BG\SABG Report

SABG Report.pdf

Community MH Services BG and SAPT BG Application Guidance and Instructions FY 2018-2019

BG\SABG Report

OMB: 0930-0168

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Block Grant Reporting Section

CFDA 93.959
Substance Abuse
Prevention and Treatment
Block Grant
(SABG)

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

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 – Syringe Services Program
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

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.

Section A. Introduction
Section 1942(a) of Title XIX, Part B, Subpart III of the Public Health Service Act (42 U.S.C. § 300x52(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 states1 have implemented the State Plan for the preceding fiscal year.
The purpose of the Substance Abuse Prevention and Treatment Block Grant (SABG) Annual Report
is to provide information to assist the Secretary in making this determination.
States 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) Notice of Award (NoA) subject to CSAT compliance review
(Compliance Award), in the format provided in this guidance. The SABG Annual Report will
address the purposes for which the SABG funds were expended, the SABG sub-recipients, 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 are required to prepare and submit their respective SABG 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 fiscal year
SABG NoA. If a receipt date falls on a weekend or federal holiday, the receipt date for a report will
be the next business day. The following schedule provides specific due dates for the SABG Annual
Reports, MHBG Implementation Reports and the Annual Synar Reports:
Due Dates for SA Only and MHBG/SABG Applications
FY for which the state
is applying for funds
2019

Application
Due
9/1/2018

Plan
Due
Yes

Planning Period

2020

9/1/2019

No*

Applicable FY
2019
2020

7/1/18 – 6/30/19

Receipt Dates for Reports
SABG Annual Report
MHBG Implementation Report
12/01/2018
12/01/2018
12/01/2019
12/01/2019

SABG Report
Due
12/1/2018
Compliance
Year is 2016
12/1/2019
Compliance
Year is 2017

Synar Report
Due
12/31/2018

12/31/2019

Annual Synar Report
12/31/2018
12/31/2019

The term ”state” means each of the several states, the District of Columbia and each of the territories of the United
States. The term “territories of the United States” means each of the Commonwealth of Puerto Rico, Virgin Islands,
American Samoa, Commonwealth of the Northern Marianas Islands, Federated States of Micronesia, Guam,
Republic of the Marshall Islands and the Republic of Palau.

States are required to prepare and submit an annual report comprised of the following sections:
Section B: Annual Update - In this section, states 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 SABG plan covering state fiscal years 2019 and 2020. The report should also include
a brief review of areas that the state identified in that SABG plan as needing improvement and
changes that the state or jurisdiction proposed to achieve the goals established for the priorities.
Section C: State Agency Expenditure Reports - In this section, states must provide information
regarding expenditures for authorized activities and services for substance misuse prevention
prevention, substance use disorder2 (SUD) treatment and recovery. The state must provide a
description of SABG expenditures for authorized activities to prevent substance misuse and treat
SUDs and related services for tuberculosis , and, if it is a “designated State”, a description of SABG
expenditures for early intervention services for regarding the human immunodeficiency virus
(EIS/HIV). In addition, the state must identify the SABG expenditures made available to
intermediaries, administrative service organizations, and community- and faith-based organizations
that received amounts from the SABG to provide authorized activities to prevent and treat SUDs.
Section D: Populations and Services Reports - In this section, states must provide specific
information regarding the number of individuals that were served with SABG funds. In addition,
states should provide specific information regarding the services these individuals received.
Section E: Performance Indicators and Accomplishments - In this section of the report, states 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 misuse prevention, SUD treatment and recovery.

The term “substance use disorder “ means substance-related and addictive disorders as described in the Diagnostic
and Statistical Manual of Mental Disorders , Fifth Edition, Arlington, VA, American Psychiatric Association, 2013.

