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| | Number range CHAPTER**OMB No: 0930-0168**                        |  |
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| | **Approval Expires: 08/31/2008**                                 |  |
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| **COMMUNITY MENTAL HEALTH SERVICES**                                  |
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| **BLOCK GRANT APPLICATION GUIDANCE AND INSTRUCTIONS**                 |
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| **FY 2008**                                                           |
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| **TRANSFORMING MENTAL HEALTH CARE**                                   |
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| **IN AMERICA**                                                        |
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| **CFDA No. 93.958**                                                   |
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| **.**                                                                 |
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| ![](media/image1.png){width="6.788888888888889in"                     |
| height="1.1236111111111111in"}                                        |
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**TABLE OF CONTENTS FOR APPLICATION GUIDANCE PACKAGE**

####### 

####### INTRODUCTION: 4

**PART A: Context and Overview of FY 2008 MHBG Application**

> I. Statutory Authority 6
>
> II\. History and Goals of Federal Mental Health Funding 7
>
> III\. CMHS Transformation and Planning Initiatives 8
>
> IV\. Plan Format: Child/Adult Plans for Single Year 12

**PART B: Administrative Requirements, Fiscal Planning Assumptions, and
Special Guidance**

> I. Federal Funding Agreements, Certifications, Assurances &
> Requirements.
>
> (1). Funding Agreements 15
>
> (2). Certifications 15
>
> \(3\) Disclosure of Lobbying Activities 15
>
> (4). Assurances 16
>
> (5). DUNS Number 16
>
> II\. Set-Aside for Children's Mental Health Services Report 17
>
> III\. Maintenance of Effort (MOE) Report 17
>
> \(1\) MOE Exclusion 18
>
> \(2\) MOE Shortfall 19
>
> IV\. Fiscal Planning Assumptions 19
>
> V. Submission Requirements and Due Dates 20
>
> VI\. State Mental Health Planning Council 21
>
> (1). Membership Requirements 21
>
> (2). State Mental Health Planning Council Membership List and
> Composition 22
>
> (3). Planning Council Charge, Role and Activities 22
>
> (4). State Mental Health Planning Council Comments and Recommendations
> 22
>
> (5). Public Comments on State Plans 22

**PART C: Specific Guidance for State Applications and Plans**

Section I: Description of State Service System 26

Section II: Identification and Analysis of Service System's Strengths,
Needs and Priorities 26

Section III. Performance Goals and Action Plans to Improve the Service
System 31

> (1). Common Requirements for Adult and Child Plans 31
>
> (2). National Outcome Measures 31
>
> (3). State Transformation Outcome Measure 31
>
> (4). Format of Plans 34
>
> \(a\) Adult Plan 34
>
> \(b\) Children's Plan 34

**PART D: Implementation Report** 38

####### I. Narrative Content of the Implementation Report 38

####### II. Performance Indicators 39

####### III. Accomplishments 40

####### 

####### PART E: Uniform Data on the Public Mental Health System 41

**Attachments:**

Revisions to URS Tables 43

Attachment A: Funding Agreements 46

Attachment B: Certifications 50

Attachment C: Disclosure of Lobbying Activities 51

Attachment D: Assurances 52

Attachment E: Face Sheet 53

**Appendices:**

I. Format for Table of Contents 54

II\. CMHS Uniform Reporting System Guidelines & Tables 56

URS Tables 58

###  

###  

### Notice to Respondents

The annual reporting burden for collection of this information is
estimated to average *255* hours for a one-year application. This
includes the time required for reviewing instructions and preparing the
application, requesting waivers and modifications, writing the
implementation report, and gathering, maintaining, and reporting the
needed data. Comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for reducing
the burden should be addressed to: SAMHSA Reports Clearance Officer,
Paperwork Reduction Project (0930-0168), Room 7-1045, One Choke Cherry
Road, Rockville, MD 20857. An agency may not conduct or sponsor or 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: 0930-0168.

**INTRODUCTION:**

The FY 2008 Community Mental Health Services (CMHS) Block Grant
Application Guidance and Instruction Packet that follows is intended to
provide specific guidance and instructions regarding the development and
submission of the required plan. The Guidance is based on the existing
CMHS Block Grant legislation and provides a foundation to promote
transformation of the state mental health system. The existing five (5)
criteria continue to be the framework for the mental health system of
care and should be used to guide state planning efforts. There continues
to be an emphasis on the reporting and use of the National Outcome
Measures (NOMS).

States should submit the FY 2008 plan based upon the standard guidance
in this instruction packet. Unlike the guidance for FY 2007 that
introduced mental health transformation but did not require plans to
describe transformation activities, this guidance includes a requirement
for state transformation efforts to be described and integrated
throughout plans for adult and children as well as the mental health
planning council. The Guidance is also consistent with SAMHSA/CMHS's
commitment to improving accountability of State's use of Federal funds
to provide services to adults with serious mental illness (SMI)and
children with serious emotional disturbances (SED).

The Application Guidance and Instructions Packet consist of five parts:

-   Part A provides a context and overview of the FY 2008 application
    with a more detailed discussion of the transition to mental health
    transformation and implementing the goals and recommendations of the
    President's New Freedom Commission on Mental Health.

-   Part B outlines the administrative requirements, fiscal planning
    assumptions, and other special guidance that is required for
    submission of the application.

-   Part C provides guidance for development of the three sections of
    the plan, including a description of the State's Service System,
    Identification and Analysis of the Service System's Strengths,
    Needs, and Priorities, Mental Health Transformation Activities, and
    Performance Goals and Action Plans to Improve the Service System for
    adults and children separately.

-   Part D gives guidance for preparation and submission of the
    Implementation Report which is used to describe the extent to which
    the State has implemented its prior year plan.

-   Part E provides guidance on submission of the data tables from the
    Uniform Data Reporting System.

There are also several required attachments and appendices that provide
useful resource information needed for the plan.

**PART A: CONTEXT AND OVERVIEW OF FY 2008 CMHS BG APPLICATION**

> **I. Statutory Authority**
>
> Under the authority of the Public Health Service Act (PHS Act)[^1] and
> subject to the availability of funds, the Secretary of the Department
> of Health and Human Services, through the Center for Mental Health
> Services (CMHS), Substance Abuse and Mental Health Services
> Administration (SAMHSA), awards Block Grants to States to establish or
> expand an organized community-based system for providing mental health
> services for adults with SMI and children with SED. In order for the
> Secretary to award these Block Grants, States, Territories and the
> District of Columbia (herein after referred to as States) are required
> to submit an application, prepared in accordance with the law for the
> fiscal year which the State is seeking funds. The funds awarded are to
> be used to carry out the State plan contained in the application, to
> evaluate programs and services set in place under the plan, and to
> conduct planning, administration and educational activities related to
> the provision of services under the plan.
>
> Specific authority for requiring data from the States is found in
> three different Sections of the law. First, the Secretary is required
> to establish definitions for SMI and SED.[^2] Second, in order to
> receive funding, States will provide to the Secretary any data
> required pursuant to Section 505, and will cooperate with the
> Secretary in the development of uniform criteria for the collection of
> data pursuant to such section. [^3] Third, the application (including
> the plan under Section 1912(a)), must be otherwise in such form, made
> in such manner, and contain such agreements, assurances, and
> information as the Secretary determines to be necessary to carry out
> this subpart.[^4] A grant may be made only if the plan meets the five
> (5) criteria in the law and is approved by CMHS. [^5] After review of
> the State plan implementation report for the previous fiscal year,
> CMHS must also determine that the State has completely implemented the
> plan approved for the previous fiscal year.

**II. History and Goals of Federal Mental Health Funding and Planning
Requirements**

Federal financial support of mental health programs has gone through
many transitions from its beginning in 1963 with passage of the
Community Mental Health Centers legislation to provide comprehensive
services in local communities, [^6] through conversion to block grants
in 1981, and passage of legislation in 1986 and 1990 requiring states to
develop and enhance comprehensive community-based systems of care.[^7]
In 1992, Congress passed legislation that moved responsibility for
administration of the mental health block grant and state planning
requirements from the National Institute of Mental Health to the newly
formed Center for Mental Health Services, part of the Substance Abuse
and Mental Health Services Administration of the Department of Health
and Human Services. Finally, in 2000, legislative changes allowed states
more flexibility in the use of block grant funds. [^8]

Over the past 20 years, the evolution of policy changes which tie the
mental health block grant funds to the development and implementation of
state plans has had the following key goals:

-   Access to a comprehensive system of care, including employment,
    housing, case management, rehabilitation, dental and health
    services, along with mental health services and supports;

-   Participation of consumers/survivors and their families in planning
    and evaluation of state systems;

-   Access for underserved populations, including homeless people and
    rural populations;

-   Promoting recovery and community integration of people with
    psychiatric disabilities; and,

-   Accountability through uniform reporting on access, quality, and
    outcomes of services.

These goals have been reaffirmed in recent years by several key federal
developments: the Surgeon General's Report on Mental Health (1999); the
New Freedom Initiative for People with Disabilities (2001); and the
report of the New Freedom Commission on Mental Health (2003). These
documents emphasize the importance of access to employment, housing,
rehabilitation, and other services which support integration into the
community for persons with mental illnesses, as well as the other goals
listed above.

# III. Center for Mental Health Services Transformation and Planning Initiatives 

**Mental Health Transformation**

**In 2003, the President's New Freedom Commission on Mental Health
issued a report on the status of mental health care in America. The
report titled, *Achieving the Promise: Transforming Mental Health Care
in America* called for a fundamental change in the way mental health
services are perceived, accessed, delivered, and financed. *Achieving
the Promise* outlined a clear direction in which America's system for
mental health care should change. Since its publication, *Achieving the
Promise* has stimulated significant developments at the national level
and proven to be formative to the planning efforts of the Center for
Mental Health Services and the Mental Health Block Grant Program.**

***Achieving the Promise* declared that millions of Americans with
mental illnesses are denied the promise of recovery and a full life in
the communities where they live. Many Americans with mental illnesses
encounter daily struggles with stigma and discrimination, seek services
from a fragmented and inadequate service system, and find available poor
opportunities for involvement and self-determination. The Commission's
report outlined six (6) overarching goals for transforming mental health
care in America. The goals are as follows:**

-   **Americans understand that Mental Health is Essential to Overall
    Health**

-   **Mental Health Care is Consumer and Family Driven**

-   **Disparities in Mental Health Services are Eliminated**

-   **Early Mental Health Screening, Assessment, and Referral to
    Services are Common Practice**

-   **Excellent Mental Health Care is Delivered and Research is
    Accelerated**

-   **Technology is Used to Access Mental Health Care and Information**

**Following the publication of the President's New Freedom Commission's
Report, SAMHSA/CMHS, through the U.S. Department of Health and Human
Services, was charged to implement the goals and recommendations.**

**Federal Action Agenda**

**In FY 2005, CMHS published the *Federal Mental Health Action Agenda*
that articulated specific, actionable objectives leading to the
initiation of a long-term strategy designed to transform the Nation\'s
public and private mental health service delivery systems. In developing
the *Federal Mental Health Action Agenda*, CMHS collaborated with key
Federal agencies to compile an inventory of current programs and
activities to address the Commission's vision, and proposed numerous
action steps to move the transformation agenda forward. To date,
twenty-one (21) agencies, known as Federal Partners, have committed to
collaborate with CMHS on behalf of adults with SMI and children with SED
to:**

-   **Send the message across the nation that mental illnesses and
    emotional disturbances are treatable and that recovery is
    possible.**

-   **Act immediately to reduce the number of suicides in the Nation
    through full implementation of the National Strategy for Suicide
    Prevention.**

-   **Help States develop the infrastructure necessary to formulate and
    implement Comprehensive State Mental Health Plans that include the
    capacity to create individualized plans of care that promote
    resilience and recovery.**

-   **Develop a plan to promote a mental health workforce better
    qualified to practice culturally competent mental health care based
    on evidence-based practices.**

-   **Improve the interface of primary care and mental health
    services.**

-   **Initiate a national effort focused on the mental health needs of
    children and promote early intervention for children identified to
    be at risk for mental disorders. Prevention and early intervention
    can help forestall or prevent disease and disability.**

-   **Expand the \"Science-to-Services\" agenda and develop new
    evidence-based practices toolkits.**

-   **Increase the employment of people with psychiatric disabilities.**

-   **Design and initiate an electronic health record and information
    system that will help providers and consumers better manage mental
    health care and that will protect the privacy and confidentiality of
    consumers\' health information.**

**OMB Program Assessment Rating Tool**

**In an effort to improve program accountability and ensure fiscal
responsibility for Federally funded programs, the Office of Management
and Budget (OMB) created the Program Assessment Rating Tool (PART). The
CMHS BG was evaluated using the PART in FFY 2003 for the 2005 budget
cycle.**

**The PART, which is one component of the Federal government's effort to
hold agencies accountable for their funded programs, assesses four
aspects of each program:**

-   **Program purpose and design -- the extent to which the program
    design and purpose are clear and defensible;**

-   **Strategic planning -- whether the agency sets valid annual and
    long term goals;**

-   **Program management -- agency management of the program, including
    financial oversight and program improvement efforts; and**

-   **Program results -- actual program performance towards goals
    reviewed in the strategic planning section of the PART.**

**The CMHS BG was reviewed FFY 2003 and received a rating of *adequate*.
In annual updates to OMB, the MHBG Program has been encouraged to
continue improving its program performance data collection as a key
component of assuring appropriate use of program funds, and as a means
to enhance planning for community based systems if care for adults with
SMI and children with SED,**

**Web Block Grant Application System (WebBGAS)**

**Beginning in FY 2008, all States are requested to use the WebBGAS
system to submit FY 2008 Block Grant plans and 2007 implementation
reports. The WebBGAS is consistent with OMB approved guidance for the
Mental Health Block Grant and Implementation Report. WebBGAS is a
web-enabled block grant management system that allows for the
submission, review and archive of the Community Mental Health Services
Block Grant Application and Implementation Report that was developed
based on the 2006-2007 MHBG Guidance and Instructions which mandated the
form and content for applications and implementation reports. WebBGAS
benefits both States and Federal government by significantly reducing
the paperwork burden required for submission, revision, and reporting.
Other benefits of submitting plans electronically include:**

-   **Elimination of redundant data entry with automatic pre-population
    of previous year's data;**

-   **Online access of Block Grant applications allows for participation
    across geographical boundaries. Since WebBGAS is on the internet, it
    is available globally.**

-   **Electronic standardization of data set allows for the production
    of streamlined reports and quantitative analysis on a national
    level.**

-   **Increased communication pathways between the State and
    SAMHSA/CMHS.**

-   **Allows the Plan and Implementation Reports to be viewed
    immediately by State users, Planning Council Chairs, State Citizens,
    and Federal staff**

-   **Allows States to control access by distributing logins and
    passwords when the plan is ready to be viewed.**

-   **Provides a mechanism for providing feedback to State Planners from
    all system users, including anonymous citizens.**

-   **Produces properly formatted PDF documents for a Plan and
    Implementation Report in accordance with the "Achieving the Promise:
    Transforming Mental Healthcare in America, Community Mental Health
    Services Block Grant Application Guidance and Instructions".**

-   **Once a Plan or Implementation Report document has been generated,
    it may be viewed, searched or printed with Adobe Acrobat.**

-   **Allows for multiple State Planners to work on different sections
    of the Plan or Implementation Report at the same time.**

-   **Integrates documents originally written in Microsoft Word,
    Microsoft Excel, WordPerfect or PDF by uploading the file through
    WebBGAS.**

-   **Eliminates mail receipt issues for States and Territories.**

The website for WebBGAS is:
[https://bgas.samhsa.gov](https://bgas.samhsa.gov/)

**NATIONAL OUTCOME MEASURES**

Accountability in the delivery of quality mental health services for
adults with serious mental illness and children with serious emotional
disturbance continues to be a guiding principle of the Federal planning
process for the Mental Health Block Grant. CMHS has established that one
level of accountability will be measured by the collection of
standardized data from States using uniform national outcome measures
(NOMS)[^9] and other measures specific to mental health services as
determined by the individual States according to their priorities and
needs. The NOMS are shown in Table 6 and are derived from tables in the
Uniform Reporting System (URS) that is described in Part E of the
guidance. The URS tables are located in Appendix II.

These tables also serve as the basis for the Data Infrastructure Grants
(DIG) that were first offered to States and Territories in FY 2001 to
provide funding to improve their data collection activities that would
result in reporting uniform data that could be aggregated on a national
basis. In FY [2004]{.underline}, States received the second set of Data
Infrastructure Grants that substantially improved their ability to
collect and report NOMS. The third set of DIG funding is expected to
continue in FY 2008. In FY 2008, the MHBG Program will continue working
with States and Territories to refine and operationalize the NOMS
contained in the URS data tables through monthly workgroup meetings with
staff from the States.

All States[^10] and Territories that accepted a DIG are required to
submit data on the URS tables consistent with the work that has been
accomplished in the DIG including using the uniform definitions and
methods agreed to by the States and Territories. Likewise, the measures
that States and Territories use for reporting and planning purposes in
their State plans should be consistent with and reflect the data
reported in the related URS table. Lastly, as work progresses under the
DIG, States will be expected to report those items. Instructions and
expectations regarding the actual reporting and implementation of NOMS
that are currently being refined or under development at SAMHSA/CMHS
will be transmitted separately to States. As stated in previous
guidance, all States are expected to report on nine (9) SAMHSA NOMS by
December 2007.

**IV. Plan Format: Child/Adult Plans**

Number range CHAPTERUnder Section 1912(b) of PHS Act (42 USC 300x-2),
the State Plan must address the five (5) legislated criteria. Criteria
1, 2, 4 and 5 must be addressed for adults with SMI, and Criteria 1-5
must be addressed for children with SED. States should submit a single
plan in which services for both adults with SMI and children with SED
are addressed separately. **As noted above, State plans should integrate
transformation activities within their descriptions of the five (5)
criteria.**

\(1\) Number range CHAPTER[Application Format for Single Year
Plans]{.underline}

In preparing State Plans for FY 2008 (due September 4, 2007), States
should use this Application Guidance and Instructions. The application
must include:

-   Face Sheet

-   Table of Contents

-   Executive Summary

-   All items in Part B

-   All items in Part C (Sections I-III).

> The implementation report (Part D & E), due December 1, 2007, will
> describe the extent to which the State implemented its mental health
> plan for FY 2007 and include data from the Uniform Reporting System
> (URS Tables).

The plan Part C (Sections I-III) must address each element of the four
(4) criteria for adults and five (5) criteria for children as enumerated
in the block grant legislation*.* **Mental health transformation
activities should be described within the specific criterion to which
they relate.** The plan should contain goals and fiscal year targets for
the NOMS. If changes occur during the year that affect the plan as
submitted and subsequently approved by CMHS, States may submit a
modification of the Plan by forwarding a copy of the modification to the
Grants Management Office [and]{.underline} entering the modification
into WebBGAS after contacting the Federal Project Officer.

