BG_Planning_Sectio BG_Planning_Section

www.samhsa.gov • 1-877-SAMHSA-7 (1-877-726-4727)

Behavioral Health is Essential To Health • Prevention Works • Treatment is Effective • People Recover

FY 2012–2013
Block Grant Application
Community Mental Health Plan and Report
Substance Abuse Prevention and Treatment Plan and Report

R e d u c i n g t h e i m p a c t o f s u b s t a n c e a b u s e a n d m e n t a l i l l n e s s o n A m e r i c a ’s c o m m u n i t i e s .

·

Table of Contents
1. Introduction
a. Background
b. Current Environmental Factors
c. Impact on State Authorities and Systems
d. Block Grant Programs’ Goals
2. Submission of Application and Timeframes
3. Behavioral Health Assessment and Plan
a. Framework for Planning – Mental Health and Substance Abuse Prevention
Treatment
b. Planning Steps
c. Use of Block Grant Dollars for Block Grant Activities
d. Activities that Support Individuals in Directing Their Services
e. Data and Information Technology
f. Quality Improvement Reporting
g. Consultation with Tribes
h. Service Management Strategies
i. State Dashboards
j. Suicide Prevention
k. Technical Assistance Needs
l. Involvement of Individuals and Families
m. Use of technology
n. Support of State Partners
o. State Behavioral Health Advisory Councils
p. Comment on State Plan
4. Mental Health Block Grant Reporting Section
a. Introduction
b. Implementation Report
c. Expenditure Report
d. Population and Services Report
e. Performance Data and Outcomes
5. Substance Abuse Prevention and Treatment Block Grant Reporting Section
a.
b.
c.
d.
e.

Introduction
Implementation Report
Expenditure Report
Population and Services Report
Performance Data and Outcomes

1

6. SYNAR Reporting
7. Required Forms
a. Face Page—Community Mental Health Services Block Grant
b. Face Page—Substance Abuse Prevention and Treatment Block Grant
c. Funding Agreements/Certifications—Mental Health Services Block Grant
d. Funding Agreements/Certifications—Substance Abuse Prevention and
Treatment Block Grant
8. Appendix

2

1. INTRODUCTION
a. Background
In 1981, President Reagan sought and received from Congress a new way of providing
assistance to States 1 for an assortment of services including substance abuse and mental
health. Termed Block Grants, these grants were originally designed to give States
maximum flexibility in the use of the funds to address the multiple needs of their
populations. This flexibility was given in exchange for reductions in the overall amount
of funding available to any given State. Over time, a few requirements were added by
Congress directing the States’ use of these funds in a variety of ways. Currently,
flexibility is given to allow States to address their unique issues. However, health care
systems, laws, knowledge and conditions have changed. Today, SAMHSA observes a
more complex interplay between the Block Grants and other funding streams such as
Medicaid, and an increasing knowledge in the behavioral health field about evidencebased practices, self-direction, and peer services require more consistency and direction
to ensure that the Nation’s behavioral health system is providing the best and most cost
effective care possible, based on the best possible evidence, and tracking the quality and
outcome of services so impacts can be reported and improvements can be made as
science and circumstances change.
Since their inception, some assumptions about the nature and use of Block Grants have
evolved. Over time, Block Grants have become equated with the common practice of
allowing States to use these funds in a generally unrestricted, flexible manner – without
strong accountability measures. In the meantime, within behavioral health, newer,
innovative, and evidence-based services have gone unfunded or without widespread
adoption. The nation’s health care system is focusing more and more on quality and
accountability, and behavioral health care is essential to the nation’s health so it must do
so as well. The “science to service” lag and a lack of adequate and consistent personlevel data have resulted in questions from stakeholders and policy makers, including
Congress and OMB, as to the effectiveness and accountability achieved through the two
Block Grants administered by SAMHSA.
The Substance Abuse Block Grant (SABG) and the Community Mental Health Block
Grant (MHBG) differ on a number of their practices (e.g., data collection at individual or
aggregate levels) and statutory authorities (e.g., method of calculating MOE, stakeholder
input requirements for planning, set asides for specific populations or programs, etc.).
Historically, the Centers within SAMHSA that administer these Block Grants have had
different approaches to application requirements and reporting. To compound this
variation, States have different structures for accepting, planning, and accounting for the
Block Grants and the Prevention Set Aside within the SABG. As a result, how these

1

References to States in this document include the 50 States, 9 Territories and for the SABG, the Red Lake
Band of the Chippewa.

3

dollars are spent and what is known about the services and clients that receive these funds
varies by Block Grant and by State.

b. Current Environmental Factors
Health Reform
National economic conditions, a growing prevention science, and recent laws create a
dynamic critical for SAMHSA to address. The Mental Health Parity and Addictions
Equity Act (MHPAEA) significantly enhances access to behavioral health services for
millions of Americans. The Affordable Care Act will also enhance access to the
prevention, treatment and recovery support services for persons with or at risk of mental
and substance use disorders. These laws will improve the nation’s ability to close service
gaps that have existed for decades for far too many individuals and their families.
In addition to these laws, recent and proposed changes in the Medicaid program will have
a significant impact on how State Mental Health Authorities (SMHAs) and State
Substance Abuse Authorities (SSAs) use their limited resources. In 2009, more than 39
percent of individuals with serious mental illnesses or serious emotional disturbances and
60 percent of individuals with substance use disorders were poor and uninsured. Their
treatment and recovery support services were supported wholly or in part by SAMHSA
Block Grant funds. A substantial proportion of this population (maybe as many as six
million people) will gain health insurance coverage in 2014 and will have some but not
all preventive, treatment and support services covered either through Medicaid,
Medicare, or private insurance. However, these plans will not provide access to the full
range of support services necessary to achieve and maintain recovery for most of these
individuals and their families.
The two Block Grants have never been able to fund all the populations or all the services
needed by persons not otherwise eligible for Medicaid or private insurance. Given that
many individuals whose services are funded (in whole or in part) by Block Grants will
likely be covered in the future by Medicaid or private insurance, SAMHSA envisions a
new generation of Block Grants. States will use the Block Grant program for prevention,
recovery supports and other services that will supplement services covered by Medicaid,
Medicare and private insurance. SAMHSA Block Grant funds will be directed toward
four purposes: 1) to fund priority treatment and support services for individuals without
insurance or for whom coverage is terminated for short periods of time; 2) to fund those
priority treatment and support services not covered by Medicaid, Medicare or private
insurance for low income individuals and that demonstrate success in improving
outcomes and/or supporting recovery; 3) to fund primary prevention – universal, selective
and indicated prevention activities and services for persons not identified as needing
treatment; and 4) to collect performance and outcome data to determine the ongoing
effectiveness of behavioral health promotion, treatment and recovery support services
and to plan the implementation of new services on a nationwide basis. SAMHSA needs
to begin planning now for the FY 2014 when more individuals who are uninsured will
4

have the option to become insured. This will require that SAMHSA use FY 2011, 2012
and 2013 to work with States to plan for and transition the Block Grants to these four
purposes. This transition includes fully exercising SAMHSA’s existing authority
regarding States’ use of Block Grant funds, and a shift in SAMHSA staff functions to
support and provide technical assistance for States receiving Block Grant funds, as they
move through these changes.
Coordination with Primary Care
Coordination between primary care and specialty care- including behavioral health- is a
necessity. Nearly 12 million visits made to U.S. hospital emergency departments in 2007
involved individuals with a mental disorder, substance abuse problem, or both, according
to News and Numbers 2, Agency for Healthcare Research and Quality (AHRQ). These
visits account for one in eight of the 95 million visits to emergency departments by adults
that year. Of these, two-thirds involved those with a mental disorder, one quarter was for
those with a substance abuse problem, and the rest involved those dealing with both a
mental disorder and substance abuse. Almost a quarter of hospital admissions are
associated with a mental or substance use disorder.
People with serious mental illness (SMI) have elevated rates of hypertension, diabetes,
obesity and cardiovascular disease, leading to morbidity and mortality disparities where
those with SMI die on average at 53 years of age. These health conditions are
exacerbated by unhealthy lifestyle practices such as lack of physical activity, poor
nutrition, smoking, substance abuse and side effects of necessary medication. Many of
these health conditions are preventable through routine primary care screening,
monitoring, treatment and care management/coordination strategies. The Massachusetts
Department of Mental Health (DMH) found that for adults ages 25 to 44, cardiovascular
mortality was 6.6 times higher among DMH clients than the general population 3. 70
percent of Maine’s population living with serious mental illnesses has at least one of
these chronic health conditions, 45 percent have two, and almost 30 percent have three or
more. 4 Integration of behavioral health and primary care is just as important for children
and youth. Studies suggest that approximately a quarter of pediatric primary care visits
are related to behavioral health issues. 5,6 The needs of children and youth with serious
emotional disturbances (SED) are best addressed when coordinated within a coordinated
System of Care that involves, but extends beyond the primary care setting. A similar
2

Owens P.L., Mutter R., Stocks C. Mental Health and Substance Abuse-Related Emergency Department
Visits among Adults, 2007. HCUP Statistical Brief #92. July 2010. Agency for Healthcare Research and
Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb92.pdf
3
NASMHPD (2006), NASMHPD Medical Directors Council Technical Report: Morbidity and Mortality in
People with Serious Mental Illness (Editors: Parks, J.; Svendsen, D.; Singer, P.; Foti, M.) Alexandria, VA
4
Freeman, E., Yoe, J.T. The Poor Health Status of Consumers of Mental Healthcare: Behavioral Disorders
and Chronic Disease, Presentation to NASMHPD Medical Directors Work Group, May 2006.
5
Horwitz, S. M., Leaf, P. J., Leventhal, J. M., Forsyth, B., & Speechley,K. N. (1992). Identification and
management of psychosocial and developmental problems in community-based primary care pediatric
practices. Pediatrics, 89, 480–485.
6

Cooper, S., et al. (2006). Running out of time: Physician management of behavioral health concerns in rural pediatric
primary care. Pediatrics, 118, 132–138.

