Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

**Family Centered Substance Abuse Treatment Grants for Adolescents and
their Families**

**(Short Title: Assertive Adolescent and Family Treatment)**

[]{.mark}

**(Initial Announcement)**

**TI-06-007**

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

**Key Dates:**

+----------------------+-----------------------------------------------+
| **Application        | **Applications are due by March 29, 2006.**   |
| Deadline**           |                                               |
+----------------------+-----------------------------------------------+
| **Intergovernmental  | **Letters from State Single Point of Contact  |
| Review**             | (SPOC) are due no later than 60 days after    |
|                      | application deadline.**                       |
| **(E.O. 12372)**     |                                               |
+----------------------+-----------------------------------------------+
| **Public Health      | **Applicants must send the PHSIS to           |
| System Impact        | appropriate State and local health agencies   |
| Statement            | by application deadline. Comments from Single |
| (PHSIS)/Single State | State Agency are due no later than 60 days    |
| Agency               | after application deadline.**                 |
| Coordination**       |                                               |
+----------------------+-----------------------------------------------+

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

H. Westley Clark, M.D., J.D., M.P.H. Charles G. Curie, M.A., A.C.S.W.

Director Administrator

Center for Substance Abuse Treatment Substance Abuse and Mental Health

Services Administration

**Table of Contents**

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

[1. INTRODUCTION 3](#introduction)

[2. EXPECTATIONS 3](#expectations)

[II. AWARD INFORMATION 8](#ii.-award-information)

[1. AWARD AMOUNT 8](#award-amount)

[2. FUNDING MECHANISM 8](#funding-mechanism)

[III. ELIGIBILITY INFORMATION 8](#iii.-eligibility-information)

[1. ELIGIBLE APPLICANTS 8](#eligible-applicants)

[2. COST SHARING 9](#cost-sharing)

[3. OTHER 9](#other)

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

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

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

[3. SUBMISSION DATES AND TIMES 17](#submission-dates-and-times)

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

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

[6. OTHER SUBMISSION REQUIREMENTS 21](#other-submission-requirements)

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

[1. EVALUATION CRITERIA 22](#evaluation-criteria)

[2. REVIEW AND SELECTION PROCESS 31](#review-and-selection-process)

[VI. AWARD ADMINISTRATION INFORMATION
32](#vi.-award-administration-information)

[1. AWARD NOTICES 32](#award-notices)

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

[3. REPORTING REQUIREMENTS 33](#reporting-requirements)

[VII. AGENCY CONTACTS 34](#vii.-agency-contacts)

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

[Appendix B -- Glossary 37](#appendix-b-glossary)

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

[Appendix D -- Logic Model Resources
40](#appendix-d-logic-model-resources)

[Appendix E -- Sample Budget and Justification
41](#appendix-e-sample-budget-and-justification)

# I. FUNDING OPPORTUNITY DESCRIPTION {#i.-funding-opportunity-description .unnumbered}

## 1. INTRODUCTION {#introduction .unnumbered}

The Substance Abuse and Mental Health Services Administration's (SAMHSA)
Center for Substance Abuse Treatment (CSAT) announces the availability
of FY 2006 funds for Family Centered Substance Abuse Treatment Grants
for Adolescents and their Families (hereafter referred to as the
Assertive Adolescent and Family Treatment program). Grants under this
program are authorized under Section 509 of the Public Health Service
Act, as amended. The program addresses the Healthy People 2010 focus
area 26-Substance Abuse.

SAMHSA's Services Grants are designed to address gaps in substance abuse
services and/or to increase the ability of States, units of local
government, federally recognized tribes, tribal organizations, and
community- and faith-based organizations to help specific populations or
geographic areas with serious, emerging substance abuse problems. SAMHSA
intends that its Services Grants result in the delivery of services as
soon as possible and [no later than 4 months]{.underline} after award
(for State applicants, the delivery of services must begin [within 60
days]{.underline} of award).

## 2. EXPECTATIONS {#expectations .unnumbered}

1.  **Background and Purpose**

Despite the availability of effective substance abuse treatment
practices for adolescents and their families/primary caregivers (i.e.,
the individual(s) currently providing care for the adolescent), these
practices are not being adequately utilized in the field. SAMHSA is
offering grants for the provision of services to adolescents and their
families/primary caregivers using previously proven effective practices
that are family centered. Families/primary caregivers are an integral
part of the treatment process and their inclusion increases the
likelihood of successful treatment and reintegration of the adolescents
into their communities following the period of formalized treatment.

Applicants are encouraged to implement the Assertive Community
Reinforcement Approach (ACRA) coupled with Assertive Continuing Care
(ACC). ACRA and ACC have proven effective in building community capacity
for family centered treatment and were developed with funding from CSAT
and NIAAA. These approaches are in the public domain, allow for
cost-effective training of multiple staff and are amenable to a
train-the-trainers approach, ensuring sustainability over time. ACRA and
ACC can be provided within the standard CSAT cost bands for treatment.

ACRA is composed of sessions with the adolescent and one or more
caregivers individually, and conjointly. ACRA therapists teach
adolescents and their caregivers how to find/use reinforcers for staying
substance free, how to use community resources to support positive
change, and how to develop a positive support system within the family.

ACC addresses the important role of continuing care following what is
traditionally thought of as the active phase of treatment. ACC was
developed to be used in combination with delivery of ACRA. ACC addresses
the roles of motivation and cognition in shaping behavior. ACC includes
enhancement of motivation and strengthening of cognitive skills in order
for the adolescent to remain free of substance use.

The ACRA and ACC manuals are available for free download at
<http://www.chestnut.org/LI/BookStore/index.html>.

If ACRA/ACC is the chosen service model, grantees will be provided
training and ongoing support and supervision to implement the
intervention. These proven effective approaches are in the public domain
with manuals that guide the treatment and provide measures of fidelity.
CSAT and its contractors will provide training, support, and supervision
for ACRA/ACC at no cost to the grantees.

Applicants are free to propose the use of another family centered
treatment intervention. Applicants proposing to implement an
intervention other than ACRA/ACC must demonstrate that they have funding
to cover the cost of initial/on-going staff training and certification,
as required, for the intervention chosen. If a model other than ACRA/ACC
is chosen, training must lead to certification in the practice (that is,
it cannot merely be "exposure training"). Grant funds may not be used
for the initial/ongoing staff training and necessary certification for
an intervention other than the recommended approach of ACRA/ACC.

