samhsa T e c h n i c a l a s s i s T a n c e P a c k a g e 

Access to Recovery Service Menus and
 

Recovery Support Services 

Contents: 

Part 1: Designing Service Menus and Recovery Support 


Services
 

Part 2: Information and Tools 

Part 3: Grantee Examples 

Part 4: References and Additional Resources 

Considerations for Designing Service Menus 

An Access to Recovery (ATR) service menu is the key 

instrument of transformation of the traditional treatment 

system for individuals with substance use disorders 

(SUDs). Constructing and implementing an ATR service 

menu is a multi-step process requiring input from many 

entities, including these individuals. ATR managers must 

identify, define, and price an array of recovery support 

services for both traditional and nontraditional providers 

as well as implement training and monitoring mechanisms 

to ensure quality of these services, positive treatment 

outcomes, and genuine independent choice. 

Introduction 

Under the Substance Abuse and Mental Health 

Services Administration (SAMHSA), ATR’s mandate 

to fund recovery support services provided by community and faith-based organizations has changed the 

treatment system for individuals with SUDs. According 

to the guidelines, recovery support services are no 

longer relegated to a subordinate role in a treatment 

system predominantly focused on clinical services. 

Services formally categorized as “adjunct” and “ancillary” to clinical treatment packages, and usually 

un- or under-funded as a result of this designation, 

are recognized for their value in supporting a person’s 

unique recovery journey. Recovery support services 

have secured their place in the continuum of care for 

individuals with SUDs. 

The resulting ATR service menus and the recovery support services included in these packages are both the 

catalyst for and proof of a transformed SUD system of 

care. To fully implement the recovery support services 

contained in these service menus, ATR grantees have 

to define, design, implement, train, evaluate, and maintain a provider network to deliver these services in an 

evolving system of care that is fundamentally different 

from the traditional treatment system. Expanded ATR 

networks and the wide variety of recovery support services offered by network providers are also evidence of 

a transformed system. 

How Should Grantees Use this Information? 

This Technical Assistance (TA) package provides 

information, resources, tips, and tools to help ATR 3 

grantee key staff understand the role of service menus 

and recovery support services in the continuing transformation of the SUD system of care. Readers will find 

information about the experiences of and the lessons 

learned by ATR grantees as they built, implemented, 

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evaluated, and refined their own ATR service menus 

and recovery support service array. 

Designing Service Menus and Recovery Support 

Services 

ATR Service Menus—A Transformed Service System 

ATR service menus are the vehicles by which the 

SUD system of care expands the number, types, and 

providers of evidence- and practice-based services 

for individuals in recovery. An ATR service menu 

is an approved list of clinical and recovery support 

services that have demonstrated success in supporting 

a person’s recovery journey. Service menus are culturally tailored, appropriate for the target population, and 

cost-effective. Complete ATR service menus include the 

following: 

•	 A brief description of the service.

•	 A recommendation regarding the frequency and

intensity of the service. 

•	 An approved rate for the service.

•	 A list of approved providers of the service.

A sample of an ATR service menu is provided in 

Appendix A. 

The cornerstone of an ATR service menu is independent choice by the individual: They choose from 

a number of approved ATR services and providers, 

participate in their chosen services from the providers 

they selected, and decide for themselves if they wish 

to continue or change the services and/or providers. 

The ATR mandate of self-directed care by individuals 

with SUDs is in direct contrast to the more traditional 

provider-directed treatment system. 

Recovery support services are a hallmark of a recovery-oriented system of care, and research suggests 

that they are integral to the recovery process. Services 

provided in the community, by the community, and for 

community members with SUDs are highly effective 

when coupled with traditional treatment services. As 

such, ATR service menus, which include recovery support service options, represent a transformed service 

system—a system driven by individual choice and supportive of the many paths to recovery. 

Clinical Treatment and Recovery Support Services 

Clinical treatment services are provided by individuals 

who are licensed, certified, or otherwise credentialed 

to provide clinical treatment services, often in settings 

that address specific treatment needs. Clinical treatment services generally include the following: 

•	 Screening and/or assessment.

•	 Brief intervention.

• Treatment planning.

• Detoxification.

•	 Medical care.

•	 Individual and/or group counseling.

•	 Residential services.

•	 Pharmacological interventions.

•	 Co-occurring treatment services.

Recovery support services are typically provided by 

paid staff or volunteers who are familiar with how 

their communities can support people seeking to live 

free of alcohol and drugs, and who are often peers 

of those seeking recovery. Recovery support services 

often include the following: 

•	 Substance use disorder education.

•	 Family services, such as marriage counseling and

parenting training. 

• Pre-employment counseling.

•	 Case management.

•	 Relapse prevention.

