OMB approval # 0930-0168

FY 2016-17 Block Grant 

Application

Community Mental Health Services Plan and Report 

Substance Abuse Prevention and Treatment 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

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’ Goals.........................................................................................................11

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

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

A. Framework for Planning—Mental Health and Substance Abuse Prevention and Treatment .........14

B. Planning Steps..................................................................................................................................17

1. Quality and Data Collection Readiness.......................................................................................22

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

C. Environmental Factors and Plan .....................................................................................................38

1.The Health Care System and Integration....................................................................................38

2.Health Disparities.......................................................................................................................43

3.Use of Evidence in Purchasing Decisions..................................................................................45

4.Prevention for Serious Mental Illness ........................................................................................48

5.Evidence-Based Practices for Early Intervention (5 Percent) ....................................................49

6. Participant Directed Care.................................................................................51

7. Program Integrity........................................................................................................................51

8. Tribes...........................................................................................................................................53

9. Primary Prevention for Substance Abuse ...................................................................................54

10. Quality Improvement Plan ........................................................................................................57
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11. Trauma .....................................................................................................................................58

12. Criminal and Juvenile Justice...................................................................................................59

13. State Parity Efforts....................................................................................................................61

14. Medication Assisted Treatment................................................................................................62

15. Crisis Services..........................................................................................................................63

16. Recovery...................................................................................................................................65

17. Community Living and the Implementation of Olmstead........................................................67

18. Children and Adolescents Behavioral Health Services............................................................68

19. Pregnant Women and Women with Dependent Children ........................................................71

20. Suicide Prevention....................................................................................................................72

21. Support of State Partners..........................................................................................................73

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

Abuse Block Grant Application .................................................................................................74

Acronyms ..................................................................................................................................................78

Resources...................................................................................................................................................81

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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FY2016-2017 Block Grant Application

I. INTRODUCTION

This block grant application includes four major parts: introduction, submission of application and plan 

timeframes, behavioral health assessment and plan and reporting requirements. These sections include 

discussion and planning around the following policy topics: health care systems and integration; health 

disparities; use of evidence in purchasing decisions; prevention of substance abuse; evidence-based 

practices for early intervention (e.g., serious mental illness (SMI)); participant-directed care; program 

integrity; tribal affairs; primary prevention for substance abuse, quality, data, and technology; quality 

improvement; trauma; criminal and juvenile justice; state parity efforts; medication-assisted treatment;

crisis services; recovery; community living and Olmstead; children and adolescents behavioral health 

services; pregnant women and women with dependent children; suicide prevention; behavioral health 

planning council; and delegation of authority letter.

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 maximum flexibility to 

address the unique behavioral health1needs 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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 In addition, the centers within SAMHSA that administer these

block grants historically have had different approaches to reviewing application requirements and their 

reporting. 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 best and most cost effective treatment and other 

services. State block grant expenditures should be based on the best possible evidence and 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 (FY) 2011, SAMHSA redesigned the FY

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

and related policy initiatives, including the Affordable Care Act, the Mental Health Parity and Addiction 

Equity Act (MHPAEA), and the Tribal Law and Order Act (TLOA). The new design offered states the

 

1

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/block-grants/lawsregulations
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opportunity to complete a combined application for mental health and substance abuse 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 abuse prevention, and treatment administration. 

Almost half of the states took advantage of this streamlined application during FY 2014-2015

application process and submitted combined plans for mental health and substance abuse 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 promotion of emotional health. 

The FY 2016-2017 Block Grant Application furthers SAMHSA’s efforts to have states use and report 

the opportunities offered under various federal initiatives. The FY 2016-2017 Block Grant Application

continues to allow states to submit an application for both mental health and substance abuse services as

well as a biennial plan. This application also reflects the Affordable Care Act’s strong emphasis on 

coordinated and integrated care along with the need to improve services for persons facing behavioral 

health crises.

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

As the driving force for its direction, 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. Leading Change 2.0: Advancing the Behavioral Health 

of the Nation 2015 – 2018, issued in late FY 2014, reflects SAMHSA’s programmatic priorities and 

policy drivers including the new HHS strategic plan and full implementation of the Affordable Care Act.

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 to focus its 

work on improving lives and capitalizing on emerging opportunities. These include:

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

SMI and severe emotional disturbance (SED)

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by maximizing opportunities to create 

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

 

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

include 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 abuse; American 

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

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

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

systems 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 will 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/SEDs) 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. This SI also will 

support the use of innovative strategies to reduce the involvement of individuals with trauma and 

behavioral health issues in the criminal and juvenile justice systems.

4. Recovery Support: Emphasizing person-centered planning, this Strategic Initiative promotes

partnering with people in recovery from mental and substance use disorders and their family 

members to guide the behavioral health system and promote individual, program, and systemlevel 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, 

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 (EHRs) 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 the behavioral health 

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

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

and treatment for substance abuse and mental illness; 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. 
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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 of 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. Changes to the block grant application(s)

incorporate several key assumptions:

States should be strategic in their efforts to purchase services.

The availability of new evidenced-based approaches and funding will require states to rethink what 

services they purchase as well as how those services are purchased. Although access to Medicaid and 

private insurance has increased, certain gaps in coverage are expected to remain for specific populations 

and services. SMHAs and SSAs need to continue to identify those gaps by first mapping out 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 illness 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 being covered by

insurers and other payers. States will need to become more diligent in their efforts to identify

individuals in their systems that may currently qualify, but are not 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. States are 

encouraged to expand Medicaid where possible for persons and services not otherwise covered.

The block grant laws and 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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Several states have indicated an interest in using block grant funds to cover client co-pays, deductibles

and other types of co-insurance for behavioral health services. SAMHSA will release guidance 

imminently to the states on these issues. States that choose to do this will need to develop specific 

policies and procedures for ensuring compliance with this guidance. 

States should 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 also consider promoting and supporting the

revenue diversification efforts of funded providers to develop a provider pool that is more adept at 

navigating the new environment. States should assist providers in the development of better financial 

strategies that will allow providers to be less dependent on SMHA and SSA funding. Funding available

from the Center for Medicare and Medicaid Services (CMS), such as Medicaid, CHIP, and Medicare

may play an important role in the state’s financial strategy. There are also national demonstration 

projects and programs (e.g., Health Homes, Clinical Practice Transformation, Innovation Accelerator 

Program, State Innovation Models, Medicaid Emergency Psychiatric Demonstration, Financial 

Alignment Initiative for Medicare-Medicaid Enrollees) that support efforts to provide behavioral health 

 

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http://www.samhsa.gov/grants/block-grants/laws-regulations
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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., loan forgiveness program, National Health Service

Corps, training grants, etc.). This means that SMHAs and SSAs (as well as public health authorities 

responsible for prevention) will need to engage and collaborate with different partners at the state, 

federal, and community levels. Both TRICARE and the Department of Veterans’ Affairs (VA) provide

behavioral health services as well. Persons eligible for such services should be assisted in accessing 

these services as appropriate.

States should think more broadly about their impact on special populations than 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 must 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, and lesbian, gay, bisexual, transgender and questioning (LGBTQ)

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 personal experiences with mental or

substance use disorders 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. 

The use of technologies may support access to services by new groups or populations, especially those 

more likely to be comfortable with these new technologies. Advances in technology have changed 

significantly since SAMHSA’s inception in 1991. Technology is playing a growing role in how 

individuals learn about, receive, and experience their health care services. Interactive Communication 

Technologies (ICTs) 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 should design and develop collaborative plans for health information systems. Health care

payers will seek to promote EHR and interoperable information technology systems that allow for the

effective exchange and use of health data.

Providers of behavioral health services should adopt health information technology 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)7. 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 (national provider numbers, International Classification of

Diseases (ICD-10), Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT), 

 

7 http://healthit.gov/policy-researchers-implementers/standards-interoperability
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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 other payers (e.g., 

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

behavioral health purchasers to begin or continue to collaborate and discuss system interoperability, 

electronic health records, federal information technology requirements, and other related matters. 

Additional information from ONC is available at http://www.healthit.gov/.

States may form strategic partnerships to provide individuals with access to effective and efficient

services systems.

SAMHSA seeks to enhance SMHAs and SSAs abilities to be full partners in developing and 

implementing and enforcing MHPAEA and delivery of health systems reform in their states. In many

respects, successful implementation will be 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 health information technology authorities are integral to the effective and 

efficient delivery of services. These collaborations will be particularly important in the areas of

Medicaid expansion, data and information management and technology, professional licensing and

credentialing, consumer protection, and workforce development.

To increase the likelihood of cooperative success, there must be a long-range view, open

communication, knowledge sharing, and a consideration of all stakeholder concerns and priorities. 

SMHAs and SSAs should develop strategic partnerships with TRICARE, primary care, public health, 

criminal and juvenile justice, education, child welfare, VA, National Guard Bureaus, insurers, and 

employers. State authorities should also engage in tribal consultation as an effective means to learn of

needs, resources, and services not previously considered as they undertake their block grant planning

process.

State authorities should focus on recovery from mental health and substance use problems.

People can and do recover from behavioral health problems, 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, people with mental and substance use disorders, 

families, and others in promoting recovery.

State authorities should 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 (MCOs) or Administrative Services 

Organizations (ASOs) to oversee and provide behavioral health services. State legislatures, state

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

to Affordable Care Act and Electronic Handbooks. SMHAs and SSAs should be involved in these

efforts to ensure that mental health and substance abuse services are appropriately included in plans, and 

that mental health and substance abuse providers are included in networks. Given that many mental 

health and substance use consumers are insured through Marketplaces or eligible for Medicaid, 

significant consideration should be given to the inclusion of necessary services and providers.
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States should make primary substance abuse 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 should be strategic in leveraging scarce resources to fund prevention services.

States need to make the most efficient use of substance abuse prevention funds 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 data-driven substance

abuse 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 abuse prevention system, as well as collaborate 

with and assure that behavioral health is part of the state’s larger public health prevention activities.

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

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

Now that the Marketplace is in effect, state legislatures, state Marketplace entities, and state insurance

commissioners are developing 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 mental and 

substance use disorders 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 should make every effort to ensure that the right recipient is receiving the right 

payment for the right reason at the right time.

Block grant funds should be directed toward four purposes: (1) to fund priority treatment and support

services for individuals without insurance or for whom coverage is terminated for short periods of

time; (2) to fund those priority treatment and support services not covered by 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 treatment; and

(4) to collect performance and outcome data to determine the ongoing effectiveness of behavioral

health promotion, treatment, and recovery support services and to plan the implementation of new

services on a nationwide basis.

States may have to make changes to their information systems and compliance review processes to 

assure better program integrity. This may include working closely with Medicaid and the Marketplace

to review information and determine whether individuals and providers in their systems are enrolled. It 

also may include implementing strategies to assist their providers with the necessary infrastructures to 

operate in commercial and public (Medicaid and Medicare) systems. States are encouraged to consider

developing metrics or targets to measure increases in the number of individuals who become enrolled or 
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providers that join commercial or publicly funded managed care networks.

State authorities should 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 a critical input for making purchasing decisions and influencing coverage offered in 

their state through commercial insurers and Medicare/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 show promising outcomes. 

State authorities should 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. 

States authorities should monitor compliance with the federal parity law to ensure that individuals with 

behavioral health conditions are receiving the mandated coverage and access.

Plans and issuers subject to MHPAEA that offer mental health and substance abuse 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 a M/SUD 

benefit do so at the same level of benefit as for physical conditions, it does not require a plan to offer a 

M/SUD benefit. M/SUD disorder services are among the ten categories of service elements that serve 

as components of the essential health benefits package that are offered in marketplaces. 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. States can work with their constituents and advocacy groups to develop resources and toolkits 

to address barriers to limited awareness. This active involvement to increase awareness helps to ensure

that consumers receive quality behavioral health prevention, care, 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 should be 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. For instance, CMS and 

SAMHSA strongly suggest that SMAs include SMHAs and SSAs in designing their approaches for
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health homes under Section 2703 of the Affordable Care Act. SMHAs and SSAs are in the best position 

to offer their Medicaid partners information regarding the most effective care coordination models, 

connect current providers (such as the SAMHSA Primary and Behavioral Health Care Integration 

(PBHCI) grantees) 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. States are beginning to develop client-level and systemic strategies (e.g., moving to Accountable 

Care Organizations (ACOs) and carve-in managed care arrangements) that are aimed at enhancing

integration between primary care and specialty care. 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 postacute care, and hospital emergency room care will see numerous behavioral health issues among the 

person served. SMHAs and SSAs should be collaborating to educate, consult and serve patients,

practitioners and families seen in these systems. Integration in community prevention activities is 

equally important. Other public health issues are impacted by substance use and/or mental 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 

behavioral health prevention, care, and recovery for diverse racial, ethnic, and LGBT 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. 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 behavioral 

health disparities.

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

health services.

The four dimensions of recovery:
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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, 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 

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.
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• 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 attaining and maintain recovery. Recovery support services include efforts such as 

self-directed care, shared decision-making, peer-operated services, peer specialists and recovery

coaches, wellness activities, supported housing, recovery housing, self-care, evidenced-based 

supported employment, supported education, warm lines, person-centered planning, peer and 

family support, social inclusion activities, and rights protection.