###### []{.mark} {#section .unnumbered}

In addition, all grantees will receive training and certification in
conducting a full bio-psycho-social clinical assessment that identifies
Substance Use Disorders (SUD), co-occurring mental health disorders, and
family support and functioning. The clinical assessment instrument is
the Global Appraisal of Individual Needs (GAIN). This instrument also
cross-walks to DSM-IV-TR and ICD-10 diagnostic criteria as well as ASAM
PPC II patient placement criteria, and is in the public domain. Use of
the GAIN is required in this grant program and is integral to providing
the clinical intervention as developed. It has been used successfully in
the current CSAT Effective Adolescent Treatment and Adolescent
Residential Treatment grant programs. CSAT and its contractors will
provide all training/support for the GAIN at no cost to the grantees.
More information on the GAIN can be found at
<http://www.chestnut.org/LI/gain/index.html>.

2.  **Target Population**

The target population for this program is adolescents with Substance Use
Disorders (SUD), and with SUD and co-occurring mental health disorders
and their families/primary caregivers.

######## **2.3 Documenting the Evidence Base for Services to be Implemented** {#documenting-the-evidence-base-for-services-to-be-implemented .unnumbered}

Applicants must document in their applications that the
services/practices they propose to implement are evidence-based
services/practices. In addition, applicants must justify use of the
proposed services/practices for the target population along with any
adaptations or modifications necessary to meet the unique needs of the
target population or otherwise increase the likelihood of achieving
positive outcomes. Further guidance on each of these requirements is
provided below.

*Documenting the Evidence-Based Practice/Service*

Applicants who choose to use ACRA/ACC only need to document this choice
and do not need to provide a justification. Applicants proposing to
implement a model other than ACRA/ACC must provide a narrative
justification that summarizes the evidence for effectiveness and
acceptability of the proposed service/practice, that it is applicable to
the target population, and that it is family centered. Evidence of
effectiveness and acceptability must include the findings from clinical
trials, efficacy and/or effectiveness studies published in the
peer-reviewed literature.

*Justifying Selection of the Service/Practice for the Target Population*

All applicants must show that the proposed service/practice is
appropriate for the proposed target population. Ideally, this evidence
will include research findings on effectiveness and acceptability
specific to the proposed target population. However, if such evidence is
not available, the applicant should provide a justification for using
the proposed service/practice with the target population. This
justification might involve, for example, a description of adaptations
to the proposed service/practice based on other research involving the
target population.

*Justifying Adaptations/Modifications of the Proposed Service/Practice*

SAMHSA has found that a high degree of faithfulness or "fidelity" (see
Glossary) to the original model for an evidence-based service/practice
increases the likelihood that positive outcomes will be achieved when
the model is used by others. Therefore, SAMHSA encourages fidelity to
the original evidence-based service/practice to be implemented. However,
SAMHSA recognizes that adaptations or modifications to the original
model may be necessary for a variety of reasons:

-   To allow implementers to use resources efficiently.

-   To adjust for specific needs of the client population.

-   To address unique characteristics of the local community where the
    service/practice will be implemented.

All applicants must describe and justify any adaptations or
modifications to the proposed service/practice that will be made.

2.4 Services Delivery

SAMHSA's Services Grant funds must be used primarily to support direct
services, including the following types of activities:

-   Conducting outreach [and]{.underline} pre-service strategies to
    expand access to treatment services to underserved populations.

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

-   Purchasing or providing "wrap-around" services (see Glossary) (e.g.,
    child care, vocational, educational and transportation services)
    designed to improve access and retention.

-   Collecting data using specified tools and standards to measure and
    monitor treatment services and costs. (No more than 20% of the total
    grant award may be used for data collection and evaluation.)

######## **2.5 Infrastructure Development (maximum 15% of total grant award)**  {#infrastructure-development-maximum-15-of-total-grant-award .unnumbered}

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

######## Although SAMHSA expects that its Services Grant funds will be used primarily for direct services, SAMHSA recognizes that infrastructure changes may be needed to support service delivery expansion in some instances. You may use up to 15% of the total Services Grant award for the following types of infrastructure development, if necessary to support the direct service expansion of the grant project. {#although-samhsa-expects-that-its-services-grant-funds-will-be-used-primarily-for-direct-services-samhsa-recognizes-that-infrastructure-changes-may-be-needed-to-support-service-delivery-expansion-in-some-instances.-you-may-use-up-to-15-of-the-total-services-grant-award-for-the-following-types-of-infrastructure-development-if-necessary-to-support-the-direct-service-expansion-of-the-grant-project. .unnumbered}

-   Building partnerships to ensure the success of the project and
    entering into service delivery and other agreements.

-   Developing or changing the infrastructure to expand treatment
    services.

-   Training to assist community support systems to identify and refer
    youth who may have SUD for treatment.

    6.  **Data and Performance Measurement**

[Performance Measurement]{.underline}: All SAMHSA grantees are required
to collect and report certain data so that SAMHSA can meet its
obligations under the Government Performance and Results Act (GPRA).
Grantees will be required to report performance in several areas
relating to the client's substance use, family and living condition,
employment status, social connectedness, access to treatment, retention
in treatment and criminal justice status.  This information will be
gathered using the data collection tool referenced below.  The
collection of these data will enable CSAT to report on the National
Outcome Measures (NOMs) which have been defined by SAMHSA as key
priority areas relating to substance use.

Applicants must document their ability to collect and report the
required data in "Section E: Evaluation and Data" of their applications.
Grantees must collect and report data using the Discretionary Services
Client Level GPRA tool, which can be found at
[www.samhsa-gpra.samhsa.gov](http://www.samhsa-gpra.samhsa.gov/) (click
on 'Data Collection Tools/Instructions'), along with instructions for
completing it. Hard copies are available in the application kits
distributed by SAMHSA's National Clearinghouse for Alcohol and Drug
Information.

GPRA data must be collected in a face-to-face interview at baseline
(i.e., the client's entry into the project), discharge, and 6 months
post the baseline. GPRA data must be entered into the GPRA web system
within 7 business days of the forms being completed. In addition, 80% of
the participants must be followed up. GPRA data are to be collected and
then entered into CSAT's GPRA Data Entry and Reporting System
(www.samhsa-gpra.samhsa.gov).

Training and technical assistance on data collecting, tracking, and
follow-up, as well as data entry, will be provided by CSAT.

