1 of 1

Inputs

Funding

Partnership

Staff

Strategies

Activity 1: E.g. outreach, linkage, naloxone

Activity 2:

Activity 3:

Activity 4:

Activity 5:

Short-Term Outcomes

Outcome 1:

Outcome 2:

Outcome 3:

Outcome 4:

Outcome 5:

Long-Term Outcomes

Outcome 1:

Outcome 2:

Outcome 3:

Outcome 4:

Impact

Write here the impact on overdose, HIV, HCV, or other community based outcomes related to substance use and service access

Instructions:

Step 1: Insert your organizational logo on the bottom left corner and partner organization logo

Step 2: Write out the inputs including what funding or personnel you’re partnership is putting into the project together

Step 3: Write the strategies you’ll eb using e.g. co-located services, expanded hours, new geographic location of services

Step 4: Write out the short-term outcomes of what you’ll expect in the first year of the partnership (e.g. increased # of participants seen, demographic shifts, services provided)

Step 5: Write out the anticipated long-term outcomes of what you’ll expect in the first five years of the partnership (e.g. increase in overdose awareness and naloxone provision, reduction in ED visits)

Step 6: Write out the bigger picture impact specific to the community you’re in - this is your north star!