OMB Approval # 0930-0168

FFY 2018-2019 Block Grant 

Application

Community Mental Health Services Block Grant 

(MHBG) 

Plan and Report

Substance Abuse Prevention and Treatment Block 

Grant (SABG)

Plan and Report

U.S. Department of Health and Human Services 

Substance Abuse and Mental Health Services Administration
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Table of Contents

FFY2018-2019 Block Grant Application....................................................................................................1

I. INTRODUCTION...................................................................................................................................1

A. Background............................................................................................................................................1

1. Leading Change 2.0 – SAMHSA’s Six Strategic Initiatives...........................................................2

B. Impact on State Authorities and Systems..............................................................................................4

C. Block Grant Programs’ Purposes ........................................................................................................11

II. SUBMISSION OF APPLICATION AND PLAN TIMEFRAMES....................................................12

III. BEHAVIORAL HEALTH ASSESSMENT AND PLAN ..................................................................14

Quality and Data Collection Readiness..............................................................................................14

A. Framework for Planning—Mental Health and Substance Use Prevention and Treatment ...........15

B. Planning Steps...............................................................................................................................19

Planning Tables..................................................................................................................................24

C. Environmental Factors and Plan....................................................................................................37

1. The Health Care System, Parity and Integration - Question 1 and 2 are Required .......................37

2. Health Disparities - Requested ......................................................................................................42

3. Innovation in Purchasing Decisions - requested............................................................................45

4. Evidence-Based Practices for Early Interventions to Address Early Serious Mental Illness 

(ESMI)-10 percent set aside - Required MHBG ...........................................................................48

5. Person Centered Planning (PCP) –Required (MHBG) .................................................................50

6. Self-Direction - Requested ..................................................................................................................51

7. Program Integrity - Required...............................................................................................................53

8. Tribes - Requested ...............................................................................................................................55

9. Primary Prevention-required (SABG only).........................................................................................56
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10. Statutory Criterion for MHBG (Required MHBG)...........................................................................64

11. Substance Use Disorder Treatment - Required SABG.......................................................................67

12. Quality Improvement Plan- requested................................................................................................77

13. Trauma -requested .........................................................................................................................77

14. Criminal and Juvenile Justice - Requested....................................................................................79

15. Medication Assisted Treatment - Requested.................................................................................80

16. Crisis Services - Requested ...........................................................................................................82

17. Recovery - Required......................................................................................................................83

18. Community Living and the Implementation of Olmstead- requested ...........................................86

19. Children and Adolescents Behavioral Health Services –required MHBG, requested SABG.......87

20. Suicide Prevention – (Required MHBG) ......................................................................................91

21. Support of State Partners - Required MHBG................................................................................92

22. State Behavioral Health Planning/Advisory Council and Input on the Mental Health/Substance 

Abuse Block Grant Application-required MHBG.........................................................................94

23. Public Comment on the State Plan- required.....................................................................................98

Acronyms ..................................................................................................................................................99

Resources................................................................................................................................................103

1. Required Forms

a. Face Page—Community Mental Health Services Block Grant

b. Face Page—Substance Abuse Prevention and Treatment Block Grant

c. Funding Agreements/Certifications—Community Mental Health Services Block Grant

d. Funding Agreements/Certifications—Substance Abuse Prevention and Treatment

Block Grant

e. Assurances
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FFY2018-2019 Block Grant Application

I. INTRODUCTION

This is an application for SAMHSA’s Community Mental Health Services Block Grant (MHBG) and 

Substance Abuse Prevention and Treatment Block Grant (SABG) as authorized by sections 1911-1920 

of Title XIX, Part B, Subpart I of the Public Health Service Act (42 U.S.CF.§§ 300x-300x-9) and 

sections 1921-1935 of Title XIX, Part B, Subpart II of the Public Health Service Act (42 U.S.C.§ 300x21-35), respectively, and sections 1941-1956 of Title XIX, Part B, Subpart III of the Public Health 

Service Act (42 U.S.C.§§ 300x-51-66). This block grant application includes four major parts: 

introduction; submission of application and plan timeframes; behavioral health assessment and plan;

and report requirements. These sections include discussions and planning around the following policy

topics: health care system, parity and integration; health disparities; innovations in purchasing 

decisions; evidence-based practices for early intervention (e.g., serious mental illness (SMI)); person 

centered planning and self-direction; program integrity; tribes; primary substance use disorder 

prevention, statutory criteria for MHBG; substance use disorder treatment; quality improvement;

trauma; criminal and juvenile justice; medication-assisted treatment; crisis services; recovery;

community living and Olmstead; children and adolescents behavioral health services; suicide 

prevention; support of state partners; state behavioral health planning/advisory council; and public 

comment .

A. Background

The Substance Abuse and Mental Health Services Administration (SAMHSA) oversees two major block 

grants: the Substance Abuse Prevention and Treatment Block Grant (SABG) and the Community

Mental Health Services Block Grant (MHBG). These block grants give states

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maximum flexibility to 

address the unique behavioral health2needs of their populations. The MHBG and SABG differ in a

number of their practices (e.g., targeted populations) and statutory authorities (e.g., method of

calculating maintenance of effort (MOE), stakeholder input requirements for planning, set-asides for

specific populations or programs, etc.).

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 As a result, information on the services and clients supported 

by block grant funds has varied by block grant and by state.

SAMHSA believes it is vital to collect, report, and analyze data at the state and federal levels to ensure

the nation’s behavioral health system is providing the highest quality and most cost effective treatment 

and other services. State block grant expenditures should be based on the best possible evidence and

 

1 The term ”state” means each of the several states, the District of Columbia and each of the territories of the United States. 

The term “territories of the United States” means each of the Commonwealth of Puerto Rico, Virgin Islands, American Samoa, 

Commonwealth of the Northern Marianas Islands, Federated States of Micronesia, Guam, Republic of the Marshall Islands 

and the Republic of Palau.

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The term “behavioral health” in this document refers to a state of mental/emotional being and/or choices and actions that affect wellness. 

Behavioral health problems include substance abuse or misuse, alcohol and drug addiction, serious psychological distress, suicide, and

mental and substance use disorders. This includes a range of problems from unhealthy stress to diagnosable and treatable diseases like

Serious Mental Illnesses (SMIs) and substance use disorders (SUDs), which are often chronic in nature but that people can and do recover 

from. The term is also used to describe the service systems encompassing the promotion of emotional health; the prevention of mental and

substance use disorders; substance use and related problems; treatments and services for mental and substance use disorders; and recovery 

support.

In addition to statutory authority, SABG is detailed by comprehensive regulation. http://www.samhsa.gov/grants/blockgrants/laws-regulations
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program quality and outcomes should be carefully tracked. Ultimately, such data will lead to 

improvements as science and circumstances change.

Better alignment of the MHBG and SABG applications will help block grant recipients improve data 

collection and coordination between programs. In fiscal year (FFY) 2011, SAMHSA redesigned the FFY

2012-2013 MHBG and SABG applications to better align with the current federal/state environments 

and related policy initiatives, including the Mental Health Parity and Addiction Equity Act (MHPAEA), 

and the Tribal Law and Order Act (TLOA). The new design offered states the opportunity to complete a

combined application for mental and substance use disorder4(M/SUD) services, submit a biennial 

versus an annual plan

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,

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and provide information regarding their efforts to respond to various federal 

and state initiatives. The new design also reflects the increasing trend among states to integrate their 

mental health, substance use disorder prevention, SUD treatment, and recovery administration. 

Almost two-thirds of the states took advantage of this streamlined application during FFY 2016-2017

application process and submitted combined plans for M/SUD services. Nearly all the states provided 

specific information requested by SAMHSA regarding strategies to respond to a variety of areas 

including primary care and behavioral health integration, recovery support services, and parity 

implementation. 

The FFY 2018-2019 Block Grant Application furthers SAMHSA’s efforts to have states use and report 

the opportunities offered under various federal initiatives. The FFY 2018-2019 Block Grant Application 

allows states to submit an application for both MHBG and SABG funds and requires a biennial plan for 

the MHBG while allowing a biennial plan for the SABG. This application also reflects the health care 

system’s strong emphasis on coordinated and integrated care along with the need to improve services 

for persons with mental and substance use disorders.

1. Leading Change 2.0 – SAMHSA’s Six Strategic Initiatives 

SAMHSA has updated and streamlined its strategic plan to align with the evolving needs of the 

behavioral health field, individuals and families with behavioral health conditions, and the changing 

fiscal environment. Issued in late FFY 2014, Leading Change 2.0: Advancing the Behavioral Health of 

the Nation 2015 – 2018, reflects SAMHSA’s programmatic priorities and policy drivers, including the 

new HHS strategic plan.

Behavioral Health is an essential part of health service systems and effective community-wide strategies 

that improve health status and lower costs for families, businesses, and governments. Through practice 

improvement in the delivery and financing of prevention, treatment, and recovery support services, 

SAMHSA and its partners can advance behavioral health and promote the nation’s health. In order to 

continue to support this goal, SAMHSA emphasizes an updated set of Strategic Initiatives (SI) to focus 

its work on improving lives and capitalizing on emerging opportunities. 

 

4 The term “substance use disorder” means substance-related and addictive disorder as described in the Diagnostic and 

Statistical Manual of Mental Disorders, Fifth Edition, Arlington, VA, American Psychiatric Association.

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State Plan for Comprehensive Community Mental Health Services for Certain Individuals (Sec. 1912 of Title XIX, Part B, Subpart I of the

Public Health Service (PHS) Act (42 USC § 300x-2)

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State Plan (Sec. 1932(b) of Title XIX, Part B, Subpart II of the Public Health Service (PHS) Act (42 USC § 300x- 32(b))
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These include:

1. Prevention of Substance Abuse and Mental Illness: Focuses on substance misuse prevention, 

SMI, and severe emotional disturbance (SED)7by maximizing opportunities to create 

environments where individuals, families, communities, and systems are motivated and 

empowered to manage their overall emotional, behavioral, and physical health. This SI includes a 

focus on several populations of high risk, including college students and transition-age youth, 

especially those at risk of first episodes of mental illness or substance misuse; American 

Indian/Alaska Natives; ethnic minorities experiencing health and behavioral health disparities; 

military families; and lesbian, gay, bisexual, transgender and questioning (LGBTQ) individuals.

2. Health Care and Health Systems Integration: Focuses on integration in health care including

systems of particular importance for persons with behavioral health needs such as community 

health promotion; health care delivery; specialty prevention; treatment and recovery; and 

community living needs. Integration efforts seek to increase access to appropriate high-quality 

prevention, treatment, recovery and wellness services and supports; reduce disparities between the 

availability of services for persons with mental illness (including SMI/SED) and substance use 

disorders compared with the availability of services for other medical conditions; and support 

coordinated care and services across systems. 

3. Trauma and Justice: Focuses on trauma and justice by integrating a trauma-informed approach 

throughout health, behavioral health, human services, and related systems to reduce the harmful 

effects of trauma and violence on individuals, families, and communities. Activities under this SI 

include integrating trauma informed approaches across service sectors; assisting communities in 

the preparation for, response to, and recovery from traumatic events that include disasters; and 

understanding the effects of community trauma. This SI also supports the use of innovative 

strategies to reduce the involvement of individuals with trauma and behavioral health issues in the 

criminal and juvenile justice systems including diversion practices; strategic links with 

community based providers and correctional health; and effective reentry.

4. Recovery Support: Promotes partnering with people in recovery from mental and substance use 

disorders and their family members to guide the behavioral health systems and promote 

individual, program, and system-level approaches that foster health and resilience (including 

helping individuals with behavioral health needs be well, manage symptoms, and achieve and 

maintain abstinence); increase housing to support recovery; reduce barriers to employment, 

education, and other life goals; and secure necessary social supports in their chosen community. 

5. Health Information Technology: Ensures that the behavioral health system – including states, 

 

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For purposes of block grant planning and reporting, SAMHSA has clarified the definitions of SED and SMI, which were first, identified in 

the 1993 Federal Register them (May 10, 1993; 58 FR 29422-29425). States may have additional elements that are included in their specific 

definitions, but the following provides a common baseline definition. Children with SED refers to persons from birth to age 18 and adults 

with SMI refers to persons age 18 and over; (1) who currently meets or at any time during the past year has met criteria for a mental disorder 

– including within developmental and cultural contexts – as specified within a recognized diagnostic classification system (e.g., most recent 

editions of DSM, ICD, etc.), and (2) who displays functional impairment, as determined by a standardized measure, which impedes progress 

towards recovery and substantially interferes with or limits the person’s role or functioning in family, school, employment, relationships, or 

community activities.
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community providers, patients, peers, and prevention specialists – fully participates with the 

general healthcare delivery system in the adoption of health information technology (Health IT). 

This includes interoperable electronic health records (EHR) and the use of other electronic 

training, assessment, treatment, monitoring, and recovery support tools, to ensure high-quality 

integrated health care, appropriate specialty care, improved patient/consumer engagement, and 

effective prevention and wellness strategies.

6. Workforce Development: Supports active strategies to strengthen and expand behavioral health 

workforce. Through technical assistance, training, and focused programs, the initiative will 

promote an integrated, aligned, competent workforce that enhances the availability of substance 

misuse prevention, M/SUD treatment, and recovery services; strengthens the capabilities of 

behavioral health professionals; and promotes the infrastructure of health systems to deliver 

competent, organized behavioral health services. This initiative will continually monitor and 

assess the needs of peers, communities, and health professionals in meeting behavioral health 

needs in America’s transformed health promotion and health care delivery systems. 

B. Impact on State Authorities and Systems

SAMHSA seeks to ensure that State Mental Health Authorities (SMHAs) and Single State Agencies

(SSAs) are prepared to address the priorities discussed throughout this document. By addressing these

environmental factors, SMHAs and SSAs will enhance their ability to decrease the prevalence and 

impact mental and substance use disorders and/or improve the health of individuals with mental illness 

and addictions, improve how they experience care, and reduce costs. The FFY 2018-2019 Block Grant

application incorporates several key assumptions:

States are strategic in their efforts to purchase services.

The continued advancement of evidenced-based approaches coupled with the focus on quality and 

outcomes of care require states to rethink what services they purchase as well as how those services are 

purchased. Value-based purchasing contracts are rapidly replacing both grant-based and fee-for-service 

as a means of procuring prevention, treatment, and recovery support services. Although access to 

Medicaid and private insurance has increased, certain gaps in coverage remain for specific populations 

and services

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. SMHAs and SSAs need to continue to identify which populations and services are

covered by various coverage options available through the Marketplaces, Medicaid and other payers. 

Secondly, within the different insurance packages, states have to consider the extent to which specific

mental or substance use disorder (M/SUD) services will remain uncovered. To identify gaps in the

continuum of services, SMHAs and SSAs will need to determine what specific M/SUD services they

should cover in addition to or above what is covered by insurers and other payers. States will continue 

to expand their efforts to identify individuals in their systems that may qualify, but are not currently 

enrolled in the Children’s Health Insurance Plan (CHIP), Medicaid, and Medicare programs. 

Accordingly, states may want to look at outreach opportunities to enroll those qualified for these

programs, as well as Qualified Health Plans (QHPs) offered through Health Insurance Marketplaces or

other commercial insurance plans.

 

8 Census Bureau American Community Survey statistics http://www.census.gov/newsroom/press-releases/2016/cb16-159.html
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The block grant authorizing legislation and implementing regulations prohibit the provision of financial 

assistance to any entity other than a public or nonprofit entity and require that the funding be used only 

for authorized activities.

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 In response to the issue raised in several states of the impact of high 

deductibles on access to services, SAMHSA has released guidance to the states on these issues. 

SAMHSA Guidance on the use of block grant funding for co-pays, deductibles, and premiums can be 

found at http://www.samhsa.gov/sites/default/files/grants/guidance-for-block-grant-funds-for-costsharing-assistance-for-private-health-insurance.pdf. States that choose to do this will need to develop 

specific policies and procedures for ensuring compliance with this guidance. 

States leverage their block grant funding and strive to diversify funding sources. 

When developing strategies for purchasing services, SMHAs and SSAs should identify other state and

federal sources available to purchase services. States should assist providers in the development of

better financial strategies that will allow providers to be less dependent on SMHA and SSA funding

only. Funding available from the Centers for Medicare & Medicaid Services (CMS), such as CHIP, 

Medicaid, and Medicare may play an important role in the states’ financial strategy. There are also 

national demonstration projects and programs (e.g., Health Homes, Clinical Practice Transformation, 

Innovation Accelerator Program, State Innovation Models, Comprehensive Community Behavioral 

Health Centers, and Financial Alignment Initiative for Medicare-Medicaid Enrollees) that support 

efforts to provide behavioral health services. In addition, behavioral health services supported through 

the Health Resources and Services Administration (HRSA) must be considered as states develop these

strategies. For example, HRSA has significantly expanded access to health and behavioral health 

services through its Health Center Program. HRSA has also made available funding and other 

opportunities to increase and enhance the quality of the behavioral health workforce (e.g., National

Health Service Corps, training grants, etc.). Both TRICARE and the Department of Veterans’ Affairs 

(VA) have enhanced their behavioral health services as well. This means that SMHAs and SSAs (as 

well as public health authorities responsible for prevention) will need to engage and collaborate with 

these partners at the federal, state and community levels. Persons eligible for such services should be 

assisted in accessing these services as appropriate.

States think more broadly about their impact on special populations that they have historically served 

through federal block grants and other funding.

In addition to populations currently targeted for the block grants, other populations have evolving needs 

that may be addressed. These populations include military families, youth who need substance use

disorder services, individuals who experience trauma, increased numbers of individuals diverted or

released from correctional facilities, diverse racial and ethnic minority groups, American Indians and 

Alaska Natives, and LGBT individuals.

The context of service delivery has also significantly changed. Services should be delivered in a manner

that promotes recovery and resiliency. Individuals who have lived experiences with M/SUD are playing 

an increasingly important role in the delivery of recovery-oriented systems of care. Services should take

into account culturally specific services for racial and ethnic minorities. Services should also address 

the unique needs of tribal populations and the role of tribal governments in planning and delivering

services. 

 

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http://www.samhsa.gov/grants/block-grants/laws-regulations
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The use of technologies may support better access to services, especially those more likely to be 

comfortable with these new technologies. Advances in technology have changed significantly since 

SAMHSA’s inception in 1992. Technology is playing a growing role in how individuals learn about, 

receive, and experience their health care services. Interactive Communication Technologies (ICT) are

being used more frequently to deliver various health care and recovery support services by providers and 

to report health information and outcomes by individuals. 

States continue to design and develop collaborative plans for health information systems. Health care

payers will seek to promote electronic health records (EHR) and interoperable health information 

technology (HIT) systems that allow for the effective exchange and use of health data.

The Health Information Technology for Economic and Clinical Health (HITECH) Act place strong 

emphasis on the widespread adoption and implementation of EHR technology. Accordingly, all 

SAMHSA grantees that provide services to individuals are encouraged to demonstrate ongoing clinical 

use of a certified EHR system. A certified EHR is an electronic health record system that has been 

tested and certified by an approved Office of the National Coordinator (ONC) certifying body.

Providers of M/SUD services should adopt HIT and systems that meet the standards and certifications 

required for interoperable health information technology as issued by the Office of the National 

Coordinator for Health Information Technology (ONC)[1]. In addition to meeting common standards 

and certification, these systems should support the privacy and security of patient information across all 

HIT technologies. Such systems should be used to collect information on provider characteristics, client 

enrollment, demographics, and treatment. Current laws will require these systems to comply with 

national standards such as national provider numbers, International Classification of Diseases (ICD-10), 

Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT), normalized names for clinical 

drugs (RxNorm), Logical Observation Identifiers Names and Codes (LOINC), and Current Procedural 

Terminology (CPT)/Healthcare Procedure Coding System (HCPCS) codes. The information technology

systems will also have to be interoperable with providers across the continuum of care, as well as health 

information exchanges (HIE), health information organizations (HIOs), and payers (e.g., Medicaid, 

Medicare, and private insurance plans, etc.). SAMHSA believes it is important for public behavioral 

health purchasers to continue to collaborate and discuss system interoperability, electronic health 

records, federal information technology requirements, and other related matters. Additional information 

can be found at https://www.samhsa.gov/health-information-technology (SAMHSA) and 

https://www.healthit.gov/ (ONC).

States continue to form strategic partnerships to provide individuals with access to effective and 

efficient service systems.

SAMHSA seeks to enhance the abilities of SMHAs and SSAs to be full partners in implementing and 

enforcing MHPAEA and delivery of health system reform in their states. In many respects, successful 

implementation is dependent on leadership and collaboration among multiple stakeholders. The

relationships among the SMHAs, SSAs, and the state Medicaid directors, insurance commissioners, 

prevention agencies, child-serving agencies, education authorities, justice authorities, public health 

authorities, and HIT authorities are integral to the effective and efficient delivery of services. These

collaborations will be particularly important in the areas of Medicaid, data and information management 
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and technology, professional licensing and credentialing, consumer protection, and workforce

development.

On October 18, 2016, the Office of the Assistant Secretary for Health (OASH) released its report, Public 

Health 3.0: A Call to Action to Create a 21st Century Public Health Infrastructure. Public Health 3.0 

(PH3) is a significant upgrade in public health practice to a modern version that emphasizes crosssectorial environmental, policy- and systems- level actions that directly affect the social determinants of 

health. SAMHSA and OASH are encouraging all public health authorities to adopt Public Health 

Accreditation Board (PHAB) criteria. Further, public health department accreditation should be 

enhanced and supported to best foster Public Health 3.0 principles, as we strive to ensure that every 

person in the United States is served by nationally accredited health departments

State authorities focus their system goals on recovery.

People can and do recover from mental and substance use disorders, and services and supports must 

foster individual and family capacity for self-directed recovery. Recovery benefits both the individual 

with a behavioral health condition and the community, leading to a healthier and more productive

population. SAMHSA is committed to assisting states, providers, and people with M/SUD, families, 

and others in promoting recovery.

State authorities continue to monitor the coverage of behavioral health services offered by QHPs and 

Medicaid to ensure that individuals with behavioral health conditions have adequate coverage and 

access to services. 

Some states have contracted with managed care organizations (MCO) or Administrative Services 

Organizations (ASO) to oversee and provide behavioral health services. State legislatures, state-based

Marketplace entities, and state insurance commissioners have developed policies and regulations related 

to Electronic Handbooks. SMHAs and SSAs should be involved in these efforts to ensure that M/SUD

services are appropriately included in plans, and that M/SUD providers are included in networks. 

States continue to make primary substance use disorder prevention a priority.

To respond to the primary prevention set-aside requirement of the SABG, states should keep in mind 

that the backbone of a prevention system is an infrastructure with the ability to collect and analyze

epidemiological data on substance use and its associated consequences. The system must also be able to 

use this data to identify areas of greatest need, and to identify, implement, and evaluate evidence-based 

programs, practices, and policies that have the ability to reduce substance use and improve health and 

well-being in all communities.

State authorities are strategic in leveraging scarce resources to fund prevention services.

States need to make the most efficient use of funds for substance use disorder prevention and be

prepared to report on the outcomes of these efforts. This means that state-funded prevention providers 

will need to be able to collect data and report this information to the state. With limited resources, states 

should also look for opportunities to leverage different streams of funding to create a coordinated datadriven substance use disorder prevention system. Specifically, SAMHSA recommends that states align

the 20 percent set-aside for primary prevention of the SABG with other federal, state, and local funding

that will aid the state in developing and maintaining a comprehensive substance use disorder prevention 

system, as well as collaborate with and assure that behavioral health is part of the state’s larger public 
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health prevention activities.

State authorities monitor the Marketplace to ensure that individuals with behavioral health conditions 

are aware of their eligibility, able to enroll, and able to remain enrolled.

State legislatures, state-based Marketplace entities, and state insurance commissioners have developed

policies and regulations related to the coordination between the Marketplace, Medicaid, and CHIP. This 

includes the role that community-based organizations will play in providing outreach and enrollment 

assistance. SMHAs and SSAs should be involved in these efforts to ensure that outreach and enrollment 

assistance is available to help individuals with M/SUD who may not have or who may lose their 

coverage. Historically, individuals who have the most difficulty navigating the public health insurance

eligibility determination and enrollment process have disproportionately high rates of behavioral health 

conditions.

State authorities use evidence of improved performance and outcomes to support their funding and 

purchasing decisions.

SMHAs and SSAs are well positioned to understand and use the evidence regarding various behavioral 

health services as critical input for making purchasing decisions and influencing coverage offered in 

their state through commercial insurers and Medicaid. In addition, states may also be able to use this 

information to educate policymakers and to justify their budget requests or other strategic planning 

efforts. States may also want to consider undertaking a similar process within their state to review local 

programs and practices that expand treatment technologies and show promising outcomes. 

State authorities ensure that they comport with changes in quality reporting.