•	 Face-to-face or telephone-based continuing care

counseling. 

•	 Alcohol and drug testing.
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• Outreach.

•	 Individual services coordination, providing linkages

to other services (e.g., legal services, Temporary 

Assistance for Needy Families, social services, food

stamps). 

•	 Recovery coaching (e.g., stage-appropriate recovery

education, assistance in recovery management, telephone monitoring). 

•	 Family support and child care.

•	 Transportation to and from treatment, recovery support activities, employment, and other activities. 

•	 Supportive transitional drug-free housing services.

•	 Self-help and support groups (e.g., 12-step groups,

SMART Recovery, Women for Sobriety). 

• Spiritual support.

• Employment coaching.

[“ATR (Initial Announcement) Request for Applications 

(RFA) No. T1-04-008,” 2010.]

Because of the system transformation begun by ATR,

States are able to use the services mentioned above 

and/or develop other services that support recovery. 

For example, because physical well-being is a critical

component of long-term recovery, nutrition services 

and/or physical fitness services may be important 

recovery support services for some. 

ATR service menus and the recovery support services 

included in them reflect service gaps identified in the 

system, services that individuals say they need, services 

that partners and providers can offer, services that 

communities will support, and services for which State 

authorities gave funding permission. Most grantees 

report that their ATR service menus evolved during the 

early phases of their projects’ development. As part of 

a continuous quality improvement process, the menus 

continue to evolve over the course of the projects. 

Many Steps to ATR Transformation 

Appendix A of the ATR 1 Request for Applications provides a list of potential services that could be included 

in grantees’ projects. While this list provides a starting point in building an ATR menu of services that is 

unique to each project, ATR grantees realized quickly 

that several processes and steps needed to be completed before the project—with its multitude of service, 

provider, and payment mechanism changes and robust 

data collection requirements—could be implemented. 

ATR grantees identify three distinct early phases of 

their projects: application, startup, and implementation. However, the rapid implementation requirement 

of the ATR grant (e.g., six months from the date of 

award to issuance of the first voucher for ATR 1 grantees and an even shorter timeframe for ATR 3 grantees) 

challenged grantees to simultaneously develop processes and products for these different project phases. 

The chart on the next page illustrates these phases and 

the processes and tasks associated with each. 

Information and Tools 

The information, tools, and templates that will assist in 

the planning, implementation, evaluation, and ongoing refinement of service menus are organized in the 

following areas: 

•	 Analyzing strengths and needs in the current SUD

treatment system. 

•	 Partnering with current and new systems, stakeholders, and providers. 

•	 Providing enrolled individuals opportunities for

input into the ATR service system’s development. 

•	 Designing service menus and recovery support services for target populations. 

•	 Developing service definitions, rates, and

requirements. 

Identifying Needs of the Community 

•	 Utilize the information that newspapers and other

social media sources are reporting as needs of the 

community. 

•	 Ask the question, Does the public media provide

insight into what the needs are and then research 

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samhsa Technical assisTance Package 

•	 Developing an expanded provider network.

•	 Disseminating information about services to individuals, communities, and referral sources. 

•	 Preparing, disseminating, and using a service

directory. 

•	 Collecting outcomes and system improvement data.

•	 Reporting on data and experiences.

Although the information is organized in a linear 

fashion—what needs to be done first through what is 

done later—the work is linear only with respect to the 

start of an activity. For example, a jurisdiction will

have to analyze the strengths and needs of its current 

SUD treatment system during the planning stage, but 

the analysis is ongoing throughout the life of ATR and 

beyond. Similarly, partnerships with new stakeholders and providers will begin during planning, but this 

activity does not end. Preparing and disseminating a

service directory—which includes provider information, such as location, hours of operation, and types of 

services available to ATR’s enrolled individuals—does 

not occur until the implementation stage, but continual 

updates to that service directory will be needed. 

ATR Project Phase Key Staff, Processes, and Tasks in Designing Service Menus and 

Recovery Support Services 

Application • Initial analysis of strengths and needs in the current SUD treatment system

• Initial selection of target population(s)

• Initial partnerships with current and new systems, stakeholders, and providers

• Initial opportunities for individuals with SUDs to have input into the ATR service system’s

development 

• Initial service definitions, rates, and requirements

• Initial description of the provider network

Start-up 

(up to 4 months 

after award of 

grant) 

• Continuing analysis of strengths and needs in the current SUD treatment system

• Ongoing partnerships with current and new systems, stakeholders, and providers

• Review of selected target population(s)

• Additional opportunities for people with SUDs to have input into the ATR service system’s development

• Finalization of service definitions, rates, and requirements

• Final development and implementation of the expanded provider network

• Certification and/or credentialing of the provider network

Implementation 

(from 4 months to 

a year) 

•			Development of data reporting tools

•			Collection of outcomes and systems improvement data on recovery support services

•			Continuous reporting on data and experiences to advance treatment and recovery

support services throughout the project’s jurisdiction, SAMHSA, and the SUD services

field 

Access to Recovery Implementation Tool Kit, Volume 1, Phase 1, 2010. 

