Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

**Jail Diversion and Trauma Recovery Program-Priority to Veterans**

[]{.mark}

**Short Title: Diversion and Trauma Recovery**

**(Initial Announcement)**

**Request for Applications (RFA) No. SM-08-009**

[]{.mark}

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

**Key Dates:**

+----------------------+-----------------------------------------------+
| **Application        | **Applications are due by May 8, 2008.**      |
| Deadline**           |                                               |
+----------------------+-----------------------------------------------+
| **Intergovernmental  | **Applicants must comply with E.O. 12372 if   |
| Review**             | their State(s) participates. Review process   |
|                      | recommendations from the State Single Point   |
| **(E.O. 12372)**     | of Contact (SPOC) are due no later than 60    |
|                      | days after application deadline.**            |
+----------------------+-----------------------------------------------+
| **Public Health      | **Applicants must send the PHSIS to           |
| System Impact        | appropriate State and local health agencies   |
| Statement            | by application deadline. Comments from Single |
| (PHSIS)/Single State | State Agency are due no later than 60 days    |
| Agency               | after application deadline.**                 |
| Coordination**       |                                               |
+----------------------+-----------------------------------------------+

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

A. Kathryn Power, M.Ed. Terry L. Cline, Ph.D.

Director Administrator

Center for Mental Health Services Substance Abuse and Mental Health

Substance Abuse and Mental Health Services Administration

Services Administration

**Table of Contents**

[I. FUNDING OPPORTUNITY DESCRIPTION 4](#funding-opportunity-description)

[1. INTRODUCTION 4](#introduction)

[2. EXPECTATIONS 4](#expectations)

[II. AWARD INFORMATION 11](#award-information)

[III. ELIGIBILITY INFORMATION 11](#eligibility-information)

[1. ELIGIBLE APPLICANTS 11](#eligible-applicants)

[2. COST SHARING and MATCH REQUIREMENTS
12](#cost-sharing-and-match-requirements)

[3. OTHER 12](#other)

[IV. APPLICATION AND SUBMISSION INFORMATION
13](#application-and-submission-information)

[1. ADDRESS TO REQUEST APPLICATION PACKAGE
13](#address-to-request-application-package)

[2. CONTENT AND FORM OF APPLICATION SUBMISSION
14](#content-and-form-of-application-submission)

[3. SUBMISSION DATES AND TIMES 16](#submission-dates-and-times)

[4. INTERGOVERNMENTAL REVIEW (E.O. 12372) REQUIREMENTS
17](#intergovernmental-review-e.o.-12372-requirements)

[5. FUNDING LIMITATIONS/RESTRICTIONS
18](#funding-limitationsrestrictions)

[6. OTHER SUBMISSION REQUIREMENTS 19](#other-submission-requirements)

[V. APPLICATION REVIEW INFORMATION 20](#application-review-information)

[1. EVALUATION CRITERIA 20](#evaluation-criteria)

[2. REVIEW AND SELECTION PROCESS 26](#review-and-selection-process)

[VI. ADMINISTRATION INFORMATION 26](#administration-information)

[1. AWARD NOTICES 26](#award-notices)

[2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS
26](#administrative-and-national-policy-requirements)

[3. REPORTING REQUIREMENTS 27](#reporting-requirements)

[VII. AGENCY CONTACTS 28](#agency-contacts)

[Appendix A -- Checklist for Formatting Requirements and Screenout
Criteria for SAMHSA Grant Applications
30](#appendix-a-checklist-for-formatting-requirements-and-screenout-criteria-for-samhsa-grant-applications)

[Appendix B -- Guidance for Electronic Submission of Applications
32](#appendix-b-guidance-for-electronic-submission-of-applications)

[Appendix C - Statement of Assurance
35](#appendix-c---statement-of-assurance)

[Appendix D -- Sample Logic Model 36](#appendix-d-sample-logic-model)

[Appendix E -- Logic Model Resources
38](#appendix-e-logic-model-resources)

[Appendix F -- Confidentiality and Participant Protection
39](#appendix-f-confidentiality-and-participant-protection)

[Appendix G -- Funding Restrictions
43](#appendix-g-funding-restrictions)

[Appendix H -- Sample Budget and Justification
45](#appendix-h-sample-budget-and-justification)

**Executive Summary:**

The Substance Abuse and Mental Health Services Administration, Center
for Mental Health Services is accepting applications for fiscal year
(FY) 2008 for Jail Diversion and Trauma Recovery Program-Priority to
Veterans grants. The purpose of this program is to support local
implementation and Statewide expansion of trauma-integrated jail
diversion programs to reach the growing number of individuals with post
traumatic stress disorder (PTSD) and trauma related disorders involved
in the justice system. In recognition of the dramatically higher
prevalence of trauma related illnesses among veterans, this program will
prioritize eligibility for veterans.

#  {#section .unnumbered}

**Funding Opportunity Title:** Diversion and Trauma Recovery

**Funding Opportunity Number:** SM-08-009

**Due Date for Applications:** May 8, 2008

**Anticipated Total Available Funding:** \$2,475,000

**Estimated Number of Awards:** 6

**Estimated Award Amount:** Up to \$412,500 per year

**Length of Project Period:** Up to 5 years

**Eligible Applicants:** State Mental Health Agencies; federally
recognized Indian Tribes, tribal organizations, urban Indian
organizations; public or private organizations designated by a State,
federally recognized Indian Tribe, tribal organization or urban Indian
organization authorized to develop or direct the State/tribal-sponsored
community jail diversion.

> \[See Section III-1 of this RFA for complete eligibility
> information.\]

# FUNDING OPPORTUNITY DESCRIPTION

## INTRODUCTION

The Substance Abuse and Mental Health Services Administration, Center
for Mental Health Services is accepting applications for fiscal year
(FY) 2008 for Jail Diversion and Trauma Recovery Program-Priority to
Veterans grants. The purpose of this program is to support local
implementation and Statewide expansion of trauma-integrated jail
diversion programs to reach the growing number of individuals with post
traumatic stress disorder (PTSD) and trauma related disorders involved
in the justice system. In recognition of the dramatically higher
prevalence of trauma related illnesses among veterans, this program will
prioritize eligibility for veterans.

With increasing numbers of combat veterans returning from duty overseas,
there is growing concern that the community provide adequate supports to
ensure their successful reintegration into American community life. As
many as 17 percent of them will develop PTSD and other mental
illnesses[^1]. For many returning veterans, PTSD and related disorders
will go untreated, placing them at risk for involvement in the justice
system.

This program will focus jail diversion programs on the underserved needs
of veterans and others with PTSD involved in the justice system.
Secondly, the program will support States to pilot projects locally and
to replicate them Statewide. This two-pronged approach is necessary
because diversion occurs locally in cities and counties where jails are
operated and mental health services are delivered. However, policies and
funding at the State level dramatically impact those local operations
and services. The State approach will bring together government
officials who develop and define State policies and funding with
stakeholders who are impacted by the untreated trauma of veterans to
develop knowledge dissemination and application strategies for the
entire State.

Diversion and Trauma Recovery grants are authorized under 520a of the
Public Health Service Act, as amended. This announcement addresses
Healthy People 2010 focus area 18 (Mental Health and Mental Disorders).

## 2. EXPECTATIONS {#expectations .unnumbered}

Applicants must develop a two-pronged approach to address the needs of
forensic populations: 1) implementing an infrastructure building program
at the State level; and 2) piloting a jail diversion program at the
local level.

Working with local communities, the State Mental Health Agencies (SMHAs)
will determine the most suitable site or sites within the State to
implement pilot projects to divert veterans and others with PTSD from
jail to community based trauma-integrated services. Project participants
must be adults involved in the criminal justice system with a priority
given to veterans. Participants may be recruited from single or multiple
intercept points along the justice continuum including first contact
with law enforcement, initial detention, court hearings and community
corrections. For those who are incarcerated, funds may be used only to
prepare inmates for reentry prior to release.

Grantees must convene State Advisory Committees that should include
representatives from State departments of corrections, mental health,
rehabilitation, parole and probation, State National Guard, Veterans
Affairs, State judiciary, State Medicaid, pilot sites, veterans'
organizations, their families, provider organizations and universities
interested in the study and treatment of trauma. The State Advisory
Committee must maintain contact with pilot communities, oversee the
projects' evaluations and develop and implement plans for Statewide
dissemination and implementation.

Applicants must screen and assess clients for the presence of
co-occurring substance use (abuse and dependence) and mental disorders
and use the information obtained from the screening and assessment to
develop appropriate treatment approaches for the persons identified as
having such co-occurring disorders.

The following projected milestones illustrate how this two-pronged
approach is expected to be developed over the 5 year funding period:

> 4 months: State Advisory Committee has convened. Local pilot sites
> have been selected and have begun strategic planning process.
>
> 12 months: Local strategic plan completed and approved. State obtains
> IRB approval to evaluate projects. Project begins roll-out, having
> hired and trained staff.
>
> 14 months: Trauma Informed Care training conducted, client screening
> and diversion begin and treatment and recovery support services are
> implemented.
>
> 24 months: Preliminary results of evaluation prompt practice
> adaptations for better fit to settings and populations. State Advisory
> Committee consulted.
>
> 36 months: Between 12 and 24 months of client level data are complete.
> Screening, recruitment, service delivery and recovery support
> instruments and protocols are refined and developed for Statewide
> dissemination. Statewide dissemination strategy is implemented
> including conferences, staff training screening and treatment
> protocols, recovery support systems, consumer and family network
> development.
>
> 48 months: Statewide implementation strategy includes increasing
> number of localities training staff, implementing trauma screening,
> treatment and recovery support. Collateral agencies and facilities
> modify practices to incorporate trauma informed services and recovery
> support.
>
> 60 months: SAMHSA grant funding ends. State and localities develop
> policy and funding approaches to sustain trauma training, screening,
> treatment and recovery.

1.  **Using Evidence-Based Practices**

Your implementation pilot must fund a service or practice that has a
demonstrated evidence base and that is appropriate for the population of
focus. An evidence-based practice, also called EBP, refers to approaches
to prevention or treatment that are validated by some form of documented
research evidence. In your application, you will need to:

-   Identify the evidence-based practice you propose to implement.

