incorporate the prevention message into ongoing Club programs.

• SMART Kids Make SMART Moves: A skills development program for boys and girls ages 6 to 9. The program focus is on self-awareness, decision making and interpersonal skills, while communicating age-appropriate information about alcohol and other drugs.

• Start SMART: A resistance skills program for youth ages 9 to 12 that focuses on ways to identify and resist peer, social and media pressures to use alcohol or other drugs, or become sexually involved. It includes age-appropriate discussions of puberty and friendships.

• Stay SMART: A social skills program for adolescents ages 13 to 15 that teaches resistance skills, stress reduction techniques, communication skills, assertiveness training and life planning. It provides accurate information about drug use, alcohol use, and adolescent sexuality.

• Keep SMART: A program for parents that emphasizes communication skills and factual information about drug use, alcohol use, and adolescent sexuality.

• SMART Ideas: A program in which the skills and knowledge acquired in the small group programs is used to promote and reinforce the prevention message throughout the community.
• SMART Leaders: A peer education program for older children that have been through the SMART Moves program

A member of the staff of the Boys & Girls Club of Billings & Yellowstone County will coordinate the SMART Moves program. His/her responsibilities will be to manage all aspects of the program including: recruiting participants, training and supervising prevention team members, scheduling and facilitating small group programs, planning and implementing club/community events, record-keeping, publicity, evaluation of the program and compilation of year-end report.

A grant of $50,000 will enable the Boys & Girls Club of Billings & Yellowstone County to implement the SMART Moves program to help young people in our community acquire the knowledge, skills, self-confidence and self-esteem they need to avoid alcohol and other drug use, and premature sexual activity. The program will be promoted through the media.

A report will be compiled on the number of youth, parents, professional and volunteer staff, and others in the community who participated in SMART Moves. The report will also contain descriptions of Club/community prevention events and the number of people involved, as well as descriptions of community service projects undertaken. The report will be disseminated to donors, schools and other agencies, and to the media.
 

Risk Factor(s) addressed:	Friends who use Favorable attitudes toward drug use
Protective Factor(s) addressed:	Skills:  Resistance and social skills
CSAP Strategy:	Information dissemination Education
Type of Strategy:	Universal
Populations found to be appropriate for this promising practice:	12-15 years old, African American, Hispanic, Caucasian

InterMountain Planned Parenthood: Friendly PEERsuasion

Friendly PEERsuasion is a program designed by Girls Incorporated to help girls of middle school age (generally ages 11 through 14) acquire the knowledge, skills and support systems to avoid substance abuse. InterMountain Planned Parenthood will include PEERsuasion in its First Things First program which is an after school prevention program targeted to inner-city Native American girls.

Working in collaboration with the Indian Health Board, First Things First will provide the opportunity for 15-20 girls to meet weekly and participate in a program designed to reduce teenage pregnancy. The groups build self-esteem, empower girls with knowledge and communication skills and create a strong, positively-focused peer group. The group also learns of the dangers of alcohol and drugs use, particularly their effect on unsafe sexual behavior and unwanted pregnancy. A project coordinator with training and materials from Girls Inc. will be able to easily include the Friendly PEERsausion program in the First Things First program.

In the first phase of PEERsuasion, the girls participate in 14 one-hour sessions facilitated by a trained adult leader, involving hands-on, interactive and enjoyable activities such as games, group discussions and role-plays. Through these activities participants learn about the short-term and long-term effects of substance abuse, experience healthy ways to manage stress, learn to recognize media and peer pressure to use drugs, practice skills for making responsible decisions about drug use, and prepare to become peer leaders. Each session focuses on a particular objective while reinforcing skills and knowledge introduced in previous sessions. After completing this core curriculum the participants are certified as peer leaders (PEERsuaders).

In the second phase of the program, small teams of peer leaders use what they have learned in phase 1 combined with their own experiences and creativity to plan and implement eight to ten short sessions of substance abuse prevention activities for children ages 6 through 10 (PEERsuade-Me's). Working with their adult leaders, they present factual information and model and practice skills, attitudes and behaviors related to substance abuse prevention.

This program has been evaluated nationally at demonstration sites that included girls from differing ethnic and racial backgrounds who lived in a variety of high-risk situations. Friendly PEERsuasion was effective in delaying initial or repeat substance use among younger participants. Younger participants also were likely to report leaving situations in which friends were using harmful substances. (Weiss, & Nicholson, 1998).
 

Risk Factor(s) addressed:	Early initiation of problem behavior Friends who engage in problem behavior Friends who engage in problem behavior Favorable attitudes toward problem behavior
Protective Factor(s) addressed:	Opportunities Skills and recognition
CSAP Strategy:	Education Alternatives
Type of Strategy:	Universal
Populations found to be appropriate for this promising practice:	African-American, Caucasian (nonminority), Latina, Native American

Big Brothers and Sisters

Big Brothers and Sisters of Yellowstone County offers mentoring services for children between the ages of 6 and 17 through a multi-program approach including:

• Core Program - matching one referred, screened child with a screened Big Brother, Big Sister or Big Couple
• High School Bigs Program - matching a child with a screened high school junior/senior
• Team Mentoring - matching a group of children from one school or neighborhood with a group of screened adults from the same company, church, organization, etc.
• Site-based Mentoring - matching an individual or group of children with an individual or group of adults; all interaction takes place at a supervised site
• Artist Mentoring - matching children with artistic interests and talent between the ages of 12 and 17 with screened, working artist.

Mentoring is one-on-one relationships between adults and youth at higher risk. In evaluations of mentoring programs that have appeared in peer reviewed journals, most programs feature three to four meetings a month or more between mentor and child, with each meeting lasting at least for several hours. Community-based mentors see juveniles in a wide range of settings, including home, movies, professional sports, plays, and concerts. They may talk frequently on the telephone, with mentees calling mentors as well as vice versa... Mentors may be paid or unpaid, college students or adults. All of them receive some sort of training, although the infrastructure supporting mentoring relationships varies. Adult volunteers in the oldest formal mentoring program, the 90+ year-old Big Brothers and Sisters of America, for example, are subjected to extensive background examinations to screen out potential child molesters.

Mentoring provides the highest dosage of adult-child interaction of any formal community-based program. Compared to street workers and recreation program supervisors, mentors can develop much stronger bonds with juveniles at risk. In theory, they can gain the power of "legitimacy" based on a pattern of respect and support the mentor establishes with the juvenile, so that the mentor's approval and attention becomes a valued resource. That resource then gives the juvenile a "stake in conformity", something to lose if the juvenile gets into trouble with the law (Prevention Pipeline, 1997).
 

Risk Factor(s) addressed:	Early initiation of the problem behavior Low commitment to school
Protective Factor(s) addressed:	Bonding Adults with healthy beliefs and clear standards Healthy beliefs and clear standard

Careful examination of community-based mentoring evaluations supports a conclusion that they are an [effective] approach to preventing crime risk factors, notably drug use. In an evaluation of the Big Brothers and Sisters program, the treatment group children [those in mentoring relationships] had a 45 percent less reported onset of drug abuse than the control group children, who had been put on the waiting list. They also had 27 percent less onset of alcohol use and 32 percent less frequency of hitting someone. The program also reduced truancy: treatment group children skipped 52 percent fewer days of school and 37 percent fewer classes on days they were in school (Department of Criminology and Criminal Justice, 1997, pg. 3-24).