• State authorities should ensure that their states have a system of care approach to children’s 

and adolescents’ behavioral health 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 developing or amending 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.

States should also consider their existing administrative and programmatic infrastructures as 

they work to support local systems of care. Existing councils, such as children’s cabinets, can 

be used to avoid duplication of effort when working towards better interagency coordination. 

Children and youth served through systems of care are likely to be involved in multiple

systems and are probably already the focus of state-level programs and partnerships (e.g., in 

education, juvenile justice, or child welfare), so such efforts may also be part of the foundation 

for a statewide systems of care approach. States are encouraged to look at the impact of

adopting this approach across different agencies, addressing issues like access to care, no 

wrong door, and the best place(s) to house care coordination or case management resources;

how to handle information sharing; and which components of a local system of care the

agencies are best situated to provide the necessary funding.

C. Block Grant Programs’ Goals

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

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

disorders and substance use disorders. The goals of the block grant programs are consistent with 

SAMHSA’s vision for a high-quality, self-directed, and satisfying life.

The components of a healthy life are the dimensions of recovery: health, home, purpose, and 

community. Additional aims of the block grant program reflect SAMHSA's role as a public health 

agency:

1. The focus is about everyone, not just those with an illness or disease, but families, 

communities, and the whole population, with an emphasis on prevention and wellness 

activities.

2. To ensure access to a comprehensive system of care, including education, employment, 
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housing, case management, rehabilitation, medical and dental services, as well as behavioral 

health services and supports, to include services to the rural and homeless populations, and 

provider training activities.

3. The activities are data driven: a public health agency uses surveillance data as well as an 

analysis of other public health drivers/levers to identify targets of opportunity.

4. There is an emphasis on access to services and availability.

5. There is an emphasis on policy impact and support: an analysis of the laws, rules, and 

infrastructure that inform and support the work.

These goals are significant drivers in the block grant application. SAMHSA’s and other federal 

agencies’ focus on accountability, person-directed care, family-driven care for children and youth, 

underserved populations, tribal sovereignty, and comprehensive planning across health and specialty

care services are reflected in these goals. States should use these aims as drivers in developing their

application(s).

II. SUBMISSION OF APPLICATION AND PLAN TIMEFRAMES

Changes to the SABG and MHBG applications are, in part, being driven by MHPAEA and related laws,

which require standardization among applications. SAMHSA wants to ensure that SMHAs and SSAs are

well positioned during FYs 2016 and 2017. 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-only is due no later than 

September 1, 2015. The application for SABG-only is due no later than October 1, 2015. A single 

application for MHBG and SABG is due no later than September 1, 2015.

The FY 2016/2017 MHBG and SABG application(s) include(s) a two-year Block Grant Behavioral 

Health Systems Assessment and Plan (Plan) as well as projected expenditure tables, certifications and

assurances. The Plan will cover a two-year period (7/1/15- 6/30/17) to align with most states’ FY budget 

cycle.

8

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

FY 2017 application. 

States should submit their block grant application(s) for FYs 2016 and 2017 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

requirements of the specific block grants and the three areas requiring or requesting a combined plan are

described in the State Plan section.

The FY 2016-2017 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 FY 2016-

2017 Block Grant Application and Plan have sections that are required and other sections where

additional information is requested but not required. The reporting sections indicate information where 

 

8

Reporting timeframes for Synar will remain on the current schedule. Annual Synar Reports (ASRs) are due on December 31. The data

reported in the FFY 2017 ASR, which is due on December 31, 2016, will be from inspections completed in FFY 2016 (October 1, 2015,

through September 30, 2016). http://www.samhsa.gov/synar
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reporting is required by using terms such as “must” or similar, and indicate information that is requested 

but not required by using terms such as “should” or similar. 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 

which is required.

The FY 2016-2017 application requires states to submit a face sheet, a table of contents, a behavioral 

health assessment and plan, reports of expenditures and persons served, 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 as related to improving the quality of life for 

individuals with behavioral health disorders. States are strongly encouraged to answer each section 

thoroughly so that SAMHSA understands the totality of a state’s 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 achieve their goals. Section IIIB, Planning Steps, requires 

states to undertake a needs assessment as part of their plan submission. This section identifies four key 

steps: assess the strengths and needs of the service system; identify unmet service needs and critical 

gaps; prioritize state planning activities to include the required target populations and other priority 

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

performance indicators. Section IIIB, Plan Tables 1 (Plan Table #1. Priority Area and Annual 

Performance Indicators) and Plan Tables 2 (State Agency Planned Expenditure) are required for both 

MHBG and SABG. For the SABG, Plan Tables 4 (SABG Planned Expenditures), 5a and/or b (SABG 

Primary Prevention Planned Expenditures), and 6a (SABG Resource Development Activities Planned 

Expenditures) are also required.

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

advancements in physical and behavioral health prevention, care, 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 a changing environment. In addition, this information 

will identify states that are models and assist other states with areas of common concern. 

For the Secretary of HHS, acting through the Administrator of SAMHSA, to make an award under the

programs involved, states must submit an application(s) sufficient to meet the requirement of law and 

sufficient enough for SAMHSA to assist and monitor the states’ efforts using these funds. The funds 

awarded will be available for obligation and expenditure

9

to plan, carry out, and evaluate activities and 

services for children with SED and adults with SMI; substance abuse prevention; youth and adults with 

a substance use disorder; adolescents and adults with co-occurring disorders; and the promotion of 

recovery among persons with SED, SMI, or substance use disorder.

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

1011

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 

 

9

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

10 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

11Section 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
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U.S.C. 300x-1) or section 1921 of Title XIX, Part B, Subpart II of the PHS Act (42 U.S.C. 300x-21)

that is applicable to a state. The State BG Plan should include a description of the manner in which the

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

12 in the proper format containing

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

purposes for which the grant will be expended. States have the option of updating their plans during the

two-year planning cycle.

States are encouraged to submit a combined mental health and substance abuse prevention and 

treatment application. If a state is submitting separate applications, it should clarify which system is 

being described in this section (e.g., mental health or substance abuse prevention and treatment).

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.

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 to 

expand this Planning Council to include prevention and substance abuse 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 substance use and mental disorders, 

providers of services and supports, representatives from racial and ethnic minorities, LGBT populations, 

persons with co-existing 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 must be provided in the application(s) for both MHBGs and SABGs.

A. Framework for Planning—Mental Health and Substance Abuse 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. 

 

12 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
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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; (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 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.

The SABG block grant program provides substance abuse prevention and treatment services (and certain

related activities) to at-risk individuals or persons in need of treatment. See 42 U.S.C. §§ 300x-300x-66. 

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. 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*

2. Services for persons with or at risk of having substance use and/or SMI/SED:

 Persons who are intravenous drug users (IVDA)*

 Adolescents with substance abuse 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

 Unaccompanied minor children and youth13

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

 Individuals with tuberculosis* and other communicable diseases

 Persons living with or at risk for HIV/AIDS and who are in need of mental health or substance

abuse early intervention, treatment, or prevention services*14

 

13 Section XXX of the Public Health Service Act does not prohibit the provision of these services. 

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

Implementation Plan 

15

 Prevention of HIV among substance users; substance use is associated with a greater

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

prevention services should be coupled with substance treatment programs 

4. Services for individuals in need of primary substance abuse 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

States should undertake a broader approach to their assessment and planning process and include other

individuals who are in need of behavioral health services. In particular, states should be planning for

individuals with incomes below 400 percent Federal Poverty Level (FPL) who are eligible for coverage

by Medicaid or private insurance. This planning will present new opportunities for public behavioral 

health systems to expand access and capacity. In addition, states should identify how to use federal 

funds to support the individuals and services that are not covered by insurance and need treatments and 

supports.

16

MHPAEA, other laws that enhances access to Medicaid, and SAMHSA’s Strategic Initiatives place an

emphasis on identifying the health, behavioral health, and long-term care needs of individuals with 

mental and substance use disorders. These laws and initiatives also present significant opportunities for

states to include in their benefit design recovery support services for adults, youth, and families who 

have behavioral health needs. In addition, policy drivers place a heavy emphasis on wellness and the 

prevention of mental, emotional, addiction, and other behavioral disorders. These major themes are 

relevant for SSAs and SMHAs.

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

 

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.

15 http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf

16 SAMHSA will provide each state with information regarding the projected number and demographics of potentially uninsured individuals.
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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 application 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 needs of the service system to address the specific populations.

Provide an overview of the state’s behavioral health prevention, early identification, treatment, and 

recovery support systems. Describe how the public behavioral health 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 SSA, the SMHA, and other state agencies with respect to the

delivery of behavioral health 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.

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

This step should identify the unmet services needs and critical gaps in the state’s current systems, as 

well as the data sources used to identify the needs and gaps of the 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 these unmet service needs and gaps.

The state’s priorities and goals must be supported by a data-driven process. 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 set 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 abuse prevention, and substance abuse 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 behavioral health services. This will allow states to have a more

comprehensive approach to identifying the number of individuals that are receiving behavioral health 

services and the 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 
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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

17 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

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 MH/SA Block 

Grant 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 abuse prevention (SAP), substance

abuse 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, 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, improving emotional 

health and prevention of mental illness, 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.

 

17 http://www.healthypeople.gov/2020/default.aspx
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• 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 integrated co-occurring treatments (ICTs) 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 (internet or texting) as a

substantial, if not primary, mode of communication. 

• 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 increase the availability of screening, brief intervention, referral and treatment 

(SBIRT). In 2013, SAMHSA brought SBIRT to scale under the SABG. States now have the

opportunity to use block grant funds for SBIRT services. However, states should be aware that 

primary prevention set-aside funds cannot be used to fund SBIRT and should be encouraging the

SMAs and Health Insurance Marketplace to include SBIRT as a covered prevention or servicedelivery benefit.

• 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 2009 IOM 

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

Improvement

18 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. 

 

18 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
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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.

• Strategies that are developed to prevent substance abuse and mental disorders and promote

emotional health and prevention of mental illness should be consistent with the latest research, 

including the 2009 IOM report, Preventing Mental, Emotional, and Behavioral Disorders Among 

Young People: Progress and Possibilities.

19 This report articulates the current scientific

understanding of the prevention of mental and substance use disorders. It also describes a set of

interventions that have proven effective in preventing substance abuse and mental illness,

promoting positive emotional health by addressing risk factors, and promoting protective factors 

related to these problems. States should identify strategies for the SABG that reflect the priorities 

identified from the needs assessment process, including:

• As specified in 45 C.F.R. §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;

• 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

20

, 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 

 

19 National Research Council and Institute of Medicine. (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young

People: Progress and Possibilities. Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and

Young Adults: Research Advances and Promising Interventions. Mary Ellen O’Connell, Thomas Boat, and Kenneth E. Warner, Editors. 

Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education. Washington, DC

20 http://store.samhsa.gov/product/Surgeon-General-s-Call-to-Action-to-Prevent-and-Reduce-Underage-Drinking/SGCTA-07
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the problems, and enhance resiliency.

• Strategies that address underage drinking based in science and encompass a range of connected

activities including policy and regulation, enforcement, and normative/behavior change

initiatives and programs.

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

abuse 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), that focus on policy and environmental 

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

alcohol use.

• 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.

• States should identify strategies for the MHBG that reflect the priorities identified from the needs

assessment process. Strategies that are focused on emotional health and the prevention of

mental illnesses should be consistent with the IOM report on Preventing Mental, Emotional, and

Behavioral Disorders Among Young People and should include:

• Strategies that work with schools, workplaces, and communities to deliver programs to improve

mental health literacy and enhance resilience.

• Strategies that target prevention and early intervention programs for children and their families 

through partnerships between mental health, maternal and child health services, schools, and

other related organizations, and to include evidence-based and cost-effective models of 

intervention for early psychosis in young people.

• Strategies that implement suicide prevention activities to identify youth at risk of suicide and 

improve the effectiveness of services and support available to them, including educating

frontline workers in health, and other social services settings about mental health and suicide 

prevention.

• Strategies that implement evidenced-based interventions and trauma- specific treatments for

highly vulnerable children and young people who have experienced physical, sexual, or

emotional abuse, bullying, and/or other trauma, with a separate focus on youth from tribal, 

racial/ethnic minority, and LGBT communities.

• Strategies that follow the Surgeon General’s National Strategy for Suicide Prevention,

including promoting the awareness that suicide is a public health problem that is preventable

and implementing community-based suicide prevention programs.

• Strategies that identify evidence-based programs that address the needs of individuals with 

early serious mental illness, including psychotic disorders.

21 22

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

needs assessment. System improvement activities should:

 

21http://www.nimh.nih.gov/health/topics/schizophrenia/raise/index.shtml?utm_source=rss_readers&utm_medium=rss&utm_campaign=rss_f

ull

22 www.samhsa.gov/sites/default/files/mhbg-5-percent-set-aside-guidance.pdf
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• 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

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 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 

health homes (§2703 of the Affordable Care Act), 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 mental 

health and substance use 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. SAMHSA will expect states to develop spending targets for certain services and 

manage within those targets.