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Analyzing the Current SUD Treatment System 

SAMHSA’s announcement of the ATR grant made clear 

to potential grantees that ATR was not “business as 

usual” for SUD treatment. ATR’s emphases on new service types, new service providers, and a new payment 

mechanism in a new system driven by genuine independent choice by the individual signaled SAMHSA’s 

intent to transform the traditional SUD system of care. 

To successfully compete for an ATR grant, a jurisdiction 

needs to map and analyze its community’s SUD system 

of care. One way to accomplish this is to use the W.K.

Kellogg Foundation’s Mapping Community Resources

Model, which comprises the following six steps: 

1.	Involve diverse stakeholders in the process.

2.	Create a forum where stakeholders can learn about

and participate in the mapping process. 

3. Set up a planning team to take inventory of the community’s traditional and nontraditional services. 

4. Take inventory of nontraditional services, which 

are assets and capacities largely under community 

control and influence. 

5. Take inventory of traditional services, which are 

assets and capacities offered largely by public and 

private organizations.

 6. Create the resources map and put it to use. 

(Community Partnership Toolkit, 2011)

It is vital to follow up community resource mapping

with a gap analysis: Find the gaps in needed recovery

support services. To visualize these gaps, chart the 

results of the community resources map by potential 

target populations. The chart below was designed with 

three potential target populations in mind—individuals 

involved with the criminal justice system, military, and 

women. This information is useful for proposal preparation, allowing the jurisdiction to clearly articulate 

to reviewers which resources are currently available, 

what gaps in recovery support services need to be filled, 

and perhaps how the jurisdiction intends to fill those 

gaps through ATR. After being awarded the ATR grant, 

revisiting this matrix and revising it as necessary will 

fast-track the ATR grantee in finding which recovery 

support services are needed to fill the gaps for the 

grantee’s selected ATR target population(s) below. 

Partnering with Systems, Stakeholders, and Providers 

In preparation for writing an ATR proposal, the community resource mapping process sparks the development 

of new partnerships among systems, stakeholders, and 

providers. During implementation of the ATR grant, 

relationships with and among traditional systems and 

providers are likely to be redefined and restructured. 

New ATR grantees must be prepared to address concerns from a variety of providers. For example, new ATR

providers are often concerned about how their programs 

or services will be monitored, what kind of individual 

and fiscal recordkeeping and review will be necessary, 

and how working relationships with traditional SUD 

Potential Target 

Population 

Identified Service/ 

Support Needs 

Traditional Service 

Providers 

Nontraditional 

Service Providers 

Service Gaps 

Individuals

involved in the 

Criminal Justice 

System 

Military

Women 
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providers will be developed. Key concerns for traditional

SUD system of care providers typically include the ability of new faith-based and nontraditional providers to 

meet State contracting and credentialing requirements, 

whether the faith-based providers will be able to maintain the required separation of religious activity and 

programmatic functions, and what methods the faithbased and nontraditional providers offering recovery 

support services will be using. 

To address these issues, ATR managers must develop 

expertise on both the existing and new providers. To 

do this, they may need to seek answers to such questions as follows: 

•	 What do we know and/or need to learn about the

community organizations that deliver faith-based or 

community recovery support services? 

•	 How can we help prepare new providers to become

partners in an integrated system of care? 

•	 How do we identify and engage other new community-based clinical and recovery support services 

providers? 

•	 What requirements for participation do community

organizations anticipate as they prepare to become 

providers in our ATR system of care? 

•	 What is the current relationship between traditional

SUD providers and community organizations that 

deliver faith-based or community recovery support 

services? 

•	 What recovery support services do individuals use

outside of traditional provider organizations and 

which of these services best support recovery? 

•	 What partnership opportunities exist between your

traditional SUD providers and faith-based or community recovery support service providers? 

Several strategies may be needed to manage the delicate 

balance between the established system of care and the 

expanded one envisioned in ATR. ATR managers can 

hold face-to-face meetings with traditional providers to 

jointly review the Request for Applications requirements 

and service and system requirements. These meetings 

can be an opportunity to both honor the contributions 

of these providers and identify challenges and gaps that 

are impacting the treatment success of the individuals 

with whom they work. Invariably, some providers will

embrace the ATR transformation and fundamentally 

change practices; others will superficially change their 

services and business practices and not really “walk the 

walk.” It is important to the success of the ATR project

and the system change activity to learn to differentiate 

between the two. 

