Disparities Impact Statement (DIS 2.0) 

Larke Huang, Tenly Biggs, Martha Kent

Office of Behavioral Health Equity

Office of the Assistant Secretary

Grantee Orientation

Sept/Oct 2023
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What is a Disparity Impact Statement (DIS)?

The Disparity Impact Statement (DIS) is a 

data-driven, quality improvement 

approach to advance equity using grant 

programs. The DIS helps grantees identify 

underserved populations at risk of 

experiencing behavioral health disparities. 

The aim is to increase inclusion of 

underserved populations in SAMHSA- funded grants, achieve behavioral health 

equity for disparity-vulnerable populations, 

and help systems better meet the needs of 

these population.
The Disparity Impact Strategy

HHS Action Plan to Reduce Racial and Ethnic Health Disparities, (2011)

Secretarial Priority #1

1. Assess and heighten the impact of all HHS policies, programs, 

processes, and resource decisions to reduce health disparities. 

HHS leadership will assure that:

(c)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.

TAKEAWAY: SAMHSA’s Office of Behavioral Health Equity was the first to develop 

an actual disparity impact statement requirement for their grant applications. 

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The DIS Issue: Grant Enrollment by Race/Ethnicity
What is the purpose of a DIS? 

• Identify, contextualize, and address health disparities 

• Develop and implement a disparity reduction quality improvement 

plan to address close the identified gap(s)

• Achieve targeted behavioral health equity for disparate 

populations and improve systems addressing the needs of these 

populations

NOTE: Grant recipients are encouraged to view their DIS as a living 

document! 

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DIS – Special Terms and Conditions

• Terms and Conditions in the Notice of Award (NoA)

• Due within 60 days of the start of the grant project

• Must be submitted as .pdf in eRA Commons

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Resource:

www.samhsa.gov

Grants-> Grants Management -> Disparity Impact Statement

Special Conditions of Awards for Behavioral Health Disparity Impact 

Statement (DIS) | SAMHSA
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DIS Sections

Section 1: 

Identifying 

behavioral health 

disparities 

Section 2: 

Addressing 

disparities using the 

funding opportunity

Section 3: 

Developing a 

disparity reduction 

quality improvement 

plan 
Section 1: Identifying Disparities

Section 1 – Identifying 

Behavioral Health 

Disparities

• Identifying the problem grantee is seeking to address 

using this grant program (funding opportunity)

• Use data to support evidence that this problem needs to 

be addressed

• Identifying the focus population experiencing disparate 

access, use, and outcomes

• Disparity Table (identify the gap or difference at 

individual/client, organizational, or systemic level)

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Step 1: Use data to identify the 

disparity/problem/gap you are

seeking to address. 01

!

?

Decide: Who?

• Who experiences disparities in access, use or health

outcomes in your area of focus?

• What groups of people within the populations your

program aims to serve/reach/train might have a harder

time accessing or using the services or trainings offered

by the grant?

• What data leads you to believe this disparity exists?

• Consider demographic characteristics that

might contribute to the disparity (e.g. race,

ethnicity, gender, sexual orientation)

02 Use Caution!

The disparity population 

is not everyone your 

program serves/trains.

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Complete DIS Section 1

 Describe the scope of the problem (Worksheet box

1a) and the disparity-vulnerable(Worksheet box 1b).

 Create a table that breaks out the subpopulations

you aim to serve/reach/train based on the

demographic characteristics that are relevant to the

identified disparity.
Potential 

Data 

Sources

The National Survey 

on Drug Use and 

Health (NSDUH)

The U.S. Census 

Bureau and the 

American Community 

Survey (ACS)

Other data from the 

Center for Behavioral 

Health Statistics and 

Quality 

Behavioral health 

agencies

Public health 

agencies Other state agencies 

Colleges or 

Universities

Community needs 

assessments 

County health 

rankings 

Law enforcement or 

judicial data 

Hospital or 

emergency medical 

services

Program Evaluator
Section 2: Addressing Disparities

Section 2 – Addressing 

Disparities Using The 

Funding Opportunity 

• Social Determinants of Health

• National CLAS Standards for Behavioral Health

Grantee is asked to identify one or more of the five SDOH domains and fifteen National CLAS 

Standards for Behavioral Health that can be improved with this funding opportunity (grant)

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Step 2: Decide how you will address the 

disparity/problem/gap so that everyone 

you aim to serve/reach/train is able to 

access and use services/trainings achieve 

better outcomes.

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Decide: How?

• How can the disparity be addressed?

• What social determinants of health can be 

addressed to improved in the environment in which 

the disparity-vulnerable was born, lives, learns, 

works, plays, and worships that could help to reduce 

the disparity?