1. Quality and Data Collection Readiness

Health surveillance is critical to SAMHSA’s ability to develop new models of care to address substance 

abuse and mental illness. SAMHSA provides decision makers, researchers and the public with enhanced 

information about the extent of substance abuse and mental illness, 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 
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toward measures for all programs consistent with SAMHSA’s NBHQF. The effort is part of the 

congressionally mandated National Quality Strategy 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 National Quality Strategy (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 the Affordable Care Act and other HHS 

priorities, these efforts will seek to understand the impact that disparities have on outcomes.

For the FY 2016-2017 Block Grant Application, SAMHSA has begun a transition to a common substance 

abuse and mental health client-level data (CLD) system. SAMHSA proposes to build upon existing data 

systems, namely TEDS and the mental health CLD system developed as part of the Uniform Reporting 

System. The short-term goal is to coordinate these two systems in a way that focuses on essential data 

elements and minimizes data collection disruptions. The long-term goal is to develop a more efficient 

and robust program of data collection about behavioral health services that can be used to evaluate the 

impact of the block grant program on prevention and treatment services performance and to inform 

behavioral health services research and policy. This will include some level of direct reporting on clientlevel data from states on unique prevention and treatment services purchased under the MHBG and 

SABG and how these services contribute to overall outcomes. It should be noted that SAMHSA itself 

does not intend to collect or maintain any personal identifying information on individuals served with 

block grant funding.

This effort will also include some facility-level data collection to understand the overall financing and 

service delivery process on client-level and systems-level outcomes as individuals receiving services 

become eligible for services that are covered under fee-for-service or capitation systems, which results in 

encounter reporting. SAMHSA will continue to work with its partners to look at current facility 

collection efforts and explore innovative strategies, including survey methods, to gather facility and client 

level data.

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

will be the collaboration with SAMHSA’s centers and offices, 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 this undertaking for states and for local service providers, and anticipates that the 

development and implementation process will take several years and will evolve over time. 

For the FY 2016-2017 Block Grant Application reporting, achieving these goals will result in a more 

coordinated behavioral health data collection program that does not duplicate and complements other 

existing systems (e.g., Medicaid administrative and billing data systems; and state mental health and 

substance abuse data systems), ensures consistency in the use of measures that are aligned across various 

agencies and reporting systems, and provides a more complete understanding of the delivery of mental 
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health and substance abuse services. Both goals can only be achieved through continuous collaboration 

with and feedback from SAMHSA’s state, provider, and practitioner partners.

SAMHSA anticipates this movement is consistent with the current state authorities’ movement toward 

system integration and will minimize challenges associated with changing operational logistics of data 

collection and reporting. SAMHSA understands modifications to data collection systems may be 

necessary to achieve these goals and will work with the states to minimize the impact of these changes.

States must answer the questions below to help assess readiness for CLD collection described above:

1. Briefly describe the state’s data collection and reporting system and what level of data can be 

reported currently (e.g., at the client, program, provider, and/or other levels). 

2. Is the state’s current data collection and reporting system specific to substance abuse and/or mental 

health services clients, or is it part of a larger data system? If the latter, please identify what other 

types of data are collected and for what populations (e.g., Medicaid, child welfare, etc.).

3. Is the state currently able to collect and report at the individual client level (that is, by client served, 

but not with client-identifying information)?

4. If not, what changes will the state need to make to be able to collect and report on these measures?

Please indicate areas of technical assistance needed related to this section.

2. 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 FY 2016 and how the state proposes to 

measure the change in FY 2017. States must use the template (Plan Table 1: Priority Areas by Goal, 

Strategy, and Performance Indicators) below.

Plan Table #1. Priority Area and Annual Performance Indicators

States should follow the guidelines presented above in Framework for Planning – Mental Health and 

Substance Abuse Prevention and Treatment and 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 WebBGAS:

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 abuse prevention, SAT –

substance abuse 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. From the drop-down menu select:
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SMI–Adults with SMI, 

SED–Children with an SED,

PWWDC–Pregnant women and women with dependent children,

PP – persons in need of primary substance abuse prevention

IVDUs–Intravenous drug users,

HIV EIS–Persons with or at risk of HIV/AIDS, who are in treatment for substance abuse,

TB–Persons with or at risk of TB who are in treatment for substance abuse, and/or

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. Objective. Objective should be a

concreate, precise and measureable statement. 

5) Strategies to attain the objective. Indicate state program strategies or means to achieve the

stated objective.

6) 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 this 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 end of State FY (SFY) 2016);

(c) Second-year target/outcome measurement (Final to end of SFY 2017),

(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: 2. Priority Type (SAP, SAT, MHS):

3. Population(s) (SMI, SED, PWWDC, PP, IVDUs, HIV EIS, 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 2016): 

b) First-year target/outcome measurement (Progress to end of SFY 2016):

c) Second-year target/outcome measurement (Final to end of SFY 2017):
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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, that 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. 

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 

Intervention (5% of total award MHBG)

$ $ $ $

4. Tuberculosis Services $ $ $ $ $ $

5. HIV Early Intervention Services $ $ $ $ $ $

6. State Hospital $ $ $ $ $

7. Other 24-Hour Care $ $ $ $ $ $ $

8. Ambulatory/Community Non-24 Hour 

Care

$ $ $ $ $ $ $

9. Administration (excluding program / 

provider level) SABG and MHBG 

must be reported separately

$ $ $ $ $ $ $

10. Subtotal (Rows 1, 2, , 4, 5 and 9) $ $ $ $ $ $ $

11. Subtotal (Rows 3, 6, 7, and 8) $ $ $ $ $ $ $
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* Prevention other than primary prevention. 

**The 20% set aside funds in the SABG must be used for activities designed to prevent substance abuse.

***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.

Plan Table 3: State Agency Planned Block Grant Expenditures by Service

States should project how SABG and MHBG funds will be used to provide services for the target populations or areas identified in their 

plans. Plan Table 3 must be completed by overall category for the planning period. If the state purchases services or activities that are 

not included in the listed categories, please report and describe them in the last row of the table in the “Other” category and in the 

summary. 

Service

SABG

Expenditures

MHBG 

Expenditures

Healthcare Home/Physical Health $ $

General and Specialized Outpatient Medical Services

Acute Primary Care

General Health Screens, Tests and Immunizations

Comprehensive Care Management

Care Coordination and Health Promotion

Comprehensive Transitional Care

Individual and Family Support

Referral to Community Services

Prevention including Promotion $ $

Screening, Brief Intervention and Referral to Treatment 

Brief Motivational Interviews

Screening and Brief Intervention for Tobacco Cessation

Parent Training

Facilitated Referrals

Relapse Prevention/Wellness Recovery Support

Warm Line

Substance Abuse Primary Prevention $

Classroom and/or small group sessions (Education)

Media campaigns (Information Dissemination)

12. Total $ $ $ $ $ $ $
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Service

SABG

Expenditures

MHBG 

Expenditures

Systematic Planning/Coalition and Community Team Building (CommunityBased Process)

Parenting and family management (Education)

Education programs for youth groups (Education)

Community Service Activities (Alternatives)

Student Assistance Programs (Problem Identification and Referral)

Employee Assistance Programs (Problem Identification and Referral)

Community Team Building (Community-Based Process)

Promoting the establishment or review of alcohol, tobacco, and drug use policies 

(Environmental) 

Engagement Services $ $

Assessment

Specialized Evaluations (Psychological and Neurological)

Service Planning (including crisis planning)

Consumer/Family Education

Outreach

Outpatient Services $ $

Individual Evidenced-based Therapies

Group Therapy

Family Therapy 

Multi-family Therapy

Consultation to Caregivers

Medication Services $ $

Medication Management

Pharmacotherapy (including MAT)

Laboratory Services

Community Support (Rehabilitative) $ $

Parent/Caregiver Support

Skill Building (social, daily living, cognitive)

Case Management

Behavior Management

Supported Employment

Permanent Supported Housing

Recovery Housing

Therapeutic Mentoring

Traditional Healing Services
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Service

SABG

Expenditures

MHBG 

Expenditures

Recovery Supports $ $

Peer Support

Recovery Support Coaching

Recovery Support Center Services

Supports for Self-directed Care

Other Supports (Habilitative) $ $

Personal Care

Homemaker

Respite

Supported Education

Transportation

Assisted Living Services

Recreational Services

Trained Behavioral Health Interpreters

Interactive Communication Technology Devices

Intensive Support Services $ $

Substance Abuse Intensive Outpatient (IOP)

Partial Hospital

Assertive Community Treatment

Intensive Home-based Services

Multi-systemic Therapy

Intensive Case Management 

Out of Home Residential Services $ $

Crisis Residential/Stabilization

Clinically Managed 24-hour Care (SA)

Clinically Managed Medium Intensity Care (SA) 

Adult Mental Health Residential 

Youth Substance Abuse Residential Services

Children's Residential Mental Health Services 

Therapeutic Foster Care

Acute Intensive Services $ $

Mobile Crisis

Peer-based Crisis Services

Urgent Care
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Service

SABG

Expenditures

MHBG 

Expenditures

23-hour Observation Bed

Medically Monitored Intensive Inpatient (SA) 

24/7 Crisis Hotline Services

Other (please list) $ $

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 FY 2016 and FY 2017 SABG awards.

Plan Table 4 SABG Planned Expenditures

State Identifier: 

Expenditure Category FY 2016 SA Block Grant Award FY 2017 SA Block Grant Award

1. Substance Abuse Prevention* and Treatment $ $

2. Primary Substance Abuse Prevention $ $

3. HIV Early Intervention Services24 $ $

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 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 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 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 does not meet the AIDS case rate threshold for the fiscal year involved. 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 would be allowed to obligate and expend FY 2016 

SABG funds for EIS/HIV if they chose to do so.
33

Plan Table 5a: SABG Primary Prevention Planned Expenditures 

States must project how they will use SABG funds to conduct and/or fund primary prevention and §192625-

related activities. Primary prevention activities are those directed at individuals who do not require treatment 

for substance abuse. In implementing a comprehensive primary prevention program, the state shall use a variety 

of strategies including but not limited to the six strategies listed on Plan Table 5a. If a state employs strategies 

not covered by these six strategies, they should be reported under ‘Other’ in a separate row for each strategy; 

alternatively, the state may choose to report those activities using the IOM model of universal, selective, and 

indicated. Note that the row entitled ‘Section 1926 Tobacco” on Plan Table 5a must be completed by states 

reporting expenditures by the six strategies and for those reporting by IOM category. Plan Table 5a must be 

completed for the FY 2016 and FY 2017 SABG awards. The total amounts should equal amount reported on 

Plan Table 4, Row 2, Primary Prevention. 

Plan Table 5a: SABG Primary Prevention Planned Expenditures

State Identifier:

Report Period- From: To:

A B C

Strategy IOM Target FY 2016 SA 

Block Grant 

Award 

FY 2017 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 $ $

 

25 Section 1926 of the PHS Act as added by the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act (P.L. 102-321, section

202).
34

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

% %

Plan Table 5b: SABG Primary Prevention Planned Expenditures

States must project how they will use SABG funds to conduct and/or fund primary prevention and §1926-related 

activities. Plan Table 5b must be completed for the FY 2016 and FY 2017 SABG awards. The total amounts 

for each award should equal amount reported on Plan Table 4, Row 2, Primary Prevention. 

Plan Table 5b: SABG Primary Prevention Planned 

Expenditures by IOM Category

State Identifier:

Activity

FY 2016 SA 

Block Grant 

Award

FY 2017 SA 

Block Grant 

Award

Universal Direct $ $

Universal Indirect $ $

Selective $ $

Indicated $ $

Column Total $

Total SABG 

Award

$ $

Planned Primary 

Prevention

Percentage

% %
35

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 FY 2016 and FY 2017 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
36

Plan Table 6a: SABG Resource Development Activities Planned Expenditures

States must project how they will use SABG funds to conduct and/or fund resource development activities. Plan 

Table 6a should be completed for the FY 2016 and FY 2017 SABG awards.

Plan Table 6A SABG Resource Development Activities Planned Expenditures

State Identifier:

FY 2016 SA Block Grant Award FY 2017 SA Block Grant Award

Prevention Treatment Combined Total Prevention Treatment Combined Total

1. Planning, Coordination, 

and Needs Assessment

$ $ $ $ $ $ $ $

2. Quality Assurance $ $ $ $ $ $ $ $

3. Training (postemployment)

$ $ $ $ $ $ $ $

4. Education (preemployment)

$ $ $ $ $ $ $ $

5. Program Development $ $ $ $ $ $ $ $

6. Research and Evaluation $ $ $ $ $ $ $ $

7. Information Systems $ $ $ $ $ $ $ $

8. Total $ $ $ $ $ $ $ $
37

Plan Table 6B MHBG Non-Direct Service Activities Planned Expenditures

State Identifier:

Planning Period - From: To:

Service MH Block Grant

MHA Technical Assistance Activities

MHA Planning Council Activities

MHA Administration

MHA Data Collection/Reporting

MHA Activities Other Than Those Above

Total Non-Direct Services

Comments: 

Plan Table 6b: MHBG Non-Direct Service Activities Planned Expenditures

States should project how they will use MHBG funds to conduct and/or fund non-direct 

service activities. Plan Table 6b should be completed for the planning period. States should 

only report the planned expenditures of the MHBG by the SMHA or programs with which 

they are in direct contract. States should not report on planned expenditures by programs 

more than one-level down from the state in funding. For example, if a state provides MHBG 

funds to county mental health authorities that in turn contract with private, not-for-profit 

mental health providers, only the planned expenditures by the SMHA and the county mental 

health authorities should be reported in this table.
38

C. Environmental Factors and Plan

1. The Health Care System and Integration

Persons with mental illness and persons with substance use disorders are likely to die earlier than 

those who do not have these conditions.