The National Behavioral Health Quality Framework (NBHQF) provides a mechanism for states to 

examine, prioritize, and report on approaches to prevention, treatment, and recovery processes through 

the block grant as well as discretionary and formula grantees. In addition to this tool, SAMHSA has

been working with states and state representative organizations to identify and implement a core set of

measures, which include approved quality measures to assess outcomes and quality in programming. 

This effort has sought to both guide and align the measurement requirements of other major service

purchasers, such as Medicaid and Medicare, and thus facilitate efficiencies in state reporting of

behavioral health quality measures to federal entities. It is anticipated that once implemented, states will 

develop an implementation plan – both general to all states and unique to their particular state –

regarding the specifics and realities of how these measures are being collected and reported, as well as 

how this effort is being coordinated with required reporting activities from Medicaid, Medicare, and 

other public payers. SAMHSA’s collaboration with CMS on the Program for Certified Community 

Behavioral Health Clinics (223) project10 that represents a significant stride toward enhanced inclusion 

of quality measures in SAMHSA programming that is expected to continue and grow for the future data 

collection efforts. 

States authorities monitor implementation status and activities under the federal parity law to ensure 

that individuals with behavioral health conditions are receiving the mandated coverage and access.

 

10 http://www.samhsa.gov/section-223
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Plans and issuers subject to MHPAEA

11 that offer M/SUD coverage as part of the overall health benefits 

packages must comply with the requirements regarding coverage of M/SUD benefits in relation to 

medical/surgical benefits. Parity requires that the plans that offer M/SUD benefits do so at the same 

level of benefit as for physical conditions; it does not require a plan to offer M/SUD benefit. M/SUD

services are among the ten categories of service elements that serve as components of the essential 

health benefits package that are offered. Whether it is federal- or state-level parity, continued efforts for

education are instrumental in increasing awareness of the benefits of mental health and addiction 

services and open the door to appropriate services, especially for potential first-time users. Some states 

have taken steps to enforce parity, and are building on lessons learned. This active involvement to 

increase awareness helps to ensure that consumers receive quality behavioral health prevention, 

treatment, and recovery services within their state and are aware of what protections and resources exist 

in their state should their claim be denied inappropriately by insurance companies.

State authorities are key players in behavioral health integration activities.

Strong partnerships between SMHAs and SSAs and their counterparts in health, public health, and 

Medicaid are essential for successful coordinated care initiatives. While the State Medicaid Authority 

(SMA) is often the lead on a variety of care coordination initiatives, SMHAs and SSAs are essential 

partners in designing, implementing, monitoring, and evaluating these efforts. SMHAs and SSAs are in 

the best position to offer their Medicaid partners information regarding the most effective care

coordination models, connect current providers that have effective models, and assist with training or

retraining staff to provide care coordination across prevention, treatment, and recovery activities.

SMHAs and SSAs can also assist the Medicaid agency in messaging the importance of the various 

coordinated care initiatives and the system changes that may be needed for success with their integration 

efforts. The collaborations will be critical among behavioral health entities and comprehensive primary

care provider organizations, such as maternal and child health clinics, community health centers, Ryan

White HIV/AIDS CARE Act providers, and rural health organizations. SMHAs and SSAs can assist 

SMAs with identifying principles, safeguards, and enhancements that will ensure that this integration 

supports key recovery principles and activities such as person-centered planning and self-direction. 

Specialty, emergency and rehabilitative care services, and systems addressing chronic health conditions 

such as diabetes or heart disease, long-term or post-acute care, and hospital emergency department care 

will see numerous behavioral health issues among the persons served. SMHAs and SSAs should be 

collaborating to educate, consult, and serve patients, practitioners, and families seen in these systems. 

The full integration of community prevention activities is equally important. Other public health issues

are impacted by behavioral health issues and vice versa. States should assure that the behavioral health 

system is actively engaged in these public health efforts.

In addition, states play a key role in developing strategies for reducing smoking among individuals with 

a behavioral health condition. States should strongly consider implementing strategies for reducing

smoking, including moving towards tobacco-free behavioral health facilities and grounds, and screening, 

referring, and/or treating tobacco use.

Population changes in many states have created a demographic imperative to focus on improving 

 

11 http://www.samhsa.gov/health-financing/implementation-mental-health-parity-addiction-equity-act
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M/SUD prevention, treatment, and recovery for diverse populations with the goal of reducing 

disparities.

States are increasingly recognizing the value in addressing health disparities, realizing that failure to take

action results in continued excess costs and spending and lost lives. States have developed plans to 

address these disparities through incentives in health insurance plans, training initiatives and 

requirements for language access, targeted quality improvement and cost containment plans, cost and 

impact estimates for the most vulnerable populations, and tracking mechanisms to evaluate progress in 

improving health equity

12

. Few of these plans, however, have focused specifically on behavioral health. 

SSAs and SMHAs need to better track access, service use, and outcomes for these subpopulations to 

develop targeted outreach, engagement, enrollment, and intervention strategies to reduce such

disparities.

State authorities are encouraged to implement, track, and monitor recovery-oriented, quality behavioral 

health services.

The four dimensions of recovery:

1. Health: overcoming or managing one’s disease(s) or symptoms — for example, 

abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an 

addiction problem — and for everyone in recovery making informed and healthy choices 

that support physical and emotional wellbeing.

• Promote treatment, health and recovery-support services for individuals with mental 

and/or substance use disorders.

• Promote health, wellness, and resiliency.

• Promote recovery-oriented service systems.

• Engage individuals in recovery and their families in self-directed care, shared 

decision-making and person-centered planning.

• Promote self-care alternatives to traditional care, where appropriate.

2. Home: a stable and safe place to live.

 

• Ensure that supported independent housing and recovery housing are available for

individuals with mental and/or substance use disorders.

• Improve access to mainstream benefits, housing assistance programs, and supportive

services for people with mental and/or substance use disorders.

• Build leadership, promote collaborations, and support the use of evidence-based 

practices related to permanent supportive housing and recovery housing.

• Increase knowledge of the behavioral health field about housing and homelessness 

among people with mental and/or substance use disorders.

3. Purpose: meaningful daily activities, such as a job, school, volunteerism, family 

caretaking, or creative endeavors, and the independence, income, and resources to 

 

12 http://www.samhsa.gov/behavioral-health-equity
OMB Approval # 0930-0168

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participate in society.

• Increase gainful employment and educational opportunities for individuals with or in 

recovery from mental and/or substance use disorders.

• Increase the proportion of individuals with mental and/or substance use disorders who 

are gainfully employed and/or participating in self-directed educational endeavors.

• Develop employer strategies to address national employment and education 

disparities among people with identified behavioral health problems.

• Implement evidence-based practices related to employment and education for

individuals with mental and/or substance use disorders.

4. Community: relationships and social networks that provide support, friendship, love, 

and hope.

• Promote peer support and the social inclusion of individuals with or in recovery from 

mental and/or substance use disorders in the community.

• Increase the number and quality of consumer/peer recovery support specialists 

and consumer-operated/peer run recovery support service provider organizations.

• Promote the social inclusion of people with mental and/or substance use disorders.

These elements - health, home, purpose, and community - are central to recovery from mental 

and substance use disorders. Treatment and formal and informal recovery support services are 

critical to attain and maintain recovery. 

State authorities ensure that their states have a system of care approach to children and adolescents’

M/SUD services.

The success of the systems of care approach has shown that interagency coordination centered on

serving the unique needs of children, youth, and families is critical. Facilitating and sustaining this 

approach at the local level requires a parallel effort at the state level. As states adopt a system of care

approach, they should address state policies that can support local efforts, identifying financing

mechanisms, and enabling a family and youth input to policy at the state level. In addition to 

identifying the resources needed for services, states will need to develop a realistic planning process for

enabling systems of care in their states that includes the necessary staff time and administrative

resources.

C. Block Grant Programs’ Purposes

SAMHSA’s MHBG and SABG provide states with the flexibility to design and implement activities and 

services to address the complex needs of individuals, families, and communities impacted by substance

use disorders and for adults with SMI and children with SED. The purposes of the block grant programs 

support these service needs and are consistent with SAMHSA’s vision for a high-quality, self-directed, 

and satisfying life.

In order to assure that the block grant program continues to support the needed and necessary services, 

SAMHSA has indicated that the block grants be used:

1. To fund priority treatment and support services for individuals without insurance or for whom
OMB Approval # 0930-0168

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coverage is terminated for short periods of time;

2. To fund those priority treatment and support services not covered by C H I P , Medicaid,

Medicare, or private insurance for low-income individuals and that demonstrate success in

improving outcomes and/or supporting recovery;

3. For SABG funds, to fund primary prevention: universal, selective, and indicated prevention

activities and services for persons not identified as needing SUD treatment; and

4. To collect performance and outcome data to determine the ongoing effectiveness of 

promotion/SUD prevention, treatment and recovery supports and to plan the implementation of 

new services.

II. SUBMISSION OF APPLICATION AND PLAN TIMEFRAMES

Statutory Deadlines

While the statutory deadlines and block grant award periods remain unchanged, SAMHSA encourages 

states to turn in their application as early as possible to allow for a full discussion and review by 

SAMHSA. Applications for the MHBG are due no later than September 1, 2017. The applications for 

SABG are due no later than October 1, 2017. Single applications for MHBG and SABG are due no later 

than September 1, 2017. MHBG and SABG Reports are due December 1, 2017. In addition, for the 

SABG, the Annual Synar Report is due no later than December 31, 2017

The FFY 2018-2019 MHBG and SABG application(s) include(s) a two-year Behavioral Health Systems 

Assessment and Plan (Plan) as well as projected expenditure tables, certifications and assurances. The

Plan will cover a two-year period aligning with states’ FY budget cycle for SFY 2018/19. States will 

have the option, but will not be required to amend their Plans when they submit their FFY 2019

application. 

States should submit their respective MHBG and SABG application(s) for FFYs 2018 and 2019 based 

on the guidance provided in this document. The Plan provides a consistent framework for SMHAs and 

SSAs to assess the strengths and needs of their systems and to plan for system improvement, which is 

consistent with the strategic planning framework currently used by SAMHSA for various grants. The

unique statutory and regulatory requirements of the specific block grants are described in the State Plan 

section.

The FFY 2018-2019 Plan seeks to collect information from states regarding their activities in response to 

federal laws, initiatives, changes in technology, and advances in research and knowledge. The FFY 2018-

2019 Plan has sections that are required and other sections where additional information is requested but 

not required. The requested information is necessary for a full understanding of the state system of care 

design and development and provides a benefit to both the states and SAMHSA. There will be no 

penalty assessed to states that provide only that information that is required.

Required Sections and Tables

The FFY 2018-2019 application requires states to submit a face sheet; a table of contents; a behavioral 

health assessment and plan;, expenditure, performance, and utilization reports; , executive summary; and 

funding agreements, assurances, and certifications. In addition, SAMHSA is requesting information on 

key focus areas that are critical to implementation of provisions related to improving the quality of life 
OMB Approval # 0930-0168

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for individuals with behavioral health disorders. States are strongly encouraged to respond to each 

section so that SAMHSA understands the totality of states’ efforts and how the block grant funding fits 

into the states’ overall goals and constraints. The requested sections also help SAMHSA tailor technical 

assistance to best assist states to achieve their goals. Section III.B, Planning Steps, requires states to 

undertake a needs assessment as part of their plan submission. This section identifies four key steps: (1) 

assess the strengths and needs of the service system; (2) identify unmet service needs and critical gaps; 

(3) prioritize state planning activities to include the required target populations and other priority 

populations (e.g. youth with substance use disorders); and (4) develop goals, objectives, strategies, and 

performance indicators. Section III.B, Plan Table 1 (Priority Area and Annual Performance Indicators) 

and Plan Table 2 (State Agency Planned Expenditure) and Plan Table 6 (Non-Direct Services/System 

Development Activities Planned Expenditures) are required for both MHBG and SABG. For the SABG, 

Plan Table 3 (SABG Persons in need/receipt of treatment), Table 5a and/or Table 5b (SABG Primary 

Prevention Planned Expenditures), are also required. 

The application requests information on state efforts on certain policy, program, and technology

advancements in physical and M/SUD prevention, treatment, and recovery. This information will help 

SAMHSA understand the whole of the applicant state’s efforts and identify how SAMHSA can assist 

the applicant state in meeting its goals. In addition, this information will identify states that are models 

and assist other states with areas of common concern. 

Application Requirements and Award

For the Secretary of HHS, acting through the Assistant Secretary of Mental Health and Substance Use, 

to make an award under the programs involved, states must submit an application(s) sufficient to meet 

the requirements described in the authorizing legislation and implementing regulations sufficient for 

SAMHSA to monitor the states’ compliance efforts regarding the obligation and expenditure of MHBG 

and SABG funds. The funds awarded will be available for obligation and expenditure

13 to plan, carry

out, and evaluate activities and services for children with SED and adults with SMI; substance use 

disorder prevention; youth and adults with a SUD; adolescents and adults with co-occurring disorders; 

and the promotion of recovery among persons with SED, SMI, or SUD.

A grant may be awarded only if a state’s application(s) include(s) a State Plan

14 15

in the proper format 

containing information including, but not limited to, detailed provisions for complying with each

funding agreement for a grant under section 1911 of Title XIX, Part B, Subpart I of the PHS Act (42 

U.S.C. § 300x-1) or section 1921 of Title XIX, Part B, Subpart II of the PHS Act (42 U.S.C. § 300x21) that is applicable to a state. The State Plan must include a description of the manner in which the

state intends to obligate the grant funds, and it must include a report

16 in the proper format containing

information that the Secretary determines to be necessary for securing a record and description of the

purposes for which both the MHBG and SABG were expended. States have the option of updating

 

13 Title XIX, Part B of the PHS Act, http://www.samhsa.gov/grants/block-grants/laws-regulations

14 Section 1912 of Title XIX, Part B, Subpart I of the PHS Act (42 U.S.C. § 300x-2), http://www.samhsa.gov/grants/block-grants/lawsregulations

15Section 1932(b) of Title XIX, Part B, Subpart II of the PHS Act (42 U.S.C. § 300x-32(b)), http://www.samhsa.gov/grants/blockgrants/laws-regulations

16 Section 1942(a) of Title XIX, Part B, Subpart III of the PHS Act (42 U.S.C. § 300x-52(a)), http://www.samhsa.gov/grants/blockgrants/laws-regulations
OMB Approval # 0930-0168

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their plans during the two year planning cycle.

States are encouraged to submit a combined MHBG and SABG application. If a state is submitting

separate MHBG and SABG plans, it should clarify which system is being described in this section (e.g., 

mental health, substance misuse prevention, SUD treatment, or recovery).

III. BEHAVIORAL HEALTH ASSESSMENT AND PLAN

SAMHSA values the importance of a thoughtful planning process that includes the use of available data

to identify the strengths, needs, and service gaps for specific populations. By identifying needs and

gaps, states can prioritize and establish tailored goals, objectives, strategies, and performance indicators. 

In addition, the planning process should provide information on how the state will specifically spend 

available block grant funds consistent with the statutory and regulatory requirements, environment, and 

priorities described in this document and the priorities identified in the state’s plan.

Quality and Data Collection Readiness

Health surveillance is critical to SAMHSA’s ability to develop new models of care to address M/SUD. 

SAMHSA provides decision makers, researchers and the public with enhanced information about the 

extent of M/SUDs, how systems of care are organized and financed, when and how to seek help, and 

effective models of care, including the outcomes of treatment engagement and recovery. SAMHSA also 

provides Congress and the nation reports about the use of block grant and other SAMHSA funding to 

impact outcomes in critical areas, and is moving toward measures for all programs consistent with 

SAMHSA’s NBHQF. The effort is part of the congressionally mandated National Quality Strategy 

(NQS) to assure health care funds - public and private - are used most effectively and efficiently to create 

better health, better care, and better value. The overarching goals of this effort are to ensure that services 

are evidence-based and effective or are appropriately tested as promising or emerging best practices; they 

are person/family-centered; care is coordinated across systems; services promote healthy living; and, they 

are safe, accessible, and affordable. 

SAMHSA is currently working to harmonize data collection efforts across discretionary programs and 

match relevant NBHQF and NQS measures that are already endorsed by the National Quality Forum 

(NQF) wherever possible. SAMHSA is also working to align these measures with other efforts within 

HHS and relevant health and social programs and to reflect a mix of outcomes, processes, and costs of 

services. Finally, consistent with HHS priorities, these efforts will seek to understand the impact that 

disparities have on outcomes.

The key to accomplishing tasks associated with data collection for the block grant will be SAMHSA’s

collaboration with the National Association of State Mental Health Program Directors (NASMHPD), the 

National Association of State Alcohol Drug Abuse Directors (NASADAD), and other state and 

community partners. SAMHSA recognizes the significant implications of any modifications or changes 

to data collection and reporting for local service providers and state agencies. This collaboration has 

resulted in a clarified description of the non-direct services/system support expenditures from the block 

grants. Similar discussions about reporting of direct services will be undertaken as we move forward.

Meaningful input of stakeholders in the development of the plan is critical. Evidence of the process and 

input of the Planning Council required by section 1914(b) of the PHS Act (42 U.S.C. § 300x-4(b)) for

the MHBG must be included in the application that addresses MHBG funds. States are also encouraged 
OMB Approval # 0930-0168

15

to expand this Planning Council to include prevention and substance use disorder stakeholders and use

this mechanism to assist in the development of the state block grant plan for the SABG application. 

States must also describe the stakeholder input process for the development of both the SABG plan and 

the MHBG plan, as mandated by section 1941 of the PHS Act (42 U.S.C.§ 300x-51), which requires that 

the state block grant plans be made available to the public in such a manner as to facilitate public 

comment during the development of the plan (including any revisions) and after the submission of the

plan to the Secretary through SAMHSA. This description should also show involvement of persons 

who are service recipients and/or in recovery, families of individuals with M/SUD, providers of services

and supports, representatives from racial and ethnic minorities, LGBTQ populations, persons with coexisting disabilities, and other key stakeholders. Evidence of meaningful consultation with federally

recognized tribes where tribal governments or lands are located within the boundaries of the state are 

strongly encouraged for both MHBG and SABG.

A. Framework for Planning—Mental Health and Substance Use Prevention and Treatment

States should identify and analyze the strengths, needs, and priorities of the state’s behavioral health 

system. The strengths, needs, and priorities should take into account specific populations that are the

current focus of the block grants, the changing health care environment, and SAMHSA’s Strategic

Initiatives. 

The MHBG program is designed to provide comprehensive community mental health servicesto adults

with SMI or children with SED. For purposes of block grant planning and reporting, SAMHSA has 

clarified the definitions of SED and SMI. States may have additional elements that are included in their 

specific definitions, but the following provides a common baseline definition. Children with SED refers 

to persons from birth to age 18 and adults with SMI refers to persons age 18 and over; who (1) currently 

meet or at any time during the past year has met criteria for a mental disorder – including within 

developmental and cultural contexts – as specified within a recognized diagnostic classification system 

(e.g., most recent editions of DSM, ICD, etc.), and (2) display functional impairment, as determined by 

a standardized measure that impedes progress towards recovery and substantially interferes with or 

limits the person’s role or functioning in family, school, employment, relationships, or community 

activities.

Section 1912(b) of the Public Health Act (42 USC § 300x-2) establishes five criteria that must be 

addressed in state mental health plans. States must describe these in the planning steps. The criteria are 

defined below:

 Criterion 1: Comprehensive Community-Based Mental Health Service Systems: Provides for 

the establishment and implementation of an organized community-based system of care for 

individuals with mental illness, including those with co-occurring M/SUD. States must have 

available services and resources within a comprehensive system of care, provided with federal, 

state, and other public and private resources, in order to enable such individuals to function 

outside of inpatient or residential institutions to the maximum extent of their capabilities. 

 Criterion 2: Mental Health System Data Epidemiology: Contains an estimate of the incidence 

and prevalence in the state of SMI among adults and SED among children; and have 

quantitative targets to be achieved in the implementation of the system of care described under 

Criterion 1. 
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 Criterion 3: Children’s Services: Provides for a system of integrated services in order for 

children to receive care for their multiple needs. Services that should be integrated into a 

comprehensive system of care include: social services; educational services, including services 

provided under IDEA; juvenile justice services; substance abuse services; and health and 

mental health services.

 Criterion 4: Targeted Services to Rural and Homeless Populations and to Older Adults:

Provides outreach to and services for individuals who experience homelessness; communitybased services to individuals in rural areas; and community-based services to older adults.

 Criterion 5: Management Systems: States describe their financial resources, staffing, and 

training for mental health services providers necessary for the plan; provides for training of 

providers of emergency health services regarding SMI and SED; and how the state intends to 

expend this grant for the fiscal years involved.

States must submit a plan on how they will utilize the 10 percent set-aside funding to support appropriate 

evidence-based programs for individuals with Early Serious Mental Illness (ESMI) including psychosis. 

If a state chooses to submit a plan to utilize the set-aside for evidence-based services other than the 

services/principles components of Coordinated Specialty Care (CSC) approach developed via the 

Recovery After an Initial Schizophrenia Episode (RAISE) initiative, SAMHSA will review the plan with 

the state to assure that the approach proposed meets the understanding of an evidence-based approach. In

consultation with National Institute of Mental Health (NIMH), as needed, either the proposals will be

accepted or requests for modifications to the plan will be discussed and negotiated with the state. This 

initiative also includes a plan for program evaluation and data collection related to demonstrating 

program effectiveness. Additional technical assistance and guidance on the expectations for evaluation, 

data collection and reporting will follow. Please note that the MHBG funds cannot be used for primary 

prevention or preventive intervention for those at risk of SMI or SED.

The SABG program provides substance use disorder prevention, SUD treatment and recovery services,

(and certain related activities) to at-risk individuals or persons in need of SUD treatment. See 42 U.S.C. 

§§ 300x-300x-66. 

Section 1921 of the PHS Act (42 U.S.C.§ 300x-21) authorizes the States to obligate and expend SABG 

funds to plan, carry out and evaluate activities and services designed to prevent and treat substance use 

disorders. Section 1932(b) of the PHS Act (42 U.S.C. § 300x-32(b)) established the criterion that must 

be addressed in the State Plan. 

 Criterion 1: Statewide Plan for Substance Use Disorder Prevention, Treatment and Recovery 

Services for Individuals, Families and Communities (42 U.S.C. § 300x-21 and 45 CFR § 96.122) 

 Criterion 2: Primary Prevention (42 U.S.C. § 300x-22(a) and 45 CFR § 96.125). The authorizing 

legislation and implementing regulation established a 20 percent set-aside for primary prevention 

programs, defined as programs for individuals who do not require treatment for substance use 

disorders.

 Criterion 3: Pregnant Women and Women with Dependent Children (42 U.S.C. § 300x-22(b); 
OMB Approval # 0930-0168

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42 U.S.C. § 300x-27; 45 CFR § 96.124(c) (e); and 45 CFR § 96.131). The authorizing legislation 

and implementing regulation established a 5 percent set-aside that was applicable to the FFY

1993 and FFY 1992 SABG Notices of Award. For FFY 1994 and subsequent fiscal years, States

have been required to comply with a performance requirement that the States are required to 

obligate and expend funds for SUD treatment services designed for such women in an amount 

equal to the amount expended in FFY 1994. 

 Criterion 4: Persons Who Inject Drugs (42 U.S.C. § 300x-23 and 45 CFR § 96.126). The 

authorizing legislation and implementing regulation established two performance requirements 

related to persons who inject drugs: (1) Any programs that receive SABG funds to serve persons 

who inject drugs must comply with the requirement to admit an individual requesting admission 

to treatment within 14 days and not later than 120 days; and (2) outreach to encourage persons 

who inject drugs to seek SUD treatment Additionally, subject to the annual appropriation 

process, States may authorize such programs to obligate and expend SABG funds for elements of 

a syringe services program (SSP) pursuant to guidance developed by the HHS’ Office of 

HIV/AIDS an Infectious Disease Policy (OHIDP) .

 Criterion 5: Tuberculosis Services (42 U.S.C. § 300x-24(a) and 45 CFR § 96.127). The 

authorizing legislation and implementing regulation require any programs that receive SABG 

funds to, directly or through arrangements with other public and non-profit entities, routinely 

make available tuberculosis services to each individual receiving SUD treatment services. 

 Criterion 6: Early Intervention Services Regarding the Human Immunodeficiency Virus (42

U.S.C. § 300x-24(b) and 45 CFR § 96.128). The authorizing legislation and implementing 

regulation require designated States to set-aside five percent of the SABG to establish 1 or more 

projects to provide EIS/HIV at the site(s) at which individuals are receiving SUD treatment 

services.

 Criterion 7: Group Homes For Persons in Recovery from Substance Use Disorders (42 U.S.C. §

300x-25 and 45 CFR § 96.129). The authorizing legislation and implementing regulation provide 

states with the flexibility to establish and maintain a revolving loan fund for the purpose of 

making loans, not to exceed $4,000, to a group of not more than six individuals to establish a 

recovery residence. 