The GAIN clinical assessment at intake, and its ongoing clinical use (at
3, 6 and 12 months post GAIN intake) are required in this program to:
measure adherence to treatment goals; identify clinical needs that arise
that require a modification of the treatment plan; and permit ongoing
clinical assessment for any newly emerging problems. This ongoing
assessment is critical for youth because of the likelihood of
co-occurring mental health disorders and/or high levels of trauma, and
to provide the needed clinical information for adequately delivering the
intervention. More information on the GAIN can be found at
<http://www.chestnut.org/LI/gain/index.html>.

Training and technical assistance on administering the GAIN clinical
instrument will be provided by CSAT at no cost to the grantee.

######## **2.7 Evaluation** {#evaluation .unnumbered}

Grantees must evaluate their projects, and you are required to describe
your evaluation plans in your application. The evaluation should be
designed to provide regular feedback to the project to improve services.
The evaluation must include both process and outcome components. Process
and outcome evaluations must measure change relating to project goals
and objectives over time compared to baseline information. Control or
comparison groups are not required. You must consider your evaluation
plan when preparing the project budget.

**Process components** should address issues such as:

-   How closely did implementation match the plan?

-   What types of deviation from the plan occurred?

-   What led to the deviations?

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

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

**Outcome components** should address issues such as:

-   What was the effect of intervention on participants?

-   What program/contextual factors were associated with outcomes?

-   What individual factors were associated with outcomes?

-   How durable were the effects?

No more than 20% of the total grant award may be used for evaluation and
data collection, including GPRA and incentives for completing the
evaluation.

######## **2.8 Grantee Meetings** {#grantee-meetings .unnumbered}

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

# II. AWARD INFORMATION {#ii.-award-information .unnumbered}

## 1. AWARD AMOUNT {#award-amount .unnumbered}

It is expected that up to \$5.2 million will be available to fund up to
17 awards in FY 2006. Annual awards are expected to be \$300,000 per
year in total costs (direct and indirect) for up to 3 years.

**Proposed budgets cannot exceed \$300,000 in any year of the proposed
project.** Annual continuation awards will depend on the availability of
funds, grantee progress in meeting project goals and objectives, and
timely submission of required data and reports.

State applicants may not request administrative costs. Funds are to be
used to pay for services delivery (not the cost of implementing a
competition among providers to be funded to implement this grant). The
grant is not a pass-through.

## 2. FUNDING MECHANISM {#funding-mechanism .unnumbered}

Awards will be made as grants.

# III. ELIGIBILITY INFORMATION {#iii.-eligibility-information .unnumbered}

## ELIGIBLE APPLICANTS

Eligible applicants are domestic public and private nonprofit entities.
For example, State and local governments; federally recognized tribes;
State recognized tribes, urban Indian organizations (as defined in P.L.
94-437, as amended); public or private universities and colleges;
community- and faith-based organizations; and tribal organizations may
apply. The statutory authority for this program prohibits grants to
for-profit organizations.

State applicants must propose to implement a project at a single site
within the State, must have a selected site at the time of application,
and must be ready to begin delivering services within 60 days of award.

## 2. COST SHARING  {#cost-sharing .unnumbered}

Cost sharing is not required in this program, and applications will not
be screened out on the basis of cost sharing.

## 3. OTHER {#other .unnumbered}

1.  **Additional Eligibility Requirements**

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

**3.2 Evidence of Experience and Credentials**

> SAMHSA believes that only existing, experienced, and appropriately
> credentialed organizations with demonstrated infrastructure and
> expertise will be able to provide required services quickly and
> effectively. Therefore, in addition to the basic eligibility
> requirements specified in this announcement, applicants must meet
> three additional requirements related to the provision of treatment
> services.
>
> The three requirements are:

-   A provider organization for direct client services (e.g., substance
    abuse treatment) appropriate to the grant must be involved in each
    application. The provider may be the applicant or another
    organization committed to the project. More than one provider
    organization may be involved; however, in the case of State
    applicants, services must be provided at one treatment site;

-   Each direct service provider organization must have at least 2 years
    experience (as of the due date of the application) providing
    services for adolescents and their families in the geographic
    area(s) covered by the application; and

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

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

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

-   meet the 2-year experience requirement

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-   meet applicable licensing, accreditation, and certification
    requirements, and,

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

In addition, if, following application review, an application's score is
within the fundable range for a grant award, the GPO will call the
applicant and request that the following documentation be sent by
overnight mail:

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

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

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

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

# IV. APPLICATION AND SUBMISSION INFORMATION  {#iv.-application-and-submission-information .unnumbered}

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

## 1. ADDRESS TO REQUEST APPLICATION PACKAGE  {#address-to-request-application-package .unnumbered}

You may request a complete application kit from:

> The National Clearinghouse for Alcohol and Drug Information (NCADI) at
> 1-800-729-6686.

You also may download the required documents from the SAMHSA web site at
[[www.samhsa.gov/grants/index.aspx]{.underline}](../www.samhsa.gov/grants/index.aspx)

Additional materials available on this web site include:

-   a technical assistance manual for potential applicants;

-   standard terms and conditions for SAMHSA grants;

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

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

## 2. CONTENT AND FORM OF APPLICATION SUBMISSION {#content-and-form-of-application-submission .unnumbered}

**2.1 Application Kit**

SAMHSA application kits include the following documents:

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

-   Request for Applications (RFA) -- Provides specific information
    about the availability of funds along with instructions for
    completing the grant application. This document is the RFA. The RFA
    will be available on the SAMHSA web site
    ([[www.samhsa.gov/grants/index.aspx]{.underline}](../www.samhsa.gov/grants/index.aspx))
    and a synopsis of the RFA is available on the Federal grants web
    site ([www.Grants.gov](http://www.Grants.gov/)).

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

**2.2 Required Application Components**

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

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

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

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

-   **Budget Form** -- Use SF 424A, which is part of the PHS 5161-1.
    Fill out Sections B, C, and E of the SF 424A. A sample budget and
    justification is included in Appendix E of this document.

-   **Project Narrative and Supporting Documentation** -- The Project
    Narrative describes your project. It consists of Sections A
    through E. Sections A-E together may not be longer than 30 pages.
    (For example, remember that if your Project Narrative starts on page
    5 and ends on page 35, it is 31 pages long, not 30 pages.) More
    detailed instructions for completing each section of the Project
    Narrative are provided in "Section V -- Application Review
    Information" of this document.