5

coordinated approach should be used to address the needs of youth with substance use
problems.
According to SAMHSA’s National Survey on Drug Use and Health (NSDUH) 7, about
9.3 percent of the general population (about 24 million Americans over the age of 12 or
older) needed treatment for a substance abuse problem in 2009. Yet only about 11
percent of those identified had been treated in the specialty treatment system within the
past year and over 40 percent of those not treated who try to get help say they cannot
access treatment because of cost or insurance barriers. Those with substance use
conditions are therefore more reliant on public funding sources for treatment. About 22
percent of general health care patients report having a co-morbid substance use disorder
of some severity, which is likely related to the myriad physical consequences resulting
from untreated substance misuse and dependency. Additionally, the presence of
substance use and mental health conditions often complicate the treatment of a variety of
common medical disorders.
Individuals with mental or substance use disorders have much higher rates of smoking
relative to the general population. In particular, individuals with schizophrenia have one
of the highest rates of smoking (58–88 percent). 8 Persons with mental illness or
substance abuse disorder represent 25 percent of the population, but they account for 44
percent of the cigarettes consumed in the U.S. SAMHSA has developed several national
initiatives regarding primary care and behavioral health coordination. Information
regarding these initiatives can be found at:
http://www.samhsa.gov/healthReform/healthHomes/index.aspx.
Consultation with Tribes
President Obama signed a Memorandum on Tribal Consultation in November 2009 9 that
directed all agencies to submit plans on how they will engage in regular and meaningful
consultation and collaboration with tribal officials in the development of Federal policies
that have tribal implications. The President reaffirmed the unique legal and political
relationship with Tribes that has been established through and confirmed by the
Constitution, treaties, statutes, executive orders and judicial decisions. States with
Federally recognized tribal governments or tribal lands within their borders will be
expected to show evidence of tribal consultation as part of their Block Grant planning
processes. Tribal governments shall not be required to waive sovereign immunity as a
condition of receiving Block Grant funds or services. SAMHSA will work with States to
develop appropriate consultation policies.
Prevention
7

Substance Abuse and Mental Health Services Administration. (2010). Results from the 2009
National Survey on Drug Use and Health: Volume I. Summary of National Findings (Office of
Applied Studies, NSDUH Series H-38A, HHS Publication No. SMA 10-4586 Findings).
Rockville, MD.
8
Kalman D, Morrisette SB, George TP. Co-morbidity of smoking with psychiatric and substance use
disorders. Am J Addict. 2005;14:106–23.
9
Federal Register: November 9, 2009 (Volume 74, Number 215

6

The 2009 Institute of Medicine (IOM) report entitled Preventing Mental, Emotional, and
Behavioral Disorders Among Young People 10 articulates the current scientific
understanding of the prevention of mental and substance use disorders. This report
summarizes those programs and interventions with the strongest scientific evidence of
effectiveness in preventing substance use and mental disorders and promoting positive
emotional/behavioral health. These programs prevent alcohol and drug abuse,
depression, conduct disorder, and other behavioral health problems and build resilience
by addressing common risk and protective factors.
Implementing these evidenced-based practices will require cooperation across a number
of community settings and service systems, including medical settings, homes, childcare,
child welfare, schools, juvenile and criminal justice systems. In addition to program
improvements, policy changes and environmental strategies such as social marketing are
a key part of a comprehensive prevention strategy. Coordinated and targeted prevention
programs in a range of settings together with research-supported environmental strategies
can and will reduce the incidence of substance use and mental disorders.
In addition to a broad approach that addresses a range of behavioral issues and settings it
is also important to target specific problems such as underage drinking. Underage
drinking is a serious health and safety issue. Many adults, including some parents,
mistakenly think that underage drinking is a part of growing up and a harmless rite of
passage. Nearly 5,000 deaths are attributable to underage drinking each year, and many
more young people fail to reach their full potential because of alcohol.
In addition to targeting specific problems such as underage drinking, States must also
focus efforts on communities at highest risk. SAMHSA encourages States to use datadriven approaches to allocate funding to communities with fewer resources and the
greatest behavioral health needs. MH and SABG funds have the flexibility to support
this targeted approach.
SAMHSA requires that States spend at least 20 percent of their SABG allotment on
primary prevention programs for persons who do not require treatment. Some States
spend more. In addition, the scientific understanding of mental health promotion and
mental illness prevention (or mitigation) was not well-known or developed when the
MHBG was first authorized in the 1980s. States and communities should take scientific
developments of the last 25 years into account as they develop plans to prevent substance
use and mental disorders and promote emotional health.

10

National Research Council and Institute of Medicine. (2009). Preventing Mental, Emotional, and
Behavioral Disorders Among Young People: Progress and Possibilities. Committee on the Prevention of
Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances
and Promising Interventions. Mary Ellen O’Connell, Thomas Boat, and Kenneth E. Warner, Editors. Board
on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington,
DC: The National Academies Press

7

States should make prevention a top priority, taking advantage of recent science, best
practices in community coordination, proven planning processes such as the Strategic
Prevention Framework, and the science articulated by the IOM report on Preventing
Mental, Emotional, and Behavioral Disorders Among Young People. States will be
allowed to use some of their current MHBG to support these activities. In the meantime,
SAMHSA will work with States to increase their accountability systems for prevention
and to develop necessary reporting capacities.
The President’s budget for FY 2012 includes several new SAMHSA programs that may
affect the MHBG and SABG. Specifically, the President proposes three new formula
grant programs: 1) the Substance Abuse-State Prevention Grant (SA-SPG) focusing
exclusively on the primary prevention of substance abuse, 2) the Mental Health-State
Prevention Grant (MH-SPG) focusing on building positive emotional health and
addressing risk and protective factors to help prevent mental, emotional, and behavioral
disorders, including substance abuse, among youth, and 3) the Behavioral Health - Tribal
Prevention Grant (BH-TPG) to prevent substance abuse and suicide in Tribal
communities. In anticipation of this enhanced emphasis on prevention in States,
Territories, Tribes and communities, SAMHSA requests that States provide a coordinated
and combined plan addressing services and activities for the primary prevention of
mental and substance use disorders (including the use of universal, selective, and
indicated strategies) in the planning section of the current Block Grant application. If the
President’s FY 2012 budget is adopted, applications for the new formula grants will be
separate from the SAPT and MHS Block Grant process. SAMHSA will work with States
to develop and/or amend their FY 2012 Block Grant State Plan(s) once a budget for FY
2012 is finalized. Additionally, SAMHSA will conduct formal tribal consultation on
development of specifications for the BH-TPG prior to appropriation of the 2012 Budget.
SAMHSA’s Strategic Initiatives
In addition to health reform, SAMHSA has established eight Strategic Initiatives to
improve the delivery and financing of prevention, treatment, and recovery support
services to advance and protect the Nation’s health. These initiatives will focus
SAMHSA’s work on improving lives and capitalizing on emerging opportunities. As
each initiative is developed and integrated throughout SAMHSA activities, information
will be disseminated to States, stakeholder groups, national organizations, and policy
makers. With this guidance, States should develop plans and application(s) with a focus
on SAMHSA’s Strategic Initiatives. The areas and goals that comprise the strategic
initiatives include:
1. Prevention of Substance Abuse and Mental Illness—Creating communities where
individuals, families, schools, faith-based organizations, and workplaces take action
to promote emotional health and reduce the likelihood of mental illness, substance
abuse including tobacco, and suicide. This initiative will focus especially on the
Nation’s high risk youth, youth in Tribal communities, and among military families.

8

2. Trauma and Justice—Reducing the pervasive, harmful, and costly health impact of
violence and trauma by integrating trauma-informed approaches throughout health,
behavioral health, and related systems and addressing the behavioral health needs of
people involved or at risk of involvement in the criminal and juvenile justice systems.
3. Military Families—Supporting America’s service men and women – Active Duty,
National Guard, Reserve, and Veterans – together with their families and
communities by leading efforts to ensure needed behavioral health services are
accessible and outcomes are successful.
4. Recovery Support—Partnering with people in recovery from mental and substance use
disorders to guide the behavioral health system and promote individual-, program-, and
system-level approaches that foster health and resilience; increase permanent housing,
employment, education, and other necessary supports; and reduce barriers to social
inclusion.
5. Health Reform—Broadening health coverage to increase access to appropriate high
quality care, and to reduce disparities that currently exist between the availability of
services for substance abuse, mental disorders, and other medical conditions.
6. Health Information Technology—Ensuring the behavioral health system, including
States, community providers, peer and prevention specialists, fully participates with
the general healthcare delivery system in the adoption of Health Information
Technology (HIT) and interoperable Electronic Health Records (EHR).
7. Data, Outcomes, and Quality—Realizing an integrated data strategy that informs
policy and measures program impact leading to improved quality of services and
outcomes for individuals, families, and communities.
8. Public Awareness and Support—Increasing understanding of mental and substance use
disorders to achieve the full potential of prevention, help people recognize mental and
substance use disorders and seek assistance with the same urgency as any other health
condition, and make recovery the expectation.
c. Impact on State Authorities and Systems
SAMHSA seeks to ensure that State Mental Health Authorities (SMHAs) and Substance
Abuse Authorities (SSAs) are prepared and ready to address the priorities described
above. These environmental factors are key drivers that will enhance the SMHAs and
SSAs ability to take advantage of many changes that will improve the health of
individuals with mental and substance use disorders, improve how they experience care
and reduce costs. While certain changes will not occur until 2014, State authorities
should begin to consider the possible changes in what services they purchase, the system
improvements necessary to operate in a new healthcare environment and how they will
prepare their providers to offer effective care. Changes to the new application allow for
this range of differences and the goals that each State has for health reform. SAMHSA
believes the application will enhance the ability of States to use resources to assist them
9

in making the transitions that are unique to their own State decisions and strategies. The
changes to the Block Grant application(s) incorporate several key assumptions:
•

States will play an important role in the design and implementation of the
national health reform strategy. At the national level, Federal agencies are
developing opportunities for States to successfully implement health reform.
However, these efforts rely heavily on States to take advantage of these new
opportunities and to begin to develop the system improvements needed to achieve
the promise of the Affordable Care Act. Federal funding has already been made
available to States and communities to enhance the home and community based
services, increase prevention activities, expand the use of primary care and to
begin planning for many State health insurance exchanges that will be operational
in FY 2014.