B. Annual Update
The information states entered into SABG Table 1 in the planning section of the 2018/2019
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 2018/2019 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, MHS):

3. Population(s) (SMI, SED, FEP, PWWDC, PP, PWID (formerly IVDUs), EIS/HIV, 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 2019):
c) Second-year target/outcome measurement (Final – end of SFY 2020):
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:

C. State Agency Expenditure Reports
States are required to provide information regarding SABG and state funds expended for authorized
activities to prevent and treat SUDs and for related public health services, e.g., tuberculosis services
(TB) and, if applicable, early intervention services regarding the human immunodeficiency virus
(EIS/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 principal agency of a state, i.e., single state agency (SSA), 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 SUDs 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; early intervention services regarding the human immunodeficiency
virus (EIS/HIV), if applicable; pursuant to section 1924(b) of Title XIX, Part B, Subpart II of the
PHS Act (42 U.S.C. § 300x-24(b)); and administration pursuant to section 1931(a)(2) of Title XIX,
Part B, Subpart II of the PHS Act (42 U.S.C. § 300x-31(a)(2)). In column A, the applicable federal
fiscal years’ SABG funds expended during the state fiscal year should be included.
SABG Table 3 – Syringe Services Program This table provides a report of SABG expenditures for
elements of syringe services programs carried out by SABG sub-recipients as described in the
guidance disseminated by the Office of HIV/AIDS and Infectious Disease Policy, the Centers for
Disease Control and Prevention, National Center on HIV/AIDS, Viral Hepatitis, STD and TB
Prevention, Division of HIV Prevention and SAMHSA. The authorization to expend federal funds
for elements of a syringe services program is subject to an authorization in the annual appropriations’
bill(s).
SABG Table 4 - SABG State Agency Expenditure Compliance Report This table provides a report of
expenditures for authorized activities to prevent and treat SUDs associated with a SABG Notice of
Award (NoA) for the applicable fiscal year. It covers the two year obligation and expenditure period.
SABG Table 5a- SABG Primary Prevention Expenditures Checklist This table provides a report of
primary prevention expenditures associated with a SABG NoA for the applicable fiscal year. It
covers the two year obligation and expenditure period. Table 5a excludes Expenditures for Systems
Development/Non-Direct Service Activities (formerly known as Resource Development
expenditures).
SABG Table 5b- SABG Primary Prevention Expenditures by IOM Category This table provides a
report of primary prevention expenditures by Institute of Medicine (IOM) categories associated with
a SABG NoA for the applicable fiscal year. It covers the two year obligation and expenditure period.
Table 5b excludes Expenditures for Systems Development/Non-Direct Service Activities (formerly
known as Resource Development expenditures).
SABG Table 5c - SABG Primary Prevention Targeted Priorities This requested table provides a
report of actual state primary prevention priorities and special population categories on which the
state expended primary prevention funds from the SABG NoA for the applicable fiscal year.

SABG Table 6 – Expenditures for System Development/Non-Direct Service Activities This table
provides a report of expenditures from the SABG NoA for system development and non-direct
service activities that were supported by the SABG. NoA for the applicable fiscal year
SABG Table 7 – SABG Statewide Entity Inventory This table provides a report of the SABG subrecipients including community- and faith-based organizations which provided SUD prevention
activities and treatment services, as well as intermediaries/administrative service organizations. Table
7 excludes Expenditures for Systems Development/Non-Direct Service Activities (formerly known
as 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 SSA for authorized
activities to prevent and treat SUDs 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 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 For designated
states, 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
early intervention services regarding the human immunodeficiency virus (EIS/HIV) provided to
individuals at the sites at which such individuals received 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 SABG and/or state funds
pursuant to 42 U.S.C. § 300x-22(b) and 45 CFR § 96.124(c)(3) expended to establish new programs
or expand the capacity of existing programs designed to serve pregnant women and women with
dependent children and the services required pursuant to 45 CFR § 96.124(e) to address the
treatment and recovery needs of such women during the state fiscal year immediately preceding the
federal fiscal year for which the state is applying for funds.

SABG Table 2 - State Agency Expenditure Report
This table provides a report of SABG and state expenditures by the SSA 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 SUDs. 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.)

