Form BG\FY 2018-2019 Bl BG\FY 2018-2019 Bl BG\FY 2018-2019 Block Grant Application

FFY 2018-2019 Block Grant
Application
Community Mental Health Services Block Grant
(MHBG)
Plan and Report
Substance Abuse Prevention and Treatment Block
Grant (SABG)
Plan and Report

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

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Table of Contents
FFY2018-2019 Block Grant Application .................................................................................................... 1
I. INTRODUCTION ................................................................................................................................... 1
A. Background ............................................................................................................................................ 1
1.

Leading Change 2.0 – SAMHSA’s Six Strategic Initiatives ........................................................... 2

B. Impact on State Authorities and Systems .............................................................................................. 4
C. Block Grant Programs’ Purposes ........................................................................................................ 11
II. SUBMISSION OF APPLICATION AND PLAN TIMEFRAMES .................................................... 12
III. BEHAVIORAL HEALTH ASSESSMENT AND PLAN .................................................................. 14
Quality and Data Collection Readiness .............................................................................................. 14
A.

Framework for Planning—Mental Health and Substance Use Prevention and Treatment ........... 15

B.

Planning Steps ............................................................................................................................... 19
Planning Tables .................................................................................................................................. 24

C.

Environmental Factors and Plan .................................................................................................... 37

1.

The Health Care System, Parity and Integration - Question 1 and 2 are Required ....................... 37

2.

Health Disparities - Requested ...................................................................................................... 42

3.

Innovation in Purchasing Decisions - requested ............................................................................ 45

4.

Evidence-Based Practices for Early Interventions to Address Early Serious Mental Illness
(ESMI)-10 percent set aside - Required MHBG ........................................................................... 48

5.

Person Centered Planning (PCP) –Required (MHBG) ................................................................. 50

6. Self-Direction - Requested .................................................................................................................. 51
7. Program Integrity - Required ............................................................................................................... 53
8. Tribes - Requested ............................................................................................................................... 55
9. Primary Prevention-required (SABG only) ......................................................................................... 56
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10. Statutory Criterion for MHBG (Required MHBG) ........................................................................... 64
11. Substance Use Disorder Treatment - Required SABG ....................................................................... 67
12. Quality Improvement Plan- requested ................................................................................................ 77
13.

Trauma -requested ......................................................................................................................... 77

14.

Criminal and Juvenile Justice - Requested .................................................................................... 79

15.

Medication Assisted Treatment - Requested ................................................................................. 80

16.

Crisis Services - Requested ........................................................................................................... 82

17.

Recovery - Required ...................................................................................................................... 83

18.

Community Living and the Implementation of Olmstead- requested ........................................... 86

19.

Children and Adolescents Behavioral Health Services –required MHBG, requested SABG ....... 87

20.

Suicide Prevention – (Required MHBG) ...................................................................................... 91

21.

Support of State Partners - Required MHBG ................................................................................ 92

22.

State Behavioral Health Planning/Advisory Council and Input on the Mental Health/Substance
Abuse Block Grant Application-required MHBG ......................................................................... 94

23. Public Comment on the State Plan- required..................................................................................... 98
Acronyms .................................................................................................................................................. 99
Resources ................................................................................................................................................ 103

1. Required Forms
a. Face Page—Community Mental Health Services Block Grant
b. Face Page—Substance Abuse Prevention and Treatment Block Grant
c. Funding Agreements/Certifications—Community Mental Health Services Block Grant
d. Funding Agreements/Certifications—Substance Abuse Prevention and Treatment
Block Grant
e. Assurances

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FFY2018-2019 Block Grant Application
I. INTRODUCTION
This is an application for SAMHSA’s Community Mental Health Services Block Grant (MHBG) and
Substance Abuse Prevention and Treatment Block Grant (SABG) as authorized by sections 1911-1920
of Title XIX, Part B, Subpart I of the Public Health Service Act (42 U.S.CF.§§ 300x-300x-9) and
sections 1921-1935 of Title XIX, Part B, Subpart II of the Public Health Service Act (42 U.S.C.§ 300x21-35), respectively, and sections 1941-1956 of Title XIX, Part B, Subpart III of the Public Health
Service Act (42 U.S.C.§§ 300x-51-66). This block grant application includes four major parts:
introduction; submission of application and plan timeframes; behavioral health assessment and plan;
and report requirements. These sections include discussions and planning around the following policy
topics: health care system, parity and integration; health disparities; innovations in purchasing
decisions; evidence-based practices for early intervention (e.g., serious mental illness (SMI)); person
centered planning and self-direction; program integrity; tribes; primary substance use disorder
prevention, statutory criteria for MHBG; substance use disorder treatment; quality improvement;
trauma; criminal and juvenile justice; medication-assisted treatment; crisis services; recovery;
community living and Olmstead; children and adolescents behavioral health services; suicide
prevention; support of state partners; state behavioral health planning/advisory council; and public
comment .
A. Background
The Substance Abuse and Mental Health Services Administration (SAMHSA) oversees two major block
grants: the Substance Abuse Prevention and Treatment Block Grant (SABG) and the Community
Mental Health Services Block Grant (MHBG). These block grants give states 1 maximum flexibility to
address the unique behavioral health2 needs of their populations. The MHBG and SABG differ in a
number of their practices (e.g., targeted populations) and statutory authorities (e.g., method of
calculating maintenance of effort (MOE), stakeholder input requirements for planning, set-asides for
specific populations or programs, etc.).3 As a result, information on the services and clients supported
by block grant funds has varied by block grant and by state.
SAMHSA believes it is vital to collect, report, and analyze data at the state and federal levels to ensure
the nation’s behavioral health system is providing the highest quality and most cost effective treatment
and other services. State block grant expenditures should be based on the best possible evidence and
1

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.
2

The term “behavioral health” in this document refers to a state of mental/emotional being and/or choices and actions that affect wellness.
Behavioral health problems include substance abuse or misuse, alcohol and drug addiction, serious psychological distress, suicide, and
mental and substance use disorders. This includes a range of problems from unhealthy stress to diagnosable and treatable diseases like
Serious Mental Illnesses (SMIs) and substance use disorders (SUDs), which are often chronic in nature but that people can and do recover
from. The term is also used to describe the service systems encompassing the promotion of emotional health; the prevention of mental and
substance use disorders; substance use and related problems; treatments and services for mental and substance use disorders; and recovery
support.
In addition to statutory authority, SABG is detailed by comprehensive regulation. http://www.samhsa.gov/grants/blockgrants/laws-regulations

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program quality and outcomes should be carefully tracked. Ultimately, such data will lead to
improvements as science and circumstances change.

Better alignment of the MHBG and SABG applications will help block grant recipients improve data
collection and coordination between programs. In fiscal year (FFY) 2011, SAMHSA redesigned the FFY
2012-2013 MHBG and SABG applications to better align with the current federal/state environments
and related policy initiatives, including the Mental Health Parity and Addiction Equity Act (MHPAEA),
and the Tribal Law and Order Act (TLOA). The new design offered states the opportunity to complete a
combined application for mental and substance use disorder4 (M/SUD) services, submit a biennial
versus an annual plan5,6 and provide information regarding their efforts to respond to various federal
and state initiatives. The new design also reflects the increasing trend among states to integrate their
mental health, substance use disorder prevention, SUD treatment, and recovery administration.
Almost two-thirds of the states took advantage of this streamlined application during FFY 2016-2017
application process and submitted combined plans for M/SUD services. Nearly all the states provided
specific information requested by SAMHSA regarding strategies to respond to a variety of areas
including primary care and behavioral health integration, recovery support services, and parity
implementation.
The FFY 2018-2019 Block Grant Application furthers SAMHSA’s efforts to have states use and report
the opportunities offered under various federal initiatives. The FFY 2018-2019 Block Grant Application
allows states to submit an application for both MHBG and SABG funds and requires a biennial plan for
the MHBG while allowing a biennial plan for the SABG. This application also reflects the health care
system’s strong emphasis on coordinated and integrated care along with the need to improve services
for persons with mental and substance use disorders.
1. Leading Change 2.0 – SAMHSA’s Six Strategic Initiatives
SAMHSA has updated and streamlined its strategic plan to align with the evolving needs of the
behavioral health field, individuals and families with behavioral health conditions, and the changing
fiscal environment. Issued in late FFY 2014, Leading Change 2.0: Advancing the Behavioral Health of
the Nation 2015 – 2018, reflects SAMHSA’s programmatic priorities and policy drivers, including the
new HHS strategic plan.
Behavioral Health is an essential part of health service systems and effective community-wide strategies
that improve health status and lower costs for families, businesses, and governments. Through practice
improvement in the delivery and financing of prevention, treatment, and recovery support services,
SAMHSA and its partners can advance behavioral health and promote the nation’s health. In order to
continue to support this goal, SAMHSA emphasizes an updated set of Strategic Initiatives (SI) to focus
its work on improving lives and capitalizing on emerging opportunities.
4

The term “substance use disorder” means substance-related and addictive disorder as described in the Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition, Arlington, VA, American Psychiatric Association.
5

State Plan for Comprehensive Community Mental Health Services for Certain Individuals (Sec. 1912 of Title XIX, Part B, Subpart I of the
Public Health Service (PHS) Act (42 USC § 300x-2)
6
State Plan (Sec. 1932(b) of Title XIX, Part B, Subpart II of the Public Health Service (PHS) Act (42 USC § 300x- 32(b))

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These include:
1. Prevention of Substance Abuse and Mental Illness: Focuses on substance misuse prevention,
SMI, and severe emotional disturbance (SED)7 by maximizing opportunities to create
environments where individuals, families, communities, and systems are motivated and
empowered to manage their overall emotional, behavioral, and physical health. This SI includes a
focus on several populations of high risk, including college students and transition-age youth,
especially those at risk of first episodes of mental illness or substance misuse; American
Indian/Alaska Natives; ethnic minorities experiencing health and behavioral health disparities;
military families; and lesbian, gay, bisexual, transgender and questioning (LGBTQ) individuals.
2. Health Care and Health Systems Integration: Focuses on integration in health care including
systems of particular importance for persons with behavioral health needs such as community
health promotion; health care delivery; specialty prevention; treatment and recovery; and
community living needs. Integration efforts seek to increase access to appropriate high-quality
prevention, treatment, recovery and wellness services and supports; reduce disparities between the
availability of services for persons with mental illness (including SMI/SED) and substance use
disorders compared with the availability of services for other medical conditions; and support
coordinated care and services across systems.
3. Trauma and Justice: Focuses on trauma and justice by integrating a trauma-informed approach
throughout health, behavioral health, human services, and related systems to reduce the harmful
effects of trauma and violence on individuals, families, and communities. Activities under this SI
include integrating trauma informed approaches across service sectors; assisting communities in
the preparation for, response to, and recovery from traumatic events that include disasters; and
understanding the effects of community trauma. This SI also supports the use of innovative
strategies to reduce the involvement of individuals with trauma and behavioral health issues in the
criminal and juvenile justice systems including diversion practices; strategic links with
community based providers and correctional health; and effective reentry.
4. Recovery Support: Promotes partnering with people in recovery from mental and substance use
disorders and their family members to guide the behavioral health systems and promote
individual, program, and system-level approaches that foster health and resilience (including
helping individuals with behavioral health needs be well, manage symptoms, and achieve and
maintain abstinence); increase housing to support recovery; reduce barriers to employment,
education, and other life goals; and secure necessary social supports in their chosen community.
5. Health Information Technology: Ensures that the behavioral health system – including states,
7

For purposes of block grant planning and reporting, SAMHSA has clarified the definitions of SED and SMI, which were first, identified in
the 1993 Federal Register them (May 10, 1993; 58 FR 29422-29425). States may have additional elements that are included in their specific
definitions, but the following provides a common baseline definition. Children with SED refers to persons from birth to age 18 and adults
with SMI refers to persons age 18 and over; (1) who currently meets or at any time during the past year has met criteria for a mental disorder
– including within developmental and cultural contexts – as specified within a recognized diagnostic classification system (e.g., most recent
editions of DSM, ICD, etc.), and (2) who displays functional impairment, as determined by a standardized measure, which impedes progress
towards recovery and substantially interferes with or limits the person’s role or functioning in family, school, employment, relationships, or
community activities.

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community providers, patients, peers, and prevention specialists – fully participates with the
general healthcare delivery system in the adoption of health information technology (Health IT).
This includes interoperable electronic health records (EHR) and the use of other electronic
training, assessment, treatment, monitoring, and recovery support tools, to ensure high-quality
integrated health care, appropriate specialty care, improved patient/consumer engagement, and
effective prevention and wellness strategies.
6. Workforce Development: Supports active strategies to strengthen and expand behavioral health
workforce. Through technical assistance, training, and focused programs, the initiative will
promote an integrated, aligned, competent workforce that enhances the availability of substance
misuse prevention, M/SUD treatment, and recovery services; strengthens the capabilities of
behavioral health professionals; and promotes the infrastructure of health systems to deliver
competent, organized behavioral health services. This initiative will continually monitor and
assess the needs of peers, communities, and health professionals in meeting behavioral health
needs in America’s transformed health promotion and health care delivery systems.

B. Impact on State Authorities and Systems
SAMHSA seeks to ensure that State Mental Health Authorities (SMHAs) and Single State Agencies
(SSAs) are prepared to address the priorities discussed throughout this document. By addressing these
environmental factors, SMHAs and SSAs will enhance their ability to decrease the prevalence and
impact mental and substance use disorders and/or improve the health of individuals with mental illness
and addictions, improve how they experience care, and reduce costs. The FFY 2018-2019 Block Grant
application incorporates several key assumptions:
States are strategic in their efforts to purchase services.
The continued advancement of evidenced-based approaches coupled with the focus on quality and
outcomes of care require states to rethink what services they purchase as well as how those services are
purchased. Value-based purchasing contracts are rapidly replacing both grant-based and fee-for-service
as a means of procuring prevention, treatment, and recovery support services. Although access to
Medicaid and private insurance has increased, certain gaps in coverage remain for specific populations
and services8. SMHAs and SSAs need to continue to identify which populations and services are
covered by various coverage options available through the Marketplaces, Medicaid and other payers.
Secondly, within the different insurance packages, states have to consider the extent to which specific
mental or substance use disorder (M/SUD) services will remain uncovered. To identify gaps in the
continuum of services, SMHAs and SSAs will need to determine what specific M/SUD services they
should cover in addition to or above what is covered by insurers and other payers. States will continue
to expand their efforts to identify individuals in their systems that may qualify, but are not currently
enrolled in the Children’s Health Insurance Plan (CHIP), Medicaid, and Medicare programs.
Accordingly, states may want to look at outreach opportunities to enroll those qualified for these
programs, as well as Qualified Health Plans (QHPs) offered through Health Insurance Marketplaces or
other commercial insurance plans.
8

Census Bureau American Community Survey statistics http://www.census.gov/newsroom/press-releases/2016/cb16-159.html

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The block grant authorizing legislation and implementing regulations prohibit the provision of financial
assistance to any entity other than a public or nonprofit entity and require that the funding be used only
for authorized activities.9 In response to the issue raised in several states of the impact of high
deductibles on access to services, SAMHSA has released guidance to the states on these issues.
SAMHSA Guidance on the use of block grant funding for co-pays, deductibles, and premiums can be
found at http://www.samhsa.gov/sites/default/files/grants/guidance-for-block-grant-funds-for-costsharing-assistance-for-private-health-insurance.pdf. States that choose to do this will need to develop
specific policies and procedures for ensuring compliance with this guidance.
States leverage their block grant funding and strive to diversify funding sources.
When developing strategies for purchasing services, SMHAs and SSAs should identify other state and
federal sources available to purchase services. States should assist providers in the development of
better financial strategies that will allow providers to be less dependent on SMHA and SSA funding
only. Funding available from the Centers for Medicare & Medicaid Services (CMS), such as CHIP,
Medicaid, and Medicare may play an important role in the states’ financial strategy. There are also
national demonstration projects and programs (e.g., Health Homes, Clinical Practice Transformation,
Innovation Accelerator Program, State Innovation Models, Comprehensive Community Behavioral
Health Centers, and Financial Alignment Initiative for Medicare-Medicaid Enrollees) that support
efforts to provide behavioral health services. In addition, behavioral health services supported through
the Health Resources and Services Administration (HRSA) must be considered as states develop these
strategies. For example, HRSA has significantly expanded access to health and behavioral health
services through its Health Center Program. HRSA has also made available funding and other
opportunities to increase and enhance the quality of the behavioral health workforce (e.g., National
Health Service Corps, training grants, etc.). Both TRICARE and the Department of Veterans’ Affairs
(VA) have enhanced their behavioral health services as well. This means that SMHAs and SSAs (as
well as public health authorities responsible for prevention) will need to engage and collaborate with
these partners at the federal, state and community levels. Persons eligible for such services should be
assisted in accessing these services as appropriate.
States think more broadly about their impact on special populations that they have historically served
through federal block grants and other funding.
In addition to populations currently targeted for the block grants, other populations have evolving needs
that may be addressed. These populations include military families, youth who need substance use
disorder services, individuals who experience trauma, increased numbers of individuals diverted or
released from correctional facilities, diverse racial and ethnic minority groups, American Indians and
Alaska Natives, and LGBT individuals.
The context of service delivery has also significantly changed. Services should be delivered in a manner
that promotes recovery and resiliency. Individuals who have lived experiences with M/SUD are playing
an increasingly important role in the delivery of recovery-oriented systems of care. Services should take
into account culturally specific services for racial and ethnic minorities. Services should also address
the unique needs of tribal populations and the role of tribal governments in planning and delivering
services.
9

http://www.samhsa.gov/grants/block-grants/laws-regulations

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The use of technologies may support better access to services, especially those more likely to be
comfortable with these new technologies. Advances in technology have changed significantly since
SAMHSA’s inception in 1992. Technology is playing a growing role in how individuals learn about,
receive, and experience their health care services. Interactive Communication Technologies (ICT) are
being used more frequently to deliver various health care and recovery support services by providers and
to report health information and outcomes by individuals.
States continue to design and develop collaborative plans for health information systems. Health care
payers will seek to promote electronic health records (EHR) and interoperable health information
technology (HIT) systems that allow for the effective exchange and use of health data.
The Health Information Technology for Economic and Clinical Health (HITECH) Act place strong
emphasis on the widespread adoption and implementation of EHR technology. Accordingly, all
SAMHSA grantees that provide services to individuals are encouraged to demonstrate ongoing clinical
use of a certified EHR system. A certified EHR is an electronic health record system that has been
tested and certified by an approved Office of the National Coordinator (ONC) certifying body.
Providers of M/SUD services should adopt HIT and systems that meet the standards and certifications
required for interoperable health information technology as issued by the Office of the National
Coordinator for Health Information Technology (ONC)[1]. In addition to meeting common standards
and certification, these systems should support the privacy and security of patient information across all
HIT technologies. Such systems should be used to collect information on provider characteristics, client
enrollment, demographics, and treatment. Current laws will require these systems to comply with
national standards such as national provider numbers, International Classification of Diseases (ICD-10),
Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT), normalized names for clinical
drugs (RxNorm), Logical Observation Identifiers Names and Codes (LOINC), and Current Procedural
Terminology (CPT)/Healthcare Procedure Coding System (HCPCS) codes. The information technology
systems will also have to be interoperable with providers across the continuum of care, as well as health
information exchanges (HIE), health information organizations (HIOs), and payers (e.g., Medicaid,
Medicare, and private insurance plans, etc.). SAMHSA believes it is important for public behavioral
health purchasers to continue to collaborate and discuss system interoperability, electronic health
records, federal information technology requirements, and other related matters. Additional information
can be found at https://www.samhsa.gov/health-information-technology (SAMHSA) and
https://www.healthit.gov/ (ONC).

States continue to form strategic partnerships to provide individuals with access to effective and
efficient service systems.
SAMHSA seeks to enhance the abilities of SMHAs and SSAs to be full partners in implementing and
enforcing MHPAEA and delivery of health system reform in their states. In many respects, successful
implementation is dependent on leadership and collaboration among multiple stakeholders. The
relationships among the SMHAs, SSAs, and the state Medicaid directors, insurance commissioners,
prevention agencies, child-serving agencies, education authorities, justice authorities, public health
authorities, and HIT authorities are integral to the effective and efficient delivery of services. These
collaborations will be particularly important in the areas of Medicaid, data and information management
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and technology, professional licensing and credentialing, consumer protection, and workforce
development.
On October 18, 2016, the Office of the Assistant Secretary for Health (OASH) released its report, Public
Health 3.0: A Call to Action to Create a 21st Century Public Health Infrastructure. Public Health 3.0
(PH3) is a significant upgrade in public health practice to a modern version that emphasizes crosssectorial environmental, policy- and systems- level actions that directly affect the social determinants of
health. SAMHSA and OASH are encouraging all public health authorities to adopt Public Health
Accreditation Board (PHAB) criteria. Further, public health department accreditation should be
enhanced and supported to best foster Public Health 3.0 principles, as we strive to ensure that every
person in the United States is served by nationally accredited health departments
State authorities focus their system goals on recovery.
People can and do recover from mental and substance use disorders, and services and supports must
foster individual and family capacity for self-directed recovery. Recovery benefits both the individual
with a behavioral health condition and the community, leading to a healthier and more productive
population. SAMHSA is committed to assisting states, providers, and people with M/SUD, families,
and others in promoting recovery.
State authorities continue to monitor the coverage of behavioral health services offered by QHPs and
Medicaid to ensure that individuals with behavioral health conditions have adequate coverage and
access to services.
Some states have contracted with managed care organizations (MCO) or Administrative Services
Organizations (ASO) to oversee and provide behavioral health services. State legislatures, state-based
Marketplace entities, and state insurance commissioners have developed policies and regulations related
to Electronic Handbooks. SMHAs and SSAs should be involved in these efforts to ensure that M/SUD
services are appropriately included in plans, and that M/SUD providers are included in networks.
States continue to make primary substance use disorder prevention a priority.
To respond to the primary prevention set-aside requirement of the SABG, states should keep in mind
that the backbone of a prevention system is an infrastructure with the ability to collect and analyze
epidemiological data on substance use and its associated consequences. The system must also be able to
use this data to identify areas of greatest need, and to identify, implement, and evaluate evidence-based
programs, practices, and policies that have the ability to reduce substance use and improve health and
well-being in all communities.
State authorities are strategic in leveraging scarce resources to fund prevention services.
States need to make the most efficient use of funds for substance use disorder prevention and be
prepared to report on the outcomes of these efforts. This means that state-funded prevention providers
will need to be able to collect data and report this information to the state. With limited resources, states
should also look for opportunities to leverage different streams of funding to create a coordinated datadriven substance use disorder prevention system. Specifically, SAMHSA recommends that states align
the 20 percent set-aside for primary prevention of the SABG with other federal, state, and local funding
that will aid the state in developing and maintaining a comprehensive substance use disorder prevention
system, as well as collaborate with and assure that behavioral health is part of the state’s larger public
7

health prevention activities.
State authorities monitor the Marketplace to ensure that individuals with behavioral health conditions
are aware of their eligibility, able to enroll, and able to remain enrolled.
State legislatures, state-based Marketplace entities, and state insurance commissioners have developed
policies and regulations related to the coordination between the Marketplace, Medicaid, and CHIP. This
includes the role that community-based organizations will play in providing outreach and enrollment
assistance. SMHAs and SSAs should be involved in these efforts to ensure that outreach and enrollment
assistance is available to help individuals with M/SUD who may not have or who may lose their
coverage. Historically, individuals who have the most difficulty navigating the public health insurance
eligibility determination and enrollment process have disproportionately high rates of behavioral health
conditions.
State authorities use evidence of improved performance and outcomes to support their funding and
purchasing decisions.
SMHAs and SSAs are well positioned to understand and use the evidence regarding various behavioral
health services as critical input for making purchasing decisions and influencing coverage offered in
their state through commercial insurers and Medicaid. In addition, states may also be able to use this
information to educate policymakers and to justify their budget requests or other strategic planning
efforts. States may also want to consider undertaking a similar process within their state to review local
programs and practices that expand treatment technologies and show promising outcomes.
State authorities ensure that they comport with changes in quality reporting.
The National Behavioral Health Quality Framework (NBHQF) provides a mechanism for states to
examine, prioritize, and report on approaches to prevention, treatment, and recovery processes through
the block grant as well as discretionary and formula grantees. In addition to this tool, SAMHSA has
been working with states and state representative organizations to identify and implement a core set of
measures, which include approved quality measures to assess outcomes and quality in programming.
This effort has sought to both guide and align the measurement requirements of other major service
purchasers, such as Medicaid and Medicare, and thus facilitate efficiencies in state reporting of
behavioral health quality measures to federal entities. It is anticipated that once implemented, states will
develop an implementation plan – both general to all states and unique to their particular state –
regarding the specifics and realities of how these measures are being collected and reported, as well as
how this effort is being coordinated with required reporting activities from Medicaid, Medicare, and
other public payers. SAMHSA’s collaboration with CMS on the Program for Certified Community
Behavioral Health Clinics (223) project10 that represents a significant stride toward enhanced inclusion
of quality measures in SAMHSA programming that is expected to continue and grow for the future data
collection efforts.
States authorities monitor implementation status and activities under the federal parity law to ensure
that individuals with behavioral health conditions are receiving the mandated coverage and access.

