Community-based Mental Health/Suicide Prevention Services Action Plan Template* State Fiscal Year 2018 This template is for use with the State Fiscal Year 2018 DSHS/DBHR Community-based Mental Health Promotion/Suicide Prevention Services grant application. Organization Name: Date Submitted: Goal: Objective: Risk/Protective Factor(s): For assistance using this template please contact the DBHR Prevention Training Team at . This form is locked for filling in form functions, but is not password protected. If you need to add rows, feel free to un-restrict the editing protection and make your edits. Action Plan: Services through June 30, 2018: Community Will you be able Who & Responsible Program/ Strategy Name to begin services How Often When Lead How Many Party (ies) by 1/16/17 Name of List all of the Who is this Organization Who is making community(ies) How many groups implementation service for? Name of program/ strategy Yes or No? delivering sure this gets this program will will be offered? months of the How many people program? done? serve program reached?
Community-based Mental Health/Suicide Prevention Services Action Plan Template* State Fiscal Year 2018 This template is for use with the State Fiscal Year 2018 DSHS/DBHR Community-based Mental Health Promotion/Suicide Prevention Services grant application. Organization Name: Date Submitted: Goal: Objective: Risk/Protective Factor(s): For assistance using this template please contact the DBHR Prevention Training Team at . This form is locked for filling in form functions, but is not password protected. If you need to add rows, feel free to un-restrict the editing protection and make your edits. Action Plan: Services through June 30, 2018: Program/ Strategy Community Name Will you be able to begin services by 1/16/17 How Often When Who & How Many Lead Responsible Party (ies) Name of program/ strategy Name of community(ies) this program will serve Yes or No? How many groups will be offered? List all of the implementation months of the program Who is this service for? How many people reached? Organization delivering program? Who is making sure this gets done?
1713-665D.docx