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PAIMI PPR
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
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| File Title | PAIMI PPR |
| Author | markstroh |
| Last Modified By | Writer |
| File Modified | 2026-03-25 |
| File Created | 2026-07-24 |
| Conversion State | complete |
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Protection and Advocacy for Individuals with Mental Illness (PAIMI)
Annual Program Performance Report (PPR)
Substance Abuse and Mental Health Services Administration (SAMHSA)
U.S. Department of Health and Human Services
Table of Contents Section A: General Program Information
1) P&A Identification
2) Main Office
3) Other Offices (if any)
4) Executive Director/Chief Executive Officer Contact Information
5) PPR Preparer Contact Information
6) Governing Authority President/Chair
7) PAIMI Advisory Council President/Chair
8) Name of P&A Chief Financial Officer/Accountant
9) Governor’s Liaison
10) Commissioner/Director of the state Mental Health Agency Name
11) Demographic composition of Governing Board, Advisory Council and PAIMI staff
12) Number of mental health professionals (social workers, psychologists, psychiatric nurses, psychiatrists, psychiatric nurse practitioners, peer support specialists, other) on the Advisory Council.
13) Governing Board (GB) Type and Number of Members
14) Governing Board Information
Governing Board Composition
15) PAIMI Advisory Council
16) Staff charging time to the PAIMI Program
Section B: Demographics - Interventions on behalf of Individuals
1) Age of PAIMI-eligible Individuals Served
2) Ethnicity and Race of Individuals Served
3) PAIMI-eligible Individuals served with PAIMI Program funds
4) Living Arrangements of PAIMI-eligible Individuals at Intake
Section C: Complaints/Problems of PAIMI-eligible Individuals
1) Complaints/Problems of PAIMI-eligible Individuals - Abuse
2) Abuse Complaints Disposition
3) Complaints/Problems of PAIMI-eligible Individuals – Neglect
4) Neglect Complaints Disposition
5) Complaints/Problems of PAIMI-eligible Individuals - Rights Violations
6) Rights Violations Complaints Disposition
7) Reasons for Closing Individual Advocacy Case Files
8) Intervention Strategies
Death Investigation Activities
The number of deaths of individuals reported to the P&A for investigation by category
1. All Death investigations conducted involving PAIMI-eligible individuals by category.
2. Brief summary examples of an individual’s death, P&A involvement, and outcome.
9) Intervention on Behalf of Groups of PAIMI-eligible Individuals (count by type).
10) Intervention on Behalf of Groups of PAIMI-eligible Individuals (number and outcome by type of intervention).
11) End Outcomes of P&A Activities
Section D: Non-Client Directed Advocacy Activities
1) Individual Information and Referral
2) State Mental Health Planning Activities
3) Education, Public Awareness Activities and Events
4) Technical Assistance
Section E: Grievance Procedures Section F: Other Services and Activities
Section G: Actual PAIMI Budget/Expenditures for FY Section H: Statement of Goals and Priorities
1) Report on previous FY Statement of Priorities and Objectives (SPO)
Section A: General Program Information for FY
1. P&A Identification
Name of state/jurisdiction
Name of P&A system
2. Main Office
Mailing address of main office
Phone number of main office
Toll free Phone Number
E-mail address
Website address
TTY phone number or Relay
County or Main Office
3. Other Offices (if any - add rows, if needed)
Mailing address (each satellite office)
County of each satellite office (location)
4. Executive Director/Chief Executive Officer Contact Information
Name
Address
Phone number & extension
E-mail address
5. PPR Preparer Contact Information
Name
Title
Phone number & extension
E-mail address
6. Governing Board President/Chair
Name
Mailing address
County of residence
7. PAIMI Advisory Council President/Chair Name
Name
Mailing Address
City
Zip Code
County of Residence
Email Address
Current Term Started
Current Term Expires
8. Name of P&A Chief Financial Officer/Accountant
Name
Title
Phone Number/Extension
Email Address
9. Governor’s Liaison
Name
Official Title
Mailing Address
City
Zip Code
County of Residence
Phone Number/Extension
Email Address
10. Commissioner/Director of the State Mental Health Agency
Name
Mailing Address
City
Zip Code
Phone Number/Extension
Email address
11. Demographic Composition of PAIMI Governing Board, Advisory Council, and Program Staff
Governing Board
Advisory Council
Program Staff
Ethnicity
Hispanic/Latino
Non-Hispanic/Latino
Ethnicity Unknown
Race
American Indian/ Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Black/African American
White
Two or more races
Some other race
Race unknown
Sex
Female
Male
12. Governing Board (GB) Type and Number of Members Included in Governing Board Information
Governing board
Minimum number of members
Maximum number of members
Private, non-profit with multi-
Member
State-operated with governing
Board
State-operated with no
governing board
13. Governing Board Information
Total seats available
Total members serving as of 9/30/
Total vacancies on 9/30/
Term of appointment (number of years)
Term maximum
Meeting frequency
Number of meetings held this fiscal year (FY)
Percentage of members present at meetings during the FY
14. Governing Board Composition
Number of individuals with mental illness who are recipients/former recipients (R/FR) of mental health services or have been eligible for services.
Number of family members of individuals with mental illness who are R/FR of mental health services, guardians, advocates or authorized representatives or other persons who broadly represent or are knowledgeable about the needs of clients served by the P&A system.