States are also reminded that criterion 5 requires information on how
the grant will be expended and a funding plan. **In FY 2008, States are
strongly encouraged to report Block Grant and State funding for
transformation activities in Table 4.**

Performance indicator tables must be reported annually and include
narrative as needed. **Additionally, States must submit at least one
performance indicator in the plan to address mental health
transformation**

It is important that the MHBG Program be notified of changes made in the
State\'s mental health system after the Plan has been submitted through
written modification submitted to SAMHSA's Division of Grants Management
Office. Before submitting applications each year, States should assess
the impact of any positive or negative changes that occurred in the
previous year that will affect the State\'s ability to carry out the
proposed plan. If changes are necessary, States may modify the plan as
part of the application package (thus modifying the original plan). In
modifying previously approved plans, States should identify specific
changes referring to related sections page numbers in the original plan,
rather than simply making changes to the original plan and resubmitting
it. These modifications should be discussed in detail within the context
of the affected criteria, goals, and targets and submitted to SAMHSA's
Division of Grants Management Office. After notifying the Grants
Management Office [and]{.underline} the Federal Project Officer, changes
to the plan may be entered into WebBGAS.

**Number range CHAPTERPART B. ADMINISTRATIVE REQUIREMENTS, FISCAL
PLANNING ASSUMPTIONS, AND SPECIAL GUIDANCE**

**I. Federal funding agreements, certifications and assurances and
Requirements**

> Federal funding agreements, certifications, assurances and other
> requirements are necessary each year in order for States to receive
> mental health block grant funds.

**(1)** **Funding Agreements** (Attachment A)

> Do not retype the Funding Agreement; this may require re-submission of
> the agreement which could delay the award of funds. The Chief
> Executive Officer (Governor) or a formal designee must sign the
> statutory funding agreements, hereby attesting that the State will
> comply with them. If the funding agreements are signed by a designee,
> a letter from the Governor authorizing the person to sign must be
> included with the application.

**(2)** **Certifications -- PHS 5161-1** (Attachment B) - (OMB Approval
0920-0428)

> Do not retype any of the certifications; this may require
> re-submission of a certification, which could delay the award of
> funds.
>
> **(a) Debarment and Suspension**

A fully executed Debarment and Suspension Certification must be
included.

> **(b) Drug-Free Workplace Requirements**

A fully executed certification regarding Drug-Free Workplace
Requirements must be included with the application unless the State has
an acceptable FY 1997 Statewide or Agency-wide certification on file
with the Department of Health and Human Services. Federal regulations
regarding these requirements are found in 45 CFR Part 76.

> **(c) Lobbying and Disclosure**

A fully executed Lobbying Certification must be included for all awards
exceeding \$100,000. This certification must be signed by the Chief
Executive Officer of the State (Governor) or his/her formally authorized
designee. Additional information about this requirement can be found in
45 CFR Part 93.

Included in the FY 2007 Application Guidance and Instructions is a copy
of Standard Form-LLL "Disclosure of Lobbying Activities" and
instructions to report lobbying activities.

> **(d)** **Program Fraud Civil Remedies Act (PFCRA)**
>
> **(e)** **Environmental Tobacco Smoke**
>
> **(3) Assurances SF 424B** (Attachment C) - (OMB Approval 0348-0040)

Do not retype any of the assurances; this may require re-submission of
the assurance(s), which could delay the award of funds.

**(4)** **DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER**

A DUNS number is a unique 9-digit number required for all applicants for
Federal grants and cooperative agreements, with the exception of
individuals other than sole proprietors. The number is used to identify
related organizations that receive funding under grants and cooperative
agreements, and to provide consistent name and address. The DUNS Number
should be entered on the Face Sheet of the State's Plan/Application.

**Ii. SET-ASIDE FOR CHILDREN'S MENTAL HEALTH SERVICES REPORT**

States are required to provide systems of integrated services for
children with serious emotional disturbances (SED).[^11] Each year the
State shall expend not less than the calculated amount for FY 1994.

## State Expenditures for Mental Health Services

Reported by: State FY \_\_\_\_\_\_\_\_\_\_\_ Federal
FY\_\_\_\_\_\_\_\_\_\_\_\_\_

  ----------------------- -------------------- ---------------------------
  **Calculated FY 1994**  **Actual FY 2006**   **Estimated/Actual FY
                                               2007**

  **\$**                  **\$**               **\$**
  ----------------------- -------------------- ---------------------------

**Waiver of Children's Mental Health Services**

If there is a shortfall in children's mental health services, the State
may request a waiver. A waiver may be granted if the Secretary
determines that the State is providing an adequate level of
comprehensive community mental health services for children with serious
emotional disturbance as indicated by a comparison of the number of such
children for which such services are sought with the availability of
services within the State. The Secretary shall approve or deny the
request for a waiver not later than 120 days after the request is made.
A waiver granted by the Secretary shall be applicable only for the
fiscal year in question.

**III. Maintenance of Effort (MOE) Report**

States are required to submit sufficient information for the Secretary
to make a determination of compliance with the statutory MOE
requirements.[^12] MOE information is necessary to document that the
State has maintained expenditures for community mental health services
at a level that is not less than the average level of such expenditures
maintained by the State for the 2-year period preceding the fiscal year
for which the State is applying for the grant. States that received
approval to exclude funds from the maintenance of effort calculation
should include the appropriate MOE approval documents.

States are required to submit expenditures in the following format:

## State Expenditures for Mental Health Services

**MOE reported by: \_\_\_\_\_\_**State FY \_\_\_\_\_\_\_\_Federal FY\_

  ----------------------- ----------------------- -----------------------
  **Actual FY 2005**      **Actual FY 2006**      **Estimated/Actual FY
                                                  2007**

  **\$**                  **\$**                  **\$**
  ----------------------- ----------------------- -----------------------

# MOE Exclusion 

The Secretary may exclude from the aggregate amount any State funds
appropriated to the principal agency for authorized activities of a
non-recurring nature and for a specific purpose. [^13]

States must consider the following in order to request an exclusion from
the MOE requirements:

1.  The State shall request the exclusion separately from the
    application;

2.  The request shall be signed by the State's Chief Executive Officer
    or by an individual authorized to apply for CMHS Block Grant on
    behalf of the Chief Executive Officer;

3.  The State shall provide documentation that supports its position
    that the funds were appropriated by the State legislature for
    authorized activities which are of a non-recurring nature and for a
    specific purpose; indicates the length of time the project is
    expected to last in years and months; and affirms that these
    expenditures would be in addition to funds needed to otherwise meet
    the State's maintenance of effort requirement for the year for which
    it is applying for exclusion.

4.  The State may not exclude funds from the MOE calculation until such
    time as the Administrator of SAMHSA has approved in writing the
    State's request for exclusion.

####### MOE Shortfalls

States are expected to meet the MOE requirement. If they do not meet the
MOE requirement, the legislation permits relief, based on the
recognition that extenuating circumstances may explain the shortfall.
These conditions are described below.

(1). Waiver for Extraordinary Economic Conditions

A State may request a waiver to the MOE requirement if it can be
demonstrated that the MOE deficiency was the result of extraordinary
economic conditions that occurred during the SFY in question. An
extraordinary economic condition is defined as a financial crisis in
which the total tax revenues declined at least one and one-half percent,
and either the unemployment increases by at least one percentage point,
or employment declines by at least one and one-half percent.

(2). Material Compliance

If the State is unable to meet the requirements for a waiver under
extraordinary economic conditions, the authorizing legislation does
permit the Secretary, under certain circumstances, to make a finding
that even though there was a shortfall on the MOE, the State maintained
material compliance with the MOE requirement for the fiscal year in
question. Therefore, the State is given an opportunity to submit
information that might lead to a finding of material compliance. The
relevant factors that SAMHSA considers in making a recommendation to the
Secretary include: 1) whether the State maintained service levels, 2)
the State's mental health expenditure history, and 3) the State's future
commitment to funding mental health services.

**IV. Fiscal Planning Assumptions**

For FY 2008, States are expected to develop their intended use of funds
based on their FY 2007 Mental Health Block Grant allocation***.*** Funds
awarded under this Block Grant must be obligated and expended within the
two-year period. For the FY 2008 block grant award, the period is
October 1, 2007 through September 30, 2009. States are also required to
submit a Financial Status Report (SF 269 Short Form) 90 days after the
end of the obligation and expenditure period which is December 31, 2009.
Each year and upon enactment of the President's Budget, States will
receive an annual allotment table, and if necessary, will be required to
modify the intended use of funds that was submitted in the annual
application if the new annual allotment is significantly increased or
decreased.

**V. Submission Requirements and Due Dates**

The Application Guidance and Instructions is available at the SAMHSA web
site as [www.mhbg.samhsa.gov](http://www.mhbg.SAMHSA.gov/). In FY 2008,
State applications will only be submitted via WEBBGAS or to LouEllen M.
Rice, Grants Management Officer, Division of Grants Management, OPS,
SAMHSA, 1 Choke Cherry Road, Room 7-1091, Rockville, Maryland 20857 (for
overnight/express mail, use zip code "20850". For applications submitted
using WebBGAS, States must also mail an original and two copies of all
of Part B to the Grants Management Office, including the signed copy of
the Mental Health Planning Council letter. If applications are submitted
in hard copies, States must submit the original and two copies of the
entire application, including Parts B and C (Sections I, II, & III). All
applications must be received by the due date of September 4.
Implementation reports, including the URS Tables, are due on or before
December 3. These due dates are statutorily set and waivers cannot be
given. [^14] Number range CHAPTERIf your State application and
implementation report are not received in the Office of Grants
Management by these mandatory dates, it will be impossible for your
State to obtain a grant for the year indicated.

If copies of your State's plan are mailed, the copies should be
submitted unbound, without staples, paper clips or fasteners. Do not
attach or include any folded material, pasted, or in a size other than
8^½"^ x11\" on white paper. Heavy or lightweight paper should not be
used, and submissions should be printed only on one side. Do not
condense type closer than 15 characters per inch. Each sheet of the
application should be numbered consecutively from beginning to the end
(for example, page 1 for the face sheet, etc.). If appendices or
additional materials are included, they should be numbered continuing
the same sequence. If the plan is submitted in hard copy, it is
recommended that the State plan be limited to 120 pages.

Should you need additional information regarding submission of the
application, contact LouEllen Rice at (240) 276-1404. Questions
regarding the Mental Health Block Grant program should be directed to
your Federal Project Officer at (240) 276-1760.

**VI. State Mental Health Planning Councils**

**CMHS continues to encourage States to work with State Mental Health
Planning and Advisory Councils to integrate the principles of mental
heath transformation throughout the state's service delivery systems. As
evidenced from the FY 2007 consultative peer reviews of State Block
Grant Plans, states are increasingly involving planning council members
on State wide-planning and policy making committees to provide input and
guidance on mental health transformation. Involving planning council
members at all levels of decision making ensures that transformation of
state mental health systems will be more** **consumer and family driven
and more responsive to the needs of adults with serious mental illness
and children with serious emotional disturbance.** **for fy 2008, States
should include a brief description of the role of the Planning Council
in the State's efforts to transform the mental health system.**

(1). [Membership Requirements]{.underline}

State Mental Health Planning Councils are required to conform to certain
membership requirements. [^15] This includes representatives of certain
principal State agencies;[^16] other public and private entities
concerned with the need, planning, operation, funding and use of mental
health services and related services; adults who are current or former
consumers of mental health services; family members of adults with
serious mental illness and children with serious emotional disturbances,
and representatives of organizations of individuals with mental illness
and their families and community groups advocating on their behalf.
Specifically, the law stipulates that not less than 50% of the members
of the planning council shall be individuals who are not State employees
or providers of mental health services. The law also requires that the
ratio of parents of children with SED to other members of the Council be
sufficient to provide adequate representation of such children in the
deliberations of the Council.

(2). [State Mental Health Planning Council Membership List and
Composition]{.underline}

To demonstrate compliance with the statutory membership requirements,
Tables 1 and 2 should be completed for the current fiscal year. In the
Table 1 column, "Type of Membership," indicate whether a member is a
consumer, a family member of a child with SED, a family member of an
adult with SMI, a provider, a state employee, or a representative not
otherwise stated in the legislation.

(3). [Planning Council Charge, Role and Activities]{.underline}

State Mental Health Planning Councils are required to perform certain
duties.[^17] If available, a charter or a narrative summarizing the
duties of the Planning Council should be included. This section should
also specify the policies and procedures for the selection of council
members, their terms, the conduct of meetings, and a report of the
Planning Council's efforts and related duties as mandated by law:

-   reviewing plans and submitting to the State any recommendations for
    modification

-   serving as an advocate for adults with serious mental illness,
    children with a severe emotional disturbance, and other individuals
    with mental illnesses or emotional problems,

-   monitoring, reviewing, and evaluating, not less than once each year,
    the allocation and adequacy of mental health services within the
    State.^25^

-   tNumber range CHAPTERhe role of the Planning Council in improving
    mental health services within the State.

(4). [State Mental Health Planning Council Comments and
Recommendations]{.underline}

With the Plan submission, States are required to submit documentation
that the State Plan was shared with the Planning Council. Any comments
and recommendations to the State plan received from the Planning Council
must be submitted, regardless of whether the State has accepted the
recommendations. In the annual implementation report, States are also
required to submit documentation that the implementation report was
shared with the Planning Council and must include any comments from the
Council on the State's annual implementation report. The documentation,
preferably in a letter signed by the Chair, should indicate that the
Council has reviewed the State plan and the annual report with
particular attention to the transformation activities that are
highlighted and specified in the plan.

(5). PUBLIC COMMENT ON THE STATE PLAN

Section 1941 of the Block Grant legislation stipulates that as a
condition of the funding agreement for the grant, States will provide
opportunity for the public to comment on the State Plan. States will
make the mental health plan public in such a manner to facilitate
comment from any person (including Federal or other public agency)
during the development of the plan (including any revisions) and after
the submission of the plan to the Secretary. States should describe
their efforts and procedures to obtain public comment on the plan in
this section.

**TNumber range CHAPTERABLE 1.**

List of Planning Council Members

+-------------------+-----------+---------------+----------+----------+
| **Name**          | **Type of | ## Agency or  | *        | **Email  |
|                   | Membe     | Organization  | *Address | Address  |
|                   | rship\*** | Represented\* | Phone &  | (If      |
|                   |           |               | Fax**    | Avai     |
|                   |           |               |          | lable)** |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+
|                   |           |               |          |          |
+-------------------+-----------+---------------+----------+----------+

\*Council members should be listed only once by type of membership and
agency/organization represented. See type of membership in Table 2.

**TABLE 2. Planning Council Composition by Type of Member**

[Note:]{.underline} 1) The ratio of parents of children with SED to
other members of the Council must be sufficient to provide adequate
representation of such children in the deliberations of the Council, 2)
State employee and provider members shall not exceed 50% of the total
members of the Planning Council, and 3) Other representatives may
include public and private entities concerned with the need, planning,
operation, funding, and use of mental health services and related
support services.

**PART C. SPECIFIC GUIDANCE FOR STATE APPLICATIONS AND PLANS**

**SECTION I. Description of State Service System**

Number range CHAPTERIn this section, States are requested to identify
issues or initiatives within the State that are important in
understanding the State plan in the context of the broader system. The
section should include:

-   An overview of the State's mental health system: a brief description
    of how the public mental health system is currently organized at the
    State and local levels, including the State Mental Health Agency's
    authority in relation to other State agencies.

-   ANumber range CHAPTER brief summary of areas identified by the State
    in the previous State plan as needing particular attention,
    including the significant achievements in its previous fiscal year.

-   New developments and issues that affect mental health service
    delivery in the State, including structural changes such as Medicaid
    waivers, managed care, State Children's Health Insurance Program
    (SCHIP) and other contracting arrangements.

-   Legislative initiatives and changes, if any.

-   A brief description of regional/sub- State programs, community
    mental health centers, and resources of counties and cities, as
    applicable, to the provision of mental health services within the
    State.

-   A description of how the State mental health agency provides
    leadership in coordinating mental health services within the broader
    system.

**SECTION II. Identification and Analysis of the Service System's
Strengths, Needs and Priorities**

This section should be written primarily in narrative form with separate
discussions of services for adults and children. In preparing the
discussions, each presentation should be organized so that it follows
the five criteria established in law. Within the discussion, States
should separately address the following:

-   A discussion of the strengths and weaknesses of the service system;

-   An analysis of the unmet service needs and critical gaps within the
    current system, and Number range CHAPTERidentification of the source
    of data which was used to identify them

-   A statement of the State's priorities and plans to address unmet
    needs.

-   A brief summary of recent significant achievements that reflect
    progress towards the development of a comprehensive community-based
    mental health system of care.

-   A brief description of the comprehensive community-based public
    mental health system that the State envisions for the future*.*

**Table 3.**

**Transformation Activities to be addressed in the State Plan**.

+-----------------------------------------------------------------------+
| Number range CHAPTER**Criterion 1: Comprehensive Community-Based      |
| Mental Health Service Systems**                                       |
|                                                                       |
| Provides for the establishment and implementation of an organized     |
| community-based system of care for individuals with mental illness.   |
|                                                                       |
| ● Describes available services and resources in a comprehensive       |
| system of care, including services for individuals with both mental   |
| illness and substance abuse. The description of the services in the   |
| comprehensive system of care to be provided with Federal, State, and  |
| other public and private resources to enable such individuals to      |
| function outside of inpatient or residential institutions to the      |
| maximum extent of their capabilities shall include:                   |
|                                                                       |
| • Health, mental health, and rehabilitation services;                 |
|                                                                       |
| • Employment services;                                                |
|                                                                       |
| • Housing services;                                                   |
|                                                                       |
| • Educational services;                                               |
|                                                                       |
| • Substance abuse services;                                           |
|                                                                       |
| • Medical and dental services;                                        |
|                                                                       |
| • Support services;                                                   |
|                                                                       |
| > • Services provided by local school systems under the Individuals   |
| > with Disabilities Education Act;                                    |
|                                                                       |
| • Case management services;                                           |
|                                                                       |
| > • Services for persons with co-occurring (substance abuse/mental    |
| > health) disorders; and                                              |
|                                                                       |
| • Other activities leading to reduction of hospitalization.           |
|                                                                       |
| **Describes mental health transformation efforts and activities in    |
| the State in Criterion 1, providing reference to specific goals of    |
| the NFC Report to which they relate.**                                |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| ## Criterion 2: Mental Health System Data Epidemiology                |
|                                                                       |
| ● Contains an estimate of the incidence and prevalence in the State   |
| of serious mental illness among adults and serious emotional          |
| disturbance among children; and                                       |
|                                                                       |
| ● Presents quantitative targets to be achieved in the implementation  |
| of the system of care described under Criterion 1.                    |
|                                                                       |
| **Describes mental health transformation efforts and activities in    |
| the State in Criterion 2, providing reference to specific goal(s) of  |
| the NFC Report to which they relate**.                                |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| ### Criterion 3: Children's Services                                  |
|                                                                       |
| ● Provides for a system of integrated services appropriate for the    |
| multiple needs of children without expending the grant under Section  |
| 1911 for the fiscal year involved for any services under such system  |
| other than comprehensive community mental health services. Examples   |
| of integrated services include:                                       |
|                                                                       |
| > • Social services;                                                  |
| >                                                                     |
| > • Educational services, including services provided under the       |
| > Individuals with Disabilities Education Act;                        |
| >                                                                     |
| > • Juvenile justice services;                                        |
| >                                                                     |
| > • Substance abuse services; and                                     |
| >                                                                     |
| > • Health and mental health services.                                |
|                                                                       |
| **Describes mental health transformation efforts and activities in    |
| the State in Criterion 3, providing reference to specific goal(s) of  |
| the NFC Report to which they relate.**                                |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| ### Criterion 4: Targeted Services to Rural and Homeless Populations  |
|                                                                       |
| ● Describes State's outreach to and services for individuals who are  |
| homeless;                                                             |
|                                                                       |
| ● Describes how community-based services will be provided to          |
| individuals in rural areas                                            |
|                                                                       |
| • Describes how community-based services are provided to older        |
| adults.                                                               |
|                                                                       |
| ***.*** **Describes mental health transformation efforts and          |
| activities in the State in Criterion 4, providing reference to        |
| specific goal(s) of the NFC Report to which they relate.**            |
+-----------------------------------------------------------------------+
| ###                                                                   |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **Criterion 5: Management Systems**                                   |
|                                                                       |
| ### Describes financial resources, staffing and                       |
| training for mental health services providers necessary for the plan. |
|                                                                       |
| ● Provides for training of providers of emergency health services     |
| regarding mental health.                                              |
|                                                                       |
| • Describes mental health transformation efforts and activities in    |
| the State in Criterion 3, providing reference to specific goal(s) of  |
| the NFC Report to which they relate.                                  |
|                                                                       |
| **Identifies transformation expenditures by Mental Health Block Grant |
| funding and other State funding sources in Table 4. CMHS strongly     |
| encourages all States to report Table 4 and will work in partnership  |
| with States to obtain this important information. Flexibility will be |
| allowed in the way in which expenditure data is reported given the    |
| structure of the table. All States should provide an explanation of   |
| the data reported.**                                                  |
+-----------------------------------------------------------------------+

Note: Criteria 1, 2, 4, and 5 must be addressed in the Adult Plan;
Criteria 1-5 must be addressed in the Children's Plan.