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

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

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

-   *Appendix* 2**:** Data Collection Instruments/Interview Protocols
    **(Do not include the GPRA tool or GAIN instruments)**

-   *Appendix 3*: Sample Consent Forms

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

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

-   **Assurances** -- Non-Construction Programs. Use Standard Form 424B
    found in PHS 5161-1. You are also required to complete the Assurance
    of Compliance with SAMHSA Charitable Choice Statutes and Regulations
    Form SMA 170. This form will be posted on SAMHSA's web site with the
    RFA and provided in the application kits available at SAMHSA's
    clearinghouse (NCADI).

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

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

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

2.3 Application Formatting Requirements

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

-   Information provided must be sufficient for review.

-   Text must be legible. For Project Narratives submitted
    electronically in Microsoft Word, see separate requirements below
    under "Guidance for Electronic Submission of Applications."

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

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

footnotes will not be considered in determining compliance.)

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

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

-   To ensure equity among applications, the amount of space allowed for
    the Project Narrative cannot be exceeded. For Project Narratives
    submitted electronically in Microsoft Word, see separate
    requirements below under "Guidance for Electronic Submission of
    Applications."

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

• Should an application not conform to these margin or page limits,
SAMHSA will use the following method to determine compliance: The total
area of the Project Narrative (excluding margins, but including charts,
tables, graphs and footnotes) cannot exceed 58.5 square inches
multiplied by 30. This number represents the full page less margins,
multiplied by the total number of allowed pages.

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

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

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

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

-   The page limit of a total of 30 pages for Appendices 1, 3 and 4
    combined should not be exceeded.

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

[Guidance for Electronic Submission of Applications]{.underline}

SAMHSA offers the opportunity for you to submit your application to us
either in electronic or paper format. Register one time, and Grants.gov
will generate your information for future applications so you don't have
to re-enter it. Built-in error-checking increases the completeness and
accuracy of your application. Electronic submission is voluntary. No
review points will be added or deducted, regardless of whether you use
the electronic or paper format.

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

You may search the Grants.gov site for the downloadable application
package, by the funding announcement number (called the opportunity
number) or by the Catalogue of Federal Domestic Assistance (CFDA)
number. You can find the CFDA number on the first page of the funding
announcement.

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

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

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

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

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

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

-   *Text legibility:* Use a font of Times New Roman 12, line spacing of
    single space, and all margins (left, right, top, bottom) of one inch
    each. Adhering to these standards will help to ensure the accurate
    transmission of your document. If the type size in the Project
    Narrative of an electronic submission exceeds 15 characters per
    inch, or the text exceeds 6 lines per vertical inch, SAMHSA will
    reformat the document to Times New Roman 12, with line spacing of
    single space. Please note that this may alter the formatting of your
    document, especially for charts, tables, graphs, and footnotes.

-   *Amount of space allowed for Project Narrative:* The Project
    Narrative for an electronic submission may not exceed 15,450 words.
    If the Project Narrative for an electronic submission exceeds the
    word limit and exceeds the allowed space as defined in Appendix A,
    then **any part of the Project Narrative in excess of these limits
    will not be submitted to review**. To determine the number of words
    in your Project Narrative document in Microsoft Word, select
    file/properties/statistics.

While keeping the Project Narrative as a separate document, please
consolidate all other materials in your application to ensure the fewest
possible number of attachments. Ensure all pages in your application are
numbered consecutively, with the exception of the standard forms in the
PHS-5161 application package. Please name and number your attachments,
indicating the order in which they should be assembled. Failure to
comply with these requirements may affect the successful transmission
and consideration of your application.

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

After you electronically submit your application, you will receive an
automatic acknowledgement from Grants.gov that contains a Grants.gov
tracking number. It is important that you retain this number. **Include
the Grants.gov tracking number in the top right corner of the face page
for any paper submission.**

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

**For United States Postal Service:**

Crystal Saunders, Director of Grant Review

Office of Program Services

Substance Abuse and Mental Health Services Administration

Room 3-1044

1 Choke Cherry Road

Rockville, MD **20857**

ATTN: Electronic Applications

**For other delivery service (DHL, Federal Express, United Parcel
Service):**

Crystal Saunders, Director of Grant Review

Office of Program Services

Substance Abuse and Mental Health Services Administration

Room 3-1044

1 Choke Cherry Road

Rockville, MD **20850**

ATTN: Electronic Applications

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

## 3. SUBMISSION DATES AND TIMES  {#submission-dates-and-times .unnumbered}

Applications are due by close of business on **March 29, 2006**. **Hand
carried applications will not be accepted. Applications may be shipped
using only DHL, Federal Express (FedEx), United Parcel Service (UPS), or
the United States Postal Service (USPS).**

Your application must be received by the application deadline, or you
must have proof of its timely submission as specified below.

-   **For packages submitted via DHL, Federal Express (FedEx), or United
    Parcel Service (UPS), proof of timely submission shall be the date
    on the tracking label affixed to the package by the carrier upon
    receipt by the carrier. That date must be at least 24 hours prior to
    the application deadline. The date affixed to the package by the
    applicant will not be sufficient evidence of timely submission.**

-   For packages submitted via the United States Postal Service (USPS),
    proof of timely submission shall be a postmark not later than 1 week
    prior to the application deadline, and the following upon request by
    SAMHSA:

    -   proof of mailing using USPS Form 3817 (Certificate of Mailing),
        or

    -   a receipt from the Post Office containing the post office name,
        location, and date and time of mailing.

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

**Applications not meeting the timely submission requirements above will
not be considered for review.** Please remember that mail sent to
Federal facilities undergoes a security screening prior to delivery.
Allow sufficient time for your package to be delivered.

If an application is mailed to a location or office (including room
number) that is not designated for receipt of the application, and that
results in the designated office not receiving your application in
accordance with the requirements for timely submission, it will cause
the application to be considered late and ineligible for review.

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

SAMHSA is collaborating with [www.Grants.gov](http://www.Grants.gov/) to
accept electronic submission of applications. Please refer to Section
IV-2.3 above for "Guidance for Electronic Submission of Applications."