Total
15. Executive Director
Initial Appointment Date X/X/XXXX (mm/dd/yyyy)
Recent performance evaluation completed X/X/XXXX (mm/dd/yyyy)
Date of previous performance evaluation X/X/XXXX (mm/dd/yyyy)
Agency has written policy and procedures to guide the ED’s evaluation process ? Yes No
Input on ED's performance evaluation obtained from the following (check all that apply)
All agency employees/staff Yes No
Senior managers Yes No
All board director Yes No
All PAIMI Advisory Council members Yes No
Stakeholders Yes No
Consumers Yes No
Family members of consumers Yes No
State mental health providers Yes No
Private mental health providers Yes No
Other Yes No
16. Number of Mental Health Professionals On the Advisory Council
Professional Category
Number on Advisory Council
Social Worker
Psychologist
Psychiatric Nurse
Psychiatrist
Psychiatric Nurse Practitioner
Peer Support Specialist
Other (Identify the professional in the Footnotes)
Total:
17. PAIMI Advisory Council (PAC)
PAC Chair
Sits on the governing board
• Yes
• No
Appointment date
MM/DD/YYYY
Other PAC member(s) sit on governing board
• Yes
• No
If yes, number serving
18. Assigned PAIMI Staff
Number of Attorneys
Full-time
Part-time
Male
Female
Number of Advocates
Full-time
Part-time
Male
Female
Ethnicity
Hispanic/Latino (of any race)
Non-Hispanic/ Latino
Race
American Indian/ Alaska Native
Asian
Black/African
American
Native Hawaiian/ Pacific Islander
White
Two or more races
Some other race
Race unknown
Section B: Demographics – Interventions on Behalf of PAIMI Individuals
Population Information
1. Age of PAIMI-eligible Individuals Served
Age
Number
0 – 2
3-5
6-10
11-22
23-64
65+
Prefer not to say
Total
2. Sex of PAIMI-eligible Individuals Served
Sex
Number
Female
Male
Total
3. Ethnicity and Race of Individuals Served
Ethnicity
Number
PAIMI%
State%
Hispanic/Latino (of any race)
Non-Hispanic/Latino
Ethnicity unknown
Total
Race
Number
PAIMI%
State%
American Indian/Alaska Native
Asian
Black/African American
Native Hawaiian/Pacific Islander
White
Two or more races
Some other race
Race unknown
Total
4. PAIMI-Eligible Individuals served with PAIMI Program Funds
What to Count
Number
1. Number of PAIMI-eligible individuals continued to be served with PAIMI program funds, including any program income resulting from legal actions supported by PAIMI program funds as of October 1, from the previous FY into the reporting year.
2. Number of new PAIMI-eligible individuals served during the reporting year.
3. Total number of PAIMI-eligible individuals served during this FY (add lines 1 and 2).
4. Individuals with more than one intervention opened/closed during the reporting year
5. Individuals with a co-occurring mental illness and Intellectual and Developmental Disability (IDD).
6. Total number of PAIMI-eligible individuals who requested program related advocacy services during the reporting year, but were not served within 30-days of initial contact due to:
a. insufficient PAIMI Program resources
b. non-priority areas.
7. Individuals served as of September 30 and will be carried over to next reporting year (This should equal ≤ item 3 above).
5. Living Arrangements of PAIMI-Eligible Individuals at Intake
Living Arrangement
Number
Community residential home for children/youth up to age 18 yrs.
Community residential home for adults
Non-medical community-based residential facility for children/youth
Foster care
Nursing homes, including skilled nursing facilities
Intermediate care facilities
Public and Private general hospitals including emergency rooms
Public institutional living arrangement
Private institutional living arrangement
Psychiatric hospitals (public/private)
a. public/state b. private
Jails
State prison
Federal detention center
Federal prison
Veterans Administration hospital/clinic
Other federal facility
Homeless
Independent (in the community & PAIMI-eligible)
Parental or other Family home & PAIMI-eligible
Unknown
Total
Section C: Complaints/Problems of PAIMI Individuals
1. Areas of Alleged Abuse
Number of complaints/problems
(Make every effort to report within the following categories)
Number from Closed Cases only
Outcomes (will add col. J &K
Total
A
B
C
D
E
F
G
H
I
a. Inappropriate or excessive medication
b. Inappropriate or excessive restraint and seclusion
c. Involuntary medication
d. Involuntary electrical convulsive therapy
e. Involuntary aversive behavioral therapy
f. Involuntary sterilization
g. Physical assault
h. Sexual assault
i. Threats of retaliation or verbal abuse by facility staff
j. Coercion
k. Financial exploitation
l. Suspicious death
m. Other - Specify type of complaint. Please describe below (in Comment Box)
*Expanded authorities under the Children’s Health Act of 2000, Part H, section 592(a) and Part I Section 595, as codified respectively under Title V. Public Health Service Act, 42 U.S.C., at 290ii- 290ii and 290jj-1 -290jj-2 (See also, the PAIMI
Act 42 U.S.C. 10802(1)(A) - (D)).
2.Abuse Complaints Disposition
3. Areas of Alleged Neglect
[Failure to provide for appropriate. .
.] - Number of complaints/problems:
Number from Closed Cases
Only
Outcomes (will add col. K)
Total
A
B
C
D
E
F
G
H
I
J
a) Failure to provide necessary or appropriate medical (other than psychiatric) treatment
b) Failure to provide necessary or appropriate mental health treatment, including access to prescribed medication
c) Failure to provide necessary or appropriate personal care and safety
d) Failure to provide appropriate discharge planning or release from a residential care or treatment facility
e) Mental health diagnostic or other evaluation (does not include treatment)
f) Medical (non-mental health related) diagnostic or physical examination
g) Other [Describe and make every effort to report within the above categories]
4. Neglect Complaints Disposition
For total closed cases listed in Table C.3., provide the numbers of neglect complaints or problem areas for each disposition category.
a. Number of complaints/problems determined after investigation not to have merit.
b. Number of complaints/problems withdrawn or terminated by the client.
c. Number of complaints/problems resolved in the client’s favor.
d. Number of complaints/problems not resolved in the client’s favor.
e. Other indicators of success or outcomes that resulted from P&A involvement.
f. Other representation found,
g. Services not needed due to client death or relocation
h. P&A withdrew due to conflict of interest or other reasons.
i. Lost Contact
j. Outcome Unknown
k. Lack of Resources
Total number of Neglect complaints/problem addressed from closed cases.