Spiritual Recovery Support Services 

While ATR includes a variety of reimbursable recovery support services beyond the traditional package of 

SUD treatment services, the proposed funding of spiritual recovery support services delivered by faith- and 

culturally based providers is perhaps the most controversial and worthy of special consideration. Two key 

issues immediately emerge: the use of Federal funding

for these services and the services themselves. 

The funding of ATR services through a voucher system 

under the control of the individual is a significant 

departure from traditional funding mechanisms. 

Unlike traditional approaches, in which providers 

receive funds to deliver SUDs treatment services, ATR 

vouchers are issued to an individual, who then uses 

them to purchase an array of clinical and recovery 

support services through a network of approved providers. This fundamental difference allows the use of 

ATR funds for services from faith- and culturally based 

providers by avoiding direct Federal funding of these

organizations and placing the choice of providers and 

services with the individual who receives a voucher. 

Many spiritual recovery support services are specific 

to a particular religious denomination, cultural group, 

or tribe. Many of these services do not lend themselves 

to “definition” and “standards of practice” and are 

often delivered by unlicensed personnel. Traditional 

SUD service providers will question the value of these 

services in the recovery process. 

ATR grantees will need to ensure that all providers 

understand the value of spiritual recovery support 

services in the recovery process and address funding 

issues and concerns. Some grantees implement strategies such as mandatory monthly ATR network meetings 
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to encourage interaction among their providers. At 

these meetings, the providers are invited to present 

information on their services, practices, and individual 

outcomes. Individuals who have effectively used spiritual recovery support services in their recovery can 

also be valuable additions to such gatherings. Meeting 

attendees regularly report a new appreciation for and 

understanding of the role and value of spiritual recovery 

support services in a person’s recovery journey. 

Providing Opportunities for Input by the Individual 

The ATR Request for Applications clearly mandates 

that ATR projects must “ensure genuine, free, and 

independent individual choice for substance abuse 

clinical treatment and recovery support services 

appropriate to the level of care needed by the client.” It defines choice in the ATR program as “a client

being able to choose from among two or more providers qualified to render the services needed by the 

client, among them at least one provider to which 

the client has no religious objection.” (“ATR [Initial 

Announcement] Request for Applications [RFA] No. 

T1-04-008,” 2010.)

Individual input into the design of an ATR service

system is a critical factor in service menu design. 

Strategies to solicit input may include creating focus 

groups to gather, review, and incorporate input that 

helps shape the initial menu of ATR services during 

the proposal planning stage. In addition, ATR managers use these opportunities to solicit feedback from 

individuals regarding their positive and negative experiences with the traditional SUD treatment system. 

They also have individuals identify the recovery support services they need for their recovery, and these 

are then often included in the ATR service menu. 

Individual choice of both providers and services is a

fundamental difference between the traditional SUD 

treatment system and ATR. Individuals served by traditional services may not be encouraged to express or 

act on their preferences in determining which services 

they want to use. Service providers may overly influence the choices the individual makes. To minimize 

this influence, ATR projects develop and implement 

strategies and processes that support the individual’s 

independent choice of services and service providers. 

Some ATR projects use a central intake model, which 

allows individuals to be assessed for services by a 

neutral third party that is separate from the provider 

network. Other ATR projects regularly track provider

“self-referrals” to monitor potential variation from the 

tenet of individual choice. All ATR projects have an 

established complaint process that allows individuals to report any concern with services or providers 

directly to ATR staff. Finally, ATR managers use

voucher management system reports to spot any other 

provider and service issues. 

Designing Service Menus for Target Populations 

A key feature of ATR is funding of a new mix of clinical and recovery support services. While a relatively 

small dollar amount, an ATR grant can bring muchneeded resources to a chronically under-funded SUD 

system of care, and thus the advocacy for specific 

recovery support services to be included in the local 

ATR service menu can be intense. Developing a matrix 

during the application process, as described previously 

under Analyzing the Current SUD Treatment System 

on page 5, will help limit the impact of these advocacy 

efforts. Potential providers will gain a better understanding of the range of services currently available 

and the gaps that they may be able to help fill. During 

the implementation phase, ATR managers will need to 

clearly understand how the current configuration of 

services fits with the needs of the target population(s) 

and, based on this assessment, what types of services 

appear to be missing from the provider network. They 

can then work with traditional and nontraditional providers to develop new lines of services as needed. 

Developing Recovery Support Services 

•	 Refer to SAMHSA’s sample list of services provided

in the Request for Applications to help with initially 

identifying appropriate providers. 

