Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

**Cooperative Agreements for**

**Screening, Brief Intervention, Referral and Treatment (SBIRT)**

**(Initial Announcement)**

**Request for Applications (RFA) No. TI-06-002**

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

**Key Dates:**

+----------------------+-----------------------------------------------+
| **Application        | **Applications are due by April 27, 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)**     |                                               |
+----------------------+-----------------------------------------------+

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

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

Director, Center for Substance Abuse Treatment Administrator

Substance Abuse and Mental Health Substance Abuse and Mental Health

Services Administration Services Administration

Table of Contents

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

[1. INTRODUCTION 1](#introduction)

[2. EXPECTATIONS 1](#expectations)

[II. AWARD INFORMATION 14](#ii.-award-information)

[1. AWARD AMOUNT 14](#award-amount)

[2. FUNDING MECHANISM 15](#funding-mechanism)

[III. ELIGIBILITY INFORMATION 17](#iii.-eligibility-information)

[1. ELIGIBLE APPLICANTS 17](#eligible-applicants)

[2. COST SHARING 17](#cost-sharing)

[3. OTHER 17](#other)

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

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

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

[3. SUBMISSION DATES AND TIMES 26](#submission-dates-and-times)

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

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

[6. OTHER SUBMISSION REQUIREMENTS 29](#other-submission-requirements)

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

[1. Evaluation Criteria 30](#evaluation-criteria)

[2. REVIEW AND SELECTION PROCESS 41](#review-and-selection-process)

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

[1. AWARD NOTICES 42](#award-notices)

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

[3. REPORTING REQUIREMENTS 43](#reporting-requirements)

[VII. AGENCY CONTACTS 44](#vii.-agency-contacts)

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

[Appendix B -- Glossary 48](#appendix-b-glossary)

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

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

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

[Appendix F - Resources for Implementing Screening, Brief Intervention,
Referral, and Treatment
56](#appendix-f---resources-for-implementing-screening-brief-intervention-referral-and-treatment)

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

## 1. INTRODUCTION {#introduction .unnumbered}

######  {#section .unnumbered}

The Substance Abuse and Mental Health Services Administration (SAMHSA),
Center for Substance Abuse Treatment (CSAT) is accepting applications
for fiscal year (FY) 2006 Cooperative Agreements for Screening, Brief
Intervention, Referral and Treatment (SBIRT). SBIRT Cooperative
Agreements will expand and enhance State substance abuse treatment
service systems by:

-   Expanding the State's continuum of care to include screening, brief
    intervention, referral, and brief treatment (SBIRT) in general
    medical and other community settings (e.g., community health
    centers, nursing homes, schools and student assistance programs,
    occupational health clinics, hospitals, emergency departments);

-   Supporting clinically appropriate services for persons at risk for,
    or diagnosed with, a Substance Use Disorder (i.e., Substance Abuse
    or Dependence) (Note: for the purpose of the RFA 'at risk' is
    defined as persons who are using substances but who do not yet meet
    the criteria for a diagnosis of Substance Use Disorder[^1]); and

-   Identifying systems and policy changes to increase access to
    treatment in generalist and specialist settings.

The SBIRT program is authorized under Section 509 of the Public Health
Service Act, as amended. This announcement addresses *Healthy People
2010*, Volume II (Part B: 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 6 months]{.underline} after award.

##  {#section-1 .unnumbered}

## 2. EXPECTATIONS {#expectations .unnumbered}

2.1 Background

For demand reduction, the 2005 National Drug Control Strategy (NDCS)
emphasizes: (1) preventing initiation of drug use for those who have not
initiated illegal drug use; (2) getting treatment resources where they
are needed; and (3) attacking the economic basis of the drug trade
(ONDCP, 2005). SBIRT's focus on early intervention and treatment
continues to be a vital component of the NDCS demand reduction
initiatives.

Federal programs, including those operated by SAMHSA/CSAT, have tended
to emphasize either universal prevention strategies aimed at those who
have never initiated use (Mrazek and Haggerty, 1994) or specialist
treatment for those who are dependent (Gerstein and Harwood, 1990).
Little attention has been paid to the large group of individuals who use
drugs but are not, or not yet, dependent and who could successfully
reduce drug use through "early intervention". (Klitzner et al., 1992;
Fleming, 2002). There is an emerging body of research and clinical
experience that supports use of the SBIRT approach as providing
effective early intervention for persons at risk for, or diagnosed with,
a Substance Use Disorder (Substance Abuse or Dependence) (e.g., Barry,
1999; Babor and Higgins-Biddle, 2000; Bernstein et. al, 1997; Zweben and
Fleming, 1999; Broskowski and Smith, 2001; Heather, 2001; Dennis, et
al., 2002; Babor, 2002; Blow, 1998; Fleming 2002; Breslin, et at., 2002;
Degutis, 2003; Fleming, 2003; Babor, 2004). (Note: A complete listing of
the references and resources (including evidence-based
practices/services) cited in this document can be found at
<http://www.mayatech.com/sbirt/tools_resources/references.htm>. Copies
of the listing are available in the application kits distributed by
SAMHSA's National Clearinghouse for Alcohol and Drug Information.)

The specialist treatment system is often not appropriate for persons at
risk for a Substance Use Disorder, nor can that system alone address the
needs of all those persons diagnosed with either a Substance Abuse or a
Substance Dependence Disorder. Consequently, new program efforts are
needed to provide funding to introduce or expand screening and brief
intervention and brief treatment for persons at risk for, or diagnosed
with, a Substance Use Disorder (Substance Abuse or Dependence). These
new program efforts should be initiated in general medical and other
community settings (e.g., community health centers, nursing homes,
schools and student assistance programs, occupational health clinics,
hospitals, emergency departments).

2.2 SBIRT Allocation of Funds

**SBIRT Services:** Grantees must develop a systematic approach and must
devote not less than **65 percent (65%)** of their award to expand and
enhance their service system to carry out the following services in
community agencies, including establishing referral linkages to
specialist treatment agencies/providers.

-   **Screening** for substance use problems and disorders

-   **Brief Interventions** (1 to 5 sessions)

-   **Brief Treatment** (up to 12 sessions) and monitoring of
    individuals who use drugs but are not yet dependent

-   **Referral to Treatment** (when indicated) for those who have a
    Substance Use Disorder. Persons who qualify for a diagnosis of drug
    abuse or dependence and who are non-responsive to an initial brief
    intervention or brief treatment must be referred for specialty
    treatment.

**Specialty Treatment Services:** While the focus of this initiative is
on screening, brief intervention, and brief treatment, it is critical to
ensure that appropriate services are available to treat persons for whom
such services in community settings are not appropriate. Therefore, a
portion of the award may be used for referral to specialty treatment.
Grantees may use up to **15 percent (15%)** of the award to expand
specialty modalities (outreach/pretreatment services, methadone and
non-methadone outpatient services, and residential services) for persons
screened in this program who require more intensive and prolonged
specialty treatments.

Guidance and requirements related to services design, project phases and
operations are provided below.

**Project Administration:** Grantees may use up to **20 percent (20%)**
of the award to carry out required project administration including: (1)
policy and systems change; (2) staff training and technical assistance;
(3) monitoring sub-recipients' service delivery and data collection; and
(4) overall project reporting. This allowable percentage of the award
may be passed along to sub-recipients to enable them to carry out
project administration activities.

Guidance and requirements related to policy and systems change and
project reporting are provided below.

3.  **Detailed Requirements**

#### [Policy and Systems Change]{.underline} {#policy-and-systems-change .unnumbered}

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

#### To implement policies that will successfully attract and effectively serve persons at risk for, or diagnosed with, a Substance Use Disorder (Substance Abuse or Dependence), the applicant will need to provide a systems change plan that reflects an understanding of the general reasons why people do not seek services, as well as how these barriers, which prevent individuals from successfully accessing the clinically appropriate level of care, may apply to their system of care.  {#to-implement-policies-that-will-successfully-attract-and-effectively-serve-persons-at-risk-for-or-diagnosed-with-a-substance-use-disorder-substance-abuse-or-dependence-the-applicant-will-need-to-provide-a-systems-change-plan-that-reflects-an-understanding-of-the-general-reasons-why-people-do-not-seek-services-as-well-as-how-these-barriers-which-prevent-individuals-from-successfully-accessing-the-clinically-appropriate-level-of-care-may-apply-to-their-system-of-care. .unnumbered}

A substantial body of research is related to barriers to access to
health care, in general, as well as barriers to treatment for Substance
Use Disorders, specifically. Various approaches exist to identify and
classify barriers (Institute of Medicine, 1990; Fiorentine, 1993;
Weisner and Schmidt, 1999; PLNP, 2000; Schermer et al., 2003; Barry et
al., 2004). Less is known about those enabling factors that increase
help-seeking and access (Grant, 1997; Weisner and Schmidt, 2001; Fortney
and Booth, 2001).

Of major concern are the numerous studies documenting the failure of
primary care physicians to identify persons at high risk of or already
experiencing a Substance Use Disorder and initiating the appropriate
referral for evaluation and treatment (Saitz et al., 1997; Hack and
Adger, 2002; NCASA, 2002; Degutis, 2003). Such identification in
mainstream medical care settings is necessary because perceived illness
severity and stigma also may act as barriers to treatment.

Addiction policy and service provision in States occurs within the
context of both general health systems and financing arrangements and
carved-out specialty prevention and treatment systems (Denmeade and
Rouse, 1994; Jainchill, N., 2004). The implications of these
arrangements for the diffusion of SBIRT must be considered in project
formulation and implementation. Financial accessibility implies that the
cost of the service is reasonable and there is no disincentive to use
needed services because of their costs or the method of reimbursement.
However, many studies identify barriers due to the manner in which
substance abuse treatment is financed, such as a lack of parity with
physical illness in commercial and public insurance leading to high
co-pays and restrictions of payment for diagnostic assessments, and lack
of coverage or payment for nontraditional specialist treatment
modalities (e.g., residential therapeutic communities) or for screening
services in emergency departments and primary care settings (Reader and
Sullivan, 1992; Buck and Umland, 1997; Sing et al., 1998; Rivara et al.,
2000; Rockett et al., 2005; Schmidt and Weisner, 2005). For example,
several States still have Uniform Accident and Sickness Policy Provision
Law (UPPL) provisions in their insurance policies that permit insurers
to deny coverage for injuries sustained due to intoxication or because
of the influence of other drugs. Although these policies are not always
enforced, they may serve as disincentives to the provision of
SBIRT-related services (Rivara, et al., 2000).

Another often cited barrier is the multiple, separate, and fragmented
Federal, State, local, and private funding streams accessed by
frequently uncoordinated agencies[^2] that have different coverage
policies, codes, and procedures for treatment modalities and ancillary
services, different eligibility criteria for providers and patients,
different reporting requirements, different placement criteria, and
inconsistent benefit designs (Gerstein and Harwood, 1990; Schlessinger
et al., 1991; Moss, 1998; Johnson, 1999; Horgan and Merrick, 2001;
Garnick et al, 2002; Hodgkin et al., 2000; Hodgkin et al., 2004; Rockett
et al., 2005; Schmidt and Weisner, 2005).

Eliminating these barriers through systems and policy change is a major
emphasis of this program (e.g., Pauly, 1991; Libertoff, 1999; Zarkin et
al., 1995). Integrating SBIRT in community settings will require the
applicant to conduct an analysis of the inhibiting and facilitating
policies and practices. Applicants must describe how these barriers will
be removed and how applicants will facilitate access to clinically
appropriate treatment, starting with screening for Substance Use
Disorders in community settings.

#### [Services Design]{.underline}  {#services-design .unnumbered}

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

#### Grantees will be required to adopt and implement a treatment system that includes all of the following components*:* {#grantees-will-be-required-to-adopt-and-implement-a-treatment-system-that-includes-all-of-the-following-components .unnumbered}

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

#### *[Screening, Identification, Brief Intervention, Referral, and Brief Treatment]{.underline}*. This involves the implementation of a system within community and specialist settings that screens for and identifies persons at risk for, or diagnosed with, a Substance Use Disorder (Substance Abuse or Dependence). Depending on the level of problems identified, the system either provides for a brief intervention within the generalist setting, when appropriate, or motivates and refers persons with a probable diagnosis of substance abuse or substance dependence to the specialist setting for assessment, diagnosis, and either brief or long-term treatment. This includes training in self-management and involvement in mutual help groups, as appropriate (Workgroup on Substance Abuse Self-Help Organizations, 2003).[^3] The evidence-based approaches and tools (discussed in the references and resources provided in this document \-- see Appendix F) utilized for screening, brief intervention, referral, and brief treatment may vary; however, the core components of SBIRT remain and can be defined as follows: 

-   *Screening --* brief screening incorporated into the normal routine
    in medical and other community settings that provides identification
    of individuals at risk for Substance Use Disorders. SAMHSA is
    committed to: (1) standardizing the screening process so that
    screening produces consistent results across sites, in terms of
    individuals identified as requiring brief intervention or referral
    to treatment; and (2) detecting and intervening with individuals who
    have a Substance Use Disorder, but whose problems are not so severe
    that they require specialty treatment. Therefore, grantees will be
    required to screen adults using the Alcohol Use Disorders
    Identification Test (AUDIT), the Drug Abuse Screening Test (DAST),
    and the Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) for
    screening of adolescents.[^4] Additional screening tools may be used
    with the agreement of the SAMHSA Project Officer*.*

-   *Brief Intervention* -- discussion that is focused on raising an
    individual's awareness of their substance use and motivating them
    toward behavioral change. Brief interventions are considered to be 1
    to 5 sessions in length.

-   *Brief Treatment* -- a distinct level of care that consists of a
    limited course of highly focused cognitive behavioral clinical
    sessions. Brief treatment is considered to be 6 to 12 sessions in
    length. It may occur in the same session as the initial screening or
    in follow-up sessions.

-   *Referral* -- a proactive process that facilitates access to care
    for individuals who are assessed to have a Substance Use Disorder
    requiring a more intensive treatment specialty.

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-   *[Sequential Assessment and Diagnosis.]{.underline}* This involves
    having a system in place to ensure that individuals who screen
    positive for Substance Use Disorders are appropriately assessed for
    the presence of co-morbid physical and mental disorders so that a
    diagnosis is made, an initial treatment plan is developed, and a
    referral is made to the clinically appropriate community or
    specialist treatment setting as dictated by the person's clinical
    status.

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-   *[Treatment]{.underline}*. This involves having a system in place to
    ensure that individuals who are diagnosed with a Substance Use
    Disorder are provided an opportunity to undergo an integrated
    pharmacological and psychosocial treatment regimen in order to
    reduce or eliminate their harmful consumption and its adverse
    effects in the clinically appropriate community or specialist
    treatment setting. This includes training in self-management and
    involvement in mutual help groups, as appropriate.

    -   *[Continued Management Support.]{.underline}* This involves
        having a system in place to ensure that individuals who complete
        their formal treatment episode will receive long term management
        support (care management and recovery support systems), as
        appropriate for their level of disability and relapse potential
        in the clinically appropriate community or specialist treatment
        setting. This includes training in self-management and
        involvement in mutual help groups.[^5]

Patients manifesting signs of intoxication, withdrawal symptoms, and
other physical problems that require emergency care or urgent action
would be managed in other components of the generalist or specialist
treatment systems. While stabilization and detoxification may be
required for some persons presenting to community agencies, the
availability of treatment resources, financing mechanisms, and other
access barriers vary from those encountered in treating individuals who
do not require withdrawal and stabilization.

This variation is recognized in the differentiation of the levels and
settings of services for detoxification and rehabilitation in the latest
version of the American Society of Addiction Medicine (ASAM) Patient
Placement Criteria (ASAM, 2001); Gastfriend et al., 2000) and the
guidelines developed by the Evidence-Based Clinical Practice Guideline
Working Group for the Veterans Health Administration and Department of
Defense (2001).

**2.4 Project Phases and Operations**

The projects will have three phases.