5. Areas of Alleged Rights Violations
Number of Complaints/Problems
Number from Closed Cases only
Outcomes
(will add col. K)
Total
A
B
C
D
E
F
G
H
I
a. Failure to provide an individualized, written treatment or service plan
b. Failure to provide written discharge plan, including a description of mental health services needed upon discharge from such program or facility
c. Failure to allow ongoing participation, appropriate to such person’s capabilities, in the planning of mental health services (including the right to participate in the development and periodic revision of the plan)
d. The right to refuse treatment
e. The right to refuse to take prescribed medications
f. The denial of financial benefits/entitlements (e.g., SSI, SSDI, Insurance)
g. Guardianship/conservator problems
h. The denial of rights protection information or legal assistance, including adequate and appropriate representation during commitment
hearings
i. The denial of privacy rights (e.g., congregation, telephone calls, receiving mail)
j. The denial of recreational opportunities (e.g., grounds access, television, and smoking)
k. The denial of visitors
l. The denial of access to or correction of records
m. Breach of confidentiality of records (e.g., failure to obtain consent before disclosure)
n. Failure to obtain informed consent
o. Advance directives issues
p. The denial of parental/family rights
q. Housing Discrimination
r. The denial of access to administrative or judicial process;
s. Failure to provide educational services in the least restricted environment for PAIMI-eligible individuals
t. The denial of access to community-based rehabilitation services and/or treatment
u. The denial of access to transportation
v. Employment Discrimination
w. The denial of access to personal possessions
x. Failure to comply with commitment regulations
y. Failure to comply with commitment time frames
z. Other [Please, make every effort to report within the above categories]
6. Rights Violations Disposition
For closed cases listed in this Table, provide the number of rights complaints or problem areas for each disposition category.
a. Number of complaints/problems determined after investigation not to have merit.
b. Number of complaints/problems withdrawn or terminated by client.
c. Number of complaints/problems resolved in the client’s favor.
d. Number of complaints/problems not resolved in the client’s favor.
e. Other indicators of success or outcomes that resulted from P&A involvement.
f. Other representation found.
g. Services not needed due to client death or relocation.
h. P&A withdrew due to conflict of interest or other reasons.
i. Lost Contact
j. Outcome Unknown
k. Lack of Resources
Total number of Rights Violation complaints/problems addressed from closed
cases.
7. Reasons for Closing Individual Advocacy Case Files
Number
Client’s objective was partially or fully met.
Case or investigation lacked merit.
Case withdrawn or terminated by the client.
Issue favorably resolved.
Issue not favorably resolved.
Other success or outcomes due to P&A involvement (i.e., provided self-advocacy assistance)
Other representation found.
Services not needed due to client’s death or relocation.
P&A withdrew due to conflict of interest or other reasons (i.e., client would not cooperate).
Appeal(s) unsuccessful.
Other appropriate entity investigating.
Lost Contact.
Lack of Resources.
Total
8. Intervention Strategies (more columns will be added to match C.1., C.3. and C.5.)
Outcomes
Abuse
Neglect
Rights Violations
Will add col. K
Strategy
Total
A
B
C
D
E
F
G
H
I
J
A
B
C
D
E
F
G
H
I
A
B
C
D
E
F
G
H
I
1. SAA
2. LA
3. AR
4. L
5. A/N I
6. M
7. N
Total
1. SAA – Self Advocacy Assistance
2. LA – Limited Advocacy
3. AR – Administrative Remedies
4. L - Litigation
5. A/N I – Abuse/Neglect Investigations
6. M – Mediation
7. N – Negotiation
9. Death Investigation Activities
a). The number of deaths reported to the P&A for investigation by the following entities:
1. State
2. The Center for Medicaid & Medicare Services (Regional Offices). If zero means the P&A did not receive any death reports from CMS for investigation, please note this in the Footnotes.
3. Other Sources. Briefly list the source for each death reported in this category (e.g., newspaper, concerned citizen, relative, etc.).
Total Number of deaths investigated.
If the information requested in this section was not available, please explain.
b). All death investigations conducted involving PAIMI-eligible individuals related to the following:
1. Number of deaths investigated involving incidents of seclusion (S).
2. Number of deaths investigated involving incidents of abuse (A).
3. Number of deaths investigated involving incidents of restraint (R).
4. Number of deaths investigated not related to incidents of S&R. (for example, deaths by suicide)
5. Death investigations with a finding of determination.
6. Provision in policy added or prevented because of a death investigation
Total Number of deaths investigated [Sum of 9b 1-6].
10. Number of Interventions on behalf of Groups of PAIMI Eligible Individuals – Individuals Impacted
Multiple counts not permitted for lines 1 – 3 and 6.
What to Count
Number
1. Group cases/projects still open on October 1 (carried over from prior FY(s)).
2. New group cases/projects opened during the year.
3. Total group cases/projects worked on during the year (Add items 1 and 2).
4. Total group cases/projects as of September 30, ___ to ___ (Carry over to next FY).
5. Group cases/projects targeted at serving the following special populations:
a. Ethnicity
b. Racial Minorities
c. Homeless
d. Veterans
e. Urban
f. Rural/Frontier
g. Older Adults/
Geriatric
6. Total # of individuals impacted by line 3.
11. Interventions on behalf of Groups of PAIMI-Eligible Individuals
Only the number of cases are needed for the last three columns, not the number of individuals
5. E. Intervention Types
(See the Instructions for Guidance)
Potential number of Individuals Impacted
Concluded Successfully
Concluded Unsuccessfully
On-going
Group Advocacy (non-Litigation)
Abuse and Neglect Investigations
(non-death related)
Facility Monitoring Services
Community Based Monitoring Services
Court Ordered Monitoring
Systemic Litigation
Educating Policy Makers
Other Systemic Advocacy
Total
In the second form, the Potential # of Individuals Impacted should match the number for Question 3. Total group cases/projects worked on during the year (Add lines 1 & 2). The total number of cases Concluded Successfully, Concluded Unsuccessfully, and On-going should match the number for Question 6. Total # of individuals potentially impacted by line 3.
12. Performance Measures of P&A Activities
Outcomes
Number from Closed Cases Only
a) PAIMI-eligible individuals who access community-based mental health or health care services that resulted in community integration and independence or are better able to advocate to do so;
b) PAIMI-eligible individuals who access benefits or services or are better able to advocate to do so;
c) PAIMI-eligible individuals who live in a healthier, safer, improved, or more integrated settings or are better able to advocate to do so;
d) PAIMI-eligible individuals are able to stay in their own home or better able to advocate to do so;
e) PAIMI-eligible individuals who can secure or maintain employment and/or are not subject to workplace discrimination or are better able to advocate for to do so;
f) PAIMI-eligible individuals who receive appropriate educational services and supports and/or are not subject to discrimination in educational settings or are better able to advocate for those outcomes;
g) PAIMI-eligible individuals who go to school in safe and more humane conditions;
h) PAIMI-eligible children (individuals) who receive appropriate services in the most integrated settings;
i) PAIMI-eligible individuals who were not subject to discrimination in government benefits/services, housing, public accommodations, etc. or are better able to advocate for such outcomes;
j) PAIMI-eligible individuals who were not subject to abuse, neglect, or rights violations or are better able to advocate for to do so;
k) PAIMI-eligible individuals who can make their own decisions to the maximum extent feasible or are better able to advocate to do so;
l) PAIMI-eligible individuals who had their rights enforced, retained, restored and/or
expanded or are better able to advocate for to do so; and
m) PAIMI-eligible individuals who were more able to participate in the voting process or are better able to advocate for to do so.
