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ATTACHMENT J:
PPW Evaluation Materials
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CSAT’s 2008 Request for Applications (RFA)
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PPW Evaluation Logic Model
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Overview of PPW Evaluation Design
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Attachment J-1
CSAT’s 2008 Request for Application (RFA)
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Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Services Grant Program for Residential Treatment for Pregnant and
Postpartum Women
Short Title: Pregnant and Postpartum Women (PPW)
(Initial Announcement)
Request for Applications (RFA) No. TI-08-009
Catalogue of Federal Domestic Assistance (CFDA) No.: 93.243
Key Dates:
Application Deadline
Intergovernmental Review
(E.O. 12372)
Public Health System Impact
Statement (PHSIS)/Single
State Agency Coordination
Applications are due by March 18, 2008.
Applicants must comply with E.O. 12372 if their State(s)
participates. Review process recommendations from the State
Single Point of Contact (SPOC) are due no later than 60 days
after application deadline.
Applicants must send the PHSIS to appropriate State and local
health agencies by application deadline. Comments from Single
State Agency are due no later than 60 days after application
deadline.
_________________________________
H. Westley Clark, M.D., J.D., M.P.H.
Director
Center for Substance Abuse Treatment
Substance Abuse and Mental Health
Services Administration
_______________________________
Terry L. Cline, Ph.D.
Administrator
Substance Abuse and Mental Health
Services Administration
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Table of Contents
I.
FUNDING OPPORTUNITY DESCRIPTION ...................................................................... 4
1.
INTRODUCTION .................................................................................................. 4
2.
EXPECTATIONS................................................................................................... 4
II.
AWARD INFORMATION ................................................................................................. 15
III.
ELIGIBILITY INFORMATION ......................................................................................... 16
1.
ELIGIBLE APPLICANTS ................................................................................... 16
2.
COST SHARING.................................................................................................. 16
3.
OTHER ................................................................................................................. 16
IV.
V.
VI.
APPLICATION AND SUBMISSION INFORMATION ................................................... 18
1.
ADDRESS TO REQUEST APPLICATION PACKAGE .................................... 18
2.
CONTENT AND FORM OF APPLICATION SUBMISSION ........................... 18
3.
SUBMISSION DATES AND TIMES .................................................................. 21
4.
INTERGOVERNMENTAL REVIEW (E.O. 12372) REQUIREMENTS ........... 22
5.
FUNDING LIMITATIONS/RESTRICTIONS .................................................... 23
6.
OTHER SUBMISSION REQUIREMENTS ........................................................ 24
APPLICATION REVIEW INFORMATION ...................................................................... 25
1.
EVALUATION CRITERIA ................................................................................. 25
2.
REVIEW AND SELECTION PROCESS ............................................................ 33
ADMINISTRATION INFORMATION .............................................................................. 34
1.
AWARD NOTICES.............................................................................................. 34
2.
ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS.............. 34
3.
REPORTING REQUIREMENTS ........................................................................ 35
VII. AGENCY CONTACTS ....................................................................................................... 36
Appendix A – Checklist for Formatting Requirements and Screenout Criteria for SAMHSA
Grant Applications ................................................................................................................ 37
Appendix B – Guidance for Electronic Submission of Applications ........................................... 39
Appendix C – Statement of Assurance ......................................................................................... 42
Appendix D – Sample Logic Model ............................................................................................. 43
Appendix E – Logic Model Resources ......................................................................................... 45
Appendix F – Confidentiality and Participant Protection............................................................. 46
Appendix G – Funding Restrictions ............................................................................................. 50
Appendix H – Sample Budget and Justification ........................................................................... 52
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Executive Summary:
The Substance Abuse and Mental Health Services Administration, Center for Substance Abuse
Treatment is accepting applications for fiscal year (FY) 2008 for the Residential Treatment for
Pregnant and Postpartum Women (PPW) program. The purpose of these grants is to expand the
availability of comprehensive, high quality residential treatment, recovery support, and family
services for pregnant and postpartum women (postpartum refers to the period after childbirth up
to 12 months) who suffer from alcohol and other drug problems, and their minor children
impacted by perinatal and environmental effects of maternal substance use and abuse. In
addition, grantees are encouraged to include fathers of the children, partners of the women, and
other extended family members of the women and children in treatment in the target population
when their inclusion in non-residential treatment services is deemed appropriate and beneficial.
Funding Opportunity Title:
Pregnant and Postpartum Women (PPW)
Funding Opportunity Number:
TI-08-009
Due Date for Applications:
March 18, 2008
Anticipated Total Available Funding:
$7.87 million
Estimated Number of Awards:
16
Estimated Award Amount:
Up to $500,000
Length of Project Period:
Up to 3 years
Eligible Applicants:
Domestic public and private nonprofit
entities
[See Section III-1 of this RFA for complete
eligibility information.]
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I.
FUNDING OPPORTUNITY DESCRIPTION
1.
INTRODUCTION
The Substance Abuse and Mental Health Services Administration, Center for Substance Abuse
Treatment is accepting applications for fiscal year (FY) 2008 for the Residential Treatment for
Pregnant and Postpartum Women (PPW) program. The purpose of these grants is to expand the
availability of comprehensive, high quality residential treatment, recovery support, and family
services for pregnant and postpartum women (postpartum refers to the period after childbirth up
to 12 months) who suffer from alcohol and other drug problems, and their minor children
impacted by perinatal and environmental effects of maternal substance use and abuse. In
addition, grantees are encouraged to include fathers of the children, partners of the women, and
other extended family members of the women and children in treatment in the target population
when their inclusion in non-residential treatment services is deemed appropriate and beneficial.
PPW is one of SAMHSA’s services grant programs. SAMHSA’s services grants are designed to
address gaps in substance abuse services and/or to increase the ability of States, units of local
government, American Indian/Alaska Native tribes and tribal organizations, and community- and
faith-based organizations to help specific populations or geographic areas with serious, emerging
substance abuse problems. SAMHSA intends that its services grants result in the delivery of
services as soon as possible after award. Service delivery should begin by the 4th month of the
project at the latest.
PPW grants are authorized under Section 508 of the Public Health Service Act, as amended.
This announcement addresses Healthy People 2010 focus area 26 (Substance Abuse).
2.
EXPECTATIONS
2.1
Background
In 1992, in accordance with the statutory authority, section 508 of the Public Health Service Act,
SAMHSA developed a gender and culturally specific residential treatment program for pregnant
and postpartum women. Providing comprehensive services to women during pregnancy
significantly improves the lives of women, children, and their families. Such services are also
important after birth, since the effects of alcohol and drug use continue to have negative
consequences for women, their children, and the entire family.
Over the years, the conceptualization of the program has evolved. While keeping the needs of
the women and their minor children at the core, the concept is more inclusive of the treatment
needs of the family as a whole. This family-centered treatment approach builds on the strength
and resources of the entire family, supports sustained recovery for individual family members,
and improves overall family functioning.
For purposes of this grant announcement, residential treatment programs are programs that offer
organized substance abuse treatment services for women and their minor children that feature a
planned regimen of care in a safe 24-hour residential setting with staff supervision. If any
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treatment services are provided off-site, they must be well-coordinated and integrated to ensure
that specific aspects of the individual treatment plan and services for the children can be
addressed in both facilities. Such services must be coupled with access to primary health, mental
health and social services for pregnant and postpartum women who suffer from alcohol and drug
use problems, and for their minor children impacted by perinatal and environmental effects of
maternal substance use and abuse. These systems of care must be designed to improve the
overall treatment outcomes for the woman, her children, and the family unit as a whole. When
minor children cannot reside in the treatment facility with their mother, and there are no other
current living arrangements available, alternative safe and appropriate accommodations for the
children must be arranged in consultation with the mother. For those minor children who do not
reside in the treatment facility, it is important that they receive required interventions and
services and are actively engaged in the treatment process with their mothers.
Applicants must also screen and assess clients for the presence of co-occurring substance use
(abuse and dependence) and mental disorders and use the information obtained from the
screening and assessment to develop appropriate treatment approaches for the persons identified
as having such co-occurring disorders. For more information on the process of selecting
screening instruments to identify co-occurring substance use and mental disorders, go to
http://www.coce.samhsa.gov/products/cod_presentations.aspx.
As of fall 2007, approximately 1.4 million men and women have been deployed to serve in
Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) in support of the Global
War on Terror. Individuals returning from Iraq and Afghanistan are at increased risk for
suffering post-traumatic stress and other related disorders. Experts estimate that up to one-third
of returning veterans will need mental health and/or substance abuse treatment and related
services. In addition, the family members of returning veterans have an increased need for
related support services. To address these concerns, SAMHSA strongly encourages all
applicants to consider the unique needs of returning veterans and their families in developing
their proposed project.
2.2
Target Population
Low-income (as defined by federal poverty definitions) women, age 18 and over, who are
pregnant, postpartum (the period after childbirth up to 12 months), and their minor children, age
17 and under, who have limited access to quality health services are the target population for the
PPW program. SAMHSA/CSAT has identified traditionally underserved populations, especially
racial and ethnic minority women, as an important subpopulation. SAMHSA/CSAT is especially
concerned about the high morbidity and mortality rates of pregnant women and their infants
among African Americans. In addition, grantees are encouraged to include fathers of the
children, partners of the women, and other extended family members of the women and children
in treatment in the target population when their inclusion in non-residential treatment services is
deemed to be appropriate and beneficial.
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2.3
Program Goals
The PPW program is intended to provide cost effective, comprehensive residential substance
abuse treatment services for women and their minor children and services for other family
members that can be sustained over time. The service system must address the individual needs
of the target population, preserve and support the family unit, and provide a safe and healthy
environment for family members. The PPW program is designed to:
Decrease the use and/or abuse of prescription drugs, alcohol, tobacco, illicit and other
harmful drugs (e.g., inhalants) among pregnant and postpartum women;
Increase safe and healthy pregnancies; improve birth outcomes; and reduce related effects
of maternal drug abuse on infants and children;
Improve the mental and physical health of the women and children;
Improve family functioning, economic stability, and quality of life; and
Decrease involvement in and exposure to crime, violence, sexual and physical abuse, and
child abuse and neglect.
2.4
Minimum Qualifications
In accordance with Section 508 of the Public Health Service Act, the Single State Agency (SSA)
for substance abuse must send a letter certifying that:
The applicant has the capacity to carry out the program described in this Request for
Applications (RFA);
The plans of the applicant for such a program (i.e., the application) are consistent with the
policies of the SSA regarding the treatment of substance abuse; and
The applicant, or any entity through which the applicant will provide required services,
meets all applicable local, city, county and State licensure or certification requirements
regarding the provision of the services involved. [NOTE: If the applicant provides
services in a State or community where licensure, accreditation, or certification is not
required, the SSA must attest to this.]
The letter from the SSA providing these certifications must be included as Appendix 1.
Applications that do not include the certifications letter will not be considered for an award.
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2.5
Program Requirements
General Agreements for Providing Services
Section 508 of the Public Health Service Act mandates that the required services are available to
the women entering the program. SAMHSA requires that services also be made available for the
minor children and family members of both the women and their minor children, as appropriate.
Therefore, in Section C: Proposed Implementation Approach, of the applicant’s Project Narrative
(see Section V of this RFA) applicants must provide a statement agreeing to meet the following
three requirements, and demonstrate their capacity to do so:
1. Services will be provided in a residential setting, in the language and cultural context that
is most appropriate, and the program will be operated at a location that is accessible to
the population served;
2. The minor children will reside with the mother in such facilities, if the mother so
requests. Efforts will be made to include as many children of the mother as is possible in
the residential facility; and
3. The grantee will provide the services directly or through formal agreements with other
public or non-profit private entities.
The applicant is required to develop comprehensive individualized and family service plans to
meet the needs of each family member and the family unit as a whole. These plans must be
developed in consultation with the woman and her family, as appropriate. Service plans must
include individual, group, and family counseling, as appropriate, as well as follow-up relapse
prevention, and supplemental treatment and recovery support services, as required.
To demonstrate that a comprehensive service system is in place to meet the complex needs of
families, applicants must have Memoranda of Understanding (MOUs) or Memoranda of
Agreements (MOAs) with key agencies and organizations, such as local public housing
authorities (for permanent housing for families), child welfare, health, mental health, and child
serving agencies, family court, criminal justice, employment and education programs.
In Appendix 8, you must provide MOUs or MOAs with key agencies and organizations in the
applicant’s network of providers.
Required Supplemental/Recovery Support Services
The following services are either required under Section 508, or are services that SAMHSA
believes are necessary for comprehensive substance abuse treatment for women, their children,
and family members.
These services must be provided either by the grantee or through MOUs/MOAs with providers in
the network.
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Women
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Outreach, engagement, pre-treatment, screening, and assessment;
Detoxification;
Substance abuse education, treatment, and relapse prevention;
Medical, dental, other physical health care services, including diabetes, hypertension,
prenatal and postpartum health care; and referrals for necessary hospital services;
Training in parenting and life skills;
Education, screening, counseling, and treatment of hepatitis, HIV/AIDS, other STDs, and
related issues;
Mental health assessment and treatment;
Trauma-informed services, including assessment and interventions for emotional, sexual,
and physical abuse;
Employment readiness, training, and placement;
Education and tutoring assistance for obtaining a GED and higher education;
Childcare during periods in which the woman is engaged in therapy or in other necessary
health or rehabilitative activities;
Transportation and other wraparound services; and
Peer-to-peer recovery support activities such as groups, mentoring, and coaching.
Children
• Screenings and developmental diagnostic assessments regarding the social, emotional,
cognitive, and physical status of the infants and children;
• Therapeutic interventions, including child care, counseling, play and art therapy,
occupational, speech and physical therapies;
• Pediatric health care, including immunizations, and treatment for asthma, diabetes,
hypertension, and any perinatal effects of maternal substance abuse, e.g., HIV;
• Social services and financial supports;
• Education and recreational services;
• Mental health and trauma services; and
• Substance abuse education and prevention.
Family
• Engagement of the family in the treatment process including individual and family
counseling/therapy;
• Alcohol and drug education;
• Parenting training;
• Family strengthening and reunification; and
• Referral services for substance abuse, social, psychological, vocational and medical
services.