• Talk to people who are familiar with the treatment

community and have knowledge of community 

services that are often under the wire and may 

have never had the attention of State or governmental funding entities. For example, set up a

meeting with your mental health services department within your agency. 
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Developing Service Definitions, Rates, and Requirements 

Essential to the goals of the ATR program is the development, implementation, and monitoring of a number 

of new recovery support services, including faith-based 

and nontraditional services. Communication strategies 

for community and faith-based providers require special 

attention to relationship building. These providers are 

typically not looking for a “contract with the State”; they 

want a relationship with an individual who understands 

their services. ATR managers need to form relationships with these providers that are based on respect and 

trust. Approaching the faith community through ministerial alliances has been a useful strategy for many 

ATR grantees. Irrespective of how collaborative relationships are developed with nontraditional support service 

providers, ATR managers will likely have to assist these 

providers in developing service definitions, establishing 

rates, and defining staffing requirements. 

Developing Service Definitions 

A fully developed service definition includes the following information: 

•	 Definition of the scope of service.

•	 Rationale for the service.

•	 Qualifications for delivering the service.

•	 Payment criteria for the service.

•	 Credentialing of the staff so they will be able to

deliver the service. 

•	 Codes for the service.

A common way to help a nontraditional support service provider develop the definition of its service is to 

compare the service to be provided to that found in the 

traditional service arena. 

Establishing Rates 

Most ATR grantees pay a higher rate for similar services if they are provided by individuals with some 

specialized training. For example, ordained clergy

typically have expertise and credentialing that is different from that of lay ministers. Both may counsel

individuals about a crisis of faith; however, the 

ordained clergy would typically do so according to an 

organized doctrine and in a theologically sound way 

using the texts of their religious beliefs. Therefore, 

ordained clergy would be paid at a higher rate than lay 

ministers, even though both may fall into the category 

of spiritual recovery support services. 

Implementing New Services 

•	 Disseminate a list of services throughout the community for providers to choose from. 

•	 Next, look at the types of services that have the

least number of providers. 

•	 Then, pay a higher rate for those services as an

incentive for providers to start offering them. 

Another approach to establishing rates is to consider 

the rates for the services of credentialed providers in 

traditional clinical settings and pay comparably for 

individuals with similar levels of education in their 

fields of expertise. Some ATR grantees even extend 

this strategy to service providers who have expertise 

in cultural practices. A description of how one ATR 

grantee expanded the standard pay rate for a clinician 

to both ordained clergy and cultural elders is provided 

in the final section of this TA Package.

Defining Staffing Requirements 

Requirements for both paid and volunteer ATR 

staff often include a criminal background screening and proof of legal eligibility to work in the State. 

Services Versus Spending 

•	 Look at the level of clinical treatment the client is

receiving to ensure that recovery support services 

aren’t interfering with treatment or overwhelming

the individual, who may be in an intensive level 

of clinical treatment. You can do this by consulting with the clinical and recovery support service 

providers. 

•	 Service limits may come down to how much money

is available in your budget, how much funding is 

available, client targets, and—in some respect—a 

simple issue of math. 
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Additionally, ATR grantees develop appropriate licensing and/or training requirements for ATR provider 

staff. For example, one grantee distinguishes between

ATR-approved staff and ATR-qualified staff by requiring qualified staff to have appropriate certification 

and/or licensure for the recovery support service they 

are providing. Types of certifications and licenses 

include professional counselor certification, qualified 

substance abuse professional designation, commercial 

driver’s licensure (for certain transportation services), 

and recovery support specialist certification. 

Developing an Expanded Provider Network 

In conjunction with the establishment of ATR service

definitions and rates, grantees also set requirements 

for provider eligibility for the ATR network. Provider

eligibility determination includes requirements at 

the organization, site, and staff levels. For example,

an ATR grantee may require a provider organization to hold a certificate of good standing issued by 

the Secretary of State. Site level requirements may 

include such items as current fire inspections, local 

Government-issued occupancy permits, and nationally 

approved inspections, including the Housing Quality

Standards established by the United States Department 

of Housing and Urban Development, to ensure the 

health and safety of staff and individuals. 

While jurisdictions will have conducted preliminary 

work around the identification of new providers for 

an expanded ATR network to prepare for proposal 

submission, the majority of the effort in network development occurs during project startup. Many of the new 

providers in the ATR network will have limited experience in State systems of care. The section of this TA 

Package titled Partnering with Systems, Stakeholders,

and Providers on page 5 includes some hints and tools

for outreach to potential providers. The Determining 

Readiness for ATR RSS Providers tool (Appendix D)

can be used by any new provider prior to application 

for ATR Provider status.

ATR managers will need to develop a number of 

documents to support the ATR network, including the 

following: 

• Applications.

•	 Contracts and/or memorandums of understanding.

•	 Documents on infrastructure requirements.

•	 Credentialing and approval forms.