Section D. Non-Client Directed Advocacy Activities
1. Individual Information and Referral (I&R) Service [See, PAIMI Rules, 42 CFR 51.24]
Provide the number of PAIMI Program I&R services.
Total
2. State Mental Health Planning Activities
Briefly list P&A collaboration/involvement in State Mental Health planning activities. Provide this in narrative form and limit the text to 2,500 characters.
3. Education, Public Awareness Activities, and Events
List the number of public awareness activities or events and the number of individuals who received the information [Refer to Glossary].
1. Number of public awareness activities or events.
2. Number of education/training activities undertaken.
3. Number (approximate) of persons trained in 2.
4. Technical Assistance
Provide the number of PAIMI Program TA services.
Total
Section E. Grievance Procedures [42 CFR Section 51.25]
1. Do you have a systemic/program assurance grievance policy, as mandated by 42 CFR 51.25(a) (2)?
• Yes ☐No
(If no, please indicate the date that the developed policy is anticipated.
/ /
2. The number of grievances filed by PAIMI-eligible clients, including representatives or family members of such individuals receiving services during this fiscal year.
Total
3. The number of grievances filed by prospective PAIMI-eligible clients (those who were not served due to limited PAIMI program resources or because of non-priority issues). 42 CFR Section 51.25(a)(1)(2)
Total
4. The number of grievances appealed to:
4.a. The Governing Authority/Board
4.b. The Executive Director
Total 4.a. & 4.b.
5. The number of reports sent to the Governing Board and the Advisory Board.
Total
6. Please IDENTIFY ALL INDIVIDUALS by name & title, responsible for grievance reviews (maximum 5):
Name & title
Name & title
Name & title
Name & title
7. What is the timetable (in days) used to ensure prompt notification of the grievance procedure process to clients, prospective clients or persons denied representation, and ensure prompt resolution?
Number of days
Section F. Other Services and Activities
2. Were the notices provided to the following persons?
a. Individuals with mental illness in residential facilities?
• Yes
• No
b. Family members and representatives of such individuals?
• Yes
• No
c. Other individuals with disabilities?
• Yes
• No
d. Brief explanation is required for each no answer in 2.a., b., or c.
3. Do the procedures provide for receipt of the comments in writing or in person?
• Yes
• No
3.a. If yes, attach a copy of the agency’s policies/procedures pertaining to public comment.
3.b. If no to 2 a, b, c., explain why the agency does not have such procedures in place.
4. Was the public provided an opportunity for public comment?
• Yes
• No
8. List Groups (e.g., states, consumer advocacy, service providers, professional organizations, and others, including groups of current and former mental health consumers or family members of such individuals) with whom the PAIMI program coordinated systems, activities, and mechanisms [PAIMI Act 42 U.S.C. 10824 (a) (D)].
9. External Impediments
Describe any problems with implementation of mandated PAIMI activities, including those activities required by Parts H and I of the Children’s Health Act of 2000 that pertain to requirements related to incidents involving seclusion and restraint and related deaths and serious injuries (e.g., access issues, delays in receiving records and documents, etc.).
10. Internal Impediments
Describe any problems with implementation of mandated PAIMI activities, including any identified
annual priorities, and objectives (e.g., lack of sufficient resources, necessary expertise, etc.).
11. Accomplishments
For this fiscal year, briefly describe the most important accomplishment(s) that resulted from PAIMI program activities. Provide copies of supporting documents (e.g., case law, news article, legislation,
etc.).
12. Recommendations
Please provide recommendations for activities and services to improve the PAIMI program. Include a
brief description of why such activities and services are needed [42 U.S.C. 10824(a) (4)].
13. Please identify any training & technical assistance requests [42 U.S.C. 10825].
Upload supporting documentation for Accomplishments here
File Name
Created Date
Download
Section G. PAIMI Budget – Actual for FY 20XX__
Planning Period From 10/1/___ to 9/30/____
In this section, provide actual expenditures for the FY __. Please only include the current FFY’s budget figures and use the Footnotes to describe methodology and any additional funding carried over from previous years, including program income. Refer to the PAIMI Application [Appendix C] submitted to SAMHSA/CMHS for the same FY. For additional information regarding this Section, please review the PPR Instructions.
I. Personnel/Name/Title (Active for PAIMI Supervisor only) – Insert additional rows, as needed.
In the section below for each funded staff position provide the name, title, annual salary, level of effort - full time equivalent charged to the PAIMI grant, and the costs billed to the PAIMI grant for each position. Please only include the current FFY’s budget figures and use the footnotes to describe methodology and any additional funding carried over from previous years.
Personnel/Name/Title
Annual Salary
A
Total PAIMI Share
B
Percent/Level of Effort to PAIMI
B / A = C
Comments
Staff Positions
Vacant Positions
Volunteer Positions
Total
II. Fringe Benefits – Insert additional rows, as needed.
Please only include the current FFY’s budget figures and document all other figures in the footnote. Please also describe methodology in the footnotes.
Fringe Breakdown
Annual Salary
A
Total PAIMI Share
B
Percent/Level of Effort to PAIMI
B / A = C
Comments
Total
III. Travel – Insert additional rows, as needed.
Please only include the current FFY’s budget figures and document all other figures (carryover) in the footnote. Using the comment field or footnote, provide the purpose of travel number of staff, PAIMI Advisory Council or board members traveling for each event, and per diem: describe the number of nights and purpose. There is a 10% limit on training, technical assistance and travel expenses [42 CFR 51.6 (3) (e)].