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Case Management
• Coordination of services;
• Assessment and monitoring of the extent to which required services are appropriate for
women and children;
• Assistance with community reintegration, before and after discharge, including referrals
to appropriate resources; and
• Assistance in accessing resources from Federal, State, and local programs that provide a
range of treatment services, including substance abuse, health, mental health, housing,
employment, education and training.
Residential Treatment Phase and Length of Stay
The project may propose a residential phase for a specific time frame, e.g., 3, 6, 9, or 12 months.
The selected treatment phase should be consistent with the applicant’s experience with, and
knowledge of, the target population and what is reflected in the literature for women who have
previously used such services. Applicants should use information about length of stay for this
target population to more accurately estimate the number of women to be served by the project.
Ultimately, a woman’s length of stay in the residential treatment phase should be guided by her
individual service plan. While there may be some exceptions, SAMHSA/CSAT recommends
that the residential treatment phase not exceed 12 months.
Phase-in Plan
In Appendix 2, you are required to include a detailed phase-in plan with timelines and a
reasonable budget for the phase-in period. The phase-in time may not exceed 3 months after the
award.
Reimbursement for Services
In Appendix 3, you must state whether or not you will seek reimbursements from the client
and/or from Medicaid. If you intend to receive such reimbursements, you must attest to your
willingness to meet the requirements noted below under Status as a Medicaid Provider and
Imposition of Charges.
Status as a Medicaid Provider: Except for institutions for mental diseases as defined in section
1905(i) of the Social Security Act, applicants must show, in the case of any authorized treatment
service available pursuant to the State plan approved under title XIX of the Social Security Act,
that:
• The services will be provided directly, the applicant has entered into a participation
agreement under the State plan, and the applicant is qualified to receive payments under
this plan; or
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• The applicant has or will enter into an agreement with a public or nonprofit private entity
under which the entity will provide the service, the entity has entered into a participation
agreement under the State plan and the entity is qualified to receive payments under the
plan. This participation agreement shall be waived if the entity does not, in providing
health care services, impose a charge or accept reimbursement from any third-party
payor, including reimbursement under an insurance policy or under any Federal or State
health benefits plan. (For further details see Section 508(e)(2) (A), (B), and (C) of the
Public Health Services Act.)
Imposition of Charges. If a charge is imposed for the provision of authorized services to an
eligible woman, such charge—
• Will be made according to a schedule of charges that is made available to the public;
• Will be adjusted to reflect the income of the woman involved; and
• Will not be imposed on any such woman with an income of less than 185 percent of the
official poverty line, as established by the Director of Management and Budget (OMB)
and revised by the Secretary in accordance with section 673 (2) of the Omnibus Budget
Reconciliation Act of 1981.
Other Award Requirements
Technical Assistance: SAMHSA/CSAT will provide post award support to grantees through
technical assistance on administrative, programmatic, and evaluation issues; data collection,
analysis and interpretation; and development of reports, products, and publications.
Facility Licensing: The residential treatment facility must meet all State and local building,
housing, health, safety and fire code regulations, as well as other applicable State and local childcare and residential facility licensing requirements. Residential facility licensure requirements
differ from those of treatment provider licensure discussed in this RFA in Section I-2.4
Minimum Qualifications. Licensing requirements for facilities offering group residential care
for infants and children are sometimes stringent, and may extend to staffing patterns with
implications for the number and characteristics of the project staff. If the applicant does not have
control of a currently operating facility and plans to lease a space/facility, then the applicant must
have a written agreement with the owner of the space/facility to lease this space to the applicant
upon award (Letter of Agreement must be provided in Appendix 4). If the applicant intends
to lease a space/facility upon award, the space/facility must already have been inspected and
meet the requirements for a residential program as certified by the appropriate State agency.
In identifying a facility, the applicant must be particularly sensitive to the public health needs of
the target population, including vulnerability for TB, hepatitis, asthma, and environmental issues
related to lead, asbestos, and mold.
Documentation of compliance with residential facility licensure requirements must be provided
in the application in Appendix 4.
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Notification: Within 30 days of receipt of an award, the grantee must notify the Single State
Agency (SSA) and local governmental unit responsible for administering substance abuse
treatment services. This notification assists State and local authorities in coordinating substance
abuse treatment activities within their communities.
Collaboration: Accessing housing suitable for project activities may be facilitated by advance
collaborations, memoranda of understanding (MOUs)/agreements (MOAs) with local Public
Housing Authorities (PHAs). The Housing and Urban Development (HUD) Handbook 7465.1
REV 2, dated August 1987 (CH. 6) permits a PHA to designate select units for occupancy by
members of a specific target population, and/or contract with a social service provider to manage
certain dwelling units, if it so chooses. A PHA may also submit a request for authorization from
HUD to lease/modify dwelling space for non-dwelling purposes such as a substance abuse
treatment center. PHAs and providers considering such approaches should discuss their
proposals with the local HUD Field Office prior to the development of an application, and obtain
any relevant assurances.
Continued Funding Considerations: Grantees will be responsible for ensuring that all direct
providers of services involved in the proposed continuum of care are in compliance with local,
city, county, and State licensing, certification and accreditation requirements, and that all
MOUs/MOAs and subcontracts within the system of care remain current and active.
2.6
Infrastructure Development (maximum 15% of total grant award)
Although services grant funds must be used primarily for direct services, SAMHSA recognizes
that infrastructure changes may be needed to implement the services or improve their
effectiveness. You may use up to 15% of the total services grant award for the following types
of infrastructure development, if necessary to support the direct service expansion of the grant
project, such as:
Developing partnerships with other service providers for service delivery.
Enhancing your computer system, management information system (MIS), electronic
health records, etc.
Training/workforce development to help your staff or other providers in the community
identify mental health or substance abuse issues or provide effective services consistent
with the purpose of the grant program.
2.7
Using Evidence-Based Practices
SAMHSA’s services grants are intended to fund services or practices that have a demonstrated
evidence base and that are appropriate for the target population. An evidence-based practice,
also called EBP, refers to approaches to prevention or treatment that are validated by some form
of documented scientific evidence. In your application, you will need to:
o Identify the evidence-based practice you propose to implement.
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o Identify and discuss the evidence that shows that the practice is effective. [See note
below.]
o Discuss the population(s) for which this practice has been shown to be effective and show
that it is appropriate for your target population(s). [See note below.]
Note: SAMHSA recognizes that EBPs have not been developed for all populations
and/or service settings. For example, certain interventions for American
Indians/Alaska Natives, rural or isolated communities, or recent immigrant
communities may not have been formally evaluated and, therefore, have a limited or
nonexistent evidence base. In addition, other interventions that have an established
evidence base for certain populations or in certain settings may not have been
formally evaluated with other subpopulations or within other settings. Applicants
proposing to serve a population with an intervention that has not been formally
evaluated with that population are encouraged to provide other forms of evidence
that the practice(s) they propose is appropriate for the target population. Evidence
may include unpublished studies, preliminary evaluation results, clinical (or other
professional association) guidelines, findings from focus groups with community
members, etc. You may describe your experience either with the target population
or in managing similar programs. Information in support of your proposed
practice needs to be sufficient to demonstrate the appropriateness of your practice
to the people reviewing your application.
o Document the evidence that the practice you have chosen is appropriate for the outcomes
you want to achieve.
o Explain how the practice you have chosen meets SAMHSA’s goals for this grant
program.
o Describe any modifications/adaptations you will need to make to this practice to meet the
goals of your project and why you believe the changes will improve the outcomes. We
expect that you will implement your evidence-based service/practice in a way that is as
close as possible to the original service/practice. However, SAMHSA understands that
you may need to make minor changes to the service/practice to meet the needs of your
target population or your program, or to allow you to use resources more efficiently. You
must describe any changes to your proposed service/practice that you believe are
necessary for these purposes. You may describe your own experience either with the
target population or in managing similar programs. However, you will need to convince
the people reviewing your application that the changes you propose are justified.
o Explain why you chose this evidence-based practice over other evidence-based practices.
Resources for Evidence-Based Practices:
You will find information on evidence-based practices in SAMHSA’s Guide to Evidence-Based
Practices on the Web at www.samhsa.gov/ebpwebguide. SAMHSA has developed this Web site
to provide a simple and direct connection to Web sites with information about evidence-based
interventions to prevent and/or treat mental and substance use disorders. The Guide provides a
short description and a link to dozens of Web sites with relevant evidence-based practices
information – either specific interventions or comprehensive reviews of research findings.
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Please note that SAMHSA’s Guide to Evidence-Based Practices also references another
SAMHSA Web site, the National Registry of Evidence-Based Programs and Practices (NREPP).
NREPP is a searchable database of interventions for the prevention and treatment of mental and
substance use disorders. NREPP is intended to serve as a decision support tool, not as an
authoritative list of effective interventions. Being included in NREPP, or in any other resource
listed in the Guide, does not mean an intervention is “recommended” or that it has been
demonstrated to achieve positive results in all circumstances. You must document that the
selected practice is appropriate for the specific target population and purposes of your project.
In addition to the Web site noted above, you may provide information on research studies to
show that the services/practices you plan to implement are evidence-based. This information is
usually published in research journals, including those that focus on minority populations. If this
type of information is not available, you may provide information from other sources, such as
unpublished studies or documents describing formal consensus among recognized experts.
2.8
Data Collection and Performance Measurement
All SAMHSA grantees are required to collect and report certain data so that SAMHSA can meet
its obligations under the Government Performance and Results Act (GPRA). Grantees will be
required to report performance in several areas relating to the client’s substance use, family and
living condition, employment status, social connectedness, access to treatment, retention in
treatment and criminal justice status. This information will be gathered using the data collection
tool referenced below. The collection of these data will enable CSAT to report on the National
Outcome Measures (NOMs) which have been defined by SAMHSA as key priority areas relating
to substance use.
Applicants must document their ability to collect and report the required data in “Section E:
Performance Assessment and Data” of their applications. Grantees must collect and report data
using the Discretionary Services Client Level GPRA tool, which can be found at www.samhsagpra.samhsa.gov (click on ‘Data Collection Tools/Instructions’), along with instructions for
completing it. Hard copies are also available in the application kits, which you can request from
the SAMHSA Information Line at 1-877-SAMHSA7 [TDD: 1-800-487-4889.]
GPRA data must be collected in a face-to-face interview at baseline (i.e., the client’s entry into
the project), discharge, and 6 months post the baseline. GPRA data must be entered into the
GPRA Web system within 7 business days of the forms being completed. In addition, 80% of
the participants must be followed up. GPRA data are to be collected and then entered into
CSAT’s GPRA Data Entry and Reporting System (www.samhsa-gpra.samhsa.gov).
Training and technical assistance on data collecting, tracking, and follow-up, as well as data
entry, will be provided by CSAT.
2.9
Performance Assessment
Grantees are required to conduct a process evaluation and participate in a cross-site evaluation,
conducted by CSAT, using a common protocol that has been approved by OMB. You must
consider your process evaluation plan and participation in the cross-site when preparing the
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project budget. Grantees are required to participate in all technical assistance and training
activities designed to support the cross-site activity.
The process evaluation should be designed to provide regular feedback to the project to improve
services. Process evaluation must measure change relating to project goals and objectives over
time compared to baseline information. Control or comparison groups are not required.
Process components should address issues such as:
How closely did implementation match the plan?
What types of deviation from the plan occurred?
What led to the deviations?
What effect did the deviations have on the planned intervention and evaluation?
Who provided (program, staff) what services (modality, type, intensity, duration), to
whom (individual characteristics), in what context (system, community), and at what cost
(facilities, personnel, dollars)?
The cross-site evaluation will measure the outcomes of treatment at each grantee site on women
and their minor children. SAMHSA/CSAT will use this information to document and report the
extent to which the goals of the RFA were achieved, as mandated by Congress. Grantees must
collect data on the women and their minor children who participate in treatment over the threeyear life of the project. Data on women and their minor children will be collected for up to
twelve months following intake and at discharge. Much of the data required for the assessment
are routinely collected by the projects as part of their own program management efforts.
However, common data collection tools need to be used in order to ensure comparability of data
gathered across projects. In addition, data will be gathered periodically from project staff to
document any changes that might have occurred in the interventions.
This cross-site evaluation seeks to show that from treatment intake to treatment discharge:
There was a decrease in the use and/or abuse of prescription drugs, alcohol, tobacco, and
illicit drugs among pregnant and postpartum women across the projects.
Women and minor children in these projects experienced improvement in their mental
and physical health, and family functioning.
There was decreased involvement and intent for involvement, in crime, violence, and
abuse of all kinds, both as victims and perpetrators.
There was improvement in quality of life from the client’s perspective related to health,
social functioning, and environmental support.
There was a decrease in barriers to accessing treatment resulting in early entry into
treatment in the first trimester of their pregnancy and a decrease in barriers to accessing
project-related services.
Data collection tools approved for the PPW program are listed below. You may download them
from the SAMHSA Web site at www.samhsa-gpra.samhsa.gov.
Child Data Collection Tool
Allen Barriers to Treatment
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Ferrans and Powers Quality of Life Index
BASIS 24 Survey
Denver Developmental Screening Inventory II
Child Well Being Scales
CRAFFT
Middle Childhood Developmental Assessment Guide
Adolescent Developmental Assessment Guide
Women’s Discharge Tool
Children’s Discharge Tool
Family Recovery Support Services Tool
No more than 20% of the total grant award may be used for data collection, performance
measurement, and performance assessment, e.g., activities required in Sections I-2.8 and
2.9.
3.0
Grantee Meetings
You must plan to send a minimum of two people (including the Project Director) to at least one
joint grantee meeting in each year of the grant, and you must include funding for this travel in
your budget. At these meetings, grantees will present the results of their projects and Federal
staff will provide technical assistance. Each meeting will be 3 days. These meetings are usually
held in the Washington, D.C., area and attendance is mandatory.
II.
