Department of Health and Human Services

**Substance Abuse and Mental Health Services Administration**

**Grants for National Technical Assistance Centers**

> **On Consumer/Peer-Run Programs (SM 04-011)**
>
> **(Initial Announcement)**

**Catalogue of Federal Domestic Assistance (CFDA) No.:** CFDA No.93.243

**Key Dates:**

+---------------------+------------------------------------------------+
| **Application       | **Applications are due by June 25, 2004.**     |
| Deadline**          |                                                |
+---------------------+------------------------------------------------+
| **Intergovernmental | **Letters from State Single Point of Contact   |
| Review**            | (SPOC) are due no later than August 24,        |
|                     | 2004.**                                        |
| **(E.O. 12372)**    |                                                |
+---------------------+------------------------------------------------+
| **Public Health     | **Applicants must send the PHSIS to            |
| System Impact       | appropriate State and local health agencies by |
| Statement           | application deadline. Comments from Single     |
| (PHSIS)/SSA         | State Agency are due no later than 60 days     |
| Coordination**      | after application deadline.**                  |
+---------------------+------------------------------------------------+

­­­­­­­­­­­­­\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

A. Kathryn Power, M.Ed. Charles G. Curie, M.A., A.C.S.W.

Director Administrator

Center for Mental Health Services Substance Abuse and Mental Health

Services Administration

Table of Contents

I.  Funding Opportunity Description Page 3

1\. Introduction

2\. Expectations

II. Award Information Page 8

> 1\. Award Amount

2.  Funding Mechanism

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III. Eligibility Information Page 9

> 1\. Eligible Applicants

2\. Definitions

3.  Cost-Sharing

4.  Other

IV\. Application and Submission Information Page 10

1\. Address to Request Application Package

2.  Content and Form of Application Submission

3.  Submission Dates and Times

4.  Intergovernmental Review (E.O. 12372) Requirements

5.  Funding Restrictions

6.  Other Submission Requirements

V. Application Review Information Page 19

1\. Criteria

2\. Review and Selection Process

VI\. Award Administration Information Page 24

1\. Award Notices

2\. Administrative and National Policy Requirements

3\. Reporting

VII\. Agency Contacts Page 26

Appendix A: Checklist for Application Formatting Requirements Page 28

Appendix B: Glossary Page 30

Appendix C: Certification of Consumer or Consumer Supporter Eligibility
Page 33

Appendix D: Guidelines for Conducting the Alternatives Conference Page
35

Appendix E: Customer Satisfaction Survey Page 37

**I**. **FUNDING OPPORTUNITY DESCRIPTION**

###### **1. INTRODUCTION** 

As authorized under Section 520A of the Public Health Service Act, the
Substance Abuse Mental Health Services Administration (SAMHSA) announces
the availability of funds for National Technical Assistance Centers on
Consumer/Peer-Run Programs (Consumer/Peer- Run TACs) grants. The
Consumer/Peer- Run TACs will assist in the transformation of the mental
health system by providing consumers with necessary skills to foster
consumer/peer-run programs. These programs maximize consumer
self-determination and recovery and assist people with severe mental
illness to decrease their dependence on expensive social services and
avoid psychiatric hospitalization.

###### **2. EXPECTATIONS** 

1.  **Background**

The Consumer/Peer- Run TACs support the work of SAMHSA's Center for
Mental Health Services (CMHS) to transform the mental health system
through changes that help adults with severe mental illnesses recover
and live independently and productively in the community. CMHS fosters
consumer involvement in the planning, delivery, and evaluation of mental
health services and recognizes the role of self-help, mutual support,
and empowerment in the recovery of persons with a severe mental illness.
In 1992, to further the development of self-help programs, Federal
funding was used to support the first national self-help technical
assistance centers directed by and for mental health consumers.
Assistance to supporters of consumers was added to the program in 1998.

**2.2 Service Population**

The primary focus for activities of the Consumer/ Peer-Run TACs must be
individuals with serious mental illnesses. These individuals should
reflect a culturally and racially diverse population. Services must be
provided to the full range of mental health consumers and must not be
limited to specific subpopulations of adults with mental illness. In
addition, outreach and assistance should be available to a range of
stakeholders, including State mental health systems serving adults,
consumer supporters, service providers, and the general public.

**2.3 Tenets of Mental Health Self-Help**

The values and philosophies that guide consumer self-help are the
driving forces behind

its development and success. SAMHSA expects these values and
philosophies to be the cornerstone of programs funded under this
announcement, including:

-   Empowerment -- grantees must promote the ability of consumers to
    make decisions that directly affect their own lives;

-   Independence -- grantees must support consumers in striving for
    self-reliance, and in pursuing opportunities to function as
    productive citizens;

-   Responsibility -- grantees must encourage individuals to take
    responsibility for themselves and others;

-   Choice -- grantees must promote an environment in which consumers
    can make informed choices about treatment, housing, and other
    services and supports;

-   Respect and Dignity -- grantees must promote the idea that all
    individuals are valued and have skills and strengths to offer
    society; and,

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-   Transformation - grantees must advocate for changes in how
    consumers/survivors are treated by the mental health system and
    society at large.

**2.4 The Roles of Consumers and Consumer Supporters in the Program**

Mental health consumer/survivor self-help is the process by which mental
health consumers provide assistance to one another. This process
involves both people with mental illnesses (i.e., \"consumers\") as well
as \"consumer supporters\" (individuals, such as parents, siblings,
spouses and significant others who are involved with the support of the
consumer).

The roles of consumers and consumer-supporters are distinct but share
some common elements. Both serve an important role in providing
opportunities for mental health consumers to assist one another.

Examples of the Role of Consumers:

-   Providing mutual support to peers to facilitate recovery.

-   Educating providers, community leaders, and others on the value of
    peer-run

> programs to transform mental health systems.

-   Developing, administering, researching and evaluating peer-run
    programs.

-   Partnering with providers, researchers, advocates and others to
    promote

> peer-run programs.

-   Providing training and consultation to other consumer/peer-run
    programs to

> expand such approaches.

-   Fostering the financing and human resource development of peer-run
    programs and the identification, dissemination and application of
    evidence based practices of peer-run programs.

Examples of the Role of Consumer Supporters:

-   Educating professionals about the value of consumer/peer-run
    programs and self-help approaches;

-   Assisting consumer/peer-run groups to obtain needed resources;

-   Facilitating referrals to consumer/peer-run programs;

-   Providing the necessary training, expertise and knowledge to
    consumers;

-   Facilitating in the collection and dissemination of research
    findings, evaluation and data related to consumer/peer-run programs;

-   Developing policies to foster consumer/peer-run programs through
    finances and human resource development (i.e. certification and
    credentialing); and,

-   Identifying, disseminating and applying best practices on
    consumer/peer run programs.

**2.5 Program Goals**

Goals of the Consumer/Peer- Run TACs program include:

1)  Promoting skills development for consumers with an emphasis on
    leadership, business and management;

2)  Strengthening consumer organizations and leadership in communities;

3)  Improving collaboration among consumers, families, advocates,
    providers, administrators and build coalitions to transform
    community mental health services and supports;

4)  Increasing the opportunities for knowledge application and
    field-based skill building of self-management/self-help approaches;
    and,

5)  Increasing consumer participation in all aspects of mental health
    system transformation, including: planning, development, evaluation
    and policy formation.

**2.6 Program Focus and Examples of Activities**

Applicants must select two of the program foci listed below as areas of
concentration for the proposed project. Although focus area number four
is specifically dedicated to cultural outreach and self-help adaptation,
all activities for selected focus areas must be culturally and
linguistically appropriate for diverse service populations.

1)  **Self-care/Self-management:** improving knowledge and information
    on best practices of consumer/peer-run programs and self-management
    approaches for people with serious mental illnesses. Examples of
    activities include: analyzing and producing materials on self-help
    best practices; convening community stakeholders and providers to
    identify barriers to implementing exemplary models.

2)  **Employment:** improving consumer workforce development. Examples
    of activities include: providing technical assistance to State and
    local organizations on recruiting and retaining self-help
    practitioners; providing technical assistance to consumers
    reentering the job market; providing technical assistance on
    identifying financing mechanisms for hiring peer employees.

3)  **Program Management and Administration:** facilitating business and
    management training and other skill development efforts for
    consumer/peer-run programs. Examples of activities include:
    providing technical assistance to consumer organizations on
    non-profit management issues including leadership and financial
    management; developing and conducting training of trainers focused
    on skills development to promote self-help.

4)  **Cultural Outreach and Self-Help Adaptation:** making
    self-help/self management approaches available and accessible to
    specific cultural groups (e.g. African Americans, Hispanics/Latinos,
    Asian and Pacific Islanders, American Indians, and Alaska Natives).
    Examples include: identifying models for serving diverse cultural
    groups; convening policy makers and consumer leaders to develop
    guidelines on how to serve ethnically diverse people.