Building Skills For Adulthood Program

Research indicates that youth discharged from out-of-home care have a number of significant needs that could effect their ability to lead productive lives as adults after discharge from foster care. Problems include: (1) few job skills or experience; (2) physical and mental health issues; (3) unmet housing needs which lead to a high number of homeless individuals; (4) alcohol and drug abuse problems; (5) high rate of early parenthood; (6) educational deficiencies; (7) inadequate interpersonal social skills; and (8) minimal money management skills (Barth, 1990; Harari, 1980; Mech, 1988; Stien & Carey, 1986; Westat, 1991; Festinger, 1983; Bass, 1992; Gershenson & Kresh, 1986; Cook & Ansell, 1986; Ohio Dept. of Human Services, 1987; Piliavin, Sosin & Weterfelt, 1987; Susser, Struening & Conover 1987). Clearly, the above needs are significant.

Building Skills for Adulthood addresses these issues through a multi-program approach:

• The Daniel Memorial Independent Living Assessment for Life Skills (1993): This assessment is administered verbally and scored by computer. The assessment is designed for administration in one on one situations. By using 231 pass/fall questions in 16 categories, this format combines the best method for comprehensively determining knowledge of life skills. Each category lists questions in a hierarchy of skill levels, allowing the interviewer to administer specific levels appropriate to the abilities of a youth. This version has been extensively field tested in the Northeast Florida area and has proven to be extremely useful in determining the independent living assets and deficits of youth in rural as well as urban areas.
• Life Skills Group: The life skills group is open to all youth 16 and older and is based on a six-week, two hours each week, schedule. Group topics are drawn from the 16 life skill categories from the Daniel Memorial Independent Living Assessment for Life Skills (1993).
• Resources: Building Skills for Adulthood has developed a resource library (Incorporated with the PLUK library in Billings) which individuals may access for information. Worksheets and project packets are also available.
• Mentors: An important service provided by the Building Skills for Adulthood Program is the mentoring program. This service utilizes volunteers from the community and matches them one-on-one with a youth to provide support and assist them in gaining knowledge and practice in important life skill areas. The goal of mentoring is to help the youth gain the life skills (i.e., job skills, money management, decision making, educational planning, etc.) and confidence to become a productive adult in their community.

• Mentors must complete the following screening process before they are matched with a youth; 1) Volunteers application, 2) Three personal references are checked, 3) Background checks (i.e., criminal, drivers, and Child Protective Services) are completed, 4) Personal interview is conducted, 5) Mandatory mentor training (Training is based on a 24 hour curriculum developed by Building Skills for Adulthood).

Building Skills for Adulthood evaluates the effectiveness of the program through research packets, consisting of 8 instruments of evaluation, pre and post assessments (completed every 6 months), and monthly phone calls to youth and mentors.

Additional funding would enable the Building Skills for Adulthood program to expand its services to additional youth within the community who would benefit from these services.

Second Step Violence Prevention Program and Family Guide to Second Step

Violence in our society is increasingly recognized as a public health concern, and research suggests that children who use violence as a problem solving strategy are more likely to engage in criminal activity as juveniles and young adults than children who have learned more effective problem solving skills. Violence, in addition to sometimes leading to severe physical injury, can also lead to non-physical injuries (fear, lack of trust, etc.) that can increase aggressive behaviors and disrupt a child’s ability to participate effectively in school and community. Additionally, the social and emotional issues that often precede violence?and proceed from it?can also lead to drug and alcohol use, high-risk sexual activity, depression and school drop out (Frey & Sylvester, 1997).

The Second Step to Violence Prevention Program is a systematic program for fostering children’s social and emotional development. This nationally recognized program has been rigorously evaluated and shown to be effective in increasing prosocial skills in children and decreasing aggressive behaviors (a longitudinal study in presently being conducted by Committee for Children, the agency that developed the program, and the University of Washington School of Medicine. A randomized controlled trial concluded that the curriculum appears to lead to moderate observed decrease in physically aggressive behavior and an increase in neutral or prosocial behavior in school?Grossman et. al., 1997).

The Second Step Program has been available to schools in Yellowstone County since 1989, with varying degrees of implementation. The purpose of this proposal is to insure greater coordination and on-site consultation with teachers and schools to insure that all schools with access to the curriculum are utilizing it to the fullest extent possible.

Moreover, research has demonstrated that prevention programs that offer a parents’ component have a greater chance to affect long term change. The Family Guide to Second Step allows parents to learn the same problem solving and violence prevention skills their children are learning; they can use this knowledge to practice and reinforce these skills with their children. Additionally, the Family Guide provides an excellent opportunity to provide parents with parent education in a non-threatening manner.

The program will be offered through the Family Tree Center which has provided prevention education training to teachers in Yellowstone County and the surrounding area for over 10 years. In addition to the Second Step Program, The Family Tree Center also provides training and resources to teachers regarding personal safety curricula and recognizing and reporting abuse. The prevention education coordinator is a Montana certified (K-8) teacher and is certified by Committee for Children to train teachers in the Second Step Curriculum. She is certified through Montana State University-Bozeman to offer CEUs for Early Childhood Professionals, and is applying to offer this to K-8 teachers as well.

Through coordination with School District #2 and Lockwood Schools (as well as other in-county schools), six teachers and support staff training will be scheduled over the course of the school year. Additionally, four "booster" training will be scheduled for teachers already familiar with the use of Second Step in the classroom. Through the cooperation of school based Second Step liaisons (already in place at District #2 elementary schools), assessment will be completed to determine the degree of implementation, problems with implementation and teacher comfort with the curriculum. Area preschool staff will also be invited to attend teacher training, and families of young children will be provided opportunities to attend the Family Guide Series.

Eight Family Guides will be provided at local schools; childcare will be provided during the five-week sessions. The Family Tree Center coordinator will insure that each school has the necessary resources to offer this curriculum, and in addition to initial training, the coordinator will provide classroom based training to teachers new to the curriculum. Additionally, curriculum kits will be purchased and provided to schools that need them for implementation.

Second Step has been validated as an effective program in addressing attitudes and social-cognitive deficits that contribute to aggressive and other high-risk behaviors. Through fostering students’ emotional understanding, social problem solving, impulse control and anger management skills, students are better able to meet the stresses of an ever more demanding world. Utilizing this curriculum throughout the day, and pairing it with other social skills programs (CARE, i.e.) increases the effectiveness of the program. Providing the parents’ component as well has been shown to help children transfer these skills to non-school settings as well. Children who develop these skills at a young age are generally able to respond positively to social pressures later on; thus students who actively engage in this training in grades K-9 may be better able to avoid alcohol and drug use later on in adolescence. Surveys, pre and posttests and focus groups will be utilized to collect data regarding the effectiveness of Second Step in our community.
 

Risk Factor(s) addressed:	Family management problems Early and persistent anti-social behavior Lack of commitment to school Lack of bonding to society
Protective Factor(s) addressed:	Positive social orientation Bonding: Families, schools, teachers, prosocial friends, positive standards for behavior
CSAP Strategy:	Information Dissemination Education

The Nurturing Program

The Nurturing Program is designed to assist parents develop and improve their nurturing skills in each of four parenting constructs?appropriate expectations, empathy, non-violent behavior management, and appropriate family roles. These four constructs are a set of parental attitudes and behaviors consisting of both cognitive and affective components; to promote change in struggling families, both components must be addressed. The programs’ philosophy, and that of The Family Tree Center, is that parenting is learned and that every parent needs to be supported and nurtured in their parenting role.