-   Identify and discuss the evidence that shows that the practice is
    effective. \[See note below.\]

-   Discuss the population(s) for which this practice has been shown to
    be effective and show that it is appropriate for [your]{.underline}
    population(s) of focus. \[See note below.\]

> **Note: SAMHSA recognizes that EBPs have not been developed for all
> populations and/or service settings. For example, certain
> interventions for American Indians/Alaska Natives, rural or isolated
> communities or recent immigrant communities may not have been formally
> evaluated and, therefore, have a limited or nonexistent evidence base.
> In addition, other interventions that have an established evidence
> base for certain populations or in certain settings may not have been
> formally evaluated with other subpopulations or within other settings.
> Applicants proposing to serve a population with an intervention that
> has not been formally evaluated with that population are encouraged to
> provide other forms of evidence that the practice(s) they propose is
> appropriate for the population of focus. Evidence may include
> unpublished studies, preliminary evaluation results, clinical (or
> other professional association) guidelines, findings from focus groups
> with community members, etc. You may describe your experience either
> with the population of focus or in managing similar programs.
> Information in support of your proposed practice needs to be
> sufficient to demonstrate the appropriateness of your practice to the
> people reviewing your application.**

-   Document the evidence that the practice you have chosen is
    appropriate for the outcomes you want to achieve.

-   Explain how the practice you have chosen meets SAMHSA's goals for
    this grant program.

-   Describe any modifications/adaptations you will need to make to this
    practice to meet the goals of your project and why you believe the
    changes will improve the outcomes. We expect that you will implement
    your evidence-based service/practice in a way that is as close as
    possible to the original service/practice. However, SAMHSA
    understands that you may need to make minor changes to the
    service/practice to meet the needs of your population of focus or
    your program or to allow you to use resources more efficiently. You
    must describe any changes to your proposed service/practice that you
    believe are necessary for these purposes. You may describe your own
    experience either with the population of focus or in managing
    similar programs. However, you will need to convince the people
    reviewing your application that the changes you propose are
    justified.

-   Explain why you chose this evidence-based practice over other
    evidence-based practices.

*Resources for Evidence-Based Practices:*

You will find information on evidence-based practices in SAMHSA's *Guide
to Evidence-Based Practices on the Web* at
[www.samhsa.gov/ebpwebguide](http://www.samhsa.gov/ebpwebguide). SAMHSA
has developed this Web site to provide a simple and direct connection to
Web sites with information about evidence-based interventions to prevent
and/or treat mental and substance use disorders. The *Guide* provides a
short description and a link to dozens of Web sites with relevant
evidence-based practices information -- either specific interventions or
comprehensive reviews of research findings.

Please note that SAMHSA's Guide to Evidence-Based Practices also
references another SAMHSA Web site, the National Registry of
Evidence-Based Programs and Practices (NREPP). NREPP is a searchable
database of interventions for the prevention and treatment of mental and
substance use disorders. NREPP is intended to serve as a decision
support tool, not as an authoritative list of effective interventions.
*Being included in NREPP, or in any other resource listed in the Guide,
does not mean an intervention is "recommended" or that it has been
demonstrated to achieve positive results in all circumstances.* You must
document that the selected practice is appropriate for the specific
population of focus and purposes of your project.

In addition to the Web site noted above, you may provide information on
research studies to show that the services/practices you plan to
implement are evidence-based. This information is usually published in
research journals, including those that focus on minority populations.
If this type of information is not available, you may provide
information from other sources, such as unpublished studies or documents
describing formal consensus among recognized experts.

1.  Services Delivery

Your implementation pilot must support allowable direct services. This
includes the following types of activities:

-   Providing outreach [and]{.underline} other strategies to increase
    participation in, and access to, treatment or prevention services to
    underserved populations. If you are proposing to provide
    [only]{.underline} outreach and other strategies to increase access,
    you must show that there are treatment services available and your
    organization has the ability to connect individuals with those
    services.

-   Providing direct treatment (including screening, assessment and care
    management) or prevention services for populations at risk.
    Treatment must be provided in outpatient, (including outreach-based
    services) intensive outpatient or residential programs.

-   Providing "wrap-around"/recovery support services (e.g., child care,
    vocational, educational and transportation services) based on
    individual needs designed to improve access and retention.

> \[Note: Grant funds may be used to purchase such services from another
> provider.\]

**Service delivery should begin by the 12^th^ month of the project [at
the latest]{.underline}.**

######## **Required Activities** 

########  {#section-1 .unnumbered}

1.  Implement a State infrastructure building program linked to a local
    pilot jail diversion and trauma recovery project. At the State
    level, the SMHA must convene a State Advisory Committee comprised of
    representatives from State departments of mental health, substance
    abuse treatment, health, corrections, parole and probation, as well
    as State National Guard, Veterans Affairs, State judiciary, State
    Medicaid, pilot sites, veterans' organizations, their families,
    provider organizations and universities interested in the study,
    training and treatment of trauma. The State Advisory Committee must
    provide oversight of pilot projects' trainings, diversion, service
    delivery and local project evaluation. The Committee must also
    design and implement plans to disseminate knowledge about effective
    pilot projects and to replicate them in other communities in the
    State.

2.  Pilot a diversion program. Pilot projects will bring together
    community stakeholders to design the local service delivery system
    and the infrastructure needed to sustain it. At the completion of
    this phase, grantees will have developed a strategic plan for a
    trauma informed integrated service system. Key stakeholders will
    include veterans and their families, representatives from the
    National Guard and Veterans Administration, providers of health,
    mental health and substance abuse services, and representatives from
    corrections, law enforcement, prosecutors, courts, social service
    organizations, faith-based organizations and other potential sources
    of subject matter expertise and funding. The Government Project
    Officer will review and approve the strategic plan before grantees
    implement the project and begin services. Pilot projects must
    include the following components:

-   Candidates for diversion with PTSD and trauma related disorders must
    be recruited from either single or multiple intercept points along
    the justice continuum including first contact with law enforcement,
    initial detention, court hearings and community corrections.

-   The pilot project(s) must screen for persons with PTSD involved in
    the justice system. A number of tools (such as the Life History
    Events Questionnaire, the PTSD Checklist for Civilians or PTSD
    Symptom Scale, Self-Report Version and the Addiction Severity Index)
    exist to screen for PTSD and assess the extent of impairment.

-   The pilot project(s) must divert clients to trauma-integrated
    treatment and recovery services that include effective practices
    such as Seeking Safety and TREM (both found in SAMHSA's National
    Registry of Evidence-based Programs and Practices) or other types of
    group psychosocial empowerment programs.

-   All staff coming in contact with program participants must receive
    training on trauma informed care (see the National Center on Trauma
    Informed Care for more information at
    <http://mentalhealth.samhsa.gov/nctic/>).

-   The pilot project(s) must ensure the delivery of comprehensive
    support services that include housing, employment, health, mental
    health, substance abuse treatment and other community support
    services.

-   The project(s) and its evaluation must be coordinated by the State
    Advisory Committee.

    1.  **Allowable Activities**

The SMHA may select more than one local site to pilot and evaluate the
delivery of trauma integrated services through a sub-contract from the
SMHA. The SMHA may implement one or more diversion strategies. Pilot
site activities include training, planning, implementation, maintenance
and evaluation of diversion and services.

Infrastructure development may include relevant State agency
collaboration toward review and change of policies and regulations,
technical assistance, conferences and development of training programs
in trauma-informed care for staff in law enforcement, justice and
correctional facilities, diversion systems and community-based human
services agencies that serve clients. Infrastructure includes the
dissemination of knowledge gained from the planning, implementation,
maintenance and evaluation of screening, treatment and recovery
services.

2.  **Data Collection and Performance Measurement**

All SAMHSA grantees are required to collect and report certain data so
that SAMHSA can meet its obligations under the Government Performance
and Results Act (GPRA).  You must document your ability to collect and
report the required data in "Section E: Performance Assessment and Data"
of your application. 

Grantees will be required to report performance on the following
performance measures: mental illness symptomatology;
employment/education; crime and criminal justice; stability in housing;
access -- number of persons served by age, gender, race, and ethnicity;
rate of readmission to psychiatric hospitals; social support/social
connectedness; and client perception of care. This information will be
gathered using the CMHS NOMs Adult Consumer Outcome Measures for
Discretionary Programs, which can be found at
<https://www.samhsa-gpra.samhsa.gov/home/index.htm> along with
instructions for completing it.  Hard copies are available in the
application kits available by calling the SAMHSA Information Line at
1-877-SAMHSA7 \[TDD: 1-800-487-4889\].  Data will be collected at
baseline, at 6 month follow-up and at discharge.  Data are to be entered
into the TRAC Web system within seven days of data collection. Technical
Assistance related to data collection and reporting will be offered. The
collection of these data will enable CMHS to report on the National
Outcome Measures (NOMs), which have been defined by SAMHSA as key
priority areas relating to mental health.

GPRA data will be reported to the public, the Office of Management and
Budget (OMB) and Congress as part of SAMHSA's budget request. In
addition to collecting GPRA data described above, grantees must agree to
participate in a national multi-site evaluation study as a condition of
award. The multi-site evaluation design, instrumentation and data
collection processes are under development.

Grantees will describe local program services and practices as well as
Statewide infrastructure development. Reports will include document
planning, implementation and evaluation of the pilot project and
Statewide expansion of diversion and trauma integrated services. In
addition, grantees will report on:

-   Increased trauma screening, treatment and/or recovery services
    provided to veterans and others with trauma related disorders in a
    State

    -   Number of jails, community corrections and/or mental health
        agencies in a State that implement trauma screening, treatment
        and/or recovery services to veterans

    -   Number of corrections and other service staff trained in
        trauma-informed care

    -   Number of local- and State-instituted policies that increase
        trauma screening, treatment and recovery services for persons
        involved in the justice system.

Grantees will collect data from pilot sites as developed by CMHS. 
Measures will be adapted from those currently under use by CMHS' TCE
Grants for Jail Diversion Program grantees.  These data include the
volume of activities involved in jail diversion including screening and
enrollment of participants as well as the delivery of treatment and
supports. Outcome data, collected through interviews with clients at
enrollment and at six and twelve months following enrollment include
drug and alcohol use; family and living conditions; education,
employment and income, crime and criminal justice status, mental and
physical health problems and treatment; traumatic exposures, traumatic
symptoms, symptoms of mental illness; quality of life measures and
perceived coercion to enter the program. Sites will also collect each
client's record of arrests, sentencing and jail days during the 1 year
period prior to jail diversion and 1 year following jail diversion. 