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

Pregnant Women and Women with
Dependent Children

All Other

Primary Prevention

Tuberculosis Services

Early Intervention Services Regarding the
Human Immunodeficiency Virus
(EIS/HIV)*

7. Administration (excluding program /
provider level administration)

A.
Substance
Abuse Block
Grant

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.)

8. Total
*Only designated states as defined in 42 U.S.C. § 300x-24(b)(2) and 45 CFR § 96.128(b) for the applicable federal fiscal year should enter information in this row. This may include a state
or states that were previously considered “designated states” during any of the thre prior federal fiscal years for which a state was applying for a grant. See EIs/HIV policy change in SABG
Annual Report instructions.

SABG Table 3 – Syringe Services Program

Step 1
Step 2
Step 3

•Request a Determination of Need from the CDC
•Go to : http://www.cdc.gov/hiv/risk/ssps-jurisdictions.html to determine
state eligibility

•Modify the 2016-2017 Plan to expend FFY 2016 and/or FFY 2017* funds and
support an existing SSP or establich a new SSP
•Include proposed protocols, timeline for implementation, and overall budget
•Submit planned expenditures and agency information on Table A listed below

•Obtain State Project Officer Approval
•Collect all SSP information on Table B listed below to be reported in the FFY
2019 SABG report due December 1, 2018.

Table 3A

Syringe Services Program

Report period
From:
To:
State Identifier:
Syringe
Services
Program
(SSP) Agency
Name

Main Address of
SSP

Dollar amount of
SABG funds used for
SSP

SUD Treatment
Provider
Yes or No

Yes

# of locations
(include
any mobile
locations)

Narcan® Provided

Yes

Table 3 SABG - Syringe Services Program
Table 3B

Syringe Services Program

Report period:
From:
To:
State Identifier:

Expenditure
Category

REFERRA
L to testing

Hep C
(Please enter
total number of
individuals
served)

ONSITE
testing

REFERRA
L to testing

STD Testing
(Please enter total
number of individuals
served)

ONSITE
testing

REFERRA
L to
treatment

Treatment for physical
health
(Please enter total
number of individuals
served)
ONSITE
treatment

REFERRA
L to
treatment

Treatment for
substance use
conditions
(Please enter total
number of
individuals served)
ONSITE
treatment

HIV
Testing
(Please enter total
number of individuals
served)
REFERRA
L to testing

# of unique
individuals served

ONSITE
testing

Syringe Services
Program Name

SABG Table 4 - State Agency SABG Expenditure Compliance Report
This table provides a description of SABG expenditures for authorized activities to prevent and treat SUDs. 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 2016 SA Block Grant Award

FY 2017 SA Block Grant Award

State Identifier:
Expenditure Category

Substance Abuse Prevention* and Treatment

Primary Prevention

Early Intervention Services Regarding the Human Immunodeficiency Virus (EIS/HIV)**

Tuberculosis Services

Administration (excluding program / provider level)

Total

* Prevention other than Primary Prevention
** Only designated states as defined in 42 U.S.C. § 300x-24(b)(2) and 45 CFR § 96.128(b) for the applicable federal fiscal year should enter information in this
row. This may include a state or states that were previously considered “designated states” during any of the thre prior federal fiscal years for which a state
was applying for a grant. See EIs/HIV policy change in SABG Annual Report instruction s

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 SABG. 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 CFR § 96.130), a state may not use the SABG 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 CFR § 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 any 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

4. Problem Identification and
Referral

5. Community-Based Processes

6. Environmental

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

Indicated

Unspecified

Universal

Selected

Indicated

Unspecified

Universal

Selected

Indicated

Universal

7. Section 1926-Tobacco

8. Other

10. Total

Selected

Indicated

Unspecified

Universal

Selected

Indicated

Universal

Selected

Indicated

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

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 SUD 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
$
$
$
$
$

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 2016 SABG NoA. 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