The Nurturing Program differs from other parenting curricula in several distinct ways. First, children and parents are taught similar skills and attitudes throughout the program, and they share these experiences during each class session. Second, the Nurturing Program offers assessment instruments designed to measure changes in parental attitudes (both are used at intake and then after the class is completed). Third, the Nurturing Program strives to increase family cohesiveness through a series of learning principles and goals:

• The family is a system and involvement of all members is essential for change;

• A major focus is to build empathy among all family members;

• Parenting exists on a continuum;

• Adults, children and adolescents learn on both cognitive and feelings levels;

• A major goal is to increase self-esteem and positive self-concept; and

• All families would prefer to display healthy interaction given a chance.

A volunteer based parent mentoring program designed to assist low to moderate risk families with infants and young children. The volunteer can assist families in accessing community resources, with parenting information and the caring voice of experience. Community Caring volunteers receive initial training and ongoing support and training?including information about the Nurturing Program, which can be offered to families in a home visiting situation.

Parents are provided the opportunity for some "free" time while children are involved in developmentally appropriate preschool and toddler activities. Parents are required to attend groups once monthly so they can learn from the modeling provided by our staff. Childcare is also available for families attending parenting classes and support groups, and a children’s group facilitator is part of the Nurturing Program team.

In addition to the Nurturing Program, The Family Tree Center also offers the Early Childhood S.T.E.P. curriculum as part of its parent education component. Additionally, through cooperation with the Parent Connection, other curricula are available on-site. Ongoing parent support groups provide parents the opportunity to share the joys and frustrations of parenthood with other parents in groups facilitated by Family Tree Center staff members.

Parents are invited to check out materials on topics ranging from bonding and attachment issues to parenting adolescents. The resource library is also available to other professionals in the community.

The Family Tree Center will add two additional Nurturing Programs to those already scheduled and funded by other granting agencies, and the Center will provide training and support to additional Nurturing Program parent and children’s group facilitators. Additionally, the Nurturing Program will continue to be utilized by volunteer parent mentors. Intake and exit information will be collected by Family Tree Center staff, and the program coordinator will schedule classes and facilitator trainings.

Parents will be asked to complete intake interviews, which will consist of questions regarding family risk factors (poverty, social isolation, history of abuse and neglect, i.e.) and the Adult Adolescent Parenting Inventory (AAPI) and Nurturing Quiz prior to participation in the Nurturing Program. The AAPI and the Nurturing Quiz, along with an exit questionnaire, will be utilized after the class has been completed. The AAPI and Nurturing Quiz are instruments that accompany the Nurturing Program, and they are designed to measure changes in parental attitudes and behaviors.

The Family Tree Center will offer one twelve-week Nurturing Program for parents and their 5-12 year old children, and one nine week session for parents and their infants. In addition to the children’s groups offered simultaneously, additional childcare will be available for children younger (or older) than the target age. Additionally, parents attending the Nurturing Program groups will be invited to attend other informative groups over the course of the year (anger management, nutrition and child development, i.e.) and to participate in other Family Tree Center programs.

The Family Tree Center will provide two facilitator training sessions and ongoing support to facilitators involved in implementing the Nurturing Program. Group facilitators will be recruited from agencies that serve children and families (School District #2 Parent Connection, Family Support Network, Head Start, i.e.) and invited to attend these trainings, thus facilitating the offering of additional groups through other facilities. All families involved in groups offered by Family Tree Center trained facilitators will complete assessment tools through The Family Tree Center.
 

Risk Factor(s) addressed:	Family management problems
Protective Factor(s) addressed:	Bonding: Family
CSAP Strategy:	Information Dissemination Education

Preparing for the Drug Free Years

The protective and risk factor assessment for Billings high school students indicated that considerable improvements could be made in the areas of family attachment, poor family management, poor discipline, family conflict, family history of antisocial behavior and parent attitudes favorable to ATOD use. These are also areas that are directly impacted by the parent education program developed by Hawkins and Catalano (Office of Juvenile Justice and Delinquency Prevention, 1993) Preparing for the Drug Free Years. In Preparing for the Drug Free Years, parents learn how to increase their children's opportunities for involvement in the family, how to teach skills needed by children and adolescents, and how to provide reinforcement for desired behavior and appropriate consequences for undesired behavior. The program covers the following topics: (1) understanding the risk factors of drug abuse, (2) understanding the nature and extent of the problem, (3) reducing risks by strengthening family bonds, (4) conducting family meetings and fostering family communication, (5) establishing a family position on drugs, (6) identifying and establishing positive reinforcements and appropriate negative consequences, (7) reinforcing a child's use of refusal skills, (8) expressing and controlling anger, (9) increasing children's participation in the family, (10) creating a parent support network. ]

Preparing for the Drug Free Years teaches parents how to reduce critical risk factors that are especially important during the late elementary and middle school years. It is designed to effectively reach adult learners regardless of learning style or educational level. The program teaches parents how to use the basic principles of the social development strategy to strengthen family bonding. As a result, families build protection against risk (Office of Juvenile Justice and Delinquency Prevention, 1993).
 

Risk Factor(s) addressed:	Family Management Problems Family Conflict Favorable Attitudes Toward Drug Use Parental Attitudes and Involvement Anti-Social Behavior in Early Adolescence Alienation/Rebelliousness Friends Who Use
Protective Factor(s) addressed:	Bonding: Family Opportunities, skills and recognition Healthy Beliefs/Clear Standards

Environmental Changes to Tobacco Use

The primary goal of tobacco-free environmental policies is to create environments that do not expose youth to the use and possession of tobacco. Tobacco is one of the most commonly available and widely used drugs, and its use results in the most widespread

drug dependency. Use of other drugs, such as marijuana and cocaine, is often preceded by the use of tobacco or alcohol. Although most young persons who use tobacco do not use illicit drugs, when further drug involvement does occur, it is typically sequential -- from use of tobacco or alcohol to use of marijuana, and from marijuana to other illicit drugs or prescription psychoactive drugs (32). This sequence may reflect, in part, the widespread availability, acceptability, and use of tobacco and alcohol, as well as common underlying causes of drug use, such as risk-seeking patterns of behavior and deficits in communication and refusal skills. Recent reports on preventing drug abuse suggest that approaches effective in preventing tobacco use can also help prevent the use of alcohol and other drugs (33-35).

Research demonstrates that tobacco use and exposure to secondhand tobacco smoke is a threat to health. Policies restricting the use of tobacco in schools and other environments should reduce adolescents’ exposure to secondhand tobacco smoke and limit places where they can use tobacco and thus reduce the health risks associated with tobacco use and secondhand smoke.

Activities

· Review existing laws and compliance with laws restricting tobacco use in certain settings

· Review the effects of antismoking school policies on adolescent smoking

· Provide technical assistance and guidance on developing and implementing tobacco-free policies and environments

· Educate and inform concerned parties about laws restricting tobacco use in certain settings

Discuss funding to increase inspections of retailer sales to minors.
 

Risk Factor(s) addressed:	Community laws and norms favorable toward drug use
Protective Factor(s) addressed:	Healthy beliefs and clear standards

The research and practice evidence reviewed indicates that it is possible to implement policies restricting tobacco use in schools and child day-care centers: There is medium evidence that it is possible to influence organizations to develop policies restricting the use, possession, and exposure to tobacco smoke adolescents and adults. Because changes in policies regarding smoking are relatively recent, it is difficult to determine the ultimate effects of these changes on adolescent tobacco use.

Lessons Learned From Reviewed Evidence

· The establishment of smoking regulations can be accomplished through a variety of mechanisms, including State and local laws, and policies at businesses, schools, and child-care centers. Comprehensive policies can decrease prevalence rates, especially when their emphasis is on prevention and cessation.