26

 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.27 It has been acknowledged that there is a high rate of cooccurring mental illness and substance abuse, with appropriate treatment required for both 

conditions.

28

 Overall, America has reduced its heart disease risk based on lessons from a 50-year 

research project on the town of Framingham, MA, outside Boston, where researchers followed 

thousands of residents to help understand what causes heart disease. The Framingham Heart 

Study produced the idea of "risk factors" and helped to make many connections for predicting 

and preventing heart disease.

There are five major preventable risks identified in the Framingham Heart Study that may impact 

people who live with mental illness. These risks are smoking, obesity, diabetes, elevated 

cholesterol, and hypertension. These risk factors can be appropriately modified by implementing 

well-known evidence–based practices29 30 that will ensure a higher quality of life.

Currently, 50 states have organizationally consolidated their mental and substance abuse 

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 

 

26 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

27 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

28 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/

29 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members 

Appointed to the Eighth Joint National Committee (JNC 8); JAMA. 2014;311(5):507-520.doi:10.1001/jama.2013.284427

30 A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: 2013 

ACC/AHA Guideline on the Assessment of Cardiovascular Risk; http://circ.ahajournals.org/
39

persons with mental illness and substance use disorders.31 Specific to children, many children 

and youth with mental illness and substance use issues are more likely to be seen in a health 

care setting than in the specialty mental health and substance abuse system. In addition, 

children with chronic medical conditions have more than two times the likelihood of having a 

mental disorder. In the U.S., more than 50 percent of adults with mental illness had symptoms 

by age 14, and three-fourths by age 24. It is important to address the full range of needs of 

children, youth and adults through integrated health care approaches across prevention, early 

identification, treatment, and recovery. 

It is vital that SMHAs’ and SSAs’ programming and planning reflect the strong connection 

between behavioral, physical and population/public health, with careful consideration to 

maximizing impact across multiple payers including Medicaid, exchange products, and 

commercial coverages. Behavioral health disorders are true physical disorders that often 

exhibit diagnostic criteria through behavior and patient reports rather than biomarkers. 

Fragmented or discontinuous care may result in inadequate diagnosis and treatment of both 

physical and behavioral conditions, including co-occurring disorders. For instance, persons 

receiving behavioral health treatment may be at risk for developing diabetes and experiencing 

complications if not provided the full range of necessary care.32 In some cases, unrecognized 

or undertreated physical conditions may exacerbate or cause psychiatric conditions.33 Persons 

with physical conditions may have unrecognized mental challenges or be at increased risk for 

such challenges.34 Some patients may seek to self-medicate due to their chronic physical pain 

or become addicted to prescribed medications or illicit drugs.35 In all these and many other 

ways, an individual’s mental and physical health are inextricably linked and so too must their 

health care be integrated and coordinated among providers and programs.

Health care professionals and consumers of mental illness and substance abuse treatment 

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 members to assist them in coordinating pediatric mental health and 

primary care.

36

 

31 Social Determinants of Health, Healthy People 2020, 

http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39; 

http://www.cdc.gov/socialdeterminants/Index.html

32 Depression and Diabetes, NIMH, http://www.nimh.nih.gov/health/publications/depression-and-diabetes/index.shtml#pub5; 

Diabetes Care for Clients in Behavioral health Treatment, Oct. 2013, SAMHSA, http://store.samhsa.gov/product/Diabetes-Carefor-Clients-in-Behavioral-Health-Treatment/SMA13-4780

33 J Pollock et al., Mental Disorder or Medical Disorder? Clues for Differential Diagnosis and Treatment Planning, Journal of 

Clinical Psychology Practice, 2011 (2) 33-40

34 C. Li et al., Undertreatment of Mental Health Problems in Adults With Diagnosed Diabetes and Serious Psychological 

Distress, Diabetes Care, 2010; 33(5) 1061-1064

35 TIP 54: Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders, SAMHSA, 2012, 

http://store.samhsa.gov/product/TIP-54-Managing-Chronic-Pain-in-Adults-With-or-in-Recovery-From-Substance-UseDisorders/SMA13-4671

36 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 
40

SAMHSA and its partners support integrated care for persons with mental illness and 

substance use disorders.37 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 mental and substance abuse 

treatment 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 electronic health records (EHRs) and telehealth are 

examples of important strategies to promote integrated care.38 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, care, 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 

homes39 and ACOs40 may be important strategies used by SMHAs and SSAs to foster 

integrated care. 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. 

 

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

37 Health Care Integration, http:// samhsa.gov/health-reform/health-care-integration; SAMHSA-HRSA Center for Integrated 

Health Solutions, (http://www.integration.samhsa.gov/)

38 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

39 Health homes, http://www.integration.samhsa.gov/integrated-care-models/health-homes

40 New financing models, http://www.samhsa.gov/co-occurring/topics/primary-care/financing_final.aspx
41

The Affordable Care Act is an important part of efforts to ensure access to care and better 

integrate care. Non-grandfathered health plans sold in the individual or the small group health 

insurance markets offered coverage for mental and substance use disorders as an essential 

health benefit.

SSAs and SMHAs also may work with Medicaid programs and Insurance Commissioners to 

encourage development of innovative demonstration projects and waivers that test approaches 

to providing integrated care for persons with mental illness and substance use disorders and 

other vulnerable populations.

41 Ensuring both Medicaid and private insurers provide required 

preventive benefits also may be an area for collaboration.42

One key population of concern is persons who are dually eligible for Medicare and 

Medicaid.43 Roughly, 30 percent of dually eligible persons have been diagnosed with a mental 

illness, more than three times the rate among those who are not dually eligible.44 SMHAs and 

SSAs also should collaborate with Medicaid, insurers and insurance regulators to develop 

policies to assist those individuals who experience health coverage eligibility changes due to 

shifts in income and employment.45 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 finding a provider.46 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 care and integration. 

SMHAs and SSAs should ensure access and integrated prevention care and recovery support

in all vulnerable populations including, but not limited to college students and transition age 

youth (especially those at risk of first episodes of mental illness or substance abuse); American 

Indian/Alaskan Natives; ethnic minorities experiencing health and behavioral health 

 

41 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

42 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

43 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

44 Dual-Eligible Beneficiaries of Medicare and Medicaid: Characteristics, Health Care Spending, and Evolving Policies, CBO, 

June 2013, http://www.cbo.gov/publication/44308

45 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

46 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
42

disparities; military families; and, LGBT individuals. SMHAs and SSAs should discuss with 

Medicaid and other partners, gaps that may exist in services in the post-Affordable Care Act

environment and the best uses of block grant funds to fill such gaps. SMHAs and SSAs 

should work with Medicaid and other stakeholders to facilitate reimbursement for evidencebased and promising practices.

47

 It also is important to note CMS has indicated its support for 

incorporation within Medicaid programs of such approaches as peer support (under the 

supervision of mental health professionals) and trauma-informed treatment and systems of 

care. Such practices may play an important role in facilitating integrated, holistic care for 

adults and children with behavioral health conditions.48

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.49 Psychiatrists, psychologists, social workers, addiction counselors, 

preventionists, therapists, technicians, peer support specialists and others will need to 

understand integrated care models, concepts and practices. 

Another key part of integration will be defining performance and outcome measures. 

Following the Affordable Care Act, the Department of Health and Human Services (HHS) and 

partners have developed the NQS, 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.50

SAMHSA recognizes that certain jurisdictions receiving block grant funds – including U.S. 

Territories, tribal entities and those jurisdictions that have signed compacts of free association 

with the U.S. – may be uniquely impacted by certain Affordable Care Act and Medicaid 

provisions or ineligible to participate in certain programs.51 However, these jurisdictions 

should collaborate with federal agencies and their governmental and non-governmental 

partners to expand access and coverage. Furthermore, the jurisdiction should ensure 

integration of prevention, treatment and recovery support for persons with, or at risk of, mental 

illnesses and substance use disorders. 

 

47 http://www.nrepp.samhsa.gov/

48 Clarifying Guidance on Peer Support Services Policy, May 2013, CMS, http://www.medicaid.gov/Medicaid-CHIP-ProgramInformation/By-Topics/Benefits/Downloads/Clarifying-Guidance-Support-Policy.pdf; Peer Support Services for Adults with 

Mental Illness and/or Substance Use Disorder, August 2007, http://www.medicaid.gov/Federal-Policy-guidance/federal-policyguidance.html; Tri-Agency Letter on Trauma-Informed Treatment, July 2013, http://medicaid.gov/Federal-PolicyGuidance/Downloads/SMD-13-07-11.pdf

49 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

50 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

51 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/
43

Numerous provisions in the Affordable Care Act and other statutes improve the coordination of

care for patients through the creation of health homes, where teams of health care professionals

will be charged with coordinating care for patients with chronic conditions. States that have

approved Medicaid State Plan Amendments (SPAs) will receive 90 percent Federal Medical 

Assistance Percentage (FMAP) for health home services for eight quarters. At this critical 

juncture, some states are ending their two years of enhanced FMAP and returning to their regular

state FMAP for health home services. In addition, many states may be a year into the

implementation of their dual eligible demonstration projects.

Please consider the following items as a guide when preparing the description of the healthcare 

system and integration within the state’s system:

1. Which services in Plan Table 3 of the application will be covered by Medicaid or by

QHPs as of January 1, 2016?

2. Is there a plan for monitoring whether individuals and families have access to 

M/SUD services offered through QHPs and Medicaid?

3. Who is responsible for monitoring access to M/SUD services by the QHPs? Briefly

describe the monitoring process.

4. Will the SMHA and/or SSA be involved in reviewing any complaints or possible 

violations or MHPAEA?

5. What specific changes will the state make in consideration of the coverage offered in 

the state’s EHB package?

6. Is the SSA/SMHA is involved in the various coordinated care initiatives in the state?

7. Is the SSA/SMHA work with the state’s primary care organization or primary care 

association to enhance relationships between FQHCs, community health centers 

(CHCs), other primary care practices, and the publicly funded behavioral health 

providers?

8. Are state behavioral health facilities moving towards addressing nicotine dependence 

on par with other substance use disorders?

9. What agency/system regularly screens, assesses, and addresses smoking among 

persons served in the behavioral health system?

10. Indicate tools and strategies used that support efforts to address nicotine cessation.

• Regular screening with a carbon monoxide (CO) monitor

• Smoking cessation classes

• Quit Helplines/Peer supports

• Others_____________________________

11. The behavioral health providers screen and refer for:

• Prevention and wellness education;

• Health risks such as heart disease, hypertension, high cholesterol, and/or diabetes; 

and, 

• Recovery supports.

Please indicate areas of technical assistance needed related to this section. 

2. Health Disparities 
44

In accordance with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities52, 

Healthy People, 202053, National Stakeholder Strategy for Achieving Health Equity54, 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 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, and people living with HIV/AIDS or other chronic diseases/impairments) 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 

standards).

55

The Action Plan to Reduce Racial and Ethnic Health Disparities, which the 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 top Secretarial 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.”56

Collecting appropriate data is a critical part of efforts to reduce health disparities and promote 

equity. In October 2011, in accordance with section 4302 of the Affordable Care Act, HHS 

issued final standards on the collection of race, ethnicity, primary language, and disability

status.

57

 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.

58 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

 

52 http://www.minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf

53 http://www.healthypeople.gov/2020/default.aspx

54 http://minorityhealth.hhs.gov/npa/files/Plans/NSS/NSSExecSum.pdf

55 http://www.ThinkCulturalHealth.hhs.gov

56 http://www.minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf

57 http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlid=208

58 http://www.whitehouse.gov/omb/fedreg_race-ethnicity
45

these practices have not been normed on various diverse racial and ethnic populations. States 

should strive to implement evidence-based and promising practices in a manner that meets the 

needs of the populations they serve. 

In the block grant application, states define the population they intend to serve. Within these

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 being served or 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, which can be defined by the following factors: race,

ethnicity, language, gender (including transgender), tribal connection, and sexual orientation 

(i.e., lesbian, gay, bisexual).

Please consider the following items as a guide when preparing the description of the state’s 

system:

1. Does the state track access or enrollment in services, types of services (including 

language services) received and outcomes by race, ethnicity, gender, LGBT, and age?

2. Describe the state plan to address and reduce disparities in access, service use, and 

outcomes for the above subpopulations. 