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

***Phase I: Project Planning and Start-Up.*** This phase is expected to
last approximately 6 months. During this time, CSAT will work
collaboratively with the grantee, project staff, and Policy Steering
Committee members (see Section II-2 below). The start-up tasks to be
completed in this phase are, at minimum:

-   Selecting the members of the Policy Steering Committee (and
    subcommittees, if appropriate).

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-   Developing a solid organizational structure that involves or enlists
    the participation of an appropriate array of service providers and
    funders representing the full spectrum of community and specialist
    services required to serve the needs of persons at risk for, or
    diagnosed with, a Substance Use Disorder (Substance Abuse or
    Dependence) in the sub-recipient communities.

-   Refining the project management, reporting, quality improvement, and
    cost control mechanisms.

-   Refining the needs assessment and survey of existing system gaps and
    precisely identifying the target populations and communities to be
    served.

-   Refining the plan to provide training and technical assistance,
    including information about SBIRT methods, training for staff in the
    community and specialist settings in carrying out SBIRT, and
    technical assistance to the overall project and its sub-recipients.

-   Finalizing all necessary interagency agreements, contracts,
    subcontracts, billing procedures and fiscal controls, and reporting
    and monitoring procedures with the agency or agencies in the
    communities that will deliver services.

-   Introducing reporting instruments and obtaining baseline data
    covering existing levels of service, patient/client needs, program
    performance characteristics, and training and technical assistance.

-   Developing a plan for garnering and sustaining necessary policy
    changes and resources required to continue the project following the
    period of Federal support.

-   Demonstrating that required resources not included in the Federal
    budget request are adequate and readily accessible.

-   Initiating service delivery in the expanded continuum of care in
    each sub-recipient target community, if required.

-   Establishing the mechanism for monitoring performance against
    targets for: (1) reducing drug use by patients receiving services
    through the SBIRT project; (2) increasing the number of persons at
    risk for, or diagnosed with, a Substance Use Disorder (Substance
    Abuse or Dependence) who receive treatment in each sub-recipient
    community; (3) increasing the number of community settings where
    SBIRT services are provided; and (4) providing treatment services
    within approved cost parameters for each treatment modality.

-   Submitting an acceptable final Project Implementation Plan that
    includes specific objectives and milestones, implementation
    timeframes and designation of staff responsible for accomplishing
    individual program objectives.

Release of funds for project implementation will be contingent on CSAT
approval of the Project Implementation Plan finalized during the initial
phase and submitted for approval by the end of the third month following
award. At the conclusion of Phase I, every component of the project
should be fully operational.

***Phase II: Operations.*** This phase is expected to last approximately
4 years and 3 months. During this time, CSAT will work collaboratively
with the grantee, project staff, State Substance Abuse Authority (SSA),
and other relevant agencies, Policy Steering Committee members, and
sub-recipients to implement project management, monitoring and
reporting, training, technical assistance to sub-recipients, and service
delivery. In Phase II, the grantee will be responsible for these
activities:

-   Operation of the Policy Steering Committee (and its subcommittees,
    if appropriate), including regular meetings; monitoring project
    activities and achievements with regard to the specific objectives
    and milestones, implementation timeframes, and designation of staff
    according to the Project Implementation Plan; and communications
    with the sub-recipients.

-   Determining the need for and providing the requisite training and
    technical assistance needed to achieve project goals.

-   Project management, reporting, quality improvement, and cost
    control.

-   Managing the continuation award process to the sub-recipients.

-   Accomplishing and tracking systems change (i.e., overcoming funding
    and other resource barriers, policy changes, improving linkages
    among specialist and community agencies, providing training and
    technical assistance, carrying out service delivery in the expanded
    continuum of care in each sub-recipient target community) and
    achieving the targets for: (1) reducing drug use by patients
    receiving treatment through the SBIRT project; (2) increasing the
    number of persons at risk for, or diagnosed with, a Substance Use
    Disorder (Substance Abuse or Dependence) who receive treatment in
    each sub-recipient community; (3) increasing the number of community
    settings where SBIRT services are provided; and (4) providing
    treatment services within approved cost parameters for a given
    treatment modality.

-   Refining operations as barriers are encountered and lessons are
    learned through feedback from the monitoring and reporting systems.

***Phase III: Phase Out.*** During the final 3 months of the cooperative
agreement award, CSAT will work cooperatively with the grantee, project
staff, Policy Steering Committee members, and sub-recipients to make the
transition from the cooperative agreement to State/Tribe and local
control and to sustain the system changes achieved by the project.

**2.5 Data and Performance Measurement**

During the course of the project, grantees must provide information
needed by SAMHSA to comply with the Government Performance and Results
Act (GPRA) reporting requirements. GPRA mandates accountability and
performance-based management by Federal agencies, focusing on results or
outcomes in assessing the effectiveness of Federal activities and on
measuring progress toward achieving national goals and objectives. The
grantee must ensure that all sub-recipients submit the required data. A
detailed description of CSAT's GPRA strategy and the Discretionary
Services Client Level GPRA Tool can be found online at
[www.samhsa-gpra.samhsa.gov](http://www.samhsa-gpra.samhsa.gov/). This
Website must be used to enter full GPRA baseline/intake, discharge and 6
months after intake data.

CSAT-GPRA requirements for this specific program include data collection
and real time reporting about cooperative agreement-supported service
recipients at baseline/intake, discharge and 6 months after intake, as
noted above. Grantees are also expected to obtain a minimum of an 80
percent (80%) follow-up rate on those clients selected as part of the
follow-up sample. Data must be entered into the CSAT GPRA web-based data
entry and reporting system on a real-time basis. Grantees also are
required to submit specified aggregate data in semi-annual reports.
These requirements should be considered when preparing the data
collection, monitoring, and reporting budget section of the application.

Applicants should carefully note that there are three categories of
services or combinations of services to be supported by these
cooperative agreement funds and each category has specific reporting
requirements with regards to GPRA.

The three categories of services or combinations of services to be
provided to individuals include:

-   Screening Only;

-   Screening and Brief Intervention (BI); and

-   Screening and Brief Treatment (BT) or Screening and Referral to
    Other Types of Treatment for Substance Use Disorders (RT).

    Varying levels of data are required on clients in each category of
    care. Intake and discharge data are required on all clients as
    specified below. The data will be used to allow CSAT to assess
    performance with respect to the National Outcome Measures (NOMs).
    Drug use, employment status, housing status, criminal justice
    status, social connectedness, access and retention will all be
    measured using the sections of the GPRA tool as detailed below. Also
    noted below are follow-up data specifications. Follow-up data will
    be required on 10 percent (10%) of the clients served in **each**
    category of care requiring intervention/treatment (BI, BT, RT).

    All adult screenings must be conducted using the AUDIT, DAST for
    adults and CRAFFT for adolescents. Additional screening
    instruments/tools may be used with the agreement of the SAMHSA
    Project Officer. The following are the reporting requirements for
    each category:

## Screening Only {#screening-only .unnumbered}

#####  {#section-6 .unnumbered}

##### Baseline Client Level Data {#baseline-client-level-data .unnumbered}

> For clients who are screened and who, based on the results of the
> screen, should not require any level of substance abuse intervention
> or treatment services, the following will be required for each grantee
> and/or each community, if applicable:
>
> Baseline (at screening) CSAT-GPRA data elements limited to the
> demographics must be collected on all clients in this category. (See
> Sections A and B of the GPRA tool.) This individual client level data
> will be used to count unduplicated clients served. No further data
> collection will be required on these clients.

#### Screening and Brief Intervention (BI) {#screening-and-brief-intervention-bi .unnumbered}

####  {#section-7 .unnumbered}

For all clients who are screened and who, based on the results of the
screen, should or do receive brief intervention, the following must be
collected and reported:

> [Baseline Client Level Data]{.underline}
>
> Baseline (at screening) CSAT-GPRA data elements limited to the
> demographic, and substance use domains must be collected on all
> clients in this category of service. (See Sections A and B of the GPRA
> tool.) This individual client level data will be used to count
> unduplicated clients served. It is important that all clients complete
> a tracking information sheet in the event they are selected for
> follow-up.
>
> [Discharge Client Level Data]{.underline}
>
> For all clients in this category, discharge data must be submitted to
> CSAT. If a Brief Intervention is completed more than 7 days from the
> time of intake, Sections A, B, J and K of the GPRA tool must be
> completed on the client. If the intervention is 7 days or less from
> the time of intake, Sections A, J and K should be completed.

##### Follow-up Client Level Data  {#follow-up-client-level-data .unnumbered}

For a representative 10 percent (10%) sample of clients in this category
who should have or did receive brief intervention, the follow-up GPRA
items asked are limited to the substance use domain and follow-up
sections of the tool. (See Sections A, B and I of the GPRA tool.) Data
must be collected at 6 months after baseline and entered into the CSAT
web-based GPRA data entry and reporting system. CSAT will provide
grantees the sampling method to obtain the representative sample of 10
percent (10%). Grantees will be notified which clients have been
selected as part of the representative sample and need to be located for
follow-up via a web based notification report. Grantees are expected to
achieve a follow-up rate of at least 80 percent (80%) of those selected
for the follow-up sample.

For example, if 100 patients are screened and should receive Brief
Intervention, 10 clients will be in the CSAT selected sample to be
followed up. Grantees will be required to attempt to locate all 10
clients. It is required that at a minimum eight of these clients
complete a follow-up interview.

##### Aggregated Data {#aggregated-data .unnumbered}

In the semi-annual report, the grantee must also provide data about the
costs for the delivery of screening and brief intervention, including
the mean, median, and range of costs overall, by facility type, and
region and sub-recipient, if applicable. The grantee must also discuss
how such costs compare to the CSAT approved cost parameters for
screening and brief intervention and what efforts they are undertaking
to bring costs into line with those expected.

#### Screening and Brief Treatment (BT) or Screening and Referral to Other Types of Treatment for Substance Use Disorders (RT) {#screening-and-brief-treatment-bt-or-screening-and-referral-to-other-types-of-treatment-for-substance-use-disorders-rt .unnumbered}

For all clients that are screened and require either brief treatment or
other treatment, the following must be collected and reported:

##### Baseline Client Level Data {#baseline-client-level-data-1 .unnumbered}

Baseline (at screening) using all of the CSAT GPRA data elements must be
collected on all clients in this category of service. (See Sections A
through G of the GPRA tool.) It is important that all clients complete a
tracking information sheet in the event they are selected for follow-up.

> [Discharge Client Level Data]{.underline}
>
> For all clients in this category, discharge data must be submitted to
> CSAT. If a Brief Treatment is completed more than 7 days from the time
> of intake, Sections A through G, J and K of the GPRA tool must be
> completed on the client. If the treatment is 7 days or less from the
> time of intake, Sections A, J and K of the GPRA tool must be
> completed.

##### Follow-up Client Level Data {#follow-up-client-level-data-1 .unnumbered}

For a representative 10 percent (10%) sample of clients in this category
who, based on the results of their screening, should have or did receive
services beyond brief intervention, follow-up data (all domains, see
Sections A through I of the GPRA tool) are to be collected at 6 months
after the initiation of substance abuse treatment services and entered
into the GPRA web-based data entry and reporting system. CSAT will
provide grantees the sampling method to obtain the representative sample
of 10 percent (10%). Grantees will be notified which clients have been
selected as part of the representative sample and need to be located for
follow-up via a web based notification report. Grantees are expected to
achieve a follow-up rate of at least 80 percent (80%) of those selected.

Note that two levels of intervention are being described here. A 10
percent (10%) sample is required for each of the two levels (BT, RT).

For example, if 100 patients are screened and should receive Brief
Treatment, 10 clients will be in the sample to be followed up. Grantees
will be required to attempt to locate all 10 clients. It is required
that at a minimum eight of these clients complete a follow-up interview.

In addition, if 100 patients were screened and should receive a Referral
to Treatment, 10 clients will be in the sample to be followed up.
Grantees will be required to attempt to locate all 10 clients. It is
required that at a minimum 8 of these clients complete a follow-up
interview.

##### Aggregated Data  {#aggregated-data-1 .unnumbered}

In the semi-annual report, the grantee must also provide data about the
costs for the delivery of screening and brief treatment as well as all
other treatment modalities supported by this cooperative agreement
including the mean, median, and range of costs overall, by modality,
facility type and region, and sub-recipient, if applicable. The grantee
must also discuss how such costs compare to the CSAT approved cost
parameters for screening and brief intervention and what efforts they
are undertaking to bring costs into line with those expected.

Grantees must comply with GPRA data collection and reporting
requirements, including continuous reporting[^6] of progress in meeting
the targets proposed (in the application) for the number of persons to
be served and the collection of the specified CSAT GPRA Core Client
Outcomes at specified time points. Grantees are required to collect and
report client level data for the overall project and for each
sub-recipient using the CSAT GPRA data entry and reporting system.

#### Other Reporting Requirements {#other-reporting-requirements .unnumbered}

####  {#section-8 .unnumbered}

CSAT's GPRA Core Client Outcome domains are:

-   Number of individuals served;

-   Percent of service recipients who: have no past month substance use;
    have no or reduced alcohol or illegal drug consequences; are
    permanently housed in the community/living in a stable housing
    environment; are employed/in school; have no or reduced involvement
    with the criminal/juvenile justice system; have increased social
    connectedness; and, have good or improved health and mental health
    status.

Applicants must clearly state which GPRA service population(s) they
propose to address as target populations. For more information, as well
as the electronic versions of the CSAT GPRA materials, go to
[www.samhsa-gpra.samhsa.gov](http://www.samhsa-gpra.samhsa.gov/).

2.6 Evaluation

While a formal local evaluation is not required, the grantee will be
expected to monitor project implementation and document State-level and
sub-recipient community level and provider agency level activities,
accomplishments, and outcomes. The grantee will be expected to provide
regular feedback to the project managers, staff, and Policy Steering
Committee to ensure fidelity and improve operations and services.

Grantees are required to describe their evaluation plans in their
application. The evaluation must include both process and outcome
measures. Process and outcome evaluations measure change relating to
project goals and objectives over time compared to baseline information.
Control or comparison groups are not required.

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

#######  {#section-9 .unnumbered}

Outcome components should address issues such as:

-   What was the effect of the intervention on participants?

-   What program/contextual factors were associated with outcomes?

-   What individual factors were associated with outcomes?

-   How durable were the effects?

SAMHSA will conduct a cross-site evaluation of all SBIRT projects funded
under its SBIRT funding announcements. Projects funded under this
announcement will be included in the cross-site evaluation and all
grantees are required to participate in this evaluation. [^7]

Data collection for the evaluation reports will be discussed and
verified during an annual interview with a CSAT contractor, either
conducted in-person or by telephone, with appropriate, knowledgeable
project staff.[^8]

2.7 Grantee Meetings

At least two people from each project (including the Project Director)
must attend one grantee meeting in each year of the grant. The applicant
must budget for these meetings. At these meetings, grantees will present
the results of their projects and Federal staff will provide technical
assistance. Each meeting will be up to 3 days in length. These meetings
will usually be held in the Washington, DC, metropolitan area and
attendance is mandatory.

Additionally, grantees are required to attend two technical assistance
meetings in the first year and one in each of the remaining years. The
applicant must budget for these meetings. A minimum of four persons from
each project is expected to attend the technical assistance meetings.
Individuals who are required to attend technical assistance meetings are
the Project Director, the individual responsible for overseeing clinical
services by contracted providers participating in SBIRT, and the
individual responsible for project GPRA reporting. The Government
Project Officer (GPO) will identify the fourth person once the award is
finalized. Meetings will be up to 5 days in length and will normally be
held in the Washington, DC, metropolitan area.

Additional meetings may be convened over the course of the program to
bring together project leadership from each grantee (e.g., the Policy
Steering Committee Chairs, Project Directors) to share experiences,
discuss implementation, policy change, financing, and reporting issues
and to compare models in order to bring this program to full scale
nationally, both in other States and other communities. The expenses for
these meetings will be borne by SAMHSA/CSAT. Meetings will normally be
held in the Washington, DC, metropolitan area.