**Table 4**

**FY 2008 -- FY 2010 MHBG Transformation Expenditure Reporting Form**

### State: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 

+-------------------------------+-------------------+-----------------+
| **State Transformation**      | **FY 2008 MHBG**  | **FY 2008**     |
|                               |                   |                 |
| **Activity**                  | **Planned**       | **Other State** |
|                               |                   |                 |
|                               | **Expenditure     | **Funding       |
|                               | Amount**          | Source Amount** |
+-------------------------------+-------------------+-----------------+
| Improving **coordination** of |                   |                 |
| care among multiple systems   |                   |                 |
+-------------------------------+-------------------+-----------------+
| Support for **culturally      |                   |                 |
| competent** services          |                   |                 |
+-------------------------------+-------------------+-----------------+
| Involving **consumers and     |                   |                 |
| families** fully in orienting |                   |                 |
| the MH system toward recovery |                   |                 |
+-------------------------------+-------------------+-----------------+
| Support for **consumer- and   |                   |                 |
| family-operated programs**,   |                   |                 |
| including Statewide consumer  |                   |                 |
| networks                      |                   |                 |
+-------------------------------+-------------------+-----------------+
| Services for **co-occurring** |                   |                 |
| mental and substance use      |                   |                 |
| disorders                     |                   |                 |
+-------------------------------+-------------------+-----------------+
| Eliminating **disparities**   |                   |                 |
| in access to and quality of   |                   |                 |
| care                          |                   |                 |
+-------------------------------+-------------------+-----------------+
| Support for integrated        |                   |                 |
| **electronic health record**  |                   |                 |
| and personal health           |                   |                 |
| information systems           |                   |                 |
+-------------------------------+-------------------+-----------------+
| Improving consumer access to  |                   |                 |
| **employment and affordable   |                   |                 |
| housing**                     |                   |                 |
+-------------------------------+-------------------+-----------------+
| Provision of **Evidence Based |                   |                 |
| Practices**                   |                   |                 |
+-------------------------------+-------------------+-----------------+
| Aligning **financing** for    |                   |                 |
| mental health services for    |                   |                 |
| maximum benefit               |                   |                 |
+-------------------------------+-------------------+-----------------+
| Supporting **individualized   |                   |                 |
| plans of care** for consumers |                   |                 |
+-------------------------------+-------------------+-----------------+
| Supporting use of **peer      |                   |                 |
| specialists**                 |                   |                 |
+-------------------------------+-------------------+-----------------+
| Linking mental health care    |                   |                 |
| with **primary care**         |                   |                 |
+-------------------------------+-------------------+-----------------+
| Supporting **school** mental  |                   |                 |
| health programs               |                   |                 |
+-------------------------------+-------------------+-----------------+
| Supporting early mental       |                   |                 |
| health **screening,**         |                   |                 |
| assessment, and referral to   |                   |                 |
| services                      |                   |                 |
+-------------------------------+-------------------+-----------------+
| **Suicide** prevention        |                   |                 |
+-------------------------------+-------------------+-----------------+
| Supporting reduction of the   |                   |                 |
| **stigma** associated with    |                   |                 |
| mental illness                |                   |                 |
+-------------------------------+-------------------+-----------------+
| Use of health **technology**  |                   |                 |
| and telehealth to improve     |                   |                 |
| access and coordination of    |                   |                 |
| mental health care            |                   |                 |
+-------------------------------+-------------------+-----------------+
| Supporting **workforce        |                   |                 |
| development** activities      |                   |                 |
+-------------------------------+-------------------+-----------------+
| **Other (specify)**           |                   |                 |
+-------------------------------+-------------------+-----------------+

### SECTION III: Performance Goals and Action Plans to Improve the Service System

1\. [Common Requirements for Adult and Child Plans]{.underline}

SAMHSA, in partnership with the States, identified data to be used to
develop performance indicators that will increase accountability and
demonstrate on a state-by-state basis whether community-based services
lead to better outcomes for people served. SAMHSA has identified a set
of National Outcome Measures (NOMS) that States are expected to
integrate into their Mental Health Block Grant planning process.

This section should be organized in the same way as Section II above,
with separate discussions of services for adults and children and
organized so that it follows the five criteria, including the new
prompts for transformation activities. Rather than focusing on
strengths, needs and priorities, this section will focus on specific
performance goals and action plans. State plans should include goals,
targets, and action plans for the appropriate criterion using the NOMS
(see Table 5 below), as well as any state-specific indicators they may
choose. The State information will include specific performance goals
and a description of how the State intends to achieve the performance
goals. States may continue to develop and maintain state-specific
performance indicators that they find useful for tracking improvements
in the public mental health system.

2\. National Outcome Measures (NOMS)

For each of the 5 criteria, States should continue to develop, maintain
and report on state-specific performance indicators that they find
useful for tracking improvements within the State and transformation of
the mental health system, in addition to incorporating the NOMS
discussed above. States should provide information on these indicators,
including specific performance goals, target performance levels, and a
description of how the State intends to achieve those performance goals.

**3. State Transformation Outcome Measure**

**States are required to identify at least one state specific mental
health transformation outcome measure and to report a performance
indicator related to the measure. State specific transformation
performance indicator(s) shall be constructed according to the guidance
provided in this document under Item 4 of Section III (Format of Plans)
and should be labeled as transformation outcome measures.**

**4. All States are expected to report on nine (9) CMHS NOMS in FY 2008.
(See Table 5 below)**. If unable to report on these measures, States
should complete the State Data Level Capacity Checklist and/or provide
and narrative explanation in the State plan.

> **Table 5.**

**NATIONAL OUTCOME MEASURES (NOMS)**

+--------------+---------------+---------+---------------+-----------+
| **National   |               | **Rel   | **DIG/URS     | **PART**  |
| Outcome      |               | evant** | Tables**      |           |
| Measures\*** |               |         |               |           |
|              |               | **Crit  |               |           |
|              |               | erion** |               |           |
+--------------+---------------+---------+---------------+-----------+
| **INDICATORS |               |         |               |           |
| REQUIRED IN  |               |         |               |           |
| 2008 --      |               |         |               |           |
| 2010**       |               |         |               |           |
+--------------+---------------+---------+---------------+-----------+
| **1.         | Number of     | C       | Tables 2A and | Yes       |
| Increased    | Persons       | riteria | 2B            |           |
| Access to    | Served by     | 2 and 3 |               |           |
| Services**   | Age, Gender,  |         |               |           |
|              | and           |         |               |           |
|              | R             |         |               |           |
|              | ace/Ethnicity |         |               |           |
+--------------+---------------+---------+---------------+-----------+
| ####         | Decreased     | C       | []{.mark}     | Yes       |
|              | Rate of       | riteria |               |           |
| **2. Reduced | Readmission   | 1 and 3 | Table 20A     |           |
| Utilization  | to State      |         |               |           |
| of           | Psychiatric   |         |               |           |
| Psychiatric  | Hospitals     |         |               |           |
| Inpatient    | within 30     |         |               |           |
| Beds**       | days and 180  |         |               |           |
|              | days          |         |               |           |
+--------------+---------------+---------+---------------+-----------+
| **3. Use of  | Number of     | C       | []{.mark}     | Yes       |
| Ev           | E             | riteria |               |           |
| idence-Based | vidence-based | 1 and 3 | Tables 16 and |           |
| Practices**  | Practices     |         | 17            |           |
|              | Provided by   |         |               |           |
|              | State         |         |               |           |
+--------------+---------------+---------+---------------+-----------+
|              | Number of     | C       | Tables 16 and | Yes       |
|              | Persons       | riteria | 17            |           |
|              | Receiving     | 1 and 3 |               |           |
|              | E             |         |               |           |
|              | vidence-based |         |               |           |
|              | Practice      |         |               |           |
|              | Services      |         |               |           |
+--------------+---------------+---------+---------------+-----------+
| **4. Client  | Clients       | C       | Table 11      | Yes       |
| Perception   | Reporting     | riteria |               |           |
| of Care**    | Positively    | 1 and 3 |               |           |
|              | About         |         |               |           |
|              | Outcomes      |         |               |           |
+--------------+---------------+---------+---------------+-----------+
| **5.         | Profile of    | Cr      | Table 4       | No        |
| Incre        | Adult Clients | iterion |               |           |
| ase/Retained | by Employment | 1       |               |           |
| Employment   | Status        |         |               |           |
| or Return    |               |         |               |           |
| to/Stay in   |               |         |               |           |
| School**     |               |         |               |           |
+--------------+---------------+---------+---------------+-----------+
|              | Increased     | C       | []{.mark}     | No        |
|              | school        | riteria |               |           |
|              | attendance    | 1 and 3 | Table 19C     |           |
+--------------+---------------+---------+---------------+-----------+
| **6.         | Profile of    | C       | Table 19A and | No        |
| Decreased    | Client        | riteria | 19B           |           |
| Criminal     | Involvement   | 1 and 3 |               |           |
| Justice      | in Criminal   |         |               |           |
| I            | and Juvenile  |         |               |           |
| nvolvement** | Justice       |         |               |           |
|              | Systems       |         |               |           |
+--------------+---------------+---------+---------------+-----------+
| **7,         | Profile of    | C       | Table 15      | No        |
| Increased    | client's      | riteria |               |           |
| Stability in | change in     | 1 and 3 |               |           |
| Housing**    | living        |         |               |           |
|              | situation     |         |               |           |
|              | (including    |         |               |           |
|              | homeless      |         |               |           |
|              | status)       |         |               |           |
+--------------+---------------+---------+---------------+-----------+
| **INDICATORS |               |         |               |           |
| IN           |               |         |               |           |
| D            |               |         |               |           |
| EVELOPMENT** |               |         |               |           |
+--------------+---------------+---------+---------------+-----------+
| **8.         | TO BE         | C       | Developmental | No        |
| Increased    | DETERMINED    | riteria |               |           |
| Social       |               | 1 and 3 | TBD           |           |
| Sup          |               |         |               |           |
| ports/Social |               |         |               |           |
| Con          |               |         |               |           |
| nectedness** |               |         |               |           |
+--------------+---------------+---------+---------------+-----------+
| **9.         | TO BE         | C       | Developmental | No        |
| Improved     | DETERMINED    | riteria |               |           |
| Level of     |               | 1, 3,   | TBD           |           |
| F            |               | and 4   |               |           |
| unctioning** |               |         |               |           |
+--------------+---------------+---------+---------------+-----------+

\* If a State does not have the data available to construct a particular
NOMS indicator, a narrative explanation must be provided which will
include: 1) The current capacity to collect this data, 2) efforts
underway to make collection of this data possible , and 3) a projected
date for when the data will be available.

The selection of specific performance indicators and targets for NOMS is
determined by each State. States will also determine the targets for
State selected indicators that are useful for tracking improvements in
the public mental health system, to include mental health
transformation**.**

4\. [Format of Plans]{.underline}

#######  (a) Adult Mental Health Plan

> \(i\) Current Activities
>
> States should describe their adult mental health service system in a
> narrative that addresses Criteria 1, 2, 4, & 5 of Table 3. Narratives
> for each criterion should convey the extent to which the services
> required under the criterion have been implemented.
>
> \(ii\) Goals, Targets and Action Plans
>
> If States are unable to collect and report the data for any of the
> tables from which the NOMS are constructed, a narrative explanation
> must be provided which will include: 1) The current status of the
> capacity to collect this data, 2) efforts underway to make collection
> of the data possible, and 3) a projected date for when the data will
> be available.
>
> For each indicator, States must show the data for the past two years
> (to the extent that it is available), and project a specific target
> for the next year. The most common table format for presenting
> indicators is provided below.

**Performance Indicator Table for State Plan**

These tables are included in WebBGAS.

**Name of Performance Indicator:**

**Population:**

**Criterion:**

+---------------+-------+-------+--------+--------+--------+--------+
| \(1\)         | \(2\) | \(3\) | \(4\)  | \(5\)  | \(6\)  | \(7\)  |
+---------------+-------+-------+--------+--------+--------+--------+
| Fiscal        | F     | F     | FY2007 | FY     | FY     | FY     |
|               | Y2005 | Y2006 |        | 2008   | 2009\* | 2010\* |
| Year          |       |       | Pro    |        |        |        |
|               | A     | A     | jected | Target | Target | Target |
|               | ctual | ctual |        |        |        |        |
+---------------+-------+-------+--------+--------+--------+--------+
| Performance   |       |       |        |        |        |        |
|               |       |       |        |        |        |        |
| Indicator     |       |       |        |        |        |        |
+---------------+-------+-------+--------+--------+--------+--------+
| Numerator\*\* |       |       | \-\--  | \-\--  | \-\--  | \-\--  |
+---------------+-------+-------+--------+--------+--------+--------+
| De            |       |       | \-\--  | \-\--  | \-\--  | \-\--  |
| nominator\*\* |       |       |        |        |        |        |
+---------------+-------+-------+--------+--------+--------+--------+

> [\*Targets for FY 2009 & FY 2010 are required only for multi-year
> plans.]{.underline}
>
> [\*\* Numerator and Denominator are not required for
> Targets]{.underline}
>
> [Table Descriptors:]{.underline}
>
> **Name of Performance Indicator**: Brief name of the performance
> indicator (*e.g*., Increased Access to Services); **clearly label
> transformation outcome measures**.
>
> **Goal**: broad, general description of what the States hopes to
> accomplish
>
> **Target**: a specific, measurable, and expected outcome to be
> achieved within a defined period of time, and, if attained, is
> expected to contribute to the realization of the goal
>
> **Population:** group targeted by this goal
>
> **Criterion:** one or more of the five statutory criteria related to
> this goal
>
> **Performance Indicator Value:** Numerator divided by Denominator
> expressed as percentage or actual number if not percentage (numerator
> and denominator not required).
>
> **Sources of Information**: data bases from which data was reported
>
> **Special Issues**: any special issues or considerations that relate
> to the indicator
>
> **Significance**: importance of indicator to the overall State Plan
>
> **Action Plan**: activity or activities to be undertaken to achieve
> the target.
>
> \(b\) Children's Mental Health Plan
>
> \(i\) Current Activities
>
> States should describe their child mental health service system in a
> narrative that addresses Criteria 1, 2, 3, 4, & 5 of Table 3 above.
> Narratives for each criterion should convey the extent to which the
> services required under the criterion have been implemented.
>
> \(ii\) Goals, Targets and Action Plans
>
> States are unable to collect and report the data for any of the tables
> from which the NOMS are constructed, a narrative explanation must be
> provided which will include: 1) The current status of the capacity to
> collect this data, 2) efforts underway to make collection of the data
> possible, and 3) a projected date for when the data will be available.
>
> For each indicator, States must show the data for the past two years
> (to the extent that it is available), and project a specific target
> for the next year. The most common table format for presenting
> indicators is provided below.

Performance Indicator Table for State Plan

These tables are included in WebBGAS.

**Name of Performance Indicator:**

**Population:**

**Criterion:**

+----------------+-------+-------+-------+-------+---------+---------+
| \(1\)          | \(2\) | \(3\) | \(4\) | \(5\) | \(6\)   | \(7\)   |
+----------------+-------+-------+-------+-------+---------+---------+
| Fiscal         | F     | F     | F     | FY    | FY      | FY      |
|                | Y2005 | Y2006 | Y2007 | 2008  | 2009\*  | 2010\*  |
| Year           |       |       |       |       |         |         |
|                | A     | A     | Proj  | T     | Target  | Target  |
|                | ctual | ctual | ected | arget |         |         |
+----------------+-------+-------+-------+-------+---------+---------+
| Performance    |       |       |       |       |         |         |
|                |       |       |       |       |         |         |
| Indicator      |       |       |       |       |         |         |
+----------------+-------+-------+-------+-------+---------+---------+
| Numerator\*\*  |       |       | \-\-- | \-\-- | \-\--   | \-\--   |
+----------------+-------+-------+-------+-------+---------+---------+
| D              |       |       | \-\-- | \-\-- | \-\--   | \-\--   |
| enominator\*\* |       |       |       |       |         |         |
+----------------+-------+-------+-------+-------+---------+---------+

> [\* Targets for FY 2009 & FY 2010 are required only for multi-year
> plans.]{.underline}
>
> [\*\*Numerator and Denominator are not required for
> Targets.]{.underline}
>
> [Table Descriptors:]{.underline}
>
> **Name of Performance Indicator**: Brief name of the performance
> indicator (*e.g*., Increased Access to Services); **clearly label
> transformation outcome measures*.***
>
> **Goal:** broad, general description of what the State hopes to
> accomplish
>
> **Target:** a specific, measurable, and expected outcome to be
> achieved within a defined period of time, and if attained, is expected
> to contribute to the realization of the goal.
>
> **Population:** group targeted by this goal
>
> **Criterion:** One of more of the five statutory criteria related to
> this goal
>
> **Performance Indicator Value:** Numerator divided by Denominator and
> expressed as a percentage or actual number if not percentage
> (numerator and denominator not required)
>
> **Source of Information:** data bases from which data was reported
>
> **Special Issues: a**ny special issues or considerations related to
> the indicator
>
> **Significance:** importance of indicator to the overall State Plan
>
> **Action Plan: a**ctivity or activities to be undertaken to achieve
> the target

**PART D. Implementation Report**

Number range CHAPTERThis section will contain the State Plan
Implementation Report for FY 2008 as required by the PHS Act[^18] Number
range CHAPTERStates are requested to prepare and submit their
implementation reports for the last completed FY in the format provided
in this guidance. This will contain a report on the purposes for which
the Community Mental Health Services Block Grant monies were
expended**,** the recipients of grant funds, and a description of block
grant-funded activities.[^19] The report shall focus on the extent to
which the State has implemented its plan for the FY, with particular
attention given to the goals and performance indicators. This section
should also contain any comments from the mental health planning
council, preferably in the form of a letter.[^20] The Data Tables
(presented in Part E) are included as a component of the Implementation
Report.