Grantees may develop independent data collection strategies that
consider outcome and process questions, such as the following:

*Outcome Questions:*

-   What was the effect of the intervention on participants?

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-   What program/contextual factors were associated with outcomes?

-   What individual factors were associated with outcomes?

-   How durable were the effects?

*Process Questions*:

-   How closely did implementation match the plan?

-   What types of deviation from the plan occurred?

-   What led to the deviations?

-   What effect did the deviations have on the planned intervention and
    performance assessment?

-   Who provided (program staff) what services (modality, type,
    intensity, duration), to whom (individual characteristics), in what
    context (system, community) and at what cost (facilities, personnel,
    dollars)?

**No more than 20% of the total grant award may be used for data
collection, performance measurement, and performance assessment, e.g.,
activities required in Section I-2.5 above.**

######## **Grantee Meetings**

Grantees must plan to send a minimum of three people (including the
Project Director, evaluator and one consumer representative) to at least
one joint grantee meeting in each year of the grant and you must include
a detailed budget and narrative for this travel in your budget. At these
meetings, grantees will present the results of their projects and
Federal staff will provide technical assistance. Each meeting will be 3
days. These meetings are usually held in the Washington, D.C., area and
attendance is mandatory.

# AWARD INFORMATION

**Funding Mechanism:** Grant

**Anticipated Total Available Funding:** \$2,475,000

**Estimated Number of Awards:** 6

**Estimated Award Amount:** Up to \$412,500 per year

**Length of Project Period:** Up to 5 years

**Proposed budgets cannot exceed \$412,500 in total costs (direct and
indirect) 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, timely submission of required data
and reports, and compliance with all terms and conditions of award.

**Applicants should be aware that funding for this program is not
included in the FY 2009 President's budget request, and funding beyond
FY 2008 is not guaranteed. SAMHSA is allowing applicants to submit
proposals for four additional budget years for planning purposes and for
technical assistance in sustainability activities.**

# ELIGIBILITY INFORMATION

## ELIGIBLE APPLICANTS

Eligible applicants are State Mental Health Agencies (SMHAs) and
federally recognized American Indian/Alaska Native (AI/AN) Tribes and
tribal organizations. Tribal organization means the recognized body of
any AI/AN Tribe; any legally established organization of American
Indians/Alaska Natives which is controlled, sanctioned, or chartered by
such governing body or which is democratically elected by the adult
members of the Indian community to be served by such organization and
which includes the maximum participation of American Indians/Alaska
Natives in all phases of its activities. Consortia of tribal
organizations are eligible to apply, but each participating entity must
indicate its approval.

**Eligibility is limited because** **the implementation of community
jail diversion and its expansion Statewide requires State and tribal
level leadership, policy and regulatory authority, funding authority and
collaboration across related State level departments and Tribes.**

## COST SHARING and MATCH REQUIREMENTS

Cost sharing/match are not required in this program.

## OTHER

1.  **Additional Eligibility Requirements**

**You must comply with the following requirements, or your application
will be screened out and will not be reviewed:** use of the PHS 5161-1
application form; application submission requirements in Section IV-3 of
this document; and formatting requirements provided in Appendix A of
this document.

2.  **Evidence of Experience and Credentials**

> SAMHSA believes that only existing experienced and appropriately
> credentialed organizations with demonstrated infrastructure and
> expertise will be able to provide required services quickly and
> effectively. You must meet three additional requirements related to
> the provision of services.
>
> The three requirements are:

-   A provider organization for direct client mental health services
    appropriate to the grant must be involved in the proposed project.
    The provider may be the applicant or another organization committed
    to the project. More than one provider organization may be involved;

-   Each direct service provider organization must have at least 2 years
    experience (as of the due date of the application) providing
    relevant services in the geographic area(s) in which services are to
    be provided (official documents must establish that the organization
    has provided relevant services for the [last 2 years]{.underline});
    and

-   Each direct service provider organization must comply with all
    applicable local (city, county) and State/tribal licensing,
    accreditation and certification requirements, as of the due date of
    the application.

\[Note: The above requirements apply to all service provider
organizations. A license from an individual clinician will not be
accepted in lieu of a provider organization's license.\]

In **Appendix 1** of your application, you must: (1) identify at least
one experienced, licensed service provider organization; (2) include a
list of all direct service provider organizations that have agreed to
participate in the proposed project, including the applicant agency if
the applicant is a treatment or prevention service provider
organization; and (3) include the Statement of Assurance (provided in
Appendix C of this announcement), signed by the authorized
representative of the applicant organization identified on the face-page
(SF 424 v2) of the application, attesting that all participating service
provider organizations:

-   meet the 2-year experience requirement;

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-   meet applicable licensing, accreditation and certification
    requirements; and

-   if the application is within the funding range for grant award, the
    applicant will provide the Government Project Officer (GPO) with the
    required documentation within the time specified.

In addition, if following application review, your application's score
is within the funding range, the GPO will call you and request that the
following documentation be sent by overnight mail:

-   a letter of commitment that specifies the nature of the
    participation and what service(s) will be provided from every
    service provider organization that has agreed to participate in the
    project;

-   official documentation that all participating organizations have
    been providing relevant services for a minimum of 2 years before the
    date of the application in the area(s) in which the services are to
    be provided; and

-   official documentation that all participating service provider
    organizations comply with all applicable local (city, county) and
    State/tribal requirements for licensing, accreditation and
    certification or official documentation from the appropriate agency
    of the applicable State/tribal, county or other governmental unit
    that licensing, accreditation and certification requirements do not
    exist.

If the GPO does not receive this documentation within the time
specified, the application will not be considered for an award.

# APPLICATION AND SUBMISSION INFORMATION 

## ADDRESS TO REQUEST APPLICATION PACKAGE 

You may request a complete application kit from the SAMHSA Information
Line at 1-877-SAMHSA7 \[TDD: 1-800-487-4889\].

You also may download the required documents from the SAMHSA Web site at
[www.samhsa.gov/grants/apply.aspx](http://www.samhsa.gov/grants/apply.aspx)

Additional materials available on this Web site include:

-   a grant writing 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

-   a list of certifications and assurances referenced in item 21 of the
    SF 424 v2.

## CONTENT AND FORM OF APPLICATION SUBMISSION

1.  **Application Kit**

SAMHSA application kits include the following documents:

-   PHS 5161-1 (revised July 2000) -- Includes the face page (SF 424
    v2), 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) -- Provides a description of the
    program, specific information about the availability of funds, and
    instructions for completing the grant application. This document is
    the RFA. The RFA will be available on the SAMHSA Web site
    ([[www.samhsa.gov/grants/index.aspx]{.underline}](../www.samhsa.gov/grants/index.aspx))
    and a synopsis of the RFA is available on the Federal grants Web
    site ([www.Grants.gov](http://www.Grants.gov/)).

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

1.  **Required Application Components**

Applications 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 --** SF 424 v2 is the face page. This form is part of
    the PHS 5161-1. \[Note: Applicants must provide a Dun and Bradstreet
    (DUNS) number to apply for a grant or cooperative agreement from the
    Federal Government. SAMHSA applicants are required to provide their
    DUNS number on the face page of the application. Obtaining a DUNS
    number is easy and there is no charge. To obtain a DUNS number,
    access the Dun and Bradstreet Web site at
    [www.dunandbradstreet.com](http://www.dunandbradstreet.com/) or call
    1-866-705-5711. To expedite the process, let Dun and Bradstreet know
    that you are a public/private nonprofit organization getting ready
    to submit a Federal grant application.\]

-   **Abstract** -- Your total abstract should not be longer than 35
    lines. It should include the project name, population to be served
    (demographics and clinical characteristics),
    strategies/interventions, project goals and measurable objectives,
    including the number of people to be served annually and throughout
    the lifetime of the project, etc. 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 PHS 5161-1.
    Fill out Sections B, C, and E of the SF 424A. A sample budget and
    justification is included in Appendix H of this document.

-   **Project Narrative and Supporting Documentation** -- The Project
    Narrative describes your project. It consists of Sections A
    through D. Sections A-D together may not be longer than 25 pages.
    (Remember that if your Project Narrative starts on page 5 and ends
    on page 30, it is 26 pages long, not 25 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 E through H. There are no page limits for
    these sections, except for Section G, Biographical Sketches/Job
    Descriptions. Additional instructions for completing these sections
    are included in Section V under "Supporting Documentation."
    Supporting documentation should be submitted in black and white (no
    color).

####### Appendices 1 through 5 -- Use only the appendices listed below. If your application includes any appendices not required in this document, they will be disregarded. Do not use more than a total of 30 pages for Appendices 1, 3 and 4 combined. There are no page limitations for Appendices 2 and 5. Do not use appendices to extend or replace any of the sections of the Project Narrative. Reviewers will not consider them if you do. Pease label the appendices as: Appendix 1, Appendix 2, etc.

-   *Appendix 1*: (1) Identification of at least one experienced,
    licensed service provider organization; (2) a list of all direct
    service provider organizations that have agreed to participate in
    the proposed project, including the applicant agency, if it is a
    treatment or prevention service provider organization; (3) the
    Statement of Assurance (provided in Appendix C of this announcement)
    signed by the authorized representative of the applicant
    organization identified on the face page of the application, that
    assures SAMHSA that all listed providers meet the 2-year experience
    requirement, are appropriately licensed, accredited, and certified,
    and that if the application is within the funding range for an
    award, the applicant will send the GPO the required documentation
    within the specified time; (4) letters of commitment/support.

-   *Appendix 2***:** Data Collection Instruments/Interview Protocols

-   *Appendix 3*: Sample Consent Forms

-   *Appendix 4*: Letter to the SSA (if applicable; see Section IV-4 of
    this document)

####### *Appendix 5*: A copy of the State or County Strategic Plan, a State or county needs assessment, or a letter from the State or county indicating that the proposed project addresses a State- or county-identified priority.