Travel Expenses
Actual Cost
A
Total PAIMI Share
B
Percent/Level of Effort to PAIMI
B / A = C
Comments
Total
IV. Equipment – Insert additional rows, as needed.
Include communications and rental equipment directly related to PAIMI project activities. Please only include the current FFY’s budget figures and use the footnote to describe any additional funding carried over from previous years.**
Equipment
Actual Cost
A
Total PAIMI Share
B
Percent/Level of Effort to PAIMI
B / A = C
Comments
Total
V. Supplies – Insert additional rows, as needed.
Please list the supplies (both the category of items and the value) expended through using PAIMI funds. Use the comments field to describe the supplies.
Supplies
Actual Cost
A
Total PAIMI Share
B
Percent/Level of Effort to PAIMI
B / A = C
Comments
Total
VI. Contractual/Consultant Costs – Insert additional rows, as needed.
In the section below provide budget expenditure information for each contractual arrangement for PAIMI program services. Any sub-contract that exceeds $25,000 must be pre-approved by SAMHSA Grants Management Officer. Only include the current FFY’s budget figures and use the footnote to describe any additional funding carried over from previous years.
Contractual/Consultant
Actual Cost
A
Total PAIMI Share
B
Percent/Level of Effort to PAIMI
B / A = C
Comments
Total
VII. Technical Assistance/Training Costs – Insert additional rows, as needed.
In the section below provide technical assistance and training costs for staff, governing board and advisory council members. Explain the training costs in the comment field (i.e. number of meetings, number of participants, explanation of staff travel cost). Only include the current FFY’s budget figures; document all other figures in the footnotes. There is a 10% limit on training, technical assistance and travel expenses [42 CFR 51.6 (3) (e)].
Technical Assistance/Training
Actual Cost
A
Total PAIMI Share
B
Percent/Level of Effort to PAIMI
B / A = C
Comments
Total
VIII. Other Expenses – Insert additional rows, as needed.
Please include any other expenses that used Federal PAIMI funds but do not fit into the prior categories. “Litigation” is an example. Please be as specific as possible the nature of other indicated expenses.
Other Expenses
Actual Cost
A
Total PAIMI Share
B
Percent/Level of Effort to PAIMI
B / A = C
Comments
Litigation
Total
IX. Indirect Costs
Attach a copy of the approved rate agreement. Federally approved IDC rate.
Indirect Costs
The Base
A
Rate * B
% Format = (.125 = 12.5%)
Total PAIMI Share
A * B = C
Comments
Federally approved IDC rate
Total
X. Carryover of PAIMI Funds Only
Carryover for FY ___ $0.00
Please upload your budget plan for 20__ carryover funds
Total Actual Costs
Total PAIMI Share
Total PAIMI Costs
Attachments (optional)
Footnotes:
PAIMI Expenditures and Revenues
PAIMI Expenditures
1. Does your P&A have an approved Federal indirect cost rate? If yes, what is the approved rate?
• Yes
0.05%
• No
2. Total indirect costs
$
3. Total of all PAIMI program costs listed in I-VIII in the Budget.
$
Total
$
Income sources and other resources (PAIMI program only)
1. PAIMI program carryover of grant funds identified by FY.
$
Enter the last two digits of the Fiscal Year FY 20__
$
2. Program income (PAIMI only).
3. State
$
4. Other funding sources [identify each source].
$
Total of all PAIMI Program resources
$
Please note in the second form that Question 2. Program Income (PAIMI only) is not the current FY PAIMI allotment. Program income is defined as gross income earned that is directly generated by a federally supported activity or earned as a result of the federal award.
Section H: Statement of Priorities (Goals)
PAIMI Program Statement of Priorities and Objectives - Report
The PAIMI Program Statement of Priorities and Objectives (SPOs) must be specific to individuals with significant mental illness (adults) and/or significant emotional impairment (children/youth), as determined by a mental health professional qualified under the laws and regulations of the state in accordance with 42 U.S.C.A. § 10802(4) (A). The SPOs in the PPR must match the same format and order approved in the FY 2025 PAIMI Application. The strategies used for each Objective must be completed. The reason why priority/goal was not achieved or was partially achieved must be completed.
A. For each Priority/Objective, please indicate the “Achieved Outcome:
Priority/Goal Description:
Objective:
Target Population:
Expected Outcome:
Actual Outcome
B. Strategies Used to Implement Goal and Address Priorities (Check all that apply below)
□ Collaboration
□ Systemic Litigation
□ Rights-Based Individual Advocacy Services
□ Educating Policy Makers
□ Investigations of Abuse and Neglect
□ Other Systemic Advocacy
□ Monitoring
□ Training/Outreach
□ Issuance of Public Report
C. Results narratives of P&A activities and accomplishments related to above priority.
Priority:
Objective:
Target Population:
limited to 500 characters
D. Other qualitative narrative related to the above priority
(Significant activity for which there were no quantifiable results goes here). Describe any other significant activity related to this goal (500 words maximum)
Section I: Glossary
This section contains definitions applicable to the Protection and Advocacy for Individuals with Mental
Illness (PAIMI) Program.
Abuse
Any act, or failure to act, by an employee of a facility rendering care or treatment, which was performed, or failed to be performed, knowingly, recklessly, or intentionally, and which caused, or may have caused, injury or death to an individual with mental illness and includes, but is not limited to, such acts as:
• rape or sexual assault;
• striking;
• the use of excessive force when placing an individual with mental illness in bodily restraints;
• the use of bodily or chemical restrains, which is not in compliance with federal and state laws and regulations, verbal, non-verbal, mental, and emotional harassment; and
• any other practice, which is likely to cause immediate physical or psychological harm or result in long term harm if such practices continue (PAIMI Rule 42 CFR 51.2).
Act
Refers to the PAIMI Act of 2000, as amended, 42 U.S.C. 10801 – 10807, 10821 – 10827 [PAIMI Rule 51.2].
Administration on Disabilities (AoD)
The AoD within the Administration on Community Living, the Department of Health and Human Services [PAIMI Rule 51.2].
Administrative Remedy
Any non-judicial complaint resolution process provided by government agencies, boards, commissions, or other designated adjudicators, exercising decision making authority delegated by statute. Administrative Remedy processes are generally simpler, less formal, and less technical than the judicial process.