All States and Territories are requested to use WebBGAS to submit State
implementation reports. If sending hard copies, mail the original and
two copies to LouEllen M. Rice, Grants Management Officer, Division of
Grants Management, OPS, SAMHSA, 1 Choke Cherry Road, Room 7-1091,
Rockville, Maryland 20857 by December 3, 2008 (for overnight/express
mail, use zip code "20850"). Please note that if your implementation
report is not received in the Office of Grants Management by December 1,
your State [will not]{.underline} receive a grant for the year
indicated.

**I. Narrative Content of the Implementation Report**

> 1\) [Report Summary]{.underline}

-   Areas which the State identified in the prior FY's approved Plan as
    needing improvement;

-   The most significant events that impacted the mental health system
    of the State in the previous FY; and

-   A report on the purposes for which the block grant monies for State
    FY were expended, the recipients of grant funds, and a description
    of activities funded by the grant*,*

**II. Performance Indicators**

1\) **Performance Indicators.** States are required to complete the
Performance **Indicator Tables for the Implementation Report** as
presented below**.** The purpose of this table is to show progress made
toward the CMHS NOMS and data for the State-selected performance
indicators. and the CMHS NOMS over time. Each indicator should include
narrative regarding: Activities and strategies/changes/innovations or
exemplary model; and Target Achieved or Not Achieved /If Not,
Explaination of Why.

**Performance Indicator Table for Implementation Plan**

**Name of Performance Indicator:**

**Population:**

**Criterion:**

+--------------+----------+----------+----------+----------+----------+
| \(1\)        | \(2\)    | \(3\)    | \(5\)    | \(6\)    | \(7\)    |
+--------------+----------+----------+----------+----------+----------+
| Fiscal       | FY2005   | FY2006   | FY 2007  | FY2007   | FY 2007  |
|              |          |          | Target   |          |          |
| Year         | Actual   | Actual   |          | Actual   | \%       |
|              |          |          |          |          | Attained |
+--------------+----------+----------+----------+----------+----------+
| Performance  |          |          |          |          |          |
|              |          |          |          |          |          |
| Indicator    |          |          |          |          |          |
+--------------+----------+----------+----------+----------+----------+
| Numerator    |          |          | \-\--    |          | \-\--    |
+--------------+----------+----------+----------+----------+----------+
| Denominator  |          |          | \-\--    |          | \-\--    |
+--------------+----------+----------+----------+----------+----------+

> [Table Descriptors:]{.underline}
>
> **Name of Performance Indicator**: Brief name of the performance
> indicator (*e.g*., Increased Access to Services**); clearly label
> transformation outcome measures**.
>
> **Goal:** broad, general description of what the State hopes to
> accomplish
>
> **Target:** a specific, measurable, and expected outcome to be
> achieved within a defined period of time, and if attained, is expected
> to contribute to the realization of the goal.
>
> **Population:** group targeted by this goal
>
> **Criterion:** One of more of the five statutory criteria related to
> this goal
>
> **Performance Indicator Value:** Numerator divided by Denominator and
> expressed as a percentage or actual number if not percentage
> (numerator and denominator not required)
>
> **Source of Information:** data bases from which data was reported
>
> **Special Issues: a**ny special issues or considerations related to
> the indicator
>
> **Significance:** importance of indicator to the overall State Plan
> activities and strategies/changes/innovations or exemplary model.

Activities and strategies/changes/innovations or exemplary model

Target Achieved or Not Achieved /If Not, Explanation of Why.

######## III. Accomplishments

This section should be integrated with the data presentation above. For
each of the targets and corresponding performance indicators, the State
should provide a brief narrative containing the following information:

-   Documentation of the activities under each indicator for each
    criterion. This shall include data to support the State's report
    about its accomplishments for each target and performance indicator
    identified in the Plan for the prior FY.

-   Description of activities and strategies the State used to address
    the performance indicator;

-   Any changes in the implementation strategy described in the Plan for
    the prior State FY;

-   Any innovative or exemplary model of mental health service delivery
    that the State developed, and its unique features;

-   At the end of each indicator's narrative, the report should clearly
    state whether or not the particular target identified in the Plan
    for the prior State FY for adults with SMI or children with SED was
    "achieved" or "not achieved"; and

-   If the targets were "not achieved," explain why.

### PART E: Uniform Data on the Public Mental Health System

This section guides States in the reporting of uniform data on public
mental health services in the State (with special focus on community
mental health services) [in a series of basic and developmental data
tables]{.mark}. [The completion of Part E is a term and condition for
funding for States and Territories that were awarded Data Infrastructure
Grants; all States and Territories that accepted the grant agreed to
submit Part E as part of the FY Implementation Report]{.mark}. States
that did not receive a Data Infrastructure Grant are encouraged to
submit data under Part E of the guidance. [If a State cannot provide
data in tables, the State must indicate its reporting capacity in the
State Level Data Reporting Capacity Checklist. To ensure uniformity, the
data reported shall be based on the data definitions agreed to in the
Mental Health Data Infrastructure Project. States are requested to
report data based on the last completed fiscal year.]{.mark}

[]{.mark}

Background of CMHS Uniform Reporting System

The CMHS's Uniform Reporting System began in 2001 and has completed
three rounds of state and national reporting. It is used by State mental
health agencies to compile and report annual data from each State as
part of the Community Mental Health Services Block rant. The reporting
effort demonstrates that the state public mental health systems provide
mental health services to 5.7 million persons each year. Data from the
URS has shown that persons served by the SMHA systems are more often
unemployed, receiving Medicaid assistance, and are frequently children
and young adults. Persons served by SMHAs are most often served in
community mental health settings and generally rate their access,
appropriateness, and outcomes of services as positive. State mental
health agencies expended over \$26 billion to provide mental health
services in FY 2003.

The URS comprises a set of 21 tables developed by CMHS, in consultation
with state mental health agencies, that compiles annual state by state
and national aggregate information including numbers and
socio-demographic characteristics of persons served by the states, the
outcomes of care, use of selected evidence based practices, client
assessment of care, and insurance status. In addition, the URS tables
compile information on the expenditures of SMHAs, local programs that
receive MHBG funds, uses of MHBG funds and general questions on the SMHA
system status. These tables are now used by SAMHSA to calculate the 10
mental health National Outcome Measures (NOMS) for state and national
reporting. The URS also includes prevalence estimates for need of mental
health services by states.

The URS reporting is the first national annual aggregate report of State
mental health public systems, and is a product of the SAMHSA/CMHS State
Mental Health Data Infrastructure Grants initiated in 2001. The State
Mental Health Data Infrastructure Grants are part of the SAMHSA/CMHS
initiative designed to support development of data infrastructure in
State Mental Health Agencies across the country that will improve
capacity for States to report URS measures annually. The URS measures
are incorporated into the CMHS Mental Health Block Grant guidance and
required to be reported to CMHS with the annual Implementation reports,
which includes benchmarking or targeting of State planning.

Uniform data on the public mental health system are required to improve
planning and oversight of community mental health services provided
under the Community Mental Health Services Block Grant. In addition to
the DIG**,** the Block Grant enhances the capacity of community mental
health systems in each state. The flexible funding of the Block Grant
allows States to fund gap-filling, new and innovative services. To
understand the extent to which the Block Grant is valued and used, it is
critical that both CMHS and the State Mental Health Authorities (SMHAs)
have accurate and uniform data on the public mental health system in
each State. Towards this end, the data requested in the tables described
in this Section answer five basic questions:

1\) What are the mental health service needs of the population in your
State?

2\) Who in your State gets access to publicly funded mental health
services?

3\) What types of services are being provided in your State?

4\) What are the outcomes of the services provided? and

5\) What financial resources are expended for the services?

All client data will be aggregated at the State level. No individual
client data is requested or should be submitted to CMHS. State
identifiers are required for each table. CMHS, working with its
contractor, the National Association of State Mental Health Program
Directors (NASMHPD) National Research Institute (NRI), will create all
derived measures from the primary data provided by the States. CMHS will
also review the State-submitted data and make requests for revision,
clarification, or additional information as appropriate from the State
MHAs. After the final review and analysis of the data is completed, CMHS
will make State-by-State data profiles available, as well as summary
tables that examine performance across all States for selected data
elements. Until the development of the URS, SAMHSA/CMHS lacked a common
set of reporting guidelines for the services provided by states under
the Block Grant which made it difficult for SAMHSA/CMHS to summarize the
activities across all the states.

**Revisions to Tables in the Uniform Reporting System**

**The proposed revisions to the URS Tables have been developed by CMHS
in conjunction with the States who report these measures to CMHS in the
Implementation Report. Over the past three years, CMHS has used the DIG
process to refine the URS Tables by sponsoring monthly conference
meetings with the DIG grantees to review and assess changes to the URS
measures. The revised tables reflect consensus on how reporting of these
measures should be made more meaningful to States while providing
SAMHSA/CMHS the necessary outcome data for the NOMS. The tables include
one major revision to Table 9 and minor revisions to ten (10) tables,
Tables 2, 4, 6, 11, 14, 16, 17, 19, 20, & 21. All revisions to the
tables reflect a collaborative effort by CMHS and the States to further
improve the States' capacity to collect and report data on the NOMS. The
minor revisions to the tables are self-explanatory and represent a
collected effort to make the data more meaningful to CMHS and the
States. Table 7 below describes the revisions to the URS tables.**

**Table 6**

+------+--------------------------+------+----------------------------+
| **R  |                          |      |                            |
| evis |                          |      |                            |
| ions |                          |      |                            |
| to   |                          |      |                            |
| Ta   |                          |      |                            |
| bles |                          |      |                            |
| in   |                          |      |                            |
| the  |                          |      |                            |
| Uni  |                          |      |                            |
| form |                          |      |                            |
| R    |                          |      |                            |
| epor |                          |      |                            |
| ting |                          |      |                            |
| Sy   |                          |      |                            |
| stem |                          |      |                            |
| T    |                          |      |                            |
| able |                          |      |                            |
| D    |                          |      |                            |
| escr |                          |      |                            |
| ipti |                          |      |                            |
| on** |                          |      |                            |
+------+--------------------------+------+----------------------------+
| **T  | **Table Name**           | **   | **Revision**               |
| able |                          | Chan |                            |
| N    |                          | ge** |                            |
| o.** |                          |      |                            |
+------+--------------------------+------+----------------------------+
| T    | Profile of State         | No   |                            |
| able | Population by Diagnosis  | Ch   |                            |
| 1    |                          | ange |                            |
+------+--------------------------+------+----------------------------+
| T    | Total Unduplicated       | M    | Combine Age 0-3 with Age   |
| able | Served by Age, Gender, & | inor | 4-12                       |
| 2    | Race                     |      |                            |
+------+--------------------------+------+----------------------------+
| T    | Total Served by Setting, | No   |                            |
| able | by Age & Gender          | Ch   |                            |
| 3    |                          | ange |                            |
+------+--------------------------+------+----------------------------+
| T    | Employment               | M    | Add Optional Table 4a.     |
| able |                          | inor | Reporting of Employment    |
| 4    |                          |      | Status by 5 Diagnostic     |
|      |                          |      | Groupings                  |
+------+--------------------------+------+----------------------------+
| T    | Medicaid Status          | No   |                            |
| able |                          | Ch   |                            |
| 5    |                          | ange |                            |
+------+--------------------------+------+----------------------------+
| T    | Profile of Client Flow   | M    | Add Column for Length of   |
| able | and Turnover             | inor | Stay for clients in        |
| 6    |                          |      | facility more than 1 year  |
+------+--------------------------+------+----------------------------+
| T    | State MH Expenditures    | No   |                            |
| able | and Revenues             | C    |                            |
| 7    |                          | hang |                            |
|      |                          | e\-- |                            |
+------+--------------------------+------+----------------------------+
| T    | Profile of Community     | No   |                            |
| able | MHBG Expenditures        | Ch   |                            |
| 8    |                          | ange |                            |
+------+--------------------------+------+----------------------------+
| T    | Public Mental Health     | M    | New table, Social          |
| able | Service System Inventory | ajor | Connectedness and Improved |
| 9    | List (Deleted in 2005)   |      | Functioning added for      |
|      |                          |      | SAMHSA's newest NOMS.      |
+------+--------------------------+------+----------------------------+
| T    | Profile of Agencies      | No   |                            |
| able | receiving MHBG Funds     | Ch   |                            |
| 10   |                          | ange |                            |
+------+--------------------------+------+----------------------------+
| T    | Consumer Evaluation of   | M    | Add revisions to tables    |
| able | Care                     | inor | and questions to clarify   |
| 11   |                          |      | survey instrument and      |
|      |                          |      | methodology used to        |
|      |                          |      | collect data for this      |
|      |                          |      | domain if the recommended  |
|      |                          |      | survey was not used.       |
+------+--------------------------+------+----------------------------+
| T    | State Mental Health      | No   |                            |
| able | Agency Profile           | Ch   |                            |
| 12   |                          | ange |                            |
+------+--------------------------+------+----------------------------+
| T    | Untreated Prevalence of  | No   | Continue as developmental  |
| able | Mental Illness           | Ch   | until refined by DIG       |
| 13   |                          | ange | Workgroup                  |
+------+--------------------------+------+----------------------------+
| T    | Adults with SMI & SED    | M    | Combine Age 0-3 with Age   |
| able | served by Age, gender,   | inor | 4-12                       |
| 14   | Race, & Ethnicity        |      |                            |
+------+--------------------------+------+----------------------------+
| T    | Living Situation Profile | No   |                            |
| able |                          | Ch   |                            |
| 15   |                          | ange |                            |
+------+--------------------------+------+----------------------------+
| T    | EBPs                     | M    | Add two questions at the   |
| able |                          | inor | end of each EBP:           |
| 16   |                          |      |                            |
|      |                          |      | 1). Did the State use the  |
|      |                          |      | SAMHSA Toolkit to guide    |
|      |                          |      | implementation? 2) Has     |
|      |                          |      | staff been specifically    |
|      |                          |      | trained to implement the   |
|      |                          |      | EBP?                       |
+------+--------------------------+------+----------------------------+
| T    | EBPs                     | M    | Add two questions at the   |
| able |                          | inor | end of each EBP:           |
| 17   |                          |      |                            |
|      |                          |      | 1\) Did the State use the  |
|      |                          |      | SAMHSA Toolkit to guide    |
|      |                          |      | implementation? 2) Has     |
|      |                          |      | staff been specifically    |
|      |                          |      | trained to implement the   |
|      |                          |      | EBP?                       |
+------+--------------------------+------+----------------------------+
| T    | Use of New Generation    | No   |                            |
| able | Atypical Antipsychotics  | Ch   |                            |
| 18   |                          | ange |                            |
+------+--------------------------+------+----------------------------+
| T    | Outcomes: Criminal       | M    | Add new questions for two  |
| able | Justice & School         | inor | CMHS NOMS: Arrests, and    |
| 19   | Attendance               |      | School Attendance          |
+------+--------------------------+------+----------------------------+
| T    | 30 and 180 day state     | M    | Combine Age 0-3 with Age   |
| able | hospital readmissions    | inor | 4-12                       |
| 20   |                          |      |                            |
+------+--------------------------+------+----------------------------+
| T    | 30 and 180 day           | M    | Combine Age 0-3 with Age   |
| able | readmission to any psych | inor | 4-12                       |
| 21   | bed                      |      |                            |
+------+--------------------------+------+----------------------------+

**Rationale for Major Revisions to Table 9**

**Table 9 -- Social Connectedness and Improved Functioning. A
determination was made in FY 2005 by the DIG Workgroup and CMHS to not
report the Public Mental Health Service System Inventory List due to
amount of time involved and the repetitious nature of the data element.
The replacement Table 9 allows States to report SAMHSA's newest NOMS,
"social connectedness" and "improved functioning." Both measures are
currently in developmental status and as each measure is further defined
by SAMHSA, States will receive updates to support their reporting
efforts in these areas.**

**Attachment A**

**COMMUNITY MENTAL HEALTH SERVICES BLOCK GRANT FUNDING AGREEMENTS**

FISCAL YEAR 2008

I hereby certify that
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
agrees to comply with the following sections of Title V of the Public
Health Service Act \[42 U.S.C. 300x-1 [et]{.underline}
[seq]{.underline}.\]

**Section 1911:**

Subject to Section 1916, the State[^21] will expend the grant only for
the purpose of:

> i\. Carrying out the plan under Section 1912(a) \[State Plan for
> Comprehensive
>
> Community Mental Health Services\] by the State for the fiscal year
> involved:
>
> ii\. Evaluating programs and services carried out under the plan; and
>
> iii\. Planning, administration, and educational activities related to
> providing services under the plan.

**Section 1912**

> (c)(1)& (2) \[As a funding agreement for a grant under Section 1911 of
> this title\] The Secretary establishes and disseminates definitions
> for the terms "adults with a serious mental illness" and "children
> with a severe emotional disturbance" and the States will utilize such
> methods \[standardized methods, established by the Secretary\] in
> making estimates \[of the incidence and prevalence in the State of
> serious mental illness among adults and serious emotional disturbance
> among children\].

**Section 1913:**

> (a)(1)(C) In the case for a grant for fiscal year 2008, the State will
> expend for such system \[of integrated services described in section
> 1912(b)(3)\] not less than an amount equal to the amount expended by
> the State for the fiscal year 1994.
>
> \[A system of integrated social services, educational services,
> juvenile services and substance abuse services that, together with
> health and mental health services, will be provided in order for such
> children to receive care appropriate for their multiple needs (which
> includes services provided under the Individuals with Disabilities
> Education Act)\].
>
> (b)(1) The State will provide services under the plan only through
> appropriate, qualified community programs (which may include community
> mental health centers, child mental-health programs, psychosocial
> rehabilitation programs, mental health peer-support programs, and
> mental-health primary consumer-directed programs).
>
> (b)(2) The State agrees that services under the plan will be provided
> through community mental health centers only if the centers meet the
> criteria specified in subsection (c).
>
> (C)(1) With respect to mental health services, the centers provide
> services as follows:
>
> \(A\) Services principally to individuals residing in a defined
> geographic area (referred to as a "service area")
>
> \(B\) Outpatient services, including specialized outpatient services
> for children, the elderly, individuals with a serious mental illness,
> and residents of the service areas of the centers who have been
> discharged from inpatient treatment at a mental health facility.

\(C\) 24-hour-a-day emergency care services.

> \(D\) Day treatment or other partial hospitalization services, or
> psychosocial rehabilitation services.
>
> \(E\) Screening for patients being considered for admissions to State
> mental health facilities to determine the appropriateness of such
> admission.
>
> \(2\) The mental health services of the centers are provided, within
> the limits of the capacities of the centers, to any individual
> residing or employed in the service area of the center regardless of
> ability to pay for such services.
>
> \(3\) The mental health services of the centers are available and
> accessible promptly, as appropriate and in a manner which preserves
> human dignity and assures continuity and high quality care.

**Section 1914:**

> The State will establish and maintain a State mental health planning
> council in accordance with the conditions described in this section.