-   **Assurances** -- Non-Construction Programs. You must read the list
    of assurances provided on the SAMHSA Web site or in the application
    kit before signing the face page (SF 424 v2) of the application.

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-   **Certifications** -- You must read the list of certifications
    provided on the SAMHSA Web site or in the application kit before
    signing the face page (SF 424 v2) of the application.

-   **Disclosure of Lobbying Activities** -- You must submit 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. If no lobbying is to be disclosed, mark
    N/A on the form.

-   **Checklist** -- Use the Checklist found in PHS 5161-1. The
    Checklist ensures that you have obtained the proper signatures,
    assurances and certifications. If you are submitting a paper
    application, the Checklist should be the last page.

2.3 Application Formatting Requirements

**Please refer to Appendix A, *Checklist for Formatting Requirements and
Screenout Criteria for SAMHSA Grant Applications*, for SAMHSA's basic
application formatting requirements. Applications that do not comply
with these requirements will be screened out and will not be reviewed.**

## SUBMISSION DATES AND TIMES 

Applications are due by close of business on May 8, 2008. Hard copy
applications are due by 5:00 PM (EST). Electronic applications are due
by 11:59 PM (EST). **Hand carried applications will not be accepted.
Applications may be shipped using only DHL, Federal Express (FedEx),
United Parcel Service (UPS), or the United States Postal Service
(USPS).**

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

**Your application must be received by the application deadline or it
will not be considered for review.** Please remember that mail sent to
Federal facilities undergoes a security screening prior to delivery. You
are responsible for ensuring that you submit your application so that it
will arrive by the application due date and time.

If an application is mailed to a location or office (including room
number) that is not designated for receipt of the application and, as a
result, the designated office does not receive your application by the
deadline, your application will be considered late and ineligible for
review.

SAMHSA will not accept or consider any applications sent by facsimile.

SAMHSA accepts electronic submission of applications through
[www.Grants.gov](http://www.Grants.gov/). Please refer to Appendix B for
"Guidance for Electronic Submission of Applications."

## INTERGOVERNMENTAL REVIEW (E.O. 12372) REQUIREMENTS

This grant program is covered under Executive Order (EO) 12372, as
implemented through Department of Health and Human Services (DHHS)
regulation at 45 CFR Part 100. Under this Order, States may design their
own processes for reviewing and commenting on proposed Federal
assistance under covered programs. Certain jurisdictions have elected to
participate in the EO process and have established State Single Points
of Contact (SPOCs). A current listing of 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 an American
    Indian/Alaska Native Tribe or tribal organization.

    -   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. **For United States Postal Service:** Crystal
        Saunders, Director of Grant Review, Office of Program Services,
        Substance Abuse and Mental Health Services Administration, Room
        3-1044, 1 Choke Cherry Road, Rockville, MD **20857**. ATTN: SPOC
        -- Funding Announcement No. **SM-08-009**. Change the zip code
        to **20850** if you are using another delivery service.

In addition, if you are a community-based, non-governmental service
provider and you are not transmitting your application through the
State, you must submit a Public Health System Impact Statement
(PHSIS)[^2] to the head(s) of appropriate State or local health agencies
in the area(s) to be affected no later than the application deadline.
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. If you are a [State or local government or American
Indian/Alaska Native Tribe or tribal organization, you 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 v2); 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.

If applicable, you [must]{.underline} include a copy of a letter
transmitting the PHSIS to the SSA in **Appendix 4, "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 the following address. **For United
States Postal Service:** Crystal Saunders, Director of Grant Review,
Office of Program Services, Substance Abuse and Mental Health Services
Administration, Room 3-1044, 1 Choke Cherry Road, Rockville, MD
**20857**. ATTN: SSA -- Funding Announcement No. **SM-08-009**. Change
the zip code to **20850** if you are using another delivery service.

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.

## FUNDING LIMITATIONS/RESTRICTIONS

Cost principles describing allowable and unallowable expenditures for
Federal grantees, including SAMHSA grantees, are provided in the
following documents, which are available at
[www.samhsa.gov/grants/management.aspx](http://www.samhsa.gov/grants/management.aspx):

-   Institutions of Higher Education: OMB Circular A-21

-   State and Local Governments and Federally Recognized Indian Tribal
    Governments: OMB Circular A-87

-   Nonprofit Organizations: OMB Circular A-122

-   Hospitals: 45 CFR Part 74, Appendix E

In addition, SAMHSA's **Diversion and Trauma Recovery** grant recipients
must comply with the following funding restrictions:

-   No more than 15% of the total grant award may be used for developing
    the infrastructure necessary for expansion of services.

-   No more than 20% of the total grant award may be used for data
    collection and performance assessment, including incentives for
    participating in the required data collection follow-up.

**SAMHSA grantees must also comply with SAMHSA's standard funding
restrictions, which are included in** **Appendix G**.

## OTHER SUBMISSION REQUIREMENTS

You may submit your application in either electronic or paper format:

**[Submission of Electronic Applications]{.underline}**

SAMHSA accepts electronic submission of applications through
[www.Grants.gov](http://www.Grants.gov/). Electronic submission is
voluntary. No review points will be added or deducted, regardless of
whether you use the electronic or paper format.

To submit an application electronically, you must use the
[www.Grants.gov](http://www.Grants.gov/) apply site. You will be able to
download a copy of the application package from
[www.Grants.gov](http://www.Grants.gov/), complete it off-line, and then
upload and submit the application via the Grants.gov site. E-mail
submissions will not be accepted.

**Please refer to Appendix B for detailed instructions on submitting
your application electronically.**

**[Submission of Paper Applications]{.underline}**

You must submit an original application and 2 copies (including
appendices). The original and copies must not be bound. Do not use
staples, paper clips, or fasteners. Nothing should be attached, stapled,
folded, or pasted.

Send applications to the address below:

**For United States Postal Service:**

> Crystal Saunders, Director of Grant Review
>
> Office of Program Services
>
> Substance Abuse and Mental Health Services Administration
>
> Room 3-1044
>
> 1 Choke Cherry Road
>
> Rockville, MD **20857**

Change the zip code to **20850** if you are using another delivery
service.

Do not send applications to other agency contacts, as this could delay
receipt. Be sure to include "**Diversion and Trauma Recovery,
SM-08-009**" in item number 12 on the face page (SF 424 v2) of any paper
applications. If you require a phone number for delivery, you may use
(240) 276-1199.

**Hand carried applications will not be accepted. Applications may be
shipped using only DHL, Federal Express (FedEx), United Parcel Service
(UPS), or the United States Postal Service (USPS).**

**SAMHSA will not accept or consider any applications sent by
facsimile.**

# APPLICATION REVIEW INFORMATION

##  {#section-2 .unnumbered}

## EVALUATION CRITERIA

The Project Narrative describes what you intend to do with your project
and includes the Evaluation Criteria in Sections A-D below. Your
application will be reviewed and scored according to the
[quality]{.underline} of your response to the requirements in Sections
A-D.

-   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**.

-   The Project Narrative (Sections A-D) together may be no longer than
    25 pages.

-   You must use the four 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 of the Project Narrative.

-   Reviewers will be looking for evidence of cultural competence in
    each section of the Project Narrative, and will consider how well
    you address the cultural competence aspects of the evaluation
    criteria when scoring your application. SAMHSA's guidelines for
    cultural competence can be found on the SAMHSA Web site at
    [www.samhsa.gov](http://www.samhsa.gov/). Click on "Grants/Applying
    for a New SAMHSA Grant/Guidelines for Assessing Cultural
    Competence."

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

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-   The number of points after each heading is the maximum number of
    points a review committee may assign to that section of your Project
    Narrative. Although scoring weights are not assigned to individual
    bullets, applicants are encouraged to respond to each bulleted
    statement.

**Section A: Statement of Need (10 points)**

-   Describe the population of veterans and others involved in the
    justice system throughout the State including demographic and
    geographic information. Propose one or more communities as jail
    diversion pilot project areas and justify their selection. Include
    demographic and other relevant data about the number of persons that
    could be served through a pilot project.

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-   Document the need for an enhanced infrastructure to increase the
    capacity to implement, sustain and improve effective trauma
    integrated services for the proposed population of focus in the (1)
    State and (2) pilot project area. Documentation of need may come
    from local data or trend analyses, State data (e.g., from State
    Needs Assessments) and/or national data (e.g., from SAMHSA's
    National Survey on Drug Use and Health or from National Center for
    Health Statistics/Centers for Disease Control reports). For data
    sources that are not well known, provide sufficient information on
    how the data were collected so reviewers can assess the reliability
    and validity of the data.

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-   Describe the service gaps, barriers and other problems related to
    the need for infrastructure development. Describe the stakeholders
    and resources in the target area that can help implement the needed
    infrastructure development.

-   Non-tribal applicants must show that identified needs are consistent
    with priorities of the State or county that has primary
    responsibility for the service delivery system. Tribal applicants
    must provide similar documentation relating to tribal priorities.
    You may include, in **Appendix 5**, a copy of the State or County
    Strategic Plan, a State or county needs assessment or a letter from
    the State or county indicating that the proposed project addresses a
    State- or county-identified priority.

**Section B: Proposed Approach (35 points)**

-   Clearly state the purpose, goals and objectives of the entire
    project including both the Statewide strategy and pilot
    implementation. Describe how achievement of the goals will produce
    meaningful and relevant results (e.g., increase access,
    availability, prevention, outreach, pre-services, treatment and/or
    intervention) and support SAMHSA's goals for the program.

-   Describe the proposed project. Provide evidence that the proposed
    activities meet the infrastructure needs and show how your proposed
    infrastructure development strategy will meet the goals and
    objectives.

-   Describe your procedures for screening and assessing PTSD and trauma
    related disorders and co-occurring substance use (abuse and
    dependence) and mental health disorders and for using information
    obtained from screening and assessment to develop appropriate
    treatment approaches for co-occurring disorders.

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-   Describe how you will reach out to and prioritize veterans for jail
    diversion and trauma integrated services at the 1) State and 2)
    pilot project.

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-   Describe the evidence-based practices and support services used to
    deliver trauma integrated services.