Advisory Council Report (ACR)
A section of an annual protection and advocacy (P&A) system’s, PAIMI program performance report, to the Secretary of the U.S. Department of Health and Human Services. The ACR is the PAIMI Advisory Council’s independent assessment of their P&A system for the previous fiscal year. The report is mandated under the PAIMI Act at 42 U.S.C. 10805 (a) (7).
Care or Treatment
Services provided (as needed or under a contractual arrangement) to prevent, identify, reduce or stabilize mental illness of emotional impairment, such as mental health screening, evaluation, counseling, biomedical, behavioral, psychotherapies, supportive of other adjunctive therapies, medication, supervision, special education, and rehabilitation, even if only as needed or under a contractual arrangement.
Case Narrative
For each Statement of Priorities and Objectives (SPO) identified for the fiscal year (FY), select one case example that best illustrates related PAIMI program activities. Include at least one example of a PAIMI individual or systemic advocacy case, and if applicable, a legislative or regulatory activity, consistent with current SAMHSA/CMHS and federal policies and restrictions on lobbying activities. Each case narrative selected by the P&A to illustrate its SPOs, must use people first language, maintain the confidentiality of the individual client, identify the presenting issue/complaint, briefly, clearly and concisely summarize the facts (who, what, when, where, why and how) of the situation, including, the impact(s) or outcome(s) of these PAIMI program activities.
Client
For the purposes of the Program Performance Report (PPR), (but not necessarily for determining a client/attorney relationship) a client is an individual or group of individuals at risk of abuse or neglect and meet the following criteria:
• He/she is eligible for the PAIMI program;
• A file/service record has been opened, which includes at least the name, address, age, race, disability, signed release of information form (if appropriate), the concern/complaint and the goal of the action to be taken; and
• He/she has been provided at least one significant service.
Client Objective
The result(s) a client(s) desires and the P&A has agreed to pursue, as documented in a retainer agreement between the client(s) and the P&A.
Client Objective Met
The result(s) a client(s) desired and the P&A agreed to pursue, as documented in a retainer was achieved, at least in part.
Closed Case
When the advocate/attorney closes the client record or case file after providing advocacy interventions on behalf of a client, and determining the client, either has no need of further intervention services or the agency has no other services available to address the issue(s)/complaint(s) for which the case was initially opened or the client is no longer available to address the issue(s).
Collaboration
An activity or set of activities the P&A undertakes with a community partner(s), to pursue a shared advocacy goal.
Complaint
Any report or communication, whether formal or informal, written or oral, received by the P&A system, including media account, newspaper articles, electronic communications, telephone calls (including anonymous calls) from any source alleging abuse or neglect of an individual with mental illness (CFR 51.2).
Department or HHS
Means: the U.S. Department of Health and Human Services.
Designated Official
The state official or public/private entity empowered by the governor or state legislature, accountable for the proper use of funds by the P&A system.
Director
Means: the Director of the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, or his/her designee.
Educating Policy Makers
Efforts directed to local, state or federal level individuals or entities: providing information about disability laws, regulations and policies. Information reported should only include work done in accordance with the limit on federal funding.
Facility
Includes; any public/private residential setting that provides overnight care accompanied by treatment services. Facilities include, but not limited to the following: general and psychiatric hospitals, nursing homes, board and care homes, community housing, juvenile detention facilities, homeless shelters, jails, and prisons, including all general areas, and special mental health, or forensic units.
Fiscal Year
Means: federal fiscal year (October 1 – September 30), unless otherwise specified.
Full Investigation
Based upon a complaint or determination of probable cause, and means the access to facilities, clients, and records authorized under this part, necessary for a P&A system to make a determination if an allegation of abuse or neglect is taking place or has taken place. Full investigation may be conducted independently or in cooperation with other agencies authorized to conduct similar investigations [CFR 51.2].
Governor
Means the state, chief executive officer of the territory or the District of Columbia, or his/her designee, formally designated to act, on behalf of the governor, in carrying out the requirements of the Act and this part.
Governing Authority
[PAIMI Rule 51.22]
Governing Board Composition
The governing board shall be composed of members, who broadly represent and are knowledgeable of client needs, served by the P&A system [PAIMI Rules 51.22 (G), 42 CFR 51.22(b) (2)].
• Individuals with mental illness (IMI) who are recipients/former recipients (R/FR) of mental health services or are/were eligible for services.
• Family members of individuals with mental illness who are R/FR of mental health services.
• Guardians.
• Advocates or authorized representatives.
• Other persons who broadly represent or knowledgeable of client needs, served by the P&A system.
Group Advocacy Services
Work on behalf of groups of people with disabilities pursued through the interventions of systemic litigation, legislative and regulatory advocacy, and systemic advocacy (non-litigious and non-legislative). It is concerted action to reform the policies or mode of operations of a system of services such as the disabilities service system or the policies and practices of private actors.
Individual with Mental Illness
Means: an individual who has a significant mental illness or emotional impairment, as determined by a mental health professional, qualified under the laws and regulations of the state and who is an inpatient or resident in a facility rendering care or treatment, even if the whereabouts of such inpatient or resident is unknown; who is in the process of being admitted to a facility rendering care or treatment, including persons being transported to such a facility, or who is involuntarily confined in a detention facility, jail or prison.
• The definition of “individual with a mental illness” contained in section 10802(4)(B)(iii) of this title shall apply, and thus an eligible system may use its allotment under this subchapter to provide representation to such individuals, only if the total allotment under this subchapter for any fiscal year is $30,000,000 or more, and in such case, an eligible system must give priority to representing persons with mental illness as defined in subparagraphs (A) and (B)(i) of section 10802(4) of this title.
Information and Referral (I&R) Service
Information and referral includes responses to individuals at meetings, one-time telephone discussions, follow-up mailings of letters, brochures and/or pamphlets per an individual’s request. I&R includes brief written or oral information, such as, generic information about the P&A including information about additional programs and resources external to the P&A relating to the individual’s service needs and statutory or constitutional rights as a person with a disability. The agency generally would not have personal identifying information about the individuals who request and/or receive I&R services, except for possibly the name, address and telephone number.