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

Plan Table #6
Proposed Categories for Expenditures for System Development/Non-Direct-Service Activities
Expenditures in the following categories of activities may involve the time of State or sub-State personnel, or may be funded through
contracts, grants, or agreements with other entities. Expenditures may come from the administrative funds and/or program funds (but may not
include the HIV set-aside funds). Please utilize the following categories to describe the types of expenditures your state supports with BG
funds, and if the preponderance of the activity fits within a category.
We understand that a particular activity may cross categories, but try to identify the primary purpose or goal of the activity. For
example, a state may utilize BG funds to train personnel to conduct fidelity assessments of evidence-based practices. While this could
fall under either training/education and/or quality assurance/improvement – the primary purpose is to assure the implementation of
EBPs, so that expenditure would most likely be captured under quality assurance/improvement.
Information systems – This includes collecting and analyzing treatment data as well as prevention data under the SABG in order to monitor
performance and outcomes. Costs for electronic health records and other health information technology also fall under this category.
Infrastructure Support – This includes activities that provide the infrastructure to support services but for which there are no individual
services delivered. Examples include the development and maintenance of a crisis-response capacity, including hotlines, mobile crisis teams,
web-based check-in groups (for medication, treatment, re-entry follow-up), drop-in centers, and respite services.
Partnerships, community outreach, and needs assessment – This includes state, regional, and local personnel salaries prorated for time and
materials to support planning meetings, information collection, analysis, and travel. It also includes the support for partnerships across state
and local agencies, and tribal governments. Community/network development activities, such as marketing, communication, and public
education, and including the planning and coordination of services, fall into this category, as do needs-assessment projects to identify the
scope and magnitude of the problem, resources available, gaps in services, and strategies to close those gaps.
Planning Council Activities – This includes those supports for the performance of a Mental Health Planning Council under the MHBG, a
combined Behavioral Health Planning Council, or (OPTIONAL) Advisory Council for the SABG.
Quality assurance and improvement – This includes activities to improve the overall quality of services, including those activities to assure
conformity to acceptable professional standards, adaptation and review of implementation of evidence-based practices, identification of areas
of technical assistance related to quality outcomes, including feedback. Administrative agency contracts to monitor service-provider quality
fall into this category, as do independent peer-review activities.
Research and evaluation – This includes performance measurement, evaluation, and research, such as services research and demonstration
projects to test feasibility and effectiveness of a new approach as well as the dissemination of such information.

Training and education– This includes skill development and continuing education for personnel employed in local programs as well as
partnering agencies, as long as the training relates to either substance use disorder service delivery (prevention, treatment and recovery) for
SABG and services to adults with SMI or children with SED for MHBG. Typical costs include course fees, tuition, and expense
reimbursements to employees, trainer(s) and support staff salaries, and certification expenditures.

Non-Direct-Services/System Development
SABG/MHBG Table 6
State Identifier:
Report Period- From:

To:

Activity

A. MHBG

B. SABG
Treatment

C. SABG
Prevention

D. SABG Combined *

Information Systems

Infrastructure Support

Partnerships, community outreach, and needs assessment

Planning Council Activities (MHBG required, SABG optional)

Quality assurance and improvement

Research and Evaluation

Training and Education

8. Total

Please enter the total amount of the block grant expended for each activity.
*Combined refers to funds both treatment and prevention portions of the SABG for overarching activities.

SABG Table 7 – State Entity Inventory
This table provides a report of the sub-recipients of SABG funds including community- and faith-based organizations which provided SUD
prevention activities and treatment services, as well as intermediaries/administrative service organizations. Table 7 excludes system
development/non-direct service 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