#  {#section-10 .unnumbered}

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

##  {#section-11 .unnumbered}

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

It is expected that approximately \$5.6 million will be available to
fund up to two awards in FY 2006. Annual awards are expected to be
approximately \$2.8 million per year in total costs (direct and
indirect) for up to 5 years. Should funding become available for SBIRT
grants in FY 2007, SAMHSA may fund awards from among the highly scored
but not funded applications received in FY 2006 (assuming a sufficient
number of high quality applications) rather than issuing a new
announcement in FY 2007.

**Proposed budgets cannot exceed \$2.8 million 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.

The applicant can propose to implement the project in as many
sub-recipient communities[^9] as it wishes. For each sub-recipient
community chosen, the applicant must demonstrate need and potential for
systems change to rapidly initiate the SBIRT approach. Each
sub-recipient community must receive sufficient funds to enable the
grantee to document an impact using the SBIRT performance targets.

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

Awards for this funding opportunity will be made as cooperative
agreements (see the Glossary in Appendix B for further explanation of
this funding mechanism). The cooperative agreement mechanism is being
used because substantial Federal staff involvement is required in the
funded project. Grantees should anticipate significant interaction with
Federal staff.

**Grantees must:**

-   Comply with the terms and conditions of the cooperative agreement
    award.

-   Agree to provide SAMHSA with data required for GPRA.

-   Collaborate with CSAT staff in project implementation and
    monitoring.

-   Select members and organize/conduct regular meetings of the
    project's Policy Steering Committee (PSC).

-   Implement and monitor activities of the cooperative agreement
    project, including accountability for sub-recipients' service
    delivery.

-   Collect, evaluate, and report Statewide treatment project and GPRA
    data.

-   Respond to requests for program-related data.

-   Document intended and actual systemic changes resulting from the
    project's activities.

-   Submit the final Project Implementation Plan by the end of the third
    month following the award.

-   Participate in the CSAT cross-site SBIRT evaluation.

**SAMHSA staff will:**

-   Collaborate in selection of PSC members; review and approve final
    membership.

-   Work collaboratively with the grantee, project staff, and PSC
    members to finalize the Project Implementation Plan; review and
    approve the plan to be submitted by the end of the third month for
    release of funds for implementation (i.e., Phases II and III).

-   Provide best practice program information, resource materials, and
    technical assistance, e.g., examples of model programs, financing
    strategies and benefit designs, and screening and assessment
    tools/protocols to help grantees identify, select, and replicate
    evidence-based practices for implementing SBIRT.

-   Provide guidance on how to assess resource allocation strategies in
    order to re-direct treatment resources toward an emphasis on persons
    at risk, or diagnosed with, a Substance Use Disorder (Substance
    Abuse or Dependence).

-   Review and approve sub-recipient contracts and awards.

-   Actively participate in PSC discussions.

-   Work cooperatively with the grantee to make the transition from the
    cooperative agreement to State/Tribal and local control and to
    sustain the system changes achieved by the project.

> **The Policy Steering Committee will:**

-   Provide strategic policy and operational advice on the SBIRT project
    to the grantee as well as provide advice on integrating SBIRT into
    the existing system of care and on policies, as appropriate.

-   Consist of 15 to 20 members and a chair, to be appointed by the
    grantee.

-   Represent the Office of the Governor/highest ranking official and
    diverse stakeholders in the State/Tribe, including, for example,
    representatives from:

> \-- Relevant State agencies (including the SSA)
>
> \-- Community specialist treatment organizations
>
> \-- General and specialist healthcare organizations (e.g., Federally
> Qualified Community Health Centers, hospitals, family practice
> clinics, emergency departments, ob-gyn clinics)
>
> \-- Occupational health clinics and employee assistance programs or
> human resources departments
>
> \-- Student health centers and student assistance programs
>
> \-- Unions and member assistance programs
>
> \-- Financial organizations (e.g., insurers, fiscal intermediaries,
> employers)
>
> \-- Professional and trade associations
>
> \-- Recovery community organizations
>
> \-- Community coalitions
>
> \-- Training agencies and universities
>
> \-- Employers and business coalitions
>
> \-- Insurers and managed care organizations

-   Hold the initial meeting within 60 days of award and continue to
    meet once a month for the first year and quarterly in subsequent
    years.

-   Coordinate with other State/Tribal agencies, commissions, and
    offices (including the SSA) as appropriate.

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

## 1. ELIGIBLE APPLICANTS {#eligible-applicants .unnumbered}

States, Territories, federally recognized tribes, and tribal
organizations are eligible to apply. For States, the applicant must be
the immediate Office of the Governor; for Territories, tribes, and
tribal organizations, the applicant must be the highest ranking
official. The Governor/highest ranking official must sign the
application. Applications not signed by the Governor/highest ranking
official are not eligible. State-level agencies are not considered to be
part of the immediate Office of the Governor and are not eligible to
apply. For example, the State Substance Abuse Authority (SSA) or other
State-level agencies within the Executive Branch cannot apply
independently. SAMHSA has limited eligibility because the immediate
Office of the Governor/highest ranking official of a Territory, tribe
and Tribal organization has the greatest potential to provide the
multi-agency leadership needed to develop the applicant's treatment
service systems to increase the applicant's capacity to provide
accessible, effective, screening, brief intervention, referral and brief
treatment services to persons at risk for, or diagnosed with, a
Substance Use Disorder (Substance Abuse or Dependence). Eligible
jurisdictions that have already begun to develop such integrated
systems, stressing early intervention for persons at risk for, or
diagnosed with, a Substance Use Disorder (Substance Abuse or
Dependence), are especially encouraged to apply.

Current SBIRT grantees are not eligible applicants.

The Governor/highest ranking official will designate a lead official to
be Project Director for the cooperative agreement. That individual may
be, but is not required to be, part of the SSA. However, the services to
be provided through this cooperative agreement program are to be
integrated into the current system of care. Therefore, SAMHSA expects
that the SSA will be involved in the project.

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

Cost sharing (see Glossary in Appendix B) is not required in this
program. Applications will not be screened out on the basis of cost
sharing.

## 3. OTHER {#other .unnumbered}

3.1 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 the 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 cooperative agreement 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;

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

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-   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, 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 a minimum of 2 years before the
    date of the application in the area(s) in which the services are to
    be provided; and

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

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

#  {#section-12 .unnumbered}

# 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.**

##  {#section-13 .unnumbered}

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

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-   **Abstract** -- Your total abstract should be no 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, in reports to Congress, and/or in 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 D. Sections A through D may not be longer than 30 pages.
    (Please Note: If the Project Narrative begins 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 the Project Narrative in
> Sections E through H. The only section with a page limitation is
> Section G, 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, 2, 3, and 5 combined. There is no page
    limitation for Appendix 4. 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*: Provide: (1) identification of at least one
        experienced, licensed service provider organization; (2) a list
        of all direct service provider organizations that have agreed to
        participate in the proposed project, including the applicant
        agency, if it is a treatment 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. The Statement of Assurance 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*.*

    -   *Appendix 2*: Provide:

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    -   identification of the sub-recipient community within the State
        where the provider will deliver services;

    -   a listing of modalities and services provided in the project;
        and

    -   a cross-walk that aligns the proposed modalities and costs with
        those that CSAT tracks if the modalities that the State funds
        within its continuum of care do not match those that CSAT tracks
        for GPRA and for which CSAT calculates program costs.

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    -   *Appendix 3*: Provide: contracts; agreements; table of
        organization; performance schedule; task-sequencing chart; and
        letters of support/commitment.

> A plan, budget, budget justification and signed agreement for training
> and technical assistance.

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

-   *Appendix 5:* Sample Consent Forms

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-   **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).

-   **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.

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-   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, 2, 3, and 5
    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 {#guidance-for-electronic-submission-of-applications .unnumbered}

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 point, 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.

##  {#section-14 .unnumbered}

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

Applications are due by close of business on **April 27, 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
>
> \-- 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-06-002

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-06-002

## 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
[www.hhs.gov/grantsnet/roadmap/index.html](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 Cooperative Agreements for Screening, Brief
Intervention, Referral and Treatment grant recipients must comply with
the following funding restriction:

-   Of the 20 percent (20%) of the award allowable for activities needed
    to carry out project administration (see Section I-2.2 SBIRT
    Allocation of Funds), no more than 10 percent (10%) of the award may
    be used for evaluation and data collection, including GPRA and
    incentives for completing the evaluation.

Cooperative Agreements for Screening, Brief Intervention, Referral and
Treatment 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.

-   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}

6.1 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 **SBIRT** and the RFA number, **TI-06-002**,
in item number 10 on the face page of any paper applications. If you
require a telephone 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.**

#  {#section-15 .unnumbered}

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

## 1. EVALUATION CRITERIA {#evaluation-criteria .unnumbered}

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--D). 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-D) together may be no longer than
    30 pages.

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

-   Reviewers will be looking for evidence of cultural competence in
    each section of the project narrative. 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."

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

-   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 need for treatment statewide and for each community in
    which SBIRT will be implemented. Include as much documentation as
    possible, with the focus on differentiating clinically appropriate
    treatment for persons at risk for, or diagnosed with, a Substance
    Use Disorder (Substance Abuse or Dependence).

> **Note:** Documentation of treatment need, demand, barriers to access,
> and resource availability may come from a variety of qualitative and
> quantitative sources (Dewit and Rush, 1996; NIDA, 1998; Weisner, 2001;
> McAuliffe, 2002.) The quantitative data could come from locally
> generated data or trend analyses, from State data such as that
> available through State Treatment Needs Assessments, social indicator
> analyses, waiting list analyses, and/or through national data sets,
> such as that available from SAMHSA's National Survey on Drug Use and
> Health (NSDUH), Drug Abuse Warning Network (DAWN), and Drug and
> Alcohol Services Information System (DASIS), which includes the
> National Survey of Substance Abuse Treatment Services (N-SSATS) and
> the Treatment Episode Data Set (TEDS). The description and data will
> provide the baseline for monitoring performance against the SBIRT
> targets.

-   Describe the State's/Tribe's current resources and continuum of care
    for persons at risk, or diagnosed with, a Substance Use Disorder
    (Substance Abuse or Dependence), including the provider and
    practitioner resources and the funding streams available for
    intervention and treatment services in the generalist and specialist
    systems.

-   Describe how the applicant currently plans for, funds, and provides
    intervention and treatment services within its continuum of care
    (including SBIRT if it is part of the current continuum of care) and
    how SBIRT (or SBIRT expansion) can be integrated into the financing
    and provider systems. Include a discussion of the use of patient
    placement criteria and standardized screening and sequential
    assessment protocols, if these are used, and the modalities in which
    persons are placed. If the modalities that the applicant funds do
    not match those for which CSAT calculates program costs, provide a
    crosswalk that aligns your modalities and costs for each with those
    that CSAT tracks for GPRA (screening, brief intervention, brief
    treatment, outreach/pretreatment services, outpatient
    (non-methadone), outpatient (methadone), and residential). Where
    necessary, include the crosswalk between CSAT program cost
    modalities and the applicant's continuum of care in **Appendix 2**.

-   Explain why the existing services are insufficient or inappropriate
    to respond to the demand for services and the treatment needs of the
    target population chosen for this application.

-   Provide a description and analysis of the three most important
    barriers existing that prevent persons who need and seek treatment
    from accessing the clinically appropriate type and level of
    treatment. Barriers to be addressed might include laws, regulations,
    eligibility requirements for service receipt, facility and provider
    eligibility requirements, varied funding streams, coverage
    limitations, lack of patient placement criteria or standardized
    screening and sequential assessment protocols, etc.

-   Describe the method used to select the communities for which funding
    is to be directed to increase services. Document for each how the
    need for treatment significantly exceeds the capacity to provide
    services, the potential for systems change, and that strategies
    exist to rapidly initiate SBIRT. Provide the same kinds of
    information about need, resources, and barriers for each community
    in which the project will be implemented that has been provided for
    the State/Tribe. Where policies are the same statewide so indicate,
    and describe only local variations (e.g., a local tax used to fund
    prevention or treatment).

**Section B: Proposed Implementation and Systems Change Approach (55
points)**

-   Cleary 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, prevention, outreach, pre-services, treatment, and/or
    intervention).

-   Provide a detailed Project Implementation Plan that explains how the
    grantee proposes to use project funds in conjunction with other
    available funding sources to provide SBIRT services. All funding
    sources that are or could be used to pay for screening and treatment
    of Substance Use Disorders (e.g., State General Fund, Medicaid,
    Preventive Health and Health Services Block Grant, Community Health
    Center grants, commercial insurance, Substance Abuse Prevention and
    Treatment Block Grant, Temporary Assistance for Needy Families
    (TANF) Block Grant, Child Care and Development (CCDF) Block Grant,
    Maternal and Child Health Block Grant) should be addressed, but the
    focus should be on the three major funding streams that you will use
    to increase support and decrease barriers.

-   Demonstrate how the proposed services/practices will meet your goals
    and objectives. Provide a logic model (see Appendix B: Glossary and
    Appendix D: Logic Model Resources) that links need, the services or
    practice to be implemented, and outcomes.

-   Describe how the applicant will increase the number of generalist
    settings that provide SBIRT in each sub-recipient community as a
    result of the award and redirection of other funding sources.

```{=html}
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```
-   Describe how the applicant will provide SBIRT within its continuum
    of care, within the geographic areas proposed, including a
    description of the modalities and services to be provided, the
    protocols that will be used for standardizing screening, assessment,
    determining the level of service required, referral,Number range
    CHAPTER brief intervention, brief treatment, and follow up. Provide
    a justification for the procedures to be used, including a
    discussion of the evidence-based services/practices that you propose
    to implement. The modalities and services described should match
    those listed in **Appendix 2**.

-   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.

```{=html}
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```
-   If the applicant chooses to expend funds for other treatment
    modalities within the continuum of care, describe how these services
    will be implemented. Applicants that do not seek to fund specific
    components of their continuum of care through the SBIRT cooperative
    agreement must provide evidence that there is a sufficient amount of
    services in those elements of the continuum (modalities) for each
    community to be included.

-   Describe how the applicant will overcome the barriers to accessing
    clinically appropriate care, using the SBIRT approach. Whenever
    possible, apply findings from recent literature and other
    information that demonstrates a thorough understanding of the issues
    faced in introducing SBIRT into the applicant's continuum of care.
    Include literature citations in Supporting Documentation, Section E
    of your application.

-   Describe the linkages to be developed between the participating
    specialist and community agencies for referrals, cooperation in case
    management, and information sharing.

-   Provide a plan to make available training and technical assistance
    to sub-recipient communities, including information about SBIRT
    methods, training for staff in the community and specialist settings
    in carrying out SBIRT, and technical assistance to the overall
    project and its sub-recipients.[^10] Include the plan, budget,
    budget justification and signed agreement in **Appendix 3** of the
    application.

-   Describe how the applicant will increase access and availability of
    services to a larger number of persons at risk, or diagnosed with, a
    Substance Use Disorder (Substance Abuse or Dependence) as a result
    of the award. State clearly the number of additional persons to be
    served for each year of the proposed cooperative agreement in each
    element of SBIRT (i.e., number of persons projected to receive
    Screening Only, number of persons projected to receive Screening and
    Brief Intervention \[BI\], and the number of persons projected to
    receive Screening and Brief Treatment \[BT\] or Screening and
    Referral to Other Types of Treatment for Substance Use Disorders
    \[RT\]) and the number of persons to receive clinically appropriate
    treatment in all other modalities within the system. Show that the
    targets are feasible and reasonable.

-   Describe the expected outcomes of treatment (e.g., decreased drug
    use in those patients receiving services through SBIRT) and the
    means by which you determined these targets. Show that the targets
    are feasible and reasonable.

-   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 C: Staff and Organizational Experience (20 points)**

**Project Management Plan.** There will be three phases to the project:
project planning and start up; operations; and phase out. For each phase
of the project, provide a realistic management plan that describes the
organizations and staff that will be involved in the project; present
their roles in the project; and address their relevant experience.