· Harsh penalties for the possession of tobacco products by minors, such as suspension from school, may be ineffective interventions for enhancing the enforcement of antismoking regulations or for preventing or decreasing adolescent tobacco use. Instead, programs that provide prevention or cessation services, such as tobacco education courses, tobacco cessation programs, or diversion alternatives, may be most effective (Center for Substance Abuse Prevention, 1997, pg. 21-22).

Social Marketing and Counter Advertising

The primary goal of social marketing and counter advertising campaign is to change perceived norms among children and adolescents regarding ATOD use. Research and experience demonstrate that adolescents develop attitudes, beliefs, and behaviors regarding ATOD use from peers, family members, television, and other cultural sources. Adolescents often think that ATOD use is more widespread and universally acceptable than it actually is. Advertising links ATOD use with peer acceptance, success, and good times. Media messages that promote negative images about ATOD use reveal the number of teens who actually use ATOD, and address the unacceptability of ATOD use will help change these perceived norms.

Discussions with Billings’s press, radio and television producers have developed into operational relationships for a local prevention media campaign (See Billings Broadcasters Association and Billings Gazette Memorandum of Agreement). This three-year plus campaign will target youth ages 9 - 18 during peak viewing and listening hours as determined by media market analysis (e.g., 3:30 p.m. - 11:00 p.m., Monday-Friday). Media channels will include a combination of public service announcements and paid message delivery that are nationally, State and locally produced.

In addition to working with the Chemical Dependency Bureau social marketing contractor, Optimal Health Concepts will analyze local ATOD data sets (YRBS & MPNA) risk factors and behaviors to formulate local media messages (e.g., emphasis on marijuana use). Focus groups will be conducted with Billings area teenagers to further develop and pilot test an effective social marketing campaign targeted at specific ATOD issues. With the assistance of professional media producers, Optimal Health Concepts will use high school peer health educators to read radio messages and act in televised messages. Messages created for this campaign will also be included on billboards and posters, in high school newspapers, yearbooks, and in event programs of athletic competitions, theatrical productions, music performances, etc..

The sustainability of the paid messages beyond the completion of this grant period will occur through active enrollment of business sponsors who will appreciate having their business associated with our campaign. Local businesses have been very supportive of the D.A.R.E. program and other youth directed services. Assistance of the Billings Gazette and the Billings Broadcasters Association will be instrumental in the corporate support of this media campaign.

Although expensive, the media campaign can be considered cost effective when one considers the number of youth both inside and outside the Billings area that will be exposed to these messages. The radio and television campaign alone will reach over 100,000 people in the Billings Metro as well as an additional 130,000 people throughout the full market coverage area.
 

Risk Factor(s) addressed:	Community laws and norms favorable toward drug use
Protective Factor(s) addressed:	Healthy beliefs and clear standards

While not designed to directly impact on social norms, counter advertising has also been shown to be effective in decreasing drug use. Excerpted from Reducing Tobacco Use Among Youth: Community-Based Approaches: A Guideline for Prevention Practitioners, the following statements outline the evaluation results of a counter advertising campaign for tobacco.

Multi-component media-based prevention efforts, can have an effect on youth with regard to awareness of media campaigns, decreased smoking prevalence, and nonsmokers’ decreased intention to start. These efforts demonstrate the ability to result in increased negative attitudes toward smoking, and increased understanding of the consequences of smoking, and decreased rates of friends’ approval of smoking.

Multicomponent prevention efforts are more effective than single-component prevention programs. Media campaigns have been shown to support and promote other components and vice versa. Effective media campaigns involve linkages with other intervention activities.

To be effective, media messages should be age appropriate and designed with the target audience’s developmental stage in mind. In particular, messages should not be too subtle or too sophisticated (CASP, 1997).
 
 

Arthur et al., (1994). A Research Guide to What Works. Developmental Research and Programs, 1996, p. 89-90.

Barth, R.P. (1990). On their own: The experiences of youth after foster care. Child and Adolescent Social Work, 31, 165-171.

Center for Substance Abuse Prevention (1997). Reducing Tobacco Use Among Youth: Community-Based Approaches: A Guideline for Prevention Practitioners. Prevention Enhancement Protocols Systems, pages 21-22.

Center for Sustance Abuse Prevention. Understanding Substance Abuse Prevention -- Toward the 21st Century:  A Primer on Effective Programs, Center for Substance Abuse Prevention, unpublished document.

Department of Criminology and Criminal Justice. (1997). Preventing Crime: What Works, What Doesn't and What's Promising. Office of Justice Programs' Research Report, University of Maryland: Department of Criminology and Criminal Justice.

Errecart, M.T., Walberg, H.J., Ross, J.G., gold, R.S., Fiedler, J.L., & Kolbe, L.J. (1991). Effectiveness of teenage health teaching modules. Journal of School Health, 61, 26-30.

Festinger, T. (1983). No one ever asked us: A postscript to foster care. New York: Columbia University Press.

Frey & Sylvester, 1997. Summary of Second Step Program Evaluations. Committee for Children; University of Washington, Seattle, Washington.

Gottfredson, Denise C. (1986). An empirical test of school-based environmental and individual interventions to reduce the risk of delinquent behavior. Criminology, 24, 705-731.

Grossman, D.C., Neckerman, H.J., Koepsell, T.D., Liu, P.—Y., Asher, K. N., Beland, K., Frey, K., & Rivara, F.P. 1997. Effectiveness of a violence prevention curriculum among children in elementary school: A randomized controlled trial. Journal of the American Medical Association, 277, 1605-1611.

Harari, T. (1980). Teenagers exiting from foster family care: A retrospective look. Unpublished Dissertation, University of California Berkley, Berkley, CA.

Key Elements of a Positive Relationship with Youth (Prevention Pipeline). Nov./Dec. 1997, p.19.

Mech, E.V. (1988). Preparing foster adolescents for self support: A new challenge for child welfare services. Child Welfare, 117 (6), 487-495.

Office of Juvenile Justice and Delinquency Prevention. (1993). Strengthening America's Families: Promising Parenting Strategies for Delinquency Prevention, Office of Juvenile Justice and Delinquency Prevention.

Pentz, M.A., Mihalic, S.F., & Grotpeter, J.K. (1998). Blueprints for Violence Prevention, Book One: The Midwestern Prevention Project. Boulder, CO: Center for the Study and Prevention of Violence.

Preventing Crime: What Works, What Doesn't and What's Promising. Office of Justice Programs' Research Report, by University of Maryland, Department of Criminology and Criminal Justice, 1997

National Institute on Drug Abuse (1997). Preventing drug use among children and adolescents: A research-based guide. Rockville, MD: National Institutes of Health, U.S. Department of Health and human Services.

CASP (1997). Reducing Tobacco Use Among Youth: Community-Based Approaches: A Guideline for Prevention Practitioners, Center for Substance Abuse Prevention, Prevention Enhancement Protocols Systems, pages 10-12.)

Office of Juvenile Justice and Delinquency Prevention. (1993). Strengthening America's Families: Promising Parenting Strategies for Delinquency Prevention. Office of Juvenile Justice and Delinquency Prevention.

Stein, M. & Carey, K. (1986). Leaving care. Oxford: Basil Blackwell.

Susser, E., Struening, E.L., & Conover, S. (1987). Childhood experiences of homeless men. American Journal of Psychiatry, 144, 1599-1601.

Tobler, N.S. 1986). Meta-analysis of 13 adolescent drug prevention programs: Quantitative outcome results of program participants compared to a control or comparison group. Journal of Drug Issues, 16(4), 537-567.