AWARD INFORMATION
Funding Mechanism:
Grants
Anticipated Total Available Funding:
$7.87 million
Estimated Number of Awards:
16
Estimated Award Amount:
Up to $500,000
Length of Project Period:
Up to 3 years
Proposed budgets cannot exceed $500,000 in total costs (direct and indirect) in any year of
the proposed project. Applicants should be aware that Congress funded this program in
the FY 2008 appropriation for SAMHSA even though funding for the program was not
requested in the FY 2008 President’s budget. Funding beyond FY 2008 is not guaranteed.
SAMHSA is allowing applicants to submit proposals for 2 additional budget years for
planning purposes and for technical assistance in sustainability activities.
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III.
ELIGIBILITY INFORMATION
1.
ELIGIBLE APPLICANTS
Eligible applicants are domestic public and private nonprofit entities. For example, State and
local governments, federally recognized American Indian/Alaska Native tribes and tribal
organizations, urban Indian organizations, public or private universities and colleges; and
community- and faith-based organizations may apply. The statutory authority for this program
prohibits grants to for-profit agencies. PPW grantees funded September 29, 2006 (FY 2006) are
ineligible to apply under this grant announcement.
2.
COST SHARING
Non-Federal Matching Funds are required under the statutory authority (Section 508 of the
Public Health Service Act) for the PPW program. Non-Federal contributions are required and
may be in cash or in-kind, fairly evaluated. The matching funds must not be less than $1 for each
$9 of Federal funds provided in years one and two, and not less than $1 for each $3 of Federal
funds in any subsequent year. Matching funds must meet the same test of allowability as costs
charged to Federal grants. Sources of matching funds are State and local governmental
appropriations (non-Federal), foundations, and other private non-profit or for-profit
organizations. In-kind contributions may include facilities, equipment, or services used in direct
support of the project.
In Appendix 5 of the application, you must provide a letter from the funding source(s) attesting
that the matching funds are available, and are not derived from Federal sources. Applications
that do not contain documentation (in Appendix 5) that non-Federal matching funds are
available will not be considered for an award.
3.
OTHER
3.1
Additional Eligibility Requirements
You must comply with the following requirements, or your application will be screened out
and will not be reviewed: use of the PHS 5161-1 application; application submission
requirements in Section IV-3 of this document; and formatting requirements provided in
Appendix A of this document.
3.2
Evidence of Experience and Credentials
SAMHSA believes that only existing, experienced, and appropriately credentialed organizations
with demonstrated infrastructure and expertise will be able to provide required services quickly
and effectively. You must meet three additional requirements related to the provision of services.
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The three requirements are:
x
A provider organization for direct client substance abuse treatment services
appropriate to the grant must be involved in the proposed project. The provider may
be the applicant or another organization committed to the project. More than one
provider organization may be involved;
x
Each direct service provider organization must have at least 2 years experience (as of
the due date of the application) providing relevant services in the geographic area(s)
in which services are to be provided (official documents must establish that the
organization has provided relevant services for the last 2 years); and
x Each direct service provider organization must comply with all applicable local (city,
county) and State/tribal licensing, accreditation, and certification requirements, as of
the due date of the application.
[Note: The above requirements apply to all service provider organizations. A
license from an individual clinician will not be accepted in lieu of a provider
organization’s license.]
In Appendix 6 of your application, you must: (1) identify at least one experienced, licensed
service provider organization; (2) include a list of all direct service provider organizations that
have agreed to participate in the proposed project, including the applicant agency if the applicant
is a treatment or prevention service provider organization; and (3) include the Statement of
Assurance (provided in Appendix C of this announcement), signed by the authorized
representative of the applicant organization identified on the face-page (SF 424 v2) of the
application, attesting that all participating service provider organizations:
• meet the 2-year experience requirement;
• meet applicable licensing, accreditation, and certification requirements; and
• if the application is within the funding range for grant award, the applicant will
provide the Government Project Officer (GPO) with the required documentation
within the time specified.
In addition, if, following application review, your application’s score is within the funding range,
the GPO will call you and request that the following documentation be sent by overnight mail:
x a letter of commitment that specifies the nature of the participation and what
service(s) will be provided from every service provider organization that has agreed
to participate in the project;
x official documentation that all participating organizations have been providing
relevant services for a minimum of 2 years before the date of the application in the
area(s) in which the services are to be provided; and
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x
official documentation that all participating service provider organizations comply
with all applicable local (city, county) and State/tribal requirements for licensing,
accreditation, and certification or official documentation from the appropriate agency
of the applicable State/tribal, county, or other governmental unit that licensing,
accreditation, and certification requirements do not exist.
If the GPO does not receive this documentation within the time specified, the application
will not be considered for an award.
IV.
APPLICATION AND SUBMISSION INFORMATION
1.
ADDRESS TO REQUEST APPLICATION PACKAGE
You may request a complete application kit from the SAMHSA Information Line at 1-877SAMHSA7 [TDD: 1-800-487-4889].
You also may download the required documents from the SAMHSA Web site at
www.samhsa.gov/grants/apply.aspx
Additional materials available on this Web site include:
a grant writing technical assistance manual for potential applicants;
standard terms and conditions for SAMHSA grants;
guidelines and policies that relate to SAMHSA grants (e.g., guidelines on cultural
competence, consumer and family participation, and evaluation); and
a list of certifications and assurances referenced in item 21 of the SF 424 v2.
2.
CONTENT AND FORM OF APPLICATION SUBMISSION
2.1
Application Kit
SAMHSA application kits include the following documents:
PHS 5161-1 (revised July 2000) – Includes the face page (SF 424 v2), budget forms,
assurances, certification, and checklist. You must use the PHS 5161-1. Applications
that are not submitted on the required application form will be screened out and
will not be reviewed.
Request for Applications (RFA) – Provides a description of the program, specific
information about the availability of funds, and instructions for completing the grant
application. This document is the RFA. The RFA will be available on the SAMHSA Web
site (www.samhsa.gov/grants/index.aspx) and a synopsis of the RFA is available on the
Federal grants Web site (www.Grants.gov).
You must use all of the above documents in completing your application.
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2.2
Required Application Components
Applications must include the required ten application components (Face Page, Abstract, Table
of Contents, Budget Form, Project Narrative and Supporting Documentation, Appendices,
Assurances, Certifications, Disclosure of Lobbying Activities, and Checklist).
Face Page – SF 424 v2 is the face page. This form is part of the PHS 5161-1. [Note:
Applicants must provide a Dun and Bradstreet (DUNS) number to apply for a grant or
cooperative agreement from the Federal Government. SAMHSA applicants are required
to provide their DUNS number on the face page of the application. Obtaining a DUNS
number is easy and there is no charge. To obtain a DUNS number, access the Dun and
Bradstreet Web site at www.dunandbradstreet.com or call 1-866-705-5711. To expedite
the process, let Dun and Bradstreet know that you are a public/private nonprofit
organization getting ready to submit a Federal grant application.]
Abstract – Your total abstract should not be longer than 35 lines. It should include the
project name, population to be served (demographics and clinical characteristics),
strategies/interventions, project goals and measurable objectives, including the number of
people to be served annually and throughout the lifetime of the project, etc. In the first
five lines or less of your abstract, write a summary of your project that can be used, if
your project is funded, in publications, reporting to Congress, or press releases.
Table of Contents – Include page numbers for each of the major sections of your
application and for each appendix.
Budget Form – Use SF 424A, which is part of the PHS 5161-1. Fill out Sections B, C,
and E of the SF 424A. A sample budget and justification is included in Appendix H of
this document.
Project Narrative and Supporting Documentation – The Project Narrative describes
your project. It consists of Sections A through E. Sections A-E together may not be
longer than 30 pages. (Remember that if your Project Narrative starts on page 5 and ends
on page 35, it is 31 pages long, not 30 pages.) More detailed instructions for completing
each section of the Project Narrative are provided in “Section V – Application Review
Information” of this document.
The Supporting Documentation provides additional information necessary for the review
of your application. This supporting documentation should be provided immediately
following your Project Narrative in Sections F through I. There are no page limits for
these sections, except for Section H, Biographical Sketches/Job Descriptions. Additional
instructions for completing these sections are included in Section V under “Supporting
Documentation.” Supporting documentation should be submitted in black and white (no
color).
Appendices 1 through 10 – Use only the appendices listed below. If your application
includes any appendices not required in this document, they will be disregarded. Do not
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use more than a total of 30 pages for Appendices 1-7, and 10 combined. There are no
page limitations for Appendices 8 and 9. Do not use appendices to extend or replace any
of the sections of the Project Narrative. Reviewers will not consider them if you do.
Appendix 1: A letter signed by the SSA certifying that the three requirements listed
in Section I-2.4 of this RFA, Minimum Qualifications section, have been met.
Appendix 2: Phase-in Plan. Include a detailed phase-in plan with timelines and a
reasonable budget for the phase-in period. The phase-in time may not exceed 3
months after the award.
Appendix 3: Certifications of the applicant’s intent to comply with Section 508
requirements regarding Status as a Medicaid Provider and Imposition of Charges.
See Section I-2.5, Program Requirements, Reimbursement for Services section.
Appendix 4: Facility. Provide documentation that the facility meets all State and
local building, housing, health, safety and fire code regulations, as well as other
applicable State and local child care and residential facility licensing. If applicable,
i.e., you are going to lease space/facility upon award, provide a letter of agreement
with the owner of the facility to be leased.
Appendix 5: Letter from the funding source attesting that the matching funds are
available and are not derived from Federal sources.
Appendix 6: (1) Identification of at least one experienced, licensed service provider
organization; (2) a list of all direct service provider organizations that have agreed to
participate in the proposed project, including the applicant agency, if it is a treatment
service provider organization; (3) the Statement of Assurance (provided in Appendix
C of this announcement) signed by the authorized representative of the applicant
organization identified on the face page of the application, that assures SAMHSA that
all listed providers meet the 2-year experience requirement, and that if the application
is within the funding range for an award, the applicant will send the GPO the required
documentation within the specified time; (4) letters of commitment/support.
Appendix 7: Letter to the SSA
Appendix 8: Memoranda of Understanding or Agreements (MOUs and MOAs)
with key agencies and organizations in the network of providers.
Appendix 9: Copies of all Data Collection Instruments/Interview Protocols that
you propose to use.
Appendix 10: Copies of Consent Forms. If consent forms are not in English,
provide English translations.
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2.3
Assurances – Non-Construction Programs. You must read the list of assurances
provided on the SAMHSA Web site or in the application kit before signing the face page
(SF 424 v2) of the application. You are also required to complete the Assurance of
Compliance with SAMHSA Charitable Choice Statutes and Regulations Form SMA 170.
This form will be posted on SAMHSA’s Web site with the RFA and provided in the
application kits.
Certifications – You must read the list of certifications provided on the SAMHSA Web
site or in the application kit before signing the face page (SF 424 v2) of the application.
Disclosure of Lobbying Activities – You must submit Standard Form LLL found in the
PHS 5161-1. Federal law prohibits the use of appropriated funds for publicity or
propaganda purposes, or for the preparation, distribution, or use of the information
designed to support or defeat legislation pending before the Congress or State
legislatures. This includes “grass roots” lobbying, which consists of appeals to members
of the public suggesting that they contact their elected representatives to indicate their
support for or opposition to pending legislation or to urge those representatives to vote in
a particular way. If no lobbying is to be disclosed, mark N/A on the form.
Checklist – Use the Checklist found in PHS 5161-1. The Checklist ensures that you
have obtained the proper signatures, assurances and certifications. If you are submitting
a paper application, the Checklist should be the last page.
Application Formatting Requirements
Please refer to Appendix A, Checklist for Formatting Requirements and Screenout Criteria
for SAMHSA Grant Applications, for SAMHSA’s basic application formatting
requirements. Applications that do not comply with these requirements will be screened
out and will not be reviewed.
3.
SUBMISSION DATES AND TIMES
Applications are due by close of business on March 18, 2008. Hard copy applications are due
by 5:00 PM (EST). Electronic applications are due by 11:59 PM (EST). Hand carried
applications will not be accepted. Applications may be shipped using only DHL, Federal
Express (FedEx), United Parcel Service (UPS), or the United States Postal Service (USPS).
You will be notified by postal mail that your application has been received.
Your application must be received by the application deadline or it will not be considered
for review. Please remember that mail sent to Federal facilities undergoes a security screening
prior to delivery. You are responsible for ensuring that you submit your application so that it
will arrive by the application due date and time.
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If an application is mailed to a location or office (including room number) that is not designated
for receipt of the application and, as a result, the designated office does not receive your
application by the deadline, your application will be considered late and ineligible for review.
SAMHSA will not accept or consider any applications sent by facsimile.
SAMHSA accepts electronic submission of applications through www.Grants.gov. Please refer
to Appendix B for “Guidance for Electronic Submission of Applications.”
4.
INTERGOVERNMENTAL REVIEW (E.O. 12372) REQUIREMENTS
This grant program is covered under Executive Order (EO) 12372, as implemented through
Department of Health and Human Services (DHHS) regulation at 45 CFR Part 100. Under this
Order, States may design their own processes for reviewing and commenting on proposed
Federal assistance under covered programs. Certain jurisdictions have elected to participate in
the EO process and have established State Single Points of Contact (SPOCs). A current listing
of SPOCs is included in the application kit and can be downloaded from the Office of
Management and Budget (OMB) Web site at www.whitehouse.gov/omb/grants/spoc.html.
Check the list to determine whether your State participates in this program. You do not
need to do this if you are an American Indian/Alaska Native tribe or tribal organization.
If your State participates, contact your SPOC as early as possible to alert him/her to the
prospective application(s) and to receive any necessary instructions on the State’s review
process.
For proposed projects serving more than one State, you are advised to contact the SPOC
of each affiliated State.
The SPOC should send any State review process recommendations to the following
address within 60 days of the application deadline. For United States Postal Service:
Crystal Saunders, Director of Grant Review, Office of Program Services, Substance
Abuse and Mental Health Services Administration, Room 3-1044, 1 Choke Cherry Road,
Rockville, MD 20857. ATTN: SPOC – Funding Announcement No. TI-08-009. Change
the zip code to 20850 if you are using another delivery service.