Individual and Group Intervention Strategies:
• Individual Advocacy Strategies (IAS) – legally based work on behalf of a client using one or more of the following intervention types: self-advocacy assistance, limited advocacy, administrative remedies, litigation, mediation, negotiation, systemic advocacy and system litigation.
• Abuse/Neglect Investigation (A/NI) – a systemic and thorough examination of information records, evidence, and circumstances surrounding an allegation of abuse and neglect. Investigations are undertaken to determine if there is a basis for administrative or legal action on behalf of the client. Investigations require a significant allocation of time to interview witnesses, gather factual information, and to issue a written report of findings.
• Administrative Remedies (AR) – includes the use of any systems for appeal within an agency of facility, or between agencies, which does not involve adjudication by a court of law.
• Legal Remedies (LR) – the legal representation of client, in litigation, in court processes concerned with rights, grievances, or appeals of such rights or grievances.
• Legislative/Regulatory Advocacy (L/RA) – activities involve monitoring, evaluating, and commenting upon the development and implementation of federal, state, and local laws, regulations, plans, budgets, taxes and other action, which may affect individuals with mental illness, [PAIMI Rules at 42 CFR at 51.24 mandates that legislative activities shall also be addressed in the development of program priorities].
• Negotiation/Mediation (N/M) – a problem-solving process in which two or more people voluntarily discuss their differences and attempt to reach a joint decision on their common concerns.
Legal Guardian, Conservator, and Legal Representative
An individual, whose appointment is made by a state court or agency, empowered under state law to appoint and review such officers, and having authority to consent to health/mental healthcare or treatment of an individual with mental illness. It does not include persons acting only as a representative payee, persons acting only to handle financial payments, attorneys or persons acting on behalf of an individual with mental illness only in individual legal matters, or officials responsible for the provision of health or mental health services to an individual with mental illness, or their designee (PAIMI Rule 42 CFR 51.2).
Limited Advocacy
A level of intervention that includes the provision of a discrete task to a client or a discrete contact on behalf of a client with a third party. Such activities upon completion require no further or ongoing actions, either formal or informal. Limited Advocacy can include communications by letter, telephone or other means to a third party; preparation of a simple legal document; or assisting a client in the preparation of documents that are submitted by the client pro se to a third party.
Litigation
Any lawsuit or other resort to the courts to determine a legal question or matter. Litigation involves many complex legal issues which require not only a knowledge of the law that governs the dispute, but also the laws governing the procedures to be followed in order to properly litigate a claim. There are rules governing who may file a claim, where it must be filed, when it must be filed, and how to file it.
Mediation
An alternative dispute resolution process using the services of an independent third party to help settle differences or disputes between two or more individuals.
Monitoring
Activities in which a P&A evaluates compliance issues and quality of service by providers of services, supports and other assistance. Monitoring may involve using the P&A’s access authority to visit and in other ways seek information from institutional or community settings including public and private facilities, where people with disabilities live, work and go to school by 1) conducting face-to-face interviews with individuals with disabilities in those settings; 2) conducting at least one face-to-face interview with a staff member in those settings; 3) observing and evaluating the physical conditions of the setting; and 4) accessing and reviewing records, when appropriate, in accordance with applicable federal and state law. Monitoring may occur in Facilities (see definition Facility) or the community and may or may not be based on a Court Order.
Neglect
Negligent act or omission by an individual responsible for providing services, in a facility rendering care or treatment, which caused or may have caused injury or death to an individual with a mental illness or emotional impairment (as defined in the PAIMI Act) which placed an individual with mental illness at risk of injury or death, and includes, but not limited to, acts or omissions such as failure to: establish or carry out an appropriate individual program plan or treatment plan (including a discharge plan); provide adequate nutrition, clothing, or health care; and the failure to provide a safe environment, which also includes failure to maintain adequate numbers of appropriately trained staff (PAIMI Rules 42 CFR 51.2).
Number Impacted Performance Measure
A number impacted performance measure is one that asks for the number of people with disabilities in a group that was the target of a P&A’s advocacy.
Objectives
Are activities undertaken to achieve annual program priorities (goals). All objectives required to have measurable outcomes and the use of numerical targets is encouraged. Each objective must clearly state why the activity was undertaken, who will benefit from the objective (the target population), how the activity will be accomplished, and what is the expected outcome for the activity? Generally, with the exception of litigation, legislative or regulatory activities, objectives shall be attainable within the fiscal reporting period (within one fiscal year).
Open Case
A PAIMI-eligible individual with a complaint is accepted as a client by the P&A system. A case record or case file is opened for that individual. System staff maintains all intervention services provided to the client and other information maintained in this case record/file.
Other Systemic Advocacy
Concerted action by the P&A agency to promote and effectuate changes in the policies, rules, and laws that impact groups of people with disabilities, and to remove the barriers that prevent or impede them from leading full and productive lives in the community (that does not fit elsewhere in the form). Systems Advocacy typically addresses the establishment, support, improvement, or expansion of (1) programs that provide services or benefits to persons with disabilities, and (2) the legal rights, protections, and entitlements of persons with disabilities; and may involve opposition to efforts to weaken, reduce or eliminate existing services or rights.
Outreach
An activity that targets information on PAIMI program activities, to specific populations or areas.
PAC Chair
A mandated position on the governing authority (private, P&A system).
PAIMI Clients (for purpose of this report)
Individuals who meet the PAIMI-eligibility criteria as defined in the PAIMI Act [42 U.S.C. 10802(4) and its Rules at 42 CFR 51.2 definitions, who have a complaint, for whom demographic data is collected, and for whom the PAIMI program, or any of its subcontractors, provides an intervention (as reported under intervention strategies in this form).
Priority (Goal)
Broad general descriptions of short-term activities for the P&A system to accomplish within one FY. The exceptions are generally regulatory, legislative, and litigation activities.
Priorities and Policies
PAIMI program must be established annually, by the governing authority, jointly with the advisory council. Priorities shall specify short-term program goals and objectives, with measurable outcomes, to implement the established priorities. In developing priorities, consideration shall be given to, at a minimum, case selection criteria, the availability of staff and monetary resources, and special problems and cultural barriers faced by individuals with mental illness who are multiply handicapped or who are members of racial or ethnic minorities in obtaining protection of their rights. Systemic and legislative activities shall also be addressed in the development and implementation of program priorities.