•	 Provider handbooks.

•	 Documents detailing data collection requirements.

Disseminating Information to Individuals, 

Community, and Referral Sources 

Word of mouth is often the most effective tool in getting individuals enrolled in ATR services. However, 

the use of several strategies may be required to ensure 

that referral sources, stakeholders, and partners 

are familiar with the new ATR network. These may 

include community outreach campaigns, provider open 

houses, or town hall meetings. To successfully implement these strategies, it is critical that ATR grantees 

identify and coordinate with a trusted community 

entity (e.g., an individual or provider) that is wellknown for supporting individuals in recovery. For

example, one grantee worked with a faith-based organization in its community, which hosted a lunch-time 

open house at its location. Referral sources, stakeholders, and partners from the community were invited 

to tour the site and learn about the services being 

offered. Another grantee used its central intake model 

to conduct a formal community outreach campaign, 

which involved posting ATR service flyers throughout 

the community, speaking with faith-based and secular 

organizations during brown-bag lunch sessions, and 

participating in radio interviews on local stations. 

Preparing, Disseminating, and Using 

a Service Directory 

The creation and dissemination of a provider service 

directory is a necessary task both prior to implementation of the project and when new services 

and providers are added to the network. Similar to a 
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service directory, the service menu includes the following information: 

•	 A brief description of the service.

•	 The recommended frequency and intensity of the

service. 

•	 The approved rate for the service.

•	 A list of approved providers of the service.

ATR project staff members need to determine how to 

keep these lists updated as providers and services are 

added to the voucher management system. One suggestion is to maintain an electronic list of providers 

and services on the ATR project’s 

Web site and prominently feature 

the Web site address in all of the 

ATR project’s materials. Staff members of many ATR projects assist 

eligible individuals in using this 

electronic service directory to select 

their services and providers during the intake/assessment process. 

ATR grantees are encouraged to use 

program structures and processes 

such as care coordination to ensure that individuals 

are aware of the provider and service options. 

Help Your Providers 

Create a recovery 

support services list 

and a manual to 

accompany it, which 

serves as a guide for 

providers on how to 

document services. 

ATR managers may use service directories to publicize 

the ATR program across project sites, to communities, 

and to partners and stakeholders by establishing an 

ATR project Web site that provides online access to 

ATR program information and these service directories. ATR managers widely disseminate this Web site 

address, including the provision of direct links from 

other Federal, State, and local Web sites, such as those

sponsored by the State Substance Abuse Authority. 

The State of Hawaii Department of Health Web site and 

the Missouri Department of Mental Health Web site are 

helpful examples of project sites that include myriad 

resource samples, such as provider handbooks and 

service directories. Samples of the other documents 

noted in this section are provided in appendices A-D 

(See the References and Additional Resources section 

on page 13 for Web site addresses.).

Collecting Outcomes and System Improvement Data 

All ATR grant recipients are required to collect the federally mandated Government Performance and Result

Act (GPRA) data set. Designed to track change over time

across several key indicators for each individual, GPRA

data reporting requirements include the following: 

•	

•	

•	

Data collection at three points during an individual’s

course of ATR services. 

An 80 percent follow-up rate of individuals at six

months. 

The ability to upload data into the Federal Services

Accountability Improvement System.

To understand ATR service utilization and the contribution of recovery support services to an individual’s 

overall recovery process, ATR grantees must regularly 

monitor GPRA and voucher management system data.

Suggested strategies follow: 

•	 Weekly review of voucher management system data

to track service and provider utilization. 

•	 Implementation of an electronic services calendar

for each individual to identify possible waste, fraud, 

and abuse. 

•	 Regular review of GPRA data, with critical analysis

of service mixes and individual outcomes. 

Each of the strategies listed above enables ATR managers 

to continuously and consistently track the implementation and utilization of their ATR grant. Voucher 

reimbursement systems are designed to reflect consumer 

utilization and, as such, change constantly. ATR managers review voucher management information, including 

service utilization frequency and duration, to identify 

both standard and outlier practices. Through the review 

of voucher management system data, for example, 

one ATR grantee identified an ongoing lack of housing providers. Steps were then implemented to increase 

reimbursement rates to, in turn, increase the number of 

providers offering this service. 

An electronic services calendar (or one done by hand) 

for individuals allows ATR managers to immediately visualize ATR service utilization (e.g., billing) 
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throughout a week, a month, or the life of a voucher. 

This calendar can be used to track both individual and 

provider data, offering a picture of the types of ATR 

services being utilized and establishing a baseline 

audit tool for individual record review. 

ATR’s requirement to collect GPRA data at set intervals

allows ATR managers to assess the impact of recovery 

support services on key individual outcomes, such 

as abstinence, ongoing criminal justice involvement, 

employment, and social connectedness. By monitoring

and analyzing GPRA data, ATR managers can adjust

the types of recovery support services being offered. 