•

States should be more strategic in their efforts to purchase services. The
availability of new evidenced-based approaches and funding will require States to
rethink what services they purchase as well as how those services are purchased.
Although access to Medicaid and private insurance will increase over the next few
years, gaps in coverage will remain for specific populations and services.
SMHAs and SSAs need to begin to identify those gaps by first mapping out which
populations will be covered by various coverage options available under health
reform. Secondly, within the different insurance packages, States have to
consider the extent to which specific MH/SUD services will remain uncovered.
In order to identify gaps in the continuum of services, State Mental Health and
Substance Abuse Authorities will need to determine what specific MH/SUD
services they should cover in addition or over and above to what is being covered
by insurers and other payers. States should use SAMHSA’s description of a Good
and Modern Mental Health and Addiction Service System 11 when they consider
service issues. In addition, States will need to become more diligent in their
efforts to identify individuals in their systems that may currently qualify, but are
not enrolled in the Children’s Health Insurance Program Reauthorization Act
(CHIPRA), Medicaid and Medicare programs.
When developing strategies for purchasing services, SMHAs and SSAs must
identify other State and Federal sources that can be used to purchase services.
Funding available from the Center for Medicare and Medicaid Services (CMS),
such as Medicaid, CHIPRA, Medicare and national demonstration projects (e.g.
Money Follows the Person, Rebalancing Initiatives, Health Homes, IMD
Demonstration) will play a more important role to States given the recent
reductions in State funding for behavioral health services. In addition, funding
from the Health Resources Services and Administration (HRSA) must be
considered as States develop these strategies. HRSA has significantly expanded
access to health and behavioral health services offered through its Federally

11

Substance Abuse and Mental Health Services Administration. (2010), Description of a Modern
Addictions and Mental Health Delivery System, Office of Policy, Planning, and Innovation, Rockville, MD
http://www.samhsa.gov/healthreform/docs/AddictionMHSystemBrief.pdf

10

Qualified Health Centers (FQHCs). HRSA has also made available funding and
other opportunities to increase and enhance the quality of the behavioral health
workforce (e.g., loan forgiveness program, National Health Service Corps,
training grants, etc.). This means that SMHAs and SSAs (as well as public health
authorities responsible for prevention) will need to engage and collaborate with
different and additional potential partners at the State and community levels.
The new environment may create new ways to purchase services. Reimbursement
for episodes of care and pay-for-outcomes are just two strategies that payers may
use in the future. These strategies have not been widely deployed by public
behavioral health payers. SAMHSA suggests that SMHAs and SSAs consider
using their block grant funds and develop reimbursement strategies that are
consistent with the intent of health reform to pay for better services, not just more
services.
•

States should think more broadly than the populations they have historically
served through Federal Block Grants and other funding. The focus of
SAMHSA’s Block Grant programs has not changed significantly over the past 20
years. While many of these populations originally targeted for the Block Grants
are still a priority, certain populations have evolving needs that must be
addressed. These populations include military families, youth who need
substance use disorder services, individuals who experience trauma, increased
numbers of individuals released from correctional facilities, and lesbian, gay, bisexual and transgendered and questioning (LGBTQ) individuals. In addition, the
context of service delivery has significantly changed. SAMHSA’s Childrens
Mental Health Initiative, which serves children and youth with serious emotional
disturbances and their families has shown that services and supports to this
population should be delivered within a System of Care approach that is
strengths-based, linguistically and culturally-competent, provided in the least
restrictive, community-based settings and coordinates care across families,
schools, and other community agencies. Systems of Care are family driven and
youth guided. This means that the family is the primary driver of the single care
plan, which should be coordinated across agencies such as the education system,
child welfare and juvenile justice. Single care plans are largely influenced by the
youth as well. Systems of care generally employ a Wraparound approach to
service delivery. Family members and youth should be included in meaningful
ways in all aspects of system development, implementation and evaluation. This
Systems of Care approach should be used to meet the needs of children and youth
with serious emotional disorders. Similar steps should be taken to ensure that the
unique needs of children and youth with substance use problems are met,
recognizing that this group’s service needs are often distinct from adults with
substance use problems.
Services must be delivered in a manner that promotes recovery and resiliency.
Individuals that have personal experiences from mental or substance abuse
disorders are playing an increasingly important role in the delivery of recovery11

oriented systems of care. Services must also take into account ethnicspecific/culture-specific services for racial and ethnic minorities. Services must
address the unique needs of tribal populations and the unique role of tribal
governments in planning and delivering services. In addition, advances in
technology have changed significantly since 1991. Technology is playing a
growing role in how individuals learn about, receive and experience their health
care services. Interactive Communication Technologies (ICTs) are being more
frequently used to deliver various health care and recovery support services.
ICTS are also being used by individuals to report health information and
outcomes. A more detailed discussion regarding ICTs is provided later in this
document in Section 3m.
•

States should design and develop collaborative plans for health information
systems—Health care payers seeks to promote EHR and interoperable information
technology systems that allow for the effective exchange and utilization of health
data. Purchasers of behavioral health services should acquire information
technology systems that collect information on provider characteristics, client
enrollment, demographics, and characteristics. Current laws will require these
systems to comply with national standards (national provider numbers, ICD-10,
CPT/HCPCS codes). The information technology systems will also have to be
interoperable with other payers (e.g. Medicaid, Medicare and private insurance
plans). SAMHSA believes it is important for public behavioral health purchasers
in a State (or region) to begin or to continue to collaborate and discuss mutual
issues concerning system interoperability, electronic health records, Federal
information technology requirements and other related issues.

•

States may form strategic partnerships in order for individuals to have access to a
good and modern services system. SAMHSA is seeking to enhance SMHAs and
SSAs ability to be full partners in developing and implementing MHPAEA, health
reform strategies in their State. In many respects, successful implementation will
be dependent on leadership and collaboration among multiple stakeholders. The
relationships among the State Mental Health and Substance Abuse Authorities
and the State Medicaid Director, the State Insurance Commissioner, State
prevention agencies, the State child serving agency, the public health authorities
and the health information technology authorities are of paramount importance
during this time of transition. These collaborations will be particularly important
in the areas of Medicaid expansion, data and information management and
technology, professional licensing and credentialing, consumer protection, and
workforce development.
To increase the likelihood of success, collaboration must foster a long-range view,
open communication, encourage knowledge-sharing and consider all stakeholder
concerns and priorities. SMHAs and SSAs should consider developing strategic
partnerships with TRICARE, primary care, public health, criminal and juvenile
justice, education, child welfare, Veterans Affairs, National Guard Bureaus,

12

insurers and employers. State authorities should also have meaningful and timely
tribal consultation as they undertake their Block Grant planning process(es).
•

State authorities should focus more on recovery from mental health and substance
use problems. People can and do recover from behavioral health problems.
Services and supports must foster individual and family capacity for self-directed
recovery. Recovery benefits both the individual with a behavioral health
condition as well as the community leading to a healthier and more productive
population. SAMHSA is committed to assisting States, providers, people with
mental and substance use disorders, families, and others in promoting recovery.

•

State authorities should redesign their systems to be more accountable for
improving the experience of care and for the health of the population. SAMHSA
is committed to engaging in a meaningful, structured process, in consultation with
States, other stakeholders and policymakers, including HHS and OMB, to develop
accountability measures for the Block Grants. Through the Block Grant
application and planning process and in conversation with States, providers,
service recipients, and other stakeholders, SAMHSA will create a flexible,
deliberate, and careful method of identifying meaningful and appropriate
measures – which may be modified as needs change and the science evolves. As
the quality and outcome measures for the Block Grants develop through
SAMHSA’s Strategic Initiative on Data, Outcomes, and Quality, the described
approach to accountability will allow those measures to drive the application(s),
review, approval, and monitoring processes.

SAMHSA wants to ensure the health and viability of State mental health and
substance abuse systems which will require that SAMHSA and the States have strong
quality improvement plans. A critical component of these plans will be the
development and use of the quality and outcome measures. SAMHSA will work with
States to identify those quality and outcome measures that can be used to develop a
“dashboard” of key indicators that will measure a State’s progress in key
programmatic and operational areas. This dashboard will be able to determine if
differences are being made to the State mental health and substance abuse system.
SAMHSA is considering developing an incentive program for States that may include
financial and administrative incentives based on their performance on this dashboard.
d. Block Grant Programs’ Goals
SAMHSA’s SABG and MHBG are designed to provide States with the flexibility to
design and implement activities and services to address the complex needs of individuals,
families, and communities impacted by mental disorders, substance use disorders and
associated problems. The goals of the Block Grant programs are consistent with
SAMHSA’s vision for a high-quality, self-directed, and satisfying life in the community
for everyone in America. This life in the community includes:
a) A physically and emotionally healthy lifestyle (health);
13

b) A stable, safe and supportive place to live (a home);
c) Meaningful daily activities such as a job, school, volunteerism, family
caretaking, or creative endeavors and the independence, income, and resources to
participate in society (a purpose); and,
d) Relationships and social networks that provide support, friendship, love, and
hope (a community).
Additional aims of the Block Grant programs reflect SAMHSA’s overall mission and
values, specifically:
•

To promote participation by people with mental and substance use disorders in
shared decision making person-centered planning, and self direction of their
services and supports.

•

To ensure access to effective culturally and linguistically competent services for
underserved populations including Tribes, racial and ethnic minorities, and
LGBTQ individuals.

•

To promote recovery, resiliency and community integration for adults with
serious mental illness and children with serious emotional disturbances and their
families.

•

To increase accountability for behavioral health services through uniform
reporting on access, quality, and outcomes of services.

•

To prevent the use, misuse, and abuse of alcohol, tobacco products, illicit drugs,
and prescription medications.

•

To conduct outreach to encourage individuals injecting or using illicit and/or licit
drugs to seek and receive treatment.

•

To provide HIV prevention as an early intervention services at the sites at which
individuals receive substance use disorder treatment services.

•

To coordinate behavioral health prevention, early identification, treatment and
recovery support services with other health and social services.

•

To increase accountability for prevention, early identification, treatment and
recovery support activities through uniform reporting regarding substance use and
abstinence, criminal justice involvement, education, employment, housing, and
recovery support services.

•

To ensure access to a comprehensive system of care, including education,
employment, housing, case management, rehabilitation, dental services, and
health services, as well as behavioral health services and supports.

14

These goals are significant drivers in the revised Block Grant application(s). SAMHSA’s
and other Federal agencies’ focus on accountability, person directed care, family-driven
care for children and youth, underserved minority populations, Tribal sovereignty, and
comprehensive planning across health and specialty care services are reflected in these
goals. States should use these aims as drivers in developing their application(s).

15

2. SUBMISSION OF APPLICATION AND TIMEFRAMES
As referenced in the Introduction, changes to the SAPT and CMHS Block Grant
applications are, in part, being driven by MHPAEA and other legislation. SAMHSA
wants to ensure that SMHAs/SSAs are well into strategic planning and implementation
phases before 2014 approaches. In addition there are a number of standardizations
between applications that are also necessary. While the statutory deadlines remain
unchanged, SAMHSA has made changes to the timeframe in which States are asked to
submit application(s) and report their progress towards implementing planned activities.
These changes were made to better coincide with the majority of State’s fiscal year
calendars, which are from July 1 through June 30th the following year. In addition, both
the MHBG and the SABG application will be due on the same date. Previously, the
MHBG and the SABG applications were due on different months. The dates for
providing reports and assurances and the reporting periods for both Block Grants were
also different. SAMHSA has also changed the report date and report periods to be
consistent across both Block Grants.
The FFY 2012 MHBG and SABG Block Grant application(s) should be submitted to
SAMHSA on 9/1/2011 and will consist of an application and plan for a twenty-one
month period (10/1/11-6/30/13) to align with most States’ fiscal year budget cycle 12. The
subsequent Block Grant application(s) should be submitted to SAMHSA on 4/1/13 for a
two year period (July1, 2013 through June 30, 2015). There are no changes to the Block
Grant award periods.
SAMHSA cannot waive the statutory deadlines for submission of applications. However,
SAMHSA is proposing a phased submission process that will allow States to submit the
parts of the plan that are completed on or before the deadline. For those States that do not
have their whole plan complete, the State in their submission should identify those
sections of the plan that require additional time. For those sections of the plan that will
require more time, the State should provide a description of the work that will be done
before the final submission, the timeframe for completing this work and submission date
for the final plan. States that will be submitting additional information after the statutory
deadline should work closely with their state project officer regarding the due dates for
the final plan.
States should submit their Block Grant application(s) for 2012 and 2103 based on the
guidance provided in this document. The Behavioral Health Systems Assessment and
Plan provides a consistent framework for State Mental Health and Substance Abuse
Authorities to assess the strengths and needs of their systems and to plan for system
improvement. This framework is consistent with the strategic planning framework
currently used by SAMHSA for various grants. The unique statutory requirements of the
specific Block Grants and the three areas requiring or requesting a combined plan are
covered in the State Plan section. The Planning Section in the FY 2012-2013 Block

12

Reporting timeframes for SYNAR will remain on the current schedule.