• Members of the public shall be given an opportunity, on an annual basis, to comment on the priorities established and the activities, of the P&A system. Procedures for public comment must provide for, notice in a format accessible to individuals with mental illness, including, individuals in residential facilities, family members, and representatives of such individuals, and other individuals with disabilities. Procedures for public comment must provide for receipt of comments in writing or in person.
• The priorities must be directly related to the purpose of the PAIMI Act of 2000 at 42 U.S.C. 10801 et seq., the PAIMI Rules 42 CFR 51.24 (a) – Program priorities, the Children’s Health Act of 2000 at 42 U.S.C. at 290ii and 290 ii – 1), and the SAMHSA/CMHS grant requirements, etc.
Priority Entity
A non- or for-profit corporation, partnership, or other non-governmental organization.
Probable Cause
Reasonable grounds that an individual with mental illness has been, or may be at risk of, abuse or neglect. The individual making such determination may base the decision on reasonable inferences drawn from his/her experience or training regarding similar incidents, conditions, or problems that are usually associated with abuse or neglect (PAIMI Rule definitions 42 CFR 51.2, defined in PAIMI Rule 51.22).
Program
Activities carried out by the P&A system and operating as part of a P&A system to meet the requirements of the Act.
Public Awareness Activities
Provide general information on disability rights and the purpose and mission of the P&A system. Public awareness activities include public service announcements, newsletter, radio, or television, publications in legal journals, we-site services, general distribution of agency brochures, etc.
Public Education and Constituency Training
The dissemination of information to one or more persons through an interactive event, which often promotes a greater understanding of the constitutional or statutory rights of persons with disabilities. Contrasted to Public Awareness Activities, education and training must be specifically targeted to meet the unique need of the group(s) trained.
Public Entity
An organizational unit of a state or local government or a quasi-governmental entity with one or more governmental powers (PAIMI Rule 51.2.).
Qualitative Results
The result of advocacy efforts expressed primarily through a narrative describing what was accomplished and includes the specifics of the outcomes and outputs reported in the quantitative results.
Quantitative Results
The result of advocacy efforts expressed using outcome or output performance measures.
Racial/Ethnic Background
For the purpose of this report, the ethnicity categories are Hispanic/Latino or Non-Hispanic/Latino. The race categories are American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or other Pacific Islander, and White.
Resolution of Complaint/Problem Area
In a client’s favor when (1) the client is satisfied with the result of the intervention or (2) the expressed wish or stated goal of the clients, is either fully attained or negotiated to an agreeable outcome, or (3) the violation in the stated case complaint/problem area was remedied.
Self-Advocacy Assistance
Self-Advocacy Assistance, formerly referred to as Short Term Assistance, is a level of intervention that can include advice and counseling, brief research, or letter writing to the client to summarize assistance given. Advice and counseling assistance includes informing a client of their rights; coaching the client in self-advocacy; reviewing information; counseling a client on actions one may take; or assisting the client in preparing letters or documents and/or the dissemination of information and materials related to the disability rights issue raised by the client. It includes providing information sheets and other materials.
Standardized Performance Measure
One to be used when doing like activity and reporting like results. For the purpose of this report, it refers to both the outcome and output performance measures, included in the result sections.
State
Means each of the several states, American Samoa, the American Indian Consortium, the District of Columbia, the Commonwealth of Puerto Rico, Guan, the Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands.
Statement of Priorities and Objectives (SPO)
The P&A system’s annual PAIMI program priorities (goals) and objectives (activities) are developed jointly by the PAC and the governing board. All PAIMI program SPOs must be within the scope and consistent with the requirements of the PAIMI Act 42 U.S.C. 10802 (4), 10804 (d) and PAIMI Rules 42 CFR 51.5, 51.6, 51.7, 51.24 (a) & (b), be consistent with the purpose of the PAIMI Act for each SPO, the P&A must select one case example/narrative that best illustrates the related PAIMI program activity and must include at least one case example of individual or systemic advocacy,
System
The organization or agency designated in a state to administer and operate a protection and advocacy program under Subtitle C – Protection and Advocacy of Individual Rights of the Developmental Disabilities Assistance Act of 2000, known as the DD Act at 42 U.S.C. 1541 – 1545 and the Restatement of the Patients’ Bill of Rights Act (42 U.S.C. 18041 et seq.), and the Patient’s Bill of Rights Act (42 U.S.C. 10841 et seq.), and thereby eligible to administer a program for individual with mental illness.
Systemic Advocacy Activities
Efforts taken, to implement changes in policies and practices of systems that impact persons with mental illness. These “systems” include, but not limited to, state agencies, various public and private residential care and treatment facilities, and other service providers, etc., [PAIMI Rules at 42 CFR 51.24(a) PAIMI priorities state that systemic activities shall be addressed in the development and implementation of program priorities].
Systemic Litigation
Concerted action to reform the policies or mode of operations of a system of services. It attempts to address a systemic issue raised by many individuals, through class action litigation, multi-plaintiff litigation, or in some cases individual litigation when the relief sought has the potential of affecting many people with disabilities.
Technical Assistance and Training
• If an eligible system is a public entity, the government of the state in which the system is located, may not require the system to obligate more than five percent of its allotment under this subchapter, in any fiscal year for administrative expenses.
• An eligible system may not use more than 10 percent of any allotment under this subchapter, for any fiscal year, for the costs of providing technical assistance and training to carry out this subchapter.
Technical assistance
Assistance provided to family members, non-legal guardians, professionals or other advocates in consultation regarding an area of the law in which the P&A has expertise. It is considered a non-client directed activity.
Training
A P&A must provide training for PAIMI program staff, and may also provide training for contractors, governing board and advisory council members, to enhance the development and implementation of effective protection and advocacy services for individuals with mental illness, including, at a minimum:
• Training of program staff to work with family members of clients served by the program where the individual with mental illness is a minor, legally competent and chooses to involve the family member; or legally incompetent and the legal guardian, conservator or other legal representative is a family member.
• Training may be provided by individuals who have received or are receiving mental health services and family members of such individuals.
• Training to conduct full investigations of abuse or neglect.