Tobler, N.S. (1992). Drug prevention programs can work: Research findings. Journal of Addictive Diseases, 11, 1-28.

Center for Substance Abuse Prevention (1996). Selected Findings in Prevention: A Decade of Results from the Center for Substance Abuse Prevention. Center for Substance Abuse Prevention.

U.S. Department of Education (1998). Safe and Smart: Making the After-School Hours Work for Kids.Washington, D.C.: U.S. Government Printing Office.

The Billings Community Incentive Program is a comprehensive community wide effort to reduce alcohol, tobacco and other drug use among area youth. Funding requested through this proposal will be disbursed through the United Way of Yellowstone County — the project fiscal agent - and delivered to ten sub-contractors. A detailed justification of expenses by each program and all cost leveraging efforts are included below.

Billings School District 2 - ATOD Prevention Curriculum

Billings School District 2 is a major recipient of funding under this proposal. The School District will purchase comprehensive drug prevention curricula to include in its health enhancement K-12 curriculum. School board approved curricula decisions will represent only those programs that have been identified as level 4 or 5 evaluated programs (e.g., Growing Healthy, Life Skills Training, Teenage Health Teaching Modules). The cost for the curricula and materials is calculated by determining the number of packages needed for twenty-six elementary schools, four middle schools, and three high schools. Table 1. represents expenses for the three curricula mentioned above assuming these packages are selected for implementation at the elementary, middle and high schools.

Table 1. Cost for School District 2 Curriculum and Training

Each of the three curricula mentioned above also requires a teacher training component that is essential to successful implementation. Trainers will be brought to Billings to offer workshops through Montana State University — Billings. Training expenses reflect the price of the training plus travel and lodging expenses. When cost effective, faculty at the university will be trained as trainers so that they can offer teacher training in years two and three to new teachers and to teachers in surrounding school districts that feed into the Billings School District.

The Billings School District 2 is not asking for any additional personnel under the Billings Community Incentive Program. Highly qualified professionals are already in place to deliver the program; they simply require effective tools and training to accomplish the goals of the program. In addition to receiving the largest segment of funding under this grant, the Billings Public School District also provides thousands of dollars in in-kind support. If one were to calculate the dollar value of hours of preparation, direct teaching and administration involved in achieving the goals of the Billings Community Incentive Program by the school district, the total would easily double the requested total of this grant. When considered from the perspective of cost effectiveness in prevention programming, this program will have the greatest long-term effect on the largest group of adolescents in the state of Montana.
 
 

School Health Conference

In a strategy designed to assist School District #2 in changing the instructional climate and policies of its schools, teams of teachers will be brought to a four-day conference at Montana State University - Billings. As described in the narrative section of this proposal, teams of faculty, staff and administrators (n = 10), from each of the 34 schools will attend workshops and develop an action plan on school improvement for their building. Participation fees paid by the Billings School District and awarded by this grant will cover the cost of the conference. Expenses of the conference are based upon an average attendance of 340 participants. The grant will reimburse the school district at a rate of $115 per person. Teachers will also be able to purchase three graduate credit hours for the conference at their own cost. A breakdown of conference expenses is included in Table 2.

Table 2. School Health Conference Expenses
 

School Health Conference	Year 1	Year 2	Year 3
Conference Administration	$1,050.00	$1,050.00
Food for participants	$22,400.00	$22,400.00
Printing & copying	$650.00	$650.00
Postage	$300.00	$300.00
Supplies & Materials	$600.00	$600.00
MSU-B Faculty (2)	$7,333.00	$7,333.00
Speaker Honorariums	$2,500.00	$2,500.00
Speaker Travel & Lodging	$4,000.00	$4,000.00
Total per year	$38,833.00	$38,833.00

Two faculty members in the Department of Health and Physical Education at Montana State University — Billings will organize and run this four-day conference and their fee (based upon a percentage of their academic salary) is included above. An honorarium and travel expenses (Travel and lodging to be reimbursed at the state rate) will pay for four conference speakers that will be brought to Billings from other areas of the country and Montana to present on their areas of expertise.

During the conference food will be provided to participants so that they do not need to leave the campus to eat each day. All administrative tasks will be controlled by the Department of Health and Physical Education and no fees will be charged for use of University facilities during the conference. Facility and equipment use will be considered as in-kind support (approximately $4000).

School improvement is an ongoing process and the conference will be repeated in year 2. At this time the conference will be promoted to the seven school districts that feed into the Billings system. At the conclusion of the first year additional funding will be requested for local school systems that provide a memorandum of agreement to join the project.

The conference will also be advertised to school districts throughout Montana during the first two years. By the third year no additional funding is requested and the conference will become self-supporting.

The Parent Connection - Preparing for the Drug Free Years

The Billings Public Schools Parent Connection (a component of the District Drug Free and Safe Schools Program) provides fee based parenting classes to area parents. The level 5 program, Preparing for the Drug Free Years will become a major focus of this successful program. Two staff members will be sent to Seattle for training in the delivery of this program. The State rate for travel expenses applies to this train the trainers program.

Beyond year one, the only funding needed is for consumable materials. In subsequent years the fees generated by parents will pay for the supplies and the cost of the course for those who are not able to pay. By the fourth year the course will be self- supporting while providing scholarships to those parents that are not able to pay.

Table 3. Preparing for the Drug Free Years

MSU-Billings - Project HELP (Health Education Leading Peers)

The training and support of peer health educators in Project HELP will occur through the Department of Health and Physical Education of Montana State University in Billings. The yearly cost for the administration of the project and its Summer Institute are included in Table 4 and are described as follows. The Summer Peer Educator Institute is a campus residential program that includes meals (five days) and lodging (4 nights) for 75 high school student and 6 college student supervisors.

Upper-class health promotion college students interviewed and selected as supervisors will be paid $1,500 each for their services in one academic year. The planning, coordination and administration of the of the project and Summer Institute will be the responsibility of two faculty members at MSU-Billings who will receive a yearly stipend of $3,000 each. Transportation expenses will be for busses and vans to carry students to training sites (e.g., drug treatment centers) and to service sites (e.g., middle and elementary schools program delivery). Facility and equipment rental ($1250) will be charged to the project for use of recreational facilities at MSU-Billings. During the Summer Institute 5 speakers will receive a honorarium of $100 each for their participation in the program. Office supplies, postage, and printing costs are for distribution to each of the three high schools. The cost for these items in relation to the Summer Institute will be provided as in-kind contributions by MSU-Billings. Program supplies (e.g., t-shirts, certificates, banners, etc.) are included in the final expense category of this project.

Table 4. Project HELP

As an indication of sustainability, the funding for this project is reduced by one third each year. In the first year of operation the project will begin to search for alternative means of funding in the local community, through the Drug Free Schools Program, and through other external grants. Due to the visibility of the social marketing campaign and other programs, it will not be difficult to generate additional funding for groups that students will be involved in.

Community After School Activities (CASA)

Currently operating 6 regional after school programs, Community After School Activities (CASA) seeks funding to expand the operation of the program at two additional sites in the Billings area. Each CASA sites will incorporate both the Second Step program and the SMART Moves program into their centers. As displayed in Table 5, start-up costs are requested to hire two site directors by the beginning of the 2000/2001 academic year. Position descriptions will be defined and job announcements will be posted in the local newspaper. Funding will also assist in purchasing educational equipment and materials for the academic enrichment programs.