• Can services/trainings be improved so that they are 

more culturally and linguistically appropriate for the 

disparity-vulnerable to help address the problem? 

Which CLAS Standard does this reflect?

?

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Use Caution!

Don’t forget to explain how your proposed 

activities will reduce disparities for the 

population of focus.

!

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Complete DIS Section 2

 Explain how you will address 

the identified SDOH domain 

(Worksheet box 2a) and CLAS 

Standard (Worksheet box 2b).
CLAS Standards

• CLAS standards provide a structure that helps grantees ensure their planned 

activities are aligned to culturally and linguistically appropriate standards 

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CLAS domain Example standard

Governance, leadership, and workforce Standard 4: Educate and train governance, leadership, 

and workforce in culturally and linguistically appropriate 

policies and practices on an ongoing basis

Communication and language 

assistance

Standard 5: Offer language assistance to individuals who 

have limited English proficiency and/or other 

communication needs at no cost to them to facilitate 

timely access to all health services

Engagement, continuous 

improvement, and accountability 

Standard 13: Partner with a community to design, 

implement, and evaluate policies, practices, and services 

to ensure cultural and linguistic appropriateness

Adapted From: The Office of Minority Health’s Behavioral Health Implementation Guide
Social Determinants of Health (SDOH)

• Identifying SDOH in the DIS helps grantees ensure their planned activities 

are aligned to address root causes of disparities that they hope to improve

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SDOH domain SDOH goals

Economic stability Help people earn steady incomes that allow them to 

meet their health needs

Education access and quality Increase educational opportunities and help children 

and adolescents do well in school

Health care access and quality Increase access to comprehensive, high-quality health 

care services

Neighborhood and built environment Create neighborhoods and environments that 

promote health and safety

Social and community context Increase social and community support

Adapted From: Healthy People 2030
Section 3: Quality Improvement Plan

Section 3 – Developing a 

Disparity Reduction 

Quality Improvement 

Plan

• Grantee is asked to develop a quality improvement plan that will allow for 

reduction of disparities for the duration of the grant project period and 

beyond

• Describe implementation using SMART goals/objectives

• Describe intended outcomes and impact expected with disparate 

population after implementation of grant activities

• Describe client, peer, and stakeholder involvement with addressing 

disparities through this funding opportunity (grant)

• Describe the projected timeline needed to implement the grant activities

• Describe how you will measure the process, progress, and outcomes of 

improving disparities with the funding opportunity (grant)

• Describe how the organization will sustain improvements made to 

continue improving disparities

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Step 3: Provide details on the activities 

you will implement to reduce 

disparities for the disparity-vulnerable 

population. 07

Decide: What?

• What activities will you implement? 

• Who will be involved in the activities? 

• What will be your timeline for implementing activities?

• What will result from your activities? 

• How will you know if you are making progress 

towards outcomes? 

• What data will you use to measure this?

• How will you keep the work going? 

• Who will be involved? 

• What processes will need to be in place?

?

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Use Caution!

Make sure activities are SMART: 

Specific, Measurable, Achievable, 

Relevant, and Timebound. !

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Complete DIS Section 3

 List the activities (using SMART) (Worksheet 

box 3a).

 Describe your intended outcomes (Worksheet 

box 3b). 

 Describe how you will engage 

client/peer/partners (Worksheet box 3c).

 Provide a timeline for the activities (Worksheet 

box 3d).

 Describe how you will evaluate your progress 

(Worksheet box 3e).

 Describe a plan for sustaining the activities 

(Worksheet box 3f).


Resources

• DIS Training

– Disparity Impact Statement 101 training video:

 https://www.youtube.com/watch?v=GC65r_YbQdM

– Disparity Impact Statement Worksheet:

https://www.samhsa.gov/sites/default/files/disparity-impact-statement.pdf

– Disparity Impact Statement Services Example:

https://www.samhsa.gov/sites/default/files/disparity-impact-statement-servicesexample.pdf 

• CLAS Standards

– Behavioral Health Guide for the National CLAS Standards: 

https://www.minorityhealth.hhs.gov/Assets/PDF/clas%20standards%20doc_v06.28.21.pdf

– Training on “Improving Cultural Competency for Behavioral Health Professionals”: 

https://thinkculturalhealth.hhs.gov/education/behavioral-health

• Social Determinants of Health

– CDC: https://health.gov/healthypeople/priority-areas/social-determinants-health

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Thank You

SAMHSA’s mission is to lead public health and service delivery efforts 

that promote mental health, prevent substance misuse, and provide 

treatments and supports to foster recovery while ensuring equitable 

access and better outcomes.

www.samhsa.gov

1-877-SAMHSA-7 (1-877-726-4727) ● 1-800-487-4889 (TDD)

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