 Criterion 8: Referrals to Treatment (42 U.S.C. § 300x-28(a) and 45 CFR § 96.132(a) and 

Coordination of Ancillary Services (42 U.S.C. § 300x-28(c) and 45 CFR § 96.132(c). The 

authorizing legislation and implementing regulation require States to promote the use of 

standardized screening and assessment instruments and placement criteria to improve patient 

retention and treatment outcomes. 

 Criterion 9: Independent Peer Review (42 U.S.C. § 300x-58(a) (1) (A) and 45 CFR § 96.136). 

The authorizing legislation and implementing regulation require states to assess the quality, 

appropriateness, and efficacy of M/SUD treatment services. 

 Criterion 10: Professional Development (42 U.S.C. § 300x-28(b) and 45 CFR § 96.132(b) The 

authorizing legislation and implementing regulation requires any programs that receive SABG 
OMB Approval # 0930-0168

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funds to ensure that prevention, treatment and recovery personnel operating in the state’s 

substance use disorder system have an opportunity to receive training on an ongoing basis 

concerning recent trends in substance use in the state, improved methods and evidence-based 

practices for providing substance use disorder prevention and treatment services, performancebased accountability, data collection and reporting requirements, and any other matters that 

would serve to further improves the delivery of substance use disorder prevention and treatment 

services within the state. 

At a minimum, the plan should address the following populations as appropriate for each block grant

(*Populations that are marked with an asterisk are required to be included in the state’s needs 

assessment for the MHBG or SABG. To the extent that the other listed populations fall within any of the

statutorily covered populations, states must include them in the plan)

1. (MHBG) Comprehensive community-based mental health services for adults with SMI and

children with SED:

 Children with SED and their families*

 Adults with SMI*

 Older Adults with SMI*

 Individuals with SMI or SED in the rural and homeless populations, as applicable*

 Individuals who have an Early Serious Mental Illness (ESMI) (10 percent MHBG set aside)

2. (SABG) Services for persons with SMI/SED or persons with or at risk of having substance

use disorder:

 Persons who inject drugs *

 Adolescents with substance use and/or mental health problems

 Children and youth who are at risk for mental, emotional, and behavioral disorders, including, 

but not limited to, addiction, conduct disorder, and depression

 Women who are pregnant and have a substance use and/or mental disorder*

 Parents with substance use and/or mental disorders who have dependent children*

 Military personnel (active, guard, reserve, and veteran) and their families

 American Indians/Alaska Natives

3. (SABG) Services for persons with or at risk of contracting communicable diseases:

 Individuals with tuberculosis* and other communicable diseases

 Persons at risk for HIV/AIDS who may be unaware of the infection status and persons living 

with HIV/AIDS who are in need of mental health or substance use early intervention, 

treatment, or prevention services*17

 

17 For the purpose of determining the states and jurisdictions which are considered “designated states” as described in section 1924(b)(2) of 

Title XIX, Part B, Subpart II of the Public Health Service Act (42 U.S.C. § 300x-24(b)(2)) and section45 CFR § 96.128(b) of the Substance 

Abuse Prevention and Treatment Block Grant; Interim Final Rule (45 CFR 96.120-137),). SAMHSA relies on the HIV Surveillance Report 

produced by the CDC, National Center for HIV/AIDS, Hepatitis, STD, and TB Prevention. The HIV Surveillance Report, Volume 25, will 

be used to determine the states and jurisdictions that will be required to set-aside 5 percent of their respective FY 2016 SABG allotments to 

establish one or more projects to provide early intervention services for HIV at the sites at which individuals are receiving SUD treatment

services. In FY 2012, SAMHSA developed and disseminated a policy change applicable to the EIS/HIV which provided any state that was a 

“designated state” in any of the 3 years prior to the year for which a state is applying for SABG funds with the flexibility to obligate and 

expend SABG funds for EIS/HIV even though the state does not meet the AIDS case rate threshold for the fiscal year involved. Therefore, 

any state whose AIDS case rate is below 10 or more such cases per 100,000 and meets the criteria described in the 2012 policy guidance 

would be allowed to obligate and expend FY 2016 SABG funds for EIS/HIV if they chose to do so.
OMB Approval # 0930-0168

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 The National HIV/AIDS Strategy (NHAS) for the United States and NHAS

Implementation Plan 18

 Prevention of HIV among persons who inject drugs; substance use is associated with a

greater likelihood of acquiring HIV infection. HIV screening and other comprehensive

HIV prevention services should be coupled with SUD treatment programs 

4. Services for individuals in need of primary substance use disorder prevention *

5. In addition to the targeted/required populations and/or services required in statute, states are

encouraged to consider the following populations, and/or services:

 Individuals with mental and/or substance use disorders who are homeless or involved in the

criminal or juvenile justice systems

 Individuals with mental and/or substance use disorders who live in rural areas

 Underserved racial and ethnic minority and LGBT populations

 Persons with disabilities

 Community populations for environmental prevention activities, including policy changing

activities, and behavior change activities to change community, school, family, and business 

norms through laws, policy and guidelines and enforcement.

 Community settings for universal, selective and indicated prevention interventions, 

including hard-to-reach communities and “late” adopters of prevention strategies

In addition, states should consider linking their Olmstead planning work in the block grant application, 

identifying trend data on individuals who are needlessly institutionalized or at risk of

institutionalization. There is a need generally for data that will help the state address housing and 

related issues in their planning efforts. To the extent that such data is available in a state’s Olmstead 

Plan, it should be used for block grant planning purposes.

B. Planning Steps

For each of the populations and common areas, states should follow the planning steps outlined below:

Step 1: Assess the strengths and organizational capacity of the service system to address the specific 

populations.

Provide an overview of the state’s M/SUD prevention, early identification, treatment, and recovery

support systems, including the five criteria that must be addressed in state mental health plans. 

Describe how the public M/SUD system is currently organized at the state and local levels, 

differentiating between child and adult systems. This description should include a discussion of the

roles of the SMHA, the SSA, and other state agencies with respect to the delivery of M/SUD services. 

States should also include a description of regional, county, tribal, and local entities that provide

behavioral health services or contribute resources that assist in providing the services.

The description should also include how these systems address the needs of diverse racial, ethnic, and 

sexual gender minorities, as well as American Indian/Alaskan Native populations in the states.

 

18 http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf
OMB Approval # 0930-0168

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Step 2: Identify the unmet service needs and critical gaps within the current system.

This step should identify the unmet service needs and critical gaps in the state’s current behavioral

health system as well as the data sources used to identify the needs and gaps of the required populations 

relevant to each block grant within the state’s behavioral health system. Especially for those required 

populations described in this document and other populations identified by the state as a priority. This 

step should also address how the state plans to meet the unmet service needs and gaps.

A data-driven process must support the state’s priorities and goals. This could include data and 

information that are available through the state’s unique data system (including community-level data), as

well as SAMHSA’s data sets including, but not limited to, the National Survey on Drug Use and Health

(NSDUH), the Treatment Episode Data Set (TEDS), the National Facilities Surveys on Drug Abuse and 

Mental Health Services, the annual State and National Behavioral Health Barometers, and the Uniform 

Reporting System (URS). Those states that have a State Epidemiological and Outcomes Workgroup

(SEOW) should describe its composition and contribution to the process for primary prevention and 

treatment planning. States should also continue to use the prevalence formulas for adults with SMI and 

children with SED, as well as the prevalence estimates, epidemiological analyses, and profiles to establish

mental health treatment, substance use disorder prevention, and SUD treatment goals at the state level. In 

addition, states should obtain and include in their data sources information from other state agencies that

provide or purchase M/SUD services. This will allow states to have a more comprehensive approach to

identifying the number of individuals that are receiving services and the types of services they are

receiving.

SAMHSA’s Behavioral Health Barometer is intended to provide a snapshot of the state of behavioral 

health in America. This report presents a set of substance use and mental health indicators measured 

through two of SAMHSA’s populations- and treatment facility-based survey data collection efforts, the

NSDUH and the National Survey of Substance Abuse Treatment Services (N-SSATS) and other 

relevant data sets. Collected and reported annually, these indicators uniquely position SAMHSA to 

offer both an overview reflecting the behavioral health of the nation at a given point in time, as well as 

a mechanism for tracking change and trends over time. It is hoped that the National and State specific 

Behavioral Health Barometers will assist states in developing and implementing their block grant 

programs.

SAMHSA will provide each state with its state-specific data for several indicators from the Behavioral 

Health Barometers. States can use this to compare their data to national data and to focus their efforts 

and resources on the areas where they need to improve. In addition to in-state data, SAMHSA has 

identified several other data sets that are available to states through various federal agencies: CMS, the

Agency for Healthcare Research and Quality (AHRQ), and others. 

Through the Healthy People Initiative

19 HHS has identified a broad set of indicators and goals to track 

and improve the nation’s health. By using the indicators included in Healthy People, states can focus 

their efforts on priority issues, support consistency in measurement, and use indicators that are being

 

19 http://www.healthypeople.gov/2020/default.aspx
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tracked at a national level, enabling better comparability. States should consider this resource in their

planning.

Step 3: Prioritize state planning activities

Using the information in Step 2, states should identify specific priorities that will be included in the

MHBG and SABG. The priorities must include the core federal goals and aims of the MHBG and 

SABG programs: target populations (those that are required in legislation and regulation for each block 

grant) and other priority populations described in this document. States should list the priorities for the

plan in Plan Table 1 and indicate the priority type (i.e., substance use disorder prevention (SAP), 

substance use disorder treatment (SAT), or mental health services (MHS).

Step 4: Develop goals, objectives, performance indicators, and strategies

For each of the priorities identified in Step 3, states should identify the relevant goals, measureable 

objectives, and at least one-performance indicator for each objective for the next two years. 

For each objective, the state should describe the specific strategy that will be used to achieve the 

objective. These strategies may include developing and implementing various service-specific changes 

to address the needs of specific populations, substance abuse prevention activities, and system 

improvements that will address the objective. Strategies to consider and address include:

• Strategies that are targeted for children and youth with SED or substance use disorders. States

should use a system of care approach that has been well established for children with SED and cooccurring substance use disorders. This approach should be used state wide, coordinating care with 

other state agencies (e.g., schools, child welfare, juvenile justice, primary care, etc.) to deliver

evidence-based treatments and supports through a family-driven, youth-guided, culturally 

competent, individualized treatment plan. For adolescents with substance use disorders and SED, 

this approach should be used in conjunction with evidence-based interventions for substance use or

dependence.

• Strategies targeted for adults with SMI/SUDs that will identify and intervene early, connect 

with, or provide the best possible treatment, and design and implement recovery-oriented 

services.

• Strategies that will promote integration and inclusion into the community: This includes housing

models that integrate individuals into the community instead of long-term care facilities or nursing

homes and other settings that fail to promote independence and inclusion. This also can include

strategies to promote competitive and evidenced-based supported employment in the community,

rather than segregated programs.

• Strategies on how technology, especially interactive communication technologies (ICT) will be used 

to engage individuals and their families into treatment and recovery supports. Almost 40 percent of 

uninsured individuals are under the age of 30 and use technology as a substantial, if not primary, 

mode of communication. 
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• Strategies that result in developing recovery support services, e.g., permanent housing and 

supportive employment or education for persons with mental and substance use disorders. This 

includes how local authorities will be engaged to increase the availability of housing, 

employment, and educational opportunities, and how the state will develop services that will 

wrap around these individuals to obtain and maintain safe and affordable housing, employment, 

and/or education.

• Strategies that will enable the state to document the diversity of its service population and 

providers and to specify the development of an array of culture-specific interventions and 

providers to improve access, engagement, quality, and outcomes of services for diverse ethnic and 

racial minorities and LGBT populations. States will be encouraged to refer to the IOM reports, 

Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement

20 and

The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better 

Understanding21 in developing this strategy.

• Strategies that will build the state and provider capacity to provide evidence-based, trauma-specific

interventions in the context of a trauma-informed delivery system. Recognizing trauma as a critical 

factor in the development of mental and substance use disorders, states should build provider

competence in using effective trauma treatments. States should ensure that these treatments are 

provided in systems that understand the impact of trauma on their service population and work to 

eliminate organizational practices and policies that may cause new or exacerbate existing trauma. 

SAMHSA has developed “SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed 

Approach” to provide states with a framework for incorporation of trauma informed care into its 

system.

• Strategies that increase the use of person-centered planning, self-direction, and participant-directed 

care. This includes measures to help individuals or caregivers (when appropriate) identify and

access services and supports that reinforce recovery or resilience. These strategies should also 

include how individuals or caregivers have access to supports to facilitate participant direction, 

including the ability to manage a flexible budget to address recovery goals; identifying, selecting hiring 

and managing support workers and providers; and ability to purchase goods and services identified in the 

recovery or resilience planning process.

• As specified in 45 CFR § 96.125(b), states shall use a variety of evidence-based programs, policies 

and practices in their prevention efforts that include:

• Information dissemination;

• Education;

• Alternatives that decrease alcohol, tobacco, and other drug use;

• Problem identification and referral;

 

20 Institute of Medicine. (2009).Race, Ethnicity, and Language Data: Standardization for Healthcare quality Improvement. 

Subcommittee on Standardization Collection of Race/Ethnicity Data for Healthcare Quality Improvement, Board on Healthcare

Services. Cheryl Ulmer, Bernadette McFadden, and David R. Nerenz, Editors, Washington, DC: The National Academies Press

21 IOM (Institute of Medicine). 2011. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation 

for Better Understanding. Washington, DC: The National Academies Press.
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• Community based programming; and,

• Environmental strategies that establish or change written and unwritten community standards,

codes, and attitudes, thereby influencing incidence and prevalence of the abuse of alcohol, 

tobacco, and other drugs used in the general population

Prevention strategies should also be consistent with the IOM Report on Preventing Mental

Emotional and Behavioral Disorders, the Surgeon General’s Call to Action to Prevent and

Reduce Underage Drinking

22

, the National Registry of Evidenced-based Programs and Practices

(NREPP), and/or other materials documenting their effectiveness. These strategies include:

• Strategies that target tobacco use prevention and tobacco-free facilities that are supported by

research and encompass a range of activities including policy initiatives and programs;

• Strategies that engage schools, workplaces, and communities to establish programs and policies 

to improve knowledge about alcohol and other drug problems, denote effective ways to address 

the problems, and enhance resiliency.

• Strategies that implement evidence-based and cost-effective models to prevent substance

misuse in young people in a variety of community settings, e.g., families, schools, 

workplaces, and faith-based institutions, consistent with the current science;

• Strategies that follow the Surgeon General’s Call to Action to Prevention and Reduce 

Underage Drinking, developed in coordination with the Interagency Coordinating Committee

on the Prevention of Underage Drinking (ICCPUD) which focus on policy and environmental 

programming to change the community’s norms around, and parental acceptance of, underage

alcohol use; and

• Strategies that address harder-to-reach racial/ethnic minority and LGBT communities that 

experience a cluster of risk factors that make them especially vulnerable to substance use and 

related problems.

SABG primary prevention set-aside funds can only be used to fund strategies that prevent 

substance use. MHBG funds can only be used for prevention activities for adults with SMI and 

children with SED.

• System improvement activities may be included as a strategy to address issues identified in the

needs assessment. System improvement activities should:

• Allow states to position their providers to increase access, retention, adoption, or adaptation of

EHRs, or to develop strategies to increase workforce numbers. These system improvement 

activities should use federal and state resources currently available and those proposed for the

planning period to enhance the competency of the behavioral health workforce. System 

improvements that seek to expand the workforce should build upon existing efforts to increase 

 

22 http://store.samhsa.gov/product/Surgeon-General-s-Call-to-Action-to-Prevent-and-Reduce-Underage-Drinking/SGCTA-07
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M/SUD skill development in a wide range of professions as well as increase the role of people in 

recovery from mental and substance use disorders in the planning and delivery of services.

• Support providers to participate in networks that may be established through managed care or

administrative service organizations (including affordable care organizations (ACOs)). This 

may include assistance to develop the necessary infrastructure (e.g., electronic billing and 

EHRs) and reporting requirements to participate in these networks.

• Encourage the use of peer specialists or recovery coaches to provide needed recovery

support services, which are already delivered by volunteers and paid staff. Peers are

trained, supervised, and regarded as staff and operate out of a community-based or

recovery organization. A state’s strategy should allow states to support peer and other

recovery support services delivered under either model. The infrastructure, including paid 

staff, to coordinate and encourage the use of volunteer- delivered or run services should 

also be supported.

• Increase links between primary, specialty, emergency and rehabilitative care and behavioral 

health providers working with behavioral health provider organizations for expertise, 

collaboration, and referral arrangements, including the support of practitioner efforts to screen 

patients for mental and substance use disorders. Activities should also focus on developing

model contract templates for reciprocal health and behavioral health integration and identifying

state policies that present barriers to reimbursement. This would include efforts to implement 

dual eligible products, ACOs, and medical homes.

• Develop support systems to provide communities with necessary needs assessment information,

planning, technical assistance, evaluation expertise, and other resources to foster the

development of comprehensive community plans to improve mental, emotional, and behavioral 

health outcomes.

• Fund auxiliary aids and services to allow people with disabilities to benefit from the M/SUD

services and language assistance services for people who experience communication barriers to

access.

• Develop benefit management strategies for high-cost services (e.g., youth out of home services

and adult residential services). SAMHSA believes that states should align their care

management to guarantee that individuals get the right service at the right time in the right 

amount. These efforts should ensure that decisions made regarding these services are clinically

sound. 

Planning Tables

States should describe specific performance indicators that will be used to determine if the goals for

that priority area were achieved. For each performance indicator, the state must describe the data and 

data source that has been used to develop the baseline for FFY 2018 and how the state proposes to 

measure the change in FFY 2019. States must use the template (Plan Table 1: Priority Areas by Goal, 

Strategy, and Performance Indicators) below.
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Plan Table #1. Priority Area and Annual Performance Indicators

States should follow the guidelines presented above in Framework for Planning – Mental Health and 

Substance Use Disorder Prevention and Treatment Planning Steps to complete Plan Table 1. States are

to complete a separate table for each state priority area to be included in the MHBG and SABG. Please 

include the following information when entering into Web BGAS:

1. Priority area (based on an unmet service need or critical gap). After this information is

completed for the first priority area, another table will appear so additional priorities can be

added.

2. Priority type. From the drop-down menu, select SAP – substance use disorder prevention, 

SAT – substance use disorder treatment, or MHS -- mental health service.

3. Targeted/required populations. Indicate the population(s) required in statute for each block 

grant as well as those populations encouraged, as described in IIIA Framework for 

Planning—Mental Health and Substance Abuse Prevention and Treatment. States must 

include at least one priority for each required population. From the drop-down menu select:

a) SMI–Adults with SMI, 

b) SED–Children with an SED,

c) ESMI - Individuals with ESMI including psychosis

d) PWWDC–Pregnant women and women with dependent children,

e) PP – persons in need of primary substance use disorder prevention,

f) PWID–Persons who inject drugs (formerly known as intravenous drug users (IVDU),

g) EIS/HIV–Persons with or at risk of HIV/AIDS who are receiving SUD treatment 

services

a) TB–Persons with or at risk of tuberculosis who are receiving SUD treatment services, 

and/or

b) Other- Specify (Refer to section IIIA of the Assessment and Plan).

4. Goal of the priority area. Goal is a broad statement of general intention. Therefore, provide a

general description of what the state hopes to accomplish. 

5. Objective: Objective should be a concrete, precise, and measureable statement.

6. Strategies to attain the objective. Indicate state program strategies or means to achieve the stated 

objective.

7. Annual Performance Indicators to measure success on a yearly basis. Each indicator must reflect 

progress on a measure that is impacted by the block grant. After indicator is completed with the

information for the first indicator below, the table will expand to enter additional indicators. For

each performance indicator, specify the following components:

a) Baseline measurement from where the state assesses progress

b) First-year target/outcome measurement (Progress to the end of SFY 2018);
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c) Second-year target/outcome measurement (Final to the end of SFY2019);

d) Data source;

e) Description of data; and

f) Data issues/caveats that affect outcome measures.

Plan Table 1: Priority Area and Annual Performance Indicators

1. Priority Area: Priority Type (SAP, SAT, MHS):

3. Population(s) (SMI, SED, ESMI, PWWDC, PP, PWID, EIS/HIV, TB, OTHER): 

4. Goal of the priority area:

5. Objective:

6. Strategies to attain the objective:

7. Annual Performance Indicators to measure achievement of the objective:

Indicator #1:

a) Baseline measurement (Initial data collected prior to and during SFY 2018): 

b) First-year target/outcome measurement (Progress to the end of SFY 2018):

c) Second-year target/outcome measurement (Final to the end of SFY 2019):

d) Data source: 

e) Description of data:

f) Data issues/caveats that affect outcome measures:

SAMHSA will work with states to monitor whether they are meeting the goals, objectives and 

performance indicators established in their plans, and to provide technical assistance as needed. 

SAMHSA staff will work closely with states during the year to discuss progress, identify barriers, and 

develop solutions to address these barriers.

If a state is unable to achieve its goals and objectives as stated in its application(s) approved by

SAMHSA, the state will be asked to provide a description of corrective actions to be taken. If further

steps are not taken, SAMHSA may ask the state for a revised plan, which SAMHSA will assist in 

developing, to achieve its goals and objectives. States that do not choose to apply for the MHBG or 

SABG will have their funds redirected to other states as provided in statute.

23

 

23 http://www.samhsa.gov/grants/block-grants/laws-regulations
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Plan Table 2: State Agency Planned Expenditures 

States must project how the SMHA and/or the SSA will use available funds to provide authorized services for the planning period for 

state fiscal years 2018/2019.

Plan Table 2 State Agency Planned Expenditures 

(Include ONLY funds expended by the executive branch agency administering the SABG and/or the MHBG*)

Planning Period- From: To:

State Identifier:

Source of Funds

ACTIVITY

(See instructions for using Row 1.)

A. 

SABG

B.

MH BG 

C. Medicaid

(Federal, State, 

and local)

D. Other Federal 

Funds (e.g., ACF 

(TANF), CDC, CMS 

(Medicare) SAMHSA, 

etc.)

E. State 

funds

F. Local funds

(excluding local

Medicaid)

G. Other

1. Substance Abuse Prevention* and 

Treatment

a. Pregnant Women and Women 

with Dependent Children* $ $ $ $ $ $

b. All Other $ $ $ $ $ $

2. Primary Prevention** $ $ $ $ $ $ $

a. Substance Abuse Primary 

Prevention $ $ $ $ $ $

b. Mental Health Primary 

prevention*** $ $ $ $ $

3. Evidence-Based Practices for Early 

Serious Mental Illness (10 percent of total 

award MHBG)****

$ $ $ $ $ $

4. Tuberculosis Services $ $ $ $ $ $

5. Early Intervention Services for HIV $ $ $ $ $ $

6. State Hospital $ $ $ $ $

7. Other 24-Hour Care $ $ $ $ $ $

8. Ambulatory/Community Non-24 Hour 

Care

$ $ $ $ $ $

9. Administration (excluding program / 

provider level) MHBG and SABG

must be reported separately

$ $ $ $ $ $ $
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* Prevention other than primary prevention. 

**The 20 percent set aside funds in the SABG must be used for activities designed to prevent substance misuse.

***While a state may use state or other funding for these services, the MHBG funds must be directed toward adults with SMI or children with SED.

**** Column 3B should include Early Serious Mental Illness programs funded through MHBG set aside

Plan Table 3: SABG Persons in need/receipt of SUD treatment

Instructions to complete Table 3

In order to complete column B of the table, please refer to the most recent edition of SAMHSA’s National Survey on Drug Use and 

Health (NHSDUH) or other federal/state data that describes the populations of focus in rows 1-5.

In order to complete column C of the table, please refer to the most recent Treatment Episode Data Set (TEDS) data prepared and 

submitted to SAMHSA’s Behavioral Health Services Information System (BHSIS) contractor, Synectics for Management Decisions, 

Inc. (SMDI).

Please provide an explanation for any data cells for which the state does not have a data source. 

Plan Table 3 SABG Persons in need/receipt of SUD treatment

State Identifier:

Aggregate number estimated in need Aggregate number in treatment

1. Pregnant Women

2. Women with Dependent Children

3. Individuals with a co-occurring M/SUD 

4. Persons who inject drugs

5. Persons experiencing homelessness

10. Subtotal (Rows 1, 2, , 4, 5 and 9) $ $ $ $ $ $ $

11. Subtotal (Rows 3, 6, 7, and 8) $ $ $ $ $ $ $

12. Total $ $ $ $ $ $ $
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Plan Table 4: SABG Planned Expenditures. 

States must project how they will use SABG funds to provide authorized services as required by the SABG regulations. Plan Table 4

must be completed for the FFY 2018 and FFY 2019 SABG awards.