3. Are linguistic disparities/language barriers identified, monitored, and addressed?

4. Describe provisions of language assistance services that are made available to clients 

served in the behavioral health provider system.

5. Is there state support for cultural and linguistic competency training for providers? 

Please indicate areas of technical assistance needed related to this section. 

 

3. Use of Evidence in Purchasing Decisions

There is increased interest in having a better understanding of the evidence that supports the

delivery of medical and specialty care including mental health and substance abuse services. 

Over the past several years, SAMHSA has received many requests from CMS, HRSA, SMAs, 

state behavioral health authorities, legislators, and others regarding the evidence of various 

mental and substance abuse prevention, treatment, and recovery support services. States and 
46

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 evidence-based 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 Institute of Medicine

(IOM) recommend that evidence play a critical role in designing health and behavioral health 

benefits for individuals enrolled in commercial insurance, Medicaid, and Medicare.

To respond to these inquiries and recommendations, SAMHSA has undertaken several 

activities. Since 2001, SAMHSA has sponsored a National Registry of Evidenced-based 

Programs and Practices (NREPP). NREPP59 is a voluntary, searchable online registry of more

than 220 submitted interventions supporting mental health promotion and treatment and 

substance abuse prevention and treatment. The purpose of NREPP is to connect members of the

public to intervention developers so that they can learn how to implement these approaches in 

their communities. 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

60

, The New

Freedom Commission on Mental Health61, the IOM

62

, and the NQF.

63 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.”

64

 SAMHSA and other federal partners (the Administration for Children and Families 

(ACF), the HHS Office of Civil Rights (OCR), 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, identify specific strategies for

embedding these practices in provider organizations, and recommend additional service

research.

In addition to evidence-based practices, there are also many promising practices in various 

stages of development. These are services that have not been studied, but anecdotal evidence

and program specific data indicate that they are effective. As these practices continue to be 

evaluated, the evidence is collected to establish their efficacy and to advance the knowledge of 

 

59 Ibid, 47, p. 41

60 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

61 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.

62 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.

63 National Quality Forum (2007). National Voluntary Consensus Standards for the Treatment of Substance Use 

Conditions: Evidence-Based Treatment Practices. Washington, DC: National Quality Forum.

64http://psychiatryonline.org/
47

the field. 

SAMHSA’s Treatment Improvement Protocols (TIPs)65 are best practice guidelines for the 

treatment of substance abuse. The Center for Substance Abuse Treatment (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 substance abuse

treatment facilities as alcohol and other drug disorders are increasingly recognized as a major

problem.

SAMHSA’s Evidence-Based Practice Knowledge Informing Transformation (KIT)

66

was

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 mental 

health and substance abuse services. 

Please consider the following items as a guide when preparing the description of the state’s 

system:

1. Describe the specific staff responsible for tracking and disseminating information 

regarding evidence-based or promising practices. 

2. How is information used regarding evidence-based or promising practices in your 

purchasing or policy decisions? 

3. Are the SMAs and other purchasers educated on what information is used to make 

purchasing decisions?

4. Does the state use a rigorous evaluation process to assess emerging and promising 

practices?

5. Which value based purchasing strategies do you use in your state:

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 incentives to drive quality.

 

65 http://store.samhsa.gov

66 http://store.samhsa.gov/product/Assertive-Community-Treatment-ACT-Evidence-Based-Practices-EBP-KIT/SMA08-4345
48

d. Provider involvement in planning value-based purchasing.

e. Gained consensus on the use of accurate and reliable measures of quality.

f. Quality measures focus on consumer outcomes rather than care processes.

g. Development of strategies to educate consumers and empower them to select 

quality services.

h. Creation of a corporate culture that makes quality a priority across the entire state 

infrastructure.

i. The state has an evaluation plan to assess the impact of its purchasing decisions.

Please indicate areas of technical assistance needed related to this section.

4. Prevention for Serious Mental Illness 

SMIs such as schizophrenia, psychotic mood disorders, bipolar disorders and others produce 

significant psychosocial and economic challenges. Prior to the first episode, a large majority of 

individuals with psychotic illnesses display sub-threshold or early signs of psychosis during 

adolescence and transition to adulthood.67 The “Prodromal Period” is the time during which a 

disease process has begun but has not yet clinically manifested. In the case of psychotic 

disorders, this is often described as a prolonged period of attenuated and nonspecific thought, 

mood, and perceptual disturbances accompanied by poor psychosocial functioning, which has 

historically been identified retrospectively. Clinical High Risk (CHR) or At-Risk Mental State 

(ARMS) are prospective terms used to identify individuals who might be potentially in the 

prodromal phase of psychosis. While the MHBG must be directed toward adults with SMI or 

children with SED, including early intervention after the first psychiatric episode, states may 

want to consider using other funds for these emerging practices.

There has been increasing neurobiological and clinical research examining the period before the 

first psychotic episode in order to understand and develop interventions to prevent the first 

episode. There is a growing body of evidence supporting preemptive interventions that are 

successful in preventing the first episode of psychosis. The National Institute for Mental Health 

(NIMH) funded the North American Prodromal Longitudinal study (NAPLS), which is a 

consortium of eight research groups that have been working to create the evidence base for early 

detection and intervention for prodromal symptoms. Additionally, the Early Detection and 

Intervention for the Prevention of Psychosis (EDIPP) program, funded by the Robert Wood 

Johnson Foundation, successfully broadened the Portland Identification and Early Referral 

(PIER) program from Portland, Maine, to five other sites across the country. SAMHSA supports 

the development and implementation of these promising practices for the early detection and 

intervention of individuals at Clinical High Risk for psychosis, and states may want to consider 

how these developing practices may fit within their system of care. Without intervention, the 

transition rate to psychosis for these individuals is 18 percent after 6 months of follow up, 22 

percent after one year, 29 percent after two years, and 36 percent after three years. With 

intervention, the risk of transition to psychosis is reduced by 54 percent at a one-year follow 

 

67 Larson, M.K., Walker, E.F., Compton, M.T. (2010). Early signs, diagnosis and therapeutics of the prodromal phase of 

schizophrenia and related psychotic disorders. Expert Rev Neurother. Aug 10(8):1347-1359. 
49

up.68 In addition to increased symptom severity and poorer functioning, lower employment rates 

and higher rates of substance use and overall greater disability rates are more prevalent.69 The 

array of services that have been shown to be successful in preventing the first episode of 

psychosis include accurate clinical identification of high-risk individuals; continued monitoring 

and appraisal of psychotic and mood symptoms and identification; intervention for substance 

use, suicidality and high risk behaviors; psycho-education; family involvement; vocational 

support; and psychotherapeutic techniques.70 71 This reflects the critical importance of early 

identification and intervention as there is a high cost associated with delayed treatment. 

Overall, the goal of early identification and treatment of young people at high clinical risk, or in 

the early stages of mental disorders with psychosis is to: (1) alter the course of the illness; (2) 

reduce disability; and, (3) maximize recovery. 

****It is important to note that 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.

Please indicate areas of technical assistance needed related to this section

5. Evidence-Based Practices for Early Intervention (5 percent set-aside) 

P.L. 113-76 and P.L. 113-235 requires that states set aside five percent of their MHBG allocation 

to support evidence-based programs that provide treatment to those with early SMI including but 

not limited to psychosis at any age.72 SAMHSA worked collaboratively with the NIMH to 

review evidence-showing efficacy of specific practices in ameliorating SMI and promoting 

improved functioning. NIMH has released information on Components of Coordinated Specialty 

Care (CSC) for First Episode Psychosis. Results from the NIMH funded Recovery After an 

Initial Schizophrenia Episode (RAISE) initiative73, a research project of the NIMH, suggest that 

mental health providers across multiple disciplines can learn the principles of CSC for First 

Episode of Psychosis (FEP), and apply these skills to engage and treat persons in the early stages 

of psychotic illness. At its core, CSC is a collaborative, recovery-oriented approach involving 

 

68 Fusar-Poli, P., Bonoldi, I., Yung, A.R., Borgwardt, S., Kempton, M.J., Valmaggia, L., Barale, F., Caverzasi, E., & McGuire, P. 

(2012). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Arch Gen Psychiatry. 

2012 March 69(3):220-229.

69 Whiteford, H.A., Degenhardt, L., Rehm, J., Baxter, A.J., Ferrari, A.J., Erskine, H.E., Charlson, F.J., Norman, R.E., Flaxman, 

A.D., Johns, N., Burstein, R., Murray, C.J., & Vos T. (2013). Global burden of disease attributable to mental and substance use 

disorders: findings from the Global Burden of Disease Study 2010. Lancet. Nov 9;382(9904):1575-1586.

70 van der Gaag, M., Smit, F., Bechdolf, A., French, P., Linszen, D.H., Yung, A.R., McGorry, P., & Cuijpers, P. (2013). 

Preventing a first episode of psychosis: meta-analysis of randomized controlled prevention trials of 12-month and longer-term 

follow-ups. Schizophr Res. Sep;149(1-3):56-62.

71 McGorry, P., Nelson, B., Phillips, L.J., Yuen, H.P., Francey, S.M., Thampi, A., Berger, G.E., Amminger, G.P., Simmons, 

M.B., Kelly, D., Dip, G., Thompson, A.D., & Yung, A.R. (2013). Randomized controlled trial of interventions for young people 

at ultra-high risk of psychosis: 12-month outcome. J Clin Psychiatry. Apr;74(4):349-56.

72 http://samhsa.gov/sites/default/files/mhbg-5-percent-set-aside-guidance.pdf

73http://www.nimh.nih.gov/health/topics/schizophrenia/raise/index.shtml?utm_source=rss_readers&utm_medium=rs

s&utm_campaign=rss_full
50

clients, treatment team members, and when appropriate, relatives, as active participants. The 

CSC components emphasize outreach, low-dosage medications, evidenced-based supported 

employment and supported education, case management, and family psycho-education. It also 

emphasizes shared decision-making as a means to address individuals’ with FEP unique needs, 

preferences, and recovery goals. Collaborative treatment planning in CSC is a respectful and 

effective means for establishing a positive therapeutic alliance and maintaining engagement with 

clients and their family members over time. Peer supports can also be an enhancement on this 

model. Many also braid funding from several sources to expand service capacity. 

States can implement models across a continuum that have demonstrated efficacy, including the 

range of services and principles identified by NIMH. Using these principles, regardless of the 

amount of investment, and with leveraging funds through inclusion of services reimbursed by 

Medicaid or private insurance, every state will be able to begin to move their system toward 

earlier intervention, or enhance the services already being implemented. 

It is expected that the states’ capacity to implement this programming will vary based on the 

actual funding from the five percent allocation. SAMHSA continues to provide additional 

technical assistance and guidance on the expectations for data collection and reporting.

Please provide the following information, updating the State’s 5% set-aside plan for 

early intervention:

1. An updated description of the states chosen evidence-based practice for early intervention 

(5% set-aside initiative) that was approved in its 2014 plan.

2. An updated description of the plan’s implementation status, accomplishments and/ any 

changes in the plan.

3. The planned activities for 2016 and 2017, including priorities, goals, objectives, 

implementation strategies, performance indicators, and baseline measures.

4. A budget showing how the set-aside and additional state or other supported funds, if any, 

for this purpose.

5. The states provision for collecting and reporting data, demonstrating the impact of this

initiative. 

Please indicate area of technical assistance needed related to this section.

6. Participant Directed Care

As states implement policies that support self-determination and improve person-centered 

service delivery, one option that states may consider is the role that vouchers may play in their 

overall financing strategy. Many states have implemented voucher and self-directed care 

programs to help individuals gain increased access to care and to enable individuals to play a 

more significant role in the development of their prevention, treatment, and recovery services. 

The major goal of a voucher program is to ensure individuals have a genuine, free, and 

independent choice among a network of eligible providers. The implementation of a voucher 
51

program expands mental and substance use disorder treatment capacity and promotes choice 

among clinical treatment and recovery support providers, providing individuals with the ability 

to secure the best treatment options available to meet their specific needs. A voucher program 

facilitates linking clinical treatment with other authorized services, such as critical recovery 

support services that are not otherwise reimbursed, including coordination, childcare, 

motivational development, early/brief intervention, outpatient treatment, medical services, 

support for room and board while in treatment, employment/education support, peer resources, 

family/parenting services, or transportation. 

Voucher programs employ an indirect payment method with the voucher expended for the 

services of the individual’s choosing or at a provider of their choice. States may use SABG and 

MHBG funds to introduce or enhance behavioral health voucher and self-directed care programs 

within the state. The state should assess the geographic, population, and service needs to 

determine if or where the voucher system will be most effective. In the system of care created 

through voucher programs, treatment staff, recovery support service providers, and referral 

organizations work together to integrate services. 

States interested in using a voucher system should create or maintain a voucher management 

system to support vouchering and the reporting of data to enhance accountability by measuring 

outcomes. Meeting these voucher program challenges by creating and coordinating a wide array 

of service providers, and leading them though the innovations and inherent system change 

processes, results in the building of an integrated system that provides holistic care to individuals 

recovering from mental and substance use disorders. Likewise, every effort should be made to 

ensure services are reimbursed through other public and private resources, as applicable and in 

ways consistent with the goals of the voucher program.