5)  **Recovery:** increasing the knowledge on what facilitates or
    hinders recovery at the

individual, as well as systems level. Examples include: serving as a
repository for

the collection, analysis and development of materials on recovery from
mental

illness; convening policy makers and community leaders to develop a
strategic

plan for the development of recovery-based approaches; educating
supporters on the

role they can play in facilitating the recovery of consumers.

2.7 Guidelines for Assessing Consumer and Family Participation

Applicants must have experience or a track record of involving mental
health consumers. The applicant organization should have a documented
history of positive programmatic involvement of recipients of mental
health services. This involvement should be meaningful and span all
aspects of the organization's activities as described below:

[Program Mission -]{.underline} An organization's mission must reflect
the value of involving consumers in order to improve outcomes.

[Program Planning]{.underline} - Consumers are involved in substantial
numbers in the conceptualization of initiatives including identifying
community needs, goals and objectives, and innovative approaches. This
includes participation in the development of the grant application for
this program. Strategies must also incorporate consumer/peer-run program
approaches.

[Training and Staffing -]{.underline} The staff of the organization must
have substantive training in and be familiar with consumer/peer-run
program approaches and related issues. Attention must be placed on
staffing the initiative with people who are themselves consumers. Such
staff must be paid commensurate with their work and in parity with other
staff.

[Rights Protection]{.underline} - Consumers and family members must be
fully informed of all their rights including those designated by the
President's Healthcare Consumer Bill of Rights and Responsibilities:
Respect and Non Discrimination.

[Program Administration, Governance, and Policy Determination
-]{.underline} Consumers must be hired in key management roles to
provide project oversight and guidance. Steering Committees must be
established for this project, which are composed of a minimum of 75%
consumers. Such committee members should be fully trained and
compensated for their activities, including childcare.

**2.8 Definitions**

CMHS has used the following definitions in developing this announcement:

[Consumer]{.underline} - An individual, 18 years of age or older, with
severe mental illness. CMHS recognizes that some consumers may choose to
identify themselves with other terminology.

[Consumer Supporter]{.underline} - An individual involved with the
support of a consumer (age 18 or older), including parents, siblings,
spouses and significant others, friends, co-workers, and neighbors, who
provide support in a nonprofessional capacity.

[Consumer Organization]{.underline} - An organization that is controlled
and managed by consumers and is dedicated to the transformation of
mental health service systems which are consumer and family driven. The
organization must have a board of directors comprised of more than 50
percent consumers.

[Consumer Supporter Organization]{.underline} -- An organization,
including volunteer mental health organizations, which is controlled and
managed by consumer supporters and mental health consumers. It must be
dedicated to the transformation of mental health service systems which
are consumer and family driven and have a board of directors comprised
of more than 50 percent consumer supporters.

**2.9 Data and Performance Measurement**

The Government Performance and Results Act of 1993 (P.L.103-62, or
"GPRA") requires all Federal agencies to:

-   develop strategic plans that specify what they will accomplish over
    a 3 to 5-year period;

-   set performance targets annually related to their strategic plan;
    and,

-   report annually on the degree to which the previous year's targets
    were met.

Agencies are expected to evaluate their programs regularly and to use
results of these evaluations to explain their successes and failures and
justify requests for funding.

To meet these requirements, SAMHSA must collect performance data
(i.e.,"GPRA data") from grantees. Grantees are required to report these
GPRA data to SAMHSA on a timely basis.

GPRA measures related to each of the program focus areas referenced in
Section I -- 2.6 in this announcement are under development. In your
application, you must demonstrate your ability to collect and report on
these measures, and you may be required to provide some baseline data.

More detailed information about how to collect and report on these
measures may be obtained by contacting the Government Project Officer,
listed in Section VII -- "Agency Contacts" of this announcement.

The terms and conditions of the grant award will specify the data to be
submitted and the schedule for submission. Grantees will be required to
adhere to these terms and conditions of award.

**2.10 Evaluation**

Grantees will be required to participate in a collaborative assessment
designed to evaluate the Consumer/Peer- Run TACs' effectiveness in
providing technical assistance to foster consumer/peer-run programs.
This evaluation will be managed by an external evaluator who will be
responsible for reporting overall the findings to SAMHSA.

The current evaluation activities assess customer satisfaction by
distributing a Customer Satisfaction Survey to any person who contacts
the Consumer/Peer- Run TACs for assistance*.*

Applicants should be aware that evaluation of the Consumer/Peer-Run TACs
will be expanded to provide increased feedback to the project to improve
services. Grantees will be required to participate in the additional
evaluation activities.

**2.11 Grantee Meetings**

The Program or Project Director must plan to attend at least three
meetings in each year of the grant, and must include funding for this
travel in your budget. This includes two meetings of the Center for
Mental Health Services National Advisory Council (including the
pre-meeting of the Subcommittee on Consumer/Survivor issues) and the
Alternatives Conference. These meetings will usually be held in the
Washington, D.C. area and attendance is mandatory.

**2.12 Alternatives Conference**

Each of the three Consumer National Technical Assistance Centers will
rotate as \`host' for the annual national conference entitled
"Alternatives," a meeting of consumers from across the Nation. This
conference is intended to present a variety of viewpoints, provide for
the exchange of information and ideas, and provide technical assistance
on many topics. The selection of the conference host for the first year
of the grants will be determined by the score on Section G (Plan for
Alternatives Conference) of the Project Narrative. In subsequent years,
the selection of the host will be based on the next highest scores on
Section G. Each grantee will host the conference at least once during
the 3-year project period.

Since each Consumer TAC will host one Alternatives Conference during the
project period, applications must include a budget for the Conference of
\$133,000. The money is for support of the conference and does not
include scholarship support. Guidelines for Conducting the Alternatives
Conference are in Appendix D. Consumer organizations may not apply only
for facilitating the Alternatives Conference or only for the Consumer
National Technical Assistance Center.

**II**. **AWARD INFORMATION**

**1. Award Amount**

It is expected that \$1.75 million will be available to fund up to five
National Technical Assistance Centers on Consumer/Peer-Run Program
awards in FY 2004, three national consumer self-help technical
assistance centers and two national consumer-supporter self-help
technical assistance centers. Annual awards are expected to be up to
\$350,000 per year in total costs (direct and indirect). Applicants may
request a project period of up to three years.

**Proposed budgets cannot exceed \$350,000 in any year of the proposed
project.** Annual continuation awards will depend on the availability of
funds, grantee progress in meeting project goals and objectives, and
timely submission of required data and reports.

An additional \$133,000 will be competitively awarded each year to one
of the three successful national consumer technical assistance centers
to facilitate the Alternatives Conference. (See section entitled
Alternatives Conference in Section V: Application Review).

**2. Funding Mechanism**

Awards will be made as grants.

**III**. **ELIGIBILITY INFORMATION**

**1. Eligible Applicants**

Eligible applicants are domestic private [nonprofit]{.underline}
entities, including faith-based organizations, which meet the criteria
for consumer or consumer supporter organizations found in Section I-2.7
Definitions and the following requirements:

> 1\) Applicant organizations must have been in operation for a minimum
> of one year.

2\) An applicant must complete the Certification of Consumer and
Consumer Supporter

> Organization Eligibility (See Appendix C of this document), indicating
> that the applicant meets all eligibility requirements. Applicants must
> complete and sign a

Certification of Eligibility and provide necessary supportive
documentation.

The statutory authority for this program precludes grants to for-profit
organizations.

2.  **Cost-Sharing**

Cost-sharing is not required in this program and applications will not
be screened out on the basis of cost sharing. However, you may include
cash or in-kind contributions in your proposal as evidence of commitment
to the proposed project.

3.  **Other**

**Applications must comply with the following requirements or they will
be screened out and will not be reviewed:** use of the PHS 5161-1
application; application submission requirements in Section IV-3 of this
document; and formatting requirements provided in Section IV-2.3 of this
document.

**IV. Application and Submission Information**

**(To ensure that you have met all submission requirements, a checklist
is provided for your use in Appendix A of this document.)**

**1. ADDRESS TO REQUEST APPLICATION PACKAGE**

You may request a complete application kit by calling the National
Mental Health Information Center at 1-800-789-CMHS (2647).

You also may download the required documents from the SAMHSA web site at
[www.samhsa.gov](http://www.samhsa.gov/). Click on "Grant Opportunities"
then click on "Useful Information for Applicants."

Additional materials available on this web site include:

-   a technical assistance manual for potential applicants;

-   standard terms and conditions for SAMHSA grants;

-   guidelines and policies that relate to SAMHSA grants (e.g.,
    guidelines on cultural competence, consumer and family
    participation, and evaluation); and,

-   enhanced instructions for completing the PHS 5161-1 application.