Plan Table 4 SABG Planned Expenditures

State Identifier: 

Expenditure Category FFY 2018 SA Block Grant Award FFY 2019 SA Block Grant Award

1. Substance Abuse Prevention* and Treatment $ $

2. Primary Substance Abuse Prevention $ $

3. Early Intervention Services for HIV24 $ $

4. Tuberculosis Services $ $

5. Administration (SSA level only) $ $

6. Total $ $

* Prevention other than Primary Prevention

 

 

24 For the purpose of determining the states and jurisdictions that are considered “designated states” as described in section 1924(b)(2) of Title XIX, Part B, Subpart II of the Public 

Health Service Act (42 U.S.C. § 300x-24(b)(2)) and section 45 CFR § 96.128(b) of the Substance Abuse Prevention and Treatment Block Grant; Interim Final Rule (45 CFR 96.120-

137), SAMHSA relies on the HIV Surveillance Report produced by the Centers for Disease Control and Prevention (CDC,), National Center for HIV/AIDS, Viral Hepatitis, STD and 

TB Prevention. The most recent HIV Surveillance Report will be published on or before October 1 of the federal fiscal year for which a state is applying for a grant is used to 

determine the states and jurisdictions that will be required to set-aside 5 percent of their respective SABG allotments to establish one or more projects to provide early intervention 

services for regarding the human immunodeficiency virus (EIS/HIV) at the sites at which individuals are receiving SUD treatment services. In FY 2012, SAMHSA developed and 

disseminated a policy change applicable to the EIS/HIV which provided any state that was a “designated state” in any of the three years prior to the year for which a state is applying 

for SABG funds with the flexibility to obligate and expend SABG funds for EIS/HIV even though the state a state’s AIDS case rate does not meet the AIDS case rate threshold for the 

fiscal year involved for which a state is applying for SABG funds. Therefore, any state with an AIDS case rate below 10 or more such cases per 100,000 that meets the criteria 

described in the 2012 policy guidance will be allowed to obligate and expend SABG funds for EIS/HIV if they chose to do so.
30

Table 5a and 5b - Primary Prevention Planned Expenditures 

States must spend no less than 20 percent of their SABG allotment on substance use disorder primary prevention 

strategies. These strategies are directed at individuals not identified to be in need of treatment. To report on 

their primary prevention planned expenditures, states must complete either Table 5a or Table 5b or may choose 

to complete both. If Table 5b is completed, the state must also complete Section 1926 –Tobacco on Table 5a.

Table 5a SABG Primary Prevention Planned Expenditures 

The state’s primary prevention program must include, but is not limited to, the six primary prevention strategies 

defined below. On Table 5a, states should list their FFY 2018 and FFFY 2019 SABG planned expenditures for 

each of the six primary prevention strategies. Expenditures within each of the six strategies should be directly 

associated with the cost of completing the activity or task; for example, information dissemination should 

include the cost of developing pamphlets, the time of participating staff or the cost of public service 

announcements, etc. If a state plans to use strategies not covered by these six categories, please report them 

under “Other” in Table 5a. 

In most cases, the total amounts should equal the amounts reported on Plan Table 4, Row 2, Primary Prevention. 

The one exception is if the state chooses to use a portion of the primary prevention set-aside to fund Non Direct 

Services/System Development activities. 

If the state chooses to report activities utilizing the IOM Model of Universal, Selective, and Indicated, complete 

Form 5b. If Form 5b is completed, the state must also complete Section 1926 –Tobacco on Form 5a.

Table 5b SABG Primary Prevention Planned Expenditures by IOM Category

Information Dissemination– This strategy provides knowledge and increases awareness of the nature and 

extent of alcohol and other drug use, abuse, and addiction, as well as their effects on individuals, families, and 

communities. It also provides knowledge and increases awareness of available prevention and treatment 

programs and services. It is characterized by one-way communication from the source to the audience, with 

limited contact between the two.

Education - This strategy builds skills through structured learning processes. Critical life and social skills 

include decision making, peer resistance, coping with stress, problem solving, interpersonal communication, and 

systematic and judgmental abilities. There is more interaction between facilitators and participants than in the 

information strategy.

Alternatives - This strategy provides participation in activities that exclude alcohol and other drugs. The 

purpose is to meet the needs filled by alcohol and other drugs with healthy activities and to discourage the use of 

alcohol and drugs through these activities.

Problem Identification and Referral - This strategy aims at identification of those who have indulged in 

illegal/age-inappropriate use of tobacco or alcohol and those individuals who have indulged in the first use of 

illicit drugs in order to assess if their behavior can be reversed through education. It should be noted, however, 

that this strategy does not include any activity designed to determine if a person is in need of treatment.

Community-based Process - This strategy provides ongoing networking activities and technical assistance to 

community groups or agencies. It encompasses neighborhood-based, grassroots empowerment models using 

action planning and collaborative systems planning.
31

Environmental - This strategy establishes or changes written and unwritten community standards, codes, and 

attitudes; thereby, influencing alcohol and other drug use by the general population.

Other - The six primary prevention strategies have been designed to encompass nearly all of the prevention 

activities. However, in the unusual case an activity does not fit one of the six strategies, it may be classified in 

the “Other” category.

Section 1926 - Tobacco: Costs Associated with the Synar Program. Per January 19, 1996, 45 CFR Part 96 

Tobacco Regulation for Substance Abuse Prevention and Treatment Block Grants; Final Rule (45 CFR §

96.130), states may not use the Block Grant to fund the enforcement of their statute, except that they may 

expend funds from their primary prevention set aside of their Block Grant allotment under 45 CFR §

96.124(b)(1) for carrying out the administrative aspects of the requirements such as the development of the 

sample design and the conducting of the inspections.

In addition, prevention strategies may be classified using the IOM Model of Universal, Selective, and Indicated, 

which classifies preventive interventions by the population targeted. Definitions for these categories appear 

below:

Universal: Activities targeted to the public or a whole population group that has not been identified based on

individual risk.

Selective: Activities targeted to individuals or a subgroup of the population whose risk of developing a disorder 

is significantly higher than average.

Indicated: Activities targeted to individuals in high-risk environments, identified as having minimal but 

detectable signs or symptoms foreshadowing disorder or having biological markers indicating predisposition for 

disorder but not meeting diagnostic levels (Adapted from The Institute of Medicine).

States that are able to report on both the strategy type and the population served (universal, selective, or 

indicated) should do so. If planned expenditure information is only available by strategy type, then the state 

should report planned expenditures in the row titled Unspecified (for example, Information Dissemination 

Unspecified).
32

Plan Table 5a: SABG Primary Prevention Planned Expenditures

State Identifier:

Report Period- From: To:

A B C

Strategy IOM Target FFY 2018 SA 

Block Grant 

Award 

FFY 2019 SA 

Block Grant 

Award

1. Information Dissemination Universal $ $

Selected $ $

Indicated $ $

Unspecified $ $

2. Education Universal $ $

Selected $ $

Indicated $ $

Unspecified $ $

3. Alternatives Universal $ $

Selected $ $

Indicated $ $

Unspecified $ $

4. Problem Identification and 

Referral

Universal $ $

Selected $ $

Indicated $ $

Unspecified $ $

5. Community-Based Processes Universal $ $

Selected $ $

Indicated $ $

Unspecified $ $

6. Environmental Universal $ $

Selected $ $

Indicated $ $

Unspecified $ $

7. Section 1926-Tobacco Universal $ $

Selected $ $

Indicated $ $

Unspecified $ $

8. Other Universal $ $

Selected $ $

Indicated $ $

Unspecified $ $

9. Total Prevention 

Expenditures

$ $

Total SABG Award $ $

Planned Primary Prevention

Percentage

% %
33

Table 5b SABG Primary Prevention Planned Expenditures by IOM Category

Table 5b Instructions: States that plan their primary prevention expenditures using the IOM model of 

universal, selective, and indicated should use Table 5b to list their FFY 2018 and FFFY 2019 SABG planned 

expenditures in each of these categories. Note that if Form 5b is completed instead of Form 5a, the state must 

also complete Section 1926 - Tobacco on Form 5a. In most cases, the total amount should equal the amounts 

reported on Plan Table 3, Row 2, Primary Prevention. The one exception is if the state chooses to use a portion 

of the primary prevention set-aside to fund Non Direct Services/System Development activities. 

Institute of Medicine Classification: Universal, Selective, and Indicated: 

Universal: Activities targeted to the public or a whole population group that have not been identified on the 

basis of individual risk.

Universal Direct. Row 1 - Intervention s directly serve an identifiable group of participants but who have 

not been identified on the basis of individual risk (e.g., school curriculum, after-school program, parenting 

class). This also could include interventions involving interpersonal and ongoing/repeated contact (e.g., 

coalitions).

Universal Indirect. Row 2 - Interventions support population-based programs and environmental strategies 

(e.g., establishing ATOD policies, modifying ATOD advertising practices). This also could include 

interventions involving programs and policies implemented by coalitions.

Selective: Activities targeted to individuals or a subgroup of the population whose risk of developing a 

disorder is significantly higher than average.

Indicated: Activities targeted to individuals in high-risk environments, identified as having minimal but 

detectable signs or symptoms foreshadowing disorder or having biological markers indicating 

predisposition for disorder but not meeting diagnostic levels (Adapted from The Institute of Medicine).

Plan Table 5b: SABG Primary Prevention Planned 

Expenditures by IOM Category

State Identifier:

Activity

FFY 2018

SA Block 

Grant Award

FFY 2019

SA Block 

Grant Award

Universal Direct $ $

Universal Indirect $ $

Selective $ $

Indicated $ $

Column Total $ $

Total SABG 

Award

$ $

Planned Primary 

Prevention

Percentage

% %
34

Plan Table 5c: SABG Planned Primary Prevention Targeted Priorities

States should identify the categories of substances the state BG plans to target with primary prevention set-aside 

dollars from the FFY 2018 and FFY 2019 SABG awards. 

Targeted Substances

Alcohol

Tobacco

Marijuana

Prescription Drugs

Cocaine

Heroin

Inhalants

Methamphetamine 

Synthetic Drugs (i.e. Bath salts, 

Spice, K2)

Instructions: In the table below, identify the special population categories the state BG plans to targets with primary 

prevention set-aside dollars.

Targeted Populations

Students in College

Military Families

LGBT

American Indians/Alaska Natives

African American

Hispanic

Homeless

Native Hawaiian/Other Pacific Islanders

Asian 

Rural 

Underserved Racial and Ethnic 

Minorities
35

Plan Table 6

Categories for Expenditures for System Development/Non-Direct-Service Activities

Expenditures for these activities may be direct expenditures (involving the time of state or substate personnel, or other state or sub-state resources) or be through funding mechanisms with 

independent organizations. Expenditures may come from the administrative funds and/ or 

program funds (but may not include the HIV set-aside funds). These include state, regional, and 

local personnel salaries prorated for time spent and operating costs such as travel, printing, 

advertising, and conducting meetings related to the categories below. 

Non-direct services/system development activities exclude expenditures through funding 

mechanisms for providing treatment or mental health “direct service” and primary prevention 

efforts themselves. Instead, these expenditures provide support to those activities.

Please utilize the following categories to describe the types of expenditures your state supports 

with BG funds, and if the preponderance of the activity fits within a category. 

We understand that a particular activity may cross categories, but try to identify the 

primary purpose or goal of the activity. For example, a state may utilize SABG funds to 

train personnel to conduct fidelity assessments of evidence-based practices. While this 

could fall under either training/education and/or quality assurance/improvement – if the 

primary purpose is to assure the implementation of EBPs, that expenditure would most 

likely be captured under quality assurance/improvement.

Information systems – This includes collecting and analyzing treatment data as well as 

prevention data under the SABG in order to monitor performance and outcomes. Costs for 

EHRs and other health information technology also fall under this category. 

Infrastructure Support – This includes activities that provide the infrastructure to support 

services but for which there are no individual services delivered. Examples include the 

development and maintenance of a crisis-response capacity, including hotlines, mobile crisis 

teams, web-based check-in groups (for medication, treatment, and re-entry follow-up), drop-in 

centers, and respite services. 

Partnerships, community outreach, and needs assessment – This includes state, regional, and 

local personnel salaries prorated for time and materials to support planning meetings, 

information collection, analysis, and travel. It also includes the support for partnerships across 

state and local agencies, and tribal governments. Community/network development activities, 

such as marketing, communication, and public education, and including the planning and 

coordination of services, fall into this category, as do needs-assessment projects to identify the 

scope and magnitude of the problem, resources available, gaps in services, and strategies to 

close those gaps.

Planning Council Activities – This includes those supports for the performance of a Mental 

Health Planning Council under the MHBG, a combined Behavioral Health Planning Council, or 

(OPTIONAL) Advisory Council for the SABG. 
36

Quality assurance and improvement - This includes activities to improve the overall quality of 

services, including those activities to assure conformity to acceptable professional standards, 

adaptation and review of implementation of evidence-based practices, identification of areas of 

technical assistance related to quality outcomes, including feedback. Administrative agency 

contracts to monitor service-provider quality fall into this category, as do independent peerreview activities.

Research and evaluation - This includes performance measurement, evaluation, and research, 

such as services research and demonstration projects to test feasibility and effectiveness of a new 

approach as well as the dissemination of such information.

Training and education - This includes skill development and continuing education for 

personnel employed in local programs as well as partnering agencies, as long as the training 

relates to either substance use disorder service delivery (prevention, treatment and recovery) for 

SABG and services to adults with SMI or children with SED for MHBG. Typical costs include 

course fees, tuition, and expense reimbursements to employees, trainer(s) and support staff 

salaries, and certification expenditures.

Please enter the total amount of the block grant expended for each activity.

Non-Direct-Services/System Development

SABG/MHBG Table 6 

State Identifier:

Report Period- From: To:

Activity A. MHBG B. SABG

Treatment

C. SABG

Prevention

D. SABG 

Combined

*

1. Information Systems $ $ $ $

2. Infrastructure Support $ $ $ $

3. Partnerships, community outreach, and needs 

assessment

$ $ $ $

4. Planning Council Activities (MHBG required, SABG 

optional)

$ $ $ $

5. Quality assurance and improvement $ $ $ $

6. Research and Evaluation $ $ $ $

7. Training and Education $ $ $ $

8. Total $ $ $ $

*Combined refers to non-direct service/system development expenditures that support both treatment and 

prevention systems
37

C. Environmental Factors and Plan

1. The Health Care System, Parity and Integration - Question 1 and 2 are Required

Persons with mental illness and persons with substance use disorders are likely to die earlier than 

those who do not have these conditions.

25

 Early mortality is associated with broader health 

disparities and health equity issues such as socioeconomic status but “[h]ealth system factors” 

such as access to care also play an important role in morbidity and mortality among these 

populations. Persons with mental illness and substance use disorders may benefit from strategies 

to control weight, encourage exercise, and properly treat such chronic health conditions as 

diabetes and cardiovascular disease.26 It has been acknowledged that there is a high rate of cooccurring M/SUD, with appropriate treatment required for both conditions.

27

 

Currently, 50 states have organizationally consolidated their mental and substance use disorder 

authorities in one fashion or another with additional organizational changes under 

consideration. More broadly, SAMHSA and its federal partners understand that such factors 

as education, housing, and nutrition strongly affect the overall health and well-being of 

persons with mental illness and substance use disorders.28 SMHAs and SSAs may wish to 

develop and support partnerships and programs to help address social determinants of health 

and advance overall health equity.29 For instance, some organizations have established 

medical-legal partnerships to assist persons with mental and substance use disorders in 

meeting their housing, employment, and education needs.30

Health care professionals and persons who access M/SUD treatment services recognize the 

need for improved coordination of care and integration of physical and behavioral health with 

other health care in primary, specialty, emergency and rehabilitative care settings in the 

community. For instance, the National Alliance for Mental Illness has published materials for 

 

25 BG Druss et al. Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally 

representative US survey. Med Care. 2011 Jun; 49(6):599-604; Bradley Mathers, Mortality among people who inject drugs: a 

systematic review and meta-analysis, Bulletin of the World Health Organization, 2013; 91:102–123 

http://www.who.int/bulletin/volumes/91/2/12-108282.pdf; MD Hert et al., Physical illness in patients with severe mental 

disorders. I. Prevalence, impact of medications and disparities in health care, World Psychiatry. Feb 2011; 10(1): 52–77

26 Research Review of Health Promotion Programs for People with SMI, 2012, http://www.integration.samhsa.gov/healthwellness/wellnesswhitepaper; About SAMHSA’s Wellness Efforts, 

http://www.promoteacceptance.samhsa.gov/10by10/default.aspx; JW Newcomer and CH Hennekens, Severe Mental Illness and 

Risk of Cardiovascular Disease, JAMA; 2007; 298: 1794-1796; Million Hearts, http://www.integration.samhsa.gov/healthwellness/samhsa-10x10; Schizophrenia as a health disparity, http://www.nimh.nih.gov/about/director/2013/schizophrenia-as-ahealth-disparity.shtml

27 Comorbidity: Addiction and other mental illnesses, http://www.drugabuse.gov/publications/comorbidity-addiction-othermental-illnesses/why-do-drug-use-disorders-often-co-occur-other-mental-illnesses Hartz et al., Comorbidity of Severe Psychotic 

Disorders With Measures of Substance Use, JAMA Psychiatry. 2014; 71(3):248-254. doi:10.1001/jamapsychiatry.2013.3726; 

http://www.samhsa.gov/co-occurring/

28 Social Determinants of Health, Healthy People 2020, 

http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39; 

http://www.cdc.gov/socialdeterminants/Index.html

29 http://www.samhsa.gov/health-disparities/strategic-initiatives

30 http://medical-legalpartnership.org/mlp-response/how-civil-legal-aid-helps-health-care-address-sdoh/
38

members to assist them in coordinating pediatric mental health and primary care.

31

SAMHSA and its partners support integrated care for persons with mental illness and 

substance use disorders.32 The state should illustrate movement towards integrated systems of 

care for individuals and families with co-occurring mental and substance use disorders. The 

plan should describe attention to management, funding, payment strategies that foster cooccurring capability for services to individuals and families with co-occurring mental and 

substance use disorders. Strategies supported by SAMHSA to foster integration of physical 

and behavioral health include: developing models for inclusion of behavioral health treatment 

in primary care; supporting innovative payment and financing strategies and delivery system 

reforms such as ACOs, health homes, pay for performance, etc.; promoting workforce 

recruitment, retention and training efforts; improving understanding of financial sustainability 

and billing requirements; encouraging collaboration between M/SUD providers, prevention of 

teen pregnancy, youth violence, Medicaid programs, and primary care providers such as 

Federally Qualified Health Centers; and sharing with consumers information about the full 

range of health and wellness programs. 

Health information technology, including EHRs and telehealth are examples of important 

strategies to promote integrated care.33 Use of EHRs – in full compliance with applicable 

legal requirements – may allow providers to share information, coordinate care, and improve 

billing practices. Telehealth is another important tool that may allow behavioral health 

prevention, treatment, and recovery to be conveniently provided in a variety of settings, 

helping to expand access, improve efficiency, save time, and reduce costs. Development and 

use of models for coordinated, integrated care such as those found in health homes34 and 

ACOs35 may be important strategies used by SMHAs and SSAs to foster integrated care. 

 

31 Integrating Mental Health and Pediatric Primary Care, A Family Guide, 2011. 

http://www.nami.org/Content/ContentGroups/CAAC/FG-Integrating.pdf; Integration of Mental Health, Addictions and Primary 

Care, Policy Brief, 2011,

http://www.nami.org/Content/NavigationMenu/State_Advocacy/About_the_Issue/Integration_MH_And_Primary_Care_2011.pdf

; Abrams, Michael T. (2012, August 30). Coordination of care for persons with substance use disorders under the Affordable 

Care Act: Opportunities and Challenges. Baltimore, MD: The Hilltop Institute, UMBC. 

http://www.hilltopinstitute.org/publications/CoordinationOfCareForPersonsWithSUDSUnderTheACA-August2012.pdf; Bringing 

Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs and Outcomes, American Hospital 

Association, Jan. 2012, http://www.aha.org/research/reports/tw/12jan-tw-behavhealth.pdf; American Psychiatric Association, 

http://www.psych.org/practice/professional-interests/integrated-care; Improving the Quality of Health Care for Mental and 

Substance-Use Conditions: Quality Chasm Series ( 2006), Institute of Medicine, National Affordable Care Academy of Sciences, 

http://books.nap.edu/openbook.php?record_id=11470&page=210; State Substance Abuse Agency and Substance Abuse Program 

Efforts Towards Healthcare Integration: An Environmental Scan, National Association of State Alcohol/Drug Abuse Directors, 

2011, http://nasadad.org/nasadad-reports

32 Health Care Integration, http:// samhsa.gov/health-reform/health-care-integration; SAMHSA-HRSA Center for Integrated 

Health Solutions, (http://www.integration.samhsa.gov/)

33 Health Information Technology (HIT), http://www.integration.samhsa.gov/operations-administration/hit; Characteristics of 

State Mental Health Agency Data Systems, SAMHSA, 2009, http://store.samhsa.gov/product/Characteristics-of-State-MentalHealth-Agency-Data-Systems/SMA08-4361; Telebehavioral Health and Technical Assistance Series, 

http://www.integration.samhsa.gov/operations-administration/telebehavioral-health; State Medicaid Best Practice, Telemental 

and Behavioral Health, August 2013, American Telemedicine Association, http://www.americantelemed.org/docs/defaultsource/policy/ata-best-practice--telemental-and-behavioral-health.pdf?sfvrsn=8; National Telehealth Policy Resource Center, 

http://telehealthpolicy.us/medicaid; telemedicine, http://www.medicaid.gov/Medicaid-CHIP-Program-Information/ByTopics/Delivery-Systems/Telemedicine.html

34 Health Homes, http://www.integration.samhsa.gov/integrated-care-models/health-homes

35 New financing models, http://www.samhsa.gov/co-occurring/topics/primary-care/financing_final.aspx
39

Training and assisting behavioral health providers to redesign or implement new provider 

billing practices, build capacity for third-party contract negotiations, collaborate with health 

clinics and other organizations and provider networks, and coordinate benefits among multiple 

funding sources may be important ways to foster integrated care. SAMHSA encourages 

SMHAs and SSAs to communicate frequently with stakeholders, including policymakers at 

the state/jurisdictional and local levels, and State Mental Health Planning Council members 

and consumers, about efforts to foster health care coverage, access and integrate care to ensure 

beneficial outcomes. 

SMHAs and SSAs also may work with state Medicaid agencies, state insurance 

commissioners, and professional organizations to encourage development of innovative 

demonstration projects, alternative payment methodologies, and waivers/state plan 

amendments that test approaches to providing integrated care for persons with M/SUD and 

other vulnerable populations.

36 Ensuring both Medicaid and private insurers provide required 

preventive benefits also may be an area for collaboration.37

One key population of concern is persons who are dually eligible for Medicare and 

Medicaid.38 Roughly, 30 percent of persons who are dually eligible have been diagnosed with 

a mental illness, more than three times the rate among those who are not dually eligible.39

SMHAs and SSAs also should collaborate with state Medicaid agencies and state insurance 

commissioners to develop policies to assist those individuals who experience health insurance 

coverage eligibility changes due to shifts in income and employment.40 Moreover, even with 

expanded health coverage available through the Marketplace and Medicaid and efforts to 

ensure parity in health care coverage, persons with behavioral health conditions still may 

experience challenges in some areas in obtaining care for a particular condition or in finding a 

provider.41 SMHAs and SSAs should remain cognizant that health disparities may affect 

access, health care coverage and integrated care of behavioral health conditions and work with 

partners to mitigate regional and local variations in services that detrimentally affect access to 

 

36 Waivers, http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers.html; Coverage and 

Service Design Opportunities for Individuals with Mental Illness and Substance Use Disorders, CMS Informational Bulletin, 

Dec. 2012, http://medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-12-03-12.pdf

37 What are my preventive care benefits? https://www.healthcare.gov/what-are-my-preventive-care-benefits/; Interim Final Rules 

for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection 

and Affordable Care Act, 75 FR 41726 (July 19, 2010); Group Health Plans and Health Insurance Issuers Relating to Coverage of 

Preventive Services Under the Patient Protection and Affordable Care Act, 76 FR 46621 (Aug. 3, 2011); Preventive services 

covered under the Affordable Care Act, http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html

38 Medicare-Medicaid Enrollee State Profiles, http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-MedicaidCoordination/Medicare-Medicaid-Coordination-Office/StateProfiles.html; About the Compact of Free Association, 

http://uscompact.org/about/cofa.php

39 Dual-Eligible Beneficiaries of Medicare and Medicaid: Characteristics, Health Care Spending, and Evolving Policies, CBO, 

June 2013, http://www.cbo.gov/publication/44308

40 BD Sommers et al. Medicaid and Marketplace Eligibility Changes Will Occur Often in All States; Policy Options can Ease 

Impact. Health Affairs. 2014; 33(4): 700-707

41 TF Bishop. Acceptance of Insurance by Psychiatrists and the Implications for Access to Mental Health Care, JAMA

Psychiatry. 2014;71(2):176-181; JR Cummings et al, Race/Ethnicity and Geographic Access to Medicaid Substance Use 

Disorder Treatment Facilities in the United States, JAMA Psychiatry. 2014; 71(2):190-196; JR Cummings et al. Geography and 

the Medicaid Mental Health Care Infrastructure: Implications for Health Reform. JAMA Psychiatry. 2013; 70(10):1084-1090; 

JW Boyd et al. The Crisis in Mental Health Care: A Preliminary Study of Access to Psychiatric Care in Boston. Annals of 

Emergency Medicine. 2011; 58(2): 218
40

care and integration. 