Please indicate areas of technical assistance needed related to this section

7. Program Integrity

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 USC §§ 300x–5 and 300x-31, 

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 USC § 300x–

55, 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 
52

authorized services to adults with SMI and children with SED and SABG funds can only be used 

for individuals with or at risk for substance abuse, SAMSHA will release guidance imminently

to the states on use of block grant funds for these purposes. States are encouraged to review the 

guidance and request any needed technical assistance to assure the appropriate use of such funds. 

The Affordable Care Act may offer additional health coverage options for persons with 

behavioral health conditions and block grant expenditures should reflect these coverage 

options. The MHBG and SABG resources are to be used to support, not supplant, individuals 

and services that will be covered through the Marketplaces and Medicaid. SAMHSA will 

provide additional guidance to the states to assist them in complying with program integrity

recommendations; develop new and better tools for reviewing the block grant application and 

reports; and train SAMHSA staff, including Regional Administrators, in these new program 

integrity approaches and tools. In addition, SAMHSA will work with CMS and states to 

discuss possible 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 

abuse 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 SABG and MHBG. 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 mental health and substance abuse benefits; 

(3) ensuring that consumers of substance abuse and mental health services have full confidence

in the confidentiality of their medical information; and (4) monitoring use of behavioral health 

benefits in light of utilization review, medical necessity, etc. Consequently, states may have to 

reevaluate their current management and oversight strategies to accommodate the new

priorities. They may also be required 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 consider the following items as a guide when preparing the description of the state’s 

system:

1. Does the state have a program integrity plan regarding the SABG and MHBG funds? 

2. Does the state have a specific policy and/or procedure for assuring that the federal 

program requirements are conveyed to intermediaries and providers?

3. Describe the program integrity activities the state employs for monitoring the appropriate 

use of block grant funds and oversight practices: 

a. Budget review;

b. Claims/payment adjudication; 

c. Expenditure report analysis; 

d. Compliance reviews; 

e. Client level encounter/use/performance analysis data; and 
53

f. Audits. 

4. Describe payment methods, used to ensure the disbursement of funds are reasonable and 

appropriate for the type and quantity of services delivered. 

5. Does the state assist providers in adopting practices that promote compliance with 

program requirements, including quality and safety standards? 

6. How does the state ensure block grant funds and state dollars are used for the four

purposes?

Please indicate areas of technical assistance needed related to this section. 

8. Tribes 

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 Consultation74 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 67% of American Indian and Alaska

Natives live off-reservation. SSAs/SMHAs and tribes should collaborate to ensure access and 

 

74 http://www.whitehouse.gov/the-press-office/memorandum-tribal-consultation-signed-president
54

culturally competent care for all American Indians and Alaska Natives in the state. 

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. 

Please consider the following items as a guide when preparing the description of the state’s 

system:

1. Describe how the state has consulted with tribes in the state and how any concerns were 

addressed in the block grant plan.

2. Describe current activities between the state, tribes and tribal populations.

Please indicate areas of technical assistance needed related to this section.

9. Primary Prevention for Substance Abuse

Federal law requires that states spend no less than 20 percent of their SABG allotment on 

primary prevention programs, although many states spend more. Primary prevention programs, 

practices, and strategies are directed at individuals who have not been determined to require 

treatment for substance abuse. 

Federal regulation (45 CFR 96.125) requires states to use the primary prevention set-aside of the 

SABG to develop a comprehensive primary prevention program that 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 abuse. The program must include, but is not 

limited to, the following strategies:

 Information Dissemination 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 information source to the audience, with limited contact between 

the two.

 Education 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 capabilities. There is more interaction 

between facilitators and participants than there is for information dissemination.

 Alternatives provide opportunities for target populations to participate in activities that 

exclude alcohol and other drugs. The purpose is to discourage use of alcohol and other 

drugs by providing alternative, healthy activities.

 Problem Identification and Referral aims to identify individuals who have indulged in 

illegal or age-inappropriate use of tobacco, alcohol or other substances legal for adults, and 

individuals who have indulged in the first use of illicit drugs. The goal is to assess if their 

behavior can be reversed through education. This strategy does not include any activity 

designed to determine if a person is in need of treatment.
55

 Community-based Process 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.

 Environmental Strategies establish or changes written and unwritten community 

standards, codes, and attitudes. The intent is to influence the general population's use of 

alcohol and other drugs.

States should use a variety of strategies that target populations with different levels of risk. 

Specifically, prevention strategies can be classified using the IOM Model of Universal, 

Selective, and Indicated, which classifies preventive interventions by targeted population. The 

definitions for these population classifications are:

 Universal: The general public or a whole population group that has not been identified 

based on individual risk.

 Selective: Individuals or a subgroup of the population whose risk of developing a disorder 

is significantly higher than average.

 Indicated: Individuals in high-risk environments that have minimal but detectable signs or 

symptoms foreshadowing disorder or have biological markers indicating predispositions for 

disorder but do not yet meet diagnostic levels.

It is important to note that classifications of preventive interventions by strategy and by IOM 

category are not mutually exclusive, as strategy classification indicates the type of activity while 

IOM classification indicates the populations served by the activity. Federal regulation requires 

states to use prevention set-aside funding to implement substance abuse prevention interventions 

in all six strategies. SAMHSA also recommends that prevention set-aside funding be used to 

target populations with all levels of risk: universal, indicated, and selective populations.

While the primary prevention set-aside of the SABG must be used only for primary substance 

abuse prevention activities, it is important to note that many evidence-based substance abuse 

prevention programs have a positive impact not only on the prevention of substance use and 

abuse, but also on other health and social outcomes such as education, juvenile justice 

involvement, violence prevention, and mental health. This reflects the fact that substance use 

and other aspects of behavioral health share many of the same risk and protective factors. 

The backbone of an effective prevention system is an infrastructure with the ability to collect and 

analyze epidemiological data on substance use and its associated consequences and use this data 

to identify areas of greatest need. Good data also enable states 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 communities. In particular, SAMHSA 

strongly encourages states to use data collected and analyzed by their SEOWs to help make datadriven funding decisions. Consistent with states using data to guide their funding decisions, 

SAMHSA encourages states to look closely at the data on opioid/prescription drug abuse, as well 

as underage use of legal substances, such as alcohol, and marijuana in those states where its use 

has been legalized. SAMHSA also encourages states to use data-driven approaches to allocate 

funding to communities with fewer resources and the greatest behavioral health needs. 
56

SAMHSA expects that state substance abuse agencies have the ability to implement the five 

steps of the strategic prevention framework (SPF) or an equivalent planning model that 

encompasses these steps: 

1. Assess prevention needs; 

2. Build capacity to address prevention needs;

3. Plan to implement evidence-based strategies that address the risk and protective 

factors associated with the identified needs; 

4. Implement appropriate strategies across the spheres of influence (individual, family, 

school, community, environment) that reduce substance abuse and its associated 

consequences; and

5. Evaluate progress towards goals.

States also need to be prepared to report on the outcomes of their efforts on substance abuserelated attitudes and behaviors. 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 

data driven substance abuse prevention system. SAMHSA expects that states coordinate the use 

of all substance abuse prevention funding in the state, including the primary prevention set-aside 

of the SABG, discretionary SAMHSA grants such as the Partnerships for Success (PFS) grant,

and other federal, state, and local prevention dollars, toward common outcomes to strive to 

create an impact in their state’s use, misuse or addiction metrics. 

Please consider the following items as a guide when preparing the description of the state’s 

system:

1. Please indicate if the state has an active SEOW. If so, please describe:

 The types of data collected by the SEOW (i.e. incidence of substance use, 

consequences of substance use, and intervening variables, including risk and 

protective factors);

 The populations for which data is collected (i.e., children, youth, young adults, 

adults, older adults, minorities, rural communities); and

 The data sources used (i.e. archival indicators, NSDUH, Behavioral Risk Factor 

Surveillance System, Youth Risk Behavior Surveillance System, Monitoring the 

Future, Communities that Care, state-developed survey). 

2. Please describe how needs assessment data is used to make decisions about the allocation 

of SABG primary prevention funds.

3. How does the state intend to build the capacity of its prevention system, including the 

capacity of its prevention workforce? 

4. Please describe if the state has:

a. A statewide licensing or certification program for the substance abuse prevention 

workforce;

b. A formal mechanism to provide training and technical assistance to the substance 

abuse prevention workforce; and

c. A formal mechanism to assess community readiness to implement prevention 

strategies.
57

5. How does the state use data on substance use consumption patterns, consequences of use, 

and risk and protective factors to identify the types of primary prevention services that 

are needed (e.g., education programs to address low perceived risk of harm from 

marijuana use, technical assistance to communities to maximize and increase 

enforcement of alcohol access laws to address easy access to alcohol through retail 

sources)?

6. Does the state have a strategic plan that addresses substance abuse prevention that was 

developed within the last five years? If so, please describe this plan and indicate whether 

it is used to guide decisions about the use of the primary prevention set-aside of the 

SABG.

7. Please indicate if the state has an active evidence-based workgroup that makes decisions 

about appropriate strategies in using SABG primary prevention funds and describe how 

the SABG funded prevention activities are coordinated with other state, local or federally 

funded prevention activities to create a single, statewide coordinated substance abuse 

prevention strategy.

8. Please list the specific primary prevention programs, practices and strategies the state 

intends to fund with SABG primary prevention dollars in each of the six prevention 

strategies. Please also describe why these specific programs, practices and strategies 

were selected. 

9. What methods were used to ensure that SABG dollars are used to fund primary substance 

abuse prevention services not funded through other means? 

10. What process data (i.e. numbers served, participant satisfaction, attendance) does the 

state intend to collect on its funded prevention strategies and how will these data be used 

to evaluate the state’s prevention system?

11. What outcome data (i.e., 30-day use, heavy use, binge use, perception of harm, 

disapproval of use, consequences of use) does the state intend to collect on its funded 

prevention strategies and how will this data be used to evaluate the state’s prevention 

system?

Please indicate areas of technical assistance needed related to this section.

10. Quality Improvement Plan

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. 
58

In an attachment to this application, states should submit a CQI plan for FY 2016-FY 

2017.

Please indicate areas of technical assistance needed related to this section.

11. Trauma 

Trauma75 is a widespread, harmful and costly public health problem. It occurs as a result of 

violence, abuse, neglect, loss, disaster, war and other emotionally harmful 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 traumaspecific 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, that is, based on the 

knowledge and understanding of trauma and its far-reaching implications. 

The effects of traumatic events place a heavy burden on individuals, families and communities 

and create challenges for public institutions and service systems.

76

 Although many people who 

experience a traumatic event will go on with their lives without lasting negative effects, others 

will have more difficulty and experience traumatic stress reactions. Emerging research has 

documented the relationships among exposure to traumatic events, impaired neurodevelopmental 

and immune systems responses, and subsequent health risk behaviors resulting in chronic 

physical or behavioral health disorders. Research has also indicated that with appropriate 

supports and intervention, people can overcome traumatic experiences. However, most people 

go without these services and supports. 

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 

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. 

In addition, the public institutions and service systems that are intended to provide services and 

supports for individuals are often themselves re-traumatizing, making it necessary to rethink 

doing “business as usual.” These public institutions and service settings are increasingly 

adopting a trauma-informed approach guided by key principles of safety, trustworthiness and 

 

75 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.

76 http://www.samhsa.gov/trauma-violence/types
59

transparency, peer support, empowerment, collaboration, and sensitivity to cultural and gender 

issues, and incorporation of trauma-specific screening, assessment, treatment, and recovery 

practices.

To meet the needs of those they serve, states should take an active approach to addressing

trauma. Trauma screening matched with trauma-specific therapies, such as exposure therapy

or trauma-focused cognitive behavioral approaches, should be used to ensure that treatments 

meet the needs of those being served. States should also consider adopting a trauma-informed

approach consistent with “SAMHSA’s Concept of Trauma and Guidance for a TraumaInformed Approach”.

77

 This means providing care based on an understanding of the

vulnerabilities or triggers of trauma survivors that traditional service delivery approaches may

exacerbate, so that these services and programs can be supportive and avoid traumatizing the 

individuals again. It is suggested that the states uses SAMHSA’s guidance for implementing 

the trauma-informed approach discussed in the Concept of Trauma78paper.

Please consider the following items as a guide when preparing the description of the state’s 

system:

1. Does the state have policies directing providers to screen clients for a personal history of 

trauma and to connect individuals to trauma-focused therapy? 

2. Describe the state’s policies that promote the provision of trauma-informed care. 

3. How does the state promote the use of evidence-based trauma-specific interventions 

across the lifespan? 

4. Does the state provide trainings to increase capacity of providers to deliver traumaspecific interventions?

Please indicate areas of technical assistance needed related to this section. 

12. Criminal and Juvenile Justice 

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 substance abuse and mental health problems. Successful diversion from or 

re-entering the community from detention, jails, and prisons is often dependent on engaging in 

appropriate substance use and/or mental health treatment. Some states have implemented such 

efforts as mental health, veteran and drug courts, crisis intervention training and re-entry 

programs to help reduce arrests, imprisonment and recidivism.

