SABG Reporting

Block Grant Reporting Section
FY 2016
FY 2017

CFDA 93.959
(Substance Abuse Prevention and Treatment)

U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration

1

Table of Contents

A. Introduction

B. Annual Update
SABG Table 1 Priority Area and Annual Performance Indicators – Progress Report

C. State Agency Expenditure Reports
SABG Table 2 - State Agency Expenditure Report
SABG Table 3 - SABG Expenditures by Service
SABG Table 4 - SABG State Agency Expenditure Compliance Report
SABG Table 5a - SABG Primary Prevention Expenditures Checklist
SABG Table 5b - SABG Primary Prevention Expenditures by IOM Category
SABG Table 5c - SABG Primary Prevention Targeted Priorities
SABG Table 6 - SABG Resource Development Expenditure Checklist
SABG Table 7 - SABG Statewide Entity Inventory
SABG Table 8a - Maintenance of Effort for State Expenditures for Substance Abuse
Prevention and Treatment
SABG Table 8b - Base and Maintenance of Effort for Statewide Non-Federal Expenditures
for Tuberculosis to Individuals in Substance Use Disorder Treatment,
SABG Table 8c - Base and Maintenance of Effort for Statewide Non-Federal Expenditures
for HIV Early Intervention Services to Individuals in Substance Use Disorder Treatment
SABG Table 8d - Base and Maintenance of Effort for Expenditures for Services to Pregnant
Women and Women with Dependent Children
D. Population and Services Reports
SABG Table 9 - Prevention Strategy Report
SABG Table 10 - Treatment Utilization Matrix
SABG Table 11 - Number of Persons Served (Unduplicated Count) for Alcohol and Other
Drug Use
SABG Table 12 - SABG HIV Early Intervention Services in Designated States
SABG Table 13 - Charitable Choice

E. Performance Data and Outcomes
Treatment Performance Measures
SABG Table 14 - Employment/Education Status
SABG Table 15 - Stability of Housing

2

SABG Table 16 - Criminal Justice Involvement
SABG Table 17 -Change in Abstinence–Alcohol Use
SABG Table 18 - Change in Abstinence – Other Drug Use
SABG Table 19 - Change in Social Support of Recovery
SABG Table 20 - Retention
Prevention Performance Measures
SABG Table 21 - Reduced Morbidity–Abstinence from Drug Use/Alcohol Use; Measure: 30
Day Use
SABG Table 22 - Reduced Morbidity –Abstinence from Drug Use/Alcohol Use; Measure:
Perception Of Risk/Harm of Use
SABG Table 23 - Reduced Morbidity–Abstinence from Drug Use/Alcohol Use; Measure:
Age of First Use
SABG Table 24 - Reduced Morbidity–Abstinence from Drug Use/Alcohol Use; Measure:
Perception of Disapproval/Attitudes
SABG Table 25 - Employment/Education; Measure: Perception of Workplace Policy
SABG Table 26 - Employment/Education; Measure: Average Daily School Attendance Rate
SABG Table 27 - Crime and Criminal Justice; Measure: Alcohol-Related Traffic Fatalities
SABG Table 28 - Crime and Criminal Justice; Measure: Alcohol and Drug Related Arrests
SABG Table 29 - Social Connectedness; Measure: Family Communications around Drug and
Alcohol Us
SABG Table 30 - Retention; Measure: Percentage of Youth Seeing, Reading, Watching, or
Listening to a Prevention Message
SABG Table 31 - Individual-Based Programs and Strategies; Measure: Number of Persons
Served By Age, Gender, Race, and Ethnicity
SABG Table 32 - Population-Based Programs and Strategies; Measure: Number of Persons
Served By Age, Gender, Race, and Ethnicity
SABG Table 33 - Number of Persons Served by Type of Intervention
SABG Table 34 - Number of Evidence-Based Programs by Types of Intervention.
SABG Table 35 - Number of Evidence-based Programs and Strategies, and Total SA Block
Grant Funds Spent on Evidence-Based Programs/ Strategies.
Prevention Attachments A, B and C
SABG Table 36 - (Optional Worksheet) Program/Strategy Detail for Computing the Total
Number of Evidence-based Programs and Strategies, and for Reporting Total SA Block
Grant Funds Spent on Substance Abuse Prevention Evidence-Based Programs and Strategies

3

Section A. Introduction
Title XIX, Part B, Subpart III of the Public Health Service Act (42 U.S.C. 300x-52(a)) requires the
Secretary of the Department of Health and Human Services, acting through the Administrator of the
Substance Abuse and Mental Health Services Administration (SAMHSA), to determine the extent to
which States and Jurisdictions have implemented the State plan for the preceding fiscal year. The
purpose of the Annual Report is to provide information to assist the Secretary in making this
determination.
States and Jurisdictions are required to prepare and submit an Annual Report that includes
expenditure summaries for 1) the State fiscal year (SFY) immediately preceding the federal fiscal
year for which the state is applying for funds, and 2) the obligation and expenditure period of the
Substance Abuse Prevention and Treatment Block Grant (SABG) award subject to CSAT
compliance review (Compliance Award), in the format provided in this guidance. The Annual Report
will address the purposes for which the SABG funds were expended, the recipients of grant funds,
and the authorized activities funded and services purchased with such funds. Particular attention
should be given to the progress made toward accomplishing the goals and performance indicators
identified in the States’ and Jurisdictions’ plans.
All States and Jurisdictions are required to prepare and submit their respective Annual Reports
utilizing SAMHSA’s Web Block Grant Application System (BGAS). Annual Reports must be
received by SAMHSA not later than December 1 in order for a State or Jurisdiction to receive its
next SABG award. If the due date falls on a weekend or Federal holiday, the report will be due on
the next business day. The following schedule provides specific due dates for Annual Reports, as
well as for Applications, Plans, and Synar Reports:
Due Dates for SA Only and MH/SA BG Applications
FY for which the state
is applying for funds
2016

Application
Due
9/1/2015

Plan
Due
Yes

Planning Period

2017

9/1/2016

No*

NA

7/1/15 – 6/30/17

SABG Report
Due
12/1/2015
Compliance
Year is 2013
12/1/2016
Compliance
Year is 2014

Synar Report
Due
12/31/2015

1/3/2017

*States may revise previously submitted plans

States and Jurisdictions are required to prepare and submit an Annual report comprised of the
following sections:
Section B: Annual Update - In this section, States and Jurisdictions are required to provide a brief
review of the extent to which their respective plans were implemented, and the progress toward the
priorities and goals identified in the Block Grant plan covering State fiscal years 2016 and 2017. The
report should also include a brief review of areas that the State or Jurisdiction identified in that Block
Grant plan as needing improvement and changes that the State or Jurisdiction proposed to achieve the
goals established for the priorities.

4

Section C: State Agency Expenditure Reports - In this section, States and Jurisdictions must provide
information regarding expenditures for authorized activities and services for substance abuse
prevention and substance use disorder treatment. The State or Jurisdiction must provide a description
of SABG expenditures for authorized activities to prevent and treat substance abuse and related
services for tuberculosis and other communicable diseases, and, if it is a “designated State”, a
description of SABG expenditures for early intervention services (EIS) for HIV. In addition, the
State or Jurisdiction must identify the SABG expenditures made available to intermediaries,
administrative service organizations, and community- and faith-based organizations who received
amounts from the SABG to provide authorized activities to prevent and treat substance abuse.
Section D: Populations and Services Reports - In this section, States and Jurisdictions must provide
specific information regarding the number of individuals that were served with SABG funds. In
addition, States and Jurisdictions should provide specific information regarding the services these
individuals received.
Section E: Performance Indicators and Accomplishments - In this section of the report, States and
Jurisdictions are required to complete the Performance Indicator tables. Performance indicators
should be reported using the table format provided in this document. The purpose of the
performance indicator tables is to show progress made over time as measured by SAMHSA’s
National Outcome Measures (NOMS) for substance abuse prevention, treatment, and recovery.

5

B. Annual Update
The information States and Jurisdictions entered into SABG Table 1 in the planning section of the
2016/2017 Behavioral Health Assessment and Plan will automatically populate cells 1 – 6 in the
progress report table below. States are required to indicate whether each first-year performance
target/outcome measurement identified in 6.b) below (from the 2016/2017 Plan) was “Achieved” or
“Not Achieved” in Cell 7, Report of Progress toward Goal Attainment. If a target was not achieved, a
detailed explanation must be provided, as well as the remedial steps proposed to meet the target.
SABG Table 1 - Priority Areas and Annual Performance Indicators – Progress Report

Priority Areas and Annual Performance Indicators
1. Priority Area:

2. Priority Type (SAP, SAT, MHP, MHS):

3. Population(s) (SMI, SED, PWWDC, IVDUs, HIV EIS, TB, OTHER):
4. Goal of the Priority Area:
5. Strategies to Attain the Goal:
6. Annual Performance Indicators to Measure Goal Success:
Indicator #1:
a)

Baseline measurement (Initial data collected prior to the first-year target/outcome):

b) First-year target/outcome measurement (Progress – end of SFY 2016):
c) Second-year target/outcome measurement (Final – end of SFY 2017):
d)

Data source:

e) Description of data:
f)

Data issues/caveats that affect outcome measures:

7. Report of Progress toward Goal Attainment:
First-year target:

____ Achieved

_____ Not Achieved (If not achieved, explain why.)

Reason why target was not achieved, and changes proposed to meet target:

6

C. State Agency Expenditure Reports
States and Jurisdictions are required to provide information regarding SA Block Grant and State
funds expended for authorized activities to prevent and treat substance abuse and for related public
health services, e.g., tuberculosis services and, if applicable, early intervention services for HIV.
Please complete the tables described below:
SABG Table 2 - State Agency Expenditure Report This table provides a report of SABG and state
expenditures by the State Substance Abuse Authority during the State fiscal year immediately
preceding the federal fiscal year for which the state is applying for funds. Expenditures to be reported
are for authorized activities to prevent and treat substance abuse pursuant to section 1921 of Title
XIX, Part B, Subpart II of the Public Health Service (PHS) Act (42 U.S.C. 300x-21), tuberculosis
services and early intervention services, if applicable, pursuant to section 1924 of Title XIX, Part B,
Subpart II of the PHS Act (42 U.S.C. 300x-24) and administration pursuant to section 1931 of Title
XIX, Part B, Subpart II of the PHS Act (42 U.S.C. 300x-31(a)(1)(F)). In column A, Block Grant
funds expended during that State fiscal year should be included regardless of the year of the Block
Grant award.
SABG Table 3 – SABG Expenditures by Service (requested) This table provides a report of SA
Block Grant expenditures for specific services during the State fiscal year immediately preceding the
federal fiscal year for which the state is applying for funds. All Block Grant funded services provided
during that period should be included in this report, regardless of the year of the Block Grant award.
SABG Table 4 - SABG State Agency Expenditure Compliance Report This table provides a report of
expenditures from the SA Block Grant Compliance Award for authorized activities to prevent and
treat substance abuse. It covers the two-year obligation and expenditure period.
SABG Table 5a- SABG Primary Prevention Expenditures Checklist This table provides a report of
prevention expenditures from the SAPT Block Grant Compliance Award for primary prevention
services.
SABG Table 5b- SABG Primary Prevention Expenditures by IOM Category This table provides a
report of prevention expenditures by Institute of Medicine (IOM) categories from the SAPT Block
Grant Compliance Award for primary prevention services.
SABG Table 5c - SABG Primary Prevention Targeted Priorities (requested) This requested table
provides a report of actual State primary prevention priorities and special population categories on
which the State expended primary prevention dollars from the SAPT Block Grant Compliance
Award.
SABG Table 6 - SABG Resource Development Expenditure Checklist This table provides a report of
expenditures from the SAPT Block Grant Compliance Award for resource development activities
that are funded by and/or or conducted by the State Substance Abuse Authority.
SABG Table 7 – SABG Statewide Entity Inventory This table provides a report of the subrecipients
of SA Block Grant funds including community- and faith-based organizations which provided