16

Table 1
Application(s) for
FFY

Plan and
Assurances Due

2012

9/1/2011

2013

*

2014

4/1/13

2015

*

2016
2017

4/1/15
*

Planning
Period

Reports
Due

Reporting
Period

10/1/11 – 6/30/13

12/1/11

*

12/1/12

7/1/11 – 6/30/12

12/1/13

7/1/12 – 6/30/13

12/1/14

7/1/13 – 6/30/14

12/1/15
12/1/16

7/1/14 - 6/30/15
7/1/15 – 6/30/16

7/1/13 – 6/30/15
*
7/1/15 – 6/30/17
*

Grant Application is comprised of a needs assessment and seeks to collect information
from States regarding their activities in response to new federal legislation, initiatives,
changes in technology, and advances in research and knowledge. The FY 2012-2013
Block Grant Application has sections that are required and other sections where
additional information is requested but not required. Section 3.b requires States to
undertake a needs assessment as part of their plan submission. This section identifies the
populations that States must include in their assessment but are encouraged to plan for
other populations (e.g. youth with a substance use disorders). Section 3c, Tables 6 and 7
are required.
Sections 3.c-n requests information on State efforts on certain policy, program and
technology advancements in health and behavioral health care. While this information is
not required, it will help SAMHSA understand the whole of the applicant State’s efforts
and identify how it can assist the applicant State meet its goals in a changing
environment. In addition, this information will identify States that are models and assist
other States with areas of common concern. Section 3.p is required for both the SABG
and MHBG. Section 3.o is required for those States submitting a combined Block Grant
application or States submitting just their MHBG application.
Some States may choose not to include other populations in their needs assessment or
provide the requested information in other sections of the plan. While not submitting this
information will not change SAMHSA’s approval of their Plan or payment, States are
strongly encouraged to submit as much as they can so the nation as a whole will have a
complete picture of needs of individuals with behavioral health conditions as well as the
innovative approaches States are undertaking in these areas as well as the barriers they
encounter designing and implementing important policies and programs.
In order for the Secretary of the U.S. Department of Health and Human Services, acting
through the Administrator of SAMHSA, to make an award under the programs involved,
States must submit an application(s) prepared in accordance with the authorizing
legislation, and implementation regulations. The funds awarded will be available for
obligation and expenditure 13 to plan, carry out, and evaluate activities and services
13

Title XIX, Part B of the Public Health Service Act

17

designed to prevent serious emotional disturbances (SED) among children and serious
mental illness (SMI) among adults and their consequences; to prevent substance abuse; to
treat children with SED, adults with SMI, and individuals (youth and adults) with a
substance use disorder (SUD); adolescents and adults with co-occurring disorders and to
promote recovery among persons with SED, SMI, or SUD.
A grant may be awarded only if an application(s) submitted by a State includes a State
Plan 14 15 in such form and containing such information including, but not limited to,
detailed provisions for complying with each funding agreement for a grant under section
1911 of Title XIX, Part B, Subpart I of the Public Health Service (PHS) Act or section
1921 of Title XIX, Part B, Subpart II of the PHS Act that is applicable to a State. This
State Plan should include a description of the manner in which the State intends to
obligate the grant. The State Plan must include a report 16 in such form and containing
such information as the Secretary determines to be necessary for securing a record and a
description of the purposes for which the grant was expended. The State Plan should
also describe the activities and services purchased by the States under the program
involved and a description of the recipients and amounts provided in the grant. States
shall have the option of updating their plans during the two year planning cycle.
States are encouraged to submit a combined mental health and substance abuse
prevention and treatment application. If a State is submitting separate applications, it
should clarify which system is being described in this section (i.e. mental health or
substance abuse prevention and treatment).

14

Section 1912 of Title XIX, Part B, Subpart I of the Public Health Service Act (42 U.S.C. § 300x-2)
Section 1932(b) of Title XIX, Part B, Subpart II of the Public Health Service Act (42 U.S.C. § 300x32(b))
16
Section 1942(a) of Title XIX, Part B, Subpart III of the Public Health Service Act (42 U.S.C. § 300x52(a))
15

18

3. BEHAVIORAL HEALTH ASSESSMENT AND PLAN
SAMHSA values the importance of a thoughtful planning process that includes the use of
available data to identify the strengths, needs and service gaps for specific populations.
By identifying needs and gaps, States can prioritize and establish tailored goals, strategies
and measurable targets. In addition, the planning process should provide information on
how the State will specifically spend available Block Grant funds consistent with the
environment and priorities described in this document and with the environment and
priorities identified in the State’s plan.
Meaningful input of stakeholders in the development of the plan is critical. Evidence of
the process and input of the Planning Council required by Section 1914(b) of the Public
Health Services Act for the MHBG must be included in the application that addresses
MHBG funds. States are encouraged, as State laws and regulations allow, to expand this
Planning Council to include prevention and substance abuse stakeholders and utilize this
mechanism to advise on the formation of the SABG application as well. Absent that
approach, the State must describe the stakeholder input process for the SABG application
and any additional input processes utilized for the MHBG process in furtherance of the
statutory requirement to make the State plan available to the public in such a manner as to
facilitate comment from any person. This description should show involvement of
persons who are service recipients and/or in recovery, families of individuals with
substance use and mental disorders (including parents and caregivers of children or youth
with behavioral health problems), providers of services and supports, representatives
from racial and ethnic minorities, LGBTQ populations, persons with co-existing
disabilities and other key stakeholders. Evidence of meaningful consultation with
Federally recognized Tribes where tribal governments or lands are located within the
boundaries of the State must be provided in the application(s) for both Block Grants.
The assessment and planning activities are different from previous years. Under the
previous SABG application, States were requested to address the seventeen national
goals. Some of the goals were population specific, others were service specific. The
MHBG application required States to address a set of criteria for children with serious
emotional disturbances and adults with serious mental illness. While both Block Grants
required States to do an assessment and plan, it did not always allow the State or
SAMHSA to obtain an overall picture of the State’s behavioral health needs and to
incorporate consistent priorities and planning activities especially for individuals with a
co-occurring mental and substance use disorder. SAMHSA has designed the current
assessment and planning activities to be consistent with the criteria established in
authorizing legislation and regulation as well as with the national goals and priorities
described in this document. SAMHSA has identified other populations and activities
beyond those that are statutorily required, that States may want to consider in their needs
assessment and State Plan activities. SAMHSA continues to encourage States to identify
other populations beyond those required in the statute and identified in the list of
populations and strategies in the following section. In addition, SAMHSA is encouraging
States to use data in their planning effort that will address services and prevention
activities that address the cultural and linguistic needs of the individuals in their State.
19

a. Framework for Planning—Mental Health and Substance Abuse Prevention and
Treatment
States should identify and analyze the strengths, needs, and priorities of the State’s
behavioral health system. The strengths, needs, and priorities should take into
consideration specific populations that are the current focus of the Block Grants, the
changing health care environment and SAMHSA’s strategic initiatives. The plan should
address the following populations as appropriate for each Block Grant:
Comprehensive community-based services for adults with SMI and children with SED:
• Children with serious emotional disturbances (SED) and their families*
• Adults with serious mental illness (SMI)*
Services for persons with or at risk of having substance use and/or mental health
disorders:
• Persons who are intravenous drug users (IDU)*
• Adolescents with substance abuse and/or a mental health problems
• Children and youth who are at risk for mental, emotional and behavioral
disorders, including, but not limited to addiction, conduct disorder and depression
• Women who are pregnant and have a substance use and/or mental disorder*
• Parents with substance use and/or mental disorders who have dependent children*
• Military personnel (active, guard, reserve, and veteran) and their families
• American Indians/Alaska Natives
Services for persons with or at risk of contracting communicable diseases:
• Individuals with tuberculosis *
• Persons with or at risk for HIV/AIDS and who are in treatment for substance
abuse*
Targeted services:
• Individuals with mental and/or substance use disorders who are homeless or
involved in the criminal or juvenile justice systems
• Individuals with mental and/or substance use disorders who live in rural areas.
• Underserved racial and ethnic minority and LGBTQ populations
• Persons with disabilities
• Community populations for environmental prevention activities, including policy
changing activities, and behavior change activities to change community, school,
family and business norms through laws, policy and guidelines and enforcement.
• Community settings for universal, selective and indicated prevention
interventions, including hard-to-reach communities and “late” adopters of
prevention strategies.
Populations that are marked with an asterisk are required to be included in the State’s
needs assessment for the MHBG or SABG. To the extent that the other listed populations

20

fall within any of the statutorily covered populations, States must include them in the
plan.
States should undertake a broader approach to their assessment and planning process and
include other individuals who are in need of behavioral health services. In particular,
States should begin planning now for individuals with low-incomes who currently are
uninsured but will be covered by Medicaid or private insurance in FY 2014 and will
present new opportunities for public behavioral health systems to expand access and
capacity. In addition, States should identify who will not be covered after FY 2014 and
how Federal funds will be used to support these individuals who may need treatment and
supports 17.
MHPAEA, other legislation that enhances access to Medicaid, and SAMHSA’s Strategic
Initiatives place an emphasis on identifying the health, behavioral health and long-term
care needs of individuals with mental and substance use disorders. These laws and
initiatives also present significant opportunities for States to include in their benefit
design recovery support services for adults, youth and families who have behavioral
health needs. In addition, policy drivers place a heavy emphasis on wellness and the
prevention of mental, emotional, and behavioral disorders. These major themes are
relevant for State substance abuse and mental health authorities. SAMHSA is
encouraging SMHAs and SSAs to develop and submit a combined plan to address the
common areas below:
•
•

Bi-directional integration of behavioral health and primary care services;
Provision of recovery support services for individuals with mental or substance
use disorders.