10

http://www.samhsa.gov/section-223

8

Plans and issuers subject to MHPAEA11 that offer M/SUD coverage as part of the overall health benefits
packages must comply with the requirements regarding coverage of M/SUD benefits in relation to
medical/surgical benefits. Parity requires that the plans that offer M/SUD benefits do so at the same
level of benefit as for physical conditions; it does not require a plan to offer M/SUD benefit. M/SUD
services are among the ten categories of service elements that serve as components of the essential
health benefits package that are offered. Whether it is federal- or state-level parity, continued efforts for
education are instrumental in increasing awareness of the benefits of mental health and addiction
services and open the door to appropriate services, especially for potential first-time users. Some states
have taken steps to enforce parity, and are building on lessons learned. This active involvement to
increase awareness helps to ensure that consumers receive quality behavioral health prevention,
treatment, and recovery services within their state and are aware of what protections and resources exist
in their state should their claim be denied inappropriately by insurance companies.
State authorities are key players in behavioral health integration activities.
Strong partnerships between SMHAs and SSAs and their counterparts in health, public health, and
Medicaid are essential for successful coordinated care initiatives. While the State Medicaid Authority
(SMA) is often the lead on a variety of care coordination initiatives, SMHAs and SSAs are essential
partners in designing, implementing, monitoring, and evaluating these efforts. SMHAs and SSAs are in
the best position to offer their Medicaid partners information regarding the most effective care
coordination models, connect current providers that have effective models, and assist with training or
retraining staff to provide care coordination across prevention, treatment, and recovery activities.
SMHAs and SSAs can also assist the Medicaid agency in messaging the importance of the various
coordinated care initiatives and the system changes that may be needed for success with their integration
efforts. The collaborations will be critical among behavioral health entities and comprehensive primary
care provider organizations, such as maternal and child health clinics, community health centers, Ryan
White HIV/AIDS CARE Act providers, and rural health organizations. SMHAs and SSAs can assist
SMAs with identifying principles, safeguards, and enhancements that will ensure that this integration
supports key recovery principles and activities such as person-centered planning and self-direction.
Specialty, emergency and rehabilitative care services, and systems addressing chronic health conditions
such as diabetes or heart disease, long-term or post-acute care, and hospital emergency department care
will see numerous behavioral health issues among the persons served. SMHAs and SSAs should be
collaborating to educate, consult, and serve patients, practitioners, and families seen in these systems.
The full integration of community prevention activities is equally important. Other public health issues
are impacted by behavioral health issues and vice versa. States should assure that the behavioral health
system is actively engaged in these public health efforts.
In addition, states play a key role in developing strategies for reducing smoking among individuals with
a behavioral health condition. States should strongly consider implementing strategies for reducing
smoking, including moving towards tobacco-free behavioral health facilities and grounds, and screening,
referring, and/or treating tobacco use.
Population changes in many states have created a demographic imperative to focus on improving
11

http://www.samhsa.gov/health-financing/implementation-mental-health-parity-addiction-equity-act

9

M/SUD prevention, treatment, and recovery for diverse populations with the goal of reducing
disparities.
States are increasingly recognizing the value in addressing health disparities, realizing that failure to take
action results in continued excess costs and spending and lost lives. States have developed plans to
address these disparities through incentives in health insurance plans, training initiatives and
requirements for language access, targeted quality improvement and cost containment plans, cost and
impact estimates for the most vulnerable populations, and tracking mechanisms to evaluate progress in
improving health equity12. Few of these plans, however, have focused specifically on behavioral health.
SSAs and SMHAs need to better track access, service use, and outcomes for these subpopulations to
develop targeted outreach, engagement, enrollment, and intervention strategies to reduce such
disparities.
State authorities are encouraged to implement, track, and monitor recovery-oriented, quality behavioral
health services.
The four dimensions of recovery:
1. Health: overcoming or managing one’s disease(s) or symptoms — for example,
abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an
addiction problem — and for everyone in recovery making informed and healthy choices
that support physical and emotional wellbeing.
•
•
•
•
•

Promote treatment, health and recovery-support services for individuals with mental
and/or substance use disorders.
Promote health, wellness, and resiliency.
Promote recovery-oriented service systems.
Engage individuals in recovery and their families in self-directed care, shared
decision-making and person-centered planning.
Promote self-care alternatives to traditional care, where appropriate.

2. Home: a stable and safe place to live.
•
•
•
•

Ensure that supported independent housing and recovery housing are available for
individuals with mental and/or substance use disorders.
Improve access to mainstream benefits, housing assistance programs, and supportive
services for people with mental and/or substance use disorders.
Build leadership, promote collaborations, and support the use of evidence-based
practices related to permanent supportive housing and recovery housing.
Increase knowledge of the behavioral health field about housing and homelessness
among people with mental and/or substance use disorders.

3. Purpose: meaningful daily activities, such as a job, school, volunteerism, family
caretaking, or creative endeavors, and the independence, income, and resources to
12

http://www.samhsa.gov/behavioral-health-equity

10

participate in society.
•
•
•
•

Increase gainful employment and educational opportunities for individuals with or in
recovery from mental and/or substance use disorders.
Increase the proportion of individuals with mental and/or substance use disorders who
are gainfully employed and/or participating in self-directed educational endeavors.
Develop employer strategies to address national employment and education
disparities among people with identified behavioral health problems.
Implement evidence-based practices related to employment and education for
individuals with mental and/or substance use disorders.

4. Community: relationships and social networks that provide support, friendship, love,
and hope.
•
•
•

Promote peer support and the social inclusion of individuals with or in recovery from
mental and/or substance use disorders in the community.
Increase the number and quality of consumer/peer recovery support specialists
and consumer-operated/peer run recovery support service provider organizations.
Promote the social inclusion of people with mental and/or substance use disorders.

These elements - health, home, purpose, and community - are central to recovery from mental
and substance use disorders. Treatment and formal and informal recovery support services are
critical to attain and maintain recovery.
State authorities ensure that their states have a system of care approach to children and adolescents’
M/SUD services.
The success of the systems of care approach has shown that interagency coordination centered on
serving the unique needs of children, youth, and families is critical. Facilitating and sustaining this
approach at the local level requires a parallel effort at the state level. As states adopt a system of care
approach, they should address state policies that can support local efforts, identifying financing
mechanisms, and enabling a family and youth input to policy at the state level. In addition to
identifying the resources needed for services, states will need to develop a realistic planning process for
enabling systems of care in their states that includes the necessary staff time and administrative
resources.
C. Block Grant Programs’ Purposes
SAMHSA’s MHBG and SABG provide states with the flexibility to design and implement activities and
services to address the complex needs of individuals, families, and communities impacted by substance
use disorders and for adults with SMI and children with SED. The purposes of the block grant programs
support these service needs and are consistent with SAMHSA’s vision for a high-quality, self-directed,
and satisfying life.
In order to assure that the block grant program continues to support the needed and necessary services,
SAMHSA has indicated that the block grants be used:
1. To fund priority treatment and support services for individuals without insurance or for whom
11

coverage is terminated for short periods of time;
2. To fund those priority treatment and support services not covered by C H I P , Medicaid,
Medicare, or private insurance for low-income individuals and that demonstrate success in
improving outcomes and/or supporting recovery;
3. For SABG funds, to fund primary prevention: universal, selective, and indicated prevention
activities and services for persons not identified as needing SUD treatment; and
4. To collect performance and outcome data to determine the ongoing effectiveness of
promotion/SUD prevention, treatment and recovery supports and to plan the implementation of
new services.

II. SUBMISSION OF APPLICATION AND PLAN TIMEFRAMES
Statutory Deadlines
While the statutory deadlines and block grant award periods remain unchanged, SAMHSA encourages
states to turn in their application as early as possible to allow for a full discussion and review by
SAMHSA. Applications for the MHBG are due no later than September 1, 2017. The applications for
SABG are due no later than October 1, 2017. Single applications for MHBG and SABG are due no later
than September 1, 2017. MHBG and SABG Reports are due December 1, 2017. In addition, for the
SABG, the Annual Synar Report is due no later than December 31, 2017
The FFY 2018-2019 MHBG and SABG application(s) include(s) a two-year Behavioral Health Systems
Assessment and Plan (Plan) as well as projected expenditure tables, certifications and assurances. The
Plan will cover a two-year period aligning with states’ FY budget cycle for SFY 2018/19. States will
have the option, but will not be required to amend their Plans when they submit their FFY 2019
application.
States should submit their respective MHBG and SABG application(s) for FFYs 2018 and 2019 based
on the guidance provided in this document. The Plan provides a consistent framework for SMHAs and
SSAs to assess the strengths and needs of their systems and to plan for system improvement, which is
consistent with the strategic planning framework currently used by SAMHSA for various grants. The
unique statutory and regulatory requirements of the specific block grants are described in the State Plan
section.
The FFY 2018-2019 Plan seeks to collect information from states regarding their activities in response to
federal laws, initiatives, changes in technology, and advances in research and knowledge. The FFY 20182019 Plan has sections that are required and other sections where additional information is requested but
not required. The requested information is necessary for a full understanding of the state system of care
design and development and provides a benefit to both the states and SAMHSA. There will be no
penalty assessed to states that provide only that information that is required.
Required Sections and Tables
The FFY 2018-2019 application requires states to submit a face sheet; a table of contents; a behavioral
health assessment and plan;, expenditure, performance, and utilization reports; , executive summary; and
funding agreements, assurances, and certifications. In addition, SAMHSA is requesting information on
key focus areas that are critical to implementation of provisions related to improving the quality of life
12

for individuals with behavioral health disorders. States are strongly encouraged to respond to each
section so that SAMHSA understands the totality of states’ efforts and how the block grant funding fits
into the states’ overall goals and constraints. The requested sections also help SAMHSA tailor technical
assistance to best assist states to achieve their goals. Section III.B, Planning Steps, requires states to
undertake a needs assessment as part of their plan submission. This section identifies four key steps: (1)
assess the strengths and needs of the service system; (2) identify unmet service needs and critical gaps;
(3) prioritize state planning activities to include the required target populations and other priority
populations (e.g. youth with substance use disorders); and (4) develop goals, objectives, strategies, and
performance indicators. Section III.B, Plan Table 1 (Priority Area and Annual Performance Indicators)
and Plan Table 2 (State Agency Planned Expenditure) and Plan Table 6 (Non-Direct Services/System
Development Activities Planned Expenditures) are required for both MHBG and SABG. For the SABG,
Plan Table 3 (SABG Persons in need/receipt of treatment), Table 5a and/or Table 5b (SABG Primary
Prevention Planned Expenditures), are also required.
The application requests information on state efforts on certain policy, program, and technology
advancements in physical and M/SUD prevention, treatment, and recovery. This information will help
SAMHSA understand the whole of the applicant state’s efforts and identify how SAMHSA can assist
the applicant state in meeting its goals. In addition, this information will identify states that are models
and assist other states with areas of common concern.
Application Requirements and Award
For the Secretary of HHS, acting through the Assistant Secretary of Mental Health and Substance Use,
to make an award under the programs involved, states must submit an application(s) sufficient to meet
the requirements described in the authorizing legislation and implementing regulations sufficient for
SAMHSA to monitor the states’ compliance efforts regarding the obligation and expenditure of MHBG
and SABG funds. The funds awarded will be available for obligation and expenditure13 to plan, carry
out, and evaluate activities and services for children with SED and adults with SMI; substance use
disorder prevention; youth and adults with a SUD; adolescents and adults with co-occurring disorders;
and the promotion of recovery among persons with SED, SMI, or SUD.
14 15

A grant may be awarded only if a state’s application(s) include(s) a State Plan
in the proper format
containing information including, but not limited to, detailed provisions for complying with each
funding agreement for a grant under section 1911 of Title XIX, Part B, Subpart I of the PHS Act (42
U.S.C. § 300x-1) or section 1921 of Title XIX, Part B, Subpart II of the PHS Act (42 U.S.C. § 300x21) that is applicable to a state. The State Plan must include a description of the manner in which the
state intends to obligate the grant funds, and it must include a report 16 in the proper format containing
information that the Secretary determines to be necessary for securing a record and description of the
purposes for which both the MHBG and SABG were expended. States have the option of updating
13

Title XIX, Part B of the PHS Act, http://www.samhsa.gov/grants/block-grants/laws-regulations
Section 1912 of Title XIX, Part B, Subpart I of the PHS Act (42 U.S.C. § 300x-2), http://www.samhsa.gov/grants/block-grants/lawsregulations
15
Section 1932(b) of Title XIX, Part B, Subpart II of the PHS Act (42 U.S.C. § 300x-32(b)), http://www.samhsa.gov/grants/blockgrants/laws-regulations
16
Section 1942(a) of Title XIX, Part B, Subpart III of the PHS Act (42 U.S.C. § 300x-52(a)), http://www.samhsa.gov/grants/blockgrants/laws-regulations
14

13

their plans during the two year planning cycle.
States are encouraged to submit a combined MHBG and SABG application. If a state is submitting
separate MHBG and SABG plans, it should clarify which system is being described in this section (e.g.,
mental health, substance misuse prevention, SUD treatment, or recovery).
III.

BEHAVIORAL HEALTH ASSESSMENT AND PLAN

SAMHSA values the importance of a thoughtful planning process that includes the use of available data
to identify the strengths, needs, and service gaps for specific populations. By identifying needs and
gaps, states can prioritize and establish tailored goals, objectives, strategies, and performance indicators.
In addition, the planning process should provide information on how the state will specifically spend
available block grant funds consistent with the statutory and regulatory requirements, environment, and
priorities described in this document and the priorities identified in the state’s plan.
Quality and Data Collection Readiness
Health surveillance is critical to SAMHSA’s ability to develop new models of care to address M/SUD.
SAMHSA provides decision makers, researchers and the public with enhanced information about the
extent of M/SUDs, how systems of care are organized and financed, when and how to seek help, and
effective models of care, including the outcomes of treatment engagement and recovery. SAMHSA also
provides Congress and the nation reports about the use of block grant and other SAMHSA funding to
impact outcomes in critical areas, and is moving toward measures for all programs consistent with
SAMHSA’s NBHQF. The effort is part of the congressionally mandated National Quality Strategy
(NQS) to assure health care funds - public and private - are used most effectively and efficiently to create
better health, better care, and better value. The overarching goals of this effort are to ensure that services
are evidence-based and effective or are appropriately tested as promising or emerging best practices; they
are person/family-centered; care is coordinated across systems; services promote healthy living; and, they
are safe, accessible, and affordable.
SAMHSA is currently working to harmonize data collection efforts across discretionary programs and
match relevant NBHQF and NQS measures that are already endorsed by the National Quality Forum
(NQF) wherever possible. SAMHSA is also working to align these measures with other efforts within
HHS and relevant health and social programs and to reflect a mix of outcomes, processes, and costs of
services. Finally, consistent with HHS priorities, these efforts will seek to understand the impact that
disparities have on outcomes.
The key to accomplishing tasks associated with data collection for the block grant will be SAMHSA’s
collaboration with the National Association of State Mental Health Program Directors (NASMHPD), the
National Association of State Alcohol Drug Abuse Directors (NASADAD), and other state and
community partners. SAMHSA recognizes the significant implications of any modifications or changes
to data collection and reporting for local service providers and state agencies. This collaboration has
resulted in a clarified description of the non-direct services/system support expenditures from the block
grants. Similar discussions about reporting of direct services will be undertaken as we move forward.
Meaningful input of stakeholders in the development of the plan is critical. Evidence of the process and
input of the Planning Council required by section 1914(b) of the PHS Act (42 U.S.C. § 300x-4(b)) for
the MHBG must be included in the application that addresses MHBG funds. States are also encouraged
14

to expand this Planning Council to include prevention and substance use disorder stakeholders and use
this mechanism to assist in the development of the state block grant plan for the SABG application.
States must also describe the stakeholder input process for the development of both the SABG plan and
the MHBG plan, as mandated by section 1941 of the PHS Act (42 U.S.C.§ 300x-51), which requires that
the state block grant plans be made available to the public in such a manner as to facilitate public
comment during the development of the plan (including any revisions) and after the submission of the
plan to the Secretary through SAMHSA. This description should also show involvement of persons
who are service recipients and/or in recovery, families of individuals with M/SUD, providers of services
and supports, representatives from racial and ethnic minorities, LGBTQ populations, persons with coexisting disabilities, and other key stakeholders. Evidence of meaningful consultation with federally
recognized tribes where tribal governments or lands are located within the boundaries of the state are
strongly encouraged for both MHBG and SABG.
A. Framework for Planning—Mental Health and Substance Use Prevention and Treatment
States should identify and analyze the strengths, needs, and priorities of the state’s behavioral health
system. The strengths, needs, and priorities should take into account specific populations that are the
current focus of the block grants, the changing health care environment, and SAMHSA’s Strategic
Initiatives.
The MHBG program is designed to provide comprehensive community mental health services to adults
with SMI or children with SED. For purposes of block grant planning and reporting, SAMHSA has
clarified the definitions of SED and SMI. States may have additional elements that are included in their
specific definitions, but the following provides a common baseline definition. Children with SED refers
to persons from birth to age 18 and adults with SMI refers to persons age 18 and over; who (1) currently
meet or at any time during the past year has met criteria for a mental disorder – including within
developmental and cultural contexts – as specified within a recognized diagnostic classification system
(e.g., most recent editions of DSM, ICD, etc.), and (2) display functional impairment, as determined by
a standardized measure that impedes progress towards recovery and substantially interferes with or
limits the person’s role or functioning in family, school, employment, relationships, or community
activities.
Section 1912(b) of the Public Health Act (42 USC § 300x-2) establishes five criteria that must be
addressed in state mental health plans. States must describe these in the planning steps. The criteria are
defined below:


Criterion 1: Comprehensive Community-Based Mental Health Service Systems: Provides for
the establishment and implementation of an organized community-based system of care for
individuals with mental illness, including those with co-occurring M/SUD. States must have
available services and resources within a comprehensive system of care, provided with federal,
state, and other public and private resources, in order to enable such individuals to function
outside of inpatient or residential institutions to the maximum extent of their capabilities.



Criterion 2: Mental Health System Data Epidemiology: Contains an estimate of the incidence
and prevalence in the state of SMI among adults and SED among children; and have
quantitative targets to be achieved in the implementation of the system of care described under
Criterion 1.
15



Criterion 3: Children’s Services: Provides for a system of integrated services in order for
children to receive care for their multiple needs. Services that should be integrated into a
comprehensive system of care include: social services; educational services, including services
provided under IDEA; juvenile justice services; substance abuse services; and health and
mental health services.



Criterion 4: Targeted Services to Rural and Homeless Populations and to Older Adults:
Provides outreach to and services for individuals who experience homelessness; communitybased services to individuals in rural areas; and community-based services to older adults.



Criterion 5: Management Systems: States describe their financial resources, staffing, and
training for mental health services providers necessary for the plan; provides for training of
providers of emergency health services regarding SMI and SED; and how the state intends to
expend this grant for the fiscal years involved.

States must submit a plan on how they will utilize the 10 percent set-aside funding to support appropriate
evidence-based programs for individuals with Early Serious Mental Illness (ESMI) including psychosis.
If a state chooses to submit a plan to utilize the set-aside for evidence-based services other than the
services/principles components of Coordinated Specialty Care (CSC) approach developed via the
Recovery After an Initial Schizophrenia Episode (RAISE) initiative, SAMHSA will review the plan with
the state to assure that the approach proposed meets the understanding of an evidence-based approach. In
consultation with National Institute of Mental Health (NIMH), as needed, either the proposals will be
accepted or requests for modifications to the plan will be discussed and negotiated with the state. This
initiative also includes a plan for program evaluation and data collection related to demonstrating
program effectiveness. Additional technical assistance and guidance on the expectations for evaluation,
data collection and reporting will follow. Please note that the MHBG funds cannot be used for primary
prevention or preventive intervention for those at risk of SMI or SED.

The SABG program provides substance use disorder prevention, SUD treatment and recovery services,
(and certain related activities) to at-risk individuals or persons in need of SUD treatment. See 42 U.S.C.
§§ 300x-300x-66.
Section 1921 of the PHS Act (42 U.S.C.§ 300x-21) authorizes the States to obligate and expend SABG
funds to plan, carry out and evaluate activities and services designed to prevent and treat substance use
disorders. Section 1932(b) of the PHS Act (42 U.S.C. § 300x-32(b)) established the criterion that must
be addressed in the State Plan.


Criterion 1: Statewide Plan for Substance Use Disorder Prevention, Treatment and Recovery
Services for Individuals, Families and Communities (42 U.S.C. § 300x-21 and 45 CFR § 96.122)



Criterion 2: Primary Prevention (42 U.S.C. § 300x-22(a) and 45 CFR § 96.125). The authorizing
legislation and implementing regulation established a 20 percent set-aside for primary prevention
programs, defined as programs for individuals who do not require treatment for substance use
disorders.



Criterion 3: Pregnant Women and Women with Dependent Children (42 U.S.C. § 300x-22(b);
16

42 U.S.C. § 300x-27; 45 CFR § 96.124(c) (e); and 45 CFR § 96.131). The authorizing legislation
and implementing regulation established a 5 percent set-aside that was applicable to the FFY
1993 and FFY 1992 SABG Notices of Award. For FFY 1994 and subsequent fiscal years, States
have been required to comply with a performance requirement that the States are required to
obligate and expend funds for SUD treatment services designed for such women in an amount
equal to the amount expended in FFY 1994.


Criterion 4: Persons Who Inject Drugs (42 U.S.C. § 300x-23 and 45 CFR § 96.126). The
authorizing legislation and implementing regulation established two performance requirements
related to persons who inject drugs: (1) Any programs that receive SABG funds to serve persons
who inject drugs must comply with the requirement to admit an individual requesting admission
to treatment within 14 days and not later than 120 days; and (2) outreach to encourage persons
who inject drugs to seek SUD treatment Additionally, subject to the annual appropriation
process, States may authorize such programs to obligate and expend SABG funds for elements of
a syringe services program (SSP) pursuant to guidance developed by the HHS’ Office of
HIV/AIDS an Infectious Disease Policy (OHIDP) .



Criterion 5: Tuberculosis Services (42 U.S.C. § 300x-24(a) and 45 CFR § 96.127). The
authorizing legislation and implementing regulation require any programs that receive SABG
funds to, directly or through arrangements with other public and non-profit entities, routinely
make available tuberculosis services to each individual receiving SUD treatment services.



Criterion 6: Early Intervention Services Regarding the Human Immunodeficiency Virus (42
U.S.C. § 300x-24(b) and 45 CFR § 96.128). The authorizing legislation and implementing
regulation require designated States to set-aside five percent of the SABG to establish 1 or more
projects to provide EIS/HIV at the site(s) at which individuals are receiving SUD treatment
services.