    **2. CONTENT AND FORM OF APPLICATION SUBMISSION**

**2.1 Required Documents**

SAMHSA application kits include the following documents:

-   PHS 5161-1 (revised July 2000) -- Includes the face page, budget
    forms, assurances, certification, and checklist. You must use the
    PHS 5161-1. **Applications that are not submitted on the required
    application form will be screened out and will not be reviewed**.

    -   Request for Applications (RFA) -- Includes instructions for the
        grant application. This document is the RFA.

> You must use all of the above documents in completing your
> application.

**2.2 Required Application Components**

To ensure equitable treatment of all applications, applications must be
complete. In order for your application to be complete, it must include
the required ten application components (Face Page, Abstract, Table of
Contents, Budget Form, Project Narrative and Supporting Documentation,
Appendices, Assurances, Certifications, Disclosure of Lobbying
Activities, and Checklist).

-   **Face Page** -- Use Standard Form (SF) 424, which is part of the
    PHS 5161-1. \[Note: Beginning October 1, 2003, applicants will need
    to provide a Dun and Bradstreet (DUNS) number to apply for a grant
    or cooperative agreement from the Federal Government. SAMHSA
    applicants will be required to provide their DUNS number on the face
    page of the application. Obtaining a DUNS number is easy and there
    is no charge. To obtain a DUNS number, access the Dun and Bradstreet
    web site at
    [www.dunandbradstreet.com](http://www.dunandbradstreet.com/) or call
    1-866-705-5711. To expedite the process, let Dun and Bradstreet know
    that you are a public/private nonprofit organization getting ready
    to submit a Federal grant application.\]

-   **Abstract** -- Your total abstract should not be longer than 35
    lines. In the first five lines or less of your abstract, write a
    summary of your project that can be used, if your project is funded,
    in publications, reporting to Congress, or press releases.

-   **Table of Contents** -- Include page numbers for each of the major
    sections of your application and for each appendix.

-   **Budget Form** -- Use SF 424A, which is part of the 5161-1. Fill
    out Sections B, C, and E of the SF 424A.

-   **Project Narrative and Supporting Documentation** -- The Project
    Narrative describes your project. It consists of Sections A-F for
    national consumer supporter technical assistance centers and
    Sections A-G for the national consumer technical assistance centers.
    The Project Narrative for Sections A-F in total may not be longer
    than 25 pages. The Project Narrative for Section G may not exceed 3
    additional pages. More detailed instructions for completing each
    section of the Project Narrative are provided in "Section
    V---Application Review Information" of this document.

    The Supporting Documentation provides additional information
    necessary for the review of your application. This supporting
    documentation should be provided immediately following your Project
    Narrative in Sections H through I. There are no page limits for
    these sections, except for Section F, Biographical Sketches/Job
    Descriptions.

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-   *Section H* - Budget Justification, Existing Resources, Other
    Support. You must provide a narrative justification of the items
    included in your proposed budget, as well as a description of
    existing resources and other support you expect to receive for the
    proposed project.

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-   *Section I*- Biographical Sketches and Job Descriptions.

    -   Include a biographical sketch for the Project Director and other
        key positions. Each sketch should be 2 pages or less. If the
        person has not been hired, include a letter of commitment from
        the individual with a current biographical sketch.

    -   Include job descriptions for key personnel. Job descriptions
        should be no longer than 1 page each.

    -   Sample sketches and job descriptions are listed on page 22, Item
        6 in the Program Narrative section of the PHS 5161-1.

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    -   **Appendices 1 through 5** -- Use only the appendices listed
        below. Do not use more than 30 pages for the appendices. Do not
        use appendices to extend or replace any of the sections of the
        Project Narrative. Reviewers will not consider them if you do.

        -   *Appendix 1*: Letters of Support

        -   *Appendix 2*: Certificate of Eligibility

        -   *Appendix 3*: Sample Consent Forms

        -   *Appendix 4*: Data Collection Instruments/Interview
            Protocols

        -   *Appendix 5*: Letter to the SSA

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-   **Assurances** -- Non-Construction Programs. Use Standard Form 424B
    found in PHS 5161-1.

-   **Certifications** -- Use the "Certifications" forms found in PHS
    5161-1.

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-   **Disclosure of Lobbying Activities** -- Use Standard Form LLL found
    in the PHS 5161-1. Federal law prohibits the use of appropriated
    funds for publicity or propaganda purposes, or for the preparation,
    distribution, or use of the information designed to support or
    defeat legislation pending before the Congress or State
    legislatures. This includes "grass roots" lobbying, which consists
    of appeals to members of the public suggesting that they contact
    their elected representatives to indicate their support for or
    opposition to pending legislation or to urge those representatives
    to vote in a particular way.

-   **Checklist** -- Use the Checklist found in PHS 5161-1. The
    Checklist ensures that you have obtained the proper signatures,
    assurances and certifications and is the last page of your
    application.

**2.3 Application Formatting Requirements**

Applicants also must comply with the following basic application
requirements. Applications that do not comply with these requirements
will be screened out and will not be reviewed.

-   Information provided must be sufficient for review.

-   Text must be legible.

• Type size in the Project Narrative cannot exceed an average of 15
characters per

inch, as measured on the physical page. (Type size in charts, tables,
graphs, and

footnotes will not be considered in determining compliance.)

• Text in the Project Narrative cannot exceed 6 lines per vertical inch.

-   Paper must be white paper and 8.5 inches by 11.0 inches in size.

-   To ensure equity among applications, the amount of space allowed for
    the Project Narrative cannot be exceeded.

• Applications would meet this requirement by using all margins (left,
right, top, bottom) of at least one inch each, and adhering to the
25-page limit for the Project Narrative (Sections A through F) and
3-page limit for Section G.

• Should an application not conform to these margin or page limits,
SAMHSA will use the following method to determine compliance: The total
area of the Project Narrative (excluding margins, but including charts,
tables, graphs and footnotes) cannot exceed 58.5 square inches
multiplied by 25 (or 28). This number represents the full page less
margins, multiplied by the total number of allowed pages.

• Space will be measured on the physical page. Space left blank within
the Project Narrative (excluding margins) is considered part of the
Project Narrative, in determining compliance.

-   The 30-page limit for Appendices 1 through 5 cannot be exceeded.

To facilitate review of your application, follow these additional
guidelines. Failure to adhere to the following guidelines will not, in
itself, result in your application being screened out and returned
without review. However, following these guidelines will help reviewers
to consider your application.

-   Pages should be typed single-spaced with one column per page.

-   Pages should not have printing on both sides.

-   Please use black ink and number pages consecutively from beginning
    to end so that information can be located easily during review of
    the application. The cover page should be page 1, the abstract page
    should be page 2, and the table of contents page should be page 3.
    Appendices should be labeled and separated from the Project
    Narrative and budget section, and the pages should be numbered to
    continue the sequence.

Send the original application and two copies to the mailing address in
Section IV-6.1 of this document. Please do not use staples, paper clips,
and fasteners. Nothing should be attached, stapled, folded, or pasted.
Do not use heavy or lightweight paper or any material that cannot be
copied using automatic copying machines. Odd-sized and oversized
attachments such as posters will not be copied or sent to reviewers. Do
not include videotapes, audiotapes, or CD-ROMs.

4.  **SAMHSA Confidentiality and Participant Protection Requirements and
    Protection of Human Subjects Regulations**

    You must describe your procedures relating to Confidentiality,
    Participant Protection and the Protection of Human Subjects
    Regulations in Section H of your application, using the guidelines
    provided below. Problems with confidentiality, participant
    protection, and protection of human subjects identified during peer
    review of your application may result in the delay of funding.

    **[Confidentiality and Participant Protection:]{.underline}**

    All applicants **[must]{.underline}** address each of the following
    elements relating to confidentiality and participant protection. You
    must document how you will address these requirements or why they do
    not apply.

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1.  [Protect Clients and Staff from Potential Risks]{.underline}

-   Identify and describe any foreseeable physical, medical,
    psychological, social, legal, or other risks or adverse affects.

-   Discuss risks that are due either to participation in the project
    itself or to the evaluation activities.

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-   Describe the procedures you will follow to minimize or protect
    participants against potential risks, including risks to
    confidentiality.

-   Identify plans to provide help if there are adverse effects to
    participants.

-   Where appropriate, describe alternative treatments and procedures
    that may be beneficial to the participants. If you choose not to use
    these other beneficial treatments, provide the reasons for not using
    them.

2.  [Fair Selection of Participants]{.underline}

-   Describe the target population(s) for the proposed project. Include
    age, gender, and racial/ethnic background and note if the population
    includes homeless youth, foster children, children of substance
    abusers, pregnant women, or other groups.