In addition, SAMHSA is also requesting a combined plan for any expenditure of funds
for the provision of services for individuals with co-occurring mental and substance use
disorders. For States that have separate mental health and substance abuse agencies, the
combined plan for these activities should be included in both the State MHBG and SABG
applications. These combined plans should be included in a State’s application (for those
states submitting one Block Grant application). For States that submit separate Block
Grant applications, the combined plan for these activities should be included in both the
State MHBG and SABG applications.
In addition, states should also consider linking their Olmstead planning work in the Block
Grant application, identifying individuals who are needlessly institutionalized or at risk of
institutionalization.
SAMHSA is encouraging states to undertake each of the following planning steps in a
timely manner. The FY 2011 Block Grant application and Addendum indicated that
some States have already undertaken a needs assessment of the populations identified in
the FY 2012/2103 Block Grant application. Other States are designing needs assessment
17

SAMHSA will provide each state with information regarding the projected number and demographics of
potentially uninsured individuals.

21

processes that will be completed after the 9/1/2011 submission date. In the Block Grant
application, States should either provide information on the unmet need or the critical
gaps within the service system or provide the timeframe within FY 2012 that the
assessment and analysis will be completed.
b. Planning Steps
For each of the populations and common areas, States should follow the following
planning steps:
Step 1: Assess the strengths and needs of the service system to address the specific
populations.
Provide an overview of the State’s behavioral health prevention, early identification,
treatment, and recovery support systems. Describe how the public behavioral health
system is currently organized at the State, intermediate and local levels differentiating
between child and adult systems. This description should include a discussion of the
roles of the SSA, the SMHA and other State agencies with respect to the delivery of
behavioral health services. States should also include a description of regional, county,
and local entities that provide behavioral health services or contribute resources that
assist in providing the services. The description should also include how these systems
address the needs of diverse racial, ethnic and sexual gender minorities as well as youth
who are often underserved.
Step 2: Identify the unmet service needs and critical gaps within the current system.
This step should identify the data sources used to identify the needs and gaps of the
populations relevant to each Block Grant within the State’s behavioral health care
system, especially for those required populations described in this document and other
populations identified by the State as a priority.
The State’s priorities and goals must be supported by a data driven process. This could
include data and information that are available through the State’s unique data system
(including community level data) as well as SAMHSA’s data set including, but not
limited to, the National Survey on Drug Use and Health, the Treatment Episode Data Set,
and the National Facilities Surveys on Drug Abuse and Mental Health Services. Those
States that have a State Epidemiological Outcomes Workgroup (SEOW) must describe its
composition and contribution to the process for primary prevention and treatment
planning. States should also continue to use the prevalence formulas for adults with
serious mental illness and children with serious emotional disturbances that have been
historically reported. States should use the prevalence estimates, epidemiological
analyses and profiles to establish substance abuse prevention, mental health promotion,
and substance abuse treatment goals at the State level. In addition, States should obtain
and include in their data sources information from other State agencies that provide or
purchase behavioral health services. This will allow States to have a more
comprehensive approach to identifying the number of individuals that are receiving
behavioral health services and the services they are receiving.

22

In addition to in-state data, SAMHSA has identified several other data sets that are
available by State through various Federal agencies such as the Center for Medicaid and
Medicare Services or the Agency for Health Research and Quality. States should use
these data when developing their needs assessment. If the State needs assistance with
data sources or other planning information, please contact
[email protected].
Step 3: Prioritize State planning activities
Using the information in Step 2, States should identify specific priorities that will be
included in the MHBG and SABG. The priorities must include the target populations (as
appropriate for each Block Grant) that are the Federal goals and aims of the Block Grant
programs (those that are required in legislation and regulation) and should include other
priority populations as identified by the State and as described in this document. Please
list the priorities for the plan in the chart below.
Table 2

Plan Year_____________
State Priorities

1
2
3
4
5
6
7
8
9
10
11
12

Add more priority areas as needed

Step 4: Develop objectives, strategies and performance indicators.
23

For each of the priorities identified in Step Three, identify the relevant goals, strategies
and performance indicators over the next two years. For each priority area, States should
identify at least one goal. Each stated objective must be measurable.
For each goal, the State should describe the specific strategy that will be used to reach the
goal. These strategies may include developing and implementing various service-specific
changes to address the needs of specific populations, substance abuse prevention
activities, emotional health and prevention of mental illness and system improvements
that will address the goal.
Strategies that use service-specific changes to achieve a goal should be consistent with
SAMHSA’s continuum of services identified in the Good and Modern System Brief 18. If
the State is recommending services that are not specifically referenced in this Brief,
please describe the population(s) that will receive these services, the rationale for this
recommendation and cite evidence regarding the effectiveness of this service. In
addition, the description of the strategy should provide the context for how the service
specific change will be implemented. Strategies that should be considered and addressed
include:
•

Strategies that are targeted for children and youth with serious emotional
disturbances or substance use disorders should utilize a System of Care approach
(Described below) that has been well-established for children with serious
emotional disorders and co-occurring substance use disorders. This approach
should be utilized state-wide, coordinating care with other State agencies (e.g.,
schools, child welfare, juvenile justice, primary care, etc.) to deliver evidencesupported treatments and supports through a family-driven, youth-guided,
culturally competent, individualized treatment plan. For adolescents with
substance use disorders, this approach should be used in conjunction with
evidence-based interventions for substance abuse or dependence.
A System of Care is a coordinated network of community-based services and
supports that is organized to meet the challenges of children and youth with
serious mental health needs and their families. Families and youth work in
partnership with public and private organizations so services and supports are
effective, build on the strengths of individuals, and address each person’s
cultural and linguistic needs. A System of Care helps children, youth, and
families function better at home, in school, in the community, and throughout
life.
Children and youth with serious mental health conditions and their families need
supports and services from many different child- and family-serving agencies
and organizations. Often, these agencies and organizations are serving the same
children, youth, and families. By creating partnerships among these groups,
Systems of Care are able to coordinate services and supports that meet the everchanging needs of each child, youth, and family. Coordinated services and

18

http://www.samhsa.gov/Healthreform/docs/AddictionMHSystemBrief.pdf

24

supports lead to improved outcomes for children, youth, and families, and help
prevent the duplication of services for authorized care among government
agencies.
SAMHSA expects that these grants will help facilitate wide scale adoption of the
System of Care framework and to create comprehensive and sustainable plans
for infrastructure, services, and supports that are consistent with the values and
principles of a System of Care approach that are articulated in Section 561 of the
Public Health Service Act, as amended. SAMHSA also expects that grantees
demonstrate how parents, caregivers and youth will be integrally involved in
decision making related to the planning, monitoring and delivering of services
for themselves as well as the development of policy and procedures governing
care for all children and youth.
• Strategies targeted for adults with mental or substance use disorders that will
design and implement recovery-oriented services.
• Strategies that will promote integration and inclusion into the community. This
includes housing models that integrate individuals into the community, instead of
nursing homes and other settings that fail to promote independence and
inclusion. This also can include strategies to promote competitive and supported
employment in the community, rather than segregated programs.
• Strategies on how technology, especially Interactive Communications
Technologies (ICTs) will be used to engage individuals and their families into
treatment and recovery supports. Almost 40 percent of uninsured individuals are
under the age of 30 and use technology (e.g. web or texting) as a mode of
communication. 19
• Strategies that result in developing recovery support services, including
permanent housing and supportive employment or education for persons with
mental and substance use disorders. This includes how local authorities will be
engaged to increase the availability of housing, employment and educational
opportunities, and how the State will develop services that will wrap around these
individuals to obtain and maintain safe and affordable housing, employment
and/or education.
• Strategies that will enable the State to document the diversity of their service
population and providers and specify the development of an array of culturallyspecific and age-appropriate interventions and providers to improve access,
engagement, quality and outcomes of services for diverse ethnic and racial
minorities and LGBTQ populations. States will be encouraged to refer to the
recent IOM (2009) report on “Race, Ethnicity, and Language Data:
Standardization for Health Care Quality Improvement” 20 in developing this
strategy.

19

Center of Budget and Policy Priorities
Institute of Medicine. (2009).Race, Ethnicity, and Language Data: Standardization for Healthcare
quality Improvement. Subcommittee on Standardization Collection of Race/Ethnicity Data for Healthcare
Quality Improvement, Board on Healthcare Services. Cheryl Ulmer, Bernadette McFadden, and David R.
Nerenz, Editors, Washington, DC: The National Academies Press
20

25

•

•

•

Strategies that will build the State and provider capacity to provide evidencebased trauma- specific interventions in the context of a trauma-informed delivery
system. Recognizing trauma as a central factor in the development of mental and
substance use disorders, States should build provider competence in the use of
effective trauma treatments. States should ensure that these treatments are
provided in systems that understand the impact of trauma on their service
population and work to eliminate organizational practices and policies that may
cause or exacerbate trauma.
Strategies that increase the use of person-centered planning and self-direction and
participant-directed care. This includes measures to help an individual or their
caregiver (when appropriate) identify and access services and supports that
reinforce recovery or resilience. These strategies should also include how
individuals or caregivers have access to supports to facilitate participant direction,
including the ability to identify, choose and hire their providers.
Strategies that are developed to prevent substance abuse and mental disorders and
promote emotional health and prevention of mental illness should be consistent
with the latest research. The 2009 Institute of Medicine (IOM) report entitled
Preventing Mental, Emotional, and Behavioral Disorders Among Young People:
Progress and Possibilities 21articulates the current scientific understanding of the
prevention of mental and substance use disorders. This report describes a set of
interventions that have shown effectiveness in preventing substance abuse and
mental illness and promoting positive emotional health. These programs prevent
substance abuse, depression, conduct disorder, and other behavioral health
problems and promote emotional health by addressing risk factors and promoting
protective factors related to these problems.

States should identify strategies for the SABG that reflect the priorities identified from
the needs assessment process, including:
•
•
•

Strategies that target tobacco use prevention, tobacco cessation, and tobacco-free
facilities that are supported by research and encompass a range of activities
including policy initiatives and programs.
Strategies that specifically target the prevention of substance abuse and its
consequences should be community based, developed using the strategic planning
framework, and data driven.
Strategies should be consistent with the IOM Report on Preventing Mental
Emotional and Behavioral Disorders, the Surgeon General’s Call to Action to
Prevent and Reduce Underage Drinking, the National Registry of Evidence-based

21

National Research Council and Institute of Medicine. (2009). Preventing Mental, Emotional, and
Behavioral Disorders Among Young People: Progress and Possibilities. Committee on the Prevention of
Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults: Research Advances
and Promising Interventions. Mary Ellen O’Connell, Thomas Boat, and Kenneth E. Warner, Editors.
Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education.
Washington, DC: The National Academies Press

26

•
•
•
•

Programs and Practices (NREPP) or other materials documenting their
effectiveness.
Strategies that engage schools, workplaces, and communities to establish
programs and policies to improve knowledge about alcohol and other drug
problem, effective ways to address them and enhance resilience.
Strategies that address underage drinking which are based in science and
encompass a range of connected activities including policy and regulation,
enforcement, and normative/behavior change initiatives and programs.
Strategies that implement evidence-based and cost-effective models to prevent
substance abuse in young people in a variety of community settings, e.g. families,
schools, workplaces, faith-based institutions, consistent with the current science.
Strategies that address harder-to-reach racial/ethnic minority and LGBTQ
communities who experience a cluster of risk factors that makes them especially
vulnerable to substance use and related problems.