In addition, if you are a community-based, non-governmental service provider and you are not
transmitting your application through the State, you must submit a Public Health System Impact
Statement (PHSIS)1 to the head(s) of appropriate State or local health agencies in the area(s) to
1
Approved by OMB under control no. 0920-0428; Public reporting burden for the Public Health System Reporting
Requirement is estimated to average 10 minutes per response, including the time for copying the face page of SF
424 v2 and the abstract and preparing the letter for mailing. An agency may not conduct or sponsor, and a person is
not required to respond to, a collection of information unless it displays a currently valid OMB control number. The
OMB control number for this project is 0920-0428. Send comments regarding this burden to CDC Clearance
Officer, 1600 Clifton Road, MS D-24, Atlanta, GA 30333, ATTN: PRA (0920-0428).
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be affected no later than the application deadline. The PHSIS is intended to keep State and local
health officials informed of proposed health services grant applications submitted by
community-based, non-governmental organizations within their jurisdictions. If you are a State
or local government or American Indian/Alaska Native tribe or tribal organization, you are not
subject to these requirements.
The PHSIS consists of the following information:
a copy of the face page of the application (SF 424 v2); and
a summary of the project, no longer than one page in length, that provides: 1) a
description of the population to be served; 2) a summary of the services to be provided;
and 3) a description of the coordination planned with appropriate State or local health
agencies.
For SAMHSA grants, the appropriate State agencies are the Single State Agencies (SSAs) for
substance abuse and mental health. A listing of the SSAs can be found on SAMHSA’s Web site
at www.samhsa.gov. If the proposed project falls within the jurisdiction of more than one State,
you should notify all representative SSAs.
If applicable, you must include a copy of a letter transmitting the PHSIS to the SSA in Appendix
7, “Letter to the SSA.” The letter must notify the State that, if it wishes to comment on the
proposal, its comments should be sent not later than 60 days after the application deadline to the
following address. For United States Postal Service: Crystal Saunders, Director of Grant
Review, Office of Program Services, Substance Abuse and Mental Health Services
Administration, Room 3-1044, 1 Choke Cherry Road, Rockville, MD 20857. ATTN: SSA –
Funding Announcement No. TI-08-009. Change the zip code to 20850 if you are using another
delivery service.
In addition:
Applicants may request that the SSA send them a copy of any State comments.
The applicant must notify the SSA within 30 days of receipt of an award.
5.
FUNDING LIMITATIONS/RESTRICTIONS
Cost principles describing allowable and unallowable expenditures for Federal grantees,
including SAMHSA grantees, are provided in the following documents, which are available at
www.samhsa.gov/grants/management.aspx:
Institutions of Higher Education: OMB Circular A-21
State and Local Governments and Federally Recognized Indian Tribal Governments:
OMB Circular A-87
Nonprofit Organizations: OMB Circular A-122
Hospitals: 45 CFR Part 74, Appendix E
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In addition, SAMHSA’s PPW grant recipients must comply with the following funding
restrictions:
No more than 15% of the total grant award may be used for developing the infrastructure
necessary for expansion of services.
No more than 20% of the total grant award may be used for data collection and
performance assessment, including incentives for participating in the required data
collection follow-up.
SAMHSA grantees must also comply with SAMHSA’s standard funding restrictions, which
are included in Appendix G.
6.
OTHER SUBMISSION REQUIREMENTS
You may submit your application in either electronic or paper format:
Submission of Electronic Applications
SAMHSA accepts electronic submission of applications through www.Grants.gov. Electronic
submission is voluntary. No review points will be added or deducted, regardless of whether you
use the electronic or paper format.
To submit an application electronically, you must use the www.Grants.gov apply site. You will
be able to download a copy of the application package from www.Grants.gov, complete it offline, and then upload and submit the application via the Grants.gov site. E-mail submissions will
not be accepted.
Please refer to Appendix B for detailed instructions on submitting your application
electronically.
Submission of Paper Applications
You must submit an original application and 2 copies (including appendices). The original and
copies must not be bound. Do not use staples, paper clips, or fasteners. Nothing should be
attached, stapled, folded, or pasted.
Send applications to the address below:
For United States Postal Service:
Crystal Saunders, Director of Grant Review
Office of Program Services
Substance Abuse and Mental Health Services Administration
Room 3-1044
1 Choke Cherry Road
Rockville, MD 20857
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Change the zip code to 20850 if you are using another delivery service.
Do not send applications to other agency contacts, as this could delay receipt. Be sure to include
“PPW – TI-08-009” in item number 12 on the face page (SF 424 v2) of any paper applications.
If you require a phone number for delivery, you may use (240) 276-1199.
Hand carried applications will not be accepted. Applications may be shipped using only
DHL, Federal Express (FedEx), United Parcel Service (UPS), or the United States Postal
Service (USPS).
SAMHSA will not accept or consider any applications sent by facsimile.
V.
APPLICATION REVIEW INFORMATION
1.
EVALUATION CRITERIA
The Project Narrative describes what you intend to do with your project and includes the
Evaluation Criteria in Sections A-E below. Your application will be reviewed and scored
according to the quality of your response to the requirements in Sections A-E.
In developing the Project Narrative section of your application, use these instructions,
which have been tailored to this program. These are to be used instead of the
“Program Narrative” instructions found in the PHS 5161-1.
The Project Narrative (Sections A-E) together may be no longer than 30 pages.
You must use the five sections/headings listed below in developing your Project
Narrative. Be sure to place the required information in the correct section, or it will
not be considered. Your application will be scored according to how well you address
the requirements for each section of the Project Narrative.
Reviewers will be looking for evidence of cultural competence in each section of the
Project Narrative, and will consider how well you address the cultural competence
aspects of the evaluation criteria when scoring your application. SAMHSA’s
guidelines for cultural competence can be found on the SAMHSA Web site at
www.samhsa.gov. Click on “Grants/Applying for a New SAMHSA Grant/Guidelines
for Assessing Cultural Competence.”
The Supporting Documentation you provide in Sections F-I and Appendices 1-10 will
be considered by reviewers in assessing your response, along with the material in the
Project Narrative.
The number of points after each heading is the maximum number of points a review
committee may assign to that section of your Project Narrative. Although scoring
weights are not assigned to individual bullets, applicants are encouraged to respond to
each bulleted statement.
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Section A:
Statement of Need (10 points)
Describe the target population and the geographic area to be served, and justify the
selection of both. Include the numbers to be served annually and through the lifetime of
the project, as well as demographic information.
Describe the nature of the problem and extent of the need (e.g., current prevalence rates
or incidence data) for the target population based on data. The statement of need should
include a clearly established baseline for the project. Documentation of need may come
from a variety of qualitative and quantitative sources. The quantitative data could come
from local data or trend analyses, State data (e.g., from State Needs Assessments), and/or
national data (e.g., from SAMHSA’s National Survey on Drug Use and Health or from
National Center for Health Statistics/Centers for Disease Control reports). For data
sources that are not well known, provide sufficient information on how the data were
collected so reviewers can assess the reliability and validity of the data.
• Non-tribal applicants must show that identified needs are consistent with priorities of the
State or county that has primary responsibility for the service delivery system.
Fully describe existing services, including the number and type of current treatment
services/slots/beds available and the number of people currently being served in the target
area and in the applicant organization. Include the number of people on a waiting list, if
there is one.
Section B:
Proposed Evidence-Based Service/Practice (30 points)
Clearly state the purpose, goals and objectives of your proposed project. Describe how
achievement of the goals will produce meaningful and relevant results (e.g., increase
access, availability, prevention, outreach, pre-services, treatment, and/or intervention)
and support SAMHSA’s goals for the program.
Identify the evidence-based service/practice that you propose to implement for the
women, children, fathers of children, partners of women and extended family members,
and the source of your information. (See Section I-2.7, Using Evidence-Based Practices.)
Discuss the evidence that shows that this practice is effective with the target population.
If the evidence is limited or non-existent for the target population, provide other
information to support your selection of the intervention for the target population.
Document the evidence that the practice you have chosen is appropriate for the outcomes
you want to achieve.
Identify and justify any modifications or adaptations you will need to make to the
proposed practice to meet the goals of your project and why you believe the changes will
improve the outcomes.
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Explain why you chose this evidence-based practice over other evidence-based practices.
If this is not an evidence-based practice, explain why you chose this intervention over
other interventions.
Describe how the proposed project will address issues of age, race, ethnicity, culture,
language, sexual orientation, disability, literacy, and gender in the target population,
while retaining fidelity to the chosen practice.
Demonstrate how the proposed service/practice will meet your goals and objectives.
Provide a logic model that links need, the services or practice to be implemented, and
outcomes. (See Appendix D for a sample logic model.)
Section C:
Proposed Implementation Approach (25 points)
Describe your strategies to preserve and reunite families, including specific family
interventions and approaches that will stabilize and strengthen family relationships.
Describe how the proposed services or practices, including your strategies to preserve
and reunite families, will be implemented for the women, their minor children, fathers of
the children, partners of the women, and the extended family members of the women and
children.
Describe the proposed service/practice for the children and demonstrate that it addresses
gender, age, culture and developmentally appropriate services for the following age
groups: 1) birth to three; 2) four to six; 3) seven to ten; and 4) eleven to seventeen.
Discuss the target population’s language, beliefs, norms and values, as well as
socioeconomic factors that must be considered in delivering programs to this population,
and how the proposed approach addresses these issues.
State your agreement to comply with Section 508 of the Public Health Service Act.
Demonstrate your capacity to meet the three requirements listed in this RFA in Section
I-2.5 Program Requirements, under General Agreements for Providing Services.
Describe your plans for providing the required supplemental/recovery support services
listed in Section I-2.5 Program Requirements, in this RFA. Identify the services that will
be provided at the residential treatment site, and those that will be provided in the
community by partners in the network. In Appendix 6, include a list of the service
provider organizations.
Describe how you will screen and assess clients for the presence of co-occurring
substance use (abuse and dependence) and mental disorders and use the information
obtained from the screening and assessment to develop appropriate treatment approaches
for the persons identified as having such co-occurring disorders.
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State your agreement to coordinate and integrate services to accomplish your
comprehensive service system. Describe the process used to achieve service coordination
and integration among the network of providers, including how off-site providers will
participate in treatment planning, service delivery, quality assurance, monitoring, and
evaluating effectiveness. Include MOUs and MOAs in Appendix 8.
Show that the necessary groundwork (e.g., planning, consensus development,
development of MOUs/MOAs, identification of potential facilities) has been completed
or is near completion so that the project can be implemented and service delivery can
begin as soon as possible and no later than 4 months after grant award.
Provide a realistic time line for the project (chart or graph) showing key activities,
milestones, and responsible staff. Timelines must include phase-in activities that will be
implemented no later than 3 months after award. Phase-in activities may include
alterations and renovations, hiring and training staff, purchasing equipment, crosstraining the network of providers, and admissions of first clients. [Note: The time line
should be part of the Project Narrative. It should not be placed in an appendix.]
Clearly state: 1) the unduplicated number of women; 2) the estimated number of children;
and 3) the estimated number of other family members you propose to serve (annually and
over the entire project period) with grant funds, including the types and numbers of
services to be provided and anticipated outcomes.
Describe the strategies for identifying and engaging women early in their pregnancies for
maximum benefit of the mothers and infants (e.g., the first trimester), and retaining them
in treatment. Discuss your plans to engage other family members when appropriate and
beneficial, including fathers of the children, partners of the women, and extended family
members in the treatment process.
Describe how project planning, implementation and assessment will include client input.
If an advisory board is proposed, identify the role and responsibilities of the board.
Describe how the project components will be embedded within the existing service
delivery system, including other SAMHSA-funded projects, if applicable. Identify any
other organizations that will participate in the proposed project. Describe their roles and
responsibilities and demonstrate their commitment to the project. Include letters of
commitment from community organizations supporting the project in Appendix 6.
Describe your treatment planning process for developing comprehensive individualized
and family service plans to meet the needs of each family member, and the family unit as
a whole. Describe your strategies for including the women and appropriate family
members in the treatment planning process while ensuring a safe and healthy
environment. Service plans must include individual, group, and family counseling, as
appropriate, as well as follow-up relapse prevention, and supplemental treatment and
recovery support services, as required.
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Describe the plan to address stigma associated with substance abuse and health related
issues such as HIV/AIDS to facilitate successful reintegration into the community.
Describe the continuing care component, including relapse prevention and strategies to
access meaningful employment and permanent, safe, drug-free and affordable housing.
Address special issues related to women who have been involved with the criminal
justice system. Identify continuing care services you will provide to minor children, and
other family members.
Discuss your plan to encourage participation of fathers of the children and partners of the
women as well as extended family members of the women and the children in treatment
when deemed to be appropriate and beneficial.
Describe the potential barriers to successful conduct of the proposed project and how you
will overcome them.
Describe your plan to continue the project after the funding period ends. Also describe
how program continuity will be maintained when there is a change in the operational
environment (e.g., staff turnover, change in project leadership) to ensure stability over
time.
Section D:
Staff and Organizational Experience (20 points)
Discuss the capability and experience of the applicant organization and other
participating organizations with similar projects and populations. Demonstrate that the
applicant organization and other participating organizations have linkages to the target
population and ties to grassroots/community-based organizations that are rooted in the
culture and language of the target population.
Provide a complete list of staff positions for the project, showing the role of each and
their level of effort and qualifications. Include the Project Director and other key
personnel, such as treatment/prevention personnel.
Discuss how key staff have demonstrated experience in serving the target population and
are familiar with the culture and language of the target population. If the target
population is multicultural and multilinguistic, describe how the staff are qualified to
serve this population.
Describe the resources available for the proposed project (e.g., facilities, equipment), and
provide evidence that services will be provided in a location that is adequate, accessible,
compliant with the Americans with Disabilities Act (ADA), and amenable to the target
population. If the ADA does not apply to your organization, please explain why.
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Section E:
Performance Assessment and Data (15 points)
Document your ability to collect and report on the required performance measures as
specified in Section I-2.8 of this RFA. Describe your plan for data collection,
management, analysis and reporting. Specify and justify any additional measures or
instruments you plan to use for your grant project.
• Describe how data will be used to manage the project and assure continuous quality
improvement.
Document your ability to collect and report data in accordance with all the required crosssite evaluation requirements as specified in Section I-2.9 of this RFA.