-   Explain the reasons for including groups of pregnant women,
    children, people with mental disabilities, people in institutions,
    prisoners, or others who are likely to be vulnerable to HIV/AIDS.

-   Explain the reasons for [including or excluding]{.underline}
    participants.

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-   Explain how you will recruit and select participants. Identify who
    will select participants.

3.  [Absence of Coercion]{.underline}

-   Explain if participation in the project is voluntary or required.
    Identify possible reasons why it is required, for example, court
    orders requiring people to participate in a program.

-   If you plan to pay participants, state how participants will be
    awarded money or gifts.

-   State how volunteer participants will be told that they may receive
    services even if they do not participate in the project.

4.  [Data Collection]{.underline}

-   Identify from whom you will collect data (e.g., from participants
    themselves, family members, teachers, others). Describe the data
    collection procedures and specify the sources for obtaining data
    (e.g., school records, interviews, psychological assessments,
    questionnaires, observation, or other sources). Where data are to be
    collected through observational techniques, questionnaires,
    interviews, or other direct means, describe the data collection
    setting.

-   Identify what type of specimens (e.g., urine, blood) will be used,
    if any. State if the material will be used just for evaluation or if
    other use(s) will be made. Also, if needed, describe how the
    material will be monitored to ensure the safety of participants.

-   Provide in **Appendix 2, "Data Collection Instruments/Interview
    Protocols,"** copies of [all]{.underline} available data collection
    instruments and interview protocols that you plan to use.

5.  [Privacy and Confidentiality]{.underline}

-   Explain how you will ensure privacy and confidentiality. Include who
    will collect data and how it will be collected.

-   Describe:

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-   How you will use data collection instruments.

-   Where data will be stored.

-   Who will or will not have access to information.

-   How the identity of participants will be kept private, for example,
    through the use of a coding system on data records, limiting access
    to records, or storing identifiers separately from data.

    **NOTE:** If applicable, grantees must agree to maintain the
    confidentiality of alcohol and drug abuse client records according
    to the provisions of **Title 42 of the Code of Federal Regulations,
    Part II.**

6.  [Adequate Consent Procedures]{.underline}

-   List what information will be given to people who participate in the
    project. Include the type and purpose of their participation.
    Identify the data that will be collected, how the data will be used
    and how you will keep the data private.

-   State:

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-   Whether or not their participation is voluntary.

-   Their right to leave the project at any time without problems.

-   Possible risks from participation in the project.

-   Plans to protect clients from these risks.

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-   Explain how you will get consent for youth, the elderly, people with
    limited reading skills, and people who do not use English as their
    first language.

    **NOTE:** If the project poses potential physical, medical,
    psychological, legal, social or other risks, you **must** get
    [written]{.underline} informed consent.

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-   Indicate if you will get informed consent from participants or from
    their parents or legal guardians. Describe how the consent will be
    documented. For example: Will you read the consent forms? Will you
    ask prospective participants questions to be sure they understand
    the forms? Will you give them copies of what they sign?

-   Include sample consent forms in your Appendix 3, "Sample Consent
    Forms." If needed, give English translations.

    **NOTE:** Never imply that the participant waives or appears to
    waive any legal rights, may not end involvement with the project, or
    releases your project or its agents from liability for negligence.

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-   Describe if separate consents will be obtained for different stages
    or parts of the project. For example, will they be needed for both
    participant protection in treatment intervention and for the
    collection and use of data.

-   Additionally, if other consents (e.g., consents to release
    information to others or gather information from others) will be
    used in your project, provide a description of the consents. Will
    individuals who do not consent to having individually identifiable
    data collected for evaluation purposes be allowed to participate in
    the project?

7.  [Risk/Benefit Discussion]{.underline}

    Discuss why the risks are reasonable compared to expected benefits
    and importance of the knowledge from the project.

    **[Protection of Human Subjects Regulations]{.underline}**

    Depending on the evaluation design you proposed in your application,
    you may have to comply with the Protection of Human Subjects
    Regulations (45 CFR 46).

    Applicants whose projects must comply with the Protection of Human
    Subjects Regulations must describe the process for obtaining
    Institutional Review Board (IRB) approval fully in their
    applications. While IRB approval is not required at the time of
    grant award, these applicants will be required, as a condition of
    award, to provide the documentation that an Assurance of Compliance
    is on file with the Office for Human Research Protections (OHRP) and
    that IRB approval has been received prior to enrolling any clients
    in the proposed project.

    Additional information about Protection of Human Subjects
    Regulations can be obtained on the web at
    [http://ohrp.osophs.dhhs.gov](http://ohrp.osophs.dhhs.gov/). You may
    also contact OHRP by e-mail (<ohrp@osophs.dhhs.gov>[)]{.underline}
    or by phone (301-496-7005).

**3. Submission Times and Dates**

Applications are due by close of business on June 25, 2004. Your
application must be received by the application deadline. Applications
sent through postal mail and received after this date must have a
proof-of-mailing date from the carrier dated at least 1 week prior to
the due date. Private metered postmarks are not acceptable as proof of
timely mailing.

You will be notified by postal mail that your application has been
received.

**Applications not received by the application deadline or not
postmarked by a week prior to the application deadline will be screened
out and will not be reviewed**.

**4. Intergovernmental Review (E.O. 12372) Instructions**

Executive Order 12372, as implemented through Department of Health and
Human Services (DHHS) regulation at 45 CFR Part 100, sets up a system
for State and local review of applications for Federal financial
assistance. A current listing of State Single Points of Contact (SPOCs)
is included in the application kit and can be downloaded from the Office
of Management and Budget (OMB) web site at
[www.whitehouse.gov/omb/grants/spoc.html](http://www.whitehouse.gov/omb/grants/spoc.html).

-   Check the list to determine whether your State participates in this
    program. You **do not** need to do this if you are a federally
    recognized Indian tribal government.

    -   If your State participates, contact your SPOC as early as
        possible to alert him/her to the prospective application(s) and
        to receive any necessary instructions on the State's review
        process.

    -   For proposed projects serving more than one State, you are
        advised to contact the SPOC of each affiliated State.

    -   The SPOC should send any State review process recommendations to
        the following address within 60 days of the application
        deadline:

Substance Abuse and Mental Health Services Administration

Office of Program Services, Review Branch

5600 Fishers Lane, Room 17-89

Rockville, Maryland, 20857

ATTN: SPOC -- Funding Announcement No. (SM 04-002)

[]{.mark}

In addition, community-based, non-governmental service providers who are
not transmitting their applications through the State must submit a
Public Health System Impact Statement (PHSIS) (approved by OMB under
control no. 0920-0428; see burden statement below) to the head(s) of
appropriate State or local health agencies in the area(s) to be affected
no later than the pertinent receipt date for applications. The PHSIS is
intended to keep State and local health officials informed of proposed
health services grant applications submitted by community-based,
non-governmental organizations within their jurisdictions. [State and
local governments and Indian tribal government applicants are not
subject to these requirements]{.underline}.

The PHSIS consists of the following information:

-   a copy of the face page of the application (SF 424); and

-   a summary of the project, no longer than one page in length, that
    provides: 1) a description of the population to be served, 2) a
    summary of the services to be provided, and 3) a description of the
    coordination planned with appropriate State or local health
    agencies.

For SAMHSA grants, the appropriate State agencies are the Single State
Agencies (SSAs) for substance abuse and mental health. A listing of the
SSAs can be found on SAMHSA's web site at
[www.samhsa.gov](http://www.samhsa.gov/). If the proposed project falls
within the jurisdiction of more than one State, you should notify all
representative SSAs.

Applicants who are not the SSA [must]{.underline} include a copy of a
letter transmitting the PHSIS to the SSA in **Appendix 5, "Letter to the
SSA**." The letter must notify the State that, if it wishes to comment
on the proposal, its comments should be sent not later than 60 days
after the application deadline to:

> Substance Abuse and Mental Health Services Administration
>
> Office of Program Services, Review Branch
>
> 5600 Fishers Lane, Room 17-89
>
> Rockville, Maryland, 20857
>
> ATTN: SSA -- Funding Announcement No. SM 04-011

In addition:

-   Applicants may request that the SSA send them a copy of any State
    comments.

-   The applicant must notify the SSA within 30 days of receipt of an
    award.