Criterion 7: Group Homes For Persons in Recovery from Substance Use Disorders (42 U.S.C. §
300x-25 and 45 CFR § 96.129). The authorizing legislation and implementing regulation provide
states with the flexibility to establish and maintain a revolving loan fund for the purpose of
making loans, not to exceed $4,000, to a group of not more than six individuals to establish a
recovery residence.



Criterion 8: Referrals to Treatment (42 U.S.C. § 300x-28(a) and 45 CFR § 96.132(a) and
Coordination of Ancillary Services (42 U.S.C. § 300x-28(c) and 45 CFR § 96.132(c). The
authorizing legislation and implementing regulation require States to promote the use of
standardized screening and assessment instruments and placement criteria to improve patient
retention and treatment outcomes.



Criterion 9: Independent Peer Review (42 U.S.C. § 300x-58(a) (1) (A) and 45 CFR § 96.136).
The authorizing legislation and implementing regulation require states to assess the quality,
appropriateness, and efficacy of M/SUD treatment services.



Criterion 10: Professional Development (42 U.S.C. § 300x-28(b) and 45 CFR § 96.132(b) The
authorizing legislation and implementing regulation requires any programs that receive SABG
17

funds to ensure that prevention, treatment and recovery personnel operating in the state’s
substance use disorder system have an opportunity to receive training on an ongoing basis
concerning recent trends in substance use in the state, improved methods and evidence-based
practices for providing substance use disorder prevention and treatment services, performancebased accountability, data collection and reporting requirements, and any other matters that
would serve to further improves the delivery of substance use disorder prevention and treatment
services within the state.
At a minimum, the plan should address the following populations as appropriate for each block grant
(*Populations that are marked with an asterisk are required to be included in the state’s needs
assessment for the MHBG or SABG. To the extent that the other listed populations fall within any of the
statutorily covered populations, states must include them in the plan)
1.

(MHBG) Comprehensive community-based mental health services for adults with SMI and
children with SED:
 Children with SED and their families*
 Adults with SMI*
 Older Adults with SMI*
 Individuals with SMI or SED in the rural and homeless populations, as applicable*
 Individuals who have an Early Serious Mental Illness (ESMI) (10 percent MHBG set aside)

2.

(SABG) Services for persons with SMI/SED or persons with or at risk of having substance
use disorder:
 Persons who inject drugs *
 Adolescents with substance use and/or mental health problems
 Children and youth who are at risk for mental, emotional, and behavioral disorders, including,
but not limited to, addiction, conduct disorder, and depression
 Women who are pregnant and have a substance use and/or mental disorder*
 Parents with substance use and/or mental disorders who have dependent children*
 Military personnel (active, guard, reserve, and veteran) and their families
 American Indians/Alaska Natives

3.

(SABG) Services for persons with or at risk of contracting communicable diseases:
 Individuals with tuberculosis* and other communicable diseases
 Persons at risk for HIV/AIDS who may be unaware of the infection status and persons living
with HIV/AIDS who are in need of mental health or substance use early intervention,
treatment, or prevention services*17

17

For the purpose of determining the states and jurisdictions which are considered “designated states” as described in section 1924(b)(2) of
Title XIX, Part B, Subpart II of the Public Health Service Act (42 U.S.C. § 300x-24(b)(2)) and section45 CFR § 96.128(b) of the Substance
Abuse Prevention and Treatment Block Grant; Interim Final Rule (45 CFR 96.120-137),). SAMHSA relies on the HIV Surveillance Report
produced by the CDC, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention. The HIV Surveillance Report, Volume 25, will
be used to determine the states and jurisdictions that will be required to set-aside 5 percent of their respective FY 2016 SABG allotments to
establish one or more projects to provide early intervention services for HIV at the sites at which individuals are receiving SUD treatment
services. In FY 2012, SAMHSA developed and disseminated a policy change applicable to the EIS/HIV which provided any state that was a
“designated state” in any of the 3 years prior to the year for which a state is applying for SABG funds with the flexibility to obligate and
expend SABG funds for EIS/HIV even though the state does not meet the AIDS case rate threshold for the fiscal year involved. Therefore,
any state whose AIDS case rate is below 10 or more such cases per 100,000 and meets the criteria described in the 2012 policy guidance
would be allowed to obligate and expend FY 2016 SABG funds for EIS/HIV if they chose to do so.

18




The National HIV/AIDS Strategy (NHAS) for the United States and NHAS
Implementation Plan 18
Prevention of HIV among persons who inject drugs; substance use is associated with a
greater likelihood of acquiring HIV infection. HIV screening and other comprehensive
HIV prevention services should be coupled with SUD treatment programs

4. Services for individuals in need of primary substance use disorder prevention *
5. In addition to the targeted/required populations and/or services required in statute, states are
encouraged to consider the following populations, and/or services:
 Individuals with mental and/or substance use disorders who are homeless or involved in the
criminal or juvenile justice systems
 Individuals with mental and/or substance use disorders who live in rural areas
 Underserved racial and ethnic minority and LGBT populations
 Persons with disabilities
 Community populations for environmental prevention activities, including policy changing
activities, and behavior change activities to change community, school, family, and business
norms through laws, policy and guidelines and enforcement.
 Community settings for universal, selective and indicated prevention interventions,
including hard-to-reach communities and “late” adopters of prevention strategies
In addition, states should consider linking their Olmstead planning work in the block grant application,
identifying trend data on individuals who are needlessly institutionalized or at risk of
institutionalization. There is a need generally for data that will help the state address housing and
related issues in their planning efforts. To the extent that such data is available in a state’s Olmstead
Plan, it should be used for block grant planning purposes.
B. Planning Steps
For each of the populations and common areas, states should follow the planning steps outlined below:
Step 1: Assess the strengths and organizational capacity of the service system to address the specific
populations.
Provide an overview of the state’s M/SUD prevention, early identification, treatment, and recovery
support systems, including the five criteria that must be addressed in state mental health plans.
Describe how the public M/SUD system is currently organized at the state and local levels,
differentiating between child and adult systems. This description should include a discussion of the
roles of the SMHA, the SSA, and other state agencies with respect to the delivery of M/SUD services.
States should also include a description of regional, county, tribal, and local entities that provide
behavioral health services or contribute resources that assist in providing the services.
The description should also include how these systems address the needs of diverse racial, ethnic, and
sexual gender minorities, as well as American Indian/Alaskan Native populations in the states.
18

http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf

19

Step 2: Identify the unmet service needs and critical gaps within the current system.
This step should identify the unmet service needs and critical gaps in the state’s current behavioral
health system as well as the data sources used to identify the needs and gaps of the required populations
relevant to each block grant within the state’s behavioral health system. Especially for those required
populations described in this document and other populations identified by the state as a priority. This
step should also address how the state plans to meet the unmet service needs and gaps.
A data-driven process must support the state’s priorities and goals. This could include data and
information that are available through the state’s unique data system (including community-level data), as
well as SAMHSA’s data sets including, but not limited to, the National Survey on Drug Use and Health
(NSDUH), the Treatment Episode Data Set (TEDS), the National Facilities Surveys on Drug Abuse and
Mental Health Services, the annual State and National Behavioral Health Barometers, and the Uniform
Reporting System (URS). Those states that have a State Epidemiological and Outcomes Workgroup
(SEOW) should describe its composition and contribution to the process for primary prevention and
treatment planning. States should also continue to use the prevalence formulas for adults with SMI and
children with SED, as well as the prevalence estimates, epidemiological analyses, and profiles to establish
mental health treatment, substance use disorder prevention, and SUD treatment goals at the state level. In
addition, states should obtain and include in their data sources information from other state agencies that
provide or purchase M/SUD services. This will allow states to have a more comprehensive approach to
identifying the number of individuals that are receiving services and the types of services they are
receiving.
SAMHSA’s Behavioral Health Barometer is intended to provide a snapshot of the state of behavioral
health in America. This report presents a set of substance use and mental health indicators measured
through two of SAMHSA’s populations- and treatment facility-based survey data collection efforts, the
NSDUH and the National Survey of Substance Abuse Treatment Services (N-SSATS) and other
relevant data sets. Collected and reported annually, these indicators uniquely position SAMHSA to
offer both an overview reflecting the behavioral health of the nation at a given point in time, as well as
a mechanism for tracking change and trends over time. It is hoped that the National and State specific
Behavioral Health Barometers will assist states in developing and implementing their block grant
programs.
SAMHSA will provide each state with its state-specific data for several indicators from the Behavioral
Health Barometers. States can use this to compare their data to national data and to focus their efforts
and resources on the areas where they need to improve. In addition to in-state data, SAMHSA has
identified several other data sets that are available to states through various federal agencies: CMS, the
Agency for Healthcare Research and Quality (AHRQ), and others.
Through the Healthy People Initiative19 HHS has identified a broad set of indicators and goals to track
and improve the nation’s health. By using the indicators included in Healthy People, states can focus
their efforts on priority issues, support consistency in measurement, and use indicators that are being
19

http://www.healthypeople.gov/2020/default.aspx

20

tracked at a national level, enabling better comparability. States should consider this resource in their
planning.

Step 3: Prioritize state planning activities
Using the information in Step 2, states should identify specific priorities that will be included in the
MHBG and SABG. The priorities must include the core federal goals and aims of the MHBG and
SABG programs: target populations (those that are required in legislation and regulation for each block
grant) and other priority populations described in this document. States should list the priorities for the
plan in Plan Table 1 and indicate the priority type (i.e., substance use disorder prevention (SAP),
substance use disorder treatment (SAT), or mental health services (MHS).
Step 4: Develop goals, objectives, performance indicators, and strategies
For each of the priorities identified in Step 3, states should identify the relevant goals, measureable
objectives, and at least one-performance indicator for each objective for the next two years.
For each objective, the state should describe the specific strategy that will be used to achieve the
objective. These strategies may include developing and implementing various service-specific changes
to address the needs of specific populations, substance abuse prevention activities, and system
improvements that will address the objective. Strategies to consider and address include:
•

Strategies that are targeted for children and youth with SED or substance use disorders. States
should use a system of care approach that has been well established for children with SED and cooccurring substance use disorders. This approach should be used state wide, coordinating care with
other state agencies (e.g., schools, child welfare, juvenile justice, primary care, etc.) to deliver
evidence-based treatments and supports through a family-driven, youth-guided, culturally
competent, individualized treatment plan. For adolescents with substance use disorders and SED,
this approach should be used in conjunction with evidence-based interventions for substance use or
dependence.

•

Strategies targeted for adults with SMI/SUDs that will identify and intervene early, connect
with, or provide the best possible treatment, and design and implement recovery-oriented
services.

•

Strategies that will promote integration and inclusion into the community: This includes housing
models that integrate individuals into the community instead of long-term care facilities or nursing
homes and other settings that fail to promote independence and inclusion. This also can include
strategies to promote competitive and evidenced-based supported employment in the community,
rather than segregated programs.

•

Strategies on how technology, especially interactive communication technologies (ICT) will be used
to engage individuals and their families into treatment and recovery supports. Almost 40 percent of
uninsured individuals are under the age of 30 and use technology as a substantial, if not primary,
mode of communication.
21

•

Strategies that result in developing recovery support services, e.g., permanent housing and
supportive employment or education for persons with mental and substance use disorders. This
includes how local authorities will be engaged to increase the availability of housing,
employment, and educational opportunities, and how the state will develop services that will
wrap around these individuals to obtain and maintain safe and affordable housing, employment,
and/or education.

•

Strategies that will enable the state to document the diversity of its service population and
providers and to specify the development of an array of culture-specific interventions and
providers to improve access, engagement, quality, and outcomes of services for diverse ethnic and
racial minorities and LGBT populations. States will be encouraged to refer to the IOM reports,
Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement 20 and
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better
Understanding21 in developing this strategy.

•

Strategies that will build the state and provider capacity to provide evidence-based, trauma-specific
interventions in the context of a trauma-informed delivery system. Recognizing trauma as a critical
factor in the development of mental and substance use disorders, states should build provider
competence in using effective trauma treatments. States should ensure that these treatments are
provided in systems that understand the impact of trauma on their service population and work to
eliminate organizational practices and policies that may cause new or exacerbate existing trauma.
SAMHSA has developed “SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed
Approach” to provide states with a framework for incorporation of trauma informed care into its
system.

•

Strategies that increase the use of person-centered planning, self-direction, and participant-directed
care. This includes measures to help individuals or caregivers (when appropriate) identify and
access services and supports that reinforce recovery or resilience. These strategies should also
include how individuals or caregivers have access to supports to facilitate participant direction,
including the ability to manage a flexible budget to address recovery goals; identifying, selecting hiring
and managing support workers and providers; and ability to purchase goods and services identified in the
recovery or resilience planning process.

•

As specified in 45 CFR § 96.125(b), states shall use a variety of evidence-based programs, policies
and practices in their prevention efforts that include:
• Information dissemination;
• Education;
• Alternatives that decrease alcohol, tobacco, and other drug use;
• Problem identification and referral;

20

Institute of Medicine. (2009).Race, Ethnicity, and Language Data: Standardization for Healthcare quality Improvement.
Subcommittee on Standardization Collection of Race/Ethnicity Data for Healthcare Quality Improvement, Board on Healthcare
Services. Cheryl Ulmer, Bernadette McFadden, and David R. Nerenz, Editors, Washington, DC: The National Academies Press
21

IOM (Institute of Medicine). 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation
for Better Understanding. Washington, DC: The National Academies Press.

22

•
•

Community based programming; and,
Environmental strategies that establish or change written and unwritten community standards,
codes, and attitudes, thereby influencing incidence and prevalence of the abuse of alcohol,
tobacco, and other drugs used in the general population

Prevention strategies should also be consistent with the IOM Report on Preventing Mental
Emotional and Behavioral Disorders, the Surgeon General’s Call to Action to Prevent and
Reduce Underage Drinking 22, the National Registry of Evidenced-based Programs and Practices
(NREPP), and/or other materials documenting their effectiveness. These strategies include:
•

Strategies that target tobacco use prevention and tobacco-free facilities that are supported by
research and encompass a range of activities including policy initiatives and programs;

•

Strategies that engage schools, workplaces, and communities to establish programs and policies
to improve knowledge about alcohol and other drug problems, denote effective ways to address
the problems, and enhance resiliency.

•

Strategies that implement evidence-based and cost-effective models to prevent substance
misuse in young people in a variety of community settings, e.g., families, schools,
workplaces, and faith-based institutions, consistent with the current science;

•

Strategies that follow the Surgeon General’s Call to Action to Prevention and Reduce
Underage Drinking, developed in coordination with the Interagency Coordinating Committee
on the Prevention of Underage Drinking (ICCPUD) which focus on policy and environmental
programming to change the community’s norms around, and parental acceptance of, underage
alcohol use; and

•

Strategies that address harder-to-reach racial/ethnic minority and LGBT communities that
experience a cluster of risk factors that make them especially vulnerable to substance use and
related problems.

SABG primary prevention set-aside funds can only be used to fund strategies that prevent
substance use. MHBG funds can only be used for prevention activities for adults with SMI and
children with SED.
•

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

22

Allow states to position their providers to increase access, retention, adoption, or adaptation of
EHRs, or to develop strategies to increase workforce numbers. These system improvement
activities should use federal and state resources currently available and those proposed for the
planning period to enhance the competency of the behavioral health workforce. System
improvements that seek to expand the workforce should build upon existing efforts to increase

http://store.samhsa.gov/product/Surgeon-General-s-Call-to-Action-to-Prevent-and-Reduce-Underage-Drinking/SGCTA-07

23

M/SUD skill development in a wide range of professions as well as increase the role of people in
recovery from mental and substance use disorders in the planning and delivery of services.
•

Support providers to participate in networks that may be established through managed care or
administrative service organizations (including affordable care organizations (ACOs)). This
may include assistance to develop the necessary infrastructure (e.g., electronic billing and
EHRs) and reporting requirements to participate in these networks.

•

Encourage the use of peer specialists or recovery coaches to provide needed recovery
support services, which are already delivered by volunteers and paid staff. Peers are
trained, supervised, and regarded as staff and operate out of a community-based or
recovery organization. A state’s strategy should allow states to support peer and other
recovery support services delivered under either model. The infrastructure, including paid
staff, to coordinate and encourage the use of volunteer- delivered or run services should
also be supported.

•

Increase links between primary, specialty, emergency and rehabilitative care and behavioral
health providers working with behavioral health provider organizations for expertise,
collaboration, and referral arrangements, including the support of practitioner efforts to screen
patients for mental and substance use disorders. Activities should also focus on developing
model contract templates for reciprocal health and behavioral health integration and identifying
state policies that present barriers to reimbursement. This would include efforts to implement
dual eligible products, ACOs, and medical homes.

•

Develop support systems to provide communities with necessary needs assessment information,
planning, technical assistance, evaluation expertise, and other resources to foster the
development of comprehensive community plans to improve mental, emotional, and behavioral
health outcomes.

•

Fund auxiliary aids and services to allow people with disabilities to benefit from the M/SUD
services and language assistance services for people who experience communication barriers to
access.

•

Develop benefit management strategies for high-cost services (e.g., youth out of home services
and adult residential services). SAMHSA believes that states should align their care
management to guarantee that individuals get the right service at the right time in the right
amount. These efforts should ensure that decisions made regarding these services are clinically
sound.

Planning Tables
States should describe specific performance indicators that will be used to determine if the goals for
that priority area were achieved. For each performance indicator, the state must describe the data and
data source that has been used to develop the baseline for FFY 2018 and how the state proposes to
measure the change in FFY 2019. States must use the template (Plan Table 1: Priority Areas by Goal,
Strategy, and Performance Indicators) below.
24

Plan Table #1. Priority Area and Annual Performance Indicators
States should follow the guidelines presented above in Framework for Planning – Mental Health and
Substance Use Disorder Prevention and Treatment Planning Steps to complete Plan Table 1. States are
to complete a separate table for each state priority area to be included in the MHBG and SABG. Please
include the following information when entering into Web BGAS:
1. Priority area (based on an unmet service need or critical gap). After this information is
completed for the first priority area, another table will appear so additional priorities can be
added.
2. Priority type. From the drop-down menu, select SAP – substance use disorder prevention,
SAT – substance use disorder treatment, or MHS -- mental health service.
3. Targeted/required populations. Indicate the population(s) required in statute for each block
grant as well as those populations encouraged, as described in IIIA Framework for
Planning—Mental Health and Substance Abuse Prevention and Treatment. States must
include at least one priority for each required population. From the drop-down menu select:
a)
b)
c)
d)
e)
f)
g)

SMI–Adults with SMI,
SED–Children with an SED,
ESMI - Individuals with ESMI including psychosis
PWWDC–Pregnant women and women with dependent children,
PP – persons in need of primary substance use disorder prevention,
PWID–Persons who inject drugs (formerly known as intravenous drug users (IVDU),
EIS/HIV–Persons with or at risk of HIV/AIDS who are receiving SUD treatment
services
a) TB–Persons with or at risk of tuberculosis who are receiving SUD treatment services,
and/or
b) Other- Specify (Refer to section IIIA of the Assessment and Plan).
4. Goal of the priority area. Goal is a broad statement of general intention. Therefore, provide a
general description of what the state hopes to accomplish.
5. Objective: Objective should be a concrete, precise, and measureable statement.
6. Strategies to attain the objective. Indicate state program strategies or means to achieve the stated
objective.
7. Annual Performance Indicators to measure success on a yearly basis. Each indicator must reflect
progress on a measure that is impacted by the block grant. After indicator is completed with the
information for the first indicator below, the table will expand to enter additional indicators. For
each performance indicator, specify the following components:
a) Baseline measurement from where the state assesses progress
b) First-year target/outcome measurement (Progress to the end of SFY 2018);
25

c)
d)
e)
f)

Second-year target/outcome measurement (Final to the end of SFY2019);
Data source;
Description of data; and
Data issues/caveats that affect outcome measures.

Plan Table 1: Priority Area and Annual Performance Indicators
1. Priority Area:

Priority Type (SAP, SAT, MHS):

3. Population(s) (SMI, SED, ESMI, PWWDC, PP, PWID, EIS/HIV, TB, OTHER):
4. Goal of the priority area:
5. Objective:
6. Strategies to attain the objective:

7. Annual Performance Indicators to measure achievement of the objective:
Indicator #1:
a) Baseline measurement (Initial data collected prior to and during SFY 2018):
b) First-year target/outcome measurement (Progress to the end of SFY 2018):
c) Second-year target/outcome measurement (Final to the end of SFY 2019):
d) Data source:
e) Description of data:
f) Data issues/caveats that affect outcome measures:

SAMHSA will work with states to monitor whether they are meeting the goals, objectives and
performance indicators established in their plans, and to provide technical assistance as needed.
SAMHSA staff will work closely with states during the year to discuss progress, identify barriers, and
develop solutions to address these barriers.
If a state is unable to achieve its goals and objectives as stated in its application(s) approved by
SAMHSA, the state will be asked to provide a description of corrective actions to be taken. If further
steps are not taken, SAMHSA may ask the state for a revised plan, which SAMHSA will assist in
developing, to achieve its goals and objectives. States that do not choose to apply for the MHBG or
SABG will have their funds redirected to other states as provided in statute.23

23

http://www.samhsa.gov/grants/block-grants/laws-regulations

26

Plan Table 2: State Agency Planned Expenditures
States must project how the SMHA and/or the SSA will use available funds to provide authorized services for the planning period for
state fiscal years 2018/2019.
Plan Table 2

State Agency Planned Expenditures
(Include ONLY funds expended by the executive branch agency administering the SABG and/or the MHBG*)

Planning Period- From:

To:

State Identifier:
Source of Funds
ACTIVITY
(See instructions for using Row 1.)

A.
SABG

1.

Substance Abuse Prevention* and
Treatment
a. Pregnant Women and Women
with Dependent Children*
b.

2.

All Other

Primary Prevention**
a. Substance Abuse Primary
Prevention
b. Mental Health Primary
prevention***

B.
MH BG

C. Medicaid
(Federal, State,
and local)

D. Other Federal
Funds (e.g., ACF
(TANF), CDC, CMS
(Medicare) SAMHSA,
etc.)

E. State
funds

F. Local funds
(excluding local
Medicaid)

G. Other

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

3. Evidence-Based Practices for Early
Serious Mental Illness (10 percent of total
award MHBG)****

$

4.

Tuberculosis Services

$

$

$

$

$

$

5.

Early Intervention Services for HIV

$

$

$

$

$

$

6.

State Hospital

$

$

$

$

$

7.

Other 24-Hour Care

$

$

$

$

$

$

8.

Ambulatory/Community Non-24 Hour
Care

$

$

$

$

$

$

9.

Administration (excluding program /
provider level) MHBG and SABG
must be reported separately

$

$

$

$

$

$

$

27

10. Subtotal (Rows 1, 2, , 4, 5 and 9)

$

$

$

$

$

$

$

11.

$

$

$

$

$

$

$

$

$

$

$

$

$

$

Subtotal (Rows 3, 6, 7, and 8)

12. Total

* Prevention other than primary prevention.
**The 20 percent set aside funds in the SABG must be used for activities designed to prevent substance misuse.
***While a state may use state or other funding for these services, the MHBG funds must be directed toward adults with SMI or children with SED.
**** Column 3B should include Early Serious Mental Illness programs funded through MHBG set aside

Plan Table 3: SABG Persons in need/receipt of SUD treatment
Instructions to complete Table 3
In order to complete column B of the table, please refer to the most recent edition of SAMHSA’s National Survey on Drug Use and
Health (NHSDUH) or other federal/state data that describes the populations of focus in rows 1-5.
In order to complete column C of the table, please refer to the most recent Treatment Episode Data Set (TEDS) data prepared and
submitted to SAMHSA’s Behavioral Health Services Information System (BHSIS) contractor, Synectics for Management Decisions,
Inc. (SMDI).
Please provide an explanation for any data cells for which the state does not have a data source.
Plan Table 3

SABG Persons in need/receipt of SUD treatment

State Identifier:
Aggregate number estimated in need
1.

Pregnant Women

2.

Women with Dependent Children

3.