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

$
$
$

Total

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

F
Syringe Services
Program

$
$
$

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 SUD prevention and treatment as required by:
a. 42 U.S.C. § 300x-30 and 45 CFR § 96.124(f)(4)
(b) the base and Maintenance of Effort (MOE) for tuberculosis services as required by:
a. 42 U.S.C. § 300x-24(d); 45 CFR § 96.127(c); and 45 CFR § 96 122(f)(5)(ii)(B));
(c) (for designated states only) the base and MOE for early intervention services regarding the human immunodeficiency virus
(EIS/HIV) as required by:
a. 42 U.S.C.§ 300x-24(d), 45 CFR § 96 122(f)(5)(ii)(C)) and 45 CFR § 96.128(f); and
(d) the base and, for 1994 and subsequent fiscal years, report the federal and state expenditures for services to pregnant women
and women with dependent children as required by:
a. 42 U.S.C. § 300x-22(b)(1) and 45 CFR § 96 122(f)(5)(ii)(A))

SABG Table 8a - Maintenance of Effort for State Expenditures for SUD 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 FY 2017 SABG Report. For the FY 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 2016
(1)
SFY 2017
(2)
SFY 2018
(3)

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

SFY 2016
SFY 2017
SFY 2018

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 as described in 42 U.S.C. § 300x-30(b) 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? ___/___/_____
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 SUD
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)

(B)

(A x B)
(C)

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

SFY 2018* (3)

*Date given is for the 2019 SABG Report. For the 2020 SABG Report, increase the year by one.)

SABG Table 8c -Statewide Non-Federal Expenditures for Early Intervention Services Regarding the Human Immunodeficiency Virus (EIS/HIV) to
Individuals in Substance Use Disorder Treatment
This Maintenance of Effort table is for a “designated State” to report all statewide, non-federal funds expended on early intervention services
regarding the human immunodeficiency virus (EIS/HIV) to individuals in SUD 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.
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 Early Intervention Services Regarding the
Human Immunodeficiency Virus (EIS/HIV)**
to Individuals in Substance Use Disorder Treatment
SABG Table 8c
State Identifier:
BASE
Period

Total of All State Funds
Spent on Early
Intervention Services
Regarding the Human
Immunodeficiency Virus
(EIS/HIV)

(A)
(1)

SFY ____

(2)

SFY____

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

MAINTENANCE

Period

Total of All State Funds Spent on Early Intervention
Services for Regarding the Human Immunodeficiency Virus
(EIS/HIV)
(A)

(3)

SFY 2018*

*Date given is for the 2019 SABG Report. For the 2020 SABG Report, increase the year by one.)

** Only designated states as defined in 42 U.S.C. § 300x-24(b)(2) and 45 CFR § 96.128(b) for the applicable federal fiscal year should enter information in this
row. This may include a state or states that were previously considered “designated states” during any of the three prior federal fiscal years for which a state
was applying for a grant. See EIs/HIV policy change in SABG Annual Report instruction s

SABG Table 8d - Expenditures for Services to Pregnant Women and Women with Dependent Children
This 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 FY 2017 SABG Report. For the FY 2018 SABG Report, increase each year (other
than the base year) by one.
G 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
2016
2017
2018

To:
Total Women’s Base

Total Expenditures

(A)

(B)

D. Populations and Services Report
States are required to provide information regarding individuals that are served by the SSA 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 (42 U.S.C. § 300x-29) 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
Behavioral Health Services Information System (BHSIS), formerly known as 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 are to provide this information on all
programs by age, gender, and race/ethnicity. States are to report whether the values reported come
from a client-based system(s) with unique client identifiers.
SABG Table 12 – SABG Designated States and Early Intervention Services Regarding the Human
Immunodeficiency Virus. This table requires designated states as defined in section 1924(b)(2) of
Title XIX, Part B, Subpart II of the PHS Act (42 U.S.C. § 300x-24(b)(2)), to provide information on
Early Intervention Services Regarding the Human Immunodeficiency Virus (EIS/HIV) 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 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 CFR Part 54) during the state
fiscal year immediately preceding the federal fiscal year for which the state is applying for funds.
Each section of this table requires that the state respond appropriately to identify the manner in which
they have complied with the requirements related to authorizing legislation and implementing
regulation. States should report on the number of clients referred, due to religious objection, from
faith and community-based programs to appropriate alternative providers. If no alternate referrals
were made, enter zero.