Provide a per-person or unit cost of the project to be implemented, based on the
applicant’s actual costs and projected costs over the life of the project. You can calculate
this figure by: 1) taking the total cost of the project over the lifetime of the grant and
subtracting 20% for data and performance assessment; 2) dividing this number by the
total unduplicated number of persons to be served. Applicants must state whether or not
the per person costs are within the following reasonable ranges by treatment modality.
Applicants must also discuss the reasonableness of the per person costs. If proposed
costs exceed reasonable ranges, a detailed justification must be provided.
Program Costs. The following are considered reasonable ranges by treatment modality:
-
Residential: $3,000 to $10,000
Outpatient (Non-Methadone): $1,000 to $5,000
Outpatient (Methadone): $1,500 to $8,000
Intensive Outpatient: $1,000 to $7,500
Screening/Brief Intervention/Brief Treatment/Outreach/Pretreatment Services:
$200 to $1,200
Drug Court Programs (regardless of client treatment modality): $3,000 to $5,000
Peer Recovery Support Services: $1,000 to $2,500
The outreach and pretreatment services cost band applies only to outreach and
pretreatment programs that do not offer treatment services but operate with a network of
substance abuse treatment facilities. Treatment programs that add outreach and
pretreatment services to a treatment modality or modalities are expected to fall within the
cost band for that treatment modality.
NOTE: Although the budget for the proposed project is not a scored review criterion, the Review
Group will be asked to comment on the appropriateness of the budget after the merits of the
application have been considered.
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SUPPORTING DOCUMENTATION
Section F: Literature Citations. This section must contain complete citations, including titles and
all authors, for any literature you cite in your application.
Section G: Budget Justification, Existing Resources, Other Support. You must provide a
narrative justification of the items included in your proposed budget, as well as a description of
existing resources and other support you expect to receive for the proposed project. Be sure to
show that no more than 15% of the total grant award will be used for infrastructure development,
if necessary, and that no more than 20% of the total grant award will be used for data collection
and performance assessment. An illustration of a budget and narrative justification is included in
Appendix H of this document.
Section H: Biographical Sketches and Job Descriptions.
o Include a biographical sketch for the Project Director and other key positions. Each
sketch should be 2 pages or less. If the person has not been hired, include a position
description and/or a letter of commitment with a current biographical sketch from the
individual.
o Include job descriptions for key personnel. Job descriptions should be no longer than 1
page each.
o Information on what should be included in biographical sketches and job descriptions can
be found on page 22, Item 6, in the Program Narrative section of the PHS 5161-1
instruction page, available on the SAMHSA Web site.
Section I: Confidentiality and SAMHSA Participant Protection/Human Subjects: You must
describe procedures relating to Confidentiality, Participant Protection and the Protection of
Human Subjects Regulations in Section I of your application, using the guidelines provided
below.
Confidentiality and Participant Protection:
Because of the confidential nature of the work in which many SAMHSA grantees are involved, it
is important to have safeguards protecting individuals from risks associated with their
participation in SAMHSA projects. All applicants must address the seven bullets below.
Appendix F of this RFA provides a more detailed discussion of issues applicants should consider
in addressing these seven bullets. If some are not applicable or relevant to the proposed project,
simply state that they are not applicable and indicate why. In addition to addressing these seven
bullets, read the section that follows entitled Protection of Human Subjects Regulations to
determine if the regulations may apply to your project. If so, you are required to describe the
process you will follow for obtaining Institutional Review Board (IRB) approval. While we
encourage you to keep your responses brief, there are no page limits for this section and no
points will be assigned by the Review Committee. Problems with confidentiality, participant
protection, and the protection of human subjects identified during peer review of the application
must be resolved prior to funding.
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Identify foreseeable risks or adverse effects due to participation in the project and/or in
the data collection (performance assessment) activities (including physical, medical,
psychological, social, legal, and confidentiality) and provide your procedures for
minimizing or protecting participants from these risks. Identify plans to provide
guidance and assistance in the event there are adverse effects to participants.
Describe the target population and explain why you are including or excluding certain
subgroups. Explain how and who will recruit and select participants.
State whether participation in the project is voluntary or required. If you plan to provide
incentives/compensate participants, specify the type (e.g., money, gifts, coupons), and the
value of any such incentives. Provide justification that the use of incentives is
appropriate, judicious, and conservative and that incentives do not provide an “undue
inducement” which removes the voluntary nature of participation. Incentives should be
the minimum amount necessary to meet the programmatic and performance assessment
goals of the grant. Applicants should determine the minimum amount that is proven to be
effective by consulting with existing local programs and reviewing the relevant literature.
In no case may the value of an incentive paid for with SAMHSA discretionary grant
funds exceed $20. (See Appendix F: Confidentiality and Participant Protection.)
Describe data collection procedures, including sources (e.g., participants, school records)
and the data collecting setting (e.g., clinic, school). Provide copies of proposed data
collection instruments and interview protocols in Appendix 9 of your application, “Data
Collection Instruments/Interview Protocols.” State whether specimens such as urine
and/or blood will be obtained and the purpose for collecting the specimens. If applicable,
describe how the specimens and process will be monitored to ensure both the safety of
participants and the integrity of the specimens.
Explain how you will ensure privacy and confidentiality of participants’ records, data
collected, interviews, and group discussions. Describe where the data will be stored,
safeguards (e.g., locked, coding systems, storing identifiers separate from data), and who
will have access to the information.
Describe the process for obtaining and documenting consent from adult participants and
assent from minors along with consent from their parents or legal guardians. Provide
copies of all consent forms in Appendix 10 of your application, “Sample Consent
Forms.” If needed, give English translations.
Discuss why the risks are reasonable compared to expected benefits from the project.
Protection of Human Subjects Regulations
SAMHSA expects that most grantees funded under this announcement will not have to comply
with the Protection of Human Subjects Regulations (45 CFR 46), which requires Institutional
Review Board (IRB) approval. However, in some instances, the applicant’s proposed
performance assessment design may meet the regulation’s criteria of research involving human
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subjects. For assistance in determining if your proposed performance assessment meets the
criteria in 45 CFR 46, Protection of Human Subjects Regulations, refer to the SAMHSA decision
tree on the SAMHSA Web site, under “Applying for a New SAMHSA Grant,”
http://www.samhsa.gov/grants/apply.aspx.
Applicants whose projects must comply with the Human Subjects Regulations must, in addition
to the bullets above, fully describe the process for obtaining IRB approval. While IRB approval
is not required at the time of grant award, these grantees will be required, as a condition of
award, to provide documentation that an Assurance of Compliance is on file with the Office for
Human Research Protections (OHRP). IRB approval must be received in these cases prior to
enrolling clients in the project. General information about Human Subjects Regulations can be
obtained through OHRP at http://www.hhs.gov/ohrp, or [email protected], or (240) 4536900. SAMHSA–specific questions should be directed to the program contact listed in Section
VII of this announcement.
2.
REVIEW AND SELECTION PROCESS
SAMHSA applications are peer-reviewed according to the evaluation criteria listed above. For
those programs where the individual award is over $100,000, applications also must be reviewed
by the appropriate National Advisory Council.
Decisions to fund a grant are based on:
the strengths and weaknesses of the application as identified by peer reviewers and, when
applicable, approved by the Center for Substance Abuse Treatment’s National Advisory
Council;
a letter (in Appendix 1) from the SSA certifying that the three requirements listed in
Section I-2.4, Minimum Qualifications, have been met;
a letter (in Appendix 5) from the funding source(s) attesting that the matching funds are
available and are not derived from federal sources;
availability of funds; and
equitable distribution of awards in terms of geography (including urban, rural and remote
settings) and balance among target populations and program size.
SAMHSA/CSAT will make no more than one award per applicant per geographic community.
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VI.
ADMINISTRATION INFORMATION
1.
AWARD NOTICES
After your application has been reviewed, you will receive a letter from SAMHSA through
postal mail that describes the general results of the review, including the score that your
application received.
If you are approved for funding, you will receive an additional notice through postal mail, the
Notice of Grant Award, signed by SAMHSA’s Grants Management Officer. The Notice of
Grant Award is the sole obligating document that allows you to receive Federal funding for work
on the grant project.
If you are not funded, you may re-apply if there is another receipt date for the program.
2.
ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS
If your application is funded, you must comply with all terms and conditions of the grant
award. SAMHSA’s standard terms and conditions are available on the SAMHSA Web
site at http://www.samhsa.gov/grants/management.aspx.
If your application is funded, you must also comply with the administrative requirements
outlined in 45 CFR Part 74 or 45 CFR Part 92, as appropriate. For more information see
the SAMHSA Web site (http://www.samhsa.gov/grants/management.aspx).
Depending on the nature of the specific funding opportunity and/or your proposed project
as identified during review, SAMHSA may negotiate additional terms and conditions
with you prior to grant award. These may include, for example:
o actions required to be in compliance with confidentiality and participant
protection/human subjects requirements;
o requirements relating to additional data collection and reporting;
o requirements relating to participation in a cross-site evaluation; or
o requirements to address problems identified in review of the application.
If your application is funded, you will be held accountable for the information provided
in the application relating to performance targets. SAMHSA program officials will
consider your progress in meeting goals and objectives, as well as your failures and
strategies for overcoming them, when making an annual recommendation to continue the
grant and the amount of any continuation award. Failure to meet stated goals and
objectives may result in suspension or termination of the grant award, or in reduction or
withholding of continuation awards.
Grant funds cannot be used to supplant current funding of existing activities. “Supplant”
is defined as replacing funding of a recipient’s existing program with funds from a
Federal grant.
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In an effort to improve access to funding opportunities for applicants, SAMHSA is
participating in the U.S. Department of Health and Human Services “Survey on Ensuring
Equal Opportunity for Applicants.” This survey is included in the application kit for
SAMHSA grants and is posted on the SAMHSA Web site. You are encouraged to
complete the survey and return it, using the instructions provided on the survey form.
3.
REPORTING REQUIREMENTS
In addition to the data reporting requirements listed in Section I-2.8, you must comply with the
following reporting requirements:
3.1
Progress and Financial Reports
You will be required to submit annual and final progress reports, as well as annual and
final financial status reports.
Because SAMHSA is extremely interested in ensuring that treatment and prevention
services can be sustained, your progress reports should explain plans to ensure the
sustainability of efforts initiated under this grant.
If your application is funded, SAMHSA will provide you with guidelines and
requirements for these reports at the time of award and at the initial grantee orientation
meeting after award. SAMHSA staff will use the information contained in the reports to
determine your progress toward meeting its goals.
3.2
Government Performance and Results Act (GPRA)
The Government Performance and Results Act (GPRA) mandates accountability and
performance-based management by Federal agencies. To meet the GPRA requirements,
SAMHSA must collect performance data (i.e., “GPRA data”) from grantees. The performance
requirements for SAMHSA’s PPW grant program are described in Section I-2.7 of this document
under “Data Collection and Performance Measurement.”
3.3
Publications
If you are funded under this grant program, you are required to notify the Government Project
Officer (GPO) and SAMHSA’s Publications Clearance Officer (240-276-2130) of any materials
based on the SAMHSA-funded grant project that are accepted for publication.
In addition, SAMHSA requests that grantees:
Provide the GPO and SAMHSA Publications Clearance Officer with advance copies of
publications.
Include acknowledgment of the SAMHSA grant program as the source of funding for the
project.
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Include a disclaimer stating that the views and opinions contained in the publication do
not necessarily reflect those of SAMHSA or the U.S. Department of Health and Human
Services, and should not be construed as such.
SAMHSA reserves the right to issue a press release about any publication deemed by SAMHSA
to contain information of program or policy significance to the substance abuse
treatment/substance abuse prevention/mental health services community.
VII. AGENCY CONTACTS
For questions about program issues contact:
Linda White Young
Public Health Advisor
Center for Substance Abuse Treatment
Substance Abuse and Mental Health Services Administration
1 Choke Cherry Road
Room 5-1081
Rockville, Maryland 20857
(240) 276-1581
[email protected]
For questions on grants management issues contact:
Kathleen Sample
Office of Program Services, Division of Grants Management
Substance Abuse and Mental Health Services Administration
1 Choke Cherry Road
Room 7-1089
Rockville, Maryland 20857
(240) 276-1407
[email protected]
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Appendix A – Checklist for Formatting Requirements and Screenout Criteria
for SAMHSA Grant Applications
SAMHSA’s goal is to review all applications submitted for grant funding. However, this goal
must be balanced against SAMHSA’s obligation to ensure equitable treatment of applications.
For this reason, SAMHSA has established certain formatting requirements for its applications.
If you do not adhere to these requirements, your application will be screened out and returned
to you without review.
Use the PHS 5161-1 application form.
Applications must be received by the application due date and time, as detailed in Section
IV-3 of this grant announcement.
Information provided must be sufficient for review.
Text must be legible. Pages must be typed in black ink, single-spaced, using a font of Times
New Roman 12, with all margins (left, right, top, bottom) at least one inch each. (For Project
Narratives submitted electronically, see separate requirements in Section IV-6 of this
announcement under “Submission of Electronic Applications.”)
To ensure equity among applications, page limits for the Project Narrative cannot be
exceeded.
Paper must be white paper and 8.5 inches by 11.0 inches in size.
To facilitate review of your application, follow these additional guidelines. Failure to adhere to
the following guidelines will not, in itself, result in your application being screened out and
returned without review. However, the information provided in your application must be
sufficient for review. Following these guidelines will help ensure your application is complete,
and will help reviewers to consider your application.
The 10 application components required for SAMHSA applications should be included and
submitted in the following order:
$
$
$
$
$
$
$
$
$
$
Face Page (Standard Form 424 v2, which is in PHS 5161-1)
Abstract
Table of Contents
Budget Form (Standard Form 424A, which is in PHS 5161-1)
Project Narrative and Supporting Documentation
Appendices
Assurances (Standard Form 424B, which is in PHS 5161-1)
Certifications
Disclosure of Lobbying Activities (Standard Form LLL, which is in PHS 5161-1)
Checklist (a form in PHS 5161-1)
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Applications should comply with the following requirements:
$
$
$
Provisions relating to confidentiality and participant protection specified in Section
V-1 of this announcement.