Individuals with a co-occurring M/SUD

4.

Persons who inject drugs

5. Persons experiencing homelessness

28

Aggregate number in treatment

Plan Table 4: SABG Planned Expenditures.
States must project how they will use SABG funds to provide authorized services as required by the SABG regulations. Plan Table 4
must be completed for the FFY 2018 and FFY 2019 SABG awards.
Plan Table 4

SABG Planned Expenditures

State Identifier:
Expenditure Category

FFY 2018 SA Block Grant Award

FFY 2019 SA Block Grant Award

1.

Substance Abuse Prevention* and Treatment

$

$

2.

Primary Substance Abuse Prevention

$

$

3.

Early Intervention Services for HIV24

$

$

4.

Tuberculosis Services

$

$

5.

Administration (SSA level only)

$

$

6.

Total
* Prevention other than Primary Prevention

$

$

24

For the purpose of determining the states and jurisdictions that are considered “designated states” as described in section 1924(b)(2) of Title XIX, Part B, Subpart II of the Public
Health Service Act (42 U.S.C. § 300x-24(b)(2)) and section 45 CFR § 96.128(b) of the Substance Abuse Prevention and Treatment Block Grant; Interim Final Rule (45 CFR 96.120137), SAMHSA relies on the HIV Surveillance Report produced by the Centers for Disease Control and Prevention (CDC,), National Center for HIV/AIDS, Viral Hepatitis, STD and
TB Prevention. The most recent HIV Surveillance Report will be published on or before October 1 of the federal fiscal year for which a state is applying for a grant is used to
determine the states and jurisdictions that will be required to set-aside 5 percent of their respective SABG allotments to establish one or more projects to provide early intervention
services for regarding the human immunodeficiency virus (EIS/HIV) at the sites at which individuals are receiving SUD treatment services. In FY 2012, SAMHSA developed and
disseminated a policy change applicable to the EIS/HIV which provided any state that was a “designated state” in any of the three years prior to the year for which a state is applying
for SABG funds with the flexibility to obligate and expend SABG funds for EIS/HIV even though the state a state’s AIDS case rate does not meet the AIDS case rate threshold for the
fiscal year involved for which a state is applying for SABG funds. Therefore, any state with an AIDS case rate below 10 or more such cases per 100,000 that meets the criteria
described in the 2012 policy guidance will be allowed to obligate and expend SABG funds for EIS/HIV if they chose to do so.

29

Table 5a and 5b - Primary Prevention Planned Expenditures
States must spend no less than 20 percent of their SABG allotment on substance use disorder primary prevention
strategies. These strategies are directed at individuals not identified to be in need of treatment. To report on
their primary prevention planned expenditures, states must complete either Table 5a or Table 5b or may choose
to complete both. If Table 5b is completed, the state must also complete Section 1926 –Tobacco on Table 5a.
Table 5a SABG Primary Prevention Planned Expenditures
The state’s primary prevention program must include, but is not limited to, the six primary prevention strategies
defined below. On Table 5a, states should list their FFY 2018 and FFFY 2019 SABG planned expenditures for
each of the six primary prevention strategies. Expenditures within each of the six strategies should be directly
associated with the cost of completing the activity or task; for example, information dissemination should
include the cost of developing pamphlets, the time of participating staff or the cost of public service
announcements, etc. If a state plans to use strategies not covered by these six categories, please report them
under “Other” in Table 5a.
In most cases, the total amounts should equal the amounts reported on Plan Table 4, Row 2, Primary Prevention.
The one exception is if the state chooses to use a portion of the primary prevention set-aside to fund Non Direct
Services/System Development activities.
If the state chooses to report activities utilizing the IOM Model of Universal, Selective, and Indicated, complete
Form 5b. If Form 5b is completed, the state must also complete Section 1926 –Tobacco on Form 5a.
Table 5b SABG Primary Prevention Planned Expenditures by IOM Category
Information Dissemination– This strategy provides knowledge and increases awareness of the nature and
extent of alcohol and other drug use, abuse, and addiction, as well as their effects on individuals, families, and
communities. It also provides knowledge and increases awareness of available prevention and treatment
programs and services. It is characterized by one-way communication from the source to the audience, with
limited contact between the two.
Education - This strategy builds skills through structured learning processes. Critical life and social skills
include decision making, peer resistance, coping with stress, problem solving, interpersonal communication, and
systematic and judgmental abilities. There is more interaction between facilitators and participants than in the
information strategy.
Alternatives - This strategy provides participation in activities that exclude alcohol and other drugs. The
purpose is to meet the needs filled by alcohol and other drugs with healthy activities and to discourage the use of
alcohol and drugs through these activities.
Problem Identification and Referral - This strategy aims at identification of those who have indulged in
illegal/age-inappropriate use of tobacco or alcohol and those individuals who have indulged in the first use of
illicit drugs in order to assess if their behavior can be reversed through education. It should be noted, however,
that this strategy does not include any activity designed to determine if a person is in need of treatment.
Community-based Process - This strategy provides ongoing networking activities and technical assistance to
community groups or agencies. It encompasses neighborhood-based, grassroots empowerment models using
action planning and collaborative systems planning.

30

Environmental - This strategy establishes or changes written and unwritten community standards, codes, and
attitudes; thereby, influencing alcohol and other drug use by the general population.
Other - The six primary prevention strategies have been designed to encompass nearly all of the prevention
activities. However, in the unusual case an activity does not fit one of the six strategies, it may be classified in
the “Other” category.
Section 1926 - Tobacco: Costs Associated with the Synar Program. Per January 19, 1996, 45 CFR Part 96
Tobacco Regulation for Substance Abuse Prevention and Treatment Block Grants; Final Rule (45 CFR §
96.130), states may not use the Block Grant to fund the enforcement of their statute, except that they may
expend funds from their primary prevention set aside of their 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.
In addition, prevention strategies may be classified using the IOM Model of Universal, Selective, and Indicated,
which classifies preventive interventions by the population targeted. Definitions for these categories appear
below:
Universal: Activities targeted to the public or a whole population group that has not been identified based on
individual risk.
Selective: Activities targeted to individuals or a subgroup of the population whose risk of developing a disorder
is significantly higher than average.
Indicated: Activities targeted to individuals in high-risk environments, identified as having minimal but
detectable signs or symptoms foreshadowing disorder or having biological markers indicating predisposition for
disorder but not meeting diagnostic levels (Adapted from The Institute of Medicine).
States that are able to report on both the strategy type and the population served (universal, selective, or
indicated) should do so. If planned expenditure information is only available by strategy type, then the state
should report planned expenditures in the row titled Unspecified (for example, Information Dissemination
Unspecified).

31

Plan Table 5a: SABG Primary Prevention Planned Expenditures
State Identifier:
Report Period- From:
To:
A
B
Strategy
IOM Target
FFY 2018 SA
Block Grant
Award
1. Information Dissemination
Universal
$
Selected
$
Indicated
$
Unspecified
$
2. Education
Universal
$
Selected
$
Indicated
$
Unspecified
$
3. Alternatives
Universal
$
Selected
$
Indicated
$
Unspecified
$
4. Problem Identification and
Universal
$
Referral
Selected
$
Indicated
$
Unspecified
$
5. Community-Based Processes
Universal
$
Selected
$
Indicated
$
Unspecified
$
6. Environmental
Universal
$
Selected
$
Indicated
$
Unspecified
$
7. Section 1926-Tobacco
Universal
$
Selected
$
Indicated
$
Unspecified
$
8. Other
Universal
$
Selected
$
Indicated
$
Unspecified
$
9. Total Prevention
$
Expenditures
Total SABG Award
Planned Primary Prevention
Percentage

$
%

C
FFY 2019 SA
Block Grant
Award
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$

$
%

32

Table 5b SABG Primary Prevention Planned Expenditures by IOM Category
Table 5b Instructions: States that plan their primary prevention expenditures using the IOM model of
universal, selective, and indicated should use Table 5b to list their FFY 2018 and FFFY 2019 SABG planned
expenditures in each of these categories. Note that if Form 5b is completed instead of Form 5a, the state must
also complete Section 1926 - Tobacco on Form 5a. In most cases, the total amount should equal the amounts
reported on Plan Table 3, Row 2, Primary Prevention. The one exception is if the state chooses to use a portion
of the primary prevention set-aside to fund Non Direct Services/System Development activities.

Institute of Medicine Classification: Universal, Selective, and Indicated:
Universal: Activities targeted to the public or a whole population group that have not been identified on the
basis of individual risk.
Universal Direct. Row 1 - Intervention s directly serve an identifiable group of participants but who have
not been identified on the basis of individual risk (e.g., school curriculum, after-school program, parenting
class). This also could include interventions involving interpersonal and ongoing/repeated contact (e.g.,
coalitions).
Universal Indirect. Row 2 - Interventions support population-based programs and environmental strategies
(e.g., establishing ATOD policies, modifying ATOD advertising practices). This also could include
interventions involving programs and policies implemented by coalitions.
Selective: Activities targeted to individuals or a subgroup of the population whose risk of developing a
disorder is significantly higher than average.
Indicated: Activities targeted to individuals in high-risk environments, identified as having minimal but
detectable signs or symptoms foreshadowing disorder or having biological markers indicating
predisposition for disorder but not meeting diagnostic levels (Adapted from The Institute of Medicine).
Plan Table 5b: SABG Primary Prevention Planned
Expenditures by IOM Category
State Identifier:
Activity
Universal Direct
Universal Indirect
Selective
Indicated
Column Total
Total SABG
Award
Planned Primary
Prevention
Percentage

FFY 2018
SA Block
Grant Award
$
$
$
$
$
$

FFY 2019
SA Block
Grant Award
$
$
$
$
$
$

%

%

33

Plan Table 5c: SABG Planned Primary Prevention Targeted Priorities
States should identify the categories of substances the state BG plans to target with primary prevention set-aside
dollars from the FFY 2018 and FFY 2019 SABG awards.
Targeted Substances
Alcohol
Tobacco
Marijuana
Prescription Drugs
Cocaine
Heroin
Inhalants
Methamphetamine
Synthetic Drugs (i.e. Bath salts,
Spice, K2)
Instructions: In the table below, identify the special population categories the state BG plans to targets with primary
prevention set-aside dollars.
Targeted Populations
Students in College
Military Families
LGBT
American Indians/Alaska Natives
African American
Hispanic
Homeless
Native Hawaiian/Other Pacific Islanders
Asian
Rural
Underserved Racial and Ethnic
Minorities

34

Plan Table 6
Categories for Expenditures for System Development/Non-Direct-Service Activities
Expenditures for these activities may be direct expenditures (involving the time of state or substate personnel, or other state or sub-state resources) or be through funding mechanisms with
independent organizations. Expenditures may come from the administrative funds and/ or
program funds (but may not include the HIV set-aside funds). These include state, regional, and
local personnel salaries prorated for time spent and operating costs such as travel, printing,
advertising, and conducting meetings related to the categories below.
Non-direct services/system development activities exclude expenditures through funding
mechanisms for providing treatment or mental health “direct service” and primary prevention
efforts themselves. Instead, these expenditures provide support to those activities.
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 SABG 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 – if the
primary purpose is to assure the implementation of EBPs, 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
EHRs 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, and 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.
35

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 peerreview 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.
Please enter the total amount of the block grant expended for each activity.
Non-Direct-Services/System Development
SABG/MHBG Table 6
State Identifier:
Report Period- From:
Activity

To:
A. MHBG

B. SABG
Treatment

C. SABG
Prevention

D. SABG
Combined
*

1.

Information Systems

$

$

$

$

2.

Infrastructure Support

$

$

$

$

3.

Partnerships, community outreach, and needs
assessment
Planning Council Activities (MHBG required, SABG
optional)

$

$

$

$

$

$

$

$

4.

5.

Quality assurance and improvement

$

$

$

$

6.

Research and Evaluation

$

$

$

$

7.

Training and Education

$

$

$

$

8.

Total

$

$

$

$

*Combined refers to non-direct service/system development expenditures that support both treatment and
prevention systems

36

C. Environmental Factors and Plan
1.

The Health Care System, Parity and Integration - Question 1 and 2 are Required

Persons with mental illness and persons with substance use disorders are likely to die earlier than
those who do not have these conditions.25 Early mortality is associated with broader health
disparities and health equity issues such as socioeconomic status but “[h]ealth system factors”
such as access to care also play an important role in morbidity and mortality among these
populations. Persons with mental illness and substance use disorders may benefit from strategies
to control weight, encourage exercise, and properly treat such chronic health conditions as
diabetes and cardiovascular disease.26 It has been acknowledged that there is a high rate of cooccurring M/SUD, with appropriate treatment required for both conditions.27
Currently, 50 states have organizationally consolidated their mental and substance use disorder
authorities in one fashion or another with additional organizational changes under
consideration. More broadly, SAMHSA and its federal partners understand that such factors
as education, housing, and nutrition strongly affect the overall health and well-being of
persons with mental illness and substance use disorders.28 SMHAs and SSAs may wish to
develop and support partnerships and programs to help address social determinants of health
and advance overall health equity.29 For instance, some organizations have established
medical-legal partnerships to assist persons with mental and substance use disorders in
meeting their housing, employment, and education needs.30
Health care professionals and persons who access M/SUD treatment services recognize the
need for improved coordination of care and integration of physical and behavioral health with
other health care in primary, specialty, emergency and rehabilitative care settings in the
community. For instance, the National Alliance for Mental Illness has published materials for

25

BG Druss et al. Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally
representative US survey. Med Care. 2011 Jun; 49(6):599-604; Bradley Mathers, Mortality among people who inject drugs: a
systematic review and meta-analysis, Bulletin of the World Health Organization, 2013; 91:102–123
http://www.who.int/bulletin/volumes/91/2/12-108282.pdf; MD Hert et al., Physical illness in patients with severe mental
disorders. I. Prevalence, impact of medications and disparities in health care, World Psychiatry. Feb 2011; 10(1): 52–77
26
Research Review of Health Promotion Programs for People with SMI, 2012, http://www.integration.samhsa.gov/healthwellness/wellnesswhitepaper; About SAMHSA’s Wellness Efforts,
http://www.promoteacceptance.samhsa.gov/10by10/default.aspx; JW Newcomer and CH Hennekens, Severe Mental Illness and
Risk of Cardiovascular Disease, JAMA; 2007; 298: 1794-1796; Million Hearts, http://www.integration.samhsa.gov/healthwellness/samhsa-10x10; Schizophrenia as a health disparity, http://www.nimh.nih.gov/about/director/2013/schizophrenia-as-ahealth-disparity.shtml
27
Comorbidity: Addiction and other mental illnesses, http://www.drugabuse.gov/publications/comorbidity-addiction-othermental-illnesses/why-do-drug-use-disorders-often-co-occur-other-mental-illnesses Hartz et al., Comorbidity of Severe Psychotic
Disorders With Measures of Substance Use, JAMA Psychiatry. 2014; 71(3):248-254. doi:10.1001/jamapsychiatry.2013.3726;
http://www.samhsa.gov/co-occurring/
28
Social Determinants of Health, Healthy People 2020,
http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39;
http://www.cdc.gov/socialdeterminants/Index.html
29
30

http://www.samhsa.gov/health-disparities/strategic-initiatives
http://medical-legalpartnership.org/mlp-response/how-civil-legal-aid-helps-health-care-address-sdoh/

37

members to assist them in coordinating pediatric mental health and primary care.31
SAMHSA and its partners support integrated care for persons with mental illness and
substance use disorders.32 The state should illustrate movement towards integrated systems of
care for individuals and families with co-occurring mental and substance use disorders. The
plan should describe attention to management, funding, payment strategies that foster cooccurring capability for services to individuals and families with co-occurring mental and
substance use disorders. Strategies supported by SAMHSA to foster integration of physical
and behavioral health include: developing models for inclusion of behavioral health treatment
in primary care; supporting innovative payment and financing strategies and delivery system
reforms such as ACOs, health homes, pay for performance, etc.; promoting workforce
recruitment, retention and training efforts; improving understanding of financial sustainability
and billing requirements; encouraging collaboration between M/SUD providers, prevention of
teen pregnancy, youth violence, Medicaid programs, and primary care providers such as
Federally Qualified Health Centers; and sharing with consumers information about the full
range of health and wellness programs.
Health information technology, including EHRs and telehealth are examples of important
strategies to promote integrated care.33 Use of EHRs – in full compliance with applicable
legal requirements – may allow providers to share information, coordinate care, and improve
billing practices. Telehealth is another important tool that may allow behavioral health
prevention, treatment, and recovery to be conveniently provided in a variety of settings,
helping to expand access, improve efficiency, save time, and reduce costs. Development and
use of models for coordinated, integrated care such as those found in health homes34 and
ACOs35 may be important strategies used by SMHAs and SSAs to foster integrated care.
31

Integrating Mental Health and Pediatric Primary Care, A Family Guide, 2011.
http://www.nami.org/Content/ContentGroups/CAAC/FG-Integrating.pdf; Integration of Mental Health, Addictions and Primary
Care, Policy Brief, 2011,
http://www.nami.org/Content/NavigationMenu/State_Advocacy/About_the_Issue/Integration_MH_And_Primary_Care_2011.pdf
; Abrams, Michael T. (2012, August 30). Coordination of care for persons with substance use disorders under the Affordable
Care Act: Opportunities and Challenges. Baltimore, MD: The Hilltop Institute, UMBC.
http://www.hilltopinstitute.org/publications/CoordinationOfCareForPersonsWithSUDSUnderTheACA-August2012.pdf; Bringing
Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs and Outcomes, American Hospital
Association, Jan. 2012, http://www.aha.org/research/reports/tw/12jan-tw-behavhealth.pdf; American Psychiatric Association,
http://www.psych.org/practice/professional-interests/integrated-care; Improving the Quality of Health Care for Mental and
Substance-Use Conditions: Quality Chasm Series ( 2006), Institute of Medicine, National Affordable Care Academy of Sciences,
http://books.nap.edu/openbook.php?record_id=11470&page=210; State Substance Abuse Agency and Substance Abuse Program
Efforts Towards Healthcare Integration: An Environmental Scan, National Association of State Alcohol/Drug Abuse Directors,
2011, http://nasadad.org/nasadad-reports
32
Health Care Integration, http:// samhsa.gov/health-reform/health-care-integration; SAMHSA-HRSA Center for Integrated
Health Solutions, (http://www.integration.samhsa.gov/)
33
Health Information Technology (HIT), http://www.integration.samhsa.gov/operations-administration/hit; Characteristics of
State Mental Health Agency Data Systems, SAMHSA, 2009, http://store.samhsa.gov/product/Characteristics-of-State-MentalHealth-Agency-Data-Systems/SMA08-4361; Telebehavioral Health and Technical Assistance Series,
http://www.integration.samhsa.gov/operations-administration/telebehavioral-health; State Medicaid Best Practice, Telemental
and Behavioral Health, August 2013, American Telemedicine Association, http://www.americantelemed.org/docs/defaultsource/policy/ata-best-practice--telemental-and-behavioral-health.pdf?sfvrsn=8; National Telehealth Policy Resource Center,
http://telehealthpolicy.us/medicaid; telemedicine, http://www.medicaid.gov/Medicaid-CHIP-Program-Information/ByTopics/Delivery-Systems/Telemedicine.html
34
Health Homes, http://www.integration.samhsa.gov/integrated-care-models/health-homes
35
New financing models, http://www.samhsa.gov/co-occurring/topics/primary-care/financing_final.aspx

38

Training and assisting behavioral health providers to redesign or implement new provider
billing practices, build capacity for third-party contract negotiations, collaborate with health
clinics and other organizations and provider networks, and coordinate benefits among multiple
funding sources may be important ways to foster integrated care. SAMHSA encourages
SMHAs and SSAs to communicate frequently with stakeholders, including policymakers at
the state/jurisdictional and local levels, and State Mental Health Planning Council members
and consumers, about efforts to foster health care coverage, access and integrate care to ensure
beneficial outcomes.
SMHAs and SSAs also may work with state Medicaid agencies, state insurance
commissioners, and professional organizations to encourage development of innovative
demonstration projects, alternative payment methodologies, and waivers/state plan
amendments that test approaches to providing integrated care for persons with M/SUD and
other vulnerable populations.36 Ensuring both Medicaid and private insurers provide required
preventive benefits also may be an area for collaboration.37
One key population of concern is persons who are dually eligible for Medicare and
Medicaid.38 Roughly, 30 percent of persons who are dually eligible have been diagnosed with
a mental illness, more than three times the rate among those who are not dually eligible.39
SMHAs and SSAs also should collaborate with state Medicaid agencies and state insurance
commissioners to develop policies to assist those individuals who experience health insurance
coverage eligibility changes due to shifts in income and employment.40 Moreover, even with
expanded health coverage available through the Marketplace and Medicaid and efforts to
ensure parity in health care coverage, persons with behavioral health conditions still may
experience challenges in some areas in obtaining care for a particular condition or in finding a
provider.41 SMHAs and SSAs should remain cognizant that health disparities may affect
access, health care coverage and integrated care of behavioral health conditions and work with
partners to mitigate regional and local variations in services that detrimentally affect access to
36

Waivers, http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers.html; Coverage and
Service Design Opportunities for Individuals with Mental Illness and Substance Use Disorders, CMS Informational Bulletin,
Dec. 2012, http://medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-12-03-12.pdf
37
What are my preventive care benefits? https://www.healthcare.gov/what-are-my-preventive-care-benefits/; Interim Final Rules
for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection
and Affordable Care Act, 75 FR 41726 (July 19, 2010); Group Health Plans and Health Insurance Issuers Relating to Coverage of
Preventive Services Under the Patient Protection and Affordable Care Act, 76 FR 46621 (Aug. 3, 2011); Preventive services
covered under the Affordable Care Act, http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html
38
Medicare-Medicaid Enrollee State Profiles, http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-MedicaidCoordination/Medicare-Medicaid-Coordination-Office/StateProfiles.html; About the Compact of Free Association,
http://uscompact.org/about/cofa.php
39
Dual-Eligible Beneficiaries of Medicare and Medicaid: Characteristics, Health Care Spending, and Evolving Policies, CBO,
June 2013, http://www.cbo.gov/publication/44308
40
BD Sommers et al. Medicaid and Marketplace Eligibility Changes Will Occur Often in All States; Policy Options can Ease
Impact. Health Affairs. 2014; 33(4): 700-707
41
TF Bishop. Acceptance of Insurance by Psychiatrists and the Implications for Access to Mental Health Care, JAMA
Psychiatry. 2014;71(2):176-181; JR Cummings et al, Race/Ethnicity and Geographic Access to Medicaid Substance Use
Disorder Treatment Facilities in the United States, JAMA Psychiatry. 2014; 71(2):190-196; JR Cummings et al. Geography and
the Medicaid Mental Health Care Infrastructure: Implications for Health Reform. JAMA Psychiatry. 2013; 70(10):1084-1090;
JW Boyd et al. The Crisis in Mental Health Care: A Preliminary Study of Access to Psychiatric Care in Boston. Annals of
Emergency Medicine. 2011; 58(2): 218

39

care and integration.
SMHAs and SSAs should work with partners to ensure recruitment of diverse, well-trained
staff and promote workforce development and ability to function in an integrated care
environment.42 Psychiatrists, psychologists, social workers, addiction counselors,
preventionists, therapists, technicians, peer support specialists, and others will need to
understand integrated care models, concepts, and practices.
Parity is vital to ensuring persons with mental health conditions and substance use disorders
receive continuous, coordinated, care. Increasing public awareness about MHPAEA could
increase access to behavioral health services, provide financial benefits to individuals and
families, and lead to reduced confusion and discrimination associated with mental illness and
substance use disorders. Block grant recipients should continue to monitor federal parity
regulations and guidance and collaborate with state Medicaid authorities, insurance regulators,
insurers, employers, providers, consumers and policymakers to ensure effective parity
implementation and comprehensive, consistent communication with stakeholders. The SSAs,
SMHAs and their partners may wish to pursue strategies to provide information, education, and
technical assistance on parity-related issues. Medicaid programs will be a key partner for
recipients of MHBG and SABG funds and providers supported by these funds. The SSAs and
SMHAs should collaborate with their states’ Medicaid authority in ensuring parity within
Medicaid programs.
SAMHSA encourages states to take proactive steps to improve consumer knowledge about
parity. As one plan of action, states can develop communication plans to provide and address
key issues.
Another key part of integration will be defining performance and outcome measures. The
Department of Health and Human Services (HHS) and partners have developed the National
Quality Strategy, which includes information and resources to help promote health, good
outcomes, and patient engagement. SAMHSA’s National Behavioral Health Quality
Framework includes core measures that may be used by providers and payers.43
SAMHSA recognizes that certain jurisdictions receiving block grant funds – including U.S.
Territories, tribal entities and those jurisdictions that have signed a Compact of Free
Association with the United States and are uniquely impacted by certain Medicaid provisions
or are ineligible to participate in certain programs.44 However, these jurisdictions should
collaborate with federal agencies and their governmental and non-governmental partners to
42

Hoge, M.A., Stuart, G.W., Morris, J., Flaherty, M.T., Paris, M. & Goplerud E. Mental health and addiction workforce
development: Federal leadership is needed to address the growing crisis. Health Affairs, 2013; 32 (11): 2005-2012; SAMHSA
Report to Congress on the Nation’s Substance Abuse and Mental Health Workforce Issues, January 2013,
http://store.samhsa.gov/shin/content/PEP13-RTC-BHWORK/PEP13-RTC-BHWORK.pdf; Annapolis Coalition, An Action Plan
for Behavioral Health Workforce Development, 2007, http://annapoliscoalition.org/?portfolio=publications; Creating jobs by
addressing primary care workforce needs, http://www.hhs.gov/healthcare/facts/factsheets/2013/06/jobs06212012.html
43
About the National Quality Strategy, http://www.ahrq.gov/workingforquality/about.htm; National Behavioral Health Quality
Framework, Draft, August 2013, http://samhsa.gov/data/NBHQF
44
Letter to Governors on Information for Territories Regarding the Affordable Care Act, December 2012,
http://www.cms.gov/cciio/resources/letters/index.html; Affordable Care Act, Indian Health Service, http://www.ihs.gov/ACA/

40

expand access and coverage. Furthermore, the jurisdiction should ensure integration of
prevention, treatment, and recovery support for persons with, or at risk of, mental and
substance use disorders.
Please respond to the following items in order to provide a description of the healthcare system
and integration activities:
1. Describe how the state integrates mental health and primary health care, including services for
individuals with co-occurring mental and substance use disorders, in primary care settings or
arrangements to provide primary and specialty care services in community -based mental and
substance use disorders settings.