## 4. INTERGOVERNMENTAL REVIEW (E.O. 12372) REQUIREMENTS {#intergovernmental-review-e.o.-12372-requirements .unnumbered}

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

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

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

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

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

> **For United States Postal Service:**
>
> Crystal Saunders, Director of Grant Review
>
> Office of Program Services
>
> Substance Abuse and Mental Health Services Administration
>
> Room 3-1044
>
> 1 Choke Cherry Road
>
> Rockville, MD **20857**
>
> ATTN: SPOC -- Funding Announcement No. TI-06-007
>
> **For other delivery service:**
>
> Crystal Saunders, Director of Grant Review
>
> Office of Program Services
>
> Substance Abuse and Mental Health Services Administration
>
> Room 3-1044
>
> 1 Choke Cherry Road
>
> Rockville, MD **20850**
>
> ATTN: SPOC -- Funding Announcement No. TI-06-007

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

The PHSIS consists of the following information:

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

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

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

Applicants who are not the SSA [must]{.underline} include a copy of a
letter transmitting the PHSIS to the SSA in **Appendix 4, "Letter to the
SSA**." The letter must notify the State that, if it wishes to comment
on the proposal, its comments should be sent not later than 60 days
after the application deadline to:

> **For United States Postal Service:**
>
> Crystal Saunders, Director of Grant Review
>
> Office of Program Services
>
> Substance Abuse and Mental Health Services Administration
>
> Room 3-1044
>
> 1 Choke Cherry Road
>
> Rockville, MD **20857**
>
> ATTN: SSA -- Funding Announcement No. TI-06-007
>
> **For other delivery service:**
>
> Crystal Saunders, Director of Grant Review
>
> Office of Program Services
>
> Substance Abuse and Mental Health Services Administration
>
> Room 3-1044
>
> 1 Choke Cherry Road
>
> Rockville, MD **20850**
>
> ATTN: SSA -- Funding Announcement No. TI-06-007

In addition:

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

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

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

## 5. FUNDING LIMITATIONS/RESTRICTIONS {#funding-limitationsrestrictions .unnumbered}

Cost principles describing allowable and unallowable expenditures for
Federal grantees, including SAMHSA grantees, are provided in the
following documents, which are available at
<http://www.hhs.gov/grantsnet/roadmap/index.html>:

-   Institutions of Higher Education: OMB Circular A-21

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

-   Nonprofit Organizations: OMB Circular A-122

-   Hospitals: 45 CFR Part 74, Appendix E

In addition, SAMHSA's Family Centered Substance Abuse Treatment Grants
for Adolescents and their Families grant recipients must comply with the
following funding restrictions:

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

-   No more than 20% of the total grant award may be used for evaluation
    and data collection, including GPRA and incentives for completing
    the evaluation.

Family Centered Substance Abuse Treatment Grants for Adolescents and
their Families grant funds must be used for purposes supported by the
program and may not be used to:

-   Pay for any lease beyond the project period.

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

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

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

-   Pay for housing other than residential substance abuse treatment.

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

-   Pay for incentives to induce individuals to enter treatment.
    However, a grantee or treatment provider may provide up to \$20 or
    equivalent (coupons, bus tokens, gifts, child care, and vouchers) to
    individuals as incentives to participate in required data collection
    follow-up. This amount may be paid for participation in each
    required interview.

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

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

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

## 6. OTHER SUBMISSION REQUIREMENTS {#other-submission-requirements .unnumbered}

1.  **Where to Send Applications**

Guidance for Electronic Submission of Applications is contained in
Section IV-2.3 of this announcement. Following are instructions for
submission of paper applications.

Send applications to the following address:

> **For United States Postal Service:**
>
> Crystal Saunders, Director of Grant Review
>
> Office of Program Services
>
> Substance Abuse and Mental Health Services Administration
>
> Room 3-1044
>
> 1 Choke Cherry Road
>
> Rockville, MD **20857**
>
> **For other delivery service:**
>
> Crystal Saunders, Director of Grant Review
>
> Office of Program Services
>
> Substance Abuse and Mental Health Services Administration
>
> Room 3-1044
>
> 1 Choke Cherry Road
>
> Rockville, MD **20850**

Do not send applications to other agency contacts, as this could delay
receipt. Be sure to include **Assertive Adolescent and Family Treatment
-TI-06-007** in item number 10 on the face page of any paper
applications. If you require a phone number for delivery, you may use
(240) 276-1199.

**6.2 How to Send Applications**

SAMHSA is collaborating with [www.Grants.gov](http://www.Grants.gov/) to
accept electronic submission of applications. Please refer to Section
IV-2.3 of this announcement for "Guidance for Electronic Submission of
Applications."

Following are instructions for submission of paper applications.

Mail or deliver an original application and 2 copies (including
appendices) to the mailing address provided above, according to the
instructions in Section IV-3. The original and copies must not be bound.
Do not use staples, paper clips, or fasteners. Nothing should be
attached, stapled, folded, or pasted.

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

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

# V. APPLICATION REVIEW INFORMATION {#v.-application-review-information .unnumbered}

## EVALUATION CRITERIA

Your application will be reviewed and scored according to the
[quality]{.underline} of your response to the requirements listed below
for developing the Project Narrative (Sections A-E). These sections
describe what you intend to do with your project.

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

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

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

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

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

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

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

-   Describe the target population (see Glossary) as well as the
    geographic area to be served, and justify the selection of both.
    Include the numbers to be served and demographic information.
    Discuss the target population's language, beliefs, norms and values,
    as well as socioeconomic factors that must be considered in
    delivering programs to this population.

-   Describe the nature of the problem and extent of the need for the
    target population based on data. The statement of need should
    include a clearly established baseline for the project.
    Documentation of need may come from a variety of qualitative and
    quantitative sources. The quantitative data could come from local
    data or trend analyses, State data (e.g., from State Needs
    Assessments), and/or national data (e.g., from SAMHSA's National
    Household Survey on Drug Abuse and Health or from National Center
    for Health Statistics/Centers for Disease Control reports). For data
    sources that are not well known, provide sufficient information on
    how the data were collected so reviewers can assess the reliability
    and validity of the data.

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

**Section B: Proposed Evidence-Based Service/Practice (30 points)**

-   Clearly state the purpose, goals and objectives of your proposed
    project. Describe how achievement of the goals will produce
    meaningful and relevant results (e.g., increase access,
    availability, outreach, treatment, and/or intervention).

-   If you propose to use ACRA/ACC, clearly document this. You do not
    need to provide further evidence of effectiveness.