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-   Discuss the population of focus's language, beliefs, norms and
    values, as well as socioeconomic factors that must be considered in
    delivering programs to this population and how the proposed approach
    addresses these issues at both the 1) State and 2) pilot project
    area. Are adaptations under consideration that meet the needs of the
    population of focus in terms of age, race, ethnicity, culture,
    language, sexual orientation, disability, literacy and gender?

-   Provide a logic model (see Appendix D) that demonstrates the linkage
    between the identified need, the proposed approach and outcomes
    building from the State advisory committee, to pilot project, to
    Statewide expansion.

-   Describe the State Advisory Committee's membership, member roles,
    function and meeting frequency. How will the Advisory Committee
    oversee the project and its evaluation?

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-   Describe any other organizations that will participate and their
    roles and responsibilities. Demonstrate their commitment to the
    project. Include letters of commitment/coordination/support from
    these community organizations in **Appendix 1** of your application.

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-   Describe how members of the population of focus were involved in the
    preparation of the application and how they will be involved in the
    planning, implementation and performance assessment of the project.

-   Describe the potential barriers to successful conduct of the
    proposed project and how you will overcome them.

-   Describe how your activities will improve mental health services.
    Include plans to train service staff in trauma informed care.

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-   Describe your plan to continue the project after the funding period
    ends. Also describe how program continuity will be maintained when
    there is a change in the operational environment (e.g., staff
    turnover, change in project leadership) to ensure stability over
    time.

**Section C: Staff, Management, and Relevant Experience (25 points)**

-   Provide a realistic time line for the entire project period (chart
    or graph) showing key activities, milestones and responsible staff.
    \[Note: The time line should be part of the Project Narrative. It
    should not be placed in an appendix.\]

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-   Clearly state the unduplicated number of individuals you propose to
    serve (annually and over the entire project period) with grant
    funds, including the types and numbers of services to be provided
    and anticipated outcomes. Describe how the population of focus will
    be identified, recruited and retained.

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-   Provide a complete list of staff positions for the project, showing
    the role of each and their level of effort and qualifications.
    Include the Project Director and other key personnel, such as the
    evaluator and treatment/prevention personnel.

-   Discuss how key staff have demonstrated experience in serving the
    population of focus and are familiar with the culture and language
    of the population of focus. If the population of focus is
    multicultural and multilinguistic, describe how the staff are
    qualified to serve this population.

-   Provide evidence that services will be provided in a location that
    is adequate, accessible, compliant with the Americans with
    Disabilities Act (ADA) and amenable to the population of focus. If
    the ADA does not apply to your organization, please explain why.

**Section D: Performance Assessment and Data (30 points)**

-   Document your ability to collect and report on performance measures
    required under GPRA as specified in Section I-2.5 of this document

-   Describe your plan for conducting the performance assessment as
    specified in Section I-2.6 of this RFA and document your ability to
    conduct the assessment.

-   Specify and justify any additional measures you plan to use for your
    grant project.

-   Describe how data will be used to manage the project and assure
    continuous quality improvement.

NOTE: Although the budget for the proposed project is not a scored
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.

**SUPPORTING DOCUMENTATION**

**Section E:** Literature Citations. This section must contain complete
citations, including titles and all authors, for any literature you cite
in your application.

**Section F:** 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. Be sure to
show that no more than 20% of the total grant award will be used for
data collection and performance assessment. An illustration of a budget
and narrative justification is included in Appendix H of this document.

**Section G:** 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 position description and/or letter of
    commitment with a current biographical sketch from the individual.

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

-   Information on what should be included in biographical sketches and
    job descriptions can be found on page 22, Item 6, in the Program
    Narrative section of the PHS 5161-1 instruction page, available at
    [www.hhs.gov/forms/PHS-5161-1.doc](http://www.hhs.gov/forms/PHS-5161-1.doc).

    **Section H:** Confidentiality and SAMHSA Participant
    Protection/Human Subjects: You must describe procedures relating to
    Confidentiality, Participant Protection and the Protection of Human
    Subjects Regulations in Section H of the application, using the
    guidelines provided below. Number range CHAPTER More detailed
    guidance for completing this section can be found in Appendix F of
    this RFA.

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

Because of the confidential nature of the work in which many SAMHSA
grantees are involved, it is important to have safeguards protecting
individuals from risks associated with their participation in SAMHSA
projects. All applicants must address the eight bullets below. If some
are not applicable or relevant to the proposed project, simply state
that they are not applicable and indicate why. In addition to addressing
these eight bullets, read the section that follows entitled Protection
of Human Subjects Regulations to determine if the regulations may apply
to your project. If so, you are required to describe the process you
will follow for obtaining Institutional Review Board (IRB) approval.
While we encourage you to keep your responses brief, there are no page
limits for this section and no points will be assigned by the Review
Committee. Problems with confidentiality, participant protection, and
the protection of human subjects identified during peer review of the
application must be resolved prior to funding.

-   Identify foreseeable risks or adverse effects due to participation
    in the project and/or in the data collection (performance
    assessment) activities (including physical, medical, psychological,
    social, legal, and confidentiality) and provide your procedures for
    minimizing or protecting participants from these risks.

-   Identify plans to provide guidance and assistance in the event there
    are adverse effects to participants.

-   Describe the population of focus and explain why you are including
    or excluding certain subgroups. Explain how and who will recruit and
    select participants.

-   State whether participation in the project is voluntary or required.
    If you plan to provide incentives/compensate participants, specify
    the type (e.g., money, gifts, coupons), and the value of any such
    incentives. Provide justification that the use of incentives is
    appropriate, judicious, and conservative and that incentives do not
    provide an "undue inducement" which removes the voluntary nature of
    participation. Incentives should be the minimum amount necessary to
    meet the programmatic and performance assessment goals of the grant.
    Applicants should determine the minimum amount that is proven to be
    effective by consulting with existing local programs and reviewing
    the relevant literature. In no case may the value of an incentive
    paid for with SAMHSA discretionary grant funds exceed \$20. (See
    Appendix F: Confidentiality and Participant Protection.)

-   Describe data collection procedures, including sources (e.g.,
    participants, school records) and the data collecting setting (e.g.,
    clinic, school). Provide copies of proposed data collection
    instruments and interview protocols in **Appendix 2** of your
    application, "Data Collection Instruments/Interview Protocols."
    State whether specimens such as urine and/or blood will be obtained
    and the purpose for collecting the specimens. If applicable,
    describe how the specimens and process will be monitored to ensure
    both the safety of participants and the integrity of the specimens.

-   Explain how you will ensure privacy and confidentiality of
    participants' records, data collected, interviews, and group
    discussions. Describe where the data will be stored, safeguards
    (e.g., locked, coding systems, storing identifiers separate from
    data), and who will have access to the information.

-   Describe the process for obtaining and documenting consent from
    adult participants and assent from minors along with consent from
    their parents or legal guardians. Provide copies of all consent
    forms in **Appendix 3** of your application, "Sample Consent Forms."
    If needed, give English translations.

-   Discuss why the risks are reasonable compared to expected benefits
    from the project.

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

SAMHSA expects that most grantees funded under this announcement will
not have to comply with the Protection of Human Subjects Regulations (45
CFR 46), which requires Institutional Review Board (IRB) approval.
However, in some instances, the applicant's proposed performance
assessment design may meet the regulation's criteria of research
involving human subjects. For assistance in determining if your proposed
performance assessment meets the criteria in 45 CFR 46, Protection of
Human Subjects Regulations, refer to the SAMHSA decision tree on the
SAMHSA Web site, under "Applying for a New SAMHSA Grant,"
<http://www.samhsa.gov/grants/apply.aspx>.

Applicants whose projects must comply with the Human Subjects
Regulations must, in addition to the bullets above, fully describe the
process for obtaining IRB approval. While IRB approval is not required
at the time of grant award, these grantees will be required, as a
condition of award, to provide documentation that an Assurance of
Compliance is on file with the Office for Human Research Protections
(OHRP). IRB approval must be received in these cases prior to enrolling
clients in the project. General information about Human Subjects
Regulations can be obtained through OHRP at <http://www.hhs.gov/ohrp>,
or <ohrp@osophs.dhhs.gov>, or (240) 453-6900. SAMHSA--specific questions
should be directed to the program contact listed in Section VII of this
announcement.

## REVIEW AND SELECTION PROCESS

SAMHSA applications are peer-reviewed according to the evaluation
criteria listed above. For those programs where the individual award is
over \$100,000, applications also must be reviewed by the appropriate
National Advisory Council.

Decisions to fund a grant are based on:

-   the strengths and weaknesses of the application as identified by
    peer reviewers and, when applicable, approved by the Center for
    Mental Health Services' National Advisory Council;

-   availability of funds; and

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-   equitable distribution of awards in terms of geography (including
    urban, rural and remote settings) and balance among population of
    focus and program size.

# ADMINISTRATION INFORMATION

## AWARD NOTICES 

#######  {#section-3 .unnumbered}

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 through postal mail, the Notice of Grant Award, signed by
SAMHSA's Grants Management Officer. The Notice of Grant Award is the
sole obligating document that allows you to receive Federal funding for
work on the grant project.

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

## ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS 

-   If your application is funded, 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 at
    http://[www.samhsa.gov/grants/management.asp](http://www.samhsa.gov/grants/management.aspx)x.

-   If your application is funded, you must also comply with the
    administrative requirements outlined in 45 CFR Part 74 or 45 CFR
    Part 92, as appropriate. For more information see the SAMHSA Web
    site
    (http://[www.samhsa.gov/grants/management.aspx](http://www.samhsa.gov/grants/management.aspx)).

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

    -   actions required to be in compliance with confidentiality and
        participant protection/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.

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-   If your application is funded, 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.

-   Grant funds cannot be used to supplant current funding of existing
    activities. "Supplant" is defined as replacing funding of a
    recipient's existing program with funds from a Federal grant.

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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 and is posted on the SAMHSA Web site. You are
    encouraged to complete the survey and return it, using the
    instructions provided on the survey form.

## REPORTING REQUIREMENTS

In addition to the data reporting requirements listed in Section I-2.5,
you must comply with the following reporting requirements:

1.  **Progress and Financial Reports**

-   You will be required to submit final progress reports, as well as
    annual and final financial status reports.