7

substance abuse prevention activities and treatment services, as well as intermediaries/administrative
service organizations. Table 7 excludes resource development expenditures.
SABG Table 8a - Maintenance of Effort for State Expenditures for Substance Abuse Prevention and
Treatment This table provides a report of aggregate State expenditures by the State Substance
Abuse Authority for authorized activities to prevent and treat substance abuse during the State fiscal
year immediately preceding the federal fiscal year for which the state is applying for funds.
SABG Table 8b - Base and Maintenance of Effort for Statewide Non-Federal Expenditures for
Tuberculosis to Individuals in Substance Use Disorder Treatment This table provides a report of
Statewide expenditures of non-Federal funds expended for tuberculosis (TB) services made available
to individuals in substance user disorder (SUD) treatment during the State fiscal year immediately
preceding the federal fiscal year for which the state is applying for funds.
SABG Table 8c - Base and Maintenance of Effort for Statewide Non-Federal Expenditures for HIV
Early Intervention Services to Individuals in Substance Use Disorder Treatment This table provides
a report of statewide expenditures of non-Federal funds during the State fiscal year immediately
preceding the Federal fiscal year for which the state is applying for funds for HIV early intervention
services provided to individuals in substance use disorder treatment at the sites at which such
individuals were receiving SUD treatment services.
SABG Table 8d - Base and Maintenance of Effort for Expenditures for Services to Pregnant Women
and Women with Dependent Children This table provides a report of SA Block Grant and/or State
expenditures for services demonstrating the Block Grant requirements designed to address the
treatment and recovery support needs of substance using pregnant women and substance abusing
women with dependent children during the State fiscal year immediately preceding the Federal fiscal
year for which the state is applying for funds.

8

SABG Table 2 - State Agency Expenditure Report
This table provides a report of SABG and State expenditures by the State Substance Abuse Authority during the State fiscal year immediately preceding
the federal fiscal year for which the state is applying for funds for authorized activities to prevent and treat substance abuse. For detailed instructions,
refer to those in the Block Grant Application System (BGAS).
State Agency Expenditure Report
SABG Table 2
State Identifier:
Report Period- From:

To:
(Include ONLY funds expended by the executive branch agency administering the Substance Abuse Block Grant
Source of Funds

ACTIVITY
(See instructions for using Row 1.)

A.
Substance
Abuse Block
Grant

B.

C.

D.

E.

F.

G.

Mental
Health Block
Grant. Block
Grant

Medicaid
(Federal,
State, and
local)

Other Federal
Funds

State funds

Local funds
(excluding
local
Medicaid)

Other

(e.g., ACF
(TANF), CDC,
CMS (Medicare)
SAMHSA, etc.)

1. Substance Abuse Prevention (Other than
Primary Prevention) and Treatment
a.

Pregnant Women and Women with
Dependent Children

b.

All Other

2.

Primary Prevention

3.

Tuberculosis Services

4.

HIV Early Intervention Services*

7. Administration (excluding program /
provider level administration)
8. Total
*Only HIV designated states should enter information in this row.

9

SABG Table 3 (Requested) - SA Block Grant Expenditures by Service
This table provides a report of SABG and state expenditures during the state fiscal year immediately preceding the federal fiscal year for which the
State is applying for funds.
Service
Healthcare Home/Physical Health
General and Specialized Outpatient Medical Services
Acute Primary Care
General Health Screens, Tests and Immunizations
Comprehensive Care Management
Care Coordination and Health Promotion
Comprehensive Transitional Care
Individual and Family Support
Referral to Community Services
Prevention including Promotion

SABG
MHBG
Expenditures Expenditures
$
$

$

$

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
Substance Abuse Primary Prevention

$

Classroom and/or small group sessions (Education)
Media campaigns (Information Dissemination)
Systematic Planning/Coalition and Community Team Building (Community- Based Process)
Parenting and family management (Education)
Education programs for youth groups (Education)
Community Service Activities (Alternatives)
Student Assistance Programs (Problem Identification and Referral)
Employee Assistance Programs (Problem Identification and Referral)
Community Team Building (Community-Based Process)
Promoting the establishment or review of alcohol, tobacco, and drug use policies (Environmental)
Engagement Services

$

$

10

Service

SABG
MHBG
Expenditures Expenditures

Assessment
Specialized Evaluations (Psychological and Neurological)
Service Planning (including crisis planning)
Consumer/Family Education
Outreach
Outpatient Services
Individual Evidenced-based Therapies
Group Therapy
Family Therapy
Multi-family Therapy
Consultation to Caregivers
Medication Services
Medication Management
Pharmacotherapy (including MAT)
Laboratory Services
Community Support (Rehabilitative)
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
Recovery Supports
Peer Support
Recovery Support Coaching
Recovery Support Center Services
Supports for Self-directed Care
Other Supports (Habilitative)
Personal Care
Homemaker
Respite

11

Service

SABG
MHBG
Expenditures Expenditures

Supported Education
Transportation
Assisted Living Services
Recreational Services
Trained Behavioral Health Interpreters
Interactive Communication Technology Devices
$

$

$

$

$

$

Peer-based Crisis Services
Urgent Care
23-hour Observation Bed
Medically Monitored Intensive Inpatient (SA)
24/7 Crisis Hotline Services
Other (please list)

$

$

Total

$

$

Intensive Support Services
Substance Abuse Intensive Outpatient (IOP)
Partial Hospital
Assertive Community Treatment
Intensive Home-based Services
Multi-systemic Therapy
Intensive Case Management
Out of Home Residential Services
Crisis Residential/Stabilization
Clinically Managed 24-hour Care (SA)
Clinically Managed Medium Intensity Care (SA)
Adult Mental Health Residential
Youth Substance Abuse Residential Services
Children's Residential Mental Health Services
Therapeutic Foster Care
Acute Intensive Services
Mobile Crisis

12

SABG Table 4 - State Agency SABG Expenditure Compliance Report
This table provides a description of SA Block Grant expenditures for authorized activities to prevent and treat substance. For detailed instructions,
refer to those in BGAS. Only one column is to be filled in each year.
State Agency SABG Expenditure Compliance Report
SABG Table 4

FY 2013 SA Block Grant Award

FY 2014 SA Block Grant Award

State Identifier:
Expenditure Category

1.

Substance Abuse Prevention* and Treatment

2.

Primary Prevention

3.

HIV Early Intervention Services**

4.

Tuberculosis Services

5.

Administration (excluding program / provider level)

6.

Total

* Prevention other than Primary Prevention
** For HIV Designated States only

13

SABG Table 5a - Primary Prevention Expenditures Checklist
The State or Jurisdiction must complete either SABG Table 5a and/or 5b. There are six primary prevention strategies typically funded by principal
agencies administering the SAPT Block Grant. Expenditures within each of the six strategies or Institute of Medicine Model (IOM) should be
directly associated with the cost of completing the activity or task. For example, information dissemination may include the cost of developing
pamphlets, the time of participating staff and/or the cost of public service announcements, etc. If a State or Jurisdiction employs strategies not
covered by these six categories, please report them under “Other”, each in a separate row.
Section 1926 – Tobacco: Costs associated with the Synar Program Pursuant to the January 19, 1996 federal regulation “Tobacco Regulation for
Substance Abuse Prevention and Treatment Block Grants, Final Rule” (45 C.F.R. §96.130), a state may not use the Block Grant to fund the
enforcement of its statute, except that it may expend funds from its primary prevention set aside of its Block Grant allotment under 45 C.F.R.
§96.124(b)(1) for carrying out the administrative aspects of the requirements, such as the development of the sample design and the conducting of
the inspections. States should include an non-SABG funds that were allotted for Synar activities in the appropriate columns under 7 below.
SABG Primary Prevention Expenditures Checklist
SABG Table 5a
State Identifier:
Report Period- From:
Strategy
1. Information Dissemination

2. Education

3. Alternatives

A.
IOM Target

To:
B.
SAPT Block Grant

C.
Other Federal

D.
State

E.
Local

F. Other

Universal

$

$

$

$

$

Selected

$

$

$

$

$

Indicated

$

$

$

$

$

Unspecified

$

$

$

$

$

Universal

$

$

$

$

$

Selected

$

$

$

$

$

Indicated

$

$

$

$

$

Unspecified

$

$

$

$

$

Universal

$

$

$

$

$

Selected

$

$

$

$

$

14

4. Problem Identification and
Referral

5. Community-Based Processes

6. Environmental

7. Section 1926-Tobacco

8. Other

Indicated

$

$

$

$

$

Unspecified

$

$

$

$

$

Universal

$

$

$

$

$

Selected

$

$

$

$

$

Indicated

$

$

$

$

$

Unspecified

$

$

$

$

$

Universal

$

$

$

$

$

Selected

$

$

$

$

$

Indicated

$

$

$

$

$

Universal

$

$

$

$

$

Selected

$

$

$

$

$

Indicated

$

$

$

$

$

Unspecified

$

$

$

$

$

Universal

$

$

$

$

$

Selected

$

$

$

$

$

Indicated

$

$

$

$

$

Universal

$

$

$

$

$

Selected

$

$

$

$

$

Indicated

$

$

$

$

$

$

$

$

$

$

$

$

$

9. Suicide Prevention

10. Total

$

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

15

SABG Table 5b - SABG Primary Prevention Expenditures by Institute of Medicine (IOM) Categories
The State or Jurisdiction must complete SABG Table 5b if it chooses to report substance abuse
primary prevention activities utilizing the IOM Model of Universal, Selective and Indicated. Indicate
how much funding supported each of the IOM classifications of Universal, Selective, or Indicated.
Include all funding sources (e.g., Centers for Disease Control and Prevention Block Grant,
foundations). For detailed instructions, refer to those in the Block Grant Application System (BGAS).
SABG Primary Prevention Expenditures by IOM Category
SABG Table 5B
State Identifier:
Report Period- From:
Activity

To:
FY 2014 SA
Block Grant
Award

Other Federal

Universal Direct
Universal Indirect
Selective
Indicated
Column Total

$
$
$
$
$

$
$
$
$
$

Total SABG Award
Planned Primary
Prevention
Percentage

$
%

$
%

State Funds
$
$
$
$
$

Local Funds
$
$
$
$
$

Other
$
$
$
$
$

16

SABG Table 5c (Requested) - SABG Primary Prevention Targeted Priorities
The purpose of the first table is for the State or Jurisdiction to identify the substance and/or
categories of substances it identified through its needs assessment and then addressed with Primary
Prevention set-aside dollars from the FY 2014 SA Block Grant award. The purpose of the second
table is to identify each special population the State or Jurisdiction selected as a priority for Primary
Prevention set-aside expenditures.