Budgetary limitations as specified in Sections I, II, and IV-5 of this announcement.
Documentation of nonprofit status as required in the PHS 5161-1.
Pages should be typed single-spaced in black ink with one column per page. Pages should
not have printing on both sides.
Pages should be numbered consecutively from beginning to end so that information can be
located easily during review of the application. The abstract page should be page 1, the table
of contents should be page 2, etc. The four pages of Standard form 424 v2 are not to be
numbered. Appendices should be labeled and separated from the Project Narrative and
budget section, and the pages should be numbered to continue the sequence.
The page limits for Appendices stated in Section IV-2.2 of this announcement should not be
exceeded.
Send the original application and two copies to the mailing address in Section IV-6 of this
document. Please do not use staples, paper clips, and fasteners. Nothing should be attached,
stapled, folded, or pasted. Do not use heavy or lightweight paper or any material that cannot
be copied using automatic copying machines. Odd-sized and oversized attachments such as
posters will not be copied or sent to reviewers. Do not include videotapes, audiotapes, or
CD-ROMs.
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Appendix B – Guidance for Electronic Submission of Applications
If you would like to submit your application electronically, you may search www.Grants.gov for
the downloadable application package by the funding announcement number (called the
opportunity number) or by the Catalogue of Federal Domestic Assistance (CFDA) number. You
can find the CFDA number on the first page of the funding announcement.
You must follow the instructions in the User Guide available at the www.Grants.gov apply site,
on the Help page. In addition to the User Guide, you may wish to use the following sources for
help:
• By e-mail: [email protected]
• By phone: 1-800-518-4726 (1-800-518-GRANTS). The Customer Support Center is
open from 7:00 a.m. to 9:00 p.m. Eastern Time, Monday through Friday, excluding
Federal holidays.
If this is the first time you have submitted an application through Grants.gov, you must
complete four separate registration processes before you can submit your application.
Allow at least two weeks (10 business days) for these registration processes, prior to
submitting your application. The processes are: 1) DUNS Number registration; 2) Central
Contractor Registry (CCR) registration; 3) Credential Provider registration; and 4) Grants.gov
registration.
It is strongly recommended that you submit your grant application using Microsoft Office
2003 products (e.g., Microsoft Word 2003, Microsoft Excel, etc.). The new Microsoft Vista
operating system and Microsoft Office 2007 products are not currently accepted by Grants.gov.
If you do not have access to Microsoft Office products, you may submit PDF files. Directions
for creating PDF files can be found on the Grants.gov Web site. Use of file formats other than
Microsoft Office or PDF may result in your file being unreadable by our staff.
The Project Narrative must be a separate document in the electronic submission. Formatting
requirements for SAMHSA grant applications are described in Appendix A of this
announcement. These requirements also apply to applications submitted electronically, with the
following exceptions only for Project Narratives submitted electronically in Microsoft Word.
These requirements help ensure the accurate transmission and equitable treatment of
applications.
• Text legibility: Use a font of Times New Roman 12, line spacing of single space, and all
margins (left, right, top, bottom) of at least one inch each. Adhering to these standards
will help to ensure the accurate transmission of your document.
• Amount of space allowed for Project Narrative: The Project Narrative for an electronic
submission may not exceed 15,450 words. If the Project Narrative for an electronic
submission exceeds the word limit, the application will be screened out and will not
be reviewed. To determine the number of words in your Project Narrative document in
Microsoft Word, select file/properties/statistics.
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Keep the Project Narrative as a separate document. Please consolidate all other materials
in your application to ensure the fewest possible number of attachments. Be sure to label
each file according to its contents, e.g., “Appendices 1-3”, “Appendices 4-5.”
Ensure all pages in your application are numbered consecutively, with the exception of the
standard forms in the PHS-5161 application package. Documents containing scanned images
must also contain page numbers to continue the sequence. Failure to comply with these
requirements may affect the successful transmission and consideration of your application.
Applicants are strongly encouraged to submit their applications to Grants.gov early enough to
resolve any unanticipated difficulties prior to the deadline. You may also submit a back-up
paper submission of your application. Any such paper submission must be received in
accordance with the requirements for timely submission detailed in Section IV-3 of this
announcement. The paper submission must be clearly marked: “Back-up for electronic
submission.” The paper submission must conform with all requirements for non-electronic
submissions. If both electronic and back-up paper submissions are received by the deadline, the
electronic version will be considered the official submission.
After you electronically submit your application, you will receive an automatic
acknowledgement from Grants.gov that contains a Grants.gov tracking number. It is important
that you retain this number. Include the Grants.gov tracking number in the top right corner
of the face page (SF 424 v2) for any paper submission. Receipt of the tracking number is
the only indication that Grants.gov has successfully received and validated your
application. If you do not receive a Grants.gov tracking number, you may want to contact
the Grants.gov help desk for assistance.
The Grants.gov Web site does not accept electronic signatures at this time. Therefore, you must
submit a signed paper original of the face page (SF 424 v2), the assurances (SF 424B), and hard
copy of any other required documentation that cannot be submitted electronically. You must
include the Grants.gov tracking number for your application on these documents with
original signatures, on the top right corner of the face page, and send the documents to the
following address. The documents must be received at the following address within 5
business days after your electronic submission. Delays in receipt of these documents may
impact the score your application receives or the ability of your application to be funded.
For United States Postal Service:
Crystal Saunders, Director of Grant Review
Office of Program Services
Substance Abuse and Mental Health Services Administration
Room 3-1044
1 Choke Cherry Road
Rockville, MD 20857
ATTN: Electronic Applications
For other delivery services, change the zip code to 20850.
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If you require a phone number for delivery, you may use (240) 276-1199.
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Appendix C - Statement of Assurance
As the authorized representative of [insert name of applicant organization]
_________________________________________________, I assure SAMHSA that all
participating service provider organizations listed in this application meet the two-year
experience requirement and applicable licensing, accreditation, and certification requirements. If
this application is within the funding range for a grant award, we will provide the SAMHSA
Government Project Officer (GPO) with the following documents. I understand that if this
documentation is not received by the GPO within the specified timeframe, the application will be
removed from consideration for an award and the funds will be provided to another applicant
meeting these requirements.
x
a letter of commitment that specifies the nature of the participation and what
service(s) will be provided from every service provider organization listed in
Appendix 1 of the application, that has agreed to participate in the project;
x
official documentation that all service provider organizations participating in the
project have been providing relevant services for a minimum of 2 years prior to the
date of the application in the area(s) in which services are to be provided. Official
documents must definitively establish that the organization has provided relevant
services for the last 2 years; and
x
official documentation that all participating service provider organizations are in
compliance with all local (city, county) and State/tribal requirements for licensing,
accreditation, and certification or official documentation from the appropriate agency
of the applicable State/tribal, county, or other governmental unit that licensing,
accreditation, and certification requirements do not exist. (Official documentation is
a copy of each service provider organization’s license, accreditation, and
certification. Documentation of accreditation will not be accepted in lieu of an
organization’s license. A statement by, or letter from, the applicant organization or
from a provider organization attesting to compliance with licensing, accreditation and
certification or that no licensing, accreditation, certification requirements exist does
not constitute adequate documentation.)
________________________________
Signature of Authorized Representative
_____________________
Date
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Appendix D – Sample Logic Model
A Logic Model is a tool to show how your proposed project links the purpose, goals, objectives,
and tasks stated with the activities and expected outcomes or “change” and can help to plan,
implement, and assess your project. The model also links the purpose, goals, objectives, and
activities back into planning and evaluation. A Logic Model is a picture of your project. It
graphically shows the activities and progression of the project. It should also describe the
relationships among what resources you put in (inputs), what you do (outputs), and what happens
or results (outcomes). Based on both your planning and evaluating activities, you can then make
a “logical” chain of “if-then” relationships.
Look at the graphic on the following page to see the chain of events that links the inputs to
program components, the program components to outputs, and the outputs to outcomes (goals).
The framework you set up to build your model is based on a review of your Statement of Need,
in which you state the conditions that gave rise to the project with your target group. Then you
look at the Inputs, which are the resources, contributions, time, staff, materials, and equipment
you will invest to change these conditions. These inputs then are organized into the Program
Components, which are the activities, services, interventions and tasks that will reach the target
population. These outputs then are intended to create Outputs such as changes or benefits for
the consumer, families, groups, communities, organizations and SAMHSA. The understanding
and further evidence of what works and what does not work will be shown in the Outcomes,
which include achievements that occur along the path of project operation.
*The logic model presented is not a required format and SAMHSA does not expect strict
adherence to this format. It is presented only as a sample of how you can present a logic model
in your application.
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Sample Logic Model*
Resources
(Inputs)
Examples
People
Staff – hours
Volunteer – hours
Funds
Other resources
Facilities
Equipment
Community services
Program Components
(Activities)
Examples
Outreach
Intake/Assessment
Client Interview
Treatment Planning
Treatment by type:
Methadone maintenance
Weekly 12-step meetings
Detoxification
Counseling sessions
Relapse prevention
Crisis intervention
Special Training
Vocational skills
Social skills
Nutrition
Child care
Literacy
Tutoring
Safer sex practices
Other Services
Placement in employment
Prenatal care
Child care
Aftercare
Program Support
Fundraising
Long-range planning
Administration
Public Relations
Outputs
(Objectives)
Examples
Waiting list length
Waiting list change
Client attendance
Client participation
Number of Clients:
Admitted
Terminated
Inprogram
Graduated
Placed
Number of Sessions:
Per month
Per client/month
Funds raised
Number of volunteer hours/month
Other resources required
Outcomes
(Goals)
Examples
Inprogram:
Client satisfaction
Client retention
In or postprogram:
Reduced drug use – self
reports, urine, hair
Employment/school
progress
Psychological status
Vocational skills
Social skills
Safer sexual practices
Nutritional practices
Child care practices
Reduced delinquency/crime
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Appendix E – Logic Model Resources
Chen, W.W., Cato, B.M., & Rainford, N. (1998-9). Using a logic model to
plan and evaluate a community intervention program: A case study. International Quarterly of
Community Health Education, 18(4), 449-458.
Edwards, E.D., Seaman, J.R., Drews, J., & Edwards, M.E. (1995). A community approach for
Native American drug and alcohol prevention programs: A logic model framework. Alcoholism
Treatment Quarterly, 13(2), 43-62.
Hernandez, M. & Hodges, S. (2003). Crafting Logic Models for Systems of Care: Ideas into
Action. [Making children’s mental health services successful series, volume 1]. Tampa, FL:
University of South Florida, The Louis de la Parte Florida Mental Health Institute, Department
of Child & Family Studies. http://cfs.fmhi.usf.edu or phone (813) 974-4651
Hernandez, M. & Hodges, S. (2001). Theory-based accountability. In M. Hernandez & S.
Hodges (Eds.), Developing Outcome Strategies in Children's Mental Health, pp. 21-40.
Baltimore: Brookes.
Julian, D.A. (l997). Utilization of the logic model as a system level planning and evaluation
device. Evaluation and Planning, 20(3), 251-257.
Julian, D.A., Jones, A., & Deyo, D. (1995). Open systems evaluation and the
logic model: Program planning and evaluation tools. Evaluation and Program
Planning, 18(4), 333-341.
Patton, M.Q. (1997). Utilization-Focused Evaluation (3rd Ed.), pp. 19, 22,
241. Thousand Oaks, CA: Sage.
Wholey, J.S., Hatry, H.P., Newcome, K.E. (Eds.) (1994). Handbook of Practical Program
Evaluation. San Francisco, CA: Jossey-Bass Inc.
J-48
Appendix F – Confidentiality and Participant Protection
1. Protect Clients and Staff from Potential Risks
Identify and describe any foreseeable physical, medical, psychological, social, and legal
risks or potential adverse effects as a result of the project itself or any data collection
activity.
Describe the procedures you will follow to minimize or protect participants against
potential risks, including risks to confidentiality.
Identify plans to provide guidance and assistance in the event there are adverse effects to
participants.
Where appropriate, describe alternative treatments and procedures that may be beneficial
to the participants. If you choose not to use these other beneficial treatments, provide the
reasons for not using them.
2. Fair Selection of Participants
Describe the target population(s) for the proposed project. Include age, gender, and
racial/ethnic background and note if the population includes homeless youth, foster
children, children of substance abusers, pregnant women, or other targeted groups.
Explain the reasons for including groups of pregnant women, children, people with
mental disabilities, people in institutions, prisoners, and individuals who are likely to be
particularly vulnerable to HIV/AIDS.
Explain the reasons for including or excluding participants.
Explain how you will recruit and select participants. Identify who will select
participants.
3. Absence of Coercion
Explain if participation in the project is voluntary or required. Identify possible reasons
why participation is required, for example, court orders requiring people to participate in
a program.
If you plan to compensate participants, state how participants will be awarded incentives
(e.g., money, gifts, etc.). Provide justification that the use of incentives is appropriate,
judicious, and conservative and that incentives do not provide an “undue inducement”
which removes the voluntary nature of participation. Incentives should be the minimum
amount necessary to meet the programmatic and performance assessment goals of the
grant. Applicants should determine the minimum amount that is proven effective by
46
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consulting with existing local programs and reviewing the relevant literature. In no case
may the value if an incentive paid for with SAMHSA discretionary grant funds exceed
$20.
State how volunteer participants will be told that they may receive services intervention
even if they do not participate in or complete the data collection component of the
project.
4. Data Collection
Identify from whom you will collect data (e.g., from participants themselves, family
members, teachers, others). Describe the data collection procedures and specify the
sources for obtaining data (e.g., school records, interviews, psychological assessments,
questionnaires, observation, or other sources). Where data are to be collected through
observational techniques, questionnaires, interviews, or other direct means, describe the
data collection setting.
Identify what type of specimens (e.g., urine, blood) will be used, if any. State if the
material will be used just for evaluation or if other use(s) will be made. Also, if needed,
describe how the material will be monitored to ensure the safety of participants.
Provide in Appendix 9, “Data Collection Instruments/Interview Protocols,” copies of
all available data collection instruments and interview protocols that you plan to use.
5. Privacy and Confidentiality
Explain how you will ensure privacy and confidentiality. Include who will collect data
and how it will be collected.