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-   Because SAMHSA is extremely interested in ensuring that treatment
    and prevention services can be sustained, your progress reports
    should explain plans to ensure the sustainability of efforts
    initiated under this grant.

-   If your application is funded, SAMHSA will provide you with
    guidelines and requirements for these reports 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
    your progress toward meeting its goals.

    1.  **Government Performance and Results Act (GPRA)**

The Government Performance and Results Act (GPRA) mandates
accountability and performance-based management by Federal agencies. To
meet the GPRA requirements, SAMHSA must collect performance data (i.e.,
"GPRA data") from grantees. The performance requirements for SAMHSA's
**Jail Diversion and Trauma Recovery** grant program are described in
Section I-2.5 of this document under "Data Collection and Performance
Measurement."

2.  **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 (240-276-2130) of any materials based on the SAMHSA-funded grant
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.

# AGENCY CONTACTS

For questions about program issues contact:

> David Morrissette, Ph.D., LCSW
>
> Center for Mental Health Services
>
> SAMHSA
>
> 1 Choke Cherry Road
>
> Room 6-1010
>
> Rockville, MD 20857

\(240\) 276-1912

> <david.morrissette@samhsa.hhs.gov>

For questions on grants management issues contact:

Gwendolyn Simpson

Office of Program Services, Division of Grants Management

SAMHSA

1 Choke Cherry Road

Room 7-1085

Rockville, MD 20857

\(240\) 276-1408

<gwendolyn.simpson@samhsa.hhs.gov>

###  

### 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.***

-   Use the PHS 5161-1 application form.

-   Applications must be received by the application due date and time,
    as detailed in Section IV-3 of this grant announcement.

-   Information provided must be sufficient for review.

-   Text must be legible. Pages must be typed in black ink,
    single-spaced, using a font of Times New Roman 12, with all margins
    (left, right, top, bottom) at least one inch each. (For Project
    Narratives submitted electronically, see separate requirements in
    Section IV-6 of this announcement under "Submission of Electronic
    Applications.")

-   To ensure equity among applications, page limits for the Project
    Narrative cannot be exceeded.

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

*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 and submitted in the following order:

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-   Face Page (Standard Form 424 v2, 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

-   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 and participant protection
    specified in Section V-1 of this announcement.

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

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

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-   Pages should be typed single-spaced in black ink with one column per
    page. Pages should not have printing on both sides.

-   Pages should be numbered consecutively from beginning to end so that
    information can be located easily during review of the application.
    The abstract page should be page 1, the table of contents should be
    page 2, etc. The four pages of Standard form 424 v2 are not to be
    numbered. Appendices should be labeled and separated from the
    Project Narrative and budget section, and the pages should be
    numbered to continue the sequence.

-   The page limits for Appendices stated in Section IV-2.2 of this
    announcement should not be exceeded.

-   Send the original application and two copies to the mailing address
    in Section IV-6 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.

###  

### Appendix B -- Guidance for Electronic Submission of Applications

If you would like to submit your application electronically, you may
search [www.Grants.gov](http://www.Grants.gov/) for the downloadable
application package by the funding announcement number (called the
opportunity number) or by the Catalogue of Federal Domestic Assistance
(CFDA) number. You can find the CFDA number on the first page of the
funding announcement.

You must follow the instructions in the User Guide available at the
[www.Grants.gov](http://www.Grants.gov/) apply site, on the Help page.
In addition to the User Guide, you may wish to use the following sources
for help:

-   By e-mail: <support@Grants.gov>

-   By phone: 1-800-518-4726 (1-800-518-GRANTS). The Customer Support
    Center is open from 7:00 a.m. to 9:00 p.m. Eastern Time, Monday
    through Friday, excluding Federal holidays.

**If this is the first time you have submitted an application through
Grants.gov, you must complete four separate registration processes
before you can submit your application. Allow at least two weeks (10
business days) for these registration processes, prior to submitting
your application.** The processes are: 1) DUNS Number registration; 2)
Central Contractor Registry (CCR) registration; 3) Credential Provider
registration; and 4) Grants.gov registration.

**It is strongly recommended that you submit your grant application
using Microsoft Office 2003 products (e.g., Microsoft Word 2003,
Microsoft Excel, etc.).** The new Microsoft Vista operating system and
Microsoft Word 2007 products are not currently accepted by Grants.gov.
If you do not have access to Microsoft Office products, you may submit
PDF files. Directions for creating PDF files can be found on the
Grants.gov Web site. Use of file formats other than Microsoft Office or
PDF may result in your file being unreadable by our staff.

The Project Narrative must be a separate document in the electronic
submission. Formatting requirements for SAMHSA grant applications are
described in Appendix A of this announcement. These requirements also
apply to applications submitted electronically, with the following
exceptions only for Project Narratives submitted electronically in
Microsoft Word. These requirements help ensure the accurate transmission
and equitable treatment of applications.

-   *Text legibility*: Use a font of Times New Roman 12, line spacing of
    single space, and all margins (left, right, top, bottom) of at least
    one inch each. Adhering to these standards will help to ensure the
    accurate transmission of your document.

-   *Amount of space allowed for Project Narrative*: The Project
    Narrative for an electronic submission may not exceed **12,875**
    words. **If the Project Narrative for an electronic submission
    exceeds the word limit, the application will be screened out and
    will not be reviewed**. To determine the number of words in your
    Project Narrative document in Microsoft Word, select
    file/properties/statistics.

**Keep the Project Narrative as a separate document. Please consolidate
all other materials in your application to ensure the fewest possible
number of attachments. Be sure to label each file according to its
contents, e.g., "Appendices 1-3", "Appendices 4-5." **

Ensure all pages in your application are numbered consecutively, with
the exception of the standard forms in the PHS-5161 application package.
**Documents containing scanned images must also contain page numbers to
continue the sequence.** Failure to comply with these requirements may
affect the successful transmission and consideration of your
application.

Applicants are strongly encouraged to submit their applications to
Grants.gov early enough to resolve any unanticipated difficulties prior
to the deadline. You may also submit a back-up paper submission of your
application. Any such paper submission must be received in accordance
with the requirements for timely submission detailed in Section IV-3 of
this announcement. The paper submission must be clearly marked:
**"Back-up for electronic submission."** The paper submission must
conform with all requirements for non-electronic submissions. If both
electronic and back-up paper submissions are received by the deadline,
the electronic version will be considered the official submission.

After you electronically submit your application, you will receive an
automatic acknowledgement from Grants.gov that contains a Grants.gov
tracking number. It is important that you retain this number. **Include
the Grants.gov tracking number in the top right corner of the face page
(SF 424 v2) for any paper submission. Receipt of the tracking number is
the only indication that Grants.gov has successfully received and
validated your application. If you do not receive a Grants.gov tracking
number, you may want to contact the Grants.gov help desk for
assistance.**

The Grants.gov Web site does not accept electronic signatures at this
time. Therefore, you must submit a signed paper original of the face
page (SF 424 v2), the assurances (SF 424B), and hard copy of any other
required documentation that cannot be submitted electronically. **You
must include the Grants.gov tracking number for your application on
these documents with original signatures, on the top right corner of the
face page, and send the documents to the following address. The
documents must be received at the following address within 5 business
days after your electronic submission.** Delays in receipt of these
documents may impact the score your application receives or the ability
of your application to be funded.

**For United States Postal Service:**

Crystal Saunders, Director of Grant Review

Office of Program Services

Substance Abuse and Mental Health Services Administration

Room 3-1044

1 Choke Cherry Road

Rockville, MD **20857**

ATTN: Electronic Applications

**For other delivery services, change the zip code to 20850.**

If you require a phone number for delivery, you may use (240) 276-1199.

### Appendix C - Statement of Assurance

As the authorized representative of \[*insert name of applicant
organization*\]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_,
I assure SAMHSA that all participating service provider organizations
listed in this application meet the two-year experience requirement and
applicable licensing, accreditation, and certification requirements. If
this application is within the funding range for a grant award, we will
provide the SAMHSA Government Project Officer (GPO) with the following
documents. I understand that if this documentation is not received by
the GPO within the specified timeframe, the application will be removed
from consideration for an award and the funds will be provided to
another applicant meeting these requirements.

-   a letter of commitment that specifies the nature of the
    participation and what service(s) will be provided from every
    service provider organization listed in Appendix 1 of the
    application, that has agreed to participate in the project;

-   official documentation that all service provider organizations
    participating in the project have been providing relevant services
    for a minimum of 2 years prior to the date of the application in the
    area(s) in which services are to be provided. Official documents
    must definitively establish that the organization has provided
    relevant services for the last 2 years; and

-   official documentation that all participating service provider
    organizations are in compliance with all local (city, county) and
    State/tribal requirements for licensing, accreditation, and
    certification or official documentation from the appropriate agency
    of the applicable State/tribal, county, or other governmental unit
    that licensing, accreditation, and certification requirements do not
    exist. (Official documentation is a copy of each service provider
    organization's license, accreditation, and certification.
    Documentation of accreditation will not be accepted in lieu of an
    organization's license. A statement by, or letter from, the
    applicant organization or from a provider organization attesting to
    compliance with licensing, accreditation and certification or that
    no licensing, accreditation, certification requirements exist [does
    not]{.underline} constitute adequate documentation.)

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

Signature of Authorized Representative Date

### Appendix D -- Sample Logic Model 

A Logic Model is a tool to show how your proposed project links the
purpose, goals, objectives, and tasks stated with the activities and
expected outcomes or "change" and can help to plan, implement, and
assess your project. The model also links the purpose, goals,
objectives, and activities back into planning and evaluation. A Logic
Model is a *picture* of your project. It graphically shows the
activities and progression of the project. It should also describe the
relationships among what resources you put in (inputs), what you do
(outputs), and what happens or results (outcomes). Based on both your
planning and evaluating activities, you can then make a "logical" chain
of "if-then" relationships.

Look at the graphic on the following page to see the chain of events
that links the inputs to program components, the program components to
outputs, and the outputs to outcomes (goals).

The framework you set up to build your model is based on a review of
your Statement of Need, in which you state the conditions that gave rise
to the project with your target group. Then you look at the **Inputs,**
which are the resources, contributions, time, staff, materials**,** and
equipment you will invest to change these conditions. These inputs then
are organized into the **Program Components**, which are the activities,
services, interventions and tasks that will reach the population of
focus. These outputs then are intended to create **Outputs** such as
changes or benefits for the consumer, families, groups, communities,
organizations and SAMHSA. The understanding and further evidence of what
works and what does not work will be shown in the **Outcomes**, which
include achievements that occur along the path of project operation.

