NOI_Waiver 26138_ Grant Application.docx

Application for Provider Participation in Positive Adolescent and Childhood Experiences to Prevent Substance Use (PACES) Initiative

NOI #Waiver 26138 Positive Adolescent and Childhood Experiences to Prevent Substance Use (PACES) Initiative Application

Name of Municipal Applicant (Lead): __________________________________________________

Primary Contact: _________________________________________________________________

Mailing Address:____________________________________________________________________

Phone # ____________________________ E-mail __________________________________

Signature __________________________________________

Date______________________

1. Identify the proposed geographic area to be served by the PACES project:

· Single municipality

· Multi-Municipal/County Name Cities/Towns in proposed Catchment: ______________________________________________________________________

2. Name and briefly describe 1-3 potential CBO partner(s). (Limit of 500 words, 3-5 paragraphs) Include in your response:

a. The reason for their selection

b. The history of work between your Municipality and selected CBO(s) on similar projects

i. Include any prior experience serving youth ages 5-14

ii. Include any prior experience supporting families

iii. Include any prior experience with structured strength frameworks or models (e.g., HOPE or similar approaches)

3. Using the check boxes below identify your experience implementing substance use prevention or other youth development programs.

· Supporting relationships with peers, parents/caregivers, mentors, educators, coaches, or other trusted adults

· Yes

· No

If Yes, provide at least one example: _________________________________________________________________________

· Creating or strengthening safe, stable, and supportive environments where youth live, learn, play, or spend time

· Yes

· No

If Yes, provide at least one example: _________________________________________________________________________

· Providing opportunities for engagement, belonging, youth leadership, school connection, community participation, cultural connection, or structured activities

· Yes

· No

If Yes, provide at least one example: _________________________________________________________________________

· Supporting social and emotional development, including communication, problem-solving, coping skills, self-regulation, decision-making, and conflict resolution

· Yes

· No

If Yes, provide at least one example: _________________________________________________________________________

· Engaging parents, caregivers, or families

· Yes

· No

If Yes, provide at least one example: _________________________________________________________________________

· Engaging youth voice or leadership

· Yes

· No

If Yes, provide at least one example: _________________________________________________________________________

· Implementing protective factor, positive youth development, trauma-informed, restorative, social emotional learning, or other strength-based approaches

· Yes

· No

If Yes, provide at least one example: _________________________________________________________________________

· Trained in HOPE

· Yes

· No

· Trained in another strength-based framework

· Yes

· No

If Yes, provide at least one example: _________________________________________________________________________

4. Describe any youth health surveys conducted in your municipality since 2021 with youth in grades 6-12. (Limit of 250 words, about 2 paragraphs) Applicant should identify:

a. Who conducted the survey

b. Whether the survey is a census or sample

c. The years in which surveys were conducted

d. The most recent survey year for which data is available

e. The next planned survey year

f. Whether protective factor measures are included.

If no youth health surveys have been implemented since 2021, the applicant should describe the feasibility of collecting these data at the outset of the PACES project and biennially throughout the duration of the project.

Please check off which of the following data are available and use bold or yellow highlighting to indicate whether the data is available for middle grades (6-8), high school grades (9-12) or both:

· Current (past 30-day) and lifetime use of alcohol (Grades 6-8, Grades 9-12, Both)

· Current (past 30-day) and lifetime use of cannabis/marijuana (Grades 6-8, Grades 9-12, Both)

· Current (past 30-day) and lifetime use of nicotine/tobacco (Grades 6-8, Grades 9-12, Both)

· Current (past 30-day) and lifetime use of electronic vapor devices/vaping (Grades 6-8, Grades 9-12, Both)

· Perceived risk of harm of using alcohol, cannabis/marijuana, and/or nicotine (Grades 6-8, Grades 9-12, Both)

· Perceived peer use of alcohol, cannabis/marijuana, and/or nicotine (Grades 6-8, Grades 9-12, Both)

· Perceived parent/caregiver disapproval of alcohol, cannabis/marijuana, and/or nicotine (Grades 6-8, Grades 9-12, Both)

· Perceived ease of access to alcohol, cannabis/marijuana, and/or nicotine (Grades 6-8, Grades 9-12, Both)

· Presence of trusted adults, supportive peer relationships, parent/caregiver connection, and/or positive family relationships (Grades 6-8, Grades 9-12, Both)

· School safety, community safety, school climate, bullying, violence, and/or harassment (Grades 6-8, Grades 9-12, Both)

· School connectedness, sense of belonging, organized activities, youth leadership, volunteering, community or civic engagement (Grades 6-8, Grades 9-12, Both)

· Coping skills, problem-solving, decision-making, self-regulation, emotional well-being, help seeking, hopefulness (Grades 6-8, Grades 9-12, Both)

If available, attach copies of the most recent survey(s) and survey results of youth in grades 6-12.

5. Provide a Letter of Commitment to the specifications/scope of work outlined in the NOI on your letterhead and signed by representative leadership (Mayor, Town Manager, Health Director, or Similar).

Letter should include:

1. Commitment to participation in initial assessment phase (first three months of the grant)

2. Commitment to engage at least one local CBO Partner in the assessment and implementation process

3. Commitment to support the availability and collection of local health data in support of assessment and evaluation

4. Commitment if selected to engage in implementation and evaluation activities over the duration of the 5 year grant period.

INSTRUCTIONS FOR SUBMISSION OF RESPONSES:

The attached application must include:

· No more than two (2) pages of narrative response (questions 2 and 4)

· Completed and attached checklists (questions 3 and 4)

· Attached letter of commitment from your Municipality (question 5)

· Attached youth health survey(s) and survey results from most recent survey administration cycle (question 4 if applicable)

· Signed and dated by the agency person designated to sign agreements/contracts.

Deadline for Submission: Received no later than July 3rd, 2026 at 4:00 PM to: ryan.h.naismith@mass.gov SUBJ: XXXXX Positive Adolescent and Childhood Experiences to Prevent Substance Use (PACES) Initiative