SMHAs and SSAs should work with partners to ensure recruitment of diverse, well-trained 

staff and promote workforce development and ability to function in an integrated care 

environment.42 Psychiatrists, psychologists, social workers, addiction counselors, 

preventionists, therapists, technicians, peer support specialists, and others will need to 

understand integrated care models, concepts, and practices.

Parity is vital to ensuring persons with mental health conditions and substance use disorders 

receive continuous, coordinated, care. Increasing public awareness about MHPAEA could 

increase access to behavioral health services, provide financial benefits to individuals and 

families, and lead to reduced confusion and discrimination associated with mental illness and 

substance use disorders. Block grant recipients should continue to monitor federal parity 

regulations and guidance and collaborate with state Medicaid authorities, insurance regulators, 

insurers, employers, providers, consumers and policymakers to ensure effective parity 

implementation and comprehensive, consistent communication with stakeholders. The SSAs, 

SMHAs and their partners may wish to pursue strategies to provide information, education, and 

technical assistance on parity-related issues. Medicaid programs will be a key partner for 

recipients of MHBG and SABG funds and providers supported by these funds. The SSAs and 

SMHAs should collaborate with their states’ Medicaid authority in ensuring parity within 

Medicaid programs.

SAMHSA encourages states to take proactive steps to improve consumer knowledge about 

parity. As one plan of action, states can develop communication plans to provide and address 

key issues. 

Another key part of integration will be defining performance and outcome measures. The 

Department of Health and Human Services (HHS) and partners have developed the National 

Quality Strategy, which includes information and resources to help promote health, good 

outcomes, and patient engagement. SAMHSA’s National Behavioral Health Quality 

Framework includes core measures that may be used by providers and payers.43

SAMHSA recognizes that certain jurisdictions receiving block grant funds – including U.S. 

Territories, tribal entities and those jurisdictions that have signed a Compact of Free 

Association with the United States and are uniquely impacted by certain Medicaid provisions 

or are ineligible to participate in certain programs.

44

 However, these jurisdictions should

collaborate with federal agencies and their governmental and non-governmental partners to 

 

42 Hoge, M.A., Stuart, G.W., Morris, J., Flaherty, M.T., Paris, M. & Goplerud E. Mental health and addiction workforce 

development: Federal leadership is needed to address the growing crisis. Health Affairs, 2013; 32 (11): 2005-2012; SAMHSA

Report to Congress on the Nation’s Substance Abuse and Mental Health Workforce Issues, January 2013, 

http://store.samhsa.gov/shin/content/PEP13-RTC-BHWORK/PEP13-RTC-BHWORK.pdf; Annapolis Coalition, An Action Plan 

for Behavioral Health Workforce Development, 2007, http://annapoliscoalition.org/?portfolio=publications; Creating jobs by 

addressing primary care workforce needs, http://www.hhs.gov/healthcare/facts/factsheets/2013/06/jobs06212012.html

43 About the National Quality Strategy, http://www.ahrq.gov/workingforquality/about.htm; National Behavioral Health Quality 

Framework, Draft, August 2013, http://samhsa.gov/data/NBHQF

44 Letter to Governors on Information for Territories Regarding the Affordable Care Act, December 2012, 

http://www.cms.gov/cciio/resources/letters/index.html; Affordable Care Act, Indian Health Service, http://www.ihs.gov/ACA/
41

expand access and coverage. Furthermore, the jurisdiction should ensure integration of 

prevention, treatment, and recovery support for persons with, or at risk of, mental and 

substance use disorders. 

Please respond to the following items in order to provide a description of the healthcare system 

and integration activities:

1. Describe how the state integrates mental health and primary health care, including services for 

individuals with co-occurring mental and substance use disorders, in primary care settings or 

arrangements to provide primary and specialty care services in community -based mental and 

substance use disorders settings.

 

2. Describe how the state provide services and supports towards integrated systems of care for 

individuals and families with co-occurring mental and substance use disorders, including 

management, funding, payment strategies that foster co-occurring capability.

3. Is there a plan for monitoring whether individuals and families have access to M/SUD

services offered through QHPs 

a) Yes No

and Medicaid

b) Yes No

2) Who is responsible for monitoring access to M/SUD services by the QHPs?

3) Is the SSA/SMHA involved in any coordinated care initiatives in the state? 

Yes No

4) Do the behavioral health providers screen and refer for:

a) Prevention and wellness education

Yes No

b) Health risks such as 

i) heart disease, Yes No 

ii) hypertension, Yes No 
42

iii) high cholesterol Yes No 

iv) diabetes Yes No 

c) Recovery supports

Yes No

5) Is the SSA/SMHA involved in the development of alternative payment methodologies, 

including risk-based contractual relationships that advance coordination of care?

Yes No

6) Is the SSA and SMHA involved in the implementation and enforcement of parity protections 

for mental and substance use disorder services?

Yes No

7) What are the issues or problems that your state is facing related to the implementation and 

enforcement of parity provisions?

8) Does the state have any activities related to this section that you would like to highlight?

\Please indicate areas of technical assistance needed related to this section 

2. Health Disparities - Requested

In accordance with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities45, 

 

45 http://www.minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
43

Healthy People, 202046, National Stakeholder Strategy for Achieving Health Equity47, and other

HHS and federal policy recommendations, SAMHSA expects block grant dollars to support 

equity in access, services provided, and behavioral health outcomes among individuals of all 

cultures, sexual/gender minorities, orientation and ethnicities. Accordingly, grantees should

collect and use data to: (1) identify subpopulations (i.e., racial, ethnic, limited English speaking,

tribal, sexual/gender minority groups, etc.) vulnerable to health disparities and (2) implement 

strategies to decrease the disparities in access, service use, and outcomes both within those

subpopulations and in comparison to the general population. One strategy for addressing health 

disparities is use of the recently revised National Standards for Culturally and Linguistically

Appropriate Services in Health and Health Care (CLAS).

48

The Action Plan to Reduce Racial and Ethnic Health Disparities, which the HHS Secretary 

released in April 2011, outlines goals and actions that HHS agencies, including SAMHSA, will 

take to reduce health disparities among racial and ethnic minorities. Agencies are required to 

assess the impact of their policies and programs on health disparities.

The HHS Secretary’s top priority in the Action Plan is to “[a]ssess and heighten the impact of 

all HHS policies, programs, processes, and resource decisions to reduce health disparities. 

HHS leadership will assure that program grantees, as applicable, will be required to submit 

health disparity impact statements as part of their grant applications. Such statements can 

inform future HHS investments and policy goals, and in some instances, could be used to score

grant applications if underlying program authority permits.”49

Collecting appropriate data is a critical part of efforts to reduce health disparities and promote 

equity. In October 2011, HHS issued final standards on the collection of race, ethnicity, 

primary language, and disability status.

50

 This guidance conforms to the existing Office of 

Management and Budget (OMB) directive on racial/ethnic categories with the expansion of

intra-group, detailed data for the Latino and the Asian-American/Pacific Islander populations.

51

In addition, SAMHSA and all other HHS agencies have updated their limited English 

proficiency plans and, accordingly, will expect block grant dollars to support a reduction in 

disparities related to access, service use, and outcomes that are associated with limited English 

proficiency. These three departmental initiatives, along with SAMHSA’s and HHS’s attention 

to special service needs and disparities within tribal populations, LGBT populations, and 

women and girls, provide the foundation for addressing health disparities in the service

delivery system. States provide behavioral health services to these individuals with state block 

grant dollars. While the block grant generally requires the use of evidence-based and 

promising practices, it is important to note that many of these practices have not been normed 

on various diverse racial and ethnic populations. States should strive to implement evidencebased and promising practices in a manner that meets the needs of the populations they serve. 

In the block grant application, states define the populations they intend to serve. Within these

 

46 http://www.healthypeople.gov/2020/default.aspx

47 http://minorityhealth.hhs.gov/npa/files/Plans/NSS/NSSExecSum.pdf

48 http://www.ThinkCulturalHealth.hhs.gov

49 http://www.minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf

50 http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=208

51 http://www.whitehouse.gov/omb/fedreg_race-ethnicity
44

populations of focus are subpopulations that may have disparate access to, use of, or outcomes 

from provided services. These disparities may be the result of differences in insurance coverage, 

language, beliefs, norms, values, and/or socioeconomic factors specific to that subpopulation. 

For instance, lack of Spanish primary care services may contribute to a heightened risk for

metabolic disorders among Latino adults with SMI; and American Indian/Alaska Native youth 

may have an increased incidence of underage binge drinking due to coping patterns related to 

historical trauma within the American Indian/Alaska Native community. While these factors 

might not be pervasive among the general population served by the block grant, they may be

predominant among subpopulations or groups vulnerable to disparities.

To address and ultimately reduce disparities, it is important for states to have a detailed 

understanding of who is and is not being served within the community, including in what 

languages, in order to implement appropriate outreach and engagement strategies for diverse

populations. The types of services provided, retention in services, and outcomes are critical 

measures of quality and outcomes of care for diverse groups. For states to address the

potentially disparate impact of their block grant funded efforts, they will address access, use,

and outcomes for subpopulations.

Please respond to the following items:

1) Does the state track access or enrollment in services, types of services received and outcomes 

of these services by: race, ethnicity, gender, LGBT, and age?

a) race Yes No

b) Ethnicity Yes No

c) gender Yes No

d) sexual orientation Yes No

e) gender identity, Yes No

f) Age? Yes No

2) Does the state have a data-driven plan to address and reduce disparities in access, service use, 

and outcomes for the above subpopulation? 

Yes No

3) Does the state have a plan to identify, address, and monitor linguistic disparities/language 

barriers? 

Yes No

4) Does the state have a workforce-training plan to build the capacity of behavioral health 

providers to identify disparities in access, services received, and outcomes and provide 

support for improved culturally and linguistically competent outreach, engagement, 

prevention, treatment, and recovery services for diverse populations? 

Yes No

5) If yes, does this plan include the Culturally and Linguistically Appropriate Services (CLAS) 

Standards? 

Yes No

6) Does the state have a budget item allocated to identifying and remediating disparities in 

behavioral health care? 

Yes No

7) Does the state have any activities related to this section that you would like to highlight?
45

Please indicate areas of technical assistance needed related to this section. 

 

3. Innovation in Purchasing Decisions - requested

While there are different ways to define value-based purchasing, the purpose is to identify 

services, payment arrangements, incentives, and players that can be included in directed 

strategies using purchasing practices that are aimed at improving the value of health care 

services. In short, health care value is a function of both cost and quality:

Health Care Value = Quality ÷ Cost, (V = Q ÷ C) 

SAMHSA anticipates that the movement toward value based purchasing will continue as 

delivery system reforms continue to shape states systems. The identification and replication of 

such value-based strategies and structures will be important to the development of behavioral 

health systems and services. 

There is increased interest in having a better understanding of the evidence that supports the

delivery of medical and specialty care including M/SUD services. Over the past several years, 

SAMHSA has collaborated with CMS, HRSA, SMAs, state behavioral health authorities, 

legislators, and others regarding the evidence of various mental and substance misuse

prevention, treatment, and recovery support services. States and other purchasers are

requesting information on evidence-based practices or other procedures that result in better

health outcomes for individuals and the general population. While the emphasis on evidencebased practices will continue, there is a need to develop and create new interventions and 

technologies and in turn, to establish the evidence. SAMHSA supports states’ use of the 

block grants for this purpose. The NQF and the IOM recommend that evidence play a critical 

role in designing health benefits for individuals enrolled in commercial insurance, Medicaid, 

and Medicare.

To respond to these inquiries and recommendations, SAMHSA has undertaken several 

activities. NREPP assesses the research evaluating an intervention's impact on outcomes and 

provides information on available resources to facilitate the effective dissemination and 

implementation of the program. NREPP ratings take into account the methodological rigor of 
46

evaluation studies, the size of a program's impact on an outcome, the degree to which a program 

was implemented as designed, and the strength of a program's conceptual framework. For each 

intervention reviewed, NREPP publishes a report called a program profile on this website. You 

will find research on the effectiveness of programs as reviewed and rated by NREPP certified 

reviewers. Each profile contains easily understandable ratings for individual outcomes based on 

solid evidence that indicates whether a program achieved its goals. NREPP is not intended to 

be an exhaustive listing of all evidence-based practices in existence.

SAMHSA reviewed and analyzed the current evidence for a wide range of interventions for

individuals with mental illness and substance use disorders, including youth and adults with 

chronic addiction disorders, adults with SMI, and children and youth with SED. The evidence 

builds on the evidence and consensus standards that have been developed in many national 

reports over the last decade or more. These include reports by the Surgeon General,

52 The New

Freedom Commission on Mental Health,

53 the IOM,54 and the NQF.55 The activity included a

systematic assessment of the current research findings for the effectiveness of the services using 

a strict set of evidentiary standards. This series of assessments was published in “Psychiatry 

Online.”

56

 SAMHSA and other federal partners, the HHS’ Administration for Children and

Families, Office for Civil Rights, and CMS, have used this information to sponsor technical

expert panels that provide specific recommendations to the behavioral health field regarding 

what the evidence indicates works and for whom, to identify specific strategies for embedding

these practices in provider organizations, and to recommend additional service research.

In addition to evidence-based practices, there are also many promising practices in various 

stages of development. Anecdotal evidence and program data indicate effectiveness for these 

services. As these practices continue to be evaluated, the evidence is collected to establish 

their efficacy and to advance the knowledge of the field. 

SAMHSA’s Treatment Improvement Protocol Series (TIPS)

57

are best practice guidelines for

the SUD treatment. The 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. The audience for the TIPS is expanding beyond 

public and private SUD treatment facilities as alcohol and other drug disorders are increasingly

recognized as a major health problem.

SAMHSA’s Evidence-Based Practice Knowledge Informing Transformation (KIT)

58

was

 

52 United States Public Health Service Office of the Surgeon General (1999). Mental Health: A Report of the Surgeon General. 

Rockville, MD: Department of Health and Human Services, U.S. Public Health Service

53 The President’s New Freedom Commission on Mental Health (July 2003). Achieving the Promise: Transforming Mental 

Health Care in America. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health

Services Administration.

54 Institute of Medicine Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders 

(2006). Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. 

Washington, DC: National Academies Press.

55 National Quality Forum (2007). National Voluntary Consensus Standards for the Treatment of Substance Use 

Conditions: Evidence-Based Treatment Practices. Washington, DC: National Quality Forum.

56http://psychiatryonline.org/

57 http://store.samhsa.gov

58 http://store.samhsa.gov/shin/content//SMA08-4367/HowtoUseEBPKITS-ITC.pdf
47

developed to help move the latest information available on effective behavioral health practices 

into community-based service delivery. States, communities, administrators, practitioners, 

consumers of mental health care, and their family members can use KIT to design and 

implement behavioral health practices that work. KIT, part of SAMHSA’s priority initiative on 

Behavioral Health Workforce in Primary and Specialty Care Settings, covers getting started, 

building the program, training frontline staff, and evaluating the program. The KITs contain 

information sheets, introductory videos, practice demonstration videos, and training manuals. 

Each KIT outlines the essential components of the evidence-based practice and provides 

suggestions collected from those who have successfully implemented them.

SAMHSA is interested in whether and how states are using evidence in their purchasing

decisions, educating policymakers, or supporting providers to offer high quality services. In

addition, SAMHSA is concerned with what additional information is needed by SMHAs and 

SSAs in their efforts to continue to shape their and other purchasers’ decisions regarding M/SUD

services. 

Please respond to the following items:

1. Is information used regarding evidence-based or promising practices in your purchasing or 

policy decisions? Yes No

2. Which value based purchasing strategies do you use in your state (check all that apply):

a) Leadership support, including investment of human and financial resources.

b) Use of available and credible data to identify better quality and monitored the impact 

of quality improvement interventions.

c) Use of financial and non-financial incentives for providers or consumers.

d) Provider involvement in planning value-based purchasing.

e) Use of accurate and reliable measures of quality in payment arrangements.

f) Quality measures focus on consumer outcomes rather than care processes.

g) Involvement in CMS or commercial insurance value based purchasing programs 

(health homes, ACO, all payer/global payments, pay for performance (P4P)).

h) The state has an evaluation plan to assess the impact of its purchasing decisions.

3. Does the state have any activities related to this section that you would like to highlight?

Please indicate areas of technical assistance needed related to this section.

 
48

4. Evidence-Based Practices for Early Interventions to Address Early Serious Mental 

Illness (ESMI)-10 percent set aside - Required MHBG

Much of the mental health treatment and recovery are focused on the later stages of illness, 

intervening only when things have reached the level of a crisis. While this kind of treatment is 

critical, it is also costly in terms of increased financial burdens for public mental health systems,

lost economic productivity, and the toll taken on individuals and families. There are growing 

concerns among consumers and family members that the mental health system needs to do more 

when people first experience these conditions to prevent long-term adverse consequences. Early 

intervention* is critical to treating mental illness before it can cause tragic results like serious 

impairment, unemployment, homelessness, poverty, and suicide. The duration of untreated 

mental illness, defined as the time interval between the onset of a mental disorder and when an 

individual gets into treatment, has been a predictor of outcome across different mental illnesses. 

Evidence indicates that a prolonged duration of untreated mental illness may be viewed as a 

negative prognostic factor for those who are diagnosed with mental illness. Earlier treatment and 

interventions not only reduce acute symptoms, but may also improve long-term prognosis.

States may implement models that have demonstrated efficacy, including the range of services 

and principles identified by National Institute of Mental Health (NIMH) via its Recovery After 

an Initial Schizophrenia Episode (RAISE) initiative. Utilizing these principles, regardless of the 

amount of investment, and by leveraging funds through inclusion of services reimbursed by 

Medicaid or private insurance, states should move their system to address the needs of 

individuals with a first episode of psychosis (FEP). NIMH sponsored a set of studies beginning 

in 2008, focusing on the early identification and provision of evidence-based treatments to 

persons experiencing FEP the RAISE model). The NIMH RAISE studies, as well as similar 

early intervention programs tested worldwide, consist of multiple evidence-based treatment 

components used in tandem as part of a CSC model, and have been shown to improve symptoms, 

reduce relapse, and improved outcomes. 

State shall expend not less than 10 percent of the amount the State receives for carrying out this 

section for each fiscal year to support evidence-based programs that address the needs of 

individuals with early serious mental illness, including psychotic disorders, regardless of the age 

of the individual at onset. In lieu of expending 10 percent of the amount the State receives under 

this section for a fiscal year as required a state may elect to expend not less than 20 percent of 

such amount by the end of such succeeding fiscal year.

* MHBG funds cannot be used for primary prevention activities. States cannot use MHBG funds 

for prodromal symptoms (specific group of symptoms that may precede the onset and diagnosis 

of a mental illness) and/or those who are not diagnosed with a SMI.
49

1. Does the state have policies for addressing early serious mental illness (ESMI)?

Yes No

2. Has the state implemented any evidence-based practices (EBPs) for those with ESMI 

Yes No

If yes, please list the EBPs and provide a description of the programs that the state currently 

funds to implement evidence-based practices for those with ESMI

3. How does the state promote the use of evidence-based practices for individuals with ESMI and 

provide comprehensive individualized treatment or integrated mental and physical health 

services?

4. Does the state coordinate across public and private sector entities to coordinate treatment and 

recovery supports for those with a FEP ESMI?

Yes No

5. Does the state collect data specifically related to FEP ESMI?

Yes No

6. Does the state provide trainings to increase capacity of providers to deliver interventions 

related to ESMI?

Yes No

7. Please provide an updated description of the state’s chosen EBPs for the 10 percent set-aside 

for ESMI.

8. Please describe the planned activities for FFY 2018 and FFY 2019 for your state’s ESMI 

programs including psychosis?
50

9. Please explain the state’s provision for collecting and reporting data, demonstrating the impact 

of the 10 percent set-aside for ESMI.

10. Please list the diagnostic categories identified for your state’s ESMI programs

Please indicate area of technical assistance needed related to this section.

5. Person Centered Planning (PCP) –Required (MHBG)

States must engage adults with a serious mental illness or children with a serious emotional 

disturbance and their caregivers where appropriate in making health care decisions, including 

activities that enhance communication among individuals, families, caregivers, and treatment 

providers. Person-centered planning is a process through which individuals develop their plan of 

service. The PCP may include a representative who the person has freely chosen, and/or who is 

authorized to make personal or health decisions for the person. The PCP may include family 

members, legal guardians, friends, caregivers and others that the person or his/her representative 

wishes to include. The PCP should involve the person receiving services and supports to the 

maximum extent possible, even if the person has a legal representative. The PCP approach 

identifies the person’s strengths, goals, preferences, needs and desired outcome. The role of state 
51

and agency workers (for example, options counselors, support brokers, social workers, peer 

support workers, and others) in the PCP process is to enable and assist people to identify and 

access a unique mix of paid and unpaid services to meet their needs and provide support during 

planning. The person’s goals and preferences in areas such as recreation, transportation, 

friendships, therapies, home, employment, family relationships, and treatments are part of a 

written plan that is consistent with the person’s needs and desires.

1. Does your state have policies related to person centered planning? Yes No

2. If no, describe any action steps planned by the state in developing PCP initiatives in the 

future.

3. Describe how the state engages consumers and their caregivers in making health care 

decisions, and enhance communication.

4. Describe the person-centered planning process in your state.

6. Self-Direction - Requested

In self-direction - also known as self-directed care - a service user or “participant” controls a 

flexible budget, purchasing goods and services to achieve personal recovery goals developed 

through a person-centered planning process. While this is not an allowable use of Block Grant 

Funds, the practice has shown to provide flexible supports for an individual’s service. The selfdirection budget may comprise the service dollars that would have been used to reimburse an 

individual’s traditional mental health care, or it may be a smaller fixed amount that supplements 

a mental health benefit. In self-direction, the participant allocates the budget in a manner of his 

or her choosing within program guidelines. The participant is encouraged to think creatively 

about setting goals and is given a significant amount of freedom to work toward those goals. 

Purchases can range from computers and bicycles to dental care and outpatient mental health 

treatment. 

Typically, a specially trained coach or broker supports the participant to identify resources, chart 
52

progress, and think creatively about the planning and budgeting processes. Often a peer 

specialist who has received additional training in self-direction performs the broker role. The 

broker or a separate agency assists the participant with financial management details such as 

budget tracking, holding and disbursing funds, and hiring and payroll logistics. Self-direction 

arrangements take different forms throughout the United States and are housed and administered 

in a variety of entities, including county and state behavioral health authorities, managed care 

companies, social service agencies, and advocacy organizations.

Self-direction is based on the premise that people with disabilities can and should make their 

own decisions about the supports and services they receive. Hallmarks of self-direction include 

voluntary participation, individual articulation of preferences and choices, and participant 

responsibility. In recent years, physical and mental health service systems have placed 

increasing emphasis on person-centered approaches to service delivery and organization. In this 

context, self-direction has emerged as a promising practice to support recovery and well-being 

for persons with mental health conditions. A small but growing evidence base has documented 

self-direction’s impact on quality of life, community tenure, and psychological well-being.

Please respond to the following:

1. Does your state have policies related to self-direction?

Yes No

2. Are there any concretely planned initiatives in your state specific to self-direction? 

Yes No

If yes, describe the current or planned initiative. In particular, please answer the 

following questions:

a. How is the initiative financed?

b. What are the eligibility criteria?

c. How are budgets set, and what is the scope of the budget?
53

d. What role, if any, do peers with lived experience of the mental health system play in 

the initiative?

e. What, if any, research and evaluation activities are connected to the initiative?

f. If no, describe any action steps planned by the state in developing self-direction 

initiatives in the future.

7. Program Integrity - Required 

SAMHSA has placed a strong emphasis on ensuring that block grant funds are expended in a

manner consistent with the statutory and regulatory framework. This requires that SAMHSA

and the states have a strong approach to assuring program integrity. Currently, the primary 

goals of SAMHSA program integrity efforts are to promote the proper expenditure of block 

grant funds, improve block grant program compliance nationally, and demonstrate the effective

use of block grant funds. 