2. Describe how the state provide services and supports towards integrated systems of care for
individuals and families with co-occurring mental and substance use disorders, including
management, funding, payment strategies that foster co-occurring capability.

3. Is there a plan for monitoring whether individuals and families have access to M/SUD
services offered through QHPs
a)
Yes
No
and Medicaid
b)
Yes
No
2) Who is responsible for monitoring access to M/SUD services by the QHPs?

3) Is the SSA/SMHA involved in any coordinated care initiatives in the state?
Yes
No
4) Do the behavioral health providers screen and refer for:
a) Prevention and wellness education
Yes
No
b) Health risks such as
i) heart disease,
Yes
No
ii) hypertension,
Yes
No
41

iii) high cholesterol
iv) diabetes

Yes
Yes

No
No

c) Recovery supports
Yes
No
5) Is the SSA/SMHA involved in the development of alternative payment methodologies,
including risk-based contractual relationships that advance coordination of care?
Yes
No
6) Is the SSA and SMHA involved in the implementation and enforcement of parity protections
for mental and substance use disorder services?
Yes
No

7) What are the issues or problems that your state is facing related to the implementation and
enforcement of parity provisions?

8) Does the state have any activities related to this section that you would like to highlight?

\Please indicate areas of technical assistance needed related to this section

2.

Health Disparities - Requested

In accordance with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities45,

45

http://www.minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf

42

Healthy People, 202046, National Stakeholder Strategy for Achieving Health Equity47, and other
HHS and federal policy recommendations, SAMHSA expects block grant dollars to support
equity in access, services provided, and behavioral health outcomes among individuals of all
cultures, sexual/gender minorities, orientation and ethnicities. Accordingly, grantees should
collect and use data to: (1) identify subpopulations (i.e., racial, ethnic, limited English speaking,
tribal, sexual/gender minority groups, etc.) vulnerable to health disparities and (2) implement
strategies to decrease the disparities in access, service use, and outcomes both within those
subpopulations and in comparison to the general population. One strategy for addressing health
disparities is use of the recently revised National Standards for Culturally and Linguistically
Appropriate Services in Health and Health Care (CLAS).48
The Action Plan to Reduce Racial and Ethnic Health Disparities, which the HHS Secretary
released in April 2011, outlines goals and actions that HHS agencies, including SAMHSA, will
take to reduce health disparities among racial and ethnic minorities. Agencies are required to
assess the impact of their policies and programs on health disparities.
The HHS Secretary’s top priority in the Action Plan is to “[a]ssess and heighten the impact of
all HHS policies, programs, processes, and resource decisions to reduce health disparities.
HHS leadership will assure that program grantees, as applicable, will be required to submit
health disparity impact statements as part of their grant applications. Such statements can
inform future HHS investments and policy goals, and in some instances, could be used to score
grant applications if underlying program authority permits.”49
Collecting appropriate data is a critical part of efforts to reduce health disparities and promote
equity. In October 2011, HHS issued final standards on the collection of race, ethnicity,
primary language, and disability status.50 This guidance conforms to the existing Office of
Management and Budget (OMB) directive on racial/ethnic categories with the expansion of
intra-group, detailed data for the Latino and the Asian-American/Pacific Islander populations.51
In addition, SAMHSA and all other HHS agencies have updated their limited English
proficiency plans and, accordingly, will expect block grant dollars to support a reduction in
disparities related to access, service use, and outcomes that are associated with limited English
proficiency. These three departmental initiatives, along with SAMHSA’s and HHS’s attention
to special service needs and disparities within tribal populations, LGBT populations, and
women and girls, provide the foundation for addressing health disparities in the service
delivery system. States provide behavioral health services to these individuals with state block
grant dollars. While the block grant generally requires the use of evidence-based and
promising practices, it is important to note that many of these practices have not been normed
on various diverse racial and ethnic populations. States should strive to implement evidencebased and promising practices in a manner that meets the needs of the populations they serve.
In the block grant application, states define the populations they intend to serve. Within these
46
47
48

http://www.healthypeople.gov/2020/default.aspx
http://minorityhealth.hhs.gov/npa/files/Plans/NSS/NSSExecSum.pdf

http://www.ThinkCulturalHealth.hhs.gov

49

http://www.minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=208
51
http://www.whitehouse.gov/omb/fedreg_race-ethnicity
50

43

populations of focus are subpopulations that may have disparate access to, use of, or outcomes
from provided services. These disparities may be the result of differences in insurance coverage,
language, beliefs, norms, values, and/or socioeconomic factors specific to that subpopulation.
For instance, lack of Spanish primary care services may contribute to a heightened risk for
metabolic disorders among Latino adults with SMI; and American Indian/Alaska Native youth
may have an increased incidence of underage binge drinking due to coping patterns related to
historical trauma within the American Indian/Alaska Native community. While these factors
might not be pervasive among the general population served by the block grant, they may be
predominant among subpopulations or groups vulnerable to disparities.
To address and ultimately reduce disparities, it is important for states to have a detailed
understanding of who is and is not being served within the community, including in what
languages, in order to implement appropriate outreach and engagement strategies for diverse
populations. The types of services provided, retention in services, and outcomes are critical
measures of quality and outcomes of care for diverse groups. For states to address the
potentially disparate impact of their block grant funded efforts, they will address access, use,
and outcomes for subpopulations.
Please respond to the following items:
1) Does the state track access or enrollment in services, types of services received and outcomes

2)

3)

4)

5)

6)

7)

of these services by: race, ethnicity, gender, LGBT, and age?
a) race
Yes
No
b) Ethnicity
Yes
No
c) gender
Yes
No
d) sexual orientation
Yes
No
e) gender identity,
Yes
No
f) Age?
Yes
No
Does the state have a data-driven plan to address and reduce disparities in access, service use,
and outcomes for the above subpopulation?
Yes
No
Does the state have a plan to identify, address, and monitor linguistic disparities/language
barriers?
Yes
No
Does the state have a workforce-training plan to build the capacity of behavioral health
providers to identify disparities in access, services received, and outcomes and provide
support for improved culturally and linguistically competent outreach, engagement,
prevention, treatment, and recovery services for diverse populations?
Yes
No
If yes, does this plan include the Culturally and Linguistically Appropriate Services (CLAS)
Standards?
Yes
No
Does the state have a budget item allocated to identifying and remediating disparities in
behavioral health care?
Yes
No
Does the state have any activities related to this section that you would like to highlight?
44

Please indicate areas of technical assistance needed related to this section.

3.

Innovation in Purchasing Decisions - requested

While there are different ways to define value-based purchasing, the purpose is to identify
services, payment arrangements, incentives, and players that can be included in directed
strategies using purchasing practices that are aimed at improving the value of health care
services. In short, health care value is a function of both cost and quality:
Health Care Value = Quality ÷ Cost, (V = Q ÷ C)
SAMHSA anticipates that the movement toward value based purchasing will continue as
delivery system reforms continue to shape states systems. The identification and replication of
such value-based strategies and structures will be important to the development of behavioral
health systems and services.
There is increased interest in having a better understanding of the evidence that supports the
delivery of medical and specialty care including M/SUD services. Over the past several years,
SAMHSA has collaborated with CMS, HRSA, SMAs, state behavioral health authorities,
legislators, and others regarding the evidence of various mental and substance misuse
prevention, treatment, and recovery support services. States and other purchasers are
requesting information on evidence-based practices or other procedures that result in better
health outcomes for individuals and the general population. While the emphasis on evidencebased practices will continue, there is a need to develop and create new interventions and
technologies and in turn, to establish the evidence. SAMHSA supports states’ use of the
block grants for this purpose. The NQF and the IOM recommend that evidence play a critical
role in designing health benefits for individuals enrolled in commercial insurance, Medicaid,
and Medicare.
To respond to these inquiries and recommendations, SAMHSA has undertaken several
activities. NREPP assesses the research evaluating an intervention's impact on outcomes and
provides information on available resources to facilitate the effective dissemination and
implementation of the program. NREPP ratings take into account the methodological rigor of
45

evaluation studies, the size of a program's impact on an outcome, the degree to which a program
was implemented as designed, and the strength of a program's conceptual framework. For each
intervention reviewed, NREPP publishes a report called a program profile on this website. You
will find research on the effectiveness of programs as reviewed and rated by NREPP certified
reviewers. Each profile contains easily understandable ratings for individual outcomes based on
solid evidence that indicates whether a program achieved its goals. NREPP is not intended to
be an exhaustive listing of all evidence-based practices in existence.
SAMHSA reviewed and analyzed the current evidence for a wide range of interventions for
individuals with mental illness and substance use disorders, including youth and adults with
chronic addiction disorders, adults with SMI, and children and youth with SED. The evidence
builds on the evidence and consensus standards that have been developed in many national
reports over the last decade or more. These include reports by the Surgeon General,52 The New
Freedom Commission on Mental Health,53 the IOM,54 and the NQF. 55 The activity included a
systematic assessment of the current research findings for the effectiveness of the services using
a strict set of evidentiary standards. This series of assessments was published in “Psychiatry
Online.”56 SAMHSA and other federal partners, the HHS’ Administration for Children and
Families, Office for Civil Rights, and CMS, have used this information to sponsor technical
expert panels that provide specific recommendations to the behavioral health field regarding
what the evidence indicates works and for whom, to identify specific strategies for embedding
these practices in provider organizations, and to recommend additional service research.
In addition to evidence-based practices, there are also many promising practices in various
stages of development. Anecdotal evidence and program data indicate effectiveness for these
services. As these practices continue to be evaluated, the evidence is collected to establish
their efficacy and to advance the knowledge of the field.
SAMHSA’s Treatment Improvement Protocol Series (TIPS)57 are best practice guidelines for
the SUD treatment. The CSAT draws on the experience and knowledge of clinical, research,
and administrative experts to produce the TIPS, which are distributed to a growing number of
facilities and individuals across the country. The audience for the TIPS is expanding beyond
public and private SUD treatment facilities as alcohol and other drug disorders are increasingly
recognized as a major health problem.
SAMHSA’s Evidence-Based Practice Knowledge Informing Transformation (KIT)58 was
52

United States Public Health Service Office of the Surgeon General (1999). Mental Health: A Report of the Surgeon General.
Rockville, MD: Department of Health and Human Services, U.S. Public Health Service
53
The President’s New Freedom Commission on Mental Health (July 2003). Achieving the Promise: Transforming Mental
Health Care in America. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health
Services Administration.
54
Institute of Medicine Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders
(2006). Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series.
Washington, DC: National Academies Press.
55
National Quality Forum (2007). National Voluntary Consensus Standards for the Treatment of Substance Use
Conditions: Evidence-Based Treatment Practices. Washington, DC: National Quality Forum.
56

http://psychiatryonline.org/

57

http://store.samhsa.gov

58

http://store.samhsa.gov/shin/content//SMA08-4367/HowtoUseEBPKITS-ITC.pdf

46

developed to help move the latest information available on effective behavioral health practices
into community-based service delivery. States, communities, administrators, practitioners,
consumers of mental health care, and their family members can use KIT to design and
implement behavioral health practices that work. KIT, part of SAMHSA’s priority initiative on
Behavioral Health Workforce in Primary and Specialty Care Settings, covers getting started,
building the program, training frontline staff, and evaluating the program. The KITs contain
information sheets, introductory videos, practice demonstration videos, and training manuals.
Each KIT outlines the essential components of the evidence-based practice and provides
suggestions collected from those who have successfully implemented them.
SAMHSA is interested in whether and how states are using evidence in their purchasing
decisions, educating policymakers, or supporting providers to offer high quality services. In
addition, SAMHSA is concerned with what additional information is needed by SMHAs and
SSAs in their efforts to continue to shape their and other purchasers’ decisions regarding M/SUD
services.
Please respond to the following items:
1. Is information used regarding evidence-based or promising practices in your purchasing or
policy decisions?
Yes
No
2. Which value based purchasing strategies do you use in your state (check all that apply):
a)
Leadership support, including investment of human and financial resources.
b)
Use of available and credible data to identify better quality and monitored the impact
of quality improvement interventions.
c)
Use of financial and non-financial incentives for providers or consumers.
d)
Provider involvement in planning value-based purchasing.
e)
Use of accurate and reliable measures of quality in payment arrangements.
f)
Quality measures focus on consumer outcomes rather than care processes.
g)
Involvement in CMS or commercial insurance value based purchasing programs
(health homes, ACO, all payer/global payments, pay for performance (P4P)).
h)
The state has an evaluation plan to assess the impact of its purchasing decisions.
3. Does the state have any activities related to this section that you would like to highlight?

Please indicate areas of technical assistance needed related to this section.

47

Evidence-Based Practices for Early Interventions to Address Early Serious Mental
Illness (ESMI)-10 percent set aside - Required MHBG
4.

Much of the mental health treatment and recovery are focused on the later stages of illness,
intervening only when things have reached the level of a crisis. While this kind of treatment is
critical, it is also costly in terms of increased financial burdens for public mental health systems,
lost economic productivity, and the toll taken on individuals and families. There are growing
concerns among consumers and family members that the mental health system needs to do more
when people first experience these conditions to prevent long-term adverse consequences. Early
intervention* is critical to treating mental illness before it can cause tragic results like serious
impairment, unemployment, homelessness, poverty, and suicide. The duration of untreated
mental illness, defined as the time interval between the onset of a mental disorder and when an
individual gets into treatment, has been a predictor of outcome across different mental illnesses.
Evidence indicates that a prolonged duration of untreated mental illness may be viewed as a
negative prognostic factor for those who are diagnosed with mental illness. Earlier treatment and
interventions not only reduce acute symptoms, but may also improve long-term prognosis.
States may implement models that have demonstrated efficacy, including the range of services
and principles identified by National Institute of Mental Health (NIMH) via its Recovery After
an Initial Schizophrenia Episode (RAISE) initiative. Utilizing these principles, regardless of the
amount of investment, and by leveraging funds through inclusion of services reimbursed by
Medicaid or private insurance, states should move their system to address the needs of
individuals with a first episode of psychosis (FEP). NIMH sponsored a set of studies beginning
in 2008, focusing on the early identification and provision of evidence-based treatments to
persons experiencing FEP the RAISE model). The NIMH RAISE studies, as well as similar
early intervention programs tested worldwide, consist of multiple evidence-based treatment
components used in tandem as part of a CSC model, and have been shown to improve symptoms,
reduce relapse, and improved outcomes.
State shall expend not less than 10 percent of the amount the State receives for carrying out this
section for each fiscal year to support evidence-based programs that address the needs of
individuals with early serious mental illness, including psychotic disorders, regardless of the age
of the individual at onset. In lieu of expending 10 percent of the amount the State receives under
this section for a fiscal year as required a state may elect to expend not less than 20 percent of
such amount by the end of such succeeding fiscal year.

* MHBG funds cannot be used for primary prevention activities. States cannot use MHBG funds
for prodromal symptoms (specific group of symptoms that may precede the onset and diagnosis
of a mental illness) and/or those who are not diagnosed with a SMI.
48

1. Does the state have policies for addressing early serious mental illness (ESMI)?
Yes
No
2. Has the state implemented any evidence-based practices (EBPs) for those with ESMI
Yes
No
If yes, please list the EBPs and provide a description of the programs that the state currently
funds to implement evidence-based practices for those with ESMI

3. How does the state promote the use of evidence-based practices for individuals with ESMI and
provide comprehensive individualized treatment or integrated mental and physical health
services?

4. Does the state coordinate across public and private sector entities to coordinate treatment and
recovery supports for those with a FEP ESMI?
Yes
No

5. Does the state collect data specifically related to FEP ESMI?
Yes
No
6. Does the state provide trainings to increase capacity of providers to deliver interventions
related to ESMI?
Yes
No
7. Please provide an updated description of the state’s chosen EBPs for the 10 percent set-aside
for ESMI.

8. Please describe the planned activities for FFY 2018 and FFY 2019 for your state’s ESMI
programs including psychosis?
49

9. Please explain the state’s provision for collecting and reporting data, demonstrating the impact
of the 10 percent set-aside for ESMI.

10. Please list the diagnostic categories identified for your state’s ESMI programs

Please indicate area of technical assistance needed related to this section.

5.

Person Centered Planning (PCP) –Required (MHBG)

States must engage adults with a serious mental illness or children with a serious emotional
disturbance and their caregivers where appropriate in making health care decisions, including
activities that enhance communication among individuals, families, caregivers, and treatment
providers. Person-centered planning is a process through which individuals develop their plan of
service. The PCP may include a representative who the person has freely chosen, and/or who is
authorized to make personal or health decisions for the person. The PCP may include family
members, legal guardians, friends, caregivers and others that the person or his/her representative
wishes to include. The PCP should involve the person receiving services and supports to the
maximum extent possible, even if the person has a legal representative. The PCP approach
identifies the person’s strengths, goals, preferences, needs and desired outcome. The role of state
50

and agency workers (for example, options counselors, support brokers, social workers, peer
support workers, and others) in the PCP process is to enable and assist people to identify and
access a unique mix of paid and unpaid services to meet their needs and provide support during
planning. The person’s goals and preferences in areas such as recreation, transportation,
friendships, therapies, home, employment, family relationships, and treatments are part of a
written plan that is consistent with the person’s needs and desires.
1. Does your state have policies related to person centered planning?

Yes

No

2. If no, describe any action steps planned by the state in developing PCP initiatives in the
future.

3. Describe how the state engages consumers and their caregivers in making health care
decisions, and enhance communication.

4. Describe the person-centered planning process in your state.

6. Self-Direction - Requested
In self-direction - also known as self-directed care - a service user or “participant” controls a
flexible budget, purchasing goods and services to achieve personal recovery goals developed
through a person-centered planning process. While this is not an allowable use of Block Grant
Funds, the practice has shown to provide flexible supports for an individual’s service. The selfdirection budget may comprise the service dollars that would have been used to reimburse an
individual’s traditional mental health care, or it may be a smaller fixed amount that supplements
a mental health benefit. In self-direction, the participant allocates the budget in a manner of his
or her choosing within program guidelines. The participant is encouraged to think creatively
about setting goals and is given a significant amount of freedom to work toward those goals.
Purchases can range from computers and bicycles to dental care and outpatient mental health
treatment.
Typically, a specially trained coach or broker supports the participant to identify resources, chart
51

progress, and think creatively about the planning and budgeting processes. Often a peer
specialist who has received additional training in self-direction performs the broker role. The
broker or a separate agency assists the participant with financial management details such as
budget tracking, holding and disbursing funds, and hiring and payroll logistics. Self-direction
arrangements take different forms throughout the United States and are housed and administered
in a variety of entities, including county and state behavioral health authorities, managed care
companies, social service agencies, and advocacy organizations.
Self-direction is based on the premise that people with disabilities can and should make their
own decisions about the supports and services they receive. Hallmarks of self-direction include
voluntary participation, individual articulation of preferences and choices, and participant
responsibility. In recent years, physical and mental health service systems have placed
increasing emphasis on person-centered approaches to service delivery and organization. In this
context, self-direction has emerged as a promising practice to support recovery and well-being
for persons with mental health conditions. A small but growing evidence base has documented
self-direction’s impact on quality of life, community tenure, and psychological well-being.
Please respond to the following:
1. Does your state have policies related to self-direction?
Yes
No
2. Are there any concretely planned initiatives in your state specific to self-direction?
Yes
No
If yes, describe the current or planned initiative. In particular, please answer the
following questions:
a. How is the initiative financed?

b. What are the eligibility criteria?

c. How are budgets set, and what is the scope of the budget?

52

d. What role, if any, do peers with lived experience of the mental health system play in
the initiative?

e. What, if any, research and evaluation activities are connected to the initiative?

f. If no, describe any action steps planned by the state in developing self-direction
initiatives in the future.

7. Program Integrity - Required
SAMHSA has placed a strong emphasis on ensuring that block grant funds are expended in a
manner consistent with the statutory and regulatory framework. This requires that SAMHSA
and the states have a strong approach to assuring program integrity. Currently, the primary
goals of SAMHSA program integrity efforts are to promote the proper expenditure of block
grant funds, improve block grant program compliance nationally, and demonstrate the effective
use of block grant funds.
While some states have indicated an interest in using block grant funds for individual co-pays
deductibles and other types of co-insurance for behavioral health services, SAMHSA reminds
states of restrictions on the use of block grant funds outlined in 42 U.S.C. §§ 300x–5 and 300x31, including cash payments to intended recipients of health services and providing financial
assistance to any entity other than a public or nonprofit private entity. Under 42 U.S.C. § 300x–
55(g), SAMHSA periodically conducts site visits to MHBG and SABG grantees to evaluate
program and fiscal management. States will need to develop specific policies and procedures for
assuring compliance with the funding requirements. Since MHBG funds can only be used for
authorized services made available to adults with SMI and children with SED and SABG funds
can only be used for individuals with or at risk for SUD. SAMHSA guidance on the use of block
grant funding for co-pays, deductibles, and premiums can be found at:
http://www.samhsa.gov/sites/default/files/grants/guidance-for-block-grant-funds-for-cost53

sharing-assistance-for-private-health-insurance.pdf. States are encouraged to review the
guidance and request any needed technical assistance to assure the appropriate use of such funds.
The MHBG and SABG resources are to be used to support, not supplant, services that will be
covered through the private and public insurance. In addition, SAMHSA will work with CMS
and states to identify strategies for sharing data, protocols, and information to assist our
program integrity efforts. Data collection, analysis, and reporting will help to ensure that
MHBG and SABG funds are allocated to support evidence-based, culturally competent
programs, substance use disorder prevention, treatment and recovery programs, and activities
for adults with SMI and children with SED.
States traditionally have employed a variety of strategies to procure and pay for behavioral
health services funded by the MHBG and SABG. State systems for procurement, contract
management, financial reporting, and audit vary significantly. These strategies may include:
(1) appropriately directing complaints and appeals requests to ensure that QHPs and Medicaid
programs are including essential health benefits (EHBs) as per the state benchmark plan; (2)
ensuring that individuals are aware of the covered M/SUD benefits; (3) ensuring that
consumers of M/SUD services have full confidence in the confidentiality of their medical
information; and (4) monitoring the use of behavioral health benefits in light of utilization
review, medical necessity, etc. Consequently, states may have to become more proactive in
ensuring that state-funded providers are enrolled in the Medicaid program and have the ability
to determine if clients are enrolled or eligible to enroll in Medicaid. Additionally, compliance
review and audit protocols may need to be revised to provide for increased tests of client
eligibility and enrollment.
Please respond to the following:
1) Does the state have a specific policy and/or procedure for assuring that the federal program
requirements are conveyed to intermediaries and providers?
Yes
No
2) Does the state provide technical assistance to providers in adopting practices that promote
compliance with program requirements, including quality and safety standards?
Yes
No

3) Does the state have any activities related to this section that you would like to highlight?