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-   If you propose an intervention other than ACRA/ACC, identify the
    evidenced-based service/practice that you propose to implement.
    Provide a narrative justification that summarizes the evidence for
    effectiveness and acceptability of the proposed service/practice,
    that it is applicable to the target population, and that it is
    family centered. Evidence of effectiveness and acceptability must
    include the findings from clinical trials, efficacy and/or
    effectiveness studies published in the peer-reviewed literature.
    (See Section I-2.3, Documenting the Evidence-Base for Services to be
    Implemented.)

-   If an intervention other than ACRA/ACC is proposed, demonstrate that
    the funding is available to provide initial/ongoing training in the
    intervention, and any certification required **without** the use of
    Federal grant funds.

-   Describe and justify any adaptations of the proposed
    service/practice necessary to meet the needs of the target
    population as well as evidence that such adaptations will be
    effective for the target population.

-   Identify and justify any additional adaptations or modifications to
    the proposed service/practice.

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-   Describe how the proposed project will address issues of age, race,
    ethnicity, culture, language, sexual orientation, disability,
    literacy, and gender in the target population, while retaining
    fidelity to the chosen practice.

-   Demonstrate how the proposed service/practice will meet your goals
    and objectives. Provide a logic model (see Glossary) that links
    need, the services or practice to be implemented, and outcomes.

-   Document your agreement to use the GAIN **(do not attach the
    instrument in response to any of the review questions).**

    **Section C: Proposed Implementation Approach (25 points)**

-   Describe how the proposed service or practice will be implemented.

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

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

-   Describe how members of the target population helped prepare the
    application and how they will help plan, implement, and evaluate the
    project.

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-   Describe how the project components will be embedded within the
    existing service delivery system, including other SAMHSA-funded
    projects, if applicable. Identify any other organizations that will
    participate in the proposed project. Describe their roles and
    responsibilities and demonstrate their commitment to the project.
    Include letters of commitment from community organizations
    supporting the project in **Appendix 1**.

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-   Show that the necessary groundwork (e.g., planning, consensus
    development, development of memoranda of agreement, identification
    of potential facilities) has been completed or is near completion so
    that the project can be implemented and service delivery can begin
    as soon as possible and no later than 4 months after grant award
    **(with the exception of State applicants -- see the next bullet
    below).**

-   State applicants must show that the necessary groundwork (e.g.,
    planning, consensus development, development of memoranda of
    agreement, identification of a single site) has been completed so
    that the project can be implemented and service delivery can begin
    within 60 days of award.

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

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

    **Section D: Staff and Organizational Experience (20 points)**

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-   Discuss the capability and experience of the applicant organization
    and other participating organizations with similar projects and
    populations. Demonstrate that the applicant organization and other
    participating organizations have linkages to the target population
    and ties to grassroots/community-based organizations that are rooted
    in the culture of the target population.

-   Provide a list of staff who will participate in the project, showing
    the role of each and their level of effort and qualifications.
    Include the Project Director and other key personnel, such as the
    evaluator and treatment personnel.

-   Describe the cultural characteristics of key staff and indicate if
    any are members of the target population/community. If the target
    population is multi-linguistic, indicate if the staffing pattern
    includes bilingual and bicultural individuals.

-   Describe the resources available for the proposed project (e.g.,
    facilities, equipment), and provide evidence that services will be
    provided in a location that is adequate, accessible, compliant with
    the Americans with Disabilities Act (ADA), and amenable to the
    target population.

    **Section E: Evaluation and Data (15 points)**

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-   Document your ability to collect and report on the required
    performance measures as specified in Section I-2.6 of this RFA.
    Specify and justify any additional measures you plan to use for your
    grant project.

    -   Describe plans for data collection, management, analysis,
        interpretation and reporting. Describe the existing approach to
        the collection of data, along with any necessary modifications.
        Be sure to include data collection instruments/interview
        protocols in **Appendix 2**. (Do not include the GPRA tool or
        the GAIN instruments.)

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-   Discuss the reliability and validity of evaluation methods and
    instrument(s) in terms of the gender/age/culture of the target
    population. Discussion of the GAIN instruments is not required.

-   Describe the process and outcome evaluation, including assessments
    of implementation and individual outcomes. Show how the evaluation
    will be integrated with requirements for collection and reporting of
    performance data, including data required by SAMHSA to meet GPRA
    requirements.

-   Describe how the evaluation will be used to ensure fidelity to the
    practice.

-   Provide a per-person or unit cost of the project to be implemented,
    based on the applicant's actual costs and projected costs over the
    life of the project. Applicants must state whether or not the per
    person costs are within the following reasonable ranges by treatment
    modality. Applicants must also discuss the reasonableness of the per
    person costs. If proposed costs exceed reasonable ranges, a detailed
    justification must be provided.

Program Costs. The following are considered reasonable ranges by
treatment modality:

Residential: \$3,000 to \$10,000

Outpatient (Non-Methadone): \$1,000 to \$5,000

Outpatient (Methadone): \$1,500 to \$8,000

Intensive Outpatient: \$1,000 to \$7,500

Screen/Brief Intervention/Brief Treatment/Outreach/Pretreatment
Services: \$200 to \$1,200

Drug Court Programs (regardless of client treatment modality): \$3,000
to \$5,000

SAMHSA/CSAT computes per person costs as follows. The total support
requested for the life of the project is multiplied by .8 (.2 will be
the allowance for GPRA reporting requirements). The resulting amount is
then divided by the number of persons the applicant proposes to serve
over the life of the project.

The outreach and pretreatment services cost band only applies to
outreach and pretreatment programs that do not also offer treatment
services but operate within a network of substance abuse treatment
facilities. Treatment programs that add outreach and pretreatment
services to a treatment modality or modalities are expected to fall
within the cost band for that treatment modality.

NOTE: The Review Group will be asked to comment on the appropriateness
of the budget after the merits of the application have been considered.

**SUPPORTING DOCUMENTATION**

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

**Section G:** Budget Justification, Existing Resources, Other Support.
You must provide a narrative justification of the items included in your
proposed budget, as well as a description of existing resources and
other support you expect to receive for the proposed project. This
should include resources other than Federal grant funds available for
training/ongoing training and certification if you are proposing a
treatment intervention other than ACRA/ACC. Be sure to show that no more
than 15% of the total grant award will be used for infrastructure
development and that no more than 20% of the total grant award will be
used for data collection and evaluation, including GPRA. An illustration
of a budget and narrative justification is included in Appendix E of
this document.