States should identify strategies for the MHBG that reflect the priorities identified from
the needs assessment process. Goals that are focused on emotional health and the
prevention of mental illnesses should be consistent with the IOM Report on Preventing
Mental, Emotional, and Behavioral Disorders and should include:
•
•

•

•

•

Strategies that work with schools, workplaces and communities to deliver
programs to improve mental health literacy and enhance resilience.
Strategies that target prevention and early intervention programs for children and
their families through partnerships between mental health, maternal and child
health services, schools and other related organizations, and to include evidencebased and cost-effective models of intervention for early psychosis in young
people.
Strategies that implement suicide prevention activities to identify youth at risk of
suicide and improve the effectiveness of services and support available to them,
including educating frontline workers in emergency, health and other social
services settings about mental health and suicide prevention.
Strategies that implement evidenced-based interventions and trauma-specific
treatments for highly vulnerable children and young people who have experienced
physical, sexual or emotional abuse, bullying, or other trauma, including youth
from racial/ethnic minority and LGBTQ communities.
Strategies to support the use of a System of Care approach to meet the needs of
children and youth with serious emotional disturbances.

System improvement activities may be included as strategies to address issues identified
in the needs assessment. System improvement activities should:
•

Allow States to position their providers to increase access and retention, adoption
or adaptation of electronic health records (EHRs) or develop strategies to develop
or increase workforce especially as many more individuals will be covered in FY
2014. These system improvement activities should make use of Federal and State
resources that are available now and proposed for the planning period to expand
27

•

•

•

•

•
•

•

and enhance the competency of the behavioral health workforce. System
improvements that seek to expand the workforce should also build upon current
efforts to increase the role of people in recovery from mental and substance use
disorders in the planning and delivery of services.
Support providers to participate in networks that may be established through
managed care or administrative service organizations (including accountable care
organizations). This support may include assistance to develop the necessary
infrastructure (e.g., electronic billing and health records) and reporting
requirements to effectively participate in these networks.
Support the use of peer specialists or recovery coaches to provide needed
recovery support services. Some of these services are delivered by volunteers and
paid staff. In all cases, peers are trained, supervised, regarded as staff and are
operating out of a community-based or recovery community organization. A
State’s strategy should allow states to support peer and other recovery support
services delivered under either model. The infrastructure – including paid staff –
to coordinate and support the use of volunteer-delivered or –run services should
also be supported.
Increase linkages between primary care and behavioral health providers, including
supporting primary care provider efforts to screen patients for mental and
substance use disorders, working with behavioral health provider organizations
for expertise, collaboration and referral arrangements. Activities should also
include developing model contract templates for bi-directional primary care and
behavioral health integration and identifying State policies that present barriers to
reimbursement.
Develop support systems to provide communities with necessary needs
assessment information, planning, technical assistance, evaluation expertise, and
other supports to foster the development of comprehensive community plans to
improve mental, emotional and behavioral health outcomes in communities.
Fund auxiliary aids and services to allow people with disabilities to benefit from
the mental health and substance use services and language assistance services for
people who experience communication barriers to accessing these services.
Develop benefit management strategies for high cost services (e.g. youth out of
home services, adult residential services). SAMHSA believes that States should
enhance their efforts to align how they manage care to ensure that individuals get
the right service at the right time in the right amount. These efforts should ensure
that decisions made regarding these services are clinically sound. SAMHSA will
expect States to develop spending targets for certain services and manage within
those targets.
Develop linkages and coordination to enable a Systems of Care approach to
services and supports for children and youth with serious emotional disturbances.

States should describe specific performance indicators that will be used to determine if
the goals for that priority area were achieved. For each performance indicator describe
the data and data source the State will use to develop the baseline for FY 2012 and how
the State proposes to measure the change in FY 2013. Use the template below.

28

Table 3

Plan Year_____________

Priority Area#
Goal:
Strategy (use as many lines needed for each strategy)
Performance Indicator:
Description of Collecting and Measuring Changes in Performance Indicator

States should be accountable for meeting the goals and performance indicators
established in their plan. SAMHSA staff will work closely with States during the year to
discuss progress, identify barriers and develop solutions to address these barriers.
However, if a State fails to demonstrate that it has taken reasonable steps to achieve its
goals as stipulated in its application(s) and approved by SAMHSA, the State will provide
a description of corrective actions to be taken. If further steps are not taken, SAMHSA
may direct the State authority responsible for the program to change the State plan to
ensure goals are met. States that do not choose to apply for the MHBG or SABG will
have their funds redirected to other States as provided in statute.
c. Use Of Block Grant Dollars For Block Grant Activities
SAMHSA requests that SMHAs and SSAs consider using Block Grant funds and develop
reimbursement strategies that are used in other areas of healthcare. Reimbursement
strategies may include risk-based payments, payments for episodes of care, and payment
for outcomes. SAMHSA understands that services for most individuals are not
purchased with SABG or MHBG but through a variety of funding sources (e.g. Medicaid,
Medicare, private insurance, other Federal funds, State, local and private sources).
However, SAMHSA encourages States to use MHBG and SABG funds to support their
or other agencies’ efforts to develop reimbursement strategies that support innovation.
This innovation could include using Block Grant funds to complement various
demonstration projects including Money Follows the Person, Health Homes for
Individuals with Chronic Conditions, Community First Choice Option and prevention
initiatives funded through the Prevention and Public Health Trust Fund.
In the chart below, please describe your State’s SMHA and/or SSAs overall
reimbursement approach for services purchased with MHBG and SABG funds.
SAMHSA understands that States may take different approaches based on strategies
identified in the plan. States should identify the reimbursement methodology proposed
for each service, prevention and emotional health development strategy, and system
improvement. States should use the following reimbursement methodology categories
for MHBG and SABG funds:
•

Encounter-based reimbursement—includes fee-for-service and other strategies
that pay individuals or organizations a specific amount for a unit of service.
29

•
•
•
•

States that have a specific reimbursement methodology or fee schedule for
services purchased with Block Grant funds should provide that information as
part of their application(s).
Grant/Contract reimbursement—includes annual or periodic payments to
individuals or organizations that provide services or system improvements.
Risk-based reimbursement—includes but is not limited to capitated (per member
per month) or case rate payment (monthly or other timeframe).
Innovative financing strategies—This includes, but is not limited to pay-foroutcomes or payment for an episode of care.
Other reimbursement strategies—States using other reimbursement strategies for
services and activities should describe the methodology and the services and
activities that are purchased using this methodology.

Table 4

Plan Year_____________

Reimbursement
Strategy
Encounter based
reimbursement
Grant/contract
reimbursement
Risk based
reimbursement
Innovative Financing
Strategy
Other reimbursement
strategy (please describe)

Services Purchased Using the Strategy

States and the service providers funded utilizing Block Grant funds should be able to
account for unique individuals served and track the services provided to each individual.
Please complete the following charts.
States should project how Block Grant funds will be used to provide services for the
target populations or areas identified in their plans for States that have a combined
MHBG and SABG application. Please complete Table 5, Projected Expenditures for
Treatment and Recovery Supports, which requests that States project their expenditures
under the MHBG and the SABG for treatment and support services. If the State
purchases services or activities that are not included in the Projected Expenditures for
Treatment and Recovery Supports, include this in the last row of the chart in the “Other”
category. Please use a separate row for each services or activity funded with SABG or
MHBG funds. Please complete a separate table for the MHBG and SABG. Also
complete a separate table for FY 2012 and 2013.
Please complete the following tables for FY 2012 and FY 2013 regarding projected
expenditures:

30

Table 6, the Primary Prevention Checklist for projecting expenditures for substance
abuse prevention activities.
Table 7 requests information regarding projected total expenditure for 2012 under the
SABG. Table 8 requests information regarding the SABG Projected Resource
Development Expenditures.

31

Table 5
Plan Year_____________
Projected Expenditures for Treatment and Recovery Supports

Estimated Percent of Funds Distributed

Category
Healthcare
Home/Physical
Health

•
•
•
•
•
•
•
•

Engagement
Services

•
•

Outpatient Services

•
•
•
•
•
•
•
•

Service/Activity Example
General and specialized outpatient medical
services
Acute Primary Care
General Health Screens, Tests and Immunization
Comprehensive Care Management
Care coordination and health promotion
Comprehensive transitional care
Individual and Family Support
Referral to Community Services

< 10%

Assessment
Specialized Evaluation (Psychological and
neurological)
Services planning (includes crisis planning)
Consumer/Family Education
Outreach
Individual evidence-based therapies
Group therapy
Family therapy
Multi-family therapy
Consultation to Caregivers

32

10-25%

26-50%

51-75%

Over 75%

Estimated Percent of Funds Distributed

Category
Medication Services

Community
Support
(Rehabilitative)

•
•
•

Service/Activity Example
Medication management
Pharmacotherapy (including MAT)
Laboratory services

•
•
•
•
•
•
•
•
•

Parent/Caregiver Support
Skill building (social, daily living, cognitive)
Case management
Behavior management
Supported employment
Permanent supported housing
Recovery housing
Therapeutic mentoring
Traditional healing services

•
•
•
•

Peer Support
Recovery Support Coaching
Recovery Support Center Services
Supports for Self Directed Care

< 10%

Recovery Supports

33

10-25%

26-50%

51-75%

Over 75%

Estimated Percent of Funds Distributed

Category
Other Supports
(Habilitative)

Intensive Support
Services

Out-of-Home
Residential Services

Acute Intensive
Services

•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

Service/Activity Example
Personal care
Homemaker
Respite
Supported Education
Transportation
Assisted living services
Recreational services
Interactive Communication Technology Devices
Trained behavioral health interpreters
Substance abuse intensive outpatient services
Partial hospitalization
Assertive community treatment
Intensive home based treatment
Multi-systemic therapy
Intensive case management
Crisis residential/stabilization
Clinically Managed 24-Hour Care
Clinically Managed Medium Intensity Care
Adult Mental Health Residential
Adult Substance Abuse Residential
Children’s Mental Health Residential Services
Youth Substance Abuse Residential Services
Therapeutic Foster Care

•
•

Mobile crisis services
Medically Monitored Intensive Inpatient

•

Peer based crisis services

•
•

Urgent care services
23 hour crisis stabilization services

< 10%

34

10-25%

26-50%

51-75%

Over 75%

Estimated Percent of Funds Distributed

Category
•

Prevention
(Including
Promotion)

•
•
•
•
•
•
•

Service/Activity Example
24/7 crisis hotline services

< 10%

Screening, Brief Intervention and Referral to
Treatment
Brief Motivational Interviews
Screening and Brief Intervention for Tobacco
Cessation
Parent Training
Facilitated Referrals
Relapse Prevention
/Wellness Recovery Support
Warm line

System
improvement
activities
Other

35

10-25%

26-50%

51-75%

Over 75%

Table 6
Plan Year_____________
Primary Prevention Planned Expenditures Checklist
Strategy
IOM
SABG
Other
Target
MHBG
Federal
Block
Grant FY
2012
Universal
$
$
Information
Dissemination Selective
$
$
Indicated
$
$
Unspecified $
$
Universal
$
$
Education
Selective
$
$
Indicated
$
$
Unspecified $
$
Universal
$
$
Alternatives
Selective
$
$
Indicated
$
$
Unspecified $
$
Universal
$
$
Problem
Identification
Selective
$
$
and Referral
Indicated
$
$
Unspecified $
$
Universal
$
$
CommunityBased Process Selective
$
$
Indicated
$
$
Unspecified $
$
$
$
Environmental Universal
Selective
$
$
Indicated
$
$

State

Local

Other

$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$

$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$

$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$

36

Section 1926
Tobacco

Other

Unspecified
Universal
Selective
Indicated
Unspecified
Universal
Selective
Indicted
Unspecified

$
$
$
$
$
$
$
$
$

$
$
$
$
$
$
$
$
$

$
$
$
$
$
$
$
$
$

$
$
$
$
$
$
$
$
$

$
$
$
$
$
$
$
$
$

*Please list all sources, if possible (e.g., Centers for Disease Control and Prevention Block Grant, foundations).