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 (42 U.S.C.§ 300x29) 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

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 Detoxification

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

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
Are the values reported in
this table generated from a
client based system with
unique client identifiers?

Yes
No

J. Hispanic
or Latino

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

To::
Early Intervention Services Regarding the Human Immunodeficiency Virus (EIS/HIV)

1. Number of EIS/HIV projects among SABG sub-recipients in the
state:
2. Total number of individuals tested through SABG sub-recipient
EIS/HIV projects:

Statewide:_____

3. Total number of HIV tests conducted with SABG EIS/HIV 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 – Required
Under Charitable Choice Provisions; Final Rule (42 CFR Part 54), 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 Behavioral Health Treatment 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. If no
alternative referrals were made, enter zero.
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 SUD treatment service systems 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 Recovery This table seeks to measure the change in
clients’ social support of 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 20 Reduced Morbidity –Abstinence from Drug Use/Alcohol Use; Measure: 30 Day Use.
This table seeks information regarding 30 day use of alcohol, tobacco and other drugs.
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.
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.
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 SABG Funds Spent
on Evidence-Based Programs/ Strategies.

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)

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 □

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

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

Admission
Clients
(T1)

Discharge
Clients
(T2)

State Description of Stability in Housing Data Collection (SABG Table 15)
STATE
CONFORMANCE TO
INTERIM STANDARD

State Description of Stability in Housing 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 the 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.

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

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

Admission
Clients
(T1)

Discharge
Clients
(T2)

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.

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.

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)

Admission
Clients
(T1)

Discharge
Clients
(T2)

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.

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
*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)

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.

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
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

Admission
Clients
(T1)

Discharge
Clients
(T2)

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.

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

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

Average
(Mean)

Median
(Median)

Interquartile Range

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) 2016
(note that pre-populated NOMs from the National Survey on Drug Use and Health (NSDUH)
reflect pooled data from CYs 2015-2016. For substance abuse prevention NOMs Table 26, the
compliance year is School Year 2015.
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
53

• 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 on those measures, but will be
encouraged to provide substitute data in Column D.

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 letter A, Pre-populated
data.
Column D: Approved Substitute Data – Grantees for which there are no NSDUH, FARS,
UCR and/or NCES data will be able to voluntarily enter data for the items in this column.
Substitute data is not allowed for grantees with pre-populated data.

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 2015-2016
Ages 21+ - CY 2015-2016
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 2015-2016
Ages 18+ - CY 2015-2016
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 (cigars, smokeless
tobacco, pipe tobacco).
Ages 12–17 - CY 2015-2016
Ages 18+ - CY 2015-2016
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 2015-2016
Ages 18+ - CY 2015-2016
5. 30-day Use of Source Survey Item: NSDUH Questionnaire: “Think specifically about the
Illicit 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,
hallucinogens, inhalants, methamphetamine, and misuse of prescription
drugs).
Ages 12–17 - CY 2015-2016
Ages 18+ - CY 2015-2016
†
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

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

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 2015-2016
Ages 21+ - CY 2015-2016
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 2015-2016
Ages 18+ - CY 2015-2016
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 2015-2016
Ages 18+ - CY 2015-2016