### 

### 

\*The logic model presented is not a required format and SAMHSA does not
expect strict adherence to this format. It is presented only as a sample
of how you can present a logic model in your application.

### 

### 

### 

Sample Logic Model\*

+--------------+---+--------------+---+---------------+---+---------------+
| *            |   | **Program    |   | **Outputs**   |   | **Outcomes**  |
| *Resources** |   | Components** |   |               |   |               |
|              |   |              |   | **(           |   | **(Goals)**   |
| **(Inputs)** |   | **(A         |   | Objectives)** |   |               |
|              |   | ctivities)** |   |               |   |               |
+--------------+---+--------------+---+---------------+---+---------------+
| **Examples** |   | **Examples** |   | **Examples**  |   | **Examples**  |
+--------------+---+--------------+---+---------------+---+---------------+
| People       |   | Outreach     |   | Waiting list  |   | Inprogram:    |
|              |   |              |   | length        |   |               |
| Staff --     |   | Intak        |   |               |   | Client        |
| hours        |   | e/Assessment |   | Waiting list  |   | satisfaction  |
|              |   |              |   | change        |   |               |
| Volunteer -- |   | Client       |   |               |   | Client        |
| hours        |   | Interview    |   | Client        |   | retention     |
|              |   |              |   | attendance    |   |               |
| Funds        |   | Treatment    |   |               |   | In or         |
|              |   | Planning     |   | Client        |   | postprogram:  |
| Other        |   |              |   | participation |   |               |
| resources    |   | Treatment by |   |               |   | > Reduced     |
|              |   | type:        |   | Number of     |   | > drug use -- |
| Facilities   |   |              |   | Clients:      |   | > self        |
|              |   | Methadone    |   |               |   | > reports,    |
| Equipment    |   | maintenance  |   | Admitted      |   | > urine, hair |
|              |   |              |   |               |   | >             |
| Community    |   | Weekly       |   | Terminated    |   | > Empl        |
| services     |   | 12-step      |   |               |   | oyment/school |
|              |   | meetings     |   | Inprogram     |   | > progress    |
|              |   |              |   |               |   | >             |
|              |   | De           |   | Graduated     |   | >             |
|              |   | toxification |   |               |   | Psychological |
|              |   |              |   | Placed        |   | > status      |
|              |   | Counseling   |   |               |   | >             |
|              |   | sessions     |   | Number of     |   | > Vocational  |
|              |   |              |   | Sessions:     |   | > skills      |
|              |   | Relapse      |   |               |   | >             |
|              |   | prevention   |   | Per month     |   | > Social      |
|              |   |              |   |               |   | > skills      |
|              |   | Crisis       |   | Per           |   | >             |
|              |   | intervention |   | client/month  |   | > Safer       |
|              |   |              |   |               |   | > sexual      |
|              |   | Special      |   | Funds raised  |   | > practices   |
|              |   | Training     |   |               |   | >             |
|              |   |              |   | Number of     |   | > Nutritional |
|              |   | Vocational   |   | volunteer     |   | > practices   |
|              |   | skills       |   | hours/month   |   | >             |
|              |   |              |   |               |   | > Child care  |
|              |   | Social       |   | Other         |   | > practices   |
|              |   | skills       |   | resources     |   | >             |
|              |   |              |   | required      |   | > Reduced     |
|              |   | Nutrition    |   |               |   | > deli        |
|              |   |              |   |               |   | nquency/crime |
|              |   | Child care   |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Literacy     |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Tutoring     |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Safer sex    |   |               |   |               |
|              |   | practices    |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Other        |   |               |   |               |
|              |   | Services     |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Placement in |   |               |   |               |
|              |   | employment   |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Prenatal     |   |               |   |               |
|              |   | care         |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Child care   |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Aftercare    |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Program      |   |               |   |               |
|              |   | Support      |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Fundraising  |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Long-range   |   |               |   |               |
|              |   | planning     |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Ad           |   |               |   |               |
|              |   | ministration |   |               |   |               |
|              |   |              |   |               |   |               |
|              |   | Public       |   |               |   |               |
|              |   | Relations    |   |               |   |               |
+--------------+---+--------------+---+---------------+---+---------------+

### Appendix E -- Logic Model Resources

Chen, W.W., Cato, B.M., & Rainford, N. (1998-9). Using a logic model to

plan and evaluate a community intervention program: A case study.
*International Quarterly of Community Health Education*, *18*(4),
449-458.

Edwards, E.D., Seaman, J.R., Drews, J., & Edwards, M.E. (1995). A
community approach for Native American drug and alcohol prevention
programs: A logic model framework. *Alcoholism Treatment Quarterly*,
*13*(2), 43-62.

Hernandez, M. & Hodges, S. (2003). *Crafting Logic Models for Systems of
Care: Ideas into Action*. \[Making children's mental health services
successful series, volume 1\]. Tampa, FL: University of South Florida,
The Louis de la Parte Florida Mental Health Institute, Department of
Child & Family Studies.
[http://cfs.fmhi.usf.edu](http://cfs.fmhi.usf.edu/) or phone (813)
974-4651

Hernandez, M. & Hodges, S. (2001). Theory-based accountability. In M.
Hernandez & S. Hodges (Eds.), *Developing Outcome Strategies in
Children\'s Mental Health*, pp. 21-40. Baltimore: Brookes.

Julian, D.A. (l997). Utilization of the logic model as a system level
planning and evaluation device. *Evaluation and Planning,* *20*(3),
251-257.

Julian, D.A., Jones, A., & Deyo, D. (1995). Open systems evaluation and
the

logic model: Program planning and evaluation tools. *Evaluation and
Program*

*Planning,* *18*(4), 333-341.

Patton, M.Q. (1997). *Utilization-Focused Evaluation* (3^rd^ Ed.), pp.
19, 22,

241\. Thousand Oaks, CA: Sage.

Wholey, J.S., Hatry, H.P., Newcome, K.E. (Eds.) (1994). *Handbook of
Practical Program Evaluation.* San Francisco, CA: Jossey-Bass Inc.

### Appendix F -- Confidentiality and Participant Protection 

### 

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

-   Identify and describe any foreseeable physical, medical,
    psychological, social, and legal risks or potential adverse effects
    as a result of the project itself or any data collection activity.

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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 guidance and assistance in the event 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 population of focus 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 targeted groups.

-   Explain the reasons for including groups of pregnant women,
    children, people with mental disabilities, people in institutions,
    prisoners, and individuals who are likely to be particularly
    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 participation is required, for
    example, court orders requiring people to participate in a program.

-   If you plan to compensate participants, state how participants will
    be awarded incentives (e.g., money, gifts, etc.). Provide
    justification that the use of incentives is appropriate, judicious,
    and conservative and that incentives do not provide an "undue
    inducement" which removes the voluntary nature of participation.
    Incentives should be the minimum amount necessary to meet the
    programmatic and performance assessment goals of the grant.
    Applicants should determine the minimum amount that is proven
    effective by consulting with existing local programs and reviewing
    the relevant literature. In no case may the value if an incentive
    paid for with SAMHSA discretionary grant funds exceed \$20.

-   State how volunteer participants will be told that they may receive
    services intervention even if they do not participate in or complete
    the data collection component of 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.

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-   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** obtain
    [written]{.underline} informed consent.

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-   Indicate if you will obtain informed consent from participants or
    assent from minors along with consent 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, as appropriate, sample consent forms that provide for: (1)
    informed consent for participation in service intervention; (2)
    informed consent for participation in the data collection component
    of the project; and (3) informed consent for the exchange (releasing
    or requesting) of confidential information. The sample forms must be
    included in **Appendix 3, "Sample Consent Forms"**, of your
    application. 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}**

Applicants may also have to comply with the Protection of Human Subjects
Regulations (45 CFR 46), depending on the evaluation and data collection
procedures proposed and the population to be served.

Applicants must be aware that even if the Protection of Human Subjects
Regulations do not apply to all projects funded, the specific
performance assessment design proposed by the applicant may require
compliance with these regulations. For assistance in determining if your
proposed performance assessment meets the criteria in 45 CFR 46,
Protection of Human Subjects Regulations, refer to the SAMHSA decision
tree on the SAMHSA Web site, under "Applying for a New SAMHSA Grant,"
<http://www.samhsa.gov/grants/apply.aspx>.

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.

General information about Protection of Human Subjects Regulations can
be obtained on the Web at <http://www.hhs.gov/ohrp>. You may also
contact OHRP by e-mail (<ohrp@osophs.dhhs.gov>[)]{.underline} or by
phone (240/453-6900). SAMHSA-specific questions related to Protection of
Human Subjects Regulations should be directed to the program contact
listed in Section VII of this RFA.

### 

###  

### Appendix G -- Funding Restrictions

SAMHSA grant funds must be used for purposes supported by the program
and may not be used to:

-   Pay for any lease beyond the project period.

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-   Provide services to incarcerated populations (defined as those
    persons in jail, prison, detention facilities, or in custody where
    they are not free to move about in the community).

-   Pay for the purchase or construction of any building or structure to
    house any part of the program. (Applicants may request up to
    \$75,000 for renovations and alterations of existing facilities, if
    necessary and appropriate to the project.)

-   Provide residential or outpatient treatment services when the
    facility has not yet been acquired, sited, approved, and met all
    requirements for human habitation and services provision. (Expansion
    or enhancement of existing residential services is permissible.)

-   Pay for housing other than residential mental health and/or
    substance abuse treatment.

-   Provide inpatient treatment or hospital-based detoxification
    services. Residential services are not considered to be inpatient or
    hospital-based services.

-   Make direct payments to individuals to induce them to enter
    prevention or treatment services. However, SAMHSA discretionary
    grant funds may be used for non-clinical support services (e.g., bus
    tokens, child care) designed to improve access to and retention in
    prevention and treatment programs.