\(b\) The duties of the Council are:

> \(1\) to review plans provided to the Council pursuant to section
> 1915(a) by the State involved and to submit to the State any
> recommendations of the Council for modifications to the plans;
>
> \(2\) to serve as an advocate for adults with a serious mental
> illness, children with a severe emotional disturbance, and other
> individuals with mental illness or emotional problems; and
>
> \(3\) to monitor, review, and evaluate, not less than once each year,
> the allocation and adequacy of mental health services within the
> State.
>
> (c)(1) A condition under subsection (a) for a Council is that the
> Council is to be composed of residents of the State, including
> representatives of:

\(A\) the principle State agencies with respect to:

> \(i\) mental health, education, vocational rehabilitation, criminal
> justice, housing, and social services; and
>
> \(ii\) the development of the plan submitted pursuant to Title XIX of
> the Social Security Act;
>
> \(B\) public and private entities concerned with the need, planning,
> operation, funding, and use of mental health services and related
> support services;
>
> \(C\) adults with serious mental illnesses who are receiving (or have
> received) mental health services; and

\(D\) the families of such adults or families of children with emotional
disturbance.

\(2\) A condition under subsection (a) for a Council is that:

> \(A\) with respect to the membership of the Council, the ratio of
> parents of children with a serious emotional disturbance to other
> members of the Council is sufficient to provide adequate
> representation of such children in the deliberations of the Council;
> and
>
> \(B\) not less than 50 percent of the members of the Council are
> individuals who are not State employees or providers of mental health
> services.

**Section 1915:**

> (a)(1) State will make available to the State mental health planning
> council for its review under section 1914 the State plan submitted
> under section 1912(a) with respect to the grant and the report of the
> State under section 1942(a) concerning the preceding fiscal year.
>
> \(2\) The State will submit to the Secretary any recommendations
> received by the State from the Council for modifications to the State
> plan submitted under section 1912(a) (without regard to whether the
> State has made the recommended modifications) and comments on the
> State plan implementation report on the preceding fiscal year under
> section 1942(a).
>
> (b)(1) The State will maintain State expenditures for community mental
> health services at a level that is not less than the average level of
> such expenditures maintained by the State for the 2-year period
> preceding the fiscal year for which the State is applying for the
> grant.

**Section 1916:**

\(a\) The State agrees that it will not expend the grant:

\(1\) to provide inpatient services;

\(2\) to make cash payments to intended recipients of health services;

> \(3\) to purchase or improve land, purchase, construct, or permanently
> improve (other than minor remodeling) any building or other facility,
> or purchase major medical equipment;
>
> \(4\) to satisfy any requirement for the expenditure of non-Federal
> funds as a condition of the receipt of Federal funds; or
>
> \(5\) to provide financial assistance to any entity other than a
> public or nonprofit entity.
>
> \(b\) The State agrees to expend not more than 5 percent of the grant
> for administrative expenses with respect to the grant.

**Section 1941:**

> The State will make the plan required in section 1912 as well as the
> State plan implementation report for the preceding fiscal year
> required under Section 1942(a) public within the State in such manner
> as to facilitate comment from any person (including any Federal or
> other public agency) during the development of the plan (including any
> revisions) and after the submission of the plan to the Secretary.

**Section 1942:**

> \(a\) The State agrees that it will submit to the Secretary a report
> in such form and containing such information as the Secretary
> determines (after consultation with the States) to be necessary for
> securing a record and description of:
>
> \(1\) the purposes for which the grant received by the State for the
> preceding fiscal year under the program involved were expended and a
> description of the activities of the State under the program; and

\(2\) the recipients of amounts provided in the grant.

> \(b\) The State will, with respect to the grant, comply with Chapter
> 75 of Title 31, United Stated Code. \[Audit Provision\]

\(c\) The State will:

> \(1\) make copies of the reports and audits described in this section
> available for public inspection within the State; and
>
> \(2\) provide copies of the report under subsection (a), upon request,
> to any interested person (including any public agency).

**Section 1943:**

\(a\) The State will:

> (1)(A) for the fiscal year for which the grant involved is provided,
> provide for independent peer review to assess the quality,
> appropriateness, and efficacy of treatment services provided in the
> State to individuals under the program involved; and
>
> \(B\) ensure that, in the conduct of such peer review, not fewer than
> 5 percent of the entities providing services in the State under such
> program are reviewed (which 5 percent is representative of the total
> population of such entities);
>
> \(2\) permit and cooperate with Federal investigations undertaken in
> accordance with section 1945 \[Failure to Comply with Agreements\];
> and
>
> \(3\) provide to the Secretary any data required by the Secretary
> pursuant to section 505 and will cooperate with the Secretary in the
> development of uniform criteria for the collection of data pursuant to
> such section
>
> \(b\) The State has in effect a system to protect from inappropriate
> disclosure patient records maintained by the State in connection with
> an activity funded under the program involved or by any entity, which
> is receiving amounts from the grant.

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

Governor Date

# 

**Attachment B. Certifications**

<http://www.mhbg.samhsa.gov/certification.pdf>

# Attachment C. Disclosure of Lobbying Activities

<http://www.mhbg.samhsa.gov/disclosure.pdf>

# 

# 

# 

# 

# 

# 

# 

# Attachment D. Assurances

# [**http://www.mhbg.samhsa.gov/assurance.pdf**](http://www.mhbg.samhsa.gov/assurance.pdf)

# 

# Attachment E 

# 

**FACE SHEET**

**COMMUNITY MENTAL HEALTH SERVICES BLOCK GRANT**

> **\_\_\_\_\_ FY 2008**

STATE NAME:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
DUNS #: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Number range CHAPTER**I. AGENCY TO RECEIVE GRANT**

AGENCY:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

ORGANIZATIONAL UNIT:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

STREET ADDRESS:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

CITY: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_STATE:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ ZIP:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TELEPHONE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ FAX:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

II\. OFFICIAL IDENTIFIED BY GOVERNOR AS RESPONSIBLE FOR ADMINISTRATION
OF THE GRANT

NAME: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
TITLE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

AGENCY
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

ORGANIZATIONAL UNIT:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

STREET ADDRESS:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

CITY:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_STATE:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
ZIP: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TELEPHONE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ FAX:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**III. STATE FISCAL YEAR**

FROM: \_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_ TO:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Month Year Month Year

**IV. PERSON TO CONTACT WITH QUESTIONS REGARDING THE APPLICATION**

NAME:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
TITLE:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

AGENCY:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

ORGANIZATIONAL
UNIT:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

STREET
ADDRESS:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

CITY:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_STATE:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
ZIP: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TELEPHONE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_ FAX:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ EMAIL:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Appendix I. Format for Table of Contents**

**TABLE of CONTENTS**

**STATE MENTAL HEALTH BLOCK GRANT APPLICATIONS and PLANS**

####### Face Sheet

**Executive Summary**

**PART B. Administrative Requirements, Fiscal Planning Assumptions, and
Special Guidance**

> I. Federal Funding Agreements, Certifications and Assurances
>
> \(1\) Funding Agreements
>
> \(2\) Certifications
>
> \(3\) Assurances
>
> II\. Set-Aside for Children's Mental Health Services Report
>
> III\. Maintenance of Effort Report (MOE)
>
> IV\. State Mental Health Planning Council Requirements
>
> 1\. Membership Requirements
>
> 2\. State Mental Health Planning Council Membership List and
> Composition
>
> 3\. Planning Council Charge, Role and Activities
>
> 4\. State Mental Health Planning Council Comments and Recommendations
>
> 5\. Public Comments on the State Plan

**PART C. State Plan**

> Section I. Description of State Service System
>
> Section II. Identification and Analysis of the Service System's
> Strengths, Needs, and Priorities
>
> a\) Adult Mental Health System
>
> b\) Children's Mental Health System
>
> Section III. Performance Goals and Action Plans to Improve the Service
> System
>
> a\) Adult Plan

1)  Current Activities

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i.  Comprehensive community-based mental health services

ii. Mental health system data epidemiology

iii. Not applicable

iv. Targeted services to rural, homeless, and older adult populations

v.  Management systems

```{=html}
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```
2)  Goals, Targets and Action Plans

> b\) Children's Plan
>
> 1\) Current Activities

i.  Comprehensive community-based mental health services

ii. Mental health system data epidemiology

iii. Children's services

iv. Targeted services to rural, homeless, and older adult populations

v.  Management systems

> 2\) Goals, Targets and Action Plans

####### Part D. Implementation Report

> I. Narrative Content of the Implementation Report
>
> II\. Performance Indicators
>
> III\. Accomplishments

####### Part E. Uniform Data on Public Mental Health System

URS Tables

**Attachments**

A. Federal Funding Agreements

B. Certifications

C. Disclosure of Lobbying Activities

D. Assurances

**[Appendix II.]{.underline}**

**[CMHS Uniform Reporting System Guidelines]{.underline}**

**Scope of Reporting:**

Based on the discussions by State workgroups and input provided by state
representatives during the regional conference calls, guidelines have
been developed for the scope of reporting. A basic tenet is that the
"scope" will represent the mental health "system" that comes under the
auspices of the state mental health agency.

This approach resulted in concern regarding comparisons that might be
made across states that might have disparate mandates and dissimilar
systems. After much discussion, the decision regarding scope was that
representation of the state mental health agency system was more
critical than comparability across states. The principle proposed was
that there needed to be common understanding that these data could not
be used to compare states but could be used to track a state's
performance across time and to produce U.S. totals.

Major points of discussion were how persons served under Medicaid and
through support of local dollars would be counted. For both these areas,
persons would be counted insofar as they were considered part of the
state mental health agency system and received services from programs
funded or operated by the state mental health agency. Persons would be
counted if they could be identified and had received a face-to-face
service in the reporting period.

More specifically, the following guidelines should be used for including
and counting people in the URS:

1 Include all persons served directly by the state mental health agency
(including persons who received services funded by Medicaid)

2 Include all persons in the system for whom the state mental health
agency contracts for services (including persons whose services are
funded by Medicaid).

3 Include any other persons who are counted as being served by the state
mental health agency or come under the auspices of the state mental
health agency system. This includes Medicaid waivers, if the mental
health component of the waiver is considered to be part of the SMHA
system.

4 Count all identified persons who have received mental health services,
including screening, assessment, and crisis services. Telemedicine
services should be counted if they are provided to identify clients.

5 For states where a separate state agency is responsible for children's
mental health, where feasible, efforts should be made to unduplicated
clients between the child mental health agency and the adult mental
health agency. If this induplication is not feasible, please report this
potential duplication to indicate there is an overlap between the Age
"0-17 group" and the Age "18 and over group" but that there is
induplication within each group.

**Persons who would not be included in the URS Tables:**

1 Persons who just received a telephone contact would not be included,
unless it was a telemedicine service to a registered client. Hotline
calls to anonymous clients should not be counted.

2 Persons who only received a Medicaid‑funded mental health service
through a provider who was not part of the SMHA system would not be
included.

3 Persons who only received a service through a private provider or
medical provider not funded by the SMHA would not be included.

4 Persons with a single diagnosis of substance abuse or mental
retardation should not be included. All persons with a diagnosis of
mental illness should be counted, including persons with a co-occurring
diagnosis of substance abuse or mental retardation.

**URS Tables**

**These updated tables have been prepared by the CMHS-funded State Data
Infrastructure Coordinating Center (SDICC) at the NASMHPD Research
Institute, Inc. For additional information about the EBP Reporting
Guidelines, please contact Vijay Ganju at <vkganju@gmail.com>. For other
questions about the tables, please contact Ted Lutterman at 703-682-9463
([ted.lutterman@nri-inc.org]{.underline})**

**Table 1: Profile of the State Population by Diagnosis**

This table summarizes the estimates of adults residing within the State
with serious mental illness (SMI) and children residing within the state
with serious emotional disturbances (SED). The table calls for estimates
for two time periods, one for the report year and one for three years
into the future. CMHS will provide this data to States based on the
standardized methodology developed and published in the Federal Register
and the State level estimates for both adults with SMI and children with
SED.

  -------------- --------------------------- --------------- ----------------
  Table 1.                                                    

  Report Year:                                                

  State                                                       
  Identifier:                                                

                                             **Current       **Three Years
                                             Report Year**   Forward**

  Adults with                                                 
  Serious Mental                                             
  Illness (SMI)                                              

  Children with                                               
  Serious                                                    
  Emotional                                                  
  Disturbances                                               
  (SED)                                                      
  -------------- --------------------------- --------------- ----------------

**Note: This Table will be completed for the States by CMHS.**

**Table 2A: Profile of Persons Served, All Programs by Age, Gender and
Race/Ethnicity**

This table provides an aggregate profile of persons in the reporting
year. The reporting year should be the latest state fiscal year for
which data are available. This profile is based on a client receiving
services in programs provided or funded by the state mental health
agency. The client profile takes into account all institutional and
community services for all such programs. Please provide unduplicated
counts if possible.

![](media/image2.wmf){width="10.197916666666666in" height="2.84375in"}

![](media/image3.wmf){width="10.1875in" height="1.36875in"}

**Instructions for Tables 2A and 2B:**

1 Include all persons served directly by the state mental health agency
(including persons whose services are funded by Medicaid)

2 Include all persons in the system for whom the state mental health
agency contracts for services (including persons whose served are funded
by Medicaid).

3 Include any other persons who are counted as being served by the state
mental health agency or come under the auspices of the state mental
health system. This includes Medicaid waivers, if the waiver is run by
the SMHA.

4 Count all identified persons who have received a mental health
services, including screening, assessment, and crisis services.

5 For state where a separate state agency is responsible for children's
mental health, unduplicated between the two child and adult agency when
feasible. Otherwise, recognize and indicate that there is overlap
between the 0-17 group and the 18 and over group but that there is
induplication within each group.

6 The "Hispanic" category on Table 2A allows for states to report if
they do not currently compile Hispanic Origin as a separate question.
States that track Hispanic Origin as a separate category should report
on Table 2B instead of Table 2A.

CMHS has sent out to the States a notice from the Federal Office of
Management and Budget (OMB) regarding how all Federal Agencies must
collect race and ethnicity information. The OMB rules allow for two
tables as set up on Table 2a and 2b. One focuses on race: White, Black,
Asian, Native Hawaiian and Other Pacific Islander, American Indian and
Alaska Native, Multiple Race, Other Race, and Race Unknown. A separate
second table will collect information on Hispanic or Latino Origin. This
is the format recommended in the Basic Tables.

The OMB standard is different from the way many states historically
compile Race and Ethnicity data in three (3) key areas:

1)  Native Hawaiian or other Pacific Islander (NHPI) is a new category
    that was previously compiled as part of Asian. This NHPI category
    now needs to be collected separately by states.

2)  Multiple Race: Programs now need to allow persons to identify
    multiple racial categories. Thus, a reporting category of More than
    one Race needs to be compiled by SMHAs. OMB specifies that Multiple
    Race should NOT be collected by adding a "Multiple Race" option, but
    rather that it should be identified by the selection of multiple
    racial categories: i.e., the list of White, Asian, Black, Native
    Hawaiian, and American Indian should allow multiple categories to be
    selected.

3)  Ethnicity: Hispanic or Latino Origin should be compiled separately
    from the "race" categories collected above. The URS Tables are set
    up this way with Table 2B and Table 5B collecting data on the number
    of persons of Hispanic or Latino Origin.

CMHS has discussed the implications of this OMB standard for URS/DIG
grants and URS Reporting: The OMB standard means that the 3 categories
discussed above must become part of SAMHSA and all other Federal data
collection. However, CMHS/SAMHSA realizes that states will need time to
modify the reporting categories of race and ethnicity. Therefore, the
Year 2 Basic Tables will continue to include an option for states to
report "Hispanic" within the "Race" categories on Table 2A (and Table
5A). However, CMHS expects that states will start changing their MIS to
reflect the new OMB guidance and will eventually be able to report the
new categories.

If a person is identified as a combination of racial groups (e.g., white
and black), that person should be counted only once and should be
reported in the "more than one race" category.

**Table 2B. Profile of Persons Served, All Programs by Age, Gender and
Race/Ethnicity**

Of the total persons served, please indicate the age, gender and the
number of persons who are Hispanic/Latino or not Hispanic/Latino. Total
persons served would be the total as indicated in Table 2A.

![](media/image4.wmf){width="9.872916666666667in"
height="4.279166666666667in"}

**Table 3: Profile of Persons served in the community mental health
setting, State Psychiatric Hospitals and Other Settings**

This table provides a profile for the clients that received public
funded mental health services in community mental health settings, in
state psychiatric hospitals, in other psychiatric inpatient programs,
and in residential treatment centers for children.

![](media/image5.wmf){width="10.000694444444445in"
height="4.291666666666667in"}

*Note: Clients can be duplicated between Rows: E.g., The same client may
be served in both state psychiatric hospitals and community mental
health centers during the same year and thus would be reported in counts
for both rows.*

**Instructions:**

1.  States that have county psychiatric hospitals that serves as
    surrogate state hospitals should report persons served in such
    settings as receiving services in state hospitals.

2.  If forensic hospitals are part of the state mental health agency
    system include them.

3.  Persons who receive non-inpatient care in state psychiatric
    hospitals should be included in the Community MH Program Row.

4.  Persons who receive inpatient psychiatric care through a private
    provider or medical provider licensed and/or contracted through the
    SMHA should be counted in the \"Other Psychiatric Inpatient\" row.
    Persons who receive Medicaid funded inpatient services through a
    provider that is not licensed or contracted by the SMHA should not
    be counted here.

5.  A person who is served in both community settings and inpatient
    settings should be included in both rows.

6.  RTC: CMHS has a standardized definition of RTC for Children: "An
    organization, not licensed as a psychiatric hospital, whose primary
    purpose is the provision of individually planned programs of mental
    health treatment services in conjunction with residential care for
    children and youth primarily 17 years old and younger. It has a
    clinical program that is directed by a psychiatrist, psychologist,
    social worker, or psychiatric nurse who has a master's degree or
    doctorate. The primary reason for the admission of the clients is
    mental illness that can be classified by DSM-IV codes-other than the
    codes for mental retardation, developmental disorders, and
    substance-related disorders such as drug abuse and alcoholism
    (unless these are co-occurring with a mental illness)."

**Table 4: Profile of Adult Clients by Employment Status**

This table describes the status of adult clients served in the report
year by the public mental health system in terms of employment status.
The focus is on employment for the working age population, recognizing,
however, that there are clients who are disabled, retired or who
homemakers, care-givers, are etc and not a part of the workforce. These
persons should be reported in the "Not in Labor Force" category. This
category has two subcategories: retired and other. (The totals of these
two categories should equal the number in the row for "Not in Labor
Force".) Unemployed refers to persons who are looking for work but have
not found employment. Data should be reported for clients in
non-institutional settings at time of discharge or last evaluation.

> ![](media/image6.wmf){width="9.629166666666666in"
> height="4.404861111111111in"}

**Instructions:**

1\. Employed means competitively employed, part-time or full-time.
Supported Employment and transitional employment, where consumer's work
in competitive employment situations should be reported as "employed".
Informal labor, for cash, i.e. day labor is counted as employed.

2\. Sheltered employment should be reported as "Not in Labor Force".

3\. Employment status should be reported for persons served in community
settings.

4\. Latest known status of employment should be reported.

**Table 4a: Optional Profile of Adult Clients by Employment Status: by
Primary Diagnosis Reported**

This is a new table for 2006. The workgroup exploring employment found
that the primary diagnosis of consumers results in major differences in
employment status. The workgroup has recommended that we explore the
ability of states to report employment by primary diagnosis and the
impact of diagnosis on employment. The workgroup recommended 5
diagnostic clusters for reporting.

![](media/image7.wmf){width="9.622222222222222in"
height="4.658333333333333in"}

Number range CHAPTER**Table 5A: Profile of Clients by Type of Funding
Support**

This table provides a summary of clients by Medicaid coverage. Since the
focus of the reporting is on clients of the public mental health service
delivery system, this table focuses on the clientele serviced by public
programs that are funded or operated by the State Mental Health
Authority. Persons are to be counted in the Medicaid row if they
received a service reimbursable through Medicaid.

Please note that the same person may be served in both Medicaid and
Non-Medicaid programs during the same reporting period.

![](media/image8.wmf){width="9.997916666666667in"
height="3.0097222222222224in"}

Each row should have a unique (unduplicated) count of clients: (1)
Medicaid Only, (2) Non-Medicaid Only, (3) Both Medicaid and Other
Sources funded their treatment, and (4) Medicaid Status Not Available).

If a state is unable to unduplicate between People whose care is paid by
Medicaid, then they should report all data into the People Served by
Both Medicaid and Other Sources and would check the box, People Served
by Both is a duplicated count.

Number range CHAPTER**Table 5B: Profile of Clients by Type of Funding
Support**

Of the total persons covered by Medicaid, please indicate the gender and
number of persons who are Hispanic/Latino or not Hispanic/Latino. Total
persons covered by Medicaid would be the total indicated in Table 5A.

![](media/image9.wmf){width="10.001388888888888in"
height="4.034722222222222in"}

Each row should have a unique (unduplicated) count of clients: (1)
Medicaid Only, (2) Non-Medicaid Only, (3) Both Medicaid and Other
Sources funded their treatment, and (4) Medicaid Status Unknown).

If a state is unable to unduplicate between People whose care is paid by
Medicaid, then they should report all data into the People Served by
Both Medicaid and Other Sources and would check the box, People Served
by Both is a duplicated count.

Number range CHAPTER**Table 6: Profile of Client Turnover**

![](media/image10.wmf){width="9.877777777777778in"
height="5.554861111111111in"}

**Instructions:**

1.  This table reflects client flow and turnover.

2.  Column 1 represents an unduplicated count of all persons receiving
    services in state hospitals and all persons receiving services at
    the start of the reporting period. This includes all people who are
    on the active books as patients at the start of the year.

3.  Column 2 is all additions or new admissions during the reporting
    period. If a person has multiple admissions during that reporting
    period, all admissions will be counted.

4.  Again as in Table 2, there may be duplication across age categories,
    depending on the state's ability to unduplicate between children and
    adult systems of care.

5.  Column 3 is all discharges during the reporting period. If a person
    has multiple discharges during that reporting period, all discharges
    will be counted.

6.  As in table 3, there may be duplication across the state hospital
    section and the community section.

7.  Changed for 2006:

> A: New Column for Length of Stay for clients in facility more than 1
> year. Persons in the hospital for exactly 1 year should be reported in
> the prior columns of persons in hospital for less than one year.
>
> B: Added "Adults" and "Age Not Available" row to "Residential
> Treatment Centers" to allow reporting of use of Residential Treatment
> Centers by Adults (over age 18). This category was added because
> several states reported that their RTCs for Children had some persons
> age 18 or over in them and they lacked a place to report them. (The
> intent of allowing reporting of adults in RTC-Children was not to open
> a new reporting category of residential settings for adults, but to
> allow states with adults in RTC-C to report those adults.

**Number range CHAPTERTable 7: Profile of Mental Health Service
Expenditures and Sources of Funding**

This table describes expenditures for public mental health services
provided or funded by the State mental health agency by source of
funding.

**[This Table will be completed by the NASMHPD Research Institute (NRI)
using data from the FY 2005 SMHA-Controlled Revenues and Expenditures
Study]{.mark}**

> ![](media/image11.wmf){width="6.763194444444444in"
> height="4.041666666666667in"}

Note: The data in this table are derived from the National Association
of State Mental Health Program Directors Research Institute, Inc\'s
State Mental Health Agency-Controlled Revenues and Expenditures Study.
FY\'2005 Data for this table is currently being compiled by the NRI.

Number range CHAPTER**Table 8: Profile of Community Mental Health Block
Grant Expenditures for Non-Direct Service Activities**

This table is used to describe the use of CMHS BG funds for non-direct
service activities that are sponsored, or conducted, by the State Mental
Health Authority.

> ![](media/image12.wmf){width="7.528472222222222in"
> height="2.654166666666667in"}

**Instructions:**

1.  States should only report on the expenditures of the CMHBG by the
    SMHA or programs that they directly contract with.

2.  States should not report on expenditures by programs more than
    one-level down from the State in funding: e.g., if a state provides
    CMHBG funds to county mental health authorities, which in turn
    contract with private, not-for-profit mental health providers, only
    the expenditures by the SMHA and the county mental health
    authorities should be reported in this table.

**Table 9: SAMHSA NOMS: SOCIAL CONNECTEDNESS AND IMPROVED FUNCTIONING**

> ![](media/image13.wmf){width="8.504166666666666in"
> height="6.088888888888889in"}

New Optional Table 9 for 2006: Optional Reporting of 2 CMHS National
Outcome Measures: Social Connectedness and Functioning

This Table permits states who implemented the recommended NOMS modules
on "Social Connectedness" and/or "Improved Functioning" as part of their
2006 Consumer Surveys to report results for these NOMS

**Recommended Scoring Rules**

Please use the same rules for reporting Social connectedness and
Functioning Domain scores as for calculating other Consumer Survey
Domain scores for Table 11: E.g.:

1.  Recode ratings of "not applicable" as missing values.

2.  Exclude respondents with more than 1/3 of the items in that domain
    missing.

3.  Calculate the mean of the items for each respondent.

4.  FOR ADULTS: calculate the percent of scores less than 2.5 (percent
    agree and strongly agree).

5.  FOR YSS-F: calculate the percent of scores greater than 3.5 (percent
    agree and strongly agree).

**Items to Score:**

**Adult MHSIP Social Connectedness Domain:**

> 1\. I am happy with the friendships I have.
>
> 2\. I have people with whom I can do enjoyable things.
>
> 3\. I feel I belong in my community.
>
> 4\. In a crisis, I would have the support I need from family or
> friends.

**Adult MHSIP Functioning Domain:**

1.  I do things that are more meaningful to me.

2.  I am better able to take care of my needs.

3.  I am better able to handle things when they go wrong.

4.  I am better able to do things that I want to do.

5.  My Symptoms are not bothering me as much (already is part of the
    MHSIP Adult Survey)

**YSS-F Social Connectedness Domain Items:**

> 1\. I know people who will listen and understand me when I need to
> talk
>
> 2\. I have people that I am comfortable talking with about my child\'s
> problems.
>
> 3\. In a crisis, I would have the support I need from family or
> friends.
>
> 4\. I have people with whom I can do enjoyable things

**YSS-F Functioning Domain Items:**

1.  My child is better able to do things he or she wants to do.

2.  My child is better at handling daily life. (existing YSS-F Survey
    item)

3.  My child gets along better with family members. (existing YSS-F
    Survey item)

4.  My child gets along better with friends and other people. (existing
    YSS-F Survey item)

5.  My child is better able to cope when things go wrong. (existing
    YSS-F Survey item)

> *Note: the YSS-F functioning domain relies on 4 items that are also
> used in calculating the YSS-F "Outcomes Domain".*

Number range CHAPTERNumber range CHAPTER**Table 10: Profile of Agencies
Receiving Block Grant Funds Directly from the SMHA.**

This table is to be used to provide an inventory of providers/agencies
who directly receive Block Grant allocations**.**

Only report those programs that receive MHBG funds to provide services.
Do not report planning council member reimbursements or other
administrative reimbursements related to running the MHBG Program.

![](media/image14.wmf){width="6.99375in" height="5.747222222222222in"}

Only one row for each program

\* If you need more lines for additional agencies, please add rows or
make copies of this table.

**Table 11: Summary Profile of Client Evaluation of Care.**

![](media/image15.wmf){width="6.998611111111111in" height="8.59375in"}

![](media/image16.wmf){width="6.998611111111111in"
height="8.343055555555555in"}

![](media/image17.wmf){width="6.916666666666667in"
height="8.999305555555555in"}

**Instructions:**

1)  Scoring of domains: States should use the approach for calculating
    domain scores developed for the 16-State Study and 5-State Study.
    Domain scores should only be calculated using surveys that had 2/3
    or more of the items complete for that domain.

2)  Report the number of "positive" responses and the total number of
    responses for each domain instead of just collecting the percent
    responding positive, i.e., instead of reporting 75% positive, states
    would report they had received 75 positive responses and 100 total
    responses for that domain. The reason for the collection of numbers
    is it will allow better analysis of data across states and at
    national levels.

3)  States should report confidence intervals at the domain level. In
    year 1, states were asked to report confidence intervals for the
    overall survey. However, it was discussed that actual confidence
    levels should be calculated for each domain, since each domain may
    have a different number of valid responses. Confidence intervals
    should be reported at the 95% level. Directions on how to calculate
    confidence intervals are included on Table 11, along with a website
    that will assist states in this calculation.

4)  Question 1 on the use of the MHSIP consumer survey: if a state or
    program conducted the MHSIP consumer survey using the wording from
    the "official" 28 item adult MHSIP survey, then the state should
    check that they used the official version. If a state added
    additional questions to the survey, but added them after the
    original 28 items, then they are still doing the official MHSIP
    survey. However, if a state modified the wording of the official
    28-item MHSIP, or added questions in the middle of the 28 items,
    then the state should check that they did a "state variation of
    MHSIP).

5)  Sample Approach: Question 2a: A random sample is a sample where
    everyone has an equal chance of being selected and the person doing
    the selection has no way of choosing who is selected. A state that
    surveys all consumers or all consumers in a particular program is
    not conducting a random sample. The options are: 1) random, 2)
    stratified random sample 3) convenience 4) all consumers.

6)  Changed for 2006:

    a.  If States conducted a Family survey other than the Recommended
        YSS-F, what survey did they use?

    b.  Response categories related to method of survey were expanded to
        allow the option of Face-to-Face/Self Administered (requested by
        states that hand surveys to clients to complete and may help
        them answer them.)

        **[Adult Consumer Surveys:]{.underline}**

        The MHSIP Survey is the preferred instrument to compile results.
        The official 28 Item version of MHSIP is the recommended
        version. If some other version of the MHSIP Survey is used,
        individual items should be combined to calculate indicator
        scores using the questions listed below. CMHS and the MHSIP
        Policy Group, and the DIG Consumer Survey Workgroup also
        recommend reporting of data for the two optional factors from
        the full 28 Item MHSIP Survey: Participation in Treatment
        Planning and General Satisfaction: The following are
        recommendations that relate to the Adult Survey.