While some states have indicated an interest in using block grant funds for individual co-pays 

deductibles and other types of co-insurance for behavioral health services, SAMHSA reminds 

states of restrictions on the use of block grant funds outlined in 42 U.S.C. §§ 300x–5 and 300x31, including cash payments to intended recipients of health services and providing financial 

assistance to any entity other than a public or nonprofit private entity. Under 42 U.S.C. § 300x–

55(g), SAMHSA periodically conducts site visits to MHBG and SABG grantees to evaluate 

program and fiscal management. States will need to develop specific policies and procedures for 

assuring compliance with the funding requirements. Since MHBG funds can only be used for 

authorized services made available to adults with SMI and children with SED and SABG funds 

can only be used for individuals with or at risk for SUD. SAMHSA guidance on the use of block

grant funding for co-pays, deductibles, and premiums can be found at: 

http://www.samhsa.gov/sites/default/files/grants/guidance-for-block-grant-funds-for-cost-
54

sharing-assistance-for-private-health-insurance.pdf. States are encouraged to review the 

guidance and request any needed technical assistance to assure the appropriate use of such funds. 

The MHBG and SABG resources are to be used to support, not supplant, services that will be

covered through the private and public insurance. In addition, SAMHSA will work with CMS 

and states to identify strategies for sharing data, protocols, and information to assist our

program integrity efforts. Data collection, analysis, and reporting will help to ensure that 

MHBG and SABG funds are allocated to support evidence-based, culturally competent 

programs, substance use disorder prevention, treatment and recovery programs, and activities 

for adults with SMI and children with SED. 

States traditionally have employed a variety of strategies to procure and pay for behavioral 

health services funded by the MHBG and SABG. State systems for procurement, contract 

management, financial reporting, and audit vary significantly. These strategies may include:

(1) appropriately directing complaints and appeals requests to ensure that QHPs and Medicaid 

programs are including essential health benefits (EHBs) as per the state benchmark plan; (2)

ensuring that individuals are aware of the covered M/SUD benefits; (3) ensuring that 

consumers of M/SUD services have full confidence in the confidentiality of their medical 

information; and (4) monitoring the use of behavioral health benefits in light of utilization 

review, medical necessity, etc. Consequently, states may have to become more proactive in 

ensuring that state-funded providers are enrolled in the Medicaid program and have the ability

to determine if clients are enrolled or eligible to enroll in Medicaid. Additionally, compliance

review and audit protocols may need to be revised to provide for increased tests of client 

eligibility and enrollment.

Please respond to the following:

1) Does the state have a specific policy and/or procedure for assuring that the federal program 

requirements are conveyed to intermediaries and providers? Yes No

2) Does the state provide technical assistance to providers in adopting practices that promote 

compliance with program requirements, including quality and safety standards?

Yes No

3) Does the state have any activities related to this section that you would like to highlight?

Please indicate areas of technical assistance needed related to this section. 
55

8. Tribes - Requested

The federal government has a unique obligation to help improve the health of American 

Indians and Alaska Natives through the various health and human services programs 

administered by HHS. Treaties, federal legislation, regulations, executive orders, and 

Presidential memoranda support and define the relationship of the federal government with 

federally recognized tribes, which is derived from the political and legal relationship that

Indian tribes have with the federal government and is not based upon race. SAMHSA is 

required by the 2009 Memorandum on Tribal Consultation59 to submit plans on how it will 

engage in regular and meaningful consultation and collaboration with tribal officials in the

development of federal policies that have tribal implications. 

Improving the health and well-being of tribal nations is contingent upon understanding their

specific needs. Tribal consultation is an essential tool in achieving that understanding. 

Consultation is an enhanced form of communication, which emphasizes trust, respect, and 

shared responsibility. It is an open and free exchange of information and opinion among

parties, which leads to mutual understanding and comprehension. Consultation is integral to a

deliberative process that results in effective collaboration and informed decision-making with 

the ultimate goal of reaching consensus on issues. 

In the context of the block grant funds awarded to tribes, SAMHSA views consultation as a 

government-to-government interaction and should be distinguished from input provided by

individual tribal members or services provided for tribal members whether on or off tribal 

lands. Therefore, the interaction should be attended by elected officials of the tribe or their

designees and by the highest possible state officials. As states administer health and human 

services programs that are supported with federal funding, it is imperative that they consult with 

tribes to ensure the programs meet the needs of the tribes in the state. In addition to general 

stakeholder consultation, states should establish, implement, and document a process for

consultation with the federally recognized tribal governments located within or governing tribal 

lands within their borders to solicit their input during the block grant planning process. 

Evidence that these actions have been performed by the state should be reflected throughout the

state’s plan. Additionally, it is important to note that approximately 70 percent of American

Indians and Alaska Natives do not live on tribal lands. The SMHAs, SSAs, and tribes should 

collaborate to ensure access and culturally competent care for all American Indians and Alaska 

Natives in the states. 

States shall not require any tribe to waive its sovereign immunity in order to receive funds or

for services to be provided for tribal members on tribal lands. If a state does not have any

federally recognized tribal governments or tribal lands within its borders, the state should make

a declarative statement to that effect. 

 

59 http://www.whitehouse.gov/the-press-office/memorandum-tribal-consultation-signed-president
56

Please respond to the following items:

1. How many consultation sessions have the state conducted with federally recognized tribes?

2. What specific concerns were raised during the consultation session(s) noted above?

Does the state have any activities related to this section that you would like to highlight?

Please indicate areas of technical assistance needed related to this section.

9. Primary Prevention-required (SABG only)

SABG statute requires states to spend not less than 20 percent of their SABG allotment on 

primary prevention strategies directed at individuals not identified to be in need of treatment. 

While primary prevention set-aside funds must be used to fund strategies that have a positive 

impact on the prevention of substance use, it is important to note that many evidence-based 

substance use disorder prevention strategies also have a positive impact on other health and 

social outcomes such as education, juvenile justice involvement, violence prevention, and mental 

health.

The SABG statute requires states to develop a comprehensive primary prevention program that 
57

includes activities and services provided in a variety of settings. The program must target both 

the general population and sub-groups that are at high risk for substance misuse. The program 

must include, but is not limited to, the following strategies:

1. Information dissemination providing awareness and knowledge of the nature, extent, and 

effects of alcohol, tobacco, and drug use, abuse, and addiction on individuals families and 

communities;

2. Education aimed at affecting critical life and social skills, such as decision making, refusal 

skills, critical analysis, and systematic judgment abilities;

3. Alternative programs that provide for the participation of target populations in activities 

that exclude alcohol, tobacco, and other drug use;

4. Problem identification and referral that aims at identification of those who have indulged in 

illegal/age inappropriate use of tobacco or alcohol, and those individuals who have indulged 

in first use of illicit drugs, in order to assess if the behavior can be reversed by education to 

prevent further use;

5. Community-based processes that include organizing, planning, and enhancing effectiveness 

of program, policy, and practice implementation, interagency collaboration, coalition 

building, and networking; and 

6. Environmental strategies that establish or change written and unwritten community

standards, codes, and attitudes, thereby influencing incidence and prevalence of the abuse of 

alcohol, tobacco and other drugs used in the general population.

In implementing the comprehensive primary prevention program, states should use a variety of 

strategies that target populations with different levels of risk, including the IOM classified 

universal, selective, and indicated strategies.

Please respond to the following questions:

Assessment

1. Does your state have an active State Epidemiological and Outcomes Workgroup (SEOW)?

a) Yes No

2. Does your state collect the following types of data as part of its primary prevention needs 

assessment process? (check all that apply):

a) Data on consequences of substance-using behaviors

b) Substance-using behaviors

c) Intervening variables (including risk and protective factors)

d) Other (please list :)
58

3. Does your state collect needs assessment data that include analysis of primary prevention 

needs for the following population groups? (check all that apply):

a) Children (under age 12)

b) Youth (ages 12-17)

c) Young adults/college age (ages 18-26)

d) Adults (ages 27-54)

e) Older adults (age 55 and above)

f) Cultural/ethnic minorities

g) Sexual/gender minorities

h) Rural communities

i) Other (please list :)

4. Does your state use data from the following sources in its primary prevention needs 

assessment? (check all that apply):

a) Archival indicators (Please list :)

b) National Survey on Drug Use and Health (NSDUH)

c) Behavioral Risk Factor Surveillance System (BRFSS)

d) Youth Risk Behavior Surveillance System (YRBS)

e) Monitoring the Future

f) Communities that Care

g) State-developed survey instrument) 

h) Other (please list :)
59

5. Does your state use needs assessment data to make decisions about the allocation of SABG 

primary prevention funds? 

a) Yes No

i) If yes, (if yes, please explain

ii) If no, please explain how SABG funds are allocated:

Capacity Building

6. Does your state have a statewide licensing or certification program for the substance use 

disorder prevention workforce?

a) Yes (if yes, please describe)

b) No

7. Does your state have a formal mechanism to provide training and technical assistance to the 

substance use disorder prevention workforce?

a) Yes (if yes, please describe mechanism used)

b) No
60

8. Does your state have a formal mechanism to assess community readiness to implement 

prevention strategies?

a) Yes (if yes, please describe mechanism used :)

b) No

Planning

9. Does your state have a strategic plan that addresses substance use disorder prevention that 

was developed within the last five years?

a) Yes (If yes, please attach the plan in BGAS)

b) No

10. Does your state use the strategic plan to make decisions about use of the primary prevention 

set-aside of the SABG?

a) Yes No

Not applicable (no prevention strategic plan)

11. Does your state’s prevention strategic plan include the following components? (check all 

that apply):

a) Based on needs assessment datasets the priorities that guide the allocation of 

SABG primary prevention funds

b) Timelines

c) Roles and responsibilities

d) Process indicators

e) Outcome indicators

f) Cultural competence component

g) Sustainability component

h) Other (please list:)

i) Not applicable/no prevention strategic plan

12. Does your state have an Advisory Council that provides input into decisions about the use of 

SABG primary prevention funds?

a) Yes No
61

13. Does your state have an active Evidence-Based Workgroup that makes decisions about 

appropriate strategies to be implemented with SABG primary prevention funds? 

a) Yes No 

b) If yes, please describe the criteria the Evidence-Based Workgroup uses to determine 

which programs, policies, and strategies are evidence based?

Implementation

14. States distribute SABG primary prevention funds in a variety of different ways. Please check 

all that apply to your state:

a) SSA staff directly implements primary prevention programs and strategies.

b) The SSA has statewide contracts (e.g. statewide needs assessment contract, statewide 

workforce training contract, statewide media campaign contract).

c) The SSA funds regional entities that are autonomous in that they issue and manage 

their own sub-contracts.

d) The SSA funds regional entities that provide training and technical assistance.

e) The SSA funds regional entities to provide prevention services.

f) The SSA funds county, city, or tribal governments to provide prevention services.

g) The SSA funds community coalitions to provide prevention services.

h) The SSA funds individual programs that are not part of a larger community effort.

i) The SSA directly funds other state agency prevention programs.

j) Other (please describe)

15. Please list the specific primary prevention programs, practices, and strategies that are funded 

with SABG primary prevention dollars in each of the six prevention strategies. Please see 

the introduction above for definitions of the six strategies:

a) Information Dissemination: 

b) Education: 
62

c) Alternatives:

 

d) Problem Identification and Referral:

e) Community-Based Processes:

e) Environmental: 

16. Does your state have a process in place to ensure that SABG dollars are used only to fund 

primary prevention services not funded through other means? 

a) Yes (if so, please describe:)

b) No 

Evaluation

17. Does your state have an evaluation plan for substance use disorder prevention that was 

developed within the last five years?

a) Yes (If yes, please attach the plan in BGAS)

b) No 

18. Does your state’s prevention evaluation plan include the following components? (check all 

that apply):

a) Establishes methods for monitoring progress towards outcomes, such as targeted 

benchmarks
63

b) Includes evaluation information from sub-recipients

c) Includes SAMHSA National Outcome Measurement (NOMs) requirements

d) Establishes a process for providing timely evaluation information to stakeholders

e) Formalizes processes for incorporating evaluation findings into resource allocation 

and decision-making

f) Other (please describe:)

g) Not applicable/no prevention evaluation plan

19. Please check those process measures listed below that your state collects on its SABG funded 

prevention services:

a) Numbers served

b) Implementation fidelity

c) Participant satisfaction

d) Number of evidence based programs/practices/policies implemented

e) Attendance

f) Demographic information

g) Other (please describe:)

20. Please check those outcome measures listed below that your state collects on its SABG 

funded prevention services:

a) 30-day use of alcohol, tobacco, prescription drugs, etc...

b) Heavy use

Binge use

Perception of harm

c) Disapproval of use

d) Consequences of substance use (e.g. alcohol-related motor vehicle crashes, drugrelated mortality)

e) Other (please describe:)
64

10. Statutory Criterion for MHBG (Required MHBG)

Criterion 1: Comprehensive Community-Based Mental Health Service Systems

Provides for the establishment and implementation of an organized community-based system of 

care for individuals with mental illness, including those with co-occurring mental and substance 

use disorders. Describes available services and resources within a comprehensive system of 

care, provided with federal, state, and other public and private resources, in order to enable such 

individual to function outside of inpatient or residential institutions to the maximum extent of 

their capabilities.

1. Describe available services and resources in order to enable individuals with mental illness, 

including those with co-occurring mental and substance use disorders to function outside of 

inpatient or residential institutions to the maximum extent of their capabilities.

2. Does your state provide the following services under comprehensive community-based mental 

health service systems?

a) Physical health

Yes No

b) Mental Health

Yes No

c) Rehabilitation services

Yes No

d) Employment services

Yes No

e) Housing services

Yes No

f) Educational services

Yes No

g) Substance misuse prevention and SUD treatment services

Yes No

h) Medical and dental services

Yes No

i) Support services

Yes No

j) Services provided by local school systems under the Individuals with Disabilities 

Education Act (IDEA)
65

Yes No

k) Services for persons with co-occurring M/SUDs

Yes No

Please describe as needed (for example, best practices, service needs, concerns, etc.)

3. Describe your state’s case management services 

4. Describe activities intended to reduce hospitalizations and hospital stays.

Criterion 2: Mental Health System Data Epidemiology

Contains an estimate of the incidence and prevalence in the state of SMI among adults and SED 

among children; and have quantitative targets to be achieved in the implementation of the system 

of care described under Criterion 1.

In order to complete column B of the table, please use the most recent SAMHSA prevalence 

estimate or other federal/state data that describes the populations of focus. 

Column C requires that the state indicate the expected incidence rate of individuals with 

SMI/SED who may require services in the state’s behavioral health system 

MHBG Estimate of statewide prevalence and incidence rates of individuals with SMI/SED

Target Population (A) Statewide prevalence (B) Statewide incidence (C)

1. Adults with SMI
66

2. Children with SED

Describe the process by which your state calculates prevalence and incidence rates and provide 

an explanation as to how this information is used for planning purposes. If your state does not 

calculate these rates, but obtains them from another source, please describe. If your state does 

not use prevalence and incidence rates for planning purposes, indicate how system planning 

occurs in their absence. 

Criterion 3: Children’s Services

Provides for a system of integrated services in order for children to receive care for their multiple 

needs. Does your state integrate the following services into a comprehensive system of care?

a) Social Services

Yes No

b) Educational services, including services provided under IDE

Yes No

c) Juvenile justice services

Yes No

d) Substance misuse prevention and SUD treatment services

Yes No

e) Health and mental health services

Yes No

f) Establishes defined geographic area for the provision of the services of such system

Yes No

Criterion 4: Targeted Services to Rural and Homeless Populations and to Older Adults

Provides outreach to and services for individuals who experience homelessness; communitybased services to individuals in rural areas; and community-based services to older adults.

Describe your state’s targeted services to rural and homeless populations and to older adults
67

Criterion 5: Management Systems

States describe their financial resources, staffing, and training for mental health services 

providers necessary for the plan; provides for training of providers of emergency health services 

regarding SMI and SED; and how the state intends to expend this grant for the fiscal years 

involved.

Describe your state’s management systems.

11. Substance Use Disorder Treatment - Required SABG

Criterion 1: Prevention and Treatment Services - Improving Access and Maintaining a 

Continuum of Services to Meet State Needs. 

Improving access to treatment services

1. Does your state provide:

a) A full continuum of services:

i) Screening

Yes No

ii) Education

Yes No

iii) Brief intervention

Yes No

iv) Assessment

Yes No

v) Detox (inpatient/social)

Yes No

vi) Outpatient

Yes No

vii)Intensive outpatient

Yes No

viii) Inpatient/residential

Yes No

ix) Aftercare; recovery support

Yes No
68

b) Are you considering any of the following: 

Targeted services for veterans

Yes No

c) Expansion of services for:

(1) Adolescents

(a) Yes No

(2) Older adults

(a) Yes No

(3) Medication-Assisted Treatment (MAT)

(a) Yes No

Criterion2: Improving Access and Addressing Primary Prevention – see Section 8

Criterion 3: Pregnant Women and Women with Dependent Children (PWWDC)

1. Does your state meet the performance requirement to establish and or maintain new 

programs or expand programs to ensure treatment availability?

a) Yes No

2. Either directly or through an arrangement with public or private nonprofit entities make 

prenatal care available to PWWDC receiving services?

a) Yes No

3. Have an agreement to ensure pregnant women are given preference in admission to treatment 

facilities or make available interim services within 48 hours, including prenatal care?

a) Yes No

4. Does your state have an arrangement for ensuring the provision of required supportive 

services?

a) Yes No

5. Are you considering any of the following:

a) Open assessment and intake scheduling

Yes No

b) Establishment of an electronic system to identify available treatment slots

Yes No

 c) Expanded community network for supportive services and healthcare

Yes No

d) Inclusion of recovery support services
69

Yes No

e) Health navigators to assist clients with community linkages

Yes No

f) Expanded capability for family services, relationship restoration, custody issue

Yes No

g) Providing employment assistance

Yes No

h) Providing transportation to and from services

Yes No

i) Educational assistance

Yes No

6. States are required to monitor program compliance related to activities and services for 

PWWDC. Please provide a detailed description of the specific strategies used by the state to 

identify compliance issues and corrective actions required to address identified problems.

Criterion 4, 5 and 6: Persons Who Inject Drugs (PWID), Tuberculosis (TB), Human 

Immunodeficiency Virus (HIV), Hypodermic Needle Prohibition, and Syringe Services 

Program

Persons Who Inject Drugs (PWID)

1. Does your state fulfill the 

a) 90 percent capacity reporting requirement

Yes No

b) 14-120 day performance requirement with provision of interim services

Yes No

c) Outreach activities

Yes No

d) Syringe services programs

Yes No

e) Monitoring requirements as outlined in the authorizing statute and implementing 

regulation

Yes No

2. Are you considering any of the following:

a) Electronic system with alert when 90 percent capacity is reached

Yes No 

b) Automatic reminder system associated with 14-120 day performance requirement
70

Yes No 

c) Use of peer recovery supports to maintain contact and support

Yes No

d) Service expansion to specific populations (military families, veterans, adolescents, older 

adults)

Yes No

3. States are required to monitor program compliance related to activities and services for 

PWID. Please provide a detailed description of the specific strategies used by the state to 

identify compliance issues and corrective actions required to address identified problems.

Tuberculosis (TB)

1. Does your state currently maintain an agreement, either directly or through arrangements 

with other public and nonprofit private entities to make available tuberculosis services to 

individuals receiving SUD treatment and to monitor the service delivery?

a) Yes No

2. Are you considering any of the following:

a) Business agreement/MOU with primary healthcare providers

Yes No 

b) Cooperative agreement/MOU with public health entity for testing and treatment

Yes No

c) Established co-located SUD professionals within FQHCs

Yes No

3. States are required to monitor program compliance related to tuberculosis services made 

available to individuals receiving SUD treatment. Please provide a detailed description of 

the specific strategies used by the state to identify compliance issues and corrective actions 

required to address identified problems.
71

Early Intervention Services for HIV (For “Designated States” Only)

1. Does your state current have an agreement to provide treatment for persons with substance 

use disorders with an emphasis on making available within existing programs early 

intervention services for HIV in areas that have the greatest need for such services and 

monitoring such service delivery?

Yes No

2. Are you considering any of the following:

a) Establishment of EIS-HIV service hubs in rural areas

Yes No

b) Establishment or expansion of tele-health and social media support services

Yes No

c) Business agreement/MOU with established community agencies/organizations serving 

persons with HIV/AIDS

Yes No

Syringe Service Programs 

1. Does your state have in place an agreement to ensure that SABG funds are NOT expended to 

provide individuals with hypodermic needles or syringes (42 U.S.C.§ 300x-31(a)(1)F)?

Yes No

2) Do any of the programs serving PWID have an existing relationship with a Syringe Services 

(Needle Exchange) Program

Yes No

3) Do any of your programs use SABG funds to support elements of a Syringe Services 

Program

a) Yes No

b) If yes, please provide a brief description of the elements and the arrangement

Criterion 8, 9 and 10: Service System Needs, Service Coordination, Charitable Choice, 

Referrals, Patient Records, and Independent Peer Review

Service System Needs

1. Does your state have in place an agreement to ensure that the state has conducted a statewide

assessment of need, which defines prevention, and treatment authorized services available, 

identified gaps in service, and outlines the state’s approach for improvement?
72

Yes No

2. Are you considering any of the following:

a) Workforce development efforts to expand service access

Yes No

b) Establishment of a statewide council to address gaps and formulate a strategic plan to 

coordinate services

Yes No

c) Establish a peer recovery support network to assist in filling the gaps

Yes No

d) Incorporate input from special populations (military families, service members, veterans, 

tribal entities, older adults, sexual and gender minorities)

Yes No

e) Formulate formal business agreements with other involved entities to coordinate services 

to fill gaps in the system, i.e. primary healthcare, public health, VA, community 

organizations

Yes No

f) Explore expansion of services for:

i) MAT

(1) Yes No

ii) Tele-health

(1) Yes No

iii) Social media outreach

(1) Yes No

Service Coordination

1. Does your state have a current system of coordination and collaboration related to the 

provision of person-centered and person-directed care?

Yes No

2. Are you considering any of the following:

a) Identify MOUs/Business Agreements related to coordinate care for persons receiving 

SUD treatment and/or recovery services

Yes No

b) Establish a program to provide trauma-informed care

Yes No
73

c) Identify current and perspective partners to be included in building a system of care, e.g.,

FQHCs, primary healthcare, recovery community organizations, juvenile justice system, 

adult criminal justice system, and education

Yes No

Charitable Choice

1. Does your state have in place an agreement to ensure the system can comply with the 

services provided by nongovernment organizations (42 U.S.C.§ 300x-65, 42 CF Part 54

(§54.8(b) and §54.8(c)(4)) and 68 FR 56430-56449)

Yes No

2. Are you considering any of the following:

a) Notice to Program Beneficiaries

Yes No

b) Develop an organized referral system to identify alternative providers

Yes No

c) Develop a system to maintain a list of referrals made by religious organizations

Yes No

Referrals

1. Does your state have an agreement to improve the process for referring individuals to the 

treatment modality that is most appropriate for their needs

Yes No

2. Are you considering any of the following:

a) Review and update of screening and assessment instruments

Yes No

b) Review of current levels of care to determine changes or additions

Yes No

c) Identify workforce needs to expand service capabilities

Yes No

d) Conduct cultural awareness training to ensure staff sensitivity to client cultural 

orientation, environment, and background

Yes No

Patient Records

1. Does your state have an agreement to ensure the protection of client records

a) Yes No
74

2. Are you considering any of the following:

a) Training staff and community partners on confidentiality requirements

Yes No

b) Training on responding to requests asking for acknowledgement of the presence of clients

Yes No

c) Updating written procedures which regulate and control access to records

Yes No

d) Review and update of the procedure by which clients are notified of the confidentiality of 

their records include the exceptions for disclosure

Yes No

Independent Peer Review

1. Does your state have an agreement to assess and improve, through independent peer review, 

the quality and appropriateness of treatment services delivered by providers

a) Yes No

2. Section 1943(a) of Title XIX, Part B, Subpart III of the Public Health Service Act (42 

U.S.C.§ 300x-52(a)) and 45 § CFR 96.136 require states to conduct independent peer review 

of not fewer than 5 percent of the block grant sub-recipients providing services under the 

program involved.

a) Please provide an estimate of the number of block grant sub-recipients identified to 

undergo such a review during the fiscal year(s) involved 

3. Are you considering any of the following:

a) Development of a quality improvement plan

Yes No

b) Establishment of policies and procedures related to independent peer review

Yes No

c) Develop long-term planning for service revision and expansion to meet the needs of 

specific populations

Yes No

4. Does your state require a block grant sub-recipient to apply for and receive accreditation 

from an independent accreditation organization, e.g., Commission on the Accreditation of 

Rehabilitation Facilities (CARF), The Joint Commission, or similar organization as an 

eligibility criterion for block grant funds?

a) Yes No

b) If Yes, please identify the accreditation organization(s)
75

i) Commission on the Accreditation of Rehabilitation Facilities

ii) The Joint Commission

iii) Other (please specify)

Criterion 7 and 11: Group Homes for Persons In Recovery and Professional Development 

Group Homes

1. Does your state have an agreement to provide for and encourage the development of group 

homes for persons in recovery through a revolving loan program?