ATR data collection represents a unique opportunity in 

the behavioral health service system. In many cases,

ATR data collection represents the first time that a 

State can actually track outcomes on a cohort of individuals at different intervals. 

Reporting on Data and Experiences 

ATR managers report on data and experiences to 

advance treatment and recovery support approaches 

throughout the project’s jurisdiction, the broader SUD 

services field, and SAMHSA. ATR managers use individual satisfaction surveys, provider and referral source 

feedback, and service utilization data to monitor and 

report on program status. GPRA and voucher management system data are provided to ATR partners, referral 

sources, legislators, and community stakeholders 

through regular network and provider meetings, regular 

status reports, and ad hoc data requests. The value 

of this information, along with GPRA outcome data,

enables ATR managers to influence the transformation 

of the traditional SUD system of care. 

Moreover, ATR data provides a rich opportunity to sort 

and review outcomes in a variety of ways, such as the 

following: 

•	 Level of care.

•	 Combinations of levels of care (e.g., clinical and

faith-based, clinical and peer). 

• Provider.

•	 Provider type.

ATR data has been used by States and Tribal Nations 

to make decisions on where State dollars should be 

used to sustain or expand a service. One grantee’s

ATR data provided enough evidence of success for the 

State to decide to sustain its ATR service through State 

funds. Those programs still exist today, not simply 

because of their success in ATR but because the data 

was collected and used appropriately. 

Many of the tenets of ATR, especially the emphasis on 

recovery support services and the implementation of 

services that produce outcomes, can be found in the 

latest SAMHSA guidelines on the combined Substance 

Abuse Treatment and Prevention and Community

Mental Health Services Block Grants. The data collected through ATR is largely responsible for this shift. 

Grantee Examples 

ATR programs can learn from the current grantees 

who designed, implemented, and revised service 

menus and recovery support services in ATR 1 or 2.

Two examples included here represent service and 

network information from Hawaii ATR and Missouri 

ATR. Additional resources from these two States can 

be obtained from their respective Web sites. (See the 

References and Additional Resources section on page 13

for Web site addresses.) 

Service Menus 

Hawaii ATR’s service menu exclusively funds recovery 

support services. However, Missouri ATR’s service 

menu includes both clinical and recovery support services. Recovery support services selected were heavily 

influenced by the faith-based community in response 

to the emphasis on faith-based initiatives in ATR 1.

Providers 

The Hawaii ATR provider network is open to all providers who meet the basic criteria; these providers are 

referred to as “authorized” providers. The Missouri 

ATR provider network, however, is limited to credentialed recovery support service organizations, certified 

clinical organizations, and housing and transportation providers, which must meet State and Federal

requirements. 
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“We thought, if we are going to find out what the 

standard pay rate is for a clinician, then that’s the 

rate we are going to pay an ordained minister and 

that’s the rate that we are going to pay a kupuna 

who’s doing cultural practices.” 

— Bernice Strand, Project Director, ATR Ohana

In Hawaii, kupuna is an umbrella term for the expert, 

respected elder, or recognized cultural or community leader, but different distinctions exist regarding 

seniority within the cultural community. Within the 

category of kupuna is the kumu, who is equivalent to 

a formal teacher. However, a kupuna who practices 

traditional crisis resolution may not necessarily be a 

kumu for a different cultural practice. Or, a kumu may 

have less experience than a kupuna in the same cultural practice. Also, a kupuna on one side of the island 

may not necessarily be a kupuna on the other side. 

Understanding these distinctions among cultural titles 

and practices is crucial. 

Governing Documents 

Given the significant difference between contracting for 

traditional SUD treatment services and ATR services, 

each grantee had to work extensively with its respective legal departments to ensure that State financing 

laws were not violated while implementing the voucherbased reimbursement system required by the grant. 

Hawaii ATR staff utilizes a general memorandum of 

understanding, including their service definitions. 

This memorandum of understanding is renewed yearly 

proactively by the State. Each service category is extensively detailed in the memorandum, reflecting Hawaii’s 

state history of comprehensive contracts for any services. Missouri ATR staff utilizes a general contract, as 

the State credentials their ATR network. 