```{=html}
<!-- -->
```
1)  Statewide Surveys: States should only report consumer survey results
    from surveys that are conducted on a statewide basis---preferably
    surveys conducted with a "scientific" sampling technique.

    a.  States that only have pilot data or only data from a few
        providers or a region of the state should not report data.

    b.  States should use a centrally conducted survey---i.e.,
        individual community providers should not each conduct their own
        surveys with the state reporting aggregate results.

    c.  States should describe their sampling methodology when they
        submit data.

2)  Sample Size: a sufficient sample size ("n") should be collected for
    surveys to be reported. States are requested to report the
    confidence interval and confidence levels for their surveys. States
    should use a sufficient sample size to report results at high
    confidence levels.

3)  Specific Questions to Use: Based on the assumption that most states
    (currently over 40 states) are using either the official 28 item
    MHSIP Consumer Survey, or a variant of the MHSIP Consumer Survey,
    the Workgroup recommends states report results based on the official
    28 survey items used by the 16 State Study for calculating scores
    for the 5 domains (2 domains are optional)

    a.  MHSIP Consumer Survey: **Perception of Access**

        i.  The location of services was convenient.

        ii. Staff was willing to see me as often as I felt it was
            necessary.

        iii. Staff returned my calls within 24 hours.

        iv. Services were available at times that were good for me.

        v.  I was able to get all the services I thought I needed \*

        vi. I was able to see a psychiatrist when I wanted to \*

    b.  MHSIP Consumer Survey: **Perception of Quality and
        Appropriateness**

        i.  Staff believed that I could grow, change and recover.

        ii. I felt free to complain.

        iii. Staff told what side effects to watch for.

        iv. Staff respected my wishes about who is and is not to be
            given information about my treatment.

        v.  Staff was sensitive to my cultural/ethnic background.

        vi. Staff helped me obtain the information needed so I could
            take charge of managing my illness.

        vii. I was give information about my rights

        viii. Staff encouraged me to take responsibility for how I live
              my life. \*

        ix. I was encouraged to use consumer-run programs. \*

    c.  MHSIP Consumer Survey: **Perceptions of Outcomes:**

        i.  I deal more effectively with daily problems.

        ii. I am better able to control my life.

        iii. I am better able to deal with crisis.

        iv. I am getting along better with my family.

        v.  I do better in social situations.

        vi. I do better in school and/or work.

        vii. My symptoms are not bothering me as much.

        viii. My housing situation has improved. \*

    d.  MHSIP Consumer Survey: **Perception of Participation in
        Treatment Planning** (Optional)

        i.  I felt comfortable asking questions about my treatment and
            medications.

        ii. I, not staff, decided my treatment goals.

    e.  MHSIP Consumer Survey: **General Satisfaction** (Optional)

        i.  I liked the services that I received here.

        ii. If I had other choices, I would still get services at this
            agency.

        iii. I would recommend this agency to a friend or family member.

    f.  New Module for **Social Connectedness** (reported on Table 9)

        i.  I am happy with the friendships I have.

        ii. I have people with whom I can do enjoyable things.

        iii. I feel I belong in my community.

        iv. In a crisis, I would have the support I need from family or
            friends.

    g.  New Module for Adult MHSIP **Functioning** Domain: (reported on
        Table 9)

        i.  I do things that are more meaningful to me.

        ii. I am better able to take care of my needs.

        iii. I am better able to handle things when they go wrong.

        iv. I am better able to do things that I want to do.

        v.  My Symptoms are not bothering me as much (Note: This
            question is used in both the "Outcomes Domain" and the
            "Functioning Domain")

\* Items noted with an \* are items from the full 28 Item Adult MHSIP
Consumer Survey that should be used to calculate domain scores. Items
marked with an \* were not used in the 16 State Study. States that do
not have the full 28 Items from the Official MHSIP Consumer Survey
should report results based on those items in each domain that they
have.

***Scoring:***

1.  Recode ratings of "not applicable" as missing values.

2.  Exclude respondents with more than 1/3 of the items **in that domain
    missing.**

3.  Calculate the mean of the items for each respondent.

4.  Calculate the percent of scores less than 2.5. (Percent agree and
    strongly agree).

    **Additional reporting to add to Table 11:**

-   The workgroup has suggested adding an **optional** reporting of
    consumer survey results by consumer characteristics.

-   States should report Consumer Survey Results for each domain by
    Race/ethnicity in addition to the Total rate currently requested in
    Table 11.

-   States should use the same categories as in other URS Tables.

-   Patient categories should not be cross tabs: e.g., report results
    for age, then for race, not age by race.

-   States should only report results for patient categories when there
    are at least 25 or 30 subjects in the category, i.e., do not report
    results for very small "n" categories.

    **[Children/Adolescent Consumer Surveys:]{.underline}**

    The workgroup recommends using the Family version (YSS-F) for
    reporting on Table 11. If states want to conduct the adolescent
    survey (YSS), that would be reported as an option. This would
    require adding a third column to Table 11 to accommodate the second
    child survey.

    Questions for each Domain for the YSS-F Survey are as follows:

> ***Good Access to Service:***

-   The location of services was convenient for us.

-   Services were available at times that were convenient for us.

> ***Satisfaction with Services:***

-   Overall, I am satisfied with the services my child received

-   The people helping my child stuck with us no matter what.

-   I felt my child had someone to talk to when he/she was troubled.

-   The services my child and/or family received were right for us.

-   My family got the help we wanted for my child.

-   My family got as much help as we needed for my child.

> ***Positive Outcomes of Services:***

-   My child is better at handling daily life.

-   My child gets along better with family members.

-   My child gets along better with friends and other people.

-   My child is doing better in school and/or work.

-   My child is better able to cope when things go wrong.

-   I am satisfied with our family life right now.

> ***Participation in Treatment:***

-   I helped to choose my child's services.

-   I helped to choose my child's treatment goals.

-   I was frequently involved in my child's treatment.

> ***Cultural Sensitivity:***

-   Staff treated me with respect.

-   Staff respected my family\'s religious/spiritual beliefs.

-   Staff spoke with me in a way that I understood.

-   Staff were sensitive to my cultural/ethnic background.

> **New YSS-F Social Connectedness Domain Items: (reported on Table 9)**
>
> 1\. I know people who will listen and understand me when I need to
> talk
>
> 2\. I have people that I am comfortable talking with about my child\'s
> problems.
>
> 3\. In a crisis, I would have the support I need from family or
> friends.
>
> 4\. I have people with whom I can do enjoyable things
>
> **New YSS-F Functioning Domain Items: (reported on Table 9)**

1.  My child is better able to do things he or she wants to do.

2.  My child is better at handling daily life. *(also used for the YSS-F
    "Outcomes Domain")*

3.  My child gets along better with family members. *(also used for the
    YSS-F "Outcomes Domain")*

4.  My child gets along better with friends and other people. *(also
    used for the YSS-F "Outcomes Domain")*

5.  My child is better able to cope when things go wrong. *(also used
    for the YSS-F "Outcomes Domain")*

*Note: the calculation of the YSS-F "Functioning Domain" uses many of
the survey items that are also used for the "Outcomes Domain".*

***Scoring:***

1.  Exclude respondents with more missing values than allowed per
    factor:

2.  Calculate the mean of the items for each respondent.

3.  Calculate the percent of scores greater than 3.5 (percent agree and
    strongly agree).

    ***Numerator:*** Total number of respondents with an average scale
    score \> 3.5.

    ***Denominator:*** Total number of respondents.

> **Table 11a: Consumer Evaluation of Care by Consumer Characteristics:
> (Optional Table by Race/Ethnicity.)**

## ![](media/image18.wmf){width="9.3125in" height="6.760416666666667in"}

Number range CHAPTER**Table 12: State Mental Health Agency Profile**

The purpose of this profile is to obtain information that provides a
context for the data provided in the tables. This profile covers the
populations served, services for which the state mental health agency is
responsible, data reporting capacities, especially related to
duplication of numbers served as well as certain summary administrative
information.

![](media/image19.wmf){width="6.9375in" height="5.972916666666666in"}

![](media/image20.wmf){width="6.9375in" height="8.066666666666666in"}

![](media/image21.wmf){width="6.9375in" height="5.472916666666666in"}

**Table 13: Profile of Unmet Needs of the State Population**

This table provides estimates of adults with serious mental illness and
children with serious emotional disturbances that have unmet service
needs. This table is to be completed based on a standardized unmet needs
estimation methodology being developed by the Center for Mental Health
Services. CMHS will provide the methodology for estimating unmet needs
to each State.

+-------------------------------+------------------+------------------+
| **Table 13.**                 |                  |                  |
+-------------------------------+------------------+------------------+
| **Report Year:**              |                  |                  |
+-------------------------------+------------------+------------------+
| **State Identifier:**         |                  |                  |
+-------------------------------+------------------+------------------+
|                               |                  |                  |
+-------------------------------+------------------+------------------+
|                               | **Current Report | **Three Years    |
|                               | Year**           | Forward**        |
+-------------------------------+------------------+------------------+
| **Adults with Serious Mental  | ***Note Table is | ***Note Table is |
| Illness (SMI)**               | Still being      | Still being      |
|                               | Operationally    | Operationally    |
|                               | Defined***       | Defined***       |
|                               |                  |                  |
|                               | ***Do not report | ***Do not report |
|                               | data in 2005***  | data in 2005***  |
|                               |                  |                  |
|                               |                  | ***Note Table is |
|                               |                  | Still being      |
|                               |                  | Operationally    |
|                               |                  | Defined***       |
|                               |                  |                  |
|                               |                  | ***Do not report |
|                               |                  | data in 2004***  |
+-------------------------------+------------------+------------------+
| **Children with Serious       | ***Note Table is | ***Note Table is |
| Emotional**                   | Still being      | Still being      |
|                               | Operationally    | Operationally    |
| **Disturbances (SED)**        | Defined***       | Defined***       |
|                               |                  |                  |
|                               | ***Do not report | ***Do not report |
|                               | data in 2005***  | data in 2005***  |
+-------------------------------+------------------+------------------+

Number range CHAPTER

**Issue:** Note States should not report data for this indicator in
2006. SAMHSA \[has stated that they\] will provide this estimation
methodology for states.

The Workgroup for this Table will be working with CMHS on a proposed
methodology. The Workgroup is currently focusing on estimating: **The
number of Persons likely to use public services who are unserved?**
(i.e., count of persons near the poverty level (\~200%) with a SMI who
are not served minus count of persons served in the public mental health
system)

**Table 14A: Profile of Persons with SMI/SED served by Age, Gender and
Race/Ethnicity**

This is a developmental table similar to Table 2A and 2B. This table
requests counts for persons with SMI or SED using the definitions
provided by the CMHS. Table 2A and 2B included all clients served by
publicly operated or funded programs. This table counts only clients who
meet the CMHS definition of SMI or SED. For many states, this table may
be the same as Tables 2A and 2B.States should report using the Federal
Definitions of SMI and SED if they can report them, if not, please
report using your state's definitions of SMI and SED and provide
information below describing your state's definition.

![](media/image22.wmf){width="9.500694444444445in"
height="3.1277777777777778in"}

![](media/image23.wmf){width="9.245833333333334in"
height="1.101388888888889in"}

# Table 14B: Profile of Persons Served, All Programs by Age, Gender and Race/Ethnicity

Of the total persons served, please indicate the age, gender and the
number of persons who meet the Federal definition of SMI and SED and who
are Hispanic/Latino or not Hispanic/Latino. The total persons served who
meet the Federal definition of SMI or SED should be the total as
indicated in Number range CHAPTERTable 14 A.

![](media/image24.wmf){width="9.247916666666667in"
height="3.7840277777777778in"}Number range CHAPTER

**Table 15: Living Situation Profile:**

Number of Clients in Each Living Situation as Collected by the Most
Recent Assessment in the Reporting Period. All Mental Health Programs by
Age, Gender, and Race/Ethnicity

*Please provide unduplicated counts, if possible. This table provides an
aggregate profile of persons served in the reporting year. The reporting
year should be the latest state fiscal year for which data are
available. This profile is based on a client.*

![](media/image25.wmf){width="7.245138888888889in"
height="4.580555555555556in"}

**[Living Situation Definitions:]{.underline}**

***Private Residence:*** Individual lives in a house, apartment,
trailer, hotel, dorm, barrack, and/or Single Room Occupancy (SRO).

***Foster Home:*** Individual resides in a Foster Home. A Foster Home is
a home that is licensed by a County or State Department to provide
foster care to children, adolescents, and/or adults. This includes
Therapeutic Foster Care Facilities. Therapeutic Foster Care is a service
that provides treatment for troubled children within private homes of
trained families.

***Residential Care:*** Individual resides in a residential care
facility. This level of care may include a Group Home, Therapeutic Group
Home, Board and Care, Residential Treatment, or Rehabilitation Center,
or Agency-operated residential care facilities.

***Crisis Residence:*** A residential (24 hours/day) stabilization
program that delivers services for acute symptom reduction and restores
clients to a pre-crisis level of functioning. These programs are time
limited for persons until they achieve stabilization. Crisis residences
serve persons experiencing rapid or sudden deterioration of social and
personal conditions such that they are clinically at risk of
hospitalization but may be treated in this alternative setting.

***Children's Residential Treatment Facility:*** Children and Youth
Residential Treatment Facilities (RTF\'s) provide fully-integrated
mental health treatment services to seriously emotionally disturbed
children and youth. An organization, not licensed as a psychiatric
hospital, whose primary purpose is the provision of individually planned
programs of mental health treatment services in conjunction with
residential care for children and youth. The services are provided in
facilities which are certified by state or federal agencies or through a
national accrediting agency.

***Institutional Setting:*** Individual resides in an institutional care
facility with care provided on a 24 hour, 7 day a week basis. This level
of care may include a Skilled Nursing/Intermediate Care Facility,
Nursing Homes, Institutes of Mental Disease (IMD), Inpatient Psychiatric
Hospital, Psychiatric Health Facility (PHF), Veterans Affairs Hospital,
or State Hospital.

***Jail/ Correctional Facility:*** Individual resides in a Jail and/or
Correctional facility with care provided on a 24 hour, 7 day a week
basis. This level of care may include a Jail, Correctional Facility,
Detention Centers, Prison, Youth Authority Facility, Juvenile Hall, Boot
Camp, or Boys Ranch.

***Homeless:*** A person should be counted in the \"Homeless\" category
if he/she was reported homeless at their most recent (last) assessment
during the reporting period (or at discharge for patients discharged
during the year). The "last" Assessment could occur at Admission,
Discharge, or at some point during treatment. A person is considered
homeless if he/she lacks a fixed, regular, and adequate nighttime
residence and/or his/her primary nighttime residency is:

A\) A supervised publicly or privately operated shelter designed to
provide temporary living accommodations,

B\) An institution that provides a temporary residence for individuals
intended to be institutionalized, or

C\) A public or private place not designed for, or ordinarily used as, a
regular sleeping accommodation for human beings (e.g., on the street).

***Not Available:*** Information on an individual's residence is not
available.

![](media/image26.wmf){width="7.190277777777778in"
height="8.752777777777778in"}

**DATA INFRASTRUCTURE GRANTS**

**Guidelines for Reporting Evidence-Based Practices**

**Number range CHAPTERTable 16: Profile of Adults with Serious Mental
Illnesses and Children with Serious Emotional Disturbances Receiving
Specific Services:**

**Table 17: Profile of Adults with Serious Mental Illnesses Receiving
Specific Services during the Year:**

**[PURPOSE]{.underline}**

The purpose of this document is to provide guidelines for reporting
evidence-based practices (EBPs) on the Uniform Reporting System (URS)
that is part of SAMHSA's Center for Mental Health Services (CMHS)
Community Mental Health Block Grant Reporting. Up to this point,
guidelines have been relatively broad: states have elected to report
their activities in the evidence-based practices categories if they were
providing services that conformed to the definitions provided. In some
cases, states that were implementing EBPs with fidelity did not report
data because they thought that comparisons with states (or the national
averages produced) that were not implementing the EBP with fidelity
could be interpreted negatively. In other cases, states that were not
monitoring fidelity chose not to report. The purpose of these guidelines
is to help states assess whether their particular services align with
the critical components of specific EBPs for DIG reporting.

**[DEVELOPMENT OF GUIDELINES]{.underline}**

To get data that were more systematically uniform and that conformed
better with the evidence-based form of the practice, CMHS charged the
DIG Coordinating Center to convene a sub-group of state representatives
to develop a set of guidelines for reporting EBPs recognizing that many
states were not monitoring fidelity for many of the EBPs.

That is, at this stage, requiring fidelity was considered too stringent
and restrictive for purposes of reporting EBPs on the URS tables. Many
states are currently moving forward with the implementation of EBPs and
the objective of these guidelines is to facilitate reporting of these
state activities. The charge to the group essentially was to develop
guidelines based on fidelity that could remove some of the ambiguity of
what could be counted under this category.

To proceed with this task, a subset of state representatives involved
with the Data Infrastructure Grants initiative was identified as the EBP
workgroup. They convened several times on conference calls; draft
recommendations were presented and reviewed by all states on the
regional monthly DIG calls. Based on these activities, draft guidelines
that are provided in this report were developed.

**[Please note:]{.underline}** **In no sense are these intended to be a
revised definition of the practice or an identification of a new set of
fidelity measures or critical elements. These guidelines are to help
states identify whether they should report their activities in these
tables or not. The intent is to obtain information if states are moving
forward with implementation of the evidence-based form of the
practice.**

**[USE OF GUIDELINES FOR DIG REPORTING]{.underline}**

As stated above, the intent of these guidelines is to provide guidance
for states to decide whether they should report data on EBPs. They are
not intended to be prescriptive or to set inflexible boundaries, but to
indicate whether the services being reported conform broadly to the
evidence-based practices. As reporting takes place, these guidelines are
expected to be revised and refined over time.

**ASSERTIVE COMMUNITY TREATMENT**

I.  **DEFINITION**

> A team based approach to the provision of treatment, rehabilitation
> and support services. ACT/PACT models of treatment are built around a
> self-contained multi-disciplinary team that serves as the fixed point
> of responsibility for all patient care for a fixed group of clients.
> In this approach, normally used with clients with severe and
> persistent mental illness, the treatment team typically provides all
> client services using a highly integrated approach to care. Key
> aspects are low caseloads and the availability of the services in a
> range of settings. The service is a recommended practice in the PORT
> study (Translating Research Into Practice: The Schizophrenia Patient
> Outcomes Research Team (PORT) Treatment Recommendations, Lehman,
> Steinwachs and Co-Investigators of Patient Outcomes Research Team,
> Schizophrenia Bulletin, 24(1):1-10, 1998) and is cited as a practice
> with strong evidence based on controlled, randomized effectiveness
> studies in the Surgeon General\'s report on mental health (Mental
> Health: A Report of the Surgeon General, December, 1999, Chapter 4,
> \"Adults and Mental Health, Service Delivery, Assertive Community
> Treatment\"). Additionally, CMS (formerly HCFA) recommended that state
> Medicaid agencies consider adding the service to their State Plans in
> HCFA Letter to State Medicaid Directors, Center for Medicaid and State
> Operations, June 07, 1999.
>
> **II. FIDELITY MEASURE**
> <http://mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/community/>

III. **MINIMUM REQUIREMENTS FOR REPORTING ACT**

     -   [Small caseload]{.underline}: Client/ provider ratio of 10:1 or
         fewer is the ideal.

     -   [Multidisciplinary team approach]{.underline}: This is a team
         approach rather than an approach which emphasizes services by
         individual providers. The team should be multidisciplinary and
         could include a psychiatrist, nurse, substance abuse
         specialist. For reporting purposes, there should be at least 3
         FTE on the team

     -   [Includes clinical component]{.underline}: In addition to case
         management, the program directly provides services such as:
         psychiatric services, counseling / psychotherapy, housing
         support, substance abuse treatment, employment/rehabilitative
         services.

     -   [Services provided in community settings]{.underline}: Program
         works to monitor status, develop community living skills in the
         community rather than the office.

     -   [Responsibility for crisis services]{.underline}: Program has
         24-hour responsibility for covering psychiatric crises.