37

Table 7
Plan Year:
State Identifier:
Projected State Agency Expenditure Report
Source of Funds
ACTIVITY
(See instr uctions for using Row 1.)

1.

Substance Abuse Pr evention** and
Tr eatment

2.

Pr imar y Pr evention

3.

Tuber culosis Ser vices

4.

HIV Ear ly Inter vention Ser vices

5.

State Hospital

A. Block Gr ant

B. Medicaid
(Feder al, State, and
local)

6. Other 24 Hour Car e
7. Ambulator y/Community Non-24 Hour
Car e
8. Administr ation (excluding pr ogr am /
pr ovider level
9. Subtotal (Rows 1, 2, 3, 4, and 8)
10. Subtotal (Rows 5, 6, 7, and 8)

38

C. Other Feder al
Funds (e.g., ACF
(TANF), CDC, CMS
(Medicar e) SAMHSA,
etc.)

D. State funds

E. Local funds
(excluding local
Medicaid)

F. Other

11. Total

39

Table 8
Plan Year:
State Identifier:

Activity

Resource Development Planned Expenditures Checklist
B. PreventionC. TreatmentD. TreatmentSA
MH
SA

E.
Combined

F. Total

1. Planning, coor dination, and needs
assessment

$

$

$

$

$

$

2. Quality Assur ance

$

$

$

$

$

$

3. Tr aining (post-employment)

$

$

$

$

$

$

4. Education (pr e-employment)

$

$

$

$

$

$

5. Pr ogr am development

$

$

$

$

$

$

6. Resear ch and evaluation

$

$

$

$

$

$

7. Infor mation Systems

$

$

$

$

$

$

8. Total

OMB No. 0930-0168

40

d. Activities that Support Individuals in Directing the Services
SAMHSA firmly believes in the importance of individuals with mental and substance use
disorders participating in choosing the services and supports they receive. To achieve this
goal, individuals and their families/support systems must be able to access and direct
their services and supports. Participant direction, often referred to as consumer direction
or self direction, is a delivery mode through which a range of services and supports are
planned, budgeted and directly controlled by an individual (with the help of
representatives, if desired) based on the individual’s needs and preferences that maximize
independence and the ability to live in the setting of his/her choice. Participant-directed
services should include a wide range of high-quality, culturally competent services based
on acuity, disability, engagement levels and individual preferences. The range of
services must be designed to incorporate the concepts of community integration and
social inclusion. People with mental and substance use disorders should have ready
access to information regarding available services, including the quality of the programs
that offer these services. An individual and their family / supports must be afforded the
choice to receive services and should have sufficient opportunities to select the
individuals and agencies from which they receive these services. Person centered
planning is the foundation of self-direction and must be made available to everyone.
Individuals must have opportunities for control over a flexible individual budget and
authority to directly employ support workers, or to direct the worker through a shared
employment model through an agency. People must have the supports necessary to be
successful in self direction including financial management services and supports
brokerage. In addition, individuals and families must have a primary decision-making
role in planning and service delivery decisions. Caregivers can play an important role in
the planning, monitoring and delivery of services and should be supported in these roles.
Families, other caregivers, and youth should be full partners in all aspects of the planning
and delivery of their own services, including policies and procedures that govern care for
children and youth.
In the section below, please address the following:
•
•
•
•
•

Either summarize your State’s policies on participant-directed services or
attach a copy to the Block Grant application(s). States can describe how they
define self-directed care in accordance with their own policies and structures.
What services for individuals and their support systems are self-directed?
What participant-directed options do you have in your State?
What percentage of individuals funded through the SMHA or SSA self direct
their care?
What supports does your State offer to assist individuals to self direct their
care?

OMB No. 0930-0168

41

e. Data and Information Technology
Regardless of financing or reimbursement strategy used, unique client-level encounter
data should be collected and reported for specific services that are purchased with Block
Grant funds. Such service tracking and reporting is required by SAMHSA to be reported
in the aggregate. Universal prevention and other non-service-based activities (e.g.
education/training) must be able to be reported describing the numbers and types of
individuals impacted by the described activities. States should be able to provide the
service utilization (as reported inTable 5 in the Reporting Section of the Application).
States should provide information on the number of unduplicated individuals provided
each service purchased with Block Grant Funds. In addition, States should provide
expenditures for each service identified in Table 5. If the State is currently unable to
provide unique client-level data for any part of its behavioral health system, SAMHSA is
requesting the State to describe in the space below its plan, process, resources needed and
timeline for developing such capacity. States should respond to the following:
•

•

•

List and briefly describe all unique IT systems maintained and/or utilized by the
State agency that provide information on one or more of the following:
o Provider characteristics
o Client enrollment, demographics, and characteristics
o Admission, assessment, and discharge
o Services provided, including type, amount, and individual service provider
o Prescription drug utilization
As applicable, for each of these systems, please answer the following:
o For provider information, are providers required to obtain national
provider identifiers, and does the system collect and record these
identifiers?
o Does the system employ any other method of unique provider
identification that provides the ability to aggregate service or other
information by provider?
o Does the system use a unique client identifier that allows for unduplicated
counts of clients and the ability to aggregate services by client?
o Are client-level data in the form of encounters or claims that include
information on individual date of service, type of service, service quantity,
and identity of individual provider?
o Does the system comply with Federal data standards in the following areas
(use of ICD-10 or CPT/HCPCS codes)?
As applicable, please answer the following:
o Do provider and client identifiers in the behavioral health IT system allow
for linkage with Medicaid provider identifiers that provides the ability to
aggregate Medicaid and non-Medicaid provider information?
o Are Medicaid data or linked Medicaid-behavioral health data used to
routinely produce reports?

OMB No. 0930-0168

42

o Does your State’s IT division participate in regular meetings with
Medicaid and other agencies to address mutual issues concerning system
interoperability, electronic health records, Federal IT requirements or
similar issues?
o Does your State have a grant to create a statewide health information
exchange and does your agency participate in the development of the
exchange and in issues concerning MH/SA data?
o Is your State Medicaid agency engaging in or planning to improve its IT
system? If so, is your agency included in such efforts for the purposes of
addressing issues related to data interoperability, behavioral health IT
system reform, and meeting Federal IT data standards?
In addition to the questions above, please:
• Provide information regarding your State’s current efforts to assist providers with
developing and using Electronic Health Records;
• Identify the barriers that your State would encounter when moving to an
encounter/claims based approach to payment; and
• Identify the specific technical assistance needs your State may have regarding
data and information technology specifically in Section 3.k.

f. Quality Improvement Reporting
SAMHSA expects States to base their administrative operations and service delivery on
principles of Continuous Quality Improvement/Total Quality Management (CQI/TQM).
These CQI processes should identify and track critical outcomes and performance
measures that will describe the health of the mental health and addiction systems. These
measures should be based on valid and reliable data. The CQI processes should
continuously measure the effectiveness of services and supports and ensure that services,
to the extent possible, reflect their evidence of effectiveness. The State’s CQI process
should also track programmatic improvements; and garner and use stakeholder input,
including individuals in recovery and their families. In addition, the CQI plan should
include a description of the process for responding to critical incidents, complaints and
grievances. In an attachment, please submit your State’s current CQI plan.
g. Consultation with Tribes
SAMHSA is required by the 2009 Memorandum on Tribal Consultation to submit plans
on how it is to engage in regular and meaningful consultation and collaboration with
tribal officials in the development of Federal policies that have Tribal implications.
Consultation is an enhanced form of communication, which emphasizes trust, respect and
shared responsibility. It is an open and free exchange of information and opinion among
OMB No. 0930-0168

43

parties, which leads to mutual understanding and comprehension. Consultation is
integral to a deliberative process, which results in effective collaboration and informed
decision making with the ultimate goal of reaching consensus on issues. For the context
of the Block Grants, SAMHSA views consultation as a government to government
interaction and should be distinguished from input provided by individual Tribal
members or services provided for Tribal members whether on or off Tribal lands.
Therefore, the interaction should include elected officials of the Tribe or their designee.
SAMHSA is requesting that States provide a description of how they consulted with
Tribes in their State. This description should indicate how concerns of the Tribes were
addressed in the State Block Grant plan(s). States shall not require any Tribe to waive its
sovereign immunity in order to receive funds or in order for services to be provided for
Tribal members on Tribal lands. If a State does not have any Federally recognized Tribal
Governments or Tribal lands within its borders, the State should make a declarative
statement to that effect. For States that are currently working with Tribes, please provide
a description of these activities in the area below. States seeking technical assistance for
conducting tribal consultation may contact the SAMHSA project officer prior to or
during the block grant planning cycle.

h. Service Management Strategies
SAMHSA, similar to other public and private payers of behavioral health services, seeks
to ensure that services purchased under the Block Grants are provided to individuals in
the right scope, amount and duration. These payers have employed a variety of methods
to assure appropriate utilization of services. These strategies include using data to
identify trends in over and underutilization that would benefit from service management
strategies. These strategies also include using empirically based clinical criteria and staff
for admission, continuing stay and discharge decisions for certain services. While some
Block Grant funded services and activities are not amenable (e.g. prevention activities or
crisis services), many direct services are managed by other purchasers.
In the space below, please describe: 1) the processes that your State will employ over the
next planning period to identify trends in over/underutilization of SABG or MHBG
funded services; 2) the strategies that your State will deploy to address these utilization
issues; 3) the intended results of your State’s utilization management strategies; 4) the
resources needed to implement utilization management strategies; and 5) the proposed
timeframes for implementing these strategies.