SABG Primary Prevention Targeted Priorities-1

Targeted Substances
Alcohol
Tobacco
Marijuana
Prescription Drugs
Cocaine
Heroin
Inhalants
Methamphetamine
Synthetic Drugs (i.e. Bath salts,
Spice, K2)

Yes

No

SABG Primary Prevention Targeted Priorities-2

Targeted Populations
Students in College
Military Families
LGBTQ
American Indians/Alaska
Natives
African American
Hispanic
Homeless
Native Hawaiian/Other Pacific
Islanders
Asian
Rural
Underserved Racial and Ethnic
Minorities

Yes

No

17

SABG Table 6 - SABG Resource Development Expenditures Checklist
If the State or Jurisdiction funded resource development activities with a SABG award, it is required to complete this table for the obligation and
expenditure period of the award. For detailed instructions, refer to those in BGAS.
SABG Resource Development Expenditures Checklist
SABG Table 6
State Identifier:
Report Period- From:
Activity

To:
A.
Treatment

B.
Prevention

C. Additional
Combined

D. Total

1. Planning, coordination, and needs assessment

$

$

$

$

2. Quality assurance

$

$

$

$

3. Training (post-employment)

$

$

$

$

4. Education (pre-employment)

$

$

$

$

5. Program development

$

$

$

$

6. Research and evaluation

$

$

$

$

7. Information systems

$

$

$

$

8. Total

18

OMB No. 0930-0080
SABG Table 7 – State Entity Inventory
This table provides a report of the subrecipients of SA Block Grant funds including community- and faith-based organizations which provided
substance abuse prevention activities and treatment services, as well as intermediaries/administrative service organizations. Table 7 excludes
resource development expenditures. For detailed instructions, see those in BGAS.
Statewide Entity Inventory
SABG Table 7
State Identifier:
Report Period- From:

To:
Source of Funds
SAPT Block Grant

Entity
Number

Total

I-BHS ID
(formerly
I-SATS)

Area
Served
(Statewide
or SubState
Planning
Area)

Provider/Program
Name

Street
Address

City

State

Zip

A
All SA
Block
Grant
Funds

$
$
$

B
Prevention
(other than
Primary
Prevention)
and
Treatment
Services
$
$
$

B
Pregnant
Women
and
Women
with
Dependent
Children
$
$
$

D
Primary
Prevention

E
Early
Intervention
Services for HIV

$
$
$

$
$
$

OMB No. 0930-0080

Description of Calculations for MOE Tables 8a through 8d
Please provide a description of the amounts and methods used to calculate the following:
(a) total Single State Agency (SSA) expenditures for substance abuse prevention and treatment 42 U.S.C. §300x-30;
(b) the base and Maintenance of Effort (MOE) for tuberculosis services as required by 42 U.S.C. §300x-24(d);
(c) (for designated states only) the base and MOE for HIV early intervention services as required by 42 U.S.C.§300x-24(d)
(See 45 C.F.R. §96 122(f)(5)(ii)(A)(B)(C)); and
(d) the base and, for 1994 and subsequent fiscal years, report the Federal and State expenditures for such services for services
to pregnant women and women with dependent children as required by 42 U.S.C. §300x-22(b)(1).

OMB No. 0930-0080

SABG Table 8a - Maintenance of Effort for State Expenditures for Substance Abuse Prevention and Treatment
This Maintenance of Effort table provides a description of non-Federal expenditures for authorized activities to prevent and treat substance abuse
flowing through the Single State Agency (SSA) during the State fiscal year immediately preceding the federal fiscal year for which the state is
applying for funds. (Dates given are for the 2017 SABG Report. For the 2018 SABG report, increase each year by one.)
For detailed instructions, see those in BGAS.
SABG Table 8a
Treatment
State Identifier:
Report Period- From:

Total Single State Agency (SSA) Expenditures for Substance Abuse Prevention and

To:

Period

Expenditures

B1 (2014) + B2 (2015)
2

(A)

(B)

(C)

SFY 2014
(1)
SFY 2015
(2)
SFY 2016
(3)

Are the expenditure amounts reported in Column B “actual” expenditures for the fiscal years involved?
Yes

No

SFY 2014
SFY 2015
SFY 2016

If any estimated expenditures are provided, please indicate when “actual” expenditure data will be submitted to SAMHSA: ___/___/_____
mm/dd/yyyy
Did the State or Jurisdiction have any non-recurring expenditures for a specific purpose which were not included in the MOE calculation?
Yes____

No ___

If yes, specify the amount and the State fiscal year ___________

Did the State or Jurisdiction include these funds in previous year MOE calculations? Yes___ No___
When did the State or Jurisdiction submit an official request to SAMHSA to exclude these funds from the MOE calculations? ___/___/_____

OMB No. 0930-0080
mm/dd/yyyy
SABG Table 8b - Statewide Non-Federal Expenditures for Tuberculosis to Individuals in Substance Use Disorder (SUD) Treatment
This Maintenance of Effort table provides a report of all statewide, non-Federal funds expended on Tuberculosis (TB) services to individuals in
substance use disorder treatment during the State fiscal year immediately preceding the federal fiscal year for which the state is applying for funds.
Statewide Non-Federal Expenditures for Tuberculosis Services to Individuals in SUD
Treatment
SABG Table 8b
State Identifier:
BASE

Period

Total of All
State Funds
Spent on TB
Services

% of TB Expenditures
Spent on Individuals in
Substance Use
Disorder Treatment

Total State Funds Spent
on Individuals in
Substance Use
Disorders Treatment
(AxB)

(A)

(B)

(C)

Total of All
State Funds
Spent on TB
Services

% of TB Expenditures
Spent on Individuals in
Substance Use
Disorder Treatment

Total State Funds Spent
on Individuals in
Substance Use
Disorders Treatment

SFY 1991 (1)
SFY 1992 (2)

MAINTENANCE
Period

(A)
SFY 2016* (3)

*Date given is for the 2017 SABG Report. For the 2018 SABG Report, increase the year by one.)

(B)

(A x B)
(C)

Average of
Columns
C1 and C2=
C1 + C2
2
(MOE BASE)
(D)

OMB No. 0930-0080
SABG Table 8c -Statewide Non-Federal Expenditures for HIV Early Intervention Services to Individuals in Substance Use Disorder Treatment
This Maintenance of Effort table is for “designated States” to report all statewide, non-Federal funds expended on HIV EIS services to individuals in
substance use disorder treatment during the State fiscal year immediately preceding the federal fiscal year for which the state is applying for funds.
Enter the federal fiscal year in which your State first became a designated State. Federal Fiscal Year

____.

Enter the prior 2 years’ expenditure data in A1 and A2. Compute the average of the amounts in boxes A1 and A2. Enter the resulting average
(Base) in box B2.
Statewide Non-Federal Expenditures for HIV Early Intervention Services
to Individuals in Substance Use Disorder Treatment
SABG Table 8c
State Identifier:
BASE
Period

Total of All State Funds
Spent on Early
Intervention Services for
HIV

(A)
(1)

SFY ____

(2)

SFY____

MAINTENANCE
Period

(3)

Total of All State Funds Spent on Early Intervention
Services for HIV
(A)

SFY 2016*
*Date given is for the 2017 SABG Report. For the 2018 SABG Report, increase the year by one.)

Average of
Columns
A1 and A2
A1+A2
2
(MOE Base)
(B)

OMB No. 0930-0080
SABG Table 8d - Expenditures for Services to Pregnant Women and Women with Dependent Children
This Maintenance of Effort table provides a report of all statewide, non-Federal funds expended on specialized treatment and related services which
meet the SABG requirements for pregnant women and women with dependent children during the State fiscal year immediately preceding the federal
fiscal year for which the state is applying for funds. (Dates given are for the 2017 SABG Report. For the 2018 SABG Report, increase each year
(other than the base year) by one.
G Table 8c
SABG Table 8c

SABG Table 8c

SABG Table 8c

For detailed instructions, see those in BGAS.
Expenditures for Services to Pregnant Women and Women with Dependent Children
SABG Table 8d
State Identifier:
Report Period- From:
Period

1994
2014
2015
2016

To:
Total Women’s Base

Total Expenditures

(A)

(B)

D. Populations and Services Report
States and Jurisdictions are required to provide information regarding individuals that are served by
the State Substance Abuse Authority in SABG Tables 9 through 13.
SABG Table 9 - Prevention Strategy Report This table requires additional information (pursuant to
Section 1929 of Title XIX, Part B, Subpart II of the PHS Act) about the primary prevention activities
conducted by the entities listed on SABG Table 7, State Entity Inventory, Column D. It seeks further
information on the specific strategies and activities being funded by the principal agency of the State
which address the sub-populations at risk for alcohol, tobacco, and other drug (ATOD) use/abuse.
SABG Table 10 - Treatment Utilization Matrix This table is intended to capture the count of
persons with initial admissions and subsequent admission(s) to an episode of care (as defined in the
Drug and Alcohol Services Information System (DASIS) Treatment Episode Data Set (TEDS)
standards (see http://oas.samhsa.gov/dasis.htm#teds2) during the State fiscal year immediately
preceding the federal fiscal year for which the state is applying for funds.
SABG Table 11 - Number of Persons Served (Unduplicated Count) for Alcohol and Other Drug Use.
This table provides an aggregate profile of the unduplicated number of admissions and persons for
services funded through the SABG during the State fiscal year immediately preceding the federal
fiscal year for which the state is applying for funds. States and Jurisdictions are to provide this
information on all programs by age, gender, and race/ethnicity. States and Jurisdictions are to report
whether the values reported come from a client-based system(s) with unique client identifiers.
SABG Table 12 – SABG HIV Designated States Early Intervention Services This table requires
“designated States”, as defined in section 1924(b) of Title XIX, Part B, Subpart II of the PHS Act (42
U.S.C. 300x-24(b)), to provide information on Early Intervention Services for HIV testing and
referral provided during the State fiscal year immediately preceding the federal fiscal year for which
the state is applying for funds.
SABG Table 13 - Charitable Choice This table requires States and Jurisdictions to provide
information regarding compliance with section 1955 of Title XIX, Part B, Subpart III of the PHS Act
(42 U.S.C. 300x-65) and the Charitable Choice Provisions and Regulations; Final Rule (42 C.F.R.
Part 54) during the State fiscal year immediately preceding the federal fiscal year for which the state
is applying for funds.