*\[Public reporting burden for the Public Health System Reporting
Requirement is estimated to average 10 minutes per response, including
the time for copying the face page of SF 424 and the abstract and
preparing the letter for mailing. An agency may not conduct or sponsor,
and a person is not required to respond to, a collection of information
unless it displays a currently valid OMB control number. The OMB control
number for this project is 0920-0428. Send comments regarding this
burden to CDC Clearance Officer, 1600 Clifton Road, MS D-24, Atlanta, GA
30333, ATTN: PRA (0920-0428).\]*

**5. FUNDING RESTRICTIONS**

Cost principles describing allowable and unallowable expenditures for
Federal grantees, including SAMHSA grantees, are provided in the
following documents:

-   Institutions of Higher Education: OMB Circular A-21

-   State and Local Governments: OMB Circular A-87

-   Nonprofit Organizations: OMB Circular A-122

-   Appendix E Hospitals: 45 CFR Part 74

In addition, SAMHSA National Technical Assistance Centers On
Consumer/Peer-Run Programs Grant recipients must comply with the
following funding restrictions:

-   Grant funds must be used for purposes supported by the program.

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-   Grant funds may not be used to pay for the purchase or construction
    of any building or structure to house any part of the grant project.

**6. OTHER SUBMISSION REQUIREMENTS**

**6.1 Where to Send Applications**

Send applications to the following address:

Substance Abuse and Mental Health Services Administration

Office of Program Services, Review Branch

5600 Fishers Lane, Room 17-89

Rockville, Maryland, 20857.

Be sure to include the short title and funding announcement number
(Consumer/Peer- Run TACs, SM 04-011) and designate whether you are
applying for a Consumer National Technical Assistance Center or a
Consumer Supporter National Technical Assistance Center in item number
10 on the face page of the application. If you require a phone number
for delivery, you may use (301) 443-4266.

**6.2 How to Send Applications**

Mail an original application and 2 copies (including appendices) to the
mailing address provided above. The original and copies must not be
bound. Do not use staples, paper clips, or fasteners,. Nothing should be
attached, stapled, folded, or pasted.

You must use a recognized commercial or governmental carrier. Hand
carried applications will not be accepted. Faxed or e-mailed
applications will not be accepted.

**V.** **APPLICATION REVIEW INFORMATION**

**1. EVALUATION CRITERIA**

Your application will be reviewed and scored against the requirements
listed below for developing the Project Narrative Sections A-F for
applicants applying for a consumer supporter National Technical
Assistance Center or Sections A-G for applicants applying for a consumer
National Technical Assistance Center**.** Sections A-F describe what you
intend to do with your project and may not exceed 25 pages. Section G
describes the plan for the Alternatives Conference and may not exceed 3
additional pages.

-   In developing the Project Narrative section of your application, use
    these instructions, which have been tailored to this program.
    **These are to be used instead of the "Program Narrative"
    instructions found in the PHS 5161-1**.

-   You must use the seven sections/headings listed below in developing
    your Project Narrative. Be sure to place the required information in
    the correct section, **or it will not be considered**. Your
    application will be scored according to how well you address the
    requirements for each section.

-   Reviewers will be looking for evidence of cultural competence in
    each section of the Project Narrative. Points will be assigned based
    on how well you address the cultural competence aspects of the
    evaluation criteria. SAMHSA's guidelines for cultural competence can
    be found on the SAMHSA web site at
    [www.samhsa.gov](http://www.samhsa.gov/). Click on "Grant
    Opportunities."

-   The Supporting Documentation you provide in Sections H-I and
    Appendices 1-5 will be considered by reviewers in assessing your
    response, along with the material in the Project Narrative.

-   The number of points after each heading below is the maximum number
    of points a review committee may assign to that section of your
    Project Narrative. Bullet statements in each section do not have
    points assigned to them. They are provided to invite the attention
    of applicants and reviewers to important areas within each section.

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-   Only the points in Section A-F will be used to determine the
    priority score for the Consumer Technical Assistance Center awards.
    Section G will be used to select the host for the Alternatives
    Conference. The Consumer Technical Assistance Center with the
    highest score on Section G will be given the first opportunity to
    host the next Conference and the Conference host will be rotated to
    the other Consumer TACs for years 2 and 3 of the grant program.

> []{.mark}

**Section A: Understanding of the Philosophy & Principals of the Project
(25 points)**

-   Describe the specifics of how your organization has integrated and
    embraced the tenets of the mental health self-help movement,
    philosophies and fundamental principals described in Section I-2.3
    of this Announcement and how consumers and family members have been
    involved in the activities of your organization.

-   Describe what you consider to be your organization's unique
    characteristics and capabilities to provide the leadership as either
    a national consumer or consumer supporter technical assistance
    center, including your organization\'s history and experience in
    providing leadership in the field for consumer/peer-run programs for
    people with a serious mental illness.

-   Provide data on the total number of employees (full and part-time)
    in your organization and any parent organization, and the number and
    percent that are consumers and consumer supporters.

-   Describe the ethnic and cultural diversity within your organization.
    Indicate whether any staff members are fluent in languages other
    than English and indicate the languages they can read, write, speak,
    and understand in conversation.

-   Describe the types and amount of technical assistance services your
    organization currently provides to consumers and consumer
    supporters, stakeholders of the mental health system, including
    faith-and community-based organizations (representing diverse
    racial, ethnic, and cultural groups), and mental health providers.

-   Describe the service population for technical assistance. Include
    numbers to be served and demographic information. Discuss the target
    population\'s language, beliefs, norms and values, as well as
    socioeconomic factors that must be considered in delivering
    technical assistance to this population.

**Section B: Understanding of the Project/Materials Development (20
points)**

-   Clearly identify which two (2) of the 'Program Focus' topics
    (referenced in Section I-2.6 of this announcement) your organization
    will concentrate on for this project and include a description of
    how cultural and linguistic issues will be addressed.

-   Clearly state the purpose of the proposed project and how it will
    address the stated

> problem/issue and assist in achieving the goals of the program.

-   Describe specific approaches for accomplishing the goals outlined in
    Section I-2.5 (Program Goals) of this announcement, including how
    these approaches will be culturally and linguistically appropriate
    for a diverse service population.

-   List and briefly describe materials you will develop, describe your
    plan for disseminating these materials, and identify how these
    products will be tailored to the cultural and linguistic needs of
    the select audience.

-   Describe the technological systems you will use to serve as a
    repository and procedures for stakeholders to access these materials
    in a timely manner.

-   Describe your organization's experience in producing and
    disseminating self-help/self-

> management materials to multiple stakeholder groups.

-   Describe your organization\'s experience in organizing, planning,
    and conducting small working meetings.

-   Describe the resources available and the capabilities of your
    organization for synthesizing, summarizing and producing documents
    that are visually appealing, culturally and linguistically relevant,
    using maps and graphics, as appropriate.

    **Section C: Provision of Consultation and Training (20 points)**

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-   Describe your plans for providing consultation, training, and
    technical assistance to a diverse group of stakeholders.

-   Describe your plans for developing training curricula and strategies
    for making sure the training materials are culturally and
    linguistically appropriate.

-   Describe your plans for developing and using web site and other web
    technology to disseminate materials and information.

-   Describe the resources available and the capabilities of your
    organization for developing and operating a web site and using other
    Internet telecommunications technology.

**Section D: Stakeholder Engagement** **(15** **points)**

-   Describe the process you will use to solicit input from a culturally
    diverse group of stakeholders regarding the development and
    dissemination of materials and other technical assistance services
    and activities.

-   Describe the process you will use to identify and reach culturally
    diverse populations (e.g., African Americans, Hispanics/Latinos,
    Asian & Pacific Islanders, American Indians, and Alaska Natives) for
    input into your Center's activities.

-   Identify issues that will be important topics of discussion for the
    field. Describe which issue is most important for each stakeholder
    group and how you will engage the stakeholders in such discussions.

-   Describe your plan to make relevant stakeholders aware of your TA
    Center and the activities, services, and materials available.

-   Describe the resources available and the capabilities of your
    organization for promoting, participating in, and convening
    discussions among stakeholders about topics of importance.

**Section E:** **Organizational Capabilities and Project Management
Plan** **(15 points)**

-   Describe your plans for organizing the TA Center, including the
    organizational structure, allocation of resources, and staffing
    plans that reflect the expertise needed and consultants who
    supplement the staff.

-   Describe the process and system you will use to ensure, prioritize,
    track and follow-up requests for products and technical assistance
    services and activities.

**Section F: Evaluation Plan Methodology (5 points)**

-   Grantees must describe their plans for collecting and reporting on
    the required GPRA measures.

-   Describe how you will incorporate, manage and as necessary change
    your project to incorporate and respond to issues raised by the
    external evaluation.

[]{.mark}

NOTE: Although the budget for the proposed project is not a review
criterion, the Review Group will be asked to comment on the
appropriateness of the budget after the merits of the application have
been considered.

**Section G: Plan for the Alternatives Conference (25 points)**

#### 

#### This section is to be answered only by applicants applying for funding for a National Consumer Technical Assistance Center. The score will only be used to select the conference host for the first year of the grant.

-   Describe your organization's experience in organizing, planning, and
    conducting very large conferences and meetings.