Describe:
o
o
o
o
How you will use data collection instruments.
Where data will be stored.
Who will or will not have access to information.
How the identity of participants will be kept private, for example, through the use of a
coding system on data records, limiting access to records, or storing identifiers
separately from data.
NOTE: If applicable, grantees must agree to maintain the confidentiality of alcohol and drug
abuse client records according to the provisions of Title 42 of the Code of Federal Regulations,
Part II.
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6. Adequate Consent Procedures
List what information will be given to people who participate in the project. Include the
type and purpose of their participation. Identify the data that will be collected, how the
data will be used and how you will keep the data private.
State:
o
o
o
o
Whether or not their participation is voluntary.
Their right to leave the project at any time without problems.
Possible risks from participation in the project.
Plans to protect clients from these risks.
Explain how you will get consent for youth, the elderly, people with limited reading
skills, and people who do not use English as their first language.
NOTE: If the project poses potential physical, medical, psychological, legal, social or other
risks, you must obtain written informed consent.
Indicate if you will obtain informed consent from participants or assent from minors
along with consent from their parents or legal guardians. Describe how the consent will
be documented. For example: Will you read the consent forms? Will you ask
prospective participants questions to be sure they understand the forms? Will you give
them copies of what they sign?
Include, as appropriate, sample consent forms that provide for: (1) informed consent for
participation in service intervention; (2) informed consent for participation in the data
collection component of the project; and (3) informed consent for the exchange (releasing
or requesting) of confidential information. The sample forms must be included in
Appendix 10, “Sample Consent Forms”, of your application. If needed, give English
translations.
NOTE: Never imply that the participant waives or appears to waive any legal rights, may not
end involvement with the project, or releases your project or its agents from liability for
negligence.
Describe if separate consents will be obtained for different stages or parts of the project.
For example, will they be needed for both participant protection in treatment intervention
and for the collection and use of data?
Additionally, if other consents (e.g., consents to release information to others or gather
information from others) will be used in your project, provide a description of the
consents. Will individuals who do not consent to having individually identifiable data
collected for evaluation purposes be allowed to participate in the project?
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7. Risk/Benefit Discussion
Discuss why the risks are reasonable compared to expected benefits and importance of the
knowledge from the project.
Protection of Human Subjects Regulations
Applicants may also have to comply with the Protection of Human Subjects Regulations (45
CFR 46), depending on the evaluation and data collection procedures proposed and the
population to be served.
Applicants must be aware that even if the Protection of Human Subjects Regulations do not
apply to all projects funded, the specific performance assessment design proposed by the
applicant may require compliance with these regulations. For assistance in determining if your
proposed performance assessment meets the criteria in 45 CFR 46, Protection of Human Subjects
Regulations, refer to the SAMHSA decision tree on the SAMHSA Web site, under “Applying for
a New SAMHSA Grant,” http://www.samhsa.gov/grants/apply.aspx.
Applicants whose projects must comply with the Protection of Human Subjects Regulations must
describe the process for obtaining Institutional Review Board (IRB) approval fully in their
applications. While IRB approval is not required at the time of grant award, these applicants will
be required, as a condition of award, to provide the documentation that an Assurance of
Compliance is on file with the Office for Human Research Protections (OHRP) and that IRB
approval has been received prior to enrolling any clients in the proposed project.
General information about Protection of Human Subjects Regulations can be obtained on the
Web at http://www.hhs.gov/ohrp. You may also contact OHRP by e-mail
([email protected]) or by phone (240/453-6900). SAMHSA-specific questions related to
Protection of Human Subjects Regulations should be directed to the program contact listed in
Section VII of this RFA.
49
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Appendix G – Funding Restrictions
SAMHSA grant funds must be used for purposes supported by the program and may not be used
to:
Pay for any lease beyond the project period.
Provide services to incarcerated populations (defined as those persons in jail, prison,
detention facilities, or in custody where they are not free to move about in the
community).
Pay for the purchase or construction of any building or structure to house any part of the
program. (Applicants may request up to $75,000 for renovations and alterations of
existing facilities, if necessary and appropriate to the project.)
Provide residential or outpatient treatment services when the facility has not yet been
acquired, sited, approved, and met all requirements for human habitation and services
provision. (Expansion or enhancement of existing residential services is permissible.)
Pay for housing other than residential mental health and/or substance abuse treatment.
Provide inpatient treatment or hospital-based detoxification services. Residential services
are not considered to be inpatient or hospital-based services.
Make direct payments to individuals to induce them to enter prevention or treatment
services. However, SAMHSA discretionary grant funds may be used for non-clinical
support services (e.g., bus tokens, child care) designed to improve access to and retention
in prevention and treatment programs.
Make direct payments to individuals to encourage attendance and/or attainment of
prevention or treatment goals. However, SAMHSA discretionary grant funds may be
used for non-cash incentives of up to $20 to encourage attendance and/or attainment of
prevention or treatment goals when the incentives are built into the program design and
when the incentives are the minimum amount that is deemed necessary to meet program
goals. SAMHSA policy allows an individual participant to receive more than one
incentive over the course of the program. However, non-cash incentives should be
limited to the minimum number of times deemed necessary to achieve program
outcomes. A grantee or treatment or prevention provider may also provide up to $20
cash or equivalent (coupons, bus tokens, gifts, child care, and vouchers) to individuals as
incentives to participate in required data collection follow up. This amount may be paid
for participation in each required interview.
Food is generally unallowable unless it’s an integral part of a conference grant or
program specific, e.g., children’s program, residential.
50
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Implement syringe exchange programs, such as the purchase and distribution of syringes
and/or needles.
Pay for pharmacologies for HIV antiretroviral therapy, sexually transmitted diseases
(STD)/sexually transmitted illnesses (STI), TB, and hepatitis B and C, or for
psychotropic drugs.
SAMHSA will not accept a “research” indirect cost rate. The grantee must use the “other
sponsored program rate” or the lowest rate available.
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Appendix H – Sample Budget and Justification
ILLUSTRATION OF A SAMPLE DETAILED BUDGET AND
NARRATIVE JUSTIFICATION TO ACCOMPANY
SF 424A: SECTION B FOR 01 BUDGET PERIOD
OBJECT CLASS CATEGORIES
Personnel
Job
Title
Project
Director
Clinical
Director
Secretary
Counselor
Name
Annual
Salary
Level of
Effort
SAMHSA
Funded
Non-Federal
Sources
J. Doe
$30,000
1.0
$30,000
$-0-
J. Doe
Unnamed
R. Down
$18,000
$25,000
0.5
1.0
$-0$-0$25,000
In-Kind
$ 9,000
$-0-
$55,000
$9,000
SUBTOTAL
Enter Personnel subtotal on 424A, Section B, 6.a.
TOTAL
$64,000
Fringe Benefits (24%)
$15,360
$-0-
SUBTOTAL
$15,360
$-0-
Enter Fringe Benefits subtotal on 424A, Section B, 6.b.
$15,360
Travel
2 trips for SAMHSA Meetings for 2 Attendees
(Airfare @ $600 x 4 = $2,400) + (per diem
@ $120 x 4 x 6 days = $2,880)
Local Travel (500 miles x .24 per mile)
$5,280
$-0-
$-0$120
[Note: Current Federal Government per diem rates are available at www.gsa.gov.]
$5,280
SUBTOTAL
$120
Enter Travel subtotal on 424A, Section B, 6.c.
$ 5,400
Equipment (List Individually)
"Equipment" means an article of nonexpendable, tangible personal property having a useful life of more
than one year and an acquisition cost which equals the lesser of (a) the capitalization level established by
the governmental unit or nongovernmental applicant for financial statement purposes, or (b) $5000.
SUBTOTAL
$-0-
Enter Equipment subtotal on 424A, Section B, 6.d.
52
$-0$-0-
J-55
ILLUSTRATION OF DETAILED BUDGET AND NARRATIVE JUSTIFICATION (cont’d.)
Supplies
Office Supplies
Computer Software – Microsoft Word
$500
$-0-
$-0500
Enter Supplies subtotal on 424A, Section B, 6.e.
$1,000
CONTRACTUAL COSTS
Evaluation
Job
Title
Evaluator
Other Staff
Name
Annual
Salary
J. Wilson
$48,000
$18,000
Level of
Effort
SAMHSA
Funded
Non-Federal
Sources
.05
1.0
$24,000
$18,000
$-0$-0-
$10,500
$-0-
Fringe Benefits (25%)
Travel
2 trips x 1 Evaluator
($600 x 2)
Per Diem @ $120 x 6
Supplies (General Office)
$ 1,200
720
500
$-0$-0$-0-
Evaluation Contractual Direct Costs
Evaluation Contractual Indirect Costs (19%)
$54,920
$10,435
Evaluation Contract Subtotal
$65,355
SUBTOTAL
$65,355
$-0-
SAMHSA
Funded
Non-Federal
Sources
$12,000
9,000
$-0$-0-
5,250
$-0-
$1,200
480
120
$-0$-0$-0-
$500
$500
$-0$-0-
$40,025
$-0-
$-0$-0-
Training
Job
Title
Name
Coordinator M. Smith
Admin. Asst. N. Jones
Annual
Salary
$ 12,000
9,000
Level of
Effort
0.5
0.5
Fringe Benefits (25%)
Travel
2 Trips for Training
Airfare @ $600 x 2
Per Diem $120 x 2 x 2 days
Local (500 miles x .24/mile)
Supplies
Office Supplies
Software (Microsoft Word)
Training Contractual Direct Costs Subtotal
Training Contractual Indirect Costs Subtotal
53
TOTAL
$-0$-0-
$65,355
TOTAL
$40,025
$-0-
J-56
ILLUSTRATION OF DETAILED BUDGET AND NARRATIVE JUSTIFICATION (cont’d.)
SUBTOTAL
$105,380
$-0-
Enter Contractual subtotal on 424A, Section B, 6.f.
$105,380
$105,380
SAMHSA
Funded
Non-Federal
Sources
TOTAL
OTHER
Rent (500 Sq. Ft. x $9.95)
Telephone
Maintenance (e.g., van)
Audit
$ 4,975
$ 500
$-0$-0-
$-0$-0$ 2,500
$ 3,000
Consultants = Expert @ $250/day X 6 day
(If expert is known, should list by name)
$ 1,500
$-0-
SUBTOTAL
$6,957
$5,500
Enter Other subtotal on 424A, Section B, 6.h.
$12,475
TOTAL DIRECT CHARGES (sum of 6.a-6.h)
Enter Total Direct on 424A, Section B, 6.i.
$192,640
INDIRECT CHARGES
15% of Salary and Wages (copy of negotiated
Indirect Cost Rate Agreement attached) [$64,000 X 15% = $9,600]
Enter Indirect Costs subtotal of 424A, Section B, 6.j.
Enter TOTALS on 424A, Section B, 6.k. (sum of 6i and 6j)
$9,600
$202,240
JUSTIFICATION
PERSONNEL - Describe the role and responsibilities of each position.
FRINGE BENEFITS - List all components of the fringe benefit rate.
EQUIPMENT - List equipment and describe the need and the purpose of the equipment in relation to the
proposed project.
SUPPLIES - Generally self-explanatory; however, if not, describe need. Include explanation of how the
cost has been estimated.
TRAVEL - Explain need for all travel other than that required by SAMHSA.
CONTRACTUAL COSTS - Explain the need for each contractual arrangement and how these
components relate to the overall project.
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OTHER - Generally self-explanatory. If consultants are included in this category, explain the need and
how the consultant’s rate has been determined. If rent is requested, provide the name of the owner of the
building/facility. If anyone related to the project owns the building which is a less than arms length
arrangement, provide cost of ownership/use allowance.
INDIRECT COST RATE - If your organization has no indirect cost rate, please indicate whether your
organization plans to: a) waive indirect costs if an award is issued; or b) negotiate and establish an
indirect cost rate with DHHS within 90 days of award issuance.
OTHER SOURCES – If other non-Federal sources of funding, including match or cost sharing as a total
operating budget is included, provide the name of the source, e.g., in-kind, foundation, program income,
Medicaid, State funds, applicant organization, etc., and explain its use.
CALCULATION OF FUTURE BUDGET PERIODS
(based on first 12-month budget period)
Review and verify the accuracy of future year budget estimates. Increases or decreases in the
future years must be explained and justified. (NOTE: salary cap of $186,600 is effective for all FY
2008 awards.)
First
12-month
Period
Second
12-month
Period
Third
12-month
Period
Project Director
Secretary*
Counselor
30,000
9,000
25,000
30,000
18,000
25,000
30,000
18,000
25,000
TOTAL PERSONNEL
64,000
73,000
73,000
Personnel
*Increased from 50% to 100% effort in 02 through 03 budget periods.
Fringe Benefits (24%)
Travel
Equipment
Supplies**
15,360
5,400
-01,000
17,520
5,400
-0520
17,520
5,400
-0520
**Increased amount in 01 year represents costs for software.
Contractual
Evaluation***
Training
65,355
40,025
67,969
40,025
70,688
40,025
***Increased amounts in 02 and 03 years reflect the increase in client data collection.
Other
Total Direct Costs
Indirect Costs
(15% S&W)
TOTAL COSTS
1,500
1,500
1,500
192,640
205,934
208,653
9,600
9,600
9,600
202,240
216,884
219,603
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The Federal dollars requested for all object class categories for the first 12-month budget period are
entered on Form 424A, Section B, Column (1), lines 6a-6i. The total Federal dollars requested for the
second through the fifth 12-month budget periods are entered on Form 424A, Section E, Columns (b) –
(e), line 20. The RFA will specify the maximum number of years of support that may be requested.