25

SABG Table 9 - Prevention Strategy Report
This table requires additional information (pursuant to Section 1929 of Title XIX, Part B, Subpart II of the PHS Act) about the primary
prevention activities conducted by the entities listed on SABG Table 7. For detailed instructions, see those in BGAS.
Prevention Strategy Report Risk-Strategies
SABG Table 9
Report Period- From:

To:

State Identifier
Column A (Risks)

Children of Substance Abusers [1]
Pregnant Women / Teens [2]
Drop-Outs [3]
Violent and Delinquent Behavior [4]
Mental Health Problems [5]
Economically Disadvantaged [6]
Physically Disabled [7]
Abuse Victims [8]
Already Using Substances [9]
Homeless and/or Runaway Youth [10]
Other, Specify [11]

Column B (Strategies)

Column C (Providers)

SABG Table 10 – Treatment Utilization Matrix
This table is intended to capture the count of persons with initial admissions and subsequent admission(s) to an episode of care. For detailed
instructions, see those in BGAS.
For detailed instructions, see those in BGAS.
SABG Table 10
Report Period- From:
To:

Level Of Care

Treatment Utilization Matrix
Number of Admissions ≥
Number of Persons Served
Number
Number of
of Admissions
Persons Served
(A)
(B)

Costs per Person
Mean Cost of Services
(C)

Standard Deviation
of Cost
(E)

Median Cost of Services
(D)

Detoxification (24-Hour Care)
1. Hospital Inpatient

$

$

$

2. Free-Standing Residential
Rehabilitation/Residential

$

$

$

3. Hospital Inpatient

$

$

$

5.

$

$

$

5. Long-term (over 30 days)
Ambulatory (Outpatient)

$

$

$

6. Outpatient

$

$

$

7. Intensive Outpatient

$

$

$

8. Detoxification
Opioid Replacement Therapy

$

$

$

9. ORT Detoxification

$

$

$

Short-term (up to 30 days)

10. Opioid Replacement Therapy

SABG Table 11 - Unduplicated Count of Persons Served for Alcohol and Other Drug Use
This table provides an aggregate profile of the unduplicated number of admissions and persons for services funded through the SABG. For
detailed instructions, see those in BGAS.
SABG Table 11
Report Period- From:
To::
State Identifier:
Number of Persons Served (Unduplicated Count) for Alcohol and Other Drug Use in State Funded Services by Age, Sex and Race/Ethnicity
Sex and Race/Ethnicity
Age
A. Total
B. White
C. Black or
D. Native
E. Asian
F. American
G. More
H. Unknown
I. Not
African
Hawaiian/
Indian/Alaska Than One
Hispanic or
American
Other Pacific
n Native
Race
Latino
Islander
Reported
M
1. 17 and
under
2. 18-24
3.

25-44

4.

45-64

5. 65 and
over
5. Total
7. Pregnant
Women
Numbers of Persons Served
who were admitted in a
Period Prior to the 12 month
reporting Period
Number of persons served
outside of the levels of care
described on SABG Table 10

F

M

F

M

F

M

F

M

F

M

F

M

F

M

F

J. Hispanic
or Latino

M

F

SABG Table 12 - SABG Human Immunodeficiency Virus (HIV) Early Intervention Services in Designated States
For detailed instructions, see those in BGAS.
SABG Table 12
Report Period- From:
State Identifier

To::
Early Intervention Services for Human Immunodeficiency Virus (HIV)

1. Number of SAPT HIV EIS programs funded in the State:

Statewide:_____

2. Total number of individuals tested through SAPT HIV EIS funded
programs:
3. Total number of HIV tests conducted with SAPT HIV EIS funds:
4. Total number of tests that were positive for HIV:
5. Total number of individuals who prior to the 12-month reporting
period were unaware of their HIV infection:
6. Total number of HIV-infected individuals who were diagnosed and
referred into treatment and care during the 12-month reporting period
Identify barriers, including State laws and regulations, that exist in carrying out HIV testing services:

Rural:_____

SABG Table 13 - Charitable Choice
Under Charitable Choice, States, local governments, and religious organizations, such as SAMHSA
grant recipients, must: (1) ensure that religious organizations that are providers provide to all
potential and actual program beneficiaries (services recipients) notice of their right to alternative
services; (2) ensure that religious organizations that are providers refer program beneficiaries to
alternative services; and (3) fund and/or provide alternative services. The term “alternative services”
means services determined by the State to be accessible and comparable and provided within a
reasonable period of time from another substance abuse provider (“alternative provider”) to which
the program beneficiary (services recipient) has no religious objection. The purpose of this table is
to document how the State is complying with these provisions.
Notice to Program Beneficiaries – Check all that apply:
□ Used model notice provided in final regulations.
□ Used notice developed by State (please attach a copy to the Report)
□ State has disseminated notice to religious organizations that are providers.
□ State requires these religious organizations to give notice to all potential beneficiaries.
Referrals to Alternative Services – Check all that apply:
□ State has developed specific referral system for this requirement.
□ State has incorporated this requirement into existing referral system(s).
□ SAMHSA’s Treatment Facility Locator is used to help identify providers.
□ Other networks and information systems are used to help identify providers.
□ State maintains record of referrals made by religious organizations that are providers.
Enter the total number of referrals to other substance abuse providers (“alternative
providers”) necessitated by religious objection, as defined above, made during the State
fiscal year immediately preceding the federal fiscal year for which the state is applying
for funds. Provide the total only. No information on specific referrals is required.
Provide a brief description (one paragraph) of any training for local governments and/or faith-based
and/or community organizations that are providers on these requirements.

E. Performance Data and Outcomes
SAMHSA is interested in demonstrating program accountability and efficacy through the National
Outcome Measures (NOMs). The NOMs are intended to document the performance of federally
supported programs and systems of care.
Treatment Performance Measures
SABG Table 14 Employment/Education Status This table describes the status of adult clients
served by the public substance use disorder treatment system in terms of employment and education
status. The Employment\Education Status Form seeks information on clients who are employed or
who are students (full-time or part-time) (prior 30 days) at admission and discharge.
SABG Table 15 Stability of Housing This table requests information regarding the number of
individuals in a Stable Living Environment as collected by the most recent assessment in the
reporting period. Specifically, information is collected on the individual’s last known living
situation.
SABG Table 16 Criminal Justice Involvement This table requests information regarding the
clients’ involvement in the criminal justice system. Specifically, the table requests information to
measure the change in number of arrests over time.
SABG Table 17 Change in Abstinence–Alcohol Use This table seeks information regarding
alcohol abstinence. Specifically, information is collected on the number of clients with no alcohol
use (all clients regardless of primary problem) at admission and discharge.
SABG Table 18 Change in Abstinence – Other Drug Use This table collects information regarding
clients’ change in abstinence with drugs of abuse other than alcohol. This table seeks to collect
information on clients with no other drug use (all clients regardless of primary problem) at admission
and discharge.
SABG Table 19 Change in Social Support of Recover This table seeks to measure the change in
clients’ social support or recovery. Specifically, this form collects information regarding the number
of clients participating in self help groups at admission and discharge
SABG Table 20 Retention This table collects information regarding retention. Specifically, this
table collects information regarding the length of stay of clients completing treatment.
Prevention Performance Measures
SABG Table 22 Reduced Morbidity –Abstinence from Drug Use/Alcohol Use; Measure: Perception
of Risk/Harm of Use. This table seeks information regarding the individuals’ perceived risk of
harming themselves with alcohol, tobacco and other drugs.

31

SABG Table 23 Reduced Morbidity–Abstinence from Drug Use/Alcohol Use; Measure: Age of
First Use. This table seeks information regarding the age of first use of alcohol, cigarettes and other
drugs.
SABG Table 24 Reduced Morbidity–Abstinence from Drug Use/Alcohol Use; Measure: Perception
of Disapproval/Attitudes. This table seeks information regarding the general public perception or
attitude regarding use of alcohol, cigarettes and other drugs.
SABG Table 25 Employment/Education; Measure: Perception of Workplace Policy. This table
reports the percent of individuals who would be more likely to work for an employer conducting
random drug and alcohol tests.
SABG Table 26 Employment/Education; Measure: Average Daily School Attendance Rate. This
table collects information regarding the average daily school attendance.
SABG Table 27 Crime and Criminal Justice; Measure: Alcohol-Related Traffic Fatalities. This
table collects information regarding the number of alcohol-related traffic fatalities divided by the
total number of traffic fatalities and multiplied by 100.
SABG Table 28 Crime and Criminal Justice; Measure: Alcohol and Drug Related Arrests. This
table collects information regarding alcohol- and drug-related arrests.
SABG Table 29 Social Connectedness; Measure: Family Communications around Drug and
Alcohol Use. This table provides information regarding the percent of youth reporting having talked
with a parent and the percent of parents reporting that they have talked to their child around alcohol
and drug use.
SABG Table 30 Retention; Measure: Percentage of Youth Seeing, Reading, Watching, or Listening
to a Prevention Message. This table collects information regarding the percent of youth reporting
having been exposed to prevention message.
SABG Table 31 Individual-Based Programs and Strategies; Measure: Number of Persons Served
By Age, Gender, Race, and Ethnicity. This table provides information on the number of persons
served by individual-based programs and strategies. This includes practices and strategies with
identifiable goals designed to change behavioral outcomes among a definable population or within a
definable geographic area.
SABG Table 32 Population-Based Programs and Strategies; Measure: Number of Persons Served
By Age, Gender, Race, And Ethnicity. This table provides information regarding the number of
persons by age, gender, race, and ethnicity that participated in population-based programs.
Population-based programs and strategies include planned and deliberate goal-oriented practices,
procedures, processes, or activities that have identifiable outcomes achieved with a sequence of steps
subject to monitoring and modification.
SABG Table 33 Number of Persons Served by Type of Intervention. This table seeks to measure
information on access and capacity of intervention programs. Specifically, this form collects
information on the number of persons served by type of Intervention. Interventions include
activities, practices, procedures, processes, programs, services, and strategies.

32

SABG Table 34 Number of Evidence-Based Programs by Types of Intervention. This table
collects information on the number of evidence-based programs and strategies by type of
intervention.
SABG Table 35 Number of Evidence-based Programs and Strategies, and Total SA Block Grant
Funds Spent on Evidence-Based Programs/ Strategies.
SABG Table 36 (Optional Worksheet) Program/Strategy Detail for Computing the Total Number of
Evidence-based Programs and Strategies, and for Reporting Total SA Block Grant Funds Spent on
Substance Abuse Prevention Evidence-Based Programs and Strategies. This table supports the
computation of the total number of evidence-based programs and strategies and the total SA Block
Grant funds spent on substance abuse prevention evidence-based programs and strategies.

33

SABG Table 14 – TREATMENT PERFORMANCE MEASURE
EMPLOYMENT\EDUCATION STATUS (From Admission to Discharge)
Most recent year for which data are available: _____________
Employment\Education Status – Clients employed or student
(full-time or part-time) (prior 30 days) at admission vs. discharge

Admission
Clients
(T1)

Discharge
Clients
(T2)

Number of clients employed or student (full-time and part-time) [numerator]

Total number of clients with non-missing values on employment\student status
[denominator]

Percent of clients employed or student (full-time and part-time)

34

State Description of Employment\Education Status Data Collection (SABG Table 15)
STATE CONFORMANCE
TO INTERIM STANDARD

State Description of Employment\Education Data Collection (SABG Table 15):
States should detail exactly how this information is collected. Where data and methods vary
from interim standard, variance should be described.