-   Describe your experience with certified meeting planners and how you
    would choose such an individual or organization.

-   Describe how you would develop the theme for the Conference.

-   Describe the process for selecting the steering committee.

-   Describe the process for planning the conference and selecting the
    location and the hotel.

-   Identify issues you feel should be important topics for the next
    Alternatives

> Conference.

-   Describe the resources available and the capabilities of your
    organization for planning, organizing, and implementing the
    Conference.

-   Describe the procedure for rating workshops.

    **2. REVIEW AND SELECTION PROCESS**

    SAMHSA applications are peer-reviewed according to the evaluation
    criteria listed above. Applications for programs having individual
    awards over \$100,000 must also be reviewed by the appropriate
    National Advisory Council.

    Decisions to fund a grant are based on:

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-   the strengths and weaknesses of the application as identified by
    peer reviewers and, when applicable, approved by the appropriate
    National Advisory Council;

-   availability of funds;

-   equitable distribution of awards in terms of geography (including
    urban, rural and remote settings) and balance among target
    populations and program size;

-   distribution of awards to support implementation of varied program
    focus areas; and,

-   after applying the aforementioned criteria, the following method for
    breaking ties: When funds are not available to fund all applications
    with identical scores, SAMHSA will make award decisions based on the
    application(s) that received the greatest number of points by peer
    reviewers on the evaluation criterion in Section V-1 with the
    highest number of possible points **Understanding of the Philosophy
    & Principals of the Project - 25 points.** Should a tie still exist,
    the evaluation criterion with the next highest possible point value
    will be used, continuing sequentially to the evaluation criterion
    with the lowest possible point value, should that be necessary to
    break all ties. If an evaluation criterion to be used for this
    purpose has the same number of possible points as another evaluation
    criterion, the criterion listed first in Section V-1 will be used
    first.

####### 

**VI. AWARD ADMINISTRATION INFORMATION**

**1. AWARD NOTICES**

After your application has been reviewed, you will receive a letter from
SAMHSA through postal mail that describes the general results of the
review, including the score that your application received.

If you are approved for funding, you will receive an **additional**
notice, the Notice of Grant Award, signed by SAMHSA's Grants Management
Officer. The Notice of Grant Award is the sole obligating document that
allows the grantee to receive Federal funding for work on the grant
project. It is sent by postal mail and is addressed to the contact
person listed on the face page of the application.

If you are not funded, you can re-apply if there is another receipt date
for the program.

**2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS**

-   You must comply with all terms and conditions of the grant award.
    SAMHSA's standard terms and conditions are available on the SAMHSA
    web site
    [www.samhsa.gov/grants/2004/useful_info.asp](http://www.samhsa.gov/grants/2004/useful_info.asp)[.]{.underline}

-   Depending on the nature of the specific funding opportunity and/or
    the proposed project as identified during review, additional terms
    and conditions may be negotiated with the grantee prior to grant
    award. These may include, for example:

    -   Actions required to be in compliance with human subjects
        requirements;

    -   Requirements relating to additional data collection and
        reporting;

    -   Requirements relating to participation in a cross-site
        evaluation; or

    -   Requirements to address problems identified in review of the
        application.

-   You will be held accountable for the information provided in the
    application relating to performance targets. SAMHSA program
    officials will consider your progress in meeting goals and
    objectives, as well as your failures and strategies for overcoming
    them, when making an annual recommendation to continue the grant and
    the amount of any continuation award. Failure to meet stated goals
    and objectives may result in suspension or termination of the grant
    award, or in reduction or withholding of continuation awards.

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-   In an effort to improve access to funding opportunities for
    applicants, SAMHSA is participating in the U.S. Department of Health
    and Human Services "Survey on Ensuring Equal Opportunity for
    Applicants." This survey is included in the application kit for
    SAMHSA grants. Applicants are encouraged to complete the survey and
    return it, using the instructions provided on the survey form.

**3. REPORTING REQUIREMENTS**

## 

## **3.1 Progress and Financial Reports**

-   Grantees must provide annual and final progress reports. The final
    progress report must summarize information from the annual reports,
    describe the accomplishments of the project, and describe next steps
    for implementing plans developed during the grant period.

-   Grantees must provide annual and final financial status reports.
    These reports may be included as separate sections of annual and
    final progress reports or can be separate documents. Because SAMHSA
    is extremely interested in ensuring that infrastructure development
    and enhancement efforts can be sustained, your financial reports
    must explain plans to ensure the sustainability of efforts initiated
    under this grant. Initial plans for sustainability should be
    described in year 1 of the grant. In each subsequent year, you
    should describe the status of the project, successes achieved and
    obstacles encountered in that year.

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-   SAMHSA will provide guidelines and requirements for these reports to
    grantees at the time of award and at the initial grantee orientation
    meeting after award. SAMHSA staff will use the information contained
    in the reports to determine the grantee's progress toward meeting
    its goals.

**3.2 Government Performance and Results Act**

> The Government Performance and Results Act (GPRA) mandates
> accountability and performance-based management by Federal agencies.
> The performance requirements for
>
> SAMHSA's Grants for National Technical Assistance Centers On
> Consumer/Peer-Run Programs grants are described in Section I -- 2.9
> under "Data and Performance Measurement".

**3.3 Publications**

If you are funded under this grant program, you are required to notify
the Government Project Officer (GPO) and SAMHSA's Publications Clearance
Officer (301-443-8596) of any materials based on the SAMHSA-funded
project that are accepted for publication.

In addition, SAMHSA requests that grantees:

-   Provide the GPO and SAMHSA Publications Clearance Officer with
    advance copies of publications.

-   Include acknowledgment of the SAMHSA grant program as the source of
    funding for the project.

-   Include a disclaimer stating that the views and opinions contained
    in the publication do not necessarily reflect those of SAMHSA or the
    U.S. Department of Health and Human Services, and should not be
    construed as such.

SAMHSA reserves the right to issue a press release about any publication
deemed by SAMHSA to contain information of program or policy
significance to the substance abuse treatment/substance abuse
prevention/mental health services community.

**VII. AGENCY CONTACTS**

For questions about program issues, contact:

Risa S. Fox, M.S.

Public Health Advisor

Center for Mental Health Services

SAMHSA

5600 Fishers Lane, Room 11C-22

Rockville, MD 20857

\(301\) 443-3653

E-mail: <rfox@samhsa.gov>

[]{.mark}

For questions on grants management issues, contact:

> Gwendolyn Simpson
>
> Office of Program Services, Division of Grants Management
>
> Substance Abuse and Mental Health Services Administration/OPS
>
> 5600 Fishers Lane
>
> Rockville, MD 20857
>
> \(301\) 443-4456
>
> E-mail: <gsimpson@samhsa.gov>

[]{.mark}

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# **Appendix A - Checklist for Formatting Requirements and**

# **Screenout Criteria for SAMHSA Grant Applications**

*SAMHSA's goal is to review all applications submitted for grant
funding. However, this goal must be balanced against SAMHSA's obligation
to ensure equitable treatment of applications. For this reason, SAMHSA
has established certain formatting requirements for its applications.
**If you do not adhere to these requirements, your application will be
screened out and returned to you without review.** In addition to these
formatting requirements, programmatic requirements (e.g., relating to
eligibility) may be stated in the specific funding announcement. Please
check the entire funding announcement before preparing your
application.*

-   Use the PHS 5161-1 application.

-   Applications must be received by the application deadline.
    Applications received after this date must have a proof of mailing
    date from the carrier dated at least 1 week prior to the due date.
    Private metered postmarks are not acceptable as proof of timely
    mailing. Applications not received by the application deadline or
    not postmarked at least 1 week prior to the application deadline
    will not be reviewed.

-   Information provided must be sufficient for review.

-   Text must be legible.

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-   Type size in the Project Narrative cannot exceed an average of 15
    characters per inch, as measured on the physical page. (Type size in
    charts, tables, graphs, and footnotes will not be considered in
    determining compliance.)

-   Text in the Project Narrative cannot exceed 6 lines per vertical
    inch.

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-   Paper must be white paper and 8.5 inches by 11.0 inches in size.

-   To ensure equity among applications, the amount of space allowed for
    the Project Narrative cannot be exceeded.

• Applications would meet this requirement by using all margins (left,
right, top, bottom) of at least one inch each, and adhering to the page
limit for the Project Narrative stated in the specific funding
announcement.

• Should an application not conform to these margin or page limits,
SAMHSA will use the following method to determine compliance: The total
area of the Project Narrative (excluding margins, but including charts,
tables, graphs and footnotes) cannot exceed 58.5 square inches
multiplied by the total number of allowed pages. This number represents
the full page less margins, multiplied by the total number of allowed
pages.

• Space will be measured on the physical page. Space left blank within
the Project Narrative (excluding margins) is considered part of the
Project Narrative, in determining compliance.