79

The SABG and MHBG may be especially valuable in supporting care coordination to promote

pre-adjudication or pre-sentencing diversion, providing care during gaps in enrollment after

 

77 http://store.samhsa.gov/product/SMA14-4884

78 Ibid

79 http://csgjusticecenter.org/mental-health/
60

incarceration, and supporting other efforts related to enrollment. Communities across the United 

States have instituted problem-solving courts, including those for defendants with mental and 

substance use disorders. These courts seek to prevent incarceration and facilitate communitybased treatment for offenders, while at the same time protecting public safety. There are two

types of problem-solving courts related to behavioral health: drug courts and mental health 

courts. In addition to these behavioral health problem-solving courts, some jurisdictions operate

courts specifically for DWI/DUI, veterans, families, and reentry, as well as courts for gambling, 

domestic violence, truancy, and other subject-specific areas.

80 81

 Rottman described the 

therapeutic value of problem-solving courts: “Specialized courts provide a forum in which the

adversarial process can be relaxed and problem-solving and treatment processes emphasized. 

Specialized courts can be structured to retain jurisdiction over defendants, promoting the

continuity of supervision and accountability of defendants for their behavior in treatment 

programs.” Youths 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.

82

Expansions in insurance coverage will mean that many individuals in jails and prisons, who 

generally have not had health coverage in the past, will now be able to access behavioral health 

services. Addressing the behavioral health needs of these individuals can reduce recidivism,

improve public safety, reduce criminal justice expenditures, and improve coordination of care

for a population that disproportionately experiences costly chronic physical and behavioral 

health conditions. Addressing these needs can also reduce health care system utilization and

improve broader health outcomes. Achieving these goals will require new efforts in enrollment, 

workforce development, screening for risks and needs, and implementing appropriate treatment 

and recovery services. This will also involve coordination across Medicaid, criminal and

juvenile justice systems, SMHAs, and SSAs.

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 mental and/or

substance use disorders from correctional settings. States should also examine specific barriers 

such as a lack of identification needed for enrollment; loss of eligibility 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.

 

80 The American Prospect: In the history of American mental hospitals and prisons, The Rehabilitation of the Asylum. David 

Rottman,2000.

81 A report prepared by the Council of State Governments. Justice Center. Criminal Justice/Mental Health Consensus Project. 

New York, New York for the Bureau of Justice Assistance Office of Justice Programs, U.S. Department of Justice, Renee L. 

Bender, 2001.

82 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.
61

Please consider the following items as a guide when preparing the description of the state’s 

system:

1. Are individuals involved in, or at risk of involvement in, the criminal and juvenile justice 

system enrolled in Medicaid as a part of coverage expansions? 

2. Are screening and services provided prior to adjudication and/or sentencing for 

individuals with mental and/or substance use disorders?

3. Do the SMHA and SSA coordinate with the criminal and juvenile justice systems with 

respect to diversion of individuals with mental and/or substance use disorders, behavioral 

health services provided in correctional facilities and the reentry process for those 

individuals? 

4. Are cross-trainings provided 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? 

Please indicate areas of technical assistance needed related to this section. 

13. State Parity Efforts

MHPAEA generally requires group health plans and health insurance issuers to ensure that

financial requirements and treatment limitations applied to M/SUD benefits are no more

restrictive than the requirements or limitations applied to medical/surgical benefits. The

legislation applies to both private and public sector employer plans that have more than 50 

employees, including both self-insured and fully insured arrangements. MHPAEA also applies 

to health insurance issuers that sell coverage to employers with more than 50 employees. The

Affordable Care Act extends these requirements to issuers selling individual market coverage. 

Small group and individual issuers participating in the Marketplaces (as well as most small 

group and individual issuers outside the Marketplaces) are required to offer EHBs, which are

required by statute to include services for M/SUDs and behavioral health treatment – and to 

comply with MHPAEA. Guidance was released for states in January 2013.

83

MHPAEA requirements also apply to Medicaid managed care, alternative benefit plans, and 

CHIP. ASPE estimates that more than 60 million Americans will benefit from new or 

expanded mental health and substance abuse coverage under parity requirements. However, 

public awareness about MHPAEA has been limited. Recent research suggests that the public

does not fully understand how behavioral health benefits function, what treatments and services 

are covered, and how MHPAEA affects their coverage.

84

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 

 

83 http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO-13-001.pdf

84 Rosenbach, M., Lake, T., Williams, S., Buck, S. (2009). Implementation of Mental Health Parity: Lessons from California. 

Psychiatric Services. 60(12) 1589-1594
62

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. 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. SMHAs and 

SSAs should collaborate with their state’s 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. 

Please consider the following items as a guide when preparing the description of the state’s 

system:

1. What fiscal resources are used to develop communication plans to educate and raise 

awareness about parity?

2. Does the state coordinate across public and private sector entities to increase consumer 

awareness and understanding about benefits of the law (e.g., impacts on covered benefits, 

cost sharing, etc.)? 

3. Does the state coordinate across public and private sector entities to increase awareness 

and understanding among health plans and health insurance issuers of the requirements of 

MHPAEA and related state parity laws and to provide technical assistance as needed?

Please indicate areas of technical assistance needed related to this section. 

 

14. Medication Assisted Treatment 

There is a voluminous literature on the efficacy of FDA-approved medications for 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 medication-assisted

treatment of these disorders is described in SAMHSA TIPs 4085, 4386, 4587, and 4988. SAMHSA 

strongly encourages the states to require that treatment facilities providing clinical care to those 

 

85 http://store.samhsa.gov/product/TIP-40-Clinical-Guidelines-for-the-Use-of-Buprenorphine-in-the-Treatment-ofOpioid-Addiction/SMA07-3939

86 http://store.samhsa.gov/product/TIP-43-Medication-Assisted-Treatment-for-Opioid-Addiction-in-OpioidTreatment-Programs/SMA12-4214

87 http://store.samhsa.gov/product/TIP-45-Detoxification-and-Substance-Abuse-Treatment/SMA13-4131

88 http://store.samhsa.gov/product/TIP-49-Incorporating-Alcohol-Pharmacotherapies-Into-Medical-Practice/SMA13-

4380
63

with substance use disorders be required to either have the capacity and staff expertise to use

MAT or have collaborative relationships with other providers such that these MATs can be 

accessed as clinically indicated for patient need. Individuals with substance use disorders who 

have a disorder for which there is an FDA-approved medication treatment should have access to 

those treatments based upon each individual patient’s needs. 

SAMHSA strongly encourages states to require the use of FDA-approved MATs for substance 

use disorders where clinically indicated (opioid use disorders with evidence of physical 

dependence, alcohol use disorders, tobacco use disorders) and particularly in cases of relapse 

with these disorders. SAMHSA is asking for input from states to inform SAMHSA’s activities.

Please consider the following items as a guide when preparing the description of the state’s 

system:

1. How will or can states use their dollars to develop communication plans to educate and 

raise awareness within substance abuse treatment programs and the public regarding 

medication-assisted treatment for substance use disorders?

2. What steps and processes can be taken to ensure a broad and strategic outreach is made to 

the appropriate and relevant audiences that need access to medication-assisted treatment 

for substance use disorders, particularly pregnant women?

3. What steps will the state take to assure that evidence-based treatments related to the use 

of FDA-approved medications for treatment of substance use disorders are used 

appropriately (appropriate use of medication for the treatment of a substance use 

disorder, combining psychosocial treatments with 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, advocacy with state payers)?

Please indicate areas of technical assistance needed related to this section. 

15. Crisis Services 

In the on-going development of efforts to build an evidence-based robust system of care for 

persons diagnosed with SMI, SED and addictive disorders 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 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 
64

Mental Health Crises89, 

“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 array of services and supports being used to address crisis response 

include the following: 

Crisis Prevention and Early Intervention: 

 Wellness Recovery Action Plan (WRAP) Crisis Planning

 Psychiatric Advance Directives

 Family Engagement

 Safety Planning

 Peer-Operated Warm Lines

 Peer-Run Crisis Respite Programs

 Suicide Prevention

Crisis Intervention/Stabilization:

 Assessment/Triage (Living Room Model)

 Open Dialogue

 Crisis Residential/Respite

 Crisis Intervention Team/ Law Enforcement

 Mobile Crisis Outreach

 Collaboration with Hospital Emergency Departments and Urgent Care Systems

Post Crisis Intervention/Support:

 WRAP Post-Crisis

 Peer Support/Peer Bridgers

 

89 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
65

 Follow-Up Outreach and Support

 Family-to-Family engagement

 Connection to care coordination and follow-up clinical care for individuals in crisis

 Follow-up crisis engagement with families and involved community members

Please indicate areas of technical assistance needed related to this section.

16. Recovery 

The implementation of recovery-based approaches is 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. This includes the use of 

psychotropic or other medications for mental illnesses or addictions to assist in the diminishing 

or elimination of symptoms as needed. Further, the use of psychiatric advance directives is

encouraged to provide an individual the opportunity to have an active role in their own treatment 

even in times when the severity of their symptoms may impair cognition significantly. 

Resolution of symptoms through acute care treatment contributes to the stability necessary for 

individuals to pursue their ongoing recovery and to make use of SAMHSA encouraged recovery 

resources.

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;
66

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:

 Drop-in centers

 Peer-delivered motivational 

interviewing

 Peer specialist/Promotoras

 Clubhouses

 Self-directed care

 Supportive housing models

 Recovery community 

centers

 WRAP

 Evidenced-based supported 

employment

 Family navigators/parent 

support partners/providers

 Peer health navigators

 Peer wellness coaching

 Recovery coaching

 Shared decision making

 Telephone recovery 

checkups

 Warm lines

 Whole Health Action 

Management (WHAM)

 Mutual aid groups for 

individuals with MH/SA 

Disorders or CODs

 Peer-run respite services

 Person-centered 

planning

 Self-care and wellness 

approaches

 Peer-run crisis diversion 

services

 Wellness-based 

community campaign

SAMHSA encourages states to take proactive steps to implement recovery support services, and 

is seeking input from states to address this position. 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 recoveryoriented supports, services, and systems for people in recovery from substance use and/or mental 

disorders.

Recovery is based on the involvement of consumers/peers and their family members. States 

should work to support and help strengthen existing consumer, family, and youth networks; 

recovery organizations; and community peer support and advocacy organizations in expanding

self-advocacy, self-help programs, support networks, and recovery support services. There are

many activities that SMHAs and SSAs can undertake to engage these individuals and families. 

In the space below, states should describe their efforts to engage individuals and families in 

developing, implementing and monitoring the state mental health and substance abuse treatment 

system.

Please consider the following items as a guideline when preparing the description of the state’s 

system:
67

1. Does the state have a plan that includes: the definition of recovery and recovery values, 

evidence of hiring people in recovery leadership roles, strategies to use person-centered 

planning and self-direction and participant-directed care, variety of recovery services 

and supports (i.e., peer support, recovery support coaching, center services, supports for 

self-directed care, peer navigators, consumer/family education, etc.)?

2. How are treatment and recovery support services coordinated for any individual served 

by block grant funds?

3. Does the state’s plan include peer-delivered services designed to meet the needs of 

specific populations, such as veterans and military families, people with a history of 

trauma, members of racial/ethnic groups, LGBT populations, and families/significant 

others?

4. Does the state provide or support training for the professional workforce on recovery 

principles and recovery-oriented practice and systems, including the role of peer 

providers in the continuum of services? Does the state have an accreditation program, 

certification program, or standards for peer-run services?

5. Does the state conduct empirical research on recovery supports/services identification 

and dissemination of best practices in recovery supports/services or other innovative 

and exemplary activities that support the implementation of recovery-oriented 

approaches, and services within the state’s behavioral health system?

6. Describe how individuals in recovery and family members are involved in the planning, 

delivery, and evaluation of behavioral health services (e.g., meetings to address 

concerns of individuals and families, opportunities for individuals and families to be 

proactive in treatment and recovery planning). 

7. Does the state support, strengthen, and expand recovery organizations, family peer 

advocacy, self-help programs, support networks, and recovery-oriented services? 

8. Provide an update of how you are tracking or measuring the impact of your consumer 

outreach activities.

9. Describe efforts to promote the wellness of individuals served including tobacco 

cessation, obesity, and other co-morbid health conditions.

10. Does the state have a plan, or is it developing a plan, to address the housing needs of 

persons served so that they are not served in settings more restrictive than necessary 

and are incorporated into a supportive community?

11. Describe how the state is supporting the employment and educational needs of 

individuals served.

Please indicate areas of technical assistance needed related to this section.

17. Community Living and the Implementation of Olmstead

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 substance 

abuse and mental illness 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
68

the most integrated 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 of Civil Rights (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. Describe the state’s Olmstead plan including housing services provided, home and 

community based services provided through Medicaid, peer support services, and 

employment services. 

2. How are individuals transitioned from hospital to community settings? 

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? 

4. Describe any litigation or settlement agreement with DOJ regarding community 

integration for children with SED or adults with SMI in which the state is involved? 