56
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Attachment J-2
PPW Evaluation Logic Model
J-60
PPW Evaluation Logic Model
Inputs
Activities
Outreach / Recruitment
CSAT Funds
Funds from
Other Sources
Grantee
Characteristics
(staff, other
services
offered)
Services to
Pregnant &
Postpartum
Women
Services to
Children
Services to Family
Members
(Fathers, Partners,
Extended Family)
TA Requested and
Received
Technical
Assistance
Short-Term
Outcomes
Client
Reduced:
- Substance use
- Related effects of maternal
drug abuse on infants &
children
-Involvement/exposure to:
crime, violence, sexual &
physical abuse
- Child abuse/neglect
- Child removals from home
Improved:
- Safe & healthy pregnancies
- Birth outcomes
- Social connectedness
- Education/employment skills
- Child behavior
Agency
- Formalized Sustainability plan
- Expanded services delivered
to women, children, & family
- Improved client / staff
retention
Long-Term
Client
Maintained reductions in:
- Substance use
- involvement/exposure to
crime, violence, sexual &
physical abuse
- Child abuse/neglect
Improved:
- Mental and physical health
of women and children
- Family functioning
- Child healthy development
- Quality of life
- Family reunification
- Economic stability
- Social connectedness
- Housing stability
Agency
- Increase in
program completers
- Prog sustainability
Contextual Factors (level of unmet need, setting of treatment facility, geographical location, availability of similar treatment agencies/services,
sources of client referrals, treatment options)
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Attachment J-3
Overview of PPW Evaluation Design
J-62
Overview of PPW Evaluation Design
Evaluation Question
Constructs Measured
Data Sources
Data Collection Time
Points
1. To what extent are PPW grantees meeting the goals and objectives of the RFA?
Goal 1. Decrease the
use and/or abuse of
prescription drugs,
alcohol, tobacco, illicit
and other harmful drugs
(e.g., inhalants) among
pregnant and
postpartum women
Goal 2. Increase safe
and healthy pregnancies;
improve birth outcomes;
and reduce related
effects of maternal drug
abuse on infants and
children
GPRA
Use of alcohol and other drugs
Recovery Support from Social Connectedness Scale
New item:
Tobacco use
Intake
6-months post-intake
Discharge
6-months post-discharge
New items:
Additional treatment, formal and informal recovery supports
6-months post-discharge
Women’s Discharge
Tool
Treatment services received such as prenatal and post-partum
care, length of stay, treatment goals achieved (indirect measure
of individual treatment needs met)
Treatment services received such as play therapy, parent-child
bonding, length of stay, treatment goals achieved (indirect
measure of individual treatment needs met)
Birth Outcomes:
Apgar score at birth, size (length and head circumference),
birth weight, gestational age, drug toxicology screens
HIV/AIDS testing, need for specialty care/services, positive
alcohol or drug tests at birth
Discharge
Other birth outcomes:
Neonatal length of hospital stay (overall, in newborn nursery,
in newborn intensive care unit); reason for hospital stay;
presence of and treatment for neonatal abstinence syndrome;
possibly Dubowitz score
Birth (and intake for
children under 3
months)
Children’s Discharge
Tool
Newborn’s Medical
Record Audit
(0-3 months)
Child Data
Collection Tool
New items:
(0-3 months)
Discharge
Birth (and intake for
children under 3
months)
Intake/Birth
J-63
Evaluation Question
Data Sources
Constructs Measured
Pregnancy outcomes:
Live birth, stillbirth, miscarriage
Goal 3.a Improve the
mental and physical
health of the women
Goal 3.b Improve the
mental and physical
health of the children
Data Collection Time
Points
Birth
GPRA
Mental and physical health problems; Treatment received
Intake
6-months post-intake
Discharge
6-months post-discharge
Women’s Discharge
Tool
Behavior and
Symptom
Identification Scale
(BASIS) 24®
Treatment services received, treatment goals achieved
Discharge
Overall psychological symptom score; depression/functioning,
interpersonal problems, psychosis, alcohol./drug use, self
harm, emotional lability
Intake
6-months post-intake
Discharge
6-months post-discharge
Ferrans and Powers
Quality of Life Index
Health and functioning subscale
Intake
6-months post-intake
Discharge
6-months post-discharge
Children’s Discharge
Tool
Brief Infant/Toddler
Social Emotional
Assessment
(BITSEA) (12-35months)
Treatment received, treatment goals achieved
Discharge
Social emotional problems and competency in infants
Intake
3-months post-intake
6-months post-intake
Discharge
6-months post-discharge
Social Skills
Improvement System
(SSIS)
(3-17 years)
Social emotional development: social skills, problem behaviors,
academic competence
Intake
3-months post-intake
6-months post-intake
Discharge
6-months post-discharge
J-64
Evaluation Question
Goal 4. Improve family
functioning, economic
stability, and quality of
life
Data Sources
Constructs Measured
Data Collection Time
Points
Intake
3-months post-intake
6-months post-intake
Discharge
6-months post-discharge
Intake
3-months post-intake
6-months post-intake
Discharge
6-months post-discharge
CRAFFT
(11-17 years)
Adolescent substance abuse screen
Trauma Symptom
Checklist for Young
Children
(TSCYC)/Trauma
Symptom Checklist
for Children (TSCC)
( 3-16 years)
Child mental health: acute and chronic posttraumatic
symptoms; anxiety; depression; anger/aggression; intrusion;
avoidance; arousal; dissociation; sexual concerns
Child Data
Collection Tool
Child biological and socio-economic background, legal
involvement and exposure to violence and trauma, educational
background, spiritual background, recreation/leisure
background, parental relationships, alcohol/other drug
use/interaction, health background
Intake/Birth
Ferrans and Powers
Quality of Life Index
Overall quality of life, health and functioning, social and
economic, psychological/spiritual, and family subscales
Women:
Intake
6-months post-intake
Discharge
6-months post-discharge
BASIS-24®
(also informs Goal 5b)
Overall psychological symptom score
Fathers/Partners:
Intake
Discharge
Intake
6-months post-intake
Discharge
J-65
Evaluation Question
Goal 5.a Decrease
pregnant and
postpartum women’s
involvement
Data Sources
Constructs Measured
Data Collection Time
Points
6-months post-discharge
GPRA
Housing stability, family living conditions,
employment/income
Intake
6-months post-intake
Discharge
6-months post-discharge
Children’s Discharge
Tool
Family Support Scale
(FSS)
Child planned living situation after discharge
Discharge
Sources of support in raising young children
Intake
6-months post-intake
Discharge
6-months post-discharge
Parenting Stress
Index (PSI)
(1 month to 12 years)
Family functioning, parenting stress associated with parenting
young children (focus is on preschool-age children): parenting
stress, parent-child dysfunctional interactions, difficult child
Parenting
Relationship
Questionnaire (PRQ)
(2-17 years)
GPRA
Family functioning, parenting: attachment; communication;
discipline approaches; involvement; parenting confidence;
satisfaction with school; relational frustration
Intake
3-months post-intake
6-months post-intake
Discharge
6-months post-discharge
Intake
6-months post-intake
Discharge
6-months post-discharge
Intake
6-months post-intake
Discharge
6-months post-discharge
Women’s criminal justice status, trouble controlling violent
behavior
Indirect indicator from GPRA, child removal by court order
J-66
Evaluation Question
in/exposure to crime,
violence, sexual and
physical abuse
Goal 5.b Decrease child
abuse/neglect
Constructs Measured
Data Sources
Data Collection Time
Points
Intake
6-months post-intake
Discharge
6-months post-discharge
New items:
Violence exposure including physical and sexual abuse
Women’s Discharge
Tool
Child Abuse
Potential Inventory
(CAP)
Experiences assumed from service delivery (e.g., traumainformed services)
Overall risk for physical abuse
Discharge
GPRA
Indirect indicator from GPRA, child removal by court order
Intake
6-months post-intake
Discharge
6-months post-discharge
Intake
6-months post-intake
Discharge
6-months post-discharge
2. How do PPW clients compare to pregnant women in other CSAT programs on GPRA outcomes and national estimates of
substance use and birth outcomes?
Benchmarks based on
existing national data and
GPRA
NSDUH
GPRA
CDC/National
Center for Health
Statistics National
Vital Statistics
System
Use of illicit drugs, alcohol, and tobacco among pregnant
women in the civilian, non-institutionalized population of the
United States
Non-PPW clients
Most recently published
data
Birth Outcomes
Most recent published
data
GPRA schedule
J-67
Evaluation Question
Data Sources
Constructs Measured
Data Collection Time
Points
3. Do treatment implementation and contextual factors mediate or moderate PPW client outcomes?
a. What are the
characteristics of the
services provided by
PPW grantees to clients
(e.g., type of services
provided, location of
services provided,
extent to which the
services provided match
what was proposed, and
degree to which services
are gender-sensitivity,
family-focused, and/or
comprehensive)?
Grantee Applications
b. What is the quality of
the services provided by
PPW grantees (e.g.,
characteristics of staff
who deliver services to
clients, quantity of
services delivered,
extent to which the
quality of services
Grantee Applications
Biannual Progress
Reports
Project Director
Biannual Telephone
Interview
Site Visit Interviews
and Document
Review
Biannual Report
Project Director
Biannual Interview
Site Visit
Online TA system
Proposed EBP/services
Modifications of treatment program and services as indicated
by biannual progress reports and staff interviews
Services delivered/received and their alignment with proposed
EBP
Number and type of services provided onsite and off-site
Percentage of clients receiving services onsite and off-site
Clients (sources of referrals, admission patterns, inclusion
criteria, outreach strategies, number served)
Comprehensive Services matrices - list of services grantees
deliver for Women, Children, & Family
Services delivered and alignment with gender sensitivity,
family-focus, and comprehensiveness
Staff and client knowledge of/experience with proposed EBP
Facility characteristics (e.g., privacy, living quarters, location of
services and clients)
Challenges to implementation
Level of detail and content of written manuals for treatment
process and delivery and/or treatment program policies
/procedures
Grantee Applications –
once in Yr 1
Proposed EBP/services
Comprehensive Services matrices - list of services grantees
delivery for Women, Children, & Family
Services delivered and alignment with gender sensitivity,
trauma-informed, and comprehensiveness
Staff experience/background (education, credentials, licensing,
years experience in field, years with program/agency)
Agency licensing & certifications
Staff turnover/vacancies
Grantee Applications once in Yr 1
Biannual Reports &
Project Director
Interview - Every 6months (May-July &
Nov-Jan)
Site Visits - Fall 2010 &
Fall 2011
Biannual Reports &
Project Director
Interview - Every 6months (May-July &
Nov-Jan)
Site Visits - Fall 2010 &
J-68
Evaluation Question
Data Sources
provided match with
what was proposed, and
the degree to which
evidence-based practices
(EBP) are
implemented)?
c. What is the
relationship between
client-level outcomes
and the characteristics
and quality of client
services received?
Constructs Measured
Professional development / training activities
Staff/client ratio
Consistency of staff in delivering services (consistency of case
load)
Level of detail and content of written manuals for treatment
process/delivery and/or treatment program policies
/procedures
Staff knowledge and implementation of treatment manuals,
and treatment program policies/procedures
Client knowledge and experience with own service plan
(women, children, family)
Challenges to implementation
TA requested/ received
Biannual Report
Project Director
Biannual Interview
Site Visit
Data Sources from
Question 1
Modifications of treatment program and services as indicated
by biannual reports and staff interviews
Comprehensive Services matrices - list of services grantees
delivery for Women, Children, & Family
Services delivered and alignment with gender sensitivity,
trauma-informed, and comprehensiveness
Facility characteristics (e.g., privacy, living quarters, location of
services and clients)
Level of detail and content of written manuals for treatment
process and delivery and/or treatment program policies
/procedures
Staff knowledge and implementation of treatment manuals,
and treatment program policies/procedures (including service
plan development)
Staff experience/background (education, credentials, licensing,
years experience in field, years with grantee/agency)
Agency licensing & certifications
Staff turnover/vacancies
Data Collection Time
Points
Fall 2011
TA data - quarterly
Biannual Reports &
Project Director
Interview - Every 6months (May-July &
Nov-Jan)
Site Visits - Fall 2010 &
Fall 2011
Data collection time
points from Question 1
J-69
Evaluation Question
Data Sources
Constructs Measured
Staff/client ratio
Consistency of staff in delivering services (consistency of case
load)
Constructs/Indicators from Question 1
d. What is the
relationship between
client-level outcomes
and the type and
amount of technical
assistance (TA)
requested and received?
Biannual Report
Project Director
Biannual Interview
Site Visit
Professional development/training activities
Staff training needs (licensing/credentials, cultural/gender
sensitivity, trauma-focused)
Number and type of TA requested and received
Constructs/Indicators from Question 1
Online TA system
Data Collection Time
Points
Biannual Reports &
Project Director
Interview - Every 6months (May-July &
Nov-Jan)
Site Visits - Fall 2010 &
Fall 2011
Data Sources from
Question 1
TA data – quarterly
Data collection time
points from Question 1
e. Does the context
within which PPW
grantees implement
services influence clientlevel outcomes?
Grantee Applications
Biannual Report
Project Director
Biannual Interview
Site Visit
Data Sources from
Question 1
Context of grantee’s treatment program (geographical area,
extent of need for services, extent of need for services, setting
of treatment facility)
Changes in local conditions related to grantee services or target
population
Availability of similar treatment agencies/services
Sources of client referrals
Challenges to program implementation
Facility quality (old/new building, safety of location/building)
Constructs/Indicators from Question 1
Grantee Applications once in Yr 1
Biannual Reports &
Project Director
Interview - Every 6months (May-July &
Nov-Jan)
Site Visits - Fall 2010 &
Fall 2011
Data collection time
points from Question 1
J-70
Evaluation Question
f. To what extent are
PPW grantees
implementing strategies
to ensure the
sustainability of their
treatment program?
Data Sources
Biannual Report
Project Director
Biannual Interview
Site visit
Interviews with ’06
Grantees
Constructs Measured
Changes in funding sources
Efforts to expand project’s capacity to serve population
Strategic development process for sustainability plan
Level of detail and content of Sustainability Plan
Level of detail and content of written manuals for treatment
process and delivery and/or treatment program policies
/procedures
Data Collection Time
Points
Biannual Reports &
Project Director
Interview - Every 6months (May-July &
Nov-Jan)
Site Visits - Fall 2010 &
Fall 2011
Interview with 06
grantees – once in FebApr 2011
| File Type | application/pdf |
| File Title | Attachment J - PPW Materials |
| Author | Victoria Castleman |
| File Modified | 2010-09-01 |
| File Created | 2010-09-01 |