C.
Prepopulated
Data

D.
Supplemental
Data, if any

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 2015-2016
Ages 21+ - CY 2015-2016
2. Age at First
Source Survey Item: NSDUH Questionnaire: “How old were you the
Use of Cigarettes
first time you smoked part or all of a cigarette?” [Response option: Write
in age at first use.]
Outcome Reported: Average age at first use of cigarettes.
Ages 12–17 - CY 2015-2016
Ages 18+ - CY 2015-2016
3. Age at First
Source Survey Item: NSDUH Questionnaire: “How old were you the
Use of Tobacco
first time you used [any other tobacco product]†?” [Response option:
Products Other
Write in age at first use.]
Than Cigarettes
Outcome Reported: Average age at first use of tobacco products other
than cigarettes.
Ages 12–17 - CY 2015-2016
Ages 18+ CY 2015-2016
4. Age at First
Source Survey Item: NSDUH Questionnaire: “How old were you the
Use of Marijuana first time you used marijuana or hashish?” [Response option: Write in age
or Hashish
at first use.]
Outcome Reported: Average age at first use of marijuana or hashish.
Ages 12–17 - CY 2015-2016
Ages 18+ - CY 2015-2016
5. Age at First
Source Survey Item: NSDUH Questionnaire: “How old were you the
Use of Heroin
first time you used heroin?” [Response option: Write in age at first use.]
Outcome Reported: Average age at first use of heroin.
Ages 12–17 - CY 2015-2016
Ages 18+ - CY 2015-2016
6. Age at First
Source Survey Item: NSDUH Questionnaire: “How old were you the
Misuse of
first time you used [specific pain reliever]‡ in a way a doctor did not
Prescription Pain
direct you to use it?” [Response option: Write in age at first use.]
Relievers Among Outcome Reported: Average age at first misuse of prescription pain
Past Year Initiates relievers among those who first misused prescription pain relievers in the
last 12 months.
Ages 12–17 - CY 2015-2016
Ages 18+ - CY 2015-2016
†
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

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 2015-2016
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 2015-2016
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 2015-2016
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 2015-2016
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 2015-2016

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

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 2015-2016
Ages 18+ - CY 2015-2016

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 2015

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 2016

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

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 2016

C.
Prepopulated
Data

D.
Supplemental
Data, if any

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 2015-2016
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?”† [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 2015-2016

†

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 2015-2016
†
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

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
for each of the following NOMS.
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

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

mm/dd/yyyy

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

mm/dd/yyyy

and

mm/dd/yyyy

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 SABG Dollars Spent on Evidence-Based
Programs/Strategies

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
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

Total

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

SABG Table 32 – SUBSTANCE ABUSE PREVENTION Population-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
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

Total

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

A.
Individual-Based
Programs and Strategies

B.
Population-Based Programs
and Strategies

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

Definition of Evidence-Based Programs and Strategies: The guidance document for the
Strategic Prevention Framework State Incentive Grant, Identifying and Selection Evidence-based
Interventions, provides the following definition for evidence-based programs:
 Inclusion in a Federal List or Registry of evidence-based interventions


Being Reported (with positive effects) in a peer-reviewed journal



Documentation of effectiveness based on the following guidelines:
o

Guideline 1: The intervention is based on a theory of change that is documented
in a clear logic or conceptual model; and

Guideline 2: The intervention is similar in content and structure to interventions
that appear in registries and/or the peer-reviewed literature; and

Guideline 3: The intervention is supported by documentation that it has been
effectively implemented in the past, and multiple times, in a manner attentive to
Identifying and Selecting Evidence-Based Interventions scientific standards of
evidence and with results that show a consistent pattern of credible and positive
effects; and

Guideline 4: The intervention is reviewed and deemed appropriate by a panel of
informed prevention experts that includes: well-qualified prevention researchers
who are experienced in evaluating prevention interventions similar to those under
review; local prevention practitioners; and key community leaders as appropriate,
e.g., officials from law enforcement and education sectors or elders within
indigenous cultures.

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

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
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

B.
Universal
Indirect

C.
Universal
Total

D.
Selective

E.
Indicated

F.
Total

SABG Table 35 – Total SUBSTANCE ABUSE PREVENTION Number of Evidence Based
Programs/Strategies and Total SABG Dollars Spent on SUBSTANCE ABUSE PREVENTION EvidenceBased 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: $

File Type	application/pdf
File Title	Block Grant Reporing Section: CFDA 93.959 Substance Abuse Prevention and Treatment Block Grant (SABG)
Subject	SAMHSA, substance abuse, mental health, prevention, treatment, block grant, SABG
Author	SAMHSA
File Modified	2017-03-21
File Created	2017-02-16