Please indicate areas of technical assistance needed related to this section.

54

8. Tribes - Requested
The federal government has a unique obligation to help improve the health of American
Indians and Alaska Natives through the various health and human services programs
administered by HHS. Treaties, federal legislation, regulations, executive orders, and
Presidential memoranda support and define the relationship of the federal government with
federally recognized tribes, which is derived from the political and legal relationship that
Indian tribes have with the federal government and is not based upon race. SAMHSA is
required by the 2009 Memorandum on Tribal Consultation59 to submit plans on how it will
engage in regular and meaningful consultation and collaboration with tribal officials in the
development of federal policies that have tribal implications.
Improving the health and well-being of tribal nations is contingent upon understanding their
specific needs. Tribal consultation is an essential tool in achieving that understanding.
Consultation is an enhanced form of communication, which emphasizes trust, respect, and
shared responsibility. It is an open and free exchange of information and opinion among
parties, which leads to mutual understanding and comprehension. Consultation is integral to a
deliberative process that results in effective collaboration and informed decision-making with
the ultimate goal of reaching consensus on issues.
In the context of the block grant funds awarded to tribes, SAMHSA views consultation as a
government-to-government interaction and should be distinguished from input provided by
individual tribal members or services provided for tribal members whether on or off tribal
lands. Therefore, the interaction should be attended by elected officials of the tribe or their
designees and by the highest possible state officials. As states administer health and human
services programs that are supported with federal funding, it is imperative that they consult with
tribes to ensure the programs meet the needs of the tribes in the state. In addition to general
stakeholder consultation, states should establish, implement, and document a process for
consultation with the federally recognized tribal governments located within or governing tribal
lands within their borders to solicit their input during the block grant planning process.
Evidence that these actions have been performed by the state should be reflected throughout the
state’s plan. Additionally, it is important to note that approximately 70 percent of American
Indians and Alaska Natives do not live on tribal lands. The SMHAs, SSAs, and tribes should
collaborate to ensure access and culturally competent care for all American Indians and Alaska
Natives in the states.
States shall not require any tribe to waive its sovereign immunity in order to receive funds or
for services to be provided for tribal members on tribal lands. If a state does not have any
federally recognized tribal governments or tribal lands within its borders, the state should make
a declarative statement to that effect.

59

http://www.whitehouse.gov/the-press-office/memorandum-tribal-consultation-signed-president

55

Please respond to the following items:
1. How many consultation sessions have the state conducted with federally recognized tribes?

2. What specific concerns were raised during the consultation session(s) noted above?

Does the state have any activities related to this section that you would like to highlight?

Please indicate areas of technical assistance needed related to this section.

9. Primary Prevention-required (SABG only)
SABG statute requires states to spend not less than 20 percent of their SABG allotment on
primary prevention strategies directed at individuals not identified to be in need of treatment.
While primary prevention set-aside funds must be used to fund strategies that have a positive
impact on the prevention of substance use, it is important to note that many evidence-based
substance use disorder prevention strategies also have a positive impact on other health and
social outcomes such as education, juvenile justice involvement, violence prevention, and mental
health.
The SABG statute requires states to develop a comprehensive primary prevention program that
56

includes activities and services provided in a variety of settings. The program must target both
the general population and sub-groups that are at high risk for substance misuse. The program
must include, but is not limited to, the following strategies:
1. Information dissemination providing awareness and knowledge of the nature, extent, and
effects of alcohol, tobacco, and drug use, abuse, and addiction on individuals families and
communities;
2. Education aimed at affecting critical life and social skills, such as decision making, refusal
skills, critical analysis, and systematic judgment abilities;
3. Alternative programs that provide for the participation of target populations in activities
that exclude alcohol, tobacco, and other drug use;
4. Problem identification and referral that aims at identification of those who have indulged in
illegal/age inappropriate use of tobacco or alcohol, and those individuals who have indulged
in first use of illicit drugs, in order to assess if the behavior can be reversed by education to
prevent further use;
5. Community-based processes that include organizing, planning, and enhancing effectiveness
of program, policy, and practice implementation, interagency collaboration, coalition
building, and networking; and
6. Environmental strategies that establish or change written and unwritten community
standards, codes, and attitudes, thereby influencing incidence and prevalence of the abuse of
alcohol, tobacco and other drugs used in the general population.
In implementing the comprehensive primary prevention program, states should use a variety of
strategies that target populations with different levels of risk, including the IOM classified
universal, selective, and indicated strategies.

Please respond to the following questions:
Assessment
1. Does your state have an active State Epidemiological and Outcomes Workgroup (SEOW)?
a)
Yes
No
2. Does your state collect the following types of data as part of its primary prevention needs
assessment process? (check all that apply):
a)
Data on consequences of substance-using behaviors
b)
Substance-using behaviors
c)
d)

Intervening variables (including risk and protective factors)
Other (please list :)

57

3. Does your state collect needs assessment data that include analysis of primary prevention
needs for the following population groups? (check all that apply):
a)
Children (under age 12)
b)
Youth (ages 12-17)
c)
Young adults/college age (ages 18-26)
d)
Adults (ages 27-54)
e)
Older adults (age 55 and above)
f)
Cultural/ethnic minorities
g)
Sexual/gender minorities
h)
i)

Rural communities
Other (please list :)

4. Does your state use data from the following sources in its primary prevention needs
assessment? (check all that apply):
a)
Archival indicators (Please list :)

b)
c)
d)
e)
f)
g)
h)

National Survey on Drug Use and Health (NSDUH)
Behavioral Risk Factor Surveillance System (BRFSS)
Youth Risk Behavior Surveillance System (YRBS)
Monitoring the Future
Communities that Care
State-developed survey instrument)
Other (please list :)

58

5. Does your state use needs assessment data to make decisions about the allocation of SABG
primary prevention funds?
a)
Yes
No
i) If yes, (if yes, please explain

ii) If no, please explain how SABG funds are allocated:

Capacity Building
6. Does your state have a statewide licensing or certification program for the substance use
disorder prevention workforce?
a)
Yes (if yes, please describe)

b)

No

7. Does your state have a formal mechanism to provide training and technical assistance to the
substance use disorder prevention workforce?
a)
Yes (if yes, please describe mechanism used)

b)

No

59

8. Does your state have a formal mechanism to assess community readiness to implement
prevention strategies?
a)
Yes (if yes, please describe mechanism used :)

b)

No

Planning
9. Does your state have a strategic plan that addresses substance use disorder prevention that
was developed within the last five years?
a)
Yes (If yes, please attach the plan in BGAS)
b)
No
10. Does your state use the strategic plan to make decisions about use of the primary prevention
set-aside of the SABG?
a)
Yes
No
Not applicable (no prevention strategic plan)
11. Does your state’s prevention strategic plan include the following components? (check all
that apply):
a)
Based on needs assessment datasets the priorities that guide the allocation of
SABG primary prevention funds
b)
Timelines
c)
Roles and responsibilities
d)
Process indicators
e)
Outcome indicators
f)
Cultural competence component
g)
Sustainability component
h)
Other (please list:)

i)

Not applicable/no prevention strategic plan

12. Does your state have an Advisory Council that provides input into decisions about the use of
SABG primary prevention funds?
a)
Yes
No
60

13. Does your state have an active Evidence-Based Workgroup that makes decisions about
appropriate strategies to be implemented with SABG primary prevention funds?
a)
Yes
No
b) If yes, please describe the criteria the Evidence-Based Workgroup uses to determine
which programs, policies, and strategies are evidence based?

Implementation
14. States distribute SABG primary prevention funds in a variety of different ways. Please check
all that apply to your state:
a)
SSA staff directly implements primary prevention programs and strategies.
b)
The SSA has statewide contracts (e.g. statewide needs assessment contract, statewide
workforce training contract, statewide media campaign contract).
c)
The SSA funds regional entities that are autonomous in that they issue and manage
their own sub-contracts.
d)
The SSA funds regional entities that provide training and technical assistance.
e)
The SSA funds regional entities to provide prevention services.
f)
The SSA funds county, city, or tribal governments to provide prevention services.
g)
The SSA funds community coalitions to provide prevention services.
h)
The SSA funds individual programs that are not part of a larger community effort.
i)
The SSA directly funds other state agency prevention programs.
j)
Other (please describe)

15. Please list the specific primary prevention programs, practices, and strategies that are funded
with SABG primary prevention dollars in each of the six prevention strategies. Please see
the introduction above for definitions of the six strategies:
a) Information Dissemination:

b) Education:

61

c) Alternatives:

d) Problem Identification and Referral:

e) Community-Based Processes:

e) Environmental:

16. Does your state have a process in place to ensure that SABG dollars are used only to fund
primary prevention services not funded through other means?
a)
Yes (if so, please describe:)

b)

No

Evaluation
17. Does your state have an evaluation plan for substance use disorder prevention that was
developed within the last five years?
a)
Yes (If yes, please attach the plan in BGAS)
b)
No
18. Does your state’s prevention evaluation plan include the following components? (check all
that apply):
a)
Establishes methods for monitoring progress towards outcomes, such as targeted
benchmarks
62

b)
c)
d)
e)

Includes evaluation information from sub-recipients
Includes SAMHSA National Outcome Measurement (NOMs) requirements
Establishes a process for providing timely evaluation information to stakeholders
Formalizes processes for incorporating evaluation findings into resource allocation
and decision-making
f)
Other (please describe:)

g)

Not applicable/no prevention evaluation plan

19. Please check those process measures listed below that your state collects on its SABG funded
prevention services:
a)
Numbers served
b)
Implementation fidelity
c)
Participant satisfaction
d)
Number of evidence based programs/practices/policies implemented
e)
Attendance
f)
Demographic information
g)
Other (please describe:)

20. Please check those outcome measures listed below that your state collects on its SABG
funded prevention services:
a)
30-day use of alcohol, tobacco, prescription drugs, etc…
b)
Heavy use
Binge use
Perception of harm
c)
Disapproval of use
d)
Consequences of substance use (e.g. alcohol-related motor vehicle crashes, drugrelated mortality)
e)
Other (please describe:)

63

10. Statutory Criterion for MHBG (Required MHBG)
Criterion 1: Comprehensive Community-Based Mental Health Service Systems
Provides for the establishment and implementation of an organized community-based system of
care for individuals with mental illness, including those with co-occurring mental and substance
use disorders. Describes available services and resources within a comprehensive system of
care, provided with federal, state, and other public and private resources, in order to enable such
individual to function outside of inpatient or residential institutions to the maximum extent of
their capabilities.
1. Describe available services and resources in order to enable individuals with mental illness,
including those with co-occurring mental and substance use disorders to function outside of
inpatient or residential institutions to the maximum extent of their capabilities.

2. Does your state provide the following services under comprehensive community-based mental
health service systems?
a) Physical health
Yes
No
b) Mental Health
Yes
No
c) Rehabilitation services
Yes
No
d) Employment services
Yes
No
e) Housing services
Yes
No
f) Educational services
Yes
No
g) Substance misuse prevention and SUD treatment services
Yes
No
h) Medical and dental services
Yes
No
i) Support services
Yes
No
j) Services provided by local school systems under the Individuals with Disabilities
Education Act (IDEA)
64

Yes
No
k) Services for persons with co-occurring M/SUDs
Yes
No

Please describe as needed (for example, best practices, service needs, concerns, etc.)

3. Describe your state’s case management services

4. Describe activities intended to reduce hospitalizations and hospital stays.

Criterion 2: Mental Health System Data Epidemiology
Contains an estimate of the incidence and prevalence in the state of SMI among adults and SED
among children; and have quantitative targets to be achieved in the implementation of the system
of care described under Criterion 1.
In order to complete column B of the table, please use the most recent SAMHSA prevalence
estimate or other federal/state data that describes the populations of focus.
Column C requires that the state indicate the expected incidence rate of individuals with
SMI/SED who may require services in the state’s behavioral health system

MHBG Estimate of statewide prevalence and incidence rates of individuals with SMI/SED
Target Population (A)
1. Adults with SMI

Statewide prevalence (B)

65

Statewide incidence (C)

2. Children with SED

Describe the process by which your state calculates prevalence and incidence rates and provide
an explanation as to how this information is used for planning purposes. If your state does not
calculate these rates, but obtains them from another source, please describe. If your state does
not use prevalence and incidence rates for planning purposes, indicate how system planning
occurs in their absence.

Criterion 3: Children’s Services
Provides for a system of integrated services in order for children to receive care for their multiple
needs. Does your state integrate the following services into a comprehensive system of care?
a) Social Services
Yes
No
b) Educational services, including services provided under IDE
Yes
No
c) Juvenile justice services
Yes
No
d) Substance misuse prevention and SUD treatment services
Yes
No
e) Health and mental health services
Yes
No
f) Establishes defined geographic area for the provision of the services of such system
Yes
No
Criterion 4: Targeted Services to Rural and Homeless Populations and to Older Adults
Provides outreach to and services for individuals who experience homelessness; communitybased services to individuals in rural areas; and community-based services to older adults.
Describe your state’s targeted services to rural and homeless populations and to older adults

66

Criterion 5: Management Systems
States describe their financial resources, staffing, and training for mental health services
providers necessary for the plan; provides for training of providers of emergency health services
regarding SMI and SED; and how the state intends to expend this grant for the fiscal years
involved.
Describe your state’s management systems.

11. Substance Use Disorder Treatment - Required SABG
Criterion 1: Prevention and Treatment Services - Improving Access and Maintaining a
Continuum of Services to Meet State Needs.
Improving access to treatment services
1. Does your state provide:
a) A full continuum of services:
i) Screening
Yes
No
ii) Education
Yes
No
iii) Brief intervention
Yes
No
iv) Assessment
Yes
No
v) Detox (inpatient/social)
Yes
No
vi) Outpatient
Yes
No
vii) Intensive outpatient
Yes
No
viii) Inpatient/residential
Yes No
ix) Aftercare; recovery support
Yes
No
67

b) Are you considering any of the following:
Targeted services for veterans
Yes

No

c) Expansion of services for:
(1) Adolescents
(a)
Yes
No
(2) Older adults
(a)
Yes
No
(3) Medication-Assisted Treatment (MAT)
(a)
Yes No
Criterion2: Improving Access and Addressing Primary Prevention – see Section 8
Criterion 3: Pregnant Women and Women with Dependent Children (PWWDC)
1. Does your state meet the performance requirement to establish and or maintain new
programs or expand programs to ensure treatment availability?
a)
Yes
No
2. Either directly or through an arrangement with public or private nonprofit entities make
prenatal care available to PWWDC receiving services?
a)
Yes
No
3. Have an agreement to ensure pregnant women are given preference in admission to treatment
facilities or make available interim services within 48 hours, including prenatal care?
a)
Yes
No
4. Does your state have an arrangement for ensuring the provision of required supportive
services?
a)
Yes
No
5. Are you considering any of the following:
a) Open assessment and intake scheduling
Yes
No
b) Establishment of an electronic system to identify available treatment slots
Yes
No
c) Expanded community network for supportive services and healthcare
Yes
No
d) Inclusion of recovery support services
68

Yes
No
e) Health navigators to assist clients with community linkages
Yes No
f) Expanded capability for family services, relationship restoration, custody issue
Yes No
g) Providing employment assistance
Yes
No
h) Providing transportation to and from services
Yes
No
i) Educational assistance
Yes
No
6. States are required to monitor program compliance related to activities and services for
PWWDC. Please provide a detailed description of the specific strategies used by the state to
identify compliance issues and corrective actions required to address identified problems.

Criterion 4, 5 and 6: Persons Who Inject Drugs (PWID), Tuberculosis (TB), Human
Immunodeficiency Virus (HIV), Hypodermic Needle Prohibition, and Syringe Services
Program
Persons Who Inject Drugs (PWID)
1. Does your state fulfill the
a) 90 percent capacity reporting requirement
Yes
No
b) 14-120 day performance requirement with provision of interim services
Yes
No
c) Outreach activities
Yes
No
d) Syringe services programs
Yes
No
e) Monitoring requirements as outlined in the authorizing statute and implementing
regulation
Yes
No
2. Are you considering any of the following:
a) Electronic system with alert when 90 percent capacity is reached
Yes
No
b) Automatic reminder system associated with 14-120 day performance requirement
69

Yes
No
c) Use of peer recovery supports to maintain contact and support
Yes
No
d) Service expansion to specific populations (military families, veterans, adolescents, older
adults)
Yes
No
3. States are required to monitor program compliance related to activities and services for
PWID. Please provide a detailed description of the specific strategies used by the state to
identify compliance issues and corrective actions required to address identified problems.

Tuberculosis (TB)
1. Does your state currently maintain an agreement, either directly or through arrangements
with other public and nonprofit private entities to make available tuberculosis services to
individuals receiving SUD treatment and to monitor the service delivery?
a)
Yes
No
2. Are you considering any of the following:
a) Business agreement/MOU with primary healthcare providers
Yes
No
b) Cooperative agreement/MOU with public health entity for testing and treatment
Yes No
c) Established co-located SUD professionals within FQHCs
Yes
No
3. States are required to monitor program compliance related to tuberculosis services made
available to individuals receiving SUD treatment. Please provide a detailed description of
the specific strategies used by the state to identify compliance issues and corrective actions
required to address identified problems.

70

Early Intervention Services for HIV (For “Designated States” Only)
1. Does your state current have an agreement to provide treatment for persons with substance
use disorders with an emphasis on making available within existing programs early
intervention services for HIV in areas that have the greatest need for such services and
monitoring such service delivery?
Yes
No
2. Are you considering any of the following:
a) Establishment of EIS-HIV service hubs in rural areas
Yes
No
b) Establishment or expansion of tele-health and social media support services
Yes
No
c) Business agreement/MOU with established community agencies/organizations serving
persons with HIV/AIDS
Yes
No
Syringe Service Programs
1. Does your state have in place an agreement to ensure that SABG funds are NOT expended to
provide individuals with hypodermic needles or syringes (42 U.S.C.§ 300x-31(a)(1)F)?
Yes
No
2) Do any of the programs serving PWID have an existing relationship with a Syringe Services
(Needle Exchange) Program
Yes
No
3) Do any of your programs use SABG funds to support elements of a Syringe Services
Program
a)
Yes
No
b) If yes, please provide a brief description of the elements and the arrangement

Criterion 8, 9 and 10: Service System Needs, Service Coordination, Charitable Choice,
Referrals, Patient Records, and Independent Peer Review
Service System Needs
1. Does your state have in place an agreement to ensure that the state has conducted a statewide
assessment of need, which defines prevention, and treatment authorized services available,
identified gaps in service, and outlines the state’s approach for improvement?
71

Yes

No

2. Are you considering any of the following:
a) Workforce development efforts to expand service access
Yes
No
b) Establishment of a statewide council to address gaps and formulate a strategic plan to
coordinate services
Yes
No
c) Establish a peer recovery support network to assist in filling the gaps
Yes
No
d) Incorporate input from special populations (military families, service members, veterans,
tribal entities, older adults, sexual and gender minorities)
Yes
No
e) Formulate formal business agreements with other involved entities to coordinate services
to fill gaps in the system, i.e. primary healthcare, public health, VA, community
organizations
Yes
No
f) Explore expansion of services for:
i) MAT
(1)
Yes
No
ii) Tele-health
(1)
Yes
No
iii) Social media outreach
(1)
Yes
No

Service Coordination
1. Does your state have a current system of coordination and collaboration related to the
provision of person-centered and person-directed care?
Yes
No
2. Are you considering any of the following:
a) Identify MOUs/Business Agreements related to coordinate care for persons receiving
SUD treatment and/or recovery services
Yes
No
b) Establish a program to provide trauma-informed care
Yes
No

72

c) Identify current and perspective partners to be included in building a system of care, e.g.,
FQHCs, primary healthcare, recovery community organizations, juvenile justice system,
adult criminal justice system, and education
Yes
No

Charitable Choice
1. Does your state have in place an agreement to ensure the system can comply with the
services provided by nongovernment organizations (42 U.S.C.§ 300x-65, 42 CF Part 54
(§54.8(b) and §54.8(c)(4)) and 68 FR 56430-56449)
Yes
No
2. Are you considering any of the following:
a) Notice to Program Beneficiaries
Yes
No
b) Develop an organized referral system to identify alternative providers
Yes
No
c) Develop a system to maintain a list of referrals made by religious organizations
Yes
No
Referrals
1. Does your state have an agreement to improve the process for referring individuals to the
treatment modality that is most appropriate for their needs
Yes
No
2. Are you considering any of the following:
a) Review and update of screening and assessment instruments
Yes
No
b) Review of current levels of care to determine changes or additions
Yes
No
c) Identify workforce needs to expand service capabilities
Yes
No
d) Conduct cultural awareness training to ensure staff sensitivity to client cultural
orientation, environment, and background
Yes
No
Patient Records
1. Does your state have an agreement to ensure the protection of client records
a)
Yes
No
73

2. Are you considering any of the following:
a) Training staff and community partners on confidentiality requirements
Yes
No
b) Training on responding to requests asking for acknowledgement of the presence of clients
Yes
No
c) Updating written procedures which regulate and control access to records
Yes
No
d) Review and update of the procedure by which clients are notified of the confidentiality of
their records include the exceptions for disclosure
Yes
No

Independent Peer Review
1. Does your state have an agreement to assess and improve, through independent peer review,
the quality and appropriateness of treatment services delivered by providers
a)
Yes
No
2. Section 1943(a) of Title XIX, Part B, Subpart III of the Public Health Service Act (42
U.S.C.§ 300x-52(a)) and 45 § CFR 96.136 require states to conduct independent peer review
of not fewer than 5 percent of the block grant sub-recipients providing services under the
program involved.
a) Please provide an estimate of the number of block grant sub-recipients identified to
undergo such a review during the fiscal year(s) involved

3. Are you considering any of the following:
a) Development of a quality improvement plan
Yes
No
b) Establishment of policies and procedures related to independent peer review
Yes
No
c) Develop long-term planning for service revision and expansion to meet the needs of
specific populations
Yes
No
4. Does your state require a block grant sub-recipient to apply for and receive accreditation
from an independent accreditation organization, e.g., Commission on the Accreditation of
Rehabilitation Facilities (CARF), The Joint Commission, or similar organization as an
eligibility criterion for block grant funds?
a)
Yes
No
b) If Yes, please identify the accreditation organization(s)
74

i)
ii)
iii)

Commission on the Accreditation of Rehabilitation Facilities
The Joint Commission
Other (please specify)

Criterion 7 and 11: Group Homes for Persons In Recovery and Professional Development
Group Homes
1. Does your state have an agreement to provide for and encourage the development of group
homes for persons in recovery through a revolving loan program?
Yes
No
2. Are you considering any of the following:
a) Implementing or expanding the revolving loan fund to support recovery home
development as part of the expansion of recovery support service
Yes
No
b) Implementing MOUs to facilitate communication between block grant service providers
and group homes to assist in placing clients in need of housing
Yes
No
Professional Development
1. Does your state have an agreement to ensure that prevention, treatment and recovery
personnel operating in the state’s substance use disorder prevention, treatment and recovery
systems have an opportunity to receive training on an ongoing basis, concerning:
a) Recent trends in substance use disorders in the state
Yes
No
b) Improved methods and evidence-based practices for providing substance use disorder
prevention and treatment services
Yes
No
c) Performance-based accountability
Yes
No
d) Data collection and reporting requirements
Yes
No

2. Are you considering any of the following:
a) A comprehensive review of the current training schedule and identification of additional
training needs
Yes
No

75

b) Addition of training sessions designed to increase employee understanding of recovery
support services
Yes
No
c) Collaborative training sessions for employees and community agencies’ staff to
coordinate and increase integrated services
Yes
No
d) State office staff training across departments and divisions to increase staff knowledge of
programs and initiatives, which contribute to increased collaboration and decreased
duplication of effort
Yes
No

Waivers
Upon the request of a state, the Secretary may waive the requirements of all or part of the
sections 1922(c), 1923, 1924 and 1928 (42 U.S.C. § 300x-32(f)).
1. Is your state considering requesting a waiver of any requirements related to:
a) Allocations Regarding Women
Yes
No
2. Requirements Regarding Tuberculosis Services and Human Immunodeficiency Virus
a) Tuberculosis
Yes
No
b) Early Intervention Services Regarding HIV
Yes
No
3. Additional Agreements
a) Improvement of Process for Appropriate Referrals for Treatment
Yes
No
b) Professional Development
Yes
No
c) Coordination of Various Activities and Services
Yes
No

Please provide a link to the state administrative regulations, which govern the Mental
Health and Substance Use Disorder Programs.