DATA SOURCE

What is the source of data for SABG Table 15 (select all that apply):
□ Client self-report □ Client self-report confirmed by another source→
Administrative data source □ Other Specify ___________________

EPISODE OF CARE

How is the admission/discharge basis defined for SABG Table 15 (Select one) □ Admission is
on the first date of service, prior to which no service has been received for 30 days AND
discharge is on the last date of service, subsequent to which no service has been received for 30
days
□ Admission is on the first date of service in a Program/Service Delivery Unit and Discharge is
on the last date of service in a Program/Service Delivery Unit
□ Other Specify ___________________________________________
_________________________________________________________
How was discharge data collected for SABG Table 15 (select all that apply)
□ Not applicable, data reported on form is collected at time period other than discharge→
Specify:
□ In-treatment data ___ days post-admission, OR □ Follow-up data ___ (specify) months Post□ admission □ discharge □ other ______
□ Discharge data is collected for the census of all (or almost all) clients who were admitted to
treatment □ Discharge data is collected for a sample or all clients who were admitted to
treatment □ Discharge records are directly collected (or in the case of early dropouts) are created
for all (or almost all) clients who were admitted to treatment
□ Discharge records are not collected for approximately ___ % of clients who were admitted for
treatment
Was the admission and discharge data linked for table 15 (select all that apply):
□ Yes, all clients at admission were linked with discharge data using an Unique Client Identifier
(UCID)
Select type of UCID □ Master Client Index or Master Patient Index, centrally assigned □ Social
Security Number (SSN) □ Unique client ID based on fixed client characteristics (such as date of
birth, gender, partial SSN, etc.) □ Some other Statewide unique ID □ Provider-entity-specific
unique ID
□ No, State Management Information System does not utilize UCID that allows comparison of
admission and discharge data on a client specific basis (data developed on a cohorts basis) or
State relied on other data sources for post admission data □ No, admission and discharge records
were matched using probabilistic record matching.
If data is not reported, why is State unable to report (select all that apply):
□ Information is not collected at admission □ Information is not collected at discharge □
Information is not collected by the categories requested □ State collects information on the
indicator area but utilizes a different measure.
State must provide time-framed plans for capturing employment\student status data on all clients,
if data is not currently available. Plans should also discuss barriers, resource needs and estimates
of cost.

DISCHARGE DATA
COLLECTION

RECORD LINKING

IF DATA IS
UNAVAILABLE
DATA PLANS IF DATA IS
NOT AVAILABLE

□ collateral source □

35

SABG Table 15–TREATMENT PERFORMANCE MEASURE
STABILITY OF HOUSING (From Admission to Discharge)
Most recent year for which data are available: _____________
Clients living in a stable living situation (prior 30 days) at admission vs. discharge

Admission
Clients
(T1)

Discharge
Clients
(T2)

Number of clients living in a stable situation [numerator]
Total number of clients with non-missing values on living arrangements [denominator]
Percent of clients in a stable living situation

36

DO NOT DISTRIBUTE – CLOSE HOLD
State Description of Stability in Housing Data Collection (SABG Table 15)
STATE
CONFORMANCE TO
INTERIM STANDARD

State Description of Criminal Involvement Data Collection (SABG Table 15):
States should detail exactly how this information is collected. Where data and methods vary
from interim standard, variance should be described.

DATA SOURCE

What is the source of data for SABG Table 15 (select all that apply):
□ Client self-report □ Client self-report confirmed by another source→ □ collateral source □
Administrative data source □ Other Specify ___________________
How is the admission/discharge basis defined for SABG Table 15 (Select one) □ Admission is
on the first date of service, prior to which no service has been received for 30 days AND
discharge is on the last date of service, subsequent to which no service has been received for 30
days
□ Admission is on the first date of service in a Program/Service Delivery Unit and Discharge is
on the last date of service in a Program/Service Delivery Unit
□ Other Specify ___________________________________________
_________________________________________________________

EPISODE OF CARE

DISCHARGE DATA
COLLECTION

RECORD LINKING

IF DATA IS
UNAVAILABLE

DATA PLANS IF DATA
IS NOT AVAILABLE

How was discharge data collected for SABG Table 15 (select all that apply)
□ Not applicable, data reported on form is collected at time period other than discharge→
Specify:
□ In-treatment data ___ days post-admission, OR □ Follow-up data ___ (specify) months Post□ admission □ discharge □ other ______
□ Discharge data is collected for the census of all (or almost all) clients who were admitted to
treatment □ Discharge data is collected for a sample or all clients who were admitted to
treatment □ Discharge records are directly collected (or in the case of early dropouts) are
created for all (or almost all) clients who were admitted to treatment
□ Discharge records are not collected for approximately ___ % of clients who were admitted
for treatment
Was the admission and discharge data linked for SABG Table 15 (select all that apply):
□ Yes, all clients at admission were linked with discharge data using an Unique Client
Identifier (UCID)
Select type of UCID □ Master Client Index or Master Patient Index, centrally assigned □
Social Security Number (SSN) □ Unique client ID based on fixed client characteristics (such as
date of birth, gender, partial SSN, etc.) □ Some other Statewide unique ID □ Provider-entityspecific unique ID
□ No, State Management Information System does not utilize UCID that allows comparison of
admission and discharge data on a client specific basis (data developed on a cohorts basis) or
State relied on other data sources for post admission data □ No, admission and discharge
records were matched using probabilistic record matching.

If data is not reported, why is State unable to report (select all that apply): □ Information is not
collected at admission □ Information is not collected at discharge □ Information is not
collected by the categories requested □ State collects information on the indicator area but
utilizes a different measure.
State must provide time-framed plans for capturing criminal justice involvement status data on
all clients, if data is not currently available. Plans should also discuss barriers, resource needs
and estimates of cost.

SAPT BG APPLICATION 37

SABG Table 16– TREATMENT PERFORMANCE MEASURE
CRIMINAL JUSTICE INVOLVEMENT (From Admission to Discharge)
Most recent year for which data are available: _____________
Clients without arrests (any charge) (prior 30 days) at admission vs. discharge

Admission
Clients
(T1)

Discharge
Clients
(T2)

Number of Clients without arrests [numerator]
Total number of clients with non-missing values on arrests [denominator]
Percent of clients without arrests

38

State Description of Criminal Involvement Data Collection (SABG Table 16)
STATE
CONFORMANCE TO
INTERIM STANDARD

State Description of Criminal Involvement Data Collection (SABG Table 16):
States should detail exactly how this information is collected. Where data and methods vary
from interim standard, variance should be described.

DATA SOURCE

What is the source of data for SABG Table 16 (select all that apply):
□ Client self-report □ Client self-report confirmed by another source→ □ collateral source □
Administrative data source □ Other Specify ___________________
How is the admission/discharge basis defined for SABG Table 16 (Select one) □ Admission is
on the first date of service, prior to which no service has been received for 30 days AND
discharge is on the last date of service, subsequent to which no service has been received for 30
days
□ Admission is on the first date of service in a Program/Service Delivery Unit and Discharge is
on the last date of service in a Program/Service Delivery Unit
□ Other Specify ___________________________________________
_________________________________________________________

EPISODE OF CARE

DISCHARGE DATA
COLLECTION

RECORD LINKING

IF DATA IS
UNAVAILABLE

DATA PLANS IF DATA
IS NOT AVAILABLE

How was discharge data collected for SABG Table 16 (select all that apply)
□ Not applicable, data reported on form is collected at time period other than discharge→
Specify:
□ In-treatment data ___ days post-admission, OR □ Follow-up data ___ (specify) months Post□ admission □ discharge □ other ______
□ Discharge data is collected for the census of all (or almost all) clients who were admitted to
treatment □ Discharge data is collected for a sample or all clients who were admitted to
treatment □ Discharge records are directly collected (or in the case of early dropouts) are
created for all (or almost all) clients who were admitted to treatment
□ Discharge records are not collected for approximately ___ % of clients who were admitted
for treatment
Was the admission and discharge data linked for SABG Table 16 (select all that apply):
□ Yes, all clients at admission were linked with discharge data using an Unique Client
Identifier (UCID)
Select type of UCID □ Master Client Index or Master Patient Index, centrally assigned □
Social Security Number (SSN) □ Unique client ID based on fixed client characteristics (such as
date of birth, gender, partial SSN, etc.) □ Some other Statewide unique ID □ Provider-entityspecific unique ID
□ No, State Management Information System does not utilize UCID that allows comparison of
admission and discharge data on a client specific basis (data developed on a cohorts basis) or
State relied on other data sources for post admission data □ No, admission and discharge
records were matched using probabilistic record matching.

If data is not reported, why is State unable to report (select all that apply): □ Information is not
collected at admission □ Information is not collected at discharge □ Information is not
collected by the categories requested □ State collects information on the indicator area but
utilizes a different measure.
State must provide time-framed plans for capturing criminal justice involvement status data on
all clients, if data is not currently available. Plans should also discuss barriers, resource needs
and estimates of cost.

39

SABG Table 17– PERFORMANCE MEASURE
CHANGE IN ABSTINENCE – ALCOHOL USE (From Admission to Discharge)
Most recent year for which data are available: _____________
Alcohol Abstinence – Clients with no alcohol use (all clients regardless of primary
problem) (use Alcohol Use in last 30 days field) at admission vs. discharge.

Admission
Clients
(T1)

Discharge
Clients
(T2)

Number of clients abstinent from alcohol [numerator]
Total number of clients with non-missing values on “used any alcohol” variable [denominator]
Percent of clients abstinent from alcohol
(1) If State does not have a "used any alcohol" variable, calculate instead using frequency of use
variables for all primary, secondary, or tertiary problem codes in which the coded problem is Alcohol
(e.g. ,TEDS Code 02)

40

State Description of Alcohol Use Data Collection (SABG Table 17)
STATE
CONFORMANCE
TO INTERIM
STANDARD
DATA SOURCE

EPISODE OF
CARE

DISCHARGE
DATA
COLLECTION

RECORD LINKING

IF DATA IS
UNAVAILABLE
DATA PLANS IF
DATA IS NOT
AVAILABLE

State Description of Alcohol Use Data Collection (SABG Table 17):
State should detail exactly how this information is collected. Where data and methods vary
from interim standard, variance should be described.
What is the source of data for SABG Table 17 (select all that apply):
□ Client self-report □ Client self-report confirmed by another source→ □ urinalysis, blood test
or other biological assay □ collateral source
□ Administrative data source □ Other Specify ___________________
How is the admission/discharge basis defined for SABG Table 17 (Select one) □ Admission is
on the first date of service, prior to which no service has been received for 30 days AND
discharge is on the last date of service, subsequent to which no service has been received for 30
days
□ Admission is on the first date of service in a Program/Service Delivery Unit and Discharge is
on the last date of service in a Program/Service Delivery Unit
□ Other Specify ___________________________________________
How was discharge data collected for SABG Table 17 (select all that apply)
□ Not applicable, data reported on form is collected at time period other than discharge→
Specify:
□ In-treatment data ___ days post-admission, OR □ Follow-up data ___ (specify) months Post□ admission □ discharge □ other ______
□ Discharge data is collected for the census of all (or almost all) clients who were admitted to
treatment □ Discharge data is collected for a sample or all clients who were admitted to
treatment □ Discharge records are directly collected (or in the case of early dropouts) are
created for all (or almost all) clients who were admitted to treatment
□ Discharge records are not collected for approximately ___ % of clients who were admitted
for treatment
Was the admission and discharge data linked for SABG Table 17 (select all that apply):
□ Yes, all clients at admission were linked with discharge data using an Unique Client
Identifier (UCID)
Select type of UCID □ Master Client Index or Master Patient Index, centrally assigned □
Social Security Number (SSN) □ Unique client ID based on fixed client characteristics (such as
date of birth, gender, partial SSN, etc.) □ Some other Statewide unique ID □ Provider-entityspecific unique ID
□ No, State Management Information System does not utilize UCID that allows comparison of
admission and discharge data on a client specific basis (data developed on a cohorts basis) or
State relied on other data sources for post admission data □ No, admission and discharge
records were matched using probabilistic record matching.
If data is not reported, why is State unable to report (select all that apply): □ Information is not
collected at admission □ Information is not collected at discharge □ Information is not
collected by the categories requested □ State collects information on the indicator area but
utilizes a different measure.
State must provide time-framed plans for capturing abstinence - alcohol use status data on all
clients, if data is not currently available. Plans should also discuss barriers, resource needs and
estimates of cost.