Example of a Recovery Support Service 

Spiritual Counseling (Individual, Qualified) helps an 

individual develop spiritually, which might include, 

but is not limited to, establishing or reestablishing 

a relationship with a higher power, acquiring skills 

needed to cope with life-changing incidents, adopting positive values or principles, identifying a sense 

of purpose and mission for one’s life, and achieving 

serenity and peace of mind. Responsible decisionmaking, social engagement, and family responsibility may 

also be addressed. Only ATR-qualified clergy may

provide spiritual counseling. (Missouri ATR) 

Pastoral Counseling may include, but is not limited 

to, a client meeting with an ordained minister, priest, 

rabbi, imam, monk, or other advanced-level, qualified, authorized, and endorsed faith expert to study 

the application of a religious text to recovery, to support during a crisis, to determine a recovery plan, or 

to receive instruction in religious rituals that provide 

meaning and can replace behaviors caused by individuals’ substance use. This may include structured 

discussions about the philosophy of religion or integration of spiritual tenets into daily living and sobriety. 

Pastoral counseling faith experts incorporate faith and

specific religious beliefs and convictions in the treatment and recovery process. Services may be provided 

individually or in a group setting. Pastoral counseling’s

purpose is to provide proactive instruction or interaction between the faith expert and the individual to 

assist the individual with developing his or her own 

concept of spirituality and its role in sustaining recovery. (Hawaii ATR) 

Example of the Evolution of a Recovery Support Service 

Missouri ATR staff noted a lack of recovery housing 

in some ATR service areas in the State. They consulted with current ATR recovery housing providers 

to determine the reasons for the disparity. They also 

conducted a rate comparison to recovery housing 

providers in other areas of the system and analyzed 

current housing market conditions. As a result of this 

research, Missouri ATR staff will adjust the reimbursement rate for recovery housing. 

Hawaii ATR staff operationalized seven categories 

from SAMHSA’s list of recovery support services. 

They plan to add more services to the 10 they currently offer. After the service menu was created, staff 

modified the service descriptions as needed. Lessons

learned from this process help staff revise the menu, 

including the notion to bundle some services and 

unbundle others. 
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Bundled services: Working with someone to get him or 

her to navigate through the care continuum and finding a housing resource is a different kind of mentoring 

from mentoring on how to create a budget sheet or 

on deciding whether a new apartment is a safe place 

to go. Yet, all of these services are offered under a 

bundled service category called “Mentoring.” 

Unbundled services: Bundling services under the category of “Spiritual Recovery Support Services” proved 

insufficient because of the difficulty in distinguishing between, for example, an ordained minister and a 

deacon, as they have different levels of expertise and 

credentialing. The lay minister who talks to an individual about faith-related crisis management doesn’t 

receive the same pay as an ordained minister who is 

reviewing with the client—according to a theologically 

sound organized doctrine—the texts of their religious 

belief. Pastoral counseling is therefore separate from

the Mentoring category, while spiritual coaching may 

be considered a type of mentoring when provided by 

noncredentialed peers. 

A Webinar on Designing Service Menus and Recovery 

Support Services will be available from SAMHSA in 

the near future. The information and resources made 

available in the Webinar, combined with this TA 

Package, should ease design and implementation processes for new ATR 3 projects and assist other grantees 

in enhancing their ATR services. Additional technical 

assistance from SAMHSA/CSAT related to this topic 

can be requested. 

References and Additional Resources 

Designing Service Menus and Recovery Support 

Services (Webinar) (forthcoming) 

The State of Hawaii Department of Health Web site, 

http://hawaii.gov/health/substance-abuse/ATR/ 

providers.html 

The Missouri Department of Mental Health Web site, 

http://dmh.mo.gov/ada/ATR 

Substance Abuse and Mental Health Services 

Administration. (2010). Access to Recovery 

Implementation Toolkit (Vol. 1, Phase 1). Rockville, 

MD: Substance Abuse and Mental Health Services 

Administration, U.S. Department of Health and Human 

Services, http://www.atr.samhsa.gov/ATR3docs/ATR_ 

Vol_1_Phase_1.pdf (accessed October 6, 2011).

Substance Abuse and Mental Health Services 

Administration. (2010). Access to Recovery (Initial 

Announcement) Request for Applications (RFA). 

(No. TI-04-008). Rockville, MD: Substance Abuse

and Mental Health Services Administration, 

U.S. Department of Health and Human Services, 

http://www.samhsa.gov/grants/2010/TI-10-008.aspx

(accessed October 6, 2011).

W.K. Kellogg Foundation’s Community Partnership 

Toolkit, http://ww2.wkkf.org/Pubs/CustomPubs/

CPtoolkit/CPToolkit/default.htm (accessed October 6,

2011).

Appendices 

Appendix A: ATR III Recovery Support Service

Descriptions and Pricing, http://dmh.mo.gov/docs/ada/

ATRIIIRSservicessummaryanddescriptions8-1-2011.pdf

Appendix B: ATR III RS Credential Status Application

Appendix C: MOU Document Requirements for

ATR Ohana

Appendix D: Determining Readiness for ATR Recovery 

Support Service (RSS) Providers