-   Describe the structure, roles, and individual tasks to be performed
    to carry out the required service delivery activities and project
    administration including: (1) policy and systems change; (2)
    training and technical assistance:[^11] (3) monitoring
    sub-recipients' implementation of service delivery and data
    collection; and (4) project reporting. The Governor's/highest
    ranking official's office must provide oversight to the grant and
    will be accountable for its related activities. This responsibility
    cannot be delegated. Be sure to include a description of the role
    and the processes to be used to ensure significant involvement and
    oversight of the project by the grantee, the Policy Steering
    Committee, the Project Director, the State Substance Abuse Authority
    (SSA), and other relevant agencies.

-   Provide a staffing plan that includes the level of effort and
    qualifications of the Project Director and other key personnel, such
    as the administrative staff providing oversight in the
    Governor's/highest ranking official's office, the clinical personnel
    in the community and specialist treatment agencies, trainers, and
    support personnel, specifying the agency that will employ these
    persons.

-   Provide a description of the project organization, Statewide and for
    each sub-recipient community system. Include Contracts, Agreements,
    Table of Organization, Performance Schedule, Task-Sequencing Chart,
    and Letters of Support/Commitment in **Appendix 3**.

-   Provide evidence that the existing and proposed staff have or will
    receive training to develop the requisite experience and cultural
    sensitivity necessary to provide services to the target population.
    Show evidence of the appropriateness of the proposed staff in
    relation to the age, race, ethnicity, culture, language, sexual
    orientation, disability, literacy, and gender of the target
    population.

-   Provide a performance schedule for task completion that includes a
    description of sequential relationships and approximate level of
    effort required per task (in person hours or full-time equivalents).
    Each task should be related to the project goals and objectives, as
    well as to management and staffing levels.

-   **Phase I: Project Planning and Start up.** Describe how the
    applicant will complete each of the start up tasks specified above
    under I-2.4 Project Phases and Operations, Phase I: Project Phases
    and Operations, which are necessary to implement the project.
    Describe how the grantee and the Policy Steering Committee will
    ensure that every component of the project is fully operational at
    the conclusion of Phase I and will monitor task accomplishments.

-   **Phase II: Operations**. Describe the actions and timelines
    necessary for carrying out the systems change and service delivery
    activities described as part of the initial planning phase. Describe
    how the applicant will carry out the activities necessary to
    implement the project as identified above under I-2.4 Project Phases
    and Operations, Phase II: Operations.

-   **Phase III: Phase-Out**. Describe the activities planned to make
    the transition from the SBIRT cooperative agreement funding to
    State/Tribe and local control and funding in order to sustain the
    system changes achieved by the project.

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

-   Provide a plan for collecting, analyzing, interpreting, and
    reporting data on activities, costs, and outcomes, including the
    means by which the overall project and each sub-recipient will
    comply with GPRA requirements\--the collection of CSAT's GPRA Core
    Client Outcomes, and tracking and follow-up procedures.

-   The applicant will be expected to monitor implementation of the
    project and the fidelity of implementation to the applicant's plan.
    Therefore, the plan should explain how the applicant intends to:

> \-- Document the State/Tribal-level and the sub-recipient community
> level and provider agency level activities, accomplishments, and
> outcomes associated with the SBIRT project;
>
> \-- Collect data in addition to the GPRA items, if any, using both
> quantitative and qualitative approaches as needed;
>
> \-- Measure changes in these activities and accomplishments over the
> life of the project;
>
> \-- Document what was actually done, what was learned, what barriers
> inhibited implementation, how such barriers were resolved, and what
> should be done differently in future projects;
>
> \-- Provide for obtaining consistent and uniform information across
> programs and sub-recipient sites Statewide; and
>
> \-- Provide regular feedback to the project managers, staff, and
> Policy Steering Committee to help the project improve operations and
> services. This feedback should include both process and outcome
> measures.

-   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
>
> \-- Screening/Brief Intervention/Brief Treatment/Outreach/Pretreatment
> Services: \$200 to \$1,200
>
> \--Drug Court Programs (regardless of client treatment modality):
> \$3,000 to \$5,000

The outreach and pretreatment services cost band only applies to
outreach and pretreatment programs that do not offer treatment services
but operate with 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**: Applicants should be aware that the Review Group will also be
asked to comment on the appropriateness of the budget after the merits
of the application have been considered.

**SUPPORTING DOCUMENTATION**

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

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

**Section G**: Biographical Sketches and Job Descriptions.

-   Include a biographical sketch for the Project Director and other key
    personnel. 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 H:** 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 H 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.

-   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.

-   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.

-   Provide in **Appendix 4, "Data Collection Instruments/Interview
    Protocols,"** copies of all available data collection instruments
    and interview protocols that you plan to use.

5\. [Privacy and Confidentiality]{.underline}

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

-   Describe:

> \-- 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:

\-- 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.

-   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.

-   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 5, "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.

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

##  {#section-16 .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 State or Tribe.

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

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

#######  {#section-17 .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.

#######  {#section-18 .unnumbered}

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

-   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
    ([www.samhsa.gov/Grants/generalinfo/grant_reqs.aspx](http://www.samhsa.gov/Grants/generalinfo/grant_reqs.aspx)
    ).

-   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.

-   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.

-   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.

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

3.1 Progress and Financial Reports

-   In addition to the data collection, monitoring, and reporting
    requirements listed in Section I of this document, grantees must
    submit semi-annual and annual progress reports and applications for
    continued funding near the end of each year. Specific submission
    dates, instructions, and format will be provided by CSAT. These
    reports will be one part of the SBIRT-specific evaluation. Because
    SAMHSA is extremely interested in ensuring that treatment services
    can be sustained, your progress reports should explain plans to
    ensure the sustainability (see Appendix B, Glossary) of efforts
    initiated under this grant. Initial plans for sustainability should
    be described in year 01. In each subsequent year, you should
    describe the status of your project, as well as the successes
    achieved and obstacles encountered in that year.

-   Grantees must submit a final report. Specific submission dates,
    instructions, and format will be provided by CSAT. The final report
    must summarize information from the semi-annual reports and describe
    the accomplishments of the project and planned next steps for
    sustaining the systems and service changes developed during the
    cooperative agreement period.

-   Grantees must commit to and report performance against targets
    for (1) reducing drug use by patients receiving treatment through
    the SBIRT project; (2) increasing the number of persons at risk for,
    or diagnosed with, a Substance Use Disorder (Substance Abuse or
    Dependence) who receive treatment in each sub-recipient
    community; (3) increasing the number of community settings where
    SBIRT services are provided, and (4) providing treatment services
    within approved cost parameters for each treatment modality.

-   Grantees must provide annual and final financial status reports.

-   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
Cooperative Agreements for Screening, Brief Intervention, Referral and
Treatment are described in Section I-2.5 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-20 .unnumbered}

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

For questions about program issues contact:

Tom Stegbauer

Center for Substance Abuse Treatment

Substance Abuse and Mental Health Services Administration

1 Choke Cherry Lane

Room 5-1099

Rockville, Maryland 20850

\(240\) 276-2965

<tom.stegbauer@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

*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, and 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:

    -   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

**[At Risk:]{.underline}** For the purpose of this Request of
Applications, a person who is "at risk" is defined as one who is using
substances but who does not yet meet the criteria for a diagnosis of
Substance Use Disorder.

**[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

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 a minimum of 2 years prior to the date of the application in the
    area(s) in which services are to be provided. Official documents
    must definitively establish that the organization has provided
    relevant services for the last 2 years; and

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

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

Signature of Authorized Representative Date

### Appendix D -- Logic Model Resources

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

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

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

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

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

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

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

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

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

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

241\. Thousand Oaks, CA: Sage.

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

### Appendix E -- Sample Budget and Justification

**ILLUSTRATION OF A SAMPLE DETAILED BUDGET AND**

**NARRATIVE JUSTIFICATION TO ACCOMPANY**

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

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

**[Personnel]{.underline}**

**Job Annual Level of 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

(based on first 12-month budget period)

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 \$183,500 is effective for all FY 2006 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.

### Appendix F - Resources for Implementing Screening, Brief Intervention, Referral, and Treatment 

#### Background {#background .unnumbered}

For purposes of this cooperative agreement, CSAT will not require
grantees to use a specific methodology for determining need,
implementing systems change, or introducing SBIRT within their continuum
of care. CSAT is not recommending a specific approach for developing
collaboration among participating generalist and specialist providers.
CSAT is requiring specific protocols for carrying out the individual
activities involved (the screening instruments will be the AUDIT, DAST
and CRAFFT which provide a basis for brief intervention, referral,
assessment, patient placement, and brief treatment). Additional
screening tools may be used with the agreement of the CSAT Project
Officer. The applicant is required to describe and justify the
strategies that will be implemented under the proposed cooperative
agreement project and to describe the methods that will be used to
assess need, eliminate barriers to access, and to carry out each of
these activities. Wherever possible, the applicant should provide a
description of any prior services or research projects on which their
proposed approach is based.

In order to introduce some commonality in responses, we will present a
brief overview of terminology and anticipated issues and provide
illustrative references that can serve as resources for proposal
development and project implementation. The resources and references
provided are not presented as an inclusive listing that must be used in
proposal preparation.

#### Terminology {#terminology .unnumbered}

From the scientific and policy perspectives, there have been two
distinct approaches for responding to the social and health problems
posed by drug abuse and addiction---the **clinical**, or diagnostic,
approach and the **environmental**, or problems, approach (Gerstein and
Green, 1993; Institute of Medicine, 1990). Over the years, drug policy
has been shaped by these perspectives, shifting between punitive and
rehabilitative strategies for reducing consumption of illicit drugs and
the criminal behaviors associated with illicit drug use (Gerstein and
Harwood, 1990).

The two perspectives have led to differences in how persons receiving
and seeking treatment are characterized in developing resource
allocation and financing schemes and create potential problems in
consolidating funding streams to carry out SBIRT. The financing of
treatment for substance use problems has differed from the rest of
health care financing in part because the public sector through block
and categorical grants has been the major payer for services (e.g.,
Horgan and Merrick, 2001). The shifting perspectives and orientations of
the policymakers and legislators have also influenced these systemic
perspectives (Gerstein and Harwood, 1990). Criminal justice funding,
originally through the Federal Law Enforcement Administration block and
categorical grant programs (more recently, the Office of Justice
Programs and the Office of Juvenile Justice programs) created a public
safety orientation, while funds from the poverty programs (e.g., the
Social Services Block grant) created a welfare orientation. On the other
hand, health insurance, like Blue Cross and Medicaid created a medical
orientation. All three orientations have co-existed in the categorical
grant and block grants directly targeted at treatment of Substance Use
Disorders, notably, the Substance Abuse Prevention and Treatment Block
Grant, which attempts to integrate the perspectives, creating what has
been labeled the mixed medical and social model orientation (IOM, 1990;
Reader and Sullivan, 1992). For example, Medicaid and other forms of
health insurance require a clinical diagnosis and a determination of
medical necessity for admission to treatment, while the Substance Abuse
Prevention and Treatment Block Grant does not. The lack of common
terminology has created problems in understanding who receives what
services for treatment of Substance Use Disorders with what outcomes
(Coffey et al., 2001)

Developing the policies and data for studying utilization and designing
policies to increase access to clinically appropriate treatment requires
use of common terms with clear definitions, starting with identifying
the conditions for which treatment is needed. Diagnosis is the process
of identifying and labeling specific diseases; diagnostic criteria for
Substance Abuse and Dependence Disorders reflect the consensus of
researchers and clinicians as to precisely which patterns of behavior or
physiological characteristics constitute symptoms of these conditions.
(Babor et al., 2005; Babor, 2001; NIAAA, 2002; NIDA, 1997) Agreement on
diagnosis in this field is relatively new, and the definitions and
techniques for establishing diagnoses are evolving. Having a consistent
set of diagnostic criteria allows clinicians to plan treatment and
monitor treatment progress; enables policymakers, and planners to ensure
the availability of needed treatment resources in each community; helps
health care insurers and other funders to decide whether treatment will
be reimbursed; and allows patients access to medical insurance coverage.

As noted in the RFA, the need for treatment is discussed in terms of the
categories used in the American Psychiatric Association Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV;
1994).[^12] DSM-IV includes a category called \"Substance Related
Disorders\" that is divided into two major subcategories, Substance
Induced Disorders and Substance Use Disorders. The focus of this program
is on that part of the continuum of care that addresses treatment of
Substance Use Disorders and not the treatment of Substance Induced
Disorders, namely Substance Intoxication and Substance Withdrawal.
Patients manifesting signs of intoxication, withdrawal symptoms, and
other physical problems that require emergency care or urgent action
would be managed in other components of the generalist or specialist
treatment systems, stabilized and medically cleared before being
screened for presence of a Substance Use Disorder (VHA/DoD, 2001; Room
et. al., 2005; Babor et al. 2005;).

Substance Use Disorders are further differentiated by type of drug
primarily involved (e.g., amphetamine, alcohol, cocaine,
marijuana/cannabis). DSM-IV is the diagnostic approach primarily used in
this country for determining treatment eligibility, developing
substance-specific treatments, and conducting epidemiological and
clinical research.

Based on the DSM-IV, *Substance Abuse Disorder* is characterized by the
presence of social or health-related problems related to the person's
consistent pattern of substance use. *Substance* D*ependence* Disorder
is characterized by a cluster of recognizable symptoms, including
physical withdrawal, loss of control over use episodes, and continued
use of substance despite knowledge of having a physical or psychological
problem that is likely caused by substance.

The World Health Organization has also developed diagnostic criteria for
the purpose of compiling statistics on all causes of death and illness,
including those related to substance abuse or dependence. These criteria
are published as the *International Classification of Diseases* (ICD).
In the current revision, ICD-10, substance dependence is defined in a
way that is similar to the DSM-IV. The diagnosis focuses on an
interrelated cluster of psychological symptoms, such as craving;
physiological signs, such as tolerance and withdrawal; and behavioral
indicators, such as the use of alcohol to relieve withdrawal discomfort.
However, in a departure from the DSM-IV, rather than include the
category \"abuse,\" ICD-10 includes the concept of \"harmful use.\" This
category was created so that health problems related to alcohol and
other drug use would not be underreported. Harmful use implies alcohol
or drug use that causes either physical or mental damage in the absence
of dependence (Babor et al, 2005; Babor, 2001). The ICD classification
approach has served as the basis for much of the research underlying the
use of brief interventions.

Review of the literature and discussions with practitioners and State
Substance Abuse Authorities (SSAs) established that, while most of the
research establishing the effectiveness of this approach has focused on
alcohol use problems and disorders and has used the **problems**
approach rather than the clinical approach, there is an emerging body of
research and clinical experience that supports use of the SBIRT approach
for persons at risk for, or diagnosed with, a Substance Use Disorder
(Substance Abuse or Dependence) who are experiencing problems related to
the use of illicit drugs, particularly for marijuana use disorders
(e.g., Stephens, et al., 2004; Stephens et al., 1994; Samet et al.,
1996; Sullivan et al., 1997: Babor et al. 2002; Barry, 1999; Bernstein
et al., 1997; Zweben and Fleming, 1999; Dennis, et al. 2002a and b;
Conrod et al., 2000; Baker et al. 2001; Babor, et al., 2002; Blow, 1999:
Fleming, 2002; Kelso, 2002; WHO ASSIST Working Group, 2002).