41

SABG Table 18 – PERFORMANCE MEASURE
CHANGE IN ABSTINENCE -- OTHER DRUG USE (From Admission to Discharge)
Most recent year for which data are available: _____________

Drug Abstinence – Clients with no drug use (all clients regardless of primary
problem) (use Any Drug Use in last 30 days field) at admission vs. discharge.

Admission
Clients
(T1)

Discharge
Clients
(T2)

Number of Clients abstinent from illegal drugs [numerator]
Total number of clients with non-missing values on “used any drug” variable [denominator]
Percent of clients abstinent from drugs
(2) If State does not have a "used any drug" variable, calculate instead using frequency of use variables for all primary, secondary, or
tertiary problem codes in which the coded problem is Drugs (e.g., TEDS Codes 03-20)

42

State Description of Other Drug Use Data Collection (SABG Table 18)
STATE
CONFORMANCE TO
INTERIM STANDARD

State Description of Other Drug Use Data Collection (SABG Table 18):
States should detail exactly how this information is collected. Where data and methods vary
from interim standard, variance should be described.

DATA SOURCE

What is the source of data for SABG Table 18 (select all that apply):
□ Client self-report □ Client self-report confirmed by another source→ □ urinalysis, blood test
or other biological assay □ collateral source
□ Administrative data source □ Other Specify ___________________
How is the admission/discharge basis defined for SABG Table 18 (Select one) □ Admission is
on the first date of service, prior to which no service has been received for 30 days AND
discharge is on the last date of service, subsequent to which no service has been received for 30
days
□ Admission is on the first date of service in a Program/Service Delivery Unit and Discharge is
on the last date of service in a Program/Service Delivery Unit
□ Other Specify ___________________________________________
How was discharge data collected for SABG Table 18 (select all that apply)
□ Not applicable, data reported on form is collected at time period other than discharge→
Specify:
□ In-treatment data ___ days post-admission, OR □ Follow-up data ___ (specify) months Post□ admission □ discharge □ other ______
□ Discharge data is collected for the census of all (or almost all) clients who were admitted to
treatment □ Discharge data is collected for a sample or all clients who were admitted to
treatment □ Discharge records are directly collected (or in the case of early dropouts) are
created for all (or almost all) clients who were admitted to treatment
□ Discharge records are not collected for approximately ___ % of clients who were admitted
for treatment
Was the admission and discharge data linked for SABG Table 18 (select all that apply):
□ Yes, all clients at admission were linked with discharge data using an Unique Client
Identifier (UCID)
Select type of UCID □ Master Client Index or Master Patient Index, centrally assigned □
Social Security Number (SSN) □ Unique client ID based on fixed client characteristics (such as
date of birth, gender, partial SSN, etc.) □ Some other Statewide unique ID □ Provider-entityspecific unique ID
□ No, State Management Information System does not utilize UCID that allows comparison of
admission and discharge data on a client specific basis (data developed on a cohorts basis) or
State relied on other data sources for post admission data □ No, admission and discharge
records were matched using probabilistic record matching.

EPISODE OF CARE

DISCHARGE DATA
COLLECTION

RECORD LINKING

IF DATA IS
UNAVAILABLE
DATA PLANS IF DATA
IS NOT AVAILABLE

If data is not reported, why is State unable to report (select all that apply): □ Information is not
collected at admission □ Information is not collected at discharge □ Information is not
collected by the categories requested □ State collects information on the indicator area but
utilizes a different measure.
State must provide time-framed plans for capturing abstinence – drug use status data on all
clients, if data is not currently available. Plans should also discuss barriers, resource needs and
estimates of cost.

43

SABG Table 19 – PERFORMANCE MEASURE
CHANGE IN SOCIAL SUPPORT OF RECOVERY (From Admission to Discharge)
Most recent year for which data are available: _____________
Social Support of Recovery – Clients participating in self-help groups
(e.g., AA, NA, etc.) (prior 30 days) at admission vs. discharge

Admission
Clients
(T1)

Discharge
Clients
(T2)

Number of clients participating in self-help (AA NA meetings attended, etc.)
[numerator]
Total number of Admission and Discharge clients with non-missing values on self-help
activities [denominator]
Percent of clients participating in self-help activities

44

State Description of Social Support of Recovery Data Collection (SABG Table 19)
STATE
CONFORMANCE TO
INTERIM STANDARD

State Description of Social Support of Recovery Data Collection (SABG Table 19):
States should detail exactly how this information is collected. Where data and methods vary from
interim standard, variance should be described.

DATA SOURCE

What is the source of data for SABG Table 19 (select all that apply):
□ Client self-report □ Client self-report confirmed by another source→
□ collateral source □ Administrative data source
□ Other Specify ___________________
How is the admission/discharge basis defined for SABG Table 19 (Select one) □ Admission is on the
first date of service, prior to which no service has been received for 30 days AND discharge is on the
last date of service, subsequent to which no service has been received for 30 days
□ Admission is on the first date of service in a Program/Service Delivery Unit and Discharge is on the
last date of service in a Program/Service Delivery Unit
□ Other Specify ___________________________________________
How was discharge data collected for SABG Table 19 (select all that apply)
□ Not applicable, data reported on form is collected at time period other than discharge→ Specify:
□ In-treatment data ___ days post-admission, OR □ Follow-up data ___ (specify) months Post- □
admission □ discharge □ other ______
□ Discharge data is collected for the census of all (or almost all) clients who were admitted to
treatment □ Discharge data is collected for a sample or all clients who were admitted to treatment □
Discharge records are directly collected (or in the case of early dropouts) are created for all (or almost
all) clients who were admitted to treatment
□ Discharge records are not collected for approximately ___ % of clients who were admitted for
treatment
Was the admission and discharge data linked for SABG Table 19 (select all that apply):
□ Yes, all clients at admission were linked with discharge data using an Unique Client Identifier
(UCID)
Select type of UCID □ Master Client Index or Master Patient Index, centrally assigned □ Social
Security Number (SSN) □ Unique client ID based on fixed client characteristics (such as date of birth,
gender, partial SSN, etc.) □ Some other Statewide unique ID □ Provider-entity-specific unique ID
□ No, State Management Information System does not utilize UCID that allows comparison of
admission and discharge data on a client specific basis (data developed on a cohorts basis) or State
relied on other data sources for post admission data □ No, admission and discharge records were
matched using probabilistic record matching.
If data is not reported, why is State unable to report (select all that apply): □ Information is not
collected at admission □ Information is not collected at discharge □ Information is not collected by
the categories requested □ State collects information on the indicator area but utilizes a different
measure.

EPISODE OF CARE

DISCHARGE DATA
COLLECTION

RECORD LINKING

IF DATA IS
UNAVAILABLE

DATA PLANS IF DATA
IS NOT AVAILABLE

State must provide time-framed plans for capturing self-help participation status data on all clients, if
data is not currently available. Plans should also discuss barriers, resource needs and estimates of
cost.

45

SABG Table 20: RETENTION
Length of Stay (in Days) of Clients Completing Treatment
Most recent year for which data are available: _____________
LENGTH OF STAY
Level of Care

Average
(Mean)

Median

Interquartile Range

(Median)

Detoxification (24-hour care)
1. Hospital Inpatient
2. Free-Standing
Residential
Rehabilitation/Residential
3. Hospital Inpatient
4. Short-term
(up to 30 days)
5. Long-term
(over 30 days)
Ambulatory (Outpatient)
6. Outpatient
7. Intensive Outpatient
8. Detoxification
Opioid Replacement Therapy
9. ORT Detox
10. Opioid Replacement
Therapy

46

Section V: Performance Indicators and Accomplishments
Tables 21-36: Prevention Performance Measures
Tables 21 – 30 Prevention Performance Measures
Introduction
The National Outcome Measures (NOMs) are a set of domains and measures that the Substance
Abuse and Mental Health Services Administration (SAMHSA) uses to accomplish its vision and
to meet all of its Federal reporting requirements, thus reducing burden and redundancy for
grantees.
The NOMs Data Collection and Reporting tables are to be completed as part of the state's annual
SABG application. For Tables 21-25 and 27-30, the compliance year is calendar year (CY) 2014
(note that pre-populated NOMs from the National Survey on Drug Use and Health (NSDUH)
reflect pooled data from CYs 2013-2014. For substance abuse prevention NOMs Table 26, the
compliance year is School Year 2014.
For purposes of this section, unless otherwise noted, the term "state" refers to states, territories,
and the one Native American tribe that receive SABG funding.
Tables 21 through 30 Information
A. Pre-populated Data
CSAP and the states have agreed that the state-level reporting requirement for the NOMs listed
in Tables 21-30 will be fulfilled through the use of extant data from sources including the
National Survey on Drug Use and Health (NSDUH), the Fatality Analysis Reporting System
(FARS) of the National Highway Traffic Safety Administration, the Uniform Crime Report
(UCR) of the Federal Bureau of Investigation, and the National Center for Education Statistics
(NCES) of the U.S. Department of Education. These pre-populated state-level NOMs will meet
most of the state-level NOMs reporting requirements for the prevention portion of the SABG
funding. These data will be pre-populated into the data tables by CSAP.
NOMs Domain - Reduced Morbidity Abstinence from Drug Use/Alcohol Use
• Table 21: 30-Day Use
• Table 22: Perception of Risk/Harm of Use
• Table 23: Age of First Use
• Table 24: Perception of Disapproval/Attitudes
NOMs Domain - Employment/Education
• Table 25: Perception of Workplace Policy
• Table 26: Average Daily School Attendance Rate
NOMs Domain - Crime and Criminal Justice
• Table 27: Alcohol-Related Traffic Fatalities
• Table 28: Alcohol- and Drug-Related Arrests
NOMs Domain - Social Connectedness
Approval Expires 09-30-2010
47