```{=html}
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```
IV. **ACT IS [NOT]{.underline} INTENSIVE CASE MANAGEMENT**

> **Note: If specific EBPs are provided as a component of ACT, they
> should be reported under ACT and not separately under other practices.
> In the revised version of the tables, please check off the EBPs that
> are provided under ACT. (Please note that to report these as EBPs;
> they should conform to the reporting guidelines for each EBP provided
> in this document.)**

**SUPPORTED EMPLOYMENT**

I.  **DEFINITION**

> Mental Health Supported Employment (SE) is an evidence-based service
> to promote rehabilitation and return to productive employment for
> persons with serious mental illnesses. SE programs use a team approach
> for treatment, with employment specialists responsible for carrying
> out all vocational services from intake through follow-along. Job
> placements are: community-based (i.e., not sheltered workshops, not
> onsite at SE or other treatment agency offices), competitive (i.e.,
> jobs are not exclusively reserved for SE clients, but open to public),
> in normalized settings, and utilize multiple employers. The SE team
> has a small client: staff ratio. SE contacts occur in the home, at the
> job site, or in the community. The SE team is assertive in engaging
> and retaining clients in treatment, especially utilizing face-to-face
> community visits, rather than phone or mail contacts. The SE team
> consults/works with family and significant others when appropriate. SE
> services are frequently coordinated with Vocational Rehabilitation
> benefits.
>
> **II.** **FIDELITY MEASURE**
> <http://mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/employment/>
>
> **III.** **MINIMUM REQUIREMENTS FOR REPORTING SUPPORTED EMPLOYMENT**

-   [Competitive employment]{.underline}: Employment specialists provide
    competitive job options that have permanent status rather than
    temporary or time-limited status. Employment is competitive so that
    potential applicants include persons in the general population.

-   [Integration with treatment]{.underline}: Employment specialists are
    part of the mental health treatment teams with shared decision
    making. They attend regular treatment team meetings (not replaced by
    administrative meetings) and have frequent contact with treatment
    team members.

-   [Rapid job search]{.underline}: The search for competitive jobs
    occurs rapidly after program entry.

-   [Eligibility based on consumer choice (not client
    characteristics)]{.underline}: No eligibility requirements such as
    job readiness, lack of substance abuse, no history of violent
    behavior, minimal intellectual functioning, and mild symptoms.

-   [Follow--along support]{.underline}: Individualized follow-along
    supports are provided to employer and client on a time-unlimited
    basis. Employer supports may include education and guidance. Client
    supports may include crisis intervention, job coaching, job
    counseling, job support groups, transportation, treatment changes
    (medication), and, networked supports (friends/family).

IV. **SUPPORTED EMPLOYMENT IS NOT**:

    -   Prevocational training

    -   Sheltered work

    -   Employment in enclaves (that is in settings, where only people
        with disabilities are employed)

    -   \[If an employment specialist is part of an ACT team, this
        should be reported under ACT and not separately as supported
        employment.\]

**SUPPORTED HOUSING**

I.  **DEFINITION**

> Services to assist individuals in finding and maintaining appropriate
> housing arrangements. This activity is premised upon the idea that
> certain clients are able to live independently in the community only
> if they have support staff for monitoring and/or assisting with
> residential responsibilities. These staff assists clients to select,
> obtain, and maintain safe, decent, affordable housing and maintain a
> link to other essential services provided within the community. The
> objective of supported housing is to help obtain and maintain an
> independent living situation.
>
> Supported Housing is a specific program model in which a consumer
> lives in a house, apartment or similar setting, alone or with others,
> and has considerable responsibility for residential maintenance but
> receives periodic visits from mental health staff or family for the
> purpose of monitoring and/or assisting with residential
> responsibilities. Criteria identified for supported housing programs
> include: housing choice, functional separation of housing from service
> provision, affordability, integration (with persons who do not have
> mental illness), and right to tenure, service choice, service
> individualization and service availability.
>
> **II. FIDELITY MEASURE** (Not currently available)
>
> **III. MINIMUM REQUIREMENTS FOR REPORTING SUPPORTED HOUSING**

-   [Target population]{.underline}: Targeted to persons who would not
    have a viable housing arrangement without this service.

-   [Staff assigned]{.underline}: Specific staff are assigned to provide
    supported housing services.

-   [Housing is integrated]{.underline}: That is, supported housing
    provided for living situations in settings that are also available
    to persons who do not have mental illnesses.

-   [Consumer has the right to tenure]{.underline}: The ownership or
    lease documents are in the name of the consumer.

-   [Affordability]{.underline}: Supported housing assures that housing
    is affordable (consumers pay no more than 30-40% on rent and
    utilities) through adequate rent subsidies, etc.

IV. **SUPPORTED HOUSING IS NOT**:

    -   Residential treatment services.

    -   A component of case management or ACT.

**FAMILY PSYCHO-EDUCATION**

I.  **DEFINITION**

> Family psycho-education is offered as part of an overall clinical
> treatment plan for individuals with mental illness to achieve the best
> possible outcome through the active involvement of family members in
> treatment and management and to alleviate the suffering of family
> members by supporting them in their efforts to aid the recovery of
> their loved ones. Family psycho-education programs may be either
> multi-family or single-family focused. Core characteristics of family
> psycho-education programs include the provision of emotional support,
> education, resources during periods of crisis, and problem-solving
> skills.
>
> **II.** **FIDELITY MEASURE**
>
> <http://mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/family/>
>
> **III.** **MINIMUM REQUIREMENTS FOR REPORTING FAMILY
> PSYCHO-EDUCATION**

-   A structured curriculum is used.

-   Psycho-education is a part of clinical treatment.

IV. **FAMILY PSYCHO-EDUCATION IS NOT:**

> Several mechanisms for family psycho-education exist. The
> evidence-based model, promoted through SAMHSA's EBP implementation
> resource kit ("toolkit") involves a clinician. For DIG reporting, do
> not include family psycho-education models not involving a clinician
> as part of clinical treatment.
>
> **Note: Some states are providing NAMI's Family-to-Family program and
> not the family psycho-education EBP described above. If a state is
> providing NAMI's Family-to-Family program, this should be reported
> under family psycho-education with an asterisk and a note indicating
> that the numbers reflect the NAMI program and not the EBP described
> above.**
>
> **INTEGRATED TREATMENT FOR CO-OCCURRING DISORDER**

**(MENTAL HEALTH / SUBSTANCE ABUSE)**

I.  **DEFINITION**

> Dual diagnosis treatments combine or integrate mental health and
> substance abuse interventions at the level of the clinical encounter.
> Hence, integrated treatment means that the same clinicians or teams of
> clinicians, working in one setting, provide appropriate mental health
> and substance abuse interventions in a coordinated fashion. In other
> words, the caregivers take responsibility for combining the
> interventions into one coherent package. For the individual with a
> dual diagnosis, the services appear seamless, with a consistent
> approach, philosophy, and set of recommendations. The need to
> negotiate with separate clinical teams, programs, or systems
> disappears. The goal of dual diagnosis interventions is recovery from
> two serious illnesses.
>
> **II. FIDELITY MEASURE**
> <http://mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/cooccurring/>
>
> **III.** **MINIMUM REQUIREMENTS FOR REPORTING INTEGRATED TREATMENT**

-   [Multidisciplinary team]{.underline}: A team of clinical, working in
    one setting provides MH and SA interventions in a coordinated
    fashion.