Table 5. Community After School Activities

Revenues generated from student tuition fees will offset the expenses of this program. The fee for service nature of the after school program qualify these grant funds as true start-up expenditures. By year 2 less than 50% of budget allocations for the two CASA sites will come from the Billings Community Incentive Program. By year three the requested amount is less than a third of the calculated expenses. The three-year total of expenses for CASA’s new sites will be $175,753. Tuition revenues will equal $94,500, CIP allocations will be $49,973 and CASA funds available from other sources balance out at $31,280.

Boys and Girls Club - SMART Moves/Leaders

The highly successful SMART Moves and Leaders program will be introduced to the Boys and Girls Club of Billings and Yellowstone County. A program coordinator and assistant will be hired and sent to a Smart MOVES training in Oklahoma City for two days. The salary for these positions is consistent with salaries offered for this position in other Boys and Girls Clubs and has been adjusted to salaries in our geographical area. A position description and advertisement will be published in the local newspaper. The administrative time and cost for these activities will not be charged to the grant and will be considered as in-kind contributions ($500).

The SMART Moves program is supplemented with the use of guest speakers and special instructors that will be paid up to a total of $1,000 in the first year. As detailed in Table 6, other line items in the grant represent telephone, postage, Internet Usage fees printing and consumable supplies such as office supplies, certificates, T-shirts, decorations, etc.

In year 2 and 3 of the program, alternative means of funding will be identified and resources within the Boys and Girls Club will be redistributed so that this program can become institutionalized. When ever possible the Club will take advantage of the many volunteer resources available in the Billings community to reduce operating expenses.

InterMountain Planned Parenthood — Friendly PEERsausion

The Director of Education and Training at InterMountain Planned Parenthood will have her duties reassigned by .25 FTE to coordinate the Friendly PEERsausion program. In the first year of the program $4,800 of her salary will be paid by the grant and $3,900 of salary for this project will be offered as an in-kind contribution by Planned Parenthood. Budget details are included in Table 7.

Table 7. InterMountain Planned Parenthood - Friendly PEERsausion

The project coordinator is required to attend a three-day training ($300 registration) with travel lodging and food reimbursed at the State level. Use of the curriculum requires the annual payment of a license fee of $1,000 to Girls Incorporated. Within this grant transportation for Native American girls is provided in a leased van which will carry girls to and from program venues. Part of the operating expenses for the van (insurance, gas, maintenance, etc. @ $855) will be paid as an in-kind contribution by Planned Parenthood. Additional in-kind contributions include room rental, equipment (i.e., computers, television, VCR), office supplies, telephone, and administrative costs are valued at $3,565. In years 2 and 3 the proportion of the program that is covered by the grant is decreased by a third and in-kind contributions increase to $4,828. By the fourth year of the program Planned Parenthood will have absorbed all program costs or will have found additional means of funding the program.

Big Brothers & Sisters of Yellowstone County

Big Brothers & Sisters of Yellowstone County (BBSYC) is requesting funding for three personnel positions in their organization. The salary for these positions is consistent with salaries offered for this position in other Big Brothers & Sisters organizations and has been adjusted to social service worker salaries in our geographical area. A position description and advertisement will be published in the local newspaper. The administrative time and cost for advertising, interviewing and hiring will not be charged to the grant and will be considered as in-kind contributions ($500). These positions will allow BBSYC to provide services to children that are currently waiting for a mentor. These positions will also allow the director of the program to become involved in fund raising which will sustain the program beyond the grant-funding period. Aggressive fund raising will begin in the first year of the program as the budget will be decreased by one third in years two and three.

In addition to personnel, a computer system with software is needed to facilitate management and evaluation of mentoring relationships. Used primarily for tracking clients this system will streamline and greatly enhance the efficiency of daily operations. Volunteer recruitment, retention and recognition is ongoing and this segment of the budget will contribute to the production of brochures, posters, and a spring recognition event. The final line item in Table 8 is for consumable supplies and materials necessary for daily office operations.

Table 8. Big Brothers and Sisters of Yellowstone County

In-kind contributions (totaling $142,440) by Big Brothers and Sisters of Yellowstone County includes but is not limited to the following: Agency staffing ($123,000, in addition to that which will be provided by the BCIP); Infrastructure (rent, telephone, postage) $15,540; Support materials, supplies, and consumables, $2,200; Volunteer recruitment, retention, and recognition efforts, $500; Big/Little group activities, $1,200. In years 2 and 3 as the grant funding decreases the in-kind contributions will increase correspondingly.

TumbleWeed — Building Skills for Adulthood

The TumbleWeed program - Building Skills for Adulthood - is requesting funding to expand their mentoring and Life Skills Groups to serve 150 Billings area youth each year. The computer assessment software required for this project will facilitate and refine the diagnostic approach necessary for quality programming. The budget line items of supplies and materials for the subsequent Life Skills groups (12 Groups/year) and training materials for mentor training are included in Table 9.

TumbleWeed in-kind donations include telephone ($560), building space ($5,445) and staff/volunteer time ($2,575).
 
 

Table 9. Building Skills for Adulthood

The Family Tree — Second Step Program

The Second Step Violence Prevention Program will be expanded to include implementation into all Billings Public Schools, Lockwood Schools, independent schools and the Catholic school system. This expansion along with an additional 8 nine week classes of the "Family Guide to Second Step" will require extending the hours of the program coordinator as reflected in Table 10.

Table 10. Second Step

To assist with classes, volunteer Family Guide Co-facilitators will be trained during years one and two and paid facilitators will be utilized to supervise volunteers. Both Second Step Family Guide and the Nurturing Program could be facilitated by Family Tree Center who would also provide training to individuals who would like to do this on a volunteer basis. Child-care will be provided to parents attending Second Step training and curriculum kits are distributed to each class participant.

Although funding requests decrease in years two and three, expenses will remain stable or are expected to increase and be maintained through fundraising efforts. The Family Tree Center has a solid fundraising base, and has produced 15 years of sustainability. Revenue generated through our Festival of Trees program has progressively increased each year, and these funds are used to support program expenses and operating expenses. Additionally, the Nurturing Program is imbedded in a comprehensive family support program?which receives funding from several additional sources?and pays a large portion of the coordinator’s salary.

The Family Tree — Nurturing Parenting

The Family Tree will offer six Nurturing Parenting classes (Two funded by the BCIP) and provide facilitator training so that additional programs may be offered over the course of the first year of funding. Funding from the Children’s Trust Fund, the state Partnership to Strengthen Families project, and Family Tree Center funds will provide additional Nurturing Programs. Request will be made in years two and three to the United Way Agency and Soroptomist to sustain programs.

As in-kind support to this program, the Family Tree Center will donate administrative staff time to administer assessment instruments, enter results into a client database and prepare reports (100 hours estimated, at a cost of approximately $1,500).
 
 

Table 11. Nurturing Parenting

Billings/Yellowstone County Tobacco Free Coalition

The Billings/Yellowstone County Tobacco Free Coalition will produce and distribute information on the proposed city-wide clean air ordinance as part of the enforcement plan for the City/County Health Department. This plan will be consistent with what has occurred in the Great Falls and Missoula communities after passage of their ordinances. It is estimated that $5,000 will be needed at the end of the first year of this grant to adequately inform businesses of the new policy. The $5000 will be evenly divided into radio and newspaper announcements, and direct mail formats (printing and postage). The design of these announcements will be donated as in-kind contributions by the members of the Coalition. The time for professional consultation on this project by members of the coalition is calculated at $400 per hour, for five hours, or $2000 of in-kind contributions.

The Coalition members will also coordinated and volunteer their time to monthly compliance checks of local tobacco retailers ($4000 in-kind contribution). Ten students from the Project HELP program will be paid $10 per hour for two hours of work each month for their assistance in this project. Continued funding of monthly compliance checks will occur as part of the Coalition’s regular operating budget.