While the effort to develop brief interventions for persons at risk for,
or diagnosed with, a Substance Use Disorder (Substance Abuse or
Dependence) has not been as extensive as that for persons with alcohol
problems, there have been several precedents. Early in the effort to
develop a national drug strategy, the Treatment Subcommittee of the
Cabinet Committee on Drug Abuse Prevention, Treatment and Rehabilitation
in responding to pressure on the limited availability of treatment
slots, recommended the establishment of distinct, lower cost
"Alternative Educational Programs" (Bloom, 1977). These "alternatives to
treatment or incarceration were recommended as the vehicle for "treating
the casual and recreational marijuana users" who were being
"inappropriately" referred to drug abuse treatment centers, most often
by the criminal justice system through diversion efforts (Domestic
Council Drug Abuse Task Force, 1975). The stated goal was to allow the
specialty drug abuse treatment system to focus on the "abusers of high
risk drugs." Marijuana, at that time, was considered a low risk drug.

The model programs presented by NIDA were short-term, inexpensive
educational programs with both didactic presentations and group
discussions. These alternative educational programs became the
forerunners of many of the intervention programs that still exist in the
gray area between prevention and treatment---often having statutory
authorization as diversion programs.

There is evidence that a number of States have already begun to
introduce protocols for screening and brief intervention for both
alcohol and drug use problems and disorders into their continuum of care
(e.g., New York OASAS, 1996; Harrison et al., 1996; Hartwell et al.,
1996: Kroutil et al., 1997).[^13] Yet, in contrast to more traditional
treatment services, early intervention services are often not
specifically defined or regulated (IOM, 1990; Klitzner, et al., 1992).
For purposes of this announcement, early intervention services (brief
interventions) are those treatment procedures designed for persons who
are exhibiting some problems associated with alcohol or other drug use
but whose problems are not deemed serious enough to warrant treatment
within a specialist setting. This would include those persons at risk
for, or diagnosed with, a Substance Use Disorder (Substance Abuse or
Dependence). Early intervention services are sometimes identified as
pre-treatment interventions (Blow, 1998) or clinical preventive services
(U.S. Preventive Task Force, 1998) or indicated preventive interventions
(Haggerty and Mrazek, 1994). The goal of early intervention is to
prevent the problems from becoming more serious, and to promote total
abstinence from alcohol and other illegal drugs. Early intervention
could include an assessment of substance use and related problems,
individual counseling provided by a health care practitioner, or
participation in school-­based or community-based educational or
counseling programs designed to deter further substance use and promote
healthier alternatives.

Rather than negating the public health approach to defining primary,
secondary, and tertiary prevention as some have held, the IOM model can
be seen as complementary, expanding the public heath approach. The newer
IOM model can be seen as actually further differentiating the public
health construct of primary prevention into the categories of universal,
selected, and indicative interventions, and the public health constructs
of secondary and tertiary prevention into the categories of treatment
and maintenance, respectively. The early intervention activities overlap
the boundaries between primary prevention (indicated prevention) and
secondary prevention (case finding).

­In filling out the treatment portion of a State's continuum of care, the
purpose of screening for substance use problems is to identify those
persons who should receive either a brief intervention or referral for
additional screening and assessment to establish whether more intensive
treatment for a Substance Use Disorder (SUD) is needed. The persons
screened *may* or *may not* meet the DSM-IV criteria for a Substance
Abuse or Dependence Disorder (American Psychiatric Association, 1994).
If they do not, but are deemed to be at risk users, then the same
technology is employed as a clinical preventive service (or indicated
preventive intervention). In practice, the activities are the same.
However, the distinction is important for developing financing policies,
for conducting epidemiological research and for tracking treatment
access, appropriateness, utilization, and effectiveness.

Since diagnosis has not always been used as a criterion for admission to
treatment in publicly funded treatment programs, States and service
providers will need to introduce and agree upon a uniform approach to
diagnosis as part of their implementation of this program and efforts to
provide sustained funding for SBIRT, particularly through public and
private health insurance mechanisms.

**Integrating the Diagnostic and Problems Approaches**

As noted, the DSM-IV term S*ubstance Use Disorders* can be used to refer
to a range of substance-related problems that require treatment. A
spectrum of Substance Use Disorders, from least to most serious, which
encompasses the problems approach used in developing screening protocols
for the use of brief interventions might be represented as follows:

Problem Use Substance Abuse Disorder Substance Dependence Disorder

or At Risk Use

In general, *problem or at-risk use* means use that exceeds an
established threshold. The threshold may be defined in different ways
depending on the source, the population, and other local conditions. The
majority of work for developing such classifications in order to
identify persons who could benefit from a brief intervention has been
carried out for alcohol use problems and disorders. For example, the WHO
manuals for introducing screening and brief intervention into primary
care present general guidelines for assigning "risk levels" based upon
AUDIT scores, that conform the spectrum above and lay out a spectrum of
intervention and treatment responses.

**Table 1: AUDIT Guidelines for Determining Intervention Strategy**[^14]

+--------------+---------------------------------------+--------------+
| Risk Level   | Intervention                          | Audit Score  |
+--------------+---------------------------------------+--------------+
| I            | Education                             | 0-7          |
+--------------+---------------------------------------+--------------+
| II           | Simple Advice                         | 8-15         |
+--------------+---------------------------------------+--------------+
| III          | Simple Advice plus                    | 16-19        |
|              |                                       |              |
|              | Brief Counseling and Continued        |              |
|              | Monitoring                            |              |
+--------------+---------------------------------------+--------------+
| IV           | Referral to Specialist for Diagnostic | 20-40        |
|              | Evaluation and Treatment              |              |
+--------------+---------------------------------------+--------------+

The risk levels are used as a basis for making clinical judgments to
tailor interventions to the particular conditions of individual
patients, assuming that higher AUDIT scores are generally indicative of
more severe levels of risk and problems or dependence. The guidelines
are to serve as a starting point for an appropriate intervention. If a
patient is not successful at the initial level of intervention, than the
protocol calls for follow-up to develop a plan to step the patient up to
the next level of intervention. (Horng and Chueh, 2004; Babor and
Higgins-Biddle, 2001; Babor et al., 2001)

This approach is similar to that used for other screening tests, such as
the Drug Abuse Screening Test (DAST).

> **Table 2: DAST Guidelines for Determining Intervention
> Strategy**[^15]

  --------------- --------------------------- ---------------------------
  ***Score***     ***Degree of Problems\      ***Suggested Action***
                  Related to Drug Abuse***    

  0               No Problems Reported        None At This Time

  1-2             Low Level                   Monitor, Reassess At A
                                              Later Date

  3-5             Moderate Level              Further Investigation

  6-8             Substantial Level           Intensive Assessment
  --------------- --------------------------- ---------------------------

These classification systems reflect the different patterns of drug use
consumption and problems that call for differential societal responses
that reflect differences in the drug (substance) used, the history,
frequency, and amount used, as well as the existence and severity of
associated physical, emotional, and social consequences of use. The
Institute of Medicine committee that carried out a Congressionally
mandated study of the evolution, effectiveness and financing of public
and private drug treatment systems (Gerstein and Harwood, 1990)
described a four level classification system reflecting these patterns
that was a starting point in developing their initial estimates of the
need for treatment, a model that was adapted for creating national
estimates of the treatment gap. Table 3 depicts individual drug use
patterns and interventions associated with each pattern of use. Each
stage of use elicits a different type of societal response. The
definitions for the categories are:

**Use**: Low or infrequent doses: experimental, occasional, "social."
Damaging consequences are rare or minor.

> **Abuse**: Higher doses and/or frequencies: sporadically heavy,
> intensive. Effects are unpredictable, sometimes severe.
>
> **Dependence**: High, frequent doses: compulsion, craving, withdrawal.
> Severe consequences are very likely.

Table 3: Individual Drug Use Patterns and Intervention Strategies[^16]

+--------+---------+--------+----------+-----------+--------+-------+
| **S    | **Cat   | **Use  | **       | **Conse   | **Soci |       |
| tage** | egory** | Pat    | Reason** | quences** | etal** |       |
|        |         | tern** |          |           |        |       |
|        | **of    |        |          |           | *      |       |
|        | Use**   |        |          |           | *Respo |       |
|        |         |        |          |           | nses** |       |
+--------+---------+--------+----------+-----------+--------+-------+
|        | Abs     |        |          |           | Prev   |       |
|        | tinence |        |          |           | ention |       |
|        |         |        |          |           |        |       |
|        |         |        |          |           | Pr     |       |
|        |         |        |          |           | ograms |       |
+--------+---------+--------+----------+-----------+--------+-------+
| Early  | Use     | Low or | Exper    | Minor     | Prev   | Mild  |
| /light |         | infr   | imental, |           | ention |       |
|        |         | equent | occ      |           |        | sanc  |
|        |         | doses  | asional, |           | Pr     | tions |
|        |         |        | "social" |           | ograms |       |
+--------+---------+--------+----------+-----------+--------+-------+
| Late   | Abuse   | Higher | Spor     | Unpre     |        |       |
| /heavy |         | doses  | adically | dictable, |        |       |
|        |         | and/or | heavy    | sometimes |        |       |
|        |         | frequ  |          | severe    |        |       |
|        |         | encies |          |           |        |       |
+--------+---------+--------+----------+-----------+--------+-------+
| Late   | Dep     | High,  | Com      | Severe    | Tre    | S     |
| /heavy | endence | fr     | pulsion, |           | atment | evere |
|        |         | equent | craving, |           | pr     | sanc  |
|        |         | doses  | wi       |           | ograms | tions |
|        |         |        | thdrawal |           |        |       |
+--------+---------+--------+----------+-----------+--------+-------+

In the SBIRT approach, all persons are first screened and referred to
the appropriate sector (community generalist, non-specialty or
specialty) for intervention or treatment. Persons with a mild or
moderate level of substance use problems would most often be offered a
brief intervention in the non-specialty primary health care, criminal
justice, educational, employment, or social service setting. Referral to
intensive treatment in the specialty sector would be made only for those
whose life situation is so unstable that prognosis is poor without
specialty treatment or for those who fail to respond to an initial brief
intervention\--the stepped care approach (Sobell and Sobell, 1999,
2000).

Persons with substantial or severe problems would be referred from
screening to specialty sequential assessment and treatment where problem
and personal assessment would lead to assignment to more differentiated
types of treatment modalities and levels of care, using a formal set of
patient placement criteria.

Recent efforts have attempted to integrate the problem and diagnostic
approaches, using both the research literature and clinical experience
to refine the methods for screening, referring, and treating person's
based on these concepts (e.g., ASAM, 2000; APA, 1994; VHA/DoD, 2001
Beich, et. al., 2003). A possible model for this integration is
presented in Table 4. The model also attempts to integrate the public
health and IOM models for defining the continuum of care.

**Table 4: Integrating the Problem and Diagnostic Perspectives\--A
Possible Model**

<table style="width:100%;">
<colgroup>
<col style="width: 14%" />
<col style="width: 0%" />
<col style="width: 15%" />
<col style="width: 0%" />
<col style="width: 0%" />
<col style="width: 27%" />
<col style="width: 0%" />
<col style="width: 13%" />
<col style="width: 0%" />
<col style="width: 28%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="2"><strong>Problems</strong></td>
<td colspan="2"><p><strong>Risk Category or</strong></p>
<p><strong>Diagnosis</strong></p></td>
<td colspan="3"><strong>Intervention Strategy</strong></td>
<td colspan="2"><strong>Exposures\ Sessions</strong></td>
<td><p><strong>Follow-up Suggested:</strong></p>
<p><strong>Track: use, risk factors, and problems</strong></p></td>
</tr>
<tr class="even">
<td colspan="2">No problems</td>
<td colspan="2"><p>No risk</p>
<p>Or low risk</p></td>
<td colspan="3">Universal prevention</td>
<td colspan="2">Variable</td>
<td><p>Periodic re-screen:</p>
<p>every year</p></td>
</tr>
<tr class="odd">
<td colspan="2">Mild problems</td>
<td colspan="2">At low risk</td>
<td colspan="3"><p>Clinical preventive service</p>
<p>Selective prevention-brief advice</p></td>
<td colspan="2">1-2</td>
<td><p>Periodic re-screen:</p>
<p>every year</p></td>
</tr>
<tr class="even">
<td>Moderate problems</td>
<td colspan="2">At high risk</td>
<td colspan="3"><p>Clinical preventive service</p>
<p>Indicated prevention</p>
<p>Brief advice</p>
<p>Brief intervention</p></td>
<td colspan="2">1-2</td>
<td colspan="2"><p>Periodic re-screen</p>
<p>every 6 months for 3 years, every year if no relapse</p></td>
</tr>
<tr class="odd">
<td colspan="2">Moderate problems</td>
<td colspan="3"><p>Substance</p>
<p>Abuse</p>
<p>Disorder</p>
<p>(DSM-IV, Axis I)</p></td>
<td colspan="2"><p>Brief advice</p>
<p>Brief intervention</p>
<p>Brief treatment</p></td>
<td colspan="2"><p>1-2</p>
<p>1-5</p>
<p>6-20</p></td>
<td><p>Periodic re-screen and booster session:</p>
<p>every 3 months for 2 years, every 6 months for 2 years, every year if
no relapse</p></td>
</tr>
<tr class="even">
<td colspan="2"><p>Substantial</p>
<p>problems</p></td>
<td colspan="2"><p>Substance</p>
<p>Dependence</p>
<p>Disorder</p>
<p>(DSM-IV, Axis I)</p></td>
<td colspan="3">Sequential assessment; match to clinically appropriate
consumption and quality of life treatment strategies</td>
<td colspan="2">21-60+</td>
<td>Periodic re-screen: every 3 months for 2 years, every 6 months for 2
years, every year if no relapse</td>
</tr>
<tr class="odd">
<td colspan="2">Severe problems</td>
<td colspan="2"><p>Substance</p>
<p>Dependence</p>
<p>Disorder</p>
<p>(DSM-IV, Axis I)</p></td>
<td colspan="3">Sequential assessment; match to clinically appropriate
consumption and quality of life treatment strategies</td>
<td colspan="2">Variable; Based on individual response to treatment</td>
<td>Periodic re-screen: every 3 months for 2 years, every 6 moths for 2
years, every year if no relapse</td>
</tr>
</tbody>
</table>

Using either the problems approach or the clinical approach, it is well
recognized that within each community there is a spectrum of persons at
risk for, or diagnosed with, a Substance Use Disorder (Substance Abuse
or Dependence). In keeping with recent summaries of the international
research literature, it is estimated that the majority of adults
(approximately 75%) are either abstainers or light or moderate users
including some persons with Substance Use Disorders (who qualify for a
diagnosis of abuse or dependence on alcohol or illicit drugs). Persons
in this group experience either no problems or mild or moderate
substance use-related problems. There is a small but often highly
visible minority of heavy, dependent users with major substance-related
problems (estimated at approximately 5%). In between these extremes,
there is a sizeable group of persons (20%) who may be drinking or using
illicit drugs substantially or heavily and who have encountered
substantial or severe problems related to their substance use. The
concepts have been more difficult to address for illicit drugs, since
any use could be seen as "abuse" because of potential legal
consequences. As will be noted below, treatment is not necessarily the
best societal response for persons at risk for, or diagnosed with, a
Substance Use Disorder, (Substance Abuse or Dependence), but a brief
intervention, early in their use career may well be.

These findings suggest that the continuum of care in each community must
include a spectrum of primary, secondary, and tertiary prevention
responses that parallels the spectrum of problems associated with use
and that the diagnostic and problem approaches must be reconciled to
ensure introduction of evidence based clinical protocols (NIDA, 1999).
Research on effectiveness of specific approaches continues, but there is
sufficient evidence available to lead to the policy conclusion that more
widespread SBIRT efforts will decrease the medical and social costs of
illicit drug use.