• Table 29: Family Communications Around Drug and Alcohol Use
NOMs Domain - Retention
• Table 30: Youth Seeing, Reading, Watching, or Listening to a Prevention Message
In this block grant application, pre-populated data are automatically provided to fulfill the
majority of the reporting requirements.
Territories and Native American tribes for which there are no NSDUH, FARS, UCR, and/or
NCES data will not be required to report on those measures at the state level, but will be
encouraged to provide substitute data.
B. Supplemental Data
States may also wish to provide additional data related to the NOMs. The data can be included in
the block grant appendix. When describing the supplemental data, states should provide any
relevant Web addresses (URLs) that provide links to specific state data sources.
D. Instructions for Completing Forms
Column A: Measure - The SAMSHA-defined measure for the domain listed.
Column B: Question/Response
• Source Survey Item: For Table 21-25, 29, and 30, the source is the NSDUH. For Tables 26-28
other "archival" sources are identified. The specific language used for each item is provided.
• Response Option: The range of responses that are provided for the survey item.
• Outcome Reported: The specific responses that are included in the calculation provided for the
item.
• Age: The age range for which the responses are provided.
Column C: Pre-populated Data - Pre-populated data are provided; see description below.
Column D: Supplemental Data, if any

Approval Expires 09-30-2010
48

SABG TABLE 21– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: REDUCED MORBIDITY ABSTINENCE FROM DRUG USE/ALCOHOL USE
MEASURE: 30-DAY USE
A.
Measure

B.
Question/Response

C.
Prepopulated
Data

D.
Supplemental
Data, if any

Source Survey Item: NSDUH Questionnaire. “Think specifically about the
past 30 days, that is, from [DATEFILL] through today. During the past 30
days, on how many days did you drink one or more drinks of an alcoholic
beverage?” [Response option: Write in a number between 0 and 30.]
Outcome Reported: Percent who reported having used alcohol during the
past 30 days.
Ages 12–20 – CY 2013-2014
Ages 21+ - CY 2013-2014
2. 30-day
Source Survey Item: NSDUH Questionnaire: “During the past 30 days,
Cigarette Use
that is, since [DATEFILL], on how many days did you smoke part or all of
a cigarette?” [Response option: Write in a number between 0 and 30.]
Outcome Reported: Percent who reported having smoked a cigarette
during the past 30 days.
Ages 12–17 - CY 2013-2014
Ages 18+ - CY 2013-2014
3. 30-day Use of Source Survey Item: NSDUH Questionnaire: “During the past 30 days,
Other Tobacco
that is, since [DATEFILL], on how many days did you use [other tobacco
Products
products]†?” [Response option: Write in a number between 0 and 30.]
Outcome Reported: Percent who reported having used a tobacco product
other than cigarettes during the past 30 days, calculated by combining
responses to questions about individual tobacco products (snuff, chewing
tobacco, pipe tobacco).
Ages 12–17 - CY 2013-2014
Ages 18+ - CY 2013-2014
4. 30-day Use of Source Survey Item: NSDUH Questionnaire: “Think specifically about the
Marijuana
past 30 days, from [DATEFILL] up to and including today. During the
past 30 days, on how many days did you use marijuana or hashish?”
[Response option: Write in a number between 0 and 30.]
Outcome Reported: Percent who reported having used marijuana or
hashish during the past 30 days.
Ages 12–17 - CY 2013-2014
Ages 18+ - CY 2013-2014
5. 30-day Use of Source Survey Item: NSDUH Questionnaire: “Think specifically about the
Illegal Drugs
past 30 days, from [DATEFILL] up to and including today. During the
Other Than
past 30 days, on how many days did you use [any other illegal drug] ‡?”
Marijuana
Outcome Reported: Percent who reported having used illegal drugs other
than marijuana or hashish during the past 30 days, calculated by combining
responses to questions about individual drugs (heroin, cocaine, stimulants,
hallucinogens, inhalants, prescription drugs used without doctors’ orders).
Ages 12–17 - CY 2013-2014
Ages 18+ - CY 2013-2014
†
NSDUH asks separate questions for each tobacco product. The number provided combines responses to all questions about tobacco
products other than cigarettes.
‡
NSDUH asks separate questions for each illegal drug. The number provided combines responses to all questions about illegal drugs other
than marijuana or hashish.
1. 30-day
Alcohol Use

49

SABG TABLE 22– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: REDUCED MORBIDITY ABSTINENCE FROM DRUG USE/ALCOHOL USE
MEASURE: PERCEPTION OF RISK/HARM OF USE
A.
Measure

1. Perception of
Risk From
Alcohol

2. Perception of
Risk From
Cigarettes

3. Perception of
Risk From
Marijuana

B.
Question/Response

C.
Prepopulated
Data

D.
Supplemental
Data, if any

Source Survey Item: NSDUH Questionnaire: “How much do people risk
harming themselves physically and in other ways when they have five or
more drinks of an alcoholic beverage once or twice a week?” [Response
options: No risk, slight risk, moderate risk, great risk]
Outcome Reported: Percent reporting moderate or great risk.
Ages 12–20 - CY 2013-2014
Ages 21+ - CY 2013-2014
Source Survey Item: NSDUH Questionnaire: “How much do people risk
harming themselves physically and in other ways when they smoke one or
more packs of cigarettes per day?” [Response options: No risk, slight risk,
moderate risk, great risk]
Outcome Reported: Percent reporting moderate or great risk.
Ages 12–17 - CY 2013-2014
Ages 18+ - CY 2013-2014
Source Survey Item: NSDUH Questionnaire: “How much do people risk
harming themselves physically and in other ways when they smoke
marijuana once or twice a week?” [Response options: No risk, slight risk,
moderate risk, great risk]
Outcome Reported: Percent reporting moderate or great risk.
Ages 12–17 - CY 2013-2014
Ages 18+ - CY 2013-2014

50

SABG TABLE 23– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: REDUCED MORBIDITY ABSTINENCE FROM DRUG USE/ALCOHOL USE
MEASURE: AGE OF FIRST USE
A.
Measure

B.
Question/Response

C.
Prepopulated
Data

D.
Supplemental
Data, if any

Source Survey Item: NSDUH Questionnaire: “Think about the first time
you had a drink of an alcoholic beverage. How old were you the first time
you had a drink of an alcoholic beverage? Please do not include any time
when you only had a sip or two from a drink.” [Response option: Write in
age at first use.]
Outcome Reported: Average age at first use of alcohol.
Ages 12–20 - CY 2013-2014
Ages 21+ - CY 2013-2014
2. Age at First
Source Survey Item: NSDUH Questionnaire: “How old were you the first
Use of
time you smoked part or all of a cigarette?” [Response option: Write in age
Cigarettes
at first use.]
Outcome Reported: Average age at first use of cigarettes.
Ages 12–17 - CY 2013-2014
Ages 18+ - CY 2013-2014
3. Age at First
Source Survey Item: NSDUH Questionnaire: “How old were you the first
Use of Tobacco time you used [any other tobacco product]†?” [Response option: Write in
Products Other
age at first use.]
Than Cigarettes Outcome Reported: Average age at first use of tobacco products other than
cigarettes.
Ages 12–17 - CY 2013-2014
Ages 18+ CY 2013-2014
4. Age at First
Source Survey Item: NSDUH Questionnaire: “How old were you the first
Use of
time you used marijuana or hashish?” [Response option: Write in age at first
Marijuana or
use.]
Hashish
Outcome Reported: Average age at first use of marijuana or hashish.
Ages 12–17 - CY 2013-2014
Ages 18+ - CY 2013-2014
5. Age at First
Source Survey Item: NSDUH Questionnaire: “How old were you the first
Use of Illegal
time you used [other illegal drugs]‡?” [Response option: Write in age at first
Drugs Other
use.]
Than Marijuana Outcome Reported: Average age at first use of other illegal drugs.
or Hashish
Ages 12–17 - CY 2013-2014
Ages 18+ - CY 2013-2014
†
The question was asked about each tobacco product separately, and the youngest age at first use was taken as the measure.
‡
The question was asked about each drug in this category separately, and the youngest age at first use was taken as the measure.
1. Age at First
Use of Alcohol

51

SABG TABLE 24– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: REDUCED MORBIDITY ABSTINENCE FROM DRUG USE/ALCOHOL USE
MEASURE: PERCEPTION OF DISAPPROVAL/ATTITUDES
A.
Measure

B.
Question/Response

1. Disapproval of
Cigarettes

Source Survey Item: NSDUH Questionnaire: “How do you feel about
someone your age smoking one or more packs of cigarettes a day?”
[Response options: Neither approve nor disapprove, somewhat
disapprove, strongly disapprove]
Outcome Reported: Percent somewhat or strongly disapproving.
Ages 12–17 - CY 2013-2014
Source Survey Item: NSDUH Questionnaire: “How do you think your
close friends would feel about you smoking one or more packs of
cigarettes a day?” [Response options: Neither approve nor disapprove,
somewhat disapprove, strongly disapprove]
Outcome Reported: Percent reporting that their friends would somewhat
or strongly disapprove.
Ages 12–17 - CY 2013-2014
Source Survey Item: NSDUH Questionnaire: “How do you feel about
someone your age trying marijuana or hashish once or twice?” [Response
options: Neither approve nor disapprove, somewhat disapprove, strongly
disapprove]
Outcome Reported: Percent somewhat or strongly disapproving.
Ages 12–17 - CY 2013-2014
Source Survey Item: NSDUH Questionnaire: “How do you feel about
someone your age using marijuana once a month or more?” [Response
options: Neither approve nor disapprove, somewhat disapprove, strongly
disapprove]
Outcome Reported: Percent somewhat or strongly disapproving.
Ages 12–17 - CY 2013-2014
Source Survey Item: NSDUH Questionnaire: “How do you feel about
someone your age having one or two drinks of an alcoholic beverage
nearly every day?” [Response options: Neither approve nor disapprove,
somewhat disapprove, strongly disapprove]
Outcome Reported: Percent somewhat or strongly disapproving.
Ages 12–20 - CY 2013-2014

2. Perception of
Peer Disapproval
of Cigarettes

3. Disapproval of
Using Marijuana
Experimentally

4. Disapproval of
Using Marijuana
Regularly

5. Disapproval of
Alcohol

C.
Prepopulated
Data

D.
Supplemental
Data, if any

52

SABG TABLE 25– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: EMPLOYMENT/EDUCATION
MEASURE: PERCEPTION OF WORKPLACE POLICY
A.
Measure

B.
Question/Response

C.
Prepopulated
Data

Perception of
Workplace
Policy

Source Survey Item: NSDUH Questionnaire: “Would you be more or less likely to
want to work for an employer that tests its employees for drug or alcohol use on a
random basis? Would you say more likely, less likely, or would it make no difference
to you?” [Response options: More likely, less likely, would make no difference]
Outcome Reported: Percent reporting that they would be more likely to work for an
employer conducting random drug and alcohol tests.
Ages 15–17 - CY 2013-2014
Ages 18+ - CY 2013-2014