Table 12. Billings/Yellowstone County Tobacco Free Coalition

Social Marketing and Counter Advertising Media Campaign

Optimal Health Concepts will develop and coordinate the social marketing and counter advertising campaign for the Billings Community Incentive Program. The two consultants will analyze data from the 1999 Youth Risk Behavior Survey the Montana Prevention Needs Assessment and other data sources to identify appropriate marketing targets. They will conduct focus groups, work with local television and radio producers, pilot test messages and develop funding sources for future sustainability of the media campaign. The consultants will charge $50 an hour for 200 hours devoted to this project (See Table 13).
 
 

Table 13. Social Marketing and Counter Advertising

High school student focus group participants will be recruited at local high schools. Three focus groups will be conducted with 10 teenagers in each group to help develop media messages. Sample media messages will then be pilot tested in three additional focus groups. Each focus group participant will receive $15 for attending a 1.5 hour session (60 participants @ $15 = $900). Refreshments will also be provided for each for the six focus groups (6 focus groups @ $25 = $150).

Television production costs are charged at a basic rate of $300 per 30-second spot. Eight media messages will be produced per year for a total of $2,400. Television airtime will be purchased at an average cost of $100 per 30-second spot. One hundred and sixty messages will be aired per year on four local television stations at this rate ($16,000). The Billings Broadcasters Association has agreed to provide the cash equivalent of an additional 80 messages for $8000. This will be in addition to a range of public service announcements that these media outlets will provide at no cost to the project.

Thirty-second radio announcements are averaged to cost $15 each. At this rate we will purchase 670 announcements from six local radio stations per year ($10,050). The Billings Broadcasters Association has again agreed to donate airtime for an additional 335 announcements ($5,025). The production and recording of messages is included in the purchased airtime for radio announcements.

Within the print media, the Billings Gazette has agreed to match dollar amounts for all purchased print advertisements. This generous arrangement will allow the grant to purchase $12,000 worth of advertisements, $6,000 of which is being donated. An additional $6,000 per year will be spent on print advertisement that includes school newspaper announcements, posters, billboards and advertisement in programs of school related functions (e.g., athletic, musical, theater).

The Community Incentive Program requires that a minimum of 10% of the total budget be devoted to evaluation. Of this amount $30,000 is needed for the school district to purchase a software program that will track student achievement of health enhancement curricular objectives. Specifically developed to assess both behavioral and cognitive objectives in the new level 4 and 5 curriculum packages, this program will demonstrate accountability for both schoolteachers and students.

The United Way of Yellowstone County

As the fiscal agent for the Billings Community Incentive Grant the United Way will require funding to cover administrative procedures of evaluation and to produce financial reports required under the grant.
 
 

Table 14. The United Way of Yellowstone County

Optimal Health Concepts

As evaluation consultants for the Billings Community Incentive Program Optimal Health Concepts will oversee all project operations and develop quarterly reports. The principals of this company will charge $50 an hour for 200 hours each during the grant year to operate as project co-directors and evaluators.

A part-time administrative assistant will be hired to record minutes at Communities that Care Committee meetings, collect and enter evaluation data, manage communication between BCIP programs, and other office duties as deemed necessary. This individual will require a computer system (IBM compatible w/combination printer, fax, copier) and software (e.g. Microsoft Office) that is Internet ready.

The following individuals will be directly responsible for the implementation and management of the BCIP. Additional staff will be hired to help administer the daily activities of the various programs participating in the BCIP. For complete description of these staff members, please refer to the budget narrative.

Co-Program Directors/Evaluators: Ernesto Randolfi, Ph.D.

South Central MT Regional Mental Health Center

The program directors will oversee the implementation of three separate components of the project. These components include Project HELP, the school health conferences, and the social marketing/counter advertising campaign. In addition, the program directors/evaluators will be responsible for process evaluation of administrative objectives and impact and outcome evaluations. Project evaluators will work closely with the evaluation coordinator (Alana Barone) to ensure participation in the National Cross-site Evaluation. The evaluation coordinator will provide the link through which Minimum Data Set (MDS) information, Alcohol and Drug Information System (ADIS), information on risk and protective factors, Montana Prevention Needs Assessment Project community student survey, and data collection required by the Department of Addictive and Mental Disorder's contracted evaluator will be reported.

Specific goals, objectives, tasks, activities and timelines can be found in under goals and objectives in the proposal narrative. A timeline for the BCIP is provided as Attachment B.

The following table outlines implementation plan for the BCIP. Additional goals, objectives, tasks, activities and timelines for year 2 and 3 of the BCIP will be formulated as the Billings Communities That Care Committee becomes operational. The program directors will facilitate the development of this committee following the Communities That Care training scheduled for September 27, 1999.
 

Tasks

Months 1999-2000

S

O

N

D

J

F

M

A

M

J

J

A

S

Organize the Communities That Care Committee (Co-Directors)

*

Participate in Communities That Care Training (Co-Directors)

*

Establish a school health prevention committee (Co-Directors)

*

Task

S

O

N

D

J

F

M

A

M

J

J

A

S

Phase in mentoring (Big Brother and Sisters)

*

Phase in Building Skills for Adulthood (Tumbleweed)

*

Phase in Tobacco Vendor Compliance Checks (Tobacco Free Coalition)

*

Phase in Tobacco Cessation Programs (Tobacco Free Coalition)

*

Begin effort of pass smoke free city ordinance (Tobacco Free Coalition)

*

Expand Nurturing Program (The Family Tree Center)

*

Phase in additional parent education (The Family Tree Center)

*

Phase in Preparing for the Drug Free Years (The Family Tree Center and Drug Free Schools)

*

Phase in SMART Moves (Boys and Girls Club)

*

Phase in additional CASA programs (Community After School Activities)

*

Phase in curriculum assessment software (Co-Evaluators and School District #2)

*

Phase in Project HELP (Co-Directors)

*

Phase in School Health Conference (Co-Directors)

*

Phase in social norm marketing and counter advertising (Co-Directors)

*

 
 
 
 

Task

S

O

N

D

J

F

M

A

M

J

J

A

S

Complete Quarterly Report (Co-Evaluators)

*

*

*

*

Collect Montana Prevention Needs Assessment Data (School District #2 and Evaluation Coordinator)

*

Process Evaluations of Administrative Objectives (Co-Evaluators)

*

*

*

*

Impact Evaluations (Co-Evaluators)

*

Outcome Evaluations (Co-Evaluators)

*

 
 
 

Task 1 (Formative/Process Evaluation)

Initial program planning activities included the formation of several goals and administrative objectives (see above). These goals and objectives were developed and refined with the help of each member of the BHCC and individual program directors. The first task of the evaluation team during the first year of the project will be to assess achievement of the various administrative objectives. Evaluation consultants from Optimal Health Concepts will help to collect the data and report it to the project coordinator. The project coordinator will report progress toward the achievement of these objectives through the submission of a quarterly report to the Addictive and Mental Disorders Division of DPHHS. Additionally, the Billings Community Incentive Program will employ the services of an evaluation coordinator from the Mental Health Center. This evaluation coordinator will submit monthly electronic entries of prevention activities into the state minimum data set.

Evaluators from Optimal Health Concepts will facilitate the collection of quantitative and qualitative evaluations during each year of the project in an effort to gain a greater understanding of the populations served through the BCIP. Focus groups will be the primary method qualitative data collection. Particular care will be taken to include diverse groups in this portion of the evaluation. These groups will include parents and youth from several sections of the Billings community. Focus group evaluations will provide additional useful data as to the effectiveness of program activities.