#######  {#section-2 .unnumbered}

####### Section H: Biographical Sketches and Job Descriptions.  {#section-h-biographical-sketches-and-job-descriptions. .unnumbered}

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

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

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

**Section I:** Confidentiality and SAMHSA Participant Protection/Human
Subjects: Applicants must describe procedures relating to
Confidentiality, Participant Protection and the Protection of Human
Subjects Regulations in Section I of the application, using the
guidelines provided below. Number range CHAPTER

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

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

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

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

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

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

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

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

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

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

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

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

3.  [Absence of Coercion]{.underline}

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

-   If you plan to compensate participants, state how participants will
    be awarded incentives (e.g., money, gifts, etc.).

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

4.  [Data Collection]{.underline}

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

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

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-   Provide in **Appendix 2, "Data Collection Instruments/Interview
    Protocols,"** copies of [all]{.underline} available data collection
    instruments and interview protocols that you plan to use **(Do not
    include the GAIN or the GPRA Tool).**

5.  [Privacy and Confidentiality]{.underline}

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

-   Describe:

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-   How you will use data collection instruments.

-   Where data will be stored.

-   Who will or will not have access to information.

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

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

6.  [Adequate Consent Procedures]{.underline}

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

-   State:

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-   Whether or not their participation is voluntary.

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

-   Possible risks from participation in the project.

-   Plans to protect clients from these risks.

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

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

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

-   Include, as appropriate, sample consent forms that provide for: (1)
    informed consent for participation in service intervention; (2)
    informed consent for participation in the data collection component
    of the project; and (3) informed consent for the exchange (releasing
    or requesting) of confidential information. The sample forms must be
    included in **Appendix 3, "Sample Consent Forms"**, of your
    application. If needed, give English translations.

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

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

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

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

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

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

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

Applicants must be aware that even if the Protection of Human Subjects
Regulations do not apply to all projects funded, the specific evaluation
design proposed by the applicant may require compliance with these
regulations.

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

General information about Protection of Human Subjects Regulations can
be obtained on the web at <http://www.hhs.gov/ohrp>. You may also
contact OHRP by e-mail (<ohrp@osophs.dhhs.gov>[)]{.underline} or by
phone (301/496-7005). SAMHSA-specific questions related to Protection of
Human Subjects Regulations should be directed to the program contact
listed in Section VII of this RFA.

##  {#section-3 .unnumbered}

## 2. REVIEW AND SELECTION PROCESS {#review-and-selection-process .unnumbered}

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

Decisions to fund a grant are based on:

-   the strengths and weaknesses of the application as identified by
    peer reviewers and, when applicable, approved by the Center for
    Substance Abuse Treatment's National Advisory Council;

-   availability of funds; and

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

SAMHSA/CSAT will make no more than one award per applicant per
geographic community.

# VI. AWARD ADMINISTRATION INFORMATION {#vi.-award-administration-information .unnumbered}

## 1. AWARD NOTICES  {#award-notices .unnumbered}

#######  {#section-4 .unnumbered}

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

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

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

## 2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS  {#administrative-and-national-policy-requirements .unnumbered}

[]{.mark}

-   Successful applicants must comply with all terms and conditions of
    the grant award. SAMHSA's standard terms and conditions are
    available on the SAMHSA web site at
    [www.samhsa.gov/grants/generalinfo/grants_management.aspx](http://www.samhsa.gov/grants/generalinfo/grants_management.aspx).

-   Successful applicants must also comply with the administrative
    requirements outlined in 45 CFR Part 74 or 45 CFR Part 92, as
    appropriate. For more information see the SAMHSA web site
    (<http://www.samhsa.gov/Grants/generalinfo/grant_reqs.aspx> ).

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

    -   actions required to be in compliance with confidentiality and
        participant protection/human subjects requirements;

    -   requirements relating to additional data collection and
        reporting;

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

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

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

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

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

#######  {#section-5 .unnumbered}

## 3. REPORTING REQUIREMENTS {#reporting-requirements .unnumbered}

1.  **Progress and Financial Reports**

-   Grant performance will require the submission of annual and final
    progress reports, as well as annual and final financial status
    reports.

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

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

3.2 Government Performance and Results Act (GPRA)

The Government Performance and Results Act (GPRA) mandates
accountability and performance-based management by Federal agencies. To
meet the GPRA requirements, SAMHSA must collect performance data (i.e.,
"GPRA data") from grantees. The performance requirements for SAMHSA's
Family Centered Substance Abuse Treatment Grants for Adolescents and
their Families grant program are described in Section I-2.6 of this
document under "Data and Performance Measurement."

**3.3 Publications**

If you are funded under this grant program, you are required to notify
the Government Project Officer (GPO) and SAMHSA's Publications Clearance
Officer (240-276-2130) of any materials based on the SAMHSA-funded grant
project that are accepted for publication.

In addition, SAMHSA requests that grantees:

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

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

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

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

#  {#section-6 .unnumbered}

# VII. AGENCY CONTACTS {#vii.-agency-contacts .unnumbered}

For questions about program issues contact:

Randolph Muck

Practice Improvement Branch, Division of Services Improvement

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Treatment

1 Choke Cherry Road

Room 5-1083

Rockville, Maryland 20857

\(240\) 276-1576

<randy.muck@samhsa.hhs.gov>

For questions on grants management issues contact:

Kimberly Pendleton

Office of Program Services, Division of Grants Management

Substance Abuse and Mental Health Services Administration

1 Choke Cherry Road

Room 7-1097

Rockville, Maryland 20857

\(240\) 276-1421

<kimberly.pendleton@samhsa.hhs.gov>

# Appendix A -- Checklist for Formatting Requirements and Screenout Criteria for SAMHSA Grant Applications {#appendix-a-checklist-for-formatting-requirements-and-screenout-criteria-for-samhsa-grant-applications .unnumbered}

*SAMHSA's goal is to review all applications submitted for grant
funding. However, this goal must be balanced against SAMHSA's obligation
to ensure equitable treatment of applications. For this reason, SAMHSA
has established certain formatting requirements for its applications.
**If you do not adhere to these requirements, your application will be
screened out and returned to you without review.***

-   Use the PHS 5161-1 application.

-   Applications must be received by the application deadline or have
    proof of timely submission, as detailed in Section IV-3 of the grant
    announcement.

-   Information provided must be sufficient for review.

-   Text must be legible. (For Project Narratives submitted
    electronically in Microsoft Word, see separate requirements in
    Section IV-2.3 of this announcement under "Guidance for Electronic
    Submission of Applications.")