D.
Supplemen
tal Data, if
any

SABG TABLE 26– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: EMPLOYMENT/EDUCATION
MEASURE: AVERAGE DAILY SCHOOL ATTENDANCE RATE
A.
Measure

Average Daily
School
Attendance
Rate

B.
Source

C.
Prepopulated
Data

D.
Supplemen
tal Data, if
any

Source: National Center for Education Statistics, Common Core of Data: The
National Public Education Finance Survey available for download at
http://nces.ed.gov/ccd/stfis.asp
Measure calculation: Average daily attendance (NCES defined) divided by total
enrollment and multiplied by 100.
CY 2014

SABG TABLE 27 – SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: CRIME AND CRIMINAL JUSTICE
MEASURE: ALCOHOL-RELATED TRAFFIC FATALITIES
A.
Measure

Alcohol-Related
Traffic Fatalities

B.
Source

C.
Prepopulated
Data

D.
Supplemental
Data, if any

Source: National Highway Traffic Safety Administration Fatality
Analysis Reporting System
Measure calculation: The number of alcohol-related traffic fatalities
divided by the total number of traffic fatalities and multiplied by 100.
CY 2014

SABG TABLE 28– SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: CRIME AND CRIMINAL JUSTICE
MEASURE: ALCOHOL- AND DRUG-RELATED ARRESTS
A.
Measure

Alcohol- and
Drug-Related
Arrests

B.
Source

C.
Prepopulated
Data

D.
Supplemental
Data, if any

Source: Federal Bureau of Investigation Uniform Crime Reports
Measure calculation: The number of alcohol- and drug-related arrests
divided by the total number of arrests and multiplied by 100.
CY 2014

53

SABG TABLE 29 – SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: SOCIAL CONNECTEDNESS
MEASURE: FAMILY COMMUNICATIONS AROUND DRUG AND ALCOHOL USE
A.
Measure

B.
Question/Response

1. Family
Communications
Around Drug and
Alcohol Use
(Youth)

2. Family
Communications
Around Drug and
Alcohol Use
(Parents of children
aged 12–17)

C.
Prepopulated
Data

D.
Supplemental
Data, if any

Source Survey Item: NSDUH Questionnaire: “Now think about the
past 12 months, that is, from [DATEFILL] through today. During the
past 12 months, have you talked with at least one of your parents about
the dangers of tobacco, alcohol, or drug use? By parents, we mean
either your biological parents, adoptive parents, stepparents, or adult
guardians, whether or not they live with you.” [Response options: Yes,
No]
Outcome Reported: Percent reporting having talked with a parent.
Ages 12–17 - CY 2013-2014
Source Survey Item: NSDUH Questionnaire: “During the past 12
months, how many times have you talked with your child about the
dangers or problems associated with the use of tobacco, alcohol, or
other drugs?Ӡ [Response options: 0 times, 1 to 2 times, a few times,
many times]
Outcome Reported: Percent of parents reporting that they have talked
to their child.
Ages 18+ - CY 2013-2014

†

NSDUH does not ask this question of all sampled parents. It is a validation question posed to parents of 12- to 17-year-old survey
respondents. Therefore, the responses are not representative of the population of parents in a State. The sample sizes are often too small
for valid reporting.

SABG TABLE 30 – SUBSTANCE ABUSE PREVENTION NOMS DOMAIN: RETENTION
MEASURE: PERCENTAGE OF YOUTH SEEING, READING, WATCHING, OR LISTENING TO A
PREVENTION MESSAGE
Measure

Question/Response

Prepopulated
Data

Supplemental
Data, if any

Source Survey Item: NSDUH Questionnaire: “During the past 12 months,
do you recall [hearing, reading, or watching an advertisement about the
prevention of substance use]†?”
Outcome Reported: Percent reporting having been exposed to prevention
message.
Ages 12–17 - CY 2013-2014
†
This is a summary of four separate NSDUH questions each asking about a specific type of prevention message delivered within a
specific context

Exposure to
Prevention
Messages

54

SABG Tables 31-35 – Reporting Period
Reporting Period - Start and End Dates for Information Reported on SABG Tables 31, 32, 33, 34,
and 35.

The following chart is for collecting information on the reporting periods for the data entered in
Tables 31-35. Please note that the correct reporting period for Tables 31-34 is the Calendar
Year (CY) which coincides with the reporting period for the pre-populated prevention
NOMs in Tables 21-30. We understand that some states have reported on the State Fiscal
Year (SFY) or Federal Fiscal Year (FFY) for these tables in past SABG Reports. If your
state is unable to report on the calendar year, please indicate in this footnote why you are
unable to report on the calendar year and the steps the state intends to take to make
calendar year reporting possible in future years. Note that the correct reporting period for
Table 35 is the SABG compliance period that coincides with the reporting period for
Tables 4, 5a, 5b, 6 and 7.
Rows 1 through 5 each correspond to a single form in the current year's application among the
following five tables: 31, 32, 33, 34 and 35.
Column A: Enter the reporting period start date.
Column B: Enter the reporting period end date.
The date format to be entered in columns A and B should be month/day/year, as follows.
• Month: enter 2 digits (e.g. January = 01; December = 12)
• Day: enter 2 digits (e.g. 1st of the month = 01; 15th of the month = 15)
• Year: enter all 4 digits (e.g. 2012, 2013)
Reporting Period Start and End Dates for Information Reported on
SABG Tables 31, 32, 33, 34 and 35
Please indicate the reporting period (start date and end date totaling 12 months by the State)
for each of the following NOMS. The start date and end date for NOMS 31-35 should be the same.
Tables

A. Reporting Period
Start Date

B. Reporting Period
End Date

1. SABG Table 31
Individual-Based Programs and Strategies –
Number of Persons Served by Age, Gender,
Race, and Ethnicity

mm/dd/yyyy

mm/dd/yyyy

2. SABG Table 32
Population-Based Programs and Strategies –
Number of Persons Served by Age, Gender,
Race, and Ethnicity

mm/dd/yyyy

mm/dd/yyyy

3. SABG Table 33 (Optional)
Number of Persons Served
Intervention

of

mm/dd/yyyy

mm/dd/yyyy

and

mm/dd/yyyy

mm/dd/yyyy

mm/dd/yyyy

mm/dd/yyyy

by

Type

4. SABG Table 34
Number of Evidence-Based Programs
Strategies by Type of Intervention

5. SABG Table 35
Total Number of Evidence-Based Programs and
Total SAPT BG Dollars Spent on EvidenceBased Programs/Strategies

55

General Questions Regarding Prevention NOMS Reporting
Question 1: Describe the data collection system you used to collect the NOMs data (e.g., MDS, DbB, KIT Solutions,
manual process).

Question 2: Describe how your State’s data collection and reporting processes record a participant’s race,
specifically for participants who are more than one race.
Indicate whether the State added those participants to the number for each applicable racial category or whether the
State added all those participants to the More Than One Race subcategory.

SABG Table 31 – SUBSTANCE ABUSE PREVENTION Individual-Based Programs and Strategies—
Number of Persons Served by Age, Gender, Race, and Ethnicity
Category
A. Age
0–4
5–11
12–14
15–17
18–20
21–24
25–44
45–64
65 and Over
Age Not Known
B. Gender
Male
Female
Gender Not Known

Total

C. Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Ethnicity Unknown
D. Race
White
Black or African American
Native Hawaiian/Other Pacific Islander
Asian
American Indian/Alaska Native

56

Form P12a

DO NOT DISTRIBUTE – CLOSE HOLD

More Than One Race (not OMB required)
Race Not Known or Other (not OMB required)

57

SABG Table 32 – SUBSTANCE ABUSE PREVENTION Population-Based Programs and Strategies—
Number of Persons Served by Age, Gender, Race, and Ethnicity
Category

Total

A. Age
0–4
5–11
12–14
15–17
18–20
21–24
25–44
45–64
65 and Over
Age Not Known
B. Gender
Male
Female
Gender Not Known
C. Race
White
Black or African American
Native Hawaiian/Other Pacific Islander
Asian
American Indian/Alaska Native
More Than One Race (not OMB required)
Race Not Known or Other (not OMB required)
D. Ethnicity
Hispanic or Latino
Not Hispanic or Latino
Ethnicity unknown

58

SABG Table 33 (Optional) – SUBSTANCE ABUSE PREVENTION
Number of Persons Served by Type of Intervention
Number of Persons Served by Individual- or Population-Based
Program or Strategy

Intervention Type

A.
Individual-Based
Programs and Strategies

B.
Population-Based Programs
and Strategies

1. Universal Direct
2. Universal Indirect
3. Selective
4. Indicated
5. Total

59

SABG Table 34 – Substance Abuse Prevention
Evidence-Based Programs and Strategies by Type of Intervention
1.

Describe the process the State will use to implement the guidelines included in the above
definition.

2.

Describe how the State collected data on the number of programs and strategies. What is
the source of the data?

SABG Table 34– SUBSTANCE ABUSE PREVENTION
Number of Evidence-Based Programs and Strategies by Type of Intervention
Number of Programs and Strategies by Type of Intervention
A.
Universal
Direct

B.
Universal
Indirect

C.
Universal
Total

D.
Selective

E.
Indicated

F.
Total

1. Number of Evidence-Based
Programs and Strategies Funded
2. Total number of Programs and
Strategies Funded
3. Percent of Evidence-Based
Programs and Strategies

60

SABG Table 35 – Total SUBSTANCE ABUSE PREVENTION Number of Evidence Based
Programs/Strategies and Total SAPT BG Dollars Spent on SUBSTANCE ABUSE PREVENTION
Evidence-Based Programs/Strategies
Total Number of Evidence-Based
Programs/Strategies for IOM Category below:

Total SAPT Block Grant $Dollars Spent on
evidence-based Programs/Strategies

Universal Direct

Total #

$

Universal Indirect

Total #

$

Selective

Total #

$

Indicated

Total #

$

Total EBPs:

Total Dollars Spent: $

61

SABG Table 36: (Optional Worksheet) Program/Strategy Detail for Computing the Total Number of
Evidence-based Programs and Strategies, and for Reporting Total SAPT Block Grant Funds Spent on
substance abuse prevention Evidence-Based Programs and Strategies.
1

2

Program/Strategy
Name
Universal Direct

Total Number of
Evidence-based
Programs and
Strategies by
Intervention

3
Total Costs of
Evidence
based Programs
and Strategies
for each IOM
Category

#

$

4
Total SAPT Block Grant Funds
Spent on Evidence-Based
Programs/Strategies

1.
2.
3.
4.
Subtotal
Universal Indirect
Programs and
Strategies
1.
2.
3.
4.
Subtotal
Selective Programs and
Strategies
1.
2.
3.
4.
Subtotal
Indicated Programs and
Strategies
1.
2.
3.
4.
Subtotal
Total Number of
(EBPs)/Strategies and
cost of these
EBPs/Strategies
Total SAPT Block Grant
substance abuse
prevention Dollars $
Spent on EvidenceBased Programs and
Strategies

$

62