Task 2 (Summative/Impact Evaluation)

In year one of project, the Billings Community Incentive Program will employ the services of an evaluation coordinator from the Mental Health Center and two additional evaluation consultants from Optimal Health Concept in an effort to collect, analyze and disseminate findings from the impact evaluation. The impact evaluation will assess achievement of behavioral and environmental objectives. The primary behavioral objectives to be measured will be the increase in protective factors and the reduction of risk factors associated with alcohol, tobacco, and other drug use. The steps to be taken in achieving this task will include the collection of Youth Risk Factor Behavior Survey data and the collection of the Montana Prevention Needs Assessment Community Student Survey data within the school districts. Analysis of these data will be conducted by their respective administering agencies, and this data will be included in quarterly reports to the Addictive and Mental Disorders Division.

In addition to the above measures, funding from the BCIP grant will provide much needed computer software to measure the impact of school health enhancement curriculum on student learning objectives. Working closely with School District #2 representatives, Optimal Health Concepts evaluators will help facilitate the implementation of this assessment software within the first year. This software will provide the school district as well as BCIP staff with valuable data on the extent to which learning objectives are being met.

As the Billings Communities that Care Committee becomes operational, additional goals and objectives will be established for years two and three of the project. It is anticipated that additional behavioral objectives will be established for each program involved in the Billings Community Incentive Program with consultants from Optimal Health Concepts facilitating evaluation procedures. Such procedures will include the collection of additional quantitative data from program participants.

Task 3 (Summative/Outcome Evaluation)

In year one of the project, the program coordinator and evaluation team will report Youth Risk Factor Behavior Survey findings. These findings will include the extent to which Billings' youth are using alcohol, tobacco, and other drugs. In addition, the Community Indicators Report will provide useful data on the extent to which alcohol, tobacco, and other drugs are being used within Billings.

Evaluation Schedule
 
 
 

	Task 1 - Process	Task 2 - Impact	Task 3 - Outcome
Year 1	Focus Groups Reassess Program Goals and Objectives Conduct Administrative Evaluation Submit Reports	Collect Montana Prevention Needs Assessment Data Collect Youth Risk Factor Behavior Survey Data Collect School District #2 Curriculum Assessment Data	Collect Youth Risk Factor Behavior Survey Data Collect Billings Social Indicators Data
Year 2	Focus Groups Reassess Programs Goals and Objectives Conduct Administrative Evaluation Submit Reports	Collect Montana Prevention Needs Assessment Data Collect Youth Risk Factor Behavior Survey Data Collect School District #2 Curriculum Assessment Data	Collect Youth Risk Factor Behavior Survey Data Collect Billings Social Indicators Data
Year 3	Focus Groups Reassess Program Goals and Objectives Conduct Administrative Evaluation Submit Reports	Collect Montana Prevention Needs Assessment Data Collect Youth Risk Factor Behavior Survey Data Collect School District #2 Curriculum Assessment Data	Collect Youth Risk Factor Behavior Survey Data Collect Billings Social Indicators Data

 

The Billings Healthy Communities Coalition and the Communities that Care Committee are committed to the long term sustainability of prevention programming for Billings area youth. The Community Incentive Program is viewed as an incubator to start up programs that have been identified as most critical to our community. As such, a variety of strategies will be implemented to ensure that programs become institutionalized and self-supporting.

During the first year, a large portion of funding has been designated to program development (e.g., School district teacher training) and purchase of program materials (e.g., curricular materials). Beyond the third year, the need for training is greatly diminished and new materials are not needed. Each agency funded through this proposal has agreed to phase out their funding and absorb the cost of offering their program during the three years of this grant. Each year the agencies will reduce their funding request by a third, so that the program becomes self supporting by the fourth year.

Agency personnel hired via the CIP grant will become permanent staff members. In agencies such as the Boys & Girls Club, agency goals and yearly objectives will be reevaluated and adjusted. Some agency programming may be eliminated or reduced so that resources can be reassigned to the Smart Moves/Leaders program. Memorandums of agreement (MOA) included in this application specify the steps that individual agencies will undergo during this process and additional MOA will be submitted as required in the CIP quarterly reports.

In addition to agencies absorbing the program costs into their general budgets, new personnel will allow existing administrative staff the opportunity to research and obtain new sources of funding. In the case of Big Brothers and Sisters the executive director currently is not able to initiate fund raising because she is doing the work of program manager and case worker. In this case, the new personnel will free up the director to implement an agency sustainability plan for years two and beyond.

A city the size of Billings provides numerous opportunities for local sponsorship of prevention programming. Billings businesses have already demonstrated their willingness to support youth related prevention by financially assisting programs such as the Sheriff and Police Department’s DARE and the United Way’s Promise. Solicitation of funding is less difficult when potential benefactors learn that they are supporting programs that are know to be effective (i.e., Level 4 & 5).

In addition to local funding sources, numerous opportunities also exist nationally for prevention efforts. Members of the he Community that Cares Committee will be responsible for identifying and sharing knowledge of funding opportunities. The Communities that Care Committee will apply for a minimum of two additional prevention grants each fiscal year to support and supplement existing programs. Whether funding is intended for a coalition of prevention programs, or a specific agency, the formulation of our Community that Cares Committee will add considerable strength to written proposals. In one example, the Committee recently became aware of federal grant money available to train educators in the use of the Life Skills Training curriculum. If the grant application deadline had not come so quickly (August 9,1999) this money could have been used to supplement the CIP RFP.

The sustainability of CASA’s program is somewhat unique. Since CASA is a fee-for-service program, the dollars requested represent costs associated with startup of new sites in the Billings area. In the second year of each site’s operation, it will become entirely self supporting. The same scenario is anticipated for the healthy school Summer Institute. As the Institute develops, it will be advertised to school districts throughout Montana, and a fee will be charged to schools from other areas that wish to attend. Like other programs included in this grant, this program will become self-supporting by the end of year three.

The social marketing campaign is one of the more difficult areas to demonstrate sustainability beyond the grants funding cycle. Media campaigns can be very expensive. Optimal Health Concepts will aggressively pursue corporate sponsorship of the social marketing and counter advertising campaign during years two and three. Various media groups have already expressed an interest in assisting our coalition in this process. Memorandums of agreement highlighting these collaborations will be included in annual and quarterly reports.

The Billings/Yellowstone County Tobacco Free Coalition is currently exploring how its state funding can be used to supplement and sustain the media campaign by purchasing advertising targeted specifically at tobacco. The Billings Broadcasters Association has agreed to match purchased air-time with its own contributions. Tobacco free funding will allow us to supplement and continue a media campaign well beyond the duration of this grant.

Although not a requirement of this RFP, evaluation efforts are also sustainable beyond the contract phase of this project. Ongoing evaluation will be sustained as an infrastructure is developed to collect and analyze project data. The evaluation services provided by Optimal Health Concepts will not be needed beyond the three year funding cycle, but individual programs will have a system in place to continue to evaluate their own programs. As university researchers, the principals of Optimal Health Concepts are interested in continuing to evaluate the long term effects of this comprehensive prevention program and sharing the results in scientific journals.
 
 

Proposal Attachments

Attachment A - Geographic Area

Attachment B - Time line of Major Milestones

Attachment C - Resumes

Attachment D - Collaboration Agreements

Attachment E - Fiscal Agent

Attachment F - Assurances, Certifications and Disclosures

Attachment G - Billings Healthy Communities Coalition Membership

Attachment H - Billings School District #2 Priorities and Recommendations for Prevention