# Crisis Counseling Assistance and Training Program (CCP) Quarterly and Final Report Outline FormatUpdated: July 2019

Preface the report with a contact sheet of identifying information: state[footnoteRef:1] contact, Federal Emergency Management Agency (FEMA) disaster number, Immediate Services Program (ISP) or Regular Services Program (RSP), and Substance Abuse and Mental Health Services Administration (SAMHSA) grant number (only required for an RSP).   [1:  In this document, we use the term “state” to refer to states, territories, and federally recognized tribal organizations.] 

Executive Summary (2 pages). Provide a brief summary of program activities described in the report. Highlight program accomplishments and anticipated challenges for the next quarter (if applicable).

Program Activities and Management (section length varies depending on program size). 

**Staffing (2 or more pages).** Provide an updated organizational chart. Provide a list of service providers that includes staffing (by position and full-time equivalency) and regions served for each provider. Include number of positions filled compared to number allotted for each provider.

**Quality assurance (1–2 pages).** Describe the program’s internal quality management system (e.g., communications, supervision, onsite visits, and staff meetings).

**Program highlights (1–2 pages).** Describe program successes, achievements, and service delivery innovations.

Fiscal Activities (section length varies depending on program size).

1. **Budget.** Refer to the online CCP Toolkit to find a template for quarterly financial reporting at https://www.samhsa.gov/dtac/ccp-toolkit/ccp-reporting*.*Include total, state, and individual provider budgets; amounts expended to date; and balances going forward (or to be returned as part of closeout).

**Budget narrative.**

Monitoring and Evaluation (section length varies depending on program size).

1. **Program monitoring.** Provide data and a brief narrative analysis of outreach activities and strategies for the state and each service provider. Indicate the program’s progress in meeting the stated outreach goal included in the CCP application needs assessment. Include details on activities related to high-risk groups such as children, adolescents, older adults, and others identified in the CCP application.

Primary services

Brief educational or supportive contacts

Individual crisis counseling

Referrals

Group counseling and public education

Community networking

Secondary services

Materials development and distribution (i.e., educational materials, media messages, and public service announcements)

**Program evaluation.** Provide data and a brief narrative analysis of evaluation activities and results.

1. **Individual/Family Encounter, Group Encounter, and Weekly Tally Sheet forms**. These are the basic forms that crisis counselors most commonly use in the CCP. They are used for reporting encounters, materials distributed, emails, calls, and social media messaging. 

1. **Assessment and Referral Tool forms**. These forms are commonly used when crisis counselors suspect an individual is experiencing serious event reactions and is in need of an immediate mental health or substance use-related referral. 

1. **Participant Feedback Survey (if applicable at the time of report submission).** Participant Feedback Surveys are conducted semiannually (i.e., usually at 6 and 12 months after the disaster event) in the RSP.

**Service Provider Feedback Form survey (if applicable at the time of report submission).** Provider surveys are also conducted semiannually in the RSP.

**Challenges or issues related to data collection, data entry, or evaluation.**

Training (1–2 pages).

1. **CCP staff training.** Describe required or recommended CCP staff training conducted. Relate it to the training plan in the approved application. Indicate the number of staff in attendance for each training. 

**Stress management.** Describe how the program has addressed self-care, stress management, and compassion fatigue for CCP staff.

**Other training.** List other trainings provided for CCP staff, and briefly describe each additional training (e.g., Skills for Psychological Recovery, child/family skills, or suicide prevention) as well as training logistics and other details (e.g., date, location, trainer, audience if other than CCP staff, learning objectives).

Media and Public Service Announcements (1–2 pages). Describe program marketing and public information activities and the use of media. Refer to websites, flyers, newsletters, public service announcements, and the development and use of hotlines.

Challenges, Goals, and Technical Assistance Needs[footnoteRef:2] (2–3 pages). [2:  For the final report, part VII should be replaced with the following: VII. Conclusions (2–5 pages). A. Best practices and lessons learned, B. Recommendations to FEMA and the SAMHSA Center for Mental Health Services.] 

1. **Program challenges.** Briefly describe program challenges. Describe possible solutions, if any, to implement in the next quarter.

**Goals for the next quarter, if applicable.**

**Technical assistance needs.**

Attachments. Programs are encouraged to include educational materials, flyers, brochures, videos, training materials, summary data reports, etc., with their quarterly reports. For the final report, programs are required to attach sample program material.

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