Using a method similar to that employed by Skinner and his colleagues in
the original development of screening for establishing brief
interventions as a valid technology, persons can be classified into four
graded categories of drug and alcohol use problems, each of which should
lead to a different treatment or intervention strategy being employed
and to a different set of resource requirements (See Table 4.):

> **Mild level of substance use problems**. Use is light or moderate;
> symptoms are rated as mild or moderate; dependence is probably not
> present or, if present, is psychological rather than physical; life
> problems related to use are rated as absent, mild, or moderate.
>
> **Moderate level of substance use problems**. Use is medium,
> substantial, or heavy; symptoms are rated as moderate; psychosocial
> problems related to use are likely and rated as moderate;
> psychological dependence may still be characteristic, but there are
> increasing signs of physical dependence, such as withdrawal symptoms;
> related life problems are rated as mild and/or moderate.
>
> **Substantial level of substance use problems**. Use is substantial or
> heavy; symptoms are rated as substantial; physical dependence is
> likely; physical disorders, mental disorders, and psychosocial
> problems related to substance use are rated as moderate and/or
> substantial.
>
> **Severe level of substance use problems**. Use is heavy; symptoms are
> rated as substantial and/or severe; physical dependence is highly
> pronounced; life problems are rated as substantial and/or severe;
> serious physical disorders and mental disorders related to use, such
> as liver disease, are likely.

As presented in Table 4, persons can also be classified as either
persons with some level of risk for, or diagnosed with, a Substance Use
Disorder, (Substance Abuse or Dependence), Substance Use Disorders,
(those with no problems, mild or moderate problems) or persons with
substance use disorders (those who qualify for a diagnosis of drug abuse
or dependence, either with moderate problems or with substantial and
severe problems. The act of diagnosis shifts the nature of the services
from prevention to treatment.

In developing strategies to increase access to clinically appropriate
treatment, SAMHSA wants States to focus on the resources needed for
improved screening, intervention, referral and treatment for Substance
Use Disorders in order to increase the resources devoted to identifying
and intervening with persons at risk for, or diagnosed with, a Substance
Use Disorder (Substance Abuse or Dependence), as part of the generalist
health care system. States should be able to provide for a similar
linkage between whatever classification system the State is using and
the DSM-IV categories in the protocol.

###### *Resources for Implementing Screening*  {#resources-for-implementing-screening .unnumbered}

In health care, screening refers to a process designed to identify
people who have, or who are at risk of having, an illness or disorder.
The purpose of screening is to target persons for treatment, so as to
reduce the long-term morbidity and mortality related to the condition.
In addition, by intervening early and raising the individual's level of
concern about the risk factors and substance-related problems, it is
expected that screening for drug and alcohol problems in community
settings can itself reduce subsequent use.

Two types of screening procedures are typically used. The first type
includes self-report questionnaires and structured interviews; the
second, clinical laboratory tests that can detect biochemical changes
associated with excessive alcohol consumption or illicit drug use.

There are a variety of screening instruments available. As noted, the
majority of studies and implementation efforts have focused on screening
for alcohol problems, with the CAGE and the AUDIT being the most
commonly used screening tools. The DAST has also been used in
conjunction with the AUDIT in several projects, where there has been an
effort to implement this approach for persons at risk, or diagnosed
with, a Substance Use Disorder (Substance Abuse or Dependence). Several
new instruments have been developed, but not yet rigorously tested to
assess harmful use of either alcohol or drugs (e.g., the CAGE-D, the
ASSIST, the TCUDS, the GAIN-QS, the PDES).

> Brown, RL and Rounds LA. 1995. Conjoint screening questionnaires for
> alcohol and other drug abuse: criterion validity in a primary care
> practice. *Wisconsin Medical Journal*, 94, 135-140.
>
> Brown R, Leonard T, Saunders LA, et al. (1997). A two-item screening
> test for alcohol and other drug problems. *Journal of Family
> Practice*, 44, 151-160.

A bibliography containing descriptions and evaluations of various
interview, questionnaire, and laboratory test screening approaches is
available from Project Cork.

> Project Cork. 2002. *CORK Bibliography: Screening Tests.* 2001-2002,
> 58 Citations.
> [www.projectcork.org/bibliographies/data/Bibliography_Screening_Tests.html](http://www.projectcork.org/bibliographies/data/Bibliography_Screening_Tests.html).

Screening instruments have been developed or modified for use with
different target populations, notably adolescents, offenders within the
criminal justice system, and welfare recipients, women, and the elderly.
Several have been translated into other languages and have been
evaluated for cultural sensitivity.

It is well recognized that screening instruments used with adolescents
must be developmentally appropriate, valid and reliable, and practical
for use in busy medical settings.  One example of a brief substance
abuse screening instrument recently developed specifically for use with
adolescents is the CRAFFT test.

> Jull, A. 2003. \"The CRAFFT Test Was Accurate for Screening for
> Substance Abuse Among Adolescent Clinic Patients.\" *Evid. Based.
> Nurs.* 6(1): 23.
>
> Levy, S., Sherritt, L., Harris, S. K., Gates, E. C., Holder, D. W.,
> Kulig, J. W., and Knight, J. R. 2004. \"Test-Retest Reliability of
> Adolescents\' Self-Report of Substance Use.\" *Alcoholism: Clinical &
> Experimental Research* 28(8): 1236-41.
>
> Knight JR, Sherritt L, Shrier LA, Harris SK, Chang G. 2002. Validity
> of the CRAFFT substance abuse screening test among adolescent clinic
> patients. *Arch Pediatr Adolesc Med*. 156(6): 607-14.

Additional screening tests and procedures targeted at adolescents,
including the PDES and the GAIN-QS, are described in these publications:

> Winters KC. 1992. Development of an adolescent alcohol and other drug
> abuse screening scale: Personal Experience Screening Questionnaire.
> *Addict Behav*. 17(5): 479-90.
>
> Winters KC. 1999. **Screening and Assessing Adolescents For Substance
> Use Disorders**. Treatment Improvement Protocol (TIP) Series 31 DHHS
> Publication No. (SMA*)* 99-3282.
>
> Winters KC. 1999. **Treatment of Adolescents With Substance Use
> Disorders.\
> **Treatment Improvement Protocol (TIP) Series 32*.* DHHS Publication
> No. (SMA*)* 99-3283.
>
> Winters KC. 2001. Assessing adolescent substance use problems and
> other areas of functioning: State of the art. In: PM Monti, SM. Colby,
> and TA. O\'Leary (eds). **Adolescents, Alcohol, and Substance Abuse:
> Reaching Teens Through Brief Interventions**. New York, Guilford
> Publications, Inc., pp. 80-108.
>
> Dennis ML 1998. **Global Appraisal of Individual Needs (GAIN) manual:
> Administration, Scoring and Interpretation**, (Prepared with funds
> from CSAT TI 11320). Bloomington IL: Lighthouse Publications.
> [www.chestnut.org/LI/GAIN/GAIN_QS/index.html](http://www.chestnut.org/LI/GAIN/GAIN_QS/index.html)
>
> Martino S, Grilo CM, and Fehon DC 2000. Development of the drug abuse
> screening test for adolescents (DAST-A). *Addictive Behaviors* 25(1):
> 57-70.

Screening tests and procedures targeted at the elderly are described in
these publications:

> Beullens, J. and Aertgeerts, B. 2004. \"Screening for Alcohol Abuse
> and Dependence in Older People Using DSM Criteria: a Review.\" *Aging
> Ment.Health* 8(1): 76-82.
>
> Blow, F.C. Consensus Panel Chair. 1998. **Substance Abuse Among Older
> Adults**. Treatment Improvement Protocol (TIP) Series 26. DHHS
> Publication No. (SMA) 98-3179.
>
> Blow FC and Barry KL. 1999-2000. Advances in alcohol screening and
> brief intervention with older adults. *Advances in Medical
> Psychotherapy*. 10:107-124

Screening tests and procedures targeted at persons in the criminal
justice system are described in these publications:

> Inciardi JA Consensus Panel Chair 1994. **Screening and Assessment for
> Alcohol and Other Drug Abuse Among Adults in the Criminal Justice
> System.** Treatment Improvement Protocol (TIP) Series 7. DHHS
> Publication No. (SMA) 94B2076
>
> Peters, RH, Greenbaum, PE, Steinberg, ML, Carter, CR, Ortiz, MM, Fry,
> BC, Valle, SK. 2000. Effectiveness of screening instruments in
> detecting substance use disorders among prisoners. *Journal Substance
> Abuse Treatment*: 18(4): 349-58.
>
> Simpson DD. 2001. Core set of TCU forms. Fort Worth: Texas Christian
> University, Institute of Behavioral Research.
> [www.ibr.tcu.edu](http://www.ibr.tcu.edu/).

Efforts are also ongoing to develop methods for screening within the
dual diagnosis population:

> Maisto SA, Carey MP, Carey KB, Gordon CM, and Gleason JR. 2000. Use of
> the AUDIT and the DAST-10 to identify alcohol and drug use disorders
> among adults with a severe and persistent mental illness.
> *Psychological Assessment* 12(2): 186-192.

**Resources for Implementing Brief Interventions and Brief Treatments**

There are now a variety of approaches that have been labeled as Brief
Interventions (BI) and Brief Treatments (BT). Examples of approaches
that address specific drugs are the Cannabis Youth Treatment protocol
and the Adult Marijuana Treatment protocol, developed through CSAT
funded testing of models originally developed through NIDA and NIAAA
research.

Brief intervention and brief treatment strategies range from relatively
unstructured advice-giving, to counseling and formalized feedback, to
formal structured manuals for the number, duration, frequency, and
content of sessions. Many of the protocols are based on behavioral
self-control training, motivational interviewing, and
cognitive-behavioral psychotherapy.

One of the most extensive efforts to attempt to conceptualize and
differentiate Brief Interventions and Brief Treatments (and Long Term
Treatments) was CSAT's TIP 34: **Brief Interventions and Brief Therapies
for Substance Abuse**, published in 1999. The Consensus Panel for CSAT
TIP #34 describes the two activities as follows:

#### Brief Intervention {#brief-intervention .unnumbered}

> Brief interventions are those practices that aim to investigate a
> potential problem and motivate an individual to begin to do something
> about his/her substance abuse, either by natural, client-directed
> means or by seeking additional substance abuse treatment.

#  {#section-21 .unnumbered}

#### Brief Treatment (Therapy) {#brief-treatment-therapy .unnumbered}

> Brief treatment (therapy) is a systematic, focused process that relies
> on assessment, client engagement, and rapid implementation of change
> strategies. Brief therapies usually consist of more (as well as
> longer) sessions than brief interventions. The duration of brief
> therapies is reported to be anywhere from 1 session (Bloom, 1997) to
> 40 sessions (Sifneos, 1987), with the typical therapy lasting between
> 6 and 20 sessions. Twenty sessions usually is the maximum because of
> limitations placed by many managed care organizations. Any therapy may
> be brief by accident or circumstance, but the focus of this TIP 34 is
> on *planned* brief therapy. The therapies described here may involve a
> set number of sessions or a set range (e.g., from 6 to 10 sessions),
> but they always work within a time limitation that is clear to both
> therapist and client.

In distinguishing between Brief Intervention and Brief Treatments,
Zweben and Fleming (1999) characterize Brief Interventions as a
low-cost, effective treatment alternative for alcohol and drug problems
that use time-limited, self-help and preventive strategies to promote
reductions in the case of nondependent clients, and in the case of
dependent clients to facilitate their referral to specialized treatment
programs. The primary goal in all cases is to increase motivation for
behavior change. Brief interventions do not teach specific cognitive or
behavioral skills, nor do they attempt to change a client's social
environment.

Some researchers, practitioners, and policy analysts have suggested that
the differentiation should be made on the basis of the number of
sessions, with Number range CHAPTERBrief Intervention typically lasting
1-3 sessions, not more than 5 sessions, and Brief Treatment typically
consisting of 6 or more sessions but not more than 20 sessions. Others
have limited Brief Interventions to only 1 or 2 sessions and Brief
Treatments to no more than 6 sessions.

Brief interventions and brief therapies may be thought of as elements on
a continuum of care, but they can be distinguished from each other
according to differences in outcome goals. Interventions are generally
aimed at motivating a client to perform a particular action (e.g., to
enter treatment, change a behavior, think differently about a
situation), whereas therapies are used to address larger concerns (such
as altering personality, maintaining abstinence, or addressing
long-standing problems that exacerbate substance abuse).

A bibliography containing descriptions and evaluations of various brief
intervention and brief treatment approaches is available from Project
Cork.

> Project Cork. 2002. *CORK Bibliography: Brief Treatment in Substance
> Abuse*: *2000-2002*, 78 Citations.
> [www.projectcork.org/bibliographies/data/Bibliography_Brief_Treatment.html](http://www.projectcork.org/bibliographies/data/Bibliography_Brief_Treatment.html)
>  

**Resources for Protocol Development**

Treatment Improvement Protocols (TIPs) are best practice guidelines for
the treatment of substance abuse. CSAT draws on the experience and
knowledge of clinical, research, and administrative experts to produce
the TIPs, which are distributed to a growing number of facilities and
individuals across the country. Examples of protocols, screening
instruments, and methods for carrying out activities required to
implement the SBIRT program can also be found in several Treatment
Improvement Protocols (TIPS) published by CSAT. TIPS can be accessed on
the internet through the Treatment Improvement Exchange at:
[www.treatment.org/Externals/tips.html](http://www.treatment.org/Externals/tips.html)

> Barry KL Consensus Panel Chair. 1999. **Brief Interventions And Brief
> Therapies for Substance Abuse.** Treatment Improvement Protocol (TIP)
> Series 34. DHHS Publication No. (SMA) 99-3353.
>
> Blow FC. Consensus Panel Chair. 1998. **Substance Abuse Among Older
> Adults**. Treatment Improvement Protocol (TIP) Series 26. DHHS
> Publication No. (SMA) 98-3179.
>
> Miller WR. Consensus Panel Chair. 1999. **Enhancing Motivation for
> Change in Substance Abuse Treatment.** Treatment Improvement Protocol
> (TIP) Series 35. DHHS Publication No. (SMA) 99-3354.
>
> Rostenberg PO. Consensus Panel Chair. 1995. **Alcohol and Other Drug
> Screening of Hospitalized Trauma Patients.** Treatment Improvement
> Protocol (TIP) Series 16. DHHS Publication No. (SMA) 95-3039.
>
> Siegal H.A Consensus Panel Chair. 1998. **Comprehensive Case
> Management for Substance Abuse** Treatment. Treatment Improvement
> Protocol (TIP) Series 27. DHHS Publication No. (SMA) 98-3222.
>
> Sullivan E., Fleming, M. Consensus Panel Co-Chairs. 1997. **A Guide to
> Substance Abuse Services for Primary Care Clinicians**. Treatment
> Improvement Protocol (TIP) Series 24. DHHS Publication No. (SMA)
> 97-3139.
>
> Winters KC. Consensus Panel Chair. 1999. Treatment of Adolescents With
> Substance Use Disorders. Treatment Improvement Protocol**. (TIP)
> Series 32. DHHS Publication No. (SMA***)* 99-3283.

An excellent example of a protocol that can guide implementation of a
systematic approach to expanding the continuum of care is that developed
by the VA/DoD Evidence-Based Clinical Practice Guideline Working Group,
Veterans Health Administration, Department of Veterans Affairs, and
Health Affairs, Department of Defense (2001). Electronic copies of the
guideline are available from: Office of Quality and Performance web
site:
[www.oqp.med.va.gov/cpg/SUD/SUD_Base.htm](http://www.oqp.med.va.gov/cpg/SUD/SUD_Base.htm).

The VA/DoD guideline consists of five modules that address inter-related
aspects of care for patients with Substance Use Disorders. Module A,
Assessment and Management in Primary Care, provides a summary of the
evidence base for the use of screening and brief interventions and
outlines pathways for referral to specialty treatment.

**Module A:** **Assessment and Management in Primary Care** includes
screening, brief intervention, and specialty referral considerations.

**Module C:** **Care Management** emphasizes chronic disease management
for patients unwilling or unable to pursue rehabilitation goals.

**Module P:** **Addiction-Focused Pharmacotherapy** addresses use of
currently approved medications as part of treatment for alcohol and
opioid dependence.

**Module R:** **Assessment and Management in Specialty Care** focuses on
patients in need of further assessment or motivational enhancement or
who endorse rehabilitation goals.