-   Make direct payments to individuals to encourage attendance and/or
    attainment of prevention or treatment goals. However, SAMHSA
    discretionary grant funds may be used for non-cash incentives of up
    to \$20 to encourage attendance and/or attainment of prevention or
    treatment goals when the incentives are built into the program
    design and when the incentives are the minimum amount that is deemed
    necessary to meet program goals. SAMHSA policy allows an individual
    participant to receive more than one incentive over the course of
    the program. However, non-cash incentives should be limited to the
    minimum number of times deemed necessary to achieve program
    outcomes. A grantee or treatment or prevention provider may also
    provide up to \$20 cash or equivalent (coupons, bus tokens, gifts,
    child care, and vouchers) to individuals as incentives to
    participate in required data collection follow up. This amount may
    be paid for participation in each required interview.

-   Food is generally unallowable unless it's an integral part of a
    conference grant or program specific, e.g., children's program,
    residential.

-   Implement syringe exchange programs, such as the purchase and
    distribution of syringes and/or needles.

-   Pay for pharmacologies for HIV antiretroviral therapy, sexually
    transmitted diseases (STD)/sexually transmitted illnesses (STI), TB,
    and hepatitis B and C, or for psychotropic drugs.

SAMHSA will not accept a "research" indirect cost rate. The grantee must
use the "other sponsored program rate" or the lowest rate available.

### Appendix H -- Sample Budget and Justification

**ILLUSTRATION OF A SAMPLE DETAILED BUDGET AND**

**NARRATIVE JUSTIFICATION TO ACCOMPANY**

**SF 424A: SECTION B FOR 01 BUDGET PERIOD**

**[OBJECT CLASS CATEGORIES]{.underline}**

**[Personnel]{.underline}**

**Job Annual Level of SAMHSA Non-Federal TOTAL**

**Title** **Name Salary Effort Funded Sources**

Project

> Director J. Doe \$30,000 1.0 \$30,000 \$-0-
>
> Clinical
>
> Director J. Doe \$-0- In-Kind

Secretary Unnamed \$18,000 0.5 \$-0- \$ 9,000

Counselor R. Down \$25,000 1.0 \$25,000 \$-0-

**SUBTOTAL \$55,000 \$9,000**

**Enter Personnel subtotal on 424A, Section B, 6.a. \$64,000**

**[Fringe Benefits]{.underline}** (24%) \$15,360 \$-0-

**SUBTOTAL \$15,360 \$-0-**

**Enter Fringe Benefits subtotal on 424A, Section B, 6.b. \$15,360**

**[Travel]{.underline}**

2 trips for SAMHSA Meetings for 2 Attendees

(Airfare @ \$600 x 4 = \$2,400) + (per diem

@ \$120 x 4 x 6 days = \$2,880) \$5,280 \$-0-

Local Travel (500 miles x .24 per mile) \$-0- \$120

\[Note: Current Federal Government per diem rates are available at
[www.gsa.gov](http://www.gsa.gov/).\]

**SUBTOTAL \$5,280 \$120**

**Enter Travel subtotal on 424A, Section B, 6.c. \$ 5,400**

**[Equipment]{.underline}** (List Individually)

\"Equipment\" means an article of nonexpendable, tangible personal
property having a useful life of more than one year and an acquisition
cost which equals the lesser of (a) the capitalization level established
by the governmental unit or nongovernmental applicant for financial
statement purposes, or (b) \$5000.

**SUBTOTAL \$-0- \$-0-**

**Enter Equipment subtotal on 424A, Section B, 6.d. \$-0-**

ILLUSTRATION OF DETAILED BUDGET AND NARRATIVE JUSTIFICATION (cont'd.)

**[Supplies]{.underline}**

Office Supplies \$500 \$-0-

Computer Software -- Microsoft Word \$-0- 500

**Enter Supplies subtotal on 424A, Section B, 6.e. \$1,000**

**[CONTRACTUAL COSTS]{.underline}**

**[Evaluation]{.underline}**

**Job Annual Level of SAMHSA Non-Federal TOTAL**

**Title** **Name Salary Effort Funded Sources**

Evaluator J. Wilson \$48,000 .05 \$24,000 \$-0-

Other Staff \$18,000 1.0 \$18,000 \$-0-

Fringe Benefits (25%) \$10,500 \$-0-

**Travel**

2 trips x 1 Evaluator

(\$600 x 2) \$ 1,200 \$-0-

Per Diem @ \$120 x 6 720 \$-0-

Supplies (General Office) 500 \$-0-

Evaluation Contractual Direct Costs \$54,920 \$-0-

Evaluation Contractual Indirect Costs (19%) \$10,435 \$-0-

Evaluation Contract Subtotal **\$65,355**

**SUBTOTAL \$65,355** **\$-0- \$65,355**

**[Training]{.underline}**

**Job Annual Level of SAMHSA Non-Federal TOTAL**

**Title** **Name Salary Effort Funded Sources**

Coordinator M. Smith \$ 12,000 0.5 \$12,000 \$-0-

Admin. Asst. N. Jones 9,000 0.5 9,000 \$-0-

Fringe Benefits (25%) 5,250 \$-0-

**Travel**

2 Trips for Training

Airfare @ \$600 x 2 \$1,200 \$-0-

Per Diem \$120 x 2 x 2 days 480 \$-0-

Local (500 miles x .24/mile) 120 \$-0-

**Supplies**

Office Supplies \$500 \$-0-

Software (Microsoft Word) \$500 \$-0-

Training Contractual Direct Costs Subtotal \$40,025 \$-0- **\$40,025**

Training Contractual Indirect Costs Subtotal \$-0- \$-0- **\$-0-**

ILLUSTRATION OF DETAILED BUDGET AND NARRATIVE JUSTIFICATION (cont'd.)

**SUBTOTAL \$105,380 \$-0-** **\$105,380**

**Enter Contractual subtotal on 424A, Section B, 6.f. \$105,380**

**SAMHSA Non-Federal TOTAL**

**Funded Sources**

**[OTHER]{.underline}**

Rent (500 Sq. Ft. x \$9.95) \$ 4,975 \$-0-

Telephone \$ 500 \$-0-

Maintenance (e.g., van) \$-0- \$ 2,500

Audit \$-0- \$ 3,000

Consultants = Expert @ \$250/day X 6 day \$ 1,500 \$-0-

(If expert is known, should list by name)

**SUBTOTAL \$6,957 \$5,500**

**Enter Other subtotal on 424A, Section B, 6.h. \$12,475**

**[TOTAL DIRECT CHARGES]{.underline} (sum of 6.a-6.h)**

> **Enter Total Direct on 424A, Section B, 6.i. \$192,640**

**[INDIRECT CHARGES]{.underline}**

15% of Salary and Wages (copy of negotiated

Indirect Cost Rate Agreement attached) \[\$64,000 X 15% = \$9,600\]

> **Enter Indirect Costs subtotal of 424A, Section B, 6.j. \$9,600**
>
> **Enter TOTALS on 424A, Section B, 6.k. (sum of 6i and 6j) \$202,240**

**[JUSTIFICATION]{.underline}**

PERSONNEL - Describe the role and responsibilities of each position.

FRINGE BENEFITS - List all components of the fringe benefit rate.

EQUIPMENT - List equipment and describe the need and the purpose of the
equipment in relation to the proposed project.

SUPPLIES - Generally self-explanatory; however, if not, describe need.
Include explanation of how the cost has been estimated.

TRAVEL - Explain need for all travel other than that required by SAMHSA.

CONTRACTUAL COSTS - Explain the need for each contractual arrangement
and how these components relate to the overall project.

OTHER - Generally self-explanatory. If consultants are included in this
category, explain the need and how the consultant's rate has been
determined. If rent is requested, provide the name of the owner of the
building/facility. If anyone related to the project owns the building
which is a less than arms length arrangement, provide cost of
ownership/use allowance.

INDIRECT COST RATE - If your organization has no indirect cost rate,
please indicate whether your organization plans to: a) waive indirect
costs if an award is issued; or b) negotiate and establish an indirect
cost rate with DHHS within 90 days of award issuance.

OTHER SOURCES -- If other non-Federal sources of funding, including
match or cost sharing as a total operating budget is included, provide
the name of the source, e.g., in-kind, foundation, program income,
Medicaid, State funds, applicant organization, etc., and explain its
use.

[CALCULATION OF FUTURE BUDGET PERIODS]{.underline}

[(based on first 12-month budget period)]{.underline}

Review and verify the accuracy of future year budget estimates.
Increases or decreases in the future years must be explained and
justified. (NOTE: salary cap of \$191,300 is effective for all FY 2008
awards.)

First Second Third

12-month 12-month 12-month

Period Period Period

Personnel

Project Director 30,000 30,000 30,000

Secretary\* 9,000 18,000 18,000

Counselor 25,000 25,000 25,000

TOTAL PERSONNEL 64,000 73,000 73,000

\*Increased from 50% to 100% effort in 02 through 03 budget periods.

Fringe Benefits (24%) 15,360 17,520 17,520

Travel 5,400 5,400 5,400

Equipment -0- -0- -0-

Supplies\*\* 1,000 520 520

\*\*Increased amount in 01 year represents costs for software.

Contractual

Evaluation\*\*\* 65,355 67,969 70,688

Training 40,025 40,025 40,025

\*\*\*Increased amounts in 02 and 03 years reflect the increase in
client data collection.

Other 1,500 1,500 1,500

Total Direct Costs 192,640 205,934 208,653

Indirect Costs 9,600 9,600 9,600

(15% S&W)

TOTAL COSTS 202,240 216,884 219,603

The Federal dollars requested for all object class categories for the
first 12-month budget period are entered on Form 424A, Section B, Column
(1), lines 6a-6i. The [total]{.underline} Federal dollars requested for
the second through the fifth 12-month budget periods are entered on Form
424A, Section E, Columns (b) -- (e), line 20. The RFA will specify the
maximum number of years of support that may be requested.

### 

[^1]: Hoge, C.W., Castro, C.A., Messer, S.C., McGurk, D., Cotting, D.I.,
    and Koffman, R.L., 2004. Combat Duty in Iraq and Afghanistan, Mental
    Health Problems, and Barriers to Care. [The New England Journal of
    Medicine]{.underline}. 351: 13-22.

[^2]: Approved by OMB under control no. 0920-0428; 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 v2 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).