76

12. Quality Improvement Plan- requested
In previous block grant applications, SAMHSA asked states to base their administrative
operations and service delivery on principles of Continuous Quality Improvement/Total Quality
Management (CQI/TQM). These CQI processes should identify and track critical outcomes and
performance measures, based on valid and reliable data, consistent with the NBHQF, which will
describe the health and functioning of the mental health and addiction systems. The CQI
processes should continuously measure the effectiveness of services and supports and ensure that
they continue to reflect this evidence of effectiveness. The state’s CQI process should also track
programmatic improvements using stakeholder input, including the general population and
individuals in treatment and recovery and their families. In addition, the CQI plan should
include a description of the process for responding to emergencies, critical incidents, complaints,
and grievances.
1. Has your state modified its CQI plan from FFY 2016-FFY 2017?
a)
Yes
No
Please indicate areas of technical assistance needed related to this section.

13.

Trauma -requested

Trauma60 is a widespread, harmful, and costly public health problem. It occurs because of
violence, abuse, neglect, loss, disaster, war and other emotionally harmful and/or life threatening
experiences. Trauma has no boundaries with regard to age, gender, socioeconomic status, race,
ethnicity, geography, or sexual orientation. It is an almost universal experience of people with
mental and substance use difficulties. The need to address trauma is increasingly viewed as an
important component of effective behavioral health service delivery. Additionally, it has become
evident that addressing trauma requires a multi-pronged, multi-agency public health approach
inclusive of public education and awareness, prevention and early identification, and effective
trauma-specific assessment and treatment. To maximize the impact of these efforts, they need to
be provided in an organizational or community context that is trauma-informed.
Individuals with experiences of trauma are found in multiple service sectors, not just in
behavioral health. People in the juvenile and criminal justice system have high rates of mental
illness and substance use disorders and personal histories of trauma. Children and families in the
60

Definition of Trauma: Individual trauma results from an event, series of events, or set of circumstances that is experienced by
an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s
functioning and mental, physical, social, emotional, or spiritual well-being.

77

child welfare system similarly experience high rates of trauma and associated behavioral health
problems. Many patients in primary, specialty, emergency and rehabilitative health care
similarly have significant trauma histories, which has an impact on their health and their
responsiveness to health interventions. Schools are now recognizing that the impact of exposure
to trauma and violence among their students makes it difficult to learn and meet academic goals.
Communities and neighborhoods experience trauma and violence. For some these are rare
events and for others these are daily events that children and families are forced to live with.
These children and families remain especially vulnerable to trauma-related problems, often are in
resource poor areas, and rarely seek or receive behavioral health care. States should work with
these communities to identify interventions that best meet the needs of these residents.
In addition, the public institutions and service systems that are intended to provide services and
supports for individuals are often re-traumatizing, making it necessary to rethink doing “business
as usual.” These public institutions and service settings are increasingly adopting a traumainformed approach. A trauma-informed approach is distinct from trauma-specific assessments
and treatments. Rather, trauma-informed refers to creating an organizational culture or climate
that realizes the widespread impact of trauma, recognizes the signs and symptoms of trauma in
clients and staff, responds by integrating knowledge about trauma into policies and procedures,
and seeks to actively resist re-traumatizing clients and staff. This approach is guided by key
principles that promote safety, trustworthiness and transparency, peer support, empowerment,
collaboration, and sensitivity to cultural and gender issues. A trauma-informed approach may
incorporate trauma-specific screening, assessment, treatment, and recovery practices or refer
individuals to these appropriate services.
It is suggested that states refer to SAMHSA’s guidance for implementing the trauma-informed
approach discussed in the Concept of Trauma61 paper.
Please consider the following items as a guide when preparing the description of the state’s
system:
1. Does the state have a plan or policy for behavioral health providers that guide how they will
address individuals with trauma-related issues?
Yes
No
2. Does the state provide information on trauma-specific assessment tools and interventions for
behavioral health providers?
Yes
No
3. Does the state have a plan to build the capacity of behavioral health providers and
organizations to implement a trauma-informed approach to care?
Yes
No
4. Does the state encourage employment of peers with lived experience of trauma in developing
trauma-informed organizations?
Yes
No
5) Does the state have any activities related to this section that you would like to highlight.
61

Ibid

78

Please indicate areas of technical assistance needed related to this section.

14.

Criminal and Juvenile Justice - Requested

More than half of all prison and jail inmates meet criteria for having mental health problems, six
in ten meet criteria for a substance use problem, and more than one-third meet criteria for having
co-occurring mental and substance use problems. Youth in the juvenile justice system often
display a variety of high-risk characteristics that include inadequate family support, school
failure, negative peer associations, and insufficient use of community-based services. Most
adjudicated youth released from secure detention do not have community follow-up or
supervision; therefore, risk factors remain unaddressed. 62
Successful diversion of adults and youth from incarceration or re-entering the community from
detention is often dependent on engaging in appropriate M/SUD treatment. Some states have
implemented such efforts as mental health, veteran and drug courts, Crisis Intervention
Training (CIT) and re-entry programs to help reduce arrests, imprisonment and recidivism.63
A diversion program places youth in an alternative program, rather than processing them in the
juvenile justice system. States should place an emphasis on screening, assessment, and
services provided prior to adjudication and/or sentencing to divert persons with M/SUD from
correctional settings. States should also examine specific barriers such as a lack of
identification needed for enrollment Medicaid and/or Marketplace; loss of eligibility for
Medicaid resulting from incarceration; and care coordination for individuals with chronic
health conditions, housing instability, and employment challenges. Secure custody rates
decline when community agencies are present to advocate for alternatives to detention.
The MHBG and SABG may be especially valuable in supporting care coordination to promote
pre-adjudication or pre-sentencing diversion, providing care during gaps in enrollment after
62

Journal of Research in Crime and Delinquency: Identifying High-Risk Youth: Prevalence and Patterns of Adolescent Drug
Victims, Judges, and Juvenile Court Reform Through Restorative Justice. Dryfoos, Joy G. 1990, Rottman, David, and Pamela
Casey, McNiel, Dale E., and Renée L. Binder. OJJDP Model Programs Guide.
63
http://csgjusticecenter.org/mental-health/

79

incarceration, and supporting other efforts related to enrollment.

Please respond to the following items:
1. Does the state (SMHA and SSA) have a plan for coordinating with the criminal and juvenile
justice systems on diversion of individuals with mental and/or substance use disorders from
incarceration to community treatment, and for those incarcerated, a plan for re-entry into the
community that includes connecting to behavioral health services?
Yes
No
2. Does the state have a plan for working with law enforcement to deploy emerging strategies
(e.g. civil citations, mobile crisis intervention, behavioral health provider ride-along, CIT,
linkage with treatment services, etc.) to reduce the number of individuals with mental and/or
substance use problems in jails and emergency rooms?
Yes
No
3. Does the state provide cross-trainings for behavioral health providers and criminal/juvenile
justice personnel to increase capacity for working with individuals with behavioral health
issues involved in the justice system?
Yes
No
4. Does the state have an inter-agency coordinating committee or advisory board that addresses
criminal and juvenile justice issues and that includes the SMHA, SSA, and other
governmental and non-governmental entities to address behavioral health and other essential
domains such as employment, education, and finances?
Yes
No
5. Does the state have any activities related to this section that you would like to highlight?

Please indicate areas of technical assistance needed related to this section.

15.

Medication Assisted Treatment - Requested

There is a voluminous literature on the efficacy of medication-assisted treatment (MAT); the use
of FDA approved medication; counseling; behavioral therapy; and social support services, in the
treatment of substance use disorders. However, many treatment programs in the U.S. offer only
abstinence-based treatment for these conditions. The evidence base for MAT for SUDs is
80

described in SAMHSA TIPs 40[1], 43[2], 45[3], and 49[4].
SAMHSA strongly encourages that the states require treatment facilities providing clinical care
to those with substance use disorders demonstrate that they both have the capacity and staff
expertise to use MAT or have collaborative relationships with other providers that can provide
the appropriate MAT services clinically needed.
Individuals with substance use disorders who have a disorder for which there is an FDAapproved medication treatment should have access to those treatments based upon each
individual patient’s needs.
In addition, SAMHSA also encourages states to require the use of MAT for substance use
disorders for opioid use, alcohol use, and tobacco use disorders where clinically appropriate.
SAMHSA is asking for input from states to inform SAMHSA’s activities.
Please respond to the following:
1. Has the state implemented a plan to educate and raise awareness within SUD treatment
programs regarding MAT for substance use disorders?
Yes
No
2. Has the state implemented a plan to educate and raise awareness of the use of MAT within
special target audiences, particularly pregnant women?
Yes
No
3. Does the state purchase any of the following medication with block grant funds?
a)
Methadone
b)
Buprenorphine; Buprenorphine/naloxone
c)
Disulfiram
d)
Acamprosate
e)
Naltrexone (oral, IM)
f)
Naloxone
4.Does the state have an implemented education or quality assurance program to assure that
evidence-based MAT with the use of FDA-approved medications for treatment of substance
use disorders are used appropriately*?
Yes
No
5. Does the state have any activities related to this section that you would like to highlight?

81

*Appropriate use is defined as use of medication for the treatment of a substance use disorder,
combining psychosocial treatments with approved medications, use of peer supports in the
recovery process, safeguards against misuse and/or diversion of controlled substances used in
treatment of substance use disorders, and advocacy with state payers.
16.

Crisis Services - Requested

In the on-going development of efforts to build an robust system of evidence-based care for
persons diagnosed with SMI, SED and SUD and their families via a coordinated continuum of
treatments, services and supports, growing attention is being paid across the country to how
states and local communities identify and effectively respond to, prevent, manage and help
individuals, families, and communities recover from behavioral health crises. SAMHSA has
recently released a publication, Crisis Services Effectiveness, Cost Effectiveness and Funding
Strategies that states may find helpful.64 SAMHSA has taken a leadership role in deepening the
understanding of what it means to be in crisis and how to respond to a crisis experienced by
people with behavioral health conditions and their families.
According to SAMHSA’s publication, Practice Guidelines: Core Elements for Responding to
Mental Health Crises65,
“Adults, children, and older adults with an SMI or emotional disorder often lead
lives characterized by recurrent, significant crises. These crises are not the
inevitable consequences of mental disability, but rather represent the combined
impact of a host of additional factors, including lack of access to essential services
and supports, poverty, unstable housing, coexisting substance use, other health
problems, discrimination, and victimization.”
A crisis response system will have the capacity to prevent, recognize, respond, deescalate, and follow-up from crises across a continuum, from crisis planning, to early
stages of support and respite, to crisis stabilization and intervention, to post-crisis followup and support for the individual and their family. SAMHSA expects that states will
build on the emerging and growing body of evidence for effective community-based
crisis-prevention and response systems. Given the multi-system involvement of many
individuals with behavioral health issues, the crisis system approach provides the
infrastructure to improve care coordination and outcomes, manage costs, and better invest
resources. The following are an array of services and supports used to address crisis
response. Please check those that are used in your state:
1. Crisis Prevention and Early Intervention
64

http://store.samhsa.gov/product/Crisis-Services-Effectiveness-Cost-Effectiveness-and-FundingStrategies/SMA14-4848
65

Practice Guidelines: Core Elements for Responding to Mental Health Crises. HHS Pub. No. SMA-09-4427.
Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration,
2009. http://store.samhsa.gov/product/Core-Elements-for-Responding-to-Mental-Health-Crises/SMA09-4427

82

a)
b)
c)
d)
e)
f)
g)

Wellness Recovery Action Plan (WRAP) Crisis Planning
Psychiatric Advance Directives
Family Engagement
Safety Planning
Peer-Operated Warm Lines
Peer-Run Crisis Respite Programs
Suicide Prevention

2. Crisis Intervention/Stabilization:
a)
Assessment/Triage (Living Room Model)
b)
Open Dialogue
c)
Crisis Residential/Respite
d)
Crisis Intervention Team/ Law Enforcement
e)
Mobile Crisis Outreach
f)
Collaboration with Hospital Emergency Departments and Urgent Care
Systems
3. Post Crisis Intervention/Support:
a)
WRAP Post-Crisis
b)
Peer Support/Peer Bridgers
c)
Follow-Up Outreach and Support
d)
Family-to-Family engagement
e)
Connection to care coordination and follow-up clinical care for individuals in
crisis
f)
Follow-up crisis engagement with families and involved community members
g)
Recovery community coaches/peer recovery coaches
h)
Recovery community organization
4. Does the state have any activities related to this section that you would like to
highlight?

Please indicate areas of technical assistance needed related to this section.

17.

Recovery - Required
83

The implementation of recovery supports and services are imperative for providing comprehensive,
quality behavioral health care. The expansion in access to and coverage for health care compels
SAMHSA to promote the availability, quality, and financing of vital services and support systems that
facilitate recovery for individuals. Recovery encompasses the spectrum of individual needs related

to those with mental disorders and/or substance use disorders. Recovery is supported through
the key components of: health (access to quality health and behavioral health treatment); home
(housing with needed supports), purpose (education, employment, and other pursuits); and
community (peer, family, and other social supports). The principles of recovery guide the
approach to person-centered care that is inclusive of shared decision-making. The continuum of
care for these conditions includes psychiatric and psychosocial interventions to address acute
episodes or recurrence of symptoms associated with an individual’s mental or substance use
disorder. Because mental and substance use disorders are chronic conditions, systems and
services are necessary to facilitate the initiation, stabilization, and management of long-term
recovery.
SAMHSA has developed the following working definition of recovery from mental and/or
substance use disorders:
Recovery is a process of change through which individuals improve their health and wellness,
live a self-directed life, and strive to reach their full potential.
In addition, SAMHSA identified 10 guiding principles of recovery:
• Recovery emerges from hope;
• Recovery is person-driven;
• Recovery occurs via many pathways;
• Recovery is holistic;
• Recovery is supported by peers and allies;
• Recovery is supported through relationship and social networks;
• Recovery is culturally-based and influenced;
• Recovery is supported by addressing trauma;
• Recovery involves individuals, families, community strengths, and responsibility;
• Recovery is based on respect.
Please see SAMHSA’s Working Definition of Recovery from Mental Disorders and Substance
Use Disorders.
States are strongly encouraged to consider ways to incorporate recovery support services,
including peer-delivered services, into their continuum of care. Examples of evidence-based and
emerging practices in peer recovery support services include, but are not limited to, the
following:





Clubhouses
Drop-in centers
Recovery community

Peer-run respite services


Peer-run crisis diversion
services
84

Whole Health Action
Management (WHAM)


Shared decision making








centers
Peer specialist
Peer recovery coaching
Peer wellness coaching
Peer health navigators
Family navigators/parent
support partners/providers
Peer-delivered
motivational interviewing








Telephone recovery
checkups
Warm lines
Self-directed care
Supportive housing models
Evidenced-based supported
employment
Wellness Recovery Action
Planning (WRAP)







Person-centered planning
Self-care and wellness
approaches
Peer-run Seeking Safety
groups/Wellness-based
community campaign
Room and board when
receiving treatment

SAMHSA strongly encourages states to take proactive steps to implement recovery support
services. To accomplish this goal and support the wide-scale adoption of recovery supports in
the areas of health, home, purpose, and community, SAMHSA has launched Bringing Recovery
Supports to Scale Technical Assistance Center Strategy (BRSS TACS). BRSS TACS assists
states and others to promote adoption of recovery-oriented supports, services, and systems for
people in recovery from substance use and/or mental disorders.
Because recovery is based on the involvement of consumers/peers/people in recovery, their
family members and caregivers, SMHAs and SSAs can engage these individuals, families, and
caregivers in developing recovery-oriented systems and services. States should also support
existing and create resources for new consumer, family, and youth networks; recovery
community organizations and peer-run organizations; and advocacy organizations to ensure a
recovery orientation and expand support networks and recovery services. States are strongly
encouraged to engage individuals and families in developing, implementing and monitoring the
state M/SUD treatment system.
Please respond to the following:
1. Does the state support recovery through any of the following:
a) Training/education on recovery principles and recovery-oriented practice and systems,
including the role of peers in care?
Yes

No

b) Required peer accreditation or certification?
Yes

No

c) Block grant funding of recovery support services.
Yes
No
d) Involvement of persons in recovery/peers/family members in planning, implementation,
or evaluation of the impact of the state’s M/SUD system?
Yes

No
85

2. Does the state measure the impact of your consumer and recovery community outreach
activity?
Yes
No
3. Provide a description of recovery and recovery support services for adults with SMI and
children with SED in your state.

4. Provide a description of recovery and recovery support services for individuals with
substance use disorders in your state.

5. Does the state have any activities that it would like to highlight?

Please indicate areas of technical assistance needed related to this section.

18.

Community Living and the Implementation of Olmstead- requested

The integration mandate in Title II of the Americans with Disabilities Act (ADA) and the
Supreme Court’s decision in Olmstead v. L.C., 527 U.S. 581 (1999), provide legal
requirements that are consistent with SAMHSA’s mission to reduce the impact of M/SUD on
America’s communities. Being an active member of a community is an important part of
recovery for persons with behavioral health conditions. Title II of the ADA and the regulations
promulgated for its enforcement require that states provide services in the most integrated
86

setting appropriate to the individual and prohibit needless institutionalization and segregation in
work, living, and other settings. In response to the 10th anniversary of the Supreme Court’s
Olmstead decision, the Coordinating Council on Community Living was created at HHS.
SAMHSA has been a key member of the council and has funded a number of technical
assistance opportunities to promote integrated services for people with behavioral health needs,
including a policy academy to share effective practices with states.
Community living has been a priority across the federal government with recent changes to
section 811 and other housing programs operated by the Department of Housing and Urban
Development (HUD). HUD and HHS collaborate to support housing opportunities for persons
with disabilities, including persons with behavioral illnesses. The Department of Justice (DOJ)
and the HHS Office for
(OCR) cooperate on enforcement and compliance measures. DOJ and OCR have expressed
concern about some aspects of state mental health systems including use of traditional
institutions and other settings that have institutional characteristics to serve persons whose
needs could be better met in community settings. More recently, there has been litigation
regarding certain evidenced-based supported employment services such as sheltered workshops.
States should ensure block grant funds are allocated to support prevention, treatment, and
recovery services in community settings whenever feasible and remain committed, as
SAMHSA is, to ensuring services are implemented in accordance with Olmstead and Title II of
the ADA.
It is requested that the state submit their Olmstead Plan as a part of this application, or address
the following when describing community living and implementation of Olmstead:
1. Does the state’s Olmstead plan include :
housing services provided
home and community based services
peer support services
employment services.

Yes
Yes
Yes
Yes

No
No
No
No

2. Does the state have a plan to transition individuals from hospital to community settings?
Yes
No
3. What efforts are occurring in the state or being planned to address the ADA community
integration mandate required by the Olmstead Decision of 1999?

Please indicate areas of technical assistance needed related to this section.

19.
Children and Adolescents Behavioral Health Services –required MHBG, requested
SABG
MHBG funds are intended to support programs and activities for children and adolescents with
87

SED, and SABG funds are available for prevention, treatment, and recovery services for youth
and young adults with substance use disorders. Each year, an estimated 20 percent of children in
the U.S. have a diagnosable mental health condition and one in 10 suffers from a serious
emotional disturbance that contributes to substantial impairment in their functioning at home, at
school, or in the community.66 Most mental disorders have their roots in childhood, with about
50 percent of affected adults manifesting such disorders by age 14, and 75 percent by age 24.67
For youth between the ages of 10 and 24, suicide is the third leading cause of death and for
children between 12 and 17, the second leading cause of death.68
It is also important to note that 11 percent of high school students have a diagnosable substance
use disorder involving nicotine, alcohol, or illicit drugs, and nine out of 10 adults who meet
clinical criteria for a substance use disorder started smoking, drinking, or using illicit drugs
before the age of 18. Of people who started using before the age of 18, one in four will
develop an addiction compared to one in twenty-five who started using substances after age
21.69 Mental and substance use disorders in children and adolescents are complex, typically
involving multiple challenges. These children and youth are frequently involved in more than
one specialized system, including mental health, substance abuse, primary health, education,
childcare, child welfare, or juvenile justice. This multi-system involvement often results in
fragmented and inadequate care, leaving families overwhelmed and children’s needs unmet.
For youth and young adults who are transitioning into adult responsibilities, negotiating
between the child- and adult-serving systems becomes even harder. To address the need for
additional coordination, SAMHSA is encouraging states to designate a point person for
children to assist schools in assuring identified children are connected with available mental
health and/or substance abuse screening, treatment and recovery support services.
Since 1993, SAMHSA has funded the Children’s Mental Health Initiative (CMHI) to build the
system of care approach in states and communities around the country. This has been an
ongoing program with 173 grants awarded to states and communities, and every state has
received at least one CMHI grant. Since then SAMHSA has awarded planning and
implementation grants to states for adolescent and transition age youth SUD treatment and
infrastructure development. This work has included a focus on financing, workforce
development and implementing evidence-based treatments.
For the past 25 years, the system of care approach has been the major framework for improving
delivery systems, services, and outcomes for children, youth, and young adults with mental
and/or SUD and co-occurring M/SUD and their families. This approach is comprised of a
spectrum of effective, community-based services and supports that are organized into a
coordinated network. This approach helps build meaningful partnerships across systems and
66

Centers for Disease Control and Prevention, (2013). Mental Health Surveillance among Children — United States, 2005-2011.
MMWR 62(2).
67
Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-ofonset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6),
593–602.
68
Centers for Disease Control and Prevention. (2010). National Center for Injury Prevention and Control. Web-based Injury
Statistics Query and Reporting System (WISQARS) [online]. (2010). Available from www.cdc.gov/injury/wisqars/index.html.
69
The National Center on Addiction and Substance Abuse at Columbia University. (June, 2011). Adolescent Substance Abuse:
America’s #1 Public Health Problem.