**Module S:** **Stabilization** addresses detoxification and
pharmacological management of withdrawal symptoms.

The VA/DOD Guidelines and the TIPS are presented here as examples that
may or may not fit a particular State's definition of its continuum of
care. New York State has developed its own procedures, as may have other
States:

New York State Office of Alcoholism and Substance Abuse Services (New
York OASAS). 1996. **Changing Directions: Reference Manual for Early
Intervention Services.** Albany NY: New York OASAS.

**Brief Intervention Manuals**

As noted in the RFA, CSAT has recently supported development and
evaluation of manualized brief intervention and brief treatment
strategies for adolescents and adults with marijuana use disorders that
can be utilized.

Manuals in the Cannabis Youth Treatment (CYT) Series include:

> Sample S., and Kadden R. 2002. **Motivational Enhancement Therapy and
> Cognitive Behavioral Therapy for Adolescent Cannabis Users: 5
> Sessions**. Cannabis Youth Treatment (CYT) Series, Volume 1.
> <http://ncadi.samhsa.gov/govpubs/bkd384/>
>
> Webb C, Scudder M, Kaminer Y, and Kadden R 2002. **The Motivational
> Enhancement Therapy and Cognitive Behavioral Therapy Supplement: 7
> Sessions of Cognitive Behavioral Therapy for Adolescent Cannabis
> Users**. Cannabis Youth Treatment (CYT) Series, Volume 2.
> <http://ncadi.samhsa.gov/govpubs/bkd385>
>
> Hamilton NL., Brantley LB, Tims FM, Angelovich N., and McDougall B.
> 2002. **Family Support Network for Adolescent Cannabis Users**.
> Cannabis Youth Treatment (CYT) Series, Volume 3.
> <http://ncadi.samhsa.gov/govpubs/bkd386/cyt3.pdf>
>
> Godley SH., Meyers RJ, Smith JE, Karvinen T, Titus JC, Godley MD.,
> Dent G, Passetti L, and Kelberg P. 2002. **The Adolescent Community
> Reinforcement Approach for Adolescent Cannabis Users.** Cannabis Youth
> Treatment (CYT) Series, Volume 4.
>
> Liddle, HA. 2002. **Multidimensional Family Therapy for Adolescent
> Cannabis Users**, Cannabis Youth Treatment (CYT) Series, Volume 5.

These efforts build on prior research done under the auspices of the
National Institute on Drug Abuse (NIDA), the National Institute on
Alcoholism and Alcohol Abuse (NIAAA) and the World Health Organization
(WHO), which have has also issued several manuals that can also serve as
resources in project development:

> Babor TF and Higgins-Biddle JF. 2001**. Brief Intervention For
> Hazardous And Harmful Drinking: A Manual for Use in Primary Car**e.
> Geneva: World Health Organization. WHO/MSD/MSB/01.6b.
>
> Babor TF, Higgins-Biddle JC, Saunders JB, and Monteiro, MG. 2001.
> **AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for
> Use in Primary Care. Second Edition**. Geneva: World Health
> Organization. WHO/MSD/MSB/01.6a.
>
> Carroll KM 1998. **A Cognitive-Behavioral Approach: Treating Cocaine
> Addiction**. National Institute on Drug Abuse Therapy Manuals for Drug
> Addiction, Manual 1, NIH Publication 98-4308.
>
> Miller WR, Zweben A, DiClemente CC, et al. 1992. **Motivational
> Enhancement Therapy Manual: A Clinical Research Guide for Therapists
> Treating Individuals with Alcohol Abuse and Dependence.** NIAAA
> Project MATCH Monograph Series Vol. 2. DHHS Publication No. (ADM)
> 92-1894.
>
> National Institute on Alcohol Abuse and Alcoholism (NIAAA) ***1995***.
> **The Physicians\' Guide to Helping Patients With Alcohol
> Problems***.* NIH Publication No. 95-3769.
>
> National Institute on Alcohol Abuse and Alcoholism (NIAAA) 2003.
> **Helping Patients with Alcohol Problems: A Health Practitioner's
> Guide**. NIH Publication No. 03-3769. Bethesda, MD: U.S. Department of
> Health and Human Services, Public Health Service, National Institutes
> of Health.
>
> Roberts LJ and McCrady BS 2002. **Alcohol Problems in Intimate
> Relationships: Identification and Intervention - A Guide for Marriage
> and Family Therapists**. Rockville MD: National Institute on Alcohol
> Abuse and Alcoholism.

#### Resources for Analyzing Barriers and Implementing Systems Change {#resources-for-analyzing-barriers-and-implementing-systems-change .unnumbered}

Additional resources for analyzing barriers to access and linkage
between the generalist and specialist agencies and devising policy
changes are provided by CSAT Technical Assistance Publications (TAPs).
TAPS are publications, manuals, and guides developed by CSAT to offer
practical responses to emerging issues and concerns in the substance
abuse treatment field. Each TAP is developed by an expert who has had
firsthand experience with the topic. TAPS can be accessed on the
internet through the Treatment Improvement Exchange at:
[www.treatment.org/Taps/](http://www.treatment.org/Taps/)

TAPS that may be useful resources include:

> Crowe AH. and R Reeves. 1994. **Treatment for Alcohol and Other Drug
> Abuse: Opportunities for Coordination**. Technical Assistance
> Publication (TAP) Series 11.DHHS Publication No. (SMA) 94-2075.
>
> Hansen C. 1995. **Forecasting the Cost of Chemical Dependency
> Treatment Under Managed Care: The Washington State Study**. Technical
> Assistance Publication (TAP) Series 15. DHHS Publication No. (SMA)
> 95--3045).
>
> Moss S. 1998. **Contracting for Managed Substance Abuse and Mental
> Health Services: A Guide for Public Purchasers.** CSAT Technical
> Assistance Publication Series, Number 22.
> [www.treatment.org/taps/tap22/TAP22TOC.htm](http://www.treatment.org/taps/tap22/TAP22TOC.htm)

Other publications that can be used to understand development of cost
estimates, financing analyses, and systems change strategies are.

> Broskowski A and Smith S. 2001. **Estimating the Cost of Preventive
> Services in Mental Health and Substance Abuse Under Managed Care**.
> Substance Abuse and Mental Health Services Administration.
>
> [www.mentalhealth.org/publications/allpubs/SMA‑02‑3617R/appendix.asp](http://www.mentalhealth.org/publications/allpubs/SMA%1E02%1E3617R/appendix.asp)
>
> Denmead G and Rouse BA (eds) 1994. **Financing Drug Treatment Through
> State Programs.** (*Services Research Monograph No.1. NIH Publication
> No.94-3543.)* Rockville MD: National Institute on Drug Abuse.
>
> Fleming MF, Mundt MP, French MT, Manwell LB, Stauffacher EA, Barry KL
> 2000. Benefit-cost analysis of brief physician advice with problem
> drinkers in primary care settings. *Med Care* 38(1): 7-18.
>
> French MT, et al. 2001. Using the drug abuse screening test to analyze
> health services utilization and cost for substance users in a
> community-based setting (DAST-10). *Substance Use and Misuse* 36(6-7):
> 927-46.

Fortney J and BM Booth. 2001. Access to substance abuse services in
rural areas. In Galanter M (ed). **Recent Developments in Alcoholism:
Volume 15. Services Research in the Era of Managed Care**. New York:
Plenum Press, pp. 177-197.

Horgan CM. and EL Merrick. 2001. Financing of substance abuse treatment
services. In Galanter M (ed) Recent Developments in Alcoholism: Volume
15. **Services Research in the Era of Managed Care**. New York: Plenum
Press, pp. 229-252.

Kunz, MF, French, MT, Bazargan-Hejazi, S. 2004. Cost-effectiveness
analysis of a brief intervention delivered to problem drinkers
presenting at an inner city hospital emergency department. *Journal of
Studies on Alcohol* 65(3): 363-371.

> Libertoff K 1999. **Fighting for Parity in an Age of Incremental
> Health Care Reform**. Montpelier VT: Vermont Association for Mental
> Health.
>
> McCrady BS and Langenbucher JW. 1996. Alcohol treatment and health
> care system reform. *Archives of General Psychiatry*, 53(8): 737-746.
>
> National Association of State Alcohol and Drug Abuse Directors
> (NASADAD). 2002. **Identification and Description of Multiple Alcohol
> and Other Drug Treatment Systems.**
>
> Physician Leadership on National Drug Policy (PLNP). 2000. **Position
> Paper on Drug Policy.** Providence RI: Brown University Center for
> Alcohol and Addiction Studies
>
> [www.caas.brown.edu/plndp/Resources/researchrpt.pdf](http://www.caas.brown.edu/plndp/Resources/researchrpt.pdf)
>
> Weisner C. 1992. The Merging of Alcohol and Drug Treatment: A Policy
> Review. *Journal of Public Health Policy* 13(1): 66‑80.
>
> Weisner C, Mertens J, Parthasarathy S, Moore C, and Lu Y. 2001.
> Integrating Primary Medical Care with Addiction Treatment: A
> Randomized Controlled Trial. *Journal of the American Medical
> Association* 286(14): 1715-1723.
>
> Weisner C, and Schmidt L. 1993. Alcohol and drug problems among
> diverse health and social service populations. *American Journal of
> Public Health* 83:824-829.
>
> Weisner C and Schmidt L 2001. Rethinking access to alcohol treatment.
> In Galanter M. (ed). **Recent Developments in Alcoholism: Volume 15.
> Services Research in the Era of Managed Care**. New York: Plenum
> Press, pp. 107-135.
>
> Weisner C, Matzger H, Tam T, and Schmidt L.  2002.  Who goes to
> alcohol and drug treatment? Understanding utilization within the
> context of insurance. *J. Stud. Alcohol* 63**:** 673-682.

Zarkin GA, Galinis DN, French MT. Fountain DL, Ingram PW, and Guyett JA.
1995. Financing strategies for drug abuse treatment programs. 1995.
*Journal of Substance Abuse Treatment*. 12(6): 385-399.

Additional articles that address strategies for overcoming resistance
and implementing systems change include:

> Babor TF and Higgins-Biddle JF. 2000. Alcohol screening and brief
> intervention: dissemination strategies for medical practice and public
> health. *Addiction.* 95(5): 677-686.
>
> Lock CA and Kaner E 2000. Use of Marketing to Disseminate Brief
> Alcohol Intervention to General Practitioners: Promoting Health Care
> Interventions to Health Promoters. *Journal of Evaluation in Clinical
> Practice*. 6(4): 345-357.
>
> Fleming MF. 2002. Screening, Assessment, and Intervention for
> Substance Use Disorders in Settings. In: ***Strategic Plan for
> Interdisciplinary Faculty Development: Arming the Nation's Health
> Professional Workforce for a New Approach to Substance Use
> Disorders*.** Providence RI: Association for Medical Education and
> Research in Substance Abuse (AMERSA).
>
> [www.projectmainstream.net/mainstream/supportdata/part1.pdf](http://www.projectmainstream.net/mainstream/supportdata/part1.pdf)
>
> Physician Leadership on National Drug Policy (PLNP). 2002**. Project
> Vital Sign.** Providence RI: Brown University Center for Alcohol and
> Addiction Studies.

The emphasis in this RFA is on expanding the State's continuum of care
to include screening, brief intervention, referral, and brief treatment
(SBIRT) in general medical and other community settings (e.g. community
health centers, nursing homes, schools and student assistant programs,
occupational health clinics, hospitals, and emergency departments). It
is recognized that SBIRT activities are being, or could be, carried out
in non-medical community settings (viz., student assistance programs,
employee assistance programs, and welfare offices, drug courts, senior
citizen centers).

While most of the research has been focused on screening in primary care
medical settings, the approach can be effectively applied in many other
contexts as well. In many cases, procedures have already been developed
and used in these community settings for specific instruments, such as
the AUDIT. To provide an example, Table 5 summarizes information about
the settings, screening personnel, and target groups considered
appropriate for a screening program using the screening instrument.

+----------------------+------------------------+---------------------+
| **Table 5:           |                        |                     |
| Personnel, Settings  |                        |                     |
| and Groups           |                        |                     |
| Considered           |                        |                     |
| Appropriate for a    |                        |                     |
| Screening Program    |                        |                     |
| Using Screening      |                        |                     |
| Instruments**[^17]   |                        |                     |
+----------------------+------------------------+---------------------+
| **Setting**          | **Target Group**       | **Screening         |
|                      |                        | Personnel**         |
+----------------------+------------------------+---------------------+
| Primary care clinic  | Medical patients       | Nurse, social       |
|                      |                        | worker              |
+----------------------+------------------------+---------------------+
| Emergency room       | Accident victims,      | Physicians, nurses, |
|                      | Intoxicated patients,  | or staff, health    |
|                      | trauma victims         | educators           |
+----------------------+------------------------+---------------------+
| Physician's office   | Medical patients       | General             |
|                      |                        | practitioners,      |
| Surgery              |                        |                     |
|                      |                        | family physicians,  |
| Prenatal and         |                        | physician           |
| perinatal clinics    |                        | extenders, nurses,  |
|                      |                        | or staff            |
+----------------------+------------------------+---------------------+
| General Hospital     | Patients with          | Internists,         |
| wards                | hypertension, heart    | physician           |
|                      | disease,               | extenders, nurses,  |
| Outpatient clinic    | gastrointestinal       | staff               |
|                      |                        |                     |
|                      | or neurological        |                     |
|                      | disorders              |                     |
+----------------------+------------------------+---------------------+
| Psychiatric hospital | Psychiatric patients,  | Psychiatrists,      |
|                      | particularly those who | psychologists,      |
|                      | are suicidal           | counselors, staff   |
+----------------------+------------------------+---------------------+
| Court, jail, prison  | DWI offenders, violent | Officers,           |
|                      | criminals              | counselors,         |
|                      |                        | probation officers  |
+----------------------+------------------------+---------------------+
| Other health-related | Persons demonstrating  | Health and human    |
| facilities           | impaired social or     | service workers     |
|                      | occupational           |                     |
|                      | functioning            |                     |
|                      |                        |                     |
|                      | (e.g. marital discord, |                     |
|                      |                        |                     |
|                      | child neglect, etc.)   |                     |
+----------------------+------------------------+---------------------+
| Military Services    | Enlisted men and       | Medics              |
|                      | officers               |                     |
+----------------------+------------------------+---------------------+
| Welfare Offices      | Applicants and clients | Social Workers,     |
|                      |                        | case aides          |
+----------------------+------------------------+---------------------+
| Workplace            | Workers, especially    | Employee assistance |
|                      | those                  | staff               |
| Employee Assistance  |                        |                     |
| Program              | having problems with   |                     |
|                      |                        |                     |
|                      | productivity,          |                     |
|                      | absenteeism            |                     |
|                      |                        |                     |
|                      | or accidents           |                     |
+----------------------+------------------------+---------------------+

A State that includes such efforts in their proposal must recognize that
these efforts must comport to the diagnostic considerations outlined
here. Examples of such activities can be found in these and other
publications:

> Peters RH and Wexler HK, Consensus Panel Co-Chairs 2005. **"Substance
> Abuse Treatment for Adults in the Criminal Justice System." Treatment
> Improvement Protocol** (TIP) series number 44. DHHS Publication No.
> (SMA) 05-4056
>
> White WL and Dennis M. 2002. **Number range CHAPTERThe cannabis youth
> treatment experiment: Key lessons for student assistance programs.**
> *Student Assistance Journal,* 14: 16-19.
>
> Young, N. K. 1996. **Alcohol and Other Drug Treatment: Policy Choices
> in Welfare Reform**. Washington DC: National Association of State
> Alcohol and Drug Abuse Directors.
>
> Young N. K., S. L. Gardner, and K. Dennis. 1998. **Responding to
> Alcohol and other Drug Problems in Child Welfare: Weaving Together
> practice and Policy**. Washington DC: Child Welfare League of America
> Press.
>
> Young NK and Gardner SL. 2002. **Navigating the Pathways: Lessons and
> Promising Practices in Linking Alcohol and Drug Services with Child
> Welfare**. . Technical Assistance Publication (TAP) Series 27. SAMHSA
> Publication No. (SMA) 02--3639.