-   [Stagewise interventions]{.underline}: That is, treatment is
    consistent with each client's stage of recovery (engagement,
    motivation, action, relapse prevention)

IV. **INTEGRATED TREATMENT IS NOT**:

-   Coordination of clinical services across provider agencies

**ILLNESS MANAGEMENT / RECOVERY**

I.  **DEFINITION**

> Illness Self-Management (also called illness management or wellness
> management) is a broad set of rehabilitation methods aimed at teaching
> individuals with mental illness, strategies for collaborating actively
> in their treatment with professionals, for reducing their risk of
> relapses and re-hospitalizations, for reducing severity and distress
> related to symptoms, and for improving their social support. Specific
> evidence-based practices that are incorporated under the broad rubric
> of illness self-management are psycho-education about the nature of
> mental illness and its treatment, \"behavioral tailoring\" to help
> individuals incorporate the taking of medication into their daily
> routines, relapse prevention planning, teaching coping strategies to
> managing distressing persistent symptoms, cognitive-behavior therapy
> for psychosis, and social skills training. The goal of illness
> self-management is to help individuals develop effective strategies
> for managing their illness in collaboration with professionals and
> significant others, thereby freeing up their time to pursue their
> personal recovery goals.
>
> **II.** **FIDELITY MEASURE**
>
> <http://mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/illness/>
>
> **III.** **MINIMUM REQUIREMENTS FOR REPORTING ILLNESS MANAGEMENT &
> RECOVERY**

-   Service includes a specific curriculum that includes mental illness
    facts, recovery strategies, using medications, stress management and
    coping skills. It is critical that a specific curriculum is being
    used for these components to be counted for reporting.

IV. **EVIDENCE-BASED ILLNESS MANAGEMENT IS NOT**:

-   Advice related to self-care but a comprehensive, systematic approach
    to developing an understanding and a set of skills that help a
    consumer be an agent for his or her own recovery.

**MEDICATION MANAGEMENT**

I.  **DEFINITION**

> In the toolkit on medication management there does not appear to be
> any explicit definition of medication management. However the critical
> elements identified for evidence-based medication management
> approaches are the following:

1.  Utilization of a systematic plan for medication management

2.  Objective measures of outcome are produced

3.  Documentation is thorough and clear

4.  Consumers and practitioners share in the decision-making

> **II. FIDELITY MEASURE**
>
> <http://mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/>
>
> **III. MINIMUM REQUIREMENTS FOR REPORTING MEDICATION MANAGEMENT**

-   Treatment plan specifies outcome for each medication.

-   Desired outcomes are tracked systematically using standardized
    instruments in a way to inform treatment decisions.

-   Sequencing of antipsychotic medication and changes are based on
    clinical guidelines.

> **IV. EVIDENCE-BASED MEDICATION MANAGEMENT IS NOT:**

-   Medication prescription administration that occurs without the
    minimum requirements specified above.

**MULTISYSTEMIC THERAPY (MST)**

I.  **DEFINITION**

> Multisystemic Therapy (MST) is an intensive family- and
> community-based treatment that addresses the multiple determinants of
> serious antisocial behavior. The multisystemic approach views
> individuals as being nested within a complex network of interconnected
> systems that encompass individual, family, and extrafamilial (peer,
> school, neighborhood) factors. Intervention may be necessary in any
> one or a combination of these systems. The goal is to facilitate
> change in this natural environment to promote individual change. The
> caregiver is viewed as the key to long-term outcomes.
>
> **II. FIDELITY MEASURE** (Contact Vijay Ganju at <vkganju@gmail.com>)
>
> **III. MINIMUM REQUIREMENTS**

-   Services take into account the life situation and environment of the
    child / adolescent and involve peers, school staff, parents, etc.

-   Services are individualized

-   Services are provided by MST Therapists or masters-level
    professional

-   Services are time-limited

-   Services are available 24/7

> **THERAPEUTIC FOSTER CARE**

I.  **DEFINITION**

> Children are placed with foster parents who are trained to work with
> children with special needs. Usually, each foster home takes one child
> at a time, and caseloads of supervisors in agencies overseeing the
> program remain small. In addition, therapeutic foster parents are
> given a higher stipend than traditional foster parents, and they
> receive extensive pre-service training and in-service supervision and
> support. Frequent contact between case managers or care coordinators
> and the treatment family is expected, and additional resources and
> traditional mental health services may be provided as needed."
>
> **II. FIDELITY MEASURE** (Contact Vijay Ganju at <vkganju@gmail.com>)
>
> **III. MINIMUM REQUIREMENTS FOR REPORTING**

-   There is an explicit focus on treatment

-   There is an explicit program to train and supervise treatment foster
    parents

-   Placement is in the individual family home

IV. **THERAPEUTIC FOSTER CARE IS NOT:**

    -   An enhanced version of regular foster care.

**FUNCTIONAL FAMILY THERAPY (FFT)**

I.  **DEFINITION**

> Functional Family Therapy (FFT) is an outcome-driven
> prevention/intervention program for youth who have demonstrated the
> entire range of maladaptive, acting out behaviors and related
> syndromes. Treatment occurs in phases where each step builds on one
> another to enhance protective factors and reduce risk by working with
> both the youth and their family. The phases are engagement,
> motivation, assessment, behavior change, and generalization.
>
> **II. FIDELITY MEASURE** (Contact Vijay Ganju at <vkganju@gmail.com>)
>
> **III. MINIMUM REQUIREMENTS**

-   Services are provided in phases related to engagement, motivation,
    assessment, behavior change, etc.

-   Services are short-term, ranging from 8-26 hours of direct service
    time

-   Flexible delivery of service by one and two person teams to clients
    in-home, clinic, juvenile court, and at time of re-entry from
    institutional placement.

![](media/image26.wmf){width="7.242361111111111in"
height="8.80486111111111in"}

INSTRUCTIONS for Table 16:

1.  Please enter the unduplicated number of adults with serious mental
    illness and children with serious emotional disturbances who
    received each service category during the reporting year.

2.  Please enter the unduplicated number of adults with serious mental
    illness and children with SED served in each of the age, sex and
    race/ethnicity categories during the reporting period.

3.  States are using a variety of instruments to monitor fidelity, some
    of which are more standardized than others. If fidelity is being
    monitored in your state, please indicate the instrument being used
    for each service category.

Changed for 2006: Add 2 questions at the end of each EBP:

1.  Did you use the SAMHSA Toolkit to guide implementation?

2.  Have staffs been specifically trained to implement the EBP?

> 3\) Combined Age 0-3 with Age 4-12.

**Table 17: Profile of Adults with Serious Mental Illnesses Receiving
Specific Services during the Year:**

![](media/image27.wmf){width="7.246527777777778in"
height="8.529861111111112in"}Number range CHAPTER

INSTRUCTIONS for Table 17:

1.  Please enter the unduplicated number of adults with serious mental
    illness who received each service category during the reporting
    year.

2.  Please enter the unduplicated number of adults with serious mental
    illness (or children with SED) in each age, sex and race/ethnicity
    category that received any service during the year.

3.  States are using a variety of instruments to monitor fidelity, some
    of which are more standardized than others. If fidelity is being
    monitored in your state, please indicate the instrument being used
    for each service category.

Changed for 2006: New 2 questions at the end of each EBP:

1.  Did you use the SAMHSA Toolkit to guide implementation?

2.  Have staffs been specifically trained to implement the EBP?

**Table 18: Profile of Adults with Schizophrenia Receiving New
Generation Medications during the Year**

![](media/image28.wmf){width="7.241666666666666in"
height="6.424305555555556in"}

[INSTRUCTIONS:]{.underline}

1 Please enter the unduplicated number of adults with schizophrenia that
received the new generation medications in each setting.

2 Please enter the unduplicated number of all adults with a primary
diagnosis of schizophrenia that received any service in the specified
setting during the year.

3 Some clinical guidelines used:

-   American Psychiatric Association

-   Consensus \"Tri-University\" Project

-   Schizophrenia Patient Outcome Research Team (PORT)

-   Texas Medications Algorithm Project (TMAP)

[DEFINITIONS]{.underline}

Adults with Schizophrenia Receiving New Generation Medications:

Adults with a primary diagnosis of schizophrenia who received
Aripiprazole (Abilify), Clozapine, Quetiapine, Olanzonpine, Risperdone
or Ziprasidone during the reporting year in the specified setting.

**Table 19A. Profile of Criminal Justice or Juvenile Justice
Involvement:**

![](media/image29.wmf){width="7.242361111111111in"
height="5.6409722222222225in"}

![](media/image30.wmf){width="7.242361111111111in"
height="3.0868055555555554in"}

**Table 19b. Profile of Change in School Attendance**

![](media/image31.wmf){width="7.240972222222222in" height="7.53125in"}

***Note these are still developmental:***

*Tables 19a-d have been extensively modified for 2006 URS Reporting.
There are now only 2 tables: 19a: Criminal Justice/Juvenile Justice and
19b: School Attendance. These tables have been designed to allow states
that have implemented the new Consumer Survey Modules for Criminal
Justice and School Attendance to report results by age and gender.*

If you did not use the new consumer survey modules, but have
administrative data available for these indicators, you may use these
tables to submit this data. If your state has administrative data for
arrests or school attendance, please report arrests this year, in the
cells for "T2 Most Recent 12 Months" and arrests in the prior year under
T1: Prior 12 months".

The DIG/URS workgroup on Outcome Measures will be analyzing the
information submitted this year. Therefore, we would like as complete
information as possible about your information sources for these tables.
Please use the check boxes and footnote spaces to tell us additional
information about how you collected data for this indicator.

**URS DEVELOPMENTAL TABLE: 20A, 20B, and 21: READMISSION TO ANY STATE**

**PSYCHIATRIC INPATIENT HOSPITAL WITHIN 30/180 DAYS OF DISCHARGE**

**Table 20A:** **Readmissions of Non-Forensic Patients to Any State
Psychiatric Hospitals within 30/180 Days of Discharge**

**Table 20B: Readmissions of Forensic Patients to Any State Psychiatric
Hospitals within 30/180 Days of Discharge**

##### Table 21: Readmissions to Any Psychiatric Inpatient Unit within 30/180 Days of Discharge

**RATIONALE FOR USE**: A major outcome of the development of a
community-based system of care is expected to be reduced utilization of
state and county-operated psychiatric inpatient beds and better
coordination of care between hospitals and community mental health
systems. The goal is to decrease the number of consumers who are
readmitted to psychiatric inpatient care within 30 and 180 days of being
discharged.

**APPROACH TO MEASURE:** The total number of admissions to any state
psychiatric inpatient care that occurred within 30 and 180 days of a
discharge from a psychiatric inpatient care during the past year divided
by the total number of discharges during the year.

Percent readmitted is derived by dividing the number of episodes of
readmission by the total number of discharges during a year in a state.
Percent readmitted is presented by state, and for age, gender, race, and
Hispanic/Latino Origin.

Since admissions and discharges of Forensic Patients are usually
determined by the courts, rather than the SMHA, there is a separate
Table 20B for reporting the readmission experiences of Forensic
Patients.

**[MEASURE(S):]{.underline}**

***Table 20A and 20B Numerator:*** The number of readmissions to a state
operated psychiatric hospital inpatient unit within a specified time
period after discharge. Readmitted is defined as returned to any state
hospital without contingency; this would exclude those who were not
discharged, including on leave, visits, leaves without consent, and
elopements. Persons who are discharged for the purpose of receiving
medical treatment in another facility who return to the state
psychiatric hospital should [not]{.underline} be counted as a
readmission when they return to the psychiatric hospital.

***Optional Table 21 Numerator:*** The number of readmissions to either
a state psychiatric hospital or an Other Psychiatric Inpatient Hospital
bed in programs that are funded by the SMHA (part of the SMHA system and
reported on Table 3 as Other Psychiatric Hospitals).

***Denominator:*** The total number of discharges from a state operated
psychiatric hospital inpatient unit (not unduplicated). Discharged is
defined as released from the hospital without contingency; this would
exclude those who are released on leave, including visits, leaves
without consent, discharges for medical treatment.

***Optional Table 21 Denominator:*** The total number of discharges from
a state operated psychiatric hospital inpatient unit or another
psychiatric hospital inpatient unit (not unduplicated). Discharged is
defined as released from the hospital without contingency; this would
exclude those who are released on leave, including visits, leaves
without consent, discharges for medical treatment.

***Data Note:*** For the 30 day readmission rate the numerator is based
on readmissions in a 13 month period. For the 180 day readmission rate,
the numerator is based on readmissions in an 18 month period.

***Changed for 2006*:** Combined Age 0-3 with Age 4-12.

**[ISSUES:]{.underline}**

When reporting by age categories: if there are different ages between
the first admission and the readmission, use the discharge age from the
first admission.

Ideally, this indicator would be expanded to include all readmissions to
any hospital, not just state psychiatric hospitals. With the increased
use of local general hospital psychiatric units, it will become
important over time to expand this indicator beyond the current focus on
state psychiatric hospitals.

[**DEFINITION**:]{.underline}

***FORENSIC CLIENTS:*** are mental health consumers who come to the
mental health system due to their contact with the criminal justice
systems. Specific forensic activities may include, but are not limited
to: a) diagnosis of individuals placed in an inpatient unit for
short‑term psychiatric observation; b) provision of diagnostic and
treatment support for correctional populations on an inpatient basis;
providing security up to maximum levels; and provision of security staff
in secure units for the rehabilitation and management of behaviorally
problematic individuals. Forensic patients include:

*NGRI/GBMI:* "Not guilty by reason of insanity\" (NGRI) and/or \"guilty
but mentally ill\" (GBMI) have been referred by legal and law
enforcement agencies for emergency psychiatric evaluations; and persons
who are to be evaluated for dangerousness. Provision of Forensic
services may occur within any of the separate state mental hospital
services, other hospital programs, community‑based programs, and/or
through the SMHA administrative offices.

***COMPETENCY:*** Defendants who are detained and evaluated as to their
mental competence to stand trial.

***TRANSFERS FROM CRIMINAL JUSTICE/JUVENILE JUSTICE:*** Services to
adult or juvenile prisoners who have been transferred to the state
hospital to receive services.

***SEXUALLY VIOLENT PREDATORS:*** An increasing population in many state
mental health systems is persons deemed to be "Sexually Violent
Predators". These persons have been convicted of a sexual offence and
been sent to the mental health system for treatment and control.

**Table 20A. Profile of Non-Forensic (Voluntary and Civil-Involuntary)
Patients Readmission to Any State Psychiatric Inpatient Hospital Within
30/180 Days of Discharge**

![](media/image32.wmf){width="7.018055555555556in" height="7.66875in"}

**Table 20B. Profile of Forensic Patients Readmission to Any State
Psychiatric Inpatient Hospital Within 30/180 Days of Discharge**

![](media/image33.wmf){width="7.018055555555556in"
height="7.381944444444445in"}

**Table 21. Profile of Non-Forensic (Voluntary and Civil-Involuntary
Patients) Readmission to Any Psychiatric Inpatient Care Unit (State
Operated or Other Psychiatric Inpatient Unit) Within 30/180 Days of
Discharge**

![](media/image34.wmf){width="7.054861111111111in"
height="8.279861111111112in"}

**Table 20A, 20B, and 21 Questions and Answers:**

I.  Several states asked about whom should they count: Only persons
    served in the community. Only persons served in state hospitals? Or
    all persons?

> ***Answer:** This indicator focuses on the persons who are served in
> the state hospitals and thus are the persons who are reported on URS
> Basic Table 3 and Table 6 as served in the state hospital during the
> year.*

II. What about Other Psychiatric Inpatient Programs? Should they be
    reported?

> ***Answer:** The Optional Table 21 for this indicator compiles
> information on persons who are served in the other psychiatric
> inpatient programs reported on URS Basic Table 3b and Table 6. Persons
> served in these programs would only be reported on the Optional Table
> 21, not on Table 20 (which focuses on state psychiatric hospitals).*

III. Should the 30 and 180 day readmissions be unduplicated or
     duplicated? e.g., during the readmissions within 30/180 days of
     discharges, is it 0‑30 days and 31‑180 days or is it 0‑30 days and
     0‑180 days thus making the 0‑30 day group a subset of the 0‑180
     group to some degree?

> ***Answer:** The 16 State Study calculated them as 0-30 and 0-180
> days, thus making the 0-30 days group a subset of the 0-180 day
> measure. Since the 16 State Study group conceived of the 180 day
> measure as a separate indicator of care (measuring community tenure),
> it is desirable to calculate the 0-180 rate as a complete rate and not
> have to add the 31-180 day numbers together with the 0-30 day numbers
> to calculate the desired rate.*

IV. If we split out the forensics, how are we determining who is a
    forensic readmission? Are we looking at their forensic status at
    discharge and readmission, just discharge or just readmission? There
    are four possible combinations of forensic status

> ***Answer:** If a person's forensic status or age changes between
> their discharge and their readmission, it is recommended that you
> report them in the category from their last discharge. This is
> consistent with the 16 State Study that recommended that states use
> the discharge client status, since that was thought to be more
> reliable (coming at the end of a hospital stay) than the readmission
> status.*

V.  Optional Table 21: Other Psychiatric Hospital Inpatient
    readmissions: Should the Optional Table include only readmissions to
    non-state psychiatric hospitals, or should the table include all
    readmissions (include data from both state psychiatric hospital
    readmissions and other psychiatric inpatient readmissions)?

> ***Answer:** The workgroup recommends that states should report the
> combined data of all readmissions to any psychiatric hospital. Each
> state should report the data as they can and describe if they are
> reporting combined data or data that excludes state psychiatric
> hospitals. Comparisons could be made over time for a single state, and
> rates can be calculated for output tables that make appropriate
> national comparisons (e.g., a state that supplied integrated data for
> both state hospitals and other inpatient would get the national rate
> of states that reported such data).*

![](media/image35.wmf){width="7.248611111111111in" height="5.2875in"}

[^1]: . Sections 1911-1920 and 1941-1954 of the Public Health Service
    Act (PHS Act)

[^2]: Section 1912(c)(1) and (2) (42 U.S.C. 300x-2)

[^3]: . Section 1943(a)(3) (42 U.S. C. 300x-53)

[^4]: . Section 1917(a)(7)

[^5]: . Section 1912 (b)

[^6]: . Gerald N. Grob, *From Asylum to Community: Mental Health Policy
    in Modern America*. Princeton, NJ: Princeton University Press, 1991,
    113-114.

[^7]: . Joseph N. De Raismes, III, *The Evolution of Federal Mental
    Health Planning Legislation*.
    http://www.namhpac.org/pages/bckground/back_evolution.html

[^8]: . De Raismes,
    http://www.namhpac.org/pages/bckground/back_evolution.html

[^9]: CMHS performance measures correspond to SAMHSA's National Outcome
    Measures (NOMS). Profiles and performance information for each State
    and Territory are posted to SAMHSA's Website
    (www.nationaloutcomemeasures.gov).

[^10]: The term "State" refers each of the 50 States, the District of
    Columbia, and each of the U.S. territories. The term "U.S.
    territories" means the Commonwealth of Puerto Rico, American Samoa,
    Guam, the Commonwealth of Northern Marianas, the Virgin Islands,
    Palau, the Republic of the Marshall Islands, and the Federated
    States of Micronesia.

[^11]: . Section 1913(a) of the PHS Act

[^12]: . Section 1915(b)(1) of the PHS Act

[^13]: . Section 1915(b)(2) of the PHS Act

[^14]: . As required by Section 1917(a)(1) (42USC 300x-6) of the PHS Act

[^15]: . Section 1914(c) of the PHS Act

[^16]: . The principal State agencies are: Mental Health, Education,
    Medicaid, Vocational Rehabilitation, Housing, Social Services and
    Criminal Justice.

[^17]: . Section 1914(b) of the PHS Act (42 U.S.C. 300x-4)

[^18]: . Section 1912(d)(1) of PHS Act (42 USC 300x-2)

[^19]: As required by Section 1942(a)(1) and (2) of PHS Act (42 U.S.C.
    300x-52).

[^20]: As required by Section 1915 (a)(2) of PHS Act.

[^21]: 21\. The term State shall hereafter be understood to include
    Territories.