88

addresses cultural and linguistic needs while improving the child, youth and young adult
functioning in home, school, and community. The system of care approach provides
individualized services, is family driven; youth guided and culturally competent; and builds on
the strengths of the child, youth or young adult and their family to promote recovery and
resilience. Services are delivered in the least restrictive environment possible, use evidencebased practices, and create effective cross-system collaboration including integrated
management of service delivery and costs.70
According to data from the 2015 Report to Congress71 on systems of care, services:
1 reach many children and youth typically underserved by the mental health system;
2 improve emotional and behavioral outcomes for children and youth;
3 enhance family outcomes, such as decreased caregiver stress;
4 decrease suicidal ideation and gestures;
5 expand the availability of effective supports and services; and
6 save money by reducing costs in high cost services such as residential settings,
inpatient hospitals, and juvenile justice settings.
SAMHSA expects that states will build on the well-documented, effective system of care
approach to serving children and youth with serious behavioral health needs. Given the multisystem involvement of these children and youth, the system of care approach provides the
infrastructure to improve care coordination and outcomes, manage costs, and better invest
resources. The array of services and supports in the system of care approach includes:




non-residential services (e.g., wraparound service planning, intensive case management,
outpatient therapy, intensive home-based services, SUD intensive outpatient services,
continuing care, and mobile crisis response);
supportive services, (e.g., peer youth support, family peer support, respite services,
mental health consultation, and supported education and employment); and
residential services (e.g., like therapeutic foster care, crisis stabilization services, and
inpatient medical detoxification).

Please respond to the following:
1. Does the state utilize a system of care approach to support:
a) The recovery and resilience of children and youth with SED?
Yes
No
b) The recovery and resilience of children and youth with SUD?
Yes
No

70

Department of Mental Health Services. (2011) The Comprehensive Community Mental Health Services for Children and
Their Families Program: Evaluation Findings. Annual Report to Congress. Available from
http://store.samhsa.gov/product/Comprehensive-Community-Mental-Health-Services-for-Children-and-Their-Families-ProgramEvaluation-Findings/PEP12-CMHI2010.
71

http://www.samhsa.gov/sites/default/files/programs_campaigns/nitt-ta/2015-report-to-congress.pdf

89

2. Does the state have an established collaboration plan to work with other child- and youthserving agencies in the state to address behavioral health needs
a) Child welfare?
Yes
No
b) Juvenile justice?
Yes No
c) Education?
Yes
No
3. Does the state monitor its progress and effectiveness, around:
a) Service utilization?
Yes
No
b) Costs?
Yes
No
c) Outcomes for children and youth services?
Yes No
4. Does the state provide training in evidence-based :
a) Substance misuse prevention, SUD treatment and recovery services for
children/adolescents, and their families.
?
Yes
No
b) Mental health treatment and recovery services for children/adolescents and their families?

5.

Yes
No
Does the state have plans for transitioning children and youth receiving services:
a) to the adult behavioral health system?
Yes
No
b) for youth in foster care?
Yes
No

6. Describe how the state provide integrated services through the system of care (social
services, educational services, child welfare services, juvenile justice services, law
enforcement services, substance use disorders, etc.)

7. Does the state have any activities related to this section that you would like to highlight?

90

Please indicate areas of technical assistance needed related to this section.

20.

Suicide Prevention – (Required MHBG)

Suicide is a major public health concern, it is the 10th leading cause of death overall, with over
40,000 people dying by suicide each year in the United States. The causes of suicide are
complex and determined by multiple combinations of factors, such as mental illness, substance
abuse, painful losses, exposure to violence, and social isolation. Mental illness and substance
abuse are possible factors in 90 percent of the deaths from suicide, and alcohol use is a factor in
approximately one-third of all suicides. Therefore, SAMHSA urges behavioral health agencies
to lead in ways that are suitable to this growing area of concern. SAMHSA is committed to
supporting states and territories in providing services to individuals with SMI/SED who are at
risk for suicide through the use of MHBG funds to address these risk factors and prevent suicide.
SAMHSA encourages the behavioral health agencies play a leadership role on suicide prevention
efforts, including shaping, implementing, monitoring, care, and recovery support services among
individuals with SMI/SED.
Please respond to the following:
1. Have you updated your state’s suicide prevention plan in the last 2 years?

Yes

No

2. Describe activities intended to reduce incidents of suicide in your state.

3. Have you incorporated any strategies supportive of Zero Suicide?

Yes

No

4. Do you have any initiatives focused on improving care transitions for suicidal patients

being discharged from inpatient units or emergency departments?
Yes
No
91

5. Have you begun any targeted or statewide initiatives since the FFY 2016-FFY 2017 plan
was submitted?
Yes
No
If so, please describe the population targeted?

Please indicate areas of technical assistance needed related to this section.

21.

Support of State Partners - Required MHBG

The success of a state’s MHBG and SABG programs will rely heavily on the strategic
partnership that SMHAs and SSAs have or will develop with other health, social services, and
education providers, as well as other state, local, and tribal governmental entities. Examples of
partnerships may include:
 The SMA agreeing to consult with the SMHA or the SSA in the development and/or
oversight of health homes for individuals with chronic health conditions or consultation
on the benefits available to any Medicaid populations;
 The state justice system authorities working with the state, local, and tribal judicial
systems to develop policies and programs that address the needs of individuals with
M/SUD who come in contact with the criminal and juvenile justice systems, promote
strategies for appropriate diversion and alternatives to incarceration, provide screening
and treatment, and implement transition services for those individuals reentering the
community, including efforts focused on enrollment;
 The state education agency examining current regulations, policies, programs, and key
data-points in local and tribal school districts to ensure that children are safe, supported in
their social/emotional development, exposed to initiatives that target risk and protective
factors for mental and substance use disorders, and, for those youth with or at-risk of
emotional behavioral and SUDs, to ensure that they have the services and supports
needed to succeed in school and improve their graduation rates and reduce out-of-district
placements;
 The state child welfare/human services department, in response to state child and family
services reviews, working with local and tribal child welfare agencies to address the
92





trauma and mental and substance use disorders in children, youth, and family members
that often put children and youth at-risk for maltreatment and subsequent out-of-home
placement and involvement with the foster care system, including specific service issues,
such as the appropriate use of psychotropic medication for children and youth involved in
child welfare;
The state public housing agencies which can be critical for the implementation of
Olmstead;
The state public health authority that provides epidemiology data and/or provides or leads
prevention services and activities; and
The state’s office of homeland security/emergency management agency and other
partners actively collaborate with the SMHA/SSA in planning for emergencies that may
result in behavioral health needs and/or impact persons with behavioral health conditions
and their families and caregivers, providers of behavioral health services, and the state’s
ability to provide behavioral health services to meet all phases of an emergency
(mitigation, preparedness, response and recovery) and including appropriate engagement
of volunteers with expertise and interest in behavioral health.

Please respond to the following items:
1. Has your state added any new partners or partnerships since the last planning period?
Yes
No
2. Has your state identified the need to develop new partnerships that you did not have in place?
Yes
No
If yes, with whom?

3. Describe the manner in which your state and local entities will coordinate services to
maximize the efficiency, effectiveness, quality and cost-effectiveness of services and
programs to produce the best possible outcomes with other agencies to enable consumers to
function outside of inpatient or residential institutions, including services to be provided by
local school systems under the Individuals with Disabilities Education Act.

93

Please indicate areas of technical assistance needed related to this section.

22.

State Behavioral Health Planning/Advisory Council and Input on the Mental
Health/Substance Abuse Block Grant Application-required MHBG

Each state is required to establish and maintain a state Mental Health Planning/Advisory
Council for adults with SMI or children with SED. To meet the needs of states that are
integrating services supported by MHBG and SABG, SAMHSA is recommending that states
expand their Mental Health Advisory Council to include substance misuse prevention, SUD
treatment, and recovery representation, referred to here as a Behavioral Health
Advisory/Planning Council (BHPC). SAMHSA encourages states to expand their required
Council’s comprehensive approach by designing and implementing regularly scheduled
collaborations with an existing substance misuse prevention, SUD treatment, and recovery
advisory council to ensure that the council reviews issues and services for persons with, or at
risk, for substance misuse and SUDs. To assist with implementing a BHPC, SAMHSA has
created Best Practices for State Behavioral Health Planning Councils: The Road to Planning
Council Integration.72
Planning Councils are required by statute to review state plans and implementation reports; and
submit any recommended modifications to the state. Planning councils monitor, review, and
evaluate, not less than once each year, the allocation and adequacy of mental health services
within the state. They also serve as an advocate for individuals with behavioral health problems.
SAMHSA requests that any recommendations for modifications to the application or comments
to the implementation report that were received from the Planning Council be submitted to
SAMHSA, regardless of whether the state has accepted the recommendations. The
documentation, preferably a letter signed by the Chair of the Planning Council, should state that
the Planning Council reviewed the application and implementation report and should be
transmitted as attachments by the state.
Please consider the following items as a guide when preparing the description of the state’s
system:
1. How was the Council involved in the development and review of the state plan and report?
Attach supporting documentation (e.g., meeting minutes, letters of support, etc.)
a) What mechanism does the state use to plan and implement substance misuse prevention,
72

http://beta.samhsa.gov/grants/block-grants/resources

94

SUD treatment, and recovery services?

b) Has the Council successfully integrated substance misuse prevention and treatment or
co-occurring disorder issues, concerns, and activities into its work?
Yes
No
2. Is the membership representative of the service area population (e.g., ethnic, cultural,
linguistic, rural, suburban, urban, older adults, families of young children)?
Yes
No
3. Please describe the duties and responsibilities of the Council, including how it gathers
meaningful input from people in recovery, families, and other important stakeholders, and
how it has advocated for individuals with SMI or SED.

Additionally, please complete the Behavioral Health Advisory Council Members and Behavioral
Health Advisory Council Composition by Member Type forms.73

73

There are strict state Council membership guidelines. States must demonstrate: (1) the involvement of people in recovery and their family
members; (2) the ratio of parents of children with SED to other Council members is sufficient to provide adequate representation of that
constituency in deliberations on the Council; and (3) no less than 50 percent of the members of the Council are individuals who are not state
employees or providers of mental health services.

95

Behavioral Health Advisory Council Members
Name

Type of
Membership*

Agency or
Organization
Represented*

Address
Phone &
Fax

Email
Address
(If
Available)

**State Mental
Health Agency
**State
Education
Agency
**State
Vocational
Rehabilitation
Agency
**State Criminal
Justice Agency
**State Housing
Agency
**State Social
Services Agency
***State
Medicaid
Agency
***State
Marketplace
Agency
***State Child
Welfare Agency
***State Health
Agency
***State Agency
on Aging
*Council members should be listed only once by type of membership and Agency/organization represented.
** Required by Statute.
***Requested not required

96

Behavioral Health Advisory Council Composition by Member Type
Type of Membership
Number

Percentage
of Total
Membership

Total Membership
Individuals in Recovery * (to include adults with SMI
who are receiving, or have received, mental health
services
Family Members of Individuals in Recovery *
(to include family members of adults with SMI)
Parents of children with SED/SUD *
Vacancies (individual & family members)
Others ( Advocates who are not State employees or
providers)
Total Individuals in Recovery, Family Members and
Others
State Employees
Providers
Vacancies
TOTAL State Employees & Providers
Individuals/Family Members from Diverse Racial,
Ethnic, and LGBT Populations
Providers from Diverse Racial, Ethnic, and LGBT
Populations
TOTAL Individuals and Providers from Diverse
Racial, Ethnic, and LGBT Populations
Persons in recovery from or providing treatment for
or advocating for SUD services
Federally Recognized Tribal Representatives
Youth/adolescent representative (or member from an
organization serving young people).
*States are encouraged to select these representatives from state Family/Consumer organizations or
include individuals with substance misuse prevention, SUD treatment, and recovery expertise in their
Councils.

97

23. Public Comment on the State Plan- required
Title XIX, Subpart III, section 1941 of the PHS Act (42 U.S.C. § 300x-51) requires, as a
condition of the funding agreement for the grant, states will provide an opportunity for the
public to comment on the state block grant plan. States should make the plan public in such
a manner as to facilitate comment from any person (including federal, tribal, or other public
agencies) both during the development of the plan (including any revisions) and after the
submission of the plan to SAMHSA.
1. Did the state take any of the following steps to make the public aware of the plan and
allow for public comment?
a) Public meetings or hearings?
Yes
No
b) Posting of the plan on the web for public comment?
Yes
No

Other?
if yes, provide URL

c) Other (e.g. public service announcements, print media)
Yes
No

98

Acronyms
ACF

Administration for Children and Families

ACL

Administration for Community Living

ACO

Accountable Care Organization

ACT

Assertive Community Treatment

AHRQ

Agency for Healthcare Research and Quality

AI

American Indian

AIDS

Acquired Immune Deficiency Syndrome

AN

Alaskan Native

AOT

Assisted Outpatient Treatment

BHSIS

Behavioral Health Services Information System

CAP

Consumer Assistance Programs

CBHSQ

Center for Behavioral Health Statistics and Quality

CCBHC

Certified Community Behavioral Health Center

CFR

Code of Federal Regulations

CHC

Community Health Center

CHIP

Children’s Health Insurance Program

CLAS

Culturally and Linguistically Appropriate Services

CMHC

Community Mental Health Center

CMHS

Center for Mental Health Services

CMS

Centers for Medicare and Medicaid Services

CPT

Current Procedural Terminology

CSAPCenter for Substance Abuse Prevention
CSAT

Center for Substance Abuse Treatment

CSC

Coordinated Specialty Care

DSM V

Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition, Arlington, VA, American Psychiatric Association

EBP

Evidence-Based Practice

EHB

Essential Health Benefit

EHR

Electronic Health Record

EIS

Early Intervention Services (association with Human
99

Immunodeficiency Virus (HIV)
ESMI

Early Serious Mental Illness

FFY

Federal Fiscal Year

FMAP

Federal Medical Assistance Percentage

FPL

Federal Poverty Level

FQHC

Federally-Qualified Health Center

HCPCS

Healthcare Common Procedure Coding System

HHS

Department of Health and Human Services

HIE

Health Information Exchange

HIT

Health Information Technology

HIV

Human Immunodeficiency Virus (associated with Early
Intervention Services)

HRSA

Health Resources and Services Administration

ICD-10
ICT

The International Statistical Classification of Diseases and Related Health
Problems, 10th Revision
Interactive Communication Technology

IDU

Intravenous Drug User

IMD

Institutions for Mental Diseases

IOM

Institute of Medicine

KIT

Knowledge Information Transformation (associated with
EBP implementation)

LGBTQ
MAT

Lesbian, Gay, Bisexual, Transgender, and Questioning
Medication Assisted Treatment

MCO

Managed Care Organization

MHBG

Community Mental Health Services Block Grant

MHPAEA

Mental Health Parity and Addiction Equity Act

MOE

Maintenance of Effort

M/SUD

Mental and/or Substance Use Disorder

NBHQF

National Behavioral Health Quality Framework

NHAS

National HIV/AIDS Strategy

NIAAA

National Institute on Alcoholism and Alcohol Abuse

NIDANational Institute on Drug Abuse
100

NIMH

National Institute on Mental Health

NOMS

National Outcome Measures

NQF

National Quality Forum

NQS

National Quality Strategy

NREPP

National Registry of Evidence-based Programs and Practices

OCR

Office for Civil Rights

OMB

Office of Management and Budget

PBHCI

Primary and Behavioral Health Care Integration

PBR

Patient Bill of Rights

PHS

Public Health Service

PPW

Pregnant and Parenting Women

PPWC

Pregnant and Postpartum Women and Children

PWWDC

Pregnant Women and Women with Dependent Children

PWID

Persons Who Inject Drugs

QHP

Qualified Health Plan

RAISE

Recovery After an Initial Schizophrenia Episode

RCO

Recovery Community Organization

RFP

Request for Proposal

SABG

Substance Abuse Prevention and Treatment Block Grant

SAMHSA

Substance Abuse and Mental Health Services Administration

SBIRT

Screening, Brief Intervention, and Referral to Treatment

SED

Serious Emotional Disturbance

SFY

State fiscal year

SEOW

State Epidemiological Outcome Workgroup

SMHA

State Mental Health Authority

SMI

Serious Mental Illness

SPA

State Plan Amendment

SPF

Strategic Prevention Framework

SSA

Single State Agency

SUD

Substance Use Disorder

TIP

Treatment Improvement Protocol
101

TLOA

Tribal Law and Order Act

U.S.C.

United States Code

VA

Veterans Administration

102

Resources

TOPIC

LINK

SAMHSA Block Grants

http://samhsa.gov/grants/block-grants

SAMHSA Topic Search

http://www.samhsa.gov/topics

SAMHSA Store
TOPIC

21st Century Cures Act
Center for Integrated
Health Solutions

Characteristics of State
Mental Health Agency
Data Systems

Children Mental Health
Co-Occurring Resources
and Models

DESCRIPTION
Description of Block Grant, its purpose, deadlines, laws and
regulations and resources
Search SAMHSA's website for resources, information and updates by
topic or program

Search SAMHSA’s store to download or order publications and
http://store.samhsa.gov/
resources
RESOURCES IN ALPHABETICAL ORDER BY TOPIC/TITLE
LINK
DESCRIPTION
https://www.congress.gov/114/bills/hr34/BILLS
-114hr34enr.pdf

Link to the 21st Century Cures Act, which includes the section on
Helping Families in Mental Health Crisis Reform Act of 2016
HRSA-SAMHSA Center for Integrated Health Solutions offers
resources, trainings, hot topics, and webinars on primary and
behavioral health care integration

http://www.integration.samhsa.gov/

http://store.samhsa.gov/product/Characteristicsof-State-Mental-Health-Agency-DataSystems/SMA08-4361
http://store.samhsa.gov/product/ComprehensiveCommunity-Mental-Health-Services-forChildren-and-Their-Families-ProgramEvaluation-Findings/PEP12-CMHI2010
http://www.samhsa.gov/co-occurring/
103

Reviews current information technology (IT) systems and technology
implementation efforts in state mental health agencies. Reports key
findings on IT and structure, client-level and claims-level data,
linking to other state data, and electronic health records.
(Downloadable report)
Presents program evaluation findings of a federally funded initiative
that supports systems of care for community-based mental health
services for children, youth, and their families. Reports on FFY2010
data that track service characteristics, use, and outcomes.
(Downloadable report)
SAMHSA's webpage dedicated to co-occurring models and practice.
Includes: resources, webinars, public resource links and more.

Health Care Integration
Health Homes
Healthy People Initiative
Health Financing
Integrated Treatment for
Co-Occurring Disorders
Evidence-Based Practices
(EBP) KIT

LGBT Populations
Medicaid Policy
Guidance
Medication Assisted
Treatment
Mental Health and
Substance Abuse Block
Grant Laws and
Regulations

http://www.samhsa.gov/health-care-healthsystems-integration
http://www.integration.samhsa.gov/integratedcare-models/health-homes

Overview of SAMHSA Health Care Integration initiatives and links
to resources and information about health care integration
SAMHSA's description of Health Homes and resources around health
homes

Government website that reviews the goals of Healthy People 2020
http://www.healthypeople.gov/2020/default.aspx and provides resources to help meet the goals.
http://www.samhsa.gov/health-financing

SAMHSA guides, trainings and technical assistance resources around
health reform implementation.

http://store.samhsa.gov/product/SMA08-4367

Provides practice principles about integrated treatment for cooccurring disorders, an approach that helps people recover by
offering M/SUD services at the same time and in one setting. Offers
suggestions from successful programs.

http://www.samhsa.gov/behavioral-healthequity/lgbt

Resources on the LGBT population include national survey reports,
agency and federal initiatives, and related behavioral health
resources.

http://www.medicaid.gov/Federal-Policyguidance/federal-policy-guidance.html
http://www.samhsa.gov/medication-assistedtreatment

http://www.samhsa.gov/grants/blockgrants/laws-regulations
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Searchable database of Medicaid Policy Guidance’s; including: peer
support services, affordable care act, health homes, prescription
drugs, etc.
SAMHSA's resources, guides and TIPs on MAT

Links to the laws and regulations that govern the Mental Health and
Substance Abuse Block Grants

Mental Health Crisis

National CLAS
Standards
National HIV/AIDS
Strategy (NHAS) for the
United States
National Partnership for
Action to End Health
Disparities
National Registry of
Evidenced-Based
Programs and Practices

National Strategy for
Suicide Prevention

Olmstead

Parity

http://store.samhsa.gov/product/Core-Elementsfor-Responding-to-Mental-HealthCrises/SMA09-4427

http://www.ThinkCulturalHealth.hhs.gov
http://www.whitehouse.gov/sites/default/files/up
loads/NHAS.pdf

http://minorityhealth.hhs.gov/npa/

Presents guidelines to improve services for people with serious
mental illness or emotional disorders who are in mental health crises.
Defines values, principles, and infrastructure to support appropriate
responses to mental health crises in various situations.
The National Standards for Culturally and Linguistically Appropriate
Services in Health and Health Care (the National CLAS Standards)
are intended to advance health equity, improve quality, and help
eliminate health care disparities by providing a blueprint for
individuals and health and health care organizations to implement
culturally and linguistically appropriate services.
July 2010 PDF of the National HIV/AIDS Strategy for the United
States

Offers an overview and resources to help end health disparities

NREPP is a searchable online registry of M/SUD interventions.
NREPP was developed to help the public learn more about evidencehttp://www.nrepp.samhsa.gov/
based interventions that are available for implementation.
Outlines a national strategy to guide suicide prevention actions.
Includes 13 goals and 60 objectives across four strategic directions:
http://store.samhsa.gov/product/Nationalwellness and empowerment; prevention services; treatment and
Strategy-for-Suicide-Prevention-2012-Goalssupport services; and surveillance, research, and evaluation.
and-Objectives-for-Action/PEP12-NSSPGOALS (Downloadable report)
Links to the Olmstead decision document, as well as, a report that
http://www.samhsa.gov/laws-regulationsoffers a basic primer on supportive housing, as well as a thorough
guidelines/civil-rights-protections
review of states’ current Olmstead planning efforts in this area
http://www.medicaid.gov/Federal-PolicyGuidance/downloads/SHO-13-001.pdf
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Letter from Medicaid on Application of the Mental Health Parity and
Addiction Equity Act to Medicaid MCOs, CHIP, and Alternative
Benefit (Benchmark) Plans

Prevention of Underage
Drinking
Recovery
SAMHSA.gov Data
Resources
SAMHSA's Evidenced
Based Practice
Knowledge Information
Transformation (KIT)
Substance Abuse for
Women
Suicide Prevention
Synar Program
Telehealth Policy
Resource
Trauma & Violence
Criminal & Juvenile
Justice

Tribal Consultation

http://www.ncbi.nlm.nih.gov/books/NBK44360/
http://www.samhsa.gov/recovery/

http://www.samhsa.gov/data/
http://store.samhsa.gov/product/AssertiveCommunity-Treatment-ACT-Evidence-BasedPractices-EBP-KIT/SMA08-4345

http://www.samhsa.gov/women-childrenfamilies

The Surgeon General's Call to Action To Prevent and Reduce
Underage Drinking seeks to engage all levels of government as well
as individuals and private sector institutions and organizations in a
coordinated, multifaceted effort to prevent and reduce underage
drinking and its adverse consequences.
SAMHSA's resources, guides and technical assistance on recovery
Links to SAMHSA data sets including: NSDUH, DAWN,
NSSATS/NMHSS, TEDS, Uniform Reporting System (URS),
National and State Barometers, etc.
SAMHSA’s Evidence-Based Practice Knowledge Informing
Transformation (KIT)[1] were developed to help move the latest
information available on effective behavioral health practices into
community-based service delivery.
Guidance on components of quality SUD treatment services for
women, states can refer to the documents found at this link
Links to resources and guides around suicide prevention and other
mental and substance misuse prevention topics.

http://www.samhsa.gov/prevention/

Description and overview of the SYNAR program, which is a
requirement of the SABG.

http://samhsa.gov/synar

http://telehealthpolicy.us/medicaid

Telehealth Medicaid Policy site that provides telehealth laws and
reimbursement by state, telehealth policy PDF and a review of
pending legislations

http://www.samhsa.gov/trauma-violence

Includes information around violence and trauma, including the
definition and review of trauma informed care.

Review of behavioral health services and resources in the criminal
http://www.samhsa.gov/criminal-juvenile-justice justice and juvenile justice systems.
http://www.whitehouse.gov/the-pressoffice/memorandum-tribal-consultation-signed- The White House memorandum regarding the requirements related to
president
tribal consultation

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