Yes No

2. Are you considering any of the following:

a) Implementing or expanding the revolving loan fund to support recovery home 

development as part of the expansion of recovery support service

Yes No

b) Implementing MOUs to facilitate communication between block grant service providers 

and group homes to assist in placing clients in need of housing

Yes No

Professional Development

1. Does your state have an agreement to ensure that prevention, treatment and recovery 

personnel operating in the state’s substance use disorder prevention, treatment and recovery 

systems have an opportunity to receive training on an ongoing basis, concerning:

a) Recent trends in substance use disorders in the state

Yes No

b) Improved methods and evidence-based practices for providing substance use disorder 

prevention and treatment services

Yes No

c) Performance-based accountability

Yes No

d) Data collection and reporting requirements

Yes No

2. Are you considering any of the following:

a) A comprehensive review of the current training schedule and identification of additional

training needs

Yes No
76

b) Addition of training sessions designed to increase employee understanding of recovery

support services

Yes No

c) Collaborative training sessions for employees and community agencies’ staff to 

coordinate and increase integrated services

Yes No

d) State office staff training across departments and divisions to increase staff knowledge of 

programs and initiatives, which contribute to increased collaboration and decreased 

duplication of effort

Yes No

Waivers

Upon the request of a state, the Secretary may waive the requirements of all or part of the 

sections 1922(c), 1923, 1924 and 1928 (42 U.S.C. § 300x-32(f)).

1. Is your state considering requesting a waiver of any requirements related to:

a) Allocations Regarding Women

Yes No

2. Requirements Regarding Tuberculosis Services and Human Immunodeficiency Virus

a) Tuberculosis

Yes No

b) Early Intervention Services Regarding HIV

Yes No

3. Additional Agreements

a) Improvement of Process for Appropriate Referrals for Treatment

Yes No

b) Professional Development

Yes No

c) Coordination of Various Activities and Services

Yes No

Please provide a link to the state administrative regulations, which govern the Mental 

Health and Substance Use Disorder Programs.
77

12. Quality Improvement Plan- requested

In previous block grant applications, SAMHSA asked states to base their administrative

operations and service delivery on principles of Continuous Quality Improvement/Total Quality

Management (CQI/TQM). These CQI processes should identify and track critical outcomes and 

performance measures, based on valid and reliable data, consistent with the NBHQF, which will 

describe the health and functioning of the mental health and addiction systems. The CQI

processes should continuously measure the effectiveness of services and supports and ensure that 

they continue to reflect this evidence of effectiveness. The state’s CQI process should also track 

programmatic improvements using stakeholder input, including the general population and

individuals in treatment and recovery and their families. In addition, the CQI plan should 

include a description of the process for responding to emergencies, critical incidents, complaints,

and grievances.

1. Has your state modified its CQI plan from FFY 2016-FFY 2017?

a) Yes No

Please indicate areas of technical assistance needed related to this section.

13. Trauma -requested

Trauma60 is a widespread, harmful, and costly public health problem. It occurs because of 

violence, abuse, neglect, loss, disaster, war and other emotionally harmful and/or life threatening 

experiences. Trauma has no boundaries with regard to age, gender, socioeconomic status, race, 

ethnicity, geography, or sexual orientation. It is an almost universal experience of people with 

mental and substance use difficulties. The need to address trauma is increasingly viewed as an 

important component of effective behavioral health service delivery. Additionally, it has become 

evident that addressing trauma requires a multi-pronged, multi-agency public health approach 

inclusive of public education and awareness, prevention and early identification, and effective 

trauma-specific assessment and treatment. To maximize the impact of these efforts, they need to 

be provided in an organizational or community context that is trauma-informed. 

Individuals with experiences of trauma are found in multiple service sectors, not just in 

behavioral health. People in the juvenile and criminal justice system have high rates of mental 

illness and substance use disorders and personal histories of trauma. Children and families in the 

 

60 Definition of Trauma: Individual trauma results from an event, series of events, or set of circumstances that is experienced by 

an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s 

functioning and mental, physical, social, emotional, or spiritual well-being.
78

child welfare system similarly experience high rates of trauma and associated behavioral health 

problems. Many patients in primary, specialty, emergency and rehabilitative health care 

similarly have significant trauma histories, which has an impact on their health and their 

responsiveness to health interventions. Schools are now recognizing that the impact of exposure 

to trauma and violence among their students makes it difficult to learn and meet academic goals. 

Communities and neighborhoods experience trauma and violence. For some these are rare 

events and for others these are daily events that children and families are forced to live with. 

These children and families remain especially vulnerable to trauma-related problems, often are in 

resource poor areas, and rarely seek or receive behavioral health care. States should work with 

these communities to identify interventions that best meet the needs of these residents. 

In addition, the public institutions and service systems that are intended to provide services and 

supports for individuals are often re-traumatizing, making it necessary to rethink doing “business 

as usual.” These public institutions and service settings are increasingly adopting a traumainformed approach. A trauma-informed approach is distinct from trauma-specific assessments 

and treatments. Rather, trauma-informed refers to creating an organizational culture or climate 

that realizes the widespread impact of trauma, recognizes the signs and symptoms of trauma in 

clients and staff, responds by integrating knowledge about trauma into policies and procedures, 

and seeks to actively resist re-traumatizing clients and staff. This approach is guided by key 

principles that promote safety, trustworthiness and transparency, peer support, empowerment, 

collaboration, and sensitivity to cultural and gender issues. A trauma-informed approach may 

incorporate trauma-specific screening, assessment, treatment, and recovery practices or refer 

individuals to these appropriate services. 

It is suggested that states refer to SAMHSA’s guidance for implementing the trauma-informed 

approach discussed in the Concept of Trauma61 paper.

Please consider the following items as a guide when preparing the description of the state’s 

system:

1. Does the state have a plan or policy for behavioral health providers that guide how they will 

address individuals with trauma-related issues? Yes No

2. Does the state provide information on trauma-specific assessment tools and interventions for 

behavioral health providers?

Yes No

3. Does the state have a plan to build the capacity of behavioral health providers and 

organizations to implement a trauma-informed approach to care? 

Yes No

4. Does the state encourage employment of peers with lived experience of trauma in developing 

trauma-informed organizations? 

Yes No

5) Does the state have any activities related to this section that you would like to highlight.

 

61 Ibid
79

Please indicate areas of technical assistance needed related to this section. 

14. Criminal and Juvenile Justice - Requested

More than half of all prison and jail inmates meet criteria for having mental health problems, six 

in ten meet criteria for a substance use problem, and more than one-third meet criteria for having 

co-occurring mental and substance use problems. Youth in the juvenile justice system often 

display a variety of high-risk characteristics that include inadequate family support, school 

failure, negative peer associations, and insufficient use of community-based services. Most 

adjudicated youth released from secure detention do not have community follow-up or

supervision; therefore, risk factors remain unaddressed.

62

Successful diversion of adults and youth from incarceration or re-entering the community from 

detention is often dependent on engaging in appropriate M/SUD treatment. Some states have 

implemented such efforts as mental health, veteran and drug courts, Crisis Intervention 

Training (CIT) and re-entry programs to help reduce arrests, imprisonment and recidivism.

63

A diversion program places youth in an alternative program, rather than processing them in the 

juvenile justice system. States should place an emphasis on screening, assessment, and 

services provided prior to adjudication and/or sentencing to divert persons with M/SUD from 

correctional settings. States should also examine specific barriers such as a lack of

identification needed for enrollment Medicaid and/or Marketplace; loss of eligibility for 

Medicaid resulting from incarceration; and care coordination for individuals with chronic

health conditions, housing instability, and employment challenges. Secure custody rates 

decline when community agencies are present to advocate for alternatives to detention.

The MHBG and SABG may be especially valuable in supporting care coordination to promote

pre-adjudication or pre-sentencing diversion, providing care during gaps in enrollment after

 

62 Journal of Research in Crime and Delinquency: Identifying High-Risk Youth: Prevalence and Patterns of Adolescent Drug

Victims, Judges, and Juvenile Court Reform Through Restorative Justice. Dryfoos, Joy G. 1990, Rottman, David, and Pamela 

Casey, McNiel, Dale E., and Renée L. Binder. OJJDP Model Programs Guide.

63 http://csgjusticecenter.org/mental-health/
80

incarceration, and supporting other efforts related to enrollment. 

Please respond to the following items:

1. Does the state (SMHA and SSA) have a plan for coordinating with the criminal and juvenile 

justice systems on diversion of individuals with mental and/or substance use disorders from 

incarceration to community treatment, and for those incarcerated, a plan for re-entry into the 

community that includes connecting to behavioral health services? 

Yes No

2. Does the state have a plan for working with law enforcement to deploy emerging strategies 

(e.g. civil citations, mobile crisis intervention, behavioral health provider ride-along, CIT, 

linkage with treatment services, etc.) to reduce the number of individuals with mental and/or 

substance use problems in jails and emergency rooms? 

Yes No

3. Does the state provide cross-trainings for behavioral health providers and criminal/juvenile 

justice personnel to increase capacity for working with individuals with behavioral health 

issues involved in the justice system? 

Yes No

4. Does the state have an inter-agency coordinating committee or advisory board that addresses 

criminal and juvenile justice issues and that includes the SMHA, SSA, and other 

governmental and non-governmental entities to address behavioral health and other essential 

domains such as employment, education, and finances?

Yes No

5. Does the state have any activities related to this section that you would like to highlight?

Please indicate areas of technical assistance needed related to this section. 

15. Medication Assisted Treatment - Requested

There is a voluminous literature on the efficacy of medication-assisted treatment (MAT); the use 

of FDA approved medication; counseling; behavioral therapy; and social support services, in the

treatment of substance use disorders. However, many treatment programs in the U.S. offer only 

abstinence-based treatment for these conditions. The evidence base for MAT for SUDs is 
81

described in SAMHSA TIPs 40[1], 43[2], 45[3], and 49[4].

SAMHSA strongly encourages that the states require treatment facilities providing clinical care 

to those with substance use disorders demonstrate that they both have the capacity and staff 

expertise to use MAT or have collaborative relationships with other providers that can provide 

the appropriate MAT services clinically needed.

Individuals with substance use disorders who have a disorder for which there is an FDAapproved medication treatment should have access to those treatments based upon each 

individual patient’s needs.

In addition, SAMHSA also encourages states to require the use of MAT for substance use 

disorders for opioid use, alcohol use, and tobacco use disorders where clinically appropriate.

SAMHSA is asking for input from states to inform SAMHSA’s activities.

Please respond to the following:

1. Has the state implemented a plan to educate and raise awareness within SUD treatment 

programs regarding MAT for substance use disorders?

Yes No

2. Has the state implemented a plan to educate and raise awareness of the use of MAT within

special target audiences, particularly pregnant women?

Yes No

3. Does the state purchase any of the following medication with block grant funds?

a) Methadone

b) Buprenorphine; Buprenorphine/naloxone

c) Disulfiram

d) Acamprosate

e) Naltrexone (oral, IM)

f) Naloxone

4.Does the state have an implemented education or quality assurance program to assure that 

evidence-based MAT with the use of FDA-approved medications for treatment of substance 

use disorders are used appropriately*?

Yes No

5. Does the state have any activities related to this section that you would like to highlight?
82

*Appropriate use is defined as use of medication for the treatment of a substance use disorder, 

combining psychosocial treatments with approved medications, use of peer supports in the 

recovery process, safeguards against misuse and/or diversion of controlled substances used in 

treatment of substance use disorders, and advocacy with state payers.

16. Crisis Services - Requested

In the on-going development of efforts to build an robust system of evidence-based care for 

persons diagnosed with SMI, SED and SUD and their families via a coordinated continuum of 

treatments, services and supports, growing attention is being paid across the country to how 

states and local communities identify and effectively respond to, prevent, manage and help 

individuals, families, and communities recover from behavioral health crises. SAMHSA has 

recently released a publication, Crisis Services Effectiveness, Cost Effectiveness and Funding 

Strategies that states may find helpful.64 SAMHSA has taken a leadership role in deepening the 

understanding of what it means to be in crisis and how to respond to a crisis experienced by 

people with behavioral health conditions and their families. 

According to SAMHSA’s publication, Practice Guidelines: Core Elements for Responding to 

Mental Health Crises65, 

“Adults, children, and older adults with an SMI or emotional disorder often lead 

lives characterized by recurrent, significant crises. These crises are not the 

inevitable consequences of mental disability, but rather represent the combined 

impact of a host of additional factors, including lack of access to essential services 

and supports, poverty, unstable housing, coexisting substance use, other health 

problems, discrimination, and victimization.”

A crisis response system will have the capacity to prevent, recognize, respond, deescalate, and follow-up from crises across a continuum, from crisis planning, to early 

stages of support and respite, to crisis stabilization and intervention, to post-crisis followup and support for the individual and their family. SAMHSA expects that states will 

build on the emerging and growing body of evidence for effective community-based 

crisis-prevention and response systems. Given the multi-system involvement of many 

individuals with behavioral health issues, the crisis system approach provides the 

infrastructure to improve care coordination and outcomes, manage costs, and better invest 

resources. The following are an array of services and supports used to address crisis 

response. Please check those that are used in your state: 

1. Crisis Prevention and Early Intervention

 

64 http://store.samhsa.gov/product/Crisis-Services-Effectiveness-Cost-Effectiveness-and-FundingStrategies/SMA14-4848

65 Practice Guidelines: Core Elements for Responding to Mental Health Crises. HHS Pub. No. SMA-09-4427. 

Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 

2009. http://store.samhsa.gov/product/Core-Elements-for-Responding-to-Mental-Health-Crises/SMA09-4427
83

a) Wellness Recovery Action Plan (WRAP) Crisis Planning

b) Psychiatric Advance Directives

c) Family Engagement

d) Safety Planning

e) Peer-Operated Warm Lines

f) Peer-Run Crisis Respite Programs

g) Suicide Prevention

2. Crisis Intervention/Stabilization:

a) Assessment/Triage (Living Room Model)

b) Open Dialogue

c) Crisis Residential/Respite

d) Crisis Intervention Team/ Law Enforcement

e) Mobile Crisis Outreach

f) Collaboration with Hospital Emergency Departments and Urgent Care 

Systems

3. Post Crisis Intervention/Support:

a) WRAP Post-Crisis

b) Peer Support/Peer Bridgers

c) Follow-Up Outreach and Support

d) Family-to-Family engagement

e) Connection to care coordination and follow-up clinical care for individuals in 

crisis

f) Follow-up crisis engagement with families and involved community members

g) Recovery community coaches/peer recovery coaches

h) Recovery community organization

4. Does the state have any activities related to this section that you would like to 

highlight?

Please indicate areas of technical assistance needed related to this section.

17. Recovery - Required
84

The implementation of recovery supports and services are imperative for providing comprehensive, 

quality behavioral health care. The expansion in access to and coverage for health care compels 

SAMHSA to promote the availability, quality, and financing of vital services and support systems that 

facilitate recovery for individuals. Recovery encompasses the spectrum of individual needs related 

to those with mental disorders and/or substance use disorders. Recovery is supported through 

the key components of: health (access to quality health and behavioral health treatment); home

(housing with needed supports), purpose (education, employment, and other pursuits); and 

community (peer, family, and other social supports). The principles of recovery guide the 

approach to person-centered care that is inclusive of shared decision-making. The continuum of 

care for these conditions includes psychiatric and psychosocial interventions to address acute 

episodes or recurrence of symptoms associated with an individual’s mental or substance use 

disorder. Because mental and substance use disorders are chronic conditions, systems and 

services are necessary to facilitate the initiation, stabilization, and management of long-term 

recovery. 

SAMHSA has developed the following working definition of recovery from mental and/or

substance use disorders: 

Recovery is a process of change through which individuals improve their health and wellness, 

live a self-directed life, and strive to reach their full potential.

In addition, SAMHSA identified 10 guiding principles of recovery:

• Recovery emerges from hope; 

• Recovery is person-driven;

• Recovery occurs via many pathways; 

• Recovery is holistic;

• Recovery is supported by peers and allies;

• Recovery is supported through relationship and social networks; 

• Recovery is culturally-based and influenced;

• Recovery is supported by addressing trauma;

• Recovery involves individuals, families, community strengths, and responsibility;

• Recovery is based on respect.

Please see SAMHSA’s Working Definition of Recovery from Mental Disorders and Substance

Use Disorders.

States are strongly encouraged to consider ways to incorporate recovery support services, 

including peer-delivered services, into their continuum of care. Examples of evidence-based and 

emerging practices in peer recovery support services include, but are not limited to, the 

following:

 Clubhouses

 Drop-in centers

 Recovery community 

Peer-run respite services

 Peer-run crisis diversion 

services

Whole Health Action 

Management (WHAM)

 Shared decision making
85

centers

 Peer specialist

 Peer recovery coaching

 Peer wellness coaching

 Peer health navigators

 Family navigators/parent 

support partners/providers

 Peer-delivered 

motivational interviewing

 Telephone recovery 

checkups

 Warm lines

 Self-directed care

 Supportive housing models

 Evidenced-based supported 

employment

 Wellness Recovery Action 

Planning (WRAP)

 Person-centered planning

 Self-care and wellness 

approaches

 Peer-run Seeking Safety 

groups/Wellness-based 

community campaign

 Room and board when 

receiving treatment

SAMHSA strongly encourages states to take proactive steps to implement recovery support

services. To accomplish this goal and support the wide-scale adoption of recovery supports in 

the areas of health, home, purpose, and community, SAMHSA has launched Bringing Recovery

Supports to Scale Technical Assistance Center Strategy (BRSS TACS). BRSS TACS assists 

states and others to promote adoption of recovery-oriented supports, services, and systems for

people in recovery from substance use and/or mental disorders.

Because recovery is based on the involvement of consumers/peers/people in recovery, their

family members and caregivers, SMHAs and SSAs can engage these individuals, families, and 

caregivers in developing recovery-oriented systems and services. States should also support 

existing and create resources for new consumer, family, and youth networks; recovery

community organizations and peer-run organizations; and advocacy organizations to ensure a 

recovery orientation and expand support networks and recovery services. States are strongly 

encouraged to engage individuals and families in developing, implementing and monitoring the

state M/SUD treatment system.

Please respond to the following:

1. Does the state support recovery through any of the following:

a) Training/education on recovery principles and recovery-oriented practice and systems, 

including the role of peers in care? 

Yes No

b) Required peer accreditation or certification?

Yes No

c) Block grant funding of recovery support services. 

Yes No

d) Involvement of persons in recovery/peers/family members in planning, implementation,

or evaluation of the impact of the state’s M/SUD system?

Yes No
86

2. Does the state measure the impact of your consumer and recovery community outreach 

activity? 

Yes No

3. Provide a description of recovery and recovery support services for adults with SMI and 

children with SED in your state.

4. Provide a description of recovery and recovery support services for individuals with 

substance use disorders in your state.

5. Does the state have any activities that it would like to highlight?

Please indicate areas of technical assistance needed related to this section.

18. Community Living and the Implementation of Olmstead- requested

The integration mandate in Title II of the Americans with Disabilities Act (ADA) and the

Supreme Court’s decision in Olmstead v. L.C., 527 U.S. 581 (1999), provide legal 

requirements that are consistent with SAMHSA’s mission to reduce the impact of M/SUD on 

America’s communities. Being an active member of a community is an important part of 

recovery for persons with behavioral health conditions. Title II of the ADA and the regulations 

promulgated for its enforcement require that states provide services in the most integrated 
87

setting appropriate to the individual and prohibit needless institutionalization and segregation in 

work, living, and other settings. In response to the 10th anniversary of the Supreme Court’s 

Olmstead decision, the Coordinating Council on Community Living was created at HHS. 

SAMHSA has been a key member of the council and has funded a number of technical 

assistance opportunities to promote integrated services for people with behavioral health needs, 

including a policy academy to share effective practices with states.

Community living has been a priority across the federal government with recent changes to 

section 811 and other housing programs operated by the Department of Housing and Urban 

Development (HUD). HUD and HHS collaborate to support housing opportunities for persons 

with disabilities, including persons with behavioral illnesses. The Department of Justice (DOJ)

and the HHS Office for 

(OCR) cooperate on enforcement and compliance measures. DOJ and OCR have expressed 

concern about some aspects of state mental health systems including use of traditional 

institutions and other settings that have institutional characteristics to serve persons whose 

needs could be better met in community settings. More recently, there has been litigation 

regarding certain evidenced-based supported employment services such as sheltered workshops. 

States should ensure block grant funds are allocated to support prevention, treatment, and 

recovery services in community settings whenever feasible and remain committed, as 

SAMHSA is, to ensuring services are implemented in accordance with Olmstead and Title II of 

the ADA.

It is requested that the state submit their Olmstead Plan as a part of this application, or address 

the following when describing community living and implementation of Olmstead:

1. Does the state’s Olmstead plan include :

housing services provided Yes No

home and community based services Yes No

peer support services Yes No

employment services. Yes No

2. Does the state have a plan to transition individuals from hospital to community settings?

Yes No

3. What efforts are occurring in the state or being planned to address the ADA community 

integration mandate required by the Olmstead Decision of 1999? 

Please indicate areas of technical assistance needed related to this section.

19. Children and Adolescents Behavioral Health Services –required MHBG, requested 

SABG

MHBG funds are intended to support programs and activities for children and adolescents with 
88

SED, and SABG funds are available for prevention, treatment, and recovery services for youth 

and young adults with substance use disorders. Each year, an estimated 20 percent of children in

the U.S. have a diagnosable mental health condition and one in 10 suffers from a serious 

emotional disturbance that contributes to substantial impairment in their functioning at home, at 

school, or in the community.

66

 Most mental disorders have their roots in childhood, with about 

50 percent of affected adults manifesting such disorders by age 14, and 75 percent by age 24.67 

For youth between the ages of 10 and 24, suicide is the third leading cause of death and for 

children between 12 and 17, the second leading cause of death.68 

It is also important to note that 11 percent of high school students have a diagnosable substance 

use disorder involving nicotine, alcohol, or illicit drugs, and nine out of 10 adults who meet 

clinical criteria for a substance use disorder started smoking, drinking, or using illicit drugs 

before the age of 18. Of people who started using before the age of 18, one in four will 

develop an addiction compared to one in twenty-five who started using substances after age

21.

69 Mental and substance use disorders in children and adolescents are complex, typically

involving multiple challenges. These children and youth are frequently involved in more than 

one specialized system, including mental health, substance abuse, primary health, education, 

childcare, child welfare, or juvenile justice. This multi-system involvement often results in

fragmented and inadequate care, leaving families overwhelmed and children’s needs unmet. 

For youth and young adults who are transitioning into adult responsibilities, negotiating 

between the child- and adult-serving systems becomes even harder. To address the need for

additional coordination, SAMHSA is encouraging states to designate a point person for

children to assist schools in assuring identified children are connected with available mental 

health and/or substance abuse screening, treatment and recovery support services.

Since 1993, SAMHSA has funded the Children’s Mental Health Initiative (CMHI) to build the

system of care approach in states and communities around the country. This has been an 

ongoing program with 173 grants awarded to states and communities, and every state has 

received at least one CMHI grant. Since then SAMHSA has awarded planning and 

implementation grants to states for adolescent and transition age youth SUD treatment and 

infrastructure development. This work has included a focus on financing, workforce

development and implementing evidence-based treatments. 

For the past 25 years, the system of care approach has been the major framework for improving

delivery systems, services, and outcomes for children, youth, and young adults with mental 

and/or SUD and co-occurring M/SUD and their families. This approach is comprised of a

spectrum of effective, community-based services and supports that are organized into a

coordinated network. This approach helps build meaningful partnerships across systems and 

 

66 Centers for Disease Control and Prevention, (2013). Mental Health Surveillance among Children — United States, 2005-2011. 

MMWR 62(2).

67 Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-ofonset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 

593–602.

68 Centers for Disease Control and Prevention. (2010). National Center for Injury Prevention and Control. Web-based Injury 

Statistics Query and Reporting System (WISQARS) [online]. (2010). Available from www.cdc.gov/injury/wisqars/index.html.