5. Is the state involved in a partnership with other state agencies to address community 

integration? 

Please indicate areas of technical assistance needed related to this section.

18. Children and Adolescents Behavioral Health Services 

MHBG funds are intended to support programs and activities for children with SED, and SABG 

funds are available for prevention, treatment, and recovery services for youth and young adults. 

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 mental disorder that contributes to substantial 
69

impairment in their functioning at home, at school, or in the community.

90

 Most mental health 

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.

91

 For youth between the ages of 10 and 24, 

suicide is the third leading cause of death.

92

 

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.

93 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 liaison 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 more than 160 grants awarded to states and communities, and every state

has received at least one CMHI grant. In 2011, SAMHSA awarded System of Care Expansion 

grants to 24 states to bring this approach to scale in states. In terms of adolescent substance

abuse, in 2007, SAMHSA awarded State Substance Abuse Coordinator grants to 16 states to 

begin to build a state infrastructure for substance abuse treatment and recovery-oriented systems 

of care for youth with substance use disorders. This work has continued with a focus on 

financing and workforce development to support a recovery-oriented system of care that 

incorporates established evidence-based treatment for youth with substance use disorders.

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 substance use disorders and co-occurring disorders 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 addresses cultural and linguistic needs while improving the child’s, youth’s

 

90 Centers for Disease Control and Prevention, (2013). Mental Health Surveillance among Children — United States, 2005-2011. 

MMWR 62(2).

91 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.

92 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.

93 The National Center on Addiction and Substance Abuse at Columbia University. (June, 2011). Adolescent Substance Abuse: 

America’s #1 Public Health Problem.
70

and young adult’s functioning in their home, school, and community. The system of care

approach provides individualized services, is family driven and youth guided, and builds on the 

strengths of the child, youth or young adult and their family and promotes recovery and 

resilience. Services are delivered in the least restrictive environment possible, and using 

evidence-based practices while providing effective cross-system collaboration, including

integrated management of service delivery and costs.

94

According to data from the National Evaluation of the Children’s Mental Health Initiative

(2011), systems of care95: 

 reach many children and youth typically underserved by the mental health system; 

 improve emotional and behavioral outcomes for children and youth; 

 enhance family outcomes, such as decreased caregiver stress; 

 decrease suicidal ideation and gestures;

 expand the availability of effective supports and services; and

 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 nonresidential services, like wraparound service planning, intensive care management, outpatient 

therapy, intensive home-based services, substance abuse intensive outpatient services, 

continuing care, and mobile crisis response; supportive services, like peer youth support, family

peer support, respite services, mental health consultation, and supported education and

employment; and residential services, like therapeutic foster care, crisis stabilization services, 

and inpatient medical detoxification.

Please consider the following items as a guide when preparing the description of the state’s 

system:

1. How will the state establish and monitor a system of care approach to support the 

recovery and resilience of children and youth with serious mental and substance use 

disorders?

2. What guidelines have and/or will the state establish for individualized care 

planning for children/youth with serious mental, substance use, and co-occurring 

disorders?

3. How has the state established collaboration with other child- and youth-serving 

 

94 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.

95 Department of Health and Human Services. (2013). Coverage of Behavioral Health Services for Children, Youth, and Young 

Adults with Significant Mental Health Conditions: Joint CMS and SAMHSA Informational Bulletin. Available from 

http://medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-05-07-2013.pdf.
71

agencies in the state to address behavioral health needs (e.g., child welfare, juvenile

justice, education, etc.)?

4. How will the state provide training in evidence-based mental and substance abuse 

prevention, treatment and recovery services for children/adolescents and their families?

5. How will the state monitor and track service utilization, costs and outcomes for 

children and youth with mental, substance use and co-occurring disorders?

6. Has the state identified a liaison for children to assist schools in assuring identified

children are connected with available mental health and/or substance abuse treatment

and recovery support services? If so, what is that position (with contact

information) and has it been communicated to the state’s lead agency of education?

7. What age is considered the cut-off in the state for receiving behavioral health services in 

the child/adolescent system? Describe the process for transitioning children/adolescents 

receiving services to the adult behavioral health system, including transition plans in 

place for youth in foster care.

Please indicate areas of technical assistance needed related to this section. 

19. Pregnant Women and Women with Dependent Children

Substance-abusing pregnant women have always been the number one priority population in the 

SAMHSA block grant (Title XIX, Part B, Subpart II, Sec.1922 (c)). A formula based on the FY 

1993 and FY 1994 block grants was established to increase the availability of treatment services 

designed for pregnant women and women with dependent children. The purpose of establishing 

a “set-aside” was to ensure the availability of comprehensive, substance use disorder treatment,

and prevention and recovery support services for pregnant and postpartum women and their 

dependent children. This population continues to be a priority, given the importance of prenatal 

care and substance abuse treatment for pregnant, substance using women, and the importance of 

early development in children. For families involved in the child welfare system, successful 

participation in treatment for substance use disorders is the best predictor for children remaining 

with their mothers. Women with dependent children are also named as a priority for specialized 

treatment (as opposed to treatment as usual) in the SABG regulations. MOE provisions require 

that the state expend no less than an amount equal to that spent by the state in a base fiscal year

for treatment services designed for pregnant women and women with dependent children.

For guidance on components of quality substance abuse treatment services for women, States 

and Territories can refer to the following documents, which can be accessed through the 

SAMHSA website at http://www.samhsa.gov/women-children-families: Treatment Improvement 

Protocol (TIP) 51, Substance Abuse Treatment; Addressing the Specific Needs of Women; 

Guidance to States; Treatment Standards for Women with Substance Use Disorders; FamilyCentered Treatment for Women with Substance Abuse Disorders: History, Key Elements and 

Challenges.

Please consider the following items as a guide when preparing the description of the state’s 

system:
72

1. The implementing regulation requires the availability of treatment and admission 

preference for pregnant women be made known and that pregnant women are prioritized 

for admission to treatment. Please discuss the strategies your state uses to accomplish 

this. 

2. Discuss how the state currently ensures that pregnant women are admitted to treatment 

within 48 hours. 

3. Discuss how the state currently ensures that interim services are provided to pregnant 

women in the event that a treatment facility has insufficient capacity to provide treatment 

services. 

4. Discuss who within your state is responsible for monitoring the requirements in 1-3.

5. How many programs serve pregnant women and their infants? Please indicate the 

number by program level of care (i.e. hospital based, residential, IPO, OP.) 

a. How many of the programs offer medication assisted treatment for the pregnant 

women in their care?

b. Are there geographic areas within the State that are not adequately served by the 

various levels of care and/or where pregnant women can receive MAT? If so, 

where are they?

6. How many programs serve women and their dependent children? Please indicate the 

number by program level of care (i.e. hospital based, residential, IPO, OP)

a. How many of the programs offer medication assisted treatment for the pregnant 

women in their care?

b. Are there geographic areas within the State that are not adequately served by the 

various levels of care and/or where women can receive MAT? If so, where are 

they?

Please indicate areas of technical assistance needed related to this section.

 

20. Suicide Prevention

In the FY 2016/2017 block grant application, SAMHSA asks states to:

1. Provide the most recent copy of your state’s suicide prevention plan; describe when your

state will create or update your plan, and how that update will incorporate 

recommendations from the revised National Strategy for Suicide Prevention (2012).

2. Describe how the state’s plan specifically addresses populations for which the block grant

dollars are required to be used.

3. Include a new plan (as an attachment to the block grant Application) that delineates the 

progress of the state suicide plan since the FY 2014-2015 Plan. Please follow the format 

outlined in the new SAMHSA document Guidance for State Suicide Prevention 

Leadership and Plans.

96

Please indicate areas of technical assistance needed related to this section.

 

96http://www.samhsa.gov/sites/default/files/samhsa_state_suicide_prevention_plans_guide_final_508_compliant.pdf
73

21. Support of State Partners

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 

mental and substance use disorders 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 

actors for mental and substance use disorders, and, for those youth with or at-risk of 

emotional behavioral and substance use disorders, 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 

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 emergency management/homeland security 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 consider the following items as a guide when preparing the description of the state’s 

system:

1. Identify any existing partners and describe how the partners will support the state in 
74

implementing the priorities identified in the planning process. 

2. Attach any letters of support indicating agreement with the description of roles and 

collaboration with the SSA/SMHA, including the state education authorities, the SMAs, 

entity(ies) responsible for health insurance and the health information Marketplace, adult 

and juvenile correctional authority(ies), public health authority (including the maternal 

and child health agency), and child welfare agency, etc.

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

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 mental health and substance abuse agencies, SAMHSA is recommending that states 

expand their Mental Health Advisory Council to include substance abuse, 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 abuse prevention and treatment advisory 

council to ensure that the council reviews issues and services for persons with, or at risk for, 

substance abuse and substance use disorders. To assist with implementing a BHPC, SAMHSA 

has created Best Practices for State Behavioral Health Planning Councils: The Road to Planning 

Council Integration.

97

Additionally, Title XIX, Subpart III, section 1941 of the PHS Act (42 U.S.C. 300x-51) applicable

to the SABG and the MHBG, requires that, 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.

For SABG only - describe the steps the state took to make the public aware of the plan 

and allow for public comment.

For MHBG and integrated BHPC; States must include documentation that they shared 

their application and implementation report with the Planning Council; please also 

describe the steps the state took to make the public aware of the plan and allow for public 

comment. 

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 

 

97 http://beta.samhsa.gov/grants/block-grants/resources
75

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 actively involved in the state plan? Attach supporting 

documentation (e.g., meeting minutes, letters of support, etc.).

2. What mechanism does the state use to plan and implement substance abuse services?

3. Has the Council successfully integrated substance abuse prevention and treatment or

co-occurring disorder issues, concerns, and activities into its work?

4. Is the membership representative of the service area population (e.g., ethnic, cultural,

linguistic, rural, suburban, urban, older adults, families of young children)?

5. 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.98

Behavioral Health Advisory Council Members

Name

Type of 

Membership*

Agency or 

Organization

Represented*

Address 

Phone & 

Fax

Email 

Address

(If 

Available)

**State Mental 

Health Agency

 

98 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. 
76

**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
77

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 *

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 substance abuse 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 abuse expertise in their Councils.
78

Acronyms

ACF: Administration for Children and Families 

ACL: Administration for Community Living 

ACO: Accountable Care Organization

AHRQ: Agency for Healthcare Research and Quality 

AI: American Indian

AIDS: Acquired Immune Deficiency Syndrome 

AN: Alaska Native

BHSIS: Behavioral Health Services Information System 

CAP: Consumer Assistance Programs

CBHSQ: Center for Behavioral Health Statistics and Quality 

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 & Medicaid Services 

CO: Carbon Monoxide

CPT: Current Procedural Terminology

CSAP: Center for Substance Abuse Prevention 

CSAT: Center for Substance Abuse Treatment 

EBP: Evidence-Based Practice

EHB: Essential Health Benefit 

EHR: Electronic Health Record 

FFY: Federal Fiscal Year

FMAP: Federal Medical Assistance Percentage 

FPL: Federal Poverty Level

FQHC: Federally-Qualified Health Center 

FY: Fiscal Year
79

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

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

LGBT: Lesbian, Gay, Bisexual, and Transgendered

LGBTQ: Lesbian, Gay, Bisexual, Transgendered, and Questioning 

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 

NIDA: National Institute on Drug Abuse

NIMH: National Institute on Mental Health 

NOMS: National Outcome Measures

NQS: National Quality Strategy

NREPP: National Registry of Evidence-based Programs and Practices 

OCR: Office of Civil Rights

OMB: Office of Management and Budget

PBHCI: Primary and Behavioral Health Care Integration 

PBR: Patient Bill of Rights
80

PHS: Public Health Service

PPW: Pregnant and Parenting Women

QHP: Qualified Health Plan

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

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 Authority

SUD: Substance Use Disorder

TIP: Treatment Improvement Protocol 

TLOA: Tribal Law and Order Act 

VA: Veterans Administration
81

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

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 FY2010 

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.
82

Early Intervention SetAside Guidance

http://www.samhsa.gov/grants/blockgrants/resources

SAMHSA guidance regarding its Fiscal Year 2014 appropriation, in 

which SAMHSA has been directed to require that states set aside 5 

percent of their Mental Health Block Grant (MHBG) allocation to 

support “evidence-based programs that address the needs of 

individuals with early serious mental illness, including psychotic 

disorders.” 

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

Health People Initiative http://www.healthypeople.gov/2020/default.aspx

Government website that reviews the goals of Health 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 mental health and substance abuse services at the same time 

and in one setting. Offers suggestions from successful programs.

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
83

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 disorder 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 more than 330 substance 

abuse and mental health interventions. NREPP was developed to 

help the public learn more about evidence-based 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
84

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-childrenfamilies

Guidance on components of quality substance abuse treatment 

services for women, States and Territories 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 abuse prevention topics.

Synar Program http://samhsa.gov/synar 

Description and overview of the SYNAR program, which is a 

requirement of the Substance Abuse Prevention Block Grant

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
85
86