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

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

footnotes will not be considered in determining compliance.)

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

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

-   To ensure equity among applications, the amount of space allowed for
    the Project Narrative cannot be exceeded. (For Project Narratives
    submitted electronically in Microsoft Word, see separate
    requirements in Section IV-2.3 of this announcement under "Guidance
    for Electronic Submission of Applications.")

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

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

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

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

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

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

-   Abstract

-   Table of Contents

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

-   Project Narrative and Supporting Documentation

-   Appendices

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

-   Certifications (a form within PHS 5161-1)

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

-   Checklist (a form in PHS 5161-1)

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-   Applications should comply with the following requirements:

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-   Provisions relating to confidentiality and participant protection
    specified in Section V-1 of this announcement.

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

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

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

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

-   The page limits for Appendices stated in the specific funding
    announcement should not be exceeded.

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

###  

# Appendix B -- Glossary {#appendix-b-glossary .unnumbered}

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

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

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

**[Fidelity:]{.underline}** Fidelity is the degree to which a specific
implementation of a program or practice resembles, adheres to, or is
faithful to the evidence-based model on which it is based. Fidelity is
formally assessed using rating scales of the major elements of the
evidence-based model. A toolkit on how to develop and use fidelity
instruments is available from the SAMHSA-funded Evaluation Technical
Assistance Center at [http://tecathsri.org](http://tecathsri.org/) or by
calling (617) 876-0426.

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

**[Logic Model:]{.underline}** A logic model is a diagrammatic
representation of a theoretical framework. A logic model describes the
logical linkages among program resources, conditions, strategies,
short-term outcomes, and long-term impact. More information on how to
develop logics models and examples can be found through the resources
listed in Appendix D.

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

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

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

**[Sustainability:]{.underline}** Sustainability is the ability to
continue a program or practice after SAMHSA grant funding has ended.

**[Target Population]{.underline}:** The target population is the
specific population of people whom a particular program or practice is
designed to serve or reach.

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

# Appendix C - Statement of Assurance {#appendix-c---statement-of-assurance .unnumbered}

As the authorized representative of the applicant organization, I assure
SAMHSA that if \[*insert name of organization*\] application is within
the funding range for a grant award, the organization will provide the
SAMHSA Government Project Officer (GPO) with the following documents. I
understand that if this documentation is not received by the GPO within
the specified timeframe, the application will be removed from
consideration for an award and the funds will be provided to another
applicant meeting these requirements.

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

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

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

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

Signature of Authorized Representative Date

# Appendix D -- Logic Model Resources {#appendix-d-logic-model-resources .unnumbered}

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

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

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

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

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

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

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

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

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

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

241\. Thousand Oaks, CA: Sage.

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

# Appendix E -- Sample Budget and Justification {#appendix-e-sample-budget-and-justification .unnumbered}

**ILLUSTRATION OF A SAMPLE DETAILED BUDGET AND**

**NARRATIVE JUSTIFICATION TO ACCOMPANY**

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

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

**[Personnel]{.underline}**

**Job Annual Level of Salary being**

**Title** **Name Salary Effort Requested**

Project

Director J. Doe \$30,000 1.0 \$30,000

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

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

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

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

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

**[Travel]{.underline}**

2 trips for SAMHSA Meetings for 2 Attendees

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

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

Local Travel (500 miles x .24 per mile)

120

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

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

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

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

**Enter Equipment subtotal on 424A, Section B, 6.d.**

**[Supplies]{.underline}**

Office Supplies \$500

Computer Software - 1 WordPerfect 500

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

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

**[Contractual Costs]{.underline}**

**Evaluation**

Job Name Annual Salary being Level of

Title Salary Requested Effort

Evaluator J. Wilson \$48,000 \$24,000 0.5

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

Fringe Benefits (25%) \$10,500

**Travel**

2 trips x 1 Evaluator

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

per diem @ \$120 x 6 720

Supplies (General Office) 500

Evaluation Direct \$54,920

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

Evaluation Subtotal \$65,355

**Training**

Job Name Level of Salary being

Title Effort Requested

Coordinator M. Smith 0.5 \$ 12,000

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

Fringe Benefits (25%) \$ 5,250

**Travel**

2 Trips for Training

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

Per Diem \$120 x 2 x 2 days 480

Local (500 miles x .24/mile) 120

**Supplies**

Office Supplies \$ 500

Software (WordPerfect) 500

**Other**

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

Telephone 500

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

Audit \$ 3,000

Training Direct \$ 40,025

Training Indirect \$ -0-

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

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

**[Other]{.underline}**

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

(If expert is known, should list by name)

**Enter Other subtotal on 424A, Section B, 6.h. \$ 1,500**

**Total Direct Charges (sum of 6.a-6.h)**

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

**[Indirect Costs]{.underline}**

15% of Salary and Wages (copy of negotiated

indirect cost rate agreement attached)

**Enter Indirect subtotal of 424A, Section B, 6.j. \$ 9,600**

**[TOTALS]{.underline}**

**Enter TOTAL on 424A, Section B, 6.k. \$202,240**

**[JUSTIFICATION]{.underline}**

PERSONNEL - Describe the role and responsibilities of each position.

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

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

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

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

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

OTHER - Generally self-explanatory. If consultants are included in this
category, explain the need and how the consultant's rate has been
determined.

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

[CALCULATION OF FUTURE BUDGET PERIODS]{.underline}

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

Review and verify the accuracy of future year budget estimates.
Increases or decreases in the future years must be explained and
justified and no cost of living increases will be honored. (NOTE: new
salary cap of \$180,100 is effective for all FY 2005 awards.) \*

First Second Third

12-month 12-month 12-month

Period Period Period

Personnel

Project Director 30,000 30,000 30,000

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

Counselor 25,000 25,000 25,000

TOTAL PERSONNEL 64,000 73,000 73,000

\*Consistent with the requirement in the Consolidated Appropriations
Act, Public Law 108-447.

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

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

Travel 5,400 5,400 5,400

Equipment -0- -0- -0-

Supplies\*\*\* 1,000 520 520

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

Contractual

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

Training 40,025 40,025 40,025

\*\*\*\*Increased amounts in 02 and 03 years are reflected of the
increase in client data collection.

Other 1,500 1,500 1,500

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

Indirect Costs 9,600 9,600 9,600

(15% S&W)

TOTAL COSTS 202,240 216,884 219,603

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