69 The National Center on Addiction and Substance Abuse at Columbia University. (June, 2011). Adolescent Substance Abuse: 

America’s #1 Public Health Problem.
89

addresses cultural and linguistic needs while improving the child, youth and young adult 

functioning in home, school, and community. The system of care approach provides

individualized services, is family driven; youth guided and culturally competent; and builds on 

the strengths of the child, youth or young adult and their family to promote recovery and 

resilience. Services are delivered in the least restrictive environment possible, use evidencebased practices, and create effective cross-system collaboration including integrated 

management of service delivery and costs.70

According to data from the 2015 Report to Congress71 on systems of care, services: 

1 reach many children and youth typically underserved by the mental health system; 

2 improve emotional and behavioral outcomes for children and youth; 

3 enhance family outcomes, such as decreased caregiver stress; 

4 decrease suicidal ideation and gestures;

5 expand the availability of effective supports and services; and

6 save money by reducing costs in high cost services such as residential settings, 

inpatient hospitals, and juvenile justice settings.

SAMHSA expects that states will build on the well-documented, effective system of care 

approach to serving children and youth with serious behavioral health needs. Given the multisystem involvement of these children and youth, the system of care approach provides the 

infrastructure to improve care coordination and outcomes, manage costs, and better invest 

resources. The array of services and supports in the system of care approach includes:

 non-residential services (e.g., wraparound service planning, intensive case management, 

outpatient therapy, intensive home-based services, SUD intensive outpatient services, 

continuing care, and mobile crisis response);

 supportive services, (e.g., peer youth support, family peer support, respite services, 

mental health consultation, and supported education and employment); and

 residential services (e.g., like therapeutic foster care, crisis stabilization services, and 

inpatient medical detoxification).

Please respond to the following:

1. Does the state utilize a system of care approach to support:

a) The recovery and resilience of children and youth with SED?

Yes No

b) The recovery and resilience of children and youth with SUD?

Yes No

 

70 Department of Mental Health Services. (2011) The Comprehensive Community Mental Health Services for Children and 

Their Families Program: Evaluation Findings. Annual Report to Congress. Available from 

http://store.samhsa.gov/product/Comprehensive-Community-Mental-Health-Services-for-Children-and-Their-Families-ProgramEvaluation-Findings/PEP12-CMHI2010.

71 http://www.samhsa.gov/sites/default/files/programs_campaigns/nitt-ta/2015-report-to-congress.pdf
90

2. Does the state have an established collaboration plan to work with other child- and youthserving agencies in the state to address behavioral health needs

a) Child welfare? 

Yes No

b) Juvenile justice?

Yes No

c) Education? 

Yes No

3. Does the state monitor its progress and effectiveness, around:

a) Service utilization? 

Yes No

b) Costs? 

Yes No

c) Outcomes for children and youth services?

Yes No

4. Does the state provide training in evidence-based :

a) Substance misuse prevention, SUD treatment and recovery services for

children/adolescents, and their families. ?

Yes No

b) Mental health treatment and recovery services for children/adolescents and their families?

Yes No

5. Does the state have plans for transitioning children and youth receiving services:

a) to the adult behavioral health system?

Yes No

b) for youth in foster care?

Yes No

6. Describe how the state provide integrated services through the system of care (social 

services, educational services, child welfare services, juvenile justice services, law 

enforcement services, substance use disorders, etc.)

7. Does the state have any activities related to this section that you would like to highlight?
91

Please indicate areas of technical assistance needed related to this section. 

 

20. Suicide Prevention – (Required MHBG)

Suicide is a major public health concern, it is the 10th leading cause of death overall, with over 

40,000 people dying by suicide each year in the United States. The causes of suicide are 

complex and determined by multiple combinations of factors, such as mental illness, substance 

abuse, painful losses, exposure to violence, and social isolation. Mental illness and substance 

abuse are possible factors in 90 percent of the deaths from suicide, and alcohol use is a factor in 

approximately one-third of all suicides. Therefore, SAMHSA urges behavioral health agencies 

to lead in ways that are suitable to this growing area of concern. SAMHSA is committed to 

supporting states and territories in providing services to individuals with SMI/SED who are at 

risk for suicide through the use of MHBG funds to address these risk factors and prevent suicide. 

SAMHSA encourages the behavioral health agencies play a leadership role on suicide prevention 

efforts, including shaping, implementing, monitoring, care, and recovery support services among 

individuals with SMI/SED.

Please respond to the following:

1. Have you updated your state’s suicide prevention plan in the last 2 years?

Yes No

2. Describe activities intended to reduce incidents of suicide in your state.

3. Have you incorporated any strategies supportive of Zero Suicide?

Yes No

4. Do you have any initiatives focused on improving care transitions for suicidal patients 

being discharged from inpatient units or emergency departments?

Yes No
92

5. Have you begun any targeted or statewide initiatives since the FFY 2016-FFY 2017 plan 

was submitted?

Yes No

If so, please describe the population targeted?

Please indicate areas of technical assistance needed related to this section.

21. Support of State Partners - Required MHBG

The success of a state’s MHBG and SABG programs will rely heavily on the strategic

partnership that SMHAs and SSAs have or will develop with other health, social services, and 

education providers, as well as other state, local, and tribal governmental entities. Examples of 

partnerships may include:

 The SMA agreeing to consult with the SMHA or the SSA in the development and/or 

oversight of health homes for individuals with chronic health conditions or consultation 

on the benefits available to any Medicaid populations; 

 The state justice system authorities working with the state, local, and tribal judicial 

systems to develop policies and programs that address the needs of individuals with 

M/SUD who come in contact with the criminal and juvenile justice systems, promote 

strategies for appropriate diversion and alternatives to incarceration, provide screening 

and treatment, and implement transition services for those individuals reentering the 

community, including efforts focused on enrollment; 

 The state education agency examining current regulations, policies, programs, and key 

data-points in local and tribal school districts to ensure that children are safe, supported in

their social/emotional development, exposed to initiatives that target risk and protective 

factors for mental and substance use disorders, and, for those youth with or at-risk of 

emotional behavioral and SUDs, to ensure that they have the services and supports 

needed to succeed in school and improve their graduation rates and reduce out-of-district 

placements;

 The state child welfare/human services department, in response to state child and family 

services reviews, working with local and tribal child welfare agencies to address the 
93

trauma and mental and substance use disorders in children, youth, and family members 

that often put children and youth at-risk for maltreatment and subsequent out-of-home 

placement and involvement with the foster care system, including specific service issues, 

such as the appropriate use of psychotropic medication for children and youth involved in 

child welfare; 

 The state public housing agencies which can be critical for the implementation of 

Olmstead;

 The state public health authority that provides epidemiology data and/or provides or leads 

prevention services and activities; and 

 The state’s office of homeland security/emergency management agency and other 

partners actively collaborate with the SMHA/SSA in planning for emergencies that may 

result in behavioral health needs and/or impact persons with behavioral health conditions 

and their families and caregivers, providers of behavioral health services, and the state’s 

ability to provide behavioral health services to meet all phases of an emergency 

(mitigation, preparedness, response and recovery) and including appropriate engagement 

of volunteers with expertise and interest in behavioral health.

Please respond to the following items:

1. Has your state added any new partners or partnerships since the last planning period? 

Yes No

2. Has your state identified the need to develop new partnerships that you did not have in place?

 

Yes No

If yes, with whom?

3. Describe the manner in which your state and local entities will coordinate services to 

maximize the efficiency, effectiveness, quality and cost-effectiveness of services and 

programs to produce the best possible outcomes with other agencies to enable consumers to 

function outside of inpatient or residential institutions, including services to be provided by 

local school systems under the Individuals with Disabilities Education Act.
94

Please indicate areas of technical assistance needed related to this section. 

22. State Behavioral Health Planning/Advisory Council and Input on the Mental 

Health/Substance Abuse Block Grant Application-required MHBG

Each state is required to establish and maintain a state Mental Health Planning/Advisory

Council for adults with SMI or children with SED. To meet the needs of states that are 

integrating services supported by MHBG and SABG, SAMHSA is recommending that states 

expand their Mental Health Advisory Council to include substance misuse prevention, SUD 

treatment, and recovery representation, referred to here as a Behavioral Health 

Advisory/Planning Council (BHPC). SAMHSA encourages states to expand their required 

Council’s comprehensive approach by designing and implementing regularly scheduled 

collaborations with an existing substance misuse prevention, SUD treatment, and recovery 

advisory council to ensure that the council reviews issues and services for persons with, or at 

risk, for substance misuse and SUDs. To assist with implementing a BHPC, SAMHSA has 

created Best Practices for State Behavioral Health Planning Councils: The Road to Planning 

Council Integration.

72

Planning Councils are required by statute to review state plans and implementation reports; and 

submit any recommended modifications to the state. Planning councils monitor, review, and 

evaluate, not less than once each year, the allocation and adequacy of mental health services 

within the state. They also serve as an advocate for individuals with behavioral health problems. 

SAMHSA requests that any recommendations for modifications to the application or comments 

to the implementation report that were received from the Planning Council be submitted to 

SAMHSA, regardless of whether the state has accepted the recommendations. The 

documentation, preferably a letter signed by the Chair of the Planning Council, should state that 

the Planning Council reviewed the application and implementation report and should be 

transmitted as attachments by the state.

Please consider the following items as a guide when preparing the description of the state’s 

system:

1. How was the Council involved in the development and review of the state plan and report? 

Attach supporting documentation (e.g., meeting minutes, letters of support, etc.)

a) What mechanism does the state use to plan and implement substance misuse prevention, 

 

72 http://beta.samhsa.gov/grants/block-grants/resources
95

SUD treatment, and recovery services?

b) Has the Council successfully integrated substance misuse prevention and treatment or

co-occurring disorder issues, concerns, and activities into its work?

 Yes No

2. Is the membership representative of the service area population (e.g., ethnic, cultural,

linguistic, rural, suburban, urban, older adults, families of young children)?

Yes No

3. Please describe the duties and responsibilities of the Council, including how it gathers

meaningful input from people in recovery, families, and other important stakeholders, and 

how it has advocated for individuals with SMI or SED.

Additionally, please complete the Behavioral Health Advisory Council Members and Behavioral 

Health Advisory Council Composition by Member Type forms.73

 

73 There are strict state Council membership guidelines. States must demonstrate: (1) the involvement of people in recovery and their family 

members; (2) the ratio of parents of children with SED to other Council members is sufficient to provide adequate representation of that 

constituency in deliberations on the Council; and (3) no less than 50 percent of the members of the Council are individuals who are not state

employees or providers of mental health services. 
96

Behavioral Health Advisory Council Members

Name

Type of 

Membership*

Agency or 

Organization

Represented*

Address 

Phone & 

Fax

Email 

Address

(If 

Available)

**State Mental 

Health Agency

**State 

Education

Agency

**State 

Vocational 

Rehabilitation 

Agency

**State Criminal 

Justice Agency

**State Housing 

Agency

**State Social 

Services Agency

***State

Medicaid 

Agency

***State 

Marketplace 

Agency

***State Child 

Welfare Agency

***State Health 

Agency

***State Agency

on Aging

*Council members should be listed only once by type of membership and Agency/organization represented. 

** Required by Statute. 

***Requested not required
97

Behavioral Health Advisory Council Composition by Member Type

Type of Membership

Number

Percentage 

of Total

Membership

Total Membership

Individuals in Recovery * (to include adults with SMI 

who are receiving, or have received, mental health 

services

Family Members of Individuals in Recovery * 

(to include family members of adults with SMI)

Parents of children with SED/SUD *

Vacancies (individual & family members)

Others ( Advocates who are not State employees or

providers)

Total Individuals in Recovery, Family Members and 

Others

State Employees

Providers

Vacancies

TOTAL State Employees & Providers

Individuals/Family Members from Diverse Racial, 

Ethnic, and LGBT Populations

Providers from Diverse Racial, Ethnic, and LGBT

Populations

TOTAL Individuals and Providers from Diverse

Racial, Ethnic, and LGBT Populations

Persons in recovery from or providing treatment for

or advocating for SUD services

Federally Recognized Tribal Representatives

Youth/adolescent representative (or member from an 

organization serving young people).

*States are encouraged to select these representatives from state Family/Consumer organizations or 

include individuals with substance misuse prevention, SUD treatment, and recovery expertise in their 

Councils.
98

23. Public Comment on the State Plan- required

Title XIX, Subpart III, section 1941 of the PHS Act (42 U.S.C. § 300x-51) requires, as a

condition of the funding agreement for the grant, states will provide an opportunity for the

public to comment on the state block grant plan. States should make the plan public in such 

a manner as to facilitate comment from any person (including federal, tribal, or other public

agencies) both during the development of the plan (including any revisions) and after the

submission of the plan to SAMHSA.

1. Did the state take any of the following steps to make the public aware of the plan and 

allow for public comment?

a) Public meetings or hearings?

Yes No

b) Posting of the plan on the web for public comment?

Yes No

Other?

if yes, provide URL

c) Other (e.g. public service announcements, print media)

Yes No
99

Acronyms

ACF Administration for Children and Families

ACL Administration for Community Living 

ACO Accountable Care Organization

ACT Assertive Community Treatment

AHRQ Agency for Healthcare Research and Quality 

AI American Indian

AIDS Acquired Immune Deficiency Syndrome 

AN Alaskan Native

AOT Assisted Outpatient Treatment

BHSIS Behavioral Health Services Information System 

CAP Consumer Assistance Programs

CBHSQ Center for Behavioral Health Statistics and Quality 

CCBHC Certified Community Behavioral Health Center

CFR Code of Federal Regulations

CHC Community Health Center

CHIP Children’s Health Insurance Program

CLAS Culturally and Linguistically Appropriate Services 

CMHC Community Mental Health Center

CMHS Center for Mental Health Services

CMS Centers for Medicare and Medicaid Services 

CPT Current Procedural Terminology

CSAPCenter for Substance Abuse Prevention 

CSAT Center for Substance Abuse Treatment

CSC Coordinated Specialty Care

DSM V Diagnostic and Statistical Manual of Mental Disorders, Fifth 

Edition, Arlington, VA, American Psychiatric Association

EBP Evidence-Based Practice

EHB Essential Health Benefit

EHR Electronic Health Record 

EIS Early Intervention Services (association with Human 
100

Immunodeficiency Virus (HIV)

ESMI Early Serious Mental Illness

FFY Federal Fiscal Year

FMAP Federal Medical Assistance Percentage 

FPL Federal Poverty Level

FQHC Federally-Qualified Health Center 

HCPCS Healthcare Common Procedure Coding System 

HHS Department of Health and Human Services

HIE Health Information Exchange 

HIT Health Information Technology 

HIV Human Immunodeficiency Virus (associated with Early 

Intervention Services)

HRSA Health Resources and Services Administration

ICD-10 The International Statistical Classification of Diseases and Related Health

Problems, 10th Revision

ICT Interactive Communication Technology

IDU Intravenous Drug User

IMD Institutions for Mental Diseases 

IOM Institute of Medicine

KIT Knowledge Information Transformation (associated with 

EBP implementation)

LGBTQ Lesbian, Gay, Bisexual, Transgender, and Questioning 

MAT Medication Assisted Treatment

MCO Managed Care Organization

MHBG Community Mental Health Services Block Grant

MHPAEA Mental Health Parity and Addiction Equity Act 

MOE Maintenance of Effort

M/SUD Mental and/or Substance Use Disorder 

NBHQF National Behavioral Health Quality Framework 

NHAS National HIV/AIDS Strategy

NIAAA National Institute on Alcoholism and Alcohol Abuse 

NIDANational Institute on Drug Abuse
101

NIMH National Institute on Mental Health

NOMS National Outcome Measures

NQF National Quality Forum

NQS National Quality Strategy

NREPP National Registry of Evidence-based Programs and Practices

OCR Office for Civil Rights

OMB Office of Management and Budget

PBHCI Primary and Behavioral Health Care Integration 

PBR Patient Bill of Rights

PHS Public Health Service

PPW Pregnant and Parenting Women

PPWC Pregnant and Postpartum Women and Children

PWWDC Pregnant Women and Women with Dependent Children

PWID Persons Who Inject Drugs

QHP Qualified Health Plan

RAISE Recovery After an Initial Schizophrenia Episode

RCO Recovery Community Organization

RFP Request for Proposal

SABG Substance Abuse Prevention and Treatment Block Grant

SAMHSA Substance Abuse and Mental Health Services Administration

SBIRT Screening, Brief Intervention, and Referral to Treatment

SED Serious Emotional Disturbance

SFY State fiscal year

SEOW State Epidemiological Outcome Workgroup 

SMHA State Mental Health Authority

SMI Serious Mental Illness

SPA State Plan Amendment

SPF Strategic Prevention Framework 

SSA Single State Agency

SUD Substance Use Disorder

TIP Treatment Improvement Protocol 
102

TLOA Tribal Law and Order Act 

U.S.C. United States Code

VA Veterans Administration
103

Resources

TOPIC LINK DESCRIPTION

SAMHSA Block Grants http://samhsa.gov/grants/block-grants

Description of Block Grant, its purpose, deadlines, laws and 

regulations and resources

SAMHSA Topic Search http://www.samhsa.gov/topics

Search SAMHSA's website for resources, information and updates by 

topic or program

SAMHSA Store http://store.samhsa.gov/

Search SAMHSA’s store to download or order publications and 

resources

RESOURCES IN ALPHABETICAL ORDER BY TOPIC/TITLE

TOPIC LINK DESCRIPTION

21st Century Cures Act

https://www.congress.gov/114/bills/hr34/BILLS

-114hr34enr.pdf

Link to the 21st Century Cures Act, which includes the section on 

Helping Families in Mental Health Crisis Reform Act of 2016

Center for Integrated 

Health Solutions http://www.integration.samhsa.gov/

HRSA-SAMHSA Center for Integrated Health Solutions offers 

resources, trainings, hot topics, and webinars on primary and 

behavioral health care integration

Characteristics of State 

Mental Health Agency 

Data Systems

http://store.samhsa.gov/product/Characteristicsof-State-Mental-Health-Agency-DataSystems/SMA08-4361

Reviews current information technology (IT) systems and technology 

implementation efforts in state mental health agencies. Reports key 

findings on IT and structure, client-level and claims-level data, 

linking to other state data, and electronic health records. 

(Downloadable report)

Children Mental Health 

http://store.samhsa.gov/product/ComprehensiveCommunity-Mental-Health-Services-forChildren-and-Their-Families-ProgramEvaluation-Findings/PEP12-CMHI2010

Presents program evaluation findings of a federally funded initiative 

that supports systems of care for community-based mental health 

services for children, youth, and their families. Reports on FFY2010 

data that track service characteristics, use, and outcomes. 

(Downloadable report)

Co-Occurring Resources 

and Models http://www.samhsa.gov/co-occurring/

SAMHSA's webpage dedicated to co-occurring models and practice. 

Includes: resources, webinars, public resource links and more.
104

Health Care Integration 

http://www.samhsa.gov/health-care-healthsystems-integrationOverview of SAMHSA Health Care Integration initiatives and links 

to resources and information about health care integration

Health Homes

http://www.integration.samhsa.gov/integratedcare-models/health-homesSAMHSA's description of Health Homes and resources around health 

homes

Healthy People Initiative http://www.healthypeople.gov/2020/default.aspx

Government website that reviews the goals of Healthy People 2020 

and provides resources to help meet the goals. 

Health Financing http://www.samhsa.gov/health-financing

SAMHSA guides, trainings and technical assistance resources around 

health reform implementation.

Integrated Treatment for 

Co-Occurring Disorders 

Evidence-Based Practices 

(EBP) KIT http://store.samhsa.gov/product/SMA08-4367

Provides practice principles about integrated treatment for cooccurring disorders, an approach that helps people recover by 

offering M/SUD services at the same time and in one setting. Offers 

suggestions from successful programs.

LGBT Populations

http://www.samhsa.gov/behavioral-healthequity/lgbt

Resources on the LGBT population include national survey reports, 

agency and federal initiatives, and related behavioral health 

resources.

Medicaid Policy 

Guidance

http://www.medicaid.gov/Federal-Policyguidance/federal-policy-guidance.html

Searchable database of Medicaid Policy Guidance’s; including: peer 

support services, affordable care act, health homes, prescription 

drugs, etc.

Medication Assisted 

Treatment

http://www.samhsa.gov/medication-assistedtreatment SAMHSA's resources, guides and TIPs on MAT

Mental Health and 

Substance Abuse Block 

Grant Laws and 

Regulations

http://www.samhsa.gov/grants/blockgrants/laws-regulationsLinks to the laws and regulations that govern the Mental Health and 

Substance Abuse Block Grants
105

Mental Health Crisis

http://store.samhsa.gov/product/Core-Elementsfor-Responding-to-Mental-HealthCrises/SMA09-4427

Presents guidelines to improve services for people with serious 

mental illness or emotional disorders who are in mental health crises. 

Defines values, principles, and infrastructure to support appropriate 

responses to mental health crises in various situations.

National CLAS 

Standards http://www.ThinkCulturalHealth.hhs.gov

The National Standards for Culturally and Linguistically Appropriate 

Services in Health and Health Care (the National CLAS Standards) 

are intended to advance health equity, improve quality, and help 

eliminate health care disparities by providing a blueprint for 

individuals and health and health care organizations to implement 

culturally and linguistically appropriate services.

National HIV/AIDS 

Strategy (NHAS) for the 

United States 

http://www.whitehouse.gov/sites/default/files/up

loads/NHAS.pdf

July 2010 PDF of the National HIV/AIDS Strategy for the United 

States

National Partnership for 

Action to End Health 

Disparities http://minorityhealth.hhs.gov/npa/ Offers an overview and resources to help end health disparities

National Registry of 

Evidenced-Based 

Programs and Practices http://www.nrepp.samhsa.gov/

NREPP is a searchable online registry of M/SUD interventions. 

NREPP was developed to help the public learn more about evidencebased interventions that are available for implementation.

National Strategy for 

Suicide Prevention

http://store.samhsa.gov/product/NationalStrategy-for-Suicide-Prevention-2012-Goalsand-Objectives-for-Action/PEP12-NSSPGOALS

Outlines a national strategy to guide suicide prevention actions. 

Includes 13 goals and 60 objectives across four strategic directions: 

wellness and empowerment; prevention services; treatment and 

support services; and surveillance, research, and evaluation. 

(Downloadable report)

Olmstead

http://www.samhsa.gov/laws-regulationsguidelines/civil-rights-protections

Links to the Olmstead decision document, as well as, a report that 

offers a basic primer on supportive housing, as well as a thorough 

review of states’ current Olmstead planning efforts in this area

Parity

http://www.medicaid.gov/Federal-PolicyGuidance/downloads/SHO-13-001.pdf

Letter from Medicaid on Application of the Mental Health Parity and 

Addiction Equity Act to Medicaid MCOs, CHIP, and Alternative 

Benefit (Benchmark) Plans
106

Prevention of Underage 

Drinking http://www.ncbi.nlm.nih.gov/books/NBK44360/

The Surgeon General's Call to Action To Prevent and Reduce 

Underage Drinking seeks to engage all levels of government as well 

as individuals and private sector institutions and organizations in a 

coordinated, multifaceted effort to prevent and reduce underage 

drinking and its adverse consequences.

Recovery http://www.samhsa.gov/recovery/ SAMHSA's resources, guides and technical assistance on recovery

SAMHSA.gov Data 

Resources http://www.samhsa.gov/data/

Links to SAMHSA data sets including: NSDUH, DAWN, 

NSSATS/NMHSS, TEDS, Uniform Reporting System (URS), 

National and State Barometers, etc.

SAMHSA's Evidenced 

Based Practice 

Knowledge Information 

Transformation (KIT)

http://store.samhsa.gov/product/AssertiveCommunity-Treatment-ACT-Evidence-BasedPractices-EBP-KIT/SMA08-4345

SAMHSA’s Evidence-Based Practice Knowledge Informing 

Transformation (KIT)[1] were developed to help move the latest 

information available on effective behavioral health practices into 

community-based service delivery.

Substance Abuse for 

Women

http://www.samhsa.gov/women-childrenfamiliesGuidance on components of quality SUD treatment services for 

women, states can refer to the documents found at this link

Suicide Prevention http://www.samhsa.gov/prevention/

Links to resources and guides around suicide prevention and other 

mental and substance misuse prevention topics.

Synar Program http://samhsa.gov/synar 

Description and overview of the SYNAR program, which is a 

requirement of the SABG.

Telehealth Policy 

Resource http://telehealthpolicy.us/medicaid

Telehealth Medicaid Policy site that provides telehealth laws and 

reimbursement by state, telehealth policy PDF and a review of 

pending legislations

Trauma & Violence http://www.samhsa.gov/trauma-violence

Includes information around violence and trauma, including the 

definition and review of trauma informed care.

Criminal & Juvenile 

Justice http://www.samhsa.gov/criminal-juvenile-justice

Review of behavioral health services and resources in the criminal 

justice and juvenile justice systems.

Tribal Consultation

http://www.whitehouse.gov/the-pressoffice/memorandum-tribal-consultation-signedpresident

The White House memorandum regarding the requirements related to 

tribal consultation