OMB No. 0930-0168

44

i. State Dashboards
An important change to the administration of the MHBG and SABG is the creation of
State dashboards on key performance indicators. SAMHSA is considering developing an
incentive program for States/Territories based on a set of state-specific and national
dashboard indicators. National dashboard indicators will be based on outcome and
performance measures that will be developed by SAMHSA in FY 2011. For FY 2012,
States should identify a set of state-specific performance measures for this incentive
program. These state-specific performance indicators proposed by a State for their
dashboard must be from the planning section on page 26. These performance indicators
were developed by the State to determine if the goals for each priority area. For instance,
a state may propose to increase the number of youth that receive addiction treatment in
2013 by X percent. The state could use this indicator for their dashboard. SAMHSA
expects that States will provide a minimum of 2 State specific performance indicators for
their Dashboard for both the SABG and MHBG.
In addition, SAMHSA will identify several national indicators to supplement the statespecific measures for the incentive program. The State, in consultation with SAMHSA,
will establish a baseline in the first year of the planning cycle and identify the thresholds
for performance in the subsequent year. The State will also propose the instrument used
to measure the change in performance for the subsequent year. The State dashboards will
be used to determine if States receive an incentive based on performance. SAMHSA is
considering a variety of incentive options for this dashboard program.
In the space below please identify the state-specific performance measures.
Table 10

Plan Year_____________

Priority Area

Performance Indicator

In the following section describe the rationale why these state-specific measures were
selected.

OMB No. 0930-0168

45

j. Suicide Prevention
In September of 2010, U.S. Health and Human Services Secretary Kathleen Sebelius and
Defense Secretary Robert Gates launched the National Action Alliance for Suicide
Prevention. Among the initial priority considerations for the newly formed Action
Alliance is updating and advancing the National Strategy for Suicide Prevention,
developing approaches to constructively engage and educate the public, and examining
ways to target high-risk populations. SAMHSA is encouraged by the number of States
that have developed and implemented plans and strategies that address suicide. However,
many States have either not developed this plan or have not updated their plan to reflect
populations that may be most at risk of suicide including America’s service men and
women -- Active Duty, National Guard, Reserve, Veterans -- and their families. As an
attachment to the Block Grant application(s), please provide the most recent copy of your
State’s suicide prevention plan. If your State does not have a suicide prevention plan or
if it has not been updated in the past three years please describe when your State will
create or update your plan.

k. Technical Assistance Needs
Please describe the data and technical assistance needs identified by the State during the
process of developing this plan that will be needed or helpful to implement the proposed
plan. The technical assistance needs identified may include the needs of State, providers,
other systems, persons receiving services, persons in recovery, or their families. Please
also take into account cultural and linguistic needs. The State should indicate what efforts
have been or are being undertaken to address or find resources to address these needs,
and what data or technical assistance needs will remain unaddressed without additional
action steps or resources.

l. Involvement of Individuals and Families
OMB No. 0930-0168

46

The State must support and help strengthen existing consumer, family, and youth
networks, recovery organizations and community peer support and advocacy
organizations in expanding self advocacy, self-help programs, support networks, and
recovery-oriented services. There are many activities that State SMHAs and SSAs can
undertake to engage these individuals and families. In the space below, States should
describe their efforts to actively engage individuals and families in developing,
implementing and monitoring the State mental health and substance abuse treatment
system. In completing this response, State should consider the following questions:
•

•

•
•

•

How are individuals in recovery and family members utilized in the development
and implementation of recovery oriented services (including therapeutic mentors,
recovery coachers and or peer specialists, recovery community centers, consumer
drop-in centers and recovery housing)?
Does the State conduct ongoing training and technical assistance for child, adult
and family mentors; ensure that curricula are culturally competent and sensitive to
the needs of individuals in recovery and their families; and help develop the skills
necessary to match goals with services and to advocate for individual and family
needs?
Does the State sponsor meetings that specifically identify individual and family
members’ issues and needs regarding the behavioral health service system and
develop a process for addressing these concerns?
How are individuals and family members presented with opportunities to
proactively engage and participate in treatment and recovery planning, shared
decision making, and the behavioral health service delivery system and direct
their ongoing care and support?
How does the State support and help strengthen and expand recovery
organizations, family peer advocacy, self-help programs, support networks, and
recovery-oriented services?

m. Use of Technology
Interactive Communication Technologies (ICTs) are being more frequently used to
deliver various health care and recovery support services. ICTS are also being used by
individuals to report health information and outcomes. ICT include but are not limited
to: text messaging, e-therapy, remote monitoring of location, outreach, recovery tools,
emotional support, prompts, videos, case manager support and guidance, telemedicine.
In the space below, please describe:
OMB No. 0930-0168

47

a. What strategies has the State deployed to support recovery in ways that
leverage Interactive Communication Technology?
b. What specific application of ICTs does the State plan to promote over the
next two years?
c. What incentives is the State planning to put in place to encourage their
use?
d. What support system does the State plan to provide to encourage their
use?
e. Are there barriers to implementing these strategies? Are there barriers to
wide-scale adoption of these technologies and how does the State plan to
address them?
f. How does the State plan to work with organizations such as FQHCs,
hospitals, community-based organizations and other local service
providers to identify ways ICTs can support the integration of mental
health services and addiction treatment with primary care and emergency
medicine?
g. Will the State use ICTs for collecting data for program evaluation at both
the client and provider levels?
h. What measures and data collection will the State promote for promoting
and judging use and effectiveness of such ICTs?

n. Support of State Partners
The success of a State’s MHBG and SABG will rely heavily on the strategic partnership
that SMHAs and SSAs have or will develop with other health, social services, education
and other State and local governmental entities. States should identify these partners in
the space below and describe the roles they will play in assisting the State to implement
the priorities identified in the plan. In addition, the State should provide either a letter of
support or memoranda of understanding indicating agreement with the description of
their role and collaboration with the SSA and/or SMHA, including the State education
authority(is); the State Medicaid agency; the State entity(ies) responsible for health
insurance and health information exchanges (if applicable); the State adult and juvenile
correctional authority(ies); the State public health authority, (including the maternal and
child health agency); and the State child welfare agency. SAMHSA will provide
technical assistance and support for SMHAs and SSAs in their efforts to obtain this
collaboration. These letters of support or memoranda of understanding should provide

OMB No. 0930-0168

48

specific activities that the partner will undertake to assist the SMHA or SSA with
implanting its plan 22. This could include, but is not limited to:
•

•

•

•

•

The State Medicaid Agency agreeing to consult with the SMHA or the SSA in the
development and/or oversight of health homes for individuals with chronic health
conditions or consultation on the benefits available to the expanded Medicaid
population.
The State Department of Justice that will work with the State and local judicial
system to develop policies and programs that address the needs of individuals
with mental and substance use disorders that come into contact with the criminal
and juvenile justice systems; promote strategies for appropriate diversion and
alternatives to incarceration; provide screening and treatment; and implement
transition services for those individuals reentering the community.
The State Education Agency examining current regulations, policies, programs,
and key data-points in local school districts to ensure that children are safe;
supported in their social-emotional development; exposed to initiatives that target
risk and protective actors for mental and substance use disorders; and, for those
youth with or at-risk of emotional behavioral and substance use disorders, to
ensure that they have the services and supports needed to succeed in school and
improve their graduation rates and reduce out-of-district placements.
The State Child Welfare/Human Services Department, in response to State Child
and Family Services Reviews, working with local child welfare agencies to
address the trauma, and mental and substance use disorders in these families that
often put their children at-risk for maltreatment and subsequent out-of-home
placement and involvement with the foster care system.
The State Bureau of Primary Care that works directly with a variety of primary
care and other health organizations including FQHCs, school based health centers,
community health centers and rural health programs.

o. State Behavioral Health Advisory Council
Each State is required to establish and maintain a State advisory council for services for
individuals with a mental disorder. SAMHSA strongly encourages States to expand and
use the same council to advise and consult regarding issues and services for persons with
or at risk of substance abuse and substance use disorders as well. In addition to the duties
specified under the MHBG, a primary duty of this newly formed behavioral health
advisory council would be to advise, consult with and make recommendations to SMHAs
and SSAs regarding their activities. The council must participate in the development of
the Mental Health Block Grant State plan and is encouraged to participate in monitoring,
22

SAMHSA will inform the Federal agencies that are responsible for other health, social services and education programs of this
requirement.

OMB No. 0930-0168

49

reviewing and evaluating the adequacy of services for individuals with substance abuse
disorders as well as individuals with mental disorders within the State. For States that
choose not to have a behavioral health advisory council please respond to the following
questions:
•
•

What planning mechanism does your State use to plan and implement
substance abuse services?
How do these efforts coordinate with the State mental health agency and its
advisory body for substance abuse prevention and treatment services?

Please complete the following forms regarding the membership of your State’s advisory
council. The first form is a list of the Advisory Council for your State. The second form
is a description of each member of the behavioral health advisory council.
p. Comment on the State Plan
SAMHSA statute requires that, as a condition of the funding agreement for the grant,
States will provide opportunity for the public to comment on the State plan. States
should make the plan public in such a manner as to facilitate comment from any person
(including Federal or other public agencies) during the development of the plan
(including any revisions) and after the submission of the plan to the Secretary. In the
section below, States should describe their efforts and procedures to obtain public
comment on the plan in this section.

OMB No. 0930-0168

50

LIST OF ADVISORY COUNCIL MEMBERS
Table 11

Plan Year_____________

Name

Type of
Membership*

Agency or
Organization
Represented*

Addr ess
Phone &
Fax

Email
Addr ess (If
Available)

State Education
Agency
State Vocational
Rehabilitation
Agency
State Criminal
Justice Agency
State Housing
Agency
State Social
Services Agency
State Medicaid
Agency
State Exchange
Agency
State Child
Serving Agency

*Council members should be listed only once by type of membership and
agency/organization represented.
OMB No. 0930-0168

51

BEHAVIORAL HEALTH ADVISORY COUNCIL COMPOSITION BY TYPE OF
MEMBER
Table 12

Plan Year_____________

Type of Membership
Number

Percentage
of Total
Membership

TOTAL MEMBERSHIP
Individuals in Recovery (from mental illness and
addictions)
Family Members of Individuals in Recovery
Parents or Caregivers of Children or Youth with
Behavioral Health Problems
Vacancies (individual & family members)
Others (Not State employees or providers)
TOTAL Individuals in Recovery, Family Members &
Others
State Employees
Providers
Leading State Experts
Federally Recognized Tribe Representatives
Vacancies
TOTAL State Employees & Providers

OMB No. 0930-0168

52