**Resources for Developing Need Estimates**

Resources that can be referred to for developing estimates of need for
treatment and resource availability are:

> DeWit DJ and Rush B 1996. Assessing the Need for Substance Abuse
> Services: A Critical Review of Needs Assessment Models. *Evaluation
> and Program Planning*. 19(1): 41-64.
>
> Epstein JF 2002. **Substance Dependence, Abuse, and Treatment:
> Findings from the 2000 National Household Survey on Drug Abuse.**
> (*DHHS Publication No. SMA 02-3642, NHSDA Series A-16*). Rockville MD:
> Substance Abuse and Mental Health Services Administration, Office of
> Applied Studies
>
> Gerstein D and Harwood H (eds). 1990. **Treating Drug Problems**, Vol.
> I. Washington DC: National Academy Press. (Chapter 3)
>
> Institute of Medicine. 1990. **Broadening the Base of Treatment for
> Alcohol Problems**. Washington DC: National Academy Press. (Chapters 7
> and 9)
>
> Maxwell JC (ed). 2001. **Multiple Indicator Analysis: Using Secondary
> Data to Analyze Illicit Drug Use**. *(DHHS Publication No. SMA
> 01-3539. Rockville, MD: Center for Substance Abuse Treatment and
> Center for Mental Health Services).* Substance Abuse and Mental Health
> Services Administration.
>
> McAuliffeWE, Woodworth R, Zhang CH, and Dunn, RP. 2002. Identifying
> substance abuse treatment gaps in substate areas. J. *Substance Abuse
> Treatment*. 23(3): 199-208.
>
> Office of Applied Studies. 2002. **National and State Estimates of the
> Drug Abuse Treatment Gap: 2000 National Household Survey on Drug
> Abuse** *(NHSDA Series H-14, DHHS Publication No. SMA 02-3640)*.
> Rockville, MD: Substance Abuse and Mental Health Services
> Administration.
> [www.samhsa.gov/oas/TXgap/toc.htm](http://www.samhsa.gov/oas/TXgap/toc.htm)
>
> Number range CHAPTERRush B. 1996. Alcohol and other drug problems and
> treatment systems: A framework for research and development.
> *Addiction*. 91(5): 629-642.

#### Collaboration with Addiction Technology Training Centers as a Training Resource {#collaboration-with-addiction-technology-training-centers-as-a-training-resource .unnumbered}

SAMHSA/CSAT funds a network of 14 independent regional Addiction
Technology Transfer Centers (ATTCs) and a National Office
([www.nattc.org](http://www.nattc.org/)). The ATTCs constitute a
nationwide, multi-disciplinary resource that draws upon the knowledge,
experience and latest work of recognized experts in the field of
addictions. A list of ATTCs, the States covered, and contact information
is provided in Table 6. Each ATTC serves as a resource to 2 or more
States, having memoranda of understanding with the State Substance Abuse
Authorities (SSAs). For additional information related to ATTC's, please
visit [www.nattc.org](http://www.nattc.org/).

#### Table 6: Addiction Technology Transfer Center Contacts {#table-6-addiction-technology-transfer-center-contacts .unnumbered}

+-----------------------------------+-----------------------------------+
| **Maine, New Hampshire,           | **Georgia, South Carolina**       |
| Vermont,**                        |                                   |
|                                   | Southeast ATTC                    |
| **Massachusetts, Connecticut,     |                                   |
| Rhode Island**                    | Morehouse School of Medicine      |
|                                   |                                   |
| ATTC of New England               | CORK Institute                    |
|                                   |                                   |
| Center for Alcohol and Addiction  | Atlanta, Georgia 30310            |
| Studies Brown University          |                                   |
|                                   | \(404\) 752-1016                  |
| Providence, Rhode Island 02912    |                                   |
|                                   | [www.s                            |
| \(401\) 444-1808                  | attc.org](http://www.sattc.org/)  |
|                                   |                                   |
| [www.attc                         | Director: Kay Gresham Morrison,   |
| -ne.org](http://www.attc-ne.org/) | LCSW, ACSW                        |
|                                   |                                   |
| Director: Susan Storti, PhD, RN   | **Virginia, Maryland, North       |
|                                   | Carolina,\                        |
| **New York, New Jersey,           | West Virginia**                   |
| Pennsylvania**                    |                                   |
|                                   | Mid-Atlantic ATTC                 |
| Northeast ATTC                    |                                   |
|                                   | Virginia Commonwealth University  |
| Institute for Research, Education |                                   |
| and                               | Richmond, Virginia 23298-0469     |
|                                   |                                   |
| Training in Addictions            | \(804\) 828-9910                  |
|                                   |                                   |
| Pittsburgh, Pennsylvania 15219    | [www.mid-at                       |
|                                   | tc.org](http://www.mid-attc.org/) |
| \(866\) 246-5344                  |                                   |
|                                   | Director: Paula Horvatich, PhD    |
| [www.ireta.org                    |                                   |
| /attc](http://www.ireta.org/attc) |                                   |
|                                   |                                   |
| Director: Michael Flaherty, PhD   | **Illinois, Ohio, Wisconsin,      |
|                                   | Indiana, Michigan**               |
| **District of Columbia,           |                                   |
| Delaware,\                        | Great Lakes ATTC                  |
| Kentucky, Tennessee, Maryland**   |                                   |
|                                   | Jane Addams College of Social     |
| Central East ATTC                 | Work                              |
|                                   |                                   |
| DANYA Institute                   | University of Illinois-Chicago    |
|                                   |                                   |
| Silver Spring, Maryland 20910     | Chicago, Illinois 60612           |
|                                   |                                   |
| \(240\) 645-1145                  | \(312\) 996-4450                  |
|                                   |                                   |
| [www.ce                           | [www.gl                           |
| attc.org](http://www.ceattc.org/) | attc.org](http://www.glattc.org/) |
|                                   |                                   |
| Director Cynthia Moreno Tuoley    | Director: Lonnetta Albright       |
+-----------------------------------+-----------------------------------+
| **Iowa, Nebraska, North Dakota,   | **California, Arizona, New        |
| South Dakota, Minnesota**         | Mexico**                          |
|                                   |                                   |
| Prairielands ATTC                 | Pacific Southwest ATTC            |
|                                   |                                   |
| University of Iowa                | UCLA Integrated Substance Abuse   |
|                                   |                                   |
| Iowa City, Iowa 52242             | Programs                          |
|                                   |                                   |
| \(319\) 335-5368                  | Los Angeles California 90025      |
|                                   |                                   |
| [www.p                            | \(310\) 445-0874                  |
| attc.org](http://www.pattc.org/)  |                                   |
|                                   | [www.psa                          |
| Director: Anne Helene Skinstad,   | ttc.org/](http://www.psattc.org/) |
| PhD                               |                                   |
|                                   | Director: Thomas Freese, PhD\     |
| **Arkansas, Kansas, Missouri,     | Co-Director: Michael Shafer, PhD  |
| Oklahoma**                        |                                   |
|                                   |                                   |
| Mid-America ATTC                  |                                   |
|                                   | **Puerto Rico, US Virgin          |
| University of Missouri-Kansas     | Islands**                         |
| City                              |                                   |
|                                   | Caribbean Basin and Hispanic ATTC |
| 5100 Rockhill Road                |                                   |
|                                   | Centro de Estudios en Adiccion    |
| Kansas City, Missouri 64110       |                                   |
|                                   | Universidad Central del Caribe    |
| \(816\) 482-1100                  |                                   |
|                                   | Call Box 60-327                   |
| [www.                             |                                   |
| mattc.org](http://www.mattc.org/) | Bayamon, Puerto Rico 00960-6032   |
|                                   |                                   |
| Director: Pat Stilen, LCSW, CADAC | \(787\) 785-4211                  |
|                                   |                                   |
| **Nevada, Montana, Wyoming, Utah, | web <http://cbattc.uccaribe.edu/> |
| Colorado**                        |                                   |
|                                   | Director: Rafaela Robles, EdD     |
| Mountain West ATTC                |                                   |
|                                   | **Alabama, Florida**              |
| University of Nevada, Reno        |                                   |
|                                   | Southern Coast ATTC               |
| Reno, Nevada 89557                |                                   |
|                                   | Florida Certification Board       |
| \(775\) 784-6265                  |                                   |
|                                   | Tallahassee Florida 32301         |
| [www.mw                           |                                   |
| attc.org](http://www.mwattc.org/) | \(850\) 222-6714                  |
|                                   |                                   |
| Principal Investigator: Nancy     | [www.sc                           |
| Roget, MS\                        | attc.org](http://www.scattc.org/) |
| Co-PI: Gary L. Fisher, PhD        |                                   |
|                                   | Director: Pam Waters              |
|                                   |                                   |
|                                   | **National Office**               |
| **Alaska, Washington, Oregon,     |                                   |
| Idaho,**                          | University of Missouri - Kansas   |
|                                   | City                              |
| **Hawaii, Pacific Islands**       |                                   |
|                                   | Kansas City, MO 64110-2499        |
| Northwest Frontier ATTC           |                                   |
|                                   | \(816\) 482-1200                  |
| Salem, Oregon 97303               |                                   |
|                                   | [www.n                            |
| \(503\) 373-1322                  | attc.org/](http://www.nattc.org/) |
|                                   |                                   |
| [www.nf                           | Director: Mary Beth Johnson, MSW  |
| attc.org](http://www.nfattc.org/) |                                   |
|                                   |                                   |
| Director: Steve Gallon, PhD       |                                   |
|                                   |                                   |
| **Texas, Louisiana, Mississippi** |                                   |
|                                   |                                   |
| Gulf Coast ATTC                   |                                   |
|                                   |                                   |
| University of Texas               |                                   |
|                                   |                                   |
| Center for Social Work Research   |                                   |
|                                   |                                   |
| Austin, Texas 78703               |                                   |
|                                   |                                   |
| \(512\) 232-0608                  |                                   |
|                                   |                                   |
| [www.ut                           |                                   |
| attc.net](http://www.utattc.net/) |                                   |
|                                   |                                   |
| Director: Richard Spence, PhD     |                                   |
+-----------------------------------+-----------------------------------+

[^1]: ^For\ purposes\ of\ this\ announcement,\ the\ need\ for\ treatment\ is\ discussed\ in\ terms\ of\ the\ categories\ of\ substance\ use\ disorders\ (substance\ dependence\ and\ substance\ abuse)\ used\ in\ the\ American\ Psychiatric\ Association\ Diagnostic\ and\ Statistical\ Manual\ of\ Mental\ Disorders\ (DSM-IV;\ 1994).^

[^2]: ^The\ complexity\ of\ these\ multiple\ treatment\ subsystems\ at\ the\ State\ level\ has\ been\ described\ in\ a\ report\ submitted\ to\ SAMHSA/CSAT\ by\ the\ National\ Association\ of\ State\ and\ Drug\ Abuse\ Directors\ (NASADAD,\ 2002)^

[^3]: ~References\ and\ resources\ that\ support\ this\ approach\ are\ available\ at\ [www.mayatech.com/sbirt/tools_resources/references.htm](http://www.mayatech.com/sbirt/tools_resources/references.htm)~

[^4]: ^OMB\ approval\ for\ these\ screening\ instruments\ will\ be\ sought.^

[^5]: References and resources that support this model include CSAT's
    Treatment Improvement Protocols (TIPs) and Technical Assistance
    Publications (TAPs).

[^6]: ^Continuous\ reporting\ is\ defined\ as\ entering\ client\ level\ data\ into\ the\ GPRA\ web\ based\ data\ system\ within\ 7\ business\ days\ of\ collection.^

[^7]: ^OMB\ approval\ for\ this\ interview\ protocol\ will\ be\ sought\ by\ CSAT.^

[^8]: ^OMB\ approval\ for\ this\ interview\ protocol\ will\ be\ sought\ by\ CSAT.^

[^9]: ^For\ purposes\ of\ this\ announcement,\ a\ community\ may\ be\ a\ geopolitical\ unit\ (city,\ county),\ a\ health\ district\ or\ human\ services\ region,\ or\ a\ substate\ planning\ area\ as\ defined\ for\ purpose\ of\ allocating\ Substance\ Abuse\ Prevention\ and\ Treatment\ Block\ Grant\ (SAPTBG)\ funds.^

[^10]: ^The\ State\ may\ wish\ to\ consider\ subcontracting\ with\ the\ SAMHSA/CSAT\ funded\ Addiction\ Technology\ Training\ Centers\ (ATTCs)\ already\ working\ with\ its\ SSA\ or\ an\ in-state\ resource.\ A\ list\ of\ ATTCs,\ the\ States\ covered\ by\ each,\ and\ contact\ information\ is\ provided\ in\ Appendix\ I.\ If\ a\ subcontract\ with\ the\ ATTC,\ another\ academic\ institution,\ or\ a\ vender\ is\ used,\ the\ plan\ should\ include\ the\ cost\ for\ providing\ these\ activities\ as\ a\ separate\ budget\ component.^

[^11]: ^Limited\ technical\ assistance\ on\ implementation,\ reporting,\ and\ monitoring\ progress\ toward\ meeting\ the\ SBIRT\ targets\ will\ be\ available\ if\ problems\ arise\ that\ cannot\ be\ resolved\ with\ the\ project's\ resources\ alone.^

[^12]: ^For\ a\ discussion\ of\ the\ methodology\ change,\ see\ Epstein,\ 2002.\ Substance\ Dependence,\ Abuse,\ and\ Treatment:\ Findings\ from\ the\ 2000\ National\ Household\ Survey\ on\ Drug\ Abuse,\ Appendix\ C:\ Measurement\ of\ Dependence,\ Abuse,\ Treatment,\ and\ Treatment\ Need.^

[^13]: ^A\ number\ of\ other\ States\ have\ included\ similar\ characterizations\ for\ differentiating\ intervention\ and\ treatment\ in\ their\ rules\ or\ planning\ efforts\ (e.g.,\ Louisiana,\ Minnesota,\ Florida,\ North\ Carolina,\ Connecticut,\ Vermont,\ and\ Washington).\ For\ example,\ South\ Dakota\ has\ defined\ its\ approach\ as\ part\ of\ the\ regulations\ governing\ licensure\ of\ treatment\ facilities:\ "A\ facility\ that\ provides\ Early\ Intervention\ and\ Outpatient\ Services\ is\ a\ nonresidential\ facility\ that\ provides\ direct\ supportive\ client\ contact,\ indirect\ or\ collateral\ client\ contact,\ community\ information\ and\ liaison\ services.\ The\ program\ also\ provides\ formally\ planned\ counseling\ services\ to\ those\ persons\ harmfully\ affected\ by\ alcohol\ or\ drugs\ and\ who\ have\ been\ determined\ not\ to\ be\ in\ need\ of\ or\ accepting\ of\ structured\ outpatient\ or\ residential\ services."\ <http://legis.state.sd.us/rules/rules/6716A.htm#67:16:11:03.04>.\ Apparently\ some\ States\ (e.g.,\ Florida)\ define\ intervention\ as\ both\ a\ treatment\ and\ non-treatment\ activity.^

[^14]: ^Based\ on\ Babor\ and\ Higgins-Biddle\ (2001)\ Brief\ Intervention\ For\ Hazardous\ And\ Harmful\ Drinking:\ A\ Manual\ for\ Use\ in\ Primary\ Care,\ Box\ 2,\ p.12^

[^15]: ^Based\ on\ Skinner\ HA\ (1982).^

[^16]: ^Based\ on\ Figure\ 3-1.\ A\ model\ of\ individual\ drug\ history,\ Gerstein\ and\ Harwood\ (1990:61).^

[^17]: ^Modified\ from\ Box\ 1,\ Personnel,\ Settings\ and\ Groups\ Considered\ Appropriate\ for\ a\ Screening\ Programme\ Using\ the\ AUDIT\ (Babor\ et\ al.,\ 2001).^