-   The page limit for Appendices stated in the specific funding
    announcement cannot be exceeded.

*To facilitate review of your application, follow these additional
guidelines. Failure to adhere to the following guidelines will not, in
itself, result in your application being screened out and returned
without review. However, the information provided in your application
must be sufficient for review. Following these guidelines will help
ensure your application is complete, and will help reviewers to consider
your application.*

-   The 10 application components required for SAMHSA applications
    should be included. These are:

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-   Face Page (Standard Form 424, which is in PHS 5161-1)

-   Abstract

-   Table of Contents

-   Budget Form (Standard Form 424A, which is in PHS 5161-1)

-   Project Narrative and Supporting Documentation

-   Appendices

-   Assurances (Standard Form 424B, which is in PHS 5161-1)

-   Certifications (a form within PHS 5161-1)

-   Disclosure of Lobbying Activities (Standard Form LLL, which is in
    PHS 5161-1)

-   Checklist (a form in PHS 5161-1)

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-   Applications should comply with the following requirements:

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-   Provisions relating to confidentiality, participant protection and
    the protection of human subjects specified in Section IV-2.4 of the
    specific funding announcement.

-   Budgetary limitations as specified in Sections I, II, and IV-5 of
    the specific funding announcement.

-   Documentation of nonprofit status as required in the PHS 5161-1.

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-   Pages should be typed single-spaced with one column per page.

-   Pages should not have printing on both sides.

-   Please use black ink and number pages consecutively from beginning
    to end so that information can be located easily during review of
    the application. The cover page should be page 1, the abstract page
    should be page 2, and the table of contents page should be page 3.
    Appendices should be labeled and separated from the Project
    Narrative and budget section, and the pages should be numbered to
    continue the sequence.

-   Send the original application and two copies to the mailing address
    in the funding announcement. Please do not use staples, paper clips,
    and fasteners. Nothing should be attached, stapled, folded, or
    pasted. Do not use heavy or lightweight paper or any material that
    cannot be copied using automatic copying machines. Odd-sized and
    oversized attachments such as posters will not be copied or sent to
    reviewers. Do not include videotapes, audiotapes, or CD-ROMs.

**Appendix B: Glossary**

**[Best Practice:]{.underline}** Best practices are practices that
incorporate the best objective information currently available from
recognized experts regarding effectiveness and acceptability.

**[Consumer-Operated Services:]{.underline}** These programs, run by
consumers, include drop-in centers, consumer operated supported
businesses, employment and housing programs, crisis services, outreach
programs and case management programs.

**[Cooperative Agreement:]{.underline}** A cooperative agreement is a
form of Federal grant. Cooperative agreements are distinguished from
other grants in that, under a cooperative agreement, substantial
involvement is anticipated between the awarding office and the recipient
during performance of the funded activity. This involvement may include
collaboration, participation, or intervention in the activity. HHS
awarding offices use grants or cooperative agreements (rather than
contracts) when the principal purpose of the transaction is the transfer
of money, property, services, or anything of value to accomplish a
public purpose of support or stimulation authorized by Federal statute.
The primary beneficiary under a grant or cooperative agreement is the
public, as opposed to the Federal Government.

**[Cost-Sharing or Matching:]{.underline}** Cost-sharing refers to the
value of allowable non-Federal contributions toward the allowable costs
of a Federal grant project or program. Such contributions may be cash or
in-kind contributions. For SAMHSA grants, cost-sharing or matching is
not required, and applications will not be screened out on the basis of
cost-sharing.  However, applicants often include cash or in-kind
contributions in their proposals as evidence of commitment to the
proposed project. This is allowed, and this information may be
considered by reviewers in evaluating the quality of the application.

**[Culturally competent services:]{.underline}** The delivery of
services that are responsive to the cultural concerns of racial and
ethnic minority groups, including their language, histories, traditions,
beliefs, and values.

**[Emerging Practice]{.underline}**: Emerging practices are specific
approaches that receive high marks from consumers and/or others, but
which are too new to have received scientific attention.

**[Grant:]{.underline}** A grant is the funding mechanism used by the
Federal Government when the principal purpose of the transaction is the
transfer of money, property, services, or anything of value to
accomplish a public purpose of support or stimulation authorized by
Federal statute. The primary beneficiary under a grant or cooperative
agreement is the public, as opposed to the Federal Government.

**[In-Kind Contribution]{.underline}**: In-kind contributions toward a
grant project are non-cash contributions (e.g., facilities, space,
services) that are derived from non-Federal sources, such as State or
sub-State non-Federal revenues, foundation grants, or contributions from
other non-Federal public or private entities.

**[National Registry of Effective Programs (NREP)]{.underline}:** The
NREP was developed to review, identify and disseminate effective
evidence-based practices for substance abuse prevention programs.

**[Peer Support:]{.underline}** Peer Support embodies a variety of
approaches that are based on the belief that people who share the same
illness can help each other through mutual support. These practices and
programs are lead by peers rather than by professionals.

**[Practice]{.underline}:** A practice is any activity, or collective
set of activities, intended to improve outcomes for people with or at
risk for substance abuse and/or mental illness. Such activities may
include direct service provision, or they may be supportive activities,
such as efforts to improve access to and retention in services,
organizational efficiency or effectiveness, community readiness,
collaboration among stakeholder groups, education, awareness, training,
or any other activity that is designed to improve outcomes for people
with or at risk for substance abuse or mental illness.

**[Practice Support System]{.underline}:** This term refers to
contextual factors that affect practice delivery and effectiveness in
the pre-adoption phase, delivery phase, and post-delivery phase, such as
a) community collaboration and consensus building, b) training and
overall readiness of those implementing the practice, and c) sufficient
ongoing supervision for those implementing the practice.

**[The President\'s New Freedom Commission on Mental Health entitled
"Achieving the Promise: Transforming Mental Health Care in
America"]{.underline}** identified primary six goals:

Goal 1 Americans Understand that Mental Health Is Essential to Overall
Health.

Goal 2 Mental Health Care Is Consumer and Family Driven.

Goal 3 Disparities in Mental Health Services Are Eliminated.

Goal 4 Early Mental Health Screening, Assessment, and Referral to
Services Are

Common Practice.

Goal 5 Excellent Mental Health Care Is Delivered and Research Is
Accelerated.

Goal 6 Technology Is Used to Access Mental Health Care and Information.

Achieving these goals will transform mental health care in America.

**[Promising Practice]{.underline}**: Promising practices are practices
that are well known and have either expert consensus or other support
which show promise in improving outcomes for consumers.

**[Recovery:]{.underline}** Refers to the process in which people are
able to live, work, learn, and participate fully in their communities.
For some individuals, recovery is the ability to live a fulfilling and
productive life despite a disability. For others, recovery implies
reduction or complete remission of symptoms. Science has shown that
having hope plays an integral role in an individual's recovery.

#### 

**[Resilience:]{.underline}** Means the personal and community qualities
that enable us to rebound from

adversity, trauma, tragedy, threats, or other stresses - and to go on
with life with a sense of mastery, competence, and hope. We now
understand from research that resilience is

fostered by a positive childhood and includes positive individual
traits, such as optimism,

good problem-solving skills, and treatments. Closely-knit communities
and neighborhoods are also resilient, providing supports for their
members.

#### Stakeholder: A stakeholder is an individual, organization, constituent group, or other entity that has an interest in and will be affected by a proposed grant project.

**[Stigma :]{.underline}** Refers to a cluster of negative attitudes and
beliefs that motivate the general public to fear, reject, avoid, and
discriminate against people with mental illnesses. Stigma is widespread
in the United States and other Western nations.16 Stigma leads others to
avoid living, socializing, or working with, renting to, or employing
people with mental disorders - especially severe disorders, such as
schizophrenia. It leads to low self-esteem, isolation, and hopelessness.
It deters the public from seeking and wanting to pay for care.5
Responding to stigma, people with mental health problems internalize
public attitudes and become so embarrassed or ashamed that they often
conceal symptoms and fail to seek treatment.

**[Target population catchment area:]{.underline}** The target
population catchment area is the geographic area from which the target
population to be served by a program will be drawn.

**[Wellness Recovery and Action Plan (WRAP]{.underline}):** a
recovery-focused practice in which an individual develops his/her own
system for monitoring and responding to symptoms in order to achieve the
highest possible levels of wellness**.**

**[Wraparound Service:]{.underline}** Wraparound services are
non-clinical supportive services---such as child care, vocational,
educational, and transportation services---that are designed to improve
the individual's access to and retention in the proposed project.

**Appendix C:** **CERTIFICATE OF ELIGIBILITY FOR NATIONAL TECHNICAL
ASSISTANCE CENTERS ON CONSUMER/PEER RUN PROGRAMS**

An authorized representative of the applicant organization (whose
signature appears on page one of the face page of the application PHS
form 5161) must complete and sign this Certificate. **Appendix 2** of
the application must include this Certificate and all supporting
documentation specified within it.

All applicant organizations must meet the criteria of either consumer
organizations or consumer supporter organizations, Sections A or B below
[and]{.underline} the requirements of Section C.

A\) Applicants for the National Technical Assistance Centers
**(controlled and managed by** **consumers)** must certify and attest to
the following:

 I certify that:

♦ The applicant is an organization that is controlled and managed by
consumers and dedicated to the improvement of mental health services.
Please include minutes of meetings and all other pertinent material to
demonstrate that your organization is controlled and managed by
consumers and dedicated to the improvement of mental health services.

♦ The applicant organization has a board of directors comprised of more
than 50 per cent consumers. Please include names of your Board of
Directors and length of time each has served.

♦ The consumers on the board of directors are individuals 18 years of
age or older with severe mental illness.

♦ The consumer Board of Directors has been in operation for more than
one year. Please include minutes and names of individuals who have
served on the Board of Directors starting in calendar year 2003.

B\) Applicants for the National Technical Assistance Centers
(**controlled and managed by** **consumer supporters**) must certify and
attest to the following:

 I certify that:

♦ The applicant is an organization that is controlled and managed by
consumer supporters and dedicated to the improvement of mental health
services. Please include minutes of meetings and all other pertinent
material to demonstrate that your organization is controlled and managed
by consumer supporters and dedicated to the improvement of mental health
services.

♦ The applicant organization has a Board of Directors comprised of more
than 50 per cent consumer supporters. Please include names of your Board
of Directors and length of time each has served.

♦ The consumer supporters on the Board of Directors are individuals
involved with the support of a consumer (age 18 or older) including
parents, siblings, spouses and significant others, friends, co-workers,
and neighbors who provide support in a non-professional capacity.

♦ The consumer supporter Board of Directors has been in operation for
more than one year. Please send minutes and names of individuals who
served on the Board of Directors starting in calendar year 2003.

C\) All applicants for National Technical Assistance Centers on
Consumer/Peer-Run Programs must certify that:

♦ The applicant organization has been in operation as a legal entity for
a minimum of one year. Please submit proof.

♦ The United States Federal Government Internal Revenue Service (I.R.S.)
has issued the applicant organization tax-exempt status. Supporting
documentation of such status dated prior to January 2004 is included in
this application.

♦ The applicant organization will take an active role in the fiscal
management and oversight of the project and will be legally, fiscally,
administratively, and programmatically responsible for the grant and
**[has not submitted]{.underline}** a "pass through," "umbrella," or
"cover letter" application.

This form must be signed and dated below by an authorized representative
of the applicant organization certifying that the aforementioned
statements are accurate.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Type or print name and title

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature of Applicant certifying validity of Date of Signature

all information contained in this document

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Type: Consumer or Consumer Supporter TAC

**Appendix D: REQUIREMENTS FOR PLANNING CSP-SUPPORTED**

**NATIONAL CONSUMER CONFERENCES**

Since 1985, the Center for Mental Health Services' (CMHS) Community
Support Program (CSP) has supported national conferences for primary
consumers (also referred to as ex-patients or survivors) of mental
health services. The purpose of this issuance is to facilitate the
planning of these conferences by clarifying CMHS and CSP policies and
defining the roles and responsibilities of grantees organizing the
event, the Government Project Officer (GPO), the Conference Advisory
Committee, and other CMHS staff involved in planning these conferences.

**[Purpose of Conference]{.underline}**

The purpose of this conference is to provide a forum for consumers from
across the Nation to meet, exchange information and ideas, and provide
and receive technical assistance on a variety of topics of interest,
such as peer support, consumer-operated services, self-help, protection
and advocacy issues, empowerment, and recovery. The conference also
transfers knowledge on best practices in mental health and support
services. The information and knowledge gained through attending this
conference enables consumers to advocate for effective individual
treatments and services, as well as for broader managed care and service
system improvements.

**[Participants]{.underline}**

The conference is open to all individuals who have had or are currently
experiencing a mental health disorder. It also is open to others at the
discretion of the Advisory Committee.

**[Grantee Organizing Conference]{.underline}**

The grantee organization responsible for overseeing the conference will
select a site that is accessible and affordable and, to the extent
possible, different from previous sites for national conferences. The
grantee also will be responsible for the logistics of the conference,
including moderating the Conference Advisory Committee meetings and
teleconference calls; developing and disseminating materials; handling
publicity; and arranging for lodging, meals, registration, meeting
rooms, emergency procedures, transportation, and the conference
evaluation. Within 3 months of the conference, the grantee is
responsible for submitting a final report on the conference that details
the expenditures, summarizes the evaluations, and provides
recommendations for future national consumer conferences.

**[Government Project Officer (GPO)]{.underline}**

The GPO will approve the individual(s) who have a major role in
coordinating the conference and will review and provide guidance on the
composition of the Conference Advisory Committee, the proposed budget
expenditures for the conference, policies regarding scholarships, and
logistical plans. Furthermore, the location, agenda, and specific
conference brochure providing presenters and workshop descriptions must
be approved by the GPO prior to finalizing and sending to the field. The
GPO will participate in Conference Advisory Committee meetings and
teleconferences. The GPO also will provide technical assistance, as
requested.

**[Advisory Committee and Planning Process]{.underline}**

The conference will be planned by a committee formed approximately 1
year prior (as funding permits) to the actual conference. The members
will include duly appointed representatives of the national consumer
organizations, Federal CMHS CSP staff (Grant Project Officer), CMHS
Consumer Affairs liaison staff, and the Directors or designees of the
CSP-funded Consumer Technical Assistance Centers. The Committee will
reflect gender, ethnic/minority representation, and, to the extent
possible, geographic distribution and involvement of individuals who
have not participated on previous Conference Advisory Committees.

The Committee will devise a process for gathering information from
consumers throughout the Nation on topics of interest for the agenda and
speakers. Final decisions regarding the agenda will be made by the
Advisory Committee. However, the workshop areas selected should
represent a variety of viewpoints and mainly include workshops run by
and for consumers.

The Advisory Committee is responsible for designing the programmatic
aspects of the conference, including the theme and logo. Only members of
the Committee may vote on decisions regarding the agenda and speakers
for the conference. The Advisory Committee should meet physically once
and handle continuing business through telephone conference calls,
mailings, and computer e-mail.

**[Involvement of National Consumer Organizations]{.underline}**

The conference agenda and official workshops [may not be
used]{.underline} to further the development of national consumer
organizations or for other purely parochial interests. However,
individuals from the various national consumer organizations may use the
times before and after the conference, free times scheduled on the
agenda, and evenings to conduct activities related to promoting or
planning for their respective organizations. Of course, national
consumer organizations and other organizations may sponsor substantive
workshops.

Information related to the business activities of individuals or
national organizations must be kept separate from the conference agenda
and sent out in separate mailings.

**Appendix E: Customer Satisfaction Survey**

> Form Approved
>
> OMB NO.[0930-0197]{.underline}
>
> Exp. Date [12/31/04]{.underline}
>
> [See burden statement on reverse]{.underline}

**[NAME OF TAC]{.underline}**

**CUSTOMER SATISFACTION SURVEY**

# **We would like to first ask you some questions about the quality of the services you received. Please use the scale below, to rate the quality of the services. Circle the appropriate number.**

1.  **Strongly Disagree (SD)**

2.  **Disagree (D)**

3.  **Agree (A)**

4.  **Strongly Agree (SA)**

5.  **Not Applicable**

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1.  I liked the quality of the:

# **2. Please utilize the same scale to rate how much you agree with the following statements:**

Again, circle the appropriate number.

3\. How would you rate your ability to accomplish things now compared to
before you received your service(s)?

1.  Much Better

2.  A Little Better

3.  About the Same

4.  A Little Worse

5.  Much Worse

4\. Do you have recommendations for other types of services,
information, or assistance that **[NAME OF TAC]{.underline}** should
make available? (**Note:** Please *do not* request specific individual
referral or treatments in this space. If needed, please call **[NAME OF
TAC]{.underline}** at **[TAC PHONE NUMBER]{.underline}** for such
requests).

**Public reporting burden for this collection of information is
estimated to average 10 minutes per response, including time for
reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection
of information. Send comments regarding this burden estimate or any
other aspect of this collection of information to SAMHSA Reports
Clearance Officer, Room 16-105, 5600 Fishers Lane, Rockville, MD 20857.
An agency may not conduct or sponsor, and a person is not required to
respond to a collection of information unless it displays a currently
valid OMB control number. The control number for this project is
0